Cuerpos extraños intraoculares tras cirugía de catarata

Intraocular foreign bodies after cataract surgery are relatively frequent, and there are many cases published in the literature on this topic. Different kinds of foreign bodies of various materials can be found, and some of them with the ability to produce side effects. Their extraction is recommended whenever possible, always individualising each case. It also recommended to carry out preventive measures in all surgeries for their prevention. In this work a review is presented on the topic, considered important due to the possible ocular complications that can occur.     

Aceite de silicona pesado (Densiron® 68) en vitreorretinopatía proliferativa: 4 años de experiencia

MethodProspective observational study including 10 patients (age range: 27-74 years) with recurrent retinal detachment (RD) and proliferative vitreoretinopathy (PVR) and 2.8 mean unsatisfactory previous surgeries. Densiron^® was injected in all patients, with surgical retinectomy being required in 70% of them. Minimum follow-up time was 12 months.ResultsThe mean length of time before Densiron^® withdrawal was 4 months. Three patients (30%) presented with a new RD. The main complication detected was cataract development. No relationship was found between re-detachments and tamponade time, baseline disease or RD evolution time. Densiron^® may be a good option in cases of recurrent RD in which previous treatment with scleral buckle, gas and/or 1,000/5,000 silicone oils has proven to be unsatisfactory.     

Complicaciones tras queratoplastia endotelial: tres años de experiencia

ObjectiveTo study the complications after Descemet's stripping automated endothelial keratoplasty (DSAEK).MethodsRetrospective study of 75 eyes in 67 patients with Fuchs’ endothelial dystrophy or bullous keratopathy operated on in the Instituto de Oftalmología La Arruzafa from March, 2007 until March, 2010. Phacoemulsification and IOL implantation was involved in 30 cases. All surgical and post-surgical complications, as well as the endothelial cell density were recorded.ResultsGraft detachment was the most common complication: 17 cases (22.5%); 16 of them resolved with reintroduction of air in the anterior chamber. The rate of detachment in cases without capsular support (8 eyes) increased up to 50%. Five cases had primary graft failure and, in 2 cases, a medium term failure was observed. Only one case of endothelial rejection was observed (1.3%). Five eyes (6.5%) developed a pupillary block, but of them were solved with the aspiration of the air. In one eye (1.3%), a posterior capsule rupture was observed during the phacoemulsification. This case ended with a retinal detachment. The endothelial cell loss was 42.75%.ConclusionsDSAEK is an effective surgical technique to resolve the corneal oedema due to endothelial failure; however, complications are not uncommon. Graft detachment is the most common complication, but is usually resolved with re-bubbling. There is an evident learning curve and the surgical trauma to the endothelium is the most important factor that influences the endothelial cell loss.     

Lente intraocular fáquica plegable acrílica de apoyo angular para la corrección de miopía: seguimiento de 5 años

Objective

To evaluate the efficacy and safety of an angle-supported foldable phakic intraocular lens (pIOL) for the correction of moderate to high myopia after 5 years follow-up.

La atropina superdiluida al 0,01% frena el aumento de miopía en niños-adolescentes. Un estudio a largo plazo 5 años de evolución: seguridad y eficacia

Objective

To confirm the clinical security and effectiveness of the daily application of 0.01% superdiluted atropine eyedrops in the progression of myopia in children.

Edema macular agudo 2 años después de la cirugía de catarata por un fragmento nuclear retenido

Case reportA 78-year-old man presented with a 2-week history of decreased vision in the right eye (RE). Ocular history included uncomplicated cataract surgery in the RE 2 years earlier. Gonioscopy revealed a retained small nuclear fragment (sNF) in the anterior chamber (AC) and OCT showed macular edema (ME). The NF was fragmented with a YAG laser.DiscussionAC retained NF resulted in ME and reduced visual acuity. We recommend gonioscopy in cases of reduced visual acuity and history of phacoemulsification. ME and reduced vision may be reversed by removing the NF with YAG laser.     

Protocolo de tratamiento de la retinopatía del prematuro en España

ObjectiveTo prepare a protocol for the treatment of retinopathy of prematurity (ROP) agreed by the majority of Spanish ophthalmologists dedicated to this topic.Material and methodA draft of the protocol was produced taking into account the experience of the participants and up to date publications. This draft was corrected by all the ophthalmologists participating in the project, and the final document was agreed by all of them.ResultsWe present general guidelines as an aid for the treatment of ROP, including treatment criteria, treatment methods, a calendar of action, and follow-up.ConclusionsIt is important to have a common working protocol for the treatment of ROP to improve care and to avoid mistakes. Although individual Hospitals may adapt the protocol to their daily activity, it is recommended that there is a minimal working protocol agreed by most of professionals dedicated to pediatric ophthalmology in Spain.     

Síndrome de Susac completo en un hombre de 22 años en Colombia: a propósito de un caso y revisión de la literatura

We report the case of a 22 year-old male with a clinical picture of 4 months onset of headaches, deafness, and a decrease of vision in the left eye. His mother mentioned he also had changes in behaviour and mood. The magnetic resonance scan of the brain showed multiple hyper-intense lesions in the knee of the corpus callosum. The hearing test reported a neurosensory deafness. In the ophthalmoscopy, a retinal infarction was observed in the nerve fibre layer in the left eye, which was confirmed using optical coherence tomography. The fluorescein angiography showed multiple foci of hyperfluorescence of the arteriole walls, arteriole filling defects, and regional ischaemia foci of the choroid. These findings confirmed the presumed diagnosis of a Susac syndrome.This is one of the few cases reported in the literature of a Susac syndrome in a young man with the complete diagnostic triad, and the first in Colombia.     

Mediadores alérgicos en lágrimas de niños con conjuntivitis alérgica estacional y perenne

PurposeTo evaluate the concentration of allergic mediators in tears of children with seasonal allergic conjunctivitis (SAC) and perennial allergic conjunctivitis (PAC) compared with controls.MethodsTwenty children with allergic conjunctivitis (17 SAC, and 3 PAC) and sixteen healthy children were included in this study. Tear samples were collected using a Merocel sponge (Oasis, 0525), and immediately eluted by incubation in elution buffer and subsequent centrifugation at 20,000 rpm for 30 min at 4 °C. Concentrations of histamine (HIS), tryptase (TPS), eosinophil chemotactic factor (ECF), major basic protein (MBP), eosinophil cationic protein (ECP), eosinophil-derived neurotoxin (EDN), IgE and E-selectin were measured using enzyme linked immunosorbent assays (ELISA). Data were compared with the Mann-Whitney U test (P<.05), and multivariate analyses were also performed.ResultsTear levels of TPS (P=.014), MBP (P=.032), ECP (P=.0041), IgE (P=.014) and EDN (P=.00077) showed significant differences in children with SAC and PAC compared to controls.ConclusionThe simultaneous analyses of allergic mediators in the tears of children with SAC and PAC showed a significant elevated concentration in EDN, ECP and MBP in allergic group and decreased levels in IgE and TPS. Statistical analyses showed a diagnostic accuracy of 94.4% using the eight molecules panel.     

Programa de cribado para la retinopatía del prematuro en España

ObjectiveTo prepare a retinopathy of prematurity (ROP) screening program as agreed by most of Spanish ophthalmologists dedicated to this topic.Material and methodA draft of the protocol was produced taking into account the experience of the participants and current publications. This draft was corrected by all the ophthalmologists participating in the project and the final document produced was agreed by all of them.ResultsWe present general guidelines to help in the screening of ROP, including treatment criteria, treatment methods, and a calendar of action.ConclusionsIt is important to have a common working protocol in the screening of ROP to improve the action and to avoid mistakes. Although individual Hospitals may adapt the protocol to their daily activity, it is recommended that there is a minimal working protocol agreed by most of professionals dedicated to pediatric ophthalmology in Spain.     

Eficacia y seguridad de la sutura ajustable en estrabismos horizontales: estudio comparativo de niños frente a adultos

ObjectiveAdjustable suture procedures allow addressing the unpredictability of some postoperative results in strabismus surgery. The purpose of the study was to compare the effectiveness of adjustable and non-adjustable suture in the treatment of horizontal strabismus in children and adults.MethodsProspective study including patients undergoing strabismus surgery to correct horizontal strabismus with fixed hanging suture (non-adjustable suture group) and adjustable suture. Visual acuity, amblyopia, deviation, oblique muscle involvement, previous surgeries, nystagmus, need for adjustment, and complications were recorded. The variables were recorded in the immediate postoperative period, at one week and at 3 and 6 months.Results186 patients were included: 157 (84.4%) with adjustable suture and 29 (15.6%) with non-adjustable suture, of which 119 were children and 67 were adults. Postoperatively, 19 children (16.0%) and 19 adults (28.4%) required adjustment (P = .044). Of 157 patients with adjustable suture, it was adjusted in 20% (32/157). Success after adjustment was higher for adjustable suture (91.72% vs 79.31%; P = .043) and remained for 6 months (P < .05). Previous surgery (P = .004) and exotropia (P = .018) correlated with the need for adjustment.Conclusions20% of patients with horizontal strabismus can benefit from a postoperative adjustment to improve the surgical result. The adjustable suture was shown to be superior to the fixed hanging suture and is an excellent surgical option, both in children and adults.     

Evaluación objetiva de la aplicación de colirios en personas mayores de 65 años

ObjectiveTo objectively evaluate the ability and skills of patients older than 65 years to successfully administer a topical ocular eye drop.MethodsA prospective study was conducted on a group of 25 patients with a diagnosis of dry eye or glaucoma, undergoing daily treatment with eye drops for at least one year. The procedure was recorded with a video camera at the time of the application.ResultsOf the total, 64% were diagnosed with glaucoma and 36% with dry eye. Almost half (44%) needed a single attempt to apply the drop, and 56% required 2 attempts. In terms of the number of eye drops applied, 52% managed with a single drop, 16% 2 drops, a 12% 3 drops, and 20% 4 or more eye drops. Areas where the eye drop was deposited in the first attempt was, 32% into the conjunctival sac, 32% on the outer corner of the eye, 8% in the inner angle, 8% in the nose, 12% on the cheek, 8% in other areas.ConclusionsSelf-administration of eye drops by the elderly is a complex activity that can have an effect on the expected results.     

Melanoma amelanótico del iris en un niño hispano de 7 años con perforación del globo subclínica

We report an unusual case of an amelanotic melanoma in a 7 year old hispanic child with subclinical globe perforation. Uveal melanoma rarely occurs in children. Young affected patients are mostly light-colored eye Caucasian adolescents. Since they are not common, these tumors are usually not recognized and misdiagnosed. Differential diagnoses and therapeutic options are outlined.     

Cirugía combinada de trabeculostomía láser excímer y facoelmusificación: datos a un año en el mundo real de una MIGS de tipo láser

PurposeTo evaluate the efficacy and complication profile of excimer laser trabeculostomy (ELT), an emerging laser-based trabecular minimally invasive glaucoma surgery (MIGS), combined with cataract surgery in routine clinical practice.Patients and methodsSingle-site, retrospective, interventional study. Preoperative and postoperative clinical data of patients with cataract and open-angle glaucoma (OAG) who underwent combined phacoemulsification and ELT were collected and analyzed at preoperative day, one week postoperatively, and after one, two, three, six, nine and 12 months. Main outcome measure was intraocular pressure (IOP). Qualified and complete success were defined as an IOP less than 21 mmHg and an IOP reduction ≥ 20% from preoperative medicated IOP with or without adjuvant medical treatment, respectively.ResultsThirty-four eyes of 29 patients were included; 29 eyes completed 1-year follow-up. The mean preoperative IOP under medications was 20.9 ± 2.6 mmHg (± standard deviation, SD) and decreased significantly at one year (16.3 ± 1.9; p < 0.0001). The mean number of IOP-lowering medications decreased from 1.7 ± 0.7 to 0.3 ± 0.8 (p < 0.0001) at the 12-month follow-up. At one year, 81% of eyes were medication free. Qualified and complete success was obtained in 62% and 58% of eyes, respectively. Two eyes had postoperative hyphema, three eyes had transient IOP spikes and one patient underwent a subsequent filtering surgery at three months.ConclusionCombining ELT with phacoemulsification in eyes with cataract and mild to moderate OAG significantly reduced IOP and medication use without meaningful complications after one-year follow-up in a real world clinical practice setting.