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1.
Middle East Afr J Ophthalmol ; 30(2): 72-79, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-39006936

RESUMEN

PURPOSE: The purpose of this study was to evaluate pre- and perioperative factors related to time for the evolution of ectopic inner foveal layers (EIFL) following pars plana vitrectomy (PPV) for epiretinal membrane (ERM) peeling. METHODS: This retrospective study included 81 consecutive eyes with idiopathic ERM that underwent vitrectomy surgery. Standard PPV + internal limiting membrane peeling was performed in all cases. A comprehensive ophthalmic examination was performed for all patients before and 1, 3, 6, and 12 months, and the last follow-up after surgery. We observed the postoperative improvement in EIFL severity in the short-term and longest follow-up and evaluated anatomical and functional improvement. Several parameters were assessed using the multivariate COX proportional hazard analysis. RESULTS: Eighty patients (81 eyes) with a mean age of 70.33 ± 7.75 years were followed for a mean of 34.37 ± 23.61 months, and 55.5% of eyes (45 eyes) with EIFL ERM showed improvement of foveal contour to a better stage at the last follow-up. The median estimated time for evolving to a better stage was 29.73 months for stage 2, 49.68 months for stage 3, and 38.67 months for stage 4 (P = 0.001, log-rank test). The severity of EIFL was the only significant factor for time to evolution of EIFL ERM to a better stage, where the eyes with stage 4 EIFL ERM showed faster foveal contour improvement compared to those with stage 3 EIFL ERM (hazard ratio: 0.317, 95% confidence interval = 0.164-0.615, P = 0.001). CONCLUSION: On assessing preoperative factors, the preoperative EIFL stage emerged as the sole significant factor for EIFL ERM improvement to a better disease stage. This study reports some of the longest follow-up durations for patients undergoing PPV for EIFL ERM, and both functional and anatomical improvements were observed across all stages of EIFL, including in the advanced stage 4 EIFL ERM.


Asunto(s)
Membrana Epirretinal , Fóvea Central , Tomografía de Coherencia Óptica , Agudeza Visual , Vitrectomía , Humanos , Membrana Epirretinal/cirugía , Membrana Epirretinal/diagnóstico , Femenino , Estudios Retrospectivos , Masculino , Estudios de Seguimiento , Vitrectomía/métodos , Anciano , Tomografía de Coherencia Óptica/métodos , Persona de Mediana Edad , Factores de Tiempo , Anciano de 80 o más Años
2.
Eur J Ophthalmol ; 32(4): 2298-2305, 2022 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-34747260

RESUMEN

PURPOSE: To report the individual retinal layer thicknesses up to mid-equator in patients with diabetic retinopathy (DR) using Spectralis (Heidelberg Engineering, Heidelberg, Germany) wide-field optical coherence tomography (OCT). METHODS: Retinal layers were segmented using a custom designed semi-automated algorithm, where reference points were marked by the examiner to enable software to automatically compute the thickness values of each retinal sublayer at an interval of 1 mm from reference points. The values of individual retinal thicknesses in eyes with varying severity of DR were compared with the values of healthy subjects. Generalized estimating equation was performed to compensate for inclusion of both eyes of patients. RESULTS: A total of 64 patients (119 eyes) with a mean age of 68.97 ± 10.27 years were included. Overall, ganglion cell layer (GCL)/ inner plexiform layer (IPL) complex (-31.67 microns, p < 0.001), outer plexiform layer (-6.78 microns, p = 0.002) and photoreceptor layer (-22.90 microns, p < 0.001) showed significant thinning, while outer nuclear layer thickening ( + 68.19 microns, <0.001) was noted in eyes with DM compared to healthy subjects. Thickness changes were significantly more in the macular segment compared to nasal and temporal segments. GCL/ IPL complex and photoreceptor layers were found to be significantly thin in all grades of DR. CONCLUSION: Retinal thicknesses vary significantly in patients with diabetic retinopathy and understanding patterns of these changes across different segments of the wide field OCT may help better elucidate the natural progression of the disease in terms of retinal anatomy.


Asunto(s)
Diabetes Mellitus , Retinopatía Diabética , Anciano , Algoritmos , Retinopatía Diabética/diagnóstico , Alemania , Humanos , Persona de Mediana Edad , Retina , Tomografía de Coherencia Óptica/métodos
3.
Eur J Ophthalmol ; 32(3): 1720-1727, 2022 May.
Artículo en Inglés | MEDLINE | ID: mdl-34132128

RESUMEN

PURPOSE: To report outcomes of pars plana vitrectomy (PPV) combined with internal limiting membrane (ILM) stuffing technique in patients with optic disc pit associated maculopathy (ODP-M). METHODS: Data including best-corrected visual acuity (BCVA), central macular thickness (CMT), foveal center point thickness (FCP), and maximum height of fluid (max_fluid) (intraretinal or subretinal) were collected from the medical records of the patients. RESULTS: Six eyes of six patients with a mean age of 28.0 ± 17.68 years (range: 9-53 year) underwent PPV + ILM plug surgery. The mean follow-up duration was 25.62 ± 26.11 months (range: 11.80-78.00 month) duration. The mean BCVA increased from 1.25 ± 1.04 logMAR (20/355, Snellen equivalent) to 0.86 ± 1.09 logMAR (20/144, Snellen equivalent) at last follow-up (p = 0.043). Compared to baseline, CMT, FCP, and max_fluid significantly decreased at all visits after the surgery (p < 0.05 for all visits). At last follow-up, 66.6% of the eyes (four eyes) showed complete resolution of fluid at a mean of 5.25 ± 4.99 months (range: 1-12 months) after the surgery. CONCLUSION: PPV with ILM plug seemed to be an effective surgical technique in ODP-M. Studies with longer follow-up and higher number of patients are needed to confirm our results.


Asunto(s)
Anomalías del Ojo , Degeneración Macular , Disco Óptico , Enfermedades de la Retina , Adolescente , Adulto , Niño , Anomalías del Ojo/complicaciones , Anomalías del Ojo/diagnóstico , Anomalías del Ojo/cirugía , Estudios de Seguimiento , Humanos , Degeneración Macular/cirugía , Persona de Mediana Edad , Enfermedades de la Retina/cirugía , Estudios Retrospectivos , Centros de Atención Terciaria , Tomografía de Coherencia Óptica/métodos , Vitrectomía/métodos , Adulto Joven
4.
Eur J Ophthalmol ; 32(3): 1627-1635, 2022 May.
Artículo en Inglés | MEDLINE | ID: mdl-34219488

RESUMEN

PURPOSE: To compare the efficacy of intravitreal (IV) ranibizumab (IVR) injection with IV dexamethasone implant (IVDEX) in treatment naive diabetic macular edema (DME) patients with inflammatory component. MATERIALS AND METHODS: Treatment naive DME eyes with subfoveal neurosensorial detachment (SND) and hyperreflective spots (HRS) were treated either three loading doses of IVR (18 eyes) or one dose of IVDEX (19 eyes). Central macular thickness (CMT), height of SND, the number of HRSs scattered on the individual retinal layers and photoreceptor integrity were assessed using spectral domain- optical coherence tomography scans over 3-months follow-up. RESULTS: The mean change in best-corrected visual acuity (BCVA) was -0.11 ± 0.08 logMAR in IVDEX group and -0.04 ± 0.06 logMAR in IVR group at 1-month (p = 0.011). IVDEX group showed statistically significant more increase in BCVA compared to those receiving IVR injections at 2-months (p = 0.004) and 3-months (p = 0.017) visits. Compared to baseline, the number of total HRSs and the number of HRSs at each individual inner retinal layer significantly decreased in both groups at all follow-up visits. However, IVDEX group showed more decrease in the total number of HRSs at 2- and 3-months (p < 0.001 at 2-months, and p = 0.006 at 3-months) and in the mean number of HRSs located at inner nuclear layer-outer plexiform layer level (p = 0.016 at 1-month, p < 0.001 at 2-months, and p < 0.001 at 3-months). After treatment, the number of HRSs on the outer nuclear layer showed some non-significant increase in both groups. CONCLUSION: HRSs tended to migrate from inner retina to the outer retina in DME eyes by treatment. Dexamethasone seemed to be more effective option in such cases with inflammatory component.


Asunto(s)
Diabetes Mellitus , Retinopatía Diabética , Edema Macular , Inhibidores de la Angiogénesis/uso terapéutico , Biomarcadores , Dexametasona , Diabetes Mellitus/tratamiento farmacológico , Retinopatía Diabética/diagnóstico , Retinopatía Diabética/tratamiento farmacológico , Humanos , Inyecciones Intravítreas , Edema Macular/diagnóstico , Edema Macular/tratamiento farmacológico , Edema Macular/etiología , Ranibizumab/uso terapéutico , Retina , Esteroides/uso terapéutico , Tomografía de Coherencia Óptica/métodos , Agudeza Visual
5.
Turk J Ophthalmol ; 51(6): 403-406, 2021 Dec 28.
Artículo en Inglés | MEDLINE | ID: mdl-34963271

RESUMEN

We aim to present a case with bilateral sequential paracentral acute middle maculopathy (PAMM). A 57-year-old man presented with paracentral scotoma in the left eye. The patient's multimodal imaging findings were consistent with PAMM in the left eye. Extensive systemic work-up revealed hypertension and a history of cerebrovascular event. One year after initial presentation, the patient had a subsequent decrease in visual acuity in the right eye and developed optical coherence tomography findings consistent with PAMM, whereas the left eye showed resolved PAMM findings. Although rare, PAMM can occur bilaterally. Clinicians should monitor unilateral PAMM patients with systemic vasculopathy for involvement in the fellow eye.


Asunto(s)
Degeneración Macular , Enfermedades de la Retina , Angiografía con Fluoresceína , Humanos , Masculino , Persona de Mediana Edad , Enfermedades de la Retina/diagnóstico , Vasos Retinianos , Tomografía de Coherencia Óptica
6.
Eur J Ophthalmol ; 31(4): 1656-1676, 2021 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-33525895

RESUMEN

Inherited retinal diseases, which results from mutations in over 260 identified genes, affect more than 2 million people globally. The diseases mostly cause severe vision loss in young working population and have severe impact on social economic status of the population. Advances in retinal imaging techniques along with developments in gene identification and cell biology techniques have yielded to a better understanding of the genetic and biochemical mechanisms causing these diseases. Retinal imaging along with through ophthalmological examination is essential to make an accurate diagnosis, to decrease the burden of unneccessary anciliary tests and to select the potential patients that can get benefit from the gene treatment. The purpose of the review is to yield an update on inherited retinal diseases by highlighting microstructural changes in retina and to summarize the retinal changes detected by currently available multimodal imaging techniques.


Asunto(s)
Enfermedades de la Retina , Humanos , Imagen Multimodal , Mutación , Retina , Enfermedades de la Retina/diagnóstico , Enfermedades de la Retina/genética , Tomografía de Coherencia Óptica , Trastornos de la Visión
7.
Curr Eye Res ; 46(6): 818-823, 2021 06.
Artículo en Inglés | MEDLINE | ID: mdl-33044093

RESUMEN

PURPOSE: To investigate diabetic retinopathy (DR), plasma long pentraxin-3 (PTX-3) and taurine levels, and systemic factors in patients with type 2 diabetes mellitus (DM). MATERIALS AND METHODS: Patients with type 2 DM were categorized based on the presence of DR and maculopathy. Retinal findings (retinopathy, maculopathy, flame-shaped hemorrhage, intraretinal microvascular abnormalities, neovascularization of the optic disc, neovascularization elsewhere, and soft exudate); laboratory findings (fasting blood glucose, glycosylated hemoglobin [HbA1c], Taurine, PTX-3); systolic blood pressure (SBP) and diastolic blood pressure (DBP) were analyzed. RESULTS: In this study, 39 patients with a mean age of 59.5 ± 8.1 years were included. The mean taurine level was significantly lower (p = .025) and HbA1c values were significantly higher (p = .0001) in patients with and without DR, respectively. In patients with varying severity of DR, a significant difference in the plasma taurine level was found (p = .0001). The mean PTX-3 level decreased with the severity of retinopathy; however, there was no significant difference in levels among the grading groups (p = .732). Taurine and PTX-3 levels were significantly lower in patients with maculopathy (p = .001 and p = .022, respectively) and significantly higher in patients with grade 0 maculopathy than in those with grade 1, 2, or 3 maculopathy (p = .023, p = .01, and p = .01, respectively). Patients with flame-shaped hemorrhage had significantly lower PTX-3 levels (p = .009) and higher SBP and DBP levels (p = .003, p = .023) than those without the hemorrhage. CONCLUSIONS: No significant relation between PTX-3 level and severity of DR was found. HbA1c, taurine, and PTX-3 levels in patients with vision-threatening DR symptoms were significantly different from those without these symptoms. Management of systemic blood pressure and glycemic control is mandatory in the follow-up of DR, and increasing the plasma taurine levels can prevent vision loss.


Asunto(s)
Proteína C-Reactiva/metabolismo , Retinopatía Diabética/sangre , Componente Amiloide P Sérico/metabolismo , Taurina/sangre , Trastornos de la Visión/sangre , Anciano , Anciano de 80 o más Años , Glucemia/metabolismo , Presión Sanguínea/fisiología , Estudios Transversales , Diabetes Mellitus Tipo 2/sangre , Ensayo de Inmunoadsorción Enzimática , Femenino , Hemoglobina Glucada/metabolismo , Humanos , Masculino , Persona de Mediana Edad , Tomografía de Coherencia Óptica , Tonometría Ocular , Agudeza Visual/fisiología
8.
Graefes Arch Clin Exp Ophthalmol ; 259(4): 847-853, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33064198

RESUMEN

PURPOSE: To demonstrate whether pars plana vitrectomy (PPV) changes the progression of dry age-related macular degeneration (AMD) by assessing longitudinal changes in drusen volume over follow-up. METHODS: Dry AMD patients who had undergone unilateral PPV for symptomatic vitreomacular disorders were evaluated for the progression of disease by spectral domain-optical coherence tomography (SD-OCT) features including drusen volume, development of geographic atrophy, or choroidal neovascularization during follow-up. Drusen volume was manually calculated using an image processing software (ImageJ, NIH) on raster SD-OCT scans. Mean change in drusen volume of surgery eyes was compared with values of the fellow eyes of the same subjects (control group). RESULTS: Among 183 eyes with both vitreoretinal disorder and dry AMD, 48 eyes of 24 patients met the inclusion criteria and were included. The mean drusen volume change during a mean of 25.49 ± 23.35 months of follow-up (range: 6.00-86.87 months) was 4.236.899 ± 20.488.913 µm3 in the study eye and 7.796.357 ± 34.798.519 µm3 in the fellow eye (p = 0.297). Best-corrected visual acuity (BCVA) significantly increased from 0.40 ± 0.18 logMAR (≈ 20/50 Snellen equivalent) to 0.32 ± 0.31 (≈ 20/41 Snellen equivalent) after surgery (p = 0.012) in the study group while BCVA remained stable in the control group (0.19 ± 0.34 logMAR [≈ 20/30 Snellen equivalent] at baseline and 0.20 ± 0.31 logMAR [≈ 20/31 Snellen equivalent], p = 0.432). Choroidal neovascularization developed in 1 vitrectomized eye (4.54%) and in 1 eye (4.54%) from the control group during follow-up. CONCLUSION: Vitrectomy did not seem to worsen dry AMD progression; even more visual acuity may improve despite a slight increase in drusen volume following surgery.


Asunto(s)
Neovascularización Coroidal , Atrofia Geográfica , Degeneración Macular , Drusas Retinianas , Neovascularización Coroidal/diagnóstico , Neovascularización Coroidal/cirugía , Atrofia Geográfica/diagnóstico , Humanos , Drusas Retinianas/diagnóstico , Drusas Retinianas/etiología , Tomografía de Coherencia Óptica , Vitrectomía
9.
Br J Ophthalmol ; 104(1): 58-63, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31302628

RESUMEN

AIM: To show the characteristics and outcomes of patients with neovascular age-related macular degeneration (nAMD) who had extended remission (ER) while on a pro re nata (PRN) treatment protocol. METHODS: This was a retrospective case-control study of a consecutive series of patients with nAMD treated with a PRN antivascular endothelial growth factor (anti-VEGF) drug regimen. ER was defined as the absence of haemorrhage, intraretinal/subretinal fluid on optical coherence tomography and leakage on fluorescein angiography for 52 weeks after cessation of anti-VEGF therapy. Matching patients with nAMD who did not achieve ER were included as control group. Cox regression analysis was fitted to identify predictors of time to achieve ER and time to recurrence. A logistic regression analysis of baseline characteristics was used to identify predictors of achieving ER. RESULTS: Of 830 eyes treated with anti-VEGF monotherapy, 77 (9.2%) eyes achieved ER during a median follow-up of 236 weeks (range 70-525 weeks). Cox regression analysis showed that ER was achieved earlier in eyes with isolated intraretinal fluid (HR, 2.05; 95% CI 1.929 to 4.520; p=0.045) at presentation. Logistic regression analysis showed that type 3 choroidal neovascularisation (OR, 0.090; 95% CI 0.021 to 0.382; p=0.001), thinner choroid (OR, 0.993; 95% CI 0.988 to 0.998; p=0.004) and absence of macular atrophy (OR, 0.233; 95% CI 0.065 to 0.839; p=0.026) at baseline increased the likelihood of achieving ER. CONCLUSION: ER is achievable in 9.2% of patients under PRN therapy for nAMD. At presentation with nAMD, anatomical features on retinal imaging may predict the likelihood of achieving ER and a shorter time to achieve ER.


Asunto(s)
Inhibidores de la Angiogénesis/uso terapéutico , Degeneración Macular Húmeda/tratamiento farmacológico , Anciano , Anciano de 80 o más Años , Inhibidores de la Angiogénesis/administración & dosificación , Estudios de Casos y Controles , Neovascularización Coroidal/diagnóstico por imagen , Neovascularización Coroidal/tratamiento farmacológico , Neovascularización Coroidal/fisiopatología , Esquema de Medicación , Femenino , Angiografía con Fluoresceína , Estudios de Seguimiento , Humanos , Inyecciones Intravítreas , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Pronóstico , Recurrencia , Inducción de Remisión , Tomografía de Coherencia Óptica , Resultado del Tratamiento , Factor A de Crecimiento Endotelial Vascular/antagonistas & inhibidores , Agudeza Visual/efectos de los fármacos , Degeneración Macular Húmeda/diagnóstico por imagen , Degeneración Macular Húmeda/fisiopatología
10.
Saudi J Ophthalmol ; 34(4): 237-242, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-34527864

RESUMEN

PURPOSE: To evaluate the surgical outcomes in combined hamartoma of retina and retinal pigment epithelium (CHRRPE) using optical coherence tomography (OCT). METHODS: This was a retrospective interventional study, in which medical records of 12 eyes with CHRRPE that underwent vitrectomy and membrane peeling at three tertiary vitreoretinal institutes were reviewed. Preoperative and postoperative color fundus photographs and OCT were reviewed for each follow-up visit. RESULTS: Five out of 12 eyes had a good visual outcome (equal or more than 2 lines gain in visual acuity), four had stable visual outcome (<2 line gain), and three had poor visual outcome (loss of visual acuity). Preretinal fibrosis preoperatively was seen in 80% of cases with good outcomes as compared to 50% and 0% of cases in the cohorts with stable and poor outcomes, respectively. Preoperatively all 5 cases with good visual outcome had Grade 4 epiretinal membrane (ERM), while only 1 case with stable and poor visual outcome had grade 4 ERM and the rest had Grade 3 ERM. Maxi peaks were seen in 80%, 50%, and 0% of cases preoperatively in the three cohorts, respectively. Hyperreflectivity of inner retinal layers preoperatively was evident in all cases having good visual outcomes, in 75% of cases with stable visual outcomes, and in 33% of cases with poor outcomes. CONCLUSION: Surgical intervention in CHRRPE with preretinal fibrosis seems to be beneficial. The visual recovery as defined by conventional predictors in cases of surgical removal of ERM fails to explain the visual outcome in CHRRPE.

11.
Ophthalmic Surg Lasers Imaging Retina ; 50(5): 295-301, 2019 05 01.
Artículo en Inglés | MEDLINE | ID: mdl-31100160

RESUMEN

BACKGROUND AND OBJECTIVE: To show the morphologic changes on the foveal avascular zone (FAZ) in patients with epiretinal membrane (ERM) using optical coherence tomography angiography (OCTA) and to demonstrate the correlation between distortion of FAZ and features of the ERM. PATIENTS AND METHODS: FAZ eccentricity index (longest diameter of FAZ/shortest diameter of FAZ) was measured in 52 patients with ERM and compared with 27 healthy subjects' values. The density of the ERM was quantified using a grading scale (0-3) on multicolor scanning laser images, and spectral-domain OCT characteristics of the eyes were assessed. RESULTS: Of the 52 eyes with ERM, 31 eyes (59.61%) showed some foveal remodeling, including full (13.46%) or partial (30.76%) apparent vascularization of FAZ, presence of a vessel crossing the fovea (9.61%), and horizontal or vertical elongation of FAZ (5.76%). The mean FAZ eccentricity index was 0.84 ± 0.46 (range: 0.0-1.86) in eyes with ERM and 0.98 ± 0.07 (range: 0.96-1.02) in the control subjects, respectively (P = .02). There was a negative significant correlation between FAZ eccentricity index and central macular thickness (P = .04). CONCLUSIONS: Thickening of the central fovea leads to foveal remodeling in ERM eyes, and OCTA enables the visualization of architectural FAZ changes. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:295-301.].


Asunto(s)
Membrana Epirretinal/diagnóstico , Angiografía con Fluoresceína/métodos , Fóvea Central/diagnóstico por imagen , Vasos Retinianos/diagnóstico por imagen , Tomografía de Coherencia Óptica/métodos , Agudeza Visual , Anciano , Membrana Epirretinal/fisiopatología , Femenino , Fóvea Central/irrigación sanguínea , Fondo de Ojo , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Índice de Severidad de la Enfermedad
13.
Retina ; 39(7): 1333-1342, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-29554078

RESUMEN

PURPOSE: To compare retinal pathology visualization in multispectral scanning laser ophthalmoscope imaging between the Spectralis and Optos devices. METHODS: This retrospective cross-sectional study included 42 eyes from 30 patients with age-related macular degeneration (19 eyes), diabetic retinopathy (10 eyes), and epiretinal membrane (13 eyes). All patients underwent retinal imaging with a color fundus camera (broad-spectrum white light), the Spectralis HRA-2 system (3-color monochromatic lasers), and the Optos P200 system (2-color monochromatic lasers). The Optos image was cropped to a similar size as the Spectralis image. Seven masked graders marked retinal pathologies in each image within a 5 × 5 grid that included the macula. RESULTS: The average area with detected retinal pathology in all eyes was larger in the Spectralis images compared with Optos images (32.4% larger, P < 0.0001), mainly because of better visualization of epiretinal membrane and retinal hemorrhage. The average detection rate of age-related macular degeneration and diabetic retinopathy pathologies was similar across the three modalities, whereas epiretinal membrane detection rate was significantly higher in the Spectralis images. CONCLUSION: Spectralis tricolor multispectral scanning laser ophthalmoscope imaging had higher rate of pathology detection primarily because of better epiretinal membrane and retinal hemorrhage visualization compared with Optos bicolor multispectral scanning laser ophthalmoscope imaging.


Asunto(s)
Angiografía con Fluoresceína/métodos , Oftalmoscopía/métodos , Retina/patología , Enfermedades de la Retina/diagnóstico , Anciano , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Estudios Retrospectivos , Tomografía de Coherencia Óptica/métodos
14.
Retina ; 39(5): 988-998, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-29394236

RESUMEN

PURPOSE: To demonstrate factors related to the presence of subfoveal detachment (SD) secondary to epiretinal membrane (ERM) and to characterize the predictors for the resolution of SD after membrane peeling. METHODS: A retrospective chart review was conducted for the patients who underwent pars plana vitrectomy for the idiopathic ERM peeling. Preoperative spectral domain optical coherence tomography characteristics of the eyes including central foveal thickness, foveal center point thickness, presence of intraretinal cyst, continuity of the membrane, area of the membrane within fovea (1 mm), and entire macula (6 mm) were evaluated to find the best predictors for the presence of SD. These predictors as well as perioperative parameters including use of internal tamponade and volume of SD were considered for time of resolution of SD. RESULTS: Of 158 included eyes, 20.2% eyes (32 eyes) had SD, and the presence of SD was significantly related to involvement of the membrane within the macula. After surgery, SD completely resolved in 90.6% of eyes (29 eyes) at a median of 2.97 months (range: 0.03-12.0 months). The area of the membrane within fovea was the only significant predictor for time to resolution of SD (hazard ratio = 1.20, 95% confidence interval = 1.100-1.324, P = 0.021). A small percent of eyes showed some further changes including fluctuation (6.2%) or persistence (3.1%) of fluid. CONCLUSION: A larger extension of ERM over the macula is related to higher likelihood of the presence of SD. Time for resolution of subfoveal detachment does not seem to be affected by the preoperative and perioperative factors except the extent of membrane within 1,000 µm of the fovea.


Asunto(s)
Membrana Epirretinal/complicaciones , Fóvea Central/patología , Desprendimiento de Retina/diagnóstico , Tomografía de Coherencia Óptica/métodos , Agudeza Visual , Anciano , Anciano de 80 o más Años , Membrana Epirretinal/diagnóstico , Membrana Epirretinal/cirugía , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Desprendimiento de Retina/etiología , Desprendimiento de Retina/cirugía , Estudios Retrospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Vitrectomía/métodos
15.
Retina ; 39(10): 2022-2031, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-30015764

RESUMEN

PURPOSE: To assess early retinal microvascular and functional changes in diabetic patients without clinical evidence of diabetic retinopathy with optical coherence tomography angiography and central visual analyzer. METHODS: This was an observational case-control study of diabetic patients without diabetic retinopathy and nondiabetic controls. Patients underwent optical coherence tomography angiography imaging and visual acuity testing using the central visual analyzer. The foveal avascular zone area and the capillary density in the superficial and deep capillary plexuses were measured manually by a masked grader. RESULTS: Sixty eyes from 35 diabetic patients were included in the study group, and 45 eyes from 31 nondiabetic patients were included in the control group. The foveal avascular zone area was not significantly different between the diabetic group and controls (both P > 0.05). The mean capillary density in the deep capillary plexus was significantly lower in diabetic eyes compared with control eyes (P = 0.04). The mean visual acuity in all central visual analyzer modules was significantly decreased in diabetic patients compared with controls (all P < 0.05). CONCLUSION: Optical coherence tomography angiography was able to detect retinal microvascular changes in the deep capillary plexus, and the central visual analyzer showed signs of decreased visual acuity under conditions simulating suboptimal contrast and glare in diabetic patients without diabetic retinopathy.


Asunto(s)
Diabetes Mellitus/diagnóstico , Angiografía con Fluoresceína/métodos , Mácula Lútea/diagnóstico por imagen , Tomografía de Coherencia Óptica/métodos , Agudeza Visual , Adulto , Anciano , Anciano de 80 o más Años , Diabetes Mellitus/fisiopatología , Retinopatía Diabética , Femenino , Fondo de Ojo , Humanos , Masculino , Persona de Mediana Edad , Vasos Retinianos/diagnóstico por imagen , Estudios Retrospectivos
16.
Retina ; 39(10): 1936-1944, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-30028411

RESUMEN

PURPOSE: To characterize the natural history and response of age-related macular degeneration-associated peripapillary choroidal neovascularization to anti-vascular endothelial growth factor therapy. METHODS: This was a retrospective case series of patients with peripapillary choroidal neovascularization secondary to neovascular age-related macular degeneration. All patients underwent complete ophthalmologic examination and retinal imaging including fluorescein angiography and spectral domain optical coherence tomography at each visit. Eyes with subretinal or intraretinal macular fluid were treated with anti-vascular endothelial growth factor monotherapy using a modified as-needed treatment algorithm. RESULTS: Thirty-three eyes of 27 patients were included. The median age was 82 years (range, 62-94), and the median duration of follow-up was 65 months (range, 6-165). Fourteen eyes (58%) without fovea-involving fluid at baseline subsequently developed exudation after a median observation period of 16 months (range, 4-107). Ten of 24 eyes (42%) without initial macular fluid remained dry during the entire follow-up. The median number of injections required until complete fluid reabsorption was 3 (range, 1-21) during the first treatment cycle. The median time to fluid recurrence was 6 months (range, 3-74). CONCLUSION: Peripapillary choroidal neovascularization secondary to wet age-related macular degeneration has a slow progression, may not require treatment for a prolonged period, and responds rapidly to anti-vascular endothelial growth factor treatment with good visual outcomes.


Asunto(s)
Neovascularización Coroidal/tratamiento farmacológico , Angiografía con Fluoresceína/métodos , Ranibizumab/administración & dosificación , Tomografía de Coherencia Óptica/métodos , Agudeza Visual , Degeneración Macular Húmeda/tratamiento farmacológico , Anciano , Anciano de 80 o más Años , Inhibidores de la Angiogénesis/administración & dosificación , Neovascularización Coroidal/diagnóstico , Femenino , Estudios de Seguimiento , Fondo de Ojo , Humanos , Inyecciones Intravítreas , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Factor A de Crecimiento Endotelial Vascular , Degeneración Macular Húmeda/diagnóstico
17.
Ophthalmic Surg Lasers Imaging Retina ; 49(10): 765-774, 2018 10 01.
Artículo en Inglés | MEDLINE | ID: mdl-30395662

RESUMEN

BACKGROUND AND OBJECTIVE: To compare subfoveal disciform scars with good and poor vision in patients with neovascular age-related macular degeneration (nAMD). PATIENTS AND METHODS: A retrospective case-control study. Twenty-two eyes of 21 consecutively treated patients with nAMD with subfoveal disciform scar and best-corrected visual acuity (BCVA) of 20/63 or better at the final visit were included. Twenty-one eyes of 21 matched patients with disciform scar and final BCVA less than 20/63 served as controls. RESULTS: Subretinal pigment epithelium scar location was more common in the good vision group than in the poor vision group (P < .001). The mean percent disruption of the ellipsoid and the external limiting membrane layers was significantly greater in poor vision eyes than in good vision eyes from scar formation and throughout follow-up (all P < .01). CONCLUSION: Preserved photoreceptor layer correlated with good vision in patients with nAMD and subfoveal disciform scar. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:765-774.].


Asunto(s)
Cicatriz/diagnóstico , Fóvea Central/patología , Refracción Ocular/fisiología , Tomografía de Coherencia Óptica/métodos , Agudeza Visual/fisiología , Degeneración Macular Húmeda/fisiopatología , Anciano de 80 o más Años , Estudios de Casos y Controles , Cicatriz/etiología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Estudios Retrospectivos , Degeneración Macular Húmeda/complicaciones , Degeneración Macular Húmeda/diagnóstico
18.
Graefes Arch Clin Exp Ophthalmol ; 256(11): 2035-2040, 2018 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-30094716

RESUMEN

PURPOSE: Automated segmentation of retinal layers by spectral-domain optical coherence tomography (SD-OCT) is usually erroneous in the presence of retinal diseases. The purpose of this study is to report the changes in ganglion cell complex (GCC) comprising retina nerve fiber layer (RNFL), ganglion cell layer (GCL), and inner plexiform layer (IPL) in neovascular age-related macular degeneration (AMD) patients by manually correcting the automated segmentation errors. METHODS: Thirty eyes of 30 patients with new-onset choroidal neovascularization secondary to neovascular AMD and 30 eyes of 30 healthy subjects were included. The inner retinal thicknesses were measured using early treatment diabetic retinopathy circle in the central 1 mm (fovea) and surrounding 3 mm diameter (parafovea) after checking the accuracy of automated segmentation lines. Manual segmentation was done to ensure the accurate segmentation, when needed. RESULTS: Neovascular AMD patients had thicker mean RNFL, GCL, IPL, and GCC thicknesses within the fovea compared to healthy eyes (p = 0.04, p = 0.001, p = 0.032, and p = 0.005, respectively). In the parafoveal area, among the thickness-related measurements, the only significant difference was a thicker mean RNFL (p = 0.002). CONCLUSION: Diffuse thickening of inner retinal layers in neovascular AMD may overestimate actual GCC thickness within fovea. This pseudo-increase in GCC thickness and inner retinal layers in general likely does not reflect more cells or tissue, but rather diffuse edema which leads to a falsely increased reading of layer thickness. Such false readings may also make the assessment of other conditions that lead to reduced inner retinal layer thickness such as glaucoma, optic nerve disease, or retinovascular occlusions more difficult.


Asunto(s)
Neovascularización Coroidal/diagnóstico , Fibras Nerviosas/patología , Papiledema/diagnóstico , Células Ganglionares de la Retina/patología , Anciano , Anciano de 80 o más Años , Neovascularización Coroidal/etiología , Estudios Transversales , Femenino , Humanos , Presión Intraocular/fisiología , Masculino , Persona de Mediana Edad , Tamaño de los Órganos , Estudios Retrospectivos , Microscopía con Lámpara de Hendidura , Tomografía de Coherencia Óptica/métodos , Agudeza Visual/fisiología , Degeneración Macular Húmeda/complicaciones
19.
Eur J Ophthalmol ; 28(6): 670-676, 2018 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-29726278

RESUMEN

PURPOSE:: Herein, we describe a novel finding which appears as a reticular pattern on multicolor confocal scanning laser ophthalmoscopy image during routine imaging of retina and we aim to show whether there is an association between this pattern and dry eye findings. MATERIALS AND METHODS:: A total of 162 eyes of 81 patients that were scheduled for a routine retinal imaging by scanning laser ophthalmoscopy at a vitreoretinal practice underwent dry eye evaluation including corneal and conjunctival lissamine green staining, fluorescein staining, tear break-up time, and tear meniscus height measurement before acquiring any images. Then, multicolor images were taken and graded for the severity of reticular pattern. RESULTS:: Among 150 eyes of 81 patients with gradable multicolor imaging, 45 eyes (30%) had some reticular pattern on multicolor image. Severity of reticular pattern on multicolor imaging was significantly correlated with total lissamine score (rho = 0.378, p = 0.007) and tear meniscus height (rho = -0.408, p = 0.011). Furthermore, they were found to be the best set of predictors for the severity pattern on multicolor imaging (odds ratio = 1.30, 95% confidence interval = 1.01-1.37, p = 0.027 and odds ratio = 0.25, 95% confidence interval = 0.128-0.342, p < 0.001, respectively). CONCLUSION:: Reticular pattern seen on multicolor image while acquiring retinal images using scanning laser ophthalmoscopy may be related to tear film instability. Further modulations of the scanning laser ophthalmoscopy instrument will likely improve this indicator of dry eye syndrome.


Asunto(s)
Síndromes de Ojo Seco/diagnóstico por imagen , Microscopía Confocal/métodos , Oftalmoscopía/métodos , Retina/diagnóstico por imagen , Lágrimas/diagnóstico por imagen , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Fluoresceína/administración & dosificación , Humanos , Masculino , Persona de Mediana Edad
20.
Graefes Arch Clin Exp Ophthalmol ; 256(4): 643-649, 2018 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-29492687

RESUMEN

PURPOSE: Our purpose was to compare the characteristics of the retinal and choroidal lesions including choroidal nevus, choroidal melanoma and congenital hypertrophy of the retina pigment epithelium using conventional color fundus photography (CFP) and multicolor imaging (MCI). METHODS: The paired images of patients with retinal or choroidal lesions were assessed for the visibility of lesion's border, halo and drusen using a grading scale (0-2). The area of the lesion was measured on both imaging modalities. The same grading was also done on the individual color channels of MCI for a further evaluation. RESULTS: Thirty-three eyes of 33 patients were included. There were no significant differences in the mean border, drusen and halo visibility scores between the two imaging modalities (p = 0.12, p = 0.70, p = 0.35). However, the mean area of the lesion was significantly smaller on MCI than that on CFP (14.9±3.3 versus 18.7±3.4 mm2, p = 0.01). CONCLUSION: The appearance of choroidal and/ or retinal lesions on MCI may be different than that on CFP. Though MCI can provide similar information with CFP for the features of retinal and/ or choroidal lesions including border, halo and drusen; the infrared light reflection on MCI underestimates the extent of the choroidal lesion by 33%.


Asunto(s)
Enfermedades de la Coroides/diagnóstico , Coroides/patología , Retina/patología , Enfermedades de la Retina/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Angiografía con Fluoresceína/métodos , Estudios de Seguimiento , Fondo de Ojo , Humanos , Masculino , Persona de Mediana Edad , Fotograbar/métodos , Estudios Retrospectivos , Tomografía de Coherencia Óptica/métodos , Adulto Joven
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