Radiotherapy for the treatment of optic nerve sheath meningioma: A systematic review and meta-analysis.

OBJECTIVES: The management of Optic Nerve Sheath Meningiomas (ONSM) has suffered a significant shift due to new radiation techniques. However, there is no conclusive information on which approach presents better results in the literature. This meta-analysis aims to evaluate the outcomes of different radiotherapy (RT) modalities in the management of ONSM. METHODS: A systematic review based on an electronic search was performed in MEDLINE, EMBASE, Cochrane, and Lilacs databases. Eligible studies included patients with ONSM treated with RT. Two reviewers independently assessed the eligibility of potential studies, extracted data, and performed the meta-analysis. Outcomes of interest were tumor control, visual acuity (VA), visual field, and complications. RESULTS: Thirty-nine non-comparative studies involving 736 eyes with ONSM treated with RT were included. Six different techniques were studied: 2-dimensional RT (2DRT), 3D-conformal RT (3CRT), Stereotactic Fractionation RT (SFRT), stereotactic radiosurgery (SRS), intensity-modulated RT (IMRT), and proton beam therapy (PBT). With a mean follow-up period of 46 months, tumor control was 97,4% (95% CI: 98-100%). No difference was observed regarding the rate of final VA post-treatment among the modalities. The 3CRT showed substantially higher rates of complication than other techniques. CONCLUSIONS: RT produces remarkable tumor control. New radiation modalities such as SFRT, IMRT, SRS, and PBT resulted in better therapeutic results with fewer complications than 2DRT and 3CRT. Thus, they should be the preferential choices for treating ONSM regardless of initial clinical presentation.

HLA-C Alleles and Cytomegalovirus Retinitis in Brazilian Patients with AIDS.

PURPOSE: Since cytomegalovirus retinitis (CR) is an important cause of visual impairment among AIDS patients and HLA-C alleles have been associated with AIDS disease outcome, we typed HLA-C locus in patients with AIDS exhibiting or not CR. METHODS: Three groups of individuals were studied: (i) 49 patients with AIDS and CR (Group I), (ii) 161 patients with AIDS without CR (Group II), and (iii) 202 healthy HIV-negative individuals (Group III). HLA-C typing was performed using commercial kits. RESULTS: The HLA-C∗07 allele group was underrepresented in AIDS patients with CR (P=0.005) when compared to controls or when compared to AIDS patients without CR (P=0.006). The HLA-C∗05 allele group was overrepresented in Group II in comparison to Group III (P=0.017). The frequency of the HLA-C∗16 allele group was increased in Group III in comparison to Group II (P=0.004). CONCLUSION: The HLA-C∗07 allele group conferred protection against the development of CR in Brazilian AIDS patients, whereas the HLA-C∗05 and HLA-C∗16 allele groups were associated with AIDS susceptibility or protection, respectively.

[Factors related to glaucoma treatment compliance: patients' opinions from a University Hospital]. / Fatores relacionados à fidelidade ao tratamento do glaucoma: opiniões de pacientes de um hospital universitário.

PURPOSE: Considering that noncompliance to glaucoma treatment is one of the risk factors associated with disease s progression, the purpose of the present study was to evaluate: 1) knowledge and feelings about the disease; 2) self-reported noncompliance to treatment and related factors; and 3) influence of disease in lifestyle. METHODS: Interviews, with application of a semi-structured questionnaire, of 50 patients with primary open-angle glaucoma. The analysis was performed using Lefèvre's technique (Collective Subject Speech--CSS, qualitative/quantitative research). RESULTS: Thirty-eight percent of patients did not consider themselves well informed about glaucoma. The percentage of patients that reported noncompliance was 20%. The main causes of noncompliance are: side effects of antiglaucomatous drugs (24%); lack of information about the disease (22%); difficulty in understanding information and communication problems with the physician (14%); difficulties in administering the eye drops (14%); poverty, with impossibility to pay for the eye drops (10%); patients attitudes and beliefs (10%). Eighteen percent of the participants informed that the disease affected their life quality. CONCLUSION: In the studied population, most of the problems related to noncompliance to glaucoma treatment pointed out different factors that may decrease with education about POAG, interventions on attitudes and behavior, improvement of doctor-patient relationship and anti-glaucoma drugs supply.

Aspirin prevents diabetic oxidative changes in rat lacrimal gland structure and function.

The aim of this study is to evaluate whether aspirin reduces Diabetis Mellitus (DM) oxidative damage in the lacrimal gland (LG), and ocular surface (OS). Ten weeks after streptozotocin induced DM and aspirin treatment, LG and OS of rats were compared for tear secretion, hidtology, peroxidase activity, and expression of uncoupling proteins (UCPs). DM reduction of tear secretion was prevented by aspirin (P < 0.01). Alterations of LG morphology and increased numbers of lipofucsin-like inclusions were observed in diabetic but not in aspirin-treated diabetic rats. Peroxidase activity levels were higher and UCP-2 was reduced in DM LG but not in aspirin treated (P = 0.0025 and P < 0.05, respectively). The findings prevented by aspirin indicate a direct inhibitory effect on oxidative pathways in LG and their inflammatory consequences, preserving the LG structure and function against hyperglycemia and/or insulin deficiency damage.

Influence of thyroid hormone on thyroid hormone receptor beta-1 expression and lacrimal gland and ocular surface morphology.

PURPOSE: Hormone diseases induce changes in the lacrimal gland (LG) and ocular surface (OS). Thyroid hormone (TH) induces cell proliferation and lipid metabolism through the activation of TH receptors. The aim of the present study was to evaluate the location and comparative expression of TH receptor beta-1 (Thrb) in LG of rats with hypothyroidism and in controls and to evaluate the impact of this disease on LG and OS structure and function. METHODS: Hypothyroidism was induced in Wistar male rats by the long-term use of tiamazole. Ten weeks later corneal cells were collected for impression cytology (IC). Rats were humanely killed, and tissues were evaluated by immunoperoxidase staining and Western blot for Thrb. The content of malondialdehyde (MDA) and acetylcholine (ACh) in LG was determined by spectrophotometry (n = 5/group in all experiments). RESULTS: LG weight was significantly lower in hypothyroid rats (P < 0.05). Western blot analysis indicated that LGs express Thrb and that hypothyroidism induces a higher expression of this receptor. IC was significantly different and ACh was significantly lower in hypothyroid rats (P < 0.05). CONCLUSIONS: Chronically reduced levels of TH lead to biochemical and structural changes and modulate the levels of Thrb in LG. These events confirm that LG is a target organ for TH and may facilitate understanding of the mechanism related to dry eye in hypothyroidism.