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1.
Ocul Immunol Inflamm ; : 1-4, 2021 Jan 21.
Artigo em Inglês | MEDLINE | ID: mdl-33476223

RESUMO

Purpose: To report a case of intraretinal tubercular granuloma successfully treated with photodynamic therapy (PDT). Methods: Retrospective case report. Multimodal imaging was performed at each follow-up visit. Results: The tuberculoma did not regress and did not significantly reduce its exudation after anti-tubercular therapy (ATT), systemic steroid therapy and intravitreal anti-VEGF. Second line treatment with PDT was attempted. The lesion showed a regression with reduced sub-retinal fluid and intra-retinal exudates. A second PDT was performed for reactivation of the lesion 5 months after the first treatment. Further regression of the lesion was observed. Conclusion: PDT may be a valuable second-line therapeutic approach for vascularized intraretinal granulomas.

2.
Ocul Immunol Inflamm ; : 1-11, 2020 Nov 17.
Artigo em Inglês | MEDLINE | ID: mdl-33200957

RESUMO

Purpose: Tubercular intermediate uveitis (TIU) and panuveitis (TBP) are difficult to manage because of limitations in diagnostic tools and lack of evidence-based treatment guidelines. The Collaborative Ocular Tuberculosis Study (COTS) analyzed treatment regimens and therapeutic outcomes in patients with TIU and TBP. Methods: Multicentre retrospective analysis. Results A total of 138 TIU and 309 TBP patients were included. A total of 382 subjects received antitubercular therapy (ATT) (n = 382/447; 85.4%) and 382 received corticosteroids (n = 382/447; 85.4%). Treatment failure was observed in 78 individuals (n = 78/447; 17.4%), occurring less frequently in patients receiving ATT (n = 66/382; 17.2%) compared to those who did not (n = 12/65; 18.5%). The study did not show any statistically significant therapeutic effect of ATT in patients with TIU and TBP. Conclusion Taking into account the limitations of the retrospective, non-randomized study design, resultant reliance on reported data records, and unequal size of the samples, the current study cannot provide conclusive evidence on the therapeutic benefit of ATT in TIU and TBP.

3.
Eur J Ophthalmol ; : 1120672120963456, 2020 Nov 02.
Artigo em Inglês | MEDLINE | ID: mdl-33135489

RESUMO

PURPOSE: To report the wide-field choroidal vessel analysis in central serous chrorioretinopathy (CSCR) and their fellow eyes. METHODS: Wide-field optical coherence tomography (WF-OCT) images (55°) were obtained using Spectralis HRA + OCT (Heidelberg Engineering, Germany) in extremes of gazes in all quadrants and manual montages were created to obtain wide field images up to equator. Choroidal thickness (CT), large choroidal vessel layer thickness (LCVT), and choroidal vascularity index (CVI) were calculated in macular segment (twice the disc to fovea distance) and all four quadrants. Regression analysis was performed to identify the factors influencing CVI. RESULTS: Thirty-one patients of CSCR including 39 eyes of CSCR (32 chronic, 7 acute) and 23 fellow eyes were analyzed. CT and LCVT were significantly higher in submacular choroid than all extramacular segments in both CSCR and fellow eyes (all p values <0.01). CVI varied significantly in different segments in horizontal (p < 0.01 in both) and vertical meridian (p < 0.01 and p = 0.01 respectively) in CSCR and fellow eyes. Both CSCR and fellow eyes had highest CVI in nasal segment with minimum CVI in macular segment. Age (p = 0.85), gender (p = 0.39), chronicity of the disease (acute vs chronic, p = 0.57), axial length (p = 0.67), SBP (p = 0.81), and DBP (p = 0.94) were not significantly correlated to CVI. CONCLUSION: CVI shows significant regional variation with macular segment showing the lowest CVI whereas nasal segments have highest CVI in both CSCR and their fellow eyes. On the contrary, submacular segment has highest CT and LCVT with taper towards periphery in both CSCR and fellow eyes.

4.
Artigo em Inglês | MEDLINE | ID: mdl-33090281

RESUMO

PURPOSE: Comparing two different sutureless scleral fixation techniques. METHODS: A retrospective study of patients who underwent sutureless scleral fixation IOL from October 2013 to May 2018 at "Luigi Sacco Hospital", University of Milan. Comparison between two groups: Group 1 implanted with a 3-piece ALCON-MA60AC and group 2 implanted with a newly developed single-piece foldable IOL SOLEKO FIL-SSF. Patients underwent a complete preoperative ophthalmic assessment and post-operative evaluation at 1, 3, and 6 months. Vitrectomy was performed in all cases. The two groups were compared for age, axial length, and lens status at baseline. Visual acuity, refractive results, surgical time, and post-operative complications were recorded. RESULTS: Thirty-one eyes were included: group 1, 15 eyes of 15 patients, and group 2, 16 eyes of 14 patients. No difference was found in visual acuity. Mean refractive error was 1D in both groups (group 1 1.01D, group 2 1.09D), but spherical equivalent was more often moved toward negative values and induced astigmatism was greater in the 3-piece group (group 1 1.91D [SD ± 2.07], group 2 0.67D [SD ± 0.88] P = 0.04). Surgical procedure was faster in group 2 (mean time difference 21', P = 0.01*). New displacement occurred in 5 cases (33%) of group 1 and in no cases of group 2 (P = 0.01*). Post-operative bleeding was registered only in group 1 (20%), but the difference was not statistically significant. CONCLUSIONS: The group 2 IOL gives in our sample better results due to less post-operative astigmatism and reducing dislocation and bleeding during follow-up. Surgical technique appeared easier and faster: the specifically designed IOL seems to be a feasible solution for sutureless scleral fixation.

5.
Retina ; 2020 Oct 14.
Artigo em Inglês | MEDLINE | ID: mdl-33079791

RESUMO

PURPOSE: To investigate the influence of age, gender and underlying disease on the optical coherence tomography (OCT) features of choroidal neovascularization (CNV) secondary to Inflammation (iCNV), myopia (mCNV) and age-related macular degeneration (AMD-CNV). METHODS: Demographic and clinical data of eyes with treatment naïve iCNV, mCNV and type 2 AMD-CNV were collected. OCT images were reviewed to determine the presence of pitchfork sign (PFS), pigment epithelial detachment (PED), subretinal fluid (SRF), intraretinal cysts (IRC), subretinal hyper reflective material (SHRM), atrophy and outer retinal disruption (ORD) graded 1 to 4. The influence of demographics and underlying etiology on OCT signs was investigated. RESULTS: 185 eyes from 179 patients were enrolled. The mean[SD] age was 36[±14.4], 62[±18] and 77[±8] for the iCNV, mCNV and AMD-CNV respectively (p<0.001). Multiple linear regression showed that the presence of PFS was negatively associated with age (p<0.0001) regardless of underlying disease. By contrast the SRF, PED, IRC and the ORD were all positively influenced by age regardless of gender and underlying disease (all p<0.01). Logistic regression showed that none of the OCT signs increased the likelihood for diagnosis of iCNV. By contrast, absence of SRF was suggestive for mCNV and presence of PED and SRF was suggestive for AMD-CNVs. CONCLUSIONS: The age of the patient had a significant effect on the OCT appearance of the CNV, particularly the presence of a PFS, regardless of the underlying etiology. The absence of SRF was suggestive for a diagnosis of mCNV. The presence of SRF and PED was suggestive for AMD-CNVs.

6.
Ocul Immunol Inflamm ; : 1-9, 2020 Oct 06.
Artigo em Inglês | MEDLINE | ID: mdl-33021421

RESUMO

PURPOSE: To report long term results of biologic treatment of severe and refractory Behçet's uveitis (BU) choosing a different biologic agent according to the uveitis clinical features. METHODS: Retrospective cohort of patients with BU refractory to conventional therapy, who received Interferon (IFN) alpha-2a or Infliximab (IFX) for at least 3 months. RESULTS: Twenty-two patients were included (mean age 29 ± 10 years, 63% males); Fifteen received IFN and 7 IFX, for a mean treatment period of 30 ± 24(SD) months. Twenty (90%) patients discontinued treatment, in most cases for complete remission (77%). Seven patients (32%) showed relapses during treatment and five (23%) after discontinuation. Visual acuity improved significantly in IFN group and all eyes showed a significant decrease in central macular thickness at 12 months. CONCLUSIONS: Both IFX and IFN Alpha-2a were effective and well tolerated in the treatment of refractory BU using a customized approach based on the uveitis features.

7.
Ocul Immunol Inflamm ; : 1-4, 2020 Oct 05.
Artigo em Inglês | MEDLINE | ID: mdl-33016855

RESUMO

PURPOSE: To evaluate the clinical relevance of subcentimetric lymph node biopsy via mediastinoscopy in patients with presumed ocular sarcoidosis (OS). METHODS: Retrospective study of consecutive patients who underwent biopsy via mediastinoscopy for suspected OS. The biopsy outcomes and clinical features of patients with subcentimetric nodes and of those with lymph nodes >1 cm were compared. RESULTS: A total of 67 patients with presumed OS were included. Forty-two patients (63%) had lymph nodes ≥1 cm in diameter, while 25(37%) showed subcentimetric lymph nodes. Biopsy was consistent with sarcoidosis in 83% of patients with lymph nodes ≥1 cm and in 76% of patients with subcentimetric lymph nodes (p = .60). Patients with OS who had subcentimetric lymph nodes had less lymphopenia (p = .01), lower lysozyme values (p = .03) and a longer diagnostic delay compared to those with larger lymph nodes. CONCLUSIONS: The biopsy of subcentimetric lymph nodes via mediastinoscopy may provide a histological diagnosis and reduce diagnostic delay.

8.
EClinicalMedicine ; 27: 100550, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32984785

RESUMO

Background: Coronavirus disease 2019 (COVID-19) has been associated to microvascular alterations. We screened the fundus of patients with COVID-19 to detect alterations of the retina and its vasculature and to assess possible correlations with clinical parameters. Methods: Cross-sectional study. The presence of retinal alterations in patients with COVID-19 and subjects unexposed to the virus was assessed using fundus photographs and their prevalence was compared. Mean arteries diameter (MAD) and mean veins diameter (MVD) were compared between patients and unexposed subjects with multiple linear regression including age, sex, ethnicity, body mass index, smoking/alcohol consumption, hypertension, hyperlipidaemia, diabetes as covariates. The influence of clinical/lab parameters on retinal findings was tested in COVID-19 patients. Findings: 54 patients and 133 unexposed subjects were enrolled. Retinal findings in COVID-19 included: haemorrhages (9·25%), cotton wools spots (7·4%), dilated veins (27·7%), tortuous vessels (12·9%). Both MAD and MVD were higher in COVID-19 patients compared to unexposed subjects (98·3 ± 15·3 µm vs 91·9 ± 11·7 µm, p = 0.006 and 138·5 ± 21·5 µm vs 123·2 ± 13·0 µm, p<0.0001, respectively). In multiple regression accounting for covariates MVD was positively associated with COVID-19 both in severe (coefficient 30·3, CI95% 18·1-42·4) and non-severe (coefficient 10·3, CI95% 1·6-19·0) cases compared to unexposed subjects. In COVID-19 patients MVD was negatively correlated with the time from symptoms onset (coefficient -1·0, CI 95% -1·89 to -0·20) and positively correlated with disease severity (coefficient 22·0, CI 95% 5·2-38·9). Interpretation: COVID-19 can affect the retina. Retinal veins diameter seems directly correlated with the disease severity. Its assessment could have possible applications in the management of COVID-19. Funding: None.

9.
Ocul Immunol Inflamm ; 28(8): 1290-1292, 2020 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-32976055

RESUMO

PURPOSE: To report a case of impending central retinal vein occlusion (iCRVO) in a COVID-19 patient. CASE REPORT: A 54 years old woman with COVID-19 related pneumonia presented to our emergency department complaining of scotomas and decreased vision in her right eye. Funduscopic examination and multimodal imaging revealed rare retinal hemorrhages, retinal whitening, and fern-like hypo-autofluorescent appearance typical of iCRVO. She had no risk factors other than a transient hyper-coagulability status likely related to the ongoing infection. Systemic treatment with steroids normalized her inflammatory and coagulation status and the occlusion completely resolved. CONCLUSIONS: Retinal circulation should be considered as a potential site for thromboembolic complications from COVID-19.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Angiofluoresceinografia/métodos , Pneumonia Viral/complicações , Retina/patologia , Oclusão da Veia Retiniana/etiologia , Tomografia de Coerência Óptica/métodos , Infecções por Coronavirus/epidemiologia , Feminino , Fundo de Olho , Humanos , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/epidemiologia , Oclusão da Veia Retiniana/diagnóstico
10.
Ocul Immunol Inflamm ; 28(8): 1223-1238, 2020 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-32976732

RESUMO

PURPOSE: Ocular tuberculosis has protean clinical manifestations. Because of its varied clinical presentation, multimodal imaging is very important to characterize the disease activity, presence of inflammation, determining therapeutic response, and detection of complications. METHODS: Narrative review. RESULTS: In this review, various imaging modalities employed in the management of ocular tuberculosis including fluorescein angiography (FA), indocyanine green angiography (ICGA), optical coherence tomography (OCT), and optical coherence tomography angiography (OCTA) have been reviewed. Not only do these imaging tools complement each other in providing a comprehensive assessment of the pathology, they also help in gaining valuable insights regarding the evolution of the disease. CONCLUSIONS: Fundus imaging plays a vital role in the diagnosis and management of patients with posterior uveitis due to tuberculosis. Fundus imaging may have a useful role in defining clinical endpoints for ocular tuberculosis in the future.

11.
Ocul Immunol Inflamm ; : 1-8, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32946308

RESUMO

PURPOSE: To analyze distribution and progression of multifocal choroiditis (MFC) inflammatory lesions and their correlations with clinical outcomes at 24 months. METHODS: Distribution and progression of inflammatory lesions were evaluated in eyes with MFC using a semi-automatic approach based on fundus autofluorescence. Twenty-four-months clinical outcomes were correlated with baseline features. RESULTS: Twenty-five eyes from 20 patients were enrolled. Visual acuity (VA) significantly improved from baseline to 24 months. Chorioretinal lesions spared the fovea in most eyes. The area of inflammatory lesions at 24 months significantly increased. Final number and area of lesions were significantly influenced by baseline features. Inflammatory lesions enlarged over time regardless of MFC recurrences. New lesion and MFC relapses did not affect final outcomes. CONCLUSIONS: Final VA correlated with baseline VA. Scars resulting from MFC lesions enlarged overtime even when the disease was under control. New lesions and MFC relapses did not affect final outcomes.

12.
Br J Ophthalmol ; 2020 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-32892162

RESUMO

PURPOSE: To evaluate the long-term functional and morphological changes occurring in myopic eyes with a dome-shaped macula (DSM), with or without untreated serous retinal detachment (SRD). METHODS: This prospective, single-centre study enrolled consecutive cases of highly myopic patients with DSM with or without a SRD. Patients underwent complete ophthalmological examinations, optical coherence tomography, axial length measurements and autofluorescence. Follow-up visits were performed with a maximum interval of 6 months for 4 years. Eyes with choroidal neovascularisation were excluded. RESULTS: Twenty-six eyes from 18 patients (mean age 61.2) were included. At baseline, 13 eyes had SRD and 13 did not. The DSMs were either horizontal (69%) or round (31%). There were no significant differences in best-corrected visual acuity (BCVA) between eyes with and without SRD during the 48-month follow-up period. Multivariate analysis showed that baseline BCVA was the only parameter among those analysed (age and SRD height) to have a significant effect on the final BCVA (p<0.0001). SRD fluctuated overtime and SRD height was significantly influenced by choroidal thickness (p=0.002). The scleral bulge thickness had no effect on SRD thickness. CONCLUSIONS: BCVA remained clinically stable over 4 years without treatment despite the fluctuations and persistence of the SRDs.

13.
Asia Pac J Ophthalmol (Phila) ; 9(4): 335-348, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32739938

RESUMO

The choroid is the vascular structure nourishing the retinal pigment epithelium and the outer retina and it plays a key role in the homeostasis of the eye both under physiological and pathological conditions. In the last 20 years we have moved from "guessing" what was happening beyond the retinal pigment epithelium to actually visualize structural and functional changes of the choroid in vivo noninvasively. In this review we describe the state of the art of choroidal imaging, focusing on the multiple techniques available in the clinical and research setting including indocyanine green angiography, labeled-cells angiographies, optical coherence tomography (OCT), enhanced depth imaging, swept source OCT, and OCT angiography. In the first section of the article, we describe their main applications and the basic principles to interpret the imaging results. Increasing evidence suggests that the choroid is much more involved than we used to think in many pathological conditions from uveitis to intraocular tumors, from vascular diseases to age-related macular degeneration. All clinicians should hence know which is the most appropriate imaging investigation to explore the choroid in the disease they are dealing with and how to interpret the results. For this reason the second section of this review summarizes the best imaging approach and the most common findings visible on choroidal imaging in different diseases of the eye.

14.
Retina ; 2020 Aug 18.
Artigo em Inglês | MEDLINE | ID: mdl-32833411

RESUMO

PURPOSE: To analyze and describe serial follow-up of choriocapillaris alterations in tubercular serpiginouslike choroiditis (SLC) using optical coherence tomography angiography (OCTA) and to compare it with multimodal imaging. METHODS: In this prospective cohort study, patients with active tubercular SLC underwent OCTA using Optovue RTVue XR Avanti and other imaging techniques including enhanced-depth imaging OCT (EDI-OCT) (Heidelberg Spectralis; Heidelberg Engineering, Heidelberg, Germany), fundus autofluorescence, fluorescein angiography, and indocyanine green angiography. Serial imaging was performed for a total follow-up of 3 months. Choriocapillaris alterations at the site of lesions were analyzed on OCTA imaging, and their mean lesion areas were calculated. RESULTS: Twenty-six eyes (26 patients; 20 males; mean age: 32.68 ± 10.56 years) were included. Fourteen eyes had active multifocal lesions (n = 39), whereas 12 eyes had active placoid lesions (n = 12). At baseline, OCTA showed hyporeflective flow deficit lesions corresponding to the hypofluorescent lesions on indocyanine green angiography in all eyes. In the multifocal type of SLC, the mean lesion area decreased in all eyes compared with baseline, and lesions with a lesion area less than 0.1 mm on OCTA showed near-complete resolution with minimal choriocapillaris atrophy. In comparison, all eyes with a placoid type of SLC showed no significant reduction in the lesion area and showed extensive choriocapillaris atrophy. CONCLUSION: Optical coherence tomography angiography has the unique ability to demonstrate pathological flow impairment at the level of choriocapillaris in active tubercular SLC. Serial OCTA analysis reveals that large tubercular SLC lesions result in choriocapillaris atrophy as the lesions heal, whereas smaller multifocal lesions show resolution of choriocapillaris hypoperfusion with minimal atrophy.

15.
Graefes Arch Clin Exp Ophthalmol ; 258(11): 2379-2387, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32803329

RESUMO

PURPOSE: To describe various clinical features of idiopathic juxtafoveal retinal telangiectasis group 2A or idiopathic macular telangiectasia type 2 (MacTel) on multicolor imaging (MCI) and compare imaging findings of MacTel on MCI with fundus autofluorescence (FAF). METHODS: Patients with a clinical diagnosis of MacTel based on Gass and Blodi's classification were included. FAF and MCI images were graded qualitatively for stage of disease, margins of involvement, hyperautofluorescence on FAF (corresponding retinal atrophy on MCI), and detection of crystals. FAF and MCI were graded quantitatively for the area and number of quadrants involved, hypoautofluorescene on FAF (corresponding intraretinal pigment hyperplasia or retinal pigment epithelium [RPE] atrophy on MCI), and foci of right-angled venules. RESULTS: Seventy-eight eyes of forty five patients were included with both imaging modalities showing no difference with respect to staging of non-proliferative MacTel. Retinal crystals were recognized on MCI but not on FAF. Neurosensory retinal atrophy and  subretinal neovascular membranes were detected using MCI with 92.3 and 83.3% sensitivity, respectively. Intraretinal pigmented hyperplasia was more accurately detected (70.1 vs 58.4%) compared with RPE atrophy on MCI. MCI showed larger area of involvement, higher number of quadrants involved (p < 0.001), and better delineation of margins (p = 0.002) compared with FAF. A higher mean number of vessel dipping foci was noted on MCI in comparison with FAF (3.34 vs 3.1). CONCLUSION: Various parameters were more easily defined using MCI compared with FAF which qualifies MCI as an enface depth-resolved imaging adjunct to conventional multimodal imaging in MacTel. The ability to detect enface as well as cross-sectional imaging features makes MCI a valuable tool in MacTel.

16.
Ocul Immunol Inflamm ; : 1-7, 2020 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-32804578

RESUMO

PURPOSE: To examine disease profile of tubercular uveitis (TBU) in Paediatric population. METHODS: Among 945 patients of the retrospective multinational study by the Collaborative Ocular Tuberculosis Study (COTS)-1, 29 Paediatric patients diagnosed with TBU were analyzed. RESULTS: Mean age of disease presentation was 12.8 (range 4-18 years), with predominance of males (n = 14/20; 70.0%) and Asian ethnicity (n = 25/29; 86.2%). Posterior uveitis (n = 14/28; 50%) was the most frequent uveitis phenotype, with choroidal involvement occurring in 64.7% (n = 11/17). Incidence of optic disc edema and macular edema was higher in children (n = 8/18; 44.4% and n = 5/18; 27.8%, respectively) than in adults (n = 160/942; 16.9% and n = 135/942; 14.3%, respectively). Comparison of optic disc edema between subgroups showed a significant difference (P =.006). All patients received oral corticosteroids, most of them with antitubercular therapy. Treatment failure developed in 4.8% (n = 1/21). CONCLUSIONS: Children have a more severe inflammatory response to the disease, and an intensive anti-inflammatory therapeutic regimen is required to achieve a positive treatment outcome.

17.
Ophthalmology ; 2020 Aug 11.
Artigo em Inglês | MEDLINE | ID: mdl-32795496

RESUMO

PURPOSE: To develop consensus terminology in the setting of polypoidal choroidal vasculopathy (PCV) and to develop and validate a set of diagnostic criteria not requiring indocyanine green angiography (ICGA) for differentiating PCV from typical neovascular age-related macular degeneration (nAMD) based on a combination of OCT and color fundus photography findings. DESIGN: Evaluation of diagnostic test results. PARTICIPANTS: Panel of retina specialists. METHODS: As part of the Asia-Pacific Ocular Imaging Society, an international group of experts surveyed and discussed the published literature regarding the current nomenclature and lesion components for PCV, and proposed an updated consensus nomenclature that reflects our latest understanding based on imaging and histologic reports. The workgroup evaluated a set of diagnostic features based on OCT images and color fundus photographs for PCV that may distinguish it from typical nAMD and assessed the performance of individual and combinations of these non-ICGA features, aiming to propose a new set of diagnostic criteria that does not require the use of ICGA. The final recommendation was validated in 80 eyes from 2 additional cohorts. MAIN OUTCOME MEASURES: Consensus nomenclature system for PCV lesion components and non-ICGA-based criteria to differentiate PCV from typical nAMD. RESULTS: The workgroup recommended the terms polypoidal lesion and branching neovascular network for the 2 key lesion components in PCV. For the diagnosis of PCV, the combination of 3 OCT-based major criteria (sub-retinal pigment epithelium [RPE] ring-like lesion, en face OCT complex RPE elevation, and sharp-peaked PED) achieved an area under the receiver operating characteristic curve of 0.90. Validation of this new scheme in a separate subset 80 eyes achieved an accuracy of 82%. CONCLUSIONS: We propose updated terminology for PCV lesion components that better reflects the nature of these lesions and is based on international consensus. A set of practical diagnostic criteria applied easily to spectral-domain OCT results can be used for diagnosing PCV with high accuracy in clinical settings in which ICGA is not performed routinely.

18.
Retina ; 2020 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-32796445

RESUMO

PURPOSE: To describe our managing strategy for COVID-19 emergency, to evaluate the adherence to intravitreal treatment (AtT) rate during the outbreak in a referral hospital in Milan and to correlate it with patients clinical features. METHODS: AtT rate of patients with scheduled intravitreal injections (IVT) during the COVID-19 outbreak from 23/02/20 to 31/03/20 was compared to the previous trimester and with March 2019. The impact of age, sex, visual function and diagnosis on the AtT rate during unlocked/locked weeks (from March 8) was evaluated. RESULTS: Of 650 consecutive patients with scheduled IVT, AtT rate during the COVID-19 outbreak was 0.37. This was significantly lower compared to AtT registered in the previous trimester (0.92) and in the same weeks in 2019 (0.90) (both p <0.001). Patients adherent to treatment were significantly younger (p<0.001) and had a lower best-corrected visual acuity in the fellow eye (p=0.046). During the lockdown weeks AtT rate was significantly lower than in the two unlocked weeks (0.19 vs 0.73, p<0.001). In addition, the AtT rate in patients classified as "Emergent" during the lockdown weeks was 0.60. CONCLUSIONS: These preliminary results can help the retina specialist community to foresee this unique scenario and to develop successful management strategies.

19.
Ophthalmol Retina ; 2020 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-32763425

RESUMO

PURPOSE: To investigate the influence of age on the thickness of the retinal pigment epithelium (RPE)/Bruch's membrane (BM) complex and the quantitative autofluorescence (qAF) and to study the possible correlation existing between these 2 parameters in a healthy White population. DESIGN: Cross-sectional, observational study. PARTICIPANTS: Healthy White volunteers aged 18 to 65 years. METHODS: All subjects underwent spectral domain OCT (SD-OCT) and qAF imaging with the Heidelberg HRA-Spectralis (Heidelberg Engineering, Heidelberg, Germany). Spectral domain OCT images were analyzed using the in-built graph-based automatic segmentation algorithm for single retinal layer identification to assess RPE/BM complex thickness in vivo. The thickness values of both inner and outer rings of the Early Treatment Diabetic Retinopathy Study (ETDRS) grid, generated by the software using the "RPE" segmentation, were averaged to obtain a single RPE/BM complex thickness value in each eye. Quantitative autofluorescence images were also evaluated using a dedicated software. The qAF values of 8 subfields forming a ring centered onto the fovea were collected and averaged to obtain a single qAF value (qAF8) in each eye. The correlation among the RPE/BM complex thickness, the qAF value, and the age of the subjects was investigated. MAIN OUTCOME MEASURES: The in vivo correlation between RPE/BM complex thickness and qAF. RESULTS: A total of 105 eyes from 105 subjects (mean age, 42.1 ± 13.9 years; range, 18-65) were included in the analysis. The mean RPE/BM complex thickness significantly increased with age (r = 0.33, P = 0.0006). The values of qAF also positively increased with age (P < 0.0001). A significant correlation was found between qAF and RPE/BM complex thickness (r = 0.27, P = 0.004). After adjusting for age, iris color, and gender, the correlation remained significant only for subjects aged less than 40 years (P = 0.009). CONCLUSIONS: BM complex thickness was significantly co/BM complex thickness increased with age in a healthy White population. A similar increase was found for qAF values. After adjusting for age and iris color, qAF and RPE/BM complex thickness were still correlated in subjects aged less than 40 years. The RPE/BM complex thickness could reflect the lipofuscin/melanolipofuscin accumulation in normal subjects, adding great interest in RPE cell biology.

20.
Ocul Immunol Inflamm ; : 1-10, 2020 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-32600163

RESUMO

PURPOSE: The Collaborative Ocular Tuberculosis Study (COTS) Group sought to address the diagnostic uncertainty through retrospective cohort analysis of treatment regimens and therapeutic outcomes for patients with tubercular Anterior Uveitis (TAU) across international centers. METHODS: Multicentre retrospective analysis of patients diagnosed with TAU between January 2004 to December 2014 that had a minimum follow-up of 1 year. RESULTS: One hundred and sixty-five patients were included. One hundred and seven subjects received antitubercular therapy (ATT) (n = 107/165; 64.9%) with all the patients receiving topical steroid therapy. Treatment failure was noted in 17 patients (n = 17/165; 10.3%), more frequently described in patients that received ATT (n = 13/107, 12.2%), than those that did not receive ATT (n = 4/58, 6.9%). CONCLUSION: In this retrospective study, addition of ATT did not have any statistically significant impact on outcome in patients with TAU.

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