RESUMO Objetivo: Analisar a camada plexiforme interna de células maculares e ganglionares e as espessuras da camada de fibras nervosas da retina após vitrectomia com técnica de flap invertido para orifício macular idiopático. Métodos: Estudo prospectivo de 28 olhos submetidos à cirurgia de orifícios ma culares idiopáticos. Foi realizada a técnica de flap invertido da membrana limitante interna usando Azul Brilhante (0,05%). Os exames oftalmológicos e a análise quantitativa da espessura do complexo de células maculares ganglionares foram analisados na linha de base com 1 mês e 3 meses após a cirurgia. Resultados: A espessura média pré-operatória da camada plexiforme interna de células ganglionares e da camada plexiforme interna de células ganglionares ± camada de fibra nervosa da retina foi de 88,9 µm e 124,8 µm, respectivamente; a espessura média da camada plexiforme interna de células ganglionares com 1 mês e 3 meses após a cirurgia foi reduzida para 72,8 µm e 65,2 µm (p<0,001 e p<0,001, respectivamente). A espessura média da camada plexiforme interna de células ganglionares pós-operatórias + da camada de fibra nervosa da retina também foi reduzida com 1 e 3 meses (108,8 µm e 99,3 µm; p<0,001 e p<0,001, respectivamente). Nenhuma diferença significativa foi observada entre a acuidade visual melhor corrigida pré e pós-operatória com 1 e 3 meses (p <0, 73 e p<0, 14, respectivamente). Conclusão: A camada plexiforme interna de células maculares ganglionares e a camada plexiforme interna de células ganglionares ± as espessuras da camada de fibra nervosa da retina foram significativamente reduzidas após vitrectomia com técnica de flap invertido usando azul brilhante (0,05%) para orifício macular idiopático.

ABSTRACT Purpose: To analyze the macular ganglion cell-inner plexiform and retinal nerve fiber layer thicknesses after vitrectomy with the inverted flap technique for idiopathic macular holes. Methods: A prospective study was conducted on 28 eyes treated with surgery for idiopathic macular holes. The inverted internal limiting membrane flap technique assisted with Brilliant Blue staining (0.05%) was performed. Ophthalmologic examinations and quantitative analysis of the macular ganglion cell complex thickness were performed at baseline,1 and 3 months after surgery. Results: The preoperative mean thicknesses of the ganglion cell-inner plexiform layer and ganglion cell-inner plexiform layer + retinal nerve fiber layer were 88.9 and 124.8 µm, respectively. The mean ganglion cell-inner plexiform layer thicknesses at 1 and 3 months after surgery were reduced to 72.8 and 65.2 µm, respectively (p<0.001 and p<0.001, respectively). The mean postoperative ganglion cell-inner plexiform layer + retinal nerve fiber layer thickness was also reduced at 1 and 3 months (108.8 and 99.3 µm, respectively; p<0.001 and p<0.001, respectively). No significant difference was found between the preoperative and postoperative best-corrected visual acuities at 1 and 3 months (p<0.73 and p<0.14, respectively). Conclusion: The macular ganglion cell-inner plexiform layer and ganglion cell-inner plexiform layer + retinal nerve fiber layer thicknesses were significantly reduced after vitrectomy with the inverted flap technique assisted with Brilliant Blue staining (0.05%) for idiopathic macular holes.

Abstract Purpose: To compare the effect of topical insulin and sodium hyaluronate in the treatment of epithelial defects secondary to intraoperative corneal epithelial debridement during pars plana vitrectomy in diabetics. Methods: Controlled clinical trial. Patients were randomized to one of three treatment groups: topical 0.15% sodium hyaluronate (group I), topical insulin 0.5 IU/drop (group II) or combined treatment with topical insulin 0.5 IU/drop and 0.15% sodium hyaluronate (group III). Results: Thirty-six eyes of 36 patients were included, 12 eyes in each group. There were no statistically significant differences in baseline characteristics. The time required until complete re-epithelialization was of 4.25 ± 0.62, 3.0 ± 0.85 and 3.33 ± 0.98 days, in groups I, II and III, respectively; group II showed a significantly shorter reepithelialization time (p <0.001). All groups had a reduction in the area of the epithelial defect from day 1; a smaller area was observed in group II; however, this difference was not statistically significant. No adverse effects were reported. Conclusions: Both topical insulin and combined treatment with topical insulin and sodium hyaluronate are effective to treat corneal epithelial defects secondary to intraoperative corneal epithelial debridement during pars plana vitrectomy in diabetics. The addition of sodium hyaluronate to topical insulin did not provide a greater benefit. The three treatments were safe and well tolerated.

Resumen Objetivo: Comparar el efecto de la insulina tópica y del hialuronato sódico en el cierre del defecto epitelial producido por el desbridamiento corneal transquirúrgico durante la vitrectomía vía pars plana en diabéticos. Método:: Ensayo clínico controlado. Los pacientes fueron aleatorizados a uno de tres grupos de tratamiento: hialuronato sódico tópico al 0.15% (grupo I), insulina tópica 0.5 UI/gota (grupo II) o tratamiento combinado con insulina 0.5 UI/gota y hialuronato sódico tópicos al 0.15% (grupo III). Resultados: Se incluyeron 36 ojos de 36 pacientes, 12 ojos en cada grupo. No hubo diferencias estadísticamente significativas en las características basales. El tiempo necesario hasta la reepitelización completa fue de 4.25 ± 0.62, 3.0 ± 0.85 y 3.33 ± 0.98 días en los grupos I, II y III, respectivamente, presentado el grupo II un tiempo de reepitelización significativamente menor (p < 0.001). En todos los grupos se redujo el área del defecto epitelial a partir del día 1, con una menor área en el grupo II; sin embargo, esta diferencia no fue estadísticamente significativa en comparación con los otros grupos. No se reportaron efectos adversos. Conclusiones: La insulina tópica y el tratamiento combinado de insulina tópica y hialuronato sódico son efectivos para el cierre de defectos epiteliales después del desbridamiento corneal transquirúrgico en diabéticos. La insulina tópica y el tratamiento combinado de esta con hialuronato sódico tienen un mayor efecto que el tratamiento solo con hialuronato sódico. El tratamiento con insulina y el tratamiento combinado demostraron ser seguros y bien tolerados.

Acute pulmonary embolism (APE) is considered a cardiovascular emergency and is one of the most important causes of morbidity and mortality in hospitalized patients. Pulmonary embolism diagnosis has to be made early in the course of the disease and its management installed immediately. Pulmonary embolism management includes hemodynamic support, anticoagulation, thrombolysis and embolectomy. We present an overview of the treatment of APE.

La tromboembolia pulmonar (TEP) es considerada como una urgencia cardiovascular, representa una de las principales causas de morbilidad y mortalidad en pacientes hospitalizados. El diagnóstico debe realizarse lo más tempranamente posible, y su tratamiento instaurarse de manera inmediata. El manejo de la embolia pulmonar aguda, incluye medidas de soporte, apoyo hemodinámico, utilización de anticoagulantes y en el caso del paciente inestable, trombólisis o embolectomía. En el presente artículo, se revisan las generalidades en el tratamiento de los pacientes con TEP.