ABSTRACT
PURPOSE: To determine whether intravitreal injection of autologous plasmin enzyme (APE) is effective in vitreomacular traction syndrome (VMTS) by improving visual acuity and restoring macular morphology. METHODS: A prospective study of 11 consecutive patients diagnosed with VMTS in the Ophthalmology Department from January to May, 2011. INCLUSION CRITERIA: best corrected visual acuity (BCVA) less than 0.5, and vitreomacular attachment in foveal area resulting in macular thickness>250 microns diagnosed by optical coherence tomography (Cirrus OCT, Carl Zeiss Meditec, Inc, Oberkochen, Germany). EXCLUSION CRITERIA: active proliferative diabetic retinopathy, axial myopia>26mm, vitrectomy, glaucoma, previous intravitreal injections and previous rhegmatogenous detachment. One to 3 monthly intravitreal injections of 0.2ml of APE were applied, interrupting if posterior vitreous detachment was attained. Wilcoxon's test was used for statistical analysis. RESULTS: A total of 12 eyes of 11 patients were treated. A complete posterior vitreous detachment was achieved in 4 (33%) eyes at the end of the study, 2 of them with one injection, and 2 with 3 monthly injections. Improvement of BCVA was statistically significant (P=.017) and the decrease in central macular thickness also was statistically significant (P=.016). There was only one complication: intraocular hypertension after injection that subsided with a new paracentesis. CONCLUSIONS: Intravitreal APE injections avoided vitrectomy in VMTS in one in every 3 patients.
Subject(s)
Fibrinolysin/therapeutic use , Vitreous Detachment/drug therapy , Aged , Aged, 80 and over , Female , Fibrinolysin/administration & dosage , Fibrinolysin/adverse effects , Humans , Intravitreal Injections , Macula Lutea , Male , Ocular Hypotension/etiology , Prospective Studies , Stress, Mechanical , Syndrome , Treatment OutcomeABSTRACT
OBJECTIVE: To prepare a protocol for the treatment of retinopathy of prematurity (ROP) agreed by the majority of Spanish ophthalmologists dedicated to this topic. MATERIAL AND METHOD: A draft of the protocol was produced taking into account the experience of the participants and up to date publications. This draft was corrected by all the ophthalmologists participating in the project, and the final document was agreed by all of them. RESULTS: We present general guidelines as an aid for the treatment of ROP, including treatment criteria, treatment methods, a calendar of action, and follow-up. CONCLUSIONS: It is important to have a common working protocol for the treatment of ROP to improve care and to avoid mistakes. Although individual Hospitals may adapt the protocol to their daily activity, it is recommended that there is a minimal working protocol agreed by most of professionals dedicated to pediatric ophthalmology in Spain.
Subject(s)
Retinopathy of Prematurity/therapy , Clinical Protocols , Humans , Practice Guidelines as Topic , SpainABSTRACT
OBJECTIVE: To prepare a retinopathy of prematurity (ROP) screening program as agreed by most of Spanish ophthalmologists dedicated to this topic. MATERIALS AND METHODS: A draft of the protocol was produced taking into account the experience of the participants and current publications. This draft was corrected by all the ophthalmologists participating in the project and the final document produced was agreed by all of them. RESULTS: We present general guidelines to help in the screening of ROP, including treatment criteria, treatment methods, and a calendar of action. CONCLUSIONS: It is important to have a common working protocol in the screening of ROP to improve the action and to avoid mistakes. Although individual Hospitals may adapt the protocol to their daily activity, it is recommended that there is a minimal working protocol agreed by most of professionals dedicated to pediatric ophthalmology in Spain.
Subject(s)
Neonatal Screening/standards , Retinopathy of Prematurity/diagnosis , Clinical Protocols , Humans , Infant, Newborn , Practice Guidelines as Topic , SpainABSTRACT
PURPOSE: To assess the features of Retinopathy of Prematurity (ROP) in a Neonatal Intensive Care Unit during 8 years, analyzing the usefulness of the criteria in the screening protocol and the risk factors relating to the disease. METHODS: A retrospective study of the infants included in the screening program for ROP. The sensitivity of the criteria of birth weight (BW) < 1,500 g, post-conceptional age (PCA) < 32 weeks and subjective pediatric criteria (SPC) in the screening program were evaluated and compared with the incidence of ROP, and the need for treatment in these patient groups. Statistical analysis for ROP and no-ROP was then applied to the risk factors BW, PCA, oxygen therapy, and intercurrent diseases. RESULTS: Forty of 303 infants studied had ROP (13.2%). In ROP cases, 31 (77.5%) had spontaneous regression and 9 (22.5%) needed treatment. The screening program included 144 children with BW < 1,500 g and 159 children with BW > 1,500 g. The incidence of ROP was 26.4% in the first group and 1.3% in the second group (p < 0.001). Two cases were detected with a BW > 1,500 g but with a PCA < 32 weeks, and neither required treatment. There were 84 cases included because of SPC (27.7%); no cases of ROP were detected in these. The only independent risk factor found in a multivariant analysis was birth weight. CONCLUSIONS: None of the children included with a BW > 1500 g required treatment for ROP, but several cases of ROP could be missed by using this criteria only. SPC must be restricted in the screening program.
Subject(s)
Birth Weight , Gestational Age , Infant, Premature , Retinopathy of Prematurity/diagnosis , Humans , Infant, Newborn , Retrospective Studies , Risk FactorsABSTRACT
Objetivo: Registrar las características de la Retinopatíade la Prematuridad (RP) en una unidad neonatala lo largo de 8 años, analizando los criterios delprotocolo de despistaje y los factores de riesgo asociados.Métodos: Estudio retrospectivo de los prematurosincluidos en el protocolo de despistaje. Evaluaciónde la sensibilidad de los criterios Peso al nacer (PN) 1.500 gr fue 1,3% (p 1500 gr y EG 1.500 gr requirió tratamiento,pero usando sólo este criterio pueden no detectarsealgunos casos de RP. La inclusión de niños por CSPdebe restringirse
Purpose: To assess the features of Retinopathy ofPrematurity (ROP) in a Neonatal Intensive CareUnit during 8 years, analyzing the usefulness of thecriteria in the screening protocol and the risk factorsrelating to the disease.Methods: A retrospective study of the infants includedin the screening program for ROP. The sensitivityof the criteria of birth weight (BW) 1,500 g. Theincidence of ROP was 26.4% in the first group and1.3% in the second group (p 1,500 g but with a PCA 1500g required treatment for ROP, but severalcases of ROP could be missed by using this criteriaonly. SPC must be restricted in the screening program
Subject(s)
Male , Female , Infant, Newborn , Humans , Mass Screening , Retinopathy of Prematurity/epidemiology , Intensive Care Units, Neonatal/statistics & numerical data , Retrospective Studies , Risk Factors , Infant, Premature, Diseases/epidemiology , Birth Weight , Gestational AgeABSTRACT
CASE REPORT: We describe a fifty year old woman who complained of headache and transient blurring vision in her left eye. Visual acuity was normal and there was no pupillary defect. Ophthalmoscopy revealed left optic disc edema, whereas the right eye was tipified as normal. After discarding an ocular or orbital condition, neuroimaging and lumbar puncture leaded to diagnosis of Pseudotumor Cerebri. Symptoms improved after Acetazolamide treatment and lumbar punctures. A more detailed fundoscopy, as suggested ocular ultrasonography and CT scanner findings, revealed a mild papilledema in the other eye. DISCUSSION: Unilateral or apparently unilateral papilledema are sometimes signs of intracranial hypertension. Our case report highlights the difficult diagnosis of highly asimmetric papilledemas, and the possible delay of a neurological study.
Subject(s)
Papilledema/etiology , Pseudotumor Cerebri/complications , Female , Humans , Middle AgedABSTRACT
Presentamos una paciente de 50 años que aquejaba cefaleas y episodios de oscurecimiento transitorio de la visión en su ojo izquierdo. A la exploración la visión era normal y no había defecto en el reflejo fotomotor. La funduscopia reveló un gran edema de papila en dicho ojo, mientras que el otro fue considerado normal a la exploración clínica. Tras descartarse patologías oculares y orbitarias, las pruebas de neuroimagen y la punción lumbar condujeron al diagnóstico de pseudotumor cerebri, que mejoró tras el tratamiento oral con acetazolamida y punciones lumbares. Una exploración más detallada del fondo de ojo, como sugerían los hallazgos de la ecografía ocular y el TAC, reveló un leve papiledema en el otro ojo. Discusión: Debe tenerse en cuenta que los papiledemas unilaterales, o aparentemente unilaterales, también son formas de presentación de la hipertensión intracraneal. Nuestro trabajo enfatiza las dificultades diagnósticas que un papiledema altamente asimétrico puede ocasionar, demorando a veces el estudio neurológico (AU)
