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Introducción: El melanoma uveal, es el cáncer intraocular más común en adultos, representa cerca del 3 % al 5 % de todos los melanomas; con un pico de incidencia en hombres en la sexta década de la vida. Objetivo: Describir la presentación clínica, diagnóstico y tratamiento de una paciente con melanoma uveal. Caso clínico: Paciente femenina de 39 años de edad, con antecedentes de salud, quien acudió a consulta por presentar dolor intenso de doce días de evolución localizado en el ojo derecho, asociado a pérdida de la visión, dolor a los movimientos oculares, astenia y anorexia. Al examen físico se encontró edema palpebral severo, abundantes secreciones mucopurulentas, quémosis conjuntival en 360 grados marcado e hiperemia cilio-conjuntival en el ojo derecho. Se realizaron estudios analíticos e imagenológicos. Al analizar el resultado de la exploración física y los complementarios se decidió la intervención quirúrgica consistente en la exenteración orbitaria derecha, esfenoidectomía y etmoidectomía transorbitaria derecha. Con una evolución satisfactoria fue egresada del centro hospitalario. La biopsia informó un melanoma coroideo. Conclusiones: El melanoma coroideo es una enfermedad ocular poco frecuente en mujeres jóvenes de piel negra. La sintomatología es extremadamente variable con las masas coroideas. Es importante conocer sus características, pues estos efectos clínicos sirven como un recordatorio para los oftalmólogos para incluirla en el diagnóstico diferencial de otras patologías oculares.
Introduction: Uveal melanoma is the most common intraocular cancer in adults, represents approximately 3 % to 5 % of all melanomas; with a peak incidence in men in the sixth decade of life. Objective : To describe the clinical presentation, diagnosis and treatment of a patient with uveal melanoma. Clinical case: A 39-year-old female patient, with a health history, who came to the consultation due to intense pain of twelve days of evolution located in the right eye, associated with loss of vision, pain with eye movements, asthenia and anorexy. Physical examination revealed severe palpebral edema, abundant mucopurulent secretions, marked 360-degree conjunctival chemosis, and cilio-conjunctival hyperemia in the right eye. Analytical and imaging studies were performed. When analyzing the results of the physical and complementary examination, the surgical intervention consisting of right orbital exenteration, sphenoidectomy and right transorbital ethmoidectomy was decided. With a satisfactory evolution, she was discharged from the hospital. Biopsy reported choroidal melanoma. Conclusions: Choroidal melanoma is a rare ocular entity in young black women. Symptomatology is extremely variable with choroidal masses. It is important to know its characteristics, since these clinical effects serve as a reminder for ophthalmologists to include it in the differential diagnosis of other ocular pathologies.
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@#Visual loss after non-ocular surgery(VLNOS)includes postoperative visual loss and perioperative visual loss after non-ocular surgery. The former accident consists of the blindness during a surgery or after a surgery, and the latter accident shows the acute visual loss in perioperative period. VLNOS can be appeared in a prone spinal surgery, cardiopulmonary bypass surgery, head and neck surgery, and facial micro-plastic injection treatment, which is a rare, extremely serious complication. VLNOS is divided into predictable and unpredictable condition. Doctors of related subjects have pay attention to VLNOS, and begin to study the possible reasons, and take positive precautions.
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Objective To determine the spectrum of conjunctival flora and the antibiotic susceptibility profiles of patients scheduled for penetrating intraocular surgeries.Methods A prospective case control study was performed.A total of 192 patients (192 eyes) scheduled for penetrating intraocular surgeries at the Fourth People's Hospital of Shenyang from February to August 2015 were enrolled.Samples from the conjunctival sac were collected before instillation of any ophthalmic solutions for both aerobic and anaerobic culture.The positive rate and bacterial spectrum were observed.Bacterial isolates were tested for antibiotic susceptibility to 7 commonly used ophthalmic antibiotics using automated drug resistance analyzing system.The research was approved by the Ethics Committee of the Fourth People's Hospital of Shenyang.Results Totally 91 strains were collected from 81 conjunctival samples during aerobic culture,the positive rate was 42.19％.Staphylococcus epidermidis was the most common microorganism (64.84％),followed by Staphylococcus lentus (7.69％) and Staphylococcus aureus (3.30％).Coagulatase negtive Staphylococcus (CNS) accounted for 80.22％ of the positively cultured aerobes.For anaerobic culture,a total of 28 strains were isolated from 28 conjunctival samples,the positive rate was 14.58％ Propionibacterium acnes was the predominant species (71.43％),followed by Finegoldia magna (10.71％).Majority of the CNS were sensitive to gentamycin and vancomycin,with resistance rates lower than 10％,but their resistance rate to erythromycin and ceftazidime was 87.67％ and 63.01％,respectively.Resistance rate of these CNS to levofloxacin,ciprofloxacin,and moxifloxacin was 42.47％,39.73％ and 17.81％,respectively.Multidrug resistance to at least 3 antibiotic classes was present in 38.36％ of the CNS.Conclusions Bacteria in the conjunctiva sac of preoperative patients are resistant to various ophthalmic antibiotics.To follow-up the bacterial distribution and antibiotic resistance is great meaningful in the prophylactic and treatment in ocular surgery-related infections.
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Safety,efficacy and predictability of corneal refractive surgery have greatly improved as the advancement of the operating technology and equipment.Laser corneal refractive surgeries include excimer laser photorefractive keratectomy (PRK),laser-assisted subepithelial keratomileusis (LASEK),laser in situ keratomileusis (LASIK) and small incision lenticule extraction (SMILE).No matter what kind of operation method,its ultimate goal is to increase the comfort level and improve visual quality.With the surgery skills improving,retinal drug use is a primary factor affecting the safety of laser corneal refractive surgery.Ophthalmologists should strictly master indications and administration of commonly used drugs in postoperative eyes to prevent drug-related eye diseases.In addition,eye doctors also should understand the postoperative complications and topical administration of eye drops.It is important to pay attention to the standard surgical operation and rational drug use after corneal refractive surgery,which can enhance the visual quality and comfort and reduce the complication.
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Perioperative visual loss (POVL), a rare but devastating complication, has been reported after spine, cardiac, and head–neck surgeries.The various causes include ischemic optic neuropathy, central or branch retinal artery occlusion, and cortical blindness. The contributory factors described are microvascular diseases and intraoperative hemodynamic compromise. However, the exact association of these factors with post‑operative blindness has not yet been confirmed. A case of POVL with caesarian section surgery is being presented. The visual loss occurred due to a combined occlusion of central retinal artery and vein.The causes, presentation, and risk factors of POVL after non‑ocular surgery are being discussed.
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El uso profiláctico de antibióticos y antiinflamatorios post cirugía oftálmica es una práctica común. La tobramicina es aminoglicósido con espectro de gram negativos y alguns gram positivos. Ciprofloxacino tiene un mayor espectro. Objetivo: Comparar la eficacia y seguridad de la combinación colirio y ungüento de cirpofloxacino/dexametasona versus tobramicina/dexametasona. Pacientes y métodos: Se estudio en forma randomizada y doble ciego, 64 pacientes durante 15 días. Se realizaron 3 controles donde se registró agudeza visual, presión intraocular y una escala subjetiva y objetiva. Resultados: 60 pacientes completaron el estudio. El prurito fue menor en el grupo tratado con ciprofloxacino (0.26 v/s 0.47; p<0,05). Conclusiones: El estudio demostró eficacia y seguridad antibiótica equivalente entre ambas combinaciones. Considerando el mayor espectro antibacteriano de ciprofloxacino y la menor incidencia de prurito se plantea que el uso de esta combinación en pacientes post cirugía de catarata entregaría una protección antibiótica segura y con espectro más amplio.
The prohylactic use of antibiotics and anti-inflammatories drugs is a common practice in ophthalmic surgery. Tobramycin is an aminoglycoside with gram negative spectrum, covering some gram positive bacteria. Ciprofloxacin has a broader spectrum of effectivity. Purpose: To compare effectiveness and safety of eye drops and ointments of ciprofloxacim/dexamethasone versus tobramysin/dexamethasone combinations. Patients and methods: Random and doubled masked study, performed in 64 patients who had cataract surgery. In a 15 days follow up, the effectiveness of both antibiotic combinations were tested. Visual acuity, intraocular pressure, objective and subjective scale were performed. Results: 60 patients (93.4 percent) completed the follow up. Itching presented a significant difference between both groups, being lower in the ciprofloxacin/dexamethasone combination (0.26 vs 0.47. p<0.05). Conclusions: The study shows an equivalent effectiveness and safety of both antibiotic combinations. Considering the broader spectrum of ciprofloxacin and the lower frequency of itchness, ciprofloxacin/dexamethasone combination seems to be a good choice for post operative treatment in cataract surgery.
Subject(s)
Humans , Male , Adult , Female , Anti-Infective Agents , Ciprofloxacin/administration & dosage , Dexamethasone/administration & dosage , Endophthalmitis/prevention & control , Cataract Extraction/methods , Tobramycin/administration & dosage , Anti-Inflammatory Agents , Antibiotic Prophylaxis , Double-Blind Method , Drug Therapy, Combination , Intraocular Pressure , Ointments , Ophthalmic Solutions , Postoperative Period , Prospective Studies , Visual AcuityABSTRACT
A retrospective clinicopathologic review of 174 eyeball specimens which were enucleated following intra-ocular surgery was made. It was found that there were 7 cases of sympathetic ophthalmia (SO), of which 4 cases were associated with lens-induced ophthalmitis (LIO). The shortest latent period of SO in this series was 2 weeks. Pathologically, there was an unclosed eyeball caused by a poorly healed incision with incarceration of uvea tissue, besides the characteristics of SO. The results suggest that the poor healing of the incision made in intra-ocular surgery may be strongly correlated with SO.