RESUMEN
PURPOSE: A guidelines for the management of retinal vein occlusion is presented. This is necessary because at this moment several therapeutic alternatives have been developed although their role is not yet sufficiently defined. METHODS: Review of the literature for evidence published up to date. Relevant literature was identified and the level of evidence graded. Evidence was then assessed for consistency, applicability and clinical impact. The information was contrasted with those guides published in other countries. RESULTS: Taking into account the different options of treatment that are currently used, several modes of action are suggested. The role of the various complementary examinations are discussed and it is recommended that criteria for the treatment are based on clinical, angiographic, and tomographic findings. CONCLUSIONS: Although there is no overall consensus, these guidelines promote a good standard of clinical practise and provide an update of the management of retinal vein occlusion.
Asunto(s)
Oclusión de la Vena Retiniana/terapia , Corticoesteroides/uso terapéutico , Anciano , Anciano de 80 o más Años , Algoritmos , Inhibidores de la Angiogénesis/uso terapéutico , Anticuerpos Monoclonales/uso terapéutico , Anticuerpos Monoclonales Humanizados , Bevacizumab , Enfermedades Cardiovasculares/complicaciones , Retinopatía Diabética/diagnóstico , Retinopatía Diabética/terapia , Medicina Basada en la Evidencia , Angiografía con Fluoresceína , Glaucoma de Ángulo Abierto/complicaciones , Fármacos Hematológicos/uso terapéutico , Humanos , Coagulación con Láser , Fotocoagulación , Edema Macular/complicaciones , Edema Macular/cirugía , Edema Macular/terapia , Persona de Mediana Edad , Oclusión de la Vena Retiniana/diagnóstico , Oclusión de la Vena Retiniana/tratamiento farmacológico , Oclusión de la Vena Retiniana/etiología , Oclusión de la Vena Retiniana/fisiopatología , Oclusión de la Vena Retiniana/cirugía , Factores de Riesgo , Trombofilia/complicaciones , Tomografía de Coherencia ÓpticaRESUMEN
Propósito: Se presenta una guía de manejo de las oclusiones venosas retinianas. Esto se hace necesario en un momento en el que han aparecido varias alternativas terapéuticas cuyo papel aún no está completamente definido.MétodosSe revisa la literatura publicada hasta el momento identificando los artículos más relevantes, clasificándolos en base al nivel de evidencia.ResultadosTeniendo en cuenta las distintas opciones de tratamiento que existen en la actualidad, se sugieren varias líneas de actuación. Se discute el papel de las exploraciones complementarias y se recomiendan pautas de tratamiento en base a los hallazgos clínicos, angiográficos y tomográficos.Conclusionesaunque no existe un consenso total, esta guía promueve un estándar de buena práctica clínica y proporciona una actualización del manejo de las oclusiones venosas retinianas (AU)
Purpose: A guidelines for the management of retinal vein occlusion is presented. This is necessary because at this moment several therapeutic alternatives have been developed although their role is not yet sufficiently defined.MethodsReview of the literature for evidence published up to date. Relevant literature was identified and the level of evidence graded. Evidence was then assessed for consistency, applicability and clinical impact. The information was contrasted with those guides published in other countries.ResultsTaking into account the different options of treatment that are currently used, several modes of action are suggested. The role of the various complementary examinations are discussed and it is recommended that criteria for the treatment are based on clinical, angiographic, and tomographic findings.ConclusionsAlthough there is no overall consensus, these guidelines promote a good standard of clinical practise and provide an update of the management of retinal vein occlusion(AU)
Asunto(s)
Humanos , Oclusión de la Vena Retiniana/diagnóstico , Oclusión de la Vena Retiniana/patología , Oclusión de la Vena Retiniana/terapia , Retina/anatomía & histología , Retina/patología , Retina/fisiopatología , Edema Macular/complicaciones , Edema Macular/patología , Edema Macular/terapia , Fotocoagulación/instrumentación , Fotocoagulación/métodos , Fotocoagulación , Angiografía/métodos , Angiografía , Tomografía de Coherencia Óptica/instrumentación , Tomografía de Coherencia Óptica/métodosRESUMEN
PURPOSE: The intravitreal injection is a minimally invasive technique which has been proved to be an effective therapy in the management of numerous vitreoretinal diseases. Its use has been rapidly increased in the last few years due to new medications and indications. However, non-standardized performance of this procedure might cause severe complications, being of special concern intraocular infection. The aim of this Guide is to give ophthalmologists, with the information we have up to date, the guidelines needed to make this procedure safe. METHODS: 1. Reviewing the literature regarding evidence published up to date. 2. Consulting with experienced surgeons their common practice in this technique. 3. Contrasting the information from this Guide with those guides published in other countries. RESULTS: Although there is no complete consensus regarding the intravitreal injection procedure technique, the recommendations in this Guide are, up to date from our point of view, the most appropriate to prevent complications, specially infection. Of most importance are antisepsis with povidone iodine, the use of sterile material and gloves and an adequate injection technique. CONCLUSIONS: Large series published of intravitreal injections which took place in clinic settings applying a procedure technique as recommended in this Guide, presented a very low incidence of complications, specially endophthalmitis.
Asunto(s)
Inyecciones Intraoculares/métodos , Cuerpo Vítreo , Algoritmos , Humanos , Inyecciones Intraoculares/efectos adversos , Factores de RiesgoRESUMEN
Objetivo: La inyección intravítrea es una técnicamínimanente invasiva de demostrada eficacia en eltratamiento de numerosas enfermedades vitreorretinianas.Su uso, gracias a nuevas medicaciones eindicaciones, se ha generalizado en los últimosaños. La práctica de esta técnica sin las precaucionesadecuadas, puede causar complicaciones graves,en especial la infección.La finalidad de esta Guía es difundir entre los oftalmólogosun compendio de recomendaciones estandarizadasque faciliten la administración de inyeccionesintravítreas, con las máximas medidas deseguridad y fiabilidad.Método: Se efectúa:1. Una revisión bibliográfica de la evidencia científicapublicada hasta la fecha.2. Consulta de práctica clínica habitual entre especialistascon experiencia acreditada.3. Contraste de nuestra información con la contenidaen las guías publicadas en otros países.Resultado: Aunque no hay un consenso absoluto,las maniobras recomendadas en esta Guía parecen,hasta el día de la fecha, las más adecuadas paraminimizar los riesgos de complicaciones, en especial la infección. Se consideran de particular importanciala antisepsis con povidona yodada, el uso deguantes y materiales estériles y una técnica adecuadade inyección.Conclusiones: Series muy grandes de inyeccionesintravitreas realizadas en consulta y aplicando lasmedidas aquí recomendadas, presentan una incidenciamuy baja de complicaciones, en especial la sospecha de infección intraocular(AU)
Purpose: The intravitreal injection is a minimallyinvasive technique which has been proved to be aneffective therapy in the management of numerousvitreoretinal diseases. Its use has been rapidlyincreased in the last few years due to new medicationsand indications. However, non-standardizedperformance of this procedure might cause severecomplications, being of special concern intraocularinfection.The aim of this Guide is to give ophthalmologists,with the information we have up to date, the guidelinesneeded to make this procedure safe.Methods: 1. Reviewing the literature regarding evidencepublished up to date.2. Consulting with experienced surgeons their commonpractice in this tecnique.3. Contrasting the information from this Guide withthose guides published in other countries.Results: Although there is no complete consensusregarding the intravitreal injection procedure technique,the recomendations in this Guide are, up todate from our point of view, the most appropriate toprevent complications, specially infection. Of mostimportance are antisepsis with povidone iodine, the use of sterile material and gloves and an adecuateinjection technique.Conclussions: Large series published of intravitrealinjections which took place in clinic settingsapplying a procedure tecnique as recomended inthis Guide, presented a very low incidente of complications,specially endophthalmitis(AU)
Asunto(s)
Humanos , Masculino , Femenino , Vitreorretinopatía Proliferativa , Inyecciones , Endoftalmitis/terapia , Inyecciones/métodos , Esterilización/métodos , Triamcinolona/uso terapéutico , Factor A de Crecimiento Endotelial Vascular/administración & dosificaciónRESUMEN
The purpose of the study was to estimate the prevalence of and risk factors for chronic glaucoma in a sample of African Caribbean people over 35 years of age living in the London Borough of Haringey. A cross-sectional voluntary sample of persons were subjected to detailed ophthalmic assessment including automated tangent screen suprathreshold visual field testing, applanation tonometry and stereoscopic disc evaluation in 50 community-based survey clinics over an 8 month period. Cases and suspects were referred to Moorfields Eye Hospital for more detailed assessment and confirmation of the diagnosis. Of 873 eligible persons examined (out of a total of 1022), 32 definite cases of glaucoma were identified, a prevalence of 3.9%; 42% of these had been previously diagnosed. Approximately 10% of the sample required further assessment and follow-up when ocular hypertensives and glaucoma suspects were included. An age-standardised comparison with the findings of the Roscommon survey revealed a relative risk for glaucoma for Haringey blacks compared with Irish whites of 3.7. Significant risk factors for glaucoma included age, African birthplace and darker skin colour. Neither diabetes nor hypertension reached significance. Despite the lack of a population base, this study provides strong evidence that the 4 times greater risk of glaucoma estimated for American blacks compared with whites applies equally to the United Kingdom population. Community-based facilities are required to raise awareness of the risk among this ethnic minority in this country and case-finding resources should be provided to meet local needs.
Asunto(s)
Glaucoma/epidemiología , África/etnología , Ceguera/etiología , Región del Caribe/etnología , Complicaciones de la Diabetes , Femenino , Humanos , Hipertensión/complicaciones , Londres/epidemiología , Masculino , Persona de Mediana Edad , Análisis Multivariante , Prevalencia , Factores de Riesgo , Pigmentación de la Piel , Campos VisualesRESUMEN
The purpose of the study was to estimate the prevalence of and risk factors for chronic glaucoma in a sample of African Caribbean people over 35 years of age living in the London Borough of Haringey. A cross-sectional voluntary sample of persons were subjected to detailed ophthalmic assessment including automated tangent screen suprathreshold visual field testing, applanation tonometry and stereoscopic disc evaluation in 50 community-based survey clinics over an 8 month period. Cases and suspects were referred to Moorfields Eye Hospital for more detailed assessment and confirmation of the diagnosis. Of 873 eligible persons examined (out of a total of 1022), 32 definite cases of glaucoma were identified, a prevalence of 3.9 percent; 42 percent of these had been previously diagnosed. Approximately 10 percent of the sample required further assessment and follow-up when ocular hypertensives and glaucoma suspects were included. An age-standardised comparison with the findings of the Roscommon survey revealed a relative risk for glaucoma for Haringey blacks compared with Irish whites of 3.7. Significant risk factors for glaucoma included age, African birthplace and darker skin colour. Neither diabetes nor hypertension reached significance. Despite the lack of a population base, this study provides strong evidence that the 4 times greater risk of glaucoma estimated for American blacks compared with whites applies equally to the United Kingdom population. Community-based facilities are required to raise awareness of the risk among this ethnic minority in this country and case-finding resources should be provided to meet local needs (Summary)