Posterior Subtenon Triamcinolone Acetonide in Gas-filled Eyes as an Adjunctive Treatment for Complicated Proliferative Diabetic Retinopathy

PURPOSE: To evaluate the effect of adjunctive subtenon injection of triamcinolone acetonide (TA) in gas-filled eyes after vitrectomy for complicated proliferative diabetic retinopathy (PDR). METHODS: This nonrandomized comparative study included 27 patients (27 eyes) who underwent pars plana vitrectomy and gas tamponade for treatment of PDR with tractional or combined tractional-rhegmatogenous retinal detachment and who received subtenon injection of TA (40 mg) at the end of surgery. The study group was compared with the control group (29 eyes), which was matched with the study group for preoperative and intraoperative parameters, but underwent pars plana vitrectomy and gas tamponade without a subtenon injection of TA. RESULTS: Retinal reattachments without reoperation were achieved in 25 eyes (92.6%) and 26 eyes (89.7%) at 6 months (p = 1.000) in the study and control groups, respectively. The study group and the control group did not differ significantly in the frequency of postoperative proliferative vitreoretinopathy, retinal redetachment rate, reoperation rate, macular pucker formation, postoperative vitreous hemorrhage, gain in visual acuity, intraocular pressure, and intraocular inflammation (p > 0.05). CONCLUSIONS: The clinical results of pars plana vitrectomy for complicated PDR are not improved significantly by an adjunctive subtenon TA injection in gas-filled eyes.

Familial exudative vitreoretinopathy (FEVR) associated with infantile osteoporosis: case report / Vitreorretinopatia exsudativa familiar (FEVR) associada à osteoporose infantil: relato de caso

Familial exudative vitreoretinopathy (FEVR) is an inherited blinding condition characterized by abnormal development of the retinal vasculature. The authors describe a rare case of the disease associated with severe infantile osteoporosis in a young female patient. The patient was submitted to multiple vitreoretinal procedures in both eyes due to tractional macular detachments. The case was complicated by diffuse uveitis of difficult control in one eye, which stimulated proliferative vitreoretinopathy and retinal redetachment. The inflammatory potential of drugs used in the control of the osteoporosis, in contrast with the inherent inflammatory activity the disease, are discussed.

Relato de um caso incomum de vitreorretinopatia exsudativa familiar (FEVR) bilateral em criança do sexo feminino portadora de grave osteoporose infantil. A paciente foi submetida a vitrectomias sucessivas para correção de descolamentos tracionais maculares em ambos os olhos. O quadro foi complicado em um olho por uveíte difusa de difícil controle, que estimulava o aparecimento de proliferação vitreorretiniana de difícil abordagem, responsável por redescolamentos sucessivos da retina. Discute-se sobre o potencial pró-inflamatório de drogas usadas no controle da osteoporose, em contraste com a atividade inflamatória inerente à doença.

TGF-betas Synthesized by RPE Cells Have Autocrine Activity on Mesenchymal Transformation and Cell Proliferation

The present study investigated the effects of transforming growth factor (TGF)-beta on retinal pigment epithelial (RPE) transformation in a simplified model and also whether or not TGF-beta exhibits similar proliferation effects on transformed RPE cells that it has on primary RPE cells. Furthermore, we examined the cell proliferation effects of RPE-conditioned medium (CM). A vertical wound measuring 2 mm in diameter was made on primary RPE monolayers. The expression of alpha- smooth muscle actin (SMA) by the cells located at the wound edges was observed using a confocal microscope under immunofluorescent staining. Cell proliferation was measured by incorporating 3H-thymidine into DNA. The presence of alpha- SMA was observed in the cells within the wound after treatment with TGF-beta2, while negative expression was observed in control cells. TGF-betas inhibited the proliferation of the primary cultures of RPE cells in a dose-dependent manner, but the spindle-shaped late-passaged RPE cells were not inhibited by these growth factors. The medium conditioned by RPE cells stimulated the proliferation of subconjunctival fibroblasts and inhibited the proliferation of primary RPE cells, in a manner similar to TGF-beta. These findings demonstrate that TGF-beta-stimulated RPE cells may evoke proliferative vitreoretinopathy through mesenchymal transformation and cell proliferation.

Necrosis retinal aguda: resultados de tratamiento / Acute retinal necrosis: treatment results

Se estudian 17 ojos de 13 pacientes con el diagnóstico de necrosis retinal aguda evaluados en el Hospital Clínico de la Universidad de Chile y en la Fundación Oftalmológica Los Andes con el propósito de evaluar las características clínicas y los resultados del tratamiento con fotocoagulación láser. Todos los pacientes eran inmunocompetentes, con edad promedio de 33 años, siendo la necrosis bilateral en el 39,8 por ciento. Se dividen los pacientes en grupo I, quienes presentaban enfermedad avanzada y/o desprendimiento de retina al momento del diagnóstico, y en grupo II a los cuales se les realizó el diagnóstico de forma relativamente precoz y recibieron tratamiento adecuado con aciclovir endovenoso y láser profiláctico. El desprendimiento de retina se presentó en todos los pacientes no tratados con láser y en el 20 por ciento de los tratados. Cinco pacientes con desprendimiento retinal y vitreorretinopatía proliferativa fueron manejados con vitrectomía con gas o aceite de silicona. La retina quedó aplicada en todos ellos pero sólo uno conservó visión útil. Los resultados visuales se relacionaron con la precocidad del diagnóstico, el tratamiento médico oportuno y el empleo de láser profiláctico

Será justificável a cirurgia para prolifraçäo vítreo-retiniana após trauma perfurante ocular? / Is surgery for proliferative vitreoretinopathy following perforating ocular injury justifiable?

Objetivo: Determinar o prognóstico e a satisfação dos pacientes com trauma ocular perfurante que foram submetidos à cirurgia para proliferação Vitreo-retiniana (PVR). Métodos: Prontuários sessenta pacientes foram reavaliados para caracterizar a taxa de sucesso cirúrgico anatômico e funcional. Trinta pacientes foram selecionados de modo aleatório e questionados por telefone. Resultados: Houve melhora visual para a maioria dos pacientes (58,3 por cento) apresentavam a retina colada no fianl do seguimento. Em média 2,89 cirurgias foram realizadas por olho. Dezenove (63,3 por cento) pacientes afirmaram que voltariam a operar novamente e 14 (46,6 por cento) que o ganho de campo periférico foi de benefício. Conclusão: Essa forma de tratamento deve ser oferecida e a decisão final deve ser tomada pelo paciente bem orientado e seu médico.

Cuerpo extraño intraocular / Intraocular foreign body

Se realizó un seguimiento de 17 pacientes portadores de Cuerpo extraño intraocular metálico, entre los años 1991-1995, con un seguimiento mínimo de 6 meses y un máximo de 48. A todos los pacientes se les practicó un examen clínico, radiológico y ecográfico con el fin de ubicar el CEIO. El mecanismo de injuria más importante fue martillar metal contra metal, que ocurrió en el 71 por ciento de los casos. La totalidad de los pacientes fueron hombres, con una edad promedio de 35,6 años. La técnica quirúrgica más utilizada fue la vitrectomías con extracción del CE mediante micromagneto de tierras raras (59 porciento de los casos). Del total de pacientes, el 65 porciento obtuvo una agudeza visual final igual o mejor a 20/40, proporción que disminuye a 58 porciento si se consideran los cuerpos extraños localizados exclusivamente en el polo posterior. Las lesiones más frecuentes fueron la hemorragia vítrea (47 porciento) y la catarata (71 porciento). En cuanto a las complicaciones tardías, las más frecuentes fueron la proliferación vitreorretinal (35 porciento) y las siderosis bulbi (17,6 porciento). Los resultados globales del estudio son concordantes con los que se observan en la literatura mundial y comparables con otras series nacionales presentadas con anterioridad