24/10/14
  
Retina
THE EVOLVING ROLE OF ANTI-VEGF THERAPY
Viernes, 08 de Enero de 2010 00:00

The American Academy of Ophthalmology Preferred Practice pattern for diabetic retinopathy was last updated in 2008, when preliminary research about intravitreal injections in the treatment of Diabetic Macular Edema (DME) had been published.

The guidelines however, still recommend the use of laser focal photocoagulation rather than intravitreal injections as first-line therapy for clinically significant macular edema.

In practice however, treatment choice may diverge from the Academy recommendations depending on the location and severity of leakage from microaneurysms.

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ACUTE RETINAL NECROSIS
Lunes, 04 de Enero de 2010 00:00

In 1971, acute retinal necrosis (ARN) was initially described in the Japanese literature as a seemingly new syndrome characterized by acute necrotizing retinitis, vitritis, retinal arteritis, choroiditis, and late-onset rhegmatogenous retinal detachment.

This presentation was initially termed Kirisawa uveitis; no etiologic agent was identified and no therapy appeared to improve the generally poor course of the disease.  Additional cases of retinitis associated with retinal detachment were reported in the 1970s.  In 1978, Young and Bird reported 2 similar cases and named the entity ”bilateral acute retinal necrosis syndrome” (BARN).  With the subsequent recognition of unilateral and asynchronous bilateral cases, the entity was renamed the ARN syndrome.

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Ocular Ischemic Syndrome
Jueves, 08 de Octubre de 2009 00:00

During a rutine eye examination, Mr. R, a 68 y.old hypertensive and heavy smoker, was found by Dr. Alisha Luu to have intraretinal hemorrhages in the midperiphery, narrowed retinal arteries and slightly engorged veins in his left eye.

The patient with ocular ischemic syndrome (OIS) is "elderly", ranging in age from the 50s to 80s. Males are affected twice as commonly as females.  The patient is only rarely asymptomatic. Decreased vision occurs at presentation in 90 percent of cases, and 40 percent of patients have attendant eye pain.  There may also be an attendant or antecedent history of transient ischemic attacks or amaurosis fugax.  Patients also have significant known or unknown systemic disease at the time of presentation.  The most commonly encountered systemic diseases are hypertension, diabetes, ischemic heart disease, stroke, and peripheral vascular disease.  To a lesser extent, patients manifest OIS as a result of giant cell arteritis (GCA).

 

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TELANGIECTASIAS PARAFOVEALES RETINALES
Jueves, 01 de Octubre de 2009 00:00

Tuvimos la oportunidad de examinar al Sr. MR quien se presentaba para un examen de rutina. Durante el examen se notó una visión de 20/60 en el ojo derecho y 20/50 mejor corregido en el izquierdo. Catarata bilateral. El Dr. Shehan había notado un área de Telangiectasia Yuxtafoveal en el ojo derecho localizado en el área inferior temporal. Nos invitó a examinar al paciente.

Telangiectasia Yuxtafoveal.

Clínicamente las telangiectasias aparentes de la retina como también las ectasias del lecho capilar, confinados a la región yuxtafoveolar de uno o ambos ojos, pueden resultar en pérdida de la visión debido a la incompetencia capilar como también a la exudación capilar que se puede producir.

 

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EL USO DEL OCT (Optical Coherence Tomography) EN AUMENTO
Martes, 22 de Septiembre de 2009 00:00

En las últimas reuniones del OSN (Ocular Surgery News) , ASCRS (American Society of Cataract and Refractive Surgery) y cursos que están dando sobre el OCT, nos muestran los adelantos obtenidos en esta tecnología no invasiva y los beneficios que hemos obtenido de ella.

Yo incluiría entre otros temas, los siguientes:

  • Tratamiento temprano del Edema Cistoide Macular postoperatorio basado en el grosor macular medido por el OCT
  • Presencia de edema macular en pacientes con Membranas Epirretinales
  • Descubrimiento de membranas neovasculares en etapas tempranas
  • Nueva clasificación de los Agujeros Maculares y su tratamiento basado en ello
  • Mejor conocimiento del Síndrome de Tracción Vitreomacular
  • Seguimiento no invasivo de lesiones maculares
  • Evaluación de la capa de fibras nerviosas retinales para glaucoma
  • Mejor seguimiento y evaluación del tratamiento del glaucoma (rápido y repetitivo)
  • Evaluación anatómica del nervio óptico,
  • Otros.

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VITREOMACULAR TRACTION SYNDROME (VMT)
Martes, 01 de Septiembre de 2009 00:00

Macular epiretinal membranes (ERMs) have a variable clinical course but usually reach maximal formation within few months before stabilizing.
Most eyes maintain excellent visual acuity with minimal distorsion of central vision, but the small percentage of patients who do develop market distortion of central vision may be candidates for pars plana vitrectomy. Patients primarily complaining of metamorphopsia may derive the most benefit from this surgery.

And following surgery, approximately 60%-80% of patients achieve 2 or more lines of visual acuity improvement, often continuing to improve for 6-12 months after surgery.
Intraoperative complications of this surgery include retinal tear or retinal detachment in less than 5% of cases.
Pregresive nuclear sclerosis occurs postoperatively in the majority of patients, and the rate increases over time.

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ASTEROID HYALOSIS
Miércoles, 26 de Agosto de 2009 00:00

Esta condicion la vemos frecuentemente, verdad ?

Y la Enfermedad de Benson ?

Pueden creer que esto me pregunto el paciente? Felizmente que en la residencia me dijeron que antes se creia que la Hialosis Asteroidea estaba relacionada con la Diabetes Mellitus, Hipertension Arterial, Arteriosclerosis y la Hipermetropia. Era conocida como la Enfermedad de Benson. Actualmente se cree que lo que pasa es que hay mayor incidencia de estas condiciones en la Hialosis Asteroide (HA).

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Pigmentary Retinophaty (PR)
Viernes, 21 de Agosto de 2009 00:00

The term pigmentary retinopathy is a generalized reference to a panretinal disturbance of the retinal pigment epithelium and retina.  Because of the heterogeneity of the pigmentary retinopathies, an overall definition was established by a working conference of RP specialists in 1984.

Retinitis  Pigmentosa (RP) was defined as a group of hereditary disorders that diffusely involve photoreceptor and pigment epithelium function characterized by progressive visual field loss and abnormal ERGs.

The pigmentary retinopathies can be divided into two large groups:

  1. primary PR, in which the disease process is confined to the eyes, with no other systemic manifestations, and
  2. secondary pigmentary retinopathy, in which the retinal degeneration is associated with single or multiple organ system disease

Just recently saw another patient with an advanced RP and the same night a close friend asked me about information on this condition.
My answer was as follows...

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OCLUSION RETINAL VENOSA - CENTRAL RETINAL VEIN OCCLUSION (CRVO)
Martes, 18 de Agosto de 2009 00:00

Les contaré que mi padre tuvo una oclusión venosa hace ya 15 años. Cuando me dijo que no veía por el izquierdo y lo examiné, realmente se trataba de una BRVO antigua con un edema macular crónico.  El tratamiento que le di fue.... nada.  Me sentí realmente mal aunque mi viejo nunca se quejó, el tratamiento era observación. Y lo observé como quedó en 20/200 !

Retinopatía diabética (DR) y oclusiones venosas retinales (RVO), incluyendo la CRVO y la BRVO, son respectivamente la primera y segunda causa de desorden vascular retinal. Ambos están asociados al edema macular que llevan a una pérdida visual tremenda.  Bajo las condiciones isquémicas hipóxicas encontradas en DR y en RVO, el edema macular aparentemente resulta de una alteración en la integridad de la barrera interna hemato-retinal en asociación con el aumento de la permeabilidad vascular.

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EARLY DETECTION, TREATMENT OF WET AMD : The CCR3 receptor.
Viernes, 31 de Julio de 2009 00:00

Researchers have identified a cellular receptor that, because it occurs only in choroidal neovascularization, might give ophthalmologists a way to simultaneously diagnose and treat subclinical, wet AMD—long before the disease has stolen any visual acuity.

Detection would be coupled with therapy because the same molecule that is a detection signature is also the therapy,” said the senior coauthor on the paper, Jayakrishna Ambati, MD, professor and vice chairman of ophthalmology, and professor of physiology, at the University of Kentucky, Lexington.

But the reason we’re most excited about this finding is that it would allow ophthalmologists to detect new blood vessels before they become manifest. For the first time, we have a unique signature to the disease.” Over the last decade, Dr. Ambati’s research team—which now includes collaborators at institutions across the United States and overseas—has produced more than two dozen papers that have helped to build a “higher fidelity model”1 of the interrelated molecular signals that lead to vision loss from CNV and geographic atrophy.

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