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1.
Arq. bras. oftalmol ; 83(1): 55-61, Jan.-Feb. 2020. tab, graf
Article Dans Anglais | LILACS | ID: biblio-1088946

Résumé

ABSTRACT Purpose: To evaluate the rate of cystoid macular edema development among cataract surgery patients on four different therapeutic regimens. Methods: The present study is a retrospective analysis of 5,380 eyes following uncomplicated phacoemulsification at Wake Forest University. The study period went from July 2007 to December 2012. Patients received one of four regimens, as follows: postoperative generic ketorolac 0.4% and prednisolone 1%, postoperative name-brand ketorolac 0.45% and prednisolone 1%, postoperative bromfenac 0.09% and prednisolone 1%, preoperative and postoperative bromfenac 0.09% alone. A statistical analysis was performed to assess the differences in rate of cystoid macular edema development among the four different therapeutic regimens. The diagnosis of cystoid macular edema required worsening of vision and evidence of increased macular thickness on optical coherence tomography. Results: The overall rate of cystoid macular edema was 0.82%. Treatment by postoperative generic ketorolac 0.45% and prednisolone 1% demonstrated the highest rate of cystoid macular edema development (2.20% of the cases). Postoperative name-brand ketorolac 0.45% and prednisolone 1% exhibited intermediate rates of cystoid macular edema development (0.90% of the cases). Postoperative administration of bromfenac 0.09% and prednisolone 1% exhibited intermediate rates of cystoid macular edema development (0.44% of the cases). Preoperative and postoperative bromfenac 0.09% alone resulted in the lowest rate of cystoid macular edema development (0.09% of the cases). The rate of cystoid macular edema was significantly lower when bromfenac was used alone vs. either regimen where ketorolac and prednisolone were used (OR 0.043, 95% CI 0.002 to 0.312; p<0.001). Conclusions: Post-cataract surgery cystoid macular edema developed less frequently following topical non-steroidal anti-inflammatory drugs regimen compared to the other therapies evaluated. Bromfenac, without corticosteroids, achieved lower rates of cystoid macular edema vs. various combinations of non-ste­roidal anti-inflammatory drugs with corticosteroids.


RESUMO Objetivo: Avaliar a taxa de desenvolvimento do edema macular cistóide em pacientes submetidos à cirurgia de catarata em quatro esquemas terapêuticos diferentes. Métodos: O presente estudo é uma análise retrospectiva de 5.380 olhos após facoemulsificação não complicada na Wake Forest University. O período do estudo foi entre julho de 2007 e dezembro de 2012. Os pacientes receberam um dos quatro esquemas: cetorolaco genérico pós-operatório 0,4% e prednisolona 1%, cetorolaco 0,45% pós-operatório e prednisolona 1%, bromfenac 0,09% e a prednisolona 1% pós-operatório, bromfenaco 0,09% no pré-operatório e isoladamente no pós-operatório. Uma análise estatística foi realizada para avaliar as diferenças na taxa de desenvolvimento do edema macular cistóide entre os quatro diferentes regimes terapêuticos. O diagnóstico de edema macular cistóide exigiu uma piora da visão e uma evidência de aumento da espessura macular na tomografia de coerência óptica. Resultados: A taxa global de edema macular cistóide foi de 0,82%. O tratamento com cetorolaco genérico pós-operatório 0,45% e prednisolona 1% demonstrou a maior taxa de desenvolvimento de edema macular cistóide (2,20% dos casos). O cetorolaco 0,45% e a prednisolona 1% no pós-operatório exibiram taxas intermediárias de desenvolvimento de edema macular cistóide (0,90% dos casos). A administração de bromofenac 0,09% e de prednisolona 1% no pós-operatório apresentou taxas interme­diárias de desenvolvimento de edema macular cistóide (0,44% dos casos). O bromfenac 0,09% no pré e pós-operatório isoladamente resultou na menor taxa de desenvolvimento de edema macular cistóide (0,09% dos casos). A taxa de edema macular cistóide foi significativamente menor quando o bromfenac foi utilizado isoladamente em relação ao esquema onde cetorolaco e a prednisolona foram usados (OR 0,043, 95% CI 0,002 a 0,312; p<0,001). Conclusões: O edema macular cistóide pós-cirurgia de catarata desenvolveu-se com menor frequência após o tratamento tópico de medicamentos anti-inflamatórios não esteroidais, comparado às outras terapias avaliadas. Bromfenac, sem corticosteróides, alcançou taxas mais baixas de edema macular cistóide vs. Várias combinações em comparação com as várias combinações de drogas anti-inflamatórias não esteroidais com corticosteróides.


Sujets)
Humains , Mâle , Femelle , Sujet âgé , Sujet âgé de 80 ans ou plus , Benzophénones/usage thérapeutique , Bromobenzènes/usage thérapeutique , Prednisolone/usage thérapeutique , Anti-inflammatoires non stéroïdiens/usage thérapeutique , Oedème maculaire/prévention et contrôle , Phacoémulsification/effets indésirables , Cataracte , Oedème maculaire/étiologie , Études rétrospectives , Association de médicaments
2.
Arq. bras. oftalmol ; 79(4): 243-246, July-Aug. 2016. tab, graf
Article Dans Anglais | LILACS | ID: lil-794576

Résumé

ABSTRACT Purpose: The objective of this study was to evaluate subfoveal choroidal thickness (SFCT) using enhanced depth imaging optical coherence tomography (EDI-OCT) in patients with naïve branch retinal vein occlusion (BRVO) before and after intravitreal dexamethasone implant (Ozurdex®) injection. Methods: Thirty-nine patients with unilateral BRVO and 35 healthy subjects were included in this prospective study. Choroidal thickness was evaluated by EDI-OCT at baseline and 1 month after dexamethasone implant. Results: The mean SFCT measured in 39 patients with BRVO was 299.41 ± 55.86 µm, significantly greater than that in contralateral eyes (283.76 ± 57.44 µm; p=0.009) and control eyes (276.14 ± 39.06 µm; p=0.044). The mean SFCT after the treatment was 279.64 ± 50.96 µm, significantly thinner than that before intravitreal dexamethasone therapy (p=0.004). Conclusions: SFCT in treatment-naive BRVO eyes was significantly greater than that in contralateral eyes and healthy eyes and decreased significantly after intravitreal dexamethasone implantation.


RESUMO Objetivo: O objetivo deste estudo foi avaliar a espessura da coróide (SFCT) usando imagens de tomografia de coerência óptica com profundidade aprimorada (EDI-OCT) no tratamento de pacientes com oclusão primária de ramo da veia central da retina (BRVO) antes e após o implante de dexametasona intravítrea (Ozurdex®). Métodos: Trinta e nove pacientes com BRVO unilateral e 35 indivíduos saudáveis foram incluídos neste estudo prospectivo. Espessura da coróide foi avaliada por EDI-OCT na antes e um mês após o tratamento. Resultados: A média da SFCT medida em 39 pacientes com BRVO foi 299,41 ± 55,86 µm, o que foi significativamente maior do que a dos olhos contralaterias (283,76 ± 57,44 µm) e dos olhos controle (276,14 ± 39,06 µm) (p=0,009 e p=0,044, respectivamente). A média da SFCT após o tratamento foi 279,64 ± 50,96 µm, o que foi significativamente menor do que antes do mesmo (p=0,004). Conclusões: A SFCT do tratamento de olhos com BRVO primária foi significativamente maior do que a dos olhos contralaterais e dos olhos saudáveis, e diminuiu significativamente após o implante intravítreo de dexametasona.


Sujets)
Humains , Mâle , Femelle , Adulte , Adulte d'âge moyen , Sujet âgé , Sujet âgé de 80 ans ou plus , Occlusion veineuse rétinienne/traitement médicamenteux , Dexaméthasone/administration et posologie , Choroïde/effets des médicaments et des substances chimiques , Glucocorticoïdes/administration et posologie , Valeurs de référence , Facteurs temps , Occlusion veineuse rétinienne/imagerie diagnostique , Acuité visuelle , Études cas-témoins , Oedème maculaire/prévention et contrôle , Études prospectives , Choroïde/imagerie diagnostique , Résultat thérapeutique , Statistique non paramétrique , Tomographie par cohérence optique/méthodes , Injections intravitréennes , Pression intraoculaire
3.
Rev. bras. oftalmol ; 74(2): 113-118, Mar-Apr/2015.
Article Dans Portugais | LILACS | ID: lil-744625

Résumé

Macular cystoid edema is one of the major causes of decreased vision after cataract surgery. The inflammatory process appears to be the main causal factor of the edema. The major risk factors are: surgical complications, previous retinal diseases, diabetes, uveitis and use of prostaglandins drops. The diagnosis is clinically, but fluorescein angiography and optical coherence tomography are also important to detect swelling and assist in differential diagnosis. Although pre-operative prophylaxis do not have scientific evidence, it is recommended especially in cases with risk factors. The initial treatment includes a combination of both topic corticosteroid and nonsteroidal anti-inflammatory. Chronic and refractory cases can be managed with alternatives treatment, such as intravitreal triamcinolone and anti-angiogenic. This article aims to discuss various aspects of pseudophakic macular cystoid edema.


O edema macular cistoide é uma das principais causas de baixa de visão após cirurgia de catarata. O processo inflamatório parece ser o principal fator causal do edema. São considerados fatores de risco complicações cirúrgicas, doenças retinianas prévias, diabetes, uveítes e uso de colírios de prostaglandinas. O diagnóstico é feito clinicamente, mas a angiografia fluoresceínica e a tomografia de coerência óptica também são ferramentas importantes para detectar o edema e auxiliar no diagnóstico diferencial. Apesar da profilaxia pré-operatória não ter evidência científica, ela é preconizada especialmente nos casos com fatores de risco. O tratamento inicial é realizado com associação de corticoide e anti-inflamatório não hormonais tópicos. Os casos crônicos e refratários têm diversas alternativas de tratamento, sendo o uso de triancinolona e antiangiogênicos intravítreos as mais utilizadas. Este artigo se propõe a discutir diversos aspectos do edema macular cistoide pseudofácico.


Sujets)
Humains , Anti-inflammatoires non stéroïdiens/usage thérapeutique , Anti-inflammatoires/usage thérapeutique , Hormones corticosurrénaliennes/usage thérapeutique , Oedème maculaire/prévention et contrôle , Oedème maculaire/traitement médicamenteux , Angiographie fluorescéinique , Inhibiteurs de l'angiogenèse/usage thérapeutique , Phacoémulsification , Tomographie par cohérence optique , Triamcinolone/usage thérapeutique , Diagnostic différentiel
4.
Yonsei Medical Journal ; : 1671-1677, 2015.
Article Dans Anglais | WPRIM | ID: wpr-70403

Résumé

PURPOSE: To compare the additive effects of two types of non-steroidal anti-inflammatory drugs (NSAIDs), bromfenac 0.1% or ketorolac 0.45%, relative to topical steroid alone in cataract surgery. MATERIALS AND METHODS: A total 91 subjects scheduled to undergo cataract operation were randomized into three groups: Group 1, pre/postoperative bromfenac 0.1%; Group 2, pre/postoperative preservative-free ketorolac 0.45%; and Group 3, postoperative steroid only, as a control. Outcome measures included intraoperative change in pupil size, postoperative anterior chamber inflammation control, change in macular thickness and volume, and ocular surface status after operation. RESULTS: Both NSAID groups had smaller intraoperative pupil diameter changes compared to the control group (p<0.05). There was significantly less ocular inflammation 1 week and 1 month postoperatively in both NSAID groups than the control group. The changes in central foveal subfield thickness measured before the operation and at postoperative 1 month were 4.30+/-4.25, 4.87+/-6.03, and 12.47+/-12.24 microm in groups 1 to 3, respectively. In the control group, macular thickness and volume increased more in patients with diabetes mellitus (DM), compared to those without DM. In contrast, in both NSAID groups, NSAIDs significantly reduced macular changes in subgroups of patients with or without DM. Although three ocular surface parameters were worse in group 1 than in group 2, these differences were not significant. CONCLUSION: Adding preoperative and postoperative bromfenac 0.1% or ketorolac 0.45% to topical steroid can reduce intraoperative miosis, postoperative inflammation, and macular changes more effectively than postoperative steroid alone.


Sujets)
Sujet âgé , Femelle , Humains , Mâle , Adulte d'âge moyen , Anti-inflammatoires non stéroïdiens/administration et posologie , Benzophénones/administration et posologie , Bromobenzènes/administration et posologie , Cataracte , Extraction de cataracte , Inflammation/prévention et contrôle , Kétorolac/administration et posologie , Pose d'implant intraoculaire , Oedème maculaire/prévention et contrôle , Myosis/prévention et contrôle , Phacoémulsification , Complications postopératoires/traitement médicamenteux , Période postopératoire , Prémédication , Résultat thérapeutique
5.
Bina Journal of Ophthalmology. 2005; 11 (3): 301-306
Dans Persan | IMEMR | ID: emr-70069

Résumé

To determine whether angiotensin II levels in aqueous humor is related to diabetes mellitus and to evaluate the effect of captopril. In a case-control study, aqueous humor samples were obtained during cataract surgery from 58 eyes of 58 patients, of which 37 were diabetic. From these latter subjects, 16 had taken captopril [captopril group] and 21 had not taken nay angiotensin converting enzyme [ACE] inhibitor [non-captopril group]. Angiotensin level was assessed by radimmunoassay. Severity of macular edema was evaluated by clinical examination after surgery. Mann Whitey U test was used to assess the statistical difference of mean angiotensin II and Hb AIIC levels between the groups and Spearman's rank-order correlation coefficient was used to evaluate correlation between aqueous levels of angiotensin II and of macular edema. The aqueous levels of angiotensin II was significantly higher in diabetic patients [31.0 +/- 7.3 pg/ml] compared to non-diabetics [6.28 +/- 2.8 pg/ml]. [P<0.0001] Aqueous concentration of angiotensin II in the captopril group [16.3 +/- 6.5 ug/ml] was significantly lower than in the non-captopril group [75.73 +/- 9.36]. [P<0.0003] Severity of macular edema was significantly lower in the captopril group as compared to the non-captopril group such that 68.75% of the captopril groups vs 33.3% of the non-captopril group had macular edema [P<0.005]. These finding suggest that the aqueous level of angiotensin II is significantly correlated with the severity of macular edema and may have a role in pathogenesis of macular edema in diabetic patients. It seems that modulation of the rennin-angiotensin system may become a very important target for medical treatment in patients with diabetic macular edema


Sujets)
Humains , Angiotensine-II/effets des médicaments et des substances chimiques , Angiotensine-II/ressources et distribution , Diabète/traitement médicamenteux , Humeur aqueuse/analyse , Humeur aqueuse/effets des médicaments et des substances chimiques , Oedème maculaire/prévention et contrôle , Complications du diabète/prévention et contrôle , Inhibiteurs de l'enzyme de conversion de l'angiotensine , Système rénine-angiotensine
6.
Bol. Soc. Peru. Med. Interna ; 12(1): 29-33, 1999. tab, graf
Article Dans Espagnol | LILACS | ID: lil-235956

Résumé

Se evaluaron 849 pacientes del Programa de Diabetes Mellitus del IPSS - Piura estudiándose la presencia de Retinopatía Diabética (RD) y Edema Macular (EM), así como su asociación con otras complicaciones de la enfermedad. La prevalencia de RD fue 30 por ciento, de ellos el 81 por ciento tuvo RD no proliferativa, 19 por ciento RD Proliferativa; y 35 por ciento EM. El tiempo de enfermedad, hipertensión arterial y tipo de tratamiento fueron factores relacionados con su aparición. La realización del fondo de ojo durante las sesiones educativas del Programa de Diabetes Mellitus incrementó marcadamente la precosidad del diagnóstico, participación y cumplimiento del tratamiento.


Sujets)
Diabète/complications , Diabète/prévention et contrôle , Diabète/thérapie , Hypertension artérielle , Oedème maculaire/complications , Oedème maculaire/prévention et contrôle , Oedème maculaire/thérapie , Rétinopathie diabétique/complications , Rétinopathie diabétique/prévention et contrôle , Rétinopathie diabétique/thérapie
7.
Rev. bras. oftalmol ; 50(5): 291-4, out. 1991. ilus, tab
Article Dans Portugais | LILACS | ID: lil-128667

Résumé

Quatorze pacientes pseudofácicos com Edema Macular Cistóide submetidos a tratamento com indometacina e com acompanhamento de 3 anos e 6 meses até 6 anos e 7 meses. A visäo mais baixa durante a vigência do Edema foi 20/80. Os pacientes que tiveram melhora de sua visäo foram aqueles que o edema surgiu antes dos 10 meses de pós-operatório. Assim os pacientes em que o edema surge tardiamente devem ter outra etiopatogenia que a liberaçäo de prostaglandinas e pesquisas nesse sentido devem ser realizadas


Sujets)
Humains , Mâle , Femelle , Adulte , Adulte d'âge moyen , Extraction de cataracte/effets indésirables , Oedème maculaire/traitement médicamenteux , Oedème maculaire/prévention et contrôle
8.
Korean Journal of Ophthalmology ; : 34-39, 1990.
Article Dans Anglais | WPRIM | ID: wpr-22316

Résumé

Eighteen eyes with vitreous strands adherent to the corneoscleral wounds of previous cataract surgery were treated with neodymium: YAG laser to lyse those strands. Twelve eyes were treated for management of cystoid macular edema (CME group); six eyes were treated for prophylaxis of possible CME (prophylactic group). In the CME group, visual acuity improved two or more lines in nine eyes (75.0%), and seven eyes had a post laser visual acuity of 0.5 or better (One eye had a pre-treatment visual acuity of 0.5 or better). In the prophylactic group, visual acuity was either maintained at the pre-treatment visual acuity of 0.5 or better. In the prophylactic group, visual acuity was either maintained at the pre-treatment level or improved in five eyes (83.3%) 18 months later following laser treatment. This procedure was complicated by retinal detachment in one case and the elevation of intraocular pressure over 10 mmHg in another case.


Sujets)
Adulte , Sujet âgé , Sujet âgé de 80 ans ou plus , Femelle , Humains , Mâle , Adulte d'âge moyen , Extraction de cataracte/effets indésirables , Maladies de l'oeil/étiologie , Thérapie laser , Oedème maculaire/prévention et contrôle , Acuité visuelle , Corps vitré/chirurgie
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