Adaptación cultural, lingüística y validación del cuestionario Dry Eye Questionnaire 5 en una población chilena / Adaptation culturally and linguistically to the Chilean population and validation the Dry Eye Questionnaire 5

Antecedentes y objetivo Existen distintos métodos de evaluación de la enfermedad de ojo seco (EOS), entre ellos cuestionarios que analizan distintos aspectos de su sintomatología, los que son importantes para su mejor comprensión y manejo terapéutico. El Dry Eye Questionnaire 5 (DEQ-5) es único en su tipo, pues además de su simplicidad, mide sintomatología en cuatro dimensiones. El objetivo de este estudio fue adaptar cultural, lingüísticamente y validar, este cuestionario para una población chilena. Materiales y métodos Para la adaptación, se realizó la traducción y retrotraducción de la versión original, su análisis lingüístico, una prueba piloto y el examen de expertos, que incorporó una especialista en lingüística. Para la validación se realizó el análisis psicométrico de fiabilidad y validez de constructo. La muestra en la que se validó quedó constituida por 205 personas con EOS. Resultados De los encuestados, 141 (69%) fueron mujeres, la media de edad fue de 48 años ± 16,7 y la mediana del puntaje total DEQ-5 fue de 13 puntos (R.I 8-15 puntos). La versión adaptada resultó con un alfa de Cronbach de 0,8085, puntaje que la clasificó como buena. Discusión El cuestionario DEQ-5 adaptado y validado resultó un buen instrumento para ser usado en poblaciones con características similares a las del estudio. Además, el análisis factorial enriqueció la comprensión de la manera en que las personas con EOS relacionan sus síntomas y qué preguntas se corresponden más entre ellas, representando de mejor manera los aspectos evaluados de la sintomatología de esta enfermedad (AU)

Background and objective There are different methods for evaluating dry eye disease (DID), including questionnaires that analyze different aspects of its symptoms, which are important for its better understanding and therapeutic management. The Dry Eye Questionnaire 5 (DEQ-5), is unique in its kind, because in addition to its simplicity, it measures symptoms in four dimensions. The aim of this study is to adapt culturally and linguistically and validate this instrument to the Chilean population. Material and methods For the adaptation, the translation and retro-translation of the original version was carried out, its linguistic analysis, the pilot test and the expert panel review (which included a linguistics specialist) were used. For the validation, a psychometric analysis of reliability and validity of the construct was incorporated. The sample in which it was validated was constituted by 205 people with dry eye disease. Results One hundred and forty-one (69%) of the respondents were women, the mean of age was 48 years ± 16.7, and the median of the total score DEQ-5 was 13 points (R.I 8–15 points). The adapted version resulted in a Cronbach alpha of 0.8085, scoring that classified it as good. Discussion The questionnaire DEQ-5, which was adapted and validated, was a good instrument to be used in populations with similar characteristics of those in the study. More so, the factor analysis enriched comprehension of the way in which people with dry eye disease relate their symptoms and which questions relate more between them, representing in a better way the aspects evaluated of the symptomatology of this disease (AU)

Adaptation culturally and linguistically to the Chilean population and validation the Dry Eye Questionnaire 5.

BACKGROUND AND OBJECTIVE: There are different methods for evaluating dry eye disease (DID), including questionnaires that analyze different aspects of its symptoms, which are important for its better understanding and therapeutic management. The Dry Eye Questionnaire 5 (DEQ-5), is unique in its kind, because in addition to its simplicity, it measures symptoms in 4 dimensions. The aim of this study is to adapt culturally and linguistically and validate this instrument to the Chilean population. MATERIAL AND METHODS: For the adaptation, the translation and retro-translation of the original version was carried out, its linguistic analysis, the pilot test and the expert panel review (which included a linguistics specialist) were used. For the validation, a psychometric analysis of reliability and validity of the construct was incorporated. The sample in which it was validated was constituted by 205 people with dry eye disease. RESULTS: 141 (69%) of the respondents were women, the mean of age was 48 years ±16,7, and the median of the total score DEQ-5 was 13 points (R.I 8-15 points). The adapted version resulted in a Cronbach alpha of 0.8085, scoring that classified it as good. DISCUSSION: The questionnaire DEQ-5, which was adapted and validated, was a good instrument to be used in populations with similar characteristics of those in the study. More so, the factor analysis enriched comprehension of the way in which people with dry eye disease relate their symptoms and which questions relate more between them, representing in a better way the aspects evaluated of the symptomatology of this disease.

El ojo seco está relacionado con un aumento intrasujeto de la variabilidad de osmolaridad lagrimal confirmado por tecnología de aprendizaje de máquinas / Dry eye is matched by increased intrasubject variability in tear osmolarity as confirmed by machine learning approach

Objetivo: La medición de la osmolaridad lagrimal en pacientes con ojo seco ha sido cuestionada debido a su alta variabilidad. El entendimiento del origen de dicha variabilidad ayudaría a la interpretación clínica de los valores obtenidos. Esta investigación evalúa la medición de la variabilidad lagrimal en la práctica clínica. Material y métodos: Veinte pacientes con ojo seco y 20 controles fueron evaluados. Fueron realizadas 3 mediciones consecutivas de osmolaridad a intervalos de 5min. La variabilidad fue definida como la diferencia entre las mediciones más extremas obtenidas en cada ojo. Se utilizaron técnicas de aprendizaje de máquinas para evaluar la capacidad discriminadora de la osmolaridad lagrimal. Resultados: La osmolaridad promedio en el grupo control y ojo seco fueron 295,1 ± 7,3 mOsm/L y 300,6 ± 11,2 mOsm/L, respectivamente (p = 0,004). La variabilidad de la osmolaridad lagrimal fue 7,5 ± 3,6 mOsm/L en el grupo control y 16,7 ± 11,9 mOsm/L en los pacientes con ojo seco (p < 0,001). Basado en la osmolaridad, un clasificador logístico obtuvo un 85% de precisión. Conclusiones: La osmolaridad promedio y la variabilidad fueron significativamente más altas en pacientes con ojo seco. Por otra parte, las técnicas de aprendizaje de máquina demostraron buena precisión para clasificar a los pacientes. Por tanto, la alta variabilidad parece ser característica propia de la enfermedad de ojo seco

Objective: Because of high variability, tear film osmolarity measures have been questioned in dry eye assessment. Understanding the origin of such variability would aid data interpretation. This study aims to evaluate osmolarity variability in a clinical setting. Material and methods: Twenty dry eyes and 20 control patients were evaluated. Three consecutive osmolarity measurements per eye at 5min intervals were obtained. Variability was represented by the difference between both extreme readings per eye. Machine learning techniques were used to quantify discrimination capacity of tear osmolarity for dry eye. Results: Mean osmolarities in the control and dry eye groups were 295.1 ± 7.3 mOsm/L and 300.6 ± 11.2 mOsm/L, respectively (P=.004). Osmolarity variabilities were 7.5 ± 3.6 mOsm/L and 16.7 ± 11.9 mOsm/L, for the control and dry eye groups, respectively (P < .001). Based on osmolarity, a logistic classifier showed an 85% classification accuracy. Conclusions: In the clinical setting, both mean osmolarity and osmolarity variability in the dry eye group were significantly higher than in the control group. Machine learning techniques showed good classification accuracy. It is concluded that higher variability of tear osmolarity is a dry eye feature

Dry eye is matched by increased intrasubject variability in tear osmolarity as confirmed by machine learning approach. / El ojo seco está relacionado con un aumento intrasujeto de la variabilidad de osmolaridad lagrimal confirmado por tecnología de aprendizaje de máquinas.

OBJECTIVE: Because of high variability, tear film osmolarity measures have been questioned in dry eye assessment. Understanding the origin of such variability would aid data interpretation. This study aims to evaluate osmolarity variability in a clinical setting. MATERIAL AND METHODS: Twenty dry eyes and 20 control patients were evaluated. Three consecutive osmolarity measurements per eye at 5min intervals were obtained. Variability was represented by the difference between both extreme readings per eye. Machine learning techniques were used to quantify discrimination capacity of tear osmolarity for dry eye. RESULTS: Mean osmolarities in the control and dry eye groups were 295.1±7.3mOsm/L and 300.6±11.2mOsm/L, respectively (P=.004). Osmolarity variabilities were 7.5±3.6mOsm/L and 16.7±11.9mOsm/L, for the control and dry eye groups, respectively (P<.001). Based on osmolarity, a logistic classifier showed an 85% classification accuracy. CONCLUSIONS: In the clinical setting, both mean osmolarity and osmolarity variability in the dry eye group were significantly higher than in the control group. Machine learning techniques showed good classification accuracy. It is concluded that higher variability of tear osmolarity is a dry eye feature.

Implante de válvula de Ahmed para el manejo del glaucoma uveítico refractario: seguimiento a largo plazo / Ahmed glaucoma drainage implant surgery in the management of refractory uveitic glaucoma: Long-term follow up

OBJETIVO: Evaluar la eficacia, seguridad y complicaciones a largo plazo del implante de válvula de Ahmed en pacientes con glaucoma uveítico refractario. MÉTODOS: Revisión retrospectiva de casos consecutivos de pacientes con glaucoma uveítico refractario intervenidos mediante un implante de válvula de Ahmed entre los años 2004-2014. Las características demográficas, la agudeza visual, la presión intraocular (PIO), el número de medicamentos antiglaucomatosos y las complicaciones operatorias y postoperatorias fueron registradas. El éxito completo se definió como una PIO ≥ 5 y ≤ 18 mmHg sin medicamentos, y el éxito calificado, como una PIO ≤ 18 mmHg con uno o más medicamentos. Aquellos pacientes con un seguimiento inferior a 12 meses fueron excluidos. RESULTADOS: Veintiún pacientes (26 ojos) fueron incluidos. El seguimiento promedio postoperatorio fue de 53,5 ± 31 meses. Ocho ojos (30%) tuvieron al menos una cirugía de glaucoma fallida previamente. La PIO se redujo de una media de 30 a 14mmHg en la última visita (p < 0,001). El número de medicamentos antiglaucomatosos se redujo de una mediana de 2,9 a 1,1 en la última visita (p < 0,001). Siete ojos (27%) se calificaron como éxito completo, 13 ojos (50%) como éxito calificado y 6 ojos (23%) cumplieron el criterio de falla. La complicación postoperatoria más frecuente fue la fase hipertensiva en 12 ojos (46%). El análisis de supervivencia de Kaplan-Meier mostró una probabilidad acumulada de éxito del 65% a los 84 meses. CONCLUSIONES: La cirugía de implante de drenaje de glaucoma de Ahmed se puede considerar una opción quirúrgica eficaz y segura a largo plazo para los pacientes con glaucoma uveítico refractario

OBJECTIVE: To examine the long-term efficacy, safety and complications of Ahmed glaucoma drainage implant surgery in patients with refractory uveitic glaucoma. METHODS: Retrospective review of consecutive cases of patients with refractory uveitic glaucoma who underwent Ahmed glaucoma drainage implant surgery between 2004-2014. Demographic characteristics of the study population, visual acuity, intraocular pressure (IOP), number of antiglaucoma medications and operative and postoperative complications were recorded. Complete success was defined as IOP ≥ 5 and ≤ 18 mmHg without any medication, as qualified success if IOP ≤ 18 mmHg with one or more medications. Patients with less than 12 months of follow-up were excluded. RESULTS: 21 patients (26 eyes) were included. The mean postoperative follow-up was 53.5 ± 31 months. Eight eyes (30%) had at least one previously failed glaucoma surgery. IOP was reduced from a mean of 30.0mmHg to 14.0mmHg at the last follow-up visit (P < .001). The number of IOP-lowering medications was reduced from a median of 2.9 preoperatively to 1.1 at the last follow-up (P < .001). Overall, 7 eyes (27%) were classified as complete success, 13 eyes (50%) were considered as qualified success, and 6 eyes (23%) met the criteria for failure. The most common postoperative complication was hypertensive phase in 12 eyes (46%). Kaplan-Meier life-table analysis showed a cumulative probability of success after Ahmed glaucoma valve implantation of 65% at 84 months. CONCLUSIONS: Ahmed glaucoma drainage implant surgery may be considered a long-term effective and safety surgical option for patients with refractory uveitic glaucoma

Ahmed glaucoma drainage implant surgery in the management of refractory uveitic glaucoma: Long-term follow up. / Implante de válvula de Ahmed para el manejo del glaucoma uveítico refractario: seguimiento a largo plazo.

OBJECTIVE: To examine the long-term efficacy, safety and complications of Ahmed glaucoma drainage implant surgery in patients with refractory uveitic glaucoma. METHODS: Retrospective review of consecutive cases of patients with refractory uveitic glaucoma who underwent Ahmed glaucoma drainage implant surgery between 2004-2014. Demographic characteristics of the study population, visual acuity, intraocular pressure (IOP), number of antiglaucoma medications and operative and postoperative complications were recorded. Complete success was defined as IOP≥5 and ≤18mmHg without any medication, as qualified success if IOP≤18mmHg with one or more medications. Patients with less than 12 months of follow-up were excluded. RESULTS: 21 patients (26 eyes) were included. The mean postoperative follow-up was 53.5±31 months. Eight eyes (30%) had at least one previously failed glaucoma surgery. IOP was reduced from a mean of 30.0mmHg to 14.0mmHg at the last follow-up visit (P<.001). The number of IOP-lowering medications was reduced from a median of 2.9 preoperatively to 1.1 at the last follow-up (P<.001). Overall, 7 eyes (27%) were classified as complete success, 13 eyes (50%) were considered as qualified success, and 6 eyes (23%) met the criteria for failure. The most common postoperative complication was hypertensive phase in 12 eyes (46%). Kaplan-Meier life-table analysis showed a cumulative probability of success after Ahmed glaucoma valve implantation of 65% at 84 months. CONCLUSIONS: Ahmed glaucoma drainage implant surgery may be considered a long-term effective and safety surgical option for patients with refractory uveitic glaucoma.

Estudio clínico y virológico en un grupo de niños chilenos con herpes ocular: análisis genómico de las cepas / Clinical-virological study in chilean children with ocular herpes: genomic analysis of strains

Objetivo: Caracterizar el diagnóstico de infección ocular por virus herpes simples (HSV) en un grupo de niños chilenos, mediante el estudio clínico y de laboratorio virológico. Métodos: La población estudiada comprendió niños menores de 15 años, con diagnóstico clínico de herpes ocular, que fueron atendidos por los autores y un grupo de oftalmólogos entrenados especialmente para el estudio. Junto con detallar el tipo de infección herpética, a todos los pacientes se les tomaron muestra para estudio virológico que incluyó estudio de cultivos celulares y posteriormente técnica de reacción en cadena de polimerasa (PCR), con el fin de tipificar las cepas y características genómicas del virus infectante. Resultados: El estudio enroló 18 niños, cuyas edades fluctuaron entre los 40 días y 13 años, con una media de 6 años. De las formas clínicas observadas, la más frecuentes fueron la blefaritis y la queratitis dendrítica constituyendo en 27 y 22 por ciento de los casos, respectivamente. El diagnóstico de HSV fue confirmado en 15 de 18 pacientes, constituyendo un 83 por ciento de positividad. 14 de 15 casos correspondieron a HSV tipo 1, y en un niño se diagnóstico infección por HSV tipo 2. Los antecedentes clínicos de este caso confirmaron que se trataba de una infección perinatal, lo que permitió instaurar el tratamiento en forma oportuna. El estudio permitió identificar un caso de excreción ocular viral asintomática, lo que sumando a un cuadro de recurrencias múltiples obligó a indicar terapia profiláctica permanente con aciclovir. Conclusiones: La blefaritis y queratitis herpética constituyeron en conjunto el 70 por ciento de los casos. El rendimiento celular y PCR fue elevado en los casos con alto índice de replicación viral, como la queratitis y blefaritis. En los casos con menor replicación, como queratitis estromal o conjuntivitis, el estudio PCR demostró una mayor sensibilidad que el estudio en cultivo celular. La presencia de un caso de infección perinatal por HSV-2 pudiera ser indicativo de un aumento en la frecuencia de esta forma de presentación.

[Role of Herpes simplex virus in the immune stromal keratitis]. / Rol del virus Herpes simplex en la queratitis inmune estromal.

BACKGROUND: Herpes simplex virus (HSV) infection of the cornea is a leading cause of blindness in occidental countries and a common recurrent manifestation of it is the immune stromal keratitis (ISK). However, it is not known whether active viral replication occurs during the acute phase of the disease, because isolation of the virus by conventional culture techniques has not been accomplished. AIM: To establish the presence of HSV in patients with ISK. MATERIAL AND METHODS: Fourteen corneal swabbing samples, from active diseased eyes of patients with clinical diagnosis of ISK, were submitted to Herpchek and PCR for the identification of HSV antigens and genome. RESULTS: All ISK samples were negative by both techniques. CONCLUSIONS: It was not possible to identify HSV antigens nor their genome by the methodology used. It is likely that, they can't be detected in corneal superficial layers or probably there is no viral replication at this stage of the disease, so antiviral therapy should be reconsidered.

[Herpetic keratitis: clinical-virological correlation]. / Queratitis herpética: correlación Clínico-virológica.

BACKGROUND: Herpetic keratitis is the main infectious cause of corneal opacity. The existence of effective antiviral agents underscores the need of an early diagnosis. AIM: To correlate clinical features of herpetic keratitis with virological studies. PATIENTS AND METHODS: Forty one patients with a clinical diagnosis of herpetic keratitis were studied. Viral isolation, polymerase chain reaction (PCR) and typification were done in a sample taken by swabbing the ocular lesion. RESULTS: Twenty six patients (31% female) had epithelial keratitis, that was mild or moderate in 88% of cases and acute in 77% of them. In 20 patients (77%), viral isolation and PCR were positive (HSV-2 in one case). Fifteen patients (67% female) had stromal keratitis, 93% of cases were moderate or severe and 53% were acute. Viral isolation was negative in all cases and in 20% PCR was positive. CONCLUSIONS: Viral isolation and PCR were equally sensitive in epithelial keratitis, but in stromal keratitis only PCR could detect the virus. Moderate acute dendrite was the predominant clinical manifestation. The higher proportion of women with stromal keratitis supports its possibly autoimmune etiology. HSV-2 is seldomly isolated and possibly associated to vertical transmission.

Genomic polymorphism in herpes simplex virus keratitis.

Viruses are the major infectious agents causing conjunctivitis and keratoconjunctivitis. Two antigenic types, herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2), can be recognized in which numerous genomic variants or genotypes have been described. HSV-1 infection is one of the major causes of blindness. Different strains can induce different types of ocular lesions. Twelve patients with acute herpetic epithelial keratitis were studied by monoclonal antibodies and restriction enzymes, and nine different HSV-1 genomic variants were identified. This study confirms that a variety of HSV-1 strains is associated to this kind of infection.

Effects of hydroquinones on intact Trypanosoma cruzi epimastigotes.

1. Hydroquinones inhibited the culture growth of Trypanosoma cruzi epimastigotes at concentrations lower than 1 mM. 2. Hydroquinones inhibited the oxygen consumption on the intact Trypanosoma cruzi cells. I50 values for hydroquinone, terbutylhydroquinone and 2,5-di-t-butylhydroquinone were 24.87 mM, 0.88 mM and 0.26 mM, respectively. t-Butylhydroquinone and 2,5-di-t-butylhydroquinone had a Michaelian type kinetic inhibition; hydroquinone also showed a Michaelian type kinetic inhibition at low concentrations but at higher concentrations it showed a positive cooperativity. 3. These hydroquinones changed the NAD(P) redox-state to a more reduced state and that of cytochrome b to a more oxidized state. The magnitude of the redox-state change was dependent of the hydrophobicity of the derivates. 4. These results suggest that the growth and oxygen uptake inhibition by the hydroquinones is due to a blockage of the mitochondrial electron transport chain before cytochrome b.