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1.
Medicine (Baltimore) ; 100(4): e23675, 2021 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-33530168

RESUMO

BACKGROUND: At present, laser is regarded as an effective treatment for macular edema secondary to branch retinal vein occlusion. With the breakthrough of anti-vascular endothelial growth factor drugs in ophthalmology clinical research, the intravitreal injection of ranibizumab is widely applied, but both methods have their limitations, so some clinical studies have combined and applied them together. However, the clinical results are inconsistent and controversial, and there is no relevant system evaluation for the laser combined with intravitreal injection of ranibizumab for treatment of macular edema secondary to branch retinal vein occlusion now. OBJECTIVE: Meta analysis is used to analyze and evaluate the effectiveness and safety of the laser combined with intravitreal injection of ranibizumab for treatment of macular edema secondary to branch retinal vein occlusion. METHOD: CNKI, VIP, WANFANG, China Biology Medicine disc, Web of Science, PubMed, Embase, Cochrane Library have used random controlled clinical trial of laser combined with intravitreal injection of ranibizumab for treatment of macular edema secondary to branch retinal vein occlusion from the establishment of the database to October 2020. Two researchers conducted independent screening, quality assessment and data extraction for the literatures, and used RevMan5.3 to conduct Meta analysis for the included literatures. RESULT: The research has evaluated the effectiveness and safety of the laser combined with intravitreal injection of ranibizumab for treatment of macular edema secondary to branch retinal vein occlusion through the aspects of the best corrected visual acuity 6 months after operation, macular center thickness and the incidence of adverse reactions such as elevated intraocular pressure, endophthalmitis, vitreous hemorrhage and cataract. CONCLUSION: Laser combined with intravitreal injection of ranibizumab for treatment of macular edema secondary to branch retinal vein occlusion has good effect, and the research has provided reliable evidence for the use of clinical treatment of the laser combined with intravitreal injection of ranibizumab for treatment of macular edema secondary to branch retinal vein occlusion.


Assuntos
Inibidores da Angiogênese/administração & dosagem , Fotocoagulação a Laser/métodos , Edema Macular/terapia , Ranibizumab/administração & dosagem , Oclusão da Veia Retiniana/terapia , Terapia Combinada , Humanos , Injeções Intravítreas , Edema Macular/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Oclusão da Veia Retiniana/complicações , Resultado do Tratamento , Acuidade Visual
2.
Vestn Oftalmol ; 137(1): 116-122, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33610159

RESUMO

The article presents an analysis of publications in main Russian and foreign journals devoted to the use of optical coherence tomography in intravital visualization of the structures of the eye for diagnosis, assessment of the changes during relapses, recovery and remission stages, as well as the effectiveness of treatment for uveitis of different localization. It describes in detail the results of studies conducted using spectral optical coherence tomography, changes in the anterior chamber and cornea in uveitis of the anterior localization, morphological changes in the vitreous body, vitreomacular interface, retina, choroid and optic disc in the anterior and posterior localization of inflammation, and presents the features of OCT diagnosis in a number of nosological forms of uveitis based on the literature data.


Assuntos
Edema Macular , Uveíte , Humanos , Federação Russa , Tomografia de Coerência Óptica , Uveíte/diagnóstico por imagem , Corpo Vítreo
3.
Medicine (Baltimore) ; 100(6): e24638, 2021 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-33578584

RESUMO

ABSTRACT: Macular edema (ME) is an inflammatory disease characterized by increased microvascular permeability. Here, we proposed that plasma angiopoietin-like protein 2 (ANGPTL2) level may be related to the severity of ME patients with type 2 diabetes mellitus (T2DM). In this cross-sectional study, 172 T2DM patients were recruited and divided into clinically significant macular edema (CSME), non-CSME (nCSME), and control groups. Serum ANGPTL2 level was quantified by ELISA and best corrected vision acuity (BCVA) was detected. After adjust age, sex, body mass index (BMI), and duration of diabetes variables, ANGPTL2 performed statistics difference among CSME-, nCSME-groups, and control group (4.46 [3.97, 4.96, 95%CI] ng/mL in CSME group, 3.80 [3.42, 4.18, 95%CI] ng/mL in nCSME-group, 3.33 [3.03, 3.63, 95%CI] ng/mL in control, P < .01). After adjustment of confounding factors, high levels of circulating ANGPTL2 were related with the diagnosis of ME, BCVA, and C reactive protein (CRP) through univariate regression analysis (P < .05). Meanwhile, in the multiple regression model, ANGPTL2 took the mainly effect proportion for the diagnosis of diabetic macular edema (DME), with a LogWorth value 3.559 (P < .001). Our study suggested that elevated circulating ANGPTL2 may be associated with the development of DME and the severity of visual impairment in patients with type 2 diabetes.


Assuntos
Proteínas Semelhantes a Angiopoietina/sangue , Diabetes Mellitus Tipo 2 , Edema Macular/diagnóstico , Biomarcadores/sangue , Estudos Transversais , Feminino , Humanos , Edema Macular/sangue , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Tomografia de Coerência Óptica
4.
Niger J Clin Pract ; 24(1): 121-126, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33473037

RESUMO

Aim: To investigate the effect of intravitreal dexamethasone implant on central foveal thickness and choroidal thickness in retinal vein occlusion. Materials and Methods: Clinical records and optical coherence tomography (OCT) scans of 41 naïve patients with retinal vein occlusion (RVO), who were initially treated with intravitreal dexamethasone (DEX) implant between 2016 and 2017 at Kocatepe University Faculty of Medicine, Department of Ophthalmology were investigated. Collected data included age and sex of the patients, crystalline lens status, baseline and final intraocular pressure, and OCT parameters including central foveal thickness and choroidal thickness. Results: Twenty-two (53.7%) female and 19 (46.3%) male patients were enrolled in the study. There were 30 phakic and 11 pseudophakic patients. The intraocular pressure increased significantly from 15.19 mmHg to 17.8 mmHg (P = 0.005), and cataract extraction was performed in two patients who developed cataract after the treatment. There was a significant decrease in the central foveal thickness from 556 µm to 288 µm (P < 0.001). In addition, although there was no statistically significant change in choroidal thickness in the patients with branched retinal vein occlusion (P = 0.423), the patients with central retinal vein occlusion had statistically significant decrease in choroidal thickness measurements (P = 0.049). Conclusion: Therapeutic effect of the DEX implant not only influences retinal layer. Its influence may also extend further to the choroid layer, thereby leading to decrease in the choroidal thickness. Our results were mostly similar to the results of studies in literature which investigated the effects of the DEX implant therapy on the choroidal thickness of the patients with RVO.


Assuntos
Edema Macular , Oclusão da Veia Retiniana , Corioide , Dexametasona , Implantes de Medicamento/uso terapêutico , Feminino , Glucocorticoides/uso terapêutico , Humanos , Injeções Intravítreas , Edema Macular/tratamento farmacológico , Masculino , Oclusão da Veia Retiniana/tratamento farmacológico , Resultado do Tratamento , Acuidade Visual
5.
BMJ Case Rep ; 14(1)2021 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-33431469

RESUMO

Bilateral sight threatening macular and optic nerve inflammation may occur with dengue fever, necessitating the use of systemic steroids. We report a case of bilateral dengue maculopathy in an elderly woman managed with targeted intravitreal steroid therapy. A 63-year-old woman presented with acute-onset painless diminution of vision in both eyes following a dengue fever episode. She had bilateral foveal inflammatory lesions, macular oedema, small vessel occlusions at the macula and scattered retinal haemorrhages and cotton-wool spots. Following systemic evaluation, intravitreal triamcinolone acetonide injection was performed in both eyes at an interval of 3 days. The foveal lesion and macular oedema resolved quickly in both eyes with a normal foveal architecture at the end of 6-week follow-up. The visual acuity improved considerably in both eyes. Inflammatory retinopathy in dengue fever may be managed with a targeted intravitreal steroid injection approach.


Assuntos
Dengue/complicações , Glucocorticoides/administração & dosagem , Edema Macular/tratamento farmacológico , Edema Macular/virologia , Triancinolona Acetonida/administração & dosagem , Dengue/diagnóstico , Dengue/terapia , Feminino , Humanos , Injeções Intravítreas , Edema Macular/diagnóstico , Pessoa de Meia-Idade
6.
Adv Exp Med Biol ; 1307: 357-373, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32166636

RESUMO

Human eye is one of the important organs in human body, with iris, pupil, sclera, cornea, lens, retina and optic nerve. Many important eye diseases as well as systemic diseases manifest themselves in the retina. The most widespread causes of blindness in the industrialized world are glaucoma, Age Related Macular Degeneration (ARMD), Diabetic Retinopathy (DR) and Diabetic Macula Edema (DME). The development of a retinal image analysis system is a demanding research topic for early detection, progression analysis and diagnosis of eye diseases. Early diagnosis and treatment of retinal diseases are essential to prevent vision loss. The huge and growing number of retinal disease affected patients, cost of current hospital-based detection methods (by eye care specialists) and scarcity in the number of ophthalmologists are the barriers to achieve the recommended screening compliance in the patient who is at the risk of retinal diseases. Developing an automated system which uses pattern recognition, computer vision and machine learning to diagnose retinal diseases is a potential solution to this problem. Damage to the tiny blood vessels in the retina in the posterior part of the eye due to diabetes is named as DR. Diabetes is a disease which occurs when the pancreas does not secrete enough insulin or the body does not utilize it properly. This disease slowly affects the circulatory system including that of the retina. As diabetes intensifies, the vision of a patient may start deteriorating and leading to DR. The retinal landmarks like OD and blood vessels, white lesions and red lesions are segmented to develop automated screening system for DR. DME is an advanced symptom of DR that can lead to irreversible vision loss. DME is a general term defined as retinal thickening or exudates present within 2 disk diameter of the fovea center; it can either focal or diffuse DME in distribution. In this paper, review the algorithms used in diagnosis of DR and DME.


Assuntos
Diabetes Mellitus , Retinopatia Diabética , Edema Macular , Algoritmos , Retinopatia Diabética/diagnóstico , Edema , Humanos , Edema Macular/diagnóstico , Retina
7.
Adv Exp Med Biol ; 1307: 375-389, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32488606

RESUMO

Diabetic macular edema (DME) is the main cause of vision loss in diabetic retinopathy (DR). Although it is one of the main complications of diabetes, the pathogenesis of DME is not completely understood. The hyperglycemic state promotes the activation of multiple interlinked pathways leading to DME. Different classifications have been proposed: based on clinical features, on pathogenesis or on diagnostic tests (optical coherence tomography - OCT and fluorescin angiography - FA). The multimodal imaging allows a better analysis of the morphological features of the DME. Indeed, new inflammatory biomarkers have been identified on OCT. Also, several studies are evaluating the role of the morphological features, identified on multimodal imaging, to find new prognostic factors. Over the past decade, great progresses have been made in the management of DME. Therapeutic alternatives include intraocular injection of anti-vascular endothelial grow factor agents (anti-VEGF) and steroid molecules, focal/grid laser photocoagulation and vitreo-retinal surgery. This review is focused on the description and analysis of the current intravitreal therapeutic pharmacological strategies. Current guidelines recommend anti-VEGF as first line therapy in DME. Corticosteroids are becoming increasingly relevant blocking the inflammatory cascade and indirectly reducing VEGF synthesis.


Assuntos
Diabetes Mellitus , Retinopatia Diabética , Edema Macular , Inibidores da Angiogênese/uso terapêutico , Diabetes Mellitus/tratamento farmacológico , Retinopatia Diabética/diagnóstico por imagem , Retinopatia Diabética/tratamento farmacológico , Glucocorticoides/uso terapêutico , Humanos , Injeções Intravítreas , Edema Macular/diagnóstico por imagem , Edema Macular/tratamento farmacológico , Tomografia de Coerência Óptica
8.
Adv Exp Med Biol ; 1307: 1-5, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32583142

RESUMO

The number of people living with diabetes, the number of deaths attributable to it, and the cost of treating the disease and its complications are increasing exponentially. Centuries of research led to the discovery of insulin and other drugs based on pathophysiology from "the triumvirate to ominous octet". The agonists of the glucagon-like peptide-1 (GLP-1) receptor, and the inhibitors of the sodium-glucose transport protein 2 (SGLT2) are the new drugs that improve cardiovascular outcomes and provide renal protection, and they are being used increasingly for evidence-based treatment of type 2 diabetes. Bariatric surgery, when indicated, results in excellent weight- and metabolic-control, and in many instances even remission of diabetes. Technological advances like Flash glucose monitoring, continuous subcutaneous insulin infusion (CSII), and continuous glucose monitoring (CGM) have improved glycemic control, reduced episodes of severe hypoglycemia, and improved quality of life. For the treatment of diabetic macular edema intravitreal injection of several anti-VEGF agents are being used. Numerous people living in the middle- and low-income countries cannot afford the costs of care of diabetes. Institutions like the World Health Organization, the World Bank and the International Monetary Fund should roll out plans to convince the politicians to invest more in improving the diabetes care facilities.


Assuntos
Diabetes Mellitus Tipo 2 , Retinopatia Diabética , Edema Macular , Glicemia/análise , Automonitorização da Glicemia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/tratamento farmacológico , Retinopatia Diabética/tratamento farmacológico , Receptor do Peptídeo Semelhante ao Glucagon 1/antagonistas & inibidores , Hemoglobina A Glicada , Humanos , Hipoglicemiantes/uso terapêutico , Insulina/administração & dosagem , Edema Macular/tratamento farmacológico , Qualidade de Vida , Inibidores do Transportador 2 de Sódio-Glicose/uso terapêutico
9.
Curr Opin Ophthalmol ; 32 Suppl 1: S1-S12, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33273209

RESUMO

PURPOSE OF REVIEW: Advances in pharmacology offer freedom from topical medical therapy without compromise of anti-inflammatory and antimicrobial coverage in the perioperative period. In this review, we describe the basis for dropless cataract surgery with the goal of improving outcomes and the patient experience. RECENT FINDINGS: Phacoemulsification outcomes depend largely on surgeon skill but also on adherence to a complex multidrug regimen of perioperative anti-inflammatory and antimicrobial therapy to prevent sight-threatening complications such as cystoid macular edema or endophthalmitis. Successful administration of this regimen can be limited by noncompliance, difficulty administering eye drops, bioavailability, and side effects, among others. The recent development of sustained-release formulations of dexamethasone - one an intracanalicular insert and the other an intraocular suspension - can provide sustained tapering doses of dexamethasone while reducing or eliminating the need for anti-inflammatory eye drop therapy. Similarly, mounting evidence compellingly demonstrates that intracameral antibiotic use intraoperatively is at least as effective as topical antibiotics in preventing endophthalmitis. SUMMARY: Sustained-release dexamethasone coupled with intracameral antibiotics at the time of phacoemulsification can provide antimicrobial and anti-inflammatory prophylaxis without the need for topical eye drop medications. This approach has the potential to improve compliance with therapy, visual acuity outcomes, and the overall patient experience.


Assuntos
Antibacterianos/administração & dosagem , Dexametasona/administração & dosagem , Glucocorticoides/administração & dosagem , Satisfação do Paciente/estatística & dados numéricos , Facoemulsificação/métodos , Complicações Pós-Operatórias/prevenção & controle , Preparações de Ação Retardada , Endoftalmite/prevenção & controle , Humanos , Edema Macular/tratamento farmacológico , Edema Macular/prevenção & controle , Corpo Vítreo/efeitos dos fármacos
10.
Zhonghua Yi Xue Za Zhi ; 100(48): 3835-3840, 2020 Dec 29.
Artigo em Chinês | MEDLINE | ID: mdl-33371627

RESUMO

Objective: To investigate the diagnostic accuracy and efficiency of an artificial intelligence (AI) triaging model in a diabetic retinopathy (DR) screening program. Methods: A DR screening program was conducted in Kashi City and Kizilsu Kirghiz Autonomous Prefecture of the Xinjiang Uyur Autonomous Region from May to July 2018, and 8 005 patients with diabetes mellitus were included. Fundus images, one centered at optic disc and one centered at macula, were taken for both eyes. A previously validated AI algorithm was applied as the first step to identify the patients with all 4 images. If the images were classified as gradable and negative DR, an AI-generated report was immediately provided without sending to manual grading, and 1/3 of these patients were randomly sampled for manual grading and quality control (group A). For the patients with at least one image classified as ungradable or positive for any DR, all images were sent for manual grading (group B). Finally, 300 patients were randomly selected from group A and group B respectively for accuracy assessment, where the patients and their images were classified by a specialist panel for referral DR (pre-proliferative DR, or proliferative DR, and/or diabetic macular edema). Results: Among 8 005 patients for DR screening [including 3 220 males and 4 785 females, aged (58.3±10.6) years], after AI triaging, 5 267 (65.8%) potentially received reports from AI system and 2 738 (34.2%) required manual grading. In group A, the accuracy and specificity of AI classification and manual grading on referral DR were all 100%. In group B, the accuracy of AI and manual grading were 75.8% and 90.3%, respectively, while the sensitivity of AI and manual grading was 100% and 79.1%, respectively. Conclusion: AI alleviates 60% of the workload of manual grading without missing any referral patients with the aid of the current AI triaging model.


Assuntos
Diabetes Mellitus , Retinopatia Diabética , Edema Macular , Idoso , Inteligência Artificial , China , Retinopatia Diabética/diagnóstico , Feminino , Humanos , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Triagem
11.
Vestn Oftalmol ; 136(6. Vyp. 2): 185-194, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33371648

RESUMO

Despite the high clinical effectiveness and widespread introduction of anti-angiogenesis (anti-VEGF) therapy into practice, its long-term effect on the development of structural changes in the treatment of primary open-angle glaucoma (POAG) patients with diabetic macular edema (DME) hasn't been studied sufficiently and so presents certain interest. PURPOSE: To study the effect of anti-VEGF therapy on the structural and functional state of the retina and optic nerve in patients with DME and POAG. MATERIAL AND METHODS: The study included 72 patients (132 eyes): the 1st group - 22 patients (40 eyes) with stage I POAG and DME, the 2nd group - 25 patients (46 eyes) with DME receiving anti-VEGF therapy. The 3rd group (control) consisted of 25 patients (46 eyes) with stage I POAG. The observation period lasted 24 months. The average number of injections was 8.48±3.65. The indicators for evaluation were: visual acuity, tonometry, perimetry, optical coherence tomography (OCT) of the optic nerve and macular region. RESULTS: By the end of the observation period, the increase in IOP in the groups was +0.82 (4.4%), 0.41 (2.4%), 0.65 (3.6%) mm Hg. In the group of comorbid patients, a small-scale increase trend of BCVA was noted: +0.05 (6.6%), a decrease in MD by -2.48 Db (92.1%), an increase in excavation volume by 0.16 (43.2%) mm3, decrease in the area of RA by 0.3 mm2 (12.7%). A decrease in retinal nerve fibers layer (RNFL) thickness of 6.55 µm (7.8%), mainly the superior (9.2%), inferior (7.3%) and nasal sectors (7.9%). Loss of GCL+IPL 8.68 µm (12.7%) in the superior (19%), superonasal (20.2%) and inferonasal (20.7%) sectors. CONCLUSION: The combined course of POAG and DME is accompanied by a decrease in the functional and structural parameters of the retina and optic nerve, and a higher rate of progression of glaucomatous optic neuropathy. Long-term results did not reveal a significant deterioration in the structural parameters of the optic disc and retina against the background of anti-VEGF therapy when comparing the study groups.


Assuntos
Diabetes Mellitus , Retinopatia Diabética , Glaucoma de Ângulo Aberto , Edema Macular , Disco Óptico , Retinopatia Diabética/complicações , Retinopatia Diabética/diagnóstico , Retinopatia Diabética/tratamento farmacológico , Glaucoma de Ângulo Aberto/complicações , Glaucoma de Ângulo Aberto/diagnóstico , Glaucoma de Ângulo Aberto/tratamento farmacológico , Humanos , Pressão Intraocular , Edema Macular/diagnóstico , Edema Macular/tratamento farmacológico , Edema Macular/etiologia , Fibras Nervosas , Tomografia de Coerência Óptica
12.
Klin Monbl Augenheilkd ; 237(11): 1320-1325, 2020 Nov.
Artigo em Inglês, Alemão | MEDLINE | ID: mdl-33202460

RESUMO

Using mobile OCT equipment and remote ophthalmological diagnosis of n = 1538 diabetics in 17 diabetes practices in Germany, we found diabetic macular edema in 10.1% of the patients and retinal bleedings or microaneurysms in 15.6%. In 1.62% of the diabetics examined, the size of the edema was > 0.4 mm², in 7% the retinal thickness was > 300 µm and thus in need of treatment. An intravitreal anti-VEGF injection was administered prior to the examination in only 10% of the patients with diabetic macular edema. By means of mobile tele-eye consultation and remote ophthalmological diagnosis using the cloud-based patient file certified as medical device IIa, patients with diabetic macular edema were identified and informed on site quickly and definitively. The data and images were made available to all attending physicians and ophthalmic surgeons.


Assuntos
Diabetes Mellitus , Retinopatia Diabética , Edema Macular , Retinopatia Diabética/tratamento farmacológico , Retinopatia Diabética/terapia , Humanos , Injeções Intravítreas , Edema Macular/tratamento farmacológico , Edema Macular/terapia , Retina , Tomografia de Coerência Óptica
13.
Georgian Med News ; (306): 28-31, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33130641

RESUMO

The aim of the study was to determine the correlation between implanted IOL material type to detect CME after NSAID use in cataract surgery. Study involved 94 eyes of 72 patients. Eyes were equally divided into two groups (n-47 in each). Post-operatively treatment regimen for participants from Group I included antibiotic and NSAID eye drops, while participants from group II were treated only with antibiotic eye drops. Acrylic hydrophobic intraocular lens (IOL) was implanted in all patients comprising both groups. No patient developed cystoid macular edema from either group (CME). In both groups (with or without NSAID eye drops cover) mean central retinal thickness (CRT) was 230±0.005 microns before the surgery. No statistically significant changes of CRT was noted in both groups (5± 0.09 microns ) (p<0.5). Study analysis has shown, that cystoid macular edema has not developed in patients, who underwent uncomplicated cataract surgery with hydrophobic IOL implantation, with or without NSAID eye drop cover. There was no statistically and clinically significant difference between the groups in terms of CRT. Implantation of acrylic hydrophobic intraocular lens(IOL) has shown to provide high uveal biocompatibility. Major risk factors of CME in cataract surgery are intraoperative surgical complications. Certain systemic and local ophthalmic diseases, as well as topical use of prostaglandin analogs are also strongly linked to postoperative CME development. In conclusion, usage of NSAID eye drops in combination with antibiotic regimen in eyes undergoing cataract surgery, showed to have a beneficial effect on prevention of postoperative CME.


Assuntos
Extração de Catarata , Edema Macular , Anti-Inflamatórios não Esteroides/efeitos adversos , Humanos , Edema Macular/diagnóstico , Edema Macular/etiologia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Tomografia de Coerência Óptica
14.
Brasília; CONITEC; nov. 2020.
Não convencional em Português | BRISA/RedTESA | ID: biblio-1145539

RESUMO

CONTEXTO: O edema macular diabético (EMD) é a principal alteração responsável por perda irreversível de acuidade visual em pacientes com diabetes mellitus (DM) que desenvolveram retinopatia diabética (RD). O EMD é caracterizado por inchaço na região central do olho resultado da ruptura da barreira sanguínea-retiniana e do acúmulo de líquido nas camadas intrarretinianas da mácula. A prevenção primária do EMD é o manejo ideal da doença, considerando a associação direta da prevalência do diabetes e da RD. As estratégias de tratamento consistem inicialmente no controle sistêmico da glicemia, da hemoglobina glicada (HbA1c), de lipídeos séricos, da função renal, estabilização da pressão sanguínea e controle do índice de massa corporal, associado à prática de exercícios físicos e alimentação adequada. O estágio da doença é determinante para a escolha do método de tratamento e o sucesso do tratamento é avaliado pela acuidade visual, pelo estadiamento da classificação da RD e pela análise dos exames complementares. Atualmente a terapia considerada padrão-ouro no tratamento do EMD consiste no uso do fator de crescimento endotelial anti-vascular (antiVEGF), mas em caso de insucesso terapêutico o emprego de corticoides em forma de implantes de liberação controlada tem sido utilizado. Pergunta: O uso do implante biodegradável de dexametasona (Ozurdex®) é eficaz, seguro e custo-efetivo para o tratamento de pacientes adultos com EMD, que falham à terapia com agente anti-VEGF? Evidências científicas: Dez publicações (uma revisão sistemática, dois ensaios clínicos e sete estudos observacionais) foram apresentados no relatório. De acordo com a metanálise, de qualidade metodológica moderada, há um ganho de 20 letras na BCVA (melhor acuidade visual corrigida) de pacientes tratados com o implante biodegradável de dexametasona, após um seguimento médio de avaliação de seis meses. A maioria dos estudos observacionais apontam melhora da BCVA em relação ao baseline do estudo. Os ensaios clínicos apresentaram um risco de viés moderado e um deles descreveu os achados anatômicos do estudo MEAD, avaliando as principais alterações morfológicas em relação ao baseline da ESCR, volume macular, área de espessamento da retina, vazamento macular, perda capilar macular e gravidade da retinopatia diabética. O implante de dexametasona atrasou o tempo de início da progressão do EMD em ± 12 meses, o que ao final do estudo, reduziu a espessura do subcampo central da retina (ESCR) em média 117,3 e 127,8 m nos grupos tratados com dexametasona versus 62,1 m nos olhos tratados com simulação (tratamentos p <0,001 vs, simulação). Entre os desfechos secundários avaliados estão: aumento da PIO, alterações da EFC, ESC e EMC, além de alterações do grau de retinopatia diabética. Os principais eventos adversos relatados em pacientes sob tratamento foram: descolamento de retina, inflamação da câmara anterior; dor ocular; queratite ou opacidade vítrea; e insurgência da catarata. AVALIAÇÃO ECONÔMICA: Foi conduzido um estudo de custo-efetividade e análises de sensibilidade univariada e probabilística. O tratamento com o implante biodegradável de dexametasona foi comparado com um procedimento simulado, ou não tratamento, num horizonte temporal de três anos. Para a indicação proposta, a incorporação da dexametasona resultaria em uma razão de custo-efetividade incremental (RCEI) estimada de R$ 54.568,99 por paciente e inclui custos de aquisição do medicamento, de administração, além de custos com visitas e de avaliação de eventos adversos. AVALIAÇÃO DE IMPACTO ORÇAMENTÁRIO: Dois cenários foram avaliados para estimar o impacto orçamentário (AIO) da incorporação da dexametasona. O cenário base foi representado por um impacto total de R$ 1,76 bilhões em uma estimativa epidemiológica e um total de R$ 159,61 milhões em uma estimativa por demanda aferida, enquanto o cenário por protocolo foi representado por uma economia acumulada total de R$ 39,11 milhões em uma estimativa epidemiológica e R$ 3,50 milhões em uma estimativa por demanda aferida, ambos os cenários em um horizonte temporal de 5 anos. MONITORAMENTO DO HORIZONTE TECNOLÓGICO: Foi detectada uma tecnologia, a fluocinolona acetonida, também um corticoide cuja via de administração é a mesma do implante biodegradável de dexametasona. Os estudos sobre a tecnologia atualmente estão em fase 4. Além disso, foi detectado no horizonte o medicamento aganirsen, um oligonucleotídeo, inibidor do gene IRS1, que está em fase 2 de pesquisa clínica para a indicação. Considerações: A evidência disponível é baseada em estudos clínicos randomizados e estudos observacionais que comparam o período pré-dexametasona e pós-dexametasona. Comparada ao procedimento simulado a dexametasona demonstrou melhora dos desfechos observados (BCVA, EFC, PIO, ESC, EMC, morfologia da retina, alterações no grau de RD e segurança), no entanto, a qualidade das evidências foi considerada baixa. Limitações importantes também foram identificadas na ACE e na AIO, indicando provável superestimação dos valores no âmbito no SUS. DECISÃO PRELIMINAR da Conitec: Diante do exposto, a Conitec, em sua 89ª reunião ordinária, realizada no dia 05 de agosto de 2020, deliberou que a matéria fosse disponibilizada em consulta pública com recomendação preliminar desfavorável à incorporação no SUS do implante biodegradável de dexametasona para tratamento de pacientes com edema macular diabético não responsivos à terapia prévia com anti-VEGF. Considerou-se que as evidências apresentadas são insuficientes para os desfechos analisados, visto baixo nível de certeza apresentado. Além disso, do ponto de vista econômico, o uso de parâmetro inadequado no modelo ocorreu por parte do demandante, pois a dexametasona tem indicação apenas para pacientes não responsivos à terapia prévia com antiangiogênicos, dessa forma não cabe a comparação dos custos com o medicamento aflibercepte, considerando que não são tecnologias substitutas. A matéria foi disponibilizada em consulta pública. CONSULTA PÚBLICA: A Consulta Pública nº 50/2020 foi realizada entre os dias 15/09/2020 a 05/10/2020. Foram recebidas 400 contribuições, sendo 152 pelo formulário para contribuições técnico-científicas e 248 pelo formulário para contribuições sobre experiência ou opinião de pacientes, familiares, amigos ou cuidadores de pacientes, profissionais de saúde ou pessoas interessadas no tema. Dentre as 152 contribuições técnico-científicas, apenas 05 foram analisadas, pois 147 se tratavam de duplicatas, contribuições em branco, desprovidas de teor científico ou que tratavam de experiência ou opinião. As 05 contribuições consideradas para análise discordaram da recomendação preliminar da Conitec, tendo como justificativas: rápida resposta terapêutica da tecnologia, melhor responsividade em comparação à terapia com antiVEGF, bons resultados clínicos em casos de oclusões vasculares, olhos fácicos e uveítes inflamatórias, opção terapêutica em caso de contraindicação aos anti-VEGF ou dificuldade de seguimento. Dentre as 248 contribuições de experiência ou opinião recebidas, apenas 123 foram analisadas, pois 125 se tratavam de duplicatas ou contribuições em branco. Dentre as 123 analisadas, 105 discordaram da recomendação preliminar da Conitec, tendo como argumentações: o implante de dexametasona se trata de única terapia corticoide pós falha terapêutica aos anti-VEGF, pois o aumento de citocinas, em alguns casos, só são controladas pelo corticoide; o implante ser menos oneroso que o custo social quando há perda irreversível de visão dos pacientes; e restrição de uso, no SUS, de um medicamento já disponível no rol de procedimentos da Agência Nacional de Saúde Suplementar (ANS). O demandante e fabricante da tecnologia enviou nova proposta de preço para incorporação com 25% de desconto, junto à nova análise de custo-efetividade e impacto orçamentário, que foram apresentados aos membros do plenário. Além desta, outras contribuições analisadas foram importantes para a complementação do relatório, especialmente por trazer as expectativas de adesão ao procedimento, por profissionais e pacientes. RECOMENDAÇÃO FINAL: Os membros do plenário presentes na 92ª reunião ordinária da Conitec, no dia 04 de novembro de 2020, deliberaram, por unanimidade, recomendar a não incorporação, no SUS, do implante biodegradável de dexametasona para tratamento de pacientes com edema macular diabético não responsivos à terapia prévia com antiVEGF. Foi considerado que ainda há alguns aspectos não esclarecidos sobre a prática clínica no cuidado do EMD, como o limiar de ineficácia ou insucesso terapêutico com anti-VEGF e que faltam evidências científicas que indiquem se a tecnologia avaliada seria substitutiva para os anti-VEGF ou se deveria ser criada uma segunda linha para o cuidado do EMD. Reiterou-se que as evidências avaliadas no relatório técnico não foram consideradas robustas o suficiente para a tomada de decisão em favor da incorporação do implante biodegradavel de dexametasona em casos de ineficácia terapêutica com anti-VEGF, que foi a proposta apresentada pelo demandante. Ademais, não foram adicionadas na CP referências que alterassem a análise das evidências apresentadas no relatório preliminar. Foi assinado o Registro de Deliberação nº 570/2020. DECISÃO: Não incorporar o implante biodegradável de dexametasona no tratamento do edema macular diabético em pacientes não responsivos à terapia prévia com anti-VEGF, no âmbito do Sistema Único de Saúde - SUS, conforme Portaria nº 58, publicada no Diário Oficial da União nº 228, seção 1, página 716, em 1º de dezembro de 2020.


Assuntos
Humanos , Dexametasona/uso terapêutico , Edema Macular/tratamento farmacológico , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Diabetes Mellitus/fisiopatologia , Avaliação da Tecnologia Biomédica , Sistema Único de Saúde , Brasil , Análise Custo-Benefício/economia
15.
Cesk Slov Oftalmol ; 76(4): 1-3, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33086850

RESUMO

The issue of macular retinal degeneration is one of the key areas of ophthalmology. Recent advances in the targeted delivery of vascular endothelial growth factor (VEGF) suppressants have significantly impacted the patient's prognosis in the form of a significant deceleration in disease progression. Some of the drugs have gradually found their use in other indications (central retinal vein occlusion or diabetic macular edema). The following text gives a brief look at the physiology of VEGF, but not only in the eye, but throughout the human body, particularly in the context of adverse effects resulting from systemic inhibition of its effects.


Assuntos
Retinopatia Diabética , Degeneração Macular , Edema Macular , Inibidores da Angiogênese/uso terapêutico , Bevacizumab/uso terapêutico , Retinopatia Diabética/tratamento farmacológico , Humanos , Injeções Intravítreas , Degeneração Macular/tratamento farmacológico , Edema Macular/tratamento farmacológico , Edema Macular/etiologia , Ranibizumab/uso terapêutico , Receptores de Fatores de Crescimento do Endotélio Vascular/uso terapêutico , Proteínas Recombinantes de Fusão/uso terapêutico , Fator A de Crescimento do Endotélio Vascular , Acuidade Visual
16.
Indian J Ophthalmol ; 68(11): 2572-2574, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33120696

RESUMO

Thromboembolic phenomenon related to Coronavirus disease 2019 (COVID-19) has been well documented in literature; however, reported ocular manifestations of COVID-19 are limited to vision sparing ocular conditions like conjunctivitis. We report a case of a 17-year-old female who presented to us with central retinal vein occlusion with proven recent past COVID-19 infection as presumed etiology which was not known to her at the time of presentation.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Oclusão da Veia Retiniana/etiologia , Adolescente , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Feminino , Humanos , Edema Macular/diagnóstico por imagem , Edema Macular/etiologia , Pandemias , Pneumonia Viral/diagnóstico , Descolamento Retiniano/diagnóstico por imagem , Descolamento Retiniano/etiologia , Oclusão da Veia Retiniana/diagnóstico , Tomografia de Coerência Óptica
17.
Curr Opin Ophthalmol ; 31(6): 563-571, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33002988

RESUMO

PURPOSE OF REVIEW: The purpose of this article is to provide an overview of drug-induced maculopathies including their clinical presentations, diagnostic findings, and treatment options. With the increasing pace of development and arrival of drugs to the market, this review aims to inform retina specialists of relevant side effects that may be encountered in a clinical practice setting. RECENT FINDINGS: The major themes visited in this article focus on relevant findings of drugs that cause pigmentary and crystalline maculopathy, photoreceptor dysfunction, cystoid macular edema, central serous choroidopathy, uveitis, and vascular damage. SUMMARY: The current review reports updated findings and discusses the pathophysiologic mechanisms, presentations, and treatments of drug-induced maculopathies.


Assuntos
Degeneração Macular/induzido quimicamente , Humanos , Edema Macular/fisiopatologia , Uveíte
18.
PLoS One ; 15(8): e0238246, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32866203

RESUMO

Young children exhibit poorer visual performance than adults due to immaturity of the fovea and of the fundamental processing of visual functions such as masking and crowding. Recent studies suggest that masking and crowding are closely related to the size of the fundamental processing unit-the perceptive field (PF). However, while it is known that the retina and basic visual functions develop throughout childhood, it is not clear whether and how changes in the size of the PF affect masking and crowding. Furthermore, no retinal and perceptual development data have been collected from the same cohort and time. Here we explored the developmental process of the PF and the basic visual functions. Psychophysical and imaging methods were used to test visual functions and foveal changes in participants ranging from 3-17 years old. Lateral masking, crowding and contrast sensitivity were tested using computerized tasks. Foveal measurements were obtained from spectral-domain optical coherence tomography (OCT). The children patterns below 6 years exhibited high crowding, while the expected facilitation was found only at a larger target-flanker distance than required for children above 6 years, who exhibited the typical adult. Foveal thickness and macular volume for the children below 6 years were significantly lower than for the older group. Significant correlation was found for contrast sensitivity, foveal thickness and macular volume with age and between contrast sensitivity and foveal thickness. Our data suggest that the developmental processes at the retina and visual cortex occur in the same age range. Thus, in parallel to maturation of the PF, which enables reduction in crowding, foveal development contributes to increasing contrast sensitivity.


Assuntos
Retina/fisiologia , Acuidade Visual/fisiologia , Córtex Visual/fisiologia , Adolescente , Criança , Pré-Escolar , Sensibilidades de Contraste/fisiologia , Aglomeração , Feminino , Fóvea Central/fisiologia , Humanos , Edema Macular/fisiopatologia , Masculino , Tomografia de Coerência Óptica/métodos
19.
Medicine (Baltimore) ; 99(35): e21992, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32871950

RESUMO

BACKGROUND: Diabetic macular edema (DME) can cause severe vision impairments for patients with diabetes. Recently, Conbercept has shown efficacy on DME with 3-monthly loading dose injection and pro re nata (PRN, 3+PRN) thereafter in retrospectivetrials. Furthermore, there are some other approaches have been recommended such as 2mg bimonthly (2q8) after 5 initial doses, or Conbercept 0.5mg treat-and-extend, however, some patients still have recurrence of the disease after treatment. Therefore, in order to identify more efficacy and safety approach on Conbercept inpatients with DME, a randomized controlled trial will be performed with 6-monthly loading dose injection and PRN (6+PRN) compared with 3+PRN treatments. METHODS: This study is a multicenter, randomized control trial of Conbecept treating DME in China. Patients with type 2 diabetes suffered from DEM who already planned to receive Conbercept treatment will be recruited. All subjects will be randomized divided into either a study agent treatment group (6+PRN) or a control group (3+PRN), and observes the subjects for 48 weeks after initiation of treatment. RESULTS: This study will provide a new powerful evidence of the efficacy and safety of Conbecept treating DME. DISCUSSION: This RTC study will determine whether multiple treatments of Conbercept provide better effectiveness in patients with DME. TRIAL REGISTRATION NUMBER: ChiCTR2000032728.


Assuntos
Retinopatia Diabética/tratamento farmacológico , Edema Macular/tratamento farmacológico , Proteínas Recombinantes de Fusão/uso terapêutico , Angiografia , Estudos de Equivalência como Asunto , Humanos , Estudos Multicêntricos como Assunto , Tomografia de Coerência Óptica
20.
Vestn Oftalmol ; 136(4. Vyp. 2): 201-206, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32880140

RESUMO

There are currently no reliable biomarkers for predicting the response to treatment of diabetic macula edema (DME). PURPOSE: To asses the predictive role of neurodegenerative biomarker of the response to anti-VEGF therapy of DME. MATERIAL AND METHODS: Examination and treatment was carried out on 14 patients (20 eyes) with DME. The eyes were divided into 2 groups by the type of diabetes: 6 eyes with type 1 diabetes and 14 eyes with type 2 diabetes. The duration of diabetes was 16.5±7.9 years, the level of glycated hemoglobin was 8.4±2%. A number of indicators were evaluated using optical coherence tomography (OCT) in order to determine the neurodegenerative biomarkers of the response to anti-VEGF treatment. All patients underwent standard loading course of Aflibercept (5 intravitreal injections). RESULTS: Significant improvement in Best Corrected Visual Acuity (BCVA) and decrease of central retinal thickness (CRT) was seen after the treatment course. Data analysis revealed a correlation between functional outcomes of the treatment, and the following pathological changes in the retina: thickness of retinal nerve fiber layer (RNFL), thickness of the complex of ganglion cell and inner plexiform layers in the macular region (GCL+), thickness of the RNFL and GCL+ complex (GCL++) in the macular region, ΔCRT, as well as BCVA, patient age, and type of diabetes. Anatomical outcomes correlate with the stage of diabetic retinopathy, RNFL, GCL+, GCL++, violation of the integrity of the ellipsoid zone before treatment. CONCLUSION: The course of intravitreal administration of the Aflibercept drug has been established to be an effective method of treating patients with clinically significant DME. Neurodegenerative biomarkers of the response to the anti-VEGF drug therapy have been determined: thickness of the peripapillary RNFL, GCL+ and GCL ++, as well as integrity of the ellipsoid zone.


Assuntos
Diabetes Mellitus Tipo 2 , Retinopatia Diabética , Edema Macular , Biomarcadores , Humanos , Células Ganglionares da Retina , Estudos Retrospectivos , Tomografia de Coerência Óptica , Acuidade Visual
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