1,720,982 research outputs found
Terapia combinata nella gestione delle complicanze in dome-shaped macula: esperienza della clinica oculistica di Ancona
Full text linkObiettivo: valutare la variazione di spessore retinico maculare dopo trattamento combinato: fotodinamica (pdt) e laser giallo sotto soglia micropulsato nei pazienti con distacco sieroso del neuroepitelio (DNE) secondario a “dome shaped “refrattari a light fotodinamica(PDT), sicurezza ed efficacia di tali trattamenti.
materiali e metodi: pazienti con diagnosi di DNE secondaria a dome shaped macula trattati presso la Clinica Oculistica di Ancona. Tutti i pazienti sono stati sottoposti a visita oculistica ,retinografia , autofluorescenza retinica,fluorangiografia (fag), esame al verde indocianina(icga),sd-oct,EDI-oct.
11 occhi miopi di 11 pazienti 8 di sesso femminile e 3 maschile con un’età media di 48 anni già sottoposti, almeno nei 3 mesi antecedenti, a light PDT e scarsamente responsivi a tale terapia sono stati oggetto di studio. Tutti i pazienti sono stati sottoposti a light PDT ICGA-guidata e dopo 2 settimane ad una seduta di laser giallo micropulsato sottosoglia 577.
Risultati: alll’ultimo follow-up si mostravano uno spessore coroideale medio pari a 183.3μm (SD 75 .41μm) e uno spessore retinico foveale pari a 271.8μm (SD 64.19μm). Sono stati considerati responders i pazienti che mostravano una riduzione del DSNF > 30% rispetto al baseline. I responders al follow-up dei 6 mesi risultavano essere 5 occhi di 5 pazienti, con risoluzione del distacco sieroso in 2 occhi già rilevabile all’OCT eseguito alla visita di follow-up dei 3 mesi. Per quanto concerne l’acuità visiva in 6 occhi si è riscontrato un aumento di almeno 2 linee della BCVA, nessun peggioramento della BCVA né un aumento dello spessore retinico foveale è stato
osservato
Conclusioni:. Nel nostro studio abbiamo utilizzato la “combo therapy” ,PDT con effetto angio- occlusivo coroideale e laser giallo 577 micropulsato sottosoglia volto a stimolare l’attività di
pompa dell’EPR i quali sembrano avere un effetto sinergico su due vie eziopatogenetiche alla base del distacco sieroso in dome shaped macula. Tale approccio si è rivelato sicuro nei pazienti presi in esame in quanto nessun paziente ha mostrato un peggioramento della BCVA né un aumento del DSNF né comparsa di neovascolarizzazione coroideale.Purpose: the aim of the present study is to report on the results obtained in a pilot study with a
combined treatment of half-fluence half-dose photodynamic therapy (PDT) and subthreshold 577 nm micropulse laser treatment (STLT) for SRD(sub retinal detachment) related to DSM(dome shaped macula) poorly responsive to previous LIGHT-PDT: Efficacy and Safety.
Methods : 11 Patients (8 females and 3 males) referred to the Department of Ophthalmology of
University Politecnica delle Marche with the diagnosis of symptomatic DSM were prospectively enrolled in the study. Inclusion criteria included the diagnosis of symptomatic DSM, associated with SRD; DSM was regarded as symptomatic whenever associated with visual acuity deterioration and distortion. DSM definition was based on the OCT identification of an inward bulge inside the chorioretinal posterior concavity of the macular area, according to Gaucher’s description. Patients who had undergone any previous treatment in the last 3 months or were affected by any other ocular disease were excluded from the study.Each patient underwent a complete ophthalmologic examination, including best-corrected visual acuity(BCVA) on standard Early Treatment Diabetic
Retinopathy Study (ETDRS) charts, blue-light fundus autofluorescence, fluorescein angiography (
FA), indocyanine green angiography (ICGA), OCT and OCT Angiography (OCTA). The patients were regularly scheduled. Each patient was first treated with half-fluence half-dose photodynamic therapy; after two weeks subthreshold 577 nm micropulse laser treatment was performed.
Results :Overall, 11 eyes of 11 patients were included in the study. Subfoveal choroidal
thickness was 183μm(SD 75.41μm ) and mean Central foveal thickness was 271.8μm (SD 64.19μm) to the last follow-up.Half-fluence half-dose photodynamic therapy and subthreshold micropulse laser treatment were uneventfully performed in all the cases, and were addressed to the ICGA- detected hyperfluorescent area. Serous retinal detachment diminished in all cases, and 5 eyes registered complete resolution at the end of the 6 month follow-up. No case showed enlargement of atrophic alterations, as assessed on blue-light fundus autofluorescence, or development of
choroidal neovascularization at the end of the follow-up.Conclusions :a multimodal imaging
evaluation is mandatory in order to better evaluate the patient with dome-shaped macula and its complications and to choose the best treatment in each case. To date, there is no validated therapy leading to DSM-related SRD resolution. Many different therapeutic approaches to SRD secondary to DSM have been attempted, with variable results.A combined treatment PDT and subthreshold 577 nm micropulse laser, with different therapeutic targets, has not been evaluated yet. In our experience, “combo therapy” can be considered an effective and safe therapy in the treatment of SRD secondary to DSM
Latest diagnostic possibilities in unsolved uveitis, suspicious for malignancy
No full textVitreo Retinal Lymphomas (VRL) are rare malignancies that display a wide spectrum of clinical patterns. Almost all VRL are non-Hodgkin's lymphomas, B-cell sub-type. Since the clinical presentation of VRL might be confused with a non-responder eye inflammation, VRL are also known as ‘masquerade syndromes’. On the basis of the potential severity of such disease, vitreous biopsy might be indicated for all the cases which can be potential VRL. Since vitreous biopsy is not diagnostic in all cases, further techniques can provide further essential data. Immunohistochemistry can be used for identifying important Cluster of Differentiation (CD) such as CD45 for leukocytes, CD20, CD79a, PAX-5 for B-cells, CD45RO for T-cells, and CD68 for macrophages. Furthermore, clonality can be established by using antibodies targeting the kappa and lambda light chains. Polymerase chain reaction gene rearrangement studies can identify monoclonality of the heavy chain variable (V), diversity (D), and joining (J) immunoglobulin gene segments. Recently, measurement of Interleukin (IL)-6 and IL-10 in aqueous and/or vitreous fluid can lead to the correct diagnosis, even though an elevated IL-10/IL-6 ratio is not specific for VRL
PUK from diagnosis to treatment
No full textPurpose To describe the treatment strategy in the management of peripheral ulcerative keratitis (PUK). Methods The current literature is reviewed and the experience of a tertiary referral centre is reported. Results Peripheral ulcerative keratitis (PUK) is rare but severe sight-threatening disease affecting the peripheral cornea. The causes of PUK are multiple and insidious. Infectious diseases, both secondary to systemic rather than purely local diseases, and non-infectious diseases can be identified as a cause of PUK. Non-infectious systemic diseases, which can induce deposition of immune complexes in the cornea and, hence, lead to corneal ulcers, include peripheral vasculitides and inflammatory diseases of collagen, such as Rheumathoid arthritis, Wegener Granulomatosis and Systemic Lupus Erythematosus. Mooren’s ulcer is one of the most characteristic PUKs: often unilateral and self-limiting in the elderly, sometimes bilateral and relentless in young patients, may cause severe visual impairment following extensive corneal destruction. Immunosuppressive therapy has been demonstrated effective in improving the prognosis of progressive cases, although a certain number of patients remain refractory to treatment. Resolution of refractory cases of Mooren’s ulcer with new systemic biologic agents, such as campath-1H and anti-tumor necrosis factor (TNF)-α, has been reported. Conclusion PUK can be a severe disease, leading to significant visual impairment. Although no guideline is provided, the current medical literature can give the basis for a successful treatment strategy. The detection of the infectious trigger can lead to the correct, specific therapy. Non-infectious diseases are basically treated with the combination of steroids with immunesuppresives and, when necessary, biologics
ICGA: why I think that it is still relevant today
No full textPurpose To discuss the role of indocyanine green angiography (ICGA) in ophthalmology and the breaking news on this methodology. Methods The current literature is reviewed and the experience of a tertiary referral centre is reported. Results ICGA is an essential method used to explore the posterior pole in several sight-threatening diseases. Although this technique has been proven effective in detecting anomalies which were unappreciable with the traditional methods, there is still reluctancy in making use of such method. In the recent past months the topic of ICGA has again moved to the forefront of angiographic actuality with two editorial articles in largely diffused ophthalmological journals. The scientific dignity of ICGA is discussed and advocated by the western World, mostly by highly specialized ophthalmic centres in Europe. We will discuss the state of the art of the clinical use and the evidences in the medical literature of the ICGA. Conclusion ICGA is a validated method for the evaluation of the posterior pole, which can provide essential informations for the clinical assessment and management of several diseases. Albeit the validity of such technique has been proven, there is still some unjustified reluctancy in accepting its pivotal role in ophthalmology: the evidences suggest its use for every single disease that can affect the choroid and cannot be appreciated by the traditional tests
Signs and symptoms of uveitis
No full textUveitis can be a sight-threatening disease. Inflammation of uveal tract can be divided into: anterior, intermediate, posterior, and panuveitis. Blurred vision, ocular pain, photophobia and floaters are some of the symptoms complained by those who are affected by uveitis. The onset of uveitis can be either acute or insidious, bilateral rather than unilateral. Posterior uveitis is usually associated with vitritis. Anterior chamber cells and flare should be graded according to standardized uveitis nomenclature (SUN) working group. Binocular indirect ophthalmoscopy (BIO) score is used to evaluate the severity of vitritis. Vitreous changes may comprehend: vitreous hemorrhage, vitreous strands, and vitreous traction. A further classification of posterior uveitis depends on the primary site of inflammation, which can identify: retinitis, choroiditis, retinochoroiditis, and chorioretinitis. Posterior pole uveal involvement can be: focal, multifocal, and placoid. Retinal vasculitis can be present. Uveitis might be complicated by anterior and posterior synechiae, which can lead to uveitic glaucoma, cystoid macular oedema, retinal and choroidal neovascularizations, and retinal ischemia
TB or not TB...or what else?!
No full textPurpose To present the clinical pattern of a complex case with atypical clinical features and controversial laboratory results. Methods Case report Results Infectious diseases represent always a challenge both for the clinical presentation and the management. The advent of new laboratory tests has lead to diagnosis of certain diseases which were undetectable in the recent past. These techniques have changed the way of treating several diseases, even though the gold standard still represents a chimera. Infact, it is not uncommon to face diseases which present themselves atypically and with laboratory tests which can be controversial. We want to present an anecdotal case that was defined a "killer case" in our tertiary referral centre. Conclusion The clinical presentation and the laboratory results of certain diseases can often be a tricky challenge even for highly specialized centres. The scientific "methodic doubt" is mandatory in cases which do not present typical clinical features
From time domain to high resolution and angio-OCT: an historical perspective
No full textOptical coherence tomography (OCT) is a non-invasive tool that allows in vivo imaging of almost all the structures of the eye. It was introduced into the clinical practice more than twenty years ago. The advances in OCT technology are mainly based on ultra high-resolution, adaptive optics, eye-tracking, and changes in signal detection. Regarding this last aspect, the technology has evolved from time-domain (TD) to spectral-domain (SD) detection, providing a higher definition of the analyzed structures. Today, SD OCT has become a part of the routine practice. Apart from its diagnostic value, OCT has allowed an objective assessment of treatment response. In addition, it has provided predictive value for visual recovery and prognosis of several diseases. Recently, SD-OCT has given to the ophthalmic researchers a renewed enthusiasm: a special processing algorithm has been developed for high-speed OCT devices. This OCT technique, known as OCT angiography, can produce images of capillary-level blood flow in the retina and choroid. OCT technology continues to develop further and this will provide new insights for the pathogenesis of several eye diseases
Signs and symptoms of uveitis
No full textInflammation of uveal tract can be divided into: anterior, intermediate, posterior, and panuveitis. Uveitis can be a sight-threatening disease. The commonest ocular symptoms are: blurred vision, ocular pain, photophobia and floaters, depending on the type of uveitis. The onset of uveitis can be either acute or insidious, involving one or both eyes. Posterior uveitis is usually associated with vitritis. Anterior chamber cells and flare should be graded according to standardized uveitis nomenclature (SUN) working group. Binocular indirect ophthalmoscopy (BIO) score is used to grade vitreous involvement. Vitreous changes may comprehend: vitreous hemorrhage, vitreous strands, and vitreous traction. A further classification of posterior uveitis depends on the primary site of inflammation, which can identify: retinitis, choroiditis, retinochoroiditis, and chorioretinitis. Posterior pole uveal involvement can be: focal, multifocal, and placoid. Retinal vasculitis can be associated with several sub-types of posterior uveitis. Uveitis can present several complications such as, anterior and posterior synechiae, which can lead to uveitic glaucoma, cystoid macular oedema, retinal and choroidal neovascularizations, and retinal ischemia
Primary vitreo-retinal lymphoma, an increasing pseudo-uveitis to be taken into account
No full textThe clinical assessment of most of vitreo-retinal (VR) inflammations is often challenging: the clinical picture of such diseases can be overlapping and, despite the advances in medical technologies, the routine diagnostic tools might not provide conclusive data. The term ‘Masquerade Syndrome’ was first used in 1967 to describe a case of conjunctival carcinoma that mimicked a chronic conjunctivitis. Masquerade syndromes are disorders that occur with intraocular inflammation and are often misdiagnosed as a chronic resistant, non-infectious uveitis. Very often mesquerade syndrome is a synonymous of intraocular lymphoma which can present insidious clinical pictures, which are very often confused. At this point, the possibility to take a vitreous tap via pars plana can help the ocular immunologist to differentiate between different sub-sets of infectious diseases and masquerade syndrome. The possibility to test the interleukines’ (IL) ratio and to analyze the cytology represents a great scientific advance. Once there is the evidence of a masquarade syndrome, the urgent referral to the hematologist is mandatory, in order to start an appropriate and prompt chemotherapy, both local and systemic
Ocular immunology and vitreoretinal surgery “face to face"
No full textThe clinical assessment of most of vitreo-retinal (VR) inflammations is often challenging: the clinical picture of such diseases can be overlapping and, despite the advances in medical technologies, the diagnostic tools might not provide data which can be conclusive. At this point, the possibility to take a vitreous tap via pars plana can help the ocular immunologist to differentiate between different sub-sets of infectious diseases and masquerade syndrome. The term "Masquerade Syndrome" was first used in 1967 to describe a case of conjunctival carcinoma that manifested as chronic conjunctivitis. Masquerade syndromes are disorders that occur with intraocular inflammation and are often misdiagnosed as a chronic idiopathic uveitis. Very often mesquerade syndrome is a synonymous of intraocular lymphoma which can present insidious clinical pictures, which are very often confused. The possibility to test the interleukines' ratio and to analyze the cytology represents a great scientific advance. A clearer role of VR surgery is played for all the complications of uveitis, such as uveitic retinal detachment, inflammatory macular pucker and dense persistent vitritis. VR surgery can warrant an important contribution to the clinical outcome
- …
