To report a case of idiopathic macular hole, with vitreoretinal traction confirmed by optical coh... more To report a case of idiopathic macular hole, with vitreoretinal traction confirmed by optical coherence tomography that was successfully treated by a single intravitreous perfluoropropane (C(3)F(8)) gas bubble injection. Case report. A 65-year-old patient with idiopathic macular hole (stage 2, one eye) received an intravitreous gas injection and was prospectively followed with optical coherence tomography. A complete posterior vitreous detachment was achieved within 6 weeks after gas injection. Visual acuity improved from 20/80 to 20/25 by 10 months of follow-up. Optical coherence tomography disclosed vitreoretinal traction release and macular hole closure. No complications were related to the procedure. This simple procedure can assist a complete posterior vitreous detachment with relief of the hyaloid-foveolar traction, facilitating macular hole closure.
Thirty-nine eyes with uveitis from various causes, and complicated by cataract and vitreous opaci... more Thirty-nine eyes with uveitis from various causes, and complicated by cataract and vitreous opacification, underwent pars plana lensectomy and vitrectomy by ultrasonic fragmentation. Anatomical results were excellent, with clearing of all lens and vitreous opacities in all eyes. Visual results showed that there was no exacerbation and no recurrence of uveitis. Visual results depended mainly on the presence of previous damage of the uveitis to the retina and optic nerve. Visual results did not depend on the presence of uveitis activity at the time of the surgery. Complications that occurred were cystoid macular edema, which was present in 17.94% of the eyes and diagnosed in some eyes at the surgery, retinal detachment in one eye (2.56%), sterile hypopyon in one eye (2.56%), and ultrasonic lesion of the retina in one eye (2.56%). Visions of 20/20 to 20/40 were obtained in 23% of the eyes, 20.5% had vision between 20/50 and 20/80, and 56.4% had vision of 20/100 or less. The good results justify the surgical intervention in cases of cataracts associated with uveitis. Pars plana lensectomy and vitrectomy appears to be the procedure of choice in removal of cataracts secondary to uveitis.
We report a case of a 19-year-old woman presenting bilateral neurosensorial hearing loss, mental ... more We report a case of a 19-year-old woman presenting bilateral neurosensorial hearing loss, mental abnormalities, and loss of visual field in the left eye. Visual acuity was 20/20 in OD and 20/25 in OS. Patient was examined systemically. Audiometry showed sensorineural hearing loss in both ears. The magnetic resonance imaging (MRI) of brain revealed multiple small lesions in the white matter in both cerebral hemispheres and at the corpus callosum. Fundoscopy showed bilateral normal optic disc and sheathing of the arterioles in the middle periphery of OD. Retinal edema and cotton-wool spots were observed. Fluorescein angiography showed bilateral peripheral occlusive arterial vasculopathy. The patient was diagnosed with Susac syndrome and treated with quetiapine fumarate, flunitrazepam, and prednisone, which resulted in stabile outcome. This case shows that a high index of suspicion leading to early recognition and treatment is important to avoid irreversible damage.
To evaluate visual acuity and anatomical outcomes of choroidal neovascularization (CNV) associate... more To evaluate visual acuity and anatomical outcomes of choroidal neovascularization (CNV) associated with angioid streaks after treatment with intravitreal bevacizumab injections. Best-corrected visual acuity, optical coherence tomography measurements (OCT), fluorescein and indocyanine green angiography, and ophthalmoscope examination at baseline and at each follow-up visit were performed. Five patients with CNV associated with angioid streaks were treated with injections of intravitreal bevacizumab (1.25 mg/0.05 mL). Re-treatment was recommended with symptomatic lesions, new subretinal hemorrhages, leakage on fluorescein and indocyanine green angiography, and/or fluid documented by OCT. Follow-up ranged between 18 and 32 months. All eyes showed an improvement of visual acuity and were treated with at least four injections of intravitreal bevacizumab. Reduction of the leakage shown by fluorescein angiography and OCT was noted in all patients. Intravitreal bevacizumab appears to be effective in stabilizing and recovering visual acuity in eyes with CNV associated with angioid streaks. Patients with early symptoms might benefit more.
Purpose: To evaluate the agreement between optical coherence tomography (OCT) and fundus fluoresc... more Purpose: To evaluate the agreement between optical coherence tomography (OCT) and fundus fluorescein angiography (FFA) regarding the detection of cystoid macular edema (CME) following cataract surgery. Methods: Retrospective comparative observational series of 25 eyes with suspected CME. Patients with low visual acuity and alterations in fundus biomicros- copy after cataract surgery underwent OCT scanning followed by FFA on the same
To investigate the effect of indocyanine green-mediated photothrombosis on choroidal neovasculari... more To investigate the effect of indocyanine green-mediated photothrombosis on choroidal neovascularization secondary to angioid streaks. Six eyes of 5 patients with an average age of 70 years were diagnosed to have subfoveal choroidal neovascularization secondary to angioid streaks. Therapy was indicated if choroidal neovascularization was considered to be active, according to evidence of fluorescein leakage on angiograms, as well as presence of intra- or subretinal fluid on optical coherence tomography. Patients received photothrombosis at baseline with retreatment as necessary at 3, 6 and 9 months follow-up. Fluorescein leakage was assessed at 3, 6 and 9 months, along with foveal thickness measured by optical coherence tomography. Indocyanine green angiography was performed initially and whenever retreatment was considered. Retreatment was performed whenever there was evidence of increased leakage on fluorescein angiograms at follow-up visits. The mean follow-up was 13.3 months. All eyes had at least 12 months follow-up. Two eyes underwent retreatment. Three eyes had visual acuity improvement and three eyes had stabilization. All patients showed less fluorescein leakage on final angiograms and reduced foveal thickness upon optical coherence tomography measurement. Photothrombosis is a feasible procedure for choroidal neovascularization secondary to angioid streaks. Lesion analysis showed anatomical improvement in most cases in this series. Further studies are warranted to evaluate long-term results of this treatment.
Postoperative CME remains a well-recognized complication following cataract surgery. It is the mo... more Postoperative CME remains a well-recognized complication following cataract surgery. It is the most common cause of decreased vision in patients following cataract surgery with or without the implantation of an intraocular lens (3) . CME more often is associated with ...
To report a series of patients with Stage II macular hole (MH) treated by gas-assisted posterior ... more To report a series of patients with Stage II macular hole (MH) treated by gas-assisted posterior vitreous detachment (GAPVD). Interventional case series. Six patients (six eyes) with Stage II MH were submitted to a 0.4 ml perfluoropropane (C(3)F(8)) intravitreal injection. Comprehensive ophthalmic examination including best-corrected visual acuity, fundus photography, and optical coherence tomography (OCT) was performed at baseline and one, three, and six months after the procedure. Preoperative OCT revealed Stage II MH in all cases. In five cases, improvement in visual acuity and closure of the macular hole on OCT was observed at one, three, and six months after GAPVD. In one case, although vitreofoveal traction was released, MH closure was not achieved; a full-thickness retinal defect persisted and final visual acuity was 20/100. GAPVD may be a viable alternative treatment for Stage II MH.
To report a case of idiopathic macular hole, with vitreoretinal traction confirmed by optical coh... more To report a case of idiopathic macular hole, with vitreoretinal traction confirmed by optical coherence tomography that was successfully treated by a single intravitreous perfluoropropane (C(3)F(8)) gas bubble injection. Case report. A 65-year-old patient with idiopathic macular hole (stage 2, one eye) received an intravitreous gas injection and was prospectively followed with optical coherence tomography. A complete posterior vitreous detachment was achieved within 6 weeks after gas injection. Visual acuity improved from 20/80 to 20/25 by 10 months of follow-up. Optical coherence tomography disclosed vitreoretinal traction release and macular hole closure. No complications were related to the procedure. This simple procedure can assist a complete posterior vitreous detachment with relief of the hyaloid-foveolar traction, facilitating macular hole closure.
Thirty-nine eyes with uveitis from various causes, and complicated by cataract and vitreous opaci... more Thirty-nine eyes with uveitis from various causes, and complicated by cataract and vitreous opacification, underwent pars plana lensectomy and vitrectomy by ultrasonic fragmentation. Anatomical results were excellent, with clearing of all lens and vitreous opacities in all eyes. Visual results showed that there was no exacerbation and no recurrence of uveitis. Visual results depended mainly on the presence of previous damage of the uveitis to the retina and optic nerve. Visual results did not depend on the presence of uveitis activity at the time of the surgery. Complications that occurred were cystoid macular edema, which was present in 17.94% of the eyes and diagnosed in some eyes at the surgery, retinal detachment in one eye (2.56%), sterile hypopyon in one eye (2.56%), and ultrasonic lesion of the retina in one eye (2.56%). Visions of 20/20 to 20/40 were obtained in 23% of the eyes, 20.5% had vision between 20/50 and 20/80, and 56.4% had vision of 20/100 or less. The good results justify the surgical intervention in cases of cataracts associated with uveitis. Pars plana lensectomy and vitrectomy appears to be the procedure of choice in removal of cataracts secondary to uveitis.
We report a case of a 19-year-old woman presenting bilateral neurosensorial hearing loss, mental ... more We report a case of a 19-year-old woman presenting bilateral neurosensorial hearing loss, mental abnormalities, and loss of visual field in the left eye. Visual acuity was 20/20 in OD and 20/25 in OS. Patient was examined systemically. Audiometry showed sensorineural hearing loss in both ears. The magnetic resonance imaging (MRI) of brain revealed multiple small lesions in the white matter in both cerebral hemispheres and at the corpus callosum. Fundoscopy showed bilateral normal optic disc and sheathing of the arterioles in the middle periphery of OD. Retinal edema and cotton-wool spots were observed. Fluorescein angiography showed bilateral peripheral occlusive arterial vasculopathy. The patient was diagnosed with Susac syndrome and treated with quetiapine fumarate, flunitrazepam, and prednisone, which resulted in stabile outcome. This case shows that a high index of suspicion leading to early recognition and treatment is important to avoid irreversible damage.
To evaluate visual acuity and anatomical outcomes of choroidal neovascularization (CNV) associate... more To evaluate visual acuity and anatomical outcomes of choroidal neovascularization (CNV) associated with angioid streaks after treatment with intravitreal bevacizumab injections. Best-corrected visual acuity, optical coherence tomography measurements (OCT), fluorescein and indocyanine green angiography, and ophthalmoscope examination at baseline and at each follow-up visit were performed. Five patients with CNV associated with angioid streaks were treated with injections of intravitreal bevacizumab (1.25 mg/0.05 mL). Re-treatment was recommended with symptomatic lesions, new subretinal hemorrhages, leakage on fluorescein and indocyanine green angiography, and/or fluid documented by OCT. Follow-up ranged between 18 and 32 months. All eyes showed an improvement of visual acuity and were treated with at least four injections of intravitreal bevacizumab. Reduction of the leakage shown by fluorescein angiography and OCT was noted in all patients. Intravitreal bevacizumab appears to be effective in stabilizing and recovering visual acuity in eyes with CNV associated with angioid streaks. Patients with early symptoms might benefit more.
Purpose: To evaluate the agreement between optical coherence tomography (OCT) and fundus fluoresc... more Purpose: To evaluate the agreement between optical coherence tomography (OCT) and fundus fluorescein angiography (FFA) regarding the detection of cystoid macular edema (CME) following cataract surgery. Methods: Retrospective comparative observational series of 25 eyes with suspected CME. Patients with low visual acuity and alterations in fundus biomicros- copy after cataract surgery underwent OCT scanning followed by FFA on the same
To investigate the effect of indocyanine green-mediated photothrombosis on choroidal neovasculari... more To investigate the effect of indocyanine green-mediated photothrombosis on choroidal neovascularization secondary to angioid streaks. Six eyes of 5 patients with an average age of 70 years were diagnosed to have subfoveal choroidal neovascularization secondary to angioid streaks. Therapy was indicated if choroidal neovascularization was considered to be active, according to evidence of fluorescein leakage on angiograms, as well as presence of intra- or subretinal fluid on optical coherence tomography. Patients received photothrombosis at baseline with retreatment as necessary at 3, 6 and 9 months follow-up. Fluorescein leakage was assessed at 3, 6 and 9 months, along with foveal thickness measured by optical coherence tomography. Indocyanine green angiography was performed initially and whenever retreatment was considered. Retreatment was performed whenever there was evidence of increased leakage on fluorescein angiograms at follow-up visits. The mean follow-up was 13.3 months. All eyes had at least 12 months follow-up. Two eyes underwent retreatment. Three eyes had visual acuity improvement and three eyes had stabilization. All patients showed less fluorescein leakage on final angiograms and reduced foveal thickness upon optical coherence tomography measurement. Photothrombosis is a feasible procedure for choroidal neovascularization secondary to angioid streaks. Lesion analysis showed anatomical improvement in most cases in this series. Further studies are warranted to evaluate long-term results of this treatment.
Postoperative CME remains a well-recognized complication following cataract surgery. It is the mo... more Postoperative CME remains a well-recognized complication following cataract surgery. It is the most common cause of decreased vision in patients following cataract surgery with or without the implantation of an intraocular lens (3) . CME more often is associated with ...
To report a series of patients with Stage II macular hole (MH) treated by gas-assisted posterior ... more To report a series of patients with Stage II macular hole (MH) treated by gas-assisted posterior vitreous detachment (GAPVD). Interventional case series. Six patients (six eyes) with Stage II MH were submitted to a 0.4 ml perfluoropropane (C(3)F(8)) intravitreal injection. Comprehensive ophthalmic examination including best-corrected visual acuity, fundus photography, and optical coherence tomography (OCT) was performed at baseline and one, three, and six months after the procedure. Preoperative OCT revealed Stage II MH in all cases. In five cases, improvement in visual acuity and closure of the macular hole on OCT was observed at one, three, and six months after GAPVD. In one case, although vitreofoveal traction was released, MH closure was not achieved; a full-thickness retinal defect persisted and final visual acuity was 20/100. GAPVD may be a viable alternative treatment for Stage II MH.
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