Purpose: To evaluate the safety and efficacy of endoscopic cyclophotocoagulation (ECP) in the treatment of refractory glaucomas. Methods: The preoperative and postoperative courses of 539 eyes of 539 patients with refractory glaucoma who underwent ECP and had a minimum 5 years follow-up were retrospectively reviewed. All procedures were performed by a single surgeon (FEL). Eyes that were included had undergone at least one incisional glaucoma surgery and had intraocular pressure (IOP) equal to or above 35 mmHg on maximum tolerated medical therapy, and a visual acuity better than light perception. Success was defined as IOP greater than 6 mmHg and lower than 22 mmHg after 5 years postoperatively, with or without topical anti-hypertensive therapy. ECP included 210° of the ciliary body, corresponding to 2 to 9 hours in the right eye and from 3 to 10 hours in the left eye, including the anterior third of the pars plana. Results: The mean follow-up was 88.9 + 10.3 months (range 60 to 108 months). Mean preoperative IOP was 38.1 ± 6.5 mmHg, and postoperative IOP was 12.1 ± 3.4 mmHg, with or without topical antiglaucomatous medication (p<0.05). The mean number of glaucoma medications used by each patient was reduced from 3.9 + 1.2 preoperatively to 1.9 + 1.4 postoperatively (p< 0.05). Best corrected visual acuity was stable or improved postoperatively in 407 eyes (95.3%) while 20 eyes (4.7%) lost 2 or more lines of Snellen acuity. The success rate at 12 and 60 months were, 92.5% and 79% respectively. KaplanMeier survival analysis showed an overall probability of success at 60 months of 71.5%. Complications included fibrin exudation in 116 eyes (21.5%), hyphema in 58 eyes (10.7%), choroidal detachment in 31 eyes (5.7%), phthisis in 13 eyes (2.4%), retinal detachment in 8 eyes (1.4%) and hypotony in 7 eyes (1.2%).Conclusion: These results suggest that ECP is a safe and effective therapeutic modality for refractory glaucomas after a long-term follow-up.
Purpose: To evaluate the reproducibility of peripapillary retinal nerve fiber layer (RNFL) thickness measurements in normal eyes and eyes with glaucoma using spectral domain optical coherence tomography (SDOCT). Methods: One eye of 79 normal and 72 glaucoma patients was analyzed. All patients underwent a complete ophthalmological examination, including visual acuity testing; intraocular pressure, slit-lamp examination, indirect ophthalmoscopy; and the glaucoma group underwent achromatic perimetry with the 24-2 SITA Fast Humphrey Field Analyzer. All patients' eyes were scanned using the spectral domain optical coherence tomography -Spectralis ® and one of them was cho sen randomly. Three con secutive circular B-scan centered at the optic disc were performed in one visit. Results: The intraclass correlation coefficient (ICC), coefficient of variation and test-retest variability for the mean retinal nerve fiber layer thickness were respectively: 0.94, 2.56% and 4.85 µm for the normal group and 0.93, 4.65% and 6.61 µm for the glaucomatous group. The intraclass correlation coefficient for retinal nerve fiber layer thickness in all quadrants were all excellent in both groups, with the superior quadrant having the highest ICCs (0.964) in glaucomatous eyes and nasal quadrant measurements having the lowest (0.800), but still excellent in eyes without glaucoma. The coefficient of variation was between 2.56% -8.74% and between 4.65% -11.44% in normal and glaucomatous group respectively. The test-retest variability was between 4.85 µm and 11.51 µm in the normal group and between 6.61 µm and 14.24 µm in the glaucomatous group. The measurements in glaucomatous eyes were more variable than normal eyes. Conclusions: Spectral domain optical coherence tomography showed excellent reproducibility with regard to retinal nerve fiber layer thickness measurements in normal and glaucomatous eyes.Keywords: Diagnostic techniques, ophthalmological; Glaucoma/diagnosis; Tomography, optical coherence/methods; Retinal ganglion cells; Optic nerve/pathology; Nerve fibers; Reproducibility of results RESUMO Objetivo: Avaliar a reprodutibilidade da medida da espessura da camada de fibras nervosas da retina (CFNR) em olhos sem e com glaucoma utilizando-se tomografia de coerência óptica de domínio espectral (spectral domain OCT -SDOCT
IOP fluctuation in primary open-angle glaucoma can be assessed using IOP measures on different days, at different time points, which strongly correlate to a diurnal curve.
Introducción: El dolor es el principal síntoma por el cual los pacientes acuden al servicio de emergencia de nuestro hospital, representando hasta un 80% de las consultas médicas y un 10% refieren tener dolor agudo. Objetivo: Evaluar si el uso de morfina como primera elección terapéutica es adecuado para disminuir la intensidad del dolor agudo en pacientes que acuden al servicio de emergencia. Metodología: Se realizó un estudio descriptivo retrospectivo en pacientes atendidos durante el año 2018 en el Servicio de Emergencia del Hospital General Ambato, en los cuales se utilizó morfina como primera elección para tratamiento de dolor agudo con escala de dolor de EVA 7 a 10 puntos. Resultados: Durante el periodo 2018 en el servicio de Emergencia del Hospital Iess Ambato se utilizó como primera elección para el tratamiento del dolor agudo analgésicos tipo morfina en 370 pacientes, con gran disminución en su intensidad en poco tiempo de la administración. Conclusiones: Se debe considerar la utilización de morfina como primera línea de tratamiento para dolor agudo por su rápida acción y disminución de la sintomatología en pacientes que acuden al servicio de emergencia con EVA >7/10.
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