RESUMO
To evaluate the success rate of Nd:YAG laser membranotomy in patients with diabetic premacular hemorrhage. This interventional case series included 24 eyes of 22 patients referred to retina clinic of Farabi Eye Hospital, Tehran, Iran during 2000-2007 with chief complaint of sudden loss of vision and clinical diagnosis of premacular hemorrhage due to proliferative diabetic retinopathy. All patients underwent complete ocular examination and color fundus photography. Nd:YAG laser membranotomy was performed in patients with >3 DD hemorrhage. Main outcome measures were success rate of membranotomy, improvement of visual acuity and the complications. Twenty-four eyes of 22 patients [68.2% female and 31.8% male] with diabetic premacular hemorrhage were enrolled. Mean age of patients was 56 +/- 6.5 years. Nd:YAG laser membranotomy was successful in 71% of patients resulting in release of trapped blood into the vitreous cavity which absorbed during 14.3 +/- 5.03 [range 8 to 27] days. Range of preoperative visual acuity was from hand motion to count finger at 4 m which improved to a range of 20/100 to 20/25 postoperatively. Patients complained of some visual disorders such as blurred vision and floater over 23-86 days [mean 43 days], postoperatively. Macular photocoagulation was performed in 11 eyes with macular edema before panretinal photocoagulation. Mean follow-up period was 34.7 +/- 18.3 [range 10-71] months. Nd:YAG laser membranotomy in diabetic premacular hemorrhage is a simple and inexpensive outpatient procedure which results in rapid visual recovery and is relatively safe. Further controlled clinical trials are recommended
RESUMO
To determine if intravitreal injection of triamcinolone acetonide is safe and effective in the treatment of diabetic macular edema unresponsive to prior laser photocoagulation. Fifty-four eyes of 38 patients with clinically significant macular edema which had received at least two sessions of laser photocoagulation according to Early Treatment Diabetic Retinopathy Study guidelines were enrolled in this study. At least four months after laser therapy; eyes with residual central macular thickness [CMT] greater than 250 microm on optical coherence tomography [OCT] and visual loss from baseline were offered intravitreal injection of 4 mg triamcinolone acetonide. Visual and anatomic responses as well as complications related to the injection procedure and corticosteroid medication were observed. Mean baseline best corrected visual acuity [BCVA] and CMT were 0.77 +/- 0.5 LogMAR and 443 +/- 138 microm, respectively. All patients completed one month of follow up and 39 of 54 eyes [72.2%] completed 6 months of follow up. Mean BCVA was 0.64 +/- 0.45, 0.56 +/- 0.48, and 0.79 +/- 0.55 LogMAR at months 1, 3, and 6, respectively. Central macular thickness measured by OCT decreased by 39% and 23.5%, at the third and sixth month visits, respectively. Intraocular pressure exceeded 21 mmHg in 36.3% of the eyes. Cataract progression was noted in 12.8% of phakic eyes. Intravitreal triamcinolone seems a promising therapeutic method for diabetic macular edema refractory to conventional laser photocoagulation without any significant complication, however the effect seems to be temporary. Further studies are warranted to assess the long-term efficacy and safety and also the need for retreatment
RESUMO
To evaluate the effect of intravitreal triamcinolone acetonide injection for management of chronic refractory uveitis in terms of inflammation, visual acuity and macular thickness. This interventional case series was conducted on uveitic eyes with no remission despite proper administration of periocular and/or systemic steroids. After systemic and rheumatologic evaluations and confirmation of non-infectious nature of uveitis, 18 eyes of 10 patients underwent intravitreal injection of 4 mg triamcinolone acetonide. Changes in intraocular inflammation, bestcorrected visual acuity [BCVA], intraocular pressure [IOP] and macular thickness on optical coherence tomography were assessed during six months of follow-up. Mean BCVA increased from a baseline value of 0.81 +/- 0.29 to 0.35 +/- 0.33 LogMAR one week and to 0.17 +/- 0.07 LogMAR one month after the injection, respectively [P<0.001]. It decreased thereafter to 0.46 +/- 0.3 LogMAR at the sixth month visit, but was still significantly greater than the baseline value [P<0.001]. Mean IOP reached its maximum level one month post-injection with an increase of 7.36 +/- 0.48 mmHg compared to the baseline value, however only two eyes had IOP>22 mmHg which were successfully controlled using topical IOP-lowering medication. Mean central macular thickness decreased from 339.8 +/- 24.1 microm to its minimum value [197.18 +/- 12.7 microm] one month after the injection [P<0.001] and then increased to 203.57 +/- 9.06 microm at sixth month visit, still less than the baseline value [P< 0.001]. Intravitreal injection of triamcinolone acetonide in chronic refractory uveitis improves visual acuity and decreases central macular thickness which is sustained for at least six months. The only noticeable complication, transient IOP elevation can be controlled with topical medications
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The authors report a case of lombar Potts disease in an 8-month baby. The diagnosis was based on clinical arguments; tuberculosis contamination, painful rachidian stiffness on exam, biological arguments; inflammatory syndrome and positive cuti-test and radiological arguments; anterior vertebral destruction and infiltration of psoas muscle. The baby was medically treated by the association of Isoniasid, Rifampicine and Ethambutol with a good evolution
RESUMO
[Invasive fibroma of the limbs in childhood] Six cases of invasive fibromata have been observed in children of various age. The symptoms are described and were found seldom to be typical. Treatment should always be surgical. Recurrence is frequent despite extensive resection