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1.
Arthritis Rheumatol ; 2019 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-31237427

RESUMO

OBJECTIVE: To compare the efficacy of infliximab (IFX) versus adalimumab (ADA) as first biologic drug in a large series of patients with refractory uveitis due to Behçet's disease (BD) for 1-year period. METHODS: Open-label multicenter study of IFX or ADA-treated patients with BD-uveitis refractory to conventional non-biologic treatment. IFX or ADA were chosen as first biologic treatment based on physician and patient agreement. Dosing schedule was: IFX: 3-5 mg/kg i.v. at 0, 2 and 6 weeks and every 4-8 weeks thereafter, and ADA: 40 mg/s.c./every other week without loading dose. Comparison between patients treated with IFX and patients treated with ADA was performed. RESULTS: 177 patients (316 affected eyes) were included. IFX was used in 103 and ADA in 74 cases. No significant differences at baseline were observed between IFX vs ADA groups regarding main demographic features, previous therapy and ocular severity. After one year of therapy, we observed an improvement in all ocular parameters in both groups. However, ADA therapy yielded better outcome in some parameters that in some cases yielded statistically significant differences: anterior chamber inflammation (78.18% in IFX-treated vs 92.31%in ADA-treated; p=0.06), vitritis (78.95% vs 93.33%; p=0.04), retinal vasculitis (97% vs 95%; p=0.28), macular thickness (264.89±59.74 vs 250.62±36.85; p=0.15), best-corrected visual acuity (0.67±0.34 vs 0.81±0.26; p=0.001), and drug retention (84.95% vs 95.24%; p=0.042). CONCLUSION: Although IFX and ADA yields efficacy refractory BD uveitis, ADA appears to be associated with better outcome than IFX after one-year follow-up. This article is protected by copyright. All rights reserved.

2.
Eur J Ophthalmol ; : 1120672118804795, 2018 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-30295080

RESUMO

We present an unusual case of Sturge-Weber syndrome whose main clinical manifestations were nevus flammeus, seizures, glaucoma, and acoria. To our knowledge, the combination of Sturge-Weber syndrome and acoria has not been previously reported.

3.
Ophthalmology ; 125(9): 1444-1451, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29602570

RESUMO

PURPOSE: To assess efficacy, safety, and cost-effectiveness of adalimumab (ADA) therapy optimization in a large series of patients with uveitis due to Behçet disease (BD) who achieved remission after the use of this biologic agent. DESIGN: Open-label multicenter study of ADA-treated patients with BD uveitis refractory to conventional immunosuppressants. SUBJECTS: Sixty-five of 74 patients with uveitis due to BD, who achieved remission after a median ADA duration of 6 (range, 3-12) months. ADA was optimized in 23 (35.4%) of them. This biologic agent was maintained at a dose of 40 mg/subcutaneously/2 weeks in the remaining 42 patients. METHODS: After remission, based on a shared decision between the patient and the treating physician, ADA was optimized. When agreement between patient and physician was reached, optimization was performed by prolonging the ADA dosing interval progressively. Comparison between optimized and nonoptimized patients was performed. MAIN OUTCOME MEASURES: Efficacy, safety, and cost-effectiveness in optimized and nonoptimized groups. To determine efficacy, intraocular inflammation (anterior chamber cells, vitritis, and retinal vasculitis), macular thickness, visual acuity, and the sparing effect of glucocorticoids were assessed. RESULTS: No demographic or ocular differences were found at the time of ADA onset between the optimized and the nonoptimized groups. Most ocular outcomes were similar after a mean ± standard deviation follow-up of 34.7±13.3 and 26±21.3 months in the optimized and nonoptimized groups, respectively. However, relevant adverse effects were only seen in the nonoptimized group (lymphoma, pneumonia, severe local reaction at the injection site, and bacteremia by Escherichia coli, 1 each). Moreover, the mean ADA treatment costs were lower in the optimized group than in the nonoptimized group (6101.25 euros/patient/year vs. 12 339.48; P < 0.01). CONCLUSION: ADA optimization in BD uveitis refractory to conventional therapy is effective, safe, and cost-effective.

4.
Ocul Immunol Inflamm ; : 1-9, 2017 Nov 20.
Artigo em Inglês | MEDLINE | ID: mdl-29157128

RESUMO

PURPOSE: To report the efficacy of intravitreal bevacizumab (IVB) injection versus intravitreal triamcinolone acetonide (IVT) for persistent non-infectious uveitic cystoid macular edema (CME). METHODS: Interventional retrospective comparative case series evaluated 37 consecutive patients (44 eyes) with completely controlled uveitis and recalcitrant CME. Patients received repeated injections of 1.25 mg of IVB or 4 mg of IVT. RESULTS: Best-corrected visual acuity (BCVA) at baseline and 24 months was logMAR 1 and 0.8 respectively, in the IVB group (p = 0.002) and; logMAR of 1.1 and 0.6, in the IVT group (p = 0.001). Central macular thickness at baseline and 24 months was 399.2 µm and 333.7 µm (p < 0.0009), respectively, for the IVB group and; 464.4 µm and 316.5 µm in the IVT group (p = 0.044). Postoperatively, IOP increased in the IVT group. CONCLUSIONS: Repeated injections with IVT improve BCVA as effectively as repeated injections with IVB in the long-term management of persistent uveitic CME.

6.
J Med Genet ; 54(1): 38-46, 2017 01.
Artigo em Inglês | MEDLINE | ID: mdl-27609017

RESUMO

BACKGROUND: Large-scale genetic studies have reported several loci associated with specific disorders involving uveitis. Our aim was to identify genetic risk factors that might predispose to uveitis per se, independent of the clinical diagnosis, by performing a dense genotyping of immune-related loci. METHODS: 613 cases and 3693 unaffected controls from three European case/control sets were genotyped using the Immunochip array. Only patients with non-infectious non-anterior uveitis and without systemic features were selected. To perform a more comprehensive analysis of the human leucocyte antigen (HLA) region, SNPs, classical alleles and polymorphic amino acid variants were obtained via imputation. A meta-analysis combining the three case/control sets was conducted by the inverse variance method. RESULTS: The highest peak belonged to the HLA region. A more detailed analysis of this signal evidenced a strong association between the classical allele HLA-A*2902 and birdshot chorioretinopathy (p=3.21E-35, OR=50.95). An omnibus test yielded HLA-A 62 and 63 as relevant amino acid positions for this disease. In patients with intermediate and posterior uveitis, the strongest associations belonged to the rs7197 polymorphism, within HLA-DRA (p=2.07E-11, OR=1.99), and the HLA-DR15 haplotype (DRB1*1501: p=1.16E-10, OR=2.08; DQA1*0102: p=4.37E-09, OR=1.77; DQB1*0602: p=7.26E-10, OR=2.02). Outside the HLA region, the MAP4K4/IL1R2 locus reached statistical significance (rs7608679: p=8.38E-07, OR=1.42). Suggestive associations were found at five other loci. CONCLUSIONS: We have further interrogated the association between the HLA region and non-infectious non-anterior uveitis. In addition, we have identified a new non-HLA susceptibility factor and proposed additional risk loci with putative roles in this complex condition.


Assuntos
Uveíte/genética , Alelos , Estudos de Casos e Controles , Grupo com Ancestrais do Continente Europeu/genética , Feminino , Loci Gênicos/genética , Antígenos HLA/genética , Haplótipos/genética , Humanos , Masculino , Pessoa de Meia-Idade , Polimorfismo de Nucleotídeo Único/genética , Fatores de Risco
7.
Retina ; 37(2): 334-343, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27429384

RESUMO

PURPOSE: To evaluate the effects of intravitreal bevacizumab (IVB) on retinal neovascularization in patients with proliferative diabetic retinopathy (PDR). METHODS: Retrospective multicenter interventional case series. A chart review was performed of 81 consecutive patients (97 eyes) with retinal neovascularization due to PDR, who received at least 1 IVB injection. RESULTS: The mean age of the patients was 55.6 ± 11.6 years. The mean number of IVB injections was 4 ± 2.5 injections (range, 1-8 injections) per eye. The mean interval between IVB applications was 3 ± 7 months. The mean duration of follow-up was 29.6 ± 2 months (range, 24-30 months). Best-corrected visual acuity and optical coherence tomography improved statistically significantly (P < 0.0001, both comparisons). Three eyes without previous panretinal photocoagulation ("naive" eyes) and with vitreous hemorrhage did not require vitreoretinal surgery. Five (5.2%) eyes with PDR progressed to tractional retinal detachment requiring vitrectomy. No systemic adverse events were noted. CONCLUSION: Intravitreal bevacizumab resulted in marked regression of retinal neovascularization in patients with PDR and previous panretinal photocoagulation. Intravitreal bevacizumab in naive eyes resulted in control or regression of 42.1% of eyes without adjunctive laser or vitrectomy during 24 months of follow-up. There were no safety concerns during the 2 years of follow-up of IVB for PDR.


Assuntos
Inibidores da Angiogênese/administração & dosagem , Bevacizumab/administração & dosagem , Retinopatia Diabética/tratamento farmacológico , Neovascularização Retiniana/tratamento farmacológico , Adulto , Idoso , Retinopatia Diabética/fisiopatologia , Feminino , Seguimentos , Humanos , Injeções Intravítreas , Masculino , Pessoa de Meia-Idade , Neovascularização Retiniana/fisiopatologia , Estudos Retrospectivos , Tomografia de Coerência Óptica , Estados Unidos , Acuidade Visual , Vitrectomia
8.
J AAPOS ; 20(3): 232-238.e1, 2016 06.
Artigo em Inglês | MEDLINE | ID: mdl-27164426

RESUMO

PURPOSE: To analyze factors predictive of having treatment-resistant uveitis in patients with juvenile idiopathic arthritis (JIA)-associated uveitis. METHODS: The medical records of patients diagnosed with JIA-associated uveitis treated at a single tertiary referral center from October 2005 to March 2013 were reviewed retrospectively. The main outcome measures were demographic characteristics, ocular comorbidity, clinical course, treatments, and baseline risk factors associated with poor response to first-line therapies. RESULTS: A total of 96 patients (175 eyes) were included. Of these, 58 patients (108 eyes) required biologic disease-modifying antirheumatic drugs or alkylating agents for their uveitis during follow-up (recalcitrant group), and 38 patients (67 eyes) did not (nonrecalcitrant group). Eyes of the recalcitrant group tended to have a higher incidence of cataract at baseline (49%; P < 0.0001). In the nonrecalcitrant group, the most frequent complications were cataract (20.9%) and secondary glaucoma (20.9%). The mean number of flares in the recalcitrant group was significantly reduced from 3.7/eye/year prior to cataract surgery to 1.6/eye/year after (P < 0.0001). Nuclear cataract was found to be an independent predictor for a severe course of JIA-associated uveitis. Any other type of cataract, posterior synechiae, male sex, or active uveitis at baseline were not found to be independently associated with recalcitrant uveitis. CONCLUSIONS: Nuclear cataract at baseline evaluation is a risk factor for poor response to first-line therapies in JIA-associated uveitis patients.


Assuntos
Artrite Juvenil/diagnóstico , Catarata/congênito , Uveíte/diagnóstico , Antirreumáticos/uso terapêutico , Artrite Juvenil/tratamento farmacológico , Catarata/diagnóstico , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Masculino , Estudos Retrospectivos , Fatores de Risco , Uveíte/tratamento farmacológico , Acuidade Visual/fisiologia
9.
J Cell Mol Med ; 20(8): 1457-66, 2016 08.
Artigo em Inglês | MEDLINE | ID: mdl-26999719

RESUMO

The retinal pigment epithelium (RPE), a monolayer located between the photoreceptors and the choroid, is constantly damaged by oxidative stress, particularly because of reactive oxygen species (ROS). As the RPE, because of its physiological functions, is essential for the survival of the retina, any sustained damage may consequently lead to loss of vision. Exosomes are small membranous vesicles released into the extracellular medium by numerous cell types, including RPE cells. Their cargo includes genetic material and proteins, making these vesicles essential for cell-to-cell communication. Exosomes may fuse with neighbouring cells influencing their fate. It has been observed that RPE cells release higher amounts of exosomes when they are under oxidative stress. Exosomes derived from cultured RPE cells were isolated by ultracentrifugation and quantified by flow cytometry. VEGF receptors (VEGFR) were analysed by both flow cytometry and Western blot. RT-PCR and qPCR were conducted to assess mRNA content of VEGFRs in exosomes. Neovascularization assays were performed after applying RPE exosomes into endothelial cell cultures. Our results showed that stressed RPE cells released a higher amount of exosomes than controls, with a higher expression of VEGFR in the membrane, and enclosed an extra cargo of VEGFR mRNA. Angiogenesis assays confirmed that endothelial cells increased their tube formation capacity when exposed to stressed RPE exosomes.


Assuntos
Exossomos/metabolismo , Células Endoteliais da Veia Umbilical Humana/metabolismo , Neovascularização Fisiológica , Estresse Oxidativo , Epitélio Pigmentado da Retina/patologia , Linhagem Celular , Etanol/farmacologia , Exossomos/efeitos dos fármacos , Exossomos/ultraestrutura , Células Endoteliais da Veia Umbilical Humana/efeitos dos fármacos , Humanos , Neovascularização Fisiológica/efeitos dos fármacos , Estresse Oxidativo/efeitos dos fármacos , RNA Mensageiro/genética , RNA Mensageiro/metabolismo , Receptores de Fatores de Crescimento do Endotélio Vascular/metabolismo , Fator A de Crescimento do Endotélio Vascular/metabolismo
10.
Retina ; 36(5): 859-67, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-26529555

RESUMO

PURPOSE: To report the long-term anatomical and functional outcomes of patients with choroidal neovascularization secondary to age-related macular degeneration treated with intravitreal bevacizumab (IVB). METHODS: Retrospective case series. Patients diagnosed with subfoveal choroidal neovascularization secondary to age-related macular degeneration that were treated with at least 1 intravitreal injection of 1.25 mg of IVB and had a minimum follow-up of 60 months. Patients underwent best-corrected Snellen visual acuity testing, optical coherence tomography, and ophthalmoscopic examination at baseline and follow-up visits. RESULTS: Two hundred and forty-seven consecutive patients (292 eyes) were included. The mean number of IVB injections per eye was 10.9 ± 6.4. At 5 years, the BCVA decreased from 20/150 (logMAR 0.9 ± 0.6) at baseline to 20/250 (logMAR 1.1 ± 0.7) (P = <0.0001). The mean CMT decreased from 343.1+ 122.3 µm at baseline to 314.7 ± 128.8 µm at 60 months of follow-up (P = 0.009). Geographic atrophy (GA) was observed at baseline in 47 (16%) of 292 eyes. By 5 years, GA developed or progressed in 124 (42.5%) of 292 eyes (P < 0.0001). CONCLUSION: The early visual gains obtained from IVB were not maintained at 5 years of follow-up. In addition, IVB may play a role in the development or progression of GA.


Assuntos
Inibidores da Angiogênese/uso terapêutico , Bevacizumab/uso terapêutico , Neovascularização de Coroide/tratamento farmacológico , Degeneração Macular/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Neovascularização de Coroide/etiologia , Feminino , Angiofluoresceinografia , Atrofia Geográfica/diagnóstico , Humanos , Injeções Intravítreas , Degeneração Macular/complicações , Masculino , Pessoa de Meia-Idade , Oftalmoscopia , Estudos Retrospectivos , Tomografia de Coerência Óptica , Resultado do Tratamento , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Acuidade Visual/fisiologia
11.
Retina ; 36(1): 131-6, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26079477

RESUMO

PURPOSE: To evaluate the safety and efficacy of intravitreal dexamethasone implant (Ozurdex) for treating refractory macular edema in retinal vascular diseases. METHODS: This is a retrospective consecutive series of 53 eyes with refractory macular edema secondary to central retinal vein occlusion (13 eyes), branch retinal vein occlusion (14 eyes), and diabetic macular edema (26 eyes) treated with a single 0.7 mg dexamethasone implant. Data were collected on best-corrected visual acuity, intraocular pressure, and central macular thickness preoperatively and at 1, 3, and 6 months postoperatively. RESULTS: Baseline best-corrected visual acuity was 20/160 and improved statistically significantly to 20/80 and 20/60 at 1 months and 3 months, respectively (P < 0.05, both postoperative visits), and 20/100 at 6 months (P > 0.05). The central macular thickness at baseline was 569.96 ± 178.11 µm, and it decreased statistically significantly to 305.81 ± 155.94 µm, 386 ± 210.79 µm, and 446.41 ± 221.21 µm at 1, 3 and 6 months, respectively (P < 0.05, all visits compared with baseline). Fourteen (26%) eyes developed high intraocular pressure after implantation and was successfully controlled with topical medications, and cataract progressed in 1 (1.8%) eye. CONCLUSION: The dexamethasone implant improved macular edema in refractory cases resulting in statistically significant improvements in best-corrected visual acuity and central macular thickness that remained stable to 3 months and 6 months, respectively.


Assuntos
Dexametasona/administração & dosagem , Retinopatia Diabética/tratamento farmacológico , Glucocorticoides/administração & dosagem , Edema Macular/tratamento farmacológico , Oclusão da Veia Retiniana/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Retinopatia Diabética/complicações , Retinopatia Diabética/fisiopatologia , Implantes de Medicamento , Feminino , Humanos , Pressão Intraocular/fisiologia , Injeções Intravítreas , Edema Macular/etiologia , Edema Macular/fisiopatologia , Masculino , Pessoa de Meia-Idade , Retina/patologia , Oclusão da Veia Retiniana/complicações , Oclusão da Veia Retiniana/fisiopatologia , Estudos Retrospectivos , Tomografia de Coerência Óptica , Tonometria Ocular , Acuidade Visual/fisiologia
12.
Biomed Res Int ; 2015: 467039, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26557673

RESUMO

The aim of this work is to investigate changes in the ocular surface (OS) and tear film (TF) by means of questionnaire-based subjective symptoms, TF break-up time, Schirmer test, and TF analysis in women working with computers and to analyze the effects of the oral supplementation with antioxidants/omega 3 fatty acids (A/ω3) in the OS outcomes. Women aged 40-65 years (n = 148) were recruited at the Administrative Offices of Valencia (Spain) and distributed into two age groups, 40-52 years (AGE1; n = 87) and 53-65 years (AGE2; n = 61), and then subdivided according to being (or not) computer users (CUG; NCUG) during the workday. Homogeneous subgroups were randomly assigned (or not) to the daily intake of three pills of A/ω3 for three months. At baseline and at the end of follow-up, personalized interviews and ocular examination were done. Reflex tear samples were collected from the inferior meniscus and processed for a multiplexed particle-based flow cytometry assay to measure proinflammatory molecules. Statistics were performed using the SPSS 15.0 program. The OS pathology was clinically evident in the AGE1-CUG (33%) versus the AGE2-CUG (64%) of women. Significantly higher interleukins-1ß and -6 tear levels were found in the AGE1 versus the AGE2 women employees (P = 0.006 and P = 0.001, resp.), as well as in the CUG versus the NCUG (P = 0.001 and P = 0.000, resp.). Supplementation with A/ω3 positively influenced the OS pathology as manifested by the amelioration of the clinical signs/symptoms related to computer uses. Strategies involving a safe environment and oral micronutrient supplements may be managed within eye-care standards in older women.


Assuntos
Olho/fisiopatologia , Lágrimas/fisiologia , Adulto , Idoso , Antioxidantes/administração & dosagem , Computadores , Suplementos Nutricionais , Síndromes do Olho Seco/tratamento farmacológico , Síndromes do Olho Seco/metabolismo , Síndromes do Olho Seco/fisiopatologia , Olho/efeitos dos fármacos , Olho/metabolismo , Ácidos Graxos Ômega-3/administração & dosagem , Feminino , Humanos , Interleucina-1beta/metabolismo , Pessoa de Meia-Idade , Espanha , Lágrimas/efeitos dos fármacos
13.
Clin Ophthalmol ; 9: 1477-81, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26316689

RESUMO

Noninfectious uveitis includes a heterogenous group of sight-threatening ocular and systemic disorders. Significant progress has been made in the treatment of noninfectious uveitis in recent years, particularly with regard to the effective use of corticosteroids and non-corticosteroid immunosuppressive drugs, including biologic agents. All of these therapeutic approaches are limited, however, by any given patient's ability to comply with and adhere to their prescribed treatment. In fact, compliance and adherence are among the most important patient-related determinants of treatment success. We discuss strategies to optimize compliance and adherence.

14.
Clin Ophthalmol ; 9: 1285-90, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26203218

RESUMO

PURPOSE: To measure thrombopoietin (TPO) levels in the serum and aqueous humors of patients with noninfectious acute anterior uveitis. METHODS: A prospective, comparative, controlled study. Serum and aqueous humors were obtained from the eyes of 16 patients with noninfectious acute anterior uveitis. TPO levels were measured using an enzyme-linked immunosorbent assay (ELISA). The results obtained were compared with those of a control group. RESULTS: Serum concentrations of TPO were not significantly different between control individuals and patients with active anterior uveitis. Aqueous humor TPO levels were 54.46±16.24 pg/mL in the eyes of patients with uveitis, and 34.32±11.63 pg/mL in the eyes of controls. The difference between the two groups was significant (Mann-Whitney U-test for independent data, P=0.0008), with uveitis patients exhibiting significantly higher levels of TPO. CONCLUSION: The high levels of TPO in the aqueous humors of uveitis patients points toward a cytoprotective role of this factor in inflammatory repair processes and the recovery of tissue homeostasis.

15.
Br J Ophthalmol ; 99(4): 566-70, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25595174

RESUMO

BACKGROUND/AIMS: A pathogenic role of Th17 cells in uveitis has become clear in recent years. Therefore, in the present study, we aimed to evaluate the possible influence of the IL17A locus on susceptibility to non-anterior uveitis and its main clinical subgroups. METHODS: Five IL17A polymorphisms (rs4711998, rs8193036, rs3819024, rs2275913 and rs7747909), selected by tagging, were genotyped using TaqMan assays in 353 Spanish patients with non-anterior uveitis and 1851 ethnically matched controls. RESULTS: The case/control analysis yielded a consistent association between two of the analysed genetic variants, rs8193036 and rs2275913, and the presence of panuveitis under a dominant model (pFDR=2.86E-03, OR=2.26, 95% CI 1.42 to 3.59 and pFDR=0.033, OR=1.83, 95% CI 1.13 to 2.97, respectively). Subsequently, a specific association of both polymorphisms with the diffuse form of the disease was evident in the subphenotype analysis when considering this same genetic model (panuveitis vs posterior and intermediate uveitis: rs8193036, p=0.020; rs2275913, p=0.038). Independent effects of rs8193036 and rs2275913 were observed by conditional regression analysis. CONCLUSIONS: Polymorphisms within the IL17A locus show a novel association with panuveitis. Our data agree with the elevated levels of this cytokine that are found in patients with uveitis, supporting a crucial role of Th17 cells in this pathology. SUBTITLE: Our results clearly evidenced the role of IL17A as a novel genetic risk factor for panuveitis, thus suggesting the implication of Th17 cells in the extensive inflammation of the uveal tract that occurs in this subtype of uveitis.


Assuntos
Predisposição Genética para Doença , Interleucina-17/genética , Pan-Uveíte/genética , Polimorfismo de Nucleotídeo Único , Adulto , Grupo com Ancestrais do Continente Europeu , Feminino , Frequência do Gene , Técnicas de Genotipagem , Humanos , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase em Tempo Real , Células Th17/patologia
17.
Arq. bras. oftalmol ; 77(6): 355-359, Nov-Dec/2014. tab
Artigo em Inglês | LILACS | ID: lil-735799

RESUMO

Purpose: This study was designed to evaluate the visual and anatomical outcomes after cataract surgery in diabetic patients with different intraoperative therapeutic strategies. Methods: The research design comprised of a multicentric, retrospective, interventional study conducted at 6 centers in Argentina, Brazil, Costa Rica, Puerto Rico, Spain, and Venezuela. We included 138 diabetic patients with at least 6-month follow-up following phacoemulsification and intraocular lens implantation. Best-corrected visual acuity (BCVA) and central subfield thickness were collected at baseline and at 1-, 2-, 3-, and 6-month follow-up. Of these, 42 cases were not treated with any intraoperative coadjuvant medication (Group 1), 59 patients received intraoperative bevacizumab (Group 2) and 37 patients received intraoperative triamcinolone (4 mg/0.1 ml) (Group 3). Results: The mean logMAR [± standard deviation (SD)] BCVA improved from 0.82 (± 0.43) at baseline, to 0.14 (± 0.23) at 6-month follow-up (p<0.001) in Group 1; from 0.80 (± 0.48) to 0.54 (± 0.45) (p<0.001) in Group 2; and from 1.0 (± 0.40) to 0.46 (± 0.34) (p<0.001) in Group 3. The mean central subfield thickness increased from 263.57 µm (± 35.7) at baseline to 274.57 µm (± 48.7) at 6-month follow-up (p=0.088) in Group 1; from 316.02 µm (± 100.4) to 339.56 µm (± 145.3) (p=0.184) in Group 2; and from 259.18 µm (± 97.9) to 282.21 µm (± 87.24) (p=0.044) in Group 3. Conclusion: Diabetic patients may significantly benefit from cataract surgery. This study provides evidence to support the use of intravitreal triamcinolone or bevacizumab at the time of cataract surgery in cases with pre-existent diabetic macular edema or moderate-severe non-proliferative diabetic retinopathy. .


Objetivo: Avaliar os resultados visuais e anatômicos após a cirurgia de catarata em pacientes diabéticos com estratégias terapêuticas intraoperatórias diferentes. Métodos: Estudo multicêntrico, retrospectivo, de intervenção realizado em 6 centros da Argentina, Brasil, Costa Rica, Porto Rico, Espanha e Venezuela. Foram incluídos 138 pacientes diabéticos com pelo menos 6 meses de seguimento após facoemulsificação com implante de lente intraocular. Acuidade visual melhor corrigida (BCVA) e a espessura subcampo central (CST ) foram coletadas no início e em 1, 2, 3 e 6 meses de seguimento. Destes, 42 casos não foram tratadas com qualquer co-adjuvante de medicamentos intra-operatório (Grupo 1), 59 pacientes receberam bevacizumab intraoperatório (Grupo 2), e 37 pacientes receberam triancinolona intraoperatória (4 mg/0,1 ml) (Grupo 3). Resultados: A média logMAR (± desvio-padrão [DP]) BCVA melhorou de 0,82 (± 0,43) no início do estudo, para 0,14 (± 0,23) aos 6 meses de seguimento (p<0,001) no Grupo 1; de 0,80 (± 0,48) para 0,54 (± 0,45) (p<0,001) no Grupo 2; e de 1,0 (± 0,40) para 0,46 (± 0,34) (p<0,001) no Grupo 3. A CST média aumentou de 263,57 µm (± 35,7) na linha de base para 274,57±48,7 µm em 6 meses acompanhamento (p=0,088) no Grupo 1; de 316,02 µm (± 100,4), para 339,56 µm (± 145,3) (p=0,184) no Grupo 2; e de 259,18 µm (± 97,9), para 282,21 µm (±87,24) (p=0,044) no grupo 3. Conclusões: Pacientes diabéticos podem se beneficiar significativamente da cirurgia de catarata. Este estudo parece fornecer evidências para apoiar o uso de triancinolona intravítrea ou bevacizumab no momento da cirurgia de catarata em casos com edema macular diabético preexistente (DME) ou retinopatia diabética não-proliferativa moderada a grave. .


Assuntos
Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Retinopatia Diabética/cirurgia , Implante de Lente Intraocular/métodos , Facoemulsificação/métodos , Inibidores da Angiogênese/uso terapêutico , Anticorpos Monoclonais Humanizados/uso terapêutico , Catarata/tratamento farmacológico , Quimioterapia Adjuvante/métodos , Seguimentos , Glucocorticoides/uso terapêutico , Cuidados Intraoperatórios , Injeções Intravítreas , Edema Macular/tratamento farmacológico , Estudos Retrospectivos , Resultado do Tratamento , Triancinolona/uso terapêutico , Acuidade Visual , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores
18.
Retin Cases Brief Rep ; 8(4): 314-7, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25372536

RESUMO

PURPOSE: To report the utility of multimodal imaging including color photography, fundus autofluorescence (FAF), and spectral domain optical coherence tomography in a case of primary vitreoretinal lymphoma. METHODS: Color photographs, FAF, and the spectral domain optical coherence tomography images were performed at baseline and through 12 months of follow-up. RESULTS: At baseline and follow-up visits, spectral domain optical coherence tomography and FAF were more sensitive than color photography in showing the extent of disease. With treatment, spectral domain optical coherence tomography showed resolution of subretinal hyperreflective material while FAF imaging showed a reduction in hyperreflective dots, which were present at baseline. CONCLUSION: Spectral domain optical coherence tomography and FAF were more sensitive than color photographs in showing the disease extent and response to treatment. These imaging techniques may supplement other metrics used to monitor the patients with primary vitreoretinal lymphoma.


Assuntos
Linfoma Intraocular/diagnóstico , Linfoma de Células B/diagnóstico , Imagem Multimodal , Neoplasias da Retina/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade
19.
J Ophthalmic Vis Res ; 9(2): 269-71, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25279130

RESUMO

PURPOSE: To report corneal findings in a familial case of the crystalline subtype of pre-Descemetic corneal dystrophy. CASE REPORT: A 19-year-old girl and her 44-year-old mother were found to have asymptomatic, bilateral, punctiform and multi-colored crystalline opacities across the whole posterior layer of the corneas. Endothelial specular microscopy revealed the presence of white round flecks located at different levels anterior to the endothelium. No systemic abnormalities or medications could be related to account for these findings. CONCLUSION: To the best of our knowledge, this is the third familial report of this rare corneal disorder. Differential diagnosis may include Schnyder corneal dystrophy, cystinosis, Bietti´s dystrophy and monoclonal gammopathy.

20.
Dev Ophthalmol ; 54: 126-34, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25196761

RESUMO

Pharmacovitrectomy refers to a particular approach consisting of the intravitreal injection of drugs that can modify the anatomical and/or biochemical composition of the vitreous and retina. It constitutes a field in permanent expansion, particularly with pharmacologic vitreolysis and vascular endothelial growth factor inhibition.


Assuntos
Doenças Retinianas/tratamento farmacológico , Corpo Vítreo/efeitos dos fármacos , Humanos , Injeções Intravítreas , Resultado do Tratamento
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