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1.
Vestn Oftalmol ; 137(2): 18-25, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33881259

RESUMO

Blood supply is known to be required for tumor growth and metastasis, and the formation of the tumor's own vasculature plays a critical role in the development of solid neoplasms. The method of optical coherence tomography angiography (OCTA) is considered promising for the study of angioarchitectonics. PURPOSE: To evaluate the OCTA signs of choroidal melanoma (CM) depending on its sizes. MATERIAL AND METHODS: The study included 24 patients with CM (24 eyes, of them with small CM - 22 eyes) aged 55.0±12.08 years (37 to 80 years old) with mean prominence of 2.35±0.87 mm (1.0 to 4.7 mm). RESULTS AND DISCUSSION: Retinal vascular attenuation in the tumor area was observed in 21 eyes. Changes in angioarchitectonics in the area of CM localization can be detected at a thickness of 1 mm, and the tumor's own vasculature - starting with a thickness of 1.4 mm. The development of vascular changes in CM can be represented as follows: initially, with CM prominence of up to 1.4 mm, indirect signs of increased blood flow in the overlaying choriocapillaris layer are visualized, most likely due to its compression; as the tumor grows and its thickness increases in its most dominant part, the choriocapillaris layer is completely destroyed, which leads to reactive expansion of the choroidal capillaries along the layer's edges. This is manifested as attenuation of the vascular signal in the central part of the tumor and its intensification along its edges. In the meantime, collaterals begin to form in the deep vascular plexus of the retina. Later on, chaotic vascular arches begin to form in the inner layers of the choroid along the tumor edge; as the tumor grows, they anastomose with the retinal vessels. Identification of the tumor's own vessels in the deeper-lying layers is possible with tumor prominence of at least 1.4 mm. At the level of the deep choroidal layers, the tumor's vascular pattern is more consistent with the angiographic data and patterns of vasculogenic mimicry described in literature. CONCLUSION: Changes in angioarchitectonics in the area of CM localization can be detected at a thickness of 1 mm, and the tumor's own vasculature - starting with a thickness of 1.4 mm. The vascular pattern at the level of the deep choroidal layers best corresponds to the reported angiographic picture and patterns of vasculogenic mimicry.


Assuntos
Neoplasias da Coroide , Melanoma , Adulto , Idoso , Corioide/diagnóstico por imagem , Neoplasias da Coroide/diagnóstico por imagem , Angiofluoresceinografia , Humanos , Melanoma/diagnóstico por imagem , Pessoa de Meia-Idade , Vasos Retinianos , Tomografia de Coerência Óptica
2.
Adv Exp Med Biol ; 1310: 343-365, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33834441

RESUMO

Optical coherence tomography (OCT) is a three-dimensional (3-D) optical imaging technology that provides noninvasive, micrometer resolution images of structural interiors within biological samples with an approximately 1 ~ 2 mm penetration depth. Over the last decades, advances in OCT have revolutionized biomedical imaging by demonstrating a potential of optical biopsy in preclinical and clinical settings. Recently, functional OCT imaging has shown a promise as angiography to visualize cell-perfused vasculatures in the tissue bed in vivo without requiring any exogenous contrast agents. This new technology termed OCT angiography (OCTA) possesses a unique imaging capability of delineating tissue morphology and blood or lymphatic vessels down to capillaries at real-time acquisition rates. For the past 10 years since 2007, OCTA has been proven to be a useful tool to identify disorder or dysfunction in tissue microcirculation from both experimental animal studies and clinical studies in ophthalmology and dermatology. In this section, we overview about OCTA including a basic principle of OCTA explained with simple optical physics, and its scan protocols and post-processing algorithms for acquisition of angiography. Then, potential and challenge of OCTA for clinical settings are shown with outcomes of human studies.


Assuntos
Capilares , Tomografia de Coerência Óptica , Animais , Meios de Contraste , Angiofluoresceinografia , Humanos , Imagem Óptica
3.
Adv Exp Med Biol ; 1256: 33-66, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33847997

RESUMO

Age-related macular degeneration (AMD) is a progressive neuro-retinal disease and the leading cause of central vision loss among elderly individuals in the developed countries. Modern ocular imaging technologies constitute an essential component of the evaluation of these patients and have contributed extensively to our understanding of the disease. A challenge with any review of ocular imaging technologies is the rapid pace of progress and evolution of these instruments. Nonetheless, for proper and optimal use of these technologies, it is essential for the user to understand the technical principles underlying the imaging modality and their role in assessing the disease in various settings. Indeed, AMD, like many other retinal diseases, benefits from a multimodal imaging approach to optimally characterize the disease. In this chapter, we will review the various imaging technologies currently used in the assessment and management of AMD.


Assuntos
Degeneração Macular , Tomografia de Coerência Óptica , Idoso , Angiofluoresceinografia , Humanos , Degeneração Macular/diagnóstico por imagem , Degeneração Macular/terapia , Imagem Multimodal , Retina/diagnóstico por imagem
4.
Adv Exp Med Biol ; 1256: 295-314, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33848007

RESUMO

Age-related macular degeneration (AMD) remains a leading cause of blindness worldwide. The assessment and management of patients with this condition has evolved in the last decades. In this chapter, current standards for diagnosis, follow-up, and treatment of patients with AMD are reviewed and summarized. Namely, we highlight how current assessment has moved from conventional ophthalmoscopy and fluorescein angiography testing to a multimodal approach, and its important advantages. Alternatives to visual acuity for functional assessment of patients with AMD are also presented. Regarding strategies for follow-up and treatment, we provide specific information for the different stages (i.e., early, intermediate, and late) and forms (for example, choroidal neovascularization and geographic atrophy) of AMD. Specifically, we discuss the relevance and options for self-monitoring and non-pharmacological interventions. Additionally, a summary of the important trials (both on exudative and non-exudative AMD) that have helped inform clinical practice is provided, including data on antiangiogenic agents currently available, and outcomes of the different regimens that have been studied. The influence of advances in imaging on treatment strategies is also discussed.In summary, this chapter is a resource for all clinicians engaged in providing state of the art care for patients with AMD, and can help improve diagnosis, management, and outcomes of individuals with this blinding condition.


Assuntos
Neovascularização de Coroide , Degeneração Macular , Inibidores da Angiogênese/uso terapêutico , Angiofluoresceinografia , Humanos , Degeneração Macular/tratamento farmacológico , Degeneração Macular/terapia , Tomografia de Coerência Óptica
5.
Medicine (Baltimore) ; 100(10): e24991, 2021 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-33725872

RESUMO

RATIONALE: Crouzon syndrome is an autosomal dominant genetic disorder caused by mutations in fibroblast growth factor receptor 2 (FGFR2) and one of the most common types of craniosynostosis. Here we report the detection of FGFR2 mutation and its related clinical findings in 2 patients with Crouzon syndrome from a Chinese family. PATIENT CONCERNS: We report a case of a 28-year-old male patient presented with the chief complaint of gradually blurring of his eyes over the last 6 months before visiting our clinics. History revealed low visual acuity in his right eye since childhood. Physical examination showed that both the patient and his mother have the appearance of craniofacial dysostosis, mandibular prognathism, ocular proptosis, short superior lip, scoliosis, and thoracic deformity. DIAGNOSIS: Auxiliary examinations lead to the diagnosis of Crouzon syndrome with binocular optic atrophy, myelinated retina nerve fibers, and ametropia in both eyes, and amblyopia in the right eye of the male patient. The molecular genetic analysis confirmed the diagnosis by detecting a heterozygous pathogenic mutation c.1026C > G (C342W) in exon 10 of FGFR2 in both the patient and his mother, but not in any of the unaffected family members. INTERVENTIONS AND OUTCOMES: None. LESSONS: Our study confirms the presence of optic nerve atrophy in patients with Crouzon syndrome carrying FGFR2 C342W mutations and indicates that MRI and funduscopy should be performed to examine the optic nerve changes for patients with Crouzon syndrome.


Assuntos
Disostose Craniofacial/complicações , Atrofias Ópticas Hereditárias/genética , Receptor Tipo 2 de Fator de Crescimento de Fibroblastos/genética , Adulto , China , Disostose Craniofacial/genética , Análise Mutacional de DNA , Éxons/genética , Feminino , Angiofluoresceinografia , Heterozigoto , Humanos , Imagem por Ressonância Magnética , Masculino , Mutação de Sentido Incorreto , Atrofias Ópticas Hereditárias/diagnóstico , Nervo Óptico/diagnóstico por imagem , Linhagem , Tomografia Computadorizada por Raios X
6.
Einstein (Sao Paulo) ; 19: eRC5521, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33656059

RESUMO

Sophisticated imaging systems have helped to redefine the clinical presentation of acute macular neuroretinopathy and have markedly enhanced diagnostic sensitivity. The proposed mechanism of paracentral acute middle maculopathy is related to ischemia at the level of the superficial and deep retinal capillary plexi. This is a case report of a patient who developed an acute macular neuroretinopathy after an uneventful angioplasty with stents in the coronary artery.


Assuntos
Angioplastia/efeitos adversos , Aterosclerose/cirurgia , Vasos Coronários/cirurgia , Stents/efeitos adversos , Doença Aguda , Feminino , Angiofluoresceinografia , Humanos , Degeneração Macular , Pessoa de Meia-Idade , Tomografia de Coerência Óptica , Síndromes do Ponto Branco/diagnóstico por imagem , Síndromes do Ponto Branco/etiologia
7.
Cesk Slov Oftalmol ; 77(1): 36-44, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33740866

RESUMO

Pachychoroid disease of retina is a spectrum of diseases manifested by thickening and hyperperfusion of the choroid with changes in the sensory part of the retina. The main unit of this group is central serous chorioretinopathy (CSC). In practice, we often encounter other conditions, which are manifested by thickening of the choroid and changes in the retina, but they cannot be classified as pachychoroid diseases. The aim of this study is to point out on a series of 3 case reports the difficulties in the differential diagnosis of retinal diseases in which we find thickening of the choroid. Case report 1: 42-year-old patient treated for central serous chorioretinopathy. After optical coherence tomography (OCT), fluorescence angiography (FAG) and indocyanine green angiography (ICG) the diagnosis was changed to choroidal hemangioma and he was treated with photodynamic therapy (PDT) which led to a reduction of the hemangioma. Case report 2: A 30-year-old patient treated for ankylosing spondylitis comes for visual impairment in the left eye. On OCT the condition resembled chronic CSC. The patient suffered from a febrile exanthema a few days ago. Serological testing for coxsackievirus was positive and the diagnosis was changed to acute chorioretinitis in coxsackievirus infection. Oral treatment with prednisone was successful. Case report 3: A 46-year-old patient was treated conservatively for CSC. After FAG and ICG, a solitary dilated choroidal vessel was found in the area of the papillomacular bundle with leakage under the sensory epithelium which was diagnosed as choroidal macrovessel. We performed PDT with a very good anatomical effect. Conclusion: Precise differentiation of these mentioned diseases from pachychoroid retinal diseases was essential in choosing the appropriate therapy. The use of all modern imaging methods of the retina and choroid plays a key role in determining the diagnosis. Key words: pachychoroid disease, central serous chorioretinopathy, choroidal hemangioma, chorioretinitis, coxsackievirus, choroidal macrovessel.


Assuntos
Coriorretinopatia Serosa Central , Macula Lutea , Adulto , Coriorretinopatia Serosa Central/diagnóstico , Coriorretinopatia Serosa Central/tratamento farmacológico , Corioide , Angiofluoresceinografia , Humanos , Masculino , Pessoa de Meia-Idade , Epitélio Pigmentado da Retina , Tomografia de Coerência Óptica
8.
Arq Bras Oftalmol ; 84(2): 174-178, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33567007

RESUMO

We report a case of a young Caucasian female presenting with sudden decrease of vision in the left eye, metamorphopsia, and nasal scotoma. Past medical history revealed a diagnosis of myasthenia gravis, which was currently treated with azathioprine, pyridostigmine, and prednisone. Ophthalmological examination showed fundus with clear vitreous and yellow-white lesions that were isolated and perimacular in the right eye, multiple and confluent in the macula, and punctate in periphery in the left eye. Laboratory workup ruled out the presence of infectious and inflammatory diseases. Fundus autofluorescence disclosed hypoautoflurescence with hyperfluorescent margins corresponding to the lesions observed in both eyes and the angiogram revealed hyperfluorescence since early phases without late leakage. Spectral-domain optical coherence tomography showed areas of intermittent retinal pigment epithelium elevations and disruption of the ellipsoid zone. She was diagnosed with punctate inner choroidopathy and then treated with an increased dose of daily prednisone, which resulted in progressive improvement of her visual acuity and anatomical status.


Assuntos
Síndromes do Ponto Branco , Feminino , Angiofluoresceinografia , Fundo de Olho , Humanos , Epitélio Pigmentado da Retina , Tomografia de Coerência Óptica
9.
Arq Bras Oftalmol ; 84(2): 149-157, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33567012

RESUMO

PURPOSE: To describe microvascular changes in the maculas of individuals with type 2 diabetes observed on optical coherence tomography angiography (OCTA) images. We compared the maculas of diabetic subjects without diabetic retinopathy with those of healthy subjects and correlated the findings with the clinical profiles of diabetic subjects. METHODS: One eye each of 30 patients with diabetes and 30 healthy individuals were examined. The patients with diabetes underwent funduscopy, retinography, and fluorescein angiography to rule out retinopathy. All subjects underwent optical coherence tomography angiography of a macular area (6×6 mm2), and the foveal and parafoveal vascular densities were analyzed in the superficial and deep retinal vascular plexus. The foveal and parafoveal thicknesses, foveal avascular zone of the superficial plexus, and choriocapillaris flow area were also examined. The optical coherence tomography angiography results were compared between the two study groups and correlated with the following parameters: visual acuity, time since diabetes diagnosis, glycemic control, lipid profile, and renal function of patients with diabetes. RESULTS: A minimal increase in the choriocapillaris flow area was observed in the patients with diabetes (mean area, 22.3 ± 4.6 mm2 in controls; 22.6 ± 3.9 mm2 in patients with diabetes) (p=0.017). No significant differences were observed between other optical coherence tomography angiography parameters analyzed in the two groups. Glycosylated hemoglobin and fasting blood glucose levels were significantly negatively correlated with the foveal vascular density of both plexuses; conversely, fasting blood glucose levels were positively correlated with the choriocapillaris flow area (p=0.034). The other clinical parameters were not correlated with the optical coherence tomography angiography findings. CONCLUSION: Optical coherence tomography angiography may not be the most appropriate tool for detecting preclinical changes in patients with diabetes, moreover, optical coherence tomography angiography; does not replace clinical examinations. Glycemic control should be the primary clinical parameter considered during retinopathy screening. Larger studies are necessary to confirm these findings.


Assuntos
Diabetes Mellitus Tipo 2 , Retinopatia Diabética , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/diagnóstico por imagem , Retinopatia Diabética/diagnóstico por imagem , Angiofluoresceinografia , Fundo de Olho , Humanos , Vasos Retinianos/diagnóstico por imagem , Tomografia de Coerência Óptica
10.
Medicine (Baltimore) ; 100(7): e24789, 2021 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-33607834

RESUMO

RATIONALE: Granulomatosis with polyangiitis (GPA) is a rare systemic autoimmune disease of unknown etiology. GPA affects multiple ocular tissues, most commonly the orbit, conjunctiva, cornea, and sclera. Retinal and choroidal manifestations are rare in GPA, but they often include choroidal neovascularization (CNV). PATIENT CONCERNS: A 36-year-old man was diagnosed with GPA. He had been taking oral steroid treatment for 8 years. He experienced disease recurrence and the dose of oral prednisolone was increased after steroid pulse therapy. Fundus examination showed small retinal pigment epithelial detachment and serous retinal detachment (SRD). Optical coherence tomography (OCT) revealed a protruded lesion inside the SRD. Fluorescein angiography (FA) showed a small, dot-shaped fluorescein leakage in the SRD, and indocyanine green fluorescein fundus angiography showed choroidal vascular hyperpermeability that was consistent with the hyperfluorescence seen with FA. We had to determine whether the protruded lesion inside the SRD was CNV secondary to the inflammation due to GPA or whether it was central serous chorioretinopathy (CSC)-like condition caused by high-dose steroid treatment. DIAGNOSES: We confirmed that the SRD was due to CSC but not CNV because the protruded lesion examined by B-scan OCT angiography (OCTA) showed no blood flow. INTERVENTIONS: We decided to reduce the dose of steroid. OUTCOMES: Since the reduction of steroids, no sign of worsening in the protruded lesions with SRD has been observed. LESSONS: We therefore propose the effectiveness of this advanced function of OCTA for the examination of blood flow signal images to detect CNV.


Assuntos
Coriorretinopatia Serosa Central/etiologia , Glucocorticoides/efeitos adversos , Granulomatose com Poliangiite/tratamento farmacológico , Prednisolona/efeitos adversos , Descolamento Retiniano/etiologia , Administração Oral , Adulto , Progressão da Doença , Angiofluoresceinografia , Granulomatose com Poliangiite/complicações , Humanos , Masculino , Prednisolona/administração & dosagem , Tomografia de Coerência Óptica
11.
Medicine (Baltimore) ; 100(7): e24790, 2021 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-33607835

RESUMO

RATIONALE: Half-dose or reduced-fluence photodynamic therapy (PDT) with verteporfin has been well acknowledged to be the most effective and permanent treatment with very low rates of complications. However, we report a case of chronic central serous chorioretinopathy (CSC) who developed choroidal neovascularization (CNV) secondary to half-dose PDT within only 3 weeks. Such an occurrence following this short a course of treatment has not been reported previously. PATIENT CONCERNS: A 46-year-old Chinese man who had been diagnosed as acute more than 1 year ago revisited our department recently and complained of blurred vision again in his left eye. DIAGNOSES: Fluorescein fundus angiography (FFA) and indocyanine green angiography (ICGA) revealed patchy hyperfluorescent dots and optical coherence tomography (OCT) indicated irregular flat pigment epithelium detachment (PED) in the central macula. The patient was diagnosed with chronic CSC. INTERVENTIONS: The patient was treated by half-dose PDT with verteporfin. Three weeks later, the patient complained of sudden blurred vision and fundus examination showed macular hemorrhages with a best-corrected visual acuity (BCVA) of 20/250. OCT angiography (OCTA) showed a distinct area of flower-like CNV located within the deep retinal slab. Secondary CNV had developed after a quite short course of half-dose PDT treatment. Subsequently, the patient was administered by 2 intravitreal injections of aflibercept (2 mg). OUTCOMES: Two months after the second intravitreal injection, macular hemorrhages and secondary CNV were completely resolved, and the BCVA improved to 20/25. LESSONS: Patients of chronic CSC with irregular PED who undergo PDT should be warned of secondary CNV within a short course after treatment. If happened, it should be treated by intravitreal injections of anti-vascular endothelial growth factor agents as soon as possible.


Assuntos
Coriorretinopatia Serosa Central/tratamento farmacológico , Neovascularização de Coroide/induzido quimicamente , Fármacos Fotossensibilizantes/efeitos adversos , Verteporfina/efeitos adversos , Inibidores da Angiogênese/administração & dosagem , Neovascularização de Coroide/tratamento farmacológico , Angiofluoresceinografia , Humanos , Injeções Intravítreas , Masculino , Pessoa de Meia-Idade , Fármacos Fotossensibilizantes/administração & dosagem , Receptores de Fatores de Crescimento do Endotélio Vascular/administração & dosagem , Proteínas Recombinantes de Fusão/administração & dosagem , Tomografia de Coerência Óptica , Verteporfina/administração & dosagem
13.
Arq Bras Oftalmol ; 84(2): 186-190, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33567017

RESUMO

Acute retinal pigment epitheliitis (ARPE) is an idiopathic, self-limiting inflammatory retinal disorder that particularly affects healthy young individuals. The characteristic fundoscopic appearance of the acute retinal pigment epitheliitis includes a fine pigment stippling surrounded by a yellow-white hypopigmented halos in the macula. Although the exact pathogenesis of the disease remains unknown, some reports have suggested a relationship between a viral infection and acute retinal pigment epitheliitis. Acute retinal pigment epitheliitis is a rare disorder, and only single case reports or case series are found in the literature. The clinical and demographic characteristics of patients with this disease are not fully understood because of its rarity. In this study, we searched the literature to collect clinical and demographic features of the reported cases. We detail the characteristics of acute retinal pigment epitheliitis were pointed and discuss the pathogenesis of the disease.


Assuntos
Doenças Retinianas , Retinite , Doença Aguda , Angiofluoresceinografia , Humanos , Pigmentos da Retina , Retinite/diagnóstico , Acuidade Visual
15.
BMJ Case Rep ; 14(2)2021 Feb 10.
Artigo em Inglês | MEDLINE | ID: mdl-33568408

RESUMO

A 38-year-old woman who had previously been diagnosed and treated for unilateral Vogt-Koyanagi-Harada syndrome (VKH) and had undergone multiple intravitreal bevacizumab injections to manage inflammatory choroidal neovascularisation in her right eye, presented 2 years later with visual complains in left eye. Clinical examination, fluorescein angiography, indocyanine green angiography (ICGA) and enhanced depth imaging optical coherence tomography (EDI-OCT) assisted evaluation confirmed active inflammation of left eye along with absence of any inflammation in the right eye. Unilateral active inflammation can be seen in the setting of VKH. To our best knowledge, ours is the first case of VKH in which unilateral active inflammation has been proven based on ICGA and EDI OCT analysis.


Assuntos
Corioide/fisiopatologia , Angiofluoresceinografia/métodos , Inflamação/diagnóstico , Doenças Retinianas/diagnóstico , Tomografia de Coerência Óptica/métodos , Síndrome Uveomeningoencefálica/diagnóstico , Adulto , Feminino , Humanos
16.
BMJ Case Rep ; 14(2)2021 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-33526522

RESUMO

A 44-year-old woman presented with decreased vision in both eyes. The retina in both eyes had drusen distributed along vascular arcades, central macula and in peripapillary region. Macula had pigmented scarring and exudation. Fundus autofluorescence showed drusen. Optical coherence tomography showed drusen, subretinal and intraretinal fluid. Fundus fluorescein and indocyanine green angiography showed drusen, retinal pigment epithelial atrophy and vascular network. Younger age at presentation, bilateral symmetry, typical distribution of drusen along the arcades in a radiating pattern, peripapillary involvement, scarring and atrophy at macula were suggestive of doyne honeycomb retinal dystrophy. The reduced vision was due to macular atrophy and an active choroidal neovascular membrane. The patient was treated with antivascular endothelial growth factor injections for choroidal neovascular membrane. Our case highlights the importance of pattern recognition and multimodal imaging for diagnosing the type of macular dystrophy as doyne honeycomb retinal dystrophy, while simultaneously managing choroidal neovascular membrane.


Assuntos
Neovascularização de Coroide/diagnóstico por imagem , Angiofluoresceinografia , Tomografia de Coerência Óptica , Adulto , Inibidores da Angiogênese/uso terapêutico , Angiografia , Neovascularização de Coroide/complicações , Neovascularização de Coroide/tratamento farmacológico , Corantes , Feminino , Fundo de Olho , Humanos , Verde de Indocianina , Injeções Intravítreas , Imagem Multimodal , Drusas do Disco Óptico/complicações , Drusas do Disco Óptico/congênito , Drusas do Disco Óptico/diagnóstico por imagem , Ranibizumab/uso terapêutico
17.
Vestn Oftalmol ; 137(1): 60-67, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33610151

RESUMO

PURPOSE: To assess the influence of the frequency of retinal protective therapy courses on the indicators of regional hemodynamics of the eye. MATERIAL AND METHODS: The study included 17 patients (34 eyes) with a diagnosis of primary open-angle glaucoma (POAG), advanced stage. The patients were divided into 2 groups: the first group received a course of retinal protective therapy with Retinalamin every 3 months, the second group received a course of retinal protective therapy with Retinalamin every 6 months. All patients underwent standard ophthalmological examination including standard automatic perimetry according to the 24-2 program, optical coherence tomography angiography (OCT-A) of the macular area and optic disc. RESULTS: The comparison of hemodynamic parameters of all vascular plexuses of the retina at the beginning and at the end of the study, as well as intergroup comparison did not reveal any statistically significant differences (p>0.05). However, when studying the density and fractal dimension of the vascular bed, multidirectional trends were observed. Specifically, in the peripapillary region, there was a decrease in the length from 19.8 (1/mm) to 19.0 (1/mm) (p=0.37) and the density from 36.6% to 35.7% (p=0.63) of the vascular bed of the peripapillary capillary plexus of the retina in patients of the first group. In the superficial vascular plexus, the trend in the density of the vascular bed in both groups slightly changed (in group 1 - 38.1% and 38.3%, p=0.97; group 2 - 37.8% and 38.7%, p=0.46). The fractal dimension of the vascular bed in the first group tended to increase during treatment from 18.8 (1/mm) to 19.1 (1/mm) (p=0.5), while in the second group, on the contrary, it had tendency to decrease from 18.6 (1/mm) to 17.9 (1/mm) (p=0.63). In the deep vascular plexus, the density of the vascular bed trended to decrease in both groups, but in group 2 (42.5% and 42.4%, p=1.0) it was more pronounced than in the first group (42.5% and 42.6%, p=0.82). However, the fractal dimension of the vascular bed increased in group 1 (21.0 (1/mm) and 21.3 (1/mm), p=0.43) and showed a slight tendency to decrease in group 2 (21.5 (1/mm) and 21.0 (1/mm), p=0.86). CONCLUSION: The general trend of changes in hemodynamic parameters demonstrates a potential positive effect, especially in the data related to the deep vascular plexus.


Assuntos
Glaucoma de Ângulo Aberto , Disco Óptico , Angiografia , Angiofluoresceinografia , Glaucoma de Ângulo Aberto/diagnóstico , Humanos , Disco Óptico/diagnóstico por imagem , Projetos Piloto , Vasos Retinianos/diagnóstico por imagem , Tomografia de Coerência Óptica
18.
Vestn Oftalmol ; 137(1): 107-114, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33610158

RESUMO

Chronic kidney disease (CKD) is a significant public health problem with a high risk of developing age-dependent eye diseases. Renal glomeruli and the choroid have similar structures and vascular networks; the internal hematoretinal barrier and the glomerular filtration barrier have similar developmental path; the renin-angiotensin-aldosterone hormonal system is found in both the eye and the kidneys. All this determines the similarity of physiological and pathogenetic features of the development of diseases associated with these organs. The article discusses general risk factors and pathophysiological mechanisms of development of retinal and renal lesions in CKD, the influence of various factors of pathogenesis on their development and progression. The anatomical similarity of vascularization, accompanied by microvascular changes in the retina and kidneys, leads to similar complications in both organs. Optical coherence tomography (OCT) and optical coherence tomography angiography (OCT-A) are accurate, well reproducible and non-invasive methods for diagnosing and assessing changes in the retinal microvascular bed, which make it possible to assess microvasculature changes in the kidneys. In CKD, the retina shows signs of impaired capillary perfusion, a decrease in their density, expansion of intercapillary spaces, a rarefaction of the density of the parafoveolar capillary network, which may indicate a decrease in peritubular capillary blood flow, blood circulation of the kidneys in general and their ischemia. Significant thinning of the retina and choroid, along with a decrease in macular volume, even in the initial stages of CKD, is accompanied by impaired renal function (changes in the estimated glomerular filtration rate and urinary albumin excretion), which is a sign of systemic microvascular lesion and pathological process in the kidneys. Therefore, monitoring of retinal vessels using OCT and OCT-A can become a reliable indicator of the progression of renal microvascular changes at any stage of the disease.


Assuntos
Insuficiência Renal Crônica , Vasos Retinianos , Corioide , Angiofluoresceinografia , Humanos , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/diagnóstico , Retina/diagnóstico por imagem , Vasos Retinianos/diagnóstico por imagem , Tomografia de Coerência Óptica
19.
Obes Surg ; 31(5): 2080-2086, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33420672

RESUMO

PURPOSE: Basic science research has shown that obesity is associated with microvascular endothelial dysfunction. However, whether bariatric surgery impacts the microvascular networks has yet to be explored. This study sought to evaluate the impact of gastric bypass in the retinal microvasculature. METHODS: Patients with obesity (BMI ≥ 35 kg/m2) scheduled to gastric bypass were consecutively recruited and included in the study. Patients were evaluated before surgery and 6-12 months after the intervention. Macular microvascular properties were evaluated using optical coherence tomography (OCT) angiography. Foveal avascular zone area, perimeter, circularity, and foveal and perifoveal vascular density (in both superficial and deep vascular plexus) were computed. RESULTS: In total, 40 eyes from 20 patients were included (30% male, mean BMI 43.4 ± 4.5 kg/m2 (range 35.7-51.4). From these, 45% were diabetic before bariatric surgery. After surgery, there was a significant increase in foveal avascular zone circularity (from 0.85 ± 0.09 to 0.92 ± 0.07, p = 0.001) and vascular density in perifoveal deep vascular plexus (from 0.69 ± 0.12 to 0.73 ± 0.12; p = 0.04), whereas foveal avascular zone perimeter decreased (from 2.34 ± 0.37 to 2.20 ± 0.35 mm, p = 0.007). Preoperative diabetic status was not a predictor of microvascular retinal changes after bariatric surgery. However, after multivariate adjustments, the increased drop in HbA1c after the surgery remained associated with the increase in perifoveal vascular density in the deep vascular plexus (B = 0.05; 95% CI 0.05-0.10; p = 0.03). CONCLUSIONS: Gastric bypass improves retinal microvascular perfusion as demonstrated by the increased parafoveal vascular density in the deep vascular plexus, increased foveal avascular zone circularity, and decreased foveal avascular zone perimeter.


Assuntos
Derivação Gástrica , Obesidade Mórbida , Feminino , Angiofluoresceinografia , Humanos , Masculino , Obesidade/cirurgia , Obesidade Mórbida/cirurgia , Perfusão , Vasos Retinianos/diagnóstico por imagem
20.
Can J Ophthalmol ; 56(2): 83-87, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33497612

RESUMO

OBJECTIVE: To examine the changes in choriocapillaris and retina caused by coronavirus disease 2019 (COVID-19) by comparing optical coherence tomography angiography (OCTA) findings of COVID-19 patients and healthy controls. METHODS: The study and control groups consisted of 54 eyes of 27 participants, each. Patients and controls underwent OCTA examination. Foveal zone vessel density and parafoveal zone vessel density (for 4 quadrants: nasal, temporal, superior, inferior) were calculated for both superficial and deep capillary plexuses. Additionally, choriocapillaris flow and foveal avascular zone areas were calculated. RESULTS: For the parafoveal area in the study group, vessel density was significantly lower in the superior and nasal quadrants of the superficial capillary plexus and in all quadrants of the deep capillary plexus compared with controls (p < 0.05 for all). The study group had significantly higher choriocapillaris flow area values compared with controls (p = 0.042). CONCLUSION: Reduced vessel density of the retinal capillary plexus was detected in COVID-19 patients who may be at risk for retinal vascular complications.


Assuntos
/diagnóstico , Doenças da Coroide/diagnóstico , Corioide/irrigação sanguínea , Infecções Oculares Virais/diagnóstico , Doenças Retinianas/diagnóstico , Vasos Retinianos/patologia , Adulto , Doenças da Coroide/virologia , Infecções Oculares Virais/virologia , Feminino , Angiofluoresceinografia , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Retinianas/virologia , Tomografia de Coerência Óptica , Acuidade Visual , Adulto Jovem
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