Joint effects of meteorological factors and PM2.5 on age-related macular degeneration: a national cross-sectional study in China

BACKGROUND@#Weather conditions are a possible contributing factor to age-related macular degeneration (AMD), a leading cause of irreversible loss of vision. The present study evaluated the joint effects of meteorological factors and fine particulate matter (PM2.5) on AMD.@*METHODS@#Data was extracted from a national cross-sectional survey conducted across 10 provinces in rural China. A total of 36,081 participants aged 40 and older were recruited. AMD was diagnosed clinically by slit-lamp ophthalmoscopy, fundus photography, and spectral domain optical coherence tomography (OCT). Meteorological data were calculated by European Centre for Medium-Range Weather Forecasts (ECMWF) reanalysis and were matched to participants' home addresses by latitude and longitude. Participants' individual PM2.5 exposure concentrations were calculated by a satellite-based model at a 1-km resolution level. Multivariable-adjusted logistic regression models paired with interaction analysis were performed to investigate the joint effects of meteorological factors and PM2.5 on AMD.@*RESULTS@#The prevalence of AMD in the study population was 2.6% (95% CI 2.42-2.76%). The average annual PM2.5 level during the study period was 63.1 ± 15.3 µg/m3. A significant positive association was detected between AMD and PM2.5 level, temperature (T), and relative humidity (RH), in both the independent and the combined effect models. For PM2.5, compared with the lowest quartile, the odds ratios (ORs) with 95% confidence intervals (CIs) across increasing quartiles were 0.828 (0.674,1.018), 1.105 (0.799,1.528), and 2.602 (1.516,4.468). Positive associations were observed between AMD and temperature, with ORs (95% CI) of 1.625 (1.059,2.494), 1.619 (1.026,2.553), and 3.276 (1.841,5.830), across increasing quartiles. In the interaction analysis, the estimated relative excess risk due to interaction (RERI) and the attributable proportion (AP) for combined atmospheric pressure and PM2.5 was 0.864 (0.586,1.141) and 1.180 (0.768,1.592), respectively, indicating a synergistic effect between PM2.5 and atmospheric pressure.@*CONCLUSIONS@#This study is among the first to characterize the coordinated effects of meteorological factors and PM2.5 on AMD. The findings warrant further investigation to elucidate the relationship between ambient environment and AMD.

Calidad de vida según función visual en degeneración macular húmeda asociada a la edad tratada con Bevacizumab / Quality of Life According to Visual Function in Age-related Wet Macular Degeneration Treated with Bevacizumab

Introducción: La degeneración macular asociada a la edad, es causa frecuente de ceguera o baja visión en el adulto mayor. La valoración de la calidad de vida relativa a la función visual, es fundamental en estos pacientes tratados con Bevacizumab. Objetivo: Evaluar la calidad de vida en relación con la función visual en pacientes con degeneración macular tratada con Bevacizumab asociada a la edad. Métodos: Estudio descriptivo longitudinal prospectivo realizado en el ICO "Ramón Pando Ferrer", desde enero de 2019 hasta mayo de 2021. La muestra fue de 52 pacientes. El cuestionario NEI VFQ-25 fue aplicado antes y después de la administración de las tres dosis del medicamento intravítreo. Resultados: Predominó el sexo femenino, el grupo etario de mayor representación fue el de 60 a 79 años, la enfermedad sistémica más frecuente fue la hipertensión y ocular, la catarata. Casi todos los pacientes ganaron más de dos líneas en la cartilla de Snellen, el 42,3 por ciento presentó una ganancia de 3 líneas o más. El resultado de la mayoría de los elementos que explora el test, así como la función visual total es significativo desde el punto de vista estadístico. Conclusiones: Hubo una mejoría en la calidad de vida relativa a la función visual en los pacientes después de ser tratados con Bevacizumab. No existió una relación directamente proporcional entre la mejor agudeza visual post tratamiento y la mejora de la función visual total(AU)

Introduction: Age-related macular degeneration constitutes a frequent cause of blindness or low vision in the older adult. The assessment of quality of life related to visual function is essential in these patients treated with Bevacizumab. Objective: To assess the quality of life in relation to visual function in patients with age-related macular degeneration treated with Bevacizumab, at the ICO "Ramón Pando Ferrer", from January 2019 to May 2021. Methods: Prospective longitudinal descriptive study. The sample was 52 patients and the NEI VFQ-25 questionnaire was applied before and after three doses of the intravitreal drug. Results: Female gender predominated, the most represented age group was 60 to 79 years, the most frequent systemic disease was hypertension and the most frequent ocular disease was cataract. Almost all patients gained more than two lines in the Snellen chart, 42.3 percent presented a gain of 3 lines or more. The result of most of the items explored by the test, as well as the total visual function is statistically significant. Conclusions: There was an improvement in quality of life relative to visual function in patients after being treated with Bevacizumab. There was no directly proportional relationship between improved post-treatment visual acuity and improvement in total visual function(AU)

Influencia del tratamiento intravítreo en la presión intraocular en pacientes con glaucoma y degeneración macular / Influence of Intravitreal Treatment on Intraocular Pressure in Patients with Glaucoma and Macular Degeneration

En los últimos años, la aparición de los fármacos antiangiogénicos ha revolucionado el tratamiento de numerosas enfermedades de la retina, su asociación con la hipertensión ocular tras las inyecciones ha sido objeto de estudio en numerosas ocasiones. Se presenta un caso clínico de una paciente con glaucoma y degeneración macular asociada a la edad con la que se estudió la relación entre la administración de antiangiogénicos intravítreos y la elevación de la presión intraocular, a corto y largo plazo. La administración de fármacos antiangiogénicos es en la actualidad el procedimiento oftalmológico más empleado en las consultas de todo el mundo. La administración de intravítreas se ha asociado a la producción de un pico hipertensivo transitorio en el momento agudo y a la elevación de la presión intraocular a largo plazo. Un estrecho intervalo entre inyecciones ( 7 al año), pacientes con cámara estrecha, fáquicos y con diagnóstico previo de glaucoma son los principales factores de riesgo para el desarrollo de una elevación sostenida de presión intraocular tras el tratamiento intravítreo con antiangiogénicos. Identificar a los pacientes con alto riesgo de desarrollar hipertensión ocular tras el uso de inyecciones intravítreas y adoptar medidas que reduzcan dicho riesgo, como la administración de hipotensores tópicos antes de la inyección, es fundamental para mejorar su salud visual. Se presenta el caso de una paciente de 78 años de edad con diagnóstico de glaucoma primario de ángulo abierto de cinco años de evolución en ambos ojos(AU)

In recent years, the emergence of antiangiogenic drugs has revolutionized the treatment of numerous retinal diseases, their association with ocular hypertension after injections has been the subject of study on numerous occasions. We present a clinical case of a patient with glaucoma and age-related macular degeneration in which the relationship between the administration of intravitreal antiangiogenic drugs and the elevation of intraocular pressure, in the short and long term, was studied. The prescribing of antiangiogenic drugs is currently the most widely used ophthalmologic procedure in practices worldwide. Intravitreal administration has been associated with the production of a transitory hypertensive peak in the acute setting and long-term elevation of intraocular pressure. A narrow interval between injections ( 7 per year), patients with narrow chamber, phakic and with a previous diagnosis of glaucoma are the main risk factors for the development of sustained intraocular pressure elevation after intravitreal treatment with antiangiogenics. Identifying patients at high risk of developing ocular hypertension after intravitreal injections and adopting measures to reduce this risk, such as the administration of topical hypotensives before the injection, is essential to improve their eyesight health. The case of a 78-year-old female patient with a diagnosis of primary open-angle glaucoma of five years of evolution in both eyes is presented(AU)

Pseudodrusen reticulares y degeneración macular asociada a la edad / Pseudodrusen reticularis and age-related macular degeneration

Objetivo: Identificar la relación de los pseudodrusen reticulares con la degeneración macular asociada a la edad mediante imágenes tomográficas. Método: Estudio observacional, descriptivo y transversal en pacientes con pseudodrusen reticulares atendidos en consulta de retina a los que se les realizó tomografía de coherencia óptica espectral desde enero de 2009 hasta diciembre de 2014 en el Instituto Cubano de Oftalmología "Ramón Pando Ferrer". La población estuvo constituida por 69 pacientes de 55 años y más con pseudodrusen reticulares en dichas imágenes. Resultados: Los pseudodrusen predominaron en pacientes con edades comprendidas entre los 70 y 79 años para un 49,3 por ciento. El sexo femenino fue el más numeroso con un 76,8 por ciento. De los 122 ojos con pseudodrusen, 86 presentaron algún signo de degeneración macular asociada a la edad representado por el 70,5 por ciento. El 58,1 por ciento de estos últimos tuvo la forma avanzada. La membrana neovascular tipo II fue la más frecuente con un 58,0 por ciento. El grosor coroideo se estimó disminuido en el 77,9 por ciento de los casos. Conclusiones: Los pseudodrusen reticulares mantienen una relación directa con la degeneración macular asociada a la edad e influyen en la progresión de esta(AU)

Objective: To identify the relationship of reticular pseudodrusen with age-related macular degeneration using tomographic imaging. Methods: An observational, descriptive and cross-sectional study was conducted in patients with reticular pseudodrusen seen in retina consultation who underwent spectral optical coherence tomography from January 2009 to December 2014 at the Cuban Institute of Ophthalmology "Ramón Pando Ferrer". The population consisted of 69 patients aged 55 years and older with reticular pseudodrusen in these images. Results: Pseudodrusen predominated in patients between 70 and 79 years of age (49.3 percent). The female gender was the most numerous with 76.8 percent. Out of the 122 eyes with pseudodrusen, 86 showed some sign of age-related macular degeneration (70.5 percent). Out of the latter, 58.1 percent had the advanced form. Type II neovascular membrane was the most frequent with 58.0 percent. Choroidal thickness was estimated decreased in 77.9 percent of cases. Conclusions: Reticular pseudodrusen maintain a direct relationship with age-related macular degeneration and influence its progression(AU)

The Influence of Diabetes, Hypertension, and Hyperlipidemia on the Onset of Age-Related Macular Degeneration in North China: The Kailuan Eye Study / 生物医学与环境科学（英文）

Objective@#To analyze the prevalence of dry and wet age-related macular degeneration (AMD) in patients with diabetes, hypertension and hyperlipidemia, and to analyze the risk factors for AMD.@*Methods@#A population-based cross-sectional epidemiologic study was conducted involving 14,440 individuals. We assessed the prevalence of dry and wet AMD in diabetic and non-diabetic subjects and analyzed the risk factors for AMD.@*Results@#The prevalence of wet AMD in diabetic and non-diabetic patients was 0.3% and 0.5%, respectively, and the prevalence of dry AMD was 17% and 16.4%, respectively. The prevalence of wet AMD in healthy, hypertensive, hyperlipidemic, and hypertensive/hyperlipidemic populations was 0.5%, 0.3%, 0.2%, and 0.7%, respectively. The prevalence of dry AMD in healthy, hypertensive, hyperlipidemic, and hypertensive/hyperlipidemic populations was 16.6%, 16.2%, 15.2%, and 17.2%, respectively. Age, sex, body mass index, and use of hypoglycemic drugs or lowering blood pressure drugs were corrected in the risk factor analysis of AMD. Diabetes, diabetes/hypertension, diabetes/hyperlipidemia, and diabetes/hypertension/hyperlipidemia were analyzed. None of the factors analyzed in the current study increased the risk for the onset of AMD.@*Conclusion@#There was no significant difference in the prevalence of wet and dry AMD among diabetic and non-diabetic subjects. Similarly, there was no significant difference in the prevalence of wet and dry AMD among subjects with hypertension and hyperlipidemia. Diabetes co-existing with hypertension and hyperlipidemia were not shown to be risk factors for the onset of dry AMD.

Association between the L55M and Q192R polymorphisms of the paraoxonase-1 gene and age-related macular degeneration: a meta-analysis / Associação entre os polimorfismos L55M e Q192R do gene da paraoxonase1 e a degeneração macular relacionada à idade: uma meta-análise

ABSTRACT Purpose: Paraoxonase-1 activity is associated with age-related macular degeneration. Two polymorphisms (L55M and Q192R) were shown to increase paraoxonase-1 activity and have been implicated in the development of age-related macular degeneration. The results of studies that have examined these polymorphisms are conflicting, showing no effect, as well as increased or decreased risk. Therefore, this meta-analysis was conducted to determine the effect of these polymorphisms on age-related macular degeneration. Methods: PubMed, EBSCO, LILACS, and Scopus databases, as well as and the retrieved bibliographies of publications were searched for case-control studies that examined for paraoxonase-1 polymorphisms and age-related macular degeneration. Data were analyzed using the Comprehensive Meta-Analysis Version 2.2 and the NCSS Statistical Version 2020 software. Genotype distributions were extracted and, depending on the level of heterogeneity, fixed effects or random effects models were used to calculate pooled odds ratios (ORs) with 95% confidence intervals (95% CIs) for the heterozygous, homozygous, dominant, recessive, and allelic genetic models. Results: Overall, for the L55M polymorphism, none of the genetic models demonstrated a significant association. However, for non-Asian populations, a significant association was determined for the heterozygous and dominant genetic models (ORrange=1.24-1.27, p<0.05). For the Asian population, the heterozygous, dominant, and allelic genetic models demonstrated a benefit/protective factor (ORrange=0.29-0.35, p<0.05). For the Q192R polymorphism, none of the genetic models demonstrated a significant association. However, when the cohort was grouped by ethnicity, a significant association was determined in the Asian population for the recessive and allelic genetic models (ORrange=1.63-2.08, p<0.05). However, for the non-Asian population, there was no association observed. Also, there was no identifiable risk when the cohort was stratified into exudative and non-exudative cases. Conclusions: The paraoxonase-1L55M polymorphism increases the risk of developing age-related macular degeneration in non-Asian populations, whereas in Asian populations, the polymorphism exerts a protective effect. However, for the paraoxonase-1 Q192R polymorphism, only the Asian population demonstrated a risk of developing age-related macular degeneration.(AU)

RESUMO Objetivo: A atividade da paraoxonase1 está associada à degeneração macular relacionada à idade. Dois polimorfismos (L55M e Q192R) mostraram aumentar a atividade da paraoxonase1 e foram implicados no desenvolvimento da degeneração macular relacionada à idade. Os estudos que examinaram esses polimorfismos apresentaram resultados conflitantes: nenhum efeito, risco aumentado ou diminuído. Assim, esta meta-análise foi realizada para determinar o efeito desses polimorfismos na degeneração macular relacionada à idade. Métodos: Foi feita uma busca nos bancos de dados PubMed, EBSCO, LILACS e SCOPUS, bem como nas bibliografias compiladas das publicações, buscando-se estudos caso-controle que tivessem analisado os polimorfismos da paraoxonase1 e a degeneração macular relacionada à idade. Os dados foram analisados com software Comprehensive Meta-Analysis, versão 2.2, e NCSS Statistical, versão 2020. As distribuições de genótipos foram extraídas e, dependendo do nível de heterogeneidade, modelos de efeitos fixos ou aleatórios foram utilizados para calcular razões de probabilidade (RPs) combinadas, com intervalos de confiança de 95% (IC 95%) para os modelos genéticos heterozigoto, homozigoto, dominante, recessivo e alélico. Resultados: Em geral, nenhum dos modelos genéticos demonstrou associação significativa para o polimorfismo L55M. Entretanto, em populações não asiáticas, foi determinada uma associação significativa para os modelos genéticos heterozigoto e dominante (RPfaixa=1,24-1,27, p<0,05). Para a população asiática, os modelos heterozigoto, dominante e alélico mostraram um fator benéfico ou protetor (RPfaixa=0,29-0,35, p<0,05). Para o polimorfismo Q192R, nenhum dos modelos genéticos demonstrou qualquer associação significativa. Porém, quando a coorte foi agrupada por etnia, determinou-se uma associação significativa na população asiática para os modelos genéticos recessivo e alélico (RPfaixa=1,63-2,08, p<0,05). Contudo, nenhuma associação foi observada para a população não asiática. Não houve risco identificável quando a coorte foi estratificada em exsudativa e não exsudativa. Conclusões: Determinamos que o polimorfismo L55M da paraoxonase1 de fato aumenta o risco de desenvolvimento de degeneração macular relacionada à idade em populações não asiáticas, enquanto que em populações asiáticas, esse polimorfismo tem um efeito protetor. Porém, para o polimorfismo Q192R da paraoxonase1, apenas a população asiática demonstrou risco de desenvolver degeneração macular relacionada à idade.(AU)

Maculopatia solar após o uso de LSD: relato de caso / Solar maculopathy after LSD use: a case report

Introdução: A maculopatia ou retinopatia solar é uma lesão foto-traumática da mácula causada pela observação direta ou indireta de fontes luminosas intensas, que ocorre comumente na presença de distúrbios psíquicos ou após o uso de drogas recreativas. O prognóstico visual varia e a conduta é expectante. Descrição do caso: Paciente V.V.A.M., sexo masculino, 20 anos, estudante, com queixa de escotoma central em ambos os olhos. Nega antecedentes patológicos e oculares. Solicitaram-se tomografia de coerência óptica (OCT) e retinografia, que revelaram uma lesão central, bilateral e simétrica na retina externa. Paciente relatou ter feito uso de Dietilamida de ácido lisérgico (LSD) e, sob influência da droga, ter olhado de forma direta para o sol por aproximadamente 40 minutos. Discussão: O prognóstico da retinopatia solar é variável e relaciona-se com o tempo de exposição e com o comprimento da onda da fonte de luz. A etiopatogênese é explicada pelo dano causado ao epitélio pigmentar da retina (EPR) pela radiação. Conclusões: Deve haver maior orientação ao público sobre os possíveis efeitos danosos de exposição a fontes de luz de origens diversas. Além disso, destaca-se a importância do OCT para a identificação da maculopatia solar. (AU)

Introduction: Solar maculopathy or retinopathy is photo-traumatic damage created on the macula, caused by direct or indirect observation of intense light sources, commonly occurring in the presence of psychic disorders or after the use of recreational drugs. The visual prognosis varies. There is currently no known treatment. Case report: A 20-year-old male with no previous complaints reported central scotoma in both eyes despite 20/20 uncorrected vision. Bilateral, symmetric, central changes could be seen in the macula in fundoscopy. Optical coherence tomography (OCT) confirmed loss of the external retina suggestive of Solar Maculopathy. The patient later claimed to have spent 40 minutes looking directly into the sun after use of Lysergic Acid Diethylamide (LSD). Discussion: The prognosis of solar retinopathy is related to the exposure time and to the wavelength of the light source, with those between 300-350 nm being the most harmful. Its etiopathogenesis is explained by damage caused to the retinal pigment epithelium (EPR) caused by radiation, interrupting the interdigitations between this layer and the external segment of the photoreceptors. Ophthalmoscopically, solar maculopathy is characterized by a small foveolar lesion that might become yellowish in the days following exposure, in the form of exudate or edema, followed by loss of foveal reflex and thinning of the fovea. The initial yellowed lesions are subsequently replaced by a spotted EPR or even by a lamellar orifice. Conclusions: There should be public guidance on the possible harmful effects of exposure to sources of light from diverse origins, as it usually occurs during solar eclipses, after exposure to certain types of lasers or observation of fires since this habit can cause severe and sometimes irreversible visual loss. (AU)

Risk factors of age-related macular degeneration in Argentina / Fatores de risco para degeneração macular relacionada à idade na Argentina

PURPOSES: To assess the risk factors of age-related macular degeneration in Argentina using a case-control study. METHODS: Surveys were used for subjects' antioxidant intake, age/gender, race, body mass index, hypertension, diabetes (and type of treatment), smoking, sunlight exposure, red meat consumption, fish consumption, presence of age-related macular degeneration and family history of age-related macular degeneration. Main effects models for logistic regression and ordinal logistic regression were used to analyze the results. RESULTS: There were 175 cases and 175 controls with a mean age of 75.4 years and 75.5 years, respectively, of whom 236 (67.4%) were female. Of the cases with age-related macular degeneration, 159 (45.4%) had age-related macular degeneration in their left eyes, 154 (44.0%) in their right eyes, and 138 (39.4%) in both eyes. Of the cases with age-related macular degeneration in their left eyes, 47.8% had the dry type, 40.3% had the wet type, and the type was unknown for 11.9%. The comparable figures for right eyes were: 51.9%, 34.4%, and 13.7%, respectively. The main effects model was dominated by higher sunlight exposure (OR [odds ratio]: 3.3) and a family history of age-related macular degeneration (OR: 4.3). Other factors included hypertension (OR: 2.1), smoking (OR: 2.2), and being of the Mestizo race, which lowered the risk of age-related macular degeneration (OR: 0.40). Red meat/fish consumption, body mass index, and iris color did not have an effect. Higher age was associated with progression to more severe age-related macular degeneration. CONCLUSION: Sunlight exposure, family history of age-related macular degeneration, and an older age were the significant risk factors. There may be other variables, as the risk was not explained very well by the existing factors. A larger sample may produce different and better results.

OBJETIVO: Determinar os fatores de risco para degeneração macular relacionada à idade na Argentina utilizando um estudo caso-controle. MÉTODOS: Questionários foram usados para a obtenção de informações dos participantes em relação à ingesta de antioxidantes, idade/sexo, raça, índice de massa corporal, hipertensão, diabetes (e tipo de tratamento), tabagismo, exposição à luz solar, consumo de carne vermelha/peixe, presença de degeneração macular relacionada à idade e história familiar de degeneração macular relacionada à idade. Modelos de efeito principal para regressão logística e regressão logística ordinal foram usados para analisar os resultados. RESULTADOS: Foram recrutados 175 casos e 175 controles com uma média de idade de 75,4 anos e 75,5, respectivamente, dos quais 236 (67,4%) eram mulheres. Cento e cinquenta e nove (45,4%) tinham degeneração macular relacionada à idade em seus olhos esquerdos, 154 (44,0%) em seus olhos direitos, e 138 (39,4%) em ambos os olhos. Entre os casos de degeneração macular relacionada à idade no olho esquerdo, 47,8% apresentavam o tipo seca, 40,3% o tipo úmida, e o tipo era desconhecido em 11,9%. Os achados para os olhos direitos foram: 51,9%, 34,4% e 13,7%, respectivamente. O modelo de efeito principal foi dominado por maior exposição à luz solar (OR [odds ratio]: 3,3) e história familiar de degeneração macular relacionada à idade (OR: 4,3). Outros fatores incluindo hipertensão (OR: 2,1), tabagismo (OR: 2,2), e pertencente à raça mestiça, que diminuiram o risco de degeneração macular relacionada à idade (OR: 0,40). Consumo de carne vermelha e de peixe, índice de massa corporal e coloração da íris não foram fatores de risco. Idade avançada foi associada com progressão para degeneração macular relacionada à idade mais grave. CONCLUSÃO: Exposição à luz solar, história familiar de degeneração macular relacionada à idade, e idade avançada foram os fatores de risco significativos. Podem existir outras variáveis, já que os riscos não foram bem explicados pelos fatores existentes. Um maior tamanho amostral poderia produzir resultados diferentes e melhores.

Síndrome Sjögren - Larsson / Sjögren - Larsson syndrome

Relatam-se os casos de dois irmãos consanguíneos com síndrome de Sjögren- Larsson, enfatizando a importância clínica do exame oftalmológico. BPLS, masculino, 11 anos e MBLS, feminino, 10 anos, irmãos de pais não-consanguíneos, apresentando ictiose congênita, diplegia espástica e retardo mental. Ao exame oftalmológico, apresentavam miopia, fotofobia, baixa acuidade visual. A fundoscopia, presença de cristais branco-amarelados em área foveal e parafoveal em ambos os olhos. Aconselhamento genético foi realizado. O manejo foi de suporte. A Síndrome de Sjögren-Larsson é uma rara doença autossômica recessiva em que há 100 por cento de penetrância. Síndrome de Sjögren-Larsson é classicamente caracterizada por ictiose, espasticidade e deficiência mental. A doença é causada por mutações no gene aldeído desidrogenase. As alterações oculares observadas são geralmente bilaterais, cristais branco-amarelados em área retiniana, que aparecem nos dois primeiros anos de vida e que vão aumentando em número com a idade. As anormalidades oculares não têm relação com a severidade da ictiose ou com as anormalidades neurológicas. Acredita-se que as lesões oftalmológicas sejam um sinal patognomônico da síndrome. É necessário enfatizar a importância do diagnóstico precoce e possibilidades de tratamento dietético.

Sjogren - Larsson syndrome is a rare autosomal recessively inherited neurocutaneous disorder which occurs with 100 percent penetrance and is classically characterized by ichthyosis, spasticity and mental handicap. The disease is caused by mutations in the aldehyde dehydrogenase gene. The ocular manifestations are highly characteristic bilateral, glistening yellow-white retinal dots from the age of 1 to 2 years onward. The number of dots increases whit age. The extent of the macular abnormality does not correlate with the severity of the ichthyosis or with the severity of the neurological abnormalities. We report the clinical characteristics and ocular manifestations associated with the Sjögren-Larsson syndrome in two siblings, emphasizing the clinical importance of the ophthalmological examination of the Sjögren-Larsson syndrome. BPLS, a eleven year old boy and MPLS, a ten year old girl from non-consanguinous parents, presenting congenital ichthyosis, spastic diplegia and mental retardation. Miopia, fotofobia, subnormal visual acuity and glistening yellow-white crystalline deposits that were located in the foveal and parafoveal area were found in the ophthalmologic examination.

The role of oxidative stress and antioxidants in the pathogenesis of age-related macular degeneration

OBJECTIVE: To investigate the role of oxidant/antioxidant status and protein oxidation in the development of age-related macular degeneration. METHOD: The activities of serum superoxide dismutase and glutathione peroxidase and the levels of serum malondialdehyde, advanced oxidation protein products, glutathione and vitamin C were measured in 25 patients with age-related macular degeneration and 25 control subjects without age-related macular degeneration. RESULT: The malondialdehyde and advanced oxidation protein product levels in the serum were significantly higher in the age-related macular degeneration patient group than in the control group (p<0.05). The superoxide dismutase activity in the serum was significantly lower in the age-related macular degeneration patient group than in the control group (p<0.05). The levels of vitamin C and glutathione and the activity of glutathione peroxidase in the serum were unchanged between groups (p>0.05). CONCLUSION: The results of the present study suggest that decreased effectiveness of the antioxidant defense system and increased oxidative stress may play a role in the pathogenesis of age-related macular degeneration.

Evaluation of Changes of Macular Thickness in Diabetic Retinopathy after Cataract Surgery

PURPOSE: To assess the macular thickness changes after cataract surgery in diabetic patients using optical coherence tomography (OCT). METHODS: We retrospectively reviewed the records of 104 diabetic patients who underwent cataract surgery. We examined the changes of macular thickness using OCT before cataract surgery and 1 week, 1-, 2- and 6-months after surgery. The central subfield mean thickness (CSMT) was used to evaluate macular edema which was defined as an increase of CSMT (DeltaCSMT) > 30% from the baseline. The association between prior laser treatment or severity of diabetic retinopathy and macular thickness were also analyzed. RESULTS: Macular edema occurred in 19 eyes (18%) from the diabetic group and 63% of macular edema developed at 1 month after surgery. Thirteen (68%) out of 19 eyes with macular edema showed the resolution of macular edema by 6 months after surgery without treatment. DeltaCSMT of eyes without a history of laser treatment was statistically greater compared to eyes with a history of laser treatment in at 1- and 2-months after surgery, but was not different than eyes who had laser treatment at 6-months after surgery. The severity of diabetic retinopathy was not significantly correlated to macular edema, but there was statistical difference when patients who had a history of prior laser treatment were excluded. CONCLUSIONS: The incidence of macular edema after cataract surgery in diabetic patients was 18%. Its peak incidence was at 1 month post surgery and it resolved spontaneously in 68% of patients by 6 months post surgery. Prior laser treatment might prevent postoperative macular edema until 2 months after cataract surgery in diabetic patients. However, macular edema did not affect the severity of diabetic retinopathy.

Degeneración macular relacionada a la edad / Age-related macular degeneration

La degeneración macular relacionada a la edad es la causa más frecuente de pérdida de visión irreversible en personas mayores de 60 años. Son factores de riesgo la edad, la genética, el tabaquismo y la obesidad abdominal. Su primera manifestación visible son las drusas, acumulación de productos provenientes de la degradación incompleta de la digestión de segmentos de fotoreceptores por el epitelio pigmentario. La administración de antioxidantes y zinc disminuye el riesgo de pérdida severa de visión en un 25 por ciento en pacientes con drusas. El proceso puede evolucionar a la atrofia de fotoreceptores y epitelio pigmentario (forma seca) o a la aparición de vasos de neoformación que invaden el espacio subretinal, son sangre y líquido subretinal (forma húmeda). La primera es de comienzo insidioso y lentamente progresiva. La segunda produce pérdida brusca de visión central. No existe hoy día un tratamiento eficaz para la forma seca. La forma neovascular no tratada tiene un pobre pronóstico conduciendo a ceguera legal. Sin embargo, la terapia antiangiogénica con inyecciones intravitreas repetidas de bloqueadores del factor de crecimiento endotelial (VEGF) permite la estabilización o mejoría de visión en la mayoría de los pacientes

Age-related macular degeneration (AMD) is the leading cause of irreversible blindness in persons over 60 years of age. Risk factors are age, genetics, smoking and abdominal obesity. Drusen are the first visible sign of the disease, as yellow deposits lying deep in the retina. Drusen are accumulation of residual bodies due to incomplete digestion of the outer segments of the photoreceptors by the retinal pigment epithelium. In patients with drusen, the administration of antioxidants and zinc, reduces the risk of severe loss of vision by 25 percent. The disease may progress to atrophy of the retinal pigment epithelium ("dry AMD") or to a neovascular form, with invasion of the subretinal space by sprouts of coroidal neovascularization, with blood and subretinal fluid ("wet AMD"). The dry form is a slowly progressive disease, with patches of retinal pigment epithelium and photoreceptor atrophy. Patients with the wet form experience sudden loss of vision. There is no proven effective treatment for the dry form today. Neovascular AMD has a poor prognosis if left untreated, resulting in legal blindness. However, antiangiogenic therapy with anti-vascular endotelial growth factor modalities, administered in repeated intravitreal injections, allows stabilization or improvement of visual acuity in most cases.

Complicações oculares da terapêutica com a cloroquina e derivados / Ocular complications of chloroquine and derivatives therapy

INTRODUÇÃO: Os derivados das 4-aminoquinolonas vêm sendo utilizados desde sua industrialização na terapêutica da malária, das doenças reumatológicas e dermatológicas. Essas drogas apresentam reações adversas sistêmicas e oculares. As reações adversas sistêmicas afetam o sistema gastrointestinal, sistema nervoso, sistema muscular esquelético e a pele, e as oculares são: fotofobia, córnea verticilata, poliose, catarata, paralisia dos músculos extraoculares, uveíte anterior, maculopatia tóxica, neurite óptica. OBJETIVO: Revisão bibliográfica das complicações do uso de cloroquina e derivados. Analisar evolução e estágio atual da propedêutica. Sugerir conduta prática no mapeamento precoce dos sinais de toxicidade. MÉTODOS: Revisão bibliográfica através da pesquisa no banco de dados MEDLINE, PUBMED, LILACS e SciELO. DISCUSSÃO: São descritos todos os exames que podem ser utilizados para mapeamento das reações adversas oculares, tais quais: exame oftalmológico completo, com ênfase na biomicroscopia e oftalmoscopia binocular indireta, campo visual computadorizado, tela de Amsler, visão de cores, exames eletrofisiológicos, polarimetria e tomografia de coerência óptica. É feita a descrição do quadro de maculopatia enfocando epidemiologia, fatores de risco, histopatologia e propedêutica. É descrita a estrutura química e as diferenças entre os derivados das 4-aminoquinolonas. CONCLUSÃO: Todo paciente em uso de cloroquina e seus derivados devem ser acompanhados e documentados desde seu início e até atingir a dose cumulativa acima de 100 gramas. Quanto maior a dose cumulativa, maior deve ser a nossa preocupação com o seguimento desse paciente.

INTRODUCTION: Byproducts of 4-aminoquinolones are being used since its industrialization in the treatment of malaria, rheumatic and dermatologic diseases. These drugs present systemic and ocular adverse events. Systemic adverse reactions affect the gastrointestinal, nervous and skeletal muscular systems and the skin. Ocular adverse reactions are: photophobia, cornea verticillata, poliosis, cataract, extraocular muscle palsy, anterior uveitis, toxic maculopathy and optical neuritis. PURPOSE: Bibliography review of complications due to the use of chloroquine and its derivatives. To analyze the current practice and propedeutics' evolution. To suggest practical managements for early toxicity signs. METHODS: Bibliographic review through research on MEDLINE, PUBMED, LILACS and SciELO database. DISCUSSION: All exams that can be used to screen ocular adverse reactions are described, such as: complete ophthalmologic exam, with emphasis on biomicroscopy and indirect binocular ophthalmoscopy, computerized visual field, Amsler grid testing and color vision testing, electrophysiological exams, polarimetry and optical coherence tomography. A description of maculopathy is presented, focusing on epidemiology, risk factors, histopathology and propedeutics. Chemical structure and the differences between 4-aminoquinolone derivatives are described. CONCLUSION: All patients using chloroquine and its derivatives must be followed-up and documented since the beginning of the therapy until they reach a cumulative dose above 100 grams. The higher the cumulative dose, the more we must be concerned with patient follow-up.

Fatores modificáveis da degeneração macular relacionada à idade / Modifiable risk factors for age-related macular degeneration

Os autores apresentam os principais fatores modificáveis considerados de risco para o desencadeamento e/ou agravamento da degeneração macular relacionada com a idade. São abordados os mecanismos de ação destes fatores, assim como medidas preventivas e eficácia de eventuais intervenções.

The authors present the main modifiable risk factors that may trigger and/or worsen age-related macular degeneration. Mechanisms of action related to these factors as well as preventive measures and intervention effectiveness are discussed.

Distrofia macular cristalina em paciente com síndrome de Sjögren-Larsson: relato de caso / Macular crystalline dystrophy in Sjögren-Larsson syndrome: case report

Apresentação de um caso de distrofia macular cristalina em paciente do sexo feminino com síndrome de Sjögren-Larsson. A doença caracteriza-se pela tríade: ictiose congênita, diplegia ou tetraplegia espástica e retardo mental. Os olhos são acometidos em até 100% dos casos sendo característica a presença de maculopatia cristalina como observado na paciente relatada. À fundoscopia observou-se a presença de depósitos esbranquiçados perifoveais. A tomografia de coerência óptica evidenciou pontos hiper-reflexivos correspondentes aos depósitos intrarretinianos, atrofia macular com redução na espessura macular em ambos os olhos. Os achados relacionados à síndrome, à tomografia de coerência óptica foram apresentados de maneira inédita em nosso meio.

Presentation of a case of crystalline macular distrophy diagnosed in a female patient with Sjögren-Larsson syndrome. The disease consists of clinical findings of spastic diplegia or tetraplegia, mental retardation, and congential ichthyosis. The eyes are affected in up to 100% of cases, and crystalline maculopathy is the main finding as described in this case report. On fundus examination multiple white dots were observed at ophthalmoscopy. The optical coherence tomography has shown not only the hipereflexive intraretinal spots but also macular atrophy with macular thickness reduction. The tomographic findings were first described in our country.

Prevalence of age-related macular degeneration in Japanese immigrants and their descendants living in Londrina (PR) - Brazil / Prevalência da degeneração macular relacionada à idade em japoneses e descendentes em Londrina (PR) - Brasil

PURPOSE: To determine the prevalence of early and late-stage age-related macular degeneration (ARMD) and its association with risk factors such as age, gender, smoking, body mass index, hypertension and diabetes history, cataracts and pseudophakia. Design: Population-based cross-sectional study in an elderly Japanese-Brazilian population from Londrina (Paraná, Brazil). METHODS: The study included 483 (80.5 percent) of the 600 registered members of a local association for Japanese immigrants and their descendants, aged 60 years and up. The presence of early and late-stage age-related macular degeneration was determined using the standard protocol and the international classification system. RESULTS: The mean age of the study subjects was 71 years. The overall prevalence of age-related macular degeneration was 15.1 percent (CI 95 percent; 12-18.7). The prevalence of early-stage age-related macular degeneration was 13.8 percent (CI 95 percent; 10.9-17.3), geographic atrophy was present in 0.4 percent and neovascular age-related macular degeneration in 0.8 percent. Age-related macular degeneration was significantly (p=0.004) and linearly (p=0.001) associated with age. CONCLUSION: Our study population displays a prevalence of early and late-stage age-related macular degeneration and component lesions similar to those of other Western countries, and data suggest a higher prevalence than that reported for populations in Japan. Since the age-related macular degeneration prevalence tends to rise as the population ages, studies identifying risk factors and exploring prevention methods are becoming increasingly important.

OBJETIVO: Identificar a prevalência da degeneração macular relacionada à idade (DMRI) inicial e tardia na população de japoneses e descendentes e verificar a associação com os fatores de risco: idade, sexo, hábito de fumar, índice de massa corpórea, história de hipertensão e diabetes, catarata e pseudofacia. MÉTODOS: Realizado um estudo transversal na população de japoneses e descendentes, acima de 60 anos, residentes na cidade de Londrina (PR) - Brasil. Quatrocentos e oitenta e três (80,5 por cento) das 600 pessoas registradas foram submetidas ao exame oftalmológico completo. A presença de degeneração macular relacionada à idade foi determinada seguindo um protocolo padrão e classificação internacional, no período de setembro de 2002 a julho de 2003. RESULTADOS: A média de idade foi de 71 anos (60-92 anos). A prevalência da degeneração macular relacionada à idade foi de 15,1 por cento (intervalo de confiança (I.C. 95 por cento: 12-18,7), sendo na fase inicial em 13,8 por cento (I.C. 95 por cento: 10,9-17,3) e na fase tardia (atrofia geográfica 0,4 por cento e membrana neovascular sub-retiniana 0,8 por cento) em 1,3 por cento. A degeneração macular relacionada à idade foi associada à idade (p=0,004) e apresentou tendência linear (p=0,001). Não foi observada associação entre a DMRI e os outros fatores de risco analisados. CONCLUSÃO: A prevalência da degeneração macular relacionada à idade neste estudo foi semelhante aos dos países do Ocidente, e é possível que ela seja maior do que a da população do Japão. Os dados comprovam a importância da degeneração macular relacionada à idade nessa população de japoneses e descendentes, e mais estudos são necessários para identificar os fatores de riscos e os métodos de prevenção.

Exudative diabetic maculopathy treated by frequency doubled Nd: Yag laser [532nm]

Diabetic maculopathy means involvement of the macula by edema and exudates or ischemia which is the most common cause of visual impairment in diabetic patients, particularly those with type 2 diabetes. The literatures are rich in publications in these regards, nevertheless the works in general were not systematic, not enough details regarding procedures and dose parameters in using laser for treatment are mentioned. [In the present work, there is an attempt to build a systematic procedure regarding dose parameters, application parameters and laser safety]. A frequency doubled Nd: YAG laser was used to treat all eyes included in this study with diabetic maculopathy. Forty eyes of twenty five non insulin dependent diabetic Iraqi patients were evaluated, sixteen males and nine females. Their ages were 42- 76 years, all of them from patients attending ophthalmic out-patient department in the medical city. Maculopathy regressed in 38/40 of the treated eyes, unchanged in 2/40 eyes and no one deteriorated. Visual acuity improved in 6/40 of the treated eyes by at least two lines of Snellen's chart while it stabilized in other 34/40. Exudative diabetic maculopathy is responsible for reduction in vision and even legal blindness in many patients. Close regular follow up and early laser treatment of eyes with maculopathy is significant in stabilization of vision and reducing the rate of visual loss

Serum Lp [a] and Hey concentrations on dry type age related macular degeneration

Age-related macular degeneration usually affects people 50 years of age or older and is a most common cause of central visual loss. In this study the alterations in the levels of plasma lipoprotein [a] [Lp [a]] a Homocysteine [Hcy] and malondialdehyde [MDA] were investigated, and their serum Levels qua age related macular degeneration risk factors compared between patient and control groups. In a case-control study, 44 dry type AMD patients from Nikookari eye hospital of Tabriz and 54 normal subjects, were studied. The serum levels of Lp [a] were assayed by immunoturbidimetric method, serum Hcy was analyzed by ELISA method. MDA and lipid profile concentrations were determined by tiobarbituric acid and spectrophotometric methods respectively. Levels of Cho, TG, LDL-C, Lp [a] and Hcy were significant and higher in patients than in control group [p<0.05 in all cases]. Level of TG, HDL-C and MDA were not significant and similar in the two groups [p>0.05 in both cases]. Increased Lp [a], Hcy, MDA and lipid profiles seems to be associated with AMD and may be involved in the pathogenesis of this disease. Therefore, alterations af serum level of these factors may effectual way for prevention and progression of AMD

Tratamento da forma neovascular de degeneração macular relacionada à idade com drogas antiangiogênicas / Treatment of neovascular age-related macular degeneration with antiangiogenic drugs

Degeneração macular relacionada à idade (DRMI) é a principal causa de cegueira no mundo ocidental. Várias formas clínicas foram reconhecidas, e membrana neovascular coroideana (MNSR) representa manifestação importante passível de tratamento. O tratamento de MNSR tem sido um foco importante de pesquisa nas últimas décadas e a primeira terapia estabelecida baseada em evidência foi a fotocoagulação a laser, que reduziu o risco de perda visual em lesões extrafoveais. No fim da década de 90 a terapia fotodinâmica foi estabelecida como método eficiente de tratamento de MNSR predominantemente clássicas e ocultas. Terapias adicionais como a translocação macular, cirurgia submacular, e protrombose mediada por indocianina verde estão atualmente em investigação em ensaios clínicos em larga escala. A biologia molecular permitiu recentemente uma melhor compreensão da patogênese da DMRI e o fator de crescimento vascular endotelial foi reconhecido como um mediador-chave na angiogênese da formação de MNSR. Portanto, a abordagem farmacológica surge como opção terapêutica no tratamento da MNSR. O primeiro agente terapêutico aprovado pelo FDA é o aptâmero pegaptanib sódio (Macugen®), que inativa a isoforma fundamental para a angiogênese intra-ocular: VEGF165. Outros inativadores de VEGF como ranibizumab RhuFab V2 (Lucentis®) e bevacizumab (Avastin®) estão em avaliação em estudos clínicos. Resultados impressionantes de bevacizumab intravítreo foram liberados recentemente. Adicionalmente, o derivado de esteróides acetato de anecortave, assim como o corticosteróide acetato de triancinolona têm sido propostos como métodos no tratamento de DMRI-neovascular. Este artigo apresenta os princípios e resultados iniciais na terapia antiangiogênica farmacológica da MNSR na DMRI.

Age-related macular degeneration (ARMD) remains a leading cause of blindness in the western world. Several clinical forms of the disease are recognized, whereas choroidal neovascularization (CNV) represents an important manifestation suitable for treatment. The treatment of CNV has been a major focus of research in the past decades, and the first evidence-based established therapy was laser photocoagulation, which reduces the risk of visual loss in extrafoveal lesions. In the late 90's photodynamic therapy has been established as an efficient method for the treatment of predominantly classic and occult CNV. Additional therapies such as macular translocation, submacular surgery, and indocyanine-mediated prothrombosis are currently under investigation in large-scale clinical trials. Molecular biology has recently provided a better comprehension of the pathogenesis of ARMD, and vascular endothelial growth factor (VEGF) was recognized as key mediator in the angiogenesis of CNV-formation. Therefore, the pharmacological approach rose as a key research area to treat CNV. The first FDA-approved agent for CNV-therapy is aptamer pegaptanib sodium (Macugen®), which inactivates the key angiogenic isoform VEGF165. Additional VEGF-blockers such as ranibizumab RhuFab V2 (Lucentis®) and bevacizumab (Avastin®) are under evaluation in major clinical studies. Impressive results of intravitreal bevacizumab were released recently. Moreover, the steroid-derived anecortave acetate as well as the corticosteroid triamcinolone acetate have been proposed as methods for treatment of wet-ARMD. This paper presents the rationale and principles of the pharmacologic antiangiogenic therapy for CNV in ARMD.

Degeneração macular relacionada à idade: prevalência e fatores de risco em dois centros oftalmológicos de referência em Pernambuco / Age-related macular degeneration: analysis in two ophthalmological centers in Pernambuco - Brazil

OBJETIVOS: Avaliar a prevalência de degeneração macular relacionada à idade (DMRI) e os fatores de risco associados em duas populações socioeconômicas distintas, atendidas em dois centros oftalmológicos de referência em Pernambuco. MÉTODOS: Foi realizado estudo de corte transversal em 200 voluntários acima de 55 anos, sendo 100 atendidos na Fundação Altino Ventura (FAV-rede pública) e 100 atendidos no Hospital de Olhos de Pernambuco (HOPE-rede privada), num total de 400 olhos. A classificação da degeneração macular relacionada à idade foi feita pelo exame de fundo de olho segundo AREDS (Age-Related Eye Disease Study). RESULTADOS: Foi observada presença de degeneração macular relacionada à idade em 61 olhos examinados da Fundação Altino Ventura (30 por cento) e em 46 olhos do Hospital de Olhos de Pernambuco (23 por cento), sendo a diferença da freqüência de degeneração macular relacionada à idade nessas duas populações socioeconômicas distintas não significante para a amostra estudada (p=0,113). Foi observado maior freqüência de degeneração macular relacionada à idade e estágio mais avançado da doença em faixas etárias mais idosas, sendo a associação entre degeneração macular relacionada à idade e o aumento da idade fortemente positiva (p<0,0001). Esta associação também esteve presente com o gênero feminino (p=0,0451), presença de catarata (p=0,0447), passado de cirurgia da catarata (p=0,0432) e obesidade (p<0,0001). Outrossim, não foi observada associação estatística entre degeneração macular relacionada à idade e raça (p=0,1367), hipertensão arterial sistêmica (p=0,1985), diabetes (p=0,6712), tabagismo (p=0,6374), alcoolismo (p=0,7359), exposição solar (p=0.9399), íris clara (p=0,1691), hipermetropia (p=0,5098) e uso de vitaminas (p=0,8251). CONCLUSÕES: A freqüência de degeneração macular relacionada à idade nos dois centros oftalmológicos estudados variou de 23 a 30 por cento, observando-se associação desta doença com a idade, gênero feminino, catarata, cirurgia de catarata e obesidade, não sendo encontrado associação com a condição socioeconômica dos indivíduos.