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PURPOSE: To describe chorioretinal findings in a patient with new-onset systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS) after a stillbirth associated with preeclampsia. STUDY DESIGN: Case report. RESULTS: We report a patient with new-onset SLE and APS after pregnancy, who had a history of preeclampsia and intrauterine death that presented with bilateral visual loss after a seizure. Clinical findings of a unilateral vaso-occlusive retinopathy and choroidopathy associated with intraocular inflammation, serous retinal detachment, and vasculitis are presented, which responded well to immunosuppressive therapy. CONCLUSION: New-onset systemic lupus erythematosus (SLE) during or after pregnancy could occur, especially when complicated with preeclampsia, making it difficult to diagnose accurately. Pregnancy-induced hypertension retinopathy and choroidopathy, as well as chorioretinal manifestations of SLE and APS, can share similar ocular manifestations that can overlap and coexist in the same patient, and it is important to recognize them for an adequate management and follow-up.
Assuntos
Síndrome Antifosfolipídica , Lúpus Eritematoso Sistêmico , Pré-Eclâmpsia , Doenças Retinianas , Feminino , Gravidez , Humanos , Síndrome Antifosfolipídica/complicações , Síndrome Antifosfolipídica/diagnóstico , Natimorto , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/diagnóstico , Doenças Retinianas/diagnósticoRESUMO
Un resultado refractivo no esperado luego de una cirugía de catarata puede tener múltiples causas, ya sean preoperatorias, operatorias y posoperatorias. Como las más importantes se han descrito los errores en el cálculo biométrico en el preoperatorio y también las menos probables o infrecuentes como: inadecuada selección del poder del LIO, ausencia de precisión en la manufactura de los LIOs, intervención quirúrgica en paciente equivocado o en el ojo equivocado y el uso de un lente de contacto blando al momento de la biometría. Presentamos el caso de un paciente operado de catarata por facoemulsificación con implante de lente intraocular (LIO) monofocal plegable en saco capsular, que a los 30 días posoperatorios presentó un astigmatismo total o refractivo de - 1.00 dioptrías (D) x 110° pero a los 90 días de la cirugía, regresó por disminución de la agudeza visual con un astigmatismo refractivo de -5.50 D x 165° que no se relacionaba con el astigmatismo corneal medido por queratometría y topografía (-0.94 D x 82°). El ojo tenía medios transparentes y sin reportes de complicaciones posoperatorias inmediatas y mediatas. En este caso encontramos un mecanismo de inclinación del LIO provocado por una háptica deficientemente desplegada al momento de la inserción del LIO que no se evidenció en el acto quirúrgico asociado a desplazamiento de este, ocasionado por la fibrosis y contracción pupilar manifestando un efecto astigmático de manera tardía. Esto fue corroborado por ecografía con ultrabiomicroscopía y reposición quirúrgica del LIO logrando solucionar el caso(AU)
An unexpected refractive outcome after cataract surgery may have multiple causes, whether preoperative, operative or postoperative. The most important ones have been described as errors in the preoperative biometric calculation and also the less probable or infrequent ones such as: inadequate selection of IOL power, lack of precision in the manufacture of IOLs, surgical intervention in the wrong patient or in the wrong eye and the use of a soft contact lens at the time of the biometry test. We present the case of a patient who underwent cataract surgery by phacoemulsification with a monofocal foldable intraocular lens (IOL) implantation in the capsular bag, who 30 days after the operation presented a total or refractive astigmatism of - 1.00 diopters (D) x 110°. Sometime later, 90 days after surgery, he returned due to decreased visual acuity with a refractive astigmatism of -5.50 D x 165° which was not related to the corneal astigmatism measured by keratometry and topography (-0.94 D x 82°). The eye had clear mediums and showed no reports of immediate and gradual postoperative complications. In this case we found a mechanism of IOL tilt caused by a poorly deployed haptic at the time of IOL insertion that was not evident at the time of surgery associated with IOL displacement caused by fibrosis and pupillary contraction, which generated a late astigmatic effect. This was corroborated by ultrasound with ultrabiomicroscopy and surgical repositioning of the IOL, which allowed the case to be solved(AU)
Assuntos
Humanos , Tecnologia HápticaRESUMO
PURPOSE: To describe a modified ab interno technique for the tube implantation from a glaucoma draining device into the ciliary sulcus. MATERIALS AND METHODS: The modified ab interno technique was performed on four eyes of four patients. RESULTS: After the plate was fixed, a 21G needle is inserted through a paracentesis 180° away from the tube position into the anterior chamber and advanced to the posterior chamber through the sclera; finally, the needle exits the eye, then the tube is inserted into the lumen of the needle. The tube is then inserted simultaneously as the 21G needle is pulled out so the tube is placed on the ciliary sulcus. CONCLUSIONS: We report a simple and novel technique for the tube implantation from a glaucoma draining device into the ciliary sulcus, in which the tube is guided with a 21G needle from an accessory paracentesis in order to achieve a posterior placement of the tube.
Assuntos
Implantes para Drenagem de Glaucoma , Glaucoma , Câmara Anterior , Glaucoma/cirurgia , Humanos , Pressão Intraocular , Agulhas , Esclera/cirurgiaRESUMO
PURPOSE: To describe the clinical outcomes of combined prolene gonioscopy assisted transluminal trabeculotomy (GATT) with phacoemulsification in patients with open-angle glaucoma. METHODS: Retrospective study of patients with cataract and open-angle glaucoma treated with GATT and phacoemulsification with intraocular lens (IOL) implantation. Patients with neovascular glaucoma, corneal decompensation, unstable IOL, and with bleeding disorders were excluded. The cumulative probability of failure was the primary outcome. Secondary outcomes were the complete success rate, the mean change on intraocular pressure (IOP), best-corrected visual acuity (BCVA) and number of glaucoma medications at the last follow-up. The frequency of complications was also recorded. RESULTS: Thirty two eyes (25 patients) were included. Nineteen (59.3%) were females, with a mean age of 73.4±12.4 (23-87 years) and a mean baseline BCVA of 1.1±0.75 (0.3-3) LogMAR units. The cumulative probability of failure was 3.2% at 1 month and 6.3% at 6 and 12 months. Sixty-eight and 65.5% of eyes achieved complete success at 3 and 6 months, respectively. The reduction of IOP and number of glaucoma medications at 6 months were statistically significant (p<0.0001 and p=0.0002, respectively). There was a statistically significant improvement of BCVA (from 1.1±0.7 to 0.4±0.7) at 6 months (p<0.0001). IOP spikes (18.7%) and transient hyphema (9.3%) were the most common complications. CONCLUSION: Combined GATT with cataract surgery reduced the IOP and was associated with low failure rates and few ocular complications. This procedure offers the advantage to avoid the need for a bleb, scleral, or conjunctival incision, allowing the possibility for future glaucoma procedures.
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PURPOSE: We present a case of a patient with progressive open angle glaucoma who presented changes suggestive of improvement in the Heidelberg retinal tomography 3 (HRT3) analysis after a cardiac catheterization. OBSERVATION: A 69-year-old woman presented with progressive open angle glaucoma despite maximum tolerable antiglaucomatous topical treatment. A filtering surgery (trabeculectomy) was performed and successfully achieved intraocular pressure (IOP) levels of 10 mm Hg on average. Despite this, changes were evidenced in the HRT3 protocols (trend analysis and topographic change analysis) suggesting marked progression. Brimonidine 0.2% twice a day was initiated, and a cardiovascular examination was requested. A cardiac catheterism was performed in the following weeks, and afterward, all structural parameters improved until the last control. Medication was not discontinued, and no signs of apparent progression on the HRT3 parameters have been evidenced up until the time of writing this case report. CONCLUSIONS AND IMPORTANCE: There was a marked improvement in the HRT3 parameters (trend and topographic change analysis), suggesting that the progression stopped after a cardiac catheterism in a patient with progressive glaucoma despite having the IOP controlled. To our knowledge, this is the first case of a patient with progressive glaucoma that was medically and surgically managed, and despite achieving low IOP levels, the progression detected by the HRT3 analysis could not be stopped until a cardiac catheterization was performed.
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La uveítis es la tercera causa de ceguera evitable, siendo una de sus complicaciones el glaucoma uveítico. Presentamos el caso de una paciente de 25 años tratada con extracción extra capsular de cristalino y trabeculectomía AO, con posterior ciclocrioterapia bilateral, llegando a controlar la enfermedad inflamatoria de fondo y presión intraocular (PIO) en el ojo derecho por siete años con posterior pérdida de la visión (pthisis bulbi). El ojo izquierdo se mantuvo estable por 15 años, presentando luego una PIO de 50 mmHg, por lo que se implanta una válvula de Ahmed por vía pars plana con previa vitrectomía, debido a las alteraciones anatómicas del segmento anterior. Se controló la PIO y se obtuvo una visión de 20/70 con correctores, sin uso de antihipertensivo ocular. El manejo adecuado de la enfermedad de fondo y el uso de dispositivos de drenaje valvulados son la mejor opción para el glaucoma uveítico. Una gran alternativa de abordaje es el implante vía pars plana, previa vitrectomía.
Uveitis is the third preventable cause of blindness, and uveitic glaucoma is one of its complications. We present the case of a 25-year old female patient who underwent an extracapsular lens excision and AO trabeculectomy, and afterwards bilateral cyclocryotherapy was performed. The underlying inflammatory condition was controlled, and the intraocular pressure (IOP) in the right eye was also controlled for seven years, although she later lost sight (pthisis bulbi). The left eye remained in a stable condition for 15 years, but afterwards it developed 50 mm Hg IOP, so an Ahmed Valve through the pars plana was placed, after having performed a vitrectomy because of the anatomic alterations in the anterior segment. The IOP got controlled and 20/70 vision using glasses was attained, without the use of an ocular antihypertensive compound. Adequate management of the underlying disease and the use of valve drainage systems constitute the best choice for the management of uveitic glaucoma. A good approach option is placing the device through the pars plana, after having performed a vitrectomy.
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BACKGROUND: We report the effect of micropulse laser trabeculoplasty (MLT) in the intraocular pressure (IOP) of patients with uncontrolled open-angle glaucoma (OAG). MATERIALS AND METHODS: In this retrospective review, 30 eyes with OAG were treated with a single session of MLT at the Vista Clinic in Lima Perú. We used a 532 nm frequency doubled Nd: YAG laser to 360° of the trabecular meshwork with a power of 1000 mW, 15% of the duty cycle, and 300 ms of exposure. The IOP was measured at baseline and at 1 day, 1 week, 3 months, and 6 months post-treatment and were followed up for one last control. RESULTS: The mean baseline IOP was 15.6 mmHg and in the last control was 12.8 mmHg, mean follow-up time of 19 months (±10 standard deviation [SD]). The mean reduction of IOP in the 1st day was 1.6 mmHg (±2.6 SD) and 1.2 mmHg (±3.3 SD) in the last follow-up. The mean percentage of IOP reduction was 17.9% and 7 eyes (40%) had IOP reduction >20%. No statistical significant difference in relation to demographic characteristics of the patients. The greatest reduction was achieved in the 1st day with a median of 2.00 (P < 0.001). A tendency to achieve a higher reduction of IOP in patients with higher baseline IOP was found but was not statistically significant. No adverse reactions occurred. CONCLUSIONS: MLT slightly reduced the IOP in a few patients with uncontrolled OAG for a very short time and may not be suitable for these patients.
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El virus de la hepatitis C (VHC) ha sido recientemente identificado debido a que desde 1990 se cuenta con pruebas diagnósticas para realizar tamizajes y por ello no se encuentran reportes de la prevalencia de esta enfermedad en el Perú. Se estima que hay una epidemia de hepatitis viral C en nuestro país, en razón que es una patología elevada proporción de asintomáticos, y de larga evolución, hecho que favorece su transmisión. La vía de transmisión, es percutánea, a través de transfusiones sanguíneas, uso de agujas contaminadas por vía sexual. La introducción de la prueba de ELISA para detectar anticuerpos anti-VHC ha permitido su utilización en donantes de sangre a fin de prevenir la infección post-transfusional. Se obtuvo la información de la Unidad de Informática del Hospital Nacional Edgardo Rebagliati Martins (HNERM) del Seguro Social de Salud (ESSALUD), donde se registran datos de los donantes: edad, sexo y resultados respectivos del tamizaje general al cual son sometidos todas las unidades de sangre donadas en el periodo de mayo-noviembre de 1998. En el Servicio de Medicina transfusional del HNERM se realiza la detección de anticuerpos para hepatitis C con el método ELISA de tercera generación utilizando el kit: Ortho HCV 3.0. De las 12,535 donantes de sangre examinados se hallaron 50 casos con resultados positivos. De los cuales 39 (78%) pertenecían al sexo masculino, y 11 (22%) al sexo femenino, obteniéndose una prevalencia de 0.399% de serología positiva para el virus de la hepatitis C. los donantes del sexo femenino sumaron en total de 1930 y la prevalencia en ese grupo fue de 0.57%. En el sexo masculino se identificó a 10,605 donantes, haciendo una prevalencia de 0.39%. La seroprevalencia predominó en las edades de 41 a 50 años (0.80%) y en segundo lugar en el grupo de 51-60 años (0.53%).
The hepatitis C virus (HCV) has been recently identified because since 1990 we count with diagnostic assays to do screenings. For this reason there arent reports about prevalence of this disease in Peru. It is estimated that there is an outbreak of viral hepatitis C in our country. Facts that favor its transmission are that the disease has a high proportion of asymptomatic patients and long evolution. The route of transmission is percutaneous, through blood transfusions, use of contained needles and by sexual contact. The introduction of the Elisa assay for detection of antibodies against HCV has allowed its utilization on blood donors with the purpose of preventing post transfusion infection. Information was obtained from the informatics unit of the Hospital Nacional Edgardo Rebagliati Martins (HNERM) of the health social security system (ESSALUD). We registered the following data: age, sex and results of the screening of all donated blood units between May and November of 1998. In the Transfusion Medical Service of the HNERM detection of hepatitis C antibodies is done with the third generation ELISA method (using the Ortho HCV 3.0 kit). Of 12,535 bloods donors exanimated, we found 50 cases with positive results. Among these, 39 (785) were male and 11 (22%) were female. The prevalence of hepatitis C positive serology was 0.399%. Female donors added a total of 1930 and the prevalence in this group was 0.57%. Male donors added 10,605, with a prevalence of 0.39%. The seroprevalence predominated in the age group 41 50 (0.8%) and in second place the age group 51-60 (0.53%):
