Optical coherence tomography imaging in commotio retinae: case report

O objetivo deste relato é correlacionar achados à tomografia de coerência óptica e prognóstico visual de pacientes com commotio retina e de gravidades diferentes. Dois pacientes do sexo masculino, de 20 e 23 anos com baixa visual unilateral após trauma ocular contuso atribuível a edema de Berlin foram avaliados pela retinografia e tomografia de coerência óptica. A acuidade visual no olho afetado era de 20/25 no primeiro paciente e conta dedos a 2 metros no segundo. O exame oftalmológico revelou uveíte traumática e, na fundoscopia, evidenciaram-se opacificação retiniana moderada no primeiro caso e grave no segundo. A tomografia de coerência óptica confirmou discreta diminuição da depressão foveal no primeiro caso e desorganização das camadas retinianas no segundo. Houve resolução anatômica e funcional completa a tomografia de coerência óptica no primeiro paciente, enquanto o segundo evoluiu com baixa visual permanente e desorganização da arquitetura retiniana. A tomografia de coerência óptica é um exame complementar útil na avaliação do trauma retiniano, ajudando a entender sua fisiopatologia e predizer prognóstico a partir da análise anatômica da região acometida.The purpose of this case report was to correlate optical coherence tomography findings and visual outcomes of patients with different degrees of commotio retinae. A 20-year-old male and a 23-year-old male that presented with decreased vision due to Berlin's edema after blunt ocular trauma were evaluated by optical coherence tomography and retinography. The visual acuity in the affected eye was 20/25 in the first patient and counting fingers in the second one. The ophthalmic examination showed traumatic uveitis and fundoscopy revealed mild retinal opacification in the first case and severe opacification in the latter. The optical coherence tomography confirmed the reduction of foveal depression on the first case and the disarrangement of all retinal layers on the second. There has been complete functional and anatomical resolution by optical coherence tomography in the first patient, while the second evolved to permanent visual loss. Optical coherence tomography is a useful method in the evaluation of retinal trauma, helping to understand its physiopathology and to predict its prognosis through the anatomical analysis of the affected region

How much information do medical practitioners and endocrinologists have about diabetic retinopathy?

OBJECTIVE: The objective of this study was to use a questionnaire to evaluate knowledge concerning diabetic retinopathy among the physicians present at the 12th Latin American Congress on Diabetes held in São Paulo, Brazil, September 2004. METHODS: A questionnaire about their experience and management of patients with diabetes mellitus and the ophthalmologic examination was administered to 168 endocrinologists attending the meeting. RESULTS: Among the 168 physicians, only 36.9% correctly referred patients with diabetes type 1 to an ophthalmologist, whereas 86.9% referred patients with the type 2 disorder as recommended by the American Academy of Ophthalmology. Regarding the correct indication for screening for diabetic retinopathy, more physicians who had received their degree less than 5 years previously implemented this practice (54.8%), as opposed to those who had received their MD 20 years or more ago (22.6%). Regarding their experience in funduscopy during their specialty training, 52.4% claimed to have experience, but only 21.4% of those interviewed performed this examination on their patients. According to 84.5% of the interviewees, the fundus examination influenced their clinical treatment program. CONCLUSION: Our study demonstrates that medical knowledge among medical practitioners and endocrinologists on preventive measures and periodicity of diabetic retinopathy examinations appears to be far from ideal for diabetes type 1, but satisfactory for diabetes type 2. Therefore, refresher courses emphasizing the correct management of diabetic patients are necessary, because the social and economic impact of retinopathy is significant.OBJETIVO: O objetivo deste estudo foi avaliar através de questionário o conhecimento dos médicos presentes no 12º Congresso Latino Americano de Diabetes Realizado em São Paulo Brasil, Setembro de 2004. MATERIAIS E MÉTODOS: Através de um questionário aplicado a 168 especialistas em endocrinologia presentes no 12º Congresso Latino Americano de Diabetes realizado São Paulo - Brasil em Setembro de 2004, os autores interrogaram sobre a experiência e conduta em relação à Retinopatia Diabética e ao exame oftalmológico. RESULTADOS: Dos 168 médicos, apenas 36,9% encaminhavam corretamente ao oftalmologista os pacientes com diabetes do tipo 1, enquanto 86,9% o faziam de acordo com a Academia Americana de Oftalmologia para os diabéticos do tipo 2. Quanto ao correto encaminhamento dos pacientes para exame de fundo de olho: os médicos com tempo de formação inferior a cinco anos foram os que mais realizam esta prática (54,8%), comparados àqueles com 20 ou mais anos (22,1%). Quanto à experiência em fundoscopia durante a especialização, embora 52,40% afirmassem possuir experiência, apenas 21,4% dos entrevistados realizavam fundo de olho em seus pacientes. Para 84,5% dos entrevistados, o exame de fundo de olho influenciava o tratamento clínico sistemico. CONCLUSÃO: O estudo demonstra que o conhecimento médico das medidas preventivas e de periodicidade do exame da Retinopatia Diabética apresenta-se distante do ideal, para diabéticos tipo 1 e satisfatória para diabéticos tipo 2. Médicos graduados ate 5 anos apresentaram maior porcentagem de correto encaminhamento. A presença de retinopatia diabética no exame de fundo de olho influencia o tratamento clinico sistêmico da maioria dos médicos entrevistados

Quanta informação os médicos gerais e endócrinologistas tem sobre retinopatia diabética?

OBJECTIVE: The objective of this study was to use a questionnaire to evaluate knowledge concerning diabetic retinopathy among the physicians present at the 12th Latin American Congress on Diabetes held in São Paulo, Brazil, September 2004. METHODS: A questionnaire about their experience and management of patients with diabetes mellitus and the ophthalmologic examination was administered to 168 endocrinologists attending the meeting. RESULTS: Among the 168 physicians, only 36.9% correctly referred patients with diabetes type 1 to an ophthalmologist, whereas 86.9% referred patients with the type 2 disorder as recommended by the American Academy of Ophthalmology. Regarding the correct indication for screening for diabetic retinopathy, more physicians who had received their degree less than 5 years previously implemented this practice (54.8%), as opposed to those who had received their MD 20 years or more ago (22.6%). Regarding their experience in funduscopy during their specialty training, 52.4% claimed to have experience, but only 21.4% of those interviewed performed this examination on their patients. According to 84.5% of the interviewees, the fundus examination influenced their clinical treatment program. CONCLUSION: Our study demonstrates that medical knowledge among medical practitioners and endocrinologists on preventive measures and periodicity of diabetic retinopathy examinations appears to be far from ideal for diabetes type 1, but satisfactory for diabetes type 2. Therefore, refresher courses emphasizing the correct management of diabetic patients are necessary, because the social and economic impact of retinopathy is significant.OBJETIVO: O objetivo deste estudo foi avaliar através de questionário o conhecimento dos médicos presentes no 12º Congresso Latino Americano de Diabetes Realizado em São Paulo Brasil, Setembro de 2004. MATERIAIS E MÉTODOS: Através de um questionário aplicado a 168 especialistas em endocrinologia presentes no 12º Congresso Latino Americano de Diabetes realizado São Paulo - Brasil em Setembro de 2004, os autores interrogaram sobre a experiência e conduta em relação à Retinopatia Diabética e ao exame oftalmológico. RESULTADOS: Dos 168 médicos, apenas 36,9% encaminhavam corretamente ao oftalmologista os pacientes com diabetes do tipo 1, enquanto 86,9% o faziam de acordo com a Academia Americana de Oftalmologia para os diabéticos do tipo 2. Quanto ao correto encaminhamento dos pacientes para exame de fundo de olho: os médicos com tempo de formação inferior a cinco anos foram os que mais realizam esta prática (54,8%), comparados àqueles com 20 ou mais anos (22,1%). Quanto à experiência em fundoscopia durante a especialização, embora 52,40% afirmassem possuir experiência, apenas 21,4% dos entrevistados realizavam fundo de olho em seus pacientes. Para 84,5% dos entrevistados, o exame de fundo de olho influenciava o tratamento clínico sistemico. CONCLUSÃO: O estudo demonstra que o conhecimento médico das medidas preventivas e de periodicidade do exame da Retinopatia Diabética apresenta-se distante do ideal, para diabéticos tipo 1 e satisfatória para diabéticos tipo 2. Médicos graduados ate 5 anos apresentaram maior porcentagem de correto encaminhamento. A presença de retinopatia diabética no exame de fundo de olho influencia o tratamento clinico sistêmico da maioria dos médicos entrevistados

Idiopathic polypoidal choroidal vasculopathy masquerading as choroidal tumors: one year follow-up of a peripheral lesion

ABSTRACT This case report describes peripheral idiopathic polypoidal choroidal vasculopathy (IPCV) with a collection of small aneurysmal dilations that masqueraded as choroidal tumors in an elderly patient. A 68-year-old African American woman was referred to us with a suspected diagnosis of asymptomatic vascular choroidal tumor and choroidal capillary hemangioma, affecting the temporal peripheral fundus. Upon examination, optical coherence tomography (OCT) revealed two large hemorrhagic pigment epithelium detachments (PED), and indocyanine green angiography (ICG) confirmed the diagnosis of IPCV. One year later, there was reduction in the hemorrhagic pigment epithelium detachments and the lesion took on a different appearance, resembling a choroidal osteoma. No treatment was necessary despite the presence of multiple polyps. IPCV is a rare condition that can resemble other choroidal diseases depending on the stage of presentation. OCT is the best tool to determine the characteristics of the lesions, and indocyanine green angiography should be used to confirm the diagnosis. Not all cases require treatment

Single intravitreal bevacizumab injection effects on contrast sensitivity in macular edema from branch retinal vein occlusion

Purpose: To evaluate the effect of a single intravitreal bevacizumab injection on visual acuity, contrast sensitivity and optical coherence tomography-measured central macular thickness in eyes with macular edema from branch retinal vein occlusion. Methods: Seventeen eyes of 17 patients with macular edema from unilateral branch retinal vein occlusion were treated with a single bevacizumab injection. Patients were submitted to a complete evaluation including best corrected visual acuity, contrast sensitivity and optical coherence tomography measurements before treatment and one and three months after injection. Visual acuity, contrast sensitivity and optical coherence tomography measurements were compared to baseline values. Results: Mean visual acuity measurement improved from 0.77 logMAR at baseline to 0.613 logMAR one month after injection (P=0.0001) but worsened to 0.75 logMAR after three months. Contrast sensitivity test demonstrated significant improvement at spatial frequencies of 3, 6, 12 and 18 cycles/degree one month after injection and at the spatial frequency of 12 cycles/degree three months after treatment. Mean +/- standard deviation baseline central macular thickness (552 +/- 150 mu m) reduced significantly one month (322 +/- 127 mu m, P=0.0001) and three months (439 perpendicular to 179 mu m, P=0.01) after treatment. Conclusions: Bevacizumab injection improves visual acuity and contrast sensitivity and reduces central macular thickness one month after treatment. Visual acuity returns to baseline levels at the 3-month follow-up, but some beneficial effect of the treatment is still present at that time, as evidenced by optical coherence tomography-measured central macular thickness and contrast sensitivity measurements

Structural and functional assessment of the macula in patients with proliferative diabetic retinopathy submitted to panretinal photocoagulation associated with intravitreal injections of bevacizumab

INTRODUÇÃO: O presente estudo avaliou o tratamento com injeções intravítreas de Bevacizumabe (IVB) associadas à panfotocoagulação (PFC) da retina na retinopatia diabética proliferativa (RDP) de alto risco com ou sem edema macular (EM). MÉTODOS: Ensaio clínico randomizado, prospectivo, aberto e mascarado composto por pacientes com Diabetes melitos (DM) tipo 2. A acuidade visual (AV) foi medida com a tabela Early Treatment Diabetic Retinopathy Study e a sensibilidade ao contraste (SC) pela da tabela Vistech Consultants Incorporation 6500. Os pacientes foram submetidos a exame de angiofluoresceinografia para observação de neovascularização retiniana e isquemia macular e à tomografia de coerência óptica (OCT), para se obter a espessura foveal (EF) e o volume macular (VM). Após os exames, um dos olhos do mesmo paciente foi randomizado para realizar somente PFC, grupo controle (GC), e o outro para PFC associado a injeções IVB, grupo de estudo (GE). A hemorragia vítrea (HV) e a presença de complicações também foram avaliadas. RESULTADOS: Dos 42 pacientes incluídos, 35 completaram o estudo. A média de idade foi de 56±8 anos, com predominância do gênero masculino 21 (60%). Vinte e seis (74%) pacientes eram portadores de Hipertensão Arterial Sistêmica com média de duração de 9±10 anos. A média de duração do DM foi de 18±9 anos sendo 23 (66%) usuários de insulina e 21 (68,5%), fácicos. A AV e a SC não demonstraram diferença entre os grupos no total da amostra. O GE demonstrou melhora em comparação ao GC na EF no 1º mês, e no VM nos 1° e 3º meses de seguimento. Quanto aos 12 pacientes com EM bilateral somente a EF demonstrou redução no GE no 1º mês de seguimento. Ao se avaliar os grupos separadamente, o GC apresentou agravamento da AV e SC durante todo seguimento. Houve também aumento da EF nos 1º e 6º meses e VM nos 1º , 3º e 6º meses de seguimento. O GE demonstrou estabilização da AV, SC, EF e VM. Correlacionado às funções visuais, AV com a SC, toda vez que houve piora da AV esta foi acompanhada pelo agravamento da SC em todos os momentos no GC e GE. Quando correlacionadas as AV e SC com as EF e VM, toda vez que a espessura macular aumentava, havia piora da função visual. Dos sete pacientes excluídos do estudo por apresentarem HV, cinco integravam o GC e dois o GE. Não houve aparecimento de catarata, endoftalmite e/ou aumento significativo da pressão ocular. CONCLUSÃO: Na RDP de alto risco, o uso adjuvante de injeções intravítreas de Bevacizumabe associadas à panfotocoagulação da retina pode estabilizar a AV, SC, EF e VM, diminuir a incidência de HV e reduzir a da espessura macular. Em relação à correlação entre as variáveis, quando houve piora da AV, esta foi acompanhada da piora da SC e o aumento da EF e VM causaram piora da AV e SCINTRODUCTION: This study evaluated the treatment with intravitreal injections of Bevacizumab (IVB) associated with panretinal photocoagulation (PRP) in high-risk proliferative diabetic retinopathy (PDR) with or without diabetic macular edema (DME). METHODS: Prospective, open and masked, randomized clinical trial, composed of patients with type 2 Diabetes Mellitus (DM). The visual acuity (VA) was measured with the Early Treatment Diabetic Retinopathy Study charts and the contrast sensitivity (CS) through the chart of Vistech Consultants Incorporation 6500. Patients were submitted to a fluorescein angiography examination to observe retinal neovascularization and macular ischemia and to an optical coherence tomography (OCT) to obtain the foveal thickness (FT) and macular volume (MV). After the tests, one of the eyes from the same patient was randomized to realize only the PRP, the control group (CG), and the other for PRP associated to IVB injections, the study group (SG). Vitreous hemorrhage (VH) and presence of complications were also evaluated. RESULTS: Thirty-five of the forty-two patients included, completed the study. The mean age was 56±8 years, with a predominance of 21 (60%) males. Twenty-six (74%) patients had systemic hypertension with a mean duration of 9±10 years. The mean duration of DM was 18±9 years, of which 23 (66%) were insulin users and 21 (68.5%) were phakic. The VA and CS showed no difference between groups in the total sample. The SG showed improvement compared to the CG in FT for the 1st month, and in MV for the 1st and 3rd month of follow-up. As for the 12 patients with bilateral ME, only the FT showed a reduction in the SG for the 1st month of follow-up. When evaluating the groups separately, the CG showed worsening of VA and CS at all times. There was also an increase of FT for the 1st and 6th months and of MV for the 1st, 3rd and 6th month follow-up. The SG showed stabilization of VA, CS, FT and MV. When correlated to visual functions, VA and CS, a worsening of the VA was accompanied every time by a worsening of the CS in both the CG and SG. When VA and CS are correlated to FT and MV, there was worsening of visual function whenever macular thickness increased. Of the seven patients excluded from the study by presenting VH, 5 belonged to the CG and the 2 to the SG. There was no incidence of cataracts, endophthalmitis and/or significant increase in intraocular pressure. CONCLUSION: In high-risk PDR, intraocular injections of Bevacizumab as an adjuvant treatment to PRP, can stabilize VA, CS, FT and MV, reduce of the incidence of VH and decrease the macular thickness. Regarding the correlation between variables, when there was a worsening of VA, this was accompanied by a worsening of the CS, and an increase in FT and MV caused the worsening of the VA and C

Dimensões palpebrais antes e após blefaroplastia superior: avaliação quantitativa

OBJETIVO: Quantificar, usando o sistema de imagem digital, medidas palpebrais antes e após a cirurgia de blefaroplastia superior. MÉTODOS: Foram avaliadas 18 pálpebras de 9 pacientes atendidas no HC da FMB - UNESP, com idade entre 40 a 75 anos, do sexo feminino, portadoras de dermatocálase. Foram obtidas fotografias das pacientes antes e após 60 dias da blefaroplastia da pálpebra superior. As imagens foram transferidas para um computador e analisadas pelo programa Scion Image Frame Grabber. Os parâmetros avaliados foram: a altura da fenda palpebral em posição primária do olhar, altura do sulco palpebral superior e o ângulo palpebral lateral antes e depois de 60 dias da realização da cirurgia de blefaroplastia superior. RESULTADOS: Após a cirurgia, houve aumento da altura da fenda palpebral e do sulco palpebral superior. Contudo, o ângulo palpebral lateral não se alterou. CONCLUSÃO: A posição palpebral se altera após a blefaroplastia e o processamento de imagens digitais possibilita quantificar estas alterações, mensurando os resultados obtidos com a cirurgia.PURPOSE: To evaluate eyelid measures before and after upper blepharoplasty surgery using a digital image system. METHODS: Eighteen eyelids of 9 patients with dermatochalasis were evaluated at the Hospital das Clínicas de Botucatu - UNESP regarding eyelid measures before and after upper blepharoplasty. All patients were female, aged between 40 and 75 years. The images were acquired by a photographic camera, transferred to a computer and then analyzed by the Scion Image Frame Grabber program. The evaluated parameters were upper eyelid position in primary gaze position, upper palpebral sulcus and lateral eyelid angle. The measures were obtained before and after 60 days of upper dermatochalasis surgery. RESULTS: After the surgery, there was an increase of upper eyelid position and upper palpebral sulcus; the lateral palpebral angle did not show any alteration. CONCLUSION: Eyelid position changes after blepharoplasty and digital image processing provides quantitative measures of the eyelid, allowing a better quantification of the surgical results