ABSTRACT
Resumo Objetivo: O objetivo desse trabalho é avaliar o perfil de aplicações intravítreas do Ranibizumab em uma população de adultos atendidos no Instituto Benjamin Constant, no ano de 2015, levando em consideração o efeito sobre a acuidade visual e a espessura macular após tratamento. O objetivo secundário é apresentar as principais indicações desse tipo tratamento no serviço de olhos acima citado. Métodos: Foi realizado um estudo retrospectivo seccional, em indivíduos acima de 20 anos entre os meses de março a agosto de 2015, para analisar a acuidade visual e espessura foveal pré e pós tratamento. A dose do anti-VEGF utilizada foi de 0,05ml por aplicação com intervalo de quatro semanas entre elas. A aferição da acuidade visual assim como o OCT pós tratamento foram realizados em torno de trinta dias após a última aplicação. As análises estatísticas foram feitas com uso do software SPSS versão 21 e o nível de significância estatística foi de 95% com um valor de p <0,05. Resultado: O estudo mostrou que a principal afecção relacionada a esse tratamento foi a retinopatia diabética não proliferativa associada ao edema macular (32,8%). Após o tratamento indicado com Ranibizumab, houve uma melhora da acuidade visual média de 0,70 para 0,59 (logMAR) e uma regressão da espessura macular, visto no OCT, de 408,1µm para 337,2 µm (valor de p <0,05). Conclusão: Pode-se concluir portanto, que o tratamento com Ranibizumab na população estudada contribuiu para uma melhor qualidade de vida dos pacientes, pois a maioria dele apresentou uma melhora estatisticamente significativa na acuidade visual após as aplicações.
Abstract The objective of this work is to evaluate the profile of intravitreal applications of Ranibizumab in a population of adults attended at the Benjamin Constant Institute in the year of 2015, taking into account the effect on visual acuity and macular thickness after the treatment. The secondary objective is to present the main indications of this type of treatment in the eye care mentioned above. A retrospective cross-sectional study was performed in individuals over 20 years of age between March and August of 2015 to analyze visual acuity and foveal thickness before and after treatment. The dose of anti-VEGF used was 0.05 ml per application with an interval of four weeks between them. Visual acuity assessment as well as OCT post treatment were performed around 30 days after the last application. Statistical analyses were performed using SPSS software version 21 and the level of statistical significance was of 95% with a value of p <0.05. The study showed that the main condition related to this treatment was non-proliferative diabetic retinopathy associated with macular edema (32.8%). After treatment indicated with Ranibizumab, there was an improvement in the average visual acuity from 0.70 to 0.59 (logMAR) and a regression of the macular thickness, seen in the OCT, from 408.1μm to 337.2μm (p < 0.05). It can be concluded, therefore, that treatment with Ranibizumab in the studied population contributed to a better quality of life of the patients, since most of them presented a statistically significant improvement in the visual acuity after the applications.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Macular Edema/drug therapy , Macular Edema/diagnostic imaging , Intravitreal Injections , Ranibizumab/administration & dosage , Retina/diagnostic imaging , Fluorescein Angiography , Visual Acuity , Retinal Neovascularization , Retrospective Studies , Choroidal Neovascularization , Angiogenesis Inhibitors/administration & dosage , Angiogenesis Inhibitors/therapeutic use , Angiogenesis Inhibitors/pharmacology , Vascular Endothelial Growth Factor A/antagonists & inhibitors , Tomography, Optical Coherence , Diabetic Retinopathy , Ranibizumab/therapeutic use , Ranibizumab/pharmacology , Fovea Centralis/diagnostic imaging , Macula Lutea/diagnostic imaging , Macular DegenerationABSTRACT
ABSTRACT During the routine ophthalmologic examination of a 38-day old female infant, indirect ophthalmoscopy revealed a dense hemorrhage on the fovea and a couple of superficial hemorrhages in the nasal retina of the left eye. No hemorrhage was observed in the right eye. A hand-held spectral domain optical coherence tomography (SD-OCT) was used at the time of diagnosis. The hemorrhage at the nasal retina resolved in the first week of follow-up, and the foveal hemorrhage resolved 12 weeks after birth. Spectral domain optical coherence tomography was repeated once the foveal hemorrhage had resorbed, and it showed that the foveal contour had reformed without any sequelae. This case suggests that birth-related foveal hemorrhages do not cause any disturbance in the foveal architecture.
RESUMO Durante o exame oftalmológico de rotina de uma criança do sexo feminino de 38 dias, a oftalmoscopia indireta revelou uma hemorragia densa na fóvea e algumas hemorragias superficiais na retina nasal do olho esquerdo. Nenhuma hemorragia foi observada no olho direito. Foi utilizada uma tomografia de coerência óptica de domínio espectral no momento do diagnóstico. A hemorragia na retina nasal foi resolvida na primeira semana de acompanhamento e a hemorragia foveal foi resolvida em 12 semanas após o nascimento. A tomografia de coerência óptica de domínio espectral foi repetida uma vez que a hemorragia foveal foi reabsorvida, e mostrou que o contorno foveal havia se reformado sem sequelas. Este caso sugere que as hemorragias foveais relacionadas ao nascimento não causam qualquer distúrbio na arquitetura foveal.
Subject(s)
Humans , Female , Infant , Retinal Hemorrhage/diagnostic imaging , Tomography, Optical Coherence/methods , Fovea Centralis/diagnostic imaging , Ophthalmoscopy , Remission, Spontaneous , Time Factors , Retinal Hemorrhage/pathology , Fovea Centralis/pathologyABSTRACT
ABSTRACT We report retinal functional and structural changes of a 40-year-old man diagnosed with occult macular dystrophy. Comprehensive ophthalmological evaluation was performed, followed by spectral-domain optical coherence tomography (SD-OC - Heidelberg) and image acquisition using an adaptive optics (AO) camera (RTX1, Imagine Eyes) for photoreceptor density analysis. Functional tests included full-field ERG (ERG) and multifocal electroretinography (mfERG) (Diagnosys, LLC) and microperimetry with scanning laser ophthalmoscope (SLO) fixation controlled (MAIA, CenterVUE). OCT revealed a line of discontinuity corresponding to cone outer-segment photoreceptors associated with a loss of cone density, highlighted by a dark blue spot on the AO co ne-density map on the fovea in both eyes. Loss of central sensitivity was revealed using microperimetry; ERG was within the normal range, although the mfERG showed a reduced central response amplitude.
RESUMO Relatamos exames de função e estrutura retiniana de paciente masculino, de 40 anos, com diagnóstico clínico de Distrofia Macular Oculta (DMO). Avaliação oftalmológica completa foi seguida por tomografia de Coerência Óptica (SD-OCT - Heidelberg) e exame com câmara de fundo de olho com tecnologia "Adaptive Optics" (AO - RTX1, Imagine Eyes) para análise da densidade de fotorreceptores. Os exames funcionais incluíram: Eletroretinografia de campo total (ERG) e multifocal (mfERG) (Diagnosys - LLC) e microperimetria com controle de fixação (MAIA - CenterVUE). Os exames revelam descontinuidade da camada de fotorreceptores na região central da fóvea em ambos os olhos pelo SD-OCT em associação com perda de densidade no mosaico cones, representado por mancha azulada no mapa do AO. Os exames de função apresentam diminuição da acuidade visual (20/80; 20/50), redução de sensibilidade central na microperimetria. Como esperado, o ERG está dentro da normalidade, mas há redução da amplitude das respostas centrais do mfERG em ambos os olhos.
Subject(s)
Humans , Male , Adult , Macular Degeneration/diagnostic imaging , Retinal Cone Photoreceptor Cells , Tomography, Optical Coherence/methods , Electroretinography/methods , Visual Field Tests/methods , Fovea Centralis/diagnostic imagingABSTRACT
PURPOSE: To discuss the unique morphology and origin of epiretinal proliferation associated with macular hole (EPMH) occasionally observed in full-thickness macular hole (FT-MH) or lamellar hole (LH) and to introduce the perifoveal crown phenomenon encountered when removing this unusual proliferative tissue. METHODS: Sixteen patients showing EPMH in spectral domain-optical coherence tomography were selected from 212 patients diagnosed with MH, LH, FT-MH, impending MH, macular pseudohole, or epiretinal membrane between January 2013 and December 2014. Of the 212 patients included for clinical analysis, 33, 23, 11, 7, and 190 exhibited LH, FT-MH, impending MH, macular pseudohole, and epiretinal membrane, respectively. We reviewed visual acuity, macular morphology, and clinical course. Surgical specimens were analyzed histologically. RESULTS: EPMH presented as an amorphous proliferation starting from the defective inner/outer segment (IS/OS) junction covering the inner macula surface. Among the 16 patients with EPMH, 11 underwent vitrectomy, and all exhibited the intraoperative perifoveal crown phenomenon. EPMH tissue was sampled in three patients, one of whom had more tissue removed than intended and showed delayed recovery in visual acuity. Despite hole closure, IS/OS junction integrity was not successfully restored in four of 11 patients. Five patients were followed-up without surgical intervention. Visual acuity slightly decreased in three patients and did not change in one patient, while the remaining patient was lost during follow-up. Among the three perifoveal crown tissues obtained, two were successfully analyzed histologically. Neither tissue showed positivity to synaptophysin or S-100 protein, but one showed positivity to cytokeratin protein immunohistochemical staining. CONCLUSIONS: EPMH exhibited a distinct but common configuration in spectral domain-optical coherence tomography. An epithelial proliferation origin is plausible based on its configuration and histological analysis. Perifoveal crown phenomenon was observed when removing EPMH during vitrectomy.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Epiretinal Membrane/diagnosis , Follow-Up Studies , Fovea Centralis/diagnostic imaging , Intraoperative Period , Retinal Perforations/complications , Retrospective Studies , Tomography, Optical Coherence , Visual Acuity , VitrectomyABSTRACT
PURPOSE: To determine the correlation between the prognosis of branch retinal artery obstruction (BRAO) and the foveal thickness or outer nuclear layer (ONL) thickness on optical coherence tomography (OCT). METHODS: Twenty-one eyes (21 patients) in patients with resolved, non-complicated BRAO and a normal control of 10 eyes (10 volunteers) were used in this study. The average macular thickness, foveal thickness and ONL thickness at central fovea were measured in both the patients and the control group using spectral domain OCT. The thickness between the patient group and the control group were compared and correlation between the best corrected visual acuity (BCVA) and each thickness was determined. RESULTS: The average age of the patients was 52 +/- 5.8 years. The average macular thickness, foveal thickness and ONL thickness at the central fovea of the patients were significantly (p < 0.001, p = 0.023, p = 0.021, respectively) thinner than that of the control group. Both the foveal thickness (r(s) = 0.56, p = 0.008) and ONL thickness (r(s) = 0.86, p < 0.001) were significantly correlated with BCVA. There was no significant correlation between the average macular thickness and BCVA. CONCLUSIONS: The foveal thickness and ONL thickness at the fovea was positively correlated with the BCVA in patients with resolved BRAO.