ANGIOFLUORESCEINOGRAFIA: PARTE III

Ya descansando un poco, he podido realizar la tercera parte de las diapos sobre angiofluoresceinografia, hace una breve revisión de la circulación coroidea y retinal.

ANGIOGRAFIA CON FLUORESCEINA-PARTE 1

Haremos una pequeña introducción a la AFG, un examen auxiliar muy importante en oftalmología , muy pronto estaré subiendo la parte 2.

Endophthalmitis More Common After Intravitreal Injection Than Intraocular Surgery

Streptococcal isolates are approximately 3 times more frequent after anti-VEGF intravitreal injections than after intraocular surgery, according to the results of a meta-analysis presented by Colin A. McCannel, MD, at the Retina Subspecialty Day in Orlando, Florida. The meta-analysis, conducted by Dr. McCannel, was published earlier this year in Retina.[1]

The meta-analysis included US literature from 2005 to 2009 that reported endophthalmitis after intravitreal injection of anti-VEGF agents; the results of this analysis was compared with reports of endophthalmitis bacterial isolates after intraocular surgery in the United States.

Among 105,536 injections, there were 52 cases of endophthalmitis, Dr. McCannel reported. Of those cases, 24 were culture negative and 26 had culture-positive organisms, 8 of which were of the Streptococcus species. In the Endophthalmitis Vitrectomy Study, Streptococcus species were significantly more frequent after intravitreal injection that after intraocular surgery, Dr. McCannel said.

To minimize the rate of oropharyngeal droplet transmission, Dr. McCannel suggested avoiding talking, coughing, and sneezing during intravitreal injection of anti-VEGF agents, and encouraging patients to refrain from talking during this time as well.

1. McCannel CA. Meta-analysis of endophthalmitis after intravitreal injection of anti-vascular endothelial growth factor agents: causative organisms and possible prevention strategies. Retina. 2011;31(4):654-661.

Effectiveness of Artificial Tears in the Management of Evaporative Dry Eye

Seventy-five subjects with dry eye were randomly divided into three groups to compare the efficacies of  sodium hyaluronate, hydroxypropyl methylcellulose (HPMC) and a new oil-in-water emulsion (Emustil unidose; SIFI) in the management of lipid-deficient dry eye. Each was allocated sodium hyaluronate, HPMC or emulsion eyedrops to be used four times daily for 90 days. Parameters were measured at baseline, 30 days and 90 days. A compliance visit was performed at days 7 and 60.

Significant reduction in evaporation and improvement in symptoms in all groups were found. No statistically significant increase in tear turnover rate (TTR) was found with any solution. A significant difference in tear stability and non-invasive tear break-up time (NITBUT) was found in the emulsion and sodium hyaluronate groups but not in the HPMC group. There was a significant decrease in osmolarity and corneal staining in the emulsion group but not in the sodium hyaluronate or HPMC group.

A significant reduction in evaporation and improvement in symptoms in all therapy groups were found from baseline to 90 days. However, no significant effect was seen on TTR for any group. The emulsion drops were shown to perform best, improving tear stability, and decreasing osmolarity and corneal staining. These results are consistent with improvements in the lipid layer of the tear film as a result of prolonged use of emulsion drops.

 

 

SOURCE: McCann LC, Tomlinson A, Pearce EI, Papa V. Effectiveness of artificial tears in the management of evaporative dry eye. Cornea. 2011; Sep 30 [Epub ahead of print].

DESPRENDIMIENTO DE RETINA REGMATOGENO

Realice esta presentación para exponerla mañana, es sobre desprendimiento de retina regmatogena, espero les guste..

QUERATITIS INTERSTICIAL

Recibí un paciente derivado de Amazonas con el diagnóstico de catarata senil para una probable cirugía, pero durante la evaluación oftalmológica encontré unas opacidades corneales en ambos ojos, con presenta de vasos fantasmas y activos  en endotelio  de ambos ojos, con una agudeza visual sin correctores de: OD:20/200 y OI:10/200. Con agujero estenopeico : 20/100 y 20/100-1 respectivamente. Aplanometría de 12  y 11 mmHg. El cristalino se presentaba levemente opaco a pesar de la turbidez corneal pudo apreciarse. Se llegó a la conclusión de una Queratitis crónica instersticial AO. Paciente refiere que desde hacer más o menos 5 años presentó estas opacidades corneales.

QUERATITIS INTERSTICIAL

Es una vascularización y cicatrización del estroma corneal sectorial o difusa, debida a edema e inflamación no necrotizante, puede ser aguda o crónica. Las causas más frecuentes son la sifilis congénita, tuberculosis y las infecciones por el virus del herpes simple, herpes zoster, lepra, la parotiditis, linfogranuloma venéreo, la sarcoidosis y el Síndrome de Cogan (tríada de queratitis intersticial, vértigo y sordera).

En la forma crónica se aprecia turbidez corneal profunda, cicatrización, adelgazamiento , vascularización, vasos fantasmas. Exámenes auxiliares: VDRL, FTA-ABS, PPD, Rx tórax.