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1.
BMJ Case Rep ; 14(2)2021 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-33526522

RESUMO

A 44-year-old woman presented with decreased vision in both eyes. The retina in both eyes had drusen distributed along vascular arcades, central macula and in peripapillary region. Macula had pigmented scarring and exudation. Fundus autofluorescence showed drusen. Optical coherence tomography showed drusen, subretinal and intraretinal fluid. Fundus fluorescein and indocyanine green angiography showed drusen, retinal pigment epithelial atrophy and vascular network. Younger age at presentation, bilateral symmetry, typical distribution of drusen along the arcades in a radiating pattern, peripapillary involvement, scarring and atrophy at macula were suggestive of doyne honeycomb retinal dystrophy. The reduced vision was due to macular atrophy and an active choroidal neovascular membrane. The patient was treated with antivascular endothelial growth factor injections for choroidal neovascular membrane. Our case highlights the importance of pattern recognition and multimodal imaging for diagnosing the type of macular dystrophy as doyne honeycomb retinal dystrophy, while simultaneously managing choroidal neovascular membrane.


Assuntos
Neovascularização de Coroide/diagnóstico por imagem , Angiofluoresceinografia , Tomografia de Coerência Óptica , Adulto , Inibidores da Angiogênese/uso terapêutico , Angiografia , Neovascularização de Coroide/complicações , Neovascularização de Coroide/tratamento farmacológico , Corantes , Feminino , Fundo de Olho , Humanos , Verde de Indocianina , Injeções Intravítreas , Imagem Multimodal , Drusas do Disco Óptico/complicações , Drusas do Disco Óptico/congênito , Drusas do Disco Óptico/diagnóstico por imagem , Ranibizumab/uso terapêutico
2.
Nat Commun ; 12(1): 34, 2021 01 04.
Artigo em Inglês | MEDLINE | ID: mdl-33397947

RESUMO

Colloidal gold nanoparticles (GNPs) serve as promising contrast agents in photoacoustic (PA) imaging, yet their utility is limited due to their absorption peak in the visible window overlapping with that of hemoglobin. To overcome such limitation, this report describes an ultrapure chain-like gold nanoparticle (CGNP) clusters with a redshift peak wavelength at 650 nm. The synthesized CGNP show an excellent biocompatibility and photostability. These nanoparticles are conjugated with arginine-glycine-aspartic acid (RGD) peptides (CGNP clusters-RGD) and validated in 12 living rabbits to perform multimodal photoacoustic microscopy (PAM) and optical coherence tomography (OCT) for visualization of newly developed blood vessels in the sub-retinal pigment epithelium (RPE) space of the retina, named choroidal neovascularization (CNV). The PAM system can achieve a 3D PAM image via a raster scan of 256 × 256 pixels within a time duration of 65 s. Intravenous injection of CGNP clusters-RGD bound to CNV and resulted in up to a 17-fold increase in PAM signal and 176% increase in OCT signal. Histology indicates that CGNP clusters could disassemble, which may facilitate its clearance from the body.


Assuntos
Ouro/química , Nanopartículas Metálicas/química , Microscopia , Imagem Molecular , Técnicas Fotoacústicas , Tomografia de Coerência Óptica , Animais , Neovascularização de Coroide/diagnóstico por imagem , Neovascularização de Coroide/patologia , Meios de Contraste/química , Feminino , Testes de Função Renal , Testes de Função Hepática , Masculino , Nanopartículas Metálicas/ultraestrutura , Camundongos , Oligopeptídeos/química , Coelhos , Distribuição Tecidual
3.
Zhonghua Yan Ke Za Zhi ; 56(12): 950-955, 2020 Dec 11.
Artigo em Chinês | MEDLINE | ID: mdl-33342122

RESUMO

Optical coherence tomography angiography (OCTA) is a novel, non-invasive imaging technology, which could acquire volumetric angiographic information. Numerous studies have reported the potential clinical use of OCTA in a variety of common retinal disorders. Polypoidal choroidal vasculopathy (PCV) is characterized by the formation of branching choroidal vascular networks (BVN) with terminal dilatations (polyps). Indocyanine green angiography (ICGA) remains the golden diagnostic standard for PCV. The clinical application of OCTA in PCV is also widely investigated recent years. But the results are controversially interpreted. In addition to various diagnostic accuracy of PCV from different studies, the clinical application of OCTA in PCV is limited. With the constant innovation of fundus imaging techniques, OCTA is reaching greater investigation depth and become more accurate at picking up blood flow signals, which also improves the diagnostic accuracy of PCV. In this paper, we reviewed the clinical application and research progress of OCTA in PCV, in order to provide some assistant for clinical practice and correct interpretation of the reports. (Chin J Ophthalmol, 2020, 56:950-955).


Assuntos
Doenças da Coroide , Neovascularização de Coroide , Corioide/diagnóstico por imagem , Doenças da Coroide/diagnóstico por imagem , Neovascularização de Coroide/diagnóstico por imagem , Angiofluoresceinografia , Fundo de Olho , Humanos , Verde de Indocianina , Estudos Retrospectivos , Tomografia de Coerência Óptica
4.
Graefes Arch Clin Exp Ophthalmol ; 258(12): 2621-2628, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33009973

RESUMO

PURPOSE: To estimate the impact of delayed care during the coronavirus disease 2019 (COVID-19) pandemic on the outcomes of patients with neovascular age-related macular degeneration (AMD). METHODS: Consecutive patients with diagnosis of neovascular AMD were consecutively enrolled between March 9, 2020, and June 12, 2020, (during and immediately after the Italian COVID-19 quarantine). During the inclusion (or pandemic) visit (V0), patients received a complete ophthalmologic evaluation, including optical coherence tomography (OCT). Best-corrected visual acuity (BCVA) and OCT findings from the two preceding visits (V-1 and V-2) were compared with data at V0. RESULTS: One-hundred patients (112 eyes) were enrolled in this study. The time interval between following visits was 110.7 ± 37.5 days within V0 and V-1 and 80.8 ± 39.7 days within V-1 and V-2, respectively (P < 0.0001). BCVA was statistically worse at the V0 visit as compared with the immediately preceding (V-1) visit (0.50 ± 0.43 LogMAR and 0.45 ± 0.38 LogMAR at the V0 and V-1 visits, respectively; P = 0.046). On structural OCT, 91 out of 112 (81.2%) neovascular AMD eyes displayed the evidence of exudative disease activity at the V0 visit, while 77 (68.7%) eyes exhibited signs of exudation at the V-1 visit (P = 0.022). No differences in terms of BCVA and OCT findings were detected between the V-1 and V-2 visits. In multiple regression analysis, the difference in BCVA between V0 and V-1 visits was significantly associated with the interval time within these two visits (P = 0.026). CONCLUSION: The COVID-19 pandemic-related postponement in patient care proved to be significantly associated with worse short-term outcomes in these patients.


Assuntos
Inibidores da Angiogênese/uso terapêutico , Betacoronavirus , Neovascularização de Coroide/tratamento farmacológico , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Neovascularização Retiniana/tratamento farmacológico , Tempo para o Tratamento , Degeneração Macular Exsudativa/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Bevacizumab/uso terapêutico , Neovascularização de Coroide/diagnóstico por imagem , Neovascularização de Coroide/fisiopatologia , Feminino , Humanos , Injeções Intravítreas , Masculino , Pessoa de Meia-Idade , Pandemias , Quarentena , Ranibizumab/uso terapêutico , Receptores de Fatores de Crescimento do Endotélio Vascular/uso terapêutico , Proteínas Recombinantes de Fusão/uso terapêutico , Neovascularização Retiniana/diagnóstico por imagem , Neovascularização Retiniana/fisiopatologia , Líquido Sub-Retiniano , Tomografia de Coerência Óptica , Resultado do Tratamento , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Acuidade Visual/fisiologia , Degeneração Macular Exsudativa/diagnóstico por imagem , Degeneração Macular Exsudativa/fisiopatologia
5.
Klin Monbl Augenheilkd ; 237(11): 1312-1319, 2020 Nov.
Artigo em Inglês, Alemão | MEDLINE | ID: mdl-32869243

RESUMO

PURPOSE: Choroidal neovascularization (CNV) in neovascular age-related macular degeneration (nAMD) undergoing anti-VEGF therapy transforms into a fibrotic lesion. This fibrovascular transformation is associated with a great variety of functional and morphological effects. The aim of this study was to investigate the vascular morphology of fibrotic CNV, to compare it with its surrounding tissue and to identify phenotypes using optical coherence tomography angiography (OCTA). METHODS: In 18 eyes with fibrotic CNV in nAMD spectral domain OCT (SD-OCT) and OCTA were performed. The automated segmentation lines were manually adjusted. A slab from 60 µm beneath Bruch's membrane to the inner edge of the subretinal hyperreflective material was applied. Quantitative analysis of the vascular morphology was performed using skeletonized OCTA images. RESULTS: Compared to the perilesional rim, the number of segments per area was significantly lower (234.75 ± 25.68 vs. 255.30 ± 20.34 1/mm2, p = 0.0003) within the fibrovascular lesion. Two phenotypes could be identified within the lesion. The phenotypic traits of cluster 1 were few, long and thick vascular segments; Cluster 2 was characterized by many, short and thin vascular segments (number of segments per area: 219.4 ± 18.8 vs. 258.8 ± 13.2 1/mm2, p = 0.00009, segment length: 49.6 ± 2.7 vs. 45.0 ± 1.3 µm, p = 0.0002, vascular caliber: 26.6 ± 1.2 vs. 23.5 ± 1.8 µm, p = 0.003). The clusters did not differ significantly regarding visual acuity (0.52 ± 0.44 vs. 0.54 ± 0.18 logMAR, p = 0.25), differentiability of subretinal (OR = 3.43, CI = [0.30, 39.64], p = 0.6) and intraretinal fluid (OR = 5.34, CI = [0.48, 89.85], p = 0.14). Less normalized ellipsoid zone (EZ) loss could be observed in cluster 1 (131.0 ± 161.3 vs. 892.4 ± 955.6 1/m, p = 0.006). CONCLUSION: In this study the vascular morphology of fibrotic CNV was analyzed using OCTA. Differences between the lesion and a perilesional rim could be detected. Two phenotypes within the fibrovascular lesion were identified. These morphological clusters could indicate different patterns of fibrovascular transformation of the CNV under long-term anti-VEGF therapy and be useful identifying possible predictive biomarkers in future studies.


Assuntos
Neovascularização de Coroide , Degeneração Macular , Degeneração Macular Exsudativa , Inibidores da Angiogênese/uso terapêutico , Neovascularização de Coroide/diagnóstico por imagem , Neovascularização de Coroide/tratamento farmacológico , Angiofluoresceinografia , Humanos , Injeções Intravítreas , Degeneração Macular/complicações , Degeneração Macular/diagnóstico por imagem , Degeneração Macular/tratamento farmacológico , Tomografia de Coerência Óptica , Degeneração Macular Exsudativa/complicações , Degeneração Macular Exsudativa/diagnóstico por imagem , Degeneração Macular Exsudativa/tratamento farmacológico
6.
PLoS One ; 15(9): e0239555, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32966311

RESUMO

OBJECTIVE: To investigate the thicknesses of the ganglion cell-inner plexiform layer (GC-IPL) and retinal nerve fiber layer (RNFL) of the fellow eyes of patients with unilateral exudative age-related macular degeneration (AMD). METHODS: A total of 107 patients with unilateral exudative AMD [34 of typical choroidal neovascularization (tCNV), Group A; 73 of polypoidal choroidal vasculopathy (PCV), Group B] and 73 normal control eyes (Group C) were included. Drusen and subretinal drusenoid deposits were assessed in all participants using fundus photography, autofluorescence, and optical coherence tomography (OCT). The GC-IPL and RNFL thicknesses were measured using Cirrus HD-OCT and compared among groups. Linear regression analyses were used to evaluate the factors associated with GC-IPL thicknesses. RESULTS: The average GC-IPL thicknesses of Groups A, B, and C were 77.09 ± 3.87, 80.10 ± 6.61, and 80.88 ± 6.50 µm, respectively (p = 0.022). Sectoral GC-IPLs and central macular thicknesses (CMTs) were significantly different among groups (all, p <0.05), whereas none of the RNFL parameters differed significantly (all, p >0.05). Multivariate linear regression analyses revealed that age (p <0.001), CMT (p <0.001), and tCNV (p = 0.013) were significantly associated with average GC-IPL thickness, and the rate of reduction of GC-IPL thickness with increasing age in the fellow eyes of tCNV patients was higher than those in the PCV and control groups. CONCLUSIONS: Unilateral tCNV patients exhibited statistically significant reduction of the GC-IPL thickness in the fellow eyes, compared to values of the fellow eyes of unilateral PCV patients or control patients. RNFL values trended to be lower but did not reach statistical significance.


Assuntos
Degeneração Macular/diagnóstico por imagem , Retina/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Neovascularização de Coroide/diagnóstico por imagem , Neovascularização de Coroide/patologia , Feminino , Angiofluoresceinografia , Humanos , Degeneração Macular/patologia , Masculino , Pessoa de Meia-Idade , Fibras Nervosas/patologia , Retina/patologia , Células Ganglionares da Retina/patologia , Neurônios Retinianos/patologia , Estudos Retrospectivos , Tomografia de Coerência Óptica
7.
Medicine (Baltimore) ; 99(30): e21472, 2020 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-32791764

RESUMO

INTRODUCTION: Choroidal osteoma (CO) is a rare benign ocular tumor characterized by ossifying choroid lesions. To the best of our knowledge, this is the first detailed report to describe the optical coherence tomography angiography (OCTA) findings of choroidal neovascularization (CNV) complicated by a rare decalcified CO following intravitreal aflibercept injection. PATIENT CONCERNS: A 26-year-old woman presented with a spontaneous but painless reduction in visual acuity in her left eye that had commenced 5 days prior. DIAGNOSIS: Clinical manifestations and multimodal imaging, including OCTA, spectral-domain optical coherence tomography, fundus fluorescein angiography and indocyanine green angiography, indicated decalcified CO with CNV. INTERVENTIONS: After receiving an appropriately detailed explanation of the procedure, the patient was treated via intravitreal aflibercept(2.0 mg) injection once. OUTCOMES: One month after the therapy, OCTA revealed that the flow areas of CNV were narrowed, the best-corrected visual acuity was improved to 20/30, however, 2 months follow-up OCTA revealed that the CNV reoccurred, the best-corrected visual acuity was dropped to 20/50. CONCLUSION: Intravitreal aflibercept injection was an effective treatment for CO with CNV, but the effects may not last long. The OCTA findings provide a better appreciation of evaluating the effects of intravitreal aflibercept injection for CO complicating CNV.


Assuntos
Neoplasias da Coroide/diagnóstico por imagem , Neovascularização de Coroide/diagnóstico por imagem , Osteoma/diagnóstico por imagem , Adulto , Angiografia , Neoplasias da Coroide/complicações , Neovascularização de Coroide/etiologia , Feminino , Humanos , Osteoma/complicações , Tomografia de Coerência Óptica
8.
Digit J Ophthalmol ; 26(1): 1-7, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32547330

RESUMO

Type 1 extrafoveal choroidal neovascularization (CNV) secondary to neovascular age-related macular degeneration was diagnosed in a 68-year-old woman using optical coherence tomography angiography (OCT-A) alone. The entire network of vessels was clearly visible on a 12 × 12 mm OCT-A scan segmented below the retinal pigment epithelium. The patient was initially treated with intravitreal ranibizumab followed by photodynamic therapy (PDT) guided by OCT-A. Complete resolution of subretinal fluid with shrinkage of the neovascular complex was noted 1 month after PDT.


Assuntos
Neovascularização de Coroide/tratamento farmacológico , Angiofluoresceinografia , Fotoquimioterapia , Fármacos Fotossensibilizantes/uso terapêutico , Tomografia de Coerência Óptica , Degeneração Macular Exsudativa/tratamento farmacológico , Idoso , Inibidores da Angiogênese/uso terapêutico , Neovascularização de Coroide/diagnóstico por imagem , Quimioterapia Combinada , Feminino , Fóvea Central , Humanos , Injeções Intravítreas , Ranibizumab/uso terapêutico , Líquido Sub-Retiniano , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Degeneração Macular Exsudativa/diagnóstico por imagem
9.
Am J Ophthalmol ; 214: 151-171, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32112774

RESUMO

PURPOSE: To describe the spectral-domain optical coherence tomography (OCT) features of fibrotic lesions associated with neovascular age-related macular degeneration (nAMD) and to outline the progression pathways from initial macular choroidal neovascular lesions (CNVs) to fibrosis. METHODS: Patients with nAMD were retrospectively included when macular subretinal fibrosis was present. Fibrosis was categorized using spectral-domain OCT with respect to retinal pigment epithelium (RPE) in 836 spectral-domain OCT slices from 44 eyes of 39 patients. In addition, in 47 distinct eyes, 4181 spectral-domain OCT slices were retrospectively reviewed to longitudinally assess progression from the initial lesion to the final fibrosis. RESULTS: Cross-sectional analysis classified fibrosis on spectral-domain OCT slices, as type A if located underneath the RPE, as type B if located above the RPE, and as type C if the remaining RPE was undistinguishable. The longitudinal analysis series revealed 3 progression pathways from the original CNV: 1) progression to type A, followed by RPE erosion and subretinal hyperreflective material, then type B and type C fibroglial lesion (FGL; 17/47 eyes); 2) progression to type B then type C FGL (17/47 eyes); and 3) persistence of type A with development of a flat, fibroatrophic lesion (13/47 eyes). Subretinal hyperreflective material, macular hemorrhage, or RPE tear occurred in 14 of 47, 13 of 47, and 10 of 47 eyes, respectively. CONCLUSION: This spectral-domain OCT analysis identified various patterns of macular fibrosis in eyes with nAMD. Three pathways of progression to fibrosis were described including the well-established pathway of type 2 CNV progression to FGL and the progression of type 1 fibrovascular CNV to FGL or fibroatrophic lesion.


Assuntos
Neovascularização de Coroide/diagnóstico por imagem , Retina/patologia , Epitélio Pigmentado da Retina/patologia , Tomografia de Coerência Óptica , Degeneração Macular Exsudativa/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Inibidores da Angiogênese/uso terapêutico , Neovascularização de Coroide/tratamento farmacológico , Estudos Transversais , Feminino , Fibrose , Angiofluoresceinografia , Humanos , Injeções Intravítreas , Masculino , Imagem Multimodal , Retina/diagnóstico por imagem , Epitélio Pigmentado da Retina/diagnóstico por imagem , Estudos Retrospectivos , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Acuidade Visual , Degeneração Macular Exsudativa/tratamento farmacológico
10.
Doc Ophthalmol ; 141(2): 137-147, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32100141

RESUMO

PURPOSE: To determine the changes in the cone-driven functions in patients with age-related macular degeneration (AMD) treated with intravitreal aflibercept. METHODS: We studied 44 eyes of 44 patients diagnosed with AMD whose mean age was 75 years. The contralateral unaffected eyes served as controls. All patients were initially treated with 3 consecutive monthly intravitreal aflibercept injections and thereafter with bimonthly injections for 12 months. Full-field cone electroretinograms (cone ERGs) were recorded at the baseline and at 3, 6, and 12 months after beginning the intravitreal aflibercept injections. The cone ERGs were elicited by red stimuli on a blue background. The focal macular ERGs (fmERGs) were elicited by 15 degrees white stimulus spot centered on the fovea. The amplitudes of the a- and b-waves, photopic negative response (PhNR), and sum of the oscillatory potentials (ΣOPs, sum of OP1-3 amplitudes) were analyzed. In addition, the implicit times of the a- and b-waves were also analyzed. RESULTS: The amplitudes and implicit times of all components of the fmERGs were significantly improved compared to the baseline at 3 months after beginning the intravitreal aflibercept injections (P < 0.0005-0.05). The amplitudes of the a-waves and PhNRs were further increased during the maintenance phase (P < 0.005-0.01). On the other hand, the amplitudes of the full-field a-waves and PhNR of the cone ERGs were significantly reduced at 6 and 12 months compared to the baseline. CONCLUSIONS: The macular function improved continuously during the maintenance phase of the intravitreal aflibercept injections. In contrast, the cone-driven functions of the more peripheral retina decreased with repeated injections suggesting adverse effects of the intravitreal aflibercept injections on the function of the more peripheral normal retina.


Assuntos
Inibidores da Angiogênese/uso terapêutico , Neovascularização de Coroide/tratamento farmacológico , Receptores de Fatores de Crescimento do Endotélio Vascular/uso terapêutico , Proteínas Recombinantes de Fusão/uso terapêutico , Células Fotorreceptoras Retinianas Cones/fisiologia , Degeneração Macular Exsudativa/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Neovascularização de Coroide/diagnóstico por imagem , Neovascularização de Coroide/fisiopatologia , Eletrorretinografia , Feminino , Humanos , Injeções Intravítreas , Masculino , Pessoa de Meia-Idade , Receptores de Fatores de Crescimento do Endotélio Vascular/antagonistas & inibidores , Tomografia de Coerência Óptica , Degeneração Macular Exsudativa/diagnóstico por imagem , Degeneração Macular Exsudativa/fisiopatologia
12.
Sci Rep ; 10(1): 1203, 2020 Jan 27.
Artigo em Inglês | MEDLINE | ID: mdl-31988359

RESUMO

We evaluated phenotype and genotype correlation of central serous chorioretinopathy (CSC) patients with or without irregular pigment epithelial detachment (PED) on optical coherence tomography (OCT). For CSC, a flat, irregular protrusion of retinal pigment epithelium (RPE) with hyper-reflective sub-RPE fluid on OCT was defined as an irregular PED. Participants were classified into 5 subgroups; (1) total CSC (n = 280) (2) CSC with irregular PED (n = 126) (3) CSC without irregular PED (n = 154) (4) typical choroidal neovascularization (CNV) (n = 203) and (5) polypoidal choroidal vasculopathy (PCV) (n = 135). Ten known major AMD-associated single-nucleotide polymorphisms (SNPs) were analyzed. Age, sex adjusted logistic regression was performed for the association between subgroups. Association analysis between CSC without irregular PED and CNV revealed that significant difference for rs10490924 in ARMS2, rs10737680 in CFH, and marginally significant difference for rs800292 in CFH. Between CSC without irregular PED and PCV, rs10490924, rs10737680, and rs800292 were significantly different. In contrast, CSC with irregular PED and CNV revealed no SNP showing significant difference. Between CSC with irregular PED and PCV, only rs10490924 was significantly different. CSC with irregular PED and CSC without irregular PED revealed significant difference for rs800292, and marginal difference for rs10737680. These findings suggest CSC patients with irregular PED are genetically different from those without irregular PED and may have genetic and pathophysiologic overlap with AMD patients.


Assuntos
Coriorretinopatia Serosa Central/genética , Genótipo , Degeneração Macular/genética , Polimorfismo de Nucleotídeo Único/genética , Descolamento Retiniano/genética , Adulto , Idoso , Idoso de 80 Anos ou mais , Coriorretinopatia Serosa Central/complicações , Coriorretinopatia Serosa Central/diagnóstico por imagem , Neovascularização de Coroide/diagnóstico por imagem , Neovascularização de Coroide/genética , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Degeneração Macular/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Fenótipo , Descolamento Retiniano/complicações , Descolamento Retiniano/diagnóstico por imagem , Tomografia de Coerência Óptica
13.
Br J Ophthalmol ; 104(1): 58-63, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31302628

RESUMO

AIM: To show the characteristics and outcomes of patients with neovascular age-related macular degeneration (nAMD) who had extended remission (ER) while on a pro re nata (PRN) treatment protocol. METHODS: This was a retrospective case-control study of a consecutive series of patients with nAMD treated with a PRN antivascular endothelial growth factor (anti-VEGF) drug regimen. ER was defined as the absence of haemorrhage, intraretinal/subretinal fluid on optical coherence tomography and leakage on fluorescein angiography for 52 weeks after cessation of anti-VEGF therapy. Matching patients with nAMD who did not achieve ER were included as control group. Cox regression analysis was fitted to identify predictors of time to achieve ER and time to recurrence. A logistic regression analysis of baseline characteristics was used to identify predictors of achieving ER. RESULTS: Of 830 eyes treated with anti-VEGF monotherapy, 77 (9.2%) eyes achieved ER during a median follow-up of 236 weeks (range 70-525 weeks). Cox regression analysis showed that ER was achieved earlier in eyes with isolated intraretinal fluid (HR, 2.05; 95% CI 1.929 to 4.520; p=0.045) at presentation. Logistic regression analysis showed that type 3 choroidal neovascularisation (OR, 0.090; 95% CI 0.021 to 0.382; p=0.001), thinner choroid (OR, 0.993; 95% CI 0.988 to 0.998; p=0.004) and absence of macular atrophy (OR, 0.233; 95% CI 0.065 to 0.839; p=0.026) at baseline increased the likelihood of achieving ER. CONCLUSION: ER is achievable in 9.2% of patients under PRN therapy for nAMD. At presentation with nAMD, anatomical features on retinal imaging may predict the likelihood of achieving ER and a shorter time to achieve ER.


Assuntos
Inibidores da Angiogênese/uso terapêutico , Degeneração Macular Exsudativa/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Inibidores da Angiogênese/administração & dosagem , Estudos de Casos e Controles , Neovascularização de Coroide/diagnóstico por imagem , Neovascularização de Coroide/tratamento farmacológico , Neovascularização de Coroide/fisiopatologia , Esquema de Medicação , Feminino , Angiofluoresceinografia , Seguimentos , Humanos , Injeções Intravítreas , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Prognóstico , Recidiva , Indução de Remissão , Tomografia de Coerência Óptica , Resultado do Tratamento , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Acuidade Visual/efeitos dos fármacos , Degeneração Macular Exsudativa/diagnóstico por imagem , Degeneração Macular Exsudativa/fisiopatologia
14.
Eur J Ophthalmol ; 30(5): 1082-1090, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31088111

RESUMO

IMPORTANCE: To provide new insights into aflibercept effect in non-naive-treated patients with neovascular age-related macular degeneration. PURPOSE: To assess the efficacy of intravitreal aflibercept in patients with neovascular age-related macular degeneration without optimal response to previous anti-vascular endothelial growth factor A therapy. DESIGN: Single-arm, multi-centre, prospective study. PARTICIPANTS: Patients ⩾50 years with active neovascular age-related macular degeneration, best-corrected visual acuity between 20/32 and 20/320 with suboptimal response to ranibizumab or bevacizumab. METHODS: Aflibercept was administered monthly (3-first months), and bimonthly thereafter until month 8. Anatomical and functional outcomes were assessed. MAIN OUTCOME MEASURE: Percentage of eyes without intra or subretinal fluid on optical coherence tomography after 3-monthly loading doses of aflibercept. RESULTS: A total of 46 patients were included. At week 12, 45.7% (95% confidence interval: 31.5%-60.1%) of eyes showed no fluid on optical coherence tomography. The mean (standard deviation) best-corrected visual acuity increased from 65.1 (8.3) to 69.6 (8.1) letters (+4.5 (5.8) p < 0.0001) and was stabilized at week 40 as compared to baseline. Mean central macular thickness decreased from 430 (119) µm to 323 (100) µm at week 12 (-107 (90) µm, p < 0.0001) and was reduced at week 40 (-46 (111) µm, p = 0.0056). At week 40, 21.7% (95% confidence interval: 9.8%-33.7%) had no fluid. There was a case of presumed noninfectious endophthalmitis that was successfully managed. CONCLUSION: Almost half of patients presented no fluid on optical coherence tomography at week 12, and there was a clinically significant improvement in best-corrected visual acuity. At week 40, one in five patients did not show intra or subretinal fluid, central macular thickness decreased and best-corrected visual acuity was stabilized compared to baseline.


Assuntos
Inibidores da Angiogênese/uso terapêutico , Neovascularização de Coroide/tratamento farmacológico , Receptores de Fatores de Crescimento do Endotélio Vascular/uso terapêutico , Proteínas Recombinantes de Fusão/uso terapêutico , Degeneração Macular Exsudativa/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Neovascularização de Coroide/diagnóstico por imagem , Neovascularização de Coroide/fisiopatologia , Feminino , Seguimentos , Humanos , Injeções Intravítreas , Masculino , Estudos Prospectivos , Líquido Sub-Retiniano , Tomografia de Coerência Óptica , Resultado do Tratamento , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Acuidade Visual/fisiologia , Degeneração Macular Exsudativa/diagnóstico por imagem , Degeneração Macular Exsudativa/fisiopatologia
16.
Eur J Ophthalmol ; 30(1): NP21-NP24, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30409043

RESUMO

PURPOSE: To evaluate the role of multimodal imaging in the diagnosis and monitoring of patients with osteogenesis imperfecta complicated with choroidal neovascularization. CASE REPORT: A 28-year-old man, diagnosed with osteogenesis imperfecta, was referred 2 months after the appearance of central scotoma and metamorphopsia in the right eye. The patient underwent a complete ophthalmological evaluation including visual acuity examination as well as ophthalmoscopy, spectral-domain optical coherence tomography, optical coherence tomography angiography, fundus autofluorescence imaging, fluorescein angiography and microperimetry. Complete examination revealed macular lacquer crack with subretinal haemorrhage. A further investigation with spectral-domain optical coherence tomography and fluorescein angiography revealed the presence of choroidal neovascularization without clear activity associated to the lacquer crack. After a 1-month follow-up, both visual acuity and retinal sensitivity improved spontaneously. CONCLUSION: Collagen deficiency of osteogenesis imperfecta leads to fragility of the Bruch's membrane; tension forces probably act at this level determining ruptures with bleeding and choroidal neovascularization formation. Multimodal imaging and functional evaluation are needed to assess retinal alterations in patients with osteogenesis imperfecta, whereas treatment of choroidal neovascularization should be reserved only for active lesion to prevent evolution and visual acuity decrement.


Assuntos
Neovascularização de Coroide/diagnóstico por imagem , Imagem Multimodal , Osteogênese Imperfeita/diagnóstico por imagem , Adulto , Neovascularização de Coroide/etiologia , Angiofluoresceinografia/métodos , Humanos , Masculino , Oftalmoscopia/métodos , Imagem Óptica , Osteogênese Imperfeita/complicações , Tomografia de Coerência Óptica/métodos , Acuidade Visual/fisiologia
17.
Eur J Ophthalmol ; 30(3): NP24-NP26, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31018677

RESUMO

PURPOSE: To report the presence of a new structural optical coherence tomography finding, namely, subretinal pseudocysts, in a patient affected by age-related macular degeneration. METHODS: Case report including multimodal imaging discussion. CASE REPORT: We report a case of a 77-year-old woman affected by age-related macular degeneration from 7 years. Best corrected visual acuity was counting fingers and 20/40 in the right and left eye, respectively. The left eye was affected by type 1 macular neovascularization treated by 34 intravitreal injections of anti-vascular endothelial growth factor (22 ranibizumab and 12 aflibercept injections). Interestingly, structural optical coherence tomography showed the persistence of a subretinal cystoid space (i.e. 'subretinal pseudocyst') after the last anti-vascular endothelial growth factor treatment, even in absence of other signs of exudation. CONCLUSIONS: Subretinal pseudocysts are a new structural optical coherence tomography entity. We reported for the first time the evidence that pseudocysts may develop in the subretinal space in a case of age-related macular degeneration.


Assuntos
Neovascularização de Coroide/diagnóstico por imagem , Edema Macular/diagnóstico por imagem , Tomografia de Coerência Óptica/métodos , Degeneração Macular Exsudativa/diagnóstico por imagem , Idoso , Inibidores da Angiogênese/uso terapêutico , Neovascularização de Coroide/tratamento farmacológico , Feminino , Angiofluoresceinografia/métodos , Humanos , Injeções Intravítreas , Edema Macular/tratamento farmacológico , Imagem Multimodal , Ranibizumab/uso terapêutico , Receptores de Fatores de Crescimento do Endotélio Vascular/uso terapêutico , Proteínas Recombinantes de Fusão/uso terapêutico , Estudos Retrospectivos , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Acuidade Visual/fisiologia , Degeneração Macular Exsudativa/tratamento farmacológico
18.
BMJ Case Rep ; 12(12)2019 Dec 04.
Artigo em Inglês | MEDLINE | ID: mdl-31806631

RESUMO

A 62-year-old woman with no associated risk factors was diagnosed as a case of type 1 choroidal neovascularisation (CNV) associated with central serous chorioretinopathy in both the eyes based on clinical features and multimodal imaging. She was primarily treated with low fluence photodynamic therapy and responded well to the treatment. There was persistence of neovascular network seen on optical coherence tomography angiography (OCTA) without any signs of activity on optical coherence tomography. However, after 5 years she developed recurrent CNV in the left eye with a new type 2 CNV as seen on OCTA which had a higher flow signal strength as compared with the previous type 1 CNV. Following two doses of intravitreal ziv-aflibercept, the new type 2 CNV network regressed as evident on OCTA along with improvement in best corrected visual acuity.


Assuntos
Coriorretinopatia Serosa Central/diagnóstico por imagem , Neovascularização de Coroide/diagnóstico por imagem , Tomografia de Coerência Óptica , Coriorretinopatia Serosa Central/tratamento farmacológico , Coriorretinopatia Serosa Central/patologia , Neovascularização de Coroide/tratamento farmacológico , Neovascularização de Coroide/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Fotoquimioterapia , Resultado do Tratamento
19.
Sci Rep ; 9(1): 19240, 2019 12 17.
Artigo em Inglês | MEDLINE | ID: mdl-31848438

RESUMO

The advent of anti-vascular endothelial growth factor (VEGF) therapies has remarkably improved the functional outcomes of neovascular age-related macular degeneration (nAMD) patients. However, there are guidelines on how to start treatment, the guidelines for discontinuing treatment are not yet clear. In this respect, the treat-extend-stop (TES) protocol have showed us the possibility of discontinuing treatment. In this study, we tried to investigate optical coherence tomography angiography (OCTA) biomarkers related to recurrence of neovascular activity in eyes with nAMD undergoing treatment using TES protocol. A total of 134 eyes with nAMD were divided into two groups (stop, non-stop) depending on whether they met criteria for stopping anti-VEGF treatment. Quantitative and qualitative OCTA parameters including the morphologic pattern of choroidal neovascularization (CNV) were compared between groups. Of these, 44 eyes (32.8%) were in the stop group and 90 eyes (67.2%) were in the non-stop group. In multivariate regression analysis, closed-circuit pattern of CNV and the presence of peripheral loop were associated with the non-stop group (all p < 0.001). Our results imply that the morphologic appearance of CNV on OCTA after anti-VEGF treatment may be a useful biomarker to predict weaning from treatment.


Assuntos
Inibidores da Angiogênese/administração & dosagem , Neovascularização de Coroide , Degeneração Macular , Tomografia de Coerência Óptica , Idoso , Idoso de 80 Anos ou mais , Neovascularização de Coroide/diagnóstico por imagem , Neovascularização de Coroide/tratamento farmacológico , Neovascularização de Coroide/metabolismo , Feminino , Humanos , Degeneração Macular/diagnóstico por imagem , Degeneração Macular/tratamento farmacológico , Degeneração Macular/metabolismo , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
20.
Ophthalmic Surg Lasers Imaging Retina ; 50(10): 620-626, 2019 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-31671194

RESUMO

BACKGROUND AND OBJECTIVE: To identify choroidal neovascular membrane (CNVM) associated with spectral-domain optical coherence tomography (SD-OCT)-defined pigment epithelial detachment (PED) using SD-OCT angiography (SD-OCTA). PATIENTS AND METHODS: Sixty-nine patients with same-day OCT and OCTA imaging were reviewed, and 41 eyes of 29 patients with PEDs were included. OCTs were analyzed for PED type, fluid, and subretinal hyperreflective material (SHRM). RESULTS: Twenty-seven eyes (66%) demonstrated CNVM on OCTA beneath all subtypes of PED. Twenty-two eyes (75.9%) with fluid or SHRM demonstrated CNVM on OCTA (P = .036). Fluid corresponded in a statistically significant manner with treatment (P = .0032), whereas SHRM did not (P = .613). OCTA-defined CNVM showed borderline statistically significant correlation to treatment (P = .05). Increased choroidal flow signal seen in 50% of eyes did not demonstrate statistically significant correlation to the presence of fluid on SD-OCT (P = .2798) or treatment decision (P = .678). A subset of 14 untreated eyes with CNVM was analyzed, 21% of which required treatment at subsequent visits. CONCLUSIONS: OCTA-defined CNVM was seen in all subtypes of PED in clinically active and inactive disease. The role of OCTA in predicting need for treatment remains to be established. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:620-626.].


Assuntos
Neovascularização de Coroide/patologia , Degeneração Retiniana/patologia , Descolamento Retiniano/patologia , Epitélio Pigmentado da Retina/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Neovascularização de Coroide/diagnóstico por imagem , Feminino , Angiofluoresceinografia/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia de Coerência Óptica/métodos
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