Dexamethasone 0.7 mg implants in the management of pseudophakic cystoid macular edema

ABSTRACT Pseudophakic cystoid macular edema (PCME) is a common complication following cataract surgery. Although majority of patients with PCME remain asymptomatic, it remains an important cause of vision loss after cataract surgery. The pathogenesis of PCME remains unclear, but most authors agree that inflammation plays a major role in its development. There is no standard algorithm for treatment procedures for PCME. A biodegradable 0.7 mg dexamethasone intravitreal implant can be used to deliver medication into the posterior segment of eyes. This drug acts on all inflammatory mediators and has been approved for the treatment of macular abnormalities secondary to retinal vein occlusion and for non-infectious posterior uveitis. In this case series, we report six patients who presented with PCME and were treated with a 0.7 mg dexamethasone intravitreal implant. Favorable anatomical outcomes were demonstrated by spectral domain-optical coherence tomography images

Hemorrhagic retinopathy in an infant with hemolytic-uremic syndrome

We describe the case of a 23-month-old female infant with a diagnosis of hemolytic uremic syndrome (HUS) and hemorrhagic retinopathy. The patient had a past history of abdominal pain, bloody diarrhea, and acute renal failure. On ophthalmologic examination, indirect ophthalmoscopy revealed extensive areas of flame-shaped hemorrhage, cotton wool spots, macular edema and optic nerve head neovascularization in both eyes. Fluorescein angiography showed severe bilateral retinal ischemia and neovascularization leakage in disk. The patient, who had the visual acuity of 20/1000 in the right eye (OD) and 20/540 in the left eye (OS) at the first examination, was treated with panretinal photocoagulation (PRP) and presented at the end of the 6th month of follow-up improvement to 20/540 in OD and 20/270 in OS. There was also a regression of disc neovascularization, hemorrhages and macular edema. Despite intense retinal ischemia, there were no complications related to angiogenesis such as vitreous hemorrhage and/or neovascular glaucoma. We describe, in this report, the association between hemorrhagic retinopathy with features of Purtscher-like disease and HUS

Reprodutibilidade da espessura da camada de fibras nervosas da retina utilizando-se o Spectral Domain OCT em pacientes brasileiros

OBJETIVO: Avaliar a reprodutibilidade da medida da espessura da camada de fibras nervosas da retina (CFNR) em olhos sem e com glaucoma utilizando-se tomografia de coerência óptica de domínio espectral (spectral domain OCT - SDOCT). MÉTODOS: Foram analisados apenas um olho de 79 pacientes normais e 72 com glaucoma. Todos os pacientes realizaram um exame oftalmológico completo, incluindo acuidade visual, pressão intraocular, biomicroscopia, oftalmoscopia indireta e, para o grupo com glaucoma, perimetria acromática 24-2 SITA Fast Humphrey Field Analyzer. Foram realizados em todos os olhos e em apenas uma visita, três B-scans circulares centrados no disco óptico utilizando-se o SDOCT - Spectralis® RESULTADOS: O coeficiente de correlação intraclasse (ICC), coeficiente de variação e variabilidade teste-reteste para a média de espessura da camada de fibras nervosas da retina foram respectivamente: 0,94, 2,56% e 4,85 µm para o grupo sem glaucoma e 0,93, 4,65% e 6,61 µm para o grupo glaucomatoso. O coeficiente de correlação intraclasse foi excelente em ambos os grupos em todos os quadrantes, com o quadrante superior sendo o maior (0,964) no grupo glaucomatoso e o nasal sendo o menor (0,800), mas ainda excelente, em olhos sem glaucoma. O coeficiente de variação foi entre 2,56% - 8,74% e entre 4,65% - 11,44%, nos grupos sem e com glaucoma, respectivamente. A variabilidade teste-reteste variou de 4,85 µm e 11,51 µm no grupo sem glaucoma; e entre 6,61 µm e 14.24 µm no com glaucoma. Olhos com glaucoma apresentaram-se mais variáveis que os sem glaucoma. CONCLUSÃO: A tomografia de coerência óptica "spectral domain" apresentou excelente reprodutibilidade da espessura da camada de fibras nervosas da retina em pacientes sem e com glaucoma.PURPOSE: To evaluate the reproducibility of peripapillary retinal nerve fiber layer (RNFL) thickness measurements in normal eyes and eyes with glaucoma using spectral domain optical coherence tomography (SDOCT). METHODS: One eye of 79 normal and 72 glaucoma patients was analyzed. All patients underwent a complete ophthalmological examination, including visual acuity testing; intraocular pressure, slit-lamp examination, indirect ophthalmoscopy; and the glaucoma group underwent achromatic perimetry with the 24-2 SITA Fast Humphrey Field Analyzer. All patients' eyes were scanned using the spectral domain optical coherence tomography - Spectralis® and one of them was chosen randomly. Three consecutive circular B-scan centered at the optic disc were performed in one visit. RESULTS: The intraclass correlation coefficient (ICC), coefficient of variation and test-retest variability for the mean retinal nerve fiber layer thickness were respectively: 0.94, 2.56% and 4.85 µm for the normal group and 0.93, 4.65% and 6.61 µm for the glaucomatous group. The intraclass correlation coefficient for retinal nerve fiber layer thickness in all quadrants were all excellent in both groups, with the superior quadrant having the highest ICCs (0.964) in glaucomatous eyes and nasal quadrant measurements having the lowest (0.800), but still excellent in eyes without glaucoma. The coefficient of variation was between 2.56% - 8.74% and between 4.65% - 11.44% in normal and glaucomatous group respectively. The test-retest variability was between 4.85 µm and 11.51 µm in the normal group and between 6.61 µm and 14.24 µm in the glaucomatous group. The measurements in glaucomatous eyes were more variable than normal eyes. CONCLUSIONS: Spectral domain optical coherence tomography showed excellent reproducibility with regard to retinal nerve fiber layer thickness measurements in normal and glaucomatous eyes

2% ibopamine vs. water-drinking test as a provocative test for glaucoma

PURPOSE: To compare the 2% ibopamine provocative test with the water drinking test as a provocative test for glaucoma. METHODS: Primary open-angle glaucoma patients and normal individuals were selected from CEROF-Universidade Federal de Goiânia UFG, and underwent the 2% ibopamine provocative test and the water drinking test in a randomized fashion, at least 1 week apart. Intraocular pressure (IOP) before and after both tests, Bland-Altman graph, sensitivity and specificity (as mesured by ROC curves) were obtained for both methods. RESULTS: Forty-seven eyes from 25 patients were included (27 eyes from 15 glaucoma patients and 20 eyes from 10 normal individuals), with a mean age of 54.2 ± 12.7 years. The mean MD of glaucoma patients was -2.8 ± 2.11 dB. There was no statistically difference in the baseline IOP (p=0.8) comparing glaucoma patients, but positive after the provocative tests (p=0.03), and in the IOP variation (4.4 ± 1.3 mmHg for ibopamine and 3.2 ± 2.2 mmHg for water drinking test, p=0.01). There was no difference in all studied parameters for normal individuals. The Bland-Altman graph showed high dispersion comparing both methods. The areas under the ROC curve were 0.987 for the ibopamine provocative test, and 0.807 for the water-drinking test. CONCLUSION: In this selected subgroup of glaucoma patients with early visual field defect, the ibopamine provocative test has shown better sensitivity/specificity than the water drinking test.OBJETIVO: Comparar o teste da ibopamina 2% com o teste de sobrecarga hídrica como testes provocativos para glaucoma. MÉTODOS: Pacientes com glaucoma primário de ângulo aberto, e indivíduos normais foram selecionados do CEROF-Universidade Federal de Goiás - UFG, e submetidos, de forma randomizada, e com intervalo mínimo de 1 semana, aos testes provocativos da ibopamina 2%, e sobrecarga hídrica. A pressão intra-ocular (Pio) antes e após os testes, confrontação entre os métodos (gráfico de Bland-Altman) além da melhor relação sensibilidade/especificidade (realizados por meio de curvas ROC) foram obtidos. RESULTADOS: Foram incluídos 47 olhos de 25 pacientes (27 olhos de 15 pacientes com glaucoma e 20 olhos de 10 pacientes normais), com idade média de 54,2 ± 12,7 anos. O MD médio dos pacientes com glaucoma foi de -2,8 ± 2,11 dB. Nos pacientes com glaucoma, não houve diferença estatisticamente significativa na Pio basal (p=0,8), ao passo que se notou diferença na Pio após os testes provocativos (p=0,03), e na variação da Pio após os testes (4,4 ± 1,3 mmHg para ibopamina e 3,2 ± 2,2 mmHg para ingestão hídrica, p=0,01). Nos pacientes normais, não houve diferença estatisticamente significativa entre os grupos para todos os parâmetros avaliados. O gráfico de Bland-Altman mostrou grande dispersão dos resultados. Finalmente, obteve-se áreas abaixo das curvas ROC de 0,987 para o teste da ibopamina e 0,807 para a ingestão hídrica. CONCLUSÃO: O teste provocativo da ibopamina apresentou melhor relação sensibilidade/especificidade que o teste de ingestão hídrica nesse subgrupo selecionado de pacientes com glaucoma com dano perimétrico inicial.49950

A survey of whole-plant corn silages from Minas Gerais dairy farms

Whole-plant corn silage (WPCS) is a commonly used forage for feeding dairy cattle in Brazil. The aim of this study was to evaluate on-farm ensilaging practices and the nutritional value, microbiology and fermentation profiles of WPCS from dairy farms in the south of the state of Minas Gerais, Brazil. Silages from 54 dairy farms located in nine cities were sampled and a questionnaire was distributed for completion to describe the herd profile and ensilage practices. Herd size ranged from 8 to 1,000 lactating cows, and 52 % of the farms had fewer than 50 cows in lactation. The majority of the farms cultivated hard endosperm texture hybrids (52 %) and used pull-type forage harvesters (87 %). Double-sided plastic was the most used form of silo sealing (56 %) and 28 % used inoculants. Lactic acid bacteria count was greater than 6.01 log CFU g–1 in 60 % of the samples, and the mean populations of enterobacteria and Bacillus spp. were 4.23 and 4.09 log CFU g–1, respectively. Silo size ranged from 100 to 250 m3 in 44 % of the farms, and the silage removal rate was below 15 cm of the face/d in 41 % of cases. Silage dry matter (DM) concentration was 33 ± 3 % of fresh matter, NDF concentration was 57 ± 7 % of the DM, and in vitro NDF digestibility was 35 ± 11 % of the NDF. Silages with high DM concentrations had large particle size, affecting the nutritional value and the fermentative pattern. Improvements in ensiling practices can potentially inhibit the growth of spoilage microorganisms and raise the nutritional value of silages

The effect of bevacizumab, 5-fluorouracil, and triamcinolone on the healing modulation of surgical wounds in rats

In this study, we aimed to analyze the effect of 5-fluorouracil, triamcinolone, and bevacizumab on scar modulation in an experimental rat model of surgical lesions. Rats (Rattus norvegicus albinus) were divided into four groups: bevacizumab, 5-fluorouracil + triamcinolone, bevacizumab + 5-fluorouracil + triamcinolone, and control (received no medication) groups. A linear, dorsal incision was created and sutured for the first intention wound healing, mimicking the surgical incision of upper blepharoplasty. Treatments were initiated on day 7, and the rats were euthanized on day 14. Only in the 5-fluorouracil + triamcinolone group was there a difference in the number of infiltrated monocytes. There was 56%, 86%, and 85% decrease in the number of neovessels in the bevacizumab, 5fluorouracil + triamcinolone, and bevacizumab + 5fluorouracil + triamcinolone groups, respectively, compared with the control. Picrosirius red staining showed higher collagen density and more organized collagen in the treatment groups than in the control group. Scar modulation was observed in all groups, but the 5-fluorouracil + triamcinolone group presented the best results. To our knowledge, this is the first study to evaluate the influence of three medications in combination on healing. When used together, these medications can prevent the development of unsightly scars, and are therefore promising alternatives to corticosteroids