Abstract Purpose To determine the efficacy of intravitreal triamcinolone injections (iv TA) for diffuse persistent diabetic macular oedema (DMO) based on the functional parameter of modification in best corrected visual acuity (BCVA) and the anatomic parameter of quantitative changes in central macular thickness, as determined by optical coherence tomography (OCT). The secondary outcome is to analyse the safety of the procedure. Methods In this retrospective study, 16 patients (22 eyes) were included over a period of six months. Type and time of evolution of diabetes mellitus, previous treatments, BCVA, lens status, intraocular pressure (IOP) and central macular thickness, were analysed. During the follow-up period were collected: number of injections, changes in BCVA, IOP, central macular thickness, and complications observed. Results Improvement in BCVA was recorded in 30.77%, 47.37% and 52.63%, at one, three and six months, respectively ( p < .05 at 3 months). The IOP increased in 57.69% at one month, and 75 and 47.05%, at 3 and 6 months, respectively ( p < .05 at 3 months). Progression of cataracts was found in 22.72%. No cases of endophthalmitis were observed. Conclusions Intravitreal TA is a good therapeutic option for patients with persistent DMO, increasing BCVA and decreasing central macular thickness in the short term, with a percentage of clinical resolution of more than 70%. However, due to the transient effect, and potential adverse effects, it should be administered to selected refractory cases with caution.
Abstract Case reports We present the case of a patient with neurotrophic queratitis in the left eye treated with a Tutopatch® cover and platelet-rich plasma (PRP). Solid autologous PRP was placed in the bed of the ulcer and Tutopatch® was sutured to the conjunctiva. Discussion We found this form of treatment very effective for progressive ulcers. Tutopatch® may constitute an alternative to amniotic membrane transplantation.
Abstract Purpose To evaluate the autofluorescence findings in patients diagnosed with pseudoxanthoma elasticum. Material and methods A prospective study was conducted on 18 eyes of 9 patients who had ocular pathology andfollowed up in the pseudoxanthoma elasticum (PSX) unit of our hospital. We evaluated the best corrected visual acuity (BCVA), colour and autofluorescence photography (AF), and fluorescein angiography (FA) in patients with choroidal neovascularitation. Results Of the 9 patients, 7 were women and 2 were men. The mean age was 40 +/– 14 years. The BCVA ranged from 1 to 0.01 (Mean 0.65 +/– 0.4). All patients showed PSX injuries. Angioid streaks (AS) 18 (100%), peau d‘orange 16 (87.5%) and pigmented fibrotic plates 5 (31,5%). We observed different hypoautofluorescence patterns (RPE atrophy), of which 2 of them were AS patterns (irregular lines with hyperautofluorescence speckled in its interior and edges, or bands with lobulated lesions inside and hyperautofluorescence at the edges), and finally widespread areas of hypoautofluorescence, larger than observed by ophthalmoscope. Conclusions Autofluorescence in patients with PSX is an easy method to evaluate the initial level of ophthalmoscopic involvement and its subsequent progression. The extensive changes in the retinal pigment epithelium (RPE) suggests the important role of this in the physiopathology of the disease.
Abstract Clinical case A 23-year-old woman who was seen due to decreasing far visual acuity 24hours after starting treatment with topiramate. In the cycloplegic refraction, RE showed –4.25 and LE –4.50. Retinal striae could be seen in the macula of both eyes. The alterations ceased 48 hours after the drug treatment was interrupted. Discussion Drug induced acute myopia is an infrequent phenomenon, the aetiology of which is still not fully known.
Abstract Objective To study the refractive and visual results after Descemet's stripping automated endothelial queratoplasty (DSAEK). Methods Retrospective study of 75 eyes in 67 patients with Fuchs’ endothelial dystrophy or bullous queratopathy operated on in the Instituto de Oftalmología La Arruzafa from March, 2007 until March, 2010. Phacoemulsification and IOL implantation was involved in 30 cases. We divided all cases into three groups, depending on the potential visual acuity: A (≤ 0.1), B (0.1–0.5) and C (≥ 0.5). Uncorrected distance visual acuity (UCVA), corrected distance visual acuity (CDVA) and refraction were measured. Results Mean CDVA improved 3 lines compared to preoperative values (P < .01). Astigmatism increased by 0.5 dioptres (P = .21). A slight myopic change was found in cases where the donor disc was ≥8.5 mm, as well as in the cases in which phacoemulsification was associated. No correlation between CDVA and donor disc thickness was found. In the group of patients who only had corneal oedema, the mean CDVA was 0.8. No patients ended with less than 0.6 of CDVA and the mean UCVA was 0.5. Conclusions After DSAEK, CDVA improved with a slight hyperopic change, without significant changes in astigmatism. Donor disc thickness does not influence the CDVA. DSAEK is an effective surgical technique to restore a good visual acuity in cases with corneal oedema due to endothelial failure.
Abstract Purpose This study was undertaken to compare the ocular haemodynamic effects of Combigan® versus placebo in patients with ocular hypertension (OHT). Methods Thirty patients with OHT were included in a controlled, randomised, double blind study in two parallel groups; 15 were randomised to receive Combigan® and 15 to receive placebo for a period of 3 months. At baseline and at 3 months retrobulbar blood flowmeasurements of the ophthalmic artery (OA) and central retinal artery (CRA) were taken using colour Doppler imaging(CDI) ultrasound, concurrently with intraocular pressure (IOP). Results Combigan® significantly reduced IOP after 3 months of treatment (P = 0.001), whereas placebo showed no significant change in IOP. The baseline haemodynamic parameters were similar between treatment and placebo groups. Patients treated with Combigan® showed a statistically significant decrease in CRA resistive index (P = 0.007). Conclusions Patients treated for 3 months with Combigan® showed a significant decrease of CRA resistive index that could be explained by the decrease in IOP
Abstract Clinical case We report two cases of patients affected by longstanding rheumatoid arthritis who developed a severe form of peripheral ulcerative keratitis (PUK). Neither of them had an optimal biological and clinical control of their systemic illness despite being treated with several disease-modifying antirheumatic drugs (DMARDs) and biologic therapy. Highdose systemic corticosteroids were given to treat the PUK without any success. Rituximab resulted in a favourable response with resolution of the corneal lesions and optimal control of their systemic illness. Discussion Rituximab may be an additional tool to arrest progressive rheumatoid arthritisassociated PUK that is refractory to other drugs.
Abstract Objectives Normal thresholds on Pulsar perimetry fall faster than those of standard perimetry in the peripheral visual field. Two related studies were performed. Firstly, the frequency distributions of glaucoma defects on standard automated perimetry (SAP) and the relationship of the centre and periphery (Study A) were studied first, followed by an attempt to establish the limits of pulsar perimetry (Study B). Material and method A: frequency of defects was calculated in 78.663 SAP perimetries (G1-TOP, Octopus 1-2-3, Haag-Streit). Study B: 204 eyes with mean defect (MD-SAP) lower than 9 dB were examined 8.92±4.19 times with SAP (TOP-32, Octopus 311) and temporal modulation perimetry (T30W, Pulsar Perimeter, Haag-Streit). Results Study A: 50.7% of the SAP examinations showed MD values lower than 9 dB and 32.7% bellow 6 dB. The MD correlation of the central 20° with the MD of the most peripheral points was r=0.933. Study B: in cases with MD-TOP-32 lower than 6 dB, SAP had the maximum possibility of detecting defect in 0.02% of points and Pulsar in 0.29%. In subjects with MD-TOP-32 between 6 and 9 dB frequencies were 0.38% in SAP and 3.5% in Pulsar (5.1% for eccentricities higher than 20°). Conclusions Pulsar allows detecting defects, without range limitations, in the initial half of SAP frequencies expected on glaucoma patients. In order to study the progression of deeper defects the examination should focus on the central points, where the dynamic range of both systems is more equivalent.
Abstract Case report We describe a case of serous retinal detachment as an atypical presentation of bilateral chronic central serous chorioretinopathy, Discussion We present its diferential diagnosis and therapeutical management with lowfluence photodynamic therapy, achieving satisfactory anatomical and functional results.
Abstract Objective To determine whether there are changes in the peripapillary nerve fibre layer, in colour vision, contrast sensitivity, dark adaptation and electroretinography changes in these patients who do not have infectious retinitis. Methods We studied 52 patients without ocular pathology; the mean age was 35.88 years old. Results We observed less thickness in all quadrants, except the nasal. The colour vision was altered in 27.77% of the patients. The contrast sensitivity test showed high frequency alterations. There was no statistically significant difference in the electroretinography test or in dark adaptation. Conclusions There are changes in the peripapillary nerve fibre layer thickness; also we found changes in colour vision, contrast sensitivity and a decreasing trend of the B wave in the electroreninogram.
Abstract Objective Pigment epithelium-derived factor (PEDF) is an antiangiogenic/neurotrophic dual functional factor, and recently it was also shown to mediate antioxidative and antiinflammatory action. The purpose of this study was to evaluate the levels of PEDF in the aqueous humor in eyes with idiopathic acute anterior uveitis (IAAU). Methods A comparative control study. Aqueous humor was collected from 20 eyes of 20 patients with IAAU. The control group included 20 aqueous humor samples from 20 patients who underwent a cataract surgery and without any other ocular or systemic diseases. Levels of PEDF were determined with the ELISA test. Results Concentration of PEDF in aqueous humor was remarkably higher in patients with IAAU than in control subjects (Mann-Whitney U test, P <.001). Levels of PEDF were 6,291,637.70±8,564,836.48 pg/ml (mean±SD) in eyes with IAAU and 449,178.10± 158,670.19 pg/ml in the eyes of the control group. Conclusion The aqueous humor PEDF levels are increased in eyes with IAAU and may be increased as self-protection against inflammatio
Abstract Case report An 85 year old male suffered vision loss in both eyes due to ruptured bilateral retinal arterial macroaneurysms. Discussion We report this unusual case and show the importance of studying these types of patients in order to detect associated systemic diseases.
Abstract Objective To study the safety and surgical time required when using the tissue adhesive 2-ethyl-cyanoacrylate compared with conventional suture in upper lid blepharoplasty. Method A retrospective study was performed on 40 eyes of 20 patients who underwent bilateral upper lid blepharoplasty. In 7 patients, continuous non-absorbable suture (6-0 nylon monofilament Ethilon® , Ethicon Inc., Somerville, NJ) was used for closure of the incision and in 13 patients 2-ethyl-cyanoacrylate (Epiglue® , Meyer -Haake, Germany) was used. The variables studied were intraoperative time required to close the incision, the cost of the material used and the incidence of infections and suture dehiscence. Results The average time taken to close the incision was 6.069 minutes with cyanoacrylate and 11.914 minutes with conventional suture ( P <.05). The price of surgical material used was practically similar. No cases of infection or wound dehiscence were found. Conclusion The closure of the incision in upper lid blepharoplasty using 2-ethyl-cyanoacrylate is a safe, effective, and faster, but not less expensive method than conventional suture.
Abstract Purpose To report the prevalence of dry eye syndrome (DES) in a subset of patients >50 years old in Valladolid, Spain, calculate internal validity of two DES screening questionnaires, and correlate the results with DES diagnostic tests. Methods Patients >50 years-old were randomly selected from the medical network census in Valladolid; they answered the modified McMonnies questionnaire (Q1) and the Ocular Surface Index questionnaire (Q2) and then underwent an ophthalmic evaluation which included tear break-up time (TBUT), fluorescein and Rose Bengal staining, and Schirmer with anesthesia were performed. Descriptive analysis, test concordance analysis, and Q1 and Q2 reliability using ROC curves were performed. Results A total of 270 subjects (58.2% female; 41.8% male) with an average age of 64.5 years (95% CI: 63.3–65.7) were enrolled. The prevalence of DES based on the Schirmer-Tear breakup time tests combination was 24.2%. The mean Q1 score was 1.2, and 1.4 for Q2. Grittiness and discomfort in dry environments (28.9%) were the most common symptoms recorded for Q1. For Q2 “grittiness” (99.2%) and “burning sensation” (98.9%) were the most common symptoms. With the Schirmer-TBUT combination, DES prevalence in Valladolid was 24.2%, 45.8% with TBUT, and 45.6% with Schirmer test. Values for the areas under the ROC curve for Q1, Q2, and most objective tests were 0.7 for all Q1 and Q2 items. Statistically significant concordance was reported for Schirmer - TBUT (k = 0.14) and TBUT- fluorescein staining (k = 0.09); (P<0.05). Conclusions Q1 and Q2 were unreliable for DES diagnosis and showed poor internal consistency. Fluorescein and Rose Bengal staining were the most concordant tests for DES diagnosis. Finally, there was no correlation between either screening questionnaire and objective DES diagnostic tests.
Abstract Objective To study the central corneal thickness of a Spanish population group and determine the influence of age, gender, axial length and refractive error on central corneal thickness (CCT) values. Methods An observational, cross-sectional, double masked study was conducted on 357 eyes of consecutive Caucasian patients without ophthalmic disease. They were distributed according to age, and high refractive defects were excluded. Ultrasonic pachymetry and a complete eye examination were performed on all patients. The relationship between the central corneal thickness values and variables of age, refractive error, axial length and gender was assessed. Results The mean central corneal thickness was 548.21 μm with a standard deviation (SD) of 30.7 μm (range 464 to 633 μm). The normal central corneal thickness value of the population studied was 486.81 to 609.61 μm (95% confidence interval). No statistical association was found between central corneal thickness values and variables of age, refractive error, axial length and gender. Conclusions Central corneal thickness varies according to race. We have analysed, for the first time, normal central corneal thickness values of a healthy Spanish population.
Abstract Objectives This study was performed to investigate whether different grades of diabetic retinopathy correlate with tear and ocular surface function in diabetic patients without subjective symptoms of dry eye. Methods A total of 129 eyes of 72 patients without dry eye, assessed using McMonnies questionnaire were recruited to the study. The tear film and ocular surface were evaluated using the Schirmer test, tear film break-up time (BUT), fluorescein and lissamine green staining test, and conjunctival impression cytology. The results were analysed. Results A normal Schirmer test and BUT was obtained in 51 and 67% of the eyes of diabetics patients, respectively. Fluorescein and lissamine green staining were negative in 81 and 95% of the eyes. The area and density of goblet cells was 580.46±370 μm2 and 235.58± 109.03 goblets cell/mm2 , respectively. Conclusions Diabetic retinopathy patients without subjective symptoms of dry eye and normal Schirmer and BUT test showed pathological grades of squamous metaplasia.
Destruction of the limbal epithelium barrier is the most important mechanism of pterygium formation (conjunctiva proliferation, encroaching onto the cornea). It is thought to arise from activated and proliferating limbal epithelial stem cells. The objective of this study is to evaluate the presence of undifferentiated mesenchymal cells (stem cells) in cultured cells extracted from human pterygium. Cells from 6 human pterygium were isolated by explantation and placed in cultures with amniomax medium. Once the monolayer was reached the cells were seeded onto 24 well microplates. The cells were studied in the second sub-culture. The immunohistochemical expression of different embryonic stem cell markers, OCT3/4 and CD9, was analysed. The differentiated phenotypes were characterized with the monoclonal antibodies anti-CD31, α-actin and vimentin. All the cell populations obtained from pterygium showed vimentin expression. Less than 1% of the cells were positive for CD31 and α-actin markers. The majority of the cell population was positive for OCT3/4 and CD9. The cell population obtained from pterygium expressed mesenchymal cell phenotype and embryonic markers, such us OCT3/4 and CD9. This undifferentiated population could be involved in the large recurrence rate of this type of tissue after surgery. La destrucción de la barrera del epitelio limbal es el mecanismo más importante en la formación del pterygium. Se piensa que proviene de la activación y proliferación de células madre del epitelio limbal. El objetivo de este estudio ha sido determinar la presencia de células mesenquimáticas indiferenciadas en cultivos celulares obtenidos de pterygium humano. Las células de 6 pterygium humanos fueron aisladas mediante explantos y cultivadas en amniomax. Al alcanzar la confluencia, las células fueron sembradas en microplacas de 24 pocillos. Los cultivos celulares fueron estudiados en el 2.° subcultivo. Se analizó mediante inmunofluorescencia la expresión de los marcadores de células madre embrionarias, OCT3/4 y CD9. Los diferentes fenotipos celulares fueron caracterizados con los anticuerpos monoclonales anti-CD31, α-actina y vimentina. Toda la población celular obtenida de pterygium mostró expresión para vimentina. Menos de un 1% de las células presentaron expresión para los marcadores CD31 y α-actina. La mayor parte de la población celular fue positiva para los marcadores embrionarios OCT3/4 y CD9. La población celular expandida a partir de pterygium está compuesta por células de fenotipo mesenquimal, que muestran expresión de marcadores embrionarios OCT3/4 y CD9. Esta población, con un alto grado de indiferenciación, podría ser responsable de la alta tasa de recurrencia del pterygium tras su extirpación quirúrgica.
To compare the intraocular pressure (IOP) measurements using the Goldmann applanation tonometer (GAT) and contact pneumotonometer (NTC), and to evaluate the effects of central corneal thickness (CCT) on the readings. This was a prospective, observational clinical study, which included 96 eyes of 49 patients, 40 glaucomatous, 29 ocular hypertensive and 27 normal subjects. The IOP measurements were performed with each tonometer. The CCT was also measured. A strong correlation coefficient between GAT and the NTC was found (Pearson=0.922, p<0.001). The mean of paired differences between GAT and NTC was 0.72±2.82 mmHg. The mean difference between GAT and NTC was low at lower levels of PIO and higher at higher levels of IOP. Readings with the GAT showed a mean increase in IOP of 0.47 mmHg for every 10 μm of CCT, and the NTC 0.34 mmHg for every 10 μm, the diference was not statistically significant. The contact pneumotonometer is a reliable method in diagnosis and follow up of our population. The effect of the central corneal thickness was more important for the Goldmann applanation tonometer. Comparar la medición de la presión intraocular (PIO) usando el tonómetro de aplanación de Goldmann (GAT) y el neumotonómetro de contacto (NTC), y evaluar el efecto del grosor corneal central (CCT) en las mediciones. Estudio prospectivo, clínico observacional. Se incluyeron 96 ojos de 49 pacientes 40 glaucomatosos, 29 hipertensos oculares y 27 controles. La PIO se midió con cada uno de los tonómetros. Además se midió el CCT. Se observó un coeficiente de correlación fuerte entre GAT y el NTC (Pearson = 0,922, p < 0,001). La media de las diferencias pareadas entre GAT y el NTC fue de 0,72 ± 2,82 mmHg. La media de las diferencias entre GAT y el NTC fue menor a valores bajos de PIO y más alta a valores mayores de PIO. Las mediciones con GAT demostraron un aumento medio de la PIO de 0,47 mmHg por cada 10 μm de CCT, y el NTC 0,34 mmHg por cada 10 μm, aunque la diferencia no fue estadísticamente significativa. La neumotonometría de contacto es un método fiable en el diagnóstico y seguimiento de nuestra población. El efecto del CCT fue mayor para el tonómetro de Goldmann.
To study the incidence of infectious keratitis (IK) after laser-assisted in situ keratomileusis (LASIK), along with its diagnosis, therapeutic action taken, its management and the results. We carried out a retrospective study of 262,191 eyes intervened consecutively with LASIK, in our 20 centres, during the period from September 2002 and December 2009. All the cases susceptible to being diagnosed with IK, either clinically or due to the biological findings were analysed. A total of 82 cases were found with infectious keratitis, which assumed an incidence of 0.031%. Distributions are presented by gender, mean age of the patients, mean days since the surgery, the clinical signs and symptoms, predisposing factors, therapeutic action, complications, details of the causal germ, and the loss of lines of vision. Infectious keratitis after LASIK is a rare complication. The early diagnosis and management of the process are determining factors when establishing the prognosis. In our series all the cases were resolved without causing any other serious complications. Estudiar la incidencia de queratitis infecciosas (QI) tras láser in situ keratomileusis (LASIK), el diagnóstico, la actitud terapéutica adoptada, el manejo y los resultados. Hemos realizado un estudio retrospectivo, entre los 262.191 ojos intervenidos consecutivamente con LASIK, en nuestros 20 centros, durante el periodo comprendido entre septiembre de 2002 y diciembre de 2009, de todos aquellos casos susceptibles de ser diagnosticados como QI, tanto por la clínica como por los hallazgos biológicos. Han sido recogidos un total de 82 casos de queratitis infecciosas, lo que supone una incidencia del 0,031%. Se presenta la distribución por sexo, la edad media de los pacientes, la media de días transcurridos desde la cirugía, el cuadro clínico, los factores predisponentes, la actitud terapéutica, las complicaciones, la filiación del germen causal, y la pérdida de líneas de visión. La queratitis infecciosa tras LASIK es una complicación poco frecuente. El diagnóstico temprano y el manejo del proceso son determinantes a la hora de establecer un pronóstico. En nuestra casuística todos los casos se resolvieron sin causar otras complicaciones de gravedad.