RESUMEN
PURPOSE: To explore the association of angiographic nonperfusion in focal and diffuse recalcitrant diabetic macular edema (DME) in diabetic retinopathy (DR). DESIGN: A retrospective, observational case series of patients with the diagnosis of recalcitrant DME for at least 2 years placed into 1 of 4 cohorts based on the degree of DR. METHODS: A total of 148 eyes of 76 patients met the inclusion criteria at 1 academic institution. Ultra-widefield fluorescein angiography (FA) images and spectral-domain optical coherence tomography (SD OCT) images were obtained on all patients. Ultra-widefield FA images were graded for quantity of nonperfusion, which was used to calculate ischemic index. Main outcome measures were mean ischemic index, mean change in central macular thickness (CMT), and mean number of macular photocoagulation treatments over the 2-year study period. RESULTS: The mean ischemic index was 47% (SD 25%; range 0%-99%). The mean ischemic index of eyes within Cohorts 1, 2, 3, and 4 was 0%, 34% (range 16%-51%), 53% (range 32%-89%), and 65% (range 47%-99%), respectively. The mean percentage decrease in CMT in Cohorts 1, 2, 3, and 4 were 25.2%, 19.1%, 11.6%, and 7.2%, respectively. The mean number of macular photocoagulation treatments in Cohorts 1, 2, 3, and 4 was 2.3, 4.8, 5.3, and 5.7, respectively. CONCLUSIONS: Eyes with larger areas of retinal nonperfusion and greater severity of DR were found to have the most recalcitrant DME, as evidenced by a greater number of macular photocoagulation treatments and less reduction in SD OCT CMT compared with eyes without retinal nonperfusion. Areas of untreated retinal nonperfusion may generate biochemical mediators that promote ischemia and recalcitrant DME.
Asunto(s)
Retinopatía Diabética/diagnóstico , Angiografía con Fluoresceína , Isquemia/diagnóstico , Edema Macular/diagnóstico , Vasos Retinianos/patología , Adulto , Anciano , Anciano de 80 o más Años , Retinopatía Diabética/cirugía , Femenino , Humanos , Coagulación con Láser , Edema Macular/cirugía , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Tomografía de Coherencia ÓpticaAsunto(s)
Inmunosupresores/efectos adversos , Edema Macular/inducido químicamente , Esclerosis Múltiple/tratamiento farmacológico , Glicoles de Propileno/efectos adversos , Esfingosina/análogos & derivados , Administración Oral , Femenino , Clorhidrato de Fingolimod , Angiografía con Fluoresceína , Humanos , Edema Macular/diagnóstico , Edema Macular/fisiopatología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Esfingosina/efectos adversos , Tomografía de Coherencia Óptica , Agudeza Visual/fisiologíaAsunto(s)
Inhibidores de la Angiogénesis/administración & dosificación , Anticuerpos Monoclonales Humanizados/administración & dosificación , Retinopatía de la Prematuridad/tratamiento farmacológico , Bevacizumab , Progresión de la Enfermedad , Edad Gestacional , Humanos , Recien Nacido con Peso al Nacer Extremadamente Bajo , Recién Nacido , Inyecciones Intravítreas , Recurrencia , Desprendimiento de Retina/diagnóstico por imagen , Insuficiencia del Tratamiento , Ultrasonografía , Factor A de Crecimiento Endotelial Vascular/antagonistas & inhibidoresRESUMEN
Ranibizumab, a recombinant, humanized, monoclonal antibody antigen-binding fragment that neutralizes all VEGF-A isoforms, is the first US FDA-approved therapy for neovascular age-related macular degeneration (AMD) to result in improvement in visual acuity. The benefit of intravitreal ranibizumab applies to all angiographic subtypes of neovascular AMD and across all lesion sizes. The two original phase III studies (ANCHOR and MARINA) demonstrated sustained visual acuity (VA) gains over a two-year monthly dosing schedule. Following these trials, several studies looked at ways to decrease the treatment burden while maintaining similar visual gains. These trials included PIER, PrONTO, EXCITE, SUSTAIN, HORIZON, and CATT. Visual acuity data shows that monthly dosing of ranibizumab produces superior vision outcomes compared to a less-frequent, fixed-dosing schedule. Intravitreal ranibizumab is well tolerated and shown to have a very low rate of adverse ocular or systemic side-effects.
Asunto(s)
Anticuerpos Monoclonales Humanizados/administración & dosificación , Ensayos Clínicos como Asunto , Degeneración Macular Húmeda/tratamiento farmacológico , Anticuerpos Monoclonales Humanizados/efectos adversos , Humanos , Ranibizumab , Agudeza Visual/fisiologíaRESUMEN
The silent sinus syndrome is characterized by atelectasis of the maxillary sinus in the setting of subclinical maxillary sinusitis and obstruction of the osteomeatal unit. The resultant expansion of orbital volume causes enophthalmos and hypoglobus. A review of the literature reveals only unilateral cases. The authors present a case of bilateral silent sinus syndrome presenting with chronic ocular surface disease. A 56-year-old man was referred for tarsorrhaphy to treat a chronic recurrent corneal ulcer. Exam revealed an area of corneal thinning in the left eye. The patient appeared cachectic and there was enophthalmos, hypoglobus, and lagophthalmos on both sides, left worse than right. Due to the patient's appearance and a history of sinonasal malignancy, recurrent malignancy was suspected. A systemic workup was unrevealing, and radiographic studies showed the features of silent sinus syndrome bilaterally. The patient underwent sinus surgery and placement of a left orbital floor implant.