Objetivo: Avaliar a prevalência de retinopatia da prematuridade (ROP) e os fatores de risco em recém-nascidos de muito baixo peso internados em uma Unidade de Tratamento Intensivo Neonatal. Métodos: Estudo transversal incluindo todos os recém-nascidos com peso ao nascimento ≤ 1500g e/ou idade gestacional ≤ 32 semanas, admitidos na UTI Neonatal do Hospital de Clínicas de Porto Alegre, entre outubro de 2002 e março de 2004. Os pacientes foram submetidos a exame de fundo de olho sob oftalmoscopia binocular indireta na 6ª semana de vida. Foi realizado tratamento a laser nos que atingiram a doença limiar. Resultados: Foram estudados 114 recém-nascidos. Em oitenta e três pacientes não se diagnosticou retinopatia da prematuridade, dezoito apresentaram retinopatia da premauridade 1, sete retinopatia da prematuridade 2, seis ROP em doença limiar. A prevalência de ROP foi de 27,2% (IC 95%: 19,28 – 36,32) afetando 31 recém-nascidos, e a prevalência de retinopatia da prematuridade que atingiu doença limiar foi de 5,26% (IC 95%: 1,96 – 11,10) afetando 6 pacientes. Verificou-se retinopatia da prematuridade em 50% dos pacientes com peso inferior a 1000g e em 71,5% dos recém-nascidos com idade gestacional inferior a 28 semanas. A idade gestacional e o peso de nascimento foram significativamente menores nos pacientes com ROP em comparação aos normais. Conclusões: Embora os resultados deste estudo mostrem que a prevalência encontrada foi semelhante a encontrada na literatura, a ocorrência de retinopatia da prematuridade ainda é alta nos recém-nascidos de muito baixo peso. O desenvolvimento da retinopatia da prematuridade foi inversamente proporcional ao peso e a idade gestacional ao nascimento. / Objective: To evaluate the prevalence of retinopathy of prematurity (ROP) and risk factors in very low birth weight infants admitted to a Neonatal Intensive Care Unit. Methods: A cross sectional study investigating all newborn infants with birth weights ≤ 1,500g and/or gestational ages ≤ 32 weeks, admitted to Neonatal Intensive Care Unit of Hospital de Clínicas de Porto Alegre, from October 2002 to March 2004. Patients underwent indirect binocular ophthalmoscopy of the fundus at six weeks postpartum. Infants who progressed to threshold disease were given laser therapy. Results: One hundred and fourteen patients were studied. Eighty-three patients were not diagnosed with retinopathy of prematurity, 18 had stage I retinopathy of prematurity, 7 stage II retinopathy of prematurity and 6 patients had threshold retinopathy of prematurity. The prevalence of retinopathy of prematurity was 27.2% (CI 95%:19.28-36.32) affecting 31 newborn infants, and the prevalence of retinopathy of prematurity progressing to threshold disease was 5.26% (CI 95%: 1.96-11.10) affecting six patients. Retinopathy of prematurity was confirmed in 50% of the patients with weights below 1.000g and 71,5% of newborn infants born of gestational ages less than 28 weeks. Gestational age and birth weight were significantly lower among patients with retinopathy of prematurity than among those without. Conclusions: Although the results of this study demonstrate that the observed prevalence was similar to described in literature, this ROP frequency remains elevated among very low birth weight infants. The development of retinopathy of prematurity was inversely proportional to birth weight and gestational age at birth.

Orientador: Jose Eduardo Tanus dos Santos / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-13T02:13:15Z (GMT). No. of bitstreams: 1 Syllos_RogerWilliamCruzde_M.pdf: 523113 bytes, checksum: 7a17db80334615a2d5ead89d954e6305 (MD5) Previous issue date: 2006 / Resumo: Polimorfismos no gene da sintase endotelial do óxido nítrico (eNOS) têm sido associados com desenvolvimento ou severidade da retinopatia diabética em pacientes com diabetes mellitus tipo 1(DM1). Entretanto, existem poucos estudos investigando esta associação em portadores de diabetes mellitus tipo 2 (DM2). Além disso, não há estudo prévio que tenha analisado a combinação de marcadores genéticos (haplótipos) e aparecimento e/ou gravidade das complicações vasculares do DM2 . Foram estudados três polimorfismos genéticos: Polimorfismo de base única (SNP) na região promotora (T 786 C), no exon 7 (Glu298Asp) e um número variável de repetições sequenciais (VNTR) no intron 4 (b/a), em 103 voluntários saudáveis e 170 pacientes portadores de diabetes mellitus tipo 2, classificados em diabéticos sem retinopatia (114) e com retinopatia (56). Outrossim, examinamos a associação dos haplótipos genéticos da eNOS com diabetes mellitus tipo 2 e retinopatia diabética. Não foram encontradas diferenças na freqüência dos genótipos e dos alelos dos três polimorfismos entre os três grupos testados. Entretanto, um determinado haplótipo "C - Glu - b" foi mais comum no grupo de indivíduos saudáveis (24%) do que nos pacientes diabéticos (7%) (P=0.0001). Quando comparamos diabéticos com retinopatia diabética com aqueles sem retinopatia, não foi identificada diferença significativa na distribuição da freqüência dos haplótipos da eNOS (P=0,7372). Estes achados sugerem que não há associação entre retinopatia diabética e haplótipos individuais da eNOS em pacientes portadores de diabetes mellitus tipo 2. O haplótipo "C - Glu - b" , no entanto, pode possuir algum efeito protetor contra o desenvolvimento de diabetes mellitus tipo 2. Novos estudos devem se conduzidos para tentar identificar uma base molecular para tal efeito / Abstract: Background: Polymorphisms in the endothelial nitric oxide synthase (eNOS) gene have been associated with the development of diabetic retinopathy (DR) in patients with type 1 diabetes mellitus (T1DM), but not with T2DM. However, no previous study has analyzed combinations of genetic markers (haplotypes), which can be more informative. Methods: We studied three eNOS genetic polymorphisms: a single nucleotide polymorphism in the promoter region (T-786C), in exon 7 (Glu298Asp), and a variable number of tandem repeats in intron 4 (b/a) in 103 healthy controls, and in 170 patients with T2DM (without DR, N=114; with DR, N=56). We also examined the association of eNOS gene haplotypes with T2DM and with DR. Results: No differences were found in the frequencies of genotypes and alleles of the three polymorphisms among the three groups of subjects. Conversely, the "C-Glu-b" haplotype was more common in healthy controls (24%) than in T2DM patients (7%) (P=0.0001). Finally, no significant difference in the distribution of eNOS haplotypes frequencies was found when T2DM patients with or without DR were compared (P=0.7372). Conclusions: These findings suggest no association between DR and individual eNOS haplotypes in T2DM patients. The "C-Glu-b" haplotype, however, may have a protective effect against T2DM. Further studies should be conducted to address the molecular basis for such an effect / Mestrado / Mestre em Farmacologia

Orientador: Anderson de Rezende Rocha / Dissertação (mestrado) - Universidade Estadual de Campinas, Instituto de Computação / Made available in DSpace on 2018-08-23T17:47:21Z (GMT). No. of bitstreams: 1 Pires_Ramon_M.pdf: 4429324 bytes, checksum: 4e4015bc2131a1f1a5e8aa215f24d98f (MD5) Previous issue date: 2013 / Resumo: A Retinopatia Diabética (RD), complicação provocada pela diabetes, se manifesta por meio de diferentes lesões que possuem suas especificidades. Estas especificidades são exploradas na literatura como estratégia para representação, proporcionando uma discriminação satisfatória entre imagens de pacientes normais e doentes. No entanto, por estarem fortemente atrelada _as características visuais de cada anomalia, a detecção de lesões distintas exige abordagens distintas. Neste trabalho, apresentamos um arcabouço geral cujo objetivo é automatizar o procedimento de análise de imagens de fundo de olho. O trabalho é dividido em quatro etapas: avaliação de qualidade, detecção de lesões individuais, triagem e verificação de necessidade de consulta. Na primeira etapa, aplicamos diferentes técnicas de caracterização de imagens para avaliar a qualidade das imagens por meio de dois critérios: definição de campo e detecção de borramentos. Na segunda etapa deste trabalho, propomos a continuação de um trabalho anterior desenvolvido pelo nosso grupo, no qual foi aplicado um método unificado na tentativa de detecção de lesões distintas. No nosso método para detecção de qualquer lesão, exploramos diferentes alternativas de representação em baixo nível (extração densa e esparsa) e médio nível (técnicas de coding/pooling para sacolas de palavras visuais) objetivando o desenvolvimento de um conjunto eficaz de detectores de lesões individuais. As pontuações provenientes de cada detector de lesão, obtidas para cada imagem, representam uma descrição de alto nível, ponto fundamental para a terceira e a quarta etapas. Tendo em mãos um conjunto de dados descritos em alto nível (pontuações dos detectores individuais), propomos, na terceira etapa do trabalho, a aplicação de técnicas de fusão de dados para o desenvolvimento de um método de detecção de múltiplas lesões. A descrição em alto nível também é explorada na quarta etapa para o desenvolvimento de um método eficaz de avaliação de necessidade de encaminhamento a um oftalmologista no intervalo de um ano, visando evitar que o médico seja sobrecarregado, bem como dar prioridade a pacientes em estado urgente / Abstract: Diabetic Retinopathy (DR), a common complication caused by diabetes, manifests through deferent lesions that have their particularities. These particularities are explored in the literature as methods for representation, providing a satisfactory discrimination between healthy/diseased retinas. However, by being strongly linked to the visual characteristics of each anomaly, the detection of distinct lesions requires distinct approaches. In this work, we present a general framework whose objective is to automate the eye-fundus image analysis. The work comprises four steps: image quality assessment, DR-related lesion detection, screening, and referral. In the first step, we apply characterization techniques to assess image quality by two criteria: field definition and blur detection. In the second step of this work, we extend up a previous work of our group which explored a unified method for detecting distinct lesions in eye-fundus images. In our approach for detection of any lesion, we explore several alternatives for low-level (dense and sparse extraction) and mid-level (coding/pooling techniques of bag of visual words) representations, aiming at the development of an effective set of individual DR-related lesion detectors. The scores derived from each individual DR-related lesion, taken for each image, represent a high-level description, fundamental point for the third and fourth steps. Given a dataset described in high-level (scores from the individual detectors), we propose, in the third step of the work, the use of machine learning fusion techniques aiming at the development of a multi-lesion detection method. The high-level description is also explored in the fourth step for the development of an effective method for evaluating the necessity of referral of a patient to an ophthalmologist in the interval of one year, avoiding overloading medical specialist with simple cases as well as give priority to patients in an urgent state / Mestrado / Ciência da Computação / Mestre em Ciência da Computação

Type 2 diabetes mellitus (T2DM) is one of the leading causes of death from worldwide non-communicable diseases. The prevalence of diabetes in the Mexico (MX)-United States border states exceeds the national rate in both countries. The economic burden of diabetes, due to decreased productivity, disability, and medical costs, is staggering and increases significantly when T2DM-related complications occur. The purpose of this study was to use a modified behavioral risk factor surveillance system (BRFSS) to describe the T2DM self-management behaviors, diabetes care, and health perception of a convenience sample of adults with T2DM in Monterrey, MX. This cross-sectional study design, with convenience sampling, was conducted with a convenience sample (n = 351) of adults in the metropolitan area of Monterrey, MX who self-reported a diagnosis of T2DM. Potential participants were recruited from local supermarkets. Twenty-six diabetes and health-related items were selected from the BRFSS and administered in face-to-face interviews by trained data collectors. Data analysis was conducted using descriptive statistics. The mean age was 47 years, and the mean length of time with T2DM was 12 years. The majority was taking oral medication and 34% required insulin. Daily self-monitoring of feet was performed by 56% of the participants; however, only 8.8% engaged in blood glucose self-monitoring. The mean number of health-care provider visits was 9.09 per year, and glycated hemoglobin level (HbA1c) was assessed 2.6 times per year. Finally, only 40.5% of the participants recalled having a dilated eye exam. We conclude the modified BRFSS survey administered in a face-to-face interview format is an appropriate tool for assessing engagement in T2DM self-management behaviors, diabetes care, and health perception. Extension of the use of this survey in a more rigorous design with a larger scale survey is encouraged.

Diabetic retinopathy (DR) is becoming a global health concern, which causes the loss of vision of most patients with the disease. Due to the vast prevalence of the disease, the automated detection of the DR is needed for quick diagnoses where the progress of the disease is monitored by detection of exudates changes and their classifications in the fundus retina images. Today in the automated system of the disease diagnoses, several image enhancement methods are used on original Fundus images. The primary goal of this thesis is to make a comparison of three of popular enhancement methods of the Mahalanobis Distance (MD), the Histogram Equalization (HE) and the Contrast Limited Adaptive Histogram Equalization (CLAHE). By quantifying the comparison in the aspect of the ability to detect and classify exudates, the best of the three enhancement methods is implemented to detect and classify soft and hard exudates. A graphical user interface is also adopted, with the help of MATLAB. The results showed that the MD enhancement method yielded better results in enhancement of the digital images compared to the HE and the CLAHE. The technique also enabled this study to successfully classify exudates into hard and soft exudates classification. Generally, the research concluded that the method that was suggested yielded the best results regarding the detection of the exudates; its classification and management can be suggested to the doctors and the ophthalmologists.

Purpose: Facing the lack of time, busy retina consultants should be aware of how the patients would prefer that time is spent and whether they wish the specialist to talk more at the expense of other medical activities. Methods: 810 persons with diabetes were asked to divide the time of 10 min between examination, consultation and treatment when envisioning a real-life scenario of diabetic retinopathy (NCT02311504). Results: With the increasing duration of diabetes, patients wanted significantly more time for diagnostics (p = 0.028), while age was found to be associated with less time for treatment (p = 0.009). Female subjects tended to prefer only little more time for talking (p = 0.051) in comparison with males, who slightly favored therapy (p = 0.025). Conclusions: The large majority recognized the need for diagnostics in their allocation of time. If individual patients are confronted with the health care perspective of time constraints, this might improve the understanding of prioritization.

PURPOSE: Retinal and choroidal ischemic retinopathies such as retinal-vein occlusion (RVO), diabetic retinopathy (DR), and age-related macular degeneration (AMD) are ocular diseases caused by abnormal changes in the microvasculature. The ischemia can lead to macular edema or neovascularization, which can affect vision. Intravitreal injections (IVI) of anti-vascular endothelial growth factor (anti-VEGF) can help to reduce macular edema and improve visual acuity. Lost to follow-up (LTFU) after anti-VEGF injections increases the risk of vision loss in patients with RVO, DR, and AMD. METHODS: Patients scheduled for an IVI of anti-VEGF between September 2009 and September 2019 with either RVO, DR, or AMD were included in the analysis. LTFU was defined as missing an appointment without another evaluation for at least one interval exceeding 180 days. All patients were seen by a single provider at an urban, hospital-based, single-site retina practice in Boston, MA. RESULTS: Among the 698 patients (mean [SD] age, 70.23 [14.2] years; 373 [53.4%] female) identified as receiving an IVI, 121 (17.3%) were LTFU. Age was not found to be statistically different between the LTFU and not LTFU groups (mean difference, -1.67; 95% CI, -4.66¬–1.32; P=.27). Odds of LTFU was lower among patients with AMD (odds ratio [OR], 0.57; 95% CI, 0.36-0.92; P=.02). Odds of LTFU was greater among patients with Medicaid insurance (OR, 2.31; 95% CI, 1.22-4.33; P=.01), compared with patients with Medicare insurance. A trend towards higher risk of LTFU was seen in patients with DR (OR, 1.42; 95% CI, 0.94-2.15; P=.09) and a toward lower risk in patients with two or more eye diseases (OR, 0.53; 95% CI, 0.24-1.15; P=.10). Medicaid insurance was the only significant (P=.02) independent risk factor of LTFU in the multivariate regression. CONCLUSION: We found a high rate of LTFU after anti-VEGF injections among patients with RVO, DR, AMD, and identified risk and protective factors associated with LTFU among this population. Although our results may not be generalizable, data on LTFU in a clinical practice setting are needed to understand the scope of the problem so that interventions may be designed to improve outcomes.

Bakgrund: Alla diabetiker erbjuds screening av ögonbottnen för diabetesretinopati så att den ska kunna upptäckas och behandlas i tid. Enligt Region Skånes riktlinje för screening av diabetesretinopati kan en traditionell funduskamera eller en wide field ka-mera som täcker 80 procent av näthinnan användas, något som hittills enbart Optos kan. Syftet med studien var att undersöka hälso- och sjukvårdspersonalens uppfattningar om Optos i samband med screening av diabetesretinopati. Metod: Femton ögonmottagningar visade sig använda Optos. Av dessa deltog tio i tvär-snittsenkätstudien. En webbenkät utformades bestående av öppna och multiple-choice frågor. Fritextsvaren analyserades med innehållsanalys som resulterade i ett antal kategorier och respektive svarsfrekvenser. Resultat: Optos uppfattades som en användar- och patientvänlig metod vilken kan öka tillgängligheten. Skärpan i Optomap uppfattades vara god, men något sämre än i fun-dusbilderna. Några uppfattade Optos som en bra metod för screening av diabetesretino-pati. Andra ansåg att användning av Optos skulle innebära en patientrisk. Då den sämre centrala skärpan skulle kunna leda till underdiagnosticering alternativt att Optomaps stora täckningsgrad skulle kunna vara anledning till en överdiagnosticering. Ett stort externt bortfall begränsar studieresultatets generaliserbarhet. Slutsats: Uppfattningar huruvida Optos anses vara lämpligt att användas i samband med screening av diabetesretinopati går isär och lämpliga användningsområden behöver definieras närmare. / Background: Screening for retinopathy is offered to all diabetics to allow detection and treatment on time. According to a regional guideline for screening of diabetic retino-pathy traditional fundus camera may be used or a wide field camera picturing 80 % of the retina, something nowadays only Optos can do. Aim of this study was to investigate health personnel’s attitude towards Optos in the context of diabetic retinopathy screening. Methods: Fifteen eye clinics using Optos were identified and ten of those took part in this survey. Self-administered questionnaires with multiple-choice and open questions were used. Free text answers were analysed using context analysis with determination of frequencies for the evolving categories. Results: Optos was perceived as being user and patient friendly, as well as being able to increase accessibility. Optomap had good but digital fundus pictures better perceived acuity. According to some was Optos a good method for screening of diabetic retino-pathy and inappropriate according to others apprehending a patient risk. Expecting underdiagnosis due to less central acuity alternatively overdiagnosis due to Optomap covering 80 % of the retina. High drop-out rate eventuates limited validity. Conclusions: Diverging attitudes emerged whether Optos is suitable for screening of diabetic retinopathy. Its appropriate use needs to be defined in further detail.

Bakgrund: Diabetes Mellitus är en sjukdom med potentiellt allvarliga konsekvenser som drabbar ett ökande antal människor runt om i världen. En av de ögonkomplikationer som kan drabba diabetiker är diabetesretinopati. Regelbunden ögonbottenscreening kan avslöja förändringar i ögonbotten innan de ger symtom eller synhotande skador som kan vara irreversibla. Tidig diagnos och behandling minskar risken för synnedsättning och blindhet, trots detta uteblir många diabetiker från planderad ögonbottenscreening.          Syfte: Syftet var att belysa erfarenheter som påverkar följsamheten vid ögonbottenscreening hos patienter med diabetes.                                                  Metod: En litteraturöversikt med kvalitativa studier utfördes.                  Resultat: Översikten resulterade i fyra huvudteman; information,ekonomiska aspekter, personliga erfarenheter och erfarenhet vid ögonbottenscreening samt i elva underteman. De viktigaste faktorerna som framkom av studien var bristande information, ekonomi, transportproblematik samt besvär av pupillvidgande ögondroppar.                Slutsats: Denna studie har identifierat faktorer och erfarenheter som påverkar följsamheten till ögonbottenscreening vilket kan ge möjlighet till en bättre förståelse för patienternas behov och till ett förbättrat samarbete mellan olika vårdinstanser. / Background: Diabetes Mellitus is a common disease with potentially serious con­sequences that affects an increasing number of people worldwide. One of the comp­lications that can affect the eye of a patient with diabetes is diabetic retinopathy. Regular retinal screening can reveal early signs of diabetic retinopathy before any irreversible sight threatening retinal complications have developed. Early diagnosis and treatment decrease the risk for visual impairment and blindness, despite this fact many patients do not attend this examination.                                                                          Aim: The aim was to illuminate experiences that affects compliance to retinal screening among patients with diabetes. Method: A literature review including qualitative studies was conducted. Results: The results from the review showed four main themes; information, economic aspects, personal experiences and experience from retinal screening as well as eleven subthemes. The main subjects that emerged were lack of information, economy, transportation problems and inconvenience of mydriatic eye drops. Conclusion: This literature review has identified factors and experiences that affects compliance to retinal screening. This can provide an opportunity for a better under­standing of patients’ needs and for improved collaboration between healthcare institutions

Juvenile neuronal ceroid lipofuscinosis (JNCL, aka. juvenile Batten disease or CLN3 disease), a lethal pediatric neurodegenerative disease without cure, often presents with vision impairment and characteristic ophthalmoscopic features including focal areas of hyper-autofluorescence. In the associated research article “Loss of CLN3, the gene mutated in juvenile neuronal ceroid lipofuscinosis, leads to metabolic impairment and autophagy induction in retinal pigment epithelium” (Zhong et al., 2020) [1], we reported ophthalmoscopic observations of focal autofluorescent lesions or puncta in the Cln3Δex7/8 mouse retina at as young as 8 month old. In this data article, we performed differential interference contrast and confocal imaging analyses in all retinal layers to localize and characterize these autofluorescent lesions, including their spectral characteristics and morphology. We further studied colocalization of these autofluorescent lesions with the JNCL marker mitochondrial ATP synthase F0 sub-complex subunit C and various established retinal cell type markers.