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BACKGROUND: Fibrin glue is an absorbable blood-derived product, a biological tissue adhesive which imitates the final stages of the coagulation cascade, it produces a firm clot, forming a seal along the whole length of the wound, the resultant fibrin clot degrades physiologically into granulation tissue 2 weeks after the application. Biological glue has been used extensively in many forms of surgical procedures. Its use in eye surgery has grown lately as we have evidence that showed it was effective in securing conjunctival grafts in pterygium surgery, in securing wounds after glaucoma surgery and more importantly in 20G and 23G vitrectomy. PURPOSE: The aim of this study is to present our experience in the use of fibrin glue in vitreoretinal surgery. MATERIAL AND METHODS: We included 281 eyes of 221 patients who underwent vitreoretinal surgery during the period of May 2009 to July 2012, the preoperative diagnoses were as following: proliferative diabetic retinopathy, rhegmatogenous retinal detachment, macular hole, epiretinal membrane, luxation of cataratous nucleous and cortex, intraocular lens luxation, penetrating trauma, silicone extraction, phaco + IOL + vitrectomy + Ahmed valve implant, vitreous biopsy and optic nerve pit associated to macular detachment. The procedures were performed with Alcon Accurus Surgical System 20-gauge, 23-gauge or a combination of both. We used fibrin glue in all of the 20-gauge sclerotomies and leaking 23-gauge sclerotomies, scleral wound for IOL extraction, conjunctival peritomy for buckle implantation, conjunctiva in Ahmed valve implant, corneal graft in corneal perforation in trauma and leaking corneal wounds for phacoemulsification, in an optic pit, and in subretinal space in a giant retinal tear. RESULTS: We did not use any suture in any of the patients throughout the different procedures, there was no leakage in any wounds in the postoperative period, we found no inflammatory reaction, infection, and whenever we had excess amount, it was trimmed. Two patients presented a small dehiscence of the wound that was corrected in-office with a small amount of fibrin glue in the post-operative period. CONCLUSIONS: Fibrin glue reduces surgical time, it is a good sealant, safe, with minimal allergic or toxic reactions and inflammation, minimizes bleeding, easy to undo and that eventually degrades. This small series shows that fibrin glue is a viable alternative for tissue coaptation in vitreoretinal surgery. However, further studies are required before fibrin glue takes the place of sutures.
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BACKGROUND: To assess the sensitivity, specificity, positive predictive value and negative predictive value of anterior chamber tap for the diagnosis of bacterial endophthalmitis on a population with high prevalence. METHODS: Retrospective, single centre, case series study. We reviewed all medical records with clinical diagnosis of bacterial endophthalmitis in our hospital from January 1st, 2000 to December 31st 2014. From each record, we documented general demographic data, best corrected visual acuity and vitreous and aqueous tap microbiological results. All cases were further divided according to the endophthalmitis aetiology to perform individual calculations of sensitivity, specificity, positive predictive value, negative predictive value, accuracy and prevalence. We used the results of the vitreous tap as the gold standard for diagnosis of bacterial endophthalmitis. We excluded those records in which the aqueous and vitreous samples were not taken simultaneously or had an incomplete microbiological report. Significance were assessed with chi squared statistics, with an alpha value of 0.05 for statistical significance. RESULTS: A total of 190 cases fulfilled the inclusion/exclusion criteria. Positive culture rate from vitreous samples was 64.74%. Positive culture rate from aqueous sample was 32.11%. Bacteria isolated from aqueous samples matched those isolated from vitreous samples 78.68% of the time. The overall sensitivity was 38.21%, specificity: 75.51%, positive predictive value: 79.66%, negative predictive value: 32.74% (p = 0.08). Subgroup analysis showed that anterior chamber taps in cases of post-surgical endophthalmitis had a moderate to low sensitivity (37.73%), high specificity (93%) and high positive predictive value (95%) (p < 0.04). CONCLUSION: The sensitivity and specificity of anterior chamber tap are low and should not be used for critical therapeutic decisions in patients with suspected bacterial endophthalmitis. In cases of post-surgical endophthalmitis, the result of an anterior chamber tap could be used for therapeutic guidance, but only in conjunction with clinical presentation and in the absence of a better method for diagnosis.
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AIM: To determine whether different intravitreal doses of quinupristin/dalfopristin lead to electroretinographic or histological changes in the rabbit retina over one month period after injection. METHODS: Eighteen New Zealand white rabbits were divided into three treatment groups (groups 1 to 3) and different intravitreal doses of quinupristin/dalfopristin were tested in each group. The right eye was injected with the drug and the left eye received intravitreal injection of 5% dextrose water and served as control eye. The doses delivered to each group were 0.1 mg/0.1 mL, 1 mg/0.1 mL and 10 mg/0.1 mL. Simultaneous, bilateral, dark-adapted electroretinography and clinical images of both eyes were obtained in all groups before injection (baseline) and after 7, 14, 21 and 28d, followed by enucleation for histological examination. RESULTS: Subjects in the group 1 showed no signs of toxicity in the electroretinogram when compared with groups 2 and 3 (Kruskall-Wallis test, P=0.000). By day 7, no electrical response to light stimuli was recorded in the treated eyes in groups 2 and 3, consistent with severe damage due to retinal toxicity. Light microscopy revealed no significant histopathological changes in the group 1, while rabbits in groups 2 and 3 had signs of granulomatous inflammation in most cases. CONCLUSION: Intravitreal 0.1 mg/0.1 mL doses of quinupristin/dalfopristin do not lead to electroretinographic or histological signs of retinal toxicity compared with 1 mg/0.1 mL and 10 mg/0.1 mL in this rabbit model.
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We reviewed all the available data regarding the current management of non-complex rhegmatogenous retinal detachment and aimed to propose a new decision-making algorithm aimed to improve the single surgery success rate for mid-severity rhegmatogenous retinal detachment. An online review of the Pubmed database was performed. We searched for all available manuscripts about the anatomical and functional outcomes after the surgical management, by either scleral buckle or primary pars plana vitrectomy, of retinal detachment. The search was limited to articles published from January 1995 to December 2015. All articles obtained from the search were carefully screened and their references were manually reviewed for additional relevant data. Our search specifically focused on preoperative clinical data that were associated with the surgical outcomes. After categorizing the available data according to their level of evidence, with randomized-controlled clinical trials as the highest possible level of evidence, followed by retrospective studies, and retrospective case series as the lowest level of evidence, we proceeded to design a logical decision-making algorithm, enhanced by our experiences as retinal surgeons. A total of 7 randomized-controlled clinical trials, 19 retrospective studies, and 9 case series were considered. Additional articles were also included in order to support the observations further. Rhegmatogenous retinal detachment is a potentially blinding disorder. Its surgical management seems to depend more on a surgeon´s preference than solid scientific data or is based on a good clinical history and examination. The algorithms proposed herein strive to offer a more rational approach to improve both anatomical and functional outcomes after the first surgery.
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PURPOSE: To evaluate ocular function and systemic development in premature infants treated with intravitreal bevacizumab injections for retinopathy of prematurity over a period of 5 years. METHODS: A prospective, interventional, noncomparative case study. The primary outcome measure was visual acuity. The secondary outcomes were structural assessment, other ocular functional measurements, and developmental state. RESULTS: Eighteen eyes of 13 consecutive patients were divided into 3 groups: Group 1, Stage 4 unresponsive to previous conventional treatment (n = 4); Group 2, in which conventional treatment was difficult or impossible because of inadequate visualization of the retina (n = 5); and Group 3, newly diagnosed high-risk prethreshold or threshold retinopathy of prematurity (n = 9). All patients showed initial regression of neovascularization. One patient was diagnosed with recurrence of neovascularization and was treated with intravitreal bevacizumab. Visual acuity was preserved, and median vision was 20/25 (excluding 2 operated eyes). Twelve eyes developed mainly low myopia over the years, with an overall mean value of 3.2 diopters. Electroretinograph was normal in 4 eyes that had no previous detachment. One patient showed delay in growth and neurodevelopment, whereas all the others were within the normal range. CONCLUSION: Five years of follow-up in a small series suggest that intravitreal bevacizumab for retinopathy of prematurity results in apparently preserved ocular function and systemic development.
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Inibidores da Angiogênese/uso terapêutico , Anticorpos Monoclonais Humanizados/uso terapêutico , Retinopatia da Prematuridade/tratamento farmacológico , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Bevacizumab , Biometria , Peso ao Nascer , Pré-Escolar , Eletrorretinografia , Feminino , Seguimentos , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Injeções Intravítreas , Masculino , Estudos Prospectivos , Recidiva , Refração Ocular/fisiologia , Neovascularização Retiniana/tratamento farmacológico , Neovascularização Retiniana/fisiopatologia , Retinopatia da Prematuridade/classificação , Retinopatia da Prematuridade/diagnóstico , Acuidade Visual/fisiologiaRESUMO
Retinal pathological angiogenesis is the leading cause of visual loss in a wide variety of ocular diseases. Some of the examples include: Age-related macular degeneration, diabetic retinopathy and retinopathy associated with prematurity. These last two entities are, in addition, public health problems in developing countries. Recent physiopathological studies, have demonstrated that growth factors play a key role on angiogenesis. Anti-angiogenic therapy came about as an attempt to inhibit the action of growth factors over the process of pathological angiogenesis in order to preserve vision. The objective of this review is to describe Mexico's experience using this therapeutic approach.
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Inibidores da Angiogênese/uso terapêutico , Neovascularização de Coroide/tratamento farmacológico , Neovascularização Retiniana/tratamento farmacológico , Algoritmos , Anticorpos Monoclonais/uso terapêutico , Anticorpos Monoclonais Humanizados , Bevacizumab , Humanos , MéxicoRESUMO
La angiogénesis patológica retiniana es la causa principal de pérdida visual en una gran cantidad de enfermedades: degeneración macular relacionada a la edad, retinopatía diabética y retinopatía del prematuro, en otras. Estas últimas dos son, además, problemas de salud pública en los países en desarrollo. Estudios recientes sobre la fisiopatología de estas enfermedades han demostrado el papel fundamental que los factores de crecimiento tienen sobre la angiogénesis. La terapia antiangiogénica ocular nació como un esfuerzo de inhibir la acción de estos factores sobre la angiogénesis patológica y preservar la visión. El objetivo de esta revisión es hacer un recuento de la experiencia en México en cuanto a esta modalidad terapéutica.
Retinal pathological angiogenesis is the leading cause of visual loss in a wide variety of ocular diseases. Some of the examples include: Age-related macular degeneration, diabetic retinopathy and retinopathy associated with prematurity. These last two entities are, in addition, public health problems in developing countries. Recent physiopathological studies, have demonstrated that growth factors play a key role on angiogenesis. Anti-angiogenic therapy came about as an attempt to inhibit the action of growth factors over the process of pathological angiogenesis in order to preserve vision. The objective of this review is to describe Mexico's experience using this therapeutic approach.
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Humanos , Inibidores da Angiogênese/uso terapêutico , Neovascularização Retiniana/tratamento farmacológico , Neovascularização de Coroide/tratamento farmacológico , Algoritmos , Anticorpos Monoclonais/uso terapêutico , MéxicoRESUMO
BACKGROUND: Central retinal vein occlusion (CRVO) is a common retinal vascular disorder with potentially complications: (1) persistent macular edema and (2) neovascular glaucoma. No safe treatment exists that promotes the return of lost vision. Eyes with CRVO may be predisposed to vitreous degeneration. It has been suggested that if the vitreous remains attached to the macula owing to a firm vitreomacular adhesion, the resultant vitreous traction can cause inflammation with retinal capillary dilation, leakage and subsequent edema6. The roll of vitrectomy in ischemic CRVO surgical procedures has not been evaluated. CASE PRESENTATION: This is a non comparative, prospective, longitudinal, experimental and descriptive series of cases. Ten eyes with ischemic CRVO. Vitrectomy with complete posterior hyaloid removal was performed. VA, rubeosis, intraocular pressure (IOP), and macular edema were evaluated clinically. Multifocal ERG (m-ERG), fluorescein angiography (FAG) and optic coherence tomography (OCT) were performed. Follow-up was at least 6 months. Moderate improvement of visual acuity was observed in 60% eyes and stabilized in 40%. IOP changed from 15.7 +/- 3.05 mmHg to 14.9 +/- 2.69 mmHg post-operative and macular edema from 976 +/- 196 microm to 640 +/- 191 microm to six month. The P1 wave amplitude changed from 25.46 +/- 12.4 mV to 20.54 +/- 11.2 mV. CONCLUSION: A solo PPV with posterior hyaloid removal may help to improve anatomic and functional retina conditions in some cases. These results should be considered when analyzing other surgical maneuvers.
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Isquemia/cirurgia , Oclusão da Veia Retiniana/cirurgia , Vasos Retinianos , Vitrectomia , Corpo Vítreo/cirurgia , Idoso , Membrana Basal/cirurgia , Eletrorretinografia , Feminino , Angiofluoresceinografia , Seguimentos , Humanos , Pressão Intraocular/fisiologia , Isquemia/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Oclusão da Veia Retiniana/fisiopatologia , Tomografia de Coerência Óptica , Acuidade Visual/fisiologiaRESUMO
PURPOSE: To investigate the feasibility and advantages of using perfluorocarbon liquid (PCL) perfusion to remove vitreous during suction-cutting vitrectomy in rabbit and pig eyes. DESIGN: Experimental study. METHODS: Balanced salt solution (BSS) was replaced by PCL perfusion during experimental vitrectomy. Oxygenated or nonoxygenated PCL was used in a recycling or a nonrecycling system. Recycling was achieved by two systems: a manual recycling system or a closed-loop system. The experiments in this study consisted of: an in vitro solubility observation, safety and feasibility of vitrectomy in rabbit eyes, effectiveness of vitrectomy with equal vitrectomy time in rabbit eyes, and retinal stability and pigment and blood dispersion in porcine eyes. Toxicity was assessed by a complete ophthalmic examination, endothelial cell count, electroretinography, and histopathology. RESULTS: Vitreous, blood, and pigments were immiscible in PCL. Manual recycling required less amounts of PCL than nonrecycling (15 vs 25 cc). Oxygenated and nonoxygenated PCL were not toxic. Perfluorocarbon liquid infusion removed more vitreous than balanced salt solution in a 3-minute vitrectomy time using the same settings on the vitrectomy machine. The PCL infusion in porcine eyes stabilized the retina and isolated vitreous cavity from pigment and blood and maintained a clear vitreous cavity. CONCLUSIONS: These data indicate that perfusion of PCL can be used to remove vitreous with a suction-cutting probe in rabbit and pig eyes. Retinal stability and isolation of the vitreous cavity at the time of vitreous removal along with PCL immiscibility and its specific gravity suggest that PCL has a potential clinical use as an irrigating solution to remove vitreous.
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Fluorocarbonos/administração & dosagem , Vitrectomia/métodos , Acetatos/administração & dosagem , Acetatos/toxicidade , Animais , Contagem de Células , Drenagem , Combinação de Medicamentos , Eletrorretinografia , Endotélio Corneano/efeitos dos fármacos , Estudos de Viabilidade , Fluorocarbonos/toxicidade , Minerais/administração & dosagem , Minerais/toxicidade , Perfusão , Coelhos , Retina/efeitos dos fármacos , Cloreto de Sódio/administração & dosagem , Cloreto de Sódio/toxicidade , Suínos , Irrigação TerapêuticaRESUMO
BACKGROUND AND OBJECTIVE: To evaluate the effectiveness of a new method of delivering diode laser (810 nm) spots through an indirect ophthalmoscope in conjunction with intravenous indocyanine green to treat choroidal neovascularizations (CNVs) larger than 5,400 microm. PATIENTS AND METHODS: A prospective, non-comparative, interventional case series study was conducted with 8 patients with CNV secondary to age-related macular degeneration. Laser pulses were applied to the CNV within 5 minutes of an intravenous injection of 25 mg of indocyanine green. The laser spot was enlarged up to one disc diameter by shortening the distance between the indirect ophthalmoscope and the 20-diopter viewing lens. The follow-up period was 3 months. RESULTS: Three eyes had an improvement in visual acuity of more than 2 lines, and fluorescein angiography showed stabilization of the membrane and reduction of the hemorrhages and subretinal fluid at the last follow-up. Three other eyes maintained the same visual acuity and two had a decrease in visual acuity of more than 2 lines at the 3-month follow-up examination. CONCLUSION: Laser treatment delivered through an indirect ophthalmoscope system may be used as a palliative treatment for CNVs larger than 5,400 microm.
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Neovascularização de Coroide/cirurgia , Corantes , Verde de Indocianina , Fotocoagulação a Laser/métodos , Degeneração Macular/complicações , Oftalmoscópios , Idoso , Idoso de 80 Anos ou mais , Neovascularização de Coroide/diagnóstico , Neovascularização de Coroide/etiologia , Feminino , Angiofluoresceinografia , Seguimentos , Humanos , Injeções Intravenosas , Fotocoagulação a Laser/instrumentação , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos , Resultado do Tratamento , Acuidade VisualRESUMO
Se considera a la Diabetes Mellitus (DM) como uno de los principales problemas de salud, debido a su elevada prevalencia así como a la gravedad y variada morbilidad de que se acompaña. La Diabetes Mellitus es una de las principales causas de morbi-mortalidad en nuestro país. El objetivo del presente estudio es determinar la frecuencia y gravedad de la retinopatía diabética en una población del estado de Durango.Se estudió una población abierta en la ciudad de Durango seleccionándose pacientes con Diabetes Mellitus después de los 30 años (no insulino dependientes). Se les examinó para determinar la frecuencia y gravedad de la retinopatía diabética. Se estratificó la retinopatía diabética usando la clasificación del ETDRS (Early Treatment Diabetic Retinopathy Study, por sus siglas en inglés). Otras variables analizadas fueron edad, sexo y tiempo de evolución de la diabetes a partir del momento del diagnóstico.Se estudiaron 253 pacientes con diagnóstico de Diabetes Mellitus. La prevalencia de cualquier forma de retinopatía varió de 21.3 por ciento en personas con menos de cinco años de diagnóstico a 80.7 por ciento en aquellos con 15 o más años, estos resultados similares a reportes previos. La proporción de retinopatía diabética proliferativa varió de 1.6 por ciento en personas con cinco años o menos años de DM hasta 30.3 por ciento en aquéllos con más de 15 años.La prevalencia de las formas proliferativas de la enfermedad a cualquier tiempo del diagnóstico de DM fue más alta que en los informes previos. Los resultados sugieren que la retinopatía diabética proliferativa es más frecuente en México que en otros países.
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Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Prevalência , México/epidemiologia , Retinopatia Diabética/epidemiologia , Diabetes Mellitus/epidemiologiaRESUMO
El Perfluoro-N-Octano(PFO) ha sido utilizado en ojos de pacientes humanos sin aparentes daños tóxicos a la retina. El propósito del presente estudio fue evaluar la toxicidad del PFO de uso no médico conocido como no purificado. A 14 conejos pigmentados se les realizó vitrectomía vía pars ciliaris en un ojo. La cavidad vítrea fue inyectada con PFO no purificado en 12 ojos y con solución salina balanceada se dejó a 2 ojos. En el grupo I permaneció en la cavidad vítrea el PFO durante 2 hrs después de la vitrectomía. En el grupo II durante 4 hrs y el grupo III con solución salina balanceada. A todos los conejos se les realizaron electrorretinogramas preoperatorios los cuales se repitieron a los 20, 40 y 60 días después de la cirugía. Todos los ojos fueron enucleados 60 días después de la inyección de PFO para examen histopatológico. Los resultados fueron los siguientes: El electrorretinograma mostró que todos los ojos con PFO tuvieron una disminución de la onda b en condiciones fotópicas y escotópicas; cambios que desaparecieron a los 20, 40 o 60 días después de la cirugía. El examen histopatológico mostró que los ojos tuvieron cambios en la capa plexiforme externa consistentes en adelgazamiento e interrupción en su continuidad, conos y bastones y demás estructuras sin alteraciones. Concluimos que el Perfluoro-N-Octano no purificado en ojos de conejo produce cambios reversibles en el electrorretinograma y alteraciones menores en la capa plexiforme externa sin alteración aparente de los fotorreceptores.