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The British Journal of Ophthalmology Apr 2004To evaluate the risk factors for rubeosis iridis by colour Doppler imaging (CDI) in patients with complete internal carotid artery occlusion (ICAO).
AIM
To evaluate the risk factors for rubeosis iridis by colour Doppler imaging (CDI) in patients with complete internal carotid artery occlusion (ICAO).
METHODS
34 eyes of 32 consecutive patients with complete ICAO were enrolled. Using CDI, blood flow direction (forward, reverse, undetectable) in the ophthalmic artery (OA), central retinal artery (CRA), and short posterior ciliary artery (SPCA) were determined. Arterial mean blood velocity (Vmean) and resistive index (RI) were calculated and correlations between the rubeosis iridis incidence and CDI parameters analysed.
RESULTS
The eyes were classified into four types according to blood flow direction: forward flow in OA, CRA, and SPCA (type 1; n = 11); reverse OA and forward CRA and SPCA flow (type 2a; n = 12); reverse OA and undetectable CRA and SPCA flow (type 2b; n = 8); undetectable flow in all three arteries (type 3; n = 3). Rubeosis iridis was seen only in type 2b and 3 eyes. Type 2b showed significantly (p<0.01) higher Vmean and lower RI values in the OA, indicating more rapid reverse flow than in type 2a eyes. Although in type 1 and 2a eyes OA flow was in opposite directions, they manifested no rubeosis iridis and no difference in the Vmean and RI values of the CRA and SPCA.
CONCLUSIONS
The classification of eyes from patients with ICAO into four types by CDI may facilitate the identification of the eyes at high risk for rubeosis iridis. Markedly diminished flow in both the CRA and SPCA may result in rubeosis iridis, regardless of OA flow direction.
Topics: Adult; Aged; Blood Flow Velocity; Carotid Artery Diseases; Carotid Artery, Internal; Eye Diseases; Female; Humans; Ischemia; Male; Middle Aged; Ophthalmic Artery; Prospective Studies; Regional Blood Flow; Ultrasonography, Doppler, Color
PubMed: 15031166
DOI: 10.1136/bjo.2003.025809 -
Graefe's Archive For Clinical and... Apr 2020To demonstrate superiority of intravitreal ranibizumab 0.5 mg compared to focal and peripheral laser treatment in patients with radiation retinopathy for choroidal... (Randomized Controlled Trial)
Randomized Controlled Trial
PURPOSE
To demonstrate superiority of intravitreal ranibizumab 0.5 mg compared to focal and peripheral laser treatment in patients with radiation retinopathy for choroidal melanoma.
METHODS
Inclusion criteria were as follows: patients with radiation retinopathy and visual acuity impairment due to radiation maculopathy accessible for laser therapy, age ≥ 18 years, and BCVA less than 20/32. The main objective was to study the change in best-corrected visual acuity (BCVA) over 6 months from ranibizumab 0.5 mg (experimental) compared to focal laser of the macula and panretinal laser treatment of the ischemic retina (control) in patients with radiation retinopathy in choroidal melanoma. The secondary objectives of the radiation retinopathy study were to compare functional and anatomical results between ranibizumab and laser group over 12 months and to measure the frequency of vitreous hemorrhage and rubeosis iridis.
RESULTS
The intention-to-treat analysis included 31 patients assigned to ranibizumab (n = 15) or laser treatment (n = 16). In terms of BCVA at month 6, ranibizumab was superior to laser treatment, with an advantage of 0.14 logMAR, 95% CI 0.01 to 0.25, p = 0.030. The positive effect of ranibizumab disappeared after treatment was discontinued. Similar results without statistically significant difference were found with respect to macular thickness. In both groups, no change was observed at month 6 in the size of ischemia in the macula or periphery compared to baseline. There was 1 case of vitreous hemorrhage in the laser group and no case of rubeosis iridis over time.
CONCLUSIONS
This study showed a statistically significant improvement in visual acuity and clear superiority of ranibizumab compared to laser treatment up to 26 weeks, but this effect disappeared at week 52 after completion of intravitreal treatment. Ranibizumab and PRP are considered equivalent in terms of the non-appearance of proliferative radiation retinopathy during the study.
TRIAL REGISTRATION
EudraCT Number: 2011-004463-69.
Topics: Aged; Angiogenesis Inhibitors; Female; Follow-Up Studies; Humans; Intravitreal Injections; Laser Coagulation; Male; Middle Aged; Prospective Studies; Radiation Injuries; Ranibizumab; Retina; Retinal Diseases; Single-Blind Method; Tomography, Optical Coherence; Treatment Outcome; Vascular Endothelial Growth Factor A; Visual Acuity
PubMed: 32112140
DOI: 10.1007/s00417-020-04618-7 -
African Health Sciences Sep 2021Neovascular glaucoma (NVG), a form of secondary glaucoma has varying causes across geographical locations.
BACKGROUND
Neovascular glaucoma (NVG), a form of secondary glaucoma has varying causes across geographical locations.
OBJECTIVE
The objective of this study was to determine the presentation, aetiology, and outcome of treatment of patients with NVG in a Nigerian tertiary hospital.
METHOD
A retrospective review of records of all cases of NVG seen over a 5year period was carried out. Demographic characteristics, presenting visual acuity and coexisting ocular and systemic conditions were noted. Data were analysed with Statistical Package for Social Sciences (SPSS) version 25.
RESULTS
29 eyes of patients with NVG were analysed. Most of the patients (89.70%) presented with visual acuity less than 3/60 in the affected eye. All patients except one were treated with anti-glaucoma medications while only 9(31%) consented to and received anti-vascular endothelial growth factor. No patient had improvement in visual acuity despite resolution of other symptoms at 12week follow up.
CONCLUSION
NVG though not as common as other forms of glaucoma accounted for a large proportion of monocular blindness in the affected eyes at presentation. There is need for health promotion and education among our people on the need for early preventive eye check practices.
Topics: Glaucoma, Neovascular; Humans; Intraocular Pressure; Nigeria; Retrospective Studies; Treatment Outcome; Visual Acuity
PubMed: 35222591
DOI: 10.4314/ahs.v21i3.37 -
Cureus Sep 2021Eales' disease is an idiopathic vasculitis that affects the peripheral retina. It is characterized by recurrent vitreous hemorrhage as a complication of retinal...
Eales' disease is an idiopathic vasculitis that affects the peripheral retina. It is characterized by recurrent vitreous hemorrhage as a complication of retinal neovascularization. It is more prevalent in India and affects young males. Here, we present a patient with neovascular glaucoma as a rare first presentation of Eales' disease. This is a 24-year-old Indian male, who complained of a sudden decrease in vision in the left eye over less than 24 hours, along with frontal headache and eye pain for the last three weeks. Ocular examination revealed peripheral retinal ischemia in the right eye, very high intraocular pressure, rubeosis iridis, vitreous hemorrhage and extensive retinal ischemia in the left eye, vascular sheathing and neovascularization in both eyes. The purified protein derivative skin test was positive. The patient was managed with anti-glaucoma, intravitreal anti-vascular endothelial growth factor and laser photocoagulation. Systemic steroids and anti-tuberculous therapy were also initiated. Neovascular glaucoma is an infrequent complication of Eales' disease. However, the lack of early detection of the disease in the early stages might lead to such serious complications.
PubMed: 34722077
DOI: 10.7759/cureus.18302 -
Archives of Medical Science : AMS Mar 2019The aim of the study was to investigate the effects of vascular endothelial growth factor (VEGF) concentration in vitreous on postoperative complications after pars...
INTRODUCTION
The aim of the study was to investigate the effects of vascular endothelial growth factor (VEGF) concentration in vitreous on postoperative complications after pars plana vitrectomy (PPV).
MATERIAL AND METHODS
Ninety subjects were surgically treated with PPV and followed up for 12 months at the Clinical Centre University Sarajevo, Clinic for Eye Disease. Exclusion criteria were presence of other eye diseases, systemic acute/chronic inflammatory conditions, or malignant neoplasms; previously performed PPV surgery; previously received intravitreal or systemic anti-VEGF therapy. A vitreous sample was obtained while performing the PPV procedure, using the Quantikine ELISA test to determine VEGF level, as a risk factor. Outcome measures were intraoperative and postoperative complications reported using categorical data: blunt and sharp dissection of membranes, intraoperative hemorrhage stopped by increasing infusion pressure, pressing with blunt instrument, or using diathermy. The following postoperative complications were assessed on the first day and at the 12-month follow-up visit: vitreous hemorrhage, fibrovascular proliferation (FVP), rubeosis iridis, and neovascular glaucoma (NVG).
RESULTS
Levels of vitreous VEGF at the time of PPV were significantly higher in eyes with: vitreous hemorrhage on the first day after PPV ( = 0.003); FVP on the first day and 12 months after PPV ( = 0.002 and < 0.001, respectively); iris rubeosis on the first day and 12 months after PPV surgery ( < 0.001, and = 0.001, respectively); NVG on the first day and 12 months after PPV surgery ( = 0.043 and = 0.011, respectively), compared to the eyes without complications.
CONCLUSIONS
Preoperative levels of VEGF in vitreous can be a useful biomarker and predictor of the postoperative outcome in terms of intraoperative and postoperative complications.
PubMed: 30899298
DOI: 10.5114/aoms.2018.73208 -
BMC Ophthalmology May 2018To evaluate symptoms, therapies and outcomes in rare microbial keratitis-induced endophthalmitis.
BACKGROUND
To evaluate symptoms, therapies and outcomes in rare microbial keratitis-induced endophthalmitis.
METHODS
Retrospective study with 11 patients treated between 2009 and 2014. Clinical findings, corneal diseases, history of steroids and trauma, use of contact lenses, number and type of surgical interventions, determination of causative organisms and visual acuity (VA) were evaluated.
RESULTS
The incidence of transformation from microbial keratitis to an endophthalmitis was 0.29% (n = 11/3773). In 90.9% (n = 10/11), there were pre-existent eyelid and corneal problems, in 45.5% (n = 5/11) rubeosis iridis with increased intraocular pressure and corneal decompensation, and in 18.2% (n = 2/11), ocular trauma. Specimens could be obtained in 10 of 11 samples: 33.3% of those 10 specimens were Gram-positive coagulase-negative Staphylococci (n = 3/10) or Gram-negative rods (n = 3/10) and 10.0% Staphylococcus aureus (n = 1/10). In 30% (n = 3/10), no pathogens were identifiable. 72.7% (n = 8/11) of all keratitis-induced endophthalmitis were treated with vitrectomy and 9.1% (n = 1/11) with amniotic-membrane transplantation. In 27.3% (n = 3/11) the infected eye had to be enucleated - 18.2% (n = 2/11) primarily, 9.1% (n = 1/11) secondarily. No patient suffered from sympathetic ophthalmia. The median initial VA was 2.1 logMAR (n = 11/11). At one month, median VA was 2.0 logMAR (n = 7/11), after three months 2.0 logMAR (n = 6/11), and after one year 2.05 logMAR (n = 6/11). The change in VA was not significant (p > 0.99). 36.4% (n = 4/11) of the cases resulted in blindness.
CONCLUSIONS
The overall outcome is poor. Enucleation should be weighed against the risk of local and systemic spread of the infection, prolonged rehabilitation and sympathetic ophthalmia.
Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Endophthalmitis; Eye Enucleation; Eye Infections, Bacterial; Female; Gram-Negative Bacterial Infections; Gram-Positive Bacterial Infections; Humans; Incidence; Keratitis; Male; Middle Aged; Prognosis; Retrospective Studies; Risk Factors; Steroids; Visual Acuity; Vitrectomy
PubMed: 29724209
DOI: 10.1186/s12886-018-0777-3 -
Indian Journal of Ophthalmology 2010To describe the clinical features, treatment and outcome patterns in 307 eyes with Coats' disease.
AIM
To describe the clinical features, treatment and outcome patterns in 307 eyes with Coats' disease.
MATERIALS AND METHODS
Retrospective chart review of patients diagnosed with Coats' disease between January 1996 and January 2006 from a single referral center in southern India.
RESULTS
Two hundred and eighty patients (307 eyes) with mean age of 15.67 years (range: Four months-80 years) were included. Decreased vision (77%), unilateral affection (90%) and male preponderance (83.4%) were chief presenting features. Anterior segment involvement was seen in 67 (21.8%) eyes. Retinal telangiectasia were seen in 302 (99%) eyes, exudation in 274 (89%) eyes and retinal detachment in 158 (51.5%) eyes. Four-quadrant disease was seen in 207 (67.2%) eyes. Visual acuity was <20/200 in 249 (80.9%) eyes. One hundred and nine of 176 treated eyes (61.93%) had favorable anatomical outcome; 207 of 280 eyes (74%) had an optimal structural outcome. Seventeen (5.3%) eyes were enucleated. Complications following treatment included phthisis bulbi (7%), neovascular glaucoma (5%), epiretinal membrane (4.4%) and rubeosis iridis (4.4%).
CONCLUSION
Indian patients with Coats' disease have a high male predominance, the majority of whom present with severe visual impairment and extensive four-quadrant exudation. Unusual presentations such as pain, vitreous hemorrhage and a high incidence of anterior segment involvement are distinctive to Indian eyes.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Female; Humans; Infant; Male; Middle Aged; Retinal Diseases; Young Adult
PubMed: 20195034
DOI: 10.4103/0301-4738.60081 -
BMJ Case Reports May 2021Chronic myeloid leukaemia (CML) is a myeloproliferative neoplasm that can present in varied ways from incidental finding on haemogram to symptomatic presentation such as...
Chronic myeloid leukaemia (CML) is a myeloproliferative neoplasm that can present in varied ways from incidental finding on haemogram to symptomatic presentation such as splenomegaly. We report an interesting case of a 22-year-old man who presented with loss of vision in right eye for 1 month. There were no pre-existing ocular or systemic diseases. On detailed ocular examination, a diagnosis of right eye rubeosis iridis, hyphaema, cataract and vitreous haemorrhage with left eye suspected leukaemic retinopathy was made. Routine haemogram revealed high leucocytosis. Systemic evaluation with investigations confirmed the diagnosis of CML and the patient was started on appropriate therapy.
Topics: Adult; Cataract; Humans; Hyphema; Iris; Leukemia, Myelogenous, Chronic, BCR-ABL Positive; Male; Vitreous Hemorrhage; Young Adult
PubMed: 34031076
DOI: 10.1136/bcr-2020-240949 -
Journal of Vascular Surgery Dec 2012Severe carotid stenosis may be associated with uncommon clinical symptoms. We report a case of ocular ischemic syndrome and subsequent rubeosis iridis due to a...
Severe carotid stenosis may be associated with uncommon clinical symptoms. We report a case of ocular ischemic syndrome and subsequent rubeosis iridis due to a high-grade carotid stenosis. The patient recovered visual acuity and his normal iris coloring after carotid endarterectomy. Rubeosis iridis may be the only clinical sign associated with severe carotid stenosis, making it mandatory to rule out the presence of carotid narrowing when it is detected. Establishing an early diagnosis is essential to improve quality of life, prognosis, and patients' outcome.
Topics: Aged; Carotid Stenosis; Humans; Iris Diseases; Male
PubMed: 22939702
DOI: 10.1016/j.jvs.2012.06.073 -
Vojnosanitetski Pregled Sep 2009Diabetes mellitus (DM) is a metabolic disorder characterized by hyperglycemia. The aim of this study was to explore the prognosis of patients with juvenile DM regarding...
BACKGROUND/AIM
Diabetes mellitus (DM) is a metabolic disorder characterized by hyperglycemia. The aim of this study was to explore the prognosis of patients with juvenile DM regarding diabetic eye complications, as well as the course of the diabetic eye disease related to the treatment undertaken.
METHODS
The study series involved 33 patients with juvenile DM during the period 1992-2007. The influence of the following factors on the course of the disease was estimated: age, the age of the disease onset, time when eye complications appeared, treatment modalities.
RESULTS
Of the total of 33 diabetics 15 patients were followed for 10 or more years and 18 from 5 to 9 years. At the time of their first visit the mean age was 23.12 +/- 6.39 and the mean duration of DM was 17.42 +/- 7.42 years. On their first visit, 7 eyes were without any complication. Most of the patients already developed clinical signs of proliferative diabetic retinopathy (41.39%), the signs of nonproliferative diabetic retinopathy (13.13%) and macula involvement (10.10%). Diabetic cataract was found in 8.8% as well as tractional retinal detachment. Eleven out of 66 eyes were with vitreous hemorrhage. Two patients (5.5%) suffered neovascular glaucoma. There was 1 (2.2%) patient with developed rubeosis iridis and simplex glaucoma. Panretinal photocoagulation was performed in 65% of patients, focal photocoagulation in 15%, 12% patients underwent pars plana vitrectomy and 4% had cataract surgery with intraocular lens implantation and peripheral retinal kryopexy.
CONCLUSION
Total vision loss due to eye complications of juvenile DM may be prevented if timely diagnosed with regular check ups and early treatment.
Topics: Adolescent; Adult; Child; Diabetes Mellitus, Type 1; Diabetic Retinopathy; Female; Humans; Male; Young Adult
PubMed: 19877552
DOI: 10.2298/vsp0909729d