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El vertiginoso desarrollo científico - tecnológico de la oftalmología requiere de una actualización sistemática desde el punto de vista teórico - práctico. A tales efectos, se diseñó una estrategia de superación para el mejoramiento del desempeño profesional de los oftalmólogos de la Atención Primaria de Salud dirigida a la atención integral de los pacientes con oclusiones vasculares retinianas. Se emplearon métodos de los niveles teórico y empírico. Fue diseñada en 4 etapas y se utilizó el ciclo Deming como referente metodológico. Se establecieron relaciones esenciales que ofrecen coherencia lógica interna a la educación médica en su concepción como ciencia en construcción, en particular en el área de la formación permanente y continuada de los profesionales de la salud, al profundizar en el orden conceptual, metodológico y epistemológico en los procesos de desempeño profesional y superación.
The fast scientific and technological development of Ophthalmology requires a systematic updating from the theoretical and practical points of view. To such effects, a training strategy was designed for the improvement of professional performance of the primary care ophthalmologists directed to the comprehensive care of patients with retinal vascular occlusions. Empiric and theoretical level methods were used. The strategy was designed in 4 stages and the Deming cycle was implemented as methodological referent. Essential relationships were established which offer internal logical coherence to the Medical Education in its conception as science, particularly in the area of permanent and continued training of the health professionals, as there is a deepening in the conceptual, methodological and epistemological order in the processes of professional and training performance.
Subject(s)
Professional Competence , Retinal Vein Occlusion/diagnosis , Ophthalmologists/education , Primary Health Care , Education, MedicalABSTRACT
Purpose: To determine the proportion of people with type 2 diabetes mellitus (T2DM) attending large eye care facilities across India who have retinal vascular occlusion (RVO). Methods: A 6-month descriptive, multicenter, observational hospital-based study of people was being presented to the 14 eye care facilities in India. The retina-specific component of comprehensive eye examination included stereoscopic biomicroscopy, binocular indirect ophthalmoscopy, and fundus fluorescein angiography, and optical coherence tomography was also available when needed. Data recording of the duration of diabetes, hypertension (HTN), stroke, and other variables was obtained from the medical history. The statistical analysis included frequencies, mean, and standard deviations for continuous variables. Odds ratio (OR) and multivariate analysis were undertaken to assess the associations between risk factors and RVO. Results: The study recruited 11,182 consecutive patients (22,364 eyes) with T2DM. About 59.0% (n = 6697) were male. The mean age was 58.2 ± 10.6 years. In this cohort, RVO was detected in 3.4% (n = 380) of patients; 67.6% (n = 257) of them had branch retinal vein occlusion (BRVO) and the remaining 32.4% (n = 123) had central retinal vein occlusion (CRVO). The frequency of unilateral BRVO (n = 220, 85.6%) and unilateral CRVO (n = 106, 86.18%) was much common. Unilateral RVO was more frequent (n = 326, 85.8%) than bilateral diseases (n = 54, 14.2%) (?2 = 126.95, P < 0.001). Ischemic CRVO was more common (n = 103, 73.6%) than nonischemic CRVO (n = 37, 26.4%). Macula-involving BRVO was found in 58.5% (n = 172) of cases, suggesting more than 50% of cases in RVO carries a risk of severe vision loss. The duration of diabetes apparently had no influence on the occurrence of RVO. On the multivariate analysis, a history of HTN [OR: 1.7; 95% confidence interval (CI): 1.3–2.1; P = 0.001) and stroke (OR: 5.1; 95% CI: 2.1–12.4; P < 0.001) was associated with RVO. Conclusion: RVO is a frequent finding in people with T2DM. History of stroke carries the highest risk followed by HTN. The management of people with T2DM and RVO must also include comanagement of all associated systemic conditions.
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Objective To explore the relationship between retinal vascular occlusion and carotid artery atherosclerotic (CAA) plaque by color Doppler ultrasonography.Methods Carotid artery color Doppler ultrasonography was performed in 65 patients with retinal vascular occlusion (case group) and 50normal controls (control group).To acknowledge the role of the CAA plaque in the ocurrence of retinal vascular occlusion by the detection rate of CAA plaque and stenosis degree of carotid arteries.Results The detection rate of CAA plaque was 64.62％(42/65) in case group,which was higher than that in control group [22.00％(11/50)],and there was significant difference (P＜0.05).Mild stenosis had 34 cases,moderate stenosis had 6 cases,severe stenosis had 2 cases in case group,and 8,3,0 case respectively in control group.There was significant difference in stenosis degree of carotid arteries between two groups (P ＜ 0.05).Conclusions CAA plaque is closely related to the ocurrence of retinal vascular occlusion.Color Doppler ultrasonography is the simplest and most effective method to monitor CAA plaque which has clinical significance in prevention and treatment of retinal vascular occlusion.
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Antiphospholipid antibodies are found in association with collagen-vascular diseases including systemic lupus erythematosus[SLE]. As the laboratory tests suggest impaired coagulation, the patients having antiphospholipid Ab have been reported to be prone to develop thrombosis. The authors present three patients with antiphospholipid antibodies in SLE who had suffered from retinal vascular occlusions. Case 1 with central retinal vein occlusion who had both lupus anticoagulant and anticardiolipin Ab resulted in visual loss. Case 2 with branch retinal vein occlusion who was positive for only lupus anticoagulant experienced moderate visual disturbance. Case 3 with branch retinal artery occlusion who was positive for both lupus anticoagulant and anticardiolipin Ab died without ocular follow-up examination. We consider that SLE patients with the antiphospholipid Ab may be at high risk to develop disturbances in vision due to thromboembolism from a hypercoagulable state.
Subject(s)
Humans , Antibodies, Antiphospholipid , Follow-Up Studies , Lupus Coagulation Inhibitor , Lupus Erythematosus, Systemic , Retinal Artery Occlusion , Retinal Vein , Retinal Vein Occlusion , Retinaldehyde , Thromboembolism , ThrombosisABSTRACT
Objective To analyse the characteristics of fundus fluorescein angiography(FFA)of iatrogenic retinal vascular occlu- sion.Design Retrospective case series.Participants 9 eyes of 9 patients with iatrogenic retinal vascular occlusion and 16 eyes of 16 patients with non-iatrogenic retinal vascular occlusion in Beijing Tongren Hospital in 2002-2005.Methods All patients were examined with FFA.The difference of circulation time of retinal vessels both in iatrogenic and non-iatrogenic retinal vascular occlusion patients was compared.Main Outcome Measures The starting perfusion time and the finishing time of retinal artery or vein.Results In pa- tients with iatrogenic(4 cases)and non-iatrogenic(12 cases)central retinal artery occlusion,the finishing perfusion time was separately 79.33?87.04s and 19.20?4.61s; the finishing time of retinal vein was separately 128.07?149.11s and 33.16?15.34s.In iatrogenic(4 cas- es)and non-iatrogenic(4 cases)central retinal artery together with central retinal vein occlusion patients,the finishing perfusion time of retinal artery was separately 211.67?371.26s and 30.07?17.26s;the finishing perfusion time of retinal vein was 232.43?358.52s and 48. 81?11.64s.One patient was ocular artery occlusion.FFA showed that choroidal background fluorescence and central artery were perfused slowly,the vascular fluorescence perfusion was interrupted before it came out of optic disk and the perfusion interruption continued until late stage with extensive peripheral non-perfusion areas.Conclusion The perfusion time of the retinal artery and vein in iatrogenic reti- nal vascular occlusion may be much longer than that in non-iatrogenic retinal vascular occlusion.