Epithelial inclusion cyst secondary to glaucoma surgery: A case series.

Epithelial inclusion cysts (EIC) are a rare ocular disease and its physiopathology is not well-known. They consist on growths of ocular surface epithelial cells inside the anterior segment of the eye in the form of a cyst. To date several cases have been published in the literature, none of them related to glaucoma surgery. We describe two cases of EIC after glaucoma devices implantation. An 86 year-old male patient with primary open angle glaucoma develop an EIC in right eye three years after removal of PRESERFLO™ MicroShunt (Santen, Osaka, Japan) and a 9 year-old female patient with glaucoma secondary to uveitis for juvenile idiopathic arthritis develops an EIC under the tube of an Ahmed valve implant during postoperative period. EIC develop after ocular penetrating wounds and an inflammatory stimulus. They are benign proliferations, follow-up is necessary to detect space complications early, so less mutilating surgery is needed for removal.

[Relationship between frailty and functional status in lung transplant candidates]. / Relación entre la fragilidad y la capacidad funcional en los pacientes candidatos a trasplante de pulmón.

INTRODUCTION: Lung transplant (LT) is one of the therapeutic options for patients with terminal respiratory diseases. It is highly important to incorporate the functional status and frailty assessment into the selection process of candidates for LT. OBJECTIVES: Identify the prevalence of frailty in the LT waiting list. Study the relationship between frailty, functional status, Lung Allocation Score (LAS) and muscular dysfunction. METHODOLOGY: Descriptive transversal study of patients on the waiting list for LT. POPULATION: 74 patients with chronic respiratory diseases assessed by the lung transplant committee and accepted to be transplanted in a university hospital in Barcelona. The outcome variables were frailty status was evaluate for SPPB test, functional capacity was evaluate for the six-minute walking test (6MWT) and muscular dysfunction. The results were analyzed with the statistical package STATA 12. RESULTS: Sample of 48 men and 26 women, with a median age of 56.55 years (SD 10.87. The prevalence of frailty assessed with the SPPB was 33.8% (8.1% are in frailty and 25.7% are in a state of pre-frailty). There is a relationship between the SPPB, 6MWT and maximal inspiratory pressure, but not with others force values. There is a relationship between the risk of frailty (scores below 9 in SPPB) and the meters walked in 6 but not with the LAS. CONCLUSIONS: The risk of frailty in patients with terminal chronic respiratory diseases is high. Frailty is related with functional capacity, but not with LAS.

Algoritmo de movilización temprana para el paciente crítico. Recomendaciones de expertos / Early mobilisation algorithm for the critical patient. Expert recommendations

Introducción La debilidad adquirida en la unidad de cuidados intensivos (DAU) es desarrollada por el 40-46% de los pacientes ingresados en UCI. Diferentes estudios han mostrado que la movilización temprana (MT) es segura, factible, costo-efectiva y mejora los resultados del paciente a corto y largo plazo. Objetivo Diseñar un algoritmo de MT para el paciente crítico en general y enumerar unas recomendaciones para la MT en subpoblaciones específicas de paciente crítico con más riesgo para la movilización: neurocrítico, traumático, sometido a terapias continuas de depuración renal (TCDR) y con dispositivos de asistencia ventricular (DAV) o membrana de oxigenación extracorpórea (ECMO). Metodología Revisión en las bases de datos Medline, CINAHL, Cochrane y PEDro de estudios publicados en los últimos 10 años, que aporten protocolos/intervenciones de MT. Resultados Se incluyeron 30 artículos. De ellos, 21 eran para guiar la MT en el paciente crítico en general, 7 en pacientes neurocríticos y/o traumáticos, uno en pacientes portadores de TCDR y uno en pacientes portadores de ECMO y/o DVA. Se diseñan 2 figuras: una para la toma de decisiones teniendo en cuenta el bundle ABCDEF y la otra con los criterios de seguridad y objetivo de movilidad para cada uno. Conclusiones Los algoritmos de MT aportados pueden promover la movilización precoz (entre el 1.er y 5.o día de ingreso en UCI), junto a aspectos a tener en cuenta antes de la movilización y criterios de seguridad para suspenderla. (AU)

Introduction Intensive care unit (ICU)-acquired weakness is developed by 40%-46% of patients admitted to ICU. Different studies have shown that Early Mobilisation (EM) is safe, feasible, cost-effective and improves patient outcomes in the short and long term. Objective To design an EM algorithm for the critical patient in general and to list recommendations for EM in specific subpopulations of the critical patient most at risk for mobilisation: neurocritical, traumatic, undergoing continuous renal replacement therapy (CRRT) and with ventricular assist devices (VAD) or extracorporeal membrane oxygenation (ECMO). Methodology Review undertaken in the Medline, CINAHL, Cochrane and PEDro databases of studies published in the last 10 years, providing EM protocols/interventions. Results 30 articles were included. Of these, 21 were on guiding EM in critical patients in general, 7 in neurocritical and/or traumatic patients, 1 on patients undergoing CRRT and 1 on patients with ECMO and/or VAD. Two figures were designed: one for decision-making, taking the ABCDEF bundle into account and the other with the safety criteria and mobility objective for each. Conclusions The EM algorithms provided can promote early mobilisation (between the 1st and 5th day from admission to ICU), along with aspects to consider before mobilisation and safety criteria for discontinuing it. (AU)

Early mobilisation algorithm for the critical patient. Expert recommendations.

INTRODUCTION: Intensive care unit (ICU)-acquired weakness is developed by 40%-46% of patients admitted to ICU. Different studies have shown that Early Mobilisation (EM) is safe, feasible, cost-effective and improves patient outcomes in the short and long term. OBJECTIVE: To design an EM algorithm for the critical patient in general and to list recommendations for EM in specific subpopulations of the critical patient most at risk for mobilisation: neurocritical, traumatic, undergoing continuous renal replacement therapy (CRRT) and with ventricular assist devices (VAD) or extracorporeal membrane oxygenation (ECMO). METHODOLOGY: Review undertaken in the Medline, CINAHL, Cochrane and PEDro databases of studies published in the last 10 years, providing EM protocols/interventions. RESULTS: 30 articles were included. Of these, 21 were on guiding EM in critical patients in general, 7 in neurocritical and/or traumatic patients, 1 on patients undergoing CRRT and 1 on patients with ECMO and/or VAD. Two figures were designed: one for decision-making, taking the ABCDEF bundle into account and the other with the safety criteria and mobility objective for each. CONCLUSIONS: The EM algorithms provided can promote early mobilisation (between the 1st and 5th day from admission to ICU), along with aspects to consider before mobilisation and safety criteria for discontinuing it.

Poor re-epithelialization following corneal collagen crosslinking with riboflavin-uva for advanced bullous keratopathy: Case series.

OBJECTIVE: To assess safety and efficacy of corneal collagen crosslinking (CXL) for advanced bullous keratopathy (BK). MATERIAL AND METHODS: Eight eyes of eight patients subjected to Dresden CXL protocol. INCLUSION CRITERIA: BK history of at least one year, severe pain and no indication for keratoplasty due to poor visual prognosis. VARIABLES: best corrected visual acuity (BCVA), pain (decimal visual scale), central corneal thickness (CCT) by tomography (Pentacam®, Oculus Inc, Germany), corneal bullae and complications. RESULTS: Seven women and one man of median age 77.00 (range 58-79) years. The median follow-up was 7 (range 5-7) months. BCVA remained unchanged through follow-up. A significant decrease in pain was observed at the end of the follow-up period (median 6, range 5-6 vs. median 0, range 0-4, P=0.05). Corneal tomography could only be performed in three cases, due to poor vision or image quality. A reduction in mean CCT was observed in the first post procedural month (from 708.33±140.48 to 627±136.89µm). In all eight cases, the absence of corneal bullae only persisted for two months after CXL. In six patients, corneal re-epithelialization after CXL was poor; in four of these eyes, the problem was resolved with topical treatment, but in the remaining two eyes, amniotic membrane transplant and mechanical debridement were required. CONCLUSIONS: In this uncontrolled small case series, CXL treatment improved pain in patients with advanced BK. However, the high rate of poor re-epithelialization requiring surgical treatment observed in one third of cases makes this treatment controversial.

Corneal densitometry and topography in patients with primary congenital glaucoma.

OBJECTIVE: To compare corneal densitometry and topography variables in patients with primary congenital glaucoma (PCG) and healthy subjects. MATERIAL AND METHODS: Cross sectional study, consecutive recruitment with gender- and age-matched control group. Forty eyes of 40 patients in each group were studied with Pentacam corneal topography. The variables compared between the two groups were: intraocular pressure (IOP), visual acuity (VA) and Pentacam (Oculus, Wetzlar, Germany) corneal topography measurements: mean and maximum keratometry (Km, Kmax), cylinder (Cyl), anterior elevation apex (AEA), central anterior elevation (CAE), maximum anterior elevation (MAE), posterior elevation apex (PEA), central posterior elevation (CPE), maximum posterior elevation (MPE), pachymetry and anterior, mid-stromal and posterior corneal densitometry in the 0-2mm, 2-6mm, 6-10mm zones. RESULTS: Significant differences between patients and healthy controls were detected in the topographic variables MAE (P=0.002) and MPE (P<0.001), and in all the densitometry variables (anterior, mid-stromal, posterior for the 0-2mm, 2-6mm and 6-10mm zones) (P<0.001 each). In the PCG group, negative correlation was observed between VA and total densitometry (r=-0.49; P=0.004). CONCLUSION: Patients with PCG and healthy subjects display differences in corneal densitometry and topographic measurements. PCG patients show greater corneal density with an inverse relationship between visual acuity and higher elevation (anterior and posterior values).

Parálisis oculomotoras en el contexto de una reactivación del virus varicela-zóster: a propósito de 4 casos / Oculomotor nerve palsy in herpes zoster ophthalmicus: Presentation of 4 cases

La infección por el virus varicela-zóster (VVZ) tiene una alta prevalencia a nivel mundial. De las muchas manifestaciones oftalmológicas que puede manifestar, la diplopía de aparición brusca es una de ellas. Revisamos 4 casos clínicos de mononeuritis del III y VI par craneales en el contexto de vesículas herpéticas por el VVZ y revisamos la fisiopatología y las manifestaciones clínicas más importantes. Es obligado para el oftalmólogo descartar complicaciones mediante pruebas de imagen y el correcto tratamiento con antivirales sistémicos

Varicella zoster virus (VZV) infection has a high prevalence worldwide. Within the multiple ophthalmologic manifestations that VZV can cause, sudden diplopia is among them. A review is presented of four clinical cases of 3rd and 4th oculomotor nerve palsies in herpes zoster ophthalmicus. A review is also presented of the physiopathology and most important clinical manifestations. Imaging tests are essential in order to rule out complications. Systemic antiviral administration is the correct treatment

Oculomotor nerve palsy in herpes zoster ophthalmicus: Presentation of 4 cases. / Parálisis oculomotoras en el contexto de una reactivación del virus varicela-zóster: a propósito de 4 casos.

Varicella zoster virus (VZV) infection has a high prevalence worldwide. Within the multiple ophthalmologic manifestations that VZV can cause, sudden diplopia is among them. A review is presented of four clinical cases of 3rd and 4th oculomotor nerve palsies in herpes zoster ophthalmicus. A review is also presented of the physiopathology and most important clinical manifestations. Imaging tests are essential in order to rule out complications. Systemic antiviral administration is the correct treatment.

Searching for Rheological Conditions for FFF 3D Printing with PVC Based Flexible Compounds.

Rheology is proposed as a tool to explore plasticized poly(vinyl chloride) (PVC) formulations to be used in the fused filament fabrication (FFF) 3D printing process and so manufactures flexible and ductile objects by this technique. The viscoelastic origin of success/failure in FFF of these materials is investigated. The analysis of buckling of the filament is based on the ratio between compression modulus and viscosity, but for a correct approach the viscosity should be obtained under the conditions established in the nozzle. As demonstrated by small amplitude oscillatory shear (SAOS) measurements, PVC formulations have a crystallites network that provokes clogging in the nozzle. This network restricts printing conditions, because only vanishes at high temperatures, at which thermal degradation is triggered. It is observed that the analysis of the relaxation modulus G(t) is more performing than the G″/G' ratio to get conclusions on the quality of layers welding. Models printed according to the established conditions show an excellent appearance and flexibility, marking a milestone in the route to obtain flexible objects by FFF.

"Ears of the Lynx" MRI Sign Is Associated with SPG11 and SPG15 Hereditary Spastic Paraplegia.

BACKGROUND AND PURPOSE: The "ears of the lynx" MR imaging sign has been described in case reports of hereditary spastic paraplegia with a thin corpus callosum, mostly associated with mutations in the spatacsin vesicle trafficking associated gene, causing Spastic Paraplegia type 11 (SPG11). This sign corresponds to long T1 and T2 values in the forceps minor of the corpus callosum, which appears hyperintense on FLAIR and hypointense on T1-weighted images. Our purpose was to determine the sensitivity and specificity of the ears of the lynx MR imaging sign for genetic cases compared with common potential mimics. MATERIALS AND METHODS: Four independent raters, blinded to the diagnosis, determined whether the ears of the lynx sign was present in each of a set of 204 single anonymized FLAIR and T1-weighted MR images from 34 patients with causal mutations associated with SPG11 or Spastic Paraplegia type 15 (SPG15). 34 healthy controls, and 34 patients with multiple sclerosis. RESULTS: The interrater reliability for FLAIR images was substantial (Cohen κ, 0.66-0.77). For these images, the sensitivity of the ears of the lynx sign across raters ranged from 78.8 to 97.0 and the specificity ranged from 90.9 to 100. The accuracy of the sign, measured by area under the receiver operating characteristic curve, ranged from very good (87.1) to excellent (93.9). CONCLUSIONS: The ears of the lynx sign on FLAIR MR imaging is highly specific for the most common genetic subtypes of hereditary spastic paraplegia with a thin corpus callosum. When this sign is present, there is a high likelihood of a genetic mutation, particularly associated with SPG11 or SPG15, even in the absence of a family history.

Haab striae: Optical coherence tomographic analysis.

PURPOSE: To study Haab striae in adults with primary congenital glaucoma and describe them by anterior segment optical coherence tomography, as well as analyze their evolution over the patient's lifetime. MATERIAL AND METHODS: Three patients with primary congenital glaucoma were recruited, aged between 17 and 48 years old, with incidentally noted Haab striae on glaucoma consultation. They were studied by: slit lamp; anterior segment optical coherence tomography, Heidelberg Engineering Inc., Germany, (with anterior segment module) and Cirrus HD-OCT, Carl Zeiss Meditec, Dublin, California, USA (with 3D reconstruction); and specular biomicroscopy. The results obtained were contrasted with other studies performed in children. RESULTS: Rounded excrescences protruding towards the anterior chamber were found, as well as dense, irregular tissue between them. In addition, endothelial abnormalities (polymegathism and polymorphism) were found. These findings fit the evolution of those obtained in pediatric studies and remain stable in adult life. CONCLUSIONS: Through noninvasive methods such as optical coherence tomography and specular biomicroscopy, it is possible to make the diagnosis and follow up these patients. The findings suggest posterior corneal topographic changes; additional studies on this subject may be necessary.

Cuerpos extraños intraoculares tras cirugía de catarata / Intraocular foreign bodies after cataract surgery

La presencia de cuerpos extraños intraoculares tras la cirugía de catarata es relativamente frecuente y son muchos los casos publicados en la literatura sobre este tema. Nos podemos encontrar con varios tipos de cuerpos extraños, de diversos materiales y algunos de ellos con capacidad de producir graves efectos secundarios. Se recomienda su extracción cuando es posible, siempre individualizando cada caso, así como extremar las medidas preventivas en todas las cirugías. En este trabajo hacemos una revisión del tema que consideramos de importancia por las posibles complicaciones oculares que pueden generarse

Intraocular foreign bodies after cataract surgery are relatively frequent, and there are many cases published in the literature on this topic. Different kinds of foreign bodies of various materials can be found, and some of them with the ability to produce side effects. Their extraction is recommended whenever possible, always individualising each case. It also recommended to carry out preventive measures in all surgeries for their prevention. In this work a review is presented on the topic, considered important due to the possible ocular complications that can occur

Biomicroscopia confocal en 4 pacientes con distrofia corneal policromática / Confocal biomicroscopy in four patients with polychromatic corneal dystrophy

INTRODUCCIÓN: La distrofia corneal policromática es una rara distrofia predescemética, con pocos casos publicados. Presentamos los hallazgos encontrados mediante lámpara de hendidura, biomicroscopia especular y confocal en una serie de 4 casos de esta entidad. Casos clínicos: Se trata de 4 mujeres de entre 36 y 72 años, diagnosticadas de distrofia corneal policromática en revisiones rutinarias. Ninguna refería síntomas visuales ni antecedentes oculares de interés. La biomicroscopia anterior objetivó múltiples y pequeñas opacidades brillantes multicolores en la zona posterior del estroma corneal, con respeto epitelial y estromal anterior. Las opacidades eran bilaterales y distribuidas por toda la córnea. Se exploró a familiares directos, los cuales no presentaban opacidades. En la biomicroscopia especular se observaba un endotelio normal con partículas hiperreflectivas predesceméticas. En la microscopia confocal no se objetivaron alteraciones en epitelio, capa de Bowman y plexo nervioso subbasal. En 2 casos se apreciaban en el estroma anterior queratocitos hiperreflectivos y pequeñas partículas hiperreflectivas entre ellos. En cuanto al estroma medio, aparecían queratocitos hiperreflectivos en los 4 casos, partículas hiperreflectivas de pequeño tamaño en 2 y en los otros 2 existían queratocitos anormales con procesos prominentes. El estroma posterior en los 4 casos mostró gran cantidad de queratocitos hiperreflectivos y de partículas hiperreflectivas de distintos tamaños. Tales partículas impedían la exploración del endotelio. CONCLUSIONES: La distrofia corneal policromática presenta signos típicos en la exploración, que permiten su diagnóstico y caracterización. Aunque la imagen biomicroscópica parece evidenciar alteraciones solo en el estroma posterior, la microscopia confocal demuestra que la distrofia afecta a todo el estroma corneal

INTRODUCTION: Polychromatic corneal dystrophy is an unusual pre-descemet dystrophy, about which there are very few publications. The findings are presented in a case series of four patients with polychromatic corneal dystrophy, using a slit lamp, specular biomicroscopy, and confocal microcospy. Clinical cases: Four women, between 36 and 72 year-old, with the diagnosis of polychromatic corneal dystrophy in routine reviews. None reported visual symptoms or ocular history of interest. Anterior biomicroscopy showed multiple and small multicoloured brilliant opacities in the posterior area of the corneal stroma, with normal epithelium and anterior stroma. The opacities were bilateral and distributed throughout the entire cornea. Direct family members were examined, but none of them showed opacities. In the specular biomicroscopy, a normal endothelium, with pre-descemet hypereflective particles, was observed. With confocal microscopy, there were no abnormalities in epithelium, Bowman layer, or sub-basal nervous plexus. In two cases, the anterior stroma showed hyper-reflective keratocytes and with small hypereflective particles among them. In the middle stroma, hyper-reflective keratocytes were seen in the four cases, two of them showed tiny hypereflective particles, and in the other two there were abnormal keratocytes with prominent cytoplasmic processes. Posterior stroma in the four cases showed a lot of hypereflective keratocytes and hypereflective particles of different sizes. These particles prevented examining the endothelium. CONCLUSIONS: Polychromatic corneal dystrophy has typical signs that allow it to be diagnosed and characterised. Although the biomicroscopy image only seems to show alterations in the posterior stroma, confocal microscopy shows that the dystrophy affects the entire corneal stroma

Intraocular foreign bodies after cataract surgery. / Cuerpos extraños intraoculares tras cirugía de catarata.

Intraocular foreign bodies after cataract surgery are relatively frequent, and there are many cases published in the literature on this topic. Different kinds of foreign bodies of various materials can be found, and some of them with the ability to produce side effects. Their extraction is recommended whenever possible, always individualising each case. It also recommended to carry out preventive measures in all surgeries for their prevention. In this work a review is presented on the topic, considered important due to the possible ocular complications that can occur.