Incidencia y comportamiento clínico de la endoftalmitis poscirugía de catarata / Incidence and clinical behavior of endophthalmitis post cataract surgery

Introducción: La endoftalmitis posquirúrgica es la complicación más temida de la cirugía de catarata. Resulta potencialmente devastadora, puede amenazar seriamente la visión y tiene una incidencia estimada de entre 0,02 y 0,71 por ciento. Objetivo: Determinar la incidencia de endoftalmitis poscirugía de catarata y su comportamiento clínico. Métodos: Se realizó un estudio observacional, descriptivo y de corte transversal. Se revisaron 13 850 cirugías consecutivas de catarata realizadas en el Centro Oftalmológico del Hospital Universitario Clínico Quirúrgico "Arnaldo Milián Castro" de Villa Clara, Cuba. Resultados: La incidencia de endoftalmitis poscirugía de catarata en esta serie fue de 0,17 por ciento (IC 95 por ciento: 0,10-0,24 por ciento); 0,18 por ciento (IC 95 por ciento 0,11-0,25 por ciento) para extracción extracapsular del cristalino y sin incidencia en la facoemulsificación. La forma de presentación aguda fue más frecuente que la crónica; 0,13 por ciento (IC 95 por ciento: 0,07-0,19 por ciento) y 0,04 por ciento (IC 95 por ciento: 0,01-0,07 por ciento), respectivamente. Los hombres fueron más afectados que las mujeres y la edad media fue de 71,8 años. La forma aguda se presentó con una media de 5,1 días entre la cirugía y el inicio de los síntomas y la crónica con una media de 21,2 semanas. El 39,1 por ciento de los pacientes tuvo agudeza visual de percepción luminosa al momento del diagnóstico. Se reportó un crecimiento bacteriano en el 44,7 por ciento de las muestras, con una positividad en humor acuoso y vítreo del 42,1 por ciento y 47,4 por ciento, respectivamente. El Staphylococcus coagulasa negativo fue el germen más frecuente. Los antibióticos intravítreos más vitrectomía plana precoz fue la conducta terapéutica más empleada. Conclusiones: La incidencia de endoftalmitis poscirugía de catarata en esta serie está en el rango de lo reportado a nivel mundial. Se presenta comúnmente de forma aguda y con pobre agudeza visual. El agente etiológico aislado con más frecuencia fue el Staphylococcus coagulasa negativa(AU)

Introduction: Postoperative endophthalmitis is the most feared complication of cataract surgery. It is potentially devastating, can seriously threaten vision and has an estimated incidence of between 0.02 and 0.71 percent. Objective: To determine the incidence of endophthalmitis after cataract surgery and its clinical behavior. Methods: An observational, descriptive, cross-sectional, descriptive study was performed. Thirteen 850 consecutive cataract surgeries performed at the Ophthalmologic Center of the Clinical Surgical University Hospital "Arnaldo Milián Castro" of Villa Clara were reviewed. Results: The incidence of endophthalmitis after cataract surgery in this series was 0.17 percent (95 percent CI: 0.10-0.24 percent); 0.18 percent (95 percent CI: 0.11-0.25 percent) for extracapsular extraction of the crystalline lens and no incidence in phacoemulsification. The acute form of presentation was more frequent than the chronic form; 0.13 percent (95 percent CI: 0.07-0.19 percent) and 0.04 percent (95 percent CI: 0.01-0.07 percent), respectively. Males were more affected than females and the mean age was 71.8 years. The acute form occurred with a mean of 5.1 days between surgery and symptom onset and the chronic form with a mean of 21.2 weeks. Thirty-nine.1 percent of patients had visual acuity of light perception at the time of diagnosis. Bacterial growth was reported in 44.7 percent of the specimens, with positivity in aqueous and vitreous humor of 42.1 percent and 47.4 percent, respectively. Coagulase-negative Staphylococcus was the most frequent germ. Intravitreal antibiotics plus remission for early flat vitrectomy was the most commonly employed therapeutic behavior. Conclusions: The incidence of post cataract surgery endophthalmitis in this series is in the range of that reported worldwide. It commonly presents acutely and with poor visual acuity. The most frequently isolated etiologic agent was coagulase-negative Staphylococcus(AU)

Um cirurgião sob o olhar de Deus

Objetivo A síndrome de Terson (ST), também conhecida como hemorragia vítrea, é relatada em pacientes com hemorragia subaracnóide causada por um aneurisma rompido. Este estudo tem como objetivo avaliar a presença de hemorragia ocular nesses pacientes, buscando identificar aqueles que poderiam se beneficiar do tratamento específico para a recuperação do déficit visual. Métodos Estudo prospectivo de 53 pacientes com hemorragia subaracnóide espontânea (SSAH) por aneurisma rompido. Os pacientes foram avaliados quanto à hemorragia vítrea por fundoscopia indireta com 6 a 12 meses de seguimento. Resultados A idade dos pacientes variou de 17 a 79 anos (média de 45,9 ± 11,7); 39 pacientes eram do sexo feminino (73%) e 14 do sexo masculino (27%). Seis pacientes (11%) apresentaram ST e 83,3% apresentaram perda transitória de consciência durante a ictus. Conclusões Uma avaliação oftalmológica deve ser realizada rotineiramente em pacientes com hemorragia subaracnóide, especialmente naqueles com pior grau neurológico. Além disso, o prognóstico foi ruim em pacientes com ST.

Pars plana vitrectomy and visual stimulation for treatment of vitreomacular traction secondary to toxoplasmosis retinochoroiditis in a 5-year-old child / Vitrectomia via pars plana e estimulação visual para tratamento da tração vitreomacular secundária à retinocoroidite por toxoplasmose em criança de 5 anos

ABSTRACT Objective: A unusual case of ocular toxoplasmosis with significant vitreomacular traction is reported. The patient improved significantly following pars plana vitrectomy combined with visual stimulation and occlusion therapy. Methods: The case of a 5-year-old girl with significant unilateral vision loss associated with vitreous condensation and macular traction is described. Results: Pars plana vitrectomy was carried out for vitreomacular traction release. This was followed by visual stimulation and occlusion therapy. Significant improvement was observed. Conclusion: Despite structural damage, the combination of properly indicated surgery and amblyopia management strategies allowed the achievement of maximum vision goals in this case, suggesting structural damage may be associated with functional amblyopia.

RESUMO Objetivo: Relata-se um caso de apresentação atípica de toxoplasmose ocular, com importante tração vitreomacular. A paciente apresentou melhora significativa após vitrectomia via pars plana, com estimulação visual e oclusão. Métodos: Descreve-se o caso de uma menina de 5 anos, com importante perda de visão unilateral associada à condensação vítrea e à tração macular. Resultados: Foi realizada vitrectomia via pars plana para alívio da tração vitreomacular, seguida de estimulação visual e oclusão. Foi observada melhora significativa. Conclusão: Apesar dos danos estruturais, a combinação de cirurgia bem indicada com estratégias de tratamento da ambliopia permitiu alcançar o máximo do potencial visual nesta paciente, sugerindo que os danos estruturais podem estar associados à ambliopia funcional.

Lente intraocular subluxado y edema macular quístico tratado con vitrectomía pars plana, Yamane y Ozurdex / Subluxated intraocular lens and cystoid macular edema treated with pars plana vitrectomy, Yamane and Ozurdex

El edema macular es el engrosamiento anormal de la mácula asociado con la acumulación de líquido en el espacio extracelular de la retina neurosensorial. En algunos casos también se ha observado edema intracelular que comprende las células de Muller. Una de estas causas es el edema macular poscirugía de catarata. Presentamos un caso masculino de 57 años de edad de la raza negra con antecedentes de haber sido operado de catarata en ambos ojos. El ojo izquierdo carecía de visión a causa de un rechazo al trasplante corneal penetrante que le fue realizado. El ojo derecho presentaba edema macular con subluxación de la lente intraocular. Le realizamos biomicroscopia de segmento anterior y posterior, tomografía de coherencia óptica, agudeza visual con corrección y presión intraocular. Se constató edema macular con membrana epirretinal y subluxación de la lente intraocular. Decidimos fijar la lente a la esclera utilizando la técnica de Yamane, ya que se trataba de una lente de 3 piezas de acrílico con háptica de fluoruro de polivinildeno configuración en C (CT Lucia 602 de Zeiss), ideal para esta técnica. Colocamos una dosis de Ozurdex en el ojo derecho para tratar el edema macular, después de ver que los colirios tópicos antinflamatorios no fueron efectivos en este caso, y tuvimos una mejoría del edema por aproximadamente 3 meses. En el edema macular posquirúrgico no solo es necesario tratar la inflamación, sino también la causa que la ha producido(AU)

Macular edema is the abnormal thickening of the macula associated to fluid accumulation in the extracellular space of the neurosensory retina. Some cases also present intracellular edema with involvement of Müller cells. One of these causes is macular edema after cataract surgery. A case is presented of a male 57-year-old patient of black skin color with a history of cataract surgery in both eyes. The left eye had no vision, due to rejection to the penetrating corneal transplantation performed. The right eye presented macular edema with intraocular lens subluxation. Examination included biomicroscopy of the anterior and posterior segments, optical coherence tomography, visual acuity with correction and intraocular pressure. A diagnosis was confirmed of macular edema with epiretinal membrane and intraocular lens subluxation. It was decided to fix the lens to the sclera using the Yamane technique, since it was a three-piece lens with a C-shaped polyvinylidene fluoride haptic (CT Lucia 602 from Zeiss), ideal for this technique. An Ozurdex dose was administered in the right eye to treat the macular edema, since topical anti-inflammatory eyedrops were not effective in this case, and improvement of the edema was achieved for about three months. In postoperative macular edema, it is not only necessary to treat the inflammation, but also its cause(AU)

Alternative technique for insertion of Eva Dorc® infusion cannula in vitreoretinal surgeries / Técnica alternativa de inserção da canula de infusão do Eva Dorc® em cirurgias vitreorretinianas

Abstract This paper provides a fast and inexpensive technique to prevent slippage of the infusion cannula from the EVA DORC® 27-gauge system. After the usual retrobulbar anesthesia, antisepsis and asepsis, a 2% hydroxypropyl methylcellulose drop is placed around the infusion cannula in the trocar to hold it in position. This technique prevents the slippage of the infusion cannula and both the surgical time and creation of the first sclerotomy in the eye can be shortened slightly.

Resumo Este artigo fornece uma técnica rápida e barata para evitar o deslizamento da cânula de infusão do sistema EVA DORC® 27-gauge. Após a habitual anestesia retrobulbar, antissepsia e assepsia, uma gota de 2% de hidroxipropilmetilcelulose é colocada ao redor da cânula de infusão no trocater para mantê-la em posição. Essa técnica evita o deslizamento da cânula de infusão e o tempo cirúrgico e da criação da primeira esclerotomia no olho podem ser ligeiramente reduzidos.

Estrategias de tratamiento para el edema macular diabético / Treatment strategies for diabetic macular edema

RESUMEN Se hace una revisión bibliográfica acerca del tratamiento que se utiliza en el edema macular clínicamente significativo. Esta es la primera causa de mala visión en los pacientes con diabetes mellitus. Entre las líneas de tratamiento tenemos los antiangiogénicos con sus variantes, los esteroides y la cirugía por medio de la vitrectomía pars plana con pelado de la membrana limitante interna. No existe hasta el momento el tratamiento ideal. La tomografía de coherencia óptica ayuda a predecir la visión final(AU)

ABSTRACT Treatment of clinically significant diabetic macular edema is the topic of our review. This condition is the first cause of vision loss in diabetic patients. Treatment options include anti-VEFG drugs, steroids and surgery (vitrectomy with internal limiting membrane peeling). There is no an ideal treatment at present. Optic coherence tomography is a useful tool to predict final vision in these patients(AU)

Flap invertido de membrana limitante interna en agujero macular grande / Inverted internal limiting membrane flap technique in large macular hole

RESUMEN El agujero macular es un desorden de la interface vitreorretinal definido como un defecto de espesor completo desde la membrana limitante interna hasta los segmentos externos de los fotorreceptores, que normalmente involucra a la fóvea. Con el desarrollo de la tomografía de coherencia óptica se han mejorado el diagnóstico, el tratamiento y el seguimiento de las enfermedades de la interface vitreorretinal, entre ellas el agujero macular. La vitrectomía pars plana es la técnica quirúrgica de elección para el agujero macular. Se presenta una paciente de 75 años, pseudofáquica, con mejor agudeza visual corregida en el ojo derecho de 0,1 Snellen. Se diagnostica agujero macular grande (810 µm) según su mínima apertura, con 8 meses de evolución. Se realizó vitrectomía pars plana, el levantamiento de la hialodes posterior, el flap invertido de membrana limitante interna, el uso de hexafluoruro de azufre en mezcla 20 por ciento y el posicionamiento de la paciente 24-72 horas. Se logró el cierre anatómico del agujero macular y la recuperación visual de 0,6 Snellen a los seis meses del tratamiento quirúrgico(AU)

ABSTRACT Macular hole is a disorder of the vitreous-retina interface defined as a full-thickness defect from the internal limiting membrane to the external segments of photoreceptors which typically involves the fovea. The development of optical coherence tomography has improved the diagnosis, treatment and follow-up of vitreous-retina interface diseases, among them macular hole. Pars plana vitrectomy is the surgical technique of choice for macular hole. A case is presented of a female 75-year-old pseudophakic patient with best corrected right eye visual acuity of 0.1 on the Snellen chart. Large macular hole is diagnosed (810 µm) according to its minimum opening, of 8 month's evolution. The following procedures were performed: pars plana vitrectomy, posterior hyalode lifting, inverted internal limiting membrane flap, use of sulfur hexafluoride in a 20% mixture, and positioning of the patient for 24-72 hours. Anatomical closure of the macular hole and a visual recovery of 0.6 Snellen were achieved six months after surgery(AU)

Vitrectomía pars plana asociada a banda de silicona comparada con vitrectomía pars plana para desprendimiento de retina pseudofáquico y afáquico / Pars plana vitrectomy plus scleral buckle versus pars plana vitrec-tomy in pseudophakic retinal detachment

INTRODUCCIÓN: La cirugía de cataratas es un factor de riesgo para el desprendimiento de retina regmatógeno. Dentro de las técnicas utilizadas para su reparación, se encuentran la vitrectomía pars plana y la banda de silicona. La combinación de ambas técnicas ha sido propuesta en pacientes con desprendimiento de retina previamente operados de cataratas (pseudofáquicos o afáquicos), pero su efectividad no está clara. MÉTODOS: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos cuatro revisiones sistemáticas que en conjunto incluyeron ocho estudios primarios, de los cuales, uno corresponde a un ensayo aleatorizado. A partir de éste, concluimos que la combinación de vitrectomía pars plana y banda de silicona podría resultar en poca o nula diferencia en la reaplicación retinal primaria, en la reaplicación retinal final y en la agudeza visual, pero la certeza de la evidencia es baja. Respecto a las complicaciones, no es posible establecer con claridad si la combinación de ambas técnicas aumenta la frecuencia de vitreorretinopatía proliferativa o si disminuye el desarrollo de glaucoma, debido a que la certeza de la evidencia fue evaluada como muy baja.

INTRODUCTION: Cataract surgery increases the risk for rhegmatogenous retinal detachment. Pars plana vitrectomy and scleral buckling are two surgical procedures used for its repair. The combination of both techniques had been proposed for rhegmatogenous retinal detachment in patients with previous cataract surgery (pseudophakic or aphakic), but its effectiveness remains unclear. METHODS: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS: We identified four systematic reviews with eight studies overall, one of them was a randomized trial. With this data, we conclud-ed that pars plana vitrectomy plus scleral buckle may make little or no difference in primary or final retinal reattachment rate nor in final visual acuity, but the certainty of the evidence is low. In terms of surgery complications, we are uncertain if vitrecto-my plus scleral buckle increases the risk of proliferative vitreoretinopathy or reduces the risk of glaucoma because the certainty of the evidence is very low.

Inverted internal limiting membrane flap for the management of optic disc pit maculopathy / Técnica do flap invertido da membrana limitante interna para o manejo da maculopatia causada pela fosseta do disco óptico

ABSTRACT Optic disc pit is a rare congenital anomaly that can cause serous macular detachment. It has no universally accepted single treatment. Recently, several investigators have performed new procedures to directly seal the pit. Herein, we report a case showing a promising method for optic pit maculopathy surgical treatment. We created an inverted internal limiting membrane flap and fold it over the pit to promote barrier in order to stop further fluid accumulation. Gradual absorption of subretinal fluid was observed over 12 months of follow-up. Optical coherence tomography can demonstrate internal limiting membrane folded over the pit and progressive subretinal fluid resolution. This technique resulted in a satisfactory anatomic outcome with good functional improvement in the best-corrected visual acuity.

RESUMO A fosseta do disco óptico é uma rara anomalia con gênita que pode causar descolamento de retina seroso na mácula. Não há um tratamento cirúrgico padrão universalmente aceito. Recentemente, cirurgiões têm realizado procedimentos novos que visam selar o buraco diretamente. Esse caso clínico mostra um método promissor para o tratamento cirúrgico da maculopatia causada pela fosseta do disco. Optamos por criar um flap invertido com a membrana limitante interna, dobrando-o sobre a fosseta para promover uma barreira, impedindo o acúmulo de fluido. A absorção gradual do líquido subretiniano foi observada ao longo de 12 meses de acompanhamento. Imagens de tomografia de coerência óptica podem demonstrar a membrana limitante interna dobrada sobre a fosseta e a resolução progressiva do fluido subretiniano. Esta técnica resultou em um resultado anatômico satisfatório com boa melhora funcional na acuidade visual.

Facoanafilaxia por cristalino mergulhado na Síndrome de Marfan / Phacoanaphylactic by dislocation of the lens in the Marfan Syndrome

Resumo A síndrome de Marfan é uma doença de herança autossômica dominante e que afeta o tecido conjuntivo com manifestações fenotípicas que envolvem os sistemas esquelético, cardiovascular e ocular. As principais manifestações oculares são a subluxação do cristalino, a miopia e o descolamento da retina. O objetivo deste artigo foi relatar a conduta clínico-cirúrgica de um paciente portador da síndrome de Marfan com cristalino luxado para a cavidade vítrea e que evoluiu com severa reação facoanafilática caracterizada por um glaucoma secundário severo e descompensação corneana.

Abstract Marfan syndrome is an autosomal dominant inheritance disease that affects connective tissue with phenotypic manifestations involving the skeletal, cardiovascular and ocular systems. The main ocular manifestations are the subluxation of the lens, myopia and retinal detachment. The aim of this article was to report the clinical and surgical management of a patient with Marfan syndrome with luxated lens for the vitreous cavity and who developed a severe phacoanaphylactic reaction characterized by severe secondary glaucoma and corneal decompensation.

New perspectives on macular hole surgery at three years of follow-up / Novas perspectivas em cirurgia de buraco macular com de 3 anos de seguimento

ABSTRACT Purpose: The aim of this study was to determine the functional and anatomical success rates as well as the safety of sutureless combined surgery involving vitreous base removal and internal limiting membrane peeling after Brilliant Blue G (0.5 mg/mL) staining for the management of idiopathic macular holes after three years. Methods: Forty-six eyes of 46 patients with an idiopathic macular hole were enrolled in this retrospective study. The inclusion criteria were macular holes with a minimum linear diameter below 1,500 mm, 0.05 or better decimal best-corrected visual acuity and duration of symptoms less than two years. The exclusion criteria included pregnancy, optic nerve atrophy, advanced glaucoma, and other chronic ocular diseases. The surgical procedure included internal limiting membrane peeling after Brilliant Blue G (0.5 mg/mL) staining, along with C3F8 tamponade and face-down positioning for three days postoperatively. Ophthalmologic examinations and optical coherence tomography were performed at 1 and 7 days and 1, 6, 12, 24, and 36 months postoperatively. If no anatomic closure of the macular holes occurred within the first month, the area of the internal limiting membrane peeling was enlarged in a second procedure. Multiple logistic regression and chi-squared tests were used for data analyses, and p-values of <0.05 were considered significant. Results: Out of 46 eyes with a preoperative idiopathic macular hole, anatomic closure was achieved in 42 (91.3%) after one procedure and in 45 (97.8%) after an additional surgery. The median postoperative best-corrected visual acuity improvement was 0.378 (range: 0.050-0.900) decimal. None of the patients experienced macular hole reopening, surgery-related complications, or ocular complications related to the dye. Conclusion: Combined surgery including vitreous base removal and internal limiting membrane peeling after staining with Brilliant Blue G (0.5 mg/mL) for the management of idiopathic macular holes resulted in adequate staining, best-corrected visual acuity improvement, and macular hole closure with no signs of ocular toxicity at the three-year follow-up examination.

RESUMO Objetivo: Determinar, após 3 anos de seguimento, as taxas de sucesso funcional e anatômico e a segurança da cirurgia combinada sem sutura, incluindo remoção da base vítrea e da membrana limitante interna após coloração com azul brilhante (0,5 mg/ml) para o manejo de buracos maculares idiopáticos. Métodos: Quarenta e seis olhos de 46 pacientes com buraco macular idiopático foram incluídos neste estudo retrospectivo. Os critérios de inclusão foram: buraco macular com diâmetro linear mínimo menor que 1500 micrômetros, acuidade visual com melhor correção de 0,05 decimal ou melhor e tempo de sintomas menor que 2 anos. Os critérios de exclusão foram gravidez, atrofia do nervo óptico, glaucoma avançado ou outra doença ocular crônica. A técnica cirúrgica incluiu a remoção da membrana limitante interna após coloração com Azul Brilhante 0,5 mg/ml, tamponamento com C3F8 posicionamento em prona ção durante 3 dias de pós-operatório. O seguimento foi realizado por exame oftalmológico e Tomografia de Coerência Óptica no 1 e 7 dias, 1, 6, 12, 24 e 36 meses de pós-operatório. Se o fechamento anatômico do buraco macular não fosse atingido na visita de um mês, realizava-se um segundo procedimento no qual a área do peeling da membrana limitante interna era ampliada. Para análise estatística, foram utilizados testes de regressão logística múltipla e Qui-quadrado. Valores de p menores que 0.05 foram considerados estatisticamente significativos. Resultados: Dos 46 olhos com buraco macular idiopático, 42 (91,3%) obtiveram fechamento do buraco macular após um procedimento cirúrgico e 45 (97,8%) após uma cirurgia adicional. A média de melhora da acuidade visual com melhor correção no pós-operatório foi de 0.378 (0.050-0.900) decimal. Não foram observados: reabertura do buraco macular, complicações relacionadas ao procedimento cirúrgico ou complicações relacionadas ao corante. Conclusão: A cirurgia combinada sem sutura que incluiu remoção da base vítrea e remoção membrana limitante interna após coloração com Azul Brilhante (0,5 mg/ml) para o tratamento de buracos maculares idiopáticos foi realizada com adequada capacidade de coloração, melhora da acuidade visual e fechamento do buraco macular sem sinais de toxicidade ocular no seguimento de 3 anos.

Effects on ocular discomfort and tear film dynamics of suturing 23-gauge pars plana vitrectomies / Efeito da sutura da vitrectomia via pars plana de calibre 23 no desconforto ocular e na dinâmica do filme lacrimal

ABSTRACT Purpose: To evaluate the effects of suturing 23-gauge pars plana vitrectomies on ocular discomfort and tear film dynamics. Methods: This retrospective chart review involved data from 50 procedures in 50 patients who underwent 23-gauge pars plana vitrectomy from January to November 2016. We divided the eyes into two groups according to the presence or absence of sutures; 35 eyes underwent sutureless vitrectomies (Group 1), and 15 eyes underwent vitrectomy with at least one sclerotomy suture site (Group 2). In each group, we assessed objective variables including tear film break-up time, Schirmer test I, corneal surface grading with Oxford system, and a quantitative method evaluating subjective dry eye symptoms using ocular surface disease index questionnaires preoperatively 1 week, and 1 and 3 months after surgery. Results: The tear film break-up time showed a significant difference at the 3-months follow-up (p=0.026). The Schirmer test I and corneal surface staining score showed no statistically significant differences between two groups at any time after the operations. The ocular surface disease index score was significantly lower in Group 1 than in Group 2 at 1 week (p=0.032), 1 month (p=0.026), and 3 months (p=0.041) after the operation. Conclusion: Sclerotomy suturing caused ocular discomfort and had a negative effect on tear film dynamics during the late postoperative period. Sclerotomies without suturing seem to reduce the ocular surface changes.

RESUMO Objetivo: Avaliar os efeitos da sutura da vitrectomia via pars plana de 23-gauge sobre o desconforto ocular e a dinâmica do filme lacrimal. Métodos: Esta revisão retrospectiva de prontuários envolveu dados de 50 casos em 50 pacientes submetidos à vitrectomia via pars plana de 23-gauge, de janeiro a novembro de 2016. Dividimos os olhos em dois grupos de acordo com a presença ou ausência de suturas; 35 olhos foram submetidos à vitrectomia sem sutura (Grupo 1) e 15 olhos foram submetidos à vitrectomia com pelo menos um ponto de sutura no local da esclerotomia (Grupo 2). Em cada grupo, avaliamos variáveis objetivas incluindo tempo de ruptura do filme lacrimal, teste de Schirmer I, gradação da superfície corneana com o sistema Oxford e um método quantitativo avaliando sintomas subjetivos de olho seco usando questionários de índice de doença da superfície ocular nos períodos: 1 semana do pré-operatório, 1 mês e 3 meses após a cirurgia. Resultados: O tempo de ruptura do filme lacrimal apresentou diferença significativa no seguimento de 3 meses (p=0,026). O teste de Schirmer I e o escore da coloração da superfície da córnea não mostraram diferenças estatisticamente significativas entre os dois grupos em nenhum momento após as operações. O escore do índice de doença da superfície ocular foi significativamente menor no Grupo 1 em relação ao Grupo 2 no período de 1 semana (p=0,032), 1 mês (p=0,026) e 3 meses (p=0,041) após a cirurgia. Conclusão: A sutura da esclerotomia causou desconforto ocular e teve um efeito negativo na dinâmica do filme lacrimal durante o período pós-operatório. Esclerotomias sem sutura parecem reduzir as alterações da superfície ocular.

Retinitis necrotizante aguda. A propósito de un caso / Acute necrotizing retinitis. Case report

RESUMEN La retinitis necrotizante aguda, es una necrosis retinal de todas las capas de la retina. Se caracteriza por necrosis fibrinoides de la pared de los vasos y oclusión vascular. Se presentó un caso de una paciente de 42 años de edad, con pérdida brusca de la visión del ojo derecho, con una semana de evolución. Al examen oftalmológico se observó haze vítreo 2+, edema sucio del disco óptico, con borramiento de todos sus bordes. Presencia de exudación blanca-amarillenta retiniana extensa, en toda la periferia y área ecuatorial asociada a hemorragias intraretinianas. Se realizó además del examen fundoscòpico toma de muestra de humor acuoso para reacción en cadena de la polimerasa y angiografía fluoresceínica. Los signos fundoscópicos de la paciente, así como las anomalías detectadas en la angiografía fluoresceínica sugirieron el diagnóstico clínico de síndrome de necrosis retinal aguda. Se confirmó el diagnóstico etiológico viral, semanas después por el resultado de polimerasa. Se practicó la terapéutica médica y fotocoagulación laser focal retiniano correspondiente, asociado a cirugía del desprendimiento de retina mixto mediante vitrectomía pars plana y se logró la re aplicación de la retina.

ABSTRACT The acute necrotizing retinitis is a retinal necrosis of all the retinal layers. It is characterized by fibrinoid necrosis of the vases' wall and vascular occlusion. The case presented is the case of a female patient aged 42 years, who suffers sudden loss of the left eye vision, with a week of evolution. At the ophthalmologic examination it was observed a 2+ vitreous haze, dirty edema of the optic disk, with effacement of all of its margins. There it was an extended white-yellowish retinal exudation in the entire periphery and the equatorial area, associated to intra-retinal hemorrhages. Besides the funduscopic examination, it was taken a sample of the aqueous humor for a polymerase chain reaction (PCR) and fluorescein angiography. The patient's funduscopic signs, and also the anomalies detected in the fluorescein angiography suggested the clinical diagnosis of acute retinal necrosis syndrome. After several weeks, the viral etiologic diagnosis was confirmed by polymerase chain reaction. It was practiced the correspondent medical therapeutics and focal retinal laser coagulation associated to mixt retinal detachment through pars plana vitrectomy; the retina reapplication was achieved.

Efecto del uso preoperatorio de bevacizumab intravítreo en pacientes con retinopatía diabética proliferativa sometidos a vitrectomía- Primera actualización / Preoperative intravitreal bevacizumab for proliferative diabetic retinopathy patients undergoing vitrectomy - First update

ACTUALIZACIÓN: Este resumen Epistemonikos (Living FRISBEE: Living FRIendly Summary of the Body of Evidence using Epistemonikos) es una actualización del resumen publicado en diciembre de 2014. INTRODUCCIÓN: La retinopatía diabética proliferativa conlleva un alto riesgo de ceguera si no es tratada de manera oportuna. El tratamiento muchas veces incluye la vitrectomía. El uso preoperatorio de bevacizumab, un anti-factor de crecimiento endotelial vascular, podría mejorar variables intraoperatorias que facilitan la cirugía y mejorarían el curso postoperatorio. MÉTODOS: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos cinco revisiones sistemáticas que en conjunto incluyeron 16 estudios primarios, de los cuales 14 corresponden a ensayos aleatorizados. Concluimos que el uso preoperatorio de bevacizumab disminuye la incidencia de hemorragia vítrea en el postoperatorio temprano y probablemente también en el postoperatorio tardío, pero no está claro su efecto sobre la agudeza visual. Además, probablemente disminuye el tiempo quirúrgico, podría disminuir la incidencia de roturas retinianas iatrogénicas, y si bien no está claro que disminuya la ocurrencia de sangrado intraoperatorio, podría disminuir la necesidad de uso de endodiatermia.

UPDATE: This Living FRISBEE (Living FRIendly Summary of the Body of Evidence using Epistemonikos) is an update of the summary published in December 2014. INTRODUCTION: Proliferative diabetic retinopathy can cause severe vision loss and even blindness if left untreated. Vitrectomy is often required in the treatment of more severe cases. Preoperative administration of bevacizumab, a humanized anti-vascular endothelial growth factor would improve intraoperative variables that facilitate surgery and improve postoperative course. METHODS: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS: We identified five systematic reviews including 16 studies overall, of which 14 were randomized trials. We concluded the preoperative use of intravitreal bevacizumab reduces the rate of vitreous hemorrhage in the early postoperative period, and probably also in the late postoperative period, but its effect on visual acuity is not clear. Furthermore, it probably decreases the surgical time and may decrease the incidence of iatrogenic retinal breaks. Although we are uncertain whether preoperative bevacizumab decreases intraoperative bleeding, it may reduce the need for endodiathermy.

Manejo actual de la endoftalmitis posterior a la cirugía de catarata / Current management of endophtalmitis after the cataract surgery

La endoftalmitis es una complicación grave de la cirugía de cataratas que todos los cirujanos oculares y pacientes se esfuerzan por evitar. La pérdida visual que se produce en una gran proporción de endoftalmitis posoperatorias puede ser de carácter grave e irreversible. Se debe sospechar endoftalmitis aguda ante una disminución brusca de la agudeza visual después de la cirugía de cataratas, normalmente asociada a dolor y signos de inflamación ocular difusa. La sospecha de endoftalmitis es una urgencia médica que se ha de tratar con antibióticos intravítreos y/o vitrectomía en el menor tiempo posible. Se realizó una búsqueda de los últimos 10 años sobre el tema, su incidencia, las recomendaciones y el manejo preoperatorio en la profilaxis de esta, los signos y síntomas clínicos, los gérmenes que con mayor frecuencia pueden ocasionarla, así como las opciones de tratamiento. Se utilizó la plataforma Infomed, específicamente la Biblioteca Virtual de Salud(AU)

Endophtalmitis is a severe complication of the cataract surgery which all the eye surgeons and patients try to avoid. The visual loss that occurs in a great proportion of postoperative endophthalmitis can be serious and irreversible. One may suspect the existence of acute endophthalmitis when there is sudden reduction of visual acuity after cataract surgery, normally associated to pain and signs of diffuse ocular inflammation. The suspicion of endophthalmitis is a medical urgency that must be treated with intravitreous antibiotics and/or vitrectomy as soon as possible. Information search about this topic in the last ten years, its incidence, recommendations and preoperative management in its prophylaxis, clinical signs and symptoms and the germs that may frequently cause it as well as the treatment options was made in Informed platform, particularly in the Virtual Library of Health(AU)

Ruptura del globo ocular / Rupture of the eyeball

Los traumatismos oculares representan la principal causa de pérdida de la agudeza visual en individuos jóvenes y se sitúa entre las causas de ceguera en el mundo. Pueden tener un efecto devastador sobre el globo ocular; es el tipo de traumatismo más severo en esta zona, con un pobre pronóstico visual para el paciente. Constituye un accidente grave, que en muchas ocasiones conlleva a la enucleación. Se presentan tres pacientes con rotura del globo ocular, con la conducta terapéutica, seguimiento y resultados visuales en cada caso, para mostrar a la comunidad médica, la complejidad y particularidades de este traumatismo(AU)

Ocular traumatisms represent the principal cause of loss of vision in young people and they are among the causes of blindness in the world. Trauma can result in a wide spectrum of tissue lesions of the globe and it can has devastating effect on the eyeball, since it is the most severe type of trauma in this area, with a poor visual prognosis for the patient. It is a serious accident, which often leads to nucleation as result of a bruised intense trauma. This is the report of three patients with rupture of the ocular globe with the therapeutic behavior, follow-up and visual results in each case, to show the medical community, the complexity and particularities of this traumatism(AU)

La endoftalmitis endógena por Candida, un marcador pronóstico / Endogenous Candida endophthalmitis, a prognostic marker

La candidiasis es la causa más común de endoftalmitis endógena. La afectación ocular se produce entre los 3 y los 15 días siguientes a la fungemia. Las dos formas características de presentación son la coriorretinitis candidiásica, que afecta a la coroides y a la retina sin afectar claramente al vítreo, y la endoftalmitis candidiásica, con presencia de lesiones vítreas redondeadas, de aspecto algodonoso (perlas vítreas), características de esta infección. Los síntomas visuales precoces más habituales son la visión borrosa y los flotadores. Se recomienda entonces realizar fondo de ojo en las 2 primeras semanas del diagnóstico de candidemia para prevenir complicaciones oculares y usar la afectación ocular como indicador de probable infección fúngica invasiva. La anfotericina B, el fluconazol, el voriconazol, el posaconazol y el ravuconazol, así como las equinocandinas entre las que se encuentran la caspofungina han demostrado su utilidad en el tratamiento de la coriorretinitis, pero la efectividad disminuye en los casos de afectación vítrea si no se asocian a vitrectomía(AU)

Candidiasis is the most common cause of endogenous endophthalmitis. Ocular damage occurs within 3 and 15 days after fungemia. The two characteristic forms of presentation are Candida chorioretinitis, affecting the choroid and the retina with no clear impact on the vitreous, and Candida endophthalmitis, with the presence of rounded cottony vitreous lesions (vitreous pearls), characteristic of this infection. The most common early visual symptoms are blurred vision and floaters. It is thus recommended to perform funduscopy within the first two weeks after the candidemia diagnosis to prevent ocular complications and use the ocular damage as an indicator of probable invasive fungal infection. Amphotericin B, fluconazole, voriconazole, posaconazole and ravuconazole, as well as echinocandins, among them caspofungin, have proven useful in the treatment of chorioretinitis, but effectiveness is lower in vitreous damage cases when they are not associated to vitrectomy(AU)

Trauma ocular a globo abierto asociado a cuerpo extraño intraocular vegetal / Ocular trauma to an open eyeball associated with a vegetable intraocular foreign body

Introducción: El trauma ocular es una causa importante de morbilidad oftalmológica en el mundo, con implicaciones socio-económicas importantes para el paciente y sus familiares, pues ocurre generalmente en adultos jóvenes, con una buena agudeza visual al inicio del evento traumático y que se verá comprometida según la severidad del trauma, las estructuras oculares que afecte y las complicaciones que puedan aparecer; de ahí que la pérdida de la visión sea una de las minusvalías más temidas. Presentación del caso: Paciente con alteraciones anatómicas y funcionales producidas por un trauma ocular a globo abierto penetrante zona 3, y presencia de cuerpo extraño intraocular vegetal, donde se logró un diagnóstico precoz y conducta quirúrgica oportuna obteniendo resultados visuales excelentes. Conclusiones: El trauma ocular a globo abierto penetrante zona III con cuerpo extraño intraocular vegetal, a pesar de su difícil manejo, permite alcanzar buenos resultados visuales. Esto depende del diagnóstico precoz, y una conducta pertinente basándose en criterios actuales del BETT Y del OTS(AU)

Introduction: Ocular trauma is a fundamental cause for ophthalmological morbidity worldwide, with important socio-economic implications for the patient and their relatives, since it usually occurs in young adults, with good visual acuity at the beginning of the traumatic event and which will be seen compromised based on trauma seriousness, the affected ocular structures and the complications that may appear; hence, vision loss is one of the most feared handicaps. Case presentation: Patient with anatomical and functional alterations produced by an ocular trauma in open penetrating globe zone III, and the presence of a vegetal intraocular foreign body, where an early diagnosis and timely surgical behavior were achieved, obtaining excellent visual results. Conclusions: Ocular trauma in open penetrating globe zone III with vegetal intraocular foreign body, in spite of its difficult management, allows to achieve good visual results. Based on current criteria, this depends on early diagnosis and relevant behavior based on current criteria(AU)