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1.
Interv Neuroradiol ; 27(3): 444-450, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33106085

RESUMO

INTRODUCTION: Dural arteriovenous fistulae (DAVF) are vascular lesions with arteriovenous shunting that may be treated with surgical obliteration or endovascular embolization. Some DAVF, such as anterior cranial fossa DAVF (AC-DAVF) derive their arterial supply from ophthalmic artery branches in nearly all cases, and trans-arterial embolization carries a risk of vision loss. We determined the efficacy and safety of trans-ophthalmic artery embolization of DAVF. MATERIALS AND METHODS: We performed a retrospective cohort study of all patients with DAVF treated by trans-ophthalmic artery embolization from 2012 to 2020. Primary outcome was angiographic cure of the DAVF. Secondary outcomes included vision loss, visual impairment, orbital cranial nerve injury, stroke, modified Rankin Scale at 90-days, and mortality. RESULTS: 12 patients met inclusion criteria (9 males; 3 females). 10 patients had AC-DAVF. Patient age was 59.7 ± 9.5 (mean ± SD) years. Patients presented with intracranial hemorrhage (4 patients), headache (4 patients), amaurosis fugax (1 patients), or were incidentally discovered (2 patients). DAVF Cognard grades were: II (1 patient), III (6 patients), and IV (5 patients). DAVF were embolized with Onyx (10 patients), nBCA glue (1 patient), and a combination of coils and Onyx (1 patient). DAVF cure was achieved in 11 patients (92%). No patients experienced vision loss, death, or permanent disability. One patient experienced a minor complication of blurry vision attributed to posterior ischemic optic neuropathy. 90-day mRS was 0 (10 patients) and 1 (2 patients). CONCLUSIONS: Trans-ophthalmic artery embolization is an effective and safe treatment for DAVF.


Assuntos
Malformações Vasculares do Sistema Nervoso Central , Embolização Terapêutica , Idoso , Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Malformações Vasculares do Sistema Nervoso Central/terapia , Embolização Terapêutica/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Oftálmica/diagnóstico por imagem , Polivinil , Estudos Retrospectivos , Resultado do Tratamento
2.
Semin Ophthalmol ; 28(2): 79-83, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23448561

RESUMO

PURPOSE: To describe the occurrence of cystoid macular edema (CME) in the setting of central foveal thickness (CFT) under 250 µm as measured by optical coherence tomography (OCT) in patients with retinitis pigmentosa (RP). METHODS: Stratus OCT was used to measure CFT in a total of 90 eyes from 46 patients with RP. Cross-sectional OCT images were also evaluated for CME, which was defined as cystoid changes in the macula seen on at least two linear scans. RESULTS: CME was identified in 13 of the 46 patients or in 22 of 90 eyes by OCT. In eyes with macular edema, CFT ranged from 224 to 718 µm (mean = 339 ± 137 µm). In eyes without macular edema, CFT ranged from 99 to 273 µm (mean = 184 ± 40 µm). Bilateral CME occurred in 9 of 13 patients (69%). CFT was considered "normal" in 7 of the 22 eyes (32%) with CME. Two patients had bilateral CME with normal CFTs, under 250 µm. CONCLUSION: We demonstrate the occurrence of CME in RP patients without associated thickening, which has not been described. This concept likely is applicable to other diseases with retinal thinning.


Assuntos
Macula Lutea/patologia , Edema Macular/etiologia , Retinose Pigmentar/complicações , Humanos , Pressão Intraocular , Edema Macular/diagnóstico , Retinose Pigmentar/diagnóstico , Tomografia de Coerência Óptica , Campos Visuais
3.
Ophthalmology ; 119(5): 1011-6, 2012 May.
Artigo em Inglês | MEDLINE | ID: mdl-22330962

RESUMO

PURPOSE: To report the first described cases of peripheral yellow corneal rings secondary to vitamin supplementation for age-related macular degeneration (ARMD). DESIGN: Retrospective single-center case series. PARTICIPANTS: The eyes of 4 patients taking vitamin supplementation for ARMD were examined at the University of Pittsburgh Medical Center Department of Ophthalmology between January 2010 and April 2011. METHODS: We reviewed the medical records of 4 patients with peripheral corneal rings receiving vitamin supplementation for ARMD. MAIN OUTCOME MEASURES: The presence of peripheral yellow corneal rings, skin findings, and serum carotene levels. RESULTS: Each patient had circumferential, yellow, peripheral corneal rings and exhibited subtle yellowing of the skin most notable on the palms. Serum carotene levels were normal in 2 of the 3 patients and markedly elevated in the last patient in whom it was measured. CONCLUSIONS: It is unclear at this time how to counsel patients with this ocular finding. We suspect that these rings are more common than generally appreciated because they may have a subtle appearance or be misdiagnosed as arcus senilis. We suggest that a formal study be performed on a cohort of patients taking vitamin supplementation for macular degeneration that specifically screens for yellow rings and measures serum carotene levels when they are identified.


Assuntos
Doenças da Córnea/induzido quimicamente , Substância Própria/efeitos dos fármacos , Suplementos Nutricionais/efeitos adversos , Limbo da Córnea/efeitos dos fármacos , Vitaminas/efeitos adversos , beta Caroteno/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Ensaios Clínicos como Assunto , Substância Própria/química , Substância Própria/patologia , Feminino , Humanos , Pressão Intraocular/fisiologia , Limbo da Córnea/química , Limbo da Córnea/patologia , Degeneração Macular/tratamento farmacológico , Degeneração Macular/fisiopatologia , Estudos Retrospectivos , Acuidade Visual/fisiologia , Vitaminas/sangue , Vitaminas/química , beta Caroteno/sangue , beta Caroteno/química
4.
Injury ; 43(9): 1462-5, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-21496818

RESUMO

OBJECTIVE: To examine the occurrence and extent of ocular injuries in ATV accidents in southwestern Pennsylvania. METHODS: This was a retrospective chart review of 37 adults and 43 children at UPMC Mercy Hospital, UMPC Presbyterian Hospital, and Children's Hospital of Pittsburgh Trauma Registry. The Trauma Registry was searched for patients sustaining ocular injuries related to an ATV accident. Records were de-identified by an honest broker and analysed in this study. RESULTS: Eighty percent (80%) of patients suffered orbital fracture; 40% had periorbital ecchymoses, and 25% had lid lacerations. Injuries ranged in severity from subconjunctival haemorrhages to traumatic avulsion of the optic nerves. CONCLUSIONS: Ocular trauma frequently accompanies ATV accidents and can have a significant impact on patient outcomes. An educational programme (except 'program' in computers) promoting eye protection could reduce the number of eye injuries associated with these recreational vehicles.


Assuntos
Acidentes de Trânsito/prevenção & controle , Cegueira/prevenção & controle , Equimose/prevenção & controle , Dispositivos de Proteção dos Olhos/estatística & dados numéricos , Veículos Off-Road/estatística & dados numéricos , Fraturas Orbitárias/prevenção & controle , Acidentes de Trânsito/estatística & dados numéricos , Adolescente , Adulto , Cegueira/epidemiologia , Cegueira/etiologia , Criança , Equimose/epidemiologia , Equimose/etiologia , Feminino , Dispositivos de Proteção da Cabeça/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Fraturas Orbitárias/epidemiologia , Fraturas Orbitárias/etiologia , Pennsylvania/epidemiologia , Sistema de Registros , Estudos Retrospectivos , Assunção de Riscos , Índices de Gravidade do Trauma , Adulto Jovem
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