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2.
Case Rep Ophthalmol ; 13(3): 885-891, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36466060

RESUMO

The purpose of this study was to compare the clinical outcomes of 13 patients with optic disc pit maculopathy (ODP-M) - progressive visual loss, serous macular detachment, and/or intraretinal fluid - who underwent different surgical approaches. This was a retrospective study including a consecutive sample of 13 patients aged 13-74 years (mean 35.38 ± 19.66 years) diagnosed with ODP-M and submitted to vitreoretinal surgery between 2005 and 2021. All patients underwent pars plana vitrectomy, posterior hyaloid detachment, and gas tamponade. Endolaser photocoagulation was applied to the temporal margin of the optic disc in 8 cases; internal limiting membrane (ILM) peeling was performed in 9 cases; and ILM inverted flap technique in 5 cases. Stuffing of the pit with an ILM flap was performed in 3 cases. Mean best-corrected visual acuity improved from 20/200 (1.04 ± 0.56 LogMAR) to 20/50 (0.43 ± 0.54 LogMAR) within 4-36 months. Central retinal thickness decreased from 587.5 ± 158.01 µm to 253.9 ± 33.55 µm, and 7 out of 10 patients had complete resolution of intraretinal fluid. All patients had complete retinal reattachment; however, a few years after surgery, 4 patients had recurrence of serous retinal detachment. The only adjunctive technique associated with greater visual improvement was endolaser (p = 0.033) and not performing peeling of the ILM was also associated with better visual results (p = 0.013), independently of preoperative visual acuity or age at the time of surgery. None of the adjunctive procedures was a significant predictor of better anatomical outcomes. In conclusion, all of these approaches for the surgical management of ODP-M were safe and effective. In this study, vitrectomy with endolaser was a good option for management of ODP-M.

3.
Ocul Immunol Inflamm ; : 1-4, 2022 Sep 20.
Artigo em Inglês | MEDLINE | ID: mdl-36126065

RESUMO

PURPOSE: to describe a clinical case of ocular sarcoidosis in a patient with Autoimmune Polyglandular Syndrome Type 2 (APS-2). METHODS: an 86-year-old female diagnosed with APS-2 was referred to our uveitis department with rapid visual loss in her left eye during a 3-month period. Her best-corrected visual acuity (BCVA) was counting fingers in her left eye (OS) and 20/40 in her right eye (OD). Slit-lamp biomicroscopy was unremarkable OD but revealed granulomatous keratic precipitates OS. Fundoscopy revealed bilateral optic disc oedema and +2 and 4+ vitritis (SUN classification) in her OD and OS, respectively. RESULTS: the patient underwent chest X-Ray which revealed bilateral hilar lymphadenopathy and fibrosis. On high-resolution computed tomography of the lungs, ground-glass opacities were visible, and a diagnosis of ocular sarcoidosis was presumed. After exclusion of infectious diseases, the patient was treated with methotrexate and oral corticosteroids and there was substantial improvement of the optic nerve oedema and vitritis. At the most recent visit, 2 years later, OS BCVA was 20/50. CONCLUSION: There may be an association between ocular sarcoidosis and APS or other autoimmune disorders.

4.
Acta Med Port ; 32(3): 219-226, 2019 Mar 29.
Artigo em Inglês | MEDLINE | ID: mdl-30946794

RESUMO

INTRODUCTION: The risks of pregnancy in women of advanced maternal age are not consensual amongst studies. The aim of this metaanalysis  was to determine whether women of advanced maternal age (≥ 35 years old) had worse obstetrical and perinatal outcomes than non- advanced maternal age women (20 - 34 years old) in singleton, naturally-conceived pregnancies. MATERIAL AND METHODS: We searched PubMed/ MEDLINE, IndexRMP and the Cochrane Database of Systematic Reviews. Ten studies were included according to the following criteria: population of > 1000 nulliparous and/or multiparous women with singleton gestations who did not undergo any type of infertility treatment. Using Review Manager v. 5.3, two meta-analysis were performed: one comparing the outcomes of 20 - 34-year-old vs 35 - 40-year-old women, and another comparing the outcomes of 35 - 40-year-old women vs > 40-year-old women. RESULTS: Women aged 35 - 40 years old were more likely to have > 12 years of education than 20 - 34 years old and > 40 years old women. Advanced maternal age women (35 - 40 and > 40 years old) were more likely to be overweight and having gestational diabetes and gestational hypertension. They were also more likely to undergo induced labour and elective caesarean deliveries. Furthermore, they had worse perinatal outcomes such as preterm delivery, low birthweight babies, higher rates of Neonatal Intensive Care Unit admission and worse Apgar scores. Advanced maternal age women had higher rates of perinatal mortality and stillbirth. DISCUSSION: Most authors present similar results to our study. Although the majority of adverse outcomes can be explained through the physio-pathological changes regarding the female reproductive apparatus that come with aging and its inherent comorbidities, according to the existing literature advanced maternal age can be an independent risk factor per se. In older pregnant women without comorbidities such as gestational hypertension or diabetes there are still worse obstetric and perinatal outcomes, which indicate that advanced maternal age is an independent strong risk factor alone. CONCLUSION: Advanced maternal age women are at a higher risk of adverse obstetrical and perinatal outcomes. In both comparisons, worse outcomes were more prevalent in the older group, suggesting that poorer outcomes are more prevalent with increasing age.


Introdução: Não há consenso na literatura sobre os riscos da gravidez em mulheres com idade materna avançada. O objetivo desta meta-análise consistiu em determinar se as mulheres com idade materna avançada (≥ 35) tiveram piores desfechos obstétricos e perinatais, comparativamente com as mulheres não-idade materna avançada (20 - 34 anos), em gestações de feto único e por conceção natural. Material e Métodos: A pesquisa bibliográfica foi feita na PubMed/MEDLINE, IndexRMP e na Cochrane Database of Systematic Reviews. Foram incluídos dez estudos segundo os seguintes critérios: população-estudo > 1000 mulheres, nulíparas e/ou multíparas, com gestações de feto único sem recurso a tecnologias de reprodução medicamente assistida. Duas meta-análises foram feitas com o programa Review Manager v. 5.3: uma comparando os desfechos da gravidez do grupo 20 - 34 anos com o grupo 35 - 40 anos e outra comparando os grupos de idades 35 - 40 e > 40 anos. Resultados: As mulheres com 35 - 40 anos tiveram mais probabilidade de ter > 12 anos de escolaridade, comparativamente ao grupo 20 - 34 e > 40 anos. Mulheres com idade materna avançada (35 - 40 e > 40 anos) tiveram maior probabilidade de ter excesso de peso e comorbilidades como diabetes gestacional e hipertensão gestacional. Tiveram também maior frequência de partos induzidos e de cesarianas eletivas. As mulheres mais velhas tiveram mais partos pré-termo e recém-nascidos com baixo peso. Os bebés das mães com idade materna avançada foram mais vezes admitidos na Unidade de Cuidados Intensivos Neonatais e tiveram piores índices de Apgar. De igual forma, as mulheres com idade materna avançada tiveram maiores taxas de mortalidade perinatal e morte in utero. Discussão: A maioria dos autores descreve resultados semelhantes àqueles que estão descritos na meta-análise. Embora os resultados desfavoráveis sejam em grande parte explicados pela fisiopatologia do envelhecimento do sistema reprodutor da mulher e comorbilidades inerentes ao avançar da idade, a bibliografia admite a idade materna avançada um fator de risco per se. Mesmo em mulheres com idade materna avançada sem comorbilidades como diabetes ou hipertensão gestacional, esta acaba por ser um fator de risco independente e significativo para desfechos adversos. Conclusão: Mulheres com idade materna avançada têm um maior risco de desfechos obstétricos e perinatais adversos. Em ambas as comparações os piores desfechos foram mais prevalentes no grupo de mulheres com maior idade, sugerindo maior expressão com o avançar da idade.


Assuntos
Idade Materna , Resultado da Gravidez , Adulto , Cesárea , Diabetes Gestacional , Feminino , Humanos , Trabalho de Parto Induzido , Gravidez , Complicações na Gravidez , Nascimento Prematuro , Natimorto , Adulto Jovem
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