Dacriocistorrinostomía láser endocanalicular y sus modificaciones: revisión sistemática de técnicas y tasa de éxito / Endocanalicular Laser Dacryocystorhinostomy and its modifications: A systematic review of techniques and success rates

Objetivo El objetivo principal de este trabajo es revisar los artículos que hacen referencia a la técnica de la dacriocistorrinostomía láser (DCRL) para la obstrucción adquirida de la vía lagrimal (OACN), así como sus modificaciones, a través de una exhaustiva revisión bibliográfica. Material y método Se realizó una revisión sistemática de las publicaciones relacionadas con cirugía láser de la vía lagrimal desde el año 2000 hasta marzo de 2021 en las bases de datos MEDLINE, EMBASE y Cochrane Library. Los términos de búsqueda en idioma español e inglés fueron: «Endocanalicular laser», dacryocystorhinostomy or «primary DCR-L» or «laser» and «tear ducts». Resultados Tras someter los artículos a los criterios de inclusión y exclusión, obtuvimos 49 artículos: 21 estudios retrospectivos y 28 estudios prospectivos. El resultado bibliométrico obtenido garantiza, para la presente revisión, una recomendación de nivel C según la escala Scottish Intercollegiate Guidelines Network. Conclusiones Actualmente la DCRL clásica tiene tasas de éxito menores que las DCRL modificadas, por lo que sugerimos el uso de estas últimas. Preferimos la DCRL con MMC-IS o bien la DCRL con técnicas de endoscopia asociadas, sin poder decantarnos por ninguna opción en particular, puesto que las tasas de éxito son muy similares. Dejamos a criterio del cirujano la elección, dependiendo del manejo de las técnicas endonasales. Son necesarios más estudios, con mayor seguimiento, y mejor definidos para clarificar cuál es la mejor técnica DCRL (AU)

Objective The main objective of this work is to review the articles that refer to transcanalicular diode laser dacryocystorhinostomy (TCL-DCR) in acquired nasolacrimal duct obstruction (NLDO), as well as its modifications. Material and methods A systematic review of publications related to TCL-DCR of the lacrimal duct from 2000 to March 2021 was carried out in the MEDLINE, EMBASE and Cochrane Library databases. The search terms in Spanish and English were: «Endocanalicular laser», dacryocystorhinostomy or «primary DCR-L» or «laser» and «tear ducts». Results After subjecting the articles to the inclusion and exclusion criteria, we got 49 articles: 21 retrospective and 28 prospective studies. The bibliometric result obtained guaranteed, for this review, a level C recommendation according to the Scottish Intercollegiate Guidelines Network scale. Conclusions Currently, the classic TCL-DCR has lower success rates than its modifications, so we suggest using the latter. We prefer TCL-DCR with IS-MMC or TCDL associated with endoscopy techniques, without being able to opt for any option, since their success rates are very similar. We leave the choice to the discretion of the surgeon, depending on the management skills of endonasal techniques. More studies, with longer follow-up, and better defined criteria are necessary to clarify which is the best TCL-DCR technique (AU)

Endocanalicular Laser Dacryocystorhinostomy and its modifications: A systematic review of techniques and success rates.

OBJECTIVE: the main objective of this work is to review the articles that refer to transcanalicular diode laser dacryocystorhinostomy (TCL-DCR) in acquired nasolacrimal duct obstruction (NLDO), as well as its modifications. MATERIAL AND METHODS: A systematic review of publications related to TCL-DCR of the lacrimal duct from 2000 to March 2021 was carried out in the MEDLINE, EMBASE and COCHRANE LIBRARY databases. The search terms in Spanish and English were: «Endocanalicular laser¼, dacryocystorhinostomy or «primary DCR-L¼ or «laser¼ and «tear ducts¼. RESULTS: After subjecting the articles to the inclusion and exclusion criteria, we got 49 articles: 21 retrospective and 28 prospective studies. The bibliometric result obtained guaranteed, for this review, a level C recommendation according to the Scottish Intercollegiate Guidelines Network scale. CONCLUSIONS: Currently, the classic TCL-DCR has lower success rates than its modifications, so we suggest using the latter. We prefer TCL-DCR with IS-MMC or TCDL associated with endoscopy techniques, without being able to opt for any option, since their success rates are very similar. We leave the choice to the discretion of the surgeon, depending on the management skills of endonasal techniques. More studies, with longer follow-up, and better defined criteria are necessary to clarify which is the best TCL-DCR technique.

Encuesta sobre las preferencias quirúrgicas entre los glaucomatólogos en España / Survey of glaucoma surgical preferences among glaucoma specialists in Spain

Propósito Conocer las cirugías de glaucoma más frecuentes entre los miembros de la Sociedad Española de Glaucoma (SEG).MétodosUna encuesta anónima de 10 preguntas fue enviada a los socios de la SEG en enero, febrero y julio de 2019 para conocer sus preferencias en las cirugías de glaucoma.Variables a estudiar Edad, tipo de glaucoma, tipo de cirugía realizada, estrategia antifibrótica usada o bien implante de las últimas 10 cirugías realizadas desde la recepción de la encuesta. La experiencia del cirujano se muestra según los años de práctica.Resultados Un total de 97 oftalmólogos repartidos por toda la geografía del país respondieron la encuesta, teniendo el 63,4% más de 10 años de experiencia. El glaucoma más frecuente intervenido fue el glaucoma primario de ángulo abierto, representando un 60,6% del total. La cirugía más realizada fue la esclerectomía profunda no perforante (EPNP) con el 37,3% de las cirugías, seguida por el 17,6% de trabeculectomía, 14,1% del microshunt de colágeno (XEN® Allergan Inc., Irvine, CA) y 10,5% de dispositivos de drenaje. Un 21,7% del total fueron reintervenciones y de estas, en el 27,3% se utilizó un dispositivo de drenaje y en el 20,3% trabeculectomía. Un 47,3% de las cirugías fueron combinadas con facoemulsificación. En un 54,8% se usó únicamente mitomicina C (MMC), en un 8,2% de los casos se usó únicamente matriz de colágeno (Ologen®, Aeon Astron Corporation, Taipei, Taiwán) y en un 13,7% la combinación de MMC y matriz de colágeno. La administración de MMC aplicada en esponja se realizó en el 79% de los casos (de estos, a concentraciones de 0,02% en el 99% y al 0,04% en el 1%) y en el 21% de los casos restante mediante inyección subconjuntival (al 0,01% en el 81% y al 0,02% en el 19% restante).Conclusiones A pesar de que el cirujano de glaucoma domina una gran variedad de técnicas quirúrgicas, la EPNP sigue siendo la técnica quirúrgica más realizada en nuestro país (AU)

Purpose To evaluate the spectrum of glaucoma surgery undertaken among members of the Spanish Glaucoma Society (SEG). Methods A 10 question web-based anonymous survey was mailed through the Annals of the Spanish Glaucoma Society to all its members on January, February and July 2019 to determine their preferred surgical approach. Main outcome measures Age, type of Glaucoma, surgery undertaken, type of anti-scarring strategy and prothesis introduced for the last 10 surgeries since the survey was received. The surgeon experience was registered in years of practice. Results A total of 97 SEG members across the country answered the survey. Sixty-two (63.4%) responders had more than 10 years of experience. Primary open angle glaucoma was the most frequent type of glaucoma (60.6%). The most popular surgery was deep-sclerectomy (37.3%) followed by trabeculectomy (17.6%) and the collagen microshunt (XEN® Allergan Inc., Irvine, CA) (14.1%). Glaucoma drainage device (GDD) was used in 10.5% of the cases. Up to 21.7% of surgeries were reinterventions, where GDD was used in 27.3% and trabeculectomy in 20.3% of the cases. Glaucoma surgery was combined with phacoemulsification in 47.3% of the eyes. Mitomycin C (MMC) was used in 54.8% of the cases, collagen matrix (Ologen®, Aeon Astron Corporation, Taipei, Taiwan) was used alone in 8.2% of the cases and in 13.7% combined with MMC. MMC was used in a soaked sponge in 79% of cases (concentrations of 0.02% in 99% and 0.04% in 1%) and in 21% of cases MMC was injected subconjunctivally (concentrations of 0.01% in 81% and 0.02% in 19%) (AU)

Survey of glaucoma surgical preferences among glaucoma specialists in Spain.

PURPOSE: To evaluate the spectrum of glaucoma surgery undertaken among members of the Spanish Glaucoma Society (SEG). METHODS: A 10 question web-based anonimous survey was mailed through the Annals of the Spanish Glaucoma Society to all its members on January, February and July 2019 to determine their preferred surgical approach. MAIN OUTCOME MEASURES: Age, type of Glaucoma, surgery undertaken, type of anti-scarring strategy and prothesis introduced for the last 10 surgeries since the survey was received. The surgeon experience was registered in years of practice. RESULTS: A total of 97 SEG members across the country answered the survey. Sixty-two (63.4%) responders had more than 10 years of experience. Primary open angle glaucoma was the most frequent type of glaucoma (60.6%). The most popular surgery was deep-sclerectomy (37.3%) followed by trabeculectomy (17,6%) and the collagen microshunt (XEN® Allergan Inc., Irvine, CA) (14.1%). Glaucoma drainage device (GDD) was used in 10.5% of the cases. Up to 21.7% of surgeries were reinterventions, where GDD was used in 27.3% and trabeculectomy in 20.3% of the cases. Glaucoma surgery was combined with phacoemulsification in 47.3% of the eyes. Mitomycin C (MMC) was used in 54,8% of the cases, collagen matrix (Ologen®, Aeon Astron Corporation, Taipei, Taiwan) was used alone in 8.2% of the cases and in 13,7% combined with MMC. MMC was used in a soaked sponge in 79% of cases (concentrations of 0.02% in 99% and 0.04% in 1%) and in 21% of cases MMC was injected subconjunctivally (concentrations of 0,01% in 81% and 0.02% in 19%). CONCLUSIONS: Although the glaucoma surgeon performs a wide range of surgical techniques, deep sclerectomy remains the most widely used surgical technique in Spain. Combined cataract and glaucoma surgery is performed almost in half of the patients and MMC is the most frequently selected antifibrotic agent, alone or combined with collagen matrix. The new minimal invasive surgical techniques represent the 20% of the total.

Thermal intravesical chemotherapy in adjuvant treatment of high risk non-muscle invasive bladder cancer. / Quimioterapia intravesical térmica como tratamiento adyuvante en pacientes de cáncer de vejiga alto riesgo no-musculoinvasivos.

OBJECTIVES: To evaluate the oncological results of hyperthermic Mitomycin C (MMC) in adjuvant treatment of high-risk non-muscle invasive bladder cancer and to assess its side-effect profile. METHODS: Patients who were followed up in two reference university hospitals due to high-risk non-muscle invasive bladder tumors were included in the study. High-risk patients according to the EAU non-muscle invasive bladder cancer guideline, patients who were rejected early cystectomy, patients who could not be treated with BCG due to a shortage, and patients for whom the cystectomy would be too risky due to their comorbidities were included in the study. All patients were followed up forat least 24 months with physical examination, cystoscopy, and urine cytology at 3-month intervals. Transurethral tumor resection was performed in all patients and a non-muscle invasive urothelial carcinoma was diagnosed pathologically. Hyperthermic MMC was administered with Synergo system SB-TS 101. Records were kept prospectively and evaluated retrospectively. RESULTS: Fifty-eight high-risk group patients 18 (31%) of whom were at pTa stage and 40 (69%) at pT1 stage were included in the study. During a mean follow-up of 42 months, 34 (58%) patients had recurrence, while 5 (8%) patients progressed to muscle-invasive disease. Eleven (19%) of the patients under went radical cystectomy. The mean time to relapse was 10 months (3-34 months), and the mean time to progression was 41 months (6-87 months). Five-year overall survival, cancer-specific survival, progression-free survival, and relapse-free survival of the patients were 76%, 88%, 90% and 38%, respectively. Multifocality alone was found to be an independent risk factor (HR: 0.26; 95% Cl: 0.08-0.78; p=0.016) affecting recurrence. The observed side effects included tachycardia, cystitis, dysuria, macrohematuria, procedure-related pain, and allergic skin reactions. Treatment had to be discontinued in one patient due to a diffuse skin reaction. CONCLUSIONS: Thermal intravesical MMC therapyis a safe treatment and it could be effective treatment option in preventing disease progression in patients with high risk and non-muscle invasive bladder cancer with unsuccessful Bacillus Calmette-Guérin (BCG) or who could not be treated with BCG for other reasons.

OBJETIVOS: Evaluar los resultados oncológicos de Mitomicina C hipertérmica en tratamiento adyuvante para el cáncer de vejiga de alto riesgono-musculoinvasivo y para evaluar el perfil de efectos secundarios.MÉTODOS: Se incluyeron en el estudio pacientes evaluados en dos centros universitarios de referencia por cáncer de vejiga no-musculoinvasivo de alto riesgo. Fueron incluídos en el estudio los pacientes de alto riesgo según las guías europeas de cáncer de vejiga no-musculoinvasivo, pacientes que no aceptaron la cistectomía precoz o pacientes en los que la cistectomía implicaría demasiado riesgo quirúrgico debido a las comorbilidades. Todos los pacientes fueron seguidos como mínimo por 24 meses con exploración física, cistoscopia y citología de orina en intervalos de 3 meses. La resección transuretral de tumores se realizó en todos los pacientes y el diagnóstico anatomopatológico de carcinoma urotelial no-musculoinvasivo fue determinado. La MMC hipertermia se administró con el sistema Synergo SB-TS101. Los datos se reportaron prospectivamente y retrospectivamente. RESULTADOS: 58 pacientes de alto riesgo, 18 (31%) de los cuales fueron pTa y 40 (69%) pT1 fueron incluidos en el estudio. Durante la media de seguimiento de 42 meses, 34 (58%) recurrieron, mientras que 5 (8% )progresaron a musculo-invasivo. 11 (19%) de los pacientes recibieron una cistectomía radical. La mediana de tiempo a la recidiva fue de 10 meses (3-34 meses) y la mediana a la progresión fue de 42 meses (6-87 meses). La supervivencia global, cáncer-especifica, libre de progresión y libre de recurrencia a 5 años fue de 76%, 88%, 90% y 38%, respectivamente. La multifocalidad fue un factor de riesgo independiente (HR:0,26; 95% Cl: 0,08-0,78; p=0,016) afectando la recurrencia. Los efectos secundarios observados fueron la taquicardia, cistitis, disuria, macrohematuria, dolor con el procedimiento y reacción alérgica. El tratamiento tuvo que pararse en un paciente debido a una reacción cutánea difusa. CONCLUSIONES: La terapia con Mitomicina C térmica es un tratamiento seguro y puede ser un tratamiento efectivo para la prevención de la progresión en pacientes de alto riesgo no-musculoinvasivo en los que la BCG ha fallado o que no se pueden tratar con BCG por otras razones.

The benefit of a neoadjuvant instillation of chemotherapy in non-muscle invasive bladder cancer: Interim analysis of the PRECAVE randomized clinical trial. / El beneficio de una instilación neoadyuvante de quimioterapia en el carcinoma vesical no músculo invasivo: análisis intermedio del ensayo clínico aleatorizado PRECAVE.

OBJECTIVE: Although an immediate postoperative instillation of chemotherapy (IPOIC) after transurethral resection of bladder tumors (TURBT) is recommended for the prevention of recurrences of non-muscleinvasive bladder cancer (NMIBC), evidence shows there is an important compliance failure worldwide. We believe that an immediate neoadjuvant instillation of chemotherapy (INAIC) can act similarly, reducing the recurrence risk of NMIBC. Here we present the interim analysis of the PRECAVE clinical trial. MATERIAL AND METHODS: Patients with clinically diagnosed NMIBC were randomized to receive an INAIC with mitomycin C before TURBT (Group A) or to a control group with TURBT only (Group B). Primary end point was to compare the efficacy of an INAIC in the early recurrence-free survival (RFS). Secondary end points were: RFS in patients who did not receive adjuvant treatments, toxicity, and feasibility. RESULTS: A total of 124 patients with Ta/T1 G1-G3NMIBC were included in the initial analysis (Group A:64, Group B: 60). Demographics, risk classification, complications, and adjuvant treatments were balanced between groups. Eighty-four patients (Group A: 45, Group B: 39) who completed a one-year follow-up were included in the efficacy analysis and no difference was observed in the RFS between groups (p=0.3). In the subgroup of patients who did not receive adjuvant treatments, we found a significant difference in favor of an INAIC (p=0.009) and an 80% reduction in the risk of early recurrences (Hazard Ratio: 0.20; 95% confidence interval: 0.05-0.81; p=0.0024). No differences were observed in adverse events. Only 4 patients did not receive an INAIC despite being planned. CONCLUSIONS: In this interim analysis, although we could not demonstrate a reduction in the RFS of all patients, we did find a significant decrease of recurrences in patients who did not receive adjuvant treatments. The administration of an INAIC seems to be safe and our protocol appears feasible and reproductive.

OBJETIVO: Aunque el uso de una instilación postoperatoria inmediata de quimioterapia (IPOIQ) tras una resección transuretral vesical (RTUV) esta recomendada para prevenir recurrencias de carcinoma vesical no músculo invasivo (CVNMI), no se llega a realizar en muchos casos debido a fallos en su cumplimiento. Nosotros creemos que una instilación neoadyuvante inmediata de quimioterapia (INAIQ) puede actuar de manera similar reduciendo el riesgo de recurrencias. Presentamos el análisis intermedio del ensayo clínico PRECAVE.MATERIAL Y MÉTODOS: Se aleatorizó a pacientes diagnosticados de CVNMI a recibir una INAIQ con mitomicina C antes de la RTUV (Grupo A) o a un grupo control con RTUV solamente (Grupo B). El objetivo primario fue comparar la eficacia de una INAIQ en la supervivencia libre de recurrencia (SLR) temprana. Los objetivos secundarios fueron la SLR en pacientes que no recibieron tratamientos adyuvantes, toxicidad y viabilidad. RESULTADOS: Analizamos un total de 124 pacientes con CVNMI Ta/T1G1-G3 fueron analizados (Grupo A:64, Grupo B: 60). No se encontraron diferencias entre datos demográficos, grupos de riesgo, complicaciones o tratamientos adyuvantes. Para el análisis de eficacias e incluyeron 84 pacientes (Grupo A: 45, Grupo B:39) con al menos un año de seguimiento, sin observar diferencias en la SLR (p=0,3). Sin embargo, en el subgrupo que no recibió tratamientos adyuvantes, sí encontramos una diferencia significativa a favor de la INAIQ (p=0,009), y una reducción del riesgo de recurrencias tempranas del 80% (Hazard Ratio: 0,20; intervalo de confianza 95%: 0,05-0,81; p=0,0024). No se observaron diferencias en la aparición de eventos adversos. Solo 4 pacientes no recibieron un INAIC a pesar de estar planificado. CONCLUSIONES: En este análisis intermedio, aunque no pudimos demostrar una reducción en la SLR de todos los pacientes, sí encontramos una diferencia en el subgrupo que no recibió tratamientos adyuvantes. La administración de una INAIC parece ser segura, y nuestro protocolo parece factible y reproducible.

Optimizing the effective doses of mitomycin C, 5-fluorouracil, and their combination on cultivated basal cell carcinoma / Otimização da dose efetiva da mitomicina C, do 5fluorouracil e da combinação de ambos em culturas de células de carcinoma basocelular

ABSTRACT Purpose: This study aimed to optimize the effective doses of mitomycin C, 5-fluorouracil, and their combination on cultivated basal cell carcinoma. Methods: Cultivated basal cell carcinoma and fibroblastic cells were treated with different concentrations of mitomycin C, 5-fluorouracil, and their combination. Cell viability, cell cycle, apoptosis, and expression levels of TP53, CDKN1A, and CDK6 were investigated. The most effective drug with its optimum dosage was administered via multiple intralesional injections to a 65-year-old woman with advanced periorbital nodulo-ulcerative BCC. Results: The concentrations of 0.00312 and 0.312 mg/mL were considered optimum for mitomycin C and 5-fluorouracil, respectively. The mean viabilities of basal cell carcinoma treated with mitomycin C alone and its combination with 5-fluorouracil were significantly less than those of the controls (p=0.002 and p=0.04, respectively). The cell cycle of all the treated basal cell carcinoma groups was arrested in the S phase. The apoptotic rates (p=0.002) of mitomycin C treated basal cell carcinoma were higher than those of the other treated cells, and their TP53 was significantly upregulated (p=0.0001). Moreover, CDKN1A was upregulated, whereas CDK6 was downregulated in basal cell carcinoma treated with either 5-fluorouracil (p=0.0001 and p=0.01, respectively) or the combination of 5-fluorouracil and mitomycin C (p=0.007 and p=0.001, respectively). Basal cell carcinoma lesions were significantly alleviated following mitomycin C injections in the reported patient. Conclusion: Our in vitro results revealed that the effective doses of mitomycin C and 5-fluorouracil on cultivated basal cell carcinoma were optimized. Mitomycin C was more effective in inducing the apoptosis of basal cell carcinoma than 5-fluorouracil and their combination. The intralesional injections of the optimum dose of mitomycin C could be proposed for the nonsurgical treatment of advanced eyelid basal cell carcinoma.

RESUMO Objetivo: Otimizar a dose efetiva de mitomicina C, 5fluorouracil e da combinação de ambos em culturas de células de carcinoma basocelular (CBC). Métodos: Culturas de células de células de carcinoma basocelular e de fibroblastos foram tratadas com diferentes concentrações de mitomicina C, 5fluorouracil e combinação de ambos. Além disto, foram investigados a viabilidade celular, o ciclo celular, a apoptose e a expressão dos genes TP53, CDKN1A e CDK6. O medicamento mais eficaz, em sua dosagem otimizada, foi administrado em últiplas injeções intralesionais em uma mulher de 65 anos com carcinoma basocelular nódulo-ulcerativo periorbital avançado. Resultados: A concentração de 0,00312 mg/mL de mitomicina C e a de 0,312 mg/mL de 5fluorouracil foram consideradas as ideias. A viabilidade média das células de carcinoma basocelular tratadas com mitomicina C isoladamente e em combinação foi significativamente menor que nas células de controle (respectivamente, p=0,002 e p=0,04). Todos os grupos de carcinoma basocelular tratados demonstraram interrupção do ciclo celular na fase S. As células de carcinoma basocelular tratadas com mitomicina C mostraram maiores taxas de apoptose (p=0,002) e significativa regulação positiva do gene TP53 (p=0,0001). Além disso, o gene CDKN1A foi positivamente regulado e o gene CDK6 foi negativamente regulado em células de carcinoma basocelular tratadas com 5fluorouracil (respectivamente, p=0,0001 e p=0,01) ou com a combinação de medicamentos (respectivamente, p=0,007 e p=0,001). Injeções posteriores de mitomicina C na paciente em questão levaram à melhora significativa da lesão do carcinoma basocelular. Conclusão: Nossos resultados in vitro otimizaram as doses efetivas de mitomicina C e 5fluorouracil na cultura de células de carcinoma basocelular e mostraram que a mitomicina C tem mais eficácia na apoptose de células de carcinoma basocelular do que o 5fluorouracil e a combinação de ambos. Injeções intralesionais de doses otimizadas de mitomicina C podem ser propostas para o tratamento não cirúrgico do células de carcinoma basocelular avançado de pálpebra.

Diferentes concentraciones de mitomicina C en la prevención del haze en la queratectomía fotorrefractiva / Different concentrations of mitomycin C for haze prevention in photorefractive keratectomy

Objetivo: Evaluar la utilidad de dos concentraciones de mitomicina C para la prevención del haze en la queratectomía fotorrefractiva. Métodos: Se realizó un estudio experimental aleatorizado en 26 ojos de 17 pacientes con defectos miópicos. Los pacientes fueron asignados a dos grupos según las dosis de mitomicina C (0,02 por ciento grupo 1 y 0,002 por ciento grupo 2). La variable de respuesta principal fue la presencia de haze. Se buscó correlación entre la magnitud del haze con grado de ametropía tratada, profundidad de ablación, microscopia endotelial y resultados visuales y refractivos. Resultados: A los 6 meses la mayoría de los pacientes del grupo 1 no presentó haze (ocho ojos / 57 por ciento), y del grupo 2 mantuvieron haze 0,5 (6 ojos / 50 por ciento). En la ametropía severa el haze en el grupo 2 fue mayor que en el grupo 1 durante todo el posoperatorio, y se observó la mayor diferencia al sexto mes con 0,5 ± 0,4 vs. 1,5 ± 0,32. En ablaciones > 75 micras el grupo dos terminó con más haze que el uno, con 0,5 ± 0,44 vs. 1,75 ± 0,76. La agudeza visual sin corrección se vio más afectada en el grupo 2. No hubo daño endotelial en ningún grupo. Conclusión: La presencia de haze predomina en los casos tratados con dosis 0,002 por ciento de mitomicina C, comparada con la dosis 0,02 por ciento, aunque en este caso ambos grupos mantuvieron un resultado visual y refractivo adecuado y baja toxicidad endotelial.

Objective: Evaluate the usefulness of two concentrations of mitomycin C for haze prevention in photorefractive keratectomy. Methods: An experimental randomized study was conducted of 26 eyes of 17 patients with myopic defects. The patients were divided into two groups according to their mitomycin C doses (Group 1: 0.02 percent and Group 2: 0.002 percent). The main response variable was the presence of haze. Verification was performed of the correlation between haze magnitude and the degree of the ametropia treated, ablation depth, endothelial microscopy, and visual and refractive results. Results: At six months most patients in Group 1 did not have any haze (eight eyes / 57 percent), whereas 0.5 (6 eyes / 50 percent) in Group 2 still had haze. In severe ametropia, haze was larger in Group 2 than in Group 1 throughout the postoperative period, the greatest difference being observed in the sixth month with 0.5 ± 0.4 vs 1.5 ± 0.32. In ablations > 75 microns, Group 2 ended with more haze than Group 1, with 0.5 ± 0.44 vs 1.75 ± 0.76. Uncorrected visual acuity was more affected in Group 2. No endothelial damage occurred in either group. Conclusion: The presence of haze prevails in cases treated with 0.002 percent doses of mitomycin C, as compared with 0.02 percent doses, though in this case both groups maintained an appropriate visual and refractive result and low endothelial toxicity(AU)

Eficácia da aplicação endoscópica tópica de mitomicina C em estenoses esofágicas cáusticas na população pediátrica: uma revisão sistemática e meta-análise de ensaios clínicos randomizados / Efficacy of endoscopic topical mitomycin c application in caustic esophageal strictures in the pediatric population: a systematic review and meta-analysis of randomized controlled trials

ABSTRACT BACKGROUND: Caustic ingestion and development of esophageal strictures are recognized major public health problems in childhood. Different therapeutic methods have been proposed in the management of such strictures. OBJECTIVE: To evaluate efficacy and risk of endoscopic topical application of mitomycin C in the treatment of caustic esophageal strictures. METHODS: We searched MEDLINE, EMBASE, Central Cochrane, and LILACS databases. The outcomes evaluated were dysphagia resolution rate, number of dilations performed in resolved cases, and the number of dilations performed in all patients. RESULTS: Three randomized clinical trials were included for final analysis with a total of 190 patients. Topical mitomycin C application group showed a significant increase in dysphagia resolution rate, corresponding to a 42% higher dysphagia resolution as compared to endoscopic dilation alone, with statistical significance between the two groups (RD: 0.42 - [CI: 0.29-0.56]; P-value <0.00001). The mean number of dilations performed in resolved cases were significantly less in the topical mitomycin C application group, compared to endoscopic dilations alone, with statistical significance between the two groups (MD: 2.84 [CI: 1.98-3.69]; P-value <0.00001). When comparing the number of dilations in all patients, there was no statistical difference between the two groups (MD: 1.46 [CI: -1.53-4.44]; P-value =0.34). CONCLUSION: Application of topical mitomycin C with endoscopic dilations in caustic esophageal strictures was more effective in dysphagia resolution than endoscopic therapy alone in the pediatric population. Moreover, topical mitomycin C application also reduced the number of dilation sessions needed to alleviate dysphagia without rising morbidity.

RESUMO CONTEXTO: A ingestão de soda cáustica e o desenvolvimento de estenoses esofágicas são reconhecidos como importantes problemas de saúde pública na infância. Diferentes métodos terapêuticos têm sido propostos no manejo dessas estenoses. OBJETIVO: Avaliar a eficácia e o risco da aplicação endoscópica tópica de mitomicina C no tratamento de estenoses esofágicas cáusticas. MÉTODOS: Buscamos as bases de dados MEDLINE, EMBASE, Central Cochrane e LILACS. Os desfechos avaliados foram taxa de resolução da disfagia, número de dilatações realizadas nos casos resolvidos e número de dilatações realizadas em todos os pacientes. RESULTADOS: Três ensaios clínicos randomizados foram incluídos para análise final com um total de 190 pacientes. O grupo de aplicação de mitomicina C tópica apresentou aumento significativo na taxa de resolução da disfagia, correspondendo a uma resolução da disfagia 42% maior em comparação à dilatação endoscópica isolada, com significância estatística entre os dois grupos (RD: 0,42 - [IC: 0,29-0,56]; P-valor <0,00001). O número médio de dilatações realizadas em casos resolvidos foi significativamente menor no grupo de aplicação tópica de mitomicina C, em comparação com as dilatações endoscópicas isoladas, com significância estatística entre os dois grupos (MD: 2,84 [IC: 1,98-3,69]; P-valor <0,00001). Ao comparar o número de dilatações em todos os pacientes, não houve diferença estatística entre os dois grupos (MD: 1,46 [IC: -1,53-4,44]; valor de P=0,34). CONCLUSÃO: A aplicação de mitomicina C tópica com dilatações endoscópicas em estenoses esofágicas cáusticas foi mais eficaz na resolução da disfagia do que a terapia endoscópica isolada na população pediátrica. Além disso, a aplicação tópica de mitomicina C também reduziu o número de sessões de dilatação necessárias para aliviar a disfagia sem aumentar a morbidade.

Colágeno polivinilpirrolidona versus mitomicina C en trabeculectomía en pacientes con glaucoma primario de ángulo abierto. Seguimiento a 36 meses / Outcomes of trabeculectomy with polyvinylpyrrolidone collagen versus mitomycin in primary open angle glaucoma. 36-month follow-up

Propósito Describir y comparar los efectos de la aplicación intraoperatoria de colágeno polivinilpirrolidona (PVP) versus mitomicina C (MMC) en el patrón de cambio de la presión intraocular (PIO) y del número de medicamentos hipotensores utilizados en un seguimiento a 36 meses en pacientes con glaucoma primario de ángulo abierto (GPAA) operados de trabeculectomía. Métodos Estudio prospectivo, comparativo y aleatorizado. Veintiséis ojos de 26 pacientes con diagnóstico de GPAA, sin cirugías incisionales de glaucoma previas, fueron operados de trabeculectomía y aleatorizados a recibir PVP o MMC durante el procedimiento. Todos los pacientes cumplieron un seguimiento de 36 meses. Los resultados principales medidos fueron cambios en la PIO y el número de medicamentos hipotensores durante el seguimiento. Resultados El análisis multivariado reveló que la reducción de la PIO media del preoperatorio a los 36 meses de seguimiento fue de 7,62mmHg (3,05; 12,18) en el grupo de MMC y de 8,15mmHg (−0,64; 16,95) en el grupo de la PVP. La reducción media porcentual de la PIO fue del 37,09% (15,93; 58,17) en el grupo de MMC y del 36,08% (5,16; 67,20) en el grupo de la PVP. El cambio en el número de medicamentos del preoperatorio a los 36 meses de seguimiento fue de −0,92 medicamentos (-2,38; +1,54) para el grupo de MMC y de −1 medicamentos (−3,12, +1,12) para el grupo de la PVP. Ambos grupos tuvieron una disminución estadísticamente significativa de la PIO durante el seguimiento (p<0,001), pero no hubo una diferencia discernible entre los grupos (p=0,5975). El análisis de sensibilidad mostró que un modelo de tendencia lineal es adecuado para describir la reducción de la PIO durante el seguimiento. Ambos grupos tuvieron una reducción estadísticamente significativa de medicamentos del preoperatorio al final del seguimiento (p<0,05), tampoco hubo una diferencia discernible entre los grupos (p=0,2917)(AU)

Purpose Describe and compare the effects of intraoperative application of Polyvinylpyrrolidone Collagen (PVP) versus Mitomycin C (MMC) on the pattern of change in mean IOP reduction and mean number of medications over 36-months follow-up in patients with primary open angle glaucoma (POAG) undergoing trabeculectomy. Methods Prospective, randomized, comparative study. Twenty-six eyes of 26 patients with POAG and no previous incisional glaucoma surgery underwent trabeculectomy and were randomized to PVP or MMC and completed a 36-month follow-up. Main outcome measures were IOP and number of glaucoma medications. Multivariate longitudinal analysis was performed by fitting a linear trend model adjusting for baseline response for the IOP outcome and a log-linear regression model with within-subject associations for the number of hypotensive medications outcome. Sensitivity analysis was performed to assess lower and higher order polynomial trends over time in IOP. Results The univariate analysis revealed that the mean IOP reduction from baseline to 36 months was 7.62mmHg (3.05; 12.18) in the MMC group and 8.15mmHg (−0.64; 16.95) in the PVP group. Mean percentage IOP reduction from baseline was 37.09% (15.93; 58.17) and 36.08% (5.16; 67.20) in the PVP group. Mean change in number of medications from baseline to 36 months was −0.92 medications (−3.38; +1.54) for the MMC group and −1 medication (−3.12; +1.12) for the PVP group. Both groups had a statistically significant decline in mean IOP over the follow-up period (p<0.001) but there was no discernible difference between the two exposure groups in the rate of change in IOP (p=0.5975). Sensitivity analysis showed that a linear trend model is adequate to describe the IOP reduction over the follow-up period. Both groups had a statistically significant change in the number of hypotensive medications used between baseline and month 36 (p<0.05) but there was no discernible difference between exposure groups (p=0.2917) (AU)

Diagnóstico citogenético de la anemia de Fanconi en pacientes cubanos con sospecha clínica de la enfermedad / Cytogenetic diagnosis of Fanconi anemia in Cuban patients with clinical suspicion of the disease

Introducción: La anemia de Fanconi es una enfermedad genética rara, de herencia autosómica o ligada al X, caracterizada por inestabilidad genómica e hipersensibilidad a los agentes de entrecruzamiento del ADN, como el diepoxibutano y la mitomicina C (MMC). La respuesta anormal a estas sustancias, que constituye un marcador celular único y se manifiesta como un incremento de la frecuencia de roturas cromosómicas, es la base de su diagnóstico. Objetivo: Realizar el análisis de roturas cromosómicas inducidas por la mitomicina C en linfocitos de sangre periférica de pacientes cubanos con sospecha de anemia de Fanconi. Métodos: Se realizó estudio de roturas cromosómicas inducidas por la mitomicina C a diferentes concentraciones en cultivos de linfocitos T provenientes de sangre venosa periférica en 32 pacientes con sospecha clínica de anemia de Fanconi e igual cantidad de sujetos controles. Resultados: Al finalizar el análisis seis pacientes (20 por ciento) fueron diagnosticados con anemia de Fanconi. De ellos, cuatro presentaron alto porcentaje de rupturas y dos un mosaicismo somático. Desde el punto de vista clínico, cuatro mostraban anemia aplásica y dos exhibían únicamente rasgos dismórficos típicos de la enfermedad. Conclusiones: El ensayo de roturas cromosómicas inducidas por la mitomicina C permitió el diagnóstico definitivo de anemia de Fanconi en pacientes con antecedentes de anemia aplásica, aún sin anomalías congénitas. Este constituye el primer estudio de este tipo en un grupo de pacientes cubanos(AU)

Introduction: Fanconi anemia is a rare genetic disease of autosomal inheritance or X-linked, characterized by genomic instability and hypersensitivity to DNA cross-linking agents like diepoxybutane and mitomycin C (MMC). The basis for its diagnosis is an abnormal response to these substances, which constitutes a unique cell marker and manifests as an increased chromosomal breakage rate. Objective: To perform the analysis of the chromosomal breakages induced by mitomycin C in peripheral blood lymphocytes of Cuban patients with suspicion of Fanconi anemia. Methods: A study was conducted of chromosomal breakages induced by mitomycin C at various concentrations in cultures of T lymphocytes from venous peripheral blood of 32 patients with clinical suspicion of Fanconi anemia and an equal number of control subjects. Results: At the end of the analysis, six patients (20 percent) were diagnosed with Fanconi anemia. Of these, four showed a high percentage of breakages and two had somatic mosaicism. From a clinical point of view, four had aplastic anemia and two only presented dysmorphic features typical of the disease. Conclusions: Evaluation of the chromosomal breakages induced by mitomycin C led to the definitive diagnosis of Fanconi anemia in patients with a history of aplastic anemia, even in the absence of congenital anomalies. This is the first study of its type in a group of Cuban patients(AU)

Outcomes of trabeculectomy with polyvinylpyrrolidone collagen versus mitomycin in primary open angle glaucoma. 36-month follow-up. / Colágeno polivinilpirrolidona versus mitomicina C en trabeculectomía en pacientes con glaucoma primario de ángulo abierto. Seguimiento a 36 meses.

PURPOSE: Describe and compare the effects of intraoperative application of Polyvinylpyrrolidone Collagen (PVP) versus Mitomycin C (MMC) on the pattern of change in mean IOP reduction and mean number of medications over 36-months follow-up in patients with primary open angle glaucoma (POAG) undergoing trabeculectomy. METHODS: Prospective, randomized, comparative study. Twenty-six eyes of 26 patients with POAG and no previous incisional glaucoma surgery underwent trabeculectomy and were randomized to PVP or MMC and completed a 36-month follow-up. Main outcome measures were IOP and number of glaucoma medications. Multivariate longitudinal analysis was performed by fitting a linear trend model adjusting for baseline response for the IOP outcome and a log-linear regression model with within-subject associations for the number of hypotensive medications outcome. Sensitivity analysis was performed to assess lower and higher order polynomial trends over time in IOP. RESULTS: The univariate analysis revealed that the mean IOP reduction from baseline to 36 months was 7.62mmHg (3.05; 12.18) in the MMC group and 8.15mmHg (-0.64; 16.95) in the PVP group. Mean percentage IOP reduction from baseline was 37.09% (15.93; 58.17) and 36.08% (5.16; 67.20) in the PVP group. Mean change in number of medications from baseline to 36 months was -0.92 medications (-3.38; +1.54) for the MMC group and -1 medication (-3.12; +1.12) for the PVP group. Both groups had a statistically significant decline in mean IOP over the follow-up period (p<0.001) but there was no discernible difference between the two exposure groups in the rate of change in IOP (p=0.5975). Sensitivity analysis showed that a linear trend model is adequate to describe the IOP reduction over the follow-up period. Both groups had a statistically significant change in the number of hypotensive medications used between baseline and month 36 (p<0.05) but there was no discernible difference between exposure groups (p=0.2917). Both the PVP and MMC groups showed an initial reduction in number of medications until month 12 and a relatively linear increase towards month 36. A longer follow-up may be warranted to reveal differences in the number of medications between the two exposure groups. Postoperative complications were less frequent in the PVP group. CONCLUSIONS: The use of PVP during trabeculectomy achieves and maintains a statistically significant IOP reduction from baseline to 36 months and decreases the number of glaucoma medications. Secondary outcome measures showed a lower incidence of adverse events in the PVP group.

Pyogenic granuloma after cosmetic eye whitening. / Granuloma piogénico tras blanqueamiento ocular cosmético.

CLINICAL CASE: A 46-year-old caucasian male with a history of chronic conjunctival hyperemia, presented at our clinic 5 years after he underwent the surgical procedure of cosmetic eye whitening. On examination we observed pyogenic granuloma in the right eye; besides acute nongranulomatous anterior uveitis and necrotizing scleritis in both eyes. RESULT: Complete clinical evaluation and full work-up exclusion of systemic diseases was done. The pyogenic granuloma was treated with surgical resection, as well as anterior uveitis and necrotizing scleritis were successfully treated with systemic corticoesteroids and methotrexate. CONCLUSION: The surgical cosmetic eye whitening could have as complication the pyogenic granuloma in addition to necrotizing scleritis and nongranulomatous anterior uveitis; and be present 5 years after the procedure. The surgical resection is a successful treatment for this presentation of pyogenic granuloma.

Aplicación transoperatoria de mitomicina-C en la dacriocistorrinostomía externa: acuerdos y desacuerdos / Intraoperative application of Mitomycin-C in external dacryocystorhinostomy: agreements and disagreements

RESUMEN Introducción: la dacriocistorrinostomía externa es la técnica más empleada por la mayoría de los cirujanos oculoplásticos para tratar a los pacientes con obstrucción del canal nasolagrimal. Es posible que los galenos cometan algunos errores en este tipo de cirugía, a pesar de los grandes avances en las tecnologías ópticas, las técnicas quirúrgicas y el uso de modernos materiales de intubación. La principal causa de los errores es el cierre de la osteotomía por tejido cicatrizal o de granulación, con la formación de sinequias en la cavidad nasal. La mitomicina C es el antibiótico alquilante más estudiado en la prevención del exceso de cicatrización en el área de la osteotomía; sin embargo, existen acuerdos y desacuerdos entre estudiosos del tema sobre la eficacia, dosis y tiempo de exposición de este medicamento. El papel de cada una de estas variables en el resultado final de la cirugía es controversial. Objetivo: brindar evidencias sobre el papel de la aplicación transoperatoria de la mitomicina C en la dacriocistorrinostomía externa. Métodos: se realizó una revisión de la bibliografía actualizada disponible en idioma español e inglés. Se consultaron los textos completos y resúmenes en las bases de datos: PubMed, Ebsco, Google Académico y Scielo. También se revisaron novedosos artículos en prestigiosas revistas especializadas. Conclusiones: la mayoría de los autores coinciden en que este medicamento contribuye a elevar la tasa de éxito de la dacriocistorrinostomía externa; aunque su aplicación es segura, todavía se estudian algunas variables que mejorarían su eficacia.

ABSTRACT Introduction: external dacryocystorhinostomy is the most used technique by oculoplastic surgeons to treat patient with nasolacrimal duct obstruction. Physicians may make some mistakes in this type of surgery despite great advances in optical technologies, surgical techniques and the use of modern materials for intubation, The main cause of errors is the closure of the osteotomy due to scar tissue or granulation with synechia formation in the nasal cavity. Mitomycin-C is the most studied alkylating antibiotic in the prevention of excessive scarring in the osteotomy area; however, there are some agreements and disagreements among scholars on the efficacy, dosage and time of exposure of this drug. The role of each of these variables in the final outcome of the surgery is controversial. Objective: to provide some evidences about the transoperative application of Mitomycin-C in external dacryocystorhinostomy. Methods: a review of the updated bibliography available in Spanish and English languages was carried out. Complete texts and abstracts were consulted in the databases: PubMed, Ebsco, Google Scholar and Scielo. Novel articles were also reviewed in prestigious specialized journals. Conclusions: must authors agree that this drug appears to improve the success rate of external dacryocystorhinostomy. Although its application is safe, some variables are still being studied that would improve its efficacy.

LASEK-mitomicina C versus PRK-mitomicina C en pacientes con miopía o astigmatismo miópico compuesto / LASEK-mitomycin C versus PRK-mitomycin C in patients with myopia or compound myopic astigmatism

RESUMEN Objetivo: Evaluar los resultados relacionados con la efectividad y la seguridad en el tratamiento con queratectomía subepitelial asistida por láser con mitomicina C versus queratectomía fotorreactiva con mitomicina C en ojos con miopía o astigmatismo miópico compuesto. Métodos: Se realizó un estudio experimental, longitudinal y prospectivo en el Instituto Cubano de Oftalmología Ramón Pando Ferrer entre abril del año 2016 y abril de 2017. Se empleó un muestreo aleatorio simple por el cual se obtuvo la técnica quirúrgica a realizar. El primer ojo operado fue el derecho y a la semana se realizó la cirugía en el ojo izquierdo, en el cual se aplicó la otra técnica quirúrgica. Esto permitió realizar en cada paciente ambas técnicas quirúrgicas. La muestra quedó constituida por 146 ojos (73 pacientes) que cumplían con los criterios de selección. Resultados: El comportamiento preoperatorio entre los dos grupos fue muy similar. En ninguno de los casos existieron diferencias en las variables que se evaluaron (agudeza visual sin corrección, agudeza visual mejor corregida, esfera, cilindro y equivalente esférico). La diferencia entre los valores preoperatorios y los encontrados a los 6 meses del tratamiento quirúrgico en cada grupo fueron estadísticamente significativos (p= 0,000) para todas las variables analizadas, excepto para la agudeza visual mejor corregida en el grupo de ojos tratados con láser con mitomicina C (p= 0,083). El haze y el defecto de epitelización fueron los dos tipos de complicaciones observadas. Conclusiones: Se demostró que ambas técnicas quirúrgicas son efectivas y seguras(AU)

ABSTRACT Objective: Evaluate the effectiveness and safety of laser-assisted subepithelial keratectomy with mitomycin C vs. photoreactive keratectomy with mitomycin C in eyes with myopia or compound myopic astigmatism. Methods: An experimental prospective longitudinal study was conducted at Ramón Pando Ferrer Cuban Institute of Ophthalmology from April 2016 to April 2017. Simple random sampling was used to decide on the surgical technique to be applied. Surgery was first performed on the right eye using one of the techniques, and then one week later on the left eye with the other technique. That way each patient could undergo both surgical techniques. The sample was composed of 146 eyes (73 patients) meeting the inclusion criteria. Results: Preoperative behavior was very similar in the two groups. In neither case were differences found in the variables analyzed (uncorrected visual acuity, best corrected visual acuity, sphere, cylinder and spherical equivalent). The differences between preoperative values and those found six months after surgery in each group were statistically significant for all the variables analyzed (p= 0.000), except for best corrected visual acuity in the group of eyes treated with laser with mitomycin C (p= 0.083). Haze and epithelization defect were the two types of complications observed. Conclusions: It was demonstrated that both surgical techniques are effective and safe(AU)

Effect of age on visual and refractive results after laser-assisted subepithelial keratomileusis (LASEK) with adjuvant use of mitomycin C.

PURPOSE: To evaluate the influence of age on visual and refractive results after laser-assisted subepithelial keratomileusis (LASEK) with the adjuvant use of mitomycin C (MMC) for the correction of myopia. METHODS: Retrospective, nonrandomized, cohort study. A total of 1374 eyes treated with LASEK+MMC were included in the study (we compared 1163 eyes of patients aged 18 to 40 years versus 211 eyes of patients over 40 years). Visual and refractive results were evaluated at the 6-month postoperative visit. RESULTS: Six months postoperatively, both the uncorrected distance visual acuity and the corrected distance visual acuity were significantly better in the group of young patients (P=0.0001). We found a slight tendency to overcorrection in the group of young patients compared to a slight tendency to undercorrection in the group of patients over 40 years (P=0.002). The efficacy index was significantly better in the group of younger patients (0.91±0.2) than in the older patients (0.86±0.2) (P=0.0001). No significant difference was found in the safety index between groups. 81.5% of eyes in the group of patients aged 18 to 40 years compared to 75.3% of eyes in the group of patients aged >40 years were within±0.5D of emmetropia (P=0.001). CONCLUSIONS: A tendency toward undercorrection and less predictability was found with aging after myopic LASEK with MMC for the correction of myopia.

Resolution of conjunctival melanoma with topical interferon alpha 2b in a patient with mitomycin C intolerance. / Resolución de un melanoma conjuntival con interferón tópico alfa 2b en un paciente con intolerancia a la mitomicina C.

OBJECTIVE: To describe the clinical and histological resolution of a case of an inexcisable conjunctival melanoma using topical interferon alpha 2b (INFα2b) in a patient with mitomycin C (MMC) intolerance. CASE REPORT: Conjunctival melanoma is a rare, but potentially sight- and life-threatening, tumour. In cases of multiple lesions, or when surgical excision is not possible, topical combination chemotherapy with MMC and INFα2b has been described as first line therapy. The case is presented of a 77 year-old woman with a multifocal conjunctival in situ melanoma, who was intolerant to initial treatment with MMC and was switched to long-term INFα2b therapy, with a good outcome. CONCLUSIONS: When topical MMC is given as chemotherapy treatment for primary acquired melanosis with atypia or in situ melanoma is not well tolerated, switching to INFα2b seems to be a good option. This approach could replace surgical management of pigmented tumours, especially the larger ones, with potential benefits that include less dependence on surgical margins. This report prompts a need for prospective studies designed to examine the role of INFα2b as primary treatment for heavily pigmented conjunctival tumours avoiding the ocular surface toxicity caused by MMC.

Epitelización de la interfase después de la técnica de LASIK / Interface epithelialization after surgery LASIK technique

La epitelización de la interfase es una de las complicaciones secundarias a la cirugía refractiva corneal mediante la técnica de LASIK y de SMILE, que pueden influir de forma negativa sobre la calidad visual de los pacientes operados. Se presenta una paciente femenina de 51 años de edad operada de astigmatismo hipermetrópico compuesto de ambos ojos, hace aproximadamente dos años, mediante la técnica de LASIK con microquerátomo pendular. Desde hace 5 meses aproximadamente comenzó con disminución de la visión del ojo derecho, agudeza visual sin corrección del ojo derecho de 0,1 y con corrección de 0,3. Al examen oftalmológico se observaron depósitos blanquecinos en la entrecara del flap corneal, correspondientes a la epitelización de la interfase. Se decidió levantar el flap corneal para eliminar el tejido epitelial de la entrecara; se realizó queratectomía fototerapéutica y se colocó mitomicina C al 0,02 por ciento. La evolución de la paciente fue satisfactoria. La agudeza visual posterior al mes sin corrección del ojo derecho mejoró a 0,5 y con corrección a 0,9, sin mostrar signos de recurrencia(AU)

Interface epithelialization is one of the secondary complications of LASIK and SMILE refractive corneal surgery which may negatively affect the visual quality of operated patients. A female 51-year-old patient presents who underwent surgery about two years ago for compound hyperopic astigmatism of both eyes by LASIK technique with a pendular microkeratome. Approximately five months ago the patient began experiencing gradual visual loss in her right eye. Visual acuity of the right eye was 0.1 without correction and 0.3 with correction. Ophthalmological examination found whitish deposits in the corneal flap interface revealing interface epithelialization. It was decided to lift the corneal flap to remove the epithelial tissue from the interface. Phototherapeutic keratectomy was performed and 0.02 percent mitomycin C applied on the area. The patient's evolution was satisfactory. At one month, visual acuity of the right eye had risen to 0.5 without correction and 0.9 with correction, and no signs of recurrence were observed(AU)

Epitelización de la interfase después de la técnica de LASIK / Interface epithelialization after surgery LASIK technique

La epitelización de la interfase es una de las complicaciones secundarias a la cirugía refractiva corneal mediante la técnica de LASIK y de SMILE, que pueden influir de forma negativa sobre la calidad visual de los pacientes operados. Se presenta una paciente femenina de 51 años de edad operada de astigmatismo hipermetrópico compuesto de ambos ojos, hace aproximadamente dos años, mediante la técnica de LASIK con microquerátomo pendular. Desde hace 5 meses aproximadamente comenzó con disminución de la visión del ojo derecho, agudeza visual sin corrección del ojo derecho de 0,1 y con corrección de 0,3. Al examen oftalmológico se observaron depósitos blanquecinos en la entrecara del flap corneal, correspondientes a la epitelización de la interfase. Se decidió levantar el flap corneal para eliminar el tejido epitelial de la entrecara; se realizó queratectomía fototerapéutica y se colocó mitomicina C al 0,02 por ciento. La evolución de la paciente fue satisfactoria. La agudeza visual posterior al mes sin corrección del ojo derecho mejoró a 0,5 y con corrección a 0,9, sin mostrar signos de recurrencia(AU)

Interface epithelialization is one of the secondary complications of LASIK and SMILE refractive corneal surgery which may negatively affect the visual quality of operated patients. A female 51-year-old patient presents who underwent surgery about two years ago for compound hyperopic astigmatism of both eyes by LASIK technique with a pendular microkeratome. Approximately five months ago the patient began experiencing gradual visual loss in her right eye. Visual acuity of the right eye was 0.1 without correction and 0.3 with correction. Ophthalmological examination found whitish deposits in the corneal flap interface revealing interface epithelialization. It was decided to lift the corneal flap to remove the epithelial tissue from the interface. Phototherapeutic keratectomy was performed and 0.02 percent mitomycin C applied on the area. The patient's evolution was satisfactory. At one month, visual acuity of the right eye had risen to 0.5 without correction and 0.9 with correction, and no signs of recurrence were observed(AU)

Review of the evidence on handling drugs and hazardous products in Urology Departments. Consensus document between the Spanish Urological Association and the Spanish Society of Hospital Pharmacy. / Revisión de la evidencia sobre el manejo de medicamentos y productos peligrosos en los servicios de Urología. Documento de consenso entre la Asociación Española de Urología y la Sociedad Española de Farmacia Hospitalaria.

BACKGROUND: The intravesical administration of hazardous drug products is a standard practice in the urology setting, which potentially exposing medical personnel to these drug products. It was deemed necessary to have a consensus document among the scientific societies involved (the Spanish Urological Association and the Spanish Society of Hospital Pharmacy) that collects the best available evidence on the safest handling possible of dangerous drug products in the setting of urology departments. METHODS: We reviewed the legislation and recommendations on the handling of dangerous drug products, both at the national and international level. RESULTS: There is national legislation and regulations for protecting workers who handle dangerous drugs and products, as well as recommendations for handling to protect both the product and workers. DISCUSSION: Following the strategic lines of the European Parliament for 2014-2020 in the chapter on occupational safety and health, the Spanish Urological Association and the Spanish Society of Hospital Pharmacy proposed a series of actions that decrease the risks of exposure for practitioners and caregivers involved in the handling of these products. CONCLUSIONS: After this review, 19 recommendations were established for handling dangerous drug products, which can be summarised as the need to train all individuals involved (from management teams to patients and caregivers), adopt systems that prevent contaminating leaks, implement exposure surveillance programmes and optimise available resources.