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1.
Int J Mol Sci ; 22(5)2021 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-33652907

RESUMO

Photoreceptors are the light-sensing cells of the retina and the major cell type affected in most inherited retinal degenerations. Different metabolic pathways sustain their high energetic demand in physiological conditions, particularly aerobic glycolysis. The principal metabolome of the mature retina has been studied, but only limited information is available on metabolic adaptations in response to key developmental events, such as eye opening. Moreover, dynamic metabolic changes due to retinal degeneration are not well understood. Here, we aimed to explore and map the ocular metabolic dynamics induced by eye opening in healthy (wild type) or Pde6b-mutant (retinal degeneration 1, Rd1) mice, in which photoreceptors degenerate shortly after eye opening. To unravel metabolic differences emerging before and after eye opening under physiological and pathophysiological conditions, we performed nuclear magnetic resonance (NMR) spectroscopy-based metabolome analysis of wild type and Rd1 retina and vitreous/lens. We show that eye opening is accompanied by changes in the concentration of selected metabolites in the retina and by alterations in the vitreous/lens composition only in the retinal degeneration context. As such, we identify NAcetylaspartate as a potential novel vitreous/lens marker reflecting progressive retinal degeneration. Thus, our data can help elucidating mechanisms underlying key events in retinal physiology and reveal changes occurring in pathology, while highlighting the importance of the vitreous/lens in the characterization of retinal diseases.


Assuntos
Cristalino/metabolismo , Metaboloma , Retina/metabolismo , Degeneração Retiniana/metabolismo , Corpo Vítreo/metabolismo , Animais , Nucleotídeo Cíclico Fosfodiesterase do Tipo 6/genética , Modelos Animais de Doenças , Cristalino/patologia , Camundongos , Mutação , Retina/patologia , Degeneração Retiniana/genética , Degeneração Retiniana/patologia , Corpo Vítreo/patologia
2.
Ocul Immunol Inflamm ; 28(8): 1298-1300, 2020 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-33021846

RESUMO

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


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Oftalmopatias/etiologia , Angiofluoresceinografia/métodos , Pneumonia Viral/complicações , Segmento Externo das Células Fotorreceptoras da Retina/patologia , Tomografia de Coerência Óptica/métodos , Corpo Vítreo/patologia , Infecções por Coronavirus/epidemiologia , Oftalmopatias/diagnóstico , Feminino , Fundo de Olho , Humanos , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/epidemiologia , Acuidade Visual
3.
Curr Opin Ophthalmol ; 31(5): 427-434, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32740067

RESUMO

PURPOSE OF REVIEW: The COVID-19 pandemic has posed an unprecedented challenge to the healthcare community. To reduce disease transmission, national regulatory agencies temporarily recommended curtailment of all nonurgent office visits and elective surgeries in March 2020, including vitreoretinal outpatient care in the USA. The effect of these guidelines on utilization of vitreoretinal care has not been explored to date. RECENT FINDINGS: Retinal outpatient visits, new patient visits, intravitreal antivascular endothelial growth factor injections and in-office multimodal retinal imaging has seen a significant decline in utilization in the early phase of the pandemic. Intravitreal injections were performed at a comparatively higher rate than office visits. Utilization appeared to steadily increase in April 2020. Telemedicine visits, enabled by new national legislation for all areas of medicine, have been adopted to a modest degree by the retina community. SUMMARY: In-office retinal care declined in response to the COVID-19 pandemic and national regulatory guidelines limiting nonurgent care. These trends in practice patterns and care utilization may be of interest to vitreoretinal providers and all ophthalmologists at large.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Pandemias/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Padrões de Prática Médica/estatística & dados numéricos , Doenças Retinianas , Corpo Vítreo/patologia , Assistência Ambulatorial/estatística & dados numéricos , Bases de Dados Factuais , Assistência à Saúde/estatística & dados numéricos , Registros Eletrônicos de Saúde/estatística & dados numéricos , Pesquisa sobre Serviços de Saúde , Humanos , Doenças Retinianas/diagnóstico , Doenças Retinianas/terapia , Telemedicina/estatística & dados numéricos , Estados Unidos/epidemiologia
4.
Middle East Afr J Ophthalmol ; 27(1): 62-64, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32549728

RESUMO

Vitreous cysts are a rare finding and rarely cause any visual disturbances. They are often classified as idiopathic when their etiology cannot be determined. They may be congenital or acquired and pigmented or nonpigmented. In previous reports, it has been suggested on the basis of electron microscopy that these pigmented vitreous cysts may have originated from the pigment epithelium. We present the case of a 46-year-old female, with complaints of an oval-shaped floater, causing some visual disturbance in her right eye. On examination, it was found to be a pigmented, round, and nonlobulated cyst floating freely in the vitreous cavity with no attachments to the retina. This was documented and confirmed by the fundus images and optical coherence tomography findings. Laboratory tests in the patient were found to be negative for any Toxoplasma, cysticercoids, Echinococcus, and Toxocara, among others. She was on follow-up for the past 6 months with no change or disturbance in the cyst or the retinal findings. We describe a rare case of idiopathic pigmented vitreous cyst with no persistent hyaloid artery or connection between the cyst and the ocular structures.


Assuntos
Cistos/etiologia , Oftalmopatias/etiologia , Corpo Vítreo/patologia , Cistos/diagnóstico por imagem , Oftalmopatias/diagnóstico por imagem , Feminino , Fundo de Olho , Humanos , Pessoa de Meia-Idade , Tomografia de Coerência Óptica , Ultrassonografia , Transtornos da Visão/etiologia , Corpo Vítreo/diagnóstico por imagem
5.
Am J Ophthalmol ; 217: 152-161, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32360335

RESUMO

PURPOSE: To compare characteristics of the vitreomacular interface (VMI) in myopic foveoschisis (mFS) and idiopathic epiretinal membrane foveoschisis (iERM-FS), and to correlate with optical coherence tomography and clinical data. DESIGN: Clinicopathologic study. METHODS: Epiretinal membrane and internal limiting membrane (ILM) specimens were removed from eyes with mFS (5 eyes) and iERM-FS (5 eyes). Harvested tissue was processed for immunocytochemistry and prepared by ultrathin series sectioning for transmission electron microscopy. Cell and collagen compositions were compared and correlated with clinical data. RESULTS: All eyes presented fibrocellular membranes irrespective if associated with mFS or iERM-FS. Cell and collagen types and distribution on the vitreal side of the ILM were similar in both groups, consistent with presence of tractional membranes on optical coherence tomography images. Immunostaining of all specimens were positive for glial cells, microglia, and hyalocytes. Electron microscopy revealed evidence of epiretinal cell multilayers with masses of vitreous collagen and signs of vitreous remodeling in both groups. Three eyes with mFS but none of the eyes with iERM-FS showed massive thinning of the ILM with prominent retinal undulations and presence of retinal nerve fiber layer fragments. CONCLUSION: Whereas fibrocellular components of premacular tissue in mFS are similar to iERM-FS, pathologic abnormalities of the ILM were exclusively present in high myopia. Although peeling of the ILM appears important to completely remove tractional components of the VMI, histopathologic findings emphasize the risk for retinal damage in these highly myopic eyes, indicating that individual preoperative assessment and modification of surgical techniques require further investigation.


Assuntos
Membrana Epirretiniana/complicações , Macula Lutea/patologia , Miopia/complicações , Retinosquise/diagnóstico , Tomografia de Coerência Óptica/métodos , Acuidade Visual , Corpo Vítreo/patologia , Idoso , Membrana Epirretiniana/diagnóstico , Feminino , Humanos , Masculino , Microscopia Eletrônica de Transmissão , Pessoa de Meia-Idade , Miopia/diagnóstico , Retinosquise/etiologia
6.
Indian J Ophthalmol ; 68(6): 962-973, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32461407

RESUMO

The COVID-19 pandemic has brought new challenges to the health care community. Many of the super-speciality practices are planning to re-open after the lockdown is lifted. However there is lot of apprehension in everyone's mind about conforming practices that would safeguard the patients, ophthalmologists, healthcare workers as well as taking adequate care of the equipment to minimize the damage. The aim of this article is to develop preferred practice patterns, by developing a consensus amongst the lead experts, that would help the institutes as well as individual vitreo-retina and uveitis experts to restart their practices with confidence. As the situation remains volatile, we would like to mention that these suggestions are evolving and likely to change as our understanding and experience gets better. Further, the suggestions are for routine patients as COVID-19 positive patients may be managed in designated hospitals as per local protocols. Also these suggestions have to be implemented keeping in compliance with local rules and regulations.


Assuntos
Betacoronavirus , Consenso , Infecções por Coronavirus/epidemiologia , Oftalmopatias/terapia , Pandemias , Pneumonia Viral/epidemiologia , Padrões de Prática Médica/normas , Agendamento de Consultas , Humanos , Exame Físico , Consulta Remota , Doenças Retinianas/terapia , Triagem , Doenças da Úvea/terapia , Corpo Vítreo/patologia
7.
Lab Invest ; 100(8): 1080-1089, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32321985

RESUMO

Acute primary angle closure (APAC) is a disease of ophthalmic urgency; lack of treatment can lead to blindness. Even after adequate treatment for APAC, subsequent elevated acute intraocular pressure induces severe neuronal damage which can result in secondary glaucomatous optic neuropathy (GON). Damage-associated molecular patterns (DAMPs) are released from damaged and dead neuronal cells, which induce secondary inflammatory changes and further tissue damage. Our hypothesis is that histone H2B (H2B), which is one of the DAMPs, is released from damaged cells in the development of GON after APAC treatment. Intravitreal injection of H2B induces neuronal cell death through toll-like receptor 4 (TLR4) expression, following the upregulation of inflammatory cytokine mRNAs and phosphorylation of mitogen activated protein kinases (MAPKs). Knockdown of TLR4 caused a reduction of H2B neurotoxicity in damaged cells through TLR4 signaling. Significantly increased H2B was observed in the vitreous cells of APAC patients. In addition, enhanced H2B protein correlated with decreased ganglion cell analysis and retinal ganglion cell (RGC) layer thinning, which indicates the effect of H2B on RGCs. Our data from clinical and animal studies show the involvement of H2B-TLR4 pathways in the development of GON after APAC treatment providing new insight for the mechanism of RGC degeneration.


Assuntos
Doenças do Nervo Óptico/metabolismo , Células Ganglionares da Retina/metabolismo , Receptor 4 Toll-Like/metabolismo , Corpo Vítreo/metabolismo , Idoso , Animais , Morte Celular , Citocinas/genética , Citocinas/metabolismo , Feminino , Regulação da Expressão Gênica , Histonas/administração & dosagem , Humanos , Masculino , Camundongos Endogâmicos C57BL , Camundongos Knockout , Doenças do Nervo Óptico/genética , Doenças do Nervo Óptico/patologia , Retina/efeitos dos fármacos , Retina/metabolismo , Células Ganglionares da Retina/citologia , Receptor 4 Toll-Like/genética , Corpo Vítreo/patologia
9.
Forensic Sci Int ; 310: 110235, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32169668

RESUMO

The chemical and biochemical analysis of bodily fluids after death is an important thanatochemical approach to assess the cause and time since death. Vitreous humor (VH) has been used as a biofluid for forensic purposes since the 1960s. Due to its established relevance in toxicology, a literature review highlighting the use of VH with an emphasis on endogenous compounds has not yet been undertaken. VH is a chemically complex aqueous solution of carbohydrates, proteins, electrolytes and other small molecules present in living organisms; this biofluid is useful tool for its isolated environment, preserved from bacterial contamination, decomposition, autolysis, and metabolic reactions. The post-mortem analysis of VH provides an important tool for the estimation of the post-mortem interval (PMI), which can be helpful in determining the cause of death. Consequently, the present review evaluates the recent chemical and biochemical advances with particular importance on the endogenous compounds present at the time of death and their modification over time, which are valuable for the PMI prediction and to identify the cause of death.


Assuntos
Drogas Ilícitas/química , Corpo Vítreo/patologia , Autopsia , Patologia Legal , Humanos , Mudanças Depois da Morte , Corpo Vítreo/química
10.
Sci Rep ; 10(1): 2783, 2020 02 17.
Artigo em Inglês | MEDLINE | ID: mdl-32066796

RESUMO

Treatment of uveitis is complicated because of its multiple aetiologies and elevation of various inflammatory mediators. To determine the mediators that are elevated in the vitreous humor according to the aetiology of the uveitis, we examined the concentrations of 21 inflammatory cytokines, 7 chemokines, and 5 colony-stimulating/growth factors in vitreous samples from 57 eyes with uveitis associated with intraocular lymphoma (IOL, n = 13), sarcoidosis (n = 15), acute retinal necrosis (ARN, n = 13), or bacterial endophthalmitis (BE, n = 16). Samples from eyes with idiopathic epiretinal membrane (n = 15), which is not associated with uveitis, were examined as controls. Heat map analysis demonstrated that the patterns of inflammatory mediators in the vitreous humor in eyes with uveitis were disease-specific. Pairwise comparisons between the 5 diseases showed specific elevation of interferon-α2 in ARN and interleukin (IL)-6, IL-17A, and granulocyte-colony stimulating factor in BE. Pairwise comparisons between IOL, ARN, and BE revealed that levels of IL-10 in IOL, RANTES (regulated on activation, normal T cell expressed and secreted) in ARN, and IL-22 in BE were significantly higher than those in the other 2 types of uveitis. These mediators are likely to be involved in the immunopathology of specific types of uveitis and may be useful biomarkers.


Assuntos
Biomarcadores/metabolismo , Inflamação/metabolismo , Uveíte/metabolismo , Corpo Vítreo/metabolismo , Idoso , Líquidos Corporais/metabolismo , Endoftalmite/complicações , Endoftalmite/epidemiologia , Endoftalmite/patologia , Membrana Epirretiniana/patologia , Olho/metabolismo , Olho/patologia , Feminino , Humanos , Inflamação/complicações , Inflamação/patologia , Interleucina-6/metabolismo , Linfoma Intraocular/complicações , Linfoma Intraocular/epidemiologia , Linfoma Intraocular/patologia , Masculino , Pessoa de Meia-Idade , Síndrome de Necrose Retiniana Aguda/complicações , Síndrome de Necrose Retiniana Aguda/epidemiologia , Síndrome de Necrose Retiniana Aguda/patologia , Sarcoidose/complicações , Sarcoidose/epidemiologia , Sarcoidose/patologia , Uveíte/complicações , Uveíte/patologia , Corpo Vítreo/patologia
11.
Cancer Sci ; 111(4): 1417-1421, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32056332

RESUMO

The characteristics of tumor cells of primary vitreoretinal lymphoma (PVRL) have not been defined, although researches have shown that most cases are of diffuse large B-cell lymphoma (DLBCL). To determine the subtype and biological characteristics of tumor cells of PVRL, we performed a gene expression profiling analysis. RNA was extracted from the vitreous fluid of 7 PVRL patients and from nodal samples of 10 DLBCL patients: 6 of germinal center B-cell (GCB) type and 4 of activated B-cell (ABC) type determined by Hans' criteria. Six PVRL samples showed gene expression profiles that were similar to each other. The patterns were different from those of the ABC-type nodular DLBCL but relatively close to those of the GCB-type nodular DLBCL. Interestingly, all of the 6 examined PVRL samples had either MYD88L265P or mutation in the immunoreceptor tyrosine-based activation motif (ITAM) region of CD79B. Five PVRL patients with similar gene expression profiles were treated with a standardized regimen: intravitreal administration of methotrexate (MTX) followed by six courses of systemic high doses of MTX. As a result, 2 patients had CD79B mutations and showed early central nervous system (CNS) progression. Patients without CNS progression did not have this mutation. In conclusion, PVRL had unique genetic features: an expression pattern different from ABC-type and relatively close to GCB-type DLBCL. CD79B mutations showed potential to serve as prognostic markers for CNS progression.


Assuntos
Antígenos CD79/genética , Linfoma Difuso de Grandes Células B/genética , Neoplasias da Retina/genética , Corpo Vítreo/metabolismo , Idoso , Linfócitos B/patologia , Biomarcadores Tumorais/genética , Sistema Nervoso Central/patologia , Feminino , Citometria de Fluxo , Perfilação da Expressão Gênica , Regulação Neoplásica da Expressão Gênica , Humanos , Linfoma Difuso de Grandes Células B/patologia , Masculino , Análise em Microsséries , Mutação , Neoplasias da Retina/patologia , Corpo Vítreo/patologia
12.
Sci Rep ; 10(1): 1994, 2020 02 06.
Artigo em Inglês | MEDLINE | ID: mdl-32029770

RESUMO

Ocular involvement in leukemia is considered rare. Ocular symptoms can be the presenting signs of leukemia, they can appear after diagnosis has been established, or they can be the first manifestation of a relapse after remission. We report, to the best of our knowledge for the first time, the ocular manifestation of a series of patients with ocular leukemia and the result of their treatment with intravitreal methotrexate (MTX) injections. This is a retrospective cohort study. The medical records of 12 consecutive patients with ocular leukemia (24 eyes, 11 eyes treated with MTX) treated at the Sheba Medical Center from January 2010 to December 2017 were retrospectively reviewed. Details on ocular inflammatory reaction and tumor cell infiltration at presentation and the end of follow-up were recorded as main outcome measures. The 12 patients included 7 women and 5 men (mean age ± standard deviation at diagnosis 25.92 ± 23.91 years, range 2-82 years). Eleven eyes of 6 patients were treated with intravitreal MTX injections. The indication for treatment was biopsy proven, tumor cell infiltration. The mean number of MTX injections was 3.37 ± 5.35 (range 1-18). The mean follow-up was 27.08 ± 36.79 months (range 1-93). All treated eyes showed improvement in the inflammatory reaction and tumor cell infiltration. In conclusion we found that Intravitreal MTX injections may be an effective therapeutic approach for eyes with intraocular leukemic tumor cell infiltration.


Assuntos
Neoplasias Oculares/complicações , Dor Ocular/tratamento farmacológico , Imunossupressores/administração & dosagem , Leucemia/complicações , Metotrexato/administração & dosagem , Acuidade Visual/efeitos dos fármacos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Câmara Anterior/patologia , Biópsia , Criança , Pré-Escolar , Esquema de Medicação , Neoplasias Oculares/tratamento farmacológico , Neoplasias Oculares/patologia , Dor Ocular/diagnóstico , Dor Ocular/etiologia , Dor Ocular/patologia , Feminino , Seguimentos , Humanos , Injeções Intravítreas , Leucemia/tratamento farmacológico , Leucemia/patologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Acuidade Visual/fisiologia , Corpo Vítreo/patologia , Adulto Jovem
13.
Sci Rep ; 10(1): 2159, 2020 02 07.
Artigo em Inglês | MEDLINE | ID: mdl-32034272

RESUMO

This nationwide retrospective case-control study was aimed at elucidating the risk from cataract surgery in end-stage renal disease (ESRD) patients. Cataract surgery patients were identified using the diagnostic and procedural codes for International Classification of Diseases, 9th Revision, Clinical Modification from Taiwan's National Health Insurance Research Database. ESRD patients were selected as cases, while propensity scores for age, sex, comorbidities and year-of-surgery-matched patients without chronic kidney disease constituted the controls. Patients who had undergone eye surgery within 3 years before cataract surgery were excluded. The main outcome measures were target cataract surgery-related complications within 3 months after surgery. A total of 352 cases and 1,760 controls were analysed. Patients with ESRD had a 5.06-fold (95% CI: 2.36-10.87; p < 0.001) risk of vitreous haemorrhage and a 2.74-fold (95% CI: 1.20-6.27; p = 0.017) risk of re-operation for dropped nucleus or vitreous complications. Non-diabetic ESRD patients had a 3.49-fold (95% CI: 1.36-8.91; p = 0.009) risk of corneal oedema. In conclusion, ESRD patients have a higher risk of vitreous haemorrhage, re-operation for dropped nucleus or vitreous complications and corneal oedema (non-diabetic patients) after cataract surgery. Pre-surgery corneal examination, surgery procedure and medication adjustment, closer and longer post-surgery follow-up may lower the risk and improve the visual outcome.


Assuntos
Extração de Catarata/efeitos adversos , Catarata/complicações , Edema/epidemiologia , Falência Renal Crônica/complicações , Hemorragia Pós-Operatória/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Córnea/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Corpo Vítreo/patologia
14.
BMC Ophthalmol ; 20(1): 10, 2020 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-31906917

RESUMO

BACKGROUND: Developing objective and repeatable indicators to evaluate the efficacy of PVRL treatment is important. The quantification of vitreous cells is a traditional criterion; however slight changes are difficult to ascertain. Spectral domain optical coherence tomography (SD-OCT) is objective, repeatable, and easily explained. The purpose of this study is to provide a longitudinal observation of OCT in PVRL treated with intravitreal injections of methotrexate (MTX) and to evaluate the utility of OCT in monitoring responsiveness of PVRL to treatment. METHODS: The medical records of patients with biopsy-positive PVRL attending our hospital between January 2016 and September 2017 who received intravitreal injections of MTX were included in this study. Pre- and post-treatment OCT images were reviewed independently by two researchers. RESULTS: Of the 24 cases reviewed, 10 patients (18 eyes) were included. SD-OCT abnormalities at the initial visit included vitreous cells (18/18), OR (outer retina) fuzzy borders (12/18), PED (pigment epithelium detachments) (9/18), subretinal hyperreflective infiltration (3/18), intraretinal infiltration (8/18), and SRF (subretinal fluid) (4/18). Post induction treatment, SRF in cases with RD (retinal detachment) was absorbed, and subretinal fibrosis appeared. Other lesions were significantly reduced. Post consolidation treatment, OR fuzzy borders, PED and SRF disappeared in 2 eyes, intraretinal infiltration disappeared in 1 eye, and other abnormalities further improved. Additionally, retinal fibrosis was observed in 3 eyes. One month post maintenance treatment, all abnormalities observed at the first visit vanished. At the last visit, OCT showed subretinal fibrosis and in 3 eyes (16.7%), the disruption of outer retina in 9 eyes (50%) and thinning of the whole layer in 4 eyes (22.2%). CONCLUSIONS: Our observations reveal that characteristic OCT features in PVRL patients can reduce gradually and finally vanish with therapy. We propose that SD-OCT may be employed to monitor the responsiveness of PVRL to treatment, which may influence decision making in the management of this disease.


Assuntos
Antimetabólitos Antineoplásicos/administração & dosagem , Linfoma , Metotrexato/administração & dosagem , Neoplasias da Retina , Tomografia de Coerência Óptica/métodos , Adulto , Idoso , Feminino , Humanos , Injeções Intravítreas , Linfoma/diagnóstico , Linfoma/tratamento farmacológico , Linfoma/patologia , Masculino , Pessoa de Meia-Idade , Neoplasias da Retina/diagnóstico , Neoplasias da Retina/tratamento farmacológico , Neoplasias da Retina/patologia , Corpo Vítreo/patologia
16.
Acta Diabetol ; 57(4): 479-489, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31749049

RESUMO

AIMS: To compare circular (circRNA) expression levels in the vitreous humour between PDR (proliferative diabetic retinopathy) and the control groups. METHODS: The present study collected vitreous humour samples of both the PDR group and the control group (composed of rhegmatogenous retinal detachment, idiopathic macular hole and idiopathic macular epiretinal membrane). All the samples were subjected to circRNA and mRNA sequencing as well as bioinformatic analysis. RESULTS: The vitreous humour of the PDR and control groups was collected during PPV surgery. Compared to the control group, 122 upregulated and 9 downregulated circRNAs, and 818 upregulated mRNAs and 864 downregulated mRNAs were identified. We further selected 12 circRNAs to validate the RNA expression level by qPCR; results showed that with the exception of 2 downregulated circRNAs the remaining were significantly upregulated in the PDR group, which was consistent with RNA sequencing results. Bioinformatic analysis was conducted to predict possible miRNAs absorbed by circRNAs. Each circRNA could interact with at least five miRNAs. We randomly chose three miRNAs to test the expression level in the vitreous humour by qPCR and found these miRNAs were significantly downregulated in the PDR group. CONCLUSIONS: The changed profiling of circRNAs in the vitreous humour was reliable and may become a promising biomarker of DR and the circRNA-miRNA-mRNA network. It may also play an important role in the progression of DR.


Assuntos
Retinopatia Diabética/genética , RNA Circular/genética , Corpo Vítreo/metabolismo , Adulto , Idoso , Biomarcadores/metabolismo , Estudos de Casos e Controles , Retinopatia Diabética/metabolismo , Retinopatia Diabética/patologia , Feminino , Perfilação da Expressão Gênica , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Masculino , Pessoa de Meia-Idade , RNA Circular/metabolismo , RNA Mensageiro/genética , RNA Mensageiro/metabolismo , Análise de Sequência de RNA , Transcriptoma , Corpo Vítreo/patologia , Adulto Jovem
17.
Ophthalmology ; 127(2): 240-248, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31708274

RESUMO

PURPOSE: Cutaneous melanoma metastatic to the vitreous is very rare. This study investigated the clinical findings, treatment, and outcome of patients with metastatic cutaneous melanoma to the vitreous. Most patients received checkpoint inhibition for the treatment of systemic disease, and the significance of this was explored. DESIGN: Multicenter, retrospective cohort study. PARTICIPANTS: Fourteen eyes of 11 patients with metastatic cutaneous melanoma to the vitreous. METHODS: Clinical records, including fundus photography and ultrasound results, were reviewed retrospectively, and relevant data were recorded for each patient eye. MAIN OUTCOME MEASURES: Clinical features at presentation, ophthalmic and systemic treatments, and outcomes. RESULTS: The median age at presentation of ophthalmic disease was 66 years (range, 23-88 years), and the median follow-up from diagnosis of ophthalmic disease was 23 months. Ten of 11 patients were treated with immune checkpoint inhibition at some point in the treatment course. The median time from starting immunotherapy to ocular symptoms was 17 months (range, 4.5-38 months). Half of eyes demonstrated amelanotic vitreous debris. Five eyes demonstrated elevated intraocular pressure, and 4 eyes demonstrated a retinal detachment. Six patients showed metastatic disease in the central nervous system. Ophthalmic treatment included external beam radiation (30-40 Gy) in 6 eyes, intravitreous melphalan (10-20 µg) in 4 eyes, enucleation of 1 eye, and local observation while receiving systemic treatment in 2 eyes. Three eyes received intravitreous bevacizumab for neovascularization. The final Snellen visual acuity ranged from 20/20 to no light perception. CONCLUSIONS: The differential diagnosis of vitreous debris in the context of metastatic cutaneous melanoma includes intravitreal metastasis, and this seems to be particularly apparent during this era of treatment with checkpoint inhibition. External beam radiation, intravitreous melphalan, and systemic checkpoint inhibition can be used in the treatment of ophthalmic disease. Neovascular glaucoma and retinal detachments may occur, and most eyes show poor visual potential. Approximately one quarter of patients demonstrated ocular disease that preceded central nervous system metastasis. Patients with visual symptoms or vitreous debris in the context of metastatic cutaneous melanoma would benefit from evaluation by an ophthalmic oncologist.


Assuntos
Antineoplásicos Alquilantes/uso terapêutico , Neoplasias Oculares/tratamento farmacológico , Neoplasias Oculares/secundário , Imunoterapia/métodos , Melanoma/patologia , Melfalan/uso terapêutico , Neoplasias Cutâneas/patologia , Corpo Vítreo/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
19.
Ophthalmology ; 127(2): 221-229, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31676123

RESUMO

PURPOSE: Collapsin response-mediator protein 5 (CRMP5) immunoglobulin G (IgG) has been associated with paraneoplastic optic neuritis, vitritis, retinitis, or a combination thereof, but few reports of these findings exist in the literature. We reviewed the neuro-ophthalmic findings and visual outcomes in a large series of CRMP5 IgG-positive patients to characterize further its clinical phenotype and response to treatment. DESIGN: Retrospective case series. PARTICIPANTS: Seventy-six patients with CRMP5 autoimmunity examined at the Mayo Clinic, Rochester, Minnesota. METHODS: Single academic medical center chart review of all CRMP5 IgG-positive (serum titer, >1:240) patients seen between 2001 and 2017. MAIN OUTCOME MEASURES: Neuro-ophthalmic manifestations and outcomes of CRMP5 autoimmunity, coexisting neural autoantibody presence and paraneoplastic associations, and the impact of immunosuppressant therapy. RESULTS: Twenty-nine of 76 patients (38%) demonstrated neuro-ophthalmic manifestations. Of the 29 patients with neuro-ophthalmic findings, the median age was 67 years (range, 33-88 years) and 20 (69%) were women. Cancer was diagnosed in 62% of the patients (small-cell carcinoma in 83%). Neuro-ophthalmic symptoms occurred before the diagnosis of cancer in 72%. Seventeen of 29 patients (59%) showed ocular (i.e., anterior visual pathway or intraocular) manifestations; presenting median visual acuity was 20/50 (range, 20/20-counting fingers) and the final median visual acuity was 20/40 (range, 20/20-hand movements). Fourteen of 17 patients (82%) demonstrated optic neuropathy, with 12 of these patients also showing retinitis or uveitis. Three of 17 patients (18%) showed retinitis or uveitis without optic neuropathy. All 12 patients with optic neuropathy and a documented fundus examination at visual symptom onset demonstrated optic disc edema. No patients showed optic nerve enhancement on magnetic resonance imaging. Twelve of 29 patients (41%) demonstrated ocular motility dysfunction consisting of central nystagmus and diplopia. Among those receiving immunosuppressive therapy, visual function improved in 50%. CONCLUSIONS: In our cohort of 29 CRMP5 IgG-positive patients with neuro-ophthalmic manifestations, optic neuropathy presented with optic disc edema, often associated with uveitis, retinitis, or both. The combination of retinitis, vitritis, and optic disc edema without optic nerve enhancement should prompt serologic testing for CRMP5 IgG to expedite vision-sparing immunosuppressant therapy and a targeted search for a systemic cancer.


Assuntos
Autoanticorpos/sangue , Oftalmopatias/imunologia , Hidrolases/imunologia , Proteínas Associadas aos Microtúbulos/imunologia , Papiledema/imunologia , Síndromes Paraneoplásicas Oculares/imunologia , Retinite/imunologia , Corpo Vítreo/imunologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Oftalmopatias/diagnóstico , Oftalmopatias/tratamento farmacológico , Feminino , Técnica Indireta de Fluorescência para Anticorpo , Glucocorticoides/uso terapêutico , Humanos , Imunoglobulina G/sangue , Imunossupressores/uso terapêutico , Masculino , Pessoa de Meia-Idade , Papiledema/diagnóstico , Papiledema/tratamento farmacológico , Síndromes Paraneoplásicas Oculares/diagnóstico , Síndromes Paraneoplásicas Oculares/tratamento farmacológico , Retinite/diagnóstico , Retinite/tratamento farmacológico , Estudos Retrospectivos , Acuidade Visual/fisiologia , Campos Visuais/fisiologia , Corpo Vítreo/efeitos dos fármacos , Corpo Vítreo/patologia
20.
Eur J Ophthalmol ; 30(5): 941-947, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31538489

RESUMO

AIM: To demonstrate the morphological outcomes of macular hole following prophylactic peripheral laser retinopexy (PPLR). METHODS: Our retrospective case-control analysis included 92 eyes, 55 in the laser group and 37 in the non-laser group. Fifty-five patients were subjected to prophylactic peripheral laser retinopexy in preparation for pars plana vitrectomy for macular hole, with and without vitreomacular adhesion (laser group). Before and after prophylactic peripheral laser retinopexy, we evaluated any changes in vitreomacular anatomy by optical coherence tomography. Optical coherence tomography changes were also analyzed in the visits preceding pars plana vitrectomy in 37 macular hole eyes not subjected to prophylactic peripheral laser retinopexy (non-laser group). RESULTS: In the laser group, 7 out of 55 eyes (12.7%) showed macular hole closure (6 out of 18 macular hole eyes with vitreomacular adhesion (33.3%) and 1 out of 37 eyes without vitreomacular adhesion (2.7%)), while no patients showed macular hole closure in the non-laser group (p < 0.05). The mean width of the seven closed macular hole was 191.4 µm (range: 59-282 µm). In all except one of the six macular hole eyes with vitreomacular adhesion, the macular hole closed without vitreomacular adhesion release. In our analysis of the patient subgroup with vitreomacular adhesion, we observed a release of vitreomacular adhesion in 3 out of 18 eyes (16.6%) in the laser group and in 1 out of 13 eyes (7.6%) in the non-laser group (p > 0.05). CONCLUSION: These findings support a possible beneficial role for prophylactic peripheral laser retinopexy in selected individuals with macular hole.


Assuntos
Terapia a Laser , Retina/patologia , Doenças Retinianas/patologia , Perfurações Retinianas/prevenção & controle , Corpo Vítreo/patologia , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Retina/diagnóstico por imagem , Doenças Retinianas/diagnóstico por imagem , Estudos Retrospectivos , Aderências Teciduais , Tomografia de Coerência Óptica , Vitrectomia/métodos , Corpo Vítreo/diagnóstico por imagem
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