enalapril and Retinal-Diseases

The purpose of this study was to evaluate the structural and functional effects of systemic oxygen therapy and enalapril in patients with diabetic macular ischemia (DMI). This randomized clinical trial consisted of 105 eyes with DMI divided into three groups. Group I received systemic oxygen by face mask at a flow rate of 10 L/min; Group II received 5 mg enalapril daily; and Group III received placebo tablets for 3 months. Best-corrected visual acuity (BCVA), central macular thickness (CMT) measured by optical coherence tomography (OCT), extent of foveal avascular zone (FAZ) on fluorescein angiograms, and electroretinograms (ERG) were obtained at baseline and after 3 and 6 months. Overall, 102 patients completed the study. Baseline characteristics were not significantly different among groups. Significant improvement in BCVA and decrease in CMT and FAZ occurred at months 3 and 6 in oxygen group compared to deterioration in enalapril and control groups (All P values <0.001). ERG parameters were significantly better in oxygen group compared to enalapril group at months 3 and 6 and better than those in control group at month 3. Normobaric oxygen therapy for 3 months in DMI decreased CMT and FAZ and improved BCVA and ERG parameters. Enalapril did not show any favorable effect.

Topics: Adult; Aged; Angiotensin-Converting Enzyme Inhibitors; Diabetic Retinopathy; Enalapril; Female; Humans; Ischemia; Macula Lutea; Macular Edema; Male; Middle Aged; Oxygen; Retinal Diseases; Tomography, Optical Coherence; Visual Acuity

Stage IV hypertensive retinopathies in children have been described, but their incidence appears to be rare. Most etiologies are nephropathies. The authors present a clinical case of malignant high blood pressure in a young girl whose ophthalmological tests detected an unusual nephropathy, the Ask-Upmark kidney, illustrating the importance of determining high blood pressure chronicity and using Kirkendall's classification. Systematic fluorescein angiography and NMR on atypical subjects prevents the diagnosis of Leber neuroretinis, the main differential diagnosis. Early treatment of high blood pressure can avoid complications such as macular exudes.

Topics: Angiotensin-Converting Enzyme Inhibitors; Antihypertensive Agents; Child; Diagnosis, Differential; Enalapril; Female; Fluorescein Angiography; Follow-Up Studies; Humans; Hypertension, Malignant; Hypertension, Renal; Kidney; Optic Atrophy, Hereditary, Leber; Retinal Diseases; Retinitis; Time Factors; Visual Acuity