ABSTRACT
Objetivo A síndrome de Terson (ST), também conhecida como hemorragia vítrea, é relatada em pacientes com hemorragia subaracnóide causada por um aneurisma rompido. Este estudo tem como objetivo avaliar a presença de hemorragia ocular nesses pacientes, buscando identificar aqueles que poderiam se beneficiar do tratamento específico para a recuperação do déficit visual. Métodos Estudo prospectivo de 53 pacientes com hemorragia subaracnóide espontânea (SSAH) por aneurisma rompido. Os pacientes foram avaliados quanto à hemorragia vítrea por fundoscopia indireta com 6 a 12 meses de seguimento. Resultados A idade dos pacientes variou de 17 a 79 anos (média de 45,9 ± 11,7); 39 pacientes eram do sexo feminino (73%) e 14 do sexo masculino (27%). Seis pacientes (11%) apresentaram ST e 83,3% apresentaram perda transitória de consciência durante a ictus. Conclusões Uma avaliação oftalmológica deve ser realizada rotineiramente em pacientes com hemorragia subaracnóide, especialmente naqueles com pior grau neurológico. Além disso, o prognóstico foi ruim em pacientes com ST.
Subject(s)
Humans , Male , Female , Aortic Rupture/diagnostic imaging , Subarachnoid Hemorrhage/diagnostic imaging , Vitreous Hemorrhage/diagnostic imaging , Retinal Hemorrhage/diagnostic imaging , Diagnostic Techniques, Ophthalmological , Aortic Rupture/mortality , Spinal Puncture/methods , Subarachnoid Hemorrhage/mortality , Vitrectomy/methods , Vitreous Hemorrhage/mortality , Retinal Hemorrhage/mortality , Cerebral Angiography/methods , Chi-Square Distribution , Prospective StudiesABSTRACT
ABSTRACT Objective: A unusual case of ocular toxoplasmosis with significant vitreomacular traction is reported. The patient improved significantly following pars plana vitrectomy combined with visual stimulation and occlusion therapy. Methods: The case of a 5-year-old girl with significant unilateral vision loss associated with vitreous condensation and macular traction is described. Results: Pars plana vitrectomy was carried out for vitreomacular traction release. This was followed by visual stimulation and occlusion therapy. Significant improvement was observed. Conclusion: Despite structural damage, the combination of properly indicated surgery and amblyopia management strategies allowed the achievement of maximum vision goals in this case, suggesting structural damage may be associated with functional amblyopia.
RESUMO Objetivo: Relata-se um caso de apresentação atípica de toxoplasmose ocular, com importante tração vitreomacular. A paciente apresentou melhora significativa após vitrectomia via pars plana, com estimulação visual e oclusão. Métodos: Descreve-se o caso de uma menina de 5 anos, com importante perda de visão unilateral associada à condensação vítrea e à tração macular. Resultados: Foi realizada vitrectomia via pars plana para alívio da tração vitreomacular, seguida de estimulação visual e oclusão. Foi observada melhora significativa. Conclusão: Apesar dos danos estruturais, a combinação de cirurgia bem indicada com estratégias de tratamento da ambliopia permitiu alcançar o máximo do potencial visual nesta paciente, sugerindo que os danos estruturais podem estar associados à ambliopia funcional.
Subject(s)
Humans , Female , Child, Preschool , Photic Stimulation , Vitrectomy/methods , Tissue Adhesions/surgery , Toxoplasmosis, Ocular/complications , Chorioretinitis/etiology , Epiretinal Membrane/surgery , Epiretinal Membrane/etiology , Traction , Chorioretinitis/complications , Vitreous Detachment/therapy , Vitreoretinal SurgeryABSTRACT
El edema macular es el engrosamiento anormal de la mácula asociado con la acumulación de líquido en el espacio extracelular de la retina neurosensorial. En algunos casos también se ha observado edema intracelular que comprende las células de Muller. Una de estas causas es el edema macular poscirugía de catarata. Presentamos un caso masculino de 57 años de edad de la raza negra con antecedentes de haber sido operado de catarata en ambos ojos. El ojo izquierdo carecía de visión a causa de un rechazo al trasplante corneal penetrante que le fue realizado. El ojo derecho presentaba edema macular con subluxación de la lente intraocular. Le realizamos biomicroscopia de segmento anterior y posterior, tomografía de coherencia óptica, agudeza visual con corrección y presión intraocular. Se constató edema macular con membrana epirretinal y subluxación de la lente intraocular. Decidimos fijar la lente a la esclera utilizando la técnica de Yamane, ya que se trataba de una lente de 3 piezas de acrílico con háptica de fluoruro de polivinildeno configuración en C (CT Lucia 602 de Zeiss), ideal para esta técnica. Colocamos una dosis de Ozurdex en el ojo derecho para tratar el edema macular, después de ver que los colirios tópicos antinflamatorios no fueron efectivos en este caso, y tuvimos una mejoría del edema por aproximadamente 3 meses. En el edema macular posquirúrgico no solo es necesario tratar la inflamación, sino también la causa que la ha producido(AU)
Macular edema is the abnormal thickening of the macula associated to fluid accumulation in the extracellular space of the neurosensory retina. Some cases also present intracellular edema with involvement of Müller cells. One of these causes is macular edema after cataract surgery. A case is presented of a male 57-year-old patient of black skin color with a history of cataract surgery in both eyes. The left eye had no vision, due to rejection to the penetrating corneal transplantation performed. The right eye presented macular edema with intraocular lens subluxation. Examination included biomicroscopy of the anterior and posterior segments, optical coherence tomography, visual acuity with correction and intraocular pressure. A diagnosis was confirmed of macular edema with epiretinal membrane and intraocular lens subluxation. It was decided to fix the lens to the sclera using the Yamane technique, since it was a three-piece lens with a C-shaped polyvinylidene fluoride haptic (CT Lucia 602 from Zeiss), ideal for this technique. An Ozurdex dose was administered in the right eye to treat the macular edema, since topical anti-inflammatory eyedrops were not effective in this case, and improvement of the edema was achieved for about three months. In postoperative macular edema, it is not only necessary to treat the inflammation, but also its cause(AU)
Subject(s)
Humans , Male , Middle Aged , Vitrectomy/methods , Macular Edema/etiology , Tomography, Optical Coherence/methods , Lenses, Intraocular/adverse effects , Ophthalmic Solutions/therapeutic use , Intraocular PressureABSTRACT
Paciente masculino con antecedente de trauma craneoencefálico severo recibido en la unidad de emergencia con una puntuación en la escala de Glasgow de 3 puntos; se describió en la tomografía computarizada un hematoma frontal epidural y una hemorragia subdural aguda; fue intervenido quirúrgicamente por neurocirugía en la Unidad de Emergencias y posteriormente fue llevado a la unidad de cuidados intensivos donde durante la recuperación (2 meses) refirió disminución de la agudeza visual en ojo izquierdo; fue evaluado en el servicio de Oftalmología donde la agudeza visual del ojo derecho fue de 20/40 y en ojo izquierdo no percibe la luz, en la evaluación oftalmológica se evidencia la presión intraocular en ojo izquierdo de 44mmHg, abundante celularidad en cámara anterior y a la evaluación ultrasonografía de cámara vítrea se describe una imagen que se correlaciona con una aparente hemorragia vítrea. Se diagnostica con Glaucoma de células fantasmas y síndrome de Terson; se inicia tratamiento médico con antiglaucomatoso para el glaucoma de células fantasmas y expectante para el síndrome de Terson, a la semana debido a la pobre respuesta se realizó trabeculectomia y vitrectomía vía Pars plana, posterior al tratamiento oftalmológico, se describió una visión de ojo izquierdo de 20/200
Male patient with a history of severe head trauma received in the emergency unit with a Glasgow coma score of 3; radiologically, an epidural frontal hematoma and an acute subdural hemorrhage are described in the computed tomography; the patient underwent surgery in the Emergency Unit and was later admitted to the intensive care unit where during recovery (2 months) he reported decreased visual acuity in the left eye; is evaluated in the ophthalmology service where is found a visual acuity of the right eye with correction of 20/40 and the left eye does not perceive light, the ophthalmology evaluation shows an intraocular pressure of the left eye of 44mmHg, abundant cellularity in the anterior chamber and in the ultrasound evaluation of the vitreous chamber describes an image that correlates with an apparent vitreous hemorrhage. He is diagnosed with Ghost Cell Glaucoma and Terson Syndrome; Medical treatment with antiglaucoma treatment for Ghost cell glaucoma and expectant for Terson syndrome is started. After a week due to the poor response, a trabeculectomy and vitrectomy via pars plana was performed, after ophthalmological treatment, a vision of the left eye of 20/200 was described
Subject(s)
Ophthalmology , Patients , Vitrectomy , Glaucoma , Eye , Craniocerebral TraumaABSTRACT
The incidence of endophthalmitis after vitrectomy is extremely low,especially lower in silicone oil-filled eyes.Silicone oil exerts a toxic effect on the cell membranes of microorganisms and leads to the lack of nutrients.It is thus believed to inhibit the growth of bacteria and fungi.Endophthalmitis induced by mixed bacteria in silicone oil-filled eye has been rarely reported.We reviewed the clinical manifestations,diagnosis,and treatment of a patient with endophthalmitis caused by mixed infection of
Subject(s)
Bacteria , Coinfection , Endophthalmitis , Humans , Silicone Oils/adverse effects , VitrectomyABSTRACT
OBJECTIVE@#To investigate the value of hand-held retinal optometer and optical coherence tomography (OCT) in predicting postoperative visual acuity in patients with age-related cataract and idiopathic macular epiretinal membrane.@*METHODS@#We retrospectively analyzed the data of patients undergoing phacoemulsification combined with intraocular lens implantation for age-related cataract in our hospital from January, 2019 to April, 2020.Preoperative examination detected idiopathic macular epiretinal membrane in 45 of the patients (52 eyes) with lens opacity grade C2N2P1 according to LOCSⅡ lens opacity classification criteria.Based on the thickness of the macular fovea, the eyes were divided into group A (9 eyes) with macular thickness 400 μm.The best corrected visual acuity and retinal visual acuity before operation and the best corrected visual acuity on the first day and at 3 months after the surgery were compared among the 3 groups.The consistency between the preoperative retinal vision and the best corrected vision at 3 months after the surgery was analyzed.@*RESULTS@#The best corrected visual acuity at one day and 3 months after the surgery differed significantly from that before the surgery in all the 3 groups (@*CONCLUSIONS@#For patients with cataract and idiopathic macular epiretinal membrane, phacoemulsification combined with intraocular lens implantation can improve postoperative vision.Hand-held retinal optometer can accurately assess postoperative vision in patients with stage C2N2P1 cataract.Patients with a macular thickness >400 μm caused by idiopathic macular epiretinal membrane are likely to have poor postoperative visual outcomes.
Subject(s)
Cataract/diagnostic imaging , Epiretinal Membrane/surgery , Humans , Retrospective Studies , Tomography, Optical Coherence , Visual Acuity , VitrectomyABSTRACT
Abstract This paper provides a fast and inexpensive technique to prevent slippage of the infusion cannula from the EVA DORC® 27-gauge system. After the usual retrobulbar anesthesia, antisepsis and asepsis, a 2% hydroxypropyl methylcellulose drop is placed around the infusion cannula in the trocar to hold it in position. This technique prevents the slippage of the infusion cannula and both the surgical time and creation of the first sclerotomy in the eye can be shortened slightly.
Resumo Este artigo fornece uma técnica rápida e barata para evitar o deslizamento da cânula de infusão do sistema EVA DORC® 27-gauge. Após a habitual anestesia retrobulbar, antissepsia e assepsia, uma gota de 2% de hidroxipropilmetilcelulose é colocada ao redor da cânula de infusão no trocater para mantê-la em posição. Essa técnica evita o deslizamento da cânula de infusão e o tempo cirúrgico e da criação da primeira esclerotomia no olho podem ser ligeiramente reduzidos.
Subject(s)
Humans , Vitrectomy/methods , Minimally Invasive Surgical Procedures , Vitreoretinal Surgery/methods , CannulaABSTRACT
RESUMEN El agujero macular es un desorden de la interface vitreorretinal definido como un defecto de espesor completo desde la membrana limitante interna hasta los segmentos externos de los fotorreceptores, que normalmente involucra a la fóvea. Con el desarrollo de la tomografía de coherencia óptica se han mejorado el diagnóstico, el tratamiento y el seguimiento de las enfermedades de la interface vitreorretinal, entre ellas el agujero macular. La vitrectomía pars plana es la técnica quirúrgica de elección para el agujero macular. Se presenta una paciente de 75 años, pseudofáquica, con mejor agudeza visual corregida en el ojo derecho de 0,1 Snellen. Se diagnostica agujero macular grande (810 µm) según su mínima apertura, con 8 meses de evolución. Se realizó vitrectomía pars plana, el levantamiento de la hialodes posterior, el flap invertido de membrana limitante interna, el uso de hexafluoruro de azufre en mezcla 20 por ciento y el posicionamiento de la paciente 24-72 horas. Se logró el cierre anatómico del agujero macular y la recuperación visual de 0,6 Snellen a los seis meses del tratamiento quirúrgico(AU)
ABSTRACT Macular hole is a disorder of the vitreous-retina interface defined as a full-thickness defect from the internal limiting membrane to the external segments of photoreceptors which typically involves the fovea. The development of optical coherence tomography has improved the diagnosis, treatment and follow-up of vitreous-retina interface diseases, among them macular hole. Pars plana vitrectomy is the surgical technique of choice for macular hole. A case is presented of a female 75-year-old pseudophakic patient with best corrected right eye visual acuity of 0.1 on the Snellen chart. Large macular hole is diagnosed (810 µm) according to its minimum opening, of 8 month's evolution. The following procedures were performed: pars plana vitrectomy, posterior hyalode lifting, inverted internal limiting membrane flap, use of sulfur hexafluoride in a 20% mixture, and positioning of the patient for 24-72 hours. Anatomical closure of the macular hole and a visual recovery of 0.6 Snellen were achieved six months after surgery(AU)
Subject(s)
Humans , Female , Aged , Retinal Perforations/diagnosis , Sulfur Hexafluoride/therapeutic use , Vitrectomy/methods , Tomography, Optical Coherence/methodsABSTRACT
RESUMEN Se hace una revisión bibliográfica acerca del tratamiento que se utiliza en el edema macular clínicamente significativo. Esta es la primera causa de mala visión en los pacientes con diabetes mellitus. Entre las líneas de tratamiento tenemos los antiangiogénicos con sus variantes, los esteroides y la cirugía por medio de la vitrectomía pars plana con pelado de la membrana limitante interna. No existe hasta el momento el tratamiento ideal. La tomografía de coherencia óptica ayuda a predecir la visión final(AU)
ABSTRACT Treatment of clinically significant diabetic macular edema is the topic of our review. This condition is the first cause of vision loss in diabetic patients. Treatment options include anti-VEFG drugs, steroids and surgery (vitrectomy with internal limiting membrane peeling). There is no an ideal treatment at present. Optic coherence tomography is a useful tool to predict final vision in these patients(AU)
Subject(s)
Humans , Vitrectomy/methods , Macular Edema/diagnosis , Tomography, Optical Coherence/methods , Review Literature as Topic , Diabetes Mellitus/epidemiologyABSTRACT
ABSTRACT Purpose: To compare the benefits and side effects of pars plana vitrectomy with those of systemic immune modulator therapy for patients with complicated intermediate uveitis. Methods: This prospective clinical trial enrolled patients with recurrent intermediate uveitis who exhibited minimal improvement of visual acuity, despite injections of periocular steroids. Twenty patients were randomized to the pars plana vitrectomy group or oral steroid and cyclosporine-A group (10 eyes of 10 patients per group). Follow-up was performed for 24 months to study changes in visual acuity, binocular indirect ophthalmoscopy score, fluorescein angiography, and optical coherence tomography findings. Results: Visual acuity (logarithm of the minimal angle of resolution) significantly improved from 0.71 to 0.42 (p=0.001) in the surgical group, whereas it improved from 0.68 to 0.43 (p=0.001) in the immune modulator therapy group. Seven patients (70%) in the surgical group gained ≥2 lines, and six patients (60%) in the immune modulator therapy group gained ≥2 lines (p=0.970). Fluorescein angiography and optical coherence tomography studies showed that six of seven pars plana vitrectomy patients who had cystoid macular edema experienced improvement, whereas two patients with diffuse macular edema did not experience improvement. In the immune modulator therapy group, three of six patients with cystoid macular edema did not experience improvement, whereas two patients with diffuse macular edema experienced improvement. Conclusions: Pars plana vitrectomy and immune modulator therapy resulted in significant improvement in visual function in patients with persistent inflammation secondary to chronic intermediate uveitis. Despite this success, there remains a need for the determination of optimal indications for the use of each modality. Immune modulator therapy was successful for the treatment of diffuse macular edema associated with chronic intermediate uveitis, whereas pars plana vitrectomy was not.
RESUMO Objetivo: Comparar os benefícios e efeitos co laterais da vitrectomia via pars plana com os da terapia imunomo duladora sistêmica em pacientes com uveíte intermediária complicada. Métodos: Estudo clínico prospectivo incluiu pacientes com uveíte intermediária recorrente que apresentaram melhora minima da acuidade visual, apesar das injeções perioculares de esteroides. Vinte pacientes foram randomizados para o grupo de vitrectomia via pars plana ou esteróide oral e ciclosporina A (10 olhos de 10 pacientes por grupo). O acompanhamento foi de 24 meses para estudar al te rações na acuidade visual, o escore da oftalmoscopia binocular indireta, a angiofluoresceinografia e achados na to mográfica de coerência óptica. Resultados: A acuidade visual (logaritmo do ângulo mínimo de resolução) melhorou significativamente de 0,71 para 0,42 (p=0,001) no grupo cirúrgico, enquanto melhorou de 0,68 para 0,43 (p=0,001) no grupo da terapia imunomoduladora. Sete pacientes (70%) no grupo cirúrgico ganharam ≥2 linhas e seis pacientes (60%) no grupo da terapia imunomoduladora ganharam ≥2 linhas (p=0,970). Os estudos de angiofluoresceinografia e tomografia de coerência óptica mostraram que seis dos sete pacientes da vitrectomia via pars plana que apresentaram edema macular cistóide melhoraram, enquanto dois pacientes com edema macular difuso não apresentaram melhora. No grupo da terapia imunomoduladora, três dos seis pacientes com edema macular cistoide não apresentaram melhora, enquanto dois pacientes com edema macular difuso melhoraram. Conclusões: A vitrectomia via pars plana e a terapia imunomoduladora resultaram em melhora significative da função visual dos pacientes com inflamação persistente secundária a uveíte intermediária crônica. Apesar desse sucesso, continua sendo necessário determinar as melhores indicações para o uso de cada modalidade. A terapia imunomoduladora foi bem sucedida no tratamento do edema macular difuso associado à uveíte intermediária crônica, enquanto a vitrectomia via pars plana não foi.
Subject(s)
Humans , Vitrectomy , Uveitis, Intermediate , Macular Edema , Immunologic Factors , Visual Acuity , Uveitis, Intermediate/therapy , Prospective Studies , Retrospective Studies , Immunologic Factors/therapeutic useABSTRACT
ABSTRACT Purpose: This study aims to compare the anatomical success rates of vitrectomy and SF6 gas tamponade for macular hole surgery with and without postoperative face-down posturing. Methods: This was an observational, longitudinal, and retrospective case series analysis. The study included 52 eyes from 52 patients who underwent pars plana vitrectomy with trypan blue-assisted internal limiting membrane peeling and 25% SF6 tamponade for stages 2, 3, and 4 macular holes. After surgery, all patients were provided with a postoperative postural regimen: 31 patients were instructed not to maintain face-down posturing, whereas 21 were instructed to maintain face-down posturing for 7 days. The primary outcome measure was the macular hole closure rate. Statistical analysis was performed using Epi Info 7.1. Results: A total of 47 (90.3%) patients achieved hole closure. The nonface-down posturing group and face-down posturing group obtained closure rates of 90.3% and 90.4%, respectively; these rates were not significantly different. Statistical analysis revealed that no significant differences existed in sex, age, hole duration, hole stage, preoperative visual acuity, or postoperative visual acuity between the two groups. Conclusion: Our results suggest that macular hole surgery with the use of short duration gas (SF6) is safe and effective and that maintaining a postural orientation of nonface-down posturing is also safe. However, these recommendations should be assessed further in a prospective and randomized study to comprehensively delineate the associated benefits and risks.
RESUMO Objetivos: Comparar as taxas de sucesso anatômico da vitrectomia e tamponamento de gás SF6 na cirurgia de buraco macular com e sem a postura pronada pós-operatória. Métodos: Foi realizado um estudo observacional, longitudinal e retrospectivo de séries de casos. O estudo incluiu 52 olhos de 52 pacientes submetidos à vitrectomia posterior via pars-plana com peeling de membrana limitante interna auxiliada por azul trypan e tamponamento com gás SF6 a 25% para os estágios 2, 3 e 4 dos buracos maculares. Após a cirurgia, todos os pacientes foram orientados a manter um regime postural pós-operatório: 31 pacientes foram orientados a não realizar posição pronada de cabeça, enquanto 21 foram orientados a manter uma pronada pós-operatória por 7 dias. O objetivo principal foi a análise da taxa de fechamento do buraco macular. A análise estatística foi realizada usando Epi-Info 7.1. Resultados: Um total de 47 (90,3%) pacientes obtiveram fechamento do buraco macular. O grupo de postura não pronada e o grupo de postura pronada obtiveram taxas de fechamento de 90,3%, e 90,4%, respectivamente; essas taxas não foram significativamente diferentes. A análise estatística revelou que não houve diferenças significativas relacionadas ao gênero, idade, duração do buraco macular, estágio do buraco macular, acuidade visual corrigida pré e pós-operatória entre os dois grupos. Conclusão: Nossos resultados sugerem que a cirurgia para buraco macular com o uso de gás de curta duração (SF6) é segura e eficaz e que a manutenção de uma orientação pós-operatória de não-pronada também é segura. No entanto, essas recomendações devem ser avaliadas em um estudo prospectivo e randomizado para delinear de forma abrangente os riscos e benefícios associados.
Subject(s)
Humans , Retinal Perforations , Fluorocarbons , Retinal Perforations/surgery , Vitrectomy , Prospective Studies , Retrospective Studies , Treatment Outcome , Prone PositionABSTRACT
Resumo É apresentado o caso de uma paciente do sexo feminino, 77 anos, internada por pielonefrite e tratada com antibóticos de amplo espectro, tendo desenvolvido endoftalmite endógena bilateral presumida por Candida. Foi submetida à vitrectomia via pars plana e injeção intravítrea de anfotericina B, além de voriconazol oral. São abordados, ainda, os aspectos clínicos da endoftalmite endógena por meio de revisão da literatura.
Abstract A 77 year-old female patient suffering from pyelonephritis developed bilateral endogenous endophthalmitis presumed by Candida after have been treated with global spectrum antibiotics. Early vitrectomy and intravitreal amphotericin B injection were performed, in addition to oral voriconazole. Clinical aspects of endogenous endophthalmitis are also pointed out by a literature review.
Subject(s)
Humans , Male , Female , Aged , Vitrectomy , Candida albicans , Eye Infections, Fungal/drug therapy , Amphotericin B/therapeutic use , Endophthalmitis/surgery , Endophthalmitis/drug therapy , Intravitreal Injections , Voriconazole/therapeutic use , Antifungal Agents/therapeutic useABSTRACT
ABSTRACT Perfluorocarbon liquid has been widely used during vitreoretinal operations. Subretinal retention is a rare intraoperative complication, but even small quantities can damage the macular structure and function, and no standard treatment has been established. We encountered a 43-year-old woman who presented a retained subfoveal bubble after a vitreoretinal operation due to primary rhegmatogenous retinal detachment. Herein, we describe the procedure we used to remove the perfluorocarbon liquid without retinotomy using internal limiting membrane peeling.
RESUMO O perfluorocarbono líquido tem sido amplamente durante cirurgias vitreorretinianas. A retenção subretiniana, é uma complicação intraoperatória rara, mas mesmo pequenas quantidades podem danificar a estrutura e função macular, e nenhum tratamento padrão foi estabelecido. Encontramos uma mulher de 43 anos que apresentou bolha subfoveal retida após uma cirurgia vitreorretiniana devido a descolamento de retina regmatogênico. Aqui, descrevemos o procedimento que usamos para remover o líquido perfluorocarbono sem retinotomia usando peeling da membrana limitante interna.
Subject(s)
Humans , Female , Adult , Retina , Retinal Detachment , Vitrectomy , Retinal Detachment/surgery , Visual Acuity , FluorocarbonsABSTRACT
INTRODUCCIÓN: La cirugía de cataratas es un factor de riesgo para el desprendimiento de retina regmatógeno. Dentro de las técnicas utilizadas para su reparación, se encuentran la vitrectomía pars plana y la banda de silicona. La combinación de ambas técnicas ha sido propuesta en pacientes con desprendimiento de retina previamente operados de cataratas (pseudofáquicos o afáquicos), pero su efectividad no está clara. MÉTODOS: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos cuatro revisiones sistemáticas que en conjunto incluyeron ocho estudios primarios, de los cuales, uno corresponde a un ensayo aleatorizado. A partir de éste, concluimos que la combinación de vitrectomía pars plana y banda de silicona podría resultar en poca o nula diferencia en la reaplicación retinal primaria, en la reaplicación retinal final y en la agudeza visual, pero la certeza de la evidencia es baja. Respecto a las complicaciones, no es posible establecer con claridad si la combinación de ambas técnicas aumenta la frecuencia de vitreorretinopatía proliferativa o si disminuye el desarrollo de glaucoma, debido a que la certeza de la evidencia fue evaluada como muy baja.
INTRODUCTION: Cataract surgery increases the risk for rhegmatogenous retinal detachment. Pars plana vitrectomy and scleral buckling are two surgical procedures used for its repair. The combination of both techniques had been proposed for rhegmatogenous retinal detachment in patients with previous cataract surgery (pseudophakic or aphakic), but its effectiveness remains unclear. METHODS: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS: We identified four systematic reviews with eight studies overall, one of them was a randomized trial. With this data, we conclud-ed that pars plana vitrectomy plus scleral buckle may make little or no difference in primary or final retinal reattachment rate nor in final visual acuity, but the certainty of the evidence is low. In terms of surgery complications, we are uncertain if vitrecto-my plus scleral buckle increases the risk of proliferative vitreoretinopathy or reduces the risk of glaucoma because the certainty of the evidence is very low.
Subject(s)
Humans , Scleral Buckling/methods , Vitrectomy/methods , Retinal Detachment/surgery , Retinal Detachment/etiology , Cataract Extraction/adverse effects , Randomized Controlled Trials as Topic , Databases, FactualABSTRACT
RESUMEN La endoftalmitis es considerada una forma grave de inflamación intraocular, generalmente de etiología infecciosa. Objetivo: Identificar la incidencia de la endoftalmitis posqueratoplastia en la población y los posibles factores de riesgo. Métodos: Se realizó un estudio descriptivo transversal en el Instituto Cubano de Oftalmología "Ramón Pando Ferrer" del año 2010 al 2015. Las variables estudiadas fueron: edad, sexo, diagnóstico preoperatorio, procedimientos asociados a la queratoplastia, tiempo de inicio de los síntomas, gérmenes aislados en cultivos y alternativas terapéuticas realizadas. Resultados: Se realizaron 1 442 queratoplastias; 0,41 por ciento de los casos (6 casos, 6 ojos) presentaron endoftalmitis posqueratoplastia. La causa más frecuente de la queratoplastia en estos pacientes fue la queratopatía bulosa pseudofáquica y fáquica, y al 33,3 por ciento se le había realizado cirugía combinada de queratoplastia y catarata. El 66,7 por ciento de los pacientes con endoftalmitis posqueratoplastia tenía más de 60 años de edad y correspondió al sexo masculino. El 50,0 por ciento de los gérmenes aislados eran gram postivos. El 100,0 por ciento de los pacientes recibió intravítreas de antibióticos y solo al 33,3 por ciento de ellos se les realizó vitrectomía precoz. Conclusiones: Es indispensable una estrecha comunicación entre el banco de ojos, los microbiólogos y los oftalmólogos para contribuir a la identificación y a la eliminación de los factores de riesgo, así como a la temprana detección y a una acertada elección terapéutica que favorezca tanto a su prevención como al mejor resultado funcional visual en pacientes portadores de esta devastadora complicación(AU)
ABSTRACT Endophthalmitis is considered to be a severe form of intraocular inflammation of frequent infectious etiology. Objective: Identify the incidence of post-keratoplasty endophthalmitis in the population and its possible risk factors. Methods: A descriptive cross-sectional study was conducted at Ramón Pando Ferrer Cuban Institute of Ophthalmology in the period 2010-2015. The variables analyzed were age, sex, preoperative diagnosis, keratoplasty-related procedures, time of symptom onset, germs isolated in cultures and therapeutic alternatives implemented. Results: A total 1 442 keratoplasties were performed; 0.41 percent of the cases (6 cases, 6 eyes) presented post-keratoplasty endophthalmitis. The most common reason for keratoplasty among these patients was pseudophakic bullous and phakic keratopathy. 33.3 percent had undergone combined keratoplasty-cataract surgery. Of the patients with post-keratoplasty endophthalmitis, 66.7 percent were aged over 60 years and male. Of the germs isolated, 50.0 percent were gram-positive. 100.0 percent of the patients received intravitreal antibiotics, and only 33.3 percent of them underwent early vitrectomy. Conclusions: Close communication is indispensable between the eye bank, microbiologists and ophthalmologists to contribute to identification and elimination of risk factors, as well as early detection and appropriate therapeutic selection to facilitate prevention and obtain the best visual functional result in sufferers of this devastating complication(AU)
Subject(s)
Humans , Male , Middle Aged , Vitrectomy/adverse effects , Endophthalmitis/epidemiology , Risk Factors , Corneal Transplantation/methods , Epidemiology, Descriptive , Cross-Sectional StudiesABSTRACT
ABSTRACT Optic disc pit is a rare congenital anomaly that can cause serous macular detachment. It has no universally accepted single treatment. Recently, several investigators have performed new procedures to directly seal the pit. Herein, we report a case showing a promising method for optic pit maculopathy surgical treatment. We created an inverted internal limiting membrane flap and fold it over the pit to promote barrier in order to stop further fluid accumulation. Gradual absorption of subretinal fluid was observed over 12 months of follow-up. Optical coherence tomography can demonstrate internal limiting membrane folded over the pit and progressive subretinal fluid resolution. This technique resulted in a satisfactory anatomic outcome with good functional improvement in the best-corrected visual acuity.
RESUMO A fosseta do disco óptico é uma rara anomalia con gênita que pode causar descolamento de retina seroso na mácula. Não há um tratamento cirúrgico padrão universalmente aceito. Recentemente, cirurgiões têm realizado procedimentos novos que visam selar o buraco diretamente. Esse caso clínico mostra um método promissor para o tratamento cirúrgico da maculopatia causada pela fosseta do disco. Optamos por criar um flap invertido com a membrana limitante interna, dobrando-o sobre a fosseta para promover uma barreira, impedindo o acúmulo de fluido. A absorção gradual do líquido subretiniano foi observada ao longo de 12 meses de acompanhamento. Imagens de tomografia de coerência óptica podem demonstrar a membrana limitante interna dobrada sobre a fosseta e a resolução progressiva do fluido subretiniano. Esta técnica resultou em um resultado anatômico satisfatório com boa melhora funcional na acuidade visual.
Subject(s)
Humans , Female , Adult , Vitrectomy/methods , Retinal Detachment/surgery , Eye Abnormalities/surgery , Tomography, Optical Coherence/methods , Optic Disk/abnormalities , Retinal Diseases , Retinal Detachment/etiology , Visual Acuity , Eye Abnormalities/complications , Subretinal Fluid , Macular Degeneration/complicationsABSTRACT
Introducción: el desprendimiento de retina regmatógeno (DRR) y agujero macular concomitante (AM) es una asociación poco frecuente, se reporta alrededor del 1-1,7%. Objetivo: presentar los resultados anatómicos y funcionales obtenidos en 11 casos intervenidos por DRR asociado a AM. Diseño del estudio: estudio observacional descriptivo retrospectivo. Método: estudio retrospectivo. Se registraron 11 pacientes con estas características entre 2010-2018. Se realizó vitrectomía con calibre 23 G, cerclaje escleral, remoción de membrana limitante interna (MLI), endofotocoagulación, lensectomía en los pacientes fáquicos y tamponaje con aceite de silicón o gas. Se evaluaron las siguientes variables: edad, sexo, agudeza visual (AV) al diagnóstico, tiempo de evolución del DRR, número de desgarros, grado de proliferación vitreoretiniana (PVR), si requirió retinectomía, tiempo de tamponaje con aceite de silicón, AV posterior a la extracción de aceite con colocación de lente intraocular y si se obtuvo el cierre del AM. El análisis estadístico descriptivo consistió en las variables cualitativas en frecuencias absolutas y relativas, mientras que en las cuantitativas medidas de tendencia central tipo promedio con rango mínimo y máximo. Resultados: los pacientes presentaban una edad promedio de 63 años (rango 53-74) con agudeza visual (AV) preoperatoria entre proyección luminosa y cuenta dedos. Diez pacientes presentaban mácula desprendida; el número de desgarros fueron de 1 a 2. El grado de PVR al diagnóstico: 2 grado B; 3 grado C2; 2 grado D1; 4 casos sin PVR. En 2 pacientes con PVR C3 y D1 se realizó retinectomía en 180°. En el 82% de los casos se logró la reaplicación de la retina en la primera cirugía, 100% en la segunda y en el 64% se constató el cierre completo del AM. La AV final fue entre 20/200 a 20/50, donde las mejores AV se asocian a casos con intervención precoz y sin PVR. Conclusión: Se encontró una tasa de reaplicación de la retina similar a O'Driscoll et al. donde alcanza el 78%, aunque solo 31% de su serie logra el cierre completo del AM utilizando gas SF6 como tamponaje sin pelaje de la MLI. En este estudio la tasa de cierre del AM es mayor alcanzando el 64% con pelaje de la MLI y una tasa de éxito anatómico con reaplicación de la retina en el 82% en la primera intervención.
Background: rhegmatogenous retinal detachment (RRD) and concomitant macular hole (MH) is a rare association, reported around 1-1,7%. Objective: to report anatomical and functional postoperative results in 11 patients with RD associated with MH. Study design: observational retrospective descriptive study. Method: this is a retrospective study. Eleven patients were registered with RRD and MH between 2010-2018. A 23G vitrectomy, scleral buckling, internal limiting membrane (ILM) peeling, laser photocoagulation, lensectomy in phakic patients and tamponade with silicone oil or gas were performed. The following variables were evaluated: age, sex, visual acuity (VA) at diagnosis, time of evolution of RRD, number of retinal tears, degree of vitreoretinal proliferation (VRP), if retinectomy is required, tamponade time with silicone oil, VA after extraction of silicon oil and scleral fixation of intraocular lens and if closure of the MH was obtained. The descriptive statistical analysis consisted of qualitative variables in absolute and relative frequencies; in the quantitative variables were applied measures of central tendency like average with minimum and maximum range. Results: the patients had an average age of 63 years (range 53-74) with preoperative visual acuity (VA) between luminous projection and counting fingers. Ten patients had detached macula; the number of retinal tears were 1 to 2. The degree VRP at diagnosis: 2 grade B; 3 grade C2; 2 grade D1; 4 cases without VRP. In 2 patients with VRP C3 and D1, a 180° retinectomy was performed. In 82% of the cases, the reapplication of the retina was achieved in the first surgery, 100% in the second and in 64% the complete closure of the MH was confi rmed. The final VA was from 20/200 to 20/50, where the best visual outcomes are associated with early intervention and without VPR. Conclusion: this study found a retinal reapplication rate similar to O'Driscoll et al. where it reaches 78%, although only 31% of this report achieves the complete closure of the MH using SF6 gas as tamponade without ILM peeling. In this study, the closure rate of the MH is greater reaching 64% with ILM peeling and an anatomical success rate with retinal reapplication in 82% in the first intervention.
Subject(s)
Retinal Detachment/surgery , Postoperative Period , Retinal Perforations/surgery , Vitrectomy , Retrospective StudiesABSTRACT
PURPOSE: To evaluate clinical outcomes of idiopathic epiretinal membrane removal in patients ≥ 80 years of age.METHODS: A retrospective review of medical records was performed with 56 patients who underwent vitrectomy and removal of idiopathic epiretinal membrane. In the ≥ 80 years of age group (n = 28), the best-corrected visual acuity (BCVA) and central macular thickness (CMT) before surgery were compared with those at the final follow-up. The amount of change in the BCVA after surgery was also compared between the ≥ 80 years of age group and the < 80 years of age group (n = 28).RESULTS: In the ≥ 80 years of age group, the mean follow-up period was 19.1 ± 17.0 months. Before surgery, 11 eyes were pseudophakic and 17 eyes were phakic. Combined cataract surgery was performed with epiretinal membrane removal in all 17 phakic eyes. The mean logarithm of the minimal angle of resolution BCVA was 0.75 ± 0.30 before surgery, which improved to 0.50 ± 0.30 at the final follow-up (p < 0.001). The CMT was 458.0 ± 79.7 µm before surgery, which decreased to 367.2 ± 83.4 µm at the final follow-up (p < 0.001). There was no significant difference in the amount of change in the BCVA after the surgery between the ≥ 80 years of age group and the < 80 years of age group (p = 0.547).CONCLUSIONS: In patients with idiopathic epiretinal membrane who were ≥ 80 years of age, the visual acuity was improved or maintained, and was accompanied with anatomical improvement after epiretinal membrane removal with or without cataract surgery. These results suggest the usefulness of epiretinal membrane removal in older patients.
Subject(s)
Cataract , Epiretinal Membrane , Follow-Up Studies , Humans , Medical Records , Retrospective Studies , Visual Acuity , VitrectomyABSTRACT
PURPOSE: We investigated the long-term outcomes of vitrectomy with internal limiting membrane (ILM) peeling as treatment for myopic traction maculopathy (MTM).METHODS: The medical records of patients who underwent vitrectomy to treat MTM were retrospectively evaluated. We excluded patients who exhibited macular holes (MHs) or retinal detachment at the time of primary surgery. The best-corrected visual acuity (BCVA) and central foveal thickness (CFT) were analyzed preoperatively, at 3, 6, 12, and 24 months after surgery, and at the final visit. Complications including retinal detachment or an MH were noted during follow-up.RESULTS: Twenty-three eyes of 22 patients were enrolled. At the time of primary surgery, the mean patient age was 64.4 ± 11.1 years and the baseline mean logMAR BCVA and CFT, 0.67 ± 0.50 and 431.8 ± 159.5 µm, respectively. The mean follow-up period was 53.7 ± 19.3 months. The mean logMAR BCVAs at 3, 6, 12, and 24 months postoperatively and at the final visit were 0.42 ± 0.39 (p = 0.001), 0.41 ± 0.38 (p = 0.001), 0.39 ± 0.40 (p < 0.001), 0.42 ± 0.43 (p < 0.001), and 0.51 ± 0.47 (p = 0.016), respectively, thus significantly better than the baseline value. The mean CFT at 3, 6, 12, and 24 months postoperatively and at the final visit were 244.6 ± 72.3, 210.5 ± 79.1, 209.6 ± 91.6, 219.8 ± 93.9, and 217.7 ± 81.3 µm, respectively, thus significantly less than baseline (all p < 0.001). MTM resolved in 18 eyes (78.3%) after primary surgery, without any complication, and remained stable to the final visit.CONCLUSIONS: Vitrectomy with ILM peeling afforded favorable long-term efficacy and safety in MTM patients.