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Authors' reply to the comments to: Retinal and vitreous hemorrhage after traumatic impact of dexamethasone implant in a vitrectomized eye
No full text[No abstract available
Retinal and vitreous hemorrhage after traumatic impact of dexamethasone implant in a vitrectomized eye
No full textPURPOSE: To report a case of retinal and vitreous hemorrhage after intravitreal injection of dexamethasone implant (0.7 mg Ozurdex) and its management.METHODS: A 49-year-old man treated for diabetic macular edema developed vitreous and retinal hemorrhage after intravitreal injection of dexamethasone implant caused by a retinal impact during the injection procedure.RESULTS: Retinal and vitreous hemorrhage absorbed spontaneously after 3 months. No retinal damage was detected. Intraocular pressure increased to 38 mm Hg after the injection and was well-controlled by medical therapy (dorzolamide hydrochloride-timolol maleate ophthalmic solution administered BID and oral acetazolamide 250 mg once a day). Since the surgeon performed the injection carefully without exerting any pressure on the eye, a device malfunction likely caused the implant to be injected too powerfully.CONCLUSIONS: Vitreous and retinal hemorrhage can occur after direct impact of an Ozurdex implant against the retina during the injection. So far this has never been described in the literature. Intraocular pressure elevation can worsen due to trabecular blockage by red blood cells. Spontaneous resolution can occur but vitrectomy is a therapeutic option if the hemorrhage persists
Optical Coherence Tomography Findings In Acute And Chronic Retinal Artery Occlusion.
No full textPurpose:To report spectral domain optical coherence tomography (SD-OCT) findings in acute and chronic retinal artery occlusions (RAO), and to compare these findings with other causes of inner retinal atrophy.
Methods:Two cases of central retinal artery occlusion (CRAO) with perfused cilio-retinal artery and one case of cilio-retinal artery occlusion were observed in the acute phase and then followed for four months with SD-OCT. Other 4 cases of chronic central and branch RAO were also evaluated. SD-OCT images of different causes of inner retinal atrophy (advanced glaucoma and ischemic optic neuropathy) are reported and compared.
Results:In the acute phase of RAO, SD-OCT discloses thickening and increased reflectivity of the inner retinal layers with shadowing effect on outer structures, and sharp demarcation between perfused and non-perfused retina. In the chronic phase, SD-OCT reveals severe and complete inner retinal atrophy and homogeneous intra-retinal structure, while outer nuclear layer and IS-OS/RPE hyper-reflective lines remain intact. On the contrary, in advanced glaucoma and optic neuropathy the inner retinal structure although reduced remains clearly detectable.
Conclusions:SD-OCT in acute-CRAO demonstrates swelling of the inner retinal layers and sharp demarcation of the affected. In the chronic phases the homogeneous inner atrophy with absence of identifiable retinal layers represents a distinctive marker of RAO compared with other causes of inner retinal atrophy
Dexamethasone Intravitreal Implant for Diabetic Macular Edema
No full textPurpose:It is well known that the presence of chronic and persistent diabetic macular edema (DME) can vanish the visual benefits of phacoemulsification (PE) in these patients. Nevertheless cataract extraction can be necessary both to maintain residual visual function and for a correct follow up of retinopathy. The use of dexamethasone intravitreal implant (Dex-I) at the time of surgery has an elevate rationale in these patients due to its combined high anti-inflammatory and anti-VEGF properties together with its long lasting effect and absence of systemic side effects. We here report the functional and anatomic results of a combined surgical procedure of Dex-I and PE in 7 patients with cataract and chronic DME followed for six months after surgery.
Methods:Seven consecutive type-2 diabetic patients with cystoid chronic DME and advanced nuclear cataract (N3-5 at LOCS-III chart) underwent PE. Dex-I was injected as the first surgical maneuver and than PE and IOL implantation proceeded as usual. Postop topical therapy for the first month included combined steroid/antibiotic and combined acetazolamide/β-blocker eye drops. Follow up visits were scheduled at one week and than monthly for 6 months. We measured variations in foveal thickness (FT) at SD-OCT, changes in ETDRS-visual acuity (VA) and in intraocular pressure (IOP).
Results:Mean preop FT was 344μ (range 278-489), preop visual acuity was 18 letters (range 5-26) and mean IOP 17mmHg (range 14-19). Mean preop glicated haemoglobin (HbA1c) was 7.2% (range 6.2-9.8). no complications were registered during or after the surgical procedure. During follow up, mean FT decreased by 122μ (range 81-213) at 1W, 137μ (76-198) at M1, remained unchanged at M2/M3 and than at M4 the gain reduced to 56μ (12-109) to progressively return to preop values at M5 and M6 (final mean FT 356μ). Mean VA change was +5 letters at 1W (range -1/+13), +8 (range +2/+12) at 1M, +11/13 (range +1/+16) at M2-3-4-5, and +9 (range +3/+8) at M6. IOP remained <23mmHg in all patients (hypotensive eye drops maintained until M6 in 3 patients).
Conclusions:In this small case series, Dex-I avoided worsening of chronic DME after cataract extraction and also improved foveal thickness for up to 4-5 months. Dex-I appears to be a good surgical adjuvant in these cases, but larger studies are necessary to confirm these data
Strabismo verticale da ipertrofia del muscolo retto inferiore in corso di tireotossicosi esogena.
No full textFrammento premaculare di telino chirurgico: una possibile causa di deficit visivo post-operatorio
No full textPrevalenza, fattori di rischio e prevenzione della retinopatia diabetica dei pazienti affetti da diabete giovanile
No full text[no abstract available
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