Factores asociados al desprendimiento de retina pseudofáquico: seguimiento a largo plazo en una población colombiana / Associated factors with pseudophakic retinal detachment: Long-term follow-up in a Colombian population

Objetivo Identificar factores asociados a la aparición de desprendimiento de retina pseudofáquico en pacientes con antecedente de cirugía de catarata. Métodos Estudio retrospectivo de casos y controles de 802 ojos de 783 pacientes con antecedente de cirugía de catarata. Los casos fueron pacientes con desprendimiento de retina pseudofáquico (n=258 ojos), mientras que los controles fueron pacientes con cirugía de cataratas que no desarrollaron desprendimiento de retina durante un período de seguimiento de 10 años (n=544 ojos). Resultados La edad de la cirugía de cataratas entre los casos fue menor que en el grupo control (57±13 vs. 67±14 años, respectivamente; p<0,0001). La edad al desprendimiento de retina fue de 59±13 años (rango 6-88) y el tiempo entre la cirugía de catarata y el desprendimiento de retina tuvo una mediana de 2 años (rango intercuartílico 1-4), con un rango de un mes a 14 años. Los factores asociados para el desprendimiento de retina pseudofáquico fueron la edad más joven (<50 años: razón de probabilidad ajustada [ORa]=18,03; intervalo de confianza del 95% [IC 95%]=5,92-54,87; 50-59 años: ORa=10,09, IC 95%=3,37-30,23 y 60-69 años: ORa=5,48, IC 95%=1,88-15,93), sexo masculino (ORa=3,71, IC 95%=2,54-5,44), vitrectomía anterior (ORa=3,26, IC 95%=1,16-9,16), antecedentes de desprendimiento de retina en el ojo contralateral (ORa=6,95, IC 95%=3,15-15,31) y complicaciones intraoperatorias durante la extracción de cataratas (ORa=7,45, IC 95%=3,54-15,69). Conclusiones Este es el primer artículo de factores asociados al desprendimiento de retina pseudofáquico en población colombiana. Se encontró que las complicaciones quirúrgicas, el sexo y la edad estaban asociados con el desprendimiento de retina. Los pacientes deben ser conscientes de estos riesgos potenciales para tomar decisiones informadas sobre su salud ocular (AU)

Objective To identify associated factors with the appearance of pseudophakic retinal detachment in patients with history of cataract surgery. Methods Retrospective case–control study of 802 eyes of 783 patients with history of cataract surgery. Cases were patients with pseudophakic retinal detachment (n=258 eyes), while controls were patients with cataract surgery who did not developed retinal detachment during a 10-year follow-up period (n=544 eyes). Results Age at cataract surgery among cases was lower than in the control group (57±13 vs. 67±14 years old, respectively; P<.0001). Age at retinal detachment was 59±13 years old (range 6–88) and the time between the cataract surgery and the retinal detachment had a median of 2 years (interquartile range 1–4) with a range of 1 month to 14 years. Associated factors for pseudophakic retinal detachment were younger age (<50 years: adjusted odds ratio [aOR]=18.03, 95% confidence interval [95% CI]=5.92–54.87; 50–59 years: aOR=10.09, 95% CI=3.37–30.23; and 60–69 years: aOR=5.48, 95% CI=1.88–15.93), male sex (aOR=3.71, 95% CI=2.54–5.44), anterior vitrectomy (aOR=3.26, 95% CI=1.16–9.16), history of retinal detachment in the fellow eye (aOR=6.95, 95% CI=3.15–15.31), and intraoperative complications during cataract extraction (aOR=7.45, 95% CI=3.54–15.69). Conclusions This is the first report of associated factors with pseudophakic retinal detachment in a Colombian population. Surgical complications, sex, and age were found to be associated with retinal detachment. Patients should be aware of these potential risks to make informed decisions about their eye health (AU)

Associated factors with pseudophakic retinal detachment: Long-term follow-up in a Colombian population.

OBJECTIVE: To identify associated factors with the appearance of pseudophakic retinal detachment in patients with history of cataract surgery. METHODS: Retrospective case-control study of 802 eyes of 783 patients with history of cataract surgery. Cases were patients with pseudophakic retinal detachment (n = 258 eyes), while controls were patients with cataract surgery who did not developed retinal detachment during a 10-year follow-up period (n = 544 eyes). RESULTS: Age at cataract surgery among cases was lower than in the control group (57 ± 13 vs. 67 ± 14 years old, respectively; p < 0.0001). Age at retinal detachment was 59 ± 13 years old (range 6-88) and the time between the cataract surgery and the retinal detachment had a median of 2 years (interquartile range 1-4) with a range of 1 month to 14 years. Associated factors for pseudophakic retinal detachment were younger age (<50 years: adjusted odds ratio [aOR] = 18.03, 95% confidence interval [95%CI] = 5.92-54.87; 50-59 years: aOR = 10.09, 95%CI = 3.37-30.23; and 60-69 years: aOR = 5.48, 95%CI = 1.88-15.93), male sex (aOR = 3.71, 95%CI = 2.54-5.44), anterior vitrectomy (aOR = 3.26, 95%CI = 1.16-9.16), history of retinal detachment in the fellow eye (aOR = 6.95, 95%CI = 3.15-15.31), and intraoperative complications during cataract extraction (aOR = 7.45, 95%CI = 3.54-15.69). CONCLUSIONS: This is the first report of associated factors with pseudophakic retinal detachment in a Colombian population. Surgical complications, sex, and age were found to be associated with retinal detachment. Patients should be aware of these potential risks to make informed decisions about their eye health.

Empirical transfusion strategies for major hemorrhage in trauma patients: A systematic review.

BACKGROUND: Major hemorrhage is a significant cause of mortality and morbidity around the world. There is currently no consensus on the best empirical transfusion strategy. The current National Institute for Clinical Excellence (NICE) guidelines suggest a ratio of 1:1 of red blood cells and plasma. The aim of this study is to compare this to alternative strategies identified through review of the available literature with the objective of identifying the best protocol for mortality outcomes and complication rates. METHODS: A systematic review of the literature was conducted using four databases. Inclusion and exclusion criteria were applied to produce a suitable list of randomized control trials for review. Critical appraisal of each article was then performed, using a Scottish Intercollegiate Guidelines Network-approved checklist, in duplicate and was subject to further independent scrutiny when required. RESULTS: Evidence suggests that early administration of cryoprecipitate within the standard practiced major hemorrhage protocol is associated with a lower risk of mortality. Other strategies suggested a negative impact. Complications including incidence of thromboembolic events, multiple organ failure and sepsis as well as length of stay in hospital following activation of the different protocols and overall transfusion requirements were assessed. No clear optimal protocol was identified from our analysis. CONCLUSION: This project demonstrates that there is no significant clarity regarding morbidity and mortality. As a preliminary recommendation, cryoprecipitate supplementation suggests more favorable mortality over the current protocol. Due to the limited sample populations, we recommend the inclusion of retrospective/prospective cohort studies to bolster the statistical power of any future reviews until randomized control trials of sufficient power are available. LEVEL OF EVIDENCE: Systematic review, Level III.

Application of botulinum toxin in Horner's muscle for the treatment of dry eye. / Aplicación de toxina botulínica en el músculo de Horner para el tratamiento de ojo seco.

OBJECTIVE/METHODS: The aim of this study is to describe the use of botulinum toxin to increase tear retention in patients with dry eye, using the description of 2 cases. RESULTS: Patients with moderate to severe dry eye that were given an injection of type A botulinum toxin in the Horner's muscle. The results at one month and 3 months are reported. An assessment was made of the subjective perception of the patient as regards any improvement, as well as taking into account, the Ocular Surface Disease Index, superficial punctate keratitis, and the time of the tear rupture and tear meniscus. A significant improvement was observed in the subjective perception of the patient, the Ocular Surface Disease Index, superficial punctate keratitis, and the time of the tear rupture and tear meniscus at one month after treatment, and the good results still being maintained at the third month. There were no adverse events. DISCUSSION: The use of type A botulinum toxin can be considered as an alternative to increase tear retention in moderate to severe dry eye, with a good response during the first month, with an acceptable response still being maintained at the third month. Given the temporary effect of the drug, further treatments would be required.

UUnilateral corneal edema caused by a hidden foreign body. / Edema corneal unilateral causado por un cuerpo extraño oculto.

CASE REPORT: A middle-aged adult male was referred to our institution due to unilateral corneal edema for a possible corneal transplant. At first, the patient denied a history of trauma. A small foreign body, which had been overlooked by the primary ophthalmologist, was detected by gonioscopy, embedded in the anterior chamber angle. It was successfully surgically removed and visual results were good. DISCUSSION: In any patient with unilateral unexplained corneal edema, it is necessary to rule out the presence of a foreign body in the anterior chamber.