This new CAD for automated analysis of OCT images offers adequate sensitivity and specificity to distinguish normal OCT images from those showing potential neovascular age-related macular degeneration. These results will enable its clinical validation and a subsequent cost-effectiveness assessment to be made before recommendations are made for population-screening purposes.
Large series published of intravitreal injections which took place in clinic settings applying a procedure technique as recommended in this Guide, presented a very low incidence of complications, specially endophthalmitis.
SpainSUMMARY The macular dazzling test was performed on 240 healthy eyes, classified into six groups according to the ages of the subjects. The test was used to assess both long distance and short distance vision with a simultaneous study of the influence of mydriasis and miosis.The MDT is a test easy to perform, requires a minimum of co-operation by the subject, and gives repeatable results. The MDT values increase significantly as the age of the subject increases. The sex of the subject has no influence on it, and there are no significant differences between a subject's right and left eyes. Mydriasis does not affect the MDT, but miosis reduces the recovery period. All the values are statistically greater for long distance vision than for short distance vision.One of the methods for the subjective exploration of the retina (visual acuity, Amsler table, static perimetry, colour vision) is the Bailliart test.' This test was formulated to determine the functional macular reaction by dazzling the retina and then measuring the length of time which the subject takes to regain the level of visual acuity he had prior to the dazzling. Since what is actually being explored with this method is the function of the macula, we refer to it as the macular dazzling test (MDT). One of the characteristics of the test is the use of induced macular fatigue, like the induced fatigue used for heart studies.2The purpose of the work reported here was to standardise the MDT technique and thus to typify the results for normal subjects, not only for long distance vision as previous authors have donebut also for short distance vision, in addition to studying the influence of the diameter of the pupil on obtaining results. Materials and methodsWe have performed the MDT on 240 healthy eyes. The ages of the subjects ranged from 10 to 69 years, the ratio of the sexes being 50:50. The subjects were divided into age groups as follows: from 10 to 19, 20 to 29, 30 to 39, 40 to 49, 50 to 59, and 60 to 69 years.Each age group contained 20 subjects, 10 male and 10 Correspondence to Dr D Francisco G6mez-Ulla de Irazazvibal, Hospital General de Galicia, Departamento de Oftalmologia, c/Galeras s/n, Santiago de Compostela, Spain. 209female. In all cases their visual acuity was equal to or greater than 20/25, with or without optical adjustment, and we accepted a refraction defect of not more than 3 dioptres of hypermetropia, myopia, or astigmatism.To produce the dazzle, a Minolta electronic flash, guide no. 20 in meters with 100 ASA, with a 1/2000s flash, was used. A Heuer chronometer was used to measure the recovery time for visual acuity following the dazzling.Long distance visual acuity was explored through the use of Snellen optotypes and short distance vision by means of the Parinaud test. To perform the MDT we followed the method proposed by Lemrini and Carreras.5 The exploration was systematically begun on the right eye, and later continued on the left eye.The subject was instructed to look directly into the light source, and the dazzle was produce...
In myopia patients, Rh and acid phosphatase were typed in two groups: group 1 consisted of 214 patients with low myopia (-6 D or less); group 2 of 124 patients with high myopia (more than -6 D). Statistical analysis of the markers showed a good Hardy-Weinberg equilibrium for both groups. In the Rh system there was a significant difference between group 1 and the control population (p < 0.05), but not between group 2 and control (p > 0.1). In the case of ACP there was a significant difference between group 2 and the control population (p < 0.05), but not between group 1 and control (p > 0.25). We conclude that the observed association between myopia and Rh system (chromosome 1) involves low myopia, while the association between myopia and acid phosphatase (chromosome 2) involves high myopia. Further DNA research will lead to more specific results.
EDITORIALDesde hace muchos años, los oftalmólogos tenemos una gran experiencia en la utilización de la vía intraocular para inyectar diferentes fármacos, gases o aceites que han permitido la curación o el control de muchas enfermedades oculares -recientemente se utiliza de manera rutinaria para la inyección de fámacos antiangiogénicos-. También la inyección intravítrea de acetónido de triamcinolona (Trigon Depot ® ) es ampliamente usada por numerosos oftalmólogos en muchos países del mundo, y en la literatura científica existe numerosas publicaciones que describen sus indicaciones, seguridad y efectos adversos, así como las medidas oportunas para minimizar estas complicaciones. Sólo en PubMed existen 131 publicaciones bajo el epígrafe Intravitreal triamcinolone and retina.En nuestro país existen dos ensayos clínicos en ejecución aprobados por la Agencia Española del Medicamento para evaluar la seguridad y eficacia de las inyecciones intravítreas de Trigon en Edema Macular Diabético (EudraCT 2005-001385-14) y en Neovascularización coroidea en la DMAE (EudraCT 2005-001324-36). En otros países como en Estados Unidos hay otros ensayos similares en marcha como por ejemplo el SCORE (Standard Care vs COrticosteroid for Retinal vein occlusion).La práctica del uso de medicamentos «off label», es decir su utilización por una vía o para una indicación no cubierta por la aprobación inicial, no es ni nueva ni infrecuente en oftalmología o en otras especialidades. En el caso del Trigon, se recurre principalmente a su uso intravítreo en diferentes situaciones (1,2): 1. Como medicación única en edema macular diabético o edema macular secundario a oclusiones venosas de la retina, uveítis o edema macular posquirúrgico. 2. Como medicación asociada a terapia fotodinámica en el caso de neovascularización coroidea secundaria a DMAE o miopía patológica (3). 3. Como coadyuvante quirúrgico en el pelado de la hialoides posterior, membranas epirretinianas y visualización del vítreo.Sin embargo, y aunque son muchos los trabajos que avalan su utilidad, es preciso tener en cuenta una serie de consideraciones con respecto a su uso. En primer lugar, que si bien estamos ante un fárma-co de eficacia demostrada y admitida por la comunidad científica y cuya utilización puede por ello ampararse en la lex artis, no está sin embargo disponible en forma de especialidad farmacéutica autorizada para su uso intraocular, por lo que la legislación española vigente en el momento actual obliga a su empleo como uso compasivo.Tal y como se refleja en el artículo 28 del Real Decreto 223/2004, de 6 de febrero (4), se entiende por uso compasivo «la utilización de principios activos en pacientes aislados y al margen de un ensayo clínico, incluidas especialidades farmacéuti-cas para indicaciones o condiciones de uso distintas de las autorizadas». La clave está en que este procedimiento sólo debe utilizarse en situaciones lími-te o especiales en las que las herramientas empleadas habitualmente en la práctica médica no son capaces de dar la respuesta esperada y para ...
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