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- ItemAcesso aberto (Open Access)Avaliação da tomografia de coerência óptica em pacientes portadores de degeneração macular relacionada à idade tratada com terapia fotodinâmica com verteporfina(Conselho Brasileiro de Oftalmologia, 2008-12-01) Bordon, Arnaldo Furman [UNIFESP]; Oshima, Akioshi [UNIFESP]; Guia, Tércio Alves [UNIFESP]; Calucci, Daniela [UNIFESP]; Sallum, Juliana Maria Ferraz [UNIFESP]; Farah, Michel Eid [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)PURPOSE: To identify the optical coherence tomography (OCT) findings in patients with age-related macular degeneration (ARMD) treated with photodynamic therapy (PDT). STUDY DESIGN: Open, non-randomized, interventional case series. METHODS: ARMD patients were submitted to a complete ophthalmological examination, fluorescein angiography, and OCT at baseline (V0), 3, 6, 9 and 12 months (V3, V6, V9 and V12, respectively). PDT was carried out according to the TAP study. Visual acuity (VA) was measured using the logMAR ETDRS chart. The following foveal measurements were performed: foveal intraretinal thickness (FIRT), foveal choriocapillaris - RPE complex thickness (FCC-RPET) and total foveal thickness (TFT). The extrafoveal thicknesses measured were: extrafoveal intraretinal thickness (EFIRT), extrafoveal choriocapillaris - RPE complex thickness (EFCC-RPET) and total extrafoveal thickness (TEFT). Statistical analysis was performed using the block variance analysis test. RESULTS: Twenty-three eyes of 23 patients were enrolled. This study identified nine OCT patterns: 1) thickening of the foveal intraretinal layers; 2) thickening of the extrafoveal intraretinal layers; 3) thickening of the foveal choriocapillaris - RPE complex; 4) thickening of the extrafoveal choriocapillaris - RPE complex; 5) intraretinal fluid; 6) subretinal fluid; 7) subretinal pigment epithelium (RPE) fluid; 8) vitreo-retinal adhesion; 9) foveal depression. At baseline, FIRT and TFT were 398.5 µ and 639.2 µ, respectively. At V12 they were 173.7 µ e 423.9 µ, respectively, and this change was statistical significant (p=0.008 e p=0.003, respectively). The variation of the other foveal and extrafoveal measurements were not statistically significant. Foveal depression was present at baseline in 36.4% of the eyes, whereas at V12 it was present in 78.3%. Subretinal fluid was present in 36.4% of eyes at V0 and in 8.7% at V12. VA at baseline was 0.93 and it V12 was 1.04 (p=0,127). CONCLUSIONS: Visual acuity was stable throughout the study. Foveal depression was reestablished in 78.3% at V12. FIRT and TFT decreased at a statistical significant level, from V0 to V12.
- ItemAcesso aberto (Open Access)Effect of corneal epithelium on ultraviolet-A and riboflavin absorption(Conselho Brasileiro de Oftalmologia, 2011-10-01) Bottós, Katia Mantovani [UNIFESP]; Schor, Paulo [UNIFESP]; Dreyfuss, Juliana Luporini [UNIFESP]; Nader, Helena Bonciani [UNIFESP]; Chamon, Wallace [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)PURPOSE: To determine if the corneal epithelium prevents the collagen cross-linking effect. Using immunofluorescence microscopy after CXL, we indirectly analyzed the role of the epithelium as ultraviolet-A (UVA) shield as well as a barrier to riboflavin penetration. METHODS: Fifteen freshly enucleated porcine eyes were divided into 3 groups. The corneal epithelium was kept intact in all groups. Five eyes served as control (Group 1). On group 2, eyes received tetracaine anesthetic drops and topical 0.1% riboflavin solution (10 mg riboflavin-5-phosphate in 10 mL 20% dextran-T-500). On Group 3, riboflavin was injected into the anterior chamber to allow penetration of the drug through the endothelium. Groups 2 and 3 were exposed to UVA (365 nm, 3 mW/cm²) for 30 minutes. Ultra-thin sections (8 µm) of the corneas were stained with anti-collagen type I and DAPI (4,6-diamidino-2-fenilindole dihydrocloride) and analyzed with fluorescence microscopy. RESULTS: Corneas treated with UVA irradiation and intracameral injection of riboflavin (Group 3) showed greater pattern of collagen organization compared to groups 1 (Control) and 2 (riboflavin and tetracaine eye drops). A yellow stromal staining, which represents the riboflavin diffusion into the stroma, was only observed in eyes injected with riboflavin into the anterior chamber. CONCLUSION: Using immunofluorescence microscopy in porcine corneas, we demonstrated that the corneal epithelium reduces the effectiveness of CXL by preventing the penetration of the drug and not by limiting the UVA transmittance. An inadequate intrastromal concentration of riboflavin may impair CXL effect.
- ItemAcesso aberto (Open Access)Indocyanine green-mediated photothrombosis for choroidal neovascularization in angioid streaks(Conselho Brasileiro de Oftalmologia, 2008-06-01) Malerbi, Fernando Korn [UNIFESP]; Huang, Sheau Jiun [UNIFESP]; Aggio, Fabio Bom [UNIFESP]; Carvalho Jr., Edenilson [UNIFESP]; Bonomo, Pedro Paulo [UNIFESP]; Farah, Michel Eid [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)PURPOSE: To investigate the effect of indocyanine green-mediated photothrombosis on choroidal neovascularization secondary to angioid streaks. METHODS: Six eyes of 5 patients with an average age of 70 years were diagnosed to have subfoveal choroidal neovascularization secondary to angioid streaks. Therapy was indicated if choroidal neovascularization was considered to be active, according to evidence of fluorescein leakage on angiograms, as well as presence of intra- or subretinal fluid on optical coherence tomography. Patients received photothrombosis at baseline with retreatment as necessary at 3, 6 and 9 months follow-up. Fluorescein leakage was assessed at 3, 6 and 9 months, along with foveal thickness measured by optical coherence tomography. Indocyanine green angiography was performed initially and whenever retreatment was considered. Retreatment was performed whenever there was evidence of increased leakage on fluorescein angiograms at follow-up visits. RESULTS: The mean follow-up was 13.3 months. All eyes had at least 12 months follow-up. Two eyes underwent retreatment. Three eyes had visual acuity improvement and three eyes had stabilization. All patients showed less fluorescein leakage on final angiograms and reduced foveal thickness upon optical coherence tomography measurement. CONCLUSION: Photothrombosis is a feasible procedure for choroidal neovascularization secondary to angioid streaks. Lesion analysis showed anatomical improvement in most cases in this series. Further studies are warranted to evaluate long-term results of this treatment.