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1.
Retina ; 44(3): 381-391, 2024 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-38166007

RESUMEN

PURPOSE: To compare the efficacy and safety of pars plana vitrectomy with and without internal limiting membrane (ILM) peeling for macular hole (MH). METHODS: A systematic literature search on Ovid MEDLINE, Embase, Cochrane Library, and Google Scholar was performed from January 2000 to 2023. The primary outcome was the final best-corrected visual acuity (BCVA). Secondary outcomes included MH closure rates and the need for repeat surgery. The authors performed a random-effects meta-analysis on Review Manager 5.4. RESULTS: Fourteen studies on 880 eyes were included. Pars plana vitrectomy with and without ILM peel achieved a similar final BCVA ( P = 0.66). However, pars plana vitrectomy without ILM peeling achieved a significantly better final BCVA in eyes with closed MHs (WMD = 0.05 logMAR, 95% CI, 0.01-0.10, P = 0.02). Pars plana vitrectomy with ILM peeling achieved a significantly higher primary MH closure rate (RR = 1.21, 95% CI, 1.04-1.42, P = 0.02) and lower incidence of MH reoperation (RR = 0.19, 95% CI, 0.11-0.33, P < 0.001). The final MH closure rate ( P = 0.12) and incidence of MH recurrence ( P = 0.25) were similar between groups. CONCLUSION: Pars plana vitrectomy with and without ILM peel achieved a similar final BCVA. However, pars plana vitrectomy without ILM peeling achieved a better final BCVA in eyes with closed MHs. ILM peeling achieved a greater primary MH closure rate and reduced need for reoperation.

2.
Retina ; 44(6): 950-953, 2024 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-38215455

RESUMEN

INTRODUCTION: To determine whether the two popular artificial intelligence chatbots, ChatGPT and Bard, can provide high-quality information concerning procedure description, risks, benefits, and alternatives of various ophthalmic surgeries. METHODS: ChatGPT and Bard were prompted with questions pertaining to the description, potential risks, benefits, alternatives, and implications of not proceeding with various surgeries in different subspecialties of ophthalmology. Six common ophthalmic procedures were included in the authors' analysis. Two comprehensive ophthalmologists and one subspecialist graded each response independently using a 5-point Likert scale. RESULTS: Likert grading for accuracy was significantly higher for ChatGPT in comparison with Bard (4.5 ± 0.6 vs. 3.8 ± 0.8, P < 0.0001). Generally, ChatGPT performed better than Bard even when questions were stratified by the type of ophthalmic surgery. There was no significant difference between ChatGPT and Bard for response length (2,104.7 ± 271.4 characters vs. 2,441.0 ± 633.9 characters, P = 0.12). ChatGPT responded significantly slower than Bard (46.0 ± 3.0 vs. 6.6 ± 1.2 seconds, P < 0.0001). CONCLUSION: Both ChatGPT and Bard may offer accessible and high-quality information relevant to the informed consent process for various ophthalmic procedures. Nonetheless, both artificial intelligence chatbots overlooked the probability of adverse events, hence limiting their potential and introducing patients to information that may be difficult to interpret.


Asunto(s)
Inteligencia Artificial , Procedimientos Quirúrgicos Oftalmológicos , Humanos , Educación del Paciente como Asunto/métodos , Internet
3.
Ophthalmologica ; 247(1): 19-29, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-37579730

RESUMEN

BACKGROUND: The comparative safety and efficacy of different doses of intravitreal triamcinolone acetonide (IVTA) for diabetic macular edema (DME) and macular edema (ME) secondary to retinal vein occlusion (RVO) is unclear. OBJECTIVES: This meta-analysis aimed to compare the safety and efficacy of different doses of IVTA in this setting. METHODS: A systematic literature search for randomized clinical trials (RCTs) was conducted on Cochrane Library, Ovid MEDLINE, and EMBASE from January 2005 to May 2022. Studies that reported on patients with DME or ME secondary to RVO that received treatment with different doses of IVTA were included. A random-effects meta-analysis was performed. Cochrane's Risk of Bias Tool 2 was used to assess the risk of bias, and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) guidelines were used to assess certainty of evidence. RESULTS: Five RCTs reporting on 1,041 eyes at baseline were included in this meta-analysis. In eyes with ME secondary to RVO, high-dose (4 mg) IVTA achieved a significantly better change in best-corrected visual acuity (WMD = -4.75 ETDRS letters, 95% CI = [-7.73, -1.78], p = 0.002) and reduction in retinal thickness (WMD = -93.02 µm, 95% CI = [-153.23, -32.82], p = 0.002) at months 4-6 compared to low-dose (1-2 mg) IVTA. However, high-dose IVTA had a higher risk of intraocular pressure-related adverse events (RR = 2.99, 95% CI = [1.05, 8.50], p = 0.04) and cataract surgery (RR = 5.67, 95% CI = [3.09, 10.41], p < 0.00001) than low-dose IVTA in eyes with ME secondary to RVO. These efficacy and safety differences in high-dose and low-dose IVTA were not observed in DME eyes. CONCLUSIONS: The RCT evidence in this setting is limited. High-dose IVTA achieved greater improvements in visual acuity and reductions in retinal thickness than low-dose IVTA at months 4-6. However, high-dose IVTA had a less favorable safety profile than low-dose IVTA. The significance of these outcomes was based on patients with ME secondary to RVO, but not DME.


Asunto(s)
Diabetes Mellitus , Retinopatía Diabética , Edema Macular , Oclusión de la Vena Retiniana , Humanos , Triamcinolona Acetonida/efectos adversos , Edema Macular/diagnóstico , Edema Macular/tratamiento farmacológico , Edema Macular/etiología , Glucocorticoides/uso terapéutico , Oclusión de la Vena Retiniana/complicaciones , Oclusión de la Vena Retiniana/diagnóstico , Oclusión de la Vena Retiniana/tratamiento farmacológico , Inyecciones Intravítreas , Retinopatía Diabética/complicaciones , Retinopatía Diabética/diagnóstico , Retinopatía Diabética/tratamiento farmacológico , Resultado del Tratamiento , Diabetes Mellitus/inducido químicamente , Diabetes Mellitus/tratamiento farmacológico
4.
Ophthalmologica ; 247(1): 30-43, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-37899043

RESUMEN

BACKGROUND: The safety and effectiveness of pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling remains poorly understood for the treatment of epiretinal membrane (ERM). OBJECTIVES: Our study aims to compare the safety and effectiveness of PPV with and without ILM peeling for ERM. METHODS: A systematic literature search was conducted on Ovid MEDLINE, Embase, Cochrane Library, and Google Scholar from January 2000 to January 2023 for comparative studies reporting visual and anatomical outcomes for patients with ERM that received PPV with or without ILM peeling. Primary outcomes included best-corrected visual acuity (BCVA) at last study observation and change in BCVA from baseline. Secondary outcomes included retinal thickness (RT) at last study observation, change in RT from baseline, risk of ERM recurrence, and adverse events. A random-effects meta-analysis was performed. Risk of bias of randomized controlled trials was assessed using the Risk of Bias 2 tool of observational studies using the Risk of Bias in Non-randomized Studies of Interventions-I tool. The certainty of evidence of outcomes was evaluated using Grading of Recommendations, Assessment, Development and Evaluation criteria. RESULTS: Nineteen studies reporting on 1,291 eyes at baseline were included. PPV with and without ILM peel achieved a similar BCVA at last study observation (p = 0.68) and change in BCVA from baseline (p = 0.79). These findings remained consistent irrespective of whether simultaneous phacoemulsification was performed. PPV with ILM peel achieved a significantly lower incidence of ERM recurrence (risk ratio [RR] = 0.26, 95% CI = [0.13, 0.51], p < 0.0001) and additional surgery (RR = 0.17, 95% CI = [0.04, 0.74], p = 0.02) compared to PPV without ILM peel. CONCLUSION: PPV with and without ILM peel achieved a similar BCVA at last study observation in ERM patients. Patients treated with PPV and ILM peel also had a reduced risk of ERM recurrence and lower reoperation risk. These conclusions are associated with a moderate certainty of evidence and potential for bias from multiple non-randomized studies.


Asunto(s)
Extracción de Catarata , Membrana Epirretinal , Humanos , Membrana Epirretinal/diagnóstico , Membrana Epirretinal/cirugía , Vitrectomía , Membrana Basal/cirugía , Retina , Estudios Retrospectivos , Tomografía de Coherencia Óptica
5.
Can Assoc Radiol J ; 75(3): 518-524, 2024 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-38183235

RESUMEN

PURPOSE: Patients may seek online information to better understand medical imaging procedures. The purpose of this study was to assess the accuracy of information provided by 2 popular artificial intelligence (AI) chatbots pertaining to common imaging scenarios' risks, benefits, and alternatives. METHODS: Fourteen imaging-related scenarios pertaining to computed tomography (CT) or magnetic resonance imaging (MRI) were used. Factors including the use of intravenous contrast, the presence of renal disease, and whether the patient was pregnant were included in the analysis. For each scenario, 3 prompts for outlining the (1) risks, (2) benefits, and (3) alternative imaging choices or potential implications of not using contrast were inputted into ChatGPT and Bard. A grading rubric and a 5-point Likert scale was used by 2 independent reviewers to grade responses. Prompt variability and chatbot context dependency were also assessed. RESULTS: ChatGPT's performance was superior to Bard's in accurately responding to prompts per Likert grading (4.36 ± 0.63 vs 3.25 ± 1.03 seconds, P < .0001). There was substantial agreement between independent reviewer grading for ChatGPT (κ = 0.621) and Bard (κ = 0.684). Response text length was not statistically different between ChatGPT and Bard (2087 ± 256 characters vs 2162 ± 369 characters, P = .24). Response time was longer for ChatGPT (34 ± 2 vs 8 ± 1 seconds, P < .0001). CONCLUSIONS: ChatGPT performed superior to Bard at outlining risks, benefits, and alternatives to common imaging scenarios. Generally, context dependency and prompt variability did not change chatbot response content. Due to the lack of detailed scientific reasoning and inability to provide patient-specific information, both AI chatbots have limitations as a patient information resource.


Asunto(s)
Inteligencia Artificial , Imagen por Resonancia Magnética , Tomografía Computarizada por Rayos X , Humanos , Imagen por Resonancia Magnética/métodos , Tomografía Computarizada por Rayos X/métodos , Medición de Riesgo , Femenino
6.
Ophthalmologica ; 246(3-4): 245-254, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-37591212

RESUMEN

INTRODUCTION: There are no guidelines on the optimal anti-vascular endothelial growth factor (anti-VEGF) monotherapy regimen for patients with polypoidal choroidal vasculopathy (PCV). In this study, we aimed to assess the comparative safety and efficacy of different treatment regimens of anti-VEGF monotherapy for PCV. METHODS: We conducted a systematic literature search on Ovid MEDLINE, Embase, and Cochrane Library from January 2000 to May 2023 for comparative articles reporting on different treatment regimens of anti-VEGF agents in PCV. Our primary outcomes were the final best-corrected visual acuity (BCVA) and the change in BCVA from baseline. Secondary outcomes were the final retinal thickness (RT), the change in RT from baseline, the rate of polyp closure, and the incidence of adverse events. RESULTS: A total of 10,440 studies were screened, and seven studies reporting on 636 eyes with PCV at baseline were included in this systematic review. One RCT of 53 eyes found a similar final BCVA, change in BCVA from baseline, final RT, and complete polyp closure rate between a treat-and-extend (T&E) regimen and a bimonthly fixed-dosing regimen of aflibercept. This trial also found superiority of T&E for change in RT from baseline. One observational study of 33 eyes found a similar BCVA at last study observation between a pro re nata (PRN) regimen and bimonthly fixed-dosing regimen of aflibercept. One observational study of 42 eyes found a similar change in BCVA from baseline and complete polyp closure rate between a PRN regimen and bimonthly fixed-dosing regimen of aflibercept. One RCT of 249 eyes found a similar change in BCVA and RT from baseline, as well as polyp closure, between a T&E regimen and fixed 12-week dosing regimen of conbercept. One observational study of 30 eyes found a superiority of T&E aflibercept for change in BCVA and risk of polyp recurrence, compared to a PRN regimen. CONCLUSION: Overall, there is a paucity of evidence comparing various treatment regimens of anti-VEGF therapy in patients with PCV. This limited evidence suggests that current treatment regimens are similarly efficacious, though T&E aflibercept achieved superior outcomes when compared to bimonthly dosing or PRN in some individual studies. Further trials are needed to confirm or refute these findings.


Asunto(s)
Inhibidores de la Angiogénesis , Vasculopatía Coroidea Polipoidea , Humanos , Receptores de Factores de Crecimiento Endotelial Vascular , Retina , Factor A de Crecimiento Endotelial Vascular , Factores de Crecimiento Endotelial Vascular , Inyecciones Intravítreas , Proteínas Recombinantes de Fusión , Resultado del Tratamiento , Estudios Observacionales como Asunto
7.
Pediatr Radiol ; 53(13): 2633-2641, 2023 12.
Artículo en Inglés | MEDLINE | ID: mdl-37837457

RESUMEN

BACKGROUND: Upper gastrointestinal (GI) contrast studies are frequently requested to aid superior mesenteric artery syndrome diagnosis, a rare entity. Compression of the third duodenal part is expected to be mid-to-left of the midline where the superior mesenteric artery arises from the aorta; however, a duodenal impression to the right of the midline due to normal anatomic impression by the inferior vena cava (IVC) is often encountered and frequently misdiagnosed. OBJECTIVE: The purpose of this study was to determine the frequencies of (1) normal right-of-midline duodenal impressions and (2) mid-to-left of midline compressions in upper GI studies in a tertiary pediatric referral center. MATERIALS AND METHODS: All upper GI studies performed at our institution over 2 years were retrospectively evaluated to determine whether the duodenum had vertical duodenal impression to the right of the vertebral midline, mid-to-left of the vertebral midline, or no identifiable duodenal impression at all. RESULTS: In total, 538 upper GI studies were included in this analysis. A total of 275 male and 247 female patients between 0 and 17 years of age (median: 6 years, range: 1 month-17 years) were included. Of 538 total upper GI studies, there were 240 studies (44.6%) with a right-of-midline impression. There were only 10 studies (1.9%) with a mid-to-left of midline compression, and 9/10 also showed a concurrent right-sided impression sign. CONCLUSION: Right-of-midline duodenal impression is a normal anatomic finding caused by the IVC and should not be confused with superior mesenteric artery syndrome. In the presence of an appropriate clinical context, proximal duodenal dilation, "to-and-fro" motion of contrast, and duodenal impression at mid-to-left of midline, a diagnosis of superior mesenteric artery syndrome should be considered.


Asunto(s)
Síndrome de la Arteria Mesentérica Superior , Humanos , Masculino , Femenino , Niño , Lactante , Síndrome de la Arteria Mesentérica Superior/diagnóstico por imagen , Síndrome de la Arteria Mesentérica Superior/etiología , Estudios Retrospectivos , Duodeno/diagnóstico por imagen , Arteria Mesentérica Superior
8.
Can Assoc Radiol J ; : 8465371231193716, 2023 Aug 14.
Artículo en Inglés | MEDLINE | ID: mdl-37578849

RESUMEN

PURPOSE: Bard by Google, a direct competitor to ChatGPT, was recently released. Understanding the relative performance of these different chatbots can provide important insight into their strengths and weaknesses as well as which roles they are most suited to fill. In this project, we aimed to compare the most recent version of ChatGPT, ChatGPT-4, and Bard by Google, in their ability to accurately respond to radiology board examination practice questions. METHODS: Text-based questions were collected from the 2017-2021 American College of Radiology's Diagnostic Radiology In-Training (DXIT) examinations. ChatGPT-4 and Bard were queried, and their comparative accuracies, response lengths, and response times were documented. Subspecialty-specific performance was analyzed as well. RESULTS: 318 questions were included in our analysis. ChatGPT answered significantly more accurately than Bard (87.11% vs 70.44%, P < .0001). ChatGPT's response length was significantly shorter than Bard's (935.28 ± 440.88 characters vs 1437.52 ± 415.91 characters, P < .0001). ChatGPT's response time was significantly longer than Bard's (26.79 ± 3.27 seconds vs 7.55 ± 1.88 seconds, P < .0001). ChatGPT performed superiorly to Bard in neuroradiology, (100.00% vs 86.21%, P = .03), general & physics (85.39% vs 68.54%, P < .001), nuclear medicine (80.00% vs 56.67%, P < .01), pediatric radiology (93.75% vs 68.75%, P = .03), and ultrasound (100.00% vs 63.64%, P < .001). In the remaining subspecialties, there were no significant differences between ChatGPT and Bard's performance. CONCLUSION: ChatGPT displayed superior radiology knowledge compared to Bard. While both chatbots display reasonable radiology knowledge, they should be used with conscious knowledge of their limitations and fallibility. Both chatbots provided incorrect or illogical answer explanations and did not always address the educational content of the question.

9.
Can Assoc Radiol J ; 74(2): 432-445, 2023 May.
Artículo en Inglés | MEDLINE | ID: mdl-35968850

RESUMEN

The Coronavirus Disease of 2019 (COVID-19) pandemic has caused significant delays in the delivery of cancer treatments in Canada. As cancer treatment and imaging volumes return to normal, radiologists will encounter more cases of chemotherapy-induced toxicities. These toxicities have varied appearances on imaging, and can affect multiple organ systems. The purpose of this review is to offer a unified resource for general radiologists regarding the imaging appearances of chemotherapy-induced toxicities.


Asunto(s)
Antineoplásicos , COVID-19 , Humanos , Diagnóstico por Imagen , Canadá
10.
Retina ; 42(11): 2134-2142, 2022 11 01.
Artículo en Inglés | MEDLINE | ID: mdl-36269802

RESUMEN

PURPOSE: This meta-analysis investigates the incidence of intraocular inflammation (IOI) after intravitreal antivascular endothelial growth factor injections in neovascular age-related macular degeneration. METHODS: A systematic search was performed on Ovid MEDLINE, Embase, and Cochrane Central from January 2005 to April 2021. Randomized controlled trials comparing IOI after intravitreal bevacizumab, ranibizumab, brolucizumab, or aflibercept in neovascular age-related macular degeneration were included. Primary outcomes were sight-threatening IOI, final best-corrected visual acuity, and change in best-corrected visual acuity from baseline. Secondary outcomes included the incidence of other IOI events. Meta-analysis was performed using a random-effects model. RESULTS: Overall, 11,460 unique studies were screened, of which 14 randomized controlled trials and 6,759 eyes at baseline were included. There was no difference between agents for the risk of endophthalmitis and retinal vascular occlusion. Compared with aflibercept, brolucizumab had a higher incidence of generalized IOI (risk ratio = 6.24, 95% confidence interval = [1.40-27.90]) and vitreous haze/floaters (risk ratio = 1.64, 95% confidence interval = [1.00-2.67]). There were no significant differences between comparators for other secondary end points. CONCLUSION: There was no difference in the risk of severe sight-threatening IOI outcomes between intravitreal antivascular endothelial growth factor agents. There was a significantly higher risk of generalized IOI after brolucizumab relative to aflibercept. Our results alongside other recent safety findings suggest the need for further investigation in the risk-benefit profile of brolucizumab for the treatment of neovascular age-related macular degeneration.


Asunto(s)
Factores de Crecimiento Endotelial , Degeneración Macular , Uveítis , Humanos , Bevacizumab/administración & dosificación , Bevacizumab/efectos adversos , Factores de Crecimiento Endotelial/administración & dosificación , Factores de Crecimiento Endotelial/efectos adversos , Inyecciones Intravítreas/efectos adversos , Degeneración Macular/tratamiento farmacológico , Ranibizumab/administración & dosificación , Ranibizumab/efectos adversos , Receptores de Factores de Crecimiento Endotelial Vascular/administración & dosificación , Proteínas Recombinantes de Fusión/administración & dosificación , Proteínas Recombinantes de Fusión/efectos adversos , Uveítis/epidemiología
11.
Ophthalmologica ; 245(6): 500-515, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-36288721

RESUMEN

BACKGROUND: Intravitreal anti-vascular endothelial growth factor (anti-VEGF) and steroid treatment are both used for macular edema (ME) secondary to retinal vein occlusion (RVO), however a continual reevaluation of their comparative efficacy is required. OBJECTIVES: This meta-analysis aimed to compare the efficacy and safety of intravitreal anti-VEGF agents and intravitreal steroids for the treatment of ME secondary to RVO. METHODS: A systematic literature search was conducted on Ovid MEDLINE, EMBASE, and the Cochrane Controlled Register of Trials for studies published between January 2005 and November 2021. Randomized controlled trials (RCTs) reporting on patients with ME secondary to RVO who were treated with intravitreal steroids or anti-VEGF agents were included. A random effects meta-analysis was performed. RESULTS: 879 eyes from 11 RCTs were included. At the last study observation, intravitreal anti-VEGF agents were associated with a significantly better best corrected visual acuity (WMD = -0.14 logMAR, 95% CI = [-0.19, -0.09], p < 0.00001) and lower retinal thickness (WMD = -38.01 µm, 95% CI = [-56.17, -19.85], p < 0.0001) relative to intravitreal steroids. Similar findings were found at 3-12 month time points. Intravitreal anti-VEGF agents were associated with a significantly lower incidence of IOP-related adverse events (RR = 0.28, 95% CI = [0.15, 0.51], p < 0.0001), cataract development/progression (RR = 0.22, 95% CI = [0.09, 0.49], p = 0.0003), and conjunctival hemorrhage (RR = 0.52, 95% CI = [0.32, 0.86], p = 0.01). CONCLUSIONS: Our meta-analysis found superiority of intravitreal anti-VEGF agents relative to intravitreal steroids for the treatment of ME secondary to RVO with regards to visual acuity, anatomic outcomes, and safety endpoints.


Asunto(s)
Edema Macular , Oclusión de la Vena Retiniana , Humanos , Ranibizumab/uso terapéutico , Oclusión de la Vena Retiniana/complicaciones , Oclusión de la Vena Retiniana/diagnóstico , Oclusión de la Vena Retiniana/tratamiento farmacológico , Bevacizumab/efectos adversos , Factor A de Crecimiento Endotelial Vascular , Edema Macular/diagnóstico , Edema Macular/tratamiento farmacológico , Edema Macular/etiología , Factores de Crecimiento Endotelial Vascular , Esteroides/uso terapéutico , Inyecciones Intravítreas , Inhibidores de la Angiogénesis/uso terapéutico
16.
17.
Can J Ophthalmol ; 59(2): 73-78, 2024 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-36803934

RESUMEN

BACKGROUND: The efficacy and safety of initial tap and inject (T/I) compared with pars plana vitrectomy (PPV) for acute postoperative bacterial endophthalmitis following cataract surgery is unclear. Understanding the comparative safety and efficacy of initial T/I and initial PPV can provide context for treatment decision making in this setting. METHODS: A systematic literature search was performed on Ovid MEDLINE, EMBASE, and the Cochrane Library from January 1990 to January 2021. Comparative studies reporting on final best-corrected visual acuity (BCVA) following initial T/I or PPV in patients with infectious endophthalmitis secondary to cataract surgery were included. Cochrane's Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I) was used to evaluate the risk of bias, and GRADE criteria were used to assess certainty of evidence. A random-effects model was used for meta-analysis. RESULTS: Seven nonrandomized studies reporting on 188 eyes at baseline were included in this meta-analysis. Initial T/I achieved a significantly better BCVA at last study observation than initial PPV (weighted mean difference [WMD] = -0.61 logMAR; 95% CI, -1.19 to -0.03; p = 0.04; I2 = 89%; n = 7 studies; GRADE = very low). The incidence of enucleation was similar between initial T/I and initial PPV (risk ratio [RR] = 0.73; 95% CI, 0.09-6.25; p = 0.78; I2 = 4%; n = 2 studies; GRADE = very low). The risk of retinal detachment was similar between treatment modalities (RR = 0.29; 95% CI, 0.01-5.94; p = 0.42; I2 = 52%; n = 2 studies; GRADE = very low). CONCLUSIONS: The quality of evidence in this setting is limited. T/I had a significantly better BCVA at last study observation than initial PPV. Safety profiles were similar between T/I and PPV.


Asunto(s)
Extracción de Catarata , Catarata , Endoftalmitis , Humanos , Vitrectomía/efectos adversos , Antibacterianos/uso terapéutico , Endoftalmitis/epidemiología , Endoftalmitis/etiología , Extracción de Catarata/efectos adversos , Catarata/complicaciones , Estudios Retrospectivos
18.
Am J Ophthalmol ; 257: 227-235, 2024 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-37797865

RESUMEN

PURPOSE: To determine sociodemographic predictors of poor vision in children and adolescents less than 18 years of age in a large, nationally representative sample of the US population. DESIGN: Retrospective, population-based cross-sectional study. METHODS: Using data from the 2021 National Health Interview Survey (NHIS), participants less than 18 years of age for whom data were available on vision difficulty were included in our analysis. Our primary outcome was vision difficulty. Sociodemographic variables were investigated as predictors of vision difficulty. Logistic regression models were performed using Stata version 17.0. An odds ratio (OR) and 95% CI were reported for analyses. RESULTS: The 2021 NHIS reported on 8261 children and adolescents, of whom 7373 had data pertaining to vision difficulty and were included in our sample. Vision difficulty was associated with being unable to afford medical care (OR = 2.60, 95% CI = 1.17, 5.80, P = 0.02) and having public health insurance (OR = 1.52, 95% CI = 1.09, 2.12, P = .01). Compared to children less than 5 years of age, children ranging from 5 to 8 years (OR = 4.29, 95% CI = 2.26, 8.15, P < .01) and adolescents ranging from 16 to 17 years (OR = 6.06, 95% CI = 3.17, 11.58, P < .01) had a higher odds of vision difficulty. Compared to participants for whom the highest level of education of adults in their family was grade 1 to 11, the odds of vision difficulty were lower in those whose parents had a professional school or doctoral degree (OR = 0.30, 95% CI = 0.11, 0.84, P = .02). CONCLUSIONS: Multiple sociodemographic factors are associated with vision difficulty in young persons. In working toward achieving equity in vision health, it is imperative that disparities mediated by sociodemographic factors be addressed through public health policies.


Asunto(s)
Seguro de Salud , Factores Sociodemográficos , Niño , Adulto , Adolescente , Humanos , Estados Unidos/epidemiología , Preescolar , Estudios Transversales , Estudios Retrospectivos , Encuestas y Cuestionarios
19.
Surv Ophthalmol ; 69(1): 85-92, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-37652188

RESUMEN

Although there have been numerous innovations in the management of retinal detachment (RD) over the past decades, there is still limited understanding of the pathophysiological processes that take place before and after repair. Summarizing key concepts using animal studies may allow for a better assessment of common pre- and postoperative microstructural abnormalities in RD. We performed a systematic literature review on Ovid MEDLINE, EMBASE, and Cochrane Controlled Register of Trials from January 1968 to January 2022, searching animal or human studies reporting retinal histologic changes following primary or induced RD. Thirty-two studies were included. Main cellular events were summarized: photoceptor apoptosis occurs as early as 12 hours after RD and, although most cells survive, there is extensive remodeling. Outer segments progressively degenerate, while inner segments are reorganized. Rod and cone opsins are redistributed, and rod axons retract while cones undergo changes in shape. Second- and third-order neurons rearrange their dendritic processes, and Müller cells become hypertrophic, growing into the subretinal space. Finally, retinal pigment epithelium cells undergo a change in their morphology. Acknowledging critical morphologic changes following RD is crucial in understanding why anatomical and functional outcomes can vary. Insights from histological studies, together with high-resolution imaging, may be key in identifying novel biomarkers in RD.


Asunto(s)
Degeneración Retiniana , Desprendimiento de Retina , Animales , Humanos , Desprendimiento de Retina/cirugía , Retina/patología , Células Fotorreceptoras Retinianas Conos/patología , Degeneración Retiniana/patología
20.
Am J Ophthalmol ; 263: 81-92, 2024 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-38387827

RESUMEN

PURPOSE: To investigate the association between social determinants of health (SDH) in the domains of social and community context, education access, environmental context, economic stability, and healthcare access, with glaucoma prevalence. DESIGN: Cross-sectional study. METHODS: The study population consisted of adult participants who answered glaucoma-related questions on the 2017 National Health Interview Survey (NHIS), the most recent iteration that includes glaucoma-related questions. The main outcome measures included the relationships between SDH-related factors and self-reported glaucoma diagnosis as well as self-reported glaucomatous vision loss were examined using univariable and multivariable regression models. RESULTS: In total, 26,696 of 26,742 (99.83%) NHIS respondents were included, of whom 880 (3.30%) reported a glaucoma diagnosis and 275 (1.03%) reported glaucomatous vision loss. Participants were predominantly middle-aged (50.95 ± 18.60 years), female (54.75%), and non-Hispanic White (70.49%). In age-adjusted multivariable regression (n = 25,456), non-Hispanic Black race (odds ratio [OR] = 1.87, 99% CI = [1.37, 2.55], P < .001, compared to non-Hispanic White race) and poor health status (OR = 1.54, 99% CI = [1.00, 2.37], P = .01, compared to good health status) were significant predictors of glaucoma diagnosis. For glaucomatous vision loss, having an income below the poverty threshold (OR = 2.41, 99% CI = [1.12, 5.20], P = .003, compared to income ≥5 times the poverty threshold) was the only significant predictor in univariable analyses. No SDH-related factors were significantly associated with glaucomatous vision loss in multivariable analysis (n = 848). Multicollinearity was minimal (variation inflation factor<1.6 for all independent variables). CONCLUSIONS: Non-Hispanic Black race and poor health status were associated with self-reported glaucoma diagnosis. Physicians and policymakers may consider SDH when assessing clinical risk and designing public health interventions.


Asunto(s)
Glaucoma , Encuestas Epidemiológicas , Autoinforme , Humanos , Masculino , Femenino , Estudios Transversales , Persona de Mediana Edad , Glaucoma/epidemiología , Glaucoma/diagnóstico , Estados Unidos/epidemiología , Anciano , Adulto , Prevalencia , Factores Sociodemográficos , Determinantes Sociales de la Salud , Factores de Riesgo , Adulto Joven
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