Serous maculopathy with absence of retinal pigment epithelium (SMARPE) associated with large drusen.

PURPOSE: To describe the association of serous maculopathy with absence of retinal pigment epithelium (SMARPE) and large drusen in patients with non-neovascular age-related macular degeneration (AMD). METHODS: A retrospective study of ophthalmic examination and multimodal imaging data of individuals with SMARPE and large drusen observed over a period of 12-month was accomplished. SMARPE was defined as subretinal accumulation of fluid within the macular area due to retinal pigment epithelium (RPE) aperture. Large drusen were identified by the presence of sub-RPE deposits using multimodal imaging analysis (color fundus photography, fundus autofluorescence, and spectral-domain optical coherence tomography). RESULTS: Twelve eyes of 7 white patients with a mean age of 77 years were observed to have SMARPE associated with large drusen. The median visual acuity was 20/100. Bilateral SMARPE lesions were observed in 71% of study patients. All SMARPE lesions were hypoautofluorescent, located in the subretinal space between the RPE and the ellipsoid zone, and presented as complete or incomplete RPE apertures associated with subretinal fluid. The SMARPE in this study had coincident multimodal imaging features as the SMARPE described in other reports in the literature. CONCLUSIONS: Bilateral SMARPE can occur in association with typical AMD large drusen. Anomalisms resulting in drusen biogenesis or mechanisms that act alongside to these may be related to SMARPE development.

Regime de Informação e tipologia documental no âmbito dos serviços de saúde: noções aplicadas à gestão da informação em hospitais federais do estado do Rio de Janeiro / Information Regime and documental typology in the field of health services: notions applied to information management in federal hospitals in the state of Rio de Janeiro / Régimen de Información y tipología documental en el ámbito de los servicios de salud: nociones aplicadas a la gestión de la información en los hospitales federales del estado de Río de Janeiro

Aborda a tipologia documental em sistemas de informação digitais, compreendendo-a como metadado essencial na estrutura de transferência da informação entre serviços, sistemas e redes de atenção e inovação à saúde. Por meio de pesquisa de campo com gestores de dois hospitais federais do Rio de Janeiro, realiza prospecção e análise da gestão de sistemas de informação digitais em saúde. Os resultados revelaram que o emprego do conceito de Regime de Informação e de seus componentes analíticos permite-nos obter uma visão dos recursos informacionais, tecnológicos, humanos e normativos do sistema nacional de saúde, que integram o Sistema Único de Saúde. Destaca a tipologia documental como um dos elementos constituintes dos sistemas de informação nos serviços dos hospitais, cujas interconexões e articulações expressam os aspectos seletivos e decisórios das práticas e ações de informação

It addresses the document typology in digital information systems, understanding it as essential metadata in the structure of information transfer between attention and innovation health services, systems and networks. Through field research with managers of two federal hospitals in Rio de Janeiro, it prospects and analyzes the management of digital health information systems. The results revealed that the use of the concept of Information System and of its analytical components allows us to obtain a vision of the informational, technological, human and normative resources of the national health system, which are part of the Unified Health System. It highlights the documentary typology as one of the constituent elements of information systems in hospital services, whose interconnections and articulations express the selective and decision-making aspects of information practices and actions

Aborda como objeto la tipología documental en los sistemas de información digital, entendiéndola como un metadato esencial en la estructura de transferencia de información entre servicios, sistemas y redes de atención e innovación en salud. A través de una investigación de campo con gerentes de dos hospitales federales de Río de Janeiro, prospecta y analiza la gestión de los sistemas digitales de información en salud. Los resultados revelaran que la utilización del concepto de Régimen de Información y de sus componen-tes analíticos permítenos obtener una visión de los recursos informacionales, tecnológicos, humanos y normativos del sistema nacional de salud, que integram el Sistema Único de Salud. Destaca la tipología documental como uno de los elementos constitutivos de los sistemas de información cuyas interconexiones y articulaciones expresan los aspectos selectivos y decisorios de las prácticas y acciones informativas reali-zadas en este dominio

Choroidal ischemia as one cardinal sign in giant cell arteritis.

PURPOSE: To describe chorioretinal signs in a case series of Giant Cell Arteritis (GCA). METHODS: This is a multicenter retrospective observational case series with GCA that presented with a headache and an abrupt, unilateral loss in vision. Workup included temporal artery biopsies, intravenous fluorescein angiography, optical coherence tomography (OCT), optical coherence tomography angiography (OCTA), blood levels of erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). RESULTS: There are a total of 8 GCA instances presented. Average age was 74.5. (Range 68-83 years). The patients reported that one eye's visual loss had suddenly started, along with a fresh headache and other systemic symptoms. Eight patients exhibited choroidal ischemia, five paracentral acute middle maculopathy (PAMM) lesions, five cotton wool spots, four anterior ischemic optic neuropathy, and one central retinal arterial occlusion at the time of presentation. The average ESR at presentation was 68 mm/hr (range 4-110), and 4/6 individuals had a significant increase. The mean CRP level was 6.2 mg/dL (range 2.0-15.4), and the level was always over the normal range. All patients' temporal artery biopsies were positive. CONCLUSION: Alongside PAMM lesions, cotton wool spots, anterior ischemic optic neuropathy, and central retinal artery occlusion, choroidal ischemia is a key angiographic indicator in the diagnosis of GCA. It may be crucial to recognize these typical ischemic chorioretinal signs while diagnosing GCA.

White dot syndrome in a patient with presumed ocular tuberculosis: a case report.

BACKGROUND: This manuscript describes a case of a patient with presumed ocular tuberculosis masquerading as multiple evanescent white dot syndrome. CASE PRESENTATION: A 32-year-old male patient presented with a complaint of reduced visual acuity in the left eye. Retinal fundus exam of the left eye revealed gray-whitish deep lesions predominantly nasal to the optic disc. The lesions were more clearly identifiable on fundus autofluorescence (FAF) imaging, fluorescein angiography (FA) and en face optical coherence tomography (OCT). FA also indicated retinal vasculitis and papillitis. Swept-source OCT B-scan demonstrated loss of the ellipsoid layer in the regions corresponding to the lesions detected by FAF. A positive tuberculin skin test (TST) confirmed presumed tuberculosis, and a related WDS diagnosis was made. Specific antituberculosis therapy was instituted with favorable anatomical recovery and visual outcome. CONCLUSION: Multiple evanescent white dot syndrome (MEWDS) may be manifestation of presumed ocular tuberculosis, and multimodal retinal exams can provide a better understanding of atypical diseases and their follow-up.

Birdshot retinochoroiditis in Brazil: a multicenter review of 40 patients.

BACKGROUND: Birdshot retinochoroiditis (BRC) is a rare and chronic bilateral uveitis mostly found in Caucasians. As few data are available about the clinical course of BRC in Hispanic patients, we aimed to report the clinical findings and the evolution of BRC in Brazilian patients. METHODS: This retrospective cohort multicenter nationwide study was performed by analyzing the records of patients with BRC diagnoses from Brazilian ophthalmological centers from April 1995 to May 2020. RESULTS: Forty patients (80 eyes) with a diagnosis of BRC were evaluated. The mean age was 53 years, and there was no sex predominance. All tested patients (34/40) were positive for HLA-A29. The diagnosis of BRC was made following the Levinson et al. criteria, and all ancillary tests were performed to exclude differential diagnoses. Clinical signs and symptoms, such as complications and treatment, were described. CONCLUSIONS: BRC evolution in Brazilian patients seems to have some peculiarities that diverge from the published literature available about Caucasians, as AS inflammation is higher in this population.

In-hospital COVID-19 infection echocardiographic analysis: a Brazilian, tertiary single-centre experience.

BACKGROUND: Information is lacking concerning in-hospital echocardiography analysis of COVID-19 infection in Brazil. We evaluated echocardiographic parameters to predict a composite endpoint of mortality, pulmonary thromboembolism or acute renal failure. METHODS: A prospective full echocardiographic study of consecutive patients hospitalized with COVID-19, single tertiary centre in Brazil. We correlated echocardiographic findings to biomarkers, clinical information, thoracic tomography, and in-hospital composite endpoint of mortality, pulmonary thromboembolism or renal failure. RESULTS: One hundred eleven patients from March to October 2020, 67 ± 17 years, 65 (58.5%) men, death was observed in 21/111 (18.9%) patients, 48 (43%) required mechanical ventilation, myocardial infarction occurred in 10 (9%), pulmonary thromboembolism in 7 (6.3%) patients, haemodialysis was required for 9 (9.8%). Echocardiography was normal in 51 (46%) patients, 20 (18%) presented with decreased left ventricle ejection, 18 (16.2%) had abnormal left ventricle global longitudinal strain, 35 (31%) had diastolic dysfunction, 6 (5.4%) had an E/e'ratio > 14, 19 (17.1%) presented with right ventricle dilated/dysfunction, 31 (28%) had pericardial effusion. The echocardiographic parameters did not correlate with mortality, biomarkers, clinical events. Tricuspid velocity was related to the composite endpoint of mortality, pulmonary thromboembolism or acute renal failure (p: 00.3; value: 2.65 m/s; AUC ROC curve: 0.739; sensitivity: 73.3; specificity: 66.7; CI: 0.95, inferior: 0.613; superior: 0,866). CONCLUSIONS: Among hospitalized patients with COVID-19, echocardiography was normal in 51(46%) patients, and 20 (18%) patients presented with a decreased left ventricle ejection fraction. Tricuspid velocity was related to the composite endpoint of mortality, pulmonary thromboembolism or acute renal failure.

Interfaces entre saúde e democracia no contexto contemporâneo: dilemas entre o sucesso e a crise / Interfaces between health and democracy in the contemporary context: dilemmas between success and crisis

Este trabalho analisa, articuladamente, dois elementos subjacentes à questão democrática na saúde, o acesso universal e a participação social na saúde, com experiências de gestores municipais de saúde em 2019 e inícios de 2020. A tese central é a de que há uma crise no binômio saúde-democracia expressas nas questões do acesso aos serviços e da participação social na saúde e que tem, em seus aspectos originários e de expressão, as estratégias vitoriosas de implementação do projeto reformador na saúde pelo movimento sanitário ao final do século XX. Realizou-se uma pesquisa empírica, por meio de entrevistas semiestruturadas com cinco gestores locais da região do Grande ABC paulista. A análise desse material permitiu identificar que a universalização do acesso tem se materializado nos municípios em estudo pelo aumento substancial do consumo individual dos serviços médico-assistenciais e a radicalização de sua expansão culmina em um amplo processo de medicalização da sociedade. No caso da participação social na saúde, identificou-se que, no âmbito dos Conselhos de Saúde, desenvolve-se uma exercício participativo pobre em inovação social e esvaziado politicamente, o que revela as características históricas da primazia do Estado na formulação da política de saúde, bem como expressa as marcas do gerencialismo e da lógica do mercado características das sociedades capitalistas contemporâneas. Identificou-se, entretanto, que concomitantemente a esse processo, os municípios experienciam a emergência de novas formas de participação social por meio das tecnologias de informação e de comunicação, com publicações e manifestações dos indivíduos nas redes sociais. O conteúdo das publicações é imprevisível para a gestão pública e seus efeitos são impostos de maneira imediata na realidade virtual assim que as postagens são realizadas, ultrapassando os limites do espaço e do tempo das atividades governamentais clássicas.

This work articulates the analysis of two elements of the relation between health and democracy, which are the universal access and the social participation in health, with experiences of municipal health managers in 2019 and 2020. The central thesis adopted is that there is a crisis in the health-democracy binomial expressed in the issues of access and participation and which has, as one of its points of origin and expression, the successful strategies for implementing the health reform project by the sanitary movement at the end of the 20th century. The work is based on empirical research realized by semi-structured interviews with five local health managers in the ABC region of São Paulo. From the interviews, it was identified that the universalization of access has materialized in the municipalities due to the substantial increase in individual consumption of medical care services, in its most positive sense, and the radicalization of its expansion culminates in a broad process of medicalization of society. In the case of social participation in health, it was identified that, within the scope of the Health Councils, a participatory exercise is poor in social innovation and politically emptied, which highlights the historical characteristics of the primacy of the State in the formulation of health policy, while expressing the marks of managerialism and market logic that are characteristic of contemporary capitalist societies. Concomitantly, the municipalities has experienced a emergence of new forms of social participation through information and communication Technologies by publications and expressions of individuals on social networks. The content of the publications is unpredictable for public management, exceeding the limits of space and time of classic government activities.

Autenticidade e preservação de Registros Eletrônicos em Saúde: proposta de modelagem da cadeia de custódia das informações orgânicas do Sistema Único de Saúde / Authenticity and preservation of Electronic Records in Health: proposal of chain of custody model for the Unified Health System organic information / Autenticidad y preservación de Registros Electrónicos en de Salud: propuesta de modelado de la cadena de custodia de las informaciones orgánicas del Sistema Único de Salud

Este artigo apresenta uma proposta de modelagem conceitual da cadeia de custódia para os Registros Eletrônicos em Saúde (RES). O interesse em conhecer os critérios de autenticidade dos RES encaminhados dos serviços até o Portal do DATASUS gerou esta investigação. A pesquisa é exploratória e descritiva por meio de uma revisão sistemática da literatura e documental para prospecção e análise sobre autenticidade e preservação dos RES. A partir dos resultados encontrados foram identificados os custodiadores e a proposta de modelagem da cadeia de custódia para o Sistema Único de Saúde (SUS). Espera-se que os custodiadores modelados assimilem subsídios para a criação de repositórios digitais em saúde confiáveis e recomenda-se a adoção e a incorporação dos processos de gestão arquivística de documentos articulados com os da TI.

This article presents a proposal of conceptual modeling of the chain of custody for Electronic Health Records (EHR). The curiosity to know the authenticity criteria of the EHR sent from the services to the DATASUS Portal generated this investigation. The research is both exploratory and descriptive by means of a systemic literature and documental review for the prospection and analysis on authenticity and preservation of the EHR. According to the results found, the custodians and the proposal of custody chain modeling for Unified Health System (SUS) were identified. The modeled custodians are expected to assimilate subsidies for the creation of reliable digital health repositories. It is recommended that they adopt and incorporate the articulated processes of archival management to those from the IT.

Este artículo presenta una propuesta de modelado conceptual de la cadena de custodia para Registros Electrónicos en Salud (RES). La curiosidad por conocer los criterios de autenticidad de los RES enviados desde los servicios hacia el Portal DATASUS generó esta investigación. La investigación es exploratoria y descriptiva a través de una revisión sistemática de literatura y documental para la prospección y análisis de autenticidad y preservación de los RES. A partir de los resultados encontrados, se identificaron los custodios y la propuesta de modelado de la cadena de custodia para el Sistema Único de Salud (SUS). Se espera que los custodios modelados asimilen los subsidios para la creación de repositorios digitales en salud confiables y se recomienda la adopción e incorporación de los procesos de gestión de archivos de documentos articulados con los de TI.

O preventivismo e os homossexuais no contexto da ditadura militar brasileira: uma análise a partir das contribuições de Sérgio Arouca / Preventivism and homosexuals in the context of the Brazilian military dictatorship: An analysis based on Sérgio Aroucas contributions / El preventivismo y los homosexuales en el contexto de la dictadura militar brasileña: un análisis a partir de las contribuciones de Sérgio Arouca

No Brasil, a reforma da escola médica ancorada na medicina preventiva difundiu-se, em grande medida, durante a ditadura militar (1964-1985). O projeto preventivista é investigado aqui para além de uma reorganização curricular, estando imbuído de um papel social e político evidenciado, especificamente, pelo modo como caracterizou os homossexuais na ditadura militar. Foram analisadas publicações do "Jornal do Brasil" sobre congressos científicos que tematizaram o preventivismo no combate aos comportamentos desviantes na juventude, com destaque ao homossexualismo. A tese de Sérgio Arouca estruturou as principais discussões presentes e embasou a análise das publicações coletadas. Como resultado, os homossexuais, tidos como degenerados desde o século XIX, foram descritos como ameaças patológicas à família, à moral e à segurança nacional, sendo necessária a sua profilaxia a partir de recomendações médico-preventivas no ambiente escolar e familiar e da repressão política direta do Estado.(AU)

In Brazil, the medical school reform grounded on preventive medicine was disseminated, to a large extent, during the military dictatorship (1964-1985). The preventivist project is investigated here beyond a curricular reorganization, as it had a social and political role. This role was clearly visible, specifically, in the way in which it characterized homosexuals in the military dictatorship. We analyzed publications of the newspaper "Jornal do Brasil" about scientific conferences that focused on preventivism in the fight against youth's deviant behaviors, emphasizing homosexuality. Sérgio Arouca's doctoral dissertation structured the main discussions and grounded the analysis of the collected publications. As a result, homosexuals, seen as degenerate since the 19th century, were described as pathological threats to the family, morals and national security; thus, prophylaxis was necessary through medical-preventive recommendations in the school and family environments and through the State's direct political repression.(AU)

En Brasil, la reforma de la escuela médica anclada en la medicina preventiva se difundió, en gran medida, durante la dictadura militar (1964-1985). El proyecto preventivista se investiga aquí más allá de una reorganización curricular, incorporando un papel social y político. Este evidenciado, específicamente, por el modo en que caracterizó a los homosexuales en la dictadura militar. Se analizaron publicaciones del "Jornal do Brasil" sobre congresos científicos que tuvieron como tema el preventivismo en el combate a los comportamientos desviantes en la juventud con destaque para la homosexualidad. La tesis de Sérgio Arouca estructuró las principales discusiones presentes y sirvió de base al análisis de las publicaciones colectadas. Como resultado, los homosexuales, considerados como degenerados desde el siglo XIX se describieron como amenazas patológicas a la familia, a la moral y a la seguridad nacional, siendo necesaria su profilaxis por medio de recomendaciones médico-preventivas en el ambiente escolar y familiar y de la represión política directa del Estado.(AU)

Diabetes induces changes in neuroretina before retinal vessels: a spectral-domain optical coherence tomography study.

PURPOSE: To investigate retinal changes prior to vascular signs in patients with type 2 diabetes without diabetic retinopathy or with mild non proliferative diabetic retinopathy. METHODS: A cross-sectional study was performed in three groups: patients without diabetes, patients with type 2 diabetes without diabetic retinopathy, and patients with diabetes with mild diabetic retinopathy. Analysis of retinal layers was performed objectively with the Cirrus Review Software 6.0 (Carl Zeiss Meditec, Dublin, CA, USA). Macular cube scans were analyzed with regard to: the ganglion cell layer + inner plexiform layer analysis, retinal nerve fiber layer thickness, central subfoveal retinal thickness and average macular thickness. RESULTS: In total, 102 patients were included in this study, of which 28 (27.4%) were classified into control group, 46 (45.0%) classified as diabetic patients with no diabetic retinopathy and 28 (27.4%) classified as mild diabetic retinopathy. Quantitative analysis with the Cirrus software showed that the mean ganglion cell layer and mean retinal nerve fiber layer were thinner in diabetes without diabetic retinopathy group when compared to controls. ANOVA with Bonferroni post test indicated a statistically significant reduction in average retinal thickness in mild diabetic retinopathy group (P = 0.032) compared to control and reduction in ganglion cell layer in diabetes with no diabetic retinopathy (P = 0.039) and mild diabetic retinopathy (P = 0.003). Also indicated reduction in retinal nerve fiber layer in diabetic without diabetic retinopathy and eyes with mild diabetic retinopathy (P < 0.001), compared to controls. CONCLUSIONS: Our study found reduction in thickness of ganglion cell layer and retinal nerve fiber layer in patients with diabetes without diabetic retinopathy, which suggests neuroretinal changes before vascular signs of diabetic retinopathy.

Outcomes of iris-claw anterior chamber versus iris-fixated foldable intraocular lens in subluxated lens secondary to Marfan syndrome.

PURPOSE: To compare the outcome of phacoemulsification using 2 different iris-fixation techniques for intraocular lens (IOL) replacement, a foldable posterior chamber IOL (PCIOL; AcrySof MA60AC, Alcon Laboratories Inc, Fort Worth, TX) and an iris-claw anterior chamber IOL (ACIOL; Artisan, Ophtec BV), for treatment of subluxated lenses in patients with Marfan syndrome (MFS). DESIGN: Randomized, controlled trial. PARTICIPANTS: A total of 31 eyes of 16 patients with subluxated lenses associated with MFS and a preoperative corrected visual acuity (CVA) < or =20/40 based on the Early Treatment Diabetic Retinopathy Study chart. METHODS: Patients were enrolled and the eye with worse visual acuity was randomly assigned to 1 of 2 study arms: phacoemulsification and iris-fixated PCIOL or phacoemulsification and iris-claw ACIOL; the second eye of the same patient received the other IOL type. Preoperative and postoperative ophthalmologic examination, optical coherence tomography, and endothelial cell counts were performed. MAIN OUTCOME MEASURES: We recorded CVA results at 3, 6, and 12 months, complications, endothelial cell loss, and central retinal thickness. RESULTS: In the iris-fixated PCIOL group, CVA was significantly improved at 3 (P = 0.011; n = 16), 6 (P = 0.006; n = 16), and 12 months (P = 0.002; n = 16). In the iris-claw ACIOL group, CVA was significantly improved at 3 (P = 0.001; n=15), 6 (P = 0.001; n = 15), and 12 months (P = 0.009; n = 12). The CVA results did not differ significantly between groups. Dislocation of the IOL occurred in 3 of 16 (18.75%) eyes in the PCIOL group. Retinal detachment occurred in 3 eyes (2 in the PCIOL group and 1 in the ACIOL group) and was successfully repaired. Postoperative foveal tomograms in both groups revealed a decrease in the mean foveal thickness (MFT; < or =172 microm) in 54.16% of the patients. CONCLUSIONS: The iris-sutured PCIOL and iris-claw ACIOL produced comparable improvements in CVA at 3, 6, and 12 months postoperatively. Although IOL dislocation tended to occur more frequently in the iris-fixated PCIOL group, the difference was not significant. At 6 months postoperatively, all study patients tended to have a thinner MFT. None of the patients in either group developed cystoid macular edema.

STRATUSOCT and multifocal ERG in unilateral acute idiopathic maculopathy.

BACKGROUND: Unilateral acute idiopathic maculopathy (UAIM) is a rare entity, in which an inflammatory process involves the macular retinal pigment epithelium (RPE) and outer retina. It represents a wide spectrum of ocular findings not consistently present in all patients, which may lead to difficulties in the recognition of the condition. METHODS: This observational case report presents the third-generation optical coherence tomography (StratusOCT) and multifocal electroretinogram (mfERG) findings in a 31-year-old woman with UAIM in the acute phase as well as two months later, and discusses the role of StratusOCT in the diagnosis. RESULTS: In the acute phase, StratusOCT demonstrated abnormal heterogeneous hyperreflectivity and thickening at the level of the outer retina and RPE in the foveal region. Two months after the initial presentation, StratusOCT examination showed a subfoveal area of homogeneous hyperreflectivity that extended from the RPE to the outer retinal layers with posterior shadowing, and sparse points of hyperreflectivity at several different levels of the neurosensory retina, including its superficial layers. The foveal retinal thickness during the acute phase was thicken compared with that after resolution. Seven days after the initial evaluation, mfERG showed severely reduced N1-P1 amplitudes with normal latencies in the region corresponding to the affected area of the papillomacular bundle and fovea. Two months later, mfERG results were normal. CONCLUSIONS: StratusOCT provided valuable information, allowing for the exclusion of other disorders that might mimic UAIM. mfERG findings were consistent with transient outer retinal dysfunction as the cause of visual loss. We are unaware of previous reports of UAIM studied by these methods and could find no reference to them in a computerized search using MEDLINE.

STRATUS optical coherence tomography in unilateral colobomatous excavation of the optic disc and secondary retinoschisis.

PURPOSE: To report the STRATUS optical coherence tomography (STRATUSOCT) findings in a patient with unilateral coloboma-like excavation of the optic disc without pit but secondary retinoschisis, as well as to discuss the possible involved pathophysiologic mechanisms. METHODS: Observational case report. STRATUSOCT findings in a 66-year-old woman with a coloboma-like excavation of the optic disc without pit but secondary retinoschisis encompassing the macular region, along with evidence of a mild epiretinal membrane superonasal to the disc were evaluated. RESULTS: STRATUSOCT showed signs of a connection between the perineural space and the inner retinal layers on the temporal optic disc border, as well as schisis-like changes extending from the disc to the macula, with cystoid degeneration and two lamellar holes in their nasal portion. CONCLUSION: The use of third generation OCT afforded an enhanced visualization of retinal structures, revealing signs of fluid at several distinct levels, as well as deep and superficial inner breaks apart from the schisis cavity. We are unaware of such previous reports, and could find no reference to them in a computerized search using MEDLINE. In addition, our study supports a common pathomechanism for the development of macular complications in optic pits and colobomas.

Retinal capillary hemangioma treatment by indocyanine green-mediated photothrombosis.

PURPOSE: To describe the clinical, angiographic and optical coherence tomography (OCT) findings of a patient with a large retinal capillary hemangioma who was treated by indocyanine green-mediated photothrombosis. Interventional case report. METHODS: An 18-year-old male patient was treated at a tertiary referral center with a novel laser-dye procedure that uses low-irradiance 810-nm laser and intravenous indocyanine green injection and was prospectively evaluated with fluorescein and indocyanine green angiography, as well as OCT. RESULTS: Vision improved from 20/125 to 20/32 + 1 at 1-year follow-up. Fundus photography showed marked reduction of a 3 disk diameters retinal capillary hemangioma. Both fluorescein and indocyanine green angiography demonstrated reduced tumor perfusion and narrowing of the lesion feeder and draining vessels as early as 5 days after indocyanine green-mediated photothrombosis; OCT showed immediate decrease in retinal elevation and complete resolution of subretinal fluid within 2 months of treatment. Minimal laser-induced effects were noted in the vicinity of the tumor. CONCLUSIONS: Photothrombosis using low-intensity, 810-nm light to direct laser energy continuously at the tumor after intravenous indocyanine green infusion was effective in restoring macular architecture and improving vision in a patient with a large peripheral retinal capillary hemangioma by means of substantial occlusion of the tumor vasculature and resolution of subretinal fluid.