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1.
J Fr Ophtalmol ; 47(2): 103980, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-37845140

RESUMO

PURPOSE: To report three cases of aneurysmal type 2 neovascularization (AT2), a novel entity within the pachychoroid disease (PD) spectrum. METHODS: We conducted an observational retrospective study of three patients with subretinal polyps treated with intravitreal aflibercept. We reviewed clinical and imaging data of the three patients. Best corrected visual acuity (BCVA), central macular thickness (CMT), choroidal subfoveal thickness, choroidal thickness under the polyps and the presence of a dry macula were assessed at baseline and throughout the follow-up. RESULTS: All of the patients showed granular hypoautofluorescence on fundus autofluorescence. Indocyanine green angiography revealed prominent hyperfluorescent branching vascular networks ending in multiple aneurysmal dilatations. Optical coherence tomography (OCT) demonstrated that the aneurysmal lesions were localized in the subretinal space. Additionally, OCT showed retinal pigment epithelial microtears, the double-layer sign and pachyvessels. En face OCT-A perfectly defined prominent telangiectatic branching vascular networks in all the patients, but only revealed polyps in two out of the three patients. Cross-sectional OCT-A demonstrated polyps as patchy circular hypoflow signals in each case. After the intravitreal treatment, BCVA remained unimproved in all of the patients, despite decreased CMT and achievement of a dry macula, as a result of the development of subretinal fibrosis. CONCLUSION: In summary, we describe a new entity within the spectrum of PD, which we have termed AT2. This novel disease is characterized by the presence of aneurysmal dilatations in the subretinal space, along with the typical features of PD, such as choroidal vascular hyperpermeability, thickening of the choroid and pachyvessels.


Assuntos
Neovascularização de Coroide , Macula Lutea , Pólipos , Humanos , Estudos Retrospectivos , Estudos Transversais , Corioide/patologia , Neovascularização de Coroide/diagnóstico , Neovascularização de Coroide/tratamento farmacológico , Neovascularização de Coroide/patologia , Macula Lutea/patologia , Tomografia de Coerência Óptica/métodos , Angiofluoresceinografia/métodos , Pólipos/diagnóstico , Injeções Intravítreas , Estudos Observacionais como Assunto
2.
J Fr Ophtalmol ; 47(1): 103950, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-37758547

RESUMO

INTRODUCTION: Optical coherence tomography angiography (OCTA) research in diabetic macular edema (DME) has focused on the retinal microvasculature with little attention to the choroid. The goal of this study was to analyze the association between quantitative choroidal OCTA parameters and various forms of DME observed on optical coherence tomography. METHODS: We conducted a retrospective study of 61 eyes of 53 patients with DME. DME was classified as early or advanced, and as sponge-like diffuse retinal thickening (DRT), cystoid macular edema (CME) or serous retinal detachment (SRD). Quantitative OCTA parameters (vessel density [VD] in the superficial capillary plexus [SCP], middle capillary plexus [MCP], deep capillary plexus [DCP] and choriocapillaris [CC]) were recorded. RESULTS: The VD in the CC and SCP was significantly higher in patients with early DME compared to patients with advanced DME (P value<0.01). CC VD was lower in subjects with SRD compared to DRT and CME (P value<0.001). Moreover, it was lower in CME compared to DRT (P value<0.05). No statistical differences were found between VD in the MCP and DCP (P value>0.05). Furthermore, CC VD was lower in patients with increased retinal thickness, disruption of the ellipsoid zone (EZ) or external limiting membrane (ELM), and disorganization of the inner retinal layers (DRIL) (P value<0.05). CONCLUSION: CC ischemia plays an important role in the pathogenesis of DME. We demonstrated a decrease in CC VD in patients with severe DME, SRD, retinal thickening, EZ and/or ELM disruption and DRIL.


Assuntos
Diabetes Mellitus , Retinopatia Diabética , Edema Macular , Descolamento Retiniano , Humanos , Edema Macular/diagnóstico por imagem , Edema Macular/etiologia , Retinopatia Diabética/complicações , Retinopatia Diabética/diagnóstico , Retinopatia Diabética/patologia , Vasos Retinianos/patologia , Tomografia de Coerência Óptica/métodos , Estudos Retrospectivos , Angiofluoresceinografia/métodos , Microvasos/diagnóstico por imagem , Descolamento Retiniano/patologia , Corioide/diagnóstico por imagem , Corioide/patologia , Diabetes Mellitus/patologia
3.
Artigo em Inglês | MEDLINE | ID: mdl-36114140

RESUMO

We present a case of autoimmune retinopathy in a patient with unknown small cell lung cáncer (SCLC), which was diagnosed after ophthalmological examination. Serology was positive for CV2/CRMP5 onconeuronal antibodies. Autoimmune retinopathy is a rare entity that can be missed and underdiagnosed. It is produced by an immune-mediated reaction against retinal antigens. The importance of its early diagnosis lies in the fact that in many of the patients, ocular symptoms appear before the diagnosis of the primary cancer, so its early identification and referral for an extension study may lead to the diagnosis of a hidden primary neoplasm.

5.
J Fr Ophtalmol ; 44(10): 1536-1544, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34728098

RESUMO

PURPOSE: To report the multimodal imaging in multiple evanescent white dot syndrome (MEWDS) during the acute and convalescent stages in order to better understand the focus of the inflammatory process. METHODS: Retrospective cohort study of 4 patients with MEWDS. Each patient underwent: enhanced depth imaging-optical coherence tomography (EDI-OCT), fundus autofluorescence (FAF), fluorescein angiography (FA), indocyanine green angiography (ICGA) and en-face OCT and OCT angiography (OCT-A). Choroidal subfoveal thickness (CST) was measured manually. All patients were studied in the acute stage and convalescent stage after disappearance of OCT abnormalities and resolution of visual symptoms. RESULTS: Four MEWDS patients with a mean age of 23.5years were studied (range: 16-33years). Two patients were women. Initial mean visual acuity (VA) was 80.25 ETDRS. Final mean VA was 84.25 ETDRS. OCT imaging showed disruption of the ellipsoid zone and a slightly elevated RPE layer with overlying hyperreflective material, all of which corresponded to hyperautofluorescent FAF lesions. FA revealed multiple hyperautofluorescent lesions, correlated with hypocyanescent spots on the late ICGA. OCT-A showed normal superficial and deep retinal capillary plexus as well as choriocapillaris. The disease was self-limited in all the cases, with a mean time of 9weeks to resolution (range: 4-16). CONCLUSION: The pathophysiology of MEWDS is still debated. We believe that there is still not enough evidence to implicate the outer retina as the primary cause. For now, we suggest that this transient disease is the consequence of choriocapillaris hypoperfusion, but further studies are required to elucidate this hypothesis.


Assuntos
Síndrome dos Pontos Brancos , Adulto , Feminino , Angiofluoresceinografia , Humanos , Imagem Multimodal , Estudos Retrospectivos , Tomografia de Coerência Óptica , Adulto Jovem
6.
Arch Soc Esp Oftalmol (Engl Ed) ; 96(11): 598-601, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34756282

RESUMO

Ophthalmological diabetic complications are one of the main causes of blindness worldwide, so careful diagnostic and management is important. The screening plans implemented in our population made possible an early diagnosis and treatment, trying to reduce the consequences. Diabetic retinopathy is widely known, however we present the case of a rare retinal condition, acute panedothelial retinal leakage. It typically affects patients with type 1 DM and poor glycemic control. Its diagnosis is important since a strict metabolic control is sufficient for its resolution, avoiding aggressive therapies.


Assuntos
Diabetes Mellitus Tipo 1 , Retinopatia Diabética , Hiperglicemia , Cegueira , Diabetes Mellitus Tipo 1/complicações , Retinopatia Diabética/diagnóstico , Humanos , Retina
9.
Arch Soc Esp Oftalmol (Engl Ed) ; 96(3): 133-140, 2021 Mar.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33012549

RESUMO

OBJECTIVE: To study the differences between solar retinopathy (SR) and the maculopathy produced by laser pointer (LPM) using multimodal imaging. METHOD: A retrospective series is presented of 20 eyes of 12 patients with injuries associated with light, 7 with SR-compatible injuries, and 5 with LPM. At diagnosis, a complete ophthalmological examination was performed, including visual acuity (VA), retinography, and spectral domain optical coherence tomography (OCT). The patients were followed-up for a mean period of 20 months. RESULTS: LPM is common in paediatrics (mean age 15.60±1.5years), and SR affects patients of all ages (mean age 47.56±1.51years). VA at diagnosis in LPM is greater, and recovery is more complete than in solar retinopathy. In conventional retinography, SR is shown as a single lesion in the macular area (100% of cases), while LPM usually presents as multifocal lesions (86% of cases). Infrared reflectance makes this difference clearer. The main sign in OCT is the disruption of the ellipsoid layer and interdigitation zone. This sign is maintained over time, and its size is greater in the SR than in the LPM. Hyper-reflective columns and hyper-reflective reaction of the retinal pigment epithelium are associated with the acute phase. CONCLUSIONS: LPM and SR show significant differences in the type of patient affected, as well as in the signs in multimodal imaging, as well as in functional impairment and their evolution.

10.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33298352

RESUMO

Ophthalmological diabetic complications are one of the main causes of blindness worldwide, so careful diagnostic and management is important. The screening plans implemented in our population made possible an early diagnosis and treatment, trying to reduce the consequences. Diabetic retinopathy is widely known, however we present the case of a rare retinal condition, acute panedothelial retinal leakage. It typically affects patients with diabetes mellitus (DM) type 1 and poor glycemic control. Its diagnosis is important since a strict metabolic control is sufficient for its resolution, avoiding aggressive therapies.

15.
16.
Arch Soc Esp Oftalmol ; 92(3): 112-119, 2017 Mar.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-27816486

RESUMO

OBJECTIVE: To describe functional/morphological outcomes of treat-and-extend (TAE) with aflibercept in different subtypes of neovascularizations (CNV) secondary to exudative age-related macular degeneration (AMD). METHODS: Retrospective study was conducted on 30 eyes of 30 patients treated with 2 mg-aflibercept according to a TAE protocol. Examinations included best corrected visual acuity (BCVA), number of injections, and visits needed. A quantitative/qualitative analysis was also performed with fluorescein angiography and spectral-domain optical coherence tomography (SD-OCT) at baseline, and at 3, 6, and 12 months. RESULTS: BCVA significantly improved from 0.61±0.26 logMAR to 0.38±0.34 logMAR. Among the total AMD patients, type 1 CNV was diagnosed in 11 eyes (36%), type 2 CNV in 7 eyes (23%), mixed CNV in 5 eyes (16%), and type 3 CNV or retinal angiomatous proliferation (RAP) in 7 eyes (23%). The final mean number of injections was 7.5±1.65, 8.71±0.76, 7.4±0.89, 7.2±0.7, and number of visits 6.6±2.17, 7.89±1.46, 5.8±1.7, and 7.14±1.57, respectively in type 1, type 2, mixed, and type 3 or RAP. There was no difference between the different subtypes of CNV (P>.05). CONCLUSIONS: Aflibercept in TAE is effective for all exudative-AMD subtypes. No significant differences in patient's visual gain, mean number of injections, or number of visits needed were found among the subtypes of CNV.


Assuntos
Inibidores da Angiogênese/uso terapêutico , Neovascularização de Coroide/tratamento farmacológico , Receptores de Fatores de Crescimento do Endotélio Vascular/uso terapêutico , Proteínas Recombinantes de Fusão/uso terapêutico , Degeneração Macular Exsudativa/complicações , Idoso , Idoso de 80 Anos ou mais , Inibidores da Angiogênese/administração & dosagem , Neovascularização de Coroide/classificação , Neovascularização de Coroide/diagnóstico por imagem , Neovascularização de Coroide/etiologia , Feminino , Angiofluoresceinografia , Humanos , Injeções Intravítreas , Masculino , Receptores de Fatores de Crescimento do Endotélio Vascular/administração & dosagem , Proteínas Recombinantes de Fusão/administração & dosagem , Estudos Retrospectivos , Tomografia de Coerência Óptica , Resultado do Tratamento , Acuidade Visual
17.
Arch Soc Esp Oftalmol ; 91(1): 34-9, 2016 Jan.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-26652731

RESUMO

OBJECTIVE: To describe the clinical findings and its complications in 2 patients with focal choroidal excavation (FCE). METHODS: A retrospective case-series including 4 eyes of 2 patients with FCE that underwent a comprehensive ophthalmological examination including slit-lamp examination, colour fundus photography, spectral-domain optical coherence tomography (SD-OCT), fluorescein angiography (FA), and indocyanine green angiography. RESULTS: In the 2 patients, both the anterior and posterior segment evaluations were mostly normal despite the of presence yellowish spots in the macular area of the right eye of patient 1, and of a small yellowish elevated lesion with serous macular detachment in the macular area of the left eye in patient 2. At diagnosis, SD-OCT revealed a conforming FCE in patient 1, and in patient 2, an FCE with perilesional subretinal fluid and a neuroepithelium detachment, suspicious of FCE complicated with central serous retinopathy (CSCR). At one year of follow-up, patient 1 developed choroidal neovascularisation (CNV) over the focal choroidal excavation. FA and indocyanine green angiography examinations revealed areas with hypofluorescence in earlier frames, and a diffuse leakage in late frames. After ranibizumab injections, the SD-OCT of patient 1 revealed no active exudation, while patient 2 showed partial resolution of subretinal fluid. CONCLUSIONS: FCE is a newly described entity of unclear aetiology. It is characterised by a choroidal excavation in eyes, with absence of posterior staphyloma, scleral ectasia, trauma, or retinal disease. Although most lesions remain stable, there could be an association with CRSC or CNV.


Assuntos
Doenças da Coroide/diagnóstico por imagem , Tomografia de Coerência Óptica , Coriorretinopatia Serosa Central , Corioide/anormalidades , Angiofluoresceinografia , Humanos , Estudos Retrospectivos , Acuidade Visual
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