Characteristics of pseudophakic retinal detachment and risk factors of recurrence.

BACKGROUND: The present study was designed to gain knowledge about the prognostic factors and evolution of pseudophakic retinal detachment (PRD) and to analyse the main characteristics of PRD, such as the mean time to retinal detachment following cataract surgery, as well as the clinical factors associated with the risk of recurrence and worse anatomical and functional outcomes. METHODS: This was a retrospective monocentric study of 330 patients with PRD who underwent surgery between 2012 and 2020. All patients were pseudophakic and were referred for retinal detachment surgery at Donostia University Hospital (Terciary Hospital, Spain). RESULTS: The mean age of the patients at the time of phacoemulsification was 63.06 ±â€¯10.8 years, and 49.09% of them had moderate myopia [axial length (AL) (23.5-26.5 mm)]. In our series, macular detachment was evident in 69.09% (n = 228) of the patients. The mean time that elapsed between phacoemulsification and PRD surgery was 4.04 ±â€¯4.17 years, which was reduced by half in the event of surgical complications (2.24 ±â€¯2.65). The rate of PRD was 28.79%. The anatomical results in terms of retinal reapplication were better with the combination of vitrectomy and scleral buckling (83.1% vs. 70.5%) (p = 0,127) compared with vitrectomy. The variables associated with a higher risk of recurrence were male sex (hazard ratio (HR) = 1.75), macular detachment (HR = 2.00) and the presence of proliferative vitreoretinopathy (PVR) (HR = 3.21). CONCLUSIONS: PRD usually occurs within 4 years of phacoemulsification, although it may occur significantly earlier in the event of surgical complications. Macular involvement, PVR, and male sex are all associated with a higher risk of PRD recurrence.

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.

Prevalencia de retinopatía diabética mediante cribado con retinógrafo no midriático / Prevalence of diabetic retinopathy using non-mydriatic retinography

Objetivo. Estudiar la prevalencia de retinopatía diabética mediante retinógrafo no midriático y valorar su utilidad como método de cribaje en la comarca de Donosti aldea. Métodos. Se realizó un estudio prospectivo incluyendo 2.444 pacientes diabéticos derivados por su médico de atención primaria y/o endocrinólogo. Se realizó una retinografía con cámara no midriática en los 45 grados centrales, agudeza visual y tonómetro de no contacto en todos los pacientes. La información se derivó al hospital para ser evaluado por un oftalmólogo especialista en retina. Resultados. El 15,02% de los pacientes eran diabéticos en tratamiento dietético, el 62,55% eran diabéticos no insulinodependientes y el 22,43% eran diabéticos insulinodependientes. Observamos una prevalencia de retinopatía diabética del 9,36%. El 5,27% presentó retinopatía diabética no proliferativa (RDNP) leve, el 2,21% RDNP moderada, el 1,67% RDNP severa y el 0,12% RD proliferativa. El 8,22% presentó hipertensión ocular. Conclusiones. Se observa una baja prevalencia de RD en los pacientes de nuestra muestra. La utilización de telemedicina con cámara no midriática es un arma importante para el diagnóstico precoz de la retinopatía diabética y puede aplicarse a otras patologías oftalmológicas como el glaucoma (AU)

Objectives. To establish the prevalence of diabetic retinopathy (RD) diagnosed after non-mydriatic retinography and to evaluate its utility as a screening test in the area of San Sebastián. Methods. A prospective study including 2,444 diabetic patients sent by their primary attention doctors and/or their endocrinologists. All patients underwent non mydriatic retinography in the central 45 degrees; visual acuity was explored, as well as IOP through non-contact tonometry. The retinographies and information obtained were sent to our hospital and were revised by an ophthalmologist from the Retina Department. Results. Fifteen point zero two (15.02%) of the patients suffered from diabetes and were under dietary treatment, 62.55% suffered from non-insulin-dependant diabetes, and 22.43% suffered from insulin-dependant diabetes. The prevalence of diabetic retinopathy was 9.36%; 5.27% mild non-proliferative diabetic retinopathy (DR); 2.21% moderate-non-proliferative DR; 1.67 % severe non-proliferative DR; and 0.05% proliferative-diabetic retinopathy. Eight point two two (8.22%) of the sample studied was diagnosed with ocular hypertension. Conclusions. We observed a low prevalence of DR in our sample. Use of non-mydriatic retinopathy in telemedicine plays an important role in the early diagnosis of diabetic retinopathy and it can be applied to other ophthalmic diseases (AU)

[Prevalence of diabetic retinopathy using non-mydriatic retinography]. / Prevalencia de retinopatía diabética mediante cribado con retinógrafo no midriático.

OBJECTIVES: To establish the prevalence of diabetic retinopathy (RD) diagnosed after non-mydriatic retinography and to evaluate its utility as a screening test in the area of San Sebastián. METHODS: A prospective study including 2,444 diabetic patients sent by their primary attention doctors and/or their endocrinologists. All patients underwent non-mydriatic retinography in the central 45 degrees; visual acuity was explored, as well as IOP through non-contact tonometry. The retinographies and information obtained were sent to our hospital and were revised by an ophthalmologist from the Retina Department. RESULTS: Fifteen point zero two (15.02%) of the patients suffered from diabetes and were under dietary treatment, 62.55% suffered from non-insulin-dependant diabetes, and 22.43% suffered from insulin-dependant diabetes. The prevalence of diabetic retinopathy was 9.36%; 5.27% mild non-proliferative diabetic retinopathy (DR); 2.21% moderate-non-proliferative DR; 1.67 % severe non-proliferative DR; and 0.05% proliferative-diabetic retinopathy. Eight point two two (8.22%) of the sample studied was diagnosed with ocular hypertension. CONCLUSIONS: We observed a low prevalence of DR in our sample. Use of non-mydriatic retinopathy in telemedicine plays an important role in the early diagnosis of diabetic retinopathy and it can be applied to other ophthalmic diseases.

Exitoso tratamiento con queratoprótesis de Boston en un paciente con síndrome de Lyell / Successful Boston keratoprrosthesis in a patient with Lyell's syndrome

Caso clínico: Presentamos el caso de una pacienteque acude a nuestro servicio remitida por presentarun síndrome de Lyell con severa participación ocular.La intensa afectación de la superficie ocular y lainsuficiencia límbica sientan la indicación paraimplantar una queratoprótesis de Boston tipo 1,logrando un resultado funcional estable y muysatisfactorio.Discusión: Como se puede ver en este caso clínico,la queratoprótesis de Boston tipo 1 parece ser unaopción viable después de múltiples trasplantes cornealesfallidos o en algunas situaciones con pobrepronóstico para una queratoplastia penetrante primariapor presentar insuficiencia límbica, como elsíndrome de Lyell(AU)

Case report: We present the case of a woman readmittedto our service to receive treatment for severeophthalmic manifestations due to Lyell’s syndrome.This intense affectation of the ocular surface alongwith limbal stem cell deficiency are grounds for treatmentwith Boston type 1 keratoprosthesis, whichprovided a stable and very satisfactory functionalresult.Discussion: As noted in this case report, the BostonType 1 keratoprosthesis seems to be a viable optionafter multiple failed corneal grafts or in situationswith a poor prognosis for primary penetrating keratoplastybecause of limbal stem cell deficiency,such as Lyell’s syndrome(AU)

[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)

[Successful Boston keratoprosthesis in a patient with Lyell's syndrome]. / Exitoso tratamiento con queratoprótesis de Boston en un paciente con síndrome de Lyell.

CASE REPORT: We present the case of a woman readmitted to our service to receive treatment for severe ophthalmic manifestations due to Lyell's syndrome. This intense affectation of the ocular surface along with limbal stem cell deficiency are grounds for treatment with Boston type 1 keratoprosthesis, which provided a stable and very satisfactory functional result. DISCUSSION: As noted in this case report, the Boston Type 1 keratoprosthesis seems to be a viable option after multiple failed corneal grafts or in situations with a poor prognosis for primary penetrating keratoplasty because of limbal stem cell deficiency, such as Lyell's syndrome.

Automatized large diameter lamellar keratoplasty and stem cell transplantation for the treatment of ocular surface diseases with limbal insufficiency.

PURPOSE: To report a new surgical procedure for the treatment of ocular surface diseases associated with severe limbal insufficiency. METHODS: A retrospective review of four patients with severe ocular surface disease who required stem cell transplantation and keratoplasty for the correction of limbal insufficiencies. They underwent large diameter lamellar keratoplasty with microkeratome. When limbal dysfunction was associated with limited alteration of the ocular surface and transparent deep corneal stroma only the anterior corneal stroma was transplanted. When the entire corneal thickness was compromised, both anterior and deep donor buttons were transplanted. RESULTS: Patients remained stable and improved their visual acuity after surgery. Best-corrected visual acuity ranged from 20/200 to 20/30. No corneal graft rejections were found. The main complication found in one of our patients was a central stromal opacity which required a secondary penetrating keratoplasty. CONCLUSIONS: Automatized large diameter lamellar keratoplasty provides a safe and successful alternative to limbal transplantation for limbal insufficiency associated with corneal opacity. This technique enables a single-stage surgical procedure and the use of a single donor which reduces the risk of rejection. In addition, better refractive results are achieved due to the quality of the interface and the absence of corneal sutures.

[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