Retinal laser – Protocols and practical tips

Background: Many a young doctors in training find retinal laser photocoagulation a daunting task. However, if correct protocols are followed and checklists are observed, then it is not difficult to have a successful laser sitting with a happy patient. Most of the complications can be avoided with correct settings and techniques. Purpose: To enumerate the basic protocols of retinal laser photocoagulation and provide practical tips including laser settings and checklists for hassle?free laser experience. Synopsis: Laser settings for a pan?retinal photocoagulation (PRP) for proliferative diabetic retinopathy differ from those for a focal laser for macular edema. A fill in PRP is indicated when an active Proliferative diabetic retinopathy (PDR) is seen after the initial PRP is completed. The settings and protocols for laser photocoagulation for lattice degeneration are different, and various techniques of barrage laser are discussed. Practical tips and checklists are given, which will not be found in any textbooks. Highlights: Animated illustrations and fundus photos are used to explain the correct techniques of performing laser photocoagulation in different indications and scenarios. Detailed instructions and checklists are provided, which can be very useful to avoid complications and medicolegal problems. The practical tips and guidelines in an easy?to?understand manner make this video highly educational for the novice retinal surgeons who want to perfect their technique of retinal laser photocoagulation.

Mobilizando a sociedade civil: inovação organizacional e repertórios de confronto no desastre do rio Doce / Mobilizing civil society: organizational innovation and repertoire of contention in the river Doce disaster / Movilización de la sociedad civil: innovación organizacional y repertorio de confrontación en el desastre del río Doce / Mobiliser la société civile: innovation organisationnelle et répertoire de confrontation dans la catastrophe de rio Doce

Analisa as mobilizações sociais no desastre socioambiental do Rio Doce, no bojo de relações conflitivas entre sociedade civil, mercado e Estado. Argumenta que no contexto de desastre emergiram mudanças na ação coletiva que caracterizam processos de inovação organizacional: (a) na emergência de novos ativismos, incremento do associativismo civil e novos formatos organizacionais e; (b) nos repertórios de confronto caracterizados pela combinação entre ação extrainstitucional, ação institucional e tática multiescalar. Argumenta também que as transformações na ação coletiva se vinculam a dois elementos que impulsionam as mobilizações: (a) as restrições políticas e institucionais impostas pelo sistema de governança do desastre à participação e ao reconhecimento das pessoas afetadas; e (b) as organizações preexistentes que desempenharam papel fundamental na mobilização dos atingidos, funcionando como incubadoras para o movimento social contencioso ao agir sobre sua formação organizacional e identitária.

I analyze the social mobilization in the social-environmental disaster of the Doce river, in the context of conflicting relations between civil society, corporations and state. I argue that in the contexto of disaster emerged changes in the collective action that characterizes processes of organizational innovation: (a) in the emergence of new activisms, increase of civil associations and new organizational formats and; (b) in the repertoires of contention characterized by a combination of extra-institutional actions, institutional actions and multi-scale tactic. I also argue that transformations in collective action are linked to two elements that encourage the mobilizations: (a) the political and institutional constraints imposed by the disaster governance system on participation and recognition of affected people; and (b) preexisting organizations which played a fundamental role in mobilizing those affected, functioning as incubators for the contentious social movement by acting in its organizational and identity formation.

En este artículo analizo la movilización social en el desastre social y ambiental en Río Doce, en medio de relaciones conflictivas entre la sociedad civil, el mercado y el estado. Sostiene que en el contexto del desastre cambios en la acción colectiva surgido, que caracteriza los procesos de innovación organizacional: (a) en surgimiento de nuevos activismos, aumento de asociaciones civiles y nuevos formatos organizacionales y; (b) en repertorios de confrontación caracterizados por la combinación de acción extrainstitucional, acción institucional y tácticas multiescala. También argumenta que las transformaciones en la acción colectiva están vinculadas a dos elementos que conducir el movilizaciones: (a) las restricciones políticas e institucionales impuestas por el sistema de gobernanza de desastres sobre la participación y el reconocimiento de las personas afectadas; y (b) las organizaciones preexistentes que desempeñaron un papel clave en la movilización de los afectados, funcionando como incubadoras del movimiento social contencioso actuando en su organización y formación de identidad.

Je analyse les mobilisations sociales dans la catastrophe sociale et environnementale de Rio Doce, dans le contexte de relations conflictuelles entre la société civile, le marché et l'État. Je soutiens que dans le contexte de la catastrophe sont apparus des changements dans l'action collective qui caractérisent les processus d'innovation organisationnelle dans: (a) l'émergence d'un nouvel activisme, le incrémenter des associations civiles et de nouveaux formats organisationnels et; (b) dans les répertoires de confrontation caractérisés par la combinaison d'une action extra-institutionnelle, d'une action institutionnelle et d'une tactique multi-échelles. Je soutiens également que les transformations de l'action collective sont liées à deux éléments qui encouragent la mobilisation: (a) les contraintes politiques et institutionnelles imposées par le système de gouvernance des catastrophes sur la participation et la reconnaissance des personnes affectées; (b) des organisations préexistantes qui ont joué un rôle clé dans la mobilisation des personnes affectées, fonctionnant comme des incubateurs pour du mouvement social contentieux en agissant dans sa formation organisationnelle et identitaire.

Campos de ação estratégica e os recursos de poder do sistema de gestão de recuperação de direitos na bacia do Rio Doce / Strategic fields of action and power resources of the rights recovery management system in the Rio Doce basin / Campos estratégicos de acción y recursos de poder del sistema de gestión de recuperación de derechos en la cuenca del Río Doce / Les champs d'action stratégique et les ressources de puissance du système de gestion du recouvrement des droits dans le bassin du Rio Doce

O rompimento da barragem de Fundão, pertencente às empresas Samarco, BHP Billiton e Vale provocou o maior desastre socioambiental do país. A lama de rejeitos de minérios de percorreu a extensão do Rio Doce até o mar, causando diversos danos ambientais, sociais, econômicos e culturais. Este estudo analisa as estratégias de ação das comunidades atingidas no território capixaba, e as instâncias do sistema de governança do desastre para compreender quais os recursos e interações potencialmente avançam na luta por seus direitos. Em vista disso, o artigo explora aspectos jurídicos do desastre através dos dispositivos extrajudiciais que organizam a gestão da recuperação e reparação dos danos. A teoria dos campos é operacionalizada para compreender o cenário de negociação, estratégias de cooperação, coalização e contestação que foi desencadeado entre os atingidos, autoridades e agentes do mercado. A investigação foi realizada através do estudo de caso, grupos de discussão, e observação participante da tecnologia social Com Rio Com Mar Opinião Popular criada como apoio e suporte aos atingidos, e da atuação da Defensoria Pública do Estado do Espírito Santo.

The breach of the Fundão dam, belonging to Samarco, BHP Billiton and Vale companies, caused the biggest social and environmental disaster in the country. The ore tailings sludge ran the length of the Rio Doce to the sea, causing various environmental, social, economic and cultural damages. This study analyzes the strategies of action of communities affected in the state of Espírito Santo, and the instances of the disaster governance system to understand which resources and interactions potentially advance in the struggle for their rights. In face of the article explores the legal aspects of the disaster through the extrajudicial arrangements that organize the management of recovery and damage repair. Field theory is operationalized to understand the negotiation scenario, cooperation strategies, coalition and contestation that was unleashed among the affected, authorities and market agents. The investigation was conducted through case study, discussion groups, and participant observation of the social technology Com Rio Com Mar Popular Opinion created as support and support to those affected, and the performance of the Public Defender's Office of the State of Espírito Santo.

La ruptura de la presa Fundão, perteneciente a las compañías Samarco, BHP Billiton y Vale, causó el mayor desastre social y ambiental en el país. El lodo de relaves minerales se extendía a lo largo del río Doce hasta el mar, causando varios daños ambientales, sociales, económicos y culturales. Este estudio analiza las estrategias de acción de las comunidades afectadas en el estado de Espírito Santo, y las instancias del sistema de gobernanza de desastres para comprender qué recursos e interacciones potencialmente avanzan en la lucha por sus derechos. En vista de esto, el artículo explora los aspectos legales del desastre a través de los arreglos extrajudiciales que organizan la gestión de la recuperación y reparación de daños. La teoría de campo se operacionaliza para comprender el escenario de negociación, las estrategias de cooperación, la coalición y la contestación que se desató entre los afectados, las autoridades y los agentes del mercado. La investigación se realizó a través de un estudio de caso, grupos de discusión y observación participante de la tecnología social. Opinión popular creada por Com Rio Com Mar como apoyo y apoyo a los afectados, y el desempeño de la Oficina del Defensor Público del Estado de Espírito Santo.

La rupture du barrage de Fundão, appartenant aux entreprises Samarco, BHP Billiton et Vale, a provoqué le plus grand désastre socio-environnemental du pays. La boue de rebuts de minerais a parcouru l'étendue du Rio Doce jusqu'à la mer, causant divers dommages environnementaux, sociaux, économiques et culturels. Cette étude analyse les stratégies d'action des communautés touchées sur le territoire capixaba, et les instances du système de gouvernance du désastre pour comprendre quelles ressources et interactions pourraient progresser dans la lutte pour leurs droits. Cet article explore donc les aspects juridiques de la catastrophe à travers les dispositifs extrajudiciaires qui organisent la gestion de la réparation et de la réparation des dommages. La théorie des champs est mise en place pour comprendre le scénario de négociation, les stratégies de coopération, la coercition et la contestation qui a été déclenchée parmi les touchés, les autorités et les acteurs du marché. La recherche a été réalisée par l'étude de cas, des groupes de discussion, et l'observation participante de la technologie sociale Com Rio Com Mar Opinião Popular créée comme soutien et soutien aux touchés, et de l'action du Défenseur Public de l'Etat de l'Esprit Saint.

Posterior laser barrage in advancing retinopathy of prematurity: A prospective randomized study

Purpose: To compare the outcomes of conventional laser photocoagulation versus additional posterior barrage laser in advanced stage 3 retinopathy of prematurity (ROP). Methods: A total of 20 infants with bilateral symmetric zone 2 stage 3 advancing ROP were treated with conventional laser treatment followed by randomization of one eye to receive additional posterior retinal laser treatment. Disc–fovea and inter-arcade distance was measured. The patients were followed up prospectively for 3 months. Structural and functional outcomes and safety profile were analyzed. Results: 18/20 (90%) eyes in the study group and 19/20 (95%) eyes in the control group achieved regression of disease. Faster and complete regression was observed at 4 weeks after posterior laser compared to the control group (P = 0.024). Disc–fovea and inter-arcade distance was comparable in both groups. Conclusion: Additional posterior barrage laser is a safe technique that led to faster and more complete regression in eyes with advancing ROP. Final regression profile was comparable in both treatment modalities.

Experience with the Pascal® photocoagulator: An analysis of over 1200 laser procedures with regard to parameter refinement.

Aim: To systematically refine and recommend parameter settings of spot size, power, and treatment duration using the Pascal® photocoagulator, a multi-spot, semi-automated, short-duration laser system. Materials and Methods: A retrospective consecutive series with 752 Caucasian eyes and 1242 laser procedures over two years were grouped into, (1) 374 macular focal / grid photocoagulation (FP), (2), 666 panretinal photocoagulation (PRP), and (3) 202 barrage photocoagulation (BP). Parameters for power, duration, spot number, and spot size were recorded for every group. Results: Power parameters for all groups showed a non-gaussian distribution; FP group, median 190 mW, range 100 – 950 mW, and PRP group, median 800 mW, range 100 – 2000 mW. On subgroup comparison, for similar spot size, as treatment duration decreased, the power required increased, albeit in a much lesser proportion than that given by energy = power × time. Most frequently used patterns were single spot (89% of cases) in FP, 5 × 5 box (72%) in PRP, and 2 × 2 box (78%) in BP. Spot diameters as high as ≈ 700 μm on retina were given in the PRP group. Single session PRP was attempted in six eyes with a median spot count of 3500. Conclusion: Overall, due to the small duration of its pulse, the Pascal® photocoagulator tends to use higher powers, although much lower cumulative energies, than those used in a conventional laser. The consequent lesser heat dissipation, especially lateral, can allow one to use relatively larger spot sizes and give more closely spaced burns, without incurring significant side effects.