Introducción y objetivo: Los trastornos hipertensivos durante la gestación son algunas de las principales complicaciones obstétricas en muchos países del mundo. En la preeclampsia, las pacientes pueden percibir fenómenos ópticos que pueden predecir la evolución de preeclampsia a eclampsia, ya que los cambios oftalmológicos se manifiestan como una retinopatía hipertensiva. El objetivo de este estudio es describir los hallazgos clínicos retinianos, mediante oftalmoscopia indirecta, en pacientes con preeclampsia durante el puerperio inmediato. Material y métodos: Estudio descriptivo, observacional, prospectivo y transversal, realizado de agosto a diciembre de 2014, en pacientes con preeclampsia hospitalizadas en un hospital materno-infantil de la Ciudad de México durante el puerperio inmediato, a quienes se les realizó una exploración oftalmológica mediante oftalmoscopia indirecta. Se revisó el fondo de ojo y se describieron los hallazgos clínicos y la clasificación de retinopatía hipertensiva en caso de existir. Así mismo, se identificó la relación de factores que puedan influir en el grado de retinopatía hipertensiva. Resultados: Se valoraron 26 pacientes con preeclampsia severa, 5 pacientes con preeclampsia leve y 1 paciente con síndrome de HELLP incompleto, de un total de 32 pacientes incluidas en el estudio. Los signos clínicos identificados con mayor frecuencia fueron vasoespasmo y la presencia de cruces arteriovenosos. El 34.61% de pacientes diagnosticadas con preeclampsia severa presentaron retinopatía hipertensiva grado II. La relación del grado de retinopatía hipertensiva con la edad tuvo una significancia estadística de p = 0.044. Conclusiones: Diferentes grados de retinopatía hipertensiva (grado I, II y III) fueron observados en pacientes con preeclampsia severa. No se encontraron pacientes con neuropatía hipertensiva o con datos de isquemia coroidea asociados a desprendimiento de retina seroso. La edad fue el factor con mayor asociación al grado de retinopatía hipertensiva.
Introduction and objective: Hypertensive disorders during pregnancy are one of the main obstetric complications in many countries. In preeclampsia, patients may perceive optical phenomena that can predict the evolution from preeclampsia to eclampsia, because ophthalmic changes manifest as a hypertensive retinopathy. The aim of this study is to describe the clinical retinal findings in patients diagnosed with preeclampsia in the immediate postpartum by indirect ophthalmoscopy. Material of methods: Descriptive, observational, prospective and cross-sectional study performed from August to December 2014, in patients diagnosed with preeclampsia admitted to a mother and child hospital, in the immediate postpartum, who underwent ophthalmic examination by indirect ophthalmoscopy. Fundus eye examination was performed describing clinical findings, and hypertensive retinopathy grading was done if present. Also, we evaluated a possible correlation between different factors that may influence the degree of hypertensive retinopathy. Results: Twenty-six patients with severe preeclampsia, 5 patients with mild preeclampsia and 1 patient with incomplete HELLP syndrome were examined, with a total of 32 patients enrolled. The prevalent clinical signs observed were vasospasm and arteriovenous crossings. We observed grade II hypertensive retinopathy in 34.61% of patients diagnosed with severe preeclampsia. Age was the main factor correlated with the degree of hypertensive retinopathy, with statistical significance (p = 0.044). Conclusions: Different grades of hypertensive retinopathy (grade I, II and III) were observed in patients with severe preeclampsia. No patients showed hypertensive neuropathy or choroidal ischemia associated with serous retinal detachment. Age is the main factor associated with the severity of hypertensive retinopathy.
Presentación de un caso clínico de un paciente de sexo masculino de 26 años, que acude por baja visual, tras ver accidentalmente una luz proyectada por un láser de espectáculos, y que presenta una hemorragia prerretiniana en el ojo izquierdo. La tomografía de coherencia óptica mostró la presencia de una hemorragia sublimitante interna. Se le realizó una vitrectomía pars plana con pelado de la limitante interna, y se produjo una rápida mejoría de la agudeza visual.
This is the case of a 26-year-old man that presented a visual acuity decrease after unintentionally looking at a light projected in a laser show. On examination, a premacular hemorrhage was observed in the left eye. Optical coherence tomography demonstrated the presence of a sub-inner limiting membrane hemorrhage. A pars plana vitrectomy was performed with internal limiting membrane peeling, followed by rapid visual acuity improvement.
Purpose To report clinical findings and final visual acuity outcomes in patients with Coats disease (CD) treated in central Mexico. Methods Retrospective case series analysis of CD patients recruited from five referral hospitals. Clinical characteristics that included age and symptoms at diagnosis, the area of retinal affected, treatment modalities and visual outcomes were recorded. Age of presentation and retinal zones involved were evaluated based on final visual outcomes. Results 67 eyes (66 patients) with diagnosis of CD were identified. Male gender occurred in 81% and the right eye was affected in 55% of the cases. Mean age at diagnosis was 11 years (median 9.8, range 6 months to 65 years). Only 9 patients (13%) had initial visual acuity (VA) better than 1.3 logMAR. Twenty patients received more than one treatment modality and laser photocoagulation was the most widely used. Final VA was classified as blindness in 57 (85%) patients, and it was correlated with worse initial visual acuity (p = 0.005). Number and extension of affected retinal zones were not correlated with age of presentation or gender (p > 0.05). During a mean follow-up of 42 months (SD +/- 37.8), there was slight improvement in visual acuity after treatment in only three cases (4.5%). Conclusion Final visual acuity in almost all CD patients was severe visual impairment. Visual prognosis is poor and depends on stage, location of disease and age of presentation. New strategies for early CD diagnosis by novel methods are needed to improve visual outcomes in these patients.
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