RESUMO
In a six-month prospective study involving 60 noninsulin-dependent diabetics, we evaluated the effect of change to conventional insulin therapy on the pre-existing retinopathy. Ten of 15 patients in group 1 (background or preproliferative diabetic retinopathy treated with insulin) compared to one of 15 patients in group 2 (background or preproliferative diabetic retinopathy treated with hypoglycemic agents) had progression of retinopathy. Worsening of retinopathy was related significantly only to the age of the patients (r = .752, P < .001). None of the 15 patients each in groups 3 and 4 (no retinopathy treated with insulin injections [group 3] or oral hypoglycemic agents [group 4]) developed retinopathy.
Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Retinopatia Diabética/fisiopatologia , Insulina/uso terapêutico , Glicemia/metabolismo , Retinopatia Diabética/tratamento farmacológico , Retinopatia Diabética/metabolismo , Feminino , Hemoglobinas Glicadas/metabolismo , Humanos , Hipoglicemiantes/uso terapêutico , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
This study evaluated a modified single-injection technique of administering peribulbar anesthesia. All 150 eyes achieved complete lid anesthesia; 49 eyes (32.7%) demonstrating exophthalmos after injection achieved excellent (grade 1) instantaneous ocular akinesia. Sequence of timed events after injection included lid anesthesia (60.2 +/- 15.33 seconds), lid akinesia (75.18 +/- 15.33), lateral rectus akinesia (90.19 +/- 2.13), inferior rectus akinesia (140.44 +/- 17.51), superior rectus akinesia (229.60 +/- 15.23), and medial rectus akinesia (250.42 +/- 18.99). Peribulbar anesthesia, when successful, achieved complete akinesia in fewer than five minutes. In 12 eyes (8%), the peribulbar injection had to be repeated. For routine intraocular surgery, we recommend this efficacious, safe technique without the use of a separate facial block.
Assuntos
Anestesia Local/métodos , Oftalmopatias/cirurgia , Bupivacaína , Pálpebras/efeitos dos fármacos , Humanos , Lidocaína , Massagem , Músculos/efeitos dos fármacos , Músculos Oculomotores/efeitos dos fármacos , Fatores de TempoRESUMO
Forty non-enucleated eyes with bilateral retinoblastoma which were treated by external beam radiation therapy (EBRT), transconjunctival cryopexy, and photocoagulation were retrospectively analysed for the age of onset and location of new intraocular tumours. Of these 40 eyes, 9 (22.5%) eyes developed 17 new tumour foci over a mean follow-up of 3 years. The risk of new tumour formation was age-related being 47% in children with age at onset of retinoblastoma less than 1 year compared to 4.4% in older children (P < 0.001). Four eyes (44%) had 2 episodes of tumour formation. All tumour foci developed within 11 months of initial treatment at an average episode interval of 4.0 months. In 89% of cases, new lesions ceased to occur by 18 months of age. Our study clearly shows that EBRT did not prevent development of new lesions. The tumour islands which developed in the peripheral retina in 88% of cases were successfully treated with transconjunctival cryopexy. In 8 cases (89%), the eye could be salvaged. All young bilateral retinoblastoma patients should undergo frequent periodic detailed examination of the retinal periphery with 360 degrees scleral depression to pick up new tumour lesion early and to treat them effectively with simple globe saving methods.
Assuntos
Neoplasias Oculares/patologia , Segunda Neoplasia Primária/patologia , Retinoblastoma/patologia , Pré-Escolar , Terapia Combinada , Criocirurgia , Enucleação Ocular , Neoplasias Oculares/terapia , Feminino , Humanos , Lactente , Fotocoagulação , Masculino , Segunda Neoplasia Primária/etiologia , Radioterapia , Retinoblastoma/terapia , Estudos RetrospectivosRESUMO
Maintenance of pupillary dilatation is necessary for success of scleral buckling procedures. The efficacy of 0.03% flurbiprofen in preventing intraoperative miosis was evaluated by a prospective randomized, double-masked controlled trial of 60 patients. Thirty patients received 0.03% flurbiprofen 6 times at 15 minute intervals 90 minutes preoperatively in addition to the routine dilation regimen. The treated group had a mean pupillary decrease of 1.88 mm and the control group had a decrease of 1.57 mm (p > 0.05). Flurbiprofen did not affect the pupillary size at any step of the surgery. Factors such as age of the patient, lens status, number of cryo applications, duration of surgery, and the size and extent of buckle were assessed. The use of flurbiprofen did not affect the mean pupillary change for any of these groups. Preoperative use of flurbiprofen does not significantly decrease intraoperative miosis during scleral buckling procedures.