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Öèòàòà:
"ranibizumab (Rx) - Lucentis Ïîáî÷íûå ýôôåêòû Çàðåãèñòðèðîâàííûå â áîëåå, ÷åì 10%ñëó÷àåâ Conjunctival hemorrhage (43-77%) Eye pain (17-37%) Vitreous floaters (3-32%) Incr IOP (8-24%) Vitreous detachment (7-22%) Eye irritation (4-19%) Intraocular inflammation (5-18%) Headache (2-15%) Upper resp tract infection (2-15%) Retinal disorder (13%) Blepharitis (3-13%) Retinal degeneration (1-11%) Çàðåãèñòðèðîâàííûå â 1-10% ñëó÷àåâ Conjunctival hyperemia (9%) Posterior capsule opacification (8%) Injection site hemorrhage (5%) Vitreous hemorrhage (4%)" [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] |
#212
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Åù¸ îäèí ïðèìåð ëàçåðíîãî ëå÷åíèÿ ñêðûòîé ÕÍÂ.
vis 0.2 è äî è ïîñëå ëå÷åíèÿ. Ýòî ñîñòîÿíèå äî ëå÷åíèÿ è ÔÀà [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] Ýòî ïîñëå ëå÷åíèÿ: [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] åù¸ åñòü ÎÑÒ äî è ïîñëå ëå÷åíèÿ. Îíè ïî 92 ìá â ôîðìàòå avi (âèäåî). Êàê èõ âûëîæèòü ÿ íå çíàþ. |
#213
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ÿ, êîíå÷íî, ñ áîëüøèì óâàæåíèåì - íî âèäíû ìíîæ. îòñëîéêè ïýñ, åãî íåñîñòîÿòåëüíîñòü. Ïî÷åìó îäíîçíà÷íî õíâ? Ïî îñò?
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#214
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- Decompress and recompress both audio and video.
- Remove and replace audio tracks without touching the video. [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] licensed under the GNU General Public License (GPL) free! Êîíâåðòèðîâàòü íàäî â MPEG4.. Âëàä, ïîðà ñîçäàâàòü ñâîé Þòóá êàíàë, èëè íà äðóãîé ñàéò.. |
#215
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Ýòî ÎÊÒ äî ëå÷åíèÿ.
[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] Ýòî ÎÊÒ ïîñëå ëå÷åíèÿ [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] |
#216
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#217
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åù¸ îäèí ñëó÷àé...
Æåíùèíà ïðèñëàíà ñ äèàãíîçîì ÖÑÕ äëÿ ëàçåðíîãî ëå÷åíèÿ. vis 0.4 [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] [Èçîáðàæåíèÿ äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì] [Èçîáðàæåíèÿ äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì] [Èçîáðàæåíèÿ äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì] Íî ìû òî âèäàëè óæå òàêèå ÖÑÕ (ñì âûøå), ïîýòîìó ëå÷èòü îáû÷íîé ËÊ íå ñòàëè. À ïîëå÷èëè êàê ìåìáðàíó (long pulse 532 íì). Ïîëó÷èëè 0.5 ïîêà, íî ôîâåîëà íå ïîñòðàäàëà. Äóìàþ ðàññìîòðèòñÿ åù¸. [Èçîáðàæåíèÿ äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì] [Èçîáðàæåíèÿ äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì] È âîò ÎÊÒ äî è ïîñëå: ( îäíîì ôàéëå ïî 2 êàðòèíêè âåðõíÿÿ - ïîñëå, íèæíÿÿ - äî) [Èçîáðàæåíèÿ äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì] __________________________________________________ _____ [Èçîáðàæåíèÿ äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì] __________________________________________________ ________ [Èçîáðàæåíèÿ äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì] __________________________________________________ _________ [Èçîáðàæåíèÿ äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì] __________________________________________________ __________ [Èçîáðàæåíèÿ äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì] __________________________________________________ __________ [Èçîáðàæåíèÿ äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì] __________________________________________________ __________ [Èçîáðàæåíèÿ äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì] __________________________________________________ __________ [Èçîáðàæåíèÿ äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì] __________________________________________________ __________ [Èçîáðàæåíèÿ äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì] __________________________________________________ __________ |
#218
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Ãîñïîäà, ïîäñêàæèòå êëàññèôèêàöèþ ÝÝÄ (ïî Âîëêîâó êàæåòñÿ), áóäó áëàãîäàðåí.
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#219
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Âûçûâàåò îòñëîéêó è äåôîðìàöèþ ÐÏÝ
1 Çàäíÿÿ îñòðàÿ ìóëüòèôîêàëüíàÿ ýïèòåëèîïàòèÿ â òîì ÷èñëå è ìîíîëàòåðàëüíàÿ ôîðìà 2 Ôèáðîâàñêóëÿðíàÿ îòñëîéêà ïèãìåíòíîãî ýïèòåëèÿ Fibrovascular Pigment Epithelial Detachment (FVPED) Îòëè÷àåòñÿ ïðèïîäíÿòîñòüþ ÐÏÝ íà ÎÊÒ òî÷å÷íîé ãèïåðôëóîðèñöåíöèåé íà 1-2 ìèíóòå ÔÀà 3Ïðîëèôåðàòèâíûé àíãèîìàòîç ñåò÷àòêè Retinal Angiomatous Proliferation (RAP) 4 Èäèîïàòè÷åñêàÿ ïîëèïîâèäíàÿ õîðèîèäàëüíàÿ âàñêóëîïàòèÿ Ýòî èç òîãî ÷òî ñðàçó â ãîëîâó ïðèøëî. È åùå Ainakoz ïî÷åìó îòâåðãàåòå ÖÑÕ õðîíè÷åñêîãî òå÷åíèÿ èëè ñ ìíîæåñòâåííûìè òî÷êàìè ôèëüòðàöèè? Ó Êîñêàñ î÷åíü êðàñèâî ýòî â àòëàñå îïèñàíî. Ëàçåð êîàãóëÿöèþ èëè ïðîãðåâàíèå òàêèõ çîí îñòàâëþ ïîä âîïðîñîì è î÷åíü áîëüøèì - ïðåäîñòàâüòå ñíèìêè è èññëåäîâàíèÿ äàííûõ ïàöèåíòîâ â îòäàëåííîì ïåðèîäå - ãîä è áîëåå. Ïîõîæåå ðàöèîíàëèçàòîðñêîå ïðåäëîæåíèå (òîëüêî òàì ïÿòíî ïîáîëüøå ïðåäëàãàëè 500ìêì) ñëûøàë íà ÐÎÎÔ 2011. Êîíêðåòíî ïî ñíèìêàì ÔÀà íå î÷åíü âèæó ÇÎÍÛ ËÎÊÀËÜÍÎÉ ÃÈÏÅÐÔËÓÎÐÅÑÖÅÍÖÈÈ (ãäå òî÷êà ïðîñà÷èâàíèÿ????) - íåò? - òîãäà ïî÷åìó ÖÑÕ ñðàçó. Èç æèçíè - âñå ïðî ñåáÿ, äà ïðî ñåáÿ - ÷àñòî âñòàþ ïåðåä ìûñëüþ ó áîëüíûõ ñ ìóëüòèôîêàëüíûì ïðîñà÷èâàíèåì ïðè ÖÑÕ ïîïðîáîâàòü àíòè-VGF. (è íå ñïðàøèâàéòå ìåíÿ ïðî òî êàê îí òàì äîëæåí ðàáîòàòü - íå ðàáîòàåò íó è ëàäóøêè, ÿ ïàöèåíòà ïëàòèòü íå çàñòàâëÿþ (ìîãó ñåáå ýòî ïîçâîëèòü) à ëó÷øå ñòàíåò - âîò òîãäà è èíòåðåñíî êàê ýòî ðàáîòàåò? Âû íå åäèíñòâåííûé êòî ÷àñòî ñîìíåâàåòñÿ â ÖÑÕ, à ïîòîì ïîëó÷àåò è ìåìáðàíêó è àíãèîìàòîç è êñòàè ìíîãèå âèðóñíûå ïîðàæåíèå (÷èòàòü ãåðïåñ). À âîò ãðåòü ýòî ñîâñåì íå íàäî. Ýòî ìîå ìíåíèå è ÿ î÷åíü íàäåþñü, ÷òî åñëè ÿ íå ïðàâ ìåíÿ èñïðàâÿò. Ñ óâàæåíèå, Ïàâåë Ø. |
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Öèòàòà:
Âî-âòîðûõ. Ìóëüòèôîêàëüíàÿ ïëàêîèäíàÿ ýïèòåëîèîïàòèÿ âûãëÿäèò íå òàê è ÿâëÿåòñÿ îñòðûì âîñïàëèòåëüíûì çàáîëåâàíèåì. Â-òðåòüèõ. õðîíè÷åñêóþ ÖÑÕ íèêòî íå îòâåðãàåò. Â-÷åòâ¸ðòûõ. Ëóöåíòèñ ïðè ÖÑÕ ðàáîòàåò. È äåéñòâèå åãî íàïðàâëåíî íà ñóùåñòâóþùóþ íåîâàñêóëÿðèçàöèþ êàê ïàòîãåíåòè÷åñêîãî çâåíà ÖÑÕ èëè åãî îñëîæíåíèÿ: Öèòàòà:
À âîò áåç íåîâàñêóëÿðèçàöèè ââåäåíèå anti-vegf ñåáÿ íå îïðàâäàëî: Öèòàòà:
Èç ýòîãî æå îáçîðà ìîæíî ïîäìåòèòü, ÷òî îñíîâíûå ñïîñîáû ëå÷åíèÿ ÖÑÕ ýòî ëàçåðíîå è ÔÄÒ. Òàê ÷òî ïðîáîâàòü íè÷åãî íå íàäî, çà âàñ óæå âñ¸ ïîïðîáîâàëè. Â-ïÿòûõ. Ïðåæäå ÷åì ÷òî-òî ïðîáîâàòü íàäî ñíà÷àëà î ñâîåé, ïðîñòèòå, çàäíèöå ïîäóìàòü , åñëè îíà Âàì åù¸ äîðîãà. Åñëè Âû ïîïðîáóåòå, à ñòàíåò õóæå, íàïðèìåð ïîëó÷èòå ýíäîôòàëüìèò... èëè ïðîñòî ïîïàä¸òñÿ íåíîðìàëüíûé, íàñìîòðåâøèéñÿ òåëåâèçîðà î âðà÷àõ êîíîâàëàõ, êîòîðûé ðåøèò ÷òî åìó ïîñëå Âàøåãî ëóöåíòèñà ñòàëî õóæå , âîò òîãäà ó Âàñ áóäåò ðåàëüíûé øàíñ ñåñòü çà ðåø¸òêó. È íå áóäåò âîçìîæíîñòè äîêàçàòü ÷òî Âû äåéñòâîâàëè îïðàâäàíî, ò.ê. ïðåïàðàò Ëóöåíòèñ íà ñåãîäíÿøíèé äåíü ÍÅ ÐÀÇÐÅØ¨Í ê ïðèìåíåíèþ ïðè ÖÑÕ. À âîò ëàçåðíîå ëå÷åíèå - äîêàçàííûé è ðàçðåø¸ííûé ìåòîä è ïðè ÕÍ è ïðè ÖÑÕ. Íó à ïðî ãåðïåñ ÿ âîîáùå íè÷åãî íå ïîíÿë. Ïðè÷¸ì òóò ãåðïåñ? |
#221
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Çà ññûëêè ïî õðîíè÷åñêóþ ÖÑÕ è àíòè-VGF ñïàñèáî.
Ïðî íåðàçðåøåííîñòü ââåäåíèÿ àíòè VGF è ýíäîôòàëüìèò - ýòî, ñîãëàøóñü, ëè÷íî ìîå äåëî, ÿ ýòîò âîïðîñ íå õî÷ó îáñóæäàòü. À âîò îáúåäåíåíèå â îäíó ãðóïïó ñ íàçâàíèåì "ðàçëè÷íûå êëèíè÷åñêèå âèäû ìåìáðàí" - FVPED, RAP . ß âî ìíîãèõ ëåêöèÿõ âñòðå÷àþ ýòè çàáîëåâàíèÿ êàê äèô äèàãíîñòèêó wet AMD. Âîò òóò ê ïðèìåðó [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] Èëè ïîäõîä ê ëå÷åíèþ îäèíàêîâûé? ß âåðþ ÷òî âû çíàåòå ðàçíèöó è áåç âñÿêîãî "ìîåãî ïîíòà" ïðîøó åå ðàññêàçàòü, ìíå ýòî èíòåðåñíî? Ìóëüòèôîêàëüíàÿ ïëàêîèäíàÿ ýïèòåëîèîïàòèÿ ïî÷åìó âû îòâåðãàåòå ýòîò äèàãíîç íà ñâîèõ ñíèìêàõ? Ïðîñòî, ÷òî íå äîòÿãèâàåò äî ýòîãî äèàãíîçà? Ïðàâäà êîðÿâî íàïèñàë ïðî ãåðïåñ. (ïîçäíî áûëî - óñòàë) Ïî÷åìó íå õîðèîðåòèíèò? (ëþáîé ýòèîëîãèè) äà, ñ îñëîæíåííîé ÕÍÂ. ÈÏÕ ìíå íå ïîíÿòíî êàê íà ÔÀà ó âàñ âèäíà? ÈÀà ýòî åå ìåòîä. Êîíå÷íî çàïðåùåí, íî ÿ ýòó òåìó ïðîñèë íå ïîäíèìàòü. Ïðîñòî êàê îòëè÷àåòå, ìíå èíòåðåñåí âàø îïûò? Ýòîò ôîðóì âîçìîæíîñòü íàì îáùàòüñÿ çà ìíîãèå êèëîìåòðû äðóã îò äðóãà. ß íå õî÷ó Âàñ îáèäåòü èëè ñêàçàòü ÷òî âàø ìåòîä ïëîõîé, ÿ ïðîñòî ê íåìó íàñòîðîæåí. Íî ìíå áîëüøå èíòåðåñåí âîïðîñ äèô äèàãíîñòèêè. Ïîñòàâèâ ïðàâèëüíûé äèàãíîç ëå÷èòü ëåãêî. Ñ óâàæåíèåì, ïðîøó îòâåòèòü, Ïàâåë Ø. |
#222
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 âàøåé ïåðâîé ññûëêå îíè ëå÷èëè àíòè VGF èìåííî îñëîæíåíèÿ ÖÑÕ. (ìîæåò è ïîñëå ëàçåðà, à?)
À èíòåðåñíî ïðÿìîå äåéñòâèå àíòè VGF íà õîðèåäàëüíûå ñîñóäû ñ çîíàìè ïîâûøåíîé ïðîíèöàåìîñòè. Êàê äóìàåòå áóäåò ðàáîòàòü? |
#223
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Öèòàòà:
Íå îäíîãî Âàñ, Ïàâåë áóäîðàæèò ìûñëü î ïðèìåíåíèè àíòè-vegf ïðè ÖÑÕÐÏ Case Report Ophthalmol. 2011 Feb 12;2(1):59-64. Central serous chorioretinopathy with subretinal deposition of fibrin-like material and its prompt response to ranibizumab injections. Symeonidis C, Kaprinis K, Manthos K, Androudi S, Anastassilakis K, Dimitrakos SA. Source 2nd Department of Ophthalmology, Aristotle University of Thessaloniki, Thessaloniki, Greece. Abstract PURPOSE: Central serous chorioretinopathy (CSCR) manifests as neurosensory detachment of the macula and can be attributed to focal or multifocal leakage in the retinal pigment epithelium (RPE). Fibrin accumulation in the subretinal space is an unusual and heretofore unreported visually damaging manifestation of severe CSCR. METHODS: The patient was followed up with the use of biomicroscopy, fluorescein angiography, and optical coherence tomography (OCT). RESULTS: A 32-year-old woman was referred to our department complaining of metamorphopsia and decreased visual acuity in the right eye. Best-corrected visual acuity (BCVA) was 20/40 in the right eye and 20/20 in the left eye. Biomicroscopy revealed an irregularly shaped foveal elevation and wrinkling in the right eye. OCT showed a steep neurosensory retina elevation with a highly reflective material accumulation in the subretinal space, presumably fibrin. Our diagnosis was CSCR complicated by subretinal fibrin accumulation. Since most of these cases resolve spontaneously, the patient was kept under observation; 1 month later, the fibrin accumulation had expanded subfoveally (BCVA 20/200). The patient was offered 3 intravitreal ranibizumab injections. After the initial injection, BCVA improved to 20/50 and, after the 3 injections, to 20/30. Two months later (BCVA 20/30), fresh leakage was observed at the margin of the original lesion, and an additional intravitreal ranibizumab injection was performed. After another 2 months, BCVA stabilized at 20/25 and remained stable throughout the 12 months after the initial injection. CONCLUSIONS: Prompt recognition of CSCR complicated by subretinal fibrin and immediate intervention may result in recovery from this potentially devastating complication. Ranibizumab may be an alternative treatment option in the management of refractory CSCR complicated by subretinal fibrin accumulation. Êîíå÷íî íå âûäåðæèâàåò êðèòèêè ïî ïðè÷èíå ìàëî÷èñëåííîñòè à ìîæåò ýòî íå ÖÑÕ à ìîæåò ýòî îñîáàÿ ôèáðèíîâàÿ ÖÑÕ "â Ãðåöèè âñ¸ åñòü" |
#224
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Ïðè ïðîñòîé ÖÑÕ çðåíèå 0.1 - êàçóèñòèêà. Ñêîðåå ýòî ñîñòîÿíèå ñ ìåìáðàíîé.
To gavriil: Ïî ïîâîäó òèïîâ ÕÍÂ: Äëÿ íà÷àëà âîò îçíàêîìüòåñü ñ äîêëàäîì óâàæàåìîãî ìíîãèìè îôòàëüìîëîãàìè, è ìíîé â òîì ÷èñëå À.Ñ. Èçìàéëîâà.: [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] Ïðè÷¸ì êîãäà ÿ óñëûõàë ýòîò äîêëàä ìíå àáñîëþòíî íå çàõîòåëîñü èñêàòü ïîäòâåðæäåíèå åãî ïðàâîòû ñðåäè äðóãèõ àâòîðîâ, ò. ê. îí èçëîæèë òî ÷òî äî ìåíÿ ñàìî äîøëî ïî ïðàêòèêå. Ôèáðîâàñêóëÿðíàÿ òêàíü - ýòî ðóáåö, êîòîðûé ðàçâèâàåòñÿ â ðåçóëüòàòå òàê ñêàæåì "ñîçðåâàíèÿ" ìåìáðàíû, òî åñòü ýòî ïî ñóòè ðóáöîâàÿ òêàíü, êñòàòè â êîòîðóþ ïåðåõîäÿò ìíîãèå ìåìáðàíû ïîñëå âîçäåéñòâèÿ anti-VEGF ïðåïàðàòîâ, ýòî âèäíî è ãëàçîì è íà OCT. Íà ÔÀà ôèáðîçíàÿ òêàíü ìåäëåííî íàêàïëèâàåò è äëèòåëüíî çàäåðæèâàåò êðàñèòåëü. Ïîëïîèäíóþ õîðèîèäîïàòèþ íà ÔÀà âèäíî ïëîõî, å¸ ñòàâèì êëèíè÷åñêè: ìíîãîôîêóñíîñòü ïðîöåññà, ìîùíàÿ òðàíññóäàöèÿ, èíîãäà íà ÔÀà âèäíû "áîëåå ãîðÿ÷èå" ôîêóñû ñðåäè ÎÏÝ, íàéäó â êîìïå - âûëîæó. Êîíå÷íî ICG çäîðîâî ïîìîãëà áû â äèàãíîñòèõå ïîëèïîâ, íî ê ñîæàëåíèþ èíäîöèàíèí- îôô ëåéáë, õîòÿ ó íàñ åñòü ôèëüòðû äëÿ ICG-àíãèîãðàôèè. |
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Êîëëåãè, ïîäñêàæèòå.
1) Öåëåñîîáðàçíî ëè îñòàâëÿòü áîëåå ñèëüíîå ãèïîòåíçèâíîå ëåêàðñòâî ïðè ëå÷åíèè ãëàóêîìû "íà ïîòîì"? Åñëè äà - ïðè ëþáûõ ëè ñòàäèÿõ? 2) Öåëåñîîáðàçíî ëè "ëå÷èòü" ãèïîòåíçèâíûìè êàïëÿìè íåáîëÿùèé òåðìèíàëüíûé íåîâàñêóëÿðíûé ãëàóêîìíûé (ïîñëå äëòöê, ïîñëå îïåðàöèé) ãëàç? Èëè ìîæíî ñî ñïîêîéíîé äóøîé âñ¸ îòìåíèòü? Íå óñêîðÿåòñÿ ëè ïðèõîä áîëåé â ãëàç ïðè ýòîì? Åñòü ëè äàííûå èññëåäîâàíèé? |