ABSTRACT
PURPOSE: To describe a temporal approach, digitally assisted phacovitrectomy in a patient with severe kyphosis due to axial spondyloarthritis. Case Report. A 70-year-old male patient with proliferative diabetic retinopathy with vitreous hemorrhage and cataract and ankylosing spondylitis with severe kyphosis. A temporal approach, digitally assisted 25 G phacovitrectomy was performed with a Constellation platform and the NGENUITY visualization system. The Trendelenburg position was utilized. CONCLUSION: A temporal approach, digitally assisted phacovitrectomy may be used in select cases of severe kyphosis with positive outcomes.
ABSTRACT
OBJECTIVE: To correlate the vitreous concentration of transforming growth factor ß-1 (TGF ß-1) with the degree of clinical severity of proliferative vitreoretinopathy (PVR). DESIGN: A prospective, observational, cross-sectional study carried out on cases and controls. PARTICIPANTS: The study included 40 patients with a diagnosis of PVR secondary to rhegmatogenous retinal detachment. METHODS: Vitreous was obtained in patients undergoing pars plana vitrectomy by rhegmatogenous retinal detachment, who were treated during the period from August 2015 to June 2016, in a national reference centre for ophthalmological care in Mexico City, Mexico. The levels of TGFß-1 were quantified by ELISA technique. An ANOVA test was performed for the comparison of the different groups, together with a post-hoc Dunns test. A statistically significant difference was considered when obtaining P <.05. RESULTS: The levels of TGFß-1 were quantified, and the following means were found for each group: In the group with PVR grade A, 1150.6 ± 452.08 pg / ml, PVR grade B: 1129.6 ± 365.54 pg / ml, and PVR grade C: 1146.4 ± 330.21 pg / ml. The statistical analysis did not find significant differences when comparing the different PVR groups. (P=.53). However, when performing the differential analysis for each level of severity, a statistically significant increase in the expression of TGFß-1 was observed in the group of patients with PVR-A at a greater number of days of evolution of the detachment. (P=.03). There were no statistically significant differences for PVR-B and PVR-C (P=.16 and P=.16, respectively). CONCLUSION: Although the levels of TGFß-1 are not directly related to the clinical severity grade, suggesting that there must be other factors involved in the advanced stages of PVR, TGFß-1 may have greater relevance during the initial stages of the clinical course by promoting the epithelial-mesenchymal transition due to its greater expression in PVR-A. Thus, it can be concluded that each isoform plays a very particular role in the complex process of PVR.
Subject(s)
Retinal Detachment/metabolism , Transforming Growth Factor beta1/metabolism , Vitreoretinopathy, Proliferative/metabolism , Vitreous Body/metabolism , Analysis of Variance , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Prospective Studies , Retinal Detachment/complications , Severity of Illness Index , Transforming Growth Factor beta1/analysis , Vitreoretinopathy, Proliferative/classification , Vitreoretinopathy, Proliferative/etiology , Vitreous Body/chemistryABSTRACT
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Subject(s)
Humans , Female , Adult , Blood Patch, Epidural/methods , Vascular Headaches/therapy , Intracranial Hypotension/complications , Intracranial Hypotension/diagnostic imaging , Vascular Headaches/cerebrospinal fluidABSTRACT
BACKGROUND: To determine the effect of the silicone on the dexamethasone intravitreal implant. METHODS: Basic, experimental, prospective and transversal study performed at the hospital "Nuestra Señora de la Luz" in Mexico City. One dexamethasone implant was placed in a test tube with 4 mL of each tamponade medium: 1000cS, 5000cS and heavy silicone oil; basic saline solution was used as the control medium. Photographs were taken weekly for 12 months. 200 µL samples were taken from each medium at 24 h, 1, 2 weeks and monthly for 12 months. ELISA test was performed to quantify dexamethasone release in every sample. An inflammatory stimulus was created and later exposed it to every sample in order to test their anti-inflammatory capacity by cytokine analysis using cytometric bead array. Statistically significant results were obtained with p < 0.05. RESULTS: Photographic follow-up showed disintegration of the implant in control medium. Implants in silicone oil suffered no changes during follow-up. Dexamethasone levels in control medium showed stability from month 2 to 12. Silicone oil mediums showed irregular dexamethasone release during the 1 year period. Dexamethasone in control medium had inhibitory effects on TNF-α starting at 24 h (p < 0.001) and remained stable. Dexamethasone in 1000cS silicone oil showed inhibitory effects from month 2 (p < 0.001) until month 6 (p < 0.001). Implants in denser silicone oils showed no inhibitory effects in any of the samples. CONCLUSIONS: Denser mediums altered the implant pharmacokinetics and showed no anti-inflammatory effects even when concentrations were quantified at levels similar to control medium in vitro.
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BACKGROUND: To assess closure rate after a single surgery of large macular holes and their visual recovery in the short term with three different surgical techniques. METHODS: Prospective multicenter randomized controlled trial. We included treatment-naïve patients with diagnosis of large macular hole (minimum diameter of > 400 µm). All patients underwent a comprehensive ophthalmological examination. Before surgery, the patients were randomized into three groups: group A: conventional internal limiting membrane peeling, group B: inverted-flap technique and group C: free-flap technique. All study measurements were repeated within the period of 1 and 3 months after surgery. Continuous variables were assessed with a Kruskal-Wallis test, change in visual acuity was assessed with analysis of variance for repeated measurements with a Bonferroni correction for statistical significance. RESULTS: Thirty-eight patients were enrolled (group A: 12, group B: 12, group C: 14). The closure rate was in group A and B: 91.6%; 95% CI 61.52-99.79%. In group C: 85.71%; 95% CI 57.19-98.22%. There were no differences in the macular hole closure rate between groups (p = 0.85). All groups improved ≈ 0.2 logMAR, but only group B reached statistical significance (p < 0.007). CONCLUSIONS: Despite all techniques displayed a trend toward visual improvement, the inverted-flap technique seems to induce a faster and more significant recovery in the short term.
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El dolor agudo es un problema muy significativo de los pacientes hospitalizados; en el periodo postoperatorio hasta un 88 % de los pacientes presentan dolor moderado-severo. Los opioides intravenosos son los analgésicos más utilizados en el control del dolor postoperatorio, los cuales se asocian con el riesgo de complicaciones y efectos adversos. El ibuprofeno intravenoso ha sido aprobado por la FDA para el tratamiento del dolor leve-moderado y asociado a opioides en dolor moderado-severo. También ha sido aprobado como antitérmico. La revisión de los estudios publicados en adultos y en pacientes pediátricos concluyen que la administración de ibuprofeno intravenoso en asociación con opioides mejora el control del dolor postoperatorio, el bienestar del paciente y disminuye las necesidades de opioides en el postoperatorio. El ibuprofeno intravenoso resulta ser un fármaco bien tolerado por esta vía y no se relaciona con alteraciones de la homeostasia o aumento del sangrado perioperatorio, ni alteraciones de la función renal en tratamientos cortos, como puede ser el dolor postoperatorio, en estudios siempre inferiores a 5 días de duración. En el postoperatorio, la dosis recomendada es 400-800 mg de ibuprofeno i.v. cada 6 horas. El ibuprofeno intravenoso es una opción interesante dentro del concepto de analgesia multimodal postoperatoria (AU)
Acute pain is a significant problem of hospitalized patients in the postoperative period up to 88 % of patients present moderate to severe pain. Intravenous opioids are most often used in controlling postoperative pain, which are associated with the risk of complications and adverse effects. Intravenous ibuprofen has been approved by the FDA for the treatment of mild to moderate pain associated with opioids in moderate to severe pain. Also it has been approved like antipyretic. The review of published studies in adults and pediatric patients, concluded that intravenous administration of ibuprofen in association with opioids, improved postoperative pain control, patient comfort and reduces opioid requirements postoperatively. The intravenous ibuprofen is well tolerated by intravenous route, and is not related to alterations of homeostasis or increased perioperative bleeding or impaired renal function in short treatments such as postoperative pain, always lower studies 5 days. Postoperatively, the recommended dose is 400-800 mg of ibuprofen intravenous every 6 hours. Intravenous ibuprofen is an interesting option within the concept of multimodal postoperative analgesia (AU)
