Central retinal artery occlusion (CRAO) is an ophthalmologic emergency that can lead to irreversible loss of vision. Intravenous thrombolysis (IVT) has been used experimentally for its treatment. Our study aimed to evaluate the effect of emergency IVT on CRAO and its impact on visual acuity outcomes. We conducted a retrospective observational study of patients with CRAO. A total of 46 patients with CRAO were analysed; 16 patients received IVT treatment (IVT group) while 30 did not (no-IVT group). Seven patients from the IVT group received IVT early, within 4.5 hours (h) after the onset of symptoms (early-IVT), and 9 patients received it beyond this timeframe (late-IVT). The median time-to-hospital was 8.5 h: 3 h for the IVT group and 24 h for the no-IVT group. The median time-to-treatment was 5 h. The median outcome of visual acuity was 0.05 in the early-IVT, 0.025 in the late-IVT, and 0.01 in the no-IVT group. Among patients who received IVT early, 86% exhibited significant visual improvement. This improvement was four-fold greater compared to all other groups (p = 0.040), including the late-IVT (p = 0.011) and no-IVT groups (p = 0.023). No complications of the treatment were reported. Our study confirms that the administration of IVT treatment for CRAO within the 4.5-h time window is both safe and effective.
PURPOSE: To determine the efficacy of pars plana vitrectomy (PPV) in children with intraocular hemorrhage (IOH) secondary to Abusive head trauma (AHT). METHODS: A long-term retrospective analysis evaluating epidemiology, management, safety, anatomical and functional results of PPV for IOH in children with AHT at tertiary referral center for children in the Czech Republic from 2004 to 2017. RESULTS: 18 children were identified with IOH due to AHT during observation period of 14 years. Overall incidence of IOH related to AHT was 29.6/100 000, in children under 1 year 22.2/100 000, in children 1 to 5 years 7.4/100 000. Mean age at the time of diagnosis was 13.7 (SD±20.53) months, median 5 months. IOH resolved in 56% of children, 64% eyes, spontaneously. 44% children, 36% eyes, underwent PPV. PPV was performed 30.5 (SD±16.98) days after established diagnosis on average. Postoperatively, 80% of eyes had anatomical improvement, 20% eyes had preexisting irreversible changes in the posterior pole. Vision of 50% eyes improved after surgery, vision of 20% eyes remained poor, 30% of eyes was not possible to test due to severe neurological impairment. Mean observational period was 33.4 (SD±38.21) months. Mortality rate of AHT in our group was 17%, all victims were younger 4 months. CONCLUSIONS: PPV is a safe and effective procedure to clear IOH in children with AHT. Ophthalmology outcomes are strongly associated with degree of neurological impairment. Best outcomes were achieved with PPV performed between 2 and 5 weeks after trauma. Opportunity to plan surgery within this time frame indicates a good neurological prospect and prevents deprivation amblyopia.
- MeSH
- dítě MeSH
- kraniocerebrální traumata * chirurgie MeSH
- lidé MeSH
- odchlípení sítnice * chirurgie MeSH
- retrospektivní studie MeSH
- vitrektomie MeSH
- zraková ostrost MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
We present a case of late acute myopia syndrome following discontinuation of treatment with a combination of sulphonamide drugs. To the best of our knowledge, this is the first reported case with such a presentation, and suggests that the pathophysiological basis for the acute myopia syndrome is a rapid decrease in serum carbonic anhydrase inhibitors levels which may lead to a rebound increase in the production of aqueous humor and accumulation of suprachoroidal fluid. It is further postulated that there may be a cumulative effect of sulphonamide drug use on carbonic anhydrase activity in the ciliary body epithelium of susceptible individuals.
- MeSH
- akutní nemoc MeSH
- antiinfekční látky škodlivé účinky MeSH
- antikonvulziva škodlivé účinky MeSH
- dospělí MeSH
- faryngitida farmakoterapie MeSH
- fruktosa škodlivé účinky analogy a deriváty MeSH
- kombinace léků trimethoprim a sulfamethoxazol škodlivé účinky MeSH
- kombinovaná farmakoterapie MeSH
- lidé MeSH
- migréna prevence a kontrola MeSH
- myopie chemicky indukované diagnóza MeSH
- nitrooční tlak účinky léků MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
- MeSH
- cytomegalovirové infekce epidemiologie farmakoterapie patofyziologie MeSH
- diferenciální diagnóza MeSH
- HIV infekce komplikace MeSH
- imunorestituční zánětlivý syndrom MeSH
- incidence MeSH
- Kaposiho sarkom epidemiologie farmakoterapie MeSH
- komorbidita MeSH
- lidé MeSH
- nemoci retiny patofyziologie MeSH
- oční infekce epidemiologie farmakoterapie patofyziologie MeSH
- příznaky a symptomy MeSH
- syfilis epidemiologie farmakoterapie MeSH
- toxoplazmóza MeSH
- virus varicella zoster patogenita MeSH
- vysoce aktivní antiretrovirová terapie škodlivé účinky MeSH
- Check Tag
- lidé MeSH
CMV retinitida je nejzávažnější oční komplikací AIDS. Zavedením kombinované antiretrovirové terapie se výskyt tohoto onemocnění výrazně snížil. Na druhé straně přineslo její užívání výskyt nové oční komplikace - CMV uveitis. CMV uveitida je způsobena imunopatologickou zánětlivou reakcí v rámci imunorestitučního zánětlivého syndromu, který je nežádoucím účinkem úspěšně zahájené cART. Tyto dvě formy CMV postižení oka asociované s HW infekcí se liší patogenezí, symptomatologií i terapií. CMV retinitida se léčí anti-CMV virostatiky, zatímco léčba CMV uveitidy spočívá především v tlumení zánědivé reakce podáváním kortikosteroidů. Optimální prevencí obou těchto komplikací je včasné zahájení cART ještě před poklesem CD4+ T lymfocytů pod hodnoty 200/μ1.
CMV retinitis is the most serious ocular complication of AIDS. Introduction of the combination antiretroviral therapy markedly reduced the occurrence of CMV retinitis, on the other hand it brought a new ocular complication - CMV uveitis. CMV uveitis is an immunopathological inflammatory reaction associated with the immune reconstitution inflammatory syndrome, which is a side effect of sfully initiated cART. These two forms of CMV ocular complications differ in pathogenesis, symptomatology and therapy. The CMV retinitis is treated with anti-CMV virostatics whereas the therapy of CMV uveitis is based on attenuation of the inflammatory reaction by administration of corticosteroids. The optimal prevention of both complications is an early initiation of cART before the CD4+ T lymphocytes drop below 200/μl.
- MeSH
- antiretrovirové látky aplikace a dávkování MeSH
- cytomegalovirové infekce diagnóza farmakoterapie MeSH
- HIV infekce komplikace MeSH
- imunorestituční zánětlivý syndrom komplikace MeSH
- lidé MeSH
- oportunní infekce doprovázející AIDS virologie MeSH
- retinitida farmakoterapie virologie MeSH
- uveitida farmakoterapie virologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
HIV retinopatie je oční afekce vyskytující se zvláště u HIV pozitivních pacientů s hlubokým imunodeficitem. Protože je benigního charakteru a nepoškozuje zrak, nemusí být sama o sobě léčena, je třeba ji však diferenciálně diagnosticky dobře odhšit od jiných očních onemocnění, která vážně poškozují visus, jako je např. cytomegalovirová retinitida. Přítomnost HIV retiniopatie může být také příznakem progrese HW infekce, a proto by měla být považována za signál pro zvážení zahájení antiretrovirové terapie u dosud neléčených pacientů.
HW retinopathy is an ocular affection occurring especially in HW positive patients with deep immunodeficiency. Because of bening character the HW retinopathy does not require any specific therapy, but it must be carefully distinguished from other ocular diseases, which can seriously damage sight, e.g. CMV retinitis. The presence of HIV retinopathy can also be a symptom of progression of HIV infection and should be perceived as a signal for considering the initiation of antiretroviral therapy in treatment naive patients.
