Vitrectomía pars plana 23 G en la endoftalmitis aguda poscirugía de catarata / 23-G pars plana vitrectomy in the acute endophthalmitis after cataract surgery

La endoftalmitis es una rara pero devastadora complicación que puede presentarse después de una cirugía de catarata. Su incidencia se reporta en un 0,4-0,41 por ciento de los casos. El diagnóstico es clínico, sustentado por el cultivo de los fluidos intraoculares. La terapéutica general se basa en la biopsia vítrea, la administración de antibióticos intravítreos y la realización o no de la vitrectomía pars plana. El manejo óptimo en estos casos con endoftalmitis posoperatoria después de una facoemulsificación depende del entrenamiento médico, la prevención, el diagnóstico temprano y las terapéuticas activas e inmediatas de tratamiento. Se presenta un paciente de 65 años de edad que a las 72 horas de la facoemulsificación en el ojo izquierdo comenzó con dolor, disminución de la visión, membrana inflamatoria en cámara anterior, hipopión y opacidad vítreas que no dejaban ver el fondo de ojo. Se diagnósticó endoftalmitis aguda y se decidió inmediatamente la toma de muestra, la vitrectomía temprana y la intravítrea de antibióticos. Al mes la agudeza visual era de 90 var sin otras complicaciones(AU)

The endoftalmitis is a strange but devastating complication that can be presented after a waterfall surgery. Their incidence is reported in 0.04 percent-0.41 percent of the cases. The diagnosis is clinical, sustained by the cultivation of the flowing intraoculares. The general therapy is based on the vitreous biopsy, the administration of antibiotic intravítreos, and the realization or not of the vitrectomía plane pars (VPP). THE good handling in these cases with postoperative endoftalmitis after a facoemulsificación depends on the medical training, the prevention, the early diagnosis and active and immediate therapies of treatment. A 65 year-old patient is presented that at the 72 hours of the facoemulsificación in left eye, you/he/she begins with pain, decrease of the vision, inflammatory membrane in previous camera, hipopión and vitreous opacity that don't allow to see eye bottom. You diagnóstica sharp endoftalmitis and he/she decides immediately taking of sample, vitrectomía temprarna and intravítrea of antibiotics. A month the visual sharpness was of 90 var without other complications(AU)

DRESS syndrome in ophthalmic patients / Síndrome DRESS em pacientes oftalmológicos

ABSTRACT Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare and potentially fatal adverse drug reaction associated with skin rash, fever, eosinophilia, and multiple organ injury. A number of pharmacological agents are known to cause DRESS syndrome such as allopurinol, anticonvulsants, vancomycin, trimethoprime-sulfamethoxazole, and pyrimethamine-sulfadiazine. Here, we describe two patients who developed DRESS syndrome during ocular treatment. The first case was being treated for late postoperative endophthalmitis with topical antibiotics, intravenous cephalothin, meropenem, and intravitreal injection of vancomycin and ceftazidime before symptoms developed. We were unable to identify the causal drug owing to the large number of medications concurrently administered. The second case presented with DRESS syndrome symptoms during ocular toxoplasmosis treatment. In this case, a clearer association with pyrimethamine-sulfadiazine was observed. As a result of the regular prescription of pharmacological agents associated with DRESS syndrome, ophthalmologists should be aware of the potentially serious complications of DRESS syndrome.

RESUMO Síndrome DRESS (drug reaction with eosinophilia and systemic symptoms) é uma reação adversa a medicamentos rara e potencialmente fatal, associada à rash cutâneo, febre, eosinofilia e lesão de múltiplos órgãos. Algumas drogas podem desencadeá-la, como: alopurinol, anticonvulsivantes, vancomicina, sulfametoxazol-trimetoprim, sulfadiazina-pirimetamina, entre outras. Descrevemos dois casos que desenvolverem DRESS síndrome durante tratamento ocular. O primeiro caso apresentou os sintomas durante tratamento para endoftalmite pós-operatória tardia com antibióticos tópicos, cefalotina e meropenem intravenosos e injeção intravítrea de vancomicina e ceftazidima; não podemos identificar a droga causadora, pois múltiplas medicações foram utilizadas. O segundo caso desenvolveu os sintomas durante tratamento clássico para toxoplasmose ocular, então a associação com sulfadiazina-pirimetamina foi mais clara. Como muitos oftalmologistas prescrevem regularmente drogas que podem desencadear a síndrome DRESS, esse diagnóstico deve ser lembrado já que pode levar a sérias complicações.

Intravítrea de bevacizumab vs. bevacizumab y triamcinolona para el edema macular diabético / Intravitreal bevacizumab versus bevacizumab and triamcinolone for the diabetic macular edema

Objetivos: evaluar el uso de la inyección IV de bevacizumab, sola o combinada con triamcinolona, así como sus efectos adversos y la correlación entre la mejor agudeza visual corregida y el grosor macular central. Métodos: se realizó un estudio observacional, longitudinal, prospectivo de caso y control a doble ciegas a 90 pacientes en la consulta de Vítreo­Retina del Instituto Cubano de Oftalmología Ramón Pando Ferrer, con edema macular diabético no tratados previamente y sin tracción vítrea. Se dividieron al azar en 3 grupos de tratamientos: un grupo control tratado con láser, otro con intravítrea de bevacizumab (1,25 mg en 0,05 mL) y otro con bevacizumab y triamcinolona (1,25 mg en 0,05 mL más 4 mg en 0,1 mL respectivamente). Cada grupo estuvo formado por 30 pacientes, con evolución a las 6, 12, 18, 24, 30 semanas y al año. Resultados: la mejor agudeza visual corregida al año de tratamiento entre los tres grupos no tuvo significación estadística (p= 0,099). En el grupo de láser el 40 por ciento mejoró 2 o más líneas, seguido del grupo de bevacizumab (20 por ciento) y el de bevacizumab y triamcinolona (10 por ciento). Hubo diferencia significativa (p= 0,001), en la disminución del grosor macular central entre los grupos al año; el grupo del láser fue el de mayor disminución (60 por ciento). El grupo de intravítrea de bevacizumab y triamcinolona logró los mejores resultados en la disminución del grosor macular central, pero no se mantuvo al año; sin embargo, el efecto del láser logró una disminución del grosor macular más estable. Conclusión: el tratamiento con fotocoagulación macular para el edema macular diabético es más eficaz al año en la disminución de grosor macular y en la mejor agudeza visual corregida(AU)

Objective: to evaluate the use of intravitreal bevacizumab injection alone or combined with triamcinolone as well as the adverse effects and the correlation between the best corrected visual acuity and the central macular thickness. Methods: prospective, longitudinal and observational double-blinded case control study performed in 90 patients with untreated diabetic macular edema and no vitreous traction in the vitreous-retina service of Ramón Pando Ferrer Institute of Ophthalmology of Cuba. They were randomly divided into 3 groups for treatment: a control group treated with laser, another one with intravitreal bevacizumab (1,25 mg in 0,05 mL) and the other with bevacizumab plus triamcinolone (1,25 mg in 0,05 mL plus 4 mg in 0,1 mL, respectively). Each group had 30 patients, with progress evaluated at 6, 12, 16, 24, 30 weeks and one year. Results: the best corrected visual acuity after a year of treatment did not have statistical significant in any of the three groups (p= 0,099). In the laser-treated group, 40 percent improved two or more lines in the Snellen chart, followed by bevacizumab group (20 percent) and that of bevacizumab plus triamcinolone (10 percent). There was significant difference (p= 0,001) in the central macular thickness decrease after one year in the three groups, being the laser group the one with highest decrease rate (60 percent). The group treated with intravitreal bevacizumab plus triamcinolone achieved the best results in reducing the central macular thickness but this result did not remain after a year. However, the laser treatment showed a more stable reduction of the macular thickness. Conclusions: macular photocoagulation for the diabetic macular edema is more effective one year after treatment in reducing the macular thickness and achieving the best corrected visual acuity(AU)

Inyección intravítrea de bevacizumab vs. acetato de triamcinolona en el edema macular secundario a oclusión de rama venosa retiniana / Intravitreal bevacizumab vs. triamcinolone acetonide injection to treat macular edema secondary to branch retinal vein occlusion

Objetivo: comparar los resultados del tratamiento intravítreo de bevacizumab y de acetato de triamcinolona en el edema macular secundario ante la oclusión de rama venosa retiniana. Métodos: estudio prospectivo, intervencional, aleatorio y comparativo realizado en 34 pacientes. El grupo 1 (16 pacientes) con inyección intravítrea de acetato de triamcinolona y el grupo 2 (18 pacientes) con inyección de bevacizumab hasta completar 3 dosis en cada grupo, seguida la tercera dosis de grid macular. La dosis inicial fue a los 3 meses de la afección, y la evaluación final a los 12 meses. Se evaluó la agudeza visual mejor corregida (Snellen), grosor macular y complicaciones. Resultados: en el grupo 1 la mejor agudeza visual con corrección evolucionó de 0,29 (0,05-0,5) a 0,64 (0,05-1,0); en el grupo 2 de 0,24 (0,05-0,5) a 0,66 (0,11,0). El grosor macular en el grupo 1, de 551,3 (346-967) micras, mejoró a 204,06 (112-449) micras; en el grupo 2, de 546,2 (283-1020) micras, hasta un grosor retinal foveal de 181,05 (112-312) micras. Como complicaciones, en el grupo 1 hubo un incremento de la tensión ocular en el 25,0 por ciento de los pacientes y una progresión de catarata en el 12,5 por ciento. Conclusiones: el tratamiento de inyección intravítrea de bevacizumab en el edema macular secundario a oclusiones venosas de rama retiniana muestra mejor resultado que el de acetato de triamcinolona. También son menores las complicaciones asociadas al bevacizumab(AU)

Objective: to compare the results of the intravitreal treatment with bevacizumab and with triamcinolone acetonide in the macular edema secondary to branch retinal vein occlusion. Methods: a prospective, interventional, random and comparative study was carried out in 34 patients. The first group (16 patients) received intravitreal triamcinolone acetonide injection whereas the second group (18 patients) had bevacizumab injection up to completing three doses in each group, followed by a third dose of macular grid. The initial dose was applied three months after the occurrence of edema and the final evaluation was made 12 months afterwards. Best corrected visual acuity (Snellen's chart), the macular thickness and complications were assessed. Results: in the first group, the best corrected visual acuity increased from 0,29 (0,05-05) to 0,64 (0,05-1,0) whereas in the second group it went from 0,24 (0,05-05) to 0,66 (0,1-1,0).The macular thickness of 551,3 (346-967) microns of the first group improved when reaching 204,06 (112-449) microns and that of the second group went from 546,2 (283-1020) microns to 181,05 (112-312) microns. As to the complications, 25 percent of patients of the first group experienced eye hypertension, and 12,5 percent of patients in the same group had cataract progression. Conclusions: intravitreal bevacizumab injection treatment of the macular edema secondary to branch retinal vein occlusion was better than that based on triamcinolone acetonide injection. The complications associated to bevacizumab treatment were fewer(AU)

Comparison of 3 different anesthetic approaches for intravitreal injections: a prospective randomized trial / Comparação de três abordagens anestésicas diferentes para injeções intravítreas: um estudo prospectivo e randomizado

Purpose: To compare the anesthetic effectiveness of topical proparacaine drops, subconjunctival lidocaine, and 2% lidocaine gel. Methods: Ninety-two patients undergoing intravitreal injections were randomized to 1 of 3 groups: proparacaine 0.5% drops (Group Drops), proparacaine 0.5% drops plus subconjunctival lidocaine (Group SC), or 2% lidocaine gel (Group Gel). Patients were asked to score their pain experience using a visual analog scale of 0 to 10 immediately following the injections and 10 min, 1 h, 6 h, and 24 h after the injections. Patients also graded the overall injection experience as Excellent, Very Good, Fair, Poor, or Awful. The physician evaluated the patients’ eye movement during intravitreal injection on 3 levels: (0) none or minimal, (1) not compromising the injection, and (2) compromising the injection. Results: The patients in Group Drops had the worst mean pain scores during the injection and 10 min after, with the highest occurrence of movements compromising the procedure (Grade 2; 38.7%). The patients in Group SC had a higher percentage of good experiences (37.9%) but a higher incidence of chemosis (16.7%). The patients in Group Gel had similar overall pain scores to Group Drops patients but a higher incidence of keratitis (19.4%). There was no statistically significant correlation between the use of aspirin or anticoagulants and the occurrence of hyperemia or hyposphagma. Conclusion: Subconjunctival lidocaine was most effective in preventing pain and eye movements during intravitreal injections. Although 2% lidocaine gel produced a good overall experience for the patients, the incidence of keratitis was very high (19.4%). Therefore, we do not recommend 2% lidocaine gel as the first anesthetic choice for intravitreal injections. There is no evidence to suspend the use of aspirin or other anticoagulants drugs prior to intravitreal injections. .

Objetivo: Comparar a eficácia anestésica entre proparacaína tópica, lidocaína subconjuntival e lidocaína gel a 2%. Métodos: Noventa e dois pacientes em tratamento com injeções intravítreas foram randomizados para um de três grupos: proparacaína 0,5% gotas (Grupo gotas), proparacaína 0,5% gotas seguida de lidocaína subconjuntival (Grupo SC), ou lidocaína gel a 2%. (Grupo Gel). Os pacientes foram orientados a graduar a sua experiência de dor por uma escala visual analógica, numa escala de 0 a 10, imediatamente após as injeções, bem como 10 minutos, 1 hora, 6 horas e 24 horas após. Os pacientes também classificaram a experiência global de injeção como excelente, muito boa, regular, ruim ou horrível. O médico avaliou o movimento do olho do paciente durante a injeção intravítrea em três níveis: nenhuma ou mínima (0), não comprometendo a injeção (1), comprometendo a injeção (2). Resultados: Os pacientes do grupo gotas apresentaram uma graduação média de dor pior durante a injeção e 10 minutos após, com maior ocorrência de movimentos comprometendo a injeção (grau 2) (38,7%). Os pacientes do grupo SC, apresentaram maior percentual de boa experiência durante o procedimento (37,9%) e maior ocorrência de quemose (16,7%). Os pacientes do grupo Gel apresentaram escore de dor geral semelhante ao grupo Gotas e maior incidência de ceratite (19,4%). Não houve correlação estatisticamente significativa com o uso de aspirina ou anticoagulantes e a ocorrência de hiperemia ou hiposfagma. Conclusão: Lidocaína subconjuntival foi mais eficaz na prevenção da dor durante injeção intravítrea com movimentação ocular mínima. Embora os pacientes do grupo lidocaína gel a 2% tenham apresentado uma boa experiência, consideramos a incidência ceratite muito elevada (19,4%) e não recomendamos lidocaína gel a 2% como a primeira escolha como anestésico para injeções intravítreas. Não há evidência para a suspensão do uso de aspirina ou drogas anti-coagulantes em pacientes ...

Survey: technique of performing intravitreal injection among members of the Brazilian Retina and Vitreous Society (SBRV) / Survey: técnica para realização de injeção intravítrea pelos membros da Sociedade Brasileira de Retina e Vítreo (SBRV)

Purpose: To evaluate and describe the precautions involved in the technique of intravitreal injection of antiangiogenic drugs adopted by the ophthalmologists who are members of the Brazilian Society of Retina and Vitreous (SBRV). Methods: A questionnaire containing 22 questions related to precautions taken before, during, and after intravitreal injection was sent electronically to 920 members of SBRV between November 15, 2013 and April 31, 2014. Results: 352 responses (38%) were obtained. There was a predominance of men (76%) from the southwest region of Brazil (51%). The professional experience varied between 6 and 15 years after medical specialization (50%). Most professionals (76%) performed an average of 1 to 10 intravitreal injections a week, and 88% of the procedures were performed in the operating room using povidone iodine (99%), sterile gloves, and blepharostat (94%). For inducing topical anesthesia, usage of anesthetic eye drops was the most used technique (65%). Ranibizumab (Lucentis®) was the most common drug (55%), and age-related macular degeneration (AMD) was the most treated disease (57%). Regarding the complications treated, 6% of the ophthalmologists had treated at least one case of retinal detachment, 20% had treated cases of endophthalmitis, 9% had treated cases of vitreous hemorrhage, and 12% had encountered cases of crystalline lens touch. Conclusion: Intravitreal injection is a procedure routinely performed by retina specialists and has a low incidence of complications. Performing the procedure in the operating room using an aseptic technique was preferred by most of the respondents. Ranibizumab was the most used drug, and AMD was the most treated disease. .

Objetivo: Avaliar e descrever os cuidados envolvidos durante o procedimento de injeção intravítrea de drogas antiangiogênicas realizado pelos oftalmologistas membros da Sociedade Brasileira de Retina e Vítreo (SBRV). Métodos: Foi enviado um questionário aos 920 membros da SBRV, por meio de correio eletrônico, entre o período de 15/11/2013 a 31/04/2014, contendo 22 questões, relacionado aos cuidados pré, intra e pós-operatório da injeção intravítrea. Resultados: Foram obtidas 352 respostas (38% dos sócios). Houve um predomínio do sexo masculino (76%), procedentes da região Sudeste (51%). O tempo de experiência profissional se concentrou entre 6 a 15 anos após o término da especialização (50%). A maioria dos participantes tem média semanal de 1 a 10 (76%), sendo 88% das vezes realizado dentro do centro cirúrgico, utilizando iodopovidona (99%), luvas e blefarostato estéreis (94%). A anestesia tópica com colírio anestésico foi a técnica mais utilizada (65%). Entre os participantes, ranibizumabe (Lucentis®) é a droga mais utilizada (55%) e a degeneração macular relacionada a idade (DMRI) é a doença mais tratada (57%). Das complicações citadas pelos oftalmologistas, 6% já vivenciaram pelo menos um caso de descolamento de retina, 20% endoftalmite, 9% hemorragia vítrea e 12% toque cristaliniano. Conclusão: A injeção intravítrea é um procedimento realizado rotineiramente por retinólogos, com baixo índice de complicações. A realização do procedimento no centro cirúrgico com técnica asséptica é preferida pelos pesquisados. A droga mais utilizada foi o ranibizumabe e a doença mais tratada foi a DMRI. .

Pain in the treatment of vitreoretinal diseases

Treatment of vitreoretinal diseases comprises a range of options that has increased in the past several years, allowing more individuals to benefit from new therapeutic approaches. The use of lasers in the retina, new surgical techniques, and intravitreal drug administration constitute common treatment options. These retinal and vitreal procedures have both benefits and drawbacks. Among the drawbacks is discomfort associated with the procedure, constituting a relevant issue because it can compromise adherence to treatment. We reviewed aspects of pain associated with vitreoretinal procedures and the available options for its control. With regard to vitreoretinal procedures, laser photocoagulation is associated with a higher pain score compared with vitrectomy and intravitreal injection using traditional anesthesia methods, suggesting that laser photocoagulation still needs to be improved with regard to comfort during the procedure. In some cases, a combination of analgesic options may be the best choice for pain-sensitive individuals. Individual differences and the specific condition that is treated should be considered when deciding the best treatment option.

Endoftalmitis poscirugía de catarata por Sphingomonas paucimobilis / Sphingomonas paucimobilis-induced endophthalmitis after cataract surgery

Se presenta la caracterización y manejo terapéutico de un caso de endoftalmitis bacteriana posoperatoria causada por el germen Sphingomonas paucimobilis. La endoftalmitis es la inflamación de los tejidos intraoculares, considerada como la más devastadora de las complicaciones posoperatorias; posee pronóstico visual muy reservado y un elevado riesgo de secuela. Las Sphingomonas paucimobilis son bacterias gramnegativas con forma de bacilo, quimioheterótrofa y estrictamente aerobias que causan enfermedades en los seres humanos, principalmente infecciones hospitalarias que típicamente son tratadas fácilmente con antibióticos. Por sus capacidades biodegradantes y biosintéticas, son pocos los reportes hallados de infección intraocular por este germen. El pronóstico visual es favorable con un diagnóstico precoz y la aplicación del tratamiento adecuado. En este artículo se presentan un caso de endoftalmitis poscirugía de catarata por Sphingomonas paucimobilis reportado en Cuba en el mes de septiembre de 2009.

The characterization and therapeutic management of a case of postsurgery bacterial endophthalmitis caused by Shingomonas paucimobilis was presented. Endophthalmitis is the inflammation of the intraocular tissues and considered as the most devastating postoperative complication. The visual prognosis of this disease is very reserved judgement and high risk of sequelae. Sphingomonas paucimobilis are bacillus-shaped, chemoheterotrophic and strictly aerobic Gramnegative bacteria that cause diseases in the human being, mainly nosocomial infections that are typically treated with antibiotics. Based on its biodegrading and biosynthetic capacities, there are few reports on intraocular infections caused by this germ. The visual prognosis is favourable when the disease is early diagnosed and adequately managed. A case of endophthalmitis following a cataract surgery and caused by Shingomonas paucimobilis in Cuba in September 2009 was presented in this article.

Suspected Bacterial Endophthalmitis Following Sustained-release Dexamethasone Intravitreal Implant: A Case Report

A 58-year-old man admitted to our opthalmology department with the complaint of branch retinal vein occlusion. He was treated with intravitreal Ozurdex in the right eye. Two days after the injection, the patient presented with ocular pain and the visual acuity was hand movement. A diagnosis of endophthalmitis was made. We performed emergent pars plana vitrectomy (PPV) and the implant was removed from the vitreous cavity using a retinal forceps. A combination of vancomycin 1.0 mg and amikacin 0.4 mg was injected intravitreally. However, because of the blurring in the vitreus one week after the procedure, phacoemulsification and a repeat PPV was performed. Five days after the last procedure the signs and symptoms of endophthalmitis were resolved. Our case demonstrated that endophthalmitis could develop after intravitreal implantation of Ozurdex. Surgical removal of the implant and immediate vitrectomy seems to be a useful treatment option in these cases.

Panretinal photocoagulation versus intravitreal injection retreatment pain in high-risk proliferative diabetic retinopathy / Dor em panfotocogulação retiniana versus injeção intravítrea em pacientes com retinopatia diabética proliferativa de alto risco

PURPOSE: To compare pain related to intravitreal injection and panretinal photocoagulation in the management of patients with high-risk proliferative diabetic retinopathy. METHODS: Prospective study including patients with high-risk proliferative diabetic retinopathy and no prior laser treatment randomly assigned to receive panretinal photocoagulation (PRP group) or panretinal photocoagulation plus intravitreal ranibizumab (PRPplus group). In all patients, panretinal photocoagulation was administered in two sessions (weeks 0 and 2), and intravitreal ranibizumab was administered at the end of the first laser session in the PRPplus group. Retreatment was performed at weeks 16 and 32 if active new vessels were detected at fluorescein angiography. Patients in the PRPplus group received intravitreal ranibizumab and patients in the PRP group received 500-µm additional spots per quadrant of active new vessels. After the end of retreatment, a 100-degree Visual Analog Scale was used for pain score estimation. The patient was asked about the intensity of pain during the whole procedure (retinal photocoagulation session or intravitreal ranibizumab injection). Statistics for pain score comparison were performed using a non-parametric test (Wilcoxon rank sums). RESULTS: Seventeen patients from PRPplus and 14 from PRP group were evaluated for pain scores. There were no significant differences between both groups regarding gender, glycosylated hemoglobin and disease duration. Mean intravitreal injection pain (±SEM) was 4.7 ± 2.1 and was significantly lower (p<0.0001) than mean panretinal photocoagulation pain (60.8 ± 7.8). Twelve out of 17 patients from the PRPplus group referred intensity pain score of zero, while the minimal score found in PRP group was found in one patient with 10.5. CONCLUSION: In patients with high-risk proliferative diabetic retinopathy who needed retreatment for persistent new vessels, there was more comfort for the patient when retreatment was performed with an intravitreal injection in comparison with retinal photocoagulation. Further larger studies are necessary to confirm our preliminary findings.

OBJETIVO: Comparar a dor relacionada à injeção intravítrea e panfotocoagulação no tratamento de pacientes com retinopatia diabética proliferativa de alto risco. MÉTODOS: Estudo prospectivo incluindo pacientes com retinopatia diabética proliferativa de alto risco e nenhum tratamento a laser prévio aleatoriamente designados para receber panfotocoagulação retiniana (grupo PRP) ou panfotocoagulação e ranibizumabe intravítreo (grupo PRPplus). Em todos os pacientes, a panfotocoagulação foi administrada em duas sessões (semanas 0 e 2), e ranibizumabe intravítreo foi administrado no final da primeira sessão de laser no grupo PRPplus. Retratamento foi realizado nas semanas 16 e 32 se neovasos ativos fossem detectados na angiofluoresceinografia, utilizando ranibizumabe intravítreo no grupo PRPplus e laser adicional grupo PRP. Após o fim do retratamento, uma Escala Analógica Visual de 100-unidades foi utilizada para a estimativa da pontuação da dor. O paciente foi questionado sobre a intensidade da dor durante todo o procedimento (sessão de fotocoagulação de retina ou injeção intravítrea de ranibizumabe). A comparação dos índices de dor foi realizada utilizando um teste não-paramétrico (Wilcoxon rank sums). RESULTADOS: Dezessete pacientes do grupo PRPplus e 14 do grupo PRP foram avaliados para os índices de dor. Não houve diferenças significativas entre os dois grupos quanto ao sexo, hemoglobina glicosilada e duração da doença. A média de dor da injeção intravítrea (±SEM) foi 4,7 ± 2,1, significativamente menor (p<0,0001) do que a dor média da panfotocoagulação (60,8 ± 7,8). Doze dos 17 pacientes do grupo PRPplus referiram pontuação de intensidade da dor zero, enquanto que o índice mínimo no grupo PRP foi encontrado em um paciente com 10,5. CONCLUSÃO: Em pacientes com retinopatia diabética proliferativa de alto risco que necessitaram de retratamento por neovasos persistentes, houve mais conforto para o paciente quando o retratamento foi realizado com uma injeção intravítrea em comparação com fotocoagulação da retina. Estudos posteriores são necessários para confirmar nossos achados preliminares.

Acute bilateral endophthalmitis following bilateral intravitreal bevacizumab [avastin] injection

The clinical presentation and management of two patients who presented with acute bilateral endophthalmitis following bilateral intravitreal bevacizumab injection. Both cases were diagnosed clinically and subsequent to a vitreous sample, intravitreal ceftazidime [2.25 mg/0.lml] and vancomycin [l mg/0.lml] were injected. One patient had a significant improvement in signs and symptoms after intravitreal antibiotics. However, there were was no improvement in the other patient and pars plana vitrectomy was performed bilaterally. Vitreous cultures were positive in both cases for Staphylococcus epidermidis

Desarrollo de un nanosistema para la liberación de fármacos intravítreo / Development of intravitreal nanosistema for drugs release

La inyección intravítrea ha sido la vía de administración más eficaz para el tratamiento de enfermedades vitreorretinianas. Su práctica continua, no es agradable para los pacientes y a su vez podría causar complicaciones indeseadas. El presente trabajo tuvo como objetivo desarrollar un nanosistema de liberación polímero-terapéutico (conjugado)/nanopartícula, utilizando Dextrano y Quitosano como polímeros transportadores biodegradables, hidrosolubles y compatibles a nivel ocular así como Hemisuccinato de Metilprednisolona como fármaco modelo. Primeramente, el fármaco fue capaz de unirse covalentemente a dos Dextranos de pesos moleculares 10 y 70 kDa. En función del contenido del componente activo y perfil de liberación, se seleccionó el Hemisuccinato de Metilprednisolona-Dextrano 10 kDa para elaborar las nanopartículas de Quitosano por el método de gelificación iónica empleando tripolifosfato sódico como agente entrecruzante. Por último, las nanopartículas fueron cubiertas con lactosa aplicando el secado por atomización. Se evaluó morfología, distribución de tamaño de las partículas, carga superficial, contenido y eficacia de captura del fármaco. Las partículas esféricas presentaron superficies lisas y uniformes. El pH tuvo influencia en el tamaño de las partículas observándose una distribución bimodal a pHs ≈ pKa del Quitosano y unimodal con un rango entre 130 - 170 nm a pHs < pKa. La variación de los potenciales Zeta entre los compuestos involucrados en la reacción, indicaron la posible ocurrencia de la misma. Al comparar la liberación del conjugado con las Nanopartículas a pH fisiológico, se observó que la encapsulación retrasó la liberación del fármaco alrededor de un 50%. Las nanopartículas recubiertas formaron micropartículas de 1.780 ± 0,5 nm, lo que favoreció su dispersibilidad en agua. Este nuevo nanosistema, evidenció su posible potencial en el desarrollo de formulaciones de liberación intravítrea, que reduzca la frecuencia de administración, ofreciendo una excelente alternativa que proporcione un mayor grado de satisfacción y mejore la calidad de vida del paciente.