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Extracción de Catarata/efectos adversos , Complicaciones Intraoperatorias/diagnóstico , Coloración y Etiquetado , Azul de Tripano/farmacocinética , Cuerpo Vítreo/metabolismo , Anciano , Capsulorrexis/efectos adversos , Catarata/etiología , Catarata/terapia , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/cirugía , Retinopatía Diabética/cirugía , Humanos , Enfermedad Iatrogénica , Complicaciones Intraoperatorias/patología , Cristalino/diagnóstico por imagen , Cristalino/metabolismo , Masculino , Cuerpo Vítreo/diagnóstico por imagenRESUMEN
PURPOSE: To analyse the clinical ocular characteristics and determine prognostic factors for functional recovery in eyes presenting with no light perception (NLP) after open globe ocular trauma. MATERIALS AND METHODS: In this retrospective study were included all the patients with no light perception after open globe trauma who presented to Amiens University Hospital between October 2014 and June 2018. RESULTS: Fifteen eyes of 15 patients were included in this study. The main mechanism of the trauma was globe rupture (80 %, n=12). The most common location was zone III (66 %, n=10). The wound size was greater than 10mm in 9 patients (60 %). The ocular lesions included expulsion of the crystalline lens or posterior chamber intraocular lens, hyphema, retinal detachment, vitreous hemorrhage and ciliochoroidal lesions. Damage to the ciliary body was a negative prognostic factor for functional recovery (P=0.04). Nine patients remained with no light perception, whereas 6 patients experienced an improvement in visual acuity (2.3 logMAR in 3 patients, 0.7 logMAR in 1 patient, 0.4 logMAR in 1 patient and 0.2 logMAR in 1 patient). These 6 patients had undergone posterior vitrectomy due to vitreoretinal involvement (P<0.001). CONCLUSION: In the case of open globe trauma with no light perception on presentation, a functional recovery is possible if there is no irreversible anatomical damage.
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Ceguera/diagnóstico , Lesiones Oculares Penetrantes/diagnóstico , Percepción Visual/fisiología , Adulto , Anciano , Anciano de 80 o más Años , Ceguera/etiología , Ceguera/rehabilitación , Ceguera/cirugía , Lesiones Oculares Penetrantes/complicaciones , Lesiones Oculares Penetrantes/cirugía , Femenino , Humanos , Luz , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Resultado del Tratamiento , Agudeza Visual/fisiología , Vitrectomía , Hemorragia Vítrea/diagnóstico , Hemorragia Vítrea/etiología , Hemorragia Vítrea/cirugíaAsunto(s)
Coroiditis/diagnóstico , Enfermedades de la Retina/diagnóstico , Epitelio Pigmentado de la Retina/patología , Líquido Subretiniano , Enfermedad Aguda , Adulto , Coroiditis/tratamiento farmacológico , Coroiditis/patología , Angiografía con Fluoresceína , Humanos , Masculino , Coroiditis Multifocal , Prednisolona/uso terapéutico , Desprendimiento de Retina/diagnóstico , Desprendimiento de Retina/tratamiento farmacológico , Desprendimiento de Retina/etiología , Desprendimiento de Retina/patología , Enfermedades de la Retina/tratamiento farmacológico , Enfermedades de la Retina/patología , Epitelio Pigmentado de la Retina/diagnóstico por imagen , Epitelio Pigmentado de la Retina/efectos de los fármacos , Tomografía de Coherencia ÓpticaAsunto(s)
Adenocarcinoma/patología , Neoplasias del Iris/secundario , Neoplasias de la Próstata/patología , Adenocarcinoma/diagnóstico , Adenocarcinoma/terapia , Corticoesteroides/administración & dosificación , Anciano de 80 o más Años , Antihipertensivos/administración & dosificación , Terapia Combinada , Fraccionamiento de la Dosis de Radiación , Humanos , Neoplasias del Iris/diagnóstico , Neoplasias del Iris/terapia , Masculino , Neoplasias de la Próstata/diagnóstico , Neoplasias de la Próstata/terapia , Radioterapia ConformacionalRESUMEN
INTRODUCTION: In the absence of sufficient capsular support, scleral fixation of the intraocular lens is an interesting alternative. The goal is to evaluate this implantation technique when traditional implantation is impossible. PATIENTS AND METHODS: This is an observational, retrospective, monocentric study at the Amiens university medical center between August 2013 and March 2016. Patients all underwent scleral fixation of a three-piece implant without suturing of the haptics, after posterior vitrectomy. All patients requiring implantation in the absence of stable capsular support were included. Patients with adequate iris or capsular support were excluded from our study. RESULTS: Eighteen patients were included, with an average age of 69.3±16.9 years. The surgical indications were: complicated surgery, trauma and endothelial decompensation. The preoperative mean corrected visual acuity was 1.2±0.4 LogMAR while the postoperative acuity was 0.7±0.5 LogMAR. The mean postoperative corneal astigmatism was 1.9±1.9 diopters. The main complications observed were ocular hypertension, macular edema, retinal detachment, iris incarceration and exteriorization of the haptic. DISCUSSION: There are two alternatives when faced with lack of a sufficient capsular support: scleral fixation or iris fixation. Our technique is the only one achievable in the presence of iris atrophy. Furthermore, it induces less astigmatism and enables the repositioning of a three-piece implant dislocated into the vitreous. CONCLUSION: Scleral fixation is a technique allowing both a satisfactory and a lasting functional result and is to be considered when faced with a lack of sufficient capsular support.
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Migracion de Implante de Lente Artificial/prevención & control , Cápsula del Cristalino/cirugía , Implantación de Lentes Intraoculares/métodos , Lentes Intraoculares , Esclerótica/cirugía , Anciano , Anciano de 80 o más Años , Afaquia Poscatarata/cirugía , Femenino , Humanos , Iris/cirugía , Lentes Intraoculares/efectos adversos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Técnicas de Sutura , Resultado del Tratamiento , Agudeza Visual , Vitrectomía/métodosAsunto(s)
Enfermedades de la Córnea/diagnóstico , Enfermedades del Prematuro/diagnóstico , Queratitis/diagnóstico , Enfermedades de la Córnea/complicaciones , Enfermedades de la Córnea/congénito , Esotropía/complicaciones , Esotropía/congénito , Esotropía/diagnóstico , Femenino , Humanos , Recién Nacido , Enfermedades del Prematuro/patología , Queratitis/complicaciones , Queratitis/congénito , Retinitis Pigmentosa/complicaciones , Retinitis Pigmentosa/congénito , Retinitis Pigmentosa/diagnóstico , Trastornos de la Visión/congénito , Trastornos de la Visión/diagnóstico , Trastornos de la Visión/etiologíaAsunto(s)
Lentes Intraoculares , Falla de Prótesis , Adulto , Humanos , Masculino , Factores de TiempoRESUMEN
INTRODUCTION: Congenital Brown syndrome and Stilling-Duane syndrome, two rare causes of strabismus are caused by fibrosis of one or more extraocular muscles. This series aims to report the clinical sensory and motor features of patients with Brown or Stilling-Duane syndrome. METHODS: Seventeen patients' records were retrospectively assessed for: the ocular deviation in primary position and in the 9 positions of gaze, head tilt, visual acuity and binocular vision. RESULTS: Eleven patients with Stilling-Duane syndrome had a mean age of 12 years, and monocular involvement, most frequently of type I. The ocular deviation was variable; 16 patients had an abnormal head position, while 50 % presented with amblyopia, and only 37 % achieved fusion in the compensatory head posture. Six patients presented with congenital Brown syndrome at mean age of 6 years. Three had a moderate form, 3 had a severe form with vertical deviation in primary position, compensatory head position, amblyopia and binocular vision impairment. DISCUSSION: The motility impairments depend highly on the identified syndrome, its classification and its severity. Therefore, these two retraction syndromes present some common features. Strabismus in primary position may lead to amblyopia and binocular vision impairment. CONCLUSION: Clinical motility and sensory assessment is essential, though difficult, to establish the diagnosis and the management of patients with retraction syndromes.
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Síndrome de Retracción de Duane/diagnóstico , Trastornos de la Motilidad Ocular/diagnóstico , Adolescente , Adulto , Niño , Preescolar , Diagnóstico Diferencial , Síndrome de Retracción de Duane/fisiopatología , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Trastornos de la Motilidad Ocular/clasificación , Trastornos de la Motilidad Ocular/fisiopatología , Músculos Oculomotores/fisiología , Estudios Retrospectivos , Agudeza Visual/fisiología , Adulto JovenRESUMEN
Retinopathy of prematurity is a retinal vasoproliferative disease affecting extremely preterm infants exposed to high concentrations of oxygen therapy. Infants born before 32 post-menstrual weeks or with a birth weight of less than 1500g should systematically have a dilated fundus examination. The time of screening and schedule for follow-up are guided by the various risk factors. This disease results from immaturity of the peripheral retinal vessels at the time of premature birth. The classification of ROP depends on the anteroposterior extent of involvement (from center to periphery: zone I, II and III), its extension in 30° sectors (clock hours) and its stage (stage 1 to 5). "Plus" disease is defined as dilation and tortuosity of the retinal blood vessels in the posterior pole of the eye and represents a major risk factor for rapid unfavorable progression. A majority of patients will spontaneously recover, but patients with a high risk of progression will require treatment to prevent retinal detachment and blindness. The indications for treatment are threshold disease and type 1 pre-threshold disease. The current treatment of choice is peripheral retinal ablation with transpupillary laser, but ab externo cryotherapy may be used instead. Intravitreal injection of vascular endothelial growth factor inhibitors may be an attractive therapeutic option and is currently under investigation. After laser treatment, unfavorable outcomes occur in only 9 to 14 % of eyes, but at the price of peripheral retinal destruction. For all patients, whether treated or not, a regular fundus examination should be insured until complete retinal vascularization has occurred.
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Retinopatía de la Prematuridad , Humanos , Recién Nacido , Enfermedades del Recién Nacido/diagnóstico , Enfermedades del Recién Nacido/epidemiología , Enfermedades del Recién Nacido/terapia , Enfermedades del Prematuro/diagnóstico , Enfermedades del Prematuro/epidemiología , Enfermedades del Prematuro/terapia , Tamizaje Neonatal/métodos , Pronóstico , Retinopatía de la Prematuridad/diagnóstico , Retinopatía de la Prematuridad/epidemiología , Retinopatía de la Prematuridad/terapiaRESUMEN
INTRODUCTION: The occurrence of a subretinal hematoma in age-related macular degeneration (AMD) is a serious complication that can impact the visual prognosis with a poor functional recovery. The management of this complication remains controversial. Several therapeutic methods have been described. We report the results of four patients treated with a protocol combining: vitrectomy, subretinal injection of r-TPA 0.025mg/0.3ml, intravitreal injection of 0.05ml of bevacizumab and retinal tamponade with 20% SF6 gas. PATIENTS AND METHODS: Our series consists of four patients with a submacular hematoma complicating AMD, included in succession between October 2013 and October 2014 and treated with the same treatment protocol and by the same surgeon. All patients underwent surgery within eight days after the onset of the macular hematoma. Patients with a consultation period longer than eight days did not undergo this treatment. Face down postoperative positioning was then carried out for seven days by the patients. RESULTS: We observed a shift in the macular hematoma in the four patients, which allowed the identification of secondary neovascularization responsible for the bleeding. The visual acuity improved in three patients from hand motion (HM) preoperatively to 2/10 at one month postoperatively. One patient maintained visual acuity 1/20 during the entire follow-up despite almost complete resorption of the subretinal hematoma. These visual acuities were stable at 6 months postoperatively. DISCUSSION: Macular subretinal hematoma can cause severe visual loss by several mechanisms. The blood accumulates between the neurosensory retina and the retinal pigment epithelium, which causes a toxic effect on the surrounding tissues, thus resulting in a loss of photoreceptors and cellular destruction in the pigment epithelium and choriocapillaris, evolving into a fibroglial scar. CONCLUSION: The therapeutic evaluation of this protocol in our series of four patients gives a favorable result. We observed an improvement in visual acuity in 3/4 of cases. This surgical technique appears to be effective in the treatment of this complication of AMD. However, a study on a larger scale is needed to confirm these results.
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Bevacizumab/administración & dosificación , Hematoma/terapia , Degeneración Macular/terapia , Hemorragia Retiniana/terapia , Hexafluoruro de Azufre/administración & dosificación , Activador de Tejido Plasminógeno/administración & dosificación , Vitrectomía/métodos , Anciano , Anciano de 80 o más Años , Femenino , Hematoma/complicaciones , Humanos , Inyecciones Intravítreas , Degeneración Macular/complicaciones , Masculino , Proteínas Recombinantes/administración & dosificación , Hemorragia Retiniana/complicacionesAsunto(s)
Anomalías del Ojo/complicaciones , Glaucoma/congénito , Glaucoma/diagnóstico , Glaucoma/etiología , Disco Óptico/anomalías , Coloboma/complicaciones , Coloboma/diagnóstico , Diagnóstico Diferencial , Anomalías del Ojo/diagnóstico , Humanos , Lactante , Masculino , Disco Óptico/diagnóstico por imagen , Nervio Óptico/anomalíasAsunto(s)
Presión de las Vías Aéreas Positiva Contínua/efectos adversos , Enfermedades de la Córnea/cirugía , Endoftalmitis/etiología , Complicaciones Posoperatorias/etiología , Síndromes de la Apnea del Sueño/terapia , Anciano , Enfermedades de la Córnea/complicaciones , Trasplante de Córnea , Infección Hospitalaria , Contaminación de Equipos , Enucleación del Ojo , Humanos , Masculino , Síndromes de la Apnea del Sueño/complicacionesAsunto(s)
Dexametasona/administración & dosificación , Implantes de Medicamentos/administración & dosificación , Inyecciones Intravítreas , Cristalino , Errores Médicos/prevención & control , Catarata/etiología , Catarata/prevención & control , Contraindicaciones , Dexametasona/efectos adversos , Lesiones Oculares Penetrantes/patología , Lesiones Oculares Penetrantes/prevención & control , Humanos , Inyecciones Intravítreas/efectos adversos , Inyecciones Intravítreas/métodos , Cristalino/efectos de los fármacos , Cristalino/patología , Lesiones por Pinchazo de Aguja/prevención & control , Complicaciones Posoperatorias/prevención & control , Pautas de la Práctica en MedicinaAsunto(s)
Síndrome Antifosfolípido/complicaciones , Síndrome Antifosfolípido/etiología , Coroides/irrigación sanguínea , Lupus Eritematoso Sistémico/complicaciones , Vasos Retinianos , Enfermedades Vasculares/etiología , Enfermedad Catastrófica , Femenino , Humanos , Índice de Severidad de la Enfermedad , Adulto JovenRESUMEN
INTRODUCTION: Since the results of the ESCRS study in 2007 and then the AFSSAPS recommendations of 2011, postoperative endophthalmitis prophylaxis in cataract surgery has evolved toward intracameral cefuroxime. Penicillin allergy is frequent and is not considered as a contra-indication to cefuroxime injection, but cross-reactions do exist. The goal of this study was to assess the tolerability of intracameral cefuroxime in patients with a penicillin allergy. MATERIALS AND METHODS: In this monocentric open prospective study, adult patients undergoing cataract surgery and declaring themselves penicillin-allergic were included. A subcutaneous test of cefuroxime was performed preoperatively. If negative, patients received the intracameral injection of cefuroxime at the conclusion of the surgical procedure. The primary assessment criteria, evaluated on the day after the surgery, was the occurrence of allergic reactions. RESULTS: Forty-eight eyes of 40 patients, 72 ± 8 years old, were included. Forty-three skin tests were performed: 1 was positive and one was unreliable. Thirty-six patients were examined in our center the day after the surgery: 2 presented a conjunctival allergic reaction. No severe anaphylactic reaction was reported. DISCUSSION: Of our patients, 95.3% declaring a penicillin allergy had a negative pre-operative cefuroxime test. According to literature, 80 to 90% of presumed penicillin allergic patients would not actually be allergic to cefuroxime. In our population, we reported 2 benign conjunctival cross-reactions. CONCLUSION: Intracameral cefuroxime injection during cataract surgery seems well-tolerated in penicillin-allergic patients with a negative preoperative skin test.
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Antibacterianos/administración & dosificación , Profilaxis Antibiótica , Extracción de Catarata , Cefuroxima/administración & dosificación , Cuidados Intraoperatorios/métodos , Anciano , Antibacterianos/efectos adversos , Cefuroxima/efectos adversos , Hipersensibilidad a las Drogas/etiología , Femenino , Humanos , Inyecciones Intraoculares , Masculino , Penicilinas/efectos adversos , Estudios ProspectivosRESUMEN
Posterior capsule opacification (PCO) is the most common complication after cataract surgery, with an incidence of 30%. It tends to be considered a normal event in the natural history of cataract surgery. Better understanding of its pathophysiology and advancement of intraocular lens material and design along with the improvement of phacoemulsification technique have contributed to decrease the incidence of PCO. Although treatment by Nd: YAG laser posterior capsulotomy is quick and non-invasive, the opening of the posterior capsule may be associated with numerous complications. Prevention remains the best measure for controlling this pathology.