RESUMO
BACKGROUND/AIMS: Socioeconomic status (SES) is associated with late disease presentation and poorer outcomes. We evaluate the effect of SES on treatment outcomes and report the correlation between SES and baseline characteristics of participants in the Treatment of Advanced Glaucoma Study. METHODS: Pragmatic multicentre randomised controlled trial. Four hundred and fifty-three patients presenting with advanced open-angle glaucoma in at least one eye (Hodapp-Parrish-Anderson classification). Participants were randomised to either glaucoma drops (medical arm) or trabeculectomy (surgery arm). Clinical characteristics, Quality of life measurement (QoL) and SES defined by the Index of Multiple Deprivation are reported. Subgroup analysis explored treatment effect modifications of SES at 24 months. Correlation between SES and baseline characteristics was tested with the χ2 test of association for dichotomous variables and pairwise Pearson's correlation for continuous variables. RESULTS: The mean visual field mean deviation was -17.2 (6.7)dB for the most deprived quintile of participants and -13.0 (5.5) for the least deprived quintile in the index eye. At diagnosis, there was a strong correlation between SES and ethnicity, age, extent of visual field loss and number of visits to opticians prior to diagnosis. At 24 months, there was no evidence that the treatment effect was moderated by SES. CONCLUSIONS: In patients presenting with advanced glaucoma. SES at baseline is correlated with poorer visual function, poorer Visual Function Questionnaire-25 QoL, ethnicity, age and number visits to an optician in the years preceding diagnosis. SES at baseline does not have an effect of the success of treatment at 24 months. TRIAL REGISTRATION NUMBER: ISRCTN56878850.
Assuntos
Glaucoma de Ângulo Aberto , Glaucoma , Trabeculectomia , Baixa Visão , Humanos , Qualidade de Vida , Pressão Intraocular , Glaucoma/cirurgia , Transtornos da Visão , Baixa Visão/cirurgiaRESUMO
Objective: To innovatively evaluate the impact of renal impairment in young work age patients with proliferative diabetic retinopathy (PDR) on their visuality after vitrectomy. Methods: To find out whether it is possible to better predict the improvement of visual acuity after vitrectomy in working-age people without adding additional preoperative testing. In view of the fact that diabetic retinopathy and diabetic nephropathy are common diabetic complications of microvascular damage, it is considered whether preoperative renal function can be used as this evaluation index. This paper studies the design under this theme. This retrospective study included 306 patients (306 eyes) diagnosed with PDR and undergoing vitrectomy in our hospital from January 2016 to June 2023. Relevant baseline data were collected, including age, history of kidney disease and clinical laboratory test results. According to the International Standard Logarithmic Visual Acuity Checklist, the best corrected visual acuity was tested on the first day of admission and one month after surgery, and the difference between the two was subtracted. A difference >0 was defined as "vision improved". Patients were classified as vision-improved group (n=245) and non-improved group (n=61). The differences in baseline serum urea nitrogen, creatinine, uric acid, Cystatin C, estimated glomerular filtration rate (eGFR) and urine protein distribution between the two groups were statistically analyzed, binary regression analysis was performed for meaningful parameters, and random forest model ranked the characteristics in importance. Results: 1.A higher level of serum cystatin C [1.02(0.80,1.48) mg/L vs 0.86(0.67,1.12) mg/L, P<0.001] and a lower eGFR [82.3(50.33, 115.11) ml/(min/1.73m²) vs 107.69(73.9, 126.01) ml/(min/1.73m²), P=0.002] appeared in the non-(vision-)improved group compared with the vision-improved group. 2. The occurrence of preoperation proteinuria history of nephropathy take a larger proportion in non-improved group. 3. Univariate regression analysis showed history of nephrology (OR=1.887, P=0.028), preoperative serum urea nitrogen (OR=0.939, P=0.043), cystatin C (Cys-C) concentration (OR=0.75, P=0.024), eGFR (OR=1.011, P=0.003) and proteinuria (OR=3.128, P<0.001) were influencing factors to postoperative visual acuity loss in young working age PDR patients. Excluding other confounding factors, preoperative proteinuria is an independent risk factor for postoperative vision improvement in working-age PDR populations (OR=2.722, P=0.009). 4. The accuracy of the prediction random forst model is 0.81. The model appears to be superior in terms of positive prediction. Conclusion: In young work aged PDR patients undergoing vitrectomy, preoperative urine protein can be an independent indicator of postoperative visual loss. Aggressive correction of kidney injury before surgery may help improve postoperative vision in patients with PDR.
Assuntos
Diabetes Mellitus , Retinopatia Diabética , Insuficiência Renal , Baixa Visão , Humanos , Idoso , Retinopatia Diabética/diagnóstico , Vitrectomia , Cistatina C , Baixa Visão/complicações , Baixa Visão/cirurgia , Estudos Retrospectivos , Transtornos da Visão , Nitrogênio , Proteinúria/complicações , Proteinúria/cirurgia , UreiaRESUMO
Introducción: a raíz del siguiente reporte de caso clínico se pretende repensar el diagnóstico diferencial de los tumores orbitales y revisar la literatura existente al respecto. Caso: paciente de 54 años, fumadora, acude a nuestro centro por una pérdida de agudeza visual progresiva de dos años de evolución en el ojo derecho, que se acompañaba de proptosis. Las pruebas de imagen basadas en resonancia magnética y tomografía por emisión de positrones tomografía computarizada (PET-TC) realizadas describían una lesión intraconal derecha de morfología indefinida, que rodeaba el nervio óptico. El estudio inmunohistoquímico y molecular anatomopatológico confirmó la sospecha de síndrome linfoproliferativo extranodal de bajo grado. Discusión: el manejo endoscópico de estas lesiones puede resultar en una menor comorbilidad en comparación con el abordaje externo tradicional. El papel de la cirugía radica en la obtención de una muestra de la lesión que permita un correcto diagnóstico. Conclusiones: el abordaje multidisciplinar con oftalmólogos, hematólogos y expertos en radioterapia permite obtener buenos resultados quirúrgicos y clínicos en la inmensa mayoría de casos.
Introduction: as result of the following clinical case report, we intend to review the differential diagnosis of orbital tumors and review the existing literature in this regard. Case report: a 54-year-old smoking patient, consulted to our department due to a progressive visual impairment over the last two years in her right eye. She presented proptosis in her clinical examination. Imaging studies based on MRI and PET-CT described a right intraconal lesion with an undefined morphology surrounding the optic nerve. Orbital tumors differential diagnosis is delicate. Nevertheless, Non-Hodgkin lymphomas followed by metastasis are the two most common found in this location. The immunohistochemistry and molecular studies, confirmed the suspected diagnosis of extranodal low-grade lymphoproliferative syndrome. Discussion: endoscopic management of these lesions may result in a lower comorbidity compared to traditional external approaches. Role of surgery lays in obtainment of a quality sample which allows a proper diagnosis. Conclusions: multidisciplinary approach with ophthalmologists, hematologists and radiotherapy experts enhance good surgical and clinical results in the vast majority of cases.
Assuntos
Humanos , Feminino , Adulto , Linfoma não Hodgkin/complicações , Neoplasias Orbitárias/complicações , Exoftalmia/etiologia , Baixa Visão/etiologia , Transtornos Linfoproliferativos/complicações , Linfoma não Hodgkin/cirurgia , Linfoma não Hodgkin/diagnóstico , Neoplasias Orbitárias/cirurgia , Neoplasias Orbitárias/diagnóstico , Exoftalmia/cirurgia , Exoftalmia/diagnóstico , Baixa Visão/cirurgia , Baixa Visão/diagnóstico , Diagnóstico Diferencial , Transtornos Linfoproliferativos/cirurgia , Transtornos Linfoproliferativos/diagnósticoRESUMO
RATIONALE: To report the visual status and results of phacoemulsification cataract surgery in a young patient with Alport syndrome associated with bilateral anterior lenticonus. The milestone of this report is the use of anterior segment optical coherence tomography (AS-OCT) to confirm the central protrusion of the anterior surface of the crystalline lens. PATIENT CONCERNS: A 23-year-old young woman presented with severe progressive visual loss in both eyes, which started several years ago. DIAGNOSES: Refractive status was indicative of high myopia with astigmatism and vision was not improved with optimal correction to better than 0.1 in the right eye and 0.2 in the left eye (visual acuities given in decimal notation). Slit-lamp examination showed transparent cornea, anterior lenticonus and posterior sub-capsular cataract in both eyes. The classical appearance of oil droplet was evident using retro-illumination on the slit lamp. INTERVENTIONS: The natural lenses were replaced with intraocular lens (IOL). OUTCOMES: An excellent refractive status achieved associated with an uncorrected distance visual acuity 0.9 and 0.8 in the right and left eye, respectively. LESSONS: AS-OCT is a valuable device for confirming the budging of the anterior crystalline lens surface.
Assuntos
Cápsula do Cristalino/patologia , Cápsula do Cristalino/cirurgia , Córtex do Cristalino/patologia , Córtex do Cristalino/cirurgia , Nefrite Hereditária/patologia , Nefrite Hereditária/cirurgia , Facoemulsificação , Feminino , Humanos , Cápsula do Cristalino/diagnóstico por imagem , Córtex do Cristalino/diagnóstico por imagem , Nefrite Hereditária/diagnóstico por imagem , Tomografia de Coerência Óptica , Baixa Visão/diagnóstico por imagem , Baixa Visão/etiologia , Baixa Visão/cirurgia , Adulto JovemRESUMO
PURPOSE: To investigate the difference in the optic canal diameter between children with autosomal recessive malignant infantile osteopetrosis and normal children, and to assess the influence of hematopoietic stem cell transplantation on the optic canal diameter. METHODS: Twenty pediatric patients with malignant infantile osteopetrosis and 22 normal control children were included in this study. Eleven patients with malignant infantile osteopetrosis underwent hematopoietic stem cell transplantation. The measurements included optical canal diameter and flash visual evoked potential. Comparisons of these measurements between patients with malignant infantile osteopetrosis and normal controls as well as before and after hematopoietic stem cell transplantation were performed. The correlation between age and optic canal diameter was analyzed using Pearson correlation analysis. RESULTS: The mean optic canal diameter before hematopoietic stem cell transplantation was 1.65 ± 0.54 mm in patients with malignant infantile osteopetrosis and 3.38 ± 0.60 mm in the control group (P < .001). The mean optic canal diameter after hematopoietic stem cell transplantation was 2.72 ± 0.66 mm, which was significantly different from the pre-transplantation measurement (P < .001). The P2 latency for the flash visual evoked potential after hematopoietic stem cell transplantation (152.3 ± 36.4 ms) was significantly less than that before transplantation (165.5 ± 27.7 ms; P = .051). Pearson correlation analysis revealed a significant correlation between age and optic canal diameter (r = 0.722, P < .001). CONCLUSIONS: The optic canal was narrower in pediatric patients with malignant infantile osteopetrosis than in age-matched normal controls. This condition can be relieved through hematopoietic stem cell transplantation and the impaired conductibility of the optic nerve can be improved in some cases. [J Pediatr Ophthalmol Strabismus. 2019;56(1):35-42.].
Assuntos
Transplante de Células-Tronco Hematopoéticas/métodos , Nervo Óptico/diagnóstico por imagem , Osteopetrose/congênito , Baixa Visão/cirurgia , Acuidade Visual , Pré-Escolar , Potenciais Evocados Visuais , Feminino , Seguimentos , Humanos , Imageamento Tridimensional , Lactente , Recém-Nascido , Masculino , Osteopetrose/complicações , Osteopetrose/diagnóstico , Osteopetrose/cirurgia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Baixa Visão/diagnóstico , Baixa Visão/etiologiaRESUMO
A 62-year-old female who was legally blind secondary to retinitis pigmentosa (RP) developed new positive visual phenomena (PVP) ("visual storms") following implantation of the Argus II Retinal Prosthesis System (Second Sight Medical Products, Sylmar, CA). The potential mechanisms for the exacerbating PVP or hallucinatory release phenomena are proposed. Clinicians should be aware of these visual phenomena in patients with RP and the potential for worsening of or de novo development of PVP in patients considering the Argus II implant. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:1022-1025.].
Assuntos
Implantação de Prótese/métodos , Retina/cirurgia , Retinose Pigmentar/complicações , Baixa Visão/cirurgia , Acuidade Visual , Próteses Visuais , Eletrorretinografia , Feminino , Humanos , Pessoa de Meia-Idade , Oftalmoscopia , Desenho de Prótese , Retina/diagnóstico por imagem , Retinose Pigmentar/diagnóstico , Retinose Pigmentar/cirurgia , Baixa Visão/etiologia , Baixa Visão/fisiopatologiaRESUMO
BACKGROUND: Chiasmapexy is used to treat empty sella syndrome, and various materials are used for the elevation of the optic chiasm. However, the use of artificial substances may have the risk of graft infection, and fat and muscle may be absorbed over the long term after surgery. In addition, bone and cartilage may be unavailable in adequate amounts. Here, we describe a new technique for chiasmapexy using an iliac crest bone graft. CASE DESCRIPTION: The first patient was a 71-year-old woman who had undergone transsphenoidal surgery twice for the treatment of pituitary adenoma and Rathke cleft cyst. The optic chiasm collapsed after the second surgery and her visual field worsened gradually. We performed chiasmapexy using fat, fascia, and a septal mucosal flap, but the optic chiasm did not remain in the normal position because of graft shrinkage. Finally, we used an iliac crest bone graft, which resulted in good visual function. The second patient was a 58-year-old man who was incidentally diagnosed with empty sella syndrome. The patient's bitemporal hemianopia gradually progressed. As in the first case, we used an iliac crest bone graft, which halted the deterioration of visual function after chiasmapexy. CONCLUSIONS: The advantages of iliac bone are that it is less likely to absorb and become infected than synthetic materials. This method may be suitable for reoperative cases, especially those wherein the septal cartilage has been removed in a previous surgery. This method will halt visual deterioration and may be one of the considerable options for chiasmapexy operations.
Assuntos
Transplante Ósseo/métodos , Síndrome da Sela Vazia/cirurgia , Ílio/transplante , Quiasma Óptico/cirurgia , Baixa Visão/cirurgia , Idoso , Síndrome da Sela Vazia/complicações , Síndrome da Sela Vazia/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Quiasma Óptico/diagnóstico por imagem , Baixa Visão/diagnóstico por imagem , Baixa Visão/etiologiaRESUMO
OBJECTIVE: To assess the visual outcomes after cataract surgery among urban and rural population aged ≥40 years in the South India state of Andhra Pradesh. METHODS: A population based cross-sectional study was conducted in which 7800 subjects were sampled from two rural and one urban location. Visual Acuity was assessed and eye examination were performed by trained personnel. A questionnaire was used to collect personal and demographic information, and history of cataract surgery. Blindness and moderate Visual Impairment (MVI) was defined as presenting VA <6/60 and <6/18 to 6/60 in the better eye respectively. RESULTS: In total, 7378 (94.6%) were examined. Of these, 1228 eyes of 870 individuals were operated for cataract. The mean age of operated subjects was 63.7 years (SD: 10.7 years). Overall, 56.3% of those operated were women, 76% were illiterate and 42% of them were using spectacles after cataract surgery. Even after surgery, 12.2% of the operated eyes had MVI and blindness was seen in 14.7% of the eyes. A significantly higher proportion of subjects in urban area had good outcome as compared to those in the rural area (p = 0.01). Uncorrected refractive error (58.7%) was the leading cause of MVI, and posterior segment disease (34.3%) was the leading cause of blindness. On applying multiple logistic regression, risk factors for poor outcomes were age ≥ 70 years (OR: 1.9, 95% CI: 1.3-2.8), rural residence (OR: 1.3, 95% CI:1.0-1.8) and presence of aphakia (OR: 8.9, 95% CI: 5.7-13.8). CONCLUSIONS: Post cataract surgery, refractive errors remain an important correctable cause of MVI, in the south Indian state of Andhra Pradesh. The correction of refractive errors is required to provide good visual recovery and achieve the benefit of cataract surgery.
Assuntos
Catarata/fisiopatologia , Catarata/terapia , Acuidade Visual/fisiologia , Idoso , Cegueira/cirurgia , Extração de Catarata/métodos , Estudos Transversais , Óculos , Feminino , Humanos , Índia , Masculino , Pessoa de Meia-Idade , Erros de Refração/fisiopatologia , Erros de Refração/terapia , População Rural , População Urbana , Baixa Visão/cirurgiaRESUMO
The authors describe the surgical approach, findings, and 8-year follow-up in a 29-year-old woman, with severe Freeman-Sheldon syndrome, presenting with congenital blepharophimosis of both upper eyelids resulting in near-complete functional visual obstruction. To avoid possible Freeman-Sheldon syndrome-associated complications of malignant hyperthermia, difficult vascular access, and challenging endotracheal intubation, the surgery was completed under local anesthesia without sedation, and anatomical and functional correction was immediate and remained stable at 8-year follow-up. Unlike many congenital craniofacial syndromes, which frequently involve life-long impairments, important implications exist for plastic surgeons to facilitate opportunities for patients to overcome functional limitations.
Assuntos
Anormalidades Múltiplas , Blefarofimose/cirurgia , Blefaroplastia/métodos , Disostose Craniofacial/complicações , Baixa Visão/cirurgia , Adulto , Blefarofimose/diagnóstico , Disostose Craniofacial/diagnóstico , Feminino , Seguimentos , Humanos , Fatores de Tempo , Baixa Visão/diagnósticoRESUMO
AIMS: To investigate the influence of lag time between the onset of central visual acuity loss and surgical intervention of macula-off retinal detachment. METHODS: This retrospective case series examined all consecutively treated eyes with primary macula-off retinal detachment at the University Hospital Hamburg (Germany) from February 2010 to February 2015. Records of 1727 patients operated by six surgeons were reviewed. Eighty-nine eyes (5.2%) from 89 patients met the inclusion and exclusion criteria. The main outcome measure studied was final visual acuity as a function of symptom duration of macula-off detachment. Secondary outcome measures studied were influence of age and surgical technique. Symptom duration was defined as the time from the onset of loss of central vision to surgical intervention. RESULTS: After 10â days no clinically relevant difference was seen in final visual acuity. Eyes with symptom duration of 3â days or less achieved best final visual acuity (p<0.001). Age and preoperative visual acuity had no influence while vitrectomised eyes had better outcome compared with those with scleral buckling. CONCLUSIONS: Our study suggests that 1. After 10â days of central visual acuity loss, the final visual outcome is clinically comparable and independent of further delay of surgery up to 30â days. 2. Eyes treated up to 3â days after onset of loss of central vision have better final visual acuity than eyes with longer lag time. However, we did not find statistically significant differences within the first 3â days. 3. Surgery for macula-off retinal detachment may therefore most likely not be postponed without compromising the patient's visual prognosis.
Assuntos
Recuperação de Função Fisiológica/fisiologia , Descolamento Retiniano/cirurgia , Baixa Visão/fisiopatologia , Acuidade Visual , Vitrectomia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Descolamento Retiniano/complicações , Descolamento Retiniano/fisiopatologia , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Baixa Visão/etiologia , Baixa Visão/cirurgiaRESUMO
Sinonasal undifferentiated carcinoma-related rhinogenic optic neuropathy is rare and may lead to visual loss. To the best of our knowledge, this is the first report of bilateral sequential visual loss induced by this etiology. It is important to differentiate between chronic sinusitis and malignancy on the basis of specific findings on magnetic resonance images. Surgical decompression with multidisciplinary therapy, including steroids, chemotherapy, and radiotherapy, is indicated. However, no visual improvement was noted in this case, emphasizing the rapid disease progression and importance of early diagnosis and treatment.
Assuntos
Carcinoma/diagnóstico , Neoplasias do Seio Maxilar/diagnóstico , Doenças do Nervo Óptico/complicações , Nervo Óptico/diagnóstico por imagem , Sinusite/diagnóstico , Baixa Visão/etiologia , Idoso , Carcinoma/complicações , Carcinoma/cirurgia , Doença Crônica , Descompressão Cirúrgica , Diagnóstico Diferencial , Feminino , Humanos , Imageamento por Ressonância Magnética , Neoplasias do Seio Maxilar/complicações , Neoplasias do Seio Maxilar/cirurgia , Doenças do Nervo Óptico/diagnóstico , Doenças do Nervo Óptico/cirurgia , Tomografia Computadorizada por Raios X/métodos , Baixa Visão/diagnóstico , Baixa Visão/cirurgiaRESUMO
A 20-year-old woman, a registered nurse, presented with best-corrected visual acuity of 6/15 (20/50) due to bilateral extensive persistent pupillary membrane. Sequential argon laser photocoagulation of the iris strands at the pupillary membrane iris collarette followed by neodymium:YAG laser lysis resulted in partial clearing of the central visual axis without bleeding. Best-corrected visual acuity improved to 6/9 (20/30) bilaterally without complications noted 1â year after combined laser therapy.
Assuntos
Anormalidades do Olho/cirurgia , Doenças da Íris/cirurgia , Iris/anormalidades , Terapia a Laser/métodos , Membranas/anormalidades , Distúrbios Pupilares/cirurgia , Baixa Visão/etiologia , Adulto , Argônio , Feminino , Humanos , Iris/cirurgia , Fotocoagulação a Laser , Lasers de Estado Sólido , Membranas/cirurgia , Pupila , Baixa Visão/cirurgia , Acuidade Visual , Adulto JovemRESUMO
BACKGROUND: Autoimmune hypophysitis very rarely spreads to nearby organs outside the pituitary tissue, for unknown reasons, with only 5 reported cases of hypophysitis spreading over the cavernous sinus. CASE PRESENTATION: Three patients presented with cases of non-infectious hypophysitis spreading outside the pituitary tissue over the cavernous sinus. All three cases were diagnosed with histological confirmation by transsphenoidal surgery, and the patients showed remarkable improvement with postoperative pulse dose steroid therapy, including disappearance of abnormal signal intensities in the bilateral hypothalami on magnetic resonance imaging, resolution of severe stenosis of the internal carotid artery, and normalization of swollen pituitary tissues. Two of 3 cases fulfilled the histological criteria of immunoglobulin G4-related disease, although none of the patients had high serum immunoglobulin G4 level. CONCLUSION: The true implications of such unusual spreading of hypophysitis to nearby organs are not fully understood, but the mechanism of occurrence might vary according to the timing of inflammation in this unusual mode of spreading. Pulse dose steroid therapy achieved remarkably good outcomes even in the patient with progressive severe stenosis of the internal carotid artery and rapid visual deterioration.
Assuntos
Estenose das Carótidas/patologia , Linfócitos/patologia , Hipófise/patologia , Baixa Visão/patologia , Adulto , Autoimunidade , Estenose das Carótidas/tratamento farmacológico , Estenose das Carótidas/imunologia , Estenose das Carótidas/cirurgia , Dexametasona/uso terapêutico , Feminino , Humanos , Imunoglobulina G/sangue , Inflamação/tratamento farmacológico , Inflamação/imunologia , Inflamação/patologia , Inflamação/cirurgia , Linfócitos/imunologia , Metilprednisolona/uso terapêutico , Pessoa de Meia-Idade , Hipófise/efeitos dos fármacos , Hipófise/imunologia , Hipófise/cirurgia , Baixa Visão/tratamento farmacológico , Baixa Visão/imunologia , Baixa Visão/cirurgiaRESUMO
BACKGROUND: Cancerous cells are known to metastasize to different ocular structures. This happens especially to the choroid in males with lung cancer and females with breast cancer. However, we observed two cases of cancerous metastasis to the optic canal region. Both cases showed only a progressive decrease in vision without any other remarkable ophthalmological symptoms or abnormalities in the affected eye. CASE PRESENTATION: Two females, a 60-year-old and a 73-year-old, came to our hospital because of progressive loss of vision. These patients showed no remarkable symptoms or signs in their eyes except visual acuity loss. Several ophthalmoscopic examinations, such as slit lamp microscopy and fundoscopy, showed no abnormal changes in their affected eye but magnetic resonance imaging indicated a massive legion around the optic nerve. CONCLUSION: It is possible for cancer to metastasize to the optic canal region and the existence of primary tumors should be considered.
Assuntos
Artrogripose/patologia , Neuropatia Hereditária Motora e Sensorial/patologia , Nervo Óptico/patologia , Neoplasias Orbitárias/secundário , Baixa Visão/patologia , Adenocarcinoma/complicações , Adenocarcinoma/secundário , Adenocarcinoma/cirurgia , Idoso , Artrogripose/complicações , Artrogripose/cirurgia , Neoplasias da Mama/complicações , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Carcinoma Ductal de Mama/complicações , Carcinoma Ductal de Mama/secundário , Carcinoma Ductal de Mama/cirurgia , Feminino , Neuropatia Hereditária Motora e Sensorial/complicações , Neuropatia Hereditária Motora e Sensorial/cirurgia , Humanos , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/cirurgia , Pessoa de Meia-Idade , Nervo Óptico/cirurgia , Neoplasias Orbitárias/complicações , Neoplasias Orbitárias/cirurgia , Baixa Visão/complicações , Baixa Visão/cirurgiaRESUMO
PURPOSE: To describe endokeratophakia in which a small incision lenticule extraction (SMILE) lenticule from a myopic patient is implanted into a recipient eye through a small incision to correct hyperopia. METHODS: A 23-year-old aphakic woman presented following cataract surgery to remove a childhood congenital cataract with hyperopia of +12.00 -1.50 × 155, corrected distance visual acuity of counting fingers, and exotropia. A SMILE procedure using the VisuMax femto-second laser (Carl Zeiss Meditec, Jena, Germany) was performed on a donor patient with high myopia and the extracted lenticule was stored (power -10.50 diopter sphere, optical zone 5.75 mm, central lenticule thickness 127 µm). In the recipient eye, a pocket lamellar incision was created using the VisuMax SMILE software. The upper interface was separated and the donor lenticule was inserted through the small incision. RESULTS: One year postoperatively, retinoscopy refraction was +7.50 -3.00 × 150, a spherical equivalent refraction reduction of 5.25 diopters. Mean keratometric power increased by 2.91 diopters. The posterior surface elevation changed significantly with a central bulge into the anterior chamber. Central corneal thickness by Pentacam (Oculus Optikgeräte, Wetzlar, Germany) increased by 121 µm. Central lenticule thickness was 130 µm and central epithelial thickness was 43 µm measured by RTVue OCT (Optovue Inc., Fremont, CA). The cornea remained clear over the 1-year postoperative period. CONCLUSIONS: Endokeratophakia appears to be a viable procedure for correcting hyperopia on the cornea by implantation of an extracted myopic SMILE lenticule from a donor patient. However, posterior surface changes and epithelial remodeling resulted in only 50% of the intended correction. No adverse side effects were observed following implantation of donor tissue for 1 year.
Assuntos
Substância Própria/transplante , Transplante de Córnea/métodos , Hiperopia/cirurgia , Miopia/cirurgia , Baixa Visão/cirurgia , Topografia da Córnea , Feminino , Humanos , Hiperopia/fisiopatologia , Retinoscopia , Doadores de Tecidos , Tomografia de Coerência Óptica , Transplante Homólogo , Baixa Visão/fisiopatologia , Acuidade Visual/fisiologia , Adulto JovemRESUMO
PURPOSE: To study the demographic evolution of acute primary angle closure. MATERIALS AND METHODS: Retrospective study of patients with acute primary angle closure treated between 2001-2003 and 2008-2010. For each period, a comparison was made of demographic data (number of cases, age at diagnosis, sex), clinical data (biometry, presence or absence of iris plateau or cataract) and therapeutic data (iridotomy, phacoemulsification, trabeculectomy). RESULTS: Fifty-two cases of acute primary angle closure were treated in the University Hospital of Nantes, France: 34 eyes in 2001-2003 and 18 in 2008-2010, representing a decrease of 47% in acute primary angle closure cases in 7years. The incidence of acute primary angle closure attacks significantly decreased from 0.0596% in 2001-2003 to 0.0224% in 2008-2010. Acute angle closure attacks secondary to cataract decreased significantly from 82% in 2001-2003 to 50% in 2008-2010. In cataractous cases with ocular hypertension persisting after peripheral iridotomy, cataract extraction was performed. Early phacoemulsification less than 10days was significantly more common in 2008-2010 than in 2001-2003 (40% versus 10%). CONCLUSION: This study confirms the recent decrease in acute primary angle closure attacks. The consistent increase in cataract surgery in the elderly has probably played a preventive role, since the highest decrease in acute primary angle closure cases was observed among the 70-80-year-old population. Recently, acute primary angle closure cases are less often due to cataract than to primary pupillary block or iris plateau. The prevention of acute primary angle closure by gonioscopic monitoring in patients at risk is indispensable.
Assuntos
Extração de Catarata/estatística & dados numéricos , Glaucoma de Ângulo Fechado/epidemiologia , Baixa Visão/epidemiologia , Baixa Visão/cirurgia , Doença Aguda , Adulto , Idade de Início , Idoso , Idoso de 80 Anos ou mais , Catarata/complicações , Catarata/epidemiologia , Extração de Catarata/tendências , Demografia , Feminino , Glaucoma de Ângulo Fechado/complicações , Glaucoma de Ângulo Fechado/etiologia , Glaucoma de Ângulo Fechado/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Baixa Visão/etiologiaRESUMO
PURPOSE: To evaluate characteristics and prognostic factors for functional success in eyes that present with no light perception (NLP) after open globe trauma. METHODS: The medical records of all subjects presenting to a single university referral center with visual acuity (VA) of NLP after sustaining an open globe eye injury from January 1, 2001, through June 30, 2010, were retrospectively analyzed to determine epidemiologic and clinical factors associated with visual outcomes. RESULTS: Of the 73 NLP eyes (73 patients) that underwent primary repair and were included in the study, final VA was 20/100 in 1 eye (1%), counting fingers in 2 eyes (3%), hand motion in 9 eyes (12%), light perception in 5 eyes (7%), and NLP in 56 eyes (77%). Recovery of some vision on postoperative Day 1, pars plana vitrectomy operation, and Zone 2 injury were significantly associated with an improvement in final VA. Zone 3 injuries were the most likely to result in NLP final VA, although this difference was not statistically significant. CONCLUSION: Visual recovery to light perception or better on postoperative Day 1 increases the likelihood of having a long-term improvement in VA. Pars plana vitrectomy may be beneficial in such eyes if posterior segment abnormalities are noted.
Assuntos
Cegueira/fisiopatologia , Ferimentos Oculares Penetrantes/fisiopatologia , Luz , Baixa Visão/fisiopatologia , Acuidade Visual/fisiologia , Percepção Visual/fisiologia , Cegueira/diagnóstico , Cegueira/cirurgia , Ferimentos Oculares Penetrantes/diagnóstico , Ferimentos Oculares Penetrantes/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Recuperação de Função Fisiológica/fisiologia , Estudos Retrospectivos , Ruptura , Baixa Visão/diagnóstico , Baixa Visão/cirurgia , VitrectomiaRESUMO
A 25-year-old woman presented with complaints of nausea and headache. She had been treated with a ventriculoperitoneal shunt for hydrocephalus when she was 7 months old. Her bilateral optic discs showed moderate atrophy. Right visual acuity allowed only perception of hand movement and left visual acuity was 0.02 (1.2). Computed tomography (CT) showed mild ventricular dilation but no periventricular lucency. Intracranial pressure (ICP) was not high when the shunt valve was punctured. Her visual acuity deteriorated 5 days after the consultation. She was referred again 8 days after the first consultation. The bilateral optic discs were completely pale. Both pupils were dilated on admission, and the bilateral direct light reflexes were absent. The patient could slightly detect only green light stimulus. CT showed moderate enlargement of the ventricle. ICP was 47 cmH(2)O when the shunt valve was punctured. Shuntgraphy showed obstruction of the shunt at the distal end of peritoneal catheter. Emergent total shunt revision was performed. She could detect dark stimulus and the still-dilated left pupil had recovered direct light reflex on the next day. The visual acuity was 0.01 (0.7) on the left 6 months after the operation, although she was blind in the right eye and the bilateral optic discs were completely pale. Visual loss associated with shunt failure remains a major morbidity in shunted congenital hydrocephalus. Early diagnosis and shunt revision may allow visual recovery.
Assuntos
Falha de Equipamento , Hidrocefalia/cirurgia , Atrofia Óptica/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/cirurgia , Derivação Ventriculoperitoneal , Baixa Visão/etiologia , Adulto , Feminino , Seguimentos , Humanos , Pressão Intracraniana/fisiologia , Atrofia Óptica/fisiopatologia , Atrofia Óptica/cirurgia , Complicações Pós-Operatórias/fisiopatologia , Reflexo Pupilar/fisiologia , Reoperação , Tomografia Computadorizada por Raios X , Baixa Visão/fisiopatologia , Baixa Visão/cirurgia , Acuidade Visual/fisiologia , Campos Visuais/fisiologiaAssuntos
Doenças da Córnea/cirurgia , Baixa Visão/cirurgia , Adulto , Doenças da Córnea/complicações , Doenças da Córnea/diagnóstico , Topografia da Córnea , Dilatação Patológica/patologia , Dilatação Patológica/cirurgia , Progressão da Doença , Humanos , Masculino , Fotoquimioterapia , Refração Ocular/fisiologia , Tomografia de Coerência Óptica , Baixa Visão/diagnóstico , Baixa Visão/etiologia , Acuidade Visual/fisiologiaRESUMO
PURPOSE: To investigate the functional outcome, as defined using the Catquest questionnaire, for patients with posterior capsule opacification (PCO) and low corrected distance visual acuity (CDVA), after capsulotomy. METHODS: Thirty-one patients with PCO and visual acuity ≥ 0.6 (log MAR, ≤ 0.25 decimal notation) in the PCO eye were examined before and 1 month after capsulotomy. An ophthalmic examination, procuring of a digital image of the posterior lens capsule and completion of Catquest were carried out. RESULTS: Mean CDVA (p < 0.001), disabilities in daily life (p = 0.004), activity (p = 0.012), symptoms of glare (p = 0.003) and satisfaction with vision (p < 0.001) all improved after capsulotomy. Sixty-five per cent of patients had good or very good benefit and 23% questionable or no benefit. The group with moderate benefit was only 6%. Compared with patients with PCO and better visual acuity, the number of patients with good benefit was greater than the number with moderate benefit. CONCLUSIONS: Most patients with PCO and low CDVA reported improved visual function in daily life as defined using Catquest, after capsulotomy. The group with moderate benefit was small, indicating that the improvement was either substantial or negligible.