RESUMO
PURPOSE: To describe the primary cancer sites and clinical features of choroidal metastasis in Mexican patients. METHODS: This was a retrospective, observational, and multi-center study. Data were recollected from 6 ophthalmological hospitals in Mexico from patients with choroidal metastasis diagnosed from 2000 to 2018. RESULTS: Seventy-eight patients were studied: 43 were female and 35 were male. Mean age at presentation was 57.6 years. Overall, primary cancer sites were: 1) breast: 27 cases (34.6%); 2) lung: 19 cases (24.3%); 3) unknown: 8 cases (10.2%); 4) gastrointestinal: 7 cases (8.9%); 5) renal: 5 cases (6.4%); 6) testicular: 3 cases (3.8%); 7) ovary: 3 Cases (3.8%); 8) prostate: 2 cases (2.5%); 9) thyroid: 2 cases (2.5%); 10) carcinoid: 1 case (1.2%); and 11) multiple myeloma: 1 case (1.2%). Divided by gender, for women, the main three sites were: breast, unknown, and ovary. For men, the main three sites were: lung, gastrointestinal, and testicular. Oldest cases were breast cancer (87 and 85 years); youngest cases were testicular (23 and 25 years). Solitary lesions were observed in 56 cases (71.7%); multiple lesions were observed in 22 cases (28.2%). Forty-two cases had a white or yellowish color, while 6 cases presented an orange color. CONCLUSION: Primary cancer sites and clinical features of choroidal metastasis in Mexican patients show important differences from other populations previously studied, mainly the presence of a higher proportion of gastrointestinal and renal cancer, as well as higher incidence of ovarian and testicular cancer. These types of cancer, although not as common as breast or lung, need to be taken into account when studying Mexican patients living abroad.
Assuntos
Triagem Neonatal/legislação & jurisprudência , Oftalmologia/tendências , Pediatria/tendências , Transtornos da Visão/prevenção & controle , Testes Visuais , Adolescente , Ambliopia/diagnóstico , Ambliopia/fisiopatologia , Catarata/congênito , Catarata/diagnóstico , Criança , Diagnóstico Precoce , Neoplasias Oculares/diagnóstico , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Terapia Intensiva Neonatal/legislação & jurisprudência , Terapia Intensiva Neonatal/métodos , México/epidemiologia , Oftalmologia/educação , Oftalmologia/legislação & jurisprudência , Pediatria/educação , Pediatria/legislação & jurisprudência , Retinoblastoma/diagnóstico , Retinopatia da Prematuridade/diagnóstico , Retinopatia da Prematuridade/epidemiologia , Retinopatia da Prematuridade/prevenção & controle , Retinopatia da Prematuridade/terapia , Estrabismo/diagnóstico , Estrabismo/fisiopatologia , Transtornos da Visão/congênito , Transtornos da Visão/diagnóstico , Transtornos da Visão/epidemiologia , Recursos HumanosRESUMO
El aumento en la sobrevida de los recién nacidos prematuros, las características del cuidado neonatal y la escasez de programas para la prevención, detección y tratamiento de la retinopatía del prematuro provocan que esta enfermedad sea la principal causa de ceguera infantil prevenible en México. El advenimiento de agentes antiangiogénicos de uso oncológico, y su uso -no autorizado, aunque con buenos resultados- en el tratamiento de enfermedades vaso proliferativas en la retina del paciente adulto, así como la presencia de reportes anecdóticos en la literatura y series de casos con serias fallas metodológicas han sugerido su utilización en el tratamiento de la retinopatía del prematuro. Desafortunadamente, estos agentes, utilizados indiscriminadamente, presentan absorción sistémica y causan efectos secundarios en el organismo del paciente prematuro. Además, no existen estudios de seguimiento a largo plazo que garanticen la seguridad de su uso en esta población. El presente artículo describe la situación en nuestro país y advierte sobre los riesgos de estos medicamentos en la población de pacientes prematuros.
The increase in survival rates among preterm infants, characteristics of neonatal care for such infants and a lack of suitable programs for preventing, detecting and treating retinopathy of prematurity (ROP) are factors that have made this disease the main cause of preventable blindness among children in Mexico. The advent of antiangiogenic agents in cancer treatment and their off-label use with favorable results in the treatment of proliferative vessel disease of the retina among adult patients, as well as anecdotal reports in the literature and a series of cases showing serious methodological flaws, have prompted their use in the treatment of retinopathy of prematurity. Unfortunately, these agents used indiscriminately in our country have a systemic absorption and secondary effects on the preterm patient's body. There are no long-term monitoring studies that guarantee their safe use in this segment of the population. This article describes the situation in our country and warns of the risks posed by the use of this type of drug on the preterm infant population.
RESUMO
BACKGROUND: The "Early Treatment for Retinopathy of Prematurity Cooperative" reported a failure rate of 55.2% using laser in zone 1 for treatment of retinopathy of prematurity (ROP). We need to offer better alternatives for those patients. We undertook this study to evaluate the efficacy of combined laser-ranibizumab therapy for ROP with threshold-prethreshold and "plus disease" and to study development of the newborn. METHODS: This is a prospective, experimental, longitudinal and open study including newborns of either <32 weeks of gestation or with a birth weight <1500 g, with threshold-prethreshold retinopathy or "plus disease." The effect of treatment was analyzed and development of the newborn was determined. RESULTS: We studied 34 eyes of 17 patients. Age at birth was 29.9 ± 2.6 weeks. Birth weight was 1,120 ± 253 g. The statistics demonstrated an important relationship between severity of retinopathy and early birth age, along with a high probability of threshold-prethreshold disease at 29.4 weeks of age or 1204 g birth weight. The Bayley scale reported normal development in 23.5% of cases, global retardation in 23.5%, psychomotor retardation but normal mental behavior in 29.4%, and mental retardation but normal psychomotor development in 23.5%. We demonstrated regression of retinopathy in all cases. Persistence of vascular tortuosity was present in 17.6% of cases without vascular dilatation, and vitreous membrane development was demonstrated in 11.7% of patients. CONCLUSIONS: Laser-ranibizumab treatment has allowed a better control of retinopathy for threshold-prethreshold and "plus disease" in this group of patients.
Assuntos
Inibidores da Angiogênese/uso terapêutico , Anticorpos Monoclonais Humanizados/uso terapêutico , Fotocoagulação a Laser , Retinopatia da Prematuridade/terapia , Inibidores da Angiogênese/administração & dosagem , Anticorpos Monoclonais Humanizados/administração & dosagem , Terapia Combinada , Progressão da Doença , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido Prematuro , Deficiência Intelectual/complicações , Injeções Intravítreas , Masculino , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Transtornos Psicomotores/complicações , Ranibizumab , Vasos Retinianos/patologia , Retinopatia da Prematuridade/complicações , Retinopatia da Prematuridade/tratamento farmacológico , Retinopatia da Prematuridade/patologia , Retinopatia da Prematuridade/cirurgia , Resultado do Tratamento , VasodilataçãoRESUMO
BACKGROUND: Strabismus has been related to different alterations of brain functions and learning in children. Early treatment for visuomotor functions may improve the executive areas of intelligence. We undertook this study to demonstrate changes of visuomotor function and intelligence in children after strabismus treatment. METHODS: This is a prospective study of patients with strabismus, before and after treatment. We applied the Human Figure Test, Visuomotor Bender Test, and Intelligence Test. RESULTS: We included nine children with an average age of 8.7 years (± 2.4 years). Stereopsis result was 724 arc sec. Visual acuity was 0.16 logMAR ± 0.15. Verbal intelligence was 91.1 ± 11, executive intelligence (EI) was 86.7 ± 8, and global intelligence (GI) was 91 ± 10. Correlation coefficient of EI was significantly related to stereopsis (-0.2), visual acuity (-0.1) and Bender (-0.1). GI results were higher than statistical prognosis (88.16 for x = 90). CONCLUSIONS: We demonstrated improvement in binocularity and psychoadaptive areas related to EI after strabismus and amblyopia treatment.
Assuntos
Inteligência , Desempenho Psicomotor , Estrabismo/terapia , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Estudos ProspectivosRESUMO
BACKGROUND: We undertook this study to analyze diagnostic and treatment alternatives in patients with skew deviation (SD). METHODS: This is a prospective, observational and longitudinal study of patients with SD. The study took place in a third-level medical center during the period from September 2007 to May 2008. Strabismological exploration, multidisciplinary diagnosis and treatment alternatives were analyzed. RESULTS: Ten patients presenting SD were studied. Diagnoses were multiple sclerosis, arteriovenous malformation, epilepsy, hydrocephalus, ischemic encephalopathy, cortical atrophy, hypoplasia of corpus callosum and thalamic hemorrhage. Psychomotor retardation was present in 80%. Other diagnoses were Cogan apraxia, Parinaud syndrome, see-saw nystagmus, Foville syndrome, and hemiplegic alterations. Related strabismuses were exotropia (5), esotropia (3), hypertropia (2), and dissociated vertical deviation (1). Lesions of II, III and VII cranial nerves were found. CONCLUSIONS: Complete strabological study allows a better diagnosis of the lesion and consequently relapsing disease in order to achieve a better treatment according to each patient. Optical rehabilitation and botulinum applications are especially indicated.
Assuntos
Transtornos da Motilidade Ocular/diagnóstico , Transtornos da Motilidade Ocular/terapia , Estrabismo/diagnóstico , Estrabismo/terapia , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Estudos Prospectivos , Adulto JovemRESUMO
Objetivo: Analizar las posibilidades de diagnóstico y tratamiento en pacientes con skew deviation (SD) o estrabismo con desviación oblicua. Material y métodos: Estudio prospectivo, observacional y longitudinal de pacientes con SD, de septiembre de 2007 a mayo de 2008. Se realizó exploración estrabológica, estudio multidisciplinario y se evaluaron alternativas terapéuticas. Resultados: Se estudiaron 10 pacientes con SD. Edad 11.5 + 13.6 años. Los diagnósticos neurológicos fueron esclerosis múltiple, malformación arteriovenosa, epilepsia, hidrocefalia, encefalopatía isquémica, atrofia cortical, hipoplasia de cuerpo calloso y hemorragia talámica. Se encontró retraso psicomotor en 80 %, además se asoció a apraxia de Cogan, síndrome de Parinaud, nistagmo en see-saw, síndrome de Foville y hemiplejía. Los estrabismos relacionados fueron exotropía en cinco, endotropía en tres, hipertropía en dos, desviación vertical disociada en uno. Se encontró lesión a II, III y VII nervios craneales. Conclusiones: El estudio estrabológico adecuado permite un mejor diagnóstico de la lesión en SD y con ello vigilar la evolución neurológica del paciente. El tratamiento debe incluir la rehabilitación óptica y el manejo del estrabismo, principalmente con toxina botulínica.
BACKGROUND: We undertook this study to analyze diagnostic and treatment alternatives in patients with skew deviation (SD). METHODS: This is a prospective, observational and longitudinal study of patients with SD. The study took place in a third-level medical center during the period from September 2007 to May 2008. Strabismological exploration, multidisciplinary diagnosis and treatment alternatives were analyzed. RESULTS: Ten patients presenting SD were studied. Diagnoses were multiple sclerosis, arteriovenous malformation, epilepsy, hydrocephalus, ischemic encephalopathy, cortical atrophy, hypoplasia of corpus callosum and thalamic hemorrhage. Psychomotor retardation was present in 80%. Other diagnoses were Cogan apraxia, Parinaud syndrome, see-saw nystagmus, Foville syndrome, and hemiplegic alterations. Related strabismuses were exotropia (5), esotropia (3), hypertropia (2), and dissociated vertical deviation (1). Lesions of II, III and VII cranial nerves were found. CONCLUSIONS: Complete strabological study allows a better diagnosis of the lesion and consequently relapsing disease in order to achieve a better treatment according to each patient. Optical rehabilitation and botulinum applications are especially indicated.
Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adolescente , Adulto , Lactente , Estrabismo/diagnóstico , Estrabismo/terapia , Transtornos da Motilidade Ocular/diagnóstico , Transtornos da Motilidade Ocular/terapia , Estudos Prospectivos , Adulto JovemRESUMO
Pattern dystrophies are defined as a group of diseases genetically determined and characterized by pigment epithelium changes that are seen on fundus examination, such as various line and dot patterns. We present a review of these pathologies including a comparative table reporting the main characteristics as well as some representative figures of each one in order to facilitate diagnosis.
Assuntos
Degeneração Macular/patologia , Epitélio Pigmentado da Retina , Humanos , Degeneração Macular/classificaçãoRESUMO
Las distrofias en patrón son patologías de la retina genéticamente determinadas que se caracterizan por anormalidades en el epitelio pigmentario que se visualizan en el fondo de ojo conformando diversos patrones de puntos o líneas. Realizamos una revisión detallada de las diversas variedades de presentación y sus características más importantes, e incluimos una secuencia fotográfica de las más representativas.
Pattern dystrophies are defined as a group of diseases genetically determined and characterized by pigment epithelium changes that are seen on fundus examination, such as various line and dot patterns. We present a review of these pathologies including a comparative table reporting the main characteristics as well as some representative figures of each one in order to facilitate diagnosis.
Assuntos
Humanos , Degeneração Macular/patologia , Epitélio Pigmentado da Retina , Degeneração Macular/classificaçãoRESUMO
BACKGROUND: We undertook this study to demonstrate the incidence of vitreoretinal dystrophies in a Mexican population. METHODS: This was a retrospective, observational, descriptive, transverse study. We analyzed the files of patients treated at the Retina Department of a medical center for state employees (ISSSTE) from January 1991 to December 2006 to obtain the incidence of vitreoretinal dystrophies. RESULTS: We studied 36,300 patient files. We found an incidence of 0.008% for familial exudative vitreoretinal dystrophy, 0.008% for X-linked juvenile retinoschisis, 0.005% for Wagner disease and 0.005% for Goldmann-Favre disease. We present here a representative case of each type of dystrophy. CONCLUSIONS: Vitreoretinal dystrophies are uncommon diseases and are difficult to diagnose. Even though their incidence is low, the poor evolution to blindness requires identification of early signs in order to offer timely and opportune treatment.