- Email: [email protected]
Simulation in ophthalmology secondary to an chronic retinal detachment
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a r c h s o c e s p o f t a l m o l . 2 0 1 5;9 0(6):292–297
ophthalmological surgery.2,3 Friedman et al.5 have demonstrated that 30 s exposure significantly reduces cultures. The use of surgical masks6 for health staff and sterile cloth over the nose and mouth of the patient has been proposed to avoid contagion of oropharyngeal secretions, as it has been evident that, in contrast with infections after other types of ophthalmological surgery, Streptococci is frequently the cause of endophthalmitis after intravitreal injections. This germ appears to originate in oropharyngeal contamination. In addition, the use of antibiotics during surgery has been analyzed without demonstrating a reduction in the incidence of infections. On the contrary, increased bacterial resistance rates have been described3 with said use of antibiotics. Asepsis procedures must always be respected with surgical handwashing, use of sterile material and gloves and preservation of stability throughout medication preparation procedures.2,3 It is also recommended to use blepharostats7 and to isolate eyelashes. Several articles have described the absence of endophthalmitis when carrying out injections in a previously prepared room.8,9 Applying said procedure in a surgical room ensures better environmental conditions derived from strict regulation of temperature, humidity, pressure, air ventilation and filtration.3 However, a randomized to study would be required to determine any difference in the risk of endophthalmitis when comparing injections carried out in surgical rooms and in consulting rooms. On the other hand, application in consulting rooms could facilitate logistics, which are increasingly complex due to the high volume of procedures being carried out as it would shorten time frames and improve patient comfort. As long as there are no conclusive studies, the above protocols should be respected in an endeavor to minimize the risk of patients contracting endophthalmitis, regardless of the environment in which said procedures are carried out.
references
1. Sai Tin S, Wiwanitkit V. Inyecciones intravítreas: satisfacción y preferencia. Arch Soc Esp Oftalmol. 2014. 2. Falavarjan KG, Nguyen QD. Adverse events and complications associated with intravitreal injection of anti-VEGF agents: a review of literature. Eye. 2013;27:787–94. 3. Casparis H, Wolfensberger TJ, Becker M, Eich G, Graf N, Ambresin A, et al. Incidence of presumed endophthalmitis after intravitreal injection performed in the operating room. Retina. 2014;34:12–7. 4. Arias L, Basauri E, Gómez-Ulla F. Manejo de las inyecciones intravítreas. Primera revisión. In: Guías de práctica clínica de la SERV; 2011. 5. Friedman DA, Mason JO 3rd, Emond T, McGwin G Jr. Povidone-iodine contact time and lid speculum use during intravitreal injection. Retina. 2013;33:975–81. 6. Doshi RR, Leng T, Fung AE. Reducing oral flora contamination of intravitreal injections with face mask or silence. Retina. 2012;32:473–6. 7. Rashaed SA, Rushood A. Acute bacterial endophthalmitis after intravitreal bevacizumab injection: case report and literature review. Saudi J Ophthalmol. 2013;27:55–7. 8. Ng DS, Kwok AK, Chan CW, Li WW. Intravitreal bevacizumab: safety of multiple doses from a single vial for consecutive patients. Hong Kong Med J. 2012;18:488–95. 9. Woo SJ, Han JM, Ahn J, Heo JW, Yu HG, Chung H, et al. Bilateral same-day intravitreal injections using a single vial and molecular bacterial screening for safety surveillance. Retina. 2012;32:667–71.
M. Rodríguez Ramírez Servicio de Oftalmología, Hospital Universitario Infanta Cristina, Parla, Madrid, Spain E-mail address: [email protected] ˜ 2173-5794/© 2014 Sociedad Espanola de Oftalmología. Published by Elsevier España, S.L.U. All rights reserved.
Simulation in ophthalmology secondary to an chronic retinal detachment夽 Simulación en oftalmología secundaria a desprendimiento de retina crónico Dear Editor, Non-organic visual loss (NOVL) is the presence of ocular symptoms, mainly loss of vision, without organic causes that could explain it. NOVL is also known as functional visual loss or simulation in ophthalmology and can appear in up to 1% of ophthalmology emergencies or in 5% of children visiting
outpatient ophthalmology practices. NOVL is suspected during normal basic ophthalmological assessment in the presence of inconsistent ocular symptoms.1,2 Adults can deliberately simulate ocular symptoms in order to obtain some type of benefit or as the result of a psychiatric disease as established in CIE 10 (F44 dissociative conversion disorder) as well as in DSM IVR (fictitious disorders).1,2
夽 Please cite this article as: Santos-Bueso E, Asorey-García A, Sáenz-Francés F, García-Sáenz S, García-Sánchez J. Simulación en oftalmología secundaria a desprendimiento de retina crónico. Arch Soc Esp Oftalmol. 2015;90:296–297.
a r c h s o c e s p o f t a l m o l . 2 0 1 5;9 0(6):292–297
However, in children, etiopathogeny is different and prognostic is generally more positive although a high percentage (up to 20%) could exhibit associated psychopathologies.1–4 A male patient, 35, construction worker, visited the Emergency section due to reduced vision in left eye (LE) secondary to frontal traumatism at work with loss of consciousness for several seconds 2 h earlier. He did not refer personal or familial relevant history or known allergy to drugs. Upon exploration, the patient exhibited a visual acuity of 1.0 in the right eye (RE) and amaurosis in LE, with normal anterior pole in RE, with corectopia and lens dislocated toward vitreous chamber in LE without Tyndall or hyphema. Intraocular pressure was 15 mm Hg in RE and 2 in LE. Ocular fundus was normal in RE, while LE exhibited funnel-shaped retina detachment (RD) with chronic appearance and lens dislocated toward the vitreous chamber, adhered in an aggregation with remains of retinal parenchyma, intraretinal cysts and folds with blood vessels without hemovitreous and negative Shaffer signs. In addition, 20◦ exotropia in LE was seen in primary gaze position. Imaging tests were made to explore said traumatism with normal results, and the neurological exploration was also normal. Due to the inconsistency of exploration results and the recent symptoms referred by the patient, the patient was referred to the Neuro-ophthalmology Unit where he was diagnosed with RD to account for vision loss due to the recent traumatism. NOVL was suspected on the basis of a strictly normal exploration and the presence of inconsistent symptomatology for which an organic basis could not be found.1–4 In this case, the disease which accounted for vision loss already existed because the patient exhibited RD in the LE but the cause thereof was spurious. As mentioned above, the RD was a chronic process and not an acute onset has referred by the patient. It is likely that the patient had regmatogenous, tractional or exudative RD several years earlier which was not treated, so he attributed the cause of the disorder to the labor accident in order to claim compensation.
297
As conclusion, it is necessary to take into account actual ocular diseases causing diminished vision but which are attributed to different causes by patients in order to claim compensation, and which must be also included in the NOVL diagnostic.
references
˜ 1. Munoz-Hernández AM, García-Catalán R, Santos-Bueso E, López-Abad C, Gil-de-Bernabé JG, Díaz-Valle D, et al. Simulación en oftalmología. Arch Soc Esp Oftalmol. 2011;86:320–6. 2. Santos-Bueso E, García-Sánchez J. Simulación en oftalmología (II). Arch Soc Esp Oftalmol. 2013;88:203–4. ˜ 3. Munoz-Hernández AM, Santos-Bueso E, Sáenz-Francés F, Méndez-Hernández CD, García-Feijoo J, Gegúndez-Fernández JA, et al. Nonorganic visual loss and associated psychopathology in children. Eur J Ophthalmol. 2012;22: 269–73. 4. Lim SA, Siatkowski RM, Farris BK. Functional visual loss in adults and children patient characteristics, management, and outcomes. Ophthalmology. 2005;112:1821–8.
E. Santos-Bueso ∗ , A. Asorey-García, F. Sáenz-Francés, S. García-Sáenz, J. García-Sánchez Unidad de Neurooftalmología, Servicio de Oftalmología, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain ∗ Corresponding
author. E-mail address: [email protected] (E. Santos-Bueso). 2173-5794/$ – see front matter ˜ © 2013 Sociedad Espanola de Oftalmología. Published by Elsevier España, S.L.U. All rights reserved.
a r c h s o c e s p o f t a l m o l . 2 0 1 5;9 0(6):292–297
ophthalmological surgery.2,3 Friedman et al.5 have demonstrated that 30 s exposure significantly reduces cultures. The use of surgical masks6 for health staff and sterile cloth over the nose and mouth of the patient has been proposed to avoid contagion of oropharyngeal secretions, as it has been evident that, in contrast with infections after other types of ophthalmological surgery, Streptococci is frequently the cause of endophthalmitis after intravitreal injections. This germ appears to originate in oropharyngeal contamination. In addition, the use of antibiotics during surgery has been analyzed without demonstrating a reduction in the incidence of infections. On the contrary, increased bacterial resistance rates have been described3 with said use of antibiotics. Asepsis procedures must always be respected with surgical handwashing, use of sterile material and gloves and preservation of stability throughout medication preparation procedures.2,3 It is also recommended to use blepharostats7 and to isolate eyelashes. Several articles have described the absence of endophthalmitis when carrying out injections in a previously prepared room.8,9 Applying said procedure in a surgical room ensures better environmental conditions derived from strict regulation of temperature, humidity, pressure, air ventilation and filtration.3 However, a randomized to study would be required to determine any difference in the risk of endophthalmitis when comparing injections carried out in surgical rooms and in consulting rooms. On the other hand, application in consulting rooms could facilitate logistics, which are increasingly complex due to the high volume of procedures being carried out as it would shorten time frames and improve patient comfort. As long as there are no conclusive studies, the above protocols should be respected in an endeavor to minimize the risk of patients contracting endophthalmitis, regardless of the environment in which said procedures are carried out.
references
1. Sai Tin S, Wiwanitkit V. Inyecciones intravítreas: satisfacción y preferencia. Arch Soc Esp Oftalmol. 2014. 2. Falavarjan KG, Nguyen QD. Adverse events and complications associated with intravitreal injection of anti-VEGF agents: a review of literature. Eye. 2013;27:787–94. 3. Casparis H, Wolfensberger TJ, Becker M, Eich G, Graf N, Ambresin A, et al. Incidence of presumed endophthalmitis after intravitreal injection performed in the operating room. Retina. 2014;34:12–7. 4. Arias L, Basauri E, Gómez-Ulla F. Manejo de las inyecciones intravítreas. Primera revisión. In: Guías de práctica clínica de la SERV; 2011. 5. Friedman DA, Mason JO 3rd, Emond T, McGwin G Jr. Povidone-iodine contact time and lid speculum use during intravitreal injection. Retina. 2013;33:975–81. 6. Doshi RR, Leng T, Fung AE. Reducing oral flora contamination of intravitreal injections with face mask or silence. Retina. 2012;32:473–6. 7. Rashaed SA, Rushood A. Acute bacterial endophthalmitis after intravitreal bevacizumab injection: case report and literature review. Saudi J Ophthalmol. 2013;27:55–7. 8. Ng DS, Kwok AK, Chan CW, Li WW. Intravitreal bevacizumab: safety of multiple doses from a single vial for consecutive patients. Hong Kong Med J. 2012;18:488–95. 9. Woo SJ, Han JM, Ahn J, Heo JW, Yu HG, Chung H, et al. Bilateral same-day intravitreal injections using a single vial and molecular bacterial screening for safety surveillance. Retina. 2012;32:667–71.
M. Rodríguez Ramírez Servicio de Oftalmología, Hospital Universitario Infanta Cristina, Parla, Madrid, Spain E-mail address: [email protected] ˜ 2173-5794/© 2014 Sociedad Espanola de Oftalmología. Published by Elsevier España, S.L.U. All rights reserved.
Simulation in ophthalmology secondary to an chronic retinal detachment夽 Simulación en oftalmología secundaria a desprendimiento de retina crónico Dear Editor, Non-organic visual loss (NOVL) is the presence of ocular symptoms, mainly loss of vision, without organic causes that could explain it. NOVL is also known as functional visual loss or simulation in ophthalmology and can appear in up to 1% of ophthalmology emergencies or in 5% of children visiting
outpatient ophthalmology practices. NOVL is suspected during normal basic ophthalmological assessment in the presence of inconsistent ocular symptoms.1,2 Adults can deliberately simulate ocular symptoms in order to obtain some type of benefit or as the result of a psychiatric disease as established in CIE 10 (F44 dissociative conversion disorder) as well as in DSM IVR (fictitious disorders).1,2
夽 Please cite this article as: Santos-Bueso E, Asorey-García A, Sáenz-Francés F, García-Sáenz S, García-Sánchez J. Simulación en oftalmología secundaria a desprendimiento de retina crónico. Arch Soc Esp Oftalmol. 2015;90:296–297.
a r c h s o c e s p o f t a l m o l . 2 0 1 5;9 0(6):292–297
However, in children, etiopathogeny is different and prognostic is generally more positive although a high percentage (up to 20%) could exhibit associated psychopathologies.1–4 A male patient, 35, construction worker, visited the Emergency section due to reduced vision in left eye (LE) secondary to frontal traumatism at work with loss of consciousness for several seconds 2 h earlier. He did not refer personal or familial relevant history or known allergy to drugs. Upon exploration, the patient exhibited a visual acuity of 1.0 in the right eye (RE) and amaurosis in LE, with normal anterior pole in RE, with corectopia and lens dislocated toward vitreous chamber in LE without Tyndall or hyphema. Intraocular pressure was 15 mm Hg in RE and 2 in LE. Ocular fundus was normal in RE, while LE exhibited funnel-shaped retina detachment (RD) with chronic appearance and lens dislocated toward the vitreous chamber, adhered in an aggregation with remains of retinal parenchyma, intraretinal cysts and folds with blood vessels without hemovitreous and negative Shaffer signs. In addition, 20◦ exotropia in LE was seen in primary gaze position. Imaging tests were made to explore said traumatism with normal results, and the neurological exploration was also normal. Due to the inconsistency of exploration results and the recent symptoms referred by the patient, the patient was referred to the Neuro-ophthalmology Unit where he was diagnosed with RD to account for vision loss due to the recent traumatism. NOVL was suspected on the basis of a strictly normal exploration and the presence of inconsistent symptomatology for which an organic basis could not be found.1–4 In this case, the disease which accounted for vision loss already existed because the patient exhibited RD in the LE but the cause thereof was spurious. As mentioned above, the RD was a chronic process and not an acute onset has referred by the patient. It is likely that the patient had regmatogenous, tractional or exudative RD several years earlier which was not treated, so he attributed the cause of the disorder to the labor accident in order to claim compensation.
297
As conclusion, it is necessary to take into account actual ocular diseases causing diminished vision but which are attributed to different causes by patients in order to claim compensation, and which must be also included in the NOVL diagnostic.
references
˜ 1. Munoz-Hernández AM, García-Catalán R, Santos-Bueso E, López-Abad C, Gil-de-Bernabé JG, Díaz-Valle D, et al. Simulación en oftalmología. Arch Soc Esp Oftalmol. 2011;86:320–6. 2. Santos-Bueso E, García-Sánchez J. Simulación en oftalmología (II). Arch Soc Esp Oftalmol. 2013;88:203–4. ˜ 3. Munoz-Hernández AM, Santos-Bueso E, Sáenz-Francés F, Méndez-Hernández CD, García-Feijoo J, Gegúndez-Fernández JA, et al. Nonorganic visual loss and associated psychopathology in children. Eur J Ophthalmol. 2012;22: 269–73. 4. Lim SA, Siatkowski RM, Farris BK. Functional visual loss in adults and children patient characteristics, management, and outcomes. Ophthalmology. 2005;112:1821–8.
E. Santos-Bueso ∗ , A. Asorey-García, F. Sáenz-Francés, S. García-Sáenz, J. García-Sánchez Unidad de Neurooftalmología, Servicio de Oftalmología, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain ∗ Corresponding
author. E-mail address: [email protected] (E. Santos-Bueso). 2173-5794/$ – see front matter ˜ © 2013 Sociedad Espanola de Oftalmología. Published by Elsevier España, S.L.U. All rights reserved.