ABSTRACT
INTRODUCTION: Papillophlebitis is a rare condition characterized by venous congestion and optic disc edema, which has been suggested to occur as a consequence of inflammation of the retinal veins or, possibly, the capillaries of the optic disc, leading to venous insufficiency and compression of the central retina vein. The disease affects healthy young adults and commonly has a benign course, however, if complications such as macular edema or ischemia appears, treatment should be instituted immediately to avoid poor prognosis. CASE REPORT: A 40-year old white male patient consulted for a slight decrease in the sensitivity of the visual field in his left eye (OS). Visual acuities (VA) were 20/20 in both eyes. OS fundus examination showed dilated and tortuous retinal vessels, disc edema, and retinal hemorrhages. The patient was diagnosed with papillophlebitis. OS VA decreased to 20/200 due to macular edema, and he was treated with a intravitreal dexamethasone implant. An exhaustive and interdisciplinary exploration process was performed, identifying a recent disease and recovery of Covid-19 as the only factor of inflammation and coagulation alteration. Other systemic diseases were excluded. We also describe a rapid decrease in disc and macular edema after intravitreal dexametasone injection, which could support the inflammatory hypothesis. CONCLUSION: The importance of this case lies in the possible association of papillophlebitis with the new Covid-19 disease. We believe that the inflammatory reaction and the coagulation alteration present in our patient due to Sars-Cov2 coronavirus may have acted as risk factors for the development of papillophlebitis.
Subject(s)
COVID-19 , Macular Edema , Retinal Vein Occlusion , Adult , Humans , Inflammation , Male , RNA, Viral , SARS-CoV-2ABSTRACT
PURPOSE: To evaluate the weight of intraocular lenses (IOLs) depending on their material, dioptric power, toricity, focality, and haptic design. METHODS: Twenty-eight different IOL models from nine different medical companies (a total of 38 IOLs) and 1 capsular tension ring (CTR) were evaluated. IOLs were weighed using a precision scale, in hydrated conditions, as an approximation to their intraocular status. RESULTS: Hydrophilic IOLs were heavier than hydrophobic lenses (p < 0.001). Regarding toricity, no statistical differences were found comparing toric to non-toric models (p=0.1). Likewise, no differences were found between multifocal IOLs and monofocal IOLs (p=0.19). Dioptric power did not affect IOL weight: IOLs of <15DP had similar weights to those of ≥15D and IOLs of ≥24D had similar weights to those of <24 D (p=0.86 and p=0.59, respectively). Plate-design IOLs were significantly heavier than 1-piece C-loop (p < 0.001), 3-piece C-loop (p < 0.001), and 4-haptic lenses (p=0.001). CONCLUSIONS: Of the characteristics analyzed that might influence IOL weight, lenses with hydrophilic material and plate-haptic design were found to be heavier. Toricity, focality, and dioptric power had no influence on IOL weight.
ABSTRACT
Graves' orbitopathy (GO) is the most common extrathyroidal manifestation of Graves' disease (GD). Our aim was to assess the efficacy and safety of Tocilizumab (TCZ) in GO refractory to conventional therapy. This was an open-label multicenter study of glucocorticoid-resistant GO treated with TCZ. The main outcomes were the best-corrected visual acuity (BVCA), Clinical Activity Score (CAS) and intraocular pressure (IOP). These outcome variables were assessed at baseline, 1st, 3rd, 6th and 12th month after TCZ therapy onset. The severity of GO was assessed according to the European Group on Graves' Orbitopathy (EUGOGO). We studied 48 (38 women and 10 men) patients (95 eyes); mean age ± standard deviation 51 ± 11.8 years. Before TCZ and besides oral glucocorticoids, they had received IV methylprednisolone (n = 43), or selenium (n = 11). GO disease was moderate (n =29) or severe (n = 19) and dysthyroid optic neuropathy (DON) (n = 7). TCZ was used in monotherapy (n = 45) or combined (n = 3) at a dose of 8 mg/kg IV every four weeks (n = 43) or 162 mg/s.c. every week (n = 5). TCZ yielded a significant improvement in all of the main outcomes at the 1st month that was maintained at one year. Comparing the baseline with data at 1 year all of the variables improved; BCVA (0.78 ± 0.25 vs. 0.9 ± 0.16; p = 0.0001), CAS (4.64 ± 1.5 vs. 1.05 ± 1.27; p = 0.0001) and intraocular pressure (IOP) (19.05 ± 4.1 vs. 16.73 ± 3.4 mmHg; p = 0.007). After a mean follow-up of 16.1 ± 2.1 months, low disease activity (CAS ≤ 3), was achieved in 88 eyes (92.6%) and TCZ was withdrawn in 29 cases due to low disease activity (n = 25) or inefficacy (n = 4). No serious adverse events were observed. In conclusion, TCZ is a useful and safe therapeutic option in refractory GO treatment.
ABSTRACT
Objetivo. Evaluar la calidad del procedimiento de la biopsia selectiva del ganglio centinela en la Unidad de Patología Mamaria de un hospital comarcal, sin servicio de Medicina Nuclear. Material y métodos. Se diseñó un estudio descriptivo, retrospectivo, en el que se incluyeron 104 pacientes con cáncer de mama no avanzado. El día previo a la cirugía se les realizó una linfogammagrafía en el hospital de referencia. Como instrumento de gestión, se empleó la guía clínica de autoevaluación de la Sociedad Española de Senología y Patología Mamaria. Estudiamos la eficacia en la detección del ganglio centinela, la sensibilidad y la media de ganglios centinelas axilares aislados por paciente. Se evaluaron tanto los resultados globales obtenidos por la Unidad de Mama, como los obtenidos individualmente por cada uno de los 3 cirujanos que la integran. Resultados. Se cumplieron los 3 criterios esenciales de la guía de autoevaluación, siendo: la detección del ganglio centinela del 94,2%, la sensibilidad acreditada del 93,2%, y la media de ganglios centinela axilares extraídos de 1,66 ± 0,84. Estos criterios también se cumplieron a nivel individual, por cada uno de los 3 cirujanos que integran la unidad. La aplicación de la guía de autoevaluación nos dio una puntuación global de 33 sobre 71 puntos, siendo el nivel de calidad ii el más prevalente. Conclusiones. En nuestra unidad, la aplicación de la guía publicada por la Sociedad Española de Senología y Patología Mamaria para evaluar los aspectos esenciales y básicos de la biopsia selectiva del ganglio centinela en cáncer de mama nos ha permitido confirmar que realizamos el procedimiento con suficiente garantía de calidad, y además, promover aspectos de mejora (AU)
Objective. To assess the quality of selective sentinel lymph node biopsy in the Breast Diseases Unit of a district hospital without a Nuclear Medicine service. Methods and material. A retrospective, descriptive study was conducted in 104 patients with nonadvanced breast cancer. The day before surgery, the patients underwent lymph node mammography in the referral hospital. The self-evaluation clinical guideline of the Spanish Society of Senology and Breast Pathology was used as part of the management protocol. We studied the efficacy of sentinel lymph node detection, the sensitivity of the procedure, and the mean number of axillary sentinel lymph nodes isolated per patient. Both the overall results obtained by the Breast Diseases Unit and the results obtained individually by each of the 3 surgeons working in the unit were evaluated. Results. The 3 main criteria of the self-evaluation guideline were fulfilled, namely: sentinel lymph node detection in 94.2%, the sensitivity ratio in 93.2% and the mean number of sentinel lymph nodes removed, 1.66 ± 0.84. These criteria were also fulfilled by each of the 3 surgeons working in the unit. The score of the self-assessment guideline was 33 out of 71 points, with level ii being the most prevalent level of quality. Conclusions. In our unit, application of the guidelines published by the Spanish Society of Senology and Breast Pathology to evaluate essential and basic aspects of selective sentinel lymph node biopsy in breast cancer demonstrated that quality criteria are being met in our unit, and allowed us to promote quality improvements (AU)
