ABSTRACT
ABSTRACT Purpose: To analyze the effects of injections of intravitreal triamcinolone acetonide (IVTA) and intravitreal bevacizumab (IVB) on the incidence rates of anterior segment neovascularization (ASN) and neovascular glaucoma (NVG) in patients with macular edema secondary to central retinal vein occlusion (CRVO). Methods: In this prospective, randomized, double-masked, sham-controlled study, 35 patients with macular edema following CRVO were randomized to intravitreal bevacizumab, intravitreal triamcinolone acetonide, or sham injections during the first 6 months of the study. The primary outcome was the incidence rate of ASN at month 6. The secondary outcomes were the mean changes from baseline in best-corrected visual acuity (BCVA) and central foveal thickness (CFT) on optical coherence tomography over time to month 12. Results: ASN developed in 8 (22.86%) eyes, including 5 (62.50%) eyes in the sham group and 3 (37.50%) eyes in the IVTA group, during 12 months of fol low-up (p=0.009). BCVA differed significantly (p<0.05) among the groups only at month 1. CFT did not differ significantly (p<0.05) among the groups over 12 months. NVG required surgery and developed in one eye despite laser treatment. Conclusion: Early treatment with intravitreal antivascular endothelial growth factor therapy decreases the rates of ASN and NVG after CRVO.
RESUMO Objetivo: Analisar as taxas de incidência de neovascularização do segmento anterior (NSA) e de glaucoma neovascular (GNV), em pacientes com edema macular secundário a oclusão de veia central da retina (OVCR), em tratamento com injeções intravítreas de triamcinolona (IVTA) ou bevacizumab (IVB). Métodos: Neste estudo prospectivo, randomizado, duplo mascarado e sham controlado, 35 pacientes com edema macular secundário a OVCR foram randomizados para IVB, IVTA ou para o grupo controle (sham), durante os 6 primeiros meses do estudo. O desfecho primário foi a taxa de incidência de NSA no mês 6. Os desfechos secundários foram alterações médias da acuidade visual corrigida (BCVA) e espessura foveal central (EFC) ao exame de tomografia de coerência óptica, até o mês 12. Resultados: NSA ocorreu em oito (22,86%) olhos, cinco (62,50%) olhos no grupo sham e três (37,50%) olhos no grupo tratado com injeções intravítreas de Triamcinolona, Não houve nenhum caso com NSA no grupo tratado com bevacizumab durante 12 meses de acompanhamento (p=0,009). A BCVA apresentou diferença estatisticamente significante (p<0,05) entre os grupos, somente no mês 1. A EFC não apresentou diferenças estatisticamente significantes (p<0,05) entre os grupos ao longo dos 12 meses. GNV ocorreu em um olho apesar do tratamento com laser e este paciente necessitou de intervenção cirúrgica. Conclusão: O tratamento precoce com injeções intravítreas de Anti VEGF podem diminuir as taxas de neovascularização do segmento anterior e glaucoma neovascular após oclusão de veia central da retina.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Triamcinolone Acetonide/administration & dosage , Macular Edema/drug therapy , Angiogenesis Inhibitors/administration & dosage , Bevacizumab/administration & dosage , Anti-Inflammatory Agents/administration & dosage , Neovascularization, Pathologic/epidemiology , Retinal Artery Occlusion/complications , Visual Acuity , Glaucoma, Neovascular/drug therapy , Macular Edema/etiology , Double-Blind Method , Incidence , Prospective Studies , Follow-Up Studies , Angiogenesis Inhibitors/adverse effects , Intravitreal Injections , Bevacizumab/adverse effects , Fovea Centralis/physiopathology , Anterior Eye Segment/blood supply , Anti-Inflammatory Agents/adverse effects , Neovascularization, Pathologic/etiologySubject(s)
Adult , Angiogenesis Inhibitors/administration & dosage , Anterior Eye Segment/blood supply , Antibodies, Monoclonal/administration & dosage , Child , Follow-Up Studies , Humans , Infant , Infant, Newborn , Injections , Ischemia/diagnosis , Laser Coagulation/adverse effects , Retinopathy of Prematurity/surgery , Severity of Illness Index , Treatment Outcome , Vascular Endothelial Growth Factor A , Vitreous BodyABSTRACT
Aggressive posterior retinopathy of prematurity (formerly known as fulminate/type II/rush disease) occurs in zone 1 or posterior zone 2. Treatment involves extensive near confluent laser ablation of a large area of avascular retina. Anterior segment ischemia is a rare complication that can occur due to injury to the long posterior ciliary arteries in the horizontal meridians during aggressive posterior laser treatment. The outcome of this rare complication is very poor. This case describes a favorable outcome of intravitreal injection of bevacizumab (Avastin) in a case of anterior segment ischemia.
Subject(s)
Angiogenesis Inhibitors/therapeutic use , Anterior Eye Segment/blood supply , Antibodies, Monoclonal/therapeutic use , Humans , Infant, Newborn , Ischemia/drug therapy , Laser Therapy/adverse effects , Male , Neovascularization, Pathologic/drug therapy , Retinopathy of Prematurity/physiopathology , Severity of Illness IndexABSTRACT
A etiologia da neuropatia óptica isquêmica anterior (NOIA) foi estudada em 328 pacientes consecutivos, examinados num período de 13 anos.A forma arterítica, causada especificamente pela arterite de células gigantes (NOIA-A), foi observada em 7,6 por cento dos casos, enquanto a forma näo arterítica (MOIA-NA) foi dividida no grupo idiopático (57,6 por cento) e no grupo de causas determinadas (34,8 por cento). Distúrbios hemodinâmicos de diferentes causas, embolias de origem cardíaca e arterial, distúrbios hematológicos trombogênicos, distúrbios oculares, doenças do tecido conectivo, sífilis, irradiaçäo, doença de Raynaud, uso de amiodarona, diabetes juvenil, e manipulaçäo cirúrgica foram encontrados como causa da NOIA-NA. Os achados do presente estudo foram comparados com os relatados na literatura. Este estudo demonstra que a etiologia da NOIA é extremamente diversa, justificando portanto extensa propedêutica no sentido de identificar os fatores causais e instituir a adequada abordagem terapêutica e profilática
Subject(s)
Humans , Male , Female , Aged , Anterior Eye Segment/blood supply , Ischemia/physiopathology , Optic Nerve/blood supply , Vision Disorders/diagnosis , Visual AcuityABSTRACT
Strabismus surgery results in the permanent interruption of anterior ciliary blood flow, predisposing the eye to anterior segment ischemia (ASI). A primate model was used to assess the effectiveness of a new muscle-scleral tuck for preserving anterior ciliary artery circulation. The model consisted of removing 3 rectus muscles from both eyes of 2 rhesus monkeys, then performing a tuck on the inferior rectus (IR) right eye while leaving the left IR as a control. Four weeks later, a modified tuck was performed on the virgin left IR. Fluorescein iris angiograms of both eyes were obtained, and preoperative angiograms at 5-15 sec. showed normal 360 degrees perfusion. Postoperative follow-up angiograms showed segmental superior temporal filling defects and preservation of perfusion in the distribution of the IR. Comparison of fellow eyes tucked vs control IR showed no difference in the filling pattern in both monkeys. Comparison of the same eye before and after tuck also showed essentially the same filling pattern in all 4 eyes with preservation of inferior circulation. Our conclusion is that the modified tuck preserves the anterior ciliary blood flow and may be useful as a muscle-strengthening procedure in patients predisposed to developing ASI.
Subject(s)
Animals , Anterior Eye Segment/blood supply , Ciliary Body/blood supply , Disease Models, Animal , Fluorescein Angiography , Follow-Up Studies , Iris/blood supply , Ischemia/prevention & control , Macaca mulatta , Oculomotor Muscles/physiology , PerfusionSubject(s)
Animals , Anterior Eye Segment/blood supply , Ischemia/pathology , Macaca mulatta , Strabismus/surgeryABSTRACT
Realizamos estudio oftalmológico de los prematuros ingresados en el servicio de neonatología de abril a agosto de 1983 en el Hospital "Enrique Cabrera". El estudio oftalmológico se dirigió a determinar la vascularización del segmento anterior en los ojos de los pretérminos y tiempo de desaparición. Se realizó una nueva clalificación de dicha vascularización. Se correlacionó el grado de vascularización encontrado con la edad gestacional de los prematuros y se comprobó que dicha vascularización guarda íntima relación con la maduración del prematuro