Pseudohipópio pós-injeção intravítrea de triancinolona: relato de casos

Report on the development of pseudohypopyon immediately after intravitreal injection of triamcinolone acetonide (TAAC). Two phakic patients presenting with a transient pseudohypopyon after having been treated with intravitreal triamcinolone. One had a clinically significant macular edema with cystoid component (CSME with CMS) and the other, active Vogt-Koyanagi-Harada (VKH) with serous retinal detachment of the macula. One eye from each patient developed a pseudohypopyon with crystal deposits adherent to the corneal endothelium. In one case it appeared right after the injection and disappeared spontaneously in 24 hours. In the other patient it appeared on day 3 and disappeared also spontaneously within 2 days. The pseudohypopyon is an important sign that can be observed after intravitreal injection of TAAC, in phakic patients, with spontaneous resolution and without complication. The pseudohypopyon caused by the deposition of TAAC in the anterior chamber immediately after its injection into the vitreous should be differentiated from other forms of hypopyon associated with this type of treatment.Descrição de dois casos de pacientes submetidos à injeção intravítrea de acetonida de triancinolona (AT), que desenvolveram pseudo-hipópio transitório. Um paciente apresentava edema macular diabético clinicamente significativo com componente cistóide e o outro, com descolamento seroso de retina agudo com Vogt-Koyanagi-Harada, e ambos desenvolveram pseudo-hipópio com presença de depósitos de cristais no endotélio corneano; em um caso o pseudo-hipópio desapareceu espontaneamente em 24 horas, no outro caso o pseudo-hipópio teve duração de 2 dias. O pseudo-hipópio é importante sinal que pode ser observado após injeção intravítrea de AT, em pacientes fácicos, apresentando resolução espontânea sem complicações. Este pseudo-hipópio causado por depósitos de cristais de AT deve ser considerado diagnóstico diferencial para hipópio infeccioso associado a este tipo de tratamento.Universidade Federal de São Paulo (UNIFESP) Departamento de Oftalmologia Setor de Uveítes e AIDSUniversidade Federal de São Paulo (UNIFESP)Universidade Federal de São Paulo (UNIFESP) Departamento de OftalmologiaUNIFESP, Depto. de Oftalmologia Setor de Uveítes e AIDSUNIFESP, Depto. de OftalmologiaSciEL

Progression of retinopathy and alteration of the blood-retinal barrier in patients with type 2 diabetes: a 7-year prospective follow-up study

BACKGROUND: The study was carried out to evaluate the correlation between blood-retinal barrier (BRB) permeability and the progression of diabetic retinopathy (DR), defined by development of "need for photocoagulation", over a 7-year period by means of vitreous fluorometry (VF). METHODS: Forty type 2 diabetic patients with minimal or no retinopathy, aged 40-65 years (mean 53.9 + 7.3 years), were followed up prospectively for 7 years. Investigations including standard ophthalmological examination, fundus photography, fluorescein angiography and VF were performed at entry and 1, 4, 5 and 7 years later. Only one eye per patient was included in the study. Need for photocoagulation was based on Early Treatment Diabetic Retinopathy Study protocols and decided by the attending ophthalmologist. RESULTS: After 7 years of follow-up a total of 22 of the 40 eyes had received photocoagulation. The eyes that needed photocoagulation were those that had higher VF values at the entry of the study and showed higher rates of deterioration (initial values 5.1 + 1.9 vs 2.8 + 1.5 x 10(-6) min-1, P < 0.001; annual increase in leakage for the first year, 1.5 + 0.8 vs 0.5 + 1.0 x 10(-6) min-1, P < 0.001,). The eyes that did not need photocoagulation during the 7 years of follow-up showed stable VF readings (-0.1 + 1.2 x 10(-6) min-1, difference between initial values and 7 years later). CONCLUSIONS: Abnormally high VF values and their rapid increase over time are good indicators of progression and worsening of the retinopathy in diabetes type 2

Surgical management of pterygium verum-historical review, current approaches

Истинският птеригиум, традиционно описван като дегенеративна лезия на конюнктивата, представлява често срещано заболяване на очната повърхност. Представя се като криловидна по форма фиброваскуларна пролиферация на булбовата конюнктива, която инвазира роговицата в посока от корнеосклералния лимб към центъра й и предизвиква деструкция на повърхностните корнеални слоеве. Птеригиумът, подобно на други слънчево-обусловени очни заболявания (т.нар. офталмохелиози), се смята че се развива при продължително въздействие на УВ-лъчи върху очната повърхност. Основен момент в патогенезата на заболяването е локалният дефицит на лимбални стволови клетки в интерпалпебралната зона. Независимо от наличието на многобройни и разнообразни техники за хирургична лечение на птеригиума, все още сериозен проблем представлява високия процент на рецидиви, вероятно дължащ се на все още не напълно изяснената етнопатогенеза на заболяването, поради което търсенето на идеалната хирургична техника все още продължава. Целта на настоящата статия е да се направи кратък преглед на съществувалите в исторически аспект методи за лечение на птеригиума, както и на съвременните подходи за третиране на заболяването.Pterygium verum, traditionally described as a degenerative disorder of the conjunctiva, is a common disease of the ocular surface. It is a wing-shaped fibrovascular proliferation of the bulbar conjunctiva, which encroaches onto the adjacent cornea in direction from the corneoscleral limbus to the center of the cornea and leads to destruction of the surface corneal layers. Pterygium, as the other sun-related eye diseases (the ophthalmohelioses), is considered to develop after a long and intensive insolation (in? uence of sun radiation, mainly UV-B lights) into ocular surface. According to current concepts, the main cause for the development of pterygium is the local deficiency of lmbal stem cells in the interpalpebral area. Although, there are a great variety of different techniques and methods for surgical treatment, nowadays the pterygium is still a surgical problem because of the high percent of the recurrences, probably as a result of the incompletely understood ethiopathogenesis of the disease and searching for the perfect surgical procedure without recurrences continues. The aim of this article is to summarize the surgical techniques and approaches in historical plan and to reveal the current concepts and methods for surgical treatment of pterygium

Treatment of Open-Angle Glaucoma and Ocular Hypertension with Preservative-Free Tafluprost/Timolol Fixed-Dose Combination Therapy: Results from the VISIONARY Study Population in Spain.

Purpose: Data are presented from ophthalmology clinics in Spain participating in the VISIONARY study, examining the effectiveness, tolerability, and safety of the preservative-free tafluprost (0.0015%) and timolol (0.5%) fixed-dose combination (PF tafluprost/timolol FC) in the treatment of OAG and OHT. Methods: An observational, multicenter prospective study examined treatment outcomes following a switch to PF tafluprost/timolol FC in adult OAG/OHT patients demonstrating insufficient response to beta-blocker or prostaglandin analog (PGA) monotherapy. Primary end point was mean change in intraocular pressure (IOP) from baseline at month 6. Changes in the severity of ocular signs and symptoms were also assessed. Results: Overall, 92 patients (51.1% female) were included. Mean (standard deviation) age was 68.3 (12.1) years. Mean IOP was reduced from 21.9 mmHg at baseline to 16.7 mmHg at month 6 (22.3% decrease; P

An estrogen receptor repressor induces cataract formation in transgenic mice

Despite the high prevalence of age-related cataracts, there are currently no known therapies to delay or prevent their occurrence. Studies in humans and rodent models suggest that estrogen may provide protection against age-related cataracts. The discovery of ocular estrogen receptors (ERs) indicates that estrogen protection may result from direct interactions with its receptors in the eye, instead an indirect consequence from effects on another tissue. Studies in our transgenic mouse model validate the concept that estrogen is beneficial for the eye. These mice express ERΔ3, a dominant-negative form of ERα that inhibits ERα function. In the ERΔ3 transgenic mice, cortical cataracts spontaneously form in ERΔ3 females after puberty and progress with age. The cataracts initiate in the equatorial region of the lens where the epithelial cells differentiate into elongating fiber cells. Cataract formation can be prevented if the females are ovariectomized before, but not after, sexual maturity. Both male and female ERΔ3 mice develop cataracts after neonatal treatment with the potent estrogen diethylstilbestrol (DES). The incidence of spontaneous and DES-induced cataracts in ERΔ3 mice is 100%, yet these cataracts are absent from the wild-type mice. These data suggest that repression of estrogen action induces cortical cataract formation because estrogen is required to activate the ERΔ3 repressor. Evidence of DES-induced cataracts in the ERΔ3 males as well as the females suggests that estrogen is important in lens physiology in both sexes. The ERΔ3 mice provide a powerful model for assessing the role of estrogen in maintaining the transparency of the lens