Luiz Guilherme Azevedo de Freitas

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.

Unilateral Uveitis with Vitreous Haze Following Zoledronic Acid Therapy for Osteoporosis

ABSTRACT Zoledronic acid is widely used in the treatment of osteoporosis and other bone diseases. However, patients may experience adverse effects involving the anterior segment of the eye following intravenous infusion. This paper reports a rare case of uveitis involving the vitreous cavity following the intravenous administration of zoledronic acid.

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.

Spontaneous closure of macular hole following blunt trauma

Ocular trauma can result in macular hole and it can lead to complete loss of central vision. We are reporting a case of traumatic macular hole associated with retinal hemorrhages and choroidal ruptures with spontaneous resolution and total vision recovery.

Edema cistoide de mácula pós-LASIK tratado com ranibizumabe

The authors report the case of a patient who developed cystoid macular edema after surgery for myopia by LASIK method. She was treated with intravitreal injections of ranibizumab and presented satisfactory visual result.

Efficacy of Sublingual Use of Ketorolac Tromethamine in Reducing Pain During Treatment with Laser Photocoagulation in Patients with Diabetic Retinopathy Double Blind, Randomized, Sham-Controlled Study

Objective: To evaluate the analgesic effect of sublingual ketorolac tromethamine during argon laser photocoagulation in patients with diabetic retinopathy. Methods: A double blind, randomized, sham - controlled study, was conducted in 60 patients with diabetic retinopathy, referred for argon laser panretinal photocoagulation (PRP). For the evaluation of pain intensity, a numerical scale from zero to ten was used. The trial sample was divided into two groups. Group 1 consisted of 27 patients who used one 10 mg tablet of ketorolac tromethamine and group 2 comprised of 33 patients who used a sham, both with the same method of administration, 30 minutes before application of the laser. Results: Of the 27 patients in Group 1, 20 (74%) felt pain in the first stage, 5 (19%) experienced pain in the second stage and 2 (7%) felt no pain at any time. Of the 33 patients in Group 2, 27 (82%) felt pain in the first stage, 3 (9%) experienced pain in the second stage and 3 (9%) felt no pain at any time. There was no statistically significant difference between the groups (p=0.65 and 0.33). Conclusion: Ketorolac tromethamine was not able to reduce pain during panretinal photocoagulation in patients with proliferative diabetic retinopathy.

Oclusão de ramo arterial retiniano bilateral

The authors report a case of a patient who presented bilateral branch retinal artery occlusion without any meaningful systemic underlying conditions. Keyworks: Retina; Vascular diseases; Retinal artery occlusion; Retinal vasculitis; Fuorescein angiography; Case reports Bilateral branch retinal artery occlusion

Asymptomatic ocular sarcoidosis

Sarcoidosis is an idiopathic systemic granulomatous disease. It commonly affects the skin, lungs, kidneys, and central nervous system. In the eyes it primarily affects the uveal tract, conjunctiva, lacrimal glands and optic nerve. Here in we describe the case of a patient with systemic sarcoidosis and asymptomatic eye inflammation.