Angiotensin II and aldosterone activate retinal microglia.

Microglial cells are important contributors to the neuroinflammation and blood vessel damage that occurs in ischemic retinopathies. We hypothesized that key effectors of the renin-angiotensin aldosterone system, angiotensin II (Ang II) and aldosterone, increase the density of microglia in the retina and stimulate their production of reactive oxygen species (ROS) as well as pro-angiogenic and pro-inflammatory factors. Two animal models were studied that featured up-regulation of Ang II or aldosterone and included transgenic Ren-2 rats which overexpress renin and Ang II in tissues including the retina, and Sprague Dawley rats with ischemic retinopathy and infused with aldosterone. Complementary studies were performed in primary cultures of retinal microglia from neonatal Sprague Dawley rats exposed to hypoxia (0.5% O2) and inhibitors of the angiotensin type 1 receptor (valsartan), the mineralocorticoid receptor (spironolactone) or aldosterone synthase (FAD286). In both in vivo models, the density of ionized calcium-binding adaptor protein-1 labelled microglia/macrophages was increased in retina compared to genetic or vehicle controls. In primary cultures of retinal microglia, hypoxia increased ROS (superoxide) levels as well as the expression of the NADPH oxidase (NOX) isoforms, NOX1, NOX2 and NOX4. The elevated levels of ROS as well as NOX2 and NOX4 were reduced by all of the treatments, and valsartan and FAD286 also reduced NOX1 mRNA levels. A protein cytokine array of retinal microglia revealed that valsartan, spironolactone and FAD286 reduced the hypoxia-induced increase in the potent pro-angiogenic and pro-inflammatory agent, vascular endothelial growth factor as well as the inflammatory factors, CCL5 and interferon γ. Valsartan also reduced the hypoxia-induced increase in IL-6 and TIMP-1 as well as the chemoattractants, CXCL2, CXCL3, CXCL5 and CXCL10. Spironolactone and FAD286 reduced the levels of CXCL2 and CXCL10, respectively. In conclusion, our findings that both Ang II and aldosterone influence the activation of retinal microglia implicates the renin-angiotensin aldosterone system in the pathogenesis of ischemic retinopathies.

Observation of neovascularization of the disc associated with proliferative diabetic retinopathy using OCT angiography.

PURPOSE: To describe the relationship between the vitreous and the neovascularization of the disc (NVD) using swept source optical coherence tomography (SS-OCT) and OCT angiography (OCTA). STUDY DESIGN: Retrospective. METHODS: We examined 17 eyes of 11 consecutive patients diagnosed as NVD associated with proliferative diabetic retinopathy (PDR). The location of the NVD feeder or collector vessels were examined by using RTVue XR Avanti. To determine the condition of the posterior vitreous detachment (PVD) and the proliferative tissue of the NVD, we performed 12 mm horizontal and vertical scans through the disc using SS-OCT. RESULTS: OCT images of all 17 cases indicated there was no PVD on the optic disc. OCTA showed that the locations of the newly formed vessels from the optic disc were overwhelmingly outside the physiological cupping (95%). No cases exhibited formation of neovascularization inside the physiological cupping. OCT images revealed all 17 eyes had proliferative tissues located under the posterior wall of the vitreous, with 12 out of 17 eyes exhibiting additional invasion of the proliferative tissue into the vitreous through the posterior wall. Epiretinal membrane or a thickened posterior wall of the vitreous was present in 10 out of the 17 eyes. CONCLUSIONS: NVD associated with PDR arises from outside the physiological cupping and grows along the posterior wall of the vitreous. The absence of PVD on the optic disc is essential to the growth of NVD.

Inhibition of Hypoxia-Induced Retinal Angiogenesis by Specnuezhenide, an Effective Constituent of Ligustrum lucidum Ait., through Suppression of the HIF-1α/VEGF Signaling Pathway.

Specnuezhenide (SPN), one of the main ingredients of Chinese medicine "Nü-zhen-zi", has anti-angiogenic and vision improvement effects. However, studies of its effect on retinal neovascularization are limited so far. In the present study, we established a vascular endothelial growth factor A (VEGFA) secretion model of human acute retinal pigment epithelial-19 (ARPE-19) cells by exposure of 150 µM CoCl2 to the cells and determined the VEGFA concentrations, the mRNA expressions of VEGFA, hypoxia inducible factor-1α (HIF-1α) & prolyl hydroxylases 2 (PHD-2), and the protein expressions of HIF-1α and PHD-2 after treatment of 3-(5'-hydroxymethyl-2'-furyl)-1-benzylindazole (YC-1, 1.0 µg/mL) or SPN (0.2, 1.0 and 5.0 µg/mL). Furthermore, rat pups with retinopathy were treated with SPN (5.0 and 10.0 mg/kg) in an 80% oxygen atmosphere and the retinal avascular areas were assessed through visualization using infusion of ADPase and H&E stains. The results showed that SPN inhibited VEGFA secretion by ARPE-19 cells under hypoxia condition, down-regulated the mRNA expressions of VEGFA and PHD-2 slightly, and the protein expressions of VEGFA, HIF-1α and PHD-2 significantly in vitro. SPN also prevented hypoxia-induced retinal neovascularization in a rat model of oxygen-induced retinopathy in vivo. These results indicate that SPN ameliorates retinal neovascularization through inhibition of HIF-1α/VEGF signaling pathway. Therefore, SPN has the potential to be developed as an agent for the prevention and treatment of diabetic retinopathy.

Traumatic Branch Retinal Vein Occlusion With Retinal Neovascularization Following Inadvertent Retrobulbar Needle Perforation.

Retrobulbar injection of anesthesia is one of the most common procedures performed for ophthalmic surgery. Complications are rare but can be potentially serious, including retrobulbar hemorrhage, brainstem anesthesia, and inadvertent globe perforation. This is the preliminary report describing branch retinal vein occlusion (BRVO) secondary to accidental retrobulbar needle laceration with subsequent preretinal neovascularization.

[Aflibercept. An approach to pharmacology]. / Aflibercept. Una aproximación a la farmacología.

Aflibercept is a fusion protein whose chemical structure combines the constant fraction of any IgG with a variable fraction constructed with fundamental parts of VEGF receptors. Consequently, it is able to bind to various VEGF as well as to placental growth factor (PIGF), which has been related to a possible synergistic effect in efficacy. The affinity of this drug is higher than that of ranibizumab and bevacizumab. Moreover, it has an intraocular antiinflammatory effect. Intravitreal administration leads to the presence of traces of the drug in plasma but the concentrations are so reduced that the presence of systemic adverse effects, including arterial hypertension, is practically nil. Because of its prolonged intraocular elimination half-life and high affinity, the drug can be administered in convenient regimens, since, after an initial monthly injection for the first three doses, the interval between injections is increased to one every two months and, after the first 12 months, the dosing will depend on the visual and anatomical results.

Proliferative radiation retinopathy after plaque radiotherapy for uveal melanoma.

PURPOSE: To determine risk factors, occurrence rate, management, and outcome of proliferative radiation retinopathy (PRR) after plaque radiotherapy for uveal melanoma. DESIGN: Case-control study. PARTICIPANTS: Three thousand eight hundred forty-one patients who underwent plaque radiotherapy for uveal melanoma were entered into the study. METHODS: Retrospective review of medical records. MAIN OUTCOME MEASURES: Proliferative radiation retinopathy after plaque radiotherapy for uveal melanoma. RESULTS: Of 3841 eyes treated with plaque radiotherapy for uveal melanoma, PRR developed in 5.8% at 5 years and in 7% at 10 and 15 years using Kaplan-Meier analysis. The mean time to onset of PRR was 32 months (median, 30 months; range, 4-88 months). On univariate analysis, baseline factors predictive of PRR (P<0.05) included young age, diabetes, hypertension, Hispanic race, shorter tumor distance to the optic disc and to the foveola, Bruch's membrane rupture, choroidal location of the tumor, subretinal fluid, higher radiation dose to the optic nerve and to the foveola, higher radiation rate to the tumor apex and to the tumor base, additional transpupillary thermotherapy, and notched plaque. In the multivariate model, young age (odds ratio [OR], 1.44; 95% confidence interval [CI], 1.25-1.67, per decade decrease), diabetes mellitus (OR, 2.73; 95% CI, 1.69-4.40), and shorter tumor distance to the optic disc (OR, 1.10; 95% CI, 1.04-1.17) were related to the occurrence of PRR. The most common forms of management included panretinal photocoagulation (70%), vitrectomy (21%), and observation (17%). Resolution of the neovascularization was obtained in 63% of eyes after treatment. CONCLUSIONS: Proliferative radiation retinopathy developed in 7% of eyes by 10 years after plaque radiotherapy for uveal melanoma. The main factors for development of PRR included young age, preexistent diabetes mellitus, and shorter tumor distance to the optic disc.

Rifampicin inhibits the retinal neovascularization in vitro and in vivo.

Rifampicin, an antibacterial drug widely used in the treatment of tuberculosis and leprosy, has recently been reported to have anti-oxidative and anti-apoptotic effects. However, its anti-angiogenic effect has not been investigated. We examined its anti-angiogenic effect on tube formation and proliferation by human umbilical vein endothelial cells (HUVECs) in vitro and on retinal neovascularization in a murine oxygen-induced retinopathy model in vivo. In addition, we explored the potential mechanisms for its anti-angiogenic effect. Rifampicin significantly suppressed HUVEC tube formation and proliferation, and its effects appeared to be mediated at least in part through inhibition of extracellular signal-regulated kinase (ERK) 1/2 phosphorylation. Retinal neovasuclarization was induced in neonatal mice by returning the retina to normoxia (21% O2) after exposure to hyperoxia (75% O2) from postnatal day 7 (P7) to P12. Rifampicin was given subcutaneously at 20mg/kg once a day from immediately after hyperoxia (P12) to P16. At P17, flat-mounted retinas were prepared and evaluated for pathological and physiological angiogenesis. Rifampicin significantly suppressed retinal neovascularization (versus vehicle treatment), but revascularization of the capillary-free area did not differ between vehicle and rifampicin treatment. Rifampicin has anti-angiogenic effects in vitro and in vivo, and may be useful as an anti-angiogenic agent in the treatment of retinal neovascularization diseases.

Intravitreal injection of the heparin analog 5-amino-2-naphthalenesulfonate reduces retinal neovascularization in mice.

The effect of the heparin analog 5-amino-2-naphthalenesulfonate (5-amino-2-NMS) on retinal neovascularization was investigated in the mouse model for oxygen-induced retinopathy (OIR). From postnatal day 7 (P7) until P12, mice were kept in a 75% oxygen environment. On P12, they received an intravitreal injection of 10mM 5-amino-2-NMS in one eye and PBS as control substance in the fellow eye. The animals were intracardially perfused with fluorescein-dextran solution on P17. Retinal whole mounts were prepared and ischemic retinopathy was evaluated in 30 animals using a standardized retinopathy score. A single intravitreal injection of 5-amino-2-NMS reduces significantly angioproliferative changes (blood vessel tufts, extra-retinal neovascularization, and blood vessel tortuosity) compared to the contralateral control eye (p=0.025). The median retinopathy score (maximal 13) for the 5-amino-2-NMS treated eyes was 6 versus 8 for the control eyes. 5-Amino-2-NMS binds to the heparin-binding site of FGF1 and FGF2 and thus may be a promising substance for the local treatment of retinal neovascularization.

[The effect of Sairei-to on oxygen-induced retinal neovascularization in the neonatal rat].

PURPOSE: To study the effect of Sairei-to (ST), a Japanese traditional medicine, on oxygen-induced retinopathy (OIR) in rats. METHODS: OIR was induced by maintaining Sprague-Dawley neonatal rats in 80% oxygen for 12 days. The rats were treated once daily with oral administration of 0.75 g/kg (n = 9), 1.5 g/kg (n = 13) of ST in water, or water alone (WA, n = 13) at 5 mL/ kg body weight from day 6 to day 17. On day 18, retinal samples were collected. Retinal neovascularization (NV) was assessed by the NV score, and by the percentage of avascular area (% AVA), using a method previously reported. The number of severe retinal NV cases (NV > or = 9) was compared. The retinal vascular endothelial growth factor (VEGF) concentrations were measured with an immunoassay kit, at 0, 12, 24, 72 and 144 hours after oxygenation. RESULTS: NV score and % AVA decreased in the ST treated group compared to the WA group. However, severe NV was seen in five cases of WA and in one case of the ST treated group. Thus severe NV was inhibited significantly by ST treatment (p = 0.0185). Retinal VEGF did not differ between groups at any time points. CONCLUSION: These data suggest that severe NV in OIR is inhibited by ST treatment.

The effect of L-thyroxine supplementation in a neonatal rat model of ROP.

PURPOSE: The role of L-thyroxine in retinopathy of prematurity (ROP) is controversial. Recent animal studies suggest both high and low levels of serum thyroxine (exogenous supplementation and pharmacologic inhibition) are associated with preretinal neovascularization (NV) or retinal vascular retardation, a precursor of NV. To address this controversy, we studied L-thyroxine supplementation in an animal model of ROP. METHODS: Five hundred newborn Sprague-Dawley rats were raised in 20 expanded litters of 25, under conditions of fluctuating high and low oxygen and high carbon dioxide, to induce preretinal neovascularization. Rats received either 3 days of intraperitoneal T4, 7 days of T4 or saline control. Doses of T4 ranged from 0.005 microg/g to 0.5 microg/g. Retinae from left eyes were dissected, flat-mounted, and ADPase-stained. The presence and severity of NV, retinal vascular area, and retinal vascular density were scored in a masked manner. RESULTS: The incidence of NV was similar in rats receiving either 3 days of T4 or 7 days of T4 and saline controls (55% and 43% NV in 3-day experiments [0.05 microg g-1 day-1 and 0.5 microg g-1 day-1] compared with 51% in saline controls, p = 0.49; 52% and 38% in 7-day experiments [0.005 microg g-1 day-1 and 0.05 microg g-1 day-1], p = 0.22). Retinal vascular area and vessel density were also similar to saline controls. CONCLUSIONS: Systemic T4 supplementation does not increase, or decrease, the incidence or severity of preretinal neovascularization in an animal model of ROP, despite its positive effect on overall animal growth. Further work is needed to elucidate the potential role of premature infant hypothyroidism in the pathogenesis of ROP.

Treatment of retinal angiomatous proliferation in age-related macular degeneration: a series of 104 cases of retinal angiomatous proliferation.

OBJECTIVE: To report the management of retinal angiomatous proliferation (RAP), a recently described intraretinal neovascular lesion occurring in age-related macular degeneration. METHODS: This was a retrospective review of consecutive patients with age-related macular degeneration who underwent treatment of RAP from January 1, 2000, through January 31, 2003. Inclusion criteria were age 55 years or older, signs of age-related macular degeneration, and diagnosis of RAP based on dynamic indocyanine green angiography. Baseline angiograms were reviewed and RAP was classified into the following 3 stages: stage 1, intraretinal neovascularization, early stage; stage 2, subretinal neovascularization, middle stage; and stage 3, choroidal neovascularization, late stage. Treatment and concomitant treatment results were assessed separately for each RAP stage. The clinical data were statistically analyzed (chi2 test and analysis of variance) for 2 main outcome measures--complete obliteration of the lesion and final visual acuity. RESULTS: Eighty-one patients (99 eyes) with 104 RAPs were identified. Forty-two lesions were at stage 1, 42 at stage 2, and 20 at stage 3. The following 5 treatments were performed: direct laser photocoagulation of the vascular lesion, laser photocoagulation of the feeder retinal arteriole, scatter "gridlike" laser photocoagulation, photodynamic therapy, and transpupillary thermotherapy. Complete obliteration of RAP was achieved in about 24 (57.1%) of the stage 1 lesions (direct laser photocoagulation of the vascular lesion, 73% success rate; photodynamic therapy, 45%), 11 (26.2%) of the stage 2 lesions (scatter gridlike laser photocoagulation, 38% success rate; direct laser photocoagulation of the vascular lesion, 17%), and only 3 (15.0%) of stage 3 lesions (P = .001). Predictive factors with a significant effect on final visual acuity were initial visual acuity (P = .003) and early lesion stage (P = .04). Best final visual acuity was 0.41 (mean, direct laser photocoagulation of the vascular lesion in stage 1) and 0.39 (mean, photodynamic therapy in stage 1), with a mean decrease of 2.5 and 3 lines from baseline, respectively. CONCLUSIONS: Treatment of RAP remains difficult. Early detection of the lesion and subsequent direct conventional laser photocoagulation seems to be associated with better anatomical and functional outcome. Once the vascular complex is well established, anatomical closure is rarely achieved. Further study is warranted to assess the long-term efficacy and the need for re-treatment.

Subretinal neovascular membranes complicating uveitis: frequency, treatments, and visual outcome.

PURPOSE: Retrospective evaluation in a uveitic population of subretinal neovascular membranes (SRNMs), their occurrence, visual impact, and outcome in differently treated subgroups of patients. METHODS: Medical records of patients were reviewed and cases with SRNM (n = 12) identified. Intraocular inflammation was classified according to vitreous examination records as high (2+ cells), low (1/2+ to 1+ cells), or inactive (0 cells). Visual outcome was considered to be +VA (same or gain of one or more Snellen lines) or -VA (loss of Snellen lines). In nine cases, treatment consisted of the oral administration of high doses of corticosteroids (CST) for one month, tapered down in favorable situations (+VA or SRNM angiographic regression) or maintained at half the dose in unfavorable situations (-VA or SRNM angiographic progression) while additional laser therapies, including photodynamic therapy (PDT), transpupillary thermotherapy (TTT), or argon laser therapy (CLT)), were performed in some of the cases. The above treatment scheme was not applied in three cases (pre-PDT period; undiagnosed underlying uveitis treated without CST). RESULTS: Twelve out of 648 patients (1.9%) with uveitis developed SRNM. The mean visual impact was 4.5 Snellen lines and mean follow-up time was 19.5 months. Two patients with high intraocular inflammation had a favorable visual outcome with CST alone. Eight patients with low intraocular inflammation had a favorable visual outcome with CST alone in three cases, with additional laser therapy in four cases (PDT in 3 cases and TTT in 1 case), and exclusively with PDT in one case (undiagnosed uveitis). Two patients with no intraocular inflammation had unfavorable visual outcome with CST alone (no PDT/TTT available). CONCLUSION: SRNMs occurred as a rare complication of uveitis. Their visual outcome was relatively favorable. Although high doses of CST seem to be the first step in the management of SRNMs, alternative laser treatments should be considered early, especially in cases of absence or low intraocular inflammation.

Transpupillary thermotherapy for subfoveal neovascularization secondary to group 2A idiopathic juxtafoveolar telangiectasis.

PURPOSE: To evaluate the efficacy and safety of transpupillary thermotherapy (TTT) for subfoveal neovascularization (SRNVM) in patients with group 2A Idiopathic Juxtafoveolar Telangiectasis (IJFT). DESIGN: Nonrandomized interventional case series. METHODS: We performed TTT for subfoveal SRNVM in 14 eyes of 13 patients with group 2A IJFT, who were referred to our tertiary care center. We evaluated visual outcome and SRNVM closure rate in these patients. RESULTS: After a mean follow-up period of 8.65 months, 92.3% of treated eyes had stabilization or improvement in visual acuity as well as regression of SRNVM by fluorescein angiography (FA). One SRNVM showed persistent leakage. One patient worsened by more than 2 Snellen lines; one required retreatment. CONCLUSION: Transpupillary thermotherapy may be a safe and useful alternative treatment option for patients with group 2A IJFT with subfoveal SRNVM.

Preretinal neovascularisation associated with choroidal melanoma.

BACKGROUND: The rare occurrence of iris neovascularisation and choroidal (subretinal) neovascularisation in patients with choroidal melanoma has been reported. However, the occurrence of preretinal neovascularisation (NVE) fed from the retinal circulation in eyes with choroidal melanoma is far less frequently reported. METHODS: Three case reports of choroidal melanoma with the very rare finding of overlying NVE. RESULTS: The three patients had choroidal melanomas, localised serous retinal detachment, and NVE. Two cases showed definite retinal capillary non-perfusion, and one of these two cases demonstrated retinal telangiectasis. One patient's melanoma responded quickly to iodine-125 plaque radiotherapy; however, the retinal neovascularisation persisted and caused vitreous haemorrhage. Localised scatter photocoagulation was successful in causing the complete regression of the neovascularisation. The other two patients had their eyes enucleated (one with planned pre-enucleation external beam radiotherapy). Demonstration of preretinal vessels in one of the cases was possible in histological sections. CONCLUSION: Preretinal neovascularisation may occur as a complication of choroidal melanoma. Possible aetiologies include the release of tumour angiogenic factors, inflammation, chronic retinal detachment with secondary retinal ischaemia, retinal vascular occlusion secondary to retinal vessel invasion by the tumour, or following radiation therapy. Optimal management of the neovascularisation is not known at this time. Supplemental localised scatter photocoagulation may be of benefit in some cases.

Termoterapia transpupilar para o tratamento de membrana neovascular sub-retiniana clássica secundária à degeneração macular relacionada à idade / Transpupillary thermotherapy of classic choroidal neovascularization in age-related macular degeneration

Objetivos: Avaliar, prospectivamente, pacientes com membrana neovascular sub-retiniana subfoveal, clássica, secundária à Degeneração Macular Relacionada à Idade, submetidos a tratamento pela termoterapia transpupilar à laser (TTT). Local: Instituto da Visão e Hospital São Geraldo da Faculdade de Medicina da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG. Pacientes e métodos: Foram estudados 12 pacientes (12 olhos), apresentando membrana neovascular sub-retiniana clássica, secundária à degeneração macular relacionada à idade, que foram submetidos à termoterapia transpupilar (TTT) com o laser diiodo de comprimento de onda de 810nm. Os resultados anatômicos e funcionais, um mês após o procedimento, foram avaliados. Resultados: A análise da retinografia fluoresceínica, um mês após a TTT, mostrou diminuição da exsudação em 10 olhos (83 por cento) e aumento da exsudação em 2 olhos (17 por cento). A acuidade visual melhorou em 3 olhos (25 por cento), manteve-se nos valores pré-tratamento em 3 olhos (25 por cento) e piorou em 6 olhos (50 por cento). Conclusão: O tratamento da membrana neovascular sub-retiniana predominantemente clássica, secundária à Degeneração Macular Relacionada à Idade, por meio da termoterapia transpupilar, proporcionou a melhora da exsudação em 83 por cento dos pacientes. Contudo, metade dos pacientes evoluiu com piora da acuidade visual após a TTT. Estudos prospectivos e randomizados, envolvendo uma amostra maior e maior tempo de seguimento, são necessários para se estabelecer, com maior segurança, a eficácia e os parâmetros ideais desse tratamento bem como o risco de efeitos colaterais.

Tratamento de membrana neovascular sub-retiniana idiopática ou secundária à miopia patológica, a estrias angióides e à distrofia padrão tipo asa de borboleta pela termoterapia transpupilar / Treatment of choroidal neovascularization secondary to butterfly dystrophy, angioid streaks, pathologic myopia and idiphatic causes by transpupilary thermoteraphy

Objetivos: Avaliar, prospectivamente, pacientes com membrana neovascular subretiniana subfoveal, de causa idiopática e secundária à miopia patológica, a estrias angióides e à distrofia em asa de borboleta, tratados pela termoterapia transpupilar (TTT). Pacientes e métodos: Foram estudados nove pacientes (9 olhos), apresentando membrana neovascular sub-retiniana predominantemente clássica, secundária à miopia patológica, a estrias angióides e à distrofia padrão em asa de borboleta e membranas idiopáticas, que foram submetidos à termoterapia trasnpupilar com o laser de diiodo de comprimento de onda de 810nm. Os resultados anatômicos e funcionais foram avaliados um mês após o procedimento. Resultados: Um mês após a TTT, a análise da retinografia fluoresceínica mostrou redução da exsudação em três olhos (33,3 por cento), exsudação estável em um olho (11,1 por cento) e aumento da exsudação em cinco olhos (55,5 por cento). A AV melhorou em um olho (11,1 por cento), manteve-se nos valores pré-tratamento em cinco olhos (55,5 por cento) e piorou em três olhos (33,3 por cento). Conclusão: O tratamento da membrana neovascular sub-retiniana não secundária à DMRI, por meio da termoterapia transpupilar, proporcionou a estabilização ou melhora da acuidade visual em 66,6 por cento dos casos. A TTT mostrou ser uma modalidade terapêutica relativamente segura e efetiva para o tratamento de MNSR não associadas à DMRI. Estudos prospectivos e randomizados, envolvendo uma amostra maior e maior tempo de seguimento, são necessários para se estabelecer, com maior segurança, a eficácia desse tratamento.

Termoterapia transpupilar para o tratamento de membrana neovascular sub-retiniana oculta secundária à degeneração macular relacionada à idade / Transpupillary thermotherapy of occult subfoveal choroidal neovascularization in age-related macular degeneration

Objetivos: Avaliar, prospectivamente, pacientes com membrana neovascular subretiniana subfoveal, predominantemente oculta, secundária à Degeneração Macular Relacionada à Idade, submetidos a tratamento pela termoterapia transpupilar (TTT). Local: Instituto da Visão e Hospital São Geraldo da Faculdade de Medicina da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG. Pacientes e métodos: Foram estudados 15 pacientes (16 olhos), apresentando membrana neovascular sub-retiniana predominantemente oculta, secundária à Degeneração Macular Relacionada à Idade, que foram submetidos à termoterapia transpupilar com o laser de diiodo de comprimento de onda de 810nm. Os resultados anatômicos e funcionais foram avaliados um mês após o procedimento. Resultados: A análise da retinografia fluoresceínica um mês após a TTT mostrou diminuição da exsudação em 7 olhos (44 por cento), exsudação estável em 2 olhos (12 por cento) e aumento da exsudação em 7 olhos (44 por cento). A acuidade visual melhorou em 2 olhos (12 por cento), manteve-se nos valores pré-tratamento em 10 olhos (63 por cento) e piorou em 4 olhos (25 por cento). Conclusão: O tratamento da membrana neovascular sub-retiniana predominantemente oculta, secundária à Degeneração Macular Relacionada à Idade, por meio da termoterapia transpupilar, proporcionou a estabilização ou melhora da acuidade visual em 75 por cento dos casos. A TTT mostrou-se segura e efetiva para o tratamento dessas membranas nesse período do seguimento. Estudos prospectivos e randomizados, envolvendo uma amostra maior e maior tempo de seguimento, são necessários para se estabelecer com maior segurança e eficácia desse tratamento, a médio e longo prazos.