Comparabilidad del autorrefractómetro portátil Retinomax K-plus 3 en modo rápido versus autorrefractómetro de sobremesa en modo estándar / Comparability of the Retinomax K-plus 3 handheld autorefractometer in quick mode versus on-table autorefractometer in standard mode

I ntroducción Este estudio analiza la comparabilidad de las medidas tomadas por un autorefractómetro portátil Retinomax K-plus 3 en modo Quick (rápido) y un autorrefractómetro de sobremesa Topcon KR-800 en modo estándar sobre la población pediátrica, y establece su correlación. Método Es un estudio comparativo retrospectivo. Se midieron las variables potencia dióptrica esférica (SPH), potencia dióptrica cilíndrica (CYL), ángulo del eje cilíndrico (AX) y equivalente esférico (SE) con el Retinomax en modo Quick y con el Topcon en modo estándar. Cada paciente fue evaluado en condiciones ciclopléjicas y no ciclopléjicas por ambos autorefractómetros. Se realizó la prueba t de Student entre ambos instrumentos para SPH, CYL y SE. Se calculó el coeficiente de correlación de Pearson y se representó la dispersión mediante gráficas de Bland-Altman, evaluándose también el subgrupo de pacientes menores de 4 años. Se realizó un análisis descriptivo de los porcentajes de medidas que diferían. Resultados Incluyó 98 ojos de 49 sujetos (rango de edad: 3-16 años). Los datos de SPH sin cicloplejia son prácticamente idénticos, mientras que con cicloplejia hay un sesgo hipermetrópico de +0,5 dioptrías medidas con Retinomax. Los resultados de CYL son muy similares con y sin cicloplejia. Existe una gran correlación de Pearson para ambos instrumentos (>0,91) y un bajo grado de dispersión en los gráficos de Bland-Altman bajo cicloplejia. Conclusión Los datos del Retinomax fueron consistentes con los obtenidos por el Topcon. El Retinomax es un instrumento útil para detectar errores de refracción en niños de entre 3 y 16 años (AU)

Introduction This study analyzes the comparability of measurements taken by a Retinomax K-plus 3 handheld autorefractometer in quick mode and a Topcon KR-800 on-table autorefractometer in standard mode on the pediatric population, and establishes their correlation. Methods It is a retrospective comparative study. Spherical diopter power (SPH), cylindrical diopter power (CYL), angle of cylindrical axis (AX), and spherical equivalent (SE) were measured with the Retinomax in quick mode and with the Topcon in standard mode. Each patient was evaluated in cycloplegic and non-cycloplegic conditions by both autorefractometers. Student's t-test was performed between the two instruments for SPH, CYL, and SE. The Pearson correlation coefficient was calculated and the dispersion was represented using Bland-Altman graphs, also evaluating the subgroup of patients under 4 years of age. A descriptive analysis of the percentages of measures that differed was performed. Results It included 98 eyes of 49 subjects (age range: 3-16 years). The data for HPS without cycloplegia are virtually identical, whereas with cycloplegia there is a hyperopic bias of +0.5 diopters measured with Retinomax. CYL results are very similar with and without cycloplegia. There is a high Pearson correlation for both instruments (>0.91) and a low degree of dispersion in the Bland-Altman plots under cycloplegia. Conclusion The Retinomax data were consistent with those obtained by Topcon. The Retinomax is a useful instrument for detecting refractive errors in children between 3 and 16 years of age (AU)

Comparability of the Retinomax K-plus 3 handheld autorefractometer in quick mode versus on-table autorefractometer in standard mode.

INTRODUCTION: This study analyzes the comparability of measurements taken by a Retinomax K-plus 3 handheld autorefractometer in Quick mode and a Topcon KR-800 on-table autorefractometer in standard mode on the pediatric population, and establishes their correlation. METHODS: It is a retrospective comparative study. Spherical diopter power (SPH), cylindrical diopter power (CYL), angle of cylindrical axis (AX), and spherical equivalent (SE) were measured with the Retinomax in Quick mode and with the Topcon in standard mode. Each patient was evaluated in cycloplegic and non-cycloplegic conditions by both autorefractometers. Student's t-test was performed between the two instruments for SPH, CYL, and SE. The Pearson correlation coefficient was calculated and the dispersion was represented using Bland-Altman graphs, also evaluating the subgroup of patients under 4 years of age. A descriptive analysis of the percentages of measures that differed was performed. RESULTS: It included 98 eyes of 49 subjects (age range: 3-16 years). The data for HPS without cycloplegia are virtually identical, whereas with cycloplegia there is a hyperopic bias of +0.5 diopters measured with Retinomax. CYL results are very similar with and without cycloplegia. There is a high Pearson correlation for both instruments (>0.91) and a low degree of dispersion in the Bland-Altman plots under cycloplegia. CONCLUSION: The Retinomax data were consistent with those obtained by Topcon. The Retinomax is a useful instrument for detecting refractive errors in children between 3 and 16 years of age.

Repetibilidad y comparabilidad de un nuevo tomógrafo con tecnología SS-OCT en biometría óptica / Repeatability and comparability of a new swept-source optical coherence tomographer in optical biometry

Objetivo Evaluar la reproducibilidad en la medición de los parámetros biométricos utilizando un nuevo biómetro por tomografía de coherencia óptica con fuente de barrido y compararlo con un biómetro por reflectometría óptica de baja coherencia. Diseño Estudio observacional, descriptivo, de corte transversal. Método Se incluyeron 45 ojos derechos de 45 pacientes, a los que se realizó tres mediciones consecutivas con el biómetro Anterion y una con el biómetro Lenstar LS900. Se recogieron las siguientes variables: longitud axial (AXL), profundidad de cámara anterior (ACD), K plana (K1), K curva (K2), grosor corneal central (CCT), grosor del cristalino (LT) y distancia blanco-blanco (WTW). Para evaluar la repetibilidad se calculó el coeficiente de Pearson «R» y la desviación estándar intrasujeto (Sw). Para evaluar la comparabilidad entre los biómetros se utilizó el coeficiente de correlación de concordancia (CCC) y el coeficiente de correlación intraclase (CCI). Además, se realizaron gráficos de Bland-Altman para cada variable. Resultados El coeficiente de Pearson fue excelente y estadísticamente significativo en la evaluación de la repetibilidad para todas las variables. Los valores más altos fueron 0,987 (AXL), 0,983 (CCT) y 0,942 (ACD). No hubo diferencias estadísticamente significativas entre las repetidas mediciones con Anterion para todas las variables. Los valores de CCC y CCI fueron excelentes en la evaluación de las variables AXL, CCT y ACD, y fueron altos para las variables K1, K2, LT y WTW. Conclusiones La realización de una biometría óptica ocular con el biómetro SS-OCT Anterion es un procedimiento reproducible y comparable con el biómetro Lenstar LS900 (AU)

Purpose To evaluate the reproducibility in the measurement of ocular biometric parameters using a new swept-source optical coherence tomographer and its comparability with an optical low coherence reflectometry biometer. Design An observational, descriptive, cross-sectional study. Methods 45 right eyes of 45 patients diagnosed with cataract were included. Three successive biometric measurements with Anterion and one with Lenstar LS900 were performed on each patient. The following variables were collected: axial length (AXL), anterior chamber depth (ACD), flat K (K1), steep K (K2), central corneal thickness (CCT), lens thickness (LT) and white-to-white distance (WTW). The intrasubject standard deviation (Sw) and the coefficient of Pearson «R» were calculated in order to assess the repeatability. The intraclass correlation coefficient (ICC) and the concordance correlation coefficient (CCC) were obtained to evaluate the comparability between devices. A Bland–Altman plot was performed for each variable. Results The coefficient of Pearson was excellent and statistically significant in the evaluation of the repeatability in all the variables. The highest values were 0.987 (AXL), 0.983 (CCT) and 0.942 (ACD). There were no statically significant differences between repeated measurements with Anterion in all the parameters. The ICC and CCC were excellent in the evaluation of AXL, CCT and ACD, and were also good in regard to K1, K2, LT and WTW. Conclusions Performing biometry with the SS-OCT Anterion is a reliable and reproducible procedure, and it is comparable with the Lenstar LS900 (AU)

Lesión permanente de las capas internas de la retina en una paciente con migraña: un caso diferente de maculopatía paracentral aguda media / Permanent damage of the inner retinal layers in a patient with migraine: A different case of paracentral acute middle maculopathy

Presentamos el caso de una paciente mujer de 20 años que consultó por un escotoma paracentral en su ojo izquierdo que no había desaparecido después de una crisis de migraña 2 días antes. La exploración realizada evidenció la presencia de 2 áreas de palidez retiniana sugestivas de isquemia aguda. Tras descartar varias causas de isquemia retiniana aguda, se llegó al diagnóstico de un síndrome vasoespástico retiniano. Un año después, la paciente presenta una atrofia de las capas internas de la retina afectada y sufre un escotoma paracentral crónico en su ojo izquierdo. Los vasoespasmos retinianos pueden provocar un daño irreversible y crónico debido a la destrucción tisular por la isquemia. Este inusual caso describe una lesión permanente secundaria a un vasoespasmo arterial tras una crisis de migraña. El hallazgo de lesiones retinianas características y la historia de migraña hacen el diagnóstico compatible con un episodio de maculopatía paracentral aguda media (AU)

We report the case of a 20-year-old patient who presented a paracentral scotoma in her left eye that had not disappeared after a migraine attack 2 days before. Ocular examination showed 2 pale paracentral areas suggesting an acute ischemia insult. Several causes of retinal ischemia were ruled out and the patient was diagnosed with secondary retinal vasospasm. One year later, the patient suffers an atrophy of the inner layers of the affected retina and has a paracentral chronic scotoma in her left eye. Retinal vasospasms can result in irreversible lesions and chronic symptoms due to ischemia and cell destruction. This unusual case reports a permanent damage due to retinal vasospasm secondary to migraine attack. The finding of typical lesions and the history of migraine could be compatible with the diagnosis of paracentral acute middle maculopathy (AU)

Permanent damage of the inner retinal layers in a patient with migraine: a different case of paracentral acute middle maculopathy.

We report the case of a 20-year-old patient who presented a paracentral scotoma in her left eye that had not disappeared after a migraine attack two days before. Ocular examination showed two pale paracentral areas suggesting an acute ischemia insult. Several causes of retinal ischemia were ruled out and the patient was diagnosed with secondary retinal vasospasm. One year later, the patient suffers an atrophy of the inner layers of the affected retina and has a paracentral chronic scotoma in her left eye. Retinal vasospasms can result in irreversible lesions and chronic symptoms due to ischemia and cell destruction. This unusual case reports a permanent damage due to retinal vasospasm secondary to migraine attack. The finding of typical lesions and the history of migraine could be compatible with the diagnosis of paracentral acute middle maculopathy (PAMM).

Repeatability and comparability of a new swept-source optical coherence tomographer in optical biometry.

PURPOSE: To evaluate the reproducibility in the measurement of ocular biometric parameters using a new swept-source optical coherence tomographer and its comparability with an optical low coherence reflectometry biometer. DESIGN: An observational, descriptive, cross-sectional study. METHODS: 45 right eyes of 45 patients diagnosed with cataract were included. Three successive biometric measurements with Anterion and one with Lenstar LS900 were performed on each patient. The following variables were collected: axial length (AXL), anterior chamber depth (ACD), flat K (K1), steep K (K2), central corneal thickness (CCT), lens thickness (LT) and white-to-white distance (WTW). The intrasubject standard deviation (Sw) and the coefficient of Pearson "R" were calculated in order to assess the repeatability. The intraclass correlation coefficient (ICC) and the concordance correlation coefficient (CCC) were obtained to evaluate the comparability between devices. A Bland-Altman plot was performed for each variable. RESULTS: The coefficient of Pearson was excellent and statistically significant in the evaluation of the repeatability in all the variables. The highest values were 0.987 (AXL), 0.983 (CCT) and 0.942 (ACD). There were no statically significant differences between repeated measurements with Anterion in all the parameters. The ICC and CCC were excellent in the evaluation of AXL, CCT and ACD, and were also good in regard to K1, K2, LT and WTW. CONCLUSIONS: Performing biometry with the SS-OCT Anterion is a reliable and reproducible procedure, and it is comparable with the Lenstar LS900.

Límites de la precisión en el resultado refractivo tras la cirugía de cataratas / Limits of the precision in refractive results after cataract surgery

Antecedentes y objetivo Para mejorar los resultados refractivos en cirugía de cataratas con implante de lente intraocular es importante conocer las fuentes de error, así como el límite de mejora de dicho proceso. Por tanto, el objetivo del presente trabajo es aproximar el límite teórico en la precisión en el resultado refractivo tras cirugía de cataratas con los medios disponibles en la actualidad y valorar el impacto de distintas fuentes de error en dicho proceso. Materiales y métodos Realizamos una búsqueda de la bibliografía para determinar la variabilidad aportada por cada componente del proceso. Tomando como base la fórmula de Barrett Universal-II realizamos un análisis de propagación de errores. El límite teórico fue definido como la situación en la que el resultado refractivo únicamente está afectado por la variabilidad en los parámetros introducidos en la fórmula, la tolerancia de la lente intraocular y la refracción subjetiva. Resultados Los principales contribuidores al error fueron: 1. La variabilidad intraoperatoria y postoperatoria, variables no consideradas por las fórmulas (49,33%). 2. La refracción subjetiva postoperatoria (38,29%). 3. La queratometría media (5,98%), y 4. la variabilidad en el etiquetado de la potencia de la lente intraocular (5,09%). El límite teórico obtenido para el cálculo de lente intraocular con los medios disponibles actualmente fue del 91,9% de los ojos entre + -0,50D. Conclusiones El límite teórico de la precisión es de 91,92% de los ojos entre + - 0,5D. Para aproximarnos al límite de precisión descrito en el estudio requiere de la utilización de biometría óptica y fórmulas de última generación, una técnica quirúrgica reproducible y la compensación de los errores sistemáticos mediante el ajuste de constantes (AU)

Background and objective In order to improve refractive results in cataract surgery with an intraocular lens implant, it is important to know the sources of error as well as the limit of this process. Therefore, the objective of the present work is to approximate the theoretical limit in the precision in the refractive result after cataract surgery with the currently available means and to assess the impact of different sources of error in this process. Materials and methods We conducted a search of the literature to determine the variability provided by each component of the process. Based on the Barrett Universal-II formula, we performed an error propagation analysis. The theoretical limit was defined as the situation in which the refractive result is only affected by the variability in the parameters introduced in the formula, the tolerance of the intraocular lens and the subjective refraction Results The main contributors to the error were: 1. Intraoperative and postoperative variability variables not considered by the formulas (49.33%). 2. Postoperative subjective refraction (38.29%). 3. Mean keratometry (5.98%), and 4. the variability in the labelling of the power of the intraocular lens (5.09%). The theoretical limit obtained for the intraocular lens calculation with the means available today was 91.9% of the eyes between + -0.50D. Conclusions We found a theoretical limit for the intraocular lens calculation of 91.9% of the eyes between + -0.50D. Approaching the precision limit described in the study requires the use of optical biometrics and state-of-the-art formulas, a reproducible surgical technique, and the compensation of systematic errors by adjusting constants (AU)

Limits of the precision in refractive results after cataract surgery.

BACKGROUND AND OBJECTIVE: In order to improve refractive results in cataract surgery with an intraocular lens implant, it is important to know the sources of error as well as the limit of this process. Therefore, the objective of the present work is to approximate the theoretical limit in the precision in the refractive result after cataract surgery with the currently available means and to assess the impact of different sources of error in this process. MATERIALS AND METHODS: We conducted a search of the literature to determine the variability provided by each component of the process. Based on the Barrett Universal-II formula, we performed an error propagation analysis. The theoretical limit was defined as the situation in which the refractive result is only affected by the variability in the parameters introduced in the formula, the tolerance of the intraocular lens and the subjective refraction. RESULTS: The main contributors to the error were (1) intraoperative and postoperative variability variables not considered by the formulas (49.33%), (2) postoperative subjective refraction (38.29%), (3) mean keratometry (5.98%) and (4) the variability in the labelling of the power of the intraocular lens (5.09%). The theoretical limit obtained for the intraocular lens calculation with the means available today was 91.9% of the eyes between ±0.50D. CONCLUSIONS: We found a theoretical limit for the intraocular lens calculation of 91.9% of the eyes between ±0.50D. Approaching the precision limit described in the study requires the use of optical biometrics and state-of-the-art formulas, a reproducible surgical technique, and the compensation of systematic errors by adjusting constants.

Luxación posterior bilateral del cristalino en una paciente agitada, ¿causa o consecuencia? / Posterior bilateral lens luxation in an agitated patient: Cause or consequence?

Las luxaciones posteriores completas del cristalino son entidades clínicas poco frecuentes. Los traumatismos son la principal causa de luxación secundaria del cristalino no iatrogénica. La mayor parte de los casos son unilaterales, siendo los casos de luxación bilateral muy poco frecuentes. Presentamos el inusual caso clínico de una mujer de 70 años que presentó una luxación bilateral posterior del cristalino en el contexto de un cuadro de instauración aguda de síndrome confusional. Discutimos acerca de la privación sensorial como un factor desencadenante de cuadros de confusión aguda y agitación en pacientes con enfermedades predisponentes. Además, describimos los beneficios que, en nuestra experiencia, nos aporta la técnica de reflotamiento con perfluorocarbono para el abordaje quirúrgico de estos casos

Complete posterior lens dislocation is an infrequent clinical entity. Trauma is the first cause of secondary lens dislocation. Most of the cases are unilateral, and bilateral cases are unusual. We report the uncommon case of a 70-year-old woman with evidence of a posterior bilateral dislocation of the lens in the context of an acute onset of confusional syndrome. We discuss about sensory deprivation as a trigger for acute confusion and agitation in patients with predisposing conditions. In addition, we describe the benefits that, in our experience, the refloating technique with perfluorocarbon liquid provides for the surgical approach to these cases

Posterior bilateral lens luxation in an agitated patient: Cause or consequence? / Luxación posterior bilateral del cristalino en una paciente agitada, ¿causa o consecuencia?

Complete posterior lens dislocation is an infrequent clinical entity. Trauma is the first cause of secondary lens dislocation. Most of the cases are unilateral, and bilateral cases are unusual. We report the uncommon case of a 70-year-old woman with evidence of a posterior bilateral dislocation of the lens in the context of an acute onset of confusional syndrome. We discuss about sensory deprivation as a trigger for acute confusion and agitation in patients with predisposing conditions. In addition, we describe the benefits that, in our experience, the refloating technique with perfluorocarbon liquid provides for the surgical approach to these cases.

Neuropatía óptica secundaria a consumo de cocaína inhalada. Causalidad o casualidad / Optical neuropathy due to inhaled cocaine, causality or chance

Varón de 44 años consumidor activo de cocaína que consultó por disminución de agudeza visual en el ojo derecho de 24 horas de evolución, siendo de 0,05 en dicho ojo y de 1 en el ojo izquierdo. La exploración reveló la presencia de un defecto pupilar aferente relativo y una papila edematizada en el ojo derecho. Los estudios sistémicos realizados se encontraban dentro de la normalidad salvo la resonancia magnética nuclear encefálica que mostró un engrosamiento de la mucosa de los senos maxilares y frontales compatibles con una sinusitis. Se decidió ingreso hospitalario e inicio de tratamiento corticoideo intravenoso, presentando una evolución favorable, una agudeza visual de unidad en ambos ojos y una mejoría anatómica de la cabeza del nervio óptico. Dados los antecedentes del paciente y tras valorar otros diagnósticos alternativos plausibles, se planteó el diagnóstico de neuropatía óptica secundaria al consumo de cocaína inhalada

A 44-year-old man, active cocaine consumer, who referred decrease in visual acuity in the right eye in 24 hours of evolution, being 0,05 in that eye and 1 in the left eye. The examination showed a relative afferent pupil defect and a swelling head of optic nerve. The systemic studies performed were normal, except the nuclear magnetic resonance of the brain that showed a thickening of the maxillary and frontal sinus mucosa, compatible with sinusitis. Hospital admission and the start of intravenous corticosteroid treatment were decided, with a favourable evolution, a visual acuity of 1.0 in both eyes and an anatomical improvement of the optic nerve head. Due to the medical history of the patient and the assessment of other plausible alternative diagnoses, we established the diagnosis of optical neuropathy due to inhaled cocaine abuse

Optical neuropathy due to inhaled cocaine, causality or chance. / Neuropatía óptica secundaria a consumo de cocaína inhalada. Causalidad o casualidad.

A 44-year-old man, active cocaine consumer, who referred decrease in visual acuity in the right eye in 24 hours of evolution, being 0,05 in that eye and 1 in the left eye. The examination showed a relative afferent pupil defect and a swelling head of optic nerve. The systemic studies performed were normal, except the nuclear magnetic resonance of the brain that showed a thickening of the maxillary and frontal sinus mucosa, compatible with sinusitis. Hospital admission and the start of intravenous corticosteroid treatment were decided, with a favourable evolution, a visual acuity of 1.0 in both eyes and an anatomical improvement of the optic nerve head. Due to the medical history of the patient and the assessment of other plausible alternative diagnoses, we established the diagnosis of optical neuropathy due to inhaled cocaine abuse.

Laceración palpebral y canalicular asociada a trauma obstétrico. Descripción de un caso / Eye lid and canalicular laceration due to obstetric trauma. Case report

Las lesiones oculares por trauma obstétrico son poco frecuentes. Su incidencia aumenta cuando el parto es asistido con instrumental, cesárea urgente y presentación anómala del feto. Presentamos el caso clínico de un recién nacido pretérmino varón asiático de 33 + 2 semanas, 1.500 g y embarazo gemelar, que nació por cesárea urgente. Se observó una laceración palpebral inferior de 5mm de longitud horizontal en el canto interno del ojo izquierdo con sección del canalículo inferior. Al séptimo día de vida se realizó la intubación con stent monocanalicular Mini-Monoka® (FCI, Issy-Les Moulineaux, Francia), consiguiendo la anastomosis de los extremos proximal y distal de la laceración. La piel se suturó con poliglactínico de 8/0 (Vicryl 8/0, Ethicon, Johnson & Johnson S. A., Madrid, España). El tratamiento postoperatorio fue con colirio de tobramicina y dexametasona 4 veces al día durante 10 días. La evolución fue favorable, la posición del punto lagrimal inferior fue adecuada y la siringación, normal. A las 14 semanas se retiró el Mini-Monoka®

Ocular injuries associated with birth trauma are rare. Their incidence increases in cases of instrument-assisted delivery, emergency cesarean section, and abnormal presentation of the fetus. We present the clinical case of a premature Asian male baby, aged 33 + 2 weeks and weighing 1,500 g. The infant was born out of a twin pregnancy and was delivered by emergency cesarean section. Following delivery, a 5 mm long lower eyelid laceration was observed in the inner corner of the left eye, with injury to the inferior canaliculus. A Mini-Monoka® (FCI, Issy-Les Moulineaux, France) monocanalicular intubation stent was inserted on the seventh day with anastomosis of the proximal and distal ends of the canaliculus laceration. The skin was then sutured with a polyglactin 8/0 (Vicryl 8/0, Ethicon, Johnson & Johnson S. A., Madrid, Spain) suture. The postoperative treatment consisted of tobramycin and dexamethasone eye drops four times per day for 10 days. A good progression was observed, the position of the inferior lacrimal punctum was adequate, and syringation was normal. The Mini-Monoka® was removed after 14 weeks

Eye lid and canalicular laceration due to obstetric trauma. Case report. / Laceración palpebral y canalicular asociada a trauma obstétrico. Descripción de un caso.

Ocular injuries associated with birth trauma are rare. Their incidence increases in cases of instrument-assisted delivery, emergency cesarean section, and abnormal presentation of the fetus. We present the clinical case of a premature Asian male baby, aged 33+2 weeks and weighing 1,500g. The infant was born out of a twin pregnancy and was delivered by emergency cesarean section. Following delivery, a 5mm long lower eyelid laceration was observed in the inner corner of the left eye, with injury to the inferior canaliculus. A Mini-Monoka® (FCI, Issy-Les Moulineaux, France) monocanalicular intubation stent was inserted on the seventh day with anastomosis of the proximal and distal ends of the canaliculus laceration. The skin was then sutured with a polyglactin 8/0 (Vicryl 8/0, Ethicon, Johnson & Johnson S. A., Madrid, Spain) suture. The postoperative treatment consisted of tobramycin and dexamethasone eye drops four times per day for 10 days. A good progression was observed, the position of the inferior lacrimal punctum was adequate, and syringation was normal. The Mini-Monoka® was removed after 14 weeks.