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2.
Curr Opin Ophthalmol ; 31(3): 155-160, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32168002

RESUMO

PURPOSE OF REVIEW: Pediatric retina is an exciting, but also challenging field, where patient age and cooperation can limit ease of diagnosis of a broad range of congenital and acquired diseases, inherited retinal degenerations are mostly untreatable and surgical outcomes can be quite different from those for adults. This review aims to highlight some recent advances and trends that are improving our ability to care for children with retinal conditions. RECENT FINDINGS: Studies have demonstrated the feasibility of multimodal imaging even in nonsedated infants, with portable optical coherence tomography (OCT) and OCT angiography in particular offering structural insights into diverse pediatric retinal conditions. Encouraging long-term outcomes of subretinal voretigene neparvovec-rzyl injection for RPE65 mutation-associated Leber congenital amaurosis have inspired research on the optimization of subretinal gene delivery and gene therapy for other inherited retinal degenerations. In retinopathy of prematurity, machine learning and smartphone-based imaging can facilitate screening, and studies have highlighted favorable outcomes from intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections. A nomogram for pediatric pars plana sclerotomy site placement may improve safety in complex surgeries. SUMMARY: Multimodal imaging, gene therapy, machine learning and surgical innovation have been and will continue to be important to advances in pediatric retina.


Assuntos
Terapia Genética/métodos , Aprendizado de Máquina , Imagem Multimodal , Procedimentos Cirúrgicos Oftalmológicos , Doenças Retinianas/diagnóstico , Doenças Retinianas/terapia , Criança , Pré-Escolar , Humanos , Lactente , Retina
3.
Medicine (Baltimore) ; 99(12): e19038, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32195929

RESUMO

Conventional levator aponeurosis plication is a widely accepted technique for correction of mild to moderate ptosis. However, this method is associated with a high recurrence rate. The objective of this study was to investigate the clinical efficacy of levator aponeurosis posterior layer plication technique for correction of mild to moderate ptosis.A convenience sampling approach was used to recruit 450 patients with mild to moderate blepharoptosis at the Guangzhou Eye-Nose-Face Aesthetic Plastic Surgery Hospital between August, 2015 and December, 2017. All participants were treated with levator aponeurosis posterior layer plication technique. The primary outcome was the postoperative change in marginal reflex distance 1 (MRD1). The paired t test was used to determine the clinical efficacy. Outcomes were assessed at 1 week, 1 month, 3 months, and 6 months after surgery.The mean preoperative MRD1 was 1.7 ±â€Š0.5 mm, and the mean postoperative MRD1 at 6-month follow-up was 3.7 ±â€Š0.4 mm (P < .0001). According to the postoperative survey, 427 (94.9%) patients were satisfied with surgical outcomes.This modified levator aponeurosis plication technique is a simple and effective procedure for correction of mild to moderate blepharoptosis. It results in good MRD1 and high patient satisfaction.


Assuntos
Blefaroptose/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/métodos , Adolescente , Adulto , Aponeurose/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Adulto Jovem
4.
Medicine (Baltimore) ; 99(6): e18836, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32028394

RESUMO

RATIONALE: Malignant glaucoma is a refractory glaucoma which often relentlessly worsened despite conventional therapy. Ultrasonographic biomicroscopy always cannot show the ciliary-block of malignant glaucoma. We report a case of capsular tension ring induced ciliary-block and successfully treated by low dose laser cyclophotocoagulation, with 1-year follow-up. PATIENT CONCERNS: A 75-year-old woman was referred for glaucoma with a history of cataract and lens zonular laxity, and surgery with combined phacoemulsification and capsular tension ring implantation. She subsequently underwent trabeculectomy for uncontrolled intraocular pressure on maximal medical therapy. One day later, the patient presented as shallow anterior chamber of Shaffer grade 1 and an elevated intraocular pressure of 51.0 mmHg in the right eye. DIAGNOSIS: Ciliary block caused by capsular tension ring and malignant glaucoma was observed. INTERVENTIONS: Low dose laser cyclophotocoagulation was performed under retrobulbar anesthesia. OUTCOMES: One day later, the patient's intraocular pressure decreased to 14.3 mmHg on topical atropine 1% and 2 classes of intraocular pressure lowering medications. The patient discontinued topical atropine and intraocular pressure lowering medications 4 months postoperatively and her condition had remained stable for 1 year without any medications. The patient had a satisfactory recovery benefited from the low dose laser cyclophotocoagulation. LESSONS: Low dose laser cyclophotocoagulation in this challenging case of capsular tension ring-induced malignant glaucoma provided an effective and fast recovery of anterior chamber depth over a 1-year period.


Assuntos
Corpo Ciliar/cirurgia , Glaucoma/diagnóstico , Idoso , Diagnóstico Diferencial , Feminino , Glaucoma/cirurgia , Humanos , Pressão Intraocular , Fotocoagulação a Laser , Procedimentos Cirúrgicos Oftalmológicos
5.
Medicine (Baltimore) ; 99(1): e18669, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895833

RESUMO

In ophthalmic surgery, coughing during emergence from general anesthesia may have a detrimental effect on intraocular pressure. Tracheal suction during emergence may elicit this reflex. The optimal effect-site concentration (EC) of propofol to prevent triggering of the cough reflex during tracheal suctioning is unknown. The aim of this study is to assess the optimal EC of propofol for tracheal suctioning during emergence in patients undergoing ophthalmic surgery.Twenty-one patients were enrolled, all of them American Society of Anesthesiologists (ASA) physical status I or II non-smokers undergoing ophthalmic surgery. Anesthesia was induced and maintained under total intravenous anesthesia using target-controlled infusion. During emergence from general anesthesia, tracheal suction was performed at different propofol concentrations as required for Dixon's up-and-down method with a step size of 0.2 µg/ml. A propofol concentration at which the cough reflex was not triggered during tracheal suctioning was considered successful.The EC50 of propofol for tracheal suction without cough was 1.4 µg/ml and the EC95 was 1.6 µg/ml.Tracheal suction may be accomplished without triggering the cough reflex when the propofol effect-site concentration is higher than 1.6 µg/ml.


Assuntos
Anestésicos Intravenosos/administração & dosagem , Tosse/prevenção & controle , Intubação Intratraqueal/efeitos adversos , Procedimentos Cirúrgicos Oftalmológicos , Propofol/administração & dosagem , Idoso , Tosse/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sucção/efeitos adversos
6.
BMC Ophthalmol ; 20(1): 9, 2020 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-31906894

RESUMO

BACKGROUND: To determine whether a sense of deviation remains in adults with successful motor alignment who fulfil diplopia criteria after surgery and to examine the factors associated with this judgement. METHODS: This was a retrospective study. Adult patients defined as having a successful outcome based on more than 1 year of post-operative follow-up visits were included in the study. The sense of deviation was determined at the last visit. Pre- and post-operative deviation and characteristics including age, gender, education level, occupation, diagnosis, size of deviation, extraocular movement (EOM), binocular function, and health-related quality of life (HRQOL) were recorded. RESULTS: In total, 22 (24%) of the 91 adults with successful surgical outcomes reported a sense of deviation. No significant differences were noted between subjects with and without a sense of deviation regarding patient demographics, pre- and post-operative deviation, changes in deviation, sensory fusion or EOM. Subjects with a sense of deviation had an increased prevalence of and larger post-operative vertical deviation, poorer stereo function, and lower HRQOL scores than those with no sense of deviation. The presence of post-operative vertical deviation was associated with a sense of deviation. CONCLUSIONS: Approximately one-fourth (24%) of adults defined as having successful surgical outcomes who still had a sense of deviation exhibited worse stereo function, higher vertical deviation size and lower HRQOL scores. The presence of 3 to 5 prism dioptres(pd) of vertical deviation would be the main factor associated with a sense of deviation post-operatively.


Assuntos
Diplopia/fisiopatologia , Procedimentos Cirúrgicos Oftalmológicos , Estrabismo/cirurgia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/métodos , Qualidade de Vida , Estudos Retrospectivos , Estrabismo/fisiopatologia , Visão Binocular
7.
PLoS One ; 15(1): e0227868, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31971985

RESUMO

PURPOSE: To determine the prevalence of cataract and its association with sun exposure and other environmental risk factors in three different geographically diverse populations of India. DESIGN: Population based cross sectional study during 2010-2016. PARTICIPANTS: People aged ≥ 40 years residing in randomly sampled villages were enumerated (12021) and 9735 (81%) underwent ophthalmic evaluation from plains, hilly and coastal regions (3595, 3231, 2909 respectively). METHODS: A detailed questionnaire-based interview about outdoor activity in present, past and remote past, usage of sun protective measures, exposure to smoke, and detailed ophthalmic examination including assessment of uncorrected and best corrected visual acuity, measurement of intraocular pressure, slit lamp examination, lens opacities categorization using LOCS III and posterior segment evaluation was done. Lifetime effective sun exposure was calculated using Melbourne formula and expressed as quintiles. These were supplemented with physical environmental measurements. MAIN OUTCOME MEASURES: Lifetime sun exposure hours, smoking, indoor kitchen smoke exposure and their association with cataract and subtypes. Prevalence of cataract calculated based on lens opacities or evidence of cataract surgery. RESULTS: Cataract was identified in 3231 (33.3%) participants. Prevalence of cataract in males (32.3%) and females (34.1%) was similar. Nuclear cataract was the commonest sub-type identified in 94.7% of affected eyes. Sun exposure had a significant association with cataract with odds ratio (OR) increasing from 1.6 (95% Confidence Intervals [CI]: 1.4, 1.9) in 3rd quintile, to 2.6 (CI: 2.2, 3.1) in 4th quintile and 9.4 (CI: 7.9, 11.2) in 5th quintile (p<0.0001). Cataract also showed a significant association with smoking (OR: 1.4, CI: 1.2, 1.6) and indoor kitchen smoke exposure (OR: 1.2, CI: 1.0-1.4). Nuclear cataract showed a positive association with increasing sun exposure in 3rd (ß coefficient 0.5, CI:0.2-0.7), 4th (ß: 0.9, CI: 0.7-1.1) and 5th (ß: 2.1, CI:1.8-2.4) quintiles of sun exposure, smoking (ß: 0.4, CI: 0.2-0.6) and indoor kitchen smoke exposure (ß: 0.3, CI: 01-0.5) while cortical cataract showed a positive association with sun exposure only in 5th quintile (ß: 2.6, CI:1.0-4.2). Posterior subcapsular cataract was not associated with any of the risk factors. CONCLUSION: Cataract is associated with increasing level of sun exposure, smoking and exposure to indoor kitchen smoke.


Assuntos
Extração de Catarata , Catarata/epidemiologia , Luz Solar/efeitos adversos , Acuidade Visual/fisiologia , Adulto , Distribuição por Idade , Idoso , Catarata/diagnóstico , Catarata/etiologia , Catarata/patologia , Olho/fisiopatologia , Feminino , Humanos , Índia/epidemiologia , Cristalino , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Oftalmológicos , Grupos Populacionais , Prevalência , Fatores de Risco , População Rural , Distribuição por Sexo , Inquéritos e Questionários
9.
Niger J Clin Pract ; 23(1): 123-125, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31929219

RESUMO

Autologous serum drop (ASD) is a safe and efficient treatment option for most of the ocular surface diseases. We report a case of a persistent corneal epithelial defect in a patient treated by ASD. A 28 year old male patient presented to our clinic with eye pain and blurry vision in his left eye. Best corrected visual acuity (BCVA) was 20/20 in the right eye and 20/200 in the left eye. Slit lamp examination revealed a central corneal epithelial defect on the left eye and the right eye was normal. Corneal epithelial defect appeared after left upper eyelid chalazion surgery and persisted for 2 months without any response to treatment with eye patching, bandage contact lenses, and artificial eyedrops. We started the treatment with ASD six times daily and preservative-free netilmicin eyedrops four times daily to prevent infection. The drops were used simultaneously with eyepatching for the first two days. The eye was left unpatched after the second day. The corneal epithelial defect resolved after 48 hours. We did not detect a new epithelial defect in the follow up visits. ASD is a quick, safe, and effective treatment option in persistent epithelial defect cases.


Assuntos
Doenças da Córnea/terapia , Epitélio Anterior/efeitos dos fármacos , Dor Ocular/etiologia , Soluções Oftálmicas/administração & dosagem , Soro , Adulto , Calázio/cirurgia , Doenças da Córnea/etiologia , Doenças da Córnea/fisiopatologia , Epitélio Anterior/fisiopatologia , Humanos , Masculino , Soluções Oftálmicas/uso terapêutico , Procedimentos Cirúrgicos Oftalmológicos/efeitos adversos , Complicações Pós-Operatórias , Resultado do Tratamento , Acuidade Visual , Cicatrização
10.
Eur J Ophthalmol ; 30(1): 132-138, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30360648

RESUMO

PURPOSE: To determine the possible predictors of the motor outcome after corrective surgery for acquired comitant esotropia. METHODS: The study included 40 patients with acquired comitant esotropia. After evaluation of the visual, sensory, and motor status; cycloplegic refraction; fundus examination; and spectacle prescription, all patients underwent corrective strabismus surgery. A successful motor outcome was defined as 0 to 10 prism diopters of horizontal tropia. Statistical analysis of the results was done using the chi-square tests. RESULTS: At the sixth postoperative month, 90% achieved a successful motor outcome, while 2.5% had a consecutive exotropia >10 prism diopters, and 7.5% had a residual esotropia >10 prism diopters. A statistically significant relationship existed between the motor outcome and the following: preoperative results of the Worth four-dot test at 6 m (p = .011) and 0.33 m (p = .009), preoperative distant (p = .016) and near (p = .017) angles of esotropia with glasses, postoperative near angles of deviation at 1 week (p = .005), 1 month (p < .001), 6 weeks (p < .001), 3 months (p = .001), and 6 months (p < .001) following surgery, postoperative distant angles of deviation at 6 weeks (p < .001) and 3 months (p = .03) following surgery, 6 week (p = .01) and 6 month (p = .036) postoperative results of the Worth four-dot test at 0.33 m, and the 6-month postoperative sensory outcome (p = .006). CONCLUSION: Preoperative and postoperative sensory and motor functions are predictors of the 6-month postoperative motor outcome.


Assuntos
Esotropia/cirurgia , Movimentos Oculares/fisiologia , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/métodos , Acuidade Visual , Adolescente , Criança , Pré-Escolar , Esotropia/fisiopatologia , Feminino , Humanos , Lactente , Masculino , Músculos Oculomotores/fisiopatologia , Período Pós-Operatório , Estudos Prospectivos , Resultado do Tratamento
11.
Ophthalmic Res ; 63(1): 34-40, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31352453

RESUMO

AIM: To report the outcomes of ab externo surgery using a surgical microscope, wide-angle viewing system, and chandelier endoilluminator (microscope-assisted ab externo surgery) for rhegmatogenous retinal detachment (RRD). METHODS: This was a retrospective study. Consecutive charts of patients with RRD who underwent microscope-assisted ab externo surgery were analyzed. The following demographic parameters were analyzed: age (years), gender (male/female), and eye (right/left). Clinical parameters were axial length (AL) measured in millimeters (mm), preoperative best-corrected visual acuity (BCVA) measured in logarithm of minimum angle of resolution (logMAR), intraocular pressure (IOP), and lens status (phakic/pseudophakic). The parameters of RRD were number and type of retinal breaks, location of retinal breaks, extent of retinal detachment (RD) (number of detached quadrants), and macular detachment (MD), as well as retinal breaks not detected preoperatively. Use of cryopexy, circumferential or segmental scleral buckle, drainage of subretinal fluid, injection of air or gas, and duration of surgery were recorded. The postoperative parameters analyzed were BCVA, IOP and recurrence of RD and postoperative complications. Follow-up was established at 3 months. RESULTS: A total of 213 eyes (97 right, 116 left) of 205 patients (114 males, 91 females) affected by primary RRD were included. Fifty-two eyes (24.4%) were affected by high myopia (AL >26.5 mm), and 160 patients (75.1%) were affected by RRD caused by a single retinal break and involving only one quadrant. The superior quadrant was the most frequently involved (49.3%). Forty-two eyes (19.7%) were affected by MD. In 13 eyes (11.3%), retinal breaks were not detected preoperatively. The duration of surgery was 75.5 ± 42 min. No significant BCVA changes were observed in the whole group, whereas a significant improvement of BCVA from the baseline (2.83 ± 0.87 logMAR) to each time point of follow-up was observed in the subgroup of patients affected by MD. Six eyes (2.8%) developed a recurrent RD, secondary to proliferative vitreoretinopathy (3 eyes) and secondary to a new retinal break (3 eyes). Two eyes developed a persistent vitreous hemorrhage, and one eye developed a macular hole after 1 week. PPV was performed for both. CONCLUSION: Microscope-assisted ab externo surgery is effective and safe, it reduces discomfort, it allows the surgeon to work with both hands free, and provides an adequate visualization of each step being performed.


Assuntos
Crioterapia/métodos , Tamponamento Interno/métodos , Procedimentos Cirúrgicos Oftalmológicos/métodos , Descolamento Retiniano/cirurgia , Adulto , Idoso , Feminino , Humanos , Masculino , Microscopia/métodos , Pessoa de Meia-Idade , Perfurações Retinianas/cirurgia , Estudos Retrospectivos , Acuidade Visual
12.
N Z Vet J ; 68(2): 112-118, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31738860

RESUMO

Aims: To evaluate the outcome of surgical management of entropion of the upper and lower eyelids in Shar Pei dogs which had previously undergone temporary palpebral tacking, using the Stades forced granulation procedure of the upper eyelid only.Methods: Medical records were retrospectively searched to identify Shar Pei dogs referred for bilateral entropion of both the lower and upper eyelids, and that were treated with the forced granulation procedure of the upper eyelid only. Dogs were included if they had previously undergone unsuccessful temporary palpebral tacking and had at least three follow-up examinations in the 30 days following surgery.Results: Twenty-seven Shar Pei dogs with a median age of 7.9 (min 4, max 24) months were included in the study. Before surgery, all dogs showed signs of severe ocular discomfort with bilateral keratitis and visual deficit due to blepharospasm, enophthalmos and protrusion of the third eyelid. In 13/54 eyes, keratitis was associated with a corneal ulcer. When re-examined 4 weeks after surgery, correction of the upper eyelid entropion and associated trichiasis resolved ocular signs in 50/54 eyes. Mild bilateral lower entropion remained in two dogs postoperatively, which underwent revision surgery with the Hotz-Celsus technique. There were no cases of long-term recurrence of entropion or ocular irritation in the 38 eyes (19 dogs) which were re-examined 1 year after surgery.Conclusion and clinical relevance: The forced granulation procedure performed on the upper eyelid only was effective for correction of entropion in the Shar Pei dogs included in this study. In our experience, it is preferable to operate on the upper eyelid alone, rather than attempting to correct upper and lower entropion during the same surgical operation. The dog can then be reassessed a few weeks later to determine whether the lower entropion is anatomical or secondary to the severe blepharospasm resulting from the painful ocular irritation.


Assuntos
Doenças do Cão/cirurgia , Entrópio/veterinária , Pálpebras/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/veterinária , Animais , Cães , Entrópio/cirurgia , Pálpebras/patologia , Feminino , Masculino , Procedimentos Cirúrgicos Oftalmológicos/métodos , Estudos Retrospectivos
13.
Strabismus ; 28(1): 29-33, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31847669

RESUMO

Purpose: Monocular transposition of the inferior oblique muscle belly (IOMBT) effectively weakened mild to moderate inferior oblique overaction and corrected small primary position hypertropia. Now we aim to evaluate the efficacy of inferior oblique muscle belly transposition (IOMBT) in treating V pattern strabismus with upshoot in adduction.Methods: This is a retrospective review of 13 patients with V pattern who underwent IOMBT procedure from January 2017 to December 2018. The inclusion criteria were: the amount of V pattern from 15 to 25 pd; the degree of upshoot in adduction from +1 to +3; no or trace vertical deviation in primary gaze position. Bilateral IOMBT was performed to reduce the V pattern. Horizontal rectus muscle surgery was performed at the same stage to correct the horizontal deviation. The angle of deviation in upgaze and downgaze was measured pre- and postoperatively. The degree of elevation in adduction was graded. The amount of V pattern was the difference in horizontal angle between up- and downgaze. The change in the amount of V pattern was assessed postoperatively.Results: All 13 patients had complete resolution of the V pattern. The amount of V pattern changed from 18.92 ± 4.310 prism diopters to 3.462 ± 1.854 prism diopters postoperatively. The mean grade of upshoot in adduction changed from 1.92 to 0.12 postoperatively. No depression in adduction or consecutive A pattern were found after surgery.Conclusions: IOMBT can successfully eliminate the V pattern in patients with mild V pattern esotropia or exotropia with mild to moderate upshoot in adduction. This procedure appears to be a useful addition to our inferior oblique surgical armamentarium.


Assuntos
Músculos Oculomotores/transplante , Procedimentos Cirúrgicos Oftalmológicos/métodos , Estrabismo/cirurgia , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Período Pós-Operatório , Estudos Retrospectivos , Estrabismo/fisiopatologia , Resultado do Tratamento , Visão Binocular/fisiologia
14.
Strabismus ; 28(1): 35-41, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31868064

RESUMO

Purpose: The aim of this study is to determine the prevalence of tropia, phoria, and their types in Islamic Azad University students in Shahrekord, Iran.Methods: Of 826 students that were invited, 752 participated in this cross-sectional study (response rate = 91.04%). After applying exclusion criteria, statistical analyses were performed on the data of 726 individuals. All participants underwent optometric tests including measurement of visual acuity, objective and subjective refraction, as well as binocular vision and ocular health examinations. The unilateral and alternate cover tests were done to detect the tropia and phoria at 6 m and 40 cm, respectively.Results: The overall prevalence and 95% confidence interval (CI) of tropia, exotropia, and esotropia were 1.5% (0.8 to 2.7), 1.2% (0.6 to 2.4), and 0.3% (0.1 to 1.1), respectively. The prevalence of esotropia was significantly higher in older age groups (24 years old) (p = .040) . The prevalence of exotropia was significantly higher in females (0.039) and in myopic individuals (p = .001). The overall prevalence and 95% CI of phoria, exophoria, and esophoria were 12.9% (10.7 to 15.6), 11.7% (9.6 to 14.3), and 1.2% (0.6 to 2.3), respectively. There was a significant difference in the overall prevalence of exophoria according to the age (0.021). The prevalence of esophoria was significantly higher in females (p = .039). The prevalence of exophoria was significantly higher in myopic participants (p = .003). Exophoria and exotropia were the most common types of phoria and tropia, respectively.Conclusion: The prevalence of strabismus in university students was similar to the Iranian general population but lower than other countries. One in every 10 students had phoria, which was much lower than similar reports on Iranian populations; however, due to near-work activity, these students are prone to asthenopia, early visual fatigue, and decreased productivity. Therefore, it is suggested that university students also undergo screening programs to detect the cases of tropia and phoria.


Assuntos
Esotropia/epidemiologia , Exotropia/epidemiologia , Estrabismo/epidemiologia , Estudantes/estatística & dados numéricos , Adolescente , Adulto , Estudos Transversais , Esotropia/diagnóstico , Exotropia/diagnóstico , Feminino , Humanos , Irã (Geográfico)/epidemiologia , Masculino , Procedimentos Cirúrgicos Oftalmológicos , Prevalência , Estrabismo/diagnóstico , Testes Visuais , Visão Binocular/fisiologia , Acuidade Visual/fisiologia , Adulto Jovem
15.
Int J Med Inform ; 133: 104007, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31706228

RESUMO

OBJECTIVE: Comprehensive analysis of ophthalmic surgical outcomes is often restricted by limited methodologies for efficiently and accurately extracting clinical information from electronic health record (EHR) systems because much is in free-text form. This study aims to utilize advanced methods to automate extraction of clinical concepts from the EHR free text to study visual acuity (VA), intraocular pressure (IOP), and medication outcomes of cataract and glaucoma surgeries. METHODS: Patients who underwent cataract or glaucoma surgery at an academic medical center between 2009 and 2018 were identified by Current Procedural Terminology codes. Rule-based algorithms were developed and used on EHR clinical narrative text to extract intraocular lens (IOL) power and implant type, as well as to create a surgery laterality classifier. MedEx (version 1.3.7) was used on free-text clinical notes to extract information on eye medications and compared to information from medication orders. Random samples of free-text notes were reviewed by two independent masked annotators to assess inter-annotator agreement on outcome variable classification and accuracy of classifiers. VA and IOP were available from semi-structured fields. RESULTS: This study cohort included 6347 unique patients, with 8550 stand-alone cataract surgeries, 451 combined cataract/glaucoma surgeries, and 961 glaucoma surgeries without concurrent cataract surgery. The rule-based laterality classifier achieved 100% accuracy compared to manual review of a sample of operative notes by independent masked annotators. For cataract surgery alone, glaucoma surgery alone, or combined cataract/glaucoma surgeries, our automated extraction algorithm achieved 99-100% accuracy compared to manual annotation of samples of notes from each group, including IOL model and IOL power for cataract surgeries, and glaucoma implant for glaucoma surgeries. For glaucoma medications, there was 90.7% inter-annotator agreement. After adjudication, 85.0% of medications identified by MedEx determined to be correct. Determination of surgical laterality enabled evaluation of pre- and postoperative VA and IOP for operative eyes. CONCLUSION: This text-processing pipeline can accurately capture surgical laterality and implant model usage from free-text operative notes of cataract and glaucoma surgeries, enabling extraction of clinical outcomes including visual acuities, intraocular pressure, and medications from the EHR system. Use of this approach with EHRs to assess ophthalmic surgical outcomes can benefit research groups interested in studying the safety and clinical efficacies of different surgical approaches.


Assuntos
Registros Eletrônicos de Saúde , Procedimentos Cirúrgicos Oftalmológicos , Idoso , Idoso de 80 Anos ou mais , Catarata , Extração de Catarata , Feminino , Glaucoma/cirurgia , Humanos , Pressão Intraocular , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Acuidade Visual
16.
Am J Ophthalmol ; 209: 55-61, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31526795

RESUMO

PURPOSE: Sagging eye syndrome (SES), horizontal and/or vertical strabismus caused by orbital connective tissue degeneration, was first defined 10 years ago. This study investigated SES and other causes of acquired binocular diplopia in adults presenting to a single institution since the description of SES. DESIGN: Retrospective observational case series. METHODS: Medical records were reviewed of all new patients over the age of 40 who presented to the Stein Eye Institute with binocular diplopia between January 2015 and December 2018. Clinical causes of diplopia were tabulated in patients grouped by age and sex. In patients with SES, we tabulated binocular alignment, types of treatment, and surgical outcomes. RESULTS: There were 945 patients of mean age 66.5 years, of whom 514 (54.4%) were female. The most common cause of diplopia was SES (31.4%). The 297 patients with SES were older at 71.2 years (P < 0.0001) and more predominantly female at 59.9% than other patients (52.0%; P = 0.023). The relative proportion of SES patients among all diplopic patients increased with age from 4.7% under age 50 years to 60.9% over the age of 90. Age-related distance esotropia was present in 35% and cyclovertical strabismus in 65% of cases of SES. Strabismus surgery was performed in 50% of cases of SES. Mean esotropia at distance decreased from 6.9 ± 0.7Δ preoperatively to 0.3 ± 0.3Δ postoperatively. Preoperative hypertropia decreased from 3.0 ± 0.3Δ to 0.7 ± 0.2Δ postoperatively. Surgery resolved diplopia in all cases. CONCLUSIONS: It is important to recognize that SES is a very common cause of adult binocular diplopia.


Assuntos
Doenças do Tecido Conjuntivo/epidemiologia , Diplopia/epidemiologia , Doenças Orbitárias/epidemiologia , Estrabismo/epidemiologia , Visão Binocular/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Envelhecimento/fisiologia , Doenças do Tecido Conjuntivo/fisiopatologia , Doenças do Tecido Conjuntivo/cirurgia , Diplopia/fisiopatologia , Diplopia/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Músculos Oculomotores/fisiopatologia , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos , Doenças Orbitárias/fisiopatologia , Doenças Orbitárias/cirurgia , Prevalência , Estudos Retrospectivos , Estrabismo/fisiopatologia , Estrabismo/cirurgia , Síndrome
17.
Curr Opin Ophthalmol ; 31(1): 43-49, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31770162

RESUMO

PURPOSE OF REVIEW: When patients have large iris defects, they may experience debilitating glare, halos, and unfavorable cosmetic appearance. Surgical iris reconstruction can alleviate these symptoms. This article will review current suturing techniques for iris reconstruction, as well as the benefits and drawbacks to various suturing methods. Alternative reconstructive methods are also discussed. RECENT FINDINGS: One of the earliest iris suturing methods described was the McCannel technique. This technique allows direct suturing of the iris using three incisions. The Siepser slipknot is another method used in closed chamber iris suturing techniques. This knot, and its recent modifications, utilizes a sliding knot, which is created outside the eye and slid into place atop the iris defect. The cerclage iris suture, in which small bites are taken around the pupillary circumference, is especially useful when treating a mydriatic pupil. Recently, a number of surgeons have adapted these techniques and developed novel suturing strategies to address complex ocular conditions. SUMMARY: The various iris suturing methods, as well as alternative techniques including cautery, corneal tattooing, and iris prosthetics, each have unique benefits, providing surgeons with a wide array of tools for iris reconstruction.


Assuntos
Doenças da Íris/cirurgia , Procedimentos Cirúrgicos Oftalmológicos , Procedimentos Cirúrgicos Reconstrutivos , Técnicas de Sutura , Humanos
18.
Klin Monbl Augenheilkd ; 236(12): 1428-1434, 2019 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-31805595

RESUMO

BACKGROUND: The long-term success of fistulating therapies for the treatment of glaucoma is essentially limited by excessive scarring reactions (fibrosis). Cytostatic agents such as mitomycin C can prevent fibrosis, but are often associated with side effects. Specific antifibrotics are not currently in clinical use. Therefore, this study describes a systems biology approach using a dedicated bioinformatics technology platform, with which active substances can be identified and repositioned as antifibrotics. MATERIALS AND METHODS: Differential gene expression data of human Tenon fibroblasts (hTF) were collected from untreated hTF and from hTF stimulated with TGF-ß1 ("fibrotic fibroblasts") by next-generation sequencing (NGS) and were used as the basis for the drug identification process. These data were filtered with the bioinformatic tool "FocusHeuristics". In comparison with the Connectivity Map database, antifibrotic agents were identified. The evaluation of a potentially promising drug as an antifibrotic was performed at hTF by indirect immunofluorescence in vitro. RESULTS: The analysis of the gene expression data led to the identification of several interaction networks of genes or proteins involved in fibrotic processes. One of these networks contains the cytokine bone morphogenic protein 6 (BMP6), interleukin 6 (IL6) and fibroblast growth factor 1 (FGF1). Another relevant network has been identified around the cluster of differentiation 34 (CD34) gene. The comparison of these data with those of the Connectivity Map allowed the identification of an inhibitory drug. Its evaluation in the fibrotic cell culture model in vitro using indirect immunofluorescence led to a significant reduction in the expression of the fibrotic marker proteins fibronectin and alpha-smooth muscle actin (α-SMA), which confirmed the predicted antifibrotic effect. CONCLUSION: Systems biological approaches can be used for the identification of antifibrotic drug candidates for the prevention of postoperative fibrosis and should be transferable by the investigating differential gene expression data of further ocular cells or tissues to other ophthalmological fields of application.


Assuntos
Fibrose , Procedimentos Cirúrgicos Oftalmológicos , Oftalmologia , Biologia de Sistemas , Actinas , Fibroblastos , Fibrose/etiologia , Fibrose/prevenção & controle , Humanos , Mitomicina , Procedimentos Cirúrgicos Oftalmológicos/efeitos adversos , Complicações Pós-Operatórias
19.
Medicine (Baltimore) ; 98(51): e18077, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31860958

RESUMO

RATIONALE: Angelman syndrome (AS) is an uncommon genetic disease characterized as serious retarded mental development and ocular abnormality. PATIENT CONCERNS: This report aims to present the ophthalmological features, and identify the diagnosis and outcomes of strabismus surgery in AS patients. DIAGNOSIS: Three children with exotropia were diagnosed with AS based on their typical clinical features. INTERVENTIONS: All patients underwent multiplex ligation-dependent probe amplification (MLPA) analysis and accepted lateral rectus recession surgery with the assistance of intravenous combined inhalation anesthesia. OUTCOMES: The maternal heritage deletion of chromosome 15q11.2-q13 was verified in all patients by MLPA. All patients with strabismus could not cooperate during the vision test, and had astigmatism. The strabismus type of AS patients was horizontal exotropia, and no vertical strabismus was found. One of these patients was combined with high myopia. The hypopigmentation on the hair and iris was ubiquitous. However, retina pigmentation was normal. After different degrees of lateral rectus recession, the exotropia was significantly relieved, and the surgical effects were stable postoperatively. LESSONS: Horizontal exotropia is the major strabismus type. Severe intellectual disability, hyperactivity, and speech impairment are the common characteristics of AS children. Its examination and operation design remains challenging. Thus, repeated examinations and intelligence rehabilitation are essential.


Assuntos
Síndrome de Angelman/diagnóstico , Exotropia/diagnóstico , Exotropia/cirurgia , Movimentos Oculares/fisiologia , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/métodos , Síndrome de Angelman/complicações , Criança , Pré-Escolar , China , Exotropia/complicações , Feminino , Humanos , Masculino , Músculos Oculomotores/fisiopatologia , Prognóstico , Doenças Raras , Recuperação de Função Fisiológica , Estrabismo/complicações , Estrabismo/diagnóstico , Estrabismo/cirurgia , Resultado do Tratamento , Testes Visuais
20.
BMC Ophthalmol ; 19(1): 254, 2019 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-31842812

RESUMO

BACKGROUND: To investigate the surgical outcomes of strabismus related to iatrogenic occlusion of the ophthalmic artery and its branches from cosmetic facial filler injection. METHODS: A retrospective study was performed on 6 patients who underwent strabismus surgery among 23 patients who had suffered occlusion of the ophthalmic artery and its branches after cosmetic facial filler injection. Initial, preoperative and final ocular motility examinations, the type of surgery and surgical outcomes were evaluated. RESULTS: At initial presentation, visual acuity was no light perception in 5 patients and hand motion in one patient. Five out of 6 patients showed initial ophthalmoplegia. Among these 5 patients, eye motility fully recovered in 3 patients although sensory strabismus developed during follow-up, while the remaining 2 patients had persistent ocular motility limitations. Strabismus surgery was performed at 2.2 ± 1.5 years after iatrogenic ophthalmic artery occlusion. Preoperatively, 5 of the 6 patients showed exotropia, and one patient had esotropia. Vertical deviation was found in 3 out of 6 patients in addition to the horizontal deviation. Successful outcome was achieved only in the 4 patients without persistent ophthalmoplegia after 1.4 ± 1.0 years from surgery. The other two patients with persistent ocular motility limitations failed to achieve successful alignment after surgery, and one patient eventually underwent evisceration due to phthisis bulbi. CONCLUSIONS: In our study, surgical outcomes of strabismus caused by cosmetic facial filler injection were successful only in patients without persistent ophthalmoplegia at the time of surgery.


Assuntos
Arteriopatias Oclusivas/induzido quimicamente , Preenchedores Dérmicos/efeitos adversos , Músculos Oculomotores/cirurgia , Artéria Oftálmica/efeitos dos fármacos , Procedimentos Cirúrgicos Oftalmológicos , Estrabismo/cirurgia , Adulto , Arteriopatias Oclusivas/diagnóstico , Humanos , Doença Iatrogênica , Oftalmoplegia/induzido quimicamente , Estudos Retrospectivos , Ritidoplastia , Estrabismo/induzido quimicamente , Estrabismo/fisiopatologia , Resultado do Tratamento , Visão Binocular/fisiologia , Acuidade Visual/fisiologia , Adulto Jovem
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