RESUMO
The use of nanomaterials is an emerging therapeutic approach for the treatment of several pathologies. Cerium oxide nanoparticles have been studied for biomedical application, including neurodegenerative disorders, such as age-related macular degeneration in several animal models. The light damage model is characterised by oxidative stress upregulation followed by photoreceptor death and microglia activation in the outer retina. For this reason, the light damage model mimics some aspects involved in human age-related macular degeneration pathogenesis. In this review, we focus on the neuroprotective effects on retinal function and microglia activation in the light damage model, considering the administration of the nanoparticles both before and after the injury. The electrical responses of the retina and the microglia number and morphology are clearly modulated by the treatment, supporting the beneficial effects of cerium oxide nanoparticles to counteract the degeneration processes in the retina.
Assuntos
Cério/uso terapêutico , Luz/efeitos adversos , Microglia/metabolismo , Fármacos Neuroprotetores/uso terapêutico , Lesões por Radiação/prevenção & controle , Retina/efeitos da radiação , Degeneração Retiniana/prevenção & controle , Células Ganglionares da Retina/metabolismo , Animais , Camundongos , Estresse Oxidativo , Lesões por Radiação/etiologia , Lesões por Radiação/metabolismo , Ratos , Degeneração Retiniana/etiologia , Degeneração Retiniana/metabolismoRESUMO
PURPOSE: To provide an in vivo confocal microscopy (IVCM) and impression cytology analysis of preserved-and unpreserved levobunolol-induced changes of conjunctival epithelium. METHODS: 27 eyes of 27 patients were consecutively randomized to receive preserved or unpreserved levobunolol; all patients had a recent diagnosis of primary open angle glaucoma (POAG) or ocular hypertension and were not previously treated with topical medications. IVCM and impression cytology were performed before and after six months of therapy. Goblet cells density and a conjunctival epithelium regularity index were considered in the IVCM analysis, whereas impression cytology specimens were graded and scored in accordance with Nelson's method. RESULTS: After six months of therapy, IVCM and impression cytology parameters showed significant differences with respect to baseline in both groups (p<0.001); significant differences were also found between the two groups (p<0.001). The IVCM analysis showed a goblet cells density reduction (61% and 17% from baseline, respectively in group 1 and 2) (p<0.001) and an higher index of epithelial regularity (p<0.001) in both groups; the impression cytology analysis showed an higher score in both groups (p<0.001). CONCLUSIONS: All the IVCM and impression cytology parameters correlated well with the conjunctival modifications induced by the topical therapy, suggesting the less toxicity of unpreserved drugs.
Assuntos
Antagonistas Adrenérgicos beta/uso terapêutico , Túnica Conjuntiva/efeitos dos fármacos , Glaucoma de Ângulo Aberto/tratamento farmacológico , Células Caliciformes/patologia , Levobunolol/uso terapêutico , Conservantes Farmacêuticos/uso terapêutico , Contagem de Células , Túnica Conjuntiva/patologia , Feminino , Humanos , Pressão Intraocular/efeitos dos fármacos , Masculino , Microscopia Confocal , Pessoa de Meia-Idade , Hipertensão Ocular/tratamento farmacológico , Método Simples-CegoRESUMO
PURPOSE: To evaluate the effects of pneumatic trabeculoplasty (PNT) in ocular hypertension and glaucoma subjects. METHODS: A total of 63 consecutive subjects, either treated (79%) or untreated (21%), with intraocular pressure (IOP) between 20 and 25 mmHg were enrolled; the eye with higher IOP (or, in case of identical IOP, worse visual field) was treated with PNT, with the fellow eye used as control. Subjects underwent a baseline evaluation the day before treatment, two PNT treatments at day 0 and 7, visits at day 1, 8, 14, and at each month until the end of the study, which lasted 6 months. Safety was addressed at all visits; an IOP curve (at 8 and 10 AM, 2 and 4 PM) was obtained at baseline and during monthly visits. RESULTS: In PNT eyes, baseline IOP was 22.2-/+1.6 mmHg. Following PNT a statistically significant reduction of IOP occurred at all visits (p<0.0001), with a mean decrease ranging from -2.7-/+2.5 (-11.9-/+10.8%) to -3.6-/+2.6 mmHg (-16.0-/+11.6%); mean reduction was 12.8-/+11.5%. Although IOP diminished also in the control eyes after baseline (p<0.05), the change in IOP was significantly higher in PNT group at each visit (p<0.05). Mild side effects were experienced by 76% of subjects and they all resolved without sequelae. CONCLUSIONS: The results suggest the effect of this procedure in reducing IOP in glaucoma and ocular hypertensive subjects.
Assuntos
Glaucoma de Ângulo Aberto/cirurgia , Pressão Intraocular/fisiologia , Trabeculectomia/métodos , Vácuo , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Glaucoma de Ângulo Aberto/fisiopatologia , Gonioscopia , Humanos , Masculino , Pessoa de Meia-Idade , Hipertensão Ocular/fisiopatologia , Hipertensão Ocular/cirurgia , Estudos Prospectivos , Tonometria Ocular , Resultado do TratamentoRESUMO
PURPOSE: The aim of the study was to evaluate the fixation patterns of microstrabismic children previously treated for unilateral amblyopia. METHODS: Thirty-three children (mean age 7.3+/-1.5 years) were included in the study. Visual acuity (VA) was measured using the Early Treatment of Diabetic Retinopathy Study charts. Fixationwas assessed by MP-1 microperimeter. Differences in position and stability of fixation between the fellow and the microstrabismic eyes were calculated by using the percentage of the preferred fixation points within central fixation and the percentage of the fixation points within target fixation, respectively. For statistical analysis Mann-Whitney test was used. To evaluate the influence of age and duration of anti-amblyopic treatment on microstrabismic eyes fixation, linear regression analysis was performed. RESULTS: In the microstrabismic eyes VA was significantly reduced when compared to the fellow eyes (0.1236+/-0.0204 vs 0.0042+/-0.0032 logMAR; p<0.001). Position and stability of fixation were significantly better in the fellow eyes (93.21+/-0.65% vs 70.91+/-4.80%; p=0.002, and 89.88+/-0.94% vs 71.73+/-2.94%; p<0.001, respectively). A significant correlation was found between fixation stability and both the duration of anti-amblyopic treatment and pretreatment VA (p=0.024 and p=0.009, respectively) and between fixation centrality and pretreatment VA (p<0.001). CONCLUSIONS: VA, centrality, and stability of fixation were significantly impaired in the microstrabismic eyes. Pretreatment VA was a risk factor for fixation impairment. The severity of fixation stability impairment was linked to the duration of anti-amblyopic treatment.
Assuntos
Ambliopia/fisiopatologia , Fixação Ocular/fisiologia , Estrabismo/fisiopatologia , Ambliopia/etiologia , Ambliopia/terapia , Criança , Óculos , Feminino , Humanos , Masculino , Estudos Prospectivos , Privação Sensorial , Estrabismo/complicações , Estrabismo/terapia , Acuidade Visual/fisiologia , Testes de Campo Visual/métodosRESUMO
PURPOSE: To report pre- and post-operative macular optical coherence tomography (OCT) and immunohistochemical findings in a case of long-lasting silicone oil tamponade followed by silicone oil removal and epimacular membrane peeling. METHODS: A 69-year-old man with long-standing silicone oil tamponade and an epiretinal membrane at the posterior pole in his right eye (RE) underwent silicone oil/BSS exchange with epiretinal membrane peeling. Preoperatively, RE best-corrected visual acuity was 20/200 and macular OCT examination revealed a small increase in foveal thickness (250 microm) with the appearance of a linear hyper-reflective signal at the foveal vitreoretinal interface and a thicker (440 microm) hyperreflective finding causing posterior shadowing at the vitreoretinal interface inferiorly to the fovea. Histopathologic and immunohistochemical study of the specimen including the epiretinal membrane was performed. RESULTS: Light microscopy revealed extensive rounded empty spaces interpreted as silicone oil bubbles in the preretinal membrane. Macrophages marker (CD68) positive staining cells were found surrounding the empty spaces within the preretinal membrane and several empty spaces were observed intracellularly within macrophage cytoplasm. Thirty days after surgery best-corrected visual acuity was 20/60 and OCT examination showed an evident decrease in foveal thickness (220 microm) with the disappearance of any hyper-reflective signal at the vitreoretinal interface referable to an epiretinal membrane. CONCLUSIONS: The immunohistochemical study showed both silicone oil droplets and macrophagic cells embedded in the epiretinal membrane. Postoperative OCT demonstrated retinal recovery after silicone oil removal and epiretinal membrane peeling, thus justifying an unexpected visual acuity recovery despite the very long term tamponade.
Assuntos
Membrana Epirretiniana/patologia , Corpos Estranhos no Olho/patologia , Óleos de Silicone , Idoso , Antígenos CD/metabolismo , Antígenos de Diferenciação Mielomonocítica/metabolismo , Membrana Epirretiniana/etiologia , Membrana Epirretiniana/cirurgia , Humanos , Técnicas Imunoenzimáticas , Macrófagos/metabolismo , Macrófagos/patologia , Masculino , Descolamento Retiniano/complicações , Descolamento Retiniano/cirurgia , Tomografia de Coerência Óptica , Acuidade Visual , Vitrectomia , Vitreorretinopatia Proliferativa/complicações , Vitreorretinopatia Proliferativa/cirurgiaRESUMO
PURPOSE: To evaluate variability of retinal nerve fiber layer (RNFL) thickness measurements in normal eyes and their correlation with optic disc diameter by using two different scan options of the ultimate commercial optical coherence tomography (OCT) unit (STRATUS OCT, Carl Zeiss Meditec, Inc., Dublin, CA). METHODS: In this observational case series and instrument validation study 30 eyes of 30 normal subjects were enrolled. Each eye underwent optic disc vertical diameter measurement by means of both stereoscopic photography and planimetry and OCT; RNFL thickness measurements were performed using OCT. Three repetitions of two series of scans were performed. Each eye was scanned at two different options (RNFL thickness 3.4 and Nerve Head Circle). For each option descriptive statistics, analysis of variance, intraclass correlation coefficients (ICCs), and coefficients of variation (COVs) were calculated. To verify the correlation between the two methods of optic disc diameter assessment and to study the influence of optic disc diameter on RNFL measurement using the two different OCT options, Pearson's correlation coefficients were calculated. RESULTS: Optic disc diameter length ranged from 1.47 to 2.04 mm (mean 1.709 mm, SD +/- 0.147) with stereoscopic photographs, and from 1.47 to 2.02 mm (mean 1.703 mm, SD +/- 0.143) with OCT (Pearson correlation coefficient 0.999, p<0.001). Mean RNFL thickness was 89.29 mm (SD +/- 10.80 mm) using the RNFL thickness 3.4 scanning option and 89.88 mm (SD +/- 1.72 mm) using the Nerve Head Circle protocol (Pearson correlation coefficient 0.065, p=0.734). The intersubject variance is higher using the RNFL thickness 3.4 option than using the NHC protocol (sum of square: 1,014,760 vs. 25,741) (p<0.001); the intrasubject variance is very similar in the two groups (2,372 vs 2,360) (p=NS). The ICC is 99.89% when using the RNFL thickness 3.4 option, 95.62% with the NHC protocol (p=NS). COVs were 12.10% and 1.91% by using RNFL thickness 3.4 and Nerve Head Circle option, respectively. Pearson's correlation coefficient was 0.988 (p<0.001) when comparing optic disc diameter and RNFL thickness by using the RNFL thickness 3.4 option and -0.016 (p=0.932) when comparing optic disc diameter and RNFL thickness by using the Nerve Head Circle option. CONCLUSIONS: These results suggest that both scan options give good RNFL thickness measurement reproducibility; the use of the Nerve Head Circle option leads to less interindividual variability and can minimize the effect of differences in optic disc diameter on RNFL thickness measurements in normal subjects.
Assuntos
Fibras Nervosas , Células Ganglionares da Retina/citologia , Tomografia de Coerência Óptica/métodos , Adulto , Anatomia Transversal , Feminino , Humanos , Masculino , Disco Óptico/anatomia & histologia , Fotografação , Valores de ReferênciaRESUMO
PURPOSE: To report a case of spontaneous closure of traumatic macular hole in a young patient followed using optical coherence tomography (OCT) and fundus microperimetry. METHODS/RESULTS: In the right eye of a 10-year-old child, a traumatic macular hole was observed to spontaneously resolve 18 weeks after blunt trauma. Initially, visual acuity in the right eye was 20/200 and OCT examination showed a 200 microm-diameter full-thickness macular hole with perifoveal edema. Fundus microperimetry examination showed an evident decrease in retinal sensitivity within the macular hole and in the upper macular region where an area of commotio retinae was clearly visible. During follow-up OCT demonstrated the appearance of a band of tissue linking the inferior edge of the hole to the foveal retinal pigment epithelium and at the bottom of the hole the presence of hyperreflective (glial) material. Eighteen weeks after trauma right eye visual acuity had improved to 20/25, OCT examination showed a restored foveal depression, and fundus microperimetry demonstrated an increase in foveal sensitivity. CONCLUSIONS: Both OCT and fundus microperimetry were useful tools for following the favorable course in a case of spontaneous closure of traumatic macular hole in a young patient. During follow-up OCT examinations were able to demonstrate the course of macular hole closure.
Assuntos
Traumatismos Oculares/diagnóstico , Macula Lutea/lesões , Perfurações Retinianas/diagnóstico , Futebol/lesões , Tomografia de Coerência Óptica/métodos , Testes de Campo Visual/métodos , Ferimentos não Penetrantes/diagnóstico , Criança , Traumatismos Oculares/fisiopatologia , Humanos , Masculino , Remissão Espontânea , Perfurações Retinianas/fisiopatologia , Acuidade Visual/fisiologia , Ferimentos não Penetrantes/fisiopatologiaRESUMO
PURPOSE: To evaluate the effect of excimer laser photorefractive keratectomy (PRK) on nerve fiber layer thickness measurements by optical coherence tomography in myopic eyes. METHODS: Twenty-two patients who had PRK for myopia underwent nerve fiber layer measurement by optical coherence tomography in both eyes before and 6 months after surgery in the first operated eye and before surgery in the fellow (control) eye, 6 months after the first PRK. Optical coherence tomography was performed with a Humphrey Optical Coherence Tomography Scanner. Each eye was scanned at the nerve head program radius of 1.5. For each of the optical coherence tomography parameters (average for each quadrant, superior, inferior, temporal, nasal; average for each clock hour; average over the entire cylindrical section), descriptive statistics were calculated. The difference between the observed change from the first to the second examination was calculated between the treated and the control eye. Individual mean differences were tested with Student's t-test. Hotelling's T-squared generalized means test was used to determine whether the set of mean differences was equal to zero. RESULTS: The average preoperative refractive error was -3.90+/-1.50 D in treated eyes and -3.89+/-1.50 D in control eyes (P = .81, Student's t-test). Mean achieved refractive correction was 3.70+/-1.70 D, corresponding to 48.1+/-22.1 microm of corneal ablation. No statistically significant difference was found in any measurement in the treated eye compared with the untreated control eye. CONCLUSIONS: At 6 months postoperatively, photorefractive keratectomy for moderate myopia that resulted in clear corneas did not affect nerve fiber layer thickness measurements, as obtained by optical coherence tomography.
Assuntos
Córnea/cirurgia , Miopia/cirurgia , Fibras Nervosas , Nervo Óptico/anatomia & histologia , Ceratectomia Fotorrefrativa , Células Ganglionares da Retina/citologia , Adulto , Feminino , Humanos , Interferometria , Lasers de Excimer , Luz , Masculino , Tomografia/métodosRESUMO
AIM: The study was designed to evaluate the long term results of intraoperative mitomycin C in patients with one recurrence of pterygium. METHODS: In 45 white patients with one recurrence of pterygium the 'bare sclera technique' was performed and a sterile sponge soaked in a 0.2 mg/ml (0.02%) mitomycin C solution was placed intraoperatively on the sclera for 3 minutes. The control group underwent surgical excision only. Recurrences were analysed by the chi 2 test and the method of Kaplan-Meier (life table analysis); the difference between survival curves was tested by the log rank test. The chi 2 test with Yates's correction or Fisher's exact test were used to analyse the difference in complications and side effects between the two groups. RESULTS: After a mean postoperative follow up of 34.55 (SD 13.70) months, 6 recurrences (12.5%) were observed in the mitomycin C treated patients and 16 (35.6%) in the control patients (p = 0.027). The 24 and 48 month life table success rates were 89% and 83% in the mitomycin C treated group and 66% and 63% in the control group, respectively (p = 0.022). No severe side effects appeared during follow up. Superficial punctate keratitis appeared in the early postoperative period in only seven mitomycin C treated eyes (15.5%) (p = 0.018). CONCLUSION: This study confirms the efficacy of intraoperative mitomycin C in improving the success rate after recurrent pterygium surgical excision.
Assuntos
Antibióticos Antineoplásicos/uso terapêutico , Mitomicina/uso terapêutico , Pterígio/tratamento farmacológico , Adulto , Antibióticos Antineoplásicos/efeitos adversos , Estudos de Casos e Controles , Terapia Combinada , Feminino , Seguimentos , Humanos , Período Intraoperatório , Ceratite/induzido quimicamente , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Pterígio/cirurgia , Recidiva , Análise de SobrevidaRESUMO
BACKGROUND/AIMS: Fellow eye prophylaxis for retinal detachment (RD) is still a controversial issue since opinions are not unanimous regarding the kind of lesions to be treated or the method of treatment. This prospective clinical study aimed to follow the course of vitreoretinal conditions in 150 high risk fellow eyes. METHODS: 150 consecutive patients with unilateral rhegmatogenous RD were included in this study. Inclusion criteria were good explorability of fellow eye retinal periphery and one of the following conditions in the fellow eye-aphakia, pseudophakia with capsulotomy, high myopia (>-6D), contralateral eye to a giant retinal tear. Prophylactic treatment (photocoagulation or scleral buckling) was performed in the presence of retinal tears and lattice degenerations. The state of the vitreous body was determined at the beginning of the study and at the end, when RD occurred. RESULTS: Follow up ranged from 36 to 132 months. 95 fellow eyes were subjected to laser treatment; five eyes underwent prophylactic surgical treatment. Initially, in the treated group posterior vitreous detachment (PVD) was present in 100 eyes (100% of cases), but as a complete PVD only in 42 of them (42%). 10 eyes in the treated group developed RD during the follow up period. In five of these cases the partial PVD had progressed and a retinal tear in a previously healthy area was the cause of the retinal detachment. In the other five eyes RD apparently developed from previously treated lesions. Progression of PVD was evident in four out of these five eyes. The untreated eyes had no visible degenerative lesions. During follow up eight eyes developed RD. These eyes had no PVD at the beginning of the study, but showed a partial PVD at the time of the diagnosis of RD. CONCLUSION: Fellow eyes with pre-existing retinal tears and PVDs can go on to retinal detachment in spite of laser prophylactic treatment. When PVD is not detectable or a partial PVD is present, the progression of posterior vitreous separation can account for retinal tears and RDs arising in formerly healthy areas.
Assuntos
Descolamento Retiniano/prevenção & controle , Perfurações Retinianas/cirurgia , Descolamento do Vítreo/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Crioterapia/métodos , Feminino , Humanos , Terapia a Laser/métodos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Descolamento Retiniano/etiologia , Descolamento Retiniano/cirurgia , Perfurações Retinianas/etiologia , Recurvamento da Esclera/métodos , Descolamento do Vítreo/complicaçõesRESUMO
In an attempt to elucidate colour vision in children with type 1 (insulin-dependent) diabetes mellitus without fluorescein angiographic signs of retinopathy, we studied a group of 50 patients of mean age + or - SD 10.27 + or - 2.89 (range 8.1-13.0 years). Results were compared with a sex-and age-matched control group. The Farnsworth-Munsell 100-hue test showed a significantly higher value in total error score (TES) in diabetics than in controls (64.07 + or - 18.32 and 54.27 + or - 12.87, respectively: P = 0.0004). Diabetic patients were divided in two groups as regards presence of persistent microalbuminuria and followed for 7 years. The HbAlc values of the two groups were: normoalbuminuric 7.10 +/- 2.92%, microalbuminuric 9.79 + or - 1.41 (P = 0.004). Microalbuminuric patients showed a significantly higher TES than normoalbuminuric subjects both at the beginning (94.79 + or - 13.98 vs. 58.10 + or - 11.98) and end of the study (103.07 + or - 14.61 vs. 61.04 + or - 13.36: P < 0.0001), and after follow-up they had a worse TES than at the beginning of the study (P = 0.01); no change in TES was found in normoalbuminuric patients during the study. The results suggest that a deficit in colour vision occurs in diabetic children before the onset of fluorescein angiographic signs of retinopathy. Our follow-up shows that microalbuminuric patients present a significant worsening of colour vision. When a patient shows persistent microalbuminuria, colour vision must be carefully evaluated, also in subjects without fluorescein angiographic signs of retinopathy.
Assuntos
Albuminúria/complicações , Percepção de Cores/fisiologia , Diabetes Mellitus Tipo 1/fisiopatologia , Nefropatias Diabéticas/complicações , Retinopatia Diabética/diagnóstico , Adolescente , Albuminúria/fisiopatologia , Albuminúria/urina , Criança , Estudos de Coortes , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 1/urina , Nefropatias Diabéticas/fisiopatologia , Nefropatias Diabéticas/urina , Retinopatia Diabética/fisiopatologia , Feminino , Angiofluoresceinografia , Seguimentos , Hemoglobinas Glicadas/análise , Hemoglobinas Glicadas/metabolismo , Humanos , Estudos Longitudinais , Masculino , Estudos ProspectivosRESUMO
A 50-year-old, white, pseudophakic man who had a neodymium:YAG (Nd:YAG) posterior capsulotomy for capsule opacification developed a persistent rise in intraocular pressure (IOP) associated with a flat anterior chamber. Full-thickness patent iridotomy performed with an Nd:YAG laser did not reduce IOP. A-scan ultrasonography showed aqueous pockets in the vitreous, leading to a diagnosis of malignant glaucoma. Medical therapy comprising atropine, phenylephrine, mannitol, and acetazolamide normalized IOP and resolved the clinical findings.
Assuntos
Humor Aquoso , Glaucoma de Ângulo Fechado/etiologia , Terapia a Laser/efeitos adversos , Cápsula do Cristalino/cirurgia , Câmara Anterior/diagnóstico por imagem , Glaucoma de Ângulo Fechado/diagnóstico por imagem , Humanos , Pressão Intraocular , Iris/cirurgia , Masculino , Pessoa de Meia-Idade , Hipertensão Ocular/etiologia , Síndrome , UltrassonografiaRESUMO
PURPOSE: To evaluate whether heparin eyedrops prevent or reduce posterior capsule opacification (PCO) after extracapsular cataract extraction (ECCE) with intraocular lens (IOL) implantation. SETTING: Institute of Ophthalmology, University G. d'Annunzio, Chieti, Italy. METHODS: This 4 year, prospective, case-controlled study evaluated 200 patients who had ECCE and implantation of the same type of posterior chamber IOL. Patients were randomly assigned to receive topical heparin eyedrops postoperatively (heparin group, n = 100) or not to receive the eyedrops (control group, n = 100). Postoperative cell response, cellular precipitates on the IOL, and presence of PCO were evaluated. RESULTS: There were no significant differences between groups in postoperative inflammation. The incidence of cellular precipitates was significantly lower in the heparin group than in the control group (P < .001). A neodymium:YAG (Nd:YAG) posterior capsulotomy was done in 7 patients in the heparin group and 14 in the control group (P = .15). During the first 24 months after surgery, the heparin group had a significantly lower incidence of Nd:YAG capsulotomy (P < .05) and fibrotic PCO (P = .02). CONCLUSION: Topical heparin eyedrops were effective in reducing fibrotic PCO in the long term, indicating their usefulness in the postoperative management of ECCE.
Assuntos
Anticoagulantes/administração & dosagem , Catarata/prevenção & controle , Heparina/administração & dosagem , Cápsula do Cristalino/efeitos dos fármacos , Administração Tópica , Idoso , Anticoagulantes/uso terapêutico , Estudos de Casos e Controles , Catarata/etiologia , Catarata/patologia , Extração de Catarata/efeitos adversos , Método Duplo-Cego , Feminino , Seguimentos , Heparina/uso terapêutico , Humanos , Cápsula do Cristalino/patologia , Cápsula do Cristalino/cirurgia , Lentes Intraoculares , Masculino , Estudos Prospectivos , Reoperação , Resultado do TratamentoRESUMO
A 29-year-old man with Schnyder's central crystalline dystrophy was treated with phototherapeutic keratectomy (PTK) in his right eye. Ocular examination revealed abnormal deposits of cholesterol and lipid within the corneal stroma (appearing as crystalline spindle-shaped deposits), high myopia, phakic anterior chamber intraocular lens implantation, and myopic macular degeneration in both eyes. Phototherapeutic keratectomy ablation to a central zone of 7.0 mm and a depth of 96 microm was performed with an Aesculap Meditec MEL-70 excimer laser. Confocal microscopy performed before PTK showed multiple deposits of large, brightly reflective crystalline material extending from the anterior to the mid stroma. The Z-scan curves revealed that the highest density of crystalline deposits was located within the first 140 microm of corneal depth. Six months after PTK, confocal microscopy showed a markedly decreased density of corneal crystalline deposits in the anterior stroma.
Assuntos
Distrofias Hereditárias da Córnea/patologia , Substância Própria/patologia , Ceratectomia Fotorrefrativa , Adulto , Distrofias Hereditárias da Córnea/cirurgia , Substância Própria/cirurgia , Humanos , Lasers de Excimer , Masculino , Microscopia Confocal , Acuidade VisualRESUMO
Purine nucleotide degradation products have been determined by HPLC in aqueous humor obtained during cataract surgery and from plasma of 22 patients (12 women). Uric acid, cytosine, guanosine monophosphate, uracyl, guanine, adenosine, adenosine monophosphate, thymine, adenine, inosine, cyclic guanosine monophosphate, hypoxanthine and xanthine were evaluated. Uric acid and the last two were the only compounds detectable in measurable amounts in aqueous humor and in plasma of all patients. Aqueous humor xanthine levels were not significantly different from plasma; aqueous humor hypoxanthine concentrations were lower than those of xanthine and than plasma oxypurine levels. In 8 patients, treated with allopurinol, oxypurinol concentrations in aqueous humor and in plasma were comparable suggesting that oxypurines are transported through the blood-aqueous humor barrier.
Assuntos
Humor Aquoso/metabolismo , Catarata/metabolismo , Hipoxantina/metabolismo , Xantinas/metabolismo , Cromatografia Líquida de Alta Pressão , Feminino , Humanos , Masculino , Espectrofotometria Ultravioleta , XantinaRESUMO
PURPOSE: To describe the corneal findings in patients with amiodarone-induced keratopathy by means of in vivo confocal microscopy. METHODS: Twenty-two eyes of 11 patients (eight men and three women) receiving amiodarone therapy and 20 eyes of 10 healthy sex-and age-matched control subjects were selected for confocal microscopic examination. The patients were examined by use of a scanning slit corneal confocal microscope (Confoscan 2.0). Five complete scans of the entire cornea were performed for each eye with a total examination time of less than 5 minutes. RESULTS: All patients receiving amiodarone showed the presence of high reflective, bright intracellular inclusions in the epithelial layers. These findings were more evident within the basal cell layers. In the eyes with advanced keratopathy (stages 2 and 3), bright microdots were detectable within the anterior and posterior stroma and on the endothelial cell layer. In the anterior stroma, the keratocyte density in the treated group was reduced compared with values of the control group (p < 0.001), and a markedly irregular aspect of the stromal nerve fibers was found. The main characteristic of this nerve irregularity was represented by the clew-shaped appearance of the nerve trunks. CONCLUSION: Detailed examination of corneal structure by confocal microscopy shows that amiodarone keratopathy in long-term treated patients presents some findings that are consistent with higher toxicity than was expected and that involve the deep corneal layers.
Assuntos
Amiodarona/efeitos adversos , Antiarrítmicos/efeitos adversos , Córnea/patologia , Doenças da Córnea/patologia , Microscopia Confocal , Córnea/efeitos dos fármacos , Doenças da Córnea/induzido quimicamente , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
PURPOSE: To report optical coherence tomography (OCT) and retinal thickness analyzer (RTA) findings in a case of spontaneous resolution of vitreomacular traction syndrome. METHODS: Qualitative and quantitative analysis of the macular region was performed with OCT and RTA. RESULTS: In the left eye of a 34-year-old woman with blurred vision, OCT and RTA examination showed a discrete linear signal anterior to the retina with attachment at the macula and secondary cystoid macular changes. OCT and RTA examination showed an increase in macular thickness (350 microm). Six months later the patient showed a spontaneous complete recovery of visual acuity. Vitreomacular traction and cystoid changes were no longer detectable at OCT and RTA examination; retinal thickness was normal (205 microm) and a posterior vitreous detachment was visible. CONCLUSIONS: Both OCT and RTA were useful tools for making the diagnosis of vitreomacular traction syndrome and demonstrating the effect of spontaneous vitreomacular traction release with resolution of cystoid macular changes.
Assuntos
Macula Lutea/patologia , Doenças Retinianas/diagnóstico , Descolamento do Vítreo/diagnóstico , Adulto , Técnicas de Diagnóstico Oftalmológico , Feminino , Humanos , Edema Macular/diagnóstico , Remissão Espontânea , Doenças Retinianas/fisiopatologia , Síndrome , Aderências Teciduais , Tomografia de Coerência Óptica , Acuidade Visual , Descolamento do Vítreo/fisiopatologiaRESUMO
In this study concerning the prevalence of myopia in patients with open angle glaucoma, its distribution was analyzed within the sample tested in relation to the refraction defect size, compared with a control group of non-glaucomatous myopic subjects. The overall myopic rate was 17.2% of the glaucomatous patients; high myopia was more frequent in the subjects with open angle glaucoma (p less than 0.001) than in the myopic patients, thus appearing as a possible risk factor for the development of glaucoma.
Assuntos
Glaucoma de Ângulo Aberto/epidemiologia , Miopia/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Glaucoma de Ângulo Aberto/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Miopia/etiologia , Prevalência , Fatores de RiscoRESUMO
PURPOSE: To report a case of surgical resolution of bilateral vitreomacular traction syndrome related to incomplete posterior vitreoschisis as documented by optical coherence tomography (Stratus OCT, Carl Zeiss Meditec, Dublin, CA). CASE REPORT: In both eyes of a 72-year-old man with bilateral blurred vision, OCT examination disclosed a relevant increase in mean foveal thickness (right eye = 714 microm; left eye = 757 microm) due to a vitreomacular traction syndrome. At the edges of the most highly elevated area of vitreo-macular traction, OCT scans showed a characteristic splitting of the hyperreflective signal in both eyes, usually identified as posterior vitreous cortex. Both eyes underwent vitrectomy with epiretinal membrane peeling. Postoperative OCT examination showed vitreomacular traction resolution in both eyes with an evident decrease in mean foveal thickness (right eye = 364 microm; left eye = 335 microm). Right visual acuity improved from 20/200 to 20/50; left visual acuity changed from 20/150 to 20/40. CONCLUSIONS: OCT was a useful tool in identifying an unusual case of bilateral vitreomacular traction syndrome linked to incomplete posterior vitreoschisis and following a favorable course after surgical management.
Assuntos
Oftalmopatias/diagnóstico , Doenças Retinianas/diagnóstico , Tomografia de Coerência Óptica , Corpo Vítreo/patologia , Idoso , Oftalmopatias/cirurgia , Humanos , Masculino , Doenças Retinianas/cirurgia , Síndrome , Resultado do Tratamento , Acuidade Visual , Vitrectomia , Corpo Vítreo/cirurgiaRESUMO
PURPOSE: Rupture of the sclera occurring during retinal detachment surgery is generally associated with unfavourable anatomic and visual outcomes. Re-operation after a failed scleral buckle procedure and pre-existing scleral thinning are considered the main risk factors for scleral rupture. CASE REPORT: We describe the management and the favourable outcome of a case of scleral rupture in a 71-year-old woman during re-operation for retinal detachment. CONCLUSIONS: We managed this case of scleral rupture in accordance with current indications concerning the anatomical recovery, by scleral suture and patch graft, restoring IOP by gas tamponade. The positive outcome was partly related to the prompt closure of the retinal hole which led to reattachment, and partly to favourable events such as the moderate intensity of vitreous hemorrhage and the lack of any more serious intraoperative and postoperative complications.