Jacqueline Coblentz

Multiple pregnancies and its relationship with the development of retinopathy of prematurity (ROP).

Background The influence of multiple gestation on the occurrence of retinopathy of prematurity (ROP) is still not completely understood. Objectives To verify the incidence of any stage of ROP and threshold ROP in singletons and in multiple gestation among preterm infants. Methods This was an institutional, prospective, and descriptive cohort study, which included preterm newborns with birth weight (BW) of 1500 g or less and/or gestational age (GA) of 32 weeks or less, as admitted to the neonatal units at Laranjeiras and Amparo Hospitals in Rio de Janeiro, Brazil, between January 2001 and July 2005, and whom remained hospitalized for at least 28 days. There were no exclusion criteria. Patients were divided into two groups: Group 1 included multiples; and Group 2 consisted of singletons. Results A total of 159 infants that remained in neonatal unit care for at least 28 days were included in this study. Group 1 comprised 56 (35%) multiples; and Group 2 comprised 103 (65%) singletons. Mean BW was 1072 g ± 272 and 1089 g ± 282 in Groups 1 and 2, respectively (analysis of variance [ANOVA] P > 0.05). Mean GA among multiple gestation (Group 1) was 29 weeks ± 2.1; and 29 weeks ± 2.4 among singletons (Group 2) (ANOVA P > 0.05). Days in oxygen therapy ranged from 0 to 188 days. Median among Group 1 was 15 days, while median in Group 2 was 10 days (Kruskal–Wallis P > 0.05). Any stage ROP was detected in 66 (41.5%) of the whole cohort comprising 159 babies. Among the 56 multiples, 30 (53.6%) achieved any stage ROP, and among 103 singletons, 36 (35%) achieved any stage ROP (Chi-square test P < 0.05). Threshold ROP occurred in 12 (7.5%) of the 159 patients included. Three (5.3%) patients from Group 1 and nine (8.7%) patients in Group 2 reached threshold ROP needing laser treatment (Fisher’s exact test P > 0.05). Conclusion This study showed higher frequency of any stage of ROP in twins and triplets but not regarding threshold disease. Because of the relatively small number of patients in this sample, other studies are necessary to determine if gemelarity plays a role in the occurrence of ROP.

Mydriatic and cardiovascular effects of phenylephrine 2.5% versus phenylephrine 10%, both associated with tropicamide 1%.

Background/Aims: To evaluate and compare cardiovascular effects (blood pressure and heart rate) of phenylephrine 2.5% versus phenylephrine 10%, and compare pupil diameter before and after instillation of eyedrops. Methods: A total of 58 patients scheduled for funduscopy were dilated with either phenylephrine 2.5% and tropicamide 1% (group 0, n = 29 patients, 58 eyes) or phenylephrine 10% and tropicamide 1% (group 1, n = 29 patients, 58 eyes). Only one drop per eye of each drug was administered. In both groups, pupil diameter, blood pressure and heart rate were measured before and 40 min after eyedrop instillation. Results: We did not observe significant changes in blood pressure or heart rate. Mean pupil diameter in group 0, before the instillation of eyedrops, was 3.51 mm and, in group 1, 2.66 mm. After medication, mean values were 7.38 mm in group 0 and 7.42 mm in group 1. Mean variation was 3.87 mm in group 0 and 4.76 mm in group 1 (p < 0.001). Conclusion: Our results corroborate the finding that one single drop of either 2.5 or 10% phenylephrine is safe and, when 1% tropicamide is combined, satisfactory pupil dilation is achieved.

Comparison between Obtained Mydriasis in Type 2 Diabetics and Non-Diabetic Patients

Background/Aims: To evaluate and compare obtained mydriasis with phenylephrine 10% associated with tropicamide 1% in type 2 diabetics and non-diabetic patients. Methods: A total of 50 patients (100 eyes) scheduled for fundoscopy were dilated with phenylephrine 10% and yropicamide 1% (group 0: n = 20 type 2 diabetic patients, 40 eyes, and group 1: n = 30 non-diabetic patients, 60 eyes). Only one drop per eye of each drug was administered. In both groups, pupil diameter was measured after 40 minutes of eye drops instillation. Results: Both groups were similar regarding age (p = 0.06, Mann-Whitney test). Mean pupil diameter in group 0 was 8.57 and 8.73 in group 1. There was no statistic difference between both groups (p = 0.44). Pupil diameter was greater than 7 mm in all patients (100%). Conclusion: When an appropriate drug combination is used, diabetic patients can achieve mydriasis as satisfactory as non-diabetic patients, allowing adequate fundus examination and/or retinopathy treatment.

Aspectos atuais na fisiopatologia do edema macular diabético

Macular edema is the leading cause of poor vision in diabetic patients.The mechanism of edema formation is complex and involves biochemical and structural changes. The authors review and update the physiopathologic concepts related to diabetic maculopathy.

Prevalência de diabetes mellitus tipo 2 e outros fatores de risco associados em pacientes com glaucoma

PURPOSE: To evaluate prevalence of diabetes mellitus in a group of patients with glaucoma; to verify if there is association between diabetes mellitus and glaucoma; to verify other associated risk factors. METHODS: Fifty(50) glaucoma patients had their medical records analyzed in a retrospective way. Registered data included sex, age, ethnic group, family history of glaucoma and personal history of type 2 diabetes mellitus. RESULTS: Five (10%) of all evaluated patients had type 2 diabetes mellitus. 3 of them were female and 2 were male, median age of 81 years old (71-88). Prevalence of diabetes in glaucoma patients did not show significant differences. (OR: 1.476; 95% Confidence Interval: 0.4438 to 4.910; p= 0.5352) when compared to the prevalence of type 2 diabetes mellitus in general brazilian population (7.6%). CONCLUSION: In this group of patients with glaucoma, prevalence of type 2 diabetes mellitus was slightly higher than in general population. However, no association was found between diabetes mellitus and glaucoma.

Pretreatment of RPE Cells with Lutein Can Mitigate Bevacizumab-Induced Increases in Angiogenin and bFGF

Purpose: To determine whether pretreatment of retinal pigmented epithelial (RPE) cells with lutein can affect the response of cells to bevacizumab therapy. Methods: One human RPE cell line (ARPE-19) was used for all experiments. The cells were treated with lutein in different concentrations (0.01, 0.1, 1, 10, or 100 μg/ml). After 24 h, all plates were treated with bevacizumab (0.25 mg/ml). Media were harvested 24 h later for sandwich ELISA-based angiogenesis arrays. A Quantibody Human Angiogenesis Array was used in order to quantify the secretion of the following 10 proangiogenic cytokines: angiogenin, ANG2, EGF, bFGF, HB-EGF, PDGF-BB, leptin, PIGF, HGF and VEGF. Results: Treatment with bevacizumab alone led to a significant decrease in VEGF, as well as a significant increase in angiogenin and bFGF. Pretreatment with 0.1 and 1.0 μg/ml of lutein led to significant decreases in both bFGF and angiogenin following treatment with bevacizumab compared to bevacizumab treatment alone. Lutein alone did not modify the secretion of proangiogenic cytokines. Conclusions: Pretreatment of human RPE cells in culture with specific doses of lutein prior to bevacizumab treatment mitigated the increase in bFGF and angiogenin caused by bevacizumab monotherapy.

Aspectos atuais no diagnóstico do edema macular diabético

O diagnostico do edema macular diabetico deve ser feito precocemente, a fim de evitar perda visual significativa. Para tal, contamos com exames complementares cada vez mais desenvolvidos e especificos. Os autores fazem uma revisao dos principais metodos existentes para diagnosticar a retinopatia diabetica.

Telangiectasia retiniana parafoveal unilateral

Telangiectasia retiniana e um termo inicialmente proposto por Reese, em 1956. Caracteriza-se por uma anormalidade vascular retiniana, com dilatacao irregular e incompetencia dos vasos. E.L.S., 44 anos, sexo masculino, branco, do Rio de Janeiro, com queixa de perda progressiva da visao em olho esquerdo (OE). Ao exame observamos acuidade visual (AV) corrigida de 20/20 em olho direito (OD) e 20/100 em OE. A fundoscopia, OD normal e OE apresentando dilatacao capilar e exsudatos duros com aspecto circinado na regiao macular. Angiografia fluoresceinica e, apos o resultado, injecao intravitrea de triancinolona em OE (4mg/0,1ml). Apos um mes da injecao de triancinolona a AV em OE passou a 20/40, os exsudatos duros tornaram-se mais visiveis e a angiografia mostrou diminuicao do vazamento do corante. Foi possivel a realizacao de fotocoagulacao com laser. A AV final corrigida foi de 20/20 em ambos os olhos. O tratamento com laser esta amplamente difundido na literatura, porem optamos inicialmente pela injecao intravitrea de triancinolona. Pode-se considerar a injecao intravitrea de triancinolona em casos de telangiectasia retiniana parafoveal com reducao importante da visao e alteracoes muito proximas a regiao avascular foveal. Entretanto, os resultados em longo prazo nao sao conhecidos e precisam ser confrontados com as outras opcoes de tratamento.