Síndrome de Charles Bonnet desencadenado por brimonidina / Charles Bonnet syndrome precipitated by brimonidine

Caso clínico: Mujer de 81 años con degeneración macular y glaucoma pseudoexfoliativo. Poco después de iniciar tratamiento con brimonidina, la paciente presentó alucinaciones visuales (caras, flores y marcos). La exploración neurológica y psiquiátrica era normal. Retiramos la brimonidina y las alucinaciones desaparecieron 10 días después. Discusión: El síndrome de Charles Bonnet (SCB) consiste en alucinaciones visuales complejas en pacientes ancianos con un deterioro de visión significativo sin alteraciones psiquiátricas. Es importante el conocimiento del SCB por parte de los oftalmólogos. Debemos tratar la enfermedad visual y tener en cuenta el posible desarrollo del SCB en pacientes tratados con brimonidina (AU)

Case report: An 81-year-old woman with age-related macular degeneration and pseudoexfoliative glaucoma developed visual hallucinations (faces, flowers and frames) shortly after beginning brimonidine drops. Neurologic and psychiatric examination was normal. Visual hallucinations disappeared within 10 days after discontinuing the drug. Discussion: The Charles Bonnet syndrome (CBS) is characterised by complex visual hallucinations in elderly patients in the setting of significant visual impairment without any psychiatric symptoms. Awareness of CBS among ophthalmologist is essential. Clinicians should treat visual impairment and be aware of possible visual hallucinations in patients treated with brimonidine (AU)

[Charles Bonnet syndrome precipitated by brimonidine]. / Síndrome de Charles Bonnet desencadenado por brimonidina.

CASE REPORT: An 81-year-old woman with age-related macular degeneration and pseudoexfoliative glaucoma developed visual hallucinations (faces, flowers and frames) shortly after beginning brimonidine drops. Neurologic and psychiatric examination was normal. Visual hallucinations disappeared within 10 days after discontinuing the drug. DISCUSSION: The Charles Bonnet syndrome (CBS) is characterised by complex visual hallucinations in elderly patients in the setting of significant visual impairment without any psychiatric symptoms. Awareness of CBS among ophthalmologist is essential. Clinicians should treat visual impairment and be aware of possible visual hallucinations in patients treated with brimonidine.

Tear clearance and ocular symptoms in patients treated with preservative-free prostaglandins.

OBJECTIVES: To assess the effects on dry eye symptoms and tear dynamics of switching from a prostaglandin with a preservative to a preservative-free prostaglandin. MATERIAL AND METHODS: Fourteen patients (N=28 eyes) with open-angle glaucoma and dry eye symptons, treated with preserved latanoprost, travoprost or bimatoprost were included in this uncontrolled prospective study. Ocular symptoms were analysed using a validated ocular surface disease questionnaire and ocular signs were assessed with tear clearance, Schirmer and tear function index test (TFI=Schirmer/clearance). Patients were assigned to preservative-free tafluprost treatment, and measurements were repeated 4 weeks after change of medication. Wilcoxon test and Spearman correlation coefficient were used in the statistical analysis. RESULTS: No statistically significant difference in intraocular pressure (IOP) was observed after switching to tafluprost. Mean IOP at baseline was 20.4 mmHg (SD2.2) and after 4 weeks 19.9 mmHg (SD2.6), (P>.05). The mean questionnaire score significantly decreased from 9.7 (SD3.7) at baseline to 5.4 (SD2.7) after one month (P<.001). No significant differences in tear clearance, Schirmer or TFI were found (P>.05). At baseline, tear clearance=0.13 (SD0.07), Schirmer=10.7 mm (SD6) and TFI=80 (48-156). After 4 weeks, tear clearance=0.1(SD0.07), Schirmer=9.5 mm (3.9) and TFI=104 (48-216). A significant association between questionnaire score and tear clearance after 4 weeks was observed (Spearman coefficient=0.62; P=.014). CONCLUSIONS: Switching from preservative prostaglandin with a preservative to preservative-free tafluprost treatment improves dry eye symptoms and suggests an improvement in TFI.

Aclaramiento lagrimal y sintomatología ocular en pacientes tratados con prostaglandinas sin conservantes / Tear clearance and ocular symptoms in patients treated with preservative-free prostaglandins

Objetivos: Evaluar el efecto en los síntomas de sequedad ocular y en la dinámica lagrimal que se produce al sustituir una prostaglandina con conservante por una prostaglandina sin conservante. Material y métodos: Estudio prospectivo no controlado en el que se seleccionaron 28 ojos de 14 pacientes con síntomas de ojo seco en tratamiento con latanoprost, travoprost o bimatoprost con conservante. Se evaluaron los síntomas oculares con un cuestionario validado de enfermedad de la superficie ocular y los signos mediante el test de aclaramiento lagrimal, el Schirmer y el índice de función lagrimal (TFI, TFI=Schirmer/aclaramiento). En todos los pacientes se cambió el tratamiento hipotensor a tafluprost sin conservante. Al mes, se repitieron los tests. En el análisis estadístico se utilizó el test de Wilcoxon y el coeficiente de correlación de Spearman. Resultados: No encontramos diferencias en la presión intraocular (PIO) al cambiar a tafluprost. La PIO inicial era 20,4mmHg (DE2,2) y la PIO al mes era 19,96mmHg (DE2,6) (p>0,05). La puntuación del cuestionario disminuyó de forma significativa desde 9,7 (DE3,7) hasta 5,4 (DE2,7) al mes del tratamiento (p<0,001). No encontramos diferencias significativas en el aclaramiento, en el Schirmer, ni en el TFI (p>0,05). Inicialmente, aclaramiento=0,13 (DE0,07), Schirmer=10,7mm (DE6) y TFI=80 (48-156). Al mes, aclaramiento=0,1 (DE0,07), Schirmer=9,5mm (DE3,9) y TFI=104 (48-216). Hemos encontrado una asociación significativa entre la puntuación del cuestionario y el aclaramiento al mes (coeficiente de correlación=0,62; p=0,014). Conclusiones: La sustitución de una prostaglandina con conservante por tafluprost sin conservante mejora los síntomas de sequedad ocular y sugiere una mejoría en el test de función lagrimal(AU)

Objectives: To assess the effects on dry eye symptoms and tear dynamics of switching from a prostaglandin with a preservative to a preservative-free prostaglandin. Material and methods: Fourteen patients (N=28 eyes) with open-angle glaucoma and dry eye symptons, treated with preserved latanoprost, travoprost or bimatoprost were included in this uncontrolled prospective study. Ocular symptoms were analysed using a validated ocular surface disease questionnaire and ocular signs were assessed with tear clearance, Schirmer and tear function index test (TFI=Schirmer/clearance). Patients were assigned to preservative-free tafluprost treatment, and measurements were repeated 4 weeks after change of medication. Wilcoxon test and Spearman correlation coefficient were used in the statistical analysis. Results: No statistically significant difference in intraocular pressure (IOP) was observed after switching to tafluprost. Mean IOP at baseline was 20.4mmHg (SD2.2) and after 4 weeks 19.9mmHg (SD2.6), (P>0.05). The mean questionnaire score significantly decreased from 9.7 (SD3.7) at baseline to 5.4 (SD2.7) after one month (P<0.001). No significant differences in tear clearance, Schirmer or TFI were found (P>0.05). At baseline, tear clearance=0.13 (SD0.07), Schirmer=10.7mm (SD6) and TFI=80 (48-156). After 4 weeks, tear clearance=0.1(SD0.07), Schirmer=9.5mm (3.9) and TFI=104 (48-216). A significant association between questionnaire score and tear clearance after 4 weeks was observed (Spearman coefficient=0.62; P=0.014). Conclusions: Switching from preservative prostaglandin with a preservative to preservative-free tafluprost treatment improves dry eye symptoms and suggests an improvement in TFI(AU)

[Dry eye and quality of life]. / Ojo seco y calidad de vida.

PURPOSE: To evaluate the relation between dry eye severity and quality of life. METHODS: 40 participants (19 with dry eye and 21 normal controls) underwent slit-lamp examination and Schirmer test to evaluate dry eye severity. Quality of life was evaluated with OSDI (Ocular Surface Disease Index) and VFQ-25 (Visual Function Questionnaire-25). RESULTS: The OSDI total score was significantly greater in patients suffering dry eye. However, BUT (break-up time) and VFQ-25 total score were significantly lower than in control subjects. In dry eye patients several statistically significant correlations (p<0.05) were found: OSDI with VFQ-25 total score (r=-0.62), BUT with corneal staining (r=-0.50) and Schirmer (0.66), BUT with OSDI total score, OSDI-symptoms and OSDI-triggers (r=-0.56, -0.56, -0.60); corneal staining with OSDI total score and OSDI-symptoms (r=0.55, 0.54), BUT with VFQ-25 total score, VFQ-25 ocular pain, mental function and role function. (r=0.56, 0.51, 0.63, 0.56); corneal staining with VFQ-25 total score, VFQ-25 ocular pain and near vision (r=-0.57, -0.49, -0.62). CONCLUSION: Quality of life is decreased in patients with dry eye. OSDI and VFQ-25 questionnaires are valid instruments for measuring the impact of dry eye disease. BUT and corneal staining provide an indirect measurement of quality of life.