A new standardised nomenclature in ophthalmology: Criteria and quantitative evaluation indicators of medical procedures. / Nuevo nomenclátor estandarizado en oftalmología: Criterios e indicadores cuantitativos de baremación de actos médicos.

PURPOSE: To create a new list of medical procedures in ophthalmology based on the International Classification of Diseases ICD-9-CM. To establish the general principles that define criteria, quantitative indicators, and scales. To develop the algorithms needed to calculate fees for medical procedures. METHODS: The out-of-date processes were removed from the list, and new techniques were added, descriptors were modified, procedures with similar descriptions were grouped together, and others were relocated to other group according to surgical complexity conditions. The criteria to calculate the medical fees were defined: training and complexity (U), proficient responsibility (R), and health value (V), with their respective quantitative indicators: period of training necessary to master a technique, frequency of complications that worsen the preoperative situation, and days of incapacity for work due to the process. The Relative Value Unit (RVU) was defined as the score sum of R, V and U. The final fee per medical procedure was calculated as the product of the RVU by its unit cost and by the weighting coefficient (WC). RESULTS: A new catalogue was prepared with 161 medical procedures, grouped into consultations, diagnostic procedures (DX.PR), therapeutic procedures (TX.PR), and surgical interventions, increasing in complexity from group 0 to group 8. The following characters were described for each one of the procedures: OMC and ICD-9-MC code, descriptor term, group, proposed modification: no changes or minimums in the descriptors, grouping of acts by similar definitions, change of origin group, new procedures, and procedures removed. The indicators for assessment were also scored: U between 1-4 points, and R and V between 0-3 points. Using their sum, the number of RVUs per medical procedure (between 1 and 10) was calculated which, together with the unit cost of the RVU and the WC (between 0.05 and 1), will determine the final rate. CONCLUSIONS: The new standardised ophthalmological nomenclature updates and improves the old classification, adapting the procedures to the descriptors included in the ICD-9-CM, and incorporating all the new techniques. Additionally, the declaration of the general principles allows defining new criteria, quantitative indicators, rating scales, and algorithms to calculate fees for medical procedures.

[Guidelines of clinical practice of the SERV: treatment of exudative age-related macular degeneration (AMD)]. / Guías de práctica clínica de la SERV: tratamiento de la degeneración macular asociada a la edad (DMAE) exudativa.

OBJECTIVE: Age related macular degeneration (ARMD) in its neovascular form is a serious disease which produces legal blindness in many patients with poor prognosis if left untreated. We intend to establish a clinical guide with the different therapeutic options that exist nowadays, which may help the ophthalmologists in their clinical practice. METHODS: A group of medical retina experts selected by SERV have evaluated the results of different published studies with the drugs currently available, obtaining an evidence-based consensus. Some recommendations have been established for diagnosis, treatment and monitoring of patients with neovascular ARMD. RESULTS: The intravitreal injection of ranibizumab at a dosage of 0.5 mg produces significant improvement of visual acuity in subfoveal lesions, according to data obtained from studies with the highest level of evidence. It should be considered as a first choice drug. The use of bevacizumab, a drug with not approved indication for intraocular use, nor for the treatment of neovascular ARMD can reach a result which is closer to the ones obtained with ranibizumab than to those obtained with photodynamic therapy (PDT) and pegaptanib. The use of intravitreal pegaptanib sodium in intravitreal injection at a dosage of 0.3 mg as a treatment for subfoveal lesions can obtain similar results to the TFD, but with a wider range of injuries. CONCLUSION: The results of the evidence-based studies are a good guide for the treatment of this disease.

[Herpes simplex keratitis following laser in situ keratomileusis]. / Queratitis por herpes simplex tras láser in situ keratomileusis.

CASE REPORT: A 40-year-old woman underwent bilateral Laser In Situ Keratomileusis (LASIK) for the correction of myopia and astigmatism. The day after, four dendritic ulcers appeared in her left eye. She was treated with topical antiviral agents until complete recovery. She had a history of recurrent labial herpetic infection. DISCUSSION: Reactivation of herpes simplex virus type 1 can occur, even without any previous history of corneal infection. Although this does not contraindicate surgery, all patients with a history of herpetic infection should be made aware of the complications related to this technique.

[Contrast vision in patients with aphakia and pseudophakia]. / Etude sur la vision de contraste chez les aphakes et les pseudophakes.

A study was carried out on contrast vision in 26 aphakic patients (48 operated eyes) and 37 pseudophakic patients (37 operated eyes); in some cases an intraocular PMMA lens had been implanted, in others an IOGEL (polimacon) had been implanted. The level of sensitivity to contrast in both cases was found to be lower than expected by the Vistech company for aphakics. At the same time a comparative study was carried out of the results obtained for sharpness of vision in aphakic and pseudophakic patients, with the traditional tests of Snellen (long sightedness) and Parinaud (short sightedness) and those obtained with the Contrast Sensitivity Test System (VCTS-6500 for long sightedness and VCTS-6000 for short sightedness). The former tests were found to overestimate the visual results. Corrected aphakia was found to affect the sensitivity to contrast more than in pseudophakic cases. Nevertheless no significant differences were found between contrast vision in eyes with PMMA lens implantation and eyes with IOGEL (polimacon) lens implantation. Summing up, alterations in the sensitivity to contrast undetected by the simple measurement of visual sharpness were found.

[Prediction of post-surgical astigmatism in pseudophakia]. / Prédiction de l'astigmatisme post-chirurgical dans la pseudophakie.

After cataract surgery, the patient wants its vision to be as he remembers it was. We known that this is very difficult to reach; however it is quite possible to approach what would be a practically normal vision, since rather than attaining maximum vision possible (10/10), we must attain what the patient sees as normal dimensions in the space. If there is a high degree of astigmatism left, this goal will not be fully attained even with an intraocular lens. Therefore, we have analyzed the degree, type and evolution of astigmatism along the time, after EICC in some cases and planned EECC in other cases, using in the first ones resorptive sutures and in the second ones non-resorptive sutures, so to predict, through a statistical study, and in each one of the two groups, the astigmatism the patients will have in each one.