Factores relacionados al éxito anatómico y funcional de la cirugía por desprendimiento de retina regmatógeno. Instituto Regional de Oftalmología "Javier Servat Univazo" (2010 - 2019), Trujillo, Perú

Evaluar los factores relacionados al éxito anatómico y funcional de la cirugía por desprendimiento de retina regmatógeno (DRR) en pacientes del Instituto Regional de Oftalmología "Javier Servat Univazo". Estudio observacional en una cohorte retrospectiva de 204 pacientes con DRR sometidos a diferentes técnicas quirúrgicas entre enero 2010-diciembre 2019, con al menos 6 meses de seguimiento. Éxito anatómico (re-aplicación primaria de retina) y éxito funcional (mejoría de agudeza visual (AV)); buscándose asociación entre estas variables y las demográficas, clínicas y tiempos de espera. Resultados: La edad promedio fue 50 + 16,5 (9-85) años. Éxito anatómico se alcanzó en 165 (80,9 %) pacientes y funcional en 110 (52,9 %). Hubo menor tiempo de espera quirúrgico en pacientes que lograron éxito anatómico (20,0 +/- 22,6 días (1-120)) vs. (29,8 +/- 40,1 días (1-210)) (p=0,04) y en los que tuvieron éxito funcional ( 13,3+/- 15,1 (1-100)) vs. (31,9 +/- 33,7 (1-210)) (p <0,001); y menor tiempo de enfermedad y menor tiempo total en los que tuvieron éxito funcional (29,7 +/-56,5 días (1-365) vs. (61,9 +/- 110,6 días (1-730)) (p=0,008) y (43,1 +/- 68,1 (5-465)) vs. 93,8 +/- 118,3 (3-766)) respectivamente (p<0,001). El menor tiempo de espera quirúrgico mostró asociación con el éxito anatómico y funcional de la cirugía por DRR. El menor tiempo de enfermedad y el menor tiempo total también mostraron asociación con el éxito funcional. Recomendamos implementar medidas para abreviar tiempos de espera e instaurar una terapia quirúrgica precoz y oportuna en estos pacientes.

To evaluate factors related to the anatomical and functional success of surgery for rhegmatogenous retinal detachment (RRA) in patients of the Regional Institute of Ophthalmology "Javier Servat Univazo". retrospective cohort study of 204 patients with RRD submitted to different surgical techniques between January 2010-December 2019, with at least 6 months of follow-up anatomical success (primary retinal reapplication) and functional success (improvement in visual acuity (VA)); looking for an association between these variables and demographics, clinics and waiting times. Results: The mean age was 50 + 16.5 (9-85) years. Anatomical success was achieved in 165 (80.9%) patients and functional in 110 (52.9%). There was a shorter surgical waiting time in patients who achieved anatomical success (20.0 +/- 22.6 days (1-120)) vs (29.8 +/- 40.1 days (1-210)) (p=0.04) and in those who had functional success (13.3+/- 15.1 (1- 100)) vs (31.9 +/- 33.7 (1-210)) (p <0.001); and shorter sick time and shorter total time in those who had functional success (29.7 +/-56.5 days (1-365) vs (61.9 +/- 110.6 days (1-730)) (p=0.008) and (43.1 +/-68.1 (5-465)) vs 93.8 +/- 118.3 (3-766)) respectively (p<0.001). The shorter surgical waiting time was associated with RRD surgery's anatomical and functional success. The shortest time of illness and the shortest total time were associated with functional success. We recommend implementing measures to shorten waiting times and establish early and timely surgical therapy in these patients.

Efecto de una emulsión lubricante en la sintomatología, daño a la superficie ocular e inestabilidad de la película lagrimal de pacientes con ojo seco asociado al síndrome visual informático / Effects of a lubricating emulsion upon symptoms, eye surface damage, and tear film instability in patients with dry eye associated to the computer vision syndrome

Objetivo: Evaluar el efecto de una emulsión lubricante en la sintomatología, inestabilidad de la película lagrimal (PL) y daño a la superficie ocular de pacientes con ojo seco asociado al síndrome visual informático (SVI). Materiales y métodos: Estudio de serie de casos, que analizó el efecto de una emulsión lubricante en pacientes con ojo seco asociado al SVI. Los síntomas se evaluaron a través del cuestionario Ocular Surface Disease Index (OSDI), la inestabilidad de la PL a través del tiempo de ruptura de película lagrimal con fluoresceína (TRPL-F), y el daño a la superficie ocular a través del test de Oxford. Las mediciones fueron realizadas antes y después de 30 días de tratamiento. Resultados: Se evaluaron a 96 pacientes, edad de 25,9 ± 7,2 (18 - 44) años, 62,9% mujeres. El TRPL-F se incrementó en 4,3 + 2,6 s (p<0,001), post-tratamiento. Este incremento fue clínicamente importante en el 70,8% de los casos. El puntaje OSDI se redujo en promedio 15,8 + 7,4 puntos luego del tratamiento (p<0,001), siendo esta reducción clínicamente importante en el 95,8% de los casos. Antes del tratamiento, el 21,9% presentaron daño de la superficie ocular (Oxford 1/5), el cual se resolvió al finalizar el tratamiento (p<0,001). Conclusiones: En pacientes con ojo seco asociado a SVI, la emulsión en estudio produjo una mejoría clínicamente significativa en las tres variables evaluadas, predominando el alivio de los síntomas. El daño a la superficie ocular fue infrecuente y leve en estos pacientes resolviéndose al mes de tratamiento.

Objective: To assess the effect of a lubricant emulsion upon symptoms, tear film instability, and eye surface damage in patients with dry eye associated to the computer vision syndrome (CVS). Materials and Methods: This is a case series study, which analyzed the effect of a lubricant emulsion in patients with CVS-associated dry eye. Symptoms were assessed using the Ocular Surface Disease Index (OSDI) questionnaire, tear film instability was assessed measuring the tear film breakup time (TFBT) using fluorescein, and eye surface damage was assessed using the Oxford Schema. Measurements were performed before and after 30-day therapy. Results: Ninety-six patients were assessed, their age was 25.9 7.2 (18 -44) years, and 62.9% were female. TFBT had a 4.3 2.6 second increase (p<0.001) after therapy. This increase was clinically important in 70.8% of all cases. The OSDI score had an average 15.8 7.4 point reduction after therapy (p<0.001), and this reduction was clinically important in 95.8% of all cases. Before therapy, 21.9% subjects had damage on the eye surface (Oxford 1/5), which was solved at the end of therapy (p<0.001). Conclusions: In patients with CVS-associated dry eye, the studied emulsion led to clinically significant improvement in the three variables that were assessed, particularly in symptom alleviation. Eye surface damage was non-frequent and mild in these patients, and it got solved after one month with therapy.

Pemphigus: An Ophthalmological Review.

OBJECTIVE: To describe the epidemiology, etiology, pathogenesis, clinical characteristics, and management of pemphigus, with an emphasis on ocular involvement. METHODS: Literature review. RESULTS: Pemphigus is an autoimmune epithelial blistering disease of the skin and mucous membranes. The typical pathological finding is acantholysis of the epidermis that leads to blister formation. Immunofluorescence techniques show autoantibody deposition on the epidermal intercellular substance. Although a genetic background is necessary, environmental factors are crucial for the onset and perpetuation of the disease. Exposure to some drugs, toxic agents, and foods and associations with other autoimmune diseases and lymphoproliferative conditions should be assessed. Generally, the skin is the most commonly affected tissue. Ocular involvement might be present and exhibit a clinical course that is independent of skin compromise. Visual function may be affected depending on the severity of the presentation. In untreated cases, mortality is high because of bacterial sepsis and hydroelectrolyte imbalance. A multidisciplinary approach should be used involving a dermatologist, ophthalmologist, and immunologist. Immunosuppressive agents are the mainstay of treatment; corticosteroids typically with azathioprine or mycophenolate mofetil are the drugs of choice. Surgical treatment of trichiasis and malposition of the eyelids and tectonic procedures for corneal perforation are sometimes required in very severe and recalcitrant cases. CONCLUSIONS: Pemphigus is a potential life- and sight-threatening disease. Understanding the disease facilitates the adequate assessment of the modifiable factors and the prompt initiation of immunotherapy. Ocular involvement can develop in patients with pemphigus. Adequate ophthalmological care is needed, in particular, prevention of infections, scarring, and corneal perforation.

Repeatability, reproducibility, and agreement between three different Scheimpflug systems in measuring corneal and anterior segment biometry.

PURPOSE: To assess the reliability of three different Scheimpflug systems and their agreement. METHODS: Eighty-four eyes of 42 patients were examined with three Scheimpflug devices: the Galilei G2 Dual Scheimpflug Analyzer (Ziemer Ophthalmic Systems AG, Port, Switzerland), Pentacam HR system (Oculus Optikgerate GmbH, Wetzlar, Germany), and Sirius 3D imaging system (Costruzione Strumenti Oftalmici, Florence, Italy). The central corneal thickness, maximum anterior and posterior corneal elevation, anterior radius of curvature, total higher-order aberrations, and anterior chamber depth were evaluated. Repeatability and re-producibility were evaluated using coefficients of variation and intraclass correlation coefficients. Interdevice agreement was assessed by Bland-Altman comparison analysis. RESULTS: The three Scheimpflug systems had excellent repeatability for central corneal thickness, anterior radius of curvature, and anterior chamber depth (coefficients of variation being less than 1%). Repeatability for anterior and posterior corneal evaluation was good for the Pentacam HR and Galilei G2 (coefficients of variation < 10%) and excellent for the Sirius 3D (coefficients of variation = 0). Reproducibility was excellent in the three devices, (intraclass correlation coefficient of more than 0.9). Interdevice agreement was excellent (P > .05) for anterior radius of curvature, central corneal thickness, and anterior chamber depth, but was poor (P < .05) for corneal elevation and higher-order aberrations. CONCLUSIONS: Reliability was good to excellent in the three devices for all measured variables. Interdevice agreement analysis suggests that measurements for anterior radius of curvature, central corneal thickness, and anterior chamber depth, but not for maximum anterior and posterior corneal elevation and total higher-order aberrations, from the Sirius 3D and Galilei G2 can be interchangeable with the Pentacam HR.

Clinical and microbiological profile of infectious keratitis in children.

BACKGROUND: Infectious keratitis is a sight-threatening condition for children. The purpose of this study was to describe the clinical profile, risk factors and microbiological profile of infectious keratitis in children. METHODS: Retrospective review of clinical records of patients under 16 years of age with history of microbial keratitis seen at a tertiary referral center. Clinical characteristics, risk factors, visual and surgical outcomes as well as the microbiological profile are analyzed. RESULTS: Forty-one eyes of 41 patients. Mean age was 8.7 years. Time between the onset of symptoms and ophthalmological examination was 12.7 days. Predisposing factors were found in 78%; ocular trauma was the most common (25%). Visual acuity equal or worse than 20/200 at admission correlated positively with a poorer visual outcome, p=0.002. Positivity of cultures was 34%. Gram-positive bacteria were isolated in 78.5%; Staphylococcus epidermidis (28.6%) was the most common microorganism. CONCLUSIONS: Our study emphasizes the importance of a prompt diagnosis and treatment of infectious corneal ulcers in children. Trauma and contact lenses were the main predisposing factors. Gram-positive organisms were isolated in the vast majority of cases and visual outcomes are usually poor.

Tectonic DSAEK for the Management of Impending Corneal Perforation.

Purpose. To report a case of severe corneal thinning secondary to dry eye treated with a tectonic Descemet stripping automated lamellar keratoplasty (DSAEK) and amniotic membrane graft. Methods. A 72-year-old man with a history of long standing diabetes mellitus type 2 and dry eye presented with 80% corneal thinning and edema on the right eye and no signs of infectious disease, initially managed with topical unpreserved lubrication and 20% autologous serum drops. Eight weeks after, the defect advanced in size and depth until Descemetocele was formed. Thereafter, he underwent DSAEK for tectonic purposes. One month after the procedure, the posterior lamellar graft was well adhered but a 4 mm epithelial defect was still present. A multilayered amniotic membrane graft was then performed. Results. Ocular surface healed quickly and reepithelization occurred over a 2-week period. Eight months after, the ocular surface remained stable and structurally adequate. Conclusion. Tectonic DSAEK in conjunction with multilayered amniotic graft may not only provide structural support and avoid corneal perforation, but may also promote reepithelization and ocular surface healing and decrease concomitant inflammation.