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1.
Am J Ophthalmol ; 223: 259-266, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33351744

RESUMO

PURPOSE: To evaluate the rate of progression of macular vessel density (mVD) in primary open-angle glaucoma (POAG) and explore the relationship between the progression of mVD and macular ganglion cell-inner plexiform layer (mGCIPL) thickness and parapapillary retinal nerve fiber layer (pRNFL) thickness. DESIGN: Prospective cohort study. METHODS: In this study, 102 eyes with POAG were followed for 36.6 ± 6.4 months. The rates of progression were estimated by linear models. The agreement of progression detection among the 3 parameters was evaluated with Kappa statistics. The influence of baseline measurements on the rates of progression of mGCIPL thickness, pRNFL thickness, and mVD was investigated by linear mixed modeling. Kaplan-Meier survival analysis was adopted to calculate the survival probabilities. RESULTS: The respective rate of progression by linear regression was -0.102 ± 0.054 µm/month, -0.160 ± 0.086 µm/month, and -0.199 ± 0.073 %/month for mGCIPL thickness, pRNFL thickness, and mVD. The agreement in detection of progression among them was poor with the Conger's Kappa coefficient of 0.098 (95% confidence interval: -0.025~0.220, P = .116). The significant factors influencing the rate of progression of mVD were baseline mGCIPL thickness, baseline pRNFL thickness, and baseline mVD (P ≤ .001), while baseline mVD was not a significant factor influencing the rates of progression of mGCIPL thickness and pRNFL thickness (P ≥ .659). Also, pRNFL thickness had a better survival probability compared with the other 2 parameters (P = .025). CONCLUSIONS: The mGCIPL thickness, pRNFL thickness, and mVD decreased over time in POAG eyes. The rate of reduction of mVD was significantly influenced by the baseline measurements of mGCIPL thickness, pRNFL thickness, and mVD.


Assuntos
Angiofluoresceinografia/métodos , Glaucoma de Ângulo Aberto/diagnóstico , Pressão Intraocular/fisiologia , Macula Lutea/patologia , Disco Óptico/patologia , Tomografia de Coerência Óptica/métodos , Feminino , Seguimentos , Fundo de Olho , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Curva ROC , Células Ganglionares da Retina/patologia
2.
Pan Afr Med J ; 35(Suppl 2): 135, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33193950

RESUMO

Tuberculous neuroretinis, a relatively rare manifestation of extra-pulmonary tuberculosis, is characterized by optic disc edema, peripapillary and macula swelling, with hard exudates forming a partial or complete 'macular star' While the disease may present a diagnostic challenge for Ophthalmologists, prognosis is usually good, with proper management. The Coronavirus Disease 2019 (COVID-19) pandemic has presented a healthcare delivery dilemma in many parts of the world, with poor accessibility to, and under-utilization of, important healthcare services by non-COVID-19-related cases. Herein is a report of a case of tuberculous neuroretinitis in Lagos, Nigeria, whose care was negatively impacted by the ongoing pandemic through the combined factors of the interruption of clinical services during the lockdown, patient avoidance of healthcare facilities and the absence of robust telehealth services. These all culminated in the delayed institution of therapy which may be responsible for the poor visual outcome of no-light-perception.


Assuntos
Continuidade da Assistência ao Paciente , Infecções por Coronavirus/epidemiologia , Acesso aos Serviços de Saúde , Pandemias , Pneumonia Viral/epidemiologia , Retinite/tratamento farmacológico , Tuberculose Ocular/tratamento farmacológico , Antituberculosos/uso terapêutico , Telefone Celular , Diagnóstico Tardio , Técnicas de Diagnóstico Oftalmológico , Quimioterapia Combinada , Feminino , Fechamento de Instituições de Saúde , Humanos , Macula Lutea/patologia , Nigéria/epidemiologia , Fotografação , Quarentena , Retinite/diagnóstico , Telemedicina , Tomografia de Coerência Óptica , Resultado do Tratamento , Recusa do Paciente ao Tratamento , Tuberculose Ocular/diagnóstico , Adulto Jovem
3.
Ocul Immunol Inflamm ; 28(8): 1293-1297, 2020 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-33021856

RESUMO

A 53-year-old man presented with acute loss of vision, negative scotoma and dyschromatopsia in his left eye. He reported contact with people with severe respiratory syndrome - coronavirus-2 (SARS-CoV-2) 8 days prior symptoms. Funduscopic examination revealed several retinal hemorrhages. Spectral-domain optical coherence tomography showed lesions consistent with acute macular neuroretinopathy and paracentral acute middle maculopathy. Quickly after his presentation, SARSCov-2 was confirmed by chest computed tomography-scan and RT-PCR in this patient. Thrombotic complications associated with Covid-19 infection have high incidence and may involve the retina. We described a case of retinal involvement associated with Covid-19 infection. PRÉCIS: Funduscopic examination revealed retinal hemorrhages in a man with loss of vision. Optical coherence tomography showed an acute macular neuroretinopathy and paracentral acute middle maculopathy. Coronavirus disease was confirmed by chest computed tomography-scan and RT-PCR.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Angiofluoresceinografia/métodos , Macula Lutea/patologia , Pneumonia Viral/complicações , Doenças Retinianas/etiologia , Tomografia de Coerência Óptica/métodos , Acuidade Visual , Doença Aguda , Infecções por Coronavirus/epidemiologia , Fundo de Olho , Humanos , Masculino , Pessoa de Meia-Idade , Oftalmoscopia , Pandemias , Pneumonia Viral/epidemiologia , Doenças Retinianas/diagnóstico
4.
PLoS One ; 15(9): e0239992, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32991629

RESUMO

PURPOSE: To compare macular choroidal thickness of idiopathic epiretinal membrane (ERM) and fellow eyes, and before and after vitrectomy in terms of the morphological features on spectral-domain optical coherent tomography (SD-OCT). METHODS: Eighty-four patients with unilateral idiopathic ERM were involved. Patients were categorized into: Group 1, ERM without membrane contraction; Group 2, ERM with membrane contraction and retinal folding; and Group 3, ERM with membrane contraction and macular edema. Twenty-two patients received surgical removal of ERM. Choroidal thickness was compared between ERM and fellow eyes, and before and after treatment. RESULTS: Mean choroidal thickness was significantly greater in ERM eyes than in fellow eyes (234.4 ± 22.5 vs 220.6 ± 20.8 µm; P<0.01). Group 1 (n = 20) showed no significant difference in choroidal thickness between ERM and fellow eyes. Eyes in Group 2 (n = 27) and Group 3 (n = 37) showed statistically significant differences in mean choroidal thickness between ERM and fellow eyes (229.6 ± 23.8 vs 220.8 ± 19.6 µm; 242.6 ± 27.8 vs 221.0 ± 21.8 µm, respectively; P<0.05). In Group 2 (n = 8) and Group 3 (n = 16), choroidal thickness in ERM eyes decreased significantly at 1 month and 6 months after surgery, compared with that before surgery (P<0.05 for all comparisons). CONCLUSIONS: Membrane contraction contributed to the increase in choroidal thickness in idiopathic ERM patients. This finding may help to elucidate the pathophysiologic features of idiopathic ERM as well as the response to treatment in these patients.


Assuntos
Corioide/patologia , Membrana Epirretiniana/diagnóstico por imagem , Tomografia de Coerência Óptica , Adulto , Idoso , Idoso de 80 Anos ou mais , Corioide/diagnóstico por imagem , Membrana Epirretiniana/patologia , Membrana Epirretiniana/cirurgia , Feminino , Humanos , Macula Lutea/diagnóstico por imagem , Macula Lutea/patologia , Masculino , Pessoa de Meia-Idade
5.
PLoS One ; 15(9): e0238958, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32915904

RESUMO

PURPOSE: To investigate the correlation between quantifiable vessel density, computed in an automated fashion, from ultra-widefield fluorescein angiography (UWFFA) images from patients with proliferative diabetic retinopathy (PDR) with visual acuity and macular thickness. METHODS: We performed a secondary analysis of a prospective randomized controlled trial. We designed and trained an algorithm to automate retinal vessel detection from input UWFFA images. We then used our algorithm to study the correlation between baseline vessel density and best corrected visual acuity (BCVA) and CRT for patients in the RECOVERY study. Reliability of the algorithm was tested using the intraclass correlation (ICC). 42 patients from the Intravitreal Aflibercept for Retinal Non-Perfusion in Proliferative Diabetic Retinopathy (RECOVERY) trial who had both baseline UWFFA images and optical coherence tomography (OCT) data were included in our study. These patients had PDR without significant center-involving diabetic macular edema (central retinal thickness [CRT] ≤320µm). RESULTS: Our algorithm analyzed UWFFA images with a reliability measure (ICC) of 0.98. A positive correlation (r = 0.4071, p = 0.0075) was found between vessel density and BCVA. No correlation was found between vessel density and CRT. CONCLUSIONS: Our algorithm is capable of reliably quantifying vessel density in an automated fashion from baseline UWFFA images. We found a positive correlation between computed vessel density and BCVA in PDR patients without center-involving macular edema, but not CRT. TRANSLATIONAL RELEVANCE: Our work is the first to offer an algorithm capable of quantifying vessel density in an automated fashion from UWFFA images, allowing us to work toward studying the relationship between retinal vascular changes and important clinical endpoints, including visual acuity, in ischemic eye diseases.


Assuntos
Retinopatia Diabética/diagnóstico , Angiofluoresceinografia , Vasos Retinianos/patologia , Adulto , Algoritmos , Retinopatia Diabética/patologia , Retinopatia Diabética/fisiopatologia , Feminino , Angiofluoresceinografia/estatística & dados numéricos , Humanos , Interpretação de Imagem Assistida por Computador , Macula Lutea/patologia , Edema Macular/diagnóstico , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Tomografia de Coerência Óptica , Acuidade Visual
6.
J Fr Ophtalmol ; 43(8): 727-730, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32620415

RESUMO

We report a case of a patient treated with tamoxifen 20mg daily as hormone therapy for breast cancer. On regular ophthalmological follow-up, tamoxifen maculopathy was detected on SD-OCT (Spectral Domain Optic Coherence Tomography, Carl Zeiss Meditec®), so the medication was discontinued. Despite discontinuation of the medication, the maculopathy progressed over time. We have been following our patient for seven years. Tamoxifen may produce a toxic maculopathy which may progress despite discontinuation of the medication. We consider our case interesting, given the lengthy follow-up of the patient with sequential SD-OCT images. To the best of our knowledge, our case represents the longest follow-up period for a patient with tamoxifen maculopathy. Moreover, we would like to stress the importance of screening in asymptomatic patients on this medication, in order to detect early pathological signs.


Assuntos
Monitorização Fisiológica , Doenças Retinianas/induzido quimicamente , Doenças Retinianas/diagnóstico , Tamoxifeno/efeitos adversos , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/patologia , Feminino , Angiofluoresceinografia , Seguimentos , Humanos , Macula Lutea/efeitos dos fármacos , Macula Lutea/patologia , Degeneração Macular/induzido quimicamente , Degeneração Macular/diagnóstico , Degeneração Macular/patologia , Monitorização Fisiológica/métodos , Doenças Retinianas/patologia , Tamoxifeno/administração & dosagem , Tomografia de Coerência Óptica
7.
PLoS One ; 15(6): e0234525, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32542038

RESUMO

Our purpose was to evaluate the concentrations of vitreous cytokines in patients with rhegmatogenous retinal detachment (RRD). We hypothesized that patients with macula on RRD have lower levels of cytokines compared to patients with macula off RRD and proliferative vitreoretinopathy (PVR). Vitreous fluids were collected during 23G pars plana vitrectomy from 58 eyes of 58 patients. Indication for vitrectomy included macula off and macula on RRD, PVR, and idiopathic epiretinal membrane (ERM). A multiplex chemiluminescent immunoassay was performed to measure the concentrations of 48 cytokines, chemokines, and growth factors. Levels of HGF, IL-6, IL-8, IL-16, IFN-gamma, MCP-1, and MIF were significantly higher in all groups of retinal detachment compared to ERM. Levels of CTACK, eotaxin, G-CSF, IP-10, MIG, SCF, SCGF-beta, SDF-1alpha were significantly higher in PVR compared to macula on RRD and ERM. Levels of IL-1ra, IL-5, IL-9, M-CSF, MIP-1alpha, and TRIAL were significantly higher in PVR compared to macula on RRD. Our results indicate that the position of macula lutea and the presence of PVR significantly influence vitreous cytokine expression. The detected proteins may serve as biomarkers to estimate the possibility of PVR formation and may help to invent personalized therapeutic strategies to slow down or prevent PVR.


Assuntos
Macula Lutea/metabolismo , Descolamento Retiniano/genética , Vitreorretinopatia Proliferativa/genética , Descolamento do Vítreo/genética , Idoso , Quimiocinas/classificação , Quimiocinas/genética , Citocinas/classificação , Citocinas/genética , Feminino , Regulação da Expressão Gênica/genética , Humanos , Peptídeos e Proteínas de Sinalização Intercelular/classificação , Peptídeos e Proteínas de Sinalização Intercelular/genética , Macula Lutea/patologia , Masculino , Pessoa de Meia-Idade , Descolamento Retiniano/metabolismo , Descolamento Retiniano/patologia , Vitreorretinopatia Proliferativa/metabolismo , Vitreorretinopatia Proliferativa/patologia , Descolamento do Vítreo/metabolismo , Descolamento do Vítreo/patologia
8.
J Fr Ophtalmol ; 43(7): 626-634, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32386726

RESUMO

OBJECTIVE: To investigate the effects of silicone oil (SiO) on macular thickness (MT) and subfoveal choroidal thickness (SFCT) in patients with macula-off rhegmatogenous retinal detachment (RRD) undergoing pars plana vitrectomy (PPV). MATERIAL AND METHODS: In this prospective study, 70 eyes of 70 patients who received SiO tamponade for the treatment of macula-off RRD were treated with PPV and a 5000-cSt SiO endotamponade followed by subsequent SiO removal. MT and SFCT were measured 1 day before and 3 months after SiO removal using spectral-domain optical tomography (SD-OCT) and enhanced depth imaging optical tomography (EDI-OCT). The patients were divided into 3 groups according to the length of time that the SiO was present: group 1 (3-6 months), group 2 (6-9 months), and group 3 (9-18 months). RESULTS: A total of 70 eyes of 70 patients with a mean age of 57.22±9.83 years (range: 30 years to 75 years) were included in the SiO (5000-cSt) study. SiO was extracted after a mean duration of 8.67±5.33 months (range, 3-18 months) after PPV. In the 1st group, BCVA increased from 1.83±0.32 log MAR before PPV to 0.85±0.41 log MAR at 3 months after silicone removal (P<0.001). In the 2nd group, BCVA increased from 1.76±0.38 log MAR before PPV to 0.86±0.48 log MAR at 3 months after silicone removal (P<0.001). In the 3rd group, BCVA increased from 1.89±0.28 log MAR before PPV to 1.08±0.63 log MAR at 3 months after SiO removal (P=0.001). There was no statistically significant change in MT in the difference values of each group. As the length of SiO presence in the eye increased, significant thinning was observed on measurement of SFCT. Differences in the SFCT values were -14.91µm, -18.76µm, and -51.50µm in groups 1, 2, and 3 respectively (P=0.004). CONCLUSIONS: A significant decrease in macular and choroidal thicknesses after SiO removal was observed. Presence of SiO endotamponade for 9 months was associated with subfoveal choroidal thinning and decreased final visual acuity in eyes undergoing RRD surgery. SD-OCT and EDI-OCT may be recommended for the treatment and follow-up of patients with complications caused by the use of SiO tamponade.


Assuntos
Corioide/patologia , Tamponamento Interno/métodos , Macula Lutea/patologia , Descolamento Retiniano/terapia , Óleos de Silicone/administração & dosagem , Adulto , Idoso , Corioide/diagnóstico por imagem , Corioide/efeitos dos fármacos , Terapia Combinada , Esquema de Medicação , Tamponamento Interno/efeitos adversos , Feminino , Humanos , Macula Lutea/diagnóstico por imagem , Macula Lutea/efeitos dos fármacos , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão/efeitos dos fármacos , Descolamento Retiniano/diagnóstico , Descolamento Retiniano/patologia , Descolamento Retiniano/cirurgia , Óleos de Silicone/efeitos adversos , Óleos de Silicone/farmacologia , Fatores de Tempo , Tomografia de Coerência Óptica , Acuidade Visual/efeitos dos fármacos , Vitrectomia/métodos
10.
Sci Rep ; 10(1): 7708, 2020 05 07.
Artigo em Inglês | MEDLINE | ID: mdl-32382106

RESUMO

To analyze longitudinal changes in peripapillary retinal nerve fiber layer (pRNFL) thicknesses over time in the fellow eyes of patients with unilateral retinal vein occlusion (RVO). A total of 47 patients with unilateral RVO and 47 healthy controls were enrolled. The mean and sectoral pRNFL thicknesses were measured using spectral domain-optical coherence tomography at 1 year intervals, and followed for 3 years. Linear mixed models were performed to calculate and compare the reduction rates of pRNFL thicknesses over time. The mean pRNFL thickness decreased significantly during the 3-year follow-up, with a significant decrease over time in both groups. The reduction rate in mean pRNFL thicknesses was -0.41 µm/year in the control group and -0.68 µm/year in the fellow eyes of RVO group, and the decrease was significantly higher in the fellow eyes of RVO group than in the control group (p < 0.001). Using a multivariate linear mixed model, age (estimate: -0.41, p = 0.011) and hypertension (HTN) (estimate: -6.51, p = 0.014) were significantly associated with the reduction in mean pRNFL thicknesses in fellow eyes of RVO group. The fellow eyes of RVO patients showed a greater reduction in pRNFL thickness over time than normal controls. Age and HTN should be considered as factors to decrease the pRNFL thickness over time in fellow eyes of RVO group.


Assuntos
Fibras Nervosas/patologia , Retina/diagnóstico por imagem , Oclusão da Veia Retiniana/patologia , Vasos Retinianos/diagnóstico por imagem , Idoso , Feminino , Humanos , Hipertensão/diagnóstico por imagem , Hipertensão/patologia , Pressão Intraocular/fisiologia , Macula Lutea/diagnóstico por imagem , Macula Lutea/patologia , Masculino , Pessoa de Meia-Idade , Fibras Nervosas/metabolismo , Retina/metabolismo , Retina/patologia , Células Ganglionares da Retina/metabolismo , Células Ganglionares da Retina/patologia , Oclusão da Veia Retiniana/diagnóstico por imagem , Vasos Retinianos/patologia , Tomografia de Coerência Óptica , Acuidade Visual/fisiologia
11.
Proc Natl Acad Sci U S A ; 117(23): 13094-13104, 2020 06 09.
Artigo em Inglês | MEDLINE | ID: mdl-32434914

RESUMO

Age-related macular degeneration (AMD) is the leading cause of blindness in the elderly. While the histopathology of the different disease stages is well characterized, the cause underlying the progression, from the early drusen stage to the advanced macular degeneration stage that leads to blindness, remains unknown. Here, we show that photoreceptors (PRs) of diseased individuals display increased expression of two key glycolytic genes, suggestive of a glucose shortage during disease. Mimicking aspects of this metabolic profile in PRs of wild-type mice by activation of the mammalian target of rapamycin complex 1 (mTORC1) caused early drusen-like pathologies, as well as advanced AMD-like pathologies. Mice with activated mTORC1 in PRs also displayed other early disease features, such as a delay in photoreceptor outer segment (POS) clearance and accumulation of lipofuscin in the retinal-pigmented epithelium (RPE) and of lipoproteins at the Bruch's membrane (BrM), as well as changes in complement accumulation. Interestingly, formation of drusen-like deposits was dependent on activation of mTORC1 in cones. Both major types of advanced AMD pathologies, including geographic atrophy (GA) and neovascular pathologies, were also seen. Finally, activated mTORC1 in PRs resulted in a threefold reduction in di-docosahexaenoic acid (DHA)-containing phospholipid species. Feeding mice a DHA-enriched diet alleviated most pathologies. The data recapitulate many aspects of the human disease, suggesting that metabolic adaptations in photoreceptors could contribute to disease progression in AMD. Identifying the changes downstream of mTORC1 that lead to advanced pathologies in mouse might present new opportunities to study the role of PRs in AMD pathogenesis.


Assuntos
Envelhecimento/patologia , Macula Lutea/patologia , Degeneração Macular/patologia , Células Fotorreceptoras Retinianas Cones/patologia , Idoso , Idoso de 80 Anos ou mais , Animais , Lâmina Basilar da Corioide/metabolismo , Modelos Animais de Doenças , Feminino , Humanos , Lipofuscina/metabolismo , Lipoproteínas/metabolismo , Macula Lutea/citologia , Masculino , Alvo Mecanístico do Complexo 1 de Rapamicina/metabolismo , Camundongos , Células Fotorreceptoras Retinianas Cones/metabolismo , Epitélio Pigmentado da Retina/metabolismo
12.
Sci Rep ; 10(1): 8439, 2020 05 21.
Artigo em Inglês | MEDLINE | ID: mdl-32439930

RESUMO

Non-response to intravitreal ranibizumab represents a frequent problem in pachychoroid neovasculopathy (PNV). To investigate the effectivity of switching to aflibercept, the database of the Ludwig Maximilians University, Munich, was screened for patients fulfilling the following inclusion criteria: (i) diagnosis of PNV; (ii) inadequate response to ≥ 3 ranibizumab injections, in spite of monthly dosing, defined as persistence of subretinal-fluid four weeks after the last ranibizumab injection; (iii) resulting switch to aflibercept administered as three monthly injections. Primary outcome measure was percentage of eyes with a dry macula four weeks after the third aflibercept injection. Secondary outcome measures included changes in maximum subretinal fluid (SRF), central subfield thickness (CST) and subfoveal choroidal thickness (SFCT). In total, 14 eyes of 14 patients were included. Mean age was 64.1 ± 7.5 (range: 51-78) years. Switching to aflibercept was performed after mean 8.4 ± 4.1 (3-15) ranibizumab injections. While no eye (0%) achieved a dry macula status during ranibizumab treatment, switching to aflibercept achieved a dry macula status in eight eyes (57.1%) after three injections. While both ranibizumab and aflibercept showed an effect on CST (p = 0.027, p = 0.003), only aflibercept showed a significant effect on SRF (p = 0.0009) and SFCT (p = 0.044). In cases of PNV not responding to intravitreal ranibizumab, switching treatment to aflibercept induces a favorable short-term response resolving persistent fluid and achieving a dry macula. Further studies with longer follow-up are warranted.


Assuntos
Inibidores da Angiogênese/farmacologia , Neovascularização de Coroide/tratamento farmacológico , Substituição de Medicamentos/métodos , Macula Lutea/efeitos dos fármacos , Ranibizumab/farmacologia , Proteínas Recombinantes de Fusão/farmacologia , Idoso , Neovascularização de Coroide/metabolismo , Neovascularização de Coroide/patologia , Feminino , Seguimentos , Humanos , Macula Lutea/patologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Receptores de Fatores de Crescimento do Endotélio Vascular , Estudos Retrospectivos
13.
Am J Ophthalmol ; 217: 268-277, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32360332

RESUMO

PURPOSE: To assess the association between optical coherence tomography angiography (OCTA)-quantified avascular areas (AAs) and diabetic retinopathy (DR) severity, progression, and treatment requirement in the following year. DESIGN: Prospective cohort study. METHODS: We recruited patients with diabetes from a tertiary academic retina practice and obtained 3-mm × 3-mm macular OCTA scans with the AngioVue system and standard 7-field color photographs at baseline and at a 1-year follow-up visit. A masked grader determined the severity of DR from the color photographs using the Early Treatment of Diabetic Retinopathy scale. A custom algorithm detected extrafoveal AA (EAA) excluding the central 1-mm circle in projection-resolved superficial vascular complex (SVC), intermediate capillary plexus (ICP), and deep capillary plexus (DCP). RESULTS: Of 138 patients, 92 (41 men, ranging in age from 26-84 years [mean 59.4 years]) completed 1 year of follow-up. At baseline, EAAs for SVC, ICP, and DCP were all significantly correlated with retinopathy severity (P < .0001). DCP EAA was significantly associated with worse visual acuity (r = -0.24, P = .02), but SVC and ICP EAA were not. At 1 year, 11 eyes progressed in severity by at least 1 step. Multivariate logistic regression analysis demonstrated the progression was significantly associated with baseline SVC EAA (odds ratio = 8.73, P = .04). During the follow-up period, 33 eyes underwent treatment. Multivariate analysis showed that treatment requirement was significantly associated with baseline DCP EAA (odds ratio = 3.39, P = .002). No baseline metric was associated with vision loss at 1 year. CONCLUSIONS: EAAs detected by OCTA in diabetic eyes are significantly associated with baseline DR severity, disease progression, and treatment requirement over 1 year.


Assuntos
Retinopatia Diabética/diagnóstico , Gerenciamento Clínico , Angiofluoresceinografia/métodos , Macula Lutea/patologia , Vasos Retinianos/diagnóstico por imagem , Tomografia de Coerência Óptica/métodos , Acuidade Visual , Adulto , Idoso , Idoso de 80 Anos ou mais , Retinopatia Diabética/fisiopatologia , Retinopatia Diabética/terapia , Progressão da Doença , Feminino , Seguimentos , Fundo de Olho , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Tempo
14.
Am J Ophthalmol ; 217: 152-161, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32360335

RESUMO

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


Assuntos
Membrana Epirretiniana/complicações , Macula Lutea/patologia , Miopia/complicações , Retinosquise/diagnóstico , Tomografia de Coerência Óptica/métodos , Acuidade Visual , Corpo Vítreo/patologia , Idoso , Membrana Epirretiniana/diagnóstico , Feminino , Humanos , Masculino , Microscopia Eletrônica de Transmissão , Pessoa de Meia-Idade , Miopia/diagnóstico , Retinosquise/etiologia
15.
Am J Ophthalmol ; 217: 104-113, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32360342

RESUMO

PURPOSE: To study the early anatomic choroidal alterations in eyes with chronic central serous chorioretinopathy (CSCR) undergoing photodynamic therapy (PDT). DESIGN: Multicenter retrospective cohort study. METHODS: A total of 77 patients and 81 eyes with chronic CSCR treated with PDT and 64 untreated fellow eyes were evaluated. Central macular thickness (CMT) and choroidal features including subfoveal choroidal thickness (SFCT), total choroidal area (TCA), luminal choroidal area (LCA), and stromal choroidal area (SCA) were analyzed. Choroidal vascularity index (CVI) was calculated in all study eyes at baseline and at 1- and 3-months post-PDT. RESULTS: In eyes receiving PDT, Snellen visual acuity (VA) significantly improved at months 1 and 3 (P < .001). CMT and SFCT showed a significant reduction from baseline at months 1 and 3 (P < .001), whereas TCA and LCA showed a significant decrease only at the 1-month follow-up visit. Baseline mean TCA and LCA were 2.30 ± 1.41 mm2 and 1.23 ± 0.73 mm2, respectively, and decreased to 2.07 ± 1.21 mm2 and 1.08 ± 0.63 mm2 at the 1-month follow-up visit, respectively (P = .01). No significant changes were recorded for SCA and CVI. In the fellow eye group, VA, CMT, and all choroidal parameters showed no differences between baseline and any follow-up visits (all P > .05). CONCLUSIONS: After PDT for chronic CSCR we observed sustained reductions in CMT and SFCT, while reductions in TCA and LCA were only noted at the 1-month follow-up interval. These choroidal parameters may provide additional quantitative biomarkers to evaluate the anatomic response to therapy but await further prospective validation.


Assuntos
Coriorretinopatia Serosa Central/diagnóstico , Corioide/patologia , Fotoquimioterapia/métodos , Verteporfina/uso terapêutico , Acuidade Visual , Coriorretinopatia Serosa Central/tratamento farmacológico , Doença Crônica , Angiofluoresceinografia , Seguimentos , Fundo de Olho , Humanos , Macula Lutea/patologia , Fármacos Fotossensibilizantes/uso terapêutico , Estudos Retrospectivos , Tomografia de Coerência Óptica , Resultado do Tratamento
16.
Am J Ophthalmol ; 217: 1-9, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32360859

RESUMO

PURPOSE: This report examines the relationship between glaucomatous macular damage and facial recognition. In addition, it assesses the role of contrast sensitivity (CS) as an intermediary step in the causal pathway between macular damage and impairment of facial recognition. DESIGN: Prospective cross-sectional study. METHODS: This study was conducted in a single tertiary care center. The study population included 144 eyes of 72 participants with a diagnosis of open angle glaucoma in one or both eyes and a visual acuity of 20/40 or better in each eye. The presence or absence of macular damage was determined by comparing corresponding regions of the retinal nerve fiber layer and the retinal ganglion cell layer with spectral-domain optical coherence tomography with the 10-2 visual field (VF). Better and worse eye was determined by 10-2 VF mean deviations (MDs). Interventions were 1) macular function as measured by 10-2 VF and 2) CS as measured by the Freiburg Visual Acuity and Contrast Test (FrACT). The primary outcome measure was the Cambridge Face Memory Test (CFMT) score. RESULTS: Regardless of eye, there was a significant correlation between facial recognition and 10-2 VF MD (P < .0001 better, worse eye). The 10-2 VF MD remained a significant predictor of facial recognition after adjusting for potential confounders including glaucoma severity, CS, age, and visual acuity (P = .004 better eye, P = .019 worse eye). CONCLUSIONS: Even with good central visual acuity, patients with glaucomatous macular damage exhibit diminished facial recognition, which is partly mediated through diminished CS.


Assuntos
Reconhecimento Facial/fisiologia , Glaucoma/fisiopatologia , Macula Lutea/patologia , Doenças Retinianas/diagnóstico , Acuidade Visual , Idoso , Estudos Transversais , Progressão da Doença , Feminino , Glaucoma/complicações , Glaucoma/diagnóstico , Humanos , Pressão Intraocular/fisiologia , Masculino , Fibras Nervosas/patologia , Disco Óptico/patologia , Estudos Prospectivos , Doenças Retinianas/etiologia , Doenças Retinianas/fisiopatologia , Células Ganglionares da Retina/patologia , Tomografia de Coerência Óptica/métodos , Campos Visuais
17.
PLoS One ; 15(4): e0231552, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32298369

RESUMO

PURPOSE: Diabetic retinal neurodegeneration (DRN) has been demonstrated in eyes of patients with diabetes mellitus (DM), even in the absence of diabetic retinopathy (DR). However, no studies have looked at the rate of change in retinal layers and presence/development of DR over time per quadrant of the macula. In this longitudinal study, we aimed to clarify whether the rate of DRN is associated with the development/presence of DR within 4 different quadrants of the retina. METHODS: 80 eyes of 40 patients with type 1 DM and no/minimal DR were included. At 4 visits over 6 years, SD-OCT and fundus images were acquired. Thickness of the Retinal Nerve Fiber Layer (RNFL), Ganglion Cell Layer (GCL) and Inner Plexiform Layer (IPL) was measured in a 1-6mm circle around the fovea overall and for each quadrant (superior, nasal, inferior, temporal). Fundus images were scored for the presence/absence of DR in these areas. Multilevel analyses were performed to determine the rate of change for each layer overall and per quadrant for eyes/quadrants without and with DR during the follow-up period. RESULTS: RNFL and GCL showed significant thinning over time, IPL significant thickening. These changes were more pronounced for GCL and IPL in eyes/quadrants with DR during the follow-up period. CONCLUSIONS: RNFL and GCL both showed thinning over time, which was more pronounced in eyes with DR for GCL. This holds true even in regional parts of the retina, as quadrant analyses showed similar results, showing that structural DRN is associated with DR per quadrant independently.


Assuntos
Diabetes Mellitus Tipo 1/complicações , Retinopatia Diabética/patologia , Retina/patologia , Degeneração Retiniana/patologia , Adulto , Retinopatia Diabética/etiologia , Feminino , Fundo de Olho , Humanos , Estudos Longitudinais , Macula Lutea/patologia , Masculino , Degeneração Retiniana/etiologia , Neurônios Retinianos/patologia , Tomografia de Coerência Óptica
18.
Invest Ophthalmol Vis Sci ; 61(4): 10, 2020 04 09.
Artigo em Inglês | MEDLINE | ID: mdl-32293667

RESUMO

Purpose: To compare structure-function relationships based on the Drasdo and Sjöstrand retinal ganglion cell displacement models. Methods: Single eyes from 305 patients with glaucoma and 55 heathy participants were included in this multicenter, cross-sectional study. The ganglion cell and inner plexiform layer (GCIPL) thickness was measured using spectral domain optical coherence tomography. Visual field measurements were performed using the Humphrey 10-2 test. All A-scan pixels (128 × 512 pixels) were allocated to the closest 10-2 location with both displacement models using degree and millimeter scales. Structure-function relationships were investigated between GCIPL thickness and corresponding visual sensitivity in nonlong (160 eyes) and long (200 eyes) axial length (AL) groups. Results: In both the nonlong and long AL groups, compared with the no-displacement model, both the Drasdo and the Sjöstrand models showed that the structure-function relationship around the fovea improved (P < 0.05). The magnitude of improvement in the area was either comparable between the model or was larger for the Drasdo model than the Sjöstrand model (P < 0.05). Meanwhile, structure-function relationships outside the innermost retinal region that were based on the Drasdo and Sjöstrand models were comparable to or were even worse than (in the case of the Drasdo model) those obtained using the no-displacement model. Conclusions: Structure-function relationships evaluated based on both the Drasdo and Sjöstrand models significantly improved around the fovea, particularly when using the Drasdo model. This was not the case in other areas.


Assuntos
Células Ganglionares da Retina/fisiologia , Adulto , Estudos de Casos e Controles , Estudos Transversais , Feminino , Glaucoma de Ângulo Aberto/diagnóstico por imagem , Glaucoma de Ângulo Aberto/patologia , Glaucoma de Ângulo Aberto/fisiopatologia , Humanos , Macula Lutea/patologia , Macula Lutea/fisiopatologia , Masculino , Pessoa de Meia-Idade , Modelos Biológicos , Retina/patologia , Retina/fisiopatologia , Células Ganglionares da Retina/ultraestrutura , Tomografia de Coerência Óptica , Testes de Campo Visual , Campos Visuais
19.
Sci Rep ; 10(1): 6362, 2020 04 14.
Artigo em Inglês | MEDLINE | ID: mdl-32286476

RESUMO

Glaucomatous visual field (VF) damage usually involves in the Bjerrum area, which refers to outside the central 10° region. However, some reports suggest that structural damage to the macula occurs even in the early stages of glaucoma. We investigated the characteristics of normal tension glaucoma (NTG) patients with temporal retinal nerve fibre layer (RNFL) defects. Ninety eyes from 90 subjects including 30 normal eyes, 30 eyes of 30 patients with normal-tension glaucoma with temporal RNFL defects, and 30 eyes of 30 patients with normal-tension glaucoma with inferotemporal or superotemporal RNFL defects were enrolled. The best-corrected visual acuity (BCVA) decreased significantly in glaucomatous eyes with temporal RNFL defects as compared with in controls and glaucomatous eyes with inferotemporal or superotemporal RNFL defects. VF tests showed more frequent central or cecocentral VF defects involving the central 10° region in glaucomatous eyes with temporal RNFL defects. VF defects were more frequently detected on short-wavelength automated perimetry (SWAP). Eyes with temporal RNFL defects had generally reduced ganglion cell-inner plexiform layer (GCIPL) thickness. In addition, the BCVA, GCIPL thicknesses, and SWAP findings were significantly different in glaucoma patients with temporal RNFL defects according to their colour vision deficiency, not RNFL thickness or standard automated perimetry (SAP) results.


Assuntos
Glaucoma de Baixa Tensão/diagnóstico por imagem , Disco Óptico/diagnóstico por imagem , Doenças do Nervo Óptico/diagnóstico por imagem , Retina/diagnóstico por imagem , Feminino , Humanos , Pressão Intraocular/fisiologia , Glaucoma de Baixa Tensão/complicações , Glaucoma de Baixa Tensão/fisiopatologia , Macula Lutea/diagnóstico por imagem , Macula Lutea/patologia , Masculino , Pessoa de Meia-Idade , Fibras Nervosas/patologia , Disco Óptico/fisiopatologia , Doenças do Nervo Óptico/complicações , Doenças do Nervo Óptico/fisiopatologia , Retina/fisiopatologia , Células Ganglionares da Retina , Tomografia de Coerência Óptica , Acuidade Visual/fisiologia , Campos Visuais/fisiologia
20.
Arq. bras. oftalmol ; 83(2): 120-126, Mar.-Apr. 2020. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1088977

RESUMO

ABSTRACT Purpose: To investigate retinal microvasculature changes in patients treated with anti-VEGF for macular edema secondary to branch retinal vein occlusion. Methods: We examined 38 eyes of 19 patients for the study. We measured superficial and deep capillary plexus vessel densities (%), foveal avascular zone areas (mm2), and central macular thicknesses. Results: Parafoveal superficial and deep capillary plexus values were significantly lower in eyes with branch retinal vein occlusion than in fellow eyes (p<0.001). We found a significant increase in parafoveal deep capillary plexus values after the anti-VEGF treatment (p=0.032). The mean foveal avascular zone was larger in eyes with branch retinal vein occlusion than in control eyes (p<0.001). The mean central macular thickness was significantly higher in eyes with branch retinal vein occlusion than in controls, and we observed a significant decrease in central macular thickness after anti-VEGF treatment (<0.001). In addition, the cystic structures in the deep capillary plexus regressed. Conclusion: Optical coherence tomography angiography enables qualitative and quantitative evaluations during follow-up of patients treated for branch retinal vein occlusion.


RESUMO Objetivo: Investigar as alterações na microvascu latura da retina em pacientes tratados com anti-VEGF para ede ma macular secundário à oclusão de ramo da veia retiniana. Métodos: Foram examinados 38 olhos de 19 pacientes para o estudo. Medimos as densidades dos vasos do plexo capilar superficial e profunda (%), áreas da zona avascular foveal (mm2) e espessura macular central. Resultados: Os valores do plexo capilar superficial e profundo parafoveal foram significativamente menores nos olhos com oclusão de ramo da veia retiniana do que nos outros olhos (p<0,001). Encontramos um aumento significativo nos valores de plexo capilar profundo parafoveal após o tratamento com anti-VEGF (p=0,032). A zona avascular foveal média foi maior nos olhos com oclusão de ramo da veia retiniana do que nos olhos controle (p<0,001). A espessura macular central média foi significativamente maior nos olhos com oclusão de ramo da veia retiniana do que nos controles, e observamos uma diminuição significativa na espessura macular central após o tratamento com anti-VEGF (< 0,001). Além disso, as estruturas císticas no plexo capilar profundo regrediram. Conclusão: A angiotomografia de coerência óptica permite avaliações qualitativas e quantitativas durante o acompanhamento de pacientes tratados por oclusão de ramo da veia retiniana.


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Oclusão da Veia Retiniana/tratamento farmacológico , Angiofluoresceinografia/métodos , Edema Macular/tratamento farmacológico , Inibidores da Angiogênese/uso terapêutico , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Tomografia de Coerência Óptica/métodos , Valores de Referência , Fatores de Tempo , Oclusão da Veia Retiniana/complicações , Capilares/efeitos dos fármacos , Capilares/patologia , Capilares/diagnóstico por imagem , Edema Macular/etiologia , Edema Macular/patologia , Edema Macular/diagnóstico por imagem , Estudos Retrospectivos , Estatísticas não Paramétricas , Macula Lutea/efeitos dos fármacos , Macula Lutea/patologia , Macula Lutea/diagnóstico por imagem
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