[Selective ophthalmic artery fibrinolysis in acute central retinal artery occlusion]. / Fibrinolisis selectiva de arteria oftálmica en la oclusión aguda de la arteria central de la retina.

PURPOSE: To evaluate efficacy and reliability of local intra-arterial fibrinolysis (LIF) in Retinal Central Artery Occlusion (RCAO). MATERIAL AND METHOD: We have studied 12 patients with RCAO. Seven patients (group I) were treated with conventional therapy and 5 patients (group II) underwent treatment with urokinase via transcutaneous femoral catheter into the ophthalmic artery. Thereafter patients received heparin sulfate for 3 days. RESULTS: Mean follow up was 14 months and mean time from onset of symptoms to the beginning of therapy was 11 hours. One patient in group I showed improvement of visual acuity (from counting fingers to 0.1). In all patients in group II there was angiographic evidence of improved perfusion of retinal arteries and 4 patients (80%) showed improvement in visual acuity. The best results were obtained when LIF was performed before 10 hours after onset of symptoms. No complications were observed after the fibrinolysis treatment. CONCLUSION: LIF in ophtalmic arteries for the treatment of RCAO reduces dosage of fibrinolytic agents and becomes a safe and useful treatment during the first hours post RCAO.

Fibrinolisis selectiva de arteria oftálmica en la oclusión aguda de la arteria central de la retina / Selective ophthalmic artery fibrinolysis in acute central retinal artery occlusion

Objetivo: Evaluar la eficacia y seguridad de la fibrinolisis local intrarterial (FLI) en la oclusión aguda de la arteria central de la retina (OACR).Material y métodos: Estudiamos 12 pacientes con OACR clasificados en dos grupos. El grupo I (7 pacientes) recibió un tratamiento conservador. El tratamiento del grupo II (5 pacientes) consistió en la infusión de urokinasa intrarterial, mediante la colocación de un microcateter en la arteria oftálmica por vía transcutánea femoral, seguida de heparinización durante 3 días. Resultados: La media de seguimiento fue de 14 meses. El período de latencia medio entre el inicio de la clínica y el tratamiento fue de 11 horas. En el grupo I sólo un paciente mejoró su agudeza visual de contar dedos a 0,1. En el grupo II se observó la perfusión del árbol retiniano en todos los pacientes y mejoró la AV de 4 de ellos (80 por ciento). Esta mejoría fue mayor en los pacientes con una evolución menor de 10 horas. No se observaron complicaciones postfibrinolisis. Conclusiones: La FLI en la arteria oftálmica, permite reducir la dosis de fibrinolítico en el tratamiento de la oclusión aguda de la arteria central de la retina. Esto hace que sea una técnica segura y eficaz si se realiza en las primeras horas del cuadro (AU)

Coroidopatía central serosa. Estudio a largo plazo / Central serous choroidopathy. Long term outcome

Objetivo: Determinar las características epidemiológicas, clínicas y la evolución a largo plazo de la coroidopatía central serosa (CCS) en nuestro medio. Métodos: Se han revisado retrospectivamente las historias clínicas y AGF de 113 pacientes diagnosticados de CCS en nuestro Servicio, con un seguimiento mínimo de 1 año. Resultados: De los 113 pacientes, 90 fueron hombres y 23 mujeres, 13 de ellos bilaterales. En el 85,7 por ciento de los ojos (Grupo I) la evolución fue buena, con resolución de los síntomas en meses y agudeza visual (AV) media al final del estudio de 79,3/100, mientras que el 14,3 por ciento de los ojos evolucionó de forma crónica (Grupo II), con afectación difusa del EPR y AV media final de 47,2/100. La edad media en el Grupo II fue de 42,5 años, significativamente mayor que en el Grupo I (37,6 años) y el porcentaje de hombres del Grupo II (93,3 por ciento) significativamente superior al del grupo I (77,6 por ciento). El porcentaje de bilateralidad fue del 6 por ciento en el Grupo I, frente al 46,6 por ciento del Grupo II. Conclusiones: La forma crónica de CSC afecta a menos del 15 por ciento de los pacientes. La edad media de estos pacientes es superior a la de la forma típica, la gran mayoría son varones, afecta a los 2 ojos en casi el 50 por ciento de los casos, con deterioro importante de visión en el 50 por ciento de los ojos (AU)

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[Central serous choroidopathy. Long term study]. / Coroidopatía central serosa. Estudio a largo plazo.

PURPOSE: To investigate the demographic characteristics, clinical findings and long-term outcome of central serous chorioretinopathy (CSC). METHODS: This study examined retrospectively the clinical stories and fluorescein angiographies of 113 patients with CSC and a minimum follow-up of 12 months. RESULTS: A total of 113 patients was examined; 90 were men and 23 women. Bilateral involvement was found in 13 cases. In 85.7% of the eyes (Group I) resolution was completed in months and mean final visual acuity (VA) was 79.3/100, while 14.3% of the eyes (Group II) showed a chronic evolution, with diffuse retinal pigment epithelipathy and mean final VA of 47.2/100. The mean age of the patients in Group II was significantly higher; male:female ratio was also higher in this Group. Bilateral involvement occurred in 6% of patients from Group I and in 46.6% in Group II. CONCLUSIONS: Chronic CSC affected less than 15% of the patients. Mean age in this group of patients was higher than in patients with a classic CSC, most of the cases were men, bilateral involvement was present in nearly 50% of the cases and 50% of them suffered a significant visual permanent impairment.

The AgNOR quantity as prognostic parameter in choroidal melanomas: a standardised analysis.

In order to assess the prognostic significance of silver-stained nucleolar organizer region (AgNOR) proteins, a standardised analysis has been performed on 34 ocular globes with choroidal melanomas. On formalin-fixed paraffin-embedded sections, the visualisation and quantification of AgNORs were achieved according to the guidelines of the Committee on AgNOR Quantification (1995); statistical analysis was performed on the mean AgNOR area values (NORA). We have encountered significantly higher NORA values in nonspindle shaped elements, in tumours of larger dimensions as well as in those with worse clinical course; no correlations were achieved when the AgNOR quantity was compared with age, sex and amount of pigment. The comparison of Kaplan-Meier survival curves revealed that patients affected by melanomas with higher NORA values (>3.327 microm2), non-spindle cell histotype and increased size of tumour had a worse prognosis; finally, by Cox multivariate analysis, the AgNOR quantity appeared the only independent prognostic variable to predict the final outcome of patients.

Diode laser photocoagulation in retinopathy of prematurity.

We used diode laser photocoagulation to treat 22 eyes of 12 patients with retinopathy of prematurity. Three infants were followed for at least six months and nine for at least one year. We treated 14 eyes with threshold disease and 8 eyes with prethreshold disease. The treatment was administered within 72 hours of diagnosis and topical anesthesia and sedation were used. No evidence of lesions of the anterior segment of preretinal or vitreous hemorrhages was found after the treatment. External inflammatory signs were neglibible. Systemic complications occurred only in three treatment sessions. Eight of the 14 eyes with threshold disease (57%) and all eight eyes with prethreshold disease had favorable outcomes. In total 73% with ROP had favorable outcomes. Treatment with the diode laser is easily performed, effective essentially in cases of prethreshold disease but in threshold disease too, with minimal ocular or systemic complications.

Semiconductor diode laser transscleral cyclophotocoagulation versus filtering surgery with Mitomycin-C.

Both filtering surgery with Mitomycin-C and diode laser cyclophotocoagulation have proved to be effective alternatives in cases of glaucoma with poor surgical prognosis. The right eyes of 40 pigmented rabbits were randomly divided into 2 groups: Mitomycin-C group underwent filtering surgery with application of 0.4 mg/ml of Mitomycin-C whereas the diode laser (DL) group received 15 applications of 1.8 J (1800 mW. 1000 ms) distributed in 270 degrees. Mean IOP showed statistical differences in two periods between days 3-13 and 45-60-Mann-Whitney U test -with a higher IOP lowering in the DL group. The comparison of IOP survival curves (Log-Rank test) was not significant p = 0.070809. Ocular hypertension, hyphema and inflammatory signs were higher in the DL group, both in short and long term, but in terms of statistical significance only ocular hypertension showed differences p = 0.00011717-Fisher exact test. Microscopic examination revealed patent sclerostomies in 60% of the MMC group eyes with different grades of fibroblastic proliferation. In the DL group we observed necrosis of the scleral stroma and of the pigmented and unpigmented ciliary epithelium, with signs of thermal coagulation of the ciliary stroma and of the stromal vasculature. We must point out that the treatment with laser has proved to be more effective although both treatments showed very acceptable IOP lowering until 2 months after the surgery.

Assessment of diurnal tensional curve in early glaucoma damage.

We know very little about the relationship between the diurnal intraocular pressure variations and the progression of visual field loss. A prospective study of 149 eyes of 149 patients suffering from intraocular hypertension has been carried out through a minimum period of five years. At least 4 years before the appearance of field defects, we detected significant oscillations of IOP in the 64% of the cases prone to develop visual field loss. Likewise, we have found a statistically significant relationship between the presence of defects in the RNFL (retinal nerve fiber layer) and the existence of significant oscillations of IOP.

Prediction of the effect of ofloxacine on intestinal absorption: effect of the body weight and substrate concentration.

1. The effect of body weight and initial concentration on the rat small intestinal absorption of DL-8280 (ofloxacine) is studied using a recirculating perfusion technique and an improved HPLC method. 2. A prediction equation is developed under statistical and physiological considerations which correlates both factors with the intestinal absorption rate parameter Kapp.