Implementation feasibility of animal-assisted therapy in a pediatric intensive care unit: effectiveness on reduction of pain, fear, and anxiety.

Animal-assisted therapies are an innovative strategy within health care humanization initiatives, and they could play a role in the reduction of pain or anxiety. The main objective of this work was to evaluate the feasibility of implementing animal-assisted therapy in a pediatric intensive care unit and its effectiveness for the reduction of pain, fear, and anxiety. A prospective, quasi-experimental study of animal-assisted therapy was designed in the pediatric intensive care unit of the Hospital Universitario 12 de Octubre of Madrid, from January 2019 to December 2019. The study sample included patients who had been admitted to the unit and were over 3 years old. Satisfaction surveys were collected from the patients, family, and health personnel involved. Physiological variables and the level of pain (visual analog scale or Wong-Baker scale), fear (Child Medical Fear Scale), and anxiety (modified Yale Preoperatory Anxiety Scale) were evaluated before and after each session. Any existence of adverse events was recorded. A total of 74 therapy sessions were performed on 61 patients. All sessions were completed without any adverse effects. A total of 164 surveys were collected, providing an overall project rating of 9.69 out of a possible 10. The survey comments were found to be positive in most cases. No differences were found in the physiological variables measured before and after each session. There was a statistically significant decrease in pain, fear, and anxiety levels (p < 0.01).   Conclusion: The implementation of an animal-assisted therapy project in a pediatric intensive care unit is feasible and safe and has a high degree of acceptance among both participants and healthcare staff. Animal-assisted therapy is effective for the reduction of pain, fear, and anxiety, and therefore, it could be considered an adjunct to non-pharmacological therapy. What is Known: • Animal assisted therapies (AAT) are an innovative strategy that could be beneficial to help pediatrics patients cope with admission difficulties and could even play a role in reducing pain, anxiety and/or delirium. • To date there are not studies to analyze the effectiveness of AAT in the field of Pediatric Intesive Care. What is New: • Our study confirms the feasibility and effectiveness of the implementation of an AAT in the field of Pediatric Intensive Care with a high degree of acceptance by participants, caregivers and healthcare personnel. • AAT demonstrated a reduction in pain, fear and anxiety in pediatrics patients admitted to Pediatric Intensive Care Unit.

Retinal Detachment Associated With Giant Retinal Tears: Surgical Management and Outcomes in the Past 2 Decades.

Purpose: To describe the surgical outcomes of rhegmatogenous retinal detachments (RRDs) associated with giant retinal tears (GRTs) and define factors associated with primary anatomic failure. Methods: This retrospective consecutive study comprised primary GRT-RRD surgeries between 1999 and 2021 at a single institution. Exclusion criteria were a follow-up of less than 3 months and incomplete surgical data. Results: The series included 69 eyes (64 patients). Single-surgery anatomic success (SSAS) was achieved in 75% and final anatomic success (FAS) in 90%. The mean logMAR visual acuity improved from 1.5 ± 1.1 to 0.6 ± 0.9. Preoperative factors significantly associated with redetachment were proliferative vitreoretinopathy (PVR) (odds ratio [OR], 6.2; P < .01), hypotony (OR, 13.6; P < .01), and a 180-degree or larger GRT (OR, 3.3; P = .04). All cases were treated with pars plana vitrectomy (PPV) and perfluoro-N-octane (PFCL). Perfluoropropane (C3F8) was used in 59% and silicone oil in 41%; the redetachment rate was significantly lower in gas cases (15% vs 39%) (P = .02). An encircling band, placed in 84% eyes, had a tendency to reduce redetachment (22% vs 36%) (P = .32). Lensectomy was performed in 61% of phakic eyes, with no effect on redetachment (20% vs 21%) (P = .92). On multivariate analysis, PVR and hypotony were significantly associated with redetachment. Conclusions: PPV with PFCL achieved high SSAS and FAS rates. PVR and hypotony were the main preoperative factors associated with anatomic failure. In cases without PVR, C3F8 tamponade significantly increased SSAS. Encircling scleral buckling showed a nonsignificant tendency toward an increase in SSAS. Lensectomy had no effect on SSAS.

Digitalization and real-time control to mitigate environmental impacts along rivers: Focus on artificial barriers, hydropower systems and European priorities.

Hydropower globally represents the main source of renewable energy, and provides several benefits, e.g., water storage and flexibility; on the other hand, it may cause significant impacts on the environment. Hence sustainable hydropower needs to achieve a balance between electricity generation, impacts on ecosystems and benefits on society, supporting the achievement of the Green Deal targets. The implementation of digital, information, communication and control (DICC) technologies is emerging as an effective strategy to support such a trade-off, especially in the European Union (EU), fostering both the green and the digital transitions. In this study, we show how DICC can foster the environmental integration of hydropower into the Earth spheres, with focus on the hydrosphere (e.g., on water quality and quantity, hydropeaking mitigation, environmental flow control), biosphere (e.g., improvement of riparian vegetation, fish habitat and migration), atmosphere (reduction of methane emissions and evaporation from reservoirs), lithosphere (better sediment management, reduction of seepages), and on the anthroposphere (e.g., reduction of pollution associated to combined sewer overflows, chemicals, plastics and microplastics). With reference to the abovementioned Earth spheres, the main DICC applications, case studies, challenges, Technology Readiness Level (TRL), benefits and limitations, and transversal benefits for energy generation and predictive Operation and Maintenance (O&M), are discussed. The priorities for the European Union are highlighted. Although the paper focuses primarly on hydropower, analogous considerations are valid for any artificial barrier, water reservoir and civil structure which interferes with freshwater systems.

[Admission, discharge and triage guidelines for paediatric intensive care units in Spain]. / Guias de ingreso, alta y triage para las unidades de cuidados intensivos pediátricos en España.

A paediatric intensive care unit (PICU) is a separate physical facility or unit specifically designed for the treatment of paediatric patients who, because of the severity of illness or other life-threatening conditions, require comprehensive and continuous inten-sive care by a medical team with special skills in paediatric intensive care medicine. Timely and personal intervention in intensive care reduces mortality, reduces length of stay, and decreases cost of care. With the aim of defending the right of the child to receive the highest attainable standard of health and the facilities for the treatment of illness and rehabilitation, as well as ensuring the quality of care and the safety of critically ill paediatric patients, the Spanish Association of Paediatrics (AEP), Spanish Society of Paediatric Intensive Care (SECIP) and Spanish Society of Critical Care (SEMICYUC) have approved the guidelines for the admission, discharge and triage for Spanish PICUs. By using these guidelines, the performance of Spanish paediatric intensive care units can be optimised and paediatric patients can receive the appropriate level of care for their clinical condition.

Guias de ingreso, alta y triage para las unidades de cuidados intensivos pediátricos en España / Admission, discharge and triage guidelines for paediatric intensive care units in Spain

La unidad de cuidados intensivos pediátricos (UCIP) es una unidad física asistencial hospitalaria independiente especialmente diseñada para el tratamiento de pacientes pediátricos quienes debido su gravedad o condiciones potencialmente letales requieren observación y asistencia médica intensiva integral y continua por un equipo médico que haya obtenido competencia especial en medicina intensiva pediátrica. La aplicación oportuna de terapia intensiva a los pacientes críticos reduce la mortalidad, el tiempo de estancia y los costes asistenciales. Con los objetivos de respetar el derecho del niño al disfrute del más alto nivel posible de salud y a servicios para el tratamiento de las enfermedades y la rehabilitación de la salud y de garantizar la calidad asistencial y la seguridad de los pacientes pediátricos críticos, la Asociación Española de Pediatría (AEP), la Sociedad Española de Cuidados Intensivos Pediátricos (SECIP) y la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC) han desarrollado y aprobado las guías de ingreso, alta y triage para las UCIP en España. Mediante la aplicación de estas guías se puede optimizar el uso de las UCIP españolas de forma que los pacientes pediátricos reciban el nivel de cuidados médicos más apropiado para su situación clínica

A paediatric intensive care unit (PICU) is a separate physical facility or unit specifically designed for the treatment of paediatric patients who, because of the severity of illness or other life-threatening conditions, require comprehensive and continuous inten-sive care by a medical team with special skills in paediatric intensive care medicine. Timely and personal intervention in intensive care reduces mortality, reduces length of stay, and decreases cost of care. With the aim of defending the right of the child to receive the highest attainable standard of health and the facilities for the treatment of illness and rehabilitation, as well as ensuring the quality of care and the safety of critically ill paediatric patients, the Spanish Association of Paediatrics (AEP), Spanish Society of Paediatric Intensive Care (SECIP) and Spanish Society of Critical Care (SEMICYUC) have approved the guidelines for the admission, discharge and triage for Spanish PICUs. By using these guidelines, the performance of Spanish paediatric intensive care units can be optimised and paediatric patients can receive the appropriate level of care for their clinical condition

Guías de ingreso, alta y triage para las unidades de cuidados intensivos pediátricos en España / Admission, discharge and triage guidelines for paediatric intensive care units in Spain

La unidad de cuidados intensivos pediátricos (UCIP) es una unidad física asistencial hospitalaria independiente especialmente diseñada para el tratamiento de pacientes pediátricos quienes debido su gravedad o condiciones potencialmente letales requieren observación y asistencia médica intensiva integral y continua por un equipo médico que haya obtenido competencia especial en medicina intensiva pediátrica. La aplicación oportuna de terapia intensiva a los pacientes críticos reduce la mortalidad, el tiempo de estancia y los costes asistenciales. Con los objetivos de respetar el derecho del niño al disfrute del más alto nivel posible de salud y a servicios para el tratamiento de las enfermedades y la rehabilitación de la salud y de garantizar la calidad asistencial y la seguridad de los pacientes pediátricos críticos, la Asociación Española de Pediatría (AEP), la Sociedad Española de Cuidados Intensivos Pediátricos (SECIP) y la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC) han desarrollado y aprobado las guías de ingreso, alta y triage para las UCIP en España. Mediante la aplicación de estas guías se puede optimizar el uso de las UCIP españolas de forma que los pacientes pediátricos reciban el nivel de cuidados médicos más apropiado para su situación clínica

A paediatric intensive care unit (PICU) is a separate physical facility or unit specifically designed for the treatment of paediatric patients who, because of the severity of illness or other life-threatening conditions, require comprehensive and continuous intensive care by a medical team with special skills in paediatric intensive care medicine. Timely and personal intervention in intensive care reduces mortality, reduces length of stay, and decreases cost of care. With the aim of defending the right of the child to receive the highest attainable standard of health and the facilities for the treatment of illness and rehabilitation, as well as ensuring the quality of care and the safety of critically ill paediatric patients, the Spanish Association of Paediatrics (AEP), Spanish Society of Paediatric Intensive Care (SECIP) and Spanish Society of Critical Care (SEMICYUC) have approved the guidelines for the admission, discharge and triage for Spanish PICUs. By using these guidelines, the performance of Spanish paediatric intensive care units can be optimised and paediatric patients can receive the appropriate level of care for their clinical condition

Admission, discharge and triage guidelines for paediatric intensive care units in Spain. / Guias de ingreso, alta y triage para las unidades de cuidados intensivos pediátricos en España.

A paediatric intensive care unit (PICU) is a separate physical facility or unit specifically designed for the treatment of paediatric patients who, because of the severity of illness or other life-threatening conditions, require comprehensive and continuous inten-sive care by a medical team with special skills in paediatric intensive care medicine. Timely and personal intervention in intensive care reduces mortality, reduces length of stay, and decreases cost of care. With the aim of defending the right of the child to receive the highest attainable standard of health and the facilities for the treatment of illness and rehabilitation, as well as ensuring the quality of care and the safety of critically ill paediatric patients, the Spanish Association of Paediatrics (AEP), Spanish Society of Paediatric Intensive Care (SECIP) and Spanish Society of Critical Care (SEMICYUC) have approved the guidelines for the admission, discharge and triage for Spanish PICUs. By using these guidelines, the performance of Spanish paediatric intensive care units can be optimised and paediatric patients can receive the appropriate level of care for their clinical condition.

Tejido tiroideo ectópico en mama / Ectopic thyroid tissue in the breast

No disponible

Stability analysis of a run-of-river diversion hydropower plant with surge tank and spillway in the head pond.

Run-of-river hydropower plants usually lack significant storage capacity; therefore, the more adequate control strategy would consist of keeping a constant water level at the intake pond in order to harness the maximum amount of energy from the river flow or to reduce the surface flooded in the head pond. In this paper, a standard PI control system of a run-of-river diversion hydropower plant with surge tank and a spillway in the head pond that evacuates part of the river flow plant is studied. A stability analysis based on the Routh-Hurwitz criterion is carried out and a practical criterion for tuning the gains of the PI controller is proposed. Conclusions about the head pond and surge tank areas are drawn from the stability analysis. Finally, this criterion is applied to a real hydropower plant in design state; the importance of considering the spillway dimensions and turbine characteristic curves for adequate tuning of the controller gains is highlighted.

Cuidados al final de la vida en la unidad de cuidados intensivos pediátricos. Empleo de técnicas de investigación cualitativa para el análisis del afrontamiento de la muerte y situaciones críticas / End-of-life care in the pediatric intensive care unit. Use of qualitative research techniques for analyzing coping with death and critical situations

Fundamento: En la última década, se aprecia un creciente interés por los aspectos más humanos de la enfermedad que se traduce en un acercamiento a la familia y a su sufrimiento. Objetivo: Conocer en profundidad la experiencia de los profesionales y de los padres de niños ingresados en la unidad de cuidados intensivos pediátricos (UCIP). Material y métodos: Se organizaron grupos focales (GF) de padres de hijos fallecidos o con secuelas graves ingresados en la UCIP los años 1999-2002. Asimismo, se desarrollaron reuniones de GF de profesionales. Se revisó desde el ingreso hasta la muerte y el seguimiento del duelo. Se recogieron las inquietudes y las necesidades expresadas por el personal sanitario. Resultados: Se contactó con 133 familias (40% de hijos fallecidos y 60% de hijos con secuelas), de los que acudieron un 75% y un 44%, respectivamente. Las madres acudieron más (61%) en el caso de fallecidos, y las parejas (51%), en el caso de niños con secuelas. Asimismo, se organizaron GF con 22 personas (5 médicos, 11 enfermeras y 5 auxiliares de enfermería). Se recogieron los principales problemas, discrepancias y soluciones. Se instauraron medidas de mejora acordes con la información recibida. Conclusiones: La aplicación de GF ha permitido el acercamiento a las necesidades y problemas más importantes de los padres de niños que ingresan en la UCIP, así como de los profesionales. Esta información ha facilitado la implantación de medidas de mejora de una forma realista y ajustada a estas necesidades

Background: In the last 10 years, there has been increasing concern for a more human approach to illness, which has led to a better understanding of families and their suffering. Objective: To gain greater insight into the experience of the parents of children admitted to the PICU and of the health workers in these units. Material and methods: Focus groups (FG) composed of parents with children who had died or who were having serious sequels were organized in the PICU from 1999-2002. Likewise, FG meetings with health professionals were set up. The period from admission to death and support for grieving families were reviewed. At the same time, the concerns and needs mentioned by health professionals were collected. Results: A total of 133 families were contacted by surface mail (40% had children who had died and 60% had children with sequels who survived); of these, 75% of the families in the first group and 44% of those in the second group attended the FG. Attendance by mothers (61%) was more frequent in the case of death, and attendance by couples (51%) was more frequent in children with sequels. Focus groups were organized with 22 health professionals (five physicians, 11 nurses and five nurses' aids). The main problems, discrepancies and solutions identified by the distinct groups were recorded. Improvement measures were implemented according to the available information. Conclusions: The use of FG allowed us to approach to the most important needs and problems of parents with children admitted to the PICU, as well as those of the heath workers in the unit. This information allowed improvement measures adjusted to these needs to be implemented in a realistic manner

[Emergent pneumococcus primary peritonitis in children: presentation of two cases]. / Serie de casos: emergencia de peritonitis bacteriana espontanea asociada a neumococo.

INTRODUCTION: Primary peritonitis is rare condition in children previously healthy. It is often related to cirrosis and kidney disease or peritoneal dyalisis. The diagnosis must be made at laparotomy in the absence of intraabdominal findings and positive cultures of peritoneal fluids. MATERIALS AND METHODS: Two cases were studied. Both cases were diagnosed during surgery and had positive cultures for streptococcus pneumaniae, recovery was rapid with broad-spectrum antibiotic therapy in peritonitis caused by gram positives cocos. CONCLUSION: Recent reports indicate an increase of primary peritonitis caused by gram negative organims specially by neumococo. It seems to be a rising of the pathology since the massive antineumococcical vaccinacion. The prognosis has improved with the correct therapy but its incidence appears unvarying.

Características clínicas y respuestas al tratamiento sistémico de la epiescleritis y escleritis primarias y secundarias, refractarias al tratamiento local / Clinical feactures and response to systemic treatment in episcleritis and scleritis resistent to local treatment

Background: Scleritis and episcleritis may extend to adjacent ocular tissues with blinding consequences and may be associated with potentially lethal systemic disorders. Aim: To evaluate the ocular complications and systemic disease associations of the different types of scleritis and episcleritis. Patients and methods: Forty six patients with refractory scleritis and episcleritis were studied and treated during the period 1991 to 1998. Results: Necrotizing type was the most common and severe category in the scleritis group of patients. A decrease in vision occurred in 58.3 percent of patients with scleritis v/s a 23.5 percent of patients with epiescleritis (p<0,05). Uveitis was present in 35.4 percent of patients with scleritis and scleromalacia was present in 33.3 percent (p<0,05). A specific disease association was uncovered in 51 percent of scleritis and in 38 percent of episcleritis patients. Rheumatoid arthritis, primary systemic vasculitic disease and Sjsgren syndrome with vasculitis were the most common associated systemic diseases. Three patients with scleritis had tuberculosis. Conclusions: Scleritis is more severe than episcleritis, and necrotizing scleritis is the most severe type of scleritis. Classification of scleritis and episcleritis provides valuable prognostic information. A meticulous approach for the detection of a specific associated disease must be undertaken. Scleritis associated with vasculitis has a worse ocular prognosis than other non infectious diseases. Cyclophosphamide is the most effective inmunosuppresive treatment to control severe ocular involvement

Estudio clínico en retinitis por citomegalovirus / Clinical study in cytomegalovirus retinitis

Objetivo: Estudiar un grupo de pacientes con SIDA (Síndrome Inmunodeficiencia Adquirida) y retinitis por CMV (citomegalovirus) atendidos en nuestro país, conocer sus características epidemiológicas y el acceso a tratamiento antiviral. Material y Método: Estudio retrospectivo de 21 pacientes (38 ojos) con SIDA y retinitis por CMV evaluados durante los años 1991 al año 2000 en la consulta privada y en el Hospital Clínico de la Universidad de Chile. Se revisaron la ficha clínica y las fotografías del fondo de ojo. Resultados: Todos los pacientes eran de sexo masculino. El seguimiento fue de 2,2 años. La retinitis de tipo granular fue la forma clínica más frecuente al fondo de ojo (65 por ciento). El 57 por ciento de los casos el daño fue unilateral. La agudeza visual en aquellos ojos que debutaron como bilaterales o unilaterales (30 ojos) fue mejor o igual de 20/40 en 16 pacientes (57 por ciento), entre 20/40 y 20/200 en pacientes (11 por ciento) y menor de 20/200 en 9 pacientes (32 por ciento). Sólo ocho de nuestros pacientes utilizaron tratamiento antirretroviral altamente activo con inhibidores de proteasas (HAART). El tratamiento contra retinitis por CMV fue adecuado en 13 pacientes (25 ojos) e inadecuado en 8 pacientes (11 ojos). El 80 por ciento de los ojos que recibieron un tratamiento adecuado contra CMV presentaban inactividad retinal y el resto presentaban retinitis activa. Más del 70 por ciento de los pacientes que usaron terapia HAART y un tratamiento adecuado contra CMV lograron agudeza visual mayor de 20/200. El 60 por ciento de los pacientes que no recibió tratamiento contra CMV llegó a la ceguera por un daño extenso de la retina. La complicación más importante fue la reactivación de la retinitis (25 por ciento) y el desprendimiento de retina (16,6 por ciento). Conclusiones. Una de las formas de tratamiento más ventajosas y efectivas en pacientes con SIDA y retinitis por CMV es el uso de Ganciclovir intravítreo semanal asociado a Ganciclovir oral, más terapia HAART. El tratamiento oportuno y agresivo logra controlar la infección por CMV en la mayoría de los pacientes: sin embargo, la dificultad en el acceso a los antivirales en nuestro medio determina un peor pronóstico visual en pacientes con una retinitis activa por CMV

Macroaneurismas retinales adquirido: estudio retrospectivo / Acquired retinal macroaneurisms: retrospective study

Se estudian en forma retrospectiva 22 ojos de 21 pacientes con el diagnóstico de macroaneurismas retinales adquiridos, evaluados en el Servicio Oftalmología del Hospitalclínico de la U. de Chile, en la Fundación Oftalmológica Los Andes y e la práctica privada de los autores. El objetivo de este trabajo fue definir las características clínicas de los pacientes con esta con fotocoagulación con láser argón y el resultado de otro grupo no tratado. Se estudiaron 22 ojos de 21 pacientes con macroaneurisma retinales, de los cuales 13 pacientes fueron sometidos a tratamiento con láser argón y 8 fueron observados. En los resultados se encuentra que la patología se presenta de predominio en mujeres mayores de 65 años, con hipertensión arterial asociada y que consultan por baja de visión o un escotoma central. Se encuentra una agudeza visual promedio de 0,15 (Snellen) del ojo afectado v/s 0.22 (Snellen) del ojo contralateral (t test p<0.05). Al fondo de ojo el macroaneurisma predominal en el O1 en 13 casos (62 por ciento), es visible en 11 casos (50 por ciento) en el primer examen, es predominante único en 20 casos (91 por ciento) y se ubica preferentemente en la rama temporal superior en 13 casos (62 por ciento). Encontramos 2 formas clínicas de presentación del macroaneurisma: una asociada a edema macular y exudación lipídica, y la otra asociada a hemorragia prerretinal, intrarretinal, subretinal o hemorragia vítrea. La angiofluoresceinografía nos muestra el macroaneurisma en 12 casos (57 por ciento), y nos ayuda al diagnóstico en 6 casos (28 por ciento) sin diagnóstico claro inicial. existen 5 casos (22 por ciento) en que el diagnóstico se hace en forma tardía, por que se presentan con una complicación hemorrágica y luego el macroaneurisma finalmente se hace visible al desaparecer la hemorragia. Se dispone el seguimiento en 16 casos (77 por ciento), y se observa que los ojos que presentan complicaciones hemorrágicas mejoran la agudeza visual, mientras que aquellos que se asocian a edema maculary exudación lipídica mantienen igual su agudeza visual. Trece casos (62 por ciento) fueron tratados con láser argón, y estos ojos finalmente mantuvieron igual visión. En nuestro estudio el resultado visual final más bien se asocia a la presencia o no edema macular o hemorragia en el examen inicial, y no al tratamiento con láser argón. El tratamiento con láser argón se sugiere solamente en caso con edema macular

Necrosis retinal aguda: resultados de tratamiento / Acute retinal necrosis: treatment results

Se estudian 17 ojos de 13 pacientes con el diagnóstico de necrosis retinal aguda evaluados en el Hospital Clínico de la Universidad de Chile y en la Fundación Oftalmológica Los Andes con el propósito de evaluar las características clínicas y los resultados del tratamiento con fotocoagulación láser. Todos los pacientes eran inmunocompetentes, con edad promedio de 33 años, siendo la necrosis bilateral en el 39,8 por ciento. Se dividen los pacientes en grupo I, quienes presentaban enfermedad avanzada y/o desprendimiento de retina al momento del diagnóstico, y en grupo II a los cuales se les realizó el diagnóstico de forma relativamente precoz y recibieron tratamiento adecuado con aciclovir endovenoso y láser profiláctico. El desprendimiento de retina se presentó en todos los pacientes no tratados con láser y en el 20 por ciento de los tratados. Cinco pacientes con desprendimiento retinal y vitreorretinopatía proliferativa fueron manejados con vitrectomía con gas o aceite de silicona. La retina quedó aplicada en todos ellos pero sólo uno conservó visión útil. Los resultados visuales se relacionaron con la precocidad del diagnóstico, el tratamiento médico oportuno y el empleo de láser profiláctico

Vitreorretinopatía familiar exudativa / Familial exudative vitreo-retinopathy

Se estudiaron cuatro pacientes varones con vitreorretinopatía familiar exudativa. Se demostró herencia recesiva ligada al sexo. Dos pacientes presentan la forma severa de la enfermedad, con desprendimiento retinal exudativo tipo Coats, tracción papilar y retinal, masas fibrovasculares en la periferia temporal, con anastomosis arteriovenosa en el límite. Se concluye que el defecto genético se manifiesta inicialmente como una inmadurez o falta de desarrollo de la circulación retinal de la periferia temporal