RESUMEN
PURPOSE: To describe the evolution of a full-thickness macular hole in myopic foveoschisis. METHODS: A 62-year-old woman with myopic foveoschisis developed a full-thickness maculare hole after 36 months. The evolution of the macular hole was observed by optical coherence tomography (Stratus OCT3). RESULTS: During the first stages of macular hole formation, a small triangular foveolar retinal detachment, with corresponding elevation of inner segment/outer segment junction line, was observed. The retinal detachment later enlarged. A concrete intraretinal columnar structure, extending between the inner fovea's layer and the roof of foveal detachment, was observed. CONCLUSION: The so-called columnar structure, detected in our case, possibly transmitted the vitreomacular traction contributing to the opening of the RD roof, the outer lamellar macular hole formation, and finally in the creation of a full-thickness macular hole.
Asunto(s)
Miopía/complicaciones , Desprendimiento de Retina/etiología , Perforaciones de la Retina/etiología , Retinosquisis/complicaciones , Femenino , Angiografía con Fluoresceína , Humanos , Persona de Mediana Edad , Desprendimiento de Retina/diagnóstico , Perforaciones de la Retina/diagnóstico , Tomografía de Coherencia Óptica , Agudeza VisualRESUMEN
PURPOSE: To study the natural course of lamellar macular hole (LMH) as examined by optical coherence tomography (OCT) in a noncomparative observational case series. METHODS: Forty-one eyes of 41 patients with LMH were included in this analysis. Baseline and final OCT findings related to LMH diameter, foveal thickness and visual acuity (VA) were collected and compared. Mean follow-up was 37.1 months. Main outcome measures were best-corrected visual acuity (BCVA), diameter of the LMH opening, foveal thickness, epiretinal membrane (ERM), posterior vitreous detachment (PVD) and vitreoretinal traction. RESULTS: The diameter of the LMH increased by an average of 13.7%. A statistically significant association was found between the LMH diameter increase and the presence of ERM. The mean foveal thickness depicted a statistically significant decrease between the initial and the final examination. The decrease of the foveal thickness showed to correlate with visual acuity deterioration. BCVA was stable in 30 (78%) and deteriorated in 11 (22%) cases. In eight of the 11 cases, the visual acuity deterioration ranged from 2 to 15 letters. CONCLUSION: We identified an increase of LMH diameter related to the presence of ERM and a decrease of the foveal thickness within a period of observation which ranged from 24 to 54 months (mean 37.1 months).
Asunto(s)
Membrana Epirretinal/patología , Fóvea Central/patología , Mácula Lútea/patología , Perforaciones de la Retina/patología , Tomografía de Coherencia Óptica , Anciano , Anciano de 80 o más Años , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Agudeza VisualRESUMEN
PURPOSE: To study the evolution of idiopathic epiretinal membrane (IERM) as examined by optical coherence tomography (OCT) in the 1-mm-diameter circle centered on the fovea. METHODS: In a case series study 71 subjects (71 eyes) with idiopathic epiretinal membrane and macular thickness greater than 220-/+10 micro m were evaluated by OCT. The fellow healthy eye of 52 patients was used as the control group. The mean follow-up was 36 months. Measurements of macular thickness at baseline and at the final examination were performed. Best-corrected visual acuity was expressed as the number of letters read on the Early Treatment Diabetic Retinopathy Study chart. RESULTS: Within the inner macular central circle of 1 mm diameter the thickness of the fovea increased by an average of 12.29% (p<0.001) during follow-up in the study group while in the control group the foveal thickness decreased by -0.44% (p=0.43). The mean increase of the fovea thickness was accompanied by a modest decrease of best-corrected visual acuity from a mean 43.26 letters at baseline to a mean 39.20 letters at the last examination (p<0.001). CONCLUSIONS: In the study group the macular thickness increased during a mean follow-up period of 36 months. The average increase between the baseline and the final examination at the inner central circle of 1 mm diameter was 12.29%. Decrease of the macular thickness was not observed in any of the studied cases. The mean decrease of visual acuity was 9.4%. OCT also depicted with accuracy the changing morphology of the affected macula during the study period.
Asunto(s)
Membrana Epirretinal/diagnóstico , Membrana Epirretinal/fisiopatología , Mácula Lútea/fisiopatología , Tomografía de Coherencia Óptica/métodos , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Agudeza Visual/fisiologíaRESUMEN
PURPOSE: To report in a single case the effectiveness of bevacizumab in the treatment of feeder vessels (FVs) of subfoveal choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD). METHODS: One patient received intravitreal bevacizumab (Avastin) (1.25 mg) which was repeated 4 weeks after the first intravitreal injection. Fluorescein angiography and optical coherence tomography (OCT) were performed. Visual acuity (VA) was also checked. RESULTS: Occlusion of the FVs was observed 4 weeks after starting treatment. During the follow-up period and in the final examination 13 months after the first injection, the FVs remained occluded. Complete resolution of macular edema and improvement of the VA were noticed after the second bevacizumab intravitreal injection. CONCLUSIONS: This report documents the successful occlusion of FVs of subfoveal neovascularization after two intravitreal bevacizumab injections in a patient who was followed up for 1 year after the occlusion. Further long-term investigation is warranted given the promising 12-month results.
Asunto(s)
Inhibidores de la Angiogénesis/administración & dosificación , Anticuerpos Monoclonales/administración & dosificación , Neovascularización Coroidal/tratamiento farmacológico , Fóvea Central/irrigación sanguínea , Anciano , Anticuerpos Monoclonales Humanizados , Bevacizumab , Neovascularización Coroidal/patología , Femenino , Angiografía con Fluoresceína , Estudios de Seguimiento , Fondo de Ojo , Humanos , Inyecciones , Tomografía de Coherencia Óptica , Factor A de Crecimiento Endotelial Vascular , Agudeza Visual , Cuerpo VítreoRESUMEN
PURPOSE: To evaluate by optical coherence tomography (OCT) the vitreous involvement in full thickness macular hole associated with optic disk pit maculopathy. METHODS: Two patients with optic disk pit maculopathy and full thickness macular hole underwent OCT for evaluation of vitreous involvement in the pathogenesis of the disease. Fluorescein angiography and fundus photographs were also performed. RESULTS: OCT documented the presence of vitreous traction at the edge of the full thickness macular hole in the first case and on the elevated macula in the second case. Partial posterior vitreous detachment was also noticed. CONCLUSIONS: Previously unreported OCT findings such as vitreous traction at the edge of the macular hole and on the elevated macula were found. OCT provided evidence for vitreous participation in full thickness macular hole associated with optic disk pit maculopathy. OCT was also able to show that the full thickness macular hole and optic disk pit maculopathy were probably caused by similar vitreous tractional forces.
Asunto(s)
Coloboma/complicaciones , Disco Óptico/anomalías , Retina/patología , Perforaciones de la Retina/diagnóstico , Tomografía de Coherencia Óptica , Cuerpo Vítreo/patología , Adulto , Femenino , Angiografía con Fluoresceína , Humanos , Masculino , Desprendimiento de Retina/etiología , Perforaciones de la Retina/etiologíaRESUMEN
PURPOSE: To report a case of pigment epithelium detachment (PED) which appeared after photodynamic therapy (PDT) and was followed up for 50 months. METHODS: Case report. RESULTS: A 71-year-old woman with occult choroidal neovascular membrane due to age-related macular degeneration (ARMD) developed PED 48 hours after PDT. The patient was studied with fluorescein angiography (FA) and optical coherence tomography (OCT). Fluorescein angiographic evidence of PED remained essentially unchanged during the follow-up period of 50 months. Although OCT initially gave clear evidence of PED, in the last 12 months of follow-up the PED appears to have resolved. CONCLUSIONS: Photodynamic treatment could be involved in the occurrence of PED in occult choroidal neovascular membrane due to ARMD. In this particular case OCT could be considered since it offers useful information in the pretreatment and the post-treatment follow-up period.
Asunto(s)
Neovascularización Coroidal/tratamiento farmacológico , Degeneración Macular/complicaciones , Fotoquimioterapia/efectos adversos , Epitelio Pigmentado Ocular/patología , Desprendimiento de Retina/etiología , Anciano , Neovascularización Coroidal/etiología , Femenino , Angiografía con Fluoresceína , Humanos , Fármacos Fotosensibilizantes , Porfirinas , Desprendimiento de Retina/diagnóstico , Tomografía de Coherencia Óptica , VerteporfinaRESUMEN
BACKGROUND: Rhegmatogenous retinal detachments (RRD) with inferior breaks are usually treated by scleral buckling (SB) or pars plana vitrectomy (PPV) or a combination of both methods. However, applying a SB during PPV may produce a risk of choroidal haemorrhage. Following a recent pilot study showing that such cases can be safely treated by PPV without SB the authors re-examined their management of RRD in which inferior breaks were present. METHODS: All patients had a detached vitreous and a complex configuration of retinal breaks. A case-control study was performed to analyse the surgical methods and results of PPV on 48 consecutive patients with RRD associated with inferior breaks and 48 age/sex matched controls who underwent PPV for RRD without inferior breaks. Exclusion criteria were giant retinal tears, retinal dialysis, trauma, proliferative vitreoretinopathy (PVR) grade B or higher, schisis detachments, and eyes that had been operated previously for RRD. A simple algorithm was followed to manage patients with inferior breaks. All patients underwent a standard three port PPV with intraocular gas tamponade without supplementary SB. Patients were asked to posture face up or right or left side down for 1 week. RESULTS: 39 of the 48 patients (81.3%) with inferior breaks were treated successfully with one operation. 41 of 48 patients (85.4%) control patients achieved primary success. The final success rate was 95.8% in both groups. There was no statistical difference between the two groups. When all the cases of RRD were analysed (including external plomb/non-drain procedures) the primary success rate was 89% and final success rate 97.5%. CONCLUSIONS: This study has shown that acceptable success rates can be achieved using PPV alone to treat RRD with inferior breaks. Complications are minimised and patients in this high risk group have an 81% chance of primary success. Pars plana vitrectomy and gas will successfully reattach the retina and a supplementary SB, to support the inferior retina, is unnecessary as the intraocular gas, and face up or, right or left side down positioning will tamponade breaks satisfactorily.