Metabolic control and diabetic retinopathy.

The Early Treatment Diabetic Retinopathy Study (ETDRS) identified important risk factors for progression to high risk proliferative diabetic retinopathy (PDR) including retinopathy severity, decreased visual acuity, and high levels of hemoglobin A1C (HbA1c). Additional risk factors for progression to PDR are decreased hematocrit and increased serum lipids. The long-term benefit of improving glycemic control was evaluated by three large studies: the Diabetes Control and Complications Trial (DCCT), the Stockholm Interventional Study, and the UK prospective study. Several small studies, notably the Kuwamoto study, also evaluated the relationship between the glycemic control and diabetic retinopathy. Intensive glycemic control reduces the risk of any retinopathy by approximately 27%. Intensive therapy is most effective when initiated early in the course of the diabetes, demonstrating a beneficial effect over the course and progression of retinopathy. The long term benefits of the intensive glycemic control greatly outweigh the risk of "early worsening." Lowering elevated serum lipid levels has been shown to decrease the risk of cardiovascular morbidity. The ETDRS data suggest that lipid lowering may also decrease the risk of hard exudate formation and associated vision loss in patients with diabetic retinopathy. Preservation of vision may be an additional motivating factor for lowering serum lipid levels in persons with diabetic retinopathy and elevated serum lipid levels.

Ranibizumab for diabetic retinopathy.

Ranibizumab (Lucentis) is a Fab-Antibody with high affinity for VEGF, and is being designed to bind to all VEGF isoforms. This quality makes it a powerful drug for VEGF inhibition. Diseases of retinal and choroidal blood vessels are the most prevalent causes of moderate and severe vision loss in developed countries. Vascular endothelial growth factor plays a critical role in the pathogenesis of many of these diseases. Results of the pilot studies showed that intraocular injections of ranibizumab (Lucentis) decrease the mean retinal thickness and improve the BCVA in all the subjects. Proliferative diabetic retinopathy, currently treated with destructive laser photocoagulation, represents another potential target for anti-VEGF therapy. The early experience in animal models with proliferative retinopathy and neovascular glaucoma shows that posterior and anterior neovascularizations are very sensitive to anti-VEGF therapy. The outcome of two phase III clinical trials will increase our knowledge of the role of Lucentis in the treatment of DME.

Functional and anatomical outcomes for intravitreal bevacizumab treatment of choroidal neovascularization in a patient with angioid streaks.

PURPOSE: To evaluate the visual and anatomical outcomes of intravitreal bevacizumab (Avastin; Genentech, Inc., South San Francisco, CA) treatment of choroidal neovascularization (CNV) in patients with angioid streaks (ASs). METHODS: A 44-year-old man with angioid streaks and CNV in both eyes (best-corrected visual acuity: 20/400, right eye; 20/50, left eye) received intravitreal bevacizumab injections at monthly intervals. RESULTS: Best-corrected visual acuity in the right eye after 2 intravitreal injections of bevacizumab was 20/70 and remained the same at the 6-month follow-up. Best-corrected visual acuity in the left eye after 3 intravitreal injections of bevacizumab was 20/25 and remained the same at the 9-month follow-up. CONCLUSIONS: After intravitreal administration of bevacizumab, our patient had visual acuity improvement in both eyes that was associated with rapid and significant reduction in thickness, subretinal fluid, and size of subfoveal neovascularization secondary to ASs. Intravitreal bevacizumab treatment resulted in a meaningful and sustained vision gain after the 9-months follow-up.

Fishing-related ocular trauma.

PURPOSE: To evaluate the characteristics of fishing-related ocular injuries. DESIGN: Retrospective observational analysis of a computerized databank. METHODS: The United States Eye Injury Registry was used to analyze 143 patients with fishing-related ocular injury. Epidemiologic and clinical information was evaluated including the age and gender of the subjects, classification of ocular trauma, surgical management, and final visual acuity. RESULTS: Of the 732 cases of sport-related ocular trauma, 143 (19.54%) occurred while fishing; of these, 79% were male patients who ranged in age from 6 to 68 years (mean, 37 years). Corneal laceration, globe rupture, and hyphema were the most common diagnoses at presentation and were caused by fishing hooks, lures, and weights. Thirty-five bystanders are included in the study. Thirty-eight percent of patients had visual acuity less than 20/50, and 21% had a visual acuity of less than 20/200. Open globe injuries portended a poor visual outcome compared with closed globe injuries. CONCLUSIONS: Fishing-related ocular injuries represent a large percent of sports-related trauma, often resulting in significant visual loss. Preventive measures such as the use of protective eyewear should be advised in this activity.

Hipercolesterolemía en la población adolescente / Hypercholesterolemia in the population adolescente

Se realizó una investigación con la finalidad de conocer los niveles de colesterol y trigliceridos de 192 adolescentes entre 12 y 18 años de edad. Además, se determinó la relación entre los antecedentes familiares de enfermedades cardiovasculares e hipercolesterolemia, horas de televisión al día e índice de masa corporal, y los niveles de lípidos séricos. La frecuencia de hipercolesterolemia fue 22,4 por ciento, mientras que la hipercolesterolemia se reportó en 12 por ciento de los adolescentes. No se encontró diferencia estadísticamente significativa en los niveles de colesterol y trigliceridos entre los jóvenes con antecedentes (p<0,05). En los pacientes que manifestaron ver más de 5 horas de televisión al día, se observó la tendencia a presentar mayores niveles de colesterol y triglicéridos; y en aquéllos con un índice de masa corporal elevado, se observaron cifras de triglicéridos significativamente superiores (p<0,05)