ABSTRACT
PURPOSE:: To analyze the effects of injections of intravitreal triamcinolone acetonide (IVTA) and intravitreal bevacizumab (IVB) on the incidence rates of anterior segment neovascularization (ASN) and neovascular glaucoma (NVG) in patients with macular edema secondary to central retinal vein occlusion (CRVO). METHODS:: In this prospective, randomized, double-masked, sham-controlled study, 35 patients with macular edema following CRVO were randomized to intravitreal bevacizumab, intravitreal triamcinolone acetonide, or sham injections during the first 6 months of the study. The primary outcome was the incidence rate of ASN at month 6. The secondary outcomes were the mean changes from baseline in best-corrected visual acuity (BCVA) and central foveal thickness (CFT) on optical coherence tomography over time to month 12. RESULTS:: ASN developed in 8 (22.86%) eyes, including 5 (62.50%) eyes in the sham group and 3 (37.50%) eyes in the IVTA group, during 12 months of fol low-up (p=0.009). BCVA differed significantly (p<0.05) among the groups only at month 1. CFT did not differ significantly (p<0.05) among the groups over 12 months. NVG required surgery and developed in one eye despite laser treatment. CONCLUSION:: Early treatment with intravitreal antivascular endothelial growth factor therapy decreases the rates of ASN and NVG after CRVO.
Subject(s)
Angiogenesis Inhibitors/administration & dosage , Anti-Inflammatory Agents/administration & dosage , Bevacizumab/administration & dosage , Macular Edema/drug therapy , Neovascularization, Pathologic/epidemiology , Triamcinolone Acetonide/administration & dosage , Adult , Aged , Aged, 80 and over , Angiogenesis Inhibitors/adverse effects , Anterior Eye Segment/blood supply , Anti-Inflammatory Agents/adverse effects , Bevacizumab/adverse effects , Double-Blind Method , Female , Follow-Up Studies , Fovea Centralis/physiopathology , Glaucoma, Neovascular/drug therapy , Humans , Incidence , Intravitreal Injections , Macular Edema/etiology , Male , Middle Aged , Neovascularization, Pathologic/etiology , Prospective Studies , Retinal Artery Occlusion/complications , Retinal Artery Occlusion/drug therapy , Treatment Outcome , Triamcinolone Acetonide/adverse effects , Visual AcuityABSTRACT
ABSTRACT Purpose: To analyze the effects of injections of intravitreal triamcinolone acetonide (IVTA) and intravitreal bevacizumab (IVB) on the incidence rates of anterior segment neovascularization (ASN) and neovascular glaucoma (NVG) in patients with macular edema secondary to central retinal vein occlusion (CRVO). Methods: In this prospective, randomized, double-masked, sham-controlled study, 35 patients with macular edema following CRVO were randomized to intravitreal bevacizumab, intravitreal triamcinolone acetonide, or sham injections during the first 6 months of the study. The primary outcome was the incidence rate of ASN at month 6. The secondary outcomes were the mean changes from baseline in best-corrected visual acuity (BCVA) and central foveal thickness (CFT) on optical coherence tomography over time to month 12. Results: ASN developed in 8 (22.86%) eyes, including 5 (62.50%) eyes in the sham group and 3 (37.50%) eyes in the IVTA group, during 12 months of fol low-up (p=0.009). BCVA differed significantly (p<0.05) among the groups only at month 1. CFT did not differ significantly (p<0.05) among the groups over 12 months. NVG required surgery and developed in one eye despite laser treatment. Conclusion: Early treatment with intravitreal antivascular endothelial growth factor therapy decreases the rates of ASN and NVG after CRVO.
RESUMO Objetivo: Analisar as taxas de incidência de neovascularização do segmento anterior (NSA) e de glaucoma neovascular (GNV), em pacientes com edema macular secundário a oclusão de veia central da retina (OVCR), em tratamento com injeções intravítreas de triamcinolona (IVTA) ou bevacizumab (IVB). Métodos: Neste estudo prospectivo, randomizado, duplo mascarado e sham controlado, 35 pacientes com edema macular secundário a OVCR foram randomizados para IVB, IVTA ou para o grupo controle (sham), durante os 6 primeiros meses do estudo. O desfecho primário foi a taxa de incidência de NSA no mês 6. Os desfechos secundários foram alterações médias da acuidade visual corrigida (BCVA) e espessura foveal central (EFC) ao exame de tomografia de coerência óptica, até o mês 12. Resultados: NSA ocorreu em oito (22,86%) olhos, cinco (62,50%) olhos no grupo sham e três (37,50%) olhos no grupo tratado com injeções intravítreas de Triamcinolona, Não houve nenhum caso com NSA no grupo tratado com bevacizumab durante 12 meses de acompanhamento (p=0,009). A BCVA apresentou diferença estatisticamente significante (p<0,05) entre os grupos, somente no mês 1. A EFC não apresentou diferenças estatisticamente significantes (p<0,05) entre os grupos ao longo dos 12 meses. GNV ocorreu em um olho apesar do tratamento com laser e este paciente necessitou de intervenção cirúrgica. Conclusão: O tratamento precoce com injeções intravítreas de Anti VEGF podem diminuir as taxas de neovascularização do segmento anterior e glaucoma neovascular após oclusão de veia central da retina.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Triamcinolone Acetonide/administration & dosage , Macular Edema/drug therapy , Angiogenesis Inhibitors/administration & dosage , Bevacizumab/administration & dosage , Anti-Inflammatory Agents/administration & dosage , Neovascularization, Pathologic/epidemiology , Retinal Artery Occlusion/complications , Visual Acuity , Glaucoma, Neovascular/drug therapy , Macular Edema/etiology , Double-Blind Method , Incidence , Prospective Studies , Follow-Up Studies , Angiogenesis Inhibitors/adverse effects , Intravitreal Injections , Bevacizumab/adverse effects , Fovea Centralis/physiopathology , Anterior Eye Segment/blood supply , Anti-Inflammatory Agents/adverse effects , Neovascularization, Pathologic/etiologyABSTRACT
PURPOSE: This study aims to study death records mentioning epilepsy, epileptic seizures and/or status epilepticus, in order to survey the population demographics and associated medical conditions, making it possible to outline the patient's profile. METHODS: A qualitative analysis was performed on the data gathered from death certificates from the Curitiba county records ranging from 1998 to 2007 bracket, in which epilepsy, seizure and/or status epilepticus were mentioned as the basic, intermediate, immediate or associated cause of death. RESULTS: Epilepsy was mentioned on 621 death cases in this 10-year-period. The deaths were mainly of male individuals (57.3%), Caucasian (71.6%), single (48.6%) and aged between 20 and 60 years (51.8%). Most of those who died were hospitalized patients (62.5%) and in 64.3% of the reported deaths, the patient received medical care during the event that led to his/her death. Epilepsy itself was considered to be the cause of death in 44%, followed by status epilepticus (9.7%). The most common intermediary and immediate causes were pulmonary infections (11.1%) and cardiac arrest (19.2%), respectively DISCUSSION: Hospitalized younger Caucasian males with epilepsy were the most common cases in this 10-year-period survey. Pulmonary infections were a common finding, but other aspects such as previous trauma, cerebrovascular disease or neoplasm were eventual associated factors. Public health and medical preventative measures can be planned based on the results of this study.
