RESUMO
PURPOSE: To evaluate the efficacy of the modified superior inverted internal limiting (ILM) membrane flap technique in retinal reattachment, macular hole closure and external retinal layers restoration in macular hole associated retinal detachment compared to ILM peeling. METHODS: Retrospective case series of 10 patients that required pars plana vitrectomy for retinal detachment with macular hole followed for more than 12 months. Data from medical records were retrospectively collected and patients were divided into the superior inverted flap (5 patients) and ILM peeling group (5 patients). We compared best corrected visual acuity (BCVA) before and after surgery, retinal attachment, macular hole closure rate and external retinal layer restoration between groups. RESULTS: There were significant improvements in BCVA in both groups before and after surgery, with no differences between the two groups at 12 months after surgery (p=0.9). The macular hole closed in 100% of cases in the inverted flap group and 80% of the ILM peeling group with no significant differences between groups. The retina was reattached in 100% of cases in both groups. Only 2 patients in the inverted flap group (40%) had external retinal layer restoration and none in ILM peeling group (p=0.62). CONCLUSIONS: ILM peeling and superior inverted flap techniques are useful for treating retinal detachment with macular hole in myopic eyes.
Assuntos
Membrana Epirretiniana , Miopia , Descolamento Retiniano , Perfurações Retinianas , Membrana Epirretiniana/cirurgia , Humanos , Miopia/cirurgia , Retina , Descolamento Retiniano/cirurgia , Perfurações Retinianas/cirurgia , Estudos Retrospectivos , Acuidade Visual , Vitrectomia/métodosRESUMO
PURPOSE: To report predictive factors for therapeutic response to anti-VEGF in patients with neovascular age-related macular degeneration (nAMD) in daily clinical practice in our patient population. METHODS: Retrospective cohort study including 56 patients (69 eyes) with nAMD treated with anti-VEGF, followed for at least two years between February 2012 and April 2018. Patients received three intravitreal anti-VEGF (bevacizumab) injections (loading dose) and were monitored and treated according to a PRN regimen. We analysed whether a gain in visual acuity of 15 or more ETDRS letters at the final visit was associated with demographic characteristics, presence of systemic comorbidities, fundus lesions or measurable improvement on Cirrus optical coherence tomography (OCT) between the first and last visit. RESULTS: After a mean follow-up of 15.5 months (4.7-27.8 interquartile range), central retinal thickness (CRT) (RR: 1.004; IC 95%: 1.001-1.007; P=0.011) and macular hemorrhage (RR: 0.30; IC 95%: 0.10-0.90, P=0.032) at baseline were found to be useful predictive factors for visual acuity improvement (≥15 letters) in patients treated for nAMD by anti-VEGF in a real world clinical setting. CONCLUSION: In the present series of patients with nAMD receiving a loading dose of bevacizumab and followed according to a PRN regimen for 24 months, the only predictable factors for a ≥15 letter gain in visual acuity were anatomical response as measured by OCT and macular hemorrhage at baseline.
Assuntos
Inibidores da Angiogênese/administração & dosagem , Bevacizumab/administração & dosagem , Degeneração Macular/tratamento farmacológico , Acuidade Visual , Idoso , Idoso de 80 Anos ou mais , Inibidores da Angiogênese/efeitos adversos , Bevacizumab/efeitos adversos , Biomarcadores Farmacológicos/análise , Feminino , Humanos , Injeções Intravítreas , Degeneração Macular/diagnóstico , Degeneração Macular/epidemiologia , Masculino , Neovascularização Patológica/diagnóstico , Neovascularização Patológica/tratamento farmacológico , Neovascularização Patológica/epidemiologia , Padrões de Prática Médica/estatística & dados numéricos , Prognóstico , Estudos Retrospectivos , Resultado do Tratamento , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Fator A de Crescimento do Endotélio Vascular/imunologiaAssuntos
Oftalmopatias Hereditárias/diagnóstico , Macula Lutea/patologia , Degeneração Retiniana/diagnóstico , Doenças Retinianas/diagnóstico , Idoso , Oftalmopatias Hereditárias/patologia , Feminino , Angiofluoresceinografia , Fundo de Olho , Humanos , Macula Lutea/diagnóstico por imagem , Degeneração Retiniana/patologia , Doenças Retinianas/etiologia , Doenças Retinianas/patologia , Baixa Visão/diagnóstico , Baixa Visão/etiologiaAssuntos
Astrocitoma/patologia , Neoplasias da Retina/patologia , Inibidores da Angiogênese/uso terapêutico , Astrocitoma/irrigação sanguínea , Astrocitoma/diagnóstico por imagem , Astrocitoma/terapia , Bevacizumab/uso terapêutico , Terapia Combinada , Crioterapia , Membrana Epirretiniana/etiologia , Exsudatos e Transudatos , Angiofluoresceinografia , Humanos , Fotocoagulação , Edema Macular/diagnóstico por imagem , Edema Macular/tratamento farmacológico , Edema Macular/etiologia , Masculino , Neoplasias da Retina/irrigação sanguínea , Neoplasias da Retina/diagnóstico por imagem , Neoplasias da Retina/terapia , Telangiectasia Retiniana/complicações , Telangiectasia Retiniana/diagnóstico , Telangiectasia Retiniana/terapia , Vitrectomia , Adulto JovemRESUMO
PURPOSE: To determine the relationship between dynamic contour tonometry (DCT), Goldmann applanation tonometry (GAT) and pneumotonometry (PNT) in ocular hypertension patients (OHT) and their relationship to central corneal thickness (CCT) and ocular pulse amplitude (OPA). METHODS: Sixty patients (101 eyes) with intraocular pressure (IOP) ≥21 mmHg using GAT and normal appearing optic nerve heads and normal visual fields were included. The following tests were performed simultaneously during a single visit: IOP using DCT, GAT and PNT, OPA using DCT and CCT using ultrasound pachymetry. We studied the difference IOP between these 3 tonometers using Wilcoxon non-parametric test and the effect of CCT on IOP and OPA, as well as the relationship between OPA and IOP using Spearman correlation coefficient. RESULTS: The median PNT IOP was 24 mmHg (Inter-quartile range [IQR]: 22-26), median GAT IOP was 22 mmHg (IQR: 22-24), and median DCT IOP was 28.2 mmHg (IQR: 24.1-30.7). PNT and DCT had higher IOP values than GAT (median 2 mmHg and 6.2 mmHg, respectively). Mean CCT was 594.5 µm (SD 30.0). GAT IOP and DCT IOP showed an increase with increased corneal thickness (r:0.209; P=.036 and r:0.195; P=.051, respectively). PNT IOP did not change with CCT (r:0.15; P=.12). The median OPA was 4.8 mmHg (IQR: 3.6-6.1), and significantly increased with GAT IOP (r:0,38; P<.001) and with CCT (r:0.287; P=.004). This association was unclear with IOP PNT and IOP DCT (r:0.067; P=.50 and r:0,17, P=.08, respectively). CONCLUSIONS: DCT and PNT IOP values were higher than GAT IOP measurements in ocular hypertension patients. GAT IOP showed a significant increase with increased corneal thickness. Increased OPA seems to correlate with increased CCT and IOP, particularly if GAT is used.
Assuntos
Paquimetria Corneana , Hipertensão Ocular/diagnóstico , Tonometria Ocular/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Córnea/ultraestrutura , Feminino , Humanos , Pressão Intraocular , Masculino , Pessoa de Meia-Idade , Hipertensão Ocular/diagnóstico por imagem , Hipertensão Ocular/fisiopatologia , Reprodutibilidade dos Testes , Tonometria Ocular/instrumentação , UltrassonografiaRESUMO
OBJECTIVE: To estimate the rate of complications and establish risk factors for their development in patients with uveitis. METHODS: Prospective study of a cohort of 398 patients (413 eyes) that were reviewed from January 2000 to October 2007 and monitored during a period of at least one month. Demographic data, laterality, course (acute, subacute, chronic), location, diagnosis (idiopathic, infectious, ocular origin, systemic origin, others) and development of complications (cataract, cystoid macular edema, macular complications, retinal complications and others) were evaluated. RESULTS: After a mean follow-up of 35.2 months (range 1-160), 25% of patients developed one or more of the following complications: cataract 8.5%, macular edema 6.1%, macular complications (epiretinal membranes, choroidal neovascular membranes, macular necrosis) 4.1%, retinal complications (retinal detachment, retinal neovascularization, vitreous hemorrhage, retinal tears, retinal vascular occlusions) 4.1%, glaucoma or ocular hypertension 3.6%, and others 1.5%. Risk factors for development of uveitis complications were chronic course OR 6.37 (3.25-12.47) P <0.0001, bilaterality OR 1.98 (1.03-3.08) P =0.039, subacute course OR 1.94 (0.02-4.08) P=0.08, and panuveitis OR 1,92 (0.99-4.80) P=0.161. CONCLUSIONS: In our patients, cases involving chronic and bilateral uveitis were more prone to develop complications, with cataracts being the most frequent complication (Arch Soc Esp Oftalmol 2009; 84: 523-528).