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1.
Eur J Ophthalmol ; 30(1): NP1-NP4, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30301374

RESUMO

Twenty-six-year-old male patient admitted to the outpatient clinic with a complaint of decreased vision in both eyes. Visual acuity was 2/10 in the right and 7/10 in the left eye. Fundus examination revealed bilateral yellow-white subretinal lesions involving the macula. Fluorescein angiography showed hypofluorescent lesions in early and hyperflourescent lesions in the late phase. Optical coherence tomography angiography performed in the acute phase showed bilateral hypofluorescency at the choriocapillary level. A diagnosis of acute posterior multifocal placoid pigment epitheliopathy was given. After steroid treatment, visual acuity was improved to 10/10 and earlier lesions in optical coherence tomography angiography were found to be reduced. In conclusion, optical coherence tomography angiography is a noninvasive imaging technique that can be used in the diagnosis and follow-up of acute posterior multifocal placoid pigment epitheliopathy.


Assuntos
Angiofluoresceinografia/métodos , Tomografia de Coerência Óptica/métodos , /diagnóstico , Doença Aguda , Adulto , Glucocorticoides/uso terapêutico , Humanos , Masculino , Transtornos da Visão/diagnóstico , Transtornos da Visão/tratamento farmacológico , Transtornos da Visão/fisiopatologia , Acuidade Visual/fisiologia , /fisiopatologia
2.
Turk J Ophthalmol ; 49(4): 188-193, 2019 09 03.
Artigo em Inglês | MEDLINE | ID: mdl-31486605

RESUMO

Objectives: Ocular tuberculosis is an extrapulmonary tuberculous infection and has varying manifestations which pose a huge challenge to diagnosis and treatment. The purpose of this study is to describe the various clinical manifestations of ocular inflammations due to tuberculosis and to assess the response to treatment following antituberculous therapy (ATT) and corticosteroids in these patients. Materials and Methods: We performed a retrospective analysis of 29 patients with presumed ocular tuberculosis who were started on ATT and completed follow-up of at least 6 months after ATT was initiated. The data collected were: age at presentation, sex, laterality, presence or absence of pulmonary/extrapulmonary tuberculosis, history of exposure to tuberculosis, site of ocular involvement and duration of illness, visual acuity at presentation and at 6-month follow-up, and response to treatment. Results: Most of the patients were of economically productive age, between 21-60 years. This most common presentation in our study population was unilateral nongranulomatous anterior uveitis. In spite of the delay between symptom onset and start of therapy, favorable response was noted in 79.3% of patients at completion of 6 months of ATT. The various reasons for the delay in start of therapy were also evaluated. Conclusion: In this case series, we presented the various ocular manifestations and the difficulties faced in the diagnosis of presumed ocular tuberculosis. Outcomes of ATT were favorable in most of our patients. Thus, the clinician should exercise a very high degree of suspicion and should not withhold a trial of ATT.


Assuntos
Edema Macular/tratamento farmacológico , Tuberculose Ocular , Uveíte/tratamento farmacológico , Corticosteroides/uso terapêutico , Adulto , Antituberculosos/uso terapêutico , Quimioterapia Combinada , Feminino , Glucocorticoides/uso terapêutico , Humanos , Edema Macular/etiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tuberculose Ocular/complicações , Tuberculose Ocular/tratamento farmacológico , Tuberculose Ocular/patologia , Tuberculose Ocular/fisiopatologia , Uveíte/etiologia , Transtornos da Visão/tratamento farmacológico , Acuidade Visual , Adulto Jovem
3.
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
4.
Pediatr Rheumatol Online J ; 17(1): 29, 2019 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-31182107

RESUMO

BACKGROUND: Behçet's disease is a chronic inflammatory multisystem disorder that is characterised by oral and/or genital ulcerations as well as intraocular inflammation. Recurrent retinal vasoocclusive episodes and macular involvement may lead to severe loss of visual acuity. Patients may eventually become resistant to systemic corticosteroid and develop side effects; therefore, other immunosuppressive therapies are needed. Biologic agents are promising for the treatment of Behçet's disease-associated uveitis. Here, we report two cases of paediatric uveitis due to Behçet's disease that were successfully treated by early administration of adalimumab. CASE PRESENTATION: Patient 1 was an 11-year-old girl who presented with right conjunctival injection and photophobia. Patient 2 was a 14-year-old girl who presented with blurry vision in the left eye. Both patients were treated with topical treatment and prednisolone for uveitis; however, relapses occurred during the tapering of prednisolone. The patients were diagnosed with Behçet's disease, and adalimumab therapy was initiated. In both cases, the inflammation was well-controlled by adalimumab administration without local or systemic corticosteroid. CONCLUSIONS: Adalimumab is effective for treating children with Behçet's disease-associated uveitis. Control of ocular inflammation was achieved without local and systemic corticosteroid, thus preventing further complications.


Assuntos
Adalimumab/administração & dosagem , Anti-Inflamatórios/administração & dosagem , Uveíte/tratamento farmacológico , Administração Oftálmica , Administração Tópica , Adolescente , Síndrome de Behçet/tratamento farmacológico , Criança , Quimioterapia Combinada , Feminino , Humanos , Prednisolona/administração & dosagem , Recidiva , Resultado do Tratamento , Transtornos da Visão/tratamento farmacológico , Transtornos da Visão/etiologia
5.
BMJ Case Rep ; 12(6)2019 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-31229976

RESUMO

Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare antineutrophil cytoplasmic antibody-associated vasculitis that can affect any organ system. It is most often characterised by chronic airway inflammation along with prominent peripheral blood eosinophilia, although the disease can affect the cardiovascular, gastrointestinal, renal or central nervous systems. Ocular manifestations are uncommon and when they do occur, are varied in their clinical presentations. To the best of our knowledge, this is the first case of corneal melt secondary to EGPA to have been reported.


Assuntos
Antibacterianos/uso terapêutico , Ciprofloxacino/uso terapêutico , Perfuração da Córnea/patologia , Úlcera da Córnea/patologia , Granulomatose com Poliangiite/complicações , Transtornos da Visão/etiologia , Idoso , Anticorpos Anticitoplasma de Neutrófilos , Perfuração da Córnea/microbiologia , Perfuração da Córnea/terapia , Úlcera da Córnea/microbiologia , Granulomatose com Poliangiite/fisiopatologia , Humanos , Masculino , Resultado do Tratamento , Transtornos da Visão/tratamento farmacológico , Transtornos da Visão/microbiologia , Transtornos da Visão/fisiopatologia
7.
Cornea ; 38(8): 948-950, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31045959

RESUMO

PURPOSE: To report the clinical features and outcomes of toxic keratitis after application of powdered custard apple seeds for hair washing for head lice infestation. METHODS: Retrospective review of all patients with toxic keratitis after application of powdered custard apple seed for head lice infestation during the time period from January 2015 to December 2017. Demographic details, clinical features, and visual outcomes were documented. RESULTS: Thirty-one eyes of 19 patients with toxic keratitis after application of crushed custard apple seeds for head lice infestation were included in the study. Eighteen females and 1 male with a median age of 14 years [interquartile range (IQR) 12-34 years] presented with severe epiphora, congestion, photophobia, and defective vision (median logMar visual acuity 0.4, IQR 0.2-0.8) after application of custard apple seed powder for hair washing. Ten eyes (32.2%) had an epithelial defect (median size 9 mm, IQR 5-12 mm), and 21 (67.7%) eyes had punctate epithelial erosions. All the patients were treated with topical antibiotics, and at 3 days follow-up, all of them had resolution of symptoms and signs with a median logarithm of the minimum angle of resolution (logMAR) visual acuity of 0 (IQR 0-0.2). CONCLUSIONS: Health education about the harmful effect of this traditional practice for head lice infestation will prevent further similar events.


Assuntos
Annona/toxicidade , Ceratite/induzido quimicamente , Infestações por Piolhos/tratamento farmacológico , Pediculus/efeitos dos fármacos , Administração Oftálmica , Adolescente , Adulto , Animais , Antibacterianos/uso terapêutico , Criança , Dor Ocular/induzido quimicamente , Dor Ocular/diagnóstico , Dor Ocular/tratamento farmacológico , Feminino , Humanos , Ceratite/diagnóstico , Ceratite/tratamento farmacológico , Doenças do Aparelho Lacrimal/induzido quimicamente , Doenças do Aparelho Lacrimal/diagnóstico , Doenças do Aparelho Lacrimal/tratamento farmacológico , Masculino , Ofloxacino/uso terapêutico , Fotofobia/induzido quimicamente , Fotofobia/diagnóstico , Fotofobia/tratamento farmacológico , Estudos Retrospectivos , Transtornos da Visão/induzido quimicamente , Transtornos da Visão/diagnóstico , Transtornos da Visão/tratamento farmacológico , Adulto Jovem
8.
Int J Rheum Dis ; 22(7): 1331-1334, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31117158

RESUMO

We present a case of an elderly, immunosuppressed patient with rheumatoid arthritis who was not appropriately vaccinated, and subsequently developed herpes zoster ophthalmicus, which initially presented similar to giant cell arteritis. Evidence-based vaccinations are integral in decreasing the incidence of preventable diseases and promoting optimal health at the individual and population level. Although the patient ultimately did not suffer any long-term adverse sequelae, this case highlights the importance of vaccination in the rheumatology setting, and to consider both inflammatory and infectious causes of headache and vision changes in the elderly.


Assuntos
Antirreumáticos/efeitos adversos , Artrite Reumatoide/tratamento farmacológico , Cefaleia/virologia , Herpes Zoster Oftálmico/virologia , Herpesvirus Humano 3/patogenicidade , Infecções Oportunistas/virologia , Transtornos da Visão/virologia , Idoso de 80 Anos ou mais , Antivirais/uso terapêutico , Artrite Reumatoide/diagnóstico , Artrite Reumatoide/imunologia , Cefaleia/diagnóstico , Cefaleia/tratamento farmacológico , Cefaleia/imunologia , Herpes Zoster Oftálmico/diagnóstico , Herpes Zoster Oftálmico/tratamento farmacológico , Herpes Zoster Oftálmico/imunologia , Herpesvirus Humano 3/efeitos dos fármacos , Herpesvirus Humano 3/imunologia , Humanos , Hospedeiro Imunocomprometido , Masculino , Infecções Oportunistas/diagnóstico , Infecções Oportunistas/tratamento farmacológico , Infecções Oportunistas/imunologia , Resultado do Tratamento , Transtornos da Visão/diagnóstico , Transtornos da Visão/tratamento farmacológico , Transtornos da Visão/imunologia
9.
Middle East Afr J Ophthalmol ; 26(1): 40-42, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31114124

RESUMO

Calotropis procera (ushaar) produces a copious amount of latex, which has both inflammatory and anti-inflammatory pharmacological properties. Local application produces an intense inflammatory response and causes significant ocular morbidity. We report corneal toxicity following self-application of latex from C. procera in a 74-year-old man. He reported painless decreased vision in the affected eye with diffuse corneal edema, and specular microscopy revealed a reduced endothelial cell count. After he was treated with topical corticosteroids, his visual acuity improved from hand motion to 20/80. The composition of the active compounds in the latex was analyzed. When topically administered, the latex may cause severe ocular injuries and a loss of endothelial cells over a period of time. Public education, early recognition of such injuries, and timely intervention may prevent permanent ocular damage.


Assuntos
Calotropis/química , Edema da Córnea/induzido quimicamente , Látex/toxicidade , Transtornos da Visão/induzido quimicamente , Administração Oftálmica , Idoso , Córnea/efeitos dos fármacos , Edema da Córnea/diagnóstico , Edema da Córnea/tratamento farmacológico , Glucocorticoides/uso terapêutico , Humanos , Masculino , Soluções Oftálmicas , Compostos Fitoquímicos , Prednisolona/análogos & derivados , Prednisolona/uso terapêutico , Autoadministração , Transtornos da Visão/diagnóstico , Transtornos da Visão/tratamento farmacológico , Acuidade Visual/efeitos dos fármacos
10.
J Fr Ophtalmol ; 42(4): e133-e146, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30850197

RESUMO

Behçet's disease is a chronic multisystem disorder characterized by relapsing inflammation for which the underlying histopathology is an occlusive vasculitis. The disease has a high prevalence in the Mediterranean region, Far and Middle Eastern countries. It is clinically characterized by oral and genital ulcerations, ocular inflammatory involvement, skin lesions, vascular involvement and numerous other systemic manifestations. Uveitis is by far the most common ocular manifestation of Behçet's disease. It typically presents in the form of relapsing-remitting panuveitis with retinal vasculitis that may result in severe visual loss. Management of Behçet's uveitis relies on corticosteroid therapy, conventional immunosuppressive drugs and biological agents and requires a close collaboration between ophthalmologist and internist. A better understanding of auto-inflammatory process and of the role of cytokines implicated in the pathogenesis of Behçet's disease will enable researchers to develop more specific and effective therapy.


Assuntos
Síndrome de Behçet/complicações , Síndrome de Behçet/fisiopatologia , Olho/fisiopatologia , Fenômenos Fisiológicos Oculares , Síndrome de Behçet/tratamento farmacológico , Síndrome de Behçet/epidemiologia , Produtos Biológicos/uso terapêutico , Olho/efeitos dos fármacos , Olho/patologia , Glucocorticoides/uso terapêutico , Humanos , Imunossupressores/uso terapêutico , Inflamação/complicações , Inflamação/tratamento farmacológico , Inflamação/epidemiologia , Vasculite Retiniana/tratamento farmacológico , Vasculite Retiniana/epidemiologia , Vasculite Retiniana/etiologia , Uveíte/tratamento farmacológico , Uveíte/epidemiologia , Uveíte/etiologia , Uveíte/fisiopatologia , Transtornos da Visão/tratamento farmacológico , Transtornos da Visão/epidemiologia , Transtornos da Visão/etiologia
11.
Exp Eye Res ; 182: 109-124, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30922891

RESUMO

Mild TBI is often accompanied by visual system dysfunction and injury, which is at least partly caused by microglial neuroinflammatory processes initiated by the injury. Using our focal cranial blast mouse model of closed-skull mild TBI, we evaluated the ability of the cannabinoid type-2 (CB2) receptor inverse agonist SMM-189, which biases microglia from the harmful M1 state to the beneficial M2 state, to mitigate visual system dysfunction and injury after TBI. Male C57BL/6 or Thy1-EYFP reporter mice received a closed-head blast of either 0-psi (sham) or 50-psi to the left side of the cranium. Blast mice received vehicle or 6 mg/kg SMM-189 daily beginning 2 h after blast. Sham mice received vehicle. In some mice, retina and optic nerve/tract were assessed morphologically at 3-7 days after blast, while other mice were assessed functionally by Optomotry 30 days after blast and morphologically at ≥30 days after blast. Mice sacrificed at 3-7 days were treated daily until sacrificed, while those assessed ≥30 days after blast were treated daily for 2 weeks post blast. Axon damage was evident in the left optic nerve and its continuation as the right optic tract at 3 days post blast in vehicle-treated blast mice in the form of swollen axon bulbs, and was accompanied by a significant increase in the abundance of microglia. Testing at 30 days post blast revealed that the contrast sensitivity function was significantly reduced in both eyes in vehicle-treated blast mice compared to vehicle-treated sham blast mice, and axon counts at ≥30 days after blast revealed a ∼10% loss in left optic nerve in vehicle-treated blast mice. Left optic nerve axon loss was highly correlated with the left eye deficit in contrast sensitivity. Immunolabeling at 30 days post blast showed a significant increase in the abundance of microglia in the retinas of both eyes and in GFAP + Müller cell processes traversing the inner plexiform layer in the left eye of vehicle-treated blast mice. SMM-189 treatment reduced axon injury and microglial abundance at 3 days, and mitigated axon loss, contrast sensitivity deficits, microglial abundance, and Müller cell GFAP upregulation at ≥30 days after blast injury. Analysis of right optic tract microglia at 3 days post blast for M1 versus M2 markers revealed that SMM-189 biased microglia toward the M2 state, with this action of SMM-189 being linked to reduced axonal injury. Taken together, our results show that focal left side cranial blast resulted in impaired contrast sensitivity and retinal pathology bilaterally and optic nerve loss ipsilaterally. The novel cannabinoid drug SMM-189 significantly mitigated the functional deficit and the associated pathologies. Our findings suggest the value of combatting visual system injury after TBI by using CB2 inverse agonists such as SMM-189, which appear to target microglia and bias them away from the pro-inflammatory M1 state, toward the protective M2 state.


Assuntos
Benzofenonas/farmacologia , Lesões Encefálicas Traumáticas/complicações , Microglia/patologia , Nervo Óptico/patologia , Trato Óptico/patologia , Transtornos da Visão/tratamento farmacológico , Acuidade Visual , Animais , Axônios/patologia , Modelos Animais de Doenças , Imuno-Histoquímica , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Microscopia Confocal , Transtornos da Visão/etiologia , Transtornos da Visão/patologia
13.
Graefes Arch Clin Exp Ophthalmol ; 257(3): 529-541, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30645696

RESUMO

PURPOSE: To demonstrate the efficacy and safety of ranibizumab 0.5 mg pro re nata (PRN) versus laser photocoagulation for the treatment of Chinese patients with visual impairment due to diabetic macular edema (DME). METHODS: REFINE was a phase III, 12-month, double-masked, multicenter, laser-controlled study in patients (aged ≥ 18 years) with DME. Patients were randomized 4:1 to receive either ranibizumab 0.5 mg or laser dosing regimen. Efficacy was evaluated as mean average change in best-corrected visual acuity (BCVA) from Months 1 to 12 versus baseline (primary endpoint), anatomical outcomes, treatment exposure, and safety were also assessed. RESULTS: Ranibizumab was statistically superior (p < 0.001) to laser treatment, with a mean average BCVA gain of 6.8 letters (ranibizumab) over 12 months versus 1.1 letters (laser). At Month 12, mean BCVA gain was 7.8 letters (ranibizumab) and 2.5 letters (laser) from baseline. Patients in the ranibizumab arm received a mean number of 7.9 intravitreal injections, whereas those in the laser arm received a mean of 2.1 treatments. There were no new safety signals. CONCLUSION: Ranibizumab 0.5 mg PRN demonstrated a statistically significant and clinically meaningful treatment effect versus laser and was well tolerated in Chinese patients with visual impairment due to DME over 12 months.


Assuntos
Retinopatia Diabética/complicações , Macula Lutea/diagnóstico por imagem , Edema Macular/tratamento farmacológico , Ranibizumab/administração & dosagem , Transtornos da Visão/tratamento farmacológico , Acuidade Visual , Idoso , Inibidores da Angiogênese/administração & dosagem , China/epidemiologia , Retinopatia Diabética/tratamento farmacológico , Retinopatia Diabética/epidemiologia , Relação Dose-Resposta a Droga , Feminino , Angiofluoresceinografia/métodos , Seguimentos , Fundo de Olho , Humanos , Incidência , Injeções Intravítreas , Edema Macular/complicações , Edema Macular/epidemiologia , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Resultado do Tratamento , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Transtornos da Visão/epidemiologia , Transtornos da Visão/etiologia
14.
Graefes Arch Clin Exp Ophthalmol ; 257(4): 759-768, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30680452

RESUMO

PURPOSE: To evaluate criteria driving retreatment with ranibizumab in Italian patients with myopic choroidal neovascularization (mCNV). METHODS: OLIMPIC was a 12-month, phase IIIb, open-label study. Patients with active mCNV were treated with ranibizumab 0.5 mg according to the European label. The study assessed local criteria in Italy driving retreatment decisions with ranibizumab; and the efficacy, safety, and tolerability of ranibizumab. RESULTS: The mean (standard deviation [SD]) age of treated patients (N = 200) was 61.8 (12.7) years; range 22-85 years. The multivariate regression model indicated that presence of active leakage (odds ratio [OR] 95% confidence interval [CI]: 11.30 [1.03-124.14]), presence of intraretinal fluid (OR [95%CI]: 28.21 [1.55-513.73]), and an improvement in best-corrected visual acuity (BCVA) from baseline < 10 letters (OR [95%CI]: 17.60 [1.39-222.75]) were the factors with the greatest effect on retreatment with ranibizumab. The mean (SD) BCVA gain from baseline to month 12 was 8.4 (12.8) letters (P < 0.0001). The mean (SD) number of injections was 2.41 (1.53); range 1-9. Ocular and non-ocular adverse events were reported in 41 (20.5%) and 30 (15.0%) patients, respectively. CONCLUSIONS: Individualized treatment with ranibizumab was effective in improving BCVA in patients with mCNV over 12 months. Both anatomical and functional variables had significant effects on causing retreatment. There were no new safety findings. TRIAL REGISTRATION: www.ClinicalTrials.Gov (NCT No: NCT02034006).


Assuntos
Inibidores da Angiogênese/uso terapêutico , Neovascularização de Coroide/tratamento farmacológico , Miopia Degenerativa/tratamento farmacológico , Ranibizumab/uso terapêutico , Transtornos da Visão/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Neovascularização de Coroide/complicações , Neovascularização de Coroide/fisiopatologia , Feminino , Humanos , Injeções Intravítreas , Masculino , Pessoa de Meia-Idade , Miopia Degenerativa/etiologia , Miopia Degenerativa/fisiopatologia , Estudos Prospectivos , Retratamento , Líquido Sub-Retiniano , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Transtornos da Visão/etiologia , Transtornos da Visão/fisiopatologia , Acuidade Visual/fisiologia , Adulto Jovem
16.
Acta Diabetol ; 56(1): 67-71, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30167869

RESUMO

AIMS: Diabetic macular edema (DME) frequently presents bilaterally. In case of bilateral retinal disease, the visual impairment (VI) and the visual acuity (VA) are strongly correlated to the better eye. The aim of this study was to assess the impact of ranibizumab intravitreal injections (IVR) on VI in patients with simultaneous VA loss due to DME. METHODS: This was a retrospective two-center study including consecutive DME patients with visual loss treated with ranibizumab since November 2011 and with a minimum follow-up of 6 months. Patients with bilateral visual decrease from DME undergoing IVR within 6 months of each other were included. RESULTS: Twenty-nine DME patients who received bilateral IVR within a 6-month interval in the second eye were included. At baseline, 82.8% (n = 24) of patients had a VA < 20/40 in their better eye versus 44.8% (n = 13) of patients at the end of follow-up, i.e. a reduction by 45.9% of VI. In the better eye, the mean VA was 57.3, 65.0 and 65.5 ETDRS letters, respectively, at baseline, month 3 and month 6 (mean VA gain +8.2 letters). In the worse eye, the mean VA was 44.2, 53.5 and 53.8 ETDRS letters, respectively, at baseline, M3 and M6 (mean VA gain +9.6 letters). CONCLUSIONS: In patients with bilateral DME, subsequent ranibizumab IVR reduced VI frequency.


Assuntos
Inibidores da Angiogênese/uso terapêutico , Retinopatia Diabética/tratamento farmacológico , Edema Macular/tratamento farmacológico , Ranibizumab/uso terapêutico , Transtornos da Visão/tratamento farmacológico , Idoso , Retinopatia Diabética/complicações , Retinopatia Diabética/epidemiologia , Feminino , Seguimentos , Humanos , Incidência , Injeções Intravítreas , Edema Macular/epidemiologia , Edema Macular/etiologia , Masculino , Pessoa de Meia-Idade , Retina/diagnóstico por imagem , Retina/efeitos dos fármacos , Estudos Retrospectivos , Tomografia de Coerência Óptica , Transtornos da Visão/diagnóstico , Transtornos da Visão/epidemiologia , Transtornos da Visão/etiologia , Acuidade Visual/efeitos dos fármacos
17.
Int J Rheum Dis ; 22(2): 325-330, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26403216

RESUMO

Several ophthalmic manifestations in patients with dermatomyositis have been described but involvement of the retina is rare. A 39-year-old man diagnosed with dermatomysitis had developed sudden painless visual loss in the left eye. He was non-diabetic and non-hypertensive. He was on treatment with systemic prednisolone (50 mg/day) and methotrexate (7.5 mg/day) for dermatomyositis. His visual acuity was finger counting at 2 feet in the left eye and 6/6 in the right eye. Left fundus showed slight blurring of the optic disc margins, large peripapillary flame-shaped haemorrhages and extensive area of opacification suggestive of central retinal artery occlusion (CRAO) with sparing of the area supplied by the cilioretinal artery. The exact pathomechanism of CRAO in dermatomyositis remains poorly elucidated. The infarctive events following endothelial damage and platelet thrombi occurring in arterioles and capillaries of retina, optic disc and choriocapillaries causing ischemia/infarction have been suggested as possible reasons. However, central artery occlusion from high intraocular pressure from marked (heliotrope) orbital edema appears more plausible in our case. The degree of retinal damage is variable when CRAO lasts between 105 and 240 min and irreversible profound visual loss may occur from its occlusion lasting for more than 240 min. A prompt ophthalmological opinion/management is recommended to limit its progression.


Assuntos
Dermatomiosite/complicações , Oclusão da Artéria Retiniana/etiologia , Transtornos da Visão/etiologia , Adulto , Dermatomiosite/diagnóstico , Dermatomiosite/tratamento farmacológico , Glucocorticoides/uso terapêutico , Humanos , Imunossupressores/uso terapêutico , Masculino , Metotrexato/uso terapêutico , Prednisolona/uso terapêutico , Recuperação de Função Fisiológica , Oclusão da Artéria Retiniana/diagnóstico , Oclusão da Artéria Retiniana/tratamento farmacológico , Resultado do Tratamento , Transtornos da Visão/diagnóstico , Transtornos da Visão/tratamento farmacológico , Transtornos da Visão/fisiopatologia , Visão Ocular , Acuidade Visual
18.
Retin Cases Brief Rep ; 13(2): 111-114, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-28267110

RESUMO

BACKGROUND/PURPOSE: To describe a case of bilateral macular edema appearing after treatment with rituximab. METHODS: This is a case report describing macular edema after rituximab infusions. The information was collected retrospectively through chart review. RESULTS: A 53-year-old patient known for IgG4-related disease of the face and sinuses presented with bilateral decreased visual acuity from cystoid macular edema shortly after undergoing two rituximab infusions. Laboratory workup did not reveal any underlying systemic etiology. Treatment with topical and oral corticosteroids as well as with anti-vascular endothelial growth factor injections led to mild improvement. Treatment with intraocular triamcinolone resulted in complete resolution of the edema, although accompanied by an increase in intraocular pressure. CONCLUSION: Rituximab has been previously associated with macular edema. Macular edema causing visual loss shortly after receiving rituximab may respond to discontinuation of the rituximab and local steroid injection.


Assuntos
Doença Relacionada a Imunoglobulina G4/tratamento farmacológico , Fatores Imunológicos/efeitos adversos , Edema Macular/induzido quimicamente , Rituximab/efeitos adversos , Feminino , Humanos , Pessoa de Meia-Idade , Transtornos da Visão/tratamento farmacológico
19.
Indian J Ophthalmol ; 66(12): 1877-1879, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30451212
20.
Invest Ophthalmol Vis Sci ; 59(14): DES29-DES35, 2018 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-30481803

RESUMO

Dry eye (DE) causes irregularity of the ocular surface and reduces the quality of vision. An intact, regular tear film is essential for high-quality retinal images; however, visual tasks requiring sustained gazing can disrupt the tear film, eventually degrading visual function. A functional visual acuity (FVA) measurement system has been uniquely developed in Japan to evaluate visual function related to tear stability in patients with DE. FVA has been shown to correlate with optical quality. The system measures the change in visual acuity (VA) over time automatically in aqueous-deficient DE and short tear breakup tear film DE characterized by decreased tear stability and minimal epithelial damage. It is also useful to detect minimal visual deterioration correlated with minimal ocular surface abnormality and vision-related quality of life otherwise undetectable by conventional VA testing, to assess and quantify vision-related symptomatology, and to determine the efficacy of treatments for DE disease. Recently, its use has been expanded, such as for the analysis of visual function accompanying refractive surgery, contact lens, cataract and cataract-related disease, retinal disease, glaucoma, amblyopia, presbyopia, and vehicle driving. Its use has revealed that FVA reflects not only visual function related to tear dynamics, but also visual function related to quick recognition of the target. This simple, noninvasive, and sensitive FVA measurement system may be expected to be used worldwide.


Assuntos
Síndromes do Olho Seco/fisiopatologia , Transtornos da Visão/fisiopatologia , Acuidade Visual/fisiologia , Síndromes do Olho Seco/diagnóstico , Síndromes do Olho Seco/tratamento farmacológico , Humanos , Japão , Soluções Oftálmicas/administração & dosagem , Qualidade de Vida , Inquéritos e Questionários , Lágrimas/fisiologia , Transtornos da Visão/diagnóstico , Transtornos da Visão/tratamento farmacológico
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