RESUMEN

La vasculitis retinal es una enfermedad inflamatoria que amenaza la visión y afecta los vasos retinales (capilares, venas y arterias). Puede ocurrir como una condición idiopática o como complicación de enfermedades infecciosas y neoplásicas o en asociación con enfermedades sistémicas inflamatorias. Sus manifestaciones clínicas típicas incluyen revestimiento perivascular, envainamiento, filltración vascular y oclusión. Puede estar asociada con signos de isquemia retinal (puntos algodonosos y hemorragias intraretinales). Es clasificada en diferentes estadíos: inflamación, isquemia, neovascularización y complicaciones. En su diagnóstico es importante la biomicroscopia, la oftalmoscopia del segmento posterior y la prueba de angiografía fluoresceínica. Se presenta un paciente de 30 años con buena historia de salud anterior. El paciente comenzó con enrojecimiento del ojo izquierdo y la observación de flotadores en ambos ojos. Fue examinado y los signos clínicos fueron descritos en el examen oftalmológico. El examen del fondo de ojo con lente de 90 dioptrias y el oftalmoscopio binocular indirecto fue realizado para un cuidadoso examen. La retinografía del fondo y las imágenes del test de angiografía y otros estudios complementarios indicados permitieron conocer que presentaba una vasculopatía obliterativa retinal ideopática (Enfermedad de Eales), y el diagnóstico diferencial fue discutido. El tratamiento indicado fue la fotocoagulación con láser y evaluar la indicación de los estudios bioquímicos del cultivo del vítreo, por antígenos de leucocito humano, factor de crecimiento endotelial vascular e interleukinas que han sido observados en este examen(AU)

Retinal vasculitis is an inflammatory disease that threatens vision and affects retinal vessels (capillaries, veins and arteries). It may occur as an isolated idiopathic condition and as a complication of infective or neoplastic disorders, in association with systemic inflammatory diseases. Typical clinical manifestations including perivascular sheathing or cuffing, vascular leakage and occlusion. It may be associated with signs of retinal ischemia (cotton-wool spots and intra-retinal hemorrhage). It is classified into different stages: lnflamation, ischemia, neovascularization and complications. In the diagnosis, biomicroscopy and ophtalmoscopic of the posterior segment and fluorescein angiography test are important. A case report is presented of a 30-year-old male patient with a history of good health. In October 2015 the patient had started out with reddening of his left eye and the viewing of floaters with both eyes. Funduscopy was performed with a 90-dioptric lens and a binocular indirect ophthalmoscope. Fundus retinography, angiographic imaging and other complementary studies revealed an idiopathic obliterative retinal vasculopathy (Eales disease). The treatment indicated was photocoagulation, as well as a recommendation to evaluate the biochemical studies of the vitreous culture, since the test had found human leukocyte antigens, vascular endothelial growth factor and interleukins(AU)

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RESUMEN

La vasculitis retinal es una enfermedad inflamatoria que amenaza la visión y afecta los vasos retinales (capilares, venas y arterias). Puede ocurrir como una condición idiopática o como complicación de enfermedades infecciosas y neoplásicas o en asociación con enfermedades sistémicas inflamatorias. Sus manifestaciones clínicas típicas incluyen revestimiento perivascular, envainamiento, filltración vascular y oclusión. Puede estar asociada con signos de isquemia retinal (puntos algodonosos y hemorragias intraretinales). Es clasificada en diferentes estadíos: inflamación, isquemia, neovascularización y complicaciones. En su diagnóstico es importante la biomicroscopia, la oftalmoscopia del segmento posterior y la prueba de angiografía fluoresceínica. Se presenta un paciente de 30 años con buena historia de salud anterior. El paciente comenzó con enrojecimiento del ojo izquierdo y la observación de flotadores en ambos ojos. Fue examinado y los signos clínicos fueron descritos en el examen oftalmológico. El examen del fondo de ojo con lente de 90 dioptrias y el oftalmoscopio binocular indirecto fue realizado para un cuidadoso examen. La retinografía del fondo y las imágenes del test de angiografía y otros estudios complementarios indicados permitieron conocer que presentaba una vasculopatía obliterativa retinal ideopática (Enfermedad de Eales), y el diagnóstico diferencial fue discutido. El tratamiento indicado fue la fotocoagulación con láser y evaluar la indicación de los estudios bioquímicos del cultivo del vítreo, por antígenos de leucocito humano, factor de crecimiento endotelial vascular e interleukinas que han sido observados en este examen(AU)

Retinal vasculitis is an inflammatory disease that threatens vision and affects retinal vessels (capillaries, veins and arteries). It may occur as an isolated idiopathic condition and as a complication of infective or neoplastic disorders, in association with systemic inflammatory diseases. Typical clinical manifestations including perivascular sheathing or cuffing, vascular leakage and occlusion. It may be associated with signs of retinal ischemia (cotton-wool spots and intra-retinal hemorrhage). It is classified into different stages: lnflamation, ischemia, neovascularization and complications. In the diagnosis, biomicroscopy and ophtalmoscopic of the posterior segment and fluorescein angiography test are important. A case report is presented of a 30-year-old male patient with a history of good health. In October 2015 the patient had started out with reddening of his left eye and the viewing of floaters with both eyes. Funduscopy was performed with a 90-dioptric lens and a binocular indirect ophthalmoscope. Fundus retinography, angiographic imaging and other complementary studies revealed an idiopathic obliterative retinal vasculopathy (Eales disease). The treatment indicated was photocoagulation, as well as a recommendation to evaluate the biochemical studies of the vitreous culture, since the test had found human leukocyte antigens, vascular endothelial growth factor and interleukins(AU)

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OBJECTIVE: Safety, feasibility and early myocardial angiogenic effects evaluation of transthoracic intramyocardial phVEGF165 administration for refractory angina in no option patients. METHODS: Cohort study, in which 13 patients with refractory angina under optimized clinical treatment where included, after cineangiograms had been evaluated and found unfeasible by surgeon and interventional cardiologist. Intramyocardial injections of 5 mL solution containing plasmidial VEGF165 where done over the ischemic area of myocardium identified by previous SPECT/Sestamibi scan. Evaluations included a SPECT scan, stress test, Minnesota QOL questionnaire and NYHA functional class and CCS angina class determinations. RESULTS: There were no deaths or new interventions during the study period. There were no significant variations in SPECT scans, QOL scores and stress tests results during medical treatment in the included patients. After the 3rd post operative month, there was improvement in SPECT segmental scores, SSS (18.38 ± 7.51 vs. 15.31 ± 7.29, P = 0.003) and SRS (11.92 ± 7.49 vs. 8.53 ± 6.68, P = 0.002). The ischemic area extension, however, had non-significant variation (23.38 ± 13.12% vs. 20.08 ± 13.88%, P = 0.1). Stress tests METs varied from 7.66 ± 4.47 pre to 10.29 ± 4.36 METs post-op (P = 0.08). QOL score improved from 48.23 ± 18.35 pre to 30.15 ± 20.13 post-op points (P = 0.02). NYHA class was 3.15 ± 0.38 pre vs. 1.77 ± 0.83 post-op (P = 0.001) and angina CCS class, 3.08 ± 0.64 vs. 1.77 ± 0.83 (P = 0.001). CONCLUSIONS: Intramyocardial VEGF165 therapy for refractory angina, in this small trial of no option patients, resulted feasible and safe. Early clinical and scintilographic data showed improvements in symptoms and myocardial perfusion, with regression of ischemia severity in treated areas.

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OBJETIVO: Avaliar a segurança, viabilidade e efeitos iniciais, clínicos e sobre a perfusão miocárdica, da administração intramiocárdica, transtorácica, de VEGF 165 plasmidial em pacientes com doença arterial coronariana avançada e angina refratária, não passíveis de revascularização percutânea e cirúrgica. MÉTODOS: Ensaio clínico fase I/II. Treze pacientes cardiopatas isquêmicos com angina refratária apesar de tratamento medicamentoso máximo por no mínimo seis meses, não passíveis de revascularização cirúrgica ou por cateter foram submetidos a injeções intramiocárdicas de 2000µg VEGF 165 plasmidial. Os pacientes foram avaliados por cintilografia miocárdica, teste ergométrico, questionário de qualidade de vida (Minnesota) e determinação das classes de insuficiência cardíaca (NYHA) e angina (CCS). RESULTADOS: Não houve óbitos ou reintervenções. Durante o período de tratamento medicamentoso máximo, não se observou diferenças em cintilografias miocárdicas, testes ergométricos e questionários de qualidade de vida, ainda, houve tendência a piora das classes NYHA (P=0,05) e CCS (P=0,05). Três meses após intervenção, observou-se melhora dos escores cintilográficos SSS (18,38±7,51 vs. 15,31±7,29, P=0,003) e SRS (11,92±7,49 vs. 8,53±6,68, P=0,002), porém não na proporção da extensão da área de miocárdio isquêmico (23,38±13,12 por cento vs. 20,08±13,88 por cento, P=0,1). Houve tendência a melhora dos METs nas ergometrias (7,66±4,47 vs. 10,29±4,36, P=0,08), melhora do escore de qualidade de vida (48,23±18,35 vs. 30,15±20,13; P=0,02) e das classes NYHA (3,15±0,38 vs. 1,77±0,83, P=0,001) e CCS (3,08±0,64 vs. 1,77±0,83, P=0,001), no mesmo período. CONCLUSÕES: A terapia demonstrou-se segura e viável nesta série de pacientes. Os resultados iniciais tendem a demonstrar melhora na gravidade da angina e redução da intensidade da isquemia miocárdica.

OBJECTIVE: Safety, feasibility and early myocardial angiogenic effects evaluation of transthoracic intramyocardial phVEGF165 administration for refractory angina in no option patients. METHODS: Cohort study, in which 13 patients with refractory angina under optimized clinical treatment where included, after cineangiograms had been evaluated and found unfeasible by surgeon and interventional cardiologist. Intramyocardial injections of 5mL solution containing plasmidial VEGF165 where done over the ischemic area of myocardium identified by previous SPECT/Sestamibi scan. Evaluations included a SPECT scan, stress test, Minnesotta QOL questionnaire and NYHA functional class and CCS angina class determinations. RESULTS: There were no deaths or new interventions during the study period. There were no significant variations in SPECT scans, QOL scores and stress tests results during medical treatment in the included patients. After the 3rd post operative month, there was improvement in SPECT segmental scores, SSS (18.38±7.51 vs. 15.31±7.29, P=0.003) and SRS (11.92±7.49 vs. 8.53±6.68, P=0.002). The ischemic area extension, however, had non-significant variation (23.38±13.12 percent vs. 20.08±13.88 percent, P=0.1). Stress tests METs varied from 7.66±4.47 pre to 10.29±4.36 METs post-op (P=0.08). QOL score improved from 48.23±18.35 pre to 30.15±20.13 post-op points (P=0.02). NYHA class was 3.15±0.38 pre vs. 1.77±0.83 post-op (P=0.001) and angina CCS class, 3.08±0.64 vs. 1.77±0.83 (P=0.001). CONCLUSIONS: Intramyocardial VEGF165 therapy for refractory angina, in this small trial of no option patients, resulted feasible and safe. Early clinical and scintilographic data showed improvements in symptoms and myocardial perfusion, with regression of ischemia severity in treated areas.

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