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Neurol Res ; : 1-10, 2020 Sep 11.
Artículo en Inglés | MEDLINE | ID: mdl-32915708


OBJECTIVES: To evaluate the use of peripapillary microperimetry in the diagnosis and follow-up of medically and surgically treated cases of papilledema due to idiopathic intracranial hypertension (IIH). METHODS: This study was a prospective non-comparative observational case series of patients with IIH. All patients underwent full ophthalmological examination, radiological imaging, and lumbar puncture, as well as microperimetric measurements around the optic nerve head. Patients were classified into a medical group, treated by weight reduction and acetazolamide, and a surgical group, treated by optic nerve sheath fenestration. Peripapillary microperimetric examinations were done at presentation and after one-month of treatment. Findings were compared to values obtained from an age-matched healthy control group. RESULTS: The study included 78 eyes of 39 patients diagnosed with IIH and 32 eyes of 16 healthy control subjects. The average of the sum of the 12 peripapillary microperimetric thresholds for both eyes of IIH cases before treatment was 53.4±59.9 dB, while for controls it was 171±14.0 dB (p<0.001). After 1 month of treatment, it improved to 86.7±56.1 dB (p<0.001) in IIH cases. Analyzed separately, the medical group improved from 68.9±43.4 dB to 105.2±76.5 dB (p<0.001), while the surgical group improved from 13.5±21.9 dB to 54.9±35.5 dB (p<0.001). Several potential roles for peripapillary microperimetry use in IIH management were identified including confirming papilledema diagnosis, follow up of treatment, and selection of cases for surgery. CONCLUSION: Microperimetry can accurately and quantitatively monitor changes in peripapillary retinal sensitivity in patients undergoing treatment for papilledema due to IIH.

Can J Ophthalmol ; 53(6): 560-567, 2018 12.
Artículo en Inglés | MEDLINE | ID: mdl-30502978


OBJECTIVE: We compare the predictability, safety, and efficacy of posterior chamber phakic intraocular lens (PCpIOL) versus small-incision lenticule extraction (SMILE) for correcting myopic anisometropia in amblyopic children. METHODS: A prospective randomized study enrolled 30 children, aged 4-12 years, with unilateral myopic anisometropic amblyopia whose refraction ranged between -5 and -10 diopters (D) and myopic astigmatic error -1 to -6 D. Patients were subdivided into group A for unilateral PCpIOL implantation and implantable collamer lens (Visian ICL/TICL) of V4C design and group B for SMILE procedure. Pre- and postoperative corrected distance visual acuity (CDVA), uncorrected visual acuity, and cycloplegic refractive spherical equivalent (CRSE) were performed in all patients and compared between both groups. Follow-up was for at least 18 months. RESULTS: Of the 15 children in group A, 12 (80%) revealed prevention of amblyopia and improvement in CDVA of 3-6 lines, and 3 children (20%) gained 1-3 lines. In group B, 6 (40%) eyes gained 3-5 lines, 6 (40%) eyes gained 1-3 lines, and 3 (20%) children gained 0-1 line. Stereoacuity improved in 93.33% of cases. Mean CRSE decreased in both groups 18 months postoperative (p < 0.001). Improvement in stereoacuity occurred in 86.66% of cases. CONCLUSIONS: To eliminate significant anisometropic myopia in children who are noncompliant with conventional treatment, PCpIOL or SMILE may be considered as alternative modalities of treatment. Being an extraocular procedure, SMILE was found to be a safer procedure with fewer and less serious complications compared to ICL.

Ambliopía/cirugía , Anisometropía/cirugía , Implantación de Lentes Intraoculares/métodos , Miopía/cirugía , Lentes Intraoculares Fáquicas , Refracción Ocular/fisiología , Agudeza Visual , Ambliopía/complicaciones , Ambliopía/fisiopatología , Anisometropía/complicaciones , Anisometropía/fisiopatología , Niño , Preescolar , Córnea/cirugía , Femenino , Estudios de Seguimiento , Humanos , Masculino , Miopía/complicaciones , Miopía/fisiopatología , Estudios Prospectivos , Diseño de Prótesis , Resultado del Tratamiento
Neurol Res ; 40(9): 728-735, 2018 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-29799769


BACKGROUND: Early diagnosis and proper monitoring of intracranial pressure (ICP) in idiopathic intracranial hypertension (IIH) could reduce morbidity. OBJECTIVES: The objective was to explore and monitor reflection of raised ICP in IIH on optic nerve sheath diameter (ONSD), papillary height and ophthalmic vessels hemodynamics, using transorbital sonography (TOS). METHODS: The study included 24 IIH patients and 30 controls. Patients were compared to controls (phase I) then reassessed twice; 1 week and 4 weeks later (phase II). Both groups underwent clinical evaluation and TOS to measure ONSD, papillary elevation, and color Doppler indices of the ophthalmic vessels. Patients underwent lumbar puncture (LP) to measure cerebrospinal fluid (CSF) pressure. RESULTS: ONSD was significantly higher in patients compared to controls (p < 0.001). The cut-off value was 6.2 mm. Papillary elevation (p = 0.006) and ONSD (p = 0.006) were significantly reduced 4 weeks following LP. Baseline color Doppler indices of the ophthalmic vessels were comparable between both groups and the changes observed during the follow-up visits in the patients were insignificant. CONCLUSION: Reflected ICP changes on ONSD and papilla, measured by TOS, could be a valuable noninvasive additional tool to diagnose and monitor IIH patients. IIH insignificantly influences ophthalmic vessels hemodynamics. Abbreviation BMI: Body mass index. CSF: Cerebrospinal fluid. EDV: End diastolic velocity. ICP: Intracranial pressure. IH:intracranial hypertension. IIH: Idiopathic intracranial hypertension. LP: Lumbar puncture. MI: Mechanical index. MRI: Magnetic resonance imaging. MRV: Magnetic resonance venography. OA: Ophthalmic artery OND: Optic nerve diameter. ONSD: Optic nerve sheath diameter. OV: Ophthalmic vein. PIs: Pulsatility indices. PSV: Peak systolic velocity. ROC: Receiver operator characteristic. TOS: Trans-orbital sonography.

Ojo/irrigación sanguínea , Ojo/diagnóstico por imagen , Hipertensión Intracraneal/diagnóstico por imagen , Nervio Óptico/diagnóstico por imagen , Ultrasonografía Doppler en Color , Adulto , Estudios de Casos y Controles , Femenino , Estudios de Seguimiento , Hemodinámica , Humanos , Hipertensión Intracraneal/patología , Presión Intracraneal , Persona de Mediana Edad , Nervio Óptico/patología , Tamaño de los Órganos , Estudios Prospectivos , Punción Espinal , Adulto Joven
J Ophthalmol ; 2017: 1923161, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-29464114


Purpose: To evaluate corneal transparency following accelerated collagen cross-linking (ACXL) in pediatric keratoconus. Design: A prospective interventional case series. Methods: This study included 47 eyes (25 patients), aged 9-14 years, with documented progressive keratoconus. After applying 0.1% riboflavin drops, ACXL was performed. Assessment included corrected distance visual acuity (CDVA), uncorrected visual acuity (UCVA), corneal haze, and corneal densitometry in grayscale units (GSU). Result: The mean baseline and corneal densitometry peaked at 3 months post-ACXL while central and posterior densitometry showed a statistically significant increase (P < 0.05) and peaked at 8 months postoperatively. By 12 months, densitometry in all corneal layers (P ≥ 0.99) and concentric zones (P ≥ 0.97) reached near baseline values. Slit-lamp graded haze peaked at 1 month to 1.82 ± 0.65 (P < 0.05) and declined to near baseline at 12 months (0.39 ± 0.58). There was a statistically significant increase in the mean UCVA and CDVA at 12 months. Conclusion: Total and anterior corneal densitometry peaked after 3 months, while central and posterior densitometry peaked after 8 months. Maximum haze was at 1 month post-ACXL. All corneal layers, concentric zone densitometry and haze reached near baseline values after 1 year. Scheimpflug densitometry showed weak correlation with CDVA over the 12-month follow-up period (r = -0.193).