Resultados de la cirugía de agujero macular grande empleando distintas técnicas de interposición macular. Serie de 9 casos / Results of large macular hole surgery using different interposition techniques. A report on 9 cases

Objetivo Describir la restauración anatómica y funcional observada a largo plazo en pacientes intervenidos por agujero macular (AM) grande empleando distintas técnicas de interposición macular. Método Análisis retrospectivo de los resultados obtenidos en una serie de 9 pacientes sometidos a cirugía de AM grande (≥450μm) realizando 4 técnicas de interposición macular distintas: flap invertido de membrana limitante interna en 4 casos, plegado de membrana limitante interna en 2, injerto de membrana amniótica en 2 e injerto autógeno de cápsula anterior en uno. El tiempo de seguimiento medio fue de 11 meses. Anatómicamente las medidas de resultados exploradas fueron la restauración de las capas externas de la retina y el patrón de cierre macular. Funcionalmente se valoró la agudeza visual final y la calidad visual. Resultados La restauración de las capas externas fue parcial en 6 casos. La tasa de cierre macular fue del 100%, apreciándose un patrón incompleto en 4 casos. La agudeza visual mejoró en 7 pacientes, manteniéndose estable en 2. Tres casos mostraron un patrón de fijación excéntrico y/o metamorfopsias. Conclusiones El desarrollo de nuevas técnicas quirúrgicas ha incrementado la tasa de cierre macular en AM grandes. Sin embargo, la restauración anatómica y funcional sigue siendo impredecible. En este trabajo se logró el cierre macular en todos los pacientes y una mayor tasa de cierre completo empleando flap invertido de membrana limitante interna. La restauración de las capas externas fue más favorable en los grupos en los que se había empleado membrana limitante interna. La recuperación funcional fue independiente de la técnica empleada (AU)

Objective To describe the long-term anatomical and functional restoration observed in patients operated on for a large macular hole (MH) using different macular interposition techniques. Method Retrospective analysis of the results obtained in a series of 9 patients undergoing large MH surgery (≥450μm) performing 4 different macular interposition techniques: inverted internal limiting membrane flap in 4 cases, autotransplantation of internal limiting membrane in 2, amniotic membrane graft in 2, and autologous anterior capsule graft in one. The mean follow-up time was 11 months. Anatomically, the outcome measures explored were the restoration of the outer layers of the retina and the pattern of MH closure. The final visual acuity and visual quality were functionally assessed. Results The restoration of the outer layers was partial in 6 cases. The macular closure rate was 100%, showing an incomplete pattern in 4 cases. Visual acuity improved in 7 patients, remaining stable in 2. Three cases showed an eccentric fixation pattern and/or metamorphopsia. Conclusion The development of new surgical techniques has increased the rate of macular closure in large MHs. However, the anatomical and functional restoration remains unpredictable. In this work, macular closure was achieved in all patients and a higher rate of complete closure using inverted internal limiting membrane flap. The restoration of the outer layers was more favorable in the groups in which internal limiting membrane had been used. Functional recovery was independent of the technique used (AU)

Results of large macular hole surgery using different interposition techniques. A report on 9 cases.

OBJECTIVE: To describe the long-term anatomical and functional restoration observed in patients operated on for a large macular hole (MH) using different macular interposition techniques. METHOD: Retrospective analysis of the results obtained in a series of 9 patients undergoing large MH surgery (≥450µm) performing 4 different macular interposition techniques: inverted internal limiting membrane flap in 4 cases, autotransplantation of internal limiting membrane in 2, amniotic membrane graft in 2, and autologous anterior capsule graft in one. The mean follow-up time was 11 months. Anatomically, the outcome measures explored were the restoration of the outer layers of the retina and the pattern of MH closure. The final visual acuity and visual quality were functionally assessed. RESULTS: The restoration of the outer layers was partial in 6 cases. The macular closure rate was 100%, showing an incomplete pattern in 4 cases. Visual acuity improved in 7 patients, remaining stable in 2. Three cases showed an eccentric fixation pattern and/or metamorphopsia. CONCLUSIONS: The development of new surgical techniques has increased the rate of macular closure in large MHs. However, the anatomical and functional restoration remains unpredictable. In this work, macular closure was achieved in all patients and a higher rate of complete closure using inverted internal limiting membrane flap. The restoration of the outer layers was more favorable in the groups in which internal limiting membrane had been used. Functional recovery was independent of the technique used.

Experimental measurement of corneal haze after excimer laser keratectomy.

We developed a model of corneal haze following photorefractive keratectomy (PRK) in Iber Braun hens and studied optical properties. The animals underwent PRK for -9.0 diopters of myopia and were divided into groups based on treatment with different wound-healing modulators. At different time points postoperatively, we evaluated haze by slit-lamp microscopy. An experimental device was developed to measure transmittance spatial maps and forward scattering of He-Ne laser light in the excised corneas. Subjective and objective haze measures were compared for each group at the different times. Keratocyte densities were determined by optical microscopy and keratocyte sizes by electron microscopy. The agreement between experimental results and a simple numerical model of scattering suggests that increases in stromal keratocyte density after PRK might explain the degree of corneal haze.

Effects of androgens on isolated rat uterus.

The 5 alpha- and 5 beta-dihydrotestosterone (DHT) androgens relax KCl-induced tonic contraction in rat uterus, in a dose-dependent way. The 5 alpha and 5 beta-DHT relaxing effect is counteracted by CaCl2 (0.1-10 mM). The 5 alpha-DHT, but not the 5 beta-DHT, effect was reduced by cycloheximide (10 micrograms/ml) and by actinomycin D (5 micrograms/ml). Flutamide at 10(-6) M shifted the effect of 5 alpha-DHT to the right. However, other doses of flutamide or cyproterone acetate did not modify the effect of both androgens. We suggest a non-genomic effect of 5 alpha-DHT and 5 beta-DHT in rat uterus contraction but that intracellular and genomic actions play a part in the relaxing effect of 5 alpha-DHT.

Effects of antiandrogens and progesterone on isolated rat uterus.

1. The effect of progesterone (P, 6 x 10(-6)-6 x 10(-5) M) and the antiandrogens cyproterone acetate (CPA, 10(-7)-10(-5) M), flutamide (F, 10(-6)-6 x 10(-5) M) and spironolactone (S, 10(-6)-6 x 10(-5) M) on the KCl-induced tonic contraction of the isolated rat uterus have been assayed. 2. The antiandrogens relaxed, in a dose-dependent way, the KCl-induced contraction (EC50, 2.804 +/- 0.506 x 10(-6); 1.671 +/- 0.308 x 10(-5); and 3.042 +/- 0.14 x 10(-5) M, respectively for CPA, S and F). P also relaxed the KCl-induced contraction (EC50, 2.436 +/- 0.524 x 10(-5) M). 3. CaCl2 (0.1-10 mM) counteracted the relaxing effect of CPA, S, F, and P, respectively, up to 100, 80.63, 60.66 and 90.57%. 4. The 17-OH-progesterone derivative CPA, but not S or F, reduces at small doses (6 x 10(-8) M), but not at higher concentrations (6 x 10(-7)-6 x 10(-6) M), the relaxing effect of progesterone.