Cirugía de catarata bilateral secuencia e inmediata / Immediate bilateral sequential cataract surgery

Propósito Existe una constante controversia entre la realización de la cirugía de la catarata de un ojo o de ambos ojos en la misma sesión quirúrgica. El objetivo de este estudio es revisar la evidencia científica sobre eficacia y seguridad, valorar la reducción de costes de la cirugía de catarata bilateral simultánea en el mismo día en comparación con la cirugía de la catarata secuencial en 2tiempos, así como comparar la tasa de complicaciones asociadas. Métodos Se ha hecho una búsqueda exhaustiva en las bases de datos PubMed y Web of Science para identificar artículos relevantes sobre cirugía de catarata bilateral secuencial desde el año 2000 hasta el 31 de diciembre de 2020. Resultados La literatura revisada muestra evidencias sólidas que demuestran la eficacia y seguridad de la cirugía de la catarata bilateral simultánea cuando se han seguido protocolos muy estrictos de esterilidad entre la cirugía de cada ojo. Bajo estas condiciones, en los estudios no se ha encontrado una mayor tasa de complicaciones postoperatorias que en la cirugía de catarata secuencial en 2tiempos. Conclusiones Existe evidencia sustancial de que la cirugía de catarata bilateral simultánea es una adecuada opción quirúrgica para la resolución de la catarata, que provoca una rápida rehabilitación visual y sin mayor número de complicaciones que la cirugía secuencial en 2tiempos cuando se extreman los protocolos de esterilidad entre los procedimientos de ambos ojos. Además, proporciona una reducción en el gasto sanitario. Existe un miedo psicológico a la realización de la cirugía bilateral por el potencial riesgo de complicaciones que afectaría a los 2ojos operados. Dentro del presente artículo discutimos la eficacia, seguridad, tasa de complicaciones y costes asociados en la cirugía de catarata bilateral simultánea en el mismo acto quirúrgico (AU)

Purpose There is a constant controversy between performing cataract surgery for one eye or for both eyes in the same surgical session. The objective of this study is to review the scientific evidence on the efficacy and safety, determine the reduction of costs of sequential bilateral cataract surgery on the same day compared to unilateral cataract surgery, as well as to compare the rate of associated complications. Methods A comprehensive search of the PubMed and Web of Science databases has been conducted to identify relevant articles on sequential bilateral cataract surgery from 2000 to 31 of December of 2020. Results Literature shows that there is strong evidence demonstrating the efficacy and safety of same-day sequential bilateral cataract surgery. Studies have not found a higher rate of postoperative complications compared to unilateral cataract surgery. Conclusions Same-day sequential bilateral cataract surgery is a good surgical option for the resolution of the cataract, provides rapid visual rehabilitation and without greater risks than unilateral surgery. It also provides a reduction in sanitary costs. There is a psychological fear of performing bilateral surgery due to the potential risk of complications that would affect both operated eyes. In this article we discuss the efficacy, safety, complications rate and associated costs in sequential bilateral cataract surgery in the same surgical act (AU)

Immediate bilateral sequential cataract surgery.

PURPOSE: There is a constant controversy between performing cataract surgery for one eye or for both eyes in the same surgical session. The objective of this study is to review the scientific evidence on the efficacy and safety, determine the reduction of costs of sequential bilateral cataract surgery on the same day compared to unilateral cataract surgery, as well as to compare the rate of associated complications. METHODS: A comprehensive search of the PubMed and Web of Science databases has been conducted to identify relevant articles on sequential bilateral cataract surgery from 2000 to 31 of December of 2020. RESULTS: Literature shows that there is strong evidence demonstrating the efficacy and safety of same-day sequential bilateral cataract surgery. Studies have not found a higher rate of postoperative complications compared to unilateral cataract surgery. CONCLUSIONS: Same-day sequential bilateral cataract surgery is a good surgical option for the resolution of the cataract, provides rapid visual rehabilitation and without greater risks than unilateral surgery. It also provides a reduction in sanitary costs. There is a psychological fear of performing bilateral surgery due to the potential risk of complications that would affect both operated eyes. In this article we discuss the efficacy, safety, complications rate and associated costs in sequential bilateral cataract surgery in the same surgical act.

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.

Phakic intraocular lenses: Recent advances and innovations. / Lentes intraoculares fáquicas: recientes avances e innovaciones.

Phakic intraocular lenses (pIOL) are recommended when counselling refractive surgery candidates presenting with high ametropia or ocular surface and/or corneal conditions that contraindicate corneal refractive surgery. This review aims to present the state-of-the-art regarding pIOL models currently available in Europe, addressing their newer indications and recent design innovations. These include, in the case of posterior chamber pIOLs, the addition of a central hole to improve aqueous humour circulation, the availability of larger optical zones, and multifocal optics for the compensation of presbyopia. The review also highlights their good safety and efficacy results, as well as the role of patient education to ensure adequate outcomes in the medium-long term. The indications of pIOLs in special situations, as well as bi-lensectomy, a procedure that most pIOL patients may eventually require as they age and develop cataracts, are also addressed.

Corneal collagen cross-linking. A review of its clinical applications. / Entrecruzamiento del colágeno corneal. Revisión de sus aplicaciones clínicas.

OBJECTIVE: To perform a literature review of the current clinical applications of corneal collagen cross-linking. METHODS: An exhaustive literature search was made, including the main biomedical databases, and encompassing all years since the introduction of cross-linking in ophthalmology practice. RESULTS: Corneal collagen cross-linking using UVA irradiation and riboflavin is a surgical technique that is currently being optimised, and is supported by a good amount of pre-clinical and clinical studies. These papers found show the beneficial effect of the surgery on preventing the progression of corneal ectasia, especially keratoconus, but also on pellucid marginal degeneration and keratectasia after refractive surgery. The effect of cross-linking on avoiding the occurrence of iatrogenic keratectasia when combined with a photo-ablative procedure is less clear to date. Additionally, it appears that cross-linking may have a considerable beneficial effect on controlling corneal infection caused by fungi, bacteria and amoebae. However, its effect on viral keratitis can be detrimental. The benefit on bullous keratopathy seems to be rather transient. CONCLUSIONS: Corneal collagen cross-linking may be used with relative safety and efficacy in patients with progressive keratoconus. Its use could also be considered in patients with other corneal ectasias or with corneal infections of non-viral origin. Currently, there is still a need for more studies as regards its effect on preventing iatrogenic keratectasia.

Cataract surgery on the previous corneal refractive surgery patient.

Cataract surgery in cases with previous corneal refractive surgery may be a major challenge for the ophthalmologist. The refractive outcome of the case deserves special attention in the preoperative planning process, which should be tailored for the type of prior refractive procedure: incisional, ablative under a flap, or on the corneal surface. Avoiding refractive surprise after cataract surgery in these cases is principally dependent on the accuracy of the intraocular lens calculation, together with the selection of the appropriate biometric formula for each case. Modern techniques for cataract surgery help surgeons to move toward the goal of cataract surgery as a refractive procedure free from refractive error. We give practical guidelines for the cataract surgeon in the management of these challenging cases.

Flexible probe for in vivo quantification of corneal epithelium permeability through non-invasive tetrapolar impedance measurements.

Studies concerning the functional status of the corneal epithelium are of special interest due to its key role in preventing ocular surface disease and corneal infections. In particular, quantitative measurements of the epithelium permeability translayer electrical resistance (TER) have been proven as a sensitive in vitro test for evaluation of the corneal barrier function. In a recent work from the authors (Guimera et al. Biosens. Bioelectron. 31:55-61, 2012), a novel method to non-invasively assess the corneal epithelial permeability by using tetrapolar impedance measurements, based on the same TER theoretical principles, was presented and validated using a rigid sensing device. In this work, the usability of this method has been dramatically improved by using SU-8 photoresist as a substrate material. The flexibility of this novel sensing device makes no need to apply pressure on the cornea to ensure the electrical contact between the electrodes and the corneal surface. The feasibility of this flexible sensor has been evaluated in vivo by increasing the permeability of rabbit corneal epithelium. For that, different concentrations of benzalkonium chloride (BAC) solution were instilled on different rabbit corneas. The obtained results have been compared with measurements of the permeability to sodium fluorescein of different excised corneas, a well-known method used to evaluate the corneal barrier function, to demonstrate the feasibility of this novel flexible sensor for quantifying the corneal epithelium permeability in vivo in a non-invasive way.

Reflexiones éticas y recomendaciones para la toma de decisiones clínicas en la atención al recién nacido sano / Ethical reflections and recommendations for making clinical decisions in the care of the healthy newborn

La atención al recién nacido (RN) sano durante su estancia en los centros sanitarios no suele plantear problemas y la relación con la familia transcurre sin que se presenten situaciones de conflicto. Solamente en algunas ocasiones puede haber momentos conflictivos debido a que los padres no aceptan los cuidados o rutinas asistenciales que le proporcionan los profesionales sanitarios. Consideran que el RN no precisa la realización de pruebas o medidas profilácticas, como la administración de vitamina K o punción para la obtención de una muestra de sangre para el cribado neonatal. Esto se debe a que la información que poseen no es la adecuada o porque rechazan algunas medidas, ya que son invasivas y que, a su entender, no se corresponden con el cuidado de un RN sano. Este documento pretende conciliar los valores de la familia y su participación en el cuidado de su hijo, los derechos del RN y los valores de los profesionales sanitarios. Está basado en la información adecuada, la buena relación clínica y la deliberación en caso de discrepancia que puede conducir a modificar algunos procedimientos que no son esenciales en el cuidado del RN(AU)

The care of healthy newborn during their stay in health centres is not usually a problem and there are few conflicts in the relationship with the family. Conflicts may arise because the parents do not accept the care or care routines that health professionals provide. They believe that the newborn does not require testing or prophylactic measures, such as administration of vitamin K, or puncture to obtain a blood sample for newborn screening. This is because the information they have is not adequate, or because they reject some measures as they are invasive and that from their point of view, do not correspond to the care of a healthy newborn. This document seeks to reconcile the values of family and participation in the care of their child, the rights of the newborn, and the values of health professionals. It is based on adequate information, a good clinical relationship, and discussion in case of discrepancies that can lead to changes in some procedures that are not essential in the care of the newborn(AU)

[Ethical reflections and recommendations for making clinical decisions in the care of the healthy newborn]. / Reflexiones éticas y recomendaciones para la toma de decisiones clínicas en la atención al recién nacido sano.

The care of healthy newborn during their stay in health centres is not usually a problem and there are few conflicts in the relationship with the family. Conflicts may arise because the parents do not accept the care or care routines that health professionals provide. They believe that the newborn does not require testing or prophylactic measures, such as administration of vitamin K, or puncture to obtain a blood sample for newborn screening. This is because the information they have is not adequate, or because they reject some measures as they are invasive and that from their point of view, do not correspond to the care of a healthy newborn. This document seeks to reconcile the values of family and participation in the care of their child, the rights of the newborn, and the values of health professionals. It is based on adequate information, a good clinical relationship, and discussion in case of discrepancies that can lead to changes in some procedures that are not essential in the care of the newborn.

A non-invasive method for an in vivo assessment of corneal epithelium permeability through tetrapolar impedance measurements.

The permeability of the cornea epithelial layer has an important role in optimal function of the cornea. To assess this property quantitatively, methods must be based on the passive electrical properties of living tissues, as they can take advantage of the fundamental role that ionic permeability plays in such properties. For such techniques, measurement of the translayer electrical resistance (TER) has been consistently used to examine the ion transport mechanisms in the corneal epithelial cells; however, this technique has been only possible in vitro. To enhance the applications of this method, in this work we present a novel sensor to perform non-invasive in vivo TER measurements. Herein, the epithelial permeability was assessed using non-invasive tetrapolar impedance measurements that were performed with four electrodes placed on the corneal surface. The geometry of these electrodes was previously optimized to maximize the sensitivity of the corneal epithelium. To evaluate the feasibility of this sensor, the permeability of a rabbit corneal epithelium was monitored by applying a solution of benzalkonium chloride (0.05% BAC). The results validate the capability of the sensor to evaluate the cornea epithelial permeability in vivo.

Progressive reduction of sleep time and quality in rats with hepatic encephalopathy caused by portacaval shunts.

Patients with liver cirrhosis show sleep disturbances. Insight into their relationship with hepatic encephalopathy (HE) can be obtained using animal models of HE. The aims of this work were to assess (1) whether rats with portacaval shunts (PCS), a model of HE, show alterations in sleep and if they are similar to those in patients with HE; (2) Whether hyperammonemia plays a role in these sleep alterations; and (3) the time course of sleep alterations in these animal models. Rats were subjected to PCS to induce HE. Another group of rats was fed an ammonium-containing diet to induce hyperammonemia. Polysomnographic recordings were acquired for 24 h and sleep architecture was analyzed in control, PCS, and hyperammonemic rats at 4, 7, and 11 weeks after surgery or diet, respectively. PCS rats show a significant reduction in rapid eye movement (REM) and non-rapid eye movement (NREM) sleep time and increased sleep fragmentation, whereas reduced sleep occurs at 4 weeks and worsens at 7 and 11 weeks, sleep fragmentation appears at 7 weeks and worsens at 11 weeks. Hyperammonemic rats show decreased REM sleep, starting at 7 weeks and worsening at 11 weeks, with no changes in NREM sleep or sleep fragmentation. Therefore, PCS rats are a good model to study sleep alterations in HE, their mechanisms, and potential treatment. Mild hyperammonemia mainly impacts mechanisms involved in REM generation and/or maintenance but does not seem to be involved in sleep fragmentation.

Estudio de los perfiles clínicos de los pacientes con trastorno de la conducta alimentaria en dispositivos específicos / Study of the clinical profiles of patients with eating disorders in specific units

Objetivo. Descripción de perfiles clínicos de pacientes diagnosticados de Trastornos de la conducta alimentaria (TCA) que acuden a un dispositivo ambulatorio especializado para mayores de 18 años. Método. Se trata de un estudio observacional, transversal y descriptivo en el que con carácter retrospectivo se analizaron 101 historias clínicas de pacientes diagnosticados de TCA. Resultados. El perfil clínico observado fue que el 93,6% son mujeres, con una media de edad de 29,9 años. El 33% presentaban una evolución de entre 2 y 5 años. Existe un predominio de las formas purgativas. El 19,8% presentan problemas con sustancias de abuso y el 54,4% de la muestra presentan trastornos de ansiedad. Conclusiones. Las unidades específicas en el tratamiento de los TCA deben integrarse en un conjunto de recursos que permitan además del abordaje del TCA de la psicopatología comorbida y de la que dependerá el pronóstico y evolución de la enfermedad (AU)

Objective. The purpose of this study is to describe the clinical profiles of patients diagnosed of a specific Eating Behavior Disorder (EBD) who come to a specialized outpatient unit for patients over 18 years old with this disorder. Method. This is an observational, cross-sectional and descriptive study in which 101 medical records of patients with an eating disorder diagnosis have been analyzed retrospectively. Results. The clinical profiles observed showed 93.9%women, medium age 29.9%, in which 33% of the patients had an illness course of 2 to 5 years. Purgative forms were more frequently observed. A total of 19.8% had substance abuse disorders and 54.4% anxiety disorders. Conclusions. Specific units for Eating Disorders should be included in the combined resources that not only allow for treatment of the eating behavior disorders but also for their psychopathological comorbidities, the prognosis and evolution of the disease depending on the latter (AU)

Study of the clinical profiles of patients with eating disorders in specific units.

OBJECTIVE: The purpose of this study is to describe the clinical profiles of patients diagnosed of a specific Eating Behavior Disorder (EBD) who come to a specialized outpatient unit for patients over 18 years old with this disorder. METHOD: This is an observational, cross-sectional and descriptive study in which 101 medical records of patients with an eating disorder diagnosis have been analyzed retrospectively. RESULTS: The clinical profiles observed showed 93.9% women, medium age 29.9%, in which 33% of the patients had an illness course of 2 to 5 years. Purgative forms were more frequently observed. A total of 19.8% had substance abuse disorders and 54.4% anxiety disorders. CONCLUSIONS: Specific units for Eating Disorders should be included in the combined resources that not only allow for treatment of the eating behavior disorders but also for their psychopathological comorbidities, the prognosis and evolution of the disease depending on the latter.

Agreement of non-contact pachymetry after LASIK: comparison of combined scanning-slit/Placido disc topography and specular microscopy.

PURPOSE: To assess the interchangeability of central corneal thickness (CCT) measurements between combined scanning-slit/Placido disc topography (Orbscan-II) and specular microscopy (Topcon SP-2000P) in patients who underwent laser in situ keratomileusis (LASIK) for myopia. PATIENTS AND METHODS: We recruited 118 consecutive patients who underwent LASIK for myopia. The CCT was measured using Orbscan-II and Topcon SP-2000P randomly. Orbscan-II and Topcon SP-2000P CCT data were analysed using the paired-sample t-test and the limits of agreement (LoA) were calculated with the method described by Bland-Altman. RESULTS: The average CCT measurements by Orbscan-II and Topcon SP-2000P were 447.55+/-49.78 microm and 461.38+/-35.35 microm, respectively (P<0.0001; mean difference, 13.83+/-22.31 microm; 95% confidence interval, 9.77-17.09 microm). The Bland-Altman plot showed an inverse association between the average and the difference between the devices: Topcon-Orbscan-II=174.23 -0.353xAverage (P<0.01). The widths of the crude and regression-based 95% limits of agreement were 87.45 and 63.72 microm, respectively. CONCLUSIONS: Orbscan-II measurements of CCT after myopic LASIK were significantly lower than those obtained using Topcon SP-2000P. The limits of agreement between the two devices were too broad and, therefore, both pachymetric values cannot be used interchangeably. Further, the tendency towards comparably Orbscan-II readings in thinner corneas precludes that one technique can directly replace the other. This is important for the adequate medium- and long-term follow-up of the growing LASIK patient population.

Alkalithermophilic actinomycetes in a subtropical area of Jujuy, Argentina.

The objective of this study was to examine the alkalithermophilic actinomycete communities in the subtropical environment of Jujuy, Argentina, characterized by sugarcane crops. Laceyella putida, Laceyella sacchari, Thermoactinomyces intermedius, Thermoactinomyces vulgaris and Thermoflavimicrobium dichotomicum were isolated on the media with novobiocin, from sugar cane plants and renewal rhizospheres, and grass and wood soils. Soil pH was almost neutral or lightly alkaline, except for grass soil acidified by lactic liquor. A smaller number of actinomycetes was found on the living plants and bagasse (recently obtained or stored according to the Ritter method) with respect to decomposed leaves on the soil. Thermophilic species of Laceyella, Thermoactinomyces, Thermoflavimicrobium, Saccharomonospora, Streptomyces and Thermononospora were isolated on the media without novobiocin, from composted sugar cane residues. Air captured near composted bagasse piles, contained alkalithermophilic actinomycete spores.

Alkalithermophilic actinomycetes in a subtropical area of Jujuy, Argentina / Actinomicetos termoalcalófilos del área subtropical de Jujuy, Argentina

The objective of this study was to examine the alkalithermophilic actinomycete communities in the subtropical environment of Jujuy, Argentina, characterized by sugarcane crops. Laceyella putida, Laceyella sacchari, Thermoactinomyces intermedius, Thermoactinomyces vulgaris and Thermoflavimicrobium dichotomicum were isolated on the media with novobiocin, from sugar cane plants and renewal rhizospheres, and grass and wood soils. Soil pH was almost neutral or lightly alkaline, except for grass soil acidified by lactic liquor. A smaller number of actinomycetes was found on the living plants and bagasse (recently obtained or stored according to the Ritter method) with respect to decomposed leaves on the soil. Thermophilic species of Laceyella, Thermoactinomyces, Thermoflavimicrobium, Saccharomonospora, Streptomyces and Thermononospora were isolated on the media without novobiocin, from composted sugar cane residues. Air captured near composted bagasse piles, contained alkalithermophilic actinomycete spores.

El objetivo de este trabajo fue examinar los actinomicetos termoalcalófilos presentes en el área subtropical de Jujuy, Argentina, caracterizada por el cultivo de la caña de azúcar. Se aislaron en medio con novobiocina las especies Laceyella putida, Laceyella sacchari, Thermoactinomyces intermedius, Thermoactinomyces vulgaris y Thermoflavimicrobium dichotomicum a partir de la rizósfera de plantas y de renuevos de caña de azúcar, así como de suelos de pastura y de monte natural. El pH de los suelos era casi neutro a ligeramente alcalino, excepto en un solo caso en que el suelo estaba acidificado por licor láctico. El número de actinomicetos encontrados sobre los tejidos vivos y en el bagazo recién obtenido o almacenado según el método de Ritter fue pequeño en comparación con el observado sobre las hojas en descomposición. L. sacchari predominó respecto de T. vulgaris. Se aislaron especies termoalcalófilas de Laceyella, Thermoactinomyces, Thermoflavimicrobium, Saccharomonospora, Streptomyces y Thermononospora de los residuos compostados de caña de azúcar utilizando medio sin novobiocina. El aire capturado cerca de pilas de bagazo en compostaje contenía esporos de estos organismos.

Afectación trigeminal en el SUNCT / Trigeminal involvement in SUNCT syndrome

No disponible

Optical coherence tomography to monitor photodynamic therapy in pathological myopia.

AIM: To evaluate the role of optical coherence tomography (OCT) in determining choroidal neovascularisation (CNV) activity before and after photodynamic therapy (PDT) in patients with pathological myopia. METHODS: 33 patients (33 eyes) with pathological myopia and being treated with PDT were included. Every 3 months all patients were evaluated and presence or absence of leakage on fluorescein angiography, presence of intraretinal or subretinal fluid on OCT, and macular and choroidal neovascular complex thickness on OCT, were determined at each examination. RESULTS: The macular thickness decreased significantly after PDT at 6 months (p = 0.001) and at 12 months follow up (p = 0.01). However, no significant changes in CNV thickness were measured after PDT at 6 months of follow up (p = 0.418) and at 12 months of follow up (p = 0.521). Once the diagnosis of CNV associated with pathological myopia was established, before treatment, OCT had a sensitivity of 96.96% for detecting CNV activity. After treatment, OCT had a good sensitivity (95.23%) and a moderate specificity (69,69%) in determining CNV activity, which resulted in a diagnostic efficiency (proportion of correct results) of 79.62%. CONCLUSIONS: OCT appears to be useful for indicating CNV activity. Therefore, it may serve as a complementary technique for deciding the need for PDT and re-treatment in patients with pathological myopia.