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1.
Acta Ophthalmol ; 100(1): e297-e303, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33847066

RESUMO

PURPOSE: To compare the efficacy of topical nepafenac 0.1% versus intravitreal triamcinolone acetonide (IVTA) at the conclusion of vitrectomy surgery versus no adjuvant therapy (NAT) in improving macular morphology post-operatively in patients undergoing vitrectomy for epiretinal membrane (ERM), as measured by optical coherence tomography (OCT) imaging and best-corrected visual acuity (BCVA). METHODS: Design: Prospective randomized clinical trial Setting: Multi-centre 80 patients scheduled to undergo vitrectomy surgery for idiopathic ERM were randomized to receive either IVTA (4 mg/0.1 cc) at the end of surgery, topical nepafenac sodium 0.1% TID for 1 month post-operation or no adjuvant treatment (NAT). Optical coherence tomography (OCT) imaging, best-corrected visual acuity and intraocular pressure (IOP) were measured before surgery, and 1 and 2 months post-operation. RESULTS: Although all three groups showed reduction in macular thickness post-operation, the NAT group showed the most improvement, with a reduction of 136.18 ± 29.84 µm at two months. There was no statistically significant difference in macular thickness between the groups at each time point, p = 0.158. The NAT group also had the best recovery in BCVA with an improvement of 0.207 logMAR (10.35 letters) at two months post-operation. There was no statistically significant difference in BCVA between the groups, p = 0.606. There was statistically significant difference in the IOP between the three groups, p = 0.04 only at 1-month visit. The IVTA group had the highest rise in average IOP at both 1 and 2 months post-operation (2.72 and 1.58 mmHg, respectively). CONCLUSION: Our study data suggest there was no advantage in the use of topical nepafenac or IVTA for post-vitrectomy ERM surgery.


Assuntos
Benzenoacetamidas/administração & dosagem , Membrana Epirretiniana/tratamento farmacológico , Fenilacetatos/administração & dosagem , Retina/diagnóstico por imagem , Tomografia de Coerência Óptica/métodos , Triancinolona Acetonida/administração & dosagem , Acuidade Visual , Adulto , Idoso , Idoso de 80 Anos ou mais , Anti-Inflamatórios não Esteroides/administração & dosagem , Membrana Epirretiniana/diagnóstico , Feminino , Seguimentos , Glucocorticoides/administração & dosagem , Humanos , Injeções Intravítreas , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento
2.
Biomaterials ; 271: 120750, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33725584

RESUMO

Vitreous substitutes are clinically used to maintain retinal apposition and preserve retinal function; yet the most used substitutes are gases and oils which have disadvantages including strict face-down positioning post-surgery and the need for subsequent surgical removal, respectively. We have engineered a vitreous substitute comprised of a novel hyaluronan-oxime crosslinked hydrogel. Hyaluronan, which is naturally abundant in the vitreous of the eye, is chemically modified to crosslink with poly(ethylene glycol)-tetraoxyamine via oxime chemistry to produce a vitreous substitute that has similar physical properties to the native vitreous including refractive index, density and transparency. The oxime hydrogel is cytocompatible in vitro with photoreceptors from mouse retinal explants and biocompatible in rabbit eyes as determined by histology of the inner nuclear layer and photoreceptors in the outer nuclear layer. The ocular pressure in the rabbit eyes was consistent over 56 d, demonstrating limited to no swelling. Our vitreous substitute was stable in vivo over 28 d after which it began to degrade, with approximately 50% loss by day 56. We confirmed that the implanted hydrogel did not impact retina function using electroretinography over 90 days versus eyes injected with balanced saline solution. This new oxime hydrogel provides a significant improvement over the status quo as a vitreous substitute.


Assuntos
Ácido Hialurônico , Hidrogéis , Animais , Biomimética , Camundongos , Oximas , Coelhos , Retina , Corpo Vítreo
3.
Retina ; 40(2): 303-311, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31972801

RESUMO

PURPOSE: To analyze and provide an overview of the incidence, management, and prevention of conjunctival erosion in Argus II clinical trial subjects and postapproval patients. METHODS: This retrospective analysis followed the results of 274 patients treated with the Argus II Retinal Prosthesis System between June 2007 and November 2017, including 30 subjects from the US and European clinical trials, and 244 patients in the postapproval phase. Results were gathered for incidence of a serious adverse event, incidence of conjunctival erosion, occurrence sites, rates of erosion, and erosion timing. RESULTS: Overall, 60% of subjects in the clinical trial subjects versus 83% of patients in the postapproval phase did not experience device- or surgery-related serious adverse events. In the postapproval phase, conjunctival erosion had an incidence rate of 6.2% over 5 years and 11 months. In 55% of conjunctival erosion cases, erosion occurred in the inferotemporal quadrant, 25% in the superotemporal quadrant, and 20% in both. Sixty percent of the erosion events occurred in the first 15 months after implantation, and 85% within the first 2.5 years. CONCLUSION: Reducing occurrence of conjunctival erosion in patients with the Argus II Retinal Prosthesis requires identification and minimization of risk factors before and during implantation. Implementing inverted sutures at the implant tabs, use of graft material at these locations as well as Mersilene rather than nylon sutures, and accurate Tenon's and conjunctiva closure are recommended for consideration in all patients.


Assuntos
Túnica Conjuntiva/cirurgia , Doenças da Túnica Conjuntiva/etiologia , Complicações Pós-Operatórias/etiologia , Implantação de Prótese/efeitos adversos , Retinose Pigmentar/cirurgia , Próteses Visuais/efeitos adversos , Doenças da Túnica Conjuntiva/epidemiologia , Doenças da Túnica Conjuntiva/prevenção & controle , Europa (Continente)/epidemiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Implantação de Prótese/métodos , Estudos Retrospectivos , Estados Unidos/epidemiologia
4.
Retina ; 40(8): 1471-1482, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31404033

RESUMO

PURPOSE: The LIGHTSITE I study investigated the efficacy and safety of photobiomodulation (PBM) treatment in subjects with dry age-related macular degeneration. METHODS: Thirty subjects (46 eyes) were treated with the Valeda Light Delivery System, wherein subjects underwent two series of treatments (3× per week for 3-4 weeks) over 1 year. Outcome measures included best-corrected visual acuity, contrast sensitivity, microperimetry, central drusen volume and drusen thickness, and quality of life assessments. RESULTS: Photobiomodulation-treated subjects showed a best-corrected visual acuity mean letter score gain of 4 letters immediately after each treatment series at Month 1 (M1) and Month 7 (M7). Approximately 50% of PBM-treated subjects showed improvement of ≥5 letters versus 13.6% in sham-treated subjects at M1. High responding subjects (≥5-letter improvement) in the PBM-treated group showed a gain of 8 letters after initial treatment (P < 0.01) and exhibited earlier stages of age-related macular degeneration disease. Statistically significant improvements in contrast sensitivity, central drusen volume, central drusen thickness, and quality of life were observed (P < 0.05). No device-related adverse events were reported. CONCLUSION: Photobiomodulation treatment statistically improved clinical and anatomical outcomes with more robust benefits observed in subjects with earlier stages of dry age-related macular degeneration. Repeated PBM treatments are necessary to maintain benefits. These pilot findings support previous reports and suggest the utility of PBM as a safe and effective therapy in subjects with dry age-related macular degeneration.


Assuntos
Atrofia Geográfica/radioterapia , Terapia com Luz de Baixa Intensidade , Idoso , Idoso de 80 Anos ou mais , Sensibilidades de Contraste/fisiologia , Método Duplo-Cego , Feminino , Atrofia Geográfica/diagnóstico , Atrofia Geográfica/fisiopatologia , Atrofia Geográfica/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida/psicologia , Drusas Retinianas/patologia , Inquéritos e Questionários , Resultado do Tratamento , Acuidade Visual/fisiologia , Testes de Campo Visual , Campos Visuais/fisiologia
6.
Can J Ophthalmol ; 53(1): 9-13, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29426448

RESUMO

Surgical restoration of vision with retinal prostheses is a new and developing technology currently available in a select group of countries, Canada among them. The Argus II retinal prosthesis is the first commercially available device for restoration of vision in patients with Retinitis Pigmentosa or with similar retinal pathology who still have minimal residual native vision. The surgery is complex and requires training however it is within the abilities of any experienced retina surgeon. Surgical experience builds up with each case and in our patients length of surgery constantly went down. Complications occurred however we experienced no catastrophic events. Most notable is that in our implanted cases the Argus II technology proved to be beneficial to most patients. In order to obtain optimal results with this surgical intervention it is absolutely required that the surgical work is complemented simultaneously with the work of a specialized rehabilitation team. A review of the technology, of our experience, comments and concerns is presented in this paper.


Assuntos
Implantação de Prótese/tendências , Retina/cirurgia , Retinose Pigmentar/cirurgia , Acuidade Visual/fisiologia , Próteses Visuais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Ontário , Desenho de Prótese , Retina/diagnóstico por imagem , Retina/fisiologia , Retinose Pigmentar/fisiopatologia , Estudos Retrospectivos , Resultado do Tratamento
7.
Retina ; 38(4): 692-697, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28338555

RESUMO

PURPOSE: To examine the relationship between retinal detachment and retrobulbar cysts in patients with optic nerve coloboma (ONC) and Morning Glory syndrome (MGS). METHODS: Patients diagnosed with either ONC or MGS were identified through a search of the Sick Kids database. Seventy-one patients either agreed to come in for a B-scan or had an incidental orbital B-scan or magnetic resonance imaging or both. Eyes with orbital B-scan ultrasound and/or magnetic resonance imaging images were assessed independently by two ophthalmologists and a radiologist for the presence of retrobulbar cysts. Retinal detachment was identified clinically with either indirect ophthalmoscopy or from fundus photographs. RESULTS: Forty-five of 71 (63%) and 26/71 (37%) patients had ONC and MGS, respectively. Retinal detachment occurred significantly more often in eyes with MGS than with ONC (9/17 [53%] vs. 5/45 [11%], P = 0.03, respectively). Retrobulbar cysts were not detected more often in MGS than in ONC (11/45 [24%] vs. 7/26 [27%]; P = 1.0). Eyes with retrobulbar cysts were significantly more likely to be associated with retinal detachment than those without (7/18 [39%] vs. 7/53 [13%]; P = 0.04). CONCLUSION: Retinal detachment occurs more frequently in MGS than in ONC in a cohort of patients referred to a specialist children's retinal service. Eyes with retrobulbar cysts are more likely to be associated with retinal detachment.


Assuntos
Coloboma/complicações , Disco Óptico/anormalidades , Doenças do Nervo Óptico/complicações , Nervo Óptico/anormalidades , Doenças Orbitárias/etiologia , Descolamento Retiniano/etiologia , Pré-Escolar , Cistos/etiologia , Feminino , Humanos , Incidência , Lactente , Masculino , Doenças do Nervo Óptico/epidemiologia , Doenças Orbitárias/epidemiologia , Descolamento Retiniano/epidemiologia , Estudos Retrospectivos , Fatores de Risco
8.
Ophthalmic Surg Lasers Imaging Retina ; 48(11): 881-886, 2017 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-29121356

RESUMO

BACKGROUND AND OBJECTIVE: The purpose of this randomized, single-masked clinical trial is to explore whether cefazolin mixed with 2% lidocaine can reduce pain. PATIENTS AND METHODS: Patients naïve to ophthalmic surgery were randomized to subconjunctival injection of either a 0.5 mL cefazolin-balanced salt solution (0.3 mL cefazolin and 0.2 mL balanced salt solution) or 0.5 mL cefazolin-lidocaine solution (0.3 mL cefazolin and 0.2 mL 2% lidocaine) during retinal surgery with a retrobulbar block. Pain scores were obtained at the start of surgery, middle of surgery, before and after cefazolin administration, and postoperatively. RESULTS: A total of 54 patients were recruited; 44.6% were male, and the mean age was 60.1 years ± 13.5 years. There were no statistically significant differences between the groups' operative characteristics or pain scores at each study time point. CONCLUSION: In pars plana vitrectomy with or without phacoemulsification and intraocular lens insertion, subconjunctival cefazolin mixed with lidocaine conferred no added analgesic benefit. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:881-886.].


Assuntos
Anestésicos Locais/uso terapêutico , Antibacterianos/uso terapêutico , Cefazolina/uso terapêutico , Dor Ocular/diagnóstico , Lidocaína/uso terapêutico , Cirurgia Vitreorretiniana , Adulto , Idoso , Idoso de 80 Anos ou mais , Túnica Conjuntiva/efeitos dos fármacos , Combinação de Medicamentos , Feminino , Humanos , Injeções Intraoculares , Implante de Lente Intraocular , Masculino , Pessoa de Meia-Idade , Medição da Dor , Facoemulsificação , Método Simples-Cego
9.
Can J Ophthalmol ; 52(5): 475-479, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28985807

RESUMO

OBJECTIVE: To assess how polypoidal choroidal vasculopathy (PCV) is recognized and treated, and to assess whether treatment outcomes are different between Chinese and Caucasian Canadian patients with age-related macular degeneration (AMD). DESIGN: Retrospective chart review. PARTICIPANTS: 154 eyes from 135 Chinese patients and 2291 eyes from 1792 Caucasian patients who were newly diagnosed with either AMD or PCV and had more than 1 year of follow-up were included. METHODS: All newly diagnosed AMD patients presenting to the Retina Service of 3 Toronto University Hospitals, between March 25, 2008, to September 30, 2014, were reviewed. RESULTS: 10/154 eyes (6.5%) in Chinese Canadians and 16/2291 eyes (0.7%) in Caucasian Canadians were diagnosed as having PCV. Indocyanine green angiography (ICGA) was used to diagnose PCV in 20% of Chinese Canadians and 8.8% of Caucasian Canadians. Clinical practices with a larger percentage of Chinese patients were more likely to diagnose PCV in both Chinese (p = 0.004) and Caucasian patients (p = 0.03), were more likely to use photodynamic therapy (PDT) (p < 0.01), and had significantly greater central retinal thickness decrease (p < 0.001). CONCLUSION: Our study has shown that PCV is under-recognized in a Canadian population, and ICGA is underutilized. In clinical practices with a greater portion of Chinese patients, PCV is more often recognized and PDT is used more liberally.


Assuntos
Inibidores da Angiogênese/uso terapêutico , Neovascularização de Coroide/diagnóstico , Corantes/administração & dosagem , Verde de Indocianina/administração & dosagem , Degeneração Macular/diagnóstico , Fotoquimioterapia , Pólipos/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Povo Asiático/etnologia , Canadá/epidemiologia , China/epidemiologia , Neovascularização de Coroide/tratamento farmacológico , Neovascularização de Coroide/cirurgia , Neovascularização de Coroide/terapia , Terapia Combinada , Feminino , Angiofluoresceinografia , Humanos , Degeneração Macular/tratamento farmacológico , Degeneração Macular/cirurgia , Degeneração Macular/terapia , Masculino , Pólipos/tratamento farmacológico , Pólipos/cirurgia , Pólipos/terapia , Estudos Retrospectivos , Acuidade Visual/fisiologia , População Branca/etnologia
10.
Acta Ophthalmol ; 95(4): e270-e277, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27989012

RESUMO

PURPOSE: To evaluate the efficacy of photobiomodulation (PBM) treatment for patients with dry age-related macular degeneration (AMD). METHODS: Assessments on 42 eyes with dry AMD (age related eye disease study (AREDS) 2-4) were conducted. Multiwavelength light emitting diode (LED) light comprising of yellow (590 nm), red (670 nm) and near-infrared (790 nm) bandwidths was applied to subjects' eyes for a treatment course of 3 weeks. Outcome measures were changes in best-corrected visual acuity (BCVA), contrast sensitivity (CS), drusen volume and central drusen thickness. RESULTS: Significant improvement in mean BCVA of 5.90 letters (p < 0.001) was seen on completion of the 3-week treatment and 5.14 letters (p < 0.001) after 3 months. Contrast sensitivity improved significantly (log unit improvement of 0.11 (p = 0.02) at 3 weeks and 3 months (log unit improvement of 0.16 (p = 0.02) at three cycles per degree. Drusen volume decreased by 0.024 mm3 (p < 0.001) and central drusen thickness was significantly reduced by a mean of 3.78 µm (p < 0.001), while overall central retinal thickness and retinal volume remained stable. CONCLUSION: This is the first study demonstrating improvements in functional and anatomical outcomes in dry AMD subjects with PBM therapy. These findings corroborate an earlier pilot study that looked at functional outcome measures. The addition of anatomical evidence contributes to the basis for further development of a non-invasive PBM treatment for dry AMD.


Assuntos
Sensibilidades de Contraste , Terapia a Laser/métodos , Degeneração Macular/complicações , Drusas Retinianas/cirurgia , Acuidade Visual , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Degeneração Macular/diagnóstico , Degeneração Macular/fisiopatologia , Masculino , Projetos Piloto , Retina/fisiopatologia , Drusas Retinianas/diagnóstico , Drusas Retinianas/etiologia , Estudos Retrospectivos , Tomografia de Coerência Óptica , Resultado do Tratamento
11.
Ophthalmologica ; 236(2): 88-94, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27362858

RESUMO

OBJECTIVE: To evaluate the pharmacogenetic relationship between CFH haplotypes and single nucleotide polymorphisms (SNPs) with response to ranibizumab treatment for neovascular age-related macular degeneration (nAMD). PATIENTS AND METHODS: This was a prospective cohort study involving 70 treatment-naive nAMD patients. Patients were genotyped for CFH haplotypes and SNPs in the C3, ARMS2, and mtDNA genes. Visual acuity and central macular thickness were assessed at baseline and during 6 monthly follow-up visits. Multivariate logistic regression was used to determine the association between genotypes and a gain of ≥15 letters at the 6-month endpoint after adjusting for potential confounders. RESULTS: CFH haplotypes were associated with a gain of ≥15 letters at the 6-month endpoint (p = 0.046). Patients expressing protective haplotypes were more likely to achieve a gain of ≥15 letters relative to the greatly increased risk haplotypes [OR 6.58 (95% CI: 1.37, 31.59)]. CONCLUSION: CFH is implicated in nAMD patient treatment response to ranibizumab.


Assuntos
DNA/genética , Predisposição Genética para Doença , Polimorfismo de Nucleotídeo Único , Ranibizumab/administração & dosagem , Degeneração Macular Exsudativa/genética , Idoso de 80 Anos ou mais , Inibidores da Angiogênese/administração & dosagem , Feminino , Angiofluoresceinografia , Seguimentos , Fundo de Olho , Frequência do Gene , Genótipo , Humanos , Injeções Intravítreas , Masculino , Estudos Prospectivos , Fatores de Risco , Fatores de Tempo , Fator A de Crescimento do Endotélio Vascular , Degeneração Macular Exsudativa/diagnóstico , Degeneração Macular Exsudativa/tratamento farmacológico
13.
Retina ; 35(8): 1489-506, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26076215

RESUMO

PURPOSE: A review of treat-and-extend regimens (TERs) with intravitreal anti-vascular endothelial growth factor agents in retinal diseases. METHODS: There is a lack of consensus on the definition and optimal application of TER in clinical practice. This article describes the supporting evidence and subsequent development of a generic algorithm for TER dosing with anti-vascular endothelial growth factor agents, considering factors such as criteria for extension. RESULTS: A TER algorithm was developed; TER is defined as an individualized proactive dosing regimen usually initiated by monthly injections until a maximal clinical response is observed (frequently determined by optical coherence tomography), followed by increasing intervals between injections (and evaluations) depending on disease activity. The TER regimen has emerged as an effective approach to tailoring the dosing regimen and for reducing treatment burden (visits and injections) compared with fixed monthly dosing or monthly visits with optical coherence tomography-guided regimens (as-needed or pro re nata). It is also considered a suitable approach in many retinal diseases managed with intravitreal anti-vascular endothelial growth factor therapy, given that all eyes differ in the need for repeat injections. CONCLUSION: It is hoped that this practical review and TER algorithm will be of benefit to health care professionals interested in the management of retinal diseases.


Assuntos
Inibidores da Angiogênese/uso terapêutico , Retinopatia Diabética/tratamento farmacológico , Degeneração Macular/tratamento farmacológico , Edema Macular/tratamento farmacológico , Oclusão da Veia Retiniana/tratamento farmacológico , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Algoritmos , Bevacizumab/uso terapêutico , Humanos , Ranibizumab/uso terapêutico , Receptores de Fatores de Crescimento do Endotélio Vascular/uso terapêutico , Proteínas Recombinantes de Fusão/uso terapêutico
14.
Br J Ophthalmol ; 98(9): 1226-9, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24782473

RESUMO

AIM: To evaluate the effect of scleral buckling on intraocular pressure (IOP) change during atmospheric decompression for eyes with small volumes of intravitreal gas. METHODS: 12 eyes of 12 patients, including 6 with and 6 without scleral buckles, were evaluated in a hypobaric chamber simulating air travel approximately 1 month post pars plana vitrectomy with 15% C3F8 gas fluid exchange. The chamber was decompressed with an ascent rate of 300 feet/min to a peak altitude of 8000 feet. After 15 min of cruising, descent was undertaken at 300 feet/min. IOP was measured at baseline and then every 5 min using slit-lamp mounted Goldmann applanation tonometry. The data were entered onto a spreadsheet and comparative statistics were done. RESULTS: During ascent, IOP steadily rose from an average of 13±3 mm Hg to a peak of 26±9 mm Hg at 8000 feet. Patients with scleral buckles had significantly lower peak IOPs compared with those without buckles (20±5 mm Hg vs 32±8 mm Hg, p=0.013, t test) representing lower absolute increases in IOP (7±1 mm Hg vs 19±7 mm Hg, p=0.001, t test) and lower percentage increases in IOP from baseline (62±25% vs 140±40%, respectively). CONCLUSIONS: Eyes with small volumes of intravitreal gas demonstrate significant IOP changes during atmospheric decompression in simulated flight. The presence of a scleral buckle significantly limits the magnitude of IOP change, suggesting that such patients can likely tolerate typical air travel without undue risk of dangerous IOP elevation.


Assuntos
Medicina Aeroespacial , Pressão Intraocular/fisiologia , Recurvamento da Esclera , Adulto , Idoso , Aeronaves , Altitude , Ambiente Controlado , Feminino , Fluorocarbonos , Humanos , Masculino , Pessoa de Meia-Idade , Descolamento Retiniano/cirurgia , Tonometria Ocular , Vitrectomia
16.
Can J Ophthalmol ; 47(5): 435-41, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23036545

RESUMO

OBJECTIVE: To present the characteristics and outcomes of macular holes (MHs) that arise in eyes that have been treated for retinal detachment (RD). DESIGN: Retrospective, interventional, consecutive case series. PARTICIPANTS: We studied 18 eyes that developed a MH following RD repair. METHODS: We report the demographic and clinical characteristics, MH closure rates, and best corrected visual acuity (BCVA) following MH repair. RESULTS: We detected 18 full-thickness MHs in 985 eyes. In 14 of 18, the original RD involved the macula, and in 16 of 18, the BCVA was 20/200 or worse. Of the RDs, 8 of 18 required multiple procedures to achieve reattachment. Post-RD BCVA was 20/200 or worse in 15 of 18 patients. The median time to MH diagnosis after RD repair was 1 month (range, 2 days to 53 months), and from MH diagnosis to MH repair, the median time was 1.75 months (range, 3 weeks to 8 months). Of 16 eyes (89%) that underwent surgical repair of the MH, 14 achieved MH closure, 1 requiring multiple pars plana vitrectomy, and 11 saw at least 1 Snellen line of improvement (median, 1; range, 1 to 6); 2 lost vision (1 and 2 Snellen lines, respectively); and 3 remained unchanged at a median follow-up of 3 months (range, 1 month to 25 months). Of the 18 patients, 6 had at least 20/80 BCVA at last follow-up. CONCLUSIONS: MHs following RDs (incidence 1.9%) are likely to be macula-off RDs requiring multiple interventions for RD repair. Post-MH-repair closure rates are similar to the rates for idiopathic MHs. BCVA outcomes are moderate and are dependent on impairment post-RD repair. The findings suggest other pathogenic mechanisms besides vitreofoveal traction may be leading to these MHs.


Assuntos
Complicações Pós-Operatórias , Descolamento Retiniano/cirurgia , Perfurações Retinianas/etiologia , Adulto , Idoso , Criança , Criocirurgia , Tamponamento Interno , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Decúbito Ventral , Perfurações Retinianas/diagnóstico , Perfurações Retinianas/cirurgia , Estudos Retrospectivos , Fatores de Tempo , Acuidade Visual/fisiologia , Vitrectomia
17.
Ophthalmology ; 119(8): 1609-14, 2012 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-22480743

RESUMO

PURPOSE: To report the incidence of endophthalmitis in association with different antibiotic prophylaxis strategies after intravitreal injections of anti-vascular endothelial growth factors and triamcinolone acetonide. DESIGN: Retrospective, comparative case series. PARTICIPANTS: Fifteen thousand eight hundred ninety-five intravitreal injections (9453 ranibizumab, 5386 bevacizumab, 935 triamcinolone acetonide, 121 pegaptanib sodium) were reviewed for 2465 patients between January 5, 2005, and August 31, 2010. The number of injections was determined from billing code and patient records. METHODS: The indications for injection included age-related macular degeneration, diabetic macular edema, central and branch retinal vein occlusion, and miscellaneous causes. Three strategies of topical antibiotic prophylaxis were used by the respective surgeons: (1) antibiotics given for 5 days after each injection, (2) antibiotics given immediately after each injection, and (3) no antibiotics given. MAIN OUTCOME MEASURES: The primary outcome measures were the incidence of culture-positive endophthalmitis and culture-negative cases of suspected endophthalmitis. RESULTS: Nine eyes of 9 patients with suspected endophthalmitis after injection were identified. Three of the 9 cases had culture-positive results. The overall incidence of endophthalmitis was 9 in 15 895. The incidence of culture-negative cases of suspected endophthalmitis and culture-proven endophthalmitis after injection was 6 in 15 895 and 3 in 15 895, respectively. Taking into account both culture-positive endophthalmitis and culture-negative cases of suspected endophthalmitis, the incidence per injection was 5 in 8259 for patients who were given antibiotics for 5 days after injection, 2 in 2370 for those who received antibiotics immediately after each injection, and 2 in 5266 who received no antibiotics. However, if considering culture-proven endophthalmitis alone, the use of topical antibiotics, given immediately or for 5 days after injection, showed lower rates of endophthalmitis compared with those without postinjection antibiotics. The risk of endophthalmitis after intravitreal injection varied among agents that were used. Among the 9 cases of clinically suspected endophthalmitis, regardless of prophylactic strategies used, the incidence of endophthalmitis per injection was 2 in 935 for triamcinolone acetonide, 3 in 9453 for ranibizumab, and 4 in 5386 for bevacizumab. CONCLUSIONS: The overall rate of intravitreal injection-related endophthalmitis is greater with the use of topical antibiotics, given immediately or for 5 days after the injection, compared with no antibiotics.


Assuntos
Inibidores da Angiogênese/administração & dosagem , Antibacterianos/uso terapêutico , Antibioticoprofilaxia/métodos , Endoftalmite/epidemiologia , Fluoroquinolonas/uso terapêutico , Glucocorticoides/administração & dosagem , Idoso , Idoso de 80 Anos ou mais , Anestésicos Locais/administração & dosagem , Retinopatia Diabética/tratamento farmacológico , Endoftalmite/microbiologia , Feminino , Humanos , Incidência , Injeções Intravítreas , Degeneração Macular/tratamento farmacológico , Edema Macular/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Oclusão da Veia Retiniana/tratamento farmacológico , Estudos Retrospectivos , Fatores de Risco , Triancinolona Acetonida/administração & dosagem , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Acuidade Visual/fisiologia
18.
Acta Ophthalmol ; 90(1): e13-20, 2012 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-21801339

RESUMO

PURPOSE: To assess the hemodynamic response of retinal arterioles and venules following a single intravitreal injection of ranibizumab in neovascular age-related macular degeneration (NV-AMD) patients and to assess the influence of the number of prior injections on this response. METHODS: Fifteen NV-AMD patients were prospectively recruited and grouped according to the dosage of ranibizumab previously received. Group 1 NV-AMD patients (n = 7) had previously received 1.50 mg or less, and group 2 patients (n = 8) had received more than 1.50 mg in the study eye. A group of 12 non-NV AMD patients were also recruited for control comparison. Vessel diameter, centreline blood velocity and blood flow were assessed with the Canon Laser Blood Flowmeter immediately prior to an injection and at a mean follow-up of 37.7 and 36.7 days for group 1 and group 2 patients, respectively. RESULTS: The NV-AMD patients as a whole and the group 1 cohort had a significantly greater arteriolar diameter at baseline than the non-NV AMD patients. There was a significant reduction in arteriolar diameter, velocity and blood flow in group 1 but not in group 2 NV-AMD patients at follow-up. There was only an insignificant decrease in measured parameters of the retinal venules. At follow-up, there was no difference in the diameter, velocity or flow between AMD patients. CONCLUSION: Intravitreal ranibizumab treatment for NV-AMD induces a reduction in arteriolar diameter, velocity, and blood flow in patients who have received <1.50 mg of ranibizumab.


Assuntos
Inibidores da Angiogênese/administração & dosagem , Anticorpos Monoclonais Humanizados/administração & dosagem , Vasos Retinianos/fisiologia , Degeneração Macular Exsudativa/tratamento farmacológico , Degeneração Macular Exsudativa/fisiopatologia , Idoso , Velocidade do Fluxo Sanguíneo/fisiologia , Pressão Sanguínea/fisiologia , Angiofluoresceinografia , Seguimentos , Humanos , Pressão Intraocular/fisiologia , Injeções Intravítreas , Fluxometria por Laser-Doppler , Estudos Prospectivos , Ranibizumab , Fluxo Sanguíneo Regional , Tomografia de Coerência Óptica , Acuidade Visual/fisiologia
19.
J Ophthalmol ; 2011: 764183, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21969910

RESUMO

Purpose. To present a series of retinal disease cases that were imaged by spectral domain optical coherence tomography (SD-OCT) in order to illustrate the potential and limitations of this new imaging modality. Methods. The series comprised four selected cases (one case each) of age-related macular degeneration (ARMD), diabetic retinopathy (DR), central retinal artery occlusion (CRAO), and branch retinal vein occlusion (BRVO). Patients were imaged using the Heidelberg Spectralis (Heidelberg Engineering, Germany) in SD-OCT mode. Patients also underwent digital fundus photography and clinical assessment. Results. SD-OCT imaging of a case of age-related macular degeneration revealed a subfoveal choroidal neovascular membrane with detachment of the retinal pigment epithelium (RPE) and neurosensory retina. Using SD-OCT, the cases of DR and BRVO both exhibited macular edema with cystoid spaces visible in the outer retina. Conclusions. The ability of SD-OCT to clearly and objectively elucidate subtle morphological changes within the retinal layers provides information that can be used to formulate diagnoses with greater confidence.

20.
Br J Ophthalmol ; 95(11): 1564-7, 2011 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-21355018

RESUMO

BACKGROUND/AIMS: A retrospective consecutive case series to evaluate the efficacy of re-operation in patients with persistent or recurrent idiopathic full-thickness macular hole after initial surgery with internal limiting membrane peel (ILM). METHODS: 491 patients underwent surgery for full-thickness macular hole from January 2004 to November 2007. Fifty-five patients either did not close or reopened during the follow-up period. Thirty patients with initial ILM peel underwent repeat surgery involving vitrectomy, enlargement of ILM rhexis and gas tamponade. RESULTS: Anatomical closure rate was 88.8% for primary surgery and 46.7% (14/30) for re-operation. There was a statistically significant improvement in overall best corrected visual acuity (BCVA) from re-operation baseline BCVA (p=0.02) within 1 year. For holes that did not close after the second surgery, visual acuity did not worsen. CONCLUSION: Re-operation has a reduced success rate of anatomical closure. However, BCVA is statistically significantly improved from re-operation baseline, so even though we cannot return vision to pre-pathological baseline, re-operation can improve on this new baseline.


Assuntos
Membrana Epirretiniana/cirurgia , Perfurações Retinianas/cirurgia , Feminino , Humanos , Masculino , Recidiva , Reoperação/métodos , Perfurações Retinianas/fisiopatologia , Estudos Retrospectivos , Tomografia de Coerência Óptica , Resultado do Tratamento , Acuidade Visual/fisiologia , Vitrectomia/métodos
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