The Effect of Switching Ranibizumab to Aflibercept in Refractory Cases of Macular Edema Secondary to Ischemic Central Vein Occlusion.

Background: Macular edema resulting from central retinal vein occlusion is effectively treated with anti-vascular endothelial growth factor injections. However, some patients need monthly retreatment and still show frequent recurrences. The purpose of this study was to evaluate the visual and anatomic outcomes of refractory macular edema resulting from ischemic central retinal vein occlusion in patients switched from ranibizumab to aflibercept intravitreal injections. Patients and Methods: We describe a retrospective series of patients followed in the Medical Retina Unit of the Jules Gonin Eye Hospital for macular edema due to ischemic central retinal vein occlusion, refractory to monthly retreatment with ranibizumab, and changed to aflibercept. Refractory macular edema was defined as persistence of any fluid at each visit one month after last injection during at least 6 months. All patients had to have undergone pan-retinal laser scan. Results: Six patients were identified, one of whom had a very short-term follow-up (excluded from statistics). Mean age was 57 ± 12 years. The mean changes in visual acuity and central macular thickness from baseline to switch were + 20.6 ± 20.3 ETDRS letters and - 316.4 ± 276.6 µm, respectively. The additional changes from before to after the switch were + 9.2 ± 9.5 ETDRS letters and - 248.0 ± 248.7 µm, respectively. The injection intervals could often be lengthened after the switch. Conclusions: Intravitreal aflibercept seems to be a promising alternative treatment for macular edema refractory to ranibizumab in ischemic central retinal vein occlusion.

Recurrent Macular Edema in Central Retinal Vein Occlusion Treated with Intravitreal Ranibizumab using a Modified Treat and Extend Regimen.

Background: The aim of this study was to evaluate the stability over time of the individually defined interval of intravitreal ranibizumab injection (IVR) for the treatment of recurrent macular edema (ME) in central retinal vein occlusion (CRVO). Patients and Methods: A case series of treatment naïve patients followed in the Jules Gonin Eye Hospital for macular edema due to central retinal vein occlusion is presented. Patients were treated monthly with IVR until complete absence of fluid on qualitative SD-OCT with a minimum of 5 monthly IVR. Thereafter, they were followed according to a modified treat and extend regimen (mTER). Results: Twelve eyes (12 patients) with ME due to CRVO were included. The mean follow-up period was 31.3 months. Analysis showed that best corrected visual acuity (BCVA), central macular thickness and qualitative spectral domain optical coherence tomography (SD-OCT) showed comparable results under monthly interval, after titration of an individualized interval and when performed in a series. 78 % of treating intervals were within ± 2 weeks of the first individually adjusted interval. The mean first defined interval was 4.3 weeks and the mean interval over time was 5.5 weeks (p = 0.003). There was a trend towards longer interval over time. Conclusion: The adjusted interval of retreatment of patients with ME due to CRVO showed a high stability with a trend toward longer duration over time. An mTER regimen seems to be valuable to follow patients with ME with good stabilization of VA.

Mikrozystisches Makulaödem bei Optikusatrophie: eine Fallserie Microcystic Macular Edema in Optic Nerve Atrophy: A Case Series.

Background:Microcystic macular edema can occur after optic neuropathies of various etiologies, and is easily demonstrated by OCT. We report a cohort of patients with microcystic macular edema. Patients and Methods: All patients with optic neuropathy and microcystic macular edema were enrolled. Demographics, visual function, retinal angiographies and OCT parameters were studied. Results: Nineteen patients (23 eyes) exhibited microcystic macular edema: 10 men/9 women, aged 17-91 years. Etiologies of optic nerve atrophy were compressive (5), inflammatory (4), glaucoma (3), ischemic (3), trauma (2), degenerative (1), and hereditary (1). Median visual acuity was 4/10 (NLP-12/10). Fluorescein angiography showed no leakage. Topography of the microcystic macular edema correlated with near infrared images but with visual field defects in only 26 %. OCT parameters were all abnormal. Conclusions: Microcystic macular edema is a non-specific manifestation from an optic neuropathy of any etiology. The precise mechanism leading to microcystic macular edema remains unknown but trans-synaptic retrograde degeneration with Müller cells dysfunction is likely. Zusammenfassung Hintergrund: Das mikrozystische Makulaödem kann im Rahmen einer Optikusatrophie jeglicher Ätiologie auftreten und ist leicht mit dem OCT zu erkennen. Wir berichten über eine Patientenkohorte mit mikrozystischem Makulaödem. Patienten und Methoden: Alle Patienten mit einer Optikusneuropathie und einem mikrozystischen Makulaödem wurden in diese Studie eingeschlossen. Die Demografie, die Sehfunktion, die Netzhautangiografie und die OCT-Parameter wurden untersucht. Ergebnisse: Neunzehn Patienten (23 Augen) hatten ein mikrozystisches Makulaödem: 10 Männer/9 Frauen im Alter von 17 bis 91 Jahren. Die Ursachen der Optikusatrophie waren Kompressionen (5), Entzündungen (4), Glaukom (3), Ischämien (3), Traumata (2), Degenerationen (1) und genetisch (1). Der mittlere Visus war 0,4 (keine Lichtwahrnehmung 1,2). In der Fluoreszenzangiografie fand sich keine Leckage. Das OCT des mikrozystischen Makulaödems korrelierte immer mit den Infrarot-Bildern (Nahaufnahme), jedoch nur in 26 % mit den Gesichtsfelddefekten. Alle OCT-Parameter waren abnormal. Schlussfolgerungen: Das mikrozystische Makulaödem ist eine unspezifische Manifestation einer Optikusneuropathie jeglicher Ätiologie. Der genaue Mechanismus, der zu einem mikrozystischen Makulaödem führt, ist unbekannt, eine trans-synaptische retrograde Degeneration mit Dysfunktion der Müller-Zellen ist jedoch wahrscheinlich.

Sustained-release steroids for the treatment of diabetic macular edema.

Glucocorticoids have been used for decades in the treatment of ocular disorders via topical, periocular, and more recently intravitreal routes. However, their exact mechanisms of action on ocular tissues remain imperfectly understood. Fortunately, two recently approved intravitreal sustained-release drug delivery systems have opened new perspectives for these very potent drugs. To date, among other retinal conditions, their label includes diabetic macular edema, for which a long-lasting therapeutic effect has been demonstrated both morphologically and functionally in several randomized clinical trials. The rate of ocular complications of intravitreal sustained-release steroids, mainly cataract formation and intraocular pressure elevation, is higher than with anti-vascular endothelial growth factor agents. Yet, a better understanding of the mechanisms underlying these adverse effects and the search for the minimal efficient dose should help optimize their therapeutic window.

Micro-implant d'acétonide de fluocinolone (ILUVIEN(®)) pour l'oedème maculaire diabétique chronique [Fluocinolone acetonide (ILUVIEN®) micro-implant for chronic diabetic macular edema].

Diabetic macular edema (DME) is a frequent complication of diabetic retinopathy and may cause severe visual loss. In this article, we examine the pathophysiology of DME and review various treatment options, such as laser photocoagulation, anti-vascular endothelial growth factor (VEGF) receptor antibodies, and steroids including ILUVIEN(®), which is a new sustained-release, non biodegradable, injectable, intravitreal micro-implant containing fluocinolone acetonide. The results of the FAME (Fluocinolone Acetonide in Diabetic Macular Edema) studies, conducted to evaluate the efficacy and safety of ILUVIEN(®) in DME, are discussed.

Caracteres das sementes, plântulas e plantas jovens de Ormosia arborea (Vell.) Harms E Ormosia fastigiata Tul. (Leg-papilionoideae)

Ormosia arborea (Vell.) Harms e Ormosia fastigiata Tul. são espécies similares em muitos caracteres morfológicos, o que resulta em dificuldade na sua identificação, tanto em campo quanto em material herborizado. Neste estudo foram descritas as características morfológicas das sementes e morfoanatômicas das plântulas e plantas jovens de O. arborea e O. fastigiata, coletadas em restinga e em mata ciliar, respectivamente. Sementes e plântulas foram processadas segundo técnicas usuais. As sementes de O. arborea são mais pesadas e têm germinação hipógea criptocotiledonar. O caule contém tricomas tectores esparsos e grande quantidade de lenticelas e, na raiz, nodulações. A folha apresenta parênquima paliçádico de células mais curtas, com base mais larga e presença de pigmentos vacuolares, espaços intercelulares conspícuos no parênquima esponjoso, tricomas tectores restritos à nervura principal e células epidérmicas da face adaxial maiores que as da face abaxial. A germinação de O. fastigiata é fanerocotiledonar, e a plântula possui muitos tricomas ao longo do caule e lenticelas restritas à região basal deste. As folhas apresentam tricomas tectores em todas as nervuras, com parênquima paliçádico de células tipicamente alongadas e parênquima esponjoso com espaços intercelulares reduzidos. Tais características são consistentes para separar as plântulas e sementes dessas espécies, que têm a mesma denominação popular e contribuem com informações úteis para o meio produtivo.

Using data mining to identify factors that influence the degree of leg injuries in broilers

Locomotor problems prevent the bird to move freely, jeopardizing the welfare and productivity, besides generating injuries on the legs of chickens. The objective of this study was to evaluate the influence of age, use of vitamin D, the asymmetry of limbs and gait score, the degree of leg injuries in broilers, using data mining. The analysis was performed on a data set obtained from a field experiment in which it was used two groups of birds with 30 birds each, a control group and one treated with vitamin D. It was evaluated the gait score, the asymmetry between the right and left toes, and the degree of leg injuries. The Weka ® software was used in data mining. In particular, C4.5 algorithm (also known as J48 in Weka environment) was used for the generation of a decision tree. The results showed that age is the factor that most influences the degree of leg injuries and that the data from assessments of gait score were not reliable to estimate leg weakness in broilers.

Edema pulmonar de reexpansão tratado com ventilação não invasiva: relato de caso

The authors report a case of Reexpansion Pulmonary Edema (RPE) seen at Hospital de Pronto Socorro de Porto Alegre 3 hours after drainage of spontaneous pneumothorax. The patient presented a unilateral pneumothorax with one-week duration. After pleural drainage respiratory failure occured being managed at the Intensive Care Unit with non-invasive positive pressure ventilation through facial mask. The patient had favorable outcome and was discharged asymtomatic after 72 hours.

Use of local muscle flaps to cover leg bone exposures

Objective: To evaluate the use of the medial gastrocnemius muscle and/or soleus muscle flaps as surgical treatment of the leg bone exposure.Methods: We retrospectively analyzed the medical records of patients undergoing transposition of the medial gastrocnemius and / or soleus for treating exposed bone in the leg, from January 1976 to July 2009, gathering information on epidemiological data, the etiology the lesion, the time between the initial injury and muscle transposition, the muscle used to cover the lesion, the healing evolution of the skin coverage and the function of the gastrocnemius-soleus unit.Results: 53 patients were operated, the ages varying between nine and 84 years (mean age 41); 42 were male and 11 female. The main initial injury was trauma (84.8%), consisting of tibia and / or fibula fracture. The most frequently used muscle was the soleus, in 40 cases (75.5%). The rank of 49 patients (92.5%) was excellent or good outcome, of three (5.6%) as regular and of one (1.9%) as unsatisfactory.Conclusion: the treatment of bone exposure with local muscle flaps (gastrocnemius and/or soleus) enables obtaining satisfactory results in covering of exposed structures, favoring local vascularization and improving the initial injury. It offers the advantage of providing a treatment in only one surgical procedure, an earlier recovery and reduced hospital stay.

Aborto em vacas na intoxicação experimental pelas favas de Stryphnodendron obovatum (Leg. Mimosoideae)

As favas maduras de Stryphnodendron obovatum Benth. procedentes de Mato Grosso, administradas a sete vacas com 3 a 7 meses de gestação, na dose de 5 g/kg/dia, durante 9 a 26 dias, causaram doença caractrizada por diminuição do apetite, diminuição da atividade ruminal, sialorréia, dificuldade em se levantar, andar desequilibrado, tremores musculares, acentuado emagrecimento e finalmente em 3 das 7 vacas, aborto entre 20 e 30 dias após o início da administração das favas; uma quarta vaca eliminou um feto mumificado 7 meses após o início do experimento. Três vacas deram nascimento a bezerros normais. Nos fetos abortados e nas placentas não foram verificadas lesões macroscópicas ou microscópicas dignas de nota. Os presentes experimentos confirmam as informações obtidas em fazendas do cerrado nos Estados de São Paulo e Mato Grosso sobre a ocorrência de aborto em vacas que ingerem as favas de S. obovatum.

Intoxicação por Senna occidentalis (Leg. Caesalpinoideae) em bovinos em pastoreio

São descritos três surtos da intoxicação por Senna occidentalis em bovinos em criação extensiva, exclusivamente em pastoreio, durante o outono e início do inverno, em três estabelecimentos do estado do Rio Grande do Sul. Os bovinos afetados tinham acesso a antigas lavouras de soja ou restevas de lavouras de soja e milho altamente infestados por fedegoso (S. occidentalis). No estabelecimento 1, de um total de 34 novilhas (de aprox. 18 meses de idade), 10 morreram (29,1%); no estabelecimento 2, morreram 9 (4,2%) de um total de 212 vacas prenhes e, no estabelecimento 3, morreram 6 (12,0%) de um total de 50 animais. O curso clínico variou de 3 a 6 dias, e os sinais clínicos incluíam urina marrom-escura, fraqueza muscular, tremores, andar cambaleante, decúbito esternal e morte. Os animais, mesmo em decúbito, permaneciam alerta e com reflexos normais, alimentando-se e bebendo água até poucas horas antes da morte. No estabelecimento 2, os bovinos começaram a adoecer 7 dias após terem sido retirados do campo infestado pela planta. As principais alterações observadas na necropsia foram áreas claras na musculatura esquelética, principalmente nos músculos dos membros posteriores e estrias esbranquiçadas na musculatura cardíaca. A principal lesão microscópica era de degeneração e necrose nos músculos esqueléticos (miopatia degenerativa tóxica multifocal multifásica). Os dados epidemiológicos, clínicos, de necropsia e histopatológico permitiram concluir pelo diagnóstico de intoxicação por S. occidentalis, nesses três surtos.

Histological changes caused by experimental Riedeliella graciliflora (Leg. Papilionoideae) poisoning in cattle and laboratory animals

Tissues from cattle, mice, rats and guinea pigs experimentally intoxicated by Riedeliella graciliflora were studied histologically. Cattle lymph nodes, spleen, Peyer patches and peribronchial lymphoid tissues had diffuse necrosis of lymphocytes, mainly in the germinal centers of the follicles. This lesion was less severe in laboratory animals. All species had severe enteritis with infiltration of the lamina propria by mononuclear cells. Some cells in this infiltrate were necrotic. Degeneration and necrosis of the epithelial cells, mainly in the tip of the villi, and detachment of the epithelial lining from the lamina propria were also observed. In the liver the trabecular structure was disrupted and the hepatocytes had some degree of individual necrosis and degeneration. A tubular nephrosis was observed in the kidneys. Liver, lung, kidney, intestine and lymph nodes had different degrees of congestion. Those lesions are similar than those caused by Polygala klotzschii, a plant that contains 5-metoxi-podophyllotoxin.