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The objective of this study is to determine the incidence and risk factors of retinopathy of prematurity (ROP) in extremely low birth weight (ELBW) Chinese infants. A retrospective medical record review of all ELBW (≤1,000 g) neonates screened for ROP from 2007 to 2012 was performed in Hong Kong. ROP screening was conducted at 2 neonatal intensive care units by 3 pediatric ophthalmologists using the Royal College of Ophthalmologists ROP guideline and the International Classification of ROP. Maternal and neonatal covariates were analyzed using univariate and multivariate regression analyses for both ROP and Type 1 ROP. In 131 ELBW Chinese infants, the mean gestational age (GA) and birth weight (BW) were 27.3 ± 3.3 weeks and 806.9 ± 133.7 g, respectively. The incidence of ROP and Type 1 ROP was 53.4 and 14.5 %, respectively. For ROP, a lighter BW, smaller GA, vaginal delivery, postnatal hypotension, inotrope use, bronchopulmonary dysplasia, surfactant use, invasive mechanical ventilation, and supplementary oxygen were independent risk factors for ROP, while PET was protective (P ≤ 0.02). On multivariate analysis, a smaller GA was a risk factor, while PET and congenital heart disease were protective for ROP development (P ≤ 0.01). For Type 1 ROP, a lighter BW, smaller GA, surfactant use, and invasive mechanical ventilation were independent risk factors for ROP, while PET was protective (P ≤ 0.02). There were no significant covariates on multivariate analysis for Type 1 ROP. In ELBW, preterm Chinese infants, a smaller GA was a risk factor for ROP, while PET and congenital heart disease were protective for ROP development in multivariate analysis.
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Recém-Nascido de muito Baixo Peso , Retinopatia da Prematuridade/epidemiologia , Retinopatia da Prematuridade/etiologia , Diabetes Gestacional/epidemiologia , Feminino , Idade Gestacional , Hong Kong/epidemiologia , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Análise Multivariada , Pré-Eclâmpsia/epidemiologia , Gravidez , Estudos Retrospectivos , Fatores de RiscoRESUMO
To investigate the etiology and prevalence of optic neuritis in a Chinese population. This was a single centre prospective cohort study. Consecutive patients with either a first or recurrent attack of optic neuritis from November 2010 to December 2011 were recruited from a district hospital in Hong Kong Special Administrative Region, China. All patients underwent serology testing for NMO (neuromyelitis optica) IgG; oligoclonal bands from lumbar puncture; computer tomography and contrast magnetic resonance imaging (MRI) of the brain and orbit as well as visual field; and optical coherence tomography testing. Patients were followed up for 1 year after the initial attack. 30 optic neuritis subjects were recruited. 73.3 % (22/30) remain as clinical isolated syndrome (CIS) after 1-year follow-up. 10 % (3/30) patients developed multiple sclerosis. 10 % (3/30) were diagnosed with NMO and 6.7 % (2/30) with NMO-spectrum disorder. The majority of acute unilateral optic neuritis in Chinese was CIS in origin although a fraction does progress to develop MS or NMO-related disorders. Clinicians should be aware of the associations and offer appropriate systemic workups.
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Neurite Óptica/epidemiologia , Adulto , Progressão da Doença , Feminino , Seguimentos , Hong Kong/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/complicações , Neuromielite Óptica/complicações , Neurite Óptica/diagnóstico , Neurite Óptica/etiologia , Prevalência , Estudos Prospectivos , Tomografia de Coerência Óptica/métodosRESUMO
The objective of this study was to investigate the longitudinal changes in retinal nerve fibre layer (RNFL) thickness 1 year after an episode of unilateral acute optic neuritis. This prospective cohort study recruited consecutive patients with a first episode of isolated, unilateral acute optic neuritis from October 2010 to June 2013. RNFL thickness of the attack and normal fellow eyes was measured by optical coherence tomography on presentation and 3, 6, and 12 months post attack in both the treatment and non-treatment groups. The treatment group consisted of subjects that opted for systemic steroids to hasten recovery time. In 20 subjects, 11 received systemic steroids and 9 were treated conservatively. The baseline RNFL thickness was similar in the attack and fellow eyes (p ≥ 0.4). Progressive RNFL thinning was seen in the attack eye over the 12-month period, with significant differences for baseline versus 3 months; baseline versus 12 months; and 3 versus 12 months (all p < 0.0001). At 12 months, the attack eye had a thinner average RNFL than the fellow eye (100.9 ± 6.1 versus 107.3 ± 5.5 µm; p = 0.002). The 12-month RNFL was similar between the treatment and non-treatment groups (p ≥ 0.6). A single episode of optic neuritis triggered an accelerated, progressive RNFL thinning up to 6 months post attack. Initial treatment with systemic steroids did not seem to alter the degree of RNFL loss at 12 months.
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PURPOSE: To investigate outcome differences of intralesional triamcinolone acetonide (TA) injection for primary chalazia in children versus adults. METHODS: A retrospective review of consecutive subjects with primary chalazion who received intralesional TA injection was conducted. A single investigator injected 0.05-0.15 mL of TA (40 mg/mL) intralesionally. Patients were stratified into the pediatric (<18 years old) and adult (≥ 18 years old) group. In both groups, the correlation of resolution time with chalazion size and TA dose was performed. RESULTS: 17 children and 24 adults were enrolled, with a mean age of 7.4 ± 5.5 and 39.3 ± 16.7 years, respectively. Both groups had statistically similar baseline characteristics. There was no significant difference between the resolution time in the pediatric (18.2 ± 11.4 days) and adult (16.5 ± 11.0 days) group (P = 0.7). There were no significant complications from the TA injection. There was no significant correlation of resolution time to chalazion size (P = 0.7) nor TA dose (P = 0.3) in both groups. CONCLUSION: TA for the treatment of primary chalazion was equally effective in children and adults, without any significant complications, and the rate of clinical response did not appear to be dose-dependent.
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Calázio/tratamento farmacológico , Glucocorticoides/administração & dosagem , Triancinolona Acetonida/administração & dosagem , Administração Tópica , Adolescente , Adulto , Calázio/patologia , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do TratamentoRESUMO
PURPOSE: To investigate the correlation of anterior chamber depth (ACD) with the peripapillary retinal nerve fiber layer (RNFL) thickness, age, axial length (AL), and spherical equivalent in children. SUBJECTS: Consecutive subjects aged 4 to 18 were recruited. Visually disabling eye conditions were excluded. Only the right eye was included for analysis. The ACD was correlated with RNFL thickness, age, spherical equivalent, and AL for all subjects. Subjects were then divided into 3 groups based on their postcycloplegic spherical equivalent: myopes (<-1.0 D), emmetropes (≥-1.0 to ≤+1.0 D), and hyperopes (>+1.0 D). The ACD was compared among the 3 groups before and after age adjustment. RESULTS: In 200 subjects (mean age 7.6 ± 3.3 years), a deeper ACD was correlated with thinner global RNFL (r = -0.2, r(2) = 0.06, P = 0.0007), older age (r = 0.4, r(2) = 0.1, P < 0.0001), myopic spherical equivalent (r = -0.3, r(2) = 0.09, P < 0.0001), and longer AL (r = 0.5, r(2) = 0.2, P < 0.0001). The ACD was deepest in myopes (3.5 ± 0.4 mm, n = 67), followed by emmetropes (3.4 ± 0.3, n = 60) and then hyperopes (3.3 ± 0.2, n = 73) (all P < 0.0001). After age adjustment, myopes had a deeper ACD than the other 2 groups (all P < 0.0001). CONCLUSIONS: In children, a deeper ACD was associated with thinner RNFL thickness, older age, more myopic spherical equivalent, and longer AL. Myopes had a deeper ACD than emmetropes and hyperopes.
Assuntos
Câmara Anterior/anatomia & histologia , Comprimento Axial do Olho/anatomia & histologia , Hiperopia/patologia , Miopia/patologia , Nervo Óptico/anatomia & histologia , Adolescente , Câmara Anterior/fisiologia , Comprimento Axial do Olho/fisiologia , Criança , Pré-Escolar , Estudos Transversais , Emetropia/fisiologia , Feminino , Humanos , Hiperopia/fisiopatologia , Masculino , Miopia/fisiopatologia , Fibras Nervosas/fisiologia , Nervo Óptico/fisiologiaRESUMO
PURPOSE: To evaluate the efficacy of using topical cyclosporin A 0.05% (Restasis) for the treatment of paediatric allergic conjunctivitis. METHODS: This retrospective study included consecutive cases of paediatric allergic conjunctivitis treated with Restasis between 2010 and 2013. Subjects with follow-up time less than 3 months after using Restasis were excluded. Itch severity score, symptom score, and sign score were compared before (baseline) and 3 months after using Restasis. RESULTS: In 27 eyes of 14 patients (mean age 10.8 ± 3.2 years), 44.4% had allergic conjunctivitis, 33.3% had vernal keratoconjunctivitis, and 22.2% had atopic keratoconjunctivitis. The mean duration of ocular symptoms was 20.4 ± 13.2 months. 92.6% of subjects were using steroid eye drop before Restasis. After 3 months of topical Restasis, there were statistically significant reductions in the symptom, sign, and itch severity scores compared with baseline (all P ≤ 0.001) and 78.6% of subjects were able to be tapered off steroid eye drops. CONCLUSION: Topical Restasis was effective and safe in significantly reducing ocular itchiness, sign, and symptom scores at 3 months after use in paediatric allergic ocular conditions.
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Conjuntivite Alérgica/tratamento farmacológico , Ciclosporina/administração & dosagem , Imunossupressores/administração & dosagem , Soluções Oftálmicas/administração & dosagem , Administração Tópica , Adolescente , Povo Asiático , Criança , Conjuntivite Alérgica/classificação , Conjuntivite Alérgica/patologia , Feminino , Hong Kong , Humanos , Masculino , Estudos Retrospectivos , Resultado do TratamentoRESUMO
PURPOSE: To determine the differences in risk factors for retinopathy of prematurity (ROP) in paired twins. METHODS: A retrospective medical record review was performed for all paired twins screened for ROP between 2007 and 2012. Screening was offered to very low birth weight (≤ 1500 grams) and preterm (≤ 32 weeks) neonates. Twins 1 and 2 were categorized based on the order of delivery. Maternal and neonatal covariates were analyzed using univariate and multivariate regression analyses for both ROP and Type 1 ROP. RESULTS: In 34 pairs of Chinese twins, the mean gestational age (GA) was 30.2 ± 2.0 weeks. In Twin 1, smaller GA (OR = 0.44, P = 0.02), higher mean oxygen concentration (OR = 1.34, P = 0.03), presence of thrombocytopenia (OR = 1429.60, P < 0.0001), and intraventricular hemorrhage (OR = 18.67, P = 0.03) were significant risk factors for ROP. For Twin 2, a smaller GA (OR = 0.45, P = 0.03) was the only risk factor. There were no significant risk factors for ROP in Twin 1 or Twin 2 on multivariate analysis. CONCLUSION: In Chinese twin pairs, smaller GA was the only common risk factor for ROP while Twin 1 was more susceptible to the postnatal risks for ROP.
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Povo Asiático/genética , Doenças em Gêmeos/genética , Recém-Nascido Prematuro , Retinopatia da Prematuridade/genética , Gêmeos/genética , Povo Asiático/etnologia , Doenças em Gêmeos/diagnóstico , Doenças em Gêmeos/etnologia , Feminino , Humanos , Recém-Nascido , Recém-Nascido Prematuro/fisiologia , Masculino , Gravidez , Retinopatia da Prematuridade/diagnóstico , Retinopatia da Prematuridade/etnologia , Estudos Retrospectivos , Fatores de RiscoRESUMO
The aim of this study was to investigate the safety and efficacy of intralesional triamcinolone acetonide (TA) injection in the treatment of primary chalazions not responding to conservative treatment. Patient medical records were retrospectively reviewed for all consecutive patients that received intralesional TA injection by a single surgeon between January 2012 and March 2013 for the treatment of unresolved primary chalazions despite 1 month of conservative treatment. The dose of TA injection ranged from 2 to 6 mg (40 mg/mL) depending on the size of the chalazion. The main outcome measures included time to resolution, time to 50 % size reduction, and complications from the treatment. During the study period, 48 chalazions from 38 patients were treated by intralesional TA injection. A 50 % reduction in size was achieved in 81.3 % of chalazions in 4 weeks and 83 % achieved complete resolution in 6 weeks. The mean time to complete resolution was 15.7 ± 10.0 days. There were no complications noted from the injections; 14.6 % required subsequent incision and curettage and 2.1 % required a second TA injection for complete resolution. Intralesional TA injection is a safe, simple, and effective procedure for the management of primary chalazions and may be considered as an alternative to incision and curettage in cases not responding to conservative treatment.
Assuntos
Anti-Inflamatórios/uso terapêutico , Calázio/tratamento farmacológico , Imunossupressores/administração & dosagem , Triancinolona Acetonida/administração & dosagem , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Relação Dose-Resposta a Droga , Feminino , Humanos , Injeções Intraoculares , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto JovemRESUMO
To investigate long-term clinical outcomes after acute angle closure in the Chinese population. A 10-year retrospective review of primary acute angle closure in Hong Kong Chinese to document patient demographics, treatment, and pre- and post-acute angle closure intraocular pressure (IOP) and visual acuity (VA). The year of attack was correlated with the timing of laser, last VA and IOP, and the number of anti-glaucoma eye drops. In 210 eyes (200 patients), 10 % had a simultaneous bilateral acute angle closure. VA improvement was noted in 68.6 % of eyes whilst 11.4 % were blinded. At 3.7 ± 2.4 years of follow-up, 49.5 % had IOP <21 mmHg with medication or surgery, 41.9 % needed anti-glaucoma eye drops, and 13.8 % had undergone trabeculectomy. The older the year of attack, the poorer the VA (r = 0.2, p = 0.03) and the longer the laser wait time (r = 0.3, p < 0.0001). VA outcome and laser promptness in acute angle closure has improved over the years. At 4 years after the attack, 50 % had normal IOP, 69 % had improved VA but 11 % were blinded.
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Glaucoma de Ângulo Fechado/fisiopatologia , Idoso , Anti-Hipertensivos/uso terapêutico , Povo Asiático , Feminino , Glaucoma de Ângulo Fechado/terapia , Hong Kong , Humanos , Pressão Intraocular/fisiologia , Terapia a Laser/métodos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Acuidade Visual/fisiologiaRESUMO
To evaluate the clinical efficacy of transcutaneous everting sutures for lower eyelid involutional entropion in Chinese patients. A retrospective, non-comparative, interventional case series. This retrospective study consecutively reviewed the medical records of all patients with involutional lower eyelid entropion who underwent transcutaneous everting suture for entropion correction at the Department of Ophthalmology, Caritas Medical Centre, from 1st January 2010 to 31st October 2013. Exclusion criteria included concurrent eyelid pathologies such as malignant tumor, infection, cicatricial entropion, post-operative follow-up period of <3 months, significant horizontal lid laxity, and aged <60 years at the time of surgery. The primary outcome measures were recurrence rate and complications. Secondary outcome measures included patient demographic data, type and number of everting sutures, duration of operation, timing of stitch removal, duration of follow-up, as well as each patient's medical history and current medications. Thirty-four eyelids of 28 patients were included. The average age was 78.2 ± 7.3 years and the male to female ratio was 4:3. In this series, 26.5 and 2.9 % of eyelids underwent entropion correction whilst receiving aspirin and warfarin, respectively. The mean duration of post-operative follow-up was 13.2 ± 10.5 months. The recurrence rate was 11.8 % at a mean of 9.0 ± 6.0 months. There were no peri-operative or post-operative complications observed. A transcutaneous everting suture was found to be a quick and effective means to correct senile involutional lower lid entropion in Chinese patients with no complications despite the continued use of anti-coagulation therapy in >25 % of our cases.
Assuntos
Entrópio/cirurgia , Técnicas de Sutura , Idoso , Idoso de 80 Anos ou mais , Povo Asiático , China , Feminino , Seguimentos , Humanos , Masculino , Recidiva , Estudos RetrospectivosRESUMO
Coexisting myasthenia gravis and neuromyelitis optica spectrum disorder was reported as a rare association, with only 26 reported cases in the literature. The authors report the case of a middle-aged Chinese woman with bilateral recurrent optic neuritis and seropositive ocular myasthenia gravis who was subsequently diagnosed with neuromyelitis optica spectrum. She was tested seropositive for the neuromyelitis optica immunoglobulin G (NMO-IgG) and had elevated antinuclear antibody titres, but workup for other autoimmune disorders were negative. She was subsequently prescribed with azathioprine and pyridostigmine, and showed good control of both autoimmune disorders. To the best of the authors' knowledge, this is the first reported case in the literature of a Chinese patient with seropositivity for both anti-acetylcholine receptor and NMO-IgG without a thymic disorder. Testing of NMO-IgG may be considered in patients with optic neuritis with underlying autoimmune disorders even in the absence of transverse myelitis for the detection of associated neuromyelitis optica spectrum disorders.
RESUMO
PURPOSE: To investigate the retinal nerve fibre layer (RNFL) thickness after unilateral acute optic neuritis using optical coherence tomography (OCT). PATIENTS AND METHODS: This prospective cohort study recruited consecutive patients with a first episode of isolated, unilateral acute optic neuritis. RNFL thickness and visual acuity (VA) of the attack and normal fellow eye were measured at presentation and 3 months in both the treatment and nontreatment groups. RESULTS: 11 subjects received systemic steroids and 9 were treated conservatively. The baseline RNFL thickness was similar in the attack and fellow eye (P ≥ 0.4). At 3 months, the attack eye had a thinner temporal (P = 0.02) and average (P = 0.05) RNFL compared to the fellow eye. At 3 months, the attack eye had significant RNFL thinning in the 4 quadrants and average thickness (P ≤ 0.0002) compared to baseline. The RNFL thickness between the treatment and nontreatment groups was similar at baseline and 3 months (P ≥ 0.1). Treatment offered better VA at 3 months (0.1 ± 0.2 versus 0.3 ± 0.2 LogMAR, P = 0.04). CONCLUSION: Generalized RNFL thinning occurred at 3 months after a first episode of acute optic neuritis most significantly in the temporal quadrant and average thickness. Visual improvement with treatment was independent of RNFL thickness.
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Anti-Inflamatórios/uso terapêutico , Fibras Nervosas/patologia , Neurite Óptica/tratamento farmacológico , Neurite Óptica/patologia , Células Ganglionares da Retina/patologia , Tomografia de Coerência Óptica/métodos , Adolescente , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fibras Nervosas/efeitos dos fármacos , Tamanho do Órgão/efeitos dos fármacos , Estudos Prospectivos , Reprodutibilidade dos Testes , Células Ganglionares da Retina/efeitos dos fármacos , Sensibilidade e Especificidade , Resultado do Tratamento , Adulto JovemRESUMO
To investigate the retinal nerve fibre layer (RNFL) changes after an acute attack of phacomorphic angle closure. This prospective study involved ten cases of phacomorphic angle closure that underwent cataract extraction and intraocular lens insertion after intraocular pressure lowering. Apart from visual acuity and intraocular pressure (IOP), RNFL thickness and vertical cup disc ratio (VCDR) were measured by optical coherence tomography (OCT) at 3-9 months post attack. Humphrey visual field assessment was performed at 9 months post attack. All cases had mean phacomorphic duration of <5 days. Postoperatively, best correct Snellen visual acuity was 0.4 ± 0.2 and IOP at 9 months was 11.0 ± 3.1 mmHg. There was no difference in VCDR and RNFL between the attack and contralateral eye at 3 months post attack (both p = 0.4). At 9 months post attack, there was significant thinning in the average (p = 0.01), superior (p = 0.01), and inferior (p = 0.006) RNFL. There was no significant difference in the pattern standard deviation (PSD) between the two eyes on the Humphrey visual field nor was there any correlation between PSD severity and RNFL thinning (all p > 0.2. Patients with <5 days duration of phacomorphic angle closure are likely to have reasonable postoperative vision. An acute episode of phacomorphic angle closure can trigger an accelerated RNFL thinning despite normal IOP and open angles, most noticeable in the superior and inferior quadrants, occurring between 3 and 9 months post attack. Glaucomatous optic neuropathy in the attack eye was evident by OCT but not by visual field assessment at the same time interval.
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Extração de Catarata/efeitos adversos , Glaucoma de Ângulo Fechado/complicações , Disco Óptico/patologia , Doenças do Nervo Óptico/patologia , Células Ganglionares da Retina/patologia , Doença Aguda , Idoso , Feminino , Glaucoma de Ângulo Fechado/patologia , Glaucoma de Ângulo Fechado/fisiopatologia , Humanos , Pressão Intraocular , Masculino , Doenças do Nervo Óptico/etiologia , Estudos Prospectivos , Tomografia de Coerência Óptica , Tonometria OcularRESUMO
PURPOSE: To compare two-year treatment outcomes of subthreshold micropulse (577 nm) laser and aflibercept for diabetic macular edema (DME). STUDY DESIGN: Retrospective case-control study. METHODS: A total 164 eyes in 164 DME patients treated with either micropulse laser (86 eyes) or intravitreal aflibercept monotherapy (78 eyes) were recruited. Main outcome measures included at least five Early Treatment Diabetic Retinopathy Study (ETDRS) letters' improvement from baseline at 6, 12 and 24 months. RESULTS: Rescue aflibercept was initiated in 24% of eyes in micropulse laser group. At 6-month visit the aflibercept group achieved a higher percentage of eyes with at least 5-letter visual acuity improvement than micropulse laser group (56% vs 38%, P = 0.044), however, this was not the case at 12-month (45% vs 49%, P = 0.584) and 24-month visits (49% vs 57%, P = 0.227). At 6-month visit the aflibercept group achieved a higher percentage of eyes with at least 10% improvement of central macular thickness (73% vs 49%, P = 0.005), but this was not the case at 12-month (73% vs 70%, P = 0.995) and 24-month visits (85% vs 84%, P = 0.872). CONCLUSION: Aflibercept achieved faster and higher rates of anatomical and functional improvement than micropulse laser in DME patients. Long term efficacy of treatment did not result in significant differences between aflibercept monotherapy and micropulse laser in DME patients. Primary treatment of micropulse laser with deferred rescue aflibercept might be the treatment option without reducing the chance of visual improvement in DME eyes.
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Diabetes Mellitus , Retinopatia Diabética , Edema Macular , Estudos de Casos e Controles , Retinopatia Diabética/complicações , Retinopatia Diabética/diagnóstico , Retinopatia Diabética/tratamento farmacológico , Humanos , Fotocoagulação a Laser , Lasers , Edema Macular/diagnóstico , Edema Macular/tratamento farmacológico , Edema Macular/etiologia , Receptores de Fatores de Crescimento do Endotélio Vascular , Proteínas Recombinantes de Fusão , Estudos Retrospectivos , Tomografia de Coerência Óptica , Resultado do TratamentoRESUMO
PURPOSE: To determine the prognostic factors associated with retinal redetachment after 1300-centistokes silicone oil removal in rhegmatogenous retinal detachments (RDs) associated with grade C proliferative vitreoretinopathy (PVR). DESIGN: Nonrandomized, retrospective, comparative interventional trial. METHODS: One hundred and forty-seven eyes with RD and grade C PVR treated with silicone oil tamponade, with subsequent silicone oil removal, in an institutional setting. Main outcome measures included anatomic success, defined as complete retinal attachment after silicone oil removal, and best-corrected visual acuity (BCVA) after silicone oil removal. RESULTS: Silicone oil was removed after a mean tamponade period of 12.4+/-9.8 months. The mean follow-up after silicone oil removal was 22.1+/-18.7 months (range, 6.0 to 71.0 months). The retina remained attached in 120 eyes after oil removal. The overall anatomic success rate was 81.6%+/-3.2%. Logistic regression showed that an increased number of previous unsuccessful RD surgeries (odds ratio [OR], 0.39; 95% confidence interval [CI], 0.19 to 0.80; P=.010) and longer axial lengths (OR, 0.42; 95% CI, 0.15 to 0.87; P=.032) were associated with a lower anatomic success rate. Previous vitrectomy, previous scleral buckling procedure, 12% perfluoropropane-air exchange immediately after silicone oil removal, and duration of silicone oil tamponade were not statistically associated with the anatomic success rate. Anatomic success was associated with a significantly better BCVA (1.169+/-0.475 vs 1.520+/-0.381 logarithm of the minimum angle of resolution; P<.001). CONCLUSIONS: The number of previous surgeries and axial length, rather than the nature of the previous surgical procedures, were significant prognostic factors for anatomic success after silicone oil removal.
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Drenagem/efeitos adversos , Complicações Pós-Operatórias , Descolamento Retiniano/etiologia , Óleos de Silicone/efeitos adversos , Vitreorretinopatia Proliferativa/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Recidiva , Descolamento Retiniano/cirurgia , Fatores de Risco , Recurvamento da Esclera , Acuidade Visual , Vitrectomia , Vitreorretinopatia Proliferativa/complicaçõesRESUMO
BACKGROUND: To evaluate the use of high-density silicone oil (HDSO) as a tamponade agent for retinal detachment secondary to myopic macular hole. METHODS: 12 eyes of 12 patients with macular hole retinal detachment underwent pars plana vitrectomy, internal limiting membrane peeling and HDSO tamponade. No posturing was required postoperatively and HDSO was removed 3-4 months later. Outcome measures included macular hole closure and retinal attachment rates, best-corrected visual acuity (BCVA), and intraoperative and postoperative complications. RESULTS: The mean age of the patients was 67.8 years and the mean spherical equivalent refractive error was -13.4 diopters. After the removal of HDSO, 10 (83%) eyes had macular hole closure with retinal reattachment without any tamponade. One eye had retinal reattachment after re-operation and the other refused further surgery. At the last follow-up, the median BCVA improved from 20/800 to 20/600 (p = 0.046). A transient increase in intraocular pressure was observed in 5 (42%) eyes and one eye each developed mild oil emulsification and transient peripheral choroidal detachment. None of the eyes was found to have severe intraocular inflammation postoperatively. CONCLUSIONS: HDSO seemed to be an effective tamponade agent for myopic macular hole retinal detachment. Further prospective controlled studies seem warranted.
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Miopia Degenerativa/complicações , Descolamento Retiniano/terapia , Perfurações Retinianas/terapia , Óleos de Silicone/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Membrana Epirretiniana/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pressão , Estudos Prospectivos , Descolamento Retiniano/etiologia , Perfurações Retinianas/complicações , Acuidade Visual , Vitrectomia/métodosRESUMO
PURPOSE: To determine the prognostic factors associated with anatomical success in the treatment of retinal detachment (RD) due to myopic macular hole by pars plana vitrectomy (PPV) and perfluoropropane (C3F8) gas tamponade. DESIGN: Retrospective, interventional, comparative case series. METHODS: In an institutional setting, 57 eyes with myopic macular hole RDs treated by PPV and C3F8 tamponade, with or without concomitant internal limiting membrane (ILM) peeling, endolaser photocoagulation, and/or phacoemulsification, were analyzed. Outcome measures were anatomical success, defined as closure of macular hole with reattachment of the surrounding retina, and postoperative best-corrected visual acuity (BCVA). RESULTS: The mean postoperative follow-up was 26.9 +/- 16.5 months. The anatomical success rate after primary PPV and C3F8 tamponade was 63.2%. Regression analysis showed that shorter axial lengths (odds ratio [OR] = 6.73, 95% confidence interval [95% CI] 1.86 to 12.22, P = .010), concomitant ILM peeling (OR 1.59, 95% CI 1.14 to 2.38, P = .013), and shorter duration of macular hole RD (OR 0.81, 95% CI 0.67 to 0.98, P = .033) were associated with a higher anatomical success. The mean pre- and postoperative BCVAs were 1.430 +/- 0.273 (range, 0.523 to 1.700) and 1.403 +/- 0.271 (range, 0.699 to 1.800) logarithm of minimal angle of resolution units, respectively. The postoperative BCVA was significantly better in eyes with macular hole closure than in eyes without (P = .021). CONCLUSIONS: Axial length, concomitant ILM peeling, and duration were important prognostic factors for PPV and C3F8 tamponade in the treatment of myopic macular hole RDs.
Assuntos
Fluorocarbonos/administração & dosagem , Miopia/complicações , Descolamento Retiniano/cirurgia , Perfurações Retinianas/complicações , Vitrectomia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Terapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Prognóstico , Reoperação , Descolamento Retiniano/etiologia , Descolamento Retiniano/fisiopatologia , Estudos Retrospectivos , Acuidade Visual/fisiologiaRESUMO
To evaluate the efficacy and safety of CO2 laser-assisted sclerectomy surgery (CLASS) in Chinese patients with advanced glaucoma.Patients with advanced glaucoma who were candidates for glaucoma filtration surgery were included. The intraocular pressure (IOP) and number of antiglaucoma medications were documented before surgery and at all postoperative clinic visits. All intra- and postoperative complications were documented. The primary outcome measures were the changes in IOP and medication use before and after the procedure as well as complications from the procedure. The secondary outcome measure included the CLASS success rate.Twenty patients (23 eyes) underwent CLASS between November 2014 and September 2015. Nineteen eyes had primary open-angle glaucoma, 2 eyes had primary angle-closure glaucoma, and 2 eyes had uveitic glaucoma. One patient was lost to follow-up. The mean age of subjects was 68.1â±â11.9 years. IOP was significantly reduced at 1 day and 1 week after CLASS. At 6 months, the IOP and number of medications were significantly reduced by 19.0% and 38.2%, respectively (both Pâ<â0.0001). One patient had intraoperative trabeculo-Descemet membrane perforation. Two patients required laser goniopuncture and 2 required needling between 3 and 6 months postoperatively. The overall success rate was 81.8% at 6 months.CLASS achieved a modest IOP reduction in the early postoperative period and was overall a safe procedure for advanced glaucoma.
Assuntos
Glaucoma/cirurgia , Lasers de Gás/uso terapêutico , Esclera/cirurgia , Idoso , China , Humanos , Procedimentos Cirúrgicos Oftalmológicos/métodos , Estudos Prospectivos , Índice de Gravidade de Doença , Resultado do TratamentoRESUMO
To investigate the clinical outcome of the Trabectome in Chinese open-angle glaucoma (OAG). This prospective case series recruited pseudophakic glaucoma subjects with open-angle configuration. Trabeculectomy ab interno was performed using the Trabectome to 120° of the trabecular meshwork. Intraocular pressure (IOP) and medications were recorded preoperatively and every 3 months postoperatively. Visual acuity was measured preoperatively and at 1 and 6 months postoperatively. One-way ANOVA with Tukey Multiple Comparison Test were used to measure the pre and postoperative parameters. In 19 eyes of 19 Chinese subjects, 26.3% were uveitic, 68.4% were primary open-angle glaucoma, and 5.3% had a history of chronic angle-closure glaucoma with open-angles after cataract extraction. The subjects' mean age was 67.5â±â14.4 years, with 4 females and 15 males. Two patients required secondary filtration procedure. At 6 months, the IOP reduced by 34.8% (24.4â±â4.4 mm Hg to 15.9â±â5.1âmm Hg, Pâ<â0.0001). The number of types of antiglaucoma medications was reduced by 28.2% (3.9â±â0.8-2.8â±â1.6, Pâ<â0.0001). The visual acuity was static at 1 and 6 months postoperatively (Pâ=â0.4). There were no intraoperative complications. 26.3% of subjects had a transient IOP spikeâ>â21âmm Hg, 1 had hyphema requiring washout, and 1 had reactivation of herpetic keratitis. The success rate at 6 months was 89.5%. Trabectome achieved a modest reduction in IOP and medications in the majority of pseudophakic Chinese OAG eyes.