Retrospective study of secondary implantation of retroiridial fixation lenses in patients without capsular support: functional results and complications.

INTRODUCTION: The correction of aphakia when there is no adequate capsular support remains a therapeutic challenge. The use of retroiridial fixation lenses has been extended given their lower complication rate compared to other available options. MATERIAL AND METHODS: Retrospective study including all cases operated with an Artisan® retropupillary aphakia implant. RESULTS: 33 eyes were included out of a total of 28 patients. The follow-up period has been 38.55 months (1-96). 32.3% had a lens dislocation and 67.7% had an intraocular lens dislocation. The previous mean best corrected visual acuity (BCVA) was 1.18 ± 0.79 logMAR and post-intervention 0.36 ± 0.62 (p < 0.01). 93.8% of the patients presented a final BCVA equal to or better and 62.5% an improvement of 3 or more lines. The most frequent complication was corectopia (31.3%) and hypotony in the immediate postoperative period (21.9%). An epiretinal membrane (ERM) developed in 18.8% and cystic macular oedema (CME) in 9.4%. The presence of complications in the postoperative period did not statistically influence the final BCVA. CONCLUSIONS: The retropupillary Artisan® lens allows the correction of aphakia with satisfactory visual results and a low rate of complications.

Estudio retrospectivo de implante secundario de lentes de fijación retroiridiana en pacientes sin soporte capsular: resultados funcionales y complicaciones / Retrospective study of secondary implantation of retroiridial fixation lenses in patients without capsular support: functional results and complications

Introducción La corrección de la afaquia en ausencia de un soporte capsular adecuado sigue suponiendo un reto terapéutico. Se ha extendido el uso de las lentes de fijación retroiridiana dada su menor tasa de complicaciones con respecto a otras opciones disponibles. Material y métodos Se realizó un estudio restrospectivo incluyendo todos los casos intervenidos con un implante Artisan® Afaquia retropupilar en un centro de tercer nivel. Resultados Se incluyeron 33 ojos de un total de 28 pacientes. El periodo de seguimiento ha sido de 38,55 meses (1-96). Un 32,3% tenían una luxación del cristalino y un 67,7% de la lente intraocular. La mejor agudeza visual corregida (MAVC) media previa fue 1,18 ± 0,79 logMAR y post intervención de 0,36 ± 0,62 (p < 0,01). El 93,8% de los pacientes presentó una MAVC final igual o mejor a la previa y el 62,5% una mejoría de 3 o más líneas. La complicación más frecuente fue la corectopia (31,3%) y la hipotonía transitoria en el postoperatorio inmediato (21,9%). En un 18,8% se desarrolló una membrana epirretiniana (MER) y en un 9,4% edema macular (EM). La presencia de complicaciones en el postoperatorio no influyó de forma estadísticamente significativa la MAVC final. Conclusiones La lente Artisan® retropupilar permite corregir la afaquia con resultados visuales satisfactorios y con una reducida tasa de complicaciones (AU)

Introduction The correction of aphakia when there is no adequate capsular support remains a therapeutic challenge. The use of retroiridial fixation lenses has been extended given their lower complication rate compared to other available options. Material and method Retrospective study including all cases operated with an Artisan® retropupillary aphakia implant. Results 33 eyes were included out of a total of 28 patients. The follow-up period has been 38.55 months (1-96). 32.3% had a lens dislocation and 67.7% had an intraocular lens dislocation. The previous mean best corrected visual acuity (BCVA) was 1.18 ± 0.79 logMAR and post-intervention 0.36 ± 0.62 (p < 0.01). 93.8% of the patients presented a final BCVA equal to or better and 62.5% an improvement of 3 or more lines. The most frequent complication was corectopia (31.3%) and hypotony in the immediate postoperative period (21.9%). An epiretinal membrane (ERM) developed in 18.8% and cystic macular oedema (CME) in 9.4%. The presence of complications in the postoperative period did not statistically influence the final BCVA. Conclusions The retropupillary Artisan® lens allows the correction of aphakia with satisfactory visual results and a low rate of complications (AU)

Epiretinal membrane surgery: anatomic and functional outcomes.

OBJECTIVE: To study the influence of anatomic preoperative characteristics (based on the parameter, foveal central thickness, measured by optical coherence tomography) and functional characteristics (based on the parameter, best corrected visual acuity, [BCVA]) on functional recovery after epiretinal membrane (ERM) surgery. METHODS: A total of 88 eyes (of 86 patients), on whom a vitrectomy due to ERM was performed during a 3 years period were reviewed in this longitudinal, prospective study. An analysis was made of, ERM aetiology, BCVA, presence or absence of metamorphopsia, lens status, and central foveal thickness. Data relating to surgery and local complications, changes in BCVA, and changes in foveal central thickness were collected during the follow-up period. RESULTS: An improvement was in observed in BCVA in 82%, as well as a decrease in foveal thickness in 79% of the eyes which underwent surgery, both of these being statistically significant (P<.01). However, most of the patients showed different grades of oedema and/or macular thickening in the postoperative period. A significant correlation was found between preoperative and postoperative BCVA (P=.001), and also between preoperative and postoperative central foveal thickness (P=.004), but not between BCVA and foveal thickness. CONCLUSIONS: There is functional recovery in terms of BCVA in more than 80% of the patients after ERM surgery. Most of the eyes showed persistent macular thickening, but this did not seem to have influenced the final BCVA. The best determinant of postoperative functional recovery (postoperative visual acuity) is, in our experience, the preoperative BCVA, and not the macular thickness.

Cirugía de las membranas epirretinianas: resultados anatómicos y funcionales / Epiretinal membrane surgery: anatomic and functional outcomes

Objetivo: Estudiar la implicación de las características preoperatorias anatómicas (según el parámetro del grosor foveal central, determinado mediante tomografía de coherencia óptica) y funcionales (según el parámetro de la mejor agudeza visual corregida, [MAVC]) en la recuperación funcional tras la cirugía de las membranas epirretinianas maculares (MEM). Métodos: En este estudio prospectivo, longitudinal se incluyeron 88 ojos (de 86 pacientes), intervenidos mediante vitrectomía debido a MEM, en un período de 3 años. Se analizaron: etiología de la MEM, MAVC, existencia o no de metamorfopsia, estado del cristalino, y grosor foveal central. Asimismo se recogieron los datos relativos a la cirugía y las complicaciones derivadas de la misma, así como los cambios observados en la MAVC y en el grosor foveal a lo largo del período de seguimiento. Resultados: Se produjo mejoría de la MAVC en el 82% de los casos, así como una disminución del grosor foveal en el 79% de los casos intervenidos, ambos estadísticamente significativos (p<0,01). Sin embargo, la mayor parte de los pacientes exhibieron grados variables de edema y/o engrosamiento macular en el postoperatorio. Se halló correlación significativa entre la MAVC preoperatoria y postoperatoria (p=0,001), así como entre el grosor foveal central preoperatorio y postoperatorio (p=0,004), pero no entre la MAVC y el grosor foveal. Conclusiones: Se produce una recuperación funcional en términos de MAVC en más del 80% de los pacientes tras cirugía de MEM. La mayor parte de los ojos muestran persistencia del engrosamiento macular, si bien este no parece tener influencia en la agudeza visual final. El mejor determinante de recuperación funcional postoperatoria (agudeza visual postoperatoria) parece ser, en nuestra experiencia, la agudeza visual preoperatoria y no el grosor macular(AU)

Objective: To study the influence of anatomic preoperative characteristics (based on the parameter, foveal central thickness, measured by optical coherence tomography) and functional characteristics (based on the parameter, best corrected visual acuity, [BCVA]) on functional recovery after epiretinal membrane (ERM) surgery. Methods: A total of 88 eyes (of 86 patients), on whom a vitrectomy due to ERM was performed during a 3 years period were reviewed in this longitudinal, prospective study. An analysis was made of, ERM aetiology, BCVA, presence or absence of metamorphopsia, lens status, and central foveal thickness. Data relating to surgery and local complications, changes in BCVA, and changes in foveal central thickness were collected during the follow-up period. Results: An improvement was in observed in BCVA in 82%, as well as a decrease in foveal thickness in 79% of the eyes which underwent surgery, both of these being statistically significant (P<0.01). However, most of the patients showed different grades of oedema and/or macular thickening in the postoperative period. A significant correlation was found between preoperative and postoperative BCVA (P=0.001), and also between preoperative and postoperative central foveal thickness (P=0.004), but not between BCVA and foveal thickness. Conclusions: There is functional recovery in terms of BCVA in more than 80% of the patients after ERM surgery. Most of the eyes showed persistent macular thickening, but this did not seem to have influenced the final BCVA. The best determinant of postoperative functional recovery (postoperative visual acuity) is, in our experience, the preoperative BCVA, and not the macular thickness(AU)

Metástasis orbitarias en carcinoma colorrectal: a propósito de un caso / Orbital metastases in colorectal cancer: a case report

Caso clínico: Varón, 32 años, con neoplasia de colon en estadio IV, resistente a tratamiento quimioterápico. Es referido a nuestro servicio por edema palpebral, quemosis conjuntival, exoftalmos severo no reductible y ptosis completa en el ojo izquierdo, así como limitación de la motilidad ocular en todas las posiciones de la mirada, de predominio en mirada lateral y supraversión. En RMN orbitaria observamos dos lesiones nodulares en la órbita izquierda, con afectación del complejo músculo recto superior-elevador del párpado y músculo recto externo, sugestivas de metástasis. Debido al mal estado general del paciente, que no permite radioterapia, se inician bolos de corticoides intravenosos, sin respuesta, falleciendo el paciente. Discusión: Las metástasis orbitarias suelen proceder de tumores de mama y pulmón, siendo las secundarias a carcinoma de colon muy infrecuentes. El tratamiento es paliativo, basado en corticoides intravenosos, y sobre todo, radioterapia, y, tan solo en casos de supervivencia más prolongada, cirugía(AU)

Clinical case: A 32-year-old male, with colon cancer stage IV, resistant to chemotherapy, was referred to our department due to palpebral oedema, conjunctival chemosis, severe exophthalmos, complete ptosis in left eye, and limitation in eye movements, mainly in abduction and supraversion. In the orbital MR scan we observed two nodular lesions in the left orbital, with involvement of the superior rectus-elevator muscle of upper eyelid complex and external rectus muscle, suggestive of metastases. Due to the patient generally feeling unwell, radiotherapy was not considered, and an intravenous bolus of corticoids was given, without response, resulting in the death of the patient. Discussion: Orbital metastases usually originate from breast and lung cancer, with those secondary to colon cancer being much less frequent. The treatment is palliative, based on intravenous corticoids, and, above all, radiotherapy, and, only in cases with a long-term survival, surgery(AU)

[Orbital metastases in colorectal cancer: a case report]. / Metástasis orbitarias en carcinoma colorrectal: a propósito de un caso.

CLINICAL CASE: A 32-year-old male, with colon cancer stage IV, resistant to chemotherapy, was referred to our department due to palpebral oedema, conjunctival chemosis, severe exophthalmos, complete ptosis in left eye, and limitation in eye movements, mainly in abduction and supraversion. In the orbital MR scan we observed two nodular lesions in the left orbital, with involvement of the superior rectus-elevator muscle of upper eyelid complex and external rectus muscle, suggestive of metastases. Due to the patient generally feeling unwell, radiotherapy was not considered, and an intravenous bolus of corticoids was given, without response, resulting in the death of the patient. DISCUSSION: Orbital metastases usually originate from breast and lung cancer, with those secondary to colon cancer being much less frequent. The treatment is palliative, based on intravenous corticoids, and, above all, radiotherapy, and, only in cases with a long-term survival, surgery.

[Outcomes of macular hole surgery using three different surgical techniques]. / Resultados de la cirugía del agujero macular con diferentes técnicas de tratamiento.

PURPOSE: To compare the effectiveness, efficiency and complications of three different surgical techniques employed for the treatment of macular holes between 1998 -2004 in our health care centre. METHODS: A retrospective, comparative, and non-randomized study of 131 eyes with macular holes, stage III and IV, treated with three different surgical techniques was performed. Vitrectomy was performed in 25 eyes (group 1). Vitrectomy was associated with internal limiting membrane peeling in 19 eyes (group 2), and in the remaining 87 eyes, the peeling of the retinal internal limiting membrane was assisted with indocyanine green (ICG) (group 3). The concentrations of ICG used were 5%, 2.5% and 0.5%. We compared the anatomic and functional results, and the complications which occurred. RESULTS: The overall anatomic success rate was 88.4% (114 eyes), and it was higher in group 3 (90.6%). A visual acuity improvement was achieved in 63.6% of eyes; however there were no significant differences between the groups studied. The most important complications included cataracts (51.9%), increase in intra-ocular pressure (37.2%), retinal detachment (7.8%) and retinal pigment epithelial changes (7%). These pigment epithelial changes were associated with the use of ICG-assisted peeling (p<0.05), but there was no correlation between the changes and the concentration of ICG employed. The hole size had an inverse correlation with initial and final visual acuity. An epi-retinal membrane was associated with better visual acuities and higher anatomic success. CONCLUSIONS: In our experience, the use of ICG-assisted internal limiting membrane peeling in macular hole surgery improves the anatomic success, but may lead to retinal pigment epithelial changes.

Resultados de la cirugía del agujero macular con diferentes técnicas de tratamiento / Outcomes of macular hole surgery using three different surgical techniques

Objetivo: Comparar la efectividad, eficiencia y complicaciones de las tres técnicas quirúrgicas empleadas en el tratamiento del agujero macular en el período 1998-2004 en nuestro centro. Métodos: Estudio retrospectivo, comparativo, intervencionista y no aleatorizado de 131 ojos con agujero macular idiopático en estadío III y IV, operados con tres técnicas. En 25 ojos se realizó vitrectomía simple (grupo 1), en 19 ojos se asoció rexis de la membrana limitante interna (MLI) (grupo 2), y en 87 ojos esta rexis se llevó a cabo previa tinción con verde de indocianina (ICG) (grupo 3). Las concentraciones de ICG empleadas fueron del 5%, 2,5% y 0,5%. Se compararon la recuperación anatómica y funcional y las complicaciones en los distintos grupos. Resultados: El 88,4% (114 ojos) lograron la resolución anatómica, siendo superior en el grupo 3 (90,6%). La recuperación funcional se consiguió en el 63,6%. En ambos casos no existieron diferencias entre grupos. Las complicaciones más importantes fueron: cataratas post-cirugía (51,9%), aumento de PIO (37,2%), desprendimientos de retina (7,8%) y alteraciones del epitelio pigmentario (7%). Esta última se relacionó con el uso de ICG (p<0,05), sin encontrarse diferencias en las concentraciones empleadas. El tamaño del agujero tuvo una correlación inversa con la agudeza visual (AV) inicial y post-quirúrgica. La presencia de membrana epirretiniana se asoció a mejores AV y a un mayor éxito anatómico. Conclusiones: En nuestra experiencia, la cirugía mejora la AV, siendo más efectiva si se asocia ICG para la rexis de la MLI. Sin embargo, esta tinción podría estar relacionada con las alteraciones del EPR encontradas

Purpose: To compare the effectiveness, efficiency and complications of three different surgical techniques employed for the treatment of macular holes between 1998 -2004 in our health care centre. Methods: A retrospective, comparative, and nonrandomized study of 131 eyes with macular holes, stage III and IV, treated with three different surgical techniques was performed. Vitrectomy was performed in 25 eyes (group 1). Vitrectomy was associated with internal limiting membrane peeling in 19 eyes (group 2), and in the remaining 87 eyes, the peeling of the retinal internal limiting membrane was assisted with indocyanine green (ICG) (group 3). The concentrations of ICG used were 5%, 2.5% and 0.5%. We compared the anatomic and functional results, and the complications which occurred. Results: The overall anatomic success rate was 88.4% (114 eyes), and it was higher in group 3 (90.6%). A visual acuity improvement was achieved in 63.6% of eyes; however there were no significant differences between the groups studied. The most important complications included cataracts (51.9%), increase in intra-ocular pressure (37.2%), retinal detachment (7.8%) and retinal pigment epithelial changes (7%). These pigment epithelial changes were associated with the use of ICG-assisted peeling (p<0.05), but there was no correlation between the changes and the concentration of ICG employed. The hole size had an inverse correlation with initial and final visual acuity. An epi-retinal membrane was associated with better visual acuities and higher anatomic success. Conclusions: In our experience, the use of ICGassisted internal limiting membrane peeling in macular hole surgery improves the anatomic success, but may lead to retinal pigment epithelial change (AU)

Metástasis coroidea de carcinoma renal / Choroidal metastasis from renal cell carcinoma

Caso clínico: Hombre de 52 años que acudió a urgencias por disminución progresiva de su visión en el ojo derecho. Como antecedentes había tenido nefrectomía derecha por carcinoma renal 7 años antes y neumonectomía derecha por metástasis 3 meses antes. En la funduscopia se observaba una masa coroidea en ojo derecho, compatible con metástasis. Se realizó enucleación. Durante un año permaneció sin progresión pero en los últimos seis meses ya ha aparecido. Discusión: Las metástasis coroideas de carcinoma renal son infrecuentes y pueden ocurrir varios años después de la curación del primario. Su sintomatología es variable y su aspecto poco característico por lo que puede dificultar su diagnóstico diferencial(AU)

Case report: A fifty-two year-old man who came to our emergency room because of gradual loss of vision in his right eye. He had suffered right nefrectomy for renal cell carcinoma seven years previously and pneumectomy for metastasis in his right lung three months ago. In the fundus examination a choroidal mass was found in his right eye, suggesting metastasis. Treatment was enucleation of the affected eye. During the first year there was no progression, but in the last six months it has re-appeared. Discussion: Choroidal metastasis of renal cell carcinoma is rare and can appear years after treating the primary tumour. Its symptoms are variable, and its shape is not very characteristic so it can be difficult to make a differential diagnosis(AU)

[Choroidal metastasis from renal cell carcinoma]. / Metástasis coroidea de carcinoma renal.

CASE REPORT: A fifty-two year-old man who came to our emergency room because of gradual loss of vision in his right eye. He had suffered right nefrectomy for renal cell carcinoma seven years previously and pneumectomy for metastasis in his right lung three months ago. In the fundus examination a choroidal mass was found in his right eye, suggesting metastasis. Treatment was enucleation of the affected eye. During the first year there was no progression, but in the last six months it has re-appeared. DISCUSSION: Choroidal metastasis of renal cell carcinoma is rare and can appear years after treating the primary tumour. Its symptoms are variable, and its shape is not very characteristic so it can be difficult to make a differential diagnosis.

[Macular hole surgery with and without internal limiting membrane peeling]. / Cirugía del agujero macular con y sin liberación de la membrana limitante interna.

PURPOSE: To determine if internal limiting membrane (ILM) peeling in idiopathic macular hole surgery improves anatomic and functional results. METHODS: Comparative retrospective, nonrandomized study, of 50 eyes from 48 patients with macular hole, Stage III an IV of the Gass Classification. All of them were operated with the same technique. In 25 eyes the ILM was peeled (group 1). In the other 25 eyes the ILM was not peeled (group 2). We compare the anatomic and functional outcome as well as the complications in both groups. RESULTS: The overall anatomic success rate in the 50 eyes was 92% (46 eyes). In group 1 the anatomic success rate was 100% and 84% in group 2 (p=0.018). The visual acuity improved, one or more Snellen lines, in 34 of the 50 operated eyes (68%). In group 1 the visual acuity improved in 20 of the 25 eyes (80%) and in group 2 in 14 of the 25 eyes (56%) (p=0.034). The most relevant complications included retinal detachment, two cases in group 1 and one case in group 2, cataract and retinal pigment epithelium changes. CONCLUSIONS: In our experience, internal limiting membrane peeling in macular hole surgery improves the anatomic and functional success, but not the final visual acuity.

[Posterior segment intraocular foreign bodies. Clinical and epidemiological features]. / Cuerpos extraños intraoculares del segmento posterior. Aspectos clínicos y epidemiológicos.

OBJECTIVES: To evaluate the epidemiologic factors, associated ocular involvement and visual results in patients with intraocular foreign bodies lodged in the posterior segment. METHODS: In this retrospective study, the clinical records of 21 patients admitted to the hospital with intraocular foreign bodies between August 1994 and March 1998 were reviewed and evaluated in regards to age, gender, type of injury, foreign body nature, need for surgical intervention, complications and final visual acuity. RESULTS: All the patients were males, with a mean age of 38.7 years and an average follow-up period of 15.04 months. The foreign bodies were caused by work accidents in 2/3 of the cases and 71.4% involved ferromagnet metal. Sixteen patients underwent vitrectomy to remove the intraocular foreign body. Final visual acuity was equal to or greater than 0.4 in 57.9% of the patients and there was no light perception in 15.7%. The principal late complications were retinal detachment (19.04%), pthisis bulbi (14.2%) and cataracts (9.5%). CONCLUSIONS: Most of the intraocular foreign bodies are found in young males as a consequence of work accidents. Most patients require vitrectomy to remove the foreign body and even though good visual results are obtained in many cases, other cases suffer severe visual loss.

Cuerpos extraños intraoculares del segmento posterior. Aspectos clínicos y epidemiológicos / Posterior segment intraocular foreign bodies. Clinical and epidemiological features

Objetivos: Evaluar los factores epidemiológicos, grado de afectación ocular y resultados funcionales en los pacientes con cuerpos extraños intraoculares del segmento posterior. Métodos: En este estudio retrospectivo, se revisaron las historias clínicas de 21 pacientes atendidos en nuestro servicio entre agosto del 94 y marzo del 98 y se analizaron su edad, sexo, tipo de herida, naturaleza del cuerpo extraño intraocular, necesidad de cirugía, complicaciones y resultados funcionales. Resultados: Todos los pacientes eran varones, con una edad media de 38,7 años y un tiempo de seguimiento medio de 15,04 meses. Los cuerpos extraños procedían de accidentes laborales en las 2/3 partes y el 71,4 por ciento eran metálicos ferromagnéticos. 16 pacientes precisaron vitrectomía con extracción del cuerpo extraño por pars plana. La agudeza visual final fue igual o mayor de 0,4 en 57,9 por ciento de pacientes. Las principales complicaciones tardías fueron el desprendimiento de retina (19,04 por ciento de pacientes), ptisis bulbi (14,2 por ciento) y cataratas (9,5 por ciento).Conclusiones: Los cuerpos extraños intraoculares afectan sobre todo a varones jóvenes como consecuencia de accidentes laborales. La mayoría precisan una vitrectomía para extraer el cuerpo extraño y, aunque en muchos casos los resultados funcionales son buenos, en otros casos conllevan una pérdida importante de agudeza visual (AU)