Types of diabetic macular edema assessed by optical coherence tomography.

Types of diabetic macular edema assessed by optical coherence tomography.

Koleva-Georgieva DN, Sivkova NP.
Department of Ophthalmology, Medical University, Plovdiv, Bulgaria.

AIM: To assess the types of diabetic macular edema (DME) in patients with type 2 diabetes mellitus by analyzing retinal thickness, morphology and presence of macular traction using optical coherence tomography (OCT).

PATIENTS AND METHODS: This prospective study included 74 diabetics with diabetic retinopathy (DR) (141 eyes), 29 diabetics without DR (57 eyes) and 25 healthy volunteers (39 eyes). The ophthalmic examination included best corrected visual acuity, stereo-ophthalmoscopy, fluorescein angiography and OCT. DME assessment was based on the analysis of several OCT features: macular thickness, retinal morphology and presence of macular traction--vitreomacular and/or from epiretinal membranes. Four OCT types of DME were suggested: type 1--early, type 2--simple, type 3--cystoid (3a--mild, 3b--intermediate, 3c--severe) and type 4--serous macular detachment. The distribution of the DME types and their correlation with retinal thickness and visual acuity were analyzed.

RESULTS: The distribution of eyes with DME was: type 1--14.1%, type 2--30.4%, type 3--45.7% (3a--14.1%, 3b--12%, 3c--19.6%) and type 4--9.8%. Macular traction with retinal distortion was detected in 31.5% of the eyes with DME. Retinal thickness at the fixation point was 176 +/- 16.8 microm (116 microm / 210 microm) in healthy eyes and 182.2 +/- 19.6 microm (138 microm / 212 microm) in eyes without DR. There was no statistically significant difference between the two groups (Independent samples test, P less then 0.05). The retina was significantly thicker in eyes with early DME (232.9 plus/minus 7.9 microm) than in healthy eyes and eyes without DR (Independent samples test, F = 16.274 and F = 13.100, P less then f equals 16.692.

CONCLUSION: OCT precisely differentiated 4 types of DME: early, simple, cystoid and serous macular detachment, as well as determined the presence of macular traction. The early diagnosis, high precision in retinal thickness measurement, assessment of the morphologic types and macular traction are of uppermost importance in determining the therapeutic approach, prognosis and the effect of treatment.

PMID: 19009748 [PubMed - in process]

Aplastic anemia induced disc edema and visual loss in pregnancy: a case report.

Aplastic anemia induced disc edema and visual loss in pregnancy: a case report.

Published: 18 November 2008

Gupta SK, Brar VS, Murthy RK, Chalam KV.

Background

A case of aplastic anemia diagnosed during pregnancy, which developed bilateral disc edema and acute pre-retinal hemorrhage leading to vision loss. Case report: A 20 year old primagravid female developed acute vision loss in her right eye, during hospitalization for treatment of aplastic anemia diagnosed during her pregnancy. Her best-corrected visual acuity (BCVA) was hand motions and fundus evaluation revealed a large pre-macular hemorrhage in the right eye (OD) and bilateral disc edema. Neuro-imaging studies did not reveal any signs of intracranial mass lesion or edema.

Conclusion

There was resolution of the disc edema with improvement in the pre-macular hemorrhage resulting in 20/50 vision in the right eye, following supportive transfusions. Ophthalmic manifestations developing in a pregnant patient with aplastic anemia can be successfully managed with supportive care including red blood cell and platelet transfusions.

Cases Journal

Improved persistence and adherence to diuretic fixed-dose combination therapy compared to diuretic monotherapy - edema

Improved persistence and adherence to diuretic fixed-dose combination therapy compared to diuretic monotherapy.

BMC Fam Pract. 2008 Nov

ABSTRACT: BACKGROUND: Diuretics are recommended as initial treatment for hypertension. Several studies have suggested suboptimal persistence and adherence to thiazide diuretic monotherapy; this study compared patient persistence and adherence with hydrochlorothiazide (HCTZ) monotherapy to fixed-dose combinations containing HCTZ.

METHODS: Patients with at least one prescription claim during 2001 to 2003 for either HCTZ or one of the following fixed-dose combinations: angiotensin-receptor blockers/HCTZ (ARB/HCTZ), angiotensin-converting enzyme inhibitor/HCTZ (ACEI/HCTZ), or beta blockers/HCTZ (BB/HCTZ) were identified. Patients were required to be continuously benefit-eligible six months pre- and one year post-index date, and to have no prescription claims for any antihypertensive therapy six months prior to the index date. Patients were followed for one year to assess persistence, medication possession ratio (MPR), adherence (MPR >80%), and proportion of days covered (PDC) with initial antihypertensive therapy. Logistic regression was used to calculate adjusted odds ratios for persistence, adherence and PDC, adjusted for age, gender, business segment, RxRisk disease categories, average co-pay and concurrent cardiovascular-related medication utilization. RESULTS: The study cohort consisted of 48,212 patients; 72.5% used HCTZ, 13.2% ACEI/HCTZ, 9.3% ARB/HCTZ, and 5.0% BB/HCTZ. Mean age was 53.7 years and 66.5% were female. A significantly lower proportion of patients using HCTZ (29.9%) remained persistent with therapy at 12 months compared with ARB/HCTZ (52.6%; OR=0.37, CI=0.36, 0.38), ACEI/HCTZ (51.4%; OR=0.38, CI=0.37, 0.39), and BB/HCTZ (51.9%; OR=0.38, 0.37, 0.40). Similarly, PDC was lower for HCTZ patients (32.5%) as compared to ARB/HCTZ (53.7%; OR=0.39, CI=0.37, 0.40), ACEI/HCTZ (50.9%; OR=0.42, CI=0.40, 0.43), and BB/HCTZ (51.3%; OR=0.44, CI 0.42, 0.45). MPR was also significantly lower for HCTZ patients as compared to those using fixed-dose combination therapies.

CONCLUSIONS: Initiating HCTZ fixed-dose combination therapy with an ACEI, ARB, or BB was associated with greater persistence and adherence as compared to HCTZ monotherapy. Further research is needed to determine the relationship between improved persistence and adherence with blood pressure control.

BioMed Central

[Pre-eclampsia (edema) screening in first and second trimester

[Pre-eclampsia screening in first and second trimester
Ther Umsch. 2008 Nov

Kang A, Struben H.
Frauenklinik, Universitätsspital Basel.

Pre-eclampsia is a pregnancy-associated disease of the second part of the pregnancy, occuring mainly after 20 weeks gestation. The prevalence of hypertension in pregnancy is between 5 to 11% and affects mainly women under 20 years of age. An inadequate invasion of trophoblasts with consequential placental ischemia as a result of insufficiently dilatated uterine spiral arteries is thought to be an initial cause in the pathogenesis of pre-eclampsia. The clinical symptoms of pre-eclamsia, such as loss of intravascular volume and edema, are caused by generalized endothelial dysfunction. These symptoms are potentiated by hypertension and reduced colloid osmotic pressure in the plama. The organs being affected by pre-eclamsia are those of the vascular-, hepatic-, renal-, cerebral- and coagulatory systems. The prognosis is much more severe when pre-eclampsia develops very early in the pregnancy. The symptoms include elevated blood pressure (over 140 mmHg systolic, 90 mmHg diastolic) combined with proteinuria. Frequent symptoms are hyperreflexia and edema. The etiology of pre-eclampsia has not been clearly defined. Risk factors/triggers for the development of pre-eclampsia can include chronic hypertension, advanced maternal age at first pregnancy (over 35 y), nephropathy, thrombophilia (heterozygous factor V Leiden mutation, antiphospholipid syndrome, heterozygous prothrombin mutation and homozygous MTHFR), multiple gestation and prior pregnancy with preeclampsia. The incidence of preeclampsia is higher in nulliparous than multiparous women. In many countries pre-eclampsia is still most frequent cause of maternal perinatal mortality. HELLP-Syndrom (haemolysis-elevated liver enzyme- low platelets) is a severe progressive course of this disease. Eclampsia, caracterized by generalized tonic-clonic convulsion, is the most dangerous complication of pre-eclampsia, and may develop before or after delivery. This form of pre-eclampsia is associated with higher maternal and fetal mortality. Constant maternal hypertension potentially alter vascular integrity of the placenta with further consequences in fetal blood supply leading to growth restriction or zero growth and subsequently resulting in low birth weight or fetal death. The sooner the disease is detected and confirmed, the better the maternal and fetal prognoses are. This is the reason why it is major importance, together with the employment of preventive measures, to identify patients with risk factors with pre-eclampsia though an adequate screening method, thereby detecting the disease earlier and ensuring better pregnancy outcomes for both mother and child.

PMID: 18979429 [PubMed - in process]