Rasgo de zónula anterior larga, lecciones aprendidas acerca de una infrecuente forma de cierre angular secundario: comunicación de un caso / Long anterior zonule trait, lessons learned about an uncommon form of secondary angle closure: A case report

Una mujer de raza negra de 62 años de edad que presentaba glaucoma crónico de ángulo estrecho no controlado en tratamiento con tres fármacos fue sometida a faco-esclerectomía profunda no perforante (facoEPNP) de su ojo izquierdo (OI). Durante la cirugía se puso de manifiesto que presentaba rasgo de zónula larga. Precisó goniopunción y desbridamiento de la ampolla posteriormente, presentando una sinequia de iris en la goniopunción que pudo ser reducida de forma conservadora. Este rasgo debe sospecharse en aquellos pacientes que presentan un ángulo estrecho combinado con un síndrome de dispersión pigmentaria. El manejo de la hipertensión ocular y el glaucoma que puede aparecer asociado a este rasgo no está protocolizado. En esta comunicación se reflexiona acerca de la mejor actuación ante esta infrecuente forma de glaucoma.(AU)

A 62-year-old black woman with uncontrolled chronic narrow-angle glaucoma on 3-drug therapy underwent phaco-non-perforating deep sclerectomy of her left eye. During surgery it was revealed that she had long zonule trait. She later required goniopuncture and conjuntival needling, presenting an iris synechia on the goniopuncture that could be reduced conservatively. Long anterior zonule trait should be suspected in those patients presenting with a combination of narrow angle and pigment dispersion syndrome. The management of ocular hypertension and glaucoma associated to this trait is not protocolized. This communication discusses on the best action in this rare form of glaucoma.(AU)

Long anterior zonule trait, lessons learned about an uncommon form of secondary angle closure: a case report.

A 62-year-old black woman with uncontrolled chronic narrow-angle glaucoma on 3-drug therapy underwent phaco-non-perforating deep sclerectomy of her left eye. During surgery it was revealed that she had long zonule trait. She later required goniopuncture and conjuntival needling, presenting an iris herniation in the goniopuncture that could be reduced conservatively. Long anterior zonule trait should be suspected in those patients presenting with a combination of narrow angle and pigment dispersion syndrome. The management of ocular hypertension and glaucoma associated to this trait is not protocolized. This communication discusses on the best action in this rare form of glaucoma.

Conjunctival Kaposi's sarcoma as the initial manifestation of acquired inmunodeficiency syndrome.

UNLABELLED: Abstract Introduction: Kaposi's sarcoma is a common neoplasm in patients with acquired immunodeficiency syndrome (AIDS). Its presentation as an initial manifestation of AIDS is very rare . OBJECTIVE: To report a rare case with Kaposi's's sarcoma as an initial manifestation of AIDS. CASE: We report the case of a 37-year-old man who was a parenteral drug addict, HIV seropositive and was not under any treatment with a conjunctival lesion which was diagnosed as Kaposi's sarcoma after surgical resection. Conjunctival Kaposi's sarcoma is present frequently in HIV patients and lesions may be mistaken with other conjunctival lesions.

[An unusual presentation of a pilomatrixoma in the eyelid]. / Presentación inusual en el párpado de pilomatricoma.

CASE REPORT: A 32-year-old man developed a lesion, over a period of 1 year, at the margin of the right upper eyelid. The presumed diagnosis was a pyogenic granuloma. An excision biopsy was performed and the histopathologic diagnosis was a pilomatrixoma. DISCUSSION: Eyelid pilomatrixoma is commonly misdiagnosed preoperatively and is extremely rare in middle-aged patients.

Presentación inusual en el párpado de pilomatricoma / An unusual presentation of a pilomatrixoma in the eyelid

Caso clínico: Hombre de 32 años de edad que presenta una lesión en borde libre palpebral de párpado superior derecho de un año de evolución, con un diagnóstico clínico de granuloma piógeno. Se realiza su escisión quirúrgica y el diagnóstico histopatológico es de pilomatricoma. Discusión: El pilomatricoma de localización palpebral es generalmente mal diagnosticado preoperatoriamente y es extremadamente raro en pacientes de edad media

Case report: A 32-year-old man developed a lesion, over a period of 1 year, at the margin of the right upper eyelid. The presumed diagnosis was a pyogenic granuloma. An excision biopsy was performed and the histopathologic diagnosis was a pilomatrixoma. Discussion: Eyelid pilomatrixoma is commonly misdiagnosed preoperatively and is extremely rare in middle-aged patients

[Results and complications of expanded polytetrafluoroethylene in frontalis suspension ptosis surgery. Study of 59 cases]. / Resultados y complicaciones del politetrafluoroetileno expandido en la cirugía de ptosis palpebral por suspensión al frontal. Estudio de 59 casos.

PURPOSE: To evaluate the functional results and complications of the use of expanded polytetrafluoroethylene (ePTFE) in frontalis suspension surgery for the treatment of moderate-severe palpebral ptosis (> 3 mm) with poor or absent levator muscle function. METHODS: Retrospective study of 59 frontalis suspension procedures performed between 1992 and 2003 on 38 patients with palpebral ptosis (21 bilateral). Seventeen (44.7%) cases were women and 21 (55.3%) men. The mean age was 51.7 S.D. 27.6 years (range, 2 to 87). The surgical techniques used were performed by a Wright fascia needle. The etiology, ptosis grade, levator function, Bell's phenomenon and frontalis compensation were studied. RESULTS: After a median follow-up time of 35.9 S.D. 18.5 months (range, 6 to 72), we observed that the functional results were good in 55 cases (93.2%). Infection with preseptal cellulitis appeared in 1 case (1.7%) and required removal of the material, and in 2 cases (3.4%) there were foreign body granulomas that were resolved by excision. Two cases (3.4%) had to be reoperated due to recurrence. CONCLUSIONS: The ePTFE, in our experience, is a good material with excellent functional results and relatively few complications in the surgical treatment of eyelid ptosis for frontalis suspension. Other synthetic materials or fascia lata may be used, but all carry the risk of potential infection, extrusion, granuloma formation or recurrence.

Resultados y complicaciones del politetrafluoroetileno expandido en la cirugía de ptosis palpebral por suspensión al frontal. Estudio de 59 casos / Results and complications of expanded polytetrafluoroetylene in frontalis suspension ptosis surgery. Study of 59 cases

Objetivo: Valorar los resultados funcionales y complicaciones del uso de politetrafluoroetileno expandido (PTFEe) en la técnica de suspensión al frontal para el tratamiento quirúrgico de la ptosis palpebral moderada-severa (>3 mm) con mala o nula función del músculo elevador.Material y Método: Estudio retrospectivo de 59 suspensiones al frontal realizadas entre los años 1992 y 2003, en 38 pacientes con ptosis palpebral (21 bilaterales). Diecisiete (44,7%) fueron mujeres y 21 (55,3%) hombres. La edad media fue de 51,7 D.E. 27,6 años (rango, 2 a 87 años). Las técnicas quirúrgicas empleadas se realizaron mediante una aguja de fascia de Wright. Se estudia además la etiología, el grado de ptosis, la función del músculo elevador, el reflejo de Bell y la compensación frontal.Resultados: Tras un período de seguimiento medio de 35,9 D.E. 18,5 meses (rango, 6 a 72) pudimos observar que los resultados funcionales fueron buenos en 55 casos (93,2%). Infección con celulitis preseptal apareció en 1 caso (1,7%) que requirió la retirada del material, y en 2 casos (3,4%) se presentaron granulomas a cuerpo extraño que se solucionaron con su escisión. Se reintervinieron 2 casos (3,4%) por recurrencia.Conclusiones: El PTFEe, según nuestra experiencia, es un buen material en el tratamiento quirúrgico de la ptosis palpebral mediante suspensión al frontal, con excelentes resultados funcionales y relativamente escasas complicaciones. También pueden usarse otros materiales sintéticos o fascia lata en este procedimiento, aunque todos tienen el riesgo potencial de infección, extrusión, formación de granulomas o recurrencias

Purpose: To evaluate the functional results and complications of the use of expanded polytetrafluoroethylene (ePTFE) in frontalis suspension surgery for the treatment of moderate-severe palpebral ptosis (>3 mm) with poor or absent levator muscle function. Methods: Retrospective study of 59 frontalis suspension procedures performed between 1992 and 2003 on 38 patients with palpebral ptosis (21 bilateral). Seventeen (44.7%) cases were women and 21 (55.3%) men. The mean age was 51.7 S.D. 27.6 years (range, 2 to 87). The surgical techniques used were performed by a Wright fascia needle. The etiology, ptosis grade, levator function, Bell’s phenomenon and frontalis compensation were studied. Results: After a median follow-up time of 35.9 S.D. 18.5 months (range, 6 to 72), we observed that the functional results were good in 55 cases (93.2%). Infection with preseptal celulitis appeared in 1 case (1.7%) and required removal of the material, and in 2 cases (3.4%) there were foreign body granulomas that were resolved by excision. Two cases (3.4%) had to be reoperated due to recurrence. Conclusions: The ePTFE, in our experience, is a good material with excellent functional results and relatively few complications in the surgical treatment of eyelid ptosis for frontalis suspension. Other synthetic materials or fascia lata may be used, but all carry the risk of potential infection, extrusion, granuloma formation or recurrence