Magnetic device in reduced port and single port bariatric surgery: First 170 cases experience / Dispositivo magnético en cirugía bariátrica por puerto reducidos y puerto único: Primera experiencia de 170 casos

Introduction: Magnetic devices have been successfully used in bariatric surgery. To the date, the only reported use of the magnet was for liver retraction. Our purpose in this study is to demonstrate the safety and viability of using a magnetic system in different steps in single port and reduced port bariatric surgery.MethodsProspective and observational study was performed. Patients older than 18 years, undergoing primary laparoscopic sleeve gastrectomy (SG), one-anastomosis gastric bypass (OAGB), and Roux-en-Y gastric bypass (RYGB) or revisional surgery by single-port or reduced-port approach between July 2020 and June 2021 were included.ResultsA total of 170 patients (mean BMI, 41.47kg/m2; mean age 36.92 yrs) completed laparoscopic bariatric surgery (54 single-port sleeve gastrectomy [SPSG], 16 reduced-port SG, 83 RYGB, 4 OAGB and 14 revision surgeries), using the magnetic surgical system in different steps of the surgery. Mean surgical time for SPSG and reduced-port SG was 65.52min and 59.36min respectively; and for RYGB 74.19min, OAGB 70.98min, and revisional surgeries 88.38min. As for intraoperative complications, 2.94% mild liver laceration without significant bleeding was reported. There were no 30-day mortalities and no major complications.ConclusionMagnetic assistance in single-port and reduced-port bariatric surgery is an innovative technique. With this prospective study we attempt to demonstrate the safety profile and potential uses that may improve the implementation of new surgical approaches in bariatric surgery (AU)

Introducción: Los dispositivos magnéticos se han usado satisfactoriamente en cirugía bariátrica. Hasta la fecha, el único uso reportado de los imanes ha sido para la retracción hepática. Nuestro propósito con este estudio es demostrar la seguridad y viabilidad de usar dispositivos magnéticos en diferentes pasos de la cirugía bariátrica por puerto único y por puerto reducido.MétodosSe realizó un estudio prospectivo y observacional. Se incluyeron pacientes mayores de 18 años que fueron sometidos a cirugía laparoscópica primaria de manga gástrica (MG), bypass gástrico de una sola anastomosis (BAGUA), bypass gástrico en Y de Roux (BGYR) y cirugía de revisión por abordaje de puerto único o puerto reducido entre los meses de julio de 2020 y junio de 2021.ResultadosA un total de 170 pacientes (media IMC, 41,47 kg/m2; media edad 36,92 años) se les realizó una cirugía bariátrica laparoscópica (54 MG por puerto único, 16 MG por puerto reducido, 4 BAGUA y 14 cirugías de revisión) utilizando el dispositivo magnético en diferentes pasos del proceso quirúrgico. El tiempo promedio de la MG por puerto único y MG por puerto reducido fueron 65,52 min y 59,36 min, respectivamente; mientras que para BGYR 74,19 min, BAGUA 70,98 min y cirugías de revisión 88,38 min. Entre las complicaciones intraoperatorias se reportaron 2,94% de laceraciones hepáticas leves sin sangrado significante. No hubo ningún porcentaje de mortalidad ni de complicaciones mayores a los 30 días.ConclusionesLa asistencia magnética en cirugía bariátrica por puerto único y por puerto reducido es una técnica innovadora. Con este estudio prospectivo intentamos demostrar el perfil de seguridad y los usos potenciales que pueden mejorar la implementación de nuevos abordajes quirúrgicos en cirugía bariátrica (AU)

Magnetic device in reduced port and single port bariatric surgery: First 170 cases experience.

INTRODUCTION: Magnetic devices have been successfully used in bariatric surgery. To the date, the only reported use of the magnet was for liver retraction. Our purpose in this study is to demonstrate the safety and viability of using a magnetic system in different steps in single port and reduced port bariatric surgery. METHODS: Prospective and observational study was performed. Patients older than 18 years, undergoing primary laparoscopic sleeve gastrectomy (SG), one-anastomosis gastric bypass (OAGB), and Roux-en-Y gastric bypass (RYGB) or revisional surgery by single-port or reduced-port approach between July 2020 and June 2021 were included. RESULTS: A total of 170 patients (mean BMI, 41.47kg/m2; mean age 36.92 yrs) completed laparoscopic bariatric surgery (54 single-port sleeve gastrectomy [SPSG], 16 reduced-port SG, 83 RYGB, 4 OAGB and 14 revision surgeries), using the magnetic surgical system in different steps of the surgery. Mean surgical time for SPSG and reduced-port SG was 65.52min and 59.36min respectively; and for RYGB 74.19min, OAGB 70.98min, and revisional surgeries 88.38min. As for intraoperative complications, 2.94% mild liver laceration without significant bleeding was reported. There were no 30-day mortalities and no major complications. CONCLUSION: Magnetic assistance in single-port and reduced-port bariatric surgery is an innovative technique. With this prospective study we attempt to demonstrate the safety profile and potential uses that may improve the implementation of new surgical approaches in bariatric surgery.

Practical Considerations About Optimal Skin Incisions/Excisions in Dermatologic Surgery with Emphasis on Incisions Orientation and Primary Cutaneous Melanoma Surgery. / Consideraciones prácticas sobre incisiones/extirpaciones óptimas en cirugía dermatológica con énfasis en la orientación de las incisiones y la cirugía del melanoma cutáneo primario.

Dermatologic surgery has 2main objectives: 1) to guarantee surgical radicality; and 2) to achieve optimal aesthetic and functional results. These 2paradigms and their hierarchy must be considered when performing surgical procedures on the skin. Even the easiest intervention, the elliptical excision, presents some features that should be known to achieve such goals. One of these features is the incision orientation. The optimal incisions orientation is still matter of debate, especially because studies that compare the outcomes of performing incisions in different directions are lacking. However, some anatomical, clinical, and histological observations may point out why incising the skin in one orientation is better than another. Knowing the theory behind skin incisions/excisions become of outmost importance when dealing with primary cutaneous melanoma surgery. Especially if the melanocytic lesion is suspected to be an invasive melanoma and a sentinel lymph node biopsy will be required.

Consideraciones prácticas sobre incisiones/extirpaciones óptimas en cirugía dermatológica con énfasis en la orientación de las incisiones y la cirugía del melanoma cutáneo primario / Practical Considerations About Optimal Skin Incisions/Excisions in Dermatologic Surgery with Emphasis on Incisions Orientation and Primary Cutaneous Melanoma Surgery

La cirugía dermatológica tiene 2objetivos principales: 1) asegurar la radicalidad quirúrgica, y 2) obtener unos resultados estéticos y funcionales óptimos. Se tienen que considerar estos 2paradigmas y su jerarquía cuando se realizan intervenciones quirúrgicas en la piel. Incluso la intervención más sencilla, el huso, presenta algunas características que deberían ser conocidas para obtener dichos objetivos. Una de estas características es la orientación de la incisión. La orientación óptima de las incisiones es todavía materia de debate, especialmente porque no hay estudios que comparen los resultados según la dirección de la incisión. Sin embargo, algunas observaciones anatómicas, clínicas e histológicas podrían indicar por qué cortar la piel con una orientación es mejor que otra. Conocer la teoría detrás de las incisiones/extirpaciones cutáneas se vuelve imprescindible cuando hay que enfrentarse a la cirugía del melanoma cutáneo primario. Especialmente si se sospecha que la lesión melanocítica es un melanoma invasivo y se requerirá una biopsia del ganglio centinela (AU)

Dermatologic surgery has 2main objectives: 1) to guarantee surgical radicality; and 2) to achieve optimal aesthetic and functional results. These 2paradigms and their hierarchy must be considered when performing surgical procedures on the skin. Even the easiest intervention, the elliptical excision, presents some features that should be known to achieve such goals. One of these features is the incision orientation. The optimal incisions orientation is still matter of debate, especially because studies that compare the outcomes of performing incisions in different directions are lacking. However, some anatomical, clinical, and histological observations may point out why incising the skin in one orientation is better than another. Knowing the theory behind skin incisions/excisions become of outmost importance when dealing with primary cutaneous melanoma surgery. Especially if the melanocytic lesion is suspected to be an invasive melanoma and a sentinel lymph node biopsy will be required (AU)

[Translated article] Practical Considerations About Optimal Skin Incisions/Excisions in Dermatologic Surgery with Emphasis on Incisions Orientation and Primary Cutaneous Melanoma Surgery / Consideraciones prácticas sobre incisiones/extirpaciones óptimas en cirugía dermatológica con énfasis en la orientación de las incisiones y la cirugía del melanoma cutáneo primario

Dermatologic surgery has 2main objectives: 1) to guarantee surgical radicality; and 2) to achieve optimal aesthetic and functional results. These 2paradigms and their hierarchy must be considered when performing surgical procedures on the skin. Even the easiest intervention, the elliptical excision, presents some features that should be known to achieve such goals. One of these features is the incision orientation. The optimal incisions orientation is still matter of debate, especially because studies that compare the outcomes of performing incisions in different directions are lacking. However, some anatomical, clinical, and histological observations may point out why incising the skin in one orientation is better than another. Knowing the theory behind skin incisions/excisions become of outmost importance when dealing with primary cutaneous melanoma surgery. Especially if the melanocytic lesion is suspected to be an invasive melanoma and a sentinel lymph node biopsy will be required (AU)

La cirugía dermatológica tiene 2objetivos principales: 1) asegurar la radicalidad quirúrgica, y 2) obtener unos resultados estéticos y funcionales óptimos. Se tienen que considerar estos 2paradigmas y su jerarquía cuando se realizan intervenciones quirúrgicas en la piel. Incluso la intervención más sencilla, el huso, presenta algunas características que deberían ser conocidas para obtener dichos objetivos. Una de estas características es la orientación de la incisión. La orientación óptima de las incisiones es todavía materia de debate, especialmente porque no hay estudios que comparen los resultados según la dirección de la incisión. Sin embargo, algunas observaciones anatómicas, clínicas e histológicas podrían indicar por qué cortar la piel con una orientación es mejor que otra. Conocer la teoría detrás de las incisiones/extirpaciones cutáneas se vuelve imprescindible cuando hay que enfrentarse a la cirugía del melanoma cutáneo primario. Especialmente si se sospecha que la lesión melanocítica es un melanoma invasivo y se requerirá una biopsia del ganglio centinela (AU)

Colecistectomía laparoscópica de dos incisiones. Estudio experimental / Two-incision Laparoscopic Cholecystectomy. experimental study

El tratamiento estándar de la patología vesicular es la colecistectomía laparoscópica, sin embargo, con el pasar del tiempo se ha venido modificando el método convencional haciéndolo cada vez menos invasivo. Objetivo: Demostrar la factibilidad y seguridad de la colecistectomía laparoscópica de dos incisiones (TILC) comparándola con la técnica clásica (CLC) en cuanto a variables tales como tiempo quirúrgico, dolor postoperatorio, estancia hospitalaria, complicaciones y resultado cosmético. Métodos: Se tomó una muestra prospectiva de pacientes y se dividió equitativamente en dos grupos, los que se intervenían por TILC y otros por CLC. Ambos grupos se cuantificaron las variables anteriormente mencionadas y se hizo un análisis estadístico de las mismas tomando como significativo un valor de p < 0.05. Resultados: Existe significancia estadística únicamente cuando se comparaba el dolor postoperatorio medido a las 24 horas del procedimiento y el desenlace estético percibido de manera objetiva por el propio paciente. El resto de las variables no mostraron diferencias importantes entre ambas técnicas. Conclusiones: La colecistectomía laparoscópica por dos incisiones es un procedimiento seguro y factible, comparable en tiempo operatorio, complicaciones y estancia hospitalaria, pero con mejoría del dolor y resultado cosmético del paciente(AU)

The standard treatment for gallbladder pathology is laparoscopic cholecystectomy, however, over time the conventional method has been modified, making it less and less invasive.Objective : The objective of this study is to demonstrate the feasibility and safety of two-incision laparoscopic cholecystectomy (TILC) compared to the classic technique (CLC) in terms of variables such as surgical time, postoperative pain, hospital stay, complications and cosmetic outcome.Methods : A prospective sample of patients was taken and divided equally into two groups, those who underwent TILC and others by CLC. Both groups quantified the variables mentioned above and a statistical analysis was made of them, taking a p value < 0.05 as significant.Results : The result showed that there was statistical significance only when comparing postoperative pain measured 24 hours after the procedure and the aesthetic outcome objectively perceived by the patient himself. The rest of the variables did not show important differences between both techniques.Conclusion : laparoscopic cholecystectomy through two incisions is a safe and feasible procedure, comparable in operative time, complications and hospital stay, but with improvement in pain and cosmetic result of the patient(AU)

Magnetic device in reduced port and single port bariatric surgery: First 170 cases experience.

INTRODUCTION: Magnetic devices have been successfully used in bariatric surgery. To the date, the only reported use of the magnet was for liver retraction. Our purpose in this study is to demonstrate the safety and viability of using a magnetic system in different steps in single port and reduced port bariatric surgery. METHODS: Prospective and observational study was performed. Patients older than 18 years, undergoing primary laparoscopic sleeve gastrectomy (SG), one-anastomosis gastric bypass (OAGB), and Roux-en-Y gastric bypass (RYGB) or revisional surgery by single-port or reduced-port approach between July 2020 and June 2021 were included. RESULTS: A total of 170 patients (mean BMI, 41.47kg/m2; mean age 36.92 yrs) completed laparoscopic bariatric surgery (54 single-port sleeve gastrectomy [SPSG], 16 reduced-port SG, 83 RYGB, 4 OAGB and 14 revision surgeries), using the magnetic surgical system in different steps of the surgery. Mean surgical time for SPSG and reduced-port SG was 65.52min and 59.36min respectively; and for RYGB 74.19min, OAGB 70.98min, and revisional surgeries 88.38min. As for intraoperative complications, 2.94% mild liver laceration without significant bleeding was reported. There were no 30-day mortalities and no major complications. CONCLUSION: Magnetic assistance in single-port and reduced-port bariatric surgery is an innovative technique. With this prospective study we attempt to demonstrate the safety profile and potential uses that may improve the implementation of new surgical approaches in bariatric surgery.

Queratotomía arcuata transepitelial o intraestromal con láser de femtosegundo para corrección de astigmatismo corneal en el momento de la cirugía de cataratas / Transepithelial or intrastromal femtosecond laser arcuate keratotomy to manage corneal astigmatism at the time of cataract surgery

Objetivo El objetivo del estudio fue comparar los resultados de las incisiones arcuatas (IA) intraestromales y transepiteliales para tratar el astigmatismo corneal en el momento de la cirugía de catarata asistida con láser de femtosegundo (FLACS). Método Este estudio retrospectivo incluyó 20 pacientes con astigmatismo corneal entre 0,70 y 2,00 dioptrías (D) que se sometieron a FLACS con IA intraestromales en un ojo e IA transepiteliales en el ojo adelfo. Los principales datos evaluados a los 2-3meses de seguimiento fueron la diferencia entre el cilindro corneal queratométrico preoperatorio y postoperatorio (Kcyl), el índice de corrección (IC) y el porcentaje de sobrecorrección. Resultados La diferencia media entre Kcyl preoperatorio y postoperatorio reveló un valor medio de 0,36±0,37D en el grupo transepitelial y 0,53±0,42D en el grupo intraestromal (p<0,001). El IC medio fue de 0,83±0,71 en el grupo transepitelial y de 0,68±0,29 en el grupo intraestromal (p=0,17). Cinco ojos (25%) tuvieron una sobrecorrección del astigmatismo en el grupo transepitelial y un ojo (5%) en el grupo intraestromal. Conclusiones Tanto las IA intraestromales como las IA transepiteliales mostraron potencial para la corrección de astigmatismo leve a moderado y parecen ser un procedimiento seguro. A pesar de que las IA transepiteliales presentaron un IC más alto, los resultados de las IA intraestromales fueron más predecibles (AU)

Purpose The aim of this study was to compare the results of intrastromal arcuate incisions (AIs) and transepithelial AIs to treat corneal astigmatism during femtosecond laser-assisted cataract surgery (FLACS). Methods This retrospective study included 20 patients with corneal astigmatism between 0.70 and 2.00 diopters (D) who underwent FLACS with concurrent intrastromal AIs in one eye and transepithelial AIs in the fellow eye. The main outcomes measures at 2-3months of follow-up were the difference between preoperative and postoperative keratometric corneal cylinder (Kcyl), the correction index (CI) and the percentage of overcorrection. Results The mean difference between preoperative and postoperative Kcyl revealed a mean value of 0.36±0.37D in the transepithelial group and 0.53±0.42D in the intrastromal group (P<.001). The mean CI was 0.83±0.71 in the transepithelial group and 0.68±0.29 in intrastromal group (P=.17). Five eyes (25%) had an astigmatism overcorrection in the transepithelial group and 1eye (5%) in the intrastromal group. Conclusions Both intrastromal and transepithelial AIs showed potential for mild to moderate astigmatism correction and appeared to be a safe procedure. Despite transepithelial AIs presented a higher CI, the intrastromal AIs results were more predictable (AU)

Transepithelial or intrastromal femtosecond laser arcuate keratotomy to manage corneal astigmatism at the time of cataract surgery.

PURPOSE: The aim of this study was to compare the results of intrastromal arcuate incisions (AIs) and transepithelial AIs to treat corneal astigmatism during femtosecond laser-assisted cataract surgery (FLACS). METHODS: This retrospective study included 20 patients with corneal astigmatism between 0.70 and 2.00 diopters (D) who underwent FLACS with concurrent intrastromal AIs in one eye and transepithelial AIs in the fellow eye. The main outcomes measures at 2-3 months of follow-up were the difference between pre-operative and postoperative keratometric corneal cylinder (Kcyl), the correction index (CI) and the percentage of overcorrection. RESULTS: The mean difference between preoperative and postoperative Kcyl revealed a mean value of 0.36 ±â€¯0.37 D in the transepithelial group and 0.53 ±â€¯0.42 D in the intrastromal group (p < 0.001). The mean CI was 0.83 ±â€¯0.71 in the transepithelial group and 0.68 ±â€¯0.29 in intrastromal group (p = 0.17). Five eyes (25 %) had an astigmatism overcorrection in the transepithelial group and 1 eye (5%) in the intrastromal group. CONCLUSIONS: Both intrastromal and transepithelial AIs showed potential for mild to moderate astigmatism correction and appeared to be a safe procedure. Despite transepithelial AIs presented a higher CI, the intrastromal AIs results were more predictable.

Evaluation of femtosecond laser-assisted cataract surgery after 10 years of clinical application. / Evaluación de la cirugía de la catarata asistida con láser femtosegundo tras 10 años de aplicación clínica.

INTRODUCTION: Femtosecond laser-assisted cataract surgery (FLACS) has been considered a technological advance in modern cataract surgery. After years of experience, it has been observed that clinical outcomes had more complications than expected at the beginning. The aim of this study is to compare the benefits and disadvantages of the FLACS technique with conventional cataract surgery. METHOD: The PubMed and Web of Science platforms were used to search for scientific literature. RESULTS: The FLACS has currently improved the surgical technique in terms of the shorter ultrasound time used and the lower loss of endothelial cells. Likewise, the centration of capsulotomy and the correction of astigmatism with arcuate incisions have also been improved. As disadvantages, are the high cost of the laser, the intraoperative capsular complications, the induction of intraoperative myosis, and the learning curve of the technique. CONCLUSIONS: The FLACS technique is considered beneficial for specific cases, such as patients with scheduled premium surgery, or with low endothelial cell count. However, it is believed that given the technological cost it is not a cost effective technique for most standard cases in our daily clinical practice.

Aportes en lifting facial masculino: diseño de las incisiones de abordaje / Contributions in male facelift: design of the approach incisions

Si bien la cirugía del envejecimiento facial es uno de los procedimientos estéticos más frecuentes en la actualidad, tanto en varones como en mujeres, el lifting facial en los pacientes de sexo masculino requiere especial atención, debido a diversos factores en los cuales difi ere del mismo procedimiento en pacientes femeninas, como el uso de cabello corto, la presencia de barba y patillas, la calvicie, etc, así como el mayor celo de su intimidad y la reserva en los varones. Por lo tanto es de primordial importancia preservar la naturalidad. El propósito de este trabajo es presentar el diseño personal de las incisiones de abordaje para el lifting facial en pacientes de sexo masculino, y evaluar los resultados obtenidos.

Although surgery of the ageing face is one of the most frequent aesthetic procedure nowadays, both on male and female patients, face lift on the male patient requires special attention, due to diff erent aspects that make this procedure diff erent from female patients, such as short hair, the presence of beard and sideburns, baldness, etc., and greater privacy zeal in male patients. Thus naturalness is of paramount importance. The purpose of this article is to present our personal design in the approach of face lift on male patients, and evaluate the results achieved.

Cirugía de estrabismo mínimamente invasiva / Minimally invasive strabismus surgery

RESUMEN La cirugía con incisiones de pequeño tamaño comienza a ser una norma en la medicina actual, la cual ha ganado popularidad en muchos campos, entre ellos el de la Oftalmología. Una muestra de esto son las pequeñas incisiones para la facoemulsificación, la vitrectomía sin sutura 25 G y los pequeños dispositivos de drenaje de glaucoma. Algo similar ocurre con la cirugía de estrabismo mínimamente invasiva (minimally invasive strabismus surgery) al permitir alcanzar iguales resultados motores y sensoriales que con la técnica de abordaje de los músculos extraoculares a nivel del limbo. Esta revisión bibliográfica ofrece nuevos conocimientos teóricos sobre una técnica mínimamente invasiva para el abordaje del estrabismo, que originará mejores resultados estéticos y la satisfacción de los pacientes con esta afección, así como su rápida reincorporación a las distintas ocupaciones laborales, a las escuelas y a las tareas habituales(AU)

ABSTRACT Surgery based on small size incisions is gradually becoming standard practice in health care, gaining popularity in many specialties, among them ophthalmology. Evidence of this are the small incisions made for phacoemulsification, sutureless 25-G vitrectomy, and the small glaucoma drainage devices. Something similar occurs in minimally invasive strabismus surgery, where the same motor and sensory results are achieved as with limbal approach of the extraocular muscles. The present bibliographic review provides new theoretical information about a minimally invasive strabismus surgery technique leading to better esthetic results and greater satisfaction by patients suffering from this disorder, as well as their quick reincorporation to their work, school and regular daily activities(AU)

Diagnóstico y control del astigmatismo en la cirugía del cristalino / Diagnosis and control of astigmatism in the crystalline surgery

Se realizó una revisión bibliográfica con el objetivo de conocer las opciones quirúrgicas para la corrección del astigmatismo preoperatorio y posoperatorio en la cirugía de catarata. Fueron abordados tópicos como los estudios preoperatorios detallados que nos permiten realizar una planificación quirúrgica personalizada, así como las diferentes soluciones quirúrgicas actuales, tanto las incisiones anastigmáticas en la facoemulsificación, como las incisiones relajantes limbares combinadas o no con las lentes intraoculares tóricas y los procederes con excímer láser. Se consultaron investigaciones que abarcan varios años hasta el presente para conocer los diferentes resultados de la utilización de estos procederes quirúrgicos hasta llegar a técnicas más novedosas en estudio como el láser femtosecond y las lentes intraoculares ajustables con la luz. Todo esto puede maximizar la corrección refractiva total y lograr en el paciente una óptima calidad visual y una mejor calidad de vida. La corrección refractiva total no es fácil de lograr; no obstante, es posible y debe ser la meta de cada cirujano de catarata(AU)

The present literature review was aimed at finding out the surgical options for the preoperative and postoperative correction of astigmatism in the cataract surgery. The addressed topics were detailed preoperative studies that allow customized surgical planning as well as several current solutions including anartigmatic incisions in phacoemulsification and relaxing limbal incisions either combined or not and Excimer laser procedures. Several research studies comprising various years up to the present were consulted to learn about different results from the use of these surgical methods as well as the most state-of-the-art techniques under study such as fentosecond laser and light-adjustable intraocular lenses. All this may maximize the total refractive correction and achieve optimal visual quality and better quality of life for the patient. It is not easy to reach complete refractive correction but it is possible and should be the goal to be accomplished by every cataract surgeon(AU)

Diagnóstico y control del astigmatismo en la cirugía del cristalino / Diagnosis and control of astigmatism in the crystalline surgery

Se realizó una revisión bibliográfica con el objetivo de conocer las opciones quirúrgicas para la corrección del astigmatismo preoperatorio y posoperatorio en la cirugía de catarata. Fueron abordados tópicos como los estudios preoperatorios detallados que nos permiten realizar una planificación quirúrgica personalizada, así como las diferentes soluciones quirúrgicas actuales, tanto las incisiones anastigmáticas en la facoemulsificación, como las incisiones relajantes limbares combinadas o no con las lentes intraoculares tóricas y los procederes con excímer láser. Se consultaron investigaciones que abarcan varios años hasta el presente para conocer los diferentes resultados de la utilización de estos procederes quirúrgicos hasta llegar a técnicas más novedosas en estudio como el láser femtosecond y las lentes intraoculares ajustables con la luz. Todo esto puede maximizar la corrección refractiva total y lograr en el paciente una óptima calidad visual y una mejor calidad de vida. La corrección refractiva total no es fácil de lograr; no obstante, es posible y debe ser la meta de cada cirujano de catarata(AU)

The present literature review was aimed at finding out the surgical options for the preoperative and postoperative correction of astigmatism in the cataract surgery. The addressed topics were detailed preoperative studies that allow customized surgical planning as well as several current solutions including anartigmatic incisions in phacoemulsification and relaxing limbal incisions either combined or not and Excimer laser procedures. Several research studies comprising various years up to the present were consulted to learn about different results from the use of these surgical methods as well as the most state-of-the-art techniques under study such as fentosecond laser and light-adjustable intraocular lenses. All this may maximize the total refractive correction and achieve optimal visual quality and better quality of life for the patient. It is not easy to reach complete refractive correction but it is possible and should be the goal to be accomplished by every cataract surgeon(AU)

Colgajo comisural palmar: su utilidad en el abordaje de la enfermedad de Dupuytren con compromiso de dedos contiguos

Introducción: El diseño de las incisiones en la enfermedad de Dupuytren es probablemente el detalle técnico más importante en el tratamiento quirúrgico. El objetivo de este trabajo es realizar una valoración retrospectiva de la utilidad del colgajo comisural palmar en el abordaje de la enfermedad de Dupuytren con compromiso de dedos contiguos. Materiales y Métodos: Entre abril de 2009 y diciembre de 2012, los autores operaron a 32 pacientes con enfermedad de Dupuytren. Se incluyeron 12 pacientes con compromiso de, al menos, 2 dedos contiguos y el diseño de un colgajo comisural palmar. Se evaluaron entre los días 3-5, 15-21, 45-60 y a los 6 meses posoperatorios. Al final del seguimiento, se constataron las recidivas, la satisfacción y el puntaje QuickDASH. Resultados: Se realizaron 13 colgajos comisurales palmares en 12 pacientes, 6 manos derechas y 6 izquierdas. Los rayos contiguos afectados fueron el 4.° y 5.° dedos (8 casos), el 3.°, 4.° y 5.° dedos (3 casos), y el 3.° y 4.° dedos (un caso). La distancia promedio del colgajo comisural palmar comisura-vértice fue de 2,23 cm (rango 1,2-4,3) y la transversal, de 2,42 cm (rango 1,6-3,8). Siempre se pudo realizar la resección de las cuerdas patológicas y la fasciectomía parcial sin complicaciones intraoperatorias. Hubo una necrosis distal parcial, tratada con técnica de palma abierta. Conclusiones: El colgajo comisural palmar es de fácil disección y seguro a causa de su múltiple vascularización, permite una correcta visualización de las estructuras vasculonerviosas digitales y las bandas patológicas, útil en afección de dedos contiguos.(AU)

Background: In Dupuytrens contracture deciding the type of surgical incision is extremely important, and several options were described. The aim of this study is to evaluate retrospectively the usefulness of palmar commissural flap in Dupuytrens disease with adjacent fingers involvement. Methods: Between April 2009 and December 2012, 32 patients with Dupuytrens disease were operated on by the authors. Twelve patients with at least 2 adjacent fingers involvement and the design of a palmar commissural flap. The flaps were evaluated at days 3-5, 15-21, 45-60, and 6 months post-surgery. At the end of the follow-up, recurrence, satisfaction and Quick Dash score were evaluated. Results: Thirteen palmar commissural flaps were performed in 12 patients (6 right hands and 6 left hands). The affected adjacent rays were the 4th and 5th fingers (8 cases); the 3rd, 4th and 5th fingers (3 cases), and the 3rd and 4th fingers (one case). Average distances of the palmar commissural flap, commissure-vertex was 2.23 cm (range 1.2-4.3), and that of the transverse 2.42 cm (range 1.6 to 3.8). In all cases it was performed according to preoperative planning resection of pathological cords and partial fasciectomy. One case presented distal necrosis, which was treated with open palm technique. Conclusions: The palmar commissural flap can identify both the digital pedicle as pathological structures. Its vascularization makes it a safe and easy flap dissection.(AU)

[Management of corneal hydrops using air and micro-punctures]. / Manejo del hydrops corneal mediante aire y micropunciones.

CASE REPORT: A 22-year- old woman with an acute hydrops and Descemet membrane detachment was managed by intracameral air injection combined with multiple corneal stromal venting incisions for the drainage of intrastromal fluid. No intraoperative complications were encountered, and the intrastromal fluid was resolved over 2 weeks. DISCUSSION: Acute corneal hydrops is a significant complication of keratoconus. If not treated, resolution usually occurs over a period of 2-4 months. The persistent oedema can cause complications, such as corneal neovascularisation, infection and corneal perforation.