Retinocoroiditis toxoplásmica y la evolución del resultado visual en pacientes inmunocompetentes / Toxoplasmic retinochoroiditis and the evolution of visual results in immunocompetent patients

Objetivo: Determinar la evolución del resultado visual en pacientes con toxoplasmosis ocular activa. Métodos: Se realizó un estudio observacional prospectivo longitudinal en 101 pacientes inmunocompetentes con toxoplasmosis ocular activa, atendidos en la consulta de Uveítis del Hospital General Docente "Abel Santamaría", desde enero de 2012 a diciembre de 2018. Se evaluaron las variables localización de la lesión, tamaño, número, episodio, grado de inflamación, complicaciones, recurrencia postratamiento y mejor agudeza visual corregida. Se analizaron los resultados utilizando frecuencias absolutas y relativas, la asociación estadística chi cuadrado, las pruebas U Mann-Whitney o Kruskall Wallis, Friedman y de rangos con signos de Wilcoxon. Resultados: Según la localización de la lesión, los resultados visuales inferiores se presentaron en los pacientes con lesiones en zona I y los mejores se obtuvieron cuando hubo afectación en zona III. Se mostró una mejor evolución del resultado visual en los que tuvieron lesiones menores o iguales a un diámetro papilar. Existió diferencia estadística entre los diferentes grados de gravedad de la inflamación, con tendencia al incremento de la mejor agudeza visual corregida en el tiempo, después del tratamiento. Conclusiones: Durante la evolución de los pacientes inmunocompetentes con toxoplasmosis ocular activa se logra mejoría de la visión(AU)

Objective: Determine the evolution of visual results in patients with active ocular toxoplasmosis. Methods: An observational longitudinal prospective study was conducted of 101 immunocompetent patients with active ocular toxoplasmosis attending the Uveitis Service at Abel Santamaría General University Hospital from January 2012 to December 2018. The variables evaluated were injury location, size, number, episode, degree of inflammation, complications, post-treatment recurrence and best corrected visual acuity. Results were analyzed with absolute and relative frequencies, chi-square statistical association, the Mann-Whitney U or Kruskall Wallis tests, the Friedman test and the Wilcoxon signed-rank test. Results: According to injury location, the lowest visual results were obtained in patients with zone I lesions, whereas the best results corresponded to zone III lesions. A better visual result evolution was achieved in patients with lesions smaller than or equal to a papillary diameter. A statistical difference was found between the various degrees of inflammation severity, with a tendency to an increase in best corrected visual acuity with the passing of time after treatment. Conclusions: Visual improvement is achieved during the evolution of immunocompetent patients with active ocular toxoplasmosis(AU)

Retinal arterial obstruction: The etiology and visual result.

A series of 17 consecutive patients with central retinal artery obstruction (CRAO; 15 patients, 16 eyes) and branch retinal arterial obstruction (BRAO, two patients) were studied at Siriraj Hospital between January 1994 and June 1997 with respect to cause, associated factors and visual result. The study group compressed 13 men and four women with a mean age of 48 years. Hyperlipidemia was the most common underlying disorder in those patients aged less than 45 years. Retinal emboli and increased intraocular pressure were identified as the ocular in three patients. The visual result improved in four patients, two each of whom had interval times from onset to treatment of less than six hours and more than 48 hours. No light perception vision at the initial examination occurred in 3 patients and none had improved vision.

Terson's Syndrome in Aneurysmal Subarachnoid Hemorrhage

Terson's syndrome is the oculocerebral syndrome of retinal and vitreous hemorrhage associated with spontaneous subarachnoid hemorrhage(SAH) or all forms of intracranial bleeding. Recent observations indicate that the patients with spontaneous subarachnoid hemorrhage have an 18% to 20% concurrent incidence of retinal and vitreous hemorrhages and about 4% incidence of viterous hemorrhage alone. Therefore, clinical ophthalmologic findings may have a significant diagnostic and prognostic value for the clinician. Total of 627 consecutive patients with aneurysmal subarachnoid hemorrhage were retrospectively studied by means of indirect fundoscopy to address the question of occur and prognostic implications of vitreous hemorrhage after subarachnoid hemorrhage from January 1993 to December 1996. Among these, we experienced 21 patients with vitreous hemorrhage(Terson's syndrome). The patients with vitreous hemorrhage commonly occurred in anterior communicating and internal carotid artery aneurysm. Twelve patients had intraocular hemorrhage within 48 hours after SAH. There were bilateral involvement in 15 cases, and the 14 experienced complete recovery of vision following massive intravitreal hemorrhage. A favorable surgical outcome was obtained in 14 of 21 patients(66.7%) and a satisfactory result in vision was achieved in 15 cases among 17 survivors(88.2%). From these results, we emphasize the significance of ocular findings in patients with aneurysmal subarachnoid hemorrhage.

Clinical Study on Rhegmatogenous Retinal Detachment Treated with Scleral Buckling

One hundred sixteen eyes with rhegmatogenous retinal detachment were treated with a scleral buckling procedure which consisted of silicone sponge or silicone band explants, cryotherapy, drainage of subretinal fluid, and other procedures. In 100(86.2%) of these eyes, anatomic reattachment was successful after one operation. Reattachment was not initially successful in 16 eyes. These failures generally resulted from proliferative vitreoretinopathy, diffuse and multiple lattice degeneration, and buckle malposition. Final success was achieved in 113(97.4%) of the 116 eyes. Overall, 49(42.2%) of the 116 eyes had a favorable functional visual result, which we defined as a final visual acuity of 0.3 or better. In this study we found no statistical relationship between age and postoperative visual outcome. But there was significant correlation between a favorable functional visual result and the location of retinal hole, the duration of retinal detachment(p<.05).

Radial keratotomy in high myopia

The visual, refractive, and keratometric results of radial keratotomies (RK) in 10 high myopic eyes of over 10 diopters(D) were evaluated. The mean follow-up period was 6.7 months with a range of 3 to 12 months. Before surgery, the mean spherical equivalent(SE) was -16.8 D and the postoperative mean change in SE was 7.9 D. In all cases postoperative uncorrected visual acuity and corrected visual acuity with tolerable glasses were improved. In 4 of the cases, best-corrected visual acuity was improved as well. RK appears to be a safe and effective procedure for eyes with high myopia of over 10 D to achieve better corrected visual acuity than with corrective lenses as well as for eyes with moderate myopia to be closer to emmetropia.