Microperimetry and fundus autofluorescence in patients with early age-related macular degeneration

Background: Early age-related macular degeneration (AMD) has been correlated with different functional alterations, but the exact relationship between fundus lesions and overlying sensitivity is not well known. The aim of this study was to compare fundus-related sensitivity (microperimetry) and fundus autofluorescence (FAF) of the macular area with drusen and pigment abnormalities in early AMD. Methods: 13 consecutive patients with early AMD and visual acuity of 20/20 were studied by means of microperimetry, which automatically analyses macular light differential threshold and fixation patterns. Fundus colour photo and FAF of the macular area were recorded on the same day. Microperimetry was exactly (topographically) superimposed over FAF images. Results: Macular sensitivity significantly decreased over large drusen (11.2 ± 5.6 dB, p<0.0001) and over pigment abnormalities (13.1 ± 3.6 dB, p<0.0001). When both characteristics were present the reduction was greater if compared with its absence (9.6 ± 4.3 versus 15.0 ± 4.5 dB, p<0.0001). Sensitivitity reduction was significant in areas with altered FAF when compared with areas with normal FAF (p<0.0001). Conclusions: Increased FAF in early AMD has a functional correlate exactly quantified by microperimetry. In retinal areas affected by early AMD retinal sensitivity deteriorates, despite good visual acuity. Microperimetry may allow the early detection of functional impairment caused by these lesions. Both microperimetry and FAF may be useful to monitor AMD progression

Diabetic Macular Edema With and Without Subfoveal Neuroretinal Detachment: Two Different Morphologic and Functional Entities

PURPOSE: To assess specific morphologic and functional characteristics in eyes with diabetic macular edema (DME) with subfoveal neuroretinal detachment (SND+) vs DME without SND (SND). DESIGN: Cross-sectional, prospective, comparative case series. METHODS: Seventy-two patients (72 eyes: 22 eyes SND + and 50 eyes SND) with treatment-naive, center-involving DME were evaluated. Data gathering included fundus color photographs, fluorescein angiography, spectral-domain optical coherence tomography (SD-OCT), best-corrected visual acuity (BCVA), and microperimetry. The following parameters were evaluated with SD-OCT: central macular thickness (CMT [including SND]); central retinal thickness (CRT [excluding SND]); choroidal thickness (CT); nasal and temporal retinal thickness (RT) at 500 mu m and 1500 mu m from the fovea; the number of hyperreflective retinal spots (HRS) in the central 3000 mu m; and the presence of SND and integrity of the external limiting membrane (ELM). Retinal sensitivity (RS) was evaluated within 4 degrees and 12 degrees of the fovea. Correlation among CT, RS, and HRS in patients with and without SND was determined. RESULTS: CMT (P = .032), temporal RT at 1500 mu m (P = .03), mean CT (P = .009), and mean number of HRS (P = .0001) were all higher in SND + vs SND eyes. CRT, BCVA, HbA1c, and prevalence of systemic arterial hypertension were not different between the 2 groups. RS within 4 degrees (P = .002) and 12 degrees (P = .015) was lower in SND+ vs SND eyes. SND correlated significantly with disruption of the ELM (54.55% vs 24%, P = .01) and lower RS. A direct correlation was found between the number of HRS, presence of SND, CT, and RS within 12 degrees in SND eyes, and an inverse correlation was found between CT and RS within 12degrees in SND+ eyes. CONCLUSIONS: These data may improve characterization of DME in eyes with SND. DME with SND correlates with greater CT, more HRS, disruption of the ELM, and significant macular functional impairment (RS decrease) vs SND

Microperimetry and fundus autofluorescence in diabetic macular edema subthreshold micropulse diode laser versus modified early treatment diabetic retinopathy study laser photocoagulation.

Abstract PURPOSE: The purpose of this study was to evaluate and compare microperimetry and fundus autofluorescence (FAF) after subthreshold micropulse diode laser versus modified Early Treatment Diabetic Retinopathy Study photocoagulation for clinically significant diabetic macular edema. METHODS: A prospective randomized clinical trial including 62 eyes (50 patients) with untreated, center-involving, clinically significant diabetic macular edema was performed. All patients underwent best-corrected visual acuity determination (logarithm of the minimum angle of resolution), slit-lamp biomicroscopy, FAF, optical coherence tomography, microperimetry (macular sensitivity), and fluorescein angiography before and after treatment. Best-corrected visual acuity, optical coherence tomography, microperimetry, and FAF were repeated at 1-, 3-, 6-, 9-, and 12-month follow-up examinations. Fluorescein angiography was performed at baseline and at 6 and 12 months. RESULTS: Before treatment, demographic and macular parameters were not different between the two treatment groups. At 12 months, best-corrected visual acuity remained stable in both groups (P = 0.41 and P = 0.82), mean central retinal thickness decreased in both groups (P = 0.0002 and P < 0.0001), and mean central 4 degrees and 12 degrees retinal sensitivity increased in the micropulse diode laser group (P = 0.02 and P = 0.0075) and decreased in the Early Treatment Diabetic Retinopathy Study group (P = 0.2 and P = 0.0026). There was no significant difference in either best-corrected visual acuity or central retinal thickness between the 2 treatment groups (P = 0.48 and P = 0.29), whereas there was a significant difference in 4 degrees and 12 degrees retinal sensitivity (P = 0.04 and P < 0.0001). Fundus autofluorescence never changed in the micropulse diode laser group even after retreatment. In the Early Treatment Diabetic Retinopathy Study group, FAF increased up to 9 months and decreased in 6 eyes (20%) at 12 months. DISCUSSION: Micropulse diode laser seems to be as effective as modified Early Treatment Diabetic Retinopathy Study laser photocoagulation in the treatment of clinically significant diabetic macular edema. Micropulse diode laser treatment does not determine any change on FAF showing (at least) nonclinically visible damage of the retinal pigment epithelium. Microperimetry data encourage the use of a new, less aggressive laser therapeutic approach in the treatment of clinically significant diabetic macular edema

Imaging retinal inflammatory biomarkers after intravitreal steroid and anti-VEGF treatment in diabetic macular oedema

PurposeTo evaluate changes of specific retinal imaging biomarkers [intraretinal hyper-reflective retinal spots: HRS ; subfoveal neuroretinal detachment: SND; and increased foveal autofluorescence: IFAF after intravitreal steroid or anti-vascular endothelial growth factor treatment in diabetic macular oedema (DME)] as possible indicators of retinal inflammatory condition. MethodsRetrospective analysis of images and clinical charts of 49 eyes (49 patients) with DME treated with intravitreal dexamethasone (dexamethasone, 23 eyes) or intravitreal ranibizumab (ranibizumab, 26 eyes). All patients had fundus colour photograph, spectral domain optical coherence tomography (SD OCT) and fundus autofluorescence (FAF), best-corrected visual acuity (BCVA) and microperimetry recorded before and 1month after the end of treatment. Central macular thickness (CMT), number of HRS and presence of SND were evaluated by SD OCT. Fundus autofluorescence images were evaluated for area of (IFAF). Retinal sensitivity within 4 degrees and 12 degrees from fovea was quantified by microperimetry. Changes in morphologic and functional parameters were assessed, and correlation was performed by Pearson's correlation. ResultsBest-corrected visual acuity and CMT improved in all patients, (p&lt;0.05, for both groups). Mean number of HRS decreased after both treatments (p&lt;0.0001). Subfoveal neuroretinal detachment resolved in 85.7% dexamethasone-treated eyes (p=0.014) and in 50% ranibizumab-treated eyes (p=0.025). Mean IFAF area decreased in both groups, (p&lt;0.0001, for both). A significantly higher decrease in CMT was observed in dexamethasone- versus ranibizumab-treated eyes, (p=0.032). In dexamethasone group, higher number of HRS at baseline and larger IFAF were correlated with higher increase in retinal sensitivity; eyes with SND at baseline had major decrease in CMT versus those without SND, (p=0.003). ConclusionHigher number of HRS, larger area of IFAF and presence of SND may indicate a prevalent inflammatory condition in DME with specific response to targeted treatment

Contribuição da reabilitação na saúde e na qualidade de vida do idoso no Brasil: reflexões para a assistência multidisciplinar

Resumo: O progressivo crescimento da população no Brasil tem causado, no âmbito sócio-econômico principalmente, preocupação aos sistemas de saúde, os quais ainda não estão preparados para atender as diversificadas demandas deste seguimento etário. Cuidar do idoso como uma pessoa integral e não apenas como um organismo biológico, protegendo-o e integrando-o dentro do contexto psicossocial do momento, deve ser o maior objetivo dos profissionais da saúde. Devemos estar tão preparados para lidar com especificidades do processo de envelhecimento quanto para tratar seus distúrbios. Há profunda inter-relação entre a qualidade de vida percebida e a saúde física e mental. Esta reflexão analisa a importância da reabilitação preventiva na promoção da qualidade de vida do idoso e de seus familiares conduzindo à conseqüente prevenção e postergação da manifestação de sintomas e de doenças crônicas. Palavras-chave: Envelhecimento. Reabilitação. Ensino. Abstract: The progressive populational growth in Brazil has caused, in the social-demographical scope mainly, much worry to the health systems, wich are not prepared to attend the different demands of this age segment. Caring for the elderly people as an integral person and not only as a biological organism, protecting them and integrating them into the psychosocial context of the moment should be the main objective of the health field professionals. We must be as well prepared to deal with the specificities of the aging process as to treat their disturbances. There is a deep inter-relation between the perceived quality of life and the mental and physical health. This reflexion analyzes the importance of the preventive rehabilitation in the elderly’s and their family’s life quality promotion, leading to the consequent prevention and postponement of the symptoms and chronical diceases manifestation. Keywords: Elderly. Rehabilitation. Teaching

ATIVIDADE FÍSICA, MANUTENÇÃO DA CAPACIDADE FUNCIONAL E DA AUTONOMIA EM IDOSOS: REVISÃO DE LITERATURA E INTERFACES DO CUIDADO

A capacidade funcional dos sistemas do organismo diminui gradualmente desde a juventude favorecendo a ocorrência de doenças crônicas, quedas e diminuição da capacidade funcional. O sedentarismo contribui significativamente na aceleração do ritmo do declínio, de modo que a eficácia da prática de atividade física na prevenção e controle dessas condições vem sendo progressivamente estudada. O objetivo deste estudo foi conhecer a produção do conhecimento, na forma de artigo, voltada para a manutenção da capacidade funcional e da autonomia em idosos por meio da atividade física, discutindo sobre as abordagens propostas para essa finalidade. Através de estudo exploratório, foi realizada uma revisão no período entre 2004 e 2008, das bases de dados Medline, Pubmed, Lilacs, Cinahal e Scielo, de onde foram selecionados artigos que verificaram as varia  das abordagens propostas em programas de atividade física. Os artigos demonstraram, em sua maioria, os benefícios da atividade física regular e adaptada aos diversos momentos e condições do idoso, na manutenção da capacidade funcional e da autonomia em idosos, confirmando inclusive a importância do incentivo à prática de atividade física em qualquer idade e principalmente ao idoso, dentro de suas amplas possibilidades e contextos.   PHYSICAL ACTIVITY, MAINTENANCE OF FUNCTIONAL CAPACITY AND AUTONOMY: LITERATURE REVIEW AND INTERFACES  OF CARE abstract The functional capacity of the body systems gradually decreases since the youth, favoring the occurrence of chronic diseases, falls and decreased functional capacity. The sedentary lifestyle contributes significantly in accelerating the pace of decline, so that the effectiveness of physical activity in the prevention and control of these conditions has been increasingly studied. The aim of this study was to know about the production of knowledge, in the form of articles, devoted to the maintenance of functional capacity and autonomy in older people through physical activity, discussing on the approaches proposed for this purpose. Through a exploratory study, a review was conducted in the period between 2004 and 2008, on the databases Medline, Pubmed, Lilacs, and Scielo Cinahal, from where were selected articles that were found in the various approaches proposed programs of physical activity. Most of the articles demonstrated the benefits of regular physical activity and adapted to different times and conditions of the elderly, the maintenance of functional capa  city and autonomy in the elderly, inclusively confirming the impor  tance of fostering physical activity at any age and especially for the elderly, within their broad scope and contexts. 

Effects of Topically Administered Neuroprotective Drugs in Early Stages of Diabetic Retinopathy:Results of the EUROCONDOR Clinical Trial

The primary objective of this study was to assess whether the topical administration of two neuroprotective drugs (brimonidine and somatostatin) could prevent or arrest retinal neurodysfunction in patients with type 2 diabetes. For this purpose, adults aged between 45 and 75 years with a diabetes duration ≥5 years and an Early Treatment of Diabetic Retinopathy Study (ETDRS) level of ≤35 were randomly assigned to one of three arms: placebo, somatostatin, or brimonidine. The primary outcome was the change in implicit time (IT) assessed by multifocal electroretinography between baseline and at the end of follow-up (96 weeks). There were 449 eligible patients allocated to brimonidine (n = 152), somatostatin (n = 145), or placebo (n = 152). When the primary end point was evaluated in the whole population, we did not find any neuroprotective effect of brimonidine or somatostatin. However, in the subset of patients (34.7%) with preexisting retinal neurodysfunction, IT worsened in the placebo group (P < 0.001) but remained unchanged in the brimonidine and somatostatin groups. In conclusion, the topical administration of the selected neuroprotective agents appears useful in preventing the worsening of preexisting retinal neurodysfunction. This finding points to screening retinal neurodysfunction as a critical issue to identify a subset of patients in whom neuroprotective treatment might be of benefit

Torpedo maculopathy: a morphofunctional evaluation.

To describe the optical coherence tomography (OCT), the standard short-wavelength fundus autofluorescence (SW-FAF) and near-infrared fundus autofluorescence (NIR-FAF), and the microperimetric findings in a child with a unique unilateral lesion of the temporal macula previously called torpedo maculopathy. A 4-year-old female with torpedo maculopathy was evaluated with spectral-domain OCT (SD-OCT), standard SW-FAF (excitation 488 nm, emission >500 nm) and NIR-FAF (excitation 787 nm, emission >800 nm). Microperimetry was performed to assess retinal sensitivity changes correlated to the macular lesion. SD-OCT showed an abnormally thin retinal pigment epithelium signal and an increased signal transmission in the choroid corresponding to the torpedo lesion with no neuroretinal changes. SW-FAF resulted in normal fluorescence of the lesion except for a small hyperfluorescent area at the tail level. NIR-FAF showed hypofluorescence corresponding to the lesion. Macular microperimetry showed reduced retinal sensitivity along the pigmented margins of the lesion with normal values over the lesion. The patient was re-evaluated 12 months later and no change was documented with all diagnostic techniques. This case supports a congenital defect of retinal pigment epithelium. The absence of both functional changes at lesion level and neuroretinal changes at OCT may depend on the very early detection of this lesion