RESUMO
AIMS: To determine the prevalence of intraocular pressure (IOP) alterations following intravitreal injection of triamcinolone acetonide (IVTA) and to assess possible risk factors of IOP elevation in eyes receiving single and/or repeat injections. METHODS: Retrospective, consecutive case series. 570 consecutive eyes of 536 patients who received a single IVTA injection (4 mg/0.1 ml) and a second set of 43 eyes of 40 patients who received a second injection. Retrospective review of all IVTA cases performed by three vitreoretinal surgeons over a 42 month period beginning in 2000. The main outcome measure was change in IOP defined as absolute value of IOP elevation (5 mm Hg or higher, 10 mm Hg or higher), and percentage of baseline (30% or higher increase from baseline IOP). RESULTS: Of the 528 eyes receiving single injections, 281 (53.2%) had an IOP elevation; 267 eyes (50.6%) experienced an elevation of IOP of at least 30%, and 245 (45.8%) and 75 (14.2%) eyes had an increase of 5 mm Hg or 10 mm Hg or more, respectively. Baseline IOP greater than 16 mm Hg is a risk factor for post-injection IOP elevation. Of the 43 eyes which received a second injection, 28 (65.1%) experienced an increase in IOP of at least 30% of baseline. Filtering surgery was required in five (0.094%) of the single and one (2.3%) of repeat injection eyes. CONCLUSIONS: Elevated IOP after IVTA is common and patients should be monitored beyond 6 months post-injection. Patients with a baseline IOP more than 16 mm Hg or receiving a second injection should be carefully monitored for an elevated IOP.
Assuntos
Anti-Inflamatórios/efeitos adversos , Glucocorticoides/efeitos adversos , Hipertensão Ocular/induzido quimicamente , Triancinolona Acetonida/efeitos adversos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anti-Inflamatórios/administração & dosagem , Anti-Hipertensivos/administração & dosagem , Esquema de Medicação , Feminino , Glaucoma/fisiopatologia , Glucocorticoides/administração & dosagem , Humanos , Injeções , Masculino , Pessoa de Meia-Idade , Hipertensão Ocular/tratamento farmacológico , Estudos Retrospectivos , Análise de Sobrevida , Triancinolona Acetonida/administração & dosagem , Corpo VítreoAssuntos
Coriorretinite/complicações , Glucocorticoides/uso terapêutico , Edema Macular/tratamento farmacológico , Triancinolona Acetonida/uso terapêutico , Adulto , Coriorretinite/metabolismo , Feminino , Antígenos HLA-A/metabolismo , Humanos , Injeções , Edema Macular/etiologia , Pessoa de Meia-Idade , Tomografia , Corpo VítreoRESUMO
The purpose of this study was to evaluate the role of corticosteroids in managing subfoveal choroidal neovascularization (CNV) secondary to the presumed ocular histoplasmosis syndrome. The cases of eighteen patients with histoplasmosis-related subfoveal CNV treated with corticosteroids were reviewed. Ten patients received oral prednisone for 4 to 6 weeks, and eight received a single sub-Tenon's injection of triamcinalone. Visual acuity outcomes were analyzed along with side effect profiles. At two-week follow-up, the prednisone group showed a median improvement in Snellen visual acuity of +2.0 lines, while the triamcinalone group remained essentially stable with a 0.5 line median loss. At treatment end (4 to 6 weeks), both groups showed no significant change in median acuity at 0.0 and -1.0 lines, respectively. Median final vision at 3 months also remained essentially stable at -0.5 lines for each group. Three patients reported anxiety, all of whom were taking prednisone 80 mg daily. Two patients reported increased appetite and weight gain on regimens of prednisone 80 and 100 mg daily. There were no adverse effects reported in the other patients receiving oral prednisone or in any patient receiving sub-Tenon's triamcinalone. The results suggest a beneficial effect of corticosteroids in stabilizing subfoveal CNV secondary to ocular histoplasmosis. In this small series, oral prednisone resulted in a short-term improvement in visual acuity, which stabilized over longer follow-up. The sub-Tenon's triamcinalone group achieved similar final stabilization without the initial improvement. Corticosteroids may be particularly valuable in managing neovascularization in patients who are awaiting interventions currently under development, in preventing recurrence after subfoveal surgery, or in treating non-surgical candidates. Further study is warranted to define the precise role of corticosteroids in this condition.
Assuntos
Inibidores da Angiogênese/uso terapêutico , Neovascularização de Coroide/tratamento farmacológico , Infecções Oculares Fúngicas/complicações , Fóvea Central/irrigação sanguínea , Glucocorticoides/uso terapêutico , Histoplasmose/complicações , Administração Oral , Administração Tópica , Adulto , Inibidores da Angiogênese/efeitos adversos , Neovascularização de Coroide/etiologia , Feminino , Fóvea Central/efeitos dos fármacos , Fóvea Central/metabolismo , Glucocorticoides/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Prednisona/efeitos adversos , Prednisona/uso terapêutico , Estudos Retrospectivos , Fatores de Tempo , Triancinolona/efeitos adversos , Triancinolona/uso terapêutico , Acuidade Visual/efeitos dos fármacosRESUMO
A 61-year-old woman had a 3-year history of imbalance. Eye movement studies revealed square-wave jerks, gaze paretic nystagmus, rebound nystagmus, impaired smooth pursuit, impaired optokinetic nystagmus, and abnormal fixation suppression of vestibular nystagmus. A brain magnetic resonance imaging study showed extensive areas of increased signal from the middle cerebellar peduncles and dentate nuclei, which enhanced with gadolinium. Histopathological analysis of a needle biopsy specimen of the left cerebellar peduncle revealed diffuse gliosis in the presence of symmetrically distributed areas of demyelination. There were associated Rosenthal fibers. Clinicopathologic correlation supported a diagnosis of Alexander disease. An adult patient with a history of progressive imbalance, ocular motility abnormalities consistent with cerebellar and/or brainstem dysfunction, and diffuse, symmetric hyperintense magnetic resonance imaging signals in brainstem and cerebellar white matter should suggest a diagnosis of adult-onset Alexander disease.
Assuntos
Encefalopatias/diagnóstico , Encéfalo/patologia , Doenças Desmielinizantes/diagnóstico , Nistagmo Patológico/diagnóstico , Biópsia por Agulha , Encefalopatias/patologia , Doenças Desmielinizantes/patologia , Eletroculografia , Feminino , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Nistagmo OptocinéticoRESUMO
PURPOSE: To document the static nature of crystalline deposits in talc retinopathy. METHOD: Case report. RESULTS: A 38-year-old woman with a remote history of intravenous drug abuse showed the incidental finding of fine, irregularly shaped refractile deposits in the retinal microvasculature. At 2-year follow-up, fundus findings were identical to the initial manifestation with respect to the distribution and position of crystalline deposits in each fundus. CONCLUSION: This case documents the static nature of crystalline deposits in talc retinopathy.
Assuntos
Embolia/induzido quimicamente , Excipientes/efeitos adversos , Doenças Retinianas/induzido quimicamente , Talco/efeitos adversos , Adulto , Embolia/patologia , Feminino , Angiofluoresceinografia , Seguimentos , Fundo de Olho , Humanos , Microcirculação/patologia , Doenças Retinianas/patologia , Vasos Retinianos/efeitos dos fármacos , Vasos Retinianos/patologia , Abuso de Substâncias por Via Intravenosa/complicaçõesAssuntos
Circulação Cerebrovascular/efeitos dos fármacos , Hidrocortisona/farmacologia , Memória/efeitos dos fármacos , Radioisótopos de Oxigênio , Esquizofrenia/fisiopatologia , Psicologia do Esquizofrênico , Encéfalo/fisiologia , Encéfalo/fisiopatologia , Circulação Cerebrovascular/fisiologia , Humanos , Hidrocortisona/administração & dosagem , Infusões Intravenosas , Memória de Curto Prazo/efeitos dos fármacos , Memória de Curto Prazo/fisiologia , Valores de Referência , Fluxo Sanguíneo Regional/efeitos dos fármacos , Fatores de Tempo , Tomografia Computadorizada de EmissãoRESUMO
The functional neuroanatomy of verbal memory was investigated using verbal free recall during H2 (15) O positron emission tomography (PET). Twelve young (25-40 years old) normal control subjects participated in eight scans during a single scanning session during which they performed three memory tasks differing by word list length. Four subjects also had scans during a "rest" condition. Temporal lobe activation was observed during all tasks, including single-word repetition. The frontal cortices, specifically Brodmann areas 9 and 10, were activated only when the recall word lists exceeded the memory spans (i. e., 12 and 15 words). Activation was also observed in the anterior cingulate cortex (BA24 and BA32). These data, obtained using a within-subject design, extend previously reported findings that used mixed within-and between-subject designs and demonstrate important functional components of normal auditoryverbal short-term memory. © 1994 Wiley-Liss, Inc.