ABSTRACT
PURPOSE:: To analyze the effects of injections of intravitreal triamcinolone acetonide (IVTA) and intravitreal bevacizumab (IVB) on the incidence rates of anterior segment neovascularization (ASN) and neovascular glaucoma (NVG) in patients with macular edema secondary to central retinal vein occlusion (CRVO). METHODS:: In this prospective, randomized, double-masked, sham-controlled study, 35 patients with macular edema following CRVO were randomized to intravitreal bevacizumab, intravitreal triamcinolone acetonide, or sham injections during the first 6 months of the study. The primary outcome was the incidence rate of ASN at month 6. The secondary outcomes were the mean changes from baseline in best-corrected visual acuity (BCVA) and central foveal thickness (CFT) on optical coherence tomography over time to month 12. RESULTS:: ASN developed in 8 (22.86%) eyes, including 5 (62.50%) eyes in the sham group and 3 (37.50%) eyes in the IVTA group, during 12 months of fol low-up (p=0.009). BCVA differed significantly (p<0.05) among the groups only at month 1. CFT did not differ significantly (p<0.05) among the groups over 12 months. NVG required surgery and developed in one eye despite laser treatment. CONCLUSION:: Early treatment with intravitreal antivascular endothelial growth factor therapy decreases the rates of ASN and NVG after CRVO.
Subject(s)
Angiogenesis Inhibitors/administration & dosage , Anti-Inflammatory Agents/administration & dosage , Bevacizumab/administration & dosage , Macular Edema/drug therapy , Neovascularization, Pathologic/epidemiology , Triamcinolone Acetonide/administration & dosage , Adult , Aged , Aged, 80 and over , Angiogenesis Inhibitors/adverse effects , Anterior Eye Segment/blood supply , Anti-Inflammatory Agents/adverse effects , Bevacizumab/adverse effects , Double-Blind Method , Female , Follow-Up Studies , Fovea Centralis/physiopathology , Glaucoma, Neovascular/drug therapy , Humans , Incidence , Intravitreal Injections , Macular Edema/etiology , Male , Middle Aged , Neovascularization, Pathologic/etiology , Prospective Studies , Retinal Artery Occlusion/complications , Retinal Artery Occlusion/drug therapy , Treatment Outcome , Triamcinolone Acetonide/adverse effects , Visual AcuityABSTRACT
ABSTRACT Purpose: To analyze the effects of injections of intravitreal triamcinolone acetonide (IVTA) and intravitreal bevacizumab (IVB) on the incidence rates of anterior segment neovascularization (ASN) and neovascular glaucoma (NVG) in patients with macular edema secondary to central retinal vein occlusion (CRVO). Methods: In this prospective, randomized, double-masked, sham-controlled study, 35 patients with macular edema following CRVO were randomized to intravitreal bevacizumab, intravitreal triamcinolone acetonide, or sham injections during the first 6 months of the study. The primary outcome was the incidence rate of ASN at month 6. The secondary outcomes were the mean changes from baseline in best-corrected visual acuity (BCVA) and central foveal thickness (CFT) on optical coherence tomography over time to month 12. Results: ASN developed in 8 (22.86%) eyes, including 5 (62.50%) eyes in the sham group and 3 (37.50%) eyes in the IVTA group, during 12 months of fol low-up (p=0.009). BCVA differed significantly (p<0.05) among the groups only at month 1. CFT did not differ significantly (p<0.05) among the groups over 12 months. NVG required surgery and developed in one eye despite laser treatment. Conclusion: Early treatment with intravitreal antivascular endothelial growth factor therapy decreases the rates of ASN and NVG after CRVO.
RESUMO Objetivo: Analisar as taxas de incidência de neovascularização do segmento anterior (NSA) e de glaucoma neovascular (GNV), em pacientes com edema macular secundário a oclusão de veia central da retina (OVCR), em tratamento com injeções intravítreas de triamcinolona (IVTA) ou bevacizumab (IVB). Métodos: Neste estudo prospectivo, randomizado, duplo mascarado e sham controlado, 35 pacientes com edema macular secundário a OVCR foram randomizados para IVB, IVTA ou para o grupo controle (sham), durante os 6 primeiros meses do estudo. O desfecho primário foi a taxa de incidência de NSA no mês 6. Os desfechos secundários foram alterações médias da acuidade visual corrigida (BCVA) e espessura foveal central (EFC) ao exame de tomografia de coerência óptica, até o mês 12. Resultados: NSA ocorreu em oito (22,86%) olhos, cinco (62,50%) olhos no grupo sham e três (37,50%) olhos no grupo tratado com injeções intravítreas de Triamcinolona, Não houve nenhum caso com NSA no grupo tratado com bevacizumab durante 12 meses de acompanhamento (p=0,009). A BCVA apresentou diferença estatisticamente significante (p<0,05) entre os grupos, somente no mês 1. A EFC não apresentou diferenças estatisticamente significantes (p<0,05) entre os grupos ao longo dos 12 meses. GNV ocorreu em um olho apesar do tratamento com laser e este paciente necessitou de intervenção cirúrgica. Conclusão: O tratamento precoce com injeções intravítreas de Anti VEGF podem diminuir as taxas de neovascularização do segmento anterior e glaucoma neovascular após oclusão de veia central da retina.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Triamcinolone Acetonide/administration & dosage , Macular Edema/drug therapy , Angiogenesis Inhibitors/administration & dosage , Bevacizumab/administration & dosage , Anti-Inflammatory Agents/administration & dosage , Neovascularization, Pathologic/epidemiology , Retinal Artery Occlusion/complications , Visual Acuity , Glaucoma, Neovascular/drug therapy , Macular Edema/etiology , Double-Blind Method , Incidence , Prospective Studies , Follow-Up Studies , Angiogenesis Inhibitors/adverse effects , Intravitreal Injections , Bevacizumab/adverse effects , Fovea Centralis/physiopathology , Anterior Eye Segment/blood supply , Anti-Inflammatory Agents/adverse effects , Neovascularization, Pathologic/etiologyABSTRACT
BACKGROUND: Ocular ischemic syndrome is a devastating eye disease caused by severe carotid artery stenosis. The reduction of blood flow produced by bilateral common carotid artery occlusion (BCCAO) of rats for 7 days induces events related to gliosis with no evident histological damage. However, retinal degeneration and cellular death occur after 90 days of BCCAO. Our purpose has been to investigate the effects of BCCAO for 30 days in the retina of adult rats. METHODS: Adult Wistar rats were submitted to BCCAO or sham surgery. Both direct and consensual pupillary light reflexes were investigated before and after surgery, everyday for the first week and weekly for 30 days. After 1 month, eyes were enucleated and embedded in paraffin. The retinal ganglion cell (RGC) density and thickness of the internal plexiform (IPL), internal nuclear, outer plexiform, and outer nuclear layers were estimated. RESULTS: Four rats of the BCCAO group (50%) lost the direct pupillary reflex in both eyes, three rats (37%) lost this reflex in one eye, and only one (13%) maintained it in both eyes. RGC density (cells/mm) was diminished in the BCCAO group, and a significant decrease was found in the total retina and IPL thickness; however, no changes were evident in the other layers. BCCAO pupillary-reflex-negative rats presented with a significant decrease in total retinal thickness and retinal ganglion cell density compared with the sham group. Both BCCAO pupillary-reflex-positive) and -negative rats showed a decrease in IPL compared with the sham group. CONCLUSION: This study demonstrates that BCCAO for 30 days induces functional and morphological damage to the retina with loss of the pupillary reflex and a decrease in IPL thickness and RGC number. We suggest that this protocol might be used as a model for ocular ischemic syndrome in the rat.
Subject(s)
Anterior Eye Segment/blood supply , Carotid Artery, Common/pathology , Carotid Stenosis/complications , Disease Models, Animal , Ischemia/etiology , Retinal Degeneration/etiology , Retinal Vessels/physiology , Animals , Cell Count , Cell Death , Chronic Disease , Gliosis/etiology , Gliosis/pathology , Ischemia/physiopathology , Male , Rats , Rats, Wistar , Reflex, Pupillary/physiology , Retinal Degeneration/physiopathology , Retinal Ganglion Cells/pathology , SyndromeABSTRACT
A etiologia da neuropatia óptica isquêmica anterior (NOIA) foi estudada em 328 pacientes consecutivos, examinados num período de 13 anos.A forma arterítica, causada especificamente pela arterite de células gigantes (NOIA-A), foi observada em 7,6 por cento dos casos, enquanto a forma näo arterítica (MOIA-NA) foi dividida no grupo idiopático (57,6 por cento) e no grupo de causas determinadas (34,8 por cento). Distúrbios hemodinâmicos de diferentes causas, embolias de origem cardíaca e arterial, distúrbios hematológicos trombogênicos, distúrbios oculares, doenças do tecido conectivo, sífilis, irradiaçäo, doença de Raynaud, uso de amiodarona, diabetes juvenil, e manipulaçäo cirúrgica foram encontrados como causa da NOIA-NA. Os achados do presente estudo foram comparados com os relatados na literatura. Este estudo demonstra que a etiologia da NOIA é extremamente diversa, justificando portanto extensa propedêutica no sentido de identificar os fatores causais e instituir a adequada abordagem terapêutica e profilática
Subject(s)
Humans , Male , Female , Aged , Anterior Eye Segment/blood supply , Ischemia/physiopathology , Optic Nerve/blood supply , Vision Disorders/diagnosis , Visual AcuityABSTRACT
Realizamos estudio oftalmológico de los prematuros ingresados en el servicio de neonatología de abril a agosto de 1983 en el Hospital "Enrique Cabrera". El estudio oftalmológico se dirigió a determinar la vascularización del segmento anterior en los ojos de los pretérminos y tiempo de desaparición. Se realizó una nueva clalificación de dicha vascularización. Se correlacionó el grado de vascularización encontrado con la edad gestacional de los prematuros y se comprobó que dicha vascularización guarda íntima relación con la maduración del prematuro