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1.
PLoS One ; 15(10): e0240064, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33091032

RESUMEN

PURPOSE: To identify objective optical coherence tomography angiography (OCTA) parameters that characterize the spectrum of non-proliferative diabetic retinopathy (NPDR), especially those that distinguish moderate from severe NPDR. METHODS: Sixty eyes of 60 patients with treatment-naïve NPDR (mild: 21, moderate: 21, severe: 18), 23 eyes with diabetes and no retinopathy, and 24 healthy control eyes were enrolled. OCTA slabs were segmented into superficial (SCP), middle (MCP), and deep capillary plexus (DCP) and thresholded by a new method based on DCP skeletonized vessel length. The foveal avascular zone (FAZ) area, parafoveal vessel density (VD), and adjusted flow index (AFI) from all three capillary layers and the vessel length density (VLD) of the SCP were compared between each severity group, after adjusting for age and image quality. RESULTS: All vessel density markers decreased with increasing severity of NPDR. SCP VD and VLD demonstrated significant differences between eyes with diabetes with no retinopathy and mild NPDR (p = 0.001 and p < 0.001, respectively), as well as between moderate vs. severe NPDR (p = 0.004 and p = 0.009, respectively). MCP VD significantly decreased between moderate and severe NPDR (p = 0.01). AFI significantly increased in the SCP and showed a decreasing trend in the MCP and DCP with increasing NPDR severity. CONCLUSIONS: Changes in the SCP VD, SCP VLD, and MCP VD can distinguish severe NPDR from lower-risk stages. SCP changes may be more reliable due to their lower susceptibility to noise and projection artifacts. Thresholding OCTA images based on DCP skeletonized vessel length showed less variability in moderate and severe NPDR. Additional studies are warranted to validate this new thresholding method.


Asunto(s)
Retinopatía Diabética/diagnóstico , Angiografía con Fluoresceína/métodos , Vasos Retinianos/fisiopatología , Adulto , Anciano , Área Bajo la Curva , Estudios Transversales , Diabetes Mellitus Tipo 1/complicaciones , Diabetes Mellitus Tipo 1/patología , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/patología , Retinopatía Diabética/diagnóstico por imagen , Retinopatía Diabética/patología , Ojo/irrigación sanguínea , Femenino , Humanos , Procesamiento de Imagen Asistido por Computador , Masculino , Persona de Mediana Edad , Curva ROC , Vasos Retinianos/diagnóstico por imagen , Índice de Severidad de la Enfermedad , Tomografía de Coherencia Óptica
2.
Medicine (Baltimore) ; 99(37): e22171, 2020 Sep 11.
Artículo en Inglés | MEDLINE | ID: mdl-32925785

RESUMEN

The correlations between retinal vessel distribution, anterior chamber depth (ACD) and other myopic eye structural parameters remains elusive. This study aims to investigate retinal vasculature and eye structure correlations in healthy and myopic eyes of Chinese young adults.In this cross-sectional study, 181 eyes (97 adults) were recruited. Macular and peripapillary vasculature was quantified by optical coherence tomography angiography. Correlations between retinal vasculature and eye structure were analyzed using multivariable linear regression.There were significant differences in ACD, spherical equivalent, axial length (AL), superficial macular vascular density (MVD), peripapillary vascular density (PVD) and circumference of foveal avascular zone (FAZ) among emmetropia, low-myopia, moderate-myopia, and high-myopia groups (both P < 0.05). Furthermore, ACD had significant positive correlation with AL and FAZ, but negative correlation with PVD. MVD also had a negative correlation with AL (beta = -0.247, P < .001). In addition, there was a significant negative correlation between circumference of the FAZ and spherical equivalent as well as central subfield thickness (beta = -0.20, P = .005; beta = -0.334, P < .001, respectively).The degree of myopia affected ACD, MVD, PVD, and circumference of the FAZ in eyes of young healthy adults. Meanwhile, ACD has a positive, while retinal vascular system measurements have a negative correlation with increasing severity of myopia.


Asunto(s)
Ojo/irrigación sanguínea , Ojo/patología , Miopía/patología , Vasos Retinianos/patología , Adolescente , Adulto , Factores de Edad , Glucemia , Capilares/patología , Estudios Transversales , Femenino , Humanos , Lípidos/sangre , Masculino , Estudios Prospectivos , Índice de Severidad de la Enfermedad , Factores Sexuales , Tomografía de Coherencia Óptica , Adulto Joven
3.
Drug Discov Ther ; 14(2): 98-99, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32378652

RESUMEN

The authors present the use of prostaglandin E1 (PGE1) for the treatment of an acute paracentral acute middle maculopathy (PAMM). A 78-year-old white female was seen with a sudden loss of vision in her left eye (OS) to 20/200 noted upon awakening. The right eye (OD) saw 20/20. A complete eye exam was done and an ocular coherent tomography revealed retinal thickening and a whitening of the inner nuclear layer in the area of the macula OS. A diagnosis of PAMM in the OS was made. Treatment was immediately started with 70 µg of PGE1 administered over 1.5 hours in the form of a skin cream. A volume of 3.5 cc of skin cream was applied in divided doses to the inner surface of the forearm, rubbed into the skin and allowed to dry. The same 70 µg of PGE1 in 3.5 cc of skin cream was repeated once the next morning. The patient began to see better the second day of treatment with a final visual acuity of 20/20. The OD was unchanged. After 14 months she was stable with no further treatment. PAMM is an ischemic process of the inner retina. PGE1, a potent vasodilator of the microcirculation, when given immediately seemed to be useful in restoring vision in this form of retinal ischemia. Treatment was immediately started with PGE1 in the form of a skin cream with visual improvement. The authors normally use PGE1 intravenously for acute ocular ischemia and would have preferred that here. Intravenous PGE1 was not available and was substituted with the skin cream of PGE1 that worked well for the patient.


Asunto(s)
Alprostadil/uso terapéutico , Isquemia/tratamiento farmacológico , Degeneración Macular/tratamiento farmacológico , Agudeza Visual/efectos de los fármacos , Anciano , Ojo/irrigación sanguínea , Femenino , Humanos
4.
Ann Vasc Surg ; 67: 567.e9-567.e12, 2020 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-32209415

RESUMEN

Ocular ischemic syndrome is a rare complication of carotid arterial disease that can lead to irreversible vision loss. The disease is related to ocular hypoperfusion secondary to carotid stenosis. Carotid endarterectomy (CEA) has been proven to reduce the risk of embolic stroke in specific patient populations; however, the role of CEA in the treatment of ocular ischemic syndrome or other flow-related symptoms is less well defined. We present a case of ocular ischemic syndrome successfully treated with carotid endarterectomy, and summarize the current literature regarding management of ocular ischemic syndrome.


Asunto(s)
Ceguera/etiología , Estenosis Carotídea/cirugía , Endarterectomía Carotidea , Ojo/irrigación sanguínea , Isquemia/etiología , Anciano de 80 o más Años , Ceguera/diagnóstico , Ceguera/fisiopatología , Estenosis Carotídea/complicaciones , Estenosis Carotídea/diagnóstico por imagen , Estenosis Carotídea/fisiopatología , Humanos , Isquemia/diagnóstico , Isquemia/fisiopatología , Masculino , Recuperación de la Función , Flujo Sanguíneo Regional , Resultado del Tratamiento , Visión Ocular
5.
World Neurosurg ; 137: 338-340, 2020 05.
Artículo en Inglés | MEDLINE | ID: mdl-32035205

RESUMEN

BACKGROUND: Cavernous-carotid fistulas (CCFs) can present with a variety of symptoms depending on the anatomy of the fistula and its venous drainage. Patients most commonly present with scleral injection, pulsatile exophthalmos, and/or chemosis. CASE DESCRIPTION: We report a patient who presented with intraparenchymal hemorrhage in the absence of any of the commonly associated ocular symptoms and signs. After multiple imaging studies, the CCF was diagnosed and treated with endovascular embolization that resulted in complete occlusion of the fistula and reflux of embolysate into one of its connecting veins. CONCLUSIONS: The morphology of the venous drainage can lead to atypical hemorrhagic presentation, whereas dilatation of one of the tributary veins with cortical venous reflux should warn the interventionist the path the embolysate may follow. We provide our experience with this unique presentation and its treatment.


Asunto(s)
Fístula del Seno Cavernoso de la Carótida/complicaciones , Hemorragia Cerebral/etiología , Adulto , Angiografía de Substracción Digital , Arterias Carótidas/diagnóstico por imagen , Fístula del Seno Cavernoso de la Carótida/diagnóstico por imagen , Fístula del Seno Cavernoso de la Carótida/fisiopatología , Fístula del Seno Cavernoso de la Carótida/terapia , Seno Cavernoso/diagnóstico por imagen , Angiografía Cerebral , Hemorragia Cerebral/fisiopatología , Diplopía , Síndrome de Down/complicaciones , Embolización Terapéutica , Epilepsia/complicaciones , Exoftalmia , Ojo/irrigación sanguínea , Humanos , Imagen por Resonancia Magnética , Masculino , Tomografía Computarizada por Rayos X , Trastornos de la Visión
6.
Biomed Res Int ; 2020: 9496242, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32104710

RESUMEN

Purpose: To evaluate the effects of intravitreal ranibizumab (IVR) treatment on the blood flow of the optic nerve head (ONH) and of retinal vessels of the peripapillary region of eyes with diabetic macular edema (DME) assessed using laser speckle flowgraphy (LSFG). Methods: Forty eyes of 30 patients treated with IVR for DME were included in this prospective clinical study. Mean blur rate (MBR) and relative flow volume (RFV) of the ONH and of a superior retinal artery and an inferior retinal vein of the peripapillary region were measured using LSFG at baseline, 2 weeks (T1), and 1 month (T2) after IVR injection. In addition, best-corrected visual acuity (BCVA) and central retinal thickness (CRT) were measured in all cases. Results: The BCVA improved and CRT decreased significantly during the follow-up period (p < 0.010). MBR-related parameters of the ONH such as MBR of all area (MA), MBR of vascular area (MV), and MBR of tissue area (MT) decreased significantly at 2 weeks after IVR compared to baseline values (MA, p < 0.010). MBR-related parameters of the ONH such as MBR of all area (MA), MBR of vascular area (MV), and MBR of tissue area (MT) decreased significantly at 2 weeks after IVR compared to baseline values (MA, p < 0.010). MBR-related parameters of the ONH such as MBR of all area (MA), MBR of vascular area (MV), and MBR of tissue area (MT) decreased significantly at 2 weeks after IVR compared to baseline values (MA, p < 0.010). MBR-related parameters of the ONH such as MBR of all area (MA), MBR of vascular area (MV), and MBR of tissue area (MT) decreased significantly at 2 weeks after IVR compared to baseline values (MA, p < 0.010). MBR-related parameters of the ONH such as MBR of all area (MA), MBR of vascular area (MV), and MBR of tissue area (MT) decreased significantly at 2 weeks after IVR compared to baseline values (MA, p < 0.010). MBR-related parameters of the ONH such as MBR of all area (MA), MBR of vascular area (MV), and MBR of tissue area (MT) decreased significantly at 2 weeks after IVR compared to baseline values (MA, p < 0.010). MBR-related parameters of the ONH such as MBR of all area (MA), MBR of vascular area (MV), and MBR of tissue area (MT) decreased significantly at 2 weeks after IVR compared to baseline values (MA, p < 0.010). MBR-related parameters of the ONH such as MBR of all area (MA), MBR of vascular area (MV), and MBR of tissue area (MT) decreased significantly at 2 weeks after IVR compared to baseline values (MA, p < 0.010). MBR-related parameters of the ONH such as MBR of all area (MA), MBR of vascular area (MV), and MBR of tissue area (MT) decreased significantly at 2 weeks after IVR compared to baseline values (MA. Conclusion: IVR injection leads to a reduction of ocular blood flow both in the ONH and in the retinal peripapillary vessels associated with peripapillary vessel constriction. The reduction of CRT and related improvement of vision may be related to the changes in ocular blood flow.


Asunto(s)
Retinopatía Diabética/tratamiento farmacológico , Ojo/efectos de los fármacos , Edema Macular/tratamiento farmacológico , Ranibizumab/administración & dosificación , Adolescente , Adulto , Anciano , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/diagnóstico por imagen , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Diabetes Mellitus Tipo 2/patología , Retinopatía Diabética/diagnóstico por imagen , Retinopatía Diabética/patología , Ojo/irrigación sanguínea , Ojo/diagnóstico por imagen , Ojo/patología , Anomalías del Ojo/complicaciones , Anomalías del Ojo/diagnóstico por imagen , Anomalías del Ojo/tratamiento farmacológico , Anomalías del Ojo/patología , Femenino , Angiografía con Fluoresceína/métodos , Humanos , Inyecciones Intravítreas , Flujometría por Láser-Doppler/métodos , Edema Macular/diagnóstico por imagen , Edema Macular/etiología , Edema Macular/patología , Masculino , Persona de Mediana Edad , Disco Óptico/diagnóstico por imagen , Disco Óptico/efectos de los fármacos , Flujo Sanguíneo Regional/efectos de los fármacos , Vasos Retinianos/diagnóstico por imagen , Vasos Retinianos/efectos de los fármacos , Vasos Retinianos/patología , Adulto Joven
7.
Ann Rheum Dis ; 79(3): 393-399, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-31900304

RESUMEN

OBJECTIVES: Ultrasound of temporal and axillary arteries may reveal vessel wall inflammation in patients with giant cell arteritis (GCA). We developed a ultrasound scoring system to quantify the extent of vascular inflammation and investigated its diagnostic accuracy and association with clinical factors in GCA. METHODS: This is a prospective study including 89 patients suspected of having GCA, of whom 58 had a confirmed clinical diagnosis of GCA after 6 months follow-up. All patients underwent bilateral ultrasound examination of the three temporal artery (TA) segments and axillary arteries, prior to TA biopsy. The extent of vascular inflammation was quantified by (1) counting the number of TA segments and axillary arteries with a halo and (2) calculating a composite Halo Score that also incorporated the thickness of each halo. RESULTS: Halo counts and Halo Scores showed moderate diagnostic accuracy for a clinical diagnosis of GCA. They correlated positively with systemic inflammation. When compared with the halo count, the Halo Score correlated better with C-reactive protein (CRP) levels and allowed to firmly establish the diagnosis of GCA in more patients. Higher halo counts and Halo Scores were associated with a higher risk of ocular ischaemia. They allowed to identify subgroups of patients with low risk (≤5%) and high risk of ocular ischaemia (>30%). CONCLUSIONS: Ultrasound halo scoring allows to quantify the extent of vascular inflammation in GCA. Extensive vascular inflammation on ultrasound may provide strong diagnostic confirmation and associates with ocular ischaemia in GCA.


Asunto(s)
Oftalmopatías/diagnóstico por imagen , Ojo/irrigación sanguínea , Arteritis de Células Gigantes/diagnóstico por imagen , Isquemia/diagnóstico por imagen , Ultrasonografía/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Arteria Axilar/diagnóstico por imagen , Biopsia , Oftalmopatías/etiología , Femenino , Arteritis de Células Gigantes/complicaciones , Humanos , Isquemia/etiología , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Sensibilidad y Especificidad , Índice de Severidad de la Enfermedad , Arterias Temporales/diagnóstico por imagen , Ultrasonografía/métodos
8.
Clin Imaging ; 59(2): 126-128, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31816539

RESUMEN

In this case, we demonstrate the ability of diffusion weighted magnetic resonance imaging to localize retinal ischemia in a patient with acute vision loss. MRI is widely used for the evaluation of acute stroke, but there has only been one other case report showing the ability of DWI to rapidly localize retinal pathology, including central retinal artery occlusion [1]. Central retinal artery occlusion is an ocular emergency presenting with acute, painless loss of vision as a result of retinal ischemia. This case demonstrates the role of diffusion weighted imaging as an adjunctive test in the prompt diagnosis and management of central retinal artery occlusion. As the technology improves, we anticipate diffusion weighted imaging will become more sensitive for the identification of acute retinal ischemia and other retinal pathologies.


Asunto(s)
Arteriopatías Oclusivas/diagnóstico por imagen , Imagen de Difusión por Resonancia Magnética/métodos , Retina/diagnóstico por imagen , Arteria Retiniana/diagnóstico por imagen , Enfermedad Aguda , Arteriopatías Oclusivas/patología , Ojo/irrigación sanguínea , Ojo/diagnóstico por imagen , Femenino , Humanos , Isquemia , Persona de Mediana Edad , Retina/patología , Arteria Retiniana/patología
9.
Microvasc Res ; 127: 103926, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31521542

RESUMEN

BACKGROUND: There is no consensus on how much and at what diameters the blood flow velocity changes in the female microcirculation during normal pregnancy. METHODS: A non-contact, digital slit-lamp biomicroscopy system was used to measure axial blood velocity (Vax) and diameter (D) in the conjunctival microcirculation of 28 normal non-pregnant women (Control Group), 17 women in the first semester of their normal pregnancy (Group 1) and 16 women in the third trimester of their normal pregnancy (Group 2). Blood volume flow (Q) was estimated from Vax and D. Microvessels were classified as "capillaries" (CAP) with D < 9 µm, "postcapillary venules of size 1" (PC1) with 9 ≤ D < 14 µm and "postcapillary venules of size 2" (PC2) with 14 ≤ D ≤ 24 µm. RESULTS: The women groups did not differ significantly in age, diastolic and systolic pressure and diameter of each size. Taking as baseline the capillary Vax of 0.51 mm/s of the Control Group, there was a statistically significant (p < 0.001) increase to 0.74 mm/s (45%) in Group 1 and to 0.95 mm/s (86%) in Group 2. This significant Vax increase in capillaries (CAP) was a consistent finding irrespective of the exact vessel size cut-off value for discriminating CAP from PC1. There was no statistical difference in Vax among groups at postcapillary venules of size 2 (PC2). Statistical conclusions for blood volume flows were similar to velocities. CONCLUSIONS: Normal pregnancy increases significantly axial blood velocity (Vax) in capillaries (CAP) with diameter <9 µm.


Asunto(s)
Capilares/fisiología , Ojo/irrigación sanguínea , Hemodinámica , Microcirculación , Vénulas/fisiología , Adulto , Velocidad del Flujo Sanguíneo , Estudios de Casos y Controles , Femenino , Humanos , Embarazo , Primer Trimestre del Embarazo , Tercer Trimestre del Embarazo , Flujo Sanguíneo Regional , Lámpara de Hendidura
10.
J Acupunct Meridian Stud ; 13(2): 40-47, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-30529435

RESUMEN

Patients with glaucoma can show blood flow anomalies at the eye vessel level. A causal relationship is reasonably expected, but so far, it has not been demonstrated. Traditional Chinese medicine indicates that acupuncture can promote specific blood perfusion in specific body districts. Ninety-eight patients with open-angle glaucoma were treated with an ultralow light-level laser, according to a specific acupuncture protocol, and their blood flow was measured before and after a six-week treatment cycle. Doppler measurements showed significant modifications in both pulsatility and resistivity indexes. The most relevant outcome of this study is that the applied treatment demonstrated its effectiveness not only in vasodilation but also in perfusion control that seems to restore appropriate functionality. The protocol therefore should be investigated in future controlled studies and perhaps in other blood perfusion-related pathologies.


Asunto(s)
Terapia por Acupuntura , Ojo/irrigación sanguínea , Glaucoma de Ángulo Abierto/fisiopatología , Glaucoma de Ángulo Abierto/terapia , Puntos de Acupuntura , Adulto , Anciano , Anciano de 80 o más Años , Velocidad del Flujo Sanguíneo , Femenino , Hemodinámica , Humanos , Masculino , Persona de Mediana Edad , Flujo Sanguíneo Regional , Estudios Retrospectivos , Resultado del Tratamiento , Adulto Joven
11.
Dev Biol ; 457(2): 226-234, 2020 01 15.
Artículo en Inglés | MEDLINE | ID: mdl-30825427

RESUMEN

Von Hippel-Lindau (VHL) syndrome is a rare, autosomal dominant disorder, characterised by hypervascularised tumour formation in multiple organ systems. Vision loss associated with retinal capillary hemangioblastomas remains one of the earliest complications of VHL disease. The mortality of Vhl-/- mice in utero restricted modelling of VHL disease in this mammalian model. Zebrafish harbouring a recessive germline mutation in the vhl gene represent a viable, alternative vertebrate model to investigate associated ocular loss-of-function phenotypes. Previous studies reported neovascularisation of the brain, eye and trunk together with oedema in the vhl-/- zebrafish eye. In this study, we demonstrate vhl-/- zebrafish almost entirely lack visual function. Furthermore, hyaloid vasculature networks in the vhl-/- eye are improperly formed and this phenotype is concomitant with development of an ectopic intraretinal vasculature. Sunitinib malate, a multi tyrosine kinase inhibitor, market authorised for cancer, reversed the ocular behavioural and morphological phenotypes observed in vhl-/- zebrafish. We conclude that the zebrafish vhl gene contributes to an endogenous molecular barrier that prevents development of intraretinal vasculature, and that pharmacological intervention with sunitinib can improve visual function and hyaloid vessel patterning while reducing abnormally formed ectopic intraretinal vessels in vhl-/- zebrafish.


Asunto(s)
Ojo/irrigación sanguínea , Retina/embriología , Proteínas Supresoras de Tumor/genética , Proteínas de Pez Cebra/genética , Pez Cebra/genética , Enfermedad de von Hippel-Lindau/genética , Animales , Antineoplásicos/farmacología , Ceguera/genética , Modelos Animales de Enfermedad , Ojo/embriología , Hemangioblastoma/genética , Sunitinib/farmacología , Visión Ocular/genética , Enfermedad de von Hippel-Lindau/patología , Enfermedad de von Hippel-Lindau/prevención & control
12.
Plast Reconstr Surg ; 145(1): 42e-50e, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31881603

RESUMEN

BACKGROUND: With an increase in recent years in the number of people receiving cosmetic facial injection treatments of hyaluronic acid, the incidence of hyaluronic acid embolism has also increased commensurately. Hyaluronic acid embolism leads to serious complications, including blindness, eye and eyelid movement disorders, skin necrosis, and cerebral embolism. However, there is a lack of robust clinical evidence regarding the benefits of treatment for hyaluronic acid embolism by intraarterial thrombolysis therapy. METHODS: This study included 24 patients with a decrease in visual acuity and other complications induced by facial hyaluronic acid injection. Patients underwent emergency intraarterial thrombolysis therapy by injection of hyaluronidase (500 to 1500 units) alone or hyaluronidase (750 to 1500 units) combined with urokinase (100,000 to 250,000 units), followed in both cases by a general symptomatic treatment and nutritional therapy. RESULTS: Ten (42 percent) of 24 patients ultimately had improvements to visual acuity, even when the clinical application of the thrombolytic treatments had passed the recommended window for optimal treatment. In all cases, patients' facial skin necrosis was restored to nearly normal appearance. In addition, the authors found that hyaluronidase combined with urokinase was a more effective therapy than hyaluronidase alone. CONCLUSIONS: The authors' results indicate that intraarterial thrombolysis therapy is beneficial to patients suffering from blindness induced by hyaluronic acid embolism. The therapy was shown to be worthy of clinical application because it alleviated the impairment to patients' vision and was also beneficial in the recovery from other serious complications, including eye movement disorder, eye edema, headaches, and skin necrosis. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Asunto(s)
Ceguera/tratamiento farmacológico , Técnicas Cosméticas/efectos adversos , Rellenos Dérmicos/efectos adversos , Embolia/tratamiento farmacológico , Arteria Oftálmica/patología , Terapia Trombolítica/métodos , Adulto , Angiografía de Substracción Digital , Ceguera/etiología , Rellenos Dérmicos/administración & dosificación , Quimioterapia Combinada/métodos , Embolia/diagnóstico por imagen , Embolia/etiología , Embolia/patología , Ojo/irrigación sanguínea , Femenino , Estudios de Seguimiento , Humanos , Ácido Hialurónico/administración & dosificación , Ácido Hialurónico/efectos adversos , Hialuronoglucosaminidasa/uso terapéutico , Inyecciones Intraarteriales , Inyecciones Subcutáneas/efectos adversos , Masculino , Arteria Oftálmica/diagnóstico por imagen , Estudios Retrospectivos , Resultado del Tratamiento , Activador de Plasminógeno de Tipo Uroquinasa/uso terapéutico , Agudeza Visual
13.
Biomed Res Int ; 2019: 8080564, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31886253

RESUMEN

Purpose: To determine the effects of selenium, melatonin, and selenium + melatonin administered for one month on anterior chamber (AC) malondialdehyde (MDA) and AC glutathione (GSH) levels in patients with ocular ischemic syndrome. Materials and Methods: Thirty-five patients were included in the study. Study groups were formed as follows: (1) control group, (2) ischemia group, (3) selenium + ischemia group, (4) melatonin + ischemia group, and (5) selenium + melatonin + ischemia group. AC samples were obtained. MDA and GSH levels in AC samples were evaluated. Results: MDA levels were significantly increased in ischemia groups. Selenium and melatonin supplementation resulted in reduction of MDA levels and significant increase in GSH values. Discussion: Increased lipid peroxidation associated with ischemia of the anterior segment has been prevented by selenium and melatonin supplementation. This trial is registered with ClinicalTrials.gov NCT04005222.


Asunto(s)
Ojo/irrigación sanguínea , Isquemia/tratamiento farmacológico , Melatonina/uso terapéutico , Selenio/uso terapéutico , Anciano , Anciano de 80 o más Años , Ojo/patología , Femenino , Glutatión/metabolismo , Humanos , Masculino , Malondialdehído , Melatonina/farmacología , Persona de Mediana Edad , Selenio/farmacología , Síndrome
14.
Facial Plast Surg Clin North Am ; 27(4): 557-564, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31587773

RESUMEN

Soft tissue fillers continue to gain popularity in addressing volume loss and changes associated with facial aging. The rare but devastating complication from iatrogenic vascular occlusion can result in irreversible vision loss. This article discusses the complications of vision loss associated with fillers and reviews applicable treatment techniques and prevention methods.


Asunto(s)
Ceguera/inducido químicamente , Ceguera/prevención & control , Técnicas Cosméticas/efectos adversos , Rellenos Dérmicos/efectos adversos , Ojo/irrigación sanguínea , Cara/irrigación sanguínea , Isquemia/inducido químicamente , Ceguera/diagnóstico , Ceguera/terapia , Vasos Sanguíneos/anatomía & histología , Humanos , Oftalmología , Derivación y Consulta , Oclusión de la Arteria Retiniana/inducido químicamente
15.
Nepal J Ophthalmol ; 11(21): 86-90, 2019 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31523073

RESUMEN

BACKGROUND: Ocular ischemic syndrome is not a common condition so most of these cases are often misdiagnosed or treated as a different entity. Therefore, it is very important for the ophthalmologists to have this condition in mind as a differential so that the patients can be diagnosed and treated as early as possible. A 42 years female presented with painless, progressive diminution of vision in right eye over the period of 1 month. She doesn't give any history of redness of eyes, fever or trauma. There is no history of diabetes mellitus or hypertension as well. On examination, vision in right and left eyes was 1.78 and 0.30 Log Mar Units respectively. On anterior segment examination, revascularization of iris (1o 4 'o'clock hrs) in right eye was noted. On dilated fund us copy, revascularization of disc (1/3rd) was present in right eye. Cotton wool spots blot hemorrhages and micro aneurysms were also noted in right eye. Likewise, attenuation of arteries were noted on both sides. Fund us fluorescent angiography revealed delayed artery covetous and venous phase. Carotid Doppler was done which showed complete occlusion of right common carotid and bilateral internal carotid artery. These findings lead to the diagnosis as ocular ischemic syndrome so she was then referred to the cardiologist who further confirmed that no active intervention was required at present. The patient was planned for right eye pan retinal photocoagulation (PRP) and was completed in 2 sittings and was asked to follow up regularly. CONCLUSION: Early diagnosis and management is very important for uncommon conditions such as ocular ischemic syndrome to prevent further complications.


Asunto(s)
Arteria Carótida Común , Estenosis Carotídea/complicaciones , Oftalmopatías/diagnóstico , Ojo/irrigación sanguínea , Isquemia/diagnóstico , Retina/diagnóstico por imagen , Adulto , Estenosis Carotídea/diagnóstico , Oftalmopatías/etiología , Oftalmopatías/cirugía , Femenino , Angiografía con Fluoresceína , Fondo de Ojo , Humanos , Isquemia/etiología , Isquemia/cirugía , Fotocoagulación/métodos , Retina/cirugía , Síndrome , Ultrasonografía Doppler
16.
Biochem Pharmacol ; 169: 113632, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31494147

RESUMEN

Glaucoma is one of the leading causes of preventable blindness, affecting > 2 million people in the United States. Recently, 11ß-hydroxysteroid dehydrogenase type 1 (11ß-HSD1) inhibitors were found to exert preventive effects against glaucoma. However, there is no evidence for the role of 11ß-HSD1 inhibitors against glaucoma. Here, we developed a novel 11ß-HSD1 inhibitor, (1R,2S,3S,5R,6S,7S)-6-(2-(6-(2,6-dichloro-4-(trifluoromethyl)phenyl)-4-methyl-1,1-dioxido-1,2,6-thiadiazinan-2-yl)acetamido)-adamantane-2-carboxamide (KR-67607) and showed its protective effects against ischemia-reperfusion-induced eye injury. We demonstrate that KR-67607 effectively reduced cortisol levels in mouse eyes and maintained the trabecular meshwork (TM) structure in the presence of transient ischemic stress. Furthermore, KR-67607 reversed the elevation of intra-ocular pressure (IOP), suggesting that the TM structure maintained by KR-67607 prevented the excessive rise in IOP that exacerbates glaucoma. KR-67607 was shown to have a higher specificity for 11ß-HSD1 than carbenoxolone (CBX) in vitro. Moreover, KR-67607 reduced apoptosis and the structural disruption of TM cells. Antioxidation was the major protective pathway of KR-67607 against chemically-induced ischemia-reperfusion in TM cells and the glucocorticoid receptor (GR) was closely associated with this pathway. When TM cells undergo ischemic stress, GR is activated and then translocates to the cell nucleus where it interferes with Nrf-2-mediated antioxidant gene expression. However, when KR-67607 inhibited GR translocation, Nrf-2 was able to induce antioxidant gene transcription, which consequently, enhanced the antioxidant capacity of the cells. In conclusion, our current work describes a novel selective 11ß-HSD1 inhibitor for glaucoma treatment and provides evidence of its physiological role in anti-oxidative pathways in the TM.


Asunto(s)
11-beta-Hidroxiesteroide Deshidrogenasa de Tipo 1/antagonistas & inhibidores , Adamantano/análogos & derivados , Ojo/irrigación sanguínea , Glaucoma/tratamiento farmacológico , Daño por Reperfusión/prevención & control , Tiadiazinas/farmacología , Adamantano/farmacología , Adamantano/uso terapéutico , Animales , Carbenoxolona/farmacología , Presión Intraocular/efectos de los fármacos , Masculino , Ratones , Ratones Endogámicos C57BL , Factor 2 Relacionado con NF-E2/fisiología , Ratas , Ratas Sprague-Dawley , Especies Reactivas de Oxígeno/metabolismo , Receptores de Glucocorticoides/fisiología , Tiadiazinas/uso terapéutico , Malla Trabecular/efectos de los fármacos
17.
BMJ Case Rep ; 12(9)2019 Sep 16.
Artículo en Inglés | MEDLINE | ID: mdl-31527207

RESUMEN

A 58-year-old woman was referred to the outpatient ophthalmology clinic with progressive bilateral eye redness and vision loss. She had presented 2 weeks earlier with an episode of hypertensive emergency. CT angiography revealed bilateral superior ophthalmic vein (SOV) dilation, prompting further workup with a cerebral angiogram. Subsequent imaging revealed an indirect (type D) carotid-cavernous fistula (CCF) with venous drainage into both SOVs and cavernous sinuses. Successful treatment of the CCF with coil embolisation required interdisciplinary teamwork between ophthalmologists and interventional neuroradiologists. The patient made a substantial visual recovery following treatment.


Asunto(s)
Fístula del Seno Cavernoso de la Carótida/etiología , Fístula del Seno Cavernoso de la Carótida/terapia , Oftalmopatías/etiología , Oftalmopatías/terapia , Hipertensión/complicaciones , Fístula del Seno Cavernoso de la Carótida/diagnóstico por imagen , Embolización Terapéutica , Ojo/irrigación sanguínea , Ojo/diagnóstico por imagen , Oftalmopatías/diagnóstico por imagen , Femenino , Humanos , Persona de Mediana Edad , Tomografía Computarizada por Rayos X
18.
Arch. Soc. Esp. Oftalmol ; 94(8): 400-404, ago. 2019. ilus
Artículo en Español | IBECS | ID: ibc-185627

RESUMEN

Mujer de 73 años que acude a consulta con diagnóstico de hipertiroidismo de 8 meses de evolución. Desde entonces comenzó con hiperemia y proptosis ocular. En la exploración se observa exoftalmos bilateral de predominio derecho, ligera hiperemia conjuntival en ojo derecho asociada a vasos epiesclerales aumentados en su calibre con forma de cabeza de medusa. Tomografía computada con recto inferior aumentado de calibre sin datos de compresión de nervio óptico. En el estudio doppler de órbita se encuentra un flujo arteriorizado sobre la vena oftálmica superior con un posible diagnóstico de fístula carótido-cavernosa. La orbitopatía tiroidea relacionada a una fístula carótido-cavernosa es una asociación infrecuente, ya que los datos clínicos de una de las patologías pueden enmascarar a la otra, por lo que es importante el conocimiento de ambas enfermedades para su correcto diagnóstico y tratamiento multidisciplinario


The case concerns a 73 year-old female with a diagnosis of hyperthyroidism of 8 months onset. Since then, she has suffered hyperaemia and ocular proptosis. Bilateral exophthalmos was observed in the physical examination, along with mild conjunctival hyperaemia in the right eye associated with dilated episcleral vessels. Computed tomography showed enlarged inferior rectus with no signs of ocular nerve or ophthalmic superior vein compression. In the orbital Doppler ultrasound scan, there was an arterialised flow over the superior ophthalmic vein, giving a possible diagnosis of cavernous carotid. Thyroid orbitopathy with a cavernous carotid fistula is an unusual combination in which the clinical signs of both pathologies can mask the complete diagnosis; thus it is important to be acquainted with both pathologies for their correct management and multidisciplinary treatment


Asunto(s)
Humanos , Femenino , Anciano , Fístula del Seno Cavernoso de la Carótida/complicaciones , Oftalmopatía de Graves/complicaciones , Fístula del Seno Cavernoso de la Carótida/diagnóstico por imagen , Ojo/irrigación sanguínea , Oftalmopatía de Graves/diagnóstico , Hiperemia/diagnóstico , Hipertiroidismo/complicaciones , Músculos Oculomotores/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Ultrasonografía Doppler , Venas/diagnóstico por imagen
19.
Cells ; 8(7)2019 07 19.
Artículo en Inglés | MEDLINE | ID: mdl-31331111

RESUMEN

Angiogenesis plays important roles in development, stress response, wound healing, tumorigenesis and cancer progression, diabetic retinopathy, and age-related macular degeneration. It is a complex event engaging many signaling pathways including vascular endothelial growth factor (VEGF), Notch, transforming growth factor-beta/bone morphogenetic proteins (TGF-ß/BMPs), and other cytokines and growth factors. Almost all of them eventually funnel to two crucial molecules, VEGF and hypoxia-inducing factor-1 alpha (HIF-1α) whose expressions could change under both physiological and pathological conditions. Hypoxic conditions stabilize HIF-1α, while it is upregulated by many oncogenic factors under normaxia. HIF-1α is a critical transcription activator for VEGF. Recent studies have shown that intracellular metabolic state participates in regulation of sprouting angiogenesis, which may involve AMP-activated protein kinase (AMPK). Indeed, AMPK has been shown to exert both positive and negative effects on angiogenesis. On the one hand, activation of AMPK mediates stress responses to facilitate autophagy which stabilizes HIF-1α, leading to increased expression of VEGF. On the other hand, AMPK could attenuate angiogenesis induced by tumor-promoting and pro-metastatic factors, such as the phosphoinositide 3-kinase /protein kinase B (Akt)/mammalian target of rapamycin (PI3K/Akt/mTOR), hepatic growth factor (HGF), and TGF-ß/BMP signaling pathways. Thus, this review will summarize research progresses on these two opposite effects and discuss the mechanisms behind the discrepant findings.


Asunto(s)
Proteínas Quinasas Activadas por AMP/fisiología , Neovascularización Patológica/enzimología , Neovascularización Fisiológica , Fosfatidilinositol 3-Quinasas/metabolismo , Proteínas Proto-Oncogénicas c-akt/metabolismo , Serina-Treonina Quinasas TOR/metabolismo , Animales , Carcinogénesis , Retinopatía Diabética/metabolismo , Ojo/irrigación sanguínea , Humanos , Subunidad alfa del Factor 1 Inducible por Hipoxia/metabolismo , Degeneración Macular/metabolismo , Ratones , Neoplasias/irrigación sanguínea , Factor de Crecimiento Transformador beta/metabolismo , Factor A de Crecimiento Endotelial Vascular/metabolismo
20.
Nanomedicine (Lond) ; 14(19): 2595-2611, 2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31361188

RESUMEN

Aim: To improve the retention of fluorescein sodium (FS) as a kind of clinical contrast agent for fundus fluorescein angiography (FFA). Materials & methods: Polyethyleneimine (PEI) was designed to synthesize PEI-NHAc-FS nanoparticles (NPs), and the formed NPs were characterized by both physicochemical properties and their effects on FFA. Results: Compared with free FS, PEI-NHAc-FS NPs showed similar optical performance, and could obviously reduce cellular adsorption and uptake both in vitro and in vivo, which could promote the metabolism of NPs in ocular blood vessels. Conclusion: PEI-NHAc-FS NPs represent a smart nanosize fluorescence contrast agent, which hold promising potential for clinical FFA diagnosis, therapy and research work.


Asunto(s)
Medios de Contraste/química , Angiografía con Fluoresceína , Fluoresceína/química , Nanopartículas/química , Adsorción/efectos de los fármacos , Vasos Sanguíneos/diagnóstico por imagen , Vasos Sanguíneos/patología , Medios de Contraste/síntesis química , Medios de Contraste/farmacología , Ojo/irrigación sanguínea , Ojo/diagnóstico por imagen , Ojo/patología , Fluoresceína/farmacología , Humanos , Polietileneimina/síntesis química , Polietileneimina/química , Polietileneimina/uso terapéutico
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