117,401 research outputs found
Photodynamic therapy for retinal angiomatous proliferations and pigment epithelium detachment.
No full textPURPOSE: To evaluate results of photodynamic therapy (PDT) with verteporfin for subfoveal neovascular age-related macular degeneration (ARMD) with retinal angiomatous proliferation (RAP) and pigment epithelial detachment (PED).
DESIGN: Interventional case series.
METHODS: Thirteen eyes (11 stage 2 and 2 stage 3 RAP) underwent PDT. Best-corrected visual acuity (BCVA), fluorescein and indocyanine-green angiography were performed to evaluate the outcome.
RESULTS: After 13.5 +/- 2.5 months and 1.7 +/- 0.4 treatments, mean BCVA decreased from 20/73 to 20/174 (P = .04). Occlusion of RAP and flattening of PED was observed in three eyes, and persistence of PED in six. Two eyes deteriorated to disciform lesions, one developed hemorrhagic PED, and one evolved toward stage 3 RAP. Three eyes, with PED exceeding 50% of the entire lesion, developed retinal pigment epithelium tear.
CONCLUSIONS: PDT might prove effective for neovascular ARMD with RAP and small PED, whereas it might cause acute retinal pigment epithelium tear for RAP with PED exceeding 50% of the lesion
Fundus autofluorescence, optical coherence tomography and visual acuity in adult-onset foveomacular dystrophy.
No full textAIM: We investigated fundus autofluorescence (FA) patterns and tomographic retinal changes by means of optical coherence tomography (OCT 3) in adult-onset foveomacular vitelliform dystrophy (AOFVD) and their possible correlation with best-corrected visual acuity (BCVA).
METHODS: Eighteen eyes of 15 consecutive patients (mean age: 73.73 +/- 9.5 years) presented to our observation with a diagnosis of AOFVD underwent BCVA measurement, evaluation of FA distribution by means of a confocal laser scanning ophthalmoscope and OCT 3 tomography.
RESULTS: The mean BCVA was 20/40 (range: 20/20-20/100). The FA pattern was patchy in 9 eyes (50%), ring-like in 5 (27.7%), focal in 3 (16.6%) and linear in 1 (5.5%). No correlation between FA patterns and BCVA was found. OCT 3 showed accumulation of highly reflective material between the neurosensory retina and retinal pigment epithelium (RPE) in 12 eyes (66.6%) with an evident overlying photoreceptor layer (PRL). In 5 eyes the highly reflective material was built up between the neurosensory retina and RPE without evidence of PRL (27.7%). Only in 1 eye was the subretinal accumulation site not well defined (5.5%). The mean thickness of the deposit was 135.52 +/- 47.53 microm, while the residual neurosensory retina thickness was 103.94 +/- 24.21 microm. The relationship between BCVA and the thickness of the neurosensory retina over the lesion was not significant (p = 0.016, r = 0.33), while the correlation between BCVA and the material deposit thickness (p = 0.017, r = 0.12) was significant.
CONCLUSIONS: In AOFVD, FA presented different patterns, while OCT usually shows a well-defined material accumulation with a generally reduced neurosensory thickness between PRL and RPE. FA imaging and OCT are useful and safe for the diagnosis and follow-up of AOFVD.
(c) 2008 S. Karger AG, Basel
Analysis of morphologic and functional outcomes in macular edema due to central retinal vein occlusion treated with intravitreal dexamethasone implant
No full textPurpose. To analyze anatomic and functional retinal changes and their correlation after intravitreal dexamethasone implant (DEX implant) in patients with central retinal vein occlusion- (CRVO-) related macular edema (ME) using optical coherence tomography and microperimetry. Methods. Fifteen treatment-naïve patients with functional impairment due to CRVO-related ME were enrolled in this prospective interventional case series. Main outcomes were best-corrected visual acuity (BCVA), retinal sensitivity (RS), and central retinal thickness (CRT). Secondary outcomes were ellipsoid zone (EZ) status and fixation behaviour. All patients underwent DEX implant and were retreated according to predefined criteria. Data were prospectively recorded at baseline and at month 1, 3, 6, 9, and 12. Correlation between main outcomes was analyzed. Results. Fifteen eyes of 15 patients (9 men, 6 women; mean age 61.8 ± 10.9 years) were included. BCVA and CRT significantly improved at all follow-up visits, while RS significantly improved at 3, 6, 9, and 12 months. EZ status and fixation behaviour did not change significantly. Baseline CRT had a significant negative correlation with BCVA and RS at different follow-up visits (r=-0.52 to -0.63, p≤0.04; r=-0.52, p=0.04; resp.). At all time points, there was not a significant correlation between CRT and BCVA and RS, while RS and BCVA showed a significant correlation, increasing over time (r=-0.72 to -0.89; p<0.001). Conclusion. DEX implant led to a significant morphofunctional improvement. Baseline CRT is predictive of changes of functional outcomes whose correlation increases over time after treatment
25-Gauge Vitrectomy in Open Eye Injury with Retained Foreign Body
No full textPurpose. Ocular trauma with retained foreign body is an important cause of visual impairment in working-age population. Clinical status impacts on the timing and planning of surgery. In the last year small gauge vitrectomy has become safer and more efficient, extending the range of pathologies successfully treated. Aims. To evaluate the safety and outcomes in patients with open eye injury with retained foreign body that underwent early 25-gauge vitrectomy. Methods. In this retrospective, noncomparative, interventional case series, we performed 25-gauge vitrectomy on 10 patients affected by open globe injuries with retained foreign body, over 3 years. We analyzed age, wound site, foreign body characteristics, ocular lesions correlated, relative afferent pupillary defect, visual acuity, and intraocular pressure. Follow-up evaluations were performed at 1, 3, and 6 months. According to the clinical status we performed other procedures to manage ocular correlated lesions. Results. The median age of patients was 37 years. The foreign body median size was 3.5 mm (size range, 1 to 10 mm). 25-gauge vitrectomy was performed within 12 hours of trauma. Foreign body removal occurred via a clear corneal or scleral tunnel incision or linear pars plana scleral access. Visual acuity improved in all patients. Endophthalmitis was never reported. Only two cases reported postoperative ocular hypertension resolved within the follow-up. Retinal detachment recurred in one case only. Conclusions. 25-gauge vitrectomy could be considered as early approach to manage open globe injuries with a retained posterior segment foreign body in selected cases with good outcomes and low complication rate
One-year outcomes of 27-gauge versus 25-gauge pars plana vitrectomy for uncomplicated rhegmatogenous retinal detachment repair
No full textBackground: 27-gauge (27G) and 25-gauge (25G) transconjunctival sutureless vitrectomy (TSV) were considered equal about safety, effectiveness and vitrectomy time for the treatment of rhegmatogenous retinal detachment (RRD), although larger and long-term comparative studies are needed to confirm previous knowledge. Furthermore, a combined comparison of time duration of surgery and vitreous removal was never performed. Our purpose was to compare the safety and efficacy of 27G versus 25G TSV for the treatment of uncomplicated RRD over a 1-year follow-up. Methods: A 12-months single-center prospective, randomized, interventional study of 92 consecutive patients was performed. 46 patients underwent 27G TSV (Group 1) and 46 underwent 25G TSV (Group 2). Primary outcomes were primary and final reattachment rate, and final functional success (visual acuity ≥ 20/200, 1 LogMar). Secondary outcomes were the surgical and vitrectomy time. Complications were recorded. Results: All functional and morphologic data at baseline and at all follow-up time points up to 12 months after surgery were available for only 88 patients. Four patients in Group 1 dropped out of the study after surgery. There was no significant difference in baseline characteristics between the two groups. Primary and final reattachment rates were 90.5% and 100% in Group 1, and 95.6% and 100% in Group 2, respectively (p> .05, p> .05, respectively). Visual acuity improved from 1.5 ± 1.09 LogMar to 0.38 ± 0.55 LogMar in Group 1 (p< .001) and 1.2 ± 0.9 LogMar to 0.49 ± 0.53 LogMar in Group 2 (p< .001), without significant difference between the groups (p> .05). The surgical time was 73.2 ± 11.3 min with 27G TSV and 64.4 ± 9.5 min with 25G TSV (p = .0001). The vitrectomy time was 19.9 ± 3.8 min with 27G TSV and 20.8 ± 3.8 min with 25G TSV (p> .05). One single case of choroidal detachment occurred. Conclusions: Reattachment rates, functional success and vitrectomy time were comparable between 27G and 25G TSV for RRD. Surgical time was significantly longer using 27G vitrectomy
One-port vs. three-port diagnostic vitrectomy for posterior segment diseases of unknown origin
No full textPurpose: To compare the safety and the effectiveness of one-port vs. three-port diagnostic vitrectomy in undiagnosed cases of posterior segment inflammation.
Methods: We retrospectively collected data from 80 consecutive diagnostic vitrectomies performed using a one-port (n = 40) or a three-port approach (n = 40). Cases of suspected postoperative endophthalmitis were not included in the study. Several variables were compared among groups, including length of surgery, postoperative best-corrected visual acuity (BCVA), diagnostic success and surgical complications.
Results: The mean duration of surgery was shorter in the one-port group when compared to the three-port group (15 ± 8 min vs. 49 ± 30; p = 0.0001). The patients were observed for a mean follow-up of 19 months (range 1-84). In the one-port group, the mean BCVA improved from 1.31 ± 0.96 to 0.57 ± 0.59 logarithm of minimum resolution (LogMAR) (p = 0.0009). In the three-port group, BCVA improved from 0.98 ± 0.76 to 0.51 ± 0.76 LogMAR (p = 0.0005). The difference in mean postoperative BCVA between groups was not significative at the last follow-up. One-port vitrectomy yields to a final diagnosis in 80% of the cases, and three-port vitrectomy in 48%. Most of the one-port vitrectomies were carried out under topical anesthesia. After surgery, in both groups three eyes developed a retinal detachment.
Conclusions: In this pilot study, the one-port diagnostic vitrectomy has proven to be as effective and safe as the three-port approach, allowing a reduction in surgical times. One-port diagnostic vitrectomy might be considered as the first option for those cases where more complex surgical procedures are not needed
Intravitreal triamcinolone acetonide in refractory pseudophakic cystoid macular edema: functional and anatomic results.
No full textPURPOSE: To evaluate safety and efficacy of intravitreal triamcinolone acetonide (TAAC) injections in the treatment of refractory pseudophakic cystoid macular edema (CME).
METHODS: Seven eyes of six patients (age range: 50-74) with pseudophakic CME resistant to standard treatment received intravitreal injections of 4 mg of TAAC with all vehicle. Mean preinjection duration of CME was 18.3 months. A mean of 2.1+/-1.2 (range 1 to 4) treatments were performed in four eyes (57.1 %) when visual acuity deteriorated towards baseline levels. Visual acuity assessment, optical coherence tomography (OCT), and fluorescein angiography (FFA) were performed pre- and postoperatively to evaluate results of TAAC injections. Intraocular pressure (IOP) and complications related to treatment were assessed.
RESULTS: After 11.1+/-3.9 months, mean best-corrected visual acuity (BCVA) increased (p =0.019) from 20/132 to a best value of 20/38. Mean macular thickness decreased from 517.29+/-146.98 mm to a best value of 263.71+/-83.13 mm (p=0.0018). Area of fluorescein leakage decreased (p<0.0001) from 11.84+/-0.93 mm2 at baseline to a minimal value of 3.86+/-0.98 mm2. The anatomic and functional improvement appeared after 1 month from the intravitreal injection and persisted through at least 3 months of follow-up. At the end of follow-up BCVA, macular thickness, and area of fluorescein leakage did not differ from baseline. Four eyes (57.1 %) developed IOP values higher than 21 mmHg, controlled by topical treatment. Two patients developed an endophthalmitis-like reaction.
CONCLUSIONS: Intravitreal TAAC was relatively safe and effective in resistant cases of pseudophakic CME with a temporary beneficial effect on visual acuity and macular edema
Combined surgical ablation and intravitreal triamcinolone acetonide for retinal angiomatous proliferation.
No full textPURPOSE: Neovascular age-related macular degeneration (ARMD) with retinal angiomatous proliferation (RAP) has a poor natural history and the efficacy of any treatment has not yet been established. The authors describe a combined surgical treatment.
METHODS: A 76-year-old woman presented with a best-corrected visual acuity (BCVA) of 20/600 in the right eye and macula with stage 3 RAP as identified by fluorescein angiography (FA), indocyanine green angiography (ICGA), and optical coherence tomography (OCT). After a standard three-port pars plana core vitrectomy (PPV), endodiathermy of the arteriolar and venous feeder vessels of each lesion was performed, intraretinal RAP feeder vessels were cut with manual vertical intraocular scissors, and 0.1 mL of triamcinolone acetonide (TAAC) was injected intravitreally. At 1 and 4 weeks and at the sixth month, the patient underwent a complete eye examination, FA, ICGA, and OCT to assess outcomes and complications.
RESULTS: Six months later, BCVA was stable at 20/300, intraocular pressure was 15 mmHg, anterior segment and vitreous cavity were clear without evidence of TAAC granules, and retina was attached. FA and ICGA showed a complete occlusion of the RAP and absence of leakage or ischemia and OCT demonstrated decreased macular thickness with resolution of both intraretinal edema and pigment epithelium detachment, and the restoration of the normal macular profile. At the end of follow-up, the authors did not observe any ocular or systemic complication.
CONCLUSIONS: Surgical approach to RAP stage 3 with intravitreal injection of 4 mg of TAAC was safe and anatomically effective
Intravitreal bevacizumab for treatment-naïve subfoveal occult choroidal neovascularization in age-related macular degeneration.
No full textPURPOSE: This study aimed to evaluate the efficacy of multiple injections of intravitreal bevacizumab for treatment-naïve subfoveal occult choroidal neovascularization (CNV) in age-related macular degeneration (AMD).
METHODS: Twelve eyes of 12 patients (mean age 76 +/- 6 years) with mean best corrected visual acuity (BCVA) of 20/100 and occult subfoveal CNV at fluorescein angiography (FA), indocyanine-green (ICG) angiography and optical coherence tomography (OCT), showing intra- or subretinal fluid with or without retinal pigment epithelial detachment (PED), underwent multiple intravitreal injections (mean 2.4 +/- 0.7) of 1.25 mg (0.05 ml) bevacizumab. Visual acuity and OCT findings were assessed at the end of follow-up.
RESULTS: After a mean follow-up of 5.7 +/- 2 months, BCVA improved from 20/100 (range 20/50-20/303) to 20/60 (range 20/28-20/200) (p = 0.038). Five eyes (42%) increased BCVA by > or = 3 lines, six eyes (50%) increased BCVA by < 3 lines and one eye (8%) remained stable. Macular thickness decreased from 298 +/- 71 microm to 223 +/- 72 microm (p = 0.017). No ocular or systemic side-effects were observed.
CONCLUSIONS: Short-term results suggest that multiple intravitreal injections of 1.25 mg bevacizumab are well tolerated and associated with significant improvements in BCVA and decreased retinal thickness by OCT in most patients with treatment-naïve occult CNV. Further evaluation of intravitreal bevacizumab for the treatment of occult CNV is warranted
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