[Acrysof(®) toric intraocular lens implantation in cataract surgery]. / Implante de lentes intraoculares tóricas Acrysof(®) en cirugía de la catarata.

AIM: To assess the medium term outcomes of Acrysof(®) toric intraocular lens implantation in 54 patients (54 eyes). METHODS: Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), preoperative astigmatism, residual postoperative astigmatism, and global average and model-specific intraocular lens (IOL) rotation grade were analyzed. RESULTS: At 2-months of follow-up,the mean UCVA was 0.83 (SD: 0.14) Snellen scale, with 73.9% of the patients ≥0.8, and 32.6% with 1.0. Mean BCVA achieved was 0.94 (SD: 0.10). Mean preoperatory astigmatism was -2.25 diopters (D) (SD: 0.78), and mean postoperative astigmatism was -0.32 D (SD: 0.56), with significant differences between both groups (p<0.001). Model-specific mean residual astigmatism was -0.1 D for T3, -0.27 D for T4 and -0.43 D for T5, without significant differences between the three models (p=0.483). Mean IOL-axis rotation grade was 3.87±3.25 degrees, with 91.6% of implanted lens within 10° of predicted axis. DISCUSSION: T3, T4 and T5 Acrysof(®) Toric intraocular lenses can correct preoperative astigmatism with a high success rate in terms of UCVA, and residual postoperative astigmatism, with minimum IOL-rotation grade at 2 months follow-up period.

[Amniotic membrane transplantation with fibrin glue as treatment of refractory conjunctivochalasis]. / Injerto de membrana amniótica con adhesivo tisular en el tratamiento de la conjuntivocalasia refractiva.

CASE REPORT: A 63-year-old man with bilateral conjunctivochalasis presented with tearing, irritation, foreign body sensation and a delayed fluorescein clearance test. After no symptomatic improvement with topical treatment, surgery was carried out, with amniotic membrane transplantation and fibrin sealant. DISCUSSION: Conjunctivochalasis is a frequent disorder that shares symptoms with dry eye syndrome. When there is no response to topical treatment, surgical treatment is needed. The surgical technique described by Tseng, and based on amniotic membrane transplantation without suture, resulted in a very useful response, due to less inflammation and a rapid resolution and improvement of symptoms.

[Traumatic submacular hemorrhage treated with rt-PA and SF6]. / Hemorragia submacular traumática tratada con rt-PA y SF6.

CASE REPORT: This patient was afflicted by a traumatic submacular hemorrhage. A posterior vitrectomy was performed and intravitreal rt-PA and SF6 were administered. Four weeks later, the visual acuity had increased from 0.1 to 0.8. No complications due to the treatment with rt-PA were reported. DISCUSSION: It is known that waiting for the spontaneous blood removal in such cases results in a poor visual acuity recovery due to a toxic effect of the blood products. Both rt-PA and the SF6 are useful for the treatment of submacular hemorrhages secondary to age-related macular degeneration, and this case report has shown they are also useful to lyse traumatic blood clots, thus contributing to a better recovery of visual acuity.

[Comparison of dynamic contour tonometry (Pascal) with pneumotonometry and Goldmann tonometry]. / Comparación del tonómetro Pascal con el neumotonómetro y el tonómetro Goldmann.

PURPOSE: To compare the intraocular pressure measurements as defined by the Pascal tonometer, the Goldmann tonometer and the pneumotonometer. METHODS: This was an observational clinical study, which included two hundred and five randomly selected subjects recruited from the Ophthalmology Department. The intraocular pressure measurements were performed with each tonometry technique in a randomized order. RESULTS: The Pascal's intraocular pressure measurement was significantly higher than that measured by the other two tonometers (p<0.05). The quality data of Pascal was: optimum in 27.3% (56 of 205 patients), acceptable in 42% (86 of 205 patients) and unacceptable in 23.4% (48 of 205 patients). In 7.3% (15 of 205 patients) it was impossible to obtain any measurement using Pascal. A weak correlation coefficient between the Pascal and the Goldmann, and between Pascal and the pneumotonometer was found. The Bland-Altman method of measurement using these tonometers showed a high degree of discordance. CONCLUSION: As reported by others authors, the Pascal's intraocular pressure measurement is higher than that of the Goldmann tonometer. The measurement differs from 0.7 to 4.4 mmHg. In corneas with pathology, it is very difficult or even unacceptable to measure the intraocular pressure using the Pascal tonometer.

[Branch retinal vein occlusion treated by intravitreal triamcinolone]. / Triamcinolona intravítrea en el tratamiento de la oclusión de rama venosa retiniana.

CLINICAL CASES: Five eyes with branch retinal vein occlusion (BRVO) were treated with intravitreal injection of 4 mg of triamcinolone. Four cases showed good visual acuity and macular thickness evolution after one dose. The remaining one case suffered a relapse three months later. Therefore a second injection was performed in that case. DISCUSSION: Several treatments have been suggested to manage macular edema in BRVO. Intravitreal triamcinolone may be a therapeutic option to increase visual acuity and decrease macular thickness in patients with macular edema secondary to BRVO.

[Silicone oil hypotonic maculopathy treatment]. / Aceite de silicona para el tratamiento de la maculopatía hipotónica.

CASE REPORT: We report a case of a man who developed hypotonic maculopathy after vitreoretinal surgery for anterior proliferative vitreoretinopathy. After an injection of intravitreal triamcinolone, the ocular pressure did not increase, therefore silicone oil was injected. After this, the visual acuity increased and the choroidal and retinal folds regressed. DISCUSSION: Hypotonic maculopathy is a frustrating problem, often resulting in poor visual acuity. There are not many effective treatments. The injection of silicone oil could be an alternative to increase the intraocular pressure and re-establish the normal anatomy of the eye, improving the visual acuity in some patients.

Triamcinolona intravítrea en el tratamiento de la oclusión de rama venosa retiniana / Branch retinal vein occlusion treated by intravitreal triamcinolone

Casos clínicos: Presentamos cinco ojos con obstrucción de rama venosa retiniana (ORVR) que fueron tratados mediante la inyección intravítrea de 4 mg de triamcinolona. En cuatro de los casos la evolución de la agudeza visual y del grosor macular fue satisfactoria tras una inyección de triamcinolona. Uno de los casos presentó una recidiva tres meses después y requirió una segunda inyección de triamcinolona.Discusión: El edema macular secundario a ORVR es una causa frecuente de disminución de agudeza visual. Se han propuesto diversas alternativas terapeúticas para ésta patología. La inyección intravítrea de triamcinolona parece ser una opción terapeútica válida en estos casos

Clinical cases: Five eyes with branch retinal vein occlusion (BRVO) were treated with intravitreal injection of 4 mg of triamcinolone. Four cases showed good visual acuity and macular thickness evolution after one dose. The remaining one case suffered a relapse three months later. Therefore a second injection was performed in that case. Discussion: Several treatments have been suggested to manage macular edema in BRVO. Intravitreal triamcinolone may be a therapeutic option to increase visual acuity and decrease macular thickness in patients with macular edema secondary to BRVO

Aceite de silicona para el tratamiento de la maculopatía hipotónica / Silicone oil hypotonic maculopathy treatment

Caso clínico: Paciente con maculopatía hipotónica secundaria a vitrectomía posterior con liberación de proliferación vitreo-retiniana por desprendimiento de retina. Ante la falta de mejoría tensional a la inyección Triamcinolona intravítrea se inyectó aceite de silicona tras lo cual mejoró la agudeza visual y los pliegues coriorretinianos desaparecieron.Discusión: La maculopatía hipotónica es un proceso de mal pronóstico con deterioro visual profundo. Las opciones terapéuticas son limitadas. Creemos que la inyección de aceite de silicona es una opción terapéutica para restablecer la PIO y la anatomía normal del ojo, pudiendo mejorar, en algunos casos, la AV

Case report: We report a case of a man who developed hypotonic maculopathy after vitreoretinal surgery for anterior proliferative vitreoretinopathy. After an injection of intravitreal triamcinolone, the ocular pressure did not increase, therefore silicone oil was injected. After this, the visual acuity increased and the choroidal and retinal folds regressed. Discussion: Hypotonic maculopathy is a frustrating problem, often resulting in poor visual acuity. There are not many effective treatments. The injection of silicone oil could be an alternative to increase the intraocular pressure and re-establish the normal anatomy of the eye, improving the visual acuity in some patients

[Benign concentric annular macular dystrophy]. / Distrofia macular anular benigna.

CLINICAL CASES: Two cases of benign concentric macular dystrophy are described. In one case, ophthalmologic examination, fluorescein angiogram and visual field measurement were performed. The presence of a juxtafoveal fibrosis in the other patient, indicate that choroidal neovascularization may be associated with this type of macular dystrophy. DISCUSSION: Benign concentric macular dystrophy is an entity with well-defined ophthalmoscopic and angiographic characteristics. Usually the prognosis is good. Rarely, choroidal neovascularization can be associated with this macular dystrophy.

Distrofia Macular anular benigna / Benign concentric annular macular dystrophy

Casos clínicos: Se presentan dos casos clínicos afectos de distrofia macular anular benigna. En el primero de ellos pudimos completar la exploración oftalmoscópica y angiográfica con la realización de campimetría. En el segundo caso describimos la existencia de un área de fibrosis yuxtafoveal que refleja la posible aparición de membranas neovasculares coroideas en pacientes con esta forma de distrofia macular.Discusión: La distrofia macular anular benigna es una patología bilateral con características oftalmoscópicas y angiográficas bien definidas y que habitualmente conlleva un pronóstico visual favorable. Excepcionalmente puede asociarse la aparición de neovascularización coroidea que comprometa de forma importante la agudeza visual

Clinical cases: Two cases of benign concentric macular dystrophy are described. In one case, ophthalmologic examination, fluorescein angiogram and visual field measurement were performed. The presence of a juxtafoveal fibrosis in the other patient, indicate that choroidal neovascularization may be associated with this type of macular dystrophy.Discussion: Benign concentric macular dystrophy is an entity with well-defined ophthalmoscopic and angiographic characteristics. Usually the prognosis is good. Rarely, choroidal neovascularization can be associated with this macular dystrophy

[Prevalence and risk factors of pseudoexfoliation syndrome in institutionalized geriatric patients in Navarra]. / Prevalencia y factores de riesgo del síndrome pseudoexfoliativo en una población institucionalizada en Navarra.

PURPOSE: To establish the prevalence of pseudoexfoliation syndrome (PSX) in an institutionalized geriatric population in Navarra. To study the risk factors for the development of this disease. MATERIAL AND METHODS: 268 nursing home residents were studied, with a mean age of 81 years. The presence of PSX material in the anterior segment was best appreciated by slit lamp after pupillary dilation. We assessed its association with 13 ocular factors and 14 systemic factors. RESULTS: We found 10.1% (27) of subjects with PSX, 19 cases were unilateral and 8 bilateral. The frequency detected in subjects from Navarra was 7.9% versus 21.2% in subjects from other regions (p=0.02), although the significance was lost after multivariant logistic regression. The PSX was 3.5 times more frequent in patients suffering heart failure (p=0.01). The PSX was associated with anti-glaucomatous treatment, which multiplies the risk by 3.2 times (p=0.02); patients affected with age-related geographic macular atrophy had a 2.6 fold increased frequency (p=0.03), both after adjusting for age remained significant. We did not find any association between the PSX and other systemic factors (systemic hypertension and diabetes mellitus) or ocular factors (senile arc and cataract). CONCLUSIONS: The prevalence of PSX syndrome seems to be lower in an institutionalized population in Navarra than in other Spanish regions. The correlation with heart failure and age-related geographic macular atrophy suggests the possibility of a vascular role. The epidemiological association with increased IOP is confirmed.

Prevalencia y factores de riesgo del síndrome pseudoexfoliativo en una población institucionalizada en Navarra / Prevalence and risk factors of pseudoexfoliation syndrome in institutionalized geriatric patients in Navarra

Objetivo: Estimar la prevalencia del síndrome pseudoexfoliativo (PSX) en una población geriátrica institucionalizada en Navarra. Conocer los factores de riesgo de desarrollar esta enfermedad. Material y métodos: Fueron estudiadas 268 personas de una residencia geriátrica, con una edad media de 81 años. Se investigó la presencia de material PSX en el segmento anterior mediante biomicroscopia bajo midriasis farmacológica. Se analizó su asociación con 13 factores oculares y 14 sistémicos. Resultados: El 10,1 por ciento (27) de las personas presentaba pseudoexfoliación, en 19 casos unilateral y en 8 bilateral. La frecuencia detectada entre los nacidos en Navarra fue del 7,9 por ciento frente al 21,2 por ciento de los no navarros (p=0,02), aunque dejó de ser significativa en el análisis logístico multivariante. La PSX fue 3,5 veces más frecuente entre los pacientes con insuficiencia cardíaca (p=0,01). Se asoció con el tratamiento anti-glaucomatoso, que aumentaba el riesgo por 3,2 veces (p=0,02), y con la atrofia geográfica macular asociada a la edad que multiplicaba su frecuencia por 2,6 veces (p=0,03), ambas incluso tras estratificar por edad. No se asoció la PSX con otros factores sistémicos (HTA, diabetes mellitus, etc.) y oculares (gerontoxon, catarata, etc.). Conclusiones: La prevalencia del síndrome PSX en una población institucionalizada en Navarra parece ser inferior a otras zonas de España. La relación con la insuficiencia cardíaca y la atrofia geográfica macular sugiere un posible componente vascular. Se confirma su asociación epidemiológica con la medicación antiglaucomatosa (AU)

Purpose: To establish the prevalence of pseudoexfoliation syndrome (PSX) in an institutionalized geriatric population in Navarra. To study the risk factors for the development of this disease. Material and methods: 268 nursing home residents were studied, with a mean age of 81 years. The presence of PSX material in the anterior segment was best appreciated by slit lamp after pupillary dilation. We assessed its association with 13 ocular factors and 14 systemic factors. Results: We found 10.1% (27) of subjects with PSX, 19 cases were unilateral and 8 bilateral. The frequency detected in subjects from Navarra was 7.9% versus 21.2% in subjects from other regions (p=0.02), although the significance was lost after multivariant logistic regression. The PSX was 3.5 times more frequent in patients suffering heart failure (p=0.01). The PSX was associated with anti-glaucomatous treatment, which multiplies the risk by 3.2 times (p=0.02); patients affected with age-related geographic macular atrophy had a 2.6 fold increased frequency (p=0.03), both after adjusting for age remained significant. We did not find any association between the PSX and other systemic factors (systemic hypertension and diabetes mellitus) or ocular factors (senile arc and cataract). Conclusions: The prevalence of PSX syndrome seems to be lower in an institutionalized population in Navarra than in other Spanish regions. The correlation with heart failure and age-related geographic macular atrophy suggests the possibility of a vascular role. The epidemiological association with increased IOP is confirmed (AU)

[Adult-onset foveomacular vitelliform dystrophy]. / Distrofia foveomacular viteliforme del adulto.

CLINIC CASES: Four cases of adult-onset foveomacular vitelliform dystrophy are shown. In two cases we were able to complete the exploration under optical coherence tomography. One of the patients developed spontaneous disappearance of the subfoveal deposit in her right eye along with an important decrease in her visual acuity. DISCUSSION: Adult-onset foveomacular vitelliform dystrophy is characterized by yellowish round-shaped bilateral, lesions in the subfoveal area. Optical coherence tomography reveal the presence of a slightly elevated lesion wich affects the retinal pigment epithelium and the external layers of neurosensory retina.

Distrofia foveomacular viteliforme del adulto / Adult-onset foveomacular vitelliform dystrophy

Se presentan cuatro casos clínicos de distrofia foveomacular viteliforme del adulto (DFMVA). En dos casos pudimos completar la exploración realizando tomografía óptica de coherencia. Uno de los pacientes evolucionó hacia la desaparición espontánea del depósito subfoveal en su ojo derecho, acompañándose esto de una importante disminución de la AV del mismo ojo. Discusión: La distrofia foveomacular se caracteriza por la presencia de lesiones redondeadas, bilaterales, de color amarillento y localización subfoveal. Las imágenes de tomografía óptica de coherencia, muestran la existencia de una lesión redondeada que afecta al epitelio pigmentario y a las capas más externas de la retina neurosensorial (AU)

[Transpupillary thermotherapy in occult subretinal neovascularization in age-related macular degeneration. Preliminary results]. / Termoterapia transpupilar en neovascularización subretiniana oculta secundaria a degeneración macular asociada a la edad. Primeros resultados.

PURPOSE: To determine the efficacy of transpupillary thermotherapy (TTT) to treat choroidal neovascularization (CNV) in patients with age-related macular degeneration (ARMD). PATIENTS AND METHODS: Eight patients (ten eyes) with occult CNV were treated by TTT. A 810 nm diode laser was used to perform TTT. The diode laser was delivered through a panfunduscopic contact lens. RESULTS: Three eyes showed a visual acuity improvement and a decrease in exudation on fluorescein angiography. Four eyes remained stable. Nevertheless, lesions worsened after treatment in three cases. One of these cases suffered an overtreatment. CONCLUSIONS: TTT may be a useful therapy in some cases of CNV in patients with age-related macular degeneration. Randomized and multicentric studies are necessary to stablish precise indications of this therapy.

Termoterapia transpupilar en neovascularización subretiniana oculta secundaria a degeneración macular asociada a la edad. Primeros resultados / Transpupillary thermotherapy in occult subretinal neovascularization in age-related macular degeneration. Preliminary results

Objetivo: Evaluar la eficacia de la termoterapia transpupilar (TTT) como tratamiento de la neovascularización coroidea (NVC) en la degeneración macular asociada a la edad (DMAE).Material y métodos: Se realizó TTT en 10 ojos (8 pacientes), afectos de neovascularización coroidea de comportamiento oculto en la angiografía fluoresceínica. La TTT se practicó mediante un láser diodo (810 nm), a través de una lente de contacto de campo amplio. Resultados: Tres de los casos tratados mejoraron tanto en agudeza visual como desde un punto de vista angiográfico. Consideramos que la lesión se estabilizó en cuatro casos. Sin embargo el cuadro clínico siguió empeorando a pesar del tratamiento en tres de los casos, en uno de ellos consideramos que se produjo un sobretratamiento. Conclusiones: La TTT puede ser una alternativa útil en el tratamiento de la NVC de la DMAE. Son necesarios estudios multicéntricos y randomizados para establecer con precisión las indicaciones de esta modalidad terapéutica (AU)

[Prevalence of drusen in homes for the elderly]. / Prevalencia de drusas en una población institucionalizada anciana.

PURPOSE: To establish the prevalence of drusen in a population of over-65 year subjects residing in institutions. MATERIAL AND METHOD: A medical interview, ophthalmological examinations and midriatic retinography were performed in 392 older-than-65 year subjects living in homes for the elder (784 eyes). Each eye was reviewed by means of the Wissconsin Age-Related Maculopathy Grading System, in order to determine drusen frequency. RESULTS: Druses frequency totalled 33.3%. A great trend to symmetry was observed; bilateral in 23% of patients. The most frequent finding was multiple units (40 to 59 per eye), well defined soft drusen of 125 micrometer in size, which showed very little tendency to confluence. Twelve to 24% of macular area was affected by drusen. Subjects between ages of 65 to 74, presented the highest frequence. Drusen decreased with age from 75 years upwards. CONCLUSION: The observed drusen frequency found appear lower than those described in other studies outside our country, perhaps due to higher prevalence of media opacities. Midriatic retinography can be a good screening method for the detection of drusen.