David Leonardo Cruvinel Isaac

Prognostic Factors in Open Globe Injuries

Purposes: To evaluate the main factors related to visual outcome after open globe injuries (excluding intraocular foreign bodies). Methods: Retrospective study analyzing consecutive ocular lacerations, primarily repaired in this institution, between January 1993 and January 2000. Of the 364 cases, 283 (77.75%) lacerations were statistically analyzed, correlating the preoperative variables with the postoperative visual acuity (VA). Excluded from this study were all patients with less than 6 months of follow-up, previous ocular surgery, unreliable information on VA, intraocular foreign bodies and endophthalmitis. When a bilateral injury was detected, only 1 eye was randomly chosen. Results: It was observed, after statistical analysis (multivariate analysis), that the most important factors related to postoperative poor VA (less than 20/100) were: the length of the laceration, the elapsed time between the injury and the surgery and the presence or absence of vitreous loss, cataract (lens damage), hyphema, laceration posterior to rectus muscle insertion and retinal detachment. Conclusion: With this study, it was possible to point out the most important factors related to visual prognosis in open globe injuries. The results found are similar to results previously reported.

Diabetic retinopathy and OCT angiography: clinical findings and future perspectives

In diabetic retinopathy (DR), macular involvement can present as either macular edema or ischemia. Fluorescein angiography remains the gold standard in the evaluation of retinal vascular perfusion and diagnosis of macular ischemia. However, it is a costly, time-consuming technique, it requires venipuncture, and reports of anaphylaxis and death related to fluorescein injections have been documented, despite their rarity. Optical coherence tomography (OCT) provides a fast and non-invasive method to assess retinal structures at a microscopic level. OCT angiography permits the noninvasive study of retinal and choroid circulation via motion contrast imaging. Split-spectrum amplitude decorrelation angiography combined with OCT angiography has furthered the understanding of retinal and choroidal vascular diseases, allowing the evaluation of retinal microvasculature and identification of subsequent disorders, including DR. Previous studies using OCT angiography have demonstrated that it may demonstrate DR findings such as microaneurysms, arteriolar wall staining, retinal neovascularization, and intraretinal microvascular abnormalities. The purpose of this article is to describe and discuss different concepts regarding OCT angiography, as well as its role in the diagnosis of DR and maculopathy.

Intravitreal bevacizumab combined with infliximab in the treatment of choroidal neovascularization secondary to age-related macular degeneration: case report series

PURPOSE To evaluate the feasibility of the combined use of bevacizumab (Avastin®) and combined with infliximab (Remicade®) in the treatment of naive choroidal neovascularization due to age-related macular degeneration eyes. METHODS Intravitreal injections of bevacizumab combined with infliximab in 6 neovascular age-related macular degeneration eyes. All patients underwent complete ophthalmologic examination on the initial visit and at days 1, 30, 60, 90, 120, 150 and 180 following the first injection. Optical coherence tomography and fluorescein angiography were performed during at initial visit and monthly during the 6 months follow-up period. Electroretinography was performed before and 30 days after initial injection, in order to evaluate retinal toxicity induced by such treatment. RESULTS Thirty days after the first injection, 5 eyes (83%) shown decrease in macular thickness. No change was seen in electroretinogram in any eyes compared to initially performed electroretinogram. All phakic eyes developed cataract. One patient developed vitritis and was submitted to medical treatment successfully. At the end of the 6 months follow-up period, 4 patients showed significant improvement in the exudative process of choroidal neovascularization. One eye had mild persistent submacular fluid without active choroidal neovascularization, and another eye had persistent amount of intraretinal fluid due to active choroidal neovascularization. CONCLUSION The combined use of bevacizumab with infliximab in eyes with neovascular age-related macular degeneration was effective in reducing leakage and improving the macular thickness. However, it is not possible to assert that the results were related to synergic effects of the combination therapy. A controlled study with more cases is necessary to precisely define the complication rates; however the dosage and/or association of drugs studied in this research should not be recommended in clinical practice due to cataract as well as inflammatory reaction.

Diabetic Macular Ischemia Diagnosis: Comparison between Optical Coherence Tomography Angiography and Fluorescein Angiography.

Purpose. To compare fluorescein angiography (FA) and optical coherence tomography angiography (OCTA) images of foveal avascular zone (FAZ) in patients with diabetic retinopathy (DR) with and without diabetic macular ischemia (DMI). Methods. The Wilcoxon signed-rank test was used to compare area measurements and p values of <0.05 were considered statistically significant. FA and OCTA images were independently graded by 2 observers that reached agreement regarding quantitative DMI according established protocols. The ischemic area was divided into “large” macular ischemia (superior to 0.32 mm2) and “small” (inferior to 0.32 mm2) groups. Quantitative analyses of the FAZ were performed using custom software. Results. Thirty-four eyes from 34 diabetic patients were enrolled. Subjects with DMI presented a mean area on FA and OCTA of 0.68 ± 0.53 mm2 and 0.58 ± 0.35 mm2, respectively (p = 0.1374). Patients without DMI presented a mean area on FA and OCTA of 0.19 ± 0.67 mm2 and 0.20 ± 0.79 mm2, respectively (p = 0.9594). The ICC for the FAZ measurements between the 2 observers on FA and OCTA was 0.96 and 0.92, respectively. Conclusion. OCTA represents a novel technique for the diagnosis of DMI and it may become an alternative to FA for this purpose.

Importância da ultra-sonografia ocular na avaliação pré-operatória de pacientes com catarata total

With the new techniques of cataract surgery visual success has increased and it became necessary to foresee undesirable postoperative results regarding visual acuity. PURPOSE: To verify the role of ocular ultrasonography in the preoperative evaluation of patients with mature cataract searching for pos terior segment pathologies that may affect surgical results, their prevalence and the main associated risk factors. METHODS: A retrospective study was performed analyzing records of 262 patients indicated for ocular ultrasonography because the presence of mature cataract, thus preventing fundoscopic evaluation of the posterior segment. It was also tried to associate the presence of those changes with sex, age, race, history of ocular trauma, systemic and ocular diseases and the presence of cataract in the contralateral eye. RESULTS: Ecographic changes were found in 24.8% of the examinations performed between 1996 and 2001, of which retinal detachment and vitreous condensations were the most common, with 9.9% of the findings for each. CONCLUSIONS: Among the risk factors pointed out as predisposing to findings in ocular ultrasonography, uveitis was the only statistically significant element. It was not possible to correlate positively the described posterior segment pathology to ocular trauma using obtained data.

Eficácia na utilização de córneas no transplante penetrante

PURPOSES: 1) To verify the impact of the creation of the Single Technical Record (STR) at the University of Campinas (Unicamp) Hospital das Clinicas, on the preservation period of corneas which were used in elective penetrating keratoplasties, and 2) to compare the primary failure incidence in cornea penetrating keratoplasties regarding the periods before and after the creation of STR. METHODS: A retrospective study was conducted at the Unicamp Hospital, which evaluated 15 consecutive cornea penetrating keratoplasties between January 1st and April 30th, 2000 and 24 consecutive penetrating keratoplasties between May 1st and September 20th of the same year (corneas under the control of the STR), totaling 39 keratoplasties. RESULTS: The mean time between cornea preparation and transplantation was 3.8 days (±1.78) in the period before STR creation, and 6.0 days (±2.97) after STR creation, representing a 36.7% increase in the preservation time. There was a statistically significant difference (p=0.02) between the two groups. No corneal primary failure was observed among the 39 transplanted patients in both groups. CONCLUSION: Based on the results of this study, it can be concluded that this new concept of the State Transplantation System has caused a statistically significant increase in the conservation period of corneas, which may reduce the period of a clear transplant due to an increased loss of endothelial cells, as well as increase the primary failure incidence or result in a high number of corneas that cannot be used due to having exceeded the preservation time recommended by the literature.

Comparação da eficácia da ropivacaína 1% quando associada ou não à hialuronidase na anestesia peribulbar para cirurgia de catarata

Purpose: To evaluate the onset time and quality of peribulbar anesthesia with 1% ropivacaine associated or not with hyaluronidase 100 tru/ml for cataract extraction. Methods: Prospective, randomized, double-blind and controlled study including fifty-seven patients, scheduled to undergo peribulbar anesthesia for cataract extraction, allocated to two groups. Group C: 1% ropivacaine with addition of 100 tru/ml hyaluronidase, and Group S 1% ropivacaine, without hyaluronidase. The onset time for globe akinesia was studied at intervals of 2 minutes, using Nicolls score. We evaluated pain by analogic score during the surgery and the necessity of complementing the anaesthesia. The peribulbar block was considered satisfactory when the Nicolls score was less than 4. Results: The mean time of onset of block in group C was 4.07 minutes (± 3.24), and in group S 5.03 (± 3.28). There was no statistically significant difference between the groups. Both were similar regarding pain score, no pain was observed in 57.14% of group C, and in 68.97% of group S. The supplementary anesthetic was necessary in 2 cases of group C and in 3 cases of group S. Two cases of bradycardia (heart rate < 50 bpm) were observed during the surgery, and in one case administration of atropine IV was necessary. Conclusion: 1% ropivacaine provided a good quality of anesthesia for cataract extraction, with a faster onset of action in the group with hyaluronidase 100 iu/ml, although without significant difference.

Retinal changes in rabbit after intravitreal injection of sunitinib encapsulated into solid lipid nanoparticles and polymeric nanocapsules

PURPOSE We aimed to evaluate the safety of single intravitreal injection of each of two concentrations of 0.1 ml of sunitinib (1 and 10 mg/ml), 0.1 ml of a drug-free dispersion containing solid lipid nanoparticles, and 0.1 ml of a drug-free dispersion containing polymeric nanocapsules for analyzing the possible toxic effects using electrophysiology and histology in albino rabbit retina. METHODS We conducted an experimental controlled study of 20 eyes of albino rabbits. Intravitreal injections of each specific agent were applied to one eye per rabbit in each 5-rabbit group, while the contralateral eyes received no treatment and were used as controls. RESULTS We noted no electroretinographic changes in the sunitinib (1 and 10 mg/ml) or in solid lipid nanoparticles groups. However, we observed significant abnormalities in ocular morphology and in the electroretinogram in the nanocapsules group. At the histological level, only the nanocapsules group demonstrated abnormal changes, including severe edema and cytoplasmic vacuole formation. CONCLUSIONS While nanocapsules intravitreal injections indicated retinal toxic effects, sunitinib and solid lipid nanoparticles intravitreal injections were not toxic to the retina. Our results suggest that a sunitinib preparation with solid lipid nanoparticles for controlled release may offer a significant therapeutic approach for vasoproliferative ocular disease.

En face and OCT angiography findings in macular retinoschisis

The diagnosis of macular retinoschisis is often complex and demands complementary exams to be confirmed. This is the report of a case of a 27 years old man diagnosed with macular retinoschisis, in which En face OCT and OCT angiography were used to identify and demonstrate the typical patterns of the disease, as well as distinguish them from the findings of cystoid macular edema.