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1.
BMJ Case Rep ; 14(2)2021 Feb 10.
Artículo en Inglés | MEDLINE | ID: mdl-33568408

RESUMEN

A 38-year-old woman who had previously been diagnosed and treated for unilateral Vogt-Koyanagi-Harada syndrome (VKH) and had undergone multiple intravitreal bevacizumab injections to manage inflammatory choroidal neovascularisation in her right eye, presented 2 years later with visual complains in left eye. Clinical examination, fluorescein angiography, indocyanine green angiography (ICGA) and enhanced depth imaging optical coherence tomography (EDI-OCT) assisted evaluation confirmed active inflammation of left eye along with absence of any inflammation in the right eye. Unilateral active inflammation can be seen in the setting of VKH. To our best knowledge, ours is the first case of VKH in which unilateral active inflammation has been proven based on ICGA and EDI OCT analysis.


Asunto(s)
Coroides/fisiopatología , Angiografía con Fluoresceína/métodos , Inflamación/diagnóstico , Enfermedades de la Retina/diagnóstico , Tomografía de Coherencia Óptica/métodos , Síndrome Uveomeningoencefálico/diagnóstico , Adulto , Femenino , Humanos
2.
J Med Case Rep ; 15(1): 15, 2021 Jan 15.
Artículo en Inglés | MEDLINE | ID: mdl-33451352

RESUMEN

BACKGROUND: Hyperreflective lesions at the level of ganglion cell (GCL) and inner plexiform retinal layers (IPL) by optical coherence tomography (OCT) and cotton wool spots in the examination of the eye fundus have recently been described as findings in patients with COVID-19 infection. CASE REPORT: We report the case of a 42-year-old healthy Caucasian male anesthetist who had treated COVID-19 patients during the previous 5 weeks and suddenly presented with a temporal relative scotoma in his left eye. Best-corrected visual acuity was 20/20 for the left eye, and no discromatopsy or afferent pupillary defect was present. Visual field test was performed, with no significant findings associated with the focal loss of sensitivity described by the patient. The anterior segment was unremarkable on slit lamp examination in both eyes. Fundus examination of the left eye showed no significant findings. A placoid, hyperreflective band at the level of the GCL and IPL was visible in OCT which spared the outer retina, at the time of diagnosis and 1 month later. An oropharyngeal swab test was performed for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ribonucleic acid (RNA), immunoglobulin G (IgG) and immunoglobulin M (IgM) enzyme-linked immunosorbent assay (ELISA) determination. Real-time reverse-transcriptase polymerase chain reaction (RT-PCR) was negative. ELISA testing and a third rapid antibody detection test performed 7 days after the onset of symptoms were positive. CONCLUSIONS: Ocular signs and symptoms in COVID-19 cases are rarely reported, but may be underestimated, especially those that affect the retina and occur in asymptomatic or paucisymptomatic cases. We present a case of COVID-19 diagnosis based on retinal ophthalmic examination.


Asunto(s)
Fondo de Ojo , Retina/diagnóstico por imagen , Escotoma , Tomografía de Coherencia Óptica/métodos , Adulto , Infecciones Asintomáticas , /diagnóstico , /métodos , Errores Diagnósticos/prevención & control , Técnicas de Diagnóstico Oftalmológico , Humanos , Masculino , Escotoma/diagnóstico , Escotoma/etiología , Agudeza Visual
3.
Curr Opin Ophthalmol ; 32(2): 105-117, 2021 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-33395111

RESUMEN

PURPOSE OF REVIEW: The field of artificial intelligence has grown exponentially in recent years with new technology, methods, and applications emerging at a rapid rate. Many of these advancements have been used to improve the diagnosis and management of glaucoma. We aim to provide an overview of recent publications regarding the use of artificial intelligence to enhance the detection and treatment of glaucoma. RECENT FINDINGS: Machine learning classifiers and deep learning algorithms have been developed to autonomously detect early structural and functional changes of glaucoma using different imaging and testing modalities such as fundus photography, optical coherence tomography, and standard automated perimetry. Artificial intelligence has also been used to further delineate structure-function correlation in glaucoma. Additional 'structure-structure' predictions have been successfully estimated. Other machine learning techniques utilizing complex statistical modeling have been used to detect glaucoma progression, as well as to predict future progression. Although not yet approved for clinical use, these artificial intelligence techniques have the potential to significantly improve glaucoma diagnosis and management. SUMMARY: Rapidly emerging artificial intelligence algorithms have been used for the detection and management of glaucoma. These algorithms may aid the clinician in caring for patients with this complex disease. Further validation is required prior to employing these techniques widely in clinical practice.


Asunto(s)
Inteligencia Artificial , Técnicas de Diagnóstico Oftalmológico , Glaucoma/diagnóstico , Modelos Estadísticos , Algoritmos , Humanos , Aprendizaje Automático , Fotograbar , Tomografía de Coherencia Óptica/métodos
4.
Curr Opin Ophthalmol ; 32(2): 98-104, 2021 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-33332883

RESUMEN

PURPOSE OF REVIEW: The aim of this article is to summarize findings of recent reports highlighting the utility of novel optical coherence tomography (OCT) parameters in the diagnosis and monitoring of glaucomatous optic neuropathy. RECENT FINDINGS: Optic nerve head (ONH), retinal nerve fiber layer (RNFL), and macular parameters show high levels of diagnostic capability. The Bruch's membrane opening-minimum rim width (BMO-MRW) measurement is a novel ONH parameter obtained using the Spectralis SD-OCT device (Heidelberg Engineering, Inc., Heidelberg, Germany). The inferotemporal BMO-MRW sector shows the highest diagnostic performance for this parameter. Minimum ganglion cell and inner plexiform layer thickness shows the highest diagnostic performance among macular parameters obtained with the Cirrus HD-OCT (Carl Zeiss, Inc., Dublin, CA, USA). Optic nerve head, macular, and retinal nerve fiber layer parameters are not interchangeable across protocols generated by varying OCT manufacturers. Novel machine-learning algorithms show promise with regards to achieving higher levels of diagnostic accuracy using OCT imaging platforms. SUMMARY: Digital imaging in glaucoma continues to evolve with novel parameters of the optic nerve head, retinal nerve fiber layer, and macula. Diagnostic abilities of these parameters are high and complementary to each other.


Asunto(s)
Glaucoma/diagnóstico , Fibras Nerviosas/patología , Disco Óptico/patología , Enfermedades del Nervio Óptico/diagnóstico , Células Ganglionares de la Retina/patología , Tomografía de Coherencia Óptica/métodos , Lámina Basal de la Coroides/patología , Humanos
5.
Rom J Ophthalmol ; 64(3): 285-291, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33367162

RESUMEN

Purpose: To describe the central three-dimensional (3D) thickness profile of the macula (CMT) and the subfoveal choroidal region (SFCT) in diabetic retinopathy (DR) following panretinal laser photocoagulation (PRP) using swept-source optical coherence tomography (SS-OCT). Methods: A prospective observational study including 17 eyes with proliferative DR (PDR) and 27 eyes with severe nonproliferative DR (sNPDR)] for whom PRP was done. All subjects received SS-OCT imaging before and 3 months after PRP (POM#3). SFCT and CMT changes were analysed at both visits. Intraclass Correlation Coefficients (ICC) and Coefficients of Variation (COV) were used to test the accuracy of thickness data. Results: SFCT has thinned from 233 ± 54 µm before PRP treatment to 216 ± 51 µm 3 months later (p < 0.001). Likewise, CMT declined at POM#3 as compared to pre-PRP status (p<0.001). SFCT was thinner in PDR before and at POM#3 (p<0.05) than sNPDR; whereas, no significant difference was observed in CMT between both groups in the two visits. No significant changes were found between groups in SFCT and CMT at POM#3. Regarding reliability, ICCSFCT=0.98 and ICCCMT=0.99. The COVs for CMT and SFCT were 5.03% and 5.91%, respectively. Conclusion: The mean SFCT and CMT decreased 3 months after PRP. We also reported reliability of SFCT measurements in DR using SS-OCT. Abbreviations: SS = Swept-Source, TD = time domain, SD = spectral domain, FD = Fourier-domain, 3D = three-dimensional, 2D = two-dimensional.


Asunto(s)
Coroides/patología , Retinopatía Diabética/diagnóstico , Coagulación con Láser/métodos , Retina/patología , Tomografía de Coherencia Óptica/métodos , Retinopatía Diabética/cirugía , Femenino , Angiografía con Fluoresceína/métodos , Estudios de Seguimiento , Fondo de Ojo , Humanos , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Retina/cirugía , Estudios Retrospectivos
6.
PLoS One ; 15(12): e0244015, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33332434

RESUMEN

High-risk coronary plaques have been considered predictive of adverse cardiac events. Both wall shear stress (WSS) in patients with hemodynamically significant lesions and optical coherence tomography (OCT) -verified thin-cap fibroatheroma (TCFA) are associated with plaque rupture, the most common underlying mechanism of acute coronary syndrome. The aim of the study was to test the hypothesis that invasive coronary angiography-based high WSS is associated with the presence of TCFA detected by OCT in obstructive lesions. From a prospective study of patients who underwent OCT examination for angiographically obstructive lesions (Yellow II), we selected patients who had two angiographic projections to create a 3-dimensional reconstruction model to allow assessment of WSS. The patients were divided into 2 groups according to the presence and absence of TCFA. Mean WSS was assessed in the whole lesion and in the proximal, middle and distal segments. Of 70 patients, TCFA was observed in 13 (19%) patients. WSS in the proximal segment (WSSproximal) (10.20 [5.01, 16.93Pa]) and the whole lesion (WSSlesion) (12.37 [6.36, 14.55Pa]) were significantly higher in lesions with TCFA compared to WSSproximal (5.84 [3.74, 8.29Pa], p = 0.02) and WSSlesion (6.95 [4.41, 11.60], p = 0.04) in lesions without TCFA. After multivariate analysis, WSSproximal was independently associated with the presence of TCFA (Odds ratio 1.105; 95%CI 1.007-1.213, p = 0.04). The optimal cutoff value of WSSproximal to predict TCFA was 6.79 Pa (AUC: 0.71; sensitivity: 0.77; specificity: 0.63 p = 0.02). Our results demonstrate that high WSS in the proximal segments of obstructive lesions is an independent predictor of OCT-verified TCFA.


Asunto(s)
Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Hemodinámica , Placa Aterosclerótica/diagnóstico por imagen , Tomografía de Coherencia Óptica/métodos , Anciano , Angiografía Coronaria/métodos , Enfermedad de la Arteria Coronaria/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Placa Aterosclerótica/patología , Túnica Íntima/diagnóstico por imagen , Túnica Íntima/patología
7.
JAMA Netw Open ; 3(12): e2030824, 2020 12 01.
Artículo en Inglés | MEDLINE | ID: mdl-33351088

RESUMEN

Importance: Mild traumatic brain injury (TBI) may predispose individuals to progressive neurodegeneration. Objective: To identify evidence of neurodegeneration through longitudinal evaluation of changes in retinal layer thickness using optical coherence tomography in veterans with a history of mild TBI. Design, Setting, and Participants: This longitudinal cohort study evaluated veterans who were receiving services at the Minneapolis Veterans Affairs Health Care System. Symptomatic or mild TBI was diagnosed according to the Mayo TBI Severity Classification System. Participants in the age-matched control group had no history of TBI. Participants with any history or evidence of retinal or optic nerve disease that could affect retinal thickness were excluded. Data analysis was performed from July 2019 to February 2020. Exposures: The presence and severity of mild TBI were determined through consensus review of self-report responses during the Minnesota Blast Exposure Screening Tool semistructured interview. Main Outcomes and Measures: Change over time of retinal nerve fiber layer (RNFL) thickness. Results: A total of 139 veterans (117 men [84%]; mean [SD] age, 49.9 [11.1] years) were included in the study, 69 in the TBI group and 70 in the control group. Veterans with mild TBI showed significantly greater RNFL thinning compared with controls (mean [SE] RNFL slope, -1.47 [0.24] µm/y vs -0.31 [0.32] µm/y; F1,122 = 8.42; P = .004; Cohen d = 0.52). Functionally, veterans with mild TBI showed greater declines in visual field mean deviation (mean [SE] slope, -0.09 [0.14] dB/y vs 0.46 [0.23] dB/y; F1,122 = 4.08; P = .046; Cohen d = 0.36) and pattern standard deviation (mean [SE] slope, 0.09 [0.06] dB/y vs -0.10 [0.07] dB/y; F1,122 = 4.78; P = .03; Cohen d = 0.39) and high spatial frequency (12 cycles/degree) contrast sensitivity compared with controls. Cognitively, there was a significantly greater decrease in the number of errors over time during the Groton Maze Learning Test (GMLT) in controls compared with veterans with mild TBI (mean [SE] slope, -9.30 [1.48] errors/y vs -5.23 [1.24] errors/y; F1,127 = 4.43; P = .04; Cohen d = 0.37). RNFL tissue loss was significantly correlated with both worsening performance on the GMLT over time (Spearman ρ = -0.20; P = .03) and mild TBI severity (Spearman ρ = -0.25; P = .006). The more severe the mild TBI (larger Minnesota Blast Exposure Screening Tool severity score), the faster the reduction in RNFL thickness (ie, the more negative the slope) across time. Conclusions and Relevance: This cohort study found longitudinal evidence for significant, progressive neural degeneration over time in veterans with mild TBI, as indicated by greater RNFL tissue loss in patients with mild TBI vs controls, as well as measures of function. These results suggest that these longitudinal measures may be useful biomarkers of neurodegeneration. Changes in this biomarker may provide early detection of subsequent cognitive and functional deficits that may impact veterans' independence and need for care.


Asunto(s)
Conmoción Encefálica , Cognición , Enfermedades Neurodegenerativas , Pruebas Neuropsicológicas/estadística & datos numéricos , Tomografía de Coherencia Óptica/métodos , Pruebas del Campo Visual , Conmoción Encefálica/complicaciones , Conmoción Encefálica/fisiopatología , Enfermedad Crónica , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Enfermedades Neurodegenerativas/diagnóstico , Enfermedades Neurodegenerativas/etiología , Enfermedades Neurodegenerativas/psicología , Estados Unidos/epidemiología , Salud de los Veteranos/estadística & datos numéricos , Pruebas del Campo Visual/métodos , Pruebas del Campo Visual/estadística & datos numéricos
9.
BMJ Case Rep ; 13(11)2020 Nov 04.
Artículo en Inglés | MEDLINE | ID: mdl-33148560

RESUMEN

A 60-year-old man recently admitted for bipedal oedema, endocarditis and a persistently positive COVID-19 swab with a history of anticoagulation on rivaroxaban for atrial fibrillation, transitional cell carcinoma, cerebral amyloid angiopathy, diabetes and hypertension presented with sudden onset diplopia and vertical gaze palsy. Vestibulo-ocular reflex was preserved. Simultaneously, he developed a scotoma and sudden visual loss, and was found to have a right branch retinal artery occlusion. MRI head demonstrated a unilateral midbrain infarct. This case demonstrates a rare unilateral cause of bilateral supranuclear palsy which spares the posterior commisure. The case also raises a question about the contribution of COVID-19 to the procoagulant status of the patient which already includes atrial fibrillation and endocarditis, and presents a complex treatment dilemma regarding anticoagulation.


Asunto(s)
Aspirina/administración & dosificación , Fibrilación Atrial , Ceguera , Infartos del Tronco Encefálico , Infecciones por Coronavirus , Diplopía , Endocarditis Bacteriana , Oftalmoplejía , Pandemias , Neumonía Viral , Pirazoles/administración & dosificación , Piridonas/administración & dosificación , Oclusión de la Arteria Retiniana , Fibrilación Atrial/complicaciones , Fibrilación Atrial/tratamiento farmacológico , Betacoronavirus/aislamiento & purificación , Ceguera/diagnóstico , Ceguera/etiología , Infartos del Tronco Encefálico/diagnóstico por imagen , Infartos del Tronco Encefálico/tratamiento farmacológico , Infartos del Tronco Encefálico/fisiopatología , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/fisiopatología , Diplopía/diagnóstico , Diplopía/etiología , Endocarditis Bacteriana/complicaciones , Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/fisiopatología , Inhibidores del Factor Xa/administración & dosificación , Humanos , Imagen por Resonancia Magnética/métodos , Masculino , Persona de Mediana Edad , Oftalmoplejía/diagnóstico , Oftalmoplejía/etiología , Inhibidores de Agregación Plaquetaria/administración & dosificación , Neumonía Viral/complicaciones , Neumonía Viral/diagnóstico , Neumonía Viral/fisiopatología , Oclusión de la Arteria Retiniana/diagnóstico por imagen , Oclusión de la Arteria Retiniana/tratamiento farmacológico , Oclusión de la Arteria Retiniana/etiología , Oclusión de la Arteria Retiniana/fisiopatología , Tomografía de Coherencia Óptica/métodos , Resultado del Tratamiento
10.
Arch. Soc. Esp. Oftalmol ; 95(11): 544-549, nov. 2020. tab, ilus, graf
Artículo en Español | IBECS | ID: ibc-197745

RESUMEN

OBJETIVO: Comparar el grosor epitelial corneal (GEC) en pacientes intervenidos de LASIK miópico de más de un año respecto a sujetos no operados. MÉTODOS: En este estudio retrospectivo observacional se incluyeron 93 sujetos no operados (186 ojos) y 26 sujetos (52 ojos) operados de LASIK miópico. Se realizó una tomografía óptica de segmento anterior (OCT-SA) combinada con anillo de Plácido en todos los sujetos y se midió el GEC por sectores. Se hizo análisis estadístico para determinar diferencias entre las variables medidas en ambos grupos, así como análisis multivariante para buscar predictores de GEC. RESULTADOS: No hubo diferencias significativas entre los grupos en términos demográficos (edad, sexo) ni de segmento anterior (equivalente esférico, paquimetría) (todas las p > 0,05). Se obtuvieron diferencias estadísticamente significativas (p < 0,05) entre los dos grupos en todos los sectores estudiados, central, anillos interno y externo, siendo mayores todos los valores de GEC en los pacientes intervenidos de LASIK ≥ 1 año. A excepción del tiempo transcurrido desde la cirugía (p = 0,00), no se encontró correlación entre el GEC y la edad, el sexo, las dioptrías ablacionadas ni otra variable estudiada (p > 0,05). CONCLUSIONES: El GEC medio y por sectores medido mediante la OCT-SA es mayor en pacientes intervenidos de LASIK hace más de un año. La única variable correlacionada con el GEC tras el LASIK es el tiempo desde la cirugía. Las modificaciones del GEC deben ser tenidas en cuenta al planear la cirugía refractiva por sus implicaciones en el resultado final


OBJECTIVE: To compare corneal epithelial thickness (CET) between patients who underwent LASIK surgery for the correction of myopia at least one year ago and healthy subjects. METHODS: A retrospective observational study was conducted that included 93 healthy subjects (186 eyes) and 26 subjects (52 eyes) that underwent myopic LASIK surgery. OCT-SA, combined with Placido disk, was performed on all subjects, and CET maps were measured. Statistical analysis was performed to analyse differences between groups. Multivariate analysis was also performed to look for possible predictors of final CET. RESULTS: There was no statistically significant differences between the groups in the demographic (age, sex) or anterior segment parameters (spherical equivalent, pachymetry) (all P > .05). Statistically significant differences (P < .05) were obtained between both groups when comparing CET, including central, internal, and external rings (higher in patients that underwent LASIK surgery ≥1 year). With the exception of the time elapsed since surgery (P = .00), no correlation was found between the CET and age, sex, ablated dioptres, or other variables studied (P < .05). CONCLUSIONS: CET values measured by the OCT-SA were higher in patients that underwent LASIK surgery ≥ 1 year. The only variable that correlated with the CET after LASIK was the time elapsed since surgery. CET changes should be taken into consideration when planning refractive surgery due to its implications on the final outcome


Asunto(s)
Humanos , Masculino , Femenino , Adulto Joven , Adulto , Paquimetría Corneal/métodos , Queratomileusis por Láser In Situ/métodos , Tomografía de Coherencia Óptica/métodos , Estudios Retrospectivos , Estudios de Casos y Controles , Resultado del Tratamiento , Valores de Referencia , Análisis de Varianza , Agudeza Visual , Córnea/patología
11.
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
13.
Am J Case Rep ; 21: e927691, 2020 Oct 29.
Artículo en Inglés | MEDLINE | ID: mdl-33116072

RESUMEN

BACKGROUND COVID-19 is the disease caused by the novel virus, severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2). The spectrum of disease seen in patients with COVID-19 infection ranges from asymptomatic or mild symptoms to severe pneumonia and even acute respiratory distress syndrome, which often requires invasive ventilation and intensive care. COVID-19-associated infection can be catastrophic, leading to both arterial and venous occlusion, microinfarcts, and multiorgan failure, although retinal vein occlusion has not yet been reported. CASE REPORT We present the case of a 40-year-old man who presented with a 3-day history of shortness of breath, cough, and fever. He also reported right calf pain and blurring of vision in both eyes. His medical history included hypertension and morbid obesity. The patient was found to have severe COVID-19 pneumonia on high-resolution computed tomography of the chest, right leg deep venous thrombosis on Doppler ultrasonography, and bilateral central retinal vein occlusion (RVO) on fundal examination. He was started on full-dose anticoagulation and discharged on rivaroxaban for 3 months. After 2 weeks of therapy, he had fully recovered from his COVID-19 symptoms and had near-normal vision. CONCLUSIONS COVID-19 infection can cause RVO. Early full-dose anticoagulation should be considered in high-risk patients with severe COVID-19 infection. Ophthalmologists and other clinicians should have a high index of suspicion for RVO in patients with COVID-19 infection who presenting with blurred vision and severe pneumonia.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/complicaciones , Neumonía Viral/complicaciones , Oclusión de la Vena Retiniana/etiología , Agudeza Visual , Adulto , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Humanos , Masculino , Pandemias , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Oclusión de la Vena Retiniana/diagnóstico , Tomografía de Coherencia Óptica/métodos , Tomografía Computarizada por Rayos X
14.
Ocul Immunol Inflamm ; 28(8): 1298-1300, 2020 Nov 16.
Artículo en Inglés | MEDLINE | ID: mdl-33021846

RESUMEN

PURPOSE: To report a unique case of intraocular inflammation and outer retinal changes in a patient with coronavirus disease (COVID-19). CASE REPORT: A 57-year-old woman was seen 12 days after COVID-19 symptoms onset confirmed by positive IgM and IgG serological tests. No anterior chamber cells were seen. Color fundus photograph showed a yellowish lesion within the macular area, and fluorescein angiography revealed hyperfluorescence on the topography of the macular lesion in both eyes. Spectral-domain optical coherence tomography demonstrated hyperreflective pinpoints at the level of posterior vitreous hyaloid, corresponding to vitritis, hyperreflective lesions at the level of inner plexiform and ganglion cell layers, and disruption of the ellipsoid zone. CONCLUSION AND IMPORTANCE: COVID-19 is known to affect the inner retinal layers. The current case not only supports but also adds a vitreal and an outer retinal layer involvement that might also be caused by this infectious disease.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/complicaciones , Oftalmopatías/etiología , Angiografía con Fluoresceína/métodos , Neumonía Viral/complicaciones , Segmento Externo de las Células Fotorreceptoras Retinianas/patología , Tomografía de Coherencia Óptica/métodos , Cuerpo Vítreo/patología , Infecciones por Coronavirus/epidemiología , Oftalmopatías/diagnóstico , Femenino , Fondo de Ojo , Humanos , Persona de Mediana Edad , Pandemias , Neumonía Viral/epidemiología , Agudeza Visual
15.
Ocul Immunol Inflamm ; 28(8): 1293-1297, 2020 Nov 16.
Artículo en Inglés | MEDLINE | ID: mdl-33021856

RESUMEN

A 53-year-old man presented with acute loss of vision, negative scotoma and dyschromatopsia in his left eye. He reported contact with people with severe respiratory syndrome - coronavirus-2 (SARS-CoV-2) 8 days prior symptoms. Funduscopic examination revealed several retinal hemorrhages. Spectral-domain optical coherence tomography showed lesions consistent with acute macular neuroretinopathy and paracentral acute middle maculopathy. Quickly after his presentation, SARSCov-2 was confirmed by chest computed tomography-scan and RT-PCR in this patient. Thrombotic complications associated with Covid-19 infection have high incidence and may involve the retina. We described a case of retinal involvement associated with Covid-19 infection. PRÉCIS: Funduscopic examination revealed retinal hemorrhages in a man with loss of vision. Optical coherence tomography showed an acute macular neuroretinopathy and paracentral acute middle maculopathy. Coronavirus disease was confirmed by chest computed tomography-scan and RT-PCR.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/complicaciones , Angiografía con Fluoresceína/métodos , Mácula Lútea/patología , Neumonía Viral/complicaciones , Enfermedades de la Retina/etiología , Tomografía de Coherencia Óptica/métodos , Agudeza Visual , Enfermedad Aguda , Infecciones por Coronavirus/epidemiología , Fondo de Ojo , Humanos , Masculino , Persona de Mediana Edad , Oftalmoscopía , Pandemias , Neumonía Viral/epidemiología , Enfermedades de la Retina/diagnóstico
16.
Rev. bras. oftalmol ; 79(5): 336-339, set.-out. 2020. tab, graf
Artículo en Inglés | LILACS | ID: biblio-1137986

RESUMEN

Abstract Sclerochoroidal calcifications (SC) are a rare and benign ocular condition characterized by yellow-white irregular subretinal lesions usually found in the supero-temporal arcade of the midperipheral fundus in middle-aged elderly men. We present a clinical case of a 79- year-old patient who during a fundus examination presented raised whitish nodules in the supero-temporal arcade in the right eye. After performing optical coherence tomography, ultrasound, ocular computed tomography and laboratory analysis, she was diagnosed with idiopathic sclerochoroidal calcifications The pathogenesis of sclerochoroidal calcifications remains unclear but systemic conditions should be discarded. It is important to distinguish sclerochoroidal calcifications from other conditions such as tumors.


Resumo Calcificações esclerocoroidais (SC) são uma condição ocular rara e benigna caracterizada por lesões sub-retinianas irregulares amarelo-brancas, geralmente encontradas na arcada superotemporal do fundo médio-periférico em homens idosos de meia-idade. Apresentamos um caso clínico de uma paciente de 79 anos que durante exame de fundo apresentou nódulos esbranquiçados elevados na arcada superotemporal do olho direito. Após realizar tomografia de coerência óptica, ultra-sonografia, tomografia computadorizada ocular e análise laboratorial, ela foi diagnosticada com calcificações esclerocoroidais idiopáticas A patogênese das calcificações esclerocoroidais permanece incerta, mas as condições sistêmicas devem ser descartadas. É importante distinguir calcificações esclerocoroidais de outras condições, como tumores.


Asunto(s)
Humanos , Femenino , Anciano , Calcinosis/diagnóstico por imagen , Enfermedades de la Esclerótica/diagnóstico por imagen , Enfermedades de la Coroides/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Ultrasonografía/métodos , Técnicas de Laboratorio Clínico/métodos , Tomografía de Coherencia Óptica/métodos , Diagnóstico Diferencial , Enfermedades Metabólicas
17.
Brasília; CONITEC; out. 2020.
No convencional en Portugués | BRISA/RedTESA | ID: biblio-1141495

RESUMEN

INTRODUÇÃO: O glaucoma é uma doença progressiva, assintomática até seus estágios avançados e cujas lesões são irreversíveis. Estimam-se que cerca de 11,2 milhões de pessoas serão acometidas com cegueira bilateral em 2020, o que torna o glaucoma a principal causa de cegueira irreversível no mundo atualmente. O diagnóstico do glaucoma recomendado no PCDT de glaucoma é realizado por exames que se baseiam nos resultados da avaliação estrutural (disco ótico) e funcional (campo visual), associado ao acompanhamento dos níveis de PIO. O exame de Tomografia de Coerência Óptica ou "Optical Coherence Tomography" (OCT) é uma tecnologia computadorizada de imagem, importante ferramenta auxiliar na avaliação dos pacientes com glaucoma, capaz de otimizar a acurácia diagnóstica da doença, particularmente nas fases iniciais, propiciando melhor qualidade da assistência aos pacientes e menor ocorrência de diagnóstico incorreto ­ "overdiagnosis", com o consequente tratamento e frequência de seguimento desnecessário para indivíduos sem glaucoma, possibilitando alocação mais apropriada/racional dos recursos públicos em saúde. TECNOLOGIA: Tomografia de Coerência Óptica (OCT). PERGUNTA: O uso da Tomografia de Coerência Óptica melhora a acurácia do diagnóstico do glaucoma em pacientes suspeitos pelo aspecto do disco óptico, e/ou alterações do campo visual, e/ou PIO elevada? EVIDÊNCIAS CLÍNICAS: Foram incluídos 4 estudos, sendo 2 revisões sistemáticas (RS) e dois estudos transversais publicados após a elaboração das RS. Para o desfecho de área sob a curva ROC (AROCs), a RS mais recente apresentou resultados de AROCs entre 0.887 e 0.906 para o parâmetro da média da espessura da camada de fibras nervosas da retina (CFNR) e AROCs entre 0.835 e 0.901 para os parâmetros segmentares da mácula, além disso, não foram observadas diferenças estatisticamente significantes entre os aparelhos de OCT. Para o desfecho de desempenho diagnóstico de glaucoma, a acurácia da OCT foi medida de acordo com diferentes parâmetros e a acurácia foi maximizada pela avaliação da CFNR do setor inferior. A sensibilidade do teste foi de 72% (IC 95%: 65% - 77%) e a especificidade de 93% (IC 95%: 92% - 95%). A qualidade da evidência foi classificada como baixa, devido ao alto risco de viés agregado aos estudos primários e incertezas sobre os resultados. AVALIAÇÃO ECONÔMICA: O demandante apresentou uma análise de custo-efetividade para quantificar o impacto da incorporação da OCT no SUS, na confirmação diagnóstica dos casos suspeitos de glaucoma primário de ângulo aberto inicial. Estimou-se que o uso do exame de OCT levaria a uma redução de custo médio de R$ 428,78 por paciente por ano e um aumento absoluto de 76,4% no percentual de diagnósticos corretos. O modelo possui limitações que podem afetar os resultados, como os valores de entrada subestimados e não justificados ou descritos. ANÁLISE DE IMPACTO ORÇAMENTÁRIO: A análise de impacto orçamentário apresentada pelo demandante estimou uma economia para o SUS com a ampliação de uso de OCT, entre R$ 824 mil a R$ 4,5 milhões ao ano, com base nos tratamentos evitados de pacientes com diagnósticos incorretos. As premissas adotadas para o cálculo da população foram consideradas não adequadas ou inconsistentes e por isso os resultados podem estar subestimados, impossibilitando sua interpretação. IMPLEMENTAÇÃO: Apesar do demandante estimar uma economia de recursos totais na análise de impacto orçamentário, a realização do exame gera custos diretos de sua implementação. Levando em consideração o custo SIGTAP do procedimento e o número de pacientes ano a ano estimado pelo demandante, calculamos um custo de R$ 4,9 milhões para o primeiro ano até R$ 5,3 milhões no quinto ano de implementação. RECOMENDAÇÃO INICIAL DA CONITEC: A Conitec, em sua 89ª reunião ordinária, realizada no dia 06 de agosto de 2020, deliberou que a matéria fosse disponibilizada em consulta pública com recomendação preliminar favorável à ampliação de uso no SUS do exame de Tomografia de Coerência Óptica para confirmação diagnóstica do glaucoma em pacientes suspeitos pelo aspecto do disco óptico, e/ou alterações do campo visual, e/ou pressão intraocular elevada. CONSULTA PÚBLICA: Foram recebidas 272 contribuições, 34 pelo formulário Técnico-científico e 238 pelo formulário de Experiência e Opinião, sendo 265 (97%) concordantes com a recomendação preliminar. O tema mais citado nas contribuições diz respeito a acurácia diagnóstica do exame de OCT em detectar alterações glaucomatosas, outros temas foram "a independência da interpretação subjetiva do avaliador dos exames disponíveis", "acurácia em diagnosticar casos precoces de glaucoma" e relatos como "Exame imprescindível para avaliação completa do paciente". RECOMENDAÇÃO FINAL DA CONITEC: Os membros da Conitec presentes na 91ª reunião ordinária, no dia 08 de outubro de 2020, deliberaram por unanimidade recomendar a ampliação de uso do exame de tomografia de coerência óptica para confirmação diagnóstica de glaucoma, conforme Protocolo Clínico e Diretrizes Terapêuticas do Ministério da Saúde. Foi assinado o registro de deliberação nº 565/2020.


Asunto(s)
Humanos , Glaucoma/diagnóstico por imagen , Tomografía de Coherencia Óptica/métodos , Evaluación de la Tecnología Biomédica , Sistema Único de Salud , Brasil , Análisis Costo-Beneficio/economía
18.
PLoS One ; 15(8): e0238246, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32866203

RESUMEN

Young children exhibit poorer visual performance than adults due to immaturity of the fovea and of the fundamental processing of visual functions such as masking and crowding. Recent studies suggest that masking and crowding are closely related to the size of the fundamental processing unit-the perceptive field (PF). However, while it is known that the retina and basic visual functions develop throughout childhood, it is not clear whether and how changes in the size of the PF affect masking and crowding. Furthermore, no retinal and perceptual development data have been collected from the same cohort and time. Here we explored the developmental process of the PF and the basic visual functions. Psychophysical and imaging methods were used to test visual functions and foveal changes in participants ranging from 3-17 years old. Lateral masking, crowding and contrast sensitivity were tested using computerized tasks. Foveal measurements were obtained from spectral-domain optical coherence tomography (OCT). The children patterns below 6 years exhibited high crowding, while the expected facilitation was found only at a larger target-flanker distance than required for children above 6 years, who exhibited the typical adult. Foveal thickness and macular volume for the children below 6 years were significantly lower than for the older group. Significant correlation was found for contrast sensitivity, foveal thickness and macular volume with age and between contrast sensitivity and foveal thickness. Our data suggest that the developmental processes at the retina and visual cortex occur in the same age range. Thus, in parallel to maturation of the PF, which enables reduction in crowding, foveal development contributes to increasing contrast sensitivity.


Asunto(s)
Retina/fisiología , Agudeza Visual/fisiología , Corteza Visual/fisiología , Adolescente , Niño , Preescolar , Sensibilidad de Contraste/fisiología , Aglomeración , Femenino , Fóvea Central/fisiología , Humanos , Edema Macular/fisiopatología , Masculino , Tomografía de Coherencia Óptica/métodos
19.
Ocul Immunol Inflamm ; 28(6): 922-925, 2020 Aug 17.
Artículo en Inglés | MEDLINE | ID: mdl-32870739

RESUMEN

OBJECTIVE: To describe the ocular manifestations in a case of novel coronavirus disease 2019 (COVID-19). MATERIAL AND METHODS: A case of unilateral panuveitis and optic neuritis as initial presentation of COVID-19. RESULTS: As it is published, angiotensin-converting-enzyme-2 receptors can be found in many organs, such as the eyes, nerves, and vessels, so extrapulmonary involvement would be expected. According to current evidence and clinical characteristics of the patient, uveitis and optic neuritis could be produced by the virus. CONCLUSIONS: It is fundamental to consider panuveitis and optic neuritis as an unusual presentation of ocular involvement in COVID-19 so proper care can be given to the patients.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/complicaciones , Infecciones Virales del Ojo/etiología , Neuritis Óptica/etiología , Panuveítis/etiología , Neumonía Viral/complicaciones , Infecciones por Coronavirus/epidemiología , Infecciones Virales del Ojo/diagnóstico , Femenino , Humanos , Persona de Mediana Edad , Nervio Óptico/patología , Neuritis Óptica/diagnóstico , Pandemias , Panuveítis/diagnóstico , Neumonía Viral/epidemiología , Tomografía de Coherencia Óptica/métodos
20.
Middle East Afr J Ophthalmol ; 27(2): 128-130, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32874047

RESUMEN

We report two cases with foveal congenital simple hamartoma of the retinal pigment epithelium (CSHRPE), as both patients presented to our retina services complaining of a unilateral decreased vision. Full ophthalmic examination and multimodal imaging were performed including fundus photography, fundus autofluorescence, optical coherence tomography, fluorescein angiography, and electrophysiological testing. Both patients presented with 20/80 vision in the affected eyes. Foveal CSHRPE was found in both eyes, along with parapapillary hyperpigmented rim, multiple pinpoint macular lesions, and few posterior pole hyperpigmented lesions. Multifocal electroretinogram showed diminished central amplitude in both eyes, with three-dimensional topography map showing blunted foveal peaks in one eye and the absence of a central peak in the other patient. Both patients had a stable vision and clinical examination of the CSHRPE during 5 and 6 years follow up, respectively. Foveal CSHRPE is usually symptomatic and results in a decline in visual acuity. Follow-up of these patients showed stable vision and clinical examination.


Asunto(s)
Hamartoma/congénito , Enfermedades de la Retina/congénito , Epitelio Pigmentado de la Retina/anomalías , Adulto , Técnicas de Diagnóstico Oftalmológico , Electrorretinografía , Angiografía con Fluoresceína , Fóvea Central/patología , Fondo de Ojo , Hamartoma/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Imagen Multimodal , Enfermedades de la Retina/diagnóstico , Epitelio Pigmentado de la Retina/patología , Tomografía de Coherencia Óptica/métodos , Agudeza Visual/fisiología
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