Desenvolvimento de sistema estruturado com inteligência artificial para apoio no diagnóstico de patologias oftalmológicas mais relevantes / Development of a structured artificial intelligence system to support the diagnosis of the most relevant ophthalmic diseases

Introdução: A inteligência artificial (IA) está revolucionando a área da saúde. Na oftalmologia, esta tecnologia pode possibilitar diagnósticos mais rápidos e precisos, impedindo a progressão das alterações na visão. Médicos e algoritimosalgoritmos podem ser mais eficientes quando trabalham juntos. Desenvolver um software de IA com alta especificidade e sensibilidade para apoio no diagnóstico de algumas patologias oftalmológicas. Métodos: O software de deep learning foi construído através de redes neurais valendo de duas bases computacionais MobileNet e Inception. Para o treinamento do banco de dados foram utilizadas 2.520 imagens de glaucoma, retinopatia diabética, toxoplasmose ocular, papiledema, descolamento de retina e retina normal. Para a validação foi utilizado 428 imagens patológicas e normais para os cálculos de sensibilidade e de especificidade. Todas as imagens foram cedidas da Sociedade Americana de Especialistas da Retina. Resultados: Os resultados de sensibilidade e especificidade foram no MobileNet de 91% (IC 95%, 89-92%) e 98,5% (IC 95%, 98-99%); no Inception, de 91,4% (IC 95%, 89-93,5%) de 98,4% (IC 95%, 98-98,8%), respectivamente. Não houve diferença significativa entre os dois métodos utilizados. Conclusão: O software apresentou resultados promissores na distinção das condições oftalmológicas pesquisadas. (AU)

Introduction: Artificial intelligence (AI) is revolutionizing health care. In ophthalmology, this technology can enable faster and more accurate diagnoses, preventing the progression of vision Physicians and algorithms are most effective when working together. To develop an AI software with high specificity and sensitivity to support the diagnosis of some ophthalmic diseases. Methods: A deep learning software was built through neural networks using two computational bases, MobileNet and Inception. For training the database, 2520 images of glaucoma, diabetic retinopathy, ocular toxoplasmosis, papilledema, retinal detachment, and normal retina were used. For validation, 428 pathological and normal images were used for calculations of sensitivity and specificity. All images were obtained from the American Society of Retina Specialists. Results: The results of sensitivity and specificity were 91% (95% confidence interval [CI], 89-92%) and 98.5% (95% CI, 98-99%) on MobileNet, and 91.4% (95% CI, 89-93.5%) and 98.4% (95% CI, 98-98.8%) on Inception, respectively. There was no significant difference between the two methods. Conclusion: The software showed promising results in distinguishing the main ophthalmic conditions surveyed. (AU)

Bilateral retinal detachment - when the kidney meets the eye / Descolamento de retina bilateral - quando o rim afeta o olho

ABSTRACT Exudative retinal detachment occurs when fluid accumulates between the neurosensory retina and the retinal pigment epithelium. Ocular diseases or multisystem conditions such as nephrotic syndrome may lead to exudative retinal detachment. This report describes a case of nephrotic syndrome secondary to minimal change disease, anasarca and bilateral serous macular detachment in an adult patient. A 75-year-old male patient presented to the emergency department with generalized edema, asthenia, and visual impairment. Medical history included a recent diagnosis of nephrotic syndrome secondary to minimal change disease, which had been controlled with corticosteroid therapy. At presentation, best corrected visual acuity was 20/100. Slit-lamp examination revealed xanthelasmas and mild bilateral eyelid edema and chemosis. Dilated fundus examination confirmed bilateral macular detachment. The patient did not respond to diuretic therapy. Ttherefore, hemodialysis was started. Two months later, visual acuity improved to 20/25 and near normal restoration of retinal anatomy was achieved, with concurrent remission of proteinuria. Exudative retinal detachment is a multifactorial condition. However, in diseases associated with severe hypoalbuminemia, such as nephrotic syndrome, low oncotic pressure in choroidal vessels and high interstitial pressure in the choroid may explain retinal detachment. Patients with chronic kidney disease carry a high risk of ophthalmic disease development. Several mechanisms that affect ocular vessels, the retina and the choroid are thought to be involved. A multidisciplinary approach is crucial to resolve the ophthalmic condition and improve overall health.

RESUMO O descolamento de retina exsudativo ocorre quando o fluido se acumula entre a retina neurossensorial e o epitélio pigmentado da retina. Patologias oculares isoladas ou doenças multissistêmicas, como a síndrome nefrótica, podem levar ao descolamento de retina exsudativo. Apresenta-se aqui o caso de um adulto com síndrome nefrótica por doença de lesões mínimas, anasarca e descolamento de retina exsudativo macular bilateral. Trata-se de um homem de 75 anos de idade, que recorreu ao serviço de urgência com edema generalizado, astenia e diminuição da acuidade visual. Os antecedentes pessoais incluíam diagnóstico recente de síndrome nefrótica secundária à doença de lesões mínimas, em uso de corticoterapia. Na apresentação, a melhor acuidade visual corrigida era 20/100. A biomicroscopia revelou xantelasmas, edema palpebral leve e quemose nos dois olhos. Fundoscopia mostrou descolamento macular bilateral. O doente iniciou diuréticos com pouca resposta clínica, tendo sido adicionada hemodiálise. Verificou-se melhora da acuidade visual para 20/25 e restauração quase total da anatomia da retina 2 meses após o início do tratamento, coincidindo com a remissão da proteinúria. A fisiopatologia dos descolamentos de retina exsudativos é multifatorial, mas, em doenças com hipoalbuminemia grave, como a síndrome nefrótica, a baixa pressão oncótica e a alta pressão intersticial na coroide podem explicar o descolamento macular exsudativo. Doentes com doença renal crônica constituem um grupo de risco para o desenvolvimento de doença ocular, envolvendo vários mecanismos que afetam vasos, retina e coroide. Uma abordagem multidisciplinar é crucial para a melhoria da doença oftalmológica e do estado geral do doente.

Hipertensión ocular asociada al desprendimiento de la retina regmatógeno / Ocular hypertension associated to rhegmatogenous retinal detachment

Objetivo: Describir el comportamiento de la hipertensión ocular asociada al desprendimiento de la retina regmatógeno. Métodos: Se realizó un estudio observacional descriptivo de corte longitudinal retrospectivo de una serie de casos atendidos en la consulta de Vítreo-Retina del Instituto Cubano de Oftalmología "Ramón Pando Ferrer" en el período comprendido de mayo del año 2016 a diciembre de 2019. Se estudiaron 7 ojos de 7 pacientes. Se utilizaron las siguientes variables: edad, sexo, antecedentes patológicos oculares, tiempo de evolución de la disminución de la visión, tensión ocular, tipo de rotura retinal, cirugía de retina realizada y tratamiento antihipertensivo ocular. Resultados: Predominó el sexo masculino, con un promedio de edad de 27,2 años. La mayoría de los pacientes tuvieron rotura retinal en el cuadrante nasal superior y todos en extrema periferia. Todos los pacientes tuvieron la presión intraocular antes de la cirugía por encima de 30 mmHg. A todos se le indicó tratamiento hipotensor tópico y se les realizó cirugía convencional. Con diferentes fluctuaciones de la presión intraocular posterior a la cirugía, todos los pacientes normalizaron la tensión ocular y mantuvieron la retina aplicada. Conclusiones: El diagnóstico correcto de este síndrome puede ofrecer dificultad porque los signos de una condición pueden enmascarar los de otra. El reconocimiento de la entidad puede ser más fácil si el oftalmólogo tiene en mente que estas entidades pueden aparecer juntas. De esta forma, se hace un diagnóstico y un tratamiento certero que evite la discapacidad visual por esta causa(AU)

Objective: Describe the behavior of ocular hypertension associated to rhegmatogenous retinal detachment. Methods: An observational retrospective longitudinal descriptive study was conducted of 7 eyes of 7 patients attending the Vitreous-Retina Service at Ramón Pando Ferrer Cuban Institute of Ophthalmology from May 2016 to December 2019. The variables considered were age, sex, ocular pathological antecedents, time of evolution of vision reduction, ocular tension, type of retinal tear, retinal surgery performed and ocular hypertension treatment. Results: A predominance was found of the male sex, with a mean age of 27.2 years. Most of the patients had retinal tear in the upper nasal quadrant, and all in the extreme periphery. In all cases, intraocular pressure was above 30 mmHg before surgery. All patients were indicated topical hypotensive treatment and underwent conventional surgery. With different intraocular pressure fluctuations after surgery, all patients normalized their ocular tension and retained the retina applied. Conclusions: Correct diagnosis of this syndrome may be difficult to achieve, since the signs of one condition may mask those of another. Identification may be easier if the ophthalmologist bears in mind that these diseases may occur together. An accurate diagnosis may thus be made and an effective treatment indicated which will prevent visual disability due to this cause(AU)

Serous retinal detachment in pre-eclampsia: Case report and literature review / Descolamento seroso da retina na pré-eclâmpsia: Um caso clínico e revisão da literatura

Abstract Pre-eclampsia (PE) is an obstetric disease with a multifactorial cause that affects ∼ 5% of pregnant women. Vision can be affected with varying severity, and retinal detachment is a very rare complication. It tends to be bilateral, diagnosed postpartum, and more prevalent in women who are primiparous and/or undergo caesarean delivery. The condition typically resolves completely and rarely causes total visual loss in the affected women. Fluorescence angiographic findings support the hypothesis that retinal detachment in PE is secondary to choroidal ischemia from intense arteriolar vasospasm. The present article is related to a case of a 37-year-old pregnant woman who had PE associated with a progressive blurred vision, diagnosed by ophthalmology as serous macular detachment of the retina.

Resumo A pré-eclâmpsia (PE) é uma doença obstétrica com uma causa multifactorial que afeta ∼ 5% das grávidas. A visão pode ser afetada com uma gravidade variável, sendo o descolamento de retina uma complicação muito rara. Geralmente é bilateral e seroso, e a sua patogênese encontra-se relacionada com a isquemia coroidal, secundária a um intenso vaso espasmo arteriolar. A maioria dos doentes tem recuperação completa da visão com tratamento conservador. No presente artigo, é relatado um caso de uma grávida de 37 anos que desenvolveu PE com critérios de gravidade associada a um quadro de visão turva progressiva, diagnosticada pela oftalmologia como descolamento macular seroso da retina.

Hemangioma de coroide e o desafio do diagnóstico diferencial / Choroidal hemangioma and the challenge of differential diagnosis

Resumo O hemangioma de coroide é um tumor benigno relativamente raro, que se apresenta de forma circunscrita ou difusa, sendo esta última normalmente associada à Síndrome de Sturge-Weber. Os tumores circunscritos manifestam-se de forma insidiosa, com o diagnóstico realizado comumente após o aparecimento de sintomas secundários. Apresentam como diagnóstico diferencial lesões graves e potencialmente letais, como melanoma de coroide e doença metastática. Neste relato descrevemos o caso de um hemangioma intraocular nodular avançado associado a descolamento hemorrágico da retina, evidenciando o desafio do diagnóstico diferencial devido às semelhanças clínicas e radiológicas compartilhadas pelos tumores.

Abstract Choroidal hemangioma is a fairly rare benign vascular tumor that can manifest in either circumscribed or diffuse type; the latter one is usually related to Sturge-Weber Syndrome. The circumscribed tumors have an insidious presentation and diagnosis is commonly made after the onset of secondary symptoms. Serious and potentially lethal lesions, such as choroidal melanoma and metastatic disease, may represent a differential diagnosis. In this report, we describe an advanced case of nodular hemangioma associated with hemorrhagic retinal detachment. This case highlights the challenge of differential diagnosis in intraocular tumors, due to their similar clinical and radiologic features.

Epidemiología del desprendimiento de la retina regmatógeno / Epidemiology of rhegmatogenous retinal detachment

RESUMEN Objetivos: Determinar los factores epidemiológicos, sistémicos y oculares del desprendimiento de la retina regmatógeno. Métodos: Se realizó un estudio observacional descriptivo transversal de los casos nuevos con desprendimiento de la retina regmatogéno que requirieron cirugía y se presentaron de forma consecutiva en la Consulta de Vítreo-Retina del Instituto Cubano de Oftalmología "Ramón Pando Ferrer", desde mayo del año 2016 hasta mayo de 2017. Se estudiaron las variables demográficas y los antecedentes patológicos sistémicos y oculares. Los resultados se expresaron en frecuencias absolutas y relativas (variables cualitativas) y se calculó la media y la desviación estándar en las cuantitativas. Resultados: En el período estudiado se atendieron 237 casos nuevos de desprendimiento de la retina regmatogéno que requirieron cirugía. La edad media de estos fue de 57,79 años (desviación estándar 11,98). Prevaleció el sexo masculino (62 por ciento). La mayor cantidad de casos provenía de las provincias occidentales, fundamentalmente de La Habana (43,9 por ciento) y los primeros síntomas se presentaron en los meses primaverales (48,1 por ciento). La hipertensión arterial se reportó en el 54,4 por ciento. Entre los antecedentes oculares predominó la cirugía de catarata (65,8 por ciento), seguida de la degeneración reticular en la retina periférica (36,3 por ciento). Conclusiones: El desprendimiento de la retina regmatógeno se presenta en edades avanzadas y la cirugía de catarata es un antecedente frecuente en estos casos(AU)

ABSTRACT Objectives: Determine the epidemiological, systemic and ocular factors of rhegmatogenous retinal detachment. Methods: A cross-sectional observational descriptive study was conducted of the new cases of rhegmatogenous retinal detachment requiring surgery and presenting consecutively at the Vitreous-Retina Service of Ramón Pando Ferrer Cuban Institute of Ophthalmology from May 2016 to May 2017. Analysis was performed of demographic variables and systemic and ocular pathological antecedents. Results were expressed as absolute and relative frequencies (qualitative variables), whereas quantitative variables underwent mean and standard deviation estimation. Results: During the study period, 237 new cases were seen of rhegmatogenous retinal detachment requiring surgery. Mean age was 57.79 years (standard deviation 11.98). The male sex prevailed (62 percent). Most cases were from the western provinces, mainly Havana (43.9 percent), and the first symptoms appeared in the spring months (48.1 percent). Hypertension was reported in 54.4 percent of the cases. The prevailing ocular antecedents included cataract surgery (65.8 percent), followed by lattice degeneration in the peripheral retina (36.3 percent). Conclusions: Rhegmatogenous retinal detachment presents in advanced ages. Cataract surgery is a common antecedent in these cases(AU)

Características clínicas y OCT-SA de pacientes con síndrome de tracción iridiana asociado a desprendimiento de retina regmatógeno. Reporte de tres casos / Clinical features and AS-OCT of patients with iris retraction syndrome following rhegmatogenous retinal detachment. Report of three cases

Introducción: se presenta una serie de 3 casos de síndrome de retracción iridiana (SRI) asociados a desprendimiento de retina regmatógeno (DRR) y desprendimiento coroideo. Objetivo: dar a conocer las características clínicas y tomográficas de tres pacientes con SRI asociado a desprendimiento de retina regmatógeno. Diseño del estudio: serie de casos. Resumen del caso: tres pacientes que presentaron DRR asociado a SRI. El tiempo de evolución promedio fue de 21 días (15-30 días), 2 de los 3 pacientes tuvieron resolución del SRI posterior al inicio de midriáticos y antes de ser intervenidos por el desprendimiento de retina, y 2 tuvieron presencia de proliferación vitreoretiniana (PVR) a pesar del corto tiempo de evolución. Adicionalmente estos 2 pacientes cursaron con desprendimientos coroideos. Todos los pacientes tuvieron un buen resultado estructural, AV menor o igual a 20/400, no redesprendimientos ni recurrencias de SRI durante el seguimiento. Conclusión: ante un paciente con SRI en el cual no sea posible valorar polo posterior, se debe tener en cuenta el diagnóstico de desprendimiento de retina regmatógeno. El SRI puede considerarse como un factor de mal pronóstico en pacientes con desprendimiento de retina regmatógeno.

Background: to report a 3 cases series of patients with iris retraction syndrome (IRS). Objective: introduce the clinical and tomographic features of tree patients with IRS following RRD. Study design: case series. Case summary: three patients presented IRS following RRD. They presented with an average evolution of 21 days (15 to 30 days), 2 patients had resolution of the IRS after mydriatics and before receiving surgical treatment for retinal detacthment, and 2 had vitreoretinal proliferation despite the short time. Besides, these 2 patients had choroidal detachments discovered in the operating room. All patients had good structural outcomes, visual acuity less or equal than 20/400, no re-detachment of the retina and no recurrence of IRS during follow up. Conclusion: the presence of a retinal detachment should be suspected in a patient with IRS in which it´s not possible to assess the posterior pole, and it should be considered a bad prognostic factor if present.

Retinitis necrotizante aguda. A propósito de un caso / Acute necrotizing retinitis. Case report

RESUMEN La retinitis necrotizante aguda, es una necrosis retinal de todas las capas de la retina. Se caracteriza por necrosis fibrinoides de la pared de los vasos y oclusión vascular. Se presentó un caso de una paciente de 42 años de edad, con pérdida brusca de la visión del ojo derecho, con una semana de evolución. Al examen oftalmológico se observó haze vítreo 2+, edema sucio del disco óptico, con borramiento de todos sus bordes. Presencia de exudación blanca-amarillenta retiniana extensa, en toda la periferia y área ecuatorial asociada a hemorragias intraretinianas. Se realizó además del examen fundoscòpico toma de muestra de humor acuoso para reacción en cadena de la polimerasa y angiografía fluoresceínica. Los signos fundoscópicos de la paciente, así como las anomalías detectadas en la angiografía fluoresceínica sugirieron el diagnóstico clínico de síndrome de necrosis retinal aguda. Se confirmó el diagnóstico etiológico viral, semanas después por el resultado de polimerasa. Se practicó la terapéutica médica y fotocoagulación laser focal retiniano correspondiente, asociado a cirugía del desprendimiento de retina mixto mediante vitrectomía pars plana y se logró la re aplicación de la retina.

ABSTRACT The acute necrotizing retinitis is a retinal necrosis of all the retinal layers. It is characterized by fibrinoid necrosis of the vases' wall and vascular occlusion. The case presented is the case of a female patient aged 42 years, who suffers sudden loss of the left eye vision, with a week of evolution. At the ophthalmologic examination it was observed a 2+ vitreous haze, dirty edema of the optic disk, with effacement of all of its margins. There it was an extended white-yellowish retinal exudation in the entire periphery and the equatorial area, associated to intra-retinal hemorrhages. Besides the funduscopic examination, it was taken a sample of the aqueous humor for a polymerase chain reaction (PCR) and fluorescein angiography. The patient's funduscopic signs, and also the anomalies detected in the fluorescein angiography suggested the clinical diagnosis of acute retinal necrosis syndrome. After several weeks, the viral etiologic diagnosis was confirmed by polymerase chain reaction. It was practiced the correspondent medical therapeutics and focal retinal laser coagulation associated to mixt retinal detachment through pars plana vitrectomy; the retina reapplication was achieved.

Retinosquise peripapilar e descolamento seroso de retina neuro-sensorial após esclerectomia profunda não penetrante / Peripapillary retinoschisis and serous detachment of neurosensory retina after a non-penetrating deep sclerectomy

Resumo Relato de caso de um paciente de 46 anos com glaucoma juvenil de controle clínico insatisfatório, portador de retinosquise peripapilar que, após ser submetido à esclerectomia profunda não penetrante, evoluiu com descolamento seroso da retina neuro-sensorial. A associação entre retinosquise peripapilar e o descolamento seroso pós cirurgia filtrante é de ocorrência rara, tendo sido descrito apenas um caso na literatura. A partir deste relato temos por objetivo, além de enfatizar a raridade da associação, mostrar a importância de investigar retinosquise peripapilar em pacientes glaucomatosos, em especial se associada a camada de fibras nervosas, e a importância da explanação adequada aos pacientes de um possível descolamento seroso de retina no pós-operatório de cirurgia filtrante.

Abstract Case report of a 46-year-old patient with unsatisfactory clinical controlled juvenile glaucoma and peripapillary retinoschisis who, after being submitted to non-penetrating deep sclerectomy, evolved with serous detachment of the neurosensory retina. The association between peripapillary retinoschisis and serous detachment after filtering surgery is rare and only one case has been described in the literature. The purpose of this report is, besides to emphasize the rarity of the association, to show the importance of investigating peripapillary retinoschisis in glaucomatous patients, especially if associated with retinal nerve fiber layer, and the importance of adequate explanation to patients of possible serous detachment of retina in the postoperative of filtering surgery.

Maculopatia viteliforme polimorfa exudativa aguda: um relato de caso / Acute exsudative polymorphous vitelliform maculopathy: a case report

Resumo A maculopatia viteliforme polimorfa exsudativa aguda é um distúrbio retiniano extremamente raro, que tem sido considerado como uma forma de retinopatia paraneoplásica, encontrada em pacientes com um tumor primário subjacente. Os sintomas de maculopatia viteliforme polimorfa exsudativa aguda incluem dor de cabeça precedente seguida de perda aguda da visão. O fundo de olho de um paciente com essa condição demonstra geralmente depósitos bilaterais, branco-amarelados na região macular. O relato de uma doença rara e que tem uma forte associação com neoplasia oculta é de extrema relevância, pois ajuda a conhecer melhor a sua historia natural, possíveis complicações e prognóstico.

Abstract Acute exudative polymorphous vitelliform maculopathy is an extremely rare retinal disorder, that has been considered as a form of paraneoplasic retinopathy, found in patients with a underlying primary tumor. Symptoms of acute exudative polymorphous vitelliform maculopathy include preceding headache followed by acute onset of vision loss. The fundus of a patient with this condition typically demonstrates bilateral, subretinal white-yellow deposits in the macular region. The report of a rare disease which has a strong association with underlying neoplasia is extremely relevant whereas it helps better comprehend its genuine history, possible complicacy and prognosis.

Bilateral exudative retinal detachment in pre-eclampsia

Exudative retinal detachment [ERD] is a rare cause of visual loss in pre-eclampsia with only few reported cases in the medical literature. We report a case of a nineteen-year-old primigravida with pre-eclampsia who developed bilateral exudative retinal detachments following delivery. Spontaneous resorption of the subretinal fluid and complete resolution of the exudative detachment occurred after a few weeks of observation

High Dose Intravitreal Bevacizumab for Refractory Pigment Epithelial Detachment in Age-related Macular Degeneration

PURPOSE: Intravitreal anti-vascular endothelial growth factor (anti-VEGF) is the first choice of treatment for age-related macular degeneration. However, quite a few eyes treated using conventional dose anti-VEGF (CDAV) have persistent pigment epithelial detachment (PED) on optical coherence tomography. This study investigated the efficacy and safety of high dose anti-VEGF (HDAV) for refractory PED. METHODS: In this retrospective study, 31 eyes of neovascular age-related macular degeneration patients with persistent PED findings despite six or more intravitreal injections of CDAV (bevacizumab 1.25 mg or ranibizumab 2.5 mg) were analyzed. Changes in visual outcome, central foveal thickness, and PED height were compared before and after HDAV (bevacizumab 5.0 mg) for these refractory PED cases. RESULTS: The mean age of patients was 67.7 years. The number of CDAV injections was 12.1. The number of HDAV injections was 3.39. Best-corrected visual acuity in logarithm of the minimum angle of resolution before and after HDAV was 0.49 and 0.41 (p < 0.001), respectively. Central foveal thickness before and after HDAV was 330.06 and 311.10 µm (p = 0.125), respectively. PED height before and after HDAV was 230.28 and 204.07 µm (p = 0.014), respectively. There were no serious adverse reactions in all the eyes. CONCLUSIONS: Increasing the dose of bevacizumab in refractory PED may be a possible treatment option.

Anatomical and visual outcomes of ranibizumab injections in retinal pigment epithelium tears / Resultados anatômicos e visuais de injeções de ranibizumab em roturas do epitélio pigmentado da retina

ABSTRACT Purpose: To report the anatomical and visual results in patients diagnosed as having retinal pigment epithelium (RPE) tears after receiving ranibizumab injections. Methods: Eyes diagnosed as having RPE tears with a minimum 6-month follow-up were retrospectively evaluated. Each eye was treated with at least three doses of ranibizumab at monthly intervals. Best-corrected visual acuity (BCVA), anterior segment findings, intraocular pressure, and fundus examination results were evaluated during control visits. Color fundus photography, fundus fluorescein angiographies, fundus autofluorescence, and spectral domain optical coherence tomography (SD-OCT) images were obtained. The height of pigment epithelial detachment (PED) was measured by SD-OCT. Results: Twelve eyes with RPE tears were studied. Nine eyes (75%) developed RPE tears during ranibizumab injections for choroidal neovascularization (eight eyes with vascularized PED and one eye with choroidal osteoma), and tears occurred in three eyes before any injections. The median number of ranibizumab injections after diagnosis of RPE tears was 3 (min 2, max 5). In the most recent follow-up visit, there was no statistically significant correlation between the grade of RPE and logMAR of BCVA (p>0.05, r=0.112). Eight of twelve eyes had PED, and seven of these had irregular PED contours before injection therapy. The mean PED height was 447 ± 122 µm. Conclusions: In this series, RPE tears developed mostly after intravitreal anti-VEGF injections for vascularized PED. Increased vertical height and irregular contours of the PEDs can be risk factors for the formation of RPE tears. The continuation of anti-VEGF therapy after tear formation is beneficial for vision improvement in eyes with RPE tears. .

RESUMO Objetivo: Apresentar os resultados anatômicos e visuais de injeções de ranibizumab em pacientes que foram diagnosticados com roturas do epitélio pigmentado da retina (RPE). Métodos: Olhos com um mínimo de seis meses de acompanhamento após diagnóstico de roturas do RPE foram avaliados retrospectivamente. Cada olho foi tratado com, pelo menos, três doses de ranibizumab em intervalos mensais. Acuidade visual com a melhor correção (BCVA), achados do segmento anterior, pressão intraocular e exames de fundo de olho foram avaliados nas visitas de controle. Retinografia colorida, angiografias fluoresceínicas, autofluorescência de polo posterior e tomografia de coerência óptica imagens de domínio espectral (SD-OCT) foram obtidos. A altura do descolamento do epitélio pigmentado (PED) foi medida com SD-OCT. Resultados: Doze olhos com roturas do epitélio pigmentado da retina foram incluídos no estudo. Nove olhos (75%) desenvolveram roturas do epitélio pigmentado da retina durante as injeções ranibizumab para neovascularização de coroide (oito olhos com descolamento do epitélio pigmentado vascularizado e um olho com osteoma de coroide), a rotura ocorreu em três olhos antes de quaisquer injeções. A mediana do número de injeções de ranibizumab após o diagnóstico da rotura do RPE foi de 3 (mínimo 2, máximo 5). Na visita de acompanhamento mais recente, não houve correlação estatisticamente significante entre o grau de RPE e logMAR de BCVA (p>0,05, r=0,112). Oito dos doze olhos tinham descolamento do epitélio pigmentado, desses, 7 olhos tinham PEDs com contornos irregulares antes da injeção. A altura média do PED foi 447 ± 122 µm. Conclusões: Nesta série, as roturas de epitélio pigmentado da retina aconteceram principalmente após a injeção intravítrea anti-VEGF para descolamento do epitélio pigmentado vascularizado. O aumento da altura vertical e contornos irregulares dos PEDs podem ser considerados fatores de risco para a formação da rotura ...

Apport de l'echographie mode B dans le diagnostic de decollement de la retine

Objectifs Preciser les aspects epidemiocliniques puis repertorier les aspects echographiques des decollements retiniens. Patients et methode. 65 patients ont beneficie d'une echographie oculaire avec une sonde lineaire de haute frequence de 12 Mhz sur une duree 18 mois. Resultats. La moyenne d'age etait de 26 ans avec des extremes de2 et90 ans et une predominance masculine (46 hommes pour 19 femmes); soit un sexe ratio de 2 hommes pour une femme. Les motifs de consultation etaient domines par le traumatisme et la cataracte. L'echographie a revele 37 decollements retiniens (DR) de l'oil droit avec 25 decollements totaux et 12 decollements partiels. Par contre 38 DR etaient localises au niveau de l'oil gauche (27 total et 11 partiel). 64;62 de patients presentaient un decollement retinien total et 27;69 pour decollement retinien partiel. Les pathologies associees au decollement etaient dominee par la cataracte et l'hemorragie intra-vitreenne. Conclusion. L'echographie oculaire est un examen essentiel dans le diagnostic du decollement retinien. C'est un examen simple a realiser permettant de deceler les pathologies associees

Apport de l'echographie mode B dans le diagnostic de decollement de la retine

Objectifs Preciser les aspects epidemiocliniques puis repertorier les aspects echographiques des decollements retiniens. Patients et methode. 65 patients ont beneficie d'une echographie oculaire avec une sonde lineaire de haute frequence de 12 Mhz sur une dure 18 mois.Resultats. La moyenne d'age etait de 26 ans avec des extremes de 2 et 90 ans et une predominance masculine (46 hommes pour 19 femmes); soit un sexe ratio de 2 hommes pour une femme. Les motifs de consultation etaient domines par le traumatisme et la cataracte. L'echographie a revele 37 decollements retiniens (DR) de l'oil droit avec 25 decollements totaux et 12 decollements partiels. Par contre 38 DR etaient localises au niveau de l'oil gauche (27 total et 11 partiel). 64;62% de patients presentaient un decollement retinien total et 27;69% pour decollement retinien partiel. Les pathologies associees au decollement etaient dominee par la cataracte et l'hemorragie intra-vitreenne. Conclusion. L'echographie oculaire est un examen essentiel dans le diagnostic du decollement retinien. C'est un examen simple a realiser permettant de deceler les pathologies associees

Comparison of the Clinical Manifestations between Acute Vogt-Koyanagi-Harada Disease and Acute Bilateral Central Serous Chorioretinopathy

PURPOSE: To compare clinical, angiographic, and optical coherence tomographic characteristics between eyes with acute Vogt-Koyanagi-Harada (VKH) disease and eyes with acute bilateral central serous chorioretinopathy (CSC), and to demonstrate distinguishing features between the two diseases in confusing cases. METHODS: The medical records of 35 patients with VKH disease and 25 patients with bilateral CSC were retrospectively reviewed. Characteristics according to slit-lamp biomicroscopy, ophthalmoscopy, fundus photography, fluorescein angiography, indocyanine green angiography, and spectral-domain optical coherence tomography were compared between the two diseases. RESULTS: Five of 35 patients (10 of 70 eyes, 14.3%) with VKH disease were initially misdiagnosed as CSC patients, and six of 25 patients (12 of 50 eyes, 24%) with bilateral CSC were initially misdiagnosed as patients with VKH disease. Pigment epithelial detachment in CSC and optic disc hyperemia in VKH disease show the highest positive predictive values of 100% for each disease. CONCLUSIONS: Optic disc hyperemia in VKH disease and pigment epithelial detachment in bilateral CSC are the most specific clinical manifestations of each disease at initial patient presentation.

Intravitreal bevacizumab therapy for idiophatic juxtafoveolar retinal telangiectasis associated with serous macular detachment / Tratamento com injeção intravítrea de bevacizumabe para telangiectasia justafoveolar idiopática associada a descolamento seroso macular

The authors describe a 50-year-old woman with group 2 juxtafoveolar retinal telangiectasis and macular detachment treated with a single-dose of intravitreous bevacizumab injection. There was an improvement in her visual acuity, with a decrease in retinal thickness showed by the optical coherence tomography and fluorescein leakage in the angiography on follow-up visits. No adverse events were observed as a result of the treatment used. After one year of follow-up, the vision remained stable and macular detachment did not recur.

Os autores descrevem uma paciente do sexo feminino com 50 anos de idade portadora de telangiectasia justafoveolar idiopática tipo 2, associada a descolamento macular e tratada com injeção intravítrea de bevacizumabe, dose única. Houve uma melhora da acuidade visual com diminuição da espessura retiniana documentada por tomografia de coerência óptica e angiografia fluoresceínica durante seu acompanhamento. Não observou-se efeitos adversos em consequência do tratamento. Após um ano de acompanhamento, sua visão permaneceu estável e o descolamento macular não recorreu.

Outcome and Significance of Silicone Oil Tamponade in Patients with Chronic Serous Retinal Detachment

PURPOSE: To evaluate the effectiveness of silicone oil tamponade in patients with chronic serous retinal detachment (SRD) persisting for three months after the resolution of ocular inflammation. METHODS: A total of 17 eyes of 17 patients diagnosed with chronic SRD persisting for three months after the resolution of ocular inflammation and with high risk of phthisis bulbi by secondary ocular hypotony and macular detachment by subretinal fibrous membrane formation were subjected to surgical intervention. Subjects underwent silicone oil tamponade after surgical drainage of subretinal fluid. Retrospective analyses on anatomical and functional success rates were then performed. RESULTS: Anatomical success with retinal reattachment was observed in ten of the 17 eyes (58.82%), while functional success measured as difference in the best-corrected visual acuity before and after the surgery were logarithm of the minimum angle of resolution (logMAR) 1.95 +/- 0.66 and logMAR 1.51 +/- 0.66, respectively (p < 0.05). CONCLUSIONS: This study suggests that, in patients with chronic SRD despite prolonged medical treatment and resolution of inflammation, surgical drainage of subretinal fluid with silicone oil tamponade can achieve anatomical and functional success.

Outcome and Significance of Silicone Oil Tamponade in Patients with Chronic Serous Retinal Detachment

PURPOSE: To evaluate the effectiveness of silicone oil tamponade in patients with chronic serous retinal detachment (SRD) persisting for three months after the resolution of ocular inflammation. METHODS: A total of 17 eyes of 17 patients diagnosed with chronic SRD persisting for three months after the resolution of ocular inflammation and with high risk of phthisis bulbi by secondary ocular hypotony and macular detachment by subretinal fibrous membrane formation were subjected to surgical intervention. Subjects underwent silicone oil tamponade after surgical drainage of subretinal fluid. Retrospective analyses on anatomical and functional success rates were then performed. RESULTS: Anatomical success with retinal reattachment was observed in ten of the 17 eyes (58.82%), while functional success measured as difference in the best-corrected visual acuity before and after the surgery were logarithm of the minimum angle of resolution (logMAR) 1.95 +/- 0.66 and logMAR 1.51 +/- 0.66, respectively (p < 0.05). CONCLUSIONS: This study suggests that, in patients with chronic SRD despite prolonged medical treatment and resolution of inflammation, surgical drainage of subretinal fluid with silicone oil tamponade can achieve anatomical and functional success.

Microperimetry and optical coherence tomography in a case of traumatic macular hole and associated macular detachment with spontaneous resolution.

The association of macular detachment with posttraumatic macular hole is a known but rare occurrence. Spontaneously occurring resolution of the detachment and closure of the macular hole has been reported only once in the literature. We describe a similar rare event in a young male, the documentation of which was done serially by microperimetry (MP) and optical coherence tomography (OCT). A 17-year-old male presented with a decrease in vision following a closed globe injury to the left eye. A coexisting macular hole and macular detachment were detected in the affected eye. Serial follow-up with OCT and MP documented complete resolution of the macular hole and the macular detachment within 1 week of presentation. The case highlights that spontaneous resolution of traumatic macular hole and related macular detachment may occur and a waiting period is advisable before undertaking any corrective surgical procedure. The pathophysiologic mechanisms of causation and the resolution of posttraumatic macular hole-related retinal detachment are discussed.