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1.
Cureus ; 16(5): e60615, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38894807

RESUMO

We report structural changes in the retina of an adolescent diagnosed with the concomitant two temporal cilioretinal artery occlusion (CLRAO) with impending central retinal vein occlusion (CRVO) along with mild protein C deficiency. An 18-year-old girl came to the emergency room with sudden onset painless loss of vision in her right eye. On comprehensive ophthalmic examination, she had a pale superior-temporal retina with spongy macular edema corresponding to two temporal CLRAO and blurred disc margins with mild disc swelling and mild tortuosity of retinal veins all over the retina with few superficial hemorrhages in the right eye corresponding to impending CRVO. Optimal coherence tomography (OCT) showed thickening of the nerve fiber layer in the superior-temporal quadrant involving some part of the macula in the right eye. Perimetry showed a right eye visual field defect in the inferior nasal quadrant. Her coagulation profile was normal but her autoimmune profile was suggestive of mild protein C deficiency. Immediately she was started on anticoagulants. After one month, her visual acuity improved from finger counting close to face to 6/9 with treatment. Over a period of one month, retinal and OCT changes recovered with the same perimetry findings as earlier. This case shows how prompt treatment resulted in dramatic improvement in the form of good visual outcomes.

2.
Graefes Arch Clin Exp Ophthalmol ; 262(7): 2111-2120, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38376563

RESUMO

PURPOSE: To investigate the impact of anti-VEGF therapy on vascular metrics in eyes with macular edema secondary to central retinal vein occlusion (CRVO) using wider field swept-source OCT angiography (WF SS-OCTA). METHODS: We included 23 eyes with macular edema associated with non-ischemic CRVO from 22 patients treated with anti-VEGF therapy (median number of injections: 5 [2-9]). Changes in vessel density (VD), vessel skeletonized density (VSD), and foveal avascular zone (FAZ) parameters were measured using WF SS-OCTA. Visual acuity (VA) and central subfield thickness (CST) were also measured. RESULTS: Median CST decreased significantly from 369 µm (305-531) to 267 µm (243-300, p < 0.001). VD and VSD parameters in 12 × 12 mm images showed significant reductions. For instance, VSD in the whole retina decreased from a median of 13.37 (11.22-13.74) to 11.29 (9.36-12.97, p = 0.013). Additionally, a significant increase in FAZ circularity was found, suggesting improved microvascular integrity. Significant inverse correlations were found between the number of anti-VEGF injections and all VSD and VD parameters on the 12 × 12 mm images (p < 0.05). Notably, the reductions in VSD and VD on 12 × 12 mm angiograms in the deep capillary plexus (DCP) after each injection significantly correlated with increased logMAR VA (worse VA). CONCLUSION: Anti-VEGF therapy in CRVO patients not only mitigates macular edema but also alters the overall microvascular morphology and functionality as revealed by WF SS-OCTA.


Assuntos
Inibidores da Angiogênese , Angiofluoresceinografia , Fundo de Olho , Injeções Intravítreas , Ranibizumab , Oclusão da Veia Retiniana , Vasos Retinianos , Tomografia de Coerência Óptica , Fator A de Crescimento do Endotélio Vascular , Acuidade Visual , Humanos , Oclusão da Veia Retiniana/tratamento farmacológico , Oclusão da Veia Retiniana/diagnóstico , Oclusão da Veia Retiniana/fisiopatologia , Tomografia de Coerência Óptica/métodos , Angiofluoresceinografia/métodos , Inibidores da Angiogênese/uso terapêutico , Inibidores da Angiogênese/administração & dosagem , Masculino , Feminino , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Idoso , Ranibizumab/administração & dosagem , Pessoa de Meia-Idade , Vasos Retinianos/diagnóstico por imagem , Vasos Retinianos/patologia , Estudos Retrospectivos , Edema Macular/tratamento farmacológico , Edema Macular/diagnóstico , Edema Macular/etiologia , Edema Macular/fisiopatologia , Seguimentos , Bevacizumab/uso terapêutico , Bevacizumab/administração & dosagem , Receptores de Fatores de Crescimento do Endotélio Vascular/uso terapêutico , Receptores de Fatores de Crescimento do Endotélio Vascular/antagonistas & inibidores , Receptores de Fatores de Crescimento do Endotélio Vascular/administração & dosagem , Idoso de 80 Anos ou mais , Resultado do Tratamento
3.
Cureus ; 16(1): e51567, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38313937

RESUMO

Celiac disease (CD) is a digestive disorder caused by an abnormal immune reaction to gluten, leading to severe malabsorption syndrome. Central retinal vein occlusion (CRVO) was reported in a couple of cases worldwide in patients with this disease entity. Herein, we are reporting a rare case of combined central retinal vein and artery occlusion in a young female celiac disease patient presented with a counting finger vision at six feet and improved to 20/60 vision after conservative management.

4.
Tomography ; 9(5): 1745-1754, 2023 09 19.
Artigo em Inglês | MEDLINE | ID: mdl-37736992

RESUMO

A rarely described condition known as branch retinal artery occlusion (BRAO) with concurrent obstruction of the central retinal vein (CRVO) is characterized by diffuse retinal hemorrhages, dilated and tortuous retinal veins, macular and disc edema, cotton wool spots, and a generalized delay in arteriovenous transit on fluorescein angiography, together with a retinal whitening in the area of the affected retinal arterial branch. Although BRAO and CRVO may share underlying systemic risk factors, the pathogenesis of combined BRAO + CRVO is still unknown. We present a BRAO + CRVO case report concerning a 63-year-old white male who came to our observation complaining of sudden vision loss in his right eye. An increased risk for thrombotic event was revealed in this case, and the patient improved only with systemic anticoagulant therapy and in the absence of ocular therapy. We also explain all the clinical findings that are detectable using different diagnostic devices and analyze the scientific literature for other, similar clinical cases.


Assuntos
Artéria Retiniana , Oclusão da Veia Retiniana , Masculino , Humanos , Pessoa de Meia-Idade , Oclusão da Veia Retiniana/complicações , Oclusão da Veia Retiniana/diagnóstico por imagem , Oclusão da Veia Retiniana/tratamento farmacológico , Artéria Retiniana/diagnóstico por imagem , Fatores de Risco
5.
Cureus ; 15(8): e43195, 2023 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-37692695

RESUMO

Hyperaldosteronism is a common cause of secondary hypertension. It has been classically associated with the clinical triad of hypertension, unexplained hypokalemia, and metabolic alkalosis. We present a case of a 66-year-old man who experienced blindness, hypokalemia, and hypertension that was resistant to anti-hypertension medications. He was found to have a retinal detachment and central retinal vein occlusion (CRVO). Laboratory evaluation revealed a marked elevation of plasma aldosterone activity and suppressed renin. A computerized tomography (CT) abdomen was subsequently ordered, which revealed bilateral adrenal nodules. Adrenal vein sampling was performed, which confirmed bilateral hyperfunctioning adrenal nodules. He was successfully treated with spironolactone. CRVO in the setting of hyperaldosteronism is an uncommon presentation.

6.
Front Med (Lausanne) ; 10: 1180234, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37601780

RESUMO

Objective: To evaluate the risk factors and outcomes of central retinal vein occlusion (CRVO) in young patients (< 40 years). Methods: In this retrospective monocentric case series, we included young patients (<40 years) with CRVO. Patients' medical files were analyzed focusing on demographic characteristics, suspected risk factors, ophthalmic work-up, visual acuity (VA), treatment, and outcomes. Results: A total of 54 eyes of 52 patients were included. Central retinal vein occlusion was considered idiopathic in 13 patients (25%). The main risk factors identified were ocular hypertension (20.4%), inflammation (20.4%), high blood pressure (14.8%), and coagulation abnormality (11.1%). Final VA was lower in patients with high blood pressure and inflammation when compared to patients with no risk factor (p = 0.03 and 0.04, respectively). Intravitreal injections were needed in 23 eyes (42.6%) and 19 eyes (35.2%) received panretinal photocoagulation treatment. Conclusion: Central retinal vein occlusion is frequently associated with risk factors in young patients (75% of patients). In addition to the usual factors found in older patients, such as ocular hypertension and high blood pressure, coagulation abnormality and inflammation were also among the risk factors identified. Young patients with CRVO should be evaluated for the presence of risk factors and patients with high blood pressure or inflammatory findings should be followed carefully since they have a worse outcome.

7.
J Med Case Rep ; 17(1): 309, 2023 Jul 06.
Artigo em Inglês | MEDLINE | ID: mdl-37408048

RESUMO

BACKGROUND: Eales' disease is an idiopathic peripheral retinal vasculopathy characterized by retinal phlebitis, ischemia, retinal neovascularization, and recurrent vitreous hemorrhages. But CRAO is an unusual presentation. CASE PRESENTATION: A 27-year-old healthy female nurse of Indian descent presented with sudden vision loss in her right eye upon awakening. Central retinal artery occlusion (CRAO), combined with mild central retinal vein occlusion (CRVO), was diagnosed. During the second of three consecutive sessions of hyperbaric oxygen treatments, her vision rapidly improved. One week later, she developed peripheral phlebitis in the same eye. Infectious, inflammatory, and hematologic etiologies were excluded. The systemic evaluation was normal except for a positive Mantoux tuberculin skin test. Following systemic steroidal treatment, she experienced gradual improvement of her vasculitis. Two weeks later, mild retinal phlebitis appeared in her left eye. Eales' disease was diagnosed after the exclusion of other diseases. CONCLUSION: This is an unusual Eales' disease case, which presented as combined CRAO with mild CRVO. The association of CRAO and Eales' disease is reported here for the first time, to our best knowledge.


Assuntos
Flebite , Oclusão da Artéria Retiniana , Vasculite Retiniana , Humanos , Feminino , Adulto , Vasculite Retiniana/diagnóstico , Vasculite Retiniana/etiologia , Neovascularização Patológica , Flebite/diagnóstico , Oclusão da Artéria Retiniana/diagnóstico , Oclusão da Artéria Retiniana/etiologia
8.
Ophthalmol Ther ; 12(4): 2157-2169, 2023 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-37294523

RESUMO

INTRODUCTION: Foveal eversion (FE) is a recently described optical coherence tomography (OCT) finding associated with negative outcome in diabetic macular edema. The main goal of the present study was to investigate the role of the FE metric in the diagnostic workup of retinal vein occlusion (RVO). METHODS: This study was a retrospective, observational case series. We included 168 eyes (168 patients) affected by central RVO (CRVO) and 116 eyes (116 patients) affected by branch (RVO). We collected clinical and imaging data from CRVO and BRVO eyes affected by macular edema with a minimum follow-up of 12 months. On structural OCT, we classified FE as pattern 1a, characterized by thick vertical intraretinal columns, pattern 1b, presenting thin vertical intraretinal lines, and pattern 2, showing no signs of vertical lines in the context of the cystoid macular edema. For statistical purposes, we considered data collected at baseline, after 1 year and at the last follow-up. RESULTS: The mean follow-up was 40 ± 25 months for CRVO eyes and 36 ± 24 months for BRVO eyes. We found FE in 64 of 168 CRVO eyes (38%) and in 25 of 116 BRVO eyes (22%). Most of the eyes developed FE during the follow-up. For CRVO eyes, we found 6 eyes (9%) with pattern 1a, 17 eyes (26%) with pattern 1b and 41 eyes (65%) with pattern 2. Of those BRVO eyes with FE, we found 8 eyes (32%) with pattern 1a + 1b and 17 eyes (68%) with pattern 2. In both CRVO and BRVO the presence of FE was significantly associated with higher persistence of macular edema and worse outcome, with FE pattern 2 representing the most severe condition. Remarkably, FE patterns 1a and 1b were characterized by BCVA stability over the follow-up, whereas FE pattern 2 showed significant bestcorrected visual acuity (BCVA) worsening at the end of the follow-up. CONCLUSIONS: FE can be considered a negative prognostic biomarker in RVO, associated with higher persistence of macular edema and worse visual outcome. Müller cell impairment might represent the pathogenic mechanism leading to the loss of macular structural support and impairment of fluid homeostasis.

9.
Front Med (Lausanne) ; 10: 1110166, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37359003

RESUMO

Retinal vein occlusions (RVOs) are the second most common retinal vascular disease after diabetic retinopathy, and are a significant cause of visual impairment, especially in the elderly population. RVOs result in visual loss due to macular ischemia, cystoid macular edema (CME), and complications related to neovascularization. Vascular assessment in RVOs traditionally relies on standard fluorescein angiography (FA) for assessment of macular and retinal ischemia, which aids in prognostication and guides intervention. Standard FA has significant limitations-it is time-consuming, requires invasive dye administration, allows for limited assessment of the peripheral retina, and is usually evaluated semi-qualitatively, by ophthalmologists with tertiary expertise. More recently, the introduction of ultra-widefield FA (UWF FA) and optical coherence tomography angiography (OCTA) into clinical practice has changed the tools available for vascular evaluation in RVOs. UWF FA allows for evaluation of peripheral retinal perfusion, and OCTA is non-invasive, rapidly-acquired, and provides more information on capillary perfusion. Both modalities can be used to provide more quantitative parameters related to retinal perfusion. In this article, we review the clinical utility and impact of UWF FA and OCTA in the evaluation and management of patients with RVOs.

10.
Am J Transl Res ; 15(3): 2098-2102, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37056866

RESUMO

Moyamoya disease is mainly caused by stenosis or occlusion of the terminal internal carotid artery, anterior cerebral artery, and proximal middle cerebral artery, and an abnormal vascular network is formed near the stenosis or occlusion of vascular lesions. Moyamoya disease can lead to a series of complications such as transient cerebral ischemia, cerebral infarction, and cerebral hemorrhage, which have been reported in the literature. Eye involvement with moyamoya disease is relatively rare in the literature. This article introduces a case of central retinal vein occlusion in a teenager related to moyamoya disease. The patient was only 16 years old and suddenly suffered from vision loss in the left eye. After detailed ophthalmological examination, she was diagnosed with central retinal vein occlusion in the left eye. In order to find the exact cause, we conducted head and neck CTA and brain DSA examinations on the patient, and finally found that the main cause of central retinal vein occlusion in this patient was moyamoya disease, which indicated that central retinal vein occlusion in young people may be caused by moyamoya disease in the early stage. This discovery has great clinical significance, for characteristic manifestations of the eye, suggesting that examination of moyamoya disease is a routine item for such patients, so as to achieve early detection, early diagnosis and early treatment, in order to avoid cerebral infarction, cerebral palsy, and serious or even life-threatening complications such as bleeding.

11.
Cureus ; 15(3): e36216, 2023 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-37073199

RESUMO

An accidental injection of a dexamethasone implant inside the crystalline lens was observed in the right eye of a 63-year-old woman suffering from a macular edema secondary to a central retinal vein occlusion. A 23-gauge pars plana vitrectomy and lensectomy followed by an intraocular lens implantation were performed to carefully remove the lens and save the whole implant in order to preserve its therapeutics effects. A strict follow-up over the following 3 months revealed an improving of macular edema and no postoperative complications. The injection of a dexamethasone implant into the lens could be effectively and successfully managed with a pars plana vitrectomy and lensectomy.

12.
Ophthalmol Sci ; 3(2): 100267, 2023 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-36824600

RESUMO

Purpose: To identify the vascular biomarkers of peripheral capillary nonperfusion in patients affected by naive central retinal vein occlusion (CRVO), and to analyze their changes over the follow-up. Study Design: Consecutive prospective case series with a planned follow-up of 2 years. Participants: Thirty-five patients affected by CRVO and 35 healthy gender- and age-matched subjects were enrolled in the study. Methods: Ophthalmic examination included best corrected visual acuity (BCVA), ultrawidefield fluorescein angiography (UWFFA), OCT, and OCT angiography (OCTA). Main Outcome Measures: Vessel density (VD) at the superficial capillary plexus and deep capillary plexus (DCP) were calculated on OCTA images. The ischemic index (ISI) was calculated on UWFFA. Results: The mean baseline ISI was 37%, increasing to 40% at the end of the follow-up, whereas it was 4.9% in the patients' fellow eyes and 4.5% in the control group with no change over the follow-up. OCT angiography revealed VD reduction in the DCP, considering both 3 × 3 mm and 12 × 12 mm scans. The correlation analyses revealed that DCP VD was the only parameter showing a statistically significant correlation with the foveal avascular zone (FAZ) area, BCVA, and ISI. Conclusions: Deep capillary plexus VD impairment is detectable in all CRVO cases, variably involving both the central retina (with enlarged FAZ) and the periphery (with VD reduction in the peripheral retina). The severity of DCP VD reduction has correlates with various clinical markers. Deep capillary plexus VD may represent a crucial biomarker to characterize CRVO, and further studies are necessary to identify the cutoff thresholds for the different clinical manifestations.

13.
J Med Case Rep ; 17(1): 59, 2023 Feb 20.
Artigo em Inglês | MEDLINE | ID: mdl-36804919

RESUMO

BACKGROUND: Waldenström macroglobulinemia is a rare hematological malignancy and is the most common diagnosis in patients with hyperviscosity syndrome. Bilateral central retinal vein occlusion as an initial presentation of hyperviscosity syndrome in Waldenström macroglobulinemia is rare. CASE PRESENTATION: A 42-year-old Nepalese male presented with sudden-onset bilateral painless blurring of vision. Fundus examination revealed bilateral, diffusely dilated, tortuous retinal veins and intraretinal deep blot hemorrhages in all four quadrants of the retina in both eyes; features of bilateral central retinal vein occlusion. Serum electrophoresis showed hypoalbuminemia with an immunoglobulin M kappa monoclonal spike. Bone marrow picture and immunohistochemistry analysis were suggestive of lymphoplasmacytic lymphoma. The patient received systemic therapy for Waldenström macroglobulinemia, along with intravitreal bevacizumab. CONCLUSION: Adequate hydration, plasmapheresis, and a combination of bortezomib, dexamethasone, and rituximab regimen as a systemic therapy may represent an ideal choice for patients with hyperviscosity in Waldenström macroglobulinemia.


Assuntos
Oclusão da Veia Retiniana , Macroglobulinemia de Waldenstrom , Humanos , Masculino , Adulto , Macroglobulinemia de Waldenstrom/complicações , Macroglobulinemia de Waldenstrom/diagnóstico , Macroglobulinemia de Waldenstrom/tratamento farmacológico , Oclusão da Veia Retiniana/diagnóstico , Oclusão da Veia Retiniana/tratamento farmacológico , Oclusão da Veia Retiniana/etiologia , Bortezomib
14.
Am J Ophthalmol Case Rep ; 29: 101793, 2023 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-36686264

RESUMO

Purpose: Acute Macular Neuroretinopathy (AMN) may be the result of deep retinal capillary plexus (DCP) impairment, but its mechanism remains elusive. A recent study has described simultaneous onset of Paracentral Acute Middle Maculopathy (PAMM) and AMN, suggesting a related pathogenic pathway. In this report, we analyze and describe the imaging characteristics of patients with concomitant Central Retinal Artery Occlusion (CRAO) and AMN and suggest a mechanistic pathway to explain this relationship. Observations: A total of 2 cases of CRAO, arteritic and non arteritic, were included in this report. At initial presentation, outer retinal layers were intact. At the two-week follow-up visit, both cases displayed Henle fiber layer hyperreflectivity and ellipsoid zone disruption consistent with AMN. Conclusions: Secondary development of AMN in CRAO is a new finding. DCP ischemia secondary to CRAO may lead to Henle fiber layer disruption, leading to the characteristic findings of AMN.

15.
Ocul Immunol Inflamm ; 31(1): 185-187, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34637677

RESUMO

PURPOSE: Coronavirus Disease 2019 (COVID-19) pneumonia may predispose to thromboembolic disease, including after the acute phase. We report on a unique case of central retinal vein occlusion (CRVO) occurring eight months after diagnosis of Coronavirus Disease 2019 (COVID-19) pneumonia in a likely case of post-COVID-19 syndrome. CASE REPORT: A 42-year-old man developed blurred vision in his right eye eight months after symptoms of pneumonia. He had no underlying medical conditions, but experienced exertional chest pain since diagnosis of COVID-19 was confirmed by detection of SARS-CoV-2 on nasopharyngeal swab and was also seeing cardiology for management of myocarditis. His best-corrected visual acuity on snellen chart testing was reduced to 6/18 in the affected right eye, and dilated fundal examination revealed a non-ischaemic CRVO. CONCLUSION: The thromboembolic complications of COVID-19 may extend to CRVO, which in this case presented months after onset of symptoms of pneumonia, in association with myocarditis.


Assuntos
COVID-19 , Miocardite , Oclusão da Veia Retiniana , Masculino , Humanos , Adulto , Oclusão da Veia Retiniana/etiologia , Oclusão da Veia Retiniana/complicações , COVID-19/complicações , COVID-19/diagnóstico , SARS-CoV-2 , Miocardite/complicações , Síndrome de COVID-19 Pós-Aguda
16.
Ocul Immunol Inflamm ; 31(4): 838-842, 2023 May.
Artigo em Inglês | MEDLINE | ID: mdl-35404737

RESUMO

AIM: To report the management of a neonate who presented with simultaneous bilateral central retinal vein occlusion (CRVO) secondary to septicemia. DESIGN: Case Report. RESULTS: A full-term infant was treated for neonatal sepsis with thrombocytopenia. He presented with poorly dilating pupil, disc edema, dilated retinal veins, perivascular exudation, retinal hemorrhages in all four quadrants radiating from the optic nerve to the ora serrata (no Roth spots), with cystoid macular edema (CME) in both the eyes. His TORCH serology was negative and peripheral blood film was normal. He was diagnosed as presumptive bilateral inflammatory CRVO with CME secondary to septicemia. He received bilateral intravitreal bevacizumab injections. After the injection, his pupils dilated completely while retinal hemorrhages and CME reduced. CONCLUSION: CRVO may present as a rare complication in neonates suffering from septicemia. Apart from the systemic treatment, aggressive ocular treatment is needed to salvage the eyes with severe ischemia.


Assuntos
Edema Macular , Oclusão da Veia Retiniana , Sepse , Masculino , Recém-Nascido , Humanos , Oclusão da Veia Retiniana/diagnóstico , Oclusão da Veia Retiniana/tratamento farmacológico , Oclusão da Veia Retiniana/complicações , Inibidores da Angiogênese/uso terapêutico , Hemorragia Retiniana/tratamento farmacológico , Bevacizumab/uso terapêutico , Edema Macular/tratamento farmacológico , Injeções Intravítreas , Tomografia de Coerência Óptica , Sepse/complicações , Sepse/tratamento farmacológico
17.
Ocul Immunol Inflamm ; 31(3): 594-598, 2023 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35119981

RESUMO

OBJECTIVES: To provide a case report of Retinal Vein Occlusion (RVO) with COVID-19 infection. CASE: A 15-year-old healthy male presented with blurring of vision, 2+ vitreous cells, retinal haemorrhages and dilated and tortuous retinal vessels in the left eye within 28 days of a positive COVID-19 reverse transcriptase polymerase chain reaction (RT-PCR) assay. He was diagnosed with left non-ischaemic CRVO, with a suspected aetiology of COVID-19. DISCUSSION: A literature review found 12 reported cases of RVO associated with COVID-19. All but one patient was younger than 60, with a mean age of 42 years. Management varied, but in the majority (8/12), visual acuity (VA) improved with follow-up, and five (42%) had a final VA of 20/20. CONCLUSION: In the absence of other known aetiological factors, ophthalmologists should consider COVID-19 as a cause of RVO. The outcome can vary, but the majority can expect improvement in VA with time.


Assuntos
COVID-19 , Oclusão da Veia Retiniana , Humanos , Masculino , Adulto , Adolescente , Oclusão da Veia Retiniana/etiologia , Oclusão da Veia Retiniana/complicações , COVID-19/complicações , Retina
18.
Ophthalmol Retina ; 7(4): 338-345, 2023 04.
Artigo em Inglês | MEDLINE | ID: mdl-36371040

RESUMO

PURPOSE: To analyze the 3-year outcomes in a broad population of patients starting VEGF inhibitors for central retinal vein occlusion (CRVO) in routine clinical practice. DESIGN: Observational database study. PARTICIPANTS: Overall, 527 treatment-naïve CRVO eyes that commenced VEGF inhibitors between December 1, 2010 and 2018 were tracked in the Fight Retinal Blindness! registry. METHODS: Longitudinal models were used to plot changes in visual acuity (VA) and central subfield thickness (CST). MAIN OUTCOME MEASURES: Mean change in VA from baseline to 36 months, injections, visits, completion, switching, and suspensions of therapy > 180 days at the final review. RESULTS: Overall (527 eyes) mean VA change (95% confidence interval [CI]) was + 10 (7, 12) letters, 37% had final VA ≥ 70 and 30% ≤ 35 letters, mean CST changed -306 µm. Completers (257/527, 49%) had mean 36-month changes in VA and CST of + 12 letters and -324 µm with a median of 18 injections at 26 visits. The adjusted mean VA change was similar to each VEGF inhibitor (mean, + 11.4 letters) despite a greater reduction in CST with aflibercept (-310 µm) versus ranibizumab (-258 µm) versus bevacizumab (-216 µm; P < 0.001). Eyes with baseline VA that was trial-eligible (19-73 letters; 356/527, 68%) gained 7 letters, very poor (< 19 letters; 129/527, 24%) gained 22 letters, or very good (> 73 letters; 42/527, 8%) lost 7 letters. Switching (160/527, 30%) was most often to aflibercept (79 eyes). By using suspensions and discontinuation reasons, we identified similar proportions had ceased therapy (154/527, 29%) and were still receiving it at 36 months (165/527, 31%). Only 62/527 eyes (12%) had resolution of macular edema without treatment for > 6 months. CONCLUSIONS: Patients with CRVO that commenced VEGF inhibitors in routine care for whom follow-up was available had VA improvements of around 12 letters at 3 years, but with > 50% lost to follow-up, the VA outcome for the entire group was likely worse. The choice of VEGF inhibitor influenced CST but not VA outcomes. We estimated that around half of the eyes were still receiving injections after 36 months. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.


Assuntos
Oclusão da Veia Retiniana , Humanos , Oclusão da Veia Retiniana/tratamento farmacológico , Fator A de Crescimento do Endotélio Vascular , Injeções Intravítreas , Inibidores da Angiogênese , Cegueira/induzido quimicamente , Sistema de Registros
19.
Cureus ; 14(10): e30609, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36426324

RESUMO

Aim This study aims to compare the ganglion cell complex changes in diabetic macular edema (DME) and central retinal vein occlusion (CRVO) macular edema using optical coherence tomography (OCT). Methods This was a hospital-based cross-sectional study conducted for six months. All patients having DME and CRVO macular edema presenting to the Ophthalmology Department at Acharya Vinobha Bhave Rural Hospital were included in the study. A detailed and comprehensive ophthalmic examination was performed, and OCT was done for each patient. Results The incidence of both DME and CRVO macular edema were both found to be maximum in the age group of 61-69 years. DME is more common in males (62.86%) than females (37.14%); the same was observed in CRVO group: 54.29% were males and 45.71% were females. Macular edema showed a mean value of 370.11 in DME and 428.71 in CRVO. Thus, the CRVO group showed more macular edema than the DME group. The ganglion cell complex thickness showed a mean value of 58.47 in DME and 66.77 in the CRVO group, implying that the thickness reduced significantly in the DME group. Conclusion OCT provides quantitative measurement of the ganglion cell complex thickness, which helps monitor the course of macular edema secondary to CRVO and diabetes Mellitus and thereby provides an assessment of the prognosis of the disease as these two diseases in particular are major causes of blindness worldwide, and timely care and management can help in altering its course.

20.
Ophthalmol Sci ; 2(1): 100083, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-36246174

RESUMO

Purpose: To define the role of optociliary shunt vessels (OSVs) in eyes with central retinal vein occlusion (CRVO) using OCT angiography (OCTA) with macular parameters. Design: Retrospective, observational, consecutive case series. Participants: Forty-one eyes in 38 consecutive patients with CRVO were analyzed in this study. Methods: Optic disc and macula were imaged by swept-source OCTA (3 × 3 mm) as well as by high-quality fundus photography. Main Outcome Measures: We compared macular vessel density (VD) and visual acuity between eyes in which OSVs developed and those in which they did not. Furthermore, we measured the diameter of the OSVs and analyzed the correlation with macular VD and visual acuity. Results: Optociliary shunt vessels were found in 25 eyes (61%). Central retinal vein occlusion with OSVs did not show any statistical difference compared with CRVO without OSVs in either macular VD of the total retina (0.31 ± 0.07 and 0.26 ± 0.09, respectively; P = 0.0937) or final best-corrected visual acuity (BCVA) (0.30 ± 0.43 logarithm of the minimum angle of resolution [logMAR] and 0.59 ± 0.54 logMAR, respectively; P = 0.0705). The mean OSV diameter was 71 ± 30 µm in CRVO with OSV. The diameter of the OSVs was correlated positively with superficial VD (r = 0.443; P = 0.027), deep VD (r = 0.494; P = 0.012), and total VD (r = 0.491; P = 0.013). Furthermore, the OSV diameter was also negatively correlated with BCVA (logMAR) at the final visit (r = -0.531; P = 0.006). Conclusions: The results demonstrated that the diameter of the OSVs was associated with macular VD and visual acuity in patients with CRVO. The development of large OSVs on the optic disc may be a good indicator of the maintenance of blood flow in the macula.

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