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.

[Cannabinoid applications in glaucoma]. / Aplicaciones de los cannabinoides en glaucoma.

INTRODUCTION: Glaucoma is a slowly progressive optic neuropathy that is one of the leading causes of legal blindness throughout the world. Currently there is a limited group of topical drugs for the medical treatment of glaucoma is currently limited, and research needs to be focused on new therapeutic horizons, such as the potential usefulness of the cannabinoid agonists for the treatment of glaucoma. AIM: To review the current scientific literature related to the beneficial effects derived from the different ways of administration of cannabinoids indicated for the glaucomatous optic neuropathy. DEVELOPMENT: Cannabinoid receptors have shown an intense expression in ocular tissues implicated in the regulation of the intraocular pressure, as well as inner layers of the retina. Through activation of CB1 and CB1 specific receptors and through other still unknown pathways, the cannabinoid agonists have shown both a clear hypotensive, as well as an experimentally proved neuroprotective effect on retinal ganglion cells. CONCLUSIONS: Some cannabinoid agonists (WIN 55212-2, anandamide) have demonstrated, in experimental studies, to act as «ideal drugs¼ in the management of glaucoma, as they have been shown to have good tolerability after topical application, efficiently reduce intraocular pressure, and behave as neuroprotectors on retinal ganglion cells. Further studies as regards the safety and clinical assays must be carried out in order to examine the effectiveness of these drugs for the treatment of glaucoma in our daily clinical practice.

Aplicaciones de los cannabinoides en glaucoma / Cannabinoid applications in glaucoma

IntroducciónEl glaucoma es una neuropatía óptica lentamente progresiva que constituye una de las principales causas de ceguera legal en el mundo. Actualmente existe un limitado grupo de fármacos tópicos para su manejo médico, siendo necesario enfocar la investigación hacia nuevos horizontes terapéuticos como el potencialmente útil grupo de los agonistas de cannabinoides.ObjetivoRevisar a través de la literatura científica actual, los efectos beneficiosos a través de distintas vías de administración de los cannabinoides para la neuropatía óptica glaucomatosa.DesarrolloLos receptores de cannabinoides han demostrado una amplia expresión en los tejidos oculares implicados en la regulación de la tensión ocular, así como en las capas internas de la retina. Mediante la activación de receptores específicos CB1, CB2 y vías aún no bien conocidas, los agonistas de cannabinoides han demostrado un claro efecto hipotensor ocular, así como un probado efecto neuroprotector sobre las células ganglionares de la retina en estudios experimentales.ConclusionesAlgunos cannabinoides (WIN 55212-2, anandamida) han demostrado a nivel experimental actuar como «fármacos ideales» en el manejo del glaucoma, al presentar buena tolerancia tras su aplicación tópica, reducir de forma eficaz la presión intraocular, y presentar un probado carácter neuroprotector sobre las células ganglionares de la retina.Se deben realizar más estudios sobre su seguridad y ensayos clínicos para poder examinar la utilidad de estos fármacos en el tratamiento del glaucoma en nuestra clínica diaria(AU)

Introduction: Glaucoma is a slowly progressive optic neuropathy that is one of the leadingcauses of legal blindness throughout the world. Currently there is a limited group of topical drugs for the medical treatment of glaucoma is currently limited, and research needs to befocused on new therapeutic horizons, such as the potential usefulness of the cannabinoidagonists for the treatment of glaucoma.Aim: To review the current scientific literature related to the beneficial effects derived fromthe different ways of administration of cannabinoids indicated for the glaucomatous opticneuropathy.Development: Cannabinoid receptors have shown an intense expression in ocular tissuesimplicated in the regulation of the intraocular pressure, as well as inner layers of the retina.Through activation of CB1 and CB1 specific receptors and through other still unknownpathways, the cannabinoid agonists have shown both a clear hypotensive, as well as anexperimentally proved neuroprotective effect on retinal ganglion cells.Conclusions: Some cannabinoid agonists (WIN 55212-2, anandamide) have demonstrated, inexperimental studies, to act as «ideal drugs» in the management of glaucoma, as they havebeen shown to have good tolerability after topical application, efficiently reduce intraocularpressure, and behave as neuroprotectors on retinal ganglion cells.Further studies as regards the safety and clinical assays must be carried out in order toexamine the effectiveness of these drugs for the treatment of glaucoma in our daily clinicalpractice(AU)

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)

[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.