Factors predicting successful customized excimer laser treatment in irregular corneas.

PURPOSE: To identify factors associated with a successful wavefront-guided customized treatment (WG-CT) with an excimer laser in highly aberrated corneas. SETTING: VISSUM Alicante Spain. DESIGN: Retrospective consecutive noncomparative case series. METHODS: Treatment was performed with the WG-CT Amaris excimer laser using the ORK-CAM software for the calculation of the ablation profile. Eyes of patients with significantly aberrated corneas, including postrefractive and keratoplasty procedures or high irregular astigmatism with significant higher-order aberrations (HOAs) that had WG-CT were included. Refractive outcomes, HOAs, and visual outcomes were recorded. Statistical analysis was performed to identify factors associated with technical (based on HOAs) or refractive outcome success. RESULTS: The study included 55 treatments of 51 eyes (35 patients). The postoperative uncorrected distance visual acuity was 0.2 logarithm of the minimum angle of resolution or better in 72% of the eyes, and the postoperative residual manifest refraction spherical equivalent was ±0.50 diopter in 56% of the eyes, whereas 11% of the eyes lost 1 line or more in corrected distance visual acuity. Successful reduction in the total root mean square (RMS) of HOAs occurred in 36 eyes (65%), and these eyes had a significantly higher preoperative RMS of HOAs (1.45 ± 0.93 µ vs 0.91 ± 0.34 µ, P = .003) and preoperative coma-like aberrations (1.09 ± 0.83 µ vs 0.55 ± 0.28 µ, P = .001). In multivariate analysis, posthyperopic treatment eyes were less likely to achieve refractive outcome success (odds ratio = 0.09, P = .02). CONCLUSIONS: WG-CT in highly aberrated corneas had a limited refractive predictability. Eyes with preoperative coma-like aberrations are more likely to benefit from a reduction in HOAs. Posthyperopic treatment is associated with a higher rate of refractive surprises.

Dermatosis ampollosa a distancia en pacientes tratados con heparina / Bullous dermatosis at distant sites in patients treated with heparin

Desde que en el año 2006 Perrinaud describiera por primera vez 3 pacientes con ampollas hemorrágicas en relación con el uso de heparinas, han sido numerosos los casos publicados hasta la fecha, pasando en pocos años a constituir un proceso patológico claramente definido. Hacemos una revisión de todos los casos reportados, repasamos las claves diagnósticas y aquellas características que las diferencian de otras manifestaciones cutáneas provocadas por heparinas, cuyo pronóstico es más grave y su identificación resulta crucial (AU)

Since Perrinaud in 2006 first described three patients with hemorrhagic bullae in relation to the use of heparins, numerous cases have been published. Currently, this entity has been established as a clearly defined pathology. We review all reported cases, diagnostic features and features that differentiate it from other skin manifestations caused by heparin having a worse prognosis and requiring a precise identification (AU)

[Bullous dermatosis at distant sites in patients treated with heparin]. / Dermatosis ampollosa a distancia en pacientes tratados con heparina.

Since Perrinaud in 2006 first described three patients with hemorrhagic bullae in relation to the use of heparins, numerous cases have been published. Currently, this entity has been established as a clearly defined pathology. We review all reported cases, diagnostic features and features that differentiate it from other skin manifestations caused by heparin having a worse prognosis and requiring a precise identification.

Anterior segment biometry with 2 imaging technologies: very-high-frequency ultrasound scanning versus optical coherence tomography.

PURPOSE: To determine the interchangeability of 2 anterior segment imaging systems: a very-high-frequency (VHF) ultrasound scanning system (Artemis 2, Ultralink LLC) and an optical coherence tomography (OCT) system (Visante, Zeiss). SETTING: Vissum Instituto Oftalmologico de Alicante, Alicante, Spain. METHODS: This study comprised 20 eyes without pathology or previous surgery. The anterior chamber depth (ACD), central corneal thickness (CCT), angle-to-angle distance (ATA), and the iridocorneal angle size (IAS) at the 0-degree and 180-degree positions were measured with 2 imaging techniques: VHF ultrasound scanning and OCT. Analysis of agreement and interchangeability was performed by the Bland and Altman method. In addition, each measurement was performed 3 times consecutively to determine intrasession repeatability by means of the coefficient of variation (CV) and the intraclass correlation coefficient (ICC). RESULTS: No statistically significant differences were found between imaging techniques in ACD, CCT, or ATA (P>.40). The ranges of agreement were 0.20 mm, 16.11 mum, and 0.80 mm for ACD, CCT, and ATA, respectively. Regarding IAS, no statistically significant differences were found in the nasal (P = .78) or temporal (P = .63) measurements between devices. However, the range of agreement for nasal (14.3 degrees) and temporal (14.90 degrees) values was relevant, indicating the 2 techniques cannot be used interchangeably for IAS measurement. Excellent intrasession repeatability scores were obtained (CV and ICC). CONCLUSION: The Artemis 2 and the Visante OCT systems provide equivalent and repeatable measurements of the ACD, CCT, and ATA and can be used interchangeably for these purposes.