La preocupación por el retraso en el tratamiento de los pacientes ya diagnosticados de estrabismo y ambliopía, así como la dificultad para el estudio integral de los casos nuevos, han sido base para la aplicación del cuestionario dirigido a los países Latinoamericanos. Método: Se estableció un cuestionario de 11 preguntas dirigidas a médicos con atención a estrabismos y ambliopías, de países latinoamericanos. Se empleó la plataforma Google Drive, con los elementos gráficos bajo estadística descriptiva, y tiempo de exposición 9-12 de octubre de 2020. Estos resultados se reportaron parcialmente durante el webinar
Se obtuvieron diversas alertas que demuestran la problemática y los requerimientos de salud pública. Conclusiones: Los altos niveles de discapacidad visual en la población mundial obligan a establecer mejores estrategias, como lo demuestra la Campaña Nacional de Ambliopía en México. Debe considerarse mantener información permanente a la población, facilitar el acceso al servicio médico de primer nivel de atención, favorecer la atención temprana de los grupos vulnerables, actualización médica continua y una permanente comunicación con los líderes de la salud que generen estrategias costo-eficaces para una detección y tratamiento temprano, regidas por normas de salud que resulten en la reducción de la discapacidad visual. Catorce países iberoamericanos se unieron a la campaña ya que aun con poblaciones diferentes las causas de ambliopía son las mismas, el desconocimiento del tema se repite y las cifras de discapacidad aumentan.
BackgroundThyroid-associated orbitopathy is commonly associated with Graves' disease with lid retraction, exophthalmos, and periorbital swelling, but rarely with autoimmune thyroiditis or euthyroid state. We reviewed 3 cases from our hospital whose antibodies to anti-receptor of TSH were normal.MethodsCase 1: 60 year-old non-diabetic woman with bilateral glaucoma in treatment, recurrent media otitis and euthyroidism, acute onset of painless diplopia, and lid ptosis in the left eye. MRI of orbit showed increased size of the III right cranial pair and high levels of thyroid autoantibodies (Tab) anti-tiroglobulin (ATG) 115.1, anti-thyroid peroxidase (ATPO) 1751 U/mL. She started oral deflazacort 30 mg each 3 days. Sixty days later, complete remission of eye symptoms correlated with lower auto-antibodies level (ATG 19 ATPO 117). Case 2: 10 year-old girl. At age 8, she had diplopia, lid ptosis and limitations of upper gaze in the left eye. The neurological study discarded ocular myasthenia; with thyroid goitier, and hypothyrodism, she started oral levothyroxin. At age 10 with normal IRM Botulinic toxin was injected, without change. High levels of Tab were found, ATG 2723, ATPO 10.7. She started oral deflazacort 30 mg each 3 days, azathioprin 100 mg, daily. Actually, Tab levels are almost normal, but she remains with ocular alterations. Case 3: 56 year-old woman, Grave´s disease with exophtalmos in 1990, treated with I131 and immunosupression, with good outcome; obesity, hypertension and bilateral glaucoma in treatment. She suddenly presented diplopia and IV pair paresia of the right eye. A year later, ATb were found slightly elevated, ATG 100 years ATPO 227; despite prednisone 50 mg, each 3 days and azathioprin 150 mg/daily treatment, a surgical procedure was required for relieve the ocular symptoms.ResultsWe found only 3 cases previously reported with this type of eye thyroid disease. Is important to note that awareness of this atypical form of orbitopathyConclusionsEarly recognition facilitates successful treatment (Case 1) or persistent disease when diagnosis is delayed (Cases 2 and 3).
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