Evidence in the prevention of the recurrence of herpes simplex and herpes zoster keratitis after eye surgery.

OBJECTIVE: Herpetic keratitis, either due to herpes simplex keratitis (HSK) or herpes zoster ophthalmicus (HZO), can recur after eye surgery.º Prophylaxis is postulated as necessary to avoid it. The objective of this study was to review the scientific evidence on the preventive methods used in the perioperative period in patients previously affected by HSK/HZO. METHODS: An exhaustive search was carried out in the PubMed and Web of Science databases to identify relevant articles on prophylaxis and risk of recurrence of HSK/HZO in patients undergoing eye surgery up to 31 December 2019. RESULTS: There is strong evidence that oral prophylaxis should be recommended after penetrating keratoplasty in patients who have previously had HSK/HZO. For other types of surgery, the evidence is less compelling. However, a latent period of inactivity should be considered between disease and oral prophylaxis. CONCLUSIONS: Penetrating and lamellar keratoplasty, corneal crosslinking, cataract surgery, and photorefractive and phototherapeutic surgery cause an alteration of the subbasal nerve plexus of the cornea. Due to surgical trauma, as well as the modulation of the ocular immune response caused by steroids applied in the postoperative period, it is possible to induce the reactivation of HSK/HZO, which is common in some cases. Within this article, we discuss the available evidence for HSK/HZO prophylaxis in eye surgery. Further studies are necessary to define the real risk of HSK/HZO recurrence after ocular surgeries, particularly in cataract surgery, and to confirm the efficacy of perioperative prophylaxis with anti-HSK/HZO antivirals.

Immediate bilateral sequential cataract surgery.

PURPOSE: There is a constant controversy between performing cataract surgery for one eye or for both eyes in the same surgical session. The objective of this study is to review the scientific evidence on the efficacy and safety, determine the reduction of costs of sequential bilateral cataract surgery on the same day compared to unilateral cataract surgery, as well as to compare the rate of associated complications. METHODS: A comprehensive search of the PubMed and Web of Science databases has been conducted to identify relevant articles on sequential bilateral cataract surgery from 2000 to 31 of December of 2020. RESULTS: Literature shows that there is strong evidence demonstrating the efficacy and safety of same-day sequential bilateral cataract surgery. Studies have not found a higher rate of postoperative complications compared to unilateral cataract surgery. CONCLUSIONS: Same-day sequential bilateral cataract surgery is a good surgical option for the resolution of the cataract, provides rapid visual rehabilitation and without greater risks than unilateral surgery. It also provides a reduction in sanitary costs. There is a psychological fear of performing bilateral surgery due to the potential risk of complications that would affect both operated eyes. In this article we discuss the efficacy, safety, complications rate and associated costs in sequential bilateral cataract surgery in the same surgical act.

Crystalline lens alterations in congenital aniridia. / Alteraciones del cristalino en la aniridia congénita.

Congenital aniridia is a rare genetic disease associated with mutations in the PAX6 gene. Changes in the lens in aniridia can be alterations of size and shape, of position - which generally reveal zonular weakness and determines subluxation of the lens - and mainly changes in transparency, cataracts, with variable morphology of polar, cortical, subcapsular, lamellar, and more rarely, nuclear cataract. Visual acuity and quality of vision in patients with congenital aniridia complicated by cataracts can be improved by carefully planned surgery, when lack of media transparency justifies surgical indication. Most patients have some improvement in visual acuity and quality of retinal image. Cataract surgery with aniridia is complicated by pathological changes due to the underlying cause of the aniridia. Challenges include corneal opacification, friable capsule and, above all, iris and pupil reconstruction. It can also determine late complications, such as secondary glaucoma or deterioration of pre-existent glaucoma, and corneal endothelial decompensation. After crystalline lens surgery in these patients, either by cataract or dislocation, for visual rehabilitation there are various techniques such as keratopigmentation, prosthetic iris devices or Morcher intraocular lenses with a black diaphragm. An appropriate individualised surgical plan should be selected depending on patient and surgical experience, in order to minimise complications and give the best chance of postoperative success.

Crystalline lens alterations in congenital aniridia.

Congenital aniridia is a rare genetic disease associated with mutations in the PAX6 gene. Changes in the lens in aniridia can be alterations of size and shape, of position - which generally reveal zonular weakness and determines subluxation of the lens - and mainly changes in transparency, cataracts, with variable morphology of polar, cortical, subcapsular, lamellar, and more rarely, nuclear cataract. Visual acuity and quality of vision in patients with congenital aniridia complicated by cataracts can be improved by carefully planned surgery, when lack of media transparency justifies surgical indication. Most patients have some improvement in visual acuity and quality of retinal image. Cataract surgery with aniridia is complicated by pathological changes due to the underlying cause of the aniridia. Challenges include corneal opacification, friable capsule and, above all, iris and pupil reconstruction. It can also determine late complications, such as secondary glaucoma or deterioration of pre-existent glaucoma, and corneal endothelial decompensation. After crystalline lens surgery in these patients, either by cataract or dislocation, for visual rehabilitation there are various techniques such as keratopigmentation, prosthetic iris devices or Morcher intraocular lenses with a black diaphragm. An appropriate individualised surgical plan should be selected depending on patient and surgical experience, in order to minimise complications and give the best chance of postoperative success.

Macular involvement in congenital aniridia. / Alteraciones maculares en aniridia congénita.

This review updates the knowledge about the morphological assessment of the foveal hypoplasia in Congenital Aniridia and resumes the reported genotype-phenotype correlations known to date. Congenital Aniridia is a pan ocular disease. Although iris absence is considered the hallmark of this entity, foveal hypoplasia is present in 94.7-84% of patients. A foveal morphology assessed by optical coherence tomography in which external retina structures can be identified, with presence of the lengthening of photoreceptors outer segment and a greater external retinal thickness, is associated with a better visual outcome, regardless a foveal pit is identified or not. This analysis can be performed once the external retina has completed its differentiation, by 6 years old. PAX6 mutations that introduce premature termination codon, C terminal extension or PAX6 involving deletions have been related to lesser foveal differentiation. Better foveal differentiation has been associated to non-coding PAX6 mutations.

Macular involvement in congenital aniridia.

This review updates the knowledge about the morphological assessment of the foveal hypoplasia in congenital aniridia and resumes the reported genotype-phenotype correlations known to date. Congenital aniridia is a pan ocular disease. Although iris absence is considered the hallmark of this entity, foveal hypoplasia is present in 94.7%-84% of patients. A foveal morphology assessed by optical coherence tomography in which external retina structures can be identified, with presence of the lengthening of photoreceptors outer segment and a greater external retinal thickness, is associated with a better visual outcome, regardless a foveal pit is identified or not. This analysis can be performed once the external retina has completed its differentiation, by 6 years old. PAX6 mutations that introduce premature termination codon, C terminal extension or PAX6 involving deletions have been related to lesser foveal differentiation. Better foveal differentiation has been associated to non-coding PAX6 mutations.

Evaluation of femtosecond laser-assisted cataract surgery after 10 years of clinical application. / Evaluación de la cirugía de la catarata asistida con láser femtosegundo tras 10 años de aplicación clínica.

INTRODUCTION: Femtosecond laser-assisted cataract surgery (FLACS) has been considered a technological advance in modern cataract surgery. After years of experience, it has been observed that clinical outcomes had more complications than expected at the beginning. The aim of this study is to compare the benefits and disadvantages of the FLACS technique with conventional cataract surgery. METHOD: The PubMed and Web of Science platforms were used to search for scientific literature. RESULTS: The FLACS has currently improved the surgical technique in terms of the shorter ultrasound time used and the lower loss of endothelial cells. Likewise, the centration of capsulotomy and the correction of astigmatism with arcuate incisions have also been improved. As disadvantages, are the high cost of the laser, the intraoperative capsular complications, the induction of intraoperative myosis, and the learning curve of the technique. CONCLUSIONS: The FLACS technique is considered beneficial for specific cases, such as patients with scheduled premium surgery, or with low endothelial cell count. However, it is believed that given the technological cost it is not a cost effective technique for most standard cases in our daily clinical practice.

Phakic intraocular lenses: Recent advances and innovations. / Lentes intraoculares fáquicas: recientes avances e innovaciones.

Phakic intraocular lenses (pIOL) are recommended when counselling refractive surgery candidates presenting with high ametropia or ocular surface and/or corneal conditions that contraindicate corneal refractive surgery. This review aims to present the state-of-the-art regarding pIOL models currently available in Europe, addressing their newer indications and recent design innovations. These include, in the case of posterior chamber pIOLs, the addition of a central hole to improve aqueous humour circulation, the availability of larger optical zones, and multifocal optics for the compensation of presbyopia. The review also highlights their good safety and efficacy results, as well as the role of patient education to ensure adequate outcomes in the medium-long term. The indications of pIOLs in special situations, as well as bi-lensectomy, a procedure that most pIOL patients may eventually require as they age and develop cataracts, are also addressed.

Assessment of the Association between In Vivo Corneal Morphogeometrical Changes and Keratoconus Eyes with Severe Visual Limitation.

Assessing changes suffered by the cornea as keratoconus progresses has proven to be vital for this disease diagnosis and treatment. This study determines the corneal biometric profile in eyes considered as affected by keratoconus (KC) showing severe visual limitation, by means of in vivo 3D modelling techniques. This observational case series study evaluated new objective indices in 50 healthy and 30 KC corneas, following a validated protocol created by our research group, which has been previously used for diagnosis and characterization of KC in asymptomatic (preclinical) and mild visually impaired eyes. Results show a statistically significant reduction of corneal volume and an increase of total corneal area in the severe KC group, being anterior and posterior corneal surfaces minimum thickness points the best correlated parameters, although with no discrimination between groups. Receiving operator curves were used to determine sensitivity and specificity of selected indices, being anterior and posterior apex deviations the ones which reached the highest area under the curve, both with very high sensitivity (96.7% and 90%, respectively) and specificity (94.0% and 99.9%, respectively). The results suggest that once severe visual loss appears, anterior corneal topography should be considered for a more accurate diagnosis of clinical KC, being anterior apex deviation the key metric discriminant. This study can be a useful tool for KC classification, helping doctors in diagnosing severe cases of the disease, and can help to characterize corneal changes that appear when severe KC is developed and how they relate with vision deterioration.

The importance of cyclotorsional changes in refractive surgery.

PURPOSE: To provide evidence of the importance of a precise record of torsional alterations in all patients about to undergo refractive surgery and particularly in patients with latent strabismus that may become decompensated due to the dissociation phenomenon produced during different surgical procedures that result in fixation loss. METHODS: Using 3D-VOG video-oculography, the authors analyzed the horizontal, vertical, and torsional movements of each eye after inducing fixation loss in one and both eyes in a patient with well-compensated dissociated vertical deviation (DVD). As the dissociated techniques, Posner maneuver and the placing of Bagolini filters with increasing densities by means of the Bielschowsky phenomenon, both pathognomonic of DVD. RESULTS: The authors observed not only horizontal and vertical alterations, but also cyclotorsional alterations which may even exceed 15 degrees depending on the resulting dissociation component. CONCLUSIONS: In view of the obtained results, the authors consider it important to conduct a meticulous study of ocular motility in all patients about to undergo refractive surgery, especially in the case of high astigmatism to rule out possible latent strabismus that may condition cyclotorsional alterations important in refractive surgery.

[Limbal transplantation: multicenter retrospective case series analysis]. / Estudio multicéntrico retrospectivo sobre trasplante de limbo.

PURPOSE: To report the results of limbal transplantation (LT) in patients with limbal stem cell deficiency (LSCD) in the context of ocular surface diseases. MATERIALS AND METHODS: A multicenter (5 centers) retrospective case series analysis of patients who underwent LT between 1996 and 2004 was performed. Data were collected by the same researcher using a customized database. Success was defined by the absence of a persistent corneal epithelial defect, on-going inflammation or recurrence of a pterygium. RESULTS: Data from 72 LT performed in 61 patients (65 eyes) with a mean follow-up of 20.8 months (SD 23.5; range, 3-115) were analyzed. There were 33 males and 28 females with a mean age of 55.8 years (SD: 15.6; range, 20-89). Fifty-eight (80.6%) LT were autografts (40 pterygia, 12 alkali burns, 3 iatrogenic cases, 2 viral infections, 1 neoplasia case) and 14 (19.4%) were allografts from cadaveric donors (7 immune-based disorders, 6 alkali burns, 1 iatrogenic case); all patients receiving allografts also received systemic immunosuppression. Of the total number of LT, 48 (66.7%) were successful. This proportion increased to 81.0% (47/58) when autografts were used. However, only 7.1% (1/14) of all allografts were successful. The success rate was higher (80.0%) when performed for a pterygium and lower when done for immune-based inflammation (14.3%). CONCLUSION: Autograft tissue for LT is always preferable to allografts to surgically treat LSCD, as clinical success is significantly higher, and systemic immunosuppression is avoided. As expected, immune-based disorders are the most difficult cases to treat. LT has been shown to be an excellent option for recurrent pterygium, although prospective studies need to be performed to further corroborate these results.

Current and Future Applications of Photoactivated Chromophore for Keratitis-Corneal Collagen Cross-Linking (PACK-CXL): An Overview of the Different Treatments Proposed.

PURPOSE: To review the application of the PACK-CXL and to identify different treatment protocols according to the pathogens associated with keratitis. METHODS: A systematic review of 21 articles. The primary outcome was the healing of a corneal ulcer, defined as epithelization, blocking corneal melting. The secondary end-point was the recovery of visual acuity. RESULTS: We studied a total of 145 eyes. Infectious keratitis was associated with bacteria in 80 eyes (55.55%), fungus in 24 eyes (16.67%), and protozoa in 13 (8.97%). In 26 (18%), the microbiological culture was negative or not performed. The mean time of re-epithelization was 25.70±29.83days (1-180). A total of 27 patients needed corneal transplantation. The overall probability of blocking corneal melting was 84.13%. Three different protocols for each group of pathogens have been proposed. CONCLUSION: PACK-CXL still has a limit in its spread. In the future, we hope that each pathogen will be treated with the most efficient and least invasive protocols available.

Protective effect of viscoelastics against retina lipid peroxidation.

Viscoelastics or ophthalmic viscosurgical devices are routinely used during anterior segment surgery and also in posterior segment surgery. Studies of the harmful effects of phacoemulsification on corneal endothelial cells suggest that much of this damage is mediated by free radicals. In this study, we compare the possible effects against lipid peroxidation in the retina of three different viscoelastic substances: Viscoat, Healon and Visiol. Herein we demonstrate for the first time that viscoelastics are effective to protect the retina against lipid peroxidation, as can be seen by the slight increase of malondialdehyde in the homogenates incubated with viscoelastic exposed to light and to a temperature of 37 degrees C when compared with the control homogenates.

Actinomyces neuii subspecies anitratus chronic endophthalmitis after cataract surgery.

PURPOSE: To report a case of unusual chronic endophthalmitis by Actinomyces neuii subspecies anitratus. METHODS: A 75-year-old man underwent uneventful phacoemulsification with implantation of a foldable posterior chamber intraocular lens in his right eye. Four weeks after surgery, a chronic post-operative endophthalmitis characterized by anterior chamber and vitreous cellular debris developed in this eye. Cultures were positive, and A neuii subspecies anitratus was identified by polymerase chain reaction and subsequent rRNA sequence analysis. Immediate treatment included intravitreal and intensive topical antibiotics along with oral ciprofloxacin. RESULTS: The condition improved rapidly, and 6 months after surgery the patient was asymptomatic, the best spectacle-corrected visual acuity was 20/22, and the anterior chamber was quiet. CONCLUSIONS: A neuii subspecies anitratus should be considered in the differential diagnosis of chronic endophthalmitis after cataract surgery. Polymerase chain reaction and subsequent RNA typing were useful in detecting the causative organism, and intravitreal antibiotics were successful.

Influence of the flap on outcomes in corneal refractive surgery with femtosecond laser: SMILE vs. FLEx. / Influencia del flap en los resultados en la cirugía refractiva corneal con láser de femtosegundo: SMILE vs. FLEx.

OBJECTIVE: To investigate the influence of creating a flap on the postoperative optical quality of the cornea in terms of predicted corneal curvature and Seidel aberrations after 2 modalities of femtosecond assisted corneal lenticule extraction laser for the correction of myopia and myopic astigmatism: The flapless procedure small incision lenticular extraction (SMILE) and the flap-based femtosecond lenticular extraction (FLEx). METHODS: The study is a prospective consecutive non-randomised comparative interventional case series including 64 eyes with myopic or myopic astigmatism refractive errors. Patients were divided into 2 groups matched for age, sex and myopia. One group underwent SMILE treatment and the other underwent FLEx treatment. Seidel aberrations root-mean-square values were obtained with a 10mm aperture using the ATLAS 9000 topographer before surgery and 3 months after surgery. The relationship between the post-surgical corneal radius and the predicted sculpted radius were analysed in each group. RESULTS: The mean percentage change in the curvature radius was -2.03% in the FLEx group and -1.77% in the SMILE group (P=.655). The higher correlation for the SMILE group demonstrates a better predictability after the surgery. As regards corneal aberrations, the FLEx treatment showed a greater increase of higher order aberrations than SMILE treatment (P=.04). CONCLUSION: The mean refractive change in corneal curvature, which is indirectly related to the biomechanical response of the corneal surface after the lenticule cut and extraction, was similar after both treatments. However, the flap based FLEx procedure showed a greater degradation of the corneal optical quality in terms of induction of higher order aberrations.

An angle-supported foldable phakic intraocular lens for correction of myopia: A five-year follow-up. / Lente intraocular fáquica plegable acrílica de apoyo angular para la corrección de miopía: seguimiento de 5 años.

OBJECTIVE: To evaluate the efficacy and safety of an angle-supported foldable phakic intraocular lens (pIOL) for the correction of moderate to high myopia after 5 years follow-up. METHODS: Prospective and retrospective, observational, longitudinal, non-randomised consecutive series of cases conducted on a total of 100 eyes of 67 patients with moderate to high myopia implanted with an Acrysof Cachet pIOL (Alcon Laboratories Inc.) with the aim of minimising the refractive error. The ages ranged between 18 to 60years. Uncorrected distance visual acuity (UDVA), manifest refraction, corrected distance visual acuity (CDVA), endothelial cells density, pIOL position, intraocular pressure, and complications were recorded preoperatively and during the 5 year follow-up. RESULTS: Five years after implantation, the mean manifest spherical equivalent refraction reduced significantly from -11.62±3.35 dioptres (D) to -0.33±0.85D. UDVA was 20/20 or better in 5 of 25 cases (20%), and 20/40 or better in 22 cases (88%). CDVA was 20/20 or better in 17 cases (68%), and 20/32 or better in 23 cases (92%) of eyes. The residual refractive error was within ±0.50D of emmetropia in 12 cases (48%), and within ±1.00D in 19 cases (76%). Mean endothelial cell loss at 5 years was 11.8% central, and 13.7% peripheral. Mean endothelium-pIOL distance was 2.11±0.18mm, and mean pIOL-crystalline distance was 0.88±0.20mm. CONCLUSIONS: This angle supported pIOL provided a favourable refractive correction and predictability, as well as acceptable safety in patients with moderate to high myopia. Although endothelial cell density decreased over 5years, the results are within the range reported in previous studies with other pIOLs.

Relación entre la condición física y el hábito de actividad física con la capacidad de atención selectiva en alumnos de enseñanza secundaria / Relação entre condição física e hábito de atividade física com capacidade de atenção seletiva em estudantes do ensino secundário / Relationship between physical fitness and the physical activity habit with the selective attention capacity in secondary school students

El objetivo del presente estudio fue analizar la relación entre las capacidades físicas, el hábito de realizar actividad física y la capacidad de atención selectiva en una muestra de estudiantes de enseñanza secundaria. La muestra fue configurada por un total de 97 participantes, concretamente 51 estudiantes de género femenino (n = 51) y 46 de género masculino (n = 46) de Barcelona (Cataluña) con edades comprendidas entre los 13 y los 15 años (13,7 ± 1,17). Para analizar la capacidad de atención selectiva se utilizó el Test de Percepción de Semejanzas y Diferencias (CARAS-R). Referente a la condición física, se evaluó la velocidad lineal (30 metros lisos), la fuerza de tren inferior (test de salto horizontal), la agilidad (test de10x5 metros) y la resistencia aeróbica (test de Luc-Léger). Finalmente el hábito de realización de actividad física se calculó con el Cuestionario internacional de actividad física en su formato adaptado para adolescentes (IPAQ-A). Los resultados mostraron que los participantes con un mayor rendimiento en el test de Luc-Léger, obtuvieron mejores puntuaciones en el test CARAS-R. Asimismo se obtuvo una correlación alta entre los registros del test de Luc-Léger y el test CARAS-R tanto para el género masculino como el femenino y una correlación alta entre el cuestionario IPAQ-A y el test CARAS-R en el género masculino. Dichos hallazgos, ponen de manifiesto la relación entre la atención selectiva y el nivel de condición física en adolescentes. En este sentido, se refuerza la importancia de practicar actividad física a esta edad, sugiriendo que el incremento de la condición física puede tener implicaciones positiva sobre la atención selectiva.

The aim of this study was to analyze the relationship between fitness, selective attention and the physical activity habit in high school students. The sample was configured by a total of 97 participants, 51 females (n = 51) and 46 males (n = 46) from Barcelona (Catalonia), aged between 13 and 15 years (13,7 ± 1,17). To analyze the selective attention capacity, it was used the Perception of Similarities and Differences Test (CARAS-R). Regarding physical fitness, linear velocity (30-meter dash test), lower body strength (board jump test), agility (10x5 meter test) and aerobic capacity (Luc-Léger test) were evaluated. Finally, the physical activity was calculated with the International Physical Activity Questionnaire adapted for adolescents (IPAQ-A). The results showed that the subjects with higher performance in the Luc-Léger test obtained better scores in the CARAS-R test. A high correlation was also obtained between the records of the Luc-Léger test and the CARAS-R test in both boys and girls and a high correlation between the IPAQ-A questionnaire and the CARAS-R test in boys. These findings highlight the relationship between selective attention and the fitness level in adolescents. In this sense, the importance of practicing physical activity at this age is reinforced, suggesting that the increase of physical condition may have positive implications on selective attention.

O objetivo do presente estudo foi analisar a relação entre habilidades físicas, atenção seletiva e o hábito de praticar atividade física numa amostra de estudantes do ensino médio. A amostra foi composta por um total de 97 sujeitos, especificamente 51 estudantes do sexo feminino (n = 51) e 46 do sexo masculino (n = 46) de Barcelona (Catalunha) com idades entre 13 e 15 anos (13,7 ± 1,17). Para analisar a capacidade de atenção seletiva, foi utilizado o Teste de Percepção de Diferenças e Diferenças (CARAS-R). A condição física foi avaliada através do teste de 30 metros de velocidade suave (velocidade linear), do teste de salto horizontal (força do corpo inferior), do teste de 10x5 metros (agilidade) e do teste de Luc-Léger (resistência). Por fim, o hábito de realizar atividade física foi calculado com o Questionário Internacional de Atividade Física, em formato adaptado para adolescentes (IPAQ-A). Os resultados mostraram que os sujeitos com maior desempenho no teste Luc-Léger obtiveram melhores pontuações no teste CARAS-R. Da mesma forma, foi obtida uma alta correlação entre os registros do teste Luc-Léger e o teste CARAS-R em meninos e meninas e uma alta correlação entre o questionário IPAQ-A e o teste CARAS-R em meninos. Os resultados revelam a relação entre a atenção seletiva e o nível de aptidão física em adolescentes. Nesse sentido, a importância da prática de atividade física nessa faixa etária é reforçada, sugerindo que o aumento da condição física pode ter implicações positivas na atenção seletiva. (AU)