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1.
Clin Neurol Neurosurg ; 210: 107008, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34775364

RESUMO

Terson's Syndrome describes intraocular hemorrhage secondary to an acutely raised intracranial pressure (ICP). Although Terson's Syndrome is common amongst patients with subarachnoid hemorrhage (SAH), it is underdiagnosed and often overlooked. This review discusses the current understanding of the etiopathogenesis, clinical features, and management of Terson's Syndrome and highlights the visual and prognostic implications to stress the importance of timely diagnosis and management. The origin of intraocular hemorrhage in Terson's Syndrome has been debated. A recognized theory suggests that an acutely raised ICP induces effusion of cerebrospinal fluid into the optic nerve sheath which dilates the retrobulbar aspect of the sheath in the orbit. Dilatation mechanically compresses the central retinal vein and retinochoroidal veins resulting in venous hypertension and rupture of thin retinal vessels. A commonly reported clinical feature is decreased visual acuity and blurred vision. These may be accompanied by symptoms of increased ICP including loss of consciousness and headache. Diagnosis is established using evidence from the clinical presentation, ophthalmoscopy, and, when required, imaging including B-mode ultrasound, CT, MRI, and fluorescein angiography. Terson's Syndrome is managed conservatively by observation for mild cases and with vitrectomy for bilateral cases and for patients whose hemorrhage has not spontaneously resolved after an observational period. Terson's Syndrome can be used as a prognostic indicator of morbidity and mortality in underlying pathology like SAH. Fundoscopy of patients with SAH, acutely raised ICP or visual disturbance with unknown etiology can help establish a timely Terson's Syndrome diagnosis. This may avoid the risk of permanent visual impairment.

2.
Ophthalmic Surg Lasers Imaging Retina ; 52(S1): S5-S12, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34310239

RESUMO

BACKGROUND AND OBJECTIVE: Proliferative vitreoretinopathy (PVR) is the leading cause of retinal detachment repair failure. However, the molecular pathogenesis remains incompletely understood. Determining the proteome of PVR will help to identify novel therapeutic targets. MATERIALS AND METHODS: Preretinal tissue samples, delaminated during surgery from six PVR cases and one idiopathic epiretinal membrane (ERM) were analyzed by mass spectrometry. Tandem mass spectra were extracted using the UniProt database, generating a list of 896 proteins, which were subjected to pathway set and fold-change (ERM vs PVR) analyses. RESULTS: Two pathways were enriched in PVR: extracellular matrix (ECM) organization and extracellular structure organization. A fold-change analysis comparing mean total spectral counts from PVR to an ERM control identified fibronectin, the ECM glycoprotein, as the protein most significantly elevated in PVR compared to ERM. CONCLUSION: These data identify pathwayskey to PVR progression, including thoseinvolved in cell-mediated ECM assembly and thus tractional force generation at the cellular level. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:S5-S12.].


Assuntos
Membrana Epirretiniana , Descolamento Retiniano , Vitreorretinopatia Proliferativa , Humanos , Proteoma , Retina , Descolamento Retiniano/cirurgia , Vitreorretinopatia Proliferativa/diagnóstico , Corpo Vítreo
3.
Retina ; 41(9): e67-e68, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34190724
4.
Ophthalmic Surg Lasers Imaging Retina ; 52(3): 138-144, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-34038688

RESUMO

BACKGROUND AND OBJECTIVE: To report indications, timing, complications, and outcomes of scleral buckle (SB) removal surgery. PATIENTS AND METHODS: Retrospective observational case series. Eyes that underwent SB removal between 2010 and 2016 with greater than 1 year of follow-up were included. Main outcome measures were post-SB removal complications and best-corrected visual acuity (BCVA). RESULTS: Fifty eyes that underwent SB removal met the inclusion criteria. Indications include exposed SB (54%), infection (26%), diplopia (16%), and recurrent retinal detachment (4%). Mean and median intervals between SB placement and removal were 65 months and 30 months. Complications include recurrent retinal detachment (12%), transient ocular hypertension (6%), and persistent diplopia (4%). There was no significant change in mean BCVA after SB removal (P = .979). CONCLUSIONS: Exposed SB, infection, and diplopia are the most common indications for SB removal. The single-surgery success rate is high and the risk for complications is relatively low. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:138-144.].


Assuntos
Descolamento Retiniano , Recurvamento da Esclera , Humanos , Descolamento Retiniano/cirurgia , Estudos Retrospectivos , Recurvamento da Esclera/efeitos adversos , Resultado do Tratamento , Acuidade Visual , Vitrectomia
5.
JAMA Ophthalmol ; 139(5): 542-547, 2021 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-33734306

RESUMO

Importance: Anti-vascular endothelial growth factor (VEGF) agents may provide a prophylactic effect in high-risk eyes with intermediate dry age-related macular degeneration (AMD) against conversion to exudative AMD (eAMD), lowering the risk of vision loss. Objective: To evaluate intravitreal aflibercept injection (IAI) as prophylaxis against the conversion to eAMD in high-risk eyes at 24 months. Design, Setting, and Participants: This single-masked, sham-controlled, randomized clinical trial performed at 4 US clinical sites enrolled patients with intermediate AMD in 1 eye (study eye), defined as presence of more than 10 medium drusen (≥63 to <125 µm), at least 1 large druse (≥125 µm), and/or retinal pigmentary changes, and eAMD in the fellow eye. Patients were treated from June 23, 2015, to March 13, 2019. Interventions: Intravitreal aflibercept injection (2 mg) or sham quarterly injection for 24 months (1:1 randomization). Main Outcomes and Measures: The primary end point was the proportion of patients with conversion to eAMD at month 24 characterized by development of choroidal neovascularization, as assessed by leakage on fluorescein angiography and fluid on spectral-domain optical coherence tomography by an independent masked reading center. Results: Of 128 patients enrolled, 127 (63 in the IAI group and 64 in the sham group) were included in the primary analysis (68 men [53.5%]; mean [SD] age, 76.5 [8.1] years). Baseline demographic and clinical characteristics were balanced between the groups. By month 24, 6 patients (9.5%) in the IAI group and 7 (10.9%) in the sham group developed eAMD (P = .98). Patients with a history of eAMD for longer than 2 years in their fellow eye at baseline showed a lower rate of conversion to eAMD in the study eye compared with those with a history of eAMD for 2 years or less in the fellow eye. Safety was consistent with previous studies involving intravitreal anti-VEGF injections. Conclusions and Relevance: In this evaluation of quarterly anti-VEGF exposure as prophylaxis to reduce conversion of eyes with high-risk dry AMD to eAMD, the rates of conversion were not lower in the IAI group compared with the sham treatment group at month 24. Understanding the mechanism of conversion to eAMD and therapies that could prevent this event remains an important unmet need. Trial Registration: ClinicalTrials.gov Identifier: NCT02462889.

6.
JAMA Ophthalmol ; 139(4): 456-463, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33662093

RESUMO

Importance: The American Academy of Ophthalmology (AAO) indicated that urgent or emergent vitreoretinal surgical procedures should continue during the coronavirus disease 2019 (COVID-19) pandemic. Although decreases in the frequency of critical procedures have been reported outside the field of ophthalmology, analyses are limited by volume, geography, and time. Objective: To evaluate whether the frequency of ophthalmic surgical procedures deemed urgent or emergent by the AAO changed across the United States during the COVID-19 pandemic. Design, Setting, and Participants: Vitreoretinal practices from 17 institutions throughout the US participated in this multicenter cross-sectional study. The frequency of 11 billed vitreoretinal Current Procedural Terminology (CPT) codes across respective weeks was obtained from each practice between January 1, 2019, and May 31, 2020. Data were clustered into intravitreal injections (code 67028), lasers and cryotherapy (codes 67141, 67145, and 67228), retinal detachment (RD) repairs (codes 67107, 67108, 67110, and 67113), and other vitrectomies (codes 67036, 67039, and 67040). Institutions were categorized by region (Northeast, Midwest, South, and West Coast), practice setting (academic [tax-exempt] or private [non-tax-exempt]), and date of respective statewide stay-at-home orders. Main Outcomes and Measures: Nationwide changes in the frequency of billing for urgent or emergent vitreoretinal surgical procedures during the COVID-19 pandemic. Results: A total of 526 536 CPT codes were ascertained: 483 313 injections, 19 257 lasers or cryotherapy, 14 949 RD repairs, and 9017 other vitrectomies. Relative to 2019, a weekly institutional decrease in injections was observed from March 30 to May 2, 2020, with a maximal 38.6% decrease (from a mean [SD] of 437.8 [436.3] to 273.8 [269.0] injections) from April 6 to 12, 2020 (95% CI, -259 to -69 injections; P = .002). A weekly decrease was also identified that spanned a longer interval, at least until study conclusion (March 16 to May 31, 2020), for lasers and cryotherapy, with a maximal 79.6% decrease (from a mean [SD] of 6.6 [7.7] to 1.5 [2.0] procedures) from April 6 to 12, 2020 (95% CI, -6.8 to -3.3 procedures; P < .001), for RD repairs, with a maximal 59.4% decrease (from a mean [SD] of 3.5 [4.0] to 1.6 [2.2] repairs) from April 13 to 19, 2020 (95% CI, -2.7 to -1.4 repairs; P < .001), and for other vitrectomies, with a maximal 84.3% decrease (from a mean [SD] of 3.0 [3.1] to 0.4 [0.8] other vitrectomies) from April 6 to 12, 2020 (95% CI, -3.3 to -1.8 other vitrectomies; P < .001). No differences were identified by region, setting, or state-level stay-at-home order adjustment. Conclusions and Relevance: Although the AAO endorsed the continued performance of urgent or emergent vitreoretinal surgical procedures, the frequency of such procedures throughout the country experienced a substantial decrease that may persist after the COVID-19 pandemic's initial exponential growth phase. This decrease appears independent of region, setting, and state-level stay-at-home orders. It is unknown to what extent vitreoretinal intervention would have decreased without AAO recommendations, and how the decrease is associated with outcomes. Although safety is paramount during the COVID-19 pandemic, practices should consider prioritizing availability for managing high-acuity conditions until underlying reasons for the reduction are fully appreciated.


Assuntos
COVID-19/epidemiologia , SARS-CoV-2 , Cirurgia Vitreorretiniana/estatística & dados numéricos , Estudos Transversais , Serviços Médicos de Emergência , Humanos , Vitrectomia/estatística & dados numéricos
7.
Retin Cases Brief Rep ; 15(5): 622-624, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-30932995

RESUMO

PURPOSE: To describe a novel surgical technique for rescuing a dislocated "in-the-bag" accommodative intraocular lens (Crystalens; Bausch and Lomb Inc, Rochester NY) and report its postoperative outcome. METHODS: Interventional case report. An 82-year-old patient with history of pseudoexfoliation syndrome presented with a posteriorly dislocated "in-the-bag" Crystalens intraocular lens. A pars plana vitrectomy was performed. The Crystalens intraocular lens was rescued, and scleral sulcus fixated using prolene suture. RESULTS: No intraoperative or postoperative complications were noted. The preoperative visual acuity was 6/200. The vision improved to 20/30, 8 weeks after the surgery. CONCLUSION: Rescuing, instead of exchanging, a Crystalens intraocular lens might be a safe alternative in patients with a dislocated "in-the-bag" Crystalens intraocular lens.

8.
Retina ; 41(1): 75-81, 2021 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-32106158

RESUMO

PURPOSE: To evaluate the effect of cataract extraction (CE) by phacoemulsification on the vitreomacular interface (VMI) of eyes with preexisting vitreomacular traction (VMT). METHODS: Retrospective, observational case series. Patients with VMT who elected to proceed with CE, before any vitreoretinal intervention, were studied. Eyes with at least a 12-month follow-up period were included. The status of the vitreomacular adhesion at different time points was assessed using spectral-domain optical coherence tomography. The best-corrected visual acuity was recorded at different time points. Other macular and systemic comorbidities were documented. RESULTS: Fifteen eyes from 15 phakic patients with symptomatic VMT were included. Six of them were male subjects. Seven patients had diabetes mellitus and two of them also had nonproliferative diabetic retinopathy. The preoperative macular comorbidities included macular hole in six eyes (Stage 1 in 3 eyes and Stage 2 or 3 in another 3 eyes), epiretinal membrane in five eyes, and cystoid macular edema in four eyes. After uncomplicated CE, the VMT was released in 5 eyes, whereas in 10 eyes, CE did not significantly change the status of the vitreomacular adhesion. Three of 3 eyes with preexisting full-thickness macular hole (Stage 2 or 3 macular hole) were found to have Stage 4 macular hole shortly after CE. In seven of seven patients with diabetes mellitus, the status of the vitreomacular interface did not change after CE. Eventually, 7 of 15 patients underwent additional pars plana vitrectomy. Compared with the baseline vision, and vision before other interventions, the visual acuity after CE improved in 5 patients, remained unchanged in 7 patients, and decreased in the 3 patients with Stage 2 or 3 macular hole. The mean preoperative and early postoperative visual acuity was 20/59 and 20/68, respectively (P > 0.05). CONCLUSION: The effect of CE in phakic eyes with known VMT varies significantly. In the current case series, every eye with VMT and Stage 2 or 3 macular hole ended up with Stage 4 macular hole, although the VMT did not change significantly in the eyes of diabetic patients. Studies with larger sample size are needed to further elucidate the impact of elective CE on VMT.


Assuntos
Facoemulsificação/métodos , Retina/patologia , Doenças Retinianas/cirurgia , Tomografia de Coerência Óptica/métodos , Acuidade Visual , Corpo Vítreo/patologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Retinianas/diagnóstico , Estudos Retrospectivos , Síndrome
9.
Am J Ophthalmol Case Rep ; 20: 100869, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32875154

RESUMO

Purpose: To report a case of unilateral prepapillary vascular loop along with peripheral third order retinal arteriolar tortuosity in the same eye, and to discuss potential diagnostic considerations. Observations: Color fundus pictures and wide-angle fluorescein angiography (FA) demonstrated a pre-papillary vascular loop and a region of retinal arteriolar tortuosity in third order arterioles superotemporally in the left eye. The examination and ancillary testing on the right eye were normal. Conclusion and Importance: The vascular abnormality in this case does not fit a pattern present in other disease states both hereditary or acquired. The patient's immediate family do not demonstrate a similar abnormality and the patient remains visually asymptomatic upon one-year follow-up.

10.
Ophthalmic Surg Lasers Imaging Retina ; 51(4): S6-S14, 2020 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-32348529

RESUMO

BACKGROUND AND OBJECTIVE: To estimate the social cost of blindness due to wet age-related macular degeneration (wAMD), diabetic macular edema (DME), and proliferative diabetic retinopathy (PDR) in the United States in 2020. PATIENTS AND METHODS: Excess costs that occur because of blindness were estimated as the difference in costs in blind versus non-blind individuals. Per-patient costs were aggregated using the number of cases of blindness due to wAMD, DME, and PDR projected in 2020. RESULTS: Associated annual excess direct costs, indirect costs, and quality-adjusted life year loss per blind individual were $4,944, $54,614, and 0.214, respectively. Combining estimates with 246,423 projected cases of blindness due to wAMD, DME, and PDR translated to total societal costs of $20 billion in 2020, estimated to triple by 2050. CONCLUSION: Excess social costs associated with blindness in individuals with wAMD, DME, and PDR are substantial, with more than half of the burden attributed to indirect costs. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:S6-S14.].


Assuntos
Cegueira/economia , Efeitos Psicossociais da Doença , Retinopatia Diabética/complicações , Acuidade Visual , Degeneração Macular Exsudativa/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Cegueira/epidemiologia , Cegueira/etiologia , Retinopatia Diabética/economia , Retinopatia Diabética/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Morbidade/tendências , Estados Unidos/epidemiologia , Degeneração Macular Exsudativa/economia , Degeneração Macular Exsudativa/epidemiologia
11.
Retina ; 40(5): 833-837, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-30689623

RESUMO

PURPOSE: To report the 1-year outcomes of a novel surgical technique for the fixation of a CZ70BD intraocular lens with Gore-Tex suture using cow-hitch knots. METHODS: A retrospective chart review of 15 patients (13 men and 2 women) who underwent fixation of a posterior chamber intraocular lens with Gore-Tex suture was performed. Short- and long-term outcomes data were collected 1 month and 1 year after surgery, respectively. RESULTS: Fourteen of the 15 patients met inclusion criteria and were included in the analysis. Mean visual acuity improved significantly from Snellen 20/491 preoperatively to Snellen 20/59 at postoperative month 12 (P = 0.002). The most common short-term complications included increased intraocular pressure (n = 6) and cystoid macular edema (n = 4). The most common long-term complications included increased intraocular pressure (n = 2) and iris capture of the intraocular lens (n = 2). CONCLUSIONS: One-year outcome data suggest that this technique is a reasonable surgical option for secondary intraocular lens placement in patients who lack capsular support.


Assuntos
Implante de Lente Intraocular/métodos , Lentes Intraoculares , Esclera/cirurgia , Técnicas de Sutura/instrumentação , Suturas , Acuidade Visual , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Estudos Retrospectivos , Fatores de Tempo , Adulto Jovem
12.
Retina ; 40(6): 1148-1152, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31095064

RESUMO

PURPOSE: To present the 1-year results of a surgical technique for the sutureless intrascleral fixation of a 3-piece intraocular lens using a 30-gauge needle. METHODS: A retrospective chart review of a consecutive series of 9 eyes of 8 patients who underwent sutureless intrascleral fixation of posterior chamber intraocular lens using a 30-gauge needle was performed. Patients were required to have at least 1 year of follow-up to be included in the analysis. Short-term data were collected 1 month after surgery, and long-term data were collected 1 year after surgery. Data collected included visual acuity, lens stability, intraocular pressure, and the development of complications. RESULTS: Visual acuity improved from Snellen 20/309 preoperatively to Snellen 20/27 at postoperative Month 12 (P = 0.03). Short-term complications included increased intraocular pressure (n = 4) and corneal edema (n = 2). Long-term complications included exposed superior haptic (n = 1) and recurrent anterior chamber inflammation (n = 1). CONCLUSION: The novel surgical technique for sutureless intrascleral fixation of a 3-piece intraocular lens is well tolerated 1 year after surgery.


Assuntos
Afacia Pós-Catarata/cirurgia , Implante de Lente Intraocular/instrumentação , Lentes Intraoculares , Esclera/cirurgia , Procedimentos Cirúrgicos sem Sutura/métodos , Acuidade Visual , Idoso , Idoso de 80 Anos ou mais , Afacia Pós-Catarata/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Estudos Retrospectivos
13.
Biomech Model Mechanobiol ; 19(2): 603-620, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31650370

RESUMO

A mechanics-based mathematical model of retinal detachment due to the geometric changes of the eye associated with the evolution of myopia is developed. This includes deformation of the retina due to biological growth of the retina, as well as elastic deformation imposed on the retina by the myopic change in shape of the much stiffer choroid and sclera. The problem is formulated as a propagating boundary value problem in the calculus of variations, which yields self-consistent governing equations, boundary conditions, and transversality conditions that establish the location of the propagating boundaries that correspond to equilibrium configurations of the detaching ocular system. Axisymmetric conditions are considered, and exact, analytical solutions to the corresponding boundary value problem are obtained for detaching retinas with and without a tear. Based upon application of the model presented herein to the emmetropic retina, a value of the bond energy of the retina to retinal pigment epithelium interface is estimated using material properties found in the literature. Simulations based on the analytical solutions are performed for a detachment in the retina located at either the posterior or superior pole of the eye. The results support the clinical finding of an increased prevalence of retinal detachment in myopic eyes and provide insight into the potential causation for the increased prevalence.


Assuntos
Miopia/complicações , Miopia/fisiopatologia , Descolamento Retiniano/etiologia , Descolamento Retiniano/fisiopatologia , Fenômenos Biomecânicos , Humanos , Modelos Biológicos , Retina/patologia , Retina/fisiopatologia , Estresse Mecânico , Termodinâmica
15.
Am J Ophthalmol ; 199: 200-208, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30552891

RESUMO

PURPOSE: To compare the rates of infectious endophthalmitis following intravitreal injection of ranibizumab using prefilled syringes vs conventional preparation. DESIGN: Multicenter retrospective cohort study. METHODS: All eyes receiving intravitreal injection of 0.5 mg ranibizumab for retinal vascular diseases at 10 retina practices across the United States (2016 to 2017) and Japan (2009 to 2017) were included. The total numbers of eyes and injections were determined from billing codes. Endophthalmitis cases were determined from billing records and evaluated with chart review. Primary outcome was the rate of postinjection acute endophthalmitis. Secondary outcomes were visual acuity and microbial spectrum. RESULTS: A total of 243 754 intravitreal 0.5 mg ranibizumab injections (165 347 conventional and 78 407 prefilled) were administered to 43 132 unique patients during the study period. In the conventional ranibizumab group, a total of 43 cases of suspected endophthalmitis occurred (0.026%; 1 in 3845 injections) and 22 cases of culture-positive endophthalmitis occurred (0.013%; 1 in 7516 injections). In the prefilled ranibizumab group, 12 cases of suspected endophthalmitis occurred (0.015%; 1 in 6534 injections) and 2 cases of culture-positive endophthalmitis occurred (0.0026%; 1 in 39 204 injections). Prefilled syringes were associated with a trend toward decreased risk of suspected endophthalmitis (odds ratio 0.59; 95% confidence interval 0.31-1.12; P = .10) and a statistically significant decreased risk of culture-positive endophthalmitis (odds ratio 0.19; 95% confidence interval 0.045-0.82; P = .025). Average logMAR vision loss at final follow-up was significantly worse for eyes that developed endophthalmitis from the conventional ranibizumab preparation compared to the prefilled syringe group (4.45 lines lost from baseline acuity vs 0.38 lines lost; P = .0062). Oral-associated flora was found in 27.3% (6/22) of conventional ranibizumab culture-positive endophthalmitis cases (3 cases of Streptococcus viridans, 3 cases of Enterococcus faecalis) compared to 0 cases in the prefilled ranibizumab group. CONCLUSION: In a large, multicenter, retrospective study the use of prefilled syringes during intravitreal injection of ranibizumab was associated with a reduced rate of culture-positive endophthalmitis, including from oral flora, as well as with improved visual acuity outcomes.


Assuntos
Inibidores da Angiogênese/administração & dosagem , Bevacizumab/administração & dosagem , Sistemas de Liberação de Medicamentos , Endoftalmite/epidemiologia , Infecções Oculares Bacterianas/epidemiologia , Seringas , Idoso , Bactérias/isolamento & purificação , Endoftalmite/microbiologia , Endoftalmite/prevenção & controle , Infecções Oculares Bacterianas/microbiologia , Infecções Oculares Bacterianas/prevenção & controle , Feminino , Humanos , Injeções Intravítreas , Masculino , Pessoa de Meia-Idade , Doenças Retinianas/tratamento farmacológico , Estudos Retrospectivos , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Acuidade Visual
16.
Retin Cases Brief Rep ; 13(2): 150-153, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-28198750

RESUMO

PURPOSE: To report a case of relentless placoid chorioretinitis (ampiginous choroiditis) treated with intravitreal triamcinolone acetonide (IVTA). METHODS: Interventional case report. RESULTS: A 34-year-old pregnant woman with a history of poor visual acuity in her left eye, secondary to an undetermined cause, developed an acute painless central scotoma and blurred vision in the right eye. The examination revealed decreased visual acuity, active inflammatory placoid choroidal lesions in the posterior pole, and mid-periphery with sharp disk margins and normal-appearing vasculature. A diagnosis of relentless placoid chorioretinitis was made, and the patient was treated biannually with 4 mg IVTA for 3 years with visual improvement to 20/25. Although she experienced a relapse at 12 months, the episode was adequately controlled with repeat IVTA. After the sixth IVTA treatment occurring at 30 months, the decision was made to stop IVTA, ultimately facilitating the preservation of 20/25 in the right eye at 63-month follow-up. The disease course was complicated by cataract progression that was successfully treated with a cataract extraction and episodic increases in intraocular pressure which were successfully treated with timolol ophthalmic solution. CONCLUSION: Intravitreal triamcinolone acetonide therapy represents an important alternative in the treatment of relentless placoid chorioretinitis. By avoiding the potentially significant side effects of long-term systemic corticosteroid and immunosuppressive therapies, IVTA can be an important alternative in the long-term management of this uncommon and complicated entity.


Assuntos
Coriorretinite/tratamento farmacológico , Glucocorticoides/administração & dosagem , Triancinolona Acetonida/administração & dosagem , Adulto , Feminino , Humanos , Injeções Intravítreas , Gravidez , Resultado do Tratamento
17.
Retina ; 39(4): 761-765, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29293206

RESUMO

PURPOSE: To describe a crystalline retinopathy observed in patients greater than 1 year after intravitreal injection of triamcinolone acetonide (IVTA). METHODS: A retrospective, interventional, noncomparative, single-center case series of patients who received IVTA and developed subsequent crystalline retinopathy lasting greater than 1 year after injection. RESULTS: Eighteen eyes of 16 patients in which preretinal crystals were observed >1 year after IVTA were included in the study, with a mean follow-up (range) of 5.8 years (1.1-9.2) after IVTA. The crystals were refractile, not visible on fluorescein nor indocyanine green angiography, exhibited slow dissolution and movement, and were occasionally distributed in a circular fashion. Optical coherence tomography confirmed the preretinal and/or subhyaloid location of crystals. CONCLUSION: Macular crystals can persist for years after IVTA. The crystals localize to the preretinal or subhyaloid space, are angiographically silent, can exhibit slow dissolution and movement, may be distributed in a circular fashion reflecting the bursa premacularis, and appear nonpathologic.


Assuntos
Cristalização , Glucocorticoides/efeitos adversos , Retina/efeitos dos fármacos , Doenças Retinianas/induzido quimicamente , Triancinolona Acetonida/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Neovascularização de Coroide/tratamento farmacológico , Retinopatia Diabética/tratamento farmacológico , Feminino , Seguimentos , Humanos , Injeções Intravítreas , Edema Macular/tratamento farmacológico , Masculino , Microscopia Eletrônica de Transmissão , Pessoa de Meia-Idade , Retina/ultraestrutura , Doenças Retinianas/diagnóstico por imagem , Oclusão da Veia Retiniana/tratamento farmacológico , Estudos Retrospectivos , Tomografia de Coerência Óptica
18.
Curr Opin Ophthalmol ; 29(3): 210-216, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29538184

RESUMO

PURPOSE OF REVIEW: The surgical approach to eyes needing a secondary intraocular lens have evolved rapidly in recent years. Here, we will focus on techniques for scleral-fixation of intraocular lenses (IOLs), and will review the evidence for their safety and efficacy. RECENT FINDINGS: Transscleral fixation of IOLs refers the placement of lens haptics within scleral tunnels to stabilize the lens in eyes that lack adequate capsular support. Various surgical techniques have been reported recently to accomplish this goal. These include the use of a trocar, microvitreoretinal blade, or hypodermic needle to create the scleral tunnels, as well as several methods for placing the haptics through the tunnels. Although long-term data is lacking, each technique has been shown to have good visual outcomes without significant side effects. SUMMARY: Surgical approaches for the transscleral fixation of secondary IOLs provide a safe and effective technique for the management of eyes with insufficient capsular support.


Assuntos
Implante de Lente Intraocular/métodos , Lentes Intraoculares , Esclera/cirurgia , Técnicas de Sutura , Humanos , Implante de Lente Intraocular/efeitos adversos , Complicações Pós-Operatórias , Técnicas de Sutura/efeitos adversos , Acuidade Visual
19.
Retina ; 38(1): 128-136, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28106706

RESUMO

PURPOSE: To investigate predictors of success, visual outcomes, and complications of intravitreal ocriplasmin for the treatment of symptomatic vitreomacular adhesion in a clinical care setting. METHODS: Retrospective chart review of 49 consecutive eyes of 47 patients who received intravitreal ocriplasmin. Spectral domain optical coherence tomography scans were examined for vitreomacular traction (VMT) release, full-thickness macular hole (FTMH) closure, and other changes in retinal anatomy. RESULTS: Pharmacologic VMT release occurred in 41% of eyes; positive predictors included age ≤75 years (P = 0.001), phakic status (P = 0.016), VMT width ≤750 µm (P = 0.001), and absence of retinal comorbidities (P = 0.035). Pharmacologic FTMH closure occurred in 25% of cases; positive predictors included successful VMT release (P = 0.042), better preinjection best-corrected visual acuity (P = 0.036), and smaller FTMH aperture width (P = 0.033). Eyes that achieved VMT release and did not undergo surgery attained significant improvement in best-corrected visual acuity (P = 0.015). Complications included subfoveal lucency (33%), ellipsoid zone disruption (33%), and FTMH base enlargement (75%). Only FTMH base enlargement resulted in worse visual outcomes (P = 0.024). Subgroup analysis of 14 eyes with ideal characteristics (all positive predictors listed above) yielded a 93% VMT release rate. CONCLUSION: Proper case selection may facilitate successful pharmacologic vitreolysis with ocriplasmin, improve visual outcomes, and minimize potential complications.


Assuntos
Fibrinolisina/administração & dosagem , Fragmentos de Peptídeos/administração & dosagem , Perfurações Retinianas/tratamento farmacológico , Tomografia de Coerência Óptica/métodos , Acuidade Visual , Descolamento do Vítreo/tratamento farmacológico , Idoso , Feminino , Seguimentos , Humanos , Injeções Intravítreas , Masculino , Perfurações Retinianas/diagnóstico , Estudos Retrospectivos , Aderências Teciduais/diagnóstico , Aderências Teciduais/tratamento farmacológico , Resultado do Tratamento , Descolamento do Vítreo/diagnóstico
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