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.

Resolution of macular edema in Coats' disease with intravitreal bevacizumab.

A 13-year-old boy was referred because of visual deterioration in his right eye. The visual acuity was two meters of counting fingers. Indirect ophthalmoscopy and biomicroscopy revealed exudative macular edema as well as tumor-like telangiectatic vessels and exudation in temporal periphery. With diagnosis of Coats' disease (stage II) confirmed by fluorescein angiography, three intravitreal injections of bevacizumab were performed at 6-week intervals. One year after the last injection, there was a significant resolution of macular edema as well as visual acuity improvement to 20/20. This is the first case report in which a distinct improvement in macular edema was observed with intravitreal bevacizumab in Coats' disease.

Resolution of Severe Macular Edema in Adult Coats' Disease with Intravitreal Triamcinolone and Bevacizumab Injection

A 47 year old male patient visited our hospital with the chief complaint of deterioration of the visual acuity in the left eye. The fundus examination revealed thick hard exudates, multiple aneurysms and telangiectasias of the retinal vessels in the posterior pole. Fluorescein angiography demonstrated massive leakage over an area of the aneurysms. Optical coherence tomography (Stratus OCT; Zeiss-Humphrey, Dubin, CA) revealed diffuse and marked thickening of the retina. Laser photocoagulation was performed under the diagnosis of Coats' disease. However, the treatment could not be performed satisfactorily. On the first and 6th weeks, an intravitreal injection of bevacizumab and triamcinolone acetonide was administered, and laser photocoagulation was again attempted. The effectiveness of eachagent on retinal edema was evaluated at the follow-up performed at 1, 2, 5, 7, 10 weeks and 6 months after the injection. At one week after the intravitreal bevacizumab injection, there was no improvement. An intravitreal injection of triamcinolone acetonide was performed 6 weeks after the initial diagnosis,which resulted in a reduction in the thickness of the macular edema. Therefore, laser photocoagulation was performed sufficiently on telangiectasias. The follow-up at 6 months showed a relative increase in the macular edema, but there was reduced leakage from the telangiectasias compared with the previous angiograph.

Clinical utility of telangiectasia of hands in scleroderma and other rheumatic disorders.

Telangiectasia of the hands were observed in 76% of patients with scleroderma (n = 53) as compared with 12% of patients with other rheumatic disorders (n = 100) and in 13% of healthy subjects (n = 30). In scleroderma, telangiectasia of the hands were commonly multiple (mean number +/- SD = 22.9+/-30.1) with 7.3% being >1 mm in size. They were found in greater numbers in those patients with the limited subtype. The distribution of telangiectasia was observed on all but 4 of 158 sectors of the hand with significant higher numbers on the ventral surface of the digits. Significant associations of telangiectasia of the hands were also observed with numbers of telangiectasia on face and lips (p = 0.001), disease duration (p = 0.002), surface area of digital calcinosis (p = 0.03) and with the presence of the centromere antibody (p = 0.005). Possible associations were observed with prior gastrointestinal bleeds (particularly with telangiectasia >1 mm) and with isolated pulmonary hypertension. No significant correlation was found between number of telangiectasia and with nailfold capillary size or density. In conclusion, multiple telangiectasia of the hands were most commonly observed in patients with the centromere positive, limited subtype of scleroderma of long duration. Their pathogenesis is unknown.

Mielinizaçäo de fibras nervosas associada a telangiectasias retinianas e hemorragia vítrea / Myelinated retinal nerve fibers associated with teleangiectasic retinal vascular and vitreous hemorrhage

Os autores relatam um caso de mielinizaçäo de fibras nervosas associada a alteraçöes vasculares retinianas tipo telangiectasias, que levaram à hemorragia vítrea. Além das alteraçöes vasculares, verifica-se a tríade miopia axial, ambliopia refracional e fibras mielinizadas

Tratamento endoscópico de ectasia vascular do cólon na vigência de sangramento com injeçäo de soluçäo de adrenalina 1:10.000 e eletrocoagulaçäo monopolar: uma abordagem alternativa: relato de caso / Endoscopic treatment of colon vascular ectasia during bleeding with injection of epinephrine solution at 1:10,000 and monopolar electrocoagulation: an alternative approach: case report

A hemorragia digestiva é responsável por 2 por cento das internaçöes hospitalares de adultos. As ectasias vasculares estäo entre as causas mais freqüentes de enterorragia. Em cerca de 80 por cento dos casos de ectasias vasculares hemorrágicas há a parada do sangramento espontaneamente, mas com freqüência ocorre a recidiva. Muitos tratamentos säo propostos tais como infusäo de substâncias vasoconstrictoras através de cateterizaçäo superseletiva por arteriografia. O uso da fotocoagulaçäo com laser, heater proable, eletrocoagulaçäo bipolar, uso de pinça tipo hot biopsy, tem sido propostos através de utilizaçäo da via colonoscópica, mas alguns com efeito fugaz e outros com elevado custo e resultado pouco efetivo. Os autores apresentam um caso de ectasia vascular do cólon na vigência de sangramento tratada com injeçäo de adrenalina 1:10.000 seguida pela eletrocauterizaçäo monopolar através de colonoscopia. Trata-se de um novo método, alternativo, seguro e eficaz na abordagem dos doentes portadores de ectasia vascular do cólon na vigência de sangramento

Terapêutica esclerosante das varizes e telangiectasias / Sclerosing therapeutic of varices and telangiectases

O autor apresenta uma visäo atual das medidas que visam tratar as varicosidades dos membros inferiores através da escleroterapia. Traça as principais açöes dos medicamentos utilizados para este fim, suas indicaçöes e intercorrência, dando ênfase especial à maneira de contorná-las e combatê-las. Por último, fundamenta os principais fenômenos bioquímicos que regem as complicaçöes que podem envolver este importante método terapêutico