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1.
Eye (Lond) ; 36(8): 1610-1614, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-34290443

RESUMO

OBJECTIVES: To analyse the changes in reported frequency of retinal detachment admissions and vitreo-retinal surgery procedures performed between 2000 and 2018 in England. To obtain information useful to contribute towards the planning of service delivery. METHODS: Analysis of England's Hospital Episode Statistics from the Health and Social Care Information Centre and population data from the United Kingdom's Office for National Statistics. RESULTS: Episodes of 'retinal detachments with breaks' increased year on year from 3447 (7.0/100 M) in 2000 to 10,971 (19.7/100 M) in 2018 (p < 0.001), whereas records of 'tractional retinal detachment' increased from 290 (0.6/100 M) to 910 (1.6/100 M) in the same period (p < 0.0001). The number of reported pars plana vitrectomies irrespective of indication increased over fourfold from 5761 to 26,900 (p < 0.0001), while the number of scleral buckling records decreased by two thirds from 2897 to 780 (p < 0.0001). During the same period, the population of England increased from 49.2 to 55.6 million, proportionally at a slower rate than that for recorded hospital episodes. CONCLUSIONS: The frequency of admissions to hospital for surgically treated retinal detachment seems to have been increasing significantly since 2000. This effect is more marked in cases of rhegmatogenous retinal detachment. This may be explained by increased incidence of disease (due to increased rates of cataract surgery, increasing longevity and increasing rates of myopia) as well as repeat surgery in cases of recurrent retinal detachment. Other factors which may play a role include improvements in patient access, increased public awareness and improved local coding and reporting practice.


Assuntos
Oftalmologia , Descolamento Retiniano , Hospitais , Humanos , Descolamento Retiniano/epidemiologia , Descolamento Retiniano/etiologia , Descolamento Retiniano/cirurgia , Estudos Retrospectivos , Recurvamento da Esclera/efeitos adversos , Resultado do Tratamento , Vitrectomia/métodos
3.
Eye (Lond) ; 33(2): 274-282, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30382236

RESUMO

Optical coherence tomography angiography (OCTA) is a non-invasive retinal imaging innovation that has been gaining popularity for the evaluation of the retinal vasculature. Of clinical importance is its current use either as an alternative or in conjunction with conventional dye-based angiography in neovascular age-related macular degeneration. OCTA is not without limitations and these include image artefact, a relatively small field of view and failure of the segmentation algorithms, which can confound the interpretation of findings. While there are numerous publications on OCTA in neovascular AMD, few have examined the diagnostic accuracy of this new technology compared with the accepted gold standard of fundus fluorescein angiography (FFA). In this review, we summarise the literature on the clinical application of OCTA in nAMD. In particular, we have reviewed the published articles that have reported the sensitivity and specificity of OCTA in the diagnosis of nAMD, and those that have described and or correlated the morphological findings and compared them to dye-based angiography.


Assuntos
Neovascularização de Coroide/diagnóstico , Angiofluoresceinografia/métodos , Tomografia de Coerência Óptica/métodos , Degeneração Macular Exsudativa/diagnóstico , Inibidores da Angiogênese/uso terapêutico , Neovascularização de Coroide/tratamento farmacológico , Humanos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Acuidade Visual/fisiologia , Degeneração Macular Exsudativa/tratamento farmacológico
5.
Am J Ophthalmol Case Rep ; 8: 25-27, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29260111

RESUMO

PURPOSE: We report a case of corneal endothelial graft failure secondary to dexamethasone intravitreal implant (Ozurdex™) migration into the anterior chamber (AC). OBSERVATIONS: A 53-year-old man with a history of bilateral idiopathic chronic uveitis, had a right anterior vitrectomy and AC intraocular lens (ACIOL) with a peripheral iridotomy. He received an intravitreal Ozurdex™ implant for right cystoid macular oedema (CMO). Three months later he developed pseudophakic bullous keratopathy and underwent a Descemet stripping automated endothelial keratoplasty (DSAEK), combined with IOL exchange (ACIOL explantation followed by scleral fixated posterior chamber IOL). He developed recurrent CMO post-operatively, for which he had a second Ozurdex™ implant. Six weeks following the implant he presented with reduced vision and corneal graft failure with migration of the Ozurdex™ implant into the AC. Despite prompt surgical removal of the implant, the graft did not recover and he underwent a repeat DSAEK. CONCLUSIONS AND IMPORTANCE: Ophthalmologists should be aware of this adverse event and the importance of early implant removal to reduce the risk of permanent corneal oedema.

6.
Graefes Arch Clin Exp Ophthalmol ; 254(12): 2333-2338, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27278373

RESUMO

PURPOSE: To describe the characteristics and outcomes of patients presenting with rhegmatogenous retinal detachment (RRD) after ocriplasmin (OCP) injection. METHODS: Retrospective, multi-centre, observational case series with case note review. RESULTS: Eight patients with symptomatic vitreomacular traction (six with concomitant macular hole) were diagnosed with RRD after a median of 16 days (range 3-131 days) post-OCP injection. Presentation was within 3 weeks of the OCP injection in six of the cases. Five patients presented with symptoms post-OCP, and three were diagnosed asymptomatically on planned visits. Seven cases were phakic, one had high myopia (>8 dioptres), and two cases had lattice degeneration. Following RRD surgery, hole closure was achieved in 5/6 MH cases. The final median BCVA at 7 months was 20/80 (range 20/40-20/1200) similar to the baseline BCVA 20/80, with four patients gaining ≥1 line of vision compared to baseline but three losing ≥3 lines. CONCLUSIONS: RRD is a non-negligible risk associated with intravitreal OCP, and it should be used with caution in eyes with high myopia and peripheral retinal pathology predisposing to RRD. Detailed peripheral retinal examination is recommended pre- and postoperatively at all visits. Patients should be advised to seek attention if symptoms recur after initial presentation.


Assuntos
Fibrinolisina/efeitos adversos , Fragmentos de Peptídeos/efeitos adversos , Retina/patologia , Descolamento Retiniano/induzido quimicamente , Acuidade Visual , Idoso , Feminino , Fibrinolisina/administração & dosagem , Seguimentos , Humanos , Injeções Intravítreas , Masculino , Pessoa de Meia-Idade , Fragmentos de Peptídeos/administração & dosagem , Prognóstico , Retina/efeitos dos fármacos , Descolamento Retiniano/diagnóstico , Perfurações Retinianas/diagnóstico , Perfurações Retinianas/tratamento farmacológico , Estudos Retrospectivos , Tomografia de Coerência Óptica/métodos , Descolamento do Vítreo/diagnóstico , Descolamento do Vítreo/tratamento farmacológico
7.
Clin Ophthalmol ; 10: 97-116, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26834454

RESUMO

This review evaluates the current surgical options for the management of idiopathic macular holes (IMHs), including vitrectomy, ocriplasmin (OCP), and expansile gas use, and discusses key background information to inform the choice of treatment. An evidence-based approach to selecting the best treatment option for the individual patient based on IMH characteristics and patient-specific factors is suggested. For holes without vitreomacular attachment (VMA), vitrectomy is the only option with three key surgical variables: whether to peel the inner limiting membrane (ILM), the type of tamponade agent to be used, and the requirement for postoperative face-down posturing. There is a general consensus that ILM peeling improves primary anatomical hole closure rate; however, in small holes (<250 µm), it is uncertain whether peeling is always required. It has been increasingly recognized that long-acting gas and face-down positioning are not always necessary in patients with small- and medium-sized holes, but large (>400 µm) and chronic holes (>1-year history) are usually treated with long-acting gas and posturing. Several studies on posturing and gas choice were carried out in combination with ILM peeling, which may also influence the gas and posturing requirement. Combined phacovitrectomy appears to offer more rapid visual recovery without affecting the long-term outcomes of vitrectomy for IMH. OCP is licensed for use in patients with small- or medium-sized holes and VMA. A greater success rate in using OCP has been reported in smaller holes, but further predictive factors for its success are needed to refine its use. It is important to counsel patients realistically regarding the rates of success with intravitreal OCP and its potential complications. Expansile gas can be considered as a further option in small holes with VMA; however, larger studies are required to provide guidance on its use.

8.
Ophthalmologica ; 233(3-4): 216-21, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25765054

RESUMO

AIMS: Analysis of pre-operative spectral domain optical coherence tomography (SD-OCT) characteristics of full-thickness macular holes (FTMH) and effect on optimum management. METHODS: We retrospectively reviewed SD-OCT characteristics of a consecutive cohort of patients waitlisted for FTMH surgery and categorized them by current evidence-based treatments. RESULTS: Out of the 106 holes analysed, 36 were small, 40 medium and 30 large. Initially, 33 holes had vitreomacular adhesion (VMA). 41 holes were analysed for change in characteristics with a median duration of 8 weeks between the scans. The number of small or medium holes decreased from 20 to 6 and that of large holes doubled. The number of holes with VMA halved. Smaller hole size (p = 0.014) and being phakic (p = 0.048) were associated with a larger increase in size. The strongest predictor of hole progression into a different surgical management category was the presence of VMA. CONCLUSION: FTMH characteristics can change significantly pre-operatively and affect optimal treatment choice.


Assuntos
Perfurações Retinianas/diagnóstico , Perfurações Retinianas/cirurgia , Vitrectomia , Idoso , Grupos Diagnósticos Relacionados , Progressão da Doença , Feminino , Humanos , Masculino , Período Pré-Operatório , Retina/metabolismo , Estudos Retrospectivos , Aderências Teciduais , Tomografia de Coerência Óptica , Acuidade Visual , Corpo Vítreo/metabolismo , Listas de Espera
9.
Invest Ophthalmol Vis Sci ; 55(9): 5924-31, 2014 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-25125604

RESUMO

PURPOSE: To describe the intraoperative staining pattern of the internal limiting membrane (ILM)-specific dye Brilliant Blue G (BBG) in a cohort of patients with idiopathic macular holes; to analyze the associations of the staining pattern with pre- and postoperative variables and to correlate the staining pattern with transmission electron microscopy (TEM) of the excised ILM. METHODS: Fifty-five consecutive patients were studied. The staining pattern was divided into three subtypes based on the intraoperative appearance. The presence of a narrow rim of nonstaining around the macular hole (MH) edge was noted and measured. In the final 21 patients, the excised ILM was examined with TEM. RESULTS: The pattern of staining observed was categorized as uniform in 33 patients (60%), patchy nonstaining in 17 (31%), and no visible staining in 5 (9%). The staining pattern correlated with the MH stage. In the patients with uniform or patchy staining, a nonstaining rim was observed in 26 (52%) of the 50. The presence of a rim was associated with a greater hole diameter and lower postoperative visual acuity. The stain pattern correlated significantly with the amount of cellular tissue on the vitreous side of the ILM on TEM, with a greater proportion of multicellular layer membranes and new collagen in the incomplete staining groups. CONCLUSIONS: A variety of nonstaining patterns around macular holes can be observed using BBG, and these patterns correlate to the amount of cellular tissue on the vitreous side of the ILM seen histologically. These patterns could be used to guide the ILM peeling requirement or extent in future studies.


Assuntos
Corantes , Membrana Epirretiniana/cirurgia , Perfurações Retinianas/cirurgia , Corantes de Rosanilina , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Membrana Basal/patologia , Membrana Basal/cirurgia , Estudos de Coortes , Membrana Epirretiniana/diagnóstico , Feminino , Humanos , Masculino , Microscopia Eletrônica de Transmissão , Pessoa de Meia-Idade , Perfurações Retinianas/diagnóstico , Vitrectomia/métodos
10.
Clin Ophthalmol ; 8: 813-7, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24812487

RESUMO

SUMMARY: We report a case of previously unsuspected myeloma, presenting with cornea verticillata due to intracorneal paraprotein deposition. HISTORY: An 85-year-old female presented via her optician with a 4-month history of cloudy vision. She had undergone an uneventful bilateral phacoemulsification surgery 7 years earlier. Extensive spiraling corneal epithelial opacification was noted on slit-lamp examination. On further investigation, she was found to have a previously unsuspected low-grade multiple myeloma. We established the nature of the corneal deposits with corneal epithelial biopsy histopathology and electron microscopy. It is very rare for multiple myeloma to present in this fashion. Ophthalmologists should be aware that such a presentation may rarely be due to systemic multiple myeloma.

11.
Am J Physiol Cell Physiol ; 297(5): C1307-17, 2009 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-19741193

RESUMO

Individuals with Type 2 diabetes mellitus (T2DM) are at increased risk of saphenous vein (SV) graft stenosis following coronary artery bypass. Graft stenosis is caused by intimal hyperplasia, a pathology characterized by smooth muscle cell (SMC) proliferation and migration. We hypothesized that SV-SMC from T2DM patients were intrinsically more proliferative and migratory than those from nondiabetic individuals. SV-SMC were cultured from nondiabetic and T2DM patients. Cell morphology (light microscopy, immunocytochemistry), S100A4 expression (real-time RT-PCR, immunoblotting), proliferation (cell counting), migration (Boyden chamber assay), and cell signaling (immunoblotting with phosphorylation state-specific antibodies) were studied. SV-SMC from T2DM patients were morphologically distinct from nondiabetic patients and exhibited a predominantly rhomboid phenotype, accompanied by disrupted F-actin cytoskeleton, disorganized alpha-smooth muscle actin network, and increased focal adhesion formation. However, no differences were observed in expression of the calcium-binding protein S100A4, a marker of rhomboid SMC phenotype, between the two cell populations. T2DM cells were less proliferative in response to fetal calf serum than nondiabetic cells, but both populations had similar proliferative responses to insulin plus PDGF. Under high glucose concentration conditions in the presence of insulin, migration of diabetic SV-SMC was greater than nondiabetic cells. Glucose concentration did not affect SV-SMC proliferation. No differences in insulin or PDGF-induced phosphorylation of ERK-1/2 or components of the Akt pathway (Akt-Ser473, Akt-Thr308, and GSK-3beta) were apparent between the two populations. In conclusion, SV-SMC from T2DM patients differ from nondiabetic SV-SMC in that they exhibit a rhomboid phenotype and are more migratory, but less proliferative, in response to serum.


Assuntos
Movimento Celular , Proliferação de Células , Diabetes Mellitus Tipo 2/metabolismo , Diabetes Mellitus Tipo 2/patologia , Miócitos de Músculo Liso/metabolismo , Miócitos de Músculo Liso/patologia , Adulto , Idoso , Western Blotting , Células Cultivadas , MAP Quinases Reguladas por Sinal Extracelular/metabolismo , Feminino , Imunofluorescência , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Músculo Liso Vascular/metabolismo , Músculo Liso Vascular/patologia , Proteínas Proto-Oncogênicas c-akt/metabolismo , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Proteína A4 de Ligação a Cálcio da Família S100 , Proteínas S100/biossíntese , Veia Safena/metabolismo , Veia Safena/patologia , Transdução de Sinais/fisiologia
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