Experiencia del uso de la toxina botulínica tipo A para el tratamiento sintomático del epiblefaron en pacientes menores de 2 años / Treatment of symptomatic epiblepharon with Botulinum toxin type A in patients under 2 years of age

INTRODUCCIÓN: El epiblefaron es una malposición palpebral congénita ocasionada por un pliegue redundante de piel y músculo orbicular que invierte las pestañas hacia el globo ocular. OBJETIVO: Reportamos nuestra experiencia en la corrección no quirúrgica del epiblefaron sintomático usando una inyección en el músculo orbicular pretarsal de 5 unidades de toxina botulínica tipo A (TbA). MATERIAL Y MÉTODOS: Revisamos los expedientes de los pacientes menores de 2 años con epiblefaron tratados con TbA. Evaluamos los síntomas y los signos del epiblefaron, previo y posterior al tratamiento. RESULTADOS: Se incluyó a un total de 40 pacientes (28 niñas [70%]). La edad media de presentación fue 11 meses (rango 4-24). Se trataron 76 párpados con TbA. Obtuvimos una mejoría estadísticamente significativa de los síntomas, del contacto cilio corneal y de la afectación corneal tras la aplicación de 5 unidades de TbA. El periodo medio de seguimiento fue de 25,55 semanas (rango 4-92). CONCLUSIONES: Con este estudio demostramos que la aplicación de TbA es un tratamiento efectivo y seguro para la corrección del epiblefaron sintomático en niños menores de 2 años

INTRODUCTION: Epiblepharon is a congenital eyelid malposition due to a horizontal skin fold and a redundant orbicular muscle, resulting in the inward positioning of the eyelashes. OBJECTIVE: Personal experience is presented of the non-surgical correction of symptomatic epiblepharon using a pretarsal injection of 5 IU of botulinum toxin type A (BoNT-A) into the orbicular muscle. MATERIAL AND METHODS: Patients with epiblepharon younger than 2 year were included in the study. A review was made of their clinical charts and the symptoms and signs of epiblepharon were evaluated before and after treatment with BoNT-A. RESULTS: A total of 40 patients were included (28 girls [70%]). The mean age at treatment was 11 months (range, 4-24 months). A total of 76 eyelids were treated with BoNT-A. A statistically significant improvement in symptoms, lash-corneal touch, and punctate corneal epitheliopathy were reported after the treatment with 5IU BoNT-A. The mean final follow-up was 25.5 weeks (range, 4-92 months). CONCLUSIONS: The present study provides evidence that a pretarsal BoNT-A injection is an effective and safe treatment for the correction of symptomatic epiblepharon in patients younger than 2 years of age

Treatment of symptomatic epiblepharon with Botulinum toxin type A in patients under 2years of age. / Experiencia del uso de la toxina botulínica tipo A para el tratamiento sintomático del epiblefaron en pacientes menores de 2 años.

INTRODUCTION: Epiblepharon is a congenital eyelid malposition due to a horizontal skin fold and a redundant orbicular muscle, resulting in the inward positioning of the eyelashes. OBJECTIVE: Personal experience is presented of the non-surgical correction of symptomatic epiblepharon using a pretarsal injection of 5 IU of botulinum toxin type A (BoNT-A) into the orbicular muscle. MATERIAL AND METHODS: Patients with epiblepharon younger than 2 year were included in the study. A review was made of their clinical charts and the symptoms and signs of epiblepharon were evaluated before and after treatment with BoNT-A. RESULTS: A total of 40 patients were included (28 girls [70%]). The mean age at treatment was 11 months (range, 4-24 months). A total of 76 eyelids were treated with BoNT-A. A statistically significant improvement in symptoms, lash-corneal touch, and punctate corneal epitheliopathy were reported after the treatment with 5IU BoNT-A. The mean final follow-up was 25.5 weeks (range, 4-92 months). CONCLUSIONS: The present study provides evidence that a pretarsal BoNT-A injection is an effective and safe treatment for the correction of symptomatic epiblepharon in patients younger than 2 years of age.

Granulomatosis con poliangeítis localizado en la glándula lagrimal, a propósito de un caso / Granulomatosis with polyangiitis confined to lacrimal gland, a case report

Caso clínico: Mujer de 43 años, consulta por aumento de volumen orbitario superolateral izquierdo, doloroso, eritematoso de 2 meses de evolución. Se realiza biopsia escisional revelando vasculitis con poliangeítis de glándula lagrimal. El estudio sistémico no reveló compromiso de otros órganos. Discusión: El compromiso orbitario ocurre hasta en el 60% de los pacientes con granulomatosis con poliangeítis. La afección de la glándula lagrimal es rara, y frecuentemente unilateral. Las pruebas serológicas generalmente son negativas, tanto en etapas iniciales, como en las formas localizadas de la enfermedad (AU)

Clinical case: A 43 year-old woman consulted due to 2 months of swelling on the superolateral side of the left orbit, with pain and erythema. An excisional biopsy was performed that revealed vasculitis with polyangiitis of the lacrimal gland. A systemic study showed that no other system was compromised. Discussion: Orbital involvement occurs in up to 60% of patients with granulomatosis with polyangiitis. The involvement of the lacrimal gland is rare and often unilateral. Serological tests are generally negative, both in initial stages, as in localized forms of the disease (AU)

Cirugía de evisceración ocular en un centro de alta especialidad en México: estudio retrospectivo de 7 años de experiencia / Evisceration surgery in a highly specialized center in Mexico: A retrospective study of 7 years of experience

INTRODUCCIÓN: En la actualidad la evisceración se está convirtiendo en la técnica de elección en el tratamiento de ciertas enfermedades oculares, como un ojo ciego doloroso, endoftalmitis, entre otras. Para la rehabilitación de la cavidad anoftálmica los implantes más utilizados actualmente son los de hidroxiapatita y polietileno poroso. OBJETIVO: Describir las indicaciones, tipo de material del implante utilizado y complicaciones en la cirugía de evisceración. MÉTODOS: Estudio retrospectivo, observacional, descriptivo, basado en expedientes clínicos de pacientes sometidos a evisceración entre 2008 y 2015 en el Instituto Fundación Conde de Valenciana. RESULTADOS: Se realizaron 186 cirugías de evisceración. El 52,7% de los pacientes eran hombres. El promedio de edad fue 54 años. El ojo derecho fue eviscerado en el 53% de los casos, el 79,2% presentaba una visión de no percepción de luz. La mayoría presentaba dolor preoperatorio.El diagnóstico más frecuente por el cual se realizó la evisceración fue endoftalmitis. Se reportaron 20 ojos en phthisis bulbi. En el 86,81% de los casos se colocó un implante primario. El 34,81% fue de polietileno poroso. Cuatro casos presentaron extrusión del implante, en 2 casos de polietileno poroso. La prótesis ocular fue tolerada en el 91% de los casos. No hubo casos de oftalmía simpática. CONCLUSIÓN: La evisceración se muestra como una alternativa a la enucleación en casos donde la esclerótica pueda preservarse, mostrando baja incidencia de oftalmía simpática

INTRODUCTION: Evisceration is currently becoming the technique of choice in the treatment of certain eye diseases, including, among others, painful blind eye and endophthalmitis. The most widely used implants are currently the hydroxyapatite and porous polyethylene for the rehabilitation of the anophthalmic socket. OBJECTIVE: To describe the indications, type of implant material used, and complications in evisceration surgery. METHODS: A retrospective, observational, descriptive study based on clinical records of patients that underwent evisceration between 2008 and 2015 in the Instituto Fundación Conde de Valenciana, Mexico. RESULTS: A total of 186 evisceration surgeries were performed, of which 52.7% of the patients were men. The mean age was 54 years. The right eye was eviscerated in 53% of cases, and 79.2% had a vision of no light perception. Most patients had preoperative pain. The most common diagnosis for which evisceration was performed was endophthalmitis. Phthisis bulbi was reported in 20 eyes. A primary implant was inserted in 86.81% of the cases, with 34.81% of the implants being made of porous polyethylene. Four cases showed extrusion of the implant, with 2 cases of porous polyethylene. The ocular prosthesis was tolerated in 91% of cases. There were no cases of sympathetic ophthalmia. CONCLUSION: Evisceration is shown to be a good alternative to enucleation in cases where the sclera can be preserved, showing a low incidence of sympathetic ophthalmia

Granulomatosis with polyangiitis confined to lacrimal gland, a case report. / Granulomatosis con poliangeítis localizado en la glándula lagrimal, a propósito de un caso.

CLINICAL CASE: A 43 year-old woman consulted due to 2 months of swelling on the superolateral side of the left orbit, with pain and erythema. An excisional biopsy was performed that revealed vasculitis with polyangiitis of the lacrimal gland. A systemic study showed that no other system was compromised. DISCUSSION: Orbital involvement occurs in up to 60% of patients with granulomatosis with polyangiitis. The involvement of the lacrimal gland is rare and often unilateral. Serological tests are generally negative, both in initial stages, as in localized forms of the disease.

Evisceration surgery in a highly specialized center in Mexico: A retrospective study of 7 years of experience. / Cirugía de evisceración ocular en un centro de alta especialidad en México: estudio retrospectivo de 7 años de experiencia.

INTRODUCTION: Evisceration is currently becoming the technique of choice in the treatment of certain eye diseases, including, among others, painful blind eye and endophthalmitis. The most widely used implants are currently the hydroxyapatite and porous polyethylene for the rehabilitation of the anophthalmic socket. OBJECTIVE: To describe the indications, type of implant material used, and complications in evisceration surgery. METHODS: A retrospective, observational, descriptive study based on clinical records of patients that underwent evisceration between 2008 and 2015 in the Instituto Fundación Conde de Valenciana, Mexico. RESULTS: A total of 186 evisceration surgeries were performed, of which 52.7% of the patients were men. The mean age was 54 years. The right eye was eviscerated in 53% of cases, and 79.2% had a vision of no light perception. Most patients had preoperative pain. The most common diagnosis for which evisceration was performed was endophthalmitis. Phthisis bulbi was reported in 20 eyes. A primary implant was inserted in 86.81% of the cases, with 34.81% of the implants being made of porous polyethylene. Four cases showed extrusion of the implant, with 2 cases of porous polyethylene. The ocular prosthesis was tolerated in 91% of cases. There were no cases of sympathetic ophthalmia. CONCLUSION: Evisceration is shown to be a good alternative to enucleation in cases where the sclera can be preserved, showing a low incidence of sympathetic ophthalmia.