RESUMEN
PURPOSE: Despite recent developments in vitrectomy technology and instrumentation, rhegmatogenous retinal detachment in Stickler syndrome (RDS) remains a challenge for surgeons. RDSs are associated with a higher rate of complications and surgical failures than those not associated with Stickler syndrome. This study is a report about anatomic and visual outcomes of RDS surgery and describes the surgical techniques associated with the treatment of this specific condition. METHODS: This is a retrospective, interventional, consecutive case series of patients with RDS undergoing retinal reattachment surgery from 1990 to 2020 at the Institute of Ocular Microsurgery (IMO) in Barcelona, Spain. RESULTS: Twenty-four eyes of 18 patients with genetically confirmed Stickler syndrome were included in the study. Ten eyes (41.6%) presented a giant retinal tear. Retinal reattachment was achieved in all cases after an average of 1.21 (range 1-6) surgical interventions. Nineteen eyes (79%) required only one operation to achieve complete retinal reattachment. The most common first surgical procedure was a 4-mm scleral buckle with posterior pars plana vitrectomy and silicone oil endotamponade, performed on 16 (66.6%) of the eyes. The mean follow-up period was 10.2 years. Mean preoperative visual acuity LogMar was 1.10 (Snellen equivalent 20/252), which improved to 0.50 (Snellen equivalent 20/63) at final follow-up (p < 0.05). CONCLUSION: In most RDS cases, anatomic success and visual acuity improvement can be achieved with the first surgical procedure, using a combination of silicone oil tamponade and a 4-mm scleral encircling band. In some early cases of RDS, other less invasive surgical techniques can be used.
Asunto(s)
Enfermedades del Tejido Conjuntivo , Desprendimiento de Retina , Curvatura de la Esclerótica , Agudeza Visual , Vitrectomía , Humanos , Desprendimiento de Retina/cirugía , Desprendimiento de Retina/diagnóstico , Desprendimiento de Retina/fisiopatología , Estudios Retrospectivos , Agudeza Visual/fisiología , Masculino , Femenino , Vitrectomía/métodos , Adulto , Curvatura de la Esclerótica/métodos , Enfermedades del Tejido Conjuntivo/complicaciones , Enfermedades del Tejido Conjuntivo/cirugía , Enfermedades del Tejido Conjuntivo/diagnóstico , Persona de Mediana Edad , Adulto Joven , Resultado del Tratamiento , Estudios de Seguimiento , Adolescente , Artritis/cirugía , Artritis/diagnóstico , Artritis/fisiopatología , Artritis/complicaciones , Pérdida Auditiva Sensorineural/cirugía , Pérdida Auditiva Sensorineural/diagnóstico , Endotaponamiento , Niño , Aceites de Silicona/administración & dosificaciónRESUMEN
OBJECTIVE: To assess the incidence of threatened preterm labor and preterm labor admissions and treatment of women with singleton gestations and no prior preterm birth before and after implementation of the universal mid-trimester transvaginal ultrasound cervical length screening. MATERIALS AND METHODS: A retrospective cohort study included of singleton gestations without a history of preterm birth presenting with threatened preterm labor between 24 0/7 and 36 6/7 gestational week in two study periods: before and after the implementation of the universal cervical length screening. Women with cervical length <25 mm were considered being at high risk for preterm birth and were prescribed a treatment with vaginal progesterone daily. The primary outcome was the incidence of threatened preterm labor. Secondary outcomes were the incidence of preterm labor. RESULTS: We have found a significant increase in the incidence of threatened preterm labor from 6.42% (410/6378) in 2011 to 11.61% (483/4158) in 2018 (p < 0.0001). Gestational age at triage consult was lower in than in 2011, although the rate of admission for threatened preterm labor was similar in both periods. There was a significant decrease in the incidence of preterm delivery <37 weeks from 25.60% in 2011 to 15.94% in 2018 (p < 0.0004). Although there was a reduction in preterm delivery ≤34 weeks, this reduction was not significant. CONCLUSION: The universal mid-trimester cervical length screening in asymptomatic women is not associated with a reduction in the frequency of threatened preterm labor or the admission rate for preterm labor, but reduces the rate of preterm births.
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Trabajo de Parto Prematuro , Nacimiento Prematuro , Embarazo , Femenino , Recién Nacido , Humanos , Nacimiento Prematuro/epidemiología , Nacimiento Prematuro/prevención & control , Estudios Retrospectivos , Trabajo de Parto Prematuro/epidemiología , Trabajo de Parto Prematuro/prevención & control , Segundo Trimestre del Embarazo , Cuello del Útero/diagnóstico por imagen , Medición de Longitud CervicalRESUMEN
OBJETIVO: valorar la frecuencia de las cesáreas realizadas en nuestro hospital empleando la clasificación estandarizada de Robson e identificar qué indicaciones son las que más contribuyen a la tasa global de cesáreas en nuestro centro. MATERIAL Y MÉTODOS: estudio retrospectivo, observacional sobre el total de cesáreas realizadas en el Hospital Universitario Cruces en un periodo de tres años (2015-2017). Para la inclusión de las gestantes en algunos de los 10 grupos de Robson hemos tenido en cuenta la paridad, edad gestacional, inicio del parto, presentación fetal y el número de fetos. RESULTADOS: durante este tiempo se han atendido un total de 15.112 partos; de los que 1.935 fueron cesárea (12,80%). El grupo que mayor incidencia tiene sobre el total de cesáreas realizadas es el grupo 2 (nulíparas, gestación única, presentación cefálica, ≥ 37 semanas, trabajo de parto inducido o cesárea antes del inicio del trabajo de parto) con una tasa del 30,64%, seguido del grupo 1 (nulíparas, gestación única, presentación cefálica, ≥ 37 semanas, trabajo de parto espontáneo) con un 19,22%. Al margen del grupo 9 (que incluye las cesáreas en presentaciones transversas), los grupos con un mayor porcentaje de cesáreas son el 6 (nulíparas, gestación única, presentación podálica) y 7 (multípara, gestación única, presentación podálica, incluidas las gestantes con cesárea anterior) con un 56,83% y 54,54% respectivamente. CONCLUSIONES: la clasificación de Robson es una buena herramienta para auditar clínicamente la tasa de cesáreas. Es fácil de implementar y permite evaluar el impacto del cambio en el manejo para cambiar dicha tasa. En nuestro centro, la protocolización adecuada de la atención a las presentaciones podálicas, gestaciones múltiples y cesáreas anteriores representa el mayor reto
OBJECTIVE: To apply the Robson 10-group classification system to identify which indications are the ones that contribute most to the cesarean section rate in our hospital. MATERIAL AND METHODS: A historical cohort study was performed on women who delivered in a 3-year period (2015-2017) at the Cruces University Hospital. Five parameters (parity including previous cesarean, gestational age, labor onset, fetal presentation, and plurality), identifiable on presentation for delivery, were used to classify all women included into 1 of 10 groups. The Robson distribution, cesarean rate, and contribution of each Robson group were analyzed, and the distribution of other outcomes was calculated for each Robson group. RESULTS: Of 15,112 deliveries, 1,935 (12.80%) were cesarean sections. Robson groups 1 (30.65%) and 3 (29.91%) (spontaneous term births) were the largest groups. Robson group 2 (single cephalic nulliparous women full-term, induced labor or cesarean section antepartum) and group 1 (single cephalic nulliparous women full-term in spontaneous labor) were the major contributors to the overall cesarean rate at 30.64% and 19.22% respectively. Besides group 9 (transverse lie), groups with higher cesarean rates are 6 (single breech, nulliparous) and 7 (single breech, multiparous, including previous cesarean section), with 56.83% and 54.54% respectively. CONCLUSIONS: The Robson classification is a good tool to clinical audit cesarean section rates. Is easy to implement and interpret and allows to evaluate the impact of changes in management that may alter these rates. In our hospital breech presentations, multiple pregnancy and previous cesarean section are the main challenges
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Humanos , Femenino , Embarazo , Recién Nacido , Cesárea/estadística & datos numéricos , Hospitales Universitarios/estadística & datos numéricos , Estudios Retrospectivos , Incidencia , EspañaRESUMEN
PURPOSE: To evaluate and compare the effects of the following dyes on human pigmented epithelial cells: indocyanine green (ICG), infracyanine green (IfCG), trypan blue (TB), bromophenol blue (BrB), patent blue (PB), and Brilliant Blue G (BBG). METHODS: ARPE-19 cells cultured in vitro were exposed to these dyes, and acute and chronic toxicity were evaluated. Cell viability was measured by colorimetry (MTT assay), morphology was observed by phase-contrast microscopy, membrane permeability (CMP) was evaluated by flow cytometry with propidium iodide (PI), and mitochondrial membrane potential (ΔΨm) was measured with 3,3'-dihexyloxacarbocyanine (DiOC(6)(3)). RESULTS: Each of the studied dyes exhibited toxicity after acute exposure at surgical doses. The presence of light often reduced cell viability, especially when measured 3 hours after incubation in the case of ICG, TB, BrB, and BBG. Morphologic changes were induced by ICG, IfCG, and BBG. Both CMP and ΔΨm were altered after exposure to surgical doses of ICG, TB, PB, and a fourfold surgical dose of BrB. Chronic exposure to residual amounts of some dyes was associated with reduced proliferation and even cell death. CONCLUSIONS: It appears to be prudent to use the lowest possible dose of each dye, to minimize the risk of toxic effects. This precaution may be particularly important in the case of BrB, which should not be used in excess of 0.5%. In addition, abundant irrigation of the vitreous cavity after surgery to completely remove traces of dye may be of crucial importance, particularly in the case of ICG, in minimizing chronic toxicity.
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Colorantes/toxicidad , Epitelio Pigmentado de la Retina/efectos de los fármacos , Azul de Bromofenol/administración & dosificación , Azul de Bromofenol/toxicidad , Permeabilidad de la Membrana Celular/efectos de los fármacos , Supervivencia Celular/efectos de los fármacos , Células Cultivadas , Colorimetría , Colorantes/administración & dosificación , Humanos , Verde de Indocianina/administración & dosificación , Verde de Indocianina/análogos & derivados , Verde de Indocianina/toxicidad , Potencial de la Membrana Mitocondrial/efectos de los fármacos , Microscopía de Contraste de Fase , Colorantes de Rosanilina/administración & dosificación , Colorantes de Rosanilina/toxicidad , Azul de Tripano/administración & dosificación , Azul de Tripano/toxicidadRESUMEN
PURPOSE: To characterize subfoveal changes in patients with longstanding epiretinal membranes (ERM). DESIGN: Retrospective study. METHODS: Analysis of 123 eyes of 123 consecutive patients who underwent surgery for ERM at the Columbia University Medical Center by a single surgeon (S.C.). Eyes were split into 2 groups: those with a preoperative yellow pigmented foveal spot and those without. The latter group was considered the control group. The primary outcome measures were logarithm of the minimum angle of resolution (logMAR) visual acuity at postoperative months 1 and 3 compared with baseline. Fundus photography, optical coherence tomography (OCT), and autofluorescence images were analyzed. RESULTS: We identified 9 eyes with a yellow pigmented spot. All of these eyes exhibited OCT evidence of outer retinal disorganization and hypoautofluorescence. The mean duration of symptoms prior to surgery in these patients was 53 months. The mean duration of symptoms in the control group was 10.7 months. Mean Snellen acuities of the control vs yellow pucker groups were 20/59.7 vs 20/83.5 (P = .041) at baseline; 20/43.3 vs 20/64.8 (P = .006) at postoperative month 1; and 20/34.2 vs 20/50.3 (P = .011) at postoperative month 3. The logMAR magnitude of visual improvement for the yellow pucker vs control groups was not statistically different at either months 1 or 3. Central macular thickness on OCT of patients with yellow pucker decreased from a mean 495 to 395 microns (P = .041). CONCLUSIONS: A characteristic yellow macular spot associated with ERM appears to be a sign of chronicity. OCT demonstrates outer retinal disorganization. This feature may portend a worse postoperative visual prognosis.
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Membrana Epirretinal/diagnóstico , Fóvea Central/patología , Epitelio Pigmentado de la Retina/patología , Adulto , Anciano , Anciano de 80 o más Años , Membrana Epirretinal/fisiopatología , Membrana Epirretinal/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Tomografía de Coherencia Óptica , Agudeza Visual/fisiología , VitrectomíaRESUMEN
PURPOSE: To present a patient with a prepapillary vascular loop, a congenital anomaly that has been associated with vitreous hemorrhage and retinal vascular occlusion, who underwent refractive surgery. METHODS: A 45-year-old man with 2.00 diopters (D) of myopia and a unilateral prepapillary arterial loop presented with an interest in LASIK. After consideration of the theoretical risks of LASIK, the patient underwent photorefractive keratectomy with manual de-epithelialization and a scanning spot excimer laser. RESULTS: Postoperatively, uncorrected visual acuity was 20/20, visual field testing was normal, and no complications occurred. Follow-up was 4 years. CONCLUSIONS: Surface ablation was a safe method in a low myopic patient with a prepapillary vascular loop. This case emphasizes the importance of a thorough vitreoretinal examination in laser refractive candidates.
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Córnea/cirugía , Anomalías del Ojo/complicaciones , Láseres de Excímeros , Miopía/cirugía , Disco Óptico/irrigación sanguínea , Queratectomía Fotorrefractiva , Arteria Retiniana/anomalías , Humanos , Masculino , Persona de Mediana Edad , Agudeza VisualRESUMEN
Postoperative complications of scleral buckling surgery are various. The anterior migration through the rectus muscles and positioning in the corneoscleral junction is an atypical and undocumented complication. The authors describe a patient with a migration and straddling of the encircling buckle in the corneoscleral junction 2 years after a classic retinal surgery with an encircling solid silicone buckle. Many predisposing factors can lead to this situation.
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Córnea/patología , Migración de Cuerpo Extraño/patología , Migración de Cuerpo Extraño/fisiopatología , Músculos Oculomotores/fisiopatología , Curvatura de la Esclerótica/efectos adversos , Curvatura de la Esclerótica/instrumentación , Adulto , Migración de Cuerpo Extraño/diagnóstico , Humanos , Masculino , Nariz , Esclerótica/patologíaRESUMEN
BACKGROUND: Intravitreal bevacizumab (Avastin, Genentech, Inc., South San Francisco, CA) treatment of neovascular age-related macular degeneration (AMD) has become an important part of clinical retinal practice. We describe retinal pigment epithelium (RPE) tears that were noted after intravitreal injection of bevacizumab. METHODS: In this multimember, retrospective case series, data on eyes that developed RPE tears after intravitreal bevacizumab injection were collected and analyzed. Previous treatments, type of lesion, time to tear, and preinjection and final visual acuities were all compared. The total numbers of bevacizumab injections were available from all four institutions and compiled to estimate the incidence rate. RESULTS: Four retina centers administered a total of 1,455 intravitreal 1.25-mg bevacizumab injections for neovascular AMD during the 9-month study period. Twelve patients presented with RPE tears within 4 days to 8 weeks of injection (mean +/- SD, 24.3 +/- 15.2 days from injection to tear). In each case, the RPE tear was preceded by an RPE detachment, and all had a component of serous sub-RPE fluid. On the basis of our collective data, we estimate an incidence rate of approximately 0.8%. CONCLUSIONS: RPE tears can occur after intravitreal injection of bevacizumab. The low incidence of this adverse event should not preclude anti-vascular endothelial growth factor therapy counseling for patients with neovascular AMD, but eyes with serous RPE detachments appear to be most vulnerable to this adverse event.