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BACKGROUND: Chorioretinopathy centralis serosa (CCS) is a common disease that leads to the loss of retinal ion/fluid homeostasis due to decompensation of the retinal pigment epithelium, resulting in fluid accumulation with detachment of the neurosensory retina and/or retinal pigment epithelium. We investigated the effect of eplerenone, a mineralocorticoid receptor inhibitor, on chronic recurrent CCS (cr-CCS). METHODS: A retrospective study with data analysis of 17 eyes (12 patients) between 2014â-â2021 with cr-CCS in whom other methods were not effective, not applicable, or not desired, was performed. Duration of CCS was at least 12 months with at least one recurrence. Each patient received 25 mg (1st week) and 50 mg (from the 2nd week) for at least 3 months. In each case, best-corrected visual acuity and central and peripheral retinal thickness were measured by spectral-domain optical coherence tomography. Side effects were rated by the patients as "none", "mild" (noticeable but not affecting), "tolerable" (affecting but acceptable because of good effect), and "not tolerable" (then discontinuation of therapy). RESULTS: There was no significant reduction in central or peripheral retinal thickness. A complete reduction of subretinal fluid was achieved in 5 of 17 eyes (29.4%). In 12 eyes, no effect of eplerenone could be detected, so other therapies were required. Visual acuity change was mainly dependent on the duration of CCS and the degree of photoreceptor damage. Side effects were reported by 11 patients as "none" and 1 patient as "mild" (arterial hypotension). No other side effects were observed. CONCLUSION: The response rates of therapy with eplerenone were relatively low, and no significant effect could be demonstrated. Eplerenone should not (no longer) be routinely used in the therapy of cr-CCS.
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BACKGROUND: To investigate whether vaccination against SARS-CoV-2 is associated with the onset of retinal vascular occlusive disease (RVOD). METHODS: In this multicentre study, data from patients with central and branch retinal vein occlusion (CRVO and BRVO), central and branch retinal artery occlusion (CRAO and BRAO), and anterior ischaemic optic neuropathy (AION) were retrospectively collected during a 2-month index period (1 June-31 July 2021) according to a defined protocol. The relation to any previous vaccination was documented for the consecutive case series. Numbers of RVOD and COVID-19 vaccination were investigated in a case-by-case analysis. A case-control study using age- and sex-matched controls from the general population (study participants from the Gutenberg Health Study) and an adjusted conditional logistic regression analysis was conducted. RESULTS: Four hundred and twenty-one subjects presenting during the index period (61 days) were enrolled: one hundred and twenty-one patients with CRVO, seventy-five with BRVO, fifty-six with CRAO, sixty-five with BRAO, and one hundred and four with AION. Three hundred and thirty-two (78.9%) patients had been vaccinated before the onset of RVOD. The vaccines given were BNT162b2/BioNTech/Pfizer (n = 221), followed by ChadOx1/AstraZeneca (n = 57), mRNA-1273/Moderna (n = 21), and Ad26.COV2.S/Johnson & Johnson (n = 11; unknown n = 22). Our case-control analysis integrating population-based data from the GHS yielded no evidence of an increased risk after COVID-19 vaccination (OR = 0.93; 95% CI: 0.60-1.45, p = 0.75) in connection with a vaccination within a 4-week window. CONCLUSIONS: To date, there has been no evidence of any association between SARS-CoV-2 vaccination and a higher RVOD risk.
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INTRODUCTION: Oxygen saturation in retinal vessels can be non-invasively measured by a new method. It is known that oxygen extraction is lowered in diabetic retinopathy. In the cross-sectional study presented here, it has been investigated whether diabetes-specific changes and typical accompanying diseases could influence the measurements in oximetry. METHODS: During a time span of seven months, 237 diabetics were included who came to our clinic for an intravitreal injection, who met the inclusion criteria, who showed no exclusion criteria and gave written consent. 203 eyes of 203 patients were evaluated. The oxygen saturation (SO2) was measured in digitally stored fundus images taken with a fundus camera (Zeiss 450 FF). In its illumination beam, a filter was inserted with two transmission maxima at 584 nm and 610 nm (bandwidth 10 nm). With the program "Oximetry" (Imedos Systems, Jena, Germany), the venous and the arterial SO2 were measured. The values were stored in a spreadsheet. Diabetes related data, clinical parameters and accompanying diseases were documented in the predefined scheme. RESULTS: In the whole patient sample, the venous oxygen saturation (vSO2) was 69 ± 12%, the arterial saturation (aSO2) 99 ± 5% and the arteriovenous difference 31 ± 9%. A statistically significant association could not be found between the measurement values of oximetry and age, duration of diabetes and HbA1c (Kruskal-Wallis ANOVA: p > 0.05). The differences in oximetry values between units of analysis (UOA) e.g. hypertension and non units of analysis (NOA) were analysed. Descriptive testing showed significant differences in vSO2% in the following units of analysis: allergies n = 47: UOA vs. NUOA: 64 vs. 69 (t test: p < 0.02); sartan therapy n = 46: UOA vs. NUOA: 64 vs. 70 (p = 0.003); state after intravitreal injections n = 144: 68 vs. 71 (p = 0.02). Oxygen extraction from the retinal capillaries was improved in patients who had injections with VEGF inhibitors. An improvement in oxygen extraction is also seen in patients with allergies and hypertension in comparison to those without these units of analysis. CONCLUSION: The clinically observed improvement in the retinal state situation after intravitreal injections with VEGF inhibitors may be seen in association with the improved oxygen extraction. It seems reasonable to study whether a switch to sartans in the therapy of hypertension may improve retinal function.
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Diabetes Mellitus , Retinopatía Diabética , Hipersensibilidad , Hipertensión , Estudios Transversales , Retinopatía Diabética/diagnóstico , Humanos , Oxígeno , Saturación de Oxígeno , Vasos Retinianos , Factor A de Crecimiento Endotelial VascularRESUMEN
BACKGROUND: There is a lack of consensus on the use of intravitreal corticosteroid therapies in patients with diabetic macular edema (DME) and prior vitrectomized eyes in clinical practice. METHODS: Retro-IDEAL was a 3-year retrospective, multicenter study in patients with chronic DME (i.e. DME that persists or recurs despite treatment) treated with ILUVIEN® (0.2 µg daily fluocinolone acetonide intravitreal implant), who had suboptimal outcomes with first-line vascular endothelial growth-factor inhibitors and other DME therapies. RESULTS: A total of 81 eyes (63 patients) were included of which 39 eyes had undergone prior vitrectomy (PV group) while 42 eyes had not undergone prior vitrectomy (NPV). Baseline characteristics were balanced; however, more patients had proliferative diabetic retinopathy in the PV group vs. the NPV group (21.62% vs 9.38%, respectively). Over 36 months, mean visual acuity (VA) increased in both groups with a tendency for more ETDRS letters being gained in the NPV group (+5.33) vs. the PV group (+2.42). By month 36, central retinal thickness was reduced to ⩽300 µm in two-thirds of the eyes in both groups and the mean change from baseline in intraocular pressure was similar in both groups (+0.50 mmHg -0.75 mmHg; NPV and PV group). CONCLUSIONS: These long-term data suggest that the 0.2 µg/day FAc implant is effective in both vitrectomized and non-vitrectomized patients, with a manageable safety profile, and improved VA and reduced supplemental therapies for patients with a suboptimal response to first-line DME therapies. Clinicians may consider utilizing the FAc implant earlier in the DME disease process.
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INTRODUCTION: The Retro-IDEAL (ILUVIEN Implant for chronic DiabEtic MAcuLar edema) study is a retrospective study designed to assess real-world outcomes achieved with the ILUVIEN® (0.19 mg fluocinolone acetonide (FAc)) in patients with chronic diabetic macular edema (DME) in clinical practices in Germany. METHODS: This study was conducted across 16 sites in Germany and involved 81 eyes (63 patients) with persistent or recurrent DME and a prior suboptimal response to a first-line intravitreal therapy (primarily anti-VEGF intravitreal therapies). RESULTS: Patients were followed-up for 30.8 ± 11.3 months (mean ± standard deviation) and had a mean age of 68.0 ± 10.4 years. Best-recorded visual acuity (BRVA) improved by +5.5 letters at month 9 (P ⩽ 0.005, n=56; from a baseline of 49 letters) and this was maintained through to month 30 (P ⩽ 0.05, n = 42). There was a concurrent improvement in central macular thickness with a reduction from 502 µm at baseline to 338 µm at year 1 (P ⩽ 0.0001, n = 43). This effect was sustained to year 3 (i.e. 318 µm; P ⩽ 0.0001, n = 29). Mean intraocular pressure (IOP) remained constant between baseline and year 3 with a peak change of 1.9 mm Hg occurring at year 1. Elevated IOP was observed in a similar percentage of patients prior to (22.2% of cases) and following (27.2%) treatment with the FAc implant. In the majority of cases, these elevations were managed effectively with IOP medications. CONCLUSIONS: Despite substantial amounts of prior intravitreal treatments - primarily with anti-vascular endothelial growth factor (VEGF) drugs - this real-world study showed that sustained structural and functional improvements can last for up to 3 years with a single FAc implant.
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Retinopatía Diabética/tratamiento farmacológico , Implantes de Medicamentos/uso terapéutico , Fluocinolona Acetonida/administración & dosificación , Glucocorticoides/administración & dosificación , Edema Macular/tratamiento farmacológico , Anciano , Retinopatía Diabética/fisiopatología , Femenino , Alemania , Humanos , Presión Intraocular/fisiología , Inyecciones Intravítreas , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Tonometría Ocular , Agudeza Visual/fisiologíaRESUMEN
PURPOSE: To investigate hair cortisol concentration (HCC), a biochemical correlate of long-term cortisol output patterns, and its relationship to active central serous chorioretinopathy (CSC). METHODS: Twenty-six participants were included in this observational pilot study (11 patients with active CSC and 15 healthy controls). Hair cortisol concentrations (HCCs) were determined from 3 cm hair strands collected near the scalp from patients and controls as an index of cumulative cortisol secretion over the 3-month period prior to hair sampling. RESULTS: Patients with CSC exhibited higher HCCs (mean value: 20.14, 95% CI: 14.89-27.16 pg/mg) than healthy controls (mean value: 11.06, 95% CI: 8.63-14.22 pg/mg, p = 0.008). Group differences were not affected by relevant covariates (BMI, smoking status, sex). CONCLUSION: Patients with active CSC have increased HCC, supporting the fact that cortisol is a major player in CSC pathogenesis.
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Coriorretinopatía Serosa Central/metabolismo , Cabello/química , Hidrocortisona/farmacocinética , Adulto , Antiinflamatorios/farmacocinética , Biomarcadores/metabolismo , Coriorretinopatía Serosa Central/diagnóstico , Coriorretinopatía Serosa Central/tratamiento farmacológico , Femenino , Angiografía con Fluoresceína , Estudios de Seguimiento , Fondo de Ojo , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Retina/patología , Estudios Retrospectivos , Tomografía de Coherencia ÓpticaRESUMEN
BACKGROUND: The purpose of this study was to investigate the effectiveness of re-switch from intravitreal aflibercept to ranibizumab in patients with exudative age-related macular degeneration. MATERIALS AND METHODS: This retrospective case series included 17 eyes of 17 patients who had previously switched from ranibizumab to aflibercept and finally back to ranibizumab. Main outcomes were change of visual acuity (VA) and assessment of central macular thickness (CMT). Secondary outcomes included predictive factors which had a beneficial effect as VA and CMT before re-switch, number of previous injections and gender. RESULTS: The mean VA was 0.64 ± 0.36 logMAR before the switch, and 0.87 ± 0.40 logMAR before the re-switch, and gained with a slight but not significantly improvement up to 0.85 ± 0.58 logMAR after the re-switch (p = 0.896). The average CMT before the switch was 448.6 µm ± 181.5. This decreased to 343.8 µm ± 161.3 after the switch (p = 0.614) to 299.1 µm ± 155.8 at switchback (p = 0.133). Overall, 8 patients (47%) had an improvement of vision, whereas in 5 patients (30%) VA deteriorated. Further analysis of predictive factors revealed a mean improvement of VA in male patients after re-switch, while female patients lost VA, with statistical significance between after the switch and after the re-switch to the benefit of male patients (p = 0.016). CONCLUSIONS: A re-switch from aflibercept to ranibizumab may enable improvement in morphological parameters and stabilization of VA in patients with exudative age-related macular degeneration who achieved no more benefit from the initial switch.
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Inhibidores de la Angiogénesis , Degeneración Macular , Ranibizumab , Receptores de Factores de Crecimiento Endotelial Vascular , Proteínas Recombinantes de Fusión , Inhibidores de la Angiogénesis/uso terapéutico , Femenino , Humanos , Inyecciones Intravítreas , Degeneración Macular/tratamiento farmacológico , Masculino , Ranibizumab/uso terapéutico , Receptores de Factores de Crecimiento Endotelial Vascular/uso terapéutico , Proteínas Recombinantes de Fusión/uso terapéutico , Estudios Retrospectivos , Tomografía de Coherencia Óptica , Resultado del TratamientoRESUMEN
Increased levels of systemic vascular endothelial growth factors (VEGFs) in patients with diabetes are associated with increased risk of microvessel disease. On the other hand, low VEGF levels after intravitreal antibody application may be associated with acute cardiovascular complications and treatment failure. Individual levels of systemic VEGF vary in a wide range depending on analytical methods and quality of diabetes control. So far only limited information exists on intraindividual fluctuations over longer periods and circadian rhythms. We analysed the intraindividual variance of VEGF-A, VEGF-C and placental growth factor (PLGF) in CTAD (citrate-theophylline-adenine-dipyridamol) plasma as well as VEGF-A in serum over a period of 6 months in patients with stable controlled type 2 diabetes (10 M, 10 F) and age and sex matched subjects with normal glucose tolerance (NGT). Furthermore, circadian levels of VEGFs were controlled hourly from 7:30 a.m. to 7:30 p.m. under standardized metabolic ward conditions. In addition, the relationship to metabolic, hormonal and inflammatory biomarkers was analyzed. VEGF-A, VEGF-C and PLGF remained stable in plasma and VEGF-A in serum over 6 months in both groups. No circadian change was observed in VEGF-A serum and plasma concentrations. A minor decrease of VEGF-C plasma levels was evident after 5 p.m. in both groups and a significant peak of PLGF concentrations occurred after lunch, which was more pronounced in T2DM. In multivariate analysis, only serum VEGF-A correlated to diabetes duration, whereas VEGF-C only correlated to HbA1c and fasting blood glucose. We did not observe significant intraindividual variances for VEGF-A in serum and VEGF-A, VEGF-C and PLGF in CTAD plasma over a period of 6 months. Taken together, a single morning measurement of systemic VEGF levels after 7:30 am appears to be a reliable parameter for the individual risk associated with abnormal VEGF concentrations in blood. TRIAL REGISTRATION: NCT02325271.
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Diabetes Mellitus Tipo 2/sangre , Factor A de Crecimiento Endotelial Vascular/sangre , Factor C de Crecimiento Endotelial Vascular/sangre , Anciano , Glucemia/análisis , Ritmo Circadiano , Femenino , Prueba de Tolerancia a la Glucosa , Hemoglobina Glucada/análisis , Humanos , Masculino , Persona de Mediana Edad , Factor de Crecimiento Placentario/sangreRESUMEN
PURPOSE: To retrospectively evaluate the re-injection interval, efficacy and safety of dexamethasone (DEX) intravitreal implant 0.7 mg in the treatment of macular oedema (ME) due to retinal vein occlusion (RVO) in Germany in 2009-2012. METHODS: Retrospective, multicentre, anonymised observational study of data collected from the first DEX implant 0.7 mg injection through 3-6 months following the last injection. Data were included if the patient was >18 years old, had a diagnosis of ME secondary to branch or central RVO, and received at least 2 DEX implant 0.7 mg injections during routine practice. RESULTS: Data from 87 patients were analysed. Mean time to re-injection between first and second treatments was 5.03 months in the total RVO population, and 5.46 and 4.52 months for the branch and central RVO subpopulations, respectively. An intraocular pressure increase of >25 mm Hg was recorded in 20% of patients, and 34% of patients began treatment with anti-glaucoma medication, but surgery was not needed for this condition. CONCLUSIONS: DEX implant 0.7 mg was found to be well tolerated and effective with repeat treatments in clinical practice.
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Dexametasona/administración & dosificación , Glucocorticoides/administración & dosificación , Edema Macular/tratamiento farmacológico , Oclusión de la Vena Retiniana/complicaciones , Anciano , Anciano de 80 o más Años , Dexametasona/efectos adversos , Implantes de Medicamentos , Femenino , Glucocorticoides/efectos adversos , Humanos , Presión Intraocular/efectos de los fármacos , Inyecciones Intravítreas , Edema Macular/etiología , Masculino , Persona de Mediana Edad , Retratamiento , Estudios Retrospectivos , Agudeza Visual/fisiologíaRESUMEN
PURPOSE: To investigate the effect(s) of intravitreally injected ranibizumab on retinal vessel diameter in patients with diabetic macular edema. METHODS: Participants of this prospective study were 14 men and 16 women (30 eyes) aged 60 ± 11 years (mean ± standard deviation), all with clinically significant diabetic macular edema. Treatment comprised 3 intravitreal injections of ranibizumab given at 4-week intervals. Examinations were conducted before the first (baseline), before the second (Month 1), before the third (Month 2) injections, and 3 months after baseline (Month 3). Measured parameters included systemic blood pressure, static retinal vessel analysis (central retinal artery equivalent and central retinal vein equivalent), and dynamic retinal vessel analysis, as measured by the change in vessel diameter in response to flicker stimulation during three measurement cycles. Flicker stimulation was accomplished using a 50-second baseline recording, followed by an online measurement during 20-second flicker stimulation and 80-second online measurements in both arteriolar and venular vessel segments. RESULTS: Static retinal vessel analysis showed a reduction of central retinal artery equivalent from 186.25 ± 51.40 µm (baseline) to 173.20 ± 22.2 µm (Month 1), to 174.30 ± 27.30 µm (Month 2), and to 170.56 ± 22.89 µm (Month 3), none of which was statistically significant (P = 0.23, 0.12, and 0.14, respectively). Central retinal vein equivalent was reduced from 216.21 ± 25.0 µm (baseline) to 214.48 ± 25.4 µm (Month 1), to 214.80 ± 24.30 µm (Month 2), and to 211.41 ± 24.30 µm (Month 3), revealing no statistically significant differences between examination time points (P = 0.54, 0.06, and 0.24, respectively). Dynamic vessel analysis yielded a mean retinal arterial diameter change of +1.47% ± 2.3 (baseline), +1.91% ± 2.5 (Month 1), +1.76% ± 2.2 (Month 2), and +1.66% ± 2.1 (Month 3), none of which showed statistically significant differences (P = 0.32, 0.49, and 0.70, respectively). Mean retinal venous diameter changes were +3.15% ± 1.7 (baseline), +3.7% ± 2.3 (Month 1), +4.0% ± 2.0 (Month 2), and +4.95% ± 1.9 (Month 3), none of which showed statistically significant differences (P = 0.12, 0.17, and 0.14, respectively). Central retinal thickness, as measured by spectral domain optical coherence tomography, decreased significantly from 435.2 ± 131.8 µm (baseline) to 372.3 ± 142.8 µm (Month 3), P = 0.01. Regression analysis of arteriolar and venular diameters indicated that there was no significant correlation between these 2 parameters (r = 0.053; P = 0.835 and r = 0.06; P = 0.817, respectively). Also, no significant correlation was observed between the difference in the central retinal thickness and change in arteriolar or venular dilatation (r = 0.291, P = 0.241 and r = 0.06, P = 0.435, respectively). CONCLUSION: Intravitreally applied ranibizumab did not significantly affect retinal vessel diameter in patients with diabetic macular edema. Decline in the central foveal thickness after ranibizumab therapy, as measured by spectral domain optical coherence tomography, was not linked to any change in retinal vessel diameter or dilatatory response, neither for arterioles nor venules.
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Inhibidores de la Angiogénesis/administración & dosificación , Anticuerpos Monoclonales Humanizados/administración & dosificación , Retinopatía Diabética/tratamiento farmacológico , Edema Macular/tratamiento farmacológico , Vasos Retinianos/efectos de los fármacos , Inhibidores de la Angiogénesis/uso terapéutico , Anticuerpos Monoclonales Humanizados/uso terapéutico , Presión Sanguínea , Diabetes Mellitus Tipo 1/complicaciones , Diabetes Mellitus Tipo 2/complicaciones , Retinopatía Diabética/fisiopatología , Femenino , Angiografía con Fluoresceína , Humanos , Presión Intraocular , Inyecciones Intravítreas , Edema Macular/fisiopatología , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Ranibizumab , Vasos Retinianos/fisiopatología , Tomografía de Coherencia Óptica , Factor A de Crecimiento Endotelial Vascular/antagonistas & inhibidoresRESUMEN
BACKGROUND: High-density silicone oils are newly developed long-term tamponade agents for the treatment of complicated retinal detachment in the inferior retina. Previous studies describe satisfying anatomical and functional results. In this study we examined the largest cohort so far for a 9-month follow-up and performed a comparison to conventional silicone oil. METHODS: Our study documents results and adverse effects after vitreoretinal surgery and endotamponade with Densiron 68 in 99 cases of complicated retinal detachment. A 9-month follow-up was performed. Data of 21 patients with intraocular conventional silicone oil tamponade in complicated retinal detachment were retrospectively analyzed and served as control. RESULTS: Anatomical success was achieved in 78 of 89 eyes (87.6%) with completed follow-up; visual acuity did not change significantly (from mean preoperative logMAR 1.88 to postoperative logMAR 1.96 (p = 0.9). Compared to control a higher anatomical success but a similar number of adverse effects were observed with heavy silicone oil in vitreous. Nevertheless, patients who received Densiron 68 twice due to redetachment showed a significantly higher rate of intraocular inflammation with the tamponade agent in situ. CONCLUSION: Our results support the hypothesis of Densiron 68 as potent tamponade agent for complicated retinal detachment in the inferior retinal segments especially in eyes where a previous operation failed.
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Desprendimiento de Retina/cirugía , Aceites de Silicona/uso terapéutico , Vitrectomía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Catarata/etiología , Enfermedades de la Córnea/etiología , Endoftalmitis/etiología , Membrana Epirretinal/etiología , Estudios de Seguimiento , Humanos , Instilación de Medicamentos , Presión Intraocular , Persona de Mediana Edad , Hipotensión Ocular/etiología , Estudios Prospectivos , Desprendimiento de Retina/complicaciones , Estudios Retrospectivos , Aceites de Silicona/administración & dosificación , Aceites de Silicona/efectos adversos , Resultado del Tratamiento , Vitrectomía/efectos adversosRESUMEN
BACKGROUND: The high-density silicone oil (Densiron 68), a mixture of F6H8 with silicone oil, seems to be a therapeutic option, at least in selected patients with complex inferior retinal re-detachment, where standard procedures have already failed. In an interventional case series we used Densiron as a primary endotamponade. METHODS: Twelve eyes of 12 patients aged 31 years to 85 years with inferior complex rhegmatogenous retinal detachment with secondary proliferative vitreoretinopathy (PVR) grades CP2 to CA8 were included. Surgical techniques (pars plana vitrectomy, membrane peeling, retinotomy, retinectomy, endophotocoagulation, cryocoagulation, endotamponade) did not include a scleral buckling procedure (except one eye). Mean duration of the Densiron endotamponade was 78.3 +/- 29.74 days, with a mean follow up after removal of 400.6 +/- 85.4 days. RESULTS: After Densiron removal, four patients (33.3%) showed a stable reattached retina without further interventions, while, in six patients (50%), recurrent retinal re-detachment appeared during endotamponade, generally within 2 months. One patient (8.3%) developed re-detachment 5 months after Densiron removal. One eye (8.3%) lost light perception due to severe intraretinal fibrosis with chronic hypotonia, despite complete retinal re-attachment. Visual acuity improved from mean logarithm of the minimum angle of resolution (logMAR) of 2.95 +/- 1.21 to 1.87 +/- 1.32 (statistically significant, P = 0.022). Side effects included temporary inflammatory reaction/fibrin accumulation (n = 2/2), moderate-to-severe intraretinal fibrosis (n = 3), elevated intraocular pressure (IOP) (n = 3), emulsification (n = 2), sterile hypopyon (n = 1), vitreous haemorrhage (n = 1) and chronic hypotony (n = 1). CONCLUSION: Primary anatomical success rate of 33.3% was less encouraging than as expected. Especially, re-detachments within the posterior staphyloma in highly myopic patients were common during Densiron endotamponade. However, the surgical success increased to 75% after reintervention, even without the use of an additional encircling band. The observed adverse effects and the functional outcomes do not contraindicate the use of Densiron as an internal tamponade for a period of 3 months.
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Desprendimiento de Retina/terapia , Aceites de Silicona/uso terapéutico , Adulto , Anciano , Anciano de 80 o más Años , Crioterapia , Drenaje/métodos , Femenino , Estudios de Seguimiento , Humanos , Coagulación con Láser , Masculino , Persona de Mediana Edad , Recurrencia , Desprendimiento de Retina/complicaciones , Factores de Tiempo , Resultado del Tratamiento , Agudeza Visual/fisiología , Vitrectomía , Vitreorretinopatía Proliferativa/etiologíaRESUMEN
BACKGROUND: In this study, we evaluated the anatomic and functional outcome and intraocular adverse effects after a 3-month endotamponade with Densiron 68, a mixture of F(6)H(8) with silicone oil, in complex inferior re-detachments. METHODS: Forty-eight eyes of 48 patients aged 27-82 years with retinal re-detachment due to proliferative vitreoretinopathy (PVR) grades CP1 to CA7 were included. Mean duration of the Densiron endotamponade was 108.7+/-66.9 days, with a mean follow-up after removal of 102.8+/-31.9 days. RESULTS: Twenty-two patients (45.8%) showed stable retinal reattachment after Densiron removal. Fourteen patients (29.2%) developed retinal re-detachment after removal, generally within 1 month and in the upper circumference (n=8). In 11 patients (22.9%) recurrent re-detachment (inferior n=8) appeared during Densiron endotamponade. In one eye (2.1%) treatment was primarily unsuccessful. Visual acuity improved from mean logMAR 1.66+/-1.03 to 1.47+/-0.97 (not statistically significant, P=0.257). Side effects included temporary inflammatory reaction (n=10), fibrin accumulation (n=6), sterile hypopyon (n=2), vitreous hemorrhage (n=6), elevated IOP (n=5), emulsification (n=4) and chronic hypotony (n=4). CONCLUSION: The anatomical success rate without further interventions of 45.8% (22 of 48 patients) seems unsatisfactory. However, in evaluating the potential of Densiron, it should be considered that all patients in this study had previous surgery with standard procedures, including silicone oil, which had already failed. Intraoperative laser photocoagulation of the periphery of the upper quadrants might reduce the risk of retinal re-detachments.
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Desprendimiento de Retina/tratamiento farmacológico , Desprendimiento de Retina/cirugía , Aceites de Silicona/uso terapéutico , Vitrectomía , Adulto , Anciano , Anciano de 80 o más Años , Terapia Combinada , Drenaje , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Recurrencia , Desprendimiento de Retina/etiología , Aceites de Silicona/efectos adversos , Resultado del Tratamiento , Agudeza Visual , Vitreorretinopatía Proliferativa/complicacionesRESUMEN
BACKGROUND: An irregular corneal surface compromises IOP measurement by Goldmann applanation tonometry. In such cases accurate measurement without corneal contact would be desirable. The new eyelid tonometer TGDc-01 measures IOP without corneal contact through the eyelid. The aim of the study was to evaluate the accuracy of the eyelid tonometer compared with Goldmann applanation tonometry (cornea thickness-corrected values) in subjects without corneal alterations. METHODS: IOP was measured in 199 eyes of 103 subjects without corneal alterations by means of two different methods. Measurements with the transpalpebral tonometer TGDc-01 and the Goldmann applanation tonometer were performed within 5 min in random order. RESULTS: The mean difference between lid tonometry and Goldmann applanation tonometry was 0.71 mmHg, SD +/-2.467 mmHg. In the reliability analysis the intraclass correlation coefficient was 0.8620. Compared with Goldmann applanation tonometry 66.4% of the IOP readings measured by lid tonometry were in an interval of +/-2 mmHg, 81.0% in an interval of +/-3 mmHg. The maximum of deviation was -6 mmHg and +6 mmHg, respectively. The Bland and Altman plots are shown. CONCLUSIONS: Lid tonometry correlates sufficiently with Goldmann applanation tonometry, but in more than 10% of the measurements the IOP readings differed by more than 3 mmHg. The eyelid tonometer may be helpful as a screening tool when Goldmann applanation tonometry is not applicable.
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Glaucoma/diagnóstico , Presión Intraocular/fisiología , Tonometría Ocular/instrumentación , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Conjuntiva , Diseño de Equipo , Párpados , Femenino , Estudios de Seguimiento , Glaucoma/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Adulto JovenRESUMEN
BACKGROUND: Recently interferon therapy has become increasingly important in the treatment of viral and malignant diseases. Subsequently, a variety of adverse effects of interferon use has been reported. Ocular complications following interferon therapy include retinal ischaemia with cotton wool spots, retinal haemorrhages, capillary nonperfusion, vasospasm, and arteriolar occlusion. CASE REPORT: A 37-year old male complained about increasingly blurred vision in his right eye. Because of a chronic type B hepatitis he has been treated with interferon alpha for a total of 35 weeks. Visual acuity was slightly reduced (OD cc 0.9, OS cc 1.0 p). Dilated fundus examination and fluorescein angiography showed an incipient ischaemic retinopathy with perimacular arteriolar alterations in both eyes and single cotton wool spots in his right eye. Perimetry showed a slight reduction of the mean deviation. Amsler-grid did not show any pathology. As the retinopathy was thought to be related to the interferon treatment, it was decided to discontinue this therapy immediately. 2 weeks later visual acuity was improved (OD cc 1.25 p, OS cc 1.0) and dilated fundus examination showed no signs of perimacular ischaemic retinopathy and the initial cotton wool spots had been resolved. CONCLUSION: In patients with long-time interferon treatment non-specific visual complaints like blurred vision or dark spots might be symptoms of an early ischaemic retinopathy. Retinal alterations might be reversible if treatment is discontinued. If an ischaemic retinopathy is present it should be considered to abandon interferon therapy, since permanent loss of vision has been described in advanced capillary non-perfusion and arteriolar occlusion. However, the decision to discontinue the interferon therapy should be made interdisciplinary while considering diagnosis and therapy indication.