Navegando por Palavras-chave "Diabetic Retinopathy"

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    Comparação entre as técnicas de panfotocoagulação utilizando laser 577 nm de multidisparos versus panfotocoagulação convencional no tratamento da retinopatia diabética
    (Universidade Federal de São Paulo (UNIFESP), 2021) Passos, Renato Magalhaes [UNIFESP]; Farah Neto, Michel Eid [UNIFESP]; Universidade Federal de São Paulo
    Purpose: To compare the outcomes after panretinal photocoagulation (PRP) with two different strategies for treating diabetic retinopathy (DR), based in criteria such as laser parameters, therapeutic response, and patient tolerance. Methods: This single-center, randomized clinical study included 41 eyes with proliferative or severe non-proliferative DR. They were treated in group 1 with 577 nanometer (nm) multispot laser and 20 milliseconds (ms) pulse duration, while in group 2 they were treated with so-called conventional PRP with 532 nm single-spot laser and 100 ms pulse duration. The outcomes included functional evaluation with best-corrected visual acuity (BCVA) and structural evaluation with imaging methods (OCT and fluorescein angiogram) at baseline, 6 and 12 months. Other variables included laser parameters, number of PRP applications required, and results of a subjective pain analysis. Results: The multispot laser (group 1) required fewer PRP applications and more laser spots delivered (P<0.001) to compensate for lower fluence/pulse duration and provided a similar pain sensibility compared with single-spot laser. Both groups maintained the initial VAs and CRTs; about 50% of cases had vitreomacular interface changes and improved macular edema, with similar angiographic improvements after 12 months. New vessels regression was seen less frequently in both groups, possibly because of baseline disease severity rather than the treatment modality. Conclusions: Multispot laser demonstrated to be equivalent and non-inferior to conventional treatment with single spot laser for diabetic retinopathy, offering some advantages such as smaller number of sessions to finish PRP and a lower fluence to obtain the desired results, producing less retinal iatrogenic damage.
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    Estatinas e fibratos na retinopatia diabética. Revisão sistemática
    (Universidade Federal de São Paulo (UNIFESP), 2020-10-29) Mozetic, Vania [UNIFESP]; Riera, Rachel [UNIFESP]; Universidade Federal de São Paulo
    Objective: To evaluate the effects (benefits and risks) of using statins or fibrates for diabetic retinopathy. Methods: Systematic review of randomized controlled trials (RCTs) following the Cochrane Handbook for Systematic Reviews of Interventions and evaluating the effects of statins and fibrates for the prevention or treatment of diabetic retinopathy. The following electronic databases were used: CENTRAL, MEDLINE, Embase, LILACS, Open Grey, and manual search was performed. There was no language restriction or publication data. Primary outcomes: incidence and progress assessed by ETDRS (Early Treatment Diabetic Retinopathy Study) (or a similar tool and severe adverse events. Secondary outcomes: worsening of visual acuity, proliferative development, non-severe adverse events, and quality of life. Study selection, data extraction, and risk assessment of the included studies were performed by two reviewers independently. The risk of bias was assessed using the Cochrane Bias Risk Table, and the certainty of the final body of evidence was assessed according to the GRADE (Grades of Recommendation, Assessment, Development and Evaluation) approach. For dichotomous variables, the relative risk (RR) was calculated to estimate the effect size. When data were available, a quantitative demonstration was performed using the Review Manager 5.3 program, using random-effects models. Results: Eight RCTs were included that evaluated the effects of fibrates (n = 4), statins (n = 3) or the fibrate-statin combination (n = 1) for the treatment (n = 8) or prevention (n = 3) of diabetic retinopathy. The risk of bias of the included RCTs was mainly due to incomplete outcome data (high loss rate in five RCTs) and the absence of a published protocol for seven RCTs. Results showed that fibrates appear to be associated with a 45% reduction in the risk of macular edema (relative risk [RR]: 0.55 95% confidence interval [95% CI]: 0.38 to 0.81, 1309 participants, 2 RCTs, heterogeneity [I2] = 0%, evidence of low certainty). The risk of adverse events was similar between fibrate and placebo, but due to the wide confidence intervals, a significant increase in adverse events associated with fibrate use cannot be ruled out. The certainty of the evidence for the other outcomes ranged from very low to low, and it was not possible to be sure about the effects of fibrates on diabetic retinopathy. For statins, there was no statistical significance for the quantitative and qualitative syntheses. The effects of statins are uncertain, and no conclusions can be drawn because of the poor evidence quality of RCTs (for the outcomes incidence and progression of retinopathy and visual acuity) or due to the lack of measurement or reporting (for the outcomes quality of life, adverse events, Abst ract XXII and progression to proliferative disease). There seems to be no benefit of the combination fibrate-statin on visual acuity (worsening by more than 15 letters, LogMAR (Logarithm of the Minimum Angle of Resolution) with OR 0.93; 95% CI 0.79 to 1.1, evidence of certainty) and progression to a proliferative form of the disease (OR 0.51; 95% CI 0.22 to 1.22; in 1583 participants; evidence of poor certainty), but further studies may likely modify this estimate once that current evidence is limited. Adverse events and quality of life were not measured or reported for this combination. Conclusions: This systematic review identified eight RCTs with limited methodological quality and quality of evidence ranging from very low to moderate that evaluated the effects of fibrates and or statins on diabetic retinopathy. Based on the findings of these RCTs, fibrates seem to reduce the incidence of macular edema (evidence of low certainty) without increasing adverse events (evidence of very low to low certainty). There is uncertainty about the effects of statins alone or associated with fibrates for this purpose.