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1.
Retina ; 43(10): 1763-1772, 2023 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-37315516

RESUMO

PURPOSE: In subretinal gene therapy for inherited retinal diseases (IRDs), blebs may not propagate predictably in the direction of the injection cannula. We evaluated factors that influenced bleb propagation among various IRDs. METHODS: Retrospective review of all subretinal gene therapy procedures performed by a single surgeon between September 2018 and March 2020 for various IRDs. Main outcome measures were directional bias of bleb propagation and intraoperative foveal detachment. RESULTS: Desired injection volumes and/or foveal treatment were successfully achieved in all 70 eyes of 46 patients with IRD regardless of IRD indication. Bullous foveal detachment was associated with retinotomy closer to the fovea, posterior bleb bias, and greater bleb volumes ( P < 0.01). Blebs biased anteriorly or posteriorly based on disease indication ( P = 0.04) and age ( P < 0.001). Retinotomy location ≤ 3.7 mm (approximately two disk diameters) from the fovea favored foveal detachment ( P < 0.001). Multiple retinotomies and blebs allowed greater surface area coverage in some eyes, but intersecting blebs did not propagate further. CONCLUSION: Bleb formation and propagation are predictable based on patient age, retinotomy location, disease indication, and how tangentially fluid is directed into the subretinal space.


Assuntos
Descolamento Retiniano , Doenças Retinianas , Humanos , Descolamento Retiniano/cirurgia , Acuidade Visual , Retina , Doenças Retinianas/genética , Doenças Retinianas/cirurgia , Terapia Genética
2.
Retina ; 42(8): 1568-1573, 2022 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-35877968

RESUMO

PURPOSE: To assess the long-term efficacy of intravitreal antivascular endothelial growth factor injections (IVI), alone or in combination with verteporfin photodynamic therapy (IVI/PDT), for management of choroidal neovascularization secondary to presumed ocular histoplasmosis syndrome (POHS). METHODS: Retrospective, comparative, interventional case series analyzing 82 eyes in 74 patients treated with either IVI or IVI/PDT for presumed ocular histoplasmosis syndrome choroidal neovascularization from January 2006 to January 2021. RESULTS: The average logarithm of the minimum angle of resolution VA in year 5 was 0.40 (20/50) and 0.52 (20/67) for IVI versus IVI/PDT groups, respectively ( P = 0.33), and in year 10 was 0.53 (20/58) and 0.64 (20/86), respectively ( P = 0.50). The average number of annual injections over the first 5 years of follow-up was 3.3 versus 1.7 for IVI versus IVI/PDT groups, respectively ( P < 0.001), and over 10 years was 3.3 versus 1.6, respectively ( P < 0.001). Treatment-free interval of 5 years was reached by 39% versus 60% in IVI versus IVI/PDT groups, respectively ( P = 0.95). CONCLUSION: Our study found both IVI and IVI/PDT to be effective in long-term management of presumed ocular histoplasmosis syndrome choroidal neovascularization, with a fewer number of annual injections and longer treatment-free interval in the combination group. However, given the limitations of a retrospective study, a prospective randomized study is necessary to determine whether the addition of PDT significantly decreases treatment burden.


Assuntos
Neovascularização de Coroide , Infecções Oculares Fúngicas , Histoplasmose , Fotoquimioterapia , Inibidores da Angiogênese , Anticorpos Monoclonais Humanizados/uso terapêutico , Neovascularização de Coroide/diagnóstico , Neovascularização de Coroide/tratamento farmacológico , Neovascularização de Coroide/etiologia , Fatores de Crescimento Endotelial , Infecções Oculares Fúngicas/complicações , Infecções Oculares Fúngicas/tratamento farmacológico , Seguimentos , Histoplasmose/complicações , Histoplasmose/diagnóstico , Histoplasmose/tratamento farmacológico , Humanos , Fármacos Fotossensibilizantes/uso terapêutico , Estudos Prospectivos , Estudos Retrospectivos , Resultado do Tratamento , Fator A de Crescimento do Endotélio Vascular , Acuidade Visual
3.
Exp Eye Res ; 205: 108505, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33617850

RESUMO

PURPOSE: To evaluate the safety and toxicity profile of a chitosan (CS) and poly(lactic-co-glycolic) acid (PLGA)-based sustained release methotrexate (MTX) intravitreal micro-implant in normal rabbit eyes using non-invasive testing that included electroretinography (ERG), ultrasound biomicroscopy (US), slit-lamp biomicroscopy (SLB), funduscopy, and intraocular pressure (IOP). METHODS: PLGA-coated CS-based micro-implants containing 400 µg of MTX and placebo (without drug) micro-implants were surgically-implanted in the vitreous of the right and the left eyes, respectively, in each of the thirty New Zealand rabbits. ERG, US, SLB, funduscopy, and IOP were assessed in both eyes at pre-determined time points (days: 1, 3, 7, 14, 28 and 56). The safety of micro-implants was assessed by analyzing the ERG data using different statistical models, to quantify and compare the functional integrity of the retina. Further, US, funduscopy, SLB and IOP determined the condition of the retina, the micro-implant and associated intraocular features. RESULTS: Statistical analyses of the ERG data showed unchanged functional integrity of retina between eyes with the PLGA-coated CS-based MTX micro-implant and the placebo micro-implant. US analysis showed that micro-implants were stationary throughout the study. SLB, funduscopy and IOP further confirmed that there were no abnormalities in the intraocular physiology. CONCLUSION: The findings from ERG, US, SLB, funduscopy, and IOP showed no detectable adverse effects caused by our biodegradable micro-implants. These non-invasive techniques appeared to show lack of significant ocular toxicity over time in spite of degradation and changes in morphology of the micro-implants following intraocular implantation.


Assuntos
Imunossupressores/toxicidade , Metotrexato/toxicidade , Retina/efeitos dos fármacos , Corpo Vítreo/efeitos dos fármacos , Implantes Absorvíveis , Animais , Quitosana/administração & dosagem , Preparações de Ação Retardada , Portadores de Fármacos , Implantes de Medicamento , Eletrorretinografia/efeitos dos fármacos , Imunossupressores/administração & dosagem , Pressão Intraocular/efeitos dos fármacos , Injeções Intravítreas , Metotrexato/administração & dosagem , Microscopia Acústica , Copolímero de Ácido Poliláctico e Ácido Poliglicólico/administração & dosagem , Coelhos , Microscopia com Lâmpada de Fenda
4.
Retina ; 39(11): 2155-2160, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30015766

RESUMO

PURPOSE: To demonstrate a novel technique to measure the intraocular pressure in silicone oil (SO)-filled eyes with Boston Type 1 keratoprosthesis (KPro) during intraocular surgery. METHODS: In this retrospective case series, an ocular manometer that is predicated on a continuous fluid column between a pressure sensor and interior of the eye was designed and used to directly measure intraocular pressure during intraocular surgery in SO-filled eyes with KPro. RESULTS: Six eyes of six patients were included in the study. The indications for SO injection with ocular manometry were hypotony in five patients, and endophthalmitis and complex retinal detachment with proliferative vitreoretinopathy in one patient. All patients had a successful reinflation of their globes without any evidence of SO underfill, without evidence of SO overfill, and without progression of glaucomatous optic neuropathy. Visual acuity increased in five eyes and was maintained in one eye. CONCLUSION: Intraoperative ocular manometry is a safe and effective technique in determining intraocular pressure in SO-filled eyes with KPro.


Assuntos
Órgãos Artificiais , Córnea/cirurgia , Tamponamento Interno/métodos , Oftalmopatias/cirurgia , Pressão Intraocular/fisiologia , Manometria/métodos , Monitorização Intraoperatória/métodos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Próteses e Implantes , Implantação de Prótese , Estudos Retrospectivos , Óleos de Silicone
5.
Ophthalmology ; 125(3): 423-431, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29146307

RESUMO

PURPOSE: To report longer-term outcomes of 27-gauge pars plana vitrectomy (PPV) in eyes with posterior segment disease. DESIGN: Multicenter, retrospective, interventional case series. PARTICIPANTS: A total of 390 eyes of 360 patients undergoing 27-gauge PPV for a vitreoretinal surgery indication. INTERVENTION: Three-port, transconjunctival, 27-gauge PPV. MAIN OUTCOME MEASURES: Change in visual acuity (VA) and occurrence of intraoperative and postoperative complications with a minimum follow-up of 365 days. RESULTS: Mean follow-up was 715±332 days (median, 514; range, 365-1440 days). Surgical indications included epiretinal membrane (ERM) (n = 121), vitreous floaters (n = 69), diabetic tractional retinal detachment (n = 49), vitreous hemorrhage (n = 40), full-thickness macular hole (n = 33), recurrent proliferative vitreoretinopathy (PVR)-related retinal detachment (n = 18), primary rhegmatogenous retinal detachment (RRD) (n = 17), silicone oil removal (n = 16), dislocated intraocular lens (n = 10), submacular hemorrhage (n = 7), endophthalmitis (n = 6), and retained lens material (n = 4). Mean logarithm of the minimum angle of resolution (logMAR) VA improved from 0.72±0.62 (20/105 Snellen equivalent) preoperatively to 0.40±0.55 (20/50 Snellen equivalent) postoperatively (P < 0.001). No case required conversion to 23- or 25-gauge instrumentation. Postoperative complications included transient ocular hypertension in 44 eyes (11.3%), vitreous hemorrhage in 31 eyes (7.9%), and transient hypotony in 22 eyes (5.6%). Acute postoperative endophthalmitis occurred in 1 case (0.26%). Overall, 82 of 390 eyes (21.0%) underwent at least 1 additional intraocular surgery in the follow-up period, most commonly for cataract extraction (n = 40/82 eyes, 48.8%). Of the 18 eyes undergoing surgery for primary RRD, recurrent detachment due to PVR occurred in 2 eyes (11.1%). CONCLUSIONS: At a minimum follow-up of 1 year, 27-gauge PPV was well tolerated with low rates of postoperative complications across varied surgical indications, including primary and complex retinal detachment.


Assuntos
Segmento Posterior do Olho/patologia , Doenças Retinianas/cirurgia , Acuidade Visual , Vitrectomia/instrumentação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Desenho de Equipamento , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Doenças Retinianas/diagnóstico , Doenças Retinianas/fisiopatologia , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Estados Unidos/epidemiologia , Adulto Jovem
6.
Graefes Arch Clin Exp Ophthalmol ; 254(11): 2111-2118, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27094701

RESUMO

PURPOSE: To demonstrate the safety and efficacy of 27-gauge pars plana vitrectomy (PPV) in selected patients with vitreoretinal diseases requiring silicone oil (SO) tamponade. METHODS: Retrospective review of a consecutive interventional case series at a single center. RESULTS: Twenty-one eyes of 19 patients were included in the study. The indications for PPV and SO tamponade were as follows: fibrovascular tractional retinal detachment (12 eyes), rhegmatogenous retinal detachment with proliferative vitreoretinopathy (three eyes), primary rhegmatogenous retinal detachment (two eyes), macular hole (two eyes), vitreous hemorrhage (one eye), and endophthalmitis (one eye). All eyes underwent transconjunctival sutureless 27-gauge PPV with either 1000-cS (16 eyes) or 5000-cS (five eyes) SO tamponade. No intraoperative complications occurred. Mean preoperative best-corrected visual acuity (BCVA) was 20/300 (range, light perception to 20/40; median, counting fingers). Mean postoperative BCVA was 20/160 (range, no light perception to 20/25; median 20/300; p = 0.022). Follow-up was 6.4 ± 8.8 months (range, 1-38 months; median, 4 months). No complications relating to 27-gauge placement of SO were observed. CONCLUSIONS: Results show that 27-gauge PPV with SO injection appears safe, is efficient, and may be considered for the surgical management of vitreoretinal diseases requiring SO tamponade.


Assuntos
Túnica Conjuntiva/cirurgia , Tamponamento Interno/instrumentação , Doenças Retinianas/cirurgia , Óleos de Silicone/administração & dosagem , Procedimentos Cirúrgicos sem Sutura/métodos , Vitrectomia/instrumentação , Desenho de Equipamento , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
7.
Retina ; 36(8): 1474-9, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26735566

RESUMO

PURPOSE: To demonstrate the outcomes of pars plana vitrectomy in patients with custom flexible iris prosthesis (CFIP). METHODS: The medical records of patients who underwent CFIP placement were retrospectively reviewed. Patients who underwent pars plana vitrectomy concurrent with or after placement of CFIP were identified. Preoperative, intraoperative, and postoperative parameters were analyzed. Surgeons were surveyed regarding the technical aspects of the vitreoretinal surgery. Outcome measures included: anatomic success, complications, surgeon-rated ease of visualization through CFIP during pars plana vitrectomy, and Snellen best-corrected visual acuity. RESULTS: Twenty-four surgeries were performed in 20 eyes of 20 patients. Postoperative best-corrected visual acuity improved in 11 eyes (55%), remained unchanged in 5 eyes (25%), and declined in 4 eyes (20%) after a mean follow-up of 16.1 ± 16.\nths (range: 3-53 months). No intraoperative complications were noted. Short-term anatomical success was 100%. Postoperative complications occurred in five eyes (recurrent retinal detachment in three eyes, recurrent epiretinal membrane in 1 eye, and CFIP and intraocular lens subluxation in 1 eye). CONCLUSION: Visualization for pars plana vitrectomy with the assistance of both direct and wide angle viewing systems through the 3.35 mm pseudopupil of a CFIP is viable in the surgical management of complex vitreoretinal diseases.


Assuntos
Órgãos Artificiais , Iris , Doenças Retinianas/cirurgia , Vitrectomia/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Humanos , Complicações Intraoperatórias , Doenças da Íris/cirurgia , Masculino , Pessoa de Meia-Idade , Próteses e Implantes , Implantação de Prótese , Estudos Retrospectivos , Acuidade Visual/fisiologia , Cirurgia Vitreorretiniana
8.
Retina ; 36(3): 582-7, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26383713

RESUMO

PURPOSE: The objective of this study was to introduce and validate a next-generation dual bore cannula for microincisional vitrectomy surgery. METHODS: The SideFlo cannula with a closed tip and four vent ports on the sides was designed and manufactured. The cannula is designed to inject vital dyes for macular staining and perfluorocarbon liquids. Injection and venting properties were assessed subjectively in vivo, and venting was quantified in a plastic eye model system; 23-, 25-, and 27-gauge SideFlo cannulas were assessed and compared with existing axial dual bore cannula designs. RESULTS: The SideFlo cannula created a broad fan-like egress of fluid that was perpendicular to the axial direction of the cannula and eliminated the possibility for retinal fluid jet damage. Enhanced outflow venting was clinically relevant in terms of smoother injection experience and less intraocular pressure rise when compared with previous dual bore designs. Testing in a model eye system confirmed marked improvement in passive outflow compared with the first-generation dual bore cannula single vent port design for all gauges. CONCLUSION: The SideFlo cannula represents a novel next-generation dual bore cannula design with significantly improved performance over first-generation dual bore cannulas. Axial jet damage from fluid injection is eliminated, and pressure equilibration by passive venting from the eye is significantly enhanced.


Assuntos
Cateterismo/instrumentação , Catéteres , Corantes/administração & dosagem , Fluorocarbonos/administração & dosagem , Verde de Indocianina/administração & dosagem , Vitrectomia/instrumentação , Drenagem/instrumentação , Desenho de Equipamento , Humanos , Modelos Anatômicos , Cirurgia Vitreorretiniana
9.
Retina ; 36(6): 1076-80, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26562562

RESUMO

PURPOSE: To report outcomes of patients who have undergone combined Trabectome and pars plana vitrectomy. METHODS: Institutional Review Board-approved retrospective chart review of patients seen at the Cincinnati Eye Institute before January 2014 undergoing combined Trabectome and pars plana vitrectomy for uncontrolled glaucoma and visually significant retina pathology. Charts were reviewed to identify changes in intraocular pressure, visual acuity, and change in glaucoma medication requirement up to 1 year after surgery. RESULTS: Four patients met the inclusion criteria with 12-month follow-up, and two of the patients were male. All patients underwent 25-gauge pars plana vitrectomy and Trabectome surgery. Mean preoperative LogMAR visual acuity was 0.39 (20/49) and 12-month LogMAR visual acuity was 0.21 (20/32) (P = 0.06). Mean preoperative intraocular pressure was 17 mmHg and mean preoperative glaucoma medication requirement was 2.5 topical medications. Twelve-month mean intraocular pressure was 12.8 mmHg (P = 0.07), and mean topical glaucoma medication requirement was 2.3 medications (P = 0.39). All patients were off steroids and anti-inflammatories at the final visit. One patient developed a hyphema requiring anterior chamber washout at 1 week. No other complications occurred. CONCLUSION: The results suggest that combined Trabectome and pars plana vitrectomy seems effective in the management of glaucoma in patients with visually significant retina pathology.


Assuntos
Glaucoma de Ângulo Aberto/cirurgia , Doenças Retinianas/cirurgia , Trabeculectomia/métodos , Vitrectomia/métodos , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Glaucoma de Ângulo Aberto/fisiopatologia , Humanos , Pressão Intraocular/fisiologia , Implante de Lente Intraocular , Masculino , Microcirurgia , Pessoa de Meia-Idade , Facoemulsificação , Prognóstico , Doenças Retinianas/fisiopatologia , Estudos Retrospectivos , Tonometria Ocular , Malha Trabecular/cirurgia , Acuidade Visual/fisiologia
11.
Retina ; 35(6): 1065-71, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25763463

RESUMO

PURPOSE: To report the outcomes of combined cataract surgery with toric intraocular lens (IOL) implantation when performed in conjunction with transconjunctival sutureless pars plana vitrectomy. DESIGN: Retrospective interventional case series. PARTICIPANTS: Consecutive series of 55 eyes of 51 patients from April 2007 to December of 2010. METHODS: All eyes underwent combined simultaneous small incision cataract surgery, toric IOL implantation, and transconjunctival sutureless vitrectomy surgery. MAIN OUTCOME MEASURES: Postoperative visual acuity, postoperative astigmatism, and rotational stability of the IOL. RESULTS: Preoperative best-corrected visual acuity was 0.32 ± 0.15 logMar (Snellen 20/43) and improved to 0.16 ± 0.10 (Snellen 20/29) postoperatively uncorrected (P < 0.01) and to 0.08 ± 0.11 best-corrected (Snellen 20/24) (P < 0.01). Preoperative astigmatism was 1.75 ± 1.0 diopters (D) (range, 0-4.75 D) and improved to 0.5 ± 0.50 D (range, 0-2.5 D) postoperatively (P < 0.01). Final measured postoperative IOL axis deviation from target axis was 4 ± 6° (range, 0-32). Final IOL axis was within 5° of target in 47 (85%) eyes, within 10 degrees of target in 51 (93%) eyes, and was within 15° of target in 52 (95%) eyes. CONCLUSION: Toric lens position and axis remained stable after implantation during combined cataract surgery and transconjunctival sutureless vitrectomy.


Assuntos
Implante de Lente Intraocular , Lentes Intraoculares , Facoemulsificação/métodos , Pseudofacia/fisiopatologia , Acuidade Visual/fisiologia , Vitrectomia , Idoso , Idoso de 80 Anos ou mais , Astigmatismo/fisiopatologia , Túnica Conjuntiva/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Falha de Prótese , Doenças Retinianas/cirurgia
13.
Artigo em Inglês | MEDLINE | ID: mdl-39311551

RESUMO

BACKGROUND AND OBJECTIVE: To objectively analyze the effect of three-dimensional screen-based surgery (3D SBS) versus traditional operating microscope (TOM) on operating surgeon posterior chain postural musculature during ophthalmic surgery. We hypothesized an increase in median amplitude of electromyography (EMG) signals when using a TOM compared to 3D SBS. The goal was to assess surgical ergonomics that may contribute to cervical and lumbar spine pathology. EMG analysis was conducted at the University of Cincinnati Medical Center Epilepsy Monitoring Unit. Data were collected in the private practice setting at Cincinnati Eye Institute. MATERIALS AND METHODS: This was an institutional review board exempt, nonrandomized, prospective, single center, n = 1 clinical methods study. EMG surface electrodes were affixed to the bilateral splenius capitis, sternocleidomastoid, upper trapezius, anterior deltoid, and quadratus lumborum musculature. EMG data were collected across four sessions consisting of one day each using 3D SBS or a TOM, and two cross-over days. A survey regarding surgeon comfort was administered before, during, and after each surgery, and at the end of each day. RESULTS: EMG cross-over data demonstrated an increase in muscle activation in all measured muscles except the anterior deltoids and right quadratus lumborum with use of a TOM. Survey data showed increased fatigue when using a TOM relative to 3D SBS. CONCLUSION: EMG demonstrated increased postural muscle activation when utilizing TOM relative to 3D SBS. Similar to previous studies, our survey data suggest inferior ergonomics of TOM relative to 3D SBS. [Ophthalmic Surg Lasers Imaging Retina 2024;55:XX-XX.].

14.
Cornea ; 2024 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-39085991

RESUMO

PURPOSE: Anterior stromal puncture is an inexpensive and widely used technique at the slit lamp to treat recurrent corneal erosions (RCE), common sequelae of corneal abrasions, trauma, and epithelial basement membrane dystrophies (EBMDs). The purpose of this study was to determine safety of a novel anterior stromal micropuncture device (termed a "plexitome") for use in the optical axis of the cornea. METHODS: We performed an IRB-approved clinical pilot study on 45 patients with diverse corneal pathologies to determine the safety of the plexitome device and examined corneal healing responses clinically for a minimum of 30 days after treatment. Follow on efficacy data was collected for treated patients with RCE. Micropuncture treatment was performed either through loose epithelial tissue or after debridement using a cotton tip at the slit lamp. After "imprinting," patients were treated with topical medications including antibiotics, hypertonic saline/ointment, bandage contact lenses, and/or patching according to the treating physician's routine care for the condition. RESULTS: Micropuncture using the "plexitome" device did not create visible scars in the corneal stroma of the 45 patients treated and followed for at least 30 days. Photographic evidence of imprinting was seen at in 1 patient at 30 days. There were no significant adverse events associated with treatment. CONCLUSIONS: Micropuncture of the cornea using the "plexitome" device does not create optically evident anterior stromal scarring after treatment. Micropuncture using the device may be an effective way of treating RCE and other corneal manifestations of EBMD in the optical axis, which is not currently possible using standard anterior stromal puncture methods.

15.
Retina ; 33(1): 97-104, 2013 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-22718153

RESUMO

PURPOSE: To describe fundus autofluorescence (FAF) characteristics associated with choroidal osteomas and their secondary complications. METHODS: Retrospective descriptive case series of six eyes of five patients with choroidal osteomas. Findings of FAF correlated with visual acuity, clinical features, lesion characteristics, and findings from other imaging modalities. RESULTS: All 6 choroidal osteomas (100%) had totally or partially calcified, orange portions that were isoautofluorescent. Partial decalcification also produced areas of hyperautofluorescence and granular hypoautofluorescence corresponding to overlying retinal pigment epithelium mottling in 3 eyes (50%). Total decalcification with retinal pigment epithelial atrophy produced decreased FAF in 2 eyes (33%). Serous retinal detachment was present in 3 eyes (50%). When the overlying retinal pigment epithelium was viable, hyperautofluorescence as a result of elongation of the outer segments of photoreceptor was observed. In one eye where geographic atrophy of the retinal pigment epithelium was present, FAF was decreased even in the presence of serous retinal detachment. Portions of three partially or totally decalcified osteomas within the treatment field of photodynamic therapy for choroidal neovascularization were hypoautofluorescent. Four eyes (67%) had reduced foveal FAF and visual acuity <20/20, while both eyes with foveal isoautofluorescence had normal (20/20) visual acuity. CONCLUSION: Calcified portions of choroidal osteomas not previously treated with photodynamic therapy were isoautofluorescent. Decalcification and secondary complications of serous retinal detachment, choroidal neovascularization, and geographic atrophy altered foveal autofluorescence and were associated with reduced visual acuity.


Assuntos
Calcinose/diagnóstico , Neoplasias da Coroide/diagnóstico , Angiofluoresceinografia , Osteoma/diagnóstico , Adolescente , Adulto , Criança , Neovascularização de Coroide/diagnóstico , Feminino , Atrofia Geográfica/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Descolamento Retiniano/diagnóstico , Epitélio Pigmentado da Retina/patologia , Estudos Retrospectivos , Tomografia de Coerência Óptica , Transtornos da Visão/diagnóstico , Acuidade Visual/fisiologia
16.
J Vitreoretin Dis ; 7(6): 490-497, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37974917

RESUMO

Purpose: To assess the impact of retinal thickness variability (RTV) control on visual and treatment burden outcomes in patients with diabetic macular edema (DME) who received the 0.19 mg fluocinolone acetonide (FAc) intravitreal implant (Iluvien, Alimera Sciences). Methods: This post hoc analysis examined the outcomes of a 3-year, phase 4, nonrandomized, open-label observational study. Retinal thickness was measured as central subfield thickness (CST). RTV was quantified by CST area under the curve (CST-AUC), retinal thickness amplitude (RTA), and retinal thickness standard deviation (RTSD). Visual outcomes were measured as best-corrected visual acuity (BCVA), and treatment burden was measured as the number of yearly supplemental DME treatments. Results: The percentage of eyes with a CST ≤300 µm fluctuated throughout the study but was significantly increased relative to baseline at 36 months (baseline: 32.9% vs 36 months: 46.8%; P < .05). FAc significantly reduced RTV in all measures more than 36 months (P < .0001). When divided into quartiles, eyes with the best RTV control post FAc had the greatest BCVA gains and improved disease control (ie, reduced need for supplemental therapy). The last-observed BCVA letter score exhibited linear correlations with CST-AUC (R2 = -0.100), RTA (R2 = -0.125), and RTSD (R2 = -0.162). A multivariate linear regression with baseline BCVA as a covariate displayed improved correlations with the last-observed BCVA, CST-AUC (R2 = -0.448), RTA (R2 = -0.432), and RTSD (R2 = -0.436). Conclusions: The sustained corticosteroid release of the 0.19 mg FAc implant reduced RTV in patients with DME, which directly correlated with significantly improved vision and a reduced supplemental treatment burden.

17.
Br J Ophthalmol ; 107(9): 1383-1389, 2023 09.
Artigo em Inglês | MEDLINE | ID: mdl-35649694

RESUMO

BACKGROUND/AIMS: Sheet-like type of epithelial downgrowth (EDG) is not easily amenable to surgical excision. We describe long-term outcomes in patients with EDG treated with intraocular methotrexate (MTX). METHODS: This is a retrospective, multicentric case series including 10 eyes (nine patients) treated with intraocular MTX for sheet-like EDG. Relevant ocular history, previous EDG treatments, MTX injection regimen, long-term outcomes and complications are reported. RESULTS: All cases were associated with intraocular surgery. Most patients were treated with 400 µm/0.1 mL MTX injections with a starting frequency of two times per week or weekly injections. Mean and SD number of injections per eye was 16±13 injections and duration of follow-up was 54±36 months (range: 7-120 months). Eradication of EDG was achieved in seven eyes of which one required a second MTX treatment course to achieve eradication, while clinical resolution with recurrence was observed in two. One treatment failure occurred despite eight weekly injections which slowed but did not halt EDG progression; the patient later requested that treatments be stopped given difficulty to come to follow-ups. Surface epitheliopathy developed in eight patients and was used to titrate MTX treatment. Six patients also developed endothelial failure. CONCLUSION: We report the largest case series of diffuse, sheet-like EDG treated with intraocular MTX with follow-ups up to 10 years. Intraocular MTX may be used effectively to achieve eradication of EDG in cases where surgery is not amenable. However, further recommendations to guide treatment remain warranted.


Assuntos
Olho , Metotrexato , Humanos , Metotrexato/uso terapêutico , Estudos Retrospectivos , Injeções , Resultado do Tratamento
18.
J Vitreoretin Dis ; 7(3): 203-210, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37188214

RESUMO

Purpose: To compare retrobulbar anesthesia injection (RAI) with hyaluronidase and without hyaluronidase in vitreoretinal surgery using clinical efficacy measures and orbital manometry (OM). Methods: This prospective randomized double-masked study enrolled patients who had surgery using an 8 mL RAI with or without hyaluronidase. Outcome measures were clinical block effectiveness (akinesia, pain scores, need for supplemental anesthetic or sedative medications) and orbital dynamics assessed by OM before and up to 5 minutes after RAI. Results: Twenty-two patients received RAI with hyaluronidase (Group H+), and 25 received RAI without hyaluronidase (Group H-). Baseline characteristics were well matched. No differences in clinical efficacy were found. OM showed no difference in preinjection orbital tension (4 ± 2 mm Hg in both groups) or calculated orbital compliance (0.6 ± 0.3 mL/mm Hg, Group H+; 0.5 ± 0.2 mL/mm Hg, Group H-) (P = .13). After RAI, the peak orbital tension was 23 ± 15 mm Hg in Group H+ and 24 ± 9 mm Hg in Group H- (P = .67); it declined more rapidly in Group H+. Orbital tension at 5 minutes was 6 ± 3 mm Hg in Group H+ and 11 ± 5 mm Hg in Group H- (P = .0008). Conclusions: OM showed faster resolution of post-RAI orbital tension elevation with hyaluronidase; however, there were no clinically evident differences between groups. Thus, 8 mL RAI with or without hyaluronidase is safe and can achieve excellent clinical results. Our data do not support the routine use of hyaluronidase with RAI.

19.
Ophthalmology ; 119(2): 327-32, 2012 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-22133795

RESUMO

PURPOSE: To assess the long-term outcomes of intravitreal bevacizumab (IVB) in the treatment of choroidal neovascularization (CNV) secondary to presumed ocular histoplasmosis syndrome (POHS). DESIGN: Retrospective, comparative case series. PARTICIPANTS: Interventional series of 150 eyes in 140 patients treated for subfoveal or juxtafoveal CNV secondary to POHS from January 2006 to January 2010. INTERVENTION: Intravitreal bevacizumab monotherapy or combination IVB and verteporfin photodynamic therapy (IVB/PDT). MAIN OUTCOME MEASURES: Visual acuity (VA) at 12 and 24 months was analyzed. Secondary outcome measures included the number of injections per year and treatment-free intervals. RESULTS: A total of 117 eyes received IVB monotherapy, and 34 eyes underwent combination IVB/PDT treatment. For all patients, the average pretreatment logarithm of minimum angle of resolution (logMAR) was 0.63 (Snellen equivalent 20/86) with a 12-month logMAR VA of 0.45 (Snellen equivalent 20/56) and a 24-month logMAR VA of 0.44 (Snellen equivalent 20/55). The mean follow-up was 21.1 months with an average of 4.24 IVB injections per year. There was no significant difference in initial VA, VA at 12 months, VA at 24 months, or number of eyes with a 3-line gain between the IVB monotherapy and IVB/PDT groups. Thirty-eight percent (39/104) of eyes gained 3 lines or more, and 81.2% (84/104) of subjects had maintained or improved their starting VA at 1 year. The proportion of subjects maintaining a 3-line gain in VA was relatively preserved at 2 years (29.8%, 17/57) and 3 years (30.3%, 10/32) follow-up. There was no increase in the proportion of subjects losing 3 lines or more over 3 years of follow-up. CONCLUSIONS: There is no significant difference in VA outcomes between IVB monotherapy versus IVB/PDT combination therapy. The use of IVB alone or in combination with PDT results in significant visual stabilization in the majority of patients with CNV secondary to POHS.


Assuntos
Inibidores da Angiogênese/uso terapêutico , Anticorpos Monoclonais Humanizados/uso terapêutico , Neovascularização de Coroide/tratamento farmacológico , Infecções Oculares Fúngicas/tratamento farmacológico , Histoplasmose/tratamento farmacológico , Inibidores da Angiogênese/administração & dosagem , Anticorpos Monoclonais Humanizados/administração & dosagem , Bevacizumab , Neovascularização de Coroide/microbiologia , Neovascularização de Coroide/fisiopatologia , Terapia Combinada , Infecções Oculares Fúngicas/microbiologia , Infecções Oculares Fúngicas/fisiopatologia , Feminino , Seguimentos , Histoplasmose/microbiologia , Histoplasmose/fisiopatologia , Humanos , Injeções Intravítreas , Masculino , Pessoa de Meia-Idade , Fotoquimioterapia , Fármacos Fotossensibilizantes/uso terapêutico , Porfirinas/uso terapêutico , Estudos Retrospectivos , Resultado do Tratamento , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Verteporfina , Acuidade Visual/fisiologia
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