[Spontaneous closure of full thickness traumatic macular holes]. / Cierre espontáneo de agujeros maculares traumáticos de espesor completo.

CASE REPORT: We present case reports of two young patients suffering from full thickness traumatic macular holes resulting in visual impairment of more than 60%. Both showed anatomical and visual improvement whilst waiting for surgical treatment. DISCUSSION: Spontaneous closure of a traumatic macular hole is an unusual outcome. OCT and clinical follow up enabled monitoring of this resolution during a period of a few weeks. Complex surgery was thus avoided by a short observational period.

[Bilateral optic nerve infiltration in acute lymphoblastic leukemia in remission]. / Infiltración bilateral del nervio óptico en un caso de leucemia aguda linfoblástica de células T en remisión.

CASE REPORT: An 18-year-old male affected by acute lymphoblastic leukemia (ALL) after having reached complete remission after chemotherapy developed bilateral optic nerve infiltration. DISCUSSION: Infiltration of the optic nerve may appear as an isolated sign of extramedullary relapse of ALL months in advance of the hematologic relapse.

In-vitro development of an effective treatment for Acanthamoeba keratitis.

The aim of this study was to develop an in-vitro topical treatment for Acanthamoeba keratitis (AK) effective against cysts and trophozoites. Qualitative assays were performed with voriconazole, chlorhexidine, propamidine, cellulase, tobramycin, ciprofloxacin and paromomycin as monotherapy and various combinations. Riboflavin with ultraviolet-A (R + UV-A) as monotherapy or combined with voriconazole and moxifloxacin was also tested. Quantitative assays to assess cyst viability after treatment were performed for the chemicals that showed the highest activity in the qualitative assays. Paromomycin and propamidine did not show antiamoebic activity. Regardless of the total dose, no amoebicidal effect was observed for R + UV-A. Tobramycin, ciprofloxacin, voriconazole, chlorhexidine and cellulase were selected for quantitative assays because they appeared to cause greater damage to the structure of amoebae. Chlorhexidine and ciprofloxacin were the most active against Acanthamoeba spp. as monotherapy. Among the combinations evaluated, ciprofloxacin-voriconazole-chlorhexidine showed the greatest amoebicidal activity, with severe damage of the cellular membrane and an important decrease in cell concentration. In summary, ciprofloxacin as monotherapy and in combination with voriconazole and chlorhexidine has been classified as promising treatment. Additional in-vivo studies in animal models and clinical trials in patients with AK should be considered to confirm the efficacy of ciprofloxacin.

A numerical-experimental protocol to characterize corneal tissue with an application to predict astigmatic keratotomy surgery.

Tonometers are intended to determine the intraocular pressure (IOP) and the quality of corneal tissue. In contrast to the physiological state of stress of the cornea, tonometers induce non-physiological bending stress. Recently, the use of a single experiment to calibrate a set of corneal mechanical properties was suggested to be an ill-posed problem. Thus, we propose a numerical-experimental protocol that uses inflation and indentation experiments simultaneously, restricting the optimization space to circumvent the ambiguity of the fitting. For the first time, both corneal behaviors, i.e., biaxial tension (physiological) and bending (non-physiological), are taken into account. The experimental protocol was performed using an animal model (New Zealand rabbit's cornea). The patient-specific geometry and IOP were registered using a MODI topographer (CSO, Italy) and an applanation tonometer, respectively. The mechanical response was evaluated using inflation and indentation experiments. Subsequently, the optimal set of material properties is identified via an inverse finite element method. To validate the methodology, an in vivo incisional refractive surgery (astigmatic keratotomy, AK) is performed on four animals. The optical outcomes showed a good agreement between the real and simulated surgeries, indicating that the protocol can provide a reliable set of mechanical properties that enables further applications and simulations. After a reliable ex vivo database of inflation experiments is built, our protocol could be extended to humans.

[Eyelid contact allergic eczema caused by topical ketorolac tromethamine 0.5%]. / Eccema alérgico de contacto palpebral por ketorolaco trometamol 0,5% tópico.

CLINICAL CASE: A 65-year-old man had been treated with eye-drops containing NSAIDs (Ketorolac). He developed conjunctival injection, edematous swelling of the eyelids and periorbital dermatitis due to a contact allergy. Allergy to NSAIDs is uncommon. DISCUSSION: This is an unusual case because topical application of ketorolac is safe in the vast majority of ophthalmologic patients. However adverse events associated with Ketorolac are similar to that of other NSAIDs.

[Intraocular lenses with blue light filter]. / Lentes intraoculares con filtros para luz azul.

PURPOSE: To evaluate if a SN60AT <> IOL (Alcon) with IMPRUV filter (Alcon) offers any advantage in patients having cataract surgery, as compared with Acrysof SA60 IOL (Alcon). METHODS: This was a prospective analytical study. We studied sixty-four eyes from 32 patients with cataracts. After a random assignment, phacoemulsification with the implant was performed using the Acrysof SN60AT tinted lens in one eye and Acrysof SA60 in the other. A variety of variables was subsequently assessed: contrast sensitivity with a CSV 1000E test, colour perception through a Farnsworth 25 test and subjective measures by a patient survey. Differences between the groups were assessed statistically. RESULTS: The contrast sensitivity results were obtained for 3, 6, 12 and 18 cycles per degree (cpd) frequencies under scotopic conditions, with better results obtained following the use of SN60AT: 0.75 (CSV 1000E test units) for 3 cpd, 0.86 for 6 cpd, 0.54 for 12 cpd and 0.35 for 18 cpd. The differences were statistically significant between the two groups for 3 cpd and 6 cpd. A total of 62.5% of patients using a tinted lens and 50% with SA60 achieved good results in the Farnsworth test; 12.5% and 21% had fair results and 25% and 28.1% respectively had poor results. CONCLUSIONS: We obtained an improvement in favour of the tinted lens for all frequencies, with this being statistically significant at lower frequencies (3 and 6 cpd). No significant differences in the Farnsworth test performance or in the patient survey were found. The tinting provided by the IMPRUV filter brings an increase in contrast sensitivity without affecting colour perception.

Central and peripheral corneal thickness in full-term newborns by ultrasonic pachymetry.

To establish a standard of normality, the authors studied the central and peripheral (superior, inferior, nasal, and temporal) corneal thickness of 152 healthy, white race, full-term newborns (304 eyes) between 1 and 6 days old, using ultrasonic pachymetry. The mean central corneal thickness (CCT) was 585 +/- 52 microns (ranging from 446-706 microns). The mean peripheral corneal thickness (PCT), significantly thicker than CCT (P = 0.0001), was: superior (SCT) 696 +/- 55 microns, inferior (ICT) 744 +/- 62 microns, nasal (NCT) 742 +/- 58 microns, and temporal (TCT) 748 +/- 55 microns. The SCT was significantly thinner than the ICT, NCT, and TCT (P = 0.0001). Differences among ICT, NCT, and TCT were not statistically significant. The mean CCT of the 1-day-old group was 611 +/- 58 microns, this being thicker than those of the other age groups (P = 0.0001). The differences between male and female babies and between right and left eyes were not statistically significant. This is the first study on peripheral corneal thickness at the limbus in the four meridians in live newborns.

Partial retinal artery occlusion after coil embolization of an intracerebral aneurysm.

Occlusion of the retinal artery is a rare complication after therapeutic embolization. We present a case of a partial retinal artery obstruction following coil embolization of an intracerebral aneurysm. To our knowledge, only six cases of acute occlusion of the choroidal and/or retinal arteries after therapeutic embolization have been reported so far. The case presented here, however, is the first in which platinum microcoils were the material used. In addition the retinal ischemia was reversible, visual acuity returning to normal and cutten-wool spot and retinal hemorrhages resolving spontaneously.

Progressive external ophthalmoplegia: a paraneoplastic manifestation of lymphoma.

PURPOSE: Paraneoplastic neurological syndromes are well-known sequelae of some malignancies. To our knowledge, a syndrome mimicking progressive external ophthalmoplegia had never been reported preceding the diagnosis of a lymphoma. CASE REPORT: A 63-year-old man developed progressive external ophthalmoplegia, without any other neurological symptoms, as the initial manifestation of a follicular lymphoma grade III. The ophthalmoplegia resolved after two cycles of combination chemotherapy. CONCLUSIONS: The ophthalmologist, when confronted with a progressive external ophthalmoplegia, should consider a neurological paraneoplastic syndrome associated with a tumor as a possible diagnosis.

Nasolacrimal polyurethane stent placement: preliminary results.

PURPOSE: To present our initial results in the treatment of nasolacrimal obstruction by placing a polyurethane stent. METHODS: 74 nasolacrimal stents were implanted under fluoroscopic guidance in obstructed nasolacrimal systems of 64 patients. Dacryocystography and CT were used to verify the position and patency of the stents. Mean follow-up was 15 months. Clinical examinations were done at the first week, first month, third month and sixth month after stent placement. RESULTS: Polyurethane stents were successfully inserted and permeable in 59 patients (92.1%), but could not be inserted in 5 patients (7.8%). Epiphora was solved and permeable in 53 cases (82.8%), it was not permeable but asymptomatic in 2 cases (3.1%), and was not permeable but symptomatic in 4 (6.2%). In 5 cases (7.8%) stents remained permeable although patients complained of epiphora. CONCLUSIONS: Polyurethane stent placement is a non-invasive technique that can replace dacryocystorhinostomy, giving better results and tolerance.

Combination of Nd:Yag laser-induced subconjunctival bleeding and intracameral viscoelastic injection to treat hypotony maculopathy.

A 38-year-old man with primary open-angle glaucoma who had undergone trabeculectomy with mitomycin-C developed macular folds consistent with hypotony maculopathy. The patient was successfully treated with a combination of Neodymium:yttrium-aluminum-garnet (Nd:YAG) laser-induced subconjunctival bleeding and injection of a viscoelastic substance into the anterior chamber. The combination of Nd:YAG laser-induced subconjunctival bleeding with intracameral viscoelastic injection appears to be a reasonable alternative to autologous blood injection and may be tried as first-line treatment for hypotony maculopathy caused by overfiltration.

[Intraocular absorption of cyclosporin A eyedrops]. / Absorption intra-oculaire du collyre cyclosporine A.

A study was carried out on ocular and systemic absorption after topical application of 2% cyclosporin A in patients requiring corneal transplants, determining by polarized light immunofluorescence the levels of this drug in the cornea, aqueous humor and blood. Between 30 and 85 minutes after the last application, considerable levels of cyclosporin A were found in the explanted cornea (236 +/- 42 ng/mL). Relatively lower levels were found in the aqueous humor although there were significant differences between the patients who received a total topical dosage of 5 mg (16.92 +/- 6.86 ng/mL) and those who received 10 mg (25.06 +/- 9.13 ng/mL) over the same period of time. No analytically detectable levels were found in the plasma. We consider that topically administered cyclosporin A can reach immunosuppressive levels of activity in some ocular compartments thus eliminating the potential systemic effects resulting from its utilization by general administration.

[Size of incision and induced astigmatism in cataract surgery]. / Taille de l'incision et astigmatisme induit dans la chirurgie de la cataracte.

A study was carried out of postoperative astigmatism in three groups of 50 eyes which had had cataracts removed by phacoemulsification or by planned extracapsular removal through incisions of 3.5-4 mm, 7-7.5 mm, and 10-11 mm respectively. No statistically significant differences were observed in the average number of cases of astigmatism found 100 days after the operation in the patients in whom incisions of 10-11 mm (1.82 +/- 0.95 Dp) and 7-7.5 mm (1.78 +/- 0.90 Dp) were made. Appreciable differences were discovered when these two groups were compared with cases in which small incisions had been used and who presented a lower degree of astigmatism (1.02 +/- 0.59 Dp). To ensure less postoperative astigmatism after phacoemulsification, the size of the incision should be modified as little as possible during the insertion of the intraocular lens.

[Bilateral choroidal metastases of pancreatic carcinoma]. / Métastases choroïdiennes bilatérales d'un carcinome du pancréas.

Pancreatic adenocarcinoma represents 2 to 5% of all the carcinomas. It is the fourth largest cause of death from cancer. It gives rise to metastasis of the liver, kidney, brain, etc. But choroidal metastasis are infrequent. We present the case of a male aged 45 years, who presented bilateral choroidal metastasis of pancreatic carcinoma.

[Cognitive evoked potential in primary wide angle glaucoma]. / Potencial evocado cognitivo en el glaucoma primario de ngulo abierto.

INTRODUCTION: Primary wide angle glaucoma (PWAG) is the commonest form of this disorder. It is initially asymptomatic, until there has been considerable visual field loss. Personality changes have been described in patients with wide angle glaucoma, with a significant percentage of developing dementia or a tendency to react defensively. The P300 endogenous evoked potential is related to memory/attention to work. INTRODUCTION: To evaluate, in PWAG, the probable occurrence of a disorder of visual processing due to alteration in the attention/working memory and its neuronal network, using the P300 visual cognitive evoked potential in correlation with Lobo s cognitive mini exam (CME). PATIENTS AND METHODS: We selected 68 patients with PWAG and 68 controls, of both sexes, aged between 50 and 65 years. The CME was done after taking the clinical history, and then an electroretinogram, visual evoked potential using the alternating dameres (ERGd and VEPd) and P300 potential (passive odd ball). Statistical analysis was done using the t test, one way ANOVA and discriminating analysis. RESULTS: The amplitude on ERGd and latency on VEPd were significantly altered. Patients with glaucoma had lower scores on CME. Regarding the P300 wave, latency was the most significant parameter, whilst the amplitude and site were less well defined. PATIENTS AND METHODS: In PWAG a process of visual cognitive dysfunction occurs and affects memory/attention to work in a way which is not only due to the peripheral visual effect.

[Intravitreal ranibizumab in the treatment of subretinal neovascularization in a case of punctate inner choroidopathy]. / Ranibizumab intravítreo en el tratamiento de membrana neovascular subretiniana en un caso de coroidopatía puntata interna.

CASE REPORT: We report the case of a 28-year old woman suffering loss of visual acuity in her left eye, who presented an image suggestive of a subretinal neovascular membrane in her left eye, and bilateral retinal lesions compatible with punctate inner choroidopathy (PIC). She was treated with intravitreal ranibizumab obtaining excellent results. DISCUSSION: The differential diagnosis must be made between PIC and the rest of "white dot syndromes" and the presumed ocular histoplasmosis syndrome (POHS). Antiangiogenic drugs may be a good alternative for the treatment of such diseases when they develop a subretinal neovascular membrane.

[Use of retinal photography in the diagnosis of diabetic macular edema]. / Utilidad de las retinografías en el diagnóstico del edema macular diabético.

OBJECTIVE: To determine the validity of retinal photography in the diagnosis of diabetic macular edema. Determine the number and size of the photographs for its correct diagnosis. METHODS: Cross-sectional observational study consisting of 420 eyes of patients with diabetic retinopathy, using a combination of retinography (simple, stereoscopic, red-free light), after expansion, to determine its validity in the diagnosis of diabetic macular edema. Sensitivity, specificity, positive and negative predictive values and the correlation with the gold standard test (optical coherence tomography) were calculated. The retinographs were evaluated by three experts and their results analyzed by the statistical program SPSS 15.0 Windows. RESULTS: Sensitivities were below 80% in simple photographs and above 80% in the stereoscopic retinography, whereas those associated with red-free filters, reaching the 30° green stereoscopic photography, showed a sensitivity of 94.3%. The specificity was 95% in color and red-free stereoscopic retinography of 45° and 30°. The positive predictive value was greater than 95% and the negative value greater than 90% with a coefficient of agreement of 80%, and a degree of consistency with the benchmark of over 80%. CONCLUSIONS: The results of the stereoscopic retinographs are sufficient to enable them to be used in screening for diabetic macular edema. The use of a green filter and its combination with visual acuity improves results in the diagnosis of this disease.

[Diagnosis of systemic disease after bilateral retinal arterial macroaneurysm]. / Diagnóstico de patología sistémica tras macroaneurisma arterial retiniano bilateral.

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.

[Effects of encircling scleral buckling on the morphology and biomechanical properties of the cornea]. / Efecto del cerclaje escleral en la cirugía vítreo-retiniana sobre la morfología y biomecánica de la córnea.

OBJECTIVE: To investigate the effects of encircling scleral buckle (SB) on corneal biomechanical properties of the cornea and its morphological parameters. METHODS: We prospectively examined twelve eyes diagnosed with vitreous haemorrhage undergoing pars plana vitrectomy (PPV), and fifteen eyes undergoing combined PPV and scleral buckle (PPV/SB) for repair of rhegmatogenous retinal detachment (RRD). Corneal biomechanical properties, including corneal hysteresis (CH) and corneal resistance factor (CRF), were measured with an Ocular Response Analyser (ORA) before and 1-month postoperatively. The ORA also determined the values of intraocular pressure (IOPg) and corneal compensated IOP (IOPcc). Finally, four morphological parameters of the cornea were measured with the Orbscan II topographer (Orbtek, Inc.): mean corneal power, thinnest corneal point (µm), and anterior chamber depth (ACD). RESULTS: CH decreased significantly from 10.2+/-1.7mmHg to 7.6+/-1.1mmHg after PPV/SB (p=0.003), but not after PPV alone (9.8+/-3.2mmHg vs 11.6+/-2.7mmHg, P=.465). CRF did not change significantly after surgery in both groups. IOPg and IOPcc increased significantly in the PPV/SB group (P=.019 and P=.010, respectively) but not in PPV group (P=.715 and P=.273, respectively). Unlike the PPV group, values were significantly higher than IOPg values before (P=.001) and after surgery (P=.003) in the PPV/SB group IOPcc. Neither the PPV/SB group nor the PPV group showed any significant changes in the corneal morphological parameters after surgery (P>.05). CONCLUSIONS: SB surgery leads to a change in the corneal biomechanical properties without altering corneal morphological parameters. It may cause an underestimation error in IOP measurement. PPV may be a less invasive surgical approach for the repair of noncomplex RRD than PPV/SB.