[Fuchs' heterochromic cyclitis without heterochromia: a diagnostic approach]. / Aproximación diagnóstica a la ciclitis heterocrómica de Fuchs en ausencia de heterocromía.

OBJECTIVE: To obtain diagnostic guidelines of Fuchs' heterochromic cyclitis (FHC) in the absence of heterochromia using Bayesian methods. METHODS: The pre-test and post-test likelihood that a certain patient without heterochromia (but with other characteristic symptoms of the disease such as iris nodules, cataracts, glaucoma or vitritis) has FCH, was assessed by the Bayes' theorem for conditioned likelihood. The prevalence values of FCH and the presentation rate of symptoms in FCH and in other forms of anterior uveitis were obtained from published literature data. RESULTS: In the absence of heterochromia, the combination of iris nodules together with cataracts, vitritis or glaucoma, and the association of the last three symptoms in the absence of nodules, resulted in an accumulated likelihood of more than 50% of subjects having the disease. CONCLUSIONS: The coincidence in one patient of several indicative symptoms, even in the absence of heterochromia, may make FCH a likely diagnostic option.

[Measurement of lens density with a Scheimpflug camera in diabetic patients]. / Medida de la densidad del cristalino con cámara de Scheimpflug en pacientes diabéticos tipo II.

OBJECTIVE: To assess if diabetes, in patients without cataracts or diabetic retinopathy, alters the densitometric values of the lens and to what degree this occurs. METHODS: A total of 93 patients, divided into two groups, were studied: the diabetic patients had a visual acuity equal to or greater than 0.8 and normal eye funduscopy, and the control group consisted of healthy patients of a similar age. Measurements in all patients were made with the Scheimpflug camera and the lens density of the anterior capsule, anterior cortex and nucleus was defined. The values obtained in the two groups were compared by analysis of variance (ANOVA). RESULTS: All densitometric values were greater in the diabetic patients than in the normal controls. The greatest difference was seen in the values of the anterior capsule, followed by the nucleus and cortex. The differences approached statistical significance (P=0.07) only in the case of the anterior capsule. CONCLUSIONS: Diabetes increases densitometric values of the anterior capsule and to a lesser degree of the anterior cortex. However, further studies are necessary to verify if this alteration is of significance.

[Have patients who go to the emergency department changed? Evolutive study for the years 1997 and 2005]. / ¿Han cambiado los pacientes oftalmológicos que acuden a urgencias? Estudio evolutivo entre los años 1997 y 2005.

OBJECTIVE: To study the change in number and profile of patients who came to the Emergency Department of a level 2 hospital with ophthalmic emergencies in the years 1997 and 2005. METHOD: Two groups of randomly selected patients who came to the Emergency Service on the same day in the years 1997 and 2005 were studied. The study focused on the following variables: number of visits per day, gender, age, time period, number of examinations done, diagnoses and type of treatment prescribed. Comparison of proportions was carried out with a confidence interval study and Chi Square Test. RESULTS: The statistically significant changes (p<0.05) were as follows: increase in number of patients seen; increase in the diagnosis of corneal foreign body (25%); decrease in the diagnosis of conjunctivitis (12%); increase in cases in which only one examination was done (19%); increase in frequency of visits between 6 p.m. and 9 p.m. and decrease between 9 a.m. and 12 p.m; reduced attendance of those of female gender (13%) and increase in the male gender (13%); increase in patients between the age of 31 and 40 years (9%); decrease in the use of treatments such as occlusion and epithelializing ointment (7% and 6% respectively); increase in use of analgesics (5%), artificial tears (5%) and NSAIDs (8%); increase in referral of patients to their primary care physician (17%) and decrease in ophthalmology check ups (34%). CONCLUSIONS: The number of ophthalmological emergencies has increased in the last eight years, especially in young male patients, with work-related disease, who came in the evening. Treatments such as the use of artificial tears have increased, and patients are sent to the primary care physician more often.

Development and validation of a Bayesian network for the differential diagnosis of anterior uveitis.

PurposeTo develop and validate a Bayesian belief network algorithm for the differential diagnosis of anterior uveitis.Patients and methodsThe 11 most common etiologies were included (idiopathic, ankylosing spondylitis, psoriasic arthritis, reactive arthritis, inflammatory bowel diseases, sarcoidosis, tuberculosis, Behçet, Posner-Schlossman syndrome, juvenile idiopathic arthritis (JIA), and Fuchs' heterochromic cyclitis). Frequencies of association between factors and etiologies were retrieved from a systematic review of the literature. Prevalences were calculated using a random sample of 200 patients receiving a diagnosis of anterior uveitis in Moorfields Eye Hospital in 2012. The network was validated in a random sample of 200 patients receiving a diagnosis of anterior uveitis in the same hospital in 2013 plus 10 extra cases of the most rare etiologies (JIA, Behçet, and psoriasic arthritis).ResultsIn 63.8% of patients the most probable etiology by the algorithm matched the senior clinician diagnosis. In 80.5% of patients the clinician diagnosis matched the first or second most probable results by the algorithm. Taking into account only the most probable diagnosis by the algorithm, sensitivities for each etiology ranged from 100% (7 of 7 patients with reactive arthritis and 5 of 5 with Behçet correctly classified) to 46.7% (7 of 15 patients with tuberculosis-related uveitis). Specificities ranged from 88.8% for sarcoidosis to 99.5% in Posner.ConclusionsThis algorithm could help clinicians with the differential diagnosis of anterior uveitis. In addition, it could help with the selection of the diagnostic tests performed.

Effect of continued treatment with timolol maleate on corneal endothelium: a fluorophotometric study.

PURPOSE: To verify whether the long-term use of timolol maleate is toxic for the corneal endothelium and whether the treatment time is a predisposing factor. METHODS: We used fluorophotometry to study 40 eyes that had been treated with timolol maleate uninterruptedly during a prolonged time (from 6 months to 14 years). The results obtained were compared with a sample of 40 hypertensive eyes that had not received any treatment. RESULTS: No statistically significant differences were found between the coefficient values of endothelial permeability between the treated and nontreated subjects. In addition, no differences were found in the coefficient of endothelial permeability between subjects treated with timolol in different treatment periods (between 6 and 12 months, between 1 and 5 years, and for > 5 years). CONCLUSION: These results suggest that long-term treatment with timolol has little effect on the integrity of the corneal endothelium.

Comparative study of three methods of evaluation of the corneal endothelium in pseudophakic patients: fluorophotometry, specular microscopy and pachymetry.

BACKGROUND: At present, three techniques, based on different methodological suppositions, are used indiscriminately for the study of the corneal endothelium. These are pachymetry, specular microscopy and fluorophotometry. The purpose of this work was to study the corneal endothelium of pseudophakic patients with the three techniques mentioned. On the basis of the results obtained, we discuss the relations between them and their practical clinical utility. METHODS: One hundred and fourteen eyes of pseudophakic patients were studied using the three corneal endothelial evaluation techniques, both in the immediate pre-operative period and 1 year after surgery. RESULTS: Statistically significant relations exist between the number of endothelial cells and the fluorophotometric endothelial permeability coefficient (Kc.ca) 12 months after surgery, between the increase in corneal thickness in the first week after the operation and the Kc.ca 12 months after surgery, and between fluctuations of the corneal thickness greater than 30 microns and both the endothelial cell count and the Kc.ca 12 months after surgery. There are no significant relationships among the pre-operative values obtained with the three methods. CONCLUSION: The results show how the parameters measured with the functional techniques (fluorophotometry, pachymetry) generally become normal after the surgical trauma, while the endothelial cell count remains irreversibly altered. The results obtained with different techniques are more closely related in more pathological endothelia, while no relation among them are shown in the study of normal endothelia. It is also shown how pachymetry is a good clinical predictor, in the immediate post-operative period, of the long-term status of the corneal endothelium.

Study of lens autofluorescence by fluorophotometry in pregnant patients with diabetes.

PURPOSE: Lens autofluorescence originates from an accumulation of fluorescent substances such as the tryptophan-derived residues and glycosylated protein aggregations, which are associated with the process of cataractogenesis and lens aging. The purpose of this investigation is to determine whether pregnancy alters the typical constituents of the lens autofluorescence in patients with diabetes and, if so, to what degree this may occur. METHODS: Lens autofluorescence was studied with fluorophotometry in 127 eyes of 72 individuals: 23 control subjects, 6 healthy pregnant women, 21 patients with diabetes, and 44 pregnant patients with diabetes. RESULTS: The autofluorescence values were 311 +/- 130 ng/ml, 253 +/- 40 ng/ml, 378 +/- 110 ng/ml, and 562 +/- 164 Eq ng/ml (Eq ng/ml = Ng/ml equivalent fluorescein) in the four groups, respectively. The difference between the nonpregnant and pregnant patients with diabetes was significant (P < 0.001). CONCLUSION: These results suggest that there is an important deterioration in the metabolic state of the lens during gestation in patients with diabetes, as is the case for diabetic retinopathy.

¿Han cambiado los pacientes oftalmológicos que acuden a Urgencias?: Estudio evolutivo entre los años 1997 y 2005 / Have patients who go to the emergency departament changed? Evolutive study for the years1997 and 2005

Objetivo: Estudiar el cambio en el número y perfil de los pacientes que acuden a las urgencias oftalmológicas de un hospital de segundo nivel durante los ocho últimos años. Método: Se estudian dos grupos de pacientes que acudieron a urgencias en los mismos días, escogidos al azar, en los años 1997 y 2005. Se utilizan distintas variables: número de visitas por día, sexo, edad, franja horaria, número de exploraciones realizadas, diagnósticos y tipo de tratamiento prescrito.La comparación de proporciones se realiza mediante el estudio del intervalo de confianza y el test Chi Cuadrado. Resultados: Son resultados estadísticamente significativos los siguientes: Aumento del número de pacientes vistos en urgencias (p< 0,05). Aumento del diagnóstico de cuerpo extraño corneal (25%); disminución del diagnóstico de conjuntivitis (12%). Aumento de los casos en los que se realizan una sola exploración (19%);aumento de la frecuencia de visitas en la franja horaria entre 18:00-21:00; disminución entre 9:00-12:00; menor frecuencia del sexo femenino (13%) y aumento del masculino (13%); aumento de los pacientes entre 31 y 40 años (9%); disminución del uso de tratamientos como la oclusión y la pomada epitelizante (7% y 6% respectivamente); aumento del uso de analgésicos (5%), lágrimas artificiales (5%) y AINES (8%); aumento de las remisiones de pacientes a su médico de atención primaria (17%) y disminución de las revisiones oftalmológicas (34%). Conclusiones: El número de urgencias oftalmológicas ha aumentado en nuestra muestra en los últimos ocho años, sobre todo a expensas de pacientes varones jóvenes, con patología de origen laboral, que acuden por la tarde. Han aumentado tratamientos como las lágrimas artificiales y son remitidos a su médico de atención primaria con más frecuencia (AU)

Objective: To study the change in number and profile of patients who came to the Emergency Department of a level 2 hospital with ophthalmic emergencies in the years 1997 and 2005. Method: Two groups of randomly selected patients who came to the Emergency Service on the same day in the years 1997 and 2005 were studied. The study focused on the following variables: number of visits per day, gender, age, time period, number of examinations done, diagnoses and type of treatment prescribed. Comparison of proportions was carried out with a confidence interval study and Chi Square Test. Results: The statistically significant changes (p<0.05) were as follows: increase in number of patients seen; increase in the diagnosis of corneal foreign body (25%); decrease in the diagnosis of conjunctivitis (12%); increase in cases in which only one examination was done (19%); increase in frequency of visits between 6 p.m. and 9 p.m. and decrease between 9 a.m. and 12 p.m; reduced attendance of those of female gender (13%) and increase in the male gender (13%); increase in patients between the age of 31 and 40 years (9%); decrease in the use of treatments such as occlusion and epithelializing ointment (7% and 6% respectively); increase in use of analgesics (5%), artificial tears (5%) and NSAIDs (8%); increase in referral of patients to their primary care physician (17%) and decrease in ophthalmology check ups (34%). Conclusions: The number of ophthalmological emergencies has increased in the last eight years, especially in young male patients, with work-related disease, who came in the evening. Treatments such as the use of artificial tears have increased, and patients are sent to the primary care physician more often (AU)

Medida de la densidad del cristalino con cámara de Scheimpflug en pacientes diabéticos tipo II / Measurement of lents density with a scheimpflug camera in diabetic patients

Objetivo: Averiguar si la diabetes en pacientes sin catarata ni retinopatía diabética altera los valores densitométricos del cristalino y en qué medida esto se produce. Métodos: Se estudian 93 ojos pertenecientes a 47 pacientes, divididos en dos grupos: 53 ojos de 27 pacientes diabéticos tipo II con agudeza visual igual o superior a 0,8 y fondo de ojo normal y un grupo control de 40 ojos de 20 pacientes sanos con una media de edad semejante. A todos se les realiza una medida con cámara de Scheimpflug y se consignan la densidad cristaliniana de la cápsula anterior, el cortex anterior y el núcleo. Los valores obtenidos en los dos grupos se comparan mediante análisis de la varianza (ANOVA). Resultados: Todos los valores densitométricos fueron mayores en los pacientes diabéticos con respecto a los normales. La mayor diferencia se produce en los valores de la cápsula anterior, seguidos del núcleo y el cortex. Solo en el caso de la cápsula anterior los valores se acercan a la significación estadística (P=0,07). Conclusiones: La diabetes incrementa los valores densitométricos de la cápsula anterior y en menor medida del cortex anterior. No obstante son necesarios nuevos estudios para verificar si esta alteración se produce de forma significativa (AU)

Objective: To assess if diabetes, in patients without cataracts or diabetic retinopathy, alters the densitometric values of the lens and to what degree this occurs. Methods: A total of 93 patients, divided into two groups, were studied: the diabetic patients had a visual acuity equal to or greater than 0.8 and normal eye funduscopy, and the control group consisted of healthy patients of a similar age. Measurements in all patients were made with the Scheimpflug camera and the lens density of the anterior capsule, anterior cortex and nucleus was defined. The values obtained in the two groups were compared by analysis of variance (ANOVA). Results: All densitometric values were greater in the diabetic patients than in the normal controls. The greatest difference was seen in the values of the anterior capsule, followed by the nucleus and cortex. The differences approached statistical significance (P=0.07) only in the case of the anterior capsule. Conclusions: Diabetes increases densitometric values of the anterior capsule and to a lesser degree of the anterior cortex. However, further studies are necessary to verify if this alteration is of significance (AU)

Aproximación diagnóstica a la ciclitis heterocrómica de Fuchs en ausencia de heterocromía / Fuchs´heterochronic cyclits without heterochromia: a diagnostic approach

Objetivo: Obtener pautas de diagnóstico de la ciclitis heterocrómica de Fuchs (CHF) en ausencia de heterocromía utilizando metodología bayesiana. Métodos: Se obtienen las probabilidades pre-test y post-test de que un determinado paciente sin heterocromía pero con otros síntomas característicos de la enfermedad, tales como nódulos iridianos, cataratas, glaucoma o vitritis anterior, tenga CHF. Para ello se utiliza el teorema de Bayes para la probabilidad condicionada. Los valores de la prevalencia de la CHF y de la frecuencia de presentación de los síntomas en la CHF y en el total de las uveitis anteriores se obtienen de los datos de la literatura publicada. Resultados: En ausencia de heterocromía, la combinación de nódulos iridianos junto con cataratas, vitritis o glaucoma, así como la asociación de estos tres últimos síntomas aún sin nódulos supone una probabilidad acumulada de más del 50% de tener la enfermedad. Conclusiones: La coincidencia en un paciente de varios síntomas indicativos aún en ausencia de heterocromía puede hacer que la CHF sea una opción diagnóstica probable

Objective: To obtain diagnostic guidelines of Fuchs’ heterochromic cyclitis (FHC) in the absence of heterochromia using Bayesian methods. Methods: The pre-test and post-test likelihood that a certain patient without heterochromia (but with other characteristic symptoms of the disease such as iris nodules, cataracts, glaucoma or vitritis) has FCH, was assessed by the Bayes’ theorem for conditioned likelihood. The prevalence values of FCH and the presentation rate of symptoms in FCH and in other forms of anterior uveitis were obtained from published literature data. Results: In the absence of heterochromia, the combination of iris nodules together with cataracts, vitritis or glaucoma, and the association of the last three symptoms in the absence of nodules, resulted in an accumulated likelihood of more than 50% of subjects having the disease. Conclusions: The coincidence in one patient of several indicative symptoms, even in the absence of heterochromia, may make FCH a likely diagnostic option

Réplica: «Neuro-Behçet y neurotoxicidad por ciclosporina» / Reply to: «Neuro-Behçet and neurotoxicity due to cyclosporine»

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Enfermedad de Behçet en tratamiento con ciclosporina y crisis comiciales: el dilema diagnóstico / Behçet’s disease in treatment with cyclosporine and seizures: diagnostic dilemma

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