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1.
Einstein (Sao Paulo) ; 18: eGS4913, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31531556

RESUMO

OBJECTIVE: To evaluate indications, results and strategy of retinal exams requested at Primary Care Units. METHODS: A retrospective study that analyzed the indications and results of retinal exams, in the modalities clinical dilated fundus exams and color fundus photographs. In the following situations, patients were considered eligible for color fundus photographs if visual acuity was normal and ocular symptoms were absent: diabetes mellitus and/or hypertension, in use of drugs with potential retinal toxicity, diagnosis or suspicion of glaucoma, stable and asymptomatic retinopathies, except myopia greater than -3.00 diopters. RESULTS: A total of 1,729 patients were evaluated (66% female, age 63.5±15.5 years), and 1,190 underwent clinical dilated fundus exam and 539 underwent color fundus photographs. Diabetes was present in 32.2%. The main indications were diabetes (23.7%) and glaucoma evaluation (23.5%). In 3.4% of patients there was no apparent indication. The main results were a large cup/disc ratio (30.7%) and diabetic retinopathy (13.2%). Exam was normal in 9.6%, detected peripheral changes in 7% and could not be performed in 1%. Considering patients eligible for fundus photographs (22.4%), more than half underwent clinical dilated fundus exams. CONCLUSION: Regarding exam modality, there were no important differences in the distribution of indications or diagnosis. Color fundus photograph is compatible with telemedicine and more cost-effective, and could be considered the strategy of choice in some scenarios. Since there are no clear guidelines for retinal exams indications or the modality of choice, this study may contribute to such standardization, in order to optimize public health resources.


Assuntos
Técnicas de Diagnóstico Oftalmológico , Atenção Primária à Saúde/estatística & dados numéricos , Retina , Doenças Retinianas/diagnóstico , Idoso , Retinopatia Diabética/diagnóstico , Técnicas de Diagnóstico Oftalmológico/economia , Feminino , Fundo de Olho , Humanos , Masculino , Pessoa de Meia-Idade , Fotografação , Exame Físico , Estudos Retrospectivos , Telemedicina , Acuidade Visual
2.
Orv Hetil ; 160(44): 1744-1750, 2019 Nov.
Artigo em Húngaro | MEDLINE | ID: mdl-31657252

RESUMO

We present herewith cases of non-infectious uveitis with biological treatment where the ocular complaints were the initial symptoms indicating a multi-organ autoimmune disease. The first case was a patient with panuveitis and Vogt-Koyanagi-Harada disease, the second case was also a panuveitic patient with sarcoidosis and the third case was a patient with intermediate uveitis and inflammatory bowel disease. In all cases, emerging new, biological therapy (adalimumab) was necessary to achieve permanent inactive period of uveitis and the autoimmune disease. Introducing systemic biological treatment (adalimumab) in ophthalmology is crucial in the therapy of immune-mediated, non-infectious uveitis in order to preserve visual acuity. Orv Hetil. 2019; 160(44): 1744-1750.


Assuntos
Adalimumab/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Oftalmologia , Pan-Uveíte/tratamento farmacológico , Uveíte/tratamento farmacológico , Humanos , Doenças Inflamatórias Intestinais/diagnóstico , Pan-Uveíte/diagnóstico , Sarcoidose/diagnóstico , Resultado do Tratamento , Uveíte/diagnóstico , Síndrome Uveomeningoencefálica/diagnóstico , Acuidade Visual
3.
Vestn Oftalmol ; 135(4): 86-97, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31573562

RESUMO

The article describes 5 cases of capsular block syndrome (CBS). This late cataract surgery complication has not been sufficiently covered in Russian scientific literature. Diagnostics were based mainly on slit-lamp biomicroscopy and anterior segment optical coherence tomography. In all cases, examination revealed a retro-optical space filled with content of different transparency and homogeneity (transparent liquid, opaque liquid, regenerative lens material). The condition caused visual acuity to decrease in each case. Patient management included follow-ups (2 cases), yttrium-aluminum-garnet laser (YAG-laser) puncture of posterior lens capsule (1 case) or YAG-laser posterior capsulotomy (2 cases). YAG-laser treatment resulted in visual functions improvement.


Assuntos
Traumatismos Oculares , Terapia a Laser , Cápsula Posterior do Cristalino , Humanos , Federação Russa , Acuidade Visual
4.
Vestn Oftalmol ; 135(4): 121-127, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31573567

RESUMO

Retinal damage in diabetes is known to manifest in two main ways: diabetic retinopathy and diabetic macular edema. The most effective anti-inflammatory drugs today are glucocorticoids, a classic representative of which is dexamethasone. Two things that should be considered by ophthalmologists in the therapy of macular edema are the switching point to dexamethasone implant when the effectiveness of anti-vasoproliferative drugs is unsatisfactory, and the identification of the main predictors of diabetic macular edema that make glucocorticoids the drugs of first choice. The data from real clinical practice was used to develop the indications for intravitreal administration of a glucocorticoid as the therapy of first choice for diabetic macular edema. Glucocorticoids are prescribed to patients diagnosed with diabetic macular edema who has a history of acute cerebrovascular events, myocardial infarction or other cardiovascular and cerebrovascular diseases, as well as patients with a very high risk of a vascular catastrophe. Intravitreal glucocorticoids can be prescribed to patients who cannot follow the schedule of frequent visits and/or are not able to visit the hospital during the first 6 months after the administration of the drug. Considering the local character of its ophthalmic action, the method can be recommended for treating patients with pseudophakic eyes, persistent diabetic macular edema, or patients who underwent vitrectomy.


Assuntos
Dexametasona/uso terapêutico , Retinopatia Diabética , Edema Macular , Retinopatia Diabética/tratamento farmacológico , Implantes de Medicamento , Humanos , Injeções Intravítreas , Edema Macular/tratamento farmacológico , Acuidade Visual
5.
Pan Afr Med J ; 33: 167, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31565128

RESUMO

Intra-orbital hydatid cyst is a very rare pathological entity that affects children and the young adults; it is secondary to the development in the orbit of the echinococcus granulosis tapeworm. Its frequency does not exceed 1% of all cases of hydatid disease. Clinical presentation of intra-orbital hydatid cyst is dominated by proptosis and a decrease in visual acuity, complete surgical excision is difficult, evolution is generally better when the treatment is early before the installation of irreversible optic atrophy. We report one case of a 3 years old girl operated for right intra-orbital hydatid cyst who presented with proptosis and blindness. Complete removal was difficult and puncture of the cyst was performed followed by excision of its membrane with good post-operative results. We also discuss the different epidemiological, clinical, radiological and therapeutic aspects of intra-orbital hydatid cyst and a review of literature of this rare pathology.


Assuntos
Equinococose/diagnóstico , Infecções Oculares Parasitárias/diagnóstico , Doenças Orbitárias/diagnóstico , Cegueira/parasitologia , Pré-Escolar , Equinococose/parasitologia , Equinococose/cirurgia , Exoftalmia/parasitologia , Infecções Oculares Parasitárias/parasitologia , Infecções Oculares Parasitárias/cirurgia , Feminino , Humanos , Doenças Orbitárias/parasitologia , Doenças Orbitárias/cirurgia , Acuidade Visual
6.
Medicine (Baltimore) ; 98(42): e17654, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626152

RESUMO

BACKGROUND: The aim of this meta-analysis is to compare the efficacy and safety of combined phacoemulsification (Phaco) with goniosynechialysis (GSL) to either Phaco or to Phaco combined with trabeculectomy or trabeculectomy alone in patients with angle closure glaucoma (ACG). METHODS: Five main electronic databases were searched for the eligible studies. Intraocular pressure (IOP) decrease was set as the primary outcome, while anti-glaucomatous medication decrease, changes of anterior chamber depth (ACD), range of peripheral anterior synechia (PAS), and complication occurrence were the secondary outcomes. Standard mean difference (SMD) and relative risk (RR) were the size effects for continuous and binomial data, respectively. Either fixed-effects model or random-effects model was chosen to pool the data based on the heterogeneities. RESULTS: A total of 7 eligible studies were included. The combined data showed the IOP decreased more significantly after Phaco-GSL than that after Phaco alone (SMD = -0.42,95%CI: -0.70 - 0.14, I = 17.6%, Z = 2.90, P = .004). However, there were no distinct differences regarding medication decrease (SMD =  -0.25,95%CI: -0.70 - 0.21, I = 0%, Z = 1.06, P = 0.29), ACD, the range of PAS and complication occurrence rate when compared Phaco-GSL to Phaco. Moreover, Phaco-GSL was comparable to Phaco-trabeculectomy/trabeculectomy in decreasing IOP (SMD =  -0.08, 95%CI = -0.32 - 0.15, I = 0%, Z = 0.70, P = .49). CONCLUSIONS: Phaco-GSL might be an optimal procedure to treat ACG with concomitant cataract due to its bleb-less nature, and its capacity for lowering IOP seems superior to Phaco alone and comparable to Phaco-trabeculectomy/trabeculectomy.


Assuntos
Catarata/complicações , Corpo Ciliar/cirurgia , Glaucoma de Ângulo Fechado/cirurgia , Pressão Intraocular/fisiologia , Facoemulsificação/métodos , Glaucoma de Ângulo Fechado/complicações , Glaucoma de Ângulo Fechado/fisiopatologia , Humanos , Trabeculectomia/métodos , Acuidade Visual
7.
Isr Med Assoc J ; 21(9): 599-602, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31542904

RESUMO

BACKGROUND: Ocular trauma in the pediatric population may lead to cataract formation. Managing traumatic cataracts in a visually immature child is a major challenge and can result in poor visual outcome. OBJECTIVES: To review our long-term surgical experience with childhood unilateral traumatic cataracts. METHODS: A retrospective observational study of children with unilateral traumatic cataracts with minimal follow-up of 5 years was conducted. Main outcomes included final visual acuity (VA) and occurrence of complications. RESULTS: Of the 18 children included in the study, 83% were male. Mean follow-up time was 12.5 years. Median age at injury was 7.5 years. Eleven patients (61%) presented with penetrating trauma injuries and 7 (39%) with blunt trauma. Sixteen patients (89%) had cataracts at presentation, while in two the cataracts developed during follow-up. Of the 18 total, cataract removal surgery was conducted in 16 (89%) with intraocular lens (IOL) implantation in 14 (87.5%), while 2 remained aphakic (12.5%). Two (11%) were treated conservatively. Long-term complications included IOL dislocation in 5 (36%), glaucoma in 8 (44%), and posterior capsular opacity in 10 (71%). No correlation was found between final visual acuity and the time interval between injury and IOL implantation nor between final VA and age at trauma. However, the final VA did correlate with time of follow-up. CONCLUSIONS: Severe complications occurred in over 30% of the patients during a long follow-up (mean 12.5 years). This finding shows the importance of discussions between the operating physician and the parents regarding the prognosis and necessity of scheduled follow-up.


Assuntos
Extração de Catarata/estatística & dados numéricos , Catarata/epidemiologia , Traumatismos Oculares/epidemiologia , Implante de Lente Intraocular/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Acuidade Visual , Adolescente , Causalidade , Criança , Pré-Escolar , Comorbidade , Traumatismos Oculares/cirurgia , Feminino , Seguimentos , Humanos , Israel/epidemiologia , Masculino , Estudos Retrospectivos , Tempo , Resultado do Tratamento
8.
Pan Afr Med J ; 33: 104, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31489082

RESUMO

Giant aneurysm of the intracranial carotid artery is a relatively rare disorder which can lead to life-threatening consequences. Ophthalmologic symptoms, mainly oculomotor nerve palsies, usually reveal lesions of the cavernous sinuses. We report the case of a 39-year old female patient presenting with rapidly progressive unilateral exophthalmos (A, B) and binocular diplopia associated with headaches affect one half of the head causing a single episode of vomiting evolving in a context of apyrexia and general state preservation. Ophthalmologic examination showed isolated palsies of the right lateral rectus muscle (abduction deficit). Static and dynamic assessment of the eyelids was normal. Corrected visual acuity was 5/10. Slit lamp exam showed dilation of the conjunctival vessels (C), clear cornea that didn't take up fluorescein, preserved direct and consensual pupillary light reflex, intra-ocular pressure 15 mmhg and venous tortuosities at the back of the eye, without papillary abnormalities (D). Neuroradiological assessment, such as magnetic resonance angiography, showed compressive aneurysms of the intracavernous portion of the right internal carotid artery with grade III exophthalmos. Cerebral angiography objectified right giant ruptured saccular cavernous carotid aneurysm in the cavernous sinuses (E) with anterior and posterior venous drainage associated with aneurysm of the left carotid syphon (F).


Assuntos
Aneurisma Roto/diagnóstico , Artéria Carótida Interna/patologia , Exoftalmia/etiologia , Aneurisma Intracraniano/diagnóstico , Adulto , Aneurisma Roto/complicações , Doenças das Artérias Carótidas/complicações , Doenças das Artérias Carótidas/diagnóstico , Feminino , Humanos , Aneurisma Intracraniano/complicações , Angiografia por Ressonância Magnética , Acuidade Visual
9.
Pan Afr Med J ; 33: 116, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31489094

RESUMO

This study aims to analyze the epidemiological, clinical, therapeutic and evolutionary profile of ocular manifestations in patients with Behçet's disease. We conducted a retrospective, descriptive study of the medical records of 121 patients managed by specialists with expertise in this disease over a period of one year and a half between January 2015 and June 2016. The average age of patients was 35 years, 63.6% of patients were male, ocular involvement was inaugural in 24% of cases. Patients had anterior uveitis (7.4%), posterior uveitis (15.7%), vasculitis (19%), irido-crystalline synechias (17.5%), macular edema (7.4%), optic atrophy (4.1%), papillary edema (2.5%) and peripheral retinal ischemia (1.7%). In our series, 41.3% of patients were under colchicine, 23.1% under oral corticosteroids, 9% under intravenous corticosteroids, 4.9% under topical corticosteroids, 8.2% under immunosuppressive drugs and 5.8% under vitamin K antagonists. After an average follow-up of 1 year, 40% of patients had stable visual acuity while receiving treatment, 23% had a significant decrease in visual acuity and 5% of cases had complete vision loss. Adequate therapy enables quick containment of the infection and decreases the frequency and severity of recurrences, thus leading to an improvement of the visual prognosis in our patients compared with outcomes in some previous case serie.


Assuntos
Síndrome de Behçet/complicações , Oftalmopatias/etiologia , Acuidade Visual , Corticosteroides/administração & dosagem , Adulto , Colchicina/administração & dosagem , Oftalmopatias/epidemiologia , Oftalmopatias/fisiopatologia , Feminino , Seguimentos , Humanos , Imunossupressores/administração & dosagem , Masculino , Prognóstico , Recidiva , Estudos Retrospectivos
10.
Fa Yi Xue Za Zhi ; 35(4): 402-405, 2019 Aug.
Artigo em Inglês, Chinês | MEDLINE | ID: mdl-31532146

RESUMO

Abstract: Objective To research the correlation between the visual acuity ratio and pattern reversal visual evoked potential (PRVEP) P100 waveform amplitude ratio of both eyes. Methods Forty-seven volunteers were selected, and the visual chart visual acuity of both eyes was measured. The visual acuity ratio of the eye with poor vision to the eye with better vision was calculated by five grade notation method. The amplitudes of P100 waveforms of both eyes were recorded respectively by using black-and-white checkerboard PRVEP and chosing 1°, 15' stimulating visual angle, and the ratio of amplitudes between the two eyes was also calculated. SPSS 20.0 software was used to analyze the correlation between the visual acuity ratio and the ratio of P100 waveform amplitudes between the two eyes. Return test and linear regression analysis with the binocular ratio of P100 waveform amplitudes as the independent variable (x) and the binocular visual acuity ratio as the dependent variable (y) were made. Results There was a positive correlation between the binocular visual acuity ratio and the ratio of P100 waveform amplitudes under 15' stimulating visual angle (Pearson correlation coefficient was 0.62, P=0.000). The fitting linear regression equation was y=0.090 x+0.846 (F=20.954, P=0.000). There was no significant correlation between the binocular ratio of visual acuity and the binocular ratio of P100 waveform amplitudes under 1° stimulating visual angle (P>0.05). Results of return test showed that there was no statistical significance in the difference between visual acuity estimated by equation and actual detected visual acuity. Conclusion In forensic appraisal of monocular injury, fitting linear regression equation of binocular visual acuity ratio and the binocular ratio of P100 waveform amplitudes under 15' stimulating visual angle, is helpful for visual acuity level estimation of the injured eye to some extent.


Assuntos
Potenciais Evocados Visuais , Olho/fisiopatologia , Visão Ocular , Acuidade Visual , Humanos , Análise de Regressão
11.
Asia Pac J Ophthalmol (Phila) ; 8(4): 280-284, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31369405

RESUMO

PURPOSE: The aim of this study was to provide a retrospective analysis of the presentation, demographics, and treatment regimens for ocular toxoplasmosis at a large tertiary referral uveitis center. DESIGN: Retrospective cohort study. PARTICIPANTS: A total of 48 patients with ocular toxoplasmosis who presented to Sydney Eye Hospital participated in this study. METHODS: This is a retrospective review of patient files who presented to Sydney Eye Hospital between 2007 and 2016 with clinical features consistent with ocular toxoplasmosis. Baseline risk factors and treatment details were recorded and analyzed. Main outcome measures were visual acuity and relapse rate compared with other studies in ocular toxoplasmosis. RESULTS: The median age was 35.5 (interquartile range 21-50) with 30 (60%) patients having no previous symptomatic episodes or evidence of chorioretinal scarring. Visual acuity at presentation was 0.51 or 6/19 (SE 0.096) and at follow-up 0.31 or 6/12 (SE 0.094). Nine patients experienced a recurrence during the period of observation with median time to recurrence 2.2 years (SE 0.45) and the relapse rate was 0.09/person-years. Location of lesion was predominantly within the vascular arcades (n = 44) with macular involvement in 9 patients. Most patients received clindamycin therapy (n = 34) with pyrimethamine and sulfadiazine was used for those with macula involvement. CONCLUSIONS: Patients with ocular toxoplasmosis had fewer recurrences compared with other published series and had better visual recovery. The majority of patients received clindamycin and oral prednisolone which were well tolerated with pyrimethazine and sulfadiazine reserved for those with macula-involving disease.


Assuntos
Anti-Infecciosos/administração & dosagem , Infecções Oculares Parasitárias/diagnóstico , Glucocorticoides/administração & dosagem , Centros de Atenção Terciária , Toxoplasmose Ocular/diagnóstico , Acuidade Visual , Administração Oral , Adulto , Anticorpos Antiprotozoários/análise , Austrália/epidemiologia , DNA de Protozoário/análise , Quimioterapia Combinada , Infecções Oculares Parasitárias/tratamento farmacológico , Infecções Oculares Parasitárias/epidemiologia , Feminino , Angiofluoresceinografia/métodos , Seguimentos , Fundo de Olho , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , Prognóstico , Estudos Retrospectivos , Tomografia de Coerência Óptica/métodos , Toxoplasma/genética , Toxoplasma/imunologia , Toxoplasma/isolamento & purificação , Toxoplasmose Ocular/tratamento farmacológico , Toxoplasmose Ocular/epidemiologia , Adulto Jovem
12.
Asia Pac J Ophthalmol (Phila) ; 8(4): 308-313, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31369406

RESUMO

PURPOSE: The aim of the current study was to compare visco-trabeculotomy (VT) with standard trabeculectomy with mitomycin C (Trab-MMC) in the treatment of quiescent neovascular glaucoma (NVG). METHODS: The study was conducted on 51 eyes of 51 patients presenting with NVG and treated at an Ophthalmic Center in Egypt between March 2014 and April 2017. All study eyes were subjected to a standard protocol of intravitreal injection of ranibizumab followed by panretinal photocoagulation. Eyes were then randomized to either VT or Trab-MMC. Study eyes were followed up for at least 18 months. Success was defined as an intraocular pressure of ≤21 mm Hg and without vision-threatening complications. Complications were noted. RESULTS: The mean ±â€ŠSD (range, median) age of the study patients was 54.1 ±â€Š6.4 (40-67, 54.5) and 52.4 ±â€Š8.8 (38-66, 53) years in the VT (26 eyes) and Trab-MMC (25 eyes) groups, respectively (P = 0.45). The mean ±â€ŠSD (range, median) intraocular pressure (IOP) of the study eyes was 45.19 ±â€Š2.97 (39-52, 45.5) and 45.64 ±â€Š3.56 (3-53, 45) mm Hg on maximal medical therapy in the VT and Trab-MMC groups, respectively (P = 0.61). At 18 months' follow-up, the mean ±â€ŠSD (range, median) IOP of the study eyes was 18.19 ±â€Š2.0 (16-23, 17) and 19.92 ±â€Š2.6 (18-26, 19) mm Hg in the VT and Trab-MMC groups, respectively (P = 0.004). There was no difference in postoperative antiglaucoma medication between the 2 groups (P = 0.62). Complications included hyphema and Descemet split in the VT group and an IOP spike in the Trab-MMC group. Success rates were 84.6% and 80% in the VT and Trab-MMC groups, respectively (P = 0.726). CONCLUSIONS: Both VT and Trab-MMC groups are effective in reducing the IOP in cases of NVG after control of neovascularization with anti-vascular endothelial growth factor and pan retinal photocoagulation.


Assuntos
Glaucoma Neovascular/terapia , Pressão Intraocular/fisiologia , Fotocoagulação/métodos , Ranibizumab/administração & dosagem , Trabeculectomia/métodos , Acuidade Visual , Adulto , Idoso , Inibidores da Angiogênese/administração & dosagem , Feminino , Seguimentos , Glaucoma Neovascular/fisiopatologia , Humanos , Injeções Intravítreas , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores
13.
Asia Pac J Ophthalmol (Phila) ; 8(4): 330-334, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31385820

RESUMO

BACKGROUND: A near vision game has been developed for the autostereoscopic screen of the Nintendo 3DS console. Ease of use and time for testing by non-English-speaking patients was not known. METHODS: Adult and pediatric patients in a remote Burma clinic were compared with US military staff with each performing conventional near acuity, Stereo Fly, and Ishihara color in addition to PDI Check game, so results could be correlated and timed. RESULTS: Seventeen Burma adults (aged 19-58), 20 Burma children (aged 7-15), and 14 US military staff (aged 21-36) completed the testing. Conventional testing correlated with PDI Check for stereo (P < 0.001), acuity oculo dexter (P < 0.01), acuity oculo sinister (P < 0.01). For visual acuity and stereopsis, the intraclass coefficient was 0.55 [95% confidence interval (CI) 0.28-0.72] and 0.62 (95% CI 0.41-0.77) respectively, but with few color deficient cases color was 0.30 (95% CI -0.05 to 0.60). The time in seconds to complete near vision testing with PDI Check (172 ±â€Š27, overall; 198 ±â€Š34, Burma; 99 ±â€Š20, military) was significantly (25% ±â€Š18%) briefer than conventional testing (226 ±â€Š31, overall; 270 ±â€Š34, Burma; 126 ±â€Š20, military). The Burma patients took significantly longer than the military staff (234 ±â€Š25 vs 112 ±â€Š14, P < 0.01). Time for Burma children did not differ from Burma adults for PDI (109 ±â€Š47 vs 217 ±â€Š54, P = 0.42) and for conventional testing (266 ±â€Š51 vs 275 ±â€Š52, P = 0.80). CONCLUSIONS: Non-English-speaking Burma children and adults were able to reliably perform 3 types of near vision testing with a Nintendo 3DS game 25% quicker than the 2 to 3 minutes for conventional methods. They were slower than experienced US military staff adults.


Assuntos
Percepção de Profundidade/fisiologia , Jogos de Vídeo , Transtornos da Visão/diagnóstico , Seleção Visual/instrumentação , Acuidade Visual , Adolescente , Adulto , Criança , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mianmar/epidemiologia , Prevalência , Estudos Prospectivos , Reprodutibilidade dos Testes , Transtornos da Visão/epidemiologia , Adulto Jovem
14.
Asia Pac J Ophthalmol (Phila) ; 8(4): 314-318, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31397675

RESUMO

PURPOSE: The aim of this study was to examine the hyperreflective dots seen in choroid on spectral domain optical coherence tomography (SDOCT) in eyes with diabetic macular edema (DME) and correlate it with visual acuity. DESIGN: Consecutive, cross-sectional case series of patients with DME between January 2017 and December 2017. METHODS: Eyes with DME having central foveal thickness ≥250 µm were included. SDOCT was performed using Spectralis system (Heidelberg Engineering, Germany). Hyperreflective choroidal foci (HCF) were defined as well-circumscribed dots within choroid having reflectivity equal to or higher than adjacent retinal pigment epithelium. HCF were counted manually within 1500 µm of fovea using a horizontal line scan by a blinded observer. Eyes were divided in 3 groups: group A (no HCF), group B (1-10 HCF), and group C (>10 HCF). RESULTS: One hundred nineteen eyes of 60 DME patients were included. Sixty (50.4%) eyes were in group A, whereas 42 (33.6%) and 17 (14.2%) eyes belonged to group B and group C, respectively. The mean logMAR best corrected visual acuity was significantly lower in group B (0.76 ±â€Š0.79) and C (1.2 ±â€Š0.78) as compared with group A (0.22 ±â€Š0.49) (P = 0.001). Mean central foveal thickness in group A (300.4 ±â€Š122.4 µm) was significantly lower than group B (455.52 ±â€Š209.1 µm) and group C (529.4 ±â€Š196.4 µm) with P value of 0.001. CONCLUSIONS: The present study describes HCF as novel prognostic SDOCT biomarker in DME whose presence denotes poor visual acuity. Further longitudinal studies are required to substantiate our findings.


Assuntos
Corioide/patologia , Retinopatia Diabética/complicações , Edema Macular/diagnóstico , Tomografia de Coerência Óptica/métodos , Acuidade Visual , Estudos Transversais , Retinopatia Diabética/diagnóstico , Feminino , Angiofluoresceinografia/métodos , Seguimentos , Fundo de Olho , Humanos , Edema Macular/etiologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Epitélio Pigmentado da Retina/patologia , Estudos Retrospectivos , Índice de Gravidade de Doença
15.
Asia Pac J Ophthalmol (Phila) ; 8(4): 285-289, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31397676

RESUMO

PURPOSE: The aim was to study the visual performance of a new refractive extended depth of focus (EDOF) intraocular lens (IOL). DESIGN: Prospective, comparative study. METHODS: Consenting patients with age-related cataract willing for bilateral cataract surgery within 2 weeks were implanted with the Supraphob EDOF IOL and those willing for 1 eye surgery were implanted with a monofocal IOL. The uncorrected and best-corrected distance, intermediate and near visual acuity, and contrast sensitivity were evaluated at 1 and 3 months postoperatively. We also inquired about glare, halos, difficulties in night driving, requirement for spectacles, and overall satisfaction with vision. RESULTS: The Supraphob EDOF group (n = 72 eyes) and the monofocal IOL group (n = 54 eyes) were comparable with respect to all preoperative parameters including biometry, visual acuity, and cataract status. The mean age of participants was 58.4 ±â€Š10.6 years. Both groups had similar distance vision but the EDOF group had significantly better intermediate (0.2 ±â€Š0.2 logMAR vs 0.75 ±â€Š0.19 logMAR, P < 0.001) and near vision (median = N6 vs N12, P < 0.001) compared to the monofocal group at 3 months. The contrast sensitivity was similar in both groups. Patients in the EDOF IOL group had much greater satisfaction for intermediate and near vision. Less than 10% patients reported glare, halos, and difficulty in driving at night in the EDOF group. CONCLUSIONS: The Supraphob EDOF IOL was effective in improving the distance, intermediate and near vision in majority of patients, and retained good contrast sensitivity with most patients reporting excellent satisfaction.


Assuntos
Sensibilidades de Contraste/fisiologia , Percepção de Profundidade/fisiologia , Lentes Intraoculares , Facoemulsificação , Acuidade Visual/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Período Pós-Operatório , Estudos Prospectivos , Desenho de Prótese
16.
Asia Pac J Ophthalmol (Phila) ; 8(4): 335-349, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31403494

RESUMO

AcrySof IQ PanOptix Model TFNT00 (Alcon Laboratories, Fort Worth, TX) is a 1-piece aspheric hydrophobic presbyopia-correcting intraocular lens (IOL) launched in 2015. Unlike traditional trifocal IOLs that usually have an intermediate focal point of 80 cm, the PanOptix IOL is designed to have an intermediate focal point of 60 cm (arms-length), a more natural and comfortable working distance to perform functional tasks on computers, laptops, mobiles, among others. The non-apodized PanOptix IOL uses the ENhanced LIGHT ENergy (ENLIGHTEN; Alcon Laboratories, Fort Worth, TX) optical technology that provides high (88%) utilization of light energy, low dependence on pupil size in all lighting conditions, and a more comfortable near-to-intermediate range of vision than traditional trifocal IOLs. This review provides an overview of the clinical performance of the PanOptix IOL and discusses it in the context of other commercially available trifocal IOLs, FineVision Micro F (PhysIOL, Liege, Belgium), the AT LISA tri 839MP (Carl Zeiss Meditec AG, Jena, Germany) and the extended depth of focus IOL, TECNIS Symfony (Abbott Medical Optics, Santa Ana, CA). A literature search was performed in the PubMed database to identify studies that have assessed the visual and other clinical outcomes with the PanOptix IOL. In total, 12 studies were included in this review article. Overall, the clinical evidence suggests that in general good visual outcomes, along with a high degree of spectacle independence, are achieved in patients implanted with the PanOptix, FineVision, AT LISA and Symfony IOLs. However, every MIOL has its benefits and limitations, which along with patient's needs and clinical conditions are important factors to consider while selecting an IOL to achieve best possible post-operative outcomes.


Assuntos
Lentes Intraoculares , Satisfação do Paciente , Pseudofacia/cirurgia , Refração Ocular/fisiologia , Visão Binocular/fisiologia , Acuidade Visual/fisiologia , Humanos , Facoemulsificação , Desenho de Prótese , Pseudofacia/fisiopatologia
17.
Medicine (Baltimore) ; 98(35): e16589, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31464893

RESUMO

RATIONALE: Lipid deposition on the cornea without previous infection, inflammation, vascularization, or trauma is idiopathic lipid keratopathy. In vivo laser confocal microscopy (IVCM) and anterior segment optical coherence tomography (AS-OCT) are 2 noninvasive methods that can help identify the structures and morphological characteristics of the focus. PATIENT CONCERNS: A 63-year-old woman with ipsilateral corneal lipid deposits developing from a small white spot into a yellow-white superotemporal elliptic shape within a year. AS-OCT showed peripheral deep stromal deposits. IVCM showed hyper-reflective material with typical crystalline-like or needle-like structures in the superotemporal area. DIAGNOSIS: Idiopathic lipid degeneration. INTERVENTIONS: Topical steroids eye drops 3 times a day for a month and further consultation every 3 months. OUTCOMES: This patient of idiopathic lipid keratopathy was observed every 3 months and till now we have reviewed this patient twice. Topical steroids eye drops were only used during the first month. No further development was observed about the lesion and the patient's visual acuity remained good. CONCLUSION: IVCM and AS-OCT can help identify the characteristic crystalline-like or needle-like hyper-reflective material that could help diagnosis of idiopathic lipid degeneration.


Assuntos
Córnea/diagnóstico por imagem , Doenças da Córnea/tratamento farmacológico , Metabolismo dos Lipídeos , Esteroides/administração & dosagem , Administração Tópica , Córnea/metabolismo , Doenças da Córnea/diagnóstico por imagem , Doenças da Córnea/metabolismo , Feminino , Humanos , Metabolismo dos Lipídeos/efeitos dos fármacos , Microscopia Confocal , Pessoa de Meia-Idade , Esteroides/farmacologia , Tomografia de Coerência Óptica , Resultado do Tratamento , Acuidade Visual
18.
Medicine (Baltimore) ; 98(35): e16886, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31464918

RESUMO

RATIONALE: Posterior scleritis is an ocular inflammatory disorder that can be associated with both infectious and non-infectious immune reactions. Behcet disease is a chronic, relapsing, multisystemic inflammatory disorder with uveitis. There are no reported cases of posterior scleritis with Bechet disease. PATIENT CONCERNS: A 50-year-old man previously diagnosed with systemic Behcet disease presented with ocular pain and decreased vision in the left eye. DIAGNOSIS: Posterior scleritis associated with Behcet disease was diagnosed based on optical coherence tomography showing choroidal folds, as well as contrast computed tomography and ultrasound sonography demonstrating thickening of the posterior sclera. INTERVENTIONS: Treatment with systemic corticosteroids was initiated. Since inflammation relapsed during steroid tapering, anti-tumor necrosis factor-alpha (TNF-α) therapy was used in combination, and tapering of steroids was possible without recurrence of inflammation for 12 months. OUTCOMES: Posterior scleritis was resolved and visual acuity improved. With the continuation of TNF-α therapy, oral prednisolone was successfully tapered and discontinued. No relapse of inflammation was observed at follow-up 1 year after discontinuation of prednisolone. LESSONS: Ophthalmologists should be aware of the possibility of rare manifestation of posterior scleritis in patients with Behcet disease, and that combined use of systemic steroids and anti-TNF-α therapy may resolve the scleritis without recurrence of inflammation.


Assuntos
Corticosteroides/uso terapêutico , Síndrome de Behçet/complicações , Esclerite/diagnóstico por imagem , Fator de Necrose Tumoral alfa/uso terapêutico , Corticosteroides/farmacologia , Humanos , Masculino , Pessoa de Meia-Idade , Esclerite/tratamento farmacológico , Esclerite/etiologia , Tomografia de Coerência Óptica , Resultado do Tratamento , Fator de Necrose Tumoral alfa/farmacologia , Ultrassonografia , Acuidade Visual/efeitos dos fármacos
19.
Health Qual Life Outcomes ; 17(1): 140, 2019 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-31412873

RESUMO

BACKGROUND: Although visual acuity and optical coherence tomography (OCT) are most widely used as outcomes in treatment of neovascular age-related Macular Degeneration (nAMD), patient reported outcome measures are increasingly recognized. National Eye Institute Visual Function Questionnaire (NEI-VFQ 25) was developed to capture the perceived visual function. Yet, evidence of psychometric performance in the target population is required. The aim of this study was to examine the psychometric properties of NEI-VFQ 25 in a Norwegian cohort of newly diagnosed nAMD patients followed with a Treat and Extend (T/E) protocol. METHODS: Patients receiving intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection treatment according to a T/E protocol completed a Norwegian translation of NEI-VFQ 25, EuroQoL Health Questionnaire (EQ-5D), and Patient acceptable symptom state (PASS 5) at baseline, 3, 6 and 12 months. In addition, a control population completed the same questionnaires. Visual acuity was assessed with LogMar for best/treated eye. Validity testing comprised face validity by a 0-10 numeric rating scale about relevance of NEI-VFQ 25 as well as regression analyses and correlations between NEI-VFQ 25 and other relevant variables. Reliability was examined with Intraclass Correlation Coefficient (ICC) and Cronbach's alpha for internal consistency were performed. Responsiveness, discriminatory power and predictive value were also explored. RESULTS: Number of respondents at baseline, after 3, 6 and 12 months was 197, 186, 176 and 168, respectively. The control population comprised 26 individuals. Face validity of NEI-VFQ 25 had a mean (SD) of 7.8 (1.7) (n = 84). NEI-VFQ was significantly correlated to visual acuity and PASS 5 as well as EQ-5D at baseline. Reliability (ICC) of the overall and sub scores for the patients/controls ranged from 0.49-0.97/0.59-0.97. Cronbach's alpha was 0.61-0.85. Discriminatory power was confirmed by significant differences of the overall score between controls and patients (P < 0.001). NEI-VFQ 25 indicates responsiveness showing overall score improved significantly (P ≤ 0.001) from baseline to 3 months. NEI-VFQ 25, general health and visual acuity at baseline were the strongest predictors for how patients reported vision after 6 months follow-up. CONCLUSION: NEI-VFQ 25 showed acceptable psychometric performance, which supports that the Norwegian version can be used to monitor patients treated for nAMD.


Assuntos
Degeneração Macular/psicologia , Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Estudos Transversais , Feminino , Humanos , Degeneração Macular/tratamento farmacológico , Masculino , Noruega , Reprodutibilidade dos Testes , Traduções , Fator A de Crescimento do Endotélio Vascular/uso terapêutico , Acuidade Visual
20.
Undersea Hyperb Med ; 46(3): 227-241, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31394594

RESUMO

Background: Audiology clinics have many tools available to evaluate auditory and vestibular complaints. However, many tools lack established normative ranges across the life span. We conducted this study to establish reference ranges across the life span for audiology/vestibular measures commonly used to evaluate patients with traumatic brain injury. Materials and Methods: In this repeated measures study, 75 adults, ages 18-65 years, without a history of traumatic brain injury, underwent robust auditory/vestibular evaluations three times over six months, including rotational chair, videonystagmography, computerized dynamic posturography, vestibular evoked myogenic potentials, and retinal fundoscopy. Results: Age effect was notable for transient evoked otoacoustic emissions, pure-tone audiometry, auditory brainstem response, auditory middle latency response, and auditory-steady state response at 4000 hertz (Hz). Older participants (50-65 years) were more likely to have delayed latency horizontal saccades, positional nystagmus, slowed lower-extremity motor control responses, and delayed latency ocular vestibular evoked myogenic potentials. Low to mid-frequency horizontal (0.003-4 Hz) and mid-frequency vertical (1-3 Hz) vestibulo-ocular reflex, otolith-mediated reflexes, dynamic visual acuity and balance measures were generally not influenced by age. Females had larger static subjective visual testing offset angles, longer cervical vestibular evoked myogenic potential P1 latency, faster velocity horizontal saccades, and quicker motor control latency for large backward translations than age-matched males. Conclusion: These reference ranges can be used to discern impairment within the auditory and vestibular pathway following traumatic brain injury in young to middle-aged adults. ID: TRIAL REGISTRATION: https://clinicaltrials.gov/ct2/show/NCT01925963.


Assuntos
Lesões Encefálicas Traumáticas/fisiopatologia , Testes Auditivos/normas , Testes de Função Vestibular/normas , Adolescente , Adulto , Fatores Etários , Idoso , Audiometria de Resposta Evocada/normas , Audiometria de Tons Puros/normas , Lesões Encefálicas Traumáticas/complicações , Potenciais Evocados Auditivos do Tronco Encefálico , Feminino , Fundo de Olho , Testes Auditivos/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Atividade Motora , Nistagmo Fisiológico , Otoscopia/métodos , Equilíbrio Postural , Estudos Prospectivos , Valores de Referência , Reflexo Acústico , Rotação , Movimentos Sacádicos , Fatores Sexuais , Fatores de Tempo , Potenciais Evocados Miogênicos Vestibulares , Testes de Função Vestibular/métodos , Acuidade Visual , Adulto Jovem
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