ABSTRACT
Introducción: El uso del medicamento ranibizumab intravítreo favorece la reducción del edema macular generador de las oclusiones vasculares retinianas causantes de la pérdida visual. Objetivo: Evaluar la eficacia y seguridad de la administración intravítreo de ranibizumab en el cambio de espesor macular central en las oclusiones vasculares retinianas analizado mediante tomografía de coherencia óptica. Material y métodos: Se desarrolló un estudio de tipo retrospectivo, analítico, correlacional y observacional de campo con diseño no experimental en 125 pacientes mayores de 30 años con oclusión vascular retiniana diagnosticados en la consulta de oftalmología del Hospital "Teodoro Maldonado Carbó" durante enero de 2017 a junio de 2018. La técnica ANOVA compara las medias para determinar mediante el proceso de contraste de hipótesis si existen diferencias estadísticamente significativas entre estas. Resultados: El análisis de la agudeza visual con escala logMAR demostró diferencias estadísticamente significativas entre los promedios obtenidos 3 meses antes y después de la aplicación del tratamiento (p=0,0001). Se encontró 28,8 por ciento de efectos adversos. Con frecuencia en aumento de presión intraocular (4 por ciento), sequedad ocular (16 por ciento) y hemorragia conjuntival (11,2 por ciento). Conclusiones: El ranibizumab en oclusiones vasculares retinianas proporciona una mejor agudeza visual corregida en relación con el grosor macular, favorece el desarrollo de nuevos vasos sanguíneos a partir de vasos preexistentes desde migración de células endoteliales(AU)
Introduction: The use of the intravitreal ranibizumab favors the reduction of the macular edema that generates retinal vascular occlusions that cause visual loss. Objective: To evaluate the efficacy and safety of the intravitreal administration of ranibizumab in the change in central macular thickness in retinal vascular occlusions analyzed by optical coherence tomography. Material and methods: A retrospective, analytical, correlational and observational field study with a non-experimental design was carried out on 125 patients over 30 years of age diagnosed with retinal vascular occlusion in the Ophthalmology Service of "Teodoro Maldonado Carbó" Hospital during the period between January 2017 and June 2018. The ANOVA technique was used to compare means in order to determine, through the hypothesis contrast process, if there are statistically significant differences between them. Results: Visual acuity analysis using the logMAR scale showed statistically significant differences between the averages obtained 3 months before and after the application of the treatment (p =0.0001). In addition, 28,8 percent of adverse effects were found. The most frequent ones included increased intraocular pressure (4 percent), dry eyes (16 percent), and conjunctival hemorrhage (11,2 percent). Conclusions: In retinal vascular occlusions, Ranibizumab provides a better corrected visual acuity in relation to macular thickness, favors the development of new blood vessels from pre-existing vessels from endothelial cell migration(AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Young Adult , Vitreous Body , Retinal Vein Occlusion/therapy , Angiogenesis Inhibitors/therapeutic use , Tomography, Optical Coherence , Ranibizumab/therapeutic use , Visual Acuity , Macular Edema/therapy , Retrospective Studies , Treatment OutcomeABSTRACT
ABSTRACT The case of a 55-year-old male who presented central retinal vein occlusion with marked macular ischemia in left eye is reported. Despite the intervention with sustained-release dexamethasone polymer injection and other clinical measures, the visual acuity was severely reduced in left eye. After 8 months, he returned to the emergency with acute visual loss of 2 hours of progression in right eye due to a central retinal artery occlusion, sparing only the territory of the cilioretinal artery. Patient underwent clinical maneuvers with anterior chamber paracentesis and intravenous injection of tissue plasminogen activator. Fluorescein angiography immediately after the procedures showed recanalization, but despite arterial vasodilation, no complete recanalization was observed after 24 hours. The patient developed retinal atrophy.
RESUMO Apresenta-se o caso de um paciente do sexo masculino, de 55 anos, com oclusão de veia central retiniana com acentuada isquemia macular em olho esquerdo. Apesar da intervenção com injeção de polímero de liberação lenta de dexametasona e outras medidas clínicas tomadas, ele evoluiu com severa baixa da acuidade visual em olho esquerdo. Após 8 meses, retornou à emergência com perda visual aguda de 2 horas de evolução em olho direito devido à oclusão de artéria central retiniana, poupando apenas o território da artéria ciliorretiniana. O paciente foi submetido a manobras clínicas, com paracentese de câmara anterior e injeção endovenosa de ativador do plasminogênio tecidual. A angiografia fluoresceínica imediatamente após as manobras mostrou recanalização, porém, a despeito do vasodilatador arterial, não foi observada completa recanalização com 24 horas. O paciente evoluiu com atrofia retiniana.
Subject(s)
Humans , Male , Middle Aged , Retinal Vein Occlusion/diagnosis , Retinal Vein Occlusion/therapy , Retinal Artery Occlusion/diagnosis , Retinal Artery Occlusion/therapy , Retinal Artery , Retinal Diseases , Retinal Vein , Fluorescein Angiography , Visual Acuity , Tomography, Optical CoherenceABSTRACT
El micropulso es una tecnología láser que consiste en proporcionar solo una fracción de la energía usualmente utilizada para la realización del efecto deseado. La eficacia clínica del láser 577 nm ha mostrado una respuesta terapéutica favorable con mínimos daños colaterales tanto en los tratamientos convencionales de onda continua como en modo micropulsado para algunas enfermedades maculares, como edema macular diabético, retinopatía serosa central y oclusión venosa retiniana. IQ577TM ofrece, además, la tecnología TxCell, la que permite el uso de patrones con múltiples spots, aumenta la eficiencia al aplicar la terapia y hace el proceso menos doloroso para el paciente. Por otra parte, tiene ventajas en el tratamiento del glaucoma, ya que la trabeculoplastia láser con micropulso no es destructiva, a diferencia de la trabeculoplastia tradicional, y permite la posibilidad de retratamientos a los pacientes que no alcanzan la presión intraocular deseada. Con el objetivo de caracterizar el láser micropulsado IRIDEX IQ577TM se realizó la presente revisión de la literatura mediante búsquedas en diferentes publicaciones relacionadas con la especialidad, para lo cual se utilizaron las bases de datos de revistas líderes de Oftalmología(AU)
Micropulse is a laser technology that consists in providing only a fraction of the energy typically used to obtain a given effect. The clinical efficacy of 577 nm laser manifests in a favorable therapeutic response with minimal collateral damage both in conventional continuous wave treatments and in micropulse mode for some macular diseases, such as diabetic macular edema, central serous retinopathy and retinal vein occlusion. IQ577TM also offers TxCell technology, which allows the use of multi-spot patterns, increasing efficiency when applying the therapy and making the process less painful for patients. On the other hand, it has advantages for the treatment of glaucoma, because, unlike traditional trabeculoplasty, micropulse laser trabeculoplasty is not destructive, making it possible to re-treat patients not achieving the desired intraocular pressure. The purpose of the study was to characterize micropulse laser IRIDEX IQ577TM. A bibliographic review was conducted based on a search in various publications related to the specialty, using the databases of leading ophthalmology journals(AU)
Subject(s)
Humans , Retinal Vein Occlusion/therapy , Review Literature as Topic , Laser Coagulation/adverse effects , Laser Therapy/methods , Macular Edema/etiology , Databases, Bibliographic/statistics & numerical dataABSTRACT
Resumo Relatar um caso de paciente com Retinopatia vaso-oclusiva por Lúpus Eritematoso Sistêmico (LES) associado à Síndrome do Anticorpo Antifosfolipídeo (SAF), que se iniciou com um quadro de anemia hemolítica autoimune acompanhado por baixa visual súbita monocular. Poucos casos foram descritos na literatura nacional e mundial em que o LES se manifeste primeiramente com alterações oculares. O screening dos Anticorpos antifosfolípideos (APAs) é de suma importância para pacientes com retinopatia lúpica para que seja instituída a terapia imediata com anticoagulantes como forma de prevenir a trombose vascular, o que piora o prognóstico visual.
Abstract To report the case of a patient with vaso-occlusive retinopathy due to systemic lupus erythematosus (SLE) associated with antiphospholipid antibody syndrome (APAS), which started with signs and symptoms of autoimune hemolytic anemia accompanied by sudden monocular visual loss. Few cases of SLE manifestation primarily involving ocular changes have been reported in the Brazilian and international literature. Screening for antiphospholipid antibodies is of the greatest importance for patients with lupus retinopathy, so that immediate therapy with anticoagulants may be instituted in order to prevent vascular thrombosis, which worsens the visual prognosis.
Subject(s)
Humans , Female , Adult , Retinal Vein Occlusion/etiology , Antiphospholipid Syndrome/complications , Lupus Erythematosus, Systemic/complications , Ophthalmoscopy , Retina/diagnostic imaging , Warfarin/therapeutic use , Retinal Vein Occlusion/diagnosis , Retinal Vein Occlusion/therapy , Methylprednisolone/therapeutic use , Prednisone/therapeutic use , Retinal Hemorrhage/diagnosis , Triamcinolone/therapeutic use , Antiphospholipid Syndrome/diagnosis , Antiphospholipid Syndrome/therapy , Pulse Therapy, Drug , Tomography, Optical Coherence , Injections, Intraocular , Hydroxychloroquine/therapeutic use , Anemia, Hemolytic, Autoimmune/drug therapy , Lupus Erythematosus, Systemic/diagnosis , Lupus Erythematosus, Systemic/therapyABSTRACT
ABSTRACT Purpose: We compared the efficacy and safety of ranibizumab versus ranibizumab plus scatter laser photocoagulation (SLP) in patients with chronic post-central retinal vein occlusion (CRVO) macular edema (ME). Methods: This prospective non-randomized pilot study included 250 patients with peripheral retinal ischemia and CRVO-related ME. The mean follow-up period was 24.5 ± 6.5 months. The clinical assessments conducted included best corrected visual acuity, optical coherence tomography, and multi-field fluorescein angiography with measurement of the ischemic area. The study population comprised two comparable patient groups with peripheral retinal ischemia that received different treatments for post-CRVO ME: ranibizumab with peripheral SLP of capillary non-perfusion areas (Group 1); and Lucentis® monotherapy (Group 2). Data analyses were performed using Statistica 7 software suite and included the estimation of х ± δ values and their dispersion and covariation coefficients at different stages of the study. Results: Clinically significant retinal ischemia was detected in 175 (70%) patients, occupying an average of 435.12 ± 225.13 mm2, i.e., 167.15 ± 45.16 optic disc areas. Peripheral ischemia was found in 125 patients, representing 50% of all patients with CRVO and 71.4% of all patients with ischemic CRVO. The mean number of ranibizumab injections in patients who underwent SLP was 3.5 ± 1.6. Patients treated with ranibizumab monotherapy for 24 months received 10.6 ± 2.5 injections. Functional and anatomic results were comparable in the two groups. Conclusions: The combination of ranibizumab injections and peripheral SLP in capillary non-perfusion areas can significantly decrease the number of injections and reduce neovascular complications.
RESUMO Objetivo: A investigação centra-se na terapia de edema macular pós-oclusão da veia retiniana central (OVCR) em casos com isquemia retiniana periférica. O objetivo foi comparar a eficácia e a segurança do tratamento com ranibizumab vs ranibizumab + fotocoagulação com laser de dispersão (SLP) em pacientes com edema macular crônico secundário a oclusão da veia retiniana central isquêmica. Métodos: O estudo prospectivo não-randomizado incluiu 250 pacientes com isquemia retiniana periférica e edema macular relacionados a oclusão da veia retiniana central. O tempo médio de seguimento foi de 24,5 ± 6,5 meses. A avaliação clínica incluiu acuidade visual melhor corrigida, tomografia de coerência óptica (OCT) e angiografia por fluoresceína multi-campo com a medição da área de isquemia. A população estudada foi constituída por dois grupos de pacientes comparáveis com o oclusão da veia retiniana central isquêmica, que receberam tratamento diferente. Em nossa prática anterior, utilizamos ranibizumab (Lucentis®) em monoterapia (de acordo com a licença do medicamento) para edema macular pós-oclusão da veia retiniana central com isquemia retiniana periférica (Grupo 2). Mais recentemente, começamos a combinar ranibizumab com SLP periférica de áreas não perfusão capilar (Grupo 1). As análises de dados foram realizadas com o software Statistica 7 e incluíram a estimação dos valores de х ± δ e seus coeficientes de dispersão e covariân cia em diferentes estágios do estudo. Resultados: Identificou-se isquemia retiniana clinicamente significativa em 175 (70%) pacientes, atingindo uma média de 435,12 ± 225,13 mm2, ou seja, 167,15 ± 45,16 áreas de disco óptico. Isquemia periférica foi encontrada em 125 casos, representando 50% de todos os pacientes com oclusão da veia retiniana central e 71,4% de todos os pacientes com oclusão da veia retiniana central isquêmica. O número médio de injeções de rani bizumab em pacientes com SLP foi de 3,5 ± 1,6. Os pacientes tratados com ranibizu mab em monoterapia durante 24 meses receberam 10,6 ± 2,5 injeções. Os resultados funcionais e anatômicos foram comparáveis nos dois grupos. Conclusões: A combinação de injeções de ranibizumab com SLP periférica em áreas de não-perfusão capilar pode diminuir significativamente o número de injeções e reduzir as complicações neovasculares.
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Retinal Vein Occlusion/therapy , Laser Coagulation/methods , Angiogenesis Inhibitors/therapeutic use , Ranibizumab/therapeutic use , Retinal Vein Occlusion/complications , Pilot Projects , Prospective Studies , Treatment Outcome , Combined Modality Therapy/methods , Angiogenesis Inhibitors/administration & dosage , Ranibizumab/administration & dosageABSTRACT
Las oclusiones venosas retinales constituyen una importante causa de deterioro de la agudeza visual. Su evolución y manejo mediante fotocoagulación retinal con láser se encuentra bien documentada por importantes estudios clínicos. Actualmente se ha sumado el uso de agentes antiangiogénicos para el tratamiento de sus complicaciones, en especial del Edema macular secundario. Se analizan cuadros clínicos, complicaciones y manejo de la Oclusión de Rama Venosa Retinal y de la Oclusión de Vena Central de la Retina resaltando el uso de terapia intravítrea con Triamcinolona
The retinal vein occlusion constitute an important cause of deterioration of visual acuity. Their evolution and management through retinal photocoagulation wuith laser, is well documented by important clinical studies. At present the use of antiangiogenics agents for the treatment of its complications has been added, and especially secondary macular edema. Clinical cases are analysed as well as complications and handling of the Branch Retinal Vein Occlusion and the Central Retinal Vein occlusion. The use of Triamcinolone and Ranibizumab is highlighted
Subject(s)
Humans , Retinal Vein Occlusion/complications , Retinal Vein Occlusion/diagnosis , Retinal Vein Occlusion/therapy , Triamcinolone Acetonide/therapeutic use , Macular Edema/etiology , Angiogenesis Inhibitors/therapeutic use , Light Coagulation , Neovascularization, Pathologic/etiologyABSTRACT
Retinal vein occlusions [RVO] are the second commonest sight threatening vascular disorder. Branch retinal vein occlusion [BRVO] and central retinal vein occlusion [CRVO] are the two basic types of vein occlusion. Branch retinal vein occlusion is three times more common than central retinal vein occlusion and- second only to diabetic retinopathy as the most common retinal vascular cause of visual loss. The origin of branch retinal vein occlusion undoubtedly includes both systemic factors such as hypertension and local anatomic factors such as arteriovenous crossings. Branch retinal vein occlusion causes a painless decrease in vision, resulting in misty or distorted vision. Current treatment options don't address the underlying aetiology of branch retinal vein occlusion. Instead they focus on treating sequelae of the occluded venous branch, such as macular oedema, vitreous haemorrhage and traction retinal detachment from neovascularization. Evidences suggest that the pathogenesis of various types of retinal vein occlusion, like many other ocular vascular occlusive disorders, is a multifactorial process and there is no single magic bullet that causes retinal vein occlusion. A comprehensive management of patients with retinal vascular occlusions is necessary to correct associated diseases or predisposing abnormalities that could lead to local recurrences or systemic event. Along with a review of the literature, a practical approach for the management of retinal vascular occlusions is required, which requires collaboration between the ophthalmologist and other physicians: general practitioner, cardiologist, internist etc. as appropriate according to each case
Subject(s)
Humans , Male , Female , Hypertension/complications , Diabetic Retinopathy , Disease Management , Incidence , Prevalence , Risk Factors , Arteriosclerosis/complications , Retinal Vein Occlusion/physiopathology , Retinal Vein Occlusion/therapy , BlindnessABSTRACT
A papiloflebite é a denominaçäo dada à obstruçäo venosa central no adulto jovem.Descrevemos um caso em um paciente de 16 anos que teve baixa acuidade visual súbita e com o tratamento retornou à visäo 20/20.
Subject(s)
Humans , Male , Adolescent , Retinal Vein Occlusion/pathology , Retinal Vein Occlusion/therapyABSTRACT
Objetivo: Analisar a eficácia de se desenvolver anastomose venosa retinocoroideana como opção terapêutica no tratamento de Obstrução da Veia Central da Retina (OVCR). Métodos: Três pacientes com OVCR foram submetidos a fotocoagulação com laser verde, com a finalidade de criar uma anastomose venosa retinocoroideana. Resultados: Dos três pacientes submetidos à fotocoagulação com laser verde, a anastomose retinocoroideana foi evidenciada angiograficamente em um paciente. Após um seguimento mínimo de três meses, houve melhora das hemorragias retinianas em todos os pacientes. Nenhum desses, entretanto, obteve melhora na acuidade visual. Conclusão: Embora o laser seja capaz de criar uma anastomose venosa retinocoroideana, estudos adicionais são necessários para avaliar eventuais benefícios desse tratamento em pacientes com OVCR.
Subject(s)
Humans , Male , Female , Middle Aged , Arteriovenous Anastomosis , Light Coagulation/methods , Retinal Vein Occlusion/therapyABSTRACT
Dado los caracteres germicida y estimulante de los procesos de metabolización del oxígeno y la circulación sanguínea que posee el ozono, se hizo un estudio preliminar sobre el posible valor de la ozonoterapia en la mejoría o cura de algunos pacientes aquejados de úlceras corneales, obstrucciones vasculares del fondo de ojo, atrofia del nervio óptico, retinopatia diabética y trasplante de córnea (para favorecer una mayor irrigación sanguínea en el injerto). Se obtuvo el 92% de buenos resultados y no se encontraron efectos colaterales perjudiciales