Intravitreal ranibizumab as adjuvant treatment for neovascular glaucoma121Figure 2: Right eye of a 56-year-old male with neovascular glaucomasecon<strong>da</strong>ry to proliferative diabetic retinopathy, submitted tointravitreal Ranibizumab and trabeculectomy with 0.5% C mitomycin;note the partially encapsulated bleb with good IOP control un<strong>de</strong>r oneantiglaucoma medication (6-month follow up)measures inclu<strong>de</strong>d 6-month best correct visual acuity (BCVA)and anti-glaucoma medications to control IOP at 6-month followup (Table 1). All eyes showed regression of rubeosis iridis andIOP control. Visual acuity improved in two eyes, worsened inone eye, and r<strong>em</strong>ained stable in two eyes. There were notreatment-related adverse effects.DISCUSSIONThis article <strong>de</strong>scribes a consecutive case series of 5 eyes(5 patients) with NVG. Two patients un<strong>de</strong>rwent only intravitrealranibizumab injection and obtained IOP control after theprocedure un<strong>de</strong>r anti-glaucoma medications. Beutel et al.evaluated the long-term effects of intraocular bevacizumabinjections as adjuvant treatment in patients with neovascularglaucoma and hypothesized that bevacizumab may be beneficialas adjuvant treatment because of its anti-angiogenic properties,its ability to induce new vessels regression and to preventprogression of angular obstruction. (2,3)Three patients un<strong>de</strong>rwent trabeculectomy with mitomycinC on the 7th <strong>da</strong>y after the intravitreal ranibizumab injection,with successful IOP control, two eyes without antiglaucomamedication and one un<strong>de</strong>r one antiglaucoma medication at 6-month follow up (Figure 2). There are reports that intravitrealbevacizumab injection may be an effective adjunct totrabeculectomy in NVG. (5) Although there was no improv<strong>em</strong>entin visual acuity due to patients’ severe disease, the IOP reductionwas achieved with treatment, which traditionally does not occurwith stan<strong>da</strong>rd filtering procedures without anti-VEGF.Trabeculectomy for NVG eyes has been <strong>de</strong>scribed as achallenging treatment with a poor surgical success rate. (1)We are unaware of previous reports using ranibizumab asan adjuvant treatment in patients with neovascular glaucoma.This antibody fragment inhibits all forms of biologically activeVEGF and its use is specifically intraocular, with known localand syst<strong>em</strong>ic safety but we should concern about the cost oftherapy and the benefit to the patient.These <strong>da</strong>ta suggest that ranibizumab may also be a usefultool in the treatment of this <strong>de</strong>vastating disease. Randomizedclinical trials are necessary to confirm the importance of thisadjuvant therapy for the treatment of NVG.REFERENCES1. Allingham RR, Damji KF, Freedman S, Moroi SE, Shafranov G. Shieldstextbook of glaucoma. 5th ed. Phila<strong>de</strong>lphia, PA: Lippincott Williams& Wilkins; 2005. p. 328-46.2. Parrish R, Hershler J. Eyes with end-stage neovascular glaucoma.Natural history following successful modified filtering operation. ArchOphthalmol.1983;101(5):745-6.3. Beutel J, Peters S, Lüke M, Aisenbrey S, Szurman P, Spitzer MS, YoeruekE; Bevacizumab Study Group, Grisanti S. Bevacizumab as adjuvantfor neovascular glaucoma. Acta Ophthalmol. 2010;88(1):103-9. Commentin Acta Ophthalmol. 2010;88(4):e133.4. Douat J, Auriol S, Mahieu-Durringer L, Ancèle E, Pagot-Mathis V,Mathis A. [Intravitreal bevacizumab for treatment of neovascular glaucoma.Report of 20 cases]. J Fr Ophtalmol. 2009;32(9):652-63.5. Saito Y, Higashi<strong>de</strong> T, Take<strong>da</strong> H, Ohkubo S, Sugiyama K. Beneficial effectsof preoperative intravitreal bevacizumab on trabeculectomy outcomesin neovascular glaucoma. Acta Ophthalmol. 2010;88(1):96-102.Corresponding Author:Flavia Gazze TiclyRua Izabel Negrão Bertotti, nº 100 - apto. 112BCEP 13087-508 - Campinas (SP), BrazilTel: (19) 8177-3499<strong>em</strong>ail: flaviaticly@yahoo.com.brRev Bras Oftalmol. 2013; 72 (2): 119-21
122RELATO DE CASOAssociation of macular microhole and optic disc pitAssociação <strong>de</strong> microburaco macular e fosseta <strong>de</strong> papilaRenata Leite <strong>de</strong> PinhoTavares 1 , Fernando José <strong>de</strong> Novelli 2 , Mário Junqueira Nóbrega 1 , Evandro Luis Rosa 2RESUMOA fosseta <strong>de</strong> papila do nervo óptico e o microburaco macular são duas patologias raras, cuja probabili<strong>da</strong><strong>de</strong> <strong>de</strong> coexistência se tornaextr<strong>em</strong>amente baixa, <strong>em</strong>bora não haja relação fisiopatológica entre ambas, <strong>de</strong>screver<strong>em</strong>os um caso <strong>de</strong> associação <strong>da</strong>s mesmas,acometendo comumente um olho, a fim <strong>de</strong> analisar as manifestações clínicas, os exames <strong>de</strong> OCT, angiografia, retinografia,biomocroscopia, o tratamento e a correlação entre ambas patologias.Descritores: Perfurações retinianas/terapia; Fundo <strong>de</strong> olho; Disco óptico/anormali<strong>da</strong><strong>de</strong>s; Tomografia <strong>de</strong> coerência óptica;Relatos <strong>de</strong> casosABSTRACTOptic disc pit and macular microhole are two rare pathologies with an extr<strong>em</strong>ely low likelihood of coexistence, this paper will report anassociation of both pathologies in the same eye with the purpose of analyzing clinical manifestations, tests, angiography, OCT, retinography,biomocroscopy, treatment outcome and the connection between the optic disc pit and macular microhole.Keywords: Retinal perforations/therapy; Fundis oculi; Optic disc/abnormalities; Tomography, optical coherence; Case reports1Facul<strong>da</strong><strong>de</strong> <strong>de</strong> Medicina, Universi<strong>da</strong><strong>de</strong> <strong>da</strong> Região <strong>de</strong> Joinville (Univille) – Joinville (SC), Brasil;2Hospital <strong>de</strong> Olhos Sa<strong>da</strong>lla Amin Ghan<strong>em</strong> - Joinville (SC), Brasil.O autor <strong>de</strong>clara não haver conflitos <strong>de</strong> interesseRecebido para publicação <strong>em</strong>: 12/9/2011 - Aceito para publicação <strong>em</strong>: 14/10/2012Rev Bras Oftalmol. 2013; 72 (2): 122-4
- Page 1 and 2: Versão impressavol. 72 - nº 2 - M
- Page 3 and 4: 80Revista Brasileira de Oftalmologi
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- Page 23 and 24: 100Ambrósio Jr R, Ramos I, Luz A,
- Page 25 and 26: 102Ambrósio Jr R, Ramos I, Luz A,
- Page 27 and 28: 104Caballero JCS, Centurion VINTROD
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- Page 35 and 36: 112 ARTIGO ORIGINALFluência do las
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- Page 39 and 40: 116RELATO DE CASOAsymptomatic ocula
- Page 41 and 42: 118Freitas LGA, Gabriel LAR, Isaac
- Page 43: 120Ticly FG, Lira RPC, Fulco EAM, V
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- Page 49 and 50: 126Marback EF, Freitas MS, Spínola
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- Page 55 and 56: 132 ARTIGO DE REVISÃOAntifúngicos
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- Page 67 and 68: 144Rehder JRCL, Paulino LV, Paulino
- Page 69 and 70: 146Rehder JRCL, Paulino LV, Paulino
- Page 71 and 72: 148Instruções aos autoresA Revist
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