Long-term refractive outcomes of posterior chamber phakic (spheric and toric implantable collamer lens) intraocular lens implantation.

To report the long-term refractive outcomes, safety, predictability, efficacy and complications of 349 eyes treated with posterior chamber phakic intraocular lenses (pIOLs). A retrospective review of consecutive clinical cases of patients who underwent spheric implantable collamer lens (ICL) and toric ICL (TICL) implantation. The study included 349 eyes of 216 patients with sphere between +8 to -24 diopters (D) and 0 to -6.5 D of astigmatism. Statistical analysis was performed to identify differences between preoperative and postoperative refractive outcomes. Main outcome measures were preoperative and postoperative uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), spherical and cylindrical errors and spherical equivalent and significant postoperative complications. 194 eyes were treated with TICL and 155 eyes with ICL. The mean age of the patients was 29 ± 6.7 years. The mean preoperative sphere was -10.35 ± 5.1 D (+8 to -24) and the postoperative sphere was -0.09 ± 1.06 D (+3.25 to -6.5), p < 0.001. Preoperative cylinder was -2.63 ± 1.44 (0 to -6.5 D) and postoperative cylinder was -0.97 ± 0.89 D (0 to -3.5), p < 0.001. The preoperative mean spherical equivalent was -11.6 ± 5.12 D (+7.875 to -25.625) and postoperative spherical equivalent was -0.52 ± 1.03 (+2.25 to -6.75), p < 0.001. The mean preoperative UDVA was 1.72 ± 0.49 and postoperative UDVA was 0.23 ± 0.22, p < 0.001. The mean preoperative CDVA was 0.21 ± 0.17 and postoperative CDVA was 0.12 ± 0.138, p < 0.001. The implantation of posterior chamber pIOLs is a safe, predictable and effective strategy to manage refractive errors during long-term follow-up.

Implantable collamer lenses after intracorneal ring segments for keratoconus.

To report the clinical characteristics and visual outcomes of patients with keratoconus treated with posterior chamber phakic intraocular lenses after implantation of intracorneal ring segments (ICRS). This retrospective study included 11 eyes of eight patients diagnosed with keratoconus treated with ICRS and posterior chamber phakic intraocular lenses. The preoperative and postoperative uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), preoperative and postoperative keratometric data, manifest refraction and spherical equivalent were recorded. No complications were observed. At 38.18 ± 18.7 months of follow-up, the mean spherical error was -0.06 ± 0.46 D (+0.75 to -0.75 D) and cylindrical error of -1.22 ± 0.65 D (-0.25 to -1.5 D). The preoperative spherical equivalent was -10.52 ± 5.88 D (-3.12 to -22.75 D) and the postoperative spherical equivalent was -0.68 ± 0.45 D (0 to -1.25 D), p < 0.001. The preoperative and postoperative UDVA were 1.31 ± 0.37 logMAR (mean 20/400 Snellen, 0.69-1.77 logMAR) and 0.14 ± 0.04 (mean 20/30 Snellen, 0.09-0.47 logMAR), with a p value <0.001. The preoperative and postoperative CDVA were 0.289 ± 0.14 logMAR (mean 20/40 Snellen, 0-0.477 logMAR) and 0.16 ± 0.08 (mean 20/25 Snellen, 0.09-0.39 logMAR), with a p value of 0.007. Combined treatment of keratoconus with ICRS and posterior chamber phakic intraocular lenses was a safe and effective procedure for high refractive errors induced by keratoconus in these selected patients.

Refractive lens exchange with toric intraocular lenses in keratoconus.

PURPOSE: To report the clinical characteristics and surgical outcomes of patients with nonprogressive keratoconus treated with in-the-bag toric intraocular lens (IOL) implantation. METHODS: A retrospective review was conducted of the medical records of patients diagnosed with keratoconus treated with refractive lens exchange (RLE) and in-the-bag toric IOL implantation (models T3 to T9, AcrySof SN60TT; Alcon Laboratories Inc). Age, pre- and postoperative uncorrected (UDVA) and corrected distance visual acuity (CDVA), objective and subjective refraction, spherical equivalent refraction, total keratometric power, total astigmatism, axis, and toric IOL model and power were analyzed. All cases had topographic and/or refractive stability for at least 1 year prior to undergoing IOL implantation. RESULTS: Nineteen eyes of 13 patients (mean age 48.15 ± 6.6 years), including 12 patients with a topographic diagnosis of keratoconus and 1 with pellucid marginal degeneration, were evaluated. Mean follow-up after RLE was 7.89 ± 6.61 months. Mean preoperative sphere was -5.25 ± 6.40 diopters (D), and mean postoperative sphere was 0.22 ± 1.01 D (P<.001). Mean preoperative cylinder was 3.95 ± 1.30 D, which decreased to 1.36 ± 1.17 D postoperatively (P<.001). Mean pre- and postoperative spherical equivalent refractions were -7.10 ± 6.41 D and -0.46 ± 1.12 D, respectively (P<.001). Preoperative mean UDVA was 1.35 ± 0.36 D (20/447 Snellen) and postoperative mean UDVA was 0.29 ± 0.23 D (20/39 Snellen) (P<.001). CONCLUSIONS: Toric IOL implantation may be an effective therapeutic option in the optical rehabilitation of patients with stable and nonprogressive keratoconus.

Prevalence of high-risk alleles in the LOXL1 gene and its association with pseudoexfoliation syndrome and exfoliation glaucoma in a Latin American population.

PURPOSE: Pseudoexfoliation syndrome (XFS) is a major risk factor for exfoliation glaucoma (XFG). A significant association exists between XFG and several SNPs in the lysyl oxidase-like 1 (LOXL1) gene. The purpose of this study was to report the results of the first association study between LOXL1 polymorphisms and XFS and/or XFG in a Latin American population. METHODS: Genotypes of three high-risk SNPs of LOXL1 (rs1048661, rs3825942, and rs2165241) were analyzed by direct sequencing. A case-control study was conducted with 102 unrelated XFS/XFG Mexican patients (42 XFS/60 XFG) as well as 97 control subjects. Allele frequencies, Hardy-Weinberg equilibrium, and haplotype association analysis were assessed with the Haplo View software. RESULTS: The T allele of the intronic SNP rs2165241 was more frequent in XFS/XFG patients than in controls (OR [95% CI] = 2.41 [1.59-3.64]; p = 0.00001). The G allele of rs3825942 was found in a higher frequency in XFS/XFG than in controls (100% vs 95% respectively, p = 0.0019). No significant association between XFS and the rs1048661 (R141L) SNP was observed. The TGT haplotype was observed in a higher frequency in patients than in controls (p = 0.025), and produced the highest risk in our study (OR [95% CI] = 3.20 [1.09-9.39]; p = 0.025). CONCLUSIONS: This is the first study associating LOXL1 gene polymorphism and XFS/XFG in Latin America. LOXL1 variants are associated with an elevated risk for XFS/XFG in the Mexican population. A higher risk was conferred by the T allele of the intronic rs2165241 SNP rather than by the worldwide "high-risk" G allele of rs3825942.

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.

Prevalencia de infecciones en donantes de sangre en la Universidad Industrial de Santander versus parques de la ciudad de Bucaramanga, 2014 / Prevalence of infections in blood donors at the Universidad Industrial de Santander versus parks at the city of Bucaramanga, 2014

RESUMEN Introducción: la sangre como recurso terapéutico es una herramienta útil en el área clínica, sin embargo, pese a una selección cuidadosa del donante y de las pruebas de tamizaje serológico el riesgo de infección todavía existe, principalmente debido a los periodos ventana. Objetivo: determinar la prevalencia de infecciones en donantes de sangre de las sedes de la Universidad Industrial de Santander versus donantes en parques de la ciudad de Bucaramanga en el año 2014. Materiales y método: se realizó un estudio transversal en el cual se evaluaron 3758 resultados de donaciones de sangre en campañas de captación en los parques Plaza Cívica, Santander y San Pío del área metropolitana de Bucaramanga. Posteriormente fueron analizadas en el banco de sangre del Hospital Universitario de Santander, para determinar la prevalencia de infecciones de transmisión por transfusión sanguínea, analizadas en el estudio; sífilis, Virus Linfotrópico de Células T Humanas, VIH, chagas, Hepatitis B y C. Resultados: se presentaron 78 casos positivos de sífilis, 20 de chagas, 81 de Hepatitis B, 13 de Hepatitis C, 6 de VIH, y 10 de HTLV. Conclusiones: se determinó una prevalencia en los parques superior a la UIS, siendo la prueba serológica para sífilis la que presenta mayor prevalencia seguida de Hepatitis B. MÉD.UIS. 2016;29(3):55-60.

ABSTRACT Introduction: the blood as a therapeutic resource is a useful tool in the clinical area. Despite careful donor selection and testing for serological screening, the risk of infection still exists, mainly due to window periods. Objective: to determine the prevalence of infections in blood donors in the facilities of the Industrial University of Santander against donors in parks around Bucaramanga in 2014. Methods: a cross-sectional study was held in which 3758 blood donation results were evaluated in recruitment campaigns executed in Plaza Cívica, Santander and San Pío parks in the metropolitan area of Bucaramanga. They were subsequently analyzed in the blood bank of the Hospital Universitario de Santander to determine the prevalence of infection transmission by blood transfusion. The infections analyzed in the study were: syphilis, Lymphotropic Virus Human T-cell, HIV, chagas, Hepatitis B and C. Results: 78 positive cases of syphilis, 20 of Chagas, 81 of Hepatitis B, 13 of Hepatitis C, 6 of HIV, and 10 of HTLV were presented. Conclusions: a higher prevalence was determined in the parks compared to the UIS facilities, being the serological test for syphilis the most prevalent followed by Hepatitis B. MÉD.UIS. 2016;29(3):55-60.

Unilateral congenital fibrosis of the extraocular muscles with lid retraction: surgical treatment with a silicon plate on the orbital floor.

Fibrosis of the extraocular muscles can be an acquired or congenital disorder (CFEOM). The congenital disorder(1) is a complex strabismus with congenital restrictive ophthalmoplegia with or without ptosis. The surgery is challenging because the eye muscles are replaced by fibrous tissue or fibrous bands and in most cases the results are not satisfactory. We present the first case report of unilateral CFEOM with palpebral adherence and hypotropia, which was managed with our technique of a silicon plate implant on the orbital floor. The purpose of the implantation of the silicon plate in the orbital floor is to improve the hypotropia caused by CFEOM.

[Uveitis immunopathology: currents knowledge, clinical correlation and research perspectives in the immue-ocular area]. / Inmunopatologia de la uveítis: conocimientos actuales, correlación clinica y perspectivas de investigación en el área inmuno-ocular.

The eye has multiple mechanisms of immune regulation implicated in the maintenance of ocular immune privilege. However, sometimes diseases or disorders appear and can cause clinical manifestations of intraocular inflammation; usually those diseases are collectively named "uveitis". Despite the uveitis is the main cause of eye morbidity and lost of visual function, the vast majority of the immune mechanisms involved in its generation remains unknown. In this article, the authors reviews the process of immune regulation inside the eye, the immunological mechanisms of damage implicated in the generation of uveitis, as well as the clinical aspects associated with the immune pathogenesis; in the last part of this paper we present the most recent trends in ocular research related to immunological damage in uveitis.