RESUMO
PURPOSE: To report a rare presentation of ocular von Hippel-Lindau disease associated with a massive epiretinal vascular proliferation over the macula removed by vitrectomy and submitted to histological analysis. METHODS: Interventional case report. RESULTS: A 13-year-old woman with von Hippel-Lindau disease reported progressive visual loss in the right eye over the preceding 6 months. Best-corrected visual acuity was 20/100 in the right eye. Fundoscopy showed retinal neovascularization (RNV) with macular traction and a small superotemporal hemangioblastoma. Spectral-domain optical coherence tomography confirmed increased macular thickness and macular traction secondary to RNV. Bevacizumab was injected intravitreally, resulting in partial regression of RNV. Five days after the injection, the patient underwent complete removal of fibrovascular proliferation via pars plana vitrectomy, followed by peripheral tumor photocoagulation. The specimen was subjected to histopathological and immunohistochemical analyses. At 2 years of follow-up, vision had improved to 20/30, and anatomical improvement was confirmed on both fundoscopy and spectral-domain optical coherence tomography. CONCLUSION: Ocular von Hippel-Lindau disease may be associated with RNV and macular traction. In such cases, RNV is likely responsive to anti-vascular endothelial growth factor and may be removed surgically along a cleavage plane between the tissue proliferation and the inner retina. In the reported case, the procedure was found to be safe and associated with macular anatomical improvement and vision recovery.
Assuntos
Neovascularização Retiniana , Doença de von Hippel-Lindau , Adolescente , Feminino , Angiofluoresceinografia/métodos , Humanos , Imuno-Histoquímica , Neovascularização Retiniana/diagnóstico , Neovascularização Retiniana/etiologia , Tomografia de Coerência Óptica , Vitrectomia , Doença de von Hippel-Lindau/complicações , Doença de von Hippel-Lindau/cirurgiaRESUMO
PURPOSE: To report features of neovascular age-related macular degeneration (AMD) in Brazilian patients. PROCEDURES: Data were prospectively collected from patients diagnosed with neovascular AMD. Eyes were classified as having typical neovascular AMD, polypoidal choroidal vasculopathy (PCV), or retinal angiomatous proliferation (RAP). RESULTS: In total, 265 eyes of 207 patients of predominantly Caucasian ancestry were included; 166 (62.6%) eyes had typical neovascular AMD, 65 (24.5%) eyes had PCV, and 34 (12.8%) eyes had RAP. RAP demonstrated a higher percentage of bilateral cases (p = 0.015). The mean foveal subfield thickness was significantly lower in eyes with PCV (p < 0.001). Cases with typical neovascular AMD had a higher percentage of predominantly classic and minimally classic lesions on fluorescein angiography (FA; p = 0.005). CONCLUSIONS: In Brazilian patients, PCV and RAP represented 24.5 and 12.8% of neovascular AMD cases. Neovascular AMD subtypes differ in relation to clinical features, mean foveal subfield thickness and FA presentation.
Assuntos
Neovascularização de Coroide/diagnóstico , Pólipos/diagnóstico , Neovascularização Retiniana/diagnóstico , Degeneração Macular Exsudativa/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Inibidores da Angiogênese/uso terapêutico , Brasil/epidemiologia , Neovascularização de Coroide/tratamento farmacológico , Neovascularização de Coroide/epidemiologia , Feminino , Angiofluoresceinografia , Humanos , Injeções Intravítreas , Masculino , Pessoa de Meia-Idade , Pólipos/tratamento farmacológico , Pólipos/epidemiologia , Estudos Prospectivos , Neovascularização Retiniana/tratamento farmacológico , Neovascularização Retiniana/epidemiologia , Tomografia de Coerência Óptica , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Acuidade Visual , Degeneração Macular Exsudativa/tratamento farmacológico , Degeneração Macular Exsudativa/epidemiologiaRESUMO
Retinal vasoproliferative tumor is a rare disease that has capillary hemangioma as the most frequent diferential diagnosis. The tumor is considered to be of reactive nature. It can be idiophatic or secondary to other ocular diseases such as: uveitis, retinitis pigmentosa, sickle cell disease, previous surgery and retinopathy of prematurity. Lesions with no exsudation or visual decrease can be observed. Lesions that need treatment can be managed by on or more modalities such as cryotherapy, a variety of lasers, surgical excision, radiation, and antiangiogenic intravitreal injections.
Assuntos
Neoplasias da Retina/diagnóstico , Neoplasias da Retina/terapia , Neovascularização Retiniana/diagnóstico , Neovascularização Retiniana/terapia , Braquiterapia , Crioterapia , Diagnóstico Diferencial , HumanosRESUMO
Retinal vasoproliferative tumor is a rare disease that has capillary hemangioma as the most frequent diferential diagnosis. The tumor is considered to be of reactive nature. It can be idiophatic or secondary to other ocular diseases such as: uveitis, retinitis pigmentosa, sickle cell disease, previous surgery and retinopathy of prematurity. Lesions with no exsudation or visual decrease can be observed. Lesions that need treatment can be managed by on or more modalities such as cryotherapy, a variety of lasers, surgical excision, radiation, and antiangiogenic intravitreal injections.
O tumor vasoproliferativo da retina é uma lesão rara, cujo principal diagnóstico diferencial é o hemangioma capilar da retina. O tumor tem natureza reacional. Pode ser idiopático ou secundário a outras doenças como: uveítes, retinose pigmentar, retinopatia da anemia falciforme, cirurgia prévia e retinopatia da prematuridade. Lesões sem exsudação ou baixa visual podem ser observadas. Quando há indicação de tratamento este pode ser feito pela crioterapia, vários tipos de lasers, excisão cirúrgica, radioterapia e injeções intravítrea de antiangiogênicos, isoladamente ou em associação.
Assuntos
Humanos , Neoplasias da Retina/diagnóstico , Neoplasias da Retina/terapia , Neovascularização Retiniana/diagnóstico , Neovascularização Retiniana/terapia , Braquiterapia , Crioterapia , Diagnóstico DiferencialRESUMO
The aim of this report is to describe a case of age-related macular degeneration with juxtafoveal subretinal neovascular membrane, initially treated with intravitreal bevacizumab (Avastin(®)) and afterwards with focal photocoagulation laser therapy. The efficacy of the initial and complementary treatment was evaluated through the visual acuity measurement and complementary exams (fluorescein angiography and optical coherence tomography). After three bevacizumab intravitreal injections , it has occurred the eccentric reduction of the neovascular subretinal membrane, changing its classification to extrafoveal, what allowed the subsequent treatment with focal photocoagulation laser therapy.
Assuntos
Inibidores da Angiogênese/uso terapêutico , Anticorpos Monoclonais Humanizados/uso terapêutico , Fotocoagulação , Neovascularização Retiniana/terapia , Idoso , Bevacizumab , Terapia Combinada/métodos , Angiofluoresceinografia , Humanos , Masculino , Neovascularização Retiniana/diagnóstico , Tomografia de Coerência Óptica , Resultado do TratamentoRESUMO
O objetivo deste relato é descrever um caso de degeneração macular relacionada à idade com presença de membrana neovascular sub-retiniana (MNVSR) justafoveal, tratada inicialmente com bevacizumab (Avastin®) intravítrea e posteriormente com terapia de fotocoagulação focal (TFC) com laser. A eficácia do tratamento inicial e complementar foi avaliada pela medida da acuidade visual e por exames complementares (angiografia fluoresceínica e tomografia de coerência óptica). Após três injeções intravítreas de bevacizumab ocorreu a redução excêntrica da MNVSR, alterando sua classificação para extrafoveal, o que permitiu o tratamento subsequente com TFC.
The aim of this report is to describe a case of age-related macular degeneration with juxtafoveal subretinal neovascular membrane, initially treated with intravitreal bevacizumab (Avastin®) and afterwards with focal photocoagulation laser therapy. The efficacy of the initial and complementary treatment was evaluated through the visual acuity measurement and complementary exams (fluorescein angiography and optical coherence tomography). After three bevacizumab intravitreal injections , it has occurred the eccentric reduction of the neovascular subretinal membrane, changing its classification to extrafoveal, what allowed the subsequent treatment with focal photocoagulation laser therapy.
Assuntos
Idoso , Humanos , Masculino , Inibidores da Angiogênese/uso terapêutico , Anticorpos Monoclonais Humanizados/uso terapêutico , Fotocoagulação , Neovascularização Retiniana/terapia , Terapia Combinada/métodos , Angiofluoresceinografia , Neovascularização Retiniana/diagnóstico , Tomografia de Coerência Óptica , Resultado do TratamentoRESUMO
PURPOSE: To create a retinal neovascularization experimental model using intravitreal injection of microspheres loaded with latex-derived angiogenic fraction. METHODS: Thirty-two albino New Zealand rabbits, divided in 4 groups of 8 animals, were enrolled in this study. Rabbits in groups I, II, and III received one intravitreal injection of PLGA (L-lactide-co-glycolide) microspheres with 10, 30, and 50 microg of latex-derived angiogenic fraction into their right eyes, respectively, and group IV received 0.1 ml of microspheres without the angiogenic fraction. Weekly follow-up with ophthalmoscopy and fluorescein angiography was performed; the rabbits were sacrificed in the 4th week and their eyes processed for light microscopy. RESULTS: All eyes from group I demonstrated increased retinal vascular tortuosity, observed from 14 days after injection and maintained for 28 days, otherwise without new vessels detection. All group II eyes showed vascular changes similar to group I. Fifty percent of the eyes from group II rabbits developed retinal neovascularization 21 days after injection. All eyes from group III demonstrated significant vascular tortuosity and retinal new vessels 2 weeks after injection, progressing to fibrovascular proliferation and tractional retinal detachment. No vascular changes or retinal new vessels were observed in group IV eyes. Light microscopy confirmed the existence of new vessels previously seen on fluorescein angiography, in retinal sections adjacent to the optic disc, not observed in sections at the same area in the control group. CONCLUSION: Thirty- and 50-microg microspheres containing latex-derived angiogenic fraction injected into the vitreous cavity induced retinal neovascularization in rabbits.
Assuntos
Indutores da Angiogênese/toxicidade , Modelos Animais de Doenças , Látex/toxicidade , Neovascularização Retiniana/induzido quimicamente , Vasos Retinianos/efeitos dos fármacos , Animais , Portadores de Fármacos , Feminino , Angiofluoresceinografia , Ácido Láctico , Microesferas , Oftalmoscopia , Ácido Poliglicólico , Copolímero de Ácido Poliláctico e Ácido Poliglicólico , Coelhos , Neovascularização Retiniana/diagnóstico , Vasos Retinianos/patologiaRESUMO
PURPOSE: To describe the clinical, angiographic, and optical coherence tomography findings of a patient with subretinal neovascularization (SRN) in idiopathic juxtafoveolar retinal telangiectasis (IJRT) treated with intravitreal bevacizumab injection. METHODS: In the setting of a tertiary referral center, a patient with bilateral acquired IJRT, complicated with juxtafoveal SRN in one eye, was treated with a single intravitreal injection of 1.5 mg of bevacizumab and then prospectively followed for 24 weeks. RESULTS: Vision improved from 20/40(-1) to 20/20(-2) by 24 weeks of follow-up. Fluorescein angiography demonstrated the absence of leakage from a previously active SRN. Optical coherence tomography revealed gradual neovascular lesion contraction and the resolution of subretinal fluid over the 24-week follow-up period. No obvious adverse events were noted. CONCLUSIONS: In the short-term, intravitreal bevacizumab treatment resulted in partial restoration of the macular architecture and vision improvement by means of neovascular lesion regression and the resolution of associated serohemorrhagic complications.
Assuntos
Inibidores da Angiogênese/uso terapêutico , Anticorpos Monoclonais/uso terapêutico , Doenças Retinianas/complicações , Neovascularização Retiniana/tratamento farmacológico , Vasos Retinianos/patologia , Telangiectasia/complicações , Anticorpos Monoclonais Humanizados , Bevacizumab , Feminino , Angiofluoresceinografia , Fóvea Central , Humanos , Injeções , Pessoa de Meia-Idade , Neovascularização Retiniana/diagnóstico , Neovascularização Retiniana/etiologia , Tomografia de Coerência Óptica , Resultado do Tratamento , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Acuidade Visual/efeitos dos fármacos , Corpo VítreoRESUMO
OBJECTIVE: To evaluate the short-term fluorescein angiographic and visual acuity effects of a single intravitreal injection of bevacizumab (Avastin) for the management of persistent new vessels (NV) associated with diabetic retinopathy. METHODS: A prospective, nonrandomized open-label study of diabetic patients with actively leaking NV refractory to laser treatment and best-corrected Early Treatment Diabetic Retinopathy Study visual acuity (BCVA) worse than 20/40. Standardized ophthalmic evaluation was performed at baseline and at weeks 1, 6, and 12 (+/-1) following intravitreal injection of 1.5 mg of bevacizumab. Main outcome measures include changes in total area of fluorescein leakage from active NV and BCVA. RESULTS: Fifteen consecutive patients (men, 9 [60%]; women, 6 [40%]) were included and all completed the 12-week follow-up period of the study. The mean +/- SD age of participants was 60.08 +/- 7.75 years (median, 59.5; range, 49-73 years). At baseline, mean +/- standard error of the mean (SEM) NV leakage area was 27.79 +/- 6.29 mm2. The mean +/- SEM area of active leaking NV decreased significantly to 5.43 +/- 2.18 mm2 and 5.50 +/- 1.24 mm2 (P < 0.05, Tukey multiple comparisons post-test) at 1 and 12 weeks postinjection, respectively; at week 6 no leakage was observed. The mean +/- SEM logMAR (Snellen equivalent) BCVA improved significantly from 0.90 (20/160) +/- 0.11 at baseline to 0.76 (20/125(+2)) +/- 0.12, 0.77 (20/125(+2)) +/- 0.11, and 0.77 (20/125(+2)) +/- 0.12 at weeks 1, 6, and 12, respectively (P < 0.05, Tukey multiple comparisons post-test). No major adverse events were observed. CONCLUSIONS: Intravitreal injection of bevacizumab achieved short-term reduction of fluorescein leakage from persistent active NV without loss of vision in patients with diabetic retinopathy. Further studies to investigate the role of anti-VEGF therapy with bevacizumab for the management of diabetic retinopathy refractory to laser treatment are warranted.
Assuntos
Inibidores da Angiogênese/uso terapêutico , Anticorpos Monoclonais/uso terapêutico , Retinopatia Diabética/tratamento farmacológico , Neovascularização Retiniana/tratamento farmacológico , Adulto , Idoso , Anticorpos Monoclonais Humanizados , Bevacizumab , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 2/complicações , Retinopatia Diabética/diagnóstico , Retinopatia Diabética/fisiopatologia , Feminino , Angiofluoresceinografia , Seguimentos , Humanos , Injeções , Masculino , Pessoa de Meia-Idade , Neovascularização Retiniana/diagnóstico , Neovascularização Retiniana/fisiopatologia , Resultado do Tratamento , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Fator A de Crescimento do Endotélio Vascular/imunologia , Acuidade Visual/fisiologia , Corpo VítreoRESUMO
Fundus flavimaculatus is a progressive, bilateral, hereditary retinal dystrophy characterized by ill-defined, yellowish, pisiform flecks at the level of the retinal pigment epithelium. Since the disease process is at level of the retinal pigment epithelium, it is not surprising that subretinal macular neovascularizations might occur. Nevertheless, they have been rarely reported as complications of the disease. The following report describes a case of fundus flavimaculatus that progressed with blurred vision by a subretinal macular neovascularization.