Intraoperative OCT Angiography in Pediatric Patients with Persistent Fetal Vasculature.

PURPOSE: To describe abnormalities of the optic nerve microvasculature in patients with persistent fetal vasculature (PFV) and their fellow eyes using OCT angiography (OCTA). DESIGN: Cross-sectional study. SUBJECTS: Fifty eyes of 25 patients with PFV who underwent prospective imaging using supine OCTA during examination under anesthesia at Bascom Palmer Eye Institute from March 1, 2019, to December 31, 2022. METHODS: OCT angiography images of the optic nerve of the included patients were analyzed with a primary focus on blood flow. Demographic, clinical, and treatment factors were compared with morphologic changes in the optic disc microvasculature. MAIN OUTCOME MEASURES: Prevalence of optic nerve microvascular abnormalities on OCTA in the affected and fellow eyes of patients with PFV. RESULTS: A total of 50 eyes from 25 patients were reviewed, and 28% (7/25) met image quality criteria for OCTA analysis. Optic nerve OCTA showed a persistent hyaloid artery (PHA) in all (7/7) PFV eyes analyzed. Of these, flow on OCTA was detectable in 57% (4/7). A Bergmeister papilla was evident in 100% (25/25) fellow eyes, of which flow was detected in 68% (17/25). Fluorescein angiography (FA) demonstrated blood flow within the stalk in 40% (10/25) of PFV eyes and within the Bergmeister papilla in 25% (6/25) of fellow eyes. Similar findings of abnormal blood flow and presence of fibrovascular stalk were seen in both treatment-naïve and treated groups. CONCLUSIONS: OCT angiography allows for high-resolution visualization of subtle vascular abnormalities that are not readily apparent using RetCam FA and may serve as a useful noninvasive test to confirm the patency of the PHA and Bergmeister papilla in children. The results of the present study suggest that PFV may be a bilateral and asymmetric process. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Peripheral combined hamartoma of the retina and retinal pigment epithelium with remote peripapillary choroidal neovascular membrane.

PURPOSE: To describe the first reported case of combined hamartoma of the retina and retinal pigment epithelium (CHRRPE) associated with a remote choroidal neovascular membrane (CNVM). OBSERVATIONS: A 19-month-old girl with a normal prenatal and infantile history presented with esotropia of the left eye. Fundus examination demonstrated a large, elevated, charcoal-colored lesion in the nasal equatorial retina. There was dragging of the nasal retinal vessels and a retinal fold, presumed to have resulted from nasal traction from the lesion. There was also subretinal hemorrhage in the peripapillary macula. Multimodal imaging demonstrated a peripapillary choroidal neovascular membrane (CNVM) underlying the retinal fold. There was no leakage within the tumor or secondary retinal neovascularization. Examination of the fellow eye was unremarkable. The patient was diagnosed with peripheral CHRRPE with associated peripapillary CNVM. She was treated with serial intravitreal bevacizumab to the affected eye which resulted in a reduction in leakage from the CNVM and resolution of the subretinal hemorrhage. The CHRRPE remained stable on follow-up. CONCLUSIONS: Peripheral CHRRPE can rarely be associated with a remote CNVM.

Mirror and Vibration Therapies Effects on the Upper Limbs of Hemiparetic Patients after Stroke: A Pilot Study.

BACKGROUND/AIM: To evaluate, in this pilot study, the effects of the mirror (MT) and vibration therapies (VT) on the functionality of hemiparesis patients after stroke. MATERIALS AND METHODS: Twenty-one individuals after stroke with upper limb hemiparesis were randomized into control group (CG), Mirror Therapy Group (MTG), and Vibration Therapy Group (VTG). The functionality was evaluated before and after 12 sessions with three tests (i) Mobility Index Rivermead, (ii) Motor Function Wolf Test (time, functional ability), and (iii) Jebsen Taylor Test. RESULTS: Significant findings were observed for MTG or VTG when compared to the CG, obtaining improvements in the three functional tests: Mobility Index Rivermead, Motor Function Test Wolf (time) and Motor Function Test Wolf (functional ability), and Jebsen Test Taylor. CONCLUSIONS: MT or VT showed enhancements on the functionality of subjects with poststroke hemiparesis. In consequence, these interventions may be used in the rehabilitation of these individuals in order to promote improvements of the affected upper limb functionality. Probably, neuromuscular responses of the used therapies would be related to these desirable effects. However, it is necessary conducting further controlled studies with more subjects.

Ureteral meatotomy as an option in the management of primary obstructive megaureter in neonates and infants. / Meatotomía ureteral como opción para gestión del megauréter obstructivo primario en neonatos y lactantes.

Differentiating between the cases of megaureter that require surgery and the ones in whom treatment can be delayed is challenging. A large number of surgical techniques for the treatment of POM been proposed aiming mainly to reduce renal damage by relieving the affected ureter. Resection of the affected ureteral segment followed by vesicoureteral reimplantation either with or without reduction ureteroplasty is the classic treatment, however posing a high rate of complications when performed in patients aged less than one year. Endoscopic techniques have also been described to avoid external diversion. Recently, refluxing ureteral reimplantation has been proposed as a temporary treatment for patients with POM. OBJECTIVE: To describe the ureteral meatotomy technique as an alternative to the refluxing ureteral reimplantation for POM in patients aged less than one year. METHOD: Retrospective study of patients with POM undergoing ureteral meatotomy, aiming to temporarily relieve the ureter. The procedure consists of a 1.5 cm-long cut made with scissors on the upper edge of the ureteral ostium at the 12 o'clock position, until the dilated portion of the ureter was found and abundant urine drainage was observed. The edges of the incision were sutured, joining together the ureteral mucosa and the bladder mucosa. RESULT: From 2011 to 2015, three patients with POM underwent ureteral meatotomy, with four renal units treated altogether. None of the patients presented complications and, as a sign of obstruction relief, all showed reduced dilatation at the ultrasound. No patient had complications. CONCLUSIONS: Ureteral meatotomy is a safe and effective technique in the initial treatment of POM in patients aged less than one year.

[Access, educational practice and empowerment of patients with chronic diseases]. / Acesso, prática educativa e empoderamento de pacientes com doenças crônicas.

Empowerment is a process whereby people achieve mastery over their lives, acquiring knowledge to make decisions about their health. Chronic diseases are increasingly common in the health service, requiring the attention of health professionals and empowering those affected by them. The scope of this study was to analyze the perceptions of users with chronic diseases and monitored by the Family Health Program with respect to empowerment. This was a qualitative study in which open interviews and systematic observations were conducted and NVIVO software was used for data analysis. Users indicate the existence of some geographical barriers in access to health, which caused fatigue, discouragement and low continuity of care. It was noted that adherence and practices of care were linked to differentiated service, based on trust and respect for the wishes of users. This includes healthcare guidance and education as key elements to encourage the practice of self-care. It is necessary to restructure the conduct of health professionals involved in the Family Health Strategy because its function is to promote health in a logical intersectoral and interdisciplinary manner.

Corneal infiltrates after excimer laser photorefractive keratectomy and LASIK.

PURPOSE: To determine the frequency and clinical characteristics of corneal infiltrates after photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK) and to evaluate the efficacy of treatment. METHODS: We retrospectively reviewed the records of 8508 eyes treated with PRK or LASIK in a university-based clinic for the correction of refractive errors for 60 days postoperatively. RESULTS: Corneal infiltrates were observed in 35 (0.8%) of 4492 PRK-operated eyes and in 4 (0.1%) of 4016 LASIK-operated eyes. The mean time of diagnosis was 5.46 days. Among the 39 eyes with infiltrates, 10 (9 PRK, 1 LASIK) had culture-verified infectious keratitis. Coagulase-negative Staphylococcus was the most frequently isolated bacterium (50%), followed by S aureus (20%), Corynebacterium xerosis (10%), Streptococcus viridans (10%), and an unidentified gram-positive coccus (10%). Final visual acuity of > or = 20/30, without correction, was achieved in 79.5% of the 39 eyes. CONCLUSIONS: Corneal infiltrates occurred in 0.8% of PRK eyes and 0.1% of LASIK eyes. Bacterial smears were positive for several eyes. In all cases, prompt treatment was responsible for good visual outcome.