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Acromegalia/complicaciones , Coroides/patología , Retina/patología , Femenino , Humanos , MasculinoAsunto(s)
Puente Cardiopulmonar , Coroides/patología , Coroides/fisiopatología , Presión Intraocular , Pulso Arterial , Humanos , MasculinoRESUMEN
Accumulating data suggest that bone plays a role in energy metabolism through decarboxylation of osteocalcin. Thus, we aimed to study the association of circulating under--carboxylated osteocalcin (UC-OCN) and car-boxylated osteocalcin (C-OCN) with metabolic syndrome in middle aged Asian population.In this cross-sectional study, 131 middle aged Asian subjects were recruited. Circulating UC-OCN, C-OCN and parameters of metabolic phenotype were measured.Circulating UC-OCN was increased in subjects with metabolic syndrome (8.1±7.2 ng/ml vs. 5.9±4.6 ng/ml, p=0.036). In contrast, C-OCN showed a non-significant trend towards reduction in subjects with metabolic syndrome (3.6±2.2 ng/ml vs. 4.3±1.8 ng/ml, p=0.057). Further analysis revealed that changes in both UC-OCN and C-OCN occurred primarily among females with metabolic syndrome. Interestingly, neither forms of OCN differed significantly between individuals with and without metabolic syndrome in males. Logistic regression revealed that UC-OCN was independently associated with metabolic syndrome after adjusting for multiple covariates. However, association between metabolic syndrome and C-OCN was dependent on gender (i. e., amongst females only) in the fully adjusted regression model.Variation in OCN (including its sub-species) was associated with variation in metabolic parameters amongst Asian adults. Circulating UC-OCN was increased while C-OCN was decreased in treatment-naïve females with metabolic syndrome. Our preliminary observations further supported a potential link between bone and energy metabolism in humans.
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Huesos/metabolismo , Metabolismo Energético , Síndrome Metabólico/sangre , Osteocalcina/sangre , Adulto , Pueblo Asiatico , Estudios Transversales , Femenino , Humanos , Síndrome Metabólico/etnología , Persona de Mediana EdadRESUMEN
PURPOSE: To determine the prevalence rates of refractive errors and pattern of ocular biometry in a multi-ethnic elderly Asian population. METHODS: A population-based study of 1835 residents aged 55-85 years, evaluating the refractive error and ocular biometry parameters, including axial length (AL) and anterior chamber depth. RESULTS: The age-standardized prevalence of myopia, hyperopia, astigmatism, and anisometropia were 30.0% (95% confidence interval (CI): 29.6, 30.4), 41.5% (95% CI: 41.1, 41.9), 43.5% (95% CI: 43.1, 44.0), and 22.1% (95% CI: 21.7, 22.4), respectively. Male gender (P=0.02), age ≥ 75 years (P=0.033), and higher educational level (P<0.001) were significantly associated with higher rates of myopia in multivariate analyses. The prevalence of astigmatism was higher in persons with diabetes (odds ratio (OR) 1.4, 95% CI: 1.03, 1.90, P=0.031). AL was longer in Chinese than other ethnic groups (23.7 vs 23.4 mm, P=0.018), and in men compared with women (24.2 vs 23.4 mm, P<0.001). AL was associated with increasing height (AL increased by 0.3 mm for every 10 cm increase in height, P<0.001). CONCLUSION: There is a high prevalence of myopia in elderly Singaporeans, consistent with trends seen in younger populations in Asia. Male gender and higher education were independent risk factors for myopia. These data suggest that higher rates of myopia in East Asians compared with Caucasians may not be a recent phenomenon.
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Envejecimiento , Pueblo Asiatico/estadística & datos numéricos , Astigmatismo/epidemiología , Biometría , Hiperopía/epidemiología , Miopía/epidemiología , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Anisometropía/epidemiología , Anisometropía/etnología , Anisometropía/fisiopatología , Astigmatismo/etnología , Astigmatismo/fisiopatología , Estudios Transversales , Femenino , Humanos , Hiperopía/etnología , Hiperopía/fisiopatología , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Análisis Multivariante , Miopía/etnología , Miopía/fisiopatología , Oportunidad Relativa , Prevalencia , Factores de Riesgo , Distribución por Sexo , Singapur/epidemiologíaRESUMEN
The understanding of polypoidal choroidal vasculopathy has evolved rapidly in the past three decades. The hallmark of the disease is the presence of typical hyperfluorescent nodules in the early phase of indocyanine green angiography. Although the classical clinical presentation is recurrent serosanguinous detachment of the retinal pigment epithelium, it may present with clinical features indistinguishable from exudative age-related macular degeneration secondary to choroidal neovascularization. Some cases may present initially with submacular haemorrhage, but later with features of exudative age-related macular degeneration. Studying the associated network of vessels using confocal scanning laser ophthalmoscopy indocyanine green dynamic angiography revealed in many cases feeder vessels, branching pattern, and leakage similar to choroidal neovascularization. Owing to the overlap of clinical and angiographic features, it may be considered as a vascular subtype of exudative age-related macular degeneration. However, having seemingly better natural history, better response to photodynamic therapy, and incomplete response to anti-vascular endothelial growth factor therapy suggests that it should be studied as a separate entity from choroidal neovascularization. Combining angio-occlusion of the polyps using photodynamic therapy and anti-permeability effect of anti-vascular endothelial growth factor therapy on the branching vascular network may provide a synergistic effect. We await the result of EVEREST trial, a multi-centre randomized controlled trial comparing photodynamic therapy, with or without ranibizumab, with ranibizumab monotherapy.
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Enfermedades de la Coroides/patología , Coroides/irrigación sanguínea , Enfermedades Vasculares Periféricas/patología , Anticuerpos Monoclonales/uso terapéutico , Anticuerpos Monoclonales Humanizados , Enfermedades de la Coroides/diagnóstico , Enfermedades de la Coroides/tratamiento farmacológico , Angiografía con Fluoresceína , Humanos , Factores Inmunológicos/uso terapéutico , Verde de Indocianina/uso terapéutico , Degeneración Macular/tratamiento farmacológico , Degeneración Macular/patología , Enfermedades Vasculares Periféricas/diagnóstico , Enfermedades Vasculares Periféricas/tratamiento farmacológico , Fotoquimioterapia/métodos , Pólipos/diagnóstico , Ranibizumab , Retina/patología , Factores de Crecimiento Endotelial Vascular/antagonistas & inhibidoresRESUMEN
AIMS: To evaluate the safety, visual outcome and complications of manual small incision cataract surgery (MSICS) in the treatment of patients with brunescent and black cataract (BBC). METHODS: In a non-randomised interventional case series, 102 consecutive patients with BBC underwent cataract extraction by MSICS, with staining of the anterior capsule by trypan blue. RESULTS: Of the 102 eyes with BBC, MSICS was performed through superior scleral tunnel (SST) in 31 eyes (30.4%) and through temporal scleral tunnel (TST) in 71 eyes (69.6%). The main intraoperative complication was posterior capsule rupture in two patients (2.0%). Postoperatively, 20 eyes (19.6%) developed corneal oedema. Mild iritis was seen in six eyes (5.9%) and moderate iritis with fibrin membrane formation occurred in three eyes (2.9%). On the 40th postoperative day, 80 patients (78.4%) achieved uncorrected visual acuity of 6/18 or better, and 99 (97.1%) had best-corrected visual acuity of 6/18 or better. Patients in the SST group had significantly higher postoperative astigmatism compared to those in the TST group (-1.08 D vs -0.72 D, P=0.017). CONCLUSION: MSICS with trypan blue staining of the anterior capsule is a safe and effective method of cataract extraction for patients with BBC.
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Extracción de Catarata/métodos , Adulto , Anciano , Anciano de 80 o más Años , Catarata/patología , Extracción de Catarata/efectos adversos , Colorantes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Azul de Tripano , Agudeza VisualRESUMEN
PURPOSE: To review the outcomes of 23-gauge transconjunctival vitrectomy in patients with postoperative endophthalmitis. METHODS: Non-randomized, interventional case series of patients with postoperative endophthalmitis over a 1-year period. RESULTS: 23-gauge transconjunctival vitrectomy was performed on 6 patients with a mean age of 67.7 years without intraoperative or postoperative complications. There were no cases of postoperative hypotony or wound leak. The mean change in IOP was -4.2 mmHg compared to the preoperative IOP (P=0.239). Final VA improved significantly compared to preoperative VA (P=0.062), with VA of at least 20/40 in 5 of 6 patients (83.3%). CONCLUSIONS: 23-gauge transconjunctival vitrectomy is a useful technique for treating postoperative endophthalmitis.
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Endoftalmitis/cirugía , Agudeza Visual/fisiología , Vitrectomía/métodos , Cuerpo Vítreo/cirugía , Anciano , Anciano de 80 o más Años , Endoftalmitis/etiología , Endoftalmitis/microbiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Técnicas de Sutura , Vitrectomía/efectos adversosRESUMEN
PURPOSE: To describe what patients expect to see and the visual sensations they actually experience during phacoemulsification under topical anaesthesia. We also sought to determine if patients find their intraoperative visual experience frightening and the factors associated with this. MATERIALS AND METHODS: Ninety-eight patients who underwent phacoemulsification and intraocular lens implantation under topical anaesthesia were interviewed preoperatively on what they expected to see with their operated eye during surgery and again postoperatively on what they actually saw. No patient received counselling about possible intraoperative visual sensations. A logistic (multivariate) regression model was used for statistical analysis. RESULTS: Preoperatively, 36 patients (36.7%) expected at least light perception, 38 (38.8%) expected no light perception, and 24 (24.5%) were unsure what to expect. Some patients also expected a variety of different visual sensations. Postoperatively, all patients (100%) reported seeing light intraoperatively and many experienced various other visual sensations. Nineteen patients (19.4%) found their visual experience frightening. The following factors were statistically associated with a frightening visual experience: preoperative anxiety, previous cataract surgery in the fellow eye, experiencing an intraoperative increase in clarity, not seeing movement intraoperatively, and not knowing what to expect. CONCLUSIONS: The majority of patients in this study either expected that they would see nothing at all during the surgery or were unsure of what to expect. All patients subsequently saw at least some light, and many perceived various other visual sensations that were frightening to nearly one in five patients. Preoperative counselling should inform about possible intraoperative visual experience.
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Anestesia Local , Actitud Frente a la Salud , Facoemulsificación , Percepción Visual , Adulto , Anciano , Anciano de 80 o más Años , Ansiedad/psicología , Consejo , Miedo/psicología , Femenino , Humanos , Periodo Intraoperatorio , Implantación de Lentes Intraoculares , Masculino , Persona de Mediana Edad , Educación del Paciente como Asunto , Cuidados Preoperatorios/métodos , Factores de RiesgoRESUMEN
BACKGROUND AND OBJECTIVE: To assess the knowledge, beliefs and attitudes of anaesthesia providers on the patients' possible intraoperative visual experiences during cataract surgery under local anaesthesia. METHODS: Anaesthesia providers from the Ophthalmic Anaesthesia Society (USA); British Ophthalmic Anaesthesia Society (UK); Alexandra Hospital, National University Hospital, Tan Tock Seng Hospital, Singapore General Hospital and Changi General Hospital (Singapore) were surveyed using a structured questionnaire. RESULTS: A total of 146 anaesthesiologists (81.6%), 10 ophthalmologists (5.6%) and 23 nurse anaesthetists (12.8%) responded to the survey. Most respondents believed that patients would experience light perception and many also felt that patients might encounter other visual sensations such as movements, flashes, colours, surgical instruments, hands/fingers and the surgeon during the surgery. A significantly higher proportion of anaesthesia providers with previous experience of monitoring patients under topical anaesthesia believed that patients might experience the various visual sensations compared to those who have not previously monitored. For both topical and regional anaesthesia, anaesthesia providers who routinely counsel their patients are (1) more likely to believe that preoperative counselling helps or (2) were previously told by patients that they could see intraoperatively and/or that they were frightened by their visual sensations. These findings were statistically significant. CONCLUSIONS: The majority of anaesthesia providers in the USA, UK and Singapore are aware that patients may experience a variety of visual sensations during cataract surgery under regional or topical anaesthesia. Those who have previously managed patients undergoing cataract surgery under topical anaesthesia are more likely to believe this compared to those who have not.
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Anestesiología , Actitud del Personal de Salud , Extracción de Catarata , Recolección de Datos , Conocimientos, Actitudes y Práctica en Salud , Periodo Intraoperatorio , Percepción Visual , Administración Tópica , Anestesia de Conducción , Distribución de Chi-Cuadrado , Femenino , Humanos , Masculino , Singapur , Reino Unido , Estados UnidosRESUMEN
OBJECTIVES: To describe the epidemiology of pterygium among residents of an island in Indonesia and to examine the roles of age and gender as determinants of bilaterality and severity of the disease. METHODS: Voluntary eye screening on Pulau Jaloh, Riau Archipelago, Indonesia. Gender difference was tested using the chi2 test. The difference in age between subjects with and without disease was tested using unpaired Student's t-test. Odds ratio (relative risk) for gender was calculated using logistic regression model with adjustment for age. RESULTS: Of the 550 inhabitants, 477 (86.7%) responded to the eye screening. The overall prevalence rate of pterygium was 17.0%. Out of 211, 48 male (22.7%) and 33 out of 266 female subjects (12.4%) had the disorder, with the gender difference being statistically significant. Adjusted for age, the risk of disease was 3.1-fold higher among the males. In all, 71.6% of subjects with pterygium had bilateral disease. Subjects with pterygium were significantly older, their mean age being 42.9 years compared to 18.7 years among those without disease. The prevalence rates in male subjects increased from age 20 to reach a plateau of 63.6% at age 35 and remained stable thereafter. In the female subjects, the rates also increased with age, albeit at a slower rate, from age 20 to reach a plateau of 46.7% at age 55 and remained stable thereafter. CONCLUSIONS: There is a high prevalence rate of pterygium among the study subjects, with the rates increasing rapidly with age.
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Pterigion/epidemiología , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Humanos , Indonesia/epidemiología , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Prevalencia , Distribución por SexoRESUMEN
INTRODUCTION: To describe the unusual manifestation of a giant frontal sinus mucocele. CLINICAL PICTURE: A 33-year-old female presented with blurring of vision in the left eye, periorbital swelling and a painless forehead mass. There was proptosis, partial ptosis, and an elongated, soft, subcutaneous mass over the left side of the forehead. CT scan showed a mass arising from the frontal sinus with both intraorbital and intracranial extension. TREATMENT: Surgical excision of the mass confirmed the diagnosis of a mucocele. OUTCOME: Postoperatively, the patient was asymptomatic. CONCLUSIONS: A subcutaneous soft-tissue mass may be the presenting complaint of a frontal mucocele. Careful examination of the surrounding skin may suggest the diagnosis of sinus-related disease and thus direct appropriate investigations.