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1.
Artigo em Inglês | MEDLINE | ID: mdl-33136191

RESUMO

PURPOSE: The purpose of this article is to review the literature on nomenclature, natural history, clinical features, diagnosis, management, and prognosis of both macular microhole (MMH) and foveal red spot syndrome (FRS). METHODS: A PubMed primary literature search (February 1, 2020) utilizing the terms macular microhole, foveal red spot syndrome, and outer retinal hole was conducted. All chosen articles were case reports or case series. Articles qualified for inclusion if they documented symptoms, imaging findings, or followed patients longitudinally. RESULTS: A total of 14 studies from 1988 to 2019 that evaluated either MMH, FRS, or both were included in the review. No comparative study between the two defects was found. Studies often used the terms FRS and MMH interchangeably to reference both partial- and full-thickness lesions of the macula. Spectral-domain optical coherence tomography (SD-OCT) was most frequently able to identify these lesions and revealed an absence of all neural retinal layers from the inner limiting membrane (ILM) to the retinal pigment epithelium (RPE) in the full-thickness lesions while the partial-thickness lesions most often involved the photoreceptor layer (PRL) and less frequently the external limiting membrane (ELM). OCT revealed that vitreomacular traction (VMT) was involved in the natural history of both FRS and MMH for a significant subset of patients. CONCLUSION: The terms MMH and FRS have been used interchangeably in the literature. Advances in OCT have revealed that MMHs and FRSs are distinct but sometimes overlapping entities. We suggest that MMH and FRS are similar entities defined as one or more sharply defined lesions in the fovea of the eye < 150 µm in size. MMHs are a full-thickness defect of the entire neuroretina at the center of the foveola while FRSs are partial-thickness lesions. Current literature suggests that there may be subtle differences in the pathogenesis, clinical features, and diagnosis between MMH and FRS; however, prognosis and management for both are favorable. Lastly, we suggest that the terms outer lamellar macular microholes and full-thickness macular microholes may be the more appropriate terminologies to refer to FRS and MMH, respectively.

2.
Ocul Immunol Inflamm ; 28(8): 1298-1300, 2020 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-33021846

RESUMO

PURPOSE: To report a unique case of intraocular inflammation and outer retinal changes in a patient with coronavirus disease (COVID-19). CASE REPORT: A 57-year-old woman was seen 12 days after COVID-19 symptoms onset confirmed by positive IgM and IgG serological tests. No anterior chamber cells were seen. Color fundus photograph showed a yellowish lesion within the macular area, and fluorescein angiography revealed hyperfluorescence on the topography of the macular lesion in both eyes. Spectral-domain optical coherence tomography demonstrated hyperreflective pinpoints at the level of posterior vitreous hyaloid, corresponding to vitritis, hyperreflective lesions at the level of inner plexiform and ganglion cell layers, and disruption of the ellipsoid zone. CONCLUSION AND IMPORTANCE: COVID-19 is known to affect the inner retinal layers. The current case not only supports but also adds a vitreal and an outer retinal layer involvement that might also be caused by this infectious disease.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Oftalmopatias/etiologia , Angiofluoresceinografia/métodos , Pneumonia Viral/complicações , Segmento Externo das Células Fotorreceptoras da Retina/patologia , Tomografia de Coerência Óptica/métodos , Corpo Vítreo/patologia , Infecções por Coronavirus/epidemiologia , Oftalmopatias/diagnóstico , Feminino , Fundo de Olho , Humanos , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/epidemiologia , Acuidade Visual
3.
Ophthalmic Surg Lasers Imaging Retina ; 51(2): 76-83, 2020 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-32084279

RESUMO

BACKGROUND AND OBJECTIVE: To report a unique case series of diffuse unilateral subacute neuroretinitis (DUSN) patients imaged with optical coherence tomography angiography (OCTA). PATIENTS AND METHODS: In this retrospective case series, multimodal imaging was performed in four patients with DUSN at the time of patient visit. The study patients underwent standard clinical treatment for DUSN. RESULTS: The clinical findings were consistent with the diagnosis of DUSN. Cross-sectional OCT showed disruption of outer retinal layers in the foveal area and an irregular structure of the outer plexiform layer. En face OCT revealed hyperreflective spots and a large hyperreflective lesion in the foveal area correspondent to the outer retina disruption seen on cross-sectional OCT. OCTA demonstrated decreased vascular perfusion in both the superficial and deep retinal capillary plexuses along with choriocapillaris preservation. CONCLUSION: OCTA may provide a more detailed assessment of the retinal microvascular changes, allowing a more precise anatomical-functional correlation in DUSN. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:76-83.].

4.
Case Rep Ophthalmol Med ; 2020: 6490535, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32099706

RESUMO

Colorectal cancer may yield metastasis to the choroid. Its management may be challenging, since there is no consensus about treatment. We describe a case of a 70-year-old male with colon cancer who complained of worsening visual acuity of his better-seeing eye to 20/40 secondary to a nonpigmented choroidal mass of medium reflectivity under the inferior temporal arcade and neurosensory foveal detachment. Besides systemic chemotherapy, local treatment with verteporfin photodynamic therapy (vPDT) was performed. After one month, visual acuity improved to 20/25 and subretinal fluid faded. In conclusion, vPDT may be a useful adjuvant treatment modality for choroidal metastasis secondary to colorectal cancer.

5.
Growth Horm IGF Res ; 34: 8-12, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-28456063

RESUMO

OBJECTIVE: Ocular function is fundamental for environmental adaptation and survival capacity. Growth factors are necessary for a mature eyeball, needed for adequate vision. However, the consequences of the deficiency of circulating growth hormone (GH) and its effector insulin-like growth factor I (IGF-I) on the physical aspects of the human eye are still debated. A model of untreated isolated GH deficiency (IGHD), with low but measurable serum GH, may clarify this issue. The aim of this study was to assess the ocular aspects of adult IGHD individuals who have never received GH therapy. DESIGN: Cross sectional study. METHODS: Setting: University Hospital, Federal University of Sergipe, Brazil. PATIENTS: Twenty-five adult (13 males, mean age 50.1years, range 26 to 70years old) IGHD subjects homozygous for a null mutation (c.57+1G>A) in the GHRH receptor gene, and 28 (15 males, mean age 51.1years, range 26 to 67years old) controls were submitted to an endocrine and ophthalmological assessment. Forty-six IGHD and 50 control eyes were studied. MAIN OUTCOME MEASURES: Visual acuity, intraocular pressure, refraction (spherical equivalent), ocular axial length (AL), anterior chamber depth (ACD), lens thickness (LT), vitreous depth (VD), mean corneal curvature (CC) and central corneal thickness (CCT). RESULTS: IGHD subjects exhibited unmeasurable serum IGF-I levels, similar visual acuity, intraocular pressure and LT, higher values of spherical equivalent and CC, and lower measures of AL, ACD, VD and CCT in comparison to controls, but within their respective normal ranges. While mean stature in IGHD group was 78% of the control group, mean head circumference was 92% and axial AL was 96%. CONCLUSIONS: These observations suggest mild ocular effects in adult subjects with severe IGF-I deficiency due to non-treated IGHD.


Assuntos
Hormônio do Crescimento Humano/deficiência , Hipopituitarismo/complicações , Hipopituitarismo/genética , Mutação com Perda de Função , Receptores de Neuropeptídeos/genética , Receptores de Hormônios Reguladores de Hormônio Hipofisário/genética , Visão Ocular/fisiologia , Adulto , Idoso , Estudos Transversais , Nanismo Hipofisário/genética , Nanismo Hipofisário/patologia , Nanismo Hipofisário/fisiopatologia , Olho/patologia , Feminino , Humanos , Hipopituitarismo/fisiopatologia , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Acuidade Visual
6.
Growth Horm IGF Res ; 30-31: 11-15, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27552668

RESUMO

OBJECTIVE: Experimental models demonstrate an important role of GH in retinal development. However, the interactions between GH and the neuro-vascularization of the human retina are still not clear. A model of untreated congenital isolated GH deficiency (IGHD) may clarify the actions of GH on the retina. The purpose of this work was to assess the retinal neuro-vascularization in untreated congenital IGHD (cIGHD). DESIGN: In a cross sectional study, we performed an endocrine and ophthalmological assessment of 25 adult cIGHD subjects, homozygous for a null mutation (c.57+1G>A) in the GHRH receptor gene and 28 matched controls. Intraocular pressure measurement, retinography (to assess the number of retinal vascular branching points and the optic disc and cup size), and optical coherence tomography (to assess the thickness of macula) were performed. RESULTS: cIGHD subjects presented a more significant reduction of vascular branching points in comparison to controls (91% vs. 53% [p=0.049]). The percentage of moderate reduction was higher in cIGHD than in controls (p=0.01). The percentage of individuals with increased optic disc was higher in cIGHD subjects in comparison to controls (92.9% vs. 57.1%). The same occurred for cup size (92.9% vs. 66.7%), p<0.0001 in both cases. There was no difference in macula thickness. CONCLUSIONS: Most cIGHD individuals present moderate reduction of vascular branching points, increase of optic disc and cup size, but have similar thickness of the macula.


Assuntos
Nanismo Hipofisário/patologia , Macula Lutea/patologia , Neurônios Retinianos/patologia , Vasos Retinianos/patologia , Adulto , Idoso , Estudos de Casos e Controles , Estudos Transversais , Nanismo Hipofisário/congênito , Nanismo Hipofisário/genética , Feminino , Humanos , Pressão Intraocular , Masculino , Pessoa de Meia-Idade , Receptores de Neuropeptídeos/genética , Receptores de Hormônios Reguladores de Hormônio Hipofisário/genética , Tomografia de Coerência Óptica
7.
Ophthalmologica ; 230 Suppl 2: 68-72, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24022721

RESUMO

PURPOSE: Intravitreous injection of vital dyes, e.g. brilliant blue (BBG), promotes better visualization of the internal limiting membrane (ILM). This paper investigates the staining properties of BBG depending on different incubation times and 2 types of solvents--5% glucose (GL) or saline solution--in a prospective study in patients. METHODS: This paper investigates various aspects of BBG in various methods. An interventional prospective study was conducted in patients to examine the binding properties of the blue dye diluted in either saline or 5% GL to epiretinal membranes (ERMs) and ILMs. Forty-nine consecutive patients older than 18 years scheduled for macular ERM, vitreomacular traction and macular hole surgeries were prospectively recruited. The primary outcomes of this study were the degree of ILM and ERM staining. The secondary outcomes of the study were the need of reinjection of BBG or any other dye, the ability of BBG to stain the vitreous, and frequency of complications. The staining of the ILM and ERM were graded as no staining, little, moderate or strong staining. RESULTS: There was no correlation between age (p = 0.32) or gender (p = 0.33) in the staining affinity of BBG to either the ILM or ERM. BBG may be an appropriate staining agent for the ILM in the majority (82%) of surgeries; however, in approximately half of the cases (45%) surgeons considered BBG not enough for ERM coloring and visualization. There is a tendency of BBG to stain the ILM better when saline solution is used compared to GL 5%; however, this was not statistically significant (p = 0.64). There was no difference in the staining efficacy of BBG to the ERMs by either solution (p = 0.70), despite the low staining affinity. CONCLUSION: BBG became the state-of-the-art dye for ILM identification. Differences in staining properties may imply that BBG should not be considered as first-line stain for ERM surgery. BBG is effective in ILM staining in over 80% of macular hole surgeries.


Assuntos
Membrana Epirretiniana/diagnóstico , Indicadores e Reagentes , Perfurações Retinianas/diagnóstico , Corantes de Rosanilina , Adulto , Idoso , Idoso de 80 Anos ou mais , Membrana Basal/patologia , Membrana Epirretiniana/cirurgia , Feminino , Angiofluoresceinografia , Glucose , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Perfurações Retinianas/cirurgia , Cloreto de Sódio , Solventes , Coloração e Rotulagem , Fatores de Tempo
8.
Retina ; 32(3): 606-12, 2012 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-22080907

RESUMO

PURPOSE: To evaluate the retinal penetration and toxicity of two doses of intravitreal infliximab in primates. METHODS: Ten marmosets (Callithrix jacchus) were given intravitreal injection of 100 µg or 400 µg of infliximab, and balanced salt solution served as control. At baseline and after 24 hours (5 animals) and 7 days (the other 5), the eyes were examined by electroretinography. They were then killed (at 24 hours and 7 days) and assessed by light microscopy and transmission electron microscopy for toxicity and immunohistochemistry, using a biotinylated anti-human immunoglobulin G, to evaluate retinal penetration. RESULTS: There was no difference over 50% of the electroretinography b-wave between baseline and the time points studied in all animals. Light and electron microscopy, and electroretinography analysis, showed no signs of toxicity in any of the animals. Strong presence of infliximab was observed in all retinal layers 7 days after intravitreal injection at both doses (100 and 400 µg). CONCLUSION: Infliximab at doses of 100 and 400 µg seemed to cause no damage to the retina 24 hours and 7 days after its intravitreal injection, and deeply penetrated all its layers, in primates. These results encourage future perspectives for the treatment of chronic inflammatory diseases of the retina in humans.


Assuntos
Anti-Inflamatórios/toxicidade , Anticorpos Monoclonais/toxicidade , Retina/efeitos dos fármacos , Animais , Anti-Inflamatórios/administração & dosagem , Anti-Inflamatórios/farmacocinética , Anticorpos Monoclonais/administração & dosagem , Anticorpos Monoclonais/farmacocinética , Callithrix , Modelos Animais de Doenças , Eletrorretinografia/efeitos dos fármacos , Imuno-Histoquímica , Infliximab , Injeções Intravítreas , Microscopia/métodos , Retina/metabolismo , Retina/patologia , Doenças Retinianas/induzido quimicamente , Doenças Retinianas/metabolismo , Doenças Retinianas/patologia
9.
Expert Opin Drug Metab Toxicol ; 7(8): 1021-34, 2011 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-21627546

RESUMO

INTRODUCTION: Intravitreal injections are a very common procedure and are the most effective route of drug delivery to the retina. There are currently several drugs available and even more are in development; therefore, safety is a very important concern. AREAS COVERED: The toxicological considerations of the most common drugs used for intravitreal pharmacotherapy such as anti-VEGFs, corticosteroids and antibiotics. Emerging agents such as anti-TNFs, VEGF-trap and kinase inhibitors are also discussed. An assessment of the efficacy and safety issues of the most relevant drugs including bevacizumab, ranibizumab and triamcinolone is presented. EXPERT OPINION: The toxicology and safety profiles are available for several drugs that are either in use or will be available for intravitreal injections. Retinal pharmacotherapy is very effective for different retinal diseases; however safety is a very important issue when intravitreal injections are applied and the possibility of retinal toxicity should always be kept in mind. Bevacizumab and ranibizumab are effective for the therapy of wet-age-related macular degeneration and macular edema, while triamcinolone remains an alternative agent to treat secondary macular edema. It is important, as some of these drugs will be used for extended periods of time, that their long-term toxicological effects are better understood.


Assuntos
Anticorpos Monoclonais Humanizados/toxicidade , Injeções Intravítreas/métodos , Triancinolona/toxicidade , Animais , Antibacterianos/uso terapêutico , Bevacizumab , Ensaios Clínicos como Assunto , Humanos , Injeções Intravítreas/efeitos adversos , Degeneração Macular/tratamento farmacológico , Edema Macular/tratamento farmacológico , Ranibizumab , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores
10.
Ophthalmic Res ; 44(4): 205-24, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-20699625

RESUMO

AIMS: Retinal pharmacotherapy has gained great importance for the treatment of various retinal diseases. An increasing number of drugs have been constantly released into the market, especially for wet age-related macular disease and diabetic macular edema. In this review, the issues concerning the toxicity of current and new classes of drugs are discussed. METHODS: An extensive search of the literature was performed to review various aspects of drug toxicity in retinal pharmacotherapy. The different major classes of drugs, such as corticosteroids, antibiotics, antimetabolites, antineoplastic agents, monoclonal antibodies (mAbs), nonsteroidal anti-inflammatory drugs, enzymes, fibrinolytics, miscellaneous anti-inflammatory and antiangiogenic agents, as well as toxicity unrelated to the drug were identified and discussed. RESULTS: Corticosteroids like fluocinolone, dexamethasone or triamcinolone at low dose cause little damage to the retina, but at high doses signs of toxicity have been well documented. Complications like cataract and glaucoma are quite common with corticosteroids. Aminoglycosides showed differences in the type and doses associated with toxic reactions, thereby the following order of toxicity can be described (from most toxic to least toxic): gentamicin > netilmicin = tobramycin > amikacin = kanamycin. Vancomycin at the usual dose of 1 mg is not toxic to the retina, while further studies are necessary in order to clarify the safety of new-generation quinolones. 5-Fluorouracil has been shown to be nontoxic to the retina after an injection of 2.5 mg in animals. mAbs like ranibizumab and bevacizumab were demonstrated to be safe to the retina in cell culture, animals and humans at high doses. The exact biocompatibility of nonsteroidal anti-inflammatory agents like diclofenac needs further evaluation. Preservatives like benzyl alcohol and changes in pH or osmolarity exert an influence on the toxic effects of intravitreally applied drugs. CONCLUSIONS: A great number of drugs are now used mainly intravitreally without relevant retinal toxicity.


Assuntos
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Modelos Animais , Retina/efeitos dos fármacos , Doenças Retinianas/induzido quimicamente , Animais , Avaliação Pré-Clínica de Medicamentos , Humanos , Testes de Toxicidade
11.
Retina ; 30(7): 1128-34, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-20616688

RESUMO

PURPOSE: The purpose of this study was to describe clinical, angiographic, and tomo-graphic prognostic factors in central serous chorioretinopathy. METHODS: This is a prospective uncontrolled case series. Forty-six eyes (43 patients) with clinical and angiographic findings consistent with central serous chorioretinopathy were included. Clinical data regarding age, sex, duration of symptoms, associated conditions, and best-corrected visual acuity (BCVA) were collected at baseline. Optical coherence tomography was performed at baseline, monthly until fluid resolution occurred, and at the end of the follow-up. RESULTS: Mean follow-up was 22.8 months. Mean baseline and final logarithm of the minimum angle of resolution BCVA were 0.3 and 0.12 (P < 0.0001), respectively. Statistically significant correlations were observed between the baseline BCVA as well as duration of symptoms and final BCVA. Angiographic patterns were not significantly correlated with the visual outcome. Shorter periods of subfoveal fluid during the follow-up were correlated with better visual acuity. Mean foveal thickness after fluid resolution was 178 +/- 22 microm. Both baseline and final BCVA were strongly correlated with the foveal thickness after fluid resolution. CONCLUSION: Initial BCVA may be a reliable predictor of the visual outcome in central serous chorioretinopathy. Eyes with worse BCVA may have an increased risk of foveal atrophy. Fluid persistence on optical coherence tomography may be associated with worse visual prognosis.


Assuntos
Coriorretinopatia Serosa Central/fisiopatologia , Acuidade Visual/fisiologia , Adulto , Coriorretinopatia Serosa Central/diagnóstico , Feminino , Angiofluoresceinografia , Humanos , Verde de Indocianina , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Fatores de Risco , Tomografia de Coerência Óptica , Adulto Jovem
12.
Surv Ophthalmol ; 54(5): 576-617, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19682624

RESUMO

Vital dyes have advanced diagnosis and surgical technique in various specialties, including oncology, gastroenterology, and ophthalmology. In ocular surgery vital dyes are widely used in cataract and vitreoretinal surgery. Worldwide, intra-operative use of trypan blue during cataract surgery has enhanced visualization of the anterior capsule during capsulorrhexis, and patent blue has been recently licensed in Europe for cataract surgery. For chromovitrectomy, the vital dyes indocyanine green, infracyanine green, and brilliant blue stain the internal limiting membrane, and trypan blue and triamcinolone acetonide help visualize epiretinal membranes and vitreous, respectively. Intra-operative vital dyes are finding uses in corneal, glaucoma, orbit, strabismus, and conjunctival surgery. We provide a summary of current knowledge of the use of vital dyes in ocular surgery. We review the properties of dyes, techniques of application, indications, and complications in ocular surgery. Vital dyes represent an expanding area of research, and novel dyes deserve further investigation.


Assuntos
Corantes , Oftalmopatias/cirurgia , Procedimentos Cirúrgicos Oftalmológicos , Coloração e Rotulagem/métodos , Corantes/efeitos adversos , Corantes/farmacologia , Humanos , Cuidados Intraoperatórios/métodos
13.
Invest Ophthalmol Vis Sci ; 50(11): 5487-94, 2009 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-19516009

RESUMO

PURPOSE: To determine effects of intravitreous anti-TNF-alpha (infliximab) in a laser-induced choroidal neovascularization (CNV) model by fluorescein angiogram (FA), immunofluorescence, ELISA, and glycosaminoglycan analyses. METHODS: CNV induction was performed using argon laser. Rats were divided into eight groups (no-laser no-infliximab; laser; laser with 10, 20, 40, 80, or 320 microg infliximab; and isotype-matched IgG). After 3 weeks, CNV area was measured by FA and von Willebrand factor (vWF) immunofluorescence. VEGF, TGF-beta, and syndecan-4 were evaluated by ELISA and immunofluorescence. Glycosaminoglycan expression was determined in retina and choroid of animals metabolically labeled with [(35)S]-sulfate. Cytotoxicity was investigated using ARPE-19 and endothelial cells. RESULTS: FA showed significant reduction in the low-dose infliximab groups (10-40 microg), confirmed by vWF immunofluorescence that showed 49% decrease in the CNV. VEGF and TGF-beta decreased expression detected by ELISA and immunofluorescence paralleled these results. Similar data were observed for syndecan-4. The expression of these molecules in the neovascularization area using 320 microg was similar to the no-infliximab laser group or laser with isotype-matched IgG. Heparan sulfate expression in retina and choroid paralleled the observed effects on angiogenesis. Increased expression of chondroitin sulfate in retina and dermatan sulfate in choroid reflects the effects of injury and fibrosis using high doses of anti-TNF-alpha. Infliximab showed no cytotoxic effect in ARPE-19 cells, whereas high doses led to 20% decrease in endothelial cell viability. CONCLUSIONS: Intravitreal infliximab shows dual effect on the development of laser-induced CNV. It reduces angiogenesis and glycosaminoglycan expression at low doses, whereas opposite effects are observed at high doses.


Assuntos
Anti-Inflamatórios/administração & dosagem , Anticorpos Monoclonais/administração & dosagem , Corioide/metabolismo , Neovascularização de Coroide/metabolismo , Modelos Animais de Doenças , Glicosaminoglicanos/metabolismo , Retina/metabolismo , Animais , Neovascularização de Coroide/etiologia , Neovascularização de Coroide/prevenção & controle , Ensaio de Imunoadsorção Enzimática , Feminino , Angiofluoresceinografia , Técnica Indireta de Fluorescência para Anticorpo , Humanos , Infliximab , Injeções , Fotocoagulação a Laser/efeitos adversos , Ratos , Ratos Zucker , Epitélio Pigmentado da Retina , Sindecana-4/metabolismo , Fator de Crescimento Transformador beta/metabolismo , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Fator A de Crescimento do Endotélio Vascular/metabolismo , Corpo Vítreo , Fator de von Willebrand/metabolismo
14.
Prog Retin Eye Res ; 28(2): 117-44, 2009 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-19114125

RESUMO

Monoclonal antibodies (mAbs) can be used therapeutically by binding to molecular targets with high specificity. Therefore, they have excellent therapeutic applications in ophthalmology. This manuscript presents four aspects of the therapeutic use of mAbs in ophthalmology: the scientific rationale, the unique characteristics of selected mAbs, the current state-of-the-art application, and relevant therapeutic mAbs for future applications in ophthalmology. We identified in the literature various single-agent therapies that inhibit the following targets: tumor necrosis factor (TNF), epithelial growth factor receptor, vascular endothelial growth factor (VEGF) receptor, basic fibroblast growth factor receptor, platelet-derived growth factor, and cluster of differentiation antigens. The roles of all biochemical targets in ocular diseases were evaluated. Current and future mAbs against various cytokines were assessed for the treatment of ocular diseases. The medical literature showed the clinical benefits of mAbs for treating angiogenic and inflammatory ocular diseases. Two anti-VEGF mAbs, bevacizumab and ranibizumab, and three anti-TNF agents, infliximab, etanercept, and adalimumab, control ocular neovascularization and intraocular inflammation. Other mAbs such as rituximab, daclizumab, efalizumab, and alemtuzumab showed positive results in animal and early clinical studies and may represent useful adjuvant therapies for ocular lymphoma or ocular inflammation. Ranibizumab is the only FDA-approved therapy; for other mAbs the so-called off-label application remains the standard. Intravenous administration of mAbs has demonstrated acceptable toxicity profiles, while intraocular injection may decrease the chances of systemic complications and increase the amount of drug available to the retina and choroid. In conclusion, effective clinical use of mAbs in ophthalmology is more commonly seen in the field of angiogenic vitreoretinal and autoimmune inflammatory diseases. The challenge for the future is combining biologic therapies to improve the quality and duration of responses while diminishing side effects. The role of mAbs within ophthalmic treatments will be defined according to future clinical experience and the results of randomized clinical trials.


Assuntos
Anticorpos Monoclonais/uso terapêutico , Oftalmopatias/terapia , Neovascularização Patológica/terapia , Adalimumab , Alemtuzumab , Animais , Anticorpos Monoclonais Humanizados , Anticorpos Monoclonais Murinos , Anticorpos Antineoplásicos/uso terapêutico , Bevacizumab , Daclizumabe , Etanercepte , Humanos , Imunoglobulina G/uso terapêutico , Infliximab , Ranibizumab , Receptores do Fator de Necrose Tumoral/uso terapêutico , Rituximab
15.
Am J Ophthalmol ; 142(5): 858-60, 2006 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-17056370

RESUMO

PURPOSE: To assess the optic nerve head (ONH) by optical coherence tomography (OCT), confocal scanning laser ophthalmoscopy (CSLO), and the retinal nerve fiber layer (RNFL) by OCT and scanning laser polarimetry (GDx) in highly myopic subjects. DESIGN: Observational cross-sectional study. METHODS: Thirty-five eyes of highly myopic individuals without glaucoma and 17 eyes of highly myopic patients with glaucoma were included in this study. All patients had myopia higher than 5.0 diopters and ocular axial length higher than 25 mm. In those patients without glaucoma, the intraocular pressure (IOP) was less than 21 mm Hg. RESULTS: Mean (SD) OCT cup-to-disk area ratio was 0.45 (0.30) and 0.58 (0.29) in the nonglaucomatous and glaucomatous subjects, respectively (P = .22); CSLO cup-to-disk area ratio was 0.27 (0.27) and 0.24 (0.23), respectively (P = .75); and OCT-RNFL was 65.2 (26.2) microm and 56.8 (28.6) microm (P = .43). CONCLUSIONS: OCT, CSLO, and GDx are not useful to discriminate nonglaucomatous and glaucomatous subjects that have high myopia.


Assuntos
Glaucoma/diagnóstico , Miopia Degenerativa/diagnóstico , Fibras Nervosas/patologia , Disco Óptico/patologia , Células Ganglionares da Retina/patologia , Adulto , Estudos Transversais , Técnicas de Diagnóstico Oftalmológico , Humanos , Pressão Intraocular , Lasers , Oftalmoscopia , Tomografia de Coerência Óptica
16.
Dig Dis Sci ; 50(5): 949-54, 2005 May.
Artigo em Inglês | MEDLINE | ID: mdl-15906774

RESUMO

Since new molecules that normally would accelerate regeneration can also be potentialized by light, the use of new substances combined with laser therapy seems to be a natural type of experiment. Therefore, the purpose of this study was to assess the effects of Hyptis pectinata leaves on liver regeneration after partial hepatectomy (PH) associated with laser therapy. Twenty-four rats were divided into four groups--PH(control), PHL (laser therapy), PH200 (200 mg/kg of Hyptispectinata), and PHL200 (200 mg/kg of the plant and laser)--which were submitted to 67% hepatectomy. Laser treatment consisted of focusing the light on the remaining liver after hepatectomy. The data analyzed were serum levels of aminotransferases, liver regeneration, and mitochondrial function. Group PH200 showed a statistically significant decrease in AST levels, and PHL200 disclosed an augmentation in ALT levels. The liver regeneration index was significantly increased in group PHL200. Concerning liver mitochondrial respiratory assay, groups PH200 and PHL200 showed lower state 3 levels than groups PH and PHL. Group PHL showed an increase in state 4 levels and a reduction in membrane potential and RCR. The present study shows that the association of the aqueous extract of Hyptis pectinata leaves at 200 mg/kg with intraoperative laser therapy can stimulate liver regeneration and cause a reduction in liver mitochondrial respiratory function without altering its phosphorylative activity.


Assuntos
Hyptis , Regeneração Hepática/efeitos dos fármacos , Regeneração Hepática/efeitos da radiação , Terapia com Luz de Baixa Intensidade , Animais , Hepatectomia , Masculino , Mitocôndrias Hepáticas/efeitos dos fármacos , Mitocôndrias Hepáticas/fisiologia , Mitocôndrias Hepáticas/efeitos da radiação , Fitoterapia , Extratos Vegetais/farmacologia , Folhas de Planta , Ratos , Ratos Wistar , Transaminases/sangue , Transaminases/efeitos dos fármacos , Transaminases/efeitos da radiação
17.
J Surg Res ; 121(1): 108-11, 2004 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-15313383

RESUMO

BACKGROUND: A prospective study was carried out to evaluate the results of distal splenorenal shunt (DSRS) with or without splenic artery ligation (SAL) in patients with schistosomal portal hypertension. MATERIALS AND METHODS: Thirty patients were divided into two groups: 15 were submitted to DSRS (Group I) and the other 15 were submitted to DSRS + SAL (Group II). They were observed for 24 months. Clinical and laboratory features were analyzed. RESULTS: There was neither mortality nor clinical manifestation of portosystemic encephalopathy in both groups. Recurrent hemorrhage and thrombosis incidence had no statistical difference. Although patients in Group II presented higher levels of postoperative pain and fever, spleen size reduction was higher than in Group I. White blood cells and platelets were increased in patients who underwent DSRS + SAL, even though there was no statistically significant difference between the groups. An increase in bilirubin was observed on the first postoperative day. Arterial blood ammonia and liver function were similar in both groups. Endoscopic control showed reduction in size of varices or their disappearance in 80 and 93% of patients from Groups I and II, respectively. CONCLUSIONS: Although SAL associated with DSRS was responsible for increasing postoperative morbidity, it did not increase the incidence of shunt thrombosis and improved white blood cells and platelets count as well as reduced the spleen size. Therefore, the authors believe that SAL associated with DSRS is an effective treatment for schistosomal portal hypertension. Besides, it should be performed when a large spleen and hypersplenism are present.


Assuntos
Hipertensão Portal/cirurgia , Esquistossomose/complicações , Artéria Esplênica/cirurgia , Derivação Esplenorrenal Cirúrgica , Humanos , Ligadura , Estudos Prospectivos
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