RESUMO

INTRODUCTION: Diabetic retinopathy is a major cause of visual loss worldwide. The most important clinical findings include diabetic macular edema (DME) and proliferative diabetic retinopathy (PDR). AREAS COVERED: PubMed was used for our literature review. Articles from 1995 to 2023 were included. Pharmacologic treatment of diabetic retinopathy generally involves the use of intravitreal anti-vascular endothelial growth factor (VEGF) therapy for DME and PDR. Corticosteroids remain important second-line therapies for patients with DME. Most emerging therapies focus on newly identified inflammatory mediators and biochemical signaling pathways involved in disease pathogenesis. EXPERT OPINION: Emerging anti-VEGF modalities, integrin antagonists, and anti-inflammatory agents have the potential to improve outcomes with reduced treatment burdens.

Assuntos

RESUMO

To describe a case of transient bilateral vitreomacular traction syndrome associated with topical 1% pilocarpine ophthalmic solution in both eyes as a treatment for advanced glaucoma. Observations: Spectral-domain OCT demonstrated bilateral vitreomacular traction syndrome after initiation of topical 1% pilocarpine solution in both eyes for advanced glaucoma. Follow-up imaging revealed the resolution of vitreomacular traction after cessation of the drug without a complete posterior vitreous detachment. Conclusions and Importance: In the advent of new pilocarpine formulations, this case raises the concern of vitreomacular traction syndrome as a serious potential sequela of long-term topical pilocarpine use.

RESUMO

OBJECTIVE: To describe the systemic disease associations and clinical features upon initial presentation of a cohort of patients with type 2 macular telangiectasia who live in Puerto Rico. METHODS: A retrospective review of patients with macular telangiectasia was performed in 4 private retina practices in Puerto Rico. The demographic and clinical characteristics were recorded. RESULTS: Twenty-one patients who were diagnosed with macular telangiectasia were included in the analysis. The median age of presentation was 62 years; 86% were female, and all patients were Hispanics. The median visual acuity at presentation was 20/50. A prior medical diagnosis of type II diabetes mellitus was found in 15 (71.4%) patients, essential hypertension in 12 (57.1%), and dyslipidemia in 9 (42.9%). All patients had bilateral disease. The most common ocular findings were the presence of right-angle vessels in 32 (76.2%) eyes and angiographic hyperfluorescence temporal to the fovea, found in 22 (52.4%) of the affected eyes. One eye had evidence of choroidal neovascularization. CONCLUSION: Our cohort showed a higher prevalence of type 2 diabetes in patients with type 2 macular telangiectasia than in other cohorts. It also supports the findings of other studies showing that macular telangiectasia patients are more likely to have type 2 diabetes and hyperlipidemia. However, the increased prevalence of diabetes and hyperlipidemia may be due to selection bias, and further studies are needed to assess the significance of these findings.

Assuntos

RESUMO

Optical coherence tomography angiography (OCT-A) is a modern non invasive imaging technique that may aid in the evaluation of retinal diseases through the assessment of chorioretinal vasculature. The literature regarding OCT-A in sclerochoroidal calcification is scarce. We present the case of a 57-year-old female who was referred to the clinic due to an atypical choroidal lesion in the right eye. OCT-A showed an apparent decrease in the vascular flow of the choroidal/choriocapillaris layers and an apparent increase in the vascular flow of the deep retinal layers. A mass effect may be seen in OCT-A en face imaging that may create artifactual vascular flow pattern. This case reports the first OCT-A findings of sclerochoroidal calcification.

Assuntos

RESUMO

Foveal hypoplasia is the absence of a foveal depression and the presence of the ganglion cell layer in the foveola. A spectrum of clinical characteristics, including normal or variably decreased visual acuity, has been described in patients with blunted foveal contours. Multiple systemic and ophthalmologic conditions including albinism, aniridia, nanophthalmos, prematurity, and fovea plana have been associated with this anomaly. This article illustrates select clinical conditions characterized by a blunted foveal contour. Given the heterogeneity of findings, a thorough medical history and detailed physical and ocular examinations are usually sufficient for the clinician to make the correct diagnosis.

RESUMO

PURPOSE: To report a case of acute macular neuroretinopathy (AMN) associated with dengue virus serotype 1 infection. OBSERVATION: An 18-year-old Puerto Rican female was evaluated due to painless paracentral scotomas in each eye that developed after being hospitalized for dengue fever a week before. Clinical examination and multimodal imaging revealed bilateral hypopigmented macular lesions, hyperreflectivity at the outer nuclear and photoreceptor layer, and reduced flow signal in the deep capillary plexus. Additionally, hypoautofluorescent parafoveal lesions were found in the left eye. AMN was diagnosed. Two-month follow-up after the initial evaluation showed resolution of symptoms but persistence of some findings on optical coherence tomography. CONCLUSIONS AND IMPORTANCE: Patients with dengue virus serotype 1 may develop paracentral scotomas with classic AMN findings and obtain complete symptomatic recovery without treatment.

RESUMO

Targeted antineoplastic agents and immunotherapies have revolutionized management strategies available for previously refractory cancer. Despite the growing list of pharmacologic agents and indications, many of the currently Food and Drug Administration-approved therapies are associated with ocular adverse effects. Retina specialists and oncologists should be aware of potential side effects because some may be severe and permanent. Although most ocular side effects require conservative treatment without discontinuation of life-preserving therapies, rare severe adverse reactions can be potentially blinding and may warrant an extensive discussion regarding different management strategies, including cessation of life-preserving therapy.

Assuntos

RESUMO

PURPOSE: To report a treatment approach for advanced extrascleral uveal melanoma. METHODS: We performed clinical examination including magnetic resonance imaging, computed tomography, angiography, and histopathologic analysis. CASE: A 49-year-old healthy woman presented with a 7-year history of an enlarging pigmented mass in her right orbit. Malignant melanoma was diagnosed after biopsy with immunohistochemical stains. Treatment included selective intra-arterial embolization. RESULTS: A significant reduction in tumor burden was seen 3 months after intra-arterial embolization. No complications were associated with the treatment. CONCLUSION: Selective intra-arterial embolization may allow adequate palliative therapy in select cases of advanced extrascleral uveal melanoma.

Assuntos

RESUMO

The purpose of this report is to document the use of bevacizumab as treatment of peripapillary subretinal neovascular membrane associated to idiopathic intracranial hypertension. This case reports a 31-year-old obese female with chronic papilledema due to idiopathic intracranial hypertension that developed an acute submacular hemorrhage due to a choroidal neovascular membrane in her left eye. Two separate intravitreal injections of bevacizumab (1.25 mg/0.5 ml) were administered with six weeks apart. Fourteen weeks after the initial injection her visual acuity improved to 20/40 in her left eye with associated angiographic resolution of the hemorrhage. Bevacizumab appears to be an effective option for patients who have subretinal neovascular membranes due to papilledema. Although choroidal neovascularization may have different pathogenic mechanisms, our case report demonstrates encouraging results without adverse ocular or systemic side effects.

Assuntos

RESUMO

A 24-year-old female presenting with influenza A pneumonia and simultaneous visual loss was hospitalized. A complete ophthalmological examination was performed three weeks later. Best corrected visual acuity was 20/70 (right eye) and 20/30 (left eye). A dilated fundus exam revealed bilateral vitreous cells and marked bilateral optic nerve swelling with associated peripapillary hemorrhages. A submacular hemorrhage was seen in the right eye. Spinal tap opening pressure was 490 mmHg, with normal cerebrospinal fluid cell counts. Eight months after the initial clinical presentation, the patient was asymptomatic, with normal posterior poles and a best corrected visual acuity of 20/30 in the right eye and 20/25 in the left eye. Although papilledema can produce peripheral retinal hemorrhages secondary to extensive retinal venous congestion, the presence of bilateral vitritis and elevated influenza serum titers suggested that the patient might be suffering from influenza retinopathy. Vitreous polymerase chain reaction could potentially aid in the diagnosis of influenza retinopathy.

Assuntos

RESUMO

OBJECTIVE: To analyze positive vitreous cultures and their respective antibiotic sensitivities in patients with endophthalmitis in Puerto Rico. METHODS: We conducted a retrospective cohort study of vitreous cultures from all of the patients with a clinical diagnosis of endophthalmitis at the Puerto Rico Medical Service Administration Center in San Juan, Puerto Rico, from August 2009 to July 2010. Positive isolates were selected for analysis. A retrospective chart review was performed to establish the mechanism involved in the development of endophthalmitis. RESULTS: Forty-three patients underwent vitreous cultures for a diagnosis of endophthalmitis, of which 16 patients had positive cultures. Seventy-eight percent of the isolates were bacterial and 22% fungal. Staphylococcus genus was identified in 38% of patients. All of the Staphylococcus epidermidis and Streptococcus pneumonia isolates were resistant to oxacillin; 66% of the Staphylococcus aureus isolates were also resistant to oxacillin. All of the Gram-positive isolates in our study were sensitive to vancomycin. All of the gram-negative isolates were sensitive to ceftazidime. Twenty-nine percent of the post-traumatic endophthalmitis cases were fungal in origin. CONCLUSION: The majority of endophthalmitis cases in our study were bacterial in origin, and the Staphylococcus genus was the most common type of organism identified. In our cohort, post-traumatic endophthalmitis was the most common mechanism leading to infection. Vancomycin in combination with ceftazidime appears to be adequate for the empiric treatment of all cases of bacterial endophthalmitis in our population. Anti-fungal agents should be considered as adjuvant empiric treatment in patients with post-traumatic endophthalmitis.

Assuntos

RESUMO

OBJECTIVE: To evaluate the effect of strabismus surgery on nystagmus and visual acuity in patients with oculocutaneous albinism. METHODS: We conducted a non-concurrent retrospective study of 13 Puerto Rican patients with all types of oculocutaneous albinism who underwent strabismus surgery. Patients underwent genetic linkage analysis to reach a final oculocutaneous albinism classification prior to surgery. Strabismus surgery was modified by under-correction of 0.5 mm in each muscle from the standard Marshall Parks' measurements in all patients. RESULTS: Six of the 13 patients with oculocutaneous reported an improved best corrected visual acuity after surgery. Two of the 13 patients with oculocutaneous had no nystagmus following strabismus surgery. All patients were orthotropic following surgery. CONCLUSION: Strabismus surgical undercorrection may be of benefit in patients with oculocutaneous albinism.

Assuntos

RESUMO

PURPOSE: To report a patient with glaucoma who developed recurrent herpetic keratitis while using two different prostaglandin analogue ophthalmic solutions. RESULTS: A 72 year-old male patient with primary open angle glaucoma and a history of herpetic keratitis in the left eye experienced recurrent herpetic keratitis in the left eye after treatment with latanoprost ophthalmic solution. Herpetic flares were controlled after discontinuation of latanoprost. Adding travoprost ophthalmic solution 0.004% to his glaucoma therapy was also associated with a recurrence of herpetic keratitis. CONCLUSION: To our knowledge, this is the first case in which travoprost has been associated to recurrent herpetic keratitis. Further, this is the first report in which a patient has a recurrence of herpetic keratitis associated to two different prostaglandin analogues. These findings suggest that patients with recurrent herpetic keratitis associated to a prostaglandin analogue might be predisposed to a flare-up with other prostaglandin analogues.

Assuntos

RESUMO

PURPOSES: The primary objective of this study was to determine if intraoperative application of mitomycin C (MMC) is safe as an adjunct for pterygium surgery. The secondary objectives of the study were to determine if MMC reduces pterygium recurrence rate and to evaluate the effect of MMC on intraocular pressure. METHODS: We conducted a nonconcurrent prospective study of 68 patients with primary or recurrent pterygium. Patients underwent a comprehensive eye examination preoperatively and postoperatively to evaluate for possible complications associated with the use of MMC. The recurrence rate of pterygia was also included in the data. RESULTS: We examined a total of 68 patients (68 eyes). The follow-up time ranged from 12 to 98 months (mean = 27.7 +/- 28.8 months). Only 2 postoperative complications were reported: a scleral dellen and a conjunctival cyst. Eight patients (12.0%) with primary pterygium had a recurrence of pterygia after surgery. However, no recurrences occurred in patients with previous recurrent pterygia. CONCLUSIONS: Findings in our study suggest that MMC is efficacious in preventing recurrences and a safe adjunct therapy during pterygium surgery. Findings in our study suggest that intraoperative MMC application leads to few complications while providing a significant reduction in the recurrence rate.

Assuntos

RESUMO

OBJECTIVE: To compare the variations in central corneal thickness and intraocular pressure measurements according to race, gender, and age. METHODS: A non-concurrent prospective study of 372 (744 eyes) glaucoma patients was conducted. Central corneal thickness was measured with ultrasound pachymeter and intraocular pressure with Goldmann tonometer. The relationship between CCT, race, gender, and age was evaluated using both descriptive and statistical analysis. RESULTS: The population age was 64 +/- 19.52 years. The mean central corneal thickness was 546 +/- 43.84 microm. The mean corrected intraocular pressure was 17 +/- 5.26 mm Hg. Central corneal thickness of male patients (549 +/- 43.43 pm) was thicker than that of female patients (546 +/- 41.83 microm). The mean corrected intraocular pressure in male patients (16 +/- 5.41 mm Hg) was less than that of female patients (17 +/- 5.18 mm Hg). The mean central corneal thickness in patients 0 to 9 years-of-age was 548 +/- 36.08 microm; 10 to 19 years-of-age was 606 +/- 82.30 microm; 20 to 29 years-of-age was 564 +/- 29.23 microm; 30 to 39 years-of-age was 579 +/- 15.32 microm; 40 to 49 years-of-age was 546 +/- 48.29 microm; 50 to 59 years-of-age was 550 +/- 38.12 mirom; 60 to 69 years-of-age was 545 +/- 40.22 microm; 70 to 79 years-of-age was 541 +/- 34.71 microm; 80 to 89 years-of-age was 541 +/- 34.05 microm; older than 90 years-of-age was 527 +/- 46.90 microm. CONCLUSIONS: Central corneal thickness of glaucoma patients in Puerto Rico was similar to that of Hispanics in the continental United States. However, the intraocular pressure and corrected intraocular pressure of glaucoma patients in Puerto Rico were statistically higher than that of Hispanics with glaucoma in the continental United States. In our study population, central corneal thickness and intraocular pressure were not affected by gender or age.

Assuntos