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PURPOSE: To investigate eyes with polypoidal lesions associated with choroidal nevi, their multimodal imaging characteristics, and long clinical follow-up. METHODS: Multicenter, retrospective case series study of patients with polypoidal lesions overlying choroidal nevi. Demographic and clinical information were recorded. Multimodal imaging including color fundus photography, optical coherence tomography, optical coherence tomography angiography, fundus fluorescein angiography, indocyanine angiography, and A- and B-scan ultrasonography were analyzed for nevus and polypoidal lesion characteristics. RESULTS: Fourteen eyes (14 patients; mean age: 70.3 ± 6.7 years) with polypoidal lesions overlying choroidal nevi were included. The mean follow-up duration was 50.0 ± 27.9 months (range 12-108). All nevi were pigmented on color fundus photography, flat on ultrasonography with a mean basal diameter of 3.8 ± 0.4 mm. In all but one eye, optical coherence tomography showed a shallow irregular pigment epithelium detachment overlying the nevus. A total of 11/14 eyes (78.6%) had exudative activity, 9 eyes received intravitreal anti-vascular endothelial growth factor injections, and one eye required intravitreal anti-vascular endothelial growth factor combined with photodynamic therapy. Mean visual acuity was 20/32 at baseline and 20/50 at final visit. CONCLUSION: We present the largest known cohort of eyes with polypoidal lesions associated with choroidal nevi with up to 9 years follow-up. The exudative degree of the polypoidal lesion in this condition is variable and treatment decisions should be taken on an individual basis. We hypothesize that choroidal ischemia because of altered choroidal vasculature rather than Haller layer hyperpermeability plays a role in the formation of polypoidal lesions overlying nevi.
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Doenças da Coroide , Neoplasias da Coroide , Nevo , Pólipos , Humanos , Pessoa de Meia-Idade , Idoso , Estudos Retrospectivos , Fatores de Crescimento Endotelial , Doenças da Coroide/tratamento farmacológico , Corioide/patologia , Neoplasias da Coroide/patologia , Tomografia de Coerência Óptica/métodos , Angiofluoresceinografia/métodos , Pólipos/tratamento farmacológico , Injeções IntravítreasRESUMO
BACKGROUND: Support groups in ophthalmology may be of utmost importance for patients and caregivers. We aimed to characterise members of an online support group for patients and parents of children with inflammatory eye disease and assess the members' expectations and perceived benefits. METHODS: A survey based on a voluntary, anonymous web questionnaire was distributed to the members of the 'Lirot' association online support group. The questionnaire included demographic, ocular and systemic information, functional and psychosocial data, support group use patterns, expectations and perceived benefits. Analysis was done for patients and parents. RESULTS: Out of 67 respondents, 43 (64%) were patients, and 24 (36%) were parents. Fifty-eight (88%) were women. The mean age of respondents was 42.9 ± 1.34 years. Anterior uveitis was the most common, and most patients had good visual acuity (<0.3 logMAR). Parents reported higher anxiety levels (p = 0.044) and a more significant effect of their child's disease on their general function (p = 0.005). Most members sought several experts' opinions, psychological treatments and alternative medicine. All members used the WhatsApp group, while only approximately half used Facebook (p < 0.001). Members' expectations were fulfilled for social support, a sense of shared experience and being able to help others, but not for receiving information (p < 0.001). All members reported being willing to recommend the group to others. CONCLUSIONS: Support group participation benefited group members. We suggest that ophthalmologists encourage their inflammatory eye disease patients to use online support groups, which may significantly improve their well-being.
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INTRODUCTION: Budd-Chiari syndrome is a heterogeneous group of disorders characterized by venous drainage obstruction of the liver and is extremely rare. The clinical manifestations are usually ascites, varicose veins and in severe cases - hepatic insufficiency. Behcet's disease is a chronic, idiopathic, inflammatory disease that manifests as obstructive vasculitis and affects a variety of organ systems. Ocular involvement occurs in approximately 70% of the patients, and is a major clinical criterion in the diagnosis. Rarely, Behcet's disease can be a cause of Budd-Chiari syndrome. In these cases, the diagnosis has a crucial impact on the treatment and prognosis of the patients since patients with Budd-Chiari syndrome secondary to Behcet's disease, will usually improve under systemic medications with no need for surgery. In addition, in these patients there is a higher chance for developing hepatocellular carcinoma so they need to have a tight and a long follow-up. DISCUSSION: In this article we discuss a case of a young patient with Budd-Chiari syndrome, who was examined due to acute vision loss in his left eye. Left eye examination revealed panuveitis presenting with anterior uveitis, intermediate uveitis and an occlusive retinal vasculitis. The ocular examination raised suspicion that the diagnosis was Behcet's disease. Actually, Budd-Chiari syndrome was part of the presentation of Behcet's disease, which was not diagnosed until he was examined by us. The patient was treated with corticosteroid therapy and biological treatment with adalimumab, an anti-TNF drug. During follow-up, a complete resolution of the intraocular inflammation was achieved, as well as stabilization of its general condition, with the disappearance of the clinical signs indicative of liver failure.
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Síndrome de Behçet , Síndrome de Budd-Chiari , Uveíte , Masculino , Humanos , Síndrome de Budd-Chiari/diagnóstico , Síndrome de Budd-Chiari/etiologia , Síndrome de Budd-Chiari/cirurgia , Síndrome de Behçet/complicações , Síndrome de Behçet/diagnóstico , Inibidores do Fator de Necrose Tumoral , Transtornos da VisãoRESUMO
Vitreo-retinal lymphoma (VRL) is the most common intraocular lymphoma and is highly associated with central nervous system (CNS) lymphoma (CNSL), both posing a therapeutic challenge. We investigated patients' characteristics, efficacy and safety of intravitreal methotrexate (MTX) injections and their outcomes over 20 years. The records of 129 patients diagnosed between 1997 and 2018 were retrospectively reviewed. Lymphoma involved both the CNS and vitreo-retina (49%), solely the CNS (37%) or solely the vitreo-retina (14%). In all, 45·5% of the patients with CNSL either presented with VRL or developed it after a mean (±SE) of 85·7 (7·3) months. In all, 66·0% of the patients diagnosed with VRL either presented with CNSL or developed it after a mean (±SE) 42·6 (7·6) months. The 81 patients with VRL (134 eyes) received a mean (±SD) of 19 (7) injections; however, only 5 (4) injections were needed to reach complete remission. Local recurrence occurred in two of the 81 patients. Overall, 80·2% of eyes had an initial moderate-severe visual loss, and >50% of them improved. Reversible keratopathy was the most prevalent side-effect. A total of 18·5% developed intraocular pressure (IOP) elevation due to angle neovascularisation after 16 injections, which could be reversed with prompt intravitreal injection of bevacizumab. Intravitreal MTX injections are a safe and effective treatment for VRL. Fewer injections (15) may offer similar results with fewer side-effects.
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Antimetabólitos Antineoplásicos/uso terapêutico , Linfoma Intraocular/tratamento farmacológico , Metotrexato/uso terapêutico , Neoplasias da Retina/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Inibidores da Angiogênese/uso terapêutico , Antimetabólitos Antineoplásicos/administração & dosagem , Antimetabólitos Antineoplásicos/efeitos adversos , Bevacizumab/uso terapêutico , Neoplasias Encefálicas/tratamento farmacológico , Neoplasias Encefálicas/patologia , Doenças da Córnea/induzido quimicamente , Diagnóstico Tardio , Endoftalmite/induzido quimicamente , Feminino , Humanos , Linfoma Intraocular/diagnóstico , Linfoma Intraocular/patologia , Injeções Intravítreas , Masculino , Metotrexato/administração & dosagem , Metotrexato/efeitos adversos , Pessoa de Meia-Idade , Neovascularização Patológica/tratamento farmacológico , Neovascularização Patológica/etiologia , Hipertensão Ocular/induzido quimicamente , Indução de Remissão , Neoplasias da Retina/diagnóstico , Neoplasias da Retina/patologia , Estudos Retrospectivos , Resultado do Tratamento , Corpo Vítreo/patologia , Adulto JovemRESUMO
PURPOSE: To describe uveitis cases after the BNT162b2 mRNA SARS-CoV-2 vaccination. METHODS: This is a multicenter, retrospective study. Vaccine-related uveitis diagnosis was supported by the classification of the World Health Organization Adverse Drug Terminology and the Naranjo criteria. RESULTS: Twenty-one patients (23 eyes) with a mean age of 51.3 years (23-78 years) were included. Eight of the 21 patients had a known history of uveitis. The median time from previous to current attack was 1 year (0.5-15 years). There were 21 anterior uveitis cases, two with bilateral inflammation. Eight cases occurred after the first vaccination and 13 after the second vaccination. All but three presented as mild to moderate disease. Two patients developed multiple evanescent white dot syndrome after the second vaccination. The mean time from vaccination to uveitis onset was 7.5 ± 7.3 days (1-30 days). At final follow-up, complete resolution was achieved in all but two eyes, which showed significant improvement. One case of severe anterior uveitis developed vitritis and macular edema after the second vaccination, which completely resolved after an intravitreal dexamethasone injection. CONCLUSION: Uveitis may develop after the administration of the BNT162b2 mRNA vaccine. The most common complication was mild to moderate anterior uveitis, while multiple evanescent white dot syndrome can also occur less frequently.
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Vacina BNT162/efeitos adversos , COVID-19/prevenção & controle , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/etiologia , SARS-CoV-2 , Uveíte Anterior/induzido quimicamente , Vacinação/efeitos adversos , Adulto , Idoso , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Uveíte Anterior/diagnóstico , Adulto JovemRESUMO
BACKGROUND: Hemolytic Uremic Syndrome (HUS) is a rare disorder characterized by the triad of microangiopathic hemolytic anemia, thrombocytopenia, and acute renal failure, considered within the group of thrombocytic microangiopathies. Ocular complications in HUS are very rare. Here, we report an adult patient who suffered from acute onset of paracentral scotoma, caused by branch retinal artery occlusion (BRAO), as a leading symptom of atypical HUS. CASE PRESENTATION: A 39-year-old healthy male was lately diagnosed with essential hypertension and mild renal impairment. He complained about acute onset of central scotoma in his left eye. Fundus examination revealed marked narrowing of retinal vessels, cotton wool spots and few retinal hemorrhages in both eyes. The patient was diagnosed with bilateral ischemic retinal vasculopathy and acute macular BRAO in his left eye. Workup revealed thrombocytopenia, worsening renal failure. Renal biopsy showed signs of chronic thrombotic microangiopathy. The patient was diagnosed with atypical HUS (aHUS) and started on plasmapheresis, together with eculizumab. As his condition continued to worsen, he was put on renal replacement therapy. Due to a persistent monoclone of IgG1, the patient underwent bone marrow biopsy which revealed Monoclonal Gammopathy of renal significance, triggering a HUS and treatment was initiated accordingly. Two months after initial presentation, the patient developed neovascularization of the optic disc (NVD) in his left eye, and was treated with 3 monthly intravitreal bevacizumab injections with complete regression of the NVD. The patient suffered from myocardial infarction in the later course and was lost for follow-up. He returned 11 months after the last bevacizumab injection because of sudden loss of vision in his left eye caused by a dense vitreous hemorrhage. Biomicroscopy revealed a new NVD in his right eye. The patient underwent panretinal photocoagulation in both eyes with regression of neovascularization. Vision improved and remained 20/20 in both eyes. CONCLUSION: We present a case report showing retinal ischemia can be linked with aHUS. As clinal diagnosis might be challenging, physicians should be aware of the rare ocular manifestations of this devastating multi-organ disease. In case of retinal ischemia, panretinal photocoagulation should be initiated soon to avoid blinding complications.
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Síndrome Hemolítico-Urêmica Atípica , Oclusão da Artéria Retiniana , Doenças Retinianas , Adulto , Síndrome Hemolítico-Urêmica Atípica/diagnóstico , Humanos , Masculino , Oclusão da Artéria Retiniana/diagnóstico , Oclusão da Artéria Retiniana/etiologia , Hemorragia Retiniana/diagnóstico , Hemorragia Retiniana/etiologia , Hemorragia VítreaRESUMO
BACKGROUND: Fever of unknown origin (FUO) is a rare manifestation of cat scratch disease (CSD). Data regarding CSD-associated FUO (CSD-FUO), particularly in adults, are limited. We aimed to study disease manifestations and long-term clinical outcome. METHODS: A national CSD surveillance study has been conducted in Israel since 1991. Data are obtained using questionnaires, review of medical records, and telephone interviews. FUO was defined as fever of ≥14 days without an identifiable cause. CSD-FUO patients were identified in the 2004-2017 CSD national registry. Follow-up included outpatient clinic visits and telephone/e-mail surveys. RESULTS: The study included 66 CSD-FUO patients. Median age was 35.5 years (range, 3-88). Median fever duration was 4 weeks (range, 2-9). Relapsing fever pattern was reported in 52% of patients, weight loss in 57%, and night sweats in 48%. Involvement of ≥1 organs occurred in 59% of patients; hepatosplenic space-occupying lesions (35%), abdominal/mediastinal lymphadenopathy (20%), ocular disease (18%), and multifocal osteomyelitis (6%) were the most common. Malignancy, particularly lymphoma, was the initial radiological interpretation in 21% of patients; 32% underwent invasive diagnostic procedures. Of the 59 patients available for follow-up (median duration, 31 weeks; range, 4-445), 95% had complete recovery; 3 patients remained with ocular sequelae. CONCLUSION: This is the first attempt to characterize CSD-FUO as a unique syndrome that may be severe and debilitating and often mimics malignancy. Relapsing fever is a common clinical phenotype. Multiorgan involvement is common. Recovery was complete in all patients except in those with ocular disease.
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Bartonella henselae , Doença da Arranhadura de Gato , Febre de Causa Desconhecida , Osteomielite , Adulto , Doença da Arranhadura de Gato/complicações , Doença da Arranhadura de Gato/diagnóstico , Doença da Arranhadura de Gato/epidemiologia , Febre de Causa Desconhecida/diagnóstico , Febre de Causa Desconhecida/etiologia , Humanos , Israel/epidemiologia , SíndromeRESUMO
PURPOSE: To evaluate the efficacy, effect profile, and safety of dexamethasone implant on diabetic macular edema (DME) in a real-life setting, further comparing results by DME duration, previous treatment status, and diabetic control. DESIGN: A multicenter, retrospective cohort of 340 DME eyes of 287 patients from 25 clinical sites from 8 countries. METHODS: Data were analyzed in 2 perspectives: per injection, in which all measurements were grouped and baseline was defined as the day of injection, and thus the pharmacodynamics of single injections could be assessed; and injection series, defined as 2 or more injections with 3 to 6 months between injections analyzing the outcome 3 to 6 months after the last injection. MAIN OUTCOME MEASURES: Primary outcome was improvement of 15 or more letters in best-corrected visual acuity (BCVA) from baseline. Secondary outcomes included improvement of 10 letters or more in BCVA, change in central macular thickness (CMT), and time to maximum improvement and safety. RESULTS: Overall, 762 injections were administered to 340 eyes of 287 patients. Injection series analysis included 171 series in 171 eyes of 150 patients, for a total of 444 injections, with a mean follow-up of 1.7±0.8 years. Of the 762 injections analyzed per injection, 22.7% achieved a 15-letter or more improvement, and 37.8% achieved a 10-letter or more improvement. Mean time to peak improvement was 81.9±39.7 days. Mean maximum change in CMT was -174±171 µm. Overall, 7.6% lost 15 or more letters. More eyes with early DME gained 10 or more letters and fewer eyes lost 10 or more letters compared with eyes with late DME (47.4% vs. 33.9% [P = 0.001] and 8.2% vs. 13.5% [P = 0.029], respectively). Patients with controlled diabetes showed greater CMT reduction (P = 0.0002). A higher percentage of treatment-naive patients gained 10 or 15 letter or more in BCVA (P = 0.001 and P = 0.006, respectively). Intraocular pressure elevation of more than 25 mmHg was found following 7.9% of injections; no endophthalmitis was reported. CONCLUSIONS: Dexamethasone implant is an effective and safe treatment for DME. Peak improvement was achieved 3 months after injection and dissipated thereafter. Clinicians and providers may consider shortening treatment intervals.
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Dexametasona/administração & dosagem , Retinopatia Diabética/tratamento farmacológico , Implantes de Medicamento/uso terapêutico , Glucocorticoides/administração & dosagem , Edema Macular/tratamento farmacológico , Adulto , Idoso , Feminino , Humanos , Injeções Intravítreas , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Acuidade VisualRESUMO
PURPOSE: This study aimed to report the clinical outcome of children with uveitis treated with anti-tumor necrosis factor alpha (TNF-α) agents. METHODS: This included a retrospective cohort study. Children with uveitis treated with infliximab or adalimumab in 2008-2014 at five dedicated uveitis clinics were identified by database search. Their medical records were reviewed for demographic data, clinical presentation, ocular complications, and visual outcome. Systemic side effects and the steroid-sparing effect of treatment were documented. RESULTS: The cohort included 24 patients (43 eyes) of whom 14 received infliximab and 10 received adalimumab after failing conventional immunosuppression therapy. Mean age was 9.3 ± 4.0 years. The most common diagnosis was juvenile idiopathic arthritis-related uveitis (n = 10), followed by Behçet's disease (n = 4), sarcoidosis (n = 1), and ankylosing spondylitis (n = 1); eight had idiopathic uveitis. Ocular manifestations included panuveitis in 20 eyes (46.5%), chronic anterior uveitis in 19 (44.2%), and intermediate uveitis in 4 (9.3%). The duration of biologic treatment ranged from 6 to 72 months. During the 12 months prior to biologic treatment, while on conventional immunosuppressive therapy, mean visual acuity deteriorated from 0.22 to 0.45 logMAR, with a trend of recovery to 0.25 at 3 months after initiation of biologic treatment, remaining stable thereafter. A full corticosteroid-sparing effect was demonstrated in 16 of the 19 patients (84.2%) for whom data were available. Treatment was well tolerated. CONCLUSIONS: Treatment of pediatric uveitis with anti-TNF-α agents may improve outcome while providing steroid-sparing effect, when conventional immunosuppression fails. The role of anti-TNF-α agents as first-line treatment should be further investigated in controlled prospective clinical trials.
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Adalimumab/uso terapêutico , Artrite Juvenil/complicações , Síndrome de Behçet/complicações , Infliximab/uso terapêutico , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Uveíte/tratamento farmacológico , Adolescente , Antirreumáticos/uso terapêutico , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Masculino , Estudos Retrospectivos , Resultado do Tratamento , Uveíte/etiologiaAssuntos
Neoplasias Oculares , Linfoma Intraocular , Neoplasias da Retina , Humanos , Neoplasias da Retina/diagnóstico , Neoplasias da Retina/terapia , Neoplasias da Retina/patologia , Corpo Vítreo/patologia , Neoplasias Oculares/patologia , Linfoma Intraocular/diagnóstico , Linfoma Intraocular/tratamento farmacológico , Linfoma Intraocular/patologiaRESUMO
PURPOSE: To study the potential toxic effects of intravitreal clindamycin on the retina of albino rabbits, by assessing functional and morphological retinal changes. METHODS: Eight albino rabbits were included in the study. In each rabbit, 1 mg/0.1 ml clindamycin was injected into the vitreous of the right (experimental) eye, and 0.1 ml saline was injected into the vitreous of the left (control) eye. The electroretinogram (ERG) was recorded before injection, 3 days, 1, 2, and 4 weeks post-injection. The visual evoked potential (VEP) was recorded 4 weeks post-injection. Clinical examination was conducted at all time points. The eyes were enucleated at the termination of the follow-up period in order to prepare the retinas for histology in order to assess retinal structure. RESULTS: ERG and VEP responses that were recorded from the experimental eye at different times following intravitreal clindamycin injection were very similar to the corresponding responses that were recorded from the control eyes. Clinical examination was normal in all eyes, and no histological damage was observed. CONCLUSIONS: Intravitreal injection of 1 mg clindamycin does not cause functional or morphological signs of retinal toxicity in albino rabbits, during a period of 4 weeks post-injection. These findings support the clinical use of 1 mg intravitreal clindamycin.
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Antibacterianos/toxicidade , Clindamicina/toxicidade , Retina/efeitos dos fármacos , Animais , Eletrorretinografia/efeitos dos fármacos , Potenciais Evocados Visuais/efeitos dos fármacos , Potenciais Evocados Visuais/fisiologia , Injeções Intravítreas , Coelhos , Retina/fisiopatologiaRESUMO
PURPOSE: To investigate the effect of oral Rifampin in patients with chronic central serous chorioretinoapthy (CSCR). METHODS: This was a prospective pilot study of patients with chronic CSCR with persistent subretinal fluid (SRF) for at least 3 months, who were treated with oral Rifampin 300 mg twice per day for 3 months and had 6 months of follow-up. All patients underwent a complete ocular examination and a spectral domain optical coherence tomography (SD-OCT) scan monthly from baseline until month 4, and then at month 6. Fluorescein angiography (FA) was performed at baseline and at the end of the study. RESULTS: Fourteen eyes of 12 patients were included in the study, nine men and three women. Mean age was 58.5 years (range 32-80). Mean duration of SRF prior to study entry was 28.4 months. Forty-two percent of eyes were treated previously for CSR with thermal laser, PDT, or intravitreal bevacizumab. Mean best corrected visual acuity (BCVA) at presentation was 20/60 and improved to a mean of 20/50 at month 3 (P > 0.05). Retinal thickness was reduced by 25.3 %, 21.2 %, and 21 % on months 1, 2, 3, respectively (P < 0.05). Mean choroidal thickness at presentation was 476 µ (SD 188 µ) decreasing to 427 µ (SD 125 µ) after 3 months of treatment (P > 0.05). SRF was reduced in nine eyes (64 %) and completely resolved in six eyes (42.8 %) at month 3 following 3 months of treatment, and four out of these six eyes remained fluid free at month 6. Two patients stopped the treatment after 2 months due to adverse events. CONCLUSIONS: Oral Rifampin may be a therapeutic option in patients with longstanding chronic CSCR.
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Coriorretinopatia Serosa Central/tratamento farmacológico , Indutores do Citocromo P-450 CYP3A/uso terapêutico , Rifampina/uso terapêutico , Administração Oral , Adulto , Idoso , Idoso de 80 Anos ou mais , Coriorretinopatia Serosa Central/diagnóstico , Coriorretinopatia Serosa Central/fisiopatologia , Doença Crônica , Feminino , Angiofluoresceinografia , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos , Retina/patologia , Líquido Sub-Retiniano , Tomografia de Coerência Óptica , Acuidade Visual/fisiologiaRESUMO
BACKGROUND: Filler injection for face augmentation is a common cosmetic procedure in the last decades, in our case report we describe long-term outcomes of a devastating complication of ophthalmic artery emboli following Calcium Hydroxylapatite filler injection to the nose bridge. CASE PRESENTATION: A healthy 24-year-old women received a Calcium Hydroxylapatite filler injection to her nose bridge for the correction of nose asymmetry 8 years post rhinoplasty. She developed sudden right eye ocular pain and visual disturbances. Visual acuity was 20/20 in both eyes and visual field in the right eye showed inferior arch with fixation sparing and supero-temporal central scotoma. Examination revealed marked periorbital edema and hematoma, ptosis, ocular movements limitation, an infero-temporal branch retinal artery occlusion and multiple choroidal emboli. Eighteen months post initial presentation ptosis and eye movements returned normal and choroidal emboli absorbed almost completely. However, visual acuity declined to 20/60, visual field showed severe progressive deterioration with a central and supero-nasal field remnant and the optic disc became pallor. CONCLUSION: Cosmetic injection of calcium hydroxylapatite to the nose bridge can result in arterial emboli to the ophthalmic system with optic nerve, retinal and choroidal involvement causing long term severe visual acuity and visual field impairment.
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Materiais Biocompatíveis/efeitos adversos , Técnicas Cosméticas/efeitos adversos , Durapatita/efeitos adversos , Embolia/etiologia , Artéria Oftálmica , Corioide/irrigação sanguínea , Feminino , Humanos , Injeções/efeitos adversos , Nariz/cirurgia , Adulto JovemRESUMO
PURPOSE: To investigate the characteristics and long-term outcome of patients with noninfectious retinal vasculitis. METHODS: This was a retrospective multicenter study. Main outcome measures included patients' characteristics, ocular findings, treatment modalities, and best-corrected visual acuity. All patients had at least 12-month follow-up time. RESULTS: Eighty-two eyes (45 patients) were included. Median follow-up was 46 months (range, 12-210 months). At presentation, 12 of the 45 patients (26.6%) had a known associated systemic or ocular disease. A diagnosis of a new systemic disease was found in additional 14 of 33 patients (42.5%) and birdshot chorioretinopathy in 3 of 33 patients (9.1%). The most common systemic disease was Behcet disease (17/24 patients; 70.8%). Laboratory tests had a low diagnostic value. The most common clinical findings were vitritis (58.5%) and perivascular sheathing (50.5%). Most patients were treated with immunosuppressive medications. Mean best-corrected visual acuity improved significantly during follow-up, patients with Behcet disease and worse visual acuity at baseline were more likely to have visual acuity improvement (P < 0.001). CONCLUSION: A new systemic or ocular disease associated with retinal vasculitis was found in more than half of the patients. Behcet disease was the most common newly diagnosed disease. Specific diagnosis leading to proper management is important to maintain favorable long-term visual outcome.
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Vasculite Retiniana/etiologia , Adolescente , Adulto , Idoso , Síndrome de Behçet/complicações , Criança , Feminino , Angiofluoresceinografia , Seguimentos , Humanos , Imunossupressores/uso terapêutico , Masculino , Pessoa de Meia-Idade , Vasculite Retiniana/tratamento farmacológico , Vasculite Retiniana/fisiopatologia , Estudos Retrospectivos , Acuidade Visual , Adulto JovemRESUMO
PURPOSE: To examine the effect of an intravitreal dexamethasone drug delivery system (DEX-DDS) in the treatment of persistent cystoid macular edema (CME) of different etiologies. METHODS: Thirty-seven eyes with persistent CME were treated with DEX-DDS and analyzed for changes in best-corrected visual acuity (BCVA) and optical coherence tomography. Eyes were categorized into three groups: diabetic macular edema (DME, n = 14), vein occlusion (n = 15) and uveitis (n = 7). RESULTS: The mean follow-up was 22 ± 6.9 weeks. BCVA improved from 0.62 ± 0.38 to 0.35 ± 0.29 logMAR (p < 0.0001). Central macular thickness decreased by 184 ± 246 µm from baseline (p < 0.0001). In eyes where CME resolved and recurred, the average CME-free period was 11 weeks. The uveitis group showed faster CME resolution (2 weeks) and a longer CME-free period (20 weeks). Similar efficacy was shown for repeat DEX-DDS injections. The safety profile was good. CONCLUSION: DEX-DDS is beneficial in the treatment of persistent CME. In cases of uveitis, CME resolution is rapid, resulting in the longest effect duration, when compared with other CME etiologies.
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Dexametasona/administração & dosagem , Glucocorticoides/administração & dosagem , Edema Macular/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Implantes de Medicamento , Feminino , Seguimentos , Humanos , Pressão Intraocular/efeitos dos fármacos , Injeções Intravítreas , Edema Macular/classificação , Edema Macular/etiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Acuidade Visual/efeitos dos fármacosRESUMO
PURPOSE: To report the long-term outcome of an intravitreal dexamethasone drug delivery system (DEX-DDS) injection for noninfectious uveitic macular edema. METHODS: This was a retrospective study of 8 eyes (7 patients). RESULTS: The mean follow-up time was 17.3 months. Macular edema resolved in all eyes at 3.9 weeks (range 1-6.9) postinjection. The central point thickness improved from 612 ± 143 to 250 ± 55 µm (p < 0.05). The mean best corrected visual acuity improved by 0.25 logMAR (p < 0.05) at 3.9 weeks (range 1-6.9) postinjection. In 5 eyes, macular edema did not recur after a mean follow-up of 14.5 months. In 3 eyes, macular edema relapsed after 4.7 months (range 3.6-6.3) and resolved again following further injections. Two eyes developed intraocular pressure elevation, which was well controlled with topical treatment. CONCLUSIONS: Intravitreal DEX-DDS injections resulted in resolution of macular edema and visual acuity improvement. Some eyes required repeated injections, but most eyes achieved long-term resolution. No significant complications were noticed.
Assuntos
Dexametasona/administração & dosagem , Glucocorticoides/administração & dosagem , Edema Macular/tratamento farmacológico , Uveíte/tratamento farmacológico , Adulto , Implantes de Medicamento , Feminino , Seguimentos , Humanos , Injeções Intravítreas , Edema Macular/diagnóstico , Edema Macular/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia de Coerência Óptica , Resultado do Tratamento , Uveíte/diagnóstico , Uveíte/fisiopatologia , Acuidade Visual/efeitos dos fármacos , Corpo Vítreo/efeitos dos fármacos , Adulto JovemRESUMO
BACKGROUND: The aim of this work was to compare the specificity-sensitivity balance of the Hardy-Rand-Rittler (HRR) 4th edition with the Ishihara color plate tests for color-vision defects in patients with optic neuropathy. METHODS: This is a prospective case-control study. The study group included 43 patients (48 eyes) with newly diagnosed optic neuropathy, and the control group included 33 patients (33 right eyes) who were referred to the eye clinic for conditions other than optic nerve or retinal macular disorders. Individuals with visual acuity of less than 20/70 (0.54 Log MAR) were excluded. All patients underwent comprehensive eye examination and color-vision evaluation with both tests in a random order under standardized lighting conditions. The scores of the Ishihara and HRR tests were set as the number of plates identified out of 12 and six respectively. RESULTS: The receiver operating characteristics (ROC) curve was statistically significantly better when using the HRR test (area under curve [AUC] = 0.93 ± 0.03) than for the Ishihara test (AUC = 0.77 ± 0.05) (P = 0.0006). The best specificity-sensitivity balance for the HRR was 100 % and 79 % respectively, and for the Ishihara test 100 % and 48 % respectively. CONCLUSIONS: The HRR 4th edition test proved to be superior to the Ishihara test in detecting acquired dyschromatopsia due to optic neuropathy. We recommend using the HRR 4th edition test as a screening method for detection of color-vision defects in patients with optic neuropathy.
Assuntos
Testes de Percepção de Cores/instrumentação , Defeitos da Visão Cromática/diagnóstico , Doenças do Nervo Óptico/diagnóstico , Adolescente , Adulto , Idoso , Estudos de Casos e Controles , Criança , Defeitos da Visão Cromática/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças do Nervo Óptico/fisiopatologia , Estudos Prospectivos , Curva ROC , Sensibilidade e Especificidade , Acuidade Visual/fisiologia , Adulto JovemRESUMO
BACKGROUND: The aim of our study was to investigate vitreal, retinal, and choroidal morphologic changes in active and scarred toxoplasmosis lesions using spectral-domain optical coherence tomography (SD-OCT). METHODS: In this prospective study, 19 eyes of 15 consecutive patients with ocular toxoplasmosis were included. Complete ophthalmologic examination and SD-OCT were done at the initial visit and during follow-up. Retina and choroid SD-OCT protocols directed to macular area and lesions observed on clinical examination were used. RESULTS: Seventeen active lesions and 56 retinochoroidal scars were studied. In the acute phase, disruption, thickening, and hyper-reflectivity of the neurosensory retina with photoreceptor (PR) interruption and retinal pigment epithelial (RPE) elevation were found. The choroid became thickened and hyporeflective. During follow-up, neurosensory retinal layers thinning and disorganization, PR interruption, and RPE elevation and/or atrophy were demonstrated. The choroid returned to normal thickness and became more hyperreflective. Five active lesions presented with hyperreflective oval deposits within the vitreoretinal interface, adjacent to or far away from the lesions. During follow-up, the deposits became smaller, entered into the inner retina layers and faded with time until complete resolution. Multiple hyperreflective dots in the vitreous cavity, compatible with vitritis, and posterior hyaloid thickening were demonstrated in the acute phase, with complete resolution and detachment of the posterior hyaloid during follow-up. Four types of scars were specified according to outer retina-choroid interface changes; atrophic, elevated, deep, and combined (atrophic & elevated). Epiretinal membrane segments were found over active and scarred lesions. CONCLUSIONS: SD-OCT imaging showed toxoplasmic retinochoroidal lesions and scars to be complex and characterized acutely by thickening and disorganization of both the retina and underlying choroid, and following scar formation by varying degrees of thinning, often in conjunction with irregularity of the outer retinal layers.
Assuntos
Doenças da Coroide/diagnóstico , Oftalmopatias/diagnóstico , Doenças Retinianas/diagnóstico , Tomografia de Coerência Óptica , Toxoplasmose Ocular/diagnóstico , Corpo Vítreo/patologia , Adolescente , Adulto , Antibacterianos/uso terapêutico , Atrofia , Criança , Doenças da Coroide/tratamento farmacológico , Doenças da Coroide/parasitologia , Clindamicina/uso terapêutico , Quimioterapia Combinada , Membrana Epirretiniana/diagnóstico , Oftalmopatias/tratamento farmacológico , Oftalmopatias/parasitologia , Feminino , Glucocorticoides/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Prednisolona/uso terapêutico , Estudos Prospectivos , Doenças Retinianas/tratamento farmacológico , Doenças Retinianas/parasitologia , Epitélio Pigmentado da Retina/patologia , Toxoplasmose Ocular/tratamento farmacológico , Toxoplasmose Ocular/parasitologia , Acuidade Visual/fisiologia , Adulto JovemRESUMO
BACKGROUND: Acute allergic conjunctivitis is a constantly challenging condition that often requires steroids for effective management. Alternative treatment options are needed due to the potential side effects of steroids. Tacrolimus has been used for vernal/atopic conjunctivitis. The aim of our study was to investigate the therapeutic effect of topical administration of 0.03 % tacrolimus (eye drops or ointment) in comparison to 0.1 % dexamethasone in a mouse model of acute allergic conjunctivitis. METHODS: BALB/c mice were sensitized by an intraperitoneal injection of 10 µg/0.2 ml ovalbumin (OVA) absorbed on ALUM (2.0 mg) on days 1 and 8. They were challenged by topical instillation of 2 µl of 15 % OVA (absorbed in 10 % glycerol) twice daily, on days 15-21. Treatment was administered twice daily on days 17-21. Mice were randomly assigned topical treatment groups: Group 1, 0.1 % dexamethasone drops; Group 2, 0.03 % tacrolimus drops; Group 3, 0.03 % tacrolimus ointment; Group 4 PBS drops (control). On day 22 all mice underwent clinical evaluation, blood sampling for IgE levels, and conjunctivas were removed for eosinophil counting. RESULTS: IgE and OVA-specific IgE levels were similar among all groups, demonstrating induction of allergic reaction in all mice. Significantly lower clinical scores were found among all treated groups as compared to controls (P < 0.001), while no significant difference was found among the three treatment groups (P > 0.05). Conjunctival eosinophil counts were significantly lower in Group 1 (P < 0.05) as compared to the other groups. CONCLUSIONS: The clinical efficacy of topical 0.03 % tacrolimus was similar to 0.1 % dexamethasone for acute allergic conjunctivitis.