RESUMO
We report a 71-year-old man with posterior capsule opacification with severe neovascularization who was treated with photodynamic therapy and neodymium:YAG capsulotomy. Treatment was performed using a diode laser at 692 nm, a light dose of 50 J/cm(2), and 6 mg/m(2) body surface area verteporfin. The initial visual acuity was hand motions; 6 months after therapy, the visual acuity was stable at 20/200. In 9 months of follow-up, there was no recurrence of neovascularization and the pupil area remained clear; no retreatment was needed. Photodynamic therapy provided safe and effective occlusion of neovascular vessels in the posterior capsule area.
Assuntos
Cápsula do Cristalino/irrigação sanguínea , Neovascularização Patológica/tratamento farmacológico , Fotoquimioterapia , Fármacos Fotossensibilizantes/uso terapêutico , Porfirinas/uso terapêutico , Idoso , Humanos , Cápsula do Cristalino/patologia , Masculino , Neovascularização Patológica/diagnóstico , Verteporfina , Acuidade VisualRESUMO
BACKGROUND AND OBJECTIVE: To assess surgical and visual outcomes with pars plana vitrectomy (PPV) in closed-globe injuries resulting in anterior and posterior segment pathologies and evaluate the factors influencing the prognosis. PATIENTS AND METHODS: Retrospective observational study. Forty-seven eyes of 47 consecutive patients who underwent PPV because of closed-globe injury between January 1992 and August 2003 were reviewed. Surgical and visual outcomes and prognostic factors were analyzed according to the Ocular Trauma Classification System. RESULTS: Preoperative visual acuity was less than 4/200 in 49% of eyes, classified as grades IV to V. After surgery, this ratio was 23% (P < .05). Final visual acuity was statistically significantly better in grade I (P = .0001), grade II (P = .002), and relative afferent pupillary defect-negative (P = .0001) injuries. Maculopathy was the most common adverse outcome influencing final visual acuity (32%), followed by secondary glaucoma (13%) and proliferative vitreoretinopathy (8%). CONCLUSION: PPV is a favorable treatment modality in severe closed-globe injuries. Assessment of injuries with respect to the Ocular Trauma Classification System seemed to predict visual outcomes in this series.
Assuntos
Oftalmopatias/cirurgia , Traumatismos Oculares/cirurgia , Vitrectomia , Ferimentos não Penetrantes/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Segmento Anterior do Olho/lesões , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Retina/lesões , Estudos Retrospectivos , Resultado do Tratamento , Acuidade Visual , Corpo Vítreo/lesõesRESUMO
Diabetic retinopathy is a leading cause of adult vision loss and blindness. Earlier studies have shown that polymorphonuclear neutrophils play an important role in the pathogenesis of diabetic vascular complications. Stimulation of these cells is associated with the desquamation of L-selectin. The aim of the study was to evaluate the relationship between the serum concentration of L-selectin and the development of retinopathy in Type 2 diabetic patients. The study comprised 51 Type 2 diabetic patients, aged 65.2 +/- 7.5 years, with a diabetes duration of 10.1 +/- 8.9 years and HbA1c of 8.2 +/- 1.4. The study subjects were divided into two groups: Group A diabetic patients with retinopathy (n = 28) and Group B diabetic patients without retinopathy (n = 23). Twenty age- and sex-matched nondiabetic healthy subjects were enrolled as the control group. Patients with any inflammatory disease were excluded. Retinopathy was assessed by centrally graded retinal photographs. The serum concentration of sL-selectin was estimated using an ELISA test. We observed significantly higher serum concentrations of sL-selectin in Type 2 diabetic patients with retinopathy than in healthy subjects (36.5 +/- 18.1 vs. 11.4 +/- 7.5 ng/ml, p < 0.001). There was also a significant difference between Group A and Group B (36.5 +/- 18.1 vs. 24.2 +/- 13.5 ng/ml, p < 0.05) as well as between Group B and the controls (24.2 +/- 13.5 vs. 11.4 +/- 7.5 ng/ml, p < 0.01) with regard to sL-selectin levels. sL-selectin was significantly correlated with HbA1c (r = 0.93, p < 0.001) and with diabetes duration (r = 0.44, p < 0.001). These results suggest that there was a strong relationship between sL-selectin and diabetic retinopathy. The strong correlation between sL-selectin and HbA1c levels supports the concept that the sL-selectin level is increased with poor glycemic control, which may affect endothelial cell activity and cause subsequent microvascular complications.
Assuntos
Retinopatia Diabética/etiologia , Hemoglobinas Glicadas/metabolismo , Selectina L/sangue , Idoso , Estudos de Casos e Controles , Diabetes Mellitus Tipo 2/complicações , Retinopatia Diabética/sangue , Ensaio de Imunoadsorção Enzimática , Humanos , Selectina L/química , Pessoa de Meia-Idade , Concentração Osmolar , Solubilidade , Fatores de TempoRESUMO
The purpose of this study was to evaluate the retinal toxicity of vancomycin and ceftazidime combined into an infusion solution that was intraoculary given after or during vitrectomy. Forty albino rabbits were divided into 4 groups of 10 each. Vitrectomized right eyes of groups 1, 2, and 3 were given recommended doses of vancomycin and ceftazidime alone or combined, while right eyes in the fourth group were vitrectomized using an infusion solution to which was added ceftazidime and vancomycin combination. Toxicity was tested with electroretinography (ERG) and light microscopy. ERG and light microscopy did not show any toxicity signs associated with vancomycin or ceftazidime alone or with combined therapy. Vancomycin and/or ceftazidime can reliably and effectively be used combined in an infusion solution at recommended doses after and during vitrectomy. This treatment modality does not have any toxic effects to retinal structures and is an alternative method to separate injections of the two antimicrobial agents.
Assuntos
Antibacterianos/toxicidade , Ceftazidima/toxicidade , Retina/efeitos dos fármacos , Vancomicina/toxicidade , Vitrectomia/veterinária , Animais , Humor Aquoso , Quimioterapia Combinada , Eletrorretinografia/efeitos dos fármacos , Injeções/métodos , Coelhos , Retina/patologia , Retina/fisiopatologiaRESUMO
BACKGROUND AND PURPOSE: To investigate the effect of circumferential scleral buckling on the prognosis for patients undergoing pars plana vitrectomy and lensectomy for severe closed globe injury. METHODS: A total of 33 cases in which pars plana vitrectomy and lensectomy were performed after severe closed globe injury between January 1990 and January 2003 were studied retrospectively. All patients had zone III contusion type injury according to The Ocular Trauma Classification Group criteria. Of the 33 patients, 15 (group 1) also underwent peripheral scleral buckling; 18 did not (group 2). RESULTS: The mean age +/- SD was 34.8 +/- 17.5 years (range, 8-73 years). There were 6 female (18%) and 27 male (82%) patients. The two groups did not differ significantly in terms of preoperative visual acuity (P = 0.76) or postoperative visual improvement (P = 0.46). In groups 1 and 2, 4 (26%) and 3 (17%) patients developed recurrent retinal detachment for which they underwent reoperation. Other postoperative complications were as follows: group 1-phthisis (1 patient; 7%), proliferative vitreoretinopathy (1 patient; 7%), and optic atrophy (1 patient; 7%); group 2, proliferative vitreoretinopathy (2 patients; 11%) and optic atrophy (2 patients; 11%). CONCLUSION: Circumferential scleral buckling did not appear to offer advantages for patients undergoing pars plana vitrectomy and lensectomy for severe closed ocular injury involving the posterior chamber.
Assuntos
Traumatismos Oculares/complicações , Retina/lesões , Descolamento Retiniano/etiologia , Descolamento Retiniano/cirurgia , Recurvamento da Esclera/métodos , Vitrectomia/métodos , Ferimentos não Penetrantes/complicações , Adolescente , Adulto , Idoso , Criança , Feminino , Fluorocarbonos/administração & dosagem , Humanos , Fotocoagulação a Laser , Cristalino/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Acuidade VisualRESUMO
PURPOSE: To compare the effectiveness, complications, and patient acceptance of local anesthesia with general anesthesia in young patients for external dacryocystorhinostomy (DCR). METHODS: Data were prospectively collected over an 8-year period (1996-2004) on young patients (mean age: 22.64+/-1.71) undergoing external DCR in Gulhane Military Medical Academy. Patients were randomly allocated in two groups: general anesthesia (GA) and local anesthesia (LA). Of the 480 DCR procedures, 182 were performed with general anesthesia (44 bilateral), 298 were performed with local anesthesia (32 bilateral). Visual analogue scales were recorded in the postoperative 2-hour period. Postoperative nausea and vomiting (PONV), epistaxis, length of hospital stay, and intraoperative bleeding were noted. RESULTS: Patients in both groups reported being comfortable during and immediately after surgery. Only 2 patients in the LA group required additional local anesthetic because of pain. Intraoperative bleeding was lower in the LA group. Analgesic requirement and signs of nausea and vomiting in the GA group were higher in the early postoperative period (p<0.05). The incidence of PONV was higher (p<0.05) in the GA group. Postoperative epistaxis was observed in 12 patients in the GA group and just 2 patients in the LA group. Length of hospital stay was 2.29+/-0.46 days in the GA group, and 1.23+/-0.42 days in the LA group (p<0.01). CONCLUSIONS: Local anesthesia in DCR is safe and comfortable when proper anatomical approach to nerve blocks is performed correctly. Local anesthesia in young patients undergoing external DCR is a good alternative because it is cost-effective and it eliminates the complications of general anesthesia.