Navegando por Palavras-chave "diabetic macular edema"

Agora exibindo 1 - 3 de 3
  • Imagem de Miniatura
    Item
    Acesso aberto (Open Access)
    Ensaio clínico randomizado multicêntrico para avaliar a eficácia de injeções intravítreas de bevacizumabe, triancinolona ou de sua combinação no tratamento do edema macular diabético
    (Universidade Federal de São Paulo (UNIFESP), 2015-07-31) Oliveira Neto, Hermelino Lopes de [UNIFESP]; Mattos Junior, Rubens Belfort [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    In diabetic patients, it is estimated that the risk of blindness is twenty times higher than the normal population and approximately 19% of blindness in the world are caused by diabetes mellitus (DM). In Brazil, diabetic retinopathy (DR), a specific microvascular complication, is among the leading causes of irreversible blindness, affecting 7.6% of the population according to the Ministry of Health, and this disease accounts for 4.6% of severe visual impairments. The diabetic macular edema (EMD) is the primary mechanism for vision lossin patients with non-proliferative DR. It arises due to secondary formation of micro aneurysms, changes in the blood-retinal barrier, increasedinflammation and angigenic factors that promote increase in thevascular permeability abd consequent leakage of fluid and lipids to the retina. The EMD treatment includes laser photocoagulation, intravitreal injection of anti-angiogenic drugs or steroids.The aim of this study was to evaluate and compare the efficacy and adverse effects of intravitreous injections of bevacizumab, triancinolone or their combination in the treatment of clinically significant diabetic macular edema through tests of visual acuity and IOP measurements and central macular thickness. This study included142 patients with diabetic retinopathy and clinically significant macular edema from eight cities. It is a randomized, multicenter and masked study. Patients underwent ophthalmologic examination and optical coherence tomography (OCT). Afterwards they were divided into three treatment groups: (1) Bevacizumab-1.25mg /0.05ml; (2) triamcinolone-4mg /0.1ml; (3) Bevacizumab+triancinolone. The obtained average age was 58.8 years for the BEVACIZUMABE group, 57.1 years for the TRIANCINOLONE group and 61years for BEVACIZUMABE+TRIANCINOLONE group(p =0.716). We observed statistically significant improvement in visual acuity (>4lines) in all groups, comparing the results of week 24 with the baseline visit. At week 24 there was no significant difference in the visual acuity between the 3 groups (p =0.436). It was observed reduction in macular thickness in all thegroups (BEVACIZUMABE=103?m, TRIANCINOLONE=160 micrometres BEVACIZUMABE TRIANCINOLONE+=125um), and the TRIANCINOLONE group showed significantly less thick(247 microns) than the bevacizumab group (287 microns). In all groups, there was an IOP increase, and the TRIANCINOLONE group had higher mean value of IOP throughout the study period (18 mmHg) .The average number of injections was higher in the BEVACIZUMABE group (3.2 injections), followed by BEVACIZUMABE+TRIAMCINOLONE (2.4 injections) and TRIANCINOLONA (2.1injections) group.In this investigation no severe adverse event was observed. At the end of the study, there was no significant difference between the groups regarding the visual acuity, intraocular pressure and central macular thickness.
  • Nenhuma Miniatura disponível
    Item
    Somente Metadadados
    Impact of Insulin Treatment in Diabetic Macular Edema Therapy in Type 2 Diabetes
    (Elsevier B.V., 2015-02-01) Matsuda, Simone [UNIFESP]; Tam, Tiffany; Singh, Rishi P.; Kaiser, Peter K.; Petkovsek, Daniel; Zanella, Maria Teresa [UNIFESP]; Ehlers, Justis P.; Cleveland Clin Fdn; Universidade Federal de São Paulo (UNIFESP)
    Objective: To evaluate the impact of insulin therapy on the outcomes of diabetic macular edema (DME) treatment with vascular endothelial growth factor (VEGF) inhibitors in people with type 2 diabetes.Methods: A retrospective consecutive case series of 95 patients with type 2 diabetes and DME who were treated with anti-VEGF therapy. We examined 2 cohorts: patients taking only oral antidiabetic agents and patients on insulin therapy. the main outcome measures were change in visual acuity and change in central subfield macular thickness measured by spectral-domain optical coherence tomography. the additional variables analyzed included glycated hemoglobin (A1C), creatinine, blood pressure and body mass index and their correlations with clinical findings.Results: Both groups had a statistically significant improvement in visual acuity (oral antidiabetic agents group: 20/61 to 20/49, p=0.003; insulin therapy group: 20/76 to 20/56, p=0.005). There was no difference between groups at initial or 12-month examination (p=0.239 and p=0.489, respectively). From an anatomic standpoint, central subfield macular thickness also improved significantly in both groups: from 454.7 mu m to 354.9 mu m (p<0.001) in the oral antidiabetic agents group and from 471.5 mu m to 368.4 mu m (p<0.001) in the insulin therapy group. Again, there was no significant difference between groups at initial or 12-month follow-up examinations (p=0.586 and p=0.591, respectively). Mean A1C levels remained relatively stable during the follow up in both groups.Conclusion: Anti-VEGF therapy is a useful treatment for DME. This study Suggests that chronic insulin therapy, compared with oral antidiabetic agents, does not modify the anatomic or functional effectiveness of DME treatment. (C) 2015 Canadian Diabetes Association
  • Nenhuma Miniatura disponível
    Item
    Somente Metadadados
    Twelve-month safety of intravitreal injections of bevacizumab (Avastin (R)): results of the Pan-American Collaborative Retina Study Group (PACORES)
    (Springer, 2008-01-01) Wu, Lihteh; Martinez-Castellanos, Maria A.; Quiroz-Mercado, Hugo; Arevalo, J. Fernando; Berrocal, Maria H.; Farah, Michel E.; Maia, Mauricio; Roca, Jose A.; Rodriguez, Francisco J.; Pan Amer Collaborative Retina Grp; Inst Cirugia Ocular; Asociac Para Evitar Ceguera; Clin Oftalmol Caracas Ctr; Univ Puerto Rico; Universidade Federal de São Paulo (UNIFESP); Clin Ricardo Palma; Fdn Oftalmol Nacl
    Background Vascular endothelial growth factor (VEGF) plays an important role in many diseases of the posterior pole that are characterized by macular edema and/or intraocular neovascularization. Recently anti-VEGF agents such as ranibizumab and pegaptanib sodium have been shown to be beneficial in the treatment of choroidal neovascularization (CNV) secondary to age-related macular degeneration (ARMD). However in most parts of the world, both pegaptanib sodium and ranibizumab are not readily available. Bevacizumab, a humanized recombinant monoclonal IgG antibody that binds and inhibits all VEGF isoforms, has been proposed as an alternative treatment option.Methods A total of 1,265 consecutive patients were injected with bevacizumab for diseases such as proliferative diabetic retinopathy, diabetic macular edema, retinal vein occlusions, and CNV of several etiologies including ARMD at eight Latin American institutions from 1 September 2005 to 31 January 2006. of these 1,265, 92 were excluded because they were injected once and lost to follow-up. the remaining 1,173 patients constitute the subjects of this retrospective, multicenter, open label, uncontrolled interventional case series that reports the cumulative systemic and ocular adverse events following intravitreal bevacizumab during 12 months of follow-up. Patients were examined at baseline and then monthly. If the patients were unable to attend the 12-month visit, a telephone interview was conducted to assess for possible systemic complications.Results A total of 4,303 intravitreal injections of bevacizumab on 1,310 eyes was reported. All 1,173 patients were accounted for at the 12-month visit. Systemic adverse events were reported in 18 (1.5%) patients. These included seven (0.59%) cases of an acute elevation of systemic blood pressure, six (0.5%) cerebrovascular accidents, five (0.4%) myocardial infarctions, two (0.17%) iliac artery aneurysms, two (0.17%) toe amputations and five (0.4%) deaths. Ocular complications included seven (0.16%) bacterial endophthalmitis, seven (0.16%) tractional retinal detachments, four (0.09%) uveitis, and a case (0.02%) each of rhegmatogenous retinal detachment and vitreous hemorrhage.Conclusions Despite the limited follow-up, repeated intravitreal injections of either 1.25 mg or 2.5 mg of bevacizumab appears to be safe and well tolerated during the 1st year.