ABSTRACT Introduction: Diabetes mellitus is a public health issue affecting an increasing number of workers, representing a disease exacerbated by work with a high social, economic, and personal cost. The nature of the work performed, coupled with occupational risks in a hospital setting, significantly contribute to the disease's progression. This study aims to address the impact of this disease on work and the role of Occupational Health in the prevention of exposure to occupational risk factors in the hospital environment, which can contribute to the metabolic imbalance of type I diabetes mellitus. Methodology: The methodology included search in PubMed, Science Direct, and Google Scholar databases, using keywords such as "diabetes mellitus, occupational medicine, risk factors and occupational health”. Filters were applied, considering publications from 2010 to 2024, totaling 463 works. Exclusion criteria focused on non-diabetes-related diseases, exclusive focus on Type II, and non-occupational approaches. Articles on diabetes and occupational health and safety published in Revista Portuguesa de Saúde Ocupacional were also considered, in a total of five studies. Sources also included Direção Geral de Saúde Clinical Guidance, a national epidemiological study, and a technical manual on workplace diabetes, totaling 30 references in the discussion. Results: The authors report two cases of healthcare professionals from a hospital unit, both diagnosed with Type I Diabetes at the age of five. Case 1: A 35-year-old healthcare assistant with a history of depressive syndrome and recent diabetic retinopathy diagnosis. Case 2: A 57-year-old nurse with diabetic retinopathy, nephropathy, neuropathy, undergoing treatment for osteomyelitis of the right big toe, without cardiovascular changes. In both they work or have worked in shifts, including night shifts, engaging in physically demanding tasks. Discussion/Conclusion: Diabetes is a chronic disease requiring continuous medical care and patient education, alongside support in preventing acute complications and reducing the risk of chronic complications. The incidence of new Type I Dm cases is higher between 12-14 years. During the transition to adulthood and entry into the job market, patients face disease stigma, treatment management challenges, and psychosocial workplace-related issues. Implementing preventive measures and monitoring these workers should help reduce work absenteeism, productivity loss, and income loss for the worker.

RESUMO Introdução: A Diabetes mellitus é um problema de Saúde Pública que afeta um número crescente de trabalhadores. Pode ser considerada uma doença agravada pelo trabalho com um elevado custo social, económico e pessoal. O tipo de trabalho realizado e as exposições a riscos laborais em contexto hospitalar, podem contribuir para a sua progressão, segundo alguns autores. Este trabalho pretende abordar o impacto desta patologia no trabalho e o papel da Saúde Ocupacional na evicção da exposição a fatores de risco laborais, em ambiente hospitalar, que contribuem para o descontrolo metabólico da Diabetes Melitus tipo I. Pretende-se identificar as exposições laborais que podem constituir fatores de risco modificáveis, interferem com a aptidão para o trabalho, podem aumentar a frequência de acidentes laborais e acelerar a progressão crónica da doença. Metodologia: Na metodologia de pesquisa e seleção de estudos utilizou as bases de dados PubMed, Science Direct e Google Scholar, com as palavras-chave “diabetes mellitus, occupational medicine, risk factors, occupational health”. Aplicaram-se filtros de revisão e revisão sistemática, considerando publicações de 2010 a 2024, totalizando 463 trabalhos. Critérios de exclusão incidiram em doenças não relacionadas à diabetes, exclusividade na tipo II e abordagens não ocupacionais. Foram ainda considerados os artigos sobre diabetes e saúde e segurança no trabalho publicados na Revista Portuguesa de Saúde Ocupacional, num total de cinco estudos. Incluíram-se a Norma de Orientação Clínica da DGS, um estudo epidemiológico nacional e um caderno técnico sobre diabetes no local de trabalho, totalizando 30 fontes na discussão. Descrição dos casos: Os autores reportam dois casos de profissionais de saúde de uma unidade hospitalar, ambos com diagnóstico de Diabetes tipo I aos cinco anos de idade. Caso 1: Uma auxiliar de ação médica de 35 anos, com antecedentes pessoais de síndrome depressivo e diagnóstico recente de retinopatia diabética. Caso 2: Uma enfermeira de 57 anos com retinopatia e nefropatia diabética, neuropatia, em tratamento para uma osteomielite do 1º dedo do pé direito, sem alterações cardiovasculares. Ambas trabalham ou trabalharam por turnos, com trabalho noturno e com tarefas fisicamente exigentes. Discussão/Conclusão: A diabetes é uma doença crónica que requer cuidados médicos contínuos e educação do doente, juntamente com apoio na prevenção de complicações agudas e redução do risco de complicações crónicas. A incidência de novos casos de Dm tipo I é maior entre os 12-14 anos. Na transição para a idade adulta e entrada no mercado laboral, os doentes podem ser sujeitos ao estigma da doença, ter dificuldade na gestão do tratamento e/ou desafios psicossociais relacionados com o trabalho. A instituição de medidas preventivas e monitorização destes trabalhadores deverá ajudar a reduzir o absentismo laboral, a perda de produtividade e a perda de rendimento para o trabalhador.

RESUMEN Introducción: la diabetes mellitus es una enfermedad crónica que, al no ser controlada, puede desencadenar en complicaciones macro y microvasculares. Uno de los indicadores de un adecuado control glucémico es la hemoglobina glicosilada. Objetivos: determinar la frecuencia de complicaciones macro y microvasculares en pacientes diabéticos tipo 2 con hemoglobina glicosilada alterada internados en el Hospital Nacional de Itauguá periodo 2022 - 2023 Metodología: estudio observacional, descriptivo de corte transversal que incluyó a 170 pacientes adultos internados en el servicio de clínica médica del Hospital Nacional (Itauguá, Paraguay) durante los años 2022 y 2023. Resultados: la edad media fue de 58 ± 12 años, con predominio del sexo femenino (51 %). La complicación más frecuentemente diagnosticada fue la enfermedad del pie relacionada a la diabetes con 83 pacientes (49 %), seguido por retinopatía diabética 23 (14 %). El valor promedio de hemoglobina glicosilada fue de 10 ± 2 %. Solamente 6 (4 %) del total de pacientes presentó un valor de HbA1C≥ 7,1 %. La comorbilidad asociada más frecuente fue la hipertensión arterial 87 (51 %). El 91 % de los pacientes conocía ser portador de la enfermedad, el 80 % recibía algún tipo de tratamiento. Conclusiones: el pie diabético fue la complicación vascular diagnosticada con mayor ,frecuencia, especialmente en pacientes con HbA1C≥ 7,1 %.

ABSTRACT Introduction: diabetes mellitus is a chronic disease that, if not controlled, can lead to macro- and microvascular complications. One of the indicators of adequate glycemic control is glycosylated hemoglobin. Objectives: to determine the frequency of macro and microvascular complications in type 2 diabetic patients with altered glycosylated hemoglobin admitted to the Hospital Nacional from 2022 to 2023 Methodology: this was an observational, descriptive, cross-sectional study that included 170 adult patients admitted to the Internal Medicine service of the Hospital Nacional (Itauguá, Paraguay) during the years 2022 and 2023. Results: the mean age was 58 ± 12 years, with a predominance of the female sex (51 %). The most frequently diagnosed complication was foot disease related to diabetes with 83 patients (49 %), followed by diabetic retinopathy 23 (14 %). The average value of glycosylated hemoglobin was 10 ± 2 %. Only 6 (4 %) of the total patients had an HbA1C value ≤7 %. The most frequent associated comorbidity was arterial hypertension 87 (51 %). 91 % of the patients knew they were carriers of the disease, 80 % received some type of treatment. Conclusions: diabetic foot was the most frequently diagnosed vascular complication, especially in patients with HbA1C ≥7.1 %.

RESUMEN Introducción: Se reconoce la asociación entre los factores de riesgo aterogénico y las alteraciones microvasculares de la retina, pero no hay consenso sobre si estas afectaciones en la retina preceden o son una respuesta fisiopatológica a dichos factores. Objetivo: Determinar si la presencia de los factores de riesgo aterogénico predice las alteraciones vasculares retinianas, a través del fondo de ojo y la retinografía. Métodos: Estudio trasversal en 55 sujetos mayores de 19 años de edad, de cualquier sexo, sin opacidades en los medios transparentes del ojo. Se estudiaron las variables edad, sexo, dislipidemia, hábito de fumar, consumo de alcohol, hipertensión arterial, diabetes mellitus tipo 2, presión arterial sistólica y diastólica, índice de masa corporal, colesterol, glicemia, triglicéridos, creatinina, lipoproteínas de alta densidad, urea, eritrosedimentación y conteo leucocitario. Resultados: El 65,45 % presentó alteraciones en el fondo de ojo: aumento del brillo arteriolar (53,03 %) y disminución del calibre arteriolar generalizado (52,24 %). La retinografía mostró daño en el 58,18 %: rectificación de los cruces arteriovenosos (65,71 %), tortuosidad venosa (28,21 %) y cruces arteriovenosos con aplastamiento (85,71 %). El aumento del colesterol sérico (p= 0,003) se asoció con la presión arterial sistólica (p= 0,037) en el fondo de ojo, y con el antecedente de hipertensión arterial (p= 0,023) en la retinografía. Conclusiones: El colesterol sérico, las cifras elevadas de tensión arterial sistólica y antecedentes de hipertensión arterial son los factores de riesgo que mejor predicen el daño vascular retinal.

ABSTRACT Introduction: The association between atherogenic risk factors and retinal microvascular alterations is recognized, but there is no consensus on whether these retinal disorders precede or are a pathophysiological response to these factors. Objective: To determine if the presence of atherogenic risk factors predicts retinal vascular alterations, through fundus examination and retinography. Methods: Cross-sectional study in 55 subjects over 19 years of age, of either sex, without opacities in the transparent media of the eye. The variables studied were age, sex, dyslipidemia, smoking habit, alcohol consumption, arterial hypertension, type 2 diabetes mellitus, systolic and diastolic blood pressure, body mass index, cholesterol, glycemia, triglycerides, creatinine, high-density lipoproteins, urea, erythrocyte sedimentation rate and leukocyte count. Results: 65.45% presented alterations in the fundus of the eye: increased arteriolar brightness (53.03%) and decreased generalized arteriolar caliber (52.24%). Retinography showed damage in 58.18%: rectification of arteriovenous crossings (65.71%), venous tortuosity (28.21%), and arteriovenous crossings with crushing (85.71%). The increase in serum cholesterol (p= 0.003) was associated with systolic blood pressure (p= 0.037) in the fundus, and with a history of arterial hypertension (p= 0.023) in retinography. Conclusions: Serum cholesterol, high systolic blood pressure and a history of hypertension are the risk factors that best predict retinal vascular damage.

ABSTRACT Purpose: To evaluate early changes after the first antivascular endothelial growth factor injection for macular edema secondary to diabetic retinopathy and retinal vein occlusion and the relationship between longterm outcomes. Methods: The study enrolled patients who received anti-vascular endothelial growth factor injections for treatment-naive macular edema due to retinal vein occlusion and diabetic retinopathy. The central macular thickness was measured at baseline, post-injection day 1, week 2, and month 1, and at the last visit using spectral-domain optical coherence tomography. A good response was defined as a central macular thickness reduction of ≥10% on post-injection day 1. Patients were reassessed at the last visit with regard to treatment response on post-injection day 1 based on the favorable anatomic outcome defined as a central macular thickness <350 µm. Results: In total, 26 (44.8%) patients had macular edema-retinal vein occlusion and 32 (55.2%) had macular edema-diabetic retinopathy. The mean follow-up time was 24.0 (SD 8.5) months. A statistically significant decrease in the central macular thickness was observed in both patients with macular edema-retinal vein occlusion and macular edema-diabetic retinopathy after antivascular endothelial growth factor injection therapy (p<0.001 for both). All patients with macular edema-retinal vein occlusion were good responders at post-injection day 1. All nongood responders at post-injection day 1 belong to the macular edema-diabetic retinopathy group (n=16.50%). The rate of hyperreflective spots was higher in nongood responders than in good responders of the macular edema-diabetic retinopathy group (p=0.03). Of 42 (2.4%) total good responders, one had a central macular thickness >350 µm, whereas 5 (31.2%) of 16 total nongood responders had a central macular thickness >350 µm at the last visit (p=0.003). Conclusion: The longterm anatomical outcomes of macular edema secondary to retinal vein occlusion and diabetic retinopathy may be predicted by treatment response 1 day after antivascular endothelial growth factor injection. Purpose Methods anti vascular treatmentnaive naive baseline postinjection post 2 spectraldomain spectral domain tomography 10 ≥10 350 <35 Results 44.8% 448 44 8 (44.8% edemaretinal 3 55.2% 552 55 (55.2% edemadiabetic followup follow up 240 24 0 24. SD 8.5 85 months p<0.001 p0001 p 001 (p<0.00 both. . both) n=16.50%. n1650 n n=16.50% 50 (n=16.50%) p=0.03. p003 p=0.03 03 (p=0.03) 4 2.4% (2.4% >35 31.2% 312 31 (31.2% p=0.003. p0003 p=0.003 003 (p=0.003) Conclusion ≥1 35 <3 44.8 (44.8 55.2 (55.2 8. p<0.00 p000 00 (p<0.0 n165 n=16.50 (n=16.50% p00 p=0.0 (p=0.03 2.4 (2.4 >3 31.2 (31.2 p=0.00 (p=0.003 ≥ < 44. (44. 55. (55. p<0.0 (p<0. n16 n=16.5 (n=16.50 p0 p=0. (p=0.0 2. (2. > 31. (31. (p=0.00 (44 (55 p<0. (p<0 n1 n=16. (n=16.5 p=0 (p=0. (2 (31 (4 (5 p<0 (p< n=16 (n=16. p= (p=0 ( (3 p< (p n=1 (n=16 (p= n= (n=1 (n= (n

RESUMO Objetivo: Avaliar as alterações precoces após a primeira injeção de anticorpos antifator de crescimento endotelial vascular (anti-VEGF) em casos de edema macular secundário à retinopatia diabética e oclusão da veia da retina e a relação entre essas alterações e o resultado a longo prazo. Métodos: Foram incluídos no estudo pacientes que receberam uma injeção de antifator de crescimento endotelial vascular para edema macular, virgem de tratamento e devido à oclusão da veia retiniana ou a retinopatia diabética. A espessura macular central foi medida no início do tratamento e no 1º dia, 2ª semana e 1º mês após a injeção, bem como na última visita, através de tomografia de coerência óptica de domínio espectral. Definiu-se uma “boa resposta” como uma redução ≥10% na espessura macular central no 1º dia após a injeção. Os pacientes foram reavaliados na última visita com relação à resposta ao tratamento no 1º dia após a injeção, com base em um resultado anatômico favorável, definido como uma espessura macular central <350 µm. Resultado: Foram registrados 26 (44,8%) pacientes com edema macular e oclusão da veia da retina e 32 (55,2%) com edema macular e retinopatia diabética. O tempo médio de acompanhamento foi de 24,0 meses (desvio-padrão de 8,5 meses). Foi observada uma diminuição estatisticamente significativa da espessura macular central após o tratamento antifator de crescimento endotelial vascular tanto em pacientes com edema macular e oclusão da veia retiniana quanto naqueles com edema macular e retinopatia diabética (p<0,001 para ambos). Todos os pacientes com edema macular e oclusão da veia retiniana responderam bem no 1º dia pós-injeção. Todos os que responderam mal no 1º dia pós-injeção pertenciam ao grupo com edema macular e retinopatia diabética (n=16,50%). A presença de manchas hiperrefletivas foi maior nos pacientes que responderam mal do que naqueles que tiveram boa resposta no grupo com edema macular e retinopatia diabética (p=0,03). Um dos 42 (2,4%) pacientes com boa resposta total teve espessura macular central >350 um, enquanto 5 (31,2%) do total de 16 pacientes com resposta ruim apresentaram espessura macular central >350 µm na última visita (p=0,003). Conclusão: O resultado anatômico de longo prazo do edema macular secundário à oclusão da veia retiniana e à retinopatia diabética pode ser previsto pela resposta ao tratamento no 1º dia após a injeção de antifator de crescimento endotelial vascular. Objetivo antiVEGF anti VEGF (anti-VEGF Métodos º ª espectral Definiuse Definiu se 10 ≥10 favorável 350 <35 Resultado 2 44,8% 448 44 8 (44,8% 3 55,2% 552 55 (55,2% 240 24 0 24, desviopadrão desvio padrão 85 8, meses. . meses) p<0,001 p0001 p 001 (p<0,00 ambos. ambos ambos) pósinjeção. pósinjeção pós n=16,50%. n1650 n n=16,50% 50 (n=16,50%) p=0,03. p003 p=0,03 03 (p=0,03) 4 2,4% (2,4% >35 31,2% 312 31 (31,2% 1 p=0,003. p0003 p=0,003 003 (p=0,003) Conclusão ≥1 35 <3 44,8 (44,8 55,2 (55,2 p<0,00 p000 00 (p<0,0 n165 n=16,50 (n=16,50% p00 p=0,0 (p=0,03 2,4 (2,4 >3 31,2 (31,2 p=0,00 (p=0,003 ≥ < 44, (44, 55, (55, p<0,0 (p<0, n16 n=16,5 (n=16,50 p0 p=0, (p=0,0 2, (2, > 31, (31, (p=0,00 (44 (55 p<0, (p<0 n1 n=16, (n=16,5 p=0 (p=0, (2 (31 (4 (5 p<0 (p< n=16 (n=16, p= (p=0 ( (3 p< (p n=1 (n=16 (p= n= (n=1 (n= (n

ABSTRACT Purpose: This study aimed to determine closure rates of large idiopathic macular holes treated with pars plana vitrectomy and 360-degree pedicled inverted internal limiting membrane flap without face-down posturing and define visual improvement, types of macular hole closure, and external retina integrity as secondary outcomes. Methods: This retrospective case series analyzed all patients who were treated by vitrectomy, 360-degree pedicled inverted internal limiting membrane flap, and gas tamponade, without face-down posturing postoperatively. Age, sex, time of visual acuity reduction, other ocular pathologies, and lens status were collected. The best-corrected visual acuity and optical coherence tomography results were recorded during pre- and postoperative follow-up examinations (15 days and 2 months after surgery). Results: This study enrolled 20 eyes of 19 patients, and the mean age was 66 years. Optical coherence tomography performed 2 months after surgery revealed hole closure in 19 (95%) eyes. The median best-corrected visual acuity improved from +1.08 preoperatively to +0.66 LogMAR 2 months postoperatively (p<0.001), with a median of 20 letters of visual improvement (0.4 LogMAR) on the Early Treatment Diabetic Retinopathy Study chart. V (47.36%)- and U (52.63%)-types of closure were observed. Conclusion: The 360-degree pedicled inverted internal limiting membrane flap technique, without face-down posturing, provided a high closure rate (95%), external layer recovery, and V- and U-type foveal closure contours, in addition to visual improvement in most cases of large macular holes (even macular holes >650 μm). This technique may be a viable alternative to patients in whom traditional postoperative face-down positioning for large macular hole treatment is not possible. Purpose 360degree degree 360 facedown face down outcomes Methods tamponade Age sex reduction pathologies collected bestcorrected best corrected pre followup follow up 15 (1 surgery. . surgery) Results 1 6 years 95% 95 (95% 108 08 +1.0 066 0 +0.6 p<0.001, p0001 p p<0.001 , 001 (p<0.001) 0.4 04 4 (0. chart 47.36% 4736 47 36 (47.36%) 52.63%types 5263types 52.63% 52 63 observed Conclusion 95%, recovery Utype type contours even 650 >65 μm. μm μm) possible ( 9 (95 10 +1. 06 +0. p000 p<0.00 00 (p<0.001 0. (0 47.36 473 3 (47.36% 5263 52.63 5 65 >6 (9 +1 +0 p00 p<0.0 (p<0.00 47.3 (47.36 526 52.6 > + p0 p<0. (p<0.0 47. (47.3 52. p<0 (p<0. (47. p< (p<0 (47 (p< (4 (p

RESUMO Objetivo: Determinar as taxas de fechamento de buracos maculares idiopáticos grandes tratados com vitrectomia posterior e técnica de flap invertido 360 graus pediculado de membrana limitante interna, sem posicionamento de cabeça pós-operatório e definir melhora visual, tipos de fechamento do buraco macular e integridade das camadas retinianas externas como objetivo secundário. Métodos: Este estudo foi uma série retrospectiva de casos. Todos os pacientes foram submetidos a vitrectomia com flap invertido 360 graus pediculado de membrana limitante interna e tamponamento com gás, sem posição de cabeça no pós-operatório. Idade, gênero, tempo de redução da acuidade visual, outras patologias oculares e status do cristalino foram compilados. Medida de melhor acuidade visual corrigida e tomografia de coerência óptica foram registradas durante as visitas de pré e pós-operatório (15 dias e 2 meses após cirurgia). Resultados: Vinte olhos de 19 pacientes foram incluídos neste estudo. A idade média foi de sessenta e seis anos. Um total de 19 olhos (95%) atingiu fechamento do buraco, observado através das imagens de tomografia de coerência óptica após 2 meses de cirurgia. Melhor acuidade visual corrigida média aumentou +1,08 pré-operatória para +0,66 LogMAR em 2 meses de cirurgia (p<0,001), com média de 20 letras de melhora visual (0,4 LogMAR) na tabela do Early Treatment Diabetic Retinopathy Study. Dois tipos de fechamento do buraco foram observados: V (47,36%) e U (52,63%). Conclusão: A técnica de flap invertido 360 graus pediculado de membrana limitante interna, sem posicionamento de cabeça no pós-operatório promoveu elevada taxa de fechamento (95%), reestabelecimento das camadas retinianas externas, fechamento com contorno foveal dos tipos V e U, além de melhora visual na maioria dos casos de BMI gran des (mesmo nos buracos maiores que 650 μm). Esta técnica pode representar uma alternativa para o tratamento de buracos maculares grandes em pacientes impossibilitados de cumprir o tradicional posicionamento de cabeça pós-operatório. Objetivo 36 pósoperatório pós operatório secundário Métodos gás pósoperatório. operatório. Idade gênero compilados 15 (1 . cirurgia) Resultados 1 anos 95% 95 (95% 108 08 +1,0 préoperatória operatória 066 0 66 +0,6 p<0,001, p0001 p p<0,001 , 001 (p<0,001) 0,4 04 4 (0, Study observados 47,36% 4736 47 (47,36% 52,63%. 5263 52,63% 52 63 (52,63%) Conclusão 95%, mesmo 65 μm. μm μm) 3 ( 9 (95 10 +1, 06 6 +0, p000 p<0,00 00 (p<0,001 0, (0 47,36 473 (47,36 526 52,63 5 (52,63% (9 +1 +0 p00 p<0,0 (p<0,00 47,3 (47,3 52,6 (52,63 + p0 p<0, (p<0,0 47, (47, 52, (52,6 p<0 (p<0, (47 (52, p< (p<0 (4 (52 (p< (5 (p

ABSTRACT Purpose: To investigate the clinical benefits of the co-application of bevacizumab and tissue plasminogen activator as adjuncts in the surgical treatment of proliferative diabetic retinopathy. Methods: Patients who underwent vitrectomy for proliferative dia-betic retinopathy complications were preoperatively given in-travitreal injection with either bevacizumab and tissue plasminogen activator (Group 1) or bevacizumab alone (Group 2). Primary outcomes were surgery time and number of intraoperative iatrogenic retinal breaks. Secondary outcomes included changes in the best-corrected visual acuity and postoperative complications at 3 months postoperatively. Results: The mean surgery time in Group 1 (52.95 ± 5.90 min) was significantly shorter than that in Group 2 (79.61 ± 12.63 min) (p<0.001). The mean number of iatrogenic retinal breaks was 0.50 ± 0.59 (0-2) in Group 1 and 2.00 ± 0.83 (0-3) in Group 2 (p<0.001). The best-corrected visual acuity significantly improved in both groups (p<0.001). One eye in each group developed retinal detachment. Conclusion: Preoperative co-application of bevacizumab and tissue plasminogen activator as adjuncts in the surgical treatment of proliferative diabetic retinopathy shortens the surgery time and reduces the number of intraoperative iatrogenic retinal breaks. Purpose coapplication co application Methods dia betic intravitreal travitreal 2. . 2) bestcorrected best corrected postoperatively Results 52.95 5295 52 95 (52.9 590 5 90 5.9 min 79.61 7961 79 61 (79.6 1263 12 63 12.6 p<0.001. p0001 p p<0.001 0 001 (p<0.001) 050 50 0.5 059 59 02 (0-2 200 00 2.0 083 83 0.8 03 (0-3 detachment Conclusion 52.9 529 9 (52. 5. 79.6 796 7 6 (79. 126 12. p000 p<0.00 (p<0.001 05 0. (0- 20 08 8 52. (52 79. (79 p00 p<0.0 (p<0.00 (0 (5 (7 p0 p<0. (p<0.0 ( p<0 (p<0. p< (p<0 (p< (p

ABSTRACT Purpose: This study aimed to evaluate the efficacy and clinical outcomes of a one-way fluid-air exchange procedure for the treatment of postvitrectomy diabetic vitreous hemorrhage in patients with proliferative diabetic retinopathy. Methods: This retrospective study included 233 patients with proliferative diabetic retinopathy, who underwent vitrectomy. A one-way fluid-air exchange procedure was performed in 24 eyes of 24 (10.30%) patients with persistent vitreous cavity rebleeding after the operation. Preprocedural and postprocedural best-corrected visual acuity values were achieved. Complications occurring during and after the procedure were analyzed. Results: Significant visual improvement was observed 1 month after the one-way fluid-air exchange procedure (2.62 ± 0.60 LogMAR at baseline vs. 0.85 ± 0.94 LogMAR at postprocedure, p<0.0001). Moreover, 19 (79.17%) eyes needed the procedure once, and 5 (20.83%) eyed had the procedure more than twice. In 3 (12.50%) eyes, reoperation was eventually required because of persistent rebleeding despite several fluid-air exchanges. No complication was observed during the follow-up. Conclusions: The one-way fluid-air exchange procedure can be an excellent alternative to re-vitrectomy for patients with proliferative diabetic retinopathy suffering from postvitrectomy diabetic vitreous hemorrhage by removing the hemorrhagic contents directly and achieving fast recovery of visual function without apparent complications. Purpose oneway one way fluidair fluid air Methods 23 vitrectomy 2 10.30% 1030 10 30 (10.30% operation bestcorrected best corrected achieved analyzed Results 2.62 262 62 (2.6 060 0 60 0.6 vs 085 85 0.8 094 94 0.9 postprocedure p<0.0001. p00001 p p<0.0001 . 0001 p<0.0001) Moreover 79.17% 7917 79 17 (79.17% once 20.83% 2083 20 83 (20.83% twice 12.50% 1250 12 50 (12.50% exchanges followup. followup follow up. up follow-up Conclusions revitrectomy re complications 10.30 103 (10.30 2.6 26 6 (2. 06 0. 08 8 09 9 p0000 p<0.000 000 79.17 791 7 (79.17 20.83 208 (20.83 12.50 125 (12.50 10.3 (10.3 2. (2 p000 p<0.00 00 79.1 (79.1 20.8 (20.8 12.5 (12.5 10. (10. ( p00 p<0.0 79. (79. 20. (20. 12. (12. (10 p0 p<0. (79 (20 (12 (1 p<0 (7 p<

ABSTRACT Objective: To assess the accuracy of general practitioners in recognizing diabetic retinopathy through color retinal retinography, with a two-hour training course, by comparing the capacity of screening and classifying diabetic retinopathy. Methods: In the first arm of the study, of 142 diabetic patients included, 274 eyes were evaluated, and these patients were examined with an indirect binocular ophthalmoscope and classified according to the degree of diabetic retinopathy. In the second arm of the study, 14 physicians who are not specialists in ophthalmology received two-hour training to diagnose diabetic retinopathy with color retinography, and the accuracy of these professionals in screening for diabetic retinopathy before and after the training course was measured using the photographic images obtained on the first front of the study. Results: There was a significant increase in sensitivity (82% to 99%) and specificity (44% to 83%) in detecting diabetic retinopathy by general practitioners, after attending the training. Conclusion: Qualified general practitioners can assess diabetic retinopathy through color retinography, and the screening program for this diabetes complication is a viable and beneficial proposal for the country. Objective retinography twohour two hour Methods study included 27 evaluated 1 Results 82% 82 (82 99% 99 44% 44 (44 83% 83 Conclusion country 2 8 (8 9 4 (4 (

RESUMO Objetivo: Avaliar a acurácia de médicos generalistas em reconhecer a retinopatia diabética por meio da retinografia colorida, com um curso de capacitação com duração de 2 horas, comparando a capacidade de rastrear e classificar a retinopatia diabética em relação ao exame presencial com oftalmologista. Métodos: No primeiro braço do estudo, de 142 pacientes diabéticos incluídos, avaliaram-se 274 olhos, em que esses pacientes foram examinados com oftalmoscópio binocular indireto e classificados quanto ao grau da retinopatia diabética. No segundo braço do estudo, 14 médicos não especialistas em oftalmologia receberam um treinamento de 2 horas para o diagnóstico de retinopatia diabética com a retinografia colorida e se aferiu a acurácia desses profissionais em rastrear a retinopatia diabética antes e depois do curso de capacitação, utilizando as retinografias obtidas na primeira frente do estudo. Resultados: Verificou-se aumento significativo da sensibilidade (82% para 99%) e da especificidade (44% para 83%) na detecção da retinopatia diabética pelos médicos generalistas, com o curso de capacitação. Conclusão: O médico generalista capacitado pode avaliar a retinopatia diabética por meio da retinografia colorida, sendo o programa de rastreamento dessa complicação do diabetes uma proposta viável e benéfica ao país. Objetivo oftalmologista Métodos estudo incluídos avaliaramse avaliaram 27 olhos 1 Resultados Verificouse Verificou 82% 82 (82 99% 99 44% 44 (44 83% 83 Conclusão país 8 (8 9 4 (4 (

Health literacy (HL) is defined as a cognitive and social skill that determines the motivation and ability of individuals to understand and use information to promote and maintain proper health. Inadequate HL has been associated with worse outcomes in diabetes control, poor self-care, and higher hospitalization rates for some chronic diseases. We hypothesized that HL influences the prevalence of diabetic retinopathy (DR) among individuals with type 2 diabetes mellitus (T2DM) and that inadequate glycemic control would mediate this association. This was a cross-sectional study carried out with 288 participants of the “Brazilian Diabetes Study” cohort. Inclusion criteria were people diagnosed with T2DM aged between 40 and 70 years and ability to read and write. In the adequate HL group, DR was found in 16.5% of participants and in the inadequate HL group, it was found in 32.8% (P=0.0081). Individuals with inadequate HL had a higher risk of having DR, and this association was still statistically significant after adjusting for HbA1c, low-density lipoprotein cholesterol, systolic blood pressure, and diastolic blood pressure. In conclusion, HL is related to DR without the mediation of classical clinical variables. (HL health selfcare, selfcare self care, care self-care diseases (DR TDM T DM (T2DM crosssectional cross sectional 28 Brazilian Study cohort 4 7 write group 165 16 5 16.5 328 32 8 32.8 P=0.0081. P00081 P P=0.0081 . 0 0081 (P=0.0081) HbA1c HbAc HbA c lowdensity low density cholesterol pressure conclusion variables 1 16. 3 32. P0008 P=0.008 008 (P=0.0081 P000 P=0.00 00 (P=0.008 P00 P=0.0 (P=0.00 P0 P=0. (P=0.0 P=0 (P=0. P= (P=0 (P= (P

ABSTRACT Purpose: This study measured serum hypoxia--inducible factor-1 (HIF-1α) and survivin levels in patients with diabetes and investigated their association with the severity of retinopathy. Methods: This study included 88 patients with type 2 diabetes mellitus who underwent routine eye examinations. Three groups were created. Group 1 consisted of patients without diabetic retinopathy. Group 2 included patients with non-proliferative diabetic retinopathy. Group 3 included patients with proliferative diabetic retinopathy. To measure serum HIF-1α and survivin levels, venous blood samples were collected from patients. Results: The mean HIF-1α levels in groups 1, 2, and 3 were 17.30 ± 2.19, 17.79 ± 2.34, and 14.19 ± 2.94 pg/ml, respectively. Significant differences were detected between groups 1 and 3 (p=0.01) and between groups 2 and 3 (p=0.01). The mean survivin levels in groups 1, 2, and 3 were 42.65 ± 5.37, 54.92 ± 5.55, and 37.46 ± 8.09 pg/ml, respectively. A significant difference was only detected between groups 2 and 3 (p=0.002). Conclusion: The present study revealed that serum HIF-1α and survivin levels are increased in patients with non-proliferative diabetic retinopathy compared to those in patients without diabetic retinopathy. Purpose hypoxiainducible hypoxia inducible factor1 factor factor- HIF1α HIFα HIF 1α α (HIF-1α Methods 8 examinations created nonproliferative non Results 1730 17 30 17.3 219 19 2.19 1779 79 17.7 234 34 2.34 1419 14 14.1 294 94 2.9 pgml pg ml pg/ml respectively p=0.01 p001 p 0 01 (p=0.01 p=0.01. . 4265 42 65 42.6 537 5 37 5.37 5492 54 92 54.9 555 55 5.55 3746 46 37.4 809 09 8.0 p=0.002. p0002 p=0.002 002 (p=0.002) Conclusion 173 17. 21 2.1 177 7 23 2.3 141 14. 29 9 2. p=0.0 p00 (p=0.0 426 4 6 42. 53 5.3 549 54. 5.5 374 37. 80 8. p000 p=0.00 00 (p=0.002 p=0. p0 (p=0. 5. (p=0.00 p=0 (p=0 p= (p= (p

ABSTRACT Purpose: Timely screening and treatment are essential for preventing diabetic retinopathy blindness. Improving screening workflows can reduce waiting times for specialist evaluation and thus enhance patient outcomes. This study assessed different screening approaches in a Brazilian public healthcare setting. Methods: This retrospective study evaluated a telemedicine-based diabetic retinopathy screening implemented during the COVID-19 pandemic and compared it with in-person strategies. The evaluation was conducted from the perspective of a specialized referral center in an urban area of Central-West Brazil. In the telemedicine approach, a trained technician would capture retinal images by using a handheld camera. These images were sent to specialists for remote evaluation. Patient variables, including age, gender, duration of diabetes diagnosis, diabetes treatment, comorbidities, and waiting time, were analyzed and compared. Results: In total, 437 patients with diabetes mellitus were included in the study (mean age: 62.5 ± 11.0 years, female: 61.7%, mean diabetes duration: 15.3 ± 9.7 years, insulin users: 67.8%). In the in-person assessment group, the average waiting time between primary care referral and specialist evaluation was 292.3 ± 213.9 days, and the referral rate was 73.29%. In the telemedicine group, the average waiting time was 158.8 ± 192.4 days, and the referral rate was 29.38%. The telemedicine approach significantly reduced the waiting time (p<0.001) and significantly lowered the referral rate (p<0.001). Conclusion: The telemedicine approach significantly reduced the waiting time for specialist evaluation in a real-world setting. Employing portable retinal cameras may address the burden of diabetic retinopathy, especially in resource-limited settings. Purpose blindness outcomes setting Methods telemedicinebased based COVID19 COVID 19 COVID-1 inperson person strategies CentralWest Central West Brazil camera variables age gender diagnosis comorbidities Results total 43 625 62 5 62. 110 11 0 11. years female 617 61 7 61.7% 153 15 3 15. 97 9 9. users 67.8%. 678 67.8% . 67 8 67.8%) group 2923 292 292. 2139 213 213. days 7329 73 29 73.29% 1588 158 158. 1924 192 4 192. 2938 38 29.38% p<0.001 p0001 p 001 (p<0.001 p<0.001. Conclusion realworld real world resourcelimited resource limited settings COVID1 1 COVID- 6 61.7 67.8 21 732 2 73.29 293 29.38 p<0.00 p000 00 (p<0.00 61. 67. 73.2 29.3 p<0.0 p00 (p<0.0 73. 29. p<0. p0 (p<0. p<0 (p<0 p< (p< (p

ABSTRACT Purpose: This study investigates the protective effect of cilostazol on the development and evolution of diabetic retinopathy in rats. Methods: Sixty male rats were divided into four groups: untreated nondiabetic rats, untreated diabetic rats, cilostazol-treated nondiabetic rats, and cilostazol-treated diabetic rats. The thickness of the internal limiting membrane to the outer limiting membrane, inner plexiform layer, inner nuclear layer, and outer nuclear layer were measured. The number of cell nuclei per 50-μm length in retinal sections was counted to quantify the degree of retinal cell loss. Results: The number of nuclei in the ganglion cell layer was significantly higher in untreated nondiabetic rats (p<0.05). The mean number of nuclei in the cilostazol-treated nondiabetic rats was significantly higher than that in the cilostazol-treated diabetic rats (p<0.05). The cilostazol-treated nondiabetic rats had a significantly higher mean nuclei count in the inner nuclear layer and inner plexiform layer as compared with the other groups (p<0.05). The total mean retinal thickness of the cilostazol-treated nondiabetic rats was significantly higher than that of cilostazol-treated diabetic rats and untreated diabetic rats (p<0.05). Conclusion: By decreasing the loss of ganglion cells and reducing the sensorineural atrophy in the internal retinal layers, cilostazol had a protective effect against changes caused by diabetic retinopathy in diabetic rats. Purpose Methods cilostazoltreated treated measured 50μm μm 50 Results p<0.05. p005 p p<0.05 . 0 05 (p<0.05) Conclusion layers 5 p00 p<0.0 (p<0.05 p0 p<0. (p<0.0 p<0 (p<0. p< (p<0 (p< (p

RESUMO Objetivo: O objetivo deste estudo foi investigar o efeito protetor do cilostazol no desenvolvimento e na evolução da retinopatia diabética em ratos. Métodos: Sessenta ratos machos foram divididos em 4 grupos: ratos não-diabéticos não-tratados, ratos diabéticos não-tratados, ratos não-diabéticos tratados com cilostazol e ratos diabéticos tratados com cilostazol. A espessura da membrana limitante interna à membrana limitante externa, a camada plexiforme interna, a camada nuclear interna e a camada nuclear externa foram medidas. Para quantificar o grau de perda de células da retina, foi contado o número de núcleos de células por 50 μm de comprimento em secções retinianas. Resultados: O número de núcleos no GCL foi significativamente maior em Ratos não-diabéticos não-tratados com cilostazol (p<0,05). O número médio de núcleos em Ratos não-diabéticos tratados com cilostazol foi significativamente maior do que em Ratos diabéticos tratados com cilostazol (p<0,05). A contagem média de núcleos em camada nuclear interna e camada plexiforme interna de ratos não-diabéticos tratados com cilostazol foi significativamente maior do que nos outros grupos (p<0,05). A espessura retiniana média total de Ratos não-diabéticos tratados com cilostazol foi significativamente maior do que em Ratos diabéticos tratados com cilostazol e Ratos diabéticos não-tratados (p<0,05). Conclusão: Os resultados demonstraram que o cilostazol teve um efeito protetor contra as alterações causadas pela retinopatia diabética em ratos diabéticos, diminuindo a perda de células ganglionares e reduzindo a atrofia neurossensorial nas camadas retinianas internas. Objetivo Métodos nãodiabéticos não nãotratados, nãotratados tratados, medidas retina 5 Resultados p<0,05. p005 p p<0,05 . 0 05 (p<0,05) Conclusão internas p00 p<0,0 (p<0,05 p0 p<0, (p<0,0 p<0 (p<0, p< (p<0 (p< (p

ABSTRACT Purpose: Diabetes mellitus is a leading cause of impaired vision. The objective of this study was to evaluate the feasibility of use of portable retinograph and remote analysis of images along with a virtual questionnaire for screening for diabetic retinopathy in basic health units in the city of Ribeirão Preto/SP during the Covid-19 pandemic. Methods: Standard Covid-19 protocol was followed during the screening. Blood pressure and capillary blood glucose were measured. Demographic and social data were collected through a standardized online questionnaire via smartphone. After pupillary dilation, fundal images were obtained with portable retinographs by trained ophthalmology residents. Two standardized 45° images were acquired: one posterior segment and another nasal to the optic nerve. Diabetic retinopathy was classified according to the Early Treatment Diabetic Retinopathy Study. Results: A total of 350 patients (64% female; 45% aged 55-70 years; 55% Caucasian) were evaluated. For 40.5% of patients, the campaign was the first opportunity for retinal evaluation; 47.56% had diabetes mellitus for >10 years. On repeat analysis of images stored in a cloud-based repository by retinal specialist, a 7.8% difference was observed in the Early Treatment Diabetic Retinopathy Study diabetic retinopathy classification, compared to the screening findings. Mild diabetic retinopathy was observed in 12.23%, moderate diabetic retinopathy in 6.31%, and proliferative diabetic retinopathy in 2.58% patients. Macular edema was present in 4.58% patients. Diabetic retinopathy was not detected in 72.78% patients. Conclusion: Use of portable retinographs together with telemedicine can provide efficient alternative to traditional methods for screening and diagnosis of diabetic retinopathy. Purpose vision PretoSP Preto SP Covid19 Covid 19 Covid-1 pandemic Methods measured smartphone dilation residents 45 acquired nerve Results 35 64% 64 (64 female 5570 55 70 55-7 years Caucasian evaluated 405 40 5 40.5 evaluation 4756 47 56 47.56 10 >1 cloudbased cloud based specialist 78 7 8 7.8 classification findings 1223 12 23 12.23% 631 6 31 6.31% 258 2 58 2.58 458 4 4.58 7278 72 72.78 Conclusion Covid1 1 Covid- 3 (6 557 55- 40. 475 47.5 > 7. 122 12.23 63 6.31 25 2.5 4.5 727 72.7 ( 47. 12.2 6.3 2. 4. 72. 12. 6.

RESUMO Objetivo: A diabetes mellitus é considerada uma epidemia global e causa de baixa visual em países em desenvolvimento. Este estudo foi realizado com o objetivo de avaliar a viabilidade do retinógrafo portátil e análise remota de imagens associada a questionário virtual para o rastreio de retinopatia diabética em Unidades Básicas de Saúde da cidade de Ribeirão Preto/SP durante a pandemia de Covid-19. Métodos: Trezentos e sessenta pacientes compareceram a campanha. O acolhimento foi realizado na Unidade Básica de Saúde pela equipe de enfermagem, respeitando medidas de prevenção do Covid-19 Os realizou-se aferição da pressão arterial e glicemia capilar seguida de dilatação. Dados demográficos e sociais foram coletados através de questionário on-line padronizado via smartphone e realizou-se a triagem da retinopatia diabética através da obtenção de imagens com retinógrafos portáteis realizados por residentes de oftalmologia previamente treinados, com a aquisição de 2 imagens padronizadas de 45º: uma do segmento posterior e outra nasal ao nervo óptico. Resultados: Trezentos e sessenta pacientes foram atendidos durante a campanha. Dez pacientes (1,02%) foram excluídos devido à opacidade de meios e impossibilidade de obtenção de imagens de fundo de olho. Foram avaliados 350 pacientes, 64% do sexo feminino, 45% entre 55 e 70 anos e 55% brancos. A Campanha foi a primeira avaliação de retina para 40,5% dos pacientes e 47,56% apresentavam diabetes mellitus há mais de 10 anos. Na análise comparativa da classificação da retinopatia diabética segundo Early Treatment Diabetic Retinopathy Study (triagem X Nuvem) observou-se uma diferença de 7,8% nos resultados. Retinopatia diabética leve foi observada em 12,23%, moderada em 6,31%, proliferativa em 2,58%; edema macular presente em 4,58% e ausência de retinopatia diabética em 72,78% dos pacientes. Conclusão: A utilização de retinógrafos portáteis juntamente a telemedicina, para o rastreamento da retinopatia diabética pode ser considerada uma alternativa eficiente para triagem e diagnóstico da retinopatia diabética dentro ou fora do cenário pandêmico, auxiliando na prevenção de perda visual pelo diabetes. Objetivo desenvolvimento PretoSP Preto SP Covid19. Covid19 Covid 19. 19 Métodos campanha enfermagem Covid-1 realizouse realizou se dilatação online on line treinados 45º º óptico Resultados 1,02% 102 1 02 (1,02% olho 35 64 feminino 45 5 7 brancos 405 40 40,5 4756 47 56 47,56 Nuvem observouse observou 78 8 7,8 resultados 1223 12 23 12,23% 631 6 31 6,31% 2,58% 258 58 458 4 4,58 7278 72 72,78 Conclusão telemedicina pandêmico Covid1 Covid- 1,02 0 (1,02 3 40, 475 47,5 7, 122 12,23 63 6,31 2,58 25 4,5 727 72,7 1,0 (1,0 47, 12,2 6,3 2,5 4, 72, 1, (1, 12, 6, 2, (1 (

ABSTRACT Purpose: Trimethylamine N-oxide serum levels have been associated with type 2 diabetes mellitus and its complications. The current study aimed to find out if plasma trimethylamine N-oxide level may be a novel marker in the diagnosis of diabetic retinopathy and if it can be used in the differential diagnosis of diabetic and nondiabetic retinopathy. Methods: The study included 30 patients with diabetic retinopathy, 30 patients with nondiabetic retinopathy, 30 patients with type 2 diabetes mellitus without retinopathy, and 30 healthy control participants. Biochemical parameters, serum IL-6, TNF-α, and trimethylamine N-oxide levels were measured in all participants. Results: Trimethylamine N-oxide level was significantly higher in diabetic retinopathy than in the other groups (p<0.001). There was no significant difference in trimethylamine N-oxide levels between nondiabetic retinopathy and control or type 2 diabetes mellitus Groups. There was a significant positive correlation between trimethylamine N-oxide level and elevated FPG, BMI, HOMA-IR score, BUN, IL-6, and TNF-α levels. Conclusion: The current study showed that the trimethylamine N-oxide level is elevated in diabetic retinopathy. These findings suggest that serum trimethylamine N-oxide level might be a novel marker for diabetic retinopathy, and it might be used in the differential diagnosis of diabetic and nondiabetic retinopathy. Purpose Noxide N oxide complications Methods 3 participants parameters IL6, IL6 IL 6, 6 IL-6 TNFα, TNFα TNF α, α Results p<0.001. p0001 p p<0.001 . 0 001 (p<0.001) Groups FPG BMI HOMAIR HOMA IR score BUN Conclusion IL- p000 p<0.00 00 (p<0.001 p00 p<0.0 (p<0.00 p0 p<0. (p<0.0 p<0 (p<0. p< (p<0 (p< (p

RESUMO Objetivo: Os níveis séricos de N-óxido de trimetilamina têm sido associados ao diabetes mellitus tipo 2 e suas complicações. O presente estudo tem como objetivo responder a duas questões, entre elas: O nível plasmático de N-óxido de trimetilamina poderia ser um novo marcador no diagnóstico de retinopatia diabética? e Ele poderia ser utilizado no diagnóstico diferencial de retinopatia diabética e não diabética? Métodos: Trinta pacientes com retinopatia diabética, 30 pacientes com retinopatia não diabética, 30 pacientes com diabetes mellitus tipo 2 sem retinopatia e 30 participantes saudáveis do grupo controle foram incluídos no estudo. Parâmetros bioquímicos, níveis séricos de IL-6, de TNF-α e de N-óxido de trimetilamina foram medidos em todos os participantes. Resultados: O nível de N-óxido de trimetilamina foi significativamente maior na retinopatia diabética do que nos outros grupos (p<0,001). Não houve diferença significativa no nível de N-óxido de trimetilamina entre o grupo de retinopatia não diabética, do grupo controle ou do grupo de diabetes mellitus tipo 2. Houve uma correlação positiva significativa entre o nível de N-óxido de trimetilamina e os níveis elevados de FPG, IMC, HOMA-IR, BUN, IL-6 e TNF-α. Conclusão: O estudo atual mostrou que o nível de N-óxido de trimetilamina encontra-se elevado na retinopatia diabética. Esses achados sugerem que o nível sérico de N-óxido de trimetilamina pode ser um novo marcador na retinopatia diabética, podendo ser usado no diagnóstico diferencial de retinopatia diabética e não diabética. Objetivo Nóxido N óxido complicações questões elas Métodos 3 bioquímicos IL6, IL6 IL 6, 6 TNFα TNF α Resultados p<0,001. p0001 p p<0,001 . 0 001 (p<0,001) FPG IMC HOMAIR, HOMAIR HOMA IR, IR HOMA-IR BUN IL- TNFα. α. Conclusão encontrase encontra se p000 p<0,00 00 (p<0,001 p00 p<0,0 (p<0,00 p0 p<0, (p<0,0 p<0 (p<0, p< (p<0 (p< (p

ABSTRACT Purpose: To present long-term results of pars plana vitrectomy combined with pan-retinal endolaser photocoagulation, Ahmed glaucoma valve implantation, and/or phacoemulsification in patients with complicated neovascular glaucoma. Methods: The study comprised 15 eyes from 15 patients with neovascular glaucoma as a complication of diabetic retinopathy and owing to ischemic central retinal vein occlusion. There was a vitreous hemorrhage n all of the patients. Furthermore, 8 of the cases showed varying degrees of hyphema. All subjects received an intravitreal injection of bevacizumab three days before surgery. In 12 phakic patients, phacoemulsification, pars plana vitrectomy, and Ahmed glaucoma valve implantation were performed. Pars plana vitrectomy and Ahmed glaucoma valve implantation were performed in 3 pseudophakic patients. Perioperative and postoperative complications, intraocular pressure values, and best-corrected visual acuity scores were also recorded. Results: The mean follow-up was 24.4 ± 14.56 months. The mean preoperative intraocular pressure was 50.06 ± 7.6 mmHg. At 1 day, 7 days, and 1-, 3-, 6-, 12-month, and last visit following surgery, the mean intraocular pressure was 11.06 ± 8.22, 12.66 ± 7.27, 13.8 ± 7.73, 18.64 ± 7.05, 19.28 ± 4.61, 16.28 ± 1.68, and 16.92 ± 2.12 mmHg, respectively (p=0.001 for every follow-up visit). The mean visual acuity on the most recent appointment was 1.18 ± 0.42 logMar (p=0.001 for each subsequent visit). As postoperative early complications, varying degrees of hyphema and fibrin reactions were recorded. During follow-up, one patient developed phthisis bulbi. In 4 cases, Ahmed glaucoma valve revision surgery was required. Conclusions: In patients with complicated neovascular glaucoma, combined surgical procedures are safe, effective, and preferable both in terms of controlling high intraocular pressure and providing reasonable visual abilities. Purpose longterm long term panretinal pan photocoagulation andor or Methods occlusion Furthermore complications values bestcorrected best corrected recorded Results followup follow up 244 24 24. 1456 14 56 14.5 months 5006 50 06 50.0 76 6 7. mmHg day 1, , 1- 3, 3- 6, 6- 12month, 12month month month, 12-month 1106 11 11.0 822 22 8.22 1266 66 12.6 727 27 7.27 138 13 13. 773 73 7.73 1864 18 64 18.6 705 05 7.05 1928 19 28 19.2 461 61 4.61 1628 16 16.2 168 68 1.68 1692 92 16.9 212 2 2.1 p=0.001 p0001 p 0 001 (p=0.00 visit. . visit) 118 1.1 042 42 0.4 followup, up, bulbi required Conclusions safe effective abilities 145 5 14. 500 50. 110 11. 82 8.2 126 12. 72 7.2 77 7.7 186 18. 70 7.0 192 19. 46 4.6 162 16. 1.6 169 9 21 2. p=0.00 p000 00 (p=0.0 1. 04 0. 8. 4. p=0.0 p00 (p=0. p=0. p0 (p=0 p=0 (p= p= (p

RESUMO Objetivo: Apresentar nossos resultados de longo período de vitrectomia pars plana combinada com fotocoagulação panretiniana com endolaser, implantação da válvula Ahmed para glaucoma e/ou facoemulsificação em pacientes com glaucoma neovascular complicado. Métodos: Foram incluídos no estudo 15 olhos de 15 pacientes com glaucoma neovascular como complicação da retinopatia diabética e devido à oclusão isquêmica da veia central da retina. Todos os casos tiveram hemorragia vítrea. Além disso, 8 dos casos apresentaram diferentes graus de hifema. A injeção intravítrea de bevacizumabe foi administrada em todos os casos 3 dias antes da cirurgia. Facoemulsificação, vitrectomia pars plana e implantação da válvula Ahmed para glaucoma foram realizadas em 12 pacientes fáquicos. A vitrectomia pars plana e a implantação da válvula Ahmed para glaucoma foram realizadas em 3 pacientes pseudofáquicos. Complicações perioperatórias e pós-operatórias, valores de pressão intraocular e valores de melhor acuidade visual corrigida pré-operatório e pós-operatório foram registrados. Resultados: O acompanhamento médio foi de 24,4 ± 14,56 meses. A média da pressão intraocular pré-operatória foi de 50,06 ± 7,6 mmHg. Em 1 dia, 7 dias e 1,3,6,12 meses, e última visita após cirurgia, a média da pressão intraocular foi de 11,06 ± 8,22, 12,66 ± 7,27, 13,8 ± 7,73, 18,64 ± 7,05, 19,28 ± 4,61, 16,28 ± 1,68 e 16,92 ± 2,12 mmHg, respectivamente (p=0,001 para cada visita de acompanhamento). A média da acuidade visual na última visita foi de 1,18 ± 0,42 logMar (p=0,001 para cada visita de acompanhamento). Vários graus de reações de hifema e fibrina foram registrados como complicações precoces pós-operatórias. Phthisis bulbi foi desenvolvido em um caso durante o acompanhamento. A cirurgia de revisão da válvula Ahmed para glaucoma foi necessária em 4 casos. Conclusões: Os procedimentos cirúrgicos combinados que realizamos são seguros, eficazes e preferenciais, tanto em termos de controle da alta pressão intraocular quanto fornecimento de habilidades visuais razoáveis em pacientes com glaucoma neovascular complicado. Objetivo endolaser eou ou complicado Métodos retina vítrea disso Facoemulsificação fáquicos pseudofáquicos pósoperatórias, pósoperatórias pós operatórias, operatórias pós-operatórias préoperatório pré operatório pósoperatório Resultados 244 24 24, 1456 14 56 14,5 meses préoperatória operatória 5006 50 06 50,0 76 6 7, mmHg dia 13612 1,3,6,1 1106 11 11,0 822 22 8,22 1266 66 12,6 727 27 7,27 138 13 13, 773 73 7,73 1864 18 64 18,6 705 05 7,05 1928 19 28 19,2 461 61 4,61 1628 16 16,2 168 68 1,6 1692 92 16,9 212 2 2,1 p=0,001 p0001 p 0 001 (p=0,00 . acompanhamento) 118 1,1 042 42 0,4 pósoperatórias. operatórias. Conclusões seguros preferenciais 145 5 14, 500 50, 1361 1,3,6, 110 11, 82 8,2 126 12, 72 7,2 77 7,7 186 18, 70 7,0 192 19, 46 4,6 162 16, 1, 169 9 21 2, p=0,00 p000 00 (p=0,0 04 0, 136 1,3,6 8, 4, p=0,0 p00 (p=0, 1,3, p=0, p0 (p=0 1,3 p=0 (p= p= (p