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Management of vitreoretinal disorders (e.g., neovascular age-related macular degeneration [nAMD] and diabetic macular edema [DME]) have assumed the standard therapy of lifelong anti-VEGF injections with drugs like aflibercept, brolucizumab, ranibizumab and bevacizumab. However, the burden imposed on patients is a major deterrent for continual therapy and recovery. Faricimab, a bispecific antibody, blocking both VEGF-A and Ang-2 molecules, produces a comparable functional and anatomical results, with less injections, significantly reducing patient burden. Visual acuity, safety, adverse effects, and anatomical outcomes are discussed in the pivotal clinical trials (YOSEMITE/RHINE and TENAYA/LUCERNE), and early data from real-world studies (TRUCKEE, TAHOE, FARWIDE-DME, FARETINA and others). In YOSEMITE and RHINE, faricimab demonstrated non-inferior vision gains, better anatomical outcomes compared to aflibercept every 8 weeks. Faricimab in the personalized treatment interval (PTI), after week 96, achieved 12-week interval in 78.1% of the patients and 16-week interval in 62.3%. TENAYA and LUCERNE reported comparable best corrected visual acuity (BCVA) improvement and better anatomic outcomes during head-to-head phase, parallel to aflibercept, at its 8-week treatment schedule. Faricimab in the PTI regimen, after week 96 achieved 12-week interval in 77.8% of the patients and 16-week interval in 63.1%. Safety of faricimab has been comparable to aflibercept in these pivotal trials. Real-world data supports the data from the pivotal studies regarding the efficacy and safety profile of faricimab in heterogenous real world patient population. Moreover, in previously treated patients, it also demonstrated a faster fluid resolution, good safety profile. Considering faricimab has demonstrated anatomic and durability benefit in the treatment of nAMD and DME, additional data from ongoing extension clinical trials, AVONELLE-X and RHONE-X will help understand longer term outcomes for patients treated with faricimab as well as patients switching from aflibercept to faricimab after finishing the pivotal trials. Longer term data from the real-world studies will also continue to contribute to our understanding of long-term efficacy, safety and durability in the real world patient population.
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RESUMO O objetivo deste trabalho foi relatar um caso raro de glaucoma neovascular em paciente portador de diabetes mellitus tipo 1 que evoluiu para esclerite necrosante com inflamação. Homem, 22 anos e com diabetes mellitus tipo 1 mal controlada apresentou perda visual dolorosa súbita no olho direito. Acuidade visual em olho direito sem percepção luminosa e 20/80 em olho esquerdo. Pressão intraocular de 35mmHg e exame compatível com glaucoma neovascular em olho direito. Foi iniciado tratamento com colírios hipotensores no olho direito e panfotocoagulação a laser no olho esquerdo. Após 3 semanas, houve piora da dor, hiperemia e aparecimento de afinamento escleral na região superior de olho direito, com posterior protrusão uveal. Quadro compatível com esclerite anterior necrosante com inflamação, apesar das sorologias para doenças autoimunes negativas. Ainda que raro, este relato de associação de glaucoma neovascular e esclerite justifica a discussão dos mecanismos inflamatórios em comum nessas doenças, para melhor compreensão da patogênese dessas graves apresentações clínicas.
ABSTRACT The aim of this study was to report a rare case of neovascular glaucoma in a patient with type 1 diabetes mellitus that progressed to necrotizing scleritis with inflammation. A 22-year-old male with poorly controlled type 1 diabetes mellitus experienced sudden painful vision loss on the right eye. Visual acuity on the right eye was no light perception, while it was 20/80 in the left eye. Intraocular pressure was measured at 35 mmHg, and the examination was consistent with neovascular glaucoma on the right eye. Treatment with hypotensive eye drops was initiated in the right eye, and panphotocoagulation laser therapy was performed on the left eye. After three weeks, there was worsening pain, redness, and the appearance of scleral thinning in the upper region of the right eye, followed by uveal protrusion. This presentation was consistent with necrotizing anterior scleritis with inflammation, despite negative serology for autoimmune diseases. Although rare, this report of the association between neovascular glaucoma and scleritis justifies the discussion of common inflammatory mechanisms in these diseases to enhance the understanding of the pathogenesis of these severe clinical presentations.
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ABSTRACT Purpose: To present long-term results of pars plana vitrectomy combined with pan-retinal endolaser photocoagulation, Ahmed glaucoma valve implantation, and/or phacoemulsification in patients with complicated neovascular glaucoma. Methods: The study comprised 15 eyes from 15 patients with neovascular glaucoma as a complication of diabetic retinopathy and owing to ischemic central retinal vein occlusion. There was a vitreous hemorrhage n all of the patients. Furthermore, 8 of the cases showed varying degrees of hyphema. All subjects received an intravitreal injection of bevacizumab three days before surgery. In 12 phakic patients, phacoemulsification, pars plana vitrectomy, and Ahmed glaucoma valve implantation were performed. Pars plana vitrectomy and Ahmed glaucoma valve implantation were performed in 3 pseudophakic patients. Perioperative and postoperative complications, intraocular pressure values, and best-corrected visual acuity scores were also recorded. Results: The mean follow-up was 24.4 ± 14.56 months. The mean preoperative intraocular pressure was 50.06 ± 7.6 mmHg. At 1 day, 7 days, and 1-, 3-, 6-, 12-month, and last visit following surgery, the mean intraocular pressure was 11.06 ± 8.22, 12.66 ± 7.27, 13.8 ± 7.73, 18.64 ± 7.05, 19.28 ± 4.61, 16.28 ± 1.68, and 16.92 ± 2.12 mmHg, respectively (p=0.001 for every follow-up visit). The mean visual acuity on the most recent appointment was 1.18 ± 0.42 logMar (p=0.001 for each subsequent visit). As postoperative early complications, varying degrees of hyphema and fibrin reactions were recorded. During follow-up, one patient developed phthisis bulbi. In 4 cases, Ahmed glaucoma valve revision surgery was required. Conclusions: In patients with complicated neovascular glaucoma, combined surgical procedures are safe, effective, and preferable both in terms of controlling high intraocular pressure and providing reasonable visual abilities.
RESUMO Objetivo: Apresentar nossos resultados de longo período de vitrectomia pars plana combinada com fotocoagulação panretiniana com endolaser, implantação da válvula Ahmed para glaucoma e/ou facoemulsificação em pacientes com glaucoma neovascular complicado. Métodos: Foram incluídos no estudo 15 olhos de 15 pacientes com glaucoma neovascular como complicação da retinopatia diabética e devido à oclusão isquêmica da veia central da retina. Todos os casos tiveram hemorragia vítrea. Além disso, 8 dos casos apresentaram diferentes graus de hifema. A injeção intravítrea de bevacizumabe foi administrada em todos os casos 3 dias antes da cirurgia. Facoemulsificação, vitrectomia pars plana e implantação da válvula Ahmed para glaucoma foram realizadas em 12 pacientes fáquicos. A vitrectomia pars plana e a implantação da válvula Ahmed para glaucoma foram realizadas em 3 pacientes pseudofáquicos. Complicações perioperatórias e pós-operatórias, valores de pressão intraocular e valores de melhor acuidade visual corrigida pré-operatório e pós-operatório foram registrados. Resultados: O acompanhamento médio foi de 24,4 ± 14,56 meses. A média da pressão intraocular pré-operatória foi de 50,06 ± 7,6 mmHg. Em 1 dia, 7 dias e 1,3,6,12 meses, e última visita após cirurgia, a média da pressão intraocular foi de 11,06 ± 8,22, 12,66 ± 7,27, 13,8 ± 7,73, 18,64 ± 7,05, 19,28 ± 4,61, 16,28 ± 1,68 e 16,92 ± 2,12 mmHg, respectivamente (p=0,001 para cada visita de acompanhamento). A média da acuidade visual na última visita foi de 1,18 ± 0,42 logMar (p=0,001 para cada visita de acompanhamento). Vários graus de reações de hifema e fibrina foram registrados como complicações precoces pós-operatórias. Phthisis bulbi foi desenvolvido em um caso durante o acompanhamento. A cirurgia de revisão da válvula Ahmed para glaucoma foi necessária em 4 casos. Conclusões: Os procedimentos cirúrgicos combinados que realizamos são seguros, eficazes e preferenciais, tanto em termos de controle da alta pressão intraocular quanto fornecimento de habilidades visuais razoáveis em pacientes com glaucoma neovascular complicado.
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BACKGROUND: Age-related macular degeneration (AMD) is a leading cause of visual impairment among individuals aged 50 and above, often resulting in irreversible vision loss (1). Currently, antiangiogenic therapy is the primary treatment approach for neovascular AMD (2). The choroid has gained significant attention in recent years due to its involvement in various ocular pathologies (7). The objective of this study was to evaluate visual acuity and correlate pre-treatment variables, such as foveal thickness and choroidal thickness, with post-treatment outcomes. MATERIALS AND METHODS: This study was designed as a prospective interventional study to investigate the changes in choroidal and macular thickness in patients with neovascular AMD who received intravitreal aflibercept injections. The study utilized medical records and employed Swept Source Optical Coherence Tomography (OCT-SS) for evaluation. The data was collected from patients treated in Presidente Prudente, Brazil, during a three-month load dose period. RESULTS: The best-corrected mean visual acuity significantly improved from 1.0 logarithm of the minimum resolution angle (logMAR) units to 0.55 logMAR after treatment with aflibercept (p < 0.001). Patients undergoing treatment exhibited a significant decrease in average macular thickness from 323 µm to 232 µm (p = 0.001), as well as a reduction in choroidal thickness from 206 µm to 172 µm (p = 0.031), while maintaining intraocular pressure within the normal range (p = 0.719) without significant variation. Statistically significant associations were found between the difference in pre- and post-treatment choroidal thickness and the pretreatment values of macular thickness (p = 0.005) and choroidal thickness (p = 0.013). There was also a statistically significant correlation between the difference in pre- and post-treatment macular thickness and the pretreatment macular thickness value (p < 0.001). CONCLUSION: In this study, aflibercept exhibited remarkable effectiveness in reducing macular and choroidal thickness, as evaluated using OCT-SS, and significantly improved visual acuity in patients with neovascular AMD. The assessment of both choroidal and macular changes, as well as their correlations, can provide valuable insights for clinicians, enabling them to make well-informed therapeutic decisions and effectively monitor treatment outcomes. Notably, this study contributes to the existing body of literature as the first to establish a correlation between pretreatment foveal thickness, variation in choroidal thickness, and post-treatment choroidal thickness.
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Objectives: To identify risk factors for loss to follow-up in periodic intravitreal anti-vascular endothelial growth factor injections for the treatment patients with diabetic macular edema, subretinal neovascularization, age-related macular degeneration, and retinal vein occlusion in a single eye center in São Paulo, Brazil. Methods: This was a retrospective longitudinal study that gathered information from 992 patients who required intravitreal anti-vascular endothelial growth factor drugs over 6 months. The authors included age, eye disease, laterality, monthly income, distance, and payment mode as risk factors. Results: Two hundred and seventy patients (29.93%) were lost to follow-up. Multivariate analysis showed age, monthly income, eye involvement, and type of medical assistance independently associated with loss to follow-up. The odds of loss to follow-up were greater among older patients than those less than 50 years (reference), p < 0.001. The odds of loss to follow-up were greater among patients who received unilateral treatment than those who received bilateral injections (p = 0.013). Concerning gross monthly income, there were no differences in the odds of the four salary strata; the data also indicate an absence of difference in the three strata of patients' distance to the clinic. Considering the diagnosis, only age-related macular degeneration showed greater odds of loss to follow-up (p = 0.016). Finally, the data suggest greater odds of loss to follow-up in private patients than in those on a health care plan (p < 0.001). Conclusion: Loss to follow-up is paramount because many patients may remain unassisted concerning their eye diseases. Identifying the risk factors is crucial to enforcing measures to increase adherence and the long-term success of the treatment.
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Se presenta un paciente masculino de 60 años de edad, con antecedentes de padecer diabetes mellitus tipo II complicada con retinopatía diabética, así como glaucoma neovascular de tórpida evolución en el ojo izquierdo. Acude a consulta de glaucoma en el Centro Oftalmológico del Hospital Universitario Clínico- Quirúrgico «Arnaldo Milián Castro» de Villa Clara por presentar visión borrosa y molestias oculares en su ojo derecho. Al examen oftalmológico de dicho ojo se observa: disminución de la visión, sangramiento activo proveniente de vaso iridiano, edema corneal, rubeosis iridiana, hipertensión ocular y al fondo de ojo retinopatía diabética; se realizan complementarios hemáticos que muestran cifras de glicemia elevada (20 mmol/l). Se plantea el diagnóstico de glaucoma neovascular del ojo derecho en el curso de una diabetes mellitus tipo II descompensada. Se le indica tratamiento médico - quirúrgico y se logra una evolución favorable.
We present a 60-year-old male patient with a history of type II diabetes mellitus complicated by diabetic retinopathy, as well as neovascular glaucoma of torpid evolution in his left eye. He came to the glaucoma consultation in the Ophthalmological Center at "Arnaldo Milián Castro" Clinical and Surgical University Hospital in Villa Clara due to blurred vision and ocular discomfort in his right eye. Decreased vision, active bleeding from the iris vessel, corneal edema, iris rubeosis, ocular hypertension was observed in such eye at ophthalmological examination and diabetic retinopathy at eye fundus; blood tests were performed showing elevated glycemia figures (20 mmol /l). The diagnosis of neovascular glaucoma of the right eye is stated in the course of a decompensated type II diabetes mellitus. Medical and surgical treatment is indicated and a favourable evolution is achieved.
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Edema da Córnea , Glaucoma Neovascular , Diabetes Mellitus Tipo 2 , Retinopatia DiabéticaRESUMO
RESUMO Ao longo da vida, o cristalino produz novas fibras dispostas de forma concêntrica, que aumentam seu diâmetro anteroposterior e peso, tornando seu núcleo mais compacto e endurecido. A catarata hipermadura é uma forma de progressão avançada dessa proliferação de fibras, que pode desencadear uma variedade de complicações. A ruptura espontânea da cápsula anterior do cristalino, evoluindo com deslocamento anterior do núcleo, é uma complicação rara e com poucos casos publicados na literatura. Descrevemos o caso de uma paciente do sexo feminino, 68 anos, que apresentou ruptura espontânea da cápsula anterior do cristalino com deslocamento anterior do núcleo em olho esquerdo sem histórico de trauma ocular. A paciente foi submetida à facoemulsificação do cristalino e ao controle da pressão intraocular, evoluindo com melhora do quadro clínico.
ABSTRACT Throughout life, the lens produces new fibers arranged concentrically, which increase its anteroposterior diameter and weight, making its nucleus more compact and hardened. Hypermature cataract is an advanced stage of this fiber proliferation, which can trigger a variety of complications. Spontaneous rupture of the anterior lens capsule evolving with anterior displacement of the nucleus is a rare complication, with few cases published in the literature. We describe the case of a 68-year-old female patient, who presented spontaneous rupture of the anterior lens capsule with anterior displacement of the nucleus in the left eye, without a history of ocular trauma. The patient underwent phacoemulsification and clinical control of intraocular pressure, improving her condition.
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Humanos , Feminino , Idoso , Catarata/complicações , Subluxação do Cristalino/diagnóstico , Subluxação do Cristalino/etiologia , Cápsula Anterior do Cristalino/patologia , Ruptura Espontânea/cirurgia , Catarata/terapia , Glaucoma Neovascular , Subluxação do Cristalino/cirurgia , Ultrassonografia , Facoemulsificação/métodos , Microscopia com Lâmpada de Fenda , Pressão Intraocular , Núcleo do Cristalino/patologia , Câmara Anterior/patologiaRESUMO
Antecedentes: La pérdida de visión tiene consecuencias tanto en la salud como en la estabilidad económica, ya que promueve retrasos en el desarrollo emocional, social, además de reducciones en la productividad laboral. Objetivo: Estimar la carga económica de la degeneración macular asociada a la edad neovascular (DMAEn) y el edema macular diabético (EMD) en Colombia para el año 2022. Método: Para una perspectiva social se incluyeron costos directos utilizando la aproximación de Bottom-up y costos indirectos relacionados con la pérdida de productividad. Resultados: El costo directo de un paciente con DMAEn fue 5.974 USD$ desde una base teórica. A nivel nacional, la DMAEn costaría 179,9 millones USD$. Los costos indirectos de DMAEn se estimaron en 13,9 millones USD$. Los costos directos teóricos en EMD fueron 741,6 millones USD$. El costo nacional sería de 132,04 millones USD$. Para los costos indirectos de EMD, se estimó un costo de 93,3 millones USD$. Conclusiones: La DMAEn y el EMD tienen un alto impacto para el sistema de salud y la sociedad.
Background: The vision loss has consequences for both health and economic stability, since it promotes delays in emotional and social development, as well as reductions in labor productivity. Objective: To estimate the economic burden of age-related macular degeneration (AMD) and diabetic macular edema (DME) in Colombia for 2022. Method: For a social perspective, direct costs were included using the bottom-up approach, and indirect costs related to lost productivity. Results: The direct costs of treating a patient with AMD were USD $5,974 from a theoretical background. At national level, the AMD would cost USD $179.9 million. The AMD indirect cost in Colombia was estimated in USD $13.9 million. Patients theoretical direct cost of DME was USD $741.6 million. The cost at national level is USD $132.04 million. Regarding the indirect costs result for DME, a cost of USD $93.31 million was estimated. Conclusions: The AMD and the DME have a considerable impact on the health system and society.
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Humanos , Colômbia , Diabetes MellitusRESUMO
Las membranas neovasculares coroidea representan el crecimiento de nuevos vasos sanguíneos originados de la coriocapilar hacia el epitelio pigmentario de la retina o el espacio subretinal por una disrupción de la membrana de Bruch ocasionado por la inflamación prolongada. El desarrollo de las membranas neovasculares coroidea está estrechamente conectado a la morbilidad asociada con la coroidopatía punteada interna y puede ser su primera forma de presentación. La coroidopatía punteada interna es clasificada como una de las enfermedades de los síndromes de puntos blancos evanescentes, es una enfermedad infrecuente, bilateral y de origen desconocido. Se presenta un caso clínico de un paciente al cual se le diagnostica membranas neovasculares coroidea en el curso de una coroidopatía punteada interna con una presentación atípica o previa a las lesiones de coroiditis. La coroidopatía punteada interna complicada con membranas neovasculares coroidea compromete la visión central de forma considerable en pacientes jóvenes(AU)
Choroidal neovascular membranes represent the growth of new blood vessels originating from the choriocapillaris into the retinal pigment epithelium or subretinal space due to disruption of Bruch's membrane caused by prolonged inflammation. The development of choroidal neovascular membranes is closely connected to the morbidity associated with punctate inner choroidopathy and may be its first form of manifestation. Punctate Inner choroidopathy is classified as one of the evanescent white dot syndromes diseases, is a rare, bilateral disease of unknown origin. We present a case report of a patient diagnosed with choroidal neovascular membranes while suffering from punctate inner choroidopathy with an atypical manifestation or prior to choroiditis lesions. Punctate Inner choroidopathy when complicated with choroidal neovascular membranes compromises significantly the central vision in young patients(AU)
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Humanos , Neovascularização de Coroide/diagnósticoRESUMO
Objetivo: Identificar la relación de los pseudodrusen reticulares con la degeneración macular asociada a la edad mediante imágenes tomográficas. Método: Estudio observacional, descriptivo y transversal en pacientes con pseudodrusen reticulares atendidos en consulta de retina a los que se les realizó tomografía de coherencia óptica espectral desde enero de 2009 hasta diciembre de 2014 en el Instituto Cubano de Oftalmología "Ramón Pando Ferrer". La población estuvo constituida por 69 pacientes de 55 años y más con pseudodrusen reticulares en dichas imágenes. Resultados: Los pseudodrusen predominaron en pacientes con edades comprendidas entre los 70 y 79 años para un 49,3 por ciento. El sexo femenino fue el más numeroso con un 76,8 por ciento. De los 122 ojos con pseudodrusen, 86 presentaron algún signo de degeneración macular asociada a la edad representado por el 70,5 por ciento. El 58,1 por ciento de estos últimos tuvo la forma avanzada. La membrana neovascular tipo II fue la más frecuente con un 58,0 por ciento. El grosor coroideo se estimó disminuido en el 77,9 por ciento de los casos. Conclusiones: Los pseudodrusen reticulares mantienen una relación directa con la degeneración macular asociada a la edad e influyen en la progresión de esta(AU)
Objective: To identify the relationship of reticular pseudodrusen with age-related macular degeneration using tomographic imaging. Methods: An observational, descriptive and cross-sectional study was conducted in patients with reticular pseudodrusen seen in retina consultation who underwent spectral optical coherence tomography from January 2009 to December 2014 at the Cuban Institute of Ophthalmology "Ramón Pando Ferrer". The population consisted of 69 patients aged 55 years and older with reticular pseudodrusen in these images. Results: Pseudodrusen predominated in patients between 70 and 79 years of age (49.3 percent). The female gender was the most numerous with 76.8 percent. Out of the 122 eyes with pseudodrusen, 86 showed some sign of age-related macular degeneration (70.5 percent). Out of the latter, 58.1 percent had the advanced form. Type II neovascular membrane was the most frequent with 58.0 percent. Choroidal thickness was estimated decreased in 77.9 percent of cases. Conclusions: Reticular pseudodrusen maintain a direct relationship with age-related macular degeneration and influence its progression(AU)
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Humanos , Feminino , Idoso , Envelhecimento , Degeneração Macular/etiologia , Epidemiologia Descritiva , Estudos Observacionais como AssuntoRESUMO
ABSTRACT Purpose: Age-related macular degeneration is the most common cause of blindness in developed countries, and several factors have been attributed for its etiology. This study was conducted to explore the relationship between serum vitamin D levels and age-related macular degeneration. Methods: We retrospectively analyzed the data of 114 patients with age-related macular degeneration. A total of 102 patients who did not have any other diseases than refractive error were allocated to the control group. The best-corrected visual acuity, fundus findings, and spectral domain optical coherence tomography findings were analyzed. Patients were allocated to groups based on the Age-related Eye Disease Study classification. Serum 25(OH) vitamin D levels were measured. The central foveal thickness and the subfoveal choroidal thickness were measured by optical coherence tomography. Results: The 25(OH) vitamin D levels in age- and gender-matched patients with age-related macular degeneration and in healthy subjects were 14.6 ± 9.8 and 29.14 ± 15.1 ng/ml, respectively. The age-related macular degeneration group had significantly lower vitamin D levels than the control group (p>0.001). The subfoveal choroidal thickness was lower in patients with age-related macular degeneration (p>0.001). The 25(OH) vitamin D level showed a weak positive correlation with choroidal thickness (r=0.357, p=0.01). When the level of 25(OH) vitamin D was evaluated according to the stages of age-related macular degeneration, it was found to be lower in the advanced-stage disease (p=0.01). The risk for the development of choroid neovascular membrane and subretinal fibrosis was found to increase with decreased vitamin D levels. Conclusions: Significantly decreased levels of 25(OH) vitamin D in advanced-stage age-related macular degeneration suggest a significant correlation existing between vitamin D deficiency and age-related macular degeneration development. Further studies are required to examine whether vitamin D supplementation has an effect on the development and progression of age-related macular degeneration.
RESUMO Objetivo: A degeneração macular relacionada à idade é a causa mais comum de cegueira em países desenvolvidos e muitos fatores etiológicos têm-lhe sido atribuídos. O objetivo do presente estudo foi investigar a relação entre os níveis séricos de vitamina D e a degeneração macular relacionada à idade. Métodos: Os dados de 114 pacientes com degeneração macular relacionada à idade foram analisados retrospectivamente. Foram alocados no Grupo Controle 102 pacientes sem registro de outras doenças além do erro refrativo. A acuidade visual melhor corrigida, os achados do exame de fundo de olho e os da tomografia de coerência óptica de domínio espectral foram analisados. Os pacientes foram alocados em grupos de acordo com a classificação do Age-Related Eye Disease Study (Estudo da Doença Ocular Relacionada à Idade). Os níveis séricos de vitamina D 25(OH) foram medidos. A espessura foveal central e a espessura da coroide subfoveal foram medidas com tomografia de coerência óptica. Resultados: Os níveis de vitamina D 25(OH) em pacientes com degeneração macular relacionada à idade e em indivíduos saudáveis pareados por idade e sexo foram 14,6 ± 9,8 ng/mL e 29,14 ± 15,1 ng/mL, respectivamente. Os níveis de vitamina D foram significativamente menores no Grupo da Degeneração Macular relacionada à idade em comparação com o Grupo Controle (p>0,001). O valor da espessura da coroide subfoveal foi menor em pacientes com degeneração macular relacionada à idade (p>0,001). Foi encontrada uma fraca correlação positiva entre o nível de vitamina D 25(OH) e a espessura da coroide (r=0,357, p=0,01). O nível de vitamina D 25(OH), quando avaliado de acordo com os estágios da degeneração macular relacionada à idade, revelou ser menor na doença em estágio avançado (p=0,01). Constatou-se um risco aumentado de desenvolvimento de membrana neovascular da coroide e de fibrose sub-retiniana com a diminuição dos níveis de vitamina D. Conclusões: A diminuição significativa dos níveis de vitamina D 25(OH) na degeneração macular relacionada à idade em estágio avançado sugere a presença de uma correlação significativa entre a deficiência de vitamina D e o desenvolvimento dessa patologia. Mais estudos são necessários para investigar se a suplementação de vitamina D tem ou não influência no desenvolvimento e progressão da degeneração macular relacionada à idade.
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Novel strategies have been developed to reduce or avoid intravitreal injections (IVTs) of the antiangiogenic (ranibizumab (RBZ)) and anti-inflammatory (triamcinolone acetonide (TA)) agents used to treat vitreoretinal diseases. One of the strategies includes liposomes. This study evaluated the safety and efficacy of a topical triamcinolone-loaded liposome formulation (TALF) as an adjuvant to intravitreal RBZ therapy in treatment- naïve patients with neovascular age-related macular degeneration (nAMD). Subjects were randomly assigned to the RBZ-TALF or the RBZ-pro re nata (RBZ-PRN) groups. Patients from the RBZ-TALF group were instructed to apply TALF for 12 months after a single dose of RBZ. Patients from the RBZ-PRN group received three monthly RBZ-IVTs. Retreatment with RBZ was considered in the case of nAMD reactivation. Regarding safety, non-ocular abnormalities were observed during TALF therapy. Concerning efficacy, non-significant differences were identified in terms of visual acuity or central foveal thickness when the RBZ-PRN and RBZ-TALF groups were compared. It is worth noting that the average number of RBZ injections was significantly lower in the RBZ-TALF group (2.5 ± 1.4 vs. 6.1 ± 1.3 IVTs; p = 0.0004). Therefore, TALF used as an adjuvant to RBZ reduces the need for RBZ-IVT retreatment with optimal visual and anatomic results.
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Objetivo: Determinar las características clínicas y epidemiológicas de la neovascularización coroidea en los pacientes con uveítis. Métodos: Se realizó un estudio observacional, descriptivo y transversal en pacientes con diagnóstico de neovascularización coroidea asociada a uveítis, atendidos en el Servicio de Uveítis e Inflamaciones Oculares del Instituto Cubano de Oftalmología "Ramón Pando Ferrer". Resultados: Esta entidad predominó en el sexo femenino, en edad pediátrica y en jóvenes. Se asoció con mayor frecuencia a enfermedades infecciosas, como la toxoplasmosis ocular, y un pequeño número de pacientes desarrolló membrana neovascular coroidea bilateral. Las membranas localizadas con mayor frecuencia fueron las subfoveales. Por angiografía fluoresceínica predominaron las clásicas, mientras el grosor de la membrana neovascular coroidea fue mayor que el grosor foveal central. La agudeza visual mejor corregida en la mayoría de nuestros pacientes fue menor de 85 VAR. Conclusión: La membrana neovascular coroidea asociada a las uveítis es reconocida como una complicación infrecuente, pero compromete de forma severa la visión en estos pacientes(AU)
Objective. To determine the clinical-epidemiological characteristics of choroidal neovascularization in patients with uveitis. Method. An observational, descriptive, cross-sectional study was carried out in patients with a diagnosis of choroidal neovascularization associated with uveitis, attended in the Uveitis and Ocular Inflammations Service of the Cuban Institute of Ophthalmology "Ramón Pando Ferrer". Results. This entity predominated in the female sex, in pediatric age and youth. It was more frequently associated with infectious diseases, such as ocular toxoplasmosis, and a small number of patients developed bilateral choroidal neovascular membrane. The most frequent location of the membranes were the subfoveal ones, by fluorescein angiography the predominantly classic ones and the thickness of the choroidal neovascular membrane was greater than the central foveal thickness. The best corrected visual acuity in most of our patients was less than 85 VAR. Conclusion. CNVM associated with uveitis is recognized as an uncommon complication but one that severely compromises vision in these patients(AU)
Assuntos
Humanos , Feminino , Criança , Adolescente , Uveíte/etiologia , Angiofluoresceinografia/métodos , Toxoplasmose Ocular/epidemiologia , Neovascularização de Coroide/diagnóstico , Epidemiologia Descritiva , Estudos Transversais , Estudos Observacionais como AssuntoRESUMO
RESUMO A hipertensão ocular aguda durante a hemodiálise constitui evento raro e pode ser causa relevante de interrupção do tratamento dialítico devido à dor. Relata-se o caso de um paciente de 70 anos de idade, do sexo masculino, que apresentou quadros recorrentes de intensa dor ocular unilateral durante sessões dialíticas devido ao aumento de pressão intraocular. O paciente era portador de grave diminuição da acuidade visual no olho direito devido a glaucoma neovascular, controlado com medicação hipotensora tópica. Uma hora após o início da sessão dialítica, apresentou dor excruciante no olho direito, sendo necessário interromper o tratamento por diversas vezes. A dor somente era amenizada com uso de opioides por via endovenosa ou após cerca de 6 horas do procedimento. Injeção intraocular de drogas antiangiogênicas e acetazolamida por via oral, assim como tratamentos tradicionais para quadros agudos de hipertensão intraocular, como uso de hipotensor tópico e medicamentos hiperosmolares, foram insuficientes para o controle da dor. O problema se resolveu com ciclofotocoagulação transescleral realizada com laser diodo, com redução da pressão intraocular basal e controle da dor, o que permitiu a realização de sessões completas de hemodiálise. A base fisiopatológica desse evento incomum e suas opções terapêuticas são discutidas aqui.
ABSTRACT Acute ocular hypertension during hemodialysis is a rare event and may lead to interruption of dialytic therapy due to pain. A case of a 70-year-old male patient is reported, who presented recurrent intense unilateral ocular pain episodes during dialysis sessions for increased intraocular pressure. The patient presented with severely decreased visual acuity in the right eye due to neovascular glaucoma, which was controlled with topical hypotensive medication. One hour after initiating dialysis, he presented an excruciating pain on the right eye, which required interruption of treatment several times. Pain relief was possible only with intravenous opioids, or approximately 6 hours after dialysis. Intraocular injection of antiangiogenic drugs and per oris acetazolamide, as well as other traditional treatments for acute episodes of intraocular hypertension, such as topical antihypertensive agents and hyperosmotic medications, were not sufficient to control pain. The problem was solved with transscleral diode laser cyclophotocoagulation, which reduced baseline intraocular pressure and controlled pain, enabling complete hemodialysis sessions. The pathophysiological aspects and therapeutic options of this unusual condition are discussed.
Assuntos
Humanos , Masculino , Idoso , Glaucoma Neovascular/complicações , Hipertensão Ocular/etiologia , Diálise Renal/efeitos adversos , Pressão Intraocular , Concentração Osmolar , Humor Aquoso/fisiologia , Soluções para Diálise , Insuficiência Renal Crônica/terapia , Dor AgudaRESUMO
The present study was an open-label, prospective, uncontrolled and multicenter clinical trial to investigate the safety and effectiveness of bevacizumab (Lumiere®) administered by the intravitreal route for the treatment of neovascular age-related macular degeneration (nAMD). A total of 22 patients without previous treatment with anti-vascular endothelial growth factor were recruited. Monthly therapy with 1.25 mg intravitreal bevacizumab was applied. Adverse events (AE), visual acuity (VA) and central retinal thickness (CRT) were assessed at baseline, day 1 and day 28 after each injection. A total of 87 AEs were reported; most of them were not serious (96.6%), expected (65.5%) and occurred after the third injection (56.3%). The most frequent AE was 'conjunctival hemorrhage' (29.9% of AEs), attributed to the injection procedure. Treatment was not suspended due to safety reasons in any case. After six months, a statistically significant gain of +8.2 (SD±8.8) letters and a CRT reduction of -75.50 µm (SD±120.3) were achieved with unilateral therapy. VA improvement and CRT reduction were also achieved with bilateral therapy, although to a lesser extent. The results of the present study suggested that therapy with a minimum of 3 doses of bevacizumab over a 6-month period was well tolerated and resulted in a sustained response regarding VA improvement and CRT reduction from the beginning of therapy compared with the baseline value. The study protocol was registered at clinicaltrials.gov (ref. no. NCT03668054).
RESUMO
INTRODUCTION: Age-related macular degeneration is the leading cause of blindness in older people in the world. One of the most effective treat-ments consists of injection intravitreal of anti-endothelial vascular growth factor (anti-VEGF) drugs. However, there is no con-sensus on their frequency of administration, being the treat and extend and the pro re nata the most commonly used regimens, but there is still controversy regarding their effectiveness. METHODS: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS: We identified two systematic reviews that together included two primary studies, both observational studies. We concluded that we are uncertain whether the treat and extend regimen is superior in terms of visual gain, decrease in retinal thickness, number of injections and serious adverse effects at 12 months in comparison with the pro re nata regimen, because the certainty of the existing evidence has been assessed as very low.
INTRODUCCIÓN: La degeneración macular asociada a la edad es la principal causa de ceguera en personas mayores en el mundo. El tratamiento más eficaz consiste en inyecciones intravítreas de fármacos anti factor del crecimiento vascular endotelial (anti-VEGF). Sin embargo, no existe consenso sobre su frecuencia de administración, siendo pro re nata y treat and extend los protocolos más utilizados, pero existe controversia sobre su efectividad. MÉTODOS: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un meta análisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos dos revisiones sistemáticas que en conjunto incluyeron dos estudios primarios, ambos observacionales. Concluimos que no es posible establecer con claridad si el protocolo treat and extend en comparación a pro re nata es superior en términos de ganancia visual, disminución del grosor de la retina, número de inyecciones ni en el desarrollo de efectos adversos serios a los 12 meses, debido a que la certeza de la evidencia existente es muy baja.
Assuntos
Inibidores da Angiogênese/administração & dosagem , Degeneração Macular/tratamento farmacológico , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Idoso , Inibidores da Angiogênese/farmacologia , Bases de Dados Factuais , Esquema de Medicação , Humanos , Injeções Intravítreas , Degeneração Macular/patologia , Acuidade Visual/efeitos dos fármacosRESUMO
CLINICAL CASE: Forteen year old patient presenting progressive decrease in visual acuity of the left eye after 3 months of evolution. On examination he presents bilateral drusen of papilla, associated with juxtapapillary neovascular membrane, which seriously compromises the vision and visual field of the left eye. RESULT: Treatment with 3 consecutive injections of intravitreal ranibizumab resulted in the inactivation of the neovascular membrane with reabsorption of subretinal fluid and improvement of the best corrected visual acuity of the left eye. After 9 months of follow-up, it was 20/20 and stable. CONCLUSION: Although optic nerve head drusen are considered benign, neovascular membranes can be a complication. Anti-VEGFs are an effective alternative for treatment.
Assuntos
Inibidores da Angiogênese/uso terapêutico , Neovascularização de Coroide/tratamento farmacológico , Drusas do Disco Óptico/tratamento farmacológico , Ranibizumab/uso terapêutico , Adolescente , Neovascularização de Coroide/complicações , Feminino , Humanos , Drusas do Disco Óptico/etiologiaRESUMO
Resumo Objetivo: Avaliar a efetividade e o perfil de segurança da ciclofotocoagulação transescleral padrão (CTCTE) e sua variação técnica denominada slow cooking (CTCTE SC) em pacientes com olho cego doloroso por glaucoma neovascular. Métodos: Pacientes foram submetidos a exame oftalmológico, graduando o nível da dor através de escala gráfica/numérica e divididos em dois grupos, um para tratamento com CTCTE e outro CTCTE SC. O acompanhamento foi realizado no primeiro, trigésimo e nonagésimo dias. Resultados: Dos 26 pacientes inclusos, 11 (42,3%) eram do sexo masculino. A idade média dos pacientes foi de 69 anos. Destes, 16 pacientes foram submetidos ao tratamento CTCTE e 10 pacientes a CTCTE SC. A pressão intraocular (PIO) teve média pré tratamento de 49 ± 23 mmHg no grupo CFCTE e medias no 1º, 30º e 90º dias pós-operatórios respectivamente: 32 ± 24 mmHg, 38 ± 18 mmHg, 43 ± 10 mmHg. No grupo submetido a técnica CFCTE SC a PIO prévia foi 54 ± 16 mmHg e médias no 1º, 30º e 90º dias pós-operatórios respectivamente: 38 ± 22 mmHg, 39 ± 10 mmHg , 44 ± 09 mmHg. A redução da dor foi efetiva em 88,4% pacientes. Durante o pós-operatório foi verificado hiperemia, quemose e hifema. Não foram observadas complicações graves. Conclusão: O tratamento do olho cego doloroso com ciclofotocoagulação transescleral com baixa carga foi um procedimento seguro e eficaz na resolução da dor, mas apresentou um baixo nível de redução da pressão intraocular em ambas técnicas usadas.
Abstract Objective: To evaluate the effectiveness and safety profile of standard transescleral cyclophotocoagulation (CTCTE) and its technical variation of slow cooking (CTCTE SC) in patients with neovascular glaucoma pain. Methods: Patients underwent ophthalmological examination, grading their pain level through a graphical / numerical scale and divided into two groups, one for treatment with CTCTE and another CTCTE SC. Follow-up was performed on the first, thirtieth and ninetieth days. Results: Of the 26 patients included, 11 (42.3%) were male. The average age of the patients was 69 years. Of these, 16 patients underwent CTCTE treatment and 10 patients underwent CTCTE SC. Intraocular pressure (IOP) had a mean pre-treatment of 49 ± 23 mmHg in the CFCTE group and medians at the 1st, 30th and 90th postoperative days respectively: 32 ± 24 mmHg, 38 ± 18 mmHg, 43 ± 10 mmHg. In the group submitted to the CFCTE SC technique, the previous IOP was 54 ± 16 mmHg and averages on the 1st, 30th and 90th postoperative days respectively: 38 ± 22 mmHg, 39 ± 10 mmHg, 44 ± 09 mmHg. Pain reduction was effective in 88.4% patients. During the postoperative period, hyperemia, chemosis and hyphema were observed. No serious complications were observed. Conclusion: Painful blind eye treatment with low load transscleral cyclophotocoagulation was a safe and effective procedure for pain resolution, but presented a low level of intraocular pressure reduction in both techniques used.