Perioperative pharmacological management in patients with glaucoma.

REVIEWS AIM: When a phacoemulsification, a filtration surgery or a combined surgery are necessary, questions about the convenience of continuing certain antiglaucomatous drugs could appear. The aim of this review article is to unify criteria that will guide daily clinical practice and including the developing algorithms of action in the preoperative and postoperative periods of filtration surgery and/or cataract surgery. PROPOSED PROTOCOLS: In the preoperative period of cataract surgery, the use of non-steroidal anti-inflammatory drugs is at the discretion of the surgeon, with the monodose presentation being recommended. The suspension of prostaglandines a fewdays before the surgery should be considered. Preservative-free drugs ensure a better recovery of the ocular surface (OS) after cataract surgery. Once all modifying factors of the intraocular pressure (IOP) have been removed, baseline IOP should be evaluated again, choosing preservative-free antiglaucomatous drugs when needed. The use of preservative-free ocular antihypertensive drugs and steroids in the preoperative period of glaucoma surgery reduces the risk of surgical failure. The interruption of prostaglandines is recommended. In the postoperative period of glaucoma surgery, steroids are the anti-inflammatory treatment of choice, the preservative-free ones being preferred. When reintroducing antiglaucomatous treatment, preservatives should be avoided to prevent scarring. The appropriate perioperative management of patients with glaucoma is essential to obtain a correct control of IOP, improve the situation of the OS, prevent complications and improve the result of the filtration surgery and cataract surgery. CONCLUSIONS: this protocol aims to unify the different lines of action in order to decrease the incidence of adverse events and maximize the surgical outcome.

[Are blood lipids a risk factor for age-related macular degeneration?]. / Los lípidos séricos, factor de riesgo de la degeneración macular asociada a la edad?

PURPOSE: To study the levels of lipids in serum, in patients with age-related macular degeneration (AMD), and to establish its pathogenic relevance in the disease. METHODS: The serums of a total of 40 patients, distributed in a AMD group (25 patients) and a control group (15 patients, with similar ages and without ocular affectation) were studied, correlating the biochemical findings with the clinical examination of these patients. RESULTS: We have observed a mean level of serum total cholesterol statistically superior in AMD patients (control= 200.18+/-18.89 mg/dL; AMD= 227.28+/-5.46 mg/dL; p<0.01). These significant differences are repeated for different lipoproteins (triglycerides, LDL, VLDL and apolipoprotein B), not appearing for the HDL and apolipoprotein A-1. We have not found correlations of these concentrations with the clinical or functional stage of the AMD. CONCLUSIONS: Serum lipids could take part in the pathogenic mechanism of AMD, either by their relation with arteriosclerosis, which would diminish the choroidal flow, or by direct deposit in the Bruch's membrane. However, more longitudinal studies are needed to understand the relation of serum lipids and AMD, and to establish therapeutic approaches on the matter.

Los lípidos séricos ¿Factor de riesgo de la degeneración macular asociada a la edad? / Cholesterol ¿A risk factor for age-related macular degeneration?

Objetivo: Estudiar el patrón de los lípidos séricos en los pacientes con degeneración macular asociada a la edad (DMAE), y establecer su importancia patogénica. Material: Se han estudiado los sueros de un total de 40 pacientes distribuidos en un grupo DMAE (25 pacientes) y un grupo control (15 sujetos sin afectación ocular) del mismo rango de edad, correlacionándose los hallazgos bioquímicos con la exploración clínica de estos enfermos. Resultados: Hemos observado una concentración media de colesterol total sérico en los pacientes con DMAE estadísticamente superior que la hallada en el grupo control (control= 200,18ñ18,19 mg/dL; DMAE= 227,28ñ5,46 mg/dL; p<0,01). Estas diferencias significativas se repiten para las distintas lipoproteínas (triglicéridos, LDL, VLDL y apolipoproteína B), no apareciendo para la HDL y la apolipoproteína A-1. No hemos encontrado correlaciones de estas concentraciones con el estadio clínico o funcional de la DMAE. Conclusiones: Los lípidos séricos podrían intervenir en la patogenia de la DMAE, bien por su relación con la arteriosclerosis, que disminuiría el flujo coroideo, o bien por depósito directo en la membrana de Bruch. No obstante, se necesitan más estudios longitudinales para comprender la relación de los lípidos séricos y la DMAE, y establecer conductas terapéuticas al respecto. (AU)

Brown-Sequard syndrome associated with Horner's syndrome after a penetrating trauma at the cervicomedullary junction.

STUDY DESIGN: Case report of a 21-year-old man that had concurrence of Brown-Sequard syndrome and Horner's syndrome after a penetrating trauma in the neck. OBJECTIVES: This report analyzes the location of lesions that cause a combination of Horner's and Brown-Sequard syndrome. It is important to know the anatomic structure of spinal cord and the sympathetic nerve chain. SETTING: Spinal Cord Unit, Department of Physical Medicine and Rehabilitation, Hospital La Fe, Valencia, Instituto Oftalmologico de Alicante, Alicante, Spain. METHODS: Description of a single patient case report. RESULTS: The clinical findings and MRI showed a good correlation. The Horner's syndrome was confirmed with a 4% cocaine test. The patient received a conservative treatment with high-dose steroid therapy (NASCIS-3). CONCLUSION: The patient presented with Brown-Sequard syndrome and Horner's syndrome. Clinical examination and MRI made a quick and correct diagnosis. The patient recovered completely after the conservative treatment.