Survey of glaucoma surgical preferences among glaucoma specialists in Spain.

PURPOSE: To evaluate the spectrum of glaucoma surgery undertaken among members of the Spanish Glaucoma Society (SEG). METHODS: A 10 question web-based anonimous survey was mailed through the Annals of the Spanish Glaucoma Society to all its members on January, February and July 2019 to determine their preferred surgical approach. MAIN OUTCOME MEASURES: Age, type of Glaucoma, surgery undertaken, type of anti-scarring strategy and prothesis introduced for the last 10 surgeries since the survey was received. The surgeon experience was registered in years of practice. RESULTS: A total of 97 SEG members across the country answered the survey. Sixty-two (63.4%) responders had more than 10 years of experience. Primary open angle glaucoma was the most frequent type of glaucoma (60.6%). The most popular surgery was deep-sclerectomy (37.3%) followed by trabeculectomy (17,6%) and the collagen microshunt (XEN® Allergan Inc., Irvine, CA) (14.1%). Glaucoma drainage device (GDD) was used in 10.5% of the cases. Up to 21.7% of surgeries were reinterventions, where GDD was used in 27.3% and trabeculectomy in 20.3% of the cases. Glaucoma surgery was combined with phacoemulsification in 47.3% of the eyes. Mitomycin C (MMC) was used in 54,8% of the cases, collagen matrix (Ologen®, Aeon Astron Corporation, Taipei, Taiwan) was used alone in 8.2% of the cases and in 13,7% combined with MMC. MMC was used in a soaked sponge in 79% of cases (concentrations of 0.02% in 99% and 0.04% in 1%) and in 21% of cases MMC was injected subconjunctivally (concentrations of 0,01% in 81% and 0.02% in 19%). CONCLUSIONS: Although the glaucoma surgeon performs a wide range of surgical techniques, deep sclerectomy remains the most widely used surgical technique in Spain. Combined cataract and glaucoma surgery is performed almost in half of the patients and MMC is the most frequently selected antifibrotic agent, alone or combined with collagen matrix. The new minimal invasive surgical techniques represent the 20% of the total.

Management of cyclodialysis cleft with transscleral cryotherapy.

A cyclodialysis cleft is a rare disease that is produced as a result of a separation of the longitudinal fibers of the ciliary body muscle from the scleral spur. A stepwise approach is the best course of action to treat cyclodialysis, starting with medical therapy and continuing with more invasive surgical options. We report a case of ocular hypotony due a traumatic cyclodialysis successfully resolved with transscleral cryotherapy.

Management of cyclodialysis cleft with transscleral cryotherapy. / Manejo de la hendidura de ciclodiálisis con crioterapia transescleral.

A cyclodialysis cleft is a rare disease that is produced as a result of a separation of the longitudinal fibers of the ciliary body muscle from the scleral spur. A stepwise approach is the best course of action to treat cyclodialysis, starting with medical therapy and continuing with more invasive surgical options. We report a case of ocular hypotony due a traumatic cyclodialysis successfully resolved with transscleral cryotherapy.

Management of the hyper-filtrating ischaemic bleb: crosslinking with riboflavin and UV radiation versus a conjunctival sliding flap and conjunctival autologous graft. / Manejo de la ampolla isquémica hiperfiltrante: crosslinking mediante el uso de riboflavina y radiación ultravioleta versus deslizamiento conjuntival y autotrasplante de conjuntiva.

INTRODUCTION: This article compares and evaluates the safety and clinical results of 3techniques for the management of hyper-filtrating ischaemic bleb in glaucoma, such as collagen crosslinking (CXL) with riboflavin versus conjunctival sliding and conjunctival autologous graft. METHODS: A total of 24 eyes were selected from 18 patients with ischemic blebs that underwent filtering glaucoma surgery between 2012 and 2017 and subjected them to crosslinking using riboflavin (n=4), conjunctival autologous graft (n=5), and conjunctival sliding (n=15). The results of the intraocular pressure (IOP) prior to the procedure and at 12 months were compared, as well as visual acuity and previous anti-glaucoma medication at 12 months. RESULTS: The 4eyes that underwent CXL, went from a previous mean IOP of 12.11 ± 3.14 to an IOP of 12.32 ±5.29 at one year (P=.655). Five eyes were treated by conjunctival autologous graft, had a previous mean IOP of 11.65 ± 5.76 and an IOP at one year of 14.68 ± 7.21 (P=.273). Fifteen eyes subjected to conjunctival sliding had a previous IOP of 9.32 ±5.34 and at one year it was 15.16 ± 9.24 (P=.021). There were no adverse effects or complications associated with any of the 3techniques. CONCLUSIONS: The management of the hyper-filtrating ischaemic bleb is difficult. Surgical procedures are associated with increased IOP and need for medication, while CXL using riboflavin and UV radiation does not seem to have an effect on the revitalisation of the bleb.

[Optic nerve infarction in Sneddon's syndrome]. / Infarto de nervio óptico asociado a síndrome de Sneddon.

CLINICAL CASE: We report a case of a 26 year old woman with Raynaud's phenomenon and livedo reticularis 2 years onset, who presented with visual field defects accompanied by hypertension, hematuria, and headache. The examination revealed multiple retinal and optic nerve head infarcts in both eyes. DISCUSSION: Sneddon's syndrome is a vasculitis that produces livedo reticularis, neurological symptoms, and less frequently myocardial, renal and retinal infarction. After reviewing the literature, this is the first case described of Sneddon's syndrome presenting with optic nerve infarction.