RESUMEN
BACKGROUND: To describe the use of intracameral recombinant tissue plasminogen activator (r-tPA) in the treatment of severe fibrinous reactions in toxic anterior segment syndrome (TASS) after cataract surgery. METHODS: A case series of 59 eyes of 59 patients with severe fibrinous anterior chamber reaction following cataract surgery who received intracameral r-tPA (25 µg/0.1 ml). The main outcome measures after intracameral r-tPA were the incidence of complete fibrinolysis, time of maximal effect, visual acuity, and complications. RESULTS: Severe fibrinous reactions appeared 11.5 ± 5.3 days after cataract surgery. Fibrinolysis was observed 2.33 ± 2.70 days after rtPA use and 36 eyes (61%) exhibited resolution of the fibrin by the end of the first day following injection (p < 0.001). Transient corneal edema observed at 1-day after injection was the only complication reported during the injection of r-tPA or at follow-up. Eight eyes (13.6%) required a second r-tPA injection. Best-corrected visual acuity improved from 0.88 ± 0.67 logMAR units before rtPA injection to 0.48 ± 0.49 logMAR units at 1-month (p < 0.001). CONCLUSIONS: The application of r-tPA was a quick and efficacious therapeutic approach for the management of severe fibrinous reactions in TASS after cataract surgery. In a clinical setting, intracameral r-tPA may be useful when rapid visual recovery is needed.
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Extracción de Catarata , Catarata , Oftalmopatías/tratamiento farmacológico , Activador de Tejido Plasminógeno/uso terapéutico , Cámara Anterior , Extracción de Catarata/efectos adversos , Oftalmopatías/etiología , Fibrinolíticos/uso terapéutico , Humanos , Complicaciones Posoperatorias/tratamiento farmacológico , Proteínas Recombinantes/uso terapéuticoRESUMEN
INTRODUCTION: Corneal endothelium is essential for adequate corneal hydration and transparency. Age and ethnicity- related variability in endothelial properties is known. OBJECTIVES: To determine specular microscopy trends in the elderly and to provide normative data of endothelial features of the sampled cohort of the Israeli population aged 55-88 years. METHODS: This is a retrospective cross-sectional study analyzing specular microscopy data of the Israeli population aged 55-88 years and the determination of correlation of age to specular microscopy features. A comparison of endothelial properties was conducted between age-based groups: 55-64 years, 65-74 years, and 75-88 years. RESULTS: One hundred and eighty eight eyes of 188 patients, mean age 71.05 ± 7.9 years, were included; Mean Cell Density 2549.53 ± 294.71 cells/mm²; Coefficient of variation (CV) 42.12 ± 6.9%; Hexagonality (Hexa) 49.15 ± 6.62%; Central Corneal thickness (CCT) 552 ± 47 µm. A weak correlation was observed between cell density and age [r = -0.169; p = 0.02); CV, Hexa, and CCT did not show any correlation with age. Group analysis did not reveal statistically significant differences between the following age groups: 55-64 years; 65-74 years; 75-88 years CONCLUSIONS: Normative data of endothelial properties of the sampled cohort of Israeli population aged 55-88 years is provided. Age has a weak correlation with cell density. DISCUSSION AND SUMMARY: Considering the aging of the population, endothelial properties do not justify the rejection of potential donors based on age alone.
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Envejecimiento/fisiología , Senescencia Celular/fisiología , Córnea , Endotelio Corneal , Factores de Edad , Anciano , Anciano de 80 o más Años , Recuento de Células/métodos , Córnea/patología , Córnea/fisiología , Estudios Transversales , Endotelio Corneal/patología , Endotelio Corneal/fisiología , Femenino , Humanos , Israel , Masculino , Microscopía/métodos , Persona de Mediana Edad , Distribución Normal , Estadística como AsuntoRESUMEN
AIMS: To describe and identify clinical characteristics, prognostic factors and visual outcome in patients with intraocular foreign bodies (IOFB) in southern Israel. METHODS: We conducted a retrospective review of all cases of open globe injury with IOFB treated and followed-up for at least 6 months in the Ophthalmology Department at Soroka University Medical Center, Beer Sheva, Israel, from 1995-2011. The study population was subdivided into two groups: 1. Patients whose difference in visual acuity (VA) between presentation and end of follow-up was considered "successful" (n = 54); 2. Patients whose difference in VA between presentation and end of follow-up was considered "non-successful"(n = 14). Comparing these two groups, we analyzed the following: time from trauma to admission, time from admission to operation, location of IOB, wound zone, best corrected VA at admission. RESULTS: A total of 97.1% of the study group were males and the mean age was 28.7 ± 15.3 years. Metallic IOB were found in 73.5% of cases. The IOFB penetrated at Zone 1 in 61.8% cases, and were located at the posterior segment in 65.2 % of cases. The two subgroups differed in their best corrected VA (by LogMAR) at presentation (p value = 0.02): the patients who were defined as "successful" (n = 54) had.a higher mean VA (1.2 ± 1.3) than those (n = 14) who were defined as "non-successful" (1.1 ± 0.6). The duration of time from trauma to admission was not found to be of statistical significance (p value = 0.361, and neither did the time from admission to operation (P value = 1). CONCLUSION: We present an innovative definition of VA changes during the follow-up period in patients with open globe injuries involving IOFB. Our study showed that patients who presented with worse VA had a better chance of a "successful" outcome.
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Antibacterianos/uso terapéutico , Cuerpos Extraños en el Ojo , Lesiones Oculares Penetrantes , Procedimientos Quirúrgicos Oftalmológicos , Agudeza Visual , Adolescente , Adulto , Cuerpos Extraños en el Ojo/diagnóstico , Cuerpos Extraños en el Ojo/etnología , Cuerpos Extraños en el Ojo/fisiopatología , Cuerpos Extraños en el Ojo/terapia , Lesiones Oculares Penetrantes/diagnóstico , Lesiones Oculares Penetrantes/etnología , Lesiones Oculares Penetrantes/fisiopatología , Lesiones Oculares Penetrantes/terapia , Femenino , Humanos , Israel/epidemiología , Masculino , Procedimientos Quirúrgicos Oftalmológicos/métodos , Procedimientos Quirúrgicos Oftalmológicos/estadística & datos numéricos , Evaluación de Procesos y Resultados en Atención de Salud , Pronóstico , Estudios Retrospectivos , Tiempo de Tratamiento , Índices de Gravedad del TraumaRESUMEN
OBJECTIVE: To determine the prevalence of epiretinal membrane (ERM) in patients with type 2 diabetes mellitus (T2DM) and to assess the associated risk factors. DESIGN: Retrospective, cross sectional study. METHODS: Patients with T2DM, seen for annual follow-up between 2009 and 2010, were evaluated by digital nonmydriatic retinal photography for the detection of diabetic retinopathy. Retinal photographs were assessed by a retina specialist. RESULTS: ERM was present in 102 of 1550 patients with T2DM (6.5%). Of the participants, 1443 had sufficient documented data to conduct statistical analysis for variant risk factors. The prevalence of ERM was significantly associated with age (p < 0.001; 1.2% for <49 years, 4% for 50-59 years, 8.2% for 60-69 years, and 9.6% for >70 years), cataract surgery (p < 0.001), diabetic nephropathy (p < 0.001), and chronic renal failure (p = 0.039). Prevalence was similar for both sexes (53% females, 47% males; p = 0.33). In logistic regression models, the prevalence of ERM was significantly associated with increasing age (p = 0.018), cataract surgery (p < 0.001), and diabetic nephropathy (p = 0.011). CONCLUSIONS: The prevalence of ERM in patients with T2DM in the present study was not significantly different than that of the general population. ERM was significantly associated with age, diabetic nephropathy, and cataract surgery.
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Diabetes Mellitus Tipo 2/diagnóstico , Retinopatía Diabética/diagnóstico , Membrana Epirretinal/diagnóstico , Membrana Epirretinal/epidemiología , Fotograbar/métodos , Distribución por Edad , Anciano , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Retrospectivos , Factores de RiesgoRESUMEN
Objective To investigate whether patients with a history of preeclampsia have an increased risk of long-term ophthalmic complications. Study Design A population-based study comparing the incidence of long-term maternal ophthalmic complications in a cohort of women with and without a history of preeclampsia. Results During the study period, a total of 103,183 deliveries met the inclusion criteria; 8.1% (n = 8,324) occurred in patients with a diagnosis of preeclampsia during at least one of their pregnancies. Patients with preeclampsia had a significantly higher incidence of long-term ophthalmic morbidity such as diabetic retinopathy and retinal detachment. In addition, a positive linear correlation was found between the severity of preeclampsia and the prevalence of future ophthalmic morbidities (0.3 vs. 0.5 vs. 2.2%, respectively). Kaplan-Meier survival curve indicated that women with preeclampsia had higher rates of total ophthalmic morbidity (0.2 vs. 0.4%, for no preeclampsia and with preeclampsia, respectively; odds ratio = 2.06, 95% confidence interval: 1.42-2.99; p < 0.001). In a Cox proportional hazards model, adjusted for confounders, a history of preeclampsia remained independently associated with ophthalmic complications. Conclusion Preeclampsia is an independent risk factor for long-term maternal ophthalmic morbidity, specifically diabetic retinopathy and retinal detachment. This risk is more substantial depending on the severity of the disease.
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Oftalmopatías/epidemiología , Preeclampsia/epidemiología , Adulto , Oftalmopatías/etiología , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Israel , Estimación de Kaplan-Meier , Parto , Embarazo , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Factores de Riesgo , Adulto JovenRESUMEN
OBJECTIVE: To investigate whether patients with a history of obesity during pregnancy have an increased risk for subsequent long-term ophthalmic complications, after controlling for diabetes and preeclampsia. METHODS: A population-based study compared the incidence of long-term maternal ophthalmic complications in a cohort of women with and without a history of obesity during pregnancy. Deliveries occurred between the years 1988 and 2013, with a mean follow-up duration of 12 years. RESULTS: During the study period 106 220 deliveries met the inclusion criteria; 2.2% (n = 2353) occurred in patients with a diagnosis of obesity during at least one of their pregnancies. These patients had a significantly higher incidence of ophthalmic complications in total and specifically of diabetic retinopathy. Using a Kaplan-Meier survival curve, we found that patients with a history of obesity during pregnancy had a significantly higher cumulative incidence of ophthalmic complications. Using a Cox proportional hazards model, adjusted for confounders such as maternal age, preeclampsia and diabetes mellitus, we found obesity during pregnancy remained independently associated with ophthalmic complications (adjusted HR, 2.4; 95% CI, 1.4-4.2; p = 0.003). CONCLUSION: Obesity during pregnancy is an independent risk factor for long-term ophthalmic complications, and specifically diabetic retinopathy.
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Índice de Masa Corporal , Oftalmopatías/etiología , Obesidad/complicaciones , Complicaciones del Embarazo , Adulto , Retinopatía Diabética/etiología , Femenino , Estudios de Seguimiento , Humanos , Estimación de Kaplan-Meier , Embarazo , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Adulto JovenRESUMEN
OBJECTIVE: To compare visual outcomes of eyes which underwent primary scleral buckling (PSB) treatment during posterior segment open-globe injury (OGI) repair with eyes not treated with PSB. METHODS: We retrospectively reviewed 38 eyes which underwent a posterior segment OGI repair with no preoperative evidence of retinal detachment (RD) at Soroka University Medical Center (1995-2010). 19 (50%) underwent scleral repair alone (control group) and the other 19 eyes were treated with PSB also (PSB group). We compared visual outcomes in these two groups and rates of subsequent postoperative complications. RESULTS: Baseline characteristics of the groups were similar. Compared with the control group, the PSB group had statistically significant lower rates of proliferative vitreoretinopathy (PVR) (5.3% versus 38.4%, P < 0.05) and a trend towards lower rates of RD (15.8% versus 41.1%, P = 0.1). PSB group eyes had a statistically significant improvement of their best distance visual acuity (BDVA) with lower means of final BDVA-grade (P < 0.05) and logMAR vision (P < 0.05). Eyes in the control group had no improvement in these parameters. CONCLUSION: PSB procedure during posterior segment OGI repair may decrease the risk of subsequent retinal complications and improve final visual outcome.
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Segmento Posterior del Ojo/lesiones , Segmento Posterior del Ojo/cirugía , Curvatura de la Esclerótica , Cicatrización de Heridas , Adulto , Estudios de Casos y Controles , Demografía , Femenino , Humanos , Masculino , Segmento Posterior del Ojo/patología , Segmento Posterior del Ojo/fisiopatología , Resultado del Tratamiento , Agudeza VisualRESUMEN
To evaluate the effectiveness of the non-mydriatic digital camera for diabetic retinopathy (DR) screening. Secondary purposes of the study were to characterize diabetic patients being screened for the presence of DR and to calculate the sensitivity, specificity, and positive predictive value of the test. All 6,962 consecutive patients with type 2 diabetes undergoing non-mydriatic digital retinal photography between January 1, 2009 and June 30, 2010 in eight community health clinics in the south of the country were included. Comparison of a random sample of patients who underwent non-mydriatic retinal photography, and who were also examined by an ophthalmologist with pupil dilation was also performed. The average age of all patients was 64.2 years. A total of 5,960 cases (85.6 % of all photographs) were of adequate quality for the diagnosis. DR of any degree was found in 1,092 (18.3 %) patients. Normal fundus pictures were found in 49.4 % of patients. In 32.2 % of cases, non-DR pathologies were found. Among cases in which DR was found, 73.3 % (801 cases) had mild non-proliferative retinopathy (NPDR), 7.1 % (77 cases) had moderate NPDR, 6.8 % (74 cases) had proliferative retinopathy, and 12.8 % (140 cases) had diabetic macular edema. Older patients had more chance of having poor quality pictures (p < 0.001 between patients older and younger than 70 years). When non-mydriatic fundus photography was compared with dilated fundus examination by an ophthalmologist, sensitivity of 99.3 %, specificity of 88.3 %, and positive predictive value of 85.3 % were found. Non-mydriatic digital retinal photography is an efficient method for DR screening. The test has high sensitivity and specificity. The test, as performed in community health centers in the south of the country, contributed to the early diagnosis of >1,000 cases of DR. Many patients can be followed up in a fast and efficient way, although the test cannot replace a complete eye examination after pupil dilation mainly in older people. Other non-DR sight-threatening ocular pathologies can be also detected.
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Retinopatía Diabética/diagnóstico , Procesamiento de Imagen Asistido por Computador/métodos , Tamizaje Masivo/métodos , Fotograbar/instrumentación , Retinoscopios , Anciano , Anciano de 80 o más Años , Análisis de Varianza , Femenino , Humanos , Israel , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Sensibilidad y EspecificidadRESUMEN
BACKGROUND: Open globe injury (OGI) is a common cause of unilateral visual loss in all age groups. OBJECTIVES: To describe and identify clinical characteristics, prognostic factors and visual outcome in a group of patients with OGI in southern Israel. METHODS: We conducted a retrospective review of all cases of OGI examined in the ophthalmology department at Soroka University Medical Center, Beer Sheva, Israel, from 1996 to 2005. A total of 118 eyes with OGI were detected and analyzed statistically. We recorded demographic data, cause of injury, initial visual acuity (VA), associated globe morbidity and injuries, Ocular Trauma Score (OTS), surgical procedures, postoperative complications, and final VA. RESULTS: The mean age of the study group was 36.1 years and included 84% males. The median follow-up was 13.3 months (range 6-66 months). The annual incidence of open globe injuries was 3.1 cases/100,000. In 84 cases (71%) the mechanism of open eye injury was laceration. Most of the injuries were work related (45%). Bilateral injury was observed in two patients. An intraocular foreign body was observed in 45 eyes (38%). Primary surgical repair was performed in 114 eyes. Six patients (5.1%) had complications with posttraumatic endophthalmitis and 12 patients (10.1%) underwent evisceration or enucleation. Clinical signs associated with poor visual outcomes included reduced initial VA, eyelid injury, and retinal detachment at presentation. CONCLUSIONS: In our study population the most important prognostic factors in open globe injury were initial VA, eyelid injury and retinal detachment.
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Lesiones Oculares , Ojo , Procedimientos Quirúrgicos Oftalmológicos , Agudeza Visual , Adolescente , Adulto , Anciano , Ojo/patología , Ojo/fisiopatología , Lesiones Oculares/diagnóstico , Lesiones Oculares/epidemiología , Lesiones Oculares/etiología , Lesiones Oculares/fisiopatología , Lesiones Oculares/cirugía , Femenino , Humanos , Israel/epidemiología , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Oftalmológicos/efectos adversos , Procedimientos Quirúrgicos Oftalmológicos/métodos , Procedimientos Quirúrgicos Oftalmológicos/estadística & datos numéricos , Evaluación de Resultado en la Atención de Salud , Pronóstico , Estudios Retrospectivos , Visión OcularRESUMEN
We report the surgical technique and outcome of planned posterior assisted levitation (P-PAL) in four cases of subluxated cataract. P-PAL was planned as the preferred approach in all cases. A spatula was inserted via the pars plana, the whole lens was lifted to the anterior chamber and then removed through a scleral tunnel incision. Anterior chamber intraocular lenses were implanted in all cases. All four eyes had severe subluxation of the crystalline lenses with marked phacodonesis. Two eyes had history of blunt trauma, and the other two eyes had severe pseudoexfoliation with spontaneous lens subluxation. Follow-up ranged from 1 to 2 years in three cases. The postoperative visual acuity was 20/80 or better. No intraoperative complications were observed. In conclusion, the P-PAL technique was successfully performed during cataract surgery in four eyes with severe subluxated cataracts. There were no complications over the long-term follow-up.
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Catarata/etiología , Subluxación del Cristalino/cirugía , Facoemulsificación/métodos , Agudeza Visual , Adulto , Catarata/diagnóstico , Femenino , Estudios de Seguimiento , Humanos , Implantación de Lentes Intraoculares , Subluxación del Cristalino/complicaciones , Subluxación del Cristalino/diagnóstico , Masculino , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
Autosomal-recessive high-grade axial myopia was diagnosed in Bedouin Israeli consanguineous kindred. Some affected individuals also had variable expressivity of early-onset cataracts, peripheral vitreo-retinal degeneration, and secondary sight loss due to severe retinal detachments. Through genome-wide linkage analysis, the disease-associated gene was mapped to â¼1.7 Mb on chromosome 3q28 (the maximum LOD score was 11.5 at θ = 0 for marker D3S1314). Sequencing of the entire coding regions and intron-exon boundaries of the six genes within the defined locus identified a single mutation (c.1523G>T) in exon 10 of LEPREL1, encoding prolyl 3-hydroxylase 2 (P3H2), a 2-oxoglutarate-dependent dioxygenase that hydroxylates collagens. The mutation affects a glycine that is conserved within P3H isozymes. Analysis of wild-type and p.Gly508Val (c.1523G>T) mutant recombinant P3H2 polypeptides expressed in insect cells showed that the mutation led to complete inactivation of P3H2.
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Etnicidad/genética , Predisposición Genética a la Enfermedad/genética , Miopía/genética , Procolágeno-Prolina Dioxigenasa/genética , Adolescente , Adulto , Secuencia de Aminoácidos , Secuencia de Bases , Femenino , Componentes del Gen , Ligamiento Genético , Humanos , Israel , Masculino , Persona de Mediana Edad , Datos de Secuencia Molecular , Mutación/genética , Miopía/patología , Linaje , Análisis de Secuencia de ADNRESUMEN
BACKGROUND: Diabetic retinopathy is a leading cause of adult blindness and accounts for about 10% of cases of legal blindness in Israel. Only about half of the patients with diabetes in Israel have regular eye examinations. OBJECTIVES: To evaluate, for the first time in southern Israel, a new service for diabetic retinopathy screening that uses a mobile non-mydriatic mobile fundus camera in primary care patients. METHODS: Diabetic members of the largest health fund in southern Israel and over 18 years old were invited for non-mydriatic fundus examination between January and October 2009. Screening was performed by a trained photographer using the Topcon TRC NW-6S non-mydriatic camera in nine primary care centers. RESULTS: A total of 4318 diabetic patients were screened, of whom 53% were classified as normal. The incidence of diabetic retinopathy was 15.8% (1.2% had proliferative retinopathy and 2.4% had suspected macular edema and were referred for laser treatment). Other possible sight-threatening conditions were detected in 9.3%. Fundus pictures were inadequate for assessment in 16% of cases. CONCLUSIONS: Diabetic retinopathy screening with a mobile non-mydriatic fundus camera improved the quality of care for diabetic patients in southern Israel. This screening method identified patients requiring prompt referral to the ophthalmologist for further complete eye examination. Extending this screening program to other areas in the country should be considered.
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Retinopatía Diabética/diagnóstico , Angiografía con Fluoresceína/instrumentación , Unidades Móviles de Salud/organización & administración , Adulto , Diseño de Equipo , Femenino , Humanos , Israel , Masculino , Atención Primaria de SaludRESUMEN
OBJECTIVE: To assess the effect of Nd:YAG laser posterior capsulotomy on ocular wave front aberrations. STUDY DESIGN: Retrospective comparative study. PARTICIPANTS: Twenty-four eyes of 24 consecutive pseudophakic patients with symptomatic PCO, who presented for Nd:YAG laser posterior capsulotomy at our clinic, were included in this study. METHODS: The wave front aberrations of the entire optical path of 24 pseudophakic eyes of 24 patients before, and 1 month after, Nd:YAG laser posterior capsulotomy were measured using the Nidek Optical Path Difference (OPD) scan aberrometer. Total, tilt, and high-order aberrations, and total coma, total trefoil, total tetrafoil, total spherical, and total high astigmatism aberrations were analyzed statistically. Secondary measures included changes in visual acuity and refraction, and repeatability of wave front measurements in the fellow eye. RESULTS: Before Nd:YAG laser posterior capsulotomy, the total higher-order aberrations root mean-square (RMS) wave front aberration was 2.08 (SD 2.20) microm, with total trefoil being a major contributor at 1.19 (SD 1.15) microm. One month after the procedure, significant decreases in total, tilt, and high-order aberrations, and total trefoil, total tetrafoil, total spherical, and total high astigmatism aberrations were noted (p< 0.05). No significant changes in total coma aberrations were found (p > 0.05). Additionally, significant improvement in visual acuity without significant change in refraction was observed. No statistically significant differences were detected in any of the RMS values of wave front measurements taken 1 month later in the fellow eye. CONCLUSIONS: Nd:YAG laser posterior capsulotomy causes significant decrease in ocular wave front aberrations measured using the Nidek-OPD scan aberrometer, which can account for a better optical quality after the procedure. Further research to examine the impact of wave front aberrations in visual function after Nd:YAG laser posterior capsulotomy is needed.
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Catarata/terapia , Córnea/fisiopatología , Terapia por Láser , Láseres de Estado Sólido , Cápsula del Cristalino/cirugía , Complicaciones Posoperatorias , Seudofaquia/fisiopatología , Errores de Refracción/fisiopatología , Anciano , Topografía de la Córnea , Femenino , Humanos , Implantación de Lentes Intraoculares , Masculino , Facoemulsificación , Refracción Ocular/fisiología , Agudeza Visual/fisiologíaRESUMEN
OBJECTIVE: To report the visual and anatomic outcome of intravitreal bevacizumab (Avastin) injections in the treatment of subfoveal neovascular age-related macular degeneration (AMD). METHODS: Interventional, consecutive, retrospective case series. Sixty-five eyes of 65 patients with subfoveal neovascular age-related macular degeneration (AMD) received three intravitreal bevacizumab (1.25 mg) injections. Outcome measures included visual acuity (VA), central retinal thickness (CRT), and size of lesion at 24 or more weeks follow-up. RESULTS: Thirty-five eyes had prior treatment with photodynamic therapy (PDT). At presentation, VA was 1.12 +/- 0.62 logMAR, CRT was 305 +/- 115 microm, and greatest linear diameter (GLD) of the lesion was 4,902 +/- 1,861 microm. There was no statistically significant difference between previous PDT and naïve eyes in VA, CRT, and GLD at presentation. After three bevacizumab injections, VA, CRT, and GLD significantly improved (P < 0.0001 in all groups). There was no statistically significant difference between CRT and GLD outcomes and subfoveal neovascular membrane type or age. Eyes with better VA at baseline and without previous PDT treatment achieved better final VA (P < 0.0001 and P = 0.045, respectively). A classic membrane type and lower age were somewhat associated with better post-treatment VA. CONCLUSIONS: Short-term results suggest that intravitreal bevacizumab is well tolerated and associated with improvement in VA, decreased CRT, and decreased lesion size in most patients. The most important predictors of final VA outcomes were baseline VA and no previous PDT treatment. Further evaluation of intravitreal bevacizumab for the treatment of subfoveal neovascular AMD is warranted.
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Inhibidores de la Angiogénesis/administración & dosificación , Anticuerpos Monoclonales/administración & dosificación , Degeneración Macular/complicaciones , Neovascularización Patológica/tratamiento farmacológico , Neovascularización Patológica/etiología , Factor A de Crecimiento Endotelial Vascular/antagonistas & inhibidores , Anciano , Anciano de 80 o más Años , Anticuerpos Monoclonales Humanizados , Bevacizumab , Femenino , Estudios de Seguimiento , Fóvea Central/irrigación sanguínea , Humanos , Inyecciones Intraoculares , Degeneración Macular/patología , Degeneración Macular/fisiopatología , Masculino , Neovascularización Patológica/patología , Neovascularización Patológica/fisiopatología , Retina/efectos de los fármacos , Retina/patología , Estudios Retrospectivos , Resultado del Tratamiento , Agudeza Visual/efectos de los fármacos , Cuerpo VítreoRESUMEN
PURPOSE: The aim of this study is to describe and identify clinical characteristics, prognostic factors and visual outcome in a group of patients with posterior open globe injuries (zone III injury). METHODS: A retrospective review was made of all cases of open globe injuries that were examined at the Ophthalmology Department of Soroka Medical Center, Beer-Sheva, Israel, from 1995 to 2005. One hundred and eight consecutive patients diagnosed with open globe injuries were reviewed. Of these, 21 eyes from 21 patients with zone III injuries were analysed and are the subject of this study. We assessed the relationship of presenting visual acuity, cause and extent of injury, as well as the number of surgical procedures, postoperative complications with the final outcome. RESULTS: The study group comprised 95% male subjects with a mean age of 35.8 years (range 20-60 years). The median follow up was 21.2 months (range 6-66 months). In 72.7% of the cases metal was the causative factor. Clinical signs associated with an adverse outcome included poor-presenting acuity, eyelid injury, cornea lamellar lacerations or abrasions, iris deformity, lens damage, ocular hypotony, coexisting injuries and a low ocular trauma score. No cases presented with post-traumatic endophthalmitis. CONCLUSIONS: From this study we determined the most important prognostic factor in zone III open globe injuries is the presenting acuity. Other prognostic factors associated with a poor final outcome are eyelid injury, iris deformity, lens damage, ocular hypotonia, coexisting injuries and low ocular trauma score (< or =2). Posterior open eye injuries were most commonly owing to metal entering the eyes of young men.
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Lesiones Oculares Penetrantes/cirugía , Adulto , Lesiones de la Cornea , Oftalmopatías/epidemiología , Oftalmopatías/etiología , Lesiones Oculares Penetrantes/complicaciones , Femenino , Cuerpos Extraños/cirugía , Humanos , Cristalino/patología , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Pronóstico , Estudios Retrospectivos , Agudeza Visual , Adulto JovenRESUMEN
PURPOSE: Some 30% of cases of congenital cataract are genetic in origin, usually transmitted as an autosomal dominant trait. The molecular defects underlying some of these autosomal dominant cases have been identified and were demonstrated to be mostly mutations in crystallin genes. The autosomal recessive form of the disease is less frequent. To date, only four genes and three loci have been associated with autosomal recessive congenital cataract. Two extended unrelated consanguineous inbred Bedouin families from southern Israel presenting with autosomal recessive congenital nuclear cataract were studied. METHODS: Assuming a founder effect, homozygosity testing was performed using polymorphic microsatellite markers adjacent to each of 32 candidate genes. RESULTS: A locus on chromosome 22 surrounding marker D22S1167 demonstrated homozygosity only in affected individuals (lod score > 6.57 at theta = 0 for D22S1167). Two crystallin genes (CRYBB1 and CRYBA4) located within 0.1 cM on each side of this marker were sequenced. No mutations were found in CRYBA4. However, an identical homozygous delG168 mutation in exon 2 of CRYBB1 was discovered in affected individuals of both families, generating a frameshift leading to a missense protein sequence at amino acid 57 and truncation at amino acid 107 of the 252-amino-acid CRYBB1 protein. Denaturing [d]HPLC analysis of 100 Bedouin individuals unrelated to the affected families demonstrated no CRYBB1 mutations. CONCLUSIONS: CRYBB1 mutations have been shown to underlie autosomal dominant congenital cataract. The current study showed that a different mutation in the same gene causes an autosomal recessive form of the disease.
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Catarata/congénito , Catarata/genética , Mutación del Sistema de Lectura , Cadena B de beta-Cristalina/genética , Secuencia de Bases , Preescolar , Cromosomas Humanos Par 22/genética , Análisis Mutacional de ADN , Exones/genética , Femenino , Efecto Fundador , Genes Recesivos , Ligamiento Genético , Haplotipos , Homocigoto , Humanos , Lactante , Masculino , Repeticiones de Microsatélite , Linaje , Reacción en Cadena de la Polimerasa , Eliminación de Secuencia/genéticaRESUMEN
PURPOSE: To elucidate whether the Bactec Peds Plus F broth traditionally used for culturing body fluids in pediatric departments can also be used for vitreous cultures in cases with clinically suspected endophthalmitis, and to compare yields between this method and the traditional method. DESIGN: Prospective, comparative clinical trial. METHODS: All consecutive cases with clinically suspected endophthalmitis treated in our institution between July 2003 and November 2005 were included in the study. All cases were cultured both in the Bactec Peds Plus F broth and using the traditional method. RESULTS: Thirteen cases were included in this study. The overall growth rate for the Bactec broth was 28.4% higher than the traditional method (69.2% and 53.9%, respectively, P = .48). In two cases, one of acute-onset postoperative endophthalmitis due to Streptococcus mitis and one of delayed-onset postoperative endophthalmitis attributable to Candida albicans, there was positive growth only in the Bactec broth. CONCLUSIONS: The Bactec Peds Plus F broth can be used successfully in the examination of clinically suspected endophthalmitis. The method appears to have several advantages over the traditional method: time-savings, as only one medium needs to be inoculated, transportation to the laboratory is simpler as there is no need for immediate incubation, and there is no need to maintain a supply of fresh agar media. This method is especially suitable for office settings and remote clinics, but also can be used in hospital settings, as an adjunct, to increase the growth yield.
Asunto(s)
Bacterias/aislamiento & purificación , Medios de Cultivo , Endoftalmitis/microbiología , Infecciones Bacterianas del Ojo/microbiología , Complicaciones Posoperatorias , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Bacterias/crecimiento & desarrollo , Técnicas Bacteriológicas/instrumentación , Técnicas Bacteriológicas/métodos , Extracción de Catarata , Niño , Femenino , Humanos , Implantación de Lentes Intraoculares , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Cuerpo Vítreo/microbiologíaRESUMEN
CASE REPORT: A previously healthy 2-year-old girl presented with severe panuveitis in her left eye. She developed chickenpox rash several days later. DNA particles of varicella-zoster virus (VZV) were detected by polymerase chain reaction (PCR) in the aqueous humor. No antiviral regimen was administered. The uveitis resolved completely after 1 week. COMMENTS: Patients with chickenpox should undergo a thorough ophthalmologic examination at the onset of visual symptoms. Clinicians should be aware of the rare occurrence of chickenpox when evaluating a uveitis patient. If there is suspicion of chickenpox, the clinician may consider ordering serology or PCR tests.
Asunto(s)
Varicela/diagnóstico , ADN Viral/análisis , Herpesvirus Humano 3/aislamiento & purificación , Panuveítis/diagnóstico , Varicela/virología , Preescolar , Diagnóstico Diferencial , Femenino , Estudios de Seguimiento , Herpesvirus Humano 3/genética , Humanos , Panuveítis/virología , Remisión EspontáneaRESUMEN
PURPOSE: To study the outcomes of laser in situ keratomileusis (LASIK) in patients with well-controlled diabetes mellitus. SETTING: Gimbel Eye Centres, Calgary and Edmonton, Canada. METHODS: The charts of all patients with diabetes who had LASIK surgery at the Gimbel Eye Centres were reviewed retrospectively. Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), final refraction, and complications were assessed. RESULTS: Twenty-four patients (16 men and 8 women) were identified. Mean patient age was 42 years (range 24 to 57 years). Seventeen patients had diabetes type II, and 7 had diabetes type I. Mean preoperative spherical equivalent (SE) was -4.88 +/- 2.13 diopters (D) (range +1.625 to -9.00 D). Median follow-up was 6 months (range 4 to 44 months). No eye lost BSCVA. Twenty-nine eyes (63%) achieved UCVA 20/25 or better, and 31 eyes (67%) were within +/-0.5 D of the intended refraction after the first LASIK surgery. Retreatment was required in 13 eyes (28.3%) because initial surgery was not adequate to correct the refractive error. At the last follow-up visit, 40 eyes (87%) achieved UCVA of 20/25 or better and 43 eyes (93.5%) were within +/-0.5 D of the intended refraction. Three eyes (6.5%) developed an epithelial defect after surgery, and secondary epithelial ingrowth developed in 2 of these eyes. No advancement of diabetic retinopathy was noticed in any eye at the end of the follow-up period. CONCLUSIONS: Laser in situ keratomileusis surgery was safely performed in patients with well-controlled diabetes. Enhancement may often be required for optimal correction.
Asunto(s)
Diabetes Mellitus Tipo 1/complicaciones , Diabetes Mellitus Tipo 2/complicaciones , Queratomileusis por Láser In Situ , Miopía/complicaciones , Miopía/cirugía , Adulto , Anteojos , Femenino , Estudios de Seguimiento , Humanos , Queratomileusis por Láser In Situ/efectos adversos , Masculino , Persona de Mediana Edad , Miopía/fisiopatología , Refracción Ocular , Estudios Retrospectivos , Resultado del Tratamiento , Agudeza VisualRESUMEN
BACKGROUND: We report our experience in removing giant papillae in cases with severe vernal keratoconjunctivitis using CO2 laser. METHODS: Five cases with conjunctival giant papillae due to severe vernal keratoconjunctivitis were treated with CO2 laser. All cases were resistant to conventional treatment. In 4 eyes, there was also an associated corneal shield ulcer. RESULTS: In all 5 cases the procedure was uneventful. Retreatment was performed in only 2 cases because of recurrence of the papillae. No intra- or postoperative complications were observed. INTERPRETATION: CO2 laser seems to be a safe method for removing conjunctival giant papillae in cases with severe vernal keratoconjunctivitis. It is also a repeatable method that enables a rapid conjunctival and corneal recovery.