Protocolo de tratamiento del edema macular quístico asociado a retinosis pigmentaria y otras distrofias hereditarias de la retina / Protocol for the treatment of cystoid macular edema secondary to retinitis pigmentosa and other inherited retinal dystrophies

Las distrofias hereditarias de la retina (DHR) son la causa principal de ceguera legal en la población laboral. El edema macular quístico (EMQ) es una de las causas tratables de pérdida visual afectando hasta un 50% de los pacientes. Se ha realizado una revisión bibliográfica combinando «inherited retinal dystrophy», «retinitis pigmentosa», «macular oedema» y un protocolo diagnóstico/terapéutico según los niveles de evidencia y recomendaciones de la «US Agency for Healthcare Research and Quality». Este protocolo se ha discutido en las reuniones mensuales del grupo XAREA DHR con la participación de más de 25 profesionales, creando un documento de consenso. La etiología del EMQ es multifactorial: disfunción de la barrera hematorretiniana, del epitelio pigmentario de la retina y de las células de Müller, inflamación y tracción vítrea. La OCT es la prueba de elección para el diagnóstico y seguimiento del EMQ asociado a las DHR. Los fármacos con mayor grado de evidencia científica son los inhibidores de la anhidrasa carbónica (IAC). Los corticoides, anti-VEGF intravítreos y vitrectomía con pelado de la membrana limitante interna no disponen de suficiente evidencia. Se propone un esquema de tratamiento en el EMQ en las DHR en adultos, otro para pacientes pediátricos y otra en las DHR y cirugía de catarata. Los IAC orales y tópicos son efectivos en el tratamiento del EMQ secundario a las DHR. El tratamiento con corticoides, anti-VEGF y vitrectomía son opciones de segunda línea. Se requieren ensayos clínicos aleatorizados para poder establecer la escala terapéutica en estos pacientes.(AU)

Inherited retinal dystrophies (IRD) are the leading cause of legal blindness in the working population. Cystic macular edema (CME) is one of the treatable causes of visual loss, affecting up to 50% of the patients. A bibliographic review has been carried out combining “inherited retinal dystrophy”, “retinitis pigmentosa”, “macular edema” and a diagnostic-therapeutic protocol according to the levels of evidence and recommendations of the “US Agency for Healthcare Research and Quality”. This protocol has been discussed in the monthly meetings of the XAREA DHR group with the participation of more than 25 experts, creating a consensus document. The etiology of CME is multifactorial: dysfunction of the blood-retinal barrier, retinal pigment epithelium, and Müller cells, inflammation, and vitreous traction.OCT is the test of choice for the diagnosis and follow-up of CME associated with IRD. The drugs with the highest degree of scientific evidence are carbonic anhydrase inhibitors (IAC). Intravitreal corticosteroids, anti-VEGF, and vitrectomy with peeling of the internal limiting membrane do not have sufficient evidence. A treatment scheme is proposed for the CME in IRD in adults, another for pediatric patients and an another for IRD and cataract surgery. Oral and topical IACs are effective in the treatment of CME secondary to IRD. Treatment with corticosteroids, anti-VEGF, and vitrectomy are second-line options. Randomized clinical trials are required to establish the therapeutic scale in these patients.(AU)

Traducción y validación del cuestionario Visual Function and Corneal Health Status (V-FUCHS) al idioma castellano / Translation and validation of the Visual Function and Corneal Health Status (V-FUCHS) questionnaire into Spanish language

Objetivo: Traducir y validar al castellano el cuestionario V-FUCHS en una población de pacientes que padecen distrofia endotelial de Fuchs (DEF).MétodosEl V-FUCHS consta de 15 preguntas, que valoran aspectos visuales de la calidad de vida en los pacientes con DEF, las cuales se pueden agrupar en 7 que valoran el factor «dificultad visual» y 8 que valoran el factor «deslumbramiento». Para la traducción y adaptación se siguieron las normas estandarizadas, destacando, una traducción, una retro-traducción y una aplicación en pacientes con DEF.ResultadosEn una primera fase se llegó al consenso de la traducción al castellano del V-FUCHS. Posteriormente, se incluyeron 25 pacientes para realizar la fase pre-test con el objetivo de valorar la aplicabilidad y la viabilidad del test. La puntuación de las mismas obtuvo un valor mínimo de −0,88 y un valor máximo de +2,44, según la escala probabilística de Rasch. El valor medio obtenido de las preguntas que conforman el factor dificultad visual fue de 0,61 (±0,71) y la media del factor deslumbramiento (Glare) fue de 0,41 (±0,51).ConclusiónLa validación del cuestionario V-FUCHS, tras su traducción y adaptación al castellano, demostró ser una herramienta útil para la valoración de la calidad visual de los pacientes con DEF. Los pacientes con un estado más avanzado de la enfermedad presentaron una mayor severidad en el resultado de la prueba. Asimismo, el factor deslumbramiento se correlaciona mejor con el aumento paquimétrico que con la agudeza visual del paciente. (AU)

Purpose: To translate and validate the V-FUCHS questionnaire into Spanish in a population of patients with Fuchs endothelial dystrophy (DEF).MethodsThe V-FUCHS consists of 15 short, easily understandable questions that assess visual aspects of quality of life in patients with DEF, which can be gathered into a group of seven that assess the “Visual Difficulty” factor and another group of eight that assess the “Glare Factor”. For the translation and cultural adaptation, the standardized norms for this process were followed, among other phases, a translation, a back-translation and an application in patients with DEF.ResultsIn the first phase, consensus was reached on the Spanish translation of the V-FUCHS. Subsequently, 25 patients were included to carry out the pre-test phase with the aim of assessing the applicability and feasibility of the test. The score obtained a minimum value of −0.88 and a maximum value of +2.44, according to the Rasch probabilistic scale. The mean value obtained from the Visual Difficulty factor was 0.61 (±0.71), while the mean for the Glare factor was 0.41 (±0.51).ConclusionThe validation of the V-FUCHS questionnaire, after its translation and adaptation into Spanish, proved to be a useful tool for assessing the visual quality of patients with DEF. Patients with a more advanced stage of the disease presented a greater severity in the test result. Likewise, the Glare factor (Glare) correlates better with the pachymetric increase than with the visual acuity of the patient. (AU)

Protocol for the treatment of cystoid macular edema secondary to retinitis pigmentosa and other inherited retinal dystrophies.

Inherited retinal dystrophies (IRD) are the leading cause of legal blindness in the working population. Cystic macular edema (CME) is one of the treatable causes of visual loss, affecting up to 50% of the patients. A bibliographic review has been carried out combining "inherited retinal dystrophy", "retinitis pigmentosa", "macular oedema" and a diagnostic-therapeutic protocol according to the levels of evidence and recommendations of the "US Agency for Healthcare Research and Quality". This protocol has been discussed in the monthly meetings of the XAREA DHR group with the participation of more than 25 ophthalmologists, creating a consensus document. The etiology of CME is multifactorial: dysfunction of the blood-retinal barrier, retinal pigment epithelium, and Müller cells, inflammation, and vitreous traction. OCT is the test of choice for the diagnosis and follow-up of CME associated with IRD. The drugs with the highest degree of scientific evidence are carbonic anhydrase inhibitors (IAC). Intravitreal corticosteroids, anti-VEGF, and vitrectomy with peeling of the internal limiting membrane do not have sufficient evidence. A treatment scheme is proposed for the CME in IRD in adults, another for pediatric patients and another for IRD and cataract surgery. Oral and topical IACs are effective in the treatment of CME secondary to IRD. Treatment with corticosteroids, anti-VEGF, and vitrectomy are second-line options. Randomized clinical trials are required to establish the therapeutic scale in these patients.

Translation and validation of the Visual Function and Corneal Health Status (V-FUCHS) questionnaire into Spanish language.

PURPOSE: To translate and validate the V-FUCHS questionnaire into Spanish in a population of patients with Fuchs endothelial dystrophy (DEF). METHODS: The V-FUCHS consists of 15 short, easily understandable questions that assess visual aspects of quality of life in patients with DEF, which can be gathered into a group of seven that assess the "Visual Difficulty" factor and another group of eight that assess the "Glare Factor". For the translation and cultural adaptation, the standardized norms for this process were followed, among other phases, a translation, a back-translation and an application in patients with DEF. RESULTS: In the first phase, consensus was reached on the Spanish translation of the V-FUCHS. Subsequently, 25 patients were included to carry out the pre-test phase with the aim of assessing the applicability and feasibility of the test. The score obtained a minimum value of -0.88 and a maximum value of +2.44, according to the Rasch probabilistic scale. The mean value obtained from the Visual Difficulty factor was 0.61 (±0.71), while the mean for the Glare Factor was 0.41 (±0.51). CONCLUSION: The validation of the V-FUCHS questionnaire, after its translation and adaptation into Spanish, proved to be a useful tool for assessing the visual quality of patients with DEF. Patients with a more advanced stage of the disease presented a greater severity in the test result. Likewise, the Glare Factor (Glare) correlates better with the pachymetric increase than with the visual acuity of the patient.

Pterygium surgery with lyophilized versus cryopreserved amniotic membrane graft.

PURPOSE: To evaluate surgical outcomes (recurrence rate, aesthetics and symptoms) of pterygium surgery with two different amniotic membrane preservation approaches - lyophilized (LAM) and cryopreserved (CAM). METHODS: Primary pterygium patients were randomized to either LAM or CAM surgery. Demographic data, ocular surface disease index (OSDI), aesthetic grading (1 to 4), recurrences and complications were recorded over a 6-month follow-up period. RESULTS: Twenty-nine patients were recruited. Recurrence at month 6 was detected in 11 cases (37.9%) and was more prevalent with CAM grafts, without reaching statistical significance (P=0.196). Aesthetic outcome grading showed no differences between LAM and CAM at month 6 (P=0.124). Aesthetic results were mostly unsatisfactory (grade 3 and 4) without statistical differences between groups (P=0.514). Baseline OSDI was similar in both groups (P=0.888), and it significantly decreased by the last follow-up visit (P<0.001) for both the LAM and CAM groups. This decrease did not significantly differ between amniotic membrane preservation approach surgery groups (P=0.714). CONCLUSION: LAM might be considered a legitimate alternative to CAM, showing no inferiority in outcomes, since clinical and aesthetic outcomes were similar for both groups.

Fast protocol for the processing of split-thickness skin into decellularized human dermal matrix.

BACKGROUND: Dermal scaffolds for tissue regeneration are nowadays an effective alternative in not only wound healing surgeries but also breast reconstruction, abdominal wall reconstruction and tendon reinforcement. The present study describes the development of a decellularization protocol applied to human split-thickness skin from cadaveric donors to obtain dermal matrix using an easy and quick procedure. METHODS: Complete split-thickness donor was decellularized through the combination of hypertonic and enzymatic methods. To evaluate the absence of epidermis and dermal cells, and ensure the integrity of the extracellular matrix (ECM) structure, histological analysis was performed. Residual genetic content and ECM biomolecules (collagen, elastin, and glycosaminoglycan) were quantified and tensile strength was tested to measure the effect of the decellularization technique on the mechanical properties of the tissue. RESULTS: Biomolecules quantification, residual genetic content (below 50 ng/mg dry tissue) and histological structure assessment showed the efficacy of the decellularization process and the preservation of the ECM. The biomechanical tests confirmed the preservation of native properties in the acellular tissue. CONCLUSIONS: The acellular dermal matrix obtained from whole split-thickness skin donor with the newly developed decellualrization protocol, maintains the desired biomechanical and structural properties and represents a viable treatment option for patients.

Effective decellularization of human nerve matrix for regenerative medicine with a novel protocol.

Injuries to the peripheral nerves represent a frequent cause of permanent disability in adults. The repair of large nerve lesions involves the use of autografts, but they have several inherent limitations. Overcoming these limitations, the use of decellularized nerve matrix has emerged as a promising treatment in tissue regenerative medicine. Here, we generate longer human decellularized nerve segments with a novel decellularization method, using nonionic, zwitterionic, and enzymatic incubations. Efficiency of decellularization was measured by DNA quantification and cell remnant analysis (myelin, S100, neurofilament). The evaluation of the extracellular matrix (collagen, laminin, and glycosaminoglycans) preservation was carried out by enzyme-linked immunosorbent assay (ELISA) or biochemical methods, along with histological and immunofluorescence analysis. Moreover, biomechanical properties and cytocompatibility were tested. Results showed that the decellularized nerves generated with this protocol have a concentration of DNA below the threshold of 50 ng/mg of dry tissue. Furthermore, myelin, S100, and MHCII proteins were absent, although some neurofilament remnants could be observed. Moreover, extracellular matrix proteins were well maintained, as well as the biomechanical properties, and the decellularized nerve matrix did not generate cytotoxicity. These results show that our method is effective for the generation of decellularized human nerve grafts. The generation of longer decellularized nerve segments would allow the understanding of the regenerative neurobiology after nerve injuries in both clinical assays and bigger animal models. Effective decellularization of human nerve matrix for regenerative medicine with a novel protocol. Combination of zwitterionic, non-ionic detergents, hyperosmotic solution and nuclease enzyme treatment remove cell remnants, maintain collagen, laminin and biomechanics without generating cytotoxic leachables.

Determination of the Culture Time Point to Induce Corneal Epithelial Differentiation in Induced Pluripotent Stem Cells.

BACKGROUND: Limbal stem cells (LSC) are progenitor cells in the ocular surface that renew the corneal epithelium. Limbal stem cell deficiency usually induces blindness through the loss of corneal transparency, and bilateral cases do not an accurate treatment because of the lack of an autologous source of stem cells. METHODS: Induced pluripotent stem cells (iPSC) are promising for use in cell therapy because of their autologous origin and the capability to differentiate into corneal epithelial cells. However, there are not standardized protocols to achieve a complete corneal epithelial differentiation. We examined the expression of several markers in a human episomal iPSC line after an induction period from embryoid bodies. RESULTS: Progenitor LSC and corneal epithelial differentiation markers, some extracellular matrix protein adhesion molecules, and wingless signaling pathway were studied. Overall, LSC progenitor and corneal epithelium differentiation markers increased after maintaining cell culture in specific conditions for 14 days, whereas pluripotency markers decreased. CONCLUSIONS: Our approach indicated that the optimal time point to initiate iPSC differentiation into LSC and corneal phenotypes, with the use of specific medium, is from 14 days after initial embryoid bodies treatment induction.

Disponibilidad de recursos para pacientes con degeneración macular asociada a la edad de tipo húmedo. Estudio Optimal / Availability of resources for patients with wet age-related macular degeneration. Optimal study

Objetivo: Evaluar la disponibilidad de recursos para los pacientes con degeneración macular asociada a la edad de tipo húmedo (DMAE-h) en la práctica clínica actual. Métodos: Estudio observacional, transversal y multicéntrico. Se incluyeron pacientes ≥ 18 años, con neovascularización coroidea activa principal/recurrente secundaria a DMAE-h, diagnosticados desde los 12-18 meses previos al inicio del estudio. Resultados: Participaron 266 pacientes (39 centros). La media de edad (DE) fue de 76,1 (8,1) años, siendo 55,6% mujeres. Según valoración de los investigadores se visitaban semanalmente de mediana (Q1-Q3) 20 (10,0-50,0) pacientes con DMAE-h. Actualmente, 100,0 (45,0-250,0) estaban en tratamiento realizado mayoritariamente en quirófanos (61,5%). Los centros tenían 1,0 (1,0-2,0) quirófano disponible para el tratamiento, durante 2,0 (2,0-5,0) días/semana. El 74,4% estaban en plantas/edificios diferentes de la consulta oftalmológica. El tiempo medio de espera para la consulta fue de 40,0 (30,0-60,0) min y la duración de la administración del tratamiento 20,0 (15,0-50,0) min. El tiempo medio entre solicitud y visita médica fue de 20,0 (15,0-30,0) días y desde el diagnóstico hasta el tratamiento 7,0 (5,0-10,0) días. Los investigadores consideraron insuficiente el personal para exploraciones (84,6%) y tratamiento (46,2%). Un 30,8% y un 20,5% reflejaron carencia de equipos para diagnóstico, tales como la tomografía de coherencia óptica y la angiografía fluoresceínica. Conclusiones: Se requieren más recursos para el diagnóstico y tratamiento de la DMAE-h. Estos resultados, asociados a la actual política de reducción presupuestaria en el sistema público de salud español, invitan a reflexionar sobre la posible recesión que pueda sufrir el diagnóstico y tratamiento de la DMAE-h (AU)

Objective: The aim of the study was to assess the availability of resources for patients with wet age-related macular degeneration (wAMD) in current clinical practice. Methods: Observational, cross-sectional and multicenter study. Eligible subjects were ≥ 18 years old, with primary/secondary active subfoveal AMD-related choroidal neovascularization diagnosed 12-18 months prior to inclusion in the study. Results: A total of 266 patients were included (39 centers). The mean age (SD) was 76.1 (8.1) years, of whom 55.6% were female. According to the investigator assessment a median (Q1-Q3) of 20.0 (10.0-50.0) patients were visited weekly. A mean of 100.0 (45.0-250.0) were currently under treatment mainly performed in operating rooms (61.5%). Centers had 1.0 (1.0-2.0) operating rooms available for treatment 2.0 (2.0-5.0) days/week. In 74.4% they were located on different floors/buildings from ophthalmology services. Waiting time until visit was 40.0 (30.0-60.0) min, and duration of treatment was 20.0 (15.0-50.0) min. The time between request until medical visit was 20.0 (15.0-30.0) days, and from diagnosis to treatment was 7.0 (5.0-10.0) days. Clinicians considered there was insufficient staff for examinations (84.6%), and treatment (46.2%). About 30.8% and 20.5% mentioned lack of diagnostic tools, such as optical coherence tomography and fluorescein angiography. Conclusions: More resources for diagnosis and treatment of wAMD are required. These results, together with the current policy of reducing the budget in the Spanish Health System, could lead to possible delays in the diagnosis and treatment of wAMD (AU)

[Availability of resources for patients with wet age-related macular degeneration. Optimal study]. / Disponibilidad de recursos para pacientes con degeneración macular asociada a la edad de tipo húmedo. Estudio Optimal.

OBJECTIVE: The aim of the study was to assess the availability of resources for patients with wet age-related macular degeneration (wAMD) in current clinical practice. METHODS: Observational, cross-sectional and multicenter study. Eligible subjects were ≥ 18 years old, with primary/secondary active subfoveal AMD-related choroidal neovascularization diagnosed 12-18 months prior to inclusion in the study. RESULTS: A total of 266 patients were included (39 centers). The mean age (SD) was 76.1 (8.1) years, of whom 55.6% were female. According to the investigator assessment a median (Q1-Q3) of 20.0 (10.0-50.0) patients were visited weekly. A mean of 100.0 (45.0-250.0) were currently under treatment mainly performed in operating rooms (61.5%). Centers had 1.0 (1.0-2.0) operating rooms available for treatment 2.0 (2.0-5.0) days/week. In 74.4% they were located on different floors/buildings from ophthalmology services. Waiting time until visit was 40.0 (30.0-60.0) min, and duration of treatment was 20.0 (15.0-50.0) min. The time between request until medical visit was 20.0 (15.0-30.0) days, and from diagnosis to treatment was 7.0 (5.0-10.0) days. Clinicians considered there was insufficient staff for examinations (84.6%), and treatment (46.2%). About 30.8% and 20.5% mentioned lack of diagnostic tools, such as optical coherence tomography and fluorescein angiography. CONCLUSIONS: More resources for diagnosis and treatment of wAMD are required. These results, together with the current policy of reducing the budget in the Spanish Health System, could lead to possible delays in the diagnosis and treatment of wAMD.

Pathological findings in the lens capsules and intraocular lens in chronic pseudophakic endophthalmitis: an electron microscopy study.

PURPOSE: The aim of this study was to describe the pathological findings in lens capsules and intraocular lens (IOL) studied by scanning and/or transmission electron microscopy (SEM and TEM, respectively) in a series of four eyes with chronic pseudophakic endophthalmitis (CPE). PATIENTS AND METHODS: We performed a retrospective study of four patients presenting CPE in whom surgical treatment with pars plana vitrectomy, capsulectomy with extraction of the IOL, and intravitreous antibiotic therapy was thereafter performed. The extracted IOL and the capsular remains were studied by SEM and/or TEM and microbiologic analysis of aqueous humour and vitreous aspirate was also carried out in all the cases. RESULTS: The presence of microorganisms was observed in the material analysed in all the cases studied. The use of TEM identified bacterial contamination by Staphylococcus spp and mixed contamination with microorganisms presenting a bacillar morphology suggestive of infection by Propionibacterium acnes in addition to the presence of cocci in the capsular remains. In another two cases, SEM localized colonies of Staphylococcus spp on the surface of the IOL in one case and mixed bacterial colonization with cocci plus filamentous bacteria in the other. The presence of macrophages associated with bacteria was observed in the capsular remains. CONCLUSIONS: Microorganisms were found in the IOL or the capsular material in the four cases studied, thereby explaining the refractoriness and severity of infection. The possible presence of polymicrobial infections, especially in the cases with filamentous bacteria, also explains the recurrence of infection.

[Acute posterior multifocal placoid pigment epitheliopathy. Study of 16 cases]. / Epiteliopatía pigmentaria placoide posterior multifocal aguda. Estudio de 16 casos.

OBJECTIVE: Acute Posterior Multifocal Placoid Pigment Epitheliopathy (APMPPE) is a rare disease with a probable inflammatory component which mostly affects young patients. The aim of our study was to analyse the demographic and clinical features of this disease in a group of 16 patients. METHODS: Sixteen patients with APMPPE were included in this study. We analyzed their demographic data (age, sex) and the most relevant clinical findings: visual acuity and retinal disease outcome, association with other systemic diseases and response to treatment. We also collected data from fluorescence angiography, autofluorescence and optical coherence tomography (OCT) in some of the patients. RESULTS: Average age at diagnosis was 26.75 years with no sex predilection. Average final visual acuity (Snellen Scale) in our study was 0.73. Four patients presented with a systemic disease related to the APMPPE. Eleven patients were treated with oral steroids (one patient with steroids and cytotoxic agents) while the remaining 5 patients received no treatment. CONCLUSIONS: In our patients, the average age at diagnosis was less than 30 years, with no sex predilection, as previously described by many authors. The visual outcome is usually good regardless of the treatment given, although there are cases with a bad visual outcome, especially those with foveal involvement when initially seen.

Epiteliopatía pigmentaria placoide posterior multifocal aguda. Estudio de 16 casos / Acute posterios multifocal placoid pigment epitheliopathy. Study of 16 cases

Objetivo: La Epiteliopatía Pigmentaria Placoide Posterior Multifocal Aguda (EPPPMA) es una enfermedad infrecuente que afecta a individuos jóvenes y de probable etiología inflamatoria. El objetivo del estudio es analizar las principales características clínicoepidemiológicas de esta enfermedad en una serie de pacientes. Métodos: Se presenta un estudio retrospectivo de 16 pacientes diagnosticados de EPPPMA. Se han estudiado sus características demográficas (edad, sexo) y clínicas: evolución de la agudeza visual y del cuadro retiniano, enfermedades sistémicas asociadas y respuesta al tratamiento. Se han recogido datos angiográficos, autofluoresecencia y tomografía de coherencia óptica (OCT) en algunos pacientes. Resultados: La edad media en nuestra serie es de 26,75 años sin preferencias por el sexo. La media de agudeza visual final en nuestra serie ha sido de 0,73. Cuatro pacientes presentaron enfermedad sistémica asociada a la EPPPMA. 11 pacientes recibieron tratamiento con corticoesteroides (un paciente corticoesteroides e inmunosupresores) y cinco no recibieron tratamiento. Conclusiones: En nuestra serie la edad media se encuentra por debajo de los 30 años y no hubo diferencias en cuanto al sexo, siendo estos resultados congruentes con lo descrito en la literatura. El pronóstico visual es bueno independientemente del tratamiento, aunque hay casos de mal pronóstico visual, especialmente aquellos con afectación foveal precoz

Objective: Acute Posterior Multifocal Placoid Pigment Epitheliopathy (APMPPE) is a rare disease with a probable inflammatory component which mostly affects young patients. The aim of our study was to analyse the demographic and clinical features of this disease in a group of 16 patients. Methods: Sixteen patients with APMPPE were included in this study. We analyzed their demographic data (age, sex) and the most relevant clinical findings: visual acuity and retinal disease outcome, association with other systemic diseases and response to treatment. We also collected data from fluorescence angiography, autofluorescence and optical coherence tomography (OCT) in some of the patients. Results: Average age at diagnosis was 26.75 years with no sex predilection. Average final visual acuity (Snellen Scale) in our study was 0.73. Four patients presented with a systemic disease related to the APMPPE. Eleven patients were treated with oral steroids (one patient with steroids and cytotoxic agents) while the remaining 5 patients received no treatment. Conclusions: In our patients, the average age at diagnosis was less than 30 years, with no sex predilection, as previously described by many authors. The visual outcome is usually good regardless of the treatment given, although there are cases with a bad visual outcome, especially those with foveal involvement when initially seen

[Efficacy of sodium carboxymethylcellulose in the treatment of dry eye syndrome]. / Eficacia de la carboximetilcelulosa sódica para el tratamiento del síndrome del ojo seco.

AIM: To assess the efficacy of sodium carboxymethylcellulose in the treatment of dry eye. MATERIAL AND METHODS: We carried out a prospective, randomized, masked-observer, control/problem group, single-center clinical assay during a period of 12 months in 19 patients that presented mild or moderate forms of dry eye. Patients were clinically evaluated each 3 months and treated with a 0.5% isotonic solution of sodium carboxymethylcellulose (CMC) or balanced salt solution. Subjective symptoms, functional tests and conjunctival impression cytology were performed according preexistent schedule study visits. To compare data between groups chi squared (chi2) analysis was applied. RESULTS: We observed a significant (p<0.05) decrease in the frequency of subjective symptoms and a significant (p<0.05) improvement of tearfilm interface stability after CMC treatment. There was a tendency to improve the degree of corneal surface wettability and the tearfilm integrity with higher percentage improvements in the CMC group compared to controls. Improved baseline values in at least one of the objective functional tests carried out (p<0.05) was also observed in an elevated percentage of patients in the CMC group (83.3%) compared with controls (34%). Furthermore, we observed a tendency to diminish the frequency of associated subjective symptoms after treatment. Conjunctival impression cytology did not provide significant differences related with therapeutic response. CONCLUSIONS: The results show a significant beneficial effect of CMC to improve clinical parameters in mild and moderate forms of dry eye.

Eficacia de la carboximetilcelulosa sódica para el tratamiento del síndrome del ojo seco / Efficacy of sodium carboxymethylcellulose in the treatment of dry eye syndrome

Objetivo: Evaluar la eficacia de la carboximetilcelulosasódica para el tratamiento del Síndrome deOjo Seco (SOS).Material y métodos: Se realizó un ensayo clínicoprospectivo randomizado unicéntrico y enmascaradode tipo grupo problema/control con 19 pacientesque padecían un SOS leve o moderado, durante unperíodo de 12 meses. Los pacientes fueron clínicamenteevaluados cada 3 meses y tratados con unasolución isotónica de carboximetilcelulosa sódica(CMC) al 0,5% o BSS. La toma de los síntomassubjetivos, las pruebas objetivas de funcionalidadclínica, y la citología de impresión conjuntival fueronrealizadas según el protocolo preestablecido.Para la comparación de los datos entre los grupos seutilizó un análisis estadístico mediante prueba dechi cuadrado (X2).Resultados: Se ha observado una disminución significativa(p<0,05) en la frecuencia de la sintomatologíasubjetiva asociada a una mejoría significativa(p<0,05) en la estabilidad de la interfase de la películalagrimal tras el tratamiento con CMC. Hubouna tendencia a la mejoría del grado de humectación de la superficie corneal y de la integridad de lapelícula lagrimal, con un porcentaje superior demejorías en el grupo problema. Se constató que unmayor porcentaje de pacientes en el grupo problema(83,3%) con relación al grupo control (34%),mejoraron por lo menos en una de las pruebas funcionalesde evaluación (p<0,05). Asimismo, seobservó una tendencia a la disminución de la frecuenciade síntomas subjetivos concomitantes trasel tratamiento con CMC. La citología de impresión(CI) no ha permitido establecer diferencias significativascon relación a la respuesta clínica al tratamiento.Conclusiones: Se pudo constatar un efecto significativamentefavorable de la CMC en la mejoría delos parámetros clínicos del SOS leve y moderado

Aim: To assess the efficacy of sodium carboxymethylcellulose in the treatment of dry eye. Material and methods: We carried out a prospective, randomized, masked-observer, control/problem group, single-center clinical assay during a period of 12 months in 19 patients that presented mild or moderate forms of dry eye. Patients were clinically evaluated each 3 months and treated with a 0.5% isotonic solution of sodium carboxymethylcellulose (CMC) or balanced salt solution. Subjective symptoms, functional tests and conjunctival impression cytology were performed according preexistent schedule study visits. To compare data between groups chi squared (X2) analysis was applied. Results:We observed a significant (p<0.05) decrease in the frequency of subjective symptoms and a significant (p<0.05) improvement of tearfilm interface stability after CMC treatment. There was a tendency to improve the degree of corneal surface wettability and the tearfilm integrity with higher percentage improvements in the CMC group compared to controls. Improved baseline values in at least one of the objective functional tests carried out (p<0.05) was also observed in an elevated percentage of patients in the CMC group (83.3%) compared with controls (34%). Furthermore, we observed a tendency to diminish the frequency of associated subjective symptoms after treatment. Conjunctival impression cytology did not provide significant differences related with therapeutic response. Conclusions: The results show a significant beneficial effect of CMC to improve clinical parameters in mild and moderate forms of dry eye

[Utility of ultrasonography in toxoplasmic uveitis]. / Utilidad de la ecografía en las uveítis por toxoplasmosis.

PURPOSE: To analyze the main indications and the most common ultrasonographic features observed in uveitis due to toxoplasmosis. MATERIAL AND METHODS: We carried out a retrospective, observational and descriptive study performed in 97 exams corresponding to 89 patients with uveitis during 7 consecutive years (1994-2000) using B-ultrasonography evaluation. RESULTS: The main ultrasonographic indication in toxoplasmosis was vitreous opacity. We observed that the most frequent findings were: a) intravitreous punctiform echoes, b) thickening of posterior hyaloid, c) partial or total posterior vitreous detachment and d) focal retinochoroidal thickening. This last finding should be highlighted due to its significant correlation (p<0.01) with toxoplasmosis. CONCLUSIONS: Our results suggest that ultrasonography plays an important role in the diagnosis and clinical follow-up of toxoplasmic uveitis.

Cloning and characterization of human syndecan-3.

Syndecans are cell-surface heparan sulfate proteoglycans, which perform a variety of functions in the cell. Most important, they are co-receptors for growth factors and mediate cell-cell and cell-matrix interactions. Four syndecans (syndecan 1-4) have been described in different species. The aim of this work was the cloning and characterization of human syndecan-3. The human syndecan-3 sequence has high homology to the rat and mouse sequences, with the exception of the 5'-region. Syndecan-3 mRNA is mostly expressed in the nervous system, the adrenal gland, and the spleen. When different cell lines were transiently transfected with full-length syndecan-3 cDNA, it was localized to the membrane and induced the formation of long filopodia-like structures, microspikes, and varicosities. Consequently, the actin cytoskeleton was re-organized, since actin staining was mostly found in the cellular extensions and at the cell periphery, co-localizing with the syndecan-3 staining. The development of the phenotype depended on the presence of sugar chains, as transfected glycosaminoglycan-deficient Chinese hamster ovary (CHO) 745 cells did not show these structural changes, nor did transfected CHO K1 cells in the presence of heparin. The similarity of the cloned DNA sequence with that of other mammalian species and the high expression in the nervous system led us to the assumption that human syndecan-3 could perform comparable functions to those described for syndecan-3 in rat and mouse. Additionally, transient transfection experiments suggest a role of human syndecan-3 in the organization of cell shape by affecting the actin cytoskeleton, possibly by transferring signals from the cell surface in a sugar-dependent mechanism.