Optical coherence tomography angiography findings in patients with branch retinal vein occlusion treated with Anti-VEGF / Achados de angiografia por tomografia de coerência óptica em pacientes com oclusão de ramo da veia retiniana tratada com anti-VEGF

ABSTRACT Purpose: To investigate retinal microvasculature changes in patients treated with anti-VEGF for macular edema secondary to branch retinal vein occlusion. Methods: We examined 38 eyes of 19 patients for the study. We measured superficial and deep capillary plexus vessel densities (%), foveal avascular zone areas (mm2), and central macular thicknesses. Results: Parafoveal superficial and deep capillary plexus values were significantly lower in eyes with branch retinal vein occlusion than in fellow eyes (p<0.001). We found a significant increase in parafoveal deep capillary plexus values after the anti-VEGF treatment (p=0.032). The mean foveal avascular zone was larger in eyes with branch retinal vein occlusion than in control eyes (p<0.001). The mean central macular thickness was significantly higher in eyes with branch retinal vein occlusion than in controls, and we observed a significant decrease in central macular thickness after anti-VEGF treatment (<0.001). In addition, the cystic structures in the deep capillary plexus regressed. Conclusion: Optical coherence tomography angiography enables qualitative and quantitative evaluations during follow-up of patients treated for branch retinal vein occlusion.

RESUMO Objetivo: Investigar as alterações na microvascu latura da retina em pacientes tratados com anti-VEGF para ede ma macular secundário à oclusão de ramo da veia retiniana. Métodos: Foram examinados 38 olhos de 19 pacientes para o estudo. Medimos as densidades dos vasos do plexo capilar superficial e profunda (%), áreas da zona avascular foveal (mm2) e espessura macular central. Resultados: Os valores do plexo capilar superficial e profundo parafoveal foram significativamente menores nos olhos com oclusão de ramo da veia retiniana do que nos outros olhos (p<0,001). Encontramos um aumento significativo nos valores de plexo capilar profundo parafoveal após o tratamento com anti-VEGF (p=0,032). A zona avascular foveal média foi maior nos olhos com oclusão de ramo da veia retiniana do que nos olhos controle (p<0,001). A espessura macular central média foi significativamente maior nos olhos com oclusão de ramo da veia retiniana do que nos controles, e observamos uma diminuição significativa na espessura macular central após o tratamento com anti-VEGF (< 0,001). Além disso, as estruturas císticas no plexo capilar profundo regrediram. Conclusão: A angiotomografia de coerência óptica permite avaliações qualitativas e quantitativas durante o acompanhamento de pacientes tratados por oclusão de ramo da veia retiniana.

Optical biometry-based axial length alterations after intravitreal dexamethasone implant / Alterações do comprimento axial com base na biometria óptica após o implante de dexametasona intravítrea

ABSTRACT Purpose: To investigate changes in axial length after intravitreal dexamethasone implantation in patients with macular edema. Methods: We performed a prospective comparative study of 46 patients with unilateral macular edema, due to diabetic retinopathy, retinal vein occlusion, and non-infectious uveitis, who underwent dexamethasone implantation. The fellow eyes of the patients were considered the control group. The central macular thickness was measured by spectral-domain optical coherence tomography, and axial length was measured by IOLMaster 700 optical coherence biometry. We compared axial length and central macular thickness values within the groups. Results: In the study group, the baseline central macular thickness was 460.19 ± 128.64 mm, significantly decreasing to 324.00 ± 79.84 mm after dexamethasone implantation (p=0.000). No significant change in central macular thickness measurements was seen in the control group (p=0.244). In the study group, the baseline axial length was 23.16 ± 0.68 mm, significantly increasing to 23.22 ± 0.65 mm after dexamethasone implantation (p=0.039). However, the control group exhibited no significant change in axial length (p=0.123). Conclusions: In addition to significantly reducing central macular thickness measurements, intravitreal dexamethasone implantation also significantly changes optical biometry-based axial length measurements.

RESUMO Objetivo: Investigar alterações no comprimento axial após implante de dexametasona intravítrea em pacientes com edema macular. Métodos: Foi realizado um estudo prospectivo e comparativo de 46 pacientes com edema macular unilateral, devido à retinopatia diabética, oclusão da veia retiniana e uveíte não infecciosa, que foram submetidos ao implante de dexametasona. Os olhos contralateral de cada paciente foram considerados o grupo controle. A espessura macular central foi medida por tomografia de coerência óptica de domínio espectral, e o comprimento axial foi medido por meio de biometria de coerência óptica de domínio espectral e o comprimento axial foi medido pela biometria de coerência óptica com IOLMaster 700. Comparamos o comprimento axial e os valores da espessura macular central dentro dos grupos. Resultados: No grupo de estudo, a espessura macular basal foi de 460,19 ± 128,64 mm, diminuindo significativamente para 324,00 ± 79,84 mm após o implante de dexametasona (p=0,000). Nenhuma mudança significativa nas medidas da espessura macular central foi observada no grupo controle (p=0,244). No grupo de estudo, o comprimento axial basal foi de 23,16 ± 0,68 mm, aumentando significativamente para 23,22 ± 0,65 mm após o implante de dexametasona (p=0,039). No entanto, o grupo controle não apresentou alteração significativa no comprimento axial (p=0,123). Conclusões: Além de reduzir significativamente as medidas da espessura macular central, o implante de dexametasona intravítrea também altera significativamente as medidas de comprimento axial baseadas na biometria óptica.

Bilateral Macula-involving Metastatic Infection Resulting from Septic Embolization

No abstract available.

Retinal Damage in Chloroquine Maculopathy, Revealed by High Resolution Imaging: A Case Report Utilizing Adaptive Optics Scanning Laser Ophthalmoscopy

A 53-year-old Asian woman was treated with hydroxychloroquine and chloroquine for lupus erythematosus. Within a few years, she noticed circle-shaped shadows in her central vision. Upon examination, the patient's visual acuity was 20 / 25 in both eyes. Humphrey visual field (HVF) testing revealed a central visual defect, and fundoscopy showed a ring-shaped area of parafoveal retinal pigment epithelium depigmentation. Fundus autofluorescence imaging showed a hypofluorescent lesion consistent with bull's eye retinopathy. Adaptive optics scanning laser ophthalmoscope (AO-SLO) revealed patch cone mosaic lesions, in which cones were missing or lost. In addition, the remaining cones consisted of asymmetrical shapes and sizes that varied in brightness. Unlike previous studies employing deformable mirrors for wavefront aberration correction, our AO-SLO approach utilized dual liquid crystal on silicon spatial light modulators. Thus, by using AO-SLO, we were able to create a photographic montage consisting of high quality images. Disrupted cone AO-SLO images were matched with visual field test results and functional deficits were associated with a precise location on the montage, which allowed correlation of histological findings with functional changes determined by HVF. We also investigated whether adaptive optics imaging was more sensitive to anatomical changes compared with spectral-domain optical coherence tomography.

Retinal Damage in Chloroquine Maculopathy, Revealed by High Resolution Imaging: A Case Report Utilizing Adaptive Optics Scanning Laser Ophthalmoscopy

A 53-year-old Asian woman was treated with hydroxychloroquine and chloroquine for lupus erythematosus. Within a few years, she noticed circle-shaped shadows in her central vision. Upon examination, the patient's visual acuity was 20 / 25 in both eyes. Humphrey visual field (HVF) testing revealed a central visual defect, and fundoscopy showed a ring-shaped area of parafoveal retinal pigment epithelium depigmentation. Fundus autofluorescence imaging showed a hypofluorescent lesion consistent with bull's eye retinopathy. Adaptive optics scanning laser ophthalmoscope (AO-SLO) revealed patch cone mosaic lesions, in which cones were missing or lost. In addition, the remaining cones consisted of asymmetrical shapes and sizes that varied in brightness. Unlike previous studies employing deformable mirrors for wavefront aberration correction, our AO-SLO approach utilized dual liquid crystal on silicon spatial light modulators. Thus, by using AO-SLO, we were able to create a photographic montage consisting of high quality images. Disrupted cone AO-SLO images were matched with visual field test results and functional deficits were associated with a precise location on the montage, which allowed correlation of histological findings with functional changes determined by HVF. We also investigated whether adaptive optics imaging was more sensitive to anatomical changes compared with spectral-domain optical coherence tomography.

Vitrectomy Combined with Intravitreal Triamcinolone Acetonide Injection and Macular Laser Photocoagulation for Nontractional Diabetic Macular Edema

PURPOSE: To evaluate the efficacy of vitrectomy combined with intravitreal injection of triamcinolone acetonide (IVTA) and macular laser photocoagulation for the treatment of nontractional diabetic macular edema (DME) refractory to anti-vascular endothelial growth factor (VEGF) therapy. METHODS: Twenty-eight eyes from 28 subjects who were diagnosed with nontractional DME refractory to three or more sequential anti-VEGF injections underwent sequential vitrectomy, IVTA, and macular laser photocoagulation. Changes in best-corrected visual acuity (BCVA) and central subfield thickness (CST) during the six months following vitrectomy were evaluated. Additionally, the CST and BCVA outcomes were compared with those of 26 eyes treated with the same triple therapy for nontractional DME refractory to conventional treatment, such as IVTA or macular laser photocoagulation, or both. RESULTS: The mean logarithm of the minimum angle of resolution BCVAs before and one, three, and six months after vitrectomy were 0.44 +/- 0.15, 0.36 +/- 0.18, 0.31 +/- 0.14, and 0.34 +/- 0.22, respectively. The mean CSTs were 433.3 +/- 77.9, 329.9 +/- 59.4, 307.2 +/- 60.2, and 310.1 +/- 80.1 microns, respectively. The values of both BCVA and CST at one, three, and six months were significantly improved from baseline (p < 0.05). The extent of CST reduction during the first month after triple therapy was greater in eyes refractory to conventional treatment than in eyes refractory to anti-VEGF (p = 0.012). CONCLUSIONS: Vitrectomy combined with IVTA and macular laser photocoagulation had a beneficial effect on both anatomical and functional outcomes in eyes with nontractional DME refractory to anti-VEGF therapy.

Change in macular thickness in a case of refractory diabetic macular edema with dexamethasone intravitreal implant in comparison to intravitreal bevacizumab: A case report.

We report on the significant improvement of central macular thickness in a case of clinically significant macular edema after dexamethasone 0.7 mg sustained-release intravitreal implant (Ozurdex®; Allergan, Inc, Irvine, CA, USA). Patient presented to us with persistent clinically significant macular edema (CSME) in both eyes. Right eye received dexamethasone implant and left eye received two intravitreal bevacizumab injections 1.25 mg/0.05 mL (Avastin®; Genentech Inc., South San Francisco, CA, USA) with an interval of four weeks. After six weeks of follow-up, dexamethasone implant in the right eye showed normal macular thickness whereas persistent macular edema (ME) was found even after second intravitreal bevacizumab injection in the left eye.

Maculopathy Associated with Tacrolimus (FK 506)

A 63-year-old man with a history of liver transplantation presented to our clinic complaining of visual disturbance. He had been receiving tacrolimus (FK 506) for 30 months (6 mg/day for 2 years and 3 mg/day for 6 months); he reported that the visual disturbance began while taking tacrolimus. A full ophthalmologic examination and electrophysiologic and imaging studies were performed. The best corrected visual acuity was 0.1 in both eyes. There were no abnormal finding in the anterior segment, pupillary reflexes were normal and, there was no swelling in either optic disc. Although the foveal reflex was slightly decreased, fluorescein angiography revealed non-specific signs, with the exception of a window defect. A multifocal electro-retinogram revealed decreased amplitude of the central ring. A Swedish interactive threshold algorithm-standard 10-2 visual field test revealed a central scotoma. These findings suggest that tacrolimus may result in maculopathy. Therefore, careful ophthalmologic examination is necessary in the patients taking tacrolimus.

A Case of Intravitreal Bevacizumab Injection for the Treatment of Choroidal Neovascularization in Angioid Streaks

A 56-year-old Korean woman presented with decreased visual acuity of the right eye. She had a history of two photodynamic therapy treatments for choroidal neovascularization (CNV) due to angioid streaks in her left eye with central scarring and low visual acuity. She was diagnosed with subfoveal CNV due to angioid streaks in her right eye and treated with six intravitreal bevacizumab (1.25 mg / 0.05 mL) injections over one year. Best corrected visual acuity improved from 20 / 125 at baseline to 20 / 50 at the final visit. The area of CNV had changed into a fibrotic scar by the final visit, and fluorescein angiography and indocyanine green angiography revealed no evidence of leakage. Optical coherence tomography showed that central macular thickness decreased from 311 microm at baseline to 203 microm with complete resolution of subretinal and intraretinal fluid at the final visit. Intravitreal bevacizumab for CNV associated with angioid streaks prevented the progression of disease and resulted in the improvement of visual acuity after one year of follow-up in our patient.

Combined Treatment of Photodynamic Therapy and Bevacizumab for Choroidal Neovascularization Secondary to Age-Related Macular Degeneration

PURPOSE: To evaluate the outcome of a combined photodynamic therapy and intravitreal injection of bevacizumab in choroidal neovascularization secondary to age-related macular degeneration. METHODS: Photodynamic therapy (PDT) was administered to 28 eyes followed by 3 consecutive bevacizumab injections. Patients were followed-up for more than 12 months. At baseline, 1, 3, 6, and 12 months post PDT, visual acuity (VA) and central macular thickness were measured using optical coherence tomography. RESULTS: The mean VA was significantly improved from logarithm of the minimal angle of resolution 0.86 at baseline to 0.69 at 1 month (p = 0.011), 0.63 at 3 months (p = 0.003), 0.64 at 6 months (p = 0.004) and 0.60 at 12 months (p < 0.001). Central macular thickness decreased significantly from 328.3 microm at baseline to 230.0 microm at 6 months and 229.9 microm at 1 year (p < 0.001). Reinjection mean number was 0.4 for 6 months and 0.8 for 12 months. By 1 year, retreatment was performed in 10 eyes (36%). CONCLUSIONS: PDT combined with three consecutive intraviteal bevacizumab injections was effective in improving VA and reducing central macular thickness.

Avaliação da tomografia de coerência óptica em pacientes portadores de degeneração macular relacionada à idade tratada com terapia fotodinâmica com verteporfina / Ocular coherence tomography in age-related macular degeneration patients treated with photodynamic therapy with vertepofirin

OBJETIVO: Identificar os achados na tomografia de coerência óptica (OCT) e suas variações ao longo de 12 meses, em pacientes portadores de degeneração macular relacionada à idade (DRMI), submetidos à terapia fotodinâmica com verteporfina (TFD). DESENHO DO ESTUDO: Série de casos, aberto, não aleatório e intervencionista. MÉTODOS: Pacientes acima de 50 anos, portadores de DMRI neovascular foram submetidos ao exame oftalmológico completo, angiofluoresceinografia e OCT antes do início do tratamento (V0) e 3, 6, 9 e 12 meses após (V3, V6, V9 e V12, respectivamente). O tratamento empregado foi a TFD. A acuidade visual (AV) foi mensurada usando-se a tabela do ETDRS. Realizaram-se as medições das espessuras foveais: espessura intraretiniana foveal (FIRT), espessura foveal do complexo coriocapilar - EPR (FCC-EPRT) e espessura foveal total (TFT). Realizaram-se as mensurações das espessuras extrafoveais, em um raio de 1500 µ da fóvea: espessura intraretiniana extrafoveal (EFIRT), espessura extrafoveal do complexo coriocapilar - EPR (EFCC-EPRT) e espessura extrafoveal total (TEFT). Análise estatística foi realizada usando-se a análise de variância em blocos. RESULTADOS: Vinte e três olhos de 23 pacientes foram avaliados. Foram identificados nove achados à OCT: 1º) espessamento das camadas intraretinianas na fóvea; 2º) espessamento das camadas intraretinianas na região extrafoveal; 3º) espessamento do complexo coriocapilar-EPR (FCC-EPRT) na fóvea; 4º) espessamento do complexo coriocapilar-EPR na área extrafoveal; 5º) presença de fluido sub-EPR; 6º) presença de fluido sub-retiniano; 7º) presença de fluido intraretiniano; 8º) presença da membrana hialóide posterior aderida à retina; 9º) presença da depressão foveal. Na visita inicial a FIRT e a TFT foram respectivamente 398,5 µ e 639,2 µ. Em V12 foram 173,7 µ e 423,9 µ. A variação foi estatisticamente significante (p = 0,008 e p = 0,003, respectivamente). As outras espessuras mensuradas não tiveram...

PURPOSE: To identify the optical coherence tomography (OCT) findings in patients with age-related macular degeneration (ARMD) treated with photodynamic therapy (PDT). STUDY DESIGN: Open, non-randomized, interventional case series. METHODS: ARMD patients were submitted to a complete ophthalmological examination, fluorescein angiography, and OCT at baseline (V0), 3, 6, 9 and 12 months (V3, V6, V9 and V12, respectively). PDT was carried out according to the TAP study. Visual acuity (VA) was measured using the logMAR ETDRS chart. The following foveal measurements were performed: foveal intraretinal thickness (FIRT), foveal choriocapillaris - RPE complex thickness (FCC-RPET) and total foveal thickness (TFT). The extrafoveal thicknesses measured were: extrafoveal intraretinal thickness (EFIRT), extrafoveal choriocapillaris - RPE complex thickness (EFCC-RPET) and total extrafoveal thickness (TEFT). Statistical analysis was performed using the block variance analysis test. RESULTS: Twenty-three eyes of 23 patients were enrolled. This study identified nine OCT patterns: 1) thickening of the foveal intraretinal layers; 2) thickening of the extrafoveal intraretinal layers; 3) thickening of the foveal choriocapillaris - RPE complex; 4) thickening of the extrafoveal choriocapillaris - RPE complex; 5) intraretinal fluid; 6) subretinal fluid; 7) subretinal pigment epithelium (RPE) fluid; 8) vitreo-retinal adhesion; 9) foveal depression. At baseline, FIRT and TFT were 398.5 µ and 639.2 µ, respectively. At V12 they were 173.7 µ e 423.9 µ, respectively, and this change was statistical significant (p=0.008 e p=0.003, respectively). The variation of the other foveal and extrafoveal measurements were not statistically significant. Foveal depression was present at baseline in 36.4 percent of the eyes, whereas at V12 it was present in 78.3 percent. Subretinal fluid was present in 36.4 percent of eyes at V0 and in 8.7 percent at V12. VA at baseline was 0.93...

Diabetic Macular Edema Before and After Intravitreal Triamcinolone Injection

PURPOSE: To compare intravitreal triamcinolone acetonide (IVT) versus natural course in refractory diabetic macular edema. METHODS: In a prospective interventional case series, twenty five eyes with refractory DME which had been allocated to the sham group of a previous clinical trial underwent new examination and optical coherence tomography about 9 months after their first enrollment. Twenty eyes that met the inclusion criteria, visual acuity (VA) 200 micrometer, were treated by 4 mg IVT. Evaluations were repeated at 2 and 4 months post-injection to imitate the similar examination intervals after sham injection. Corrected visual acuity and macular thickness changes following IVT were compared to the corresponding changes after sham injection (the natural course). RESULTS: Visual acuity changes within and between each period were not statistically significant. Visual acuity decreased 0.08 & 0.09 logMAR by 2 months and 0.06 & 0.04 logMAR by 4 months after sham and IVT injections, respectively. The changes of macular thickness after IVT and sham intervention were not meaningful either. However, the difference between thickness changes by 4 months (52+/-50 micrometer increase after sham vs. 262+/-115 micrometer reduction after IVT) was significant (P=0.014). CONCLUSIONS: Concerning macular thickness, IVT has beneficial effect on refractory diabetic macular edema as opposed to observation. However, considering visual acuity, it does not induce significant difference in comparison to the natural course of the disease.

Diabetic Macular Edema Before and After Intravitreal Triamcinolone Injection

PURPOSE: To compare intravitreal triamcinolone acetonide (IVT) versus natural course in refractory diabetic macular edema. METHODS: In a prospective interventional case series, twenty five eyes with refractory DME which had been allocated to the sham group of a previous clinical trial underwent new examination and optical coherence tomography about 9 months after their first enrollment. Twenty eyes that met the inclusion criteria, visual acuity (VA) 200 micrometer, were treated by 4 mg IVT. Evaluations were repeated at 2 and 4 months post-injection to imitate the similar examination intervals after sham injection. Corrected visual acuity and macular thickness changes following IVT were compared to the corresponding changes after sham injection (the natural course). RESULTS: Visual acuity changes within and between each period were not statistically significant. Visual acuity decreased 0.08 & 0.09 logMAR by 2 months and 0.06 & 0.04 logMAR by 4 months after sham and IVT injections, respectively. The changes of macular thickness after IVT and sham intervention were not meaningful either. However, the difference between thickness changes by 4 months (52+/-50 micrometer increase after sham vs. 262+/-115 micrometer reduction after IVT) was significant (P=0.014). CONCLUSIONS: Concerning macular thickness, IVT has beneficial effect on refractory diabetic macular edema as opposed to observation. However, considering visual acuity, it does not induce significant difference in comparison to the natural course of the disease.

Intravitreal gas for submacular haemorrhage.

Submacular haemorrhage is an important cause for sudden visual loss needing immediate intervention. We report a case of submacular haemorrhage causing profound visual loss, which resolved after intravitreal injection of perfluoropropane (C3F8) gas followed by strict prone positioning.

Estudio comparativo de sensibilidad macular en pacientes tratados con metotrexate y cloroquina, en artritis reumatoide / Comparative study of macular sensibility in subjects with theumatoid arthritis in pharmacological treatment with methotrexate and chloroquine

El metotrexate (MTX) es una droga de uso reciente en el tratamiento de artritis reumatoide (AR) a dosis de 10-15 mg/m2/semana, por su rápido efecto antiinflamatorio. En la actualidad los reportes sobre efectos secundarios a nivel ocular son escasos. Este es un estudio donde se han incluido pacientes de ambos sexos, con antecedentes de AR, colaboradores, orientados, con agudeza visual de 20/40 o mejor, sin otra enfermedad sistémica.