[Complications after endothelial keratoplasty: three years of experience]. / Complicaciones tras queratoplastia endotelial: tres años de experiencia.

OBJECTIVE: To study the complications after Descemet's stripping automated endothelial keratoplasty (DSAEK). METHODS: Retrospective study of 75 eyes in 67 patients with Fuchs' endothelial dystrophy or bullous keratopathy operated on in the Instituto de Oftalmología La Arruzafa from March, 2007 until March, 2010. Phacoemulsification and IOL implantation was involved in 30 cases. All surgical and post-surgical complications, as well as the endothelial cell density were recorded. RESULTS: Graft detachment was the most common complication: 17 cases (22.5%); 16 of them resolved with reintroduction of air in the anterior chamber. The rate of detachment in cases without capsular support (8 eyes) increased up to 50%. Five cases had primary graft failure and, in 2 cases, a medium term failure was observed. Only one case of endothelial rejection was observed (1.3%). Five eyes (6.5%) developed a pupillary block, but of them were solved with the aspiration of the air. In one eye (1.3%), a posterior capsule rupture was observed during the phacoemulsification. This case ended with a retinal detachment. The endothelial cell loss was 42.75%. CONCLUSIONS: DSAEK is an effective surgical technique to resolve the corneal oedema due to endothelial failure; however, complications are not uncommon. Graft detachment is the most common complication, but is usually resolved with re-bubbling. There is an evident learning curve and the surgical trauma to the endothelium is the most important factor that influences the endothelial cell loss.

Complicaciones tras queratoplastia endotelial: tres años de experiencia / Complications after endothelial keratoplasty: three years of experience

ObjetivoExaminar las complicaciones tras queratoplastia endotelial automatizada con disección de la membrana de Descemet (DSAEK).MétodosRevisión retrospectiva de 75 cirugías de DSAEK en 67 pacientes con distrofia endotelial de Fuchs o queratopatía bullosa realizadas en el Instituto de Oftalmología La Arruzafa desde marzo de 2007 hasta marzo de 2010. En 30 casos se asoció facoemulsificación e implante de LIO. Todas las complicaciones intraoperatorias y postoperatorias fueron registradas, además de la densidad celular endotelial.ResultadosLa dislocación del disco fue la complicación más frecuente: 17 casos (22,5%); 16 se resolvieron con la reintroducción de aire en cámara anterior. La tasa de desprendimiento del injerto fue del 50% en los 8 ojos sin soporte capsular. En 5 casos se produjo un fracaso primario del injerto y en 2 (2,6%) el injerto ha fracasado a medio plazo; solo tenemos un caso de rechazo endotelial (1,3%). Cinco ojos (6,5%) desarrollaron un bloqueo pupilar postquirúrgico que se resolvió tras la extracción del aire. Un ojo (1,3%) con rotura capsular posterior durante la cirugía desarrolló al año un desprendimiento de retina. La pérdida celular media fue del 42,75%.ConclusionesDSAEK ha demostrado ser un tratamiento efectivo para la disfunción endotelial; sin embargo no está exenta de complicaciones. La dislocación del disco es la complicación más frecuente siendo resuelta tras la reintroducción de aire en la mayoría de los casos. Existe una curva de aprendizaje y el traumatismo intraoperatorio es un factor relacionado con la pérdida endotelial(AU)

ObjectiveTo study the complications after Descemet's stripping automated endothelial keratoplasty (DSAEK).MethodsRetrospective study of 75 eyes in 67 patients with Fuchs’ endothelial dystrophy or bullous keratopathy operated on in the Instituto de Oftalmología La Arruzafa from March, 2007 until March, 2010. Phacoemulsification and IOL implantation was involved in 30 cases. All surgical and post-surgical complications, as well as the endothelial cell density were recorded.ResultsGraft detachment was the most common complication: 17 cases (22.5%); 16 of them resolved with reintroduction of air in the anterior chamber. The rate of detachment in cases without capsular support (8 eyes) increased up to 50%. Five cases had primary graft failure and, in 2 cases, a medium term failure was observed. Only one case of endothelial rejection was observed (1.3%). Five eyes (6.5%) developed a pupillary block, but of them were solved with the aspiration of the air. In one eye (1.3%), a posterior capsule rupture was observed during the phacoemulsification. This case ended with a retinal detachment. The endothelial cell loss was 42.75%.ConclusionsDSAEK is an effective surgical technique to resolve the corneal oedema due to endothelial failure; however, complications are not uncommon. Graft detachment is the most common complication, but is usually resolved with re-bubbling. There is an evident learning curve and the surgical trauma to the endothelium is the most important factor that influences the endothelial cell loss(AU)

[Functional results after endothelial queratoplasty: three years of experience]. / Resultados funcionales tras queratoplastia endotelial: tres años de experiencia.

OBJECTIVE: To study the refractive and visual results after Descemet's stripping automated endothelial queratoplasty (DSAEK). METHODS: Retrospective study of 75 eyes in 67 patients with Fuchs' endothelial dystrophy or bullous queratopathy operated on in the Instituto de Oftalmología La Arruzafa from March, 2007 until March, 2010. Phacoemulsification and IOL implantation was involved in 30 cases. We divided all cases into three groups, depending on the potential visual acuity: A (≤ 0.1), B (0.1-0.5) and C (≥ 0.5). Uncorrected distance visual acuity (UCVA), corrected distance visual acuity (CDVA) and refraction were measured. RESULTS: Mean CDVA improved 3 lines compared to preoperative values (P<.01). Astigmatism increased by 0.5 dioptres (P=.21). A slight myopic change was found in cases where the donor disc was≥8.5mm, as well as in the cases in which phacoemulsification was associated. No correlation between CDVA and donor disc thickness was found. In the group of patients who only had corneal oedema, the mean CDVA was 0.8. No patients ended with less than 0.6 of CDVA and the mean UCVA was 0.5. CONCLUSIONS: After DSAEK, CDVA improved with a slight hyperopic change, without significant changes in astigmatism. Donor disc thickness does not influence the CDVA. DSAEK is an effective surgical technique to restore a good visual acuity in cases with corneal oedema due to endothelial failure.

Resultados funcionales tras queratoplastia endotelial / Functional results after endothelial queratoplasty: three years of experience

Objetivo: Evaluar los resultados refractivos y visuales tras realizar una queratoplastia endotelialautomatizada con disecci¨®n de la membrana de Descemet (DSAEK).M¨¦todos: Estudio retrospectivo de 75 cirug¨ªas de DSAEK en 67 pacientes con distrofia endotelialde Fuchs o queratopat¨ªa bullosa realizadas en el Instituto de Oftalmolog¨ªa La Arruzafadesde marzo de 2007 hasta marzo de 2010. En 30 casos se asoci¨® facoemulsificaci¨®n eimplante de LIO. Dividimos los casos en 3 grupos seg¨²n el potencial visual: A (¡Ü 0,1), B(0,1-0,5) y C (¡Ý 0,5). Se estudi¨® la agudeza visual sin correcci¨®n (AVSC), la refracci¨®n y laagudeza visual corregida (AVCC).Resultados: La AVCC postoperatoria media (teniendo en cuenta los tres grupos de pacientes)ha mejorado 3 l¨ªneas respecto a la preoperatoria (p < 0,01). El astigmatismo se ha incrementadoen 0,5 dioptr¨ªas (p = 0,21). El equivalente esf¨¦rico entre los injertos ¡Ü8mm con respectoa los ¡Ý8,5 mm revela una leve miopizaci¨®n en el grupo de injertos de mayor di¨¢metro; igualmenteocurre en los casos asociados a facoemulsificaci¨®n. No existe correlaci¨®n entre laAVCC postoperatoria y el grosor del disco corneal. En el grupo C, la media de la AVCC fue de0,8, ning¨²n paciente qued¨® por debajo de 0,6 de AVCC y la media de AVSC fue de 0,5.Conclusiones: Tras DSAEK, la AVCC increment¨® con una ligera hipermetropizaci¨®n, sin cambiosastigm¨¢ticos significativos y sin que influya el grosor del injerto corneal. DSAEK es unat¨¦cnica efectiva para el tratamiento del edema corneal secundario a alteraci¨®n endotelial(AU)

Objective: To study the refractive and visual results after Descemet¡¯s stripping automatedendothelial queratoplasty (DSAEK).Methods: Retrospective study of 75 eyes in 67 patients with Fuchs¡¯ endothelial dystrophy orbullous queratopathy operated on in the Instituto de Oftalmolog¨ªa La Arruzafa from March, 2007 until March, 2010. Phacoemulsification and IOL implantation was involved in 30 cases.We divided all cases into three groups, depending on the potential visual acuity: A (¡Ü 0.1), B(0.1-0.5) and C (¡Ý 0.5). Uncorrected distance visual acuity (UCVA), corrected distance visualacuity (CDVA) and refraction were measured.Results: Mean CDVA improved 3 lines compared to preoperative values (P < .01). Astigmatismincreased by 0.5 dioptres (P = .21).Aslightmyopic changewas found in cases where the donordisc was¡Ý8.5mm, as well as in the cases in which phacoemulsification was associated. Nocorrelation between CDVA and donor disc thicknesswas found. In the group of patients whoonly had corneal oedema, the mean CDVA was 0.8. No patients ended with less than 0.6 ofCDVA and the mean UCVA was 0.5.Conclusions: After DSAEK,CDVAimproved with a slight hyperopic change, without significantchanges in astigmatism. Donor disc thickness does not influence the CDVA. DSAEK is aneffective surgical technique to restore a good visual acuity in cases with corneal oedemadue to endothelial failure(AU)

[Clinico-epidemiological study of neurolisteriosis in the province of Segovia]. / Estudio clinicoepidemiológico de la neurolisteriosis en la provincia de Segovia.

INTRODUCTION: Listeria monocytogenes is a microorganism with marked tropism towards the central nervous system. One of the commonest forms of presentation is as a meningeal infection. The objective of this study is to describe the epidemiological, clinical and laboratory characteristics and therapeutic implications. PATIENTS AND METHODS: We made a retrospective analysis of four patients, admitted to hospital with the diagnosis of meningeal infection and positive culture for L. monocytogenes in the cerebrospinal fluid (CSF), who were admitted to our centre between 1 January 1996 and 31 December 2000. The overall rate of meningitis due to L. monocytogenes in the province of Segovia is similar to that reported from the USA and Europe (six cases per million inhabitants per year). All the patients were male, aged between 19 and 79 years. The commonest form of presentation was a meningeal syndrome. Analysis of the CSF showed pleocytosis with high protein and low glucose levels. Gram staining was negative in all cases. Initial empirical treatment proved to be correct in two of the four patients. The only predisposing factors observed were alcoholism and diabetes mellitus. All four cases recovered. CONCLUSION: We emphasize the difficulty in diagnosing meningitis due to L. monocytogenes, since the presenting symptoms are relatively non specific, CSF analysis gives variable results and Gram staining is of little use. Clinical suspicion is important so that specific antibiotic treatment may be given to improve the prognosis.

Estudio clinicoepidemiológico de la neurolisteriosis en la provincia de Segovia / Clinico-epidemiological study of neurolisteriosis in the province of Segovia

Introducción. Listeria monocytogenes es un microorganismo con especial tropismo por el sistema nervioso central. Una de sus manifestaciones clínicas más frecuentes es la infección meníngea. El objetivo de este estudio es describir las características epidemiológicas, clínicas, analíticas e implicaciones terapéuticas. Pacientes y métodos. Análisis retrospectivo de cuatro pacientes ingresados con el diagnóstico de infección meníngea con positividad en el cultivo de líquido cefalorraquídeo (LCR) para L. monocytogenes, atendidos en nuestro centro entre el 1 de enero de 1996 y el 31 de diciembre de 2000. Resultados. La tasa global de meningitis por L. monocytogenes en la provincia de Segovia es similar a la publicada en EE.UU. y Europa (seis casos por millón de habitantes/año). Todos los pacientes eran varones, con edades comprendidas entre 19 y 79 años. La forma de presentación más frecuente fue un síndrome meníngeo. El análisis del LCR mostró pleocitosis, hiperproteinorraquia e hipoglucorraquia. La tinción de Gram fue negativa en todos los casos. El tratamiento empírico inicial fue correcto en dos de los cuatro pacientes. El alcoholismo y la diabetes mellitus fueron los únicos factores predisponentes encontrados. La evolución fue favorable en los cuatro casos. Conclusiones. Queremos resaltar la dificultad del diagnóstico de meningitis por L. monocytogenes, probablemente sobre la base de la baja especificidad de los síntomas de presentación, la variabilidad de los resultados del análisis del LCR y el bajo rendimiento de la tinción de Gram. La importancia de la sospecha clínica radica en la necesidad de instaurar un tratamiento antibiótico específico para mejorar su pronóstico (AU)