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1.
Arch. Soc. Esp. Oftalmol ; 95(12): 611-614, dic. 2020. ilus
Artículo en Español | IBECS | ID: ibc-197761

RESUMEN

CASO CLÍNICO: Presentamos tres casos de pacientes con hiperquilomicronemia familiar y lipemia retinalis, y analizamos de forma comparada las características fundoscópicas de cada uno de ellos. DISCUSIÓN: El aspecto característico del fondo retiniano en color salmón-pálido corresponde con grados severos de lipemia retinalis. Los hallazgos relativos a la tonalidad del árbol vascular en segmentos distales constituyen probablemente el dato exploratorio que mejor orienta el diagnóstico oftalmológico en niveles inferiores de hipertrigliceridemia


CASES REPORT: Three cases are presented of patients with familial hyperchylomicronaemia and lipaemia retinalis, in whom an analysis is made of the fundoscopic characteristics of each of them. DISCUSSION: The typical appearance of the retinal fundus is pale salmon coloured and corresponds to levels of severe lipaemia retinalis. As regards the findings, the vascular tree tonality is probably the best exploratory evidence to help in the ophthalmological diagnosis


Asunto(s)
Humanos , Femenino , Adulto Joven , Adulto , Persona de Mediana Edad , Hiperlipoproteinemia Tipo I/diagnóstico por imagen , Oftalmoscopía/métodos , Hiperlipidemias/diagnóstico por imagen , Enfermedades de la Retina/diagnóstico por imagen , Hiperlipoproteinemia Tipo I/patología , Hiperlipidemias/patología , Enfermedades de la Retina/patología , Fondo de Ojo
2.
Arch. Soc. Esp. Oftalmol ; 95(11): 555-558, nov. 2020. ilus
Artículo en Español | IBECS | ID: ibc-197747

RESUMEN

El pseudoxantoma elástico (PXE) es una enfermedad hereditaria rara, que cursa con alteraciones del tejido conectivo, debido a una alteración en el cromosoma 16p del gen ABCC6. Desde una perspectiva clínica, da lugar a manifestaciones predominantemente cutáneas, cardiacas y oftalmológicas. La asociación de β-talasemia y cuadros clínicos compatibles con PXE (síndromes PXE-like) ha sido descrita en la literatura en pacientes con β-talasemia mayor e intermedia, que es indistinguible clínicamente del PXE clásico. Presentamos el caso de un niño de 10 años con beta-talasemia minor y lesiones características de PXE. Cabe destacar el beneficio de la imagen multimodal para el diagnóstico y seguimiento de las lesiones


Pseudoxanthoma elasticum (PXE) is a rare genetic disorder characterised by elastic tissue alterations and caused by mutations in a single gene, ABCC6, on chromosome 16p that includes manifestations that are predominantly cutaneous, ocular and cardiovascular. PXE-like lesions in association with β-thalassemia have previously been reported in the literature in patients with Beta-thalassaemia intermediate and major, being clinically indistinguishable from classic PXE. The case is presented of a 10-year-old boy with β-thalassaemia minor and characteristic lesions of PXE. It is worth noting the benefit of multimodal imaging in the diagnosis and monitoring of the lesions


Asunto(s)
Humanos , Masculino , Niño , Seudoxantoma Elástico/patología , Talasemia beta/patología , Seudoxantoma Elástico/diagnóstico por imagen , Talasemia beta/diagnóstico por imagen , Tomografía de Coherencia Óptica/métodos , Oftalmoscopía/métodos , Imagen Multimodal
5.
Diabetes Res Clin Pract ; 167: 108361, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-32745697

RESUMEN

The most common microvascular complication of diabetes is diabetic retinopathy, the leading cause of blindness in adults of working age. Our understanding of the vascular changes in diabetic retinopathy was enhanced by the demonstration of fluorescein angiography (FA) in the human retina for the first time in 1961. It was subsequently integrated with digital fundoscopic imaging to become an invaluable technique in evaluation of the retinal vasculature. The recent development of OCT-angiography (OCT-A) has revolutionized the clinician's ability to examine the retinal vasculature without the need for injection of a contrast dye. By coupling OCT, which can provide noninvasive cross-sectional imaging of the central retina, with angiography in OCT-A, one can reveal retinal perfusion by allowing visualization of the depth-resolved retinal capillary plexus. OCT-A has allowed for more precise delineation of changes in the retinal microvasculature, specifically the alterations of retinal vasculature and loss of capillary perfusion from chronic microvascular occlusion in diabetic retinopathy.


Asunto(s)
Angiografía/métodos , Retinopatía Diabética/diagnóstico por imagen , Retinopatía Diabética/terapia , Tomografía de Coherencia Óptica/métodos , Adulto , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/patología , Retinopatía Diabética/patología , Angiografía con Fluoresceína/métodos , Humanos , Microvasos/diagnóstico por imagen , Persona de Mediana Edad , Oftalmoscopía/métodos , Retina/diagnóstico por imagen , Vasos Retinianos/diagnóstico por imagen
7.
J Vis ; 20(6): 10, 2020 06 03.
Artículo en Inglés | MEDLINE | ID: mdl-32543650

RESUMEN

The human fovea lies at the center of the retina and supports high-acuity vision. In normal visual system development, the highest acuity is correlated with both a high density of cone photoreceptors in the fovea and a magnified retinotopic representation of the fovea in the visual cortex. Both cone density and the cortical area dedicated to each degree of visual space-the latter describing cortical magnification (CM)-steadily decrease with increasing eccentricity from the fovea. In albinism, peak cone density at the fovea and visual acuity are decreased, but seem to be within normal limits in the periphery, thus providing a model to explore the correlation between retinal structure, cortical structure, and behavior. Here, we used adaptive optics scanning light ophthalmoscopy to assess retinal cone density and functional magnetic resonance imaging to measure CM in the primary visual cortex of normal controls and individuals with albinism. We find that retinotopic organization is more varied among individuals with albinism than previously appreciated. Additionally, CM outside the fovea is similar to that in controls, but also more variable. CM in albinism and controls exceeds that which might be predicted based on cone density alone, but is more accurately predicted by retinal ganglion cell density. This finding suggests that decreased foveal cone density in albinism may be partially counteracted by nonuniform connectivity between cones and their downstream signaling partners. Together, these results emphasize that central as well as retinal factors must be included to provide a complete picture of aberrant structure and function in albinism.


Asunto(s)
Albinismo/fisiopatología , Células Fotorreceptoras Retinianas Conos/fisiología , Corteza Visual/fisiología , Adolescente , Adulto , Recuento de Células , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Oftalmoscopía/métodos , Óptica y Fotónica , Retina/fisiología , Células Fotorreceptoras Retinianas Conos/citología , Células Ganglionares de la Retina/fisiología , Agudeza Visual/fisiología , Adulto Joven
9.
Sci Rep ; 10(1): 7819, 2020 05 08.
Artículo en Inglés | MEDLINE | ID: mdl-32385371

RESUMEN

In this work we evaluated a postprocessing, customized automatic retinal OCT B-scan enhancement software for noise reduction, contrast enhancement and improved depth quality applicable to Heidelberg Engineering Spectralis OCT devices. A trained deep neural network was used to process images from an OCT dataset with ground truth biomarker gradings. Performance was assessed by the evaluation of two expert graders who evaluated image quality for B-scan with a clear preference for enhanced over original images. Objective measures such as SNR and noise estimation showed a significant improvement in quality. Presence grading of seven biomarkers IRF, SRF, ERM, Drusen, RPD, GA and iRORA resulted in similar intergrader agreement. Intergrader agreement was also compared with improvement in IRF and RPD, and disagreement in high variance biomarkers such as GA and iRORA.


Asunto(s)
Angiografía con Fluoresceína/métodos , Oftalmoscopía/métodos , Retina/diagnóstico por imagen , Tomografía de Coherencia Óptica/métodos , Algoritmos , Humanos , Redes Neurales de la Computación , Prueba de Estudio Conceptual , Retina/fisiopatología , Programas Informáticos
10.
Invest Ophthalmol Vis Sci ; 61(4): 42, 2020 04 09.
Artículo en Inglés | MEDLINE | ID: mdl-32343782

RESUMEN

Purpose: To study cone structure and function in patients with retinitis pigmentosa (RP) owing to mutations in rhodopsin (RHO), expressed in rod outer segments, and mutations in the RP-GTPase regulator (RPGR) gene, expressed in the connecting cilium of rods and cones. Methods: Four eyes of 4 patients with RHO mutations, 5 eyes of 5 patients with RPGR mutations, and 4 eyes of 4 normal subjects were studied. Cone structure was studied with confocal and split-detector adaptive optics scanning laser ophthalmoscopy (AOSLO) and spectral-domain optical coherence tomography. Retinal function was measured using a 543-nm AOSLO-mediated adaptive optics microperimetry (AOMP) stimulus. The ratio of sensitivity to cone density was compared between groups using the Wilcoxon rank-sum test. Results: AOMP sensitivity/cone density in patients with RPGR mutations was significantly lower than normal (P < 0.001) and lower than patients with RHO mutations (P < 0.015), whereas patients with RHO mutations were similar to normal (P > 0.9). Conclusions: Retinal sensitivity/cone density was lower in patients with RPGR mutations than normal and lower than patients with RHO mutations, perhaps because cones express RPGR and degenerate primarily, whereas cones in eyes with RHO mutations die secondary to rod degeneration. High-resolution microperimetry can reveal differences in cone degeneration in patients with different forms of RP.


Asunto(s)
Proteínas del Ojo/genética , Células Fotorreceptoras Retinianas Conos/patología , Retinitis Pigmentosa/diagnóstico por imagen , Retinitis Pigmentosa/genética , Rodopsina/genética , Tomografía de Coherencia Óptica/métodos , Adulto , Factores de Edad , Estudios de Casos y Controles , Electrorretinografía/métodos , Femenino , Regulación de la Expresión Génica , Humanos , Masculino , Mutación/genética , Oftalmoscopía/métodos , Medición de Riesgo , Polarimetría de Barrido por Laser/métodos , Factores Sexuales , Estadísticas no Paramétricas , Adulto Joven
12.
N Engl J Med ; 382(18): 1687-1695, 2020 04 30.
Artículo en Inglés | MEDLINE | ID: mdl-32286748

RESUMEN

BACKGROUND: Nonophthalmologist physicians do not confidently perform direct ophthalmoscopy. The use of artificial intelligence to detect papilledema and other optic-disk abnormalities from fundus photographs has not been well studied. METHODS: We trained, validated, and externally tested a deep-learning system to classify optic disks as being normal or having papilledema or other abnormalities from 15,846 retrospectively collected ocular fundus photographs that had been obtained with pharmacologic pupillary dilation and various digital cameras in persons from multiple ethnic populations. Of these photographs, 14,341 from 19 sites in 11 countries were used for training and validation, and 1505 photographs from 5 other sites were used for external testing. Performance at classifying the optic-disk appearance was evaluated by calculating the area under the receiver-operating-characteristic curve (AUC), sensitivity, and specificity, as compared with a reference standard of clinical diagnoses by neuro-ophthalmologists. RESULTS: The training and validation data sets from 6779 patients included 14,341 photographs: 9156 of normal disks, 2148 of disks with papilledema, and 3037 of disks with other abnormalities. The percentage classified as being normal ranged across sites from 9.8 to 100%; the percentage classified as having papilledema ranged across sites from zero to 59.5%. In the validation set, the system discriminated disks with papilledema from normal disks and disks with nonpapilledema abnormalities with an AUC of 0.99 (95% confidence interval [CI], 0.98 to 0.99) and normal from abnormal disks with an AUC of 0.99 (95% CI, 0.99 to 0.99). In the external-testing data set of 1505 photographs, the system had an AUC for the detection of papilledema of 0.96 (95% CI, 0.95 to 0.97), a sensitivity of 96.4% (95% CI, 93.9 to 98.3), and a specificity of 84.7% (95% CI, 82.3 to 87.1). CONCLUSIONS: A deep-learning system using fundus photographs with pharmacologically dilated pupils differentiated among optic disks with papilledema, normal disks, and disks with nonpapilledema abnormalities. (Funded by the Singapore National Medical Research Council and the SingHealth Duke-NUS Ophthalmology and Visual Sciences Academic Clinical Program.).


Asunto(s)
Aprendizaje Profundo , Fondo de Ojo , Redes Neurales de la Computación , Oftalmoscopía/métodos , Papiledema/diagnóstico , Fotograbar , Retina/diagnóstico por imagen , Algoritmos , Área Bajo la Curva , Conjuntos de Datos como Asunto , Diagnóstico Diferencial , Humanos , Valor Predictivo de las Pruebas , Curva ROC , Retina/patología , Estudios Retrospectivos , Sensibilidad y Especificidad
13.
Acta Diabetol ; 57(9): 1043-1047, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-32246268

RESUMEN

PURPOSE: To compare nonmydriatic montage widefield images with dilated fundus ophthalmoscopy for determining diabetic retinopathy (DR) severity. MATERIALS AND METHODS: In this prospective, observational, cross-sectional study, patients with a previous diagnosis of diabetes and without history of diabetes-associated ocular disease were screened for DR. Montage widefield imaging was obtained with a system that combines confocal technology with white-light emitting diode (LED) illumination (DRSplus, Centervue, Padua, Italy). Dilated fundus examination was performed by a retina specialist. RESULTS: Thirty-seven eyes (20 patients, 8 females) were finally included in the analysis. Mean age of the patients enrolled was 58.0 ± 11.6 years [range 31-80 years]. The level of DR identified on montage widefield images agreed exactly with indirect ophthalmoscopy in 97.3% (36) of eyes and was within 1 step in 100% (37) of eyes. Cohen's kappa coefficient (κ) was 0.96, this suggesting an almost perfect agreement between the two modalities in DR screening. Nonmydriatic montage widefield imaging acquisition time was significantly shorter than that of dilated clinical examination (p = 0.010). CONCLUSION: Nonmydriatic montage widefield images were compared favorably with dilated fundus examination in defining DR severity; however, they are acquired more rapidly.


Asunto(s)
Retinopatía Diabética/diagnóstico , Técnicas de Diagnóstico Oftalmológico , Tamizaje Masivo/métodos , Retina/diagnóstico por imagen , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Dilatación , Femenino , Fondo de Ojo , Humanos , Luz , Masculino , Microscopía Confocal/métodos , Persona de Mediana Edad , Midriáticos/farmacología , Oftalmoscopía/métodos , Reconocimiento de Normas Patrones Automatizadas/métodos , Fotograbar/métodos , Estudios Prospectivos , Retina/fisiopatología
15.
Am J Ophthalmol ; 217: 121-130, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32222370

RESUMEN

PURPOSE: The prediction of atherosclerosis using retinal fundus images and deep learning has not been shown possible. The purpose of this study was to develop a deep learning model which predicted atherosclerosis by using retinal fundus images and to verify its clinical implications by conducting a retrospective cohort analysis. DESIGN: Retrospective cohort study. METHODS: The database at the Health Promotion Center of Seoul National University Hospital (HPC-SNUH) was used. The deep learning model was trained using 15,408 images to predict carotid artery atherosclerosis, which was named the deep-learning funduscopic atherosclerosis score (DL-FAS). A retrospective cohort was constructed of participants 30-80 years old who had completed elective health examinations at HPC-SNUH. Using DL-FAS as the main exposure, participants were followed for the primary outcome of death due to CVD until Dec. 31, 2017. RESULTS: For predicting carotid artery atherosclerosis among subjects, the model achieved an area under receiver operating curve (AUROC) and area under the precision-recall curve (AUPRC), accuracy, sensitivity, specificity, positive and negative predictive values of 0.713, 0.569, 0.583, 0.891, 0.404, 0.465, and 0.865 respectively. The cohort consisted of 32,227 participants, 78 cardiovascular disease (CVD) deaths, and 7.6-year median follow-up visits. Those with DL-FAS greater than 0.66 had an increased risk of CVD deaths compared to those with DL-FAS <0.33 (hazard ratio: 8.33; 95% confidence interval [CI], 3.16-24.7). Risk association was significant among intermediate and high Framingham risk score (FRS) subgroups. The DL-FAS improved the concordance by 0.0266 (95% CI, 0.0043-0.0489) over the FRS-only model. The relative integrated discrimination index was 20.45% and net reclassification index was 29.5%. CONCLUSIONS: A deep learning model was developed which could predict atherosclerosis from retinal fundus images. The resulting DL-FAS was an independent predictor of CVD deaths when adjusted for FRS and added predictive value over FRS.


Asunto(s)
Enfermedades Cardiovasculares/mortalidad , Aprendizaje Profundo , Oftalmoscopía/métodos , Retina/patología , Medición de Riesgo/métodos , Adulto , Anciano , Anciano de 80 o más Años , Aterosclerosis/diagnóstico , Aterosclerosis/mortalidad , Enfermedades Cardiovasculares/diagnóstico , Arterias Carótidas/diagnóstico por imagen , Femenino , Estudios de Seguimiento , Fondo de Ojo , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Pronóstico , República de Corea/epidemiología , Estudios Retrospectivos , Factores de Riesgo , Tasa de Supervivencia/tendencias , Ultrasonografía/métodos
16.
Invest Ophthalmol Vis Sci ; 61(2): 40, 2020 02 07.
Artículo en Inglés | MEDLINE | ID: mdl-32097477

RESUMEN

Purpose: To determine the relationship between funduscopic findings in myopic eyes and the prevalence and structure of the conus in the optical coherence tomographic (OCT) images. Methods: A prospective observational cross-sectional study of 121 right eyes of 121 young healthy volunteers. All participants underwent color fundus photography (CFP), scanning laser ophthalmoscopy, and OCT. Based on the OCT analyses, the area between the edge of the ellipsoid zone (EZ) and that of choroid was defined as the "choroidal conus (CC)", and the area between the edge of the choroid and the scleral edge as the "scleral conus (SC)". The eyes were classified into three groups such as the non-conus (NC) group, CC group, and SC group. The differences in the axial length, optic disc tilt, ovality ratio, papillomacular position angle, and peripapillary nerve fiber elevation (pNFE) between the three groups were determined. Results: CFPs detected a conus in 79 eyes (65.3 %). The outer border of the conus in CFPs corresponded with the edge of the EZ in the OCT in all subjects. Thirty-seven eyes had CC alone (CC group) and 42 eyes had both CC and SC (SC group). The CC and SC groups had longer axial lengths and more frequent pNFEs than the NC group. There was a significant difference in the optic disc tilt and ovality ratio between the CC and SC groups. Conclusions: The eyes with SC tend to have larger optic disc tilt and smaller ovality ratio than the eyes with CC only.


Asunto(s)
Miopía/patología , Disco Óptico/patología , Esclerótica/patología , Adulto , Estudios Transversales , Humanos , Masculino , Oftalmoscopía/métodos , Estudios Prospectivos , Tomografía de Coherencia Óptica/métodos , Adulto Joven
17.
Opt Lett ; 45(4): 840-843, 2020 Feb 15.
Artículo en Inglés | MEDLINE | ID: mdl-32058484

RESUMEN

Offset aperture and split detector imaging are variants of adaptive optics scanning ophthalmoscopy recently introduced to improve the image contrast of retinal cells. Unlike conventional confocal scanning ophthalmoscopy, these approaches collect light laterally decentered from the optical axis. A complete explanation of how these methods enhance contrast has not been described. Here, we provide an optical model with supporting in vivo data that show contrast is generated from spatial variations in the refractive index as it is in phase contrast microscopy. A prediction of this model is supported by experimental data that show contrast is optimized when the detector is placed conjugate with a deeper backscattering screen such as the retinal pigment epithelium and choroid, rather than with the layer being imaged as in conventional confocal imaging. This detection strategy provides a substantial improvement in the contrast these new methods can produce.


Asunto(s)
Oftalmoscopía/métodos , Fenómenos Ópticos , Animales , Ratones , Retina/diagnóstico por imagen , Relación Señal-Ruido
18.
Adv Ther ; 37(2): 860-868, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31916031

RESUMEN

INTRODUCTION: Binocular indirect ophthalmoscopy (BIO) is fundamental for screening of retinopathy of prematurity (ROP). Digital retinal imaging devices with fluorescein angiography (FA) proved to be useful in screening and management of ROP. FA provides valuable additional information that is not detectable through ophthalmoscopy. FA images are relatively easy to interpret even by personnel without specific experience in ROP. The aim of this study is to evaluate reproducibility of FA for the screening and follow-up of ROP. METHODS: A total of 106 pairs of FA images of 30 eyes of 15 premature infants with stage II ROP were evaluated by 5 ophthalmologists: 2 experts, 2 non-experts, and 1 expert in reading FA in adult patients. Each operator gave a score to each of following parameters: leakage, ischemic areas, peripheral plus disease and vascular anomalies. The images were reviewed twice. Intra- and inter-concordance between the readers of the FA findings was evaluated by the means of Cohen's kappa coefficient (κ). RESULTS: The intra-operator concordance was very good (κ > 0.81) for all FA findings. Inter-operator concordance was good (κ > 0.41) for all operators and all FA findings. Global concordance was: substantial (intra-inter readers: κ > 0.61) for leakage, ischemic areas, and plus disease; almost perfect (κ > 0.81) for vascular anomalies; and moderate (κ = 0.41-0.60) for continuity/discontinuity of the ischemic areas. Total FA score was directly correlated to the percentage of treatment: a score ≥ 7 was correlated with 100% treatment and a score ≤ 3 with no treatment. Treatment timing was inversely correlated to FA score: a score ≥ 8 was correlated with a timely treatment (≤ 6 days), and a score ≤ 7 was correlated with a delayed treatment (< 10 days). CONCLUSION: This study showed that FA represents a reproducible imaging technique. It is useful for detecting ROP progression, and to define the treatment timing and type.


Asunto(s)
Angiografía con Fluoresceína/métodos , Angiografía con Fluoresceína/estadística & datos numéricos , Tamizaje Masivo/métodos , Tamizaje Masivo/estadística & datos numéricos , Oftalmoscopía/métodos , Oftalmoscopía/estadística & datos numéricos , Retinopatía de la Prematuridad/diagnóstico , Peso al Nacer , California/epidemiología , Femenino , Estudios de Seguimiento , Edad Gestacional , Humanos , Lactante , Recién Nacido , Recien Nacido Prematuro , Masculino , Reproducibilidad de los Resultados , Retinopatía de la Prematuridad/epidemiología
19.
Arch. Soc. Esp. Oftalmol ; 95(1): 4-8, ene. 2020.
Artículo en Español | IBECS | ID: ibc-195311

RESUMEN

OBJETIVO: Comparar los resultados de una oftalmoscopia indirecta a la determinación del reflejo rojo en recién nacidos ingresados en la unidad neonatal de cuidados intensivos intermedios. MÉTODOS: A todos los pacientes (71) ingresados en la unidad neonatal de cuidados intensivos intermedios durante el periodo de julio a setiembre de 2017 se les realizó un cribado con el reflejo rojo. Inmediatamente después las pupilas de los pacientes fueron dilatadas farmacológicamente y se realizó una oftalmoscopia indirecta. El cribado con el reflejo rojo y el examen oftalmológico con oftalmoscopia indirecta fue realizado por el mismo examinador. RESULTADOS: Un total de un 14,1% (20/142) de los ojos presentaba una alteración del reflejo rojo. La oftalmoscopia indirecta demostró que el 21,8% (31/142) de los ojos tenía anormalidades intraoculares. Dos de estos ojos tenían colobomas del nervio óptico, 2 ojos tenían cataratas y el resto tenía hemorragias intrarretinianas. La oftalmoscopia indirecta demostró que solo un 35% (7/20) de los ojos con un reflejo rojo alterado tenía un proceso patológico intraocular. Además en un 77,4% (24/31) de los ojos la oftalmoscopia indirecta demostró que había enfermedad intraocular presente, a pesar de un reflejo rojo normal. La tasa de falsos positivos del reflejo rojo se calculó en un 9,2% y la tasa de falsos negativos en un 16,9%. La sensibilidad del reflejo rojo era únicamente de un 56,4% y la especificidad de un 89,5%. El valor predictivo positivo fue de un 70,4% y el valor predictivo negativo de un 82,2%. CONCLUSIONES: Un cribado neonatal con el reflejo rojo no es suficiente para detectar un proceso patológico intraocular. Un reflejo rojo dentro de los límites normales no excluye enfermedad intraocular. El reflejo rojo tiene una especificad de casi un 90%, pero su sensibilidad es de solo un 56%. La mayoría de las hemorragias intrarretinianas se mantienen sin diagnosticar, ya que no se detectan con un reflejo rojo


OBJECTIVE: To compare the results of indirect ophthalmoscopy versus determination of the red reflex in newborns admitted to the intermediate neonatal intensive care unit. METHODS: All the patients (71) admitted to the intermediate neonatal intensive care unit from July to September of 2017 were screened with the red reflex. Immediately afterwards, they were pharmacologically dilated and indirect ophthalmoscopy was performed. All of the red-reflex screening and the funduscopic examination were performed by the same evaluator. RESULTS: A total of 14.1% (20/142) of the eyes had an altered red reflex. Indirect ophthalmoscopy revealed that 21.8% (31/142) of the eyes had intraocular abnormalities. Two of these eyes had optic nerve colobomas, two eyes had cataracts, and the rest had intra-retinal haemorrhages. Indirect ophthalmoscopy revealed that only 35% (7/20) of the eyes with an altered red reflex had intraocular disease. Indirect ophthalmoscopy also revealed that intraocular disease was present in 77.4% (24/31) of the eyes despite a normal red reflex. The false positive rate of the red reflex was calculated to be 9.2%, and the false negative rate was 16.9%. The sensitivity of the red reflex was only 56.4%, and the specificity was 89.5%. The positive predictive value was 70.4%, and the negative predictive value was 82.2%. CONCLUSIONS: Neonatal screening with the red reflex is not sufficient to detect intraocular disease. A normal neonatal red reflex does no exclude intraocular disease. It has a specificity of nearly 90%, but its sensitivity is only 56%. Most retinal haemorrhages are undiagnosed as they cannot be detected with a red réflex


Asunto(s)
Humanos , Masculino , Femenino , Oftalmopatías/diagnóstico , Recién Nacido/fisiología , Tamizaje Neonatal/métodos , Oftalmoscopía/métodos , Catarata/congénito , Catarata/diagnóstico , Coloboma/diagnóstico , Costa Rica , Reacciones Falso Negativas , Reacciones Falso Positivas , Fondo de Ojo , Edad Gestacional , Recién Nacido de Bajo Peso , Recien Nacido Prematuro , Enfermedades del Prematuro/diagnóstico , Nervio Óptico/anomalías , Valor Predictivo de las Pruebas , Hemorragia Retiniana/diagnóstico , Sensibilidad y Especificidad
20.
Clin Exp Hypertens ; 42(6): 479-482, 2020 Aug 17.
Artículo en Inglés | MEDLINE | ID: mdl-31856594

RESUMEN

PURPOSE: Hypertension is a common chronic disorder with end organ damage. Hypertensive retinopathy is a response to elevated blood pressure characterized retinal arteriolar intimal thickening, hyperplasia of the intima-media end with sclerosis. There is a relationship between high blood pressure and retinopathy grade. Masked hypertension is a phenomenon of normal blood pressure in the office but high in out of office that associated with an increases risk of cardiovascular disease. In this study, we aimed to investigate retinopathy in masked hypertensive patients. METHODS: We enrolled 92 patients with masked hypertension and 87 healthy controls in to the study. We use ambulatory blood pressure monitoring (ABPM) to detect the masked hypertension. Bilateral fundus examination was performed. Hypertensive retinopathy (HTRP) grading was determined according to the Keith-Wagener-Barker classification. We examined retinopathy grade in patients with masked hypertension and without. RESULTS: 55 (11.6%) participants had signs of retinopathy. Fifty (54.3%) subjects had any retinopathy in patients with masked hypertension and five (5.7%) subjects had any retinopathy in controls (p < .001). Median of KWB grade was 1 (0-4) in patients with masked hypertension and 0 (0-2) in controls (p < .001). There were a positive significant correlation between KWB grade and day-time systolic blood pressure (r = 0.460, p < .001), day-time diastolic blood pressure (r = 0.448, p < .001), presence of masked hypertension (r = 0.527, p < .001). CONCLUSIONS: There was a considerable rate of any retinopathy in masked hypertension. Consequently, ophthalmoscopic examination should be as part of the care in patients who have a risk for masked hypertension.


Asunto(s)
Retinopatía Hipertensiva , Hipertensión Enmascarada/diagnóstico , Oftalmoscopía/métodos , Monitoreo Ambulatorio de la Presión Arterial/métodos , Monitoreo Ambulatorio de la Presión Arterial/estadística & datos numéricos , Femenino , Humanos , Retinopatía Hipertensiva/diagnóstico , Retinopatía Hipertensiva/fisiopatología , Masculino , Hipertensión Enmascarada/fisiopatología , Persona de Mediana Edad , Medición de Riesgo
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