Modification of the inverted flap technique compared to conventional internal limiting membrane peeling in complete macular hole surgery.

AIM: To describe the efficacy of a modification of the superior inverted flap technique, with maculorrhexis, in vitrectomy for full-thickness macular hole (MH) surgery compared to internal limiting membrane peeling (ILM). METHODS: Retrospective and comparative study of patients with MH. In group A, a superior ILM flap is created to cover the macular hole, and in group B conventional ILM peeling was performed. RESULTS: A total of 80 eyes were included (44 group A and 36 group B). MH closure occurred in 100% in group A and 91.67% in group B (p = 0.0869). There were more U-type closures in group A(90.91%) than in group B(58.33%), p = 0.0017. Both groups showed Best corrected visual acuity (BCVA) improvement at 3 and 6 months. At 3 months BCVA in group A was significantly better but at 6 months results were similar. Ellipsoid layer (EZ) recovery at 6 months was achieved in 81.82% patients in group A and 52.78% in B (p = 0.005), and external limiting membrane in 81.82% in group A and 69.44% in B (p = 0.1957). CONCLUSIONS: The superior inverted flap maculorrhexis technique is suitable for idiopathic MH treatment, with better anatomical and non-inferior functional results than the classic ILM peeling. It achieves functional recoveries earlier, better BCVA and greater gains at 3 months compared to the classic ILM peeling. It also obtains a higher number of U-shaped closures and higher EZ restorations.

Técnica modificada del flap invertido superior con vitrectomía versus vitrectomía con pelado de membrana limitante interna para el desprendimiento de retina con agujero macular miópico / Modified superior inverted internal limiting membrane flap technique with vitrectomy versus vitrectomy with internal limiting membrane peeling for retinal detachment with myopic macular hole

Objetivo Evaluar la eficacia de la técnica del flap invertido superior de membrana limitante interna (MLI) modificada para el tratamiento del desprendimiento de retina (DR) por agujero macular (AM), comparada con el pelado clásico de la MLI. Materiales y métodos Análisis retrospectivo de 10 pacientes que requirieron vitrectomía pars plana por DR con AM. Se dividieron en dos grupos, según la técnica quirúrgica realizada: grupo del flap (5 pacientes) y de pelado de MLI (5 pacientes). Se comparó la agudeza visual mejor corregida (AVMC) pre y posquirúrgica, la resolución del DR, la tasa de cierre del AM y la restauración de las capas externas de la retina entre los grupos. Resultado La AVMC poscirugía mejoró en ambos grupos, sin diferencias significativas (p=0,9). La tasa de cierre del AM fue del 100% en el grupo del flap y del 80% del grupo de pelado de la MLI, sin diferencias significativas entre los grupos. La retina se reaplicó en el 100% de los casos en ambos grupos. Solo se restauraron las capas externas de la retina en 2 pacientes del grupo del flap invertido (40%) y en ninguno del grupo de pelado de la MLI (p=0,62). Conclusiones Las técnicas de pelado de MLI y del flap invertido superior modificada son útiles para el tratamiento del DR con agujero macular en ojos miopes (AU)

Purpose To evaluate the efficacy of the modified superior inverted internal limiting (ILM) membrane flap technique in retinal reattachment, macular hole closure and external retinal layers restoration in macular hole associated retinal detachment compared to ILM peeling. Methods Retrospective case series of 10 patients that required pars plana vitrectomy for retinal detachment with macular hole followed for more than 12months. Data from medical records were retrospectively collected and patients were divided into the superior inverted flap (5 patients) and ILM peeling group (5 patients). We compared best corrected visual acuity (BCVA) before and after surgery, retinal attachment, macular hole closure rate and external retinal layer restoration between groups. Results There were significant improvements in BCVA in both groups before and after surgery, with no differences between the two groups at 12months after surgery (P=.9). The macular hole closed in 100% of cases in the inverted flap group and 80% of the ILM peeling group with no significant differences between groups. The retina was reattached in 100% of cases in both groups. Only 2 patients in the inverted flap group (40%) had external retinal layer restoration and none in ILM peeling group (P=.62). Conclusions ILM peeling and superior inverted flap techniques are useful for treating retinal detachment with macular hole in myopic eyes (AU)

Modified superior inverted internal limiting membrane flap technique with vitrectomy versus vitrectomy with internal limiting membrane peeling for retinal detachment with myopic macular hole.

PURPOSE: To evaluate the efficacy of the modified superior inverted internal limiting (ILM) membrane flap technique in retinal reattachment, macular hole closure and external retinal layers restoration in macular hole associated retinal detachment compared to ILM peeling. METHODS: Retrospective case series of 10 patients that required pars plana vitrectomy for retinal detachment with macular hole followed for more than 12 months. Data from medical records were retrospectively collected and patients were divided into the superior inverted flap (5 patients) and ILM peeling group (5 patients). We compared best corrected visual acuity (BCVA) before and after surgery, retinal attachment, macular hole closure rate and external retinal layer restoration between groups. RESULTS: There were significant improvements in BCVA in both groups before and after surgery, with no differences between the two groups at 12 months after surgery (p=0.9). The macular hole closed in 100% of cases in the inverted flap group and 80% of the ILM peeling group with no significant differences between groups. The retina was reattached in 100% of cases in both groups. Only 2 patients in the inverted flap group (40%) had external retinal layer restoration and none in ILM peeling group (p=0.62). CONCLUSIONS: ILM peeling and superior inverted flap techniques are useful for treating retinal detachment with macular hole in myopic eyes.

[Endophthalmitis after cataract surgery: epidemiology, clinical features and antibiotic prophylaxis]. / Endoftalmitis tras cirugía de cataratas: epidemiología, aspectos clínicos y profilaxis antibiótica.

PURPOSE: To estimate the incidence of endophthalmitis after cataract surgery and to describe the main epidemiological and clinical data, as well as the role of intracameral antibiotics. METHODS: A cross-sectional descriptive study was conducted on patients who underwent cataract surgery in a public hospital over an 11-year period. An ocular infection database was used to report endophthalmitis occurrences and to collect the clinical features. Qualitative variables are described with their frequency distribution and qualitative variables, with the mean and the standard deviation. RESULTS: From January 1999 to December 2009, 15.173 patients underwent cataract surgery. A total of 43 patients suffered from postoperative endophthalmitis, giving an overall infection rate of 0.28% (95% CI: 0.20-0.36%). Among the 43 cases, there were 19 men and 24 women with a mean age of 78.5. Other clinical parameters evaluated were as follows: 25.58% were diabetic, 44.18% had some degree of immunosuppression and there were complications with posterior capsular tears in 18.6%. As regards antibiotic prophylaxis, 2 groups were considered: the first one did not receive intracameral antibiotic (8,099 patients) and the second group received intracameral cefuroxime (7,074 patients). There were 39 endophthalmitis in the first group with an infection incidence of 0.48% and 4 endophthalmitis in the second group with an infection incidence of 0.056%. The relative risk (RR) after-before cefuroxime was 0.12 (0.04-0.33) with P<0.05. CONCLUSIONS: The incidence of endophthalmitis after cataract surgery in an 11-year period was lower than 0.3%. Almost half of the patients had a higher systemic risk. Intracameral cefuroxime resulted in nearly a 9-fold reduction in the rate of infection.

Endoftalmitis tras cirugía de cataratas: epidemiología, aspectos clínicos y profilaxis antibiótica / Endophthalmitis after cataract surgery: epidemiology, clinical features and antibiotic prophylaxis

Objetivo: Estimar la incidencia de endoftalmitis tras cirugía de cataratas, la clínica y el papelde los antibióticos intracamerales.Métodos: Se realizó un estudio descriptivo transversal en pacientes operados de cataratas enun hospital público durante 11 años. Se diseñó una base de datos de infecciones ocularespara analizar los aspectos clínico-quirúrgicos. Las variables cualitativas se describen con sudistribución de frecuencias y las cuantitativas con la media y la desviación estándar.Resultados: Desde enero de 1999 hasta diciembre de 2009, 15.173 pacientes se operaron decataratas. Hubo 43 endoftalmitis postquirúrgicas con una incidencia global de 0,28% (IC95%: 0,20-0,36%). Había 19 varones y 24 mujeres, con una edad media de 78,5 an˜ os. Se evaluarondistintos parámetros clínicos: un 25,58% eran diabéticos, un 44,18% tenían algúngrado de inmunosupresión y hubo complicaciones con vitreorragia en el 18,6%. En cuanto aprofilaxis antibiótica, se consideraron 2 grupos: el primer grupo no recibió antibiótico intracameral(8.099 pacientes) y el segundo grupo sí recibió cefuroxima (7.074 pacientes). De las43 endoftalmitis, 39 pertenecieron al primer grupo y 4 al segundo, con lo que la incidenciade infección fue de 0,48% en el primer grupo y 0,056% en el segundo. El riesgo relativo (RR)tras la evaluación después-antes de cefuroxima fue de 0,12 (0,04-0,33) con una p < 0,05.Conclusiones: La incidencia de endoftalmitis tras cirugía de cataratas en 11 años fue inferioral 0,3%. Casi la mitad de los pacientes tenían un riesgo sistémico mayor. Con la cefuroximaintracameral la tasa de infección se redujo casi nueve veces más(AU)

Purpose: To estimate the incidence of endophthalmitis after cataract surgery and to describe the main epidemiological and clinical data, as well as the role of intracameral antibiotics. Methods: A cross-sectional descriptive study was conducted on patients who underwentcataract surgery in a public hospital over an 11-year period. An ocular infection databasewasused to report endophthalmitis occurrences and to collect the clinical features. Qualitativevariables are described with their frequency distribution and qualitative variables, with themean and the standard deviation.Results: From January 1999 to December 2009, 15.173 patients underwent cataract surgery. Atotal of 43 patients suffered from postoperative endophthalmitis, giving an overall infectionrate of 0.28% (95% CI: 0.20-0.36%). Among the 43 cases, there were 19 men and 24 womenwith a mean age of 78.5. Other clinical parameters evaluated were as follows: 25.58% werediabetic, 44.18% had some degree of immunosuppression and there were complicationswith posterior capsular tears in 18.6%. As regards antibiotic prophylaxis, 2 groups were considered:the first one did not receive intracameral antibiotic (8,099 patients) and the secondgroup received intracameral cefuroxime (7,074 patients). There were 39 endophthalmitis inthe first group with an infection incidence of 0.48% and 4 endophthalmitis in the secondgroup with an infection incidence of 0.056%. The relative risk (RR) after-before cefuroximewas 0.12 (0.04-0.33) with P < 0.05.Conclusions: The incidence of endophthalmitis after cataract surgery in an 11-year periodwas lower than 0.3%. Almost half of the patients had a higher systemic risk. Intracameralcefuroxime resulted in nearly a 9-fold reduction in the rate of infection(AU)

[Efficiency of brimonidine 0.2% and dorzolamide 2% as adjunctive therapy to beta-blockers]. / Eficacia de brimonidina 0,2% y dorzolamida 2% como tratamiento adyuvante a un beta-bloqueante.

PURPOSE: To evaluate the clinical efficiency and tolerability of brimonidine and dorzolamide twice daily as an adjunctive therapy for glaucoma patients with an inadequate response to beta-blockers therapy. METHODS: This multicenter prospective analysis included 92 patients (180 eyes) with primary open-angle glaucoma or ocular hypertension on therapy beta-blockers and with intraocular pressure (IOP) greater than or equal to 18mmHg. The patients were randomly treated either with brimonidine 0.2% or dorzolamide 2% added for three months. Efficiency was determined by the reduction in 15% IOP from baseline at the first and the third month. RESULTS: Mean pre-treatment IOP was 22.37 DE 2.8 mmHg in the brimonidine group and 22.38 DE 2.6 mmHg in the dorzolamide group; mean post-treatment IOP decrease was 4.39 mmHg in the brimonidine group and 3.29 mmHg in the dorzolamide group. Clinical control at the first month was achieved in 78.3% and 71% of cases respectively (p=0.05). No statistical differences existed between groups for systemic adverse events. Four patients on brimonidine discontinued treatment due to local side effects. In the dorzolamide group, two patients left the treatment referring itching and three others left due to ocular allergy. CONCLUSIONS: This study found similar efficiency and safety when treating with brimonidine or dorzolamide as an adjunctive therapy for patients with hypertension or primary open-angle glaucoma.

[Indocyanine green angiography in chorioretinal inflammatory diseases]. / Valoración de enfermedades inflamatorias coriorretinianas con angiografía verde indocianina.

PURPOSE: To determine the role of indocyanine green angiography (ICG) in handling chorioretinal inflammatory disorders. METHOD: We present several posterior uveitis whose diagnosis and therapeutic approach was facilitated with ICG. RESULTS: ICG is useful in the differential diagnosis of <>. In serpiginous choroiditis, the edges and the progression of the inflammatory areas are clearly delineated. In infectious uveitis such as toxoplasmosis, ICG determines the presence or absence of active lesions. There are granulomatous diseases such as sarcoidosis where some areas of choroidal inflammation that cannot be detected with other methods are shown by ICG. Moreover, ICG can detect areas of subretinal neovascularization in some choroidal pathologies such as polypoidal choroidal vasculopathy. CONCLUSIONS: ICG appears to be a useful and complementary tool in the clinical interpretation of posterior uveitis.

Valoración de enfermedades inflamatorias coriorretinianas con angiografía verde indocianina / Indocyanine green angiography in chorioretinal inflammatory diseases

Objetivo: Determinar el papel de la angiografía con verde indocianina (ICG) en el manejo de inflamaciones coriorretinianas. Métodos: Se presentan uveítis posteriores cuyo diagnóstico y actitud terapéutica se facilitó con la ICG. Resultados: La ICG contribuye al diagnóstico diferencial de las "enfermedades de puntos blancos". En coroiditis serpiginosa ayuda a delimitar la extensión y progresión de los bordes activos de la enfermedad. En uveítis infecciosas como la toxoplasmosis, la ICG determina la presencia o ausencia de lesiones activas. Hay enfermedades granulomatosas, como la sarcoidosis, donde se detectan zonas de inflamación coroideas no objetivables con otros métodos. La ICG permite además detectar zonas de neovascularización subretiniana en algunas coroidopatías como en la vasculopatía coroidea polipoidal. Conclusiones: La ICG resulta una herramienta útil y complementaria en la interpretación clínica de las uveítis posteriores (AU)

Human aqueous humor levels of oral ciprofloxacin, levofloxacin, and moxifloxacin.

PURPOSE: To evaluate the penetration of ciprofloxacin, levofloxacin, and moxifloxacin into the aqueous humor after oral administration. SETTING: Alcorcon Hospital, Madrid, Spain. METHODS: Forty-two patients having cataract surgery were randomly divided into 3 groups the day before surgery. The first group received 2 oral 500 mg doses of ciprofloxacin at 12-hour intervals. The second group received a single oral 500 mg dose of levofloxacin. The third group received a single oral 400 mg dose of moxifloxacin. At the time of surgery, 0.1 mL aqueous fluid was aspirated from the anterior chamber just before the operation and immediately stored at -80 degrees C. Drug concentrations were measured using a biological assay. RESULTS: The mean aqueous level of ciprofloxacin was 0.50 microg/mL +/- 0.25 (SD); of levofloxacin, 1.50 +/- 0.50 microg/mL; and of moxifloxacin, 2.33 +/- 0.85 microg/mL. The mean aqueous levels of levofloxacin and moxifloxacin were above the 90% minimum inhibitory concentration for most of the common microorganisms that cause endophthalmitis. CONCLUSIONS: Therapeutic concentrations of fluoroquinolones, mainly levofloxacin and moxifloxacin, were reached with oral administration. These antibiotics may be effective for prophylaxis and adjuvant therapy of bacterial endophthalmitis.