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  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
101

Avaliação de retinopatia da prematuridade em recém-nascidos prematuros acompanhados em serviço de seguimento no Paraná / Retinopathy of prematurity (ROP) evaluation in preterm newborns babies in a follow-up vision health service in Paraná

Pastro, Joziana 13 March 2018 (has links)
Submitted by Neusa Fagundes (neusa.fagundes@unioeste.br) on 2018-07-10T19:46:34Z No. of bitstreams: 2 Joziana_Pastro2018.pdf: 1649555 bytes, checksum: 769cd69a9e879a09907152dd2e64987c (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2018-07-10T19:46:34Z (GMT). No. of bitstreams: 2 Joziana_Pastro2018.pdf: 1649555 bytes, checksum: 769cd69a9e879a09907152dd2e64987c (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2018-03-13 / Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPq / Retinopathy of prematurity (ROP) is a vasoproliferative disease, related to blindness, in Premature Newborns (PN) who, within other factors, used oxygen during hospitalization. Early visual follow-up of preterm newborns by ophthalmologists makes it possible to identify the stage and grade of the disease and the indication of treatment or attendance of its evolution. Nursing orientation is essential to the PN relatives, since ROP is not an easily seen disease, so, parents being aware that the ophthalmologic follow-up is of vital importance for the visual recovery of the baby will make a difference in the child future visual health. Therefore, this study aims to evaluate the prevalence and evolution of ROP in PN, hospitalized in a Neonatal Intensive Care Unit (NICU) and attended at a referral ophthalmologic follow-up service. This is a quantitative, descriptive and exploratory study, carried out in the city of Cascavel. Data collection was done in medical records of PN, born between January 2014 and June 2016, hospitalized in the NICU of the West Paraná University hospital, and followed by the outpatient clinic of Cascavel Eyes Hospital, totaling 181 charts. A quantitative analysis was performed through descriptive and inferential statistic. The prevalence of ROP was 11.31% (n = 50). Relating its characteristics to evolution, the diagnoses prevalent in the PN of the study were respiratory diseases (41.99%) and among comorbidities, sepsis prevailed (63.54%). 80 PN required blood transfusion (44,20%) and 152 (83.98%) used oxygen therapy, with a predominance of mask device (n = 141; 77,90%) and orotracheal tube - TOT (n = 100; 55.25%), on average for 15 days. The highest concentration recorded was hood (45.0%). The time of use and the O2 concentration of TOT, time of mask use and time and concentration of O2 of Continuous Positive Airway Pressure (CPAP), were significant to trigger ROP. Among ROP cases, ten (5.5%) children had severe ROP and required laser treatment. All the PN diagnosed with ROP used oxygen. ROP prevailed in moderate preterm newborns (44%), with ROP grade 3 being the most severe, affecting both extreme and moderate PN. Respiratory diseases, sepsis and procedures such as blood transfusion and oxygen therapy influenced the presence of ROP, with prevalence in moderate preterm newborns. The adoption of ophthalmologic screening for ROP detection, with background examinations of the eyes in the NICU contributed to the early treatment and prevention of severe visual impairment and blindness caused by ROP. Thus, nurses are fundamentally important, from the prevention, the diagnosis until the course of the treatment and for discharge counselling. / A Retinopatia da Prematuridade (ROP) é uma enfermidade vasoproliferativa, relacionada à cegueira, em recém-nascidos prematuros (RNPT) que, dentre outros fatores, utilizaram oxigênio durante a hospitalização. O acompanhamento visual precoce de prematuros por oftalmologistas possibilita a identificação do estágio e do grau da doença, assim como a indicação de tratamento ou de acompanhamento da sua evolução. A orientação da enfermagem é primordial aos familiares dos RNPT, visto que a ROP não é uma doença de fácil visualização; portanto, os pais estarem cientes de que o acompanhamento oftalmológico é de vital importância para a recuperação visual do bebê fará diferença na vida futura da criança. Assim, este estudo objetiva avaliar a prevalência e a evolução da ROP em RNPT internados em uma Unidade de Terapia Intensiva Neonatal (UTIN) e acompanhados em serviço de seguimento oftalmológico de referência. Trata-se de uma pesquisa quantitativa, descritiva e exploratória, realizada no município de Cascavel. A coleta de dados ocorreu em prontuários de RNPT, nascidos entre janeiro de 2014 e junho de 2016, hospitalizados na UTIN do Hospital Universitário do Oeste do Paraná – HUOP, e em seguimento pelo ambulatório do Hospital de Olhos de Cascavel, totalizando 181 prontuários. Realizou-se análise quantitativa, por meio de estatística descritiva e inferencial. A prevalência de ROP foi de 11,31% (n=50). Relacionados às suas características e evolução, os diagnósticos prevalentes nos RNPT do estudo foram as doenças respiratórias (41,99%) e, entre as comorbidades, a sepse prevaleceu (63,54%). Necessitaram de transfusão de sangue 80 RNPT (44,20%), e 152 (83,98%) fizeram uso de oxigenioterapia, com predomínio do dispositivo máscara (n=141; 77,90%) e tubo orotraqueal - TOT (n=100; 55,25%), em média por 15 dias. A maior concentração registrada foi por halo (45%). O tempo de uso e a concentração de O2 de TOT, tempo de uso de máscara e tempo e concentração de O2 do Continuous Positive Airway Pressure (CPAP) foram significativos para desencadear a ROP. Dentre os casos de ROP, dez (5,5%) crianças tiveram ROP grave e necessitaram de tratamento com laser. Todos os RNPT diagnosticados com ROP fizeram uso de oxigênio. A ROP prevaleceu nos prematuros moderados (44%), sendo o grau 3 de ROP o mais grave encontrado, acometendo tanto RNPT extremos quanto moderados. Doenças respiratórias, sepse e procedimentos como a transfusão de sangue e a oxigenioterapia influenciaram na presença da ROP, com prevalência em prematuros moderados. A adoção da triagem oftalmológica para a detecção da ROP, com exames de fundo de olho sistematicamente realizados na UTIN, contribuíram para o tratamento precoce e a prevenção de deficiências visuais graves e cegueira causados pela ROP. Nesse sentido, o enfermeiro é de fundamental importância, desde a prevenção, o diagnóstico até o decorrer do tratamento e a alta.
102

Quedas e recorrência: associação com déficit visual e auditivo autopercebidos e acesso dispensado ao evento em idosos comunitários

Generoso, Carla Karoline Pires 06 April 2017 (has links)
Submitted by Renata Lopes (renatasil82@gmail.com) on 2017-08-17T17:42:08Z No. of bitstreams: 1 carlakarolinepiresgeneroso.pdf: 14361490 bytes, checksum: 84df5809af87f48f3b7f1313923e54f8 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2017-08-18T11:01:38Z (GMT) No. of bitstreams: 1 carlakarolinepiresgeneroso.pdf: 14361490 bytes, checksum: 84df5809af87f48f3b7f1313923e54f8 (MD5) / Made available in DSpace on 2017-08-18T11:01:38Z (GMT). No. of bitstreams: 1 carlakarolinepiresgeneroso.pdf: 14361490 bytes, checksum: 84df5809af87f48f3b7f1313923e54f8 (MD5) Previous issue date: 2017-04-06 / As quedas configuram-se como um evento prevalente entre os idosos e em virtude de sua dimensão física, psicológica, social e econômica é considerada um grave problema de saúde pública. Subjacente aos fatores de risco já conhecidos, enfatizamos neste estudo fatores comportamentais como a autopercepção e a influência de déficits visual, sobretudo o auditivo autopercebidos relacionados à queda e quedas recorrentes. Considera-se a importância de conhecer os serviços de saúde que esses indivíduos têm acesso e utilizam após ocorrência desse evento. Portanto, o objetivo deste estudo foi estimar a prevalência e recorrência de queda e sua associação com a déficit visual e auditivo autopercebidos, descrever o acesso e gravidade relativo a este evento em idosos do município de Juiz de Fora. Estudo de delineamento transversal, que avaliou 315 idosos comunitários ≥ 60 anos, de ambos os sexos por meio de inquérito domiciliar. Os dados foram analisados pelo programa Stata 13,0 verificando as Razões de Prevalência com respectivos Intervalos de Confiança de 95% (IC 95%) e α = 0,10. Nas análises multivariadas ajustaram-se modelos de Regressão de Poisson e Multinomial. Os resultados serão apresentados em dois estudos. No primeiro a prevalência de quedas foi de 34,3% e 10,8% de recorrência. A prevalência de quedas nos indivíduos com deficiência auditiva autopercebida foi de 45,6%. Esteve associada à queda: faixa etária de 70 a 79 anos sexo feminino e não uso de dispositivos para correção visual e a Quedas recorrentes: idade ≥ 80 anos e Deficiência visual e Deficiência auditiva autopercebidas. No segundo estudo observamos que idade superior a 80 anos, necessidade de internação em pronto atendimento ou internação e maior percentual de perda de consciência após a queda esteve mais associada à queda recorrente que foi considerada mais grave que as quedas sofridas pelos idosos que caíram uma vez. Ambos os grupos declararam ter mais acesso aos serviços públicos, apesar de grande parcela ter pelo menos algum plano de saúde. As quedas caracterizaram-se como domiciliares e diurnas, porém idosos que relatam uma queda caíram mais na escada e varanda diferente da queda recorrente que ocorreu em locais mais restritos como quarto e sala. Os resultados indicam importante relação entre déficit auditivo autopercebido e queda além de informações relevantes sobre as características e gravidade da queda entre idosos comunitários. Considerando a partir disso a necessidade de investigação ampla da relação entre déficits auditivos e as adaptações que são feitas aos idosos que escutam pouco e que segundo nosso estudo tem pouco acesso aos dispositivos de correção auditiva poderiam auxiliar em estratégias para a prevenção deste evento. Além de salientar a importância da prevenção através de um acesso mais eficaz à atenção primaria e assim como a oferta de visitas domiciliares pelas equipes de Estratégias de Saúde da Família que poderiam auxiliar em orientações a fim de diminuir a ocorrência de quedas nos locais mais prevalentes e o impacto do medo de quedas recorrentes entre os idosos da comunidade. / The falls are a prevalent event among the elderly and because of their physical, psychological, social and economic dimension, it is considered a serious public health problem. Underlying the already known risk factors, we emphasize in this study behavioral factors such as self-perception and the influence of visual deficits, especially the self-perceived auditory hearing related to fall and recurrent falls. It is considered the importance of knowing the health services that these individuals have access to and use after this event occurs. Therefore, the objective of this study was to estimate the prevalence and recurrence of falls and their association with selfperceived visual and auditory deficit, to describe the access and severity related to this event in the elderly in the city of Juiz de Fora. A cross - sectional study, which evaluated 315 community - dwelling elderly individuals ≥ 60 years of age, of both sexes by means of a household survey. Data were analyzed by the Stata 13.0 program, checking the Prevalence Ratios with 95% Confidence Intervals (95% CI) and α = 0.10. In the multivariate analyzes, the Poisson and Multinomial Regression models were fitted. The results will be presented in two studies. In the first, the prevalence of falls was 34.3% and 10.8% of recurrence. The prevalence of falls in individuals with self-perceived hearing loss was 45.6%. It was associated with the fall: age group of 70 to 79 years female and no use of devices for visual correction and recurrent falls: age ≥ 80 years and Visual Deficiency and Self-perceived Deficiency. In the second study, we observed that age greater than 80 years, need for hospitalization at the prompt or hospitalization, and greater percentage of loss of consciousness after the fall was more associated with the recurrent fall that was considered more severe than the falls suffered by the elderly who fell once. Both groups reported having more access to public services, although a large portion had at least some health insurance. The falls were characterized as domiciliary and diurnal, but elderly people reporting a fall fell more on the staircase and balcony different from the recurring fall that occurred in more restricted places such as bedroom and living room. The results indicate an important relation between selfperceived hearing deficit and fall besides relevant information about the characteristics and severity of falls among community-dwelling elders. Considering from this the need for a broad investigation of the relationship between auditory deficits and the adaptations that are made to the elderly who listen poorly and who according to our study have little access to hearing correction devices could help in strategies for the prevention of this event. In addition to highlighting the importance of prevention through more effective access to primary care and the provision of home visits by Family Health Strategy teams that could assist in guidelines to reduce the occurrence of falls in the most prevalent places and the impact of the fear of recurrent falls among the elderly in the community.
103

Irlen Syndrome and the reading process

Altman, Jodi Beth 01 January 2003 (has links)
The purpose of the project was to determine if a school-wide intervention for students demonstrating symptons of Irlen Syndrome would result in improvements in reading skills and a reduction in physical symptoms that might impede visual processing necessary for successful reading.
104

Livet med synnedsättning : Upplevelser av att leva med nedsatt syn / Living with visual impairment : The experience of individuals living with impaired vision

Nergård, Amanda, Nguyen, Josefin January 2019 (has links)
Bakgrund: Ögonsjukdomar och nedsatt syn är ett folkhälsoproblem som förväntas att öka runt om i världen. Den främsta orsaken till synnedsättning och blindhet är ögonsjukdomar där några av de vanligaste är katarakt, åldersrelaterad makuladegeneration, glaukom och retinopati. Synnedsättning kan skapa fysiska och psykiska följder i det dagliga livet, exempelvis isolering, ökad risk för skador och minskad självständighet. Syfte: Syftet var att belysa personers upplevelser av att leva med synnedsättning och hur detta påverkar utförandet av aktiviteter i det dagliga livet. Metod: En litteraturstudie har genomförts med induktiv ansats. Sökningar gjordes i databaserna CINAHL och PubMed där 12 artiklar valdes ut som utgör grunden för uppsatsens resultat. Bearbetningen av den insamlade datan genomfördes med stöd av en innehållsanalys. Resultat: Det framkom att personer med nedsatt syn upplevde att synnedsättningen hade en betydande inverkan på de dagliga aktiviteterna. Detta visade sig genom att svårigheter uppstod vid vissa aktiviteter, såsom matlagning och mobilisering. Detta medförde att strategier skapades för att underlätta aktiviteterna. Situationen medförde även olika känslor, både positiva och negativa. Konklusion: Resultatet kan bidra med betydande kunskap kring hur personer med synnedsättning upplever aktiviteter i det dagliga livet, vilket är användbart för sjuksköterskan för att kunna tillämpa god omvårdnad och personcentrerad vård. / Background: Eye diseases and impaired vision are a public health problem that is expected to increase around the world. The main causes of visual impairment and blindness are eye diseases where some of the most common are cataract, age-related macular degeneration, glaucoma and retinopathy. Visual impairment can create physical and mental consequences in daily life, such as isolation, increased risk of injury and reduced independence. Purpose: The purpose was to highlight people's experience of living with visual impairment and how this affects the performance of activities in daily living. Method: A literature study has been conducted with an inductive approach. Searches were made in the databases CINAHL and PubMed where 12 articles were selected which formed the basis for this essays result. Results: It was found that people with impaired vision experienced that visual impairment had a significant impact on daily activities. This was evidenced by the fact that difficulties arose for example with cooking and mobilisation. This resulted in strategies that were created to facilitate activities. The situation also led to different emotions, both positive and negative. Conclusion: The results can contribute knowledge about how people with visual impairment experience activities in daily living, which is useful for better nursing and person-centered care.
105

"Jag önskar att jag kunde få vara bara elev" - Om punktkriftsläsares litteraturtillgång i högre studier / "I wish I could be nothing but a student" - About braille readers’ access to litterature in higher education

Wallsten, Anna January 2023 (has links)
This study aims to explain the experiences that individuals with visual impairments in higher education undergo. In this study, I focus on people who consider themselves braille readers, as my objective is not only to investigate the reality regarding the process of acquiring accessible literature but also to understand the importance of braille literacy in a broader sense. I also want to show the connection and interdependency between education, citizenship, and disability in contemporary Sweden but also in historical retrospect.My study shows that there is an inequality in access to course literature and education in Sweden. The literature is not always available on time and is often inaccessible for individuals who are braille readers, though accessibility is required through laws and regulations that demand that every citizen be treated equally and have the same opportunities, disregarding disabilities. The conclusion is that authorities, including universities, have a lot of work to do to follow regulations such as the Convention on the Rights of Persons with Disabilities and the Discrimination Act. One of the solutions to this problem is to increase the status of the braille language.
106

Knowledge of Computer Vision Syndrome among computer users in the workplace in Abuja, Nigeria

Raymond, Akinbinu Tope 30 May 2013 (has links)
Quantitative, descriptive, cross-sectional study was conducted to determine the level of knowledge and extent of Computer Vision Syndrome (CVS) among computer users in the Securities and Exchange Commission (SEC), Abuja, Nigeria. Structured questionnaires were administered to 100 computer users aged between 18 and 40 years. The study findings revealed that 40 respondents (40%) were aware of CVS and 27 (27%) of them had knowledge of the disorder. 74 (74%) of the respondents experienced at least one symptom of CVS. Headache and eyestrain were the most common symptom of CVS among the population. The study also revealed that the internet (accounting for 50%) was the major source of information about CVS awareness. The study concluded that 27% knowledge level is too low and much emphasis is needed to educate the people at risk of CVS / Health Studies / M.A. (Public Health)
107

Tratamento do edema macular difuso do diabético com triancinolona intravítrea e fotocoagulação com laser de argônio / Use of intravitreal triamcinolone and laser photocoagulation for the treatment of diffuse diabetic macular edema

Saraiva, Fábio Petersen 17 March 2008 (has links)
INTRODUÇÃO: O edema macular difuso é uma importante causa de baixa visual em portadores de diabetes mellitus. O tratamento clássico deste tipo de retinopatia consiste na fotocoagulação, entretanto, esta terapêutica é ineficaz em muitos casos. Neste trabalho, avaliou-se a eficácia do uso intravítreo da triancinolona acetonida associada à fotocoagulação com laser de argônio no tratamento do edema macular difuso diabético. Esta associação terapêutica foi comparada com o uso isolado de cada tratamento. MÉTODOS: Neste estudo, realizado entre junho de 2005 e setembro de 2006, foram estudados 30 pacientes diabéticos clinicamente controlados e portadores de edema macular difuso. Estes pacientes foram alocados de forma aleatória e proporcional em um dos seguintes grupos de tratamento: (1) fotocoagulação macular em grade com laser de argônio; (2) aplicação intravítrea de 4 mg de triancinolona acetonida; (3) associação dos itens anteriores. O seguimento foi realizado em intervalos pré-determinados de um dia, uma semana e mensalmente, até completar 6 meses. Foram analisados os parâmetros: acuidade visual corrigida LogMAR; espessura macular central e volume macular total medido pela tomografia de coerência óptica; e pressão intra-ocular aferida pelo tonômetro de Goldmann. RESULTADOS: A fotocoagulação com laser não reduziu de forma estatisticamente significativa a espessura macular central (p=0,0862) e o volume macular total (p=0,11). Esta redução foi significativa e estatisticamente semelhante nos outros dois grupos (p<0,001). Todos os grupos apresentaram melhora da acuidade visual (p=0,003), entretanto, o grupo que recebeu a associação do laser com a triancinolona intravítrea, obteve maior percentagem de pacientes com ganho de 10 ou mais letras de visão no quarto e quinto mês de seguimento (p=0,026; p=0,034). A pressão intra-ocular elevou-se em 5 mmHg ou mais em 12 pacientes, sendo seis no grupo submetido apenas a triancinolona e os outros seis no grupo que recebeu a associação de tratamento (p<0,001).Todos estes casos foram bem controlados com colírio de maleato de timolol 0,5%. CONCLUSÕES: O uso simultâneo da fotocoagulação com a triancinolona intravítrea proporcionou maior ganho de linhas de visão do que o uso isolado de cada tratamento. A fotocoagulação com laser foi a única terapia que não reduziu de forma significativa a espessura e o volume macular total e, também, foi a única que não apresentou casos de hipertensão ocular durante o seguimento. / INTRODUCTION: The diffuse macular edema is an important cause of visual impairment in diabetic subjects. Laser photocoagulation is the main treatment for this disorder, however, it is not effective in a large number of patients. In this study, we evaluated the efficacy of intravitreal use of triamcinolone acetonide combined with laser photocoagulation for the treatment of diffuse diabetic macular edema and we compare it with either laser alone or intra-vitreal triancinolone. METHODS: In this study, performed between june 2005 and september 2006, we studied 30 well controlled diabetic patients with diffuse macular edema. These patients were randomly divided into the following treatment groups: (1) macular grid photocoagulation; (2) intravitreal injection of 4 mg of triamcinolone acetonide; (3) combination of the two previous therapies. Follow up was scheduled at predetermined intervals of one day, one week and monthly until completion of six months. The following parameters were analyzed: LogMAR best corrected visual acuity; central macular thickness and total macular volume measured by ocular coherence tomography; and intraocular pressure assessed by Goldman\'s tonometer. RESULTS: Grid photocoagulation did not significantly reduce the central macular thickness (p=0,0862) or the total macular volume (p=0,11). On the other side, this reduction was significant and statistically similar in the others two groups (p<0,001). All groups improved the mean visual acuity (p=0,003), however, the group that received the association treatment had a higher percentage of patients gaining 10 or more letters at the fourth and fifth month of follow up (p=0,026; p=0,034). A rise in 5 or more mmHg in intraocular pressure was observed in 12 patients; half of them was in the triamcinolone group and the other half was in the group that received combined therapies (p<0,001). These cases with elevated intraocular pressure were well controlled with timolol maleate 0,5% drops. CONCLUSION: The simultaneous use of photocoagulation and intravitreal triamcinolone provided a higher gain of visual lines than the isolated use of each treatment. The laser photocoagulation was the only therapy that did not significantly reduce the macular volume and the macular thickness, however, it was also the only one that did not present cases of ocular hypertension during follow up.
108

Étude des fonctions neuropsychologiques des enfants et adolescents atteints de l'ataxie récessive spastique de Charlevoix-Saguenay (ARSCS) /

Drolet, Mélanie, January 2002 (has links)
Thèse (M.Ps.)--Université du Québec, 2002. / Document électronique également accessible en format PDF. CaQCU
109

Knowledge of Computer Vision Syndrome among computer users in the workplace in Abuja, Nigeria

Raymond, Akinbinu Tope 30 May 2013 (has links)
Quantitative, descriptive, cross-sectional study was conducted to determine the level of knowledge and extent of Computer Vision Syndrome (CVS) among computer users in the Securities and Exchange Commission (SEC), Abuja, Nigeria. Structured questionnaires were administered to 100 computer users aged between 18 and 40 years. The study findings revealed that 40 respondents (40%) were aware of CVS and 27 (27%) of them had knowledge of the disorder. 74 (74%) of the respondents experienced at least one symptom of CVS. Headache and eyestrain were the most common symptom of CVS among the population. The study also revealed that the internet (accounting for 50%) was the major source of information about CVS awareness. The study concluded that 27% knowledge level is too low and much emphasis is needed to educate the people at risk of CVS / Health Studies / M.A. (Public Health)
110

Tratamento do edema macular difuso do diabético com triancinolona intravítrea e fotocoagulação com laser de argônio / Use of intravitreal triamcinolone and laser photocoagulation for the treatment of diffuse diabetic macular edema

Fábio Petersen Saraiva 17 March 2008 (has links)
INTRODUÇÃO: O edema macular difuso é uma importante causa de baixa visual em portadores de diabetes mellitus. O tratamento clássico deste tipo de retinopatia consiste na fotocoagulação, entretanto, esta terapêutica é ineficaz em muitos casos. Neste trabalho, avaliou-se a eficácia do uso intravítreo da triancinolona acetonida associada à fotocoagulação com laser de argônio no tratamento do edema macular difuso diabético. Esta associação terapêutica foi comparada com o uso isolado de cada tratamento. MÉTODOS: Neste estudo, realizado entre junho de 2005 e setembro de 2006, foram estudados 30 pacientes diabéticos clinicamente controlados e portadores de edema macular difuso. Estes pacientes foram alocados de forma aleatória e proporcional em um dos seguintes grupos de tratamento: (1) fotocoagulação macular em grade com laser de argônio; (2) aplicação intravítrea de 4 mg de triancinolona acetonida; (3) associação dos itens anteriores. O seguimento foi realizado em intervalos pré-determinados de um dia, uma semana e mensalmente, até completar 6 meses. Foram analisados os parâmetros: acuidade visual corrigida LogMAR; espessura macular central e volume macular total medido pela tomografia de coerência óptica; e pressão intra-ocular aferida pelo tonômetro de Goldmann. RESULTADOS: A fotocoagulação com laser não reduziu de forma estatisticamente significativa a espessura macular central (p=0,0862) e o volume macular total (p=0,11). Esta redução foi significativa e estatisticamente semelhante nos outros dois grupos (p<0,001). Todos os grupos apresentaram melhora da acuidade visual (p=0,003), entretanto, o grupo que recebeu a associação do laser com a triancinolona intravítrea, obteve maior percentagem de pacientes com ganho de 10 ou mais letras de visão no quarto e quinto mês de seguimento (p=0,026; p=0,034). A pressão intra-ocular elevou-se em 5 mmHg ou mais em 12 pacientes, sendo seis no grupo submetido apenas a triancinolona e os outros seis no grupo que recebeu a associação de tratamento (p<0,001).Todos estes casos foram bem controlados com colírio de maleato de timolol 0,5%. CONCLUSÕES: O uso simultâneo da fotocoagulação com a triancinolona intravítrea proporcionou maior ganho de linhas de visão do que o uso isolado de cada tratamento. A fotocoagulação com laser foi a única terapia que não reduziu de forma significativa a espessura e o volume macular total e, também, foi a única que não apresentou casos de hipertensão ocular durante o seguimento. / INTRODUCTION: The diffuse macular edema is an important cause of visual impairment in diabetic subjects. Laser photocoagulation is the main treatment for this disorder, however, it is not effective in a large number of patients. In this study, we evaluated the efficacy of intravitreal use of triamcinolone acetonide combined with laser photocoagulation for the treatment of diffuse diabetic macular edema and we compare it with either laser alone or intra-vitreal triancinolone. METHODS: In this study, performed between june 2005 and september 2006, we studied 30 well controlled diabetic patients with diffuse macular edema. These patients were randomly divided into the following treatment groups: (1) macular grid photocoagulation; (2) intravitreal injection of 4 mg of triamcinolone acetonide; (3) combination of the two previous therapies. Follow up was scheduled at predetermined intervals of one day, one week and monthly until completion of six months. The following parameters were analyzed: LogMAR best corrected visual acuity; central macular thickness and total macular volume measured by ocular coherence tomography; and intraocular pressure assessed by Goldman\'s tonometer. RESULTS: Grid photocoagulation did not significantly reduce the central macular thickness (p=0,0862) or the total macular volume (p=0,11). On the other side, this reduction was significant and statistically similar in the others two groups (p<0,001). All groups improved the mean visual acuity (p=0,003), however, the group that received the association treatment had a higher percentage of patients gaining 10 or more letters at the fourth and fifth month of follow up (p=0,026; p=0,034). A rise in 5 or more mmHg in intraocular pressure was observed in 12 patients; half of them was in the triamcinolone group and the other half was in the group that received combined therapies (p<0,001). These cases with elevated intraocular pressure were well controlled with timolol maleate 0,5% drops. CONCLUSION: The simultaneous use of photocoagulation and intravitreal triamcinolone provided a higher gain of visual lines than the isolated use of each treatment. The laser photocoagulation was the only therapy that did not significantly reduce the macular volume and the macular thickness, however, it was also the only one that did not present cases of ocular hypertension during follow up.

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