الملخص
ABSTRACT Purpose: To assess tomographic ganglion cell complex changes in patients with diabetic macular edema treated with intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF). Methods: We analyzed data from 35 eyes of 35 previously untreated patients in whom diabetic macular edema improved after three loading doses of anti-VEGF injection and who did not receive repeated injections. We recorded spectral domain-optical coherence tomography assessments of ganglion cell complex and central macular thickness at baseline and monthly for three months, and on the sixth and ninth month after treatment. We compared the results with those of the unaffected eyes in the same patients and with those in a control group of patients with diabetic macular edema who were untreated. Results: The mean age of the patients in the treatment group was 60 ± 4.38 years. The foveal thicknesses measured using optical coherence tomography decreased significantly from baseline to the third month post-injection (p<0.05). The mean ganglion cell complex thickness was 115.08 ± 16.72 µm before the first injection and 101.05 ± 12.67 µm after the third injection (p<0.05). The mean ganglion cell complex was 110.04 ± 15.07 µm on the sixth month (p>0.05) and 113.12 ± 11.15 µm on the ninth month (p>0.05). We found a significant difference between the patients and the control group in terms of mean ganglion cell complex thickness on the second- and third-months post-injection (p<0.05). Conclusion: Our study showed that the ganglion cell complex thickness in patients with diabetic macular edema decreased after the anti-VEGF injections. We cannot ascertain whether the ganglion cell complex thickness decreases were due to effects of the anti-VEGF agents or to the natural disease course.
RESUMO Objetivo: Avaliar as alterações do complexo tomográfico das células ganglionares em pacientes com edema macular diabético tratados com injeções intravítreas do fator de crescimento endotelial anti-vascular (anti-VEGF). Métodos: Analisamos dados de 35 olhos de 35 pacientes previamente não tratados nos quais o edema macular diabético melhorou após três doses de injeção de anti-VEGF e que não receberam injeções repetidas. Registramos avaliações da tomografia de coerência óptica de domínio espectral do complexo de células ganglionares e da espessura macular central na linha de base e mensalmente por três meses e, também no sexto e nono mês após o tratamento. Comparamos os resultados com os olhos não afetados nos mesmos pacientes e com os de um grupo controle de pacientes com edema macular diabético que não foram tratados. Resultados: A média da idade dos pacientes no grupo de tratamento foi de 60 ± 4,38 anos. As espessuras foveais medidas pela tomografia de coerência óptica diminuiram significativamente desde o início até o terceiro mês após a injeção (p<0,05). A espessura média do complexo de células ganglionares foi de 115,08 ± 16,72 µm antes da primeira injeção e 101,05 ± 12,67 µm após a terceira injeção (p<0,05). A média do complexo de célula ganglionar foi de 110,04 ± 15,07 µm no sexto mês (p>0,05) e 113,12 ± 11,15 µm no nono mês (p>0,05). Encontramos uma diferença significativa entre os pacientes e o grupo controle quanto à média da espessura do complexo de células ganglionares no segundo e terceiro meses após a injeção (p<0,05). Conclusão: Nosso estudo mostrou que a espessura do complexo de células ganglionares em pacientes com edema macular diabético diminuiu após as injeções de anti-VEGF. Não podemos determinar se a diminuição da espessura do complexo de células ganglionares ocorreu devido aos efeitos dos agentes anti-VEGF ou ao curso natural da doença.
الموضوعات
Humans , Middle Aged , Macular Edema , Angiogenesis Inhibitors , Vascular Endothelial Growth Factor A , Diabetes Mellitus , Diabetic Retinopathy , Visual Acuity , Macular Edema/drug therapy , Macular Edema/diagnostic imaging , Treatment Outcome , Angiogenesis Inhibitors/therapeutic use , Vascular Endothelial Growth Factor A/antagonists & inhibitors , Tomography, Optical Coherence , Diabetic Retinopathy/drug therapy , Diabetic Retinopathy/diagnostic imaging , Intravitreal Injections , Bevacizumab/therapeutic useالملخص
INTRODUCTION: The incidence of cystoid macular edema (CME) after cataract surgery varies substantially and depending on the diagnostic method used. In addition, other factors that influence the incidence of CME are the technique of surgery and the associated comorbidities. OBJECTIVE: The aim of the present study was to evaluate the incidence of EMC after uncomplicated phacoemulsification surgery, using the spectral domain optical coherence tomography (OCT). METHODS: The incidence of subclinical and clinical CME was evaluated in 14 patients who underwent uncomplicated phacoemulsification surgery, using OCT before the surgical procedure and after seven and 28 days after it. The volunteers could not use a prostaglandin analogue or present any retinopathy that compromised visual acuity. RESULTS: The incidence of clinically significant CME was 6.4%, however retinal thickening by OCT was observed in all patients in the fourth postoperative week. Regarding gender and laterality, the percentages were similar. CONCLUSION: In this study, we obtained a low incidence of EMC in patients assisted at this center, corroborating multicenter studies.
الموضوعات
Humans , Male , Female , Postoperative Period , Cataract , Macular Edema/epidemiology , Macular Edema/diagnostic imaging , Phacoemulsification , Tomography, Optical Coherence , Visual Acuity , Eye Health Servicesالملخص
ABSTRACT Purpose: To investigate retinal microvasculature changes in patients treated with anti-VEGF for macular edema secondary to branch retinal vein occlusion. Methods: We examined 38 eyes of 19 patients for the study. We measured superficial and deep capillary plexus vessel densities (%), foveal avascular zone areas (mm2), and central macular thicknesses. Results: Parafoveal superficial and deep capillary plexus values were significantly lower in eyes with branch retinal vein occlusion than in fellow eyes (p<0.001). We found a significant increase in parafoveal deep capillary plexus values after the anti-VEGF treatment (p=0.032). The mean foveal avascular zone was larger in eyes with branch retinal vein occlusion than in control eyes (p<0.001). The mean central macular thickness was significantly higher in eyes with branch retinal vein occlusion than in controls, and we observed a significant decrease in central macular thickness after anti-VEGF treatment (<0.001). In addition, the cystic structures in the deep capillary plexus regressed. Conclusion: Optical coherence tomography angiography enables qualitative and quantitative evaluations during follow-up of patients treated for branch retinal vein occlusion.
RESUMO Objetivo: Investigar as alterações na microvascu latura da retina em pacientes tratados com anti-VEGF para ede ma macular secundário à oclusão de ramo da veia retiniana. Métodos: Foram examinados 38 olhos de 19 pacientes para o estudo. Medimos as densidades dos vasos do plexo capilar superficial e profunda (%), áreas da zona avascular foveal (mm2) e espessura macular central. Resultados: Os valores do plexo capilar superficial e profundo parafoveal foram significativamente menores nos olhos com oclusão de ramo da veia retiniana do que nos outros olhos (p<0,001). Encontramos um aumento significativo nos valores de plexo capilar profundo parafoveal após o tratamento com anti-VEGF (p=0,032). A zona avascular foveal média foi maior nos olhos com oclusão de ramo da veia retiniana do que nos olhos controle (p<0,001). A espessura macular central média foi significativamente maior nos olhos com oclusão de ramo da veia retiniana do que nos controles, e observamos uma diminuição significativa na espessura macular central após o tratamento com anti-VEGF (< 0,001). Além disso, as estruturas císticas no plexo capilar profundo regrediram. Conclusão: A angiotomografia de coerência óptica permite avaliações qualitativas e quantitativas durante o acompanhamento de pacientes tratados por oclusão de ramo da veia retiniana.
الموضوعات
Humans , Male , Female , Middle Aged , Aged , Retinal Vein Occlusion/drug therapy , Fluorescein Angiography/methods , Macular Edema/drug therapy , Angiogenesis Inhibitors/therapeutic use , Vascular Endothelial Growth Factor A/antagonists & inhibitors , Tomography, Optical Coherence/methods , Reference Values , Time Factors , Retinal Vein Occlusion/complications , Capillaries/drug effects , Capillaries/pathology , Capillaries/diagnostic imaging , Macular Edema/etiology , Macular Edema/pathology , Macular Edema/diagnostic imaging , Retrospective Studies , Statistics, Nonparametric , Macula Lutea/drug effects , Macula Lutea/pathology , Macula Lutea/diagnostic imagingالملخص
ABSTRACT Gyrate atrophy is a rare metabolic autosomal recessive disorder caused by ornithine aminotransferase enzyme deficiency that leads to characteristic progressive, degenerative chorioretinal findings. Patients complain mostly of low vision, night blindness, and peripheral vision loss. Posterior subcapsular cataract, myopia, choroid neovascularization, and intraretinal cysts may be accompanying factors related to vision loss. We encountered a patient with vision loss secondary to posterior subcapsular cataract and intraretinal cysts. After treatment with topical brinzolamide and nepafenac (and without any diet mo dification and/or supplementation), we observed 143- and 117-mm macular thickness resolutions with 2 and 1 Snellen lines of visual gain in his right and left eyes, respectively. Also, we detected a novel homozygous mutation in the ornithine aminotransferase gene: c.1253T>C (p.Leu418Pro). Carbonic anhydrase inhibitors and/or non-steroid anti-inflammatory drugs can control macular edema in patients with gyrate atrophy-associated intraretinal cysts. The genetic variants may also be a determinant in the responsiveness to the therapy type.
RESUMO A atrofia girata é um distúrbio autossômico recessivo metabólico raro causado pela deficiência da enzima ornitina ami notransferase, que leva a achados degenerativos coriorretinianos progressivos característicos. Os pacientes queixam-se principalmente de baixa visão, cegueira noturna e perda de vi são periférica. A catarata subcapsular posterior, a miopia, a neovascularização da coróide e os cistos intrarretinianos podem ser fatores associados à perda da visão. Encontramos um paciente com perda de visão secundária à catarata subcapsular posterior e cistos intrarretinianos. Após o tratamento com brinzolamida tópica e nepafenaco (e sem modificação e/ou suplementação da dieta), observamos resoluções de espessura macular de 143 e 117 mm e com 2 e 1 linhas de Snellen de ganho visual nos olhos direito e esquerdo, respectivamente. Além disso, detectamos uma nova mutação homozigótica no gene da ornitina aminotransfera se: c.1253T>C (p.Leu418Pro). Inibidores da anidrase carbônica e/ou drogas anti-inflamatórias não esteróides podem controlar o edema macular em pacientes com cistos intrarretinianos associados à atrofia girata. As variantes genéticas também podem ser determinantes na responsividade ao tipo de terapia.
الموضوعات
Humans , Male , Adult , Phenylacetates/administration & dosage , Carbonic Anhydrase Inhibitors/administration & dosage , Gyrate Atrophy/genetics , Anti-Inflammatory Agents, Non-Steroidal/administration & dosage , Macular Edema/drug therapy , Benzeneacetamides/administration & dosage , Ornithine-Oxo-Acid Transaminase/genetics , Sulfonamides/administration & dosage , Thiazines/administration & dosage , Fluorescein Angiography , Macular Edema/diagnostic imaging , Tomography, Optical Coherence , High-Throughput Nucleotide Sequencing , Administration, Ophthalmic , Mutationالملخص
Introduction: Patients with diabetic macular edema can develop fundus autofluorescence alterations; thus far, these alterations have been more widely studied with scanning or confocal laser systems. Objective: To describe and classify fundus autofluorescence abnormal patterns in patients with diabetic macular edema using the fundus autofluorescence system with a flash camera. Method: Observational, retrospective, cross-sectional, descriptive study. Fundus autofluorescence digital images of non-comparative cases with untreated diabetic macular edema, obtained and stored with a flash camera system, were assessed. Inter-observer variability was evaluated. Results: 37 eyes of 20 patients were included. Lens opacity was the most common cause of inadequate image quality. Five different fundus autofluorescence patterns were observed: decreased (13%), normal (40%), single-spot hyper-autofluorescent (17 %), multiple-spot hyper-autofluorescent (22 %) and plaque-like hyper-autofluorescent (8 %). The kappa coefficient was 0.906 (p = 0.000). Conclusions: Different fundus autofluorescence phenotypic patterns are observed with flash camera systems in patients with diabetic macular edema. A more accurate phenotypic classification could help establish prognostic factors for visual loss or for the design of clinical trials for diabetic macular edema.
الموضوعات
Humans , Male , Female , Middle Aged , Macular Edema/diagnostic imaging , Diabetic Retinopathy/diagnostic imaging , Optical Imaging/instrumentation , Optical Imaging/methods , Phenotype , Observer Variation , Macular Edema/classification , Macular Edema/etiology , Cross-Sectional Studies , Retrospective Studies , Diabetes Mellitus, Type 2/complications , Diabetic Retinopathy/classification , Diabetic Retinopathy/complications , Mexicoالملخص
Abstract We herein report a patient without risk factors who presented acute bilateral Irvine-Gass syndrome after uneventful phacoemulsification. The novelty of our case lies on the fact that the patient presented acute bilateral Irvine-Gass syndrome without a predisposing systemic disease. Even though Cystoid Macular Edema (CME) was somehow expected in the first eye because of the ocular history of trauma, prophylactic measures were not strong enough to avoid its development. Furthermore, those measures could not avoid developing CME in the second eye. A 44-years-old male who underwent cataract surgery in both eyes presented bilateral Irvine-Gass syndrome. Despite prophylactic measures, both eyes developed CME after uneventful cataract surgery. Regular treatment options could not solve the situation and intravitreal Anti-VEGF injections were needed. Bilateral cases of Irvine-Gass Syndrome are rare and generally associated with systemic risk factors. Patients who developed CME following their first cataract surgery should be counseled about the risks of developing the condition following surgery on the contralateral eye. On top of that, aggressive prophylactic measures should be encouraged to prevent CME in these cases.
Resumo Relatamos aqui um paciente sem fatores de risco que apresentou síndrome de Irvine-Gass bilateral aguda após facoemulsificação sem intercorrências. A novidade do nosso caso reside no fato de o paciente apresentar síndrome de Irvine-Gass bilateral aguda sem doença sistêmica predisponente. Embora o Edema Macular Cistoide (EMC) fosse de alguma forma esperado no primeiro olho por causa do histórico ocular de trauma, as medidas profiláticas não foram suficientemente fortes para evitar seu desenvolvimento. Além disso, essas medidas não puderam evitar o desenvolvimento de EMC no segundo olho. Homem de 44 anos submetido a cirurgia de catarata em ambos os olhos apresentou síndrome de Irvine-Gass bilateral. Apesar das medidas profiláticas, ambos os olhos desenvolveram EMC após a cirurgia de catarata sem intercorrências. As opções de tratamento regular não conseguiram resolver a situação e foram necessárias injeções intravítreas de Anti-VEGF. Casos de Síndrome de Irvine-Gass bilateral são raros e geralmente associados a fatores de risco sistêmicos. Os pacientes que desenvolveram EMC após a primeira cirurgia de catarata devem ser avisados sobre os riscos de desenvolver a doença após a cirurgia no olho contralateral. Além disso, medidas profiláticas agressivas devem ser incentivadas para evitar a EMC nesses casos.
الموضوعات
Humans , Male , Adult , Macular Edema/etiology , Phacoemulsification/adverse effects , Visual Acuity , Macular Edema/drug therapy , Macular Edema/diagnostic imaging , Lens Implantation, Intraocular , Angiogenesis Inhibitors/administration & dosage , Vascular Endothelial Growth Factor A/antagonists & inhibitors , Tomography, Optical Coherence , Intravitreal Injectionsالملخص
Resumo Objetivo: O objetivo desse trabalho é avaliar o perfil de aplicações intravítreas do Ranibizumab em uma população de adultos atendidos no Instituto Benjamin Constant, no ano de 2015, levando em consideração o efeito sobre a acuidade visual e a espessura macular após tratamento. O objetivo secundário é apresentar as principais indicações desse tipo tratamento no serviço de olhos acima citado. Métodos: Foi realizado um estudo retrospectivo seccional, em indivíduos acima de 20 anos entre os meses de março a agosto de 2015, para analisar a acuidade visual e espessura foveal pré e pós tratamento. A dose do anti-VEGF utilizada foi de 0,05ml por aplicação com intervalo de quatro semanas entre elas. A aferição da acuidade visual assim como o OCT pós tratamento foram realizados em torno de trinta dias após a última aplicação. As análises estatísticas foram feitas com uso do software SPSS versão 21 e o nível de significância estatística foi de 95% com um valor de p <0,05. Resultado: O estudo mostrou que a principal afecção relacionada a esse tratamento foi a retinopatia diabética não proliferativa associada ao edema macular (32,8%). Após o tratamento indicado com Ranibizumab, houve uma melhora da acuidade visual média de 0,70 para 0,59 (logMAR) e uma regressão da espessura macular, visto no OCT, de 408,1µm para 337,2 µm (valor de p <0,05). Conclusão: Pode-se concluir portanto, que o tratamento com Ranibizumab na população estudada contribuiu para uma melhor qualidade de vida dos pacientes, pois a maioria dele apresentou uma melhora estatisticamente significativa na acuidade visual após as aplicações.
Abstract The objective of this work is to evaluate the profile of intravitreal applications of Ranibizumab in a population of adults attended at the Benjamin Constant Institute in the year of 2015, taking into account the effect on visual acuity and macular thickness after the treatment. The secondary objective is to present the main indications of this type of treatment in the eye care mentioned above. A retrospective cross-sectional study was performed in individuals over 20 years of age between March and August of 2015 to analyze visual acuity and foveal thickness before and after treatment. The dose of anti-VEGF used was 0.05 ml per application with an interval of four weeks between them. Visual acuity assessment as well as OCT post treatment were performed around 30 days after the last application. Statistical analyses were performed using SPSS software version 21 and the level of statistical significance was of 95% with a value of p <0.05. The study showed that the main condition related to this treatment was non-proliferative diabetic retinopathy associated with macular edema (32.8%). After treatment indicated with Ranibizumab, there was an improvement in the average visual acuity from 0.70 to 0.59 (logMAR) and a regression of the macular thickness, seen in the OCT, from 408.1μm to 337.2μm (p < 0.05). It can be concluded, therefore, that treatment with Ranibizumab in the studied population contributed to a better quality of life of the patients, since most of them presented a statistically significant improvement in the visual acuity after the applications.
الموضوعات
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Macular Edema/drug therapy , Macular Edema/diagnostic imaging , Intravitreal Injections , Ranibizumab/administration & dosage , Retina/diagnostic imaging , Fluorescein Angiography , Visual Acuity , Retinal Neovascularization , Retrospective Studies , Choroidal Neovascularization , Angiogenesis Inhibitors/administration & dosage , Angiogenesis Inhibitors/therapeutic use , Angiogenesis Inhibitors/pharmacology , Vascular Endothelial Growth Factor A/antagonists & inhibitors , Tomography, Optical Coherence , Diabetic Retinopathy , Ranibizumab/therapeutic use , Ranibizumab/pharmacology , Fovea Centralis/diagnostic imaging , Macula Lutea/diagnostic imaging , Macular Degenerationالملخص
ABSTRACT Background: Systematization of characteristics and morphological changes in the retina, and understanding its role in occlusive diseases involving retinal vessels can contribute to research on the dynamic of the pathological process and to improved understanding of disease treatment. Objective: To research the basic morphometric and structural indicators of the macular region of the retina in patients with central retinal vein occlusion (CRVO). Settings and Design: Ufa Eye Research Institute, retrospective case series. Methods: The basic morphometric and structural indices of the macular region of the retina in 15 patients with CRVO were studied using the optical coherence tomography. Patients with CRVO (15 eyes) were included in Group I (study), and 10 patients with no retinal pathology (10 eyes) were included in Group II (control). Statistical analysis used: For the statistical analysis, the Statistica 6.1 program was used with a parametric method, the Student's test.To consider the probability of statistically significant differences, values beginning with up to p<0.05 were accepted. Results: In Group II, we determined the correct profile of the macula with fovea centralis and a range of retinal thickness from 221.4 ± 10.97 to 355.2 ± 12.17 µm, with an average value of - 299.01 ± 7.56 µm. In Group I mean retinal thickness at all points of the study area ranged from 247.86 ± 39.06 to 494.07 ± 40.22 µm with a gradual thickening of the periphery to the center, reaching a maximum at a distance of 893 µm from the center of the fovea. The average thickness of the retina as a result of edema increased by a multiple of 1.3 and amounted to - 386.97 ± 16.26 µm. Conclusions: The study indicated that the edema is the main morphological substrate, promoting structural changes in the central retina in retinal vein occlusion, and is cystic in nature. Increase in total retinal thickness (up to 386.97 ± 16.26 µm) in this pathology is largely due to the structural changes in zones, covering the îuter plexiform layer - the inner nuclear layer and the nerve fiber layer with the inner limiting membrane. Meanwhile a significant increase in the thickness of the outer plexiform with the inner nuclear layers (up to 94.94 ± 5.08 µm) and nerve fiber layers (up to 54.6 ± 3.26µm) was observed.
RESUMO Introdução: Sistematização característica e alterações morfológicas na retina, compreensão de sua arquitetura em doenças oclusivas de vasos retinianos para contribuir com a melhoria dos estudos sobre as regularidades da dinâmica do processo patológico, diagnóstico e tratamento da doença. Objetivo: Investigar a morfometria de base e indicadores estruturais da região macular da retina em pacientes com oclusão da veia central da retina (CRVO). Definições e design: Ufa Eye Research Institute, série de casos retrospectiva. Métodos: A análise morfométrica de base e índices estruturais da região macular da retina em quinze pacientes com CRVO. Foram estudados pacientes com CRVO (15 olhos), incluídos no Grupo I (em estudo), 10 pacientes com qualquer patologia da retina (10 olhos), incluídos no Grupo II (controle), com o uso da tomografia de coerência óptica. Para a análise estatística utilizou-se o programa Statistica 6.1 usando o método paramétrico - teste de Student. A probabilidade de diferenças estatisticamente significativas foram valores começando com até p <0,05. Resultados: No Grupo II, o perfil correcto da mácula com fovea centralis e uma gama de espessura da retina de 221,4 ± 10,97 a 355,2 ± 12,17µm, com um valor médio de - 299,01 ± 7,56 µm foram determinadas. No Grupo I, a espessura média da retina em todos os pontos da área de estudo variou de 247.86 ± 39.06 a 494,07 ± 40,22µm com um espessamento gradual da periferia para o centro, atingindo um máximo em um raio de 893µm a partir do centro da fóvea.A espessura média da retina, como resultado do edema aumentado em 1,3 vezes e elevou se a - 386,97 ± 16,26 µm. Conclusões: O estudo indicou que o edema é cístic por natureza e é o principal substrato morfológico responsável por mudanças estruturais que promovem a oclusão da veia central da retina. O aumento na espessura total da retina (de 386.97 ± 16.26 µm) nesta patologia deve-se às mudanças estruturais nas zonas que vão da camada plexiforme - nucleo interno, camada de fibras do nervo óptico e membrana limitante Foi observado ainda um aumento significativo da esessura do plexiforme externo com cas camadas nucleaes internas (de 94.94 ± 5.08 µm) e camadas de fibras do nervo óptico (de 54.6 ± 3.26µm).
الموضوعات
Humans , Male , Female , Adult , Middle Aged , Aged , Retinal Vein Occlusion/physiopathology , Retinal Vein Occlusion/pathology , Retinal Vein Occlusion/diagnostic imaging , Tomography, Optical Coherence/methods , Macula Lutea/anatomy & histology , Macula Lutea/pathology , Macular Edema/physiopathology , Macular Edema/pathology , Macular Edema/diagnostic imaging , Macula Lutea/ultrastructure , Macula Lutea/diagnostic imagingالملخص
ABSTRACT Pseudophakic cystoid macular edema (PCME) is a common complication following cataract surgery. Although majority of patients with PCME remain asymptomatic, it remains an important cause of vision loss after cataract surgery. The pathogenesis of PCME remains unclear, but most authors agree that inflammation plays a major role in its development. There is no standard algorithm for treatment procedures for PCME. A biodegradable 0.7 mg dexamethasone intravitreal implant can be used to deliver medication into the posterior segment of eyes. This drug acts on all inflammatory mediators and has been approved for the treatment of macular abnormalities secondary to retinal vein occlusion and for non-infectious posterior uveitis. In this case series, we report six patients who presented with PCME and were treated with a 0.7 mg dexamethasone intravitreal implant. Favorable anatomical outcomes were demonstrated by spectral domain-optical coherence tomography images.
RESUMO O edema macular cistóide do pseudofácico (PCME) é uma frequente complicação no acompanhamento pós-operatório da cirurgia de catarata. Embora a maioria dos pacientes apresente-se sem sintomas, PCME ainda permanece como importante causa de baixa visão após facectomia. Sua patogênese ainda permanece obscura, porém, autores sugerem que fatores que promovem maior inflamação possuem papel fundamental em sua origem. Não há um algoritmo padrão no manejo do PCME. O implante biodegradável de dexametasona 0,7 mg surgiu como possível arma terapêutica, após aplicação intra-vítrea. Essa droga consegue agir sobre mediadores inflamatórios, além de já ter sido aprovada no tratamento do edema de macula secundário à oclusões venosas da retina, e uveítes posteriores de origem não infecciosa. Na seguinte série de casos, relatamos a evolução de 6 pacientes com PCME, submetidos a terapia com implante de dexametasona 0,7 mg. A melhora anatômica foi documentada com imagens de SD OCT.
الموضوعات
Humans , Male , Female , Middle Aged , Aged , Dexamethasone/therapeutic use , Macular Edema/drug therapy , Pseudophakia/drug therapy , Anti-Inflammatory Agents/therapeutic use , Retina/physiopathology , Macular Edema/diagnostic imaging , Treatment Outcome , Pseudophakia/diagnostic imaging , Absorbable Implants , Tomography, Optical Coherence , Drug Implantsالملخص
PURPOSE: To evaluate the effects of posterior subtenon triamcinolone acetonide injection on refractory diabetic macular edema (DME) after intravitreal bevacizumab (IVB) injection failure. METHODS: Patients with DME and central subfield thickness (CST) >300 microm who did not respond to IVB injections were retrospectively included. Specifically, we enrolled patients who were diagnosed with refractory DME and who experienced an increase in CST after 1 to 2 IVB injections or no decrease after > or =3 consecutive IVB injections. One clinician injected 20 mg of triamcinolone acetonide into the posterior subtenon space. All patients received ophthalmic examinations at baseline and at 2, 4, and 6 months post-baseline. Examinations included Snellen visual acuity, intraocular pressure, and spectral-domain optical coherence tomography. RESULTS: Forty eyes of 34 patients were included. The average baseline CST was 476 microm. The average CST decreased to 368 microm at 2 months, 374 microm at 4 months, and 427 microm at 6 months (p < 0.001 for all results, Wilcoxon signed-rank test). The average intraocular pressure increased from 15.50 to 16.92 mmHg at 2 months but decreased to 16.30 mmHg at 4 months and 15.65 mmHg at 6 months. Logarithm of the minimum angle of resolution visual acuity improved from 0.56 to 0.50 at 2 months (p = 0.023), 0.50 at 4 months (p = 0.083), and 0.48 at 6 months (p = 0.133, Wilcoxon signed-rank test). No complications were detected. CONCLUSIONS: Posterior subtenon triamcinolone acetonide is an effective and safe treatment for reducing CST in DME refractory to IVB.
الموضوعات
Aged , Female , Humans , Male , Middle Aged , Angiogenesis Inhibitors/therapeutic use , Bevacizumab/therapeutic use , Diabetic Retinopathy/diagnostic imaging , Glucocorticoids/administration & dosage , Injections, Intraocular , Intraocular Pressure/physiology , Intravitreal Injections , Macular Edema/diagnostic imaging , Retrospective Studies , Tenon Capsule/drug effects , Tomography, Optical Coherence , Treatment Failure , Triamcinolone Acetonide/administration & dosage , Vascular Endothelial Growth Factor A/antagonists & inhibitors , Visual Acuity/physiologyالملخص
PURPOSE: To report a polypoidal vascular choroidopathy clinical case causing cystoid macular edema and the response to Ranibizumab intravitreal treatment. METHODS: A 62-year old caucasian woman was referred by her comprehensive ophthalmologist for retinal avaliation. On presentation best corrected visual acuity was 20/100 in the left eye and 20/20 in right eye.Anterior segment examination was unremarkable in both eyes. Clinical examination and FA on the left eye demonstrated numerous small drusen and a cystoid macular edema due leakage from any polips in justapapilar region and from polips in the superior arcade vascular region and subretinal fluid and cystic change in the OCT.The right eye had FA normal. The patient refused to submitt a ICGV angiography. The patient was treated by intravitreal ranibizumab injections in the left eye every 4 weeks, 3 injections ,three months. RESULTS: The patient showed resolution both of cystic change and subretinal fluid in the OCT, and the visual acuity in the six months follow-up improved to 20/25. The patient was followed by 18 months at this time and the visual acuity remained stable 20/25. CONCLUSION: We reported a patient case of cystoid macular edema from a polypoidal choroidal vaculopathy that responded well to ranibizumab intravitreal injection as monotheraphy with disappearance of the initial subretinal fluid and cystic change in OCT follow-up and stop the polips.
OBJETIVO: Relatar um caso de paciente com Vasculopatia coroidiana polipoidal com edema macular cistóide e a resposta ao tratamento com Ranibizumab intravítrea como monoterapia MÉTODOS: Uma paciente com 62 anos foi referida por seu oftalmologista para avaliação retiniana . Apresentava acuidade visual com correção de 20/100 no olho esquerdo e 20/20 no olho direito. A avaliação do segmento anterior era normal em ambos os olhos. No exame de fundo de olho e retinografia fluoresceínica apresentava numerosas drussas pequenas e edema macular cistóide devido a vazamentos de alguns pólipos vasculares coroidianos na arcada vascular superior e ainda fluido sub-retiniano e alteração cística no OCT . O olho direito apresentava angiografia fluoresceínica da retina e OCT normais.A paciente recusou-se a se submeter a vídeoangiografia com indocianina verde. A paciente foi tratada com injeção intravítrea de Ranibizumab como monoterapia, sendo uma injeção a cada quatro semanas, três injeções em três meses. RESULTADOS: A paciente apresentou resolução da alteração cística e do fluido sub-retiniano, ambos presentes no OCT prévio ao tratamento no olho esquerdo. A acuidade visual melhorou para 20/25 após 6 meses de tratamento. A paciente permanence com acuidade visual estável de 20/25 após 18 meses de acompanhamento. CONCLUSÃO: Reportamos um caso de paciente com edema macular cistóide originada da vasculopatia coroidiana polipoidal que respondeu ao tratamento com Ranibizumab intravítrea, como monoterapia com desaparecimento do fluido sub-retiniano e da alteração cística no OCT tendo cessado o vazamento dos pólipos que eram a causa do edema macular cistóde.
الموضوعات
Humans , Female , Middle Aged , Macular Edema/drug therapy , Macular Edema/diagnostic imaging , Angiogenesis Inhibitors/administration & dosage , Angiogenesis Inhibitors/therapeutic use , Ranibizumab/administration & dosage , Ranibizumab/therapeutic use , Polyps/diagnosis , Polyps/drug therapy , Fluorescein Angiography , Visual Acuity , Macular Edema/etiology , Choroid/pathology , Choroid/diagnostic imaging , Treatment Outcome , Choroidal Neovascularization/complications , Choroidal Neovascularization/diagnosis , Choroidal Neovascularization/drug therapy , Tomography, Optical Coherence , Intravitreal Injections , Fundus Oculiالملخص
Edema of the macula in diabetic patients is a frequent component of diabetic retinopathy, as well as a leading cause of loss of vision in this common disorder. The disease macular edema [ME] is subdivided into focal and diffuse. Many factors, both local and systemic, may contribute to the formation of diabetic ME. Several studies have shown that photocoagulation treatment of eyes with diabetic ME decreases the risk of visual loss. Early detection of asymptomatic diabetic patients with clinically significant ME is important for effective treatment. The results of the Early Treatment Diabetic Retinopathy Study [ETDRS] suggest that clinical signs of ME, rather than deterioration of visual acuity, are the important criteria in deciding whether and when to apply focal photocoagulation in persons with diabetes