RESUMO
PURPOSE: To assess the anatomical and functional efficacy of ranibizumab on vascularized pigment epithelial detachment (V-PED) secondary to neovascular age-related macular degeneration (nAMD). METHODS: One hundred and nine patients (116 eyes) were retrospectively selected from medical records of 2097 patients who benefited from intravitreal injection between January 2011 and June 2013 in a tertiary-care University-based Department of Ophthalmology. Inclusion criteria were: nAMD, treatment-naive eyes, presence of V-PED higher than 250 µm, intravitreal ranibizumab with a loading phase, followed by a pro-re-nata regimen, and 1-year follow-up. Baseline characteristics and type of choroidal neovascularization (CNV) were analyzed. PED height, central macular thickness (CMT) and best-corrected visual acuity (BCVA, logMAR) were measured at baseline, months 3, 6 and 12. RESULTS: CNV was of type 1 in 91 eyes (78.4 %), type 2 in seven (6 %), type 3 in six (5.2 %), and polypoidal choroidal vasculopathy in 12 (10.3 %). Mean CMT at baseline was 572.1 µm and decreased to 396.6 µm (p < 0.0001) at 12 months. Mean height of PED was 458.2 µm at baseline and 306.8 µm (p < 0.0001) at 12 months. Mean BCVA improved from 0.46 at baseline to 0.39 at 12 months (p = 0.013). CONCLUSIONS: Treatment with ranibizumab improved visual and anatomical outcome in nAMD patients with V-PED.
Assuntos
Neovascularização de Coroide/tratamento farmacológico , Angiofluoresceinografia/métodos , Ranibizumab/administração & dosagem , Descolamento Retiniano/tratamento farmacológico , Epitélio Pigmentado da Retina/patologia , Tomografia de Coerência Óptica/métodos , Idoso , Inibidores da Angiogênese/administração & dosagem , Neovascularização de Coroide/diagnóstico , Feminino , Seguimentos , Fundo de Olho , Humanos , Injeções Intravítreas , Masculino , Pessoa de Meia-Idade , Descolamento Retiniano/diagnóstico , Estudos Retrospectivos , Fatores de Tempo , Fator A de Crescimento do Endotélio Vascular , Acuidade VisualRESUMO
PURPOSE: To report the case of a 44-year-old woman with acute transient visual loss likely because of idiopathic pulmonary arterial hypertension. METHODS: Case report imaged with fundus photographs, spectral-domain optical coherence tomography, fundus autofluorescence, and fluorescein and indocyanine green angiographies. RESULTS: The patient complained of unilateral vision loss with metamorphopsia. Fundus examination of the right eye showed serous macular detachment and retinal folds. Fluorescein angiography and indocyanine green angiography showed delayed choroidal filling with multiple choroidal perfusion defects and dye leakage from areas of multiple pigment epithelial detachments. Spectral-domain optical coherence tomography showed a thick choroid. Medical history included idiopathic pulmonary arterial hypertension treated with tadalafil. Ocular signs regressed spontaneously within 1 week. CONCLUSION: Transient severe choroidal filling defects with subretinal exudation may be observed in idiopathic pulmonary arterial hypertension. The present case raised the questions of the triggering factor of the acute decompensation of the blood-retinal barrier and the cause of its spontaneous regression.
Assuntos
Hipertensão Pulmonar Primária Familiar/complicações , Descolamento Retiniano/etiologia , Acuidade Visual , Doença Aguda , Adulto , Feminino , Angiofluoresceinografia , Fundo de Olho , Humanos , Descolamento Retiniano/diagnóstico , Tomografia de Coerência ÓpticaRESUMO
PURPOSE: To assess the difference in best-corrected visual acuity (BCVA) at presentation between the first and second eye in patients with bilateral neovascular age-related macular degeneration (AMD). METHODS: We reviewed the charts of all patients who had a clinical examination for neovascular AMD at the University Eye Clinic of Creteil in January 2013. We retrospectively analyzed demographic and clinical data for 264 patients. RESULTS: In the fellow eye, choroidal neovascularization (CNV) developed in 75/264 patients (28.4%) with a time interval between the 2 events of 30.3 months (range 6-145). Data were available on 65 patients: 14/65 (21.5%) were asymptomatic, 24/65 (36.9%) had BCVA >20/40, whereas at the time of CNV diagnosis in the first eye, no patient was asymptomatic (p<0.0001), and 11/65 (16.9%) eyes had BCVA >20/40 (p<0.0001). The mean BCVA of the first affected eye was 0.68 (± 0.41) logarithm of minimum angle of resolution (logMAR) and the mean BCVA for the second eye was 0.36 (± 0.29) logMAR (p<0.0001). CONCLUSIONS: The BCVA at the time of diagnosis of CNV was higher in the second eye than in the first affected eye. This was possibly due to several factors including systematic bilateral examination in follow-up of unilateral exudative AMD that allowed detection of 20% of cases.