[A protocol for the treatment of retinopathy of prematurity in Spain]. / Protocolo de tratamiento de la retinopatía del prematuro en España.

OBJECTIVE: To prepare a protocol for the treatment of retinopathy of prematurity (ROP) agreed by the majority of Spanish ophthalmologists dedicated to this topic. MATERIAL AND METHOD: A draft of the protocol was produced taking into account the experience of the participants and up to date publications. This draft was corrected by all the ophthalmologists participating in the project, and the final document was agreed by all of them. RESULTS: We present general guidelines as an aid for the treatment of ROP, including treatment criteria, treatment methods, a calendar of action, and follow-up. CONCLUSIONS: It is important to have a common working protocol for the treatment of ROP to improve care and to avoid mistakes. Although individual Hospitals may adapt the protocol to their daily activity, it is recommended that there is a minimal working protocol agreed by most of professionals dedicated to pediatric ophthalmology in Spain.

Screening program for retinopathy of prematurity in Spain.

OBJECTIVE: To prepare a retinopathy of prematurity (ROP) screening program as agreed by most of Spanish ophthalmologists dedicated to this topic. MATERIALS AND METHODS: A draft of the protocol was produced taking into account the experience of the participants and current publications. This draft was corrected by all the ophthalmologists participating in the project and the final document produced was agreed by all of them. RESULTS: We present general guidelines to help in the screening of ROP, including treatment criteria, treatment methods, and a calendar of action. CONCLUSIONS: It is important to have a common working protocol in the screening of ROP to improve the action and to avoid mistakes. Although individual Hospitals may adapt the protocol to their daily activity, it is recommended that there is a minimal working protocol agreed by most of professionals dedicated to pediatric ophthalmology in Spain.

Tear clearance and ocular symptoms in patients treated with preservative-free prostaglandins.

OBJECTIVES: To assess the effects on dry eye symptoms and tear dynamics of switching from a prostaglandin with a preservative to a preservative-free prostaglandin. MATERIAL AND METHODS: Fourteen patients (N=28 eyes) with open-angle glaucoma and dry eye symptons, treated with preserved latanoprost, travoprost or bimatoprost were included in this uncontrolled prospective study. Ocular symptoms were analysed using a validated ocular surface disease questionnaire and ocular signs were assessed with tear clearance, Schirmer and tear function index test (TFI=Schirmer/clearance). Patients were assigned to preservative-free tafluprost treatment, and measurements were repeated 4 weeks after change of medication. Wilcoxon test and Spearman correlation coefficient were used in the statistical analysis. RESULTS: No statistically significant difference in intraocular pressure (IOP) was observed after switching to tafluprost. Mean IOP at baseline was 20.4 mmHg (SD2.2) and after 4 weeks 19.9 mmHg (SD2.6), (P>.05). The mean questionnaire score significantly decreased from 9.7 (SD3.7) at baseline to 5.4 (SD2.7) after one month (P<.001). No significant differences in tear clearance, Schirmer or TFI were found (P>.05). At baseline, tear clearance=0.13 (SD0.07), Schirmer=10.7 mm (SD6) and TFI=80 (48-156). After 4 weeks, tear clearance=0.1(SD0.07), Schirmer=9.5 mm (3.9) and TFI=104 (48-216). A significant association between questionnaire score and tear clearance after 4 weeks was observed (Spearman coefficient=0.62; P=.014). CONCLUSIONS: Switching from preservative prostaglandin with a preservative to preservative-free tafluprost treatment improves dry eye symptoms and suggests an improvement in TFI.

Aclaramiento lagrimal y sintomatología ocular en pacientes tratados con prostaglandinas sin conservantes / Tear clearance and ocular symptoms in patients treated with preservative-free prostaglandins

Objetivos: Evaluar el efecto en los síntomas de sequedad ocular y en la dinámica lagrimal que se produce al sustituir una prostaglandina con conservante por una prostaglandina sin conservante. Material y métodos: Estudio prospectivo no controlado en el que se seleccionaron 28 ojos de 14 pacientes con síntomas de ojo seco en tratamiento con latanoprost, travoprost o bimatoprost con conservante. Se evaluaron los síntomas oculares con un cuestionario validado de enfermedad de la superficie ocular y los signos mediante el test de aclaramiento lagrimal, el Schirmer y el índice de función lagrimal (TFI, TFI=Schirmer/aclaramiento). En todos los pacientes se cambió el tratamiento hipotensor a tafluprost sin conservante. Al mes, se repitieron los tests. En el análisis estadístico se utilizó el test de Wilcoxon y el coeficiente de correlación de Spearman. Resultados: No encontramos diferencias en la presión intraocular (PIO) al cambiar a tafluprost. La PIO inicial era 20,4mmHg (DE2,2) y la PIO al mes era 19,96mmHg (DE2,6) (p>0,05). La puntuación del cuestionario disminuyó de forma significativa desde 9,7 (DE3,7) hasta 5,4 (DE2,7) al mes del tratamiento (p<0,001). No encontramos diferencias significativas en el aclaramiento, en el Schirmer, ni en el TFI (p>0,05). Inicialmente, aclaramiento=0,13 (DE0,07), Schirmer=10,7mm (DE6) y TFI=80 (48-156). Al mes, aclaramiento=0,1 (DE0,07), Schirmer=9,5mm (DE3,9) y TFI=104 (48-216). Hemos encontrado una asociación significativa entre la puntuación del cuestionario y el aclaramiento al mes (coeficiente de correlación=0,62; p=0,014). Conclusiones: La sustitución de una prostaglandina con conservante por tafluprost sin conservante mejora los síntomas de sequedad ocular y sugiere una mejoría en el test de función lagrimal(AU)

Objectives: To assess the effects on dry eye symptoms and tear dynamics of switching from a prostaglandin with a preservative to a preservative-free prostaglandin. Material and methods: Fourteen patients (N=28 eyes) with open-angle glaucoma and dry eye symptons, treated with preserved latanoprost, travoprost or bimatoprost were included in this uncontrolled prospective study. Ocular symptoms were analysed using a validated ocular surface disease questionnaire and ocular signs were assessed with tear clearance, Schirmer and tear function index test (TFI=Schirmer/clearance). Patients were assigned to preservative-free tafluprost treatment, and measurements were repeated 4 weeks after change of medication. Wilcoxon test and Spearman correlation coefficient were used in the statistical analysis. Results: No statistically significant difference in intraocular pressure (IOP) was observed after switching to tafluprost. Mean IOP at baseline was 20.4mmHg (SD2.2) and after 4 weeks 19.9mmHg (SD2.6), (P>0.05). The mean questionnaire score significantly decreased from 9.7 (SD3.7) at baseline to 5.4 (SD2.7) after one month (P<0.001). No significant differences in tear clearance, Schirmer or TFI were found (P>0.05). At baseline, tear clearance=0.13 (SD0.07), Schirmer=10.7mm (SD6) and TFI=80 (48-156). After 4 weeks, tear clearance=0.1(SD0.07), Schirmer=9.5mm (3.9) and TFI=104 (48-216). A significant association between questionnaire score and tear clearance after 4 weeks was observed (Spearman coefficient=0.62; P=0.014). Conclusions: Switching from preservative prostaglandin with a preservative to preservative-free tafluprost treatment improves dry eye symptoms and suggests an improvement in TFI(AU)

[IGF-I, VEGF and bFGF as predictive factors for the onset of retinopathy of prematurity (ROP)]. / IGF-I, VEGF y bFGF, como factores pronósticos de la aparición de la retinopatía de la prematuridad.

OBJECTIVE: To determine if IGF-I, VEGF and bFGF, present in the serum of premature infants, are independent risk factors of the development of ROP. It was also our objective to design a multivariate model that included these three cytokines as indicator parameters in the ROP screening, in addition to the other parameters already in existence. METHODS: 74 patients were recruited with a birth weight below 1500g or gestational age below 32 weeks. These were classified into those who developed ROP (N = 37) and those without ROP (N = 37). We obtained serum from each infant at the time of the first examination at 4-6 postnatal weeks. These samples were frozen until the time of analysis. The roles of gestational age and birth weight were also evaluated. RESULTS: There were significant differences in the amount of the cytokines IGF-I and VEGF between the groups with or without ROP, but there were no significant differences for bFGF. The differences enabled us to establish a multivariate model including IGF-I and VEGF for the prediction of risk of ROP. CONCLUSIONS: Cytokine serum levels in premature infants can be useful as an indicator in ROP screening, as well as being used to predict the probability of suffering the illness.

IGF-I, VEGF y b-FGF, como factores pronósticos de la aparición de la retinopatía de la prematuridad / IGF-I, VEGF and b-FGF as predictive factors for the onset of retinopathy of prematurity (ROP)

Objetivo: Identificar en suero de prematuros a IGF, VEGF y bFGF, como factores de riesgo independientes en el desarrollo de la ROP. Es también nuestro objetivo el diseño de un modelo multivariante que englobe a las tres citokinas y que este pueda ser usado como parámetro indicador del examen de la ROP, además de los ya existentes. Métodos: 74 pacientes prematuros fueron reclutados con un peso al nacer menor de 1500 grs o edad gestacional menor de 32 semanas, y fueron divididos en pacientes enfermos de ROP (N=37) y pacientes no enfermos de ROP (N=37). Se tomaron muestras de sangre de cada paciente, coincidiendo con el primer examen, entre la 4 a 6 primeras semanas de vida y estas fueron congeladas en espera de su determinación. La edad gestacional y el peso al nacer fueron evaluados. Resultados: Encontramos diferencias significativas entre grupos en función de los valores de IGF-I y VEGF, pero no encontramos diferencias en función de la bFGF. Establecimos un modelo multivariante incluyendo a la IGF-I y VEGF, para la predicción del riesgo de padecer ROP en función de estas dos citokinas. Conclusiones: Los niveles en sangre de prematuros de estas citokinas pueden ser usados como factores indicadores del examen de la ROP, así como para predecir la probabilidad de sufrir la enfermedad

Objective: To determine if IGF-I, VEGF and bFGF, present in the serum of premature infants, are independent risk factors of the development of ROP. It was also our objective to design a multivariate model that included these three cytokines as indicator parameters in the ROP screening, in addition to the other parameters already in existence. Methods: 74 patients were recruited with a birth weight below 1500g or gestational age below 32 weeks. These were classified into those who developed ROP (N = 37) and those without ROP (N = 37). We obtained serum from each infant at the time of the first examination at 4-6 postnatal weeks. These samples were frozen until the time of analysis. The roles of gestational age and birth weight were also evaluated. Results: There were significant differences in the amount of the cytokines IGF-I and VEGF between the groups with or without ROP, but there were no significant differences for bFGF. The differences enabled us to establish a multivariate model including IGF-I and VEGF for the prediction of risk of ROP. Conclusions: Cytokine serum levels in premature infants can be useful as an indicator in ROP screening, as well as being used to predict the probability of suffering the illness

[Serum IGF-I levels in retinopathy of prematurity. New indications for ROP screening]. / Valores de IGF-I séricos en la ROP. Buscando nuevas indicaciones para su screening.

OBJECTIVE: To determine the IGF-I serum levels in premature infants with the objective of being able to use these levels as an indicator of the need for exploration in a screening program for retinopathy of prematurity (ROP). METHODS: This was a comparative study in which IGF-I levels were measured in every infants' serum during the first exploration in the 4 to 6 postnatal weeks. The degree of ROP and a variety of morbidity factors were evaluated, including the presence of intraventricular haemorrhage, sepsis, need for blood transfusion and the number of days of mechanical ventilation. RESULTS: The average IGF-I values during the first 4 to 6 postnatal weeks were lowest in the ROP cases (10.75 microg/L SD 16.053) while the NO-ROP cases yielded higher values (29.75 microg/L, SD 13.022). The Mann-Whitney U test showed a value of P for the IGF-I values of 0.004, indicating significant differences between the groups with or without ROP. CONCLUSIONS: The low IGF-I serum levels in ROP infants in comparison with the NO-ROP cases, suggest that this marker could be used as an indicator in the screening for ROP.

Valores de IGF-I séricos en la ROP. Buscando nuevas indicaciones para su screening / Serum IGF-I levels in retinopathy of prematurity. New indications for ROP screening

Objetivo: Determinar los niveles séricos IGF-I en niños prematuros con el objetivo de que éstos, pueden ser usados como indicadores de la exploración en el despistaje de la ROP.Método: Nuestro estudio se diseña como transversal comparativo, midiendo los valores de IGF-I en suero de cada niño en la primera exploración entre las primeras 4-6 semanas postnatales. Se evaluaron el grado de ROP y otros factores de morbilidad: hemorragia intraventricular, sepsis, transfusiones y días de ventilación mecánica.Resultados: Los valores medios de la IGF-I entre las 4-6 primeras semanas postnatales fue más baja en los casos de ROP, 10,75 µg/L D.E. 16,053, siendo los casos de No ROP de 29,75 µg/L D.E. 13,022. El test de la U de Mann-Whitney reflejó un valor de la P para los valores de IGF-I de .004, indicando así diferencias significativas entre los dos grupos.Conclusión: Los bajos niveles de IGF-I séricos en niños con ROP en comparación con los casos de no ROP, sugieren que este marcador podría servir como indicador del screening de la ROP

Objective: To determine the IGF-I serum levels in premature infants with the objective of being able to use these levels as an indicator of the need for exploration in a screening program for retinopathy of prematurity (ROP).Methods: This was a comparative study in which IGF-I levels were measured in every infants’ serum during the first exploration in the 4 to 6 postnatal weeks. The degree of ROP and a variety of morbidity factors were evaluated, including the presence of intraventricular haemorrhage, sepsis, need for blood transfusion and the number of days of mechanical ventilation.Results: The average IGF-I values during the first 4 to 6 postnatal weeks were lowest in the ROP cases (10.75 µg/L SD 16.053) while the NO-ROP cases yielded higher values (29.75 µg/L, SD 13.022). The Mann-Whitney U test showed a value of P for the IGF-I values of 0.004, indicating significant differences between the groups with or without ROP.Conclusions: The low IGF-I serum levels in ROP infants in comparison with the NO-ROP cases, suggest that this marker could be used as an indicator in the screening for ROP

[Intraocular phakic lens ZSAL-4 for high myopia correction]. / Lente ZSAL-4 para la corrección de la alta miopía.

PURPOSE: To evaluate the effectiveness, safety and predictability of the phakic intraocular lens (IOL) ZSAL-4 for correction of high myopia. METHODS: In this retrospective study 28 IOL in 19 patientes were implanted. The following data were recorded, preoperatively, one week, one month, 3, 6 and 12 months postoperatively: spherical equivalent (SE), astigmatism, uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), endothelial cell density (CD), coefficient of variation (CV) and intraocular pressure (IOP). We performed LASIK in 3 eyes to correct a residual refractive defect. RESULTS: The mean age was 29.7 S.D. 5.77 years and the mean following 7.62 S.D. 7.29 months. Six months postoperatively, the preoperative SE of -14.91 S.D. 2.88 was reduced to -1.29 S.D. 0.53; the BCVA varied from 0.56 S.D. 0.16 to 0.58 S.D. 0.12; the CD changed from 2670 S.D. 252 cells/mm2 to 2344 S.D. 262. The CV showed stability. The UCVA six months postoperatively was 0.39 S.D. 0.15. No eyes lost any line of BCVA; during the first month 63% of the eyes won 2 or more lines. The efficacy index was 0.83 S.D. 0.24 one month postoperatively and 0.63 S.D. 0.32 one year postoperatively; the safety index was 1.44 D.S. 0.34 and 1.30 S.D. 0.35 respectively. One IOL was explanted the second day due to pupilary blockage; 7 eyes had transient high IOP; 2 eyes developed pupilary ovalization and in 4 cases the IOL suffered some degree of rotation. One eye presented a flat retinal detachment one year postoperatively but with no other complications. The 3 eyes submitted to LASIK presented 0.8 of BCVA the third month after LASIK. CONCLUSIONS: ZSAL-4 IOL implantation is an effective and safe procedure with an acceptable predictability which, in some cases, could be improved with LASIK.

Aqueous humor and serum tumor necrosis factor-alpha in clinical uveitis.

OBJECTIVE: To study the local and systemic behavior of the tumor necrosis factor-alpha (TNF-alpha) in patients with active uveitis. METHODS: TNF-alpha levels were measured in aqueous humor and peripheral blood samples using an enzyme-linked immunosorbent assay from 23 patients with uveitis and 16 control patients who had been operated on for uncomplicated cataracts. RESULTS: Aqueous humor and sera of patients with uveitis showed higher levels of TNF-alpha than those of controls (p < 0.001). A comparison of cytokine levels between aqueous humor and sera showed significantly higher levels of TNF-alpha in serum than aqueous humor (p < 0.001). Correlation studies using the regression test for successive steps showed that serum TNF-alpha levels correlated with recurrent uveitis (r = 0.4150; p = 0.0489). CONCLUSIONS: TNF-alpha is a cytokine that participates actively in the pathogenesis of clinical uveitis. Our data emphasize the greater systemic than local participation of TNF-alpha. Finally, an elevated serum TNF-alpha seems to be associated with a recurrent pattern of uveitis.

[Aqueous humor and serum interleukin-6 in patients with uveitis]. / Interleucina-6 en humor acuoso y suero de pacientes con uveítis.

PURPOSE: A study on local and systemic behavior of interleukin-6 in patients with active uveitis. METHODS: IL-6 levels were measured in aqueous humor and peripheral blood samples using an enzyme-linked immunosorbent assay (ELISA) from 23 patients with uveitis and 16 control patients who had been operated for uncomplicated cataracts. RESULTS: Aqueous humor of patients with uveitis showed higher levels of interleukin-6 than those of controls (p<0.001). A comparison of cytokine levels between aqueous humor and serum from patients with uveitis showed significantly higher levels of interleukin-6 in aqueous than serum (p<0.001). Correlation studies using regression test for successive steps failed to demonstrate any association between interleukin-6 levels and the different clinical characteristics of uveitis patients (laterality, onset, patterns, visual damage, localization, inflammatory activity, etiology, and association with the B27 + histocompatibility antigen). CONCLUSIONS: IL-6 is a cytokine that actively participates in the pathogenesis of clinical uveitis. Our data emphasize the greater local than systemic participation of this cytokine.

Interleucina-6 en humor acuoso y suero de pacientes con uveítis / Aqueous humor and serum interleukin-6 in clinical uveitis

Objetivo: Estudiar el comportamiento local y sistémico de la interleucina-6 en pacientes con uveítis en actividad. Método: Se determinaron los niveles de interleucina-6 en humor acuoso y sangre periférica de 23 pacientes con uveítis en actividad y de 16 pacientes operados de catarata no complicada como grupo control, mediante la técnica inmunoenzimática ELISA. Resultados: Los pacientes con uveítis presentaron niveles superiores de interleucina-6 en humor acuoso respecto a controles (p<0,001). La comparación entre humor acuoso y suero de los pacientes con uveítis mostró unos niveles significativamente superiores de interleucina-6 en humor acuoso (p<0,001). El análisis mediante el test de regresión múltiple por pasos sucesivos no demostró ninguna asociación entre los niveles de interleucina-6 y las diferentes características clínicas de las uveítis (lateralidad, comienzo, patrón, daño visual, localización, actividad inflamatoria, etiología y asociación al antígeno HLAB27+).Conclusiones: La interleucina-6 es una citocina que participa activamente en la patogenia de la uveítis clínica. Nuestros datos demuestran una mayor participación local que sistémica de esta citocina (AU)

[Retinopathy of prematurity. The results after a 1-year follow-up]. / Retinopatía del prematuro. Resultados tras un año de seguimiento.

OBJECTIVE: To analyze prospectively the incidence and outcome of retinopathy of prematurity (ROP) in preterm infants admitted to a neonatal intensive care unit. PATIENTS AND METHODS: A high risk group of infants with birth weights less than 1,500 g, and/or a gestational age less than 30 weeks, was studied. Ophthalmoscopic examination was performed at six weeks of age. Frequent ophthalmoscopic examinations were then performed depending on the gravity of the ROP. RESULTS: ROP was found in 14 of the 20 preterm infants (70%). Two developed stage 3 and none of them stage 4 or 5. Cryotherapy for ROP was not used. None of the infants progressed to advanced stages of ROP and complete resolution was the rule. CONCLUSION: Despite the low incidence of advanced stages of ROP in our study, we suggest that all preterm infants less than 1,500 g and/or 30 weeks of gestational age, should be screened for ROP and repeated ophthalmoscopic examination performed in order to evaluate the progression and treatment of ROP.