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1.
Cesk Slov Oftalmol ; 76(4): 166-170, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33297701

RESUMO

Pregnancy is associated with increased risk of progression of diabetic retinopathy (DR), the greatest risk of worsening occurs during the second trimester of pregnancy and persists as long as one year after the childbirth. The risk factors include duration of the diabetes, insufficient metabolic control, severity of DR at the time of conception and presence of coexisting vascular disease, such as arterial hypertension, and pregnancy itself. The recommendations for retinopathy screening in pregnancy vary significantly. A dilated fundus exam should be done in the beginning of pregnancy, the next follow-up throughout pregnancy depends on the severity of ocular findings. The cooperation of multi-disciplinary team consisting of ophthalmologist, obstetrition and endocrinologist is essential to provide the best health care. The authors present a case report of a pregnant woman with type 1 diabetes mellitus (DM), who had a progression of DR and diabetic macular edema (DME) in both eyes during pregnancy. She has had DM for 24 years and has been treated with insulin. The patient was examined at the 23rd week of the second pregnancy (first pregnancy was terminated because of missed miscarriage). The diagnosis of advanced proliferative DR and advanced DME in both eyes was made so we performed panretinal laser photocoagulation of the retina of both eyes. Despite that the ocular findings got worse and we found vitreous haemorrhage in the left eye. We performed pars plana vitrectomy (PPV) of the left eye at the 28th week of pregnancy, nevertheless the DME got worse in both eyes, so we recommended to terminate the pregnancy at the 31st week because of the risk of loss of vision. The visual acuity of the left eye improved, but suddenly there was vitreous haemorrhage in the right eye after the delivery. We indicated PPV of the right eye, the outcome of the surgery was satisfying. We still take care about this patient.


Assuntos
Diabetes Mellitus Tipo 1 , Retinopatia Diabética , Edema Macular , Diabetes Mellitus Tipo 1/complicações , Retinopatia Diabética/complicações , Retinopatia Diabética/diagnóstico , Retinopatia Diabética/cirurgia , Feminino , Humanos , Fotocoagulação a Laser , Gravidez , Retina
2.
Zhonghua Fu Chan Ke Za Zhi ; 55(12): 823-829, 2020 Dec 25.
Artigo em Chinês | MEDLINE | ID: mdl-33355756

RESUMO

Objective: To analyze the perioperative maternal complications of twin-twin transfusion syndrome (TTTS) after fetolascopic laser photocoagulation (FLP). Methods: A retrospective study was conducted among 182 cases with TTTS received FLP in Shanghai First Maternity and Infant Hospital from January 2010 to December 2018. The types, incidence and related factors of perioperative maternal complications as well as the changes of maternal laboratory parameters before and after FLP were analyzed. Results: The age of 182 TTTS pregnant women was (29.8±3.9) years old, body mass index (BMI) before pregnancy was (21.3±2.9) kg/m2. The median gestational week of FLP treatment was 22.0 weeks, the preoperative cervical length was (34.1±9.0) mm, and the median preoperative maximum vertical pocket was 12.0 cm. During the perioperative period of FLP treatment, 22 cases (12.1%, 22/182) presented maternal complications, among which 4 cases (2.2%, 4/182) presented severe postoperative maternal complications, including 3 cases of pulmonary edema and 1 case of pulmonary embolism accompanied with right cardiac insufficiency. There were 18 cases (9.9%, 18/182) of common maternal complications during the perioperative period, including 6 cases (3.3%, 6/182) of intraoperative hemorrhage, 5 cases (2.7%, 5/182) of intraoperative amniotic fluid leakage into the pelvic cavity, 5 cases (2.7%, 5/182) of premature rupture of membrane 72 hours after the operation, 1 case (0.5%, 1/182) of inevitable abortion, and 1 case (0.5%, 1/182) of infection. The analysis of related risk factors found that maternal complications were only related to BMI before pregnancy, and the BMI of TTTS pregnant women with complications was lower than that of those without complications, the difference was statistically significant (P<0.01). The hemoglobin level, hematocrit and albumin level of TTTS pregnant women were significantly decreased at 4-6 hours and 24 hours after FLP respectively, compared with those before surgery (P<0.01), and there were no significant correlations with the amount of amniodrainage during surgery (P>0.05 for all). Conclusions: The overall incidence of perioperative maternal complications in the treatment of TTTS by FLP is not high, among which the serious complications mainly include pulmonary edema and pulmonary embolism. Timely correction of maternal hemodilution that may occur in TTTS pregnant women could achieve a good prognosis after FLP.


Assuntos
Ruptura Prematura de Membranas Fetais/etiologia , Transfusão Feto-Fetal , Fetoscopia/métodos , Fotocoagulação a Laser/métodos , Gravidez de Gêmeos , Adulto , China/epidemiologia , Feminino , Transfusão Feto-Fetal/cirurgia , Fetoscopia/efeitos adversos , Idade Gestacional , Humanos , Recém-Nascido , Fotocoagulação a Laser/efeitos adversos , Lasers , Masculino , Gravidez , Estudos Retrospectivos , Resultado do Tratamento , Gêmeos Monozigóticos
3.
Vestn Oftalmol ; 136(6. Vyp. 2): 147-154, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33371643

RESUMO

PURPOSE: To compare the effectiveness and safety of panretinal laser photocoagulation targeting far-periphery (sPRP) versus conventional panretinal laser photocoagulation (cPRP) in patients with ischemic central retinal vein occlusion (iCRVO) in terms of the degree of macular edema. MATERIAL AND METHODS: The study included eight (5 males and 3 females, mean age 59.4±17.2 years) and seven (6 males and 1 female, mean age 75.7±9.1 years) patients in sPRP and cPRP groups, respectively. iCRVO was defined as a CRVO case with baseline best corrected visual acuity (BCVA) of <0.2, central retinal thickness (CRT) of >500 µm and severe intraretinal hemorrhages. sPRP included dense photocoagulation of far-periphery over 360˚ and standard photocoagulation of the mid-periphery. Primary outcome measures were CRT and macular volume at the end of the follow-up. BCVA served as the secondary outcome measure. RESULTS: The median of the follow-up period was 9.5 months (ranged from 1.5 to 19 months). In the sPRP group, at the end of the follow-up both CRT and macular volume significantly decreased from 892.0±149.4 µm to 391.8±131.2 µm (p<0.001) and from 16.6±4.1 mm3 to 9.7±1.4 mm3, respectively (p=0.008). In the cPRP group, at the end of the follow-up CRT and macular volume changes were statistically insignificant: from 761.0±162.1 µm to 705.0±181.8 µm (p=0.46) and from 13.6± 3.2 mm3 to 11.8±1.7 mm3, respectively (p=0.38). At the end of the follow-up, cPRP group did not have changes in BCVA, while in the sPRP group BCVA increased statistically significantly from 1.45±0.6 LogMAR (≈0.06) to 1.1±0.6 LogMAR (≈0.14) (p=0.03). There were no adverse events or complications associated with laser treatment in any of the study patients. CONCLUSION: This study demonstrates the superiority of sPRP compared with cPRP for treatment of patients with iCRVO, showing that selective laser treatment of the far-periphery results in significant reduction of macular edema associated with severe retinal ischemia.


Assuntos
Oclusão da Veia Retiniana , Adulto , Idoso , Idoso de 80 Anos ou mais , Inibidores da Angiogênese/uso terapêutico , Feminino , Humanos , Injeções Intravítreas , Isquemia , Fotocoagulação a Laser , Lasers , Masculino , Pessoa de Meia-Idade , Oclusão da Veia Retiniana/complicações , Oclusão da Veia Retiniana/diagnóstico , Oclusão da Veia Retiniana/cirurgia , Tomografia de Coerência Óptica , Resultado do Tratamento , Acuidade Visual
4.
Rom J Ophthalmol ; 64(3): 285-291, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33367162

RESUMO

Purpose: To describe the central three-dimensional (3D) thickness profile of the macula (CMT) and the subfoveal choroidal region (SFCT) in diabetic retinopathy (DR) following panretinal laser photocoagulation (PRP) using swept-source optical coherence tomography (SS-OCT). Methods: A prospective observational study including 17 eyes with proliferative DR (PDR) and 27 eyes with severe nonproliferative DR (sNPDR)] for whom PRP was done. All subjects received SS-OCT imaging before and 3 months after PRP (POM#3). SFCT and CMT changes were analysed at both visits. Intraclass Correlation Coefficients (ICC) and Coefficients of Variation (COV) were used to test the accuracy of thickness data. Results: SFCT has thinned from 233 ± 54 µm before PRP treatment to 216 ± 51 µm 3 months later (p < 0.001). Likewise, CMT declined at POM#3 as compared to pre-PRP status (p<0.001). SFCT was thinner in PDR before and at POM#3 (p<0.05) than sNPDR; whereas, no significant difference was observed in CMT between both groups in the two visits. No significant changes were found between groups in SFCT and CMT at POM#3. Regarding reliability, ICCSFCT=0.98 and ICCCMT=0.99. The COVs for CMT and SFCT were 5.03% and 5.91%, respectively. Conclusion: The mean SFCT and CMT decreased 3 months after PRP. We also reported reliability of SFCT measurements in DR using SS-OCT. Abbreviations: SS = Swept-Source, TD = time domain, SD = spectral domain, FD = Fourier-domain, 3D = three-dimensional, 2D = two-dimensional.


Assuntos
Corioide/patologia , Retinopatia Diabética/diagnóstico , Fotocoagulação a Laser/métodos , Retina/patologia , Tomografia de Coerência Óptica/métodos , Retinopatia Diabética/cirurgia , Feminino , Angiofluoresceinografia/métodos , Seguimentos , Fundo de Olho , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Retina/cirurgia , Estudos Retrospectivos
5.
Vestn Oftalmol ; 136(6): 50-56, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33084279

RESUMO

PURPOSE: To determine the indications and assess the effectiveness of laser coagulation of the retina (RLC) after different types of surgeries for retinal detachment (RD), except vitrectomy. MATERIAL AND METHODS: The study included 160 patients (165 eyes) with various types of retinal detachment and retinoschisis who remained under observation for 11 years. RESULTS: In case of retinal tear with a slight local RD (less than one quadrant), we recommend the use of RLC as monotherapy. Such patients are indicated to undergo regular examinations (1 month, 3 months, 6 months, 1 year). Due to risk of tractional defects of the retina in the lower quadrants during the introduction of gas-air mixture into the vitreous cavity, in the presence of retinal pathology it is recommended to perform RLC before the pneumatic retinopexy stage. In large retinal tears, despite their upper localization, pneumatic retinopexy is not indicated due to the possibility of gas spilling over the edges of the tear under the retina, leading to an increase in the initial size of the tear and spread of RD. We noted the effectiveness of RLC monotherapy for retinal detachment of various localization. After sealing the sclera, retinal laser coagulation on the shaft along the seal is necessary to limit the tear along the edge, since over time the seal may shift causing a relapse of RD. CONCLUSION: The study has confirmed the effectiveness of laser coagulation of the retina as an independent method for the treatment of retinoschisis and retinal tears with local detachment.


Assuntos
Descolamento Retiniano , Retinosquise , Humanos , Fotocoagulação a Laser , Retina/diagnóstico por imagem , Retina/cirurgia , Descolamento Retiniano/diagnóstico , Descolamento Retiniano/etiologia , Descolamento Retiniano/cirurgia , Retinosquise/diagnóstico , Retinosquise/etiologia , Retinosquise/cirurgia , Vitrectomia
6.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 5272-5275, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33019173

RESUMO

Focal laser ablation offers a minimally invasive method of treating solid organ tumors via hyperthermia. Real-time monitoring of the induced tissue damage is critical for clinical success, and is typically accomplished using thermal measurements and Arrhenius models. In this manuscript, the utility of interstitial fluence probes in assessing coagulation directly in real-time was assessed through a Monte Carlo simulation and an experimental study in tissue mimicking prostate phantoms. In the simulation results, fluence increases greater than 100% were observed inside the coagulation zone, as coagulation effectively acts as a 'light trap'. Moreover, the passing of the coagulation boundary at any given point was shown to correspond with an inflection in fluence with a mean absolute difference of 0.1mm and 0.4mm observed for the simulation and phantom respectively. These results suggest that interstitial fluence probes may be capable of providing real-time feedback during focal laser ablation.


Assuntos
Hipertermia Induzida , Fotocoagulação a Laser , Masculino , Método de Monte Carlo , Imagens de Fantasmas , Próstata
7.
PLoS One ; 15(9): e0239138, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32970724

RESUMO

There are multiple surgical approaches to the repair of rhegmatogenous retinal detachment (RRD). Here, we evaluated the outcomes of small-gauge pars plana vitrectomy (PPV), alone or in combination with scleral buckle (SB-PPV), for RRD repair using a standardized technique by 3 vitreoretinal surgeons: "extensive" removal of the vitreous with scleral depression and dynamic examination of the peripheral retina. One hundred eighty seven eyes of 180 consecutive patients treated for primary RRD by three vitreoretinal surgeons at a tertiary academic medical center from September 2015 to March 2018 were analyzed. Most RRDs occurred in males (134 [71.3%] eyes), affected the left eye (102 [54.3%]), and were phakic (119 [63.3%]). PPV alone was performed in 159 eyes (84.6%), with a combined SB-PPV used in the remaining 29 eyes (15.4%); focal endolaser was used in all (100%) cases. The single surgery anatomic success rate was 186 eyes (99.5%) at 3 months, and 187 (100%) at last follow up. Overall best-corrected visual acuity (BCVA) had significantly improved at 3 months ([Snellen 20/47] P<0.00005) and last follow up ([Snellen 20/31] P<0.00005), as compared to day of presentation ([Snellen 20/234]). Our findings suggest that "extensive" removal of the vitreous and dynamic peripheral examination with scleral depression may lead to high single surgery success in primary uncomplicated RRD repair.


Assuntos
Oftalmopatias Hereditárias/cirurgia , Fotocoagulação a Laser/métodos , Descolamento Retiniano/cirurgia , Recurvamento da Esclera/métodos , Vitrectomia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Terapia Combinada/métodos , Oftalmopatias Hereditárias/diagnóstico , Feminino , Seguimentos , Humanos , Fotocoagulação a Laser/instrumentação , Masculino , Pessoa de Meia-Idade , Retina/diagnóstico por imagem , Retina/cirurgia , Descolamento Retiniano/diagnóstico , Estudos Retrospectivos , Esclera/diagnóstico por imagem , Esclera/cirurgia , Recurvamento da Esclera/instrumentação , Fatores Sexuais , Tomografia de Coerência Óptica , Resultado do Tratamento , Acuidade Visual , Vitrectomia/instrumentação
8.
Cesk Slov Oftalmol ; 76(1): 29-36, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32917092

RESUMO

The objective of this study was a retrospective assessment of two-year experience with micropulse cyclophotocoagulation (MP CPC) in the therapy of various types of glaucoma. MATERIAL AND METHOD: The cohort of patients consisted of 47 people, out of which 16 men and 31 women. An average age of males was 58.9 years (the range from 35 to 78 years), and an average age of females was 64.7 years (the range from 33 to 86 years). Both eyes were treated in three patients, and therefore the total number of assessed eyes was 50. Patients who underwent the therapy were in different stages of glaucoma disease, with various types of primary and secondary glaucoma. Most of the patients were those with primary open angle glaucoma (POAG): 26 patients, followed by patients with secondary pseudoexfoliative glaucoma (PEXG): 9 patients; diagnoses of the remaining patients: 4 patients - secondary pigmentary glaucoma (PG), 3 patients - primary angle closure glaucoma (PACG), 2 patients normal tension glaucoma (NTG), 3 patients - Posner-Schlossman syndrome, 1 patient - Cogan-Reese syndrome, 1 patient - neovascular glaucoma and 1 patient - secondary traumatic glaucoma. On the operated eye prior to the surgery 3 patients underwent laser iridotomy, 4 patients trabeculectomy, 4 patients EX-PRESS® implant, 3 patients EX-PRESS® implant and trabeculectomy and 1 patient transscleral cyclophotocoagulation. During surgery we opted for from 2,000 to 2,250 mW infrared laser with 810 nm wavelength which uses a micropulse system of laser energy emission. For the procedure we used a new MP3 application probe. 30% drop in intraocular pressure (IOP) compared to the baseline IOP values was set as a success. RESULTS: Our results correlated with the most of available studies when we achieved drop in the values of intraocular pressure by the minimum of 30% in 53.4% of the eyes. The effect of therapy failed in 9 eyes (18%) where we subsequently selected a different therapeutic procedure. CONCLUSION: MP CPC is a non-incisional laser treatment with minimum complications. It is characterized by a high safety profile and predictability of results. In our study we achieved drop in the values of intraocular pressure by the minimum of 30% in 53.4% of treated eyes. Its use is not limited by the type of glaucoma disease. In the event of insufficient effect, it may be repeated.


Assuntos
Glaucoma , Fotocoagulação a Laser , Adulto , Idoso , Corpo Ciliar , Feminino , Glaucoma/cirurgia , Humanos , Pressão Intraocular , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
10.
Invest Ophthalmol Vis Sci ; 61(10): 14, 2020 08 03.
Artigo em Inglês | MEDLINE | ID: mdl-32761140

RESUMO

Purpose: To evaluate the incidence, visual prognosis, and mortality in retinopathy of prematurity (ROP) in Korea. Methods: We used the National Health Insurance and the Korean Disability Registry database, which covers the entire newborn population in 2006 to 2014 and includes information on all newborns diagnosed with ROP until 2016. Using these databases, we evaluated the incidence, rate of visual impairment (VI), and mortality in patients with ROP according to the birth weight categories and treatment modalities. Results: The ROP incidence per 1000 newborns was 1.99, which broke down into 317.14 in the very low birth weight (VLBW) less than 1500 g population, 25.45 in the 1500 to 2499 g population, and 0.29 in the 2500 g or greater population. When assessed at age 10, the VI rate was 2.2 per 100 person-years, which was highest at 4.5 per 100 person-years in the VLBW population compared with the population in other birth weight categories. Among treated cases, the proportion of VI in patients undergoing laser photocoagulation or cryotherapy was 1.6% (42/2595), which was lower than the 2.9% (2/68) of patients treated with anti-vascular endothelial growth factor injection, and 32.2% (82/255) of patients undergoing vitrectomy or scleral buckling. The mortality rate was 4.8 per 1000 person-years, which was highest in the VLBW population, but similar across treatment modalities. Conclusions: The ROP incidence in Korea was approximately 1 in 500 among all newborns, and 1 in 3 in the VLBW population. As the first nationwide population-based study of long-term visual prognosis in ROP, we report the higher VI rate in ROP than previously determined in other studies. Differences in visual outcomes and comparable mortality risks between treatment modalities require further verification.


Assuntos
Retinopatia da Prematuridade/mortalidade , Acuidade Visual/fisiologia , Inibidores da Angiogênese/uso terapêutico , Peso ao Nascer , Crioterapia , Feminino , Seguimentos , Idade Gestacional , Humanos , Incidência , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido de muito Baixo Peso , Fotocoagulação a Laser , Masculino , Inquéritos Nutricionais/estatística & dados numéricos , República da Coreia/epidemiologia , Retinopatia da Prematuridade/fisiopatologia , Retinopatia da Prematuridade/terapia , Recurvamento da Esclera , Pessoas com Deficiência Visual/estatística & dados numéricos , Vitrectomia
11.
Invest Ophthalmol Vis Sci ; 61(10): 20, 2020 08 03.
Artigo em Inglês | MEDLINE | ID: mdl-32780864

RESUMO

Purpose: Ciliary neurotrophic factor (CNTF) is a well-characterized neurotrophic factor currently in clinical trials for the treatment of macular telangiectasia type II. Our previous work showed that CNTF-induced STAT3 signaling is a potent inhibitor of pathologic preretinal neovascular tuft formation in the mouse model of oxygen-induced retinopathy. In this study, we investigated the effect of CNTF on outer retinal and choroidal angiogenesis and the mechanisms that underpin the observed decrease in outer retinal neovascularization following CNTF treatment. Methods: In the Vldlr-/- and laser-CNV mouse models, mice received a one-time injection (on postnatal day [P] 12 in the Vldlr-/- model and 1 day after laser in the Choroidal Neovascularization (CNV) model) of recombinant CNTF or CxCl10, and the extent of neovascular lesions was assessed 6 days posttreatment. STAT3 downstream targets affected by CNTF treatment were identified using quantitative PCR analysis. A proteome array was used to compare media conditioned by CNTF-treated and control-treated primary Müller cells to screen for CNTF-induced changes in secreted angiogenic factors. Results: Intravitreal treatment with recombinant CNTF led to significant reduction in neovascularization in the Vldlr-/- and laser-CNV mouse models. Treatment effect in the Vldlr-/- was long-lasting but time sensitive, requiring intravitreal treatment before P19. Mechanistic workup in vitro as well as in vivo confirmed significant activation of the STAT3-signaling pathway in Müller cells in response to CNTF treatment and upregulation of CxCl10. Intravitreal injections of recombinant CxCl10 significantly reduced outer retinal neovascularization in vivo in both the Vldlr-/- and laser-CNV mouse models. Conclusions: CNTF treatment indirectly affects outer retinal and choroidal neovascularization by inducing CxCl10 secretion from retinal Müller cells.


Assuntos
Quimiocina CXCL10/metabolismo , Fator Neurotrófico Ciliar/uso terapêutico , Neovascularização Retiniana/prevenção & controle , Animais , Western Blotting , Células Cultivadas , Neovascularização de Coroide/metabolismo , Neovascularização de Coroide/patologia , Neovascularização de Coroide/prevenção & controle , Modelos Animais de Doenças , Ensaio de Imunoadsorção Enzimática , Células Ependimogliais , Imuno-Histoquímica , Fotocoagulação a Laser , Camundongos , Camundongos Endogâmicos C57BL , RNA Mensageiro/genética , Reação em Cadeia da Polimerase em Tempo Real , Neovascularização Retiniana/metabolismo , Neovascularização Retiniana/patologia , Fator de Transcrição STAT3/metabolismo , Regulação para Cima
12.
Cochrane Database Syst Rev ; 7: CD009510, 2020 07 07.
Artigo em Inglês | MEDLINE | ID: mdl-32633861

RESUMO

BACKGROUND: Branch retinal vein occlusion (BRVO) is one of the most commonly occurring retinal vascular abnormalities. The most common cause of visual loss in people with BRVO is macular oedema (MO). Grid or focal laser photocoagulation has been shown to reduce the risk of visual loss. Limitations to this treatment exist, however, and newer modalities may have equal or improved efficacy. Antiangiogenic therapy with anti-vascular endothelial growth factor (anti-VEGF) has recently been used successfully to treat MO resulting from a variety of causes. OBJECTIVES: To investigate the efficacy and gather evidence from randomised controlled trials (RCTs) on the potential harms of anti-vascular endothelial growth factor (VEGF) agents for the treatment of macular oedema (MO) secondary to branch retinal vein occlusion (BRVO). SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials Register) (2019, Issue 6); MEDLINE Ovid; Embase Ovid; the ISRCTN registry; ClinicalTrials.gov; and the WHO ICTRP. The date of the last search was 12 June 2019. SELECTION CRITERIA: We included randomised controlled trials (RCTs) investigating BRVO. Eligible trials had to have at least six months' follow-up where anti-VEGF treatment was compared with another treatment, no treatment, or placebo. We excluded trials where combination treatments (anti-VEGF plus other treatments) were used; and trials that investigated the dose and duration of treatment without a comparison group (other treatment/no treatment/sham). DATA COLLECTION AND ANALYSIS: Two review authors independently extracted the data using standard methodological procedures expected by Cochrane. The primary outcome was the proportion of participants with an improvement from baseline in best-corrected visual acuity of greater than or equal to 15 letters (3 lines) on the Early Treatment in Diabetic Retinopathy Study (ETDRS) Chart at six months and 12 months of follow-up. The secondary outcomes were the proportion of participants who lost greater than or equal to 15 ETDRS letters (3 lines) and the mean visual acuity (VA) change at six and 12 months, as well as the change in central retinal thickness (CRT) on optical coherence tomography from baseline at six and 12 months. We also collected data on adverse events and quality of life (QoL). MAIN RESULTS: We found eight RCTs of 1631 participants that met the inclusion criteria after independent and duplicate review of the search results. These studies took place in Europe, North America, Eastern Mediterranean region and East Asia. Included participants were adults aged 18 or over with VA of 20/40 or worse. Studies varied by duration of disease but permitted previously treated eyes as long as there was sufficient treatment-free interval. All anti-VEGF agents (bevacizumab, ranibizumab and aflibercept) and steroids (triamcinolone and dexamethasone) were included. Overall, we judged the studies to be at moderate or unclear risk of bias. Four of the eight studies did not mask participants or outcome assessors, or both. One trial compared anti-VEGF to sham. At six months, eyes receiving anti-VEGF were significantly more likely to have a gain of 15 or more ETDRS letters (risk ratio (RR) 1.72, 95% confidence interval (CI) 1.19 to 2.49; 283 participants; moderate-certainty evidence). Mean VA was better in the anti-VEGF group at six months compared with control (mean difference (MD) 7.50 letters, 95% CI 5.29 to 9.71; 282 participants; moderate-certainty evidence). Anti-VEGF also proved more effective at reducing CRT at six months (MD -57.50 microns, 95% CI -108.63 to -6.37; 281 participants; lower CRT is better; moderate-certainty evidence). There was only very low-certainty evidence on adverse effects. There were no reports of endophthalmitis. Mean change in QoL (measured using the National Eye Institute Visual Functioning Questionnaire VFQ-25) was better in people treated with anti-VEGF compared with people treated with sham (MD 7.6 higher score, 95% CI 4.3 to 10.9; 281 participants; moderate-certainty evidence). Three RCTs compared anti-VEGF with macular laser (total participants = 473). The proportion of eyes gaining 15 or more letters was greater in the anti-VEGF group at six months (RR 2.09, 95% CI 1.44 to 3.05; 2 studies, 201 participants; moderate-certainty evidence). Mean VA in the anti-VEGF groups was better than the laser groups at six months (MD 9.63 letters, 95% CI 7.23 to 12.03; 3 studies, 473 participants; moderate-certainty evidence). There was a greater reduction in CRT in the anti-VEGF group compared with the laser group at six months (MD -147.47 microns, 95% CI -200.19 to -94.75; 2 studies, 201 participants; moderate-certainty evidence). There was only very low-certainty evidence on adverse events. There were no reports of endophthalmitis. QoL outcomes were not reported. Four studies compared anti-VEGF with intravitreal steroid (875 participants). The proportion of eyes gaining 15 or more ETDRS letters was greater in the anti-VEGF group at six months (RR 1.67, 95% CI 1.33 to 2.10; 2 studies, 330 participants; high-certainty evidence) and 12 months (RR 1.76, 95% CI 1.36 to 2.28; 1 study, 307 participants; high-certainty evidence). Mean VA was better in the anti-VEGF group at six months (MD 8.22 letters, 95% CI 5.69 to 10.76; 2 studies, 330 participants; high-certainty evidence) and 12 months (MD 9.15 letters, 95% CI 6.32 to 11.97; 2 studies, 343 participants; high-certainty evidence). Mean CRT also showed a greater reduction in the anti-VEGF arm at 12 months compared with intravitreal steroid (MD -26.92 microns, 95% CI -65.88 to 12.04; 2 studies, 343 participants; moderate-certainty evidence). People receiving anti-VEGF showed a greater improvement in QoL at 12 months compared to those receiving steroid (MD 3.10, 95% CI 0.22 to 5.98; 1 study, 307 participants; moderate-certainty evidence). Moderate-certainty evidence suggested increased risk of cataract and raised IOP with steroids. There was only very low-certainty evidence on APTC events. No cases of endophthalmitis were observed. AUTHORS' CONCLUSIONS: The available RCT evidence suggests that treatment of MO secondary to BRVO with anti-VEGF improves visual and anatomical outcomes at six and 12 months.


Assuntos
Inibidores da Angiogênese/administração & dosagem , Anticorpos Monoclonais Humanizados/administração & dosagem , Edema Macular/tratamento farmacológico , Oclusão da Veia Retiniana/complicações , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Inibidores da Angiogênese/efeitos adversos , Anticorpos Monoclonais Humanizados/efeitos adversos , Bevacizumab/administração & dosagem , Humanos , Injeções Intravítreas , Fotocoagulação a Laser , Terapia a Laser , Edema Macular/etiologia , Edema Macular/cirurgia , Ensaios Clínicos Controlados Aleatórios como Assunto , Ranibizumab/administração & dosagem , Receptores de Fatores de Crescimento do Endotélio Vascular/administração & dosagem , Proteínas Recombinantes de Fusão/administração & dosagem , Terapia de Salvação/métodos , Esteroides/administração & dosagem , Acuidade Visual/efeitos dos fármacos
13.
PLoS One ; 15(6): e0234798, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32555597

RESUMO

PURPOSE: To investigate the effect and complications of Combined Endoscope assisted Procedures (CEaP): endoscopic cyclophotocoagulation and pars plana ablation (ECP-plus), along with endoscopic panretinal photocoagulation (PRP). PATIENTS AND METHODS: The study design is a retrospective and noncomparative interventional case series from a tertiary referral center in Taiwan. Patients experiencing vessel growth at the iris and anterior chamber angle, along with an IOP > 21 mmHg were included. RESULTS: Twenty-five eyes from 23 patients were included over a 24-month period. After the procedures, all of them had a lower IOP value than their preoperative value. The mean IOP was 38.2± 7.1 mm Hg preoperatively, and 10.2± 4.7 mmHg (1 day), 13.8± 4.6 mmHg (1 week), 15.0± 5.3 mmHg (2 weeks), 17.4± 4.7 mmHg (1 month), 16.6± 4.1 mmHg (3 months), 16.0± 5.0 mmHg (6 months), and 15.7± 5.5 mmHg (12 months) postoperatively. At the 6th and 12th months, the IOP stabilized rate was 84% and 75%, respectively. Complications in the initial postoperative period (< 3 months) included uveitis (24%), and hyphema (16%), which were both resolved in the early postoperative period. Complications beyond 6 months included hypotony and phthisis bulbi in two patients (8%) in our study. There was no subject who suffered from retinal detachment, endophthalmitis or any other severe complications. CONCLUSIONS: The results of this study show that CEaP offers positive results in IOP lowering and NV regression. Additionally, CEaP is a complete treatment for NVG in controlling IOP and NV growth. The IOP lowering effects can be sustained upon completion of the treatment.


Assuntos
Endoscópios , Glaucoma Neovascular/terapia , Fotocoagulação a Laser/instrumentação , Feminino , Humanos , Fotocoagulação a Laser/efeitos adversos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Segurança , Resultado do Tratamento
14.
Middle East Afr J Ophthalmol ; 27(1): 4-9, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32549717

RESUMO

Peripheral exudative hemorrhagic chorioretinopathy (PEHCR) is a rare retinal vasculopathy that might cause subretinal and/or vitreous hemorrhages. Although the primary etiology is still unknown, choroidal neovascularization is mainly involved in the pathogenesis. The main risk factors are age and systemic hypertension. Ancillary testing such as fluorescein angiography, indocyanine green angiography and ultrasonography can be of great value for diagnosing this entity and distinguishing PEHCR from other lesions as choroidal melanoma and retinal vasoproliferative tumor. Various treatments have been reported including photocoagulation, cryotherapy, intravitreal injection of anti-vascular endothelial growth factor (Anti-VEGF) and surgical intervention as pars plana vitrectomy. This review handles an up-to-date perspective regarding PEHCR.


Assuntos
Hemorragia Retiniana/etiologia , Hemorragia Vítrea/etiologia , Inibidores da Angiogênese/uso terapêutico , Corantes/administração & dosagem , Crioterapia , Angiofluoresceinografia , Humanos , Verde de Indocianina/administração & dosagem , Injeções Intravítreas , Fotocoagulação a Laser , Hemorragia Retiniana/diagnóstico , Hemorragia Retiniana/terapia , Fatores de Risco , Tomografia de Coerência Óptica , Ultrassonografia , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Vitrectomia , Hemorragia Vítrea/diagnóstico , Hemorragia Vítrea/terapia
15.
Middle East Afr J Ophthalmol ; 27(1): 34-39, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32549722

RESUMO

PURPOSE: The purpose of this study was to analyze the diagnostic and therapeutic approach of five cases with optic disc pit (ODP) maculopathy. MATERIALS AND METHODS: This was a retrospective study of five patients diagnosed with ODP maculopathy. Four of these cases had unilateral involvement, whereas one case had bilateral findings. The medical notes of these individuals were reviewed in order to record the presenting symptoms, clinical signs, visual acuity (VA), imaging, management, and the final visual outcome on their last follow-up appointment. RESULTS: The first patient (53-year-old female) underwent a left pars plana vitrectomy (PPV) combined with inner retinal fenestration, endolaser, and perfluoropropane (C3F8) gas tamponade and her VA improved from 6/24 to 6/9 Snellen. A focal retinal laser treatment was carried out on our second patient leading to decrease of the subretinal fluid but had a poor visual outcome due to the underlying secondary glaucoma from iris melanoma treatment in the past. The third patient was an asymptomatic 7-year-old girl in which the maculopathy resolved spontaneously without any surgical intervention with a final VA of 6/5. The fourth and fifth patients were asymptomatic with good vision in both eyes and were, therefore, only monitored with follow-ups. CONCLUSION: ODP maculopathy remains a challenging clinical entity for a vitreoretinal surgeon. The current management for ODP maculopathy involves surgical procedures with PPV being a common treatment of choice. Spontaneous resolution of ODP maculopathy has also been reported. Our study highlights the contrasting management that can be adopted in the treatment of ODP maculopathy, and there is not one definite treatment for this condition.


Assuntos
Anormalidades do Olho/etiologia , Disco Óptico/anormalidades , Doenças Retinianas/etiologia , Adulto , Idoso , Criança , Tamponamento Interno , Anormalidades do Olho/diagnóstico , Anormalidades do Olho/cirurgia , Feminino , Fluorcarbonetos/administração & dosagem , Humanos , Fotocoagulação a Laser , Masculino , Pessoa de Meia-Idade , Doenças Retinianas/diagnóstico , Doenças Retinianas/cirurgia , Estudos Retrospectivos , Líquido Sub-Retiniano , Tomografia de Coerência Óptica/métodos , Acuidade Visual/fisiologia , Vitrectomia/métodos
16.
Sci Rep ; 10(1): 10272, 2020 06 24.
Artigo em Inglês | MEDLINE | ID: mdl-32581240

RESUMO

This study was performed to evaluate clinical characteristics of branch retinal vein occlusion (BRVO) patients with increased retinal haemorrhage during macular oedema (MO) treatment. Patients were divided into increased and non-increased retinal haemorrhage groups. The former group was sub-divided based on the degree of increase: < 50% or ≥ 50%. Baseline characteristics, clinical data, and best vision achieved before and after increased retinal haemorrhage were assessed. Sixty-eight eyes of 68 patients were included. Forty-six eyes were non-increased, 11 eyes experienced < 50% increase in retinal haemorrhage, and 11 eyes had ≥ 50% increase. Ischaemic BRVO was related to increased haemorrhage based on the multivariate analysis. The ≥ 50% increase group exhibited higher baseline central subfield macular thickness (CSMT), poorer baseline best corrected visual acuity (BCVA), and longer mean periods between the final intravitreal injections and the time increased retinal haemorrhages were observed, compared to the < 50% group. The best vision achieved before and after increased haemorrhage was significantly worse in the ≥ 50% group. In conclusion, the ischaemic type of BRVO is related to increased retinal haemorrhage during MO treatment, and a ≥ 50% increase in haemorrhages is associated with higher CSMT and poorer BCVA at baseline, with poor visual gain.


Assuntos
Edema Macular/terapia , Hemorragia Retiniana/diagnóstico , Oclusão da Veia Retiniana/diagnóstico , Idoso , Inibidores da Angiogênese/administração & dosagem , Feminino , Fundo de Olho , Humanos , Injeções Intravítreas/efeitos adversos , Fotocoagulação a Laser/efeitos adversos , Edema Macular/etiologia , Masculino , Pessoa de Meia-Idade , Fotografação , Hemorragia Retiniana/epidemiologia , Hemorragia Retiniana/etiologia , Oclusão da Veia Retiniana/complicações , Estudos Retrospectivos , Índice de Gravidade de Doença , Tomografia de Coerência Óptica , Acuidade Visual
17.
Int J Comput Assist Radiol Surg ; 15(5): 791-801, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32350787

RESUMO

PURPOSE: Fetoscopic laser photocoagulation is a minimally invasive surgery for the treatment of twin-to-twin transfusion syndrome (TTTS). By using a lens/fibre-optic scope, inserted into the amniotic cavity, the abnormal placental vascular anastomoses are identified and ablated to regulate blood flow to both fetuses. Limited field-of-view, occlusions due to fetus presence and low visibility make it difficult to identify all vascular anastomoses. Automatic computer-assisted techniques may provide better understanding of the anatomical structure during surgery for risk-free laser photocoagulation and may facilitate in improving mosaics from fetoscopic videos. METHODS: We propose FetNet, a combined convolutional neural network (CNN) and long short-term memory (LSTM) recurrent neural network architecture for the spatio-temporal identification of fetoscopic events. We adapt an existing CNN architecture for spatial feature extraction and integrated it with the LSTM network for end-to-end spatio-temporal inference. We introduce differential learning rates during the model training to effectively utilising the pre-trained CNN weights. This may support computer-assisted interventions (CAI) during fetoscopic laser photocoagulation. RESULTS: We perform quantitative evaluation of our method using 7 in vivo fetoscopic videos captured from different human TTTS cases. The total duration of these videos was 5551 s (138,780 frames). To test the robustness of the proposed approach, we perform 7-fold cross-validation where each video is treated as a hold-out or test set and training is performed using the remaining videos. CONCLUSION: FetNet achieved superior performance compared to the existing CNN-based methods and provided improved inference because of the spatio-temporal information modelling. Online testing of FetNet, using a Tesla V100-DGXS-32GB GPU, achieved a frame rate of 114 fps. These results show that our method could potentially provide a real-time solution for CAI and automating occlusion and photocoagulation identification during fetoscopic procedures.


Assuntos
Transfusão Feto-Fetal/cirurgia , Fetoscopia/métodos , Fotocoagulação a Laser/métodos , Redes Neurais de Computação , Feminino , Humanos , Gravidez
18.
Acta Diabetol ; 57(10): 1219-1225, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32472172

RESUMO

AIMS: To compare intravitreal ranibizumab as monotherapy or in combination with panretinal photocoagulation (PRP) in patients with proliferative diabetic retinopathy (PDR) and coexistent diabetic macular edema (DME) in a long-term follow-up of 24 months. METHODS: Participants in this prospective study were 47 patients with PDR and concurrent DME, who were randomized at baseline into two groups: (i) the "ranibizumab alone" group (n = 23), which was treated with at least 3 intravitreal ranibizumab injections as a loading phase, and (ii) the "combination" group (n = 24), which was treated with PRP and at least 3 intravitreal ranibizumab injections. Thereafter, all patients were followed up at a pro re nata (PRN) basis, with regular monthly monitoring for 24 months. At each visit, best corrected visual acuity (BCVA) and spectral domain-optical coherence tomography were performed, while regression of neovascularization was also recorded. RESULTS: The "combination" group had better control of neovascularization and less events of vitreous hemorrhage than ranibizumab alone through the 2 years. BCVA did not differ significantly between the two groups at months 12 and 24 of the follow-up. The "ranibizumab" alone group presented greater reduction in central retinal thickness at month 12, which did not reach significance at month 24 compared to "combination" group. Greater number of injections was needed in the monotherapy group (mean 14 injections) compared to "combination" group (mean 11 injections) through month 24. CONCLUSIONS: Both intravitreal ranibizumab alone or in combination with PRP could be used effectively for the treatment of PDR and coexistent DME. Even though there was no difference in BCVA and CRT at the 24-month follow-up between the two groups, the combination group presented greater regression of neovascularization with less injections.


Assuntos
Retinopatia Diabética/tratamento farmacológico , Retinopatia Diabética/cirurgia , Fotocoagulação a Laser/métodos , Edema Macular/tratamento farmacológico , Edema Macular/cirurgia , Ranibizumab/administração & dosagem , Idoso , Inibidores da Angiogênese/administração & dosagem , Terapia Combinada , Retinopatia Diabética/complicações , Feminino , Humanos , Injeções Intravítreas , Fotocoagulação a Laser/efeitos adversos , Edema Macular/complicações , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Ranibizumab/efeitos adversos , Resultado do Tratamento , Fator A de Crescimento do Endotélio Vascular , Acuidade Visual , Vitreorretinopatia Proliferativa/complicações , Vitreorretinopatia Proliferativa/tratamento farmacológico , Vitreorretinopatia Proliferativa/cirurgia
19.
J Glaucoma ; 29(7): e57-e59, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32398588

RESUMO

Choroidal hemorrhages involve bleeding into the potential space between the choroid and sclera and are a serious ocular complication. Common causes of choroidal hemorrhages include intraocular surgeries, such as scleral buckling, cataract extractions, and glaucoma filtering procedures, or trauma. We report a case of choroidal and vitreous hemorrhage after micropulse cyclophotocoagulation. An 82-year-old female presented postoperative day 1 with blurry vision and pain in her right eye. Examination showed that she had a choroidal hemorrhage, 200 degrees of ciliary body swelling, and vitreous hemorrhage. Although the choroidal hemorrhage resolved with steroids, the vitreous hemorrhage required pars plana vitrectomy. To the best of our knowledge, this article discusses the first reported case of choroidal and vitreous hemorrhage due to micropulse cyclophotocoagulation.


Assuntos
Hemorragia da Coroide/etiologia , Corpo Ciliar/cirurgia , Fotocoagulação a Laser/efeitos adversos , Esclera/cirurgia , Hemorragia Vítrea/etiologia , Idoso de 80 Anos ou mais , Hemorragia da Coroide/tratamento farmacológico , Feminino , Glaucoma de Ângulo Aberto/cirurgia , Glucocorticoides/uso terapêutico , Humanos , Pressão Intraocular/fisiologia , Vitrectomia , Hemorragia Vítrea/cirurgia
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