[Retinal vasculopathy in systemic lupus erythematosus: a case of lupus vasculitis and a case of non-vasculitis venous occlusion]. / Vasculopatía retiniana en el lupus eritematoso sistémico: caso de vasculitis lúpica y caso de oclusión venosa no vasculítica.

CLINIC CASE: Two patients with systemic lupus erythematosus presented with vision loss, and were diagnosed with retinal vasculopathy. Patient 1 had occlusive vasculitis with macular oedema and retinal ischaemia in the right eye. Corticosteroid therapy was increased and intravenous rituximab added. Intravitreal therapy and panretinal photocoagulation were performed. Patient 2 presented with a left central retinal vein occlusion without vasculitis but was on anticoagulation therapy due to having an antiphospholipid syndrome. Both patients maintained a stable visual acuity. DISCUSSION: Occlusive lupus retinal vasculitis has severe visual and systemic consequences (central nervous system vasculitis). It is crucial to differentiate it from standard vascular occlusion syndromes.

Penetration of levofloxacin into the anterior chamber (aqueous humour) of the human eye after intravenous administration.

In the study presented here, levofloxacin concentrations in serum samples and the aqueous humour (AH) of 16 patients undergoing cataract extraction were measured in order to determine the penetration characteristics of levofloxacin into the AH of the non-inflamed human eye. Cataract removal was performed at various times (from 90 to 270 min) after the end of a 30-min intravenous infusion of 500 mg of levofloxacin. Serum samples were obtained 1 h after the end of levofloxacin administration (Cmax); AH and a second serum sample were taken simultaneously during the operation, and the concentrations of levofloxacin in AH (C(AH)) and serum (C(S)) were determined using a rapid high-performance liquid chromatography assay. The mean Cmax was 6.07 microg/ml (range 3.75-9.53 microg/ml, SD 1.83). The mean C(AH) at the first hour following levofloxacin administration was 1.37 microg/ml (range 1.17-1.6 microg/ml, SD 0.22) and the mean ratio (R=C(AH)/C(S)) was 0.26 (range 0.24-0.3, SD 0.02). The mean C(AH) at 125-270 min following levofloxacin administration was 1.39 microg/ml (range 0.82-1.98 microg/ml, SD 0.33) and the mean R was 0.3 (range 0.15-0.53, SD 0.11). Of 16 patients, 15 had a C(AH) of >1 microg/ml 1 h after levofloxacin administration. In conclusion, 1 h after administration of 500 mg of levofloxacin, the levels obtained were higher than the MIC at which 90% of methicillin-susceptible Staphylococcus aureus and certain gram-negative bacteria strains are inhibited.

La radioterapia en el tratamiento de las metástasis coroideas y cerebrales simultáneas / Radiation therapy in simultaneous choroidal and brain metastases

Las metástasis coroideas de cáncer de pulmón pueden presentarse como primera manifestación clínica de extensión metastásica de la enfermedad aunque suelen coexistir con al menos dos localizaciones metastásicas. La sintomatología más frecuente es la disminución de la agudeza visual. Sin embargo, hasta un 20% de las metástasis cerebrales también pueden presentar alteraciones visuales, por lo que debe realizarse el diagnóstico diferencial entre metástasis cerebral y/o coroidea.Presentamos un caso de una paciente diagnosticada de adenocarcinoma de pulmón que a raíz de una disminución de la agudeza visual fue diagnosticada de metástasis coroideas y cerebrales simultáneas. Fue tratada con irradiación holocraneal (DT 20Gy/5fracciones) con una mejoría significativa de la agudeza visual. Este caso ilustra que aunque la expectancia de vida de los pacientes con cáncer de pulmón metastático es corta, un diagnóstico y tratamiento adecuado puede mejorar la calidad de vida de estos pacientes

Choroidal metastases from lung cancer can be the initial clinical manifestation of metastasic disease, although they generally coexist with at least two more metastasic sites. The most common symptom is decreased vision, however 20% of brain metastases can present with visual alterations. A differential diagnosis within brain metastases and/or choroidal is necessary. We present the case of a patient with lung cancer and decreased vision who was diagnosed as simultaneous choroidal and brain metastases. Radiation therapy (20Gy/5fractions) significantly improves decreased vision. This case shows that, although life expectancy of patients with metastasic lung cancer is short, an adequate diagnosis and treatment, can improve the quality of life of those patients

[Radiation therapy in simultaneous choroidal and brain metastases]. / La radioterapia en el tratamiento de las metástasis coroideas y cerebrales simultáneas.

Choroidal metastases from lung cancer can be the initial clinical manifestation of metastasic disease, although they generally coexist with at least two more metastasic sites. The most common symptom is decreased vision, however 20% of brain metastases can present with visual alterations. A differential diagnosis within brain metastases and/or choroidal is necessary. We present the case of a patient with lung cancer and decreased vision who was diagnosed as simultaneous choroidal and brain metastases. Radiation therapy (20Gy/5fractions) significantly improves decreased vision. This case shows that, although life expectancy of patients with metastasic lung cancer is short, an adequate diagnosis and treatment, can improve the quality of life of those patients.

Penetration of linezolid into the anterior chamber (aqueous humor) of the human eye after intravenous administration.

We determined the linezolid concentrations in serum samples and aqueous humors (AHs) from 21 patients undergoing cataract extraction. Cataract removal was performed at various times (from 60 to 270 min) after the end of a 30-min infusion of 600 mg of linezolid. Serum samples were obtained 1 h after the end of linezolid administration to determine the maximum concentration of linezolid (C(max)); AHs and a second serum sample were taken simultaneously during the operation, and the concentrations of linezolid in AH (C(AH)) and serum (C(S)) were determined. The mean C(AH) 1 h after linezolid administration was 4.94 micro g/ml, and the mean ratio of C(AH) to C(S) (R = C(AH)/C(S)) was 0.43. All patients had a C(AH) of >2 micro g/ml, which was higher than the MIC at which 90% of Staphylococcus epidermidis strains are inhibited.

Cold chain monitoring during cold transportation of human corneas for transplantation.

BACKGROUND: As recommended by international standards the cornea should be maintained in a specific temperature range (2 degrees -8 degrees C) to guarantee its viability. However, there is no standard packaging method to maintain these conditions during transport. Our packaging system is similar to those used by the main eye banks in Spain and elsewhere in Europe. The objective is to monitor the cold chain in the current packaging method to validate the maintenance of temperature within the adequate range for a minimum 24-hour period. METHODS: The effects of the following variables were studied: number and freezing temperature of the cold packs; air volume in the packaging system; position of the cornea in the packaging system; and the wall section of the container. Exterior temperature was maintained constant at 20 degrees to 24 degrees C. The cold chain was monitored using a device that measures temperature continuously and for which a histogram of temperature variation can be downloaded to a computer for further analysis. RESULTS: When the cold packs were frozen to -40 degrees C or the number of cold packs increased to four, the temperature decreased quickly to 0 degrees C and the transport period was not prolonged. The main objective was to improve isolation by reducing inner air volume, and maintaining the position of the cornea in the container. CONCLUSIONS: The currently used cold packaging systems (not frozen, 4 degrees C) do not maintain the temperature within the accepted range for the required distribution period. The improved system maintains the cornea at between 2 degrees C and 6 degrees C for a minimum of 24 hours.

Afección ocular en las enfermedades por helmintos

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Una conjuntivitis alérgica

La alergia ocular es una de las afecciones más frecuentes en la práctica oftalmológica diaria. La inflamación de la conjuntiva de etiología alérgica raramente se presenta aislada, y suele hacerlo junto con afección de las estructuras anejas oculares, como la córnea y los párpados, por lo que suelehablarse genéricamente de "enfermedad ocular alérgica" (AU)

Uveítis anterior

La uveítis anterior o iridociclitis es la inflamación intraocular más frecuente. Afecta al iris y al cuerpo ciliar, que aunque responden como un todo ante la inflamación, son dos estructuras anatómicas y funcionalmente diferenciadas. En este artículo se revisa la anatomía de la zona para adentrarnos después en un complejo repertorio de síntomas y signos oculares que pueden ser producidos por la uveítis anterior, tanto los más frecuentes como los producidos por las complicaciones de la inflamación (AU)

Cataract surgery: an analysis of patient satisfaction with medical care.

INTRODUCTION: Patient satisfaction is a good performance indicator for measuring the quality of health care delivered by hospitals. Satisfaction is understood to be the positive difference between users' perceptions of their experience at the moment of discharge and their expectations at the moment of admission. OBJECTIVE: To evaluate the expectations and the perceived quality of care in cataract surgery patients attending Hospital Clinic (HC). METHOD: A two-stage descriptive study carried out at the HC in Barcelona, Spain. The target population consisted of patients operated on for cataracts during the 1996 calendar year. Two study groups were established: Group I, patients attending outpatient service before admission; and Group II, patients attending outpatient service after surgery. After informed consent was obtained, the patients were directly interviewed by three researchers especially trained for that purpose. The questionnaire included demographic variables and 31 questions related to expectations, all to be answered by means of a 7 points Likert's visual scale. All statistical calculations were performed using the SPSS program for Microsoft Windows. RESULTS: A total of 148 interviews were performed: 80 (54.1%) in Group I and 68 (45.9%) in Group II. The mean age was 64.2 +/- 11.6 years. The difference between scores at admission and at discharge was nearly significant (p = 0.064) for the "information" component. CONCLUSIONS: The study of several fields where the patient's expectations are higher or lower contributes to prioritizing efforts to improve quality. There is a need for a frequent review and update of any patient satisfaction evaluation tools that are used.

Photorefractive keratectomy for myopia: 18-month results in 178 eyes.

To evaluate the predictability, efficacy, and stability of myopic photorefractive keratectomy (PRK), we present the results of 18 months of 178 consecutive myopic eyes. Results demonstrated a stable change in the power of the cornea with long-term corneal clarity.