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1.
Clin Ophthalmol ; 14: 3931-3940, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33235432

RESUMO

Objective: To determine normal macular thickness values in a healthy Mexican population and its variation by age and gender using Huvitz spectral-domain optical coherence tomography (HOCT-1F). Methods: This cross-sectional study included 211 consecutive eyes from clinically normal subjects (66 men, 145 women) between October 2018 and December 2018, with best-corrected visual acuities better than 20/30. One eye was selected for the macular scan using the Huvitz OCT (Huvitz OCT-1F, HOCT-1F, Huvitz Co., Ltd., Republic of Korea) with an automated segmentation algorithm. Three vertical and horizontal scans, centered on the fovea with an area of 9 mm, and a color 45° fundus photograph were obtained using Huvitz OCT-1F. Macular measurements were presented as means with standard deviations values for each of the nine regions defined by the Early Treatment Diabetic Retinopathy Study (ETDRS). Results: The mean age was 34.3±11.9 years. Using the ETDRS map, the mean central subfield thickness (CST) was 227.4±18.9 µm. Male gender was associated with greater CST (P<0.001) compared to females. There was no association between mean macular CST (r2=0.011; P=0.11) and age. Macular thickness was thicker in the inner ring than in the outer ring, and there were no significant differences in mean CST among age groups (P=0.70). Conclusion: Normal macular thickness values using the Huvitz OCT in a Mexican healthy population aged from 18-70 years were thinner in the foveal macular region than values reported in other populations. Female patients had a thinner CST, and age was not correlated with macular thickness.

2.
Transl Vis Sci Technol ; 9(9): 27, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32879783

RESUMO

Purpose: High circulating levels of the hormone prolactin (PRL) protect against experimental diabetic retinopathy (DR) due to the retinal accumulation of vasoinhibin, a PRL fragment that inhibits blood vessel permeability and growth. A phase 2 clinical trial is investigating a new therapy for DR based on elevating serum PRL levels with levosulpiride, a prokinetic dopamine D2 receptor blocker. Here, we tested whether levosulpiride-induced hyperprolactinemia elevates PRL and vasoinhibin in the vitreous of volunteer patients with proliferative DR (PDR) undergoing elective pars plana vitrectomy. Methods: Patients were randomized to receive placebo (lactose pill, orally TID; n = 19) or levosulpiride (25 mg orally TID; n = 18) for the 7 days before vitrectomy. Vitreous samples from untreated non-diabetic (n = 10) and PDR (n = 17) patients were also studied. Results: Levosulpiride elevated the systemic (101 ± 13 [SEM] vs. 9.2 ± 1.3 ng/mL, P < 0.0001) and vitreous (3.2 ± 0.4 vs. 1.5 ± 0.2 ng/mL, P < 0.0001) levels of PRL, and both levels were directly correlated (r = 0.58, P < 0.0002). The vitreous from non-diabetic patients or from PDR patients treated with levosulpiride, but not from placebo-treated PDR patients, inhibited the basic fibroblast growth factor (bFGF)- and vascular endothelial growth factor (VEGF)-induced proliferation of endothelial cells in culture. Vasoinhibin-neutralizing antibodies reduced the vitreous antiangiogenic effect. Matrix metalloproteases (MMPs) in the vitreous cleaved PRL to vasoinhibin, and their activity was higher in non-diabetic than in PDR patients. Conclusions: Levosulpiride increases the levels of PRL in the vitreous of PDR patients and promotes its MMP-mediated conversion to vasoinhibin, which can inhibit angiogenesis in DR. Translational Relevance: These findings support the potential therapeutic benefit of levosulpiride against vision loss in diabetes.

3.
Case Rep Ophthalmol ; 11(2): 315-321, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32774298

RESUMO

Appropriate medical management can be an alternative in those patients with submacular cysticercosis in whom achieving good visual outcome with vitreoretinal surgery is not possible. We report the case of a 25-year-old female who presented complaining of blurred vision in her left eye associated with photopsias and metamorphopsias of 3 months duration. Initial visual acuity in the right eye was 20/20 and 20/100 in the left eye. Upon indirect ophthalmoscopy in the left eye, a yellow-white, dome-shaped, elevated lesion with foveal involvement was observed. The rest of the ophthalmological examination proved normal. With clinical findings and images, submacular cysticercosis was diagnosed, and vitreoretinal surgery was suggested. Nevertheless, the patient did not accept the treatment; therefore, medical management was initiated. Central nervous system involvement was ruled out, and treatment with praziquantel and systemic prednisolone was initiated. Cysticercosis was resolved with significant improvement of her symptoms and visual acuity.

4.
J Glaucoma ; 29(9): 756-760, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32618804

RESUMO

PRéCIS:: Intraocular pressure (IOP) measurement differences with Goldmann applanation tonometry (GAT) and dynamic contour tonometry (DCT) are affected by atmospheric pressure inside a hyperbaric chamber. PURPOSE: To compare IOP measurements obtained with GAT and DCT in 22 normal individuals at different atmospheric pressures simulated in a hyperbaric chamber. METHODS: The IOP of both eyes of 22 healthy volunteers was measured using GAT and DCT at 4 different atmospheric pressure levels.Starting at 1 Queretaro atmospheric pressure (QATM), the IOP was measured with GAT and DCT. The atmospheric pressure was then increased to 1.1 QATM (equivalent to 1032 m above sea level), 1.2 QATM (equivalent to 315 m above sea level), and 1.25 QATM (equivalent to sea level), starting 5 minutes after reaching each level. The limits of agreement between various measurements with each tonometer were calculated using the Bland-Altman plots. RESULTS: The first 4 subjects were used to measure feasibility, consistency, variability, and the time needed for IOP to return to baseline after each atmospheric pressure increase.For the entire 44 eyes, the mean GAT IOP at 1 QATM was 12.23 mm Hg (range, 8 to 20 mm Hg; SD, 2.84) and mean DCT was 16.36 (range, 12.1 to 25.3; SD, 2.84), with a mean 4.14 mm Hg difference (range, -0.1 to 7.5 mm Hg; SD, 1.62; P<0.001).Using the second measurements of the first 4 subjects and those after 5 minutes of adaptation for the rest of the group at 1.1 QATM, mean GAT IOP was 11.05±2.68 mm Hg and mean DCT IOP was 15.60±3.02 mm Hg, for a mean difference between instruments of 4.56±1.81 mm Hg (P<0.001).At 1.2 QATM, mean GAT IOP was 11.14±2.53 mm Hg and mean DCT IOP was 15.39±2.91 mm Hg. The difference between instruments was 4.25±2.12 mm Hg (P<0.001).At 1.25 QATM, the mean GAT IOP was 12.39±3.11 mm Hg and mean DCT IOP was 14.91±2.73 mm Hg. The difference between instruments after 5 minutes of adaptation was 2.53±1.62 mm Hg (P<0.001).Generalized estimating equations for performing linear regression multivariable analysis using atmospheric pressure, expressed as altitude, and age as covariates, shows that the difference between GAT and DCT increases by 1 mm Hg per 673 m of increase of altitude above sea level. Age was not a significant predictor. CONCLUSIONS: Acute changes in atmospheric pressure induce changes in IOP measurements for both GAT and DCT and in different directions. Despite the limitation of sample size, it may be postulated that the difference of IOP measurements between the 2 tonometers increases with lower atmospheric pressures.

5.
Medwave ; 20(2): e7831, 2020 Mar 03.
Artigo em Espanhol, Inglês | MEDLINE | ID: mdl-32225130

RESUMO

Introduction: Macular hemorrhages result in a sudden and profound loss of vision. The primary treatment modalities include observation, intravitreal injection of antiangiogenic drugs, neodymium-doped yttrium aluminum garnet hialoidotomy, intravitreal injection of gas with or without tissue plasminogen activator, as monotherapy or combined with surgery. In this paper, we report four cases of macular hemorrhages of different causes treated with different approaches, and we review the literature in this regard. Case presentation: All four patients presented different causes of macular hemorrhage. The first case had a preretinal hemorrhage due to a Valsalva retinopathy and was treated with surgery. Case 2 had a multilevel macular hemorrhage due to a rupture of a retinal arteriolar macroaneurysm and was treated with pneumatic displacement, laser, and intravitreal ranibizumab. Case 3 presented an extensive subretinal hemorrhage due to a choroidal rupture after high-energy ocular trauma that was also successfully treated with surgery. The last case was a preretinal hemorrhage due to diabetic retinopathy managed with neodymium-doped yttrium aluminum garnet laser. Different treatment approaches were successfully performed in all cases with good outcomes. Conclusion: There is an extensive range of options available for the management of macular hemorrhages, and the best option depends on the characteristics of each particular case. Proper and timely management of these diseases can achieve an excellent visual outcome, especially if the location of the hemorrhage is preretinal.


Assuntos
Inibidores da Angiogênese/uso terapêutico , Terapia a Laser , Hemorragia Retiniana/terapia , Corioide/patologia , Retinopatia Diabética/complicações , Humanos , Injeções Intravítreas , Hemorragia Retiniana/etiologia , Ruptura , Ativador de Plasminogênio Tecidual
6.
Medwave ; 20(1): e7772, 2020 Jan 28.
Artigo em Espanhol, Inglês | MEDLINE | ID: mdl-32119652

RESUMO

Background: Determining the precise location of intraocular foreign bodies is crucial for the management of patients with open-globe injury. Computed tomography is the most common method for detecting intraocular foreign bodies in the posterior segment. In this article, we describe three cases of open-globe injury with different types of intraocular foreign bodies in the posterior segment that were accurately located using computed tomography scans and B-scan ultrasonography. Case presentation: Each of the three cases of open-globe injury described in this report had different types of ocular trauma, clinical symptoms, and intraocular foreign bodies. Computed tomography scans showed the exact location of the intraocular foreign bodies in the posterior segment in two of the three cases. A B-scan ultrasound was used to determine the location of a non-metallic intraocular foreign body in the third case. All three patients had intraocular foreign bodies, and one of them had an additional orbital foreign body. Case 1 had a perforating eye injury with the additional intraorbital foreign body; Cases 2 and Case 3 had different types of intraocular foreign bodies and prognoses. Various treatment approaches were used, ranging from observation to surgery, depending on the location of the intraocular foreign bodies, and all cases were successfully managed. These three cases show that proper use of various types of imaging tests is indispensable in the context of an intraocular foreign body related to open-globe injury. Conclusion: Imaging techniques are crucial for the detection of an intraocular foreign body, and computed tomography is one of the simplest and most useful, especially in cases of open-globe injury.


Assuntos
Corpos Estranhos no Olho/diagnóstico por imagem , Ferimentos Oculares Penetrantes/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Ultrassonografia , Adolescente , Adulto , Traumatismos por Explosões/complicações , Traumatismos por Explosões/diagnóstico por imagem , Corpos Estranhos no Olho/etiologia , Ferimentos Oculares Penetrantes/complicações , Vidro , Humanos , Imagem por Ressonância Magnética , Masculino , Metais , Plásticos , Radiografia , Ferimentos por Arma de Fogo/complicações , Ferimentos por Arma de Fogo/diagnóstico por imagem
7.
Medwave ; 20(2)31-03-2020.
Artigo em Inglês, Espanhol | LILACS-Express | LILACS | ID: biblio-1095945

RESUMO

Introducción Las hemorragias maculares producen una pérdida de la visión súbita y profunda. Las principales modalidades de tratamiento incluyen observación, inyección intravítrea de fármacos antiangiogénicos, hialoidotomía con láser neodymium-doped yttrium aluminium garnet, inyección intravítrea de gas y/o activador de plasminógeno tisular, en monoterapia o combinadas con cirugía. En el presente trabajo reportamos cuatro casos de hemorragias maculares de distintas causas, tratadas con diferentes abordajes, y realizamos una revisión de la literatura al respecto. Presentación de casos Los cuatro pacientes mostrados presentaron diferentes causas de hemorragias maculares. El primer caso tuvo una hemorragia prerretiniana debido a retinopatía de Valsalva y fue tratado con cirugía, el Caso 2 tuvo una hemorragia macular multinivel debido a una rotura de un macroaneurisma arteriolar retiniano y fue manejado con desplazamiento neumático, láser y ranibizumab intravítreo, el Caso 3 presentó una hemorragia subretiniana extensa debido a rotura coroidea posterior a un trauma ocular cerrado de alta energía y fue tratado exitosamente con cirugía. El último caso presentó una hemorragia prerretiniana debido a retinopatía diabética, manejada con láser neodymium-doped yttrium aluminium garnet. Los diferentes tratamientos fueron realizados exitosamente con buenos resultados. Conclusión Existen amplias opciones disponibles para el manejo de las hemorragias maculares y la mejor opción depende de las características de cada caso en particular. El manejo apropiado y oportuno de éstas puede lograr un resultado visual bueno, especialmente si la localización de la hemorragia es prerretiniana.


Introduction Macular hemorrhages result in a sudden and profound loss of vision. The primary treatment modalities include observation, intravitreal injection of antiangiogenic drugs, neodymium-doped yttrium aluminum garnet hialoidotomy, intravitreal injection of gas with or without tissue plasminogen activator, as monotherapy or combined with surgery. In this paper, we report four cases of macular hemorrhages of different causes treated with different approaches, and we review the literature in this regard. Case presentation All four patients presented different causes of macular hemorrhage. The first case had a preretinal hemorrhage due to a Valsalva retinopathy and was treated with surgery. Case 2 had a multilevel macular hemorrhage due to a rupture of a retinal arteriolar macroaneurysm and was treated with pneumatic displacement, laser, and intravitreal ranibizumab. Case 3 presented an extensive subretinal hemorrhage due to a choroidal rupture after high-energy ocular trauma that was also successfully treated with surgery. The last case was a preretinal hemorrhage due to diabetic retinopathy managed with neodymium-doped yttrium aluminum garnet laser. Different treatment approaches were successfully performed in all cases with good outcomes. Conclusion There is an extensive range of options available for the management of macular hemorrhages, and the best option depends on the characteristics of each particular case. Proper and timely management of these diseases can achieve an excellent visual outcome, especially if the location of the hemorrhage is preretinal.

9.
BMC Ophthalmol ; 19(1): 91, 2019 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-30987639

RESUMO

BACKGROUND: Retinopathy of prematurity (ROP), the primary cause of blindness in children, is a potential complication for 7.7% of live births in Mexico. Given that less than one-third of all neonatal intensive care units follow Mexican National ROP guidelines, there have been few reports regarding the incidences of types 1 and 2 ROP. METHODS: This was a retrospective study that investigated the incidence and onset of ROP in a representative sample of children in Mexico. We analyzed the results obtained by the ROP Detection and Treatment Program, compliant with the Mexican National ROP guidelines, over a 1-year period. This study included 132 children who were born prematurely, were initially screened between October 2, 2017 and October 1, 2018, and underwent follow-up based on their risk group (in accordance with the Mexican National ROP guidelines). RESULTS: The mean gestational age (GA) at birth was 32 weeks and 3 days (32w3d) (95% CI, ± 3 days), and the mean birth weight (BW) was 1594 g (95% CI, ± 96 g). The clinical features were as follows: 36.4% had immature retina without ROP, 22.0% had mild ROP, 5.3% had type 2 ROP, 27.3% had type 1 ROP, and 1.5% had advanced disease. Premature children with ROP requiring treatment (i.e., type 1 ROP + advanced ROP) were born at an MGA of 30w4d (95% CI, ± 5d; range, 26-35 weeks); their MBW was 1316 g (95% CI, ± 110 g; range, 830-2220 g). Diagnosis of ROP requiring treatment was made at a mean postmenstrual age (PMA) of 37w3d (95% CI, ± 5d; range, 31w1d to 42w1d). CONCLUSION: In Mexico, screening and close ophthalmological follow-up of children who present with risk factors of birth weight < 1750 g and gestational age ≤ 34 weeks, both of which are observed more frequently in children with type 1 ROP, appears essential for implementing timely treatments (within 72 h). This is particularly important for children with PMA between 36 and 38 weeks, which is considered to be the peak age for disease stages that require timely intervention.


Assuntos
Triagem Neonatal/métodos , Retinopatia da Prematuridade/epidemiologia , Feminino , Seguimentos , Idade Gestacional , Humanos , Incidência , Recém-Nascido , Masculino , México/epidemiologia , Estudos Retrospectivos , Fatores de Risco
10.
Artigo em Inglês | MEDLINE | ID: mdl-29896154

RESUMO

Background: Diabetic retinopathy (DR) and diabetic macular edema (DME) are potentially blinding, microvascular retinal diseases in people with diabetes mellitus. Preclinical studies support a protective role of the hormone prolactin (PRL) due to its ocular incorporation and conversion to vasoinhibins, a family of PRL fragments that inhibit ischemia-induced retinal angiogenesis and diabetes-derived retinal vasopermeability. Here, we describe the protocol of an ongoing clinical trial investigating a new therapy for DR and DME based on elevating the circulating levels of PRL with the prokinetic, dopamine D2 receptor blocker, levosulpiride. Methods: It is a prospective, randomized, double-blind, placebo-controlled trial enrolling male and female patients with type 2 diabetes having DME, non-proliferative DR (NPDR), proliferative DR (PDR) requiring vitrectomy, and DME plus standard intravitreal therapy with the antiangiogenic agent, ranibizumab. Patients are randomized to receive placebo (lactose pill, orally TID) or levosulpiride (75 mg/day orally TID) for 8 weeks (DME and NPDR), 1 week (the period before vitrectomy in PDR), or 12 weeks (DME plus ranibizumab). In all cases the study medication is taken on top of standard therapy for diabetes, blood pressure control, or other medical conditions. Primary endpoints in groups 1 and 2 (DME: placebo and levosulpiride), groups 3 and 4 (NPDR: placebo and levosulpiride), and groups 7 and 8 (DME plus ranibizumab: placebo and levosulpiride) are changes from baseline in visual acuity, retinal thickness assessed by optical coherence tomography, and retinal microvascular abnormalities evaluated by fundus biomicroscopy and fluorescein angiography. Changes in serum PRL levels and of PRL and vasoinhibins levels in the vitreous between groups 5 and 6 (PDR undergoing vitrectomy: placebo and levosulpiride) serve as proof of principle that PRL enters the eye to counteract disease progression. Secondary endpoints are changes during the follow-up of health and metabolic parameters (blood pressure, glycated hemoglobin, and serum levels of glucose and creatinine). A total of 120 patients are being recruited. Discussion: This trial will provide important knowledge on the potential benefits and safety of elevating circulating and intraocular PRL levels with levosulpiride in patients with DR and DME. Ethics and dissemination: Ethics approval has been obtained from the Ethics Committees of the National University of Mexico (UNAM) and the Instituto Mexicano de Oftalmología, I.A.P. Dissemination will include submission to peer-reviewed scientific journals and presentation at congresses. Clinical trial registration: Registered at www.ClinicalTrials.gov, ID: NCT03161652 on May 18, 2017.

11.
Arch Cardiol Mex ; 82(1): 48-53, 2012.
Artigo em Espanhol | MEDLINE | ID: mdl-22452866

RESUMO

Acute pulmonary embolism (APE) is considered a cardiovascular emergency and is one of the most important causes of morbidity and mortality in hospitalized patients. Pulmonary embolism diagnosis has to be made early in the course of the disease and its management installed immediately. Pulmonary embolism management includes hemodynamic support, anticoagulation, thrombolysis and embolectomy. We present an overview of the treatment of APE.


Assuntos
Embolia Pulmonar/terapia , Doença Aguda , Anticoagulantes/uso terapêutico , Embolectomia , Humanos , Guias de Prática Clínica como Assunto , Terapia Trombolítica
12.
Arch. cardiol. Méx ; 82(1): 48-53, ene.-mar. 2012.
Artigo em Espanhol | LILACS | ID: lil-657947

RESUMO

La tromboembolia pulmonar (TEP) es considerada como una urgencia cardiovascular, representa una de las principales causas de morbilidad y mortalidad en pacientes hospitalizados. El diagnóstico debe realizarse lo más tempranamente posible, y su tratamiento instaurarse de manera inmediata. El manejo de la embolia pulmonar aguda, incluye medidas de soporte, apoyo hemodinámico, utilización de anticoagulantes y en el caso del paciente inestable, trombólisis o embolectomía. En el presente artículo, se revisan las generalidades en el tratamiento de los pacientes con TEP.


Acute pulmonary embolism (APE) is considered a cardiovascular emergency and is one of the most important causes of morbidity and mortality in hospitalized patients. Pulmonary embolism diagnosis has to be made early in the course of the disease and its management installed immediately. Pulmonary embolism management includes hemodynamic support, anticoagulation, thrombolysis and embolectomy. We present an overview of the treatment of APE.


Assuntos
Humanos , Embolia Pulmonar/terapia , Doença Aguda , Anticoagulantes/uso terapêutico , Embolectomia , Guias de Prática Clínica como Assunto , Terapia Trombolítica
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