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PURPOSE: The interplay between myopia and glaucoma has gained attention, with escalating myopia demonstrating a significant association with increased POAG rates, particularly in patients with severe myopia. This systematic review aimed to comprehensively analyze the relationship between myopia and glaucoma, focusing on the structural and functional implications, risk factors, and assessment modalities. Optical coherence tomography (OCT) played a crucial role in this study, particularly in highly myopic populations. METHODS: This study's rigor is underscored by using the PRISMA guidelines, which ensured a meticulous search strategy was employed across multiple databases from 2012 to 2024. The inclusion criteria included individuals aged 18 years or older with high myopia, defined as a spherical equivalent of less than -6.0 diopters or an axial length > 26.0 mm, diagnosed with chronic glaucoma. Various study designs were incorporated, including randomized controlled trials, prospective cohort studies, and observational studies. Quality assessment was performed using the Jadad Scale, and statistical analyses were performed to summarize the study characteristics and outcomes. RESULTS: Of the 350 initial articles, 15 met the inclusion criteria. OCT assessments revealed structural changes such as thinning of the retinal nerve fiber layer preceding functional losses. Meta-analyses demonstrated a heightened risk of POAG with increasing myopia severity, showing a significant nonlinear relationship. This meta-analysis of six studies involving 3040 patients revealed a relationship between myopia and glaucoma (OR = 12.0, 95% CI 10.1-4.7, P < 0.00001). CONCLUSION: This comprehensive analysis consolidates the evidence of the relationship between myopia and glaucoma, emphasizing the pivotal role of OCT and other imaging modalities in early detection and monitoring.
Glaucoma is a significant cause of permanent blindness worldwide. This causes damage to the visual nerve that worsens over time. The primary way to treat open-angle glaucoma and its many causes is to lower eye pressure. Further research is being conducted to determine the relationship between nearsightedness and glaucoma. Increased nearsightedness is significantly linked to higher rates of glaucoma, especially in people with severe nearsightedness. This review aimed to examine the link between myopia and glaucoma in greater depth, focusing on structural and functional effects, risk factors, and assessment methods, especially optical coherence tomography (OCT), in very nearsighted people. We conducted a thorough search of several databases between 2012 and 2024. Individuals aged 18 years or older with myopia greater than six diopters or an axial length greater than 26 mm and a diagnosis of chronic glaucoma were eligible. Randomized controlled trials, prospective cohort studies, and observational studies were some of the methods used in this study. The quality of the work and statistical methods were used to summarize the features and results of the study. Of the 350 articles initially published, only 15 met the inclusion criteria. These studies mostly used different optical tomography tests to detect structural changes, such as ocular nerve fiber layer damage, before functional loss. According to meta-analyses, the risk of chronic glaucoma increases as myopia worsens, indicating a solid nonlinear relationship. Myopia and glaucoma are linked, demonstrating the importance of thorough evaluation. Severe myopia is strongly associated with damage to the visual nerve. Over the past few years, optical tomography has become a vital imaging tool for identifying early damage to the optic nerve. However, further research is needed on the sex-related tendencies of glaucoma patients. This study provides data that reveal a link between nearsightedness and glaucoma, highlighting the importance of optical tomography and other imaging techniques for early detection and monitoring. To better manage glaucoma in highly myopic individuals, we need to understand how the severity of myopia, changes in structure, and changes in function affect each other.
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Glaucoma , Miopía , Células Ganglionares de la Retina , Tomografía de Coherencia Óptica , Humanos , Glaucoma/fisiopatología , Glaucoma/diagnóstico , Glaucoma/complicaciones , Presión Intraocular/fisiología , Miopía/diagnóstico , Miopía/fisiopatología , Miopía/complicaciones , Fibras Nerviosas/patología , Disco Óptico/diagnóstico por imagen , Disco Óptico/patología , Células Ganglionares de la Retina/patología , Factores de Riesgo , Tomografía de Coherencia Óptica/métodos , Campos Visuales/fisiologíaRESUMEN
BACKGROUND: Antidiabetic therapies are effective, but could indirectly modify the inflammatory response in the ocular microenvironment; therefore, a study was developed to evaluate the inflammatory cytokine profile in the vitreous humor of diabetic patients with retinopathy under treatment with antidiabetic drugs. METHODS: Observational, comparative, retrospective, cross-sectional study. Interleukins 1ß, 6, 8, 10, and tumor necrosis factor-alpha (TNFα) were evaluated in the vitreous humor obtained from patients with type 2 diabetes mellitus, proliferative diabetic retinopathy, and concomitant retinal detachment or vitreous hemorrhage, and who were already on antidiabetic treatment with insulin or metformin + glibenclamide. The quantification analysis of each cytokine was performed by the cytometric bead array (CBA) technique; medians and interquartile ranges were obtained, and the results were compared between groups using the Mann-Whitney U test, where a p-value < 0.05 was considered significant. RESULTS: Thirty-eight samples; quantification of TNFα concentrations was higher in the group of patients administered insulin, while interleukin-8 was lower; in the metformin + glibenclamide combination therapy group, it occurred inversely. In the stratified analysis, the highest concentrations of interleukin-8 and TNFα occurred in patients with vitreous hemorrhage; however, the only statistical difference existed in patients with retinal detachment, whose TNFα concentration in the combined therapy group was the lowest value found (53.50 (33.03-86.66), p = 0.03). Interleukins 1ß, 6, and 10 were not detected. CONCLUSION: Interleukin-8 and TNFα concentrations are opposite between treatment groups; this change is more accentuated in patients with proliferative diabetic retinopathy and vitreous hemorrhage, where the highest concentrations of both cytokines are found, although only TNFα have statistical difference.
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Diabetes Mellitus Tipo 2 , Retinopatía Diabética , Hipoglucemiantes , Interleucina-8 , Factor de Necrosis Tumoral alfa , Cuerpo Vítreo , Humanos , Retinopatía Diabética/tratamiento farmacológico , Retinopatía Diabética/metabolismo , Masculino , Cuerpo Vítreo/metabolismo , Femenino , Persona de Mediana Edad , Estudios Transversales , Factor de Necrosis Tumoral alfa/metabolismo , Estudios Retrospectivos , Hipoglucemiantes/uso terapéutico , Anciano , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Interleucina-8/metabolismo , Insulina/uso terapéutico , Metformina/uso terapéutico , Gliburida/uso terapéutico , Quimioterapia CombinadaRESUMEN
Background: Open globe injuries (OGIs) are a leading cause of monocular blindness worldwide and require prompt intervention to prevent proliferative vitreoretinopathy (PVR) and endophthalmitis when serious intraocular damage occurs. The management of OGIs involves initial wound closure within 24 hours, followed by vitrectomy as a secondary surgery. However, there is a lack of consensus regarding the optimal timing of vitrectomy for maximizing visual outcomes. This meta-analysis aimed to investigate whether early or delayed vitrectomy leads to better outcomes in patients with OGIs. Methods: This review was conducted based on PRISMA guidelines. The Medline, Embase, Scopus, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov databases were searched (October 23, 2023). Clinical studies that used vitrectomy to manage OGIs as early (within 7 days) or delayed (8-14 days) interventions were included. Randomized controlled trials (RCTs) and non-RCTs were appraised using the Cochrane risk of bias and JBI tools, respectively. Results: Eleven studies met the inclusion criteria and were included in the quantitative analyses. There were 235 patients with OGIs who received early intervention and 211 patients who received delayed intervention. The retina was reattached in 91% and 76% of the patients after early and delayed intervention, respectively. Traumatic PVR was present in 9% and 41% of the patients in the early and delayed groups, respectively. The odds of retinal reattachment after vitrectomy were greater in the early group (OR = 3.42, p = 0.010, 95% CI=1.34-8.72), and the odds of visual acuity ≥ 5/200 were 2.4 times greater in the early group. The incidence of PVR was significantly greater in the delayed surgery group (OR = 0.16, p < 0.0001; 95% CI=0.06-0.39), which also required more than one vitrectomy surgery. Conclusion: Early vitrectomy results in better postoperative visual acuity, a greater proportion of retinal reattachment, and a decreased incidence of PVR.
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Macular holes (MHs), including atraumatic idiopathic and refractory MHs, affect central vision acuity due to full-thickness defects in the retinal tissue. The existing controversy regarding the pathophysiology and management of MHs has significantly improved with the implementation of internal limiting membrane (ILM) surgical techniques and improved MH closure rates. Thus, to determine the effect of ILM techniques on large idiopathic and refractory MH management, the present study systematically reviewed 5910 original research articles extracted from online literature databases, including PubMed, Cochrane, Google Scholar, and Embase, following the PRISMA guidelines. The primary outcome measures were MH closure rate and postoperative visual acuity. A total of 23 randomized controlled trials (RCTs) with adequate patient information and information on the effect of ILM peeling, inverted ILM flaps, autologous retinal transplantation (ART), and ILM insertion techniques on large idiopathic and refractory MH patients were retrieved and analyzed using RevMan software (version 5.3) provided by the Cochrane Collaboration. Statistical risk of bias analysis was also conducted on the selected sources using RoB2, which showed a low risk of bias in the included studies. A meta-analysis indicated that the inverted ILM flap technique had a significantly greater MH closure rate for primary MH than the other treatment methods (OR = 3. 22, 95% CI 1.34-7.43; p = 0.01). Furthermore, the findings showed that the inverted ILM flap group had significantly better postoperative visual acuity than did the other treatment options for patients with idiopathic MH (WMD = - 0.13; 95% CI = 0.22-0.09; p = 0.0002). The ILM peeling technique had the second highest statistical significance for MH closure rates in patients with idiopathic MH (OR = 2. 72, 95% CI: 1.26-6.32; p = 0.016). In refractory MHs, autologous retinal transplant (ART) and multilayer ILM plug (MIP) techniques improve the closure rate and visual function; human amniotic membrane grafting (hAMG) provides a high degree of anatomical outcomes but disappointing visual results. This study demonstrated the reliability and effectiveness of ILM techniques in improving the functional and anatomical outcomes of large idiopathic and refractory MH surgery. These findings will help clinicians choose the appropriate treatment technique for patients with idiopathic and refractory MH.
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BACKGROUND: Rhegmatogenous retinal detachment (RRD) is a serious condition that occurs when the retina detaches from its underlying retinal pigment epithelium. RRDs associated with giant retinal tears (GRTs) are caused by retinal tears at least 90° or one-quarter of the circumferential extent. This scoping review systematically identifies and summarizes clinical studies evaluating surgical techniques for the management of GRT-related RRDs, discusses functional and visual outcomes and the risk factors affecting treatment outcomes. METHODS: This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Scopus, Google Scholar, and Springer Link databases were searched for relevant papers (from January 2001 to March 2023). Studies that were published in the English language and reported the risk factors, management, and treatment outcomes of GRT-related RRDs were included in the review. The outcome measures included anatomic success rates, changes in BCVA (logMAR) from baseline to the final follow-up, and adverse events. RESULTS: A total of 11,982 articles were identified. After the title and abstract review, 71 studies were deemed eligible for full-text review. Thirty-six studies that met the eligibility criteria were included in the final review. Four surgical techniques were identified: pars plana vitrectomy (PPV), combined PPV and scleral buckling, scleral buckling alone, and pneumatic retinopexy. Various types of tamponades, including gas, silicone oil, and air, have been used. PPV was the most commonly used surgical technique in 33.1-100% of patients. Among the 20 studies that used PPV alone, 17 were associated with preoperative PVR. In addition, scleral buckling alone or in combination with PPV was reported as a treatment option in 10 studies, with 2-100% of patients experiencing scleral buckling alone and 13.6-100% experiencing combined PPV and complementary scleral buckling. Primary anatomic success (PAS) was achieved with retinal reattachment via a single operation with no residual tamponade, whereas final anatomic success (FAS) was achieved via more than one operation with no residual tamponade. Reported single surgery anatomic success (SSAS) rates range from 65.51 to 100%. The preoperative best-corrected visual acuity (BCVA) ranged from 0.067 to 2.47 logMAR, whereas the postoperative BCVA ranged from 0.08 to 2.3 logMAR. An improvement in visual acuity was observed in 29 studies. Cataracts (3.9-28.3%) were the most common postoperative complication, followed by high IOP (0.01-51.2%) and PVR (0.8-31.57%). CONCLUSION: PPV is the most common surgical technique, and currently microincision vitrectomy surgery (MIVS) systems are commonly employed. Silicone oil is the most frequently used tamponade in RRD repair. Risk factors for GRT-related RRD include age, sex, lens status, high myopia status, proliferative vitreoretinopathy (PVR), presenting visual acuity, the extent of the GRT and retinal detachment, and macular involvement. Future research areas include guidelines to reduce variability in the reporting of surgical methodology, choice of tamponades, and reporting of functional and visual outcomes to inform the best therapeutic interventions in GRT-related RRD.
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BACKGROUND: Myopic traction maculopathy (MTM) is a complication of pathological myopia and encompasses various pathological conditions caused by tractional changes in the eye. These changes include retinoschisis, foveal retinal detachment, and lamellar or full-thickness macular holes (FTMHs). This meta-analysis evaluated the safety and efficacy of novel surgical for treating MTM. METHODS: To compare the outcomes of different surgical approaches for MTM, multiple databases, including Web of Science, PubMed, Scopus, ClinicalTrials.gov, the Cochrane Central Register of Controlled Trials, Ovid MEDLINE, Embase, and the Meta-Register of Controlled Trials, were comprehensively searched. The meta-analysis was performed using RevMan 5.1. RESULTS: Nine comparative studies involving 350 eyes were included in this meta-analysis. There were significant differences between fovea-sparing internal limiting membrane peeling (FSIP) and standard internal limiting membrane peeling (ILMP). Preoperative best-corrected visual acuity BCVA (standard mean difference (SMD): -0.10, 95% CI: -0.32 to 0.12) and central foveal thickness CFT (SMD: 0.05, 95% CI: -0.22 to 0.33) were not significantly different (p = 0.39 and p = 0.71, respectively). However, the postoperative BCVA improved significantly (SMD = - 0.47, 95% CI: - 0.80, - 0.14, p = 0.006) in the FSIP group compared to the standard ILMP group. Postoperative CFT did not differ significantly between the two groups (p = 0.62). The FSIP group had a greater anatomical success rate than the other groups, although the difference was not statistically significant (p = 0.26). The incidence of postoperative macular hole formation was significantly lower (OR = 0.19, 95% CI = 0.07-0.54; p = 0.05) in the FSIP group than in the standard ILMP group. The unique characteristics of highly myopic eyes, such as increased axial length and structural changes, may have contributed to the greater incidence of FTMH in the ILMP group. CONCLUSION: Based on the findings of this meta-analysis, FSIP is the initial surgical approach for early-stage MTM and has shown promising outcomes. However, to establish the safest and most efficient surgical technique for treating different MTM stages, further comparative studies, specifically those focusing on ILMP and FSIP, are necessary. TRIAL REGISTRATION: Retrospectively registered.
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Degeneración Macular , Miopía Degenerativa , Desprendimiento de Retina , Perforaciones de la Retina , Humanos , Fóvea Central , Miopía Degenerativa/complicaciones , Miopía Degenerativa/cirugía , Perforaciones de la Retina/cirugíaRESUMEN
BACKGROUND: The choroidal vasculature supplies the outer retina and is altered in many retinal diseases, including myopic traction maculopathy (MTM). Choroid health is typically assessed by measuring the choroidal thickness; however, this method has substantial limitations. The choroidal vascularity index (CVI) was recently introduced to provide quantitative information on the vascular flow in the choroid. This index has been evaluated in a wide range of diseases but has not been extensively used to characterize MTM. AIM: This study aimed to investigate the CVI across different stages of MTM and the influence of macular surgery on choroidal perfusion markers in different surgically resolved MTM stages. METHODS: Eighteen healthy myopic eyes in the control group and forty-six MTM eyes in the surgical group were evaluated using enhanced optical coherence tomography (OCT) imaging. Binarized OCT images were processed to obtain the luminal choroidal area (LCA) and stromal choroidal area (SCA), which were used to calculate CVI in the form of a percentage ratio. CVI data were collected at baseline, one and four months postoperatively, and at the final clinical visit. MTM eyes were divided into four stages based on disease severity. The choriocapillaris flow area (CFA) and central subfield thickness (CSFT) were measured along side the CVI. RESULTS: No significant differences were observed between the two groups at baseline, except for visual acuity (p < 0.0001). Surgery significantly improved vision at all postoperative time points (p < 0.0001). At baseline, there were no significant differences in CVI, CFA, or CSFT scores between the control and surgical groups. However, all three measurements were lower at the final visit in the surgical group (p ≤0.0001). No significant differences were found in any of the parameters among the four stages of MTM (p > 0.05). Ultimately, correlation and multivariate linear regression analyses did not reveal any significant association between CVI and visual acuity. CONCLUSIONS: This study did not find significant preoperative differences in CVI between healthy myopic eyes and eyes with MTM. However, the postoperative CVI and CFA values were significantly lower than those of the control eyes. Thus, CVI may not be a good biomarker for surgical outcomes, as the correlation between CVI and visual acuity was not statistically significant.The CVI and CFA decreased after surgery, providing evidence of choroidal changes after surgical management.
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Degeneración Macular , Miopía , Humanos , Vitrectomía/métodos , Tracción , Coroides/irrigación sanguínea , Tomografía de Coherencia Óptica/métodos , Perfusión , Estudios RetrospectivosRESUMEN
BACKGROUND: The epiretinal membrane (ERM) is a nonvascular fibrocellular tissue formed by cellular metaplasia and proliferation at the vitreoretinal surface and is generally treated by pars plana vitrectomy (PPV) with or without internal limiting membrane (ILM) peeling. This network meta-analysis aimed to compare the efficacy of all available ERM removal interventions and assessed the use and efficacy of surgical dyes in managing idiopathic ERMs. METHODS: MEDLINE, EMBASE, Cochrane CENTRAL, and the US National Library of Medicine were searched (June 28, 2023). Clinical studies that included patients with ERMs were included. Randomized controlled trials (RCTs) were also appraised using Cochrane risk of bias (ROB). RESULTS: Ten RCTs and ten non-RCTs were included in this study. A pairwise meta-analysis between ERM removal and combined ERM and ILM removal showed no significant difference in visual outcome (change in BCVA) 1 year postintervention (MD = - 0.0034, SE = 0.16, p = 0.832). Similarly, there was no significant difference in the central macular thickness postoperatively between the two groups (MD = - 4.95, SE = 11.11, p = 0.656) (Q = 4.85, df = 3, p = 0.182, I2 = 41.21%). The difference in ERM recurrence between the groups was also not statistically significant (OR = 4.64, p = 0.062, I2 = 0). In a network meta-analysis, there was no significant difference in visual outcomes between ERM removal only and other treatment modalities: combined ILM and ERM removal (MD = 0.039, p = 0.837) or watchful waiting (MD = 0.020, p = 0.550). In a network meta-analysis, there was no significant difference in the visual outcomes between ERM removal alone and dye-stained combined ERM and ILM peeling (MD = 0.122, p = 0.742 for brilliant blue G; BBG and MD = 0.00, p = 1.00 for membrane blue-dual; MBD). The probability of being a better surgical dye for better visual outcomes was 0.539 for the MBD group and 0.396 for the BBG group. The recurrence of ERM was not significantly different when the ILM was stained with any of the dyes. No study was judged on ROB assessment as having low ROB in all seven domains. CONCLUSION: The two types of surgical modalities provided comparable efficacy, with no significant differences between the outcomes. Among the dye-assisted ILM peeling methods, the membrane blue-dual dye was the most effective in providing better structural and functional outcomes.
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This review aimed to systematically compare the efficacy and safety of intravitreal aflibercept (IVA) and vitrectomy for treating severe vitreous hemorrhage (VH) secondary to proliferative diabetic retinopathy (PDR). The review was conducted in accordance with PRISMA guidelines. A search strategy, including the MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and US National Library of Medicine databases, was developed to identify randomized controlled trials (RCTs) that compared vitrectomy and IVA for managing VH due to PDR (participant age ≥ 18 years). The primary outcome measure was the difference in the mean visual acuity between the two treatment groups at 1, 6, and 24 months. Outcome measures included clearance of VH (in weeks), the incidence of recurrent VH, and the rate of complications. The studies were evaluated using the Cochrane Bias (ROB) tool. We identified 774 articles; six articles met the inclusion criteria, and two were ultimately included (n = 239 eyes). With or without PRP, IVA injections and vitrectomy were performed in 117 and 122 eyes, respectively. The mean BCVA at one month was significantly better in the vitrectomy group (MD=0.22, CI:0.10-0.34, p=0.0003), but no difference was found at six months (MD=0.04, CI: -0.04-0.12, p=0.356). The incidence of recurrent VH was significantly higher in the IVA group (OR=5.05, CI:2.71-9.42, p<0.0001). The probability of recurrent VH was five times greater in the IVA group than that in the vitrectomy group. There were no significant differences in the overall proportions of intra- or postoperative complications (OR=0.64, CI: 0.09-4.85, p=0.669). None of the studies had a low ROB in any of the seven domains. We conclude that IVA can be considered a viable treatment modality for diabetic VH in patients with a good follow-up. Vitrectomy initially provides better visual effect, faster VH recovery, and lower VH recurrence than IVA injections.
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BACKGROUND: We conducted a systematic review to compare the effects of pneumatic vitreolysis (PV), enzymatic vitreolysis (EVL) with ocriplasmin, and pars plana vitrectomy (PPV) on vitreomacular traction (VMT) syndrome and macular holes (MHs) to assess their efficacy as treatment options. METHODS: Databases, including PubMed, ClinicalTrials.gov ( www. CLINICALTRIALS: gov ), the Cochrane Central Register of Controlled Trials (CENTRAL)-including the Cochrane Eyes and Vision Group Trials Register (The Cochrane Library 2013, Issue 2)-, Ovid MEDLINE, and EMBASE (January 2000-October 2022), were searched to identify studies comparing the outcomes of PV versus PPV, PPV versus ocriplasmin and ocriplasmin versus PV. RevMan 5.1 was used for the meta-analysis of the studies. RESULTS: Among the 89 studies, 79 were considered eligible for qualitative analysis, and 10 quantitative studies were subjected to meta-analysis. PPV resulted in better postoperative visual acuity improvement than ocriplasmin (standardized mean deviation (SMD) = 0.38, 95% CI 0.03-0.73, p = 0.0003). PV resulted in no significant difference in visual improvement compared with PPV (SMD = - 0.15, 95% CI - 0.47 to 0.16, p = 0.35). PPV was significantly more effective in terms of the VMT release rate (risk ratio = 0.48, 95% CI 0.38-0.62, p = 0.00001) and MH closure rate (risk ratio = 0.49, 95% CI 0.30-0.81, p = 0.006) than ocriplasmin. PV was more effective than ocriplasmin in terms of the VMT release rate (risk ratio = 0.49, 95% CI 0.35-0.70, p = 0.0001). Qualitative analysis showed MH closure rates of 46%, 47.8%, and 95% and VMT releases rates of 46%, 68% and 100% after ocriplasmin, PV, and PPV treatments, respectively. Adverse events and postoperative complications occurring after treatment have also been documented in these studies. CONCLUSION: PPV appears to be the most promising option for MH closure and VMT release, with fewer serious complications than EVL or PV. However, given the limited number of studies comparing these treatments, further research is needed to establish the superiority of PPV over the other options.
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Resumen Objetivo: La fotografía de campo ultra amplio no requiere midriasis, evalúa 200° de la retina y es adecuada para detectar cambios desapercibidos, con riesgo de desprendimiento de retina en individuos asintomáticos; se identificó la frecuencia de cambios periféricos retinianos y cambios con riesgo de desprendimiento de retina, en una muestra de sujetos fáquicos asintomáticos. Materiales y Métodos: Estudio no experimental, analítico, prospectivo, transversal en sujetos con edades de 40-70 años, de cualquier sexo, sin cirugía intraocular previa o síntomas de desgarros retinianos (fotopsias, eritropsia, escotoma periférico). Se obtuvieron imágenes de campo ultra amplio de retina (sin midriasis) con el equipo Optos y se identificó la proporción e intervalos de confianza (I.C.) del 95% de la muestra que tuvo cambios en la retina periférica y cambios con riesgo de desprendimiento de retina (agujeros retinianos, desprendimiento de retina subclínico). Se comparó esta proporción entre sexos y grupos de edad (χ2). Resultados: 1204 ojos de 602 sujetos (promedio de edad 52,92 desviación estándar D.E. ± 7,83 años), 74,41% de los sujetos fueron del sexo femenino. El 16,61% de la muestra presentó cambios periféricos retinianos (I.C. 95% 13,64- 19,58), el 1% de la muestra tuvo cambios con riesgo de desprendimiento de retina. Los cambios periféricos fueron más frecuentes en el grupo de edad de 50-59 años y en mujeres. La miopia superior a -6,00 dioptrías fue infrecuente en ojos con riesgo de desprendimiento de retina. Conclusiones: La fotografía de campo ultra amplio ayuda a demostrar, sin necesidad de dilatar la pupila, que existe una prevalencia baja de cambios retinianos periféricos y cambios con riesgo de desprendimiento de retina en sujetos fáquicos asintomáticos.
Abstract Objective: Ultra wide field photography requires no mydriasis, evaluates 200° of the retina and is adequate to detect overlooked retinal changes, with a risk of retinal detachment in asymptomatic subjects; we identified the frequency of peripheral retinal changes and changes with risk of retinal detachment, in a sample of asymptomatic phakic subjects. Materials and methods: Non-experimental, analytical, prospective, cross- sectional study in subjects aged 40-70 years, of any gender, without previous intraocular surgery or symptoms of retinal tears (photopsia, eritrhopsia, peripheral scotoma). We obtained ultra wide field retinal photographs (without mydriasis) with the Optos device and identified the proportion and 95% confidence intervals (C.I.) of the sample that had peripheral retinal changes and changes with risk of retinal detachment (retinal holes, subclinical retinal detachments). This proportion was compared between genders and age groups (χ2). Results: 1204 eyes of 602 subjects (mean age 59,92 standard deviation ± 7,83 years), 74,41% of the subjects were female. 16,61% of the sample had peripheral retinal changes (95% C.I. 13,64-19,58), 1% of the sample has changes with risk of retinal detachment. Peripheral retinal changes were more frequent in the 50-59 years age group and in women. Myopia over -6.00 diopters was infrequent in eyes with risk of retinal detachment. Conclusions: Ultra wide field photography helped to prove, without the need of mydriasis, that there is a low prevalence of peripheral retinal changes and changes with risk of retinal detachment, in phakic asymptomatic subjects.
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Our objective was to determine whether (-)-Epicatechin administered alone or simultaneously with topical Ketorolac decreased the relative expression of GFAP and modulated the response of Nrf2 in a mouse model with induced hyperglycemia. We found that GFAP and Nrf2 decreased in the groups that received treatments alone or simultaneous during 8 weeks; even when the effect on the Nrf2 was not pronounced, it showed a higher concentration when GFAP decreased. Our results suggest a protective effect of Ketorolac and (-) - Epicatechin, which seem to limit the preclinical retinal damage caused by inflammation in hyperglycemia.
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Catequina , Hiperglucemia , Enfermedades de la Retina , Animales , Ratones , Catequina/farmacología , Catequina/uso terapéutico , Catequina/metabolismo , Hiperglucemia/tratamiento farmacológico , Hiperglucemia/metabolismo , Ketorolaco/uso terapéutico , Ketorolaco/metabolismo , Ketorolaco/farmacología , Ratones Endogámicos C57BL , Factor 2 Relacionado con NF-E2/metabolismo , Factor 2 Relacionado con NF-E2/farmacología , Retina/metabolismoRESUMEN
OBJECTIVE: To compare the incidence and onset time of epiretinal membranes after two surgical techniques to treat retinal detachment (retinopexy). METHOD: Non-experimental, retrospective, longitudinal and comparative study in patients treated of primary rhegmatogenous retinal detachment either with cryotherapy and scleral buckle (group 1) or vitrectomy techniques (group 2), without an epiretinal membrane at the moment of surgery. We compared the incidence of postoperative epiretinal membrane between groups, the median onset time (Mann-Whitney's U) and the proportions of eyes without an epiretinal membrane along time with a survival analysis (log-rank). RESULTS: 112 eyes in group 1, 48 in group 2; the incidence of epiretinal membrane was 23.2% in group 1 and 20.8% in group 2 (p = 0.8). The median time of onset was 12 weeks in group 1 (interquartile rank 8.75-16) and 18 in group 2 (12.5-22, p = 0.02). The log-rank test showed no differences of incidence along the follow-up between groups (p = 0.6). CONCLUSIONS: Epiretinal membranes appear early after retinopexy, before in eyes treated with crio-retinopexy. Although their incidence does not differ between groups, detecting them could start two months after a scleral buckle and three after a vitrectomy procedure.
OBJETIVO: Comparar la incidencia y el tiempo en que aparecen las membranas epirretinianas después de dos técnicas quirúrgicas para tratar el desprendimiento de retina (retinopexia). MÉTODO: Estudio observacional, retrospectivo, longitudinal y comparativo en pacientes operados por desprendimiento regmatógeno primario de retina sin una membrana epirretiniana al momento de la cirugía, divididos en grupos: operados mediante criorretinopexia/cerclaje escleral (grupo 1) o vitrectomía (grupo 2). Se compararon entre grupos la incidencia de membrana epirretiniana, la mediana del tiempo de aparición (U de Mann-Whitney) y las proporciones de ojos sin membrana epirretiniana temporalmente mediante un análisis de sobrevida (log-rank). RESULTADOS: En 112 ojos en el grupo 1 y 48 ojos en el grupo 2, la incidencia de membrana epirretiniana fue del 23.2% en el grupo 1 y del 20.8% en el grupo 2 (p = 0.8). La mediana del tiempo de aparición fue de 12 semanas en el grupo 1 (rango intercuartílico [RIC]: 8.75-16) y de 18 semanas en el grupo 2 (RIC: 12.5-22; p = 0.02). La prueba de log-rank no mostró diferencias en la incidencia durante el seguimiento (p = 0.6). CONCLUSIONES: Las membranas epirretinianas se presentan tempranamente después de una retinopexia, antes en ojos operados mediante criorretinopexia. De acuerdo con la incidencia observada, su búsqueda podría empezar 2 meses después de un cerclaje y 3 meses después de una vitrectomía.
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Membrana Epirretinal , Desprendimiento de Retina , Membrana Epirretinal/diagnóstico , Membrana Epirretinal/epidemiología , Membrana Epirretinal/cirugía , Humanos , Incidencia , Desprendimiento de Retina/epidemiología , Desprendimiento de Retina/etiología , Desprendimiento de Retina/cirugía , Estudios Retrospectivos , Curvatura de la Esclerótica/efectos adversos , Curvatura de la Esclerótica/métodos , Resultado del Tratamiento , Vitrectomía/efectos adversos , Vitrectomía/métodosAsunto(s)
Colectomía , Neoplasias del Recto , Humanos , Neoplasias del Recto/cirugía , Estudios RetrospectivosRESUMEN
Vessel and perfusion densities may decrease before diabetic retinopathy appears; it is unknown whether these changes affect the contribution of vessel density to perfusion density. This was a non-experimental, comparative, prospective, cross-sectional study in non-diabetic subjects (group 1) and diabetics without retinopathy (group 2). Vessel and perfusion densities in the superficial capillary plexus were compared between groups at the center, inner, and full regions and by field (superior, temporal, inferior, nasal) using optical coherence tomography angiography. Coefficients of determination (R2) between vessel and perfusion densities were calculated to find the contribution of larger retinal vessels to perfusion density. Percent differences were used to evaluate the contribution of these vessels to perfusion density in a regression model. There were 62 participants, 31 eyes by group; vessel and perfusion densities as well as the coefficients of determination between them were lower in group 2, especially in the nasal field (R2 0.85 vs. 0.71), which showed a higher contribution of larger retinal vessels to perfusion density. The regression model adjusted to a quadratic equation. In diabetics without retinopathy the contribution of vessel density to perfusion density may decrease; a low vessel density may increase the contribution of larger retinal vessels to perfusion density.
Asunto(s)
Angiografía , Diabetes Mellitus/diagnóstico por imagen , Imagen de Perfusión , Vasos Retinianos/diagnóstico por imagen , Tomografía de Coherencia Óptica , Adulto , Estudios de Casos y Controles , Estudios Transversales , Diabetes Mellitus/fisiopatología , Femenino , Humanos , Masculino , Densidad Microvascular , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Prospectivos , Flujo Sanguíneo Regional , Vasos Retinianos/fisiopatologíaRESUMEN
PURPOSE: To describe a case of stellate nonhereditary idiopathic foveomacular retinoschisis in a middle-aged woman and to depict the classic retinal fluorangiography (FA) findings, structural characteristics using macular spectral-domain optical coherence tomography angiographic data of vascular and perfusion density using optical coherence tomography angiography (OCT-A), and standardized multifocal electroretinography (mfERG) findings. METHODS: This is a case report of a 53-year-old ophthalmologist who was incidentally diagnosed with unilateral idiopathic foveomacular retinoschisis. Stellate nonhereditary idiopathic foveomacular retinoschisis is defined as a foveal elevation without alternative explanation for retinoschisis. FA, spectral-domain optical coherence tomography, optical coherence tomography angiography, and multifocal electroretinography were used as tools to obtain an integral multimodal diagnosis of this entity. RESULTS: Clinical examination and multimodal imaging were able to detect unilateral idiopathic retinoschisis, revealing a stellate pattern of retinal concentric cysts with minimal changes in vascular and perfusion density metrics and confirming the absence of bridging vessels. There were consistent FA findings, with almost unaltered foveal changes. Multifocal electroretinography depicted a subtle reduction in dark-adapted a-wave and b-wave amplitudes. CONCLUSION: Improvements and innovations in technology for ophthalmic diagnosis have revolutionized our capacity for diagnostic decision-making. Spectral-domain optical coherence tomography and optical coherence tomography angiography are useful tools for diagnosis and follow-up assessment. This fortuitous case gives a window on the importance of a routine specialized ophthalmic examination and how multimodal imaging can depict important and specific findings not evident from a clinical point of view. The subtle but important changes observed in optical coherence tomography angiography and multifocal electroretinography will help better define this clinical entity.
Asunto(s)
Quistes , Retinosquisis , Electrorretinografía , Femenino , Angiografía con Fluoresceína/métodos , Fóvea Central , Humanos , Persona de Mediana Edad , Imagen Multimodal , Retinosquisis/diagnóstico por imagen , Tomografía de Coherencia Óptica/métodosRESUMEN
INTRODUCTION: Different optical coherence tomography angiography (OCTA) scanning protocols evaluate the macula. OBJECTIVE: To compare the determination coefficients (R2) between vessel and perfusion densities of two OCTA scanning protocols in order to determine if their metrics could be interchanged. METHOD: Cross-sectional, prospective, comparative, observational, study between two OCTA scanning protocols (Angioplex, Zeiss) in healthy subjects. The R2 between central, inner, and full densities (3 x 3 mm protocol) and between central, inner, outer and full densities (6 x 6 mm protocol) was identified, both for vessel and perfusion densities. RESULTS: Seventy-eight eyes were evaluated; subjects' median age was 23 years. There were high R2 between inner and full densities with the 3 x 3 mm protocol (0.96), between outer and full densities with the 6 x 6 mm protocol (0.96), and between central vessel and perfusion densities (≥ 0.96); R2 between central vessel and perfusion densities of different protocols was ≤ 0.71. CONCLUSIONS: Vessel and perfusion densities have high determination coefficients within a scanning protocol, but not between protocols, given that each one preferentially measures different macular areas. Metrics from different protocols should not be interchanged for follow up.
INTRODUCCIÓN: Distintos protocolos de angiotomografía de coherencia óptica evalúan la mácula. OBJETIVO: R2 entre las densidades vascular y de perfusión de dos protocolos de angiotomografía de coherencia óptica, para determinar si sus mediciones podían intercambiarse. MÉTODO: Estudio observacional, comparativo, prospectivo, transversal entre dos protocolos de angiotomografía de coherencia óptica (AngioPlex, Zeiss) en sujetos sanos. Se identificó la R2 entre las densidades vascular y de perfusión central, interna y completa (protocolo de 3 x 3 mm), y central, interna, externa y completa (protocolo de 6 x 6 mm). RESULTADOS: 78 ojos, mediana de edad 23 años. Hubo R2 altas entre las densidades interna y completa del protocolo de 3 x 3 mm (0.96), externa y completa del de 6 x 6 mm (0.96), y centrales vasculares y de perfusión (≥ 0.96); la R2 entre las densidades centrales vascular y de perfusión de distintos protocolos fue ≤ 0.71. CONCLUSIONES: Las densidades vasculares y de perfusión tienen R2 alta dentro de un protocolo, pero no entre protocolos, porque estos miden preferentemente zonas distintas, lo cual limita intercambiar mediciones.
Asunto(s)
Angiografía/métodos , Mácula Lútea/irrigación sanguínea , Tomografía de Coherencia Óptica/métodos , Adulto , Vasos Sanguíneos/diagnóstico por imagen , Estudios Transversales , Femenino , Voluntarios Sanos , Humanos , Mácula Lútea/diagnóstico por imagen , Masculino , Estudios Prospectivos , Flujo Sanguíneo Regional/fisiología , Estadísticas no Paramétricas , Agudeza Visual , Adulto JovenRESUMEN
Resumen Introducción: Distintos protocolos de angiotomografía de coherencia óptica evalúan la mácula. Objetivo: R2) entre las densidades vascular y de perfusión de dos protocolos de angiotomografía de coherencia óptica, para determinar si sus mediciones podían intercambiarse. Método: Estudio observacional, comparativo, prospectivo, transversal entre dos protocolos de angiotomografía de coherencia óptica (AngioPlex, Zeiss) en sujetos sanos. Se identificó la R2 entre las densidades vascular y de perfusión central, interna y completa (protocolo de 3 x 3 mm), y central, interna, externa y completa (protocolo de 6 x 6 mm). Resultados: 78 ojos, mediana de edad 23 años. Hubo R2 altas entre las densidades interna y completa del protocolo de 3 x 3 mm (0.96), externa y completa del de 6 x 6 mm (0.96), y centrales vasculares y de perfusión (≥ 0.96); la R2 entre las densidades centrales vascular y de perfusión de distintos protocolos fue ≤ 0.71. Conclusiones: Las densidades vasculares y de perfusión tienen R2 alta dentro de un protocolo, pero no entre protocolos, porque estos miden preferentemente zonas distintas, lo cual limita intercambiar mediciones.
Abstract Introduction: Different optical coherence tomography angiography (OCTA) scanning protocols evaluate the macula. Objective: To compare the determination coefficients (R2) between vessel and perfusion densities of two OCTA scanning protocols, to learn whether their metrics could be interchanged. Method: Non-experimental, comparative, prospective, observational, cross-sectional study, between two OCTA scanning protocols (Angioplex, Zeiss) in healthy subjects. We found the R2 between central, inner, and full densities (3 x 3 mm protocol), and between central, inner, outer and full densities (6 x 6 mm protocol), both for vessel and perfusion densities. Results: 78 eyes, median age 23 years. There were high R2 between inner and full densities in the 3 x 3 mm protocol (0.96), between outer and full densities in the 6 x 6 mm protocol (0.96) and between central vessel and perfusion densities (≥0.96); R2 between central vessel and perfusion densities of different protocols (≤0.71). Conclusions: Vessel and perfusion densities have high determination coefficients within a scanning protocol, but not between protocols, because each preferentially measures different macular areas. The metrics of different protocols should not be interchanged for follow-up.