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.     

Valoración de técnicas intraoperatorias para la prevención de la opacificación del eje visual en la cirugía de cataratas congénitas

ObjectiveTo evaluate the effectiveness of various surgical procedures in the management of posterior capsule and anterior vitreous on the prevention of visual axis opacification.Subjects, material and methodsWe retrospectively reviewed 120 eyes operated for unilateral congenital cataracts, with a median age at the time of cataract surgery of 21 months (interquartile range, 6-52 months). The eyes were divided into 3 groups: group 1 (eyes with intact posterior capsule, n = 39), group 2 (eyes with posterior continuous curvilinear capsulorhexis, n = 38), group 3 (eyes with posterior continuous curvilinear capsulorhexis and anterior vitrectomy, n = 43).ResultsTo determine the effect of posterior continuous curvilinear capsulorhexis on visual axis opacification we compared group 2 with group 1 (chi-square Pearson test, P =.281), therefore in this study the implementation of the posterior continuous curvilinear capsulorhexis did not show any decreases in the incidence of visual axis opacification. To study the effect of posterior continuous curvilinear capsulorhexis associated anterior vitrectomy, we compared group 3 with group 1 (chi-square Pearson test, P =.014), demonstrating that the combination of both techniques (posterior continuous curvilinear capsulorhexis and anterior vitrectomy) decreases the incidence of visual axis opacification.ConclusionPosterior continuous curvilinear capsulorhexis as a single technique did not show any decrease in the incidence of visual axis opacification. Posterior continuous curvilinear capsulorhexis together with anterior vitrectomy are required to prevent visual axis opacification and to decrease reoperation rate.     

Evolución de la técnica «avance de colgajo frontal» en la ptosis congénita

The treatment of congenital ptosis with poor levator activity is often based upon the union of the superior eyelid to the frontalis muscle by using different materials as potential grafts. Nevertheless, theses grafts may lead some complications. In order to avoid them, a new technic has been described using an advancement flap of the frontalis muscle, that is tided to the upper tarsus, eliminating the need of a graft.Although, it is not yet a standard procedure, reason why many variants has been recently described with the objective of improving the aesthetical and functional results.The goal of this systematic review is to conscientiously evaluate these variants with the propose of determining which one gives the best results in terms of safety, functional and aesthetical outcomes.From the review of the published procedures, we conclude that the best technique in terms of functional and aesthetical results is: sub-orbicularis dissection via lid crease incision reaching the orbital margin, followed by blunt dissection of the frontalis muscle and creation of a “U” shaped flap (that might be associated to a levator advancement in severe cases), finally, the frontalis flap is stitched to the upper end of the tarsus taking care to maintain a symmetrical contour when compared to the contralateral eye. The final eyelid margin height should be 1.5 mm above the sclero-corneal limbus.