Long-lasting disabling photophobia after uneventful cataract surgery.

The case concerns a 54-year-old woman, with a history of fibromyalgia and normal preoperative ocular and systemic study, who presented with a long-lasting disabling photophobia, after sequential bilateral cataract surgery without complications. Photophobia was accompanied by good uncorrected VA, with no pain or subjective eye discomfort, without migraine or indicators of psychic conflict. It was refractory to any prescribed treatment of the ocular surface, finally responding to oral anticonvulsants (carbamazepine) that are frequently used in neuropathic pain. To the best of our knowledge this is the first reported case of a long-lasting disabling photophobia without pain and good VA after cataract surgery.

Fotofobia invalidante de larga duración tras cirugía no complicada de cataratas / Long-lasting disabling photophobia after uneventful cataract surgery

Paciente mujer, de 54 años, con antecedente de fibromialgia y estudio preoperatorio ocular y sistémico normal, que presenta fotofobia invalidante de larga duración, tras cirugía bilateral secuencial de cataratas sin complicaciones. La fotofobia se acompañaba de buena AV no corregida, sin dolor ni molestias subjetivas oculares y sin migraña ni indicadores de conflictos psíquicos. Fue refractaria a cualquier tratamiento de la superficie ocular pautado, respondiendo finalmente a anticonvulsivantes orales (carbamazepina) frecuentemente utilizados en dolor de tipo neuropático. Según nuestro conocimiento es el único caso descrito de fotofobia invalidante de larga duración sin dolor y buena AV tras cirugía de cataratas (AU)

The case concerns a 54-year-old woman, with a history of fibromyalgia and normal preoperative ocular and systemic study, who presented with a long-lasting disabling photophobia, after sequential bilateral cataract surgery without complications. Photophobia was accompanied by good uncorrected VA, with no pain or subjective eye discomfort, without migraine or indicators of psychic conflict. It was refractory to any prescribed treatment of the ocular surface, finally responding to oral anticonvulsants (carbamazepine) that are frequently used in neuropathic pain. To the best of our knowledge this is the first reported case of a long-lasting disabling photophobia without pain and good VA after cataract surgery (AU)

[Pterygium surgery and fibrin glue: avoiding dehiscence]. / Cirugía del pterygium y adhesivo de fibrina: evitar la dehiscencia.

OBJECTIVE/METHOD: The purpose of the study is to evaluate those cases of pterygium surgery with fibrin sealant that produced dehiscence of the graft, and then apply and evaluate the efficacy of a different surgical technique in an attempt eliminate this complication in previously identified cases of high risk. The first phase is a retrospective study of 42 cases of pterygium surgery. In the second phase, the variation in the surgical technique was prospectively used in 14 cases of pterygium surgery. RESULTS/CONCLUSIONS: Cases of recurrent pterygium, broad pterygium, and complicated surgery were identified as the groups with a risk of suffering dehiscence of the graft. With the variant applied surgery no dehiscence occurred when using the variation in surgical technique, with no added complications.

[Comparison of the effectiveness of two different pharmacologic approaches to prevent intraoperative floppy iris syndrome]. / Comparación de la efectividad de dos estrategias farmacológicas para la prevención del síndrome de iris flácido intraquirúrgico.

OBJECTIVE: To compare the effectiveness of two strategies to prevent the appearance of intraoperative floppy iris syndrome (IFIS) in patients exposed to a-blockers. METHODS: We compared retrospectively the presence and severity of the appearance of IFIS in 29 patients subjected to cataract surgery, establishing two groups of 12 patients (22 eyes) and 17 patients (33 eyes). The strategy applied to group one consisted of suspending the exposure to a-blockers for at least one week prior to the intervention, the topical application of 1% atropine three times a day for two days before the intervention and the use of intracameral lidocaine. The strategy for group two consisted of suspending use of the drug for at least one week before the intervention and the intracameral application at the beginning of surgery of a solution of physiological serum, adrenaline and lidocaine. RESULTS: Six patients from group one showed no evidence of IFIS, 2 exhibited bilateral mild symptoms, 2 bilateral moderate and 2 unilateral severe symptoms of IFIS. In total, 45.5% eyes suffered from IFIS. In group two, only 3 eyes (9.1%) from 2 patients exhibited mild symptoms. Statistical analysis showed a significant difference between both groups (p=0.002). If only those exhibiting moderate and severe symptoms are taken into account the result was highly statistically significant (p=0.0002). CONCLUSION: The study shows a greater statistical effectiveness of the strategy applied to group two compared to the strategy applied to group one (Arch Soc Esp Oftalmol 2009; 84: 549-556).

[Intraocular lens power calculation in complicated cases: the "Silguero"method]. / Cálculo de lente intraocular en casos complicados: el método "Silguero".

PURPOSE: To report a new method for intraocular lens (IOL) calculation in patients treated by corneal refractive surgery, in whom the application of other methods is not possible because of the absence of necessary data. This method is also applicable in other situations where the IOL calculation is difficult and in cases of IOL exchange because of unexpected refractive difficulties. METHODS: We performed phaco-emulsifications, refracting the patient's eye before IOL implantation, using the refraction data in aphakia as the only variable for the application of the formula, which itself is based on the existing correlation between the graduation of glasses (12 mm) and the IOL power at the lens level. The formula has been applied in 3 patients in whom no other calculation method was applicable. RESULTS: After the appropriate intervention, the 3 patients presented a spherical equivalent below 1 diopter. CONCLUSION: We believe this formula is valid in some situations where other formulas cannot be applied because of the absence of the necessary variables.

[Technique of inverse scleral flap in the treatment of peripheral corneal defects (Abreu and Delgado technique)]. / Técnica de recubrimiento escleral inverso en el tratamiento de defectos corneales periféricos (Técnica de Abreu y Delgado).

PURPOSE: To present a new easy-to-perform technique for the treatment of peripheral corneal defects (perforation or significant thinning), which has had good results. METHODS: This technique, which consists in sliding and suturing a limbal based inverted scleral flap (similar to the scleral flap used in glaucoma surgery) over the affected peripheral cornea, is described. We present 7 cases: one dellen, two marginal ulcers, two perforating traumatisms, one descematocele and one case of corneal thinning after pterygium surgery. RESULTS: All 7 cases were satisfactorily resolved without modifying either the astigmatism or visual acuity. CONCLUSIONS: This is an easy-to-perform technique which offers good results and although it has some limitations, it can be recommended for the treatment of many peripheral corneal defects (perforations and significant thinning).