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1.
Ophthalmic Res ; 63(1): 25-33, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31013505

RESUMO

PURPOSE: To determine the long-term outcome of patients operated with pars plana vitrectomy (PPV) for primary rhegmatogenous retinal detachment (RRD) and to identify potential predictors for poor visual outcome. METHODS: Prospective, observational 30-month study of patients operated for primary RRD with PPV. Examinations were performed preoperatively and after months 2, 6, and 30. RESULTS: Eighty-four patients (84 eyes) were included and 73 (86.9%) participated at month 30. The macula was attached in 30 (35.7%) patients at primary operation. The majority of patients (n = 59, 80.8%) achieved a good final best corrected visual acuity (BCVA ≤0.3 logMAR, ≥0.5 Snellen) with a better outcome in patients with the macula attached than detached (0.02 vs. 0.17 logMAR, p = 0.007). Variables associated with poor visual outcome were baseline BCVA >0.3 logMAR (p = 0.03), female gender (p = 0.02), silicone oil (p = 0.03), and larger areas of retinal detachment (p = 0.01). In multivariable regression analysis, female gender (OR = 8.5 [95% CI 1.8-39.8]) was the strongest risk factor for poor visual outcome. CONCLUSION: The majority of patients operated for primary RRD achieved a reasonable long-term visual outcome. Notably, female gender was associated with poor visual outcome, indicating a need for closer follow-up.


Assuntos
Descolamento Retiniano/cirurgia , Vitrectomia/métodos , Idoso , Feminino , Humanos , Macula Lutea/patologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Análise de Regressão , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Acuidade Visual
2.
Medicine (Baltimore) ; 98(49): e18297, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31804376

RESUMO

RATIONALE: Lamellar macular hole (LMH) comprises a partial-thickness defect of the macula, the central part of the neural retina. Classification of LMHs into degenerative and tractional types has been proposed based on macular morphology observed on optical coherence tomography (OCT) imaging. Although LMHs are assumed to develop from aborted full-thickness macular holes, the clinical course of LMH development is not fully understood. PATIENT CONCERNS: A 67-year-old man noticed slight changes in his central vision, and exhibited gradual change in macular morphology. DIAGNOSIS: The patient was first diagnosed with macular hole, which closed spontaneously. He then developed an LMH. INTERVENTIONS: The patient was placed under observation. OUTCOMES: The patient first exhibited a macular hole, which resolved spontaneously. However, the tractional force at the surface of the macula became more severe, thereby causing retinoschisis-like appearance, which is the characteristic finding of a tractional LMH. The same eye then developed a lamellar hole-associated epiretinal proliferation (LHEP)-like structure, which is often observed in a degenerative LMH; importantly, the retinoschisis-like appearance persisted. Finally, the macula formed a typical degenerative LMH, characterized by intraretinal cavitation with persistent LHEP and disappearance of the retinoschisis-like structure. LESSONS: The present report shows dynamic changes of neural retinal morphology during development of an LMH: a tractional LMH developed initially; it then transformed into a degenerative LMH, which comprises a neurodegenerative disease. The findings in this report may help to understand the pathogenesis of LMHs and to elucidate the neurodegenerative disease process in various fields.


Assuntos
Macula Lutea/patologia , Doenças Neurodegenerativas/patologia , Perfurações Retinianas/patologia , Idoso , Progressão da Doença , Humanos , Masculino , Prognóstico , Tomografia de Coerência Óptica
3.
Invest Ophthalmol Vis Sci ; 60(15): 4985-4990, 2019 12 02.
Artigo em Inglês | MEDLINE | ID: mdl-31791062

RESUMO

Purpose: Swept-source optical coherence tomography angiography (SS-OCTA) was used to investigate if the clinical stage of dry age-related macular degeneration (AMD) was correlated with global and regional macular choriocapillaris (CC) perfusion. Methods: In this retrospective, cross-sectional study, 6 × 6-mm SS-OCTA images from eyes with early, intermediate, and advanced dry AMD (56 eyes, 41 patients) were analyzed using algorithms described in the literature to assess regional flow deficit percentage (FD%) and average flow deficit size. Regions were defined by concentric areas centered on the fovea: a 1-mm-diameter area, 3-mm-diameter ring, 5-mm-diameter area, 5-mm-diameter ring, and 6 × 6-mm whole image. Data were modeled using the generalized estimating equations approach. Results: The relationship between age and CC FD% and average flow deficit size was statistically significant (P ≤ 0.05) in all regions of analysis by linear modeling. The relationship between dry AMD stage and FD% was statistically significant by linear modeling in the 5-mm ring, and between dry AMD stage and average flow deficit size in the 3-mm ring, 5-mm area, 5-mm ring, and 6 × 6-mm whole image. Conclusions: Linear modeling suggests a statistically significant relationship between dry AMD stage and CC perfusion, most prominent in the more peripheral regions of the macula.


Assuntos
Capilares/fisiopatologia , Corioide/irrigação sanguínea , Angiofluoresceinografia/métodos , Atrofia Geográfica/diagnóstico , Macula Lutea/irrigação sanguínea , Fluxo Sanguíneo Regional/fisiologia , Tomografia de Coerência Óptica/métodos , Idoso , Idoso de 80 Anos ou mais , Capilares/patologia , Corioide/patologia , Estudos Transversais , Feminino , Fundo de Olho , Atrofia Geográfica/fisiopatologia , Humanos , Macula Lutea/patologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
4.
BMC Ophthalmol ; 19(1): 212, 2019 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-31684897

RESUMO

BACKGROUND: To report and describe an unusual case of a patient with optic disc pit in one eye and optic disc coloboma with a focal pit associated with macular retinoschisis in the other eye. CASE PRESENTATION: A 21-year-old woman presented with optic disc pit in the right eye and optic disc coloboma with a focal pit like excavation in the left eye. Macular spectral domain optical coherence tomography (SD-OCT) of the left eye revealed macular retinoschisis, without serous detachment. CONCLUSIONS: Proper monitoring of patients with disc anomalies associated with maculopathy is mandatory. The use of OCT imaging during follow-up can help to identify involvement of the fovea or enlargement of the retinoschisis area.


Assuntos
Coloboma/complicações , Angiofluoresceinografia/métodos , Macula Lutea/patologia , Disco Óptico/patologia , Nervo Óptico/anormalidades , Retinosquise/complicações , Tomografia de Coerência Óptica/métodos , Campos Visuais , Coloboma/diagnóstico , Feminino , Fundo de Olho , Humanos , Retinosquise/diagnóstico , Adulto Jovem
5.
Ophthalmic Surg Lasers Imaging Retina ; 50(11): 684-690, 2019 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-31755967

RESUMO

BACKGROUND AND OBJECTIVE: To report the correlation of central macular thickness (CMT) and best-corrected visual acuity (BCVA) after 1-year treatment by two doses (2.5 mg or 1.25 mg) of intravitreal ziv-aflibercept (IVZ) versus bevacizumab (IVB) in eyes with diabetic macular edema (DME). PATIENTS AND METHODS: In this study, the correlation of CMT and BCVA changes of the eyes enrolled in a previous clinical trial of 123 eyes were re-evaluated. The correlation of BCVA and CMT changes at each visit was evaluated in the three study arms individually. Then, the eyes in each of the arms were classified at each follow-up visit into three subgroups based on their CMT changes related to the baseline CMT: CMT decrease of 30% or more of baseline CMT, between 10% to 29% of baseline CMT, and less than 9% of baseline CMT or CMT increase. RESULTS: BCVA and CMT changes were correlated significantly (P < .05) in all and in half of the follow-up visits, respectively, in the eyes treated by IVZ 1.25 mg and IVB (r = 0.554 and r = 0.617 at 1 year, respectively). Nevertheless, such a significant correlation was not detected in the eyes treated by IVZ 2.5 mg in any of the follow-up visits (r = 0.202 at 1 year; P = .259). In the IVZ 2.5 mg group, BCVA improvement was observed in all subgroups with each level of CMT reductions. CONCLUSION: Ziv-aflibercept 2.5 mg might have a beneficial effect on DME beyond thickness reduction. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:684-690.].


Assuntos
Inibidores da Angiogênese/administração & dosagem , Bevacizumab/administração & dosagem , Retinopatia Diabética/complicações , Macula Lutea/patologia , Edema Macular/tratamento farmacológico , Receptores de Fatores de Crescimento do Endotélio Vascular/administração & dosagem , Proteínas Recombinantes de Fusão/administração & dosagem , Acuidade Visual/fisiologia , Adulto , Idoso , Retinopatia Diabética/tratamento farmacológico , Feminino , Angiofluoresceinografia , Humanos , Injeções Intravítreas , Edema Macular/fisiopatologia , Masculino , Pessoa de Meia-Idade , Tomografia de Coerência Óptica
6.
Korean J Ophthalmol ; 33(5): 399-405, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31612649

RESUMO

PURPOSE: In the present study, the volume of hard exudates (HEs) was quantitatively measured using optical coherence tomography (OCT) and the agreement and correlation with area of HEs in fundus photography were analyzed. METHODS: The medical records of patients with diabetic macular edema who underwent focal laser treatment and were followed up more than 3 months were retrospectively evaluated. An automated customized program designed for measuring HE volume was used. The HEs in each OCT B-scan binary image were measured using 512 × 128 pixels, 6 mm × 6 mm OCT cube scans. The volume was measured by summing the segmented HEs in each 128 B-scan image. The area was measured in 6 mm x 6 mm fundus photography. The volume and area were measured before and 3 months after the treatment. The agreement of increase and decrease in HEs, and the correlation of volume and area of HEs were analyzed. RESULTS: A total of 35 patients (39 eyes) were included in the study. The volume was significantly reduced from 0.07978 to 0.02565 mm³ at 3 months (p < 0.001). The area was also significantly reduced from 15.35 to 8.60 mm² at 3 months (p < 0.001). The volume was decreased in 34 eyes and increased in 5 eyes. The area was decreased in 37 eyes and increased in 2 eyes. A significant correlation between volume and area was found (p < 0.001) as well as agreement between increase and decrease in volume and area. CONCLUSIONS: In the 3-dimensional quantitative volumetric analysis, the volume and area of HEs were correlated and the direction of increase and decrease was concordant. Considering the distribution of HEs in multiple layers of the retina, volumetric analysis could be considered a substitute for the analysis of HE area.


Assuntos
Retinopatia Diabética/diagnóstico , Macula Lutea/patologia , Edema Macular/diagnóstico , Tomografia de Coerência Óptica/métodos , Acuidade Visual , Retinopatia Diabética/complicações , Exsudatos e Transudatos/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Edema Macular/etiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
7.
Turk J Ophthalmol ; 49(5): 258-269, 2019 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-31650792

RESUMO

Objectives: To assess outcomes of a risk-based algorithm-guided treatment protocol for neovascular age-related macular degeneration. Materials and Methods: Two hundred and ten eyes of 184 patients managed with anti-vascular endothelial growth factor (anti-VEGF) agents according to a protocol consisting of one of three initial regimens depending on risk with at least 2 years of follow-up were retrospectively evaluated. The "short-term monthly injections" protocol was used for low-risk patients with low-risk lesions and good fellow-eye vision. Patients with low-risk lesions but without good fellow-eye vision, or those with good fellow-eye vision and high-risk lesions were managed according to the "short-term treat-and-extend (TREX)" protocol. The "extended TREX" protocol was for patients with high-risk lesions and low fellow-eye visual acuity. Results: The initial treatment plan consisted of short-term monthly injections in 62 eyes (30%), the short-term TREX regimen in 120 eyes (57%), and the extended TREX regimen in 28 eyes (13%). Overall, 63% of cases met the criteria for cessation of treatment. Approximately 58% of these cases had recurrence, at a mean of 13 months. The mean change in VA from baseline was +9.0 letters at 12 months and +8.0 letters at 24 months. VA improved during a mean follow-up of 46.8±22 months, with a mean of 3.4±1.6 anti-VEGF injections per year. Conclusion: The risk-based algorithm-guided treatment protocol yielded visual outcomes similar to those of the common alternative treatment and monitoring regimens, with a dramatically reduced number of injections, as required by the individual lesion and vision in the fellow eye.


Assuntos
Algoritmos , Gerenciamento Clínico , Ranibizumab/administração & dosagem , Medição de Risco/métodos , Acuidade Visual , Degeneração Macular Exsudativa/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Inibidores da Angiogênese/administração & dosagem , Feminino , Angiofluoresceinografia , Seguimentos , Fundo de Olho , Humanos , Injeções Intravítreas , Macula Lutea/patologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Fator A de Crescimento do Endotélio Vascular , Degeneração Macular Exsudativa/diagnóstico
8.
Turk J Ophthalmol ; 49(5): 297-299, 2019 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-31650814

RESUMO

We report a patient with unilateral syphilitic intermediate uveitis without dermatological, neurological, or any systemic involvement. He presented to our clinic with complaints of eye floaters and worsening visual acuity in the left eye. He had intermediate uveitis and cystoid macular edema in that eye and both venereal disease research laboratory and microhemagglutination assay for Treponema pallidum serological tests were confirmatory for syphilis. Ocular manifestations of syphilis have variable presentations, and it should be considered when diagnosing unexplained ocular inflammatory diseases, even if the patient's recent history and systemic evaluation are not compatible.


Assuntos
Infecções Oculares Bacterianas/etiologia , Sífilis/complicações , Uveíte Intermediária/etiologia , Acuidade Visual , Anticorpos Antibacterianos/análise , Infecções Oculares Bacterianas/diagnóstico , Infecções Oculares Bacterianas/microbiologia , Humanos , Macula Lutea/patologia , Masculino , Sífilis/diagnóstico , Sífilis/microbiologia , Tomografia de Coerência Óptica , Treponema pallidum/imunologia , Uveíte Intermediária/diagnóstico , Uveíte Intermediária/microbiologia , Adulto Jovem
9.
N Engl J Med ; 381(15): 1422-1433, 2019 10 10.
Artigo em Inglês | MEDLINE | ID: mdl-31509666

RESUMO

BACKGROUND: Identifying mechanisms of diseases with complex inheritance patterns, such as macular telangiectasia type 2, is challenging. A link between macular telangiectasia type 2 and altered serine metabolism has been established previously. METHODS: Through exome sequence analysis of a patient with macular telangiectasia type 2 and his family members, we identified a variant in SPTLC1 encoding a subunit of serine palmitoyltransferase (SPT). Because mutations affecting SPT are known to cause hereditary sensory and autonomic neuropathy type 1 (HSAN1), we examined 10 additional persons with HSAN1 for ophthalmologic disease. We assayed serum amino acid and sphingoid base levels, including levels of deoxysphingolipids, in patients who had macular telangiectasia type 2 but did not have HSAN1 or pathogenic variants affecting SPT. We characterized mice with low serine levels and tested the effects of deoxysphingolipids on human retinal organoids. RESULTS: Two variants known to cause HSAN1 were identified as causal for macular telangiectasia type 2: of 11 patients with HSAN1, 9 also had macular telangiectasia type 2. Circulating deoxysphingolipid levels were 84.2% higher among 125 patients with macular telangiectasia type 2 who did not have pathogenic variants affecting SPT than among 94 unaffected controls. Deoxysphingolipid levels were negatively correlated with serine levels, which were 20.6% lower than among controls. Reduction of serine levels in mice led to increases in levels of retinal deoxysphingolipids and compromised visual function. Deoxysphingolipids caused photoreceptor-cell death in retinal organoids, but not in the presence of regulators of lipid metabolism. CONCLUSIONS: Elevated levels of atypical deoxysphingolipids, caused by variant SPTLC1 or SPTLC2 or by low serine levels, were risk factors for macular telangiectasia type 2, as well as for peripheral neuropathy. (Funded by the Lowy Medical Research Institute and others.).


Assuntos
Neuropatias Hereditárias Sensoriais e Autônomas/genética , Mutação , Telangiectasia Retiniana/genética , Serina C-Palmitoiltransferase/genética , Serina/metabolismo , Esfingolipídeos/metabolismo , Adulto , Idoso , Animais , Análise Mutacional de DNA , Modelos Animais de Doenças , Exoma/genética , Feminino , Neuropatias Hereditárias Sensoriais e Autônomas/complicações , Neuropatias Hereditárias Sensoriais e Autônomas/metabolismo , Humanos , Metabolismo dos Lipídeos , Macula Lutea/patologia , Masculino , Camundongos , Pessoa de Meia-Idade , Linhagem , Telangiectasia Retiniana/complicações , Telangiectasia Retiniana/metabolismo , Fatores de Risco , Serina/sangue , Esfingosina/análogos & derivados , Esfingosina/análise , Adulto Jovem
10.
Ophthalmologica ; 242(4): 214-221, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31509827

RESUMO

PURPOSE: To identify the predictors for anatomical and functional outcome after re-vitrectomy with application of autologous platelet concentrate (APC) in eyes with persistent idiopathic macular hole (MH). METHODS: Retrospective study of 103 eyes with persistent MHs after vitrectomy with peeling of internal limiting membrane (ILM) and expansive gas. All patients underwent re-vitrectomy with APC and endotamponade. The anatomical MH closure rate and postoperative best-corrected visual acuity (BCVA) were evaluated. Further, predictive factors influencing the success of the surgery were analyzed. RESULTS: Median BCVA (logMAR) before the surgery was 1.00 (interquartile range [IQR] 0.80-1.30) and the median of minimum diameter between hole edges was 508 µm (IQR 387-631). The final closure rate after re-vitrectomy with APC was 60.2% (62 of 103 eyes). The following predictors were identified to significantly influence the closure rate: tractional hole index (THI), axial length, time between first and second surgery, and the experience of the surgeon (p < 0.05). CONCLUSIONS: Re-vitrectomy with APC led to the closure of 60.2% of the persistent MHs. The closure rate negatively correlates with increasing axial length, time between the first and second surgery, and the decreased THI. Further, experienced surgeons (with a history of >100 pars plana vitrectomies with ILM peeling) had significantly higher closure rates.


Assuntos
Plaquetas , Transfusão de Sangue Autóloga/métodos , Tamponamento Interno/métodos , Macula Lutea/patologia , Perfurações Retinianas/terapia , Acuidade Visual , Vitrectomia/métodos , Idoso , Feminino , Seguimentos , Humanos , Masculino , Prognóstico , Reoperação , Perfurações Retinianas/diagnóstico , Estudos Retrospectivos , Tomografia de Coerência Óptica , Resultado do Tratamento
11.
BMJ Case Rep ; 12(9)2019 Sep 26.
Artigo em Inglês | MEDLINE | ID: mdl-31558488

RESUMO

We describe a case of a 23-year-old man with giant macular schisis which can be seen in Goldmann-Favre syndrome. Associated history of decreased night vision and an enhanced S cone electroretinogram helps in confirming the diagnosis. Swept source optical coherence tomography of the same helps in confirming the schisis and delineates the extent and level of schisis. Other differential diagnosis of bilateral macular schisis in a young man could be juvenile X-linked retinoschisis.


Assuntos
Oftalmopatias Hereditárias/complicações , Macula Lutea/patologia , Degeneração Retiniana/complicações , Retinosquise/etiologia , Transtornos da Visão/complicações , Anti-Hipertensivos/uso terapêutico , Diagnóstico Diferencial , Eletrorretinografia , Oftalmopatias Hereditárias/diagnóstico por imagem , Oftalmopatias Hereditárias/tratamento farmacológico , Humanos , Macula Lutea/diagnóstico por imagem , Macula Lutea/efeitos dos fármacos , Masculino , Cegueira Noturna , Degeneração Retiniana/diagnóstico por imagem , Degeneração Retiniana/tratamento farmacológico , Retinosquise/diagnóstico por imagem , Retinosquise/tratamento farmacológico , Sulfonamidas/uso terapêutico , Tiofenos/uso terapêutico , Tomografia de Coerência Óptica , Transtornos da Visão/diagnóstico por imagem , Transtornos da Visão/tratamento farmacológico , Adulto Jovem
12.
Graefes Arch Clin Exp Ophthalmol ; 257(11): 2357-2365, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31485730

RESUMO

PURPOSE: To investigate the associations between macular complications and demographic, clinical, and optical coherence tomography characteristics (OCT) of highly myopic eyes with a dome-shaped macula (DSM). METHODS: We retrospectively analyzed the findings of 90 patients (167 eyes) with DSM who had vertical and horizontal OCT scans between January 2011 and June 2018. Demographic data, clinical characteristics, and OCT-derived morphologic parameters were determined, and the associations of these parameters with macular complications were evaluated. RESULTS: Among 167 eyes, the following patterns were observed: horizontally oriented DSM (71%), symmetric DSM (27%), and vertically oriented DSM (2%). Complications or abnormalities involving the macular area were detected by OCT in 63% (106/167) of the eyes. Specific complications were as follows: choroidal neovascularization (CNV) (37.1%), macular retinoschisis (9.0%), serous retinal detachment (RD) (7.8%), epiretinal membrane (4.2%), lamellar macular hole (3.0%), and macular hole (2.4%). The eyes with CNV had thinner choroid (P < 0.001) and lower macular bulge height (P = 0.04). The eyes with serous RD had thicker choroid (P < 0.001) and higher macular bulge height (P < 0.001). Serous RD was significantly more common when the macular height was greater than 250 µm (P = 0.001) and if the DSM pattern was vertical (P < 0.001). CONCLUSIONS: A greater bulge height and thicker choroid in highly myopic eyes with DSM may be protective against the development of myopic CNV. A thicker choroid, a higher macular bulge (> 250 µm), and a vertical DSM pattern are associated with a risk of developing serous RD.


Assuntos
Macula Lutea/patologia , Miopia/diagnóstico , Refração Ocular/fisiologia , Doenças Retinianas/etiologia , Tomografia de Coerência Óptica/métodos , Acuidade Visual , Adulto , Idoso , Feminino , Angiofluoresceinografia/métodos , Fundo de Olho , Humanos , Masculino , Pessoa de Meia-Idade , Miopia/complicações , Miopia/fisiopatologia , Prognóstico , Doenças Retinianas/diagnóstico , Estudos Retrospectivos , Adulto Jovem
13.
Cesk Slov Oftalmol ; 75(2): 86-90, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31537077

RESUMO

An optic disc pit is a rare congenital anomaly of the optic nerve disc. It occurs rarely, and in case of its bilateral occurance, it can be caused by an autosomal dominant inheritance pattern. Ophthalmoscopically, the disc pit appears as an ovoid depression of the optic nerve disc. When identified unilaterally, the optic nerve disc is usually larger than the disc of the other healthy eye. Optic disc pits can be located anywhere in optic disc. Moreover, when located in the temporal margin, they can be accompanied by a maculopathy. The latest therapeutic possibilities include the retinal laser photocoagulation and pars plana vitrectomy, however the prognosis quoad visum neverthelles remains poor. This report deals with bilateral occurance of the optic disc pit in case of 9-year-old asymptomatic patient. The patient had been transferred to our ophthalmology department with suspected retinal detachment. Following the examination, the optic disc pit was diagnosed. The patient remains subject to further observation, however, owing to his current satisfactory vision without the need for a surgical intervention.


Assuntos
Anormalidades do Olho , Disco Óptico , Descolamento Retiniano , Criança , Anormalidades do Olho/complicações , Humanos , Macula Lutea/patologia , Disco Óptico/patologia , Descolamento Retiniano/etiologia , Tomografia de Coerência Óptica , Vitrectomia
14.
Ophthalmologica ; 242(4): 222-233, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31533121

RESUMO

PURPOSE: To report the surgical results and technique of perfluorocarbon-assisted neurosensory retinal flap transplantation into macular hole for concomitant macular hole and complicated retinal detachment. METHOD: This is a retrospective, consecutive case series of 7 cases with concomitant macular hole and complicated retinal detachment with proliferative vitreoretinopathy. All eyes had previous vitrectomy and internal limiting membrane peeling, or very large (>1,000 µm) macular holes. Perfluorocarbon liquid-assisted free neurosensory retinal flap transplantation into the macular hole, and subretinal fluid drainage through iatrogenic retinectomy/retinotomy were performed, followed by air-fluid exchange with gas or silicone oil tamponade. RESULTS: All eyes had retina reattached. Macular hole was closed in all eyes, with the graft visualized by optical coherence tomography. The best corrected visual acuity in logarithm of minimal angle of resolution improved from 2.80 ± 0.45 preoperatively to 1.40 ± 0.51 postoperatively (p < 0.01). CONCLUSIONS: Neurosensory retinal flap may be a good option in closing macular holes in eyes with concomitant macular hole and complicated retinal detachment. Because of its specific properties, the flap is easy to handle during the operation. Retinectomy or retinotomy serves to release traction, drain subretinal fluid, and provide retinal flap tissue.


Assuntos
Tamponamento Interno/métodos , Fluorcarbonetos/farmacologia , Retalhos de Tecido Biológico , Retina/transplante , Descolamento Retiniano/cirurgia , Perfurações Retinianas/cirurgia , Vitrectomia/métodos , Idoso , Feminino , Seguimentos , Humanos , Macula Lutea/patologia , Masculino , Pessoa de Meia-Idade , Descolamento Retiniano/complicações , Descolamento Retiniano/diagnóstico , Perfurações Retinianas/complicações , Perfurações Retinianas/diagnóstico , Estudos Retrospectivos , Tomografia de Coerência Óptica , Resultado do Tratamento , Vitreorretinopatia Proliferativa/complicações , Vitreorretinopatia Proliferativa/diagnóstico , Vitreorretinopatia Proliferativa/cirurgia
15.
Arch. Soc. Esp. Oftalmol ; 94(9): 430-435, sept. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-186221

RESUMO

Objetivo: Evaluar los resultados visuales y anatómicos de aflibercept en pacientes naïve con degeneración macular asociada a la edad neovascular (DMAEnv) no seleccionados tras un año de tratamiento en régimen bimestral fijo en un entorno de práctica clínica real. Métodos: Estudio retrospectivo, serie de casos consecutivos no aleatorizados que incluye 35 pacientes naïve, 38 ojos con DMAEnv, tratados con aflibercept intravítreo (Eylea(R)). Los pacientes recibieron una dosis de carga de 3 inyecciones mensuales (2 mg/0,05 ml) seguida de inyecciones cada 2 meses. Resultados: Tras la dosis de carga y a los 12 meses de tratamiento, el cambio en la mejor agudeza visual corregida (MAVC) mejoró significativamente respecto a la MAVC basal (ETDRS 50,5 ± 14,5 y 53,1 ± 14,5 vs. 39,6 ± 14,7, respectivamente, p < 0,05). Al mes 3 y al mes 12, la proporción de pacientes que mejoró la agudeza visual en ≥ 15 letras fue de 37,1% y de 45,7%, respectivamente. La disminución media del espesor central de la retina fue también significativa tras la dosis de carga (239,6 ± 52,0 μm) y al mes 12 (227 ± 53,2μm) comparada con los valores pretratamiento (370,3 ± 117,6; p < 0,001). También se observó la resolución del desprendimiento del epitelio pigmentario en 14 de los 20 ojos (70%) con ese desprendimiento previo al tratamiento. Conclusión: Mejorías funcionales y anatómicas significativas fueron observadas tras el tratamiento con aflibercept intravítreo en pacientes naïve con DMAEnv en práctica clínica real


Objective: To investigate the visual and anatomical outcomes of aflibercept as therapy in patients with treatment-naïve neovascular age-related macular degeneration during one year in routine clinical practice. Methods: The study was a retrospective, case series, including 35 patients, 38 eyes, with neovascular age-related macular degeneration that received aflibercept injections (Eylea(R)). Patients received a loading dose of 3 monthly injections (2 mg / 0.05 ml) followed by intravitreal injections every 2 months. Results: At 3 and 12 months, the mean best-corrected visual acuity improved significantly as compared with baseline (ETDRS 50.5 ± 14.5 and 53.1 ± 14.5 vs. 39.6 ± 14.7, respectively, P < .05). At 3 and 12 months, the proportion of patients who improved visual acuity by ≥ 15 letters was 37.1% and 45.7%, respectively. The mean decrease in central macular thickness was also significant after loading dose (239.6 ± 52.0μm) and at 12 month (227 ± 53.2 μm) compared with pre-treatment values (370.3 ± 117, 6) (P < .001). Resolution of pigment epithelial detachment (PED) was also observed in 14 out of 20 (70%) eyes with PED at baseline. Conclusion: Aflibercept administered by fixed dosing over one year improved visual acuity and macular morphology in treatment-naïve eyes in routine daily practice


Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Inibidores da Angiogênese/uso terapêutico , Degeneração Macular/tratamento farmacológico , Receptores de Fatores de Crescimento do Endotélio Vascular/uso terapêutico , Proteínas Recombinantes de Fusão/uso terapêutico , Avaliação de Medicamentos , Seguimentos , Macula Lutea/patologia , Degeneração Macular/patologia , Descolamento Retiniano/tratamento farmacológico , Descolamento Retiniano/etiologia , Hemorragia Retiniana/etiologia , Epitélio Pigmentado da Retina/patologia , Estudos Retrospectivos , Resultado do Tratamento , Acuidade Visual
17.
Graefes Arch Clin Exp Ophthalmol ; 257(11): 2367-2373, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31418105

RESUMO

PURPOSE: The purpose of the present paper is to describe a surgical technique aimed at creating multiple layers of Internal Limiting Membrane (ILM) using Perfluorocarbon Liquid (PFCL) in order to favour the closure of large, chronic and myopic Macular Holes (MH). METHODS: Thirty patients belonging to 3 subgroups: large (> 500 µm), chronic (> 12 months) and myopic (> - 9 diopters), MHs, underwent surgery and completed 6 months follow-up. The ILM was engaged and peeled 360° around the MH, hinged to the rim and folded over the hole. A PFCL bubble spanning the vascular arcades was then injected and the ILM is grasped repeatedly to fold the distal edge towards the MH centre, creating multiple ILM layers over the MH. RESULTS: MH closed in 26/30 cases (86.6%) with no significant difference among subgroups. Vision improved 2.57 ± 1.56 Snellen lines from LogMAR 1.50 ± 1.19 to 1.19 ± 1.32 (p < 0.01). Ellipsoid Zone (EZ) interruption width reduced from 1129 ± 439 µm to 258 ± 507 µm (p < 0.001) and correlated to pattern of MH closure, post-BCVA and line improvement (p < 0.001 in all cases). DISCUSSION: The use PFCL allows multiple ILM layers and resulted in a high closure rate. Pattern of MH closure differs from those previously described leaving a plug of ILM tissue that interrupts retinal architecture often only in the inner layers. PFCL gravity and hydrophobicity displace aqueous while the intensely polar opposite faces of the ILM attract each other. The folded ILM plugs MH and bridges the gap and may help glial cell proliferation and migration.


Assuntos
Membrana Basal/transplante , Tamponamento Interno/métodos , Fluorcarbonetos/farmacologia , Miopia/complicações , Refração Ocular/fisiologia , Perfurações Retinianas/cirurgia , Retalhos Cirúrgicos , Idoso , Doença Crônica , Feminino , Seguimentos , Humanos , Macula Lutea/patologia , Masculino , Pessoa de Meia-Idade , Miopia/diagnóstico , Miopia/fisiopatologia , Perfurações Retinianas/diagnóstico , Perfurações Retinianas/etiologia , Estudos Retrospectivos , Tomografia de Coerência Óptica , Resultado do Tratamento , Acuidade Visual , Vitrectomia/métodos
19.
Indian J Ophthalmol ; 67(9): 1502-1505, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31436216

RESUMO

We present a case of a 37-year-old gentleman with a rare diagnosis of Torpedo maculopathy (TM). We describe the multimodal imaging features of torpedo maculopathy using adaptive optics, visual fields, OCT and multifocal ERG, and understand the clinical and structural-functional correlation in TM. According to us, this is the first case report to describe the adaptive optics imaging findings in Torpedo maculopathy in English Medical literature.


Assuntos
Eletrorretinografia/métodos , Angiofluoresceinografia/métodos , Macula Lutea/patologia , Degeneração Macular/terapia , Tomografia de Coerência Óptica/métodos , Campos Visuais/fisiologia , Adulto , Fundo de Olho , Humanos , Degeneração Macular/diagnóstico , Degeneração Macular/fisiopatologia , Masculino , Óptica e Fotônica , Epitélio Pigmentado da Retina , Acuidade Visual
20.
Graefes Arch Clin Exp Ophthalmol ; 257(11): 2375-2380, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31401683

RESUMO

PURPOSE: To evaluate the effect of three intravitreal bevacizumab (IVB) injections alone or in combination with intravitreal erythropoietin (EPO) in the treatment of refractory diabetic macular edema (DME). METHODS: In a randomized double-blind clinical trial, 48 eyes of 34 diabetic patients with refractory DME were enrolled. Eyes were randomly assigned to receive either 3 monthly injections of 0.05 cc (1.25 mg) IVB plus 0.05 cc (1000 unit) EPO or 0.05 cc (1.25 mg) IVB alone. Main outcome was best-corrected visual acuity (BCVA) changes and secondary outcome was central macular thickness (CMT). The patients were followed for 6 months. RESULTS: Mean BCVA changes up to 4 and 6 months were insignificant in both groups. It changed from 0.72 ± 0.56 logMAR at baseline to 0.74 ± 0.5 (P = 0.85) and 0.71 ± 0.44 (P = 0.40) in the combination group and from 0.48 ± 0.39 logMAR to 0.47 ± 0.35 (P = 0.48) and 0.52 ± 0.33 (P = 0.69) in the IVB alone group, at 4 and 6 months, respectively. The difference of mean BCVA changes between the groups was insignificant at both 4 and 6 months (P = 0.07 and P = 0.36, respectively). Within the group changes of mean CMT were significant only in the combination group at 4 and 6 months, from 518 ± 134 µ at baseline to 472 ± 151 to 475 ± 167 µ, respectively (P = 0.01 and P = 0.05). Corresponding changes were not significant in the IVB alone group. However, the difference between the groups was not significant at all visits (P = 0.51 and P = 0.71, respectively). CONCLUSIONS: This clinical trial demonstrated that intravitreal erythropoietin had no additional effect to IVB in the treatment of refractory DME in the short term. TRIAL REGISTRATION: Clinical trials.gov identifier: NCT03821168.


Assuntos
Bevacizumab/administração & dosagem , Retinopatia Diabética/tratamento farmacológico , Eritropoetina/administração & dosagem , Edema Macular/tratamento farmacológico , Idoso , Inibidores da Angiogênese/administração & dosagem , Retinopatia Diabética/complicações , Retinopatia Diabética/diagnóstico , Método Duplo-Cego , Quimioterapia Combinada , Feminino , Seguimentos , Humanos , Injeções Intravítreas , Macula Lutea/patologia , Edema Macular/diagnóstico , Edema Macular/etiologia , Masculino , Pessoa de Meia-Idade , Tomografia de Coerência Óptica/métodos , Resultado do Tratamento , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores
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