Effects and safety of perfluorohexyloctane on the eye surface and corneal endothelium. / Efectos y seguridad del perfluorohexiloctano en la superficie ocular y el endotelio corneal.

OBJECTIVE: To evaluate the effects and safety of topical drops of perfluorohexyloctane (F6H8) on the ocular surface and the corneal endothelium. METHODS: Forty-five patients (90 eyes) diagnosed with dry eye disease were recruited and prescribed treatment with F6H8 as part of a six-month prospective multicentre study. Variables in corneal staining were documented using the National Eye Institute/Industry Workshop scale. The conjunctival variables included using the Oxford scale, as well as corneal parameters, such as central corneal thickness, cell density, coefficient of variation, hexagonality, and mean cell area, at the start of the study, and at 3months and 6months. Compliance and satisfaction with the treatment were measured. RESULTS: F6H8 drops reduced mean corneal staining based on the NEI scale in compliant patients to a mean of -0.84 ± 1.95 at 3months (P=.001) and to -1.65 ± 2.42 at 6months (P<.001). Conjunctival staining at 6months showed a mean decrease of -0.13 (P=.319). The endothelial parameters did not show a significant difference, in contrast to the central corneal thickness that showed a statistically significant decrease (545.30 ± 32.25 at the start of the study to 538.40 ± 31.36 after 6months, P=.009). At the end of the study, 46% of patients reported feeling subjectively better, 40.5% felt the same, and 13.5% felt subjectively worse. CONCLUSIONS: Topical treatment with F6H8 for dried eye disease did not alter the measured variables of the corneal endothelium, but showed improvement in corneal staining and satisfaction.

[Intravitreal ranibizumab for choroidal neovascularisation associated with adult-onset vitelliform dystrophy]. / Ranibizumab intravítreo en neovascularización coroidea secundaria a distrofia foveomacular viteliforme del adulto.

CASE REPORT: A 70-year-old male patient diagnosed with bilateral adult-onset vitelliform dystrophy presented with a sudden decrease of vision in his left eye associated with the appearance of an occult type of neovascular membrane. It was treated with intravitreal ranibizumab due to juxtafoveal location of the membrane. Two injections were needed to induce total regression of the lesion. DISCUSSION: Intravitreal ranibizumab may be effective to induce morphological and functional improvement in cases of choroidal neovascularization secondary to adult-onset vitelliform foveomacular dystrophy. Further case series are required to confirm this observation.

[Retinal angiomatous proliferation not associated with age-related macular degeneration. Favourable outcome after photodynamic therapy]. / Proliferación angiomatosa retiniana no relacionada con degeneración macular asociada a la edad. Buena respuesta al tratamiento con terapia fotodinámica.

CASE: A 55-year-old male was diagnosed with exudative-hemorrhagic maculopathy, with no signs observed of drusen or pigmentary epithelium defects suggestive of age-related macular degeneration (ARMD). Fluorescein angiography (FA) and indocyanine green choroidal angiography (ICGA) showed retinal angiomatous proliferation (RAP). Afferent arteriole and retinal drainage venule connection was also observed. Treatment with a single Photodynamic Therapy provided an optimal outcome. DISCUSSION: RAP is a form of neovascular ARMD described in recent years; it consists of an angiomatous proliferation that originates from the retinal capillary system and extends posteriorly into the subretinal space. Our patient showed typical RAP findings without any sign of ARMD

[Topical versus contact anaesthesia in conventional trabeculectomy. Prospective randomised study]. / Anestesia tópica versus anestesia de contacto en la trabeculectomía convencional. Estudio prospectivo aleatorizado.

PURPOSE: To compare the pain rates, comfort levels and safety between conventional topical anaesthesia and the application of a long lasting lidocaine soaked film or contact anaesthesia. METHODS: Fifty patients undergoing conventional trabeculectomy with or without Mitomycin-C were included. One half received topical anaesthesia and the other half contact anaesthesia in a random fashion. Pain and discomfort rates before, during and after surgery were evaluated on a scale from 0 to 5, also, surgeon subjective stress and complications observed were included in the clinical protocol. RESULTS: Significant differences were found between both groups regarding pain rates, during and after surgery, and surgeon stress level. Sedation and change of anesthesic method were required more frequently by the patients included in the topical anaesthesia group. CONCLUSIONS: Topical anaesthesia provides sufficient level of anaesthesia for performing a trabeculectomy. Nevertheless pain rate differences between contact and conventional topical anaesthesia were patent during and after surgery. Contact anaesthesia appears to be a valid and practical alternative in a wide range of patients undergoing glaucoma surgery.

[Cup-to-disk ratio asymmetry: diagnostic value in glaucoma]. / Asimetría papilar: valor diagnóstico en el glaucoma.

PURPOSE: To assess visual field abnormalities in suspected glaucoma patients showing evident asymmetry in cup-to-disk ratio. MATERIAL AND METHOD: Twenty two hypertensive eyes in 11 subjects evidencing lateral differences in cup-to-disk ratio of more than 2/10 were included in the study. Conventional and short wavelength automated perimetry (SWAP) was performed with a Humphrey field analyser. A retinal nerve fiber layer (RNFL) study was also performed. RESULTS: Differences in IOP were 1.23 mmHg (p<0.05). No differences were evidenced in conventional automated perimetry between both eyes. Average sensitivity (SWAP) showed significantly lower (p<0.05) in those ayes with greater cup-to-disk ratio. RNFL showed a higher rate of defects in eyes with a higher cup-to-disk ratio. CONCLUSION: Lateral differences in cup-to-disk ratio indicate structural glaucomatous damage which is related to IOP levels. Associated functional loss was evidenced with SWAP (Arch Soc Esp Oftalmol 2002; 77: 17-22).

[Short-wavelength automated perimetry (SWAP) in subjects with suspected glaucoma (I): assessment of sensitivity thresholds]. / Perimetría automatizada de longitud de onda corta (PALOC) en sujetos sospechosos de glaucoma (I): Evaluación de los umbrales de sensibilidad.

PURPOSE: To evaluate the threshold values of short-wavelength-sensitive (SWS, or S-cone pathways) mechanisms, throughout the 30 degrees central visual field, in a glaucoma suspect population, and to compare the results with those obtained in the Retinal Nerve Fiber Layer study. METHODS: We studied the central visual field from 288 eyes of 211 subjects classified as ocular hypertensives (160 eyes) or age-matched normal controls (128 eyes). A modified Humphrey Field Analyser was used to isolate and measure the sensitivity of the SWS mechanisms. Monochromatic red-free photographs (RNFL) were taken with a wideangle fundus camera at the same period. RESULTS: Comparing normal and OHT eyes, we found significant differences in sensitivity for SWS cone pathways in the superior and inferior nasal quadrants, paracentral and peripheral region, and in the superior hemifield (p<0.05). Based on the perimetric criteria described, the SWAP was pathological in 57 cases. which represents 35.6% of the total sample. Using RNFL as early glaucoma diagnostic criterion, SWAP sensitivity and specificity values were 62% and a 89% respectively. CONCLUSIONS: SWAP is a useful test for the early detection of visual field losses. It is more sensitive than, standard automated perimetry and gives a high correlation with RNFL assessment, which has proved capable of detecting signs of glaucomatous damage several years before the onset of the typical visual field defects.

[Short-wavelength automated perimetry (SWAP) in patients with suspected glaucoma (II): correlation with a probabilistic multifactorial model of risk for developing glaucomatous damage]. / Perimetría automatizada de longitud de onda corta (PALOC) en sujetos sospechosos de glaucoma (II): correlación con un modelo multifactorial probabilístico de riesgo de desarrollar daño glaucomatoso.

PURPOSE: To evaluate the efficiency and predictability of a multifactorial probability model to assess the risk of developing glaucomatous visual field defects and to determine the correlation between retinal nerve fiber layer (RNFL) photographs and short-wavelength automated perimetry (SWAP) in a population of patients suspected of having glaucoma. METHODS: One hundred and sixty eyes belonging to 83 patients with ocular hypertension [ocular pressure figures over 21 mmHg and normal conventional automated perimetry (AP) (white-white)] were included in the study. The risk of developing glaucomatous defects was assessed by a multifactorial model that includes intraocular pressure. vertical cup-to-disk ratio, age and family background. RNFL photographs and SWAP tests were also performed. RESULTS: SWAPs were pathological in 57 cases (35.6% of the sample); 23% of the perimetries were abnormal in the low-risk group while the moderate and high risk groups showed abnormal perimetries 38% and 56% respectively. The RNFL defects at the different risk levels were consistent with the SWAP results. The multiple regression analysis of the four variables included in the model showed the relationship among the risk factors, evaluated globally, and the presence of glaucomatous damage evaluated by RNFL and SWAP (p<0.001). CONCLUSIONS: The usefulness of this probability model as predictive indicator of subsequent glaucomatous damage is based on the good correlation between the risk scale and the RNFL and SWAP assessments. These techniques evaluate structural (RNFL) and functional (SWAP) changes in early stages of the glaucomatous disease.

[An analysis of the responses to the Cage test obtained among young people from a rural area]. / Análisis de las respuestas al test de Cage obtenidas entre jóvenes del medio rural.

OBJECTIVE: The aim of this study is to detect alcoholism problems among the young population, using the CAGE test. DESIGN: Transversal descriptive study. SITE. Work developed with high school students (BUP and COU) from a rural context in Aragón. PATIENTS AND OTHER PARTICIPANTS: Random sample of 1,012 students, ordered by gender and academic course (57.9% female, age average 16 +/- 1.3 years old). INTERVENTIONS: The CAGE test was answered in written and anonymous way. MAIN MEASUREMENTS AND RESULTS: 368 students (36.5%) obtained scores. 1. Among them, 159 (15.7%) scored 2. The prevalence of alcoholism was greater in male students (p = 0.01). The test shows false positivity in 7 sober people. Youngsters with high scores presented higher risk of suffering a traffic accident (p = 0.001). CONCLUSIONS: Because of the psychological peculiarities of the teenagers CAGE test might have some reliability disturbances. In any case, the results show the existence of an important number of young people in the rural site with problems related to alcohol (although not necessarily linked to physical dependence.