Queratoplastia penetrante temprana después de queratitis fúngica de la interface en la queratoplastia endotelial de la membrana de Descemet

In this case-report we describe the first reported case of early-onset fungal interface keratitis (IK) after Descemet Membrane Endothelial Keratoplasty (DMEK) successfully treated with penetrating keratoplasty (PK) during the active stage of infection. A patient with graft failure after Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) was operated on with DMEK. Donor rim culture and broth were positive for Candida albicans. Several interface infiltrates were confirmed and localized using anterior segment optical coherence tomography. Three days after diagnosis, observing clear signs of intraocular infection, the graft was removed with simultaneous washed-up of anterior chamber with fluconazole 1% followed by a PK and intrastromal corneal injections of fluconazole. A best-corrected visual acuity of 20/20 was achieved. This case highlights the importance of analysing every donor rim and broth, despite the patient doesn’t show any symptoms or signs during the post-operative period. PK is a viable treatment option in early-onset interface keratitis.     

Satisfacción de la cirugía de estrabismo basada en la opinión de cirujanos expertos

PurposeTo assess the perception of strabismus surgeons in Spain regarding patient satisfaction after surgery, by analysing the types of strabismus with the most satisfied patients, as well as the causes of dissatisfaction.MethodsA survey was carried out among the members of the Spanish Strabology Society who were over 50 years of age, active in Spain, with more than 20 years of surgical experience, and whose main surgical activity was strabismus. The questionnaire consisted of 18 questions about the perception of patient satisfaction according to the type of strabismus, patient age, as well as the most frequent cause of dissatisfaction after surgery.ResultsThe questionnaires were completed by a total of 29 surgeons, with a mean of 31 years of surgical experience. The most frequent cause of perceived dissatisfaction was residual strabismus. No differences were found in the satisfaction index between children and adults. The surgery that was considered to produce greater satisfaction was endotropia, followed by decompensated 4 th nerve palsy, and exotropia, while 3 rd nerve palsy was the cause of the most dissatisfaction.ConclusionsAccording to strabismus surgeons, endotropia is the most satisfactory surgery for the patient, followed by exotropia, vertical strabismus, and traumatic paralysis of the 4 th cranial nerve.     

El rol actual de los trombolíticos en el tratamiento de la obstrucción de arteria central de la retina

ObjectiveThe purpose of this study is to determine the application of thrombolytic treatment in central retinal artery occlusion (CRAO), its real benefit, safety and possible indications for treatment.MethodsWe searched the PubMed, Cochrane and Google Scholar databases delving first into the effectiveness of the traditional treatment for CRAO, and then comparing them with new treatment strategies with intra venous or intra arterial fibrinolysis.ResultsWhereas small retrospective and open-label observational trials support the use of thrombolytic therapy, multicenter randomized trials failed to demonstrate a significant visual improvement with this new strategy. Besides that, a greater risk of life threatening adverse event was observed in patients using thrombolytic treatment.ConclusionUntil well-conducted clinical trials demonstrate a clear benefit of thrombolytic therapy for improving visual acuity and their benefit are weighted against the frequency and severity of adverse events, we could not recommend fibrinolysis for treating CRAO.     

Contribution a l'étude de la tonométrie et de la tonographie en ophtalmologie

Sans résumé     

Comparación de tres instrumentos de tomografía de coherencia óptica,un time-domain y dos Fourier-domain,en la estimación del grosor de la capa de fibras nerviosas de la retina

PurposeTo assess agreement between one system of time-domain optical coherence tomography (OCT) (Stratus) and two systems of fourier-domain OCT (Cirrus and 3D OCT1000) for the measurement of the retinal nerve fibre layer thickness (RNFL).MethodsFifty eyes from 25 patients with neuro-ophthalmological disorders of the afferent visual pathway were included. A triple RNFL thickness OCT examination with Stratus, Cirrus and 3D OCT-1000 was performed on both eyes of every patient, on the same day and by the same technician. The average RNFL thickness by quadrants and clock sectors were compared with the Lin's concordance correlation coefficient (CCC) and Bland-Altman plots.ResultsThe average RNFL thickness, the temporal and nasal quadrants and corresponding clock sectors, was higher by 3D OCT-1000 (mean 90.02 microns), nevertheless, RNFL thickness of the superior and inferior quadrants and corresponding clock hours was higher when measured by Stratus device. The CCC agreement between Stratus and Cirrus was high (0.820), between Stratus and 3D OCT-1000 was moderate (mean 0.573) and between Cirrus and 3D OCT-1000 was moderate with a mean of 0.564 but too low in the nasal and temporal quadrants (0.362 and 0.347 respectively).ConclusionsThe RNFL thickness measurements by Stratus, Cirrus and 3D OCT-1000 OCT are not equivalent. Although the agreement between Stratus and Cirrus was high, it was too low between 3D OCT-1000 and Stratus or Cirrus.© 2009 Sociedad Española de Oftalmología. Published by Elsevier España, S.L. All rights reserved.     

Variante de la técnica de Nishida para la corrección quirúrgica del síndrome de déficit monocular de la elevación

Monocular elevation deficiency (MED) is characterized by unilateral limitation of supraductions, similar in adduction and abduction, in addition to hypotropia and ptosis. We describe a case of a 62-year-old woman with long-standing left ptosis who was initially operated with a frontal suspension technique. On subsequent examinations, a MED of that eye was found. The passive duction test was positive, so the inferior rectus was recessed. In addition, a modified Nishida technique was performed, consisting of the scleral anchorage of the superior edges of the rectus, medial and lateral, 12 mm from the corneal limbus in the superonasal and superotemporal quadrants, respectively. Postoperatively, the left eye presented a minimal hypotropia of 3 PD. This modified technnique used here on the horizontal rectus muscles, turned out to be effective and safe for the correction of MED.     

Presentación atípica de la enfermedad de Best

Clinical case

A 43-year-old man was treated for reduced visual acuity, initially attributed to strabismic amblyopia. On fundus examination, bilateral neurosensory detachments (NSD) were observed in posterior pole, surrounded by deposits of lipofuscin. His 3-year-old son was also examined and circumscribed NSD was observed with the presence of pseudohypopyon in OD and a fibrosis scar in OS. The Arden ratio were decreased in electrooculography (EOG) in both patients, and genetic studies revealed a single mutation of the BEST1 gene.

Actualización de la utilidad de la tomografía de coherencia óptica para el estudio del ángulo iridocorneal

The iridocorneal angle, due to its implications in the physiopathology of aqueous humour drainage, is a fundamental structure of the anterior chamber. Anterior segment optical coherence tomography is a rapid and non-invasive technique that obtains images in vivo. The high resolution allows it to analyse the normal anatomy of the angle, any alterations, and the changes that occur after different therapeutic interventions. Anterior segment optical coherence tomography technology has evolved to provide images that allow the identification and quantification of the angular structures in healthy subjects and in glaucoma patients, and especially the trabecular meshwork and the Schlemm's canal. It also enables the angle width to be quantified, with some objective parameters that have been standardised in recent years, such as the trabecular-iris angle, the angle opening distance, and the trabecular-iris area. This technique has multiple uses in the study of the different mechanisms of angle closure, the evaluation of changes after a laser peripheral iridotomy or iridoplasty after cataract surgery, as well as after the implantation of phakic lenses.     

Alteraciones de la motilidad ocular en el síndrome de Kabuki

Kabuki syndrome is a rare genetic disorder, caused by mutation in the KMT2D or KDM6A genes, which affects several organs in the majority of patients, among which are the eyes. The most typical clinical characteristics are mental retardation, postnatal growth retardation, skeletal anomalies, and characteristic facial features. As the eyes are affected in most of the cases, ophthalmological examination is recommended for the early detection of ocular anomalies, in order to prevent visual impairment. The most frequent ocular signs are strabismus, ptosis, and refractive anomalies. A series of cases of Kabuki syndrome is described in five children, four of whom exhibited strabismus with esotropia, over action of inferior oblique muscles, and under action of superior oblique muscles associated with a V pattern. Most published papers do not report or might underestimate the ocular problems.It may be appropriate to perform orbital magnetic resonances in order to detect changes in the muscle paths that are related to the pathology of the eye movements found.