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1.
PLoS One ; 15(2): e0228861, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32084146

RESUMO

A wireless photovoltaic retinal prosthesis is currently being studied with the aim of providing prosthetic vision to patients with retinitis pigmentosa (RP) and age-related macular degeneration (AMD). The major challenge of a photovoltaic device is its limited power efficiency. Our retinal prosthetic design implements a unique divisional power supply scheme (DPSS) system that provides the electrical power generated by all of the solar cells to only a subset of electrodes at any moment in time. The aim of the present study was to systematically characterize the spatiotemporal integration performance of the system under various DPSS conditions using human subjects and a psychophysical approach. A 16x16 pixels LED array controlled by Arduino was used to simulate the output signal of the DPSS design, and human performance under different visual stimulations at various update frequencies was then used to assess the spatiotemporal capability of retinal prostheses. The results showed that the contrast polarity of the image, image brightness, and division number influenced the lower limit of the update frequency of the DPSS system, while, on the other hand, visual angle, ambient light level, and stimulation order did not affect performance significantly. Pattern recognition by visual persistence with spatiotemporal integration of multiple frames of sparse dots is a feasible approach in retinal prosthesis design. These findings provide an insight into how to optimize a photovoltaic retinal prosthesis using a DPSS design with an appropriate update frequency for reliable pattern recognition. This will help the development of a wireless device able to restore vision to RP and AMD patients in the future.


Assuntos
Fontes de Energia Elétrica , Próteses Visuais , Adulto , Sensibilidades de Contraste/fisiologia , Estimulação Elétrica , Eletrodos Implantados , Voluntários Saudáveis , Humanos , Degeneração Macular/fisiopatologia , Degeneração Macular/cirurgia , Reconhecimento Visual de Modelos/fisiologia , Estimulação Luminosa , Psicofísica , Retinite Pigmentosa/fisiopatologia , Retinite Pigmentosa/cirurgia , Energia Solar , Análise Espaço-Temporal , Percepção Visual/fisiologia , Tecnologia sem Fio , Adulto Jovem
2.
Eur J Ophthalmol ; 30(1): 221-223, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31177825

RESUMO

PURPOSE: To present our experience treating hypotony maculopathy with a simple, minimally invasive, and removable ab interno tube Ahmed glaucoma valve occlusion. METHODS: Under topical anesthesia a 5-0 polypropylene suture (Prolene; Ethicon) was inserted into the Ahmed glaucoma valve tube. The length of the tube was measured, and an external suture cauterization was performed to allow an easier and safer fixation in the tube. The suture was introduced into the tube itself with the viscoelastic 27-gauge cannula. RESULTS: This technique was performed in three cases of hypotony maculopathy with a complex history of medical treatments: a 4-year-old boy with Donnai-Barrow syndrome and previous pars plana vitrectomy that developed hypotony maculopathy the day after Ahmed glaucoma valve insertion and two male patients (69 and 49 years old) that underwent hypotony maculopathy after cyclophotocoagulation as a last option to reduce intraocular pressure. One of the men had three filtering surgeries, two 5-fluorouracil needlings and Ahmed glaucoma valve insertion. The other male patient had keratoplasty and posterior Ahmed glaucoma valve insertion. In the three cases, both hypotony and maculopathy were reversed within a week and a month, respectively, after Ahmed glaucoma valve occlusion with no complications. When hypotony maculopathy develops it seems suitable to occlude completely the Ahmed glaucoma valve tube to swiftly reverse clinical and anatomic changes. CONCLUSION: Intraluminal Ahmed glaucoma valve occlusion with cauterized suture is a simple, quick, reversible, and effective technique that may offer a minimally invasive way to resolve hypotony maculopathy in complex cases and avoid severe loss of vision.


Assuntos
Cauterização/métodos , Implantes para Drenagem de Glaucoma , Degeneração Macular/cirurgia , Hipotensão Ocular/cirurgia , Falha de Prótese/efeitos adversos , Técnicas de Sutura , Idoso , Pré-Escolar , Cirurgia Filtrante , Humanos , Pressão Intraocular/fisiologia , Degeneração Macular/etiologia , Degeneração Macular/fisiopatologia , Masculino , Pessoa de Meia-Idade , Hipotensão Ocular/etiologia , Hipotensão Ocular/fisiopatologia , Implantação de Prótese , Tonometria Ocular , Resultado do Tratamento
3.
Rom J Ophthalmol ; 63(2): 128-134, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31334390

RESUMO

Objective (aim): Age-related macular degeneration (AMD) is the main cause of visual impairment in developed countries among the elderly. Our aim was to share our experiences with an implant designed to help improve near vision of patients with the non-exudative form of the disease. Methods: 15 pseudophakic patients suffering from dry type AMD, who had been implanted with the Scharioth Macula Lens (A45SML; Medicontur, Hungary), were included in the retrospective study. Prospective visual improvement was tested preoperatively, using the method recommended by the manufacturer: improvement in near visual acuity with +2.5D compared to +6.0D addition. Follow-up period was three months. Using pre- and postoperative data, changes in near and distance visual acuity, and the correlation between the predicted and achieved improvement were evaluated. Results: Preoperative corrected near vision with +2.5D and +6.0D addition was 0.17±0.07, and 0.36±0.11, respectively. Uncorrected near visual acuity 3 months postoperatively was 0.46±0.16. Predicted and actual visual improvement was 3.5 and 4.4 lines, respectively. No significant change in either the uncorrected or the best-corrected distance vision could be observed three months postoperatively. Neovascularization occurred three months postoperatively in one patient who had had stabilized wet macular degeneration before. Following treatment, the visual acuity returned to the sixth week level. Conclusions: The preoperative test is a reliable tool to predict the effectiveness of the implant. Our results suggested that the SML significantly improves near visual acuity without affecting distance vision; therefore, the SML can be an effective method to ameliorate the quality of life for these patients. Abbreviations: AMD = Age-Related Macular Degeneration, anti-VEGF = Anti-Vascular Endothelial Growth Factor, AREDS = Age-Related Eye Disease Study, BCDVA = Best Corrected Distance Visual Acuity, CNVA = Corrected Near Visual Acuity, ETDRS = Early Treatment Diabetic Retinopathy Study, IOL = Intraocular Lens, SML = Scharioth Macula Lens, T2.5 = Corrected Near Visual Acuity at 40 cm with an addition of +2.5 D, T6.0 = Corrected Near Visual Acuity at 15 cm with an addition of +6.0 D, UCDVA = Uncorrected Distance Visual Acuity, UCNVA = Uncorrected Near Visual Acuity.


Assuntos
Lentes Intraoculares , Macula Lutea/cirurgia , Degeneração Macular/cirurgia , Qualidade de Vida , Refração Ocular/fisiologia , Acuidade Visual , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Implante de Lente Intraocular/métodos , Macula Lutea/fisiopatologia , Degeneração Macular/fisiopatologia , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Estudos Retrospectivos
4.
Ophthalmic Surg Lasers Imaging Retina ; 50(3): e61-e70, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30893458

RESUMO

BACKGROUND AND OBJECTIVE: Age-related macular degeneration (AMD) is the leading cause of irreversible blindness among the elderly in developed countries. Subthreshold retinal laser therapy is a new technique that targets drusen - a marker of nonexudative AMD - without causing incidental retinal damage associated with conventional laser photocoagulation. This review summarizes published literature on subthreshold retinal laser therapy as prophylactic treatment of nonexudative AMD. PATIENTS AND METHODS: A literature search of the PubMed, Medline, and Embase databases was conducted from January 1997 to April 2018. Studies were analyzed based upon study design, laser parameters, drusen reduction, changes in visual acuity (VA), and the development of choroidal neovascularization (CNV) and/or geographic atrophy (GA). RESULTS: Twelve studies involving 2,481 eyes treated with subthreshold retinal laser therapy were included in this review. Treatment led to increased drusen reduction, and studies with significant VA improvement were associated with significant drusen reduction. There was no significant change in the risk of developing CNV or GA. CONCLUSIONS: Subthreshold retinal laser therapy is effective for reducing drusen and potentially improving vision in patients with nonexudative AMD. This therapy does not show benefits in reducing development of CNV or GA. Thus, its long-term efficacy to prevent progression to advanced AMD cannot yet be recommended. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:e61-e70.].


Assuntos
Fotocoagulação a Laser/métodos , Degeneração Macular/cirurgia , Neovascularização de Coroide/prevenção & controle , Progressão da Doença , Atrofia Geográfica/prevenção & controle , Humanos , Drusas Retinianas/cirurgia , Acuidade Visual
5.
Ophthalmic Surg Lasers Imaging Retina ; 50(2): 125-131, 2019 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-30768222

RESUMO

The histologic findings of a subretinal band and epiretinal membrane (ERM) excised from two patients who developed retinal detachments (RDs) after non-U.S. Food and Drug Administration-regulated intravitreal "stem cell" injections are reported. Both membranes were composed of fibrocellular tissue that stained positively with Smooth Muscle Actin and Masson's trichrome, consistent with collagenous and smooth muscle composition. CD34 immunostain (for hematopoietic cells) was negative for the subretinal band and minimally positive for the ERM. The authors speculate that the "stem cells" may cause RDs by differentiation into myofibroblasts that cause tractional membranes, though further studies are warranted. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:125-131.].


Assuntos
Membrana Epirretiniana/patologia , Descolamento Retiniano/etiologia , Transplante de Células-Tronco/efeitos adversos , Idoso , Feminino , Humanos , Injeções Intravítreas , Degeneração Macular/cirurgia
6.
Sao Paulo Med J ; 137(6): 530-542, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-32159640

RESUMO

BACKGROUND: Age-related macular degeneration (AMD) is the third largest cause of blindness worldwide, accounting for 8.7% of all cases. A considerable number of preventive or therapeutic interventions have been used for AMD. OBJECTIVE: This study presents a critical view of the interventions that have been assessed through Cochrane systematic reviews. DESIGN AND SETTING: Review of systematic reviews, conducted in the Discipline of Evidence-Based Medicine, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP). METHODS: Review of Cochrane systematic reviews about interventions for AMD. RESULTS: The 18 systematic reviews included assessed the effects of surgical techniques, laser/photo/radiotherapy, intravitreal injections, systemic drugs and phytotherapy/vitamins/supplements. CONCLUSION: The Cochrane systematic reviews found evidence that use of bevacizumab, ranibizumab, pegaptanib, laser photocoagulation, photodynamic therapy and multivitamin compounds may present some benefits for treating AMD. There was insufficient evidence for supporting the use of macular translocation, submacular surgery, steroid implantation, radiotherapy, intravitreal aflibercept, interferon alfa, statins or omega-3 fatty acids for treating AMD; or the use of multivitamin antioxidant vitamins or mineral supplementation for preventing AMD. Future randomized controlled trials are imperative to reduce the uncertainty in several clinical questions regarding AMD.


Assuntos
Medicina Baseada em Evidências , Degeneração Macular/terapia , Humanos , Injeções Intravítreas/métodos , Fotocoagulação/métodos , Degeneração Macular/prevenção & controle , Degeneração Macular/cirurgia , Radioterapia/métodos , Literatura de Revisão como Assunto , Revisões Sistemáticas como Assunto
7.
Ophthalmic Surg Lasers Imaging Retina ; 49(9): e65-e74, 2018 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-30222821

RESUMO

BACKGROUND AND OBJECTIVE: To evaluate a stereological method in optical coherence tomography (OCT) as an in vivo volume measurement of laser-induced choroidal neovascularization (L-CNV) lesion size. PATIENTS AND METHODS: Laser photocoagulation was applied in rats to rupture Bruch's membrane and induce L-CNV. In vivo OCT images of neovascular lesions were acquired with a spectral-domain OCT system at days 0, 3, 7, 10, and 14 after laser surgery. A stereological image-processing method was used to calculate lesion volumes from the OCT images. Rats were euthanized at day 14, and confocal microscopy was used to obtain accurate volume measurements of the lesions ex vivo. Lesion sizes calculated from OCT and confocal were compared. RESULTS: In vivo assessment by OCT allowed three distinct stages of L-CNV to be visualized: the initial early reaction, neovascular proliferation, and regression. At day 14, correlations between OCT and confocal lesion volumes showed a positive association (Pearson's r = 0.50, P < .01). Except for the largest lesions, volumes measured by OCT were statistically similar to those measured by the confocal gold standard (P = .90). CONCLUSION: The stereological approach used to measure neovascular lesion volume from OCT images offers an accurate means to track L-CNV lesion size in vivo. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:e65-e74.].


Assuntos
Corioide/irrigação sanguínea , Neovascularização de Coroide/diagnóstico , Terapia com Luz de Baixa Intensidade/efeitos adversos , Tomografia de Coerência Óptica/métodos , Animais , Neovascularização de Coroide/etiologia , Modelos Animais de Doenças , Angiofluoresceinografia/métodos , Fundo de Olho , Degeneração Macular/diagnóstico , Degeneração Macular/cirurgia , Masculino , Ratos , Ratos Endogâmicos BN
9.
Mol Vis ; 24: 252-260, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29618920

RESUMO

Purpose: This study aims to quantify the concentration of apolipoprotein A1 (APOA1) and retinol binding protein (RBP4) expressed in the vitreous humors of patients with rhegmatogenous retinal detachment associated with choroidal detachment (RRDCD), rhegmatogenous retinal detachment (RRD), and idiopathic epimacular membrane (IEM). This study also aims to investigate the potential role of APOA1 and RBP4 as biomarkers of RRDCD. Methods: Enzyme-linked immunosorbent assay (ELISA) kits were used to obtain levels of APOA1 and RBP4 from the vitreous humor samples of 76 primary patients. These patients included 23 patients with RRDCD, 28 patients with RRD, and 24 patients with IEM. All patients were undergoing planned pars plana vitrectomy. The differences between the concentrations of the molecular biomarkers among different patient groups were analyzed using the Mann-Whitney U-test for nonparametric values and independent samples t-test or one-way ANOVA analysis for parametric data. The relationship between the molecular biomarkers, grades of proliferative vitreoretinopathy (PVR), and quadrants of retinal detachment were analyzed using nonparametric Spearman's rank correlation analysis. Results: The vitreous concentrations of APOA1 and RBP4 were statistically significantly higher in the RRDCD group compared to the RRD and IEM groups. Patients with severe PVR demonstrated a higher concentration of APOA1 and RBP4 compared to those with mild PVR, but this finding was not statistically significant. There was a statistically significant positive correlation between APOA1 and RBP4 in the RRDCD and RRD groups. Nonparametric Spearman's rank correlation analysis revealed that levels of APOA1 and RBP4 increased statistically significantly with an increasing number of detached retinal quadrants in the RRDCD and RRD groups. Conclusions: The findings of this study allude to the potential of APOA1 and RBP4 as specific biomarkers of RRDCD. The findings of this study may contribute to increased understanding regarding the role of APOA1 and RBP4 in RRDCD.


Assuntos
Apolipoproteína A-I/genética , Doenças da Coroide/genética , Oftalmopatias Hereditárias/genética , Degeneração Macular/genética , Descolamento Retiniano/genética , Proteínas Plasmáticas de Ligação ao Retinol/genética , Idoso , Apolipoproteína A-I/metabolismo , Biomarcadores/metabolismo , Corioide/metabolismo , Corioide/patologia , Corioide/cirurgia , Doenças da Coroide/diagnóstico , Doenças da Coroide/metabolismo , Doenças da Coroide/cirurgia , Oftalmopatias Hereditárias/diagnóstico , Oftalmopatias Hereditárias/metabolismo , Oftalmopatias Hereditárias/cirurgia , Feminino , Expressão Gênica , Humanos , Degeneração Macular/diagnóstico , Degeneração Macular/metabolismo , Degeneração Macular/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Retina/metabolismo , Retina/patologia , Retina/cirurgia , Descolamento Retiniano/diagnóstico , Descolamento Retiniano/metabolismo , Descolamento Retiniano/cirurgia , Proteínas Plasmáticas de Ligação ao Retinol/metabolismo , Índice de Gravidade de Doença , Vitrectomia , Corpo Vítreo/metabolismo , Corpo Vítreo/patologia , Corpo Vítreo/cirurgia
10.
Artif Organs ; 42(8): E186-E203, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29633282

RESUMO

Retinal prosthesis or artificial retina is a promising modality of treatment for outer retinal degeneration, caused by primary and secondary loss of photoreceptor cells, in hereditary retinal dystrophy and age-related macular degeneration, respectively. Okayama University-type retinal prosthesis (OUReP) is a photoelectric dye-coupled polyethylene film which generates electric potential in response to light and stimulates nearby neurons. The dye-coupled films were implanted by vitreous surgery in the subretinal space of monkey eyes with macular degeneration which had been induced by cobalt chloride injection from the scleral side. A pilot 1-month observation study involved 6 monkeys and a pivotal 6-month observation study involved 8 monkeys. Of 8 monkeys in 6-month group, 3 monkeys underwent dye-coupled film removal at 5 months and were observed further for 1 month. The amplitude of visual evoked potential which had been reduced by macular degeneration did recover at 1 month after film implantation and maintained the level at 6 months. Optical coherence tomography showed no retinal detachment, and full-field electroretinograms maintained a-wave and b-wave amplitudes, indicative of no retinal toxicity. Pathological examinations after 6-month implantation showed structural integrity of the inner retinal layer in close apposition to dye-coupled films. The implanted films which were removed by vitrectomy 5 months later showed light-evoked surface electric potentials by scanning Kelvin probe measurement. The photoelectric dye-coupled film (OUReP), which serves as a light-receiver and a displacement current generator in the subretinal space of the eye, has a potential for recovering vision in diseases with photoreceptor cell loss, such as retinitis pigmentosa and age-related macular degeneration.


Assuntos
Potenciais Evocados Visuais , Degeneração Macular/cirurgia , Implantação de Prótese/instrumentação , Retina/cirurgia , Próteses Visuais , Compostos de Anilina/química , Compostos de Anilina/efeitos da radiação , Animais , Modelos Animais de Doenças , Estudos de Viabilidade , Luz , Macaca fascicularis , Degeneração Macular/patologia , Degeneração Macular/fisiopatologia , Projetos Piloto , Polietileno/química , Desenho de Prótese , Recuperação de Função Fisiológica , Retina/patologia , Retina/fisiopatologia , Propriedades de Superfície , Tiazóis/química , Tiazóis/efeitos da radiação , Fatores de Tempo
11.
J Vis Exp ; (132)2018 02 12.
Artigo em Inglês | MEDLINE | ID: mdl-29553543

RESUMO

This study is aimed at examining whether a suprachoroidal graft of autologous cells can improve best corrected visual acuity (BCVA) and responses to microperimetry (MY) in eyes affected by dry Age-related Macular Degeneration (AMD) over time through the production and secretion of growth factors (GFs) on surrounding tissue. Patients were randomly assigned to each study group. All patients were diagnosed with dry AMD and with BCVA equal to or greater than 1 logarithm of the minimum angle of resolution (logMAR). A suprachoroidal autologous graft by Limoli Retinal Restoration Technique (LRRT) was carried out on group A, which included 11 eyes from 11 patients. The technique was performed by implanting adipocytes, adipose-derived stem cells obtained from the stromal vascular fraction, and platelets from platelet-rich plasma in the suprachoroidal space. Conversely, group B, including 14 eyes of 14 patients, was used as a control group. For each patient, diagnosis was verified by confocal scanning laser ophthalmoscope and spectral domain-optical coherence tomography (SD-OCT). In group A, BCVA improved by 0.581 to 0.504 at 90 days and to 0.376 logMAR at 180 days (+32.20%) postoperatively. Furthermore, MY test increased by 11.44 dB to 12.59 dB at 180 days. The different cell types grafted behind the choroid were able to ensure constant GF secretion in the choroidal flow. Consequently, the results indicate that visual acuity (VA) in the grafted group can increase more than in the control group after six months.


Assuntos
Tecido Adiposo/transplante , Degeneração Macular/terapia , Transplante de Células-Tronco/métodos , Tecido Adiposo/citologia , Idoso , Idoso de 80 Anos ou mais , Corioide/cirurgia , Feminino , Humanos , Degeneração Macular/cirurgia , Masculino , Pessoa de Meia-Idade , Transplante Autólogo
12.
Clin Interv Aging ; 13: 243-249, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29467571

RESUMO

Purpose: To evaluate visual and surgical outcomes in very elderly patients (above 85 years of age) undergoing pars plana vitrectomy (PPV). Patients and methods: A single-center, retrospective study was carried out on the medical records of 82 patients aged 85 years and older who had undergone PPV from 2006 to 2013. Patients ranged in age from 86 to 99 years, with a mean age of 88.9 years (±2.88). Visual results and intraoperative and postoperative complications were the main outcome measures. Visual improvement/worsening was defined as at least ±0.1 logMAR change. Results: Mean follow-up was 7.25 months (±5.35), with a range of 1-28 months. General anesthesia was used in 63% of the operations. The most common indication was retinal detachment (27%). The ocular condition necessitating PPV was secondary to trauma (most commonly after a fall) in 10 eyes (12%). Mean visual acuity (VA) improved from 1/58 preoperatively to 1/29 at the final evaluation (p=0.014). Mean improvement in VA in eyes of patients with the comorbidity of age-related macular degeneration (n=34) was 41% lower compared to eyes of patients without the disease (n=48, p=0.013). In the subgroup of patients operated on for retinal detachment, 45.4% did not reach primary anatomic success and 45.4% needed additional retina-affecting surgery. One or more major ocular complications were reported in 24 eyes (29%), while 19 eyes (23%) had minor ocular complications. Conclusion: Improved VA was documented in more than half of the older adults aged 85-99 undergoing vitrectomy. Despite the rate of complications in the very elderly, the possibility of optimizing visual function may positively affect quality of life in this subgroup.


Assuntos
Complicações Pós-Operatórias/epidemiologia , Acuidade Visual , Vitrectomia/métodos , Idoso de 80 Anos ou mais , Feminino , Humanos , Degeneração Macular/cirurgia , Masculino , Prognóstico , Qualidade de Vida , Retina , Descolamento Retiniano/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
13.
Retina ; 38(3): 531-540, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28257377

RESUMO

PURPOSE: To describe the morphologic characteristics of the vitreomacular interface in intermediate age-related macular degeneration associated with tangential traction due to premacular membrane formation and to correlate with optical coherence tomography (OCT) findings and clinical data. METHODS: Premacular membrane specimens were removed sequentially with the internal limiting membrane from 27 eyes of 26 patients with intermediate age-related macular degeneration during standard vitrectomy. Specimens were processed for immunocytochemical staining of epiretinal cells and extracellular matrix components. Ultrastructural analysis was performed using transmission electron microscopy. Spectral domain optical coherence tomography images and patient charts were evaluated in retrospect. RESULTS: Immunocytochemistry revealed hyalocytes and myofibroblasts as predominant cell types. Ultrastructural analysis demonstrated evidence of vitreoschisis in all eyes. Myofibroblasts with contractile properties were observed to span between folds of the internal limiting membrane and vitreous cortex collagen. Retinal pigment epithelial cells or inflammatory cells were not detected. Mean visual acuity (Snellen) showed significant improvement from 20/72 ± 20/36 to 20/41 ± 20/32 (P < 0.001) after a mean follow-up period of 19 months (median, 17 months). During this period, none of the eyes required anti-vascular endothelial growth factor therapy. CONCLUSION: Fibrocellular premacular proliferation in intermediate age-related macular degeneration predominantly consists of vitreous collagen, hyalocytes, and myofibroblasts with contractile properties. Vitreoschisis and vitreous-derived cells appear to play an important role in traction formation of this subgroup of eyes. In patients with intermediate age-related macular degeneration and contractile premacular membrane, release of traction by vitrectomy with internal limiting membrane peeling results in significantly functional and anatomical improvement.


Assuntos
Membrana Basal/patologia , Degeneração Macular , Vitrectomia , Idoso , Idoso de 80 Anos ou mais , Membrana Basal/cirurgia , Membrana Basal/ultraestrutura , Feminino , Humanos , Degeneração Macular/patologia , Degeneração Macular/cirurgia , Masculino , Microscopia Eletrônica de Transmissão , Pessoa de Meia-Idade , Vitrectomia/métodos
14.
Cell Reprogram ; 20(6): 329-336, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-31251672

RESUMO

This prospective clinical case series aimed to investigate the safety and efficacy of suprachoroidal adipose tissue-derived mesenchymal stem cell (ADMSC) implantation in patients with dry-type age-related macular degeneration (AMD) and Stargardt's macular dystrophy (SMD). This study included four patients with advanced-stage dry-type AMD and four patients with SMD who underwent suprachoroidal implantation of ADMSCs. The best-corrected visual acuity (BCVA) in the study was 20/200. The worse eye of the patient was operated on. Patients were evaluated on the first day, first week, and first, third, and sixth months postoperatively. BCVA, anterior segment and fundus examination, color photography, fundus autofluorescence, optical coherence tomography, and visual field examination were carried out at each visit. Fundus fluorescein angiography and multifocal electroretinography (mf-ERG) recordings were performed at the end of the first, third, and sixth months and anytime if necessary during the follow-up. All eight patients completed the sixth month follow-up. None of them had any systemic or ocular complications. All of the eight patients experienced visual acuity improvement, visual field improvement, and improvement in mf-ERG recordings. Stem cell treatment with suprachoroidal implantation of ADMSCs seems to be safe and effective in the treatment of dry-type AMD and SMD.


Assuntos
Tecido Adiposo , Atrofia Geográfica/cirurgia , Degeneração Macular/congênito , Transplante de Células-Tronco Mesenquimais , Adulto , Idoso , Eletrorretinografia , Feminino , Angiofluoresceinografia , Seguimentos , Atrofia Geográfica/diagnóstico por imagem , Atrofia Geográfica/patologia , Atrofia Geográfica/fisiopatologia , Humanos , Degeneração Macular/diagnóstico por imagem , Degeneração Macular/patologia , Degeneração Macular/fisiopatologia , Degeneração Macular/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Recuperação de Função Fisiológica , Doença de Stargardt , Fatores de Tempo , Tomografia de Coerência Óptica
16.
J Coll Physicians Surg Pak ; 27(11): 725-726, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29132488

RESUMO

We describe a case of a healthy lady with a known optic disc pit who developed serous maculopathy a few hours after childbirth. We believe this is the first published description of a trigger factor responsible for serous macular detachment in eyes known to have a disc pit. She was successfully treated by means of pars plana vitrectomy and gas injection, resulting in slight visual improvement.


Assuntos
Tamponamento Interno , Degeneração Macular/diagnóstico por imagem , Disco Óptico/anormalidades , Doenças do Nervo Óptico/diagnóstico por imagem , Tomografia de Coerência Óptica/métodos , Vitrectomia , Adulto , Feminino , Humanos , Degeneração Macular/cirurgia , Doenças do Nervo Óptico/cirurgia , Gravidez , Resultado do Tratamento , Acuidade Visual
17.
Can J Ophthalmol ; 52(5): 475-479, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28985807

RESUMO

OBJECTIVE: To assess how polypoidal choroidal vasculopathy (PCV) is recognized and treated, and to assess whether treatment outcomes are different between Chinese and Caucasian Canadian patients with age-related macular degeneration (AMD). DESIGN: Retrospective chart review. PARTICIPANTS: 154 eyes from 135 Chinese patients and 2291 eyes from 1792 Caucasian patients who were newly diagnosed with either AMD or PCV and had more than 1 year of follow-up were included. METHODS: All newly diagnosed AMD patients presenting to the Retina Service of 3 Toronto University Hospitals, between March 25, 2008, to September 30, 2014, were reviewed. RESULTS: 10/154 eyes (6.5%) in Chinese Canadians and 16/2291 eyes (0.7%) in Caucasian Canadians were diagnosed as having PCV. Indocyanine green angiography (ICGA) was used to diagnose PCV in 20% of Chinese Canadians and 8.8% of Caucasian Canadians. Clinical practices with a larger percentage of Chinese patients were more likely to diagnose PCV in both Chinese (p = 0.004) and Caucasian patients (p = 0.03), were more likely to use photodynamic therapy (PDT) (p < 0.01), and had significantly greater central retinal thickness decrease (p < 0.001). CONCLUSION: Our study has shown that PCV is under-recognized in a Canadian population, and ICGA is underutilized. In clinical practices with a greater portion of Chinese patients, PCV is more often recognized and PDT is used more liberally.


Assuntos
Inibidores da Angiogênese/uso terapêutico , Neovascularização de Coroide/diagnóstico , Corantes/administração & dosagem , Verde de Indocianina/administração & dosagem , Degeneração Macular/diagnóstico , Fotoquimioterapia , Pólipos/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Grupo com Ancestrais do Continente Asiático/etnologia , Canadá/epidemiologia , China/epidemiologia , Neovascularização de Coroide/tratamento farmacológico , Neovascularização de Coroide/cirurgia , Neovascularização de Coroide/terapia , Terapia Combinada , Grupo com Ancestrais do Continente Europeu/etnologia , Feminino , Angiofluoresceinografia , Humanos , Degeneração Macular/tratamento farmacológico , Degeneração Macular/cirurgia , Degeneração Macular/terapia , Masculino , Pólipos/tratamento farmacológico , Pólipos/cirurgia , Pólipos/terapia , Estudos Retrospectivos , Acuidade Visual/fisiologia
18.
Drug Discov Ther ; 11(4): 226-229, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28867757

RESUMO

Non-arteritic posterior ischemic optic neuropathy (NA-PION) is a disorder of reduced blood flow to the retrobulbar optic nerve. There is usually an acute loss of visual acuity and field. Previous studies have noted an improvement in visual acuity and in ocular and retrobulbar blood flow with the use of a potent vasodilator of the microcirculation, prostaglandin E1 (PGE1), and steroids. The current report describes immediate improvement in the visual fields and visual acuity in a patient with NA-PION treated with intravenous PGE1 and steroids 66 hours after onset. An 89-year-old white female was first seen in December 2016 with a sudden loss of vision in the right eye. After a complete eye exam and visual fields, the patient was diagnosed with NA-PION. Treatment was immediately started with steroids and intravenous PGE1. This was repeated once again the next morning. Visual acuity in the right eye improved from 1/10 + 1 to 7/10 + 3 at 5 days. The mean deviation of the visual field improved from - 7.10 decibels (dB) with a central scotoma of - 22 dB to - 2.97 dB with a central scotoma of - 19 dB. After 2 weeks, her visual acuity was 7/10 + 1 and visual field testing of the right eye revealed a mean deviation of - 2.54 dB with a central scotoma of - 9 dB. The left eye was unchanged. In cases of NA-PION, PGE1 and steroids should be considered to immediately restore blood flow to help improve visual acuity and visual fields.


Assuntos
Alprostadil/uso terapêutico , Glucocorticoides/uso terapêutico , Degeneração Macular/cirurgia , Procedimentos Cirúrgicos Oftalmológicos , Neuropatia Óptica Isquêmica/tratamento farmacológico , Complicações Pós-Operatórias/tratamento farmacológico , Prednisona/uso terapêutico , Vasodilatadores/uso terapêutico , Administração Intravenosa , Idoso de 80 Anos ou mais , Feminino , Humanos , Neuropatia Óptica Isquêmica/fisiopatologia , Complicações Pós-Operatórias/fisiopatologia , Resultado do Tratamento , Campos Visuais
19.
Ophthalmic Surg Lasers Imaging Retina ; 48(9): 772-775, 2017 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-28902341

RESUMO

A 77-year-old woman with exudative macular degeneration underwent bilateral intravitreal injections of "stem cells" at a clinic in Georgia. One month and 3 months after injection, she developed retinal detachments in the left and right eyes, respectively. Increased awareness within the medical community of such poor outcomes is critical so that clinics offering untested practices that have been shown to be potentially harmful to patients can be identified and brought under U.S. Food and Drug Administration oversight. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:772-775.].


Assuntos
Degeneração Macular/cirurgia , Descolamento Retiniano/etiologia , Transplante de Células-Tronco/efeitos adversos , Adipócitos/citologia , Idoso , Feminino , Humanos , Injeções Intravítreas
20.
An. sist. sanit. Navar ; 40(2): 299-302, mayo-ago. 2017. ilus
Artigo em Espanhol | IBECS | ID: ibc-165880

RESUMO

La ciclodiálisis es el resultado de la separación de las fibras longitudinales del músculo ciliar de su inserción escleral, creando estados de hipotonía ocular. Es causada principalmente por traumatismos. La gonioscopia ha sido tradicionalmente la prueba diagnóstica para esta entidad, sin embargo, en la actualidad está siendo sustituida por otras técnicas, como la biomicroscopía ultrasónica (BMU). Presentamos el caso de un varón de 57 años que tras sufrir un traumatismo en el ojo izquierdo con un disco de sierra radial, presentó perforación corneal y hemorragia vítrea con edema panretiniano. La gonioscopia fue normal a pesar de la existencia de hipotonía ocular persistente. La realización de una BMU permitió diagnosticar una pequeña ciclodiálisis, inferior de diez grados. El tratamiento quirúrgico permitió recuperar una presión intraocular normal (AU)


Cyclodialysis is the result of the separation of the longitudinal fibres of the ciliary muscle from their scleral insertion, creating states of ocular hypotony. It is mainly caused by traumatisms. Gonioscopy has traditionally been the diagnostic test for this entity, however, at present it is being replaced by other techniques, such as ultrasound biomicroscopy (UBM). We present the case of a 57-year-old male who, following a traumatism in the left eye caused by the disc of a radial saw, presented corneal perforation and vitreous haemorrhage with pan-retinal edema. The gonioscopy was normal in spite of the existence of persistent ocular hypotony. The realization of a UBM enabled diagnosis of a small cyclodialysis of less than ten degrees. Surgical treatment made it possible to recover normal intraocular pressure (AU)


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Vitrectomia/instrumentação , Corpo Ciliar/lesões , Corpo Ciliar/cirurgia , Criocirurgia/métodos , Traumatismos Oculares/cirurgia , Vitrectomia/métodos , Hexafluoreto de Enxofre/uso terapêutico , Traumatismos Oculares/diagnóstico , Traumatismos Oculares/etiologia , Microscopia , Hipotonia Muscular , Hipotensão Ocular , Hipotonia Muscular/cirurgia , Hipotensão Ocular/cirurgia , Acuidade Visual , Gonioscopia , Degeneração Macular/cirurgia
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