Implante de válvula de Ahmed para el manejo del glaucoma uveítico refractario: seguimiento a largo plazo / Ahmed glaucoma drainage implant surgery in the management of refractory uveitic glaucoma: Long-term follow up

OBJETIVO: Evaluar la eficacia, seguridad y complicaciones a largo plazo del implante de válvula de Ahmed en pacientes con glaucoma uveítico refractario. MÉTODOS: Revisión retrospectiva de casos consecutivos de pacientes con glaucoma uveítico refractario intervenidos mediante un implante de válvula de Ahmed entre los años 2004-2014. Las características demográficas, la agudeza visual, la presión intraocular (PIO), el número de medicamentos antiglaucomatosos y las complicaciones operatorias y postoperatorias fueron registradas. El éxito completo se definió como una PIO ≥ 5 y ≤ 18 mmHg sin medicamentos, y el éxito calificado, como una PIO ≤ 18 mmHg con uno o más medicamentos. Aquellos pacientes con un seguimiento inferior a 12 meses fueron excluidos. RESULTADOS: Veintiún pacientes (26 ojos) fueron incluidos. El seguimiento promedio postoperatorio fue de 53,5 ± 31 meses. Ocho ojos (30%) tuvieron al menos una cirugía de glaucoma fallida previamente. La PIO se redujo de una media de 30 a 14mmHg en la última visita (p < 0,001). El número de medicamentos antiglaucomatosos se redujo de una mediana de 2,9 a 1,1 en la última visita (p < 0,001). Siete ojos (27%) se calificaron como éxito completo, 13 ojos (50%) como éxito calificado y 6 ojos (23%) cumplieron el criterio de falla. La complicación postoperatoria más frecuente fue la fase hipertensiva en 12 ojos (46%). El análisis de supervivencia de Kaplan-Meier mostró una probabilidad acumulada de éxito del 65% a los 84 meses. CONCLUSIONES: La cirugía de implante de drenaje de glaucoma de Ahmed se puede considerar una opción quirúrgica eficaz y segura a largo plazo para los pacientes con glaucoma uveítico refractario

OBJECTIVE: To examine the long-term efficacy, safety and complications of Ahmed glaucoma drainage implant surgery in patients with refractory uveitic glaucoma. METHODS: Retrospective review of consecutive cases of patients with refractory uveitic glaucoma who underwent Ahmed glaucoma drainage implant surgery between 2004-2014. Demographic characteristics of the study population, visual acuity, intraocular pressure (IOP), number of antiglaucoma medications and operative and postoperative complications were recorded. Complete success was defined as IOP ≥ 5 and ≤ 18 mmHg without any medication, as qualified success if IOP ≤ 18 mmHg with one or more medications. Patients with less than 12 months of follow-up were excluded. RESULTS: 21 patients (26 eyes) were included. The mean postoperative follow-up was 53.5 ± 31 months. Eight eyes (30%) had at least one previously failed glaucoma surgery. IOP was reduced from a mean of 30.0mmHg to 14.0mmHg at the last follow-up visit (P < .001). The number of IOP-lowering medications was reduced from a median of 2.9 preoperatively to 1.1 at the last follow-up (P < .001). Overall, 7 eyes (27%) were classified as complete success, 13 eyes (50%) were considered as qualified success, and 6 eyes (23%) met the criteria for failure. The most common postoperative complication was hypertensive phase in 12 eyes (46%). Kaplan-Meier life-table analysis showed a cumulative probability of success after Ahmed glaucoma valve implantation of 65% at 84 months. CONCLUSIONS: Ahmed glaucoma drainage implant surgery may be considered a long-term effective and safety surgical option for patients with refractory uveitic glaucoma

Ahmed glaucoma drainage implant surgery in the management of refractory uveitic glaucoma: Long-term follow up. / Implante de válvula de Ahmed para el manejo del glaucoma uveítico refractario: seguimiento a largo plazo.

OBJECTIVE: To examine the long-term efficacy, safety and complications of Ahmed glaucoma drainage implant surgery in patients with refractory uveitic glaucoma. METHODS: Retrospective review of consecutive cases of patients with refractory uveitic glaucoma who underwent Ahmed glaucoma drainage implant surgery between 2004-2014. Demographic characteristics of the study population, visual acuity, intraocular pressure (IOP), number of antiglaucoma medications and operative and postoperative complications were recorded. Complete success was defined as IOP≥5 and ≤18mmHg without any medication, as qualified success if IOP≤18mmHg with one or more medications. Patients with less than 12 months of follow-up were excluded. RESULTS: 21 patients (26 eyes) were included. The mean postoperative follow-up was 53.5±31 months. Eight eyes (30%) had at least one previously failed glaucoma surgery. IOP was reduced from a mean of 30.0mmHg to 14.0mmHg at the last follow-up visit (P<.001). The number of IOP-lowering medications was reduced from a median of 2.9 preoperatively to 1.1 at the last follow-up (P<.001). Overall, 7 eyes (27%) were classified as complete success, 13 eyes (50%) were considered as qualified success, and 6 eyes (23%) met the criteria for failure. The most common postoperative complication was hypertensive phase in 12 eyes (46%). Kaplan-Meier life-table analysis showed a cumulative probability of success after Ahmed glaucoma valve implantation of 65% at 84 months. CONCLUSIONS: Ahmed glaucoma drainage implant surgery may be considered a long-term effective and safety surgical option for patients with refractory uveitic glaucoma.

Alta prevalencia de infestación por Demodex spp. en pacientes con blefaritis posterior: correlación con edad y caspa cilíndrica / High prevalence of Demodex spp. infestation among patients with posterior blepharitis: correlation with age and cylindrical dandruff

Objetivo: Determinar la prevalencia e índice de infestación (II) por Demodex spp. en pacientes con blefaritis en distintos grupos etarios y evaluar su asociación con la presencia de caspa cilíndrica (CC). Materiales y métodos: Estudio prospectivo que incluye a pacientes de la Fundación Oftalmológica Los Andes (Chile), con diagnóstico clínico de blefaritis con compromiso de la lámina posterior entre 2013 y 2015, sin tratamiento acaricida previo. Cuatro pestañas de cada párpado fueron extraídas al azar para la detección del ectoparásito y determinación del II, calculado como el cociente entre el número observado de especímenes de demodex y la totalidad de las pestañas extraídas. Además, se realizó una determinación semicuantitativa de la presencia de CC. Resultados: Se incluyó a 178 pacientes, de los cuales el 51,3% eran hombres. La edad promedio fue de 58,49 ± 20,66 años. El 83,7% de los pacientes resultaron infestados por demodex, con un II promedio de 0,96 ± 0,84 ácaros/pestaña. El II fue significativamente mayor en pacientes sobre los 50 años (p<0,0001). La edad de los pacientes y el II presentaron un coeficiente de correlación lineal de Pearson (R2) de 0,12 (p<0,0001). El 71,4% de los pacientes presentaron CC, con valores significativamente más altos en pacientes mayores de 50 años. Se observó una correlación positiva entre la cantidad de CC y el II (R2=0,33; p<0,0001). Conclusiones: Existe una elevada prevalencia de infestación por demodex en pacientes con blefaritis posterior. El II por Demodex folliculorum se correlaciona positivamente con la edad de los pacientes y con la presencia de CC en el borde palpebral (AU)

Objective: To determine prevalence of Demodex spp. and infestation index (II) by the parasite among patients of different ages with blepharitis and to assess association with occurrence of cylindrical dandruff (CC). Materials and methods: Prospective study including patients diagnosed with posterior blepharitis between 2013 and 2015, without previous acaricide treatment, was conducted by Fundación Oftalmológica Los Andes (Chile). Four eyelashes were randomly extracted from each eyelid for parasite detection. The II was calculated as the ratio between the total number of demodex specimens found in the total number of eyelashes removed. A semi-quantitative determination of the CC was performed. Results: A total of 178 patients (91 men, 87 women), with a mean age of 58.49 ± 20.66 years, were included. It was found that 83.7% of patients were infested with Demodex folliculorum with a mean II of 0.96 ± 0.84 mites/eyelash. The II was significantly higher in patients over 50 years (p<.0001). Patient age and II showed a Pearson correlation coefficient (R2) of 0.12 (p<.0001). CC was observed in 71.4% of patients, with those over 50 years-old showing significantly higher values. A positive correlation was also observed between the amount of CC and the II (R2=.33; p<.0001). Conclusions: The prevalence of infestation by Demodex folliculorum is high in patients with posterior blepharitis. The II by the parasite is positively correlated with age and with the occurrence of CC on the eyelid border (AU)

High prevalence of Demodex spp. infestation among patients with posterior blepharitis: correlation with age and cylindrical dandruff. / Alta prevalencia de infestación por Demodex spp. en pacientes con blefaritis posterior: correlación con edad y caspa cilíndrica.

OBJECTIVE: To determine prevalence of Demodex spp. and infestation index (II) by the parasite among patients of different ages with blepharitis and to assess association with occurrence of cylindrical dandruff (CC). MATERIALS AND METHODS: Prospective study including patients diagnosed with posterior blepharitis between 2013 and 2015, without previous acaricide treatment, was conducted by Fundación Oftalmológica Los Andes (Chile). Four eyelashes were randomly extracted from each eyelid for parasite detection. The II was calculated as the ratio between the total number of demodex specimens found in the total number of eyelashes removed. A semi-quantitative determination of the CC was performed. RESULTS: A total of 178 patients (91 men, 87 women), with a mean age of 58.49±20.66 years, were included. It was found that 83.7% of patients were infested with Demodex folliculorum with a mean II of 0.96±0.84 mites/eyelash. The II was significantly higher in patients over 50 years (p<.0001). Patient age and II showed a Pearson correlation coefficient (R2) of 0.12 (p<.0001). CC was observed in 71.4% of patients, with those over 50 years-old showing significantly higher values. A positive correlation was also observed between the amount of CC and the II (R2=.33; p<.0001). CONCLUSIONS: The prevalence of infestation by Demodex folliculorum is high in patients with posterior blepharitis. The II by the parasite is positively correlated with age and with the occurrence of CC on the eyelid border.

Citología de impresión conjuntival en pacientes con valores OSDI normales y alterados / Conjunctival impression cytology in patients with normal and impaired OSDI scores

OBJETIVO: Describir la graduación de Nelson y la densidad de células caliciformes en distintas áreas de la superficie ocular usando citología de impresión conjuntival (CIC), en pacientes con valores Ocular Surface Disease Index (OSDI©) normales y alterados. MATERIALES Y MÉTODOS: Los pacientes (n = 166) en evaluación por ojo seco, reclutados entre 2011 y 2012, fueron clasificados según el cuestionario OSDI en 4 categorías (normal y alteradas). Se evaluó citología (CIC con tinción Papanicolaou) aplicando el sistema de graduación de Nelson, con modificaciones en la determinación de la estadificación, y recuento de células caliciformes en zonas nasal, temporal, superior e inferior de la superficie conjuntival. RESULTADOS: El grado de Nelson fue significativamente mayor en pacientes con valores OSDI severos, variando desde 0,86 ± 0,09 en pacientes normales a 1,41 ± 0,14 en OSDI severo (p < 0,01). La densidad de células caliciformes disminuyó desde 497,31 ± 50,07 células por muestra en pacientes normales a 310,24 ± 56,24 células por muestra en pacientes con OSDI severo (p < 0,001). La conjuntiva bulbar no fotoexpuesta presentó un número de células caliciformes significativamente mayor (p < 0,0001) que la zona fotoexpuesta en pacientes con OSDI leve (p < 0,01) y moderado (p < 0,001). CONCLUSIÓN: La densidad de células caliciformes es menor y la clasificación de Nelson es mayor en pacientes con OSDI severo. La densidad de células caliciformes es mayor en la conjuntiva bulbar no fotoexpuesta

PURPOSE: To describe goblet cell density and Nelson grading in different areas of the ocular surface using conjunctival impression cytology (CIC) among patients with normal and impaired Ocular Surface Disease Index (OSDI) scores. MATERIAL AND METHODS: Patients (n = 166) under assessment for dry eye were recruited between 2011 and 2012 and classified according to the OSDI score in 4 categories (normal and impaired). Cytological study (CIC plus Papanicolaou staining) using the Nelson grading system, with modifications in staging, and goblet cell counting were performed on the nasal, temporal, inferior, and superior bulbar conjunctival surfaces. RESULTS: Nelson grading was significantly higher in patients with a severely impaired OSDI score (1.41 ± 0.14) compared to normal patients (0.86 ± 0.09) (P<0.01). Goblet cell density was significantly reduced in patients with a severely impaired OSDI score (310.24 ± 56.24 cells per sample) compared with normal subjects (497.31 ± 50.07 cells per sample) (P<0.001). Compared with the photoexposed bulbar conjunctiva, goblet cell density on the non-photoexposed conjunctiva was significantly higher both in patients with mild (P<0.01) and moderate (P<0.001) OSDI scores. CONCLUSION: Patients with severely impaired OSDI scores have less goblet cells and a higher Nelson grade. Goblet cells are more abundant on the non-photoexposed conjunctiva

[Conjunctival impression cytology in patients with normal and impaired OSDI scores]. / Citología de impresión conjuntival en pacientes con valores OSDI normales y alterados.

PURPOSE: To describe goblet cell density and Nelson grading in different areas of the ocular surface using conjunctival impression cytology (CIC) among patients with normal and impaired Ocular Surface Disease Index (OSDI) scores. MATERIAL AND METHODS: Patients (n=166) under assessment for dry eye were recruited between 2011 and 2012 and classified according to the OSDI score in 4 categories (normal and impaired). Cytological study (CIC plus Papanicolaou staining) using the Nelson grading system, with modifications in staging, and goblet cell counting were performed on the nasal, temporal, inferior, and superior bulbar conjunctival surfaces. RESULTS: Nelson grading was significantly higher in patients with a severely impaired OSDI score (1.41±0.14) compared to normal patients (0.86±0.09) (P<.01). Goblet cell density was significantly reduced in patients with a severely impaired OSDI score (310.24±56.24 cells per sample) compared with normal subjects (497.31±50.07 cells per sample) (P<.001). Compared with the photoexposed bulbar conjunctiva, goblet cell density on the non-photoexposed conjunctiva was significantly higher both in patients with mild (P<.01) and moderate (P<.001) OSDI scores. CONCLUSION: Patients with severely impaired OSDI scores have less goblet cells and a higher Nelson grade. Goblet cells are more abundant on the non-photoexposed conjunctiva.