Sealed Unilateral Full-Thickness Macular Hole with Amniotic Membrane Graft in a Patient with Alport Syndrome: A Case Report

We present a case of unilateral full-thickness macular hole (MH) successfully repaired with an amniotic membrane (AM) graft in a patient with Alport syndrome. A 58-year-old Asian female with past medical history of Alport syndrome diagnosed at early stage, presented with a 5-week history of vision loss in her right eye. Examination of her eyes showed normal retinal vessels and an MH measuring 1,300 μm in basal diameter, 806 μm in minimum linear diameter, and 490 μm in height in the right eye and macular thinning with laser scars inferiorly in the left eye. The patient underwent 23-g pars plana vitrectomy with intraocular lens explantation. After multiple unsuccessful attempts in inducing a posterior vitreous detachment around the optic nerve and in the posterior pole, a 1 mm AM graft placed on the MH and the edges tucked under the edges of the hole using a bimanual technique. Five months after surgery, the MH remained sealed with improved final vision. MHs are rare manifestations of Alport syndrome, and surgical treatment of Alport syndrome-associated MHs is challenging. However, further studies to explore new techniques using AM are needed

Aerobic and combined exercise sessions reduce glucose variability in type 2 diabetes: crossover randomized trial.

To evaluate the effects of aerobic (AER) or aerobic plus resistance exercise (COMB) sessions on glucose levels and glucose variability in patients with type 2 diabetes. Additionally, we assessed conventional and non-conventional methods to analyze glucose variability derived from multiple measurements performed with continuous glucose monitoring system (CGMS).Fourteen patients with type 2 diabetes (56±2 years) wore a CGMS during 3 days. Participants randomly performed AER and COMB sessions, both in the morning (24 h after CGMS placement), and at least 7 days apart. Glucose variability was evaluated by glucose standard deviation, glucose variance, mean amplitude of glycemic excursions (MAGE), and glucose coefficient of variation (conventional methods) as well as by spectral and symbolic analysis (non-conventional methods).Baseline fasting glycemia was 139±05 mg/dL and HbA1c 7.9±0.7%. Glucose levels decreased immediately after AER and COMB protocols by ∼16%, which was sustained for approximately 3 hours. Comparing the two exercise modalities, responses over a 24-h period after the sessions were similar for glucose levels, glucose variance and glucose coefficient of variation. In the symbolic analysis, increases in 0 V pattern (COMB, 67.0±7.1 vs. 76.0±6.3, P = 0.003) and decreases in 1 V pattern (COMB, 29.1±5.3 vs. 21.5±5.1, P = 0.004) were observed only after the COMB session.Both AER and COMB exercise modalities reduce glucose levels similarly for a short period of time. The use of non-conventional analysis indicates reduction of glucose variability after a single session of combined exercises.Aerobic training, aerobic-resistance training and glucose profile (CGMS) in type 2 diabetes (CGMS exercise). ClinicalTrials.gov ID: NCT00887094

Glucose variability evaluated by conventional analysis before and after aerobic (AER) or aerobic plus resistance exercise (COMB) exercise.

<p>Panel A, glucose variance; Panel B, coefficient of variation and Panel C, standard deviation. Data are reported as mean ± SEM; n = 14. Two-way analysis of variance for repeated measures (ANOVA); Bonferroni correction.</p

Glucose variability evaluated by non-conventional analysis: symbolic analysis and the mathematical analysis to method validation.

<p>Panel A: Comparison between original (black line) and surrogated (gray line) series with respect to Probability density function (PDF), indicating a random result in surrogate series. Panel B: Normalized corrected conditional entropy (NCCE), exhibiting a deep minimum in original series. Panel C: Example of an original and a surrogated series. Panel D: Example of symbolic analysis results. One way repeated measures ANOVA.</p

Baseline characteristics of the patients studied.

<p>HbA1c: glycated hemoglobin; VO₂peak: peak oxygen uptake per kilogram of body weight/fat-free mass; R_peak peak respiratory exchange ratio of peak.</p>**<p>Data are expressed as mean ± SEM, except duration of diabetes, which is expressed as median (95% CI); categorical variables are presented as numbers (%).</p

Cardiovascular and metabolic responses to exercise.

<p>P: Two-way analysis of variance for repeated measures (ANOVA).Data are expressed as mean ± SEM.</p

Example of a glucose curve obtained from CGMS record of 72 hours depicting the time periods used to evaluate the effects of meals, pre (section A) and post prandial (section B), and exercise, pre (section B) and post (section C) sessions, indicated in blocks.

<p>The dark grey line represents the period of exercise session.</p

Results of glucose variability evaluated by symbolic analysis after AER or COMB exercise (n = 14) and comparison between before (open bars) and after (close bars) both exercises.

<p>Occurrence percentage of each pattern: 0 V (no variation), 1 V (one variation), 2 LV (two low variations) and 2 UV (two up variations). Data are reported as mean ± SEM. *P<0.01 <i>vs</i>. pre-exercise values (COMB), Two way repeated measures ANOVA.</p

Glucose variability evaluated by conventional and non-conventional analysis before and after meals, before any exercise session.

<p>Comparisons were performed by Student’s <i>t</i>-test;</p>*<p>P<0.05 <i>vs.</i> pre-prandial. Data are expressed as mean ± SEM. MAGE index could not be evaluated before meal because its value depends on postprandial oscillations.</p

Flow Diagram.

<p>Flow Diagram.</p