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At a point during the latter third of an incremental exercise protocol, ventilation begins to exceed the rate of clearance of carbon dioxide (CO2) at the lungs ( V Ë CO2). The onset of this hyperventilation, which is confirmed by a fall from a period of stability in end-tidal and arterial CO2 tensions (PCO2), is referred to as the respiratory compensation point (RCP). The mechanisms that contribute to the RCP remain debated as does its surrogacy for the maximal metabolic steady state of constant-power exercise (i.e., the highest work rate associated with maintenance of physiological steady state). The objective of this current opinion is to summarize the original research contributions that support and refute the hypotheses that: (i) the RCP represents a rapid, peripheral chemoreceptor-mediated reflex response engaged when the metabolic rate at which the buffering systems can no longer constrain the rise in hydrogen ions ([H+]) associated with rising lactate concentration and metabolic CO2 production is surpassed; and (ii) the metabolic rate at which this occurs is equivalent to the maximal metabolic steady state of constant power exercise. In doing so, we will shed light on potential mechanisms contributing to the RCP, attempt to reconcile disparate findings, make a case for its adoption for exercise intensity stratification and propose strategies for the use of RCP in aerobic exercise prescription.
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PURPOSE: Predicting the progression of intermediate AMD (iAMD) to neovascular AMD (nAMD) will help to identify high-risk patients and improve treatment outcomes. The present study assessed whether choroidal OCT biomarkers could predict conversion to nAMD. METHODS: This retrospective study included patients with clinically stable iAMD who either converted to nAMD (C group) or did not convert (NC group) during one year of follow-up. OCT parameters included subfoveal choroidal thickness (SFCT), central macular thickness (CMT), Haller vascular thickness (HVT), inner choroidal thickness (ICT), and double-layer sign (DLS). RESULTS: Of 116 total eyes, there were 37 in the NC group and 79 in the C group. Baseline SFCT was significantly lower in the C group compared to the NC group (169.0 ± 63.2 µm vs. 218.0 ± 97.8 µm, p = 0.01). Baseline HVT and ICT were lower in the C group (105.2 ± 40.6 µm vs. 121.0 ± 56.6 µm, p = 0.17 and 61.9 ± 35.5 µm vs. 77.5 ± 41.7 µm, p = 0.09). HVT was decreased at all time points in the C group vs NC (p > 0.05). The ICT was reduced in the C group at each time point except at conversion time (p > 0.05). Of all eight eyes who presented DLS at baseline, 100% converted to nAMD (p < 0.001). CONCLUSION: Lower SFCT at baseline may signal conversion to nAMD within 12 months.
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BACKGROUND: To report real-world outcomes of patients with primary Reghmatogenous Retinal Detachment (RRD) treated with Pneumatic Retinopexy (PnR) according to the indications of the Pneumatic Retinopexy versus Vitrectomy for management of Primary Rhegmatogenous Retinal Detachment Outcomes Randomized Trial (PIVOT) trial. METHODS: Multicenter, retrospective study. Patients treated with PnR for RRD between 2021 and 2023 and a follow-up of at least 6 months were included. Single-procedure anatomical success, final anatomical success, complications, causes of failures, best corrected visual acuity (BCVA) after surgery, and the vision-related quality of life using the 25-Item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) were reported. RESULTS: A total of 76 eyes of 76 patients were included. Mean age was 60 ± 8.1 years. Primary anatomic reattachment was achieved by 84.3% of patients and final anatomical reattachment after pars plana vitrectomy was obtained in 100% of patients. BCVA improved from 0.32 (20/40) to 0.04 (20/20) logMar (p < 0.001) at 6 months. The main cause of failure was related to the presence of additional (likely missed) retinal breaks (66.6% of cases). Also, primary PnR failure was more frequent in eyes of patients with older age, macular involvement, worse baseline BCVA, greater extent of the RRD, and increased duration from diagnosis to treatment. Overall, the mean NEI-VFQ 25 composite score was 93.9% ± 6.4 at 6 months. CONCLUSIONS: The criteria of the PIVOT trial can be applied to real-world scenarios in the decision-making process for the treatment of primary RRD, with excellent anatomical and functional outcomes.
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Qualidade de Vida , Descolamento Retiniano , Acuidade Visual , Vitrectomia , Humanos , Descolamento Retiniano/cirurgia , Descolamento Retiniano/fisiopatologia , Pessoa de Meia-Idade , Feminino , Masculino , Acuidade Visual/fisiologia , Estudos Retrospectivos , Idoso , Vitrectomia/métodos , Tamponamento Interno/métodos , Seguimentos , Resultado do Tratamento , Fluorocarbonos/administração & dosagemRESUMO
This study investigated whether a heavy-intensity priming exercise precisely prescribed within the heavy-intensity domain would lead to a greater peak-power output (POpeak) and a longer maximal oxygen uptake (VÌo2max) plateau. Twelve recreationally active adults participated in this study. Two visits were required: 1) a step-ramp-step test [ramp-incremental (RI) control], and 2) an RI test preceded by a priming exercise within the heavy-intensity domain (RI primed). A piecewise equation was used to quantify the VÌo2 plateau duration (VÌo2plateau-time). The mean response time (MRT) was computed during the RI control condition. The delta (Δ) VÌo2 slope (S; mL·min-1·W-1) and VÌo2-Y intercept (Y; mL·min-1) within the moderate-intensity domain between conditions (RI primed minus RI control) were also assessed using a novel graphical analysis. VÌo2plateau-time (P = 0.001; d = 1.27) and POpeak (P = 0.003; d = 1.08) were all greater in the RI primed. MRT (P < 0.001; d = 2.45) was shorter in the RI primed compared with the RI control. A larger ΔVÌo2plateau-time was correlated with a larger ΔMRT between conditions (r = -0.79; P = 0.002). This study demonstrated that heavy-intensity priming exercise lengthened the VÌo2plateau-time and increased POpeak. The overall faster RI-VÌo2 responses seem to be responsible for the longer VÌo2plateau-time. Specifically, a shorter MRT, but not changes in RI-VÌo2-slopes, was associated with a longer VÌo2plateau-time following priming exercise.NEW & NOTEWORTHY It remains unclear whether priming exercise extends the maximal oxygen uptake (VÌo2max) plateau and increases peak-power output (POpeak) during ramp-incremental (RI) tests. This study demonstrates that a priming exercise, precisely prescribed within the heavy-intensity domain, extends the plateau at VÌo2max and leads to a greater POpeak. Specifically, the extended VÌo2max plateau was associated with accelerated RI-VÌo2 responses.
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Exercício Físico , Consumo de Oxigênio , Humanos , Masculino , Consumo de Oxigênio/fisiologia , Adulto , Feminino , Adulto Jovem , Exercício Físico/fisiologia , Teste de Esforço , Fatores de Tempo , Músculo Esquelético/fisiologiaRESUMO
This study aims to report the efficacy of a combined intrastromal injection in optimizing the outcome of severe mycotic keratitis. Herein, we report a case series of 20 consecutive patients with positive fungal cultures not responding to topical antifungal treatment. Patients received cycles of intrastromal injections of voriconazole (50 µg/0.1 mL) and amphotericin B (2.5 µg/0.1 mL); all patients continued their topical antifungal therapy. The organisms isolated were Fusarium (n = 5), Aspergillus (n = 4), Candida (n = 4), Rhodotorula (n = 2), Penicillium (n = 2), Alternaria (n = 1), Bipolaris (n = 1), and Curvularia (n = 1). The size of the infiltrate varied from 6.5 to 1.5 mm. At presentation, the best corrected visual acuity (BCVA, namely, the best visual acuity achieved with glasses, if needed) was less than 20/400 in all patients, improving to better than 20/400 in eleven patients. Seven patients required surgical intervention; four of them underwent penetrating keratoplasty (PK) à chaud one month after the first intrastromal injection. Patients who underwent surgery achieved a BCVA of 20/40 or better. Combined intrastromal injections before therapeutic penetrating keratoplasty (TPK) effectively reduced ulcer size and graft diameter, preventing infection recurrence. Our results highlight the efficacy of combined intrastromal injections in optimizing outcomes for severe mycotic keratitis undergoing TPK.
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The role of muscle mass in modulating performance and perceived fatigability across the entire intensity spectrum during cycling remains unexplored. We hypothesized that at task failure (Tlim), muscle contractile function would decline more following single- (SL) versus double-leg (DL) cycling within severe and extreme intensities, but not moderate and heavy intensities. After DL and SL ramp-incremental tests, on separate days, 11 recreationally active males (VÌo2max: 49.5 ± 7.7 mL·kg-1·min-1) completed SL and DL cycling until Tlim within each intensity domain. Power output for SL trials was set at 60% of the corresponding DL trial. Before and immediately after Tlim, participants performed an isometric maximal voluntary contraction (MVC) coupled with one superimposed and three resting femoral nerve stimulations [100 Hz; 10 Hz; single twitch (Qtw)] to measure performance fatigability. Perceived fatigue, leg pain, dyspnea, and effort were collected during trials. Tlim within each intensity domain was not different between SL and DL (all P > 0.05). MVC declined more for SL versus DL following heavy- (-42 ± 16% vs. -30 ± 18%; P = 0.011) and severe-intensity cycling (-41 ± 12% vs. -31 ± 15%; P = 0.036). Similarly, peak Qtw force declined more for SL following heavy- (-31 ± 12% vs. -22 ± 10%; P = 0.007) and severe-intensity cycling (-49 ± 13% vs. -40 ± 7%; P = 0.048). Except for heavy intensity, voluntary activation reductions were similar between modes. Similarly, except for dyspnea, which was lower for SL versus DL across all domains, ratings of fatigue, pain, and effort were similar at Tlim between exercise modes. Thus, the amount of muscle mass modulates the extent of contractile function impairment in an intensity-dependent manner.NEW & NOTEWORTHY We investigated the modulatory role of muscle mass on performance and perceived fatigability across the entire intensity spectrum. Despite similar time-to-task failure, single-leg cycling resulted in greater impairments in muscle contractile function within the heavy- and severe-intensity domains, but not the moderate- and extreme-intensity domains. Perceived fatigue, pain, and effort were similar between cycling modes. This indicates that the modulatory role of muscle mass on the extent of performance fatigability is intensity domain-dependent.
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Ciclismo , Fadiga Muscular , Músculo Esquelético , Humanos , Masculino , Músculo Esquelético/inervação , Músculo Esquelético/fisiologia , Adulto Jovem , Adulto , Percepção/fisiologia , Contração Muscular , Contração Isométrica , Estimulação Elétrica , Esforço FísicoRESUMO
Introduction: The present study aimed to describe a case series of patients in which a cohesive ophthalmic viscous device (OVD) was used to viscodissect and posteriorly displace the retina in cases of total retinal detachment complicated by proliferative vitreoretinopathy, operated with minimally invasive pars plana vitrectomy. Case Presentations: Three patients with a mean age of 67 years were included in the present study. One eye was aphakic, while the others were pseudophakic. OVD injection was performed through the limbus in the aphakic eye and via pars plana in the pseudophakic eyes. In all cases, the OVD injection led to a posterior displacement of the detached retina with a smooth dissection. No complications related to the surgery were observed. At the last follow-up visit, the retina was attached in all cases, with an improvement in visual acuity. Conclusion: To conclude, the injection of a cohesive OVD anterior to the detached retina allowed to posteriorize and viscodissect to some extent the retina, facilitating the implant of trocars.
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PURPOSE: Different strategies for near-infrared spectroscopy (NIRS)-derived muscle oxidative capacity assessment have been reported. This study compared and evaluated (I) approaches for averaging trials; (II) NIRS signals and blood volume correction equations; (III) the assessment of vastus lateralis (VL) and tibialis anterior (TA) muscles in two fitness levels groups. METHODS: Thirty-six participants [18 chronically trained (CT: 14 males, 4 females) and 18 untrained (UT: 10 males, 8 females)] participated in this study. Two trials of twenty transient arterial occlusions were performed for NIRS-derived muscle oxidative capacity assessment. Muscle oxygen consumption ( V Ë O2m) was estimated from deoxygenated hemoglobin (HHb), corrected for blood volume changes following Ryan (HHbR) and Beever (HHbB) equations, and from oxygen saturation (StO2) in VL and TA. RESULTS: Superimposing or averaging V Ë O2m or averaging the rate constants (k) from the two trials resulted in equivalent k values [two one-sided tests (TOST) procedure with 5% equivalence margin-P < 0.001]. Whereas HHbR (2.35 ± 0.61 min-1) and HHbB (2.34 ± 0.58 min-1) derived k were equivalent (P < 0.001), StO2 derived k (2.81 ± 0.92 min-1) was greater (P < 0.001) than both. k values were greater in CT vs UT in both muscles (VL: + 0.68 min-1, P = 0.002; TA: + 0.43 min-1, P = 0.01). CONCLUSION: Different approaches for averaging trials lead to similar k. HHb and StO2 signals provided different k, although different blood volume corrections did not impact k. Group differences in k were detected in both muscles.
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Músculo Esquelético , Consumo de Oxigênio , Espectroscopia de Luz Próxima ao Infravermelho , Humanos , Masculino , Espectroscopia de Luz Próxima ao Infravermelho/métodos , Consumo de Oxigênio/fisiologia , Feminino , Músculo Esquelético/metabolismo , Músculo Esquelético/fisiologia , Adulto , Oxigênio/metabolismo , Oxigênio/sangue , Hemoglobinas/metabolismoRESUMO
INTRODUCTION: This study assessed the effect of individualized, domain-based exercise intensity prescription on changes in maximal oxygen uptake (VÌO 2max ) and submaximal thresholds. METHODS: Eighty-four young healthy participants (42 females, 42 males) were randomly assigned to six age, sex, and VÌO 2max -matched groups (14 participants each). Groups performed continuous cycling in the 1) moderate (MOD), 2) lower heavy (HVY1), and 3) upper heavy-intensity (HVY2) domain; interval cycling in the form of 4) high-intensity interval training (HIIT) in the severe-intensity domain, or 5) sprint-interval training (SIT) in the extreme-intensity domain; or no exercise for 6) control (CON). All training groups, except SIT, were work-matched. Training participants completed three sessions per week for 6 wk with physiological evaluations performed at PRE, MID, and POST intervention. RESULTS: Compared with the change in VÌO 2max (∆VÌO 2max ) in CON (0.1 ± 1.2 mL·kg -1 ·min -1 ), all training groups, except MOD (1.8 ± 2.7 mL·kg -1 ·min -1 ), demonstrated a significant increase ( P < 0.05). HIIT produced the highest increase (6.2 ± 2.8 mL·kg -1 ·min -1 ) followed by HVY2 (5.4 ± 2.3 mL·kg -1 ·min -1 ), SIT (4.7 ± 2.3 mL·kg -1 ·min -1 ), and HVY1 (3.3 ± 2.4 mL·kg -1 ·min -1 ), respectively. The ΔPO at the estimated lactate threshold ( θLT ) was similar across HVY1, HVY2, HIIT, and SIT, which were all greater than CON ( P < 0.05). The ΔVÌO 2 and ΔPO at θLT for MOD was not different from CON ( P > 0.05). HIIT produced the highest ΔPO at maximal metabolic steady state, which was greater than CON, MOD, and SIT ( P < 0.05). CONCLUSIONS: This study demonstrated that i) exercise intensity is a key component determining changes in VÌO 2max and submaximal thresholds and ii) exercise intensity domain-based prescription allows for a homogenous metabolic stimulus across individuals.
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Treinamento Intervalado de Alta Intensidade , Consumo de Oxigênio , Humanos , Masculino , Feminino , Consumo de Oxigênio/fisiologia , Treinamento Intervalado de Alta Intensidade/métodos , Adulto Jovem , Adulto , Ácido Láctico/sangue , Ciclismo/fisiologia , Frequência Cardíaca/fisiologia , Limiar Anaeróbio/fisiologiaRESUMO
PURPOSE: This study aimed to investigate whether a ramp-to-constant WR (rCWR) transition compared with a square-wave-to-constant WR (CWR) transition within the heavy-intensity domain can reduce metabolic instability and decrease the oxygen cost of exercise. METHODS: Fourteen individuals performed (i) a ramp-incremental test to task failure, (ii) a 21-min CWR within the heavy-intensity domain, and (iii) an rCWR to the same WR. Oxygen uptake (VÌO 2 ), lactate concentration ([La - ]), and muscle oxygen saturation (SmO 2 ) were measured. VÌO 2 and VÌO 2 gain (VÌO 2 -G) during the first 10-min steady-state VÌO 2 were analyzed. [La - ] before, at, and after steady-state VÌO 2 and SmO 2 during the entire 21-min steady-state exercise were also examined. RESULTS: VÌO 2 and VÌO 2 -G during rCWR (2.49 ± 0.58 L·min -1 and 10.7 ± 0.2 mL·min -1 ·W -1 , respectively) were lower ( P < 0.001) than CWR (2.57 ± 0.60 L·min -1 and 11.3 ± 0.2 mL·min -1 ·W -1 , respectively). [La - ] before and at steady-state VÌO 2 during the rCWR condition (1.94 ± 0.60 and 3.52 ± 1.19 mM, respectively) was lower than the CWR condition (3.05 ± 0.82 and 4.15 ± 1.25 mM, respectively) ( P < 0.001). [La - ] dynamics after steady-state VÌO 2 were unstable for the rCWR ( P = 0.011). SmO 2 was unstable within the CWR condition from minutes 4 to 13 ( P < 0.05). CONCLUSIONS: The metabolic disruption caused by the initial minutes of square-wave exercise transitions is a primary contributor to metabolic instability, leading to an increased VÌO 2 -G compared with the rCWR condition approach. The reduced early reliance on anaerobic energy sources during the rCWR condition may be responsible for the lower VÌO 2 -G.
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Teste de Esforço , Consumo de Oxigênio , Humanos , Consumo de Oxigênio/fisiologia , Exercício Físico/fisiologia , Ácido Láctico , OxigênioRESUMO
PURPOSE: To describe a new surgical technique involving the use of a human amniotic membrane (hAM) epiretinal patch to treat a primary macular hole retinal detachment (MHRD) in a highly myopic patient. METHODS: A 60 years old highly myopic man was referred to our clinic with a diagnosis of MHRD in his right eye. The patient was pseudophakic, with a visual acuity of counting fingers at the baseline evaluation. Pars plana vitrectomy was performed, a small retinotomy was created at the inner margin of the staphyloma, and membrane blue dual was used to obtain an adequate peeling of the inner limiting membrane. Then, a 1.5 mm diameter circular hAM patch was obtained and positioned over the macular hole with the chorion layer settled over the retina. After a complete fluid-air exchange, 20% sulfur hexafluoride gas was used as endotamponade, and the patient was asked to remain face down for three days. RESULTS: Four weeks after surgery, optical coherence tomography (OCT) scan showed the hAM patch, visualized as a distinct hyperreflective layer well integrated with the retina. Nine months after surgery, the macular hole was closed, the retina reattached, the hAM patch was adherent to the retina, and the patient presented a best-corrected visual acuity improved to 0.7 logMar. No postoperative adverse events were registered during the follow-up. CONCLUSIONS: Epiretinal hAM implant could represent a novel surgical technique, feasible and easier compared to other current techniques used to treat MHRD in highly myopic patients.
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Membrana Epirretiniana , Miopia , Descolamento Retiniano , Perfurações Retinianas , Masculino , Humanos , Pessoa de Meia-Idade , Descolamento Retiniano/diagnóstico , Descolamento Retiniano/etiologia , Descolamento Retiniano/cirurgia , Perfurações Retinianas/diagnóstico , Perfurações Retinianas/etiologia , Perfurações Retinianas/cirurgia , Âmnio , Estudos Retrospectivos , Miopia/cirurgia , Tomografia de Coerência Óptica , Membrana Epirretiniana/complicações , Membrana Epirretiniana/cirurgia , Vitrectomia/métodosRESUMO
BACKGROUND: This study aimed to evaluate the impact of PreserFlo Microshunt on the ocular surface, focusing on both objective and subjective parameters. METHODS: Prospective-observational study on 48 eyes undergoing PreserFlo Microshunt implantation, standalone or combined with phacoemulsification. At baseline, 1-month, 6-months and 12-months post-operative follow-ups, we performed Ocular Surface Disease Index (OSDI) questionnaire, Schirmer's test (ST), Tear-film break-up time (TBUT), fluoresceine staining (FS), tear osmolarity and minimum corneal epithelial thickness (Epi-ThkMIN. ) measurements. RESULTS: OSDI score improved from 37.43 ± 17.49 at baseline, to 24.13 ± 12.55 at 1-month (p = 0.003) and to 12.89 ± 8.54 and 13.09 ± 10.22 at 6-months and 12-months (p < 0.0001). TBUT and ST, in a similar way, non-significantly increased at 1-month, but then improved at 6-months and 12-months (p < 0.05 for both). Tear osmolarity significantly decreased from 308.2 ± 7.3 mOsm/L at baseline, to 303.3 ± 8.2 mOsm/L, 295.6.2 ± 7.0 mOsm/L and 297.6 ± 6.8 mOsm/L at 1-month, 6-months and 12-months (p < 0.05 for all). Epi-ThkMIN was stable when comparing baseline (44.9 ± 5.7 µm) and 1-month (p = 0.28), and successively increased in 6-months (47.8 ± 5.5 µm, p = 0.02) and 12-months (48.0 ± 3.6 µm, p = 0.01). In subgroup analysis, OSDI score and tear osmolarity were significantly higher at 1-month in combined group compared to standalone group (p = 0.03 and p = 0.02, respectively), but reaching comparable values in successive follow-ups. Further, Oxford scale grades for FS were significantly improved when comparing baseline-6-months and baseline-12-months. CONCLUSION: PreserFlo implantation improved ocular surface subjective symptoms, increased TBUT and ST, and reduced FS, highlighting the potential benefits of this surgical intervention. Moreover, we reported significant improvements of tear osmolarity and corneal epithelium.
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Síndromes do Olho Seco , Humanos , Síndromes do Olho Seco/diagnóstico , Síndromes do Olho Seco/cirurgia , Estudos Prospectivos , Qualidade de Vida , Lágrimas , Fluoresceína , Concentração OsmolarRESUMO
PURPOSE: To assess whether: i) a lower amplitude constant-load MOD is appropriate to determine the mean response time (MRT); ii) the method accurately corrects the dissociation in the VÌO 2 -PO relationship during ramp compared with constant-load exercise when using different ramp slopes. METHODS: Eighteen participants (7 females) performed three SRS tests including: i) step-transitions into MOD from 20 to 50 W (MOD 50 ) and 80 W (MOD 80 ); and ii) slopes of 15, 30, and 45 W·min -1 . The VÌO 2 and PO at the gas exchange threshold (GET) and the corrected respiratory compensation point (RCP CORR ) were determined. Two to three 30-min constant-load trials evaluated the VÌO 2 and PO at the maximal metabolic steady state (MMSS). RESULTS: There were no differences in VÌO 2 at GET (1.97 ± 0.36, 1.99 ± 0.36, 1.95 ± 0.30 L·min -1 ), and RCP (2.81 ± 0.57, 2.86 ± 0.59, 2.84 ± 0.59) between 15, 30, and 45 W·min -1 ramps, respectively ( P > 0.05). The MRT in seconds was not affected by the amplitude of the MOD or the slope of the ramp (range 19 ± 10 s to 23 ± 20 s; P > 0.05). The mean PO at GET was not significantly affected by the amplitude of the MOD or the slope of the ramp (range 130 ± 30 W to 137 ± 30 W; P > 0.05). The PO at RCP CORR was similar for all conditions ((range 186 ± 43 W to 193 ± 47 W; P > 0.05). CONCLUSIONS: The SRS protocol accounts for the VÌO 2 MRT when using smaller amplitude steps, and for the VÌO 2 slow component when using different ramp slopes, allowing for accurate partitioning of the exercise intensity domains in a single test.
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Exercício Físico , Consumo de Oxigênio , Feminino , Humanos , Consumo de Oxigênio/fisiologia , Exercício Físico/fisiologia , Teste de Esforço/métodos , Terapia por Exercício , Tempo de ReaçãoRESUMO
BACKGROUND: To report a case of sutureless scleral-fixated hydrophilic intraocular lens (FIL SSF IOL, Soleko, Italy) opacification following pars plana vitrectomy surgery using sulfur hexafluoride (SF6) for traumatic lens luxation associated with retinal detachment. CASE PRESENTATION: A 77-year-old woman was referred to our emergency department after blunt trauma in her right eye. At the ophthalmic evaluation, visual acuity was hand movement, biomicroscopy showed pseudoexfoliation syndrome and a traumatic lens luxation in the vitreous chamber. The patient underwent pars plana vitrectomy, subluxated cataract explantation, and FIL SSF IOL implant. During surgery, an inferior retinal detachment was encountered, requiring 20% SF6 gas tamponade. No adverse events were encountered. One month postoperatively, visual acuity (BCVA) improved to 0,3 logMAR. At the 3-month follow-up, the patient presented with BCVA of 0,5 logMAR, and biomicroscopy showed a minimal IOL opacification. Six months postoperatively, BCVA decreased to 1.0 logMAR, and diffuse, IOL opacification was noted at slit lamp examination. The patient refused any other surgical intervention for IOL exchange. CONCLUSIONS: Although hydrophilic IOL opacification gas related is known, to the best of our knowledge, this is the first case reported in the literature of FIL SSF IOL opacification after pars plana vitrectomy with gas tamponade for retinal detachment.
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Traumatismos Oculares , Lentes Intraoculares , Descolamento Retiniano , Humanos , Feminino , Idoso , Descolamento Retiniano/etiologia , Descolamento Retiniano/cirurgia , Vitrectomia/efeitos adversos , Traumatismos Oculares/complicações , Traumatismos Oculares/cirurgia , Complicações Pós-Operatórias , Segmento Anterior do Olho , Lentes Intraoculares/efeitos adversosRESUMO
The metabolic rate (VO2) at the maximal metabolic steady state (MMSS) is generally not different from the VO2 at the respiratory compensation point (RCP). Based on this, it is often assumed that the heart rate (HR) at RCP would also be similar to that at MMSS. The study aims to compare the HR at RCP with that at MMSS. Seventeen individuals completed a ramp-incremental test, a series of severe-intensity trials to estimate critical power and two-to-three 30-min trials to confirm MMSS. The HR at RCP was retrieved by linear interpolation of the ramp-VO2/HR relationship and compared to the HR at MMSS recorded at 10, 15, 20, 25 and 30 min. The HR at RCP was 166 ± 12 bpm. The HR during MMSS at the timepoints of interest was 168 ± 8, 171 ± 8, 175 ± 9, 177 ± 9 and 178 ± 10 bpm. The HR at RCP was not different from the HR at MMSS at 10 min (P > 0.05) but lower at subsequent timepoints (P < 0.05) with this difference becoming progressively larger. For all timepoints, limits of agreement were large (~30 bpm). Given these differences and the variability at the individual level, the HR at RCP cannot be used to control the metabolic stimulus of endurance exercise.
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Consumo de Oxigênio , Troca Gasosa Pulmonar , Humanos , Consumo de Oxigênio/fisiologia , Frequência Cardíaca , Troca Gasosa Pulmonar/fisiologia , Teste de EsforçoRESUMO
Suprachoroidal hemorrhage (SCH) refers to the accumulation of blood in the suprachoroidal space, a relatively uncommon but significant complication that can occur spontaneously, during ophthalmic surgery, or as a consequence of ocular trauma. If left undiagnosed and untreated, SCH can lead to severe vision loss or even blindness. Therefore, it is crucial for ophthalmologists to have a thorough understanding of this complication, taking proactive measures to prevent it during surgery and being knowledgeable about effective management strategies for patients with SCH. This review article aimed to provide a comprehensive overview of SCH, covering its risk factors, diagnostic approaches, and the best practices for its management. By enhancing awareness and knowledge in this area, we can improve patient outcomes and minimize the impact of SCH in ophthalmic practice.
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Hemorragia da Coroide , Oftalmologia , Humanos , Hemorragia da Coroide/diagnóstico , Hemorragia da Coroide/etiologia , Hemorragia da Coroide/cirurgia , Vitrectomia/efeitos adversos , Fatores de Risco , Acuidade VisualRESUMO
BACKGROUND: The purpose of this study was to present a modified surgical technique involving pars plana vitrectomy with large chorioretinectomy for eyes with rupture of the globe due to severe ocular blunt trauma. METHODS: This retrospective study included consecutive patients with rupture of the globe due to blunt trauma who were treated at the King Khaled Eye Specialist Hospital (Riyadh, Saudi Arabia). All patients underwent 25-gauge pars plana vitrectomy with large chorioretinectomies involving all the tissue around the posterior scleral wounds. Outcome measures included best-corrected visual acuity (BCVA), anatomical success and globe survival, rates of complications. RESULTS: 15 eyes of 15 patients were included. Mean BCVA was 2.88 ± 0.13 logMAR at presentation, and significantly improved to 0.83 ± 0.28 logMAR (P < 0.001), with 10 patients (67%) achieving a final BCVA ≥ 20/200. Anatomical success and globe survival were achieved in 11 (73%) and 15 (100%) of eyes, respectively. Postoperative complications included retinal detachment in 6 eyes (40%), epiretinal membrane in 6 (40%), hypotony in 4 (26%), PVR in 2 (13%). CONCLUSIONS: Pars plana vitrectomy with large chorioretinectomy is an effective treatment for globe rupture following severe blunt trauma, yielding good visual outcomes and anatomical success rates.
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PURPOSE: We aimed to test the extended capabilities of the SRS protocol by validating its capacity to predict the power outputs for targeted metabolic rates (VÌO 2 ) and time-to-task failure ( Tlim ) within the heavy- and severe-intensity domain, respectively. METHODS: Fourteen young individuals completed (i) an SRS protocol from which the power outputs at GET and RCP (RCP CORR ), and the work accruable above RCP CORR , defined as W ' RAMP , were derived; (ii) one heavy-intensity bout at a power output predicted to elicit a targeted VÌO 2 equidistant from GET and RCP; and (iii) four severe-intensity trials at power outputs predicted to elicit targeted Tlim at minutes 2.5, 5, 10, and 13. These severe-intensity trials were also used to compute the constant-load-derived critical power and W ´ ( W ' CONSTANT ). RESULTS: Targeted (2.41 ± 0.52 L·min -1 ) and measured (2.43 ± 0.52 L·min -1 ) VÌO 2 at the identified heavy-intensity power output (162 ± 43 W) were not different ( P = 0.71) and substantially concordant (CCC = 0.95). Likewise, targeted and measured Tlim for the four identified severe-intensity power outputs were not different ( P > 0.05), and the aggregated coefficient of variation was 10.7% ± 8.9%. The derived power outputs at RCP CORR (192 ± 53 W) and critical power (193 ± 53 W) were not different ( P = 0.65) and highly concordant (CCC = 0.99). There were also no differences between W ' RAMP and W ' CONSTANT ( P = 0.51). CONCLUSIONS: The SRS protocol can accurately predict power outputs to elicit discrete metabolic rates and exercise durations, thus providing, with time efficiency, a high precision for the control of the metabolic stimulus during exercise.
Assuntos
Teste de Esforço , Exercício Físico , Humanos , Teste de Esforço/métodos , Terapia por Exercício , Consumo de OxigênioRESUMO
INTRODUCTION: Recent technologies and new devices continue to be developed in vitreoretinal surgeries, and they provide more details, enhance safety, improve surgeons' comfort, and better visual and anatomical outcomes. Some devices have been used for better visualization during surgery, and some help the operation performance. They are divided into the following titles: Intraoperative OCT (including hand-held, probe-integrated, and microscope-integrated OCT), three-dimensional visualization system, virtual reality system, endoscopic vitrectomy (fiber optics and non-fiber optics), wide-angle viewing systems (contact and non-contact lenses), endo-illumination, light filters, chromovitrectomy, the retinal prosthesis (including epiretinal, subretinal, and suprachoroidal devices), robot-assisted vitreoretinal surgery, newer Vitreoretinal instruments, gene and cell therapy. AREAS COVERED: In this narrative review, we focused on PubMed articles between 2010-2023 with these keywords: 'Optical Coherence Tomography,' 'Three-Dimensional,' 'Virtual System,' 'intraoperative,' 'endoscopic,' 'vitrectomy,' 'lens,' 'illumination,' 'filters,' 'chromovitrectomy,' 'prosthesis,' 'robotic surgery,' 'instrument,' 'gene,' 'cell.' EXPERT OPINION: The main aim of this review is to update the reader on the latest progression in intraoperative imaging and surgical vision technologies and to provide an understanding of how each has helped improve operation and surgical outcomes. The surgeons should know recent updates to do their best and achieve the most excellent results.