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2.
Angiol Sosud Khir ; 25(4): 108-115, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31855207

RESUMO

AIM: The purpose of the study was to compare the results of using compression knitwear and elastic bandaging in the postoperative period after endovasal laser coagulation in patients with varicose veins. PATIENTS AND METHODS: A total of forty 20-to-55-year-old women with a body mass index of ≤ 35 kg/m2 and CEAP class C2-C3 lower limb varicose veins were randomized into two numerically equal groups. The Study Group included those receiving postoperative compression on the operated leg with the help an elastic stocking, whereas in the Comparison Group compression was achieved by laying an elastic bandage. Both group women underwent laser coagulation of the great saphenous vein and removal of separate veins with the help of Mueller hooks. Efficacy of compression therapy was comparatively assessed based on the results of interviewing the patients prior to intervention and 1 month thereafter, as well as by the level of pain syndrome according to the visual analogue scale at 24 and 48 postoperative hours, by the time spent by the personnel for bandaging of the limb or putting on the compression stocking intraoperatively and at the first dressing, by the degree of lower limb oedema and dynamics of regression thereof, by the area of postoperative haematoma and its dynamics after 2, 7 days and at 1 month. Besides, we evaluated the findings of ultrasonographic angioscanning of lower limb veins at one month postoperatively. RESULTS: The obtained findings demonstrated that efficacy of using a medical compression stocking after the procedure of endovasal laser coagulation in women with varicose veins was comparable to that of elastic bandaging. By the incidence rate and area of extension of postoperative haematomas, degree of pain syndrome, patient-oriented assessment using the Chronic Venous Insufficiency Quality of Life Questionnaire (CIVIQ), condition of veins according to the findings of ultrasonographic angioscanning no significant differences were revealed between the two methods of elastic compression of the leg. However, using a medical stocking appeared to promote a statistically significant 1.4-1.6-fold reduction in the time spent for formation of elastic compression of the lower limb, as well as a decrease in the incidence rate and degree of local oedema of the lower limb in the postoperative period.


Assuntos
Bandagens Compressivas , Fotocoagulação a Laser/métodos , Varizes/terapia , Procedimentos Endovasculares , Feminino , Humanos , Qualidade de Vida , Meias de Compressão , Resultado do Tratamento , Varizes/complicações , Varizes/cirurgia , Insuficiência Venosa/etiologia , Insuficiência Venosa/cirurgia , Insuficiência Venosa/terapia
3.
Invest Ophthalmol Vis Sci ; 60(14): 4865-4871, 2019 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-31747687

RESUMO

Purpose: To evaluate the perfusion status of the retina and choriocapillaris in the area of laser scars on swept-source optical coherence tomography angiography (OCTA) images of eyes previously treated with panretinal photocoagulation (PRP). Methods: Cross-sectional exploratory analysis of swept-source OCTA images, which were retrospectively reviewed for laser scars. The appearance of the capillary networks in the area of previous laser were evaluated following a three-step grading system (normal/sparse/missing capillary network). The superficial and deep capillary plexus of the retina and the choriocapillaris were graded separately. Results: A total of 3140 laser scars in 54 eyes of 31 patients (13 female, mean age 57 ± 12 years) were included in this analysis. In the retina, 6.8% of the superficial and deep capillary network in the area evaluated appeared normal, 58% and 56% sparse, and 35% and 37% missing. Capillary dropout in the retina was not restricted to the area of prior laser treatment. The choriocapillaris decorrelation signal was either sparse (61%) or completely missing (38%) within the laser scar area. The perfusion of the choriocapillaris appeared normal in the area adjacent to laser scars. Conclusions: Capillary non-perfusion in the choriocapillaris was found within the laser scar area. Laser treatment seems to cause sustained non-perfusion of choriocapillaris in the area treated.


Assuntos
Corioide/irrigação sanguínea , Cicatriz/fisiopatologia , Retinopatia Diabética/fisiopatologia , Fotocoagulação a Laser , Vasos Retinianos/fisiologia , Idoso , Capilares/fisiologia , Cicatriz/diagnóstico , Estudos Transversais , Retinopatia Diabética/diagnóstico , Retinopatia Diabética/cirurgia , Feminino , Angiofluoresceinografia/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Fluxo Sanguíneo Regional/fisiologia , Estudos Retrospectivos , Tomografia de Coerência Óptica/métodos
4.
Medicine (Baltimore) ; 98(44): e17706, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689801

RESUMO

RATIONALE: Lumbar degeneration-related May-Thurner syndrome (dMTS) is characterized by venous compression induced by degenerated lower lumbar structures. Treatment strategies for May-Thurner syndrome (MTS) include clearing the thrombus and correcting venous compression. Despite having different etiological factors from other MTS types, treatments for dMTS are similar, including endovascular angioplasty and continuous anticoagulation therapies. Thus, a particular treatment was designed herein to focus on compressive lumbar structures instead of intravenous management. PATIENT CONCERNS: A 59-year-old female patient with dMTS, which was induced by inferior vena cava (IVC) stenosis compressed by L4-5 anterior disc herniation. DIAGNOSIS: The patient was diagnosed with IVC stenosis and L4-5 lumbar disc herniation based on abdominal computed tomography, ultrasound, and lumbar magnetic resonance imaging findings. INTERVENTIONS: Radiofrequency thermocoagulation (RF) was applied to the patient to decrease the compression caused by anterior disc herniation. OUTCOMES: After surgery, the patient's swelling started to improve within 5 hours and completely diminished after 48 hours. Postsurgical abdominal ultrasound showed that her IVC patency increased by 20%. On follow-up, her leg symptoms did not recur at 12 months after surgery. LESSONS: We provided a novel idea in the treatment of dMTS, in which we shifted the treatment focus from endovascular patency restoration to extravascular decompression. Our case proved that RF was effective in treating dMTS, which is a complementary treatment modality to angioplasty.


Assuntos
Deslocamento do Disco Intervertebral/cirurgia , Fotocoagulação a Laser/métodos , Síndrome de May-Thurner/cirurgia , Terapia por Radiofrequência/métodos , Feminino , Humanos , Deslocamento do Disco Intervertebral/complicações , Vértebras Lombares/cirurgia , Síndrome de May-Thurner/etiologia , Pessoa de Meia-Idade
5.
Urologiia ; (4 ()): 7-11, 2019 Sep.
Artigo em Russo | MEDLINE | ID: mdl-31535791

RESUMO

Laser technology has taken a place among the methods of treatment of various urological diseases. The new laser devices are being developed in addition to commonly used. Physicists of the russian NTO "IRE Polus" in collaboration with doctors from Sechenov University have developed a new generation laser device - thulium fiber laser. It has been actively used since 2017 for laser enucleation of prostate. Later the laser was used for treatment of bladder tumor, lithotripsy. The device has already managed to prove its efficacy in in-vitro experiments and clinical practice surpassing foreign analogues.


Assuntos
Cálculos Renais/terapia , Fotocoagulação a Laser/instrumentação , Terapia a Laser , Litotripsia a Laser/instrumentação , Túlio , Urologia , Humanos , Litotripsia a Laser/métodos , Masculino , Próstata/patologia , Próstata/cirurgia , Cálculos Ureterais/terapia , Cálculos da Bexiga Urinária/terapia , Neoplasias da Bexiga Urinária/terapia
6.
Lancet ; 394(10208): 1551-1559, 2019 10 26.
Artigo em Inglês | MEDLINE | ID: mdl-31522845

RESUMO

BACKGROUND: Despite increasing worldwide use of anti-vascular endothelial growth factor agents for treatment of retinopathy of prematurity (ROP), there are few data on their ocular efficacy, the appropriate drug and dose, the need for retreatment, and the possibility of long-term systemic effects. We evaluated the efficacy and safety of intravitreal ranibizumab compared with laser therapy in treatment of ROP. METHODS: This randomised, open-label, superiority multicentre, three-arm, parallel group trial was done in 87 neonatal and ophthalmic centres in 26 countries. We screened infants with birthweight less than 1500 g who met criteria for treatment for retinopathy, and randomised patients equally (1:1:1) to receive a single bilateral intravitreal dose of ranibizumab 0·2 mg or ranibizumab 0·1 mg, or laser therapy. Individuals were stratified by disease zone and geographical region using computer interactive response technology. The primary outcome was survival with no active retinopathy, no unfavourable structural outcomes, or need for a different treatment modality at or before 24 weeks (two-sided α=0·05 for superiority of ranibizumab 0·2 mg against laser therapy). Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, NCT02375971. INTERPRETATION: Between Dec 31, 2015, and June 29, 2017, 225 participants (ranibizumab 0·2 mg n=74, ranibizumab 0·1 mg n=77, laser therapy n=74) were randomly assigned. Seven were withdrawn before treatment (n=1, n=1, n=5, respectively) and 17 did not complete follow-up to 24 weeks, including four deaths in each group. 214 infants were assessed for the primary outcome (n=70, n=76, n=68, respectively). Treatment success occurred in 56 (80%) of 70 infants receiving ranibizumab 0·2 mg compared with 57 (75%) of 76 infants receiving ranibizumab 0·1 mg and 45 (66%) of 68 infants after laser therapy. Using a hierarchical testing strategy, compared with laser therapy the odds ratio (OR) of treatment success following ranibizumab 0·2 mg was 2·19 (95% Cl 0·99-4·82, p=0·051), and following ranibizumab 0·1 mg was 1·57 (95% Cl 0·76-3·26); for ranibizumab 0·2 mg compared with 0·1 mg the OR was 1·35 (95% Cl 0·61-2·98). One infant had an unfavourable structural outcome following ranibizumab 0·2 mg, compared with five following ranibizumab 0·1 mg and seven after laser therapy. Death, serious and non-serious systemic adverse events, and ocular adverse events were evenly distributed between the three groups. FINDINGS: In the treatment of ROP, ranibizumab 0·2 mg might be superior to laser therapy, with fewer unfavourable ocular outcomes than laser therapy and with an acceptable 24-week safety profile. FUNDING: Novartis.


Assuntos
Inibidores da Angiogênese/administração & dosagem , Fotocoagulação a Laser , Ranibizumab/administração & dosagem , Retinopatia da Prematuridade/terapia , Inibidores da Angiogênese/efeitos adversos , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Recém-Nascido de muito Baixo Peso , Injeções Intravítreas , Fotocoagulação a Laser/efeitos adversos , Masculino , Ranibizumab/efeitos adversos , Resultado do Tratamento , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores
7.
Invest Ophthalmol Vis Sci ; 60(12): 3813-3820, 2019 09 03.
Artigo em Inglês | MEDLINE | ID: mdl-31525777

RESUMO

Purpose: To determine whether elevated levels of immune/inflammatory proteins in cord blood, alone or in combination with conventional clinical parameters, can predict the occurrence and progression of retinopathy of prematurity (ROP) in preterm infants. Methods: This was a retrospective cohort study of 110 premature singleton infants who were born at ≤32.0 weeks. Cord plasma at birth was assayed for interleukin-6, C3a, C5a, matrix metalloproteinase-2 (MMP-2), MMP-9, tissue inhibitor of metalloproteinase-1, macrophage colony-stimulating factor, endostatin, a proliferation-inducing ligand, insulin-like growth factor-binding protein-1 (IGFBP-1), IGFBP-2, and calcium-binding protein A8/A9 complex levels. The primary outcome measures were the occurrence of any stage ROP, severe ROP (>stage 3), and vision-threatening type 1 ROP requiring laser treatment. Results: ROP was diagnosed in 30 of 110 infants (27.3%), including 14 (12.7%) with severe ROP. Laser treatment was performed on 7 infants (6.4%). Multiple logistic regression analyses indicated that elevated levels of cord plasma IL-6 were significantly associated with severe ROP, whereas elevated levels of cord plasma C5a were significantly associated with ROP laser treatments. However, none of the proteins measured in the cord plasma were associated with ROP occurrence. Using a stepwise regression procedure, we developed a combined prediction model, which included high cord plasma IL-6 levels and low birth weight for severe ROP (area under the curve [AUC], 0.840), and high cord plasma C5a levels and low birth weight for laser treatment (AUC, 0.884). Conclusions: Elevated levels of cord plasma IL-6 and C5a could be used as independent markers to predict severe ROP and laser treatment, respectively, with combined models predicting ROP progression with good accuracy.


Assuntos
Biomarcadores/sangue , Complemento C5a/metabolismo , Sangue Fetal/metabolismo , Recém-Nascido Prematuro , Interleucina-6/sangue , Retinopatia da Prematuridade/diagnóstico , Complemento C3a/metabolismo , Citocinas/sangue , Progressão da Doença , Ensaio de Imunoadsorção Enzimática , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido de Baixo Peso , Recém-Nascido , Fotocoagulação a Laser , Masculino , Metaloproteases/sangue , Nascimento Prematuro , Retinopatia da Prematuridade/sangue , Retinopatia da Prematuridade/cirurgia , Estudos Retrospectivos
8.
Ophthalmic Res ; 62(4): 225-230, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31554001

RESUMO

Over the past two decades, the Diabetic Retinopathy Clinical Research Network (now known as the DRCR Retina Network) has contributed to multiple and substantial advances in the clinical care of diabetic eye disease. Network studies helped establish anti-vascular endothelial growth factor (VEGF) agents as an effective alternative to panretinal photocoagulation for eyes with proliferative diabetic retinopathy (PDR) and as first-line therapy for eyes with visual impairment for diabetic macular edema (DME), defined treatment algorithms for the use of intravitreal medications in these conditions, and provided critical data to understand how to better evaluate the diabetic eye using optical coherence tomography and other imaging modalities. Ongoing DRCR.net studies will address whether anti-VEGF therapy is effective at preventing vision-threatening complications in eyes with severe non-proliferative diabetic retinopathy, if photobiomodulation has a beneficial effect in eyes with DME, and whether initiation of DME treatment with bevacizumab and rescue with aflibercept can provide visual outcomes as good as those achieved with aflibercept alone. Future plans for the Network also include the expansion into non-diabetic eye disease in areas such as age-related macular degeneration.


Assuntos
Inibidores da Angiogênese/administração & dosagem , Protocolos Clínicos , Retinopatia Diabética/terapia , Fotocoagulação a Laser/métodos , Retina/diagnóstico por imagem , Acuidade Visual , Retinopatia Diabética/diagnóstico , Humanos , Injeções Intravítreas , Tomografia de Coerência Óptica
9.
Ophthalmic Surg Lasers Imaging Retina ; 50(8): 520-521, 2019 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-31415700

RESUMO

Plus disease, or the presence of vascular dilation and tortuosity, is the most reliable predictor of the progression of retinopathy of prematurity (ROP), making resolution of plus disease one of the earliest signs of ROP regression. Patients with certain comorbid conditions such as anemia and cardiovascular disease may have persistent plus-like disease following successful resolution of ROP. The authors present a case of a 24-week premature infant who was treated with panretinal photocoagulation for stage 3, zone II. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:520-521.].


Assuntos
Fotocoagulação a Laser/métodos , Vasos Retinianos/patologia , Retinopatia da Prematuridade/cirurgia , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido Prematuro , Masculino
10.
BMC Ophthalmol ; 19(1): 195, 2019 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-31455285

RESUMO

BACKGROUND: The subconjunctival anesthesia with local anesthetics is considered as a low-risk procedure allowing ocular surgery without serious complications typical for retro- or parabulbar anesthesia, especially in patients with preexisting Optic Nerve damage. We report development of ipsilateral transient amaurosis accompanied with mydriasis and both, direct and consensual light response absence. CASE PRESENTATION: Three patients with advanced refractory glaucoma undergoing laser cyclophotocoagulation (CPC) for intraocular pressure lowering experienced these adverse effects just few minutes after subconjunctival injection of mepivacaine 2% solution (Scandicaine® 2%, without vasoconstrictor supplementation). The vision was completely recovered to usual values in up to 20 h after mepivacaine application. Extensive ophthalmological examination, including cranial magnetic resonance imaging (MRI), revealed no further ocular abnormalities, especially no vascular constriction or thrombotic signs as well as no retinal detachment. The oculomotor function remained intact. The blockade of ipsilateral ciliary ganglion parasympathetic fibers by mepivacaine may be the responsible mechanism. Systemic pathways as drug-drug interactions seem to be unlikely involved. Importantly, all three patients tolerated the same procedure previously or at a later date without any complication. Overall, our thoroughly elaborated risk management could not determine the causative factor explaining the observed ocular complications just in the current occasion and not at other time points. CONCLUSIONS: Doctors should be aware and patients should be informed about such rare complications after subconjunctival local anesthetics administration. Adequate risk management should insure patients' safety.


Assuntos
Anestésicos Locais/efeitos adversos , Cegueira/induzido quimicamente , Túnica Conjuntiva/efeitos dos fármacos , Glaucoma de Ângulo Aberto/cirurgia , Mepivacaína/efeitos adversos , Midríase/induzido quimicamente , Distúrbios Pupilares/induzido quimicamente , Idoso , Anestesia Local/métodos , Anestésicos Locais/administração & dosagem , Cegueira/fisiopatologia , Corpo Ciliar/cirurgia , Humanos , Injeções Intraoculares , Pressão Intraocular , Fotocoagulação a Laser , Masculino , Mepivacaína/administração & dosagem , Pessoa de Meia-Idade , Midríase/fisiopatologia , Distúrbios Pupilares/fisiopatologia
11.
Zhonghua Yan Ke Za Zhi ; 55(8): 565-568, 2019 Aug 11.
Artigo em Chinês | MEDLINE | ID: mdl-31422634

RESUMO

Diabetic retinopathy (DR) is one of the most important etiologies of diabetic blindness. The vascular endothelial growth factor (VEGF) is thought to mediate pathophysiological changes of DR. Anti-VEGF therapy for DRdevelops rapidly. However, there are some misunderstandings about its clinical application, and the strategy is not clear. Sometimes its therapeutic effects are even exaggerated. In this article, by discussing whether anti-VEGF therapy can reverse the course of DR disease, promote the absorption of vitreous hemorrhage, and replace fundus laser therapy, the application strategy of anti-VEGF therapy for DR is proposed. At present, anti-VEGF therapy cannot completely replace retinal photocoagulation therapy, and its clinical application value should not be exaggerated. More innovative drugs and therapies are expected to provide new ways forthe treatment of DR while preserving visual function. (Chin J Ophthalmol, 2019, 55: 565-568).


Assuntos
Inibidores da Angiogênese , Retinopatia Diabética , Fator A de Crescimento do Endotélio Vascular , Inibidores da Angiogênese/uso terapêutico , Retinopatia Diabética/tratamento farmacológico , Humanos , Fotocoagulação a Laser , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores
13.
J Pediatr Ophthalmol Strabismus ; 56(4): 222-228, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31322711

RESUMO

PURPOSE: To investigate persistent avascular retina in infants with type 2 retinopathy of permaturity (ROP) that persisted after 45 weeks' post-menstrual age when regular ROP screening ceased. METHODS: A prospective observational study where fundus fluorescein angiography (FFA) was completed on consecutive infants who had a history of type 2 ROP and avascular retina during ROP screening that persisted after 45 weeks' post-menstrual age. RESULTS: FFA was completed on 72 eyes of 36 infants (53% male), with a mean gestational age of 26.0 ± 2.2 weeks and a mean birth weight of 834.6 ± 216.3 grams. The mean age at discharge from ROP screening was 47.6 weeks' post-menstrual age. All patients had type 2 ROP at the worst stage of their disease, with predominantly stage 2 disease. FFA was performed at a mean age of 18.8 ± 10.3 months post-menstrual age. All patients had detectable avascular retina in peripheral zone II or III on FFA. Peripheral vessel leakage was present in 3 eyes of 2 infants (5.5%), who both subsequently received peripheral laser treatment. CONCLUSIONS: Premature infants with type 2 ROP may have persistent peripheral avascular retina with unknown long-term ocular complications, which can present management dilemmas. Retinal FFA is recommended to determine retinal ischemia and aid decision making for treatment in these cases. [J Pediatr Ophthalmol Strabismus. 2019;56(4):222-228.].


Assuntos
Tomada de Decisões , Fotocoagulação a Laser , Retina/anormalidades , Vasos Retinianos/anormalidades , Retinopatia da Prematuridade/diagnóstico , Acuidade Visual , Feminino , Angiofluoresceinografia , Fundo de Olho , Idade Gestacional , Humanos , Recém-Nascido , Masculino , Estudos Prospectivos , Retina/diagnóstico por imagem , Vasos Retinianos/diagnóstico por imagem , Retinopatia da Prematuridade/terapia , Microscopia com Lâmpada de Fenda
14.
Folia Med (Plovdiv) ; 61(2): 240-248, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31301668

RESUMO

BACKGROUND: There is an ambiguity regarding the therapy of choice for patients with macular edema following branch retinal vein occlusion (BRVO). AIM: The purpose of the study was to compare the efficacy and safety of ranibizumab (3 injections 0.5 mg) versus ranibizumab (1 injection 0.5 mg) with laser photocoagulation (LP) versus dexamethamethasone intravitreal (IVT) implant (0.7 mg) with or without LP in patients with macular edema following BRVO. MATERIALS AND METHODS: 60 eyes of 60 patients were divided into 4 groups. Group 1 received IVT ranibizumab (3 injections 0.5 mg), Group 2 received IVT ranibizumab (1 injection 0.5 mg) + LP, Group 3 received dexamethasone IVT implant (0.7 mg), and Group 4 received dexamethasone IVT implant (0.7 mg) + LP. The endpoints were the difference in mean changes in best corrected visual acuity (BCVA), central macular thickness (CMT), and inter-group differences in contrast sensitivity (CS), retinal sensitivity (RS), and intraocular pressure (IOP). RESULTS: BCVA gains in Group 1 (18.00±8.51) patients were significantly (p < 0.05) higher than patients in Groups 2 (10.00±10.26), 3 (9.50±9.60), and 4 (10.50±10.97), after 6 months of therapy. No significant inter-group variation was found in the CMT, CS, and RS. CONCLUSIONS: Ranibizumab (3 injections 0.5 mg) showed significantly higher BCVA gains at 6 months post-therapy. Improvements in the BCVA, CMT, CS, and RS were comparable initially in all the therapies.


Assuntos
Inibidores da Angiogênese/uso terapêutico , Dexametasona/uso terapêutico , Glucocorticoides/uso terapêutico , Fotocoagulação a Laser/métodos , Edema Macular/terapia , Ranibizumab/uso terapêutico , Idoso , Sensibilidades de Contraste , Implantes de Medicamento , Feminino , Humanos , Pressão Intraocular , Injeções Intravítreas , Edema Macular/etiologia , Edema Macular/patologia , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Oclusão da Veia Retiniana/complicações , Resultado do Tratamento , Acuidade Visual , Corpo Vítreo
15.
Semin Ophthalmol ; 34(5): 398-402, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31284800

RESUMO

Purpose: To compare the success rates and safety of transscleral cyclophotocoagulation (TSCPC) for the treatment of refractory glaucoma using the slow coagulation technique and the conventional technique. Methods: A retrospective, interventional case series of 44 patients (44 eyes) who underwent TSCPC using the slow coagulation technique (22 eyes) and conventional technique (22 eyes) in a tertiary hospital was done. The main outcome measures were success and complications. Success was defined as a final intraocular pressure (IOP) between 6 and 21 mmHg with or without IOP lowering medications with the cessation of oral carbonic anhydrase inhibitor at 12 months. Results: Preoperative characteristics were statistically similar with regard to age, sex, laterality, diagnosis, IOP, and the number of glaucoma medications used. Both procedures had similar success rates of 40.9% and 36.3% in the conventional technique group and slow coagulation group, respectively (p = .757). The slow coagulation group had less prolonged anterior chamber inflammation (p = .048). Conclusions: Diode laser TSCPC using the slow coagulation technique is a safe and effective technique for lowering IOP in patients with refractory glaucoma in Chinese eyes.


Assuntos
Glaucoma/cirurgia , Fotocoagulação a Laser/métodos , Procedimentos Cirúrgicos Oftalmológicos , Esclera/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anti-Hipertensivos/uso terapêutico , Inibidores da Anidrase Carbônica/uso terapêutico , Feminino , Glaucoma/fisiopatologia , Humanos , Pressão Intraocular/fisiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
16.
Urologiia ; (2): 55-58, 2019 Jun.
Artigo em Russo | MEDLINE | ID: mdl-31162902

RESUMO

The article describes the clinical observation of the patient 84 years old with prostate cancer T2bNxM0, left kidney cancer T1N0M0 and severe comorbidity. Stepwise interstitial laser coagulation was performed using the Russian microsecond Nd: YAG laser surgical complex.


Assuntos
Neoplasias Renais/cirurgia , Fotocoagulação a Laser , Lasers de Estado Sólido/uso terapêutico , Neoplasias da Próstata/cirurgia , Idoso de 80 Anos ou mais , Comorbidade , Humanos , Neoplasias Renais/complicações , Fotocoagulação a Laser/instrumentação , Masculino , Neoplasias da Próstata/complicações
17.
Ophthalmic Res ; 62(2): 111-115, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31167215

RESUMO

OBJECTIVES: To study the efficacy and safety of different treatments for diabetic neovascular glaucoma (NVG). We additionally attempt to determine if the presence of NVG could be a predictor of cardiovascular disease or death. METHOD: This is a retrospective, observational cohort study including patients diagnosed with diabetic NVG from 2006 to 2016 at the Hospital Clínico Universitario de Valladolid (Spain). Extracted data included clinical characteristics of the patients, glycated haemoglobin levels, and ocular treatment. Visual acuity (VA), intraocular pressure (IOP), cardiovascular events, and deaths were registered. RESULTS: 30 eyes from 23 patients were followed for a mean of 4.48 years (SD = 2.82 years). The IOP-lowering intervention groups were: Ahmed implant (11 eyes), laser cyclo-photocoagulation (CPC; 6 eyes), both (4 eyes), or none (9 eyes). IOP success was achieved in 100% of the eyes with Ahmed and/or laser CPC and in 44.4% of the eyes with no IOP-lowering procedure (p= 0.002). Most eyes with Ahmed implant (with or without CPC) maintained or improved their VA (100 and 63.6%, respectively). 33.3% of the eyes with laser CPC and 25% of those with no IOP-lowering intervention maintained or improved their VA (p = 0.028). Hypotony was the only adverse effect (after laser CPC). No statistically significant difference could be established between low VA (finger count or worse), poor IOP control, or bad metabolic control and mortality or cardiovascular event (p > 0.05), however, the four patients who died had poor VA at the time of NVG diagnosis. CONCLUSIONS: Ahmed implant surgery is a safe and effective treatment option for diabetic NVG. Medical treatment alone is not the best option for most cases. Advanced NVG could be an indicator of higher mortality risk in diabetic patients.


Assuntos
Diabetes Mellitus , Retinopatia Diabética/terapia , Implantes para Drenagem de Glaucoma , Glaucoma Neovascular/terapia , Fotocoagulação a Laser/métodos , Adulto , Idoso , Feminino , Seguimentos , Hemoglobina A Glicada/análise , Humanos , Pressão Intraocular/fisiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Acuidade Visual
18.
Ophthalmologica ; 242(2): 113-117, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31163427

RESUMO

PURPOSE: To evaluate the effects of repeated intra-silicone oil (SO) injections of methotrexate (MTX) on the outcomes of surgery for rhegmatogenous retinal detachment (RRD) with grade C proliferative vitreoretinopathy (PVR-C). METHODS: In this prospective pilot case series, eyes with RRD and PVR-C underwent pars plana vitrectomy and intraocular injection of SO. At the conclusion of the procedure, 250 µg of MTX was injected into the SO-filled vitreous cavity. Intra-SO injection was repeated at weeks 3 and 6; the minimum follow-up period was 6 months. The main outcome measure was retinal reattachment rate. RESULTS: Eleven eyes of 11 patients (mean age, 52.73 ± 18.01 years) were included. The mean follow-up period was 9 ± 3 months (range, 6-15 months). Total retinal detachment with anterior and/or posterior PVR-C was present in all eyes before surgery. Mean preoperative best-corrected visual acuity (BCVA) was 2.62 ± 0.04 logMAR. All operated eyes exhibited retinal reattachment posterior to the equator during the follow-up period. Mean postoperative BCVA was significantly improved to 1.02 ± 0.51 logMAR (p = 0.003). No ocular or systemic side effects were observed. CONCLUSION: Repeated intra-SO injection of MTX as an adjunctive therapy for RRD complicated by PVR showed promising results and was not associated with adverse effects. Further studies are needed to confirm its possible beneficial effects on the final anatomic and functional outcomes in these cases.


Assuntos
Metotrexato/administração & dosagem , Descolamento Retiniano/terapia , Óleos de Silicone , Acuidade Visual , Vitrectomia/métodos , Vitreorretinopatia Proliferativa/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Tamponamento Interno , Feminino , Humanos , Imunossupressores/administração & dosagem , Injeções Intraoculares , Fotocoagulação a Laser , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos , Retina/patologia , Descolamento Retiniano/diagnóstico , Descolamento Retiniano/etiologia , Tomografia de Coerência Óptica , Resultado do Tratamento , Vitreorretinopatia Proliferativa/complicações , Vitreorretinopatia Proliferativa/diagnóstico , Adulto Jovem
19.
Semin Pediatr Surg ; 28(3): 143-150, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31171149

RESUMO

The growth of the field of fetal surgery over the last two decades driven by new indications and data from prospective randomized trials supporting prenatal intervention has resulted in techniques protocols and methodologies that have gained confidence by insuring good outcomes. Error traps are methods or techniques that usually work well in most of the cases, but which are apt to fail under certain specific circumstances. The very confidence the surgeon develops in these techniques or methodologies makes them a trap for the unwary surgeon. The purpose of this article is to discuss common error traps in fetal interventions, including ultrasound guided procedures, fetoscopic surgery, open fetal surgery and EXIT procedures. Awareness of these error traps and approaches to avoid them may enhance fetal surgical outcomes and reduce complications rates.


Assuntos
Doenças Fetais/cirurgia , Fetoscopia/normas , Fotocoagulação a Laser/normas , Erros Médicos , Ablação por Radiofrequência/normas , Procedimentos Cirúrgicos Operatórios/normas , Ultrassonografia Pré-Natal/normas , Feminino , Fetoscopia/métodos , Humanos , Fotocoagulação a Laser/métodos , Gravidez , Ablação por Radiofrequência/métodos , Procedimentos Cirúrgicos Operatórios/métodos , Ultrassonografia Pré-Natal/métodos
20.
Ophthalmol Retina ; 3(6): 473-477, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31174668

RESUMO

PURPOSE: To report the rate of new vessel (NV) regression after monthly injections of bevacizumab in laser-treated proliferative diabetic retinopathy (PDR) eyes with persistent neovascularization. DESIGN: Prospective cohort study. PARTICIPANTS: Eyes with PDR with incomplete response to prior complete panretinal photocoagulation (PRP). METHODS: Ninety eyes of 80 patients with persistent PDR (pPDR) despite adequate PRP were prospectively followed on a monthly basis with anti-vascular endothelial growth factor (VEGF) injections when needed and stereo fundus images looking at the regression of NVs. MAIN OUTCOME MEASURES: Regression of NVs. RESULTS: A total of 70 of 90 eyes (77.8%) had regression of the NV. Mean number of injections to reach quiescence was 9±3 for pPDR in the high-risk characteristics (HRC) group (80 eyes) and 3±1 for PDR in the group without HRC (10 eyes) (P < 0.001). All patients with PDR without HRC responded to the adjuvant therapy, whereas 75.0% of the eyes with PDR with HRC responded. Eyes with initial retinal neovascularization all responded to the adjuvant treatment. Eyes without a vitreous hemorrhage at study entry were more likely to respond (odds ratio, 5.43; 95% confidence interval, 1.37-21.44; P < 0.01). Therapy was judged unsuccessful because of the continuous growth of the NV despite treatment (3 eyes), the development of traction (5 eyes), and the development of a dense vitreous hemorrhage (6 eyes). CONCLUSIONS: Anti-VEGF rescue therapy has a potential role in select cases of laser-treated PDR with persistent NVs and no evidence of traction to achieve regression of neovessels.


Assuntos
Bevacizumab/administração & dosagem , Retinopatia Diabética/terapia , Fotocoagulação a Laser/métodos , Retina/patologia , Neovascularização Retiniana/terapia , Acuidade Visual , Adulto , Inibidores da Angiogênese/administração & dosagem , Retinopatia Diabética/complicações , Retinopatia Diabética/diagnóstico , Feminino , Seguimentos , Humanos , Injeções Intravítreas , Masculino , Pessoa de Meia-Idade , Oftalmoscopia , Estudos Prospectivos , Neovascularização Retiniana/diagnóstico , Neovascularização Retiniana/etiologia , Microscopia com Lâmpada de Fenda , Tomografia de Coerência Óptica , Resultado do Tratamento , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores
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