Povidona yodada. ¿Un nuevo paradigma en el tratamiento de la conjuntivitis adenovírica? / Iodine povidone. A new paradigm in the treatment of adenoviral conjunctivitis?

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Maculopatía fótica: revisión de la literatura (I) / Photic maculopathy: A review of the literature (I)

La retina humana, como tejido transductor de la energía lumínica, está especialmente expuesta a la toxicidad inducida por la exposición a la luz. La maculopatía solar ha sido durante milenios la única forma de maculopatía fótica, muchas veces en relación con la observación de un eclipse. Durante el último siglo los avances tecnológicos han conducido a la aparición de nuevas formas de retinopatía fótica, en relación con la exposición a nuevas formas de luz artificial como los dispositivos de soldar o emisores de láser. En los últimos años la generalización del uso de punteros láser ha hecho que repunte el interés por esta patología. El objetivo de esta revisión es ofrecer una visión integrada de los diversos tipos de maculopatía fótica. La revisión se presenta dividida en dos partes, debido a la extensión del tema tratado. En esta primera parte se trata la maculopatía solar y la maculopatía producida por exposición a los dispositivos de soldar

The human retina, as transducer of light energy, is especially exposed to light toxicity. Solar maculopathy has been the only form of photic maculopathy for millennia, often secondary to the observation of an eclipse. During the last century, technological advances have led to the appearance of new forms of photic maculopathy, related to the exposure to new forms of artificial light, such as welding devices and lasers. In recent years, the general use of laser pointers has led to an upturn in interest in this pathology. The aim of this review is to offer an integrated view of the different types of photic maculopathy. Due to the extension of this topic, the review is presented divided into two parts. In this first part solar maculopathy and welding arc maculopathy are presented

Maculopatía fótica: revisión de la literatura (II) / Photic maculopathy: A review of the literature (II)

La retina humana, como tejido transductor de la energía lumínica, está especialmente expuesta a la toxicidad inducida por la exposición a la luz. La maculopatía solar ha sido durante milenios la única forma de maculopatía fótica, muchas veces en relación con la observación de un eclipse. Durante el último siglo los avances tecnológicos han conducido a la aparición de nuevas formas de retinopatía fótica, en relación con la exposición a nuevas formas de luz artificial como los dispositivos de soldar o emisores de láser. En los últimos años la generalización del uso de punteros láser ha hecho que repunte el interés por esta dolencia. El objetivo de esta revisión es ofrecer una visión integrada de los diversos tipos de maculopatía fótica. La revisión se presenta dividida en 2 partes, debido a la extensión del tema tratado. En esta segunda parte se presentan la maculopatía fótica secundaria a explosiones nucleares, a láser, las formas iatrogénicas de maculopatía fótica y la retinitis foveomacular

The human retina, as transducer of light energy, is especially exposed to light toxicity. Solar maculopathy has been the only form of photic maculopathy for millennia, often secondary to the observation of an eclipse. During the last century, technological advances have led to the appearance of new forms of photic maculopathy, related to the exposure to new forms of artificial light, such as welding devices and lasers. In recent years the general use of laser pointers has led to an upturn in interest in this pathology. The aim of this review is to offer an integrated view of the different types of photic maculopathy. Due to the extension of the topic, the review is presented divided into 2 parts. In this second part, atomic bomb maculopathy, laser maculopathy, iatrogenic forms of photic maculopathy, and foveomacular retinitis are presented

Photic maculopathy: A review of the literature (I). / Maculopatía fótica: revisión de la literatura (I).

The human retina, as transducer of light energy, is especially exposed to light toxicity. Solar maculopathy has been the only form of photic maculopathy for millennia, often secondary to the observation of an eclipse. During the last century, technological advances have led to the appearance of new forms of photic maculopathy, related to the exposure to new forms of artificial light, such as welding devices and lasers. In recent years, the general use of laser pointers has led to an upturn in interest in this pathology. The aim of this review is to offer an integrated view of the different types of photic maculopathy. Due to the extension of this topic, the review is presented divided into two parts. In this first part solar maculopathy and welding arc maculopathy are presented.

Photic maculopathy: A review of the literature (ii). / Maculopatía fótica: revisión de la literatura (ii).

The human retina, as transducer of light energy, is especially exposed to light toxicity. Solar maculopathy has been the only form of photic maculopathy for millennia, often secondary to the observation of an eclipse. During the last century, technological advances have led to the appearance of new forms of photic maculopathy, related to the exposure to new forms of artificial light, such as welding devices and lasers. In recent years the general use of laser pointers has led to an upturn in interest in this pathology. The aim of this review is to offer an integrated view of the different types of photic maculopathy. Due to the extension of the topic, the review is presented divided into 2 parts. In this second part, atomic bomb maculopathy, laser maculopathy, iatrogenic forms of photic maculopathy, and foveomacular retinitis are presented.

Ciclodiálisis traumática tratada con láser ciclodiodo transescleral: evolución de la exploración del segmento anterior y posterior / Traumatic cyclodialysis treated with transscleral ciclodiode laser: Anterior and posterior segment evolution

Caso clínico: Paciente varón de 35 años de edad, que presentó un cuadro severo de maculopatía por hipotensión tras recibir una patada en el ojo izquierdo. Presentaba una zona amplia de iridodiálisis. La gonioscopia, biomicroscopia ultrasónica y tomografía de coherencia óptica no permitieron localizar la ciclodiálisis. Cinco meses después, ante la falta de respuesta al tratamiento médico, el paciente fue tratado con ciclofotocoagulación transescleral con láser de diodo, que produjo la resolución del cuadro clínico. Discusión: La ciclofotocoagulación transescleral con láser diodo constituye un tratamiento eficaz, produce poca iatrogenia y permite incluso resolver cuadros de hipotensión ocular producidos por ciclodiálisis que no han podido ser localizadas (AU)

Case report: A 35-year-old man suffered a severe hipotension maculopathy after being kicked in his left eye. He presented a broad area of iridodialisis. Gonioscopy, ultrasound biomicroscopy and optic coherence tomography were not able to locate the suspected cyclodialysis. Medical treatment was ineffective. Five months later the patient received transcleral diode laser cyclophotocoagulation with clinical resolution. Discussion: Transscleral diode laser constitutes an effective treatment, with low iatrogenia, that can solve cases of ocular hypotension, even when the location of the cyclodialysis has not been determined (AU)

Traumatic cyclodialysis treated with transscleral ciclodiode laser: Anterior and posterior segment evolution. / Ciclodiálisis traumática tratada con láser ciclodiodo transescleral: evolución de la exploración del segmento anterior y posterior.

CASE REPORT: A 35-year-old man suffered a severe hipotension maculopathy after being kicked in his left eye. He presented a broad area of iridodialisis. Gonioscopy, ultrasound biomicroscopy and optic coherence tomography were not able to locate the suspected cyclodialysis. Medical treatment was ineffective. Five months later the patient received transcleral diode laser cyclophotocoagulation with clinical resolution. DISCUSSION: Transscleral diode laser constitutes an effective treatment, with low iatrogenia, that can solve cases of ocular hypotension, even when the location of the cyclodialysis has not been determined.

Cambios precoces en la tomografía de coherencia óptica en un niño con maculopatía inducida por puntero láser / Early changes in optic coherence tomography in a child with laser pointer maculopathy

CASO CLÍNICO: Niño de 9 años de edad, que refiere pérdida visual en su ojo derecho, después de jugar con un puntero láser. En la primera exploración (12 h después) la agudeza visual (AV) era 0,15, la fóvea presentaba una lesión hipopigmentada, y la tomografía de coherencia óptica (OCT) demuestra la presencia de bandas hiperreflectivas verticales. Al cabo de 6 meses, la AV había mejorado a 0,5 y se aprecia en la OCT un área bien definida de interrupción de la retina externa. Discusión: Un inadecuado uso de los punteros láser, puede producir pérdida visual severa e irreversible

CASE REPORT: A 9-year-old boy referred due to visual loss in his right eye after playing with a laser pointer. In the first visit (12 hours later) visual acuity (VA) was 0.15. A hypopigmented lesion was present in the fovea, and optic coherence tomography (OCT) showed vertical hyper-reflective bands. In the last visit (6 months later), VA had improved to 0.5, and OCT showed a well defined area of outer retinal layer disruption. Discussion: An inadequate use of laser pointers can induce severe and permanent visual loss

Early changes in optic coherence tomography in a child with laser pointer maculopathy. / Cambios precoces en la tomografía de coherencia óptica en un niño con maculopatía inducida por puntero láser.

CASE REPORT: A 9-year-old boy referred due to visual loss in his right eye after playing with a laser pointer. In the first visit (12hours later) visual acuity (VA) was 0.15. A hypopigmented lesion was present in the fovea, and optic coherence tomography (OCT) showed vertical hyper-reflective bands. In the last visit (6 months later), VA had improved to 0.5, and OCT showed a well-defined area of outer retinal layer disruption. DISCUSSION: An inadequate use of laser pointers can induce severe and permanent visual loss.

Sobrediagnóstico y sobretratamiento en Oftalmología: revisión de la literatura / Over-diagnosis and over-treatment in Ophthalmology: A review of the literature

OBJETIVO: Determinar si los efectos perniciosos del sobrediagnóstico (overdiagnosis) y del sobretratamiento (overtreatment) han sido estudiados en las principales enfermedades oftalmológicas. MATERIAL Y MÉTODOS: Búsqueda bibliográfica en Pubmed. RESULTADOS: El algoritmo de búsqueda utilizado localizó 29 artículos relacionados con el tema. La mayoría de ellos abordan el tema de forma tangencial. Solo 4 artículos abordan el tema de forma directa. Uno de ellos trata el problema del sobrediagnóstico en la hipertensión intracraneal idiopática. Los 3 restantes tratan el sobrediagnóstico y el sobretratamiento en glaucoma. Conclusión La comunidad oftalmológica ha reflexionado poco sobre los efectos perjudiciales del sobrediagnóstico y el sobretratamiento

OBJECTIVE: To determine if the pernicious effects of over-diagnosis and over-treatment have been studied in the most common ocular diseases. MATERIAL AND METHODS: Bibliographic search conducted in PubMed. RESULTS: The search algorithm used retrieved 29 articles related with the topic. Most of them address the issue tangentially. Only 4 of them address the problem directly. One of them focuses on the problem of over-diagnosis and over-treatment in idiopathic intracranial hypertension. The remaining 3 focus on the problem of over-diagnosis and over-treatment in glaucoma. CONCLUSION: The ophthalmology community has thought very little about the detrimental effects of over-diagnosis and over-treatment

Over-diagnosis and over-treatment in Ophthalmology: A review of the literature. / Sobrediagnóstico y sobretratamiento en Oftalmología: revisión de la literatura.

OBJECTIVE: To determine if the pernicious effects of over-diagnosis and over-treatment have been studied in the most common ocular diseases. MATERIAL AND METHODS: Bibliographic search conducted in PubMed. RESULTS: The search algorithm used retrieved 29 articles related with the topic. Most of them address the issue tangentially. Only 4 of them address the problem directly. One of them focuses on the problem of over-diagnosis and over-treatment in idiopathic intracranial hypertension. The remaining 3 focus on the problem of over-diagnosis and over-treatment in glaucoma. CONCLUSION: The ophthalmology community has thought very little about the detrimental effects of over-diagnosis and over-treatment.

Opacificación de la cápsula posterior, síndrome de distensión capsular y síndrome de fimosis de la cápsula anterior: estudio de cohortes retrospectivo / Posterior capsule opacification, capsular bag distension syndrome, and anterior capsular phimosis: A retrospective cohort study

OBJETIVO: Determinar la incidencia y los factores de riesgo implicados en el desarrollo de las tres principales complicaciones capsulares postoperatorias: opacificación de cápsula posterior (OCP), síndrome de distensión capsular (SDC) y fimosis de la cápsula anterior (FCA). Sujetos, material y métodos: Estudio de cohortes retrospectivo. Se incluyó a 801 pacientes operados mediante cirugía de catarata en el Servicio de Oftalmología del Hospital del Henares (Madrid), entre el 2 de marzo de 2009 y el 28 de febrero de 2010. La historia clínica electrónica fue revisada durante el mes de julio de 2012. La OCP se estudió utilizando el método de Kaplan-Meier (log rank test). RESULTADOS: Un total de 167 pacientes desarrollaron OCP. No se pudo demostrar asociación entre la OCP y edad, sexo, diabetes mellitus, técnica de facoemulsificación, modelo de lente intraocular (LIO), consumo de tamsulosina, grado de síndrome de iris flácido intraoperatorio, glaucoma ni la degeneración macular asociada a la edad. Tres pacientes desarrollaron SDC, todos ellos habían recibido una LIO Akreos Adapt AO® (Bausch & Lomb). Dos de ellos eran varones jóvenes, con diagnóstico de catarata subcapular posterior. Tres pacientes desarrollaron FCA, dos de ellos habían recibido una LIO MicroSlim® (PhysIOL). CONCLUSIONES: No pudo demostrarse asociación de la OCP con ninguna de las variables estudiadas. El sexo masculino, la edad joven, la catarata subcapsular posterior y las LIO grandes no anguladas como la Akreos Adapt AO®podrían asociarse al desarrollo de SDC. Las LIO de microincisión, como la MicroSlim®, podrían asociarse al desarrollo de FCA

OBJECTIVE: To determine the incidence and the risk factors involved in the development of the three main postoperative capsular complications: posterior capsule opacification (PCO), capsular bag distension syndrome (CBDS), and anterior capsular phimosis syndrome (ACP). Subjects, material and methods: A retrospective cohort study was conducted on 801 patients submitted to cataract surgery in the ophthalmology unit of Hospital del Henares (Madrid) from March 2, 2009 to February 28, 2010. Computerized clinical charts were reviewed during July 2012. PCO was studied using the Kaplan-Meier method (log rank test). RESULTS: A total of 167 patients developed PCO. No association could be demonstrated between PCO and age, sex, diabetes mellitus, phaco technique, IOL model, tamsulosin intake, glaucoma, and age-related macular degeneration. Three patients developed CBDS, all of them have received and Akreos Adapt AO® (Bausch & Lomb). Two of them were young men who had received surgery for posterior subcapsular cataracts. Three patients developed ACP, 2 of whom had received a MicroSlim® IOL (PhysIOL). CONCLUSIONS: No association was found between PCO and any of the studied variables. Male gender, young age, subcapsular cataract and large non-angulated lens such as Akreos Adapt AO® could be associated with CBDS. ACP could be more frequent when microincision IOLs (like MicroSlim®) are implanted

Síndrome de iris flácido intraoperatorio tras tratamiento con duloxetina: ¿casualidad, asociación o causalidad? / Intraoperative floppy iris syndrome after treatment with duloxetine: coincidence, association, or causality?

CASO CLÍNICO: Se presenta un caso de síndrome de iris flácido intraoperatorio (IFIS) severo en una paciente que había recibido tratamiento con duloxetina. DISCUSIÓN: Aunque el agente etiológico principal es la tamsulosina, se han descrito casos de IFIS supuestamente secundarios a fármacos pertenecientes a diversos grupos farmacológicos. Los autores utilizan este caso para realizar un análisis crítico de todas estas asociaciones anecdóticas comunicadas en la literatura

CASE REPORT: The case is presented of a severe Intraoperative Floppy Iris Syndrome (IFIS) in a patient that had been treated with duloxetine. DISCUSSION: Tamsulosin is the main etiological agent involved in IFIS. However several cases of IFIS, supposedly secondary to drugs of different groups have recently been reported in the literature. The authors use this case report as a means to discuss why most of these cases should be considered anecdotal evidence

[Posterior capsule opacification, capsular bag distension syndrome, and anterior capsular phimosis: A retrospective cohort study]. / Opacificación de la cápsula posterior, síndrome de distensión capsular y síndrome de fimosis de la cápsula anterior: estudio de cohortes retrospectivo.

OBJECTIVE: To determine the incidence and the risk factors involved in the development of the three main postoperative capsular complications: posterior capsule opacification (PCO), capsular bag distension syndrome (CBDS), and anterior capsular phimosis syndrome (ACP). SUBJECTS, MATERIAL AND METHODS: A retrospective cohort study was conducted on 801 patients submitted to cataract surgery in the ophthalmology unit of Hospital del Henares (Madrid) from March 2, 2009 to February 28, 2010. Computerized clinical charts were reviewed during July 2012. PCO was studied using the Kaplan-Meier method (log rank test). RESULTS: A total of 167 patients developed PCO. No association could be demonstrated between PCO and age, sex, diabetes mellitus, phaco technique, IOL model, tamsulosin intake, glaucoma, and age-related macular degeneration. Three patients developed CBDS, all of them have received and Akreos Adapt AO(®) (Bausch & Lomb). Two of them were young men who had received surgery for posterior subcapsular cataracts. Three patients developed ACP, 2 of whom had received a MicroSlim(®) IOL (PhysIOL). CONCLUSIONS: No association was found between PCO and any of the studied variables. Male gender, young age, subcapsular cataract and large non-angulated lens such as Akreos Adapt AO(®) could be associated with CBDS. ACP could be more frequent when microincision IOLs (like MicroSlim(®)) are implanted.

[Intraoperative floppy iris syndrome after treatment with duloxetine: coincidence, association, or causality?]. / Síndrome de iris flácido intraoperatorio tras tratamiento con duloxetina: ¿casualidad, asociación o causalidad?

CASE REPORT: The case is presented of a severe Intraoperative Floppy Iris Syndrome (IFIS) in a patient that had been treated with duloxetine. DISCUSSION: Tamsulosin is the main etiological agent involved in IFIS. However several cases of IFIS, supposedly secondary to drugs of different groups have recently been reported in the literature. The authors use this case report as a means to discuss why most of these cases should be considered anecdotal evidence.