Insulina colirio en afecciones de la superficie ocular / Insulin Eye Drops for Eye Surface Conditions

Cuando se produce una erosión corneal y fracasa la epitelización corneal surgen los defectos epiteliales corneales persistentes, cuyo tratamiento es un desafío para el oftalmólogo. Es muy frecuente el fracaso del tratamiento convencional por lo que se mantiene el interés en la búsqueda de otros factores de crecimiento para la cicatrización epitelial tales como los colirios de insulina. La insulina es un péptido estrechamente relacionado con el factor de crecimiento similar a la insulina 1. Su mecanismo de acción no es bien comprendido, sin embargo se acepta que es capaz de inducir migración y proliferación de las células epiteliales corneales, por lo que promueve y acelera la reepitelización de defectos epiteliales persistentes refractarios a tratamiento. La ausencia de una presentación comercial de colirio de insulina, hace necesario conocer su estabilidad físicoquímica y microbiológica así como la eficacia, efectividad y seguridad del colirio de insulina a diferentes concentraciones. De ahí la motivación para realizar una revisión de la literatura existente sobre el empleo del colirio de insulina en el tratamiento del defecto epitelial corneal persistente. Se realizó la búsqueda en bases de datos electrónicas como PubMed Central, EBSCO, Clinical Trials.gov, MEDLINE OVID, EMBASE OVID con el objeto de identificar artículos relacionados con el tema(AU)

When corneal erosion occurs and corneal epithelialization fails, persistent corneal epithelial defects arise, whose treatment is a challenge for the ophthalmologist. The failure of conventional treatment is very frequent; therefore, there is still interest in the search for other growth factors for epithelial healing, such as insulin eye drops. Insulin is a peptide closely related to insulin-like growth factor 1. Its mechanism of action is not well understood; however, it is accepted that it is capable of inducing migration and proliferation of corneal epithelial cells, thereby promoting and accelerating reepithelialization of persistent epithelial defects refractory to treatment. The absence of a commercial presentation for insulin eye drops makes it necessary to know its physicochemical and microbiological stability, as well as the efficacy, effectiveness and safety of insulin eye drops at different concentrations; hence the motivation to review the existing literature on the use of insulin eye drops in the treatment of persistent corneal epithelial defects. The search was carried out in electronic databases such as PubMed Central, EBSCO, Clinical Trials.gov, MEDLINE OVID, EMBASE OVID, with the aim of identifying relevant articles related to the topic(AU)

Management of corneal neurotrophic ulcers with Cacicol®-RGTA (ReGeneraTing Agent): a case series. / Manejo de las úlceras corneales neurotróficas con Cacicol®- ReGeneraTing Agent: serie de casos.

PURPOSE: Neurotrophic corneal ulcers are difficult to treat, and the conventional treatment often results in failure. A new matrix regenerating agent ("ReGeneraTing Agents"), Cacicol® (Laboratoires Théa), has demonstrated good results over the last few years. Therefore, the aim of this study was to evaluate the response to Cacicol® in a series of cases with neurotrophic corneal ulcers. METHODS: Retrospective case series looking at 11 patients with corneal ulcers unresponsive to conventional therapy that underwent treatment with Cacicol®. One cycle included 1 drop every two days for 5 days. RESULTS: The range of conventional therapy prior to Cacicol® was 0-91 days. On introducing Cacicol® 82% (9/11) of the cases were cured, and 18% (2/11) failed, requiring an amniotic membrane transplant or penetrating keratoplasty. The healing only required one cycle of Cacicol® in 67% (6/9) of the patients. More than one cycle of Cacicol® was needed in 45% (5/11) patients. One corneal bacterial ulcer responded favourably and one case related to Acanthamoeba did not respond. Most of the patients improved or maintained their visual acuity. CONCLUSION: Cacicol® was a useful therapy in a high number of difficult neurotrophic corneal ulcers, including corneal infections. Some cases may require more than one cycle of Cacicol® or used as first-line treatment in order to achieve the desired result.

Neurotrophic keratitis after transscleral diode laser cyclophotocoagulation. / Queratitis neurotrófica posciclofotocoagulación transescleral con láser diodo.

OBJECTIVE: To study the relationship between treatment with diode laser transscleral cyclophotocoagulation and development a neurotrophic keratitis due to the damage of the sensitive corneal innervation. METHODS: A study was conducted on 5 eyes of 5 patients who were treated with diode laser transscleral cyclophotocoagulation and soon developed neurotrophic ulcers. Personal characteristics of the patients were collected, as well as refraction and risk factors for corneal hypoesthesia, and the parameters of the laser used in the surgery. RESULTS: It was found that the 5 patients had predisposing factors of corneal hypoesthesia prior to surgery (chronic use of topical beta blockers, surgery with corneal incisions, diabetes mellitus, or corneal dystrophies); however none had developed neurotrophic keratitis until the cyclophotocoagulation was performed. It also showed that 4 of them were highly myopic, and they all were treated with high laser parameters (with an average of 2880 mW for 3s at an average surface of 275°), triggering neurotrophic ulcers between 10 and 35 days after surgery. CONCLUSION: Neurotrophic keratitis is a rare complication that can occur after diode laser transscleral cyclophotocoagulation, secondary to the damage of the long ciliary nerves. The emergence of this disorder can be triggered by the existence of previous risk factors, including high myopia, thus it is important to respect the recommended treatment parameters to prevent the development of this disorder.

Herpes Zoster Oftálmico. Presentación de un caso / Herpes zoster ophthalmicus. Case presentation

Introducción: la infección inicial por el virus de la varicela-zoster produce una enfermedad exantemática aguda (varicela). Meses después se desarrolla el Herpes Zoster por reactivación del virus endógeno latente. El área inervada por el nervio trigémino es la segunda en cuanto a frecuencia de afectación. Cuando la enfermedad afecta la primera división de este, recibe el nombre de Herpes Zoster Oftálmico y tiene especial importancia debido al peligro que implica para el ojo.Objetivo: evidenciar manifestaciones clínicas, complicaciones y secuelas oftalmológicas en un paciente con diagnóstico de Herpes Zoster oftálmico.Presentación del caso: paciente masculino de 75 años con antecedentes personales de varicela en la infancia, acude a consulta por lagrimeo, fotofobia y edema palpebral en ojo derecho, acompañado de lesiones vesiculares y costras en piel de la frente y nariz. El examen oftalmológico evidencia inyección cilio-conjuntival intensa, lesiones dendríticas en la córnea, precipitados queráticos en endotelio corneal y Signo de Hutchinson positivo. Se diagnosticó Herpes Zoster oftálmico complicado con uveítis anterior aguda que dejó como secuela queratitis neurotrófica y queratoconjuntivitis seca. Se indicó, previo consentimiento informado del paciente, tratamiento con Aciclovir, prednisolona, homatropina, lágrimas artificiales y vitaminoterapia. Se realizó el diagnóstico diferencial con enfermedades que afectan piel y mucosas, en especial la conjuntiva, con lesiones vesículo-ampollar, como penfigoide cicatrizal, Síndrome de Stevens-Johnson, queratitis por herpes simple, entre otros. Conclusiones: el Herpes Zoster oftálmico es causa importante de morbilidad ocular debido a secuelas como queratitis neurotrófica y queratoconjuntivitis seca, con el consecuente daño a la superficie ocular(AU)

Introduction: the initial infection by the virus of the varicella-zoster produces an exanthematous acute illness (varicella). A few months later the herpes zoster is developed because of a reactivation of the latent endogenous virus. The area innervated by the trigeminal nerve is the second taking in consideration its frequency. When the illness affects the first branch of the nerve, receives the name ophthalmic herpes zoster and it is very important because it is very dangerous for the eye. Objective: to show the clinical manifestations evidence, complications and ophthalmic sequels in a patient with an ophthalmic herpes zoster diagnosis. Case Presentation: a male patient of 75 years old with personal medical records of varicella in the childhood, he goes to outpatient service because of lacrimation, photophobia and great palpebral edema in his right eye, accompanied by clear watery vesicles and scabs in skin of the forehead and nose. The ophthalmic exam evidences severe ciliary and conjunctival injection, dendritic keratitis, corneal endothelial plaques and positive Hutchinson's sign. It was diagnosed as complicated herpes zoster ophthalmicus with acute uveitis that left as a sequel a neurotropic keratitis and dry eyes. It was indicated, previous information to the patient, treatment with acyclovir, prednisolone, homatropin, artificial tears and multivitamins. It was carried out the differential diagnosis with illnesses that affect skin and mucous, especially the conjunctive one, with lesions to blister as cicatrizal pemphigoid, Stevens-Johnson syndrome and herpes simplex keratitis. Conclusions: the herpes zoster ophthalmicus is an important cause of ocular morbidity due to the sequels like the neurotropic keratitis and dry eyes, with the consequent damage to the ocular surface(AU)