Érika Pacheco Magalhães

Macular edema associated with gyrate atrophy managed with intravitreal triamcinolone: a case report

PURPOSE To describe the use of 4 mg intravitreal triamcinolone acetonide (IVTA) for gyrate atrophy-related macular edema (ME) and to report anatomic and functional outcomes, during a nine-month period. CASE REPORT A 27-year-old female complained of decreased vision since diagnosis of gyrate athrophy (GA), six years before admission. At presentation visual acuity was 20/100 in OD and 20/80 in OS. Ophthalmological examination disclosed significant cataract in OD, pseudophakia in OS and typical GA findings. Fluorescein angiography (FA) disclosed ME that was confirmed by optical coherence tomography (OCT), which also showed subfoveal fluid. OS was treated with a 4-mg IVTA injection. One month later, vision improved to 20/50+1 and foveal thickness decreased, with less leakage in FA. This picture was maintained up to six months, when there was recurrence of ME to a level similar to the baseline. At nine months, visual acuity dropped to 20/80, and ME was maintained, with remodeling in macular profile. CONCLUSION There is a transient therapeutic effect with 4-mg IVTA injection for GA-related ME. After drug clearance, edema recurs, with return of visual acuity to pretreatment level.

Choroidal neovascularization after accidental macular damage by laser

A 30‐year‐old male physics professor was examined 2 months afterbeing accidentally hit by a laser beam in his left eye. He complainedof abrupt vision loss and central scotoma after the laser accident,with stabilization of the vision thereafter. At presentation, hepresented best‐corrected visual acuity of 6/18 in the lefteye. Fundoscopy disclosed a slightly elevated foveal brownish lesion,surrounded by a subtle subretinal haemorrhage. Fluorescein angiographydemonstrated a hyperfluorescent foveal lesion with stainingand a slight leakage in the late phase, characterizing a fibrovascularchoroidal neovascularization (CNV). Optical coherence tomography showeda discrete increase in retinal thickness and a subretinalfibrotic CNV. Visual acuity remained stable during the follow up(4 months). CNV after laser injury is rare. The evolutionof this case suggests that CNV, after an accidental laser injury,in a healthy macula of a young patient might have a self‐limitedcourse and a relatively good prognosis.

Avaliação clínica e incidência de endoftalmite infecciosa e não-infecciosa após injeção intravítrea de acetonida de triancinolona

PURPOSE: To report the incidence of infectious and noninfectious endophthalmitis after intravitreal injection of 4 mg of triamcinolone acetonide (Kenalog® - 40 mg/ml; 0.1 ml) and to evaluate distinguishing characteristics that may assist the clinician in differentiating these entities. Design: Observational nonconcurrent prospective study. METHODS: Charts of 121 patients (154 injections) who consecutively underwent intravitreal injection of triamcinolone acetonide to treat various chorioretinal diseases were evaluated. All procedures were performed in an operating room with careful antiseptic protocol. RESULTS: Two eyes (1.29%/injection and 1.65%/patient) presented a noninfectious endophthalmitis characterized by decreased vision, hyperemia, hypopyon and vitreous inflammatory reaction, on the first day after the injection. These eyes were treated with topical and subconjunctival corticosteroids with complete resolution of the inflammatory reaction. CONCLUSION: In the present case series, no case of infectious endophthalmitis occurred. Despite being relatively rare, noninfectious endophthalmitis can be associated with intravitreal injection of triamcinolone simulating an infectious endophthalmitis. In selected cases, the differential diagnosis can be made solely by clinical evaluation.

Comparisons of retinal nerve fiber layer thickness changes after macular hole surgery

PURPOSE To compare postoperative changes in retinal nerve fiber layer thickness in patients with macular holes treated with vitrectomy with Brilliant Blue-assisted internal limiting membrane peeling. METHODS Twenty-two eyes of 20 patients with macular holes were studied. Each eye was selected to undergo Brilliant Blue-assisted internal limiting membrane peeling. The circumferential retinal nerve fiber layer thickness was determined using spectral domain optical coherence tomography preoperatively and 2 months postoperatively. Mean overall and sectoral retinal nerve fiber layer thicknesses were obtained for each patient. RESULTS There was no statistically significant difference (p≥0.05) between the pre- and post-treatment measurements in relation to each CFN variable, i.e., on average, pre-treatment measures were the same as post-treatment measures. Furthermore, despite the differences between the pre- and post-treatment measures always being positive (pre-post >0), they are not statistically significant. CONCLUSIONS This study showed no significant decrease in retinal nerve fiber layer thickness measurements after macular holes surgery, regardless of age or sex.

Transpupillary thermotherapy alone and enhanced by standard doses of indocyanine green in pigmented rabbits.

BACKGROUND AND OBJECTIVE To evaluate the chorioretinal effects of transpupillary thermotherapy (TTT) and TTT enhanced by standard doses of indocyanine green (ICG) in pigmented rabbits. MATERIALS AND METHODS In 25 eyes, two retinal areas were irradiated using identical subthreshold diode laser irradiation. The subthreshold diode laser irradiation level was first determined using the other eye. ICG (0.5 mg/kg) was injected before irradiation of the second area. Red-free photographs, fluorescein angiography, and ICG videoangiography were performed after TTT. Specimens were prepared for light microscopy. RESULTS In 35% of the cases, ICG videoangiography revealed a hypofluorescent spot in the area irradiated after injection of ICG that disappeared after ICG re-injection. None of the areas irradiated before ICG injection were hypofluorescent. Red-free photographs and fluorescein angiography were normal in most cases. Light microscopy demonstrated patent choriocapillaris and choroid in most areas. CONCLUSIONS Subthreshold TTT, whether enhanced by ICG or not, did not cause significant choroidal or choriocapillaris vascular occlusion. Standard doses of ICG had no significant effect on TTT.