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BACKGROUND: Age-related macular degeneration (AMD) is a leading cause of vision loss. Photobiomodulation (PBM) offers a controversial approach for managing dry AMD, aiming to halt or reverse progression through mitochondrial activity modulation. However, the efficacy and clinical relevance of PBM as a potential approach for managing dry AMD remain debated. METHODS: We systematically searched PubMed, Embase, and Cochrane databases for randomized controlled trials (RCTs) comparing PBM versus a sham in patients with dry AMD. We performed trial sequential analysis (TSA) and minimal clinically important difference (MCID) calculations to assess statistical and clinical significance applying a random-effects model with 95% confidence intervals (CI). RESULTS: We included three RCTs comprising 247 eyes. The pooled analysis showed that PBM significant improved BCVA (MD 1.76 letters; 95% CI: 0.04 to 3.48) and drusen volume (MD -0.12 mm³; 95% CI: -0.22 to -0.02) as compared with a sham control. However, the TSA indicated that the current sample sizes were insufficient for reliable conclusions. No significant differences were observed in GA area. The MCID analysis suggested that the statistically significant results did not translate into clinically significant benefits. In the quality assessment, all studies were deemed to have a high risk of bias. CONCLUSION: This meta-analysis points limitations in the current evidence base for PBM in dry AMD treatment, with issues around small sample sizes. Statistically significant improvements do not translate into clinical benefits. The research underscores need for larger RCTs to validate PBM's therapeutic potential for dry AMD.
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PURPOSE: To evaluate the results of central pars plana vitrectomy + phacoemulsification + intraocular lens implantation in patients with small eyes, cataract, and narrow chambers. METHODS: This prospective study was carried out in 89 eyes of 58 patients undergoing central pars plana vitrectomy + phacoemulsification + IOL implantation in small eyes with cataract at Clínica La Luz Eye Institute in Lima, Peru. RESULTS: The mean best corrected visual acuity (BCVA) was 0.8±0.6 preoperatively, 0.5±0.6 at 1 month, 0.3±0.3 at 6 months, 0.1±0.1 at 9 months, and 0.05±0.1 at 1 year, which was statistically significant from the preoperative period to 1 year of follow-up. Mean intraocular pressure was 22.09±2.4 mmHg preoperatively, 14.55±2.9 mmHg at 1 day, 12.94±2.04 mmHg at 1 month, 12.01±1.2 mmHg at 6 months, 12.20±1.9 mmHg at 9 months, and 11.34±1.1 mmHg at 1 year. The reduction in the intraocular pressure from the preoperative control period to the follow-up at 1 year was statistically significant. There was only one complication, a rupture of the posterior capsule, which was quickly resolved. CONCLUSION: Central pars plana vitrectomy with phacoemulsification is a safe and effective technique to perform in narrow chambers with all types of cataracts, in experienced hands, which can avoid intraoperative complications.
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PURPOSE: To report the ophthalmological approach of a patient with Blau syndrome (BS) in Colombia. OBSERVATIONS: We describe a 9-year-old Colombian boy with sporadic BS due to a de novo nucleotide-binding oligomerization domain containing 2 (NOD2) mutation, who presented with joint and dermatologic symptoms. He was referred to the uveitis service with a single functional eye, due to retinal detachment in the other eye. Despite treatment with corticosteroids, methotrexate, and adalimumab, the patient continued to exhibit progressive disease. CONCLUSION: BS-related uveitis is characterized by severe ocular morbidity. Appropriate interdisciplinary treatment is necessary for the correct identification and management of the disease, considering the inherent difficulty in its diagnosis due to its diverse clinical manifestations. The severity of BS-related uveitis in this report highlights the need for more effective therapies.
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BACKGROUND: Photocoagulation reduces the incidence of visual loss in diabetic patients with focal macular edema, but it can induce it for Efficacy of topical ketorolac for improving visual function after photocoagulation in diabetic patients with focal macular edema 6 weeks after treatment and produces visual improvement in some cases. Topical ketorolac may reduce the inflammation caused by photocoagulation and improve visual outcome. PURPOSE: To determine the efficacy of topical ketorolac for improving visual function after photocoagulation in diabetic patients with focal macular edema. METHODS: An experimental, comparative, prospective, longitudinal study in diabetic patients with focal macular edema was conducted. Eyes were randomized into two groups of topical treatment for 3 weeks after photocoagulation (A: ketorolac, B: placebo). Best corrected visual acuity before and after treatment was compared in each group (paired t test), and the proportion of eyes with visual improvement was compared between groups (χ(2)). The evaluation was repeated after stratifying for initial visual acuity (≥ 0.5, < 0.5). RESULTS: There were 105 eyes included. In group A (n= 46) mean visual acuity changed from 0.50 to 0.58 (p= 0.003), and from 0.55 to 0.55 in group B (n= 59, p= 0.83); mean percent change was 22.3% in group A and 3.5% in group B (p= 0.03). Visual improvement was identified in 25 eyes from group A (54.3%) and 19 from group B (32.2%, p= 0.019, RR 1.65); the difference only persisted when initial visual acuity was ≥ 0.5 (10 [40%], group A, 5 [14.7%], group B, p= 0.02, RR 2.72). CONCLUSION: Topical ketorolac was more effective than placebo to improve best corrected visual acuity in diabetic patients with focal macular edema.
Antecedentes: la fotocoagulación reduce la incidencia de pérdida visual en diabéticos con edema macular focal, aunque puede inducirla durante 6 semanas; la mejoría visual después del tratamiento es excepcional. El ketorolaco tópico puede limitar la inflamación causada por la fotocoagulación, y mejorar el desenlace visual. Objetivo: determinar la eficacia del ketorolaco tópico en la mejoría de la función visual después de la fotocoagulación, en diabéticos con edema macular focal. Material y métodos: estudio experimental, comparativo, prospectivo, longitudinal efectuado en diabéticos con edema macular focal, asignados al azar a dos grupos de tratamiento tópico durante 3 semanas después de la fotocoagulación (A: ketorolaco, B: placebo). En cada grupo se comparó la agudeza visual antes y después del tratamiento (t pareada) y entre grupos la proporción de ojos con mejoría visual (χ2). La evaluación se repitió con estratificación por agudeza visual inicial (≥ 0.5, < 0.5). Resultados: se analizaron 105 ojos; en el grupo A (n= 46) el promedio de agudeza visual cambió de 0.50 a 0.58 (p= 0.003), en el B (n= 59) de 0.55 a 0.55 (p= 0.83); el promedio del cambio porcentual fue 22.3% en el grupo A y 3.5% en el B (p= 0.03). Hubo mejoría visual en 25 ojos del grupo A (54.3%) y 19 del B (32.2%, p= 0.019, RR 1.65); la diferencia persistió cuando la agudeza visual inicial era ≥ 0.5 (10 [40%], grupo A, 5 [14.7%], grupo B, p= 0.02, RR 2.72). Conclusiones: el ketorolaco fue más eficaz que el placebo para mejorar la agudeza visual en pacientes diabéticos con edema macular focal.