ABSTRACT
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Subject(s)
Humans , Female , Middle Aged , Retinal Diseases/diagnosis , Breast Carcinoma In Situ/etiology , Breast Carcinoma In Situ/secondary , Neoplasm Metastasis , Vitelliform Macular Dystrophy/complications , Retinal Diseases/complications , Vitelliform Macular Dystrophy/pathologySubject(s)
Breast Neoplasms/complications , Paraneoplastic Syndromes, Ocular/etiology , Vitelliform Macular Dystrophy/etiology , Fatal Outcome , Female , Fluorescein Angiography , Humans , Middle Aged , Neoplasm Metastasis , Paraneoplastic Syndromes, Ocular/diagnostic imaging , Tomography, Optical Coherence , Vitelliform Macular Dystrophy/diagnostic imagingABSTRACT
OBJETIVO: Estudiar la relación existente entre el tratamiento con ciclofotocoagulación transescleral con láser de diodo y el desarrollo de queratitis neurotróficas por lesión de la inervación sensitiva corneal. MÉTODOS: Se han estudiado 5 ojos de 5 pacientes que fueron tratados con ciclofotocoagulación transescleral con láser de diodo y al poco tiempo desarrollaron úlceras neurotróficas. Se han recogido las diferentes características personales de los pacientes, incluyendo refracción y factores de riesgo de hipoestesia corneal, así como los parámetros de láser empleados en el tratamiento. RESULTADOS: Se comprobó que los 5 pacientes presentaban factores predisponentes de hipoestesia corneal previos a la cirugía (uso de betabloqueantes tópicos crónicos, cirugías corneales, diabetes mellitus o distrofias corneales). Sin embargo, ninguno había desarrollado queratitis neurotróficas hasta el momento de la ciclofotocoagulación. Se evidenció, además, que 4 de ellos eran altos miopes y que todos ellos fueron tratados con parámetros elevados de láser (2.880 mW por 3 s, en una superficie de 275° de media), y se desencadenaron úlceras neurotróficas entre los 10 y los 35 días después de la cirugía. CONCLUSIONES: La queratopatía neurotrófica es una complicación poco frecuente que puede aparecer tras la ciclofotocoagulación transescleral con láser de diodo, debido a la lesión secundaria de los nervios ciliares largos. La aparición de esta se puede ver favorecida por la existencia de factores de riesgo previos, entre los que hay que incluir la alta miopía. Es crucial respetar los parámetros de tratamiento recomendados, para evitar la aparición de esta dolencia
OBJECTIVE: To study the relationship between treatment with diode laser transscleral cyclophotocoagulation and development a neurotrophic keratitis due to the damage of the sensitive corneal innervation. METHODS: A study was conducted on 5 eyes of 5 patients who were treated with diode laser transscleral cyclophotocoagulation and soon developed neurotrophic ulcers. Personal characteristics of the patients were collected, as well as refraction and risk factors for corneal hypoesthesia, and the parameters of the laser used in the surgery. RESULTS: It was found that the 5 patients had predisposing factors of corneal hypoesthesia prior to surgery (chronic use of topical beta blockers, surgery with corneal incisions, diabetes mellitus, or corneal dystrophies); however none had developed neurotrophic keratitis until the cyclophotocoagulation was performed. It also showed that 4 of them were highly myopic, and they all were treated with high laser parameters (with an average of 2880 mW for 3 s at an average surface of 275°), triggering neurotrophic ulcers between 10 and 35 days after surgery. CONCLUSION: Neurotrophic keratitis is a rare complication that can occur after diode laser transscleral cyclophotocoagulation, secondary to the damage of the long ciliary nerves. The emergence of this disorder can be triggered by the existence of previous risk factors, including high myopia, thus it is important to respect the recommended treatment parameters to prevent the development of this disorder
Subject(s)
Humans , Male , Female , Middle Aged , Keratitis/therapy , Keratitis , Light Coagulation , Lasers, Semiconductor , Corneal Opacity/complications , Corneal Opacity , Laser Coagulation/methods , Corneal Injuries/therapy , Corneal Injuries , Adrenergic beta-Antagonists/therapeutic use , Keratitis/surgery , Retrospective StudiesABSTRACT
OBJECTIVE: To study the relationship between treatment with diode laser transscleral cyclophotocoagulation and development a neurotrophic keratitis due to the damage of the sensitive corneal innervation. METHODS: A study was conducted on 5 eyes of 5 patients who were treated with diode laser transscleral cyclophotocoagulation and soon developed neurotrophic ulcers. Personal characteristics of the patients were collected, as well as refraction and risk factors for corneal hypoesthesia, and the parameters of the laser used in the surgery. RESULTS: It was found that the 5 patients had predisposing factors of corneal hypoesthesia prior to surgery (chronic use of topical beta blockers, surgery with corneal incisions, diabetes mellitus, or corneal dystrophies); however none had developed neurotrophic keratitis until the cyclophotocoagulation was performed. It also showed that 4 of them were highly myopic, and they all were treated with high laser parameters (with an average of 2880 mW for 3s at an average surface of 275°), triggering neurotrophic ulcers between 10 and 35 days after surgery. CONCLUSION: Neurotrophic keratitis is a rare complication that can occur after diode laser transscleral cyclophotocoagulation, secondary to the damage of the long ciliary nerves. The emergence of this disorder can be triggered by the existence of previous risk factors, including high myopia, thus it is important to respect the recommended treatment parameters to prevent the development of this disorder.
