Comparability of the Retinomax K-plus 3 handheld autorefractometer in quick mode versus on-table autorefractometer in standard mode.

INTRODUCTION: This study analyzes the comparability of measurements taken by a Retinomax K-plus 3 handheld autorefractometer in Quick mode and a Topcon KR-800 on-table autorefractometer in standard mode on the pediatric population, and establishes their correlation. METHODS: It is a retrospective comparative study. Spherical diopter power (SPH), cylindrical diopter power (CYL), angle of cylindrical axis (AX), and spherical equivalent (SE) were measured with the Retinomax in Quick mode and with the Topcon in standard mode. Each patient was evaluated in cycloplegic and non-cycloplegic conditions by both autorefractometers. Student's t-test was performed between the two instruments for SPH, CYL, and SE. The Pearson correlation coefficient was calculated and the dispersion was represented using Bland-Altman graphs, also evaluating the subgroup of patients under 4 years of age. A descriptive analysis of the percentages of measures that differed was performed. RESULTS: It included 98 eyes of 49 subjects (age range: 3-16 years). The data for HPS without cycloplegia are virtually identical, whereas with cycloplegia there is a hyperopic bias of +0.5 diopters measured with Retinomax. CYL results are very similar with and without cycloplegia. There is a high Pearson correlation for both instruments (>0.91) and a low degree of dispersion in the Bland-Altman plots under cycloplegia. CONCLUSION: The Retinomax data were consistent with those obtained by Topcon. The Retinomax is a useful instrument for detecting refractive errors in children between 3 and 16 years of age.

Repetibilidad y comparabilidad de un nuevo tomógrafo con tecnología SS-OCT en biometría óptica / Repeatability and comparability of a new swept-source optical coherence tomographer in optical biometry

Objetivo Evaluar la reproducibilidad en la medición de los parámetros biométricos utilizando un nuevo biómetro por tomografía de coherencia óptica con fuente de barrido y compararlo con un biómetro por reflectometría óptica de baja coherencia. Diseño Estudio observacional, descriptivo, de corte transversal. Método Se incluyeron 45 ojos derechos de 45 pacientes, a los que se realizó tres mediciones consecutivas con el biómetro Anterion y una con el biómetro Lenstar LS900. Se recogieron las siguientes variables: longitud axial (AXL), profundidad de cámara anterior (ACD), K plana (K1), K curva (K2), grosor corneal central (CCT), grosor del cristalino (LT) y distancia blanco-blanco (WTW). Para evaluar la repetibilidad se calculó el coeficiente de Pearson «R» y la desviación estándar intrasujeto (Sw). Para evaluar la comparabilidad entre los biómetros se utilizó el coeficiente de correlación de concordancia (CCC) y el coeficiente de correlación intraclase (CCI). Además, se realizaron gráficos de Bland-Altman para cada variable. Resultados El coeficiente de Pearson fue excelente y estadísticamente significativo en la evaluación de la repetibilidad para todas las variables. Los valores más altos fueron 0,987 (AXL), 0,983 (CCT) y 0,942 (ACD). No hubo diferencias estadísticamente significativas entre las repetidas mediciones con Anterion para todas las variables. Los valores de CCC y CCI fueron excelentes en la evaluación de las variables AXL, CCT y ACD, y fueron altos para las variables K1, K2, LT y WTW. Conclusiones La realización de una biometría óptica ocular con el biómetro SS-OCT Anterion es un procedimiento reproducible y comparable con el biómetro Lenstar LS900 (AU)

Purpose To evaluate the reproducibility in the measurement of ocular biometric parameters using a new swept-source optical coherence tomographer and its comparability with an optical low coherence reflectometry biometer. Design An observational, descriptive, cross-sectional study. Methods 45 right eyes of 45 patients diagnosed with cataract were included. Three successive biometric measurements with Anterion and one with Lenstar LS900 were performed on each patient. The following variables were collected: axial length (AXL), anterior chamber depth (ACD), flat K (K1), steep K (K2), central corneal thickness (CCT), lens thickness (LT) and white-to-white distance (WTW). The intrasubject standard deviation (Sw) and the coefficient of Pearson «R» were calculated in order to assess the repeatability. The intraclass correlation coefficient (ICC) and the concordance correlation coefficient (CCC) were obtained to evaluate the comparability between devices. A Bland–Altman plot was performed for each variable. Results The coefficient of Pearson was excellent and statistically significant in the evaluation of the repeatability in all the variables. The highest values were 0.987 (AXL), 0.983 (CCT) and 0.942 (ACD). There were no statically significant differences between repeated measurements with Anterion in all the parameters. The ICC and CCC were excellent in the evaluation of AXL, CCT and ACD, and were also good in regard to K1, K2, LT and WTW. Conclusions Performing biometry with the SS-OCT Anterion is a reliable and reproducible procedure, and it is comparable with the Lenstar LS900 (AU)

Repeatability and comparability of a new swept-source optical coherence tomographer in optical biometry.

PURPOSE: To evaluate the reproducibility in the measurement of ocular biometric parameters using a new swept-source optical coherence tomographer and its comparability with an optical low coherence reflectometry biometer. DESIGN: An observational, descriptive, cross-sectional study. METHODS: 45 right eyes of 45 patients diagnosed with cataract were included. Three successive biometric measurements with Anterion and one with Lenstar LS900 were performed on each patient. The following variables were collected: axial length (AXL), anterior chamber depth (ACD), flat K (K1), steep K (K2), central corneal thickness (CCT), lens thickness (LT) and white-to-white distance (WTW). The intrasubject standard deviation (Sw) and the coefficient of Pearson "R" were calculated in order to assess the repeatability. The intraclass correlation coefficient (ICC) and the concordance correlation coefficient (CCC) were obtained to evaluate the comparability between devices. A Bland-Altman plot was performed for each variable. RESULTS: The coefficient of Pearson was excellent and statistically significant in the evaluation of the repeatability in all the variables. The highest values were 0.987 (AXL), 0.983 (CCT) and 0.942 (ACD). There were no statically significant differences between repeated measurements with Anterion in all the parameters. The ICC and CCC were excellent in the evaluation of AXL, CCT and ACD, and were also good in regard to K1, K2, LT and WTW. CONCLUSIONS: Performing biometry with the SS-OCT Anterion is a reliable and reproducible procedure, and it is comparable with the Lenstar LS900.

Límites de la precisión en el resultado refractivo tras la cirugía de cataratas / Limits of the precision in refractive results after cataract surgery

Antecedentes y objetivo Para mejorar los resultados refractivos en cirugía de cataratas con implante de lente intraocular es importante conocer las fuentes de error, así como el límite de mejora de dicho proceso. Por tanto, el objetivo del presente trabajo es aproximar el límite teórico en la precisión en el resultado refractivo tras cirugía de cataratas con los medios disponibles en la actualidad y valorar el impacto de distintas fuentes de error en dicho proceso. Materiales y métodos Realizamos una búsqueda de la bibliografía para determinar la variabilidad aportada por cada componente del proceso. Tomando como base la fórmula de Barrett Universal-II realizamos un análisis de propagación de errores. El límite teórico fue definido como la situación en la que el resultado refractivo únicamente está afectado por la variabilidad en los parámetros introducidos en la fórmula, la tolerancia de la lente intraocular y la refracción subjetiva. Resultados Los principales contribuidores al error fueron: 1. La variabilidad intraoperatoria y postoperatoria, variables no consideradas por las fórmulas (49,33%). 2. La refracción subjetiva postoperatoria (38,29%). 3. La queratometría media (5,98%), y 4. la variabilidad en el etiquetado de la potencia de la lente intraocular (5,09%). El límite teórico obtenido para el cálculo de lente intraocular con los medios disponibles actualmente fue del 91,9% de los ojos entre + -0,50D. Conclusiones El límite teórico de la precisión es de 91,92% de los ojos entre + - 0,5D. Para aproximarnos al límite de precisión descrito en el estudio requiere de la utilización de biometría óptica y fórmulas de última generación, una técnica quirúrgica reproducible y la compensación de los errores sistemáticos mediante el ajuste de constantes (AU)

Background and objective In order to improve refractive results in cataract surgery with an intraocular lens implant, it is important to know the sources of error as well as the limit of this process. Therefore, the objective of the present work is to approximate the theoretical limit in the precision in the refractive result after cataract surgery with the currently available means and to assess the impact of different sources of error in this process. Materials and methods We conducted a search of the literature to determine the variability provided by each component of the process. Based on the Barrett Universal-II formula, we performed an error propagation analysis. The theoretical limit was defined as the situation in which the refractive result is only affected by the variability in the parameters introduced in the formula, the tolerance of the intraocular lens and the subjective refraction Results The main contributors to the error were: 1. Intraoperative and postoperative variability variables not considered by the formulas (49.33%). 2. Postoperative subjective refraction (38.29%). 3. Mean keratometry (5.98%), and 4. the variability in the labelling of the power of the intraocular lens (5.09%). The theoretical limit obtained for the intraocular lens calculation with the means available today was 91.9% of the eyes between + -0.50D. Conclusions We found a theoretical limit for the intraocular lens calculation of 91.9% of the eyes between + -0.50D. Approaching the precision limit described in the study requires the use of optical biometrics and state-of-the-art formulas, a reproducible surgical technique, and the compensation of systematic errors by adjusting constants (AU)

Limits of the precision in refractive results after cataract surgery.

BACKGROUND AND OBJECTIVE: In order to improve refractive results in cataract surgery with an intraocular lens implant, it is important to know the sources of error as well as the limit of this process. Therefore, the objective of the present work is to approximate the theoretical limit in the precision in the refractive result after cataract surgery with the currently available means and to assess the impact of different sources of error in this process. MATERIALS AND METHODS: We conducted a search of the literature to determine the variability provided by each component of the process. Based on the Barrett Universal-II formula, we performed an error propagation analysis. The theoretical limit was defined as the situation in which the refractive result is only affected by the variability in the parameters introduced in the formula, the tolerance of the intraocular lens and the subjective refraction. RESULTS: The main contributors to the error were (1) intraoperative and postoperative variability variables not considered by the formulas (49.33%), (2) postoperative subjective refraction (38.29%), (3) mean keratometry (5.98%) and (4) the variability in the labelling of the power of the intraocular lens (5.09%). The theoretical limit obtained for the intraocular lens calculation with the means available today was 91.9% of the eyes between ±0.50D. CONCLUSIONS: We found a theoretical limit for the intraocular lens calculation of 91.9% of the eyes between ±0.50D. Approaching the precision limit described in the study requires the use of optical biometrics and state-of-the-art formulas, a reproducible surgical technique, and the compensation of systematic errors by adjusting constants.

Posterior bilateral lens luxation in an agitated patient: Cause or consequence? / Luxación posterior bilateral del cristalino en una paciente agitada, ¿causa o consecuencia?

Complete posterior lens dislocation is an infrequent clinical entity. Trauma is the first cause of secondary lens dislocation. Most of the cases are unilateral, and bilateral cases are unusual. We report the uncommon case of a 70-year-old woman with evidence of a posterior bilateral dislocation of the lens in the context of an acute onset of confusional syndrome. We discuss about sensory deprivation as a trigger for acute confusion and agitation in patients with predisposing conditions. In addition, we describe the benefits that, in our experience, the refloating technique with perfluorocarbon liquid provides for the surgical approach to these cases.

Optical neuropathy due to inhaled cocaine, causality or chance. / Neuropatía óptica secundaria a consumo de cocaína inhalada. Causalidad o casualidad.

A 44-year-old man, active cocaine consumer, who referred decrease in visual acuity in the right eye in 24 hours of evolution, being 0,05 in that eye and 1 in the left eye. The examination showed a relative afferent pupil defect and a swelling head of optic nerve. The systemic studies performed were normal, except the nuclear magnetic resonance of the brain that showed a thickening of the maxillary and frontal sinus mucosa, compatible with sinusitis. Hospital admission and the start of intravenous corticosteroid treatment were decided, with a favourable evolution, a visual acuity of 1.0 in both eyes and an anatomical improvement of the optic nerve head. Due to the medical history of the patient and the assessment of other plausible alternative diagnoses, we established the diagnosis of optical neuropathy due to inhaled cocaine abuse.

Eye lid and canalicular laceration due to obstetric trauma. Case report. / Laceración palpebral y canalicular asociada a trauma obstétrico. Descripción de un caso.

Ocular injuries associated with birth trauma are rare. Their incidence increases in cases of instrument-assisted delivery, emergency cesarean section, and abnormal presentation of the fetus. We present the clinical case of a premature Asian male baby, aged 33+2 weeks and weighing 1,500g. The infant was born out of a twin pregnancy and was delivered by emergency cesarean section. Following delivery, a 5mm long lower eyelid laceration was observed in the inner corner of the left eye, with injury to the inferior canaliculus. A Mini-Monoka® (FCI, Issy-Les Moulineaux, France) monocanalicular intubation stent was inserted on the seventh day with anastomosis of the proximal and distal ends of the canaliculus laceration. The skin was then sutured with a polyglactin 8/0 (Vicryl 8/0, Ethicon, Johnson & Johnson S. A., Madrid, Spain) suture. The postoperative treatment consisted of tobramycin and dexamethasone eye drops four times per day for 10 days. A good progression was observed, the position of the inferior lacrimal punctum was adequate, and syringation was normal. The Mini-Monoka® was removed after 14 weeks.

Laser and ranibuzumab combination for retinal vasoproliferative tumor's management.

CASE REPORT: A 34 year-old man presented with progressive visual loss in his right eye. Ocular fundus showed a vasoproliferative tumor in the peripheral retina with an associated epiretinal macular membrane. Angiography showed a rapid filling of tumor vessels. The treatment consisted of laser photocoagulation and a single injection of intravitreal ranibizumab. After 8 weeks, there was a residual area of fibrosis, the posterior hyaloid was detached, and the epiretinal membrane disappeared. Visual acuity returned to 20/25. DISCUSSION: Laser photocoagulation and intravitreal ranibizumab combination could be useful for vasoproliferative tumors.

Hemorragia vítrea asociada a arteria hialoidea persistente / Vitreous haemorrhage associated with persistent hyaloid artery

Introducción: La hemorragia vítrea secundaria a una arteria hialoidea persistente (AHP) íntegra es una anomalía infrecuente. Caso clínico: Una mujer de 52 años presentó disminución de visión en su ojo ambliope. La biomicroscopia reveló una AHP rellena de sangre que se insertaba en la cristaloides posterior. En la oftalmoscopia se objetivó un hemovítreo leve. La tomografía de coherencia óptica (TCO) permitió analizar la estructura tubular de la AHP mostrando un interior hiporreflectivo. Sin embargo, el eco-doppler no detectó la presencia de flujo sanguíneo activo en su interior. Conclusiones: La realización de pruebas de imagen no invasivas que incluyen la TCO y el eco-doppler pueden ser útiles en el estudio de una hemorragia asociada a una AHP(AU)

Introduction: Haemorrhage from an entire persistent hyaloid artery (PHA) is an uncommon anomaly. Case report: A 52 year old female presented with blurred vision in her amblyopic eye. Biomicroscopy revealed a blood filled PHA which was inserted in the posterior crystalloid. Ophthalmoscopy showed a mild vitreous haemorrhage. A tubular structure showing a hypo-reflexivity inside the PHA was able to be analysed using optical coherence tomography (OCT). However, Doppler ultrasound did not detect the presence of active blood flow within it. Conclusions: The performance of non-invasive imaging tests such as the OCT and Doppler ultrasound may be useful in the study of vitreous haemorrhage associated with PHA(AU)

[Drug therapy for corneo-conjunctival neoplasm]. / Tratamiento farmacológico de la neoplasia corneal y conjuntival.

BACKGROUND: The goal of therapy for corneo-conjunctival neoplasm is lesion removal, with the most widespread procedure being complete tumor resection with or without associated chemotherapy lines. As this sort of procedure entails a high relapse rate (9-52%) the use of adjuvant therapies to reduce the occurence of relapse becomes a need. The administration of a number of topically administered drugs has been used for adjuvant therapy, including mitomycin C, 5-fluorouracil and interferon a 2b. OBJECTIVE: To determine the clinical experience published regarding the effectiveness of the various drug therapies for cor-neo-conjunctival neoplasm. SEARCH STRATEGY: Information reported on this topic in the Medline database (1966-2004) was searched using corneo-conjunctival neoplasm, 5-fluorouracil, mitomycin C, and interferon ca2b as key words. SELECTION CRITERIA: All papers quoting dosage for drugs used,treatment length, adverse effect development, and clinical response obtained were included. PRIMARY RESULTS: Papers reporting the use of 5-fluorouracil re few when compared to those quoting other drugs, with a response rate of 88% and a relapse rate of 20%. The use of mitomycin C is widely described in the medical literature with a response rate of 90% and a relapse rate of 13%, but in association with the development of adverse effects in a high percentage of patients. Interferon ca 2b is the last drug to be incorporated in the treatment of these ocular lesions, with a response rate of 100% and a low incidence of adverse effects, with a relapse rate of 4%. CONCLUSIONS: Mitomycin C is an effective drug, but its use is associated with a high number of adverse events, some of which may lead to therapy discontinuation. Interferon ct 2b has efficacy outcomes comparable to mitomycin C and a lower incidence of adverse effects, which are mostly mild in nature. The use of 5-fluorouracil is relegated to a second-tier status.

Tratamiento farmacológico de la neoplasia corneal conjuntival / Drug therapy for corneo-conjunctival neoplasm

Antecedentes: El objetivo del tratamiento de la neoplasia córneo- conjuntival es la eliminación de la lesión, siendo el más extendido la resección quirúrgica completa del tumor asociado o no a varias hileras de crioterapia. Debido a la elevada tasa de recidivas de este tipo de intervención (9-52%), se hace necesaria la utilización de tratamientos adyuvantes que la reduzcan. Para el tratamiento adyuvante se ha empleado la administración de varios fármacos por vía tópica tales como: la mitomicina-C, el 5-fluorouracilo y el interferón alfa 2b. Objetivo: Conocer la experiencia clínica publicada sobre la efectividad de los diferentes tratamientos farmacológicos de la neoplasia córneo-conjuntival. Estrategia de la búsqueda: Se revisó la información publicada sobre este tema en la base de datos Medline (1966-2004), utilizando como palabras clave neoplasia córneo conjuntival, 5- fluorouracilo, mitomicina C e interferón alfa 2b. Criterios de selección: Se incluyeron todos los trabajos en los que se expresaba la dosis de fármaco utilizado, la duración del tratamiento, la aparición de efectos adversos y la respuesta clínica obtenida. Resultados principales: Los artículos publicados en los que se ha utilizado el 5-fluorouracilo son escasos en comparación con los publicados con los otros dos fármacos, presentando una tasa de respuesta del 88% y una tasa de recidivas del 20%. La utilización de mitomicina-C está ampliamente descrita en la literatura médica con una tasa de respuesta del 90% y tasa de recidivas del 13%, pero está asociada a la aparición de efectos adversos en un porcentaje elevado de pacientes. El interferón alfa 2b, ha sido el último fármaco incorporado para el tratamiento de estas lesiones oculares obteniendo unos resultados en cuanto a respuesta del 100% y un bajo número de efectos adversos, con un tasa de recidivas del 4%. Conclusiones: La mitomicina C es un fármaco eficaz, pero que se asocia a la aparición de un gran número de efectos adversos, que en algunos casos obligan a suspender el tratamiento. El interferón alfa 2b presenta unos resultados de eficacia comparables a la mitomicina-C y con un menor número de reacciones adversas, siendo en su mayoría de carácter leve. Queda en un segundo plano la utilización del 5-fluorouracilo

Background: The goal of therapy for corneo-conjunctival neoplasm is lesion removal, with the most widespread procedure being complete tumor resection with or without associated chemotherapy lines. As this sort of procedure entails a high relapse rate (9-52%) the use of adjuvant therapies to reduce the occurence of relapse becomes a need. The administration of a number of topically administered drugs has been used for adjuvant therapy, including mitomycin C, 5-fluorouracil and interferon alpha 2b. Objective: To determine the clinical experience published regarding the effectiveness of the various drug therapies for corneo- conjunctival neoplasm. Search strategy: Information reported on this topic in the Medline database (1966-2004) was searched using corneo-conjunctival neoplasm, 5-fluorouracil, mitomycin C, and interferon alpha 2b as key words. Selection criteria: All papers quoting dosage for drugs used, treatment length, adverse effect development, and clinical response obtained were included. Primary results: Papers reporting the use of 5-fluorouracil are few when compared to those quoting other drugs, with a response rate of 88% and a relapse rate of 20%. The use of mitomycin C is widely described in the medical literature with a response rate of 90% and a relapse rate of 13%, but in association with the development of adverse effects in a high percentage of patients. Interferon alpha 2b is the last drug to be incorporated in the treatment of these ocular lesions, with a response rate of 100% and a low incidence of adverse effects, with a relapse rate of 4%. Conclusions: Mitomycin C is an effective drug, but its use is associated with a high number of adverse events, some of which may lead to therapy discontinuation. Interferon alpha 2b has efficacy outcomes comparable to mitomycin C and a lower incidence of adverse effects, which are mostly mild in nature. The use of 5-fluorouracil is relegated to a second-tier status

[Treatment of persistent epithelial defects using autologous serum application]. / Tratamiento de defectos epiteliales persistentes mediante suero autólogo.

PURPOSE: To study the impact of topical treatment with autologous serum on the clinical evolution of persistent corneal epithelial defects (PED) and to observe its effect on squamous metaplasia in 7 cases of dry eye. PATIENTS AND METHODS: In this prospective, clinical, non-comparative case series study we evaluated a total of 17 eyes (14 patients). We analized the clinical evolution (fluorescein staining, Schirmer's I and II tests and photographic control) of PED in these patients, to whom 20% autologous serum eyedrops were applied for 28 days. Using impression cytology technique (Tseng's method) we evaluated the involution of squamous metaplasia in 7 eyes of 4 patients with ocular cicatricial pemphigoid and dry eye who were treated with autologous serum. The Wilconxon test was used for the statistical treatment of the data. RESULTS: The epithelial defect healed within 2 weeks in 6 eyes (35.2%). Eight eyes (47%) healed within 2-4 weeks and 3 eyes (17.6%) did not heal after week 4. The duration of PED, before serum therapy was 36 days. Six of seven eyes treated with autologous serum presented an involution of squamous metaplasia 28 days after initiation of the serum drops. CONCLUSIONS: Autologous serum treatment accelerates PED healing. Autologous serum application causes an involution of squamous metaplasia.

Metallic fragment deposits during phacoemulsification.

PURPOSE: To describe the nature and origin of foreign metallic intraocular bodies appearing after phacoemulsification. SETTING: Department of Ophthalmology, University Hospital of San Juan, Alicante, Spain. METHODS: Two metallic particles, 1 extracted during surgery and the other from a patient in whom surgery had been performed, were studied by scanning electronic microscopy and X-ray dispersive energy spectroscopy. Also evaluated were all metallic elements used in phacoemulsification including phaco tips, Sinskey hooks, and handpieces. A morphologic analysis at various magnifications was performed and the composition of the elements studied. RESULTS: Scanning electronic microscopy showed irregularities of the phaco tip and Sinskey hook after their use. Spectrographic analysis found that the phaco tip was mainly aluminum and titanium; the Sinskey hook, iron, chromium, cobalt, and nickel; the handpiece, iron, chromium, and nickel; and the 2 metallic particles, iron, chromium, and nickel, the same as the handpiece. CONCLUSION: The metallic particles extracted corresponded to those of the phaco handpiece. Vibration during prolonged use of the phacoemulsifier probably caused these particles to chip off the handpiece.

Intrastromal corneal suture for small incision cataract surgery.

Proper wound closure is important in preventing postoperative endophthalmitis. We developed an intrastromal corneal suture technique that uses some principles of the running, locked, intradermal suture for light-tension skin wounds. It achieves close approximation of the wound edges, reduces postoperative wound care and the risk of wound infection in clean surgical wounds, and obviates suture removal. It may also help prevent endophthalmitis and early against-the-rule astigmatism without the complications associated with external suture exposure.