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1.
Eye (Lond) ; 29(9): 1213-9, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26183284

RESUMO

PURPOSE: To evaluate the outcomes and complications of 25-gauge (G) pars plana vitrectomy (PPV) for repair of diabetic tractional retinal detachment (TRD). METHODS: Retrospective review of consecutive, single-surgeon 25-G PPV cases between July 2007 and July 2014. Seventy eyes from 55 patients were operated on for diabetic TRD; all eyes were tamponaded with sulfur hexafluoride, octofluoropropane, silicone oil, or balanced salt solution. Mean age at surgery was 47.7 years (range 23-76 years), and mean length of follow-up was 713 days (range 90-2368 days; median 671 days). Primary outcomes included best-corrected visual acuity (BCVA), intraocular pressure (IOP), anatomic success, redetachment, and endophthalmitis. RESULTS: Preoperatively, 49 eyes (70%) had a concurrent rhegmatogenous component (8 of which also had proliferative vitreoretinopathy (PVR)). Mean BCVA improved from logarithm of the minimal angle of resolution 1.59 (20/800, SD 0.88) to 0.68 postoperatively (20/100, 0.77), P-value<0.001. Mean IOP increased from 15.9 to 20 mm Hg 1 day after surgery. Elevated postoperative IOP (≥ 22 mm Hg) occurred in 25 eyes, and low IOP (≤ 5 mm Hg) occurred in 2 eyes. Primary reattachment was achieved in 63 eyes (90%), and final anatomical success occurred in 69 eyes (99%). There were no cases of endophthalmitis. CONCLUSIONS: Twenty-five-G PPV repair was safe and effective in the repair of diabetic TRD, including eyes with a combined rhegmatogenous detachment or PVR. Gas, silicone oil, and balanced salt solution tamponading agents all proved to be efficacious in this surgical population.


Assuntos
Retinopatia Diabética/cirurgia , Descolamento Retiniano/cirurgia , Vitrectomia/métodos , Adulto , Idoso , Endoftalmite/etiologia , Feminino , Seguimentos , Humanos , Pressão Intraocular , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Recidiva , Estudos Retrospectivos , Óleos de Silicone/administração & dosagem , Acuidade Visual , Adulto Jovem
2.
Eye (Lond) ; 27(5): 663-7; quiz 668, 2013 May.
Artigo em Inglês | MEDLINE | ID: mdl-23558214

RESUMO

PURPOSE: The aim of this study is to report the short-term efficacy of aflibercept in the treatment of neovascular age-related macular degeneration (AMD) with associated retinal pigment epithelial detachment (PED) which is refractory or develops tachyphylaxis to bevacizumab and ranibizumab. METHODS: The method comprised a retrospective review of the medical records of patients with neovascular AMD and associated PEDs recently treated with aflibercept and previously treated with bevacizumab and ranibizumab. RESULTS: Three eyes of three female patients of ages 49, 55, and 65 years old with large serous PEDs and subretinal fluid (SRF) associated with occult choroidal neovascularization and neovascular AMD were treated with aflibercept after intravitreal bevacizumab and/or ranibizumab failed to resolve the lesions. All had complete resolution of SRF and complete or near-complete resolution of the PEDs after aflibercept injections over a 3-month period. Visual acuity improved in all three eyes. CONCLUSION: Intravitreal aflibercept may be an effective treatment option for serous PED in neovascular AMD patients after bevacizumab and ranibizumab have previously failed. Larger studies with longer follow-up are required to determine the role of aflibercept in treatment of PED in neovascular AMD.


Assuntos
Inibidores da Angiogênese/administração & dosagem , Neovascularização de Coroide/tratamento farmacológico , Degeneração Macular/tratamento farmacológico , Receptores de Fatores de Crescimento do Endotélio Vascular/administração & dosagem , Proteínas Recombinantes de Fusão/administração & dosagem , Descolamento Retiniano/tratamento farmacológico , Idoso , Anticorpos Monoclonais Humanizados/uso terapêutico , Bevacizumab , Neovascularização de Coroide/complicações , Feminino , Humanos , Injeções Intravítreas , Degeneração Macular/complicações , Pessoa de Meia-Idade , Ranibizumab , Descolamento Retiniano/etiologia , Estudos Retrospectivos , Falha de Tratamento
3.
Br J Ophthalmol ; 92(6): 747-50, 2008 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-17981985

RESUMO

AIMS: To determine visual and anatomic outcomes following transpupillary thermotherapy (TTT) as a primary treatment for small choroidal malignant melanomas. METHODS: 20 patients with small choroidal melanomas who underwent primary TTT at our institution were retrospectively reviewed. Patients with choroidal melanomas posterior to the equator with a basal diameter less than 12 mm and thickness less than 3.5 mm were included if the lesion had documented growth or clinical risk factors for growth. RESULTS: Thirteen women and seven men (mean age: 65 years, range: 41-85 years) underwent TTT. The mean preoperative tumour thickness was 1.81 mm (range: 0.78-3.40 mm). The mean follow-up time after TTT was 44.6 months (range: 11-108 months, median: 47.5 months). After a mean of 2.15 primary TTT sessions (range: 1-4), tumour regression without recurrence was attained in 11 (55%) of 20 cases. Five of the nine remaining tumours with recurrence were successfully treated with additional TTT. One patient declined further TTT and underwent enucleation. Three other tumours had recurrence after repeat TTT. The mean time to recurrence after initial TTT was 20.8 months (range: 8-37 months). The mean time to recurrence after repeat TTT was 35 months (range: 5-69 months). There was no tumour-related metastasis or death. CONCLUSIONS: Tumours treated with TTT have significant recurrence rates. Although tumour control may ultimately be achieved with TTT, close monitoring of these tumours is necessary, since repeat TTT or alternative therapies may be required.


Assuntos
Neoplasias da Coroide/cirurgia , Terapia a Laser/métodos , Melanoma/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Coroide/fisiopatologia , Feminino , Seguimentos , Humanos , Masculino , Melanoma/fisiopatologia , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/cirurgia , Pupila , Reoperação , Estudos Retrospectivos , Resultado do Tratamento , Acuidade Visual
4.
Br J Ophthalmol ; 91(12): 1607-9, 2007 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-17522146

RESUMO

AIM: To report the early vitreous involvement in a rare familial amyloidotic polyneuropathy (FAP) mutation and associated vitreous vascular endothelial growth factor (VEGF) levels. DESIGN: Observational case series. METHODS: Review of clinical, pathological, photographic, and angiographic records of two FAP siblings with severe vitreous involvement. Laboratory ELISA analysis of vitreous samples for VEGF, and DNA sequence analysis of peripheral blood for transthyretin (TTR) mutational analysis. RESULTS: Two patients underwent 25-gauge vitrectomy in three eyes with marked improvement of visual acuity. Neovascularisation seen intraoperatively responded to endolaser. Analysis of vitrectomy samples for VEGF showed raised levels in all three specimens. Mutational analysis revealed an isolated Glu54Gly mutation in the transthyretin gene. CONCLUSIONS: Early involvement of the vitreous occurs in a rare transthyretin mutation of FAP, with increased vitreous levels of VEGF.


Assuntos
Neuropatias Amiloides Familiares/genética , Oftalmopatias Hereditárias/genética , Mutação , Pré-Albumina/genética , Fator A de Crescimento do Endotélio Vascular/metabolismo , Corpo Vítreo/metabolismo , Adulto , Idade de Início , Neuropatias Amiloides Familiares/diagnóstico , Neuropatias Amiloides Familiares/epidemiologia , Neuropatias Amiloides Familiares/metabolismo , Neuropatias Amiloides Familiares/cirurgia , Povo Asiático/genética , Oftalmopatias Hereditárias/diagnóstico , Oftalmopatias Hereditárias/epidemiologia , Oftalmopatias Hereditárias/metabolismo , Oftalmopatias Hereditárias/cirurgia , Angiofluoresceinografia , Fundo de Olho , Ácido Glutâmico , Glicina , Humanos , Masculino , Vitrectomia
5.
J Pharmacol Exp Ther ; 318(2): 555-62, 2006 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-16699068

RESUMO

Human cathepsin K, a cysteine proteinase of the papain family, has been recognized as a potential drug target for the treatment of osteoporosis. The predominant expression of cathepsin K in osteoclasts has rendered the enzyme into a major target for the development of novel antiresorptive drugs. Now, we report the pharmacological properties of OST-4077 [furan-2-carboxylic acid (1-{1-[4-fluoro-2-(2-oxo-pyrrolidin-1-yl)-phenyl]-3-oxo-piperidin-4-ylcarbamoyl}-cyclohexyl)-amide] as a novel selective cathepsin K inhibitor. Human and rat cathepsin K were inhibited in vitro by OST-4077 with the IC50 values of 11 and 427 nM, respectively. OST-4077 suppressed bone resorption induced by rabbit osteoclasts (IC50, 37 nM) but did not affect bone mineralization or cellular alkaline phosphatase activity in MC3T3-E1 cells. Parathyroid hormone-induced bone resorption was inhibited in a dose-dependent manner in thyroparathyroidectomized rats gavaged with a single dose of OST-4077 (ED50, 69 mg/kg). When given orally twice daily for 4 weeks to 3-month-old ovariectomized (OVX) rats, OST-4077 dose-dependently prevented bone loss, as monitored by bone densitometry, ash content, and urinary excretion of deoxypyridinoline. No change in serum osteocalcin in the OVX rats by OST-4077 suggested that bone formation might not be affected by the agent. In summary, OST-4077 selectively inhibited bone resorbing activities of osteoclasts and prevented bone loss induced by estrogen deficiency but did not affect bone formation. OST-4077, an orally active selective human cathepsin K inhibitor, may have the therapeutic potential for the treatment of diseases characterized by excessive bone loss including osteoporosis.


Assuntos
Amidas/farmacologia , Amidas/uso terapêutico , Conservadores da Densidade Óssea/farmacologia , Conservadores da Densidade Óssea/uso terapêutico , Reabsorção Óssea/tratamento farmacológico , Catepsinas/antagonistas & inibidores , Inibidores Enzimáticos/farmacologia , Inibidores Enzimáticos/uso terapêutico , Furanos/farmacologia , Furanos/uso terapêutico , Osteoclastos/efeitos dos fármacos , Fosfatase Alcalina/metabolismo , Animais , Biomarcadores , Densidade Óssea/efeitos dos fármacos , Reabsorção Óssea/metabolismo , Catepsina K , Catepsinas/genética , Clonagem Molecular , Estrogênios/deficiência , Feminino , Humanos , Ovariectomia , Hormônio Paratireóideo/farmacologia , Coelhos , Ratos , Ratos Sprague-Dawley
7.
Invest Ophthalmol Vis Sci ; 42(7): 1617-25, 2001 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-11381069

RESUMO

PURPOSE: To determine whether vascular endothelial growth factor (VEGF) regulates angiopoietin (Ang)-1 and -2 expression in retinal pigment epithelial (RPE) cells. METHODS: Expression of VEGF, Ang1, and Ang2 in surgically removed human choroidal neovascular membranes (CNVMs) was analyzed by double-label confocal immunofluorescence microscopy. Total RNA was extracted from cultured human RPE cells treated with VEGF for mRNA analysis. Northern blot analysis was performed to examine the time course and dose response of Ang1 and Ang2 mRNA expression. mRNA stability and nuclear run-on analyses were performed. Secreted Ang1 and Ang2 protein levels in conditioned media from RPE cells were examined by Western blot analysis. RESULTS: Ang1 and Ang2 immunostaining colocalized with VEGF-positive stromal cells in human CNVMS: Ang1 and Ang2 mRNAs were expressed by cultured serum-starved RPE cells. VEGF upregulated Ang1 mRNA in a time- and dose-dependent manner without a significant change in Ang2 mRNA. Ang1 and Ang2 mRNAs in RPE cells were as stable as that of S18. VEGF stimulation further increased the half-life of Ang1 mRNA, but did not alter its transcription rate. VEGF increased the amount of Ang1, but not Ang2, protein secreted into the medium. CONCLUSIONS: The colocalization of Ang1 and Ang2 with VEGF in CNVM stromal cells and the upregulation of Ang1 expression by VEGF in cultured RPE cells suggest that VEGF may selectively modulate Ang expression during CNV.


Assuntos
Fatores de Crescimento Endotelial/farmacologia , Linfocinas/farmacologia , Glicoproteínas de Membrana/metabolismo , Epitélio Pigmentado Ocular/efeitos dos fármacos , Angiopoietina-1 , Angiopoietina-2 , Northern Blotting , Western Blotting , Células Cultivadas , Neovascularização de Coroide/metabolismo , Relação Dose-Resposta a Droga , Fatores de Crescimento Endotelial/genética , Fatores de Crescimento Endotelial/metabolismo , Inibidores Enzimáticos/metabolismo , Técnica Indireta de Fluorescência para Anticorpo , Expressão Gênica , Humanos , Linfocinas/genética , Linfocinas/metabolismo , Glicoproteínas de Membrana/genética , Microscopia Confocal , Pessoa de Meia-Idade , Epitélio Pigmentado Ocular/metabolismo , Proteínas/genética , Proteínas/metabolismo , RNA Mensageiro/metabolismo , Fatores de Tempo , Regulação para Cima/efeitos dos fármacos , Fator A de Crescimento do Endotélio Vascular , Fatores de Crescimento do Endotélio Vascular
8.
Ophthalmology ; 107(10): 1927-31, 2000 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-11013201

RESUMO

PURPOSE: To describe the outcome of radioactive episcleral plaque therapy for treatment of metastatic carcinoma to the choroid. DESIGN: Retrospective, noncomparative case series. PARTICIPANTS: Five patients (six eyes) with carcinoma metastatic to the choroid. METHODS: Retrospective review of the clinical records of five patients (six eyes) who underwent radioactive episcleral plaque therapy for choroidal metastases. MAIN OUTCOME MEASURES: Tumor height, visual acuity, radiation optic neuropathy, and radiation retinopathy. RESULTS: Radioactive episcleral plaque therapy resulted in shrinkage of the treated tumors and resolution of subretinal fluid in all eyes. After plaque treatment, best-corrected visual acuity was maintained within two lines of initial visual acuity for two eyes, decreased more than two lines for one eye, and improved more than two lines in three eyes. The treatment was well tolerated and there was no acute toxicity. Late complications included optic nerve atrophy (at 2 years) with proliferative radiation retinopathy (at 3 years) in one eye and optic atrophy (at 6 months) in another eye that had received prior external beam therapy. CONCLUSIONS: In carefully selected cases, radioactive episcleral plaque therapy appears to be an effective and reasonable treatment for carcinoma metastatic to the choroid.


Assuntos
Adenocarcinoma/radioterapia , Braquiterapia , Neoplasias da Mama/patologia , Carcinoma Ductal de Mama/radioterapia , Neoplasias da Coroide/radioterapia , Neoplasias Pancreáticas/patologia , Adenocarcinoma/secundário , Adulto , Idoso , Braquiterapia/efeitos adversos , Carcinoma Ductal de Mama/secundário , Neoplasias da Coroide/secundário , Feminino , Humanos , Radioisótopos do Iodo/efeitos adversos , Radioisótopos do Iodo/uso terapêutico , Radioisótopos de Irídio/efeitos adversos , Radioisótopos de Irídio/uso terapêutico , Masculino , Pessoa de Meia-Idade , Atrofia Óptica/etiologia , Nervo Óptico/efeitos da radiação , Lesões por Radiação/etiologia , Retina/efeitos da radiação , Estudos Retrospectivos , Acuidade Visual
9.
Ophthalmology ; 107(6): 1083-8, 2000 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-10857827

RESUMO

PURPOSE: To compare vitrectomy procedures and visualization of posterior segment structures through multifocal silicone intraocular lenses (IOLs) with the same procedures through monofocal silicone IOLs in rabbit eyes. DESIGN: Experimental study. PARTICIPANTS: Twelve eyes of six rabbits. METHODS: Each rabbit eye underwent phacoemulsification of the lens and posterior chamber implantation of a silicone multifocal or silicone monofocal IOL. The type of IOL (monofocal vs. multifocal) implanted in the first eye of each rabbit was randomly decided. The fellow eye then received the other IOL type. Vitrectomy procedures were performed through the IOLs by using a flat contact lens (part 1) or wide-angled contact lens (part 2) for visualization through fluid-filled (parts 1 and 2) and air-filled (part 2) eyes. MAIN OUTCOME MEASURES: Image quality, stereopsis, and contrast were subjectively graded on a scale of 0 (none) to 4 (excellent) for each eye by each surgeon. RESULTS: In part 1, image quality averaged 4 for the monofocal IOL and 3.6 for the multifocal IOL. Stereopsis averaged 4 for the monofocal IOL and 4 for the multifocal IOL. Contrast averaged 4 for the monofocal IOL and 3.9 for the multifocal IOL. Vitrectomy with retinal surface maneuvers was successfully performed in both pigmented and nonpigmented rabbit eyes through both IOL types. In part 2, image quality, stereopsis, and contrast were rated as 4 for both multifocal and monofocal silicone IOLs. Air-fluid exchange was performed without difficulty. Image quality, stereopsis, and contrast were rated as 4 for air-filled eyes. CONCLUSIONS: Visualization of posterior segment structures through multifocal silicone IOLs was sufficient for retinal surface maneuvers during vitrectomy procedures in both fluid-filled and air-filled rabbit eyes.


Assuntos
Ar , Membrana Epirretiniana/cirurgia , Ácido Hialurônico , Lentes Intraoculares , Vitrectomia/métodos , Animais , Segmento Anterior do Olho/cirurgia , Sensibilidades de Contraste , Percepção de Profundidade , Implante de Lente Intraocular , Facoemulsificação , Coelhos , Elastômeros de Silicone , Acuidade Visual
10.
Ophthalmology ; 107(5): 866-70, 2000 May.
Artigo em Inglês | MEDLINE | ID: mdl-10811076

RESUMO

PURPOSE: The purpose of this study was to compare nonmydriatic digital images with 35-mm slide images for the detection of diabetic retinal findings. STUDY DESIGN: Comparative, observational case series. PARTICIPANTS: Twenty-two patients with diabetes. METHODS: Diabetic patients underwent digital (nonmydriatic fundus camera attached to a digital back) and standard dilated 35-mm retinal photography of three areas: posterior pole, nasal retina, and temporal retina. The images were reviewed by a single masked grader for the presence or absence of specific retinal findings. PRIMARY OUTCOME MEASURES: Presence or absence of neovascularization of the disc (NVD), neovascularization elsewhere (NVE), venous beading (VB), nerve fiber layer (NFL) hemorrhage, dot-blot hemorrhage, microaneurysm (MA), clinically significant macular edema, cotton wool spot, intraretinal microvascular anomaly (IRMA), hard exudate (HE), and retinal pigment epithelial (RPE) pigmentary changes. RESULTS: Forty eyes of 22 patients underwent both imaging procedures. The agreement between image type was highest for IRMA (97.5%) and VB (95%) and lowest for RPE pigmentary changes (65%) and MA (62.5%). Sensitivity ranged from 25% (NVD) to 100% (VB). Specificity ranged from 90% (RPE pigmentary changes) to 100% (NVD, NVE, VB, NFL hemorrhage, HE). Positive predictive value ranged from 50% (IRMA) to 100% (NVD, NVE, HE, NFL, VB). Negative predictive value ranged from 48% (MA) to 100% (IRMA). CONCLUSIONS: Nonmydriatic digital fundus imaging for detection of diabetic retionopathy has a low sensitivity rate and a high specificity rate and is less clinically useful than standard dilated 35-mm fundus slide images.


Assuntos
Retinopatia Diabética/diagnóstico , Fundo de Olho , Fotografação/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Reações Falso-Positivas , Humanos , Edema Macular/diagnóstico , Pessoa de Meia-Idade , Fibras Nervosas/patologia , Fotografação/métodos , Valor Preditivo dos Testes , Pupila/efeitos dos fármacos , Reprodutibilidade dos Testes , Células Ganglionares da Retina/patologia , Hemorragia Retiniana/diagnóstico , Neovascularização Retiniana/diagnóstico , Vasos Retinianos/patologia , Sensibilidade e Especificidade , Processamento de Sinais Assistido por Computador
12.
Am J Ophthalmol ; 127(3): 288-93, 1999 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-10088738

RESUMO

PURPOSE: To determine anatomic and visual acuity outcomes of posterior segment complications after ganciclovir implant surgery. METHODS: We reviewed the medical records of 63 patients with acquired immunodeficiency syndrome who had active cytomegalovirus retinitis in 82 eyes and who underwent 110 consecutive ganciclovir implant procedures. Preoperative and postoperative visual acuity, type of postoperative complication, treatment, and lines of visual acuity change were determined. RESULTS: Thirty-eight eyes of 19 patients had bilateral ganciclovir implant procedures, and 25 eyes of 19 patients underwent two or more ganciclovir implant procedures. Thirteen (12%) of 110 ganciclovir implant procedures developed posterior segment complications: rhegmatogenous retinal detachment in six, vitreous hemorrhage in four, endophthalmitis in two, and cystoid macular edema with epiretinal membrane in one. Treatment included pars plana vitrectomy with silicone oil in two cases and without silicone oil in three cases, scleral buckling in one, intravitreal antibiotic injection in two, and laser photocoagulation in two. Overall, median visual acuity was 20/25 preoperatively. Median follow-up was 6 months for all eyes and 7 months for eyes with complications. Postoperative median visual acuity was 20/25 for eyes without complications vs 20/40 at 1 month, 20/60 at 3 and 6 months, and 20/100 at 12 months in eyes with complications (P < .001). More eyes with than without complications lost 2 or more lines of visual acuity (P < .001). CONCLUSION: Postoperative complications occurred in 12% of the ganciclovir implant procedures and were associated with decreased visual acuity despite treatment.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Antivirais/uso terapêutico , Retinite por Citomegalovirus/tratamento farmacológico , Ganciclovir/uso terapêutico , Complicações Pós-Operatórias , Doenças Retinianas/etiologia , Acuidade Visual , Adulto , Implantes de Medicamento , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Oftalmológicos/efeitos adversos , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/cirurgia , Doenças Retinianas/fisiopatologia , Doenças Retinianas/cirurgia , Resultado do Tratamento , Vitrectomia
13.
Retina ; 18(4): 322-9, 1998.
Artigo em Inglês | MEDLINE | ID: mdl-9730174

RESUMO

PURPOSE: To evaluate a tissue sealant (autologous cryoprecipitate activated with bovine thrombin) as an adjuvant in macular hole surgery. METHODS: Sixty-nine patients with stage 2, 3, or 4 full-thickness macular hole were enrolled consecutively in a prospective pilot study. Anatomic closure of the macular holes with a single operation was the primary outcome. Fifty-eight patients had pre- and postoperative standardized measurements including best refracted visual acuity, reading speed, and contrast sensitivity. Group A patients (45) had primary macular holes; Group B patients (13) had recurrent macular holes or macular holes with "other" retinal pathology. Surgical technique was standardized and membrane dissections were optional. RESULTS: The anatomic closure rate was 80% with a minimum of 6 months follow-up. Mean improvement in visual acuity for Group A (2.9+/-0.4 lines) was significantly better than for Group B (0.8+/-0.5 lines; P = 0.008). Eyes that underwent internal limiting membrane (ILM) dissections had an anatomic closure rate of 96% (23/24), compared with 71% (32/45) in "non-ILM" cases (P = 0.034). Adverse reactions included sterile hypopyon (10%), intraretinal hemorrhage (9%), pigmentary hyperplasia (3%), and retinal detachment (3%). CONCLUSION: Tissue sealants should be evaluated as an adjuvant in macular hole surgery in a randomized clinical trial. Inflammatory reactions may occur in some patients. Internal limiting membrane dissection may improve anatomic closure rates without adversely affecting the visual acuity.


Assuntos
Membrana Epirretiniana/cirurgia , Adesivo Tecidual de Fibrina/administração & dosagem , Perfurações Retinianas/cirurgia , Trombina/administração & dosagem , Adesivos Teciduais , Adulto , Idoso , Idoso de 80 Anos ou mais , Sensibilidades de Contraste , Feminino , Adesivo Tecidual de Fibrina/efeitos adversos , Fluorocarbonos/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos , Leitura , Perfurações Retinianas/terapia , Trombina/efeitos adversos , Adesivos Teciduais/efeitos adversos , Resultado do Tratamento , Acuidade Visual , Vitrectomia
16.
Curr Opin Ophthalmol ; 7(3): 46-50, 1996 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-10163459

RESUMO

For the past year, indocyanine green angiography has been applied to evaluation of choroidal neovascularization, pigment epithelial detachment, retinal vascular disorders, and choroidal diseases and tumors. These applications have expanded the potential use of this technique. The relative safety of indocyanine green angiography has contributed to its continued wide-spread application.


Assuntos
Doenças da Coroide/diagnóstico , Angiofluoresceinografia , Verde de Indocianina , Doenças Retinianas/diagnóstico , Angiofluoresceinografia/métodos , Angiofluoresceinografia/tendências , Fundo de Olho , Humanos
17.
Am J Ophthalmol ; 121(5): 575-7, 1996 May.
Artigo em Inglês | MEDLINE | ID: mdl-8610806

RESUMO

PURPOSE: We used intravitreal autologous fibrinogen with bovine thrombin for the surgical closure of macular holes in 60 cases. METHODS: Pars plana vitrectomy with separation of the posterior cortical vitreous was performed after air/fluid exchange. One to two drops each of autologous fibrinogen and bovine thrombin (20 to 80 U) were instilled in each patient. RESULTS: Five (8%) of 60 patients developed a hypopyon without unusual pain on the first postoperative day. Inflammation responded to frequent topical corticosteroids within 48 to 72 hours. CONCLUSION: Postvitrectomy hypopyon after the use of bovine thrombin may represent an immune reaction that must be differentiated from endophthalmitis. We recommend careful observation and frequent topical corticosteroids.


Assuntos
Câmara Anterior/efeitos dos fármacos , Complicações Pós-Operatórias/induzido quimicamente , Perfurações Retinianas/tratamento farmacológico , Trombina/efeitos adversos , Terapia Trombolítica , Adulto , Animais , Câmara Anterior/patologia , Anti-Inflamatórios/uso terapêutico , Bovinos , Quimioterapia Combinada , Fibrinogênio/uso terapêutico , Humanos , Masculino , Soluções Oftálmicas , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/patologia , Perfurações Retinianas/cirurgia , Esteroides , Supuração/induzido quimicamente , Supuração/tratamento farmacológico , Supuração/patologia , Trombina/uso terapêutico , Vitrectomia , Corpo Vítreo
18.
Retina ; 16(2): 135-8, 1996.
Artigo em Inglês | MEDLINE | ID: mdl-8724958

RESUMO

PURPOSE: The authors report the clinicopathologic features of a recurrent retinoblastoma after radioactive iodine 125 (125l) plaque therapy. METHODS: The clinical and histopathologic findings of a 1-year-old boy with a recurrent retinoblastoma after 125l radioactive plaque application were reviewed. The patient's enucleated right eye was processed for routine histologic evaluation. Immunostains for glial fibrillary acid protein and S-100 protein were performed. RESULTS: Examination of the enucleated eye revealed a retinal tumor composed of two populations of cells. One population consisted of poorly differentiated cells, and the second population at the base of the tumor contained well-differentiated cells with numerous fleurettes. Immunohistochemical stains were positive for glial fibrillary acid protein and S-100 protein in the well-differentiated portion of the tumor. CONCLUSION: This case illustrates a recurrent retinoblastoma that may have arisen from radioresistant well-differentiated cells after 125l plaque therapy.


Assuntos
Braquiterapia , Neoplasias Oculares/radioterapia , Radioisótopos do Iodo/uso terapêutico , Recidiva Local de Neoplasia , Retinoblastoma/radioterapia , Neoplasias Oculares/diagnóstico por imagem , Neoplasias Oculares/patologia , Humanos , Lactente , Masculino , Recidiva Local de Neoplasia/diagnóstico por imagem , Recidiva Local de Neoplasia/patologia , Retinoblastoma/diagnóstico por imagem , Retinoblastoma/patologia , Ultrassonografia
19.
Invest Ophthalmol Vis Sci ; 36(9): 1893-903, 1995 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-7543465

RESUMO

PURPOSE: To determine the in vitro permeability of human sclera to compounds varying in molecular weight. To evaluate the effects of age, cryotherapy, transscleral diode laser, and surgical thinning on scleral permeability. METHODS: Scleral tissue from 97 human eye bank eyes was tested individually in a two-chamber Ussing apparatus with the following hydrophilic radiolabeled compounds on one side of the chamber: 5-fluorouracil, sucrose, dexamethasone, methotrexate, inulin, and three separate dextran polymers (MWt = 10,000, 40,000, and 70,000). Scleral hydration levels were obtained on 20 more scleral specimens. Additional groups of scleral specimens were treated with either a cryotherapy probe, a transscleral diode laser retinopexy probe, or partial thickness lamellar dissection, and specimens were mounted in the Ussing chambers for testing. Scleral tissue was digested to measure the amount of radioactivity present. Scleral sections were examined with electron microscopy. RESULTS: Scleral hydration was maintained during the perfusion. The mean scleral permeability (cm/second x 10(-6) +/- SD) was established for each of the above compounds. Age, cryotherapy, or diode laser treatment did not alter permeability or ultrastructure of the sclera. Surgical thinning significantly increased the scleral permeability to dexamethasone (P = 0.011) and methotrexate (P = 0.037). CONCLUSION: This study establishes baseline human scleral permeability to a series of hydrophilic compounds with various molecular weights. Age, cryotherapy, and diode laser treatment do not alter the permeability or ultrastructure of the sclera, whereas surgical thinning significantly increases permeability.


Assuntos
Envelhecimento/metabolismo , Criocirurgia , Terapia a Laser , Farmacocinética , Esclera/metabolismo , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Água Corporal , Criança , Pré-Escolar , Dextranos/química , Dextranos/farmacocinética , Fluoruracila/química , Fluoruracila/farmacocinética , Humanos , Lactente , Recém-Nascido , Inulina/química , Inulina/farmacocinética , Pessoa de Meia-Idade , Peso Molecular , Permeabilidade , Esclera/cirurgia , Esclera/ultraestrutura , Sacarose/química , Sacarose/farmacocinética
20.
Infect Dis Obstet Gynecol ; 2(5): 228-30, 1995.
Artigo em Inglês | MEDLINE | ID: mdl-18475398

RESUMO

BACKGROUND: Candidal retinitis is a rare but potentially devastating infection in the postoperative patient. Due to the possibility of blindness if the diagnosis and treatment are delayed, we present this report to help educate gynecologic surgeons. CASE: A postmenopausal patient presented for the treatment of ovarian carcinoma. Her surgical therapy required radical tumor debulking with partial bowel resection. The patient was begun on intravenous (IV) hyperalimentation through a central venous catheter. On the 7th postoperative day, a cephalosporin antibiotic was administered. Because of persistent fever, a septic workup was instituted and revealed an infected central venous catheter that was culture positive for Candida albicans. The patient complained of visual disturbances and an ophthalmological examination revealed candidal retinitis. Amphotericin B and fluconazole were administered with resolution of her fever and visual changes. CONCLUSION: The risk factors of malignancy, abdominopelvic surgery, antibiotic therapy, and IV catheters are discussed. In view of the common association of these iatrogenic factors in gynecologic and obstetrical practice, we present this case to help make physicians aware of this potentially devastating infection.

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