published_or_final_version / Anatomy / Master / Master of Philosophy

<p><span lang="EN-GB" style="font-size:12.0pt / font-family:&quot / Times New Roman&quot / ,&quot / serif&quot / mso-fareast-font-family:&quot / Times New Roman&quot / mso-ansi-language:EN-GB / mso-fareast-language: EN-ZA">Literature shows that cataracts are the leading cause of blindness globally and nationally. Retinal detachment has also been a substantial problem both globally and nationally. Both of these conditions are prevalent in patients of 50 years and older. The treatment for both conditions is for surgery to be performed. In the Western Cape the three leading hospitals do not have ophthalmic pre-operative and post-operative protocols<span style="mso-bidi-font-weight:bold">.</span>Review question:What are the best practices to manage pre-operative and post-operative nursing care in patients waiting for cataract and retinal detachment surgery? bjectives:1. To determine the best practice in pre-operative and post-operative care in patients who have undergone cataract and/or retinal detachment surgery regarding: health education offered by nurses, counselling to prevent psychological effects, and positioning to prevent physical complications. 2. To develop a framework based on systematic reviews for pre-operative and post-operative ophthalmic nursing care in South Africa. Methodology: </span><span lang="EN-GB" style="font-size: 12.0pt / font-family:&quot / Times New Roman&quot / ,&quot / serif&quot / mso-ansi-language:EN-GB">A systematic review using the guide by the Centre for Reviews and Dissemination was done, and <span style="mso-bidi-font-weight:bold">studies were </span>identified by searching various electronic databases and visually scanning reference lists from the relevant studies. Studies that were included were evidence-based. All study types were considered and the studies were selected based on the title and, where available, the abstract. These were then assessed against the inclusion criteria. A narrative synthesis was used. Finally the evidence was summarised and a framework was drawn up, focusing on pre-operative and post-operative nursing care for cataract and retinal detachment surgery</span></p> <p>&nbsp / </p>

Magister Curationis - MCur / Literature shows that cataracts are the leading cause of blindness globally and nationally. Retinal detachment has also been a substantial problem both globally and nationally. Both of these conditions are prevalent in patients of 50 years and older. The treatment for both conditions is for surgery to be performed. In the Western Cape the three leading hospitals do not have ophthalmic pre-operative and post-operative protocols.Review question:What are the best practices to manage pre-operative and post-operative nursing care in patients waiting for cataract and retinal detachment surgery? bjectives:1. To determine the best practice in pre-operative and post-operative care in patients who have undergone cataract and/or retinal detachment surgery regarding: health education offered by nurses, counselling to prevent psychological effects, and positioning to prevent physical complications. 2. To develop a framework based on systematic reviews for pre-operative and post-operative ophthalmic nursing care in South Africa. Methodology: A systematic review using the guide by the Centre for Reviews and Dissemination was done, and studies were identified by searching various electronic databases and visually scanning reference lists from the relevant studies. Studies that were included were evidence-based. All study types were considered and the studies were selected based on the title and, where available, the abstract. These were then assessed against the inclusion criteria. A narrative synthesis was used. Finally the evidence was summarised and a framework was drawn up, focusing on pre-operative and post-operative nursing care for cataract and retinal detachment surgery

Quinolones are a group of antibiotics that have gained significant popularity on a global scale since the end of the last century. This popularity was predominantly based on their proven potency, broad coverage against a wide range of bacteria, in addition to possessing a favorable pharmacologic profile. Whereas quinolone-associated adverse reactions are generally tolerable and self-limiting, some reactions have generated heightened concerns due to their serious nature, which have resulted in label changes or even market withdrawal in some instances. This thesis investigates the association between quinolone antibiotics and two adverse reactions of an acute and serious nature: acute liver failure and retinal detachment. Each adverse reaction is investigated through integrating evidence from three studies utilizing different designs based on data from different sources, with each source offering a unique perspective on this issue. The first study type (chapter 2 for acute liver failure ‘ALF’ and Chapter 5 for retinal detachment ‘RD’) analyzes spontaneous reports submitted to the US Food & Drug Administration (FDA) adverse event reporting system database. Chapters 3 and 6 systematically identified all relevant (published and unpublished) clinical trials for occurrences of ALF and RD, respectively, among trial participants. Finally, chapters 4 (ALF) and 7 (RD) involved case-control analysis of a major US database of electronic health records for nearly 70 million inpatients admitted to more than 500 hospitals between 2000 and 2016. The FAERS analysis revealed a positive ALF signal with ciprofloxacin and a marginal signal for RD with moxifloxacin. Examination of the evidence from clinical trials revealed only two cases of ALF, one associated with gemifloxacin and one with moxifloxacin. No cases of RD were reported in any of the identified clinical trials. Primary analyses of the Health Facts® data revealed no overall association between quinolones and the risk of ALF or RD. However, elevated risk was identified in some subgroups, including African Americans (ALF, RD), Caucasians (ALF), women (ALF, RD), men (ALF), those ≤60 years of age (ALF) or 56-70 years of age (RD), and those with no or few comorbidities (ALF). Evidence from analyses of data from spontaneous reports and clinical trials provided some evidence for an elevated risk of ALF or RD following the systemic administration of quinolone antibiotics. Some evidence of elevated risk was also identified in the case-control analyses of inpatient EHR records. Findings from our six epidemiologic studies are in line with current advisories by FDA and Health Canada.

Background: High-density silicone oils are newly developed long-term tamponade agents for the treatment of complicated retinal detachment in the inferior retina. Previous studies describe satisfying anatomical and functional results. In this study we examined the largest cohort so far for a 9-month follow-up and performed a comparison to conventional silicone oil. Methods: Our study documents results and adverse effects after vitreoretinal surgery and endotamponade with Densiron® 68 in 99 cases of complicated retinal detachment. A 9-month follow-up was performed. Data of 21 patients with intraocular conventional silicone oil tamponade in complicated retinal detachment were retrospectively analyzed and served as control. Results: Anatomical success was achieved in 78 of 89 eyes (87.6%) with completed follow-up; visual acuity did not change significantly (from mean preoperative logMAR 1.88 to postoperative logMAR 1.96 (p = 0.9). Compared to control a higher anatomical success but a similar number of adverse effects were observed with heavy silicone oil in vitreous. Nevertheless, patients who received Densiron 68 twice due to redetachment showed a significantly higher rate of intraocular inflammation with the tamponade agent in situ. Conclusion: Our results support the hypothesis of Densiron 68 as potent tamponade agent for complicated retinal detachment in the inferior retinal segments especially in eyes where a previous operation failed. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Intraoperative Blutungskomplikationen sind bei der Versorgung von Patienten mit primärer rhegmatogener Netzhautablösung relativ selten. Bei den aufgetretenen Komplikationen handelte es sich fast ausschließlich um leichtere Blutungen, die intraoperativ gut zu beherrschen waren. Die Wahl der Antikoagulation hatte dabei keinen Einfluss auf die Wahrscheinlichkeit des Auftretens intraoperativer Blutungskomplikationen. Dies gilt sowohl für die Thrombozytenaggregationshemmer Acetylsalicylsäure und Clopidogrel als auch für die gerinnungshemmenden Substanzen Heparin und Phenprocoumon. Interessanterweise zeigte sich bei den mit Phenprocoumon behandelten Patienten keine Korrelation zwischen einem erniedrigten Quick-Wert und einer erhöhten intraoperativen Blutungsneigung. Bei den wenigen Patienten, bei denen es unter der Therapie mit Phenprocoumon zu einer Blutung während der Operation kam, lagen die Quick-Werte sogar eher im oberen Bereich. Wenn man nun bedenkt, dass es sich bei der rissbedingten Netzhautablösung um einen Notfall handelt und beim Zuwarten mit einer Progredienz der Ablösung zu rechnen ist, kann eine klare Empfehlung für die sofortige Operation trotz wirksamer Antikoagulation ausgesprochen werden. Untermauert wird dies noch durch die erhöhte Gefahr thromboembolischer Ereignisse, wenn eine indizierte Gerinnungshemmung perioperativ abgesetzt oder auf andere Substanzen umgestellt wird. Schließlich werden nur Patienten antikoaguliert, bei denen dies aufgrund von gravierenden Erkrankungen in der Vorgeschichte indiziert ist. Dazu gehören zum Beispiel abgelaufene tiefe Beinvenenthrombosen oder Embolien, Vorhofflimmern oder auch der Herzklappenersatz. Im Gegensatz zu den Ergebnissen für die Antikoagulation ergab sich eine Abhängigkeit der intraoperativen Blutungswahrscheinlichkeit von der Wahl des operativen Verfahrens. Die wenigsten Blutungen traten bei den rein eindellenden Operationen (Plomben und Cerclagen) auf. Bei den kombinierten Operationen (Plombe oder Cerclage in Kombination mit Pars plana Vitrektomie) lag die Komplikationsrate schon deutlich höher. Die höchste Rate intraoperativer Blutungskomplikationen zeigte sich bei den nicht-eindellenden Operationen (Pars plana Vitrektomien). Dabei war die Komplikationsrate bei den nicht-eindellenden Verfahren gegenüber den rein eindellenden Verfahren signifikant erhöht (p<0,001). Es kann also festgehalten werden, dass intraoperative Blutungen bei der Akutversorgung von Patienten mit rissbedingter Netzhautablösung selten sind und nicht im Zusammenhang mit der Einnahme von Gerinnungshemmern zu stehen scheinen. Die Wahl des Operationsverfahrens hingegen beeinflusst die Rate intraoperativer Blutungskomplikationen.

No description available.

In nature, cells are not randomly clustered to form tissues. The tissue is a more complicated system with functions that go beyond what any single cell type could accomplish. While studying single-cell mechanics and dynamics is relevant from an investigative point of view, this approach loses, or fail to gather information about the tissue. The tissue investigated in this study is the neurosensory retina which seeing as extension of the brain is a very convenient model for the central nervous system due to its accessibility. The retina is constantly subjected to different mechanical stresses from development to adulthood. Although the majority of the phenomena where mechanical stresses are involved are well-studied, the mechanics behind them is not well understood. However, knowledge about the ability of the retina to adjust to mechanical stresses is essential, for example, for improving retinal surgery. Establishing a method to mechanically probe the retina is a challenge due to the extremely delicate nature of this multilayered neural tissue and to the short-time survival ex vivo. The organotypic tissue culture is a powerful tool because it allows to maintain with high accuracy the complex multicellular anatomy and the microenvironment of the original tissue. One of the limitations of the organotypic culture techniques has been until recently due to the ability to use only post-natal/juvenile tissues for long-term culture. The importance of using adult tissue is incontestable when the investigation focuses on age-related pathologies such as vitreous shrinkage or macula degeneration. In this work, TiO2 nanotube arrays are presented as the innovative substrate for long-term organotypic culture of adult neural tissue. The retinal whole-mount of adult guinea pig and the brain slices of adult mouse were cultures for 14 days without showing any sign of edema or swelling. Furthermore, in order to study the behavior of the retinal tissue under shear stress new set-ups were designed. For the first time, the behavior of the retinal layers were observed showing that the retina does not act as an homogeneous material in response to an applied stress. The methods developed here can be used for future quantitative studies, to provide an exact knowledge of retinal biomechanics which will help retinal surgeons to optimize their methods.

Orientadores: Newton Kara-Jose, Rodrigo Pessoa Cavalcanti Lira / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-09T11:04:58Z (GMT). No. of bitstreams: 1 Soares_PauloHenriqueLimeira_D.pdf: 4979795 bytes, checksum: a3e56d06c84ca0781142bae68e8cc1ef (MD5) Previous issue date: 2007 / Resumo: Os objetivos deste estudo foram caracterizar a demanda e a capacidade resolutiva de um serviço oftalmológico terciário para pacientes com doenças vitreorretinianas em uma população urbana definida no sudeste brasileiro. Os dados foram coletados dos pacientes consecutivos atendidos pela primeira vez no Departamento de Oftalmologia, Universidade Estadual de Campinas, São Paulo, Brasil, de 1º. de junho de 2003 a 31 de julho de 2004. A capacidade resolutiva e a incidência da demanda foram calculadas para cirurgia de retina e fotocoagulação. Os dados foram analisados com os programas EpiInfo¿ 2000 (Centers for Disease Control and Prevention, Atlanta, Georgia, USA) e Statistical Package for the Social Sciences® (version 11.0). A estimativa populacional da área de abrangência é de 3.389.294 de pessoas. Dos 7500 pacientes referidos para o Departamento no período do estudo, 641 foram incluídos no estudo. Os diagnósticos considerados para análise foram descolamento de retina (26,0%), retinopatia diabética (21,0%) e hemorragia vítrea (7,7%) com medianas das idades de 52, 59 e 57,5, respectivamente. A capacidade resolutiva para descolamento de retina, hemorragia vítrea e retinopatia diabética foram, respectivamente, 38,1%, 33,0% e 93,5%. O principal motivo para a não realização de cirurgia de retina ou fotocoagulação foi horário não disponível (87,1%). A incidência da demanda global para descolamento de retina foi 9,2:100.000. Descolamentos em fácicos não traumáticos apresentaram a mais alta incidência da demanda com 7,1:100.000. 26,5% dos pacientes apresentaram descolamentos de retina inoperáveis. A incidência da demanda idade-específica aumenta com a idade. Descolamentos de retina não traumáticos em fácicos foram o tipo mais comum. A incidência de descolamentos traumáticos foi maior no gênero masculino. O estudo revelou que condições que ameaçam a visão como descolamento de retina e retinopatia diabética não são totalmente cobertos pelo Serviço nesta área. Alternativas para solução do problema são consideradas. O estudo fornece informações para planejamento de serviços oftalmológicos de alta complexidade na população estudada / Abstract: The aims of the study were to evaluate either the characteristics of the demand and the performance of the tertiary care delivered to patients with vitreoretinal diseases in a defined urban population in the Southeast of Brazil. Data were collected from consecutive first time patients between June 1 2003 and July 31 2004 in the Department of Ophthalmology, State University of Campinas, São Paulo, Brazil. Problem-solving capacity rates as well as demand incidence were calculated for vitreoretinal surgery and photocoagulation. Data were entered into the Statistical Package for the Social Sciences (version 11.0). There were a total population of 3 389 294 in the cities of Campinas catchment area. Of the 7500 patients referred to the Department, 641 were deemed to analysis. Diagnoses analyzed were retinal detachment (26.0%), diabetic retinopathy (21.0%), and vitreous hemorrhage (7.7%). Median ages were 52, 59, 57.5, respectively. The problem-solving capacity rates showed that 38.1%, 33.0%, and 93.5% of those eligible for ophthalmic intervention (retinal detachment, vitreous hemorrhage and diabetic retinopathy) have obtained the treatment. The main reason for not performing the treatment was lack of available intervention time (87.1%). The overall demand incidence of retinal detachment was 9.2:100 000. Nontraumatic phakic detachments had the highest demand incidence of 7.1:100 000. 26,5% of all patients seeking treatment presented inoperable cases of retinal detachments. The age specific demand incidence increases with age. Nontraumatic phakic detachments were the most common type of detachment. The incidence of the traumatic types of detachment was higher in males than that in females. Sight threatening conditions are not thoroughly covered by the health system in this area. Some alternatives to reduce the problem are considered. It provides valuable information on planning high complexity eye services in the population likely to be served. / Doutorado / Oftalmologia / Doutor em Ciências Médicas

Background: High-density silicone oils are newly developed long-term tamponade agents for the treatment of complicated retinal detachment in the inferior retina. Previous studies describe satisfying anatomical and functional results. In this study we examined the largest cohort so far for a 9-month follow-up and performed a comparison to conventional silicone oil. Methods: Our study documents results and adverse effects after vitreoretinal surgery and endotamponade with Densiron® 68 in 99 cases of complicated retinal detachment. A 9-month follow-up was performed. Data of 21 patients with intraocular conventional silicone oil tamponade in complicated retinal detachment were retrospectively analyzed and served as control. Results: Anatomical success was achieved in 78 of 89 eyes (87.6%) with completed follow-up; visual acuity did not change significantly (from mean preoperative logMAR 1.88 to postoperative logMAR 1.96 (p = 0.9). Compared to control a higher anatomical success but a similar number of adverse effects were observed with heavy silicone oil in vitreous. Nevertheless, patients who received Densiron 68 twice due to redetachment showed a significantly higher rate of intraocular inflammation with the tamponade agent in situ. Conclusion: Our results support the hypothesis of Densiron 68 as potent tamponade agent for complicated retinal detachment in the inferior retinal segments especially in eyes where a previous operation failed. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.