ABSTRACT
AIM: Evidence of the relationship between the polymorphism of the complement factor H (CFH) gene at position 402 (Y402H) and the response to the treatment of wet AMD is controversial. The aim of this study was to compare the functional and morphological 1-year evolution of patients with exudative AMD treated with antivascular endothelial growth factor (VEGF) drugs with the CFH Y402H polymorphism in the Brazilian population. METHODS: Forty-six patients treated for wet AMD with bevacizumab or ranibizumab in a pro re nata regimen were included. The evolution of best-corrected visual acuity (BCVA) and central retinal thickness (CRT), and the number of injections over 1 year of follow-up were correlated with CFH genotypes. RESULTS: The analysis of variance for the difference between the BCVA denoted as logMAR (logarithm of the minimum angle of resolution) values showed an improvement at 1 year when compared to baseline (p = 0.039). Profile contrast analysis showed that this difference was significant only in the group without the C allele (p = 0.049), without significance in patients presenting with the risk allele (p = 0.241). CRT showed a mean reduction at 1 year compared to baseline (p < 0.001). Significant differences in the profile contrast test were found in the group without the C allele (p < 0.001) and in patients with the risk allele (p = 0.002). No difference was found in the number of injections among the different groups (p = 0.787). CONCLUSIONS: The presence of the risk allele of the Y402H polymorphism in the CFH gene was related to a less favorable evolution over 1 year in this sample of the Brazilian population with exudative AMD who were being treated with anti-VEGF drugs. In agreement with similar previous studies, this study concludes that the CFH risk genotypes may affect the disease response to treatment.
Subject(s)
Angiogenesis Inhibitors/therapeutic use , Polymorphism, Single Nucleotide , Wet Macular Degeneration/drug therapy , Wet Macular Degeneration/genetics , Aged , Alleles , Bevacizumab/therapeutic use , Brazil , Complement Factor H/genetics , Female , Genotyping Techniques , Humans , Intravitreal Injections , Male , Pharmacogenetics , Ranibizumab/therapeutic use , Retrospective Studies , Tomography, Optical Coherence , Vascular Endothelial Growth Factor A/antagonists & inhibitors , Visual Acuity/physiology , Wet Macular Degeneration/diagnosis , Wet Macular Degeneration/physiopathologyABSTRACT
PURPOSE: To evaluate the effect of a single intravitreal bevacizumab injection on visual acuity, contrast sensitivity and optical coherence tomography-measured central macular thickness in eyes with macular edema from branch retinal vein occlusion. METHODS: Seventeen eyes of 17 patients with macular edema from unilateral branch retinal vein occlusion were treated with a single bevacizumab injection. Patients were submitted to a complete evaluation including best corrected visual acuity, contrast sensitivity and optical coherence tomography measurements before treatment and one and three months after injection. Visual acuity, contrast sensitivity and optical coherence tomography measurements were compared to baseline values. RESULTS: Mean visual acuity measurement improved from 0.77 logMAR at baseline to 0.613 logMAR one month after injection (P=0.0001) but worsened to 0.75 logMAR after three months. Contrast sensitivity test demonstrated significant improvement at spatial frequencies of 3, 6, 12 and 18 cycles/degree one month after injection and at the spatial frequency of 12 cycles/degree three months after treatment. Mean ± standard deviation baseline central macular thickness (552 ± 150 µm) reduced significantly one month (322 ± 127 µm, P=0.0001) and three months (439 ± 179 µm, P=0.01) after treatment. CONCLUSIONS: Bevacizumab injection improves visual acuity and contrast sensitivity and reduces central macular thickness one month after treatment. Visual acuity returns to baseline levels at the 3-month follow-up, but some beneficial effect of the treatment is still present at that time, as evidenced by optical coherence tomography-measured central macular thickness and contrast sensitivity measurements.
Subject(s)
Angiogenesis Inhibitors/therapeutic use , Antibodies, Monoclonal, Humanized/therapeutic use , Macular Edema/drug therapy , Retinal Vein Occlusion/complications , Visual Acuity/drug effects , Aged , Bevacizumab , Contrast Sensitivity/drug effects , Female , Humans , Injections, Intraocular , Macular Edema/etiology , Male , Retinal Vein Occlusion/diagnosis , Retrospective Studies , Tomography, Optical Coherence , Treatment OutcomeABSTRACT
PURPOSE: To evaluate the effect of a single intravitreal bevacizumab injection on visual acuity, contrast sensitivity and optical coherence tomography-measured central macular thickness in eyes with macular edema from branch retinal vein occlusion. METHODS: Seventeen eyes of 17 patients with macular edema from unilateral branch retinal vein occlusion were treated with a single bevacizumab injection. Patients were submitted to a complete evaluation including best corrected visual acuity, contrast sensitivity and optical coherence tomography measurements before treatment and one and three months after injection. Visual acuity, contrast sensitivity and optical coherence tomography measurements were compared to baseline values. RESULTS: Mean visual acuity measurement improved from 0.77 logMAR at baseline to 0.613 logMAR one month after injection (P=0.0001) but worsened to 0.75 logMAR after three months. Contrast sensitivity test demonstrated significant improvement at spatial frequencies of 3, 6, 12 and 18 cycles/degree one month after injection and at the spatial frequency of 12 cycles/degree three months after treatment. Mean ± standard deviation baseline central macular thickness (552 ± 150 µm) reduced significantly one month (322 ± 127 µm, P=0.0001) and three months (439 ± 179 µm, P=0.01) after treatment. CONCLUSIONS: Bevacizumab injection improves visual acuity and contrast sensitivity and reduces central macular thickness one month after treatment. Visual acuity returns to baseline levels at the 3-month follow-up, but some beneficial effect of the treatment is still present at that time, as evidenced by optical coherence tomography-measured central macular thickness and contrast sensitivity measurements.
OBJETIVO: Avaliar o efeito de uma única injeção intravítrea de bevacizumabe na função visual, sensibilidade ao contraste, em olhos com edema macular causado por oclusão de ramo venoso retiniano. MÉTODOS: Dezessete olhos de 17 pacientes com edema macular unilateral causado por oclusão de ramo venoso retiniano foram tratados com uma única injeção intravítrea de bevacizumabe. Pacientes previamente foram submetidos a exame ocular completo, sensibilidade ao contraste, variável de maior interesse, melhor acuidade visual corrigida e tomografia de coerência óptica e foram reavaliados no 1º e 3º mês de seguimento. RESULTADOS: O teste de sensibilidade ao contraste demonstrou melhora significante nas frequências espaciais 3, 6, 12 e 18 ciclos/grau (c/g) no primeiro mês de seguimento e na frequência espacial 12 c/g após o 3º mês de tratamento. A média da acuidade visual melhorou de 0,77 no pré-tratamento para 0,61 logMAR no 1º mês de seguimento (P=0,0001), com piora ao final do 3º mês, 0,75 logMAR. A média da espessura foveal central (552 ± 150 µm) reduziu significantemente no 1º (322 ± 127 µm, P=0,0001) e 3º (439 ± 179 µm, P=0,01) mês de seguimento. CONCLUSÃO: No edema macular causado por oclusão de ramo venoso retiniano, uma única injeção intravítrea de bevacizumabe melhora a sensibilidade ao contraste, acuidade visual e reduz a espessura foveal central após 1 mês de tratamento. Após 3 meses de seguimento, ainda é possível observar benefício com o tratamento, como foi evidenciado pela sensibilidade ao contraste e a medida da espessura foveal central à tomografia de coerência óptica.
Subject(s)
Aged , Female , Humans , Male , Angiogenesis Inhibitors/therapeutic use , Antibodies, Monoclonal, Humanized/therapeutic use , Macular Edema/drug therapy , Retinal Vein Occlusion/complications , Visual Acuity/drug effects , Contrast Sensitivity/drug effects , Injections, Intraocular , Macular Edema/etiology , Retrospective Studies , Retinal Vein Occlusion/diagnosis , Tomography, Optical Coherence , Treatment OutcomeABSTRACT
PURPOSE: To investigate whether the time interval between type 2 diabetes mellitus (DM) diagnosis and the first fundoscopic examination is related with the presence and the severity of diabetic retinopathy (DR) observed. METHODS: A survey of 105 type 2 DM patients referred to ophthalmologic evaluation in the "Hospital das Clinicas" (HC), University of São Paulo Medical School (USPMS). RESULTS: Regarding classification of DR in the 105 patients, 15 (14.28%) did not show signs of DR, and 90 (85.72%) exhibited them on fundoscopy. Sixty patients underwent laser therapy, and 46.66% reported poor control of DM. Only 15.23% of DM patients were adequately screened for DR on the first year of their DM diagnosis. Among the 36 patients (34.30%) examined within five years of DM diagnosis, 58.33% did not present or demonstrate signs of mild DR and 22.20% of proliferative DR; 30 patients underwent an ophthalmologic examination after more than eleven years of DM diagnosis, 21.62% did not exhibit signs of DR and 59.46% were classified as proliferative DR. CONCLUSION: This study showed a statistically significant relationship between the time interval from the diagnosis of type 2 DM and the first fundoscopic examination with the severity of DR.
Subject(s)
Diabetes Mellitus, Type 2/diagnosis , Diabetic Retinopathy/diagnosis , Adult , Aged , Diabetic Retinopathy/surgery , Female , Fundus Oculi , Humans , Laser Coagulation , Male , Middle Aged , Ophthalmoscopy , Severity of Illness Index , Time FactorsABSTRACT
Purpose: To investigate whether the time interval between type 2 diabetes mellitus (DM) diagnosis and the first fundoscopic examination is related with the presence and the severity of diabetic retinopathy (DR) observed. Methods: A survey of 105 type 2 DM patients referred to ophthalmologic evaluation in the "Hospital das Clinicas" (HC), University of São Paulo Medical School (USPMS). Results: Regarding classification of DR in the 105 patients, 15 (14.28 percent) did not show signs of DR, and 90 (85.72 percent) exhibited them on fundoscopy. Sixty patients underwent laser therapy, and 46.66 percent reported poor control of DM. Only 15.23 percent of DM patients were adequately screened for DR on the first year of their DM diagnosis. Among the 36 patients (34.30 percent) examined within five years of DM diagnosis, 58.33 percent did not present or demonstrate signs of mild DR and 22.20 percent of proliferative DR; 30 patients underwent an ophthalmologic examination after more than eleven years of DM diagnosis, 21.62 percent did not exhibit signs of DR and 59.46 percent were classified as proliferative DR. Conclusion: This study showed a statistically significant relationship between the time interval from the diagnosis of type 2 DM and the first fundoscopic examination with the severity of DR.
Objetivo: Avaliar se o tempo de intervalo entre o diagnóstico do diabetes mellitus (DM) tipo 2 e o primeiro exame de fundo de olho está relacionado com a gravidade da retinopatia diabética (RD). Métodos: Inquérito realizado em 105 pacientes portadores de DM tipo 2 que foram referenciados para avaliação oftalmológica no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Resultados: Quanto à classificação da RD, dos 105 pacientes, 15 (14,28 por cento) não apresentavam sinais de RD e 90 (85,72 por cento) demonstraram presença de sinais de RD ao exame de fundo de olho. Somente 15,23 por cento dos pacientes avaliados foram examinados no primeiro ano do diagnóstico de DM. Sessenta pacientes foram submetidos à laserterapia, 46,66 por cento relataram mal controle do DM. Quando examinados em até 5 anos de diagnóstico de DM, 36 (34,30 por cento), pacientes, 58,33 por cento não apresentaram sinais ou demonstravam sinais de RD grau leve e 22,20 por cento RD proliferativa. Trinta pacientes receberam exame oftalmológico superior a 11 anos do diagnóstico de DM, 21,62 por cento não apresentavam sinais de RD e 59,46 por cento classificados com RD proliferativa. Conclusão: Este estudo demonstrou significância estatística na relação entre o intervalo de tempo do diagnóstico do DM tipo 2 e o primeiro exame de fundo de olho com a gravidade de RD.
