Serous maculopathy with absence of retinal pigment epithelium (SMARPE) associated with large drusen.

PURPOSE: To describe the association of serous maculopathy with absence of retinal pigment epithelium (SMARPE) and large drusen in patients with non-neovascular age-related macular degeneration (AMD). METHODS: A retrospective study of ophthalmic examination and multimodal imaging data of individuals with SMARPE and large drusen observed over a period of 12-month was accomplished. SMARPE was defined as subretinal accumulation of fluid within the macular area due to retinal pigment epithelium (RPE) aperture. Large drusen were identified by the presence of sub-RPE deposits using multimodal imaging analysis (color fundus photography, fundus autofluorescence, and spectral-domain optical coherence tomography). RESULTS: Twelve eyes of 7 white patients with a mean age of 77 years were observed to have SMARPE associated with large drusen. The median visual acuity was 20/100. Bilateral SMARPE lesions were observed in 71% of study patients. All SMARPE lesions were hypoautofluorescent, located in the subretinal space between the RPE and the ellipsoid zone, and presented as complete or incomplete RPE apertures associated with subretinal fluid. The SMARPE in this study had coincident multimodal imaging features as the SMARPE described in other reports in the literature. CONCLUSIONS: Bilateral SMARPE can occur in association with typical AMD large drusen. Anomalisms resulting in drusen biogenesis or mechanisms that act alongside to these may be related to SMARPE development.

Applicability of portable retinal cameras and telemedicine as facilitating tools in screening diabetic retinopathy in the COVID-19 pandemic scenario / Aplicabilidade do retinógrafo portátil e telemedicina como ferramentas facilitadoras na triagem de retinopatia diabética no cenário de pandemia de COVID-19

ABSTRACT Purpose: Diabetes mellitus is a leading cause of impaired vision. The objective of this study was to evaluate the feasibility of use of portable retinograph and remote analysis of images along with a virtual questionnaire for screening for diabetic retinopathy in basic health units in the city of Ribeirão Preto/SP during the Covid-19 pandemic. Methods: Standard Covid-19 protocol was followed during the screening. Blood pressure and capillary blood glucose were measured. Demographic and social data were collected through a standardized online questionnaire via smartphone. After pupillary dilation, fundal images were obtained with portable retinographs by trained ophthalmology residents. Two standardized 45° images were acquired: one posterior segment and another nasal to the optic nerve. Diabetic retinopathy was classified according to the Early Treatment Diabetic Retinopathy Study. Results: A total of 350 patients (64% female; 45% aged 55-70 years; 55% Caucasian) were evaluated. For 40.5% of patients, the campaign was the first opportunity for retinal evaluation; 47.56% had diabetes mellitus for >10 years. On repeat analysis of images stored in a cloud-based repository by retinal specialist, a 7.8% difference was observed in the Early Treatment Diabetic Retinopathy Study diabetic retinopathy classification, compared to the screening findings. Mild diabetic retinopathy was observed in 12.23%, moderate diabetic retinopathy in 6.31%, and proliferative diabetic retinopathy in 2.58% patients. Macular edema was present in 4.58% patients. Diabetic retinopathy was not detected in 72.78% patients. Conclusion: Use of portable retinographs together with telemedicine can provide efficient alternative to traditional methods for screening and diagnosis of diabetic retinopathy.

RESUMO Objetivo: A diabetes mellitus é considerada uma epidemia global e causa de baixa visual em países em desenvolvimento. Este estudo foi realizado com o objetivo de avaliar a viabilidade do retinógrafo portátil e análise remota de imagens associada a questionário virtual para o rastreio de retinopatia diabética em Unidades Básicas de Saúde da cidade de Ribeirão Preto/SP durante a pandemia de Covid-19. Métodos: Trezentos e sessenta pacientes compareceram a campanha. O acolhimento foi realizado na Unidade Básica de Saúde pela equipe de enfermagem, respeitando medidas de prevenção do Covid-19 Os realizou-se aferição da pressão arterial e glicemia capilar seguida de dilatação. Dados demográficos e sociais foram coletados através de questionário on-line padronizado via smartphone e realizou-se a triagem da retinopatia diabética através da obtenção de imagens com retinógrafos portáteis realizados por residentes de oftalmologia previamente treinados, com a aquisição de 2 imagens padronizadas de 45º: uma do segmento posterior e outra nasal ao nervo óptico. Resultados: Trezentos e sessenta pacientes foram atendidos durante a campanha. Dez pacientes (1,02%) foram excluídos devido à opacidade de meios e impossibilidade de obtenção de imagens de fundo de olho. Foram avaliados 350 pacientes, 64% do sexo feminino, 45% entre 55 e 70 anos e 55% brancos. A Campanha foi a primeira avaliação de retina para 40,5% dos pacientes e 47,56% apresentavam diabetes mellitus há mais de 10 anos. Na análise comparativa da classificação da retinopatia diabética segundo Early Treatment Diabetic Retinopathy Study (triagem X Nuvem) observou-se uma diferença de 7,8% nos resultados. Retinopatia diabética leve foi observada em 12,23%, moderada em 6,31%, proliferativa em 2,58%; edema macular presente em 4,58% e ausência de retinopatia diabética em 72,78% dos pacientes. Conclusão: A utilização de retinógrafos portáteis juntamente a telemedicina, para o rastreamento da retinopatia diabética pode ser considerada uma alternativa eficiente para triagem e diagnóstico da retinopatia diabética dentro ou fora do cenário pandêmico, auxiliando na prevenção de perda visual pelo diabetes.

Intravitreal bevacizumab plus propranolol for neovascular age-related macular degeneration (the BEVALOL study): a phase I clinical trial.

BACKGROUND: Given the persistently large public health impact of neovascular age-related macular degeneration (nARMD) despite many years of anti-VEGF therapy as the first-line treatment and the demonstrated ability of b-blockers to reduce neovascularization, a synergistic effect between an anti-VEGF agent and an intravitreal beta-blocker is important to investigate in the quest for therapeutic alternatives that maximize efficacy and/or reduce costs. The main purpose of this study is to investigate the safety of a 0.1 ml intravitreal injection of a combination of bevacizumab (1.25 mg/0.05 ml) and propranolol (50 g/0.05 ml) to treat nARMD. METHODS: Prospective phase I clinical trial that included patients with nARMD. Comprehensive ophthalmic evaluation was performed at baseline and included Early Treatment Diabetic Retinopathy Study (ETDRS) best-corrected visual acuity (BCVA), biomicroscopy of the anterior and posterior segments, binocular indirect ophthalmoscopy, color fundus photography, spectral domain optical coherence tomography (OCT), OCT angiography (OCT-A), fluorescein angiography (Spectralis, Heidelberg), and full-field electroretinography (ERG). All eyes were treated with a 0.1 ml intravitreal injection of a combination of bevacizumab (1.25 mg/0.05 ml) and propranolol (50 g/0.05 ml) within 1 week of baseline evaluation. The patients were reexamined at weeks 4, 8 and 12, and clinical evaluation and SD-OCT were performed at all follow-up visits. Additional injections of combination bevacizumab (1.25 mg/0.05 ml) and propranolol (50 g/0.05 ml) were administered at weeks 4 and 8. At the final study evaluation (week 12), color fundus photography, OCT-A, fluorescein angiography, and full-field ERG were repeated. RESULTS: Eleven patients (11 eyes) completed all study visits of the 12 week study. Full field ERG b-waves did not show significant (p < 0.05) changes at week 12 compared to baseline. During the 12 week follow-up period, none of the study eyes developed intraocular inflammation, endophthalmitis or intraocular pressure elevation more than 4 mmHg over baseline. Mean ± SE BCVA (logMAR) was 0.79 ± 0.09 at baseline and was significantly (p < 0.05) improved to 0.61 ± 0.10 at week 4; 0.53 ± 0.10 at week 8; and 0.51 ± 0.09 at week 12. Mean ± SE central subfield thickness (CST) (µm) was 462 ± 45 at baseline and was significantly (p < 0.05) lower at 4, 8 and 12 weeks (385 ± 37; 356 ± 29 and 341 ± 24, respectively). CONCLUSIONS: In this 12 week trial of a combination of intravitreal bevacizumab and propranolol for treatment of nARMD, no adverse events or signals of ocular toxicity were observed. Further studies using this combination therapy are warranted. Trial Registration Project registered in Plataforma Brasil with CAAE number 28108920.0.0000.5440 and approved in ethics committee of Clinics Hospital of Ribeirao Preto Medicine School of São Paulo University-Ribeirão Preto, São Paulo, Brazil (appreciation number 3.999.989 gave the approval).

A slow-release dexamethasone implant for cancer-associated retinopathy / Implante de liberacao lenta de dexametasona para retinopatia associada ao cancer

ABSTRACT This case report aims to show the anatomical and functional results of a patient diagnosed as having cancer-associated retinopathy treated with a controlled-release dexamethasone implant (Ozurdex). Anatomical outcomes were assessed using spectral domain optical coherence tomography; and functional outcomes, by measuring visual acuity, microperimetry, and mutifocal electroretinography. The follow-up period was 1 year.

RESUMO Este relato de caso tem como objetivo mostrar os resultados anatômicos e funcionais de um paciente com diagnóstico de retinopatia associada ao câncer tratado com implante de liberação controlada de dexametasona (Ozurdex®). Os resultados anatômicos foram avaliados por SD-OCT e os resultados funcionais por medida de acuidade visual, microperimetria e eletrorretinograma multifocal. O período de acompanhamento foi de um ano.

Recurrent optic disc pit maculopathy due to Valsalva's maneuver.

PURPOSE: We report a patient with recurrent optic disc pit maculopathy after Valsalva's maneuver and discuss its pathophysiology. We also hypothesize the role of Valsalva's maneuver in its genesis. METHOD: Case report of one patient, male, 12 years old. RESULTS: Serous retinal detachment may occur in association with the optic disc pit, a developmental anomaly of the optic nerve head. Histopathologically, it consists of a dysplastic retina herniation into a pocket extending posteriorly through a defect in the lamina cribrosa into the subarachnoid space. These three different compartments - intraocular space, optic nerve head and subarachnoid space - and the dynamic interactions among them should be understood as the key factors for the occurrence of optic disc pit-related serous retinal detachment. CONCLUSION: Based on the possibility that serous retinal detachment secondary to the ODP could be related to the Valsalva's maneuver, we strongly recommend that patients with ODP be advised to avoid intense physical or work activities that may increase abdominal, thoracic and cerebral pressure, and to refrain from playing wind instruments in order to avoid pre, per and post treatment intercurrences.

A slow-release dexamethasone implant for cancer-associated retinopathy.

This case report aims to show the anatomical and functional results of a patient diagnosed as having cancer-associated retinopathy treated with a controlled-release dexamethasone implant (Ozurdex). Anatomical outcomes were assessed using spectral domain optical coherence tomography; and functional outcomes, by measuring visual acuity, microperimetry, and mutifocal electroretinography. The follow-up period was 1 year.

Applicability of portable retinal cameras and telemedicine as facilitating tools in screening diabetic retinopathy in the COVID-19 pandemic scenario.

PURPOSE: Diabetes mellitus is a leading cause of impaired vision. The objective of this study was to evaluate the feasibility of use of portable retinograph and remote analysis of images along with a virtual questionnaire for screening for diabetic retinopathy in basic health units in the city of Ribeirão Preto/SP during the Covid-19 pandemic. METHODS: Standard Covid-19 protocol was followed during the screening. Blood pressure and capillary blood glucose were measured. Demographic and social data were collected through a standardized online questionnaire via smartphone. After pupillary dilation, fundal images were obtained with portable retinographs by trained ophthalmology residents. Two standardized 45° images were acquired: one posterior segment and another nasal to the optic nerve. Diabetic retinopathy was classified according to the Early Treatment Diabetic Retinopathy Study. RESULTS: A total of 350 patients (64% female; 45% aged 55-70 years; 55% Caucasian) were evaluated. For 40.5% of patients, the campaign was the first opportunity for retinal evaluation; 47.56% had diabetes mellitus for >10 years. On repeat analysis of images stored in a cloud-based repository by retinal specialist, a 7.8% difference was observed in the Early Treatment Diabetic Retinopathy Study diabetic retinopathy classification, compared to the screening findings. Mild diabetic retinopathy was observed in 12.23%, moderate diabetic retinopathy in 6.31%, and proliferative diabetic retinopathy in 2.58% patients. Macular edema was present in 4.58% patients. Diabetic retinopathy was not detected in 72.78% patients. CONCLUSION: Use of portable retinographs together with telemedicine can provide efficient alternative to traditional methods for screening and diagnosis of diabetic retinopathy.

A case of permanent vision loss due to a carotidcavernous fistula: importance of early diagnosis / Relato de caso de perda visual secundária a fístuda carótido-cavernosa: a importância de um diagnóstico adequado

ABSTRACT A 97-year-old female presented with spontaneous acute-onset palpebral hyperemia and edema of the right eye that had progressively worsen over the previous three days. These signs did not suggest possible carotid-cavernous fistula until a second examination 72 h later, during which the patient exhibited significant progression. Despite embolization, the patient exhibited sustained corneal edema, clots, and turbidity in the aqueous humor, which resulted in permanent visual loss. A greater level of clinical suspicion for possible carotid-cavernous fistula is warranted on initial presentation of palpebral hyperemia and edema to prevent possible irreversible vision loss.

RESUMO O objetivo deste relato é apresentar o caso de uma paciente de 97 anos com início agudo e espontâneo de hiperemia e edema palpebral. Estes sinais não levaram a uma suspeita diagnóstica de fístula carótido-cavernosa até um segundo momento, quando a paciente apresentou progressão importante do quadro clínico. Apesar da realização de tratamento efetivo com embolização da fístula, a paciente manteve alterações oculares como edema de córnea, coágulos e turvação no humor aquoso, e manteve perda visual definitiva.

A case of permanent vision loss due to a carotidcavernous fistula: importance of early diagnosis.

A 97-year-old female presented with spontaneous acute-onset palpebral hyperemia and edema of the right eye that had progressively worsen over the previous three days. These signs did not suggest possible carotid-cavernous fistula until a second examination 72 h later, during which the patient exhibited significant progression. Despite embolization, the patient exhibited sustained corneal edema, clots, and turbidity in the aqueous humor, which resulted in permanent visual loss. A greater level of clinical suspicion for possible carotid-cavernous fistula is warranted on initial presentation of palpebral hyperemia and edema to prevent possible irreversible vision loss.

Use of an ultra-clean air flow for surgical field asepsis when performing intravitreous injections in an ambulatory surgical environment.

BACKGROUND: Intravitreal injection of medications is one of the most common procedures performed in ophthalmology. Intravitreal anti-VEGF agents are currently the chosen treatment for ocular fundus diseases, including age-related macular degeneration and diabetic retinopathy. As an invasive procedure it involves risks. The most serious complication from intravitreal injection of anti-VEGF agents is endophthalmitis (EO). Although rare, EO can result in devastating loss of vision. This article evaluates whether the use of an ultra-clean air flow (UA) can be another useful tool in the prevention of EOs. Accordingly, the maintenance of asepsis of the surgical field of intravitreal injections was verified with and without the use of UA. METHODS: The study was conducted in operating room of an ambulatory surgery center on four different surgical days when just intravitreal injections were scheduled. Two experiments using two Blood Agar and two Chocolate Agar plates (first 2 days; 4 plates by day) were carried out by positioning an UA directed to the surgical table and two other experiments (last 2 days; 4 plates per day) were carried out using similar plates without the use of the UA. All Blood Agar and four Chocolate Agar plates were positioned on the surgical table, close to the surgical filed. At the end of the day, after the conclusion of the intravitreous injections, the plates were sent for a biomolecular study that was carried out after 1 day of incubation at 37 °C. RESULTS: The sixteen plates, eight Blood Agar and eight Chocolate Agar, were analyzed qualitatively for the growth or not of microorganism's colonies and identification of their species. The biomolecular study demonstrated the growth of bacteria of the genus Micrococcus sp. with the use of the UA and without the the UA bacterias of the genera Bacillus sp, Staphylococcus haemolyticus, Staphylococcus aureus and Staphylococcus cohnii ssp urealyticus were found. CONCLUSION: The use of UA close to the operating table prevented the growth of pathogenic bacteria and should be considered as an alternative tool to avoid the contamination of materials and drugs used for intravitreal injections.

Nível de conhecimento sobre diabetes e perfil epidemiológico dos pacientes diabéticos atendidos no Hospital Electro Bonini de Ribeirão Preto/SP / Level of knowledge about diabetes and epidemiological profile of diabetic patients attended in the Hospital Electron Bonini in Ribeirão Preto/SP

Avaliamos o perfil epidemiológico e o conhecimento dos pacientes com diagnóstico de diabetes mellitus (DM) atendidos em ambulatórios na cidade de Ribeirão Preto ­ SP. Trata-se de um estudo de pesquisa básica, de campo, quantitativa, transversal, observacional e descritiva, realizada por entrevista estruturada. O instrumento da pesquisa foi constituído de um questionário, com perguntas objetivas. A amostra total foi composta de 191 participantes. Quanto ao grau de escolaridade, apenas 13,1% apresentaram curso superior, 63,9% cursaram apenas o ensino fundamental e 23% o ensino médio. Em relação ao tempo de doença, 22 tiveram o diagnóstico há menos de um ano, 62 entre 2-5 anos, 43 entre 6-10 anos e 64 há mais de 10 anos. Identificamos quanto às consultas pela oftalmologia, que 54% faz avaliação anual, 22% semestral, 12% procuram o oftalmologista somente quando têm queixa visual e 12% relataram ter feito apenas consulta. Sobre as complicações que o DM pode ocasionar, 3,1% relataram impotência sexual, 8,3% infarto agudo do miocárdio, 16,3% falência renal, 15,2% amputação de membros e 57,1% cegueira. Em relação a perguntas sobre o autocuidado, um elevado percentual de pessoas não o realiza de forma adequada. Em conclusão, a maioria dos pacientes, apesar do acompanhamento multidisciplinar, apresentou pouco conhecimento sobre o DM e suas complicações. Para que haja aderência adequada ao tratamento e se possam evitar as complicações relativas ao diabetes, é fundamental a disseminação da informação a respeito da doença e cuidado adequado (AU)

We evaluate the epidemiological profile and knowledge of patients diagnosed with diabetes mellitus (DM) attended at outpatient clinics in the city of Ribeirão Preto - SP. This is a basic, field-based, quantitative, cross-sectional, observational and descriptive study conducted by a structured interview. The research instrument consisted of a questionnaire, with objective questions. The total sample consisted of 191 participants. Of those, only 13.1% had a college degree, 63.9% had complete primary school and 23% had completed high school. Regarding the time of disease, 22 had the diagnosis less than one year, 62 between 2-5 years, 43 between 6-10 years and 64 over 10 years. We identified about ophthalmology consultations, that 54% made an annual evaluation, 22% twice a year, 12% only visited the ophthalmologist when they had a visual complaint and 12% reported having only consulted. Of the complications that DM can cause, 3.1% reported sexual impotence, 8.3% acute myocardial infarction, 16.3% kidney failure, 15.2% limb amputation and 57.1% blindness. Regarding questions about self-care, a high percentage of people do not do it properly. In conclusion, the majority of patients, despite multidisciplinary follow-up, presented little knowledge about DM and its complications. Adequate adherence to treatment and avoidance of complications related to diabetes are essential to the dissemination of information on the disease and adequate care.