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INTRODUCTION: Retinal detachment is visually impairing in children and adults. The treatment for retinal detachment is challenging, especially in children. There are many etiologies for retinal detachment such as retinal detachment due to retinal tear (rhegmatogenous), tractional retinal detachment and exudative detachment. It is crucial to understand retinal detachment etiology in the pediatric population as it affects treatment decisions. After the diagnosis of retinal detachment in a child, and its etiology, a long process of surgical treatment and recovery begins. The process may include more than one surgery, and therefore close follow-up is very important. Even with anatomic success, functional results are worse with children. The purpose of this article is to review the common etiologies for retinal detachment in children and present case studies that were treated in our department.
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Descolamento Retiniano , Criança , Humanos , Descolamento Retiniano/diagnóstico , Descolamento Retiniano/etiologia , Perfurações Retinianas/diagnóstico , Perfurações Retinianas/etiologia , Acuidade VisualRESUMO
Retinal vein occlusion (RVO) results in ischemia followed by an inflammatory response. Both processes affect tissue temperature in opposite directions. Here, we evaluate the effect of RVO on the ocular surface temperature (OST) profile. Subjects with RVO were prospectively recruited. Healthy subjects without any ocular disease served as controls. The OST was determined using the Therm-App thermal imaging camera, and image processing software was employed to compute the mean temperature values of the medial canthus, lateral canthus, and cornea. We obtained thermographic images from 30 RVO subjects (30 eyes) and 148 controls (148 eyes). A univariate analysis found that eyes with RVO had significantly elevated OSTs compared to the controls (mean difference of 0.6 ± 0.3 Celsius, p < 0.05). However, this distinction between the groups lost statistical significance upon adjusting for possible confounders, including patient and environmental factors. These findings were confirmed with a post hoc case-control matched comparison. In conclusion, RVO does not seem to affect the OST. This might be due to the balance between inflammatory thermogenesis and heat constriction from ischemia in RVO. It is also possible that, in our cohort, the RVO pathophysiological processes involved were localized and did not extend to the anterior segment. Patient and environmental factors must be considered when interpreting the OST.
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PURPOSE: To define the effect of age-related macular degeneration (AMD) and diabetic retinopathy (DR) on the ocular thermographic profile. METHODS: This retrospective cross-sectional study included subjects diagnosed with DR or AMD between January and April 2019. Individuals without ocular disease served as controls. A thermal imaging camera was used for ocular surface temperature (OST) acquisition. The mean temperatures of the medial cantus, lateral cantus, and cornea were calculated. RESULTS: Thermographic images were obtained from 133 subjects (260 eyes, 97 DR and 163 AMD) and 48 controls (55 eyes). Ocular surface temperature was higher among patients with AMD and lowest among patients with DR (P < 0.001). A subgroup analysis revealed that eyes with diabetic macular edema had significantly higher OSTs than DR eyes without diabetic macular edema. Moreover, the OST in eyes with diabetic macular edema was similar to the measurements of the AMD group. There were no differences in OSTs between neovascular and nonneovascular AMD eyes. CONCLUSION: Although AMD and DR are considered posterior segment conditions, their effect on OST implies that the entire globe is involved. Although both conditions result from similar multifactorial pathophysiologic changes, the differences in OST between DR and AMD might be due to dissimilarity in the balance of pathologic processes involved in each condition. Further research is required to better understand the pathophysiology of these diseases and their effect on OST as well as to determine the effect of vasculature, circulation, and tissue metabolism on ocular temperature.
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Temperatura Corporal/fisiologia , Olho/fisiopatologia , Doenças Retinianas/fisiopatologia , Vasos Retinianos/diagnóstico por imagem , Termografia/métodos , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Retina/diagnóstico por imagem , Retina/fisiopatologia , Doenças Retinianas/diagnóstico , Vasos Retinianos/fisiopatologia , Estudos Retrospectivos , Tomografia de Coerência Óptica/métodosRESUMO
PURPOSE: To report the visual and anatomic outcomes of eyes with exceedingly long-term silicone oil tamponade. METHODS: A retrospective chart review of 43 eyes of 41 patients with silicone oil tamponade for 5 years or more. Rates of retinal reattachment, visual acuity, and complications are presented. Further analysis was performed to identify if silicone oil complications are more common in eyes with lower vision. For this, cases were divided into group A-visual acuity of 20/400 or better and group B-visual acuity of less than 20/400. RESULTS: Mean silicone oil duration was 12.6 ± 6.3 years. The etiology at presentation included: recurrent RRD (60.46%), RRD secondary to trauma (25.58%), and TRD (13.95%). Ninety-three percent of eyes underwent at least one ocular surgery before the vitrectomy with silicone oil tamponade. The retinal attachment rate was 55.8%. Mean visual acuity at presentation was 2.03 ± 0.6 logMAR, and at the final follow-up, 1.85 ± 0.78 logMAR (p = 0.166). Emulsification developed in 33.3% of cases, glaucoma in 28.6%, band keratopathy in 21.4%, and corneal decompensation in 16.7%. In 26.2% of eyes, the final visual acuity was 20/400 or better (group A). In 73.8% of eyes, final visual acuity was worse than 20/400 (group B). The rates of silicone oil emulsification and glaucoma were not statistically significant between groups. CONCLUSIONS: Long-term silicone oil tamponade is a possible option in eyes with complicated retinal detachment following multiple intravitreal procedures, although the complication rates are relatively high. In 26.2% of eyes, visual acuity of 20/400 or better can be preserved for many years.
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Glaucoma , Descolamento Retiniano , Glaucoma/cirurgia , Humanos , Descolamento Retiniano/diagnóstico , Descolamento Retiniano/etiologia , Descolamento Retiniano/cirurgia , Estudos Retrospectivos , Óleos de Silicone/efeitos adversos , Resultado do Tratamento , Vitrectomia/métodosRESUMO
OBJECTIVE: To outline the incidence of posterior segment injuries related to soccer-ball blunt trauma in children. METHODS: Retrospective search of the computerized hospital medical database between the years 2007 and 2017. All pediatric trauma cases were reviewed and cases with blunt trauma related to direct orbital/ocular hit from a soccer-ball were included. Cases were divided into two groups (non-severe and severe) based on the presence of sight-threatening findings on presentation (e.g. retinal tear, vitreous hemorrhage, retinal detachment, and macular edema). RESULTS: Out of 343 pediatric patients with relevant diagnoses, 14 (4.1%) were treated for injuries related to soccer-ball trauma. All patients were males at their early-to-mid teens (14.3 ± 2.1 years). The most common funduscopic finding was peripheral commotio retina (13, 93%). There was equal distribution between the two groups (seven each). Retinal injury in the severe group included retinal tear (3), vitreous hemorrhage (4), retinal detachment (1), and macular hole (1). Five patients in this group presented with visual acuity of 20/25 or better. Rate of external signs of injury were similar in both groups. CONCLUSION: Soccer-ball blunt trauma in children can cause significant posterior segment injuries regardless of the presence of external injury or ocular complaints. A thorough ocular exam is mandatory in all cases for the detection of vision-threatening retinal injuries.
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Traumatismos Oculares/epidemiologia , Retina/lesões , Descolamento Retiniano/epidemiologia , Perfurações Retinianas/epidemiologia , Futebol/lesões , Ferimentos não Penetrantes/epidemiologia , Adolescente , Criança , Traumatismos Oculares/diagnóstico , Traumatismos Oculares/terapia , Humanos , Incidência , Israel/epidemiologia , Masculino , Descolamento Retiniano/diagnóstico , Descolamento Retiniano/terapia , Perfurações Retinianas/diagnóstico , Perfurações Retinianas/terapia , Estudos Retrospectivos , Acuidade Visual/fisiologia , Hemorragia Vítrea/diagnóstico , Hemorragia Vítrea/epidemiologia , Hemorragia Vítrea/terapia , Ferimentos não Penetrantes/diagnóstico , Ferimentos não Penetrantes/terapiaRESUMO
BACKGROUND: To describe ocular injuries sustained by Israeli Defense Forces (IDF) soldiers during low-intensity conflicts from 1998 to 2017, and to evaluate the use of protective eyewear. METHODS: Retrospective analysis of data retrieved from two tertiary Israeli medical centers and the military trauma registry. The analysis included all IDF soldiers with ocular injuries who were referred to these centers between 1998 and 2017. Data on injury type, the use of protective eyewear, and interventions were retrieved and analyzed. Additional data regarding the use of protective eyewear and ocular injuries in 108 patients with head and neck injuries in one operation was analyzed. RESULTS: A total of 126 soldiers, all males, mean age 22 (SD 5.3) years, sustained ocular injuries during low-intensity conflicts and treated at one of the two participating medical centers. Blast was the most common type of injury (n = 70/126, 56%), followed by shrapnel (n = 37/126, 29%) and gunshot wound (n = 12/126, 9%). The Birmingham Eye Trauma Terminology System (BETTS) injury pattern disclosed lamellar laceration (n = 34/126, 27%), intraocular foreign body (n = 27/126, 21%), penetrating (n = 10/126, 8%), and perforating (n = 7/126, 6%) injuries. Average VA improved from 20/140 at presentation to 20/60 after surgical or conservative intervention, the median VA improved from 20/40 to 20/30 (P < 0.001). Forty-nine patients (49/126, 39%) had poor visual outcome. The mean follow-up lasted 22 (SD 31) months. The use of protective eyewear was correlated with better initial VA(20/30 vs 20/217, P = 0.07). Among 108 patients with head and neck injuries, there was a higher rate of ocular injuries in the group of patients who did not use protective eyewear (n = 26/73, 36% vs n = 4/35, 11%, P = 0.016). CONCLUSIONS: Ocular injuries are common occurrences in low-intensity conflicts. The use of protective eyewear significantly reduces these injuries and should be mandatory. LEVEL OF EVIDENCE: III, prognostic.
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Traumatismos por Explosões , Corpos Estranhos no Olho , Traumatismos Oculares , Militares , Ferimentos por Arma de Fogo , Adulto , Traumatismos por Explosões/epidemiologia , Traumatismos por Explosões/prevenção & controle , Traumatismos Oculares/epidemiologia , Traumatismos Oculares/prevenção & controle , Humanos , Masculino , Sistema de Registros , Estudos Retrospectivos , Ferimentos por Arma de Fogo/epidemiologia , Ferimentos por Arma de Fogo/prevenção & controle , Adulto JovemRESUMO
PURPOSE: To evaluate the indications, outcomes, and complications of scleral buckle removal over the past decade and compare to previously published data. METHODS: Forty nine eyes of 49 patients who underwent scleral buckle removal and had at least 6 months of follow-up were included in this retrospective study. Recorded parameters included demographic information, history of the retinal detachment, details of the scleral buckling surgery, indication for scleral buckle removal, time from scleral buckle placement to removal, culture results, length of follow up, visual acuity (VA) throughout the follow up, and the occurrence of any complications or need for additional surgery after scleral buckle removal. RESULTS: The overall rate of scleral buckle removal over the last decade was 5.7% (85/1493). Indications included buckle extrusion (57.1%), infection (8.2%), both (26.5%) eyes, and strabismus and diplopia (8.2%). The median time from scleral buckle placement to removal was 35 months, but in 22.4% of cases the buckles were removed after less than 6 months, and in an additional 22.4% of cases after more than 10 years. The rate of recurrent retinal detachment after scleral buckle removal was 8.2%, with half of the cases occurring within 3 months of the removal. CONCLUSIONS: Removal of scleral buckles is associated with a 8.2% risk for redetachment. Redetachment can occur many years following the removal and long-term follow up in these patients is warranted.
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Previsões , Descolamento Retiniano/cirurgia , Recurvamento da Esclera/métodos , Feminino , Seguimentos , Humanos , Incidência , Israel/epidemiologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Recidiva , Descolamento Retiniano/diagnóstico , Estudos Retrospectivos , Resultado do Tratamento , Acuidade VisualRESUMO
PURPOSE: To identify prognostic factors related to ruptured and lacerated globes and compare the visual outcomes of these 2 mechanisms of injury. METHODS: Medical records of patients with open-globe injuries referred to the Goldschleger Eye Institute between 2004 and 2010 were reviewed. Clinical parameters were summarized as defined by the ocular trauma score (OTS). All cases were classified as either ruptured or lacerated globes and a statistical analysis was performed in order to identify prognostic factors. RESULTS: Medical records of 73 patients (55 male) were reviewed. Mean age of male injured patients was 33 years and of female injured patients was 64 years. Thirty-three percent of injuries were classified as ruptured globes. Males were mostly injured by a lacerating mechanism, compared to females (79.6% and 33.3%, respectively; p = 0.01). Mean logMAR at presentation after lacerated and ruptured globes was 1.42 ± 1.01 and 2.02 ± 0.91, respectively. Mean logMAR at the final follow-up visit after lacerated and ruptured globes was 0.65 ± 0.85 and 1.69 ± 1.10, respectively. Mean logMAR of the lacerated globes improved to a better extent compared to the ruptured ones (p = 0.046). The OTS was found to be a significant predictor of final mean logMAR for the lacerated globes (p<0.001), whereas mean logMAR at presentation was found to be the only predictive measure for ruptured globes (p<0.001). CONCLUSIONS: Ruptured and lacerated globes differ from each other in regard to prognostic factors and visual outcomes. We recommend distinguishing these 2 injury types in clinical practice as different open-globe injuries.
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Corpos Estranhos no Olho/fisiopatologia , Ferimentos Oculares Penetrantes/fisiopatologia , Lacerações/fisiopatologia , Ruptura/fisiopatologia , Acuidade Visual/fisiologia , Adulto , Distribuição por Idade , Idoso , Corpos Estranhos no Olho/diagnóstico , Corpos Estranhos no Olho/cirurgia , Ferimentos Oculares Penetrantes/diagnóstico , Ferimentos Oculares Penetrantes/cirurgia , Feminino , Humanos , Lacerações/diagnóstico , Lacerações/cirurgia , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Ruptura/diagnóstico , Ruptura/cirurgia , Distribuição por Sexo , Resultado do TratamentoRESUMO
OBJECTIVE: To assess the outcome and risk factors for failure of pneumatic retinopexy (PR) in eyes with primary rhegmatogenous retinal detachment (RRD). METHODS: Data of patients who underwent PR for the repair of primary RRD, from January 1, 2000, through June 30, 2011, were retrieved from medical records and retrospectively analyzed. Patients with a follow-up time of less than 4 months were contacted and invited for examination. Patients with less than 2 months of follow-up were excluded. Successful cases (attached retina at 2 months after the PR) were compared with failures. A subgroup analysis was performed comparing successful and failed cases of RRD that were reattached with only 1 additional operation. RESULTS: Two hundred seventy-six eyes (271 patients) underwent PR during the study period, of which 258 eyes (93.5%) were included in the study. Mean (SD) follow-up time was 36.1 (39.4) months; only 23 eyes (8.9%) had a follow-up of less than 4 months. Successful reattachment at 2 months was achieved in 171 eyes (66.3%). Sixty-seven eyes (77.0% of the failed cases) were reattached with only 1 additional operation and final anatomical success was achieved in 256 eyes (99.2%). Successful cases had significantly better final vision (P= .002) and fewer postoperative complications (P ≤ .026). However, nonsignificant differences were found between the primary failure PR cases that underwent only 1 additional operation and the successful cases (P ≥ .073). CONCLUSIONS: Pneumatic retinopexy is a good surgical option for primary RRD. Most cases of primary failure are reattached with 1 additional procedure and have excellent final vision.
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Criocirurgia , Tamponamento Interno , Fluorocarbonos/administração & dosagem , Descolamento Retiniano/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Terapia a Laser , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Retina/fisiopatologia , Descolamento Retiniano/fisiopatologia , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Acuidade Visual/fisiologia , Vitrectomia , Adulto JovemRESUMO
PURPOSE: To report a series of full-thickness macular holes (MH) that developed after pars plana vitrectomy for rhegmatogenous retinal detachment (RRD). METHODS: A retrospective review of the demographic and medical data, including optical coherence tomography studies of 6 patients (7 eyes) who underwent pars plana vitrectomy for RRD and subsequently developed MH. RESULTS: There were 4 women and 2 men with a mean age of 60 ± 10 years (range, 50-79 years). The mean interval between RRD repair and MH formation was 20 ± 18 months (range, 1-48 years). Five eyes underwent surgery to repair the MHs, four of which were closed at the last follow-up. Two eyes were not operated, one because of unfavorable prognosis, and in the other, which presented with an epiretinal membrane before the development of the MH, the hole closed spontaneously. In all operated cases, the inner limiting membrane was peeled during MH surgery. The mean logarithm of the minimal angle of resolution was 0.73, 0.53, 0.77, and 0.57 at RRD presentation, after surgical repair of RRD and before MH diagnosis, at MH presentation, and at last follow-up, respectively. The study subjects accounted for 1.1% of our 609 patients who underwent pars plana vitrectomy for primary RRD during the study period. CONCLUSION: Macular hole may develop after pars plana vitrectomy for RRD, and these cases can be surgically repaired. The pathogenesis of the formation of these holes remains unclear.
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Descolamento Retiniano/cirurgia , Perfurações Retinianas/etiologia , Vitrectomia/efeitos adversos , Idoso , Feminino , Seguimentos , Humanos , Israel/epidemiologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Prevalência , Perfurações Retinianas/epidemiologia , Perfurações Retinianas/fisiopatologia , Estudos Retrospectivos , Tomografia de Coerência Óptica , Acuidade Visual/fisiologia , Vitrectomia/métodosRESUMO
BACKGROUND: The objective of this study is to report ocular and orbital findings in a series of six patients (8 eyes) with gunshot wounds and to review the literature on the pathophysiology, management, and outcome of such patients. METHODS: Retrospective case series and review of the literature. Main outcome measures were ocular and orbital injury, surgical intervention, and presenting and final visual acuity. RESULTS: Six male patients (mean age, 32 years) were enrolled. Three patients with globe concussion and low presenting visual acuity were treated by observation. Two patients (25%) underwent primary enucleation or evisceration. Retinal detachment developed in one patient who had a globe perforation, and he underwent vitrectomy and lensectomy with silicone oil injection. Visual acuity remained unchanged in all but one patient who underwent retinal detachment surgery. Final visual acuity was poor in all patients, with five eyes ending in no perception of light. Four patients had orbital fractures, two of whom underwent orbital reconstruction. One of these patients also underwent drainage of orbital abscess, eyelid surgery, and a dacryocystorhinostomy. The mean follow-up time was 26 months. CONCLUSIONS: Gunshot wounds to the eye and orbit cause severe open and closed ocular injuries with guarded outcome and poor visual acuity. When feasible, initial wound closure may preserve the globe and allow further surgical rehabilitation. Primary evisceration may be required in cases of a severely ruptured globe. Orbital surgery may be needed in cases of infection, orbital wall disruption with disfigurement, or late enophthalmos.
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Traumatismos Oculares/diagnóstico , Traumatismos Oculares/terapia , Órbita/lesões , Ferimentos por Arma de Fogo/diagnóstico , Ferimentos por Arma de Fogo/terapia , Adulto , Traumatismos Oculares/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Ferimentos por Arma de Fogo/complicações , Adulto JovemRESUMO
BACKGROUND AND OBJECTIVE: To evaluate the ability of optical coherence tomography (OCT) to predict the risk of retinal pigment epithelium (RPE) tear in patients with choroidal neovascular membrane associated with pigment epithelium detachment treated with bevacizumab. PATIENTS AND METHODS: Retrospective observational case series of 24 consecutive patients treated with bevacizumab. All patients had sequential OCT scans performed before treatment and during follow-up. Six patients developed an RPE tear. Eighteen patients served as the non-tear group. RESULTS: Wavy RPE indentations or small interruptions and breaks in the elevated RPE were evident in all six patients who developed an RPE tear, whereas only two of the remaining 18 patients had such findings (P < .001). CONCLUSION: Indentations or minute interruptions and breaks in the RPE layer seen on OCT were correlated with increased risk of developing an RPE tear in patients with pigment epithelium detachment following treatment with bevacizumab.
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Inibidores da Angiogênese/efeitos adversos , Anticorpos Monoclonais/efeitos adversos , Neovascularização de Coroide/tratamento farmacológico , Perfurações Retinianas/diagnóstico , Epitélio Pigmentado da Retina/patologia , Tomografia de Coerência Óptica/métodos , Idoso , Inibidores da Angiogênese/administração & dosagem , Anticorpos Monoclonais/administração & dosagem , Anticorpos Monoclonais Humanizados , Bevacizumab , Neovascularização de Coroide/patologia , Feminino , Seguimentos , Humanos , Injeções , Masculino , Prognóstico , Perfurações Retinianas/induzido quimicamente , Epitélio Pigmentado da Retina/efeitos dos fármacos , Estudos Retrospectivos , Fatores de Risco , Fator A de Crescimento do Endotélio Vascular , Corpo VítreoRESUMO
Optic disc swelling occurs when there is an obstruction to axonal transport at the level of the lamina cribrosa. This may result from compression, ischemia, inflammation, or metabolic and toxic etiologies. Some of these etiologies may be life threatening and others may be self-limited. Thus, differentiating the different etiologies is important, albeit often difficult. We present a case of a 25-yr-old high-performance fighter aviator who presented with unilateral optic disc swelling 2 d after an F-16 flight, in which decompression was suspected. Visual acuity of the affected eye was decreased to 20/25, with enlarged blind spot and shallow arcuate scotomata on visual field testing. Pupil function, brightness intensity, and color vision were normal. Marked swelling of the entire optic disc, retinal flame-shaped hemorrhages, and engorgement of the retinal veins were seen. Since decompression sickness with nitrogen bubbles obstructing the optic nerve head vasculature was suspected, he was treated with hyperbaric oxygen. He rapidly improved, recovering full vision function within 6 d. No concurrent disease was found on extensive investigation. He returned to high-performance aviation 3 mo after onset of symptoms. No recurrence was seen during 3 yr of follow-up.
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Medicina Aeroespacial , Doença da Descompressão/complicações , Militares , Doenças do Nervo Óptico/etiologia , Adulto , Doença da Descompressão/terapia , Angiofluoresceinografia , Humanos , Oxigenoterapia Hiperbárica , Israel , Masculino , Doenças Profissionais , Flebite/etiologia , Campos VisuaisRESUMO
PURPOSE: To assess the risks of intraoperative and postoperative bleeding associated with cataract extraction without prophylactic treatment in patients with severe factor XI (FXI) deficiency. DESIGN: Prospective interventional case series. SETTING: Single institute. STUDY POPULATION: Consecutive unrelated patients with severe FXI deficiency who underwent cataract extraction under topical anesthesia, with a clear corneal incision, phacoemulsification, and implantation of a foldable posterior chamber intraocular lens (PCIOL) were enrolled. Patients with associated intraocular conditions that could complicate the surgery were excluded. INTERVENTION: Cataract extraction without prophylactic treatment for the FXI deficiency. MAIN OUTCOME MEASURES: Assessment of intraoperative and postoperative ocular bleeding and other related complications. RESULTS: Seven patients ranging in age from 61 to 95 years (median, 79) underwent phacoemulsification and PCIOL implantation in 11 eyes. Five patients (71%) were homozygotes for type II mutation of the FXI gene (activity level of <1 U/dl), 1 patient was a homozygote for type III mutation (activity level of 11 U/dl), and 1 patient was a compound heterozygote for types II and III (activity level of 3 U/dl). Three of the patients (43%), all type II homozygotes, also had an inhibitor antibody to FXI. All 7 patients were followed for at least 1 week after the operation. The surgery was uneventful in all eyes, and neither major nor minor bleeding events were observed in any of the operated eyes during surgery and follow-up. CONCLUSIONS: Cataract extraction by phacoemulsification in uncomplicated eyes can be performed safely without prophylactic treatment in patients with severe FXI deficiency with or without inhibitor antibodies against FXI.
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Perda Sanguínea Cirúrgica/prevenção & controle , Hemorragia Ocular/prevenção & controle , Deficiência do Fator XI/cirurgia , Implante de Lente Intraocular , Facoemulsificação , Hemorragia Pós-Operatória/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Fator XI/genética , Fator XI/imunologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , Estudos Prospectivos , Tempo de Protrombina , Medição de RiscoRESUMO
PURPOSE: To describe the morphologic appearance of the retina during the course of acute retinal pigment epitheliitis (ARPE) with optical coherence tomography (OCT). METHODS: Observational case report. RESULTS: OCT demonstrated an abnormality in the inner higher reflective line, which represents the outer and inner segments of the retinal photoreceptors at the fovea. Four months later, the tomographic appearance returned to normal. CONCLUSION: Photoreceptors segments are involved in the disease process of ARPE. OCT demonstrated the different stages in the resolution of ARPE.
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BACKGROUND AND OBJECTIVE: To evaluate the role of photodynamic therapy (PDT) in the management of vascularized pigment epithelial detachment in age-related macular degeneration (AMD) when the pigment epithelial detachment is the predominant component of the neovascular complex. PATIENTS AND METHODS: Seventeen eyes of 17 patients underwent indocyanine green angiography-guided PDT and had at least 6 months of follow-up. Data retrieved included visual acuity and angiographic features prior to the treatment, number of PDT sessions, visual acuity, angiographic outcomes at the end of the follow-up, length of follow-up, and status of the fellow eye. in the series, with an average age of 77 years and a mean follow-up time of 11 months. Six (35%) of the patients lost less than 3 lines of visual acuity, 6 (35%) lost between 3 and 6 lines, and 5 (30%) lost 6 or more lines. Angiographic outcomes were categorized as failures in 14 (82%) of the treated eyes and successful in 3 (17%) eyes. CONCLUSIONS: In 82% of the eyes, PDT failed to flatten the pigment epithelial detachment or prevent growth of the choroidal neovascular membrane. Visual acuity outcomes correlated poorly with angiographic outcomes. PDT does not seem to improve the prognosis of eyes with large pigment epithelial detachments in AMD.
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Corantes , Angiofluoresceinografia , Verde de Indocianina , Degeneração Macular/tratamento farmacológico , Fotoquimioterapia/métodos , Epitélio Pigmentado Ocular/efeitos dos fármacos , Descolamento Retiniano/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Neovascularização de Coroide/diagnóstico , Neovascularização de Coroide/tratamento farmacológico , Neovascularização de Coroide/etiologia , Feminino , Seguimentos , Humanos , Degeneração Macular/complicações , Degeneração Macular/diagnóstico , Masculino , Fármacos Fotossensibilizantes/uso terapêutico , Epitélio Pigmentado Ocular/patologia , Porfirinas/uso terapêutico , Descolamento Retiniano/diagnóstico , Descolamento Retiniano/etiologia , Estudos Retrospectivos , Resultado do Tratamento , Verteporfina , Acuidade VisualRESUMO
BACKGROUND: The major cause of visual impairment in diabetic patients is macular edema. The failure of laser photocoagulation in a large subgroup of patients with clinically significant diabetic macular edema has prompted interest in other treatment methods. OBJECTIVES: To evaluate the long-term efficacy and safety of an intravitreal injection of triamcinolone acetonide for clinically significant diabetic macular edema. METHODS: In a retrospective case series 31 diabetic patients with persistent, recurrent or diffuse clinically significant diabetic macular edema received a single 4 mg (0.1 ml) intravitreal triamcinolone acetonide injection and were followed for at least 6 months. The main outcome measures evaluated were classified as primary: visual acuity and central macular thickness, and secondary: intraocular pressure and cataract progression. Statistical analysis included Student's t-test, chi-square test and the MacNamar test. RESULTS: Best visual acuity results were observed 2.6 +/- 2.4 months post-injection. At that time the mean foveal thickness had decreased by 37% from a baseline of 455 +/- 100 to 288 +/- 99 mu (P< 0.001) and the mean visual acuity improved from 6/42 to 6/23 (P< 0.001). Final mean visual acuity after an average of 10 +/- 1.8 months follow-up (range 6-13 months) was identical to the baseline, although mean foveal thickness was still significantly lower than the initial thickness (368 +/- 166 vs. 455 +/- 100 mu, P< 0.01). Statistical analysis did not identify any pre-injection prognostic factors for improved visual acuity. The only complications that occurred were elevated intraocular pressure in 42% of patients and cataract progression in 21%. There was no endophthalmitis. CONCLUSIONS: Intravitreal injection of triamcinolone acetonide for clinically significant diabetic macular edema is effective in reducing foveal thickness and improving visual acuity in the short term. Longer follow-up revealed that visual acuity returned to pre-injection values, even though a modest decrease in the foveal thickness persisted. Further studies are needed to evaluate the long-term efficacy in conjunction with laser photocoagulation treatment.
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Retinopatia Diabética/complicações , Edema Macular/tratamento farmacológico , Edema Macular/etiologia , Triancinolona Acetonida/administração & dosagem , Corpo Vítreo , Adulto , Idoso , Idoso de 80 Anos ou mais , Retinopatia Diabética/tratamento farmacológico , Retinopatia Diabética/patologia , Retinopatia Diabética/fisiopatologia , Feminino , Fóvea Central/patologia , Humanos , Edema Macular/patologia , Edema Macular/fisiopatologia , Masculino , Prontuários Médicos , Microinjeções , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Acuidade VisualRESUMO
Rickettsial infection may cause severe systemic disease. The ocular manifestations of rickettsial infection may include sub-conjunctival hemorrhages, corneal abscesses, uveitis, optic nerve head edema, retinal vasculitis hemorrhages and infiltrates and endophthalmitis. Ocular complications may result in significant visual loss. Ocular manifestations may precede other systemic signs and symptoms and assist in clinical diagnosis. This report describes two cases with ocular involvement of rickettsial disease.
Assuntos
Oftalmopatias/epidemiologia , Infecções por Rickettsiaceae/complicações , Oftalmopatias/virologia , HumanosRESUMO
PURPOSE: To assess the efficacy and safety of implanting a second intraocular lens (IOL) to correct pseudophakic refractive errors. SETTING: Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel. METHODS: This prospective noncomparative case series included 10 pseudophakic eyes, 5 with a myopic residual refractive error and 5 with a hyperopic residual refractive error. All eyes had secondary piggyback IOL implantation with the IOL placed in the ciliary sulcus. Five types of IOLs were used to correct the residual refractive error. RESULTS: The mean preoperative myopia was -6.6 diopters +/- 3.3 (SD), and the refractive outcome was within 0.5 +/- 0.7 D of the desired refraction (range -1.5 [undercorrected] and +1.0 D [overcorrected]). The mean preoperative hyperopia was +3.8 +/- 0.8 D, and the refractive outcome was within 0.46 +/- 0.4 D of the desired refraction (range 0 and 1.0 D overcorrected). All patients showed visual acuity improvement. Best spectacle-corrected visual acuity improved from 20/44 to 20/30 (P<.05). CONCLUSION: An IOL type that is appropriate for implantation in the ciliary sulcus is a viable option for correcting pseudophakic refractive error using the piggyback technique.
Assuntos
Hiperopia/cirurgia , Implante de Lente Intraocular/métodos , Miopia/cirurgia , Complicações Pós-Operatórias , Pseudofacia/cirurgia , Acuidade Visual/fisiologia , Adulto , Idoso , Feminino , Humanos , Lentes Intraoculares , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , ReoperaçãoRESUMO
BACKGROUND AND OBJECTIVE: To evaluate the efficacy and safety of pars plana vitrectomy with indocyanine green (ICG)-assisted internal limiting membrane (ILM) peeling versus pars plana vitrectomy without ILM peeling for stage 3 and 4 primary idiopathic macular hole. PATIENTS AND METHODS: Sixty-two eyes of 60 consecutive patients with idiopathic macular hole underwent vitrectomy with gas (C3F8) injection. The first 46 eyes underwent vitrectomy without ILM peeling; of these, 14 had epiretinal membrane peeling and were excluded, leaving 32 eyes (no ILM group). The remaining 16 eyes underwent vitrectomy with ICG-assisted ILM peeling (ICG-ILM group). Follow-up data at 6 to 48 months postoperatively were recorded and analyzed. RESULTS: Macular hole closure was achieved in 13 (81%) of 16 patients in the ICG-ILM group and 16 (50%) of 32 patients in the no ILM group (P = .036). Analysis of the data from eyes with closed holes indicates that the ICG-ILM group achieved a better mean final visual acuity compared with the no ILM group (20/60 vs 20/100, respectively) (P = .017). No complications were attributed to the use of ICG. CONCLUSIONS: ICG-assisted ILM peeling significantly increased the rate of hole closure in eyes with stage 3 or 4 idiopathic macular hole. The use of ICG did not adversely affect the visual acuity results, and it appears to be a safe adjunct to macular hole surgery.