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    • Paper abrangente e mais recente (2017) sobre Membrana Epiretiniana (MER). Elucida vários aspectos anatômicos, fisiopatológicos e desfechos relativos a Membrana Epiretiniana.....

    • Apresentação de artigo científico da reunião clínica do dia 16/07/2020

    • Estudo AAO 2016. Elucida aspectos fisiopatologicos da lesão pelas medicações e suas implicações. Mostra também a sugestão de exames e periodicidade da avaliação para esses casos

    • Fernanda B. O. Porto 1,2 ID , Evan M. Jones 3,4, Justin Branch 4, Zachry T. Soens 3,4, Igor Mendes Maia 5, Isadora F. G. Sena 5, Shirley A. M. Sampaio 1, Renata T. Simões 5 and Rui Chen 3,4,6,*

      Abstract: Leber congenital amaurosis (LCA) is a severe disease that leads to complete blindness in children, typically before the first year of life. Due to the clinical and genetic heterogeneity among LCA and other retinal diseases, providing patients with a molecular diagnosis is essential to assigning an accurate clinical diagnosis. Using our gene panel that targets 300 genes that are known to cause retinal disease, including 24 genes reported to cause LCA, we sequenced 43 unrelated probands with Brazilian ancestry. We identified 42 unique variants and were able to assign a molecular diagnosis to 30/43 (70%) Brazilian patients. Among these, 30 patients were initially diagnosed with LCA or a form of early-onset retinal dystrophy, 17 patients harbored mutations in LCA-associated genes, while 13 patients had mutations in genes that were reported to cause other diseases involving the retina. Keywords: retina; genetics; ophthalmology; Leber congenital amaurosis; early-onset retinal dystrophy; next-generation sequencing



    • In vivo release and retinal safety of intravitreal implants of thalidomide in rabbit eyes and antiangiogenic effect on the chorioallantoic membrane Silvia L. Fialho1, Pedro A. F. Souza1, Gustavo O. Fulgeˆncio2, Murilo M. O. Miranda3, Bruno G. Pereira1, Antonio Haddad4, Andre ́ Messias3, Rodrigo Jorge3, and Armando Silva-Cunha2 Abstract Purpose: To evaluate the in vivo release, retinal safety and antiangiogenic effect of a thalidomide-loaded poly-lactide-co-glycolide intravitreal implant. Methods: New Zealand white rabbits, divided into two groups, I and II, received an intravitreal implant containing or not thalidomide, respectively (n1⁄412). Intravitreal drug levels were determined during a six-week study period. The potential for toxicity associated with the implants was evaluated by electroretinography and light microscopy (n1⁄48). Twelve chorio- allantoic membranes (CAMs) from chicken eggs were incubated with thalidomide dispersion, implants containing or not thalidomide and vitreous samples and analyzed after two days regarding the percentage of vessels regression. Results: Intravitreal concentrations of thalidomide (ng/ml) were 690.21 +- 177.95, 372.51 +- 185.56, 240.59 +- 133.48, 327.54 +- 169.71, 294.26 +- 142.41 and 465.18 +- 157.51 at 1, 2, 3, 4, 5 and 6 weeks, respectively, after implantation in group I rabbits. No drug was detected in group II samples. Electroretinography and histological evaluations did not show any sign of retina toxicity. There was significant regression of vessels in CAM incubated with thalidomide dispersion, thalidomide-loaded implants and vitreous samples from group I when compared to control. Conclusion: The intravitreal implants delivered safe doses of thalidomide that were also effective to induce vessels regression in CAMs. Keywords Biomaterials, controlled release, drug delivery systems, ophthalmic drug delivery, PLGA, toxicity

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    • Multimodal fundus imaging in Best vitelliform macular dystrophy

      Daniela C. Ferrara & Rogério A. Costa & Stephen Tsang & Daniela Calucci & Rodrigo Jorge & K. Bailey Freund Abstract Background Best vitelliform macular dystrophy (BVMD) is a rare autosomal dominant retinal disease of highly variable phenotypic expression. Interpretations of disease mechanisms based on histopathology, electrophysiology, genetic analysis, and retinal imaging are somewhat discordant in fundamental issues such as the location and extension of primary retinal changes. Herein we describe the morphological macular features in patients with BVMD undergoing simultaneous multimodal fundus imaging and compare to those of normal age-matched subjects. Methods Comparative study including seven patients with BVMD (14 eyes) and seven age-matched healthy subjects (14 eyes). All participants were submitted to complete ophthalmological examination, fundus photography, and standardized multimodal fundus imaging protocol including Fourier-domain optical coherence tomography (Fd-OCT) combined with near-infrared reflectance and blue-light fundus autofluorescence (FAF). Results In two eyes in the “subclinical” stage, Fd-OCT revealed thickening of the middle highly reflective layer (HRL) localized between the photoreceptors’ inner/outer segments junction (inner-HRL) and RPE/Bruch’s mem- brane reflective complex (outer-HRL) throughout the macula. In one eye in the “vitelliform” stage, a homoge- neous hyper-reflective material on Fd-OCT was observed between the middle-HRL and outer-HRL; this material presented increased fluorescence on FAF. The outer nuclear layer (ONL) was thinned in the central macula and subretinal fluid was not identified in these earlier disease stages. In patients of “pseudohypopyon” (two eyes), “vitelliruptive” (eight eyes) and “atrophic” (one eye) stages, Fd-OCT revealed a variety of changes in the middle- and inner-HRLs and thinning of ONL. These changes were found to be associated with the level of visual acuity observed. Thickening of the middle-HRL was observed beyond the limits of the clinically evident macular lesion in all eyes. Conclusions Multimodal fundus imaging demonstrated thickening of the reflective layer corresponding to the photoreceptors’ outer segments throughout the macula with no subretinal fluid accumulation as the earliest detectable feature in BVMD. Changes detected in the photoreceptors’ reflective layers (middle- and inner- HRLs) and ONL thinning seemed to be progressive with direct implications for the level of visual acuity impairment observed among the different stages of the disease.


      Keywords

      Best disease . Fourier-domain . Fundus autofluorescence . Infrared . Retinal pigment epithelium . Spectral . Tomography, optical coherence . Vitelliform macular dystrophy


    • Ranibizumab for Retinal Neovascularization

      RODRIGO JORGE, MD, PHD RODRIGO S. OLIVEIRA, MD ANDRE MESSIAS, MD FELIPE P. ALMEIDA, MD MARIO L. STRAMBE, COT ROGÉRIO A. COSTA, MD, PHD Ribeirão Preto, Brazil INGRID U. SCOTT, MD, MPH Hershey, Pennsylvania

      Proliferative diabetic retinopathy (PDR) is an important cause of severe vision loss in patients with diabetes mellitus. Laser photocoagulation is the standard treatment for retinal or optic disc neovascularization, and approximately 60% of patients respond to panretinal photocoagulation (PRP) with regression of neovascularization within 3 months. However, in some cases complete regression of neovascularization does not occur after PRP, but rather, persistent retinal neovascularization is present and approximately 4.5% of patients require pars plana vitrectomy despite PRP. Such cases, as well as the demonstrated upregulation of intravitreal vascular endothelial growth factor (VEGF) in patients with retinal neovascularization, have prompted investigations about anti-VEGF drugs for management of this condition. Based on the promising results using bevacizumab, we evaluated the effects of another humanized anti–VEGF-A neutralizing drug, intravitreal ranibizumab (IVR), in diabetic patients with persistent new vessels (NV) unresponsive to PRP performed at least 4 months prior, with best-corrected visual acuity (BCVA) of 20/32 or worse. Patients were not enrolled if they had a history of vitrectomy, thromboembolic event, sur- gery within the prior 6 months or planned within the next 28 days, uncontrolled hypertension, or known coagulation abnor- malities. If both eyes were eligible for treatment, the eye with worse visual acuity was included.

      Continue to read the article:


    • Gabriella M. Fernandes-Cunha, Juliana B. Saliba, Rubens C. Siqueira, Rodrigo Jorge, Armando Silva-Cunha.

      Journal of Pharmaceutical and Biomedical Analysis,

      Volume 89,

      2014,

      Pages 24-27,

      ISSN 0731-7085,

      https://doi.org/10.1016/j.jpba.2013.10.025.

      (http://www.sciencedirect.com/science/article/pii/S0731708513004846)

      Abstract A simple and accurate method including liquid–liquid extraction and protein precipitation procedures from silicone oil and aqueous humor samples followed by high-performance liquid chromatography (HPLC-UV) was developed and validated to determine the pharmacokinetic profile of triamcinolone acetonide in silicone oil and aqueous humor of rabbits’ eyes submitted to the pars plana vitrectomy surgery. The method was successfully applied to quantify the drug remaining in silicone oil and aqueous humor (LOQ range of 1 μg/mL). The triamcinolone acetonide remained in silicone oil and aqueous humor of vitrectomized rabbits’ eyes for four weeks after the intravitreal injections.

      Graphical abstract



      Highlights

      •High-performance liquid chromatography method was developed and validated.•Administration of TA injections in rabbits’ eyes.•Method was successfully applied to quantify the drug in SO and aqueous humor.•TA remained in SO and aqueous humor of rabbits’ eyes for 4 weeks.•SO may play an important role in the elimination of lipophilic drugs.

      Gabriella M. Fernandes-Cunha, Juliana B. Saliba, Rubens C. Siqueira, Rodrigo Jorge, Armando Silva-Cunha,

      Determination of triamcinolone acetonide in silicone oil and aqueous humor of vitrectomized rabbits’ eyes: Application for a pharmacokinetic study with intravitreal triamcinolone acetonide injections (Kenalog® 40),

      Journal of Pharmaceutical and Biomedical Analysis,

      Volume 89,

      2014,

      Pages 24-27,

      ISSN 0731-7085,

      https://doi.org/10.1016/j.jpba.2013.10.025.

      (http://www.sciencedirect.com/science/article/pii/S0731708513004846)


      Keywords: Silicone oil; Triamcinolone acetonide; Intravitreal injections; Vitrectomy; HPLC-UV


    • INTRAVITREAL INJECTION OF RANIBIZUMAB DURING CATARACT SURGERY IN PATIENTS WITH DIABETIC MACULAR EDEMA

      PAULO I. RAUEN, MD,* JEFFERSON A. S. RIBEIRO, MD,* FELIPE P. P. ALMEIDA, MD,* INGRID U. SCOTT, MD, MPH,† ANDRÉ MESSIAS, MD, PHD,* RODRIGO JORGE, MD, PHD* Purpose:

      To investigate macular thickness and visual acuity changes after 1 intravitreal injection of 0.5-mg ranibizumab during phacoemulsification cataract surgery in eyes with diabetic macular edema refractory to laser treatment. Methods:

      Eleven eyes of 11 patients with diabetic macular edema refractory to modified Early Treatment Diabetic Retinopathy Study laser therapy received intravitreal during phacoemulsification cataract surgery. Comprehensive ophthalmic evaluation was per- formed preoperatively and at 1, 4, 8 ± 1, and 12 ± 2 weeks postoperatively. Main outcome measures included central subfield thickness and best-corrected Early Treatment Diabetic Retinopathy Study visual acuity. Results:

      Eleven patients completed the 12-week study visit. Mean central subfield thickness (±SEM) was 399.82 ± 29.50 mm at baseline and did not change significantly at any postoperative study visit (P . 0.05). Mean (±SEM) best-corrected Early Treatment Diabetic Retinopathy Study visual acuity was 0.95 ± 0.13 logarithm of the minimum angle of resolution (20/200) at baseline and was significantly improved at Weeks 1 (0.38 ± 0.13), 4 (0.38 ± 0.11), 8 (0.35 ± 0.08), and 12 (0.46 ± 0.12) after treatment (P , 0.05). Conclusion:

      In this case series of patients with diabetic macular edema refractory to laser therapy, intravitreal ranibizumab administered during cataract surgery was associated with no significant change in central subfield thickness postoperatively. Significant improvement in best-corrected Early Treatment Diabetic Retinopathy Study visual acuity was observed after treatment, likely because of cataract removal. RETINA 0:1–5, 2012


    • INTRAVITREAL INJECTION VERSUS SUBTENON INFUSION OF TRIAMCINOLONE ACETONIDE DURING CATARACT SURGERY IN PATIENTS WITH REFRACTORY DIABETIC MACULAR EDEMA CLECIO TAKATA, MD,* ANDRE MESSIAS, MD, PHD,* MARCO S. FOLGOSA, MD,* LEVY R. LUCENA, MD,* DANIEL R. LUCENA, MD, PHD,* INGRID U. SCOTT, MD, MPH,† RODRIGO JORGE, MD, PHD* Purpose:

      Thepurposeofthisstudywastocomparetheeffectivenessofintravitrealinjection (IVT) versus posterior subtenon infusion (STI) of triamcinolone acetonide performed during phacoemulsification cataract surgery in eyes with refractory diffuse diabetic macular edema. Methods: Twenty-four eyes of 24 patients with refractory diffuse diabetic macular edema scheduled to undergo phacoemulsification cataract surgery were randomly assigned to re- ceive either a 4-mg IVT (n 􏰀 12) or a 40-mg STI (n 􏰀 12) of triamcinolone acetonide during cataract surgery. Comprehensive ophthalmic evaluation, including best-corrected visual acu- ity, intraocular pressure, and central macular thickness measured with optical coherence tomography, was performed at baseline and at 1, 4, 8 􏰁 1, 12 􏰁 2, and 24 􏰁 2 weeks postoperatively. Results:

      Ten patients from the IVT group and 9 patients from the STI group completed the 24-week study visit. Mean baseline best-corrected visual acuity (logarithm of the minimum angle of resolution) was 20/259 and 20/222 in the IVT and STI groups, respec- tively (t 􏰀 0.41; P 􏰀 0.3407). A significant improvement in best-corrected visual acuity was observed only in the IVT group at 4 weeks (mean difference 􏰁 standard error, improved to 20/116; P 􏰀 0.0437), 8 weeks (20/110; P 􏰀 0.0355), and 12 weeks (20/121; P 􏰀 0.0471) postoperatively. There was no significant change from baseline in mean intraocular pressure in either group. Mean 􏰁 standard error baseline central macular thickness was 474.1 􏰁 42.4 􏰅m and 490.8 􏰁 70.8 􏰅m in the IVT and STI groups, respectively (t 􏰀 0.21; P 􏰀 0.5807). The central macular thickness reductions after surgery at all study follow-up visits were significantly greater in the IVT group than in the STI group (P 􏰂 0.05). Conclusion:

      These data suggest that IVT is more effective than STI of triamcinolone acetonide for the management of refractory diffuse diabetic macular edema in eyes undergoing phacoemulsification. Further investigation of a larger number of patients with longer follow-up is necessary to confirm these findings. RETINA X:1–1, 2010


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