ABSTRACT
RESUMO Objetivo: Calcular as velocidades médias da dilatação de pupila para classificar a gravidade da lesão derivada da escala de coma de Glasgow, estratificada por variáveis de confusão. Métodos: Neste estudo, analisaram-se 68.813 exames das pupilas para determinar a velocidade normal de dilatação em 3.595 pacientes com lesão cerebral leve (13 - 15), moderada (9 - 12) ou grave (3 - 8), segundo a escala de coma de Glasgow. As variáveis idade, sexo, raça, tamanho da pupila, tempo de permanência na unidade de terapia intensiva, pressão intracraniana, uso de narcóticos, classificação pela escala de coma de Glasgow e diagnóstico foram consideradas confundidoras e controladas para análise estatística. Empregou-se regressão logística com base em algoritmo de classificação com aprendizado de máquina para identificar os pontos de corte da velocidade de dilatação para as categorias segundo a escala de coma de Glasgow. Resultados: As razões de chance e os intervalos de confiança desses fatores se mostraram estatisticamente significantes em sua influência sobre a velocidade de dilatação. A classificação com base na área sob a curva mostrou que, para o grau leve, na escala de coma de Glasgow, o limite da velocidade de dilatação foi de 1,2mm/s, com taxas de falsa probabilidade de 0,1602 e 0,1902 e áreas sob a curva de 0,8380 e 0,8080, respectivamente, para os olhos esquerdo e direito. Para grau moderado na escala de coma de Glasgow, a velocidade de dilatação foi de 1,1mm/s com taxas de falsa probabilidade de 0,1880 e 0,1940 e áreas sob a curva de 0,8120 e 0,8060, respectivamente, nos olhos esquerdo e direito. Mais ainda, para o grau grave na escala de coma de Glasgow, a velocidade de dilatação foi de 0,9mm/s, com taxas de falsa probabilidade de 0,1980 e 0,2060 e áreas sob a curva de 0,8020 e 0,7940, respectivamente, nos olhos esquerdo e direito. Esses valores foram diferentes dos métodos prévios de descrição subjetiva e das velocidades de dilatação previamente estimadas. Conclusão: Observaram-se velocidades mais lentas de dilatação pupilar em pacientes com escores mais baixos na escala de coma de Glasgow, indicando que diminuição da velocidade pode indicar grau mais grave de lesão neuronal.
ABSTRACT Objective: To calculate mean dilation velocities for Glasgow coma scale-derived injury severity classifications stratified by multiple confounding variables. Methods: In this study, we examined 68,813 pupil readings from 3,595 patients to determine normal dilation velocity with brain injury categorized based upon a Glasgow coma scale as mild (13 - 15), moderate (9 - 12), or severe (3 - 8). The variables age, sex, race, pupil size, intensive care unit length of stay, intracranial pressure, use of narcotics, Glasgow coma scale, and diagnosis were considered as confounding and controlled for in statistical analysis. Machine learning classification algorithm-based logistic regression was employed to identify dilation velocity cutoffs for Glasgow coma scale categories. Results: The odds ratios and confidence intervals of these factors were shown to be statistically significant in their influence on dilation velocity. Classification based on the area under the curve showed that for the mild Glasgow coma scale, the dilation velocity threshold value was 1.2mm/s, with false probability rates of 0.1602 and 0.1902 and areas under the curve of 0.8380 and 0.8080 in the left and right eyes, respectively. For the moderate Glasgow coma scale, the dilation velocity was 1.1mm/s, with false probability rates of 0.1880 and 0.1940 and areas under the curve of 0.8120 and 0.8060 in the left and right eyes, respectively. Furthermore, for the severe Glasgow coma scale, the dilation velocity was 0.9mm/s, with false probability rates of 0.1980 and 0.2060 and areas under the curve of 0.8020 and 0.7940 in the left and right eyes, respectively. These values were different from the previous method of subjective description and from previously estimated normal dilation velocities. Conclusion: Slower dilation velocities were observed in patients with lower Glasgow coma scores, indicating that decreasing velocities may indicate a higher degree of neuronal injury.
Subject(s)
Humans , Brain Injuries , Pupil , Biomarkers , Glasgow Coma Scale , DilatationABSTRACT
Fundamento: la pupiloplastia consiste en la modificación del tamaño o la forma de la pupila mediante la aplicación de la fotocoagulación sobre el iris. Objetivo: describir la evolución de dos casos clínicos con características diferentes y así mostrar la utilidad, beneficios y complicaciones de la microcirugía no invasiva con neodimio yag láser. Caso clínico: se describen dos pacientes de 70 años de edad, raza blanca, con antecedentes oculares de pseudofaquia, los cuales acudieron a la consulta de Oftalmología por presentar irregularidades en la forma de sus pupilas y, uno de ellos, disminución de la visión. Se realizó una sesión de láser para pupiloplastia en ambos casos con notable mejoría de la forma pupilar y en la visión. Conclusiones: los casos evolucionaron muy rápido de manera satisfactoria. El sangrado ligero se presentó como complicación. Este procedimiento tiene numerosas ventajas para el médico y el paciente, es un recurso muy útil y efectivo.
Background: pupilloplasty consists in the modification of the size and shape of the pupil by the application of photocoagulation on the iris. Objective: to describe the evolution of two clinical cases with different characteristics and present the utility, profits and complications of the non invading microsurgery with neodymium yag laser. Clinical case: a description of two 70-years-old, white patients with ocular antecedents of pseudophakia was presented who came to ophthalmology consultation complaining of an irregular pupils and low vision one of them. A pupillolasty was carrying on in both cases with a considerable improvement of the pupil shape and the vision. Conclusions: the evolutions of the cases were fast and satisfactory. A light bleeding was presented as complication. This procedure has many advantages to the doctor and the patient being a useful and effective resource.
ABSTRACT
Objective To observe the neuro-ophthalmological features of intracranial aneurysm.Methods 169 patients with intracranial aneurysm were retrospectively studied.45 patients, including 18 men and 27 women, had neuro ophthalmological symptoms or signs.Their average age was (56.21 ± 16.11) years and 32 (71.11％)patients' age was more than 50 years.The onset time ranged from 30 minutes to 20 years.20 (44.44％) patients' onset time was among 24 hours.CT, CT angiography, MRI, MRI angiography and cerebral digital subtraction angiography were performed alone or combined in all 45 patients.Visual acuity, pupil reflex and eye movement were examined.Clinical data including general condition, initial symptoms, neuro-ophthalmological changes, imaging data and treatment effects were recorded.Results 26.63％ of the 169 patients had neuro-ophthalmological symptoms or signs.There were 6 patients (13.33％) with neuro ophthalmological changes as their first manifestation and 39 patients (86.67 ％) with neurologic changes as first manifestation.Neuro-ophthalmological symptoms included vision loss (10 patients, 22.22％), diplopia (4 patients, 8.89％) and ocular pain (2 patients, 4.44％).The most common neuro-ophthalmological sign was pupil abnormality which was found in 31 patients (68.89 ％).The second most common sign was eye movement disorder (16 patients, 35.56％).The other signs included ptosis (8 patients, 17.78％), nystagmus (2 patients, 4.44％), exophthalmos (1 patient, 2.22％) and disappeared corneal reflection (1 patient, 2.22％).Imaging examination indicated that intracranial hemorrhage happened in 29 patients (64.44％).The most common neuro-ophthalmological features were pupil abnormality, eye movement disorder and vision loss in both patients with or without intracranial hemorrhage.The incidence of pupil abnormality was higher in patients with intracranial hemorrhage than that without intracranial hemorrhage, the difference was statistically significant (x2=7.321, P=0.007).Pupil abnormality and vision loss were common in patients with internal carotid artery aneurysm, and eye movement disorder was common in patients with internal carotid artery aneurysm and posterior communicating aneurysms.Conclusions Patients with intracranial aneurysm have different neuroophthalmological features.The most common features are pupil abnormality, eye movement disorder and vision loss.