Comparison of macular retinal sensitivity and its contribution to the foveal sensitivity between diabetic and non-diabetic patients with normal visual acuity.

PURPOSE: To compare the retinal sensitivity and evaluate its contribution to the foveal sensitivity in patients with and without diabetes who maintain normal visual acuity. METHODS: Observational, descriptive, cross-sectional and prospective study in 20 subjects without diabetes (group 1) and 23 with type 2 diabetes mellitus (group 2) that had no ocular abnormalities. Retinal sensitivity was measured with the macular threshold test by the Humphrey's computerized perimeter. The mean sensitivity in each of the 16 points and the foveal sensitivity were compared between groups using the Mann-Whitney's U test; the correlation between retinal sensitivity and foveal sensitivity was analyzed by the Spearman's test and the contribution of each point to the foveal sensitivity was identified by multiple regression. RESULTS: Sixty eyes were evaluated, 30 in group 1 and 30 in group 2; the mean foveal sensitivity was 34.77±0.5dB in group 1 and 32.87±0.6 in group 2. The highest sensitivity of the temporal visual field had an inferior paracentral location (point 3) in both groups. In the linear regression analysis, points which contributed to the foveal sensitivity were 1 in group 1 and points 7 and 15 in group 2. CONCLUSIONS: Subjects without diabetes have a significantly higher sensitivity in the temporal retina compared with those with diabetes; points with highest mean retinal sensitivity do not correspond to the central four. The reduced sensitivity in point 1 decreases the mean foveal sensitivity in subjects with diabetes, because this variable correlates with lower perimetry points.

Serous retinal detachment in patients with macular edema secondary to branch retinal vein occlusion.

PURPOSE: The aim of the present study was to evaluate visual acuity (VA) and central macular thickness (CMT) to assess the influence of serous retinal detachment (SRD) in eyes with macular edema (ME) secondary to branch retinal vein occlusion (BRVO). METHODS: Sixty-one eyes with BRVO from 61 patients with ME were analyzed and divided into two groups according to the spectral domain optical coherence tomography (OCT) findings of SRD and cystoid macular edema (CME). All patients underwent complete ophthalmic examinations and OCT measurements (Cirrus, Carl Zeiss Meditec Inc, Dublin, CA). Patients with marked retinal hemorrhage, diabetic retinopathy, previous laser photocoagulation, and/or intravitreal injection were excluded. RESULTS: The mean age of included patients (37 males, 24 females) was 65.4 ± 11.4 (53-77) years. There were 21 patients with SRD and 40 patients with CME. All of the 21 patients with SRD had CME. VA was significantly worse in the SRD group compared with the CME (non-SRD) group (0.82 ± 0.34 logMAR vs 0.64 ± 0.38 logMAR; P=0.005). Conversely, CMT was significantly greater in the SRD group than in the CME group (465 ± 115 µ vs 387 ± 85 µ; P=0.00004). CONCLUSION: SRD may be associated with decreased VA. The prognosis of patients with BRVO and SRD requires further investigation.

Serous retinal detachment in patients with macular edema secondary to branch retinal vein occlusion / Descolamento seroso de retina em pacientes com edema macular secundário à oclusão de ramo da veia retiniana

ABSTRACT Purpose: The aim of the present study was to evaluate visual acuity (VA) and central macular thickness (CMT) to assess the influence of serous retinal detachment (SRD) in eyes with macular edema (ME) secondary to branch retinal vein occlusion (BRVO). Methods: Sixty-one eyes with BRVO from 61 patients with ME were analyzed and divided into two groups according to the spectral domain optical coherence tomography (OCT) findings of SRD and cystoid macular edema (CME). All patients underwent complete ophthalmic examinations and OCT measurements (Cirrus, Carl Zeiss Meditec Inc, Dublin, CA). Patients with marked retinal hemorrhage, diabetic retinopathy, previous laser photocoagulation, and/or intravitreal injection were excluded. Results: The mean age of included patients (37 males, 24 females) was 65.4 ± 11.4 (53-77) years. There were 21 patients with SRD and 40 patients with CME. All of the 21 patients with SRD had CME. VA was significantly worse in the SRD group compared with the CME (non-SRD) group (0.82 ± 0.34 logMAR vs 0.64 ± 0.38 logMAR; P=0.005). Conversely, CMT was significantly greater in the SRD group than in the CME group (465 ± 115 µ vs 387 ± 85 µ; P=0.00004). Conclusion: SRD may be associated with decreased VA. The prognosis of patients with BRVO and SRD requires further investigation.

RESUMO Objetivo: O objetivo deste estudo foi investigar a acuidade visual (VA) e espessura macular central (CMT) para avaliar a influência do descolamento seroso da retina (SRD) em olhos com edema macular (ME) secundário a oclusão de ramo da veia da retina (BRVO). Método: Sessenta e um olhos de 61 pacientes com oclusão de ramo da veia da retina e edema macular foram analisados e divididos em dois grupos, de acordo com os achados na a tomografia de coerência óptica por domínio espectral (OCT), de edema macular cistóide (CME) e descolamento seroso da retina. Todos os pacientes foram submetidos a exame oftalmológico completo e exame de tomografia de coerência óptica (Cirrus, Carl Zeiss Meditec Inc, Dublin, CA). Os pacientes com hemorragia acentuada da retina, retinopatia diabética, fotocoagulação a laser e/ou injeção intravítrea prévia foram excluídos. Resultados: A idade média dos pacientes (37 homens, 24 mulheres) foi de 65,4 ± 11,4 (53-77) anos. Havia 21 pacientes com SRD e 40 pacientes com edema macular cistóide. Todos os 21 pacientes com SRD também apresentaram edema macular cistóide. VA foi significativamente pior no grupo SRD do que no grupo edema macular cistóide (non-SRD) (0,82 ± 0,34 vs 0,64 ± 0,38 logMAR, p=0,005). Por outro lado, a espessura macular central foi significativamente maior no grupo descolamento seroso da retina do que no grupo edema macular cistóide (465 ± 115 µ vs 387 ± 85 µ, p=0,00004). Conclusão: Observou-se que o descolamento seroso da retina em si pode estar relacionado à diminuição de acuidade visual. Os prognósticos dos pacientes com oclusão de ramo da veia da retina e descolamento seroso da retina precisam ser adequadamente investigados.

Visual function and macular architecture in patients with inactive zone 2 and 3 toxoplasmic retinochoroiditis.

PURPOSE: To evaluate the visual function and architecture of the central and peripapillary retina in patients with inactive toxoplasmic retinochoroiditis outside the macular and peripapillary regions (zones 2 and 3). METHODS: Cross-sectional study of 20 eyes (18 patients) with zone 2 and 3 toxoplasmic scars and visual acuity ≥20/25. Patients underwent Humphrey 10-2 perimetry, contrast sensitivity (Mars test), and color vision testing (L'Anthony desaturated D-15). The retinal nerve fiber layer (RNFL) and macular thicknesses were determined by optical coherence tomography. RESULTS: The patients' mean age was 27.4 ± 10.3 years, and the mean duration of remission was 6.15 ± 5.19 months. Abnormal contrast sensitivity and color vision were observed in three (15.0%) and four eyes (20.0%), respectively. Mean deviation (MD) and pattern standard deviation (PSD) fell outside the 95% normal confidence limits of the perimeter's database in 14 (70.0%) and seven eyes (35.0%), respectively. Foveal and mean RNFL thicknesses were within the normal limits in all eyes. Eyes with zone 2 retinochoroiditis had lower foveal sensitivity than eyes with zone 3 lesions (p=0.041). Eyes with a longer duration of remission had a higher MD (r=0.575; p=0.013) and a lower PSD (r=-0.593; p=0.010). CONCLUSIONS: Despite normal central and peripapillary retinal architecture, eyes with inactive zone 2 and 3 toxoplasmic retinochoroiditis can present with abnormal color, contrast, and macular perimetric sensitivity. Zone 2 retinochoroiditis was associated with lower foveal sensitivity, and a longer duration of retinochoroiditis remission was associated with better perimetric parameters (MD and PSD).

Visual function and macular architecture in patients with inactive zone 2 and 3 toxoplasmic retinochoroiditis / Função visual e arquitetura macular em pacientes com retinocoroidite toxoplásmica inativa nas zonas 2 e 3

ABSTRACTPurpose:To evaluate the visual function and architecture of the central and peripapillary retina in patients with inactive toxoplasmic retinochoroiditis outside the macular and peripapillary regions (zones 2 and 3).Methods:Cross-sectional study of 20 eyes (18 patients) with zone 2 and 3 toxoplasmic scars and visual acuity ≥20/25. Patients underwent Humphrey 10-2 perimetry, contrast sensitivity (Mars test), and color vision testing (L'Anthony desaturated D-15). The retinal nerve fiber layer (RNFL) and macular thicknesses were determined by optical coherence tomography.Results:The patients' mean age was 27.4 ± 10.3 years, and the mean duration of remission was 6.15 ± 5.19 months. Abnormal contrast sensitivity and color vision were observed in three (15.0%) and four eyes (20.0%), respectively. Mean deviation (MD) and pattern standard deviation (PSD) fell outside the 95% normal confidence limits of the perimeter's database in 14 (70.0%) and seven eyes (35.0%), respectively. Foveal and mean RNFL thicknesses were within the normal limits in all eyes. Eyes with zone 2 retinochoroiditis had lower foveal sensitivity than eyes with zone 3 lesions (p=0.041). Eyes with a longer duration of remission had a higher MD (r=0.575; p=0.013) and a lower PSD (r=-0.593; p=0.010).Conclusions:Despite normal central and peripapillary retinal architecture, eyes with inactive zone 2 and 3 toxoplasmic retinochoroiditis can present with abnormal color, contrast, and macular perimetric sensitivity. Zone 2 retinochoroiditis was associated with lower foveal sensitivity, and a longer duration of retinochoroiditis remission was associated with better perimetric parameters (MD and PSD).

RESUMOObjetivo:Avaliar a função visual e arquitetura da retina central e peripapilar em pacientes com retinocoroidite toxoplásmica inativa fora da região macular e peripapilar (zonas 2 e 3).Métodos:Estudo transversal de 20 olhos (18 pacientes) com cicatrizes toxoplásmicas nas zonas 2 e 3 com acuidade visual ≥20/25. Os pacientes foram submetidos à perimetria Humphrey 10-2, teste de sensibilidade ao contraste (Teste Mars) e teste de visão de cores (L'Anthony D-15 dessaturado). As espessuras da camada de fibras nervosas da retina (CFNR) e da mácula foram determinadas pela tomografia de coerência óptica.Resultados:A média de idade dos pacientes foi 27,4 ± 10,3 anos, e a duração média da remissão da retinocoroidite foi de 6,15 ± 5,19 meses. Alterações na sensibilidade ao contraste e cores foram observada em, respectivamente, 3 olhos (15,0%) e 4 olhos (20,0%). Os índices perimétricos mean deviation (MD) e pattern standard deviation (PSD) estiveram fora do intervalo de confiança de 95% do perímetro em 14 olhos (70,0%) e 7 olhos (35,0%), respectivamente. A espessura foveal e da CFNR média estiveram dentro do limite da normalidade em todos os olhos. Olhos com retinocoroidite na zona 2 tiveram menor sensibilidade foveal que olhos com lesões na zona 3 (p=0,041). Olhos com remissão de longa duração tiveram um MD mais alto (r=0,575; p=0,013) e um PSD mais baixo (r=-0,593; p=0,010).Conclusão:Apesar da arquitetura normal da retina central e peripapilar, olhos com retinocoroidite inativa nas zonas 2 e 3 podem apresentar anormalidades da visão de cores, sensibilidade ao contras e perimetria macular. A retinocoroidite na zona 2 está associada a uma menor sensibilidade foveal. Longos intervalos de remissão da retinocoroidite estiveram associados a melhores parâmetros perimétricos (MD e PSD).

[Evaluation of the macular function by focal electroretinography and by fluorescein angiography in patients with neovascular age-related macular degeneration submitted to verteporfin photodynamic therapy]. / Avaliação da função macular por eletrorretinografia focal e por angiofluoresceinografia em pacientes com degeneração macular relacionada à idade neovascular submetidos à terapia fotodinâmica com verteporfina.

PURPOSE: To evaluate macular function by focal electroretinography and fluorescein angiography (FA) in patients with neovascular age-related macular degeneration submitted to verteporfin photodynamic therapy (VPT). METHODS: Prospective study involving 22 patients with age-related macular degeneration and predominantly classic subfoveal neovascular membrane, in non consecutive series, treated with VPT and followed for 12 months. They had their best corrected visual acuity measured by ETDRS chart, changes of lesion measured by fluorescein angiography and cone function assessed by focal electroretinography at baseline and each 3-month follow-up. RESULTS: All 22 patients completed the scheduled follow-up. After a mean of 3.5 sessions of treatment per patient, the mean visual acuity variation was not significant at the end of study. Eleven patients showed variation > or =1 line. 86% of patients achieved stabilization of lesion leakage at the end of the study. Focal electroretinography showed a mean of 194.88 nV in amplitude and 29.19 ms in latency and did not present a significant variation during treatment. CONCLUSIONS: There were no significant differences in focal electroretinography amplitudes and latencies after a 9-month period. Visual acuity did not show important variations during the 12 months. The decrease of lesion size showed a significant difference at 12 months with negative correlation between the amplitude of focal electroretinography and best corrected visual acuity.

Avaliação da função macular por eletrorretinografia focal e por angiofluoresceinografia em pacientes com degeneração macular relacionada à idade neovascular submetidos à terapia fotodinâmica com verteporfina / Evaluation of the macular function by focal electroretinography and by fluorescein angiography in patients with neovascular age-related macular degeneration submitted to verteporfin photodynamic therapy

OBJETIVOS: Avaliar a função macular por eletrorretinografia focal e angiofluoresceinografia em pacientes com degeneração macular relacionada à idade neovascular submetidos à terapia fotodinâmica com verteporfina. MÉTODOS: Estudo prospectivo incluindo 22 pacientes (12 homens) com degeneração macular relacionada à idade e lesão neovascular coroídea subfoveal predominantemente clássica, não consecutivos, tratados com terapia fotodinâmica com verteporfina padrão e acompanhados por um período de 12 meses. A acuidade visual melhor corrigida foi medida utilizando tabela ETDRS, as alterações das lesões foram avaliadas pela angiofluoresceinografia e a função dos cones foram obtidas pela eletrorretinografia focal na visita inicial e nas subsequentes a cada três meses. RESULTADOS: Todos os pacientes completaram as visitas programadas. Após uma média de 3,5 sessões por paciente, a variação da acuidade visual melhor corrigida não foi significante no decorrer do estudo. Em 50 por cento dos pacientes a variação da acuidade visual melhor corrigida foi >1 linha. Ao final do estudo observou-se ausência de vazamento em 86 por cento dos pacientes. A média da amplitude e latência do ERG focal na visita inicial foram de, respectivamente, 194,88 nV e 29,19 ms e as variações no decorrer do estudo não foram significantes. CONCLUSÕES: Não foram encontradas diferenças na amplitude e latência do eletrorretinografia focal após um período de 9 meses. A acuidade visual melhor corrigida não sofreu variações significativas ao longo dos 12 meses. A lesão foi significativamente reduzida ao longo do tempo e houve uma correlação negativa entre a amplitude e a acuidade visual melhor corrigida.

PURPOSE: To evaluate macular function by focal electroretinography and fluorescein angiography (FA) in patients with neovascular age-related macular degeneration submitted to verteporfin photodynamic therapy (VPT). METHODS: Prospective study involving 22 patients with age-related macular degeneration and predominantly classic subfoveal neovascular membrane, in non consecutive series, treated with VPT and followed for 12 months. They had their best corrected visual acuity measured by ETDRS chart, changes of lesion measured by fluorescein angiography and cone function assessed by focal electroretinography at baseline and each 3month follow-up. RESULTS: All 22 patients completed the scheduled follow-up. After a mean of 3.5 sessions of treatment per patient, the mean visual acuity variation was not significant at the end of study. Eleven patients showed variation >1 line. 86 percent of patients achieved stabilization of lesion leakage at the end of the study. Focal electroretinography showed a mean of 194.88 nV in amplitude and 29.19 ms in latency and did not present a significant variation during treatment. CONCLUSIONS: There were no significant differences in focal electroretinography amplitudes and latencies after a 9-month period. Visual acuity did not show important variations during the 12 months. The decrease of lesion size showed a significant difference at 12 months with negative correlation between the amplitude of focal electroretinography and best corrected visual acuity.

Descolamento regmatogênico de retina: avaliação pós-operatória da mácula / Rhegmatogenous retinal detachment: a postoperative study of the macula

OBJETIVO: Avaliar função e estrutura macular de pacientes submetidos a cirurgia de descolamento regmatogênico da retina. MÉTODOS: Estudo prospectivo de pacientes submetidos a retinopexia pneumática ou introflexão escleral com seguimento feito por meio de exame oftalmológico completo e tomografia de coerência óptica. RESULTADOS: A amostra foi composta por 14 olhos (14 pacientes), sendo 10 (71,4 por cento) submetidos a introflexão escleral e 4 (28,6 por cento), a retinopexia pneumática. A idade variou entre 24 e 59 anos, média de 39,3 anos. Houve correlações negativas entre a acuidade visual final e a idade (r= -0,64 e p= 0,0127) e entre a acuidade visual final e o tempo de descolamento (r= -0,54 e p= 0,0447). Houve correlação positiva entre as acuidades visual do seguimento inicial e final (r= 0,69 e p= 0,0059). Na tomografia de coerência óptica, quatro olhos (28,6 por cento) apresentaram descolamento residual na fóvea, com resolução espontânea e melhora na acuidade visual (p= 0,031); não houve relação entre tempo de resolução e acuidade final (p= 0,5546). CONCLUSÃO: Os resultados mostram que quanto mais jovem o paciente e mais precoce a intervenção cirúrgica, melhor acuidade visual final. Adicionalmente, quanto maior acuidade no início do pós-operatório, melhor acuidade final. Todos os casos de descolamento foveal evidenciados por meio da tomografia de coerência óptica, no pós-operatório, cursaram com reabsorção do líquido subfoveal e melhora da visão.

PURPOSE: To evaluate the structure and function of the macula following rhegmatogenous retinal detachment surgery. METHODS: Prospective study of patients submitted to scleral buckle surgery or pneumatic retinopexy. The follow-up comprised a complete ophthalmologic exam and optical coherence tomography. RESULTS: The sample was composed of 14 eyes (14 patients), 71.4 percent operated with the scleral buckle technique, and 28.6 percent with the pneumatic retinopexy. The age range was from 24 to 59 years (mean of 39.3 years). There was a negative correlation between the final visual acuity and age of patient (r=-0.64, p=0.0127) and between final vision and duration of detachment (r=-0.54, p=0.0447). There was a positive correlation between visual acuity at initial follow-up and that at the final follow-up (r=0.69, p=0.0059). The optical coherence tomography of the initial follow-up showed subclinical foveal detachment in four eyes (28.6 percent of cases); at the final follow-up the retina was applied by itself with improved vision in all eyes (p=0.031), regardless the time span until reapplication (p=0.5546). CONCLUSION: The results show that the younger the patient and the earlier the surgical procedure, the better the final visual acuity. Furthermore, there is a positive correlation between initial and final postoperative vision and, all cases that presented foveal detachment on the optical coherence tomography at the initial follow-up had the retina flattened and the vision improved at the final examination.

[Rhegmatogenous retinal detachment: a postoperative study of the macula]. / Descolamento regmatogênico de retina: avaliação pós-operatória da mácula.

PURPOSE: To evaluate the structure and function of the macula following rhegmatogenous retinal detachment surgery. METHODS: Prospective study of patients submitted to scleral buckle surgery or pneumatic retinopexy. The follow-up comprised a complete ophthalmologic exam and optical coherence tomography. RESULTS: The sample was composed of 14 eyes (14 patients), 71.4% operated with the scleral buckle technique, and 28.6% with the pneumatic retinopexy. The age range was from 24 to 59 years (mean of 39.3 years). There was a negative correlation between the final visual acuity and age of patient (r=-0.64, p=0.0127) and between final vision and duration of detachment (r=-0.54, p=0.0447). There was a positive correlation between visual acuity at initial follow-up and that at the final follow-up (r=0.69, p=0.0059). The optical coherence tomography of the initial follow-up showed subclinical foveal detachment in four eyes (28.6% of cases); at the final follow-up the retina was applied by itself with improved vision in all eyes (p=0.031), regardless the time span until reapplication (p=0.5546). CONCLUSION: The results show that the younger the patient and the earlier the surgical procedure, the better the final visual acuity. Furthermore, there is a positive correlation between initial and final postoperative vision and, all cases that presented foveal detachment on the optical coherence tomography at the initial follow-up had the retina flattened and the vision improved at the final examination.

AntiVEGF e outras medidas terapêuticas no edema macular diabético / AntiVEGF and other therapeutical measures in edema to stain diabetic

O Diabetes Mellitus (DM) e suas complicações sistêmicas e oftalmológicas representam um grande problema de saúde pública no Brasil e no mundo. No Brasil, mais de 7,6% de pessoas são afetadas por essa patologia, sem contar os inúmeros casos de diabéticos não-diagnosticados. Neste artigo, são vistos conceitos acerca do edema macular diabético, tais como a fisiopatologia e as opções de tratamentos, enfatizando o uso de antiVEGF, bem como aspectos legais.

Use of a stenopeic semiocclusor enhances vep diagnosis.

PURPOSE: We conducted a study to assess the capability of a 2-mm stenopeic semiocclusor in improving the sensitivity of the standard full-field pattern-visual evoked potential technique to disclose abnormalities of the pre-chiasmatic visual pathway. METHODS: Nineteen control subjects and fifty-five patients with a diagnosis of definite or probable Multiple Sclerosis (MS) were evaluated. All subjects were seated in front of a 19" TV monitor depicting a black and white square pattern, standard condition (R). Two trials of 100 stimulus repetitions at 1.8 Hz, recording at Oz- Fz were performed for each eye. After two minutes the procedure was replicated using an stenopeic semiocclusor, central field condition (S). The main parameters quantified were the P100 latency in each eye (a) and P100 inter-ocular difference (b). RESULTS: Under condition R abnormalities were detected in 42 patients for parameter "a", and in 39 patients for parameter "b". If both parameters, a + b, were considered 48 patients (87%) showed abnormalities. Under condition S, abnormalities were detected in 49 patients for parameter "a" and 41 patients for parameter "b". When both parameters, a + b, were considered 53 patients (96%) showed abnormalities. DISCUSSION: The main point of interest of this study is the fact that when a pattern reversal stimulus is restricted to the central area the evoked response shows a P100 peak with prolonged latency in comparison to the full-field stimulus. Additionally, used in combination with the standard full-field technique it improves the abnormality detection rate whilst adding little extra time to the procedure.

Avaliação da mácula e camada de fibras nervosas peripapilar em olhos normais, glaucomatosos e com suspeita de glaucoma utilizando a tomografia de coerência óptica / Optical coherence tomography measurement of macular and peripapillar nerve fiber layer thickness in normal, glaucoma suspect and glaucomatous eyes

Esse estudo transversal avalia a espessura macular e da camada de fibras nervosas peripapilar em olhos normais, glaucomatosos e suspeitos com a unidade protótipo de tomografia de coerência óptica. Foram estudados 534 olhos, incluindo 166 normais, 196 com glaucoma inicial, 89 com glaucoma avançado e 83 olhos suspeitos. Todos os parâmetros da camada de fibras nervosas mostraram diferenças estatisticamente significativas entre olhos normais e com glaucoma inicial ou avançado (p = 0,0001). Este fato não aconteceu em relação aos parâmetros maculares. Houve diminuição da espessura macular e da camada de fibras nervosas em olhos glaucomatosos, sendo que a redução desta última parece ser superior.This cross-sectional study evaluates macular and peripapillary nerve fiber layer thickness in normal, glaucoma suspect and glaucomatous eyes. It was used prototype optical coherence tomography unit to measure macular and nerve fiber layer thickness. It was studied 534 eyes, including 166 normal, 83 of glaucoma suspects, 196 of early and 89 eyes of advanced glaucoma. All nerve fiber layer parameters were statistically significantly different comparing normals and either early or advanced glaucoma (p=0.0001). This did not happen for macular parameteres. Nerve fiber layer and macular thickness measurements were reduced in glaucoma, although nerve fiber layer thickness was more reduced...

Estudo das alteraçöes da funçäo macular em pacientes portadores de glaucoma crônico simples submetidos à trabeculoectomia / Macular assessment in patients operated on for glaucoma

Para avaliarmos a alteraçäo da acuidade visual após a cirurgia de trabeculectomia, analisamos 28 pacientes (28 olhos) com glaucoma primário de ângulo aberto que foram submetidos a esta cirurgia na Santa Casa de Säo Paulo. No pré-operatório testamos a acuidade visual e realizamos o campo visual com o programa "macular test". Trinta dias após o procedimento, todos os pacientes foram examinados novamente. Nossos resultados mostram que tanto a acuidade visual e o "foveal threshold" diminuíram após a cirurgia

Manejo de la maculopatía hipotónica en cirugía de glaucoma / Hypotony maculopathy management in glaucoma surgery

La maculopatía hipotónica es una complicación de la cirugía de glaucoma que se caracteriza por marcada disminución de visión, pliegues coroideo-retinales, hipotonía ocular y edema de papila. Esta serie comprende 7 casos de maculopatía hipotónica, 5 asociados a trabeculectomía, uno a trabeculotomía y uno a facoemulsificación combinada con trabeculectomía. En 5 casos se usó 5 fluoruracilo o mitomicina. La edad promedio de los pacientes fue 38,7 años, 5 casos presentaban miopía. La causa de la hipotonía fue exceso de filtración a través de la trabeculotomía en 5 casos, en un caso fue a través de brecha ciclodiálisis causada por trabeculotómia y un caso por perforación de ampolla filtrante. El tratamiento fue causal en cada caso; diatermia para cerrar la ciclodiálisis en un caso, suturas adicionales en un caso, sutura de compresión y láser en un caso, hemoterapia en un caso y recuperación espontánea en tres casos. Todos los casos elevaron la presión ocular de un rango entre 0 y 4 mmHg a un rango entre 8 y 17 mmHg. La visión se recuperó al nivel preoperatorio en 5 casos. En dos casos la visión no se recuperó permaneciendo en el nivel subnormal. Existen varias opciones de tratamiento que deben ser adoptadas a las necesidades de cada caso y realizadas lo antes posible

Variations in the clinical course of submacular hemorrhage.

PURPOSE: To assess variations in the clinical course of submacular hemorrhages. METHODS: We reviewed fundus photography charts taken of patients during a 27-month period. Thirty-one eyes of 31 patients with submacular hemorrhages under the foveal avascular zone were reviewed. RESULTS: In 20 of the eyes, the underlying etiology was age-related macular degeneration (ARMD). The other 11 eyes had various underlying conditions, including macroaneurysms (two), presumed ocular histoplasmosis syndrome (two), trauma (one), Valsalva's retinopathy (one), idiopathic central serous choroidopathy (one), diabetic retinopathy (two), central retinal vein occlusion (one), and choroidal rupture (one). Of the eyes with ARMD (mean follow-up, 29 months), eight (40%) of 20 showed an improvement in visual acuity (> or = 2 Snellen lines), six (30%) of 20 had a final visual acuity of 20/80 or better, and three (15%) had a final visual acuity of 20/40 or better (range, 20/25 to 20/80). Of the eyes without ARMD (mean follow-up, 29 months), five (45) of 11 had an improvement in visual acuity and five (45%) of 11 attained a final visual acuity of 20/40 or better (range, 20/20 to 20/40). The best predictive factor for poor final visual acuity was the presence of a subretinal neovascular membrane. CONCLUSIONS: Patients with submacular hemorrhage may have spontaneous improvement in visual acuity without surgery. Patients without subretinal neovascular membranes had a better visual improvement rate.

Avaliaçäo da funçäo macular e da funçäo dos cones em pacientes com retinose pigmentar por meio de: potencial visual evocado por padräo reverso, potencial visual evocado focal, flicker perimetria / Valuation of the remaining macular and cone function in retinitis pigmentosa patients. The electrophysiologycal tests of pattern visual evoked potencial, focal visual evoked potencial, flicker perimetry

Objetivo: Avaliar a funçäo da mácula e a funçäo dos cones em pacientes com retinose pigmentar (RP) por meio dos exames de potencial visual evocado (PVE) por padräo reverso (PVE-P) potencial visual evocado focal (PVE-F) e da flicker perimetria (FP). Método: O PVE-P realizado foi do tipo steady-state, com uma frequência de reversäo dos quadrados de 6 Hz. Foram testados cinco padröes diferentes: 160, 80, 40, 20 e 10 minutos de arco. Para a realizaçäo do PVE-F foi utilizada uma iluminaçäo homogênea que compreendia 4,5§ de ângulo visual do paciente. A intensidade de luz era controlada através de filtros de densidade neutra. A intensidade do estímulo sem nenhum filtro era de 14.290 mL. A FP era realizada em ambiente fotópico, com um estímulo de 2§, cuja frequência de piscamento era reduzida até que o paciente percebesse. Estimulava-se o centro (0§), e os pontos periféricos (5§, 10§, 20§, 30§, 40§, 50§ e 60§, no meridiano horizontal, tanto no sentido nasal como no temporal). Conclusöes: Em pacientes com RP e AV relativamente preservada, a funçäo da mácula e dos cones pôde ser mensurada pelos exames de PVE-P, PVE-F e FP. Houve uma boa correlaçäo positiva entre a AV e os testes de PVE-P, PVE-F e FP. Houve uma boa correlaçäo positiva entre o CV e o PVE-P. A correlaçäo entre o CV e o resultado do PVE-F e da FP foi fraca. A CAFP do PVE-P teve uma conformaçäo achatada. O gráfico da FP teve uma configuraçäo em montanha. Os cones da retina de pacientes com RP e AV relativamente preservada estavam acometidos em toda a extensäo testada, incluindo a mácula, porém o acometimento foi mais marcante nos cones da periferia do que nos cones da retina central. A funçäo visual remanescente na retina de pacientes com RP e AV relativamente preservada pode ser quantificada pelos exames de PVE-P, PVE-F e FP, permitindo que estes exames sejam incorporados à rotina de avaliaçäo e acompanhamento da progressäo da retinose pigmentar...

Estudio de la frecuencia macular y el potencial evocado visual en pacientes miopes del servicio de microcirugía ocular : valor pronóstico / Estudy of acular frecuency and visual evoked potential in myopic patients at the ocular microsurgery service: prognostic valvue

En el servicio de Microcirugía ocular en Serie del Hospital Oftalmológico Docente "Ramón Pando Ferrer"se hace un estudio a 60 pacientes miopes de potencial evocado visual; se realiza una correlación con la frecuencia macular y la agudeza visual alcanzada. Se encontró que existe una relación directamente proporcional entre la agudeza visual, la respuesta macular y el resultado pronóstico para este tipo de paciente cuando van a ser sometidos a intervención quirúrgica (AU)

Estudio de la frecuencia macular y el potencial evocado visual en pacientes miopes del servicio de microcirugía ocular : valor pronóstico / Estudy of macular frecuency and visual evoked potential in myopic patients at the ocular microsurgery service: prognostic valvue

En el servicio de Microcirugía ocular en Serie del Hospital Oftalmológico Docente "Ramón Pando Ferrer"se hace un estudio a 60 pacientes miopes de potencial evocado visual; se realiza una correlación con la frecuencia macular y la agudeza visual alcanzada. Se encontró que existe una relación directamente proporcional entre la agudeza visual, la respuesta macular y el resultado pronóstico para este tipo de paciente cuando van a ser sometidos a intervención quirúrgica

Métodos de estudio de la función macular en las cataratas / Methods of study of the macular function in cataract

El autor presenta distintos métodos para estudiar la visión macular en pacientes con catarata que no alcanzan a ver la escala de Snellen a ninguna distancia. Comienza por usar la tabla de Jaeguer acercando el plano de lectura a 20-10 y 5cms., adicionando en la montura de prueba lentes + 5 esf + 10 y + 20 esf, respectivamente. Si el paciente no las lee utiliza test de Amsler a las mismas distancias. Si no ve las líneas directamente utiliza, en la misma forma pero haciendo mirar al paciente contra la luz dentro de un simple visor de (slides) transparencias, las tablas de Snellen, Jaeguer, Amsler o bien paisaje con líneas. Si el paciente es miope o fuerte hipermétrope agrega en la montura los lentes que usaba. Con este método logra estudios de mácula en pacientes entre 1/50 y cuenta dedos con un alto porcentaje de seguridad