Cirugía combinada de catarata y queratoplastia lamelar endotelial en el síndrome iridocórneo endotelial / Combined cataract surgery and lamellar endothelial keratoplasty in iridocorneal endothelial síndrome

Reportamos el caso de una mujer de 59 años, que refería disminución de agudeza visual (AV) en el ojo izquierdo (OI). Mediante la exploración, se objetivó en dicho ojo una AV corregida de cuenta dedos a 30 cm, y en la lámpara de hendidura se observó la presencia de edema corneal moderado, con pliegues en la membrana de Descemet. También se apreciaron sinequias iridianas anteriores, atrofia de iris y corectopia. Se diagnosticó de síndrome iridocórneo endotelial (ICE). Se decidió un abordaje terapéutico quirúrgico mediante una cirugía combinada de catarata y queratoplastia endotelial automatizada con disección de la membrana de Descemet (DSAEK). No se reportaron complicaciones intraoperatorias. La recuperación anatómica y funcional fue exitosa, presentando una AV corregida al año de 0,8. Este resultado apoya la eficacia de la DSAEK en el síndrome ICE animando a la realización de más estudios que soporten igualmente su eficacia en este síndrome

The case is reported of a 59-year-old woman, who reported decreased visual acuity (VA) in the left eye (LE). On examination, a corrected VA of finger count/ 30cm was observed in LE. Corneal oedema and folds in the Descemet's membrane were observed using the slit lamp. Anterior synechiae, iris atrophy, and corectopia were also found. ridocorneal endothelial syndrome (ICE) was diagnosed. The treatment option was a combination of cataract surgery and automated endothelial keratoplasty with Descemet's membrane dissection (DSAEK). There were no complications during the operation, with a successful anatomical and functional recovery, with a VA of 0,8 being observed after one year. This result supports the efficacy of DSAEK in ICE syndrome, encouraging more studies to be carried out that should also support its efficacy in this syndrome

Combined cataract surgery and lamellar endothelial keratoplasty in iridocorneal endothelial syndrome. / Cirugía combinada de catarata y queratoplastia lamelar endotelial en el síndrome iridocórneo endotelial.

The case is reported of a 59-year-old woman, who reported decreased visual acuity (VA) in the left eye (LE). On examination, a corrected VA of finger count/ 30cm was observed in LE. Corneal oedema and folds in the Descemet's membrane were observed using the slit lamp. Anterior synechiae, iris atrophy, and corectopia were also found. Iridocorneal endothelial syndrome (ICE) was diagnosed. The treatment option was a combination of cataract surgery and automated endothelial keratoplasty with Descemet's membrane dissection (DSAEK). There were no complications during the operation, with a successful anatomical and functional recovery, with a VA of 0,8 being observed after one year. This result supports the efficacy of DSAEK in ICE syndrome, encouraging more studies to be carried out that should also support its efficacy in this syndrome.

Metabolómica de la lágrima / Human tear metabolome

No disponible

Nuevas terapias para el tratamiento de la queratitis neurotrófica / New therapies for neurotrophic keratitis

No disponible

Cuerpo extraño enclavado en iris después de cirugía de catarata / Foreign body embedded in the iris after cataract surgery

CASO CLÍNICO: Mujer de 75 años intervenida de catarata en ojo izquierdo, que presentaba a las 24 h una agudeza visual de 0,8. En la biomicroscopia destacaba un cuerpo extraño anclado al iris en sector nasal coincidente con la incisión principal de la facoemulsificación, que fue retirado en un segundo acto quirúrgico. Fue analizado e informado como estructura inerte de naturaleza plástica. DISCUSIÓN: Planteamos el posible origen de la presencia del resto plástico en el postoperatorio de la cirugía de la catarata. En este caso su naturaleza inerte no desencadenó mayor inflamación intraocular. Además, la estructura rígida favoreció su anclaje al iris evitando otras complicaciones. Deben extremarse las medidas preventivas en la cirugía de la catarata revisando incluso los instrumentos y accesorios al terminar la cirugía

CASE REPORT: a 75-year old woman who had had cataract surgery in her left eye and showed a visual acuity of 0.8 twenty-four hours post-surgery. Biomicroscopy revealed a foreign body attached to the iris in the nasal sector that coincided with the main incision of the phacoemulsification, which was then removed in a second surgical procedure. It was analysed and described as an inert structure made of plastic. DISCUSSION: The possible origin of the presence of a fragment of plastic in the postoperative period following cataract surgery is established. In this case, its inert nature did not cause any further intraocular inflammation. Its rigid structure also favoured its attachment to the iris, thus avoiding any other complications. There must be greater preventative measures during cataract surgery, including checking the instruments and accessories before and after the surgical procedure

Foreign body embedded in the iris after cataract surgery.

CASE REPORT: a 75-year old woman who had had cataract surgery in her left eye and showed a visual acuity of 0.8 twenty-four hours post-surgery. Biomicroscopy revealed a foreign body attached to the iris in the nasal sector that coincided with the main incision of the phacoemulsification, which was then removed in a second surgical procedure. It was analysed and described as an inert structure made of plastic. DISCUSSION: The possible origin of the presence of a fragment of plastic in the postoperative period following cataract surgery is established. In this case, its inert nature did not cause any further intraocular inflammation. Its rigid structure also favoured its attachment to the iris, thus avoiding any other complications. There must be greater preventative measures during cataract surgery, including checking the instruments and accessories before and after the surgical procedure.

[0.1% dexamathasone and 1% rimexolone. A comparative study in the postoperative treatment after cataract extraction]. / Dexametasona al 0,1% versus rimexolona al 1%. Estudio comparativo en el postoperatorio de la cirugía de cataratas.

PURPOSE: To compare the efficiency and secondary effects of using 1% rimexolone or 0.1% dexamethasone as postoperative treatment for cataract surgery. MATERIALS AND METHODS: A prospective study performed on a cohort of 37 patients undergoing cataract surgery by phacoemulsification with no intraoperative complications at the Hospital Clínico San Carlos, Madrid. After surgery, 19 of the patients were randomly assigned to receive topical 0.1% dexamethasone (DEX group) as inflammatory treatment and the remaining 18 subjects were treated with 1% rimexolone ( RIMEX group) following the same regime. Twenty four hours and one month after surgery, visual acuity, conjunctival hyperaemia, anterior chamber cells, anterior chamber flare, intraocular pressure, corneal thickness and macular edema were determined in each patient. RESULTS: The repeated measures test performed on 24 hours and 1 month data revealed a significant difference between the two treatments in terms of Tyndall (p = 0.001) and flare (p= 0.034) values; these variables being lower in the dexamethasone group. No differences were observed in the remaining variables examined. CONCLUSIONS: Rimexolone is as efficient and safe as dexamethasone for the treatment of patients undergoing cataract extraction.

Dexametasona al 0, 1% versus rimexolona al 1%. Estudio comparativo en el postoperatorio de la cirugía de cataratas / 0.1% dexamathasone and 1% rimexolone. A comparative study in the postoperative treatment after cataract extraction

Objetivo: Comparar la eficacia y los efectos secundariosde la rimexolona 1% y de la dexametasona0,1% en el tratamiento postoperatorio de la cirugíade catarata.Material y métodos: Estudio de cohortes prospectivoen el que se ha seleccionado una muestra de 37pacientes intervenidos de cataratas mediante facoemulsificación,sin complicaciones intraoperatorias,en el Hospital Clínico San Carlos, y se han divididoen dos grupos. El grupo DEX, de 19 pacientes setrato con dexametasona al 0,1% tópica como tratamientoantiinflamatorio y el grupo RIMEX, de 18pacientes se trató con rimexolona 1% tópicasiguiendo la misma pauta en ambos casos. En todoslos pacientes se han estudiado la agudeza visual, lahiperemia conjuntival, las células en cámara anterior,el flare, la presión intraocular, el grosor cornealy la presencia de edema macular a las 24 horas y al mes de la cirugía. Resultados: Al comparar ambos fármacos medianteel test de medidas repetidas a las 24 horas y almes de la cirugía se obtuvieron diferencias estadísticamentesignificativas en el tyndall (p = 0,001) yen el flare (p= 0,034), siendo la reducción de éstosparámetros mayor en el grupo dexametasona, mientrasque no se observaron cambios significativos enel resto de los parámetros evaluados.Conclusiones: La Rimexolona ha resultado ser unfármaco útil y seguro, al igual que la dexametasona,como tratamiento postoperatorio de la cirugía de catarata(AU)

Purpose: To compare the efficiency and secondaryeffects of using 1% rimexolone or 0.1% dexamethasoneas postoperative treatment for cataract surgery.Materials and methods: A prospective study performedon a cohort of 37 patients undergoing cataractsurgery by phacoemulsification with no intraoperativecomplications at the Hospital Clínico SanCarlos, Madrid. After surgery, 19 of the patientswere randomly assigned to receive topical 0.1%dexamethasone (DEX group) as inflammatory treatmentand the remaining 18 subjects were treatedwith 1% rimexolone ( RIMEX group) following thesame regime. Twenty four hours and one monthafter surgery, visual acuity, conjunctival hyperaemia,anterior chamber cells, anterior chamber flare,intraocular pressure, corneal thickness and macularedema were determined in each patient.Results: The repeated measures test performed on24 hours and 1 month data revealed a significant difference between the two treatments in terms ofTyndall (p = 0.001) and flare (p= 0.034) values; thesevariables being lower in the dexamethasonegroup. No differences were observed in the remainingvariables examined.Conclusions: Rimexolone is as efficient and safe asdexamethasone for the treatment of patients undergoingcataract extraction(AU)

[Ultrasound biomicroscopy in pigmentary glaucoma]. / Estudio de glaucoma pigmentario mediante biomicroscopia ultrasónica.

OBJECTIVE: To study the anterior chamber in pigmentary glaucoma by anterior ultrasound biomicroscopy (UBM), and to determine the effect of the YAG-laser iridotomy on intraocular pressure (IOP) and the iris morphology in pigmentary glaucoma. MATERIAL AND METHODS: Seven patients (14 eyes) with a diagnosis of pigmentary glaucoma were studied. YAG-laser iridotomy was performed on all the patients with demonstrable iris concavity by UBM, performing UBM one week post-iridotomy and control of the IOP at one week, six months and at one year following treatment. RESULTS: The existence of iris concavity was demonstrated in 6 of the 7 patients (12 of the 14 eyes), performing a YAG-laser iridotomy in all of them. Remission of the iris concavity was observed in 5 of the 6 patients (10 of the 12 eyes) and good control of the IOP was achieved without additional topical treatment in 3 (6 eyes). At one year, the number of drugs needed for IOP control decreases (p<0,005, Wilcoxon test, correction for small samples). CONCLUSIONS: In our sample, the YAG-laser iridotomy rectifies the iris concavity present in pigmentary glaucoma, reducing the IOP and the number of drugs needed for its control.

Estudio de glaucoma pigmentario mediante biomicroscopia ultrasónica / Ultrasound biomicroscopy in pigmentary glaucoma

Objetivo: Estudio de la cámara anterior en el glaucoma pigmentario mediante biomicroscopía ultrasónica de cámara anterior (BMU) y determinar el efecto de la iridotomía YAG sobre la presión intraocular y morfología del iris en el glaucoma pigmentario. Material y métodos: Se estudian mediante BMU 7 pacientes (14 ojos) con diagnóstico de glaucoma pigmentario. A todos los pacientes en los que se detecta concavidad iridiana se realiza iridotomía YAG repitiéndose la BMU a la semana y control de la presión intraocular (PIO) a la semana, a los 6 meses y al año del tratamiento. Resultados: Se demuestra la existencia de concavidad iridiana en 6 de los 7 pacientes (12 de los 14 ojos) practicándose iridotomía YAG a todos ellos. En 5 de los 6 pacientes (10 de los 12 ojos) se objetivó la remisión de la concavidad iridiana y buen control de PIO en 3 (6 ojos) sin tratamiento tópico adicional. Al año, el número de fármacos necesarios para el control de la PIO disminuye, siendo este descenso estadísticamente significativo. (p<0,005, test de Wilcoxon con corrección para muestras pequeñas).Conclusiones: En nuestra muestra, la iridotomía YAG rectifica la concavidad iridiana presente en el glaucoma pigmentario, reduciendo la PIO y el número de fármacos necesarios para su control (AU)

Objective: To study the anterior chamber in pigmentary glaucoma by anterior ultrasound biomicroscopy (UBM), and to determine the effect of the YAG-laser iridotomy on intraocular pressure (IOP) and the iris morphology in pigmentary glaucoma. Material and methods: Seven patients (14 eyes) with a diagnosis of pigmentary glaucoma were studied. YAG-laser iridotomy was performed on all the patients with demonstrable iris concavity by UBM, performing UBM one week post-iridotomy and control of the IOP at one week, six months and at one year following treatment. Results: The existence of iris concavity was demonstrated in 6 of the 7 patients (12 of the 14 eyes), performing a YAG-laser iridotomy in all of them. Remission of the iris concavity was observed in 5 of the 6 patients (10 of the 12 eyes) and good control of the IOP was achieved without additional topical treatment in 3 (6 eyes). At one year, the number of drugs needed for IOP control decreases (p<0,005, Wilcoxon test, correction for small samples). Conclusions: In our sample, the YAG-laser iridotomy rectifies the iris concavity present in pigmentary glaucoma, reducing the IOP and the number of drugs needed for its control (AU)

Peritubular filtration as cause of severe hypotony after Ahmed valve implantation for glaucoma.

PURPOSE: To report peritubular filtration as the cause of severe hypotony after Ahmed valve implantation. METHODS: Interventional case report. In a 65-year-old man with primary open-angle glaucoma, ultrasound biomicroscopy was used to image the peritubular region of his right eye that had severe hypotony during the early postoperative period after an Ahmed valve implantation. RESULTS: The ultrasound biomicroscopy examination showed peritubular filtration. Additional surgery consisting of tube extraction, closure of the previous insertion opening, reformation of the anterior chamber with viscoelastic, and reintroduction of the tube through a new paracentesis was performed to solve this complication. Twenty-four hours postoperatively, the intraocular pressure increased to 10 mm Hg. During the 6-month follow-up, the mean intraocular pressure was 16.36 mm Hg (standard deviation, 1.45). CONCLUSION: The possibility of peritubular filtration should be considered in eyes with severe hypotony after restrictive valve implantation.

Síndrome de dispersión pigmentaria en paciente con megalocórnea / Pigment dispersion syndrome in a patient with megalocornea

Caso clínico: Presentamos un caso clínico de un varón de 12 años de edad con megalocórnea y síndrome de dispersión pigmentaria bilateral. Realizamos un estudio bioultrasónico con el UBM 840 (Zeiss-Humphrey, 50 MHz) observando la existencia de una importante concavidad del iris con contacto iridolenticular e iridozonular. Tras la instilación de pilocarpina se observa una clara disminución de la concavidad iridiana con una reducción del contacto zonular y lenticular.Discusión: La especial configuración de la cámara anterior de este paciente analizada mediante biomicroscopia ultrasónica nos permite conocer mejor el probable mecanismo por el que puede producirse la dispersión de pigmento. (AU)