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PURPOSE: To report two cases of ibrutinib-related uveitis and review the literature to date. METHODS: We report two cases of ibrutinib-related uveitis using CARE guidelines and review the cases reported in the literature. RESULTS: Case 1) A 55-year-old female with recurrent primary central nervous system lymphoma presented with bilateral decreased visual acuity, photophobia, and floaters that started one month after initiating oral treatment with ibrutinib. Chronic non-granulomatous bilateral anterior-intermediate uveitis with macular edema was identified. Secondary causes were ruled out, and a presumptive diagnosis of ibrutinib-related uveitis was made. Case 2) A 57-year-old female with Waldenström macroglobulinemia who was treated with ibrutinib for two years presented with bilateral blurred vision, photophobia, red eyes, and floaters. A diagnosis of non-granulomatous, noninfectious panuveitis with bilateral cystoid macular edema was made. Secondary causes were ruled out, and ibrutinib toxicity was the most likely cause. CONCLUSION: Ibrutinib-related uveitis is a novel and under-diagnosed clinical entity. The most frequent clinical presentation in the literature is bilateral, non-granulomatous, anterior, and intermediate uveitis. Macular edema is a frequent complication. Uveitis usually requires topical treatment and the suspension of ibrutinib. Switching to second-generation Bruton tyrosine kinase inhibitors is proposed as a potential therapeutic alternative.
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Adenina , Piperidinas , Humanos , Femenino , Adenina/análogos & derivados , Adenina/efectos adversos , Persona de Mediana Edad , Piperidinas/efectos adversos , Tomografía de Coherencia Óptica , Agudeza Visual , Inhibidores de Proteínas Quinasas/efectos adversos , Uveítis/inducido químicamente , Uveítis/diagnóstico , Uveítis/tratamiento farmacológico , Linfoma no Hodgkin/tratamiento farmacológico , Macroglobulinemia de Waldenström/tratamiento farmacológico , Macroglobulinemia de Waldenström/diagnóstico , Pirimidinas/efectos adversos , Pirimidinas/uso terapéutico , Edema Macular/inducido químicamente , Edema Macular/diagnóstico , Edema Macular/tratamiento farmacológico , Angiografía con Fluoresceína , Pirazoles/efectos adversos , Pirazoles/uso terapéutico , Neoplasias del Sistema Nervioso Central/tratamiento farmacológico , Neoplasias del Sistema Nervioso Central/diagnósticoRESUMEN
Optic neuritis is an important cause of unilateral and acute visual loss in young adults, but other differential diagnoses should be considered, especially when the disease has an atypical presentation. This report presents the case of a young woman with reduced visual acuity in her right eye, associated with optic disc edema and a relative afferent pupillary defect, that was initially misdiagnosed as optic neuritis and subsequently found to have paracentral acute middle maculopathy, possibly secondary to subtle impending central retinal vein occlusion. This case emphasizes the need to remember that retinal vascular diseases can occasionally mimic optic neuritis. Detailed anamnesis and ophthalmic examination can avoid unnecessary interventions.
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Neuritis Óptica , Papiledema , Agudeza Visual , Humanos , Neuritis Óptica/diagnóstico , Femenino , Diagnóstico Diferencial , Papiledema/diagnóstico , Tomografía de Coherencia Óptica/métodos , Adulto , Enfermedad Aguda , Angiografía con Fluoresceína/métodos , Enfermedades de la Retina/diagnósticoRESUMEN
PURPOSE: To describe a rare presentation of pachychoroid neovascular membrane in a patient with sickle cell trait and the accuracy of ruling out hemoglobinopathies in the presentation of pachychoroid spectrum. METHODS: The patient was subjected to physical examinations, multimodal images (fluorescein angiography, optical coherence tomography), hemoglobin electrophoresis, and peripheral blood smear, documenting sickle cell trait. The management included laser treatment to target non-perfusion areas, along with a single dose of anti-VEGF. RESULTS: A 45-year-old male patient with diagnosis of pachychoroid neovascularization treated for 6 years with multiple anti VEGF injections in the left eye. A detailed clinical evaluation included hypochromic conjunctiva, peripheral vascular occlusion with non-perfusion areas led us to suspect sickle cell disease retinopathy. The images of fluorescein angiography showed peripheral arteriovenous anastomosis with non-perfusion areas; the optical coherence tomography revealed a thinner neuroepithelium with a thicker choroid; also, hemoglobin electrophoresis and peripheral blood smear documenting sickle cell trait. The chosen management was photocoagulation of the peripheral retina on the non-perfusion areas and anti VEGF without neovascular activity recurrence in the follow up period. CONCLUSION: Although sickle cell trait is considered a mild form of this pathology without serious retinal manifestations, it has to be noted that in the context of pachychoroid spectrum diseases is a trigger that could perpetuate retinal ischemia and neovascular activity.
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Neovascularización Coroidal , Angiografía con Fluoresceína , Rasgo Drepanocítico , Tomografía de Coherencia Óptica , Humanos , Masculino , Persona de Mediana Edad , Angiografía con Fluoresceína/métodos , Neovascularización Coroidal/diagnóstico , Neovascularización Coroidal/tratamiento farmacológico , Neovascularización Coroidal/etiología , Rasgo Drepanocítico/complicaciones , Rasgo Drepanocítico/diagnóstico , Inhibidores de la Angiogénesis/uso terapéutico , Factor A de Crecimiento Endotelial Vascular/antagonistas & inhibidores , Coagulación con Láser , Agudeza Visual , Coroides/irrigación sanguínea , Coroides/patología , Fondo de Ojo , Inyecciones IntravítreasRESUMEN
A young woman presented at our clinic with sudden visual loss in the right eye, recurrent vertigo, and right-sided tinnitus. We performed a complete ophthalmological evaluation. This revealed effects of the condition on the small arterioles of the peripheral retina. Susac syndrome is characterized by the clinical triad of retinal arteriolar occlusions, cochleovestibular manifestations, and encephalopathy (which can be identified by neuroimaging abnormalities). Early diagnosis and immunosuppressive therapy improved the patient's visual acuity and the remission of her other symptoms. Hemi-central retinal artery occlusion is an atypical neuro-ophthalmological finding in this disease. However, its identification as a sign of Susac syndrome may facilitate timely diagnosis and accurate treatment.
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Oclusión de la Arteria Retiniana , Síndrome de Susac , Humanos , Oclusión de la Arteria Retiniana/etiología , Oclusión de la Arteria Retiniana/diagnóstico por imagen , Síndrome de Susac/complicaciones , Síndrome de Susac/diagnóstico por imagen , Síndrome de Susac/diagnóstico , Femenino , Adulto , Angiografía con Fluoresceína/métodos , Agudeza VisualRESUMEN
BACKGROUND Idiopathic epiretinal membranes (ERMs) are commonly associated with fibrovascular tissue, primarily observed in ischemic retinopathies. However, idiopathic vascularized ERMs (IVEM) are exceedingly rare, and their pathogenesis and clinical course remain poorly understood. This report aims to contribute to the limited literature on IVEM, shedding light on its characteristics and potential implications for patient management. CASE REPORT We present the case of a 70-year-old man diagnosed with idiopathic ERM in the left eye, revealing a neovascular complex within the membrane. Despite the absence of ocular symptoms and medical history, multimodal imaging using the Nidek Mirante, including spectral domain optical coherence tomography (SD-OCT) and optical coherence tomography angiography (OCT-A), revealed a thick pre-retinal hyper-reflective line with a partial posterior vitreous detachment and an abnormal vascular complex resembling a pruned-vascular-tree pattern. Notably, fluorescein angiography confirmed hyperfluorescence and leakage corresponding to the observed vessels. Despite the rarity of IVEM, the patient remained asymptomatic, and observation was deemed appropriate. CONCLUSIONS IVEM poses a rare challenge in clinical practice, necessitating a comprehensive understanding of its features and potential complications. While the etiopathogenesis remains unclear, hypertension has been proposed as a contributing factor. This case adds valuable insights to the growing literature on IVEM, emphasizing the importance of multimodal imaging in diagnosis and decision-making. Given the limited reports and varied treatment outcomes, managing IVEM requires careful consideration of observation and various therapeutic approaches, highlighting the need for further research to optimize patient care.
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Membrana Epirretinal , Masculino , Humanos , Anciano , Membrana Epirretinal/diagnóstico por imagen , Membrana Epirretinal/etiología , Tomografía de Coherencia Óptica/métodos , Angiografía con Fluoresceína/métodos , Agudeza Visual , Imagen MultimodalRESUMEN
We report a case of acute methanol toxicity with unique optical coherence tomography findings. A 56-year-old man was referred to our ophthalmology clinic with a history of handmade vodka consumption and vision loss. On ophthalmologic examination, his vision was 20/100 in his right eye and 20/200 in his left eye. Bilateral mild optic disk hyperemia was detected on fundus examination. Because of the severity of systemic symptoms in such cases, it is very difficult to include optical coherence tomography in the ophthalmologic examination. However, we managed to perform optical coherence tomography and recorded shallow subretinal fluid and a prominent middle limiting membrane sign as acute retinal structural changes in the patient. The patient was treated with hemodialysis, intravenous ethanol, and sodium bicarbonate. On the fourth day of treatment, visual acuity improved to 20/20 in both eyes. In addition, the prominent middle limiting membrane sign and subretinal fluid disappeared. In this unusual case, retinal pigment epithelium damage and retinal ischemia may have contributed to the prominent middle limiting membrane and subretinal fluid, which are novel optical coherence tomography findings of methanol toxicity.
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Enfermedades de la Retina , Tomografía de Coherencia Óptica , Masculino , Humanos , Persona de Mediana Edad , Tomografía de Coherencia Óptica/métodos , Metanol , Retina/diagnóstico por imagen , Enfermedades de la Retina/inducido químicamente , Enfermedades de la Retina/diagnóstico por imagen , Fondo de Ojo , Angiografía con FluoresceínaRESUMEN
INTRODUCTION: Alagille syndrome (AGS) is a genetic disease with multisystemic affection, including ocular manifestations. Recently, a high frequency of posterior segment findings, including macular changes, has been reported. This publication aims to report an unusual finding of macular atrophy and a focal choroidal excavation in a patient with JAG1 related AGS. METHODS: Case report. RESULTS: This publication describes an atypical presentation of focal choroidal excavation (FCE) and unilateral macular atrophy in a 7-year-old male with Alagille syndrome (AGS). Genetic analysis revealed a pathogenic variant in the JAG1 gene. Ophthalmological examination and imaging findings demonstrated characteristic ocular manifestations of AGS, including posterior embryotoxon, chorioretinal atrophy, and thinning of the choroid. CONCLUSION: The presence of FCE in AGS is uncommon, and the underlying mechanisms remain unclear. Further exploration of similar cases is necessary to better understand the evolution and visual prognosis in patients with AGS and FCE.
This case report highlights the presence of focal choroidal excavation and unilateral macular atrophy in a patient with Alagille syndrome. The genetic analysis identified a pathogenic variant in the JAG1 gene.
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Síndrome de Alagille , Proteína Jagged-1 , Humanos , Síndrome de Alagille/genética , Síndrome de Alagille/complicaciones , Síndrome de Alagille/diagnóstico , Síndrome de Alagille/patología , Proteína Jagged-1/genética , Masculino , Niño , Tomografía de Coherencia Óptica , Enfermedades de la Coroides/genética , Enfermedades de la Coroides/diagnóstico , Angiografía con Fluoresceína , Agudeza Visual/fisiología , Atrofia , Mácula Lútea/patología , Mácula Lútea/anomalías , Coroides/patología , Coroides/anomalíasRESUMEN
PURPOSE: To evaluate macular chorioretinal flow changes on optical coherence tomography angiography, in participants who received inactivated and messenger RNA (mRNA) vaccines to prevent Coronavirus disease 2019 (COVID-19). METHODS: In this prospective cohort study, healthy participants who received two doses of an inactivated COVID-19 vaccine (CoronaVac) and then one dose of an mRNA vaccine (BNT162b2) were examined before and after each vaccination. Ophthalmologic examination and imaging with optical coherence tomography angiography were performed during each visit. We evaluated vascular densities in the superficial and deep capillary plexuses in foveal, parafoveal, and perifoveal areas; the foveal avascular zone; and choriocapillaris flows (in 1- and 6-mm-diameter areas). RESULTS: One eye in each of the 24 participants was assessed. Superficial capillary plexus vascular densities in the parafoveal area were significantly lower after the second dose of the CoronaVac vaccine than after the first dose. In the deep capillary plexus, vascular attenuation was observed only in the parafoveal region after the first CoronaVac dose. However, in all regions, the deep capillary plexus vascular densities and subfoveal choriocapillaris flow were significantly decreased after the second CoronaVac dose. After the BNT162b2 dose, the superficial capillary plexus vascular densities, the deep capillary plexus vascular densities, and subfoveal choriocapillaris flow of most regions were significantly lower than those before vaccinations. CONCLUSION: Vascular attenuation, observed particularly after the second dose of the CoronaVac vaccine, may explain the pathogenesis of postvaccine ocular ischemic disorders reported in the literature. However, these disorders are extremely rare, and the incidence of thrombotic events caused by COVID-19 itself is higher.
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COVID-19 , Vasos Retinianos , Humanos , Vasos Retinianos/diagnóstico por imagen , Vasos Retinianos/patología , Angiografía con Fluoresceína/métodos , Vacunas contra la COVID-19 , Vacuna BNT162 , Tomografía de Coherencia Óptica/métodos , Estudios Prospectivos , COVID-19/prevención & control , PerfusiónRESUMEN
OBJECTIVE: To describe the peculiarities in imaging acquisition of fourteen patients with choroidal nevus using the Broad Line Fundus Imaging (BLFI) technology. METHODS: Single-center, retrospective, cross-sectional analysis. RESULTS: All images were acquired using the BLFI technology. We have found that choroidal nevus is undetectable in the blue channel (BC) (435-500â nm) and the green channel (GC) (500-585â nm). The only visible changes are related to the drusen, which appeared in BC and GC as light focal dots, correlated to the yellowish foci in the true-color image. On the red channel (RC) (585-640â nm), all lesions revealed the same pattern: a well-defined dark spot, with enhanced contrast, allowing the better visualization, measuring, and characterization of the nevus when compared with the other color channels, including the true-color imaging. CONCLUSION: BLFI application in choroidal nevus might be helpful at presentation, refining the diagnostic reliability, and monitoring, as it allows for better detection of alterations in the lesions. The peculiarities of the choroidal nevus are better assessed when using the RC due to its longer wavelength and deeper penetration in the retina and choroid.
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Neoplasias de la Coroides , Nevo Pigmentado , Humanos , Neoplasias de la Coroides/diagnóstico por imagen , Neoplasias de la Coroides/diagnóstico , Estudios Retrospectivos , Estudios Transversales , Femenino , Masculino , Persona de Mediana Edad , Adulto , Nevo Pigmentado/diagnóstico por imagen , Nevo Pigmentado/diagnóstico , Angiografía con Fluoresceína/métodos , Anciano , Fondo de OjoRESUMEN
BACKGROUND: To evaluate structural changes in retina and choroid in patients with type 2 diabetes (T2D) and their association with diabetic kidney disease (DKD). METHODS: T2D patients with mild or no diabetic retinopathy (DR) were followed for 3 years using structural SS-OCT and OCT angiography (OCT-A) taken every 6 months. Parameters were compared longitudinally and according to the DKD status on baseline. RESULTS: One hundred and sixty eyes from 80 patients were followed for 3 years, 72 with no DKD (nDKD) at baseline and 88 with DKD. Trend analysis of T2D showed significant thinning in GCL + and circumpapillary retinal fiber neural layer (cRFNL), choroid, and decreased vascular density (VD) in superficial plexus and central choriocapillaris with foveal avascular zone (FAZ) enlargement. Patients with no DKD on baseline presented more significant declines in retinal center and choroidal thickness, increased FAZ and loss of nasal and temporal choriocapillaris volume. In addition, the nDKD group had worse glycemic control and renal parameters at the end of the study. CONCLUSION: Our data suggests the potential existence of early and progressive neurovascular damage in the retina and choroid of patients with Type 2 Diabetes (T2D) who have either no or mild Diabetic Retinopathy (DR). The progression of neurovascular damage appears to be correlated with parameters related to glycemic control and renal damage.
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Diabetes Mellitus Tipo 2 , Nefropatías Diabéticas , Retinopatía Diabética , Humanos , Diabetes Mellitus Tipo 2/complicaciones , Estudios Prospectivos , Nefropatías Diabéticas/diagnóstico , Nefropatías Diabéticas/complicaciones , Tomografía de Coherencia Óptica , Vasos Retinianos/diagnóstico por imagen , Angiografía con Fluoresceína , Retina , Retinopatía Diabética/complicaciones , Retinopatía Diabética/diagnóstico , Coroides/irrigación sanguíneaRESUMEN
PURPOSE: To report a case of exudative perifoveal exudative vascular anomalous complex (ePVAC) in a Brazilian healthy patient that underwent a complete resolution after aflibercept intravitreal injections. CASE DESCRIPTION: A 41-year-old healthy Brazilian man complained of acute central vision loss in his right eye (RE). Fundus examination showed a perifoveal hemorrhagic aneurysmal lesion, accompanied by several hard exudates in RE. On fluorescein angiography, these abnormalities showed a progressive hyperfluorescence with surrounding leakage. Optical coherence tomography (OCT) revealed a deep, perifoveal hyporeflective cystic space with a hyperreflective wall and hyperreflective material inside of fibrin-like aspect. Around this aneurism, intraretinal hyporeflective spaces suggestive of exudation were detected. Nor pathological flow signal, or telangiectatic dilations were evidenced on OCT-angiography. Therefore, a diagnosis of exudative ePVAC in RE was hypothesized. After an initial observation, the patient underwent three monthly aflibercept intravitreal injections (0.05â ml/2â mg), with a significative anatomical and functional improvement after two weeks from first dose. On last follow-up at five months from baseline, patient experienced no evidence of new exudation and a stable visual acuity. DISCUSSION: Placental growth factor (PlGF) may impact on pericytes' dropout, and thus on ePVAC development. In contrast to the other anti-VEGF drugs, aflibercept is the only molecule contrasting PlGF. Therefore, aflibercept would act on ePVAC not as an anti-VEGF drug, but rather as an anti-PlGF one. CONCLUSION: This report encouraged the use of aflibercept as a therapeutic option for ePVAC. Further studies are required to confirm our result and the impact of PlGF on ePVAC pathogenesis.
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Receptores de Factores de Crecimiento Endotelial Vascular , Malformaciones Vasculares , Masculino , Humanos , Femenino , Adulto , Inyecciones Intravítreas , Brasil , Factor de Crecimiento Placentario/uso terapéutico , Receptores de Factores de Crecimiento Endotelial Vascular/uso terapéutico , Proteínas Recombinantes de Fusión/uso terapéutico , Angiografía con Fluoresceína/métodos , Malformaciones Vasculares/diagnóstico , Malformaciones Vasculares/tratamiento farmacológico , Tomografía de Coherencia Óptica/métodos , Inhibidores de la Angiogénesis/uso terapéuticoRESUMEN
RESUMO Com o crescimento da indústria cosmética global, a busca pela estética e pelo rejuvenescimento impulsionou o aumento de procedimentos estéticos. A gordura autóloga é o tipo de preenchimento mais comum e mais grave relacionado à cegueira iatrogênica. A oclusão iatrogênica da artéria oftálmica é uma complicação rara (mas devastadora) das injeções de preenchimento facial. Embora diversos tratamentos tenham sido relatados e propostos, até o momento não há eficácia comprovada. Na identificação da oclusão de artéria central da retina, o tempo é de fundamental importância para o prognóstico visual do paciente. Os resultados, em geral, são insatisfatórios, e há pouca ou nenhuma evidência favorável. O objetivo deste trabalho foi relatar o caso de uma paciente que apresentou oclusão de artéria central da retina após procedimento cosmético com gordura autóloga em região nasolabial.
ABSTRACT The global cosmetic industry growth and the desire for aesthetics and rejuvenation have increased the aesthetic procedures. Autologous fat is the most common and most serious type of filling related to iatrogenic blindness. Iatrogenic occlusion of the ophthalmic artery is a rare but devastating complication of facial filler injections. Although several treatments have been reported and proposed, to date there is no proven efficacy. In identifying central retinal artery occlusion, timing is crucial to the patient's visual prognosis. The results, in general, are unsatisfactory and there is little or no favorable evidence. This paper aimed to report the case of a patient who presented central retinal artery occlusion after a cosmetic procedure with autologous fat in the nasolabial region.
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Humanos , Femenino , Adulto , Arteria Oftálmica/patología , Oclusión de la Arteria Retiniana/etiología , Técnicas Cosméticas/efectos adversos , Embolia Grasa/etiología , Grasa Subcutánea/trasplante , Enfermedad Iatrogénica , Complicaciones Posoperatorias , Trasplante Autólogo , Inyecciones Intradérmicas/efectos adversos , Angiografía con Fluoresceína , Oclusión de la Arteria Retiniana/diagnóstico , Agudeza Visual , Ceguera/etiología , Tomografía de Coherencia ÓpticaRESUMEN
This case report identified paracentral acute middle maculopathy as the cause of severe and irreversible vision loss after cataract surgery. Cataract surgeons should be aware of known risk factors for the development of paracentral acute middle maculopathy. In those patients, extra care regarding anesthesia, intraocular pressure, and some other aspects of cataract surgery must be taken. Paracentral acute middle maculopathy is currently understood as a clinical sign evident on spectral-domain optical coherence tomography, and it is probably evidence of deep ischemic insult to the retina. It should be a differential diagnosis in cases of marked low vision acuity associated with no fundus abnormalities in the immediate postoperative period, as demonstrated in the presented case.
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Catarata , Mácula Lútea , Degeneración Macular , Enfermedades de la Retina , Humanos , Enfermedades de la Retina/etiología , Enfermedades de la Retina/diagnóstico , Angiografía con Fluoresceína/métodos , Enfermedad Aguda , Tomografía de Coherencia Óptica/métodos , Catarata/complicaciones , Degeneración Macular/complicacionesRESUMEN
To report a unique case of acute posterior multifocal placoid pigment epitheliopathy (APMPPE) in a patient with positive serology for Bartonella, presenting with ocular signs and symptoms not attributable to other diseases. A 27-year-old woman presented with decreased visual acuity in both eyes. Multimodal fundus image analysis was performed. A color fundus photograph of both eyes revealed peripapillary and macular yellow-white placoid lesions. The fundus autofluorescence of both eyes demonstrated hypo- and hyperautofluorescence of the macular lesions. Fluorescein angiography showed early-stage hypofluorescence and late staining of placoid lesions in both eyes. Spectral domain optical coherence tomography (SD-OCT) of both eyes revealed irregular elevations in the retinal pigment epithelium with the disruption of the ellipsoid zone on the topography of macular lesions. At 3 months after the treatment initiation for Bartonella infection, the placoid lesions became atrophic and hyperpigmented, and SD-OCT revealed loss of both the outer retinal layers and retinal pigment epithelium on the topography of macular lesions in both eyes.
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Infecciones por Bartonella , Enfermedades de la Retina , Síndromes de Puntos Blancos , Femenino , Humanos , Adulto , Enfermedades de la Retina/diagnóstico , Retina/patología , Síndromes de Puntos Blancos/patología , Epitelio Pigmentado de la Retina/diagnóstico por imagen , Epitelio Pigmentado de la Retina/patología , Angiografía con Fluoresceína/métodos , Tomografía de Coherencia Óptica/métodos , Infecciones por Bartonella/complicaciones , Infecciones por Bartonella/patología , Enfermedad AgudaRESUMEN
Aim: To evaluate retinal vascular perfusion and density by optical coherence tomography angiography (OCTA) before, during, and after hypoglycemia in individuals with diabetes mellitus with or without diabetic retinopathy (DR). Methods: A focused clinical history was performed, followed by an ophthalmological examination to document retinopathy status. OCTA was performed at baseline, at hypoglycemia, and at glucose normalization. Eye tracking and eye alignment devices on the platform were used to obtain a macular thickness cube (512 × 128) and vascular perfusion and density protocols of 3 × 3 mm. Retinal vascular reactivity was analyzed with superficial plexus vascular perfusion and density protocols on OCTA. Results: Fifty-two participants encompassing 97 eyes fulfilled the eligibility criteria. Their mean age was 42.9 ± 15.1 years (range, 22 to 65), and 20 (38.2%) were men. We found a statistically significant difference in vascular perfusion and density when comparing all groups at baseline. The controls had higher vascular perfusion and density values than the cases. Vascular perfusion and density were significantly reduced in all groups during the hypoglycemia episode, except for vascular density in DR cases. Conclusion: Acute hypoglycemia significantly alters the retinal vascularity in DM patients with and without DR, suggesting that repeated episodes of acute hypoglycemia could exacerbate retinopathy in the long term.
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Retinopatía Diabética , Hipoglucemia , Insulinas , Masculino , Humanos , Adulto , Persona de Mediana Edad , Femenino , Densidad Microvascular , Vasos Retinianos/diagnóstico por imagen , Angiografía con Fluoresceína/métodos , Retinopatía Diabética/diagnóstico , Perfusión , Hipoglucemia/inducido químicamenteRESUMEN
PURPOSE: To evaluate using optical coherence tomography angiography the macular and optic nerve head blood flow in pediatric patients with epilepsy treated with levetiracetam for at least 12 months. METHODS: This study included 33 pediatric patients with epilepsy and 30 sex- and age-matched healthy volunteer children were included in the study. Optical coherence tomography angiography was used to evaluate the optic nerve head and macular perfusion changes. The mean ocular perfusion pressures were also calculated. Patients who were using multiple antiepileptic drugs or had a prior history of using different drugs were excluded. RESULTS: The choriocapillaris flow area was significantly lower in the Study Group than in the Control Group (p=0.006). However, the foveal avascular zone and vessel densities of the macula in the superficial capillary plexus, deep capillary plexus, and optic nerve head of the study group were not significantly different from those of the control group (p>0.05). Moreover, no significant difference in means of mean ocular perfusion pressure was found between the two groups (p=0.211). No obvious correlation was found between treatment duration and optical coherence tomography angiography parameters or mean ocular perfusion pressure. CONCLUSION: Choroidal perfusion was reduced in children taking levetiracetam compared with that in the control group, whereas retinal perfusion was not affected in this optical coherence tomography angiography study.