RESUMO
The authors report a new variant of idiopathic polypoidal choroidal vasculopathy (IPCV) in middle-aged Haitian men characterized by extramacular polypoidal lesions and bilateral extensive pigmentary alterations in the posterior pole in an annular wreath-like pattern surrounding the optic nerve and macular area. Two patients were seen at Massachusetts Eye and Ear Infirmary and one at Boston University Medical Center between 2010 and 2015. All three patients were middle-aged Haitian men who exhibited bilateral features of IPCV, including subretinal hemorrhages and serosanguinous pigment epithelial detachments. Indocyanine green angiography revealed extramacular polypoidal lesions located mostly along the major vascular arcades. Extensive pigmentary alterations were evident in the posterior pole surrounding the macula and optic nerve in an annular wreath-like pattern. These cases further expand the clinical spectrum of IPCV.
Assuntos
Neovascularização de Coroide/diagnóstico , Pólipos/diagnóstico , Descolamento Retiniano/diagnóstico , Hemorragia Retiniana/diagnóstico , Epitélio Pigmentado da Retina/patologia , Adulto , Idoso , Inibidores da Angiogênese/uso terapêutico , Neovascularização de Coroide/terapia , Terapia Combinada , Exsudatos e Transudatos , Angiofluoresceinografia , Haiti , Humanos , Masculino , Pessoa de Meia-Idade , Imagem Multimodal , Fotoquimioterapia , Pólipos/tratamento farmacológico , Descolamento Retiniano/terapia , Hemorragia Retiniana/terapia , Tomografia de Coerência Óptica , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidoresRESUMO
Se realizó una revisión sobre el tratamiento de la neovascularización coroidea en la miopía degenerativa. Se consultaron fundamentalmente artículos científicos de revistas publicados e indexados en las bases de datos PubMED y Cochrane, así como textos básicos que abordan este tema. No se encontraron certezas del beneficio de la fotocoagulación con láser de las lesiones neovasculares en esta entidad, mientras que la terapia fotodinámica parece brindar estabilidad de la lesión y mejoría visual, al menos a los 3 años de seguimiento. El uso de antiangiogénicos intravítreos tiene los mejores resultados en la actualidad respecto a la inactivación de la lesión y la recuperación visual pero no hay ensayos clínicos controlados que avalen su beneficio a largo plazo. Otras opciones de tratamiento se encuentran en investigación y desarrollo. No se ha concebido el protocolo ideal para tratar las membranas neovasculares miópicas
A literature review on the treatment of the choroidal neovascularization in the degenerative myopia was made. Published scientific articles of journals indexed in Pubmed and Cochrane databases, as well as basic texts that deal with this topic. No evidences of the benefits of the laser photocoagulation for neovascular lesions were found, whereas the photodynamic therapy seems to offer stability of the lesion and visual improvement after three years of follow-up. The use of intravitreous antiangiogenic drugs has currently achieved the best results in terms of lesion inactivation and visual recovery, but there are no controlled clinical trials that support their long-term benefits. Other treatment options are under research and development. The ideal protocol of treatment of neovascular myopic membranes has not yet been devised
Assuntos
Humanos , Inibidores da Angiogênese/uso terapêutico , Miopia Degenerativa/complicações , Neovascularização de Coroide/patologia , Neovascularização de Coroide/terapiaRESUMO
Introducción: La degeneración macular asociada a la edad (DMAE) es una enfermedad prevalente en pacientes de la tercera edad. Tiene prevalencia incrementada por aumento en la expectativa de vida, es un problema de salud pública por ser una causa importante de ceguera; por muchos años no ha tenido un tratamiento eficaz para la detención o prevención de dicha enfermedad. Los anti-VEFG (vascular endotelial factor growth) son el tratamiento de elección. El ranibizumab es un anti-VEFG aprobada por la FDA (2004) para el tratamiento de la forma húmeda de la degeneración macular asociada a la edad. Se ha demostrado en diversos estudios de ensayos clínicos fase III como ANCHOR y MARINA, la mejora y mantenimiento de la agudeza visual (AV), en nuestro estudio nosotros evaluamos los resultados de nuestro tratamiento con ranibizumab en 2 años de seguimiento. Métodos: Fueron revisadas las historias clínicas de los pacientes sometidos a tratamiento de la membrana neo vascular asociada a la DMAE, durante los años 2011-2012, consignando los datos estadísticos sexo, edad, AV pre tratamiento, AV post tratamiento, grosor macular central pre y post tratamiento, complicaciones oculares y sistémicas. Resultados: Se trataron 83 pacientes el 51,8 por ciento masculinos, mientras que el 48,2 por ciento femenino. Con una edad media de 73,36, siendo el pico de la prevalencia de la enfermedad entre los 65-85 años. La media del número de dosis fue de 4,52 por persona; La media de agudeza visual antes del tratamiento fue de 0,1923 (Snellen=20/104), y luego del pos tratamiento de 0,3429 (Snellen=20/58), 10 que representa una ganancia media de 10 letras, luego de concluido el tratamiento (p=0,00). El espesor macular tiene una media de 408,57 micras antes del tratamiento versus una media de 324,16 micras luego de instalado el tratamiento, con una variación media de 84,4 micras (p=0,00). No se reportó ninguna complicación ocular ni sistémica secundaria al uso de ranibizumab. La enfermedad...
Background: The age-related macular degeneration (ARMD) is a disease prevalent in patients of the third age, has prevalence a greater life expectation. Is a problem of public health for being an important cause of blindness. For many years it not had an effective treatment or prevention of the above mentioned disease. The anti- VEFG is treatment choice now. The ranibizumab is an anti-VEFG approved by the FDA (2004) for the treatment of the "wet" form of ARMD, it ~as been demonstrated in several studies of clinical tests ANCHOR and MARINA phase III, the improvement and maintenance of the visual acute (V A). In our study we evaluate the results of our treatment with ranibizumab in 2 years of follow-up. Method: We studied the clinical histories of the patients submitted to treatment of the neo vascular membrane associated with ARMD, during the years 2011-2012, recording the statistical information sex, age, VA pre treatment, V A post treatment, central retinal thickness pre and post treatment also ocular and systemic complications. Results: 83 patients treated 51, 8 per cent masculine and 48,2 per cent feminine. With a middle ages of 73, 36 being the peak of the prevalence of the disease between 65-85 years. The average of the number of dose was of 4, 52 for person; The average of VA before the treatment was of 0,1923 (Snellen=20/104), and after the pos treatment of 0,3429 (Snellen=20/58), which represents an average profit of 10 letters, after concluded the treatment (p=0,00). The central macular thickness has an average of 408,57 microns before the treatment versus an average of 324,16 microns after post treatment, with an average variation of 84,4 microns (p=0,00). There have not any ocular complications or systemic secondary to the use of ranibizumab. The most frequent systemic disease was the arterial hypertension 36,1 per cent, diabetes mellitus 9,6 per cent, others not mentioned were the obesity, chronicle renal disease (1,2 per cent), and a group of...
Assuntos
Masculino , Feminino , Humanos , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Acuidade Visual , Anticorpos Monoclonais Humanizados/uso terapêutico , Degeneração Macular , Neovascularização de Coroide/terapia , Terapia Biológica , Estudo Observacional , Estudos Longitudinais , Estudos RetrospectivosRESUMO
PURPOSE: To evaluate the long-term safety and visual acuity outcomes associated with epimacular strontium 90 brachytherapy combined with intravitreal bevacizumab for the treatment of subfoveal choroidal neovascularization because of age-related macular degeneration. METHODS: Thirty-four treatment-naive patients with predominantly classic, minimally classic, and occult subfoveal choroidal neovascularization lesions participated in this prospective, 2-year, nonrandomized multicenter study. Subjects from 1 center (n = 19) were reconsented and followed-up for 3 years. Each subject received a single 24-Gy beta irradiation treatment via an intraocular delivery device and 2 planned injections of bevacizumab at treatment and 1 month later. Additional bevacizumab therapy was permitted based on prespecified retreatment criteria. Adverse events were observed, and best-corrected visual acuity was measured using Early Treatment Diabetic Retinopathy Study vision charts. Subjects were evaluated every 3 months during the first year of follow-up and every 6 months during Years 2 and 3 of follow-up. RESULTS: All 34 subjects were followed-up for 24 months and 19 were followed-up through 36 months. With up to 24 months of follow-up, 12 of 24 phakic patients (50%) exhibited ≥ 2 grades of progression in Lens Opacification Classification System (LOCS) II lens classification; 5 eyes underwent cataract extraction before the Month 36 visit. There was 1 case of nonproliferative retinopathy identified at 36 months of follow-up that did not have an adverse effect on visual acuity, was stable at 43 months of follow-up, and was isolated to the parafoveal region. Mean best-corrected visual acuity demonstrated an average gain of +15.0 and -4.9 letters at 12 months and 24 months, respectively; the drop in mean gain at Month 24 was largely attributable to cataract formation. At 36 months (n = 19), the mean best-corrected visual acuity was +3.9, 90% (17 of 19) of eyes had lost <15 letters from baseline, 53% (10 of 19) had gained ≥ 1 letter, and 21% (4 of 19) had gained ≥ 15 letters. Through 36 months, 11 eyes required additional bevacizumab retreatment therapy and received a mean of 3.0 injections (range, 2-7 injections). CONCLUSION: Epimacular brachytherapy shows promise as a therapeutic option for subfoveal neovascular age-related macular degeneration. The procedure was safe and well tolerated, with a reasonable risk-benefit profile that warrants further study in larger subject populations. The most common adverse event was cataract progression/formation. Surgical complications are similar to those expected from standard vitrectomy trials. This novel device is currently being evaluated in two prospective, randomized, controlled trials in treatment-naive subjects (CABERNET) and in subjects already treated with anti-vascular endothelial growth factor therapy (MERLOT).
Assuntos
Inibidores da Angiogênese/uso terapêutico , Anticorpos Monoclonais Humanizados/uso terapêutico , Braquiterapia/métodos , Neovascularização de Coroide/terapia , Degeneração Macular/complicações , Idoso , Bevacizumab , Braquiterapia/efeitos adversos , Neovascularização de Coroide/etiologia , Neovascularização de Coroide/fisiopatologia , Terapia Combinada , Estudos de Viabilidade , Feminino , Humanos , Degeneração Macular/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Dosagem Radioterapêutica , Radioisótopos de Estrôncio/uso terapêutico , Acuidade Visual/efeitos da radiação , Radioisótopos de Ítrio/uso terapêuticoRESUMO
The purpose is to report a complication after photodynamic therapy (PDT) and intravitreal triamcinolone for a presumed choroidal neovascularization in age-related macular degeneration. Photodynamic therapy and intravitreal triamcinolone were used in an 84-year-old man with choroidal neovascularization in the left eye. Forty-five days after therapy, the patient returned with a severe necrotizing uveitis in the posterior pole and vitritis. Laboratory investigation disclosed a high anti-Toxoplasma IgG titer. Therapy with pyrimethamine, sulfadiazine and folinic acid resulted in total lesion healing although central vision was lost. Intravitreal triamcinolone may have had an influence on the exacerbation of retinochoroiditis in the posterior pole of the patient. Although rare, this complication may not be disregarded in the cases that require intraocular corticosteroids for treatment of several conditions, especially in patients who had previously suffered from toxoplasmosis infection.
O objetivo é relatar complicação após terapia fotodinâmica (PDT) e triancinolona intravítrea para presumida neovascularização de coróide em degeneração macular relacionada à idade. A terapia fotodinâmica e triancinolona intravítrea foram utilizados em paciente de 84 anos, do sexo masculino, com neovascularização de coróide no olho esquerdo. Quarenta e cinco dias após o tratamento, o paciente retornou com grave retinite necrosante do pólo posterior e vitreíte. Investigação laboratorial indicou alto título de IgG anti-Toxoplasma. Tratamento com pirimetamina, sulfadiazina e ácido folínico levaram à total cicatrização da lesão embora a visão central tenha sido comprometida. Conclui-se que a triancinolona intravítrea pode ter influenciado na exacerbação da retinocoroidite no pólo posterior do paciente. Embora rara, esta complicação não pode ser descartada nos casos que necessitem corticóide intra-ocular para tratamento de várias doenças, principalmente em pacientes que tenham tido surtos prévios de toxoplasmose ocular.
Assuntos
Humanos , Masculino , Feminino , Idoso de 80 Anos ou mais , Coriorretinite/imunologia , Glucocorticoides/efeitos adversos , Hospedeiro Imunocomprometido , Porfirinas/administração & dosagem , Toxoplasmose Ocular/imunologia , Triancinolona Acetonida/efeitos adversos , Coriorretinite/tratamento farmacológico , Neovascularização de Coroide/etiologia , Neovascularização de Coroide/terapia , Angiofluoresceinografia , Glucocorticoides/administração & dosagem , Degeneração Macular/complicações , Fotoquimioterapia , Fármacos Fotossensibilizantes/administração & dosagem , Índice de Gravidade de Doença , Toxoplasmose Ocular/tratamento farmacológico , Triancinolona Acetonida/administração & dosagem , Acuidade VisualRESUMO
BACKGROUND AND OBJECTIVE: To evaluate the chorioretinal effects of transpupillary thermotherapy (TTT) and TTT enhanced by standard doses of indocyanine green (ICG) in pigmented rabbits. MATERIALS AND METHODS: In 25 eyes, two retinal areas were irradiated using identical subthreshold diode laser irradiation. The subthreshold diode laser irradiation level was first determined using the other eye. ICG (0.5 mg/kg) was injected before irradiation of the second area. Red-free photographs, fluorescein angiography, and ICG videoangiography were performed after TTT. Specimens were prepared for light microscopy. RESULTS: In 35% of the cases, ICG videoangiography revealed a hypofluorescent spot in the area irradiated after injection of ICG that disappeared after ICG re-injection. None of the areas irradiated before ICG injection were hypofluorescent. Red-free photographs and fluorescein angiography were normal in most cases. Light microscopy demonstrated patent choriocapillaris and choroid in most areas. CONCLUSIONS: Subthreshold TTT, whether enhanced by ICG or not, did not cause significant choroidal or choriocapillaris vascular occlusion. Standard doses of ICG had no significant effect on TTT.
Assuntos
Neovascularização de Coroide/terapia , Corantes/uso terapêutico , Hipertermia Induzida/métodos , Verde de Indocianina/uso terapêutico , Animais , Corioide/patologia , Neovascularização de Coroide/patologia , Corantes/administração & dosagem , Modelos Animais de Doenças , Angiofluoresceinografia , Seguimentos , Fundo de Olho , Verde de Indocianina/administração & dosagem , Injeções Intravenosas , Pupila , Coelhos , Retina/patologia , Gravação em VídeoRESUMO
BACKGROUND: To assess the effect of intravitreal triamcinolone acetonide (iTA) as an adjunctive treatment to transpupillary therapy (TTT) for new subfoveal choroidal neovascular membranes (CNV) in age-related macular degeneration (AMD). METHODS: This prospective randomized controlled pilot study comprised 26 patients scheduled to receive TTT, due to either absent indications for photodynamic therapy or financial issues. Patients were assigned into; Group A (n = 14) received TTT alone and Group B (n = 12) received iTA (4 mg) followed by TTT within one week. Follow ups were at 2 weeks, and 1, 3 and 6 months for; best-corrected visual acuity (BCVA) by ETDRS chart at 4 meters, intraocular pressures (IOP), fluorescein angiography (FAG), and central foveal thickness by optical coherence tomography (OCT). RESULTS: All 26 patients completed 6 months of follow ups. The average age for both groups was 74 years. Occult CNV formed 64% and 41%; classis/predominately classic 21% and 16.6%; and minimally classic 15% and 42.4% of group A and B respectively. At baseline; the mean BCVA was 0.045 for group A and 0.04 for group B; mean CNV size was 6.15 disc diameter (DD) and 2.44 DD; mean OCT foveal thickness was 513 um and 411 um for group A and B respectively with no statistical differences (P = 0.8, 0.07, and 0.19). At six months the proportion of patients gained > or = 1 lines was 14% and 25% (P = 0.136) and stabilization was 86% and 66% (P = 0.336); the mean size of the CNV was 5.63 DD and 2.67 DD (P = 0.162); rate of CNV closure was 64% and 83% (P = 0.275); and the mean OCT central foveal thickness was 516.36 um and 453.67 um (P = 0.341), for group A and B respectively. CONCLUSION: The use of iTA as an adjunctive to TTT for new subfoveal CNV in AMD showed a tendency towards better functional results. However due to the small sample size of the study a statistically significant results could not be reached.
Assuntos
Neovascularização de Coroide/terapia , Glucocorticoides/uso terapêutico , Hipertermia Induzida/métodos , Degeneração Macular/terapia , Triancinolona Acetonida/uso terapêutico , Idoso , Neovascularização de Coroide/etiologia , Terapia Combinada , Humanos , Injeções , Degeneração Macular/complicações , Projetos Piloto , Estudos Prospectivos , Pupila , Acuidade Visual , Corpo VítreoRESUMO
PURPOSE: To determine the feasibility, safety, and clinical effect of treating patients with subfoveal choroidal neovascularization (CNV) in age-related macular degeneration (AMD) with indocyanine green (ICG)-mediated photothrombosis (IMP) with and without intravitreal triamcinolone acetonide (TA). METHODS: Fifteen patients (19 eyes) participated in the study. Nine eyes of seven patients were treated with IMP immediately followed by an intravitreal injection of 4 mg of TA (Group A), and 10 eyes of 8 patients were treated with IMP only (Group B). Patients had a mean follow-up of 6.9 months (range: 3 to 12 months). Patients underwent single or two sessions of IMP. RESULTS: In Group A, visual acuity (VA) showed stability in 6 eyes (66.7%), improvement of VA in 2 eyes (22.2%), and worsening of VA in 1 eye (11.1%). Group B presented VA stability in 9 eyes (90%), and improvement in 1 eye (10%). In total, of the 15 patients (19 eyes) with IMP with or without intravitreal TA, 3 eyes (15.8%) showed improvement, 15 eyes (78.9%) stability, and 1 eye (5.3%) showed worsening of VA. A significant regression of the CNV and diminishing of subretinal fluid was demonstrated with fluorescein angiography and optical coherence tomography in both groups. No patient in Group A required retreatment. Four of 10 eyes (40%) in Group B required one retreatment during the study period. CONCLUSIONS: ICG-mediated photothrombosis with and without intravitreal TA may provide stability or improvement in visual acuity and fundus findings in subfoveal CNV in AMD. Further evaluation in a multicenter, randomized, placebo-controlled clinical trial with longer follow-up is needed to accurately assess the safety and efficacy of this new treatment modality.
Assuntos
Neovascularização de Coroide/terapia , Corantes/uso terapêutico , Embolização Terapêutica/métodos , Glucocorticoides/uso terapêutico , Verde de Indocianina/uso terapêutico , Degeneração Macular/terapia , Triancinolona Acetonida/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Neovascularização de Coroide/etiologia , Terapia Combinada , Estudos de Viabilidade , Feminino , Angiofluoresceinografia , Fóvea Central , Humanos , Injeções , Degeneração Macular/complicações , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos , Tomografia de Coerência Óptica , Acuidade Visual , Corpo VítreoRESUMO
A degeneraçäo macular senil é a principalcausa de cegueira legal em vários países do mundo ocidental e, atualmente, a maior causa de perda de visäo em pessoas acima de 50 anos. Este trabalho foi realizado com a finalidade de determinar se a terapia fotodinâmica com Verteporfirina pode reduzir com segurança o risco de perda de visäo nos pacientes com neovascularizaçäo coroideana com Degeneraçäo Macular Relacionada à Idade (DMRI). Trinta e cinco pacientes com DMRI foram submetidos à injeçäo de Verteporfirina (Visudyne), com subseqüente aplicaçäo de laser, de comprimento de onda de 690 nm, durante 83 segundos. Tais pacientes foram analisados quanto à acuidade visual pré e pós-tratamento, bem como quanto à regressäo ou näo da membrana neovascular. Dos 35 olhos estudados, a Membrana Neovascular Subretiniana (MNVSR) mostrou sinais de regressäo em 29 (82,86 por cento) deles. Nestes olhos a membrana era do tipo clássica ou predominantemente clássica. Em 6 (17,14 por cento) pacientes, näo houve regressäo da membrana. Quatro deles possuíam MNVSR com padräo angiográfico do tipo oculto e em 2 olhos a membrana era predominantemente clássica, porém muito espessa e extensa, näo havendo alteraçöes de suas características. Ocorreu recidiva em 11 (31,42 por cento) olhos. Houve melhora da visäo em 18 (51,42 por cento) pacientes; em 14 (40 por cento) pacientes manteve-se nos mesmos valores pré-tratamento; e em 3 pacientes houve piora da acuidade visual.A través desse estudo vemos que a Terapia Fotodinâmica é um bom método para controle da degeneraçäo macular relacionada à idade, principalmente quando a lesäo possui componente clássico e näo oculto. O seguimento desses pacientes, entretanto, ainda é muito pequeno para que conclusöes de mais longo prazo possam ser tiradas
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Fotoquimioterapia , Degeneração Macular , Neovascularização de Coroide/terapia , Doenças Retinianas/terapiaRESUMO
Photodynamic therapy (PDT) with verteporfin is a 2-step procedure that involves the infusion of phtosensitizing drug (verteporfin) followed by activation of the drug using a low density ("cold") laser at a wavelength of 689 nm. Once activated, free radicals are generated and cause thrombosis within the neovascular tissue and surrounding choriocapillaris. However, within 3 months, the neovascularization tends to recur in most patients and additional treatments are necessary to preserve vision and contain the growth of the neovascular lesion. PDT with verteporfin has been shown to be safe and effective for the treatment of choroidal neovascularization. The benefits of verteporfin therapy have been proven in several multicentre placebo controlled double-masked clinical trials. The treatment of Age-related Macular Degeneration with Photodynamic Therapy (TAP) investigation demonstrated that verteporfin therapy could prevent moderate visual loss, preserve contrast sensitivity, and contain lesion growth in subjects with predominantly classic choroidal neovascularization (CNV). This treatment benefit was observed at one-year and was sustained at 3 years. Another study known as the VIP Trial (Verteporfin In Photodynamic Therapy) demonstrated that verteporfin therapy was beneficial in patients with AMD and occult neovascularization. Another treatment arm of this same study demonstrated a treatment benefit for patients with pathologic myopia and CNV. Finally, in a small open-label study of patients with occular histoplasmosis and CNV known as the VOH (Verteporfin in Ocular Histoplasmosis) Study, verteporfin therapy was found to result in overall visual improvement . Additional studies are ongoing to improve this therapy and broaden the indications for use in all patients with CNV. (AU)