RESUMO
PURPOSE: To report surgical outcomes in a series of cases with symptomatic vitreomacular traction that met MIVI-TRUST (Microplasmin for intravitreous injection-traction release without surgical treatment) criteria for ocriplasmin use who underwent primary 25-gauge vitrectomy. MATERIALS AND METHODS: A single-center retrospective chart review study was performed in patients who underwent primary 25-gauge vitrectomy for symptomatic vitreomacular traction (VTM) from January 2013 through January 2016. Pre- and postoperative visual acuity (measured by the early treatment diabetic retinopathy acuity test), and posterior hyaloid focal attachment to the macula (demonstrated by high-definition optical coherence tomography) were analyzed. In addition, intra- and postoperative complications were obtained from medical records. RESULTS: Fifteen consecutive cases of symptomatic VMT traction that underwent primary 25-gauge vitrectomy were included. All met the MIVI-TRUST criteria for ocriplasmin use. In all cases, VMT resolution, macular hole closure, and improvement in best corrected visual acuity (BCVA) were observed. Mean visual acuity improved from 56.53 ± 16.04 letters at baseline to 73.13 ± 7.46 letters at 24 weeks of follow-up. The mean BCVA improvement from baseline was 16.60 letters (range 6-44), which was statistically significant (P < 0.0001). Ten of fifteen patients (66.6%) showed significant improvement of their BCVA to 20/40 or better (70 or more in ETDRS visual acuity test). No significant intra- or postoperative complications were documented. CONCLUSIONS: Primary 25-gauge pars plana vitrectomy in eyes with symptomatic vitreomacular traction is able to efficiently resolve VMT and macular holes, improving vision in candidates for intravitreal injection of ocriplasmin. This well-tolerated surgical procedure may be a reliable and predictable alternative for resolving VMT pathology.
Assuntos
Oftalmopatias/cirurgia , Fibrinolisina/administração & dosagem , Fibrinolíticos/administração & dosagem , Fragmentos de Peptídeos/administração & dosagem , Perfurações Retinianas/cirurgia , Vitrectomia/métodos , Corpo Vítreo/cirurgia , Idoso , Terapia Combinada , Oftalmopatias/diagnóstico por imagem , Oftalmopatias/fisiopatologia , Feminino , Humanos , Injeções Intravítreas , Masculino , Microcirurgia , Pessoa de Meia-Idade , Perfurações Retinianas/diagnóstico por imagem , Perfurações Retinianas/fisiopatologia , Estudos Retrospectivos , Tomografia de Coerência Óptica , Acuidade Visual/fisiologia , Corpo Vítreo/diagnóstico por imagem , Corpo Vítreo/fisiopatologiaRESUMO
PURPOSE: To assess whether hyaloid adhesion is more prevalent in patients with age-related macular degeneration (AMD) than in control patients and to evaluate whether it is more prevalent in exudative AMD than in non-exudative AMD. METHODS: This was a cross-sectional, controlled analytical study. Patients from the Ophthalmology Department of the Public Service Hospital of the State of São Paulo were included if they were diagnosed with AMD that was confirmed by fundus biomicroscopy and fluorescein angiography. Patients were divided into three groups: patients without a vitreoretinal disease (controls), patients with exudative AMD, and patients with non-exudative AMD. For the optimal study of the vitreoretinal interface, all patients were subjected to spectral-domain optical coherence tomography (SD-OCT; Cirrus HD-OCT, version 4000; Carl Zeiss Meditec) and ultrasonography (UltraScan®, Alcon). Results with p values of ≤0.05 were considered statistically significant. RESULTS: We assessed 75 eyes of 23 patients with AMD (14 women and nine men) and 15 the control patients (11 women and four men). In total, 33 eyes had AMD that was consistent with the inclusion criteria, of which 11 had the non-exudative form (non-atrophic) and 22 had the exudative form (11 active and 11 disciform scars). Adherence was observed in eight eyes in the control group (26.67%), in seven eyes with exudative AMD (31.82%), and in five eyes with non-exudative AMD (45.45%). CONCLUSION: Patients with exudative and non-exudative forms of AMD did not present with higher vitreoretinal adhesion than control patients as assessed by SD-OCT and ultrasound. Moreover, patients with exudative AMD (neovascular membrane and disciform scar) did not reveal a higher adherence than those with non-exudative AMD when evaluated by the same methods.
Assuntos
Degeneração Macular/patologia , Retina/patologia , Corpo Vítreo/patologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Estudos de Casos e Controles , Estudos Transversais , Membrana Epirretiniana/patologia , Feminino , Humanos , Degeneração Macular/diagnóstico por imagem , Degeneração Macular/fisiopatologia , Masculino , Pessoa de Meia-Idade , Retina/fisiopatologia , Fatores de Risco , Aderências Teciduais , Tomografia de Coerência Óptica , Ultrassonografia , Corpo Vítreo/fisiopatologiaRESUMO
ABSTRACT Purpose: To assess whether hyaloid adhesion is more prevalent in patients with age-related macular degeneration (AMD) than in control patients and to evaluate whether it is more prevalent in exudative AMD than in non-exudative AMD. Methods: This was a cross-sectional, controlled analytical study. Patients from the Ophthalmology Department of the Public Service Hospital of the State of São Paulo were included if they were diagnosed with AMD that was confirmed by fundus biomicroscopy and fluorescein angiography. Patients were divided into three groups: patients without a vitreoretinal disease (controls), patients with exudative AMD, and patients with non-exudative AMD. For the optimal study of the vitreoretinal interface, all patients were subjected to spectral-domain optical coherence tomography (SD-OCT; Cirrus HD-OCT, version 4000; Carl Zeiss Meditec) and ultrasonography (UltraScan®, Alcon). Results with p values of ≤0.05 were considered statistically significant. Results: We assessed 75 eyes of 23 patients with AMD (14 women and nine men) and 15 the control patients (11 women and four men). In total, 33 eyes had AMD that was consistent with the inclusion criteria, of which 11 had the non-exudative form (non-atrophic) and 22 had the exudative form (11 active and 11 disciform scars). Adherence was observed in eight eyes in the control group (26.67%), in seven eyes with exudative AMD (31.82%), and in five eyes with non-exudative AMD (45.45%). Conclusion: Patients with exudative and non-exudative forms of AMD did not present with higher vitreoretinal adhesion than control patients as assessed by SD-OCT and ultrasound. Moreover, patients with exudative AMD (neovascular membrane and disciform scar) did not reveal a higher adherence than those with non-exudative AMD when evaluated by the same methods.
RESUMO Objetivo: Avaliar se a adesão hialoidea é mais prevalente em pacientes com degeneração macular relacionada a idade (DMRI) (exsudativa e não exsudativa) comparado ao grupo controle e avaliar se a prevalência é maior na forma exsudativa comparada a forma não exsudativa. Métodos: Trata-se de um estudo transversal, analítico, de grupo controle, com os pacientes atendidos no Departamento de Retina do Serviço de Oftalmologia do Hospital do Servidor Público Estadual de São Paulo (HSPE), que tiveram o diagnóstico de DMRI confirmado após a biomicroscopia de fundo e angiofluoresceinografia. Os pacientes foram divididos em três grupos, um composto por pacientes sem doenças vitreorretinianas (30 olhos), outro pacientes com DMRI exsudativa (22 olhos) e o terceiro grupo por pacientes com DMRI não exsudativa (11 olhos). Para melhor estudo da interface vitreorretiniana, todos os pacientes foram submetidos aos exames de SD-TCO (Cirrus HD-TCO, versão 4000; Carl Zeeis Meditec) e ultrassonografia (UltraScan®, Alcon). Foram considerados significativos os resultados com valor de p≤0,05. Resultados: Foram avaliados 75 olhos de 23 pacientes com DMRI e 15 no grupo controle, sendo que apenas 33 olhos que apresentavam DMRI obedeciam aos critérios de inclusão, sendo 11 pertencentes à forma seca (nenhuma forma atrófica) e 22 à forma exsudativa (11 de forma ativa e 11 disciforme). A adesão foi encontrada em oito olhos no grupo controle (26,67%), em sete olhos com DMRI exsudativa (31,82%) e em cinco olhos no grupo DMRI não exsudativa (45,45%). Conclusão: Neste estudo, pacientes com DMRI (formas exsudativa e não exsudativa) não apresentaram maior adesão vitreorretiniana quando comparados ao grupo controle, ao serem avaliados através SD-TCO (Cirrus HD-TCO, versão 4000; Carl Zeeis Meditec) e ultrassonografia (UltraScan®, Alcon). Neste estudo, pacientes com DMRI exsudativa (ativa e disciforme) não apresentaram maior adesão quando comparados à forma seca, ao serem avaliados pelos mesmos métodos.
Assuntos
Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Degeneração Macular/patologia , Retina/patologia , Corpo Vítreo/patologia , Fatores Etários , Análise de Variância , Estudos de Casos e Controles , Estudos Transversais , Membrana Epirretiniana/patologia , Degeneração Macular/fisiopatologia , Degeneração Macular , Fatores de Risco , Retina/fisiopatologia , Aderências Teciduais , Tomografia de Coerência Óptica , Corpo Vítreo/fisiopatologiaRESUMO
PURPOSE OF REVIEW: As Reese first described the vitreomacular traction (VMT) syndrome in 1970, the knowledge base about the disease has been changing over time due to the advent of the high-definition optical coherence tomography (HD-OCT). The aim of this article was to present the current information on the pathophysiology, anatomic macular abnormality associations, treatments, and new concepts in VMT syndrome. RECENT FINDINGS: HD-OCT has provided unprecedented visualization of the vitreomacular interface, which has led to better comprehension of the VMT syndrome. The technologic advances also emphasized the need to review the basis of the VMT syndrome and define as yet unsettled and often confusing concepts. SUMMARY: The recognition of the role of VMT in a variety of macular conditions is imperative for proper diagnosis and appropriate management of these diseases.
Assuntos
Oftalmopatias/fisiopatologia , Doenças Retinianas/fisiopatologia , Corpo Vítreo/fisiopatologia , Oftalmopatias/diagnóstico , Oftalmopatias/cirurgia , Humanos , Retina/metabolismo , Doenças Retinianas/diagnóstico , Doenças Retinianas/cirurgia , Síndrome , Aderências Teciduais/metabolismo , Tomografia de Coerência Óptica/métodos , Tração , Acuidade Visual/fisiologia , Corpo Vítreo/metabolismoRESUMO
Diabetic retinopathy (DR) remains the major threat to sight in the working age population. Diabetic macular edema (DME) is a manifestation of DR that produces loss of central vision. Macular edema within 1 disk diameter of the fovea is present in 9% of the diabetic population. Proliferative diabetic retinopathy (PDR) is a major cause of visual loss in diabetic patients. In PDR, the growth of new vessels from the retina or optic nerve, is thought to occur as a result of vascular endothelial growth factor (VEGF) release into the vitreous cavity as a response to ischemia. Furthermore, VEGF increases vessel permeability leading to deposition of proteins in the interstitium that facilitate the process of angiogenesis and macular edema. This review demonstrates multiple benefits of intravitreal bevacizumab on DR including DME and PDR. The results indicate that intravitreal bevacizumab injections may have a beneficial effect on macular thickness and visual acuity (VA), independent of the type of macular edema that is present. Therefore, in the future this new treatment modality could replace or complement focal/grid laser photocoagulation in DME. In addition, in PDR, this new option could be an adjuvant agent to PRP so that more selective therapy may be applied.
Assuntos
Inibidores da Angiogênese/uso terapêutico , Anticorpos Monoclonais/uso terapêutico , Retinopatia Diabética/tratamento farmacológico , Edema Macular/tratamento farmacológico , Neovascularização Patológica/prevenção & controle , Corpo Vítreo/efeitos dos fármacos , Anticorpos Monoclonais Humanizados , Bevacizumab , Retinopatia Diabética/patologia , Humanos , Edema Macular/patologia , Nervo Óptico/efeitos dos fármacos , Nervo Óptico/patologia , Recidiva , Vasos Retinianos/efeitos dos fármacos , Vasos Retinianos/patologia , Fator A de Crescimento do Endotélio Vascular/fisiologia , Corpo Vítreo/irrigação sanguínea , Corpo Vítreo/fisiopatologiaRESUMO
De 132 ojos operados de agujero macular en forma consecutiva, 120 (91 por ciento) tuvieron cierre del agujero después de la cirugía inicial. De estos 120 ojos 5 (4.2 por ciento) se reabrieron entre 7 y 63 meses (promedio 25.2 meses) después de la primera cirugía. Los cinco ojos fueron sometidos a una segunda cirugía, la cual tuvo éxito al cerrar el agujero y mejorar la agudeza visual en todos los casos. Dos de estos agujeros se volvieron a abrir 2.5 y 28 meses después de la segunda cirugía, ambos fueron sometidos a un tercer procedimiento el cual tuvo éxito al cerrar el agujero y mejorar la agudeza visual en ambos casos. Una nueva vitrectomía puede resultar en cierre del agujero y mejoría de la agudeza visual, después de una tercer cirugía
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Perfurações Retinianas/cirurgia , Perfurações Retinianas/terapia , Vitrectomia , Procedimentos Cirúrgicos Oftalmológicos , Retina/cirurgia , Retina/patologia , Olho/patologia , Corpo Vítreo/fisiopatologiaRESUMO
La diálisis temporal inferior de la retina (DTIR) es una entidad frecuente. No se ha podido determinar de forma precisa su etiología. Se realizó un estudio retrospectivo a 3 años en el Hospital de la Luz, en el cual se revisaron expedientes de 36 pacientes (46 ojos) con DTIR. La incidencia fue de 11.78 por ciento con predominio en el sexo masculino. En el 69 por ciento de los casos se consideró de etiología idiopática, siendo unilateral en 72 por ciento y bilateral en 28 por ciento. El síntoma principal fue la disminución de agudeza visual aun cuando se conserva una visión aceptable al momento de diagnóstico. La degeneración microquística fue la principal lesión periférica asociada, se encontró en 15.2 por ciento de los ojos afectados y en el 11 por ciento de los ojos contralaterales. En el 93 por ciento de los casos se realizó cirugía presentando una evolución satisfactoria en el 80.4 por ciento con pocas complicaciones. La DTIR resalta como una lesión frecuente con alta prevalencia en México y quizá en otros países con características reciales similares.
Assuntos
Humanos , Masculino , Adulto , Perfurações Retinianas/fisiopatologia , Corpo Vítreo/fisiopatologia , Fotocoagulação/reabilitação , Fotocoagulação , Descolamento Retiniano/complicações , Oftalmopatias/fisiopatologiaRESUMO
Se presenta el estudio clínico y genético de una familia (cinco casos) con Síndrome de Goldmann-Favé. Cuatro pacientes son del sexo femenino y uno masculino: Todos con disminución de la agudeza visual bilateral, con nictalopia reportada desde la primera década de la vida, presencia de catarata subcapsular posterior en algunos de ellos; así como desprendimiento de retina en tres pacientes. En la exploración al fondo de ojo se encontró licuefacción vítrea y datos de retinosis pigmentaria.