RESUMEN
A multicenter review of Periorbital Necrotizing Fasciitis including nine cases, aged 41 to 82, mostly female, and mainly post-traumatic or idiopathic. Streptococcus pyogenes was the most frequent pathogen. Treatment involved debridement alongside antibiotic therapy in all cases. Two cases experienced toxic shock, with no fatalities. Visual outcomes varied from exenteration to preserved visual acuity with minimal aesthetic impact. Early detection and prompt intervention are paramount due to the significant risks associated with this condition, which may lead to severe complications ranging from vision loss to systemic decline or death.
Asunto(s)
Antibacterianos , Desbridamiento , Fascitis Necrotizante , Infecciones Estreptocócicas , Humanos , Fascitis Necrotizante/microbiología , Fascitis Necrotizante/tratamiento farmacológico , Fascitis Necrotizante/cirugía , Femenino , Persona de Mediana Edad , Masculino , Anciano , Adulto , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Infecciones Estreptocócicas/tratamiento farmacológico , Infecciones Estreptocócicas/microbiología , Infecciones Estreptocócicas/diagnóstico , Streptococcus pyogenes/aislamiento & purificación , Resultado del TratamientoRESUMEN
PURPOSE: The aim of this article is to describe a new reconstructive technique of the lower eyelid in the surgery of tumors involving the medial canthal tendon. METHODS: Our new technique consists of detaching and reflecting the most medial portion of the anterior medial canthal tendon and reinserting it into the posterior lamella. We describe the cases in which our technique can be useful, as well as the results we have obtained. RESULTS: The result after a year of follow-up showed no disruption of the angulation of the lower eyelid line and no changes in eyelid position. CONCLUSIONS: The medial canthal tendon reflection could provide both aesthetic and functional results that may be superior to the usual techniques.
Asunto(s)
Blefaroplastia , Neoplasias de los Párpados , Párpados , Tendones , Humanos , Neoplasias de los Párpados/cirugía , Tendones/cirugía , Blefaroplastia/métodos , Párpados/cirugía , Masculino , Femenino , Anciano , Persona de Mediana Edad , Procedimientos de Cirugía Plástica/métodosRESUMEN
Palytoxin (PTX) is produced by corals such as zoanthid corals. Here we present a case of bilateral PTX-induced keratoconjunctivitis. A 63-year-old man presented to the emergency department with symptoms of red eye, purulent discharge, and foreign body sensation in both eyes. On slit lamp examination, epithelial defects in both eyes with a ring-shaped corneal stromal infiltrate in the right eye and a marginal stromal infiltrate in the left eye were noted. High-resolution anterior segment optical coherence tomography (HR-AS-OCT) showed stromal hyperreflectivity and Descemet folds. Bacterial, fungal, and amoebic cultures were taken. Empirical treatment with topical dexamethasone as well as antibiotics and systemic doxycycline was started. The next day the patient stated that he had been handling zoanthid coral without gloves and had rubbed his eyes afterward. Bilateral PTX-induced keratoconjunctivitis was diagnosed. His eyes were irrigated abundantly with saline solution, and umbilical cord serum eye drops were added to the treatment. Treatment was tapered according to improvement of the corneal infiltrates and epithelial defects. After four months, the stromal infiltrates were resolved but corneal scars persisted in both eyes. HR-AS-OCT showed anterior stromal hyperreflectivity corresponding to corneal leucomas. PTX can cause ocular adverse effects such as keratolysis and corneal inflammation, and in some cases can lead to corneal perforation. It can also produce systemic adverse effects, hence the importance of the preventive measures when handling corals that can produce this toxin.
Asunto(s)
Venenos de Cnidarios , Enfermedades de la Córnea , Queratoconjuntivitis , Acrilamidas , Enfermedades de la Córnea/inducido químicamente , Enfermedades de la Córnea/diagnóstico , Humanos , Queratoconjuntivitis/diagnóstico , Masculino , Persona de Mediana Edad , Tomografía de Coherencia ÓpticaRESUMEN
PURPOSE: To identify predictive response optical coherence tomography (OCT) findings in uveitic macular edema (UME) treated with intravitreal dexamethasone implant (DEX). METHODS: Retrospective study of 66 eyes (53 patients) treated with DEX for UME. SD-OCT macular scans were collected prior to DEX treatment and 6 weeks and 3 months after the DEX implant. OCT images were evaluated for qualitative and quantitative characteristics (central retinal thickness, CRT and macular volume, MV). A multivariate analysis of covariance (ANCOVA) was carried out to study the predictive influence of OCT and clinical covariates on outcomes. The main outcome was a composite endpoint based on the simultaneous gain of 5 or more letters associated with a 20% or more reduction in CRT. RESULTS: A significant improvement in BCVA at 6 weeks (mean change from baseline -0.2, SD 0.3) and 3 months (mean -0.2, SD 0.4) was observed after the DEX implant. A significant decrease in CRT (change from baseline -187.7 µm at 3 months) and MV (change from baseline -1.7 mm3 at 3 months) were also observed. An association of ≥ 5-letter improvement in BCVA and a ≥ 20% CRT reduction was observed in 44.6% of cases at 6 weeks and 31.4% at 3 months. ANCOVA multivariate analyses found CRT at 3 months independent from baseline clinical variables but from CRT. CONCLUSION: DEX implant is an effective treatment for UME independently of basal characteristics, producing both a gain of visual acuity and improvement of macular anatomy by OCT measures at 3 months.