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1.
Eye (Lond) ; 30(6): 865-72, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27055672

RESUMO

PurposeTo develop and validate a Bayesian belief network algorithm for the differential diagnosis of anterior uveitis.Patients and methodsThe 11 most common etiologies were included (idiopathic, ankylosing spondylitis, psoriasic arthritis, reactive arthritis, inflammatory bowel diseases, sarcoidosis, tuberculosis, Behçet, Posner-Schlossman syndrome, juvenile idiopathic arthritis (JIA), and Fuchs' heterochromic cyclitis). Frequencies of association between factors and etiologies were retrieved from a systematic review of the literature. Prevalences were calculated using a random sample of 200 patients receiving a diagnosis of anterior uveitis in Moorfields Eye Hospital in 2012. The network was validated in a random sample of 200 patients receiving a diagnosis of anterior uveitis in the same hospital in 2013 plus 10 extra cases of the most rare etiologies (JIA, Behçet, and psoriasic arthritis).ResultsIn 63.8% of patients the most probable etiology by the algorithm matched the senior clinician diagnosis. In 80.5% of patients the clinician diagnosis matched the first or second most probable results by the algorithm. Taking into account only the most probable diagnosis by the algorithm, sensitivities for each etiology ranged from 100% (7 of 7 patients with reactive arthritis and 5 of 5 with Behçet correctly classified) to 46.7% (7 of 15 patients with tuberculosis-related uveitis). Specificities ranged from 88.8% for sarcoidosis to 99.5% in Posner.ConclusionsThis algorithm could help clinicians with the differential diagnosis of anterior uveitis. In addition, it could help with the selection of the diagnostic tests performed.


Assuntos
Algoritmos , Teorema de Bayes , Uveíte Anterior/diagnóstico , Diagnóstico Diferencial , Humanos , Prevalência , Sensibilidade e Especificidade
2.
Arch Soc Esp Oftalmol ; 81(3): 141-6, 2006 Mar.
Artigo em Espanhol | MEDLINE | ID: mdl-16572357

RESUMO

PURPOSE: To study the clinical signs, treatment and prognosis of strabismus after sub-Tenon's anesthesia for cataract surgery. METHODS: Eight patients without previous strabismus developed incomitant diplopia immediately after cataract surgery; the left eye was affected in five patients and the right eye in three. Restrictive strabismus was diagnosed with the cover test, prisms, and active and passive ductions in all cases. In seven cases the deviation was vertical and in one patient it was horizontal. The average deviation was 17.5 S.D. 9.84 (range 5-35) prismatic dioptres in primary position. The deviation increased looking upward in seven cases, and looking sideways to the left in the other. It was considered to be a good result if the diplopia disappeared after treatment. RESULTS: Botulinum toxin was the first treatment applied in four patients, but only one showed a good response and required no further therapy. Strabismus surgery was required in four cases, and prisms were adapted in three. Three patients required two strabismus operations. A good result was achieved in all cases, with the average time interval being 10.12 (SD 5.5) months. CONCLUSIONS: Sub-Tenon's anesthesia may result in restrictive strabismus and incomitant diplopia which does not resolve spontaneously. The inferior rectus is the most commonly affected muscle. Strabismus surgery is required to resolve the diplopia in half of the cases. Good results have been achieved in all patients.


Assuntos
Anestesia Local/efeitos adversos , Extração de Catarata/efeitos adversos , Diplopia/etiologia , Estrabismo/etiologia , Idoso , Idoso de 80 Anos ou mais , Anestesia Local/métodos , Toxinas Botulínicas Tipo A/administração & dosagem , Extração de Catarata/métodos , Diplopia/tratamento farmacológico , Feminino , Humanos , Masculino , Fármacos Neuromusculares/administração & dosagem , Complicações Pós-Operatórias , Estrabismo/tratamento farmacológico , Resultado do Tratamento , Acuidade Visual
3.
Arch. Soc. Esp. Oftalmol ; 81(3): 141-146, mar. 2006. tab
Artigo em Es | IBECS | ID: ibc-046735

RESUMO

Objetivo: Estudiar las características del estrabismosecundario a la cirugía de catarata con anestesiasubtenoniana; su tratamiento y pronóstico.Método: Ocho enfermos sin estrabismo previo presentarondiplopía inmediatamente después de lacirugía de catarata; cinco de ojo izquierdo, tres deojo derecho. La exploración con cover test, prismasy ducción activa y pasiva mostró estrabismo restrictivo:siete de componente vertical y uno horizontal.La desviación media fue de 17,5 DE: 9,84 dioptríasprismáticas (rango 5-35) en la mirada al frente. Laposición máxima de desviación fue en supraversiónen siete, y en levoversión en otro. Todos teníandiplopía invalidante. Se considera buen resultado sidesaparecía la diplopía con el tratamiento.Resultados: Cuatro casos recibieron tratamientoquirúrgico, en uno sólo se inyectó toxina botulínicay en tres se pusieron prismas. La toxina botulínicase empleó como primera opción en cuatro casos ysólo fue eficaz en un enfermo. De los cuatro casosoperados, tres necesitaron dos cirugías y un pacientesólo un tiempo quirúrgico. Se consiguió buenresultado en los ocho pacientes tratados. El tiempomedio de evolución fue de 10,12 DE: 5,46 meses. Conclusiones: La anestesia subtenoniana puedeprovocar un estrabismo restrictivo y una diplopíamuy invalidantes que no se resuelven espontáneamente.El recto inferior es el músculo más frecuentementeafectado. La cirugía muscular es necesariapara resolver el problema en la mitad de los casos.Se consiguen buenos resultados quirúrgicos


Purpose: To study the clinical signs, treatment and ;;prognosis of strabismus after sub-Tenon’s anesthesia ;;for cataract surgery. ;;Methods: Eight patients without previous strabismus ;;developed incommitant diplopia immediately ;;after cataract surgery; the left eye was affected in ;;five patients and the right eye in three. Restrictive ;;strabismus was diagnosed with the cover test, ;;prisms, and active and passive ductions in all cases. ;;In seven cases the deviation was vertical and in one ;;patient it was horizontal. The average deviation was ;;17.5 S.D. 9.84 (range 5-35) prismatic dioptres in ;;primary position. The deviation increased looking ;;upward in seven cases, and looking sideways to the ;;left in the other. It was considered to be a good ;;result if the diplopia disappeared after treatment. ;;Results: Botulinum toxin was the first treatment ;;applied in four patients, but only one showed a good ;;response and required no further therapy. Strabismus ;;surgery was required in four cases, and prisms ;;were adapted in three. Three patients required two ;;strabismus operations. A good result was achieved ;;in all cases, with the average time interval being ;;10.12 (SD 5.5) months. Conclusions: Sub-Tenon’s anesthesia may result in ;;restrictive strabismus and incommitant diplopia ;;which does not resolve spontaneously. The inferior ;;rectus is the most commonly affected muscle. Strabismus ;;surgery is required to resolve the diplopia in ;;half of the cases. Good results have been achieved ;;in all patients


Assuntos
Masculino , Feminino , Idoso , Humanos , Extração de Catarata/efeitos adversos , Diplopia/etiologia , Anestesia/efeitos adversos , Estrabismo/etiologia , Complicações Pós-Operatórias/cirurgia
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