RESUMO
Neovascular glaucoma (NVG) is a devastating secondary glaucoma characterized by the appearance of neovascular over the iris and the proliferation of fibrovascular tissue in the anterior chamber angle. Proliferative diabetic retinopathy (PDR) is one of the leading causes of NVG. Currently increasing diabetes population drive the prevalence rate of NVG into a fast-rising lane. The pathogenesis underlying NVG makes it refractory to routine management for other types of glaucoma in clinical practice. The combination of panretinal photocoagulation (PRP), anti-vascular endothelial growth factor (VEGF) injections, anti-glaucoma drugs, surgical intervention as well as blood glucose control is needed. Early diagnosis and aggressive treatment in time are crucial in halting the neovascularization process and preserving vision. This review provides an overview of NVG secondary to diabetic retinopathy (DR), including the epidemiology, pathogenesis and management, so as to provide a better understanding as well as potential therapeutic strategies for future treatment.
Assuntos
Diabetes Mellitus , Retinopatia Diabética , Glaucoma Neovascular , Humanos , Retinopatia Diabética/epidemiologia , Retinopatia Diabética/etiologia , Retinopatia Diabética/terapia , Fator A de Crescimento do Endotélio Vascular , Glaucoma Neovascular/epidemiologia , Glaucoma Neovascular/etiologia , Glaucoma Neovascular/terapia , Fotocoagulação a Laser , Retina , Diabetes Mellitus/terapiaRESUMO
This retrospective study evaluated changes in the central retinal thickness (CRT) and the risk factors for neovascular glaucoma (NVG) after intravitreal bevacizumab injection under a pro re nata (PRN) regimen for macular oedema in 57 eyes with central retinal vein occlusion (CRVO). The clinical characteristics at the time of NVG diagnosis were assessed, and baseline and final clinical characteristics and mean CRT values at 1-, 3-, and 6-month follow-up evaluations were recorded. The incidence of NVG was 21.1%, with the neovascular group (12 eyes) showing poor baseline and final visual acuity, a higher incidence of baseline ischaemic-type CRVO and subretinal fluid, a higher mean CRT at the 1-month follow-up, and a higher number of intravitreal bevacizumab injections during the 6-month follow-up. Nine eyes with NVG (75%) showed a mean CRT < 300 µm at the time of diagnosis. An ischaemic CRVO and higher CRT at the 1-month follow-up were related to the development of NVG in the multivariate analysis. Thus, NVG development in CRVO patients treated with intravitreal bevacizumab injections was associated with an ischaemic CRVO and elevated CRT at the 1-month follow-up; PRN bevacizumab regimens based on CRT or control of macular oedema did not completely prevent NVG development.
Assuntos
Inibidores da Angiogênese/uso terapêutico , Bevacizumab/uso terapêutico , Glaucoma Neovascular/epidemiologia , Edema Macular/tratamento farmacológico , Oclusão da Veia Retiniana/terapia , Idoso , Inibidores da Angiogênese/administração & dosagem , Bevacizumab/administração & dosagem , Feminino , Humanos , Injeções Intravítreas , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidoresRESUMO
PURPOSE: To report the clinical profile and visual impairment in various stages of neovascular glaucoma (NVG) at a tertiary eye center in East India. METHODS: The electronic medical records of the hospital database of patients with neovascular glaucoma seen between 2013 and 2020 were reviewed. Gonioscopic details were used to stratify patients into nonspecified NVG (Group 1), open-angle NVG (Group 2), and closed-angle NVG (Group 3). The clinical profile, angle features, cause of NVG, systemic associations, visual impairment, and blindness (defined as logarithm of the minimum angle of resolution, LogMar >1.3 at baseline and at final follow-up), and outcomes of medical/surgical interventions were compared between the three groups. RESULTS: Of 846 eyes of 810 patients with NVG (Group 1, n = 564 eyes, Group 2, n = 61 eyes, and Group 3, n = 220 eyes), at baseline, the blindness rates in Groups 3 and 2 were 90 and 75%, respectively. The time from a previous intervention to the onset of NVG ranged from 3 to 5 months, while the median duration of NVG was about 4-4.5 months (0.03-120 months). Multivariate regression identified a longer duration of NVG as the only variable associated with poor final visual acuity. CONCLUSION: Visual morbidity by NVG remains as high as 75-90% in developing countries, even with the availability of anti-VEGFs and after improved management/investigative at all stages.
Assuntos
Glaucoma Neovascular , Bevacizumab , Olho , Glaucoma Neovascular/diagnóstico , Glaucoma Neovascular/tratamento farmacológico , Glaucoma Neovascular/epidemiologia , Humanos , Pressão Intraocular , Fator A de Crescimento do Endotélio VascularRESUMO
PURPOSE: To compare the disease characteristics and treatment outcomes of patients with neovascular glaucoma (NVG) presenting with visual acuity (VA) 6/60 or better in two different health systems. METHODS: Retrospective chart review of consecutive patients with NVG who presented between January 2016 to January 2018 in 5 tertiary-centres in India and one eye-specialist centre in London (UK) was performed. The baseline characteristics, treatment provisions, and visual outcomes in the India and UK cohorts were compared. RESULTS: At presentation, 18% (83 of 451) and 22% (59 of 270) of patients with NVG had VA 6/60 or better in India and the UK cohorts, respectively. The aetiologies of NVG were similar with proliferative diabetic retinopathy being the most common cause (60.9%, India; 64.4%, UK; p = 0.38). Previous panretinal photocoagulation was more prevalent in the UK cohort compared to the India cohort (94.9% versus 66.3%, respectively; p < 0.001). The mean number of intravitreal anti-VEGF injections per eye was higher in the Indian cohort (1.65 ± 0.97 versus 1.14 ± 1.02 injections; p < 0.001). The number of eyes with closed angles (36.9% India versus 30.5% UK; p = 0.45) and the number of eyes needing glaucoma interventions (52.1% India; 62.7% UK; p = 0.82) were similar in two cohorts. Among glaucoma surgeries, trabeculectomies were more commonly performed in the Indian cohort (23 vs 4; p < 0.001),while glaucoma drainage device surgeries were more prevalent in the UK cohort (18 vs 4 p < 0.001). After a median follow-up of 21 months (IQR 8.4-34.8 India; 24-36 months UK), favourable visual outcomes (vision stable or improved) were similar in both health systems (52.5% in the Indian cohort vs 43.4% in the UK cohort; p = 0.28). On multivariate regression analysis, the need for trans-scleral cyclophotocoagulation was associated with worse visual outcomes in both cohorts. CONCLUSIONS: The causes and clinical profile of neovascular glaucoma with presenting visual acuity 6/60 or better in India and the UK were similar. Only up to 50% of eyes achieved favourable visual outcomes with current management protocols in both health systems.
Assuntos
Glaucoma Neovascular , Inibidores da Angiogênese/uso terapêutico , Bevacizumab/uso terapêutico , Glaucoma Neovascular/diagnóstico , Glaucoma Neovascular/epidemiologia , Glaucoma Neovascular/etiologia , Humanos , Índia/epidemiologia , Pressão Intraocular , Estudos RetrospectivosRESUMO
OBJECTIVE: The incidence and risk factors of neovascular glaucoma (NVG) secondary proliferative diabetic retinopathy (PDR) after pars plana vitrectomy (PPV) are unclear and reports in the published literature are inconsistent. Therefore, a systematic review and meta-analysis were conducted to clarify the risk factors associated with neovascular glaucoma. METHODS: PubMed, Embase, and The Cochrane Library were systematically searched without language limitations for studies related to NVG after PPV in PDR patients. We used R software to fit the correlation between incidence and the date of publication for studies and performed a Spearman analysis. For binary and continuous variables, the odds ratios (ORs) with 95% confidence intervals (CIs) were pooled, respectively, using Review Manager 5.3 (The Cochrane Collaboration). RESULTS: Twenty-six studies with 5161 patients were included in our meta-analysis. The overall pooled incidence of NVG after PPV in PDR patients was 6% (95% CI, 0.05-0.07, p-value < 0.00001). Pooled estimates indicated a positive correlation for NVG after PPV in PDR patients with higher baseline IOP (OR, 1.26; 95%CI,0.56-1.95, p-value = 0.0004), preoperative iris neovascularization (INV) (OR, 5.66; 95% CI, 2.10-15.23, p-value = 0.0006), preoperative or intraoperative combined cataract surgery (OR, 2.00; 95% CI, 1.15-3.46, p-value = 0.01), postoperative vitreous hemorrhage (VH) (OR, 3.53; 95% CI, 1.63-7.66, p-value = 0.001), and a negative correlation with age (OR, -2.90; 95%CI, -5.00 to -0.81, p-value < 0.007). CONCLUSION: Our systematic review and meta-analysis indicated that the main risk factors for NVG after PPV in PDR patients included higher baseline IOP, preoperative INV, preoperative or intraoperative combined cataract surgery, postoperative VH, and was negatively correlated with age.
Assuntos
Diabetes Mellitus , Retinopatia Diabética , Glaucoma Neovascular , Retinopatia Diabética/epidemiologia , Retinopatia Diabética/cirurgia , Glaucoma Neovascular/epidemiologia , Glaucoma Neovascular/etiologia , Glaucoma Neovascular/cirurgia , Humanos , Incidência , Fatores de Risco , VitrectomiaRESUMO
INTRODUCTION: Systemic lupus erythematosus (SLE) is a multisystem, chronic, autoimmune disease which can affect any organ system including the eye. About one-third of the patients can be diagnosed with SLE-related eye involvement which is usually indicative of disease activity. Retinopathy is one of the most vision-threatening complications that can be associated with the disease. PATIENT CONCERNS: An 11-year-old girl was hospitalized with complains of repeated swelling and pain in her extremities for 1 month, chest pain for 24 days, rash for 5 days and proteinuria for 1 day. On the morning of her fourth day in hospital, she suddenly complained of sudden, painless vision loss in the left eye. The ophthalmologist found that she had obstruction of central retinal vein and artery with diffuse retinal hemorrhages and macular edema. DIAGNOSIS: The patient was diagnosed with systemic lupus erythematosus, lupus nephritis, and lupus retinopathy through her clinical manifestations and laboratory tests. INTERVENTIONS: After diagnosis, she received steroid therapy, retinal laser photocoagulation, and intravitreal injection of dexamethasone (OZURDEX, Allergan Pharmaceuticals, Dublin, Ireland) early in her course. OUTCOMES: At the latest follow-up, her vision improved partially. However, she still has the possibility of subsequent neovascular glaucoma and bleeding in the future. CONCLUSIONS: An early diagnosis and the prompt therapeutic measures are necessary to prevent sight-threatening consequences, especially in pediatric patients with SLE.
Assuntos
Lúpus Eritematoso Sistêmico/complicações , Doenças Retinianas/etiologia , Doenças Retinianas/terapia , Transtornos da Visão/etiologia , Criança , Dexametasona/administração & dosagem , Dexametasona/uso terapêutico , Feminino , Glaucoma Neovascular/epidemiologia , Glaucoma Neovascular/etiologia , Glucocorticoides/administração & dosagem , Glucocorticoides/uso terapêutico , Hemorragia , Humanos , Injeções Intravítreas , Fotocoagulação a Laser/métodos , Lúpus Eritematoso Sistêmico/diagnóstico , Lúpus Eritematoso Sistêmico/patologia , Nefrite Lúpica/complicações , Nefrite Lúpica/diagnóstico , Edema Macular , Oclusão da Artéria Retiniana/diagnóstico , Oclusão da Artéria Retiniana/etiologia , Doenças Retinianas/patologia , Oclusão da Veia Retiniana/diagnóstico , Oclusão da Veia Retiniana/etiologia , Resultado do TratamentoRESUMO
Purpose: To assess the clinical effects of preoperative, intraoperative, or preoperative combined with intraoperative intravitreal conbercept (IVC) injection in vitrectomy with silicone oil tamponade for severe proliferative diabetic retinopathy (PDR). Methods: Ninety-eight eyes of 98 severe PDR patients undergoing vitrectomy with silicone oil tamponade were randomly assigned to 3 groups: Group 1 (34 eyes) received IVC injections 3 to 5 days before surgery; Group 2 (35 eyes) received IVC injections at the end of surgery; and Group 3 (29 eyes) received IVC injections 3 to 5 days before and at the end of operation. Follow-up examinations were performed for 6 months. Results: The incidence and severity of intraoperative bleeding were not significantly different (P = 0.233). However, the duration of surgery was significantly shorter in Group 1 and Group 3 compared with Group 2 (P < 0.001). The incidences of early and late recurrent vitreous hemorrhage (VH) were 32.35%, 28.57%, and 13.80%, respectively. At 6-month follow-up, mean best-corrected visual acuity had significantly increased to 1.25 ± 0.45 logMAR in Group 1, 1.29 ± 0.46 logMAR in Group 2, 1.16 ± 0.44 logMAR in Group 3 (all P < 0.001). The incidence of postoperative VH, neovascular glaucoma, and retinal detachment in Group 3 was slightly lower, however, no significant differences were observed (all P > 0.05). In young patients, similar results were observed and Group 3 had better visual improvements (P = 0.037). Conclusions: Preoperative IVC injection could be a safe and effective adjunct in pars plana vitrectomy with silicone oil tamponade for severe PDR. Preoperative combined with intraoperative IVC are promising, especially in young patients.
Assuntos
Inibidores da Angiogênese/uso terapêutico , Quimioterapia Adjuvante/métodos , Retinopatia Diabética/tratamento farmacológico , Proteínas Recombinantes de Fusão/uso terapêutico , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Vitrectomia/métodos , Adulto , Idoso , Inibidores da Angiogênese/administração & dosagem , Quimioterapia Adjuvante/estatística & dados numéricos , Terapia Combinada , Retinopatia Diabética/diagnóstico , Retinopatia Diabética/cirurgia , Feminino , Seguimentos , Glaucoma Neovascular/epidemiologia , Hemorragia/epidemiologia , Humanos , Incidência , Cuidados Intraoperatórios/estatística & dados numéricos , Injeções Intravítreas , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Cuidados Pré-Operatórios/estatística & dados numéricos , Estudos Prospectivos , Proteínas Recombinantes de Fusão/administração & dosagem , Descolamento Retiniano/epidemiologia , Índice de Gravidade de Doença , Óleos de Silicone/administração & dosagem , Óleos de Silicone/uso terapêutico , Acuidade Visual/fisiologia , Hemorragia Vítrea/epidemiologiaAssuntos
Síndrome de Exfoliação/epidemiologia , Glaucoma de Ângulo Fechado/epidemiologia , Glaucoma Neovascular/epidemiologia , Glaucoma de Ângulo Aberto/epidemiologia , Hipertensão Ocular/epidemiologia , Centros de Atenção Terciária/estatística & dados numéricos , Adulto , Idoso , Anti-Hipertensivos/uso terapêutico , Síndrome de Exfoliação/diagnóstico , Síndrome de Exfoliação/terapia , Feminino , Cirurgia Filtrante , Glaucoma de Ângulo Fechado/diagnóstico , Glaucoma de Ângulo Fechado/terapia , Glaucoma Neovascular/diagnóstico , Glaucoma Neovascular/terapia , Glaucoma de Ângulo Aberto/diagnóstico , Glaucoma de Ângulo Aberto/terapia , Humanos , Pressão Intraocular , Masculino , Pessoa de Meia-Idade , Hipertensão Ocular/diagnóstico , Tonometria Ocular , Vietnã/epidemiologiaRESUMO
PURPOSE: We aimed to examine the clinical features and prognosis of ocular ischemic syndrome and to investigate the risk factors for the development of neovascular glaucoma (NVG). METHODS: The medical records from 25 patients (25 eyes) who were diagnosed with ocular ischemic syndrome were retrospectively analyzed. We recorded the length of time between symptom onset and diagnosis, visual acuity, intraocular pressure, clinical findings of the anterior and posterior segments of the eye, fluorescein angiography, systemic diseases, smoking history, and the extent of any ipsilateral carotid artery stenosis. The risk factors for NVG in patients with ocular ischemic syndrome were investigated. RESULTS: The mean age was 67.9 ± 12.5 years, and 21 men and 4 women were included in this study. At initial examination, the mean logarithm of the minimum angle of resolution (logMAR) was 2.02 ± 1.26, and the mean intraocular pressure was 21.0 ± 10.3 mmHg. Among 25 eyes of the 25 patients, NVG occurred in 17 eyes after a mean period of 12.6 ± 14.0 months. The length of time between symptom onset and diagnosis (p = 0.025) and the extent of ipsilateral carotid artery stenosis (p = 0.032) were identified as significant risk factors for NVG. At the final follow-up, the mean logMAR visual acuity was 3.13 ± 1.24, showing a poor prognosis regardless of whether NVG occurred. CONCLUSIONS: Overall, the prognosis for ocular ischemic syndrome is very poor. The risk of NVG increases with the length of time between symptom onset and diagnosis, as well as with the severity of ipsilateral carotid artery stenosis.
Assuntos
Olho/irrigação sanguínea , Glaucoma Neovascular/etiologia , Pressão Intraocular , Isquemia/complicações , Medição de Risco , Idoso , Feminino , Angiofluoresceinografia , Seguimentos , Fundo de Olho , Glaucoma Neovascular/epidemiologia , Glaucoma Neovascular/fisiopatologia , Humanos , Incidência , Isquemia/diagnóstico , Masculino , Prognóstico , República da Coreia/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Síndrome , Acuidade VisualRESUMO
BACKGROUND: The purpose of this study is to report the prevalence, etiology, treatment and outcomes of neovascular glaucoma (NVG) in a tertiary care ophthalmic center in China. METHODS: Medical records of patients diagnosed as NVG at the Wenzhou Medical University between 2003 and 2014 were reviewed. Success was defined as IOP between 6 and 21 mmHg without topical or systemic glaucoma medications with retention of presenting visual acuity (VA). RESULTS: NVG was diagnosed in 483 of 8306 (5.8%) of all glaucoma patients. Etiology is reported for all 310 eyes of 284 patients managed in the department. Interventions depended on insurance as well as personal finances; outcomes are reported for the 149 eyes of 138 patients with complete data that met follow up requirements. Diabetic retinopathy (DR,39.7%) was the major cause of NVG. Kaplan Meier survival analysis showed a success rate of 84.8% at 1 year, 47.5% at 3 years and 21.9% at 5 years. Major interventions included glaucoma drainage device (GDD) in 103 eyes and trans-scleral cyclophotocoagulation (TSCPC) in 22 eyes. Complications were more common in the GDD group. CONCLUSIONS: NVG comprised 5.8% of glaucoma patients seen in a tertiary Chinese hospital. DR was identified as the commonest cause and probably reflects the increasing prevalence of diabetes in China. Surgical interventions were partly determined by insurance status and personal finances. GDD was the commonest surgical intervention used and also had the most complications.
Assuntos
Glaucoma Neovascular/epidemiologia , Centros de Atenção Terciária/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Extração de Catarata , Criança , China/epidemiologia , Corpo Ciliar/cirurgia , Feminino , Implantes para Drenagem de Glaucoma , Glaucoma Neovascular/etiologia , Glaucoma Neovascular/terapia , Humanos , Fotocoagulação a Laser , Masculino , Pessoa de Meia-Idade , Oftalmologia/estatística & dados numéricos , Prevalência , Estudos Retrospectivos , VitrectomiaRESUMO
PURPOSE: To present the clinical aspects and treatment outcomes of Coats disease in Saudi Arabia. METHODS: A retrospective chart review was performed of 92 patients (97 eyes) diagnosed with Coats disease at King Khalid Eye Specialist Hospital from 1983 to 2010. RESULTS: The most common presenting complaint was decreased visual acuity followed by strabismus and then leukocoria. Snellen visual acuity was 20/20 to 20/50 in 9 eyes (9%), 20/50 to 20/160 in 11 eyes (11%), 20/200-counting fingers in 29 eyes (30%), and hand motion to no light perception in 24 eyes (25%). Telangiectasia was located in the preequatorial area in 71 eyes (73%) and most commonly involved the temporal retina in 67 eyes (69%). In eyes with clear view to the fundus, quadrant involvement by telangiectasia had the following distribution: 1) quadrant (n = 36, 37%); 2) quadrants (n = 26, 27%); 3) quadrants (n = 8, 8%); and 4 quadrants (n = 15, 15%). Total retinal detachment was present at presentation in 28 eyes (29%) and neovascular glaucoma in 8 (8%). Based on the Shields classification, the eyes were Stage 1 (n = 1, 1%), Stage 2A (n = 7, 7%), Stage 2B (n = 23, 24%), Stage 3A1 (n = 26, 27%), Stage 3A2 (n = 12, 12%), Stage 3B (n = 16, 17%), Stage 4 (n = 11, 11%), and Stage 5 (n = 5, 1%). Stage 3A was the most commonly presented stage (39%). Primary management included cryotherapy (19%), laser photocoagulation (64%), intravitreal agents (9%), and surgical drainage (4%). Combination treatment was performed in 29% of eyes. Thirteen eyes (13%) were enucleated because of clinical suspicion of retinoblastoma or the presence of glaucoma. Factors that were associated with a poor visual outcome of 20/200 or worse included age less than 10 years (relative risk: 1.27), Stages 3 and 4 disease (relative risk: 1.40), presence of subretinal fluid in all 4 quadrants including the fovea (relative risk: 14.25), and initial visual acuity of 20/200 (relative risk: 6.72) or worse (P < 0.005 for all factors). CONCLUSION: Although rare, Coats disease is usually advanced at presentation and has a poor visual prognosis in the Saudi population, like in other populations. The findings of this study give validity and applicability to the Shields staging scheme, which we recommend using in clinical practice.
Assuntos
Crioterapia , Fotocoagulação a Laser , Telangiectasia Retiniana , Adolescente , Adulto , Idoso , Inibidores da Angiogênese/uso terapêutico , Criança , Pré-Escolar , Enucleação Ocular , Feminino , Glaucoma Neovascular/diagnóstico , Glaucoma Neovascular/epidemiologia , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Descolamento Retiniano/diagnóstico , Descolamento Retiniano/epidemiologia , Telangiectasia Retiniana/diagnóstico , Telangiectasia Retiniana/epidemiologia , Telangiectasia Retiniana/terapia , Estudos Retrospectivos , Arábia Saudita/epidemiologia , Estrabismo/diagnóstico , Estrabismo/epidemiologia , Resultado do Tratamento , Transtornos da Visão/diagnóstico , Transtornos da Visão/epidemiologia , Acuidade VisualRESUMO
INTRODUCTION: Neovascular glaucoma (NVG), participates in the group of secondary glaucoma causing the-increase of intraocular pressure (IOP) as a result of iridocorneal angle enclosure with the development of neovase derived from the retinal ischemic and other inflamatory diseases. PURPOSE OF THE STUDY: Is to show the incidence, etiopathogenesis, clinical development and the management of NVG by comparing the contemporary and referring literature to other clinics. METHODS: In this study there were presented the results of NVG treatment for the 2010- 2014 interval. The data processing were conducted using statistically package SPSS 22. RESULTS: In this scientific study were included 61 patients with NVG containing 4.3% of all cases with glaucoma and 14% of cases with secondary glaucoma, aged 22-79. The mean age of the patients was 60.9 year (SD + 10.6 year), 39 cases or 63.9% were of masculine gender and 22 cases or 36.1% of feminine gender, as it seems there is a differentiation with a statistical significance (X2 = 4.74, P = 0.03, therefore P < 0.05). The most frequent cause of NVG was PDR in 55 cases or 55.6% of them, then, ischemic CRVO with 11 cases or 11.1%. The most frequent complications to the NVG were hemophthalmos, cataract and absolute glaucoma. CONCLUSION: In many aspects our results were in line with the results of other authors. Therefore we should focus on the adequate treatment of ocular ischemic in time, as it is only prevention method of NVG.
Assuntos
Inibidores da Angiogênese/administração & dosagem , Glaucoma Neovascular/diagnóstico , Glaucoma Neovascular/terapia , Trabeculectomia , Adulto , Distribuição por Idade , Idoso , Albânia/epidemiologia , Feminino , Glaucoma/diagnóstico , Glaucoma/terapia , Glaucoma Neovascular/epidemiologia , Glaucoma Neovascular/etiologia , Humanos , Incidência , Kosovo/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Distribuição por Sexo , Trabeculectomia/métodos , Resultado do TratamentoRESUMO
PURPOSE: To determine the long-term results of carbon ion radiation therapy (C-ion RT) in patients with choroidal melanoma, and to assess the usefulness of CT-based 2-port irradiation in reducing the risk of neovascular glaucoma (NVG). METHODS AND MATERIALS: Between January 2001 and February 2012, a total of 116 patients with locally advanced or unfavorably located choroidal melanoma received CT-based C-ion RT. Of these patients, 114 were followed up for more than 6 months and their data analyzed. The numbers of T3 and T2 patients (International Union Against Cancer [UICC], 5th edition) were 106 and 8, respectively. The total dose of C-ion RT varied from 60 to 85 GyE, with each dose given in 5 fractions. Since October 2005, 2-port therapy (51 patients) has been used in an attempt to reduce the risk of NVG. A dose-volume histogram analysis was also performed in 106 patients. RESULTS: The median follow-up was 4.6 years (range, 0.5-10.6 years). The 5-year overall survival, cause-specific survival, local control, distant metastasis-free survival, and eye retention rates were 80.4% (95% confidence interval 89.0%-71.8%), 82.2% (90.6%-73.8%), 92.8% (98.5%-87.1%), 72.1% (81.9%-62.3%), and 92.8% (98.1%-87.5%), respectively. The overall 5-year NVG incidence rate was 35.9% (25.9%-45.9%) and that of 1-port group and 2-port group were 41.6% (29.3%-54.0%) and 13.9% (3.2%-24.6%) with statistically significant difference (P<.001). The dose-volume histogram analysis showed that the average irradiated volume of the iris-ciliary body was significantly lower in the non-NVG group than in the NVG group at all dose levels, and significantly lower in the 2-port group than in the 1-port group at high dose levels. CONCLUSIONS: The long-term results of C-ion RT for choroidal melanoma are satisfactory. CT-based 2-port C-ion RT can be used to reduce the high-dose irradiated volume of the iris-ciliary body and the resulting risk of NVG.
Assuntos
Neoplasias da Coroide/radioterapia , Glaucoma Neovascular/prevenção & controle , Radioterapia com Íons Pesados/métodos , Melanoma/radioterapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Coroide/diagnóstico por imagem , Neoplasias da Coroide/mortalidade , Neoplasias da Coroide/patologia , Corpo Ciliar/efeitos da radiação , Feminino , Glaucoma Neovascular/epidemiologia , Glaucoma Neovascular/etiologia , Radioterapia com Íons Pesados/efeitos adversos , Humanos , Incidência , Iris/efeitos da radiação , Masculino , Melanoma/diagnóstico por imagem , Melanoma/mortalidade , Melanoma/patologia , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Dosagem Radioterapêutica , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Adulto JovemRESUMO
PURPOSE: To investigate whether vitreous and aqueous humor concentrations of vascular endothelial growth factor (VEGF) predict postoperative complications after vitrectomy for proliferative diabetic retinopathy (PDR). METHODS: Sixty eyes of 52 patients with PDR who underwent vitrectomy were enrolled. Vitreous and aqueous humor were obtained from eyes with PDR during primary vitrectomy and the levels of VEGF were measured using a commercial flow cytometer. Patients were followed for more than 6 months after surgery. Demographic data and both intraoperative and postoperative findings were recorded. The relationship between VEGF levels in ocular fluids and the main postoperative complications of early vitreous hemorrhage (VH) and neovascular glaucoma (NVG) occurring during follow-up was analyzed. Logistic regression analyses were performed to examine risk factors related to postoperative complications. RESULTS: Early VH occurred in 25%, and NVG occurred in 8% of 60 eyes. The vitreous levels of VEGF were significantly higher (P = 0.015) in eyes with early VH than in those without. The aqueous humor and vitreous levels of VEGF were significantly higher (P = 0.005 and P = 0.001, respectively) in eyes with NVG than in those without. Axial length was significantly shorter in eyes with early VH than in those without (P = 0.028). Multivariate logistic regression analysis showed that the higher vitreous VEGF level was associated with a risk of early VH after vitrectomy for PDR (odds ratio, 5.1; P = 0.020). CONCLUSIONS: High intraocular VEGF level at the time of primary vitrectomy in patients with PDR was identified as a significant risk factor for postoperative early VH.
Assuntos
Retinopatia Diabética , Complicações Pós-Operatórias/metabolismo , Fator A de Crescimento do Endotélio Vascular/metabolismo , Vitrectomia/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Humor Aquoso/metabolismo , Retinopatia Diabética/epidemiologia , Retinopatia Diabética/metabolismo , Retinopatia Diabética/cirurgia , Feminino , Glaucoma Neovascular/epidemiologia , Glaucoma Neovascular/metabolismo , Humanos , Hipertensão/epidemiologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Valor Preditivo dos Testes , Prevalência , Fatores de Risco , Resultado do Tratamento , Corpo Vítreo/metabolismo , Hemorragia Vítrea/epidemiologia , Hemorragia Vítrea/metabolismoRESUMO
Entre las enfermedades oculares, el glaucoma, está contemplado entre aquellas que más cambios han sufrido en muchos de sus variados aspectos con el decursar de los años. Objetivo: Describir el comportamiento clínico epidemiológico del glaucoma neovascular en el Servicio de Glaucoma del Centro Oftalmológico Carlos J Finlay de la provincia de Camagüey. Método: Se realizó un estudio descriptivo, longitudinal y retrospectivo para determinar el comportamiento clínico epidemiológico del glaucoma neovascular en pacientes atendidos en dicho centro durante el período del 1 de enero del 2006 al 31 de octubre del 2007. El universo estuvo constituido por sesenta pacientes y la muestra quedó constituida por cincuenta y dos de ellos. Las variables estudiadas fueron: grupos de edades, sexo, color de la piel, antecedentes patológicos personales generales, antecedentes patológicos personales oculares, síntomas, signos, agudeza visual y variantes de tratamiento en cada paciente. Resultados: Se encontraron un total de cincuenta y dos pacientes con glaucoma neovascular. Predominaron el grupo de edades de más de 60 años, el sexo masculino y la raza blanca. Primó la Diabetes Mellitus como antecedente patológico personal general y la Retinopatía Diabética como antecedente patológico ocular. Conclusiones: El glaucoma neovascular ocupa un lugar importante dentro de la oftalmología, si se tiene en cuenta sus fatales consecuencias oculares, se expone la descripción de sus características.
Among the ocular diseases, glaucoma is considered among those that more changes have suffered in many of its varied aspects with the course of the years. Objective: To describe the clinical epidemic behavior of the neovascular glaucoma in the Glaucoma Service at the Ophthalmologic Center Carlos J Finlay" of Camagüey province. Method: A descriptive, longitudinal and retrospective study was conducted to determine the clinical epidemic behavior of the neovascular glaucoma in patients attended in the Glaucoma Service at the Ophthalmologic Center Carlos J. Finlay of Camagüey province from January 1st, 2006 to October 31st, 2007. The universe was constituted by sixty patients and the sample was conformed by fifty-two of them. The studied variables were: age groups, sex, skin color, general personal pathological antecedents, ocular personal pathological antecedents, symptoms, signs and visual acuity and treatment variants in each patient. Results: A total of fifty-two patients with neovascular glaucoma were found. The age group of more than 60 years, the masculine sex and the white race prevailed. Diabetes mellitus as general personal pathological antecedent and diabetic retinopathy as ocular pathological antecedent predominated. Conclusions: The neovascular glaucoma occupies an important place in ophthalmology, if it is take into account its ocular fatal consequences; the description of its characteristics is exposed.
Assuntos
Humanos , Oftalmopatias , Glaucoma Neovascular/diagnóstico , Glaucoma Neovascular/epidemiologia , Epidemiologia Descritiva , Estudos Longitudinais , Estudos RetrospectivosRESUMO
OBJECTIVES: To determine the prevalence and the various types of glaucoma in a Black urban Cameroonian population. MATERIAL AND METHOD: A retrospective analysis of 1,343 glaucomatous patients' files (757 men and 586 women) from a total of 24,462 Cameroonian patients of all ages was carried out from January 1991 to December 2001 in the Douala General Hospital in Cameroon in Central Africa. RESULTS: The prevalence of glaucoma of all types is 5.5%. It increases with age. Of subjects with glaucoma, 79.6% had not been previously diagnosed. The mean patient's age is 53.3 (+/-17.1) years. The mean intraocular pressure is 29.6 (+/-12.6) mmHg. The mean vertical cup-disc ratio is 0.7 (+/-0.2). The prevalence of primary glaucoma of any type is 4.5%. The overall prevalence of primary open-angle glaucoma, primary angle-closure glaucoma and congenital glaucoma was 4.3%, 0.03% and 0.07%, respectively. The normal-tension glaucoma is rare in this study (6.3% of primary open-angle glaucoma).The most common form of primary angle closure glaucoma is chronic angle closure glaucoma (61,1%) and is usually undiagnosed due to a lack of gonioscopic evaluation. The prevalence of secondary glaucoma of any type is 1%. The most common forms of secondary angle closure glaucoma were neovascular glaucoma (47.4% of cases with the prevalence of 0.5%) and post-traumatic glaucoma (23.1% of cases with the prevalence of 0.2%). Prevalence of bilateral and monocular blindness due to glaucoma is 8% (108/1,343) and 32.9% (441/1,343) respectively of glaucoma patients. CONCLUSION: This study confirms the high prevalence of glaucoma in a black African population. Gonioscopy is an important diagnostic tool that should be promoted to guide more effective glaucoma treatment in our region. The very high rate of blindness among the glaucoma patients in Cameroon is due to a lack of care. The patients are young, the disease is advanced, and compliance and follow-up are poor. Glaucoma surgery therefore offers a favourable option from an economical standpoint. Glaucoma is a devastating disease and constitutes a significant public health problem.
Assuntos
Glaucoma/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Cegueira/epidemiologia , Camarões/epidemiologia , Criança , Pré-Escolar , Feminino , Glaucoma/classificação , Glaucoma/congênito , Glaucoma de Ângulo Fechado/epidemiologia , Glaucoma Neovascular/epidemiologia , Glaucoma de Ângulo Aberto/epidemiologia , Humanos , Lactente , Pressão Intraocular , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Saúde da População Urbana/estatística & dados numéricosRESUMO
OBJECTIVE: To investigate the incidence and clinical findings of radiation retinopathy after single-fraction high-dose gamma knife radiosurgery for choroidal melanoma. DESIGN: Retrospective noncomparative interventional case series. PARTICIPANTS: Thirty-two patients with choroidal melanoma. METHODS: Review of charts, color fundus photographs, and fluorescein angiograms of 32 choroidal melanoma patients after radiosurgery. All patients were treated with the Leksell gamma knife in one fraction with a marginal dose between 40 and 80 Gy (median, 50 Gy) and were followed for at least 24 months (or until enucleation because of complications secondary to radiation). MAIN OUTCOME MEASURES: Any clinical feature of radiation retinopathy and neovascular glaucoma. RESULTS: During a mean follow-up of 38 months (range, 6-81 months) we found radiation retinopathy in 84% of our patients. The most common findings in these patients were intraretinal hemorrhages with an incidence of 70%, macular edema and capillary nonperfusion in 63%, and hard exudates in 52% of the patients. Less common were microaneurysms in 30% and retinal neovascularization in 22%. The time of onset of the various radiation-associated retinal findings ranged between 1 and 22 months. Forty-seven percent of all patients developed neovascular glaucoma. In our study there was no correlation between radiation dosage applied and clinical findings. CONCLUSIONS: Single-fraction high-dose Leksell gamma knife radiosurgery of choroidal melanomas with a median marginal dose of 50 Gy is highly associated with early radiation retinopathy and with neovascular glaucoma.
Assuntos
Neoplasias da Coroide/cirurgia , Melanoma/cirurgia , Lesões por Radiação/etiologia , Radiocirurgia/efeitos adversos , Retina/efeitos da radiação , Doenças Retinianas/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Angiofluoresceinografia , Seguimentos , Glaucoma Neovascular/epidemiologia , Glaucoma Neovascular/etiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Lesões por Radiação/epidemiologia , Doenças Retinianas/epidemiologia , Estudos RetrospectivosRESUMO
BACKGROUND: Iris rubeosis and neovascular glaucoma (NVG) are serious complications of vitrectomy for proliferative diabetic retinopathy. The present study analyzes incidence and risk factors of these complications. METHODS: Preoperative and postoperative iris rubeosis were compared in 389 diabetic eyes after vitrectomy. Minimum follow-up was 6 months (median 26 months). Risk factors were studied using multivariate logistic regression analysis. RESULTS: Following vitrectomy, in 8.5% of the eyes stromal iris rubeosis developed de novo; NVG occurred in 5%. Significant risk factors for postoperative rubeosis were preexisting iris neovascularizations and postoperative retinal detachment. Six months after surgery, regression of preexisting iris rubeosis was observed in 57% of the eyes. In eyes without preoperative iris rubeosis, progression was found in 13% of cases 6 months postoperatively. CONCLUSION: With current surgical techniques iris rubeosis is more commonly regressive than progressive after vitreous surgery in diabetic eyes.
Assuntos
Retinopatia Diabética/cirurgia , Doenças da Íris/etiologia , Complicações Pós-Operatórias , Vitrectomia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Glaucoma Neovascular/epidemiologia , Glaucoma Neovascular/etiologia , Humanos , Incidência , Iris/irrigação sanguínea , Doenças da Íris/epidemiologia , Masculino , Pessoa de Meia-Idade , Neovascularização Patológica/complicações , Fatores de RiscoRESUMO
Objetivo: Avaliar as causas de glaucoma neovascular (GNV), bem como os fatores que influenciam prognóstico e o resultado do tratamento efetuado. Métodos: Estudou-se retrospectivamente um grupo de 38 pacientes com diagnóstcos de GNV atendidos consecutivamentes no setor de Glaucoma da UNICAMP entre setembro de 1996 e março de 1997. Resultados: A principal causa de GNV encontrada foi retinopatia diabética proliferativa (RDP)em 18 pacientes (47,4 por cento), seguida de oclusäo da veia central de retina (OVCR) em 14 (36,8 por cento). O único fator progóstico positivamente correlacionado à acuidade visual final foi a acuidade visual inicial (p=0,004). Näo houve associaçäo entre pressäo intraocular (PIO) inicial e acuidade visual final, nem tampouco entre extensäo de goniossinéquias e acuidade visual final(p>0,05). Entre os 38 pacientes, 8(21,1por cento) foram submetidos a cirurgia, onde observamos uma diminuiçäo significativa da PIO de 39,75ñ10,99mmHg para 21,88ñ12,14mmHg(p=0,01,)5(13,1por5 cento)obtiveram reduçäo da PIO de 31,4ñ7,4mmHg para 16,0ñ4,6 mmHg graças a tratamento clínico da PIO( medicaçäo anti-glaumatosa + ablaçäo retiniana) (p=0,01).Os demais 25 pacientes (65,8 por cento) näo apresentavam prognóstico visual suficiente que justificasse cirurgia (acuidade visual menor ou igual a percepçäo luminosa). Ao final do período de seguimento, 71,1 por cento dos pacientes apresentaram acuidade visual pior ou igual à percepçäo de luminosa. Conclusäo: O GNV mostrou ser moléstia de difícil controle terapêutico e com prognóstico visual ruim. Na tentativa de minimizar esta evoluçäo desfavorável, propusemos um fluxograma de abordagem do paciente com GNV.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Glaucoma Neovascular/diagnóstico , Glaucoma Neovascular/epidemiologia , Glaucoma Neovascular/terapia , Pressão Intraocular , GonioscopiaRESUMO
Between 1978 and 1988, 307 patients with uveal melanoma were irradiated using helium ions at Lawrence Berkeley Laboratory. The length of follow-up ranged from 1-115 months (median 42 months). The 5-year actuarial treatment results were: local control rate, 96.8%, determinate survival rate, 81%, freedom from distant metastases, 76%, eye retention rate, 83%, and risk of developing neovascular glaucoma, 36%. Long-term vision outcome was analyzed in 81 patients with a minimum follow-up of 5 years. Forty-seven percent of patients retained vision of 20/200 or better. The median change in vision was a loss of four lines on the standard eye chart. Thirty-eight percent of patients had visual acuity either improve or remain within two lines of their pretreatment vision. A multivariate analysis identified tumor size as the only independently significant risk factor affecting survival, development of neovascular glaucoma, or the risk of enucleation; no risk factor correlated with local recurrence. Tumor size, tumor-fovea distance, and pretreatment visual acuity were independently significant risk factors influencing vision outcome. These results confirm that helium ion irradiation is an effective treatment for uveal melanoma which combines high rates of local control, survival, and eye retention with a substantial likelihood of long-term vision preservation.