Vitrectomy combined with posterior-segment Ahmed valve implant: A case series study.

PURPOSE: To analyze the surgical outcomes and complication rates in a group of patients with refractory glaucoma who underwent simultaneous pars plana vitrectomy (PPV) and PC7 or PC8 Ahmed glaucoma valve (AGV) implantation. METHODS: Retrospective case series study of 10 eyes in 9 patients with secondary glaucoma, refractory to other treatment, who underwent 23G-PPV and implantation of PC7 or PC8 AGV between 2012 and 2014. Study variables were postoperative BCVA, IOP and the number of glaucoma medications, which were evaluated preoperatively and at 1 day, 1 week and 1, 3, 6, and 12 months after the surgical intervention. Absolute success was defined as IOP less than 21 mmHg in the absence of any medication and qualified success if medication was needed to control IOP under 21 mmHg. RESULTS: The average follow-up was 10.2 ±â€¯2.89 months. Postoperative IOP levels decreased in all cases in comparison with preoperative values (p < 0.05). Absolute success rate was 60%, reaching 100% in terms of qualified success. Kaplan-Meier survival analysis showed 60% absolute success at 12 months. Changes in postoperative BCVA were not statistically significant in comparison with preoperative data. Early postoperative complications were athalamia, hyphema, and retinal detachment; late complications were pars plana clip extrusion and cystic bleb. CONCLUSIONS: PC7 and PC8 Ahmed valve implantation via pars plana is a safe and useful option in patients with secondary refractory glaucoma who are either candidates for PPV or have been previously vitrectomized.

Aceite de silicona pesado (Densiron ® 68) en vitreorretinopatía proliferativa: 4 años de experiencia / Heavy silicone oil (Densiron ® 68) in proliferative vitreoretinopathy: 4 years of experience

Método: Se estudiaron los antecedentes de 10 pacientes (rango de edad: 27-74 años), los cuales, a pesar de una media de 2,8 intervenciones previas, presentaban de nuevo desprendimiento de retina (DR) y vitreorretinopatía proliferativa (VRP). En todos ellos se optó por realizar retinotomía quirúrgica e implantación de Densiron® y valoramos su evolución con un seguimiento de 12 meses. Resultados: El tiempo medio de Densiron® hasta su retirada fue de 4 meses. Tres pacientes (30%) presentaron nuevo DR. El desarrollo de cataratas fue la complicación principal. No encontramos relación entre los redesprendimientos y la duración del tamponamiento, enfermedad de base o tiempo de evolución del DR. Densiron® puede ser una buena opción en casos de DR recidivante en los que el tratamiento previo con cerclaje, gas o aceites de silicona de 1.000/5.000 cts resulte insuficiente (AU)

Method: Prospective observational study including 10 patients (age range: 27-74 years) with recurrent retinal detachment (RD) and proliferative vitreoretinopathy (PVR) and 2.8 mean unsatisfactory previous surgeries. Densiron® was injected in all patients, with surgical retinectomy being required in 70% of them. Minimum follow-up time was 12 months. Results: The mean length of time before Densiron® withdrawal was 4 months. Three patients (30%) presented with a new RD. The main complication detected was cataract development. No relationship was found between re-detachments and tamponade time, baseline disease or RD evolution time. Densiron® may be a good option in cases of recurrent RD in which previous treatment with scleral buckle, gas and/or 1,000/5,000 silicone oils has proven to be unsatisfactory (AU)

[Heavy silicone oil (Densiron® 68) in proliferative vitreoretinopathy: 4 years of experience]. / Aceite de silicona pesado (Densiron(®) 68) en vitreorretinopatía proliferativa: 4 años de experiencia.

METHOD: Prospective observational study including 10 patients (age range: 27-74 years) with recurrent retinal detachment (RD) and proliferative vitreoretinopathy (PVR) and 2.8 mean unsatisfactory previous surgeries. Densiron® was injected in all patients, with surgical retinectomy being required in 70% of them. Minimum follow-up time was 12 months. RESULTS: The mean length of time before Densiron® withdrawal was 4 months. Three patients (30%) presented with a new RD. The main complication detected was cataract development. No relationship was found between re-detachments and tamponade time, baseline disease or RD evolution time. Densiron® may be a good option in cases of recurrent RD in which previous treatment with scleral buckle, gas and/or 1,000/5,000 silicone oils has proven to be unsatisfactory.

Injectability of silicone oil-based tamponade agents.

BACKGROUND/AIMS: High viscosity silicone oils are used as tamponade agents to increase the resistance to emulsification; however, this makes the oils more difficult to inject. Increasing the extensional viscosity is one way to reduce emulsification. This study aimed to evaluate how silicone oils with increased extensional viscosity behave in terms of their ease of injection. METHODS: The shear viscosity and the length of time taken to inject 9 ml of Siluron 1000, Siluron 2000, Siluron 5000, SiliconMate, a 56/44 w/w blend of Siluron 1000/Siluron 5000 (Blend A) and a 90/10 w/w blend of Siluron 1000/PDMS 423kDa molecular weight (Blend B) were examined. RESULTS: The shear viscosity of Siluron 1000, Siluron 2000 and Siluron 5000 were within the expected ranges. The shear viscosity of Blend A was 2283 mPa s, Blend B was 4710 mPa s and SiliconMate was 995.3 mPa s. Siluron 1000 and SiliconMate had the shortest injection times as expected due to their lower shear viscosities. Comparison of Siluron 2000 and Blend A demonstrated that Siluron 2000 was easier to inject. Similarly, Blend B was easier to inject than Siluron 5000. CONCLUSION: Silicone oil blends containing small percentages of a high molecular weight additive are easier to inject than single grade oils of the equivalent shear viscosity.

[Pigmentary epitheliopathy multifocal acute placoid associated with paralysis of VI cranial par]. / Epiteliopatía pigmentaria placoide multifocal aguda asociada a parálisis del VI par craneal.

CLINICAL CASE: We report the case of a 24-year-old patient who attended our hospital with an acute posterior multifocal placoid pigment epitheliopathy (APMPPE) which was later confirmed by fluorescein angiography. One month after presentation the patient developed a right VI nerve palsy. DISCUSSION: APMPPE is an acute-onset bilateral inflammatory disease causing impaired vision. Although it is thought to be benign, neurologic manifestations have been described even months after presentation. There is no previous report of APMPPE associated with VI nerve palsy.

Epiteliopatía pigmentaria placoide multifocal aguda asociada a parálisis del VI par craneal / Pigmentary epitheliopathy multifocal acute placoid associated with paralysis of vi cranial par

Caso clínico: Se presenta el caso de un paciente de24 años con una epiteliopatía multifocal placoideposterior bilateral aguda, confirmada medianteangiografía fluoresceínica . Al mes de seguimiento,el paciente presentó diplopia por paresia del VI parcraneal derecho.Discusión: La epiteliopatía multifocal placoideposterior, es una entidad que se engloba dentro delos síndromes de puntos blancos. Se considera unapatología benigna, aunque en ocasiones se asocianalteraciones neurológicas que pueden manifestarseincluso meses después del episodio. Nuestropaciente presentó una paresia del VI. par comocomplicación neurológica, hecho no descrito en la literatura(AU)

Clinical case: We report the case of a 24-year-oldpatient who attended our hospital with an acute posteriormultifocal placoid pigment epitheliopathy(APMPPE) which was later confirmed by fluoresceinangiography. One month after presentation thepatient developed a right VI nerve palsy.Discussion: APMPPE is an acute-onset bilateralinflammatory disease causing impaired vision.Although it is thought to be benign, neurologicmanifestations have been described even monthsafter presentation. There is no previous report ofAPMPPE associated with VI nerve palsy(AU)

Cirugía radioguiada: extirpación de metástasis de un carcinoma papilar de tiroides / Probe-guided surgery: metastases of a papillary thyroid carcinoma. Surgical Excision

Paciente de sexo masculino operado de Carcinoma Papilar Tiroideo (variedad folicular) con recurrencia tumoral luego de tiroidectomía, linfadenectomía y Dosis Terapéutica de Iodo 131. Bajo tratamiento con hormonas tiroideas a dosis inhibitorias de TSH, persistencia de valores elevados de Tiroglobulina Plasmática e imágenes detectables en la Ecografía y Resonancia Magnética Nuclear ( RMN). Por la Dosis Terapéutica se sospechaba que las mismas concentrarían radioyodo. Se planificó por lo tanto cirugía radioguiada, según el protocolo del Instituto Gustave Roussy (modificado). Dosis Terapéutica de Iodo 131; al 4º día Rastreo Corporal Total en Cámara Gamma (RCT); al 5º día cirugía con sonda exploradora (gamma probe) y a las 48 hs. poscirugía nuevo RCT. El procedimiento fue exitoso, pudiendo extirparse adenopatías metastásicas con la desaparición en el RCT posquirúrgico de las imágenes que fijaban francamente radioyodo en el preoperatorio. Los vlores de Tiroglobulina plasmática descendieron francamente con terapia hormonal de reemplazo, a los sesenta y noventa días postratamiento.

A male patient with papillary thyroid cancer -folliculary variety- is chosen to be presented. After thyroidectomy, lymfhadenectomy and therapeutic dose of radioiodine treatments, cancer relapse was observed. After thyrotrophyn supressive therapy with l-thyroxine, a high serum thyroglobulin concentration was observed. The Ultrasonography ( US) and Magnetic Resonance (MR) images showed visible node structures in the neck. This node structures were probably going to concentrate I-131 as seen in the first whole body scan after therapeutic dose. Therefore a radio-guided surgery was planned as the best choice. (Institute Gustave Roussy protocol). A therapeutic dose of radioiodine (I-131) was given and up to the 4th day a whole body scan was performed. In the 5th day a gamma- probe-guided surgery was performed as well, and localized metastatic foci in the pretracheal region and under right recurrent laryngeal nerve. No other foci were identified with the probe at surgery. Forty eight hours after surgery a new whole-body scan was made again. The procedure was successful. The metastatic lessions were completely dissected. The last whole body scan showed that radioiodine concentration had disappeared at all. Forty five days and three months after surgery under levothyroxin treatment, the serum thyroglobulin level concentration decrease to very low values.

[Prospective randomized trial comparing Discovisc versus Healon in phacoemulsification]. / Estudio prospectivo randomizado comparando Discovisc versus Healon en facoemulsificación.

OBJECTIVE: To compare the intraoperative behaviour of both, DisCoVisc and Healon used as viscoelastics in cataract surgery. METHOD: We prospectively evaluated 35 patients with cataracts who underwent phacoemulsification and intraocular lens implantation. Patients were randomized into two groups. Group A included 17 patients in where Healon was used as a viscoelastic, whereas group B included 18 patients in where the viscoelastic used was DisCoVisc. After each procedure, the surgeon filled in a questionnaire describing the behaviour of the viscoelastic during the different stages of phacoemulsification. RESULTS: DisCoVisc behaved as both cohesive and dispersive viscoelastic during capsulorrhexis, phacoemulsification and viscoelastic aspiration, whereas Healon acted as a cohesive substance during all surgical stages. DisCoVisc enabled better visualization and transparency during all the surgical stages and maintains the capsular bag better during the intraocular lens implantation. Viscoelastic aspiration was easier with Healon. CONCLUSIONS: DisCoVisc is a new viscosurgical device with both cohesive and dispersive properties, which avoids using two different viscoelastics to improve the performance at different surgical stages. DisCoVisc has been shown to be more transparent and provides better anterior chamber maintenance when compared with Healon. Healon was more easily aspirated due to its cohesive character.

[Progressive geographic chorioretinopathy associated with Alagille syndrome]. / Coriorretinopatía geográfica progresiva asociada al síndrome de Alagille.

CASE REPORT: We report the case of a patient with the genetic diagnosis of Alagille Syndrome, who has attended our hospital since 1992, and has shown a progressive bilateral chorioretinopathy with severe deterioration in visual acuity. DISCUSSION: Ocular abnormalities associated with Alagille Syndrome are variable and can affect most ocular structures. Although severe visual threat or progressive ocular disease associated with Alagille syndrome have not yet been described, our patient has shown a marked decrease in visual acuity and a clear progression of the chorioretinal atrophy.

Estudio prospectivo randomizado comparando Discovisc(R) versus Healon(R) en facoemulsificación / Prospective randomized trial comparing Discovisd(R) versus Healon(R) in phacoemulsification

Propósito: Comparar el comportamiento de ambos viscoelásticos intraoperatoriamente. Método: Estudio prospectivo aleatorio en el que se incluyen 35 pacientes con catarata, intervenidos mediante facoemulsificación ultrasónica e implantación de lente intraocular. En el grupo A, se incluyeron 17 pacientes en los que se utilizó Healon(R) (hialuronato sódico 1%) y en el grupo B, 18 pacientes en los que se utilizó DisCoVisc(R) (ácido hialurónico al 1,6% y condroitín sulfato al 4%). Tras la intervención el cirujano rellenó un cuestionario sobre el comportamiento de los viscoelásticos en cada momento de la cirugía. Resultados: El DisCoVisc(R) se ha comportado como dispersivo y cohesivo durante la capsulorrexis, la facoemulsificación y la aspiración del viscoelástico, mientras el Healon® ha demostrado ser una sustancia cohesiva en dichas fases. El DisCo- Visc(R) permite una mejor visualización y transparencia durante todos los pasos quirúrgicos, y mantiene mejor el el espacio capsular durante la implantación de la lente intraocular. La aspiración del viscoelástico ha resultado ser más fácil utilizando Healon(R). Conclusiones: El DisCoVisc(R) es un nuevo viscoelástico que presenta propiedades dispersivas y cohesivas, evitando la utilización de dos viscoelásticos (uno cohesivo y otro dispersivo) para adaptarse a las necesidades de todos los pasos de la facoemulsificación. Ha demostrado ofrecer mayor transparencia en la cirugía con respecto al Healon(R) y un mejor mantenimiento de la cámara anterior en todas las fases de la cirugía. La aspiración del Healon(R) se realizó con mayor sencillez por su carácter cohesivo

Objective: To compare the intraoperative behaviour of both, DisCoVisc(R) and Healon(R) used as viscoelastics in cataract surgery. Method: We prospectively evaluated 35 patients with cataracts who underwent phacoemulsification and intraocular lens implantation. Patients were randomized into two groups. Group A included 17 patients in where Healon(R) was used as a viscoelastic, whereas group B included 18 patients in where the viscoelastic used was DisCoVisc(R). After each procedure, the surgeon filled in a questionnaire describing the behaviour of the viscoelastic during the different stages of phacoemulsification. Results: DisCoVisc(R) behaved as both cohesive and dispersive viscoelastic during capsulorrhexis, phacoemulsification and viscoelastic aspiration, whereas Healon® acted as a cohesive substance during all surgical stages. DisCoVisc(R) enabled better visualization and transparency during all the surgical stages and maintains the capsular bag better during the intraocular lens implantation. Viscoelastic aspiration was easier with Healon(R). Conclusions: DisCoVisc(R) is a new viscosurgical device with both cohesive and dispersive properties, which avoids using two different viscoelastics to improve the performance at different surgical stages. DisCoVisc(R) has been shown to be more transparent and provides better anterior chamber maintenance when compared with Healon®. Healon® was more easily aspirated due to its cohesive character

Coriorretinopatía geográfica progresiva asociada al síndrome de Alagille / Progressive geographic chorioretinopathy associated with Alagille syndrome

Caso clínico: Paciente diagnosticada genéticamente de Síndrome de Alagille, vista en el servicio de oftalmología desde 1992 por atrofia coriorretiniana progresiva que ha dado lugar a una pérdida severa de agudeza visual bilateral. Discusión: Las manifestaciones oftalmológicas asociadas al síndrome de Alagille son variables, pudiendo afectarse la práctica totalidad de las estructuras oculares. A pesar de que hasta el momento no se han descrito alteraciones severas de la agudeza visual ni progresión de las lesiones oculares asociadas al síndrome de Alagille, nuestra paciente ha presentado una marcada disminución de su agudeza visual así como una clara progresión de las lesiones coriorretinianas

Case report: We report the case of a patient with the genetic diagnosis of Alagille Syndrome, who has attended our hospital since 1992, and has shown a progressive bilateral chorioretinopathy with severe deterioration in visual acuity. Discussion: Ocular abnormalities associated with Alagille Syndrome are variable and can affect most ocular structures. Although severe visual threat or progressive ocular disease associated with Alagille syndrome have not yet been described, our patient has shown a marked decrease in visual acuity and a clear progression of the chorioretinal atrophy

[Floppy-iris syndrome associated with tamsulosin. A prospective case-control study]. / Síndrome de iris fláccido por tamsulosina. Estudio prospectivo frente a grupo control.

OBJECTIVE: The main objectives of this study were: To assess the incidence of the intraoperative floppy-iris syndrome associated with tamsulosin and to analyse the incidence of intraoperative and postoperative complications as compared to a control group. Secondary objectives were: to describe the pupillary modifications associated with tamsulosin and to quantify the endothelial cell loss. METHODS: A prospective review of 38 eyes of 38 patients was performed. Patients were assigned to two different groups. Group 1 (cases) included 19 eyes of 19 male patients taking tamsulosin, and group 2 (controls) included 19 eyes of 19 male patients not taking tamsulosin. RESULTS: Only two patients (10%) of our study had the complete triad seen in floppy-iris syndrome; 9 patients (47%) showed 2 of the 3 main features of the syndrome and only 2 patients showed iris billowing during phacoemulsification. None of the patients in group 2 showed any of the characteristic intraoperative features. The complication rate was similar in both groups. CONCLUSIONS: Intraoperative floppy-iris syndrome occurred in 67% of the patients treated with tamsulosin. The only postoperative secondary effect was a lower pupil reactivity in patients taking tamsulosin.

Síndrome de iris fláccido por tamsulosina. Estudio prospectivo frente a grupo control / floppy-iris syndrome associated with Tamsulosin. A prospective case-control study

Objetivos: Los objetivos de este estudio son: determinar la incidencia real del síndrome del iris fláccido intraoperatorio asociado al tratamiento con tamsulosina y analizar las diferentes tasas de complicaciones tanto intra como postoperatorias frente a un grupo control. Los objetivos secundarios son: describir las alteraciones pupilares asociadas a la toma de tamsulosina y cuantificar la pérdida endotelial de la cirugía de catarata. Método: Estudio prospectivo que incluye 38 ojos de 38 pacientes divididos en dos grupos. El grupo 1 (casos) compuesto por 19 ojos de 19 pacientes varones en tratamiento con tamsulosina y el grupo 2 (controles) compuesto por 19 ojos de 19 varones sin tratamiento con tamsulosina. En todos los casos, se trata de pacientes consecutivos que acuden a nuestro hospital para ser intervenidos de catarata. Resultados: La incidencia de iris fláccido en nuestra serie se limita a dos pacientes (10%) que presentaron la tríada completa, 9 pacientes (47%) presentaron 2 de los 3 signos, y solo dos pacientes (10%) presentaron bamboleo del iris aislado. Ninguno de los pacientes del grupo control presentó característica alguna de este síndrome. La incidencia de complicaciones fue similar en ambos grupos. Conclusiones: Como conclusión mencionar que el síndrome IFIS se presenta en el 67% de los pacientes en tratamiento con tamsulosina. El único efecto secundario postoperatorio a destacar ha sido la observación de una menor reactividad pupilar en los pacientes tratados con tamsulosina, circunstancia no descrita en la literatura

Objective: The main objectives of this study were: To assess the incidence of the intraoperative floppyiris syndrome associated with tamsulosin and to analyse the incidence of intraoperative and postoperative complications as compared to a control group. Secondary objectives were: to describe the pupillary modifications associated with tamsulosin and to quantify the endothelial cell loss. Methods: A prospective review of 38 eyes of 38 patients was performed. Patients were assigned to two different groups. Group 1 (cases) included 19 eyes of 19 male patients taking tamsulosin, and group 2 (controls) included 19 eyes of 19 male patients not taking tamsulosin. Results: Only two patients (10%) of our study had the complete triad seen in floppy-iris syndrome; 9 patients (47%) showed 2 of the 3 main features of the syndrome and only 2 patients showed iris billowing during phacoemulsification. None of the patients in group 2 showed any of the characteristic intraoperative features. The complication rate was similar in both groups. Conclusions: Intraoperative floppy-iris syndrome occurred in 67% of the patients treated with tamsulosin. The only postoperative secondary effect was a lower pupil reactivity in patients taking tamsulosin

Alpha2B-adrenergic receptor deletion polymorphism and cardiac autonomic nervous system responses to exercise in obese women.

OBJECTIVE: To investigate the association of short form (Glu9/Glu9) of the 12Glu9 deletion polymorphism of the alpha2B-adrenergic receptor (alpha2B-AR) gene polymorphism with the cardiac autonomic responsiveness during sustained isometric handgrip exercise. DESIGN: Cross-sectional clinical study. SUBJECTS: In all, 97 normotensive obese women (body mass index (BMI) = 33.2 kg/m2). Of these, 78 (80.41%) were genotyped as Glu12/Glu12, 13 (13.40%) as Glu12/Glu9 and six (6.19%) as Glu9/Glu9 form. MEASUREMENTS: The sympathovagal balance was assessed by means of power spectral analysis of heart rate variability at rest and during sustained isometric handgrip exercise at 30% of maximal voluntary handgrip contraction for 3 min. Two spectral components were analysed: low-frequency component reflecting sympathetic efferent activity and high-frequency power (HFnu) reflecting parasympathetic modulation. In addition, a normalized low-frequency power (LFnu) and HFnu were analysed. Genotypes were determined by polymerase chain reaction followed by agarose gel electrophoresis. RESULTS: There were no differences in baseline measurements among groups. The absolute level of LFnu throughout handgrip exercise was significantly lower in Glu9/Glu9 subjects compared with other genotypes, while the decline of absolute HFnu was significantly smaller compared with Glu12/Glu12 genotype. CONCLUSION: These findings suggest that 12Glu9 deletion polymorphism of the alpha2B-AR gene (Glu9/Glu9 genotype) might result in reduced autonomic responsiveness by altering cardiac sympathetic and vagal function during sustained handgrip exercise in normotensive obese women.

Low toxicity with continuous infusion of high-dose bleomycin in poor prognostic testicular cancer.

Bleomycin is a powerful antitumoral antibiotic whose utilization has been limited by pulmonary toxicity. At the Medical Oncology Department of the Hospital General de Mexico, SS, 17 patients with high-risk testicular cancer were treated with therapeutic regimens based on cisplatin and bleomycin in continuous infusion. The mean bleomycin dose was 813 mg. Adequate renal function was observed in all patients during and after chemotherapy. During a minimum 4-year follow-up period, no patient experienced pulmonary toxicity; 3 patients died due to tumoral progression. The remaining 14 patients are alive and none of them had shown x-ray abnormalities nor a significant reduction in pulmonary vital capacity (PVC) or carbon monoxide diffusion capacity (DLCO). Bleomycin in continuous infusion can be an appropriate alternative for reducing pulmonary toxic effects. Therefore, randomized controlled studies should be conducted in order to determine if this treatment regime could enhance the therapeutic index.

Quimioterapia en cáncer testicular de alto riesgo: experiencia del grupo uro-oncológico del Hospital General de México, SS / Chemotherapy in high risk testicular cancer: experience of uro-oncologic group of the Hospital General of México, SS

Se analiza el uso de tres esquemas distintos de quimioterapia en cáncer testicular de alto riesgo. El grupo I incluyó 21 pacientes tratados entre 1976 y 1980 que recibieron vinblastina y blemicina (esquema VBII); el grupo II, 15 pacientes manejados de 1981 a 1985 con cisplatino, vinblastina y bleomicina (esquema PVB); y el grupo III, 17 pacientes atendidos entre 1986 y 1990 con cisplatino, ciclofosfamida y adriamicina, en ciclos alternos con vinblastina y bleomicina (esquema CISCA II/VBIV). Se obtuvieron, respectivamente, respuestas completas de 19.0, 46.7 y 76.5 por ciento (p= 0.0003), lo cual se elevó a 59.8 por ciento en el grupo II y a 100.0 por ciento en el gurpo III, con cirugía citorreductiva (p=0.0000). Después de 104 semanas de seguimiento, el 33.0 por ciento de los pacientes del grupo II y el 94.0 por ciento del grupo III sa encontraban libres de enfermedad (p= 0.0002). Los efectos tóxicos fueron mayores en el tercer grupo; sin embargo no hubo diferencia estadística. Las características inherentes a los distintos períodos en que fueron tratados los grupos imposibilitan una comparación objetiva. La experiencia adquiridad perfila una curva positiva de aprendisaje. Con cada etapa se lograron mejores resultados; sobre todo al implantar regímenes más agresivos de quimioterapia, que implican mayor número de grogas efectivas, administradas en un lapso menor, con un manejo adecuado de los efectos secundadios