Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 37
Filtrar
6.
J Craniofac Surg ; 28(3): 750-751, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28328595

RESUMO

An 82-year-old woman who had a history of essential thrombocythemia presented with ocular pain, bleeding, and decreased visual acuity of the left eye. Orbital computed tomography revealed a relatively well-defined homogenous mass-like lesion in the left subconjunctival and intraconal space. Conjunctival biopsy showed acute inflammation with necrosis, vascular ectasia with thrombosis and hemorrhage. After the treatment with hydroxyurea and anagrelide, her symptom and lesion were markedly improved. Hematologic disorders like essential thrombocythemia should be considered in patients with severe spontaneous bleeding around the eye.


Assuntos
Túnica Conjuntiva/patologia , Hemorragia Ocular , Hidroxiureia/administração & dosagem , Órbita/diagnóstico por imagem , Quinazolinas/administração & dosagem , Trombocitemia Essencial/complicações , Trombose , Idoso de 80 Anos ou mais , Biópsia/métodos , Hemorragia Ocular/diagnóstico , Hemorragia Ocular/etiologia , Hemorragia Ocular/fisiopatologia , Hemorragia Ocular/terapia , Feminino , Fármacos Hematológicos/administração & dosagem , Humanos , Trombose/diagnóstico , Trombose/etiologia , Trombose/fisiopatologia , Trombose/terapia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Acuidade Visual
7.
Acta Ophthalmol ; 94(5): e298-304, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26687402

RESUMO

PURPOSE: To report the incidence and management of haemorrhagic Descemet membrane detachment (HDMD) in canaloplasty and phacocanaloplasty. METHODS: This study included 105 eyes of 92 patients with uncontrolled open angle glaucoma who underwent canaloplasty and phacocanaloplasty between 2010 and 2014. Eyes that developed either HDMD or non-HDMD were identified. The main outcome measures were the development of HDMD and non-HDMD, best corrected visual acuity, recovery time after Descemet membrane detachment (DMD), intra-ocular pressure (IOP) and number of antiglaucoma medications. Each eye was managed according to the time of development, type and extent of DMD. RESULTS: Ten eyes (9.5%) developed DMD- four eyes underwent canaloplasty (3.8%) and six eyes underwent phacocanaloplasty (5.7%). Three of 10 eyes developed non-HDMD while seven of 10 developed HDMD, the majority of HDMD cases occurred in combination with phacocanaloplasty (five of seven). The non-HDMD eyes resolved completely within 2 weeks without intervention. One eye with HDMD was observed for 2 weeks, before a 15% sulphur hexafluoride (SF6) intracameral injection was given. The patient developed a dense corneal stain that was resolving slowly over 30 months. One eye with HDMD underwent YAG laser membranotomy 2 weeks after being identified, which regained corneal transparency 1 month after treatment, while the remaining five eyes underwent immediate surgical drainage and regained corneal transparency 1 day post-procedure. CONCLUSION: HDMD occurred in up to 6.7% in canaloplasty and phacocanaloplasty procedures, mostly during catheter withdrawal and the viscodilation step. Early recognition and management prevented further manipulation.


Assuntos
Doenças da Córnea/epidemiologia , Lâmina Limitante Posterior/patologia , Hemorragia Ocular/epidemiologia , Cirurgia Filtrante/efeitos adversos , Glaucoma de Ângulo Aberto/cirurgia , Facoemulsificação/efeitos adversos , Malha Trabecular/cirurgia , Adulto , Idoso , Câmara Anterior/efeitos dos fármacos , Anti-Hipertensivos/administração & dosagem , Doenças da Córnea/fisiopatologia , Doenças da Córnea/terapia , Tamponamento Interno , Hemorragia Ocular/fisiopatologia , Hemorragia Ocular/terapia , Feminino , Humanos , Incidência , Pressão Intraocular/fisiologia , Masculino , Pessoa de Meia-Idade , Hexafluoreto de Enxofre/administração & dosagem , Tonometria Ocular , Acuidade Visual/fisiologia
8.
JAMA Ophthalmol ; 133(7): 834-9, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25950647

RESUMO

IMPORTANCE: In noninferiority trials, novel oral anticoagulants (NOACs), also known as non-vitamin K oral anticoagulants, were at least noninferior to standard care in the prevention of most prothrombotic conditions. However, differences exist in the safety profile of antithrombotic drugs, and little is known about their intraocular bleeding risk. OBJECTIVE: To evaluate the risk of substantial intraocular bleeding associated with NOACs. DATA SOURCES: MEDLINE, Cochrane Library, SciELO collection, and Web of Science databases were searched from inception to November 2014, as well as other systematic reviews and regulatory agencies documentation. STUDY SELECTION: All phase 3 randomized clinical trials (RCTs) comparing NOACs with any other control that reported intraocular bleeding events. DATA EXTRACTION AND SYNTHESIS: Data were extracted independently by 2 of the authors and pooled using random-effects meta-analysis. Heterogeneity was assessed with the I2 test. MAIN OUTCOMES AND MEASURES: Substantial intraocular bleeding was evaluated with pooled risk ratios (RRs) and 95% CIs. RESULTS: Seventeen RCTs were included. In patients with atrial fibrillation, no difference was identified between NOACs and vitamin K antagonists (RR, 0.84; 95% CI, 0.59-1.19; I2 = 35%; 5 RCTs), and no increased risk was identified compared with acetylsalicylic acid (RR, 14.96; 95% CI, 0.85-262.00; 1 RCT). In patients with venous thromboembolism, no increased risk of substantial intraocular bleeding compared with sequential treatment with low-molecular-weight heparin and a vitamin K antagonist (RR, 0.67; 95% CI, 0.37-1.20; I2 = 0%; 5 RCTs) was identified. Regarding patients who underwent orthopedic surgery, the risk was not different between NOACs and low-molecular-weight heparin (RR, 2.13; 95% CI, 0.22-20.50; I2 = 0%; 5 RCTs). CONCLUSIONS AND RELEVANCE: Randomized data suggest that no differences exist in the risk of substantial intraocular bleeding between NOACs and other antithrombotic drugs. However, the number of events was scarce so that additional studies from larger databases that monitor patients under conditions of ophthalmologic routine clinical practice should be performed to better characterize the safety profile of NOACs.


Assuntos
Anticoagulantes/efeitos adversos , Hemorragia Ocular/induzido quimicamente , Hemorragia Ocular/epidemiologia , Tromboembolia Venosa/prevenção & controle , Administração Oral , Anticoagulantes/uso terapêutico , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/tratamento farmacológico , Relação Dose-Resposta a Droga , Esquema de Medicação , Hemorragia Ocular/fisiopatologia , Feminino , Humanos , Masculino , Prevalência , Prognóstico , Ensaios Clínicos Controlados Aleatórios como Assunto , Medição de Risco , Tromboembolia Venosa/tratamento farmacológico
9.
N Z Med J ; 127(1388): 71-5, 2014 Jan 24.
Artigo em Inglês | MEDLINE | ID: mdl-24481390

RESUMO

We present an unusual case of congestion bleeding of the head and neck following myocardial infarction. A 51-year-old man presented with widespread facial petechiae and subconjunctival haemorrhages following a collapse associated with evolving electrocardiographic changes. Emergency coronary artery stent placement was undertaken. No cardiopulmonary resuscitation (CPR) was performed. We hypothesise that the presence of facial petechiae in our case following transient loss of consciousness due to a presumed ventricular arrhythmia in the setting of acute myocardial ischaemia, may have been precipitated by a Valsalva manoeuvre on regaining consciousness with sudden acute increase in venous pressure and consequent venous congestion of the head and neck, and that congestion bleeding of the face may occur in acute cardiac events without a history of CPR.


Assuntos
Doenças da Túnica Conjuntiva/etiologia , Hemorragia Ocular/etiologia , Hiperemia/etiologia , Infarto do Miocárdio/complicações , Stents , Angioplastia Coronária com Balão/métodos , Doenças da Túnica Conjuntiva/fisiopatologia , Angiografia Coronária/métodos , Eletrocardiografia/métodos , Tratamento de Emergência , Hemorragia Ocular/fisiopatologia , Face , Seguimentos , Humanos , Hiperemia/fisiopatologia , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/terapia , Pescoço , Púrpura/etiologia , Púrpura/fisiopatologia , Medição de Risco , Índice de Gravidade de Doença , Resultado do Tratamento
10.
Aviat Space Environ Med ; 84(9): 961-70, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24024308

RESUMO

INTRODUCTION: Red Bull Stratos was a commercial program that brought a test parachutist protected by a full pressure suit to 127,852 ft (38,964 m), via a stratospheric balloon with a pressurized capsule, from which he free fell and subsequently parachuted to the ground. In light of the uniqueness of the operation and the medical threats faced, medical protocols specific to distinctive injury patterns were developed. One unique threat was that of a flat spin during free fall with resultant exposure to -Gz (toe-to-head) acceleration. In preparation for stratospheric free fall, the medical team conducted a review of the literature on the spectrum of human and animal injury patterns attributable to -Gz exposures. Based on the findings, an emergency medical field response protocol was developed for the rapid assessment, diagnosis, and treatment of individuals suspected of -Gz injury. METHODS: A systematic review was conducted on available literature on human and animal studies involving significant -Gz exposure, with subsequent development of an applicable field treatment protocol. RESULTS: The literature review identified pathophysiologic processes and mitigation strategies that were used to develop a prevention and treatment protocol, outlining appropriate interventions using current best medical practices. A medical field treatment protocol was successfully established for the high-altitude balloon program. DISCUSSION: Available literature provided insight into best medical practices for the prevention and treatment of significant -Gz exposures during high-altitude parachute activity. Using the protocol developed for the field medical response, injuries from sustained -Gz exposure can be effectively managed in similar high-altitude and space operations.


Assuntos
Altitude , Hipogravidade/efeitos adversos , Arritmias Cardíacas/fisiopatologia , Glicemia/análise , Edema Encefálico/fisiopatologia , Circulação Cerebrovascular/fisiologia , Confusão/fisiopatologia , Circulação Coronária/fisiologia , Serviços Médicos de Emergência , Tratamento de Emergência , Hemorragia Ocular/fisiopatologia , Hemorragia/fisiopatologia , Humanos , Hipotensão/fisiopatologia , Hipóxia Encefálica/fisiopatologia , Pressão Intraocular/fisiologia , Ácido Láctico/sangue , Pneumopatias/fisiopatologia , Oxigênio/sangue , Propriocepção/fisiologia , Circulação Pulmonar/fisiologia , Edema Pulmonar/fisiopatologia , Púrpura/fisiopatologia , Ácido Pirúvico/sangue , Fluxo Sanguíneo Regional/fisiologia , Taxa Respiratória/fisiologia , Síncope/fisiopatologia
11.
Curr Opin Otolaryngol Head Neck Surg ; 21(4): 417-22, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-23838551

RESUMO

PURPOSE OF REVIEW: To review the most recent literature on the management of the orbit under high pressure (the tight orbit) with threatened visual loss. RECENT FINDINGS: Definitive management of traumatic optic neuropathy remains unclear, lacking randomized head-to-head treatment option trials. Instead, numerous case series and anecdotal reports show benefit in each of the four treatment modalities currently in use, but a multitude of variables confound cross-study comparison. In contrast, the management of orbital hemorrhage and orbital emphysema is well known. A number of immunomodulatory protocols have recently arisen for the medical suppression of Graves' ophthalmopathy, but when surgical decompression is required, most authors currently favor a combined transconjunctival and endoscopic endonasal approach. SUMMARY: This article reviews the anatomy, pathophysiology, diagnosis, and intervention of the 'tight orbit' with associated visual loss. Guidelines for the intervention are given.


Assuntos
Enfisema/terapia , Hemorragia Ocular/terapia , Oftalmopatia de Graves/terapia , Doenças do Nervo Óptico/terapia , Transtornos da Visão/prevenção & controle , Descompressão Cirúrgica/métodos , Enfisema/diagnóstico , Enfisema/fisiopatologia , Hemorragia Ocular/diagnóstico , Hemorragia Ocular/fisiopatologia , Oftalmopatia de Graves/diagnóstico , Oftalmopatia de Graves/fisiopatologia , Humanos , Doenças do Nervo Óptico/diagnóstico , Doenças do Nervo Óptico/fisiopatologia
12.
Acta Ophthalmol ; 91(3): 226-30, 2013 May.
Artigo em Inglês | MEDLINE | ID: mdl-22405023

RESUMO

PURPOSE: To the best of our knowledge, no large population-based studies on the relationship between conjunctival haemorrhage and stroke have been conducted to date. Using a nationwide population-based data set, this study investigated the relationship between conjunctival haemorrhage and the subsequent risk of stroke within a 3-year period following diagnosis. METHODS: We analysed data sourced from the Taiwan Longitudinal Health Insurance Database 2000. The study cohort consisted of 17 349 patients with conjunctival haemorrhage and 86 745 comparison subjects. Each patient was individually tracked for a 3-year period from their index date to identify all those who had subsequently received a diagnosis of stroke. RESULTS: The incidence rate of stroke was 2.44 (95% CI = 2.31-2.55) per 100 person-years in patients with conjunctival haemorrhage and 1.63 (95% CI = 1.59-1.68) per 100 person-years in comparison patients. After adjusting for patients' monthly income and geographic location, as well as for hypertension, atrial fibrillation, diabetes, hyperlipidaemia and coronary heart disease, stratified Cox proportional hazards regressions revealed a statistically significant hazard ratio for stroke in patients with conjunctival haemorrhage (HR = 1.33; 95% CI = 1.24-1.42, p < 0.001). CONCLUSIONS: In this study, patients with conjunctival haemorrhage were found to be at a significant risk of stroke during a 3-year follow-up period after diagnosis.


Assuntos
Doenças da Túnica Conjuntiva/epidemiologia , Hemorragia Ocular/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/epidemiologia , Comorbidade , Doenças da Túnica Conjuntiva/fisiopatologia , Doença das Coronárias/epidemiologia , Bases de Dados Factuais , Diabetes Mellitus/epidemiologia , Hemorragia Ocular/fisiopatologia , Feminino , Seguimentos , Humanos , Hiperlipidemias/epidemiologia , Hipertensão/epidemiologia , Incidência , Masculino , Pessoa de Meia-Idade , Grupos Populacionais , Fatores de Risco , Acidente Vascular Cerebral/fisiopatologia , Taiwan/epidemiologia
14.
Mol Vis ; 18: 1952-4, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22876120

RESUMO

PURPOSE: To evaluate the tear film characteristics of spontaneous subconjunctival hemorrhage patients by Schirmer test I and tear interferometry. METHODS: Forty-six spontaneous subconjunctival hemorrhage patients and 46 controls were enrolled in the study. Schirmer test I and tear interferometry were performed in all 92 subjects. The results obtained were compared between the two groups. RESULTS: The Schirmer test I value of the spontaneous subconjunctival hemorrhage patients was 6.93 (4.72) mm, and that of the controls was 14.70 (3.70) mm. A statistical difference was found between the two groups (independent samples t test, t=-8.79, p<0.001). The mean rank of the tear interferometry patterns of the spontaneous subconjunctival hemorrhage patients was 50.07, and that of the controls was 42.93. No statistical difference was found between the two groups (Mann-Whitney U test, Z=-1.85, p=0.064). CONCLUSIONS: For the spontaneous subconjunctival hemorrhage patients, the Schirmer test I value was lower than that of the controls, whereas the tear interferometry patterns were comparable to that of the controls.


Assuntos
Túnica Conjuntiva/fisiopatologia , Doenças da Túnica Conjuntiva/fisiopatologia , Hemorragia Ocular/fisiopatologia , Lágrimas/metabolismo , Adulto , Idoso , Estudos de Casos e Controles , Túnica Conjuntiva/patologia , Doenças da Túnica Conjuntiva/patologia , Hemorragia Ocular/patologia , Humanos , Interferometria , Pessoa de Meia-Idade , Fitas Reagentes
18.
Ophthalmology ; 116(10): 1880-6, 2009 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-19596440

RESUMO

OBJECTIVE: Subconjunctival hemorrhage (SCH) is a relatively common disease, but there have been no reports concerning the relationship between SCH and conjunctivochalasis (CCh). We compared the grade of CCh between patients with SCH and control patients. DESIGN: Prospective, nonrandomized study. PARTICIPANTS: A total of 104 patients with SCH aged 41 to 94 years and 120 age- and gender-matched controls aged 41 to 94 years were enrolled. METHODS: The conjunctiva was divided into the following 8 equal areas: superior, superior/nasal, nasal, inferior/nasal, inferior, inferior/temporal, temporal, and superior/temporal. The age, gender, medical history, ocular history, site of hemorrhage, grade of CCh at 3 locations (nasal, middle, and temporal), and other parameters of CCh were determined in all subjects. MAIN OUTCOME MEASURES: Grade of each CCh parameter and location of SCH. RESULTS: The mean grade of CCh was higher in patients with SCH than in control patients at the nasal (P<0.00001), middle (P<0.00001), and temporal areas (P<0.00001). The downward gaze- or digital pressure-dependent changes of CCh and the frequency of superficial punctate keratitis were all increased in SCH patients compared with control patients (P<0.00001, P<0.00001, and P = 0.00106, respectively). The number of areas involved by SCH and the presence of SCH in each area were positively correlated with the grade of each CCh-related parameter (P<0.05). CONCLUSIONS: This was the first assessment of the grade of CCh in a large series of consecutive patients with SCH. Our results strongly suggest that CCh may have an important role in the pathogenesis of SCH.


Assuntos
Doenças da Túnica Conjuntiva/fisiopatologia , Hemorragia Ocular/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Túnica Conjuntiva/patologia , Doenças da Túnica Conjuntiva/diagnóstico , Hemorragia Ocular/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco
20.
Korean J Ophthalmol ; 21(4): 222-7, 2007 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-18063887

RESUMO

PURPOSE: To document the clinical features of disc hemorrhage in patients with branch retinal vein occlusion (BRVO) and normal tension glaucoma (NTG), and to evaluate the relationship between BRVO and NTG with disc hemorrhages. METHODS: From July 2001 to May 2006, sixteen patients with both NTG and BRVO in different eyes were successively collected from outpatient population of Seoul National University Hospital in this observational case series. The frequency and location of disc hemorrhages, history of associated systemic diseases, and the order of the time of diagnosis between NTG and BRVO were studied. RESULTS: All patients had unilateral BRVO, and their mean age was 63.3+/-10.6 years. Disc hemorrhages were detected in eight patients (50%) during the mean follow-up of 26.8 months (range, 3-96 months). Six patients (75%) had disc hemorrhages in the non-BRVO eyes and two patients (25%) in BRVO eyes. Five hemorrhages (62.5%) were located at inferior-temporal quadrant of the optic disc. History of systemic hypertension was identified in 12 patients (75.0%). In 11 patients (68.8%), NTG was diagnosed at the same time as BRVO. CONCLUSIONS: A higher frequency of disc hemorrhages was identified in patients with both BRVO and NTG. Therefore, some cases of NTG, especially with disc hemorrhages, may share a common vascular pathophysiology with BRVO.


Assuntos
Hemorragia Ocular/etiologia , Glaucoma de Ângulo Aberto/complicações , Disco Óptico/patologia , Doenças do Nervo Óptico/etiologia , Oclusão da Veia Retiniana/complicações , Adulto , Idoso , Hemorragia Ocular/patologia , Hemorragia Ocular/fisiopatologia , Feminino , Angiofluoresceinografia , Seguimentos , Fundo de Olho , Glaucoma de Ângulo Aberto/patologia , Glaucoma de Ângulo Aberto/fisiopatologia , Humanos , Pressão Intraocular , Masculino , Pessoa de Meia-Idade , Doenças do Nervo Óptico/patologia , Doenças do Nervo Óptico/fisiopatologia , Oclusão da Veia Retiniana/patologia , Estudos Retrospectivos , Índice de Gravidade de Doença , Acuidade Visual
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...