Results of the treatment of patients with exudative AMD during the COVID-19 pandemic.

BACKGROUND AND OBJECTIVE: The SARS-CoV-2 pandemic has caused chaos in all health systems on the planet. It has been difficult to cope with COVID 19, but also to maintain the activity in other specialties. In ophthalmology, the scientific societies recommended providing urgent care, including the intravitreal treatment of patients with active neovascular age-related macular degeneration (AMD), since a delay in treatment implies a potential loss of visual acuity (VA). The main objective of this study was to measure the impact of the coronavirus lockdown on the activity and visual results in patients with neovascular AMD in Area 3 of Madrid. MATERIAL AND METHOD: A retrospective observational study was conducted of all patients with neovascular AMD who attended a consultation and/or received intravitreal treatment in the 3 months before the lockdown. RESULTS: In the 3 months before the lockdown, 144 patients with neovascular AMD were treated, of whom only 51 attended a consultation during the lockdown and, at 6 months after it, only 117 patients had resumed their follow-up. Mean VA before the lockdown was 58.0 ±â€¯23.7 letters and was statistically significantly reduced to 53.0 ±â€¯27.1 letters at 6 months after the lockdown. We also observed a significant decrease in the number of visits during the lockdown, despite the security measures implemented. CONCLUSIONS: Our study shows that patients with neovascular AMD have had a statistically significant decrease in VA due to the lockdown. A VA of almost 58 letters was reduced to 53 at 6 months after the lockdown. The percentage of patients who lost 15 or more letters doubled. We observed a 63.3% loss of temporary follow-up during the lockdown and a 14.58% loss of permanent follow-up at 6 months after the lockdown.

Resultados del tratamiento de los pacientes con DMAE exudativa durante la pandemia por COVID-19 / Results of the treatment of patients with exudative AMD during the COVID-19 pandemic

Antecedentes y objetivo La pandemia SARS-CoV-2 ha supuesto un caos organizativo para todos los sistemas sanitarios del planeta. No solo ha sido complicado hacer frente a la COVID 19, sino también ajustar la actividad asistencial en otras especialidades. En oftalmología las recomendaciones de las sociedades científicas eran dar asistencia urgente y dentro de esta se contemplaba el tratamiento intravítreo de los pacientes con degeneración macular asociada a la edad neovascular (DMAEn) activa, puesto que el retraso en el tratamiento supone una pérdida potencialmente irrecuperable de agudeza visual (AV). El objetivo primario del presente estudio es medir el impacto en la actividad y los resultados visuales del confinamiento por coronavirus en los pacientes con DMAEn en el área 3 de la Comunidad de Madrid. Material y método Se plantea un estudio observacional retrospectivo de todos los pacientes con DMAEn que habían acudido a consulta y/o recibido tratamiento intravítreo los 3 meses previos al inicio del confinamiento. Resultados Los 3 meses previos al confinamiento se atendieron a 144 pacientes con DMAEn de los cuales solo 51 acudieron durante el confinamiento y a los 6 meses tras el confinamiento solo 117 pacientes han retomado su seguimiento. La AV media antes del confinamiento era de 58±23,7 letras y se redujo de forma estadísticamente significativa a 53±27,1 letras a los 6 meses tras el confinamiento. También observamos una disminución significativa del número de visitas durante el confinamiento a pesar de las medidas de seguridad implementadas. Conclusiones Nuestro estudio demuestra que los pacientes con DMAEn presentan una disminución estadísticamente significativa de la AV durante el confinamiento. De una AV de casi 58 letras, se redujo a 53 a los 6 meses del confinamiento. El porcentaje de pacientes que perdió 15 o más letras se duplicó (AU)

Background and objective The SARS-CoV-2 pandemic has caused chaos in all health systems on the planet. It has been difficult to cope with COVID 19, but also to maintain the activity in other specialties. In ophthalmology, the scientific societies recommended providing urgent care, including the intravitreal treatment of patients with active neovascular age-related macular degeneration (AMD), since a delay in treatment implies a potential loss of visual acuity (VA). The main objective of this study was to measure the impact of the coronavirus lockdown on the activity and visual results in patients with neovascular AMD in Area 3 of Madrid. Material and method A retrospective observational study was conducted of all patients with neovascular AMD who attended a consultation and/or received intravitreal treatment in the 3 months before the lockdown. Results In the 3 months before the lockdown, 144 patients with neovascular AMD were treated, of whom only 51 attended a consultation during the lockdown and, at 6 months after it, only 117 patients had resumed their follow-up. Mean VA before the lockdown was 58.0±23.7 letters and was statistically significantly reduced to 53.0±27.1 letters at 6 months after the lockdown. We also observed a significant decrease in the number of visits during the lockdown, despite the security measures implemented. onclusions Our study shows that patients with neovascular AMD have had a statistically significant decrease in VA due to the lockdown. A VA of almost 58 letters was reduced to 53 at 6 months after the lockdown. The percentage of patients who lost 15 or more letters doubled. We observed a 63.3% loss of temporary follow-up during the lockdown and a 14.58% loss of permanent follow-up at 6 months after the lockdown (AU)

[Results of the treatment of patients with exudative AMD during the COVID-19 pandemic]. / Resultados del tratamiento de los pacientes con DMAE exudativa durante la pandemia por COVID-19.

Background and objective: The SARS-CoV-2 pandemic has caused chaos in all health systems on the planet. It has been difficult to cope with COVID 19, but also to maintain the activity in other specialties. In ophthalmology, the scientific societies recommended providing urgent care, including the intravitreal treatment of patients with active neovascular age-related macular degeneration (AMD), since a delay in treatment implies a potential loss of visual acuity (VA).The main objective of this study was to measure the impact of the coronavirus lockdown on the activity and visual results in patients with neovascular AMD in Area 3 of Madrid. Material and method: A retrospective observational study was conducted of all patients with neovascular AMD who attended a consultation and/or received intravitreal treatment in the 3 months before the lockdown. Results: In the 3 months before the lockdown, 144 patients with neovascular AMD were treated, of whom only 51 attended a consultation during the lockdown and, at 6 months after it, only 117 patients had resumed their follow-up. Mean VA before the lockdown was 58.0 ± 23.7 letters and was statistically significantly reduced to 53.0 ± 27.1 letters at 6 months after the lockdown. We also observed a significant decrease in the number of visits during the lockdown, despite the security measures implemented. Conclusions: Our study shows that patients with neovascular AMD have had a statistically significant decrease in VA due to the lockdown. A VA of almost 58 letters was reduced to 53 at 6 months after the lockdown. The percentage of patients who lost 15 or more letters doubled. We observed a 63.3% loss of temporary follow-up during the lockdown and a 14.58% loss of permanent follow-up at 6 months after the lockdown.

Ocular residual astigmatism's effect on high myopic astigmatism LASIK surgery.

PURPOSE: To analyze the effect of ocular residual astigmatism (ORA) on the effectiveness of LASIK for treating high myopic astigmatism. METHODS: This is an observational, cross-sectional study. We studied 116 consecutive myopic eyes with -3 diopters (D) or more of astigmatism that underwent LASIK surgery. The magnitude of uncorrected residual refractive astigmatism 3 months postoperatively was measured. RESULTS: The mean preoperative cylinder was -4.0±0.83 D (range, -7.5 to -3 D) and the mean preoperative ORA was 0.82±0.5 D. The mean residual refractive cylinder 3 months postoperatively was -0.78±0.83 D (range, -3 to 0 D). No correlation was found between ORA and the refractive cylinder 3 months postoperatively (P=0.6). CONCLUSION: In eyes with high myopic astigmatism undergoing LASIK, ORA was not correlated with the residual postoperative cylinder.

La vitrectomía como terapia antinflamatoria de la uveítis intermedia en niños / Pars plana vitrectomy as anti-inflammatory therapy for intermediate uveitis in children

ObjetivoLas uveítis intermedias constituyen entre el 2 y el 26% de las uveítis en niños. El curso natural es variable existiendo desde casos leves autolimitados hasta formas crónicas más severas que cursan con múltiples recurrencias y complicaciones. El objetivo de este estudio es valorar la utilidad de la vitrectomía para controlar la inflamación en niños con uveítis intermedias recurrentes.MétodosEstudio retrospectivo con seguimiento de al menos seis meses. Se incluyeron todos los niños menores de dieciséis años intervenidos mediante vitrectomía por uveítis intermedia tras haber sufrido al menos dos brotes de inflamación intermedia sin tratamiento profiláctico inmunosupresor sistémico previo a la cirugía. Se recogieron los cambios en la agudeza visual (AV), las recaídas y las complicaciones derivadas de la cirugía.ResultadosSe seleccionaron siete ojos de cinco niños con uveítis intermedia que requirieron vitrectomía. Tras un seguimiento medio de 34 meses, la AV había mejorado en todos los ojos respecto a la situación prequirúrgica. Cuatro ojos desarrollaron cataratas subcapsulares posteriores leves. Las recurrencias posquirúrgicas fueron de localización anterior y controladas con tratamiento tópico, salvo un brote de uveítis intermedia tratada con una inyección de triamcinolona periocular. Solo un niño se encuentra actualmente bajo terapia inmunosupresora sistémica, debido a la presencia de brotes de uveítis intermedia en el ojo no operado y dado que sus padres rechazaron la cirugía.ConclusiónLa vitrectomía con crioterapia inferior es una opción terapéutica a considerar para el control de la actividad inflamatoria de las uveítis intermedias en niños a medio plazo para evitar los efectos secundarios asociados a los inmunosupresores sistémicos(AU)

PurposeIntermediate uveitis represents between 2 and 26% of uveitis in children. The spectrum of the disease is highly variable, ranging between mild cases that resolve spontaneously and chronic, severe forms that develop multiple episodes and complications. The purpose of this study is to evaluate the efficacy of vitrectomy to control inflammation in children with recurrent intermediate uveitis.MethodsRetrospective evaluation of patients with at least six months of follow-up. All patients under 16 who had undergone vitrectomy for intermediate uveitis were included. Vitrectomy was performed after at least two episodes of intermediate uveitis in children that had had no previous prophylactic systemic immunosuppressant treatment. Data recorded were visual acuity (VA), recurrences and surgical complications.ResultsSeven eyes of five children with intermediate uveitis who underwent vitrectomy were included. After a mean follow-up of 34 months, VA improved in all eyes after surgery. Four eyes developed mild subcapsular posterior cataracts. Post-surgical recurrences were anterior and responded to topical treatment, except for an episode of intermediate uveitis that required a periocular injection of triamcinolone. Only one patient is being treated with systemic immunosuppressants, due to the presence of repeated episodes of uveitis in the non-vitrectomised eye and since his parents were unwilling to have him undergo new surgery.ConclusionsVitrectomy with inferior cryotheraphy controls inflammation in intermediate uveitis in children with good mid-term results avoiding the secondary side-effects of systemic immunosuppressants(AU)

Results of bevacizumab as the primary treatment for retinal vein occlusions.

BACKGROUND: The purpose of this study is to evaluate the efficacy of intravitreal bevacizumab as the primary treatment of macular oedema due to retinal vein occlusions. METHODS: Patients diagnosed as having central retinal vein occlusion (CRVO) or branch retinal vein occlusion (BRVO) with visual acuity of less than 20/40 and macular oedema with more than 300 microm central retinal thickness were recruited. Patients that had received any prior treatment were excluded. After an initial intravitreal injection of bevacizumab, re-treatment was performed if intraretinal or subretinal fluid with distortion of the foveal depression was found in optical coherence tomography. RESULTS: 18 eyes with CRVO and 28 eyes with BRVO were included. During a 6-month period, the mean number of injections per patient was 3.7 (BRVO group) and 4.6 (CRVO group). In the BRVO group, mean baseline logMAR visual acuity was 0.80 (SD 0.38) and macular thickness was 486.9 microm (SD 138.5 microm). After 6 months, mean logMAR visual acuity improved significantly to 0.44 (SD 0.34), p<0.001. Mean macular thickness decreased significantly to 268.2 microm (SD 62.5 microm), p<0.001. In the CRVO group, mean baseline logMAR visual acuity was 1.13 (SD 0.21) and macular thickness was 536.4 microm (SD 107.1 microm). Mean final logMAR visual acuity improved significantly to 0.83 (SD 0.45), p<0.001. Mean macular thickness decreased significantly to 326.17 microm (SD 96.70 microm), p<0.001. CONCLUSIONS: Intravitreal bevacizumab seems to be an effective primary treatment option for macular oedema due to retinal occlusions. Its main drawback is that multiple injections are necessary to maintain visual and anatomic improvements.

[Pars plana vitrectomy as anti-inflammatory therapy for intermediate uveitis in children]. / La vitrectomía como terapia antinflamatoria de la uveítis intermedia en niños.

PURPOSE: Intermediate uveitis represents between 2 and 26% of uveitis in children. The spectrum of the disease is highly variable, ranging between mild cases that resolve spontaneously and chronic, severe forms that develop multiple episodes and complications. The purpose of this study is to evaluate the efficacy of vitrectomy to control inflammation in children with recurrent intermediate uveitis. METHODS: Retrospective evaluation of patients with at least six months of follow-up. All patients under 16 who had undergone vitrectomy for intermediate uveitis were included. Vitrectomy was performed after at least two episodes of intermediate uveitis in children that had had no previous prophylactic systemic immunosuppressant treatment. Data recorded were visual acuity (VA), recurrences and surgical complications. RESULTS: Seven eyes of five children with intermediate uveitis who underwent vitrectomy were included. After a mean follow-up of 34 months, VA improved in all eyes after surgery. Four eyes developed mild subcapsular posterior cataracts. Post-surgical recurrences were anterior and responded to topical treatment, except for an episode of intermediate uveitis that required a periocular injection of triamcinolone. Only one patient is being treated with systemic immunosuppressants, due to the presence of repeated episodes of uveitis in the non-vitrectomised eye and since his parents were unwilling to have him undergo new surgery. CONCLUSIONS: Vitrectomy with inferior cryotheraphy controls inflammation in intermediate uveitis in children with good mid-term results avoiding the secondary side-effects of systemic immunosuppressants.

Inferior sclerotomies without subretinal fluid drainage for exudative retinal detachment in diffuse retinal pigment epitheliopathy.

PURPOSE: To evaluate the efficacy of inferior sutureless sclerotomies without subretinal fluid drainage for the treatment of bullous exudative retinal detachment secondary to diffuse retinal pigment epitheliopathy. METHODS: A retrospective interventional case series of eyes treated with two inferior postequatorial full-thickness sclerotomies without subretinal fluid drainage. Patients were placed in an upright position 24 hours after surgery. Main outcomes were visual acuity and retinal reattachment rate. RESULTS: Three eyes with recent diagnoses of diffuse retinal pigment epitheliopathy and bullous inferior retinal detachment were included in the study. In all cases, a very thick sclera was evident during surgery. The day after surgery the retina was completely attached in the three eyes. Preoperative visual acuity was light perception, 20/200, and counting fingers. After surgery, visual acuity improved to 20/200, 20/70, and 20/50, respectively. No intra- or postoperative complications occurred. CONCLUSIONS: The performance of inferior sutureless sclerotomies without a draining procedure in cases of diffuse retinal pigment epitheliopathy with inferior bullous retinal detachment is a simple and effective technique. It achieves retinal reattachment the day after surgery, allowing laser photocoagulation of the leaking lesions disclosed in fluorescein angiography.

[Intracranial hypertension and cranial sinus stenosis]. / Hipertensión intracraneal y estenosis de los senos craneales.

CLINICAL CASE: Craneal sinuses stenosis can appear in patients with idiopathic intracranial hypertension. Neuroimaging techniques revealed a right transverse sinus stenosis. As the pressure gradient between both sides of the stenosis was small and response to conservative treatment good, angioplasty was not indicated. DISCUSSION: Lateral sinus stenosis in patients with idiopathic intracranial hypertension is prevalent. It is not clear whether these stenoses are the origin of, or secondary to, cerebrospinal fluid pressure increases. Some cases refractory to conservative treatment may respond to angioplasty with stent placement.

Hipertensión intracraneal y estenosis de los senos craneales / Intracranial hypertension and cranial sinus stenosis

Caso clínico: Varón diagnosticado de hipertensión intracraneal idiopática (HII) que en el estudio diagnóstico presentaba una estenosis del seno transverso derecho. Debido al pequeño gradiente de presión a ambos lados de la estenosis, medido por manometría y a la buena evolución con tratamiento conservador se decide no dilatar la estenosis. Discusión: Las estenosis en los senos laterales aparecen en pacientes con HII, sin que todavía este claro si son la causa del cuadro o secundarias al aumento de la presión del líquido cefalorraquídeo (LCR). En determinados casos la dilatación porangioplastia y colocación de stent han mejorado cuadros que habían sido refractarios a otros tratamientos

Clinical case: Craneal sinuses stenosis can appear in patients with idiopathic intracranial hypertension. Neuroimaging techniques revealed a right transverse sinus stenosis. As the pressure gradient between both sides of the stenosis was small and response to conservative treatment good, angioplasty was not indicated. Discussion: Lateral sinus stenosis in patients with idiopathic intracranial hypertension is prevalent. Itis not clear whether these stenoses are the origin of, or secondary to, cerebrospinal fluid pressure increases. Some cases refractory to conservative treatment may respond to angioplasty with stent placement

Optociliary shunt vessels in compressive optic neuropathy by the intracranial internal carotid artery.

PURPOSE: To report a clinical case of optic nerve compression by supraclinoidal internal carotid artery associated with optociliary shunt vessels. METHODS: A 78-year-old woman with the clinical triad of left visual loss, ipsilateral optic disc pallor, and retinochoroidal (optociliary) shunt vessels is reported. She complained of loss of vision in the left eye of 2 years'' duration. RESULTS: A diffuse depression of the visual field was found in the affected eye. Magnetic resonance imaging revealed left optic nerve compression by the supraclinoidal internal carotid artery. CONCLUSIONS: The occurrence of optociliary shunt vessels, visual loss, and optic atrophy is a nonspecific sign of chronic optic nerve compression and in some instances may be falsely localized.

[Results of nonpenetrating deep sclerectomy in inflammatory glaucoma: one year follow up]. / Resultados de la esclerectomía profunda no perforante en el tratamiento del glaucoma inflamatorio al año de seguimiento.

PURPOSE: To assess the efficacy and safety of nonpenetrating deep sclerectomy in uveitic glaucoma. METHODS: In this observational retrospective trial, 6 eyes with inflammatory glaucoma underwent a nonpenetrating deep sclerectomy and a reticulated hyaluronic acid implant. The minimal follow-up period was 12 months. RESULTS: At 12 months, the complete success rate (defined as an IOP higher than 5 and lower than 21 mmHg without medication) was 66.67% and the qualified success rate was 100%. The mean postoperative IOP at 12 months was 16.67 mmHg (SD: 3.26), and the mean IOP reduction was 23.00 mmHg (SD:13.75) (p= 0.027). The mean number of antiglaucoma medications required was reduced from 2.67 (SD: 0.52) before surgery to 0.50 (SD: 0.84) one year after surgery (p= 0.038). No change on visual acuity was observed. Complications included one case of hyphema and one case of bleb encapsulation. CONCLUSIONS: Nonpenetrating deep sclerectomy in this preliminary study, deep sclerectomy was efficacious and had few postoperative complications, so it can be an alternative in the management of uveitic glaucoma.

Resultados de la esclerectomía profunda no perforante en el tratamiento del glaucoma inflamatorio al año de seguimiento / Results of nonpenetrating deep sclerectomy in inflammatory glaucoma: one year follow up

Objetivo: Determinar la eficacia y seguridad de le esclerectomía profunda no perforante en el manejo quirúrgico del glaucoma inflamatorio. Métodos: Estudio observacional retrospectivo que evalúa una muestra de 6 ojos diagnosticados de glaucoma inflamatorio a los que se les realiza una esclerectomía profunda no perforante con implante de ácido hialurónico reticulado, con un seguimiento postoperatorio de 12 meses. Resultados: Tras un seguimiento medio de 12 meses, el 66,67% de los casos presenta un éxito completo (PIO entre 5 y 21 mmHg sin necesidad de fármacos) y el 100% éxito parcial. La tensión media al año fue de 16,67 mmHg (DE: 3,26), siendo este descenso medio (23,00 mmHg, DE: 13,75 mmHg) estadísticamente significativo (p = 0,027). El número medio de fármacos hipotensores para controlar la presión intraocular se redujo significativamente desde 2,67 (DE: 0,52) a 0,50 (DE: 0,84) a los doce meses de seguimiento. No se observó pérdida de agudeza visual en ningún caso. Las únicas complicaciones postoperatorias observadas fueron un caso de hifema y un quiste de tenon. Conclusiones: La esclerectomía profunda no perforante en este estudio preliminar muestra una elevada eficacia y escasas complicaciones postoperatorias, por lo que podría ser una alternativa en el manejo quirúrgico del glaucoma inflamatorio

Purpose: To assess the efficacy and safety of nonpenetrating deep sclerectomy in uveitic glaucoma. Methods: In this observational retrospective trial, 6 eyes with inflammatory glaucoma underwent a nonpenetrating deep sclerectomy and a reticulated hyaluronic acid implant. The minimal follow-up period was 12 months. Results: At 12 months, the complete success rate (defined as an IOP higher than 5 and lower than 21 mmHg without medication) was 66.67% and the qualified success rate was 100%. The mean postoperative IOP at 12 months was 16.67 mmHg (SD: 3.26), and the mean IOP reduction was 23.00 mmHg (SD:13.75) (p= 0.027). The mean number of antiglaucoma medications required was reduced from 2.67 (SD: 0.52) before surgery to 0.50 (SD: 0.84) one year after surgery (p= 0.038). No change on visual acuity was observed. Complications included one case of hyphema and one case of bleb encapsulation. Conclusions: Nonpenetrating deep sclerectomy in this preliminary study, deep sclerectomy was efficacious and had few postoperative complications, so it can be an alternative in the management of uveitic glaucoma

[Conservative surgical management of a post-traumatic iris cyst]. / Tratamiento quirúrgico conservador en un caso de quiste de iris postraumático.

CASE REPORT: A 32-year-old man with recent visual loss in his right eye, was found to have an iris cyst involving about 50% of the anterior chamber. He had been treated three years previously for a penetrating injury to that eye. The cyst was treated by aspiration, viscodissection and ab-externo photocoagulation, with this achieving a rapid recovery of vision and good anatomic results. At the six month follow-up visit the visual acuity remains stable with no signs of recurrence of the cyst. DISCUSSION: Conservative surgical treatment consisting of aspiration, viscodissection and photocoagulation appears to be an effective strategy to manage secondary anterior chamber cysts, achieving good anatomic and functional results.

Massive exophthalmos after traumatic carotid-cavernous fistula embolization.

An 18-year-old man without previous clinical problems developed a left traumatic carotid-cavernous fistula after a traffic accident. An endovascular embolization with coils was performed without success. The drainage was derived to the superior ophthalmic vein solely and clinical worsening occurred. Left eye proptosis, chemosis and intraocular pressure increased. Complete ophthalmoplegia developed and visual acuity decreased due to a central retinal vein obstruction. After a second embolization attempt the fistula was closed successfully but proptosis, chemosis and intraocular pressure remained uncontrolled despite medical treatment. Therefore an orbital decompression surgery was performed. Ophthalmoplegia, proptosis and chemosis improved and intraocular pressure was controlled. Although retinal hemorrhages persist, no neovascularization has developed. Central retinal vein occlusion in young patients seems to have a different etiology than in the elderly. In young patients, local factors are more frequently identified than systemic vascular diseases. Early detection of central retinal vein obstruction may prevent deterioration of visual acuity.

Tratamiento quirúrgico conservador en un caso de quiste de iris postraumático / Conservative surgical management of a posttraumatic iris cyst

Caso clínico: Varón de 32 años aquejado de pérdida visual en ojo derecho (OD) secundario a un quiste que ocupa la mitad de la cámara anterior, diagnosticado clínicamente de quiste secundario epitelial de iris. Tres años antes había sufrido un traumatismo penetrante. Se realiza aspiración con aguja, viscodisección y fotocoagulación ab externo, logrando una rápida recuperación visual sin secuelas funcionales ni anatómicas. A los seis meses la agudeza visual permanece estable sin recidiva de la lesión. Discusión: El manejo quirúrgico conservador mediante aspiración y fotocoagulación en este caso fue eficaz y seguro en el tratamiento del quiste epitelial adquirido de iris

Case report: A 32-year-old man with recent visual loss in his right eye, was found to have an iris cyst involving about 50% of the anterior chamber. He had been treated three years previously for a penetrating injury to that eye. The cyst was treated by aspiration, viscodissection and ab-externo photocoagulation, with this achieving a rapid recovery of vision and good anatomic results. At the six month follow-up visit the visual acuity remains stable with no signs of recurrence of the cyst. Discussion: Conservative surgical treatment consisting of aspiration, viscodissection and photocoagulation appears to be an effective strategy to manage secondary anterior chamber cysts, achieving good anatomic and functional results

Síndrome constitucional secundario a fluoxetina: a propósito de un caso / Fluoxetine-induced constitutional syndrome: a propos of a case

El síndrome constitucional es un cuadro de gran importancia en pacientes mayores debido a su elevada frecuencia y su gravedad. Este síndrome puede tener distintas etiologías. Las más frecuentes son enfermedades orgánicas, pero también puede deberse a fármacos. Aunque la fluoxetina causa con frecuencia alteraciones gastrointestinales como efecto adverso, sólo existe un estudio que la asocie con el síndrome constitucional. Presentamos un caso de síndrome constitucional secundario a fluoxetina en una mujer de 80 años. (AU)

[Study of 112 patients with septic arthritis caused by pyogenic organisms and fungi: changes in the clinical spectrum during the last 2 decades]. / Estudio de 112 pacientes con artritis séptica por piógenos y hongos: cambios en el espectro clínico durante las dos últimas décadas.

A retrospective study of 112 patients with septic arthritis (SA) caused by pyogenic organisms and fungi attended at the same Medical Service from 1975 to 1994. This SA was more common among male patients and the age at onset of disease was 42 +/- 23.2 years. Predisposing factors were identified in 53 patients, the more common being connective tissue diseases and parenteral drug abuse (PDA). The main portal of entry was bacteremia from a distant infective source. The most common causative agents were Grampositive cocci (particularly S. aureus) and the more uncommon organisms were recovered from patients with underlying diseases. The diagnostic delay was 14.1 +/- 28.1 days. Single joint SA occurred in 88% of patients. Large joints were mainly involved. On admission, 25% of patients had no fever and only 54% of them had leukocytosis; therefore, the lack of these findings in a given patient with acute arthritis should not rule out the possibility of SA. Initial therapy consisted of daily arthrocentesis and i.v. antibiotics. The mean duration of antibiotic therapy was 47 +/- 23 days; the duration of the i.v. route was 23 +/- 14 days. An eighty percent of patients recovered without functional sequelae. The 31 patients who required surgical drainage had a longer diagnostic delay and a worse evolution, thus stressing the necessity of an early diagnosis. In the last decade (1986-1994) an increase in some predisposing factors (iatrogenic SA and PDA), a shorter diagnostic delay, a more prolonged antibiotic therapy, a smaller proportion of surgical drainage and an ultimate evolution identical to that in the previous decade were observed.