[Corrective techniques of lacrimal obstruction in the vertical system]. / Técnicas correctoras de la obstrucción del sistema lagrimal en el sistema vertical.

PURPOSE: To describe current surgical techniques of dacryocystorhinostomy (DCR) and to compare their effectiveness by analysing the advantages and disadvantages between external, endonasal and transcanalicular surgery. PATIENTS AND METHODS: A total of 91 DCRs were analysed using a retrospective, cross-sectional and multicentre study in 75 patients who had symptoms of nasolacrimal duct obstruction. Of these, 28 were operated using external DCR, 31 endonasal technic, and 32 transcanalicular DCR with diode laser. Outcomes were evaluated subjectively using patient symptoms for the grade of epiphora and the results from the syringing before and after surgery. RESULTS: External DCR was performed in 28 cases, with 19 cases asymptomatic (67.85%), and 20 patients had a patent tract (71.42%). Endonasal DCR was performed in 31 cases, of which 19 cases were asymptomatic (61.29%), and 21 showed patency of the nasolacrimal duct (67.74%). A transcanalicular technique was performed in 32 cases, with absence of epiphora in 24 patients (75%), and the syringing was successful in 24 of them (75%). CONCLUSIONS: Any of these 3 surgery techniques would be an adequate treatment for lacrimal obstruction, due to the significant development of endonasal and transcanalicular techniques in recent decades. With improvement, we could use either endonasal or transcanalicular techniques with diode laser with the same lever of effectiveness as the classic external approach, with the advantages of minimally invasive surgery.

Técnicas correctoras de la obstrucción del sistema lagrimal en el sistema vertical / Corrective techniques of lacrimal obstruction in the vertical system

Objetivo: Describir las técnicas quirúrgicas actuales de dacriocistorrinostomía, y comparar la efectividad de cada una de ellas analizando las ventajas y desventajas de la cirugía externa, la cirugía por vía endonasal y por vía transcanalicular. Pacientes y métodos. Se realizó un estudio retrospectivo, transversal y multicéntrico en el que se practicaron un total de 91 DCR en 75 pacientes con clínica de obstrucción lagrimal, de las cuales 28 fueron realizadas con la técnica externa, 31 con la técnica endonasal, y 32 con la técnica transcanalicular con láser diodo. En todos los pacientes se valoró el grado de epifora subjetiva y la permeabilidad de la vía lagrimal mediante la siringación previa y posterior a la cirugía. Resultados: De las 28 DCR realizadas con la técnica externa, permanecieron asintomáticos 19 casos (67,85%), y la vía era permeable al alta en 20 (71,42%). Con la técnica endonasal de las 31 DCR practicadas fueron 19 los casos que permanecieron asintomáticos (61,29%) y 21 tenían la vía permeable al alta (67,74%). Y en la técnica transcanalicular el número de pacientes con ausencia de epifora al alta fue de 24 de las 32 intervenciones realizadas (75%), y la siringación fue permeable en 24 de ellos (75%). Conclusiones: Cualquiera de las tres técnicas quirúrgicas puede emplearse como un adecuado tratamiento para la obstrucción de la vía lagrimal, teniendo la técnica endonasal y la transcanalicular un importante desarrollo en las últimas décadas. Con su desarrollo y perfeccionamiento, se podrían igualar los resultados de la cirugía mínimamente invasiva frente a la técnica clásica, con las ventajas que esto supondría(AU)

Purpose: To describe current surgical techniques of dacryocystorhinostomy (DCR) and to compare their effectiveness by analysing the advantages and disadvantages between external, endonasal and transcanalicular surgery. Patients and methods: A total of 91 DCRs were analysed using a retrospective, cross-sectional and multicentre study in 75 patients who had symptoms of nasolacrimal duct obstruction. Of these, 28 were operated using external DCR, 31 endonasal technic, and 32 transcanalicular DCR with diode laser. Outcomes were evaluated subjectively using patient symptoms for the grade of epiphora and the results from the syringing before and after surgery. Results: External DCR was performed in 28 cases, with 19 cases asymptomatic (67.85%), and 20 patients had a patent tract (71.42%). Endonasal DCR was performed in 31 cases, of which 19 cases were asymptomatic (61.29%), and 21 showed patency of the nasolacrimal duct (67.74%). A transcanalicular technique was performed in 32 cases, with absence of epiphora in 24 patients (75%), and the syringing was successful in 24 of them (75%). Conclusions: Any of these 3 surgery techniques would be an adequate treatment for lacrimal obstruction, due to the significant development of endonasal and transcanalicular techniques in recent decades. With improvement, we could use either endonasal or transcanalicular techniques with diode laser with the same lever of effectiveness as the classic external approach, with the advantages of minimally invasive surgery(AU)

[Treatment with amniotic membrane in keratolysis secondary to adult gonococcal keratoconjunctivitis]. / Tratamiento con membrana amniótica en queratolisis secundaria a queratoconjuntivitis gonocócica del adulto.

CASE REPORT: We present a 46-year-old man diagnosed initially with atypical adenoviral conjunctivitis and advanced marginal queratolysis with risk of perforation. The final diagnosis was gonococcal keratoconjunctivitis. The patient was successfully treated with amniotic membrane transplant, topic and systemic ceftriaxone (50 mg/ml and 1 grame/12 hours intravenous). DISCUSSION: Gonorrhea must be suspected in cases of torpid evolution conjunctivitis.

[Pterygium surgery: comparative study of conjunctival autograft with suture versus fibrin adhesive]. / Cirugía del pterigión: estudio comparativo entre autoinjerto conjuntival con sutura y con adhesivo tisular.

PURPOSE: To compare recurrence rate, complications, and biomicroscopical findings after conjunctival autograft pterygium surgery with the use of a fibrin glue (Tissucol Duo, Baxter AG, Vienna, Austria) or suture (7-0 silk). METHODS: Patients with nasal pterygium were included in two groups of conjunctival autograft surgery. In 9 of them the graft was sutured to the surrounding conjunctiva and in 8 of them the graft was fixed to the conjunctiva using fibrin glue. RESULTS: 17 patients (17 eyes) 41.2% women and 58.8% men were surgically treated. Mean patient age was 59.8 years. Five of the patients presented recurrence for simple excision and 12 presented primary pterygium. The extent of corneal invasion was 2 to 4 mm. In the suture group, 33.3% of the patients experienced pain after surgery compared to none in the fibrin glue group. In the suture group, 44.4% of the patients presented inflammation after surgery compared to none in the glue group. One patient from the glue group lost the graft and presented a recurrence one month later. CONCLUSIONS: The use of fibrin glue in pterygium surgery reduces patient symptoms, inflammation and discomfort. The rate of recurrence seems to be similar in both procedures.

Cirugía del pterigión: estudio comparativo entre autoinjerto conjuntival con sutura y con adhesivo tisular / Pterygium sugery: comparative study of conjuctival autograft with suture versus fibrin adhesive

Objetivo: Comparar la tasa de recurrencias, complicacionesy hallazgos biomicroscópicos despuésde cirugía de pterigión con autoinjerto conjuntivalusando adhesivo tisular (Tissucol Duo®, BaxterAG, Viena, Austria) o sutura (seda 7-0).Material y métodos: Se han incluido en el estudiopacientes con pterigión nasal en dos grupos de cirugíade autoinjerto conjuntival: en 9 de ellos el injertose sutura a conjuntiva y en 8 de ellos se fija conadhesivo tisular.Resultados: Se intervinieron 17 ojos de 17 pacientes,41,2% mujeres y 58,8% hombres con edadmedia de 59,8 años. 5 ojos presentaban recurrenciade resección simple y 12 de ellos presentaban pterigiónprimario. El tamaño de la invasión cornealosciló entre 2 y 4 mm. 33,3% de los pacientes delgrupo de sutura presentaron molestias después de lacirugía frente a ninguno en el grupo de adhesivo.44,4% de los pacientes presentaron inflamación trasla cirugía frente a ninguno en el grupo de sutura. Enuno de los pacientes del grupo del adhesivo se produjo una pérdida del injerto causando una posteriorrecidiva del pterigión.Conclusiones: El uso de adhesivo tisular reduce lossíntomas postquirúrgicos así como la inflamación yel disconfort. La tasa de recurrencias parece sersimilar con los dos procedimientos(AU)

Purpose: To compare recurrence rate, complications,and biomicroscopical findings after conjunctivalautograft pterygium surgery with the use of afibrin glue (Tissucol Duo®, Baxter AG, Vienna,Austria) or suture (7-0 silk).Methods: Patients with nasal pterygium wereincluded in two groups of conjunctival autograftsurgery. In 9 of them the graft was sutured to thesurrounding conjunctiva and in 8 of them the graftwas fixed to the conjunctiva using fibrin glue.Results: 17 patients (17 eyes) 41.2% women and58.8% men were surgically treated. Mean patient agewas 59.8 years. Five of the patients presented recurrencefor simple excision and 12 presented primary pterygium.The extent of corneal invasion was 2 to 4 mm. Inthe suture group, 33.3% of the patients experiencedpain after surgery compared to none in the fibrin gluegroup. In the suture group, 44.4% of the patients presentedinflammation after surgery compared to none inthe glue group. One patient from the glue group lost thegraft and presented a recurrence one month later. Conclusions: The use of fibrin glue in pterygiumsurgery reduces patient symptoms, inflammationand discomfort. The rate of recurrence seems to besimilar in both procedures(AU)

Tratamiento con membrana amniótica en queratolisis secundaria a queratoconjuntivitis gonocócica del adulto / Treatament with amniotic membrane in keratolysis secondary to adult gonococcal keratoconjunctivitis

Caso clínico: Varón de 46 años diagnosticado inicialmentede conjuntivitis adenovírica atípica conqueratolisis marginal avanzada y riesgo de perforaciónocular. El diagnóstico final fue queratoconjuntivitisgonocócica. El paciente fue tratado eficazmentecon recubrimiento de membrana amniótica,ceftriaxona tópica y sistémica (50 mg/ml y1 gr/12 h intravenosa).Discusión: La gonorrea debe ser sospechada encasos de conjuntivitis de evolución tórpida(AU)

Case report: We present a 46-year-old man diagnosedinitially with atypical adenoviral conjunctivitisand advanced marginal queratolysis with risk ofperforation. The final diagnosis was gonococcalkeratoconjunctivitis. The patient was successfullytreated with amniotic membrane transplant, topicand systemic ceftriaxone (50 mg/ml and 1 grame/12hours intravenous).Discussion: Gonorrhea must be suspected in casesof torpid evolution conjunctivitis(AU)