Stratifying eyes according to presurgical IOP showed greater long-term IOP reductions than previously reported. The reduction was proportional to the presurgical IOP. The decrease was greatest in eyes with the highest presurgical IOP. The IOP remained unchanged in eyes with the lowest presurgical IOP. The IOP reductions at 1 year were sustained over 10 years and were similar in patients of all ages.
Diabetic retinopathy is an increasingly prevalent disease, and a leading contributor to the burden of all-cause blindness worldwide. In addition to retinal changes, choroidal abnormalities are common in patients with diabetes. The first studies concerning this vascular structure were based on histologic, indocyanine angiography and laser Doppler flowmetry techniques, but the development of new optical coherence tomography (OCT) technologies and imaging software for enhanced depth imaging (EDI)-OCT in recent years has made it possible to provide more detailed images of the choroidal anatomy and topography.In diabetic patients, several choroidal changes have been described in the literature throughout the years; the recent focus is choroidal thickness, which is significantly different from that in healthy patients. However, understanding choroidal manifestations of diabetic eye disease remains a real challenge, and this gap is hindering efforts towards better defining choroidal evaluation as a predictive factor for disease evolution and treatment response.This review aims to summarize the recent literature concerning changes in choroidal structure in diabetic patients, the relationship to diabetic retinal disease progression, and finally, the current and potential application of the measurement of variations in choroidal thickness for patient management.
IntroductionThe purpose of this study was to measure and to compare macular choroidal thickness (CT) between patients with mild Alzheimer's disease (AD), patients without AD, and elderly patients.MethodsCT was measured manually in 13 locations at 500-μm intervals of a horizontal and a vertical section from the fovea. Linear regression models were used to analyze the data.ResultsFifty patients with a diagnosis of mild AD (73.1 years), 152 patients without AD (71.03 years), and 50 elderly without AD (82.14 years) were included. In the AD patients, CT was significantly thinner in all 13 locations (P < .001—comparing with age-match group), and comparing with the elderly group, a more pronounced difference was found in two locations temporal to the fovea.DiscussionPatients with AD showed a significant choroidal thinning even when compared with elderly subjects. The reduction of CT may aid in the diagnoses of AD, probably reflecting the importance of vascular factors in their pathogenesis.
Cataract surgery is one of the most performed surgeries in the developed world. In addition to its significant impact on visual acuity, phacoemulsification has been hailed as a potential intraocular pressure (IOP)-lowering procedure. While current evidence suggests an overall significant and sustained decrease in IOP to exist after cataract surgery, the specific ocular characteristics that could help predict which patients are likely to benefit from this IOP-lowering effect remain unclear. This definition is important in glaucoma patients if this surgery is to be used in the treatment for this disease. Our review aims to summarize the literature on the subject, depicting possible mechanisms behind this IOP decrease, which type of patients are more likely to benefit from this surgery for IOP-lowering purposes and ultimately help optimizing disease management for the increasing number of patients with concomitant glaucoma and cataract.
Introduction: Some patients with epilepsy identify weather as a typical seizure trigger. However, it is yet to be confirmed. Thus, we aimed to evaluate possible relationships between daily meteorological conditions and the daily incidence of seizures. Methods: This was a retrospective single center study that included adult patients who were admitted to the emergency room of a tertiary hospital in Lisbon, with a seizure, between January and December 2015. The influence of temperature, atmospheric pressure, relative humidity, wind, precipitation, sunlight duration, and the seasons on seizure frequency was evaluated. Results: Three hundred seven seizure episodes were included (from 286 patients) in a total of 365 days, 117 (38.1%) first unprovoked seizures and 190 (61.9%) with previous seizure episodes. There were 82 days with higher incidence of seizures (≥2) and 171 days without seizures. We found a statistical significant relation between lower ambient temperatures, higher atmospheric pressure, and higher maximum humidity with days with two or more seizures. We also found a statistically significant higher incidence of seizures in the winter days (p-value: 0.001) and in days with lower daylight duration (10.8 vs. 12.7 h; p-value: 0.0001). With the exception of humidity, these findings remained true when analyzing the subgroup of patients with previous seizures, but there was no significant difference in the subgroup of first unprovoked seizures. Conclusions: Our results support the possible influence of the weather on seizure frequency in the overall admissions of the emergency department of a tertiary hospital. In particular, these findings suggest that winter conditions, such as, lower ambient temperatures, higher atmospheric pressure, higher humidity, and reduced sunlight exposure, may have impact in the occurrence of higher incidence of seizures in patients with epilepsy.
The coronavirus disease 2019 (COVID-19) pandemic led the French government, like others throughout the world, to introduce measures such as lockdowns, bans on public events,
Cerebral venous thrombosis (CVT) can rarely present with acute ipsilateral cochlear and/or vestibular loss, to date always in the absence of a clear local otogenic process evidenced by magnetic resonance imaging (MRI). This association has been putatively attributed to inner ear anoxia due to blockage of inner ear venous drainage. We present a nonreported case of thrombosis of the left transverse and sigmoid sinuses presenting with acute unilateral vestibulopathy in which MRI disclosed concurrent ipsilateral labyrinthine haemorrhage. A 69‐year‐old female presented with acute vertigo without hearing loss or other accompanying neurological symptoms. Bedside examination revealed spontaneous right‐beating nystagmus and an impaired left head impulse response, with an otherwise normal neurological examination. Audiometry and head and ear computed tomography were unremarkable, whereas MRI showed a nonenhancing hyperintensity of the left inner ear consistent with labyrinthine haemorrhage, and additional venography disclosed thrombosis of the left transverse and sigmoid sinuses. Oral anticoagulation was started, and the patient experienced gradual improvement of symptoms. The current case provides support for the existence of inner ear anoxia in CVT cases presenting with acute ipsilateral vestibular loss, which can ultimately be complicated by secondary bleeding, as seen in our patient. Importantly, presentation in our case closely mimicked that of peripheral vestibular neuritis, and only MRI venography enabled us to make a prompt diagnosis. This raises an important question as to when a diagnosis of vestibular neuritis can be made securely in the absence of MRI assessment with or without venography to completely discard labyrinthine haemorrhage with or without CVT.
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