RESUMO
Despite recent advances in the medical management of diabetic retinal disease, there remain established indications for vitreoretinal surgery in the treatment of severe proliferative diabetic retinopathy. These include non-clearing vitreous hemorrhage and tractional retinal detachment. Advances in surgical instrumentation, technique, and experience have led to improved visual outcomes, as well as a corresponding decrease in the incidence of postoperative complications. However, the presence of systemic and ocular factors in diabetic patients increases the risk of adverse events compared to non-diabetic individuals. This review will focus on the most important postoperative complications following pars plana vitrectomy, with specific considerations for the diabetic patient.
Assuntos
Retinopatia Diabética/cirurgia , Complicações Pós-Operatórias , Vitrectomia/efeitos adversos , Humanos , Acuidade VisualRESUMO
A 14-year-old girl presented with a history of left-sided headache and acute bilateral blurred vision. She had a remote history of oral tetracycline use for the treatment of acne vulgaris, which had been discontinued for 1 month. The patient was diagnosed with drug-induced intracranial hypertension (IH) and treated with oral acetazolamide with subsequent resolution of symptoms. IH, a known rare complication of the tetracycline class of antibiotics, can also have a delayed presentation after discontinuation of the medication.
Assuntos
Acne Vulgar/tratamento farmacológico , Antibacterianos/efeitos adversos , Hipertensão Intracraniana/induzido quimicamente , Tetraciclina/efeitos adversos , Transtornos da Visão/induzido quimicamente , Acetazolamida/uso terapêutico , Adolescente , Inibidores da Anidrase Carbônica/uso terapêutico , Feminino , Humanos , Hipertensão Intracraniana/diagnóstico , Hipertensão Intracraniana/tratamento farmacológico , Transtornos da Visão/diagnóstico , Acuidade Visual/efeitos dos fármacos , Testes de Campo Visual , Campos Visuais , Suspensão de TratamentoRESUMO
Periorbital infections after strabismus surgery are rare. We describe the first reported case of necrotizing group A streptococcal infection of the conjunctiva and Tenon's capsule complicating uneventful strabismus surgery in a 23-month-old boy, successfully managed with conservative intraoperative debridement and with targeted local and systemic antibiotics.
Assuntos
Conjuntivite Bacteriana/microbiologia , Esotropia/cirurgia , Infecções Oculares Bacterianas/microbiologia , Fasciite Necrosante/microbiologia , Infecções Estreptocócicas/microbiologia , Streptococcus pyogenes/isolamento & purificação , Cápsula de Tenon/microbiologia , Combinação Amoxicilina e Clavulanato de Potássio/uso terapêutico , Antibacterianos/uso terapêutico , Conjuntivite Bacteriana/diagnóstico , Conjuntivite Bacteriana/tratamento farmacológico , Infecções Oculares Bacterianas/diagnóstico , Infecções Oculares Bacterianas/tratamento farmacológico , Fasciite Necrosante/diagnóstico , Fasciite Necrosante/tratamento farmacológico , Humanos , Lactente , Masculino , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos , Penicilina G/uso terapêutico , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/tratamento farmacológico , Cápsula de Tenon/efeitos dos fármacos , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Inibidores de beta-Lactamases/uso terapêuticoRESUMO
OBJECTIVE: To compare the peripapillary retinal nerve fibre layer (RNFL) thickness in nonexudative versus exudative age-related macular degeneration (wet AMD) eyes treated chronically with intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF). DESIGN: Cross-sectional study. PARTICIPANTS: Twenty-nine patients with unilateral wet AMD with at least 12 prior intravitreal anti-VEGF injections and 2 years of therapy were analyzed. The fellow eye with nonexudative (dry) AMD with no prior treatment served as the control group. METHODS: All patients were prospectively enrolled from a single academic subspecialist practice. Bilateral spectral-domain optical coherence tomography (Cirrus SD-OCT; Carl Zeiss Meditec, Dublin, Calif.) of the peripapillary RNFL was performed on all pairs of eyes. Optic nerve head (ONH) parameters were also computed. The primary outcome was mean difference in peripapillary RNFL thickness compared between the treated and the nontreated eyes. RESULTS: Mean RNFL in the chronically treated eyes (95.0 [95% CI 89.8-100.2] µm) was significantly greater than the nontreated fellow eyes (89.9 [95% CI 85.5-94.3] µm) (p = 0.01). Quadrantic optic nerve analysis revealed the temporal RNFL to be greater in the treated group (p = 0.02), whereas all other locations were similar. No significant differences were found between the 2 groups in any ONH parameters. CONCLUSIONS: This study demonstrated no deleterious optic nerve RNFL thinning in a series of wet AMD eyes with long-term repetitive exposure to intravitreal anti-VEGF injections. Furthermore, we observed that those with wet AMD have a relatively thickened temporal peripapillary RNFL layer, which is an important association for all observers of optic nerve disease.
Assuntos
Inibidores da Angiogênese/uso terapêutico , Atrofia Geográfica/tratamento farmacológico , Fibras Nervosas/patologia , Disco Óptico/patologia , Células Ganglionares da Retina/patologia , Degeneração Macular Exsudativa/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Estudos Transversais , Exsudatos e Transudatos , Feminino , Seguimentos , Humanos , Injeções Intravítreas , Masculino , Tamanho do Órgão , Estudos Prospectivos , Líquido Sub-Retiniano , Tomografia de Coerência Óptica , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidoresRESUMO
OBJECTIVE: To explore FPs' perspectives on the value of personal health records (PHRs) in primary care and the implementation and adoption of PHRs in Canada. DESIGN: A qualitative design using semistructured interviews. SETTING: Southwestern Ontario. PARTICIPANTS: Ten FPs. METHODS: The 10 FPs participated in semistructured interviews, which were audiotaped and transcribed verbatim. An iterative approach using immersion and crystallization was employed for analysis. MAIN FINDINGS: Participants were generally positive about PHRs, and were attracted to their portability and potential to engage patients in health care. Their concerns focused on 3 main themes: data management, practice management, and the patient-physician relationship. Subthemes included security, privacy, reliability of data, workload, remuneration, physician obligations, patient misinterpretation of medical information, and electronic communication displacing face-to-face visits. Participants identified 3 key facilitators for adoption of PHR systems: integration with existing electronic health record systems, ease of use without being a burden on either time or money, and offering a demonstrated added value to family practice. CONCLUSION: This study replicates previously published literature about FP concerns and opinions, and it further identifies remuneration as a potential barrier in Canadian fee-for-service payment models. Participants identified 3 key facilitators, which were suggested for implementation and adoption of PHRs, providing a basis for future research and development of these systems for use in Canadian family practice.
Assuntos
Atitude do Pessoal de Saúde , Registros Eletrônicos de Saúde , Registros de Saúde Pessoal , Médicos de Família , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ontário , Relações Médico-Paciente , Administração da Prática Médica , Pesquisa QualitativaRESUMO
PURPOSE: To compare the anesthetic effectiveness of 3 topical agents used for intravitreal injections. DESIGN: Randomized, triple-armed, double-blinded, prospective, single-centered trial in patients receiving intravitreal ranibizumab for neovascular age-related macular degeneration. METHODS: Patients were randomized 1:1:1 to receive 0.5% tetracaine hydrochloride drops and a 4% lidocaine pledget (n = 31), 0.5% tetracaine hydrochloride drops alone (n = 31), or 4% cocaine (+ epinephrine 1/100,000) drops alone (n = 31). Patients were asked to score their pain experience using a visual analogue scale (VAS) immediately following and 15 minutes after their injection. The average of these scores was used as the primary outcome. The physician performing the procedure separately scored his perception of the patients' pain using the Wong-Baker FACES scale. RESULTS: Means of the averaged VAS pain score for Groups 1, 2, and 3 were: 19 (95% confidence interval [CI] 12-26), 21 (95% CI 13-29), and 21 (95% CI 16-27) respectively. Mean Wong-Baker pain scores for Groups 1, 2, and 3 were 1.9 (95% CI 1.3-2.6), 2.1 (95% CI 1.4-2.7), and 2.3 (95% CI 1.6-3.1) respectively. There was no significant difference (P = .549) between groups for average VAS pain score. Similarly, there was no significant difference (P = .790) for the physician-perceived pain score between groups. CONCLUSIONS: There was no clinical difference in patient pain experience between the 3 anesthetic options tested. The addition of a 4% lidocaine pledget offered no clinical advantage in pain relief compared to 0.5% tetracaine or 4% cocaine (+ epinephrine 1/100,000) drops alone.