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1.
Eur J Ophthalmol ; 30(1): NP7-NP10, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30354490

RESUMO

AIM: To test if hyaluronic acid gel injection in the upper eyelid achieves correction of congenital cicatricial ectropion and reduction in lagophthalmos, in preparation for intraocular surgery. METHODS: This case reports the long-term outcome of hyaluronic acid gel injection in the upper eyelid for the correction of ectropion prior to cataract surgery. One millilitre of hyaluronic acid gel was injected in both the upper eyelids of a child with congenital ichthyosis in the suborbicularis plane, prior to cataract surgery. RESULTS: Lagophthalmos reduced by 15 mm in the right eye and 13 mm in the left eye. Subsequently, the child underwent cataract surgery without any complications. CONCLUSION: We demonstrate the long-term outcome of using hyaluronic acid gel injection for successful, non-surgical correction of cicatricial ectropion in ichthyosis.


Assuntos
Ectrópio/tratamento farmacológico , Pálpebras/efeitos dos fármacos , Ácido Hialurônico/análogos & derivados , Ictiose Lamelar/tratamento farmacológico , Ectrópio/congênito , Humanos , Ácido Hialurônico/uso terapêutico , Recém-Nascido , Injeções Intraoculares , Masculino , Estudos Retrospectivos
2.
Int J Nanomedicine ; 14: 9763-9776, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31849467

RESUMO

Background: Photoreceptor degeneration is one of the most refractory oculopathy in the world, leading to vision loss in severe cases. Methyprednisolone is one of the most commonly prescribed medications for the treatment of retinal degenerative diseases, either by oral administration or repeated intraocular injections. However, the efficacy was unsatisfactory due to its systemic or local side effects and short retention time within the retina. Methods: Nanoscale zirconium-porphyrin metal-organic framework (NPMOF) was synthesized and characterized. The biotoxicity and imaging capability of NPMOF were evaluated using zebrafish embryos and larvae. NPMOF was then used as a skeleton and loaded with methylprednisolone (MPS) to prepare a novel kind of nanoparticle, MPS-NPMOF. Photoreceptor degeneration was induced by high-intensity light exposure in adult zebrafish. MPS-NPMOF was delivered to the injured retina by intraocular injection. The photoreceptor regeneration and its underlying mechanism were explored by immunohistochemistry, quantitative real-time polymerase chain reaction and behavioral test. Results: NPMOF not only had low biotoxicity but also emitted bright fluorescence. Following a single MPS-NPMOF intraocular injection, the injured retina exhibited the faster photoreceptor regeneration with better visual function by promoting the cell proliferation. Conclusion: NPMOF is an ideal carrier and could be applied in tracking and delivering medications. By intraocular injection, the novel drug delivery system, MPS-NPMOF, accomplishes the sustained release of drug and plays a therapeutic role in photoreceptor degeneration.


Assuntos
Sistemas de Liberação de Medicamentos/métodos , Estruturas Metalorgânicas/química , Metilprednisolona/administração & dosagem , Porfirinas/química , Degeneração Retiniana/tratamento farmacológico , Zircônio/química , Animais , Animais Geneticamente Modificados , Proliferação de Células/efeitos dos fármacos , Modelos Animais de Doenças , Embrião não Mamífero/efeitos dos fármacos , Fluorescência , Injeções Intraoculares , Estruturas Metalorgânicas/administração & dosagem , Estruturas Metalorgânicas/farmacologia , Metilprednisolona/farmacologia , Nanoestruturas/administração & dosagem , Nanoestruturas/química , Células Fotorreceptoras de Vertebrados/metabolismo , Retina/efeitos dos fármacos , Retina/lesões , Degeneração Retiniana/etiologia , Peixe-Zebra/embriologia
3.
Ophthalmic Surg Lasers Imaging Retina ; 50(10): 661-663, 2019 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-31671202

RESUMO

Leber's congenital amaurosis (LCA) is a rare inherited retinal degeneration (IRD) that causes severe vision loss, nyctalopia, and nystagmus within the first few years of life. RPE65 gene mutations cause approximately 6% of LCA cases and have become the target for therapy since voretigene neparvovec-rzyl became the first U.S. Food and Drug Administration-approved gene therapy product for IRDs in 2017. The surgery involves pars plana vitrectomy with subretinal injection of a viral vector that carries a functional copy of the RPE65 gene. Intraoperative optical coherence tomography is a useful adjunctive tool to confirm the injection has reached the subretinal space.


Assuntos
Terapia Genética/métodos , Amaurose Congênita de Leber/terapia , Pré-Escolar , Feminino , Humanos , Injeções Intraoculares , cis-trans-Isomerases/genética
5.
Exp Eye Res ; 189: 107824, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31585119

RESUMO

Injection into the suprachoroidal space (SCS) allows drug delivery targeted to sclera, choroid, and retina. Here, we studied SCS injection formulated with collagenase to expand drug delivery coverage and increase posterior drug targeting within SCS by breaking down collagen fibrils that link sclera and choroid in the SCS. When 1 µm latex microparticles were injected with a collagenase formulation using microneedles into the SCS of rabbit eyes ex vivo and incubated at 37 °C for 4 h, microparticle delivery coverage increased from 20% to 45% and enhanced posterior drug targeting. Collagenase concentration was optimized to 0.5 mg/mL to maximize expanded posterior delivery and minimize tissue damage. Effects of collagenase injection within SCS increased and then plateaued 4 h after injection. Simultaneous injection of collagenase and microparticles had a greater effect on expanded delivery in the SCS compared to sequential injection. Collagenase injection into the SCS of rabbit eyes in vivo was also effective to expand delivery and was generally well-tolerated, showing transiently lowered IOP, but no apparent lasting adverse effects on ocular tissues such as sclera, choroid, and retina, as determined by analyzing histology, sclera tensile strength, and fundus imaging. We conclude that addition of collagenase during SCS injection can expand drug delivery coverage and increase posterior drug targeting.


Assuntos
Colágeno/metabolismo , Colagenases/administração & dosagem , Segmento Posterior do Olho/efeitos dos fármacos , Retina/metabolismo , Doenças Retinianas/tratamento farmacológico , Animais , Corioide , Colagenases/farmacocinética , Modelos Animais de Doenças , Sistemas de Liberação de Medicamentos , Injeções Intraoculares , Pressão Intraocular/fisiologia , Segmento Posterior do Olho/diagnóstico por imagem , Coelhos , Retina/patologia , Doenças Retinianas/metabolismo , Doenças Retinianas/patologia
6.
Invest Ophthalmol Vis Sci ; 60(12): 4008-4020, 2019 09 03.
Artigo em Inglês | MEDLINE | ID: mdl-31560364

RESUMO

Purpose: The injection of cultured human corneal endothelial cells (cHCECs) into the anterior chamber (AC) is a newly developed modality for the successful treatment of corneal endothelium dysfunction. Here, we investigated whether or not cHCECs could be labeled using quantum dots (QDs) composed of semiconductor nanoparticle octa-arginine (R8) to trace injected cHCECs and examined the utility of in vivo fluorescence imaging to analyze the dynamics and accumulation of QD-labeled injected cHCECs in a corneal endothelial dysfunction mouse model. Methods: The cHCECs, either of high quality or with cell-state transition, were labeled by adding a mixture of QDs655 and R8. The labeling efficiency and the unchanging of the cell phenotypes by the labeling was confirmed by flow cytometry. The labeled cHCECs were injected into the AC of either healthy mice or mice with corneal endothelium damaged by cryogenic treatment. The kinetics of the injected cHCECs was traced quantitatively via multiphoton confocal laser microscopy. Results: QD labeling induced no morphologic change in the cHCECs or in the expression of the functional markers of cHCECs (i.e., Na+/K+-ATPase and zonula occludens-1). The injected cHCECs-QDs were quantitatively detected, and the retention of cHCECs-QDs was evident, from 3 to 48 hours post cell injection on the posterior surface in the cryogenically injured corneal endothelium mouse model eyes, yet not in the noninjured healthy control eyes. Conclusions: The findings of this study show that in the field of regenerative medicine, QD labeling of cells presents a convenient and sensitive method of finely monitoring the fate of injected cells in vivo.


Assuntos
Câmara Anterior/metabolismo , Epitélio Posterior/metabolismo , Pontos Quânticos , Adulto , Animais , Biomarcadores/metabolismo , Contagem de Células , Diferenciação Celular , Células Cultivadas , Citometria de Fluxo , Humanos , Injeções Intraoculares , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Microscopia de Fluorescência , Microscopia de Contraste de Fase , Medicina Regenerativa/métodos , ATPase Trocadora de Sódio-Potássio/metabolismo , Doadores de Tecidos , Adulto Jovem , Proteína da Zônula de Oclusão-1/metabolismo
7.
Artigo em Inglês | MEDLINE | ID: mdl-31494629

RESUMO

Background Subtenon anticancer drugs are given as an adjunct to systemic chemotherapy for conditions like retinoblatoma. This study evaluated the ocular kinetics of nano-emulsion formulation of etoposide (NanoEt) and compared it with an equal dose of commercially available alcohol-based etoposide formulation in healthy rabbits. Methods A nanoemulsion formulation of NanoEt was developed and then evaluated for its ocular kinetics by subtenon administration in healthy rabbits. After the sterile subtenon administration of the drug, the eyes were enucleated after CO2 euthanasia at time intervals of 2 h, 6 h, 12 h, and 24 h, and ocular tissues, blood, and plasma were separated. The concentration of etoposide in the ocular tissues and blood was quantified using liquid chromatography tandem mass spectrometry (LC MS/MS). Results This study found that subtenon injection of NanoEt showed 24 times higher concentration in rabbit retina compared to an equal dose of conventional marketed formulation. Based on the ocular tissue bioavailability calculations (AUC0-24), the present study revealed that the formulation enhanced 90% ocular bioavailability of etoposide, when it was injected in the form of nano-emulsion in most of the tissues. Conclusions NanoEt has better bioavailability compared to the commercial alcohol-based formulation for subtenon injection. Low systemic exposure showed further advantage for its projected use in retinoblastoma (Rb) as an adjunct therapy. Further studies in Rb animal models are required to evaluate its safety and efficacy, for its clinical utility.


Assuntos
Etoposídeo/administração & dosagem , Etoposídeo/farmacocinética , Olho/metabolismo , Animais , Disponibilidade Biológica , Composição de Medicamentos , Emulsões/administração & dosagem , Emulsões/farmacocinética , Feminino , Injeções Intraoculares , Masculino , Nanotecnologia , Coelhos
8.
Graefes Arch Clin Exp Ophthalmol ; 257(10): 2185-2191, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31392416

RESUMO

PURPOSE: This large retrospective observational study describes the evolution of the rates of postoperative endophthalmitis in cataract surgery in a 16-year period, and compares them before and after two different changes in the prophylaxis protocol of a general hospital in Barcelona, Spain. METHODS: This study included all the phacoemulsification procedures performed from January 2002 to December 2017. In January 2004, intracameral cefazolin at the end of the surgery was added to the prophylaxis protocol of cataract surgery. In January 2011, topical postoperative ofloxacin was replaced by topical moxifloxacin. Cumulative incidences of postoperative endophthalmitis before and after the addition of intracameral cefazolin and the change of ofloxacin by moxifloxacin as postoperative topical treatment were compared. RESULTS: The study included 55,984 surgeries. In the period after the introduction of intracameral cefazolin (2004-2010), the cumulative incidence of endophthalmitis was 0.047% (95% CI 0.019-0.099%), significantly lower than in the previous period. From January 2011 to December 2017, after the postoperative change of topical ofloxacin by moxifloxacin, the cumulative incidence dropped to 0.0037% (95% CI 0.000468-0.01862%), with a relative risk reduction between both periods of 91.3%. CONCLUSION: An intracameral bolus of cefazolin was a very effective prophylaxis of endophthalmitis in cataract surgery. The continuous surveillance and prophylaxis protocol revision over time further reduced the incidence of this complication to extremely low levels.


Assuntos
Cefazolina/administração & dosagem , Endoftalmite/prevenção & controle , Infecções Oculares Bacterianas/prevenção & controle , Previsões , Moxifloxacina/administração & dosagem , Facoemulsificação/efeitos adversos , Infecção da Ferida Cirúrgica/prevenção & controle , Administração Tópica , Idoso , Antibacterianos/administração & dosagem , Antibioticoprofilaxia/métodos , Endoftalmite/diagnóstico , Endoftalmite/etiologia , Infecções Oculares Bacterianas/diagnóstico , Infecções Oculares Bacterianas/etiologia , Feminino , Seguimentos , Humanos , Injeções Intraoculares , Masculino , Cuidados Pós-Operatórios/métodos , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/diagnóstico , Infecção da Ferida Cirúrgica/etiologia
9.
J Refract Surg ; 35(8): 534-537, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31393992

RESUMO

PURPOSE: To describe a patient with chronic periocular pain after bilateral photorefractive keratectomy (PRK) and ocular neuralgia that was controlled with regular orbital steroid and anesthetic injections. METHODS: Case report. RESULTS: A 21-year-old man presented 3 months following bilateral PRK surgery in severe bilateral orbital pain. Previous treatments included topical (artificial tears, corticosteroids, and nonsteroidal anti-inflammatory drugs [NSAIDs) and oral (NSAIDs, opioids, and pregabalin) therapies with minimal pain relief. A bilateral orbital triamcinolone acetonide 40 mg/cc and 0.25% bupivacaine injection was done after a successful, diagnostic unilateral 0.25% bupivacaine injection. Following bilateral bupivacaine and triamcinolone acetonide injections, pain intensity improved from 7 of 9 to 1 of 3 out of 10. Repeat injections have been regularly performed over the past 3 years, allowing the patient to experience improved symptoms lasting from 4 to 9 months. CONCLUSIONS: In this case, orbital nerve blocks provided relief and may be considered as a potential treatment for orbital neuralgia after refractive surgery. [J Refract Surg. 2019;35(8):534-537.].


Assuntos
Anestésicos Locais/uso terapêutico , Bupivacaína/uso terapêutico , Dor Ocular/tratamento farmacológico , Glucocorticoides/uso terapêutico , Neuralgia/tratamento farmacológico , Doenças Orbitárias/tratamento farmacológico , Ceratectomia Fotorrefrativa/efeitos adversos , Triancinolona Acetonida/uso terapêutico , Dor Ocular/etiologia , Humanos , Injeções Intraoculares , Masculino , Neuralgia/etiologia , Doenças Orbitárias/etiologia , Adulto Jovem
10.
Eye Contact Lens ; 45(5): 306-309, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31442213

RESUMO

PURPOSE: To compare the rate of endophthalmitis of intracameral versus topical antibiotic prophylaxis for patients undergoing phacoemulsification at a single-centered, multispecialty ophthalmological institute. METHODS: A retrospective analysis of the rate of endophthalmitis by coding search within 90 days of cataract surgery in periods before (May 15, 2012-May 15, 2014) and after (April 30, 2015-April 30, 2017) intracameral antibiotics became the institution's preferred practice pattern for phacoemulsification. Clinical data were collected for each endophthalmitis case, including timing of onset, presenting symptoms and signs, culture results, treatment performed, and visual acuity outcome. RESULTS: The rate of postphacoemulsification endophthalmitis decreased from 0.18% (29 eyes among 16,201 cataract surgeries) to 0.07% (11 eyes among 16,325 surgeries) when the preferred method was changed from topical to intracameral antibiotics (P=0.004) with an odds ratio of 0.32. Endophthalmitis cases in the 2 groups had comparable visual acuity at initial presentation and at 3 months (P=0.86). The most commonly isolated organism in culture-proven cases of endophthalmitis in both groups was coagulase-negative staphylococcus. The rate of gram-positive endophthalmitis decreased from 0.08% to 0.02% with an odds ratio of 0.23 (P=0.012) while the rate of gram-negative cases remained similar. CONCLUSIONS: The use of intracameral antibiotics during cataract surgery was associated with a statistically significant reduction of postoperative endophthalmitis.


Assuntos
Antibacterianos/uso terapêutico , Antibioticoprofilaxia , Endoftalmite/epidemiologia , Implante de Lente Intraocular , Facoemulsificação , Complicações Pós-Operatórias/epidemiologia , Administração Oftálmica , Adulto , Idoso , Câmara Anterior/efeitos dos fármacos , Endoftalmite/diagnóstico , Endoftalmite/tratamento farmacológico , Feminino , Humanos , Injeções Intraoculares , Masculino , Pessoa de Meia-Idade , Moxifloxacina/uso terapêutico , Estudos Retrospectivos , Acuidade Visual
11.
BMJ Case Rep ; 12(8)2019 Aug 10.
Artigo em Inglês | MEDLINE | ID: mdl-31401582

RESUMO

A 65-year-old man was referred to our department with complaints of blurred vision in the left eye. Funduscopic examination revealed areas of retinochoroidal atrophy along the retinal veins bilaterally and bone spicule pigmentation along the nasal and superior temporal venous branches, as well as macular oedema in the left eye. Fluorescein angiography, visual field test, optical coherence tomography and electrophysiological examination were performed, and results were compatible with the diagnosis of pigmented paravenous retinochoroidal atrophy (PPRCA). Treatment with topical dorzolamide and intravitreal bevacizumab in the left eye resulted in poor anatomical and visual response. There is scarce documentation of macular involvement with non-inflammatory unilateral cystoid macular oedema in PPRCA in the literature. Further investigation is required to elucidate the pathogenesis of PPRCA and to properly manage these patients.


Assuntos
Oftalmopatias Hereditárias/complicações , Edema Macular/complicações , Degeneração Retiniana/complicações , Idoso , Inibidores da Angiogênese/administração & dosagem , Bevacizumab/administração & dosagem , Inibidores da Anidrase Carbônica/administração & dosagem , Oftalmopatias Hereditárias/diagnóstico por imagem , Oftalmopatias Hereditárias/tratamento farmacológico , Oftalmopatias Hereditárias/patologia , Angiofluoresceinografia , Humanos , Injeções Intraoculares , Edema Macular/diagnóstico por imagem , Edema Macular/tratamento farmacológico , Edema Macular/patologia , Masculino , Degeneração Retiniana/diagnóstico por imagem , Degeneração Retiniana/tratamento farmacológico , Degeneração Retiniana/patologia , Sulfonamidas/administração & dosagem , Tiofenos/administração & dosagem , Tomografia de Coerência Óptica
12.
Drug Deliv ; 26(1): 841-848, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31401891

RESUMO

The purpose of this study was to compare the pharmacokinetic profile of tetramethylpyrazine hydrochloride (TMPH) in rat plasma and tissues following intravenous (iv), intragastric (ig) and intraocular (io) administration. After io, ig and iv administration of a single dose at 10 mg/kg, tissue and plasma samples drawn from the femoral artery were collected at timed intervals. The concentration of TMPH in the samples was analyzed using high-performance liquid chromatography (HPLC). The area under the concentration-time curve (AUC) and the drug targeting efficiency percentage (DTE(%)) were calculated to evaluate the targeting efficiency of the drug with the three different administration routes. After io administration, TMPH was rapidly absorbed to reach its peak plasma and brain concentration within 5 min. The systemic bioavailability obtained with io administration was greater than that obtained through the ig route (63.22% vs. 16.88%). The AUCt rank order of the iv administration group was AUCkidney >AUCheart >AUCliver >AUCbrain >AUCspleen >AUClung; that of the ig administration group as AUCkidney >AUCliver >AUCheart >AUCspleen >AUCbrain >AUClung; while that of the io administration group was AUCkidney >AUCbrain >AUCheart >AUCliver >AUCspleen >AUClung. The ratio of the AUCbrain value between the io route and iv injection was 1.05, which was greater than that obtained after ig administration (0.30). The DTE after io administration was calculated: brain (165.72%), heart (97.76%), liver (113.06%), spleen (105.31%), lung (163.40%) and kidney (135.31%). The io administration group showed obvious drug transport to the brain. These results indicate that TMPH is rapidly absorbed from the eye into the systemic circulation, and there may be a direct translocation pathway for TMPH from the eye to the brain. Therefore, io administration of TMPH could be a promising alternative to intravenous and oral approaches.


Assuntos
Encéfalo/efeitos dos fármacos , Pirazinas/administração & dosagem , Animais , Disponibilidade Biológica , Transporte Biológico/fisiologia , Sistemas de Liberação de Medicamentos/métodos , Injeções Intraoculares/métodos , Masculino , Ratos , Ratos Sprague-Dawley
13.
Cir Cir ; 87(5): 496-500, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31448802

RESUMO

Objective: To identify the efficacy and safety of the steam-roller maneuver, in patients treated with pneumatic retinopexy. Method: Experimental, prospective, comparative, longitudinal study in patients with retinal detachment, treated with pneumatic retinopexy. Patients were assigned to one of two groups: without steam roller maneuver (group 1) or with it (group 2). The proportions of single-intervention anatomical success, visual improvement, anatomical success with reintervention, and adverse events were compared between groups (chi squared); preoperative and postoperative visual acuity in logMAR was compared within groups (Wilcoxon's t). Results: 40 eyes were evaluated (mean age 55.9 ± 13.3 years); 15 were assigned to group 1, 25 to group 2. The proportions of single-intervention anatomical success, visual improvement, anatomical success with reintervention, and adverse events did not differ between groups (p > 0.05). At the end of follow up, visual acuity improved in both groups; however, it only improved in group 2, in eyes with single intervention anatomical success (mean log MAR before surgery 1.72 ± 1.64; after surgery 0.61 ± 0.61; p = 0.008). Conclusions: The steam roller maneuver is efficient for improving visual acuity in patients with pneumatic retinopexy, who achieve single intervention anatomical success; furthermore, the maneuver does not impair prognosis in eyes that require reintervention.


Assuntos
Movimentos da Cabeça , Modalidades de Fisioterapia , Descolamento Retiniano/cirurgia , Adulto , Feminino , Seguimentos , Humanos , Injeções Intraoculares , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Descolamento Retiniano/etiologia , Perfurações Retinianas/complicações , Hexafluoreto de Enxofre/administração & dosagem , Resultado do Tratamento , Acuidade Visual
14.
BMC Ophthalmol ; 19(1): 195, 2019 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-31455285

RESUMO

BACKGROUND: The subconjunctival anesthesia with local anesthetics is considered as a low-risk procedure allowing ocular surgery without serious complications typical for retro- or parabulbar anesthesia, especially in patients with preexisting Optic Nerve damage. We report development of ipsilateral transient amaurosis accompanied with mydriasis and both, direct and consensual light response absence. CASE PRESENTATION: Three patients with advanced refractory glaucoma undergoing laser cyclophotocoagulation (CPC) for intraocular pressure lowering experienced these adverse effects just few minutes after subconjunctival injection of mepivacaine 2% solution (Scandicaine® 2%, without vasoconstrictor supplementation). The vision was completely recovered to usual values in up to 20 h after mepivacaine application. Extensive ophthalmological examination, including cranial magnetic resonance imaging (MRI), revealed no further ocular abnormalities, especially no vascular constriction or thrombotic signs as well as no retinal detachment. The oculomotor function remained intact. The blockade of ipsilateral ciliary ganglion parasympathetic fibers by mepivacaine may be the responsible mechanism. Systemic pathways as drug-drug interactions seem to be unlikely involved. Importantly, all three patients tolerated the same procedure previously or at a later date without any complication. Overall, our thoroughly elaborated risk management could not determine the causative factor explaining the observed ocular complications just in the current occasion and not at other time points. CONCLUSIONS: Doctors should be aware and patients should be informed about such rare complications after subconjunctival local anesthetics administration. Adequate risk management should insure patients' safety.


Assuntos
Anestésicos Locais/efeitos adversos , Cegueira/induzido quimicamente , Túnica Conjuntiva/efeitos dos fármacos , Glaucoma de Ângulo Aberto/cirurgia , Mepivacaína/efeitos adversos , Midríase/induzido quimicamente , Distúrbios Pupilares/induzido quimicamente , Idoso , Anestesia Local/métodos , Anestésicos Locais/administração & dosagem , Cegueira/fisiopatologia , Corpo Ciliar/cirurgia , Humanos , Injeções Intraoculares , Pressão Intraocular , Fotocoagulação a Laser , Masculino , Mepivacaína/administração & dosagem , Pessoa de Meia-Idade , Midríase/fisiopatologia , Distúrbios Pupilares/fisiopatologia
15.
Exp Eye Res ; 186: 107714, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31288022

RESUMO

Choroidal neovascularization (CNV) is a major cause of vision loss that consists of abnormal growth of new blood vessels from the choroidal vasculature. High resolution in vivo imaging of animal models is essential to better elucidate and conduct research on CNV. This study evaluates a novel multimodal imaging platform combining optical coherence tomography (OCT) and photoacoustic microscopy (PAM). Using real-time OCT guidance subretinal injection to induce and multimodality imaging system to monitor CNV over time in rabbit eyes. The significance of our work lies in providing the optimal setting and conditions to make use of the OCT image guided system to improve the consistency and reproducibility of experimental results in subretinal injection induced CNV model in rabbits. For the first time, this study successfully demonstrated the dual-modality PAM-OCT system, without using exogenous contrast agents, can detect and visualize CNV in the rabbit eye with high resolution. This is promising system for diagnosing and monitoring CNV.


Assuntos
Neovascularização de Coroide/diagnóstico por imagem , Técnicas de Diagnóstico Oftalmológico , Microscopia Acústica/métodos , Tomografia de Coerência Óptica/métodos , Animais , Neovascularização de Coroide/etiologia , Injeções Intraoculares/efeitos adversos , Imagem Multimodal , Coelhos , Reprodutibilidade dos Testes
17.
Cornea ; 38(8): 959-963, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31276460

RESUMO

PURPOSE: Patients undergoing primary pterygium excision with autologous conjunctival autograft and human tissue adhesive in New Zealand, currently receive subconjunctival anesthesia with oral postoperative analgesia for pain. Our aim was to investigate the potential added benefit of intraoperative subtenon bupivacaine to this regimen. METHODS: A double-blinded, placebo-controlled, randomized trial was conducted at 2 centers. All patients received topical and subconjunctival anesthesia intraoperatively, with standardized oral analgesia as required postoperatively. Participants were allocated to receive subtenon bupivacaine 0.5% or placebo at the conclusion of surgery. Corneal epithelial defect and conjunctival graft size were recorded. Pain and ocular surface irritation were assessed (Likert scale) immediately postoperatively at 3, 6, 12, 24, and 36 hours. Cumulative oral analgesia consumption (doses) was reported at 24 and 36 hours. RESULTS: Forty-two patients were randomized with participants evenly matched at baseline. Postoperative pain at all time points ≤24 hours was significantly less (2.4 vs. 1.2; P < 0.04) in the bupivacaine arm with no difference at 36 hours (P = 0.27). Ocular surface irritation was also significantly less at all time points ≤12 hours (4.8 vs. 1.3; P < 0.01) with no difference at 24 hours (P = 0.10). Analgesia consumption was less in the bupivacaine arm at 24 (6.5 vs. 2.5; P < 0.01) and 36 hours (7.6 vs. 3.4; P < 0.01). No complications were observed. CONCLUSIONS: Intraoperative subtenon bupivacaine improves patient comfort after pterygium excision by reducing pain, irritation, and requirement for oral analgesia after surgery.


Assuntos
Anestésicos Locais/uso terapêutico , Bupivacaína/uso terapêutico , Dor Ocular/tratamento farmacológico , Dor Pós-Operatória/tratamento farmacológico , Pterígio/cirurgia , Cápsula de Tenon/efeitos dos fármacos , Administração Oftálmica , Adulto , Método Duplo-Cego , Dor Ocular/etiologia , Feminino , Humanos , Injeções Intraoculares , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Oftalmológicos/efeitos adversos , Medição da Dor , Dor Pós-Operatória/etiologia
18.
Int J Mol Sci ; 20(13)2019 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-31261943

RESUMO

BACKGROUND: To induce a moderate chronic ocular hypertension (OHT) by injecting polidocanol, a foamed sclerosant drug, in the aqueous humor outflow pathway. METHODS: Intraocular pressure (IOP) was monitored for up to 6 months. Pattern and full-field electroretinogram (PERG and ERG) were recorded and retinal ganglion cells (RGC) and retinal nerve fiber layer (RNFL) thickness were assessed in vivo with optical coherence tomography (OCT) and ex vivo using Brn3a immunohistochemistry. RESULTS: In the first 3 weeks post-injection, a significant IOP elevation was observed in the treated eyes (18.47 ± 3.36 mmHg) when compared with the control fellow eyes (12.52 ± 2.84 mmHg) (p < 0.05). At 8 weeks, 65% (11/17) of intervention eyes had developed an IOP increase >25% over the baseline. PERG responses were seen to be significantly reduced in the hypertensive eyes (2.25 ± 0.24 µV) compared to control eyes (1.44 ± 0.19 µV) (p < 0.01) at week 3, whereas the ERG components (photoreceptor a-wave and bipolar cell b-wave) remained unaltered. By week 24, RNFL thinning and cell loss in the ganglion cell layer was first detected (2/13, 15.3%) as assessed by OCT and light microscopy. CONCLUSIONS: This novel OHT rat model, with moderate levels of chronically elevated IOP, and abnormal PERG shows selective functional impairment of RGC.


Assuntos
Modelos Animais de Doenças , Glaucoma/etiologia , Polidocanol/toxicidade , Soluções Esclerosantes/toxicidade , Animais , Glaucoma/metabolismo , Glaucoma/patologia , Injeções Intraoculares , Pressão Intraocular , Masculino , Ratos , Ratos Wistar , Fator de Transcrição Brn-3A/metabolismo
19.
Plast Reconstr Surg ; 144(2): 315-320, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31348334

RESUMO

BACKGROUND: Retrobulbar injection of hyaluronidase is a proposed but unproven treatment for blindness induced by hyaluronic acid gel fillers. This study examines the viability of this treatment by determining whether hyaluronidase can diffuse through the dural sheath of the optic nerve to clear a filler-mediated occlusion of the central retinal artery. METHODS: Six human cadaveric optic nerves were studied in vitro. One optic nerve was selected as a control and maintained at physiologic temperature, without any exposure to hyaluronic acid gel or hyaluronidase. Another optic nerve was randomly selected to simulate the filler-induced central retinal artery occlusion with subsequent retrobulbar hyaluronidase injection. To simulate a central retinal artery occlusion, this experimental nerve and additional controls were injected with hyaluronic acid gel. These hyaluronic acid gel-injected nerves were then either injected directly with hyaluronidase to establish a control for intraneural hyaluronidase exposure, or immersed in undiluted hyaluronidase to simulate retrobulbar hyaluronidase injection. To control for passive diffusion of hyaluronic acid gel from neural parenchyma, one nerve was immersed in saline. Following fixation, the nerves were grossly and microscopically assessed for the quantity and distribution of hyaluronic acid. RESULTS: Intact hyaluronic acid gel was observed grossly and microscopically in the control optic nerves injected directly with filler and not with hyaluronidase. The control optic nerve injected with intraneural hyaluronidase exhibited partial digestion of the filler. Immersion in undiluted hyaluronidase led to no apparent gross or microscopic digestion of injected intraneural hyaluronic acid gel. CONCLUSION: Hyaluronidase does not demonstrate the ability to cross the dural sheath of the optic nerve, suggesting that retrobulbar hyaluronidase injection is unlikely to alleviate hyaluronic acid gel-mediated central retinal artery occlusion and blindness.


Assuntos
Cegueira/tratamento farmacológico , Preenchedores Dérmicos/efeitos adversos , Ácido Hialurônico/efeitos adversos , Hialuronoglucosaminidase/administração & dosagem , Oclusão da Artéria Retiniana/tratamento farmacológico , Cegueira/induzido quimicamente , Cadáver , Géis , Humanos , Injeções Intraoculares , Nervo Óptico , Proteínas Recombinantes , Oclusão da Artéria Retiniana/induzido quimicamente
20.
Plast Reconstr Surg ; 144(2): 336-339, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31348340

RESUMO

The soft-tissue composition of the eyelid varies from lateral to medial, in that the orbicularis area (in square millimeters) is greatest medially and least laterally, whereas the reverse is true for the preauricularis and postorbicularis fat. The purpose of this study was to describe the relative contribution of tissue types to the volume of the lower eyelid-midface junction. This is an observational cohort study of 11 subjects (20 eyes) without a history of orbital or periorbital surgery or abnormality. Quasi-sagittal surface coil magnetic resonance imaging scans in planes parallel to the long axis of each orbit were obtained during central gaze fixation. Measurements of the tissue area (in square millimeters) of the skin, preorbicularis fat, orbicularis, and postorbicularis fat were obtained in the center, medial, and lateral eyelid regions. Differences in tissue area across the eyelid were assessed. The segmental cross-sectional area and percentage of total segment represented by the orbicularis muscle increased from the lateral (9.4 mm; 21.8 percent) to the central (14.1 mm; 35.0 percent) and to the medial (18.5 mm; 47.0 percent) eyelid (p < 0.01). The inverse pattern was noted for both preorbicularis and postorbicularis fat, each occupying less area (in square millimeters) from lateral to medial (p < 0.01). Skin thickness did not vary significantly across the eyelid. The soft-tissue composition of the eyelid varies from lateral to medial in that the orbicularis increases in area, whereas the reverse is true for the preorbicularis and postorbicularis fat. This anatomical progression may help to explain the stereotypical location of blue discoloration in some patients after hyaluronic acid filler injection.


Assuntos
Preenchedores Dérmicos/efeitos adversos , Pálpebras/efeitos dos fármacos , Ácido Hialurônico/administração & dosagem , Ácido Hialurônico/efeitos adversos , Pigmentação da Pele/efeitos dos fármacos , Adolescente , Adulto , Estudos de Coortes , Preenchedores Dérmicos/administração & dosagem , Feminino , Humanos , Injeções Intraoculares , Masculino , Envelhecimento da Pele , Adulto Jovem
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