Endoftalmitis endógena / The Endogenous endophthalmitis

La endoftalmitis endógena es una enfermedad ocular infrecuente pero grave. Su manejo ha de ser necesariamente multidisciplinario por la complejidad de la afección sistémica, dirigido a erradicar el foco infeccioso primario, conocido o no, así como a preservar la función visual. Se presenta a un paciente masculino diabético de 66 años, ingresado en un hospital general para tratamiento quirúrgico de úlcera séptica del pie derecho, quien debutó con endoftalmitis endógena anterior difusa por Staphylococcus aureus confirmado mediante cultivos de humor acuoso y sangre. Aunque inicialmente se pensó en uveítis anterior aguda, la presencia de foco séptico en partes blandas y el empeoramiento del cuadro clínico oftalmológico fueron los elementos que condujeron al diagnóstico de la endoftalmitis endógena. La actuación conjunta de varias especialidades médicas hizo posible el manejo satisfactorio del paciente(AU)

Endogenous endophthalmitis is a rare but serious pathology. A multidisciplinary care team should lead the treatment because of the complexity of the systemic affection, in order to eradicate the primary infectious focus, either known or not, and to preserve the visual function. This a 66 years old male diabetic patient who was admitted to a general hospital with the purpose of practicing surgery of the right foot septic ulcer, who began suffering diffuse anterior endogenous endophthalmitis caused by Staphylococcus aureus, and confirmed through aqueous humor and blood cultures. Although the initial diagnosis was acute anterior uveitis, the presence of a septic focus in the soft tissue and the worsening of clinical ophthalmological symptoms led to finally diagnose him with endogenous endophthalmitis. The joint performance of several medical specialists made the satisfactory management of this patient possible(AU)

Imágenes Scheimpflug útiles en el diagnóstico de desprendimiento de la membrana de Descemet / Useful Scheimpflug images for the diagnosis of Descemet membrane detachment

El desprendimiento de la membrana de Descemet es una complicación infrecuente de la cirugía intraocular que puede resultar devastadora si no se diagnostica y se trata a tiempo. Habitualmente está asociado a la cirugía de la catarata, aunque tiene múltiples etiologías. Existen tratamientos muy variados, desde la simple observación hasta la queratoplastia penetrante. Se presenta una paciente femenina de 66 años de edad, con antecedentes de salud, quien fue operada de catarata del ojo derecho por la técnica de facoemulsificación con implante de lente intraocular de cámara posterior sin complicaciones aparentes durante la cirugía. En el posoperatorio presentó a las 24 horas edema corneal tres cruces con tensión ocular normal, el cual se mantuvo durante la primera semana a pesar del tratamiento intensivo con cloruro de sodio hipertónico y antinflamatorios esteroideos. No se recogieron alteraciones del endotelio corneal previas a la cirugía. En las imágenes de Scheimpflug del pentacam se observó desprendimiento de la membrana de Descemet en distintos puntos. Se realizó neumopexia y a las 24 horas la córnea se encontraba transparente(AU)

Descemet´s membrane detachment is an uncommon complication of the intraocular surgery that can be devastating if it is not diagnosed and treated on time. It is usually associated to cataract surgery, although has multiple etiologies. Treatments vary from the simple observation to the penetrating keratoplasty. This is the case of a 66 year-old woman, with a history of health problems, who was operated on of cataract in her right eye through the phacoemulsification technique with posterior chamber intraocular lens implantation without apparent complications during surgery. After 24 hours, she presented with corneal edema, three crosses and normal ocular pressure. She remained with the same condition during the first week despite treatment with hypertonic sodium chloride and steroid anti-inflammatory drugs. There were no alterations in the corneal endothelium before surgery. Scheimpflug images in Pentacam showed Descemet´s membrane detachment in several sites. It was decided to apply pneumopexia which rendered transparent cornea after other 24 hours(AU)

Ceratopatia bolhosa: etiopatogênese e tratamento: [revisão] / Bullous keratopathy: etiopathogenesis and treatment: [review]

A ceratopatia bolhosa caracteriza-se pelo edema corneano estromal acompanhado de bolhas epiteliais e subepiteliais devido à perda de células e/ou alterações da junção endotelial. Nos casos mais avançados, ocorre espessamento do estroma e presença de fibrose subepitelial e vascularização corneana. Apresenta baixa de acuidade visual devido à diminuição da transparência da córnea e pode estar acompanhada de sensação de corpo estranho, lacrimejamento e dor devido as alterações epiteliais como a presença de bolhas íntegras ou rotas. Ceratite bolhosa é uma das principais causas de transplante de córnea em diferentes regiões e países. A principal etiologia é a perda de células endoteliais, principalmente após cirurgia de catarata e na distrofia endotelial de Fuchs. Sabe-se que atualmente há cerca de 20 milhões de pessoas com catarata no mundo, e esta complicação pode afetar 1 a 2 por cento das cirurgias de catarata. Este texto faz uma revisão sobre a etiopatogênese da ceratopatia bolhosa e sobre os tratamentos clínicos e cirúrgicos disponíveis para a doença.

Bullous keratopathy is characterized by corneal stromal edema with epithelial or subepithelial bullae due to cell loss and endothelial decompensation. In more advanced cases, subepithelial fibrosis, formation of a posterior collagenous layer or retrocorneal fibrous membrane, and corneal vascularization can occur. Decreased vision is present because the loss of corneal transparency with symptoms like tearing and pain caused by epithelial bullae that can rupture. Currently, bullous keratopathy is the most common indication for penetrating keratoplasty and regraft. The main etiology is the endothelial cell loss after ophthalmic surgeries as cataract surgery. Cataract affects approximately 20 million people worldwide, and this complication can occur in 1 to 2 percent of cataract surgeries. This study revised bullous keratopathy etiopathogenesis, clinical and surgical treatment available for this corneal disease.

[Prediction of visual outcome after penetrating keratoplasty for pseudophakic and aphakic corneal edema]

To evaluate the ability to predict visual outcome after penetrating keratoplasty [PKP] in patients with pseudophakic or aphakic corneal edema [PCE or ACE]. Medical records of 34 patients [34 eyes] who underwent PKP for PCE or ACE during 1994-2004 in Ahvaz were retrospectively analyzed for variables in the history and ocular examination before PKP and visual outcome after PKP. The predictive value of each preoperative variable including age, gender, method of intraocular lens [IOL] implantation, vitreous loss during cataract surgery, time between cataract and PKP surgery, and history of glaucoma or increased intraocular pressure [IOP] before PKP surgery on post-PKP visual outcome was assessed using logistic regression analysis. Odds ratio [OR] with 95% confidence interval [95% CI] was calculated for predictive factors. Mean follow-up was 23.6 months. Best corrected visual acuity [BCVA] of 20/200 or better was achieved in 17 patients [50%]. The strongest predictors of this outcome were time between cataract surgery and PKP [P=0.008, OR=3.50, 95% CI; 0.48-31.18], aphakia [P=0.027, OR=4.29, 95% CI; 0.36-114.8] and no history of glaucoma or increased IOP before PKP [P=0.020, OR=3.75, 95% CI; 0.71-21.41]. In patients with PCE and ACE who are candidates for PKP, time between cataract and PKP less than 20 month, no history of glaucoma or increased IOP before PKP, aphakia versus presence of IOL are associated with a better visual outcome

Uso del cloruro de sodio al 5 en el tratamiento del edema corneal / Use of the sodium chlorides 5

En el presente estudio se evalúo la eficacia del cloruro de sodio al 5 por ciento en solución para reducir o eliminar el edema corneal de diversas etiologías, como cirugía de catarata, presión intraocular elevada y distrofias corneales. También se analiza la tolerancia al medicamento. El estudio se dividió en una fase experimental y otra clínica. Durante la primera fue aplicado el medicamento en ojos de conejo para valorar la irritabilidad. En la fase clínica se incluyeron 56 pacientes; 23 de ellos fueron asignados al azar para ser tratados con cloruro de sodio al 5 por ciento, y los otros 23 se usaron como grupo control y fueron tratados con solución salina al 0.9 por ciento. Los resultados del estudio demuestran que el cloruro de sodio al 5 por ciento es bien tolerado tanto en conejos como en humanos. Los pacientes tratados con cloruro de sodio al 5 por ciento mostraron disminución del edema corneal en un 91.3 por ciento y sintomatología en 87 por ciento de los casos. Estos resultados justifican el uso clínico del cloruro de sodio al 5 por ciento para el control sintomático del edema corneal leve a moderado.