Evaluación objetiva de la aplicación de colirios en personas mayores de 65 años / Objective evaluation of applying eye drops by elderly patients

OBJETIVO: Evaluar las habilidades y destrezas de los pacientes mayores de 65 años en el momento de instilarse un tratamiento ocular en forma de colirio. MÉTODOS: Se realizó un estudio prospectivo sobre un grupo de 25 pacientes afectos de ojo seco o de glaucoma en tratamiento diario con gotas con, por lo menos, un año de evolución a los que procedimos a grabar con una cámara de vídeo en el momento de la instilación. RESULTADOS: Un 64% del total estaban diagnosticados de glaucoma y un 36% de ojo seco. Un 44% necesitaron un único intento para aplicarse la gota y un 56%, dos intentos. En cuanto al número de gotas instiladas, un 52% se instilaba una única gota, un 16% dos gotas, un 12% 3 gotas y un 20% cuatro o más gotas. Las zonas donde se depositó la gota en el primer intento fue en un 32% en el saco conjuntival, en un 32% en el ángulo externo del ojo, en un 8% en el ángulo interno, en un 8% en la nariz, en un 12% en la mejilla y en un 8% en otras zonas. CONCLUSIONES: La autoadministración de colirios en la población de la tercera edad se presenta como una actividad compleja que puede modificar los resultados esperados

OBJECTIVE: To objectively evaluate the ability and skills of patients older than 65 years to successfully administer a topical ocular eye drop. METHODS: A prospective study was conducted on a group of 25 patients with a diagnosis of dry eye or glaucoma, undergoing daily treatment with eye drops for at least one year. The procedure was recorded with a video camera at the time of the application. RESULTS: Of the total, 64% were diagnosed with glaucoma and 36% with dry eye. Almost half (44%) needed a single attempt to apply the drop, and 56% required 2 attempts. In terms of the number of eye drops applied, 52% managed with a single drop, 16% 2 drops, a 12% 3 drops, and 20% 4 or more eye drops. Areas where the eye drop was deposited in the first attempt was, 32% into the conjunctival sac, 32% on the outer corner of the eye, 8% in the inner angle, 8% in the nose, 12% on the cheek, 8% in other areas. CONCLUSIONS: Self-administration of eye drops by the elderly is a complex activity that can have an effect on the expected results

[Objective evaluation of applying eye drops by elderly patients]. / Evaluación objetiva de la aplicación de colirios en personas mayores de 65 años.

OBJECTIVE: To objectively evaluate the ability and skills of patients older than 65 years to successfully administer a topical ocular eye drop. METHODS: A prospective study was conducted on a group of 25 patients with a diagnosis of dry eye or glaucoma, undergoing daily treatment with eye drops for at least one year. The procedure was recorded with a video camera at the time of the application. RESULTS: Of the total, 64% were diagnosed with glaucoma and 36% with dry eye. Almost half (44%) needed a single attempt to apply the drop, and 56% required 2 attempts. In terms of the number of eye drops applied, 52% managed with a single drop, 16% 2 drops, a 12% 3 drops, and 20% 4 or more eye drops. Areas where the eye drop was deposited in the first attempt was, 32% into the conjunctival sac, 32% on the outer corner of the eye, 8% in the inner angle, 8% in the nose, 12% on the cheek, 8% in other areas. CONCLUSIONS: Self-administration of eye drops by the elderly is a complex activity that can have an effect on the expected results.

Prescribing prophylactic antibiotics to users of therapeutic contact lenses.

BACKGROUND: To describe the benefits and optimum use of prophylactic antibiotics in users of therapeutic contact lenses (TCL). METHODS: A microbiological study was carried out on samples from 33 patients who continuously wore TCL. The resistance to antibiotics of bacteria isolated in our health region was also reviewed. An assessment was also made on whether there were microorganisms of a higher pathogenic potential in TCL than conventional contact lenses, as reported in the literature. RESULTS: No bacteria were isolated from 17 (52%) of the 33 lenses studied. From the 16 (48%) remaining lenses, coagulase negative Staphylococci were isolated from 10 (62%), Propionibacterium acnes from 4 (25%), and Corynebacterium from 2 (13%). CONCLUSIONS: The high number of negative cultures and the presence of saprophytic bacteria indicate that prophylactic antibiotic treatment is not precise. The most frequent pathogenic bacteria found in contact lenses are strongly resistant to the current commercially available antibiotics.

Pertinencia de prescribir antibióticos profilácticos en usuarios de lentes de contacto terapéuticas / Prescribing prophylactic antibiotics to users of therapeutic contact lenses

Objetivos: Conocer la pertinencia o no de prescribir antibióticos profilácticos en usuarios de lentes de contacto terapéuticas (LCT). Métodos: Se procedió a realizar un estudio microbiológico sobre 33 LCT de 33 pacientes portadores de LCT. Se valoraron las resistencias de los gérmenes aislados a los antibióticos a partir de los estudios publicados en nuestra región sanitaria durante el año 2010. Valoramos lo mismo en el supuesto que las LCT se encontraran contaminadas por los gérmenes con mayor potencial patógeno según la literatura médica en usuarios de lentes de contacto convencionales. Resultados: De las 33 LCT estudiadas en 17 (52%) no se aisló ningún germen. En las 16 LCT restantes (48%) se aisló en diez (62%) Staphylococcus coagulasa negativo, en cuatro (25%) Propionibacterium acnes y en dos (13%) Corynebacterium. Conclusiones: El elevado número de cultivos negativos y la presencia de gérmenes saprofitos indican que no es preciso el tratamiento antibiótico profiláctico. Los gérmenes con mayor potencial patógeno en usuarios de lentes de contacto presentan severas resistencias a los antibióticos comercializados en forma de colirio(AU)

Background: To describe the benefits and optimum use of prophylactic antibiotics in users of therapeutic contact lenses (TCL). Methods: A microbiological study was carried out on samples from 33 patients who continuously wore TCL. The resistance to antibiotics of bacteria isolated in our health region was also reviewed. An assessment was also made on whether there were microorganisms of a higher pathogenic potential in TCL than conventional contact lenses, as reported in the literature. Results: No bacteria were isolated from 17 (52%) of the 33 lenses studied. From the 16 (48%) remaining lenses, coagulase negative Staphylococci were isolated from 10 (62%), Propionibacterium acnes from 4 (25%), and Corynebacterium from 2 (13%). Conclusions: The high number of negative cultures and the presence of saprophytic bacteria indicate that prophylactic antibiotic treatment is not precise. The most frequent pathogenic bacteria found in contact lenses are strongly resistant to the current commercially available antibiotics(AU)

[Experimental study of pig dislocated intraocular lens shift after Nd: YAG laser capsulotomy]. / Estudio experimental en ojos de cerdo sobre el desplazamiento de las lentes intraoculares subluxadas tras una capsulotomía láser Nd: YAG.

OBJECTIVES: To evaluate the movement from their initial set position of subluxated intraocular lenses (IOL) in pig eyes following Nd: YAG laser capsulotomy. METHODS: An extracapsular surgical intervention of the transparent crystalline lens was performed on 15 pig eyes. After the introduction of an intraocular lens into the capsular sac, a zonular dialysis was carried out to observe the shift of the IOL. We carried out a high intensity Nd: YAG laser capsulotomy in a 3.5mm cross shape in the central optical axis and then measured the final displacement of the IOL using a millimetre ruler. RESULTS: We did not observe a significant shift of the lens in any of the eyes studied. CONCLUSIONS: Nd: YAG laser capsulotomy is a safe short-term operation for static and subluxated intraocular lenses.

Estudio experimental en ojos de cerdo sobre el desplazamiento de las lentes intraoculares subluxadas tras una capsulotomía láser Nd: YAG / Experimental study of pig dislocated intraocular lens shift after Nd: YAG laser capsulotomy

Objetivos: Valorar en los ojos del cerdo el desplazamiento de las lentes intraoculares subluxadasrespecto a la posición inicial tras la realización de una capsulotomía láser Nd: YAG.Métodos: Se utilizaron 15 ojos de cerdo a los que les realizamos una cirugía extracapsular decristalino transparente. Tras la introducción de una lente intraocular (LIO) dentro del sacocapsular se provocó una diálisis zonular hasta objetivar un desplazamiento de la LIO de unvalor mínimo de 4mm. Efectuamos una capsulotomía láser Nd: YAG en forma de cruz enlos 3,5mm centrales del eje óptico a elevadas energías. Se midió el desplazamiento final dela LIO con la ayuda de una regla milimetrada.Resultados: En ninguno de los ojos estudiados se objetivó un desplazamiento significativo enrelación a la situación inicial.Conclusiones: La capsulotomía láser Nd: YAG en LIOs subluxadas se presenta para ojos estáticoscomo una maniobra segura a corto plazo(AU)

Objectives: To evaluate the movement from their initial set position of subluxated intraocularlenses (IOL) in pig eyes following Nd: YAG laser capsulotomy.Methods: An extracapsular surgical intervention of the transparent crystalline lens was performedon 15 pig eyes. After the introduction of an intraocular lens into the capsular sac,a zonular dialysis was carried out to observe the shift of the IOL. We carried out a high intensity Nd: YAG laser capsulotomy in a 3.5mmcross shape in the central optical axis andthen measured the final displacement of the IOL using a millimetre ruler.Results: We did not observe a significant shift of the lens in any of the eyes studied.Conclusions: Nd: YAG laser capsulotomy is a safe short-term operation for static and subluxatedintraocular lenses(AU)

[Tuberculous retinitis with associated periphlebitis]. / Retinitis por tuberculosis asociada a periflebitis.

CASE REPORT: A female 23 years old, from Equador, was referred to us because of a vision decrease in her left eye. Fundus exploration demonstrated an inflammatory chorioretinal lesion with associated periphlebitis. Serology results showed positive for PPD. A vitreous biopsy was carried out together with tuberculosis prophylactic treatment with isoniacide (300 mg/day); the clinical findings improved. Finally, PCR test was positive for mycobacterium tuberculosis. In consequence, therapeutic treatment for tuberculosis was initiated. DISCUSSION: Due to the current increase in prevalence of tuberculosis, we should always take this into account as a possible etiology when dealing with cases of chorioretinitis.

[Is microalbuminuria a risk factor for diabetic retinopathy?]. / La microalbuminurie est-elle un facteur de risque épidémiologique de la rétinopathie diabétique?

PURPOSE: To determine the relationship between microalbuminuria and diabetic retinopathy. METHODS: A prospective 10-year study of 104 younger-onset diabetic patients. The diabetic retinopathy diagnosis was made by fundus retinography, and determination of microalbuminuria was made from urine samples. RESULTS: The incidence of diabetic retinopathy in this group of patients was 39 (37.5%). The epidemiological factors implicated were diabetes duration, higher levels of HbA(1c), male sex, and diastolic arterial hypertension. The incidence of microalbuminuria was 21 patients (20.2%), with high levels of HbA(1c) the epidemiological factor implicated. The association between microalbuminuria and diabetic retinopathy grouped the patients as follows: 56 patients without microalbuminuria or retinopathy, 16 patients who developed microalbuminuria and diabetic retinopathy, 23 patients who developed retinopathy but not microalbuminuria, and nine patients who developed only microalbuminuria. The discriminant analysis showed that the high levels of HbA(1c) were associated with microalbuminuria and diabetes duration and high levels of HbA(1c) were associated with diabetic retinopathy. CONCLUSIONS: In the population studied, microalbuminuria was not a good marker for diabetic retinopathy.

Estudio de relación entre microangiopatía retinianay renal en pacientes diabéticos tipo 1 / Study of the relationship between retinal and renal microangiopathy in patients with diabetes mellitus type 1

Las similitudes en la vascularización de la retina y el riñón hacen que las complicaciones de la diabetes mellitus en los pequeños vasos (microangiopatía) aparezcan en ambos órganos. El presente estudio ofrece los resultados obtenidos de forma prospectiva a lo largo de 10 años en 104 pacientes diabéticos tipo 1, con las características de no presentar microalbuminuria ni retinopatía diabética al inicio del mismo; los resultados tienen por objetivo la relación entre la presencia de retinopatía diabética proliferativa y microalbuminuria, teniendo en cuenta diferentes factores de riesgo epidemiológico: sexo, duración de la diabetes, presencia de hipertensión arterial diastólica, niveles de HbA1c y lípidos sanguíneos. Los resultados obtenidos indican una incidencia de retinopatía diabética a los 10 años de seguimiento de 37,50 por ciento (siendo la forma proliferativa 13,46 por ciento) y la incidencia de microalbuminuria es de un 20,19 por ciento. La aparición de retinopatía diabética proliferativa se asocia a la presencia de hipertensión arterial diastólica, mientras que la aparición de microalbuminuria a los niveles elevados de HbA1c. Los resultados obtenidos de incidencia de retinopatía diabética proliferativa y microalbuminuria son similares a los de otros autores. Al final del estudio se configuran 4 grupos de pacientes según presenten retinopatía diabética proliferativa y/o microalbuminuria. De los resultados obtenidos en el presente estudio se desprende la posible existencia de dos poblaciones de pacientes diabéticos, una que desarrollaría retinopatía diabética proliferativa y lesión renal y una segunda en la que solamente aparecería retinopatía diabética proliferativa (AU)

[Study of the relationship between retinal and renal microangiopathy in patients with diabetes mellitus type 1]. / Estudio de relación entre microangiopatía retiniana y renal en pacientes diabéticos tipo 1.

The similarities in the vascularization of the retina and the kidney give rise to the complications of diabetes mellitus in the small vessels (microangiopathy) that appear in both organs. The present study presents the prospectively obtained results along 10 years in 104 diabetic type 1 patients, with the characteristics not to present microalbuminuria nor diabetic retinopathy at the beginning of the study; the results bear as objective the establishment of the relation between the presence of proliferative diabetic retinopathy and microalbuminuria, taking into account different factors of epidemiological risk: gender, duration of diabetes, presence of diastolic hypertension, levels of HbAlc, and blood lipids. The results obtained indicate a 10 years of follow-up incidence of diabetic retinopathy of 37.50% (being the proliferative form 13.46%) and the incidence of microalbuminuria is of 20.19%. The appearance of proliferative diabetic retinopathy is associated to the presence of diastolic hypertension, while the appearance of microalbuminuria is related to the elevation of levels of HbAlc. The results obtained in the proliferative diabetic retinopathy and microalbuminuria incidence are similar to those of other authors. At the end of the study four groups of patients are configured depending on whether they present proliferative diabetic retinopathy and/or microalbuminuria. The results obtained in the present study suggest the possible existence of two populations of diabetic patients, one that would develop proliferative diabetic retinopathy and renal injury, and a second population in which only would appear proliferative diabetic retinopathy.

[Results in the treatment of acute endophthalmitis by vitrectomy using limbal incision]. / Resultados obtenidos en el tratamiento de la endoftalmitis aguda mediante vitrectomía vía limbar.

PURPOSE: To describe the results obtained in the treatment of acute onset endophthalmitis after cataract surgery in our center using vitrectomy with corneal limbal incisions. METHODS: Study carried out in 12 patients with acute endophthalmitis after cataract surgery in whom a posterior vitrectomy by limbic incisions was performed followed by intravitreal injections of antibiotics (vancomycin + ceftazidime/amikacin) with systemic and topical antibiotic and corticosteroid treatment in the post-operative period. RESULTS: The incidence of endophthalmitis in our center was 0.92%. The most frequently isolated microorganism was Staphylococcus epidermidis (4 cases, 33.33%). Four cases were negative (33.33%). A visual acuity equal to or greater than 0.5 at three months was obtained in 6 patients (50%). Only one case required a second administration of intravitreal injections. One patient suffered vitreal hemorrhaging in the post-operative period, and no other complications were observed in the remaining patients. CONCLUSIONS: We consider that vitrectomy through limbal incisions is a valid alternative for acute onset endophthalmitis treatment.

Resultados obtenidos en el tratamiento de la endoftalmitis aguda mediante vitrectomía vía limbar / Results in the treatment of acute endophthalmitis by vitrectomy using limbal incision

Objetivo: Describir los resultados obtenidos en el tratamiento de la endoftalmitis aguda, tras cirugía de catarata en nuestro centro, mediante vitrectomía con incisiones límbicas corneales Métodos: Estudio realizado en 12 pacientes con endoftalmitis aguda tras cirugía de catarata, en los que se practicó vitrectomía posterior a través de incisiones límbicas, seguido de inyecciones intravítreas de antibióticos (vancomicina + ceftazidime / amikacina); con tratamiento antibiótico y corticoide, sistémico y tópico en el postoperatorio Resultados: La incidencia de endoftalmitis en nuestro centro fue de 0,92 por ciento. El germen aislado con mayor frecuencia fue el Staphilococcus epidermidis (4 casos 33,33 por ciento), resultando negativos 4 casos (33,33 por ciento); de los doce casos tratados se consiguió una agudeza visual a los 3 meses, igual o superior a 0,5 en 6 pacientes (50 por ciento), solo un caso requirió la administración de una segunda serie de inyecciones intra vítreas. Una paciente sufrió una hemorragia vítrea en el postoperatorio, no observándose ninguna otra complicación en el resto de pacientes. Conclusiones: Creemos que la vitrectomía por vía límbica corneal es una alternativa válida para la endoftalmitis aguda (AU)

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[Anterior optic neuritis do to ulcerative colitis]. / Neuritis óptica anterior por colitis ulcerosa.

PURPOSE/METHODS: We present the case of a 27 year old woman with acute bilateral loss of vision associated with abdominalgia, bloody diarrhea and arthralgia. In the present article, the different forms of ocular complications in relationship to chronic intestinal inflammations and their possible causes are discussed. RESULTS/CONCLUSIONS: On examination, bilateral anterior uveitis associated to a picture of optic nerve lesion compatible with a bilateral anterior optic neuritis was observed. The patient was diagnosed of ulcerative colitis by intestinal biopsy. The ocular affectation resolved after the ulcerative colitis was treated with systemic mesalamine.

Neuritis óptica anterior por colitis ulcerosa / Anterior optic neuritis do to ulcerative colitis

Objetivo/Métodos: Presentamos un caso clínico de una paciente de 27 años de edad, que acudió por un cuadro de pérdida aguda de visión bilateral asociada a artralgia y diarrea serosanguinolenta. En el presente artículo se discuten las diferentes formas de afectación ocular en la inflamación crónica intestinal y sus posibles causas patogénicas. Resultados/Conclusiones: A la exploración se apreció uveítis anterior bilateral, asociada a la presencia de un cuadro de afectación del nervio óptico compatible con neuritis óptica anterior bilateral, se realizo el diagnóstico de colitis ulcerosa, mediante biopsia intestinal. El cuadro remitió al tratar la inflamación intestinal crónica con mesalamina por vía oral (AU)