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PURPOSE: The aim of this article is to do a comprehensive literature review about the current role of pars plana vitrectomy in uveitis and in its different structural complications such as cystoid macular edema, epiretinal membrane, macular hole, and retinal detachment. METHODS: This comprehensive literature review was performed based on a search on PubMed, BioMed Central, Science Open, and CORE databases, of relevant articles abording pars plana vitrectomy in uveitis. DISCUSSION: Uveitis is a complex disease with multiple etiologies and pathogenic mechanisms. Therapeutic pars plana vitrectomy (PPV) may aid in uveitic structural complications such as cystoid macular edema, epiretinal membranes, macular hole, and retinal detachments even though some cases may present unpredictable visual outcomes. Diagnostic PPV with appropriate ancillary testing is also a valuable tool for the assessment and diagnosis of uveitis in a large proportion of patients. CONCLUSION: Over the years, pars plana vitrectomy has undergone significant transformations since its invention nearly 5 decades ago, however, the quality of evidence in the literature regarding its use for uveitis has not improved in the same way. Even though some structural uveitis complications (as previously mentioned) may respond well to surgery, there is still a certain unpredictability regarding its visual outcomes. On the other hand, diagnostic vitrectomy with appropriate ancillary testing is also a valuable tool for the assessment and diagnosis of uveitis in a large proportion of patients.

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INTRODUCTION: We describe characteristic findings on multimodal evaluation and the features of hemorrhage within a foveal cystoid space in a patient presenting cystoid macular edema secondary to Branch Retinal Vein Occlusion (BRVO). CASE DESCRIPTION: We report a case of a 64-year-old diabetic male patient presenting gradual blurry vision in the left eye. Fundoscopic findings were suggestive of BRVO, such as hard exudates and mild venous engorgement superotemporally and diffuse macular intraretinal hemorrhages. In the foveal area, there was cystoid edema with blood-fluid level (BFL) inside one of the cystoid spaces. Retina multimodal evaluation, including color, blue filter, and red-free fundus photography, fluorescein angiography, fundus autofluorescence, and spectral-domain optical coherence tomography (SD-OCT) B and C scan imaging, confirmed blood within foveal cystoid space. The patient underwent antiangiogenic therapy with significant improvement of macular edema and reduction of the cystoid space after 3 months. In addition, there was a resolution of visual symptoms. The cystoid space previously partially filled with blood, persisted, despite presenting smaller volume and medium reflectivity in the SD-OCT. CONCLUSIONS: Multimodal evaluation of blood-fluid level within foveal cystoid space in patients with BRVO has not been described previously. Identification of this sign may support the diagnosis of retinal vein occlusion in doubtful cases and further studies must be carried out to establish if the presence of BFL correlates with visual outcomes.

Assuntos

Edema Macular , Oclusão da Veia Retiniana , Humanos , Masculino , Pessoa de Meia-Idade , Retina , Edema Macular/diagnóstico , Edema Macular/tratamento farmacológico , Edema Macular/etiologia , Oclusão da Veia Retiniana/complicações , Oclusão da Veia Retiniana/diagnóstico , Oclusão da Veia Retiniana/tratamento farmacológico , Tomografia de Coerência Óptica/métodos , Hemorragia Retiniana/diagnóstico , Hemorragia Retiniana/tratamento farmacológico , Hemorragia Retiniana/etiologia , Angiofluoresceinografia/métodos , Metilcelulose , Estudos Retrospectivos

RESUMO

Purpose: The main purpose of this study was to report a case of cystoid macular edema (CME) after gonioscopy-assisted transluminal trabeculotomy (GATT). Methods: We describe the case of a 73-year-old woman with ocular hypertension and history of cataract surgery combined with posterior vitrectomy and epiretinal membrane peeling 2 years before, who developed CME after uncomplicated GATT procedure. Results: Uneventful GATT surgery was performed in an eye with ocular hypertension. A month after GATT surgery, the patient com-plained of blurry vision. Best corrected visual acuity had deteriorated from 20/20 on Snellen chart, to 20/70. The patient was diagnosed with CME. Treatment with topical non-steroidal anti-inflammatory drug (NSAID) and topical corticosteroids for one month, and oral carbonic anhydrase inhibitor for one week achieved a total CME regression with recovery of a normal macular and foveal architecture. Conclusions: Surgery-induced CME may occur following stand-alone microinvasive glaucoma surgery (MIGS) such as GATT. It would be worthwhile to conduct studies to explore whether the prophylactic use of NSAID and corticosteroids is justified.

Assuntos

Glaucoma de Ângulo Aberto , Edema Macular , Hipertensão Ocular , Trabeculectomia , Corticosteroides/efeitos adversos , Idoso , Anti-Inflamatórios não Esteroides , Feminino , Seguimentos , Glaucoma de Ângulo Aberto/complicações , Glaucoma de Ângulo Aberto/diagnóstico , Glaucoma de Ângulo Aberto/cirurgia , Gonioscopia , Humanos , Pressão Intraocular , Edema Macular/etiologia , Estudos Retrospectivos , Trabeculectomia/efeitos adversos , Trabeculectomia/métodos

RESUMO

PURPOSE: To evaluate the occurrence of transient central retinal artery occlusion following intravitreal anti-vascular endothelial growth factor injection. METHODS: Prospective, observational study of 807 patients (807 eyes) who were given intravitreal injections of ranibizumab or aflibercept to treat any cause of retinal vascular diseases between 1 January 2017 and 30 November 2018 at the Federal Fluminense University Hospital in Niteroi, and a private facility in Rio de Janeiro, Brazil. Patients who did not present transient central retinal artery occlusion were excluded. RESULTS: Among 4069 injections, only 18 patients (0.44%) presented transient central retinal artery occlusion, 14 mild cases (77.7%), and 4 severe cases (22.3%). The clinical factors associated with more severe cases of transient central retinal artery occlusion were the duration of the transient central retinal artery occlusion (p = 0.001), number of prior injections (p = 0.01), and a positive carotid Doppler test (p = 0.01). Twelve cases (66.6%) had positive carotid artery obstruction (atheroma plaque size ≥70%) while 6 cases (33.3%) had negative carotid artery obstruction (atheroma plaque size <70%). The age group >60 years old (p = 0.06), cup/disc ratio >0.6 (p = 0.06), and pseudophakic lens status were also factors with association with transient central retinal artery occlusion, although did not meet criteria for statistical significance. The only patient who experienced a recurrent episode of transient central retinal artery occlusion had diabetic macular edema, positive carotid Doppler test, and cup/optic disc ratio >0.6. CONCLUSION: Transient central retinal artery occlusion is a rare adverse event that can appear in patients with retinal vascular disease receiving anti-vascular endothelial growth factor therapy. The atheroma plaque size and the number of prior injections can be associated with the severity of the event.

Assuntos

Retinopatia Diabética , Edema Macular , Placa Aterosclerótica , Oclusão da Artéria Retiniana , Oclusão da Veia Retiniana , Inibidores da Angiogênese/efeitos adversos , Artérias , Bevacizumab/uso terapêutico , Brasil , Retinopatia Diabética/tratamento farmacológico , Fatores de Crescimento Endotelial/uso terapêutico , Humanos , Injeções Intravítreas , Edema Macular/tratamento farmacológico , Pessoa de Meia-Idade , Placa Aterosclerótica/induzido quimicamente , Placa Aterosclerótica/complicações , Placa Aterosclerótica/tratamento farmacológico , Estudos Prospectivos , Ranibizumab/efeitos adversos , Receptores de Fatores de Crescimento do Endotélio Vascular/uso terapêutico , Proteínas Recombinantes de Fusão/efeitos adversos , Retina , Oclusão da Artéria Retiniana/induzido quimicamente , Oclusão da Artéria Retiniana/complicações , Oclusão da Artéria Retiniana/diagnóstico , Oclusão da Veia Retiniana/diagnóstico , Oclusão da Veia Retiniana/tratamento farmacológico , Fator A de Crescimento do Endotélio Vascular , Acuidade Visual

RESUMO

BACKGROUND: To analyze the relationship between the central foveal thickness (CFT) and the integrity of the ellipsoid portion of inner segments (EPIS) and interdigitating zone (IZ) retinal layers in the visual outcome of uveitic macular edema (UME). METHODS: Prospective, observational, and cross-sectional study of eyes with UME. Spectral-domain optical coherence tomography (SD-OCT) macular morphological pattern, CFT, and integrity of the outer retinal layers were analyzed. We arranged the data by EPIS or IZ integrity and contrasted it with student t-test (quantitative variables) and Fisher exact test or χ² distribution (categorical variables) to evaluate visual impairment and retinal measures. Receiver operator curve (ROC) estimation and logistic regression (probit) assessed if the sample´s variance could be associated with IZ or EPIS integrity. RESULTS: We included 145 SD-OCT macular scans from 45 patients at different stages of UME. Cystoid macular edema (CME) increased the risk of severe (P ≤ 0.0162) and moderate visual loss (P ≤ 0.0032). The highest CFT values occurred in patients with moderate (478.11 ± 167.62 µm) and severe (449.4 ± 224.86 µm) visual loss. Of all morphological patterns of macular edema, only CME showed a statistically significant relationship with severe visual impairment (44.92%, p = 0.0035, OR 4.29 [1.62-11.4]). Likewise, an increased probability of severe visual loss correlated negatively with both, IZ (37.93%, P ≤ 0.001, OR 10.02) and EPIS (38.98%, P ≤ 0.001, OR 13.1) disruption. A CFT > 337 µm showed a higher probability of IZ (AUROC = 0.7341, SEN 77.59%, ESP 65.52) and EPIS (AUROC = 0.7489, SEN 76.37%, ESP 65.12%) loss of integrity. Moreover, when BCVA reached 0.44 LogMAR (≤ 20/50 Snellen eq.), it was more likely to have IZ (AUROC = 0.8706, ESP 88.51%, SEN 77.59%) and EPIS (AUROC = 0.8898, ESP 88.3%, SEN 76.27) disruption. CONCLUSIONS: Significantly increased CFT has a higher probability for EPIS and IZ disruption, which significantly increases the risk for irreversible visual loss in eyes with UME. Evaluating these layers' integrity by optical coherence tomography helps predict the visual outcome and make the right therapeutic decisions. Trial registration The study was registered on April 13, 2020, at the Instituto Tecnologico y de Estudios Superiores de Monterrey Research Committee (License No. COFEPRIS 20 CI 19 039 002), project registration No. P000338-CAVICaREMU-CI-CR002, and the Ethics Committee (License No. CONBIOETICA 19 CEI 011-2016-10-17), project registration No. P000338-CAVICaREMU-CEIC-CR002.

RESUMO

ABSTRACT This report aims to describe the effectiveness of a unilateral intravitreal dexamethasone implant (Ozurdex®) used for the treatment of cystoid macular edema in a patient with recurrent intermediate uveitis. Bearing in mind the adverse effects of the prolonged use of systemic corticosteroids, the objective here was to provide a less damaging form of intervention, and also to demonstrate the safety of the dexamethasone implant for patients who fail to respond to conventional treatment. In the present case, there was bilateral improvement in retinal anatomy and function with use of the unilateral intravitreal dexamethasone implant (Ozurdex®).

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RESUMO Neste estudo, o objetivo foi descrever, a partir de um relato de caso, a eficácia do uso de implante de dexametasona intravítrea (Ozurdex®) unilateral, para o tratamento de edema macular cistoide, em um paciente com quadro de uveíte intermediária recorrente, visando uma terapêutica menos lesiva, diante dos efeitos colaterais do uso prolongado de corticoesteroides sistêmicos, demonstrando também a segurança desse tratamento alternativo para aqueles pacientes que se apresentam refratários a terapêutica tradicional. No caso relatado, vale ressaltar a melhora bilateral da anatomia e função retiniana com o implante unilateral de dexametasona intravítrea (Ozurdex®).

Assuntos

Humanos , Feminino , Pessoa de Meia-Idade , Dexametasona/administração & dosagem , Uveíte Intermediária/complicações , Edema Macular/etiologia , Edema Macular/tratamento farmacológico , Acuidade Visual , Uveíte Intermediária/diagnóstico , Edema Macular/diagnóstico , Tomografia de Coerência Óptica , Implantes de Medicamento/administração & dosagem , Injeções Intravítreas

RESUMO

Objetivo: Evaluar la efectividad del tratamiento combinado con dorzolamida tópica en pacientes con edema quístico macular poscirugía de catarata. Métodos: Se realizó un estudio experimental en pacientes atendidos en el Servicio de Vítreo-Retina del Instituto Cubano de Oftalmología "Ramón Pando Ferrer", en el año 2018. Se definió el grupo de casos (dorzolamida y tratamiento convencional) y el grupo control (tratamiento convencional), los cuales se evaluaron en la consulta inicial y al mes de tratamiento. Resultados: La edad media fue de 60,73 ± 11,25 años. Predominó el sexo femenino (53,33 por ciento), el ojo afectado derecho (60,00 por ciento), el tiempo posquirúrgico ≤ 3 meses (63,33 por ciento), sin factores de riesgo asociados (56,67 por ciento). El edema sin alteraciones asociadas fue más frecuente (80,00 por ciento). La media del grosor macular disminuyó en ambos grupos (de 529,27 ± 183,58 a 349,93 ± 221,35 en los casos y de 498,87 ± 213,26 a 373,53 ± 215,51 en los controles). Resultó mayor la variación en el grupo de casos (179,33 p= 0,008). La agudeza visual aumentó en ambos grupos. Se observó un porcentaje mayor de ojos que mejoraron la visión en el grupo de casos (52,38 por ciento). La mejoría de la agudeza visual se relacionó con la recuperación del grosor macular. Conclusiones: En los casos con edema quístico macular poscirugía de catarata, en los que está indicado el tratamiento tópico con antinflamatorios, la combinación con dorzolamida resulta efectiva para la reducción del grosor macular y la mejoría de la agudeza visual corregida(AU)

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ABSTRACT Objective: Evaluate the effectiveness of a treatment combined with topical dorzolamide in patients with cystoid macular edema after cataract surgery. Methods: An experimental study was conducted of patients attending the Vitreous-Retina Service at Ramón Pando Ferrer Cuban Institute of Ophthalmology in the year 2018. The sample was divided into a case group (dorzolamide and conventional treatment) and a control group (conventional treatment), and evaluated at the initial consultation and after one month of treatment. Results: Mean age was 60.73 ± 11.25 years. A predominance was found of the female sex (53.33 percent), affected right eye (60.00 percent), postsurgical time ≤ 3 months (63.33 percent), and no associated risk factors (56.67 percent). Edema without associated alterations was more common (80.00 percent). Mean macular thickness decreased in both groups (from 529.27 ± 183.58 to 349.93 ± 221.35 in cases and from 498.87 ± 213.26 to 373.53 ± 215.51 in controls). Variation was greater in the case group (179.33 p= 0.008). Visual acuity increased in both groups. A higher percentage of eyes with improved vision was found in the case group (52.38 percent). Visual acuity improvement was related to macular thickness recovery. Conclusions: In cases of cystoid macular edema after cataract surgery with indication of topical treatment with anti-inflammatories, the combination with dorzolamide is effective to reduce macular thickness and improve corrected visual acuity(AU)

Assuntos

Humanos , Extração de Catarata/métodos , Edema Macular/epidemiologia , Anti-Inflamatórios/uso terapêutico , Resultado do Tratamento

RESUMO

INTRODUCTION: The incidence of cystoid macular edema (CME) after cataract surgery varies substantially and depending on the diagnostic method used. In addition, other factors that influence the incidence of CME are the technique of surgery and the associated comorbidities. OBJECTIVE: The aim of the present study was to evaluate the incidence of EMC after uncomplicated phacoemulsification surgery, using the spectral domain optical coherence tomography (OCT). METHODS: The incidence of subclinical and clinical CME was evaluated in 14 patients who underwent uncomplicated phacoemulsification surgery, using OCT before the surgical procedure and after seven and 28 days after it. The volunteers could not use a prostaglandin analogue or present any retinopathy that compromised visual acuity. RESULTS: The incidence of clinically significant CME was 6.4%, however retinal thickening by OCT was observed in all patients in the fourth postoperative week. Regarding gender and laterality, the percentages were similar. CONCLUSION: In this study, we obtained a low incidence of EMC in patients assisted at this center, corroborating multicenter studies.

Assuntos

Humanos , Masculino , Feminino , Período Pós-Operatório , Catarata , Edema Macular/epidemiologia , Edema Macular/diagnóstico por imagem , Facoemulsificação , Tomografia de Coerência Óptica , Acuidade Visual , Serviços de Saúde Ocular

RESUMO

ABSTRACT Purpose: To evaluate the rate of cystoid macular edema development among cataract surgery patients on four different therapeutic regimens. Methods: The present study is a retrospective analysis of 5,380 eyes following uncomplicated phacoemulsification at Wake Forest University. The study period went from July 2007 to December 2012. Patients received one of four regimens, as follows: postoperative generic ketorolac 0.4% and prednisolone 1%, postoperative name-brand ketorolac 0.45% and prednisolone 1%, postoperative bromfenac 0.09% and prednisolone 1%, preoperative and postoperative bromfenac 0.09% alone. A statistical analysis was performed to assess the differences in rate of cystoid macular edema development among the four different therapeutic regimens. The diagnosis of cystoid macular edema required worsening of vision and evidence of increased macular thickness on optical coherence tomography. Results: The overall rate of cystoid macular edema was 0.82%. Treatment by postoperative generic ketorolac 0.45% and prednisolone 1% demonstrated the highest rate of cystoid macular edema development (2.20% of the cases). Postoperative name-brand ketorolac 0.45% and prednisolone 1% exhibited intermediate rates of cystoid macular edema development (0.90% of the cases). Postoperative administration of bromfenac 0.09% and prednisolone 1% exhibited intermediate rates of cystoid macular edema development (0.44% of the cases). Preoperative and postoperative bromfenac 0.09% alone resulted in the lowest rate of cystoid macular edema development (0.09% of the cases). The rate of cystoid macular edema was significantly lower when bromfenac was used alone vs. either regimen where ketorolac and prednisolone were used (OR 0.043, 95% CI 0.002 to 0.312; p<0.001). Conclusions: Post-cataract surgery cystoid macular edema developed less frequently following topical non-steroidal anti-inflammatory drugs regimen compared to the other therapies evaluated. Bromfenac, without corticosteroids, achieved lower rates of cystoid macular edema vs. various combinations of non-ste­roidal anti-inflammatory drugs with corticosteroids.

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RESUMO Objetivo: Avaliar a taxa de desenvolvimento do edema macular cistóide em pacientes submetidos à cirurgia de catarata em quatro esquemas terapêuticos diferentes. Métodos: O presente estudo é uma análise retrospectiva de 5.380 olhos após facoemulsificação não complicada na Wake Forest University. O período do estudo foi entre julho de 2007 e dezembro de 2012. Os pacientes receberam um dos quatro esquemas: cetorolaco genérico pós-operatório 0,4% e prednisolona 1%, cetorolaco 0,45% pós-operatório e prednisolona 1%, bromfenac 0,09% e a prednisolona 1% pós-operatório, bromfenaco 0,09% no pré-operatório e isoladamente no pós-operatório. Uma análise estatística foi realizada para avaliar as diferenças na taxa de desenvolvimento do edema macular cistóide entre os quatro diferentes regimes terapêuticos. O diagnóstico de edema macular cistóide exigiu uma piora da visão e uma evidência de aumento da espessura macular na tomografia de coerência óptica. Resultados: A taxa global de edema macular cistóide foi de 0,82%. O tratamento com cetorolaco genérico pós-operatório 0,45% e prednisolona 1% demonstrou a maior taxa de desenvolvimento de edema macular cistóide (2,20% dos casos). O cetorolaco 0,45% e a prednisolona 1% no pós-operatório exibiram taxas intermediárias de desenvolvimento de edema macular cistóide (0,90% dos casos). A administração de bromofenac 0,09% e de prednisolona 1% no pós-operatório apresentou taxas interme­diárias de desenvolvimento de edema macular cistóide (0,44% dos casos). O bromfenac 0,09% no pré e pós-operatório isoladamente resultou na menor taxa de desenvolvimento de edema macular cistóide (0,09% dos casos). A taxa de edema macular cistóide foi significativamente menor quando o bromfenac foi utilizado isoladamente em relação ao esquema onde cetorolaco e a prednisolona foram usados (OR 0,043, 95% CI 0,002 a 0,312; p<0,001). Conclusões: O edema macular cistóide pós-cirurgia de catarata desenvolveu-se com menor frequência após o tratamento tópico de medicamentos anti-inflamatórios não esteroidais, comparado às outras terapias avaliadas. Bromfenac, sem corticosteróides, alcançou taxas mais baixas de edema macular cistóide vs. Várias combinações em comparação com as várias combinações de drogas anti-inflamatórias não esteroidais com corticosteróides.

Assuntos

Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Benzofenonas/uso terapêutico , Bromobenzenos/uso terapêutico , Prednisolona/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Edema Macular/prevenção & controle , Facoemulsificação/efeitos adversos , Catarata , Edema Macular/etiologia , Estudos Retrospectivos , Quimioterapia Combinada

RESUMO

Abstract We herein report a patient without risk factors who presented acute bilateral Irvine-Gass syndrome after uneventful phacoemulsification. The novelty of our case lies on the fact that the patient presented acute bilateral Irvine-Gass syndrome without a predisposing systemic disease. Even though Cystoid Macular Edema (CME) was somehow expected in the first eye because of the ocular history of trauma, prophylactic measures were not strong enough to avoid its development. Furthermore, those measures could not avoid developing CME in the second eye. A 44-years-old male who underwent cataract surgery in both eyes presented bilateral Irvine-Gass syndrome. Despite prophylactic measures, both eyes developed CME after uneventful cataract surgery. Regular treatment options could not solve the situation and intravitreal Anti-VEGF injections were needed. Bilateral cases of Irvine-Gass Syndrome are rare and generally associated with systemic risk factors. Patients who developed CME following their first cataract surgery should be counseled about the risks of developing the condition following surgery on the contralateral eye. On top of that, aggressive prophylactic measures should be encouraged to prevent CME in these cases.

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Resumo Relatamos aqui um paciente sem fatores de risco que apresentou síndrome de Irvine-Gass bilateral aguda após facoemulsificação sem intercorrências. A novidade do nosso caso reside no fato de o paciente apresentar síndrome de Irvine-Gass bilateral aguda sem doença sistêmica predisponente. Embora o Edema Macular Cistoide (EMC) fosse de alguma forma esperado no primeiro olho por causa do histórico ocular de trauma, as medidas profiláticas não foram suficientemente fortes para evitar seu desenvolvimento. Além disso, essas medidas não puderam evitar o desenvolvimento de EMC no segundo olho. Homem de 44 anos submetido a cirurgia de catarata em ambos os olhos apresentou síndrome de Irvine-Gass bilateral. Apesar das medidas profiláticas, ambos os olhos desenvolveram EMC após a cirurgia de catarata sem intercorrências. As opções de tratamento regular não conseguiram resolver a situação e foram necessárias injeções intravítreas de Anti-VEGF. Casos de Síndrome de Irvine-Gass bilateral são raros e geralmente associados a fatores de risco sistêmicos. Os pacientes que desenvolveram EMC após a primeira cirurgia de catarata devem ser avisados sobre os riscos de desenvolver a doença após a cirurgia no olho contralateral. Além disso, medidas profiláticas agressivas devem ser incentivadas para evitar a EMC nesses casos.

Assuntos

Humanos , Masculino , Adulto , Edema Macular/etiologia , Facoemulsificação/efeitos adversos , Acuidade Visual , Edema Macular/tratamento farmacológico , Edema Macular/diagnóstico por imagem , Implante de Lente Intraocular , Inibidores da Angiogênese/administração & dosagem , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Tomografia de Coerência Óptica , Injeções Intravítreas

RESUMO

PURPOSE: To report the efficacy of intravitreal bevacizumab (IVB) injection versus intravitreal triamcinolone acetonide (IVT) for persistent non-infectious uveitic cystoid macular edema (CME). METHODS: Interventional retrospective comparative case series evaluated 37 consecutive patients (44 eyes) with completely controlled uveitis and recalcitrant CME. Patients received repeated injections of 1.25 mg of IVB or 4 mg of IVT. RESULTS: Best-corrected visual acuity (BCVA) at baseline and 24 months was logMAR 1 and 0.8 respectively, in the IVB group (p = 0.002) and; logMAR of 1.1 and 0.6, in the IVT group (p = 0.001). Central macular thickness at baseline and 24 months was 399.2 µm and 333.7 µm (p < 0.0009), respectively, for the IVB group and; 464.4 µm and 316.5 µm in the IVT group (p = 0.044). Postoperatively, IOP increased in the IVT group. CONCLUSIONS: Repeated injections with IVT improve BCVA as effectively as repeated injections with IVB in the long-term management of persistent uveitic CME.

Assuntos

Bevacizumab/administração & dosagem , Edema Macular/tratamento farmacológico , Triancinolona Acetonida/administração & dosagem , Uveíte/complicações , Acuidade Visual , Adulto , Idoso , Inibidores da Angiogênese/administração & dosagem , Feminino , Seguimentos , Glucocorticoides/administração & dosagem , Humanos , Injeções Intravítreas , Macula Lutea/patologia , Edema Macular/diagnóstico , Edema Macular/etiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Tomografia de Coerência Óptica , Resultado do Tratamento , Uveíte/diagnóstico , Uveíte/tratamento farmacológico , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Adulto Jovem

RESUMO

Introducción: El edema macular es la causa más frecuente de deterioro visual en pacientes con retinopatía diabética no proliferativa, la separación de los fotorreceptores, inducida por permeabilidad vascular anormal, reduce el poder de resolución del ojo y la capacidad visual, lo que lleva al paciente a la baja visión. Objetivo: Caracterizar el comportamiento del edema macular diabético y su clasificación según la tomografía de coherencia óptica. Material y métodos: Se realizó un estudio descriptivo, prospectivo, de corte transversal no controlado, en 40 diabéticos (80 ojos) con diagnóstico clínico de edema macular diabético, quienes acudieron a la consulta de Retina del Hospital Docente Dr. Salvador Allende y el Centro de Atención al Diabético entre enero 2014 y diciembre 2016. La evaluación única fue realizada mediante la biomicroscopía posterior y la tomografía de coherencia óptica (OCT Stratus 3000), basada en la clasificación propuesta por Panozzo y colaboradores. Resultados: Se constataron variaciones del grosor macular por encima de las 250 micras, predominó el engrosamiento cistoide y según la clasificación aplicada y el grado de tracción epirretiniana, se incluyeron más pacientes en los grupos T1 y T2. Finalmente, se clasificó el edema en no traccional (T0 y T1, 69 por ciento) y en traccional (T2yT3, 31 por ciento). Conclusiones: La tomografía de coherencia óptica y la clasificación de Panozzo son de gran utilidad para caracterizar el tipo de edema macular traccional o no traccional y orienta sobre el adecuado tratamiento a seguir en cada paciente. El edema macular diabético no traccional sobresalió en la muestra estudiada(AU)

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Introduction: Macular edema is the most frequent cause of visual loss in patients suffering from non-proliferative diabetic retinopathy. In this condition, the detachment of photoreceptors induced by an abnormal vascular permeability reduces the resolving power of the eye and visual capacity, causing low vision in the patient. Objective: To characterize the behavior of diabetic macular edema and its classification according to the main changes in the optical coherence tomography. Material and methods: A descriptive, prospective, cross-sectional and non-controlled study was carried out in 40 diabetic patients, (80 eyes), with the clinical diagnosis of diabetic macular edema in the Department of Retina of Salvador Allende University Hospital and the Diabetes Care Center from January 2014 to December 2016. A single evaluation was carried out with a subsequent biomicroscopy and optical coherence tomography (Stratus OCT; model 3000), based on the classification suggested by Panozzo and collaborators. Results: Variations in retinal volume over 250 microns were found in the tomography. The cystoid thickening predominated; and according to the classification used and the degree of epiretinal traction, more patients were included in T1 and T2 groups. Finally, edema was classified as non-tractional (T0 and T1, 69 percent), and tractional (T2 and T3, 31 percent). Conclusions: Optical coherence tomography and the classification suggested by Panozzo are highly useful to characterize the type of the macular edema into tractional or non-tractional, and allows to follow the adequate treatment in each patient. Non-tractional diabetic macular edema was highly noticeable in the sample studied(AU)

Assuntos

Humanos , Edema Macular/complicações , Tomografia de Coerência Óptica/métodos , Epidemiologia Descritiva , Estudos Transversais , Estudos Prospectivos

RESUMO

PURPOSE: The purpose of this study was to evaluate the aqueous humor bioavailability and clinical efficacy of bromfenac 0.09% vs nepafenac on the presence of cystoid macular edema (CME) after phacoemulsification. MATERIAL AND METHODS: A Phase II, double-blind, masked, active-controlled, multicenter, clinical trial of 139 subjects, randomized to either a bromfenac 0.09% ophthalmic solution (n=69) or nepafenac 0.1% (n=70). Subjects instilled a drop three times a day for a period of 30 days. Follow-up visits were on days 2, 7, 15, 30, and 60. Biomicroscopy, clinical ocular signs, and assessment of posterior segment were performed. The primary efficacy endpoints included the presence of CME evaluated by optical coherence tomography. Safety evaluation included intraocular pressure, transaminase enzymes, lissamine green, and fluorescein stain. RESULTS: The demographic and efficacy variables were similar between groups at baseline. The presence of pain, photophobia, conjunctival hyperemia, chemosis, cellularity, and corneal edema disappeared by day 30 in both groups. The central retinal thickness did not show significant changes after treatment when compared to baseline as follows: in the bromfenac group (247.2±32.9 vs 252.0±24.9 µm; P=0.958) and in nepafenac group (250.8±34 vs 264.0±34.1 µm; P=0.137), respectively. A statistically significant difference was observed between bromfenac and nepafenac group: (252.0±24.9 vs 264.0±34.1 µm; P=0.022), at day 30, respectively; even though there was no clinical relevance in the presentation of CME. There were no significant alterations in intraocular pressure, either lissamine green or fluorescein stains. The adverse events were not related to the interventions. CONCLUSION: Bromfenac 0.09% ophthalmic solution showed similar clinical efficacy to reduce the presentation of CME after phacoemulsification compared to nepafenac 0.01%.

RESUMO

Objetivo: Evaluar la respuesta al tratamiento con corticoides e inmunomoduladores en niños con pars planitis. Materiales y método: Se realiza un estudio retrospectivo y observacional de nueve historias clínicas de pacientes con diagnóstico de pars planitis atendidos en el servicio de oftalmología del Hospital de Pediatría Juan P. Garrahan desde el año 2010. Resultados: De los nueve pacientes 6 eran niños y 3 niñas. El motivo de consulta principal fue disminución de la visión. La mayoría de los pacientes fueron derivados por otros oftalmólogos para tratamiento. El 100% sufrió afectación ocular bilateral. Las complicaciones fueron: catarata, queratopatía en banda, hipertensión ocular y edema macular cistoide. El 100% de los pacientes recibió tratamiento con corticoides por vía oral e inmunomoduladores. A algunos se les efectuó inyecciones de triamcinolona subtenoniana y criocoagulación. Conclusiones: con el tratamiento con prednisona e inmunomoduladores se logró mejoría en la agudeza visual en 15 ojos y 3 ojos mantuvieron igual agudeza visual. La pars planitis es una patología crónica con un pronóstico visual reservado que requiere de un seguimiento estrecho y tratamiento prolongado por parte de un equipo interdisciplinario (AU)

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Objective: To assess response to steroid and immunomodulating treatment in children with pars planitis. Material and methods: A retrospective observational study was conducted reviewing nine clinical charts of children with a diagnosis of pars planitis seen at the Department of Ophthalmology of the Pediatric Hospital Juan P. Garrahan since 2010. Results: Of nine patients, six were boys and three were girls. Main complaint was loss of vision. The majority of patients were referred to our hospital by other ophthalmologists for treatment. All children had bilateral eye involvement. Complications observed were: cataracts, band keratopathy, ocular hypertension, and cystoid macular edema. All patients received oral steroids and immunomodulating treatment. In some subtenonian injection of triamcinolone and cryocoagulation was performed. Conclusions: Prednisone and immunomodulating treatment resulted in an improvement of visual acuity in 15 eyes and three eyes visual acuity remained unchanged. Pars planitis is a chronic disease with an uncertain visual prognosis that requires close follow-up and prolonged treatment by an interdisciplinary team (AU)

Assuntos

Humanos , Pré-Escolar , Criança , Adolescente , Corticosteroides/uso terapêutico , Doenças da Córnea/etiologia , Fatores Imunológicos/uso terapêutico , Edema Macular/etiologia , Pars Planite/complicações , Pars Planite/diagnóstico , Pars Planite/tratamento farmacológico , Doença Crônica

RESUMO

BACKGROUND: Cystoid macular edema (CME) remains an important complication after cataract surgery. There is no consensus about how to prevent this frequent complication. The purpose of this study was to conceive an effective anti-inflammatory strategy using nonsteroidal anti-inflammatory drugs (NSAIDs) together with regular treatment with corticosteroids to prevent CME and improve visual acuity after cataract surgery in patients without risk factors. MATERIALS AND METHODS: We searched the PubMed, Cochrane, and Google Scholar databases focused on prospective, controlled, randomized, double-blind clinical trials published in the last 10 years, with a minimum follow-up of 4 weeks. RESULTS: A total of nine clinical trials, one systematic review, and two reviews satisfied our search criteria. Most studies highlighted that NSAIDs are as powerful as corticosteroids to diminish postoperative inflammation, and demonstrated an additional benefit when used in combination with standard corticosteroid postsurgical therapy. In addition, the use of NSAIDs in the perioperative period seems to significantly improve the outcome after surgery and helps prevent CME in low-risk patients. CONCLUSION: The prophylactic use of NSAIDs in combination with the standard postoperative steroid scheme appears to be a positive course of action for preventing CME after cataract surgery. We suggest a therapeutic scheme based on the administration of one drop four times a day, beginning the day before surgery and for 4 weeks after the procedure. It is also advisable to administer one drop every 15 minutes in the hour prior to surgery in order to obtain better anti-inflammatory efficacy.

RESUMO

The advent of new technologies such as high definition optical coherence tomography (OCT) has not only provided unprecedented imaging capabilities, but also raised the need to define concepts not yet settled and often confusing such as the vitreomacular traction (VMT) syndrome. While technological advances drive us into the future by clarifying the pathophysiology of many diseases and enabling novel therapeutic options, it is at the same time necessary to review basic disease concepts in addition to definitions and classifications. VMT syndrome is implicated in the pathophysiology of a number of macular disorders, translating into a variety of anatomical and functional consequences underscoring the complexity of the condition. These macular changes are closely related to the VMT configuration and have led to proposing classification of this syndrome based on OCT findings. The size and severity of the remaining vitreomacular attachment may define the specific maculopathy. Focal VMT usually leads to macular hole formation, tractional cystoid macular edema and foveal retinal detachment, while broad VMT is associated with epiretinal membranes, diffuse retinal thickening and impaired foveal depression recovery. Despite similar postoperative visual acuity (VA) in focal and broad VMT subgroups, visual improvement is greater with focal VMT because preoperative VA is frequently lower. Surgical procedures are effective to relieve VMT and improve VA in most eyes; outcomes vary with VMT morphology and the duration of symptoms.

RESUMO

OBJETIVOS: Describir la frecuencia de edema quístico macular diagnosticado por tomografía de coherencia óptica en pacientes operados de catarata senil en el Instituto Cubano de Oftalmología "Ramón Pando Ferrer", de diciembre 2006 a febrero 2007. MÉTODOS: Se realizó un estudio descriptivo, prospectivo en 108 ojos de 94 pacientes operados, a los que se les realizó un examen con el Stratus OCT 3000 de Zeiss Meditec AG. RESULTADOS: El 20,3 por ciento de los pacientes presentó edema quístico macular. El 59,1 por ciento de pacientes con edema quístico macular no manifestaron sintomatología alguna. Existió mayor probabilidad de desarrollar edema quístico macular cuando ocurrieron complicaciones durante la cirugía. Se observó por biomicroscopia del polo posterior, quistes intrarretiniales perifoveolares en el 81,8 por ciento de los operados, y una relación inversamente proporcional entre el grosor macular y la agudeza visual alcanzada. CONCLUSIONES: Un número apreciable de pacientes con edema quístico macular fueron diagnosticados por tomografía de coherencia óptica. Se presentó de manera asintomática en la mayoría de los pacientes. Existe mayor probabilidad de desarrollar edema quístico macular cuando ocurren complicaciones durante la cirugía, en especial la ruptura de la cápsula posterior con vitreorragia. Los cambios morfológicos que se presentan en estos pacientes determinan que exista una relación inversamente proporcional entre el grosor macular y la agudeza visual alcanzada.

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OBJECTIVES: To describe the frequency of cystoid macular edema diagnosed with optical coherence tomography in patients operated on from senile cataract at "Ramón Pando Ferrer" Cuban Institute of Ophthalmology in the period from December 2006 to February 2007. METHODS: A prospective and descriptive study of 106 eyes from 94 surgical patients was conducted; they were examined with Zeiss Meditec AG Stratus OCT 3000. RESULTS: Of the total number of patients, 20,3 percent presented with cystoid macular edema. No symptoms were felt by 59.1 percent of patients with this edema. It was more likely to develop cystoid macular edema when there were complications at surgery. Posterior pole biomicroscopy allowed observing perifoveal intraretinal cysts in 81, 8 percent of the operated patients and an inversely proportional relation between macular thickness and final visual acuity. CONCLUSIONS: A sizeable number of patients with cystoid macular edema were diagnosed with optical coherence tomography. This disorder occurred asymptomatically in most of patients. It was more likely to develop cystoid macular edema when complications occurred during the surgery, particularly the rupture of posterior capsule with vitreous hemorrhage. The morphological changes in patients with cystoid macular edema determine inversely proportional relations between macular thickness and final visual acuity.