Estudio de la queratitis infecciosa en el injerto corneal / Study of infectious keratitis complicating penetrating keratoplasty

Objetivo: Analizar es un estudio retrospectivo, la microbiología y los factores de riesgo asociados en la queratitis infecciosa (Ql) tras queratoplastia penetrante (QP).Métodos: Han sido estudiadas 246 QP (realizadas en 17 años, 1980-1997) para identificar QI en QP. Criterio de inclusión fue el cultivo o extensión positiva. Fueron estudiadas las indicaciones de QP, intervalo de tiempo entre QP y QI, factores de riesgo asociados, estudio microbiológico, complicaciones y transparencia final del injerto. Resultados: Se encontraron 12 casos de QI en 246 QP, por tanto, una incidencia del 4,8 por ciento. Entre estos casos, la causa más frecuente de QP fue la queratopatía herpética (41,6 por ciento). Los factores de riesgo asociados fueron: 1.º Oculares (descompensación del injerto, lente de contacto terapéutica y sutura); 2.º Medicaciones tópicas (antibióticos y corticoides) y 3.º Sistémicas (diabetes mellitus). El tiempo medio entre QP y QI fue de 27,1ñ25,7 meses. El 25 por ciento de casos se aparecieron en el período precoz (12 meses) asociados a la descompensación del injerto y empleo lente de contacto terapéutica. El 66,6 por ciento de casos fueron bacterianos predominando los Gram (+) (Staphyilococcus y Streptococcus) y el resto de origen fúngico (Candida). Se observó un caso de queratopatía cristalina infecciosa por Streptococcus Mitis. La incidencia de complicaciones severas como evisceración y pérdida de trasparencia del injerto es del 75 por ciento. Conclusiones: La QI en QP es una complicación poco frecuente (4,8 por ciento) y grave. Es mayor la incidencia de QI tardía asociada a descompensación del injerto y empleo de lente de contacto terapéutica. Los microorganismos más frecuentemente implicados son bacterias Gram (+) y hongos (Cándida) (AU)

[Study of infectious keratitis in corneal graft]. / Estudio de la queratitis infecciosa en el injerto corneal.

PURPOSE: This retrospective study was conducted to identify the associated risk factors and microbiologic spectrum in infectious keratitis (IK) after penetrating keratoplasty (PK). METHODS: Medical records of 246 PK (corneal grafts for a 17-year period, 1980-1997) were reviewed to identify IK. Criterion for inclusion was IK in PK and positive corneal culture or smear Gram stain. PK indications, interval PK-IK, risk associations microbiologic study, complications, and final corneal graft clarity were reviewed. RESULTS: The incidence reported was 4.8%, 12 cases of IK identified in 246 PK performed. The most common PK diagnosis was herpes simplex keratopathy. Potential risk factors have been categorized in :1- Local ocular (graft discompensation, therapeutic contact lens, suture-related), 2- Topical medication (corticosteroids and antibiotics) and 3- Systemic causes (diabetes mellitus). Time interval between PK-IK was 27.1+/-25.7 months (25% occurred within 12 months PK and suture complications were the main cause; 75% later than 12 months and corneal oedema and therapeutic contact lens the main late causes). Microbial spectrum: 66.6% cases were bacterial, Gram (+) organisms were predominantly involved (Streptococcus and Staphylococci) and the remaining cases were fungal (Candida). There was one case of infectious crystalline keratopathy due to Streptococcus Mitis. The prevalence of complications like evisceration and failure clear graft were 75%. CONCLUSIONS: IK after PK is an uncommon (4.8%) but serious complication. It proves a major later form incidence, associated to graft discompensation and contact lens use. Gram (+) bacterial organism and fungi (Candida) were predominantly involved.

[Ophthalmological exploration of children with Down's syndrome. Main results and comparison with a control group]. / Exploración oftalmológica en niños con síndrome de Down: principales resultados y comparación con un grupo control.

BACKGROUND: Down's Syndrome is the most frequent chromosomal aberration. There is a wide variety of symptoms. From an ophthalmological point of view, numerous alterations associated with Down's Syndrome have been described. MATERIAL AND METHODS: We have carried out a complete ophthalmic exploration on 60 children with Down's Syndrome and 60 control children. RESULTS: The first group showed a high percentage of refraction errors (90%), nystagmus (28%), strabismus (48%) and cataracts (13%). If we compare these results with those of the control group we find that the Down's group has a frequency significantly higher both in refraction errors as a whole (p < 0.001) and myopia (p < 0.01), hypermetropia (p < 0.02) and stigmatism (p < 0.001). They have also shown a frequency significantly higher of strabismus (p < 0.001). CONCLUSION: All of the observed alterations can have a negative influence on the appropriate educational development of these children. An early ophthalmological exploration would be advisable in children with Down's Syndrome.

[Cogan's syndrome]. / Síndrome de Cogan. Presentación de un caso.

The association of non syphilitic interstitial keratitis with vestibulo-auditory symptoms was first described by Cogan in 1945. Owing to the rarity of this condition our opportunity of dealing with one of such cases is the reason for this paper, in which are contemplated besides the review of the published literature other points concerning the etiopathogenesis, the treatment and the follow-up of the disease.

Hemorrhagic retinopathy in newborns: frequency, form of presentation, associated factors and significance.

During the first 72 hours of their lives, 420 neonates were checked for retinal hemorrhages and macular affection. The neonate's gestational age, birth weight, and Apgar scores and maternal data (nulliparty, fetal presentation, duration of labor and delivery, induction of labor and obstetric technique) were all recorded. In 81 cases (19.2%), retinal hemorrhages were found. No significant relation was established with any of the associated factors, except for a significantly lower frequency of hemorrhages in cases of cesarean delivery (p < 0.01) and a significantly longer expulsive phase in the group with hemorrhages (p < 0.05). In follow-up examination 3 to 4 months later, neither the infants with hemorrhages nor the control group presented alterations.