Fernando Korn Malerbi

Impaired awareness of hypoglycemia is associated with progressive loss of heart rate variability in patients with type 1 diabetes

Background Hypoglycemia unawareness affects approximately 25% of patients with type 1 diabetes and is strong associated with severe hypoglycemia. Cardiovascular Autonomic Neuropathy (CAN) is one important factor related to hypoglycemia unawareness, although its role is not fully understood due to conflicting data in the literature. Heart rate variability (HRV) in time and frequency domain has been described as a more accurate method to assess CAN. The objective of the present study was to investigate the relationship between hypoglycemia unawareness and autonomic dysfunction assessed by HRV in time and frequency domain.

Indocyanine green-mediated photothrombosis for choroidal neovascularization in angioid streaks

PURPOSE To investigate the effect of indocyanine green-mediated photothrombosis on choroidal neovascularization secondary to angioid streaks. METHODS Six eyes of 5 patients with an average age of 70 years were diagnosed to have subfoveal choroidal neovascularization secondary to angioid streaks. Therapy was indicated if choroidal neovascularization was considered to be active, according to evidence of fluorescein leakage on angiograms, as well as presence of intra- or subretinal fluid on optical coherence tomography. Patients received photothrombosis at baseline with retreatment as necessary at 3, 6 and 9 months follow-up. Fluorescein leakage was assessed at 3, 6 and 9 months, along with foveal thickness measured by optical coherence tomography. Indocyanine green angiography was performed initially and whenever retreatment was considered. Retreatment was performed whenever there was evidence of increased leakage on fluorescein angiograms at follow-up visits. RESULTS The mean follow-up was 13.3 months. All eyes had at least 12 months follow-up. Two eyes underwent retreatment. Three eyes had visual acuity improvement and three eyes had stabilization. All patients showed less fluorescein leakage on final angiograms and reduced foveal thickness upon optical coherence tomography measurement. CONCLUSION Photothrombosis is a feasible procedure for choroidal neovascularization secondary to angioid streaks. Lesion analysis showed anatomical improvement in most cases in this series. Further studies are warranted to evaluate long-term results of this treatment.

Microalbuminuria is associated with increased choroidal thickness in type 1 diabetes mellitus patients without diabetic retinopathy

pattern was observed for CPFT. SCT decreased from 245 57 lm at treatment start and remained decreased throughout the follow-ups. On average, 7.6 3.4 injections were given per eye. Only seven eyes (24%) needed additional PDT. No major adverse events, retinal detachment or endophthalmitis were observed. A Kaplan–Meier analysis showed that eyes in need of retreatment were 88% after 12 months and 59% after 24 months (Fig. 1). This is one of few studies to report treatment results of PCV in Caucasians and the first study to report results of aflibercept treatment beyond the first year. We ran the analyses separately for the treatment-na€ıve, which did not change the direction of the results or the conclusions. Overall, we found a short-term improvement in the BCVA, which on long term was more of a stabilization. Unlike in our Caucasian patients, lesions are more often located macular in Asians, which may explain why Asians present with a worse baseline BCVA but also experience a better treatment response (Kikushima et al. 2017; Lee et al. 2017). Hence, the relative worse response in terms of BCVA improvement in our Caucasian patients is likely a question of more peripherally located lesions that remains relatively unaffected by anatomical improvements from the treatment.

Prevalence and risk factors for referable diabetic retinopathy in patients with type 1 diabetes: a nationwide study in Brazil

Department of Ophthalmology, State University of Rio de Janeiro, Rio de Janeiro, Brazil; Department of Ophthalmology, Federal University of S~ao Paulo, S~ao Paulo, Brazil; Department of Ophthalmology, Federal Hospital of the Servers of Rio de Janeiro, Rio de Janeiro, Brazil; Department of Internal Medicine, Diabetes Unit, State University of Rio de Janeiro, Rio de Janeiro, Brazil; Department of Ophthalmology, Center of Endocrinology and Diabetes of the State of Bahia, Salvador, Brazil; Department of Ophthalmology, Regional hospital of Taguatinga, Bras ılia, Brazil; Department of Ophthalmology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil; Department of Ophthalmology, University of Campinas, Campinas, S~ao Paulo, Brazil; Diabetics Association of Bauru, S~ao Paulo, Brazil; Department of Endocrinology and Ophthalmology, Federal University of S~ao Paulo, S~ao Paulo, Brazil

Association between severity of hypoglycemia and loss of heart rate variability in patients with type 1 diabetes mellitus

The occurrence of hypoglycemia has been associated with the presence of cardiovascular autonomic neuropathy. Cardiovascular autonomic reflex tests are the gold standard diagnostic method for cardiovascular autonomic neuropathy. Nevertheless, impaired heart rate variability indices on spectral analysis have been reported before cardiovascular autonomic reflex test abnormalities arise. The objective of the present study was to analyse the association between the severity of hypoglycemia and indices of heart rate variability on spectral analysis.