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1.
Eur J Ophthalmol ; 31(4): 1688-1694, 2021 Jul.
Article in English | MEDLINE | ID: mdl-32783469

ABSTRACT

PURPOSE: To describe the surgical approach and long-term outcomes of Descemet-stripping automated endothelial keratoplasty (DSAEK) for endothelial failure secondary to phakic intraocular lenses (pIOL). METHODS: Retrospective, interventional case series of 18 eyes of 13 patients who developed endothelial failure secondary to pIOL implant. Patients were submitted to pIOL explant and DSAEK for visual rehabilitation, with or without phacoemulsification plus posterior-chamber intraocular lens implant. The minimum follow-up time was 3 years and the main outcome measures were best-corrected visual acuity (BCVA), endothelial cell density (ECD) and percentage of endothelial cell loss (ECL), intraoperative and postoperative complications. RESULTS: Patients' mean age was 47.44 (7.86) years with a mean follow-up time of 55.61 (14.13) months. Sixteen eyes (88.9%) had an angle-supported pIOL. The mean pIOL implant-to explant time was 8.17 (2.73) years. BCVA improved from 1.00 (0.36) logMAR preoperatively to 0.29 (0.36) logMAR at 1 year of follow-up (p < 0.001), remaining stable over the entire follow-up period (p > 0.05). At the last visit, all corneas were clear, with a mean ECD of 724.74 (325.57) cells/mm2. During the follow-up, two eyes (11.1%) required a re-DSAEK due to early graft failure (<3 months). CONCLUSION: Our outcomes reveal that an individualized and careful approach may result in a stable visual rehabilitation in young patients with corneal decompensation following pIOL implant.


Subject(s)
Descemet Stripping Endothelial Keratoplasty , Phakic Intraocular Lenses , Endothelium, Corneal , Humans , Middle Aged , Postoperative Complications , Retrospective Studies , Treatment Outcome , Visual Acuity
2.
Retina ; 40(6): 1185-1190, 2020 Jun.
Article in English | MEDLINE | ID: mdl-30973440

ABSTRACT

PURPOSE: To study structural chorioretinal changes in tamoxifen-treated patients. METHODS: Cross-sectional case-control study comparing structural chorioretinal aspects in tamoxifen-treated patients and healthy controls. Enhanced depth spectral domain optic coherence tomography with choroidal binarization and optic coherence tomography angiography were performed. Individual retinal layer thickness and chorioretinal vascular components were compared. Subgroup analysis regarding history of chemotherapy was performed. RESULTS: Two hundred eyes of 100 TAM-treated patients (Group 1) and 80 eyes of 40 healthy controls (Group 2) were included. Of the 200 spectral domain optic coherence tomography scans from patients, 2 showed structural changes attributable to tamoxifen. Group 1 showed significantly lower values in choroidal parameters and in total retinal, ganglion cell layer, inner plexiform layer, outer nuclear layer, and retinal pigment epithelial thicknesses as well as an increased thickness in the outer plexiform layer. The subgroup not submitted to chemotherapy maintained significant reductions in total retinal thickness, ganglion cell layer, retinal pigment epithelium, outer nuclear layer, outer retinal layer, choroidal parameters, as well as an increased thickness in the outer plexiform layer, in comparison with Group 2. CONCLUSION: Subclinical structural retinal changes could indicate early retinal pigment epithelial and photoreceptor damage. The new finding of choroidal thinning could point toward another important pathophysiologic process in tamoxifen-induced toxicity.


Subject(s)
Choroid/pathology , Fluorescein Angiography/methods , Retinal Diseases/diagnosis , Retinal Ganglion Cells/pathology , Tamoxifen/adverse effects , Tomography, Optical Coherence/methods , Case-Control Studies , Choroid/drug effects , Cross-Sectional Studies , Estrogen Antagonists/adverse effects , Female , Fundus Oculi , Humans , Male , Middle Aged , Retinal Diseases/chemically induced , Retinal Ganglion Cells/drug effects
3.
Arq. bras. oftalmol ; 82(5): 422-424, Sept.-Oct. 2019. graf
Article in English | LILACS | ID: biblio-1019438

ABSTRACT

ABSTRACT Bilateral orbital metastases restricted to the extraocular muscles (EOMs) are exceedingly rare. We report a case of bilateral extraocular muscle metastases from a small cell lung carcinoma and provide a review of the relevant literature. A 56-year-old smoker presented with proptosis, motility changes, and a relative afferent pupillary defect of the left eye, with a previous history of a small cell lung carcinoma. An orbital computerized tomography scan revealed a mass restricted to the left medial rectus. An incisional biopsy confirmed metastasis. Visual acuity of the left eye decreased rapidly, and right globe proptosis became evident. Orbital magnetic resonance imaging at two months follow-up showed marked left orbital mass enlargement and a new right lateral rectus mass. The patient was maintained on palliative care and died from metastatic disease-related complications.


RESUMO As metástases orbitárias bilaterais restritas aos mús­culos extraoculares são extremamente raras. Os autores apresentam um caso de metástases bilaterais, localizadas aos musculares extraoculares com base num carcinoma de pequenas células do pulmão e revisão da literatura relevante. Um homem, fumador, de 56 anos recorreu ao serviço de urgência por proptose, alterações de motilidade ocular extrínseca e um defeito pupilar aferente relativo do olho esquerdo, com história pessoal de carcinoma de pequenas células do pulmão. A tomografia computadorizada orbitária revelou uma massa restrita ao reto medial esquerdo. Uma biópsia incisional confirmou o diagnóstico de metástase. A acuidade visual do olho esquerdo diminuiu rapidamente e surgiu uma proptose do globo ocular direito. A ressonância magnética orbitária aos dois meses de seguimento revelou um aumento da massa orbitária esquerda e uma nova massa no reto lateral direito. O paciente foi mantido em cuidados paliativos e faleceu devido a complicações relacionadas com doença metastática.


Subject(s)
Humans , Male , Middle Aged , Orbital Neoplasms/secondary , Exophthalmos/etiology , Small Cell Lung Carcinoma/pathology , Lung Neoplasms/pathology , Oculomotor Muscles/pathology , Biopsy , Orbital Neoplasms/pathology , Magnetic Resonance Imaging , Tomography, X-Ray Computed , Exophthalmos/pathology , Fatal Outcome
4.
Arq Bras Oftalmol ; 82(5): 422-424, 2019 08 29.
Article in English | MEDLINE | ID: mdl-31482960

ABSTRACT

Bilateral orbital metastases restricted to the extraocular muscles (EOMs) are exceedingly rare. We report a case of bilateral extraocular muscle metastases from a small cell lung carcinoma and provide a review of the relevant literature. A 56-year-old smoker presented with proptosis, motility changes, and a relative afferent pupillary defect of the left eye, with a previous history of a small cell lung carcinoma. An orbital computerized tomography scan revealed a mass restricted to the left medial rectus. An incisional biopsy confirmed metastasis. Visual acuity of the left eye decreased rapidly, and right globe proptosis became evident. Orbital magnetic resonance imaging at two months follow-up showed marked left orbital mass enlargement and a new right lateral rectus mass. The patient was maintained on palliative care and died from metastatic disease-related complications.


Subject(s)
Exophthalmos/etiology , Lung Neoplasms/pathology , Oculomotor Muscles/pathology , Orbital Neoplasms/secondary , Small Cell Lung Carcinoma/pathology , Biopsy , Exophthalmos/pathology , Fatal Outcome , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Orbital Neoplasms/pathology , Tomography, X-Ray Computed
5.
Int Ophthalmol ; 39(12): 2947-2973, 2019 Dec.
Article in English | MEDLINE | ID: mdl-31140022

ABSTRACT

INTRODUCTION: Image processing of optical coherence tomography scans through binarization techniques represent a non-invasive way to separately asses and measure choroidal components, in vivo. In this review, we systematically search the scientific literature regarding binarization studies published so far. METHODS: A systematic research was conducted at PubMed database, including English literature articles for all of the following terms in various combinations: binarization, choroid/al, enhanced depth spectral domain/swept source optic coherence tomography, and latest publications up to November 2018 were reviewed. RESULTS: Thirty-seven articles were included and analyzed regarding studied disease, binarization method, studied variables, and outcomes. Most of the studies have focused on the more common retinal pathologies, such as age-related macular degeneration, central serous chorioretinopathy and diabetic retinopathy but binarization techniques have also been applied to the study of choroidal characteristics in ocular inflammatory diseases, corneal dystrophies and in postsurgical follow-up. Advantages and disadvantages of binarization techniques are also discussed. CONCLUSION: Binarization of choroidal images seems to represent a promising approach to study choroid subcomponents in an increasingly detailed manner.


Subject(s)
Choroid Diseases/diagnosis , Choroid/diagnostic imaging , Diagnostic Techniques, Ophthalmological , Image Processing, Computer-Assisted , Tomography, Optical Coherence/methods , Humans
6.
Curr Eye Res ; 44(2): 111-117, 2019 02.
Article in English | MEDLINE | ID: mdl-30309248

ABSTRACT

Nanotechnology enabled the development of materials and devices with great utility in different fields of medicine. By using engineered-based nano-devices and structures, human biological systems may be controlled and repaired at a molecular scale, ultimately leading to a biological benefit. In particular, in the field of glaucoma treatment, nanotechnology may, for example, enhance drug residence time on the ocular surface and ocular bioavailability, as well as improve surgical success by both optimizing postoperative scarring and providing a wider safety window. Further studies are still needed to entirely explain the pharmacodynamics of nanotechnology-based therapeutic approaches and prove their biological consequences in human eyes. This review aims to summarize the literature concerning the advances in nanotechnology, specifically regarding ocular devices applied to the treatment of glaucoma.


Subject(s)
Antihypertensive Agents/administration & dosage , Drug Delivery Systems , Glaucoma/drug therapy , Nanoparticles/administration & dosage , Nanotechnology/instrumentation , Humans
7.
Cornea ; 38(2): 221-228, 2019 Feb.
Article in English | MEDLINE | ID: mdl-30379721

ABSTRACT

PURPOSE: To evaluate lower tear meniscus and corneal sub-basal nerve plexus in primary Sjögren's syndrome (pSS) and Sicca syndrome patients. METHODS: Cross-sectional study of 116 patients with Sicca syndrome associated with pSS and not associated with Sjögren's syndrome (non-SS Sicca) and 20 normal control subjects. Tear meniscus height and area were measured using anterior segment optical coherence tomography; corneal sub-basal nerve plexus density, length, and tortuosity were evaluated using in vivo confocal microscopy. Data analysis was performed using IBM-SPSS Statistics 24.0. RESULTS: Corneal sub-basal nerve plexus density and length were significantly lower, and tortuosity was significantly higher in pSS and non-SS Sicca groups than in normal control subjects (P < 0.001; P = 0.018, respectively). Corneal sub-basal nerve plexus presented a strong association with Schirmer test I and tear breakup time. Cutoff values of sub-basal nerve plexus density (36.5 nerve/mm) and length (12.5 mm/mm) presented 80.2% to 81.9% sensitivity and 85% specificity for detecting Sicca syndrome patients. No significant differences were found between the 3 groups regarding tear meniscus height and area. CONCLUSIONS: Corneal sub-basal nerve plexus in vivo confocal microscopy may be a useful tool in the assessment of dry eye disease in Sicca syndrome, complementing the information provided by the conventional modalities used in dry eye disease evaluation.


Subject(s)
Cornea/innervation , Dry Eye Syndromes/diagnosis , Sjogren's Syndrome/complications , Tears/metabolism , Adult , Aged , Case-Control Studies , Cross-Sectional Studies , Dry Eye Syndromes/etiology , Dry Eye Syndromes/physiopathology , Female , Humans , Male , Microscopy, Confocal , Middle Aged , Tomography, Optical Coherence/methods
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