RESUMEN
PURPOSE: This study aimed to evaluate the ability of a freely accessible internet algorithm to correctly identify the need for emergency ophthalmologic consultation for correct diagnosis and management. METHOD: This retrospective observational cohort study was based on the first 100 patients who requested recommendations on the necessity of breaking the lockdown for emergency ophthalmology consultation during the period from March to May 2020. RESULTS: Ninety-one patients completed questionnaires. Forty-nine were directed to emergency consultation and 42 to differed scheduled visits or telemedicine visits. One patient sent for emergency consultation had an overestimated severity and could have been seen later, while two patients initially recommended for a scheduled visit were considered appropriate for emergency consultation. However, these patients' management did not suffer as a consequence of the delay. The sensitivity of the algorithm, defined as the number of emergency consultations suggested by the algorithm divided by the total number of emergency consultations deemed appropriate by the practitioner's final evaluation, was 96.0%. The specificity of the algorithm, defined as the number of patients recommended for delayed consultation by the algorithm divided by the number of patients deemed clinically appropriate for this approach, was 97.5%. The positive predictive value, defined as the number of appropriate emergency consultations divided by the total number of emergency consultations suggested by the algorithm, was 97.9%. Finally, the negative predictive value, defined as the number of appropriately deferred patients divided by the number of deferred patients recommended by the algorithm, was 95.2%. CONCLUSION: This study demonstrates the reliability of an algorithm based on patients' past medical history and symptoms to classify patients and direct them to either emergency consultation or to a more appropriate deferred, scheduled appointment. This algorithm might allow reduction of walk-in visits by half and thus help control patient flow into ophthalmologic emergency departments.
Asunto(s)
Algoritmos , Citas y Horarios , COVID-19/epidemiología , Urgencias Médicas , Oftalmopatías/terapia , Oftalmología/organización & administración , Cuarentena , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Control de Enfermedades Transmisibles/normas , Urgencias Médicas/epidemiología , Servicios Médicos de Urgencia/organización & administración , Servicio de Urgencia en Hospital/organización & administración , Servicio de Urgencia en Hospital/normas , Oftalmopatías/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Paris/epidemiología , Derivación y Consulta/organización & administración , Derivación y Consulta/normas , Reproducibilidad de los Resultados , Estudios Retrospectivos , Encuestas y Cuestionarios , Telemedicina/organización & administración , Telemedicina/normas , Adulto JovenRESUMEN
INTRODUCTION: Current screening recommendations for chloroquine (CQ) and hydroxychloroquine (HCQ) retinopathy are based on central 10°C static perimetry and a high-resolution SD-OCT with a special attention to the inferior part of the macula where the toxicity usually starts by ellipsoid zone disruption. However, Melles and Marmor, have recently shown a great variability in the topography of the initial toxicity observed among various ethnicities, which is important to keep in mind so as not to miss early toxicity in certain subgroups of patients. METHODS: Review of the literature. RESULTS: Ethnic differences have been shown regarding the topography of the initial retinal toxicity of CQ and HCQ, particularly between Caucasian and Asian subjects. In Caucasians, the first signs of toxicity are more often localized in the inferior para-foveal area associated with a decrease in retinal sensitivity in the upper 10°C visual field. However, in Asian subjects, the first signs of toxicity appear more pericentral (still inferior) with an extramacular pattern that could be missed by the usual 10°C visual field screening. DISCUSSION/CONCLUSION: The pathophysiology of these ethnic differences is unknown and may be due to distinct genetic predisposition to CQ and HCQ toxicity. Screening strategies should be adjusted to the ethnicity and performed in Asian subjects with larger visual fields (30°C), along with SD-OCT, looking for ellipsoid disruption≥8°C from the fovea. The recognition of this pericentral topography and an adjusted screening protocol should avoid late diagnosis in Asians treated with CQ and HCQ.
Asunto(s)
Antirreumáticos/efectos adversos , Cloroquina/efectos adversos , Etnicidad , Hidroxicloroquina/efectos adversos , Retina/patología , Enfermedades de la Retina/etnología , Antirreumáticos/uso terapéutico , Pueblo Asiatico/genética , Cloroquina/uso terapéutico , Diagnóstico Tardío , Diagnóstico Precoz , Electrorretinografía , Etnicidad/genética , Predisposición Genética a la Enfermedad , Humanos , Hidroxicloroquina/uso terapéutico , Mácula Lútea/efectos de los fármacos , Mácula Lútea/patología , Imagen Óptica , Retina/efectos de los fármacos , Enfermedades de la Retina/inducido químicamente , Enfermedades de la Retina/patología , Enfermedades de la Retina/fisiopatología , Tomografía de Coherencia Óptica/métodos , Pruebas del Campo Visual/métodos , Campos Visuales , Población Blanca/genéticaRESUMEN
The goal of this manuscript is to assess data suggesting that intravitreal injection of anti-vascular endothelial growth factors (anti-VEGFs) could result in systemic adverse events (AEs). The class-specific systemic AEs should be similar to those encountered in cancer trials. The most frequent AE observed in oncology, hypertension and proteinuria, should thus be the most common expected in ophthalmology, but their severity should be lower because of the much lower doses of anti-VEGFs administered intravitreally. Such AEs have not been frequently reported in ophthalmology trials. In addition, pharmacokinetic and pharmacodynamic data describing systemic diffusion of anti-VEGFs should be interpreted with caution because of significant inconsistencies reported. Thus, safety data reported in ophthalmology trials and pharmacokinetic/pharmacodynamic data provide robust evidence that systemic events after intravitreal injection are very unlikely. Additional studies are needed to explore this issue further, as much remains to be understood about local and systemic side effects of anti-VEGFs.
Asunto(s)
Inhibidores de la Angiogénesis/efectos adversos , Factor A de Crecimiento Endotelial Vascular/antagonistas & inhibidores , Inhibidores de la Angiogénesis/administración & dosificación , Inhibidores de la Angiogénesis/farmacocinética , Inhibidores de la Angiogénesis/uso terapéutico , Antineoplásicos/efectos adversos , Bevacizumab/administración & dosificación , Bevacizumab/efectos adversos , Bevacizumab/farmacocinética , Ensayos Clínicos como Asunto , Relación Dosis-Respuesta a Droga , Humanos , Hipertensión/inducido químicamente , Inyecciones Intravítreas/efectos adversos , Neoplasias/tratamiento farmacológico , Seguridad del Paciente , Proteinuria/inducido químicamente , Ranibizumab/administración & dosificación , Ranibizumab/efectos adversos , Ranibizumab/farmacocinética , Receptores de Factores de Crecimiento Endotelial Vascular/administración & dosificación , Proteínas Recombinantes de Fusión/administración & dosificación , Proteínas Recombinantes de Fusión/efectos adversos , Proteínas Recombinantes de Fusión/farmacocinética , Tromboembolia/inducido químicamente , Cicatrización de Heridas/efectos de los fármacosRESUMEN
INTRODUCTION: Recommendations for screening for chloroquine (CQ) and hydroxychloroquine (HCQ) retinopathy have recently been changed by the American Academy of Ophthalmology, taking into account new published data on toxicity prevalence, risk factors, location of onset in the retina and the efficacy of screening tests. METHODS: Literature review. RESULTS AND DISCUSSION: The risk of developing CQ or HCQ retinopathy depends on the daily dose and duration of treatment. At recommended doses, the risk is<1 % at 5 years, <2 % at 10years but increases to about 20 % after 20years of treatment. The maximum recommended daily dose is 5.0mg/kg for HCQ and 2.3mg/kg for CQ. The two main risk factors are the daily dose and duration of treatment. The presence of kidney failure and treatment with tamoxifen are also significant risk factors. A baseline examination should be performed at the initiation of treatment to rule out pre-existing maculopathy. The screening is then annual and starts from the 5th year of treatment. The two tests recommended for screening are the automated visual field and spectral domain OCT. Multifocal ERG and autofluorescence fundus imaging are only carried out secondarily to confirm the pathology.
Asunto(s)
Antimaláricos/efectos adversos , Técnicas de Diagnóstico Oftalmológico/normas , Hidroxicloroquina/efectos adversos , Guías de Práctica Clínica como Asunto , Enfermedades de la Retina/inducido químicamente , Enfermedades de la Retina/diagnóstico , Antimaláricos/administración & dosificación , Técnicas de Diagnóstico Oftalmológico/tendencias , Relación Dosis-Respuesta a Droga , Humanos , Hidroxicloroquina/administración & dosificación , Tamizaje Masivo/métodos , Tamizaje Masivo/normas , Tamizaje Masivo/tendencias , Factores de Tiempo , Selección Visual/métodos , Selección Visual/normas , Selección Visual/tendenciasRESUMEN
Retinal venous occlusions comprise central retinal vein occlusion, hemiretinal vein occlusions, and branch retinal vein occlusions. They are associated with arterial hypertension and glaucoma. Retinal vein occlusions occur more frequently in males, at a median age of 55. The pathogenesis of retinal venous occlusions remains obscure. The clinical presentation of the disease is variable. In most cases, there is a unilateral visual loss over days with a painless, white and quiet eye. However, retinal venous occlusions may also present as an abrupt and profound loss of vision, or be asymptomatic. The course of the disease may be chronic, often with exacerbations. The most severe complication is the onset of extensive capillary non-perfusion, with a high risk of neovascular glaucoma. The most frequent complication is macular edema due to breakdown of the blood-retinal barrier, which can originate from the macula itself and/or from the disc. The treatment is symptomatic. Retinal venous occlusions may resolve either because of the recanalization of the affected vein, or because of the establishment of an efficient collateral circulation. Intravitreal anti-VEGF antibodies or steroids may transiently improve vision, as well as laser photocoagulation, focused or not on macroaneurysms. Visual sequelae are frequent.
Asunto(s)
Oclusión de la Vena Retiniana , Glaucoma/complicaciones , Glaucoma/epidemiología , Glaucoma/terapia , Humanos , Hipertensión/complicaciones , Hipertensión/epidemiología , Hipertensión/terapia , Inyecciones Intravítreas , Fotocoagulación , Ranibizumab/administración & dosificación , Oclusión de la Vena Retiniana/complicaciones , Oclusión de la Vena Retiniana/diagnóstico , Oclusión de la Vena Retiniana/epidemiología , Oclusión de la Vena Retiniana/terapia , Trastornos de la Visión/diagnóstico , Trastornos de la Visión/epidemiología , Trastornos de la Visión/etiología , Trastornos de la Visión/terapiaRESUMEN
BACKGROUND: In recent years, intravitreal injections have added to the treatment modalities available for macular edema (ME) secondary to retinal vein occlusion (RVO). This article aims to provide an update regarding the management of ME secondary to RVO. METHODS: A work group met in order to analyze the literature available on Embase/PubMed, regarding treatments for venous occlusion that have received market approval and are reimbursed in France. In total, 33 articles were selected. Consensus within the group for recommendations was based on this data from the literature review and clinical experience and was reported in this article. RESULTS: The management of ME secondary to branch retinal vein occlusion (BRVO) or central vein occlusion of the retina (CRVO) differs on a number of points. Methods of best practice were discussed separately for BRVO and CRVO, taking into account various ocular and associated parameters. DISCUSSION: Ranibizumab and dexamethasone implant are the first-line treatments for visual impairment due to ME secondary to RVO. The choice of either of these drugs may take into account various ocular and extraocular parameters. A change of treatment to one or the other or to laser may also be considered during follow-up.
Asunto(s)
Edema Macular/etiología , Edema Macular/terapia , Oclusión de la Vena Retiniana/complicaciones , Oclusión de la Vena Retiniana/terapia , Consenso , Dexametasona/administración & dosificación , Implantes de Medicamentos , Humanos , Inyecciones Intravítreas , Ranibizumab/administración & dosificación , Resultado del TratamientoRESUMEN
PURPOSE: Prospective evaluation of aqueous flare following intravitreal bevacizumab (Avastin, Genentech Inc., San Francisco, CA, USA) injections in eyes with choroidal neovascularization due to age-related macular degeneration. PATIENTS AND METHODS: Sixteen eyes of eight patients were recruited. Aqueous humor flare was determined by laser flare meter every month after one intravitreal injection of 1.25mg of bevacizumab at baseline followed by a second injection at month3 (day 100±21days). Four patients received an injection at month6 (±10days), and one patient received an injection at month7. RESULTS: Two months after the first intravitreal bevacizumab injection, flare values decreased from 10±5.57 (mean±standard deviation) to 5.2±1.69photon count/ms (P=0.0207) and from 8.3±3.59 to 5.4±0photon counts/ms, 2months after the second injection (P=0.02). CONCLUSION: Significantly decreased aqueous humor flare levels were noted after repeated injections of bevacizumab.
Asunto(s)
Anticuerpos Monoclonales Humanizados/administración & dosificación , Humor Acuoso/efectos de los fármacos , Neovascularización Coroidal/tratamiento farmacológico , Degeneración Macular/tratamiento farmacológico , Neovascularización Retiniana/tratamiento farmacológico , Anciano , Anciano de 80 o más Años , Bevacizumab , Neovascularización Coroidal/complicaciones , Femenino , Humanos , Inyecciones Intravítreas , Degeneración Macular/complicaciones , Masculino , Proyectos Piloto , Neovascularización Retiniana/complicaciones , Agudeza Visual/efectos de los fármacosRESUMEN
Many drugs are presently tested in the different types of age-related macular degeneration (AMD), i.e. geographic atrophy or exudative AMD. In atrophic AMD, drugs attempt to spare the photoreceptors and the retinal pigment epithelium to prevent the oxidative damages or to suppress the inflammation process. In exudative AMD, some drugs try to challenge the available anti-VEGF drugs but others try to improve the visual prognosis in targeting other mechanisms or cells involved in angiogenesis, such as pericytes. The present article aims to summarize the available data, given in scientific meetings or given by the companies.
Asunto(s)
Degeneración Macular/terapia , Predicción , HumanosRESUMEN
Recent observations have found that premacular hemorrhage in Valsalva retinopathy is located under the internal limiting membrane. We confirm these findings in two case reports of Valsalva retinopathy. Visual acuity rehabilitation was obtained in the first case by conservative treatment and by draining the hemorrhage into the vitreous with Neodymium (Nd):Yag laser in the second case. We report the current therapeutic guidelines for Valsalva retinopathy, including the systematic search of autosomal dominant syndrome of retinal arterial tortuosity, a rare condition, often discovered after this type of benign macular hemorrhage.
Asunto(s)
Hemorragia Retiniana/diagnóstico , Tomografía de Coherencia Óptica , Adulto , Femenino , Humanos , Persona de Mediana Edad , Reproducibilidad de los ResultadosRESUMEN
AIM: To report four cases of central retinal vein occlusion (CRVO) in a French family. PATIENTS AND METHODS: Ophthalmological examination and medical work-up of seven members of the family. RESULTS: There were four cases of CRVO in two consecutive generations. Three of them had CRVO in both eyes. Arterial hypertension was present in two, associated to glaucoma in one. Medical work-up did not reveal additional risk factors. CONCLUSIONS: We report a case of familial clustering of CRVO. Our cases combined to other cases reported in the literature provide arguments for the existence in some subjects of a genetic predisposition of CRVO. Additional case series are however needed to confirm this hypothesis.
Asunto(s)
Oclusión de la Vena Retiniana/genética , Adulto , Anciano , Femenino , Predisposición Genética a la Enfermedad , Humanos , Masculino , Persona de Mediana Edad , LinajeRESUMEN
INTRODUCTION: To evaluate the tolerance and efficacy of heavy silicone oil as internal tamponade for retinal detachment surgery. PATIENTS AND METHODS: Sixty-six eyes requiring heavy silicone oil for retinal detachment, with at least 1 month follow-up, were retrospectively studied. Preoperative status, surgical technique, tolerance, and anatomical and functional results were analyzed from the patient's file. Indications for heavy silicone injection were inferior retinotomy or inferior retraction in 65% of cases. PVR grade C was present in at least 63% of cases. Retinotomy was performed in 45% of cases. An exchange procedure was performed versus DKline in 65% of cases. Mean follow-up was 7 +/- 4 months. RESULTS: At the end of follow-up, 59% of eyes had a completely reattached retina, 32% without internal tamponade. Another surgery was necessary in 54% of cases. During follow-up, mean intraocular pressure was normal, and there was a significant intraocular inflammation in three cases (4.5%). In seven cases of the 44 ablations of heavy silicone oil, an adherence of residual bubbles was present. Redetachment occurred after ablation for anatomical success in 41% of cases. BCVA was better than 0.05 (20/400) in 54% of cases at the end of follow-up. CONCLUSION: Heavy silicone was well tolerated and seems not to be pro-inflammatory in our study. It is a good alternative to standard silicone for inferior retinotomy and inferior breaks without PVR. It is not a treatment of inferior retraction, and is not a long-term internal tamponade. During the ablation of heavy silicone oil, adherence of residual bubbles is possible, in which case a coaxial light or an endoillumination could be needed during ablation.
Asunto(s)
Desprendimiento de Retina/cirugía , Aceites de Silicona , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
Peripheral retinal neovascularization occurs in approximately 10% of cases of sarcoidosis. Its pathogenesis is unknown, but it probably results from retinal ischemia and/or inflammation. In cases of peripheral retinal neovascularization associated with sarcoidosis, sickle cell disease should be considered, even if sarcoidosis is histologically proved: new vessels seen in sickle cell disease and sarcoidosis may have a very similar pattern. We present two cases with histologically proven sarcoidosis who developed peripheral neovascularization: the first one had no associated disease and new vessels were likely to be related to sarcoidosis; in the second case, hemoglobin electrophoresis revealed hemoglobin SC, and provided diagnosis of sickle cell hemoglobinopathy.