Características clínico-epidemiológicas del queratocono en Asturia / Clinical-epidemiological characteristics of keratoconus in Asturias

Introducción El queratocono es la ectasia corneal más frecuente y la segunda causa de queratoplastia en el mundo. Las características clínicas y epidemiológicas del queratocono no han sido apenas estudiadas en España y, hasta la fecha, no se ha hecho ningún trabajo en Asturias. Material y métodos Se realizó un estudio transversal analizando todos los casos de queratocono diagnosticado en las primeras consultas de la sección de Córnea y Superficie de los centros Hospital Universitario Central de Asturias (Oviedo) y Hospital Universitario de Cabueñes (Gijón) entre 2017 y 2020. A todos los pacientes se les recogieron datos demográficos, agudeza visual y se les realizó una topografía corneal. Resultados Se incluyeron un total de 112 pacientes (42,0% mujeres y 58,0% hombres). La edad media era de 36,84±15,59, teniendo un 39,3% una edad superior a 40 años. Un 31,8; 28,0; 15,0 y 25,2% se encontraban en los estadios i, ii, iii y iv, respectivamente, en la escala Amsler-Krumeich. En un 7,5% se implantaron segmentos corneales, en un 4,7% se realizó cross-linking y en un 13,2% se realizó queratoplastia. Conclusión Aproximadamente un 40% de los queratoconos se detectan en estadios avanzados y otro 40% a una edad superior a los 40 años. Un 13% de los mismos requieren queratoplastia, por lo que sigue siendo una indicación frecuente en nuestro medio. Es necesario, por tanto, realizar un diagnóstico precoz para actuar antes de que exista una pérdida visual irreversible. (AU)

Introduction Keratoconus is the most frequent corneal ectasia and second most common cause of keratoplasty worldwide. The clinical and epidemiological characteristics of keratoconus have rarely been studied in Spain, and to date, no study has been done in Asturias. Material and methods A cross-sectional study was conducted to analyze all cases of keratoconus diagnosed in the first consultations of the cornea and surface section of the Hospital Universitario Central de Asturias (Oviedo) and Hospital Universitario de Cabueñes (Gijón) between 2017 and 2020. Demographic data, visual acuity and corneal topography were collected. Results A total of 112 patients (42.0% women and 58.0% men) were included. The mean age was 36.84±15.59, with 39.3% being older than 40 years. 31.8%, 28.0%, 15.0%, and 25.2% were in stages i, ii, iii and iv, Amsler–Krumeich scale, respectively. Corneal segments were implanted in 7.5% of patients, cross-linking was performed in 4.7%, and keratoplasty was performed in 13.2%. Conclusion Approximately 40% of keratoconus cases are detected at advanced stages and another 40% are detected at an age over 40 years. 13% of these patients require keratoplasty, which is why it is frequently performed in our setting. Therefore, early diagnosis before irreversible visual loss is necessary. (AU)

Clinical-epidemiological characteristics of keratoconus in Asturias.

INTRODUCTION: Keratoconus is the most frequent corneal ectasia and second most common cause of keratoplasty worldwide. The clinical and epidemiological characteristics of keratoconus have rarely been studied in Spain, and to date, no study has been done in Asturias. MATERIAL AND METHODS: A cross-sectional study was conducted to analyze all cases of keratoconus diagnosed in the first consultations of the Cornea and Surface section of the Hospital Universitario Central de Asturias (Oviedo) and Hospital Universitario de Cabueñes (Gijón) between 2017 and 2020. Demographic data, visual acuity and corneal topography were collected. RESULTS: A total of 112 patients (42.0% women and 58.0% men) were included. The mean age was 36.84 ±â€¯15.59, with 39.3% being older than 40 years. 31.8%, 28.0%, 15.0%, and 25.2% were in stages I, II, III and IV, Amsler-Krumeich scale, respectively. Corneal segments were implanted in 7.5% of patients, cross-linking was performed in 4.7%, and keratoplasty was performed in 13.2%. CONCLUSION: Approximately 40% of keratoconus cases are detected at advanced stages and another 40% are detected at an age over 40 years. 13% of these patients require keratoplasty, which is why it is frequently performed in our setting. Therefore, early diagnosis before irreversible visual loss is necessary.

Tratamiento del melanoma conjuntival / Treatment of conjunctival melanoma

CASOS CLÍNICOS: Mujer de 86 años y varón de 61 años con sendas tumoraciones conjuntivales pigmentadas. En ambos casos se realiza biopsia escisional, crioterapia en conjuntiva, recubrimiento con membrana amniótica y aplicación de mitomicina C (MMC) en el pos-operatorio. El estudio histológico confirmó la sospecha clínica de melanoma. Durante el seguimiento la tolerancia ha sido buena, sin signos de recurrencia al cabo de 12 y 6 meses, respectivamente. DISCUSIÓN: El tratamiento de elección en el melanoma conjuntival es la resección quirúrgica, asociada a tratamientos adyuvantes como la crioterapia o la MMC tópica. Es una terapia bien tolerada y eficaz en la prevención de recurrencias a corto-medio plazo

CLINICAL CASE: The cases of an 86 year-old woman and a 61 year-old man with conjunctival pigmented tumors are presented. An excisional biopsy, conjunctival cryotherapy and amniotic membrane grafts were performed in both cases, along with the application of mitomycin-C in the postoperative period. The histology study confirmed the clinical suspicion of melanoma. Tolerance was good during the follow-up with no signs of recurrence in the last 12 and 6 months, respectively. DISCUSSION: The recommended treatment for conjunctival melanoma is surgical removal with adjunctive therapies such as cryotherapy or topical mitomycin-C. This is a well tolerated therapy and effective for preventing recurrences in the short-medium term

[Treatment of conjunctival melanoma]. / Tratamiento del melanoma conjuntival.

CLINICAL CASE: The cases of an 86 year-old woman and a 61 year-old man with conjunctival pigmented tumors are presented. An excisional biopsy, conjunctival cryotherapy and amniotic membrane grafts were performed in both cases, along with the application of mitomycin-C in the postoperative period. The histology study confirmed the clinical suspicion of melanoma. Tolerance was good during the follow-up with no signs of recurrence in the last 12 and 6 months, respectively. DISCUSSION: The recommended treatment for conjunctival melanoma is surgical removal with adjunctive therapies such as cryotherapy or topical mitomycin-C. This is a well tolerated therapy and effective for preventing recurrences in the short-medium term.

[The elaboration, use and evaluation of eye-drops with autologous serum in corneal lesions]. / Elaboración, utilización y evaluación de un colirio con suero autólogo en las lesiones corneales.

OBJECTIVES: To expose the elaboration process, microbiological control and effectiveness of an eyewash prepared with the patient's serum, for the treatment of injure corneas of different etiology. METHOD: It was edited an elaboration protocol and microbiological control, following the norms of correct elaboration picked up in the real Ordinance 175/2001. The clinical answer was valued objectively and subjectively. RESULTS: The eyewashes got ready under sterile conditions, using the patient's serum diluted to 20% with physiologic. None of the containers conserved in the Service of Pharmacy were contaminated, while the contamination in those already used, varied according to the patient. Of the eleven evaluated cases, six experienced a total recovery of its corneal lesions, three improved partially, and in the remaining ones the treatment was not effective. CONCLUSIONS: The elaboration of the eyewash doesn't present technical problems if we have the appropriate equipment for the realization under sterile conditions. The contamination of the containers seems to be due to the inadecuate use by the patients. The results, in spite of the even scarce number of treated patients, justify the treatment in serious cases of dry eye and corneal ulceration.

Elaboración, utilización y evaluación de un colirio con suero autólogo en las lesiones corneales / The elaboration, use and evaluation of eye-drops with autologous serum in corneal lesion

Objetivos: Exponer el proceso de elaboración, control microbiológico y eficacia de un colirio preparado a partir de suero del paciente, para el tratamiento de lesiones cornéales de diferente etiología. Método: Se redactó un protocolo de elaboración y control microbiológico, siguiendo las normas de correcta elaboración recogidas en el real Decreto 175/2001.La respuesta clínica se valoró objetiva y subjetivamente. Resultados: Los colirios se prepararon en condiciones estériles, utilizando suero del paciente diluido al 20 per cent con fisiológico. Ninguno de los envases conservados en el Servicio de Farmacia se contaminó, mientras que la contaminación en los ya utiliza dos varió según el paciente. De los once casos evaluados, seis experimentaron una recuperación total de sus lesiones cornéales, tres mejoraron parcialmente y en los restantes el tratamiento no fue efectivo. Conclusiones: La elaboración del colirio no presenta problemas técnicos si se dispone del equipamiento adecuado para su realización en condiciones estériles. La contaminación de los envases parece deberse al uso inadecuado por los pacientes. Los resultados, pese al aún escaso número de pacientes tratados, justifican el tratamiento en casos graves de ojo seco con ulceración corneal (AU)