RESUMO
PURPOSE: Macular telangiectasia (MacTel) Type 2 is a progressing neurovascular disease of the macula, currently lacking effective treatment. This study assessed the effect of nondamaging retinal laser therapy (NRT) compared with sham. METHODS: Twelve MacTel patients were enrolled in this double-masked, controlled, randomized clinical trial. For the nine patients with both eyes eligible, one eye was randomized to NRT or sham and the other received alternate treatment. For three patients with only one eye eligible, that eye was randomly assigned either NRT or sham. Ellipsoid zone disruption, best-corrected visual acuity, and macular automated perimetry at 12 months served as structural and functional measures. RESULTS: Eleven eyes were randomized to sham and 10 to NRT. Baseline best-corrected visual acuity was 66 letters (20/50) for sham and 72 letters (20/40) for NRT (P = 0.245). Ellipsoid zone disruption area was 298 µm2 in sham and 368 µm2 in NRT (P = 0.391). At 12 months, ellipsoid zone disruption increased by 24% in sham and decreased by 34% in NRT (P < 0.001). Best-corrected visual acuity measures remained stable during follow-up compared with baseline. At 1 year, the mean macular sensitivity was 28 dB in the NRT group, compared with 26 dB in sham. CONCLUSION: Nondamaging retinal laser therapy was safe and well tolerated in patients with MacTel and resulted in structural and functional improvements, which could represent a protective effect of laser-induced hyperthermia. Longer follow-up and larger number of patients should help corroborate these effects.
Assuntos
Angiofluoresceinografia/métodos , Terapia a Laser/métodos , Macula Lutea/diagnóstico por imagem , Telangiectasia Retiniana/cirurgia , Tomografia de Coerência Óptica/métodos , Acuidade Visual , Idoso , Progressão da Doença , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Macula Lutea/cirurgia , Masculino , Pessoa de Meia-Idade , Telangiectasia Retiniana/diagnóstico por imagem , Telangiectasia Retiniana/fisiopatologia , Resultado do TratamentoRESUMO
PURPOSES: To compare surgeons' opinions regarding idiopathic full-thickness macular hole (MH) surgery by using traditional microscopy and three-dimensional (3-D) visualization system. To analyze the required time for pars plana vitrectomy (PPV) and for internal limiting membrane (ILM) rhexis by using both visualization methods. To evaluate anatomical surgical results. METHODS: Four surgeons (surgeon 1, fellows 1, 2, 3) performed the total of 40 surgeries for treating MHs. Each one performed 10 surgeries (5 with traditional microscopy and 5 with 3-D visualization). The completion time for PPV and ILM rhexis was determined by using both methods. Ergonomics, educational value, image sharpness, depth perception, field of view and technical skills were analyzed through answering a questionnaire. RESULTS: Forty patients were included in the study. The MH size for surgeon 1, fellows 1, 2 and 3 groups, individually, ranged from 237 to 602 µm; 228 to 590 µm, 271 to 611 µm and 289 to 600 µm, respectively. In the 3-D and in the traditional microscopy subgroups (which includes all 4 physicians on the use of one or the other method), the MH size ranged from 228 to 602 µm and 237 to 611 µm, respectively. Comparisons between the average time for full PPV and ILM rhexis by using the two methods were non-significant, neither in each individual case of 3-D surgery for each surgeon. Surgeon 1 had always been faster than his fellows. Depth perception was rated as similar for both methods. Field of view and educational values were rated as superior when using the 3-D system. Image resolution and ergonomics were rated as superior when using traditional microscopy. Technical skills strongly tended toward 'superiority' when using traditional microscopy. Thirty-six (90%) full-thickness MHs were successfully closed with one surgery. CONCLUSION: The 3-D system for MH surgery had a short learning curve and was a refined educational tool, when used with reduced illumination and precise focus. Concerning MH surgery, heads-up method was similar to traditional microscopy regarding length of time and anatomical surgical results. Heads-up surgery may become a new pattern for ophthalmic surgery as ongoing improvements are applied.
Assuntos
Atitude do Pessoal de Saúde , Imageamento Tridimensional/métodos , Macula Lutea/cirurgia , Perfurações Retinianas/cirurgia , Cirurgia Vitreorretiniana/métodos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Curva de Aprendizado , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos ProspectivosRESUMO
PURPOSE: To evaluate the association between macular hole volume (MHV) and postoperative central macular thickness (CMT) using spectral-domain optical coherence tomography (SD-OCT). METHODS: Thirty-three eyes of 30 patients with a large full-thickness idiopathic macular hole with or without vitreomacular traction who underwent surgical intervention were included in this cross-sectional study. Complete ophthalmological examination, including SD-OCT, was performed for all participants during the pre- and postoperative visits. MHV was preoperatively measured using SD-OCT, which captured the widest cross-sectional image of the hole. For normal distribution analysis of the data, the Kolmogorov-Smirnov test was performed, and for statistical analyses, chi-square, Student's t-test, Mann-Whitney U test, and Pearson's correlation coefficient test were performed. RESULTS: Mean preoperative best-corrected visual acuity (BCVA) and MHV were found to be 0.99 ± 0.36 (range, 0.3-2.0) logMAR and 0.139 ± 0.076 (range, 0.004-0.318) mm3, respectively. Mean follow-up was 16.3 ± 14.3 (range, 3-50) months. No statistical correlations were found between MHV and postoperative BCVA (p=0.588) and between MHV and disease recurrence (p=0.544). A weak negative correlation existed between MHV and final CMT scores (p=0.04, r=-0.383). CONCLUSIONS: Greater MHV was found to be weakly associated with lower postoperative CMT scores.
Assuntos
Macula Lutea/patologia , Macula Lutea/cirurgia , Perfurações Retinianas/patologia , Perfurações Retinianas/cirurgia , Adolescente , Adulto , Idoso , Anatomia Transversal , Estudos Transversais , Feminino , Humanos , Pressão Intraocular , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Período Pós-Operatório , Período Pré-Operatório , Valores de Referência , Estatísticas não Paramétricas , Fatores de Tempo , Tomografia de Coerência Óptica/métodos , Resultado do Tratamento , Acuidade Visual , Adulto JovemRESUMO
ABSTRACT Purpose: To evaluate the association between macular hole volume (MHV) and postoperative central macular thickness (CMT) using spectral-domain optical coherence tomography (SD-OCT). Methods: Thirty-three eyes of 30 patients with a large full-thickness idiopathic macular hole with or without vitreomacular traction who underwent surgical intervention were included in this cross-sectional study. Complete ophthalmological examination, including SD-OCT, was performed for all participants during the pre- and postoperative visits. MHV was preoperatively measured using SD-OCT, which captured the widest cross-sectional image of the hole. For normal distribution analysis of the data, the Kolmogorov-Smirnov test was performed, and for statistical analyses, chi-square, Student's t-test, Mann-Whitney U test, and Pearson's correlation coefficient test were performed. Results: Mean preoperative best-corrected visual acuity (BCVA) and MHV were found to be 0.99 ± 0.36 (range, 0.3-2.0) logMAR and 0.139 ± 0.076 (range, 0.004-0.318) mm3, respectively. Mean follow-up was 16.3 ± 14.3 (range, 3-50) months. No statistical correlations were found between MHV and postoperative BCVA (p=0.588) and between MHV and disease recurrence (p=0.544). A weak negative correlation existed between MHV and final CMT scores (p=0.04, r=-0.383). Conclusions: Greater MHV was found to be weakly associated with lower postoperative CMT scores.
RESUMO Objetivo: Avaliar a relação entre o volume do buraco macular (MHV) e a espessura macular central pós-operatória (CMT) por meio da tomografia de coerência óptica de domínio espectral (SD-OCT). Método: Trinta e três olhos de 30 pacientes com buracos maculares idiopáticos de espessura total grandes, com ou sem tração vitreorretiniana, que foram submetidos a intervenção cirúrgica foram incluídos neste estudo transversal. O exame oftalmológico completo, incluindo SD-OCT foi realizado nas visitas pré e pós-operatórias de todos os participantes. MHV foi medido a partir da imagem de SD-OCT pré-operatória que capturou a imagem mais larga da secção transversal do buraco. Após a análise distribuição nomral da população do estudo ter sido realizada com o teste Kolmogorov-Smirnov, os testes de qui-quadrado, t de Student, Mann-Whitney U e teste de correlação de Pearson foram utilizados para as estatísticas. Resultados: As médias pré-operatórias da melhor acuidade visual corrigida (BCVA) e MHV foram 0,99 ± 0,36 logMAR (variação de 0,3-2,0) e 0,139 ± 0,076 mm3 (variação de 0,004-0,318). O seguimento médio foi de 16,3 ± 14,3 meses (variação de 3-50). Não foram encontradas correlações estatísticas entre MHV e BCVA pós-operatória (p=0,588), bem como MHV e recorrência da doença (p=0,544). Uma fraca correlação negativa estava presente entre MHV e pontuações finais CMT (p=0,04, r=-0,383). Conclusões: Maior MHV foi fracamente relacionado com CMT mais baixo, no pós-operatório.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Adulto Jovem , Perfurações Retinianas/cirurgia , Perfurações Retinianas/patologia , Macula Lutea/cirurgia , Macula Lutea/patologia , Tamanho do Órgão , Período Pós-Operatório , Valores de Referência , Fatores de Tempo , Acuidade Visual , Estudos Transversais , Resultado do Tratamento , Estatísticas não Paramétricas , Anatomia Transversal , Tomografia de Coerência Óptica/métodos , Período Pré-Operatório , Pressão IntraocularRESUMO
PURPOSE: Retinal photocoagulation and nondamaging laser therapy are used for treatment of macular disorders, without understanding of the response mechanism and with no rationale for dosimetry. To establish a proper titration algorithm, we measured the range of tissue response and damage threshold. We then evaluated safety and efficacy of nondamaging retinal therapy (NRT) based on this algorithm for chronic central serous chorioretinopathy (CSCR) and macular telangiectasia (MacTel). METHODS: Retinal response to laser treatment below damage threshold was assessed in pigmented rabbits by expression of the heat shock protein HSP70 and glial fibrillary acidic protein (GFAP). Energy was adjusted relative to visible titration using the Endpoint Management (EpM) algorithm. In clinical studies, 21 eyes with CSCR and 10 eyes with MacTel were treated at 30% EpM energy with high spot density (0.25-diameter spacing). Visual acuity, retinal and choroidal thickness, and subretinal fluid were monitored for 1 year. RESULTS: At 25% EpM energy and higher, HSP70 was expressed acutely in RPE, and GFAP upregulation in Müller cells was observed at 1 month. Damage appeared starting at 40% setting. Subretinal fluid resolved completely in 81% and partially in 19% of the CSCR patients, and visual acuity improved by 12 ± 3 letters. Lacunae in the majority of MacTel patients decreased while preserving the retinal thickness, and vision improved by 10 letters. CONCLUSIONS: Heat shock protein expression in response to hyperthermia helps define the therapeutic window for NRT. Lack of tissue damage enables high-density treatment to boost clinical efficacy, therapy in the fovea, and retreatments to manage chronic diseases.
Assuntos
Terapia a Laser/métodos , Macula Lutea/cirurgia , Degeneração Macular/cirurgia , Acuidade Visual , Animais , Modelos Animais de Doenças , Análise de Elementos Finitos , Angiofluoresceinografia , Seguimentos , Fundo de Olho , Proteínas de Choque Térmico HSP72/biossíntese , Humanos , Imuno-Histoquímica , Macula Lutea/metabolismo , Macula Lutea/patologia , Degeneração Macular/diagnóstico , Degeneração Macular/metabolismo , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Coelhos , Fatores de Tempo , Tomografia de Coerência Óptica , Resultado do TratamentoRESUMO
RESUMO Paciente do sexo feminino, portadora de glaucoma juvenil sem controle clínico adequado, foi submetida à trabeculectomia com mitomicina C, após a qual, desenvolveu hipotensão ocular refratária às medidas conservadoras, evoluindo com um quadro de maculopatia hipotônica. Foi realizado um implante de enxerto de retalho escleral de doador sobre a fístula, com resolução do quadro e ganho de acuidade visual. A enxertia de retalho escleral de doador mostrou-se uma terapia adequada para correção da hipotensão ocular por bolha hiperfiltrante pós trabeculectomia. O cirurgião deve considerar o emprego dessa técnica ao programar a revisão destes casos.
ABSTRACT A female patient with juvenile glaucoma without clinical control underwent a trabeculectomy with mitomycin C, and developed eye hypotension which did not respond to conservative treatment, with subsequent hypotonic maculopathy. The patient was treated using a scleral patch provided by a donor above the fistula, which improved intraocular pressure and visual acuity. The use of the scleral patch above the fistula seems an adequate therapy to treat ocular hypotension due to the over-filtering trabeculectomy bubble. The surgeon should consider this technique when planning surgical solutions for such cases.
Assuntos
Humanos , Feminino , Adulto , Doenças Retinianas/cirurgia , Doenças Retinianas/etiologia , Esclera/transplante , Trabeculectomia/efeitos adversos , Hipotensão Ocular/complicações , Hipotensão Ocular/induzido quimicamente , Macula Lutea/patologia , Doenças Retinianas/diagnóstico , Glaucoma/diagnóstico , Glaucoma/tratamento farmacológico , Mitomicina/efeitos adversos , Tomografia de Coerência Óptica , Microscopia com Lâmpada de Fenda , Macula Lutea/cirurgiaAssuntos
Oftalmopatias/diagnóstico , Macula Lutea/cirurgia , Doenças Retinianas/diagnóstico , Corpo Vítreo/cirurgia , Idoso , Oftalmopatias/cirurgia , Feminino , Humanos , Descolamento Retiniano/diagnóstico , Descolamento Retiniano/cirurgia , Doenças Retinianas/cirurgia , Síndrome , Tomografia de Coerência Óptica , Acuidade Visual , VitrectomiaRESUMO
PURPOSE: To evaluate 5 patients with serous macular detachment due to optic disc pit that were submitted to pars plana vitrectomy and were followed for at least 7 years. METHODS: Patients were submitted to pars plana vitrectomy, posterior hyaloid removal, autologous serum injection and gas-fluid exchange, without laser photocoagulation, and were evaluated pre and post-operatively with visual acuity and Amsler grid testing, retinography, and recently, with autofluorescence imaging and high resolution OCT. RESULTS: All 5 eyes improved visual acuity significantly following the surgical procedure maintaining good vision throughout the follow-up period. Mean pre-operative visual acuity was 20/400 and final visual acuity was 20/27 with a mean follow-up time of 13.6 years. No recurrences of serous detachments were observed. OCT examinations demonstrated an attached retina up to the margin of the pit. CONCLUSION: Serous macular detachments due to optic disc pits were adequately treated with pars plana vitrectomy and gas fluid exchange, without the need for laser photocoagulation, maintaining excellent visual results for a long period of time.
Assuntos
Macula Lutea/cirurgia , Disco Óptico/anormalidades , Doenças do Nervo Óptico/complicações , Descolamento Retiniano/cirurgia , Vitrectomia/métodos , Adolescente , Adulto , Feminino , Humanos , Masculino , Descolamento Retiniano/etiologia , Fatores de Tempo , Tomografia de Coerência Óptica , Resultado do Tratamento , Acuidade Visual , Adulto JovemRESUMO
OBJETIVO: Avaliar 5 olhos com descolamento seroso da mácula devido à fosseta de disco óptico que foram submetidos à vitrectomia via pars plana e seguidos por pelo menos 7 anos. MÉTODOS: Os pacientes foram submetidos à vitrectomia via pars plana, remoção da membrana hialoide posterior, injeção de soro autólogo e troca fluido-gasosa, sem aplicação de fotocoagulação a laser, e foram testados quanto à acuidade visual, tela de Amsler, retinografia e, recentemente, retinografia com autofluorescência e OCT de alta resolução. RESULTADOS: Todos os 5 olhos operados tiveram significativa melhora da visão após o procedimento cirúrgico, mantendo boa visão durante todo período de acompanhamento. A acuidade visual pré-operatoria média foi de 20/400 enquanto a acuidade visual final foi de 20/27 com um tempo médio de seguimento de 13,6 anos. Não foram observadas recorrências do descolamento seroso da mácula e os exames de OCT mostraram a retina perfeitamente aplicada até a margem da fosseta de disco óptico. CONCLUSÃO: Descolamentos serosos da mácula causados por fosseta de disco óptico são adequadamente tratados com vitrectomia via pars plana e troca fluido-gasosa, sem a necessidade de fotocoagulação da retina, mantendo excelente acuidade visual por vários anos após o procedimento, sem o aparecimento de recorrências.
PURPOSE: To evaluate 5 patients with serous macular detachment due to optic disc pit that were submitted to pars plana vitrectomy and were followed for at least 7 years. METHODS: Patients were submitted to pars plana vitrectomy, posterior hyaloid removal, autologous serum injection and gas-fluid exchange, without laser photocoagulation, and were evaluated pre and post-operatively with visual acuity and Amsler grid testing, retinography, and recently, with autofluorescence imaging and high resolution OCT. RESULTS: All 5 eyes improved visual acuity significantly following the surgical procedure maintaining good vision throughout the follow-up period. Mean pre-operative visual acuity was 20/400 and final visual acuity was 20/27 with a mean follow-up time of 13.6 years. No recurrences of serous detachments were observed. OCT examinations demonstrated an attached retina up to the margin of the pit. CONCLUSION: Serous macular detachments due to optic disc pits were adequately treated with pars plana vitrectomy and gas fluid exchange, without the need for laser photocoagulation, maintaining excellent visual results for a long period of time.
Assuntos
Adolescente , Adulto , Feminino , Humanos , Masculino , Adulto Jovem , Macula Lutea/cirurgia , Disco Óptico/anormalidades , Doenças do Nervo Óptico/complicações , Descolamento Retiniano/cirurgia , Vitrectomia/métodos , Descolamento Retiniano/etiologia , Fatores de Tempo , Tomografia de Coerência Óptica , Resultado do Tratamento , Acuidade VisualRESUMO
PURPOSE: To evaluate the efficacy of triamcinolone as an aid in vitreous visualization during 3D-vitrectomy for the treatment of diabetic vitreomacular traction. METHODS: Prospective interventional study in patients with symptomatic vitreomacular traction. Pre- and postoperative assessments included visual acuity, retinography, intraocular pressure and optical coherence tomography. All patients were operated by the same surgeon (OOMJ). Triamcinolone was used as a visual enhancer during surgery. The parameters of the vitreophage (Accurus 800CS, Alcon) were set to the 3D-system (dual dynamic drive), contact lenses (plain and wide angle) being used for visualization. Peripheral 360 masculine vitreous circumcision at high cut rate was performed, carefully releasing the vitreomacular adhesion at the posterior pole by means of an appropriate pic or vitreoretinal forceps. RESULTS: The sample consisted of five consecutive patients (five eyes), three female and two male, with symptomatic vitreomacular traction. Their age ranged from 54 to 71 years (mean 62.6 +/- 6.3 years). During the surgical procedure, the areas with vitreomacular traction were properly visualized and identified after the application of triamcinolone. No complications were recorded during or after surgery. There was a statistically significant improvement in visual acuity after the surgical procedure (p=0.0313). CONCLUSION: Triamcinolone facilitates the surgical treatment of vitreomacular traction by improving visibility of both the vitreous humor and the vitreous-retina interface. Triamcinolone-assisted 3D vitrectomy proved to be an effective procedure in these cases.
Assuntos
Retinopatia Diabética/cirurgia , Glucocorticoides , Macula Lutea/cirurgia , Triancinolona Acetonida , Vitrectomia/métodos , Corpo Vítreo/cirurgia , Idoso , Feminino , Humanos , Cuidados Intraoperatórios , Masculino , Pessoa de Meia-Idade , Cuidados Pós-Operatórios , Cuidados Pré-Operatórios , Estudos Prospectivos , Acuidade Visual/fisiologia , Corpo Vítreo/patologiaRESUMO
PURPOSE: To evaluate the efficacy of triamcinolone as an aid in vitreous visualization during 3D-vitrectomy for the treatment of diabetic vitreomacular traction. METHODS: Prospective interventional study in patients with symptomatic vitreomacular traction. Pre- and postoperative assessments included visual acuity, retinography, intraocular pressure and optical coherence tomography. All patients were operated by the same surgeon (OOMJ). Triamcinolone was used as a visual enhancer during surgery. The parameters of the vitreophage (Accurus 800CS, Alcon) were set to the 3D- system (dual dynamic drive), contact lenses (plain and wide angle) being used for visualization. Peripheral 360º vitreous circumcision at high cut rate was performed, carefully releasing the vitreomacular adhesion at the posterior pole by means of an appropriate pic or vitreoretinal forceps. RESULTS: The sample consisted of five consecutive patients (five eyes), three female and two male, with symptomatic vitreomacular traction. Their age ranged from 54 to 71 years (mean 62.6 ± 6.3 years). During the surgical procedure, the areas with vitreomacular traction were properly visualized and identified after the application of triamcinolone. No complications were recorded during or after surgery. There was a statistically significant improvement in visual acuity after the surgical procedure (p=0.0313). CONCLUSION: Triamcinolone facilitates the surgical treatment of vitreomacular traction by improving visibility of both the vitreous humor and the vitreous-retina interface. Triamcinolone-assisted 3D vitrectomy proved to be an effective procedure in these cases.
OBJETIVO: Avaliar a eficácia da triancinolona como marcador vítreo na vitrectomia 3D para tratamento da tração vitreomacular do diabetes. MÉTODOS: Realizou-se um estudo prospectivo intervencionista numa série de portadores de tração vitreomacular sintomática. Na avaliação pré e pós-operatória foram realizadas a medida da acuidade visual, retinografia, pressão intra-ocular e tomografia de coerência óptica. Todos pacientes foram submetidos à vitrectomia pelo mesmo cirurgião (OOMJ). No intra-operatório, utilizou-se triancinolona como marcador vítreo. Os parâmetros do vitreófago (Accurus 800CS, Alcon) foram programados no sistema 3D (dual dynamic drive), sendo utilizadas lentes de contato (grande angular e plana) para visibilização. Realizou-se circuncisão vítrea periférica 360° com alto corte, desfazendo cuidadosamente as adesões vitreomaculares no pólo posterior por meio de gancho ou pinças vítreo-retinianas adequadas. RESULTADOS: A amostra foi composta por cinco pacientes (cinco olhos) consecutivos com tração vitreomacular sintomática. Três eram do sexo feminino e dois, do masculino. A idade variou de 54 a 71 anos (média de 62,6 ± 6,3 anos). Durante o procedimento cirúrgico, os locais de tração vitreomacular foram identificados com boa visibilidade após aplicação da triancinolona. Não foram observadas intercorrências tanto no intra quanto no pós-operatório. Houve melhora estatisticamente significante na acuidade visual após procedimento cirúrgico (p=0,0313). CONCLUSÃO: A triancinolona tem ação facilitadora no tratamento cirúrgico da tração vitreomacular, por melhorar visibilização tanto do humor vítreo quanto da interface vítreo-retina. A cirurgia de vitrectomia 3D, guiada por triancinolona, mostrou-se ser um procedimento eficiente nesses casos.
Assuntos
Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Retinopatia Diabética/cirurgia , Glucocorticoides , Macula Lutea/cirurgia , Triancinolona Acetonida , Vitrectomia/métodos , Corpo Vítreo/cirurgia , Cuidados Intraoperatórios , Cuidados Pós-Operatórios , Cuidados Pré-Operatórios , Estudos Prospectivos , Acuidade Visual/fisiologia , Corpo Vítreo/patologiaRESUMO
PURPOSE: The objective of this paper is to describe the optical coherence tomography (OCT) characteristics of patients with full-thickness traumatic macular hole (TMH) and to correlate them with biomicroscopy findings. METHODS: Twelve eyes of ten consecutive patients with full-thickness TMH participated in this observational retrospective multicentre study. Patients underwent biomicroscopic fundus examination, colour fundus photography, and OCT. RESULTS: Traumatic macular hole was documented with OCT in five women and five men. Mean (range) time between trauma and macular hole (MH) diagnosis was 8.1 (1-24) months. The shape of TMHs was round in 11 (91.7%) eyes. The posterior vitreous was completely detached in six (50%) eyes, and with an operculum in one (8.3%) eye. The common findings seen on OCT were: (1) full-thickness loss of retinal tissue through the hole with sharp edges, perpendicular to the retinal pigment epithelium in five (41.7%) eyes; (2) TMH with an operculum totally detached from the hole's edge in two (16.7%) eyes; (3) presence of epiretinal membrane around of the hole in three (25%) eyes; and (4) presence of abnormalities of the surrounding retina in all (100%) eyes. The OCT characteristics correlated well with biomicroscopic findings, and these characteristics may be predictive for final visual acuity (VA) in TMHs. Only one of the TMHs closed spontaneously in our series. CONCLUSION: Optical coherence tomography complements biomicroscopy in the evaluation of full-thickness TMHs.
Assuntos
Ferimentos Oculares Penetrantes/diagnóstico , Perfurações Retinianas/diagnóstico , Descolamento do Vítreo/diagnóstico , Adolescente , Adulto , Criança , Membrana Epirretiniana/cirurgia , Ferimentos Oculares Penetrantes/cirurgia , Feminino , Fundo de Olho , Humanos , Macula Lutea/cirurgia , Masculino , Microscopia Acústica , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Perfurações Retinianas/cirurgia , Estudos Retrospectivos , Tomografia de Coerência Óptica/métodos , Acuidade Visual/fisiologia , Descolamento do Vítreo/cirurgia , Adulto JovemRESUMO
PURPOSE: To present a clinico-pathologic report on ocular toxocariasis in a nine-year-old boy with a submacular fibravascular membrane who underwent submacular surgery. MATERIALS AND METHODS: A nine-year-old boy affected by chronic ocular toxocariasis in his right eye was treated. Fundus examination disclosed multiple vitreous strands attached to the retina in the inferonasal quadrant and a submacular membrane with a surrounding exudative macular detachment. Vitrectomy surgery with submacular membrane removal was performed. RESULTS: Visual acuity improved from hand motion to 20/400 after two months of follow-up. The pathological findings revealed a fibrovascular scar without parasitic remnants in the serial section of the tissue. CONCLUSION: In this case of ocular toxocariasis, submacular surgery turned out to be a good alternative treatment to improve the patient's visual acuity. Through this kind of surgery it could be possible not only to treat vitreoretinal complications of the disease but also to excise submacular membranes and reattach the retina in the macular area.
Assuntos
Infecções Oculares Parasitárias/cirurgia , Macula Lutea/cirurgia , Toxocaríase/cirurgia , Vitrectomia , Criança , Infecções Oculares Parasitárias/parasitologia , Infecções Oculares Parasitárias/patologia , Fundo de Olho , Humanos , Masculino , Epitélio Pigmentado Ocular , Toxocaríase/patologia , Acuidade VisualRESUMO
Objetivo: Presentar un reporte clínico-patológico de toxocariasis ocular en un paciente de nueve años de edad con una membrana fibrovascular submacular, que fue tratado mediante cirugía submacular. Materiales y Métodos: Un niño de nueve años de edad afectado por toxocariasis crónica en su ojo derecho recibió tratamiento. El examen de fondo de ojos reveló múltiples bandas vítreas adheridas a la retina en el cuadrante Inferonasal y una membrana submacular, rodeada por un desprendimiento macular exudativo. Se llevó a cabo una vitrectomía con remoción de la membrana submacular. Resultados: La agudeza visual mejoró de movimientos de manos a 20/400 luego de dos meses de seguimiento. Los hallazgos anatomopatológicos revelaron una cicatriz fibrovascular sin restos parasitarios en los cortes seriados del tejido. Conclusión: En este caso de toxocariasis ocular la cirugía submacular resultó ser una buena alternativa para mejorar la visión del paciente. Mediante este tipo de cirugía seria posible no sólo tratar las complicaciones vitreoretinlanas de esta enfermedad sino también resecar membranas submaculares y reaplicar la retina en el área macular.
Purpose: To present a clinico-pathologic report on ocular toxocariasis in a nine-year-old boy with a submacular fibravascular membrane who underwent submacular surgery. Materials And Methods: A nine-year-old boy affected by chronic ocular toxocariasis in his right eye was treated. Fundus examination disclosed multiple vitreous strands attached to the retina in the inferonasal quadrant and a submacular membrane with a surrounding exudative macular detachment. Vitrectomy surgery with submacular membrane removal was performed. Results: Visual acuity improved from hand motion to 20/400 after two months of follow-up. The pathological findings revealed a fibrovascular scar without parasitic remnants in the serial section of the tissue. Conclusion: In this case of ocular toxocariasis, submacular surgery turned out to be a good alternative treatment to improve the patient's visual acuity. Through this kind of surgery it could be possible not only to treat vitreoretinal complications of the disease but also to excise submacular membranes and reattach the retina in the macular area.
Assuntos
Humanos , Masculino , Criança , Infecções Oculares Parasitárias/cirurgia , Macula Lutea/cirurgia , Toxocaríase/cirurgia , Vitrectomia , Infecções Oculares Parasitárias/parasitologia , Infecções Oculares Parasitárias/patologia , Fundo de Olho , Epitélio Pigmentado Ocular , Toxocaríase/patologia , Acuidade VisualRESUMO
Objetivo: Presentar un reporte clínico-patológico de toxocariasis ocular en un paciente de nueve años de edad con una membrana fibrovascular submacular, que fue tratado mediante cirugía submacular. Materiales y Métodos: Un niño de nueve años de edad afectado por toxocariasis crónica en su ojo derecho recibió tratamiento. El examen de fondo de ojos reveló múltiples bandas vítreas adheridas a la retina en el cuadrante Inferonasal y una membrana submacular, rodeada por un desprendimiento macular exudativo. Se llevó a cabo una vitrectomía con remoción de la membrana submacular. Resultados: La agudeza visual mejoró de movimientos de manos a 20/400 luego de dos meses de seguimiento. Los hallazgos anatomopatológicos revelaron una cicatriz fibrovascular sin restos parasitarios en los cortes seriados del tejido. Conclusión: En este caso de toxocariasis ocular la cirugía submacular resultó ser una buena alternativa para mejorar la visión del paciente. Mediante este tipo de cirugía seria posible no sólo tratar las complicaciones vitreoretinlanas de esta enfermedad sino también resecar membranas submaculares y reaplicar la retina en el área macular.(AU)
Purpose: To present a clinico-pathologic report on ocular toxocariasis in a nine-year-old boy with a submacular fibravascular membrane who underwent submacular surgery. Materials And Methods: A nine-year-old boy affected by chronic ocular toxocariasis in his right eye was treated. Fundus examination disclosed multiple vitreous strands attached to the retina in the inferonasal quadrant and a submacular membrane with a surrounding exudative macular detachment. Vitrectomy surgery with submacular membrane removal was performed. Results: Visual acuity improved from hand motion to 20/400 after two months of follow-up. The pathological findings revealed a fibrovascular scar without parasitic remnants in the serial section of the tissue. Conclusion: In this case of ocular toxocariasis, submacular surgery turned out to be a good alternative treatment to improve the patients visual acuity. Through this kind of surgery it could be possible not only to treat vitreoretinal complications of the disease but also to excise submacular membranes and reattach the retina in the macular area. (AU)