[Bibliometric study and analysis of citation networks of visual screening in primary care]. / Estudio bibliométrico y análisis de redes de citación de los screening visuales en atención primaria.

AIM: Screenings make it possible to detect anomalies that can be treated and identify patients who require referral to a specialist. The objective is to identify the different areas of research and determine the most cited publications on screening in primary care. METHODS: An analysis of publications and visualization of citation networks has been carried out using the Citation Network Explorer software. The bibliographic search was carried out with the Web of Science (WOS) database using the search term: "screening AND (vision OR eye OR ocular OR visual)". RESULTS: We analyzed 16707 publications in all fields, 23919 citation networks have been found. The number of publications has increased, with 2021 being the year with the highest number. The majority are scientific articles and the predominant language is English. The most cited article is a global meta-analysis on the prevalence of glaucoma, showing the importance of screening for its early detection since it is essential to avoid blindness. Using the clustering function we found 8 groups with a significant number of publications where we have bibliography on certain eye diseases: glaucoma, diabetic retinopathy, pediatric amblyopia, keratoconus and dry eye. CONCLUSIONS: The main areas of study in relation to screening are the detection of diseases such as glaucoma, retinopathy of prematurity, keratoconus and dry eye. As well as the detection through visual analysis of childhood amblyopia and vision loss in elderly patients. It also gives importance to performing ocular motility tests in problems of acquired brain damage.

Myopia progression and axial elongation in Spanish children: Efficacy of atropine 0.01% eye-drops.

PURPOSE: To assess myopia progression in Spanish children and whether treatment with low-dose atropine eye drops delays myopia progression and axial elongation. METHODS: 339 eyes of 339 Caucasian patients with myopia, aged 5 to 11 years, were examined. Participants were randomized to a treatment arm, receiving one atropine (0.01%) eye drop/day for two, and an untreated control arm. At the baseline and 2-year follow-up visits, we recorded: spherical equivalent (SE), axial length (AL), mean keratometry (Mean-K) and anterior chamber depth (ACD). We also examined the rate of children with higher myopia progression (change in SE >1 D/2 years) and identified risk factors for progression. RESULTS: In 339 eyes of the 339 children (age=7.61; SD 1.70; range 5-11 years), the mean baseline SE was-2.15 (SD 0.62) D, and AL was 24.24 (SD 0.79) mm. After 2 years, higher increases occurred in all variables except ACD in the untreated group vs. the atropine group, respectively: SE (-0.51 (SD 0.39) D vs. -0.76 (SD 0.37) D, P<0.001), AL (0.20 (SD 0.20) mm vs. 0.37 (SD 0.27) mm, P<0.001) and Mean-K (0.01 (0.28) D vs. 0.09 (0.32) D, P=0.018). Myopia progression was reduced by 32% in the treatment group. There were more progressors >1D/2y in the control group: 62/168 (36.9%) vs. 35/171 (20.5%) (P<0.001). Atropine was identified as a protective factor against myopia progression (B=1.12; 95% CI= 0.98-1.27; P=<0.001). CONCLUSION: Spanish children showed a low rate of myopia progression. Atropine 0.01% showed a significant effect in slowing the progression of both refractive error and axial elongation.

Reproducibilidad de la medición manual del grosor coroideo utilizando la tomografía de coherencia óptica / Reproducibility of manual choroidal thickness measurements using optical coherence tomography

OBJETIVO: La tomografía de coherencia óptica de dominio espectral (SD-OCT) es la herramienta de mayor utilidad para medir el grosor coroideo (GC). El GC puede estar aumentado tanto en las enfermedades oftalmológicas como en las sistémicas. No obstante, existen ciertas inquietudes en relación con la reproducibilidad y la validez externa de la OCT. El objetivo de este estudio fue determinar la variabilidad interobservador e intraobservador de la medición manual de la OCT. MÉTODOS: El GC fue medido de manera manual en la región central en 40 ojos de 21 sujetos (11 sanos y 10 con espondilitis anquilosante) utilizando RTVue-100 OCT (Optovue Inc., Fremont, CA, EE.UU.). Las mediciones fueron obtenidas por 9 oftalmólogos independientes de 6 centros diferentes. Para determinar la variabilidad interobservador se utilizó el cálculo del coeficiente de correlación intraclase (CCI). También la variabilidad intraobservador fue determinada en 2 de los oftalmólogos. RESULTADOS: La media del GC subfoveal fue de 364,9 ± 85,1μm (rango, 170-572). El CCI interobservador fue 0,823 (IC 95%, 0,749-0,888; p < 0,001). El CCI intraobservador fue 0,885 (IC 95%, 0,783-0,939; p < 0,001) y 0,925 (IC 95%, 0,859-0,960; p < 0,001). CONCLUSIONES: En este estudio la medición manual del GC ha demostrado buena concordancia. Los resultados sugieren que la medición manual con la OCT es un método válido para los estudios multicéntricos

PURPOSE: Spectral-domain optical coherence tomography (SD-OCT) is the most useful tool to measure choroidal thickness (CT). CT may be increased in ocular and systemic diseases. However, there are concerns relating reproducibility and external validity of OCT. The aim of this study was to assess the inter-observer and intra-observer variability of manual OCT measurements. METHODS: CT was manually measured in the central choroid of 40 eyes from 21 subjects (11 healthy and 10 with ankylosing spondylitis) using RTVue-100 OCT (Optovue Inc., Fremont, CA, EE.UU.). Measurements were performed by 9 independent ophthalmologists from 6 different centers. To assess the inter-observer variability, the intra-class correlation coefficient (ICC) method was calculated. Also, intra-observer variability was assessed in 2 of the ophthalmologists. RESULTS: The mean subfoveal CT was 364.9 ± 85.1μm (range, 170 to 572). The inter-observer ICC was 0.823 (CI 95%, 0.749 to 0.888, p < 0.001). The intra-observer ICCs were 0.885 (CI 95%, 0.783 to 0.939, p < 0.001) and 0.925 (CI 95%, 0.859 to 0.960. p < 0.001). CONCLUSIONS: In this study, manual measurements of CT with OCT showed a good concordance. These results suggest that manual OCT is a valid tool for multicenter studies

Reproducibility of manual choroidal thickness measurements using optical coherence tomography. / Reproducibilidad de la medición manual del grosor coroideo utilizando la tomografía de coherencia óptica.

PURPOSE: Spectral-domain optical coherence tomography (SD-OCT) is the most useful tool to measure choroidal thickness (CT). CT may be increased in ocular and systemic diseases. However, there are concerns relating reproducibility and external validity of OCT. The aim of this study was to assess the inter-observer and intra-observer variability of manual OCT measurements. METHODS: CT was manually measured in the central choroid of 40 eyes from 21 subjects (11 healthy and 10 with ankylosing spondylitis) using RTVue-100 OCT (Optovue Inc., Fremont, CA, EE.UU.). Measurements were performed by 9 independent ophthalmologists from 6 different centers. To assess the inter-observer variability, the intra-class correlation coefficient (ICC) method was calculated. Also, intra-observer variability was assessed in 2 of the ophthalmologists. RESULTS: The mean subfoveal CT was 364.9±85.1µm (range, 170 to 572). The inter-observer ICC was 0.823 (CI 95%, 0.749 to 0.888, p<0.001). The intra-observer ICCs were 0.885 (CI 95%, 0.783 to 0.939, p<0.001) and 0.925 (CI 95%, 0.859 to 0.960. p<0.001). CONCLUSIONS: In this study, manual measurements of CT with OCT showed a good concordance. These results suggest that manual OCT is a valid tool for multicenter studies.

[Optic nerve drusen and deep visual fields defects]. / Drusas del nervio óptico y defectos campimétricos severos.

PURPOSE: Optic nerve drusen needs to be included in the differential diagnosis of pseudopapilledema. As the identification of this entity by funduscopy may be difficult, ultrasonography has thus become the gold standard for its diagnosis. Severe optic nerve drusen has been correlated with a reduction of the nerve fiber layer measured by optic coherence tomography and with the presence of serious visual field defects. To demonstrate the relationship between extensive optic nerve drusen and visual field defects. METHOD: A prospective observational study of the visual fields of a series of 5 patients with severe optic nerve drusen diagnosed by ultrasonography. RESULTS: Visual field defects of widely differing severity, from inferior nasal quadrant to severe hemivisual field defects, were described in each patient studied. CONCLUSIONS: Visual field defects of diverse severity are common in patients with deep optic nerve drusen. For that reason ultrasonography and/or optical coherence tomography is highly recommended where such visual field defects exist.

Drusas del nervio óptico y defectos campimétricos severos / Optic nerve drusen and deep visual fields defects

Objetivo: Las drusas del nervio óptico deben serincluidas en el diagnóstico diferencial de pseudopapiledema,ya que pueden resultar difícilmente identificablesmediante funduscopia. Por ello se hacenecesaria la utilización de la ecografía, como goldstandard en su diagnóstico. Se ha correlacionado laseveridad de las drusas papilares con la reduccióndel espesor de la capa de fibras nerviosas medidaspor tomografía óptica de coherencia y con la existenciade defectos importantes en el campo visual.Demostrar la existencia de una alteración campimétricaasociada a la presencia de drusas del nervioóptico extensas.Métodos: Estudio descriptivo prospectivo de campimetríasrealizadas por una serie de 5 pacientesafectos de drusas del nervio óptico severas diagnosticadasmediante ultrasonografía.Resultados: Se han observado defectos campimétricosdestacables de diversa severidad en todos lospacientes estudiados, que oscilan entre escalónnasal y defectos de hemicampos severos. Conclusiones: Los pacientes afectos de drusaspapilares profundas presentan con frecuencia alteracionesen su campo visual de profundidad variable,por lo que los autores recomiendan un seguimientocampimétrico y/o con tomografía de coherenciaóptica en estos casos

Purpose: Optic nerve drusen needs to be included ;;in the differential diagnosis of pseudopapilledema. ;;As the identification of this entity by funduscopy ;;may be difficult, ultrasonography has thus become ;;the gold standard for its diagnosis. Severe optic nerve ;;drusen has been correlated with a reduction of ;;the nerve fiber layer measured by optic coherence ;;tomography and with the presence of serious visual ;;field defects. To demonstrate the relationship between ;;extensive optic nerve drusen and visual field ;;defects. ;;Method: A prospective observational study of the ;;visual fields of a series of 5 patients with severe ;;optic nerve drusen diagnosed by ultrasonography. ;;Results: Visual field defects of widely differing ;;severity, from inferior nasal quadrant to severe ;;hemivisual field defects, were described in each ;;patient studied. ;;Conclusions: Visual field defects of diverse severity ;;are common in patients with deep optic nerve ;;drusen. For that reason ultrasonography and/or optical coherence tomography is highly recommended ;;where such visual field defects exist

[Photic maculopathy and iris damage in a psychotic patient]. / Maculopatía solar y lesiones del iris autoinducidas en paciente psicótico.

CASE REPORT: A 37-year-old psychotic patient inflicted injuries to his skin and eyes in the context of an interpretational delirium with aesthetic content. He used magnifying glasses to concentrate sunlight and suffered burns to his arms and face. In the eyes, these resulted in massive iridial atrophy with loss of the sphincteric function, photic maculopathy and peripheral retinal coagulation. The macular lesion resolved spontaneously although he did not recover visual acuity. DISCUSSION: This is the first reported case of ocular self-injury secondary to sunlight. It is also the first case reporting retinal photo-coagulative lesions secondary to sunlight.

Maculopatía solar y lesiones del iris autoinducidas en paciente psicótico / Photic maculopathy and iris damage in a psychotic patient

Caso clínico: Paciente varón de 37 años de edad, entratamiento psiquiátrico por trastorno psicótico. Enel transcurso de un delirio de interpretación no sistematizadoy buscando un fin estético se autoindujounas lesiones en la piel y los ojos. Utilizó lupas paraconcentrar los rayos solares desarrollando en la caray los brazos quemaduras de segundo y tercer grado,y en los ojos una atrofia masiva del iris con pérdidade la función esfínter, maculopatía solar y fotocoagulaciónde la retina periférica. La lesión macularse resolvió espontáneamente aunque la agudezavisual no se recuperó.Discusión: No se ha descrito hasta ahora ningúncaso de daño solar autoinducido sin fin destructivopurificativo,ni que presente lesiones fotocoagulativasde la retina

Case report: A 37-year-old psychotic patient ;;inflicted injuries to his skin and eyes in the context ;;of an interpretational delirium with aesthetic content. ;;He used magnifying glasses to concentrate ;;sunlight and suffered burns to his arms and face. In ;;the eyes, these resulted in massive iridial atrophy ;;with loss of the sphincteric function, photic maculopathy ;;and peripheral retinal coagulation. The ;;macular lesion resolved spontaneously although he ;;did not recover visual acuity. ;;Discussion: This is the first reported case of ocular ;;self-injury secondary to sunlight. It is also the first ;;case reporting retinal photo-coagulative lesions ;;secondary to sunlight

[Immunomediate scleritis in a patient with lepromatous leprosy]. / Escleritis inmunomediada en paciente con lepra lepromatosa.

CASE REPORT: A 55 year-old Spanish woman with a personal history of lepromatous leprosy treated for 10 years with anti-lepromatous triple therapy was referred to us presenting nodular scleritis in her left eye with no other clinical manifestations. Ophthalmological evaluation disclosed several inflammatory features in both eyes. Complementary tests performed were negative and the clinical picture was diagnosed as an immuno-mediated manifestation of leprosy. A favorable outcome was achieved with steroidal treatment. DISCUSSION: Scleritis and some immunomediated conditions may appear during the evolution of lepromatous patients whose disease may have been declared clinically cured.

Escleritis inmunomediada en paciente con lepra lepromatosa / Immunomediate scleritis in a patient with lepromatous leprosy

Caso clínico: Mujer española de 55 años con antecedentes de lepra lepromatosa tratada durante 10 años con triple terapia antilepromatosa fue remitida por un episodio de escleritis nodular en ojo izquierdo sin otra clínica adicional. La exploración reveló diversas secuelas inflamatorias no activas en ambos ojos. Las pruebas complementarias descartaron una recidiva lepromatosa, etiquetándose el cuadro de manifestación inmunomediada de la lepra y evolucionando favorablemente con tratamiento esteroideo.Discusión: La escleritis y otras manifestaciones inmunomediadas pueden aparecer tardíamente en pacientes lepromatosos cuya enfermedad había sido declarada curada (AU)

[Efficacy of topical povidone-iodine applied the day before cataract surgery to reduce conjunctival flora]. / Eficacia de la povidona yodada tópica administrada el día previo a la cirugía de catarata para reducir la flora conjuntival.

OBJECTIVE: To evaluate the efficacy of the topical use of periocular and conjunctival povidone-iodine solution applied the day before cataract surgery to reduce conjunctival flora. PATIENTS AND METHODS: Randomized and prospective clinical trial with 82 patients. The treatment group (41 patients) received an application of topical 10% povidone-iodine solution on the periocular skin and instillation of topical 5% povidone-iodine solution on the forniceal conjunctiva the day before and one hour before surgery. The control group (41 patients) only received the usual perioperative disinfectant. Conjunctival smears were obtained from in all patients at the end of the surgery and these were sent to the Microbiology Laboratory for culture. RESULTS: In the treatment group 1 positive culture was found in the 41 eyes (2.4%). In the control group, there were positive cultures in 6 out of 41 eyes (14.6%). The difference is statistically significant (p<0.05). CONCLUSIONS: The disinfecting of the periocular skin with 10% povidone-iodine solution and of the conjunctiva with 5% povidone-iodine solution the day before and one hour before cataract surgery is effective in reducing conjunctival bacterial colonization compared with perioperative disinfection alone.

Eficacia de la povidona yodada tópica administrada el día previo a la cirugía de catarata para reducir la flora conjuntival / Efficacy of topical povidone-iodine applied the day before cataract surgery to reduce conjunctival flora

Objetivo: Valorar la eficacia de la aplicación tópica de povidona yodada periocular y conjuntival administrada el día previo a la cirugía de catarata para reducir la flora conjuntival. Pacientes y métodos: Estudio prospectivo y aleatorio con 82 pacientes. En el grupo de casos (41 pacientes) se aplicó una solución de povidona yodada al 10 por ciento periocular y al 5 por ciento instilada en fondos de saco conjuntivales, el día previo y una hora antes de la cirugía. En el grupo control (41 pacientes) se realizó solamente la desinfección peroperatoria. Se tomaron frotis conjuntivales de todos los pacientes al finalizar la cirugía, enviándolos al Laboratorio de Microbiología. Resultados: En el grupo de casos se encontró cultivo positivo en 1 de 41 ojos (2,4 por ciento), mientras que en el grupo control se aislaron cultivos positivos en 6 de 41 ojos (14,6 por ciento). La diferencia es estadísticamente significativa (p<0,05). Conclusión: La desinfección de la piel periocular con povidona yodada al 10 por ciento y la instilación conjuntival de la misma solución al 5 por ciento el día previo y una hora antes de la cirugía de catarata se ha mostrado eficaz para disminuir la colonización bacteriana conjuntival en comparación con la desinfección peroperatoria aislada. (AU)

[Antibiotic therapy of infected cerebrospinal fluid in hydrocephalus treated by a shunt]. / Antibioticoterapia del LCR infectado en hidrocefalias tratadas con shunt.

Nine hydrocephalic shunted children with infected cerebrospinal fluid (CSF) were treated. Ages ranged from 0 to 10 years. Diagnosis was made through clinical symptoms, CSF examination, echographic and computed tomography (CT). The microorganism which was seen more frequently, was S. epidermidis. This germ was more often found in young children. Treatment of these patients consisted of a systematic change of the shunt which was externally diverted, implantation of a CSF Ommaya reservoir in the lateral ventricle, and intraventricular and systemic administration of antibiotic, were made. Using this protocol CSF sterilization was obtained in all cases, after 5 to 12 days of treatment. CSF shunt infected with S. epidermidis can be effectively cleaned with daily intra-shunt vancomycin, and shunt infected with gram-negative are also cleaned with daily intra-shunt gentamycin.