RESUMO
AIM: To describe the efficacy of a modification of the superior inverted flap technique, with maculorrhexis, in vitrectomy for full-thickness macular hole (MH) surgery compared to internal limiting membrane peeling (ILM). METHODS: Retrospective and comparative study of patients with MH. In group A, a superior ILM flap is created to cover the macular hole, and in group B conventional ILM peeling was performed. RESULTS: A total of 80 eyes were included (44 group A and 36 group B). MH closure occurred in 100% in group A and 91.67% in group B (p = 0.0869). There were more U-type closures in group A(90.91%) than in group B(58.33%), p = 0.0017. Both groups showed Best corrected visual acuity (BCVA) improvement at 3 and 6 months. At 3 months BCVA in group A was significantly better but at 6 months results were similar. Ellipsoid layer (EZ) recovery at 6 months was achieved in 81.82% patients in group A and 52.78% in B (p = 0.005), and external limiting membrane in 81.82% in group A and 69.44% in B (p = 0.1957). CONCLUSIONS: The superior inverted flap maculorrhexis technique is suitable for idiopathic MH treatment, with better anatomical and non-inferior functional results than the classic ILM peeling. It achieves functional recoveries earlier, better BCVA and greater gains at 3 months compared to the classic ILM peeling. It also obtains a higher number of U-shaped closures and higher EZ restorations.
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
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
A retinal pigment epithelial (RPE) tear is a well-known complication of retinal pigment epithelial detachments (PED) and may cause a significant visual impairment. The most common cause is a vascularized PED in patients with exudative age-related macular degeneration (AMD). The development of diagnostic imaging techniques brings us closer to the etiology and pathophysiological mechanisms of this entity, offering us new strategies for treatment and follow-up. The advent of intravitreal antiangiogenic treatment (anti-VEGF) has led to an increase in the number of reported cases of RPE tears, which are an important vision-limiting factor during treatment. However, RPE tears may occur spontaneously or as a consequence of thermal laser treatment, photodynamic therapy or anti-VEGF therapy. It is accepted that the mechanism of RPE tears is multifactorial. The optimization of the functional outcome of this complication has been described with continuous treatment with antiangiogenic drugs. The goal of the present review is to evaluate the incidence, risk factors and treatment of RPE tears.
Assuntos
Perfurações Retinianas , Epitélio Pigmentado da Retina/lesões , Diagnóstico por Imagem/métodos , Humanos , Descolamento Retiniano/complicações , Descolamento Retiniano/diagnóstico , Descolamento Retiniano/epidemiologia , Descolamento Retiniano/terapia , Perfurações Retinianas/diagnóstico , Perfurações Retinianas/epidemiologia , Perfurações Retinianas/etiologia , Perfurações Retinianas/terapia , Epitélio Pigmentado da Retina/diagnóstico por imagem , Epitélio Pigmentado da Retina/cirurgia , Fatores de Risco , Ruptura Espontânea/diagnóstico , Ruptura Espontânea/epidemiologia , Ruptura Espontânea/etiologia , Ruptura Espontânea/terapiaRESUMO
Geographic atrophy is characterized by severe visual deficit whose etiology and pathophysiology are yet to be elucidated. As a working hypothesis, oxidative damage could trigger a chronic inflammation in Bruch's membrane-RPE-choriocapillaris complex, mostly due to complement pathway overactivation. Some individuals with mutations in the complement system and other factors have diminished capacity in the modulation of the inflammatory response, which results in cell damage and waste accumulation. This accumulation of intracellular and extracellular waste products manifests as drusen and pigmentary changes that precede the atrophy of photoreceptors, RPE, choriocapillaris with an ischemic process with decreased choroid flow. All these processes can be detected as tomographic findings and autofluorescence signals that are useful in the evaluation of patients with atrophic AMD, which helps to establish an individualized prognosis. Anti-inflammatory, antioxidant and therapies that decrease the accumulation of toxins for the preservation of the RPE cells and photoreceptors are being investigated in order to slow down the progression of this disease.