RESUMO
AIMS: We aimed to investigate a novel optical coherence tomography (OCT) finding of outer retinal hyperreflective deposits (ORYDs) in patients with naïve diabetic macular oedema (DMO) seen after small gauge pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling. Furthermore, we evaluated the predictive value of ORYD for visual outcome over 24 months follow-up. METHODS: Retrospective cohort study including 111 eyes from 111 patients with naïve DMO treated by PPV and ILM peeling with a follow-up of 24 months. OCT scans were analysed for the presence of ORYD 1 week and 1, 6, 12, 18 and 24 months after surgery. Change in baseline best-corrected visual acuity (BCVA) and central subfoveal thickness (CST) after surgery were measured over the follow-up period. Presence of ORYD was correlated with baseline characteristics and BCVA after 24 months. RESULTS: Hundred and eleven eyes from 111 patients were included (mean age 67.5±14.8 years). ORYD was identified in the outer plexiform layer as hyperreflective deposits in 92 patients (82.8%) 7 days after surgery but it was not present before surgery. There was a significant reduction in the presence of ORYD. After 24 months ORYD disappeared in all cases (p<0.001). CONCLUSIONS: We describe a novel OCT feature of ORYD present in the early postoperative phase in the majority of patients after PPV with ILM peeling for naïve DMO, disappearing over the postoperative course. These deposits might be a result of sudden desinflammation and could shed new light on the process of DMO resolution after operative intervention.
Assuntos
Membrana Basal/cirurgia , Retinopatia Diabética/complicações , Edema Macular/diagnóstico , Segmento Externo das Células Fotorreceptoras da Retina/patologia , Tomografia de Coerência Óptica/métodos , Acuidade Visual , Vitrectomia/métodos , Adulto , Idoso , Retinopatia Diabética/diagnóstico , Retinopatia Diabética/cirurgia , Feminino , Seguimentos , Humanos , Edema Macular/etiologia , Edema Macular/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
PURPOSE: To evaluate the physiological and behavioral pain response in premature infants receiving intravitreal bevacizumab injection (IVB) for retinopathy of prematurity (ROP) under topical anesthesia. METHODS: A prospective interventional non-comparative case series. Premature infants with high-risk prethreshold or threshold ROP received IVB using topical anesthesia with tetracaine eye drops. A Premature Infant Pain Profile was used to assess the pain response during the procedure. RESULTS: Nine premature infants requiring bilateral IVB therapy were included in the study. Mean gestational age was 28.7 ± 1.3 weeks, and birth weight was 1,200 ± 194 grams. The mean total pain score was found to be 8.7 ± 2.4 (range 5-14), indicating generally mild pain during the procedure. Eye squeeze was the most prominent indicator of pain. Most changes occurred at the beginning, with the insertion of the lid speculum and were hardly noted during the rest of the procedure including the injection itself. CONCLUSION: Topical anesthesia with tetracaine is an effective method for the relief of pain associated with intravitreal injections in premature infants with ROP.
Assuntos
Inibidores da Angiogênese/uso terapêutico , Anticorpos Monoclonais Humanizados/uso terapêutico , Dor Ocular/diagnóstico , Recém-Nascido Prematuro , Retinopatia da Prematuridade/tratamento farmacológico , Anestesia Local , Anestésicos Locais/administração & dosagem , Inibidores da Angiogênese/administração & dosagem , Anticorpos Monoclonais Humanizados/administração & dosagem , Bevacizumab , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Recém-Nascido de muito Baixo Peso , Injeções Intravítreas , Masculino , Medição da Dor , Estudos Prospectivos , Neovascularização Retiniana/tratamento farmacológico , Tetracaína/administração & dosagem , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidoresRESUMO
PURPOSE: To evaluate ocular outcome in premature infants treated with intravitreal ranibizumab injections for retinopathy of prematurity (ROP) over a period of 3 years. METHODS: An interventional case series. Premature infants with high-risk prethreshold or threshold ROP with plus disease received an off label monotherapy with intravitreal injections of ranibizumab. The primary outcome was treatment success defined as regression of neovascularisation (NV) and absence of recurrence. The secondary outcomes were ocular and systemic adverse events and visual acuity. RESULTS: Six eyes were included in the study and treated with intravitreal injections of ranibizumab. All showed complete resolution of NV after a single injection. The anti-angiogenic intravitreal injections allowed for continued normal vessel growth into the peripheral retina, without any signs of disease recurrence or progression during the follow up period. No ocular or systemic adverse effects were observed. CONCLUSIONS: Three years of follow up in a small series suggest that intravitreal ranibizumab injections for ROP result in apparently preserved ocular outcome. Further large scale studies are needed to address the long-term safety and efficacy.
Assuntos
Inibidores da Angiogênese/uso terapêutico , Anticorpos Monoclonais Humanizados/uso terapêutico , Neovascularização Retiniana/tratamento farmacológico , Retinopatia da Prematuridade/tratamento farmacológico , Inibidores da Angiogênese/efeitos adversos , Anticorpos Monoclonais Humanizados/efeitos adversos , Peso ao Nascer , Feminino , Angiofluoresceinografia , Seguimentos , Idade Gestacional , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Injeções Intravítreas , Masculino , Ranibizumab , Neovascularização Retiniana/fisiopatologia , Retinopatia da Prematuridade/fisiopatologia , Resultado do Tratamento , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Acuidade Visual/fisiologiaRESUMO
PURPOSE: To evaluate ocular function and systemic development in premature infants treated with intravitreal bevacizumab injections for retinopathy of prematurity over a period of 5 years. METHODS: A prospective, interventional, noncomparative case study. The primary outcome measure was visual acuity. The secondary outcomes were structural assessment, other ocular functional measurements, and developmental state. RESULTS: Eighteen eyes of 13 consecutive patients were divided into 3 groups: Group 1, Stage 4 unresponsive to previous conventional treatment (n = 4); Group 2, in which conventional treatment was difficult or impossible because of inadequate visualization of the retina (n = 5); and Group 3, newly diagnosed high-risk prethreshold or threshold retinopathy of prematurity (n = 9). All patients showed initial regression of neovascularization. One patient was diagnosed with recurrence of neovascularization and was treated with intravitreal bevacizumab. Visual acuity was preserved, and median vision was 20/25 (excluding 2 operated eyes). Twelve eyes developed mainly low myopia over the years, with an overall mean value of 3.2 diopters. Electroretinograph was normal in 4 eyes that had no previous detachment. One patient showed delay in growth and neurodevelopment, whereas all the others were within the normal range. CONCLUSION: Five years of follow-up in a small series suggest that intravitreal bevacizumab for retinopathy of prematurity results in apparently preserved ocular function and systemic development.