Visual Impairment Due to Lissencephaly.

Lissencephaly is a rare disorder due to abnormal neural migration, causing neurological impairment and clinically characterised by mental retardation and epilepsy. Any disturbance of the visual pathway can cause loss of vision. The authors describe a case of a 6-year-old boy referred to the ophthalmologist presenting poor bilateral vision. This child had no other known medical conditions, and neurological examination was completely normal. Only when a magnetic resonance imaging was made that a lissencephaly-pachygyria with band heterotopia mostly occipital was noted. Cortical defects should be considered in order to diagnosis some visual defects in children.

Retrospective study of success rate and associated factors of two laser dacryocystorhinostomy techniques, in a third-level hospital.

BACKGROUND AND OBJECTIVE: To compare the success rate of two laser dacryocystorhinostomy (L-DCR) techniques. MATERIALS AND METHODS: A retrospective study of patients who underwent surgery for acquired nasolacrimal duct obstruction (NLDO) between 2000 and 2021, carried out in a third level hospital, using L-DCR and modifications of this technique. Intraoperative findings, complications, and anatomical and functional success rate of the 2 techniques were analyzed. The follow-up time was 1 year. RESULTS: We included 92 lacrimal ducts with NLDO. 66 (71.7%) were women. 78 (84.8%) underwent unilateral surgery. The mean age was 62.77 ±â€¯13.08 years. 61 (66.3%) underwent intraoperative laser dacryocystorhinostomy with MMTC (L-DCR + MMTC) and 31 (33.6%) L-DCR associated with endoscopic ostium enlargement (L-DCRend-amp). The one-year anatomical/functional success rate of the L-DCRend-amp + MMTC was 71%/64,5%. L-DCR + MMTC obtained a lower success rate, 65.6/60,7% (P = .391). There were no differences throughout the follow-up between the anatomical or functional success rates of the 2 techniques, nor between the different visits (P > ,05). Intraoperative findings rate was 3.63% in L-DCR + MMTC, and 32.26% in L-DCRend-amp + MMTC. Postoperative complication rate was 3.27% in L-DCR + MMTC, and 3.23% in L-DCRend-amp + MMTC. CONCLUSIONS: The L-DCRend-amp + MMTC gets a higher success rate than the L-DCR + MMTC. We must consider the surgical time-cost of the L-DCRend-amp + MMTC, as well as the learning curve of endoscopy techniques, and the skill of the surgeon, without a clear benefit in the success rate.

Retrospective study of peripheral facial paralysis in a tertiary hospital over 3 years.

PURPOSE: To identify clinical and epidemiological characteristics of patients with peripheral facial palsy (PFP) at a tertiary care hospital. METHOD: This is a retrospective observational study of patients with PFP treated at a tertiary medical center. We gathered demographic data, etiology, laterality, recurrence, recovery, clinical ophthalmology, severity according to the House-Brackmann (HB) scale, electrophysiological tests, medical services attended, medical and surgical treatment. RESULTS: Two hundred and eighty-three PFP were included, 135 (48%) were men and 148 (52%) were women p = 0.47). All patients had unilateral involvement. The mean age was 54 ± 20 years. The main etiology was idiopathic in 215 (76%) patients. Median recovery time was 7 weeks. Recovery was complete in 190 (67%) patients. One hundred and seventy (84%) patients with idiopathic PFP had complete recovery, versus 30 (16%) patients with non-idiopathic PFP (p < 0.01). The 84% of patients with HB grade II, recovered completely, while with HB grade VI only 17% recovered (p = 0.003). Two hundred and twenty-nine patients (81%) had lagophthalmos. The majority received ocular surface care treatment in 271 (96%) patients and of these 249 (88%) patients received oral corticosteroid therapy. Thirteen patients (5%) required ophthalmologic surgery. CONCLUSIONS: PFP affects all age ranges, without predilection for sex and unilateral. Its main cause is idiopathic. Recovery is complete in most cases, being more favorable in mild and idiopathic affections. Most only require medical treatment.

Recurrent bilateral asynchronous cellulitis: Report of two cases and a literature review.

Bilateral recurrent periorbital cellulitis is a very rare condition, with only five cases having been reported. Two cases are presented of recurrent bilateral asynchronous eyelid oedema in two paediatric patients. It was associated with respiratory infections, with no systemic disease. The patients had recurrent episodes (three times) since nine months old. They received oral and intravenous antibiotics, with a good response. There were no complications and no surgery was needed.

Recurrent bilateral asynchronous cellulitis: Report of two cases and a literature review. / Celulitis recurrente bilateral asincrónica: a propósito de 2 casos y revisión de la bibliografía.

Bilateral recurrent periorbital cellulitis is a very rare condition, with only five cases having been reported. Two cases are presented of recurrent bilateral asynchronous eyelid oedema in two paediatric patients. It was associated with respiratory infections, with no systemic disease. The patients had recurrent episodes (three times) since nine months old. They received oral and intravenous antibiotics, with a good response. There were no complications and no surgery was needed.

The effect of light and outdoor activity in natural lighting on the progression of myopia in children.

PURPOSE: To investigate potential risk factors for the progression of myopia. METHODS: Prospective study. Myopic progression was evaluated by cycloplegic autorefraction and axial length (AL) every 6 months in children 6 to 15 years old. Univariate analysis and multiple logistic regression were applied. RESULTS: Around 82 children with median age of 10.3±2.3 years. Myopia progressed by -0.816±0.6 D over 18 months. Increased myopic spherical equivalent refraction (SER) was correlated with increase in AL (P<0.001). Univariate analysis found SER to be significantly associated with: age, especially between 6 and 9.4 years old (P=0.001), parental myopia (P=0.028), and less time spent outdoors (P=0.009). There was a significantly greater increase in SER during months with the least daylight hours (P<0.001). CONCLUSION: Outdoor activities and daylight have a protective effect against increased AL and progression of myopia. Younger children with significant myopia should be monitored closely, especially those around 6 years old with myopic parents.

[The use of optical coherence tomography in hereditary optic neuropathies: description of a family]. / Utilización de la tomografía óptica de coherencia en neuropatías ópticas hereditarias. Descripción de una familia.

CASE REPORT: This report describes two siblings, a woman aged 44 years and her brother aged 29 years, who both complained of visual loss in both eyes. The woman had bilateral optic nerve (ON) temporal pallor and severe reduction of ON fibre layer thickness in this area. Both she and her brother had cecocentral defects in perimetry and color vision deficiency with a marked tritanopia deficit. DISCUSSION: ON pallor, limited to the temporal region, is the basic criterion for the diagnosis of dominant optic atrophy. Optical coherence tomography can be a useful technique in defining the diagnosis and improving the follow-up of patients with this pathology.

[A new method to quantify subjective aniseikonia]. / Un nuevo método de diagnóstico y cuantificación de la aniseiconia subjetiva.

PURPOSE: To design subjective aniseikonia measuring criteria in order to quantify its value and to use it to the clinical practice. MATERIAL AND METHODS: In order to carry out the aniseikonia measurements, a sinoptophore (Clement Clark) was used and two tests (one per eye of each patient) were performed. A viewfinder capable of measuring the difference in size between subjective images in both eyes was used and a percentage scale of ratio between 0 and 30%, with an accuracy of 1% was developed. An observational descriptive study was performed on 358 patients, and a complete ophthalmological examination also performed. The patients were divided in 3 groups: emmetropic patients, ametropic patients with non-progressive spectacles, and ametropic patients with hydrophilic contact lenses. RESULTS: Of the 358 patients studied, 22.7% were men and 67.3% women. The average age was 38.3 (SD 17.3) years. 40.2% of the patients were emmetropic and 59.8% had some type of ametropia. When analyzing the refractive defect measured as the spherical equivalent we found a higher prevalence of myopia than hyperopia. The level of aniseikonia in the group of emmetropic patients was 1.6% (SD 3.11), in patients with glasses was 1.3% (SD 2.81), and in patients with contact lenses was 1.1% (SD 2.96). Comparing the results of aniseikonia in anisometropic and emmetropic patients, no statistically significant differences were found. CONCLUSION: A simple method to quantify subjective aniseikonia, useful in clinical diagnosis has been designed.

[Correlation between intraocular pressure, paquimetry and keratometry in a normal population]. / Correlación entre presión intraocular, paquimetría y queratometría en una población normal.

PURPOSE: To study the intraocular pressure (IOP), the corneal thickness and the corneal curvature distribution in a normal population. To investigate the relation between these variables, and to determine if the IOP and the paquimetry will be modified by the refractive error and age. METHODS: A population of 273 subjects, 545 eyes, without ocular pathology was selected. The refractive error, the corneal curvature, the corneal thickness and the IOP [with a non-contact tonometer (NCT) and with a Goldmann tonometer (GT)] were evaluated. RESULTS: The average age of the population was 49.34 (SD 7.23) years (27-68). The average corneal thickness was 544.3 (SD 33) mm in females and 543.1 (SD 29) mm in males. An inverse correlation was found between corneal thickness and age but this was not significant statistically. A mildly statistically significant correlation was found between corneal thickness and intraocular pressure with both methods of measurement of IOP: r = 0.316 (p < 0,001) and r = 0.264 (p < 0,001), with NCT and GT respectively. No correlation was found between corneal thickness and refractive error, or with mean corneal curvature. In the regression model, corneal thickness and mean corneal curvature were significant in the IOP prediction: R = 0.341 (p < 0.001). CONCLUSION: Mean corneal thickness was very similar to that reported in other studies of a latin population. A statistically significant inferior corneal thickness has been found in people older than 54 years. The relationship between the corneal thickness and the corneal curvature with the IOP has been calculated by linear regression analyses.

[Contact lens fitting in 133 eyes with irregular astigmatism]. / Adaptación de lentes de contacto en 133 ojos con astigmatismo irregular.

PURPOSE: To study the adaptation of contact lens in a sample of 133 eyes with irregular astigmatism. METHODS: A retrospective study was made in 133 eyes with irregular astigmatism. The selection criterion was to obtain a sample population with irregular astigmatism that was unlikely to be corrected with spectacles or conventional contact lens. A complete ophthalmologic exploration which included a topography with the Eye-Sys 2000 corneal topographer was made was made. The variables analyzed in the study were: refraction, visual acuity before and after the correction, cause of the astigmatism and contact lens used. RESULTS: An equal number of women and men were enrolled in the study. The right eye was studied in 52% of cases, and the left eye in 46%. Both eyes were affected in 67% of the subjects. The reason for the astigmatism was keratoconus in 110 eyes (78.2%), and there were 4 corneal injuries, 9 ocular infections, and 6 idiopathic astigmatisms. Among the contact lens used in the study: in 103 eyes a hybrid lens (Softperm) was adapted, in 20 eyes a piggy-back system, in 5 eyes a thick hydrophilic lens (Queratosoft), in 4 eyes a hydrophilic contact lens and in 3 cases a rigid gas permeable contact lens. The average visual acuity before the adaptation was 0.28 (SD 0.24) (range 0.1-0.8). After the use of the lens the average visual acuity was 0.81 (SD 0.23) (range 0.1-1). Statistically significant differences between the visual acuity before and after treatment were found, with an improvement of 0.53 (SD 0.28) obtained. CONCLUSION: Only with experience using a large variety of non-conventional contact lens can a specialist contact lens ophthalmologist achieve a good result.

[Utility of optic coherence tomography (OCT) in the follow-up of idiopathic intracranial hypertension in childhood]. / Utilidad del tomógrafo de coherencia óptica (OCT) en el seguimiento de la hipertensión intracraneal idiopática en la infancia.

PURPOSE: To show the utility of optic coherence tomography (OCT) in the follow up of the idiopathic intracranial hypertension (IIH) in childhood. METHODS: Three girls, aged between 4 and 11 years, were diagnosed and subsequently followed with the help of OCT for an episode of idiopathic intracranial hypertension. All of them had presented with non-specific symptoms such as visual disturbance, headache, stomach ache, and in one case diplopia and torticolis. Brain imaging studies were normal, however lumbar puncture found an elevated intracranial pressure. Visual fields were tested using Octopus automated perimetry and the optic nerve fiber layer (ONF) was measured by OCT at each of the attendances. RESULTS: The visual acuity was normal in all cases, but two girls had evidence of an abducens nerve palsy. Fundus biomicroscopy revealed marked papilledema. The thickness of the ONF was increased 2-3 times over normally expected levels. The follow up and the treatment with prednisone and azetazolamide was monitored by OCT, with a good outcome and return of the ONF levels to normal. In one case, however, a recurrence was detected after three months without treatment. CONCLUSION: IIH in childhood is an uncommon condition, often with a different presentation from what is seen in teenagers and adults. OCT is a useful technique helping in both the diagnosis and the follow-up of this disorder in children (Arch Soc Esp Oftalmol 2006; 81: 383-390).

Stromal keratitis in a neonate: Herpes virus a diagnosis to consider.

OBJECTIVE: Neonatal herpes simple virus (HSV) keratitis, relatively uncommon are associated with significant morbidity. CASE REPORT: The case is presented of a newborn girl who developed herpes simplex virus (HSV) keratoconjunctivitis, despite a vaginal delivery, and the absence of medical history or active clinical maternal HSV infection. Diagnosis relies on a high level of clinical suspicion and the use of diagnostic tests. DISCUSSION: Neonatal herpes simplex virus (HSV) keratitis, although relatively uncommon, is associated with significant morbidity.

[Comparative study between the non-contact pneumotonometer Canon TX10 and the Goldmann tonometer]. / Estudio comparativo entre el neumotonómetro de no contacto Canon TX-10 y el tonómetro de Goldmann.

PURPOSE: To study and contrast the measurement of intraocular pressure (IOP) with an air non-contact tonometer (Canon TX-10) with that obtained with the Goldmann tonometer. METHODS: Intraocular pressure was measured in 649 subjects with both the pneumotonometer and the Goldmann tonometer. Statistically significant differences between the results obtained by both tonometers and the influence of variables including age, corneal thickness, and corneal curvature were studied. RESULTS: The mean age of the study population was 48.5 years, standard deviation (SD) 7.6 years, with a range of 22-68 years. The mean IOP was 15.4, SD 2.7 mm Hg, (range 8-25) with the Goldmann tonometer and 15.6, SD 2.9 mm Hg (range 8-29) with the pneumotonometer. There was a statistically significant difference between the measurements using the air pneumotonometer and the Goldmann tonometer (p<0.001). The mean of the differences between both tonometers was 0.24, SD 2 mm Hg. Seventy-five percent of measurements were in the range of +/-1, 85% in +/-2, and 95% in the Bland and Altman's interval of 4.42, -3.94. These differences were more significant for higher values of IOP, in thicker corneas and in corneas with greater curvature. A correlation between IOP and age was not found (p=0.247). CONCLUSIONS: The pneumotonometer is a useful and reliable instrument for measuring the IOP providing there is additional checking in cases with borderline values of IOP, or excessive corneal thickness and/or curvature.

[Optic nerve pilocytic astrocytoma with retinal involvement]. / Astrocitoma pilocítico de nervio óptico con afectación de retina.

INTRODUCTION: This is an atypical case of a pilocytic astrocytoma that involved the optic nerve (ON) and the retina. CLINICAL CASE: The patient was a 30-year-old male, who had attended ONCE since his early childhood because of the suspicion of an intraocular tumor. The ophthalmology exploration showed an ON and retinal coloboma in the right eye and microphthalmy, shutting of the pupil, retinal detachment and proof of an intraocular tumor in the left eye. The MR revealed an ON tumor that involved the retina. The histopathological study after enucleation was pilocytic astrocytoma. DISCUSSION: Long standing congenital pathology in a blind patient does not exclude the possibility of the patient suffering from other pathology as well.

[Cost-effectivity analysis of the most used antiglaucoma drugs]. / Análisis coste-eficacia hipotensora de los fármacos antiglaucomatosos más utilizados.

PURPOSE: To evaluate the yearly cost and the cost-effectiveness of commercially available topical products in treatment of glaucoma. METHODS: This analysis evaluates 12 topical agents in glaucoma: Betoptic, Betagan, Timoftol, Timogel, Alphagan, Lumigan, Travatan, Xalatan, Trusopt, Azopt. The number of drops per bottle of glaucoma medications is determined for all commercially tested products. The yearly cost of the dosage schedules was compared. We selected for each one 5 to 10-reported comparative hypotensive efficacy studies and we calculated the cost-effectiveness as the ratio between the yearly cost and the mean hypotensive efficacy. RESULTS: The range of hypotensive efficacy of monotherapy components is from 13.8% to 31.9%. Lumigan and Xalatan present the highest hypotensive efficacy, 31.9% and 28.6% respectively. The cheapest medication is the beta-blockers group. The cost-efficacy ratio of glaucoma therapy is 1.5 for Timoftol, 2.8 for Betagan, 9.6 for Alphagan, 9.1 for Lumigan, 10.7 for Xalatan and 11.3 for Travatan. CONCLUSIONS: Over time, Lumigan is significantly most effective in controlling IOP. The cost-effectiveness for managing IOP will depend on both price and hypotensive efficacy. The beta-blockers group has lower hypotensive efficacy than prostaglandin analogs but cost-effectiveness is better in the former because of its low price.

[Usefulness of conjunctival biopsy as diagnostic technique]. / Utilidad de la biopsia conjuntival como técnica diagnóstica.

PURPOSE: The conjuctival biopsy is described as a useful technique in the diagnosis of some chronic conjunctivitis, with low specific signs and with poor response to the conventional treatment. Furthermore it is quite important in the diagnosis of conjunctival diseases with potential dangerous treatment. PATIENTS AND METHODS: Three clinical cases are described. Case 1: A 37 years old woman with a chronic lesion of conjuctiva and the suspicion of blepharoconjunctivitis. There was no improvement with treatment. Case 2: A 58 years old woman with a chronic conjunctivitis and follicular reaction. Case 3: A 66 years old man who suffers from a cicatricial conjunctivis in both eyes with corneal lesion in one eye. A conjunctival biopsy was perfomed and studied under light microscopy and immunohistochemistry. There is a description of the technique. RESULTS: The results of every clinical case are described. In the first case the biopsy established the diagnosis of conjunctival lymphoma. In the second, the biopsy showed the appearance of granulomas and a diagnosis of conjunctival sarcoidosis was performed. In the third case a diagnosis of ocular cicatricial pemphigoid was established. CONCLUSION: Conjunctival biopsy is a useful and effective technique in the diagnosis of chronic conjunctivitis.

[Granuloma annulare of the eyelid: an unusual presentation]. / Granuloma anular del párpado: una localización poco frecuente.

CASE REPORT: Granuloma annulare is a benign dermatosis, relatively common during childhood, usually self-limited and of unknown etiology. Localized ocular involvement is rare. We report a case of granuloma annulare involving the eyelid of a child. A biopsy taken from a similar lesion presented later on the back of a thumb confirmed the diagnosis. Treatment with topical corticosteroids was introduced. DISCUSSION: The literature on periocular granuloma annulare is reviewed. This diagnosis should be considered for any acquired papular of the periorbital area, especially if there is a history of antecedent trauma. Unnecessary surgical excision can then be avoided.

[Epidemiologic study of ocular emergencies in a general hospital]. / Estudio epidemiológico de las urgencias oftalmológicas en un hospital general.

PURPOSE: To provide epidemiological data about patients attending an ophthalmic emergencies center of a general hospital. METHODS: A retrospective analysis of all patients attending the emergency department (ED) of Rio Hortega Hospital during a 9-month period was carried out. Pathology was identified by International Classification of Diseases ((ICD9-CM) codes. RESULTS: A total of 2914 visits have been examined: 6% of patients were under 20 years of age, 35.4% between 21-50, 29% between 51-70, and 23.3% over 71 years. Thirteen per cent of visits were due to injuries, 50.7% of which occurred in patients 21 to 50 years old. Almost half of visits were due to inflammatory conditions of the cornea, conjunctiva and eyelids. CONCLUSIONS: ED plays a major role in the ophthalmology departments in a hospital. Certainly a considerable proportion of these patients had conditions which could have been dealt with in an ophthalmic outpatient clinic or by general practitioners. Ocular trauma is a common cause of visits to the ED.

[Transpupillary thermotherapy in occult subretinal neovascularization in age-related macular degeneration. Preliminary results]. / Termoterapia transpupilar en neovascularización subretiniana oculta secundaria a degeneración macular asociada a la edad. Primeros resultados.

PURPOSE: To determine the efficacy of transpupillary thermotherapy (TTT) to treat choroidal neovascularization (CNV) in patients with age-related macular degeneration (ARMD). PATIENTS AND METHODS: Eight patients (ten eyes) with occult CNV were treated by TTT. A 810 nm diode laser was used to perform TTT. The diode laser was delivered through a panfunduscopic contact lens. RESULTS: Three eyes showed a visual acuity improvement and a decrease in exudation on fluorescein angiography. Four eyes remained stable. Nevertheless, lesions worsened after treatment in three cases. One of these cases suffered an overtreatment. CONCLUSIONS: TTT may be a useful therapy in some cases of CNV in patients with age-related macular degeneration. Randomized and multicentric studies are necessary to stablish precise indications of this therapy.

[Dermoid cyst in childhood, diagnosed as ptosis]. / Quiste dermoide en la infancia bajo el diagnóstico de ptosis.

CLINICAL CASE: A four year-old boy, diagnosed of palpebral ptosis since he was 2 by his paediatrician. At the initial ophthalmological revies he had asymmetrical upper eyelids. In the follow-up a mild ocular hypotrophy appeared in his left eye and an increasing astigmatism, which made us suspect an orbital disease. The MRI confirmed a mass, compatible with a dermoid cyst. CONCLUSION: Due to the slow growth of these tumours, it is only with clinical follow-up and the aid of imaging techniques that we may achieve the diagnosis and offer a definitive treatment with surgical extirpation.