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BACKGROUND: Candida endophthalmitis is a severe complication of candidemia. Currently, the recommended treatment of fungal endophthalmitis is a combination of intravitreal and systemic antifungal drugs, and in some cases vitrectomy is also required. Intravitreal therapies that are commonly used are amphotericin B and voriconazole, although recently the use of intravitreal caspofungin has been described in a few case reports. However, clinical experience with intravitreal caspofungin is still limited. CASE PRESENTATION: We report a case of bilateral candida tropicalis endophthalmitis, initially managed with repeated 100 µg/0.1 ml caspofungin intravitreal injections and posteriorly treated with pars plana vitrectomy in both eyes. CONCLUSIONS: Intravitreal caspofungin could be a safe intravitreal alternative to habitual antimycotic drugs in cases with resistant candida endophthalmitis.Abbreviations: Intensive Care Unit (ICU); Best-Corrected Visual Acuity (BCVA).
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BACKGROUND & AIMS: Non-alcoholic fatty liver disease (NAFLD) is associated with poorer glycemic control and a higher risk of type-2 diabetes (T2D) complications, extrahepatic and cardiovascular disease (CVD). Our study aim was to evaluate the association between NAFLD, T2D complications, and the development of overall clinical events (OCE) (CV, liver-related, and mortality) in patients with T2D. METHODS: Prospective single-center study comprising T2D subjects with no history of CVD and non-T2D matched controls. Patients were selected from the Outpatient Diabetes Clinic of Vall d'Hebron Hospital and related primary care centers. RESULTS: 186 diabetics and 57 controls were included. Amongst T2D, 124/186 subjects had NAFLD (66.6%). T2D-NAFLD subjects showed a heavier metabolic burden and higher median liver stiffness (5.6kPa [4.5-7.3] vs 4.8 [4.2-5.8]; p=0.004) compared to non-NAFLD diabetics. During a median follow-up of 5.6 years, 33 (17.7%) T2D patients developed OCE vs 4 (7.0%) controls (p=0.049). No differences were found for OCE between NAFLD and non-NAFLD diabetics (16.9% vs 19.4%; p=0.68). CV was the most reported outcome and only one liver event occurred. NAFLD diabetics showed more often chronic kidney disease (CKD), whereas T2D complications and subclinical CVD rates were similar. A higher liver stiffness, older age, and male gender were independently associated with OCE amongst the entire T2D population and NAFLD diabetics. CONCLUSIONS: NAFLD and liver stiffness were associated with CKD and clinical outcomes in diabetics, respectively. A hepatic evaluation is recommended to identify high-risk T2D patients that would benefit from early referral to specialized care.
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Enfermedades Cardiovasculares , Complicaciones de la Diabetes , Diabetes Mellitus Tipo 2 , Enfermedad del Hígado Graso no Alcohólico , Insuficiencia Renal Crónica , Humanos , Masculino , Enfermedad del Hígado Graso no Alcohólico/complicaciones , Enfermedad del Hígado Graso no Alcohólico/epidemiología , Factores de Riesgo , Estudios Prospectivos , Diabetes Mellitus Tipo 2/complicaciones , Insuficiencia Renal Crónica/complicaciones , Complicaciones de la Diabetes/epidemiología , Complicaciones de la Diabetes/complicaciones , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/etiologíaRESUMEN
BACKGROUND: To identify different response patterns to intravitreal dexamethasone implants (IDI) in naïve and previously treated (PT) diabetic macular edema (DME) eyes in a real-life setting. METHODS: 342 IDI injections (203 DME eyes) were included. Number of IDI injections, percentage (%) of eyes with 1, 2, 3 and ≥ 4 injections, time to reinjections, visual acuity (VA), intraocular pressure (IOP) and central retinal thickness (CRT) were evaluated for naïve and PT DME eyes over 24 months. RESULTS: Mean number of injections was significantly lower in naïve vs PT DME eyes (1.40 ± 0.9 vs 1.82 ± 0.9, p < 0.001). The percentage of eyes receiving 1 injection was significantly higher in naïve vs PT DME eyes (76.1 vs 47.7), (p < 0.001). However, it was significantly lower for 2 (16.4 vs 29.4), or 3 injections (1.4 vs 17.6) (both p < 0.001), with no differences in eyes receiving ≥4 injections (5.9 vs 5.1 respectively, p = 0.80). Mean time to reinjection was not significantly different between both groups for the second, third and fourth injection (9.6 ± 4.0 vs 10.0 ± 5.5, p = 0.75, 13.2 ± 4.0 vs 16.0 ± 3.5, p = 0.21 and 21.7 ± 3.8 vs 19.7 ± 5.8, p = 0.55). VA scores were consistently better in naïve vs PT DME eyes at all studied timepoints, with no significant differences in CRT reduction or adverse effect rates. CONCLUSION: Naïve DME eyes received lower number of IDI injections and showed better VA levels than PT DME eyes for 24 months in a real-world setting. This data supports the IDI use in early DME stages and provide further evidence of better IDI response when used as first-line therapy.
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Diabetes Mellitus , Retinopatía Diabética , Edema Macular , Dexametasona/uso terapéutico , Retinopatía Diabética/tratamiento farmacológico , Implantes de Medicamentos , Glucocorticoides/uso terapéutico , Humanos , Inyecciones Intravítreas , Edema Macular/tratamiento farmacológico , Estudios RetrospectivosRESUMEN
PURPOSE: To evaluate the long-term cumulative probability of intraocular pressure (IOP) elevation with the intravitreal dexamethasone implant (IDI) when used to treat different indications: diabetic macular edema, uveitis, retinal vein occlusion. METHODS: 705 IDI injections (429 eyes) were assessed and Kaplan-Meier graphs were generated to assess: the probability of different levels of IOP elevation (IOP≥21, ≥25 or ≥35 mmHg), IOP change ≥10 mmHg, initiation of IOP-lowering treatment, glaucoma surgery, IOP change with repeat injections and IOP elevation in eyes with glaucoma and ocular hypertension (OHT). RESULTS: The cumulative probability of IOP ≥21, ≥25 and ≥35 mmHg was 50%-60%, 25%-30% and 6%-7% at 12-24 months, respectively. The probability of initiating IOP-lowering medication was 31%-54% at 12-24 months. Glaucoma and OHT eyes had a higher probability of mild IOP elevation (≥21 mmHg, 65.1%, 75% and 57.8%, p = 0.01), yet a similar moderate (≥25 mmHg, 22.3%, 28% and 30.2%, p = 0.91) and severe elevation of IOP (≥35 mmHg, 3.7%, 7.1% and 4%, p = 0.71) as normal eyes. Glaucoma surgery was required in only 0.9% cases (4/429). At baseline, 8.8% of the treated eyes had glaucoma, 6.7% OHT and 16.9% were already on IOP-lowering medication. CONCLUSIONS: In the long-term (24 months), IOP elevation is common, generally mild (30% IOP, ≥25 mmHg) and well-tolerated, resolving with topical treatment (54%) and rarely requiring surgery (0.9%).
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Dexametasona/uso terapéutico , Presión Intraocular/fisiología , Hipertensión Ocular/tratamiento farmacológico , Anciano , Dexametasona/administración & dosificación , Femenino , Glaucoma/tratamiento farmacológico , Glaucoma/fisiopatología , Humanos , Estimación de Kaplan-Meier , Edema Macular/tratamiento farmacológico , Edema Macular/fisiopatología , Masculino , Hipertensión Ocular/fisiopatología , Oclusión de la Vena Retiniana/tratamiento farmacológico , Oclusión de la Vena Retiniana/fisiopatología , Uveítis/tratamiento farmacológico , Uveítis/fisiopatologíaRESUMEN
Objective: Detection of subclinical cardiovascular disease (CVD) has significant impact on the management of type 2 diabetes. We examined whether the assessment of diabetic retinopathy (DR) is useful for identifying patients at a higher risk of having silent CVD. Research design and methods: Prospective case-control study comprising 200 type 2 diabetic subjects without history of clinical CVD and 60 age-matched non-diabetic subjects. The presence of subclinical CVD was examined using two parameters: (1) calcium coronary score (CACs); (2) composite of CACs >400 UA, carotid plaque ≥3 mm, carotid intima-media thickness ratio >1, or the presence of ECG changes suggestive of previous asymptomatic myocardial infarction. In addition, coronary angio-CT was performed. DR was assessed by slit-lamp biomicroscopy and retinography. Results: Type 2 diabetic subjects presented higher CACs than non-diabetic control subjects (p<0.01). Age, male gender, and the presence of DR were independently related to CACs >400 (area under the receiver operating characteristic curve (AUROC) 0.76). In addition, an inverse relationship was observed between the degree of DR and CACs <10 AU. The variables independently associated with the composite measurement of subclinical CVD were age, diabetes duration, the glomerular filtration rate, microalbuminuria, and the presence of DR (AUROC 0.71). In addition, a relationship (p<0.01) was observed between the presence and degree of DR and coronary stenosis. Conclusions: The presence and degree of DR is independently associated with subclinical CVD in type 2 diabetic patients. Our results lead us to propose a rationalized screening for coronary artery disease in type 2 diabetes based on prioritizing patients with DR, particularly those with moderate-severe degree.
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Biomarcadores/análisis , Enfermedades Cardiovasculares/diagnóstico , Grosor Intima-Media Carotídeo , Diabetes Mellitus Tipo 2/fisiopatología , Retinopatía Diabética/epidemiología , Anciano , Enfermedades Cardiovasculares/diagnóstico por imagen , Enfermedades Cardiovasculares/etiología , Estudios de Casos y Controles , Angiografía Coronaria , Retinopatía Diabética/complicaciones , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Prospectivos , Factores de Riesgo , España/epidemiología , Tomografía Computarizada por Rayos XRESUMEN
Diabetic macular edema (DME) is the most common cause of vision loss in diabetic patients. Thirty years ago, the Early Treatment Diabetic Retinopathy Study (ETDRS) demonstrated that focal/grid laser photocoagulation reduces moderate vision loss from DME by 50% or more; thus, macular photocoagulation became the gold standard treatment for DME. However, with the development of anti-VEGF drugs (bevacizumab, ranibizumab, and aflibercept), better outcomes were obtained in terms of visual acuity gain and decrease in macular thickness in some studies when antiangiogenic drugs were administered in monotherapy. Macular laser therapy may still play an important role as an adjuvant treatment because it is able to improve macular thickness outcomes and reduce the number of injections needed. Here, we review some of the clinical trials that have assessed the efficacy of macular laser treatment, either as part of the treatment protocol or as rescue therapy.
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PURPOSE: To report the surgical results of primary pseudophakic rhegmatogenous retinal detachment (RRD) with only inferior retinal breaks (IRBs) repaired by pars plana vitrectomy (PPV) alone and complete drainage of subretinal fluid. DESIGN: Prospective, interventional cohort study. PARTICIPANTS: A total of 147 consecutive pseudophakic eyes of 147 patients with primary RRD with causative inferior breaks. METHODS: All eyes underwent PPV alone and complete drainage of subretinal fluid, with air, 20% sulfur hexafluoride (SF6), or 12% perfluoropropane (C3F8) as tamponade and with no face-down position in the postoperative period. MAIN OUTCOME MEASURES: Postoperative primary and final anatomic outcome, visual acuity, and complications. RESULTS: The patient population consisted of 44 women (30%) and 103 men (70%) with a mean age of 60.8±12.9 years. The mean follow-up period was 24.9±19.4 months. The mean number of quadrants affected was 2.4 (range, 1-4). A single break was present in 90 cases (61.2%), and 2 to 4 breaks were present in 57 cases (38.8%). The macula was found to be detached in 118 cases (80.3%) and attached in 29 cases (19.7%) intraoperatively. Of 152 breaks located between 5 and 7 clock-hours, 124 breaks (81.6%) were located outside the limits of the gas bubble on the first or third day postoperatively. Initial reattachment was achieved in 139 cases (94.5%; 95% confidence interval, 89.5-97.6). Final reattachment was achieved in 147 cases (100%). Two cases (1.3%) redetached because of new or missed retinal breaks. Six cases (4.1%) redetached because of incomplete retinal adhesion of the treated break(s). Mean preoperative best-corrected visual acuity (BCVA) was 1.11±0.59 logarithm of the minimum angle of resolution (logMAR). The mean final postoperative BCVA was 0.42±0.33 logMAR. CONCLUSIONS: Pars plana vitrectomy alone with complete drainage of subretinal fluid achieves a high reattachment rate in the management of primary pseudophakic RRD due to IRBs.
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Seudofaquia/cirugía , Desprendimiento de Retina/cirugía , Perforaciones de la Retina/cirugía , Vitrectomía/métodos , Adulto , Anciano , Drenaje/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Estudios Prospectivos , Desprendimiento de Retina/patología , Líquido Subretiniano , Agudeza VisualRESUMEN
PURPOSE: To compare outcomes of eyes that did or did not develop an epiretinal membrane (ERM) after repair of primary pseudophakic or aphakic rhegmatogenous retinal detachment by pars plana vitrectomy alone. METHODS: Interventional, prospective, consecutive case series. Of 312 consecutive eyes that underwent pars plana vitrectomy for primary rhegmatogenous retinal detachment, 28 (8.97%) developed ERM during the postoperative period. Best-corrected visual acuity (BCVA) and fundus examinations were performed 1 month and 3, 6, and 12 months postoperatively. RESULTS: Eyes with an ERM more often had a break at the equator (odds ratio, 3.92; 95% confidence interval, 1.311.2; P < 0.011). At ERM diagnosis, BCVA ranged from 20/400 to 20/25 with a mean of 20/100 (0.75 logarithm of the minimum angle of resolution), and BCVA at the final visit ranged from 20/200 to 20/25 with a mean of 20/63 (0.53 logarithm of the minimum angle of resolution). Of the 22 eyes that underwent surgical removal of the ERM, BCVA was ≥ 20/40 in 5 (22.7%) before the surgical procedure and in 13 (59%) at the final follow-up visit. CONCLUSION: The incidence of ERM after pars plana vitrectomy alone for the repair of primary pseudophakic or aphakic rhegmatogenous retinal detachment was similar to reported incidences after scleral buckling. Best-corrected visual acuity improved after surgical removal of ERM, although eyes with the macula detached had lower final BCVA.
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Afaquia Poscatarata/cirugía , Membrana Epirretinal/etiología , Complicaciones Posoperatorias , Seudofaquia/cirugía , Desprendimiento de Retina/cirugía , Vitrectomía , Anciano , Afaquia Poscatarata/etiología , Endotaponamiento , Membrana Epirretinal/cirugía , Femenino , Fluorocarburos/administración & dosificación , Humanos , Incidencia , Coagulación con Láser , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Seudofaquia/etiología , Desprendimiento de Retina/etiología , Hexafluoruro de Azufre/administración & dosificación , Resultado del Tratamiento , Agudeza Visual/fisiologíaRESUMEN
PURPOSE: To review the surgical management and functional outcome of macular holes (MHs) developing after rhegmatogenous retinal detachment repair. METHODS: Retrospective, interventional, noncomparative case series. Twenty patients with MH developing after rhegmatogenous retinal detachment repair were included. Pars plana vitrectomy with internal limiting membrane peeling and gas tamponade was performed. Macular attachment status and number of best-corrected visual acuity lines of improvement after MH repair were evaluated. RESULTS: The fovea had been detached in all eyes at the time of rhegmatogenous retinal detachment repair. Six MHs developed after scleral buckling surgery and 14 MHs after vitrectomy with an encircling band. In 5 of the 20 patients, ≥ 2 operations had been required to achieve retinal reapplication. The mean time to MH diagnosis was 38 weeks. Preoperative best-corrected visual acuity was ≤ 20/100 in all but one case. Single-operation MH closure rate was 100%, with a mean of 4 Early Treatment Diabetic Retinopathy Study lines of visual improvement (P < 0.001). Mean postoperative Snellen best-corrected visual acuity was 20/70 (± 0.15) (P < 0.001). CONCLUSION: In this small retrospective study, standard surgical treatment for idiopathic MH was effective in achieving anatomical closure of these secondary MHs, but visual acuity gain was limited by the previous macula-involving rhegmatogenous retinal detachment status.
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Endotaponamiento , Complicaciones Posoperatorias , Desprendimiento de Retina/cirugía , Perforaciones de la Retina/fisiopatología , Perforaciones de la Retina/cirugía , Agudeza Visual/fisiología , Vitrectomía , Adulto , Anciano , Membrana Basal/cirugía , Femenino , Fluorocarburos/administración & dosificación , Humanos , Masculino , Microscopía Acústica , Persona de Mediana Edad , Perforaciones de la Retina/etiología , Estudios Retrospectivos , Tomografía de Coherencia ÓpticaRESUMEN
OBJECTIVE: To evaluate the association between insulin resistance and diabetic macular oedema in type 2 diabetes. METHODS: Patients with type 2 diabetes who agreed to undergo blood sampling were enrolled into this cross-sectional study. Patients who had received treatment for macular oedema within the past 3 months and those with other retinal diseases were excluded. The following data were recorded: age, sex, time of diabetes evolution, HbA1c, ophthalmologic and systemic treatment, and lens status. Optical coherence tomography (OCT) was performed to determine the morphological patterns of macular oedema. Insulin resistance was established by a McAuley index of <6.3 and fasting insulin levels of >16 mU/l. RESULTS: A total of 177 eyes from 90 patients were included; 27.1% of eyes were from insulin-resistant patients. There were no differences in age, time of evolution, sex, HbA1c level or lens status between insulin-resistant and non-resistant patients. Insulin-resistant patients were more likely to have exogenous insulin therapy (p<0.05; OR=3.8). An association was found between diabetic cystoid macular oedema and insulin resistance (Fisher exact test p=0.007; OR=2.53, 95% CI 1.52 to 4.2). There were no associations between insulin resistance and the other morphological patterns of oedema. Patients undergoing insulin therapy were found to have an association with a diffuse retinal thickening pattern on OCT (p=0.036; OR=1.4). However, no association was found between insulin therapy and the presence of cystoid macular oedema. CONCLUSIONS: The findings of this study indicate a relationship between insulin resistance and cystoid macular oedema that unrelated to the use of insulin. Insulin treatment was associated with diffuse macular oedema.
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Diabetes Mellitus Tipo 2/etiología , Retinopatía Diabética/etiología , Resistencia a la Insulina/fisiología , Edema Macular/etiología , Estudios Transversales , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Retinopatía Diabética/sangre , Retinopatía Diabética/tratamiento farmacológico , Hemoglobina Glucada/metabolismo , Humanos , Hipoglucemiantes/uso terapéutico , Insulina/uso terapéutico , Edema Macular/sangre , Edema Macular/tratamiento farmacológico , Tomografía de Coherencia ÓpticaRESUMEN
OBJECTIVE: To report on pars plana vitrectomy with diffuse illumination, wide-angle viewing, and meticulous vitreous dissection for identifying and managing retinal breaks when no breaks were detected before surgery for primary rhegmatogenous retinal detachment. METHODS: Prospective clinical study of 61 of 800 consecutive eyes (7.6%) (61 of 782 patients) seen at a university hospital during the 48-month study for primary rhegmatogenous retinal detachment in whom no break could be identified preoperatively despite thorough examinations. All of the patients underwent pars plana vitrectomy alone with meticulous peripheral vitreous dissection assisted by diffuse illumination, a wide-angle viewing system, perfluorocarbon liquid, triamcinolone acetonide suspension, and balanced salt solution to identify and manage primary retinal breaks. RESULTS: Retinal breaks were found intraoperatively in 60 eyes (98%). In 51 of 61 eyes (84%), balanced salt solution was left in the vitreous cavity. Best-corrected visual acuity was 20/40 or better in 25 of 61 study eyes (41%). Primary retinal reattachment was attained in 60 study eyes (98%). Final reattachment was achieved in all 61 eyes (100%). CONCLUSIONS: Pars plana vitrectomy alone with diffuse illumination and extensive vitreous dissection led to identification and management of retinal breaks undetectable before surgery, achieving a high primary reattachment rate.
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Desprendimiento de Retina/cirugía , Perforaciones de la Retina/diagnóstico , Perforaciones de la Retina/cirugía , Vitrectomía , Cuerpo Vítreo/cirugía , Acetatos , Adulto , Anciano , Anciano de 80 o más Años , Criocirugía , Combinación de Medicamentos , Femenino , Fluorocarburos/administración & dosificación , Humanos , Periodo Intraoperatorio , Iluminación , Masculino , Persona de Mediana Edad , Minerales , Estudios Prospectivos , Aceites de Silicona/administración & dosificación , Cloruro de Sodio , Triamcinolona Acetonida , Agudeza Visual/fisiología , Adulto JovenRESUMEN
This paper reviews the current experience and trends in 23-gauge transconjunctival sutureless vitrectomy for diabetic retinopathy in those patients that need a surgical intervention for either vitreous hemorrhage, fibrovascular proliferation with traction retinal detachment affecting or threatening the macula, traction-rhegmatogenous retinal detachment, or refractory macular edema with taut posterior hyaloid. Since the instruments in 23-gauge vitrectomy are less flexible and perform in a more similar way to 20-gauge instruments, the vitrectomy is more thorough and for more complex manoeuvres can be done. The 23-gauge transconjuntival sutureless vitrectomy avoids some of the shortcomings of the 25-gauge systems.
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Retinopatía Diabética/cirugía , Edema Macular/cirugía , Desprendimiento de Retina/cirugía , Vitrectomía/métodos , Retinopatía Diabética/complicaciones , Retinopatía Diabética/patología , Femenino , Humanos , Edema Macular/etiología , Masculino , Desprendimiento de Retina/etiología , SuturasRESUMEN
PURPOSE: To evaluate photodynamic therapy (PDT) for symptomatic circumscribed choroidal hemangioma (CCH). DESIGN: Prospective, multicenter, nonrandomized clinical trial. PARTICIPANTS: Thirty-one eyes of 31 patients with posterior pole CCH and symptoms caused by exudation into the macular area. INTERVENTION: Photodynamic therapy was applied by Zeiss laser. Intravenous verteporfin at 6 mg/m(2) body surface was administered before treatment, and light emitted at 689 nm for photosensitization. The treatment spot diameter was calculated on early-phase frames of pretreatment indocyanine green angiography. Fifteen minutes after starting the verteporfin infusion, the laser beam was applied to the retina at radiant exposure 50 J/cm(2) and exposure time 83 seconds. One to 4 treatments were applied at 12-week intervals over 1 year. Standardized evaluation was performed before and at 4-week intervals after each treatment, and at 3, 6, 9, and 12 months. All patients were followed for >or=12 months. MAIN OUTCOME MEASURES: The primary outcome measure was the absence of exudative retinal detachment at the 12-month follow-up visit on ophthalmoscopy, fluorescein angiography, and optical coherence tomography. Secondary measures were the visual acuity outcome, with best-corrected visual acuity determined by the Early Treatment for Diabetic Retinopathy Study chart, tumor thickness decrease on B-scan ultrasonography, and adverse events. RESULTS: Among the total, 82.8% of patients required 1, 13.8% 2, and 3.4% 3 PDTs to eliminate exudative retinal detachment. Visual acuity increased from a mean of 20/60 to 20/35 (P<0.001). Sixty-nine percent of patients demonstrated visual recovery (P<0.001). Cystoid macular edema regressed in all cases and exudative macular detachment disappeared in all but 2 cases. The CCH thickness decreased in all cases from a mean of 3.0 to 1.7 mm, with the most intense effect seen after 4 weeks of treatment (P<0.001). Visual fields showed resolution of central scotomas. There were no severe adverse events. CONCLUSIONS: Combining PDT with the standard age-related macular degeneration protocol is an effective treatment for CCH in terms of resolution of exudative subretinal fluid and recovery of VA. FINANCIAL DISCLOSURE(S): The authors have no proprietary or commercial interest in any materials discussed in this article.
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Neoplasias de la Coroides/tratamiento farmacológico , Hemangioma/tratamiento farmacológico , Fotoquimioterapia , Fármacos Fotosensibilizantes/uso terapéutico , Porfirinas/uso terapéutico , Adulto , Anciano , Neoplasias de la Coroides/diagnóstico , Colorantes , Femenino , Angiografía con Fluoresceína , Hemangioma/diagnóstico , Humanos , Verde de Indocianina , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Tomografía de Coherencia Óptica , Resultado del Tratamiento , Verteporfina , Agudeza VisualAsunto(s)
Líquidos Corporales , Mácula Lútea/patología , Desprendimiento de Retina/diagnóstico , Tomografía de Coherencia Óptica/métodos , Exudados y Transudados , Fluorocarburos/administración & dosificación , Humanos , Edema Macular/diagnóstico , Desprendimiento de Retina/cirugía , Curvatura de la Esclerótica , Hexafluoruro de Azufre/administración & dosificación , Agudeza Visual , VitrectomíaRESUMEN
PURPOSE: To evaluate the effectiveness of radial optic neurotomy (RON) for central retinal vein occlusion (CRVO) in patients < or =50 years of age (group 1) vs those >50 (group 2). DESIGN: Prospective, interventional, comparative case series. METHODS: The study included 43 consecutive patients with CRVO and preoperative visual acuity (VA) < or =0.70 logarithm of minimal angle of resolution (logMAR). All patients underwent pars plana vitrectomy and RON at the nasal border of the optic disk. VA and optical coherence tomography (OCT) findings were recorded preoperatively and at one, six, and 12 months postoperatively. RESULTS: Systemic hypertension, diabetes, and open-angle glaucoma were statistically significantly more prevalent in group 2 (P < .05). One patient in group 1 had hyperhomocysteinemia, and had another antiphospholipid syndrome. Fifty percent of patients in group 1 gained > or =3 lines of Early Treatment Diabetic Retinopathy Study (ETDRS) vision, vs 33% in group 2. Mean final VA was 0.5 logMAR VA in group 1 vs 0.8 in group 2 (P = .04). Foveal thickness decreased significantly in both groups (P < .001). Ten patients (55.6%) in group 1 and 13 (54.2%) in group 2 developed retinochoroidal collaterals. CONCLUSIONS: Underlying systemic disease does not seem to be an important factor in the pathogenesis of CRVO in younger patients, and thrombophilia was present in only 11% of patients in this age group. RON yielded better functional results in younger patients, although functional improvement remained limited in those with low baseline VA.
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Envejecimiento/fisiología , Procedimientos Quirúrgicos Oftalmológicos , Disco Óptico/cirugía , Nervio Óptico/cirugía , Oclusión de la Vena Retiniana/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Complicaciones de la Diabetes , Femenino , Glaucoma de Ángulo Abierto/complicaciones , Humanos , Hipertensión/complicaciones , Masculino , Persona de Mediana Edad , Oftalmoscopía , Disco Óptico/irrigación sanguínea , Estudios Prospectivos , Oclusión de la Vena Retiniana/fisiopatología , Tomografía de Coherencia Óptica , Resultado del Tratamiento , Agudeza Visual/fisiología , VitrectomíaRESUMEN
OBJECTIVE: To evaluate a novel pars plana vitrectomy (PPV) approach with aqueous tamponade for repair of primary pseudophakic rhegmatogenous retinal detachment (RRD). DESIGN: Prospective, noncomparative, interventional case series. PARTICIPANTS: Sixty nonconsecutive patients (60 eyes) with primary pseudophakic RRD. INTERVENTION: Patients underwent PPV alone with injection of perfluoro-n-octane followed by fluid-air exchange and transscleral diode laser retinopexy and then balanced salt solution (BSS) tamponade. All patients were observed for at least 1 year. MAIN OUTCOME MEASURES: Anatomic outcome, visual acuity (VA), and complications. RESULTS: The mean follow-up period was 16.4 months (range, 12.1-21.5). Preoperatively, 32 patients (53.3%) had 1 break and 28 patients (46.7%) had 2 to 4 breaks (mean, 2.7). Intraoperatively, 108 retinal breaks were identified, 82 (75.9%) superior and 26 (24%) inferior. Eight breaks in 8 patients that were not seen preoperatively or intraoperatively were diagnosed after air-BSS exchange. Mean preoperative best-corrected VA (BCVA) was 20/700 (range, hand movements [HM]-20/20). Final BCVA was a mean of 20/59 (range, 20/200-20/20). For the 13 eyes with macula-attached RRD, BCVA was the same preoperatively and postoperatively (mean, 20/27; range, 20/50-20/20). For the 47 eyes with macula-detached RRD, the mean BCVA was 20/888 preoperatively (range, HM-20/50) and 20/68 postoperatively (range, 20/200-20/20). Final VA was > or =20/40 in 34 of 60 eyes (56.6%). Primary retinal reattachment (attachment at 1 month postoperatively) was attained in 59 of the 60 patients (98.3%). The single failure was due to a new break postoperatively; this break was treated by pneumatic retinopexy and photocoagulation of the break. At the 12-month follow-up visit, reattachment had been attained in all 60 eyes (100%). Postoperatively, 1 patient (1.6%) had hypotony at the 1-day postoperative visit, but intraocular pressure was 14 mm at the 4-day visit, and 2 patients (3.3%) had mild vitreous hemorrhage during the first 48 hours that resolved spontaneously during the following 10 days. CONCLUSION: Pars plana vitrectomy with laser retinopexy followed by BSS tamponade is effective for intraoperative sealing of retinal breaks causing pseudophakic RRD. We did not identify safety concerns in this 60-patient series.
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Humor Acuoso , Criocirugía/métodos , Coagulación con Láser/métodos , Seudofaquia/cirugía , Desprendimiento de Retina/cirugía , Vitrectomía/métodos , Acetatos/administración & dosificación , Adulto , Anciano , Anciano de 80 o más Años , Terapia Combinada , Combinación de Medicamentos , Femenino , Fluorocarburos/administración & dosificación , Humanos , Complicaciones Intraoperatorias , Masculino , Persona de Mediana Edad , Minerales/administración & dosificación , Complicaciones Posoperatorias , Estudios Prospectivos , Seudofaquia/etiología , Desprendimiento de Retina/etiología , Perforaciones de la Retina/complicaciones , Perforaciones de la Retina/cirugía , Cloruro de Sodio/administración & dosificación , Tomografía de Coherencia Óptica , Agudeza VisualRESUMEN
OBJECTIVE: To evaluate the effect of radial optic neurotomy on visual acuity (VA) and foveal thickness in patients with hemicentral retinal vein occlusion. METHODS: A prospective noncomparative case series of 13 eyes in 13 patients with hemicentral retinal vein occlusion and a preoperative VA of 20/60 or less from a total of 232 retinal vein occlusions diagnosed. All patients underwent pars plana vitrectomy, posterior hyaloid dissection, and radial optic neurotomy at the nasal border of the optic disc. RESULTS: Visual acuity and macular thickness were measured with optical coherence tomography. Nine patients (69.2%) gained 2 or more Snellen lines of vision, and in 4 patients (30.8%) VA improved by 4 or more Snellen lines (median visual acuity, 20/50; mean VA, 20/45; P<.01) (average gain, 2.7 Snellen lines). The decrease in foveal thickness was statistically significant (P<.01) (median decrease, 297 microm). Final VA was statistically related to decreased macular thickness at optical coherence tomography (P = .03; rho = -0.62). Retinochoroidal shunts developed in 6 patients (46.1%) at the radial optic neurotomy site. No surgical complications were observed. CONCLUSIONS: Radial optic neurotomy seems to be a potential treatment in selected patients with hemicentral retinal vein occlusion, probably because of the more rapid appearance of retinochorioretinal collateral vessels, which promote faster resolution of macular edema.
Asunto(s)
Descompresión Quirúrgica/métodos , Disco Óptico/cirugía , Nervio Óptico/cirugía , Oclusión de la Vena Retiniana/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Angiografía con Fluoresceína , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Oftalmológicos , Disco Óptico/irrigación sanguínea , Estudios Prospectivos , Oclusión de la Vena Retiniana/fisiopatología , Tomografía de Coherencia Óptica , Agudeza Visual/fisiologíaRESUMEN
OBJECTIVE: To determine the role of pars plana vitrectomy without scleral buckling and air as a tamponade with 24 hours of prone positioning in the management of inferior breaks in primary pseudophakic rhegmatogenous retinal detachment. METHODS: Prospective, noncomparative, interventional case series. Fifteen consecutive eyes (15 patients) with primary pseudophakic rhegmatogenous retinal detachment with causative breaks located between the 4-o'clock and 8-o'clock positions underwent pars plana vitrectomy with air tamponade. The prone position was maintained for 24 hours. Anatomic and functional results are presented. RESULTS: The anatomic reattachment rate was 93.3% after 1 procedure and 100% at the 6-month visit. Mean preoperative best-corrected visual acuity was 20/60 (range, 20/400 to 20/25) and mean postoperative best-corrected visual acuity was 20/30 (range, 20/100 to 20/20). In 1 case the retina redetached at the second week because of an undetected break. Postoperative epiretinal membrane was observed in 1 case. CONCLUSION: Pars plana vitrectomy and air tamponade with only 24 hours of prone positioning postoperatively is effective in the management of primary pseudophakic rhegmatogenous retinal detachment with causative breaks between the 4-o'clock and 8-o'clock positions.
Asunto(s)
Aire , Seudofaquia/complicaciones , Desprendimiento de Retina/cirugía , Perforaciones de la Retina/cirugía , Vitrectomía/métodos , Adulto , Anciano , Extracción de Catarata , Femenino , Humanos , Implantación de Lentes Intraoculares , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Posición Prona , Estudios Prospectivos , Desprendimiento de Retina/etiología , Perforaciones de la Retina/etiología , Seguridad , Esclerostomía , Resultado del Tratamiento , Agudeza VisualRESUMEN
OBJECTIVE: To introduce a new approach with pars plana vitrectomy (PPV) alone and no facedown positioning in the management of pseudophakic retinal detachments (RDs) with inferior breaks. DESIGN: Prospective noncomparative interventional case series. PARTICIPANTS: Forty consecutive pseudophakic eyes of 40 patients with rhegmatogenous RD with causative inferior breaks. INTERVENTION OR METHODS: All eyes underwent PPV alone, with air as tamponade and with no facedown position in the postoperative period. The supine position was used in some cases for 30 minutes. MAIN OUTCOME MEASURES: Postoperative primary and final anatomical outcome, visual acuity (VA), and complications. RESULTS: Patients were observed for a minimum of 7 months (mean, 11.7). Primary retinal reattachment was obtained in 36 of 40 patients (90%). Final reattachment was obtained in 40 of 40 patients (100%). One patient (2.5%) developed proliferative vitreoretinopathy at the sixth week after surgery. Three patients (7.5%) redetached, presumably due to untreated breaks. Two patients (5%) developed a macular epiretinal membrane that required surgery. Mean preoperative best-corrected VA (BCVA) was 20/63 (range, hand movements [HM] to 20/20). Mean final BCVA was 20/33 (range, 20/200-20/20). Of the 16 eyes with a macula-attached rhegmatogenous RD, mean preoperative BCVA was 20/29 (range, 20/100-20/20). Mean postoperative BCVA was 20/30 (range, 20/60-20/20). Of the 24 eyes with macula-detached RDs, mean preoperative BCVA was 20/300 (range, HM to 20/40). Mean postoperative BCVA was 20/36 (range, 20/200-20/20). Visual acuity of 20/40 or better was seen in 17 of 24 eyes (70.8%). CONCLUSIONS: This pilot study provides evidence that the facedown posture after PPV is not necessary to achieve retinal reattachment in pseudophakic RD with inferior breaks.