RESUMEN
OBJECTIVE: To investigate trends in terms of number and cost of intravitreal injection, photocoagulation and panphotocoagulation procedures performed by the Brazilian Public Health System, from 2010 to 2019. METHODS: The Brazilian Public Health System Database was used as the primary source of data. Intravitreal injection, photocoagulation and panphotocoagulation procedures performed from 2010 to 2019 were investigated. Procedure prevalence and cost trends were analyzed according to year and region. Annual trends were examined using generalized linear models, with a significance level of 5% (p=0.05). RESULTS: There was a significant increase in the prevalence of intravitreal injections (1,088%), panphotocoagulation (51%) and photocoagulation (37%) procedures from 2010 to 2019. Intravitreal injections accounted for the most significant increase. However, costs were not significantly readjusted over the years. CONCLUSION: Over a 10-year period, there was a significant increase in the number of procedures associated with retinal disorders. Procedure costs saw little readjustments over time. In spite of limitations, inaccuracies and lack of details, the Brazilian Public Health System Database is the primary source of data for the Public Health System related research in Brazil, and can contribute with information on ocular health and costs of ophthalmic procedures.
Asunto(s)
Salud Pública , Enfermedades de la Retina , Brasil/epidemiología , Humanos , Inyecciones Intravítreas , Enfermedades de la Retina/epidemiología , Enfermedades de la Retina/terapiaRESUMEN
ABSTRACT: Gene therapy offers the potential to treat inherited retinal disorders and deliver sustained therapy for acquired retinal diseases. In the latter case, host cells can be harnessed to produce non-native proteins that have beneficial properties, such as antivascular endothelial growth factor activity, transforming the eye into an ocular "biofactory." Several gene therapy programs have entered clinical testing for delivery to the vitreous, subretinal, and suprachoroidal space. Improved viral vectors and refined surgical techniques are critical to successful delivery of therapeutic products to the target tissue. In this review, we discuss the development of gene therapy products aimed at acquired retinal diseases and the surgical techniques utilized to achieve targeted delivery.
Asunto(s)
Terapia Genética , Enfermedades de la Retina , Vectores Genéticos , Humanos , Retina , Enfermedades de la Retina/cirugía , Enfermedades de la Retina/terapiaRESUMEN
ABSTRACT Objective: To investigate trends in terms of number and cost of intravitreal injection, photocoagulation and panphotocoagulation procedures performed by the Brazilian Public Health System, from 2010 to 2019. Methods: The Brazilian Public Health System Database was used as the primary source of data. Intravitreal injection, photocoagulation and panphotocoagulation procedures performed from 2010 to 2019 were investigated. Procedure prevalence and cost trends were analyzed according to year and region. Annual trends were examined using generalized linear models, with a significance level of 5% (p=0.05). Results: There was a significant increase in the prevalence of intravitreal injections (1,088%), panphotocoagulation (51%) and photocoagulation (37%) procedures from 2010 to 2019. Intravitreal injections accounted for the most significant increase. However, costs were not significantly readjusted over the years. Conclusion: Over a 10-year period, there was a significant increase in the number of procedures associated with retinal disorders. Procedure costs saw little readjustments over time. In spite of limitations, inaccuracies and lack of details, the Brazilian Public Health System Database is the primary source of data for the Public Health System related research in Brazil, and can contribute with information on ocular health and costs of ophthalmic procedures.
RESUMO Objetivo: Investigar as tendências dos números e dos custos dos procedimentos de injeção intravítrea, fotocoagulação e panfotocoagulação realizados pelo Sistema Único de Saúde brasileiro, no período de 2010 a 2019. Métodos: Foram extraídos dados do Departamento de Informática do Sistema Único de Saúde acerca dos atendimentos associados aos procedimentos de injeção intravítrea, fotocoagulação e panfotocoagulação, realizados de 2010 a 2019. A prevalência de procedimentos e os custos foram analisados por ano e por região de atendimento. As tendências ao longo dos anos foram avaliadas por meio de modelos lineares generalizados. Valores de p=0,05 foram considerados estatisticamente significantes. Resultados: Em relação aos procedimentos específicos, houve aumento nas frequências de injeção intravítrea (1.088%), panfotocoagulação (51%) e fotocoagulação (37%), no comparativo de 2010 a 2019. A injeção intravítrea foi o procedimento que apresentou maior crescimento ao longo dos anos, porém não houve reajuste de custo significativo durante o período estudado. Conclusão: Ao longo de 10 anos, houve aumento significativo do número de atendimentos associados aos tratamentos de distúrbios da retina. Os custos relacionados aos procedimentos mostraram pouco reajuste ao longo dos anos. Embora o Departamento de Informática do Sistema Único de Saúde apresente algumas limitações, como imprecisões e falta de detalhamento em alguns procedimentos, esta é a ferramenta de dados disponível no Brasil para o acesso a pesquisa relacionada ao Sistema Único de Saúde e pode contribuir com informações da saúde ocular e os custos dos procedimentos.
Asunto(s)
Humanos , Enfermedades de la Retina/terapia , Enfermedades de la Retina/epidemiología , Salud Pública , Brasil/epidemiología , Inyecciones IntravítreasRESUMEN
RESUMEN Presentamos el caso de un paciente con foseta del disco óptico, quien presentó una disminución de la agudeza visual secundaria a desprendimiento seroso de retina. Se decidió realizar una inyección intravítrea de 0.3ml de gas C3F8 (100%), seguida de fotocoagulación con láser de argón en el borde temporal de la foseta, logrando reaplicación total de la retina, con reabsorción de todo el líquido subretiniano visible en la tomografía de coherencia optica (OCT) luego de 400 días. Además hubo una mejoría significativa en la agudeza visual.
ABSTRACT We present the case of a patient with an optic disk pit, presenting with great loss of visual acuity secondary to serous retinal detachment. The management chosen was an intravitreal injection of 0.3 mL of C3F8 (100%), followed by argon laser photocoagulation on the temporal edge of the pit, ), achieving total retinal reattachment , and reabsorption of all subretinal fluid visible at optical coherence tomography after 400 days, in addition to great improvement in visual acuity.
Asunto(s)
Humanos , Femenino , Anciano , Disco Óptico/anomalías , Enfermedades de la Retina/terapia , Desprendimiento de Retina , Anomalías del Ojo/terapia , Endotaponamiento/métodos , Fluorocarburos/administración & dosificación , Fotocoagulación , Degeneración Macular/terapia , Argón , Enfermedades de la Retina/diagnóstico , Anomalías del Ojo/diagnóstico , Tomografía de Coherencia Óptica , Inyecciones Intravítreas , Mácula Lútea , Degeneración Macular/diagnósticoRESUMEN
Incontinentia pigmenti is a rare neurocutaneous disorder with a frequency of 1 in 40,000 newborn; it is associated with mutations in IKBKG gene in Xq28, inherited as an X-linked dominant trait. Clinical manifestations detected since the newborn period are highly variable, with skin, teeth, eyes, and nervous system manifestations, and each with a characteristic differential diagnosis. We present a pediatric patient diagnosed with incontinentia pigmenti at the first week of life. In the initial ophthalmologic evaluation, retinal vascular lesions were observed. The outcomes of laser treatment of the ischemic peripheral retina were good and resulted in stability of vision.
La incontinencia pigmenti es un trastorno neurocutàneo raro, con una frecuencia de 1 en 40 000 recién nacidos, de etiología genética asociada a mutaciones en el gen IKBKG, localizado en Xq28, con herencia dominante ligada al X. Tiene una presentación clínica de manifestaciones muy variables detectadas desde la etapa neonatal y puede asociar afectación cutànea, dental, ocular y neurológica, y cada una de estas con un diagnóstico diferencial distinto. Se presenta a una paciente pediàtrica con diagnóstico de incontinencia pigmenti a la semana de vida. En la evaluación oftalmológica inicial, se observaron lesiones vasculares retinianas. Se decidió el tratamiento con làser, con buenos resultados, y se consiguió estabilizar la visión.
Asunto(s)
Incontinencia Pigmentaria/complicaciones , Terapia por Láser/métodos , Enfermedades de la Retina/terapia , Diagnóstico Diferencial , Femenino , Humanos , Incontinencia Pigmentaria/diagnóstico , Recién Nacido , Enfermedades de la Retina/diagnóstico , Enfermedades de la Retina/etiología , Resultado del TratamientoRESUMEN
Resumo Um traumatismo ocular contuso pode gerar uma vasta gama de lesões intraoculares que são dependentes da quantidade de energia que o objeto transfere ao olho durante o impacto. As lesões da íris, malha trabecular e corpo ciliar podem repercutir na drenagem do humor aquoso. A ocorrência de uma ciclodiálise caracterizada pelo descolamento do corpo ciliar da parede escleral, criando uma comunicação entre a câmara anterior e o espaço supracoroidiano, pode provocar importante redução da pressão intraocular. Esta diminuição pressórica é a responsável pela ocorrência da maculopatia hipotônica que pode cursar com diminuição irreversível da acuidade visual. Não existe consenso na literatura sobre o tratamento das ciclodiálises. Neste relato, descrevemos um caso de ciclodiálise traumática pós impacto com projétil de arma de fogo tratada com aplicação de laser de argônio.
Abstract Blunt eye trauma can generate a wide range of intraocular lesions that are dependent on the amount of energy the object transfers to the eye during the impact. Lesions of the iris, trabecular meshwork and ciliary body may influence aqueous humor drainage. The cyclodialysis which is characterized by the detachment of ciliary body from the scleral wall, creating a communication between the anterior chamber to supracoroid space, can cause a several reduction of intraocular pressure. This pressure decrease is responsible for the occurrence of hypotonic maculopathy which may induce a severe impact on visual acuity. There is no consensus in the literature about cyclodialysis treatment. In this report, we describe a case of traumatic cyclodialysis after impact with a firearm projectile treated with argon laser photocoagulation.
Asunto(s)
Humanos , Femenino , Adulto , Enfermedades de la Retina/etiología , Heridas por Arma de Fuego/complicaciones , Hipotensión Ocular/etiología , Lesiones Oculares/complicaciones , Oftalmoscopía , Retina/diagnóstico por imagen , Enfermedades de la Retina/terapia , Enfermedades de la Retina/diagnóstico por imagen , Hemorragia Vítrea , Agudeza Visual , Hipotensión Ocular/terapia , Cuerpo Ciliar , Ultrasonografía , Coagulación con Láser/métodos , Tomografía de Coherencia Óptica , Párpados/lesiones , Microscopía con Lámpara de Hendidura , Gonioscopía , Mácula Lútea/diagnóstico por imagenRESUMEN
Objetivo: Exponer la experiencia local sobre el tratamiento de las enfermedades retinales con terapias anti factor de crecimiento endotelial vascular (anti-VEGF) y crear conciencia en relación con la atención centrada en el paciente reconociendo el papel de los médicos especialistas en la determinación del tratamiento más apropiado basado principalmente en la evidencia científica, pero también teniendo en cuenta la experiencia y práctica exitosas en el manejo de cada paciente, con base en sus características únicas e individuales. Método: Revisión y comparación de la literatura científica con la experiencia de los autores, en el diagnóstico y tratamiento de las enfermedades que involucran inyecciones intraoculares, haciendo especial énfasis en la degeneración macular relacionada con la edad neo vascular (DMRE-NV), el edema macular diabético (EMD), la retinopatía diabética (RD), edema macular por oclusión venosa de rama de vena central de la retina (ORVR), la oclusión de vena central de la retina (OVCR) y la neo vascularización sub retiniana asociada a miopía patológica (MP). Resultados: la revisión realizada reafirma que tanto cuando hablamos de clases de medicamentos, de algoritmos de tratamiento o de perfiles de paciente, los diferentes agentes de una misma clase terapéutica pueden tener eficacias o perfiles de seguridad variables. Se debe considerar la importancia clínica que representa la valoración adecuada de los resultados pos tratamiento, pero sobre todo, la selección cuidadosa para determinar el agente y esquema más apropiado en la intención de tratar a un paciente. Si bien existen recomendaciones y guías de tratamiento para las patologías, los protocolos en el manejo individualizado y la exposición de estas experiencias de vida real se hacen necesarios, ya que no todos los pacientes ni todas las enfermedades de la retina responden de igual forma a cada agente terapéutico. Conclusión: La efi cacia y seguridad en el uso de las terapias anti-VEGF son aspectos de suma importancia cuando se trata de proporcionar una atención verdaderamente centrada en el paciente. No hay ninguna solución, intervención o alternativa terapéutica que se ajuste a todas las enfermedades oculares complejas, por lo que es importante hacer un balance que considere la evidencia disponible, la experiencia, y las expectativas de los pacientes y tratantes. Esto permitirá acceder a las alternativas terapéuticas adecuadas, en el momento adecuado siempre teniendo en mente los perfiles de eficacia, seguridad, farmacovigilancia activa y los costos asociados a las alternativas terapéuticas utilizadas en el país.
Purpose: To display local experience on treatment for retinal diseases with anti-Vascular Endothelial Growth Factor (anti-VEGF) therapies and to raise awareness regarding patient-centered care, recognizing the role of medical specialists in determining the most appropriate treatment mainly based on scientific evidence, but also considering the successful experience and practice handling each patient, based on their unique and individual characteristics. Method: Review and comparison of scientific literature according to the authors experience to diagnose and treat diseases involving intraocular injections, focusing on Neovascular Age-related Macular Degeneration (NV-AMD), Diabetic Macular Edema (DME), Diabetic Retinopathy (DR), Macular Edema due to Branch Retinal Vein Occlusion (BRVO), Central Retinal Vein Occlusion (CRVO) and Sub-retinal Neovascularization associated with Pathological Myopia (PM). Results: the review confi rms that, when speaking of drug classes, treatment algorithms or patient profi les, diff erent agents of the same therapeutic class can result in variable efficacies or safety profiles. The clinical relevance represented by the adequate assessment of post-treatment results must be considered, but specially, the careful screening to determine the most appropriate agent and regimen in the intention-to-treat a patient. Th ough recommendations and treatment guidelines for pathologies exist, protocols in individualized management and exposure of these real-life experiences are necessary, since not all patients or all retinal diseases respond in the same way to each therapeutic agent. Conclusion: Efficacy and safety using anti-VEGF therapies are extremely important when it comes to providing truly patient-centered care. There is no therapeutic solution, intervention or alternative that fi ts all complex ocular diseases, so it is important to weigh the available evidence, the experience and the expectations of both patients and prescribers. Th is will allow to get access to the appropriate therapeutic alternatives, in a timely manner, always considering the efficacy and safety profiles, active pharmacovigilance and the costs associated with the therapeutic alternatives used locally.
Asunto(s)
Enfermedades de la Retina/terapia , Educación de Personas con Discapacidad Visual , Oftalmopatías/terapia , Inyecciones Intraoculares , Factor A de Crecimiento Endotelial Vascular/uso terapéuticoRESUMEN
Summary Hemoglobinopathies are a group of hereditary diseases that cause quantitative or qualitative changes in the shape, function or synthesis of hemoglobin. One of the most common is sickle cell anemia, which, due to sickling of erythrocytes, causes vaso-occlusive phenomena. Among the possible ocular manifestations, the most representative is retinopathy, which can lead to blindness if left untreated. Therefore, periodic ophthalmologic monitoring of these patients is important for early diagnosis and adequate therapeutic management, which can be done localy by treating the lesions in the eyes, or systemically.
Resumo As hemoglobinopatias são um grupo de doenças hereditárias que causam alterações quantitativas ou qualitativas no formato, na função ou na síntese de hemoglobinas. Uma das mais comuns é a anemia falciforme, cuja patogenia é a foicização das hemácias, causando fenômenos vaso-oclusivos. Dentre as manifestações oculares possíveis, a mais representativa é a retinopatia, que pode levar à cegueira caso não seja tratada. Por isso, é importante que haja o acompanhamento oftalmológico periódico desses pacientes, a fim de obter diagnóstico precoce e abordagem terapêutica adequada. Esta última pode ser de maneira direta, com tratamento das lesões oculares, ou de forma sistêmica.
Asunto(s)
Humanos , Enfermedades de la Retina/etiología , Anemia de Células Falciformes/complicaciones , Enfermedades de la Retina/diagnóstico , Enfermedades de la Retina/terapia , Vasos Retinianos , Hemoglobina Falciforme/análisis , Angiografía con Fluoresceína , Anemia de Células Falciformes/diagnóstico , Anemia de Células Falciformes/terapiaRESUMEN
INTRODUCTION: Retinal dystrophies (RDs) are the most common cause of inherited blindness and one of the most genetically heterogeneous human diseases. RDs arise from mutations in genes involved in development and function of photoreceptors or other retinal cells. Identification of the genetic defect causing RD allows accurate diagnosis, prognosis, and counseling in affected patients. Molecular diagnosis is a tremendous challenge in RDs due to their locus and phenotypic heterogeneity. As conventional DNA sequencing approaches are impractical in such situation, Next Generation Sequencing (NGS)-based protocols are needed to identify RD-causing mutations. This is being accomplished by sequencing RD gene panels or by whole exome or whole genome sequencing approaches. Areas covered: This review discusses the current strategies for molecular diagnosis in RDs including their advantages and limitations, as well as their utility in diagnosis of non-syndromic versus syndromic RDs. Results of ongoing gene therapy protocols in RDs are also presented. Expert commentary: Molecular diagnosis in RD improves the medical management of patients. Importantly, demand for molecular screening for RDs is greatly expanding not only as a result of increasing development and availability of NGS technologies, but also of the growing number of gene-based clinical trials offering a potential treatment to patients.
Asunto(s)
Enfermedades Genéticas Congénitas/diagnóstico , Enfermedades Genéticas Congénitas/genética , Técnicas de Diagnóstico Molecular , Enfermedades de la Retina/diagnóstico , Enfermedades de la Retina/genética , Animales , Tratamiento Basado en Trasplante de Células y Tejidos/métodos , Estudios de Asociación Genética/métodos , Enfermedades Genéticas Congénitas/terapia , Predisposición Genética a la Enfermedad , Terapia Genética/métodos , Secuenciación de Nucleótidos de Alto Rendimiento , Humanos , Reproducibilidad de los Resultados , Enfermedades de la Retina/terapia , Trasplante de Células Madre/métodosRESUMEN
Hemoglobinopathies are a group of hereditary diseases that cause quantitative or qualitative changes in the shape, function or synthesis of hemoglobin. One of the most common is sickle cell anemia, which, due to sickling of erythrocytes, causes vaso-occlusive phenomena. Among the possible ocular manifestations, the most representative is retinopathy, which can lead to blindness if left untreated. Therefore, periodic ophthalmologic monitoring of these patients is important for early diagnosis and adequate therapeutic management, which can be done localy by treating the lesions in the eyes, or systemically.
Asunto(s)
Anemia de Células Falciformes/complicaciones , Enfermedades de la Retina/etiología , Anemia de Células Falciformes/diagnóstico , Anemia de Células Falciformes/terapia , Angiografía con Fluoresceína , Hemoglobina Falciforme/análisis , Humanos , Enfermedades de la Retina/diagnóstico , Enfermedades de la Retina/terapia , Vasos RetinianosRESUMEN
Any of the various layers of the eye may suffer injury in systemic lupus erythematosus, ranging from keratoconjunctivitis sicca to retinopathy and optic neuritis. Rheumatologists must always be aware of ocular involvement in those patients since rapid diagnosis and a prompt intervention in those severe cases can prevent visual loss or even irreversible blindness. We present here the case of a 14-year-old girl who, despite a short period of disease, developed chorioretinopathy with transitory visual impairment with a good treatment response.
Asunto(s)
Enfermedades de la Coroides/etiología , Lupus Eritematoso Sistémico/complicaciones , Enfermedades de la Retina/etiología , Trastornos de la Visión/etiología , Adolescente , Edad de Inicio , Enfermedades de la Coroides/patología , Enfermedades de la Coroides/terapia , Femenino , Humanos , Enfermedades de la Retina/patología , Enfermedades de la Retina/terapia , Factores de Tiempo , Trastornos de la Visión/terapiaRESUMEN
Objetivo: determinar la tendencia de uso de medicamentos AntiVEGF en las patologías oftalmológicas en la Clínica de Oftalmología de Cali y comparar con otros escenarios nacionales. Metodología: se realizó un estudio descriptivo que determinó la tendencia de uso de AntiVEGF en la Clínica de Oftalmología de Cali. Se construyeron indicadores sobre el número de inyecciones ordenadas por cada 100 consultas de oftalmología y se determinó la tendencia de aplicación por cada tipo de AntiVEGF, en el periodo 2013-2014. Basados en los datos de ventas por Lucentis por ciudad, se construyeron indicadores proxy similares para las otras ciudades, teniendo en cuenta las poblaciones mayores de 35 años proyectadas para las ciudades por el DANE. Los datos se expresan en tasas por 100.000 habitantes. La comparación de tasas se realizó por el método indirecto. Adicionalmente se realizó una revisión documental sobre los costos de los medicamentos AntiVEGF y las disposiciones legales y normativas sobre su uso en Colombia. Estos se presentan de forma descriptiva. Resultados: se encontró que la tendencia de uso de AntiVEGF está en aumento, con una frecuencia de 8 indicaciones de AntiVEGF por cada 100 consultas por retinólogo. En 2013 fue de 7 por cada 100 consultas que aumentó a 9 por cada 100 consultas en el año 2014. Existe una tendencia creciente de aplicar 2 inyecciones más de AntiVEGF por cada mes transcurrido El Avastin mantiene una tendencia estable con escasas variaciones Existe una variación importante en la tasa de inyecciones por 100.000 habitantes entre las diferentes ciudades en Colombia. Conclusiones: hay una tendencia al aumento del uso de medicamentos AntiVEGF intravitreos, con el consecuente gasto en salud asociado. Esto necesariamente afecta los recursos del Sistema general de Seguridad Social en Salud de Colombia, por lo que es importante conocer adecuadamente las indicaciones y el costo-beneficio del tratamiento, no sólo en términos del individuo, sino en términos de la comunidad.
Objective: to determine trend of use of anti VEGF in eye diseases in an ophthalmology clinic in Cali and compare with other national settings. Methodology: a descriptive study that determined the use of anti-VEGF trend in Clínica de Oftalmología de Cali was conducted. Indicators on the number of injections per 100 ophthalmology visits and trend of application for each type of anti-VEGF was determined, in the period 2013-2014. Based in sales data by a pharmacological company, proxy indicators were built to compare with other cities, considering population above 35 years old acording to DANE projections. Data are expressed in rates per 100,000 inhabitants rates comparison was performed by the indirect method. Additionally a literature review on the costs of the anti-VEGF drugs and the laws and regulations on its use in Colombia was made. These are presented descriptively. Results: It was found that the anti-VEGF's trend is increasing, with a frequency of 8 indications of antiVEGF per 100 consultations by retina specialist. In 2013 it was 7 indications per 100 consultations and increased to 9 indications per 100 consultations in 2014. There is a growing tendency to apply two more injections of anti-VEGF for each month elapsed. Avastin maintained a stable trend with few variations There is considerable variation injection rate per 100,000 among different cities in Colombia. Conclusions: There is a trend towards increased use of intravitreal anti-VEGF drugs, with consequent associated health spending. This necessarily affects the resources of the General System of Social Security in Health of Colombia, so it is important to properly understand the indications and the cost-benefit of treatment, not only in terms of the individual, but in terms of the community.
Asunto(s)
Oftalmopatías/terapia , Inyecciones Intraarteriales/tendencias , Preparaciones Farmacéuticas/administración & dosificación , Preparaciones Farmacéuticas/normas , Enfermedades de la Retina/terapiaRESUMEN
En los últimos años se han publicado algunos artículos que plantean las posibilidades que puede aportar el uso de la terapia celular para el tratamiento de ciertas retinopatías. El presente trabajo pretende comunicar la factibilidad y seguridad de la implantación de células madre en pacientes con degeneraciones de retina, como la retinosis pigmentaria y la degeneración macular seca relacionada con la edad, a partir de un estudio preliminar, realizado en pacientes atendidos en la consulta de oftalmología del Hospital General Docente Dr. Ernesto Guevara de La Serna, en la provincia de Las Tunas, Cuba. Los mismos fueron tratados con implantación de células madre adultas autólogas, procedentes de la médula ósea, y movilizadas a la sangre periférica mediante el factor estimulador de colonias de granulocitos. Se hizo aplicación local por las vías retrobulbar y peribulbar en ambos ojos, e intravitrea sólo en el ojo más afectado. El resto de las células obtenidas se inyectó por vía endovenosa. Se trataron 30 pacientes en ambos ojos en el periodo de marzo a agosto del presente año. Las variables analizadas fueron: agudeza visual y complicaciones del método de implante. Se pudo comprobar que la mejoría visual en ellos fue en el ojo del triple implante, aplicación intravitrea. En ningún caso hubo reacciones adversas generales y se presentaron complicaciones locales en dos casos, debido a uveítis anterior ligera en un ojo, después del implante de células madre, con resolución a las 72 horas con colirios esteroideos. El estudio evidenció la seguridad del método aplicado y los resultados obtenidos son alentadores, pues crean nuevas perspectivas que pueden contribuir significativamente al tratamiento de estas retinopatías (AU)
In recent years there have been some articles that show the possibilities that the use of cell therapy can add to the treatment of certain retinopathies. This paper aims to report the feasibility and safety of stem cell implantation in patients with retinal degenerations, such as retinitis pigmentosa and dry macular degeneration related to age, starting from a preliminary study carried out in patients seen in the ophthalmology consultation of Dr. Ernesto Guevara de La Serna General Teaching Hospital in Las Tunas province, Cuba. They were treated with implantation of autologous adult stem cells from bone marrow and carried to the peripheral blood by the granulocyte colony-stimulating factor. Local application was made by retrobulbar and peribulbar pathways in both eyes and intra-vitreous only in the affected eye. The rest of the cells obtained were injected intravenously. 30 patients were treated in both eyes from March to August, this year. The variables analyzed were: visual acuity and complications of the implant method. It was proved that their visual improvement was in the eye of the triple implant, intra-vitreous application. No case showed general adverse reactions and local complications occurred only in two cases, due to slight anterior uveitis in one eye after the implantation of stem cells, and solved within 72 hours with steroid eye drops. The study evidenced the safety of the method used and the results obtained are encouraging, since they create new perspectives that can contribute significantly to the treatment of these retinopathies (AU)
Asunto(s)
Humanos , Células Madre , Retinitis Pigmentosa/terapia , Enfermedades de la Retina/terapiaRESUMEN
El desprendimiento de retina (DR) produce pérdida visual. El desgarro en herradura (DH) es la lesión retiniana mayormente asociada a los desprendimientos de retina y aparece con frecuencia en población. La fotocoagulación focal láser (FCF) de desgarros reduce el riesgo de presentar desprendimiento de retina, por tanto se debería realizar este tratamiento a las lesiones retinianas.
Retinal detachment produces visual loss. Horseshoe retinal tears is directly associated with retinal detachment and it is usually found in general population. Retinal laser photocoagulation signifi cantly reduces the incidence of retinal detachment.
Asunto(s)
Desprendimiento de Retina/terapia , Enfermedades de la Retina/terapia , Perforaciones de la Retina/terapia , Coagulación con Láser/métodosRESUMEN
Purpose: to describe one case of concomitance of sildenafil intake and Central Serous Chorioretinopathy (CSC) in a 29 years male. Considerations about evolution and treatment are presented as well as a revision of the carce literature found. Conclusion: concomitance between sildenafil and CSC is extremely rare, and as an adverse event can be classified just as "possible". Evidence reports are not statically significant for this association although there is plausible hipothesis to support it.
Asunto(s)
Enfermedades del Nervio Óptico/terapia , Enfermedades de la Retina/terapia , Desprendimiento de Retina/terapia , Oftalmopatías/terapiaRESUMEN
Distinct stem cell types have been established from embryos and identified in the fetal tissues and umbilical cord blood as well as in specific niches in many adult mammalian tissues and organs such as bone marrow, brain, skin, eyes, heart, kidneys, lungs, gastrointestinal tract, pancreas, liver, breast, ovaries, and prostate. All stem cells are undifferentiated cells that exhibit unlimited self-renewal and can generate multiple cell lineages or more restricted progenitor populations that can contribute to tissue homeostasis by replenishing the cells or to tissue regeneration after injury. The remarkable progress of regenerative medicine in the last few years indicates promise for the use of stem cells in the treatment of ophthalmic disorders. Experimental and human studies with intravitreal bone marrow-derived stem cells have begun. This paper reviews recent advances and potential sources of stem cells for cell therapy in retinal diseases.
Asunto(s)
Enfermedades de la Retina/terapia , Células Madre/citología , Células de la Médula Ósea/citología , Células Madre Embrionarias/citología , Células Madre Embrionarias/trasplante , Células Endoteliales/citología , Células Madre Hematopoyéticas/citología , Humanos , Células Madre Pluripotentes Inducidas/citología , Células Madre Pluripotentes Inducidas/trasplante , Células Madre Mesenquimatosas/citología , Medicina Regenerativa , Trasplante de Células MadreRESUMEN
One-third of asphyctic neonates develop long-term neurological injuries, including several degrees of ischemic proliferative retinopathy (IPR) such as retinopathy of prematurity (ROP). Given that the retina is altered by perinatal asphyxia, our aim was to study the effects of nitric oxide (NO) in the retina in order to analyze its impact on the retinal injury. Application of hypothermia was evaluated as preventive treatment. Sprague-Dawley rats were subjected to perinatal asphyxia [either at 37°C (PA group) or at 15°C (HYP group)]. Full-term rats were used as controls (CTL). A significantly increased activity of both constitutive NO synthase (nNOS, Ca(2+)-dependent) and inducible NO synthase (iNOS, Ca(2+)-independent) was observed in PA retinas from 21 days old up to 60 days old with respect to age-matched CTL, with a significant increase along the time course in the PA. nNOS was immunolocalized at amacrine, horizontal, and ganglion cells of the PA group, with a significant increase in relative optical density (R.O.D.), cellular area, and number of cells. iNOS immunoreactivity was observed in the inner nuclear layer and in the internal Müller cell processes of PA, with a significant increase in R.O.D. and colocalizing with GFAP in the 60-day-old PA group. Six nitrated protein species were increased in retinas from PA rats. Nitrotyrosine immunoreactivity showed a localization similar to that of iNOS, with increased R.O.D. in the PA group and colocalization with GFAP in 60-day-old animals. HYP prevented all the changes observed in PA rats. Although the NO system displays changes induced by hypoxia-ischemia, hypothermia application shows a strong protective effect.
Asunto(s)
Asfixia Neonatal/metabolismo , Hipotermia Inducida/métodos , Óxido Nítrico/antagonistas & inhibidores , Óxido Nítrico/fisiología , Retina/metabolismo , Enfermedades de la Retina/metabolismo , Animales , Asfixia Neonatal/fisiopatología , Asfixia Neonatal/terapia , Humanos , Recién Nacido , Masculino , Óxido Nítrico/metabolismo , Ratas , Ratas Sprague-Dawley , Retina/fisiopatología , Enfermedades de la Retina/fisiopatología , Enfermedades de la Retina/terapiaRESUMEN
Se realizó un estudio de evaluación de la eficacia terapéutica en 21 pacientes con retinosis pigmentaria asociada a glaucoma, atendidos en la Clínica de Retinosis Pigmentaria de Santiago de Cuba desde mayo del 2008 hasta igual mes del 2009. Los valores de agudeza visual, campo visual y tomografía del nervio óptico permitieron medir la eficacia de los tratamientos con ozono, magnetismo y electroestimulación, al comparar los resultados de las cuantificaciones visuales obtenidos al mes con los efectuados antes de iniciar la terapéutica. Prevalecieron el glaucoma crónico de ángulo abierto y la retinosis típica de herencia autosómica recesiva, así como los procedimientos consistentes en trabeculectomía y cirugía revitalizadora temporal, respectivamente, con mejorías o estabilidad del cuadro clinico, confirmadas a través de las modificaciones en los parámetros luego de aplicada la triple terapia. Se produjeron cambios favorables en la mayoría de los integrantes de la casuística(AU)
A study of evaluation of the therapeutic effectiveness in 21 patients with pigmentary retinosis associated to glaucoma was carried out. They were assisted in the Pigmentary Retinosis Clinic of Santiago de Cuba from May, 2008 to May, 2009. The values of visual acuity, visual field and tomography of the optic nerve allowed to measure the effectiveness of the treatments with ozone, magnetism and electrostimulation, when comparing the results of the visual quantifications obtained within a month with those made before beginning the therapy. The chronic glaucoma of open angle and the typical retinosis of autosomal recessive inheritance prevailed, as well as procedures such as trabeculectomy and revitalizing temporary surgery, respectively, with improvements or stability of the clinical pattern, confirmed through the modifications in the parameters after having applied the triple therapy. Favorable changes took place in most of the members of the case material(AU)