Proliferative diabetic retinopathy treated with intravitreal ranibizumab and photocoagulation directed at ischemic retinal areas-A randomized study.

PURPOSE: To compare ETDRS panretinal laser photocoagulation (PRP) combined with intravitreal injection of ranibizumab (IVR) and photocoagulation targeted to ischemic retina (PIR) combined with IVR in patients with proliferative diabetic retinopathy (PDR). METHODS: PDR patients were randomly assigned to treatment with either PRP + IVR or PIR + IVR. ETRDS Best-corrected visual acuity (BCVA) and central subfield thickness (CSFT) measured on optic-coherence tomography images (OCT-Heidelberg Spectralis) were recorded at baseline and every 4 weeks for one year. Fluorescein leakage area (FLA) from active new vessels was measured every 12 weeks. Full-field ERG was recorded by means of DTL electrodes, following ISCEV standard recommendations, at baseline and after 3 months. RESULTS: Twenty-eight eyes completed the study period. At baseline, mean ± SE BCVA (logMAR) was 0.44 ± 0.07 and 0.37 ± 0.08 (P = 0.5030); CSFT (µm) was 324.0 ± 20.4 and 330.1 ± 22.1 (P = 0.8417); and FLA (mm2) was 16.10 ± 4.42 and 9.97 ± 1.83 (P = 0.2114) for PRP + IVR and PIR + IVR groups, respectively. There were no relevant changes on BCVA or CSFT, but a significant reduction for FLA was observed at all visits compared to baseline for both groups, with no differences between groups. ERG showed at baseline reduced dark-adapted amplitudes, and these changes were also significantly amplified after laser treatment. ROD b-wave amplitude was further reduced in 62 ± 6% for PRP + IVR and 59 ± 4% for group PIR + IVR, but with no between-groups significant difference (P = 0.9082). CONCLUSIONS: PIR + IVR or PRP + IVR are comparable strategies regarding FLA control in PDR and led to similar retinal function impairment, based on ERG changes up to one-year follow-up. TRIAL REGISTRATION NUMBER: NCT03904056, date of registration 02/11/2019, retrospectively registered.

Comparative efficacy of two different topical povidone-iodine 5% regimens in reducing conjunctival bacterial flora: A randomized parallel double-masked clinical trial.

INTRODUCTION: The increasing prevalence of multi-resistant bacteria is a major public health concern. Infections acquired during ophthalmic surgery are devastating. The purpose of the current study is to compare the proportion of eyes with negative bacterial cultures on all tested media after 1 versus 3 sequential drops of povidone-iodine (PI) 5% into the inferior conjunctival fornix. METHODS: Patients were randomly assigned to receive 1 (PI group) drop (at time 28 minutes) or 3 (PI plus group) sequential drops (at time 0, 20 minutes and 28 minutes) of PI 5% into the inferior conjunctival sac of one randomly selected eye. A swab culture was obtained from the inferior conjunctival fornix 5 minutes before and 30 minutes after time 0. Central corneal thickness (CCT) was measured shortly before time 0 and shortly after time 30. Conjunctival swabs were incubated aerobically in enriched Thioglycolate liquid medium (meat broth) and in three solid culture media (chocolate agar, trypticase soy agar with 5% sheep blood, and Sabouraud agar). RESULTS: There was no significant difference in the proportion of negative cultures after intervention between groups (p = 0.1638). Also in the PI group (n = 59), the proportion of eyes with negative cultures after PI (79.7%) did not differ significantly from baseline (76.3%; p = 0.7539). However in the PI plus group (n = 61), the proportion of eyes with all negative cultures after PI (85.3%) was significantly higher than before PI (70.5%) (p = 0.0177). There was no significant difference in mean CCT before and after the intervention in both groups. CONCLUSION: Instillation of 3 sequential drops of PI was associated with a significant increase in the proportion of eyes with all negative cultures, while instillation of a single drop of PI was not associated with a significant increase in the proportion of negative cultures. Further study is warranted to determine whether the difference between the PI administration regimens is also associated with differences in the rates of postoperative ocular infections.

Intravitreal use of bone marrow mononuclear fraction containing CD34+ stem cells in patients with atrophic age-related macular degeneration.

PURPOSE: To evaluate the therapeutic potential and safety of intravitreal injections of bone marrow mononuclear fraction (BMMF) containing CD34+ cells in patients with atrophic age-related macular degeneration (AMD). METHODS: Ten patients with atrophic AMD and best-corrected visual acuity (BCVA) in the worse-seeing eye of ≤20/100 were enrolled in this study. The bone marrow from all patients was aspirated and processed for mononuclear cell separation. A 0.1 mL suspension of BMMF CD34+ cells was injected into the vitreous cavity of the worse-seeing eye. Patients were evaluated at Baseline and 1,3,6,9 and 12 months after injection. Ophthalmic evaluation included BCVA measurement, microperimetry, infrared imaging, fundus autofluorescence and SD-optical coherence tomography at all study visits. Fluorescein angiography was performed at Baseline and at 6 and 12 months after intravitreal therapy. RESULTS: All patients completed the 6-month follow-up, and six completed the 12-month follow-up. Prior to the injection, mean BCVA was 1.18 logMAR (20/320-1), ranging from 20/125 to 20/640-2, and improved significantly at every follow-up visit, including the 12-month one, when BCVA was 1.0 logMAR (20/200) (P<0.05). Mean sensitivity threshold also improved significantly at 6, 9 and 12 months after treatment (P<0.05). Considering the area of atrophy identified by fundus autofluorescence, significant mean BCVA and mean sensitivity threshold improvement were observed in patients with the smallest areas of atrophy. Fluorescein angiography did not identify choroidal new vessels or tumor growth. CONCLUSION: The use of intravitreal BMMF injections in patients with AMD is safe and is associated with significant improvement in BCVA and macular sensitivity threshold. Patients with small areas of atrophy have a better response. The paracrine effect of CD34+ cells may explain the functional improvement observed; however, larger series of patients are necessary to confirm these preliminary findings.

Aleitamento Materno e Dermatite Atópica: Estudo do Tipo Caso-Controle / Breastfeeding and Atopic Dermatitis: A Case Control Study

O estudo do aleitamento materno em crianças atópicas énecessário em razão do provável efeito protetor que podeexercer na modulação dessa doença. Objetivo: Verificar secrianças com dermatite atópica apresentam hipersensibilidadeàs proteínas do leite de vaca em relação ao grupo-controle eestabelecer uma possível relação entre a idade da exposiçãoe sensibilização alergênica ao mesmo. Material e Métodos:Estudo analítico do tipo caso-controle. A época da introduçãodo leite de vaca foi avaliada através de questionário eanalisada mês a mês. A sensibilização a proteínas do leite devaca foi determinada por meio do Prick test. A análise foirealizada de forma bidimensional e determinado a Odds Ratiocom o intervalo de confiança. Resultados: Houve maiorfreqüência de exposição precoce ao leite de vaca no grupocaso.O Prick test às proteínas do leite de vaca demonstroumaior freqüência de positividade no grupo-caso em relaçãoàs do grupo-controle. No grupo-caso, a positividade ao leitein natura e b-lactoglobulina foram 9/48 e 8/48, enquanto nogrupo controle apenas 1/48 paciente apresentouhipersensibilidade às proteínas do leite de vaca. Conclusão:As crianças com dermatite atópica foram expostasprecocemente ao leite de vaca, e apresentaram maiorfreqüência de positividade para o Prick test...

Breastfeeding study in atopic dermatitis is important becausethere is necessary to know if breastfeeding has anyprotective effect in these disease´s modulation. Objective:To evaluate whether children with atopic dermatitis havehypersensitivity to cow milk proteins comparing to a controlgroup and to establish the possible correlation between theage of exposure and the allergic sensibilization to it. Materialand Methods: Study design is a case control study. The timeof cow milk introduction was evaluated through aquestionnaire and analyzed every month. Cow sensibilizationwas determined with Prick test. The analysis was done inthe bidimensional way and an Odds Ratio was determinedwith a confidence interval. Results: There was a greaterfrequency of early exposure to cow milk in the case group.The Prick test to cow milk proteins showed positivityfrequency in the case group, in correlation to the controlgroup. In the case group, positivity to in natura milk and blactoglobulinwere 9/48 and 8/48, and in the control grouponly 1/48 had hypersensitivity to cow milk proteins.Conclusions: Children with atopic dermatitis were exposedearlier to cow milk, and had more frequently the Prick testpositive...