Effect of intravitreal dexamethasone solution on the reduction of macular thickness in pseudophakic diabetic patients in a public hospital in Brazil: a randomized clinical trial.

PURPOSE: To determine the effect of short-term 4 mg/mL dexamethasone solution treatment in diabetic macular edema (DME). PATIENTS AND METHODS: Twenty-seven pseudophakic diabetic patients with visual impairment caused by DME were randomized to receive 0.01 mL (40 µg), 0.03 mL (120 µg) or 0.05 mL (200 µg) intravitreal dexamethasone solution. Eyes were evaluated in terms of macular thickness, best-corrected visual acuity (BCVA) and intraocular pressure (IOP) at 3, 7 and 28 days after injection (D). RESULTS: There was a significant reduction in macular thickness between D0 and D3 for all groups (0.01 mL - P=0.008, 0.03 mL - P=0.038, and 0.05 mL - P=0.008). Between D0 and D7, a significant reduction in macular thickness was observed in 0.01 mL and 0.05 mL groups (0.01 mL - P=0.013 and 0.05 mL - P=0.021). Between D0 and D28, no significant reduction of macular thickness was observed for any group. Between D0 and D3, a significant improvement in BCVA in the 0.03 mL group (P=0.028) was observed. Between D0 and D7, a significant improvement in BCVA was observed in 0.01 mL and 0.03 mL groups (0.01 mL - P=0.018 and 0.03 mL - P=0.027). Between D0 and D28, a significant improvement in BCVA was observed for the 0.01 mL group (P=0.017). No significant differences in IOP measurements were observed for any group. Safety analysis revealed no serious ocular or systemic events. CONCLUSION AND RELEVANCE: Intravitreal dexamethasone solution is effective in reducing macular thickness secondary to DME in the short-term. Improvement in short-term visual acuity was observed. Although DME requires long-term treatment, it may be a low cost therapeutic option used in specific short-term situations.Trial registration: NCT03608839 (http://www.clinicaltrials.gov).

Scleral buckle is good option for treatment of uncomplicated retinal detachment / Introflexão escleral é boa opção para tratamento de descolamento de retina não complicado

OBJETIVE: To describe the reattachment rate and visual acuity results of patients with uncomplicated rhegmatogenous retinal detachment who underwent segmental scleral buckle surgery. METHODS: Prospective case series of 100 patients with visual loss or symptoms (floaters and photopsia) of less than 30 days' duration scheduled for surgery. No patient had a retinal break greater than 30°, a retinal detachment larger than 2 quadrants or proliferative vitreoretinopathy. RESULTS: The 1-week, 1-month, and 6-month anatomical success rates were 93%, 100%, and 100%, respectively. Seven patients underwent one additional retinal detachment surgery (pars plan vitrectomy) after primary failure at 1-week follow-up. The preoperative, 1-month, and 6-month best correct visual acuity were 20/100, 20/80, and 20/50, respectively. The postoperative complications were: eyelid edema in 10% of the patients, transient ocular hypertension in 5%, macular pucker in 3%, transient diplopia in 3%, and hyphema (<0.5mm) in 1%. CONCLUSION: In patients with uncomplicated retinal detachment, segmental scleral buckle showed a very good anatomical and functional success, with a few number of major complications.

OBJETIVO: Descrever a taxa de reaplicação e os resultados da acuidade visual dos pacientes com descolamento de retina regmatogênico simples que se submeteram à cirurgia de introflexão escleral segmentar. MÉTODOS: Uma série de casos prospectivo de 100 pacientes com perda visual ou sintomas (floaters e fotopsia), com duração inferior a 30 dias, agendados para a cirurgia. Nenhum paciente apresentou uma ruptura da retina superior a 30°, um descolamento de retina maior que 2 quadrantes ou vitreorretinopatia. RESULTADOS: As taxas de sucesso anatômico em 1 semana, 1 mês e 6 meses foram de 93%, 100% e 100%, respectivamente. Sete pacientes foram submetidos à cirurgia de descolamento de retina adicional (vitrectomia via pars plana) após falha primária em uma semana de seguimento. A melhor acuidade visual pré-operatória, 1 mês, e de 6 meses pós-operatório foram 20/100, 20/80 e 20/50, respectivamente. As complicações pós-operatórias foram: edema palpebral em 10% dos pacientes, a hipertensão ocular transitória em 5%, pucker macular em 3%, diplopia transiente em 3%, e hifema (<0,5 mm) em 1%. CONCLUSÃO: Em pacientes com descolamento da retina sem complicações, a cirurgia de introflexão segmentar escleral mostrou um sucesso anatômico e funcional muito bom, com um número menor de complicações maiores.

Cryotherapy vs laser photocoagulation in scleral buckle surgery: A randomized clinical trial.

OBJECTIVE: To compare the reattachment rate and visual acuity results among patients with rhegmatogenous retinal detachment who underwent scleral buckle surgery with retinopexy by intraoperative cryotherapy (cryopexy) vs postoperative (1 month later) laser photocoagulation (laserpexy). METHODS: Eighty-six patients with rhegmatogenous retinal detachment scheduled for scleral buckle surgery were randomly assigned to the cryopexy or laserpexy group. MAIN OUTCOME MEASURES: The primary outcome was the 1-week reattachment rate. Other outcome measures included later reattachment rate (1 month and 6 months), best-corrected visual acuity, rate of subsequent operations, and postoperative complications. RESULTS: The 1-week, 1-month, and 6-month anatomical success rates were similar in the 2 groups: 93% (40 patients), 100%, and 100% in the cryopexy group and 95% (41 patients), 100%, and 100% in the laserpexy group, respectively. Three patients in the cryopexy group and 2 in the laserpexy group underwent 1 additional rhegmatogenous retinal detachment surgery (pars plan vitrectomy) after primary failure at 1-week follow-up. The types of postoperative complications were similar in both groups, except for eyelid edema. Visual recovery was slower in the cryotherapy group, but the difference in visual acuity after 6 months was not significant. CONCLUSIONS: In patients with uncomplicated retinal detachment, both techniques of retinopexy have shown satisfactory anatomical and functional success. Laserpexy offers faster visual acuity recuperation with fewer postoperative complications but requires a second intervention and costs more than cryotherapy. APPLICATION TO CLINICAL PRACTICE: Laserpexy is a successful alternative to cryopexy in creating chorioretinal adhesion for scleral buckle surgery. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01068379.

Obito pelo uso do hidrato de cloral: apresentaçäo de um caso / Death by use of chloral hydrate: report of a case

Apresenta-se o caso de uma criança de baixo peso que foi a óbito após a administraçäo de hidrato de cloral por via oral em dosagem considerada segura (50 mg/kg de peso). Ressalta-se que a literatura pesquizada apresenta complicaçöes transitórias pelo uso do hidrato de cloral, sendo este o primeiro caso de óbito relatado

Alteraçöes oftalmoscópicas na hipertensäo arterial e gravidez / Ophtalmoscopic changes in arterial hypertension and pregnancy

Os autores estudam as alteraçöes fundoscópicas no hipertensäo arterial durante a gestaçäo. Discutem as diferenças oftalmoscópicas entre a toxemia gravídica e a hipertensäo arterial crônica. Finalmente apresentam o prognóstico visual decorrente da hipertensäo arterial grave e a possibilidade da interrupçäo prematura da gestaçäo diante da gravidade da retinopatia