Reliability of foveal avascular zone measurements in eyes with retinal vein occlusion using optical coherence tomography angiography.

BACKGROUND: To evaluate the reliability of foveal avascular zone (FAZ) area measurements using optical coherence tomography angiography (OCTA) in eyes with retinal vein occlusion (RVO). METHODS: Twenty-five OCTA exams of patients with RVO were evaluated retrospectively. Three examiners performed manual measurements of the FAZ, and interrater and intrarater reliability were obtained. RESULTS: The intraclass correlation coefficient (ICC) for interrater reliability for individual measurements was 0.62 (moderate) with a 95% confidence interval (CI) of 0.40 to 0.79 (p < 0.001). The ICC (95% CI) for intrarater reliability was 0.92 (0.82 to 0.96) for rater A, 0.96 (0.91 to 0.98) for B, and 0.88 (0.76 to 0.94) for C (p < 0.001). In all subanalyses including presence of edema and type of occlusion, interrater reliability was poor/moderate, and intrarater reliability was good/excellent. CONCLUSION: The FAZ varies significantly among eyes with RVO, so measurements obtained using OCTA should be analyzed with caution due to the moderate level of reliability among different examiners.

INTRAVITREAL INJECTIONS OF ZIV-AFLIBERCEPT FOR THE TREATMENT OF A PATIENT WITH MACULAR EDEMA SECONDARY TO BRANCH RETINAL VEIN OCCLUSION.

PURPOSE: To describe the visual, tomographic, and electroretinographic findings in a patient with macular edema secondary to branch retinal vein occlusion who was submitted to three consecutive intravitreal injections of ziv-aflibercept. METHODS: The patient underwent a complete ophthalmic examination, as well as optical coherence tomography and full-field electroretinography at baseline and 90 days after the first injection. RESULTS: The best-corrected visual acuity improved from 20/400 to 20/40, and the central retinal thickness decreased from 791 µm to 198 µm after three consecutive intravitreal injections of ziv-aflibercept. Full-field electroretinography showed an increase in cone amplitude and decrease in rod amplitude. No adverse side effects were observed after injections. CONCLUSION: Intravitreal injections of ziv-aflibercept showed both effectiveness and safety in the treatment of a patient with macular edema secondary to branch retinal vein occlusion. The observed anatomic (by ophthalmic examination, optical coherence tomography) and functional (best-corrected visual acuity, full-field electroretinography) improvements and lack of serious adverse side effects demonstrates the potential of intravitreal injections of ziv-aflibercept for the treatment of macular edema secondary to branch retinal vein occlusion.

Epidemiological findings of ocular trauma in childhood.

PURPOSE: To describe epidemiological findings of ocular trauma in childhood in an emergency unit. METHODS: A retrospective study was carried out including patients under 16 years old who were treated for ocular trauma at the emergency unit of the Federal University of São Paulo from September 2001 to September 2004. Age, sex, involved eye, place, circumstance and mechanism of injury, initial visual acuity and immediate management were recorded. RESULTS: A total of 273 patients were included in the study. The age group comprising most cases was 7 to 10 years (39.9%). The most frequent cause of ocular injury was traumatism by external agents like stone, iron and wood objects (27.9%). The commonest place was the home (53.1%). Initial visual acuity was over 20/40 in 63.4% of cases. Closed globe injury occurred in 201 (73.6%) accidents. Seventy-six children (27. 8%) were treated with medicines and in forty-eight (17.6%) cases surgery was necessary. CONCLUSION: Ocular trauma in childhood was more frequent in the male schoolchild and was due mostly to traumatism with agents like stone, wood and iron pieces, domestic utensils and leisure objects. The injuries occurred most frequently at home. Closed globe injuries predominated. Programs of education and prevention for ocular trauma in childhood are necessary.

Direct cyclopexy surgery for post-traumatic cyclodialysis with persistent hypotony: ultrasound biomicroscopic evaluation.

Cyclodialysis is a relatively rare condition usually caused by ocular injury; however, it can also be caused iatrogenically during intraocular surgery. Hypotony maculopathy is the most important complication and the primary reason for visual loss. Clinical diagnosis using gonioscopy may be difficult, and ultrasound biomicroscopy (UBM) can be an alternative. There are different kinds of treatments, and the optimal one remains controversial. Here we describe a case of traumatic cyclodialysis with persistent ocular hypotony treated by direct cyclopexy, as illustrated by UBM performed before and after surgery.

The potential neuroprotective effects of weekly treatment with glatiramer acetate in diabetic patients after panretinal photocoagulation.

PURPOSE: Evaluation of the neuroprotective effect of weekly glatiramer acetate (GA) on retinal structure and function in diabetic patients who underwent panretinal photocoagulation (PRP). PATIENTS AND METHODS: patients with severe nonproliferative or early diabetic proliferative retinopathy and no previous laser treatment were randomly divided into two groups: (1) those who received four GA treatments and (2) those who received placebo treatment. The subcutaneous injections were administered 1 week prior to laser and weekly in the subsequent three sessions of PRP in both groups. All patients underwent a full ophthalmic examination (best-corrected logMAR visual acuity, slit lamp examination, applanation tonometry, fundus biomicroscopy and indirect fundus examination); functional examination (standard automated perimetry, electroretinography and frequency-doubling technology C-20 visual field) and anatomic examination (color photography, optical coherence tomography (OCT) and Heidelberg retinal tomography). The examinations were performed before the photocoagulation and repeated 1,3,6, and 12 months after treatment (in a double-masked manner). To compare the two groups, generalized estimating equation models were performed to account for the dependence between eyes of the same patient. RESULTS: Thirteen patients (23 eyes) were included in the study group and 13 patients (24 eyes) were included in the control group. OCT showed a statistically significant difference in retinal nerve fiber layer (RNFL) thickness in the inferior peripapillary region and average thickness with thinner measurements in the control group at 1-year post-PRP. Functional analysis demonstrated a difference between groups, but it did not reach statistical significance. CONCLUSION: The results of this study suggest that weekly GA treatment has a potential neuro-protective effect on the RNFL following photocoagulation for diabetic retinopathy.

Direct cyclopexy surgery for post-traumatic cyclodialysis with persistent hypotony: ultrasound biomicroscopic evaluation / Ciclopexia direta em ciclodiálise pós-traumática com hipotonia ocular persistente -acompanhamento por biomicroscopia ultrassônica (UBM)

Cyclodialysis is a relatively rare condition usually caused by ocular injury; however, it can also be caused iatrogenically during intraocular surgery. Hypotony maculopathy is the most important complication and the primary reason for visual loss. Clinical diagnosis using gonioscopy may be difficult, and ultrasound biomicroscopy (UBM) can be an alternative. There are different kinds of treatments, and the optimal one remains controversial. Here we describe a case of traumatic cyclodialysis with persistent ocular hypotony treated by direct cyclopexy, as illustrated by UBM performed before and after surgery.

Ciclodiálise é uma condição relativamente rara, geralmente devido a um trauma ocular, mas também pode ser causada iatrogenicamente como consequência de cirurgia intraocular. A maculopatia hipotônica é a complicação mais importante e a principal razão para a perda visual nessa situação. O diagnóstico clínico por gonioscopia pode ser difícil e a biomicroscopia ultrassônica (UBM) pode ser uma alternativa. Existem diferentes tipos de tratamentos e algumas controvérsias sobre a melhor opção. Neste relato, nós descrevemos um caso de ciclodiálise traumática com hipotonia ocular persistente tratado por cyclopexia direta avaliado por UBM antes e depois da cirurgia.

Epidemiological findings of ocular trauma in childhood

PURPOSE: To describe epidemiological findings of ocular trauma in childhood in an emergency unit. METHODS: A retrospective study was carried out including patients under 16 years old who were treated for ocular trauma at the emergency unit of the Federal University of São Paulo from September 2001 to September 2004. Age, sex, involved eye, place, circumstance and mechanism of injury, initial visual acuity and immediate management were recorded. RESULTS: A total of 273 patients were included in the study. The age group comprising most cases was 7 to 10 years (39.9 percent). The most frequent cause of ocular injury was traumatism by external agents like stone, iron and wood objects (27.9 percent). The commonest place was the home (53.1 percent). Initial visual acuity was over 20/40 in 63.4 percent of cases. Closed globe injury occurred in 201 (73.6 percent) accidents. Seventy-six children (27. 8 percent) were treated with medicines and in forty-eight (17.6 percent) cases surgery was necessary. CONCLUSION: Ocular trauma in childhood was more frequent in the male schoolchild and was due mostly to traumatism with agents like stone, wood and iron pieces, domestic utensils and leisure objects. The injuries occurred most frequently at home. Closed globe injuries predominated. Programs of education and prevention for ocular trauma in childhood are necessary.

OBJETIVO: Descrever os achados epidemiológicos do trauma ocular na infância em uma unidade de emergência. MÉTODOS: Em estudo retrospectivo, foram analisados prontuários de pacientes menores que 16 anos que foram atendidos por trauma ocular no Pronto-Socorro de Oftalmologia da Universidade Federal de São Paulo de setembro de 2001 a setembro de 2004. Foram coletadas informações a respeito da idade, sexo, olho envolvido, local, circunstância e mecanismo do trauma, acuidade visual inicial e conduta imediata. RESULTADOS: Um total de 273 pacientes foi incluído no estudo. A faixa etária com maior número de casos foi a de 7 a 10 anos (39,9 por cento). A causa mais freqüente de lesão ocular foi traumatismo com objetos externos como pedra, ferro ou madeira (28,9 por cento) e o local mais comum foi a própria casa (53,1 por cento). A acuidade visual inicial foi melhor que 20/40 em 63,4 por cento dos casos. Houve trauma ocular fechado em 201 (73,6 por cento) acidentes. Setenta e seis pacientes (27,8 por cento) foram tratadas com medicamentos e em quarenta e oito (17,6 por cento) casos foi necessário procedimento cirúrgico. CONCLUSÃO: O trauma ocular na infância foi mais freqüente no sexo masculino, em escolares e foi associado a objetos tais como pedra, madeira, ferro, utensílios domésticos e brinquedos. Os acidentes aconteceram mais freqüentemente em casa e trauma fechado foi a lesão predominante. São necessários programas de educação e prevenção do trauma na infância.

Agreement between optical coherence tomography and fundus fluorescein angiography in post-cataract surgery cystoid macular edema

Purpose: To evaluate the agreement between optical coherence tomography (OCT) and fundus fluorescein angiography (FFA) regarding the detection of cystoid macular edema (CME) following cataract surgery. Methods: Retrospective comparative observational series of 25 eyes with suspected CME. Patients with low visual acuity and alterations in fundus biomicros-copy after cataract surgery underwent OCT scanning followed by FFA on the same visit. The diagnosis of CME was established considering fluo-rescein leakage on FFA and retinal thickness andor cystoid spaces and/ or subretinal fluid on OCT. Results: Twenty-five eyes of 25 patients were enrolled. Twenty-two eyes had similar results on both OCT and FFA, of which 15 eyes had CME and 7 eyes had no CME. Two eyes had CME detected only by FFA and one eye only by OCT. The agreement between the two examinations was good (Kappa = 0.7331; p=0.0001) with no tendency to have neither more positive nor negative findings (p=1.0). Conclusion: According to these preliminary data, OCT seems to be as effective as FFA to detect CME with a good agreement between the two techniques.

Seguimento ambulatorial de pacientes vítimas de trauma ocular aberto / Ambulatorial follow-up of ocular open trauma

Objetivo: Avaliar as causas e fatores associados ao trauma ocular aberto, bem como o resultado de intervenções terapêuticas na evolução da função visual em pacientes acompanhados em um ambulatório especializado. Métodos: Análise retrospectiva dos prontuários de 100 pacientes atendidos no pronto-socorro de oftalmologia do Hospital São Paulo no período de janeiro de 2002 a fevereiro de 2003, com quadro de trauma ocular aberto. Os mesmos foram posteriormente acompanhados pelo ambulatório de Trauma Ocular do Departamento de Oftalmologia da Universidade Federal de São Paulo - Escola Paulista de Medicina. Resultados: Entre os pacientes atendidos neste período, 80 por cento eram do sexo masculino, com idade variando de 2 a 85 anos, tendo a maior parte (61 por cento) recebido atendimento médico prévio. Apenas 40 por cento dos pacientes chegaram ao pronto-socorro dentro das primeiras 12 horas após o acidente. A sutura de córnea foi o procedimento cirúrgico mais realizado. Foram observadas lesões que comprometeram o prognóstico visual em 80 por cento dos pacientes dentro de um período de seguimento mínimo de três semanas e máximo de 10 meses. Conclusão: Apesar do aperfeiçoamento e melhor treinamento dos profissionais médicos e da disponibilidade de equipamentos de altas tecnologias e complexidade, o trauma ocular penetrante continua sendo uma importante causa de debilidade e perda visual, devendo os esforços serem dirigidos para sua prevenção.