Short-term results of early switch from Ranibizumab to Aflibercept in poor or non responder age related macular degeneration in clinical practice.

BACKGROUND: To evaluate the change in best corrected visual acuity (VA) and central macular thickness (CMT) following treatment with intravitreal aflibercept (AFL) in patients poorly responders or non responders to ranibizumab (RBZ). METHODS: Charts of patients injected with RBZ from January 2016 to December 2018 (548 cases) due to neovascular age-related macular degeneration (nAMD) were reviewed. Fifty-six cases met our criteria for poor responders to RBZ (CMT decreased between 5 and 15% over treatment) or for non responders to RBZ (CMT decreased less than 5% or increased over treatment). RESULTS: After the third AFL injection, CMT decreased from 384.38 ± 123.20 µm to 296.18 ± 70.52 µm in the non-responder group and from 320.00 ± 82.05 µm to 282.27 ± 56.86 µm in the poor responder group. Although decrease in macular thickness was overall achieved 3 months after switching to AFL, it was not translated in VA improvement. CONCLUSIONS: it was observed that nAMD patients classified as RBZ non-responders tend to respond better to AFL than RBZ poor-responders anatomically, without correspondent improvement in VA.

Effect of intravitreal anti-VEGF on choroidal thickness in patients with diabetic macular edema using spectral domain OCT.

PURPOSE: To evaluate choroidal thickness (CT) using spectral domain optical coherence tomography (SD-OCT) imaging at baseline and 6 months after intravitreal anti-vascular endothelial growth factor (anti-VEGF) treatment in patients with diabetic macular edema (DME). METHODS: A retrospective chart review was performed to identify patients with DME who underwent intravitreal injection of anti-VEGF (bevacizumab or ranibizumab) in a pro re nata (PRN) regimen. Subfoveal choroidal thickness was compared between values obtained at baseline and at 6-month follow-up visits. RESULTS: Thirty-nine eyes (15 females, 24 males) from 39 patients were enrolled (mean age, 62.43 ± 8.7 years; range, 44-79 years). Twenty-three and 16 eyes were treated with ranibizumab and bevacizumab respectively. The mean number of anti-VEGF injections was 2.28 ± 1.27 (range, 1-5). Mean nasal, subfoveal, and temporal choroidal thickness (CT) measurements at baseline were 234.10 ± 8.63 µm, 246.89 ± 8.94 µm, and 238.12 ± 8.20 µm, respectively, and those at 6 months post-treatment were 210.46 ± 8.00 µm, 215.66 ± 8.29 µm, and 212.43 ± 8.14 µm, respectively. Significant differences in CT were observed between baseline and the 6-month follow-up at all measured points (p=0.0327). CONCLUSIONS: Over a 6-month period, the use of intravitreal anti-VEGF was associated with significant thinning of the choroid in patients with DME. The clinical significance of a thinner choroid in DME is currently unknown; however, it may contribute to long-term adverse effects on choroidal and retinal function, representing an area requiring future investigation.

Effect of intravitreal anti-VEGF on choroidal thickness in patients with diabetic macular edema using spectral domain OCT / Efeito de injeção intravítrea na espessura de coroide em pacientes com edema macular diabético utilizando OCT de domínio espectral

ABSTRACT Purpose: To evaluate choroidal thickness (CT) using spectral domain optical coherence tomography (SD-OCT) imaging at baseline and 6 months after intravitreal anti-vascular endothelial growth factor (anti-VEGF) treatment in patients with diabetic macular edema (DME). Methods: A retrospective chart review was performed to identify patients with DME who underwent intravitreal injection of anti-VEGF (bevacizumab or ranibizumab) in a pro re nata (PRN) regimen. Subfoveal choroidal thickness was compared between values obtained at baseline and at 6-month follow-up visits. Results: Thirty-nine eyes (15 females, 24 males) from 39 patients were enrolled (mean age, 62.43 ± 8.7 years; range, 44-79 years). Twenty-three and 16 eyes were treated with ranibizumab and bevacizumab respectively. The mean number of anti-VEGF injections was 2.28 ± 1.27 (range, 1-5). Mean nasal, subfoveal, and temporal choroidal thickness (CT) measurements at baseline were 234.10 ± 8.63 µm, 246.89 ± 8.94 µm, and 238.12 ± 8.20 µm, respectively, and those at 6 months post-treatment were 210.46 ± 8.00 µm, 215.66 ± 8.29 µm, and 212.43 ± 8.14 µm, respectively. Significant differences in CT were observed between baseline and the 6-month follow-up at all measured points (p=0.0327). Conclusions: Over a 6-month period, the use of intravitreal anti-VEGF was associated with significant thinning of the choroid in patients with DME. The clinical significance of a thinner choroid in DME is currently unknown; however, it may contribute to long-term adverse effects on choroidal and retinal function, representing an area requiring future investigation.

RESUMO Objetivos: Avaliar a espessura de coroide pré-tratamento e após 6 meses da injeção intravítrea de anti-fator de crescimento vascular endotelial (anti-VEGF) em pacientes com edema macular diabético (EMD), utilizando a tomografia de coerência óptica de domínio espectral (SD-OCT). Métodos: Análise retrospectiva, com revisão de prontuários, foi realizada para identificação de pacientes submetidos a tratamento com injeções intravítreas de anti-VEGF, no regime pro re nata, para tratamento de EMD. As medidas da espessura de coroide pré-tratamento foi comparada com as medidas após acompanhamento de 6 meses. Resultados: Trinta e nove olhos de 39 pacientes (15 femininos, 24 masculinos) foram incluídos, com idade média de 62,43 ± 8,7 anos (variando de 44-79 anos). Trinta e três olhos foram tratados com ranibizumab e 18 com bevacizumab. O número médio de injeções de anti-VEGF foi 2,28 ± 1,27 (variando de 1-5). A medida média pré-tratamento da espessura de coroide nasal, subfoveal e temporal foi 234,10 ± 8,63 µm, 246,89 ± 8,94 µm e 238,12± 8,20 µm, respectivamente. Após acompanhamento de 6 meses as medidas médias da espessura de coroide foram 210,46 ± 8,00 µm, 215,66 ± 8,29 µm e 212,43 ± 8,14 µm. A diferença entre as medidas médias pré e pós tratamento foi estatisticamente significante (p=0,0327) em todos os pontos medidos. Conclusão: Após um período de 6 meses, o uso de injeções intravítreas de anti-VEGF foi associado com diminuição significante da espessura de coroide nos pacientes com EMD. O significado clínico de uma coroide mais fina nos pacientes com EMD é desconhecido mas pode causar eventos adversos a longo prazo para função da coroide e retina, representando uma área para futura investigações.

Implante intra-ocular de lentes dobráveis piggyback em paciente portador de catarata congênita no primeiro ano de vida: relato de caso / Piggyback foldable intraocular lens implant in patient with congenital cataract in the first year of life: case report

No presente relato os autores descrevem um caso de catarata congênita unilateral tratada cirurgicamente com implante intra-ocular de lentes dobráveis "piggyback", ainda não descrito na literatura nacional. São analisadas as diferenças e semelhanças com outros casos descritos na literatura.

Resultados visuais e incidência de complicaçöes em facoemulsificaçäo com LIO por residentes / Visual results and complications of phacoemulsifications with intraocular lens implantation performed by residents

Os autores analisaram retrospectivamente a evoluçäo visual e a incidência de complicaçöes em 48 olhos submetidos à facoemulsificaçäo por 4 residentes do terceiro ano. Em todos os casos foi implantada uma lente de 7,0mm de zona óptica com a supervisäo de um assistente. As incidências de rotura de cápsula posterior e perda vítrea foi 6,25 p/cento (2/48) e 10,40 p/cento (5/48), respectivamente. O momento da rotura capsular ocorreu em 60 p/cento dos casos (3 pacientes) durante a emulsificaçäo do núcleo e em 2 (40 p/cento) olhos ao se aspirar o córtex automaticamente. A acuidade visual foi 20/40 em 89,60 p/cento dos casos com folow-up médio de 5,4 meses. Estes resultados säo comparáveis ao desempenho de residentes fazendo extra-capsular publicado em trabalhos anteriores. Nós acreditamos que, com treinamento apropriado e supervisäo de cirurgiöes

Tratamento do Edema Macular Cistóide na Vitreous-Tug Syndrome por vitreólise com ND-YAG Laser / Treatment of CME by Nd-YAG Laser

Este estudo analisa prospectivamente 16 olhos de 16 pacientes com "Adesäo Vítreo-corneana" e edema macular cistóide (EMC). Estes indivíduos foram tratados por vitreólise com ND: YAG Laser, obtendo melhora da acuidade visual em 75 por cento dos casos. Os autores enfatizam também a importância deste tratamento como profilaxia do EMC para estes pacientes.