Efectos y seguridad del perfluorohexiloctano en la superficie ocular y el endotelio corneal / Effects and safety of perfluorohexyloctane on the eye surface and corneal endothelium

OBJETIVO: Evaluar los efectos y la seguridad del perfluorohexiloctano (F6H8) tópico en la superficie ocular y el endotelio corneal. MÉTODOS: Fueron diagnosticados 45 pacientes (90 ojos) de enfermedad de ojo seco, se seleccionaron y se les prescribió tratamiento con F6H8 durante 6 meses. Las variables en la tinción corneal se documentaron usando la escala National Eye Institute/Industry Workshop (NEI), las variables conjuntivales usando la escala Oxford y los parámetros corneales, como el espesor corneal central, la densidad celular, el coeficiente de variación, la hexagonalidad y el área celular promedio, al inicio del estudio, a los 3 meses y a los 6 meses. Se evaluó también el cumplimiento y la satisfacción. RESULTADOS: El tratamiento con F6H8 redujo la tinción corneal promedio en pacientes cumplidores a una media de −0,84 ± 1,95 a los 3meses (p = 0,001) y a −1,65 ± 2,42 a los 6 meses (p < 0,001). La tinción conjuntival a los 6meses mostró una disminución promedio de −0,13 (p = 0,319). Los parámetros endoteliales no mostraron diferencia significativa, excepto el espesor corneal central, que mostró una disminución estadísticamente significativa (era de 545,30 ± 32,25 μm al comienzo del estudio y 538,40 ± 31,36 μm tras 6 meses, p = 0,009). Al final del estudio, el 46% de los pacientes informaron sentirse subjetivamente mejor, el 40,5% no sintió cambios y el 13,5% se sintió subjetivamente peor. CONCLUSIONES: El tratamiento tópico con F6H8 para la enfermedad de ojo seco no alteró las variables medidas del endotelio corneal, aunque sí mostró mejoría en la tinción corneal y en la satisfacción

OBJECTIVE: To evaluate the effects and safety of topical drops of perfluorohexyloctane (F6H8) on the ocular surface and the corneal endothelium. METHODS: Forty-five patients (90 eyes) diagnosed with dry eye disease were recruited and prescribed treatment with F6H8 as part of a six-month prospective multicentre study. Variables in corneal staining were documented using the National Eye Institute/Industry Workshop scale. The conjunctival variables included using the Oxford scale, as well as corneal parameters, such as central corneal thickness, cell density, coefficient of variation, hexagonality, and mean cell area, at the start of the study, and at 3 months and 6 months. Compliance and satisfaction with the treatment were measured. RESULTS: F6H8 drops reduced mean corneal staining based on the NEI scale in compliant patients to a mean of −0.84 ± 1.95 at 3months (P=.001) and to −1.65 ± 2.42 at 6months (P<.001). Conjunctival staining at 6months showed a mean decrease of −0.13 (P=.319). The endothelial parameters did not show a significant difference, in contrast to the central corneal thickness that showed a statistically significant decrease (545.30 ± 32.25 at the start of the study to 538.40 ± 31.36 after 6months, P=.009). At the end of the study, 46% of patients reported feeling subjectively better, 40.5% felt the same, and 13.5% felt subjectively worse. CONCLUSIONS: Topical treatment with F6H8 for dried eye disease did not alter the measured variables of the corneal endothelium, but showed improvement in corneal staining and satisfaction

Effects and safety of perfluorohexyloctane on the eye surface and corneal endothelium. / Efectos y seguridad del perfluorohexiloctano en la superficie ocular y el endotelio corneal.

OBJECTIVE: To evaluate the effects and safety of topical drops of perfluorohexyloctane (F6H8) on the ocular surface and the corneal endothelium. METHODS: Forty-five patients (90 eyes) diagnosed with dry eye disease were recruited and prescribed treatment with F6H8 as part of a six-month prospective multicentre study. Variables in corneal staining were documented using the National Eye Institute/Industry Workshop scale. The conjunctival variables included using the Oxford scale, as well as corneal parameters, such as central corneal thickness, cell density, coefficient of variation, hexagonality, and mean cell area, at the start of the study, and at 3months and 6months. Compliance and satisfaction with the treatment were measured. RESULTS: F6H8 drops reduced mean corneal staining based on the NEI scale in compliant patients to a mean of -0.84 ± 1.95 at 3months (P=.001) and to -1.65 ± 2.42 at 6months (P<.001). Conjunctival staining at 6months showed a mean decrease of -0.13 (P=.319). The endothelial parameters did not show a significant difference, in contrast to the central corneal thickness that showed a statistically significant decrease (545.30 ± 32.25 at the start of the study to 538.40 ± 31.36 after 6months, P=.009). At the end of the study, 46% of patients reported feeling subjectively better, 40.5% felt the same, and 13.5% felt subjectively worse. CONCLUSIONS: Topical treatment with F6H8 for dried eye disease did not alter the measured variables of the corneal endothelium, but showed improvement in corneal staining and satisfaction.

Distrofia de Fuchs asociada a queratotomía radial: ¿queratoplastia penetrante o lamelar? / Fuchs' dystrophy associated with radial keratotomy: Lamellar or perforating keratoplasty?

CASO CLINICO: Paciente de 70 años que acude con queratotomía radial, signos de distrofia de Fuchs con edema central y catarata. Se realiza cirugía en 2 tiempos: facoemulsificación e implante de lente intraocular y 4 meses después DSAEK (descemet stripping automatized endothelial keratoplasty) en ambos ojos sucesivamente sin complicaciones, salvo edema macular cistoide recurrente en ambos ojos. La agudeza visual corregida final es 20/40 en ambos ojos y el paciente se encuentra satisfecho. DISCUSIÓN: Ante coexistencia de queratotomía radial y disfunción endotelial, la DSAEK constituye una alternativa a la queratoplastia penetrante si no se detecta ectasia corneal ni opacidad estromal significativa

CASE REPORT: A 70 year-old male patient with a history of radial keratotomy suffering from Fuchs' dystrophy and a cataract. The patient received a two-step surgery: lens phacoemulsification and intraocular lens implant, followed by descemet stripping automated endothelial keratoplasty in both eyes, four months later. There were no complications apart from a recurrent cystoid macular oedema in both eyes. The best corrected visual acuity was 20/40 both eyes, and the patient was satisfied. DISCUSSION: Descemet stripping automated endothelial keratoplasty may be considered as an alternative to penetrating keratoplasty in the case of endothelial dysfunction and radial keratotomy in patients with no corneal ectasia or significant stromal opacity

Fuchs' dystrophy associated with radial keratotomy: Lamellar or perforating keratoplasty? / Distrofia de Fuchs asociada a queratotomía radial: ¿queratoplastia penetrante o lamelar?

CASE REPORT: A 70 year-old male patient with a history of radial keratotomy suffering from Fuchs' dystrophy and a cataract. The patient received a two-step surgery: lens phacoemulsification and intraocular lens implant, followed by descemet stripping automated endothelial keratoplasty in both eyes, four months later. There were no complications apart from a recurrent cystoid macular oedema in both eyes. The best corrected visual acuity was 20/40 both eyes, and the patient was satisfied. DISCUSSION: Descemet stripping automated endothelial keratoplasty may be considered as an alternative to penetrating keratoplasty in the case of endothelial dysfunction and radial keratotomy in patients with no corneal ectasia or significant stromal opacity.

Tacrolimus tópico al 0, 03% en el tratamiento de la psoriasis ocular / Topical tacrolimus 0.03% for the treatment of ocular psoriasis

OBJETIVO/MÉTODO: Presentamos una serie de 4 pacientes afectos de psoriasis ocular con sintomatología severa, a los que se indicó tratamiento off label con tacrolimus tópico al 0,03% una vez al día. Resultados/conclusión: La blefaritis mixta y queratitis es común a los 4, y en 3 casos hay seudopterigión y opacidades corneales. Se apreció mejoría subjetiva del prurito en 2 semanas, y al mes mejoría de la superficie. Todos manifiestan mejoría significativa de su calidad de vida tras un rango de seguimiento de 6 meses a 2 años. El tacrolimus tópico puede ser considerado una opción en el tratamiento de la psoriasis ocular

OBJECTIVE/METHODS: Cases are presented of 4 patients suffering from severe symptoms due to ocular psoriasis and who were treated with off-label 0.03% tacrolimus once a day. Results/conclusions: All four patients had a mixed blepharitis and keratitis. Pseudopterygium and corneal opacities were present in three of them. All of them experienced an improvement of their itching and ocular surface. They all referred to a marked improvement of their quality of life in a follow-up period ranging from six months to two years. Therefore, topical tacrolimus could be considered an option in the treatment of ocular psoriasis

Topical tacrolimus 0.03% for the treatment of ocular psoriasis. / Tacrolimus tópico al 0,03% en el tratamiento de la psoriasis ocular.

OBJECTIVE/METHODS: Cases are presented of 4 patients suffering from severe symptoms due to ocular psoriasis and who were treated with off-label 0.03% tacrolimus once a day. RESULTS/CONCLUSIONS: All four patients had a mixed blepharitis and keratitis. Pseudopterygium and corneal opacities were present in three of them. All of them experienced an improvement of their itching and ocular surface. They all referred to a marked improvement of their quality of life in a follow-up period ranging from six months to two years. Therefore, topical tacrolimus could be considered an option in the treatment of ocular psoriasis.

Carcinoma de células escamosas en la córnea: un nuevo signo de invasión corneal en la tomografía de coherencia óptica / A new oct sign of invasive squamous cell carcinoma of the cornea

CASO CLÍNICO: Presentamos un caso de inusual opacificación corneal y neovascularización progresiva, causada por un carcinoma de células escamosas (CCE). El infiltrado estromal blanquecino sugestivo de queratitis estromal herpética, mostró una imagen en la tomografía de coherencia óptica (OCT) semejante a una "lengua de lava" deslizándose entre las lamelas corneales. El análisis histopatológico confirmó que se trataba de un CCE. DISCUSIÓN: A nuestro conocimiento, es la primera descripción en la literatura de esta peculiar imagen. El CCE es una causa extremadamente infrecuente de opacificación corneal progresiva y neovascularización, y el retraso en el diagnóstico y tratamiento puede conducir a fracaso del tratamiento y pérdida del globo ocular

CASE REPORT: A case is reported of an unusual progressive corneal opacification and neovascularization caused by a squamous cell carcinoma (SCC) of the cornea. A patient with a white stromal infiltrate, consistent with herpetic stromal keratitis, showed a very particular image in optical coherence tomography (OCT), resembling a "tongue of lava" sliding between corneal lamellae. Histopathological analysis confirmed the diagnosis of SCC. DISCUSSION: To our knowledge this is the first report in the literature of this peculiar image with OCT. Squamous Cell Carcinoma is an extremely rare cause of progressive corneal opacification and neovascularization, and a delayed diagnosis may lead to unsuccessful treatment and loss of the eyeball

A new oct sign of invasive squamous cell carcinoma of the cornea.

CASE REPORT: A case is reported of an unusual progressive corneal opacification and neovascularization caused by a squamous cell carcinoma (SCC) of the cornea. A patient with a white stromal infiltrate, consistent with herpetic stromal keratitis, showed a very particular image in optical coherence tomography (OCT), resembling a "tongue of lava" sliding between corneal lamellae. Histopathological analysis confirmed the diagnosis of SCC. DISCUSSION: To our knowledge this is the first report in the literature of this peculiar image with OCT. Squamous Cell Carcinoma is an extremely rare cause of progressive corneal opacification and neovascularization, and a delayed diagnosis may lead to unsuccessful treatment and loss of the eyeball.

Micropunción estromal anterior como tratamiento del síndrome de Brown-McLean / Anterior stromal puncture for the treatment of Brown-McLean syndrome

El síndrome Brown-McLean consiste en la presencia de edema corneal periférico respetando la córnea central. Se presenta un paciente con queratopatia bullosa anular años después de facoemulsificación e implante de lente en cámara posterior. Su agudeza visual espontánea y corregida era 20/30 y precisaba lente de contacto blanda para aliviar molestias desde hacía cinco años. Practicamos micropunción estromal anterior con cistitomo, y en dos semanas las molestias desaparecieron y no precisa porte de lente blanda. La micropunción estromal es un procedimiento simple que se realiza en lámpara de hendidura y que puede eliminar la sintomatología del síndrome de Brown-McLean (AU)

Case report: The Brown-McLean syndrome is defined by peripheral corneal edema sparing the central cornea. We report a patient with bullous annular keratopathy following phacoemulsification and implantation of posterior chamber intraocular lens. The uncorrected and best corrected visual acuity was 20/30. The patient required the use of a bandage contact lens for almost 5 years to relieve the ocular discomfort. Discussion: Anterior stromal puncture was performed using a cystotome. Two weeks after the procedure the ocular discomfort disappeared and the use of bandage contact lens was no longer required. Anterior stromal puncture is a simple procedure that is performed under the slit lamp, and can alleviate the symptoms in patients with Brown-McLean syndrome (AU)

Anterior stromal puncture for the treatment of Brown-McLean syndrome.

CASE REPORT: The Brown-McLean syndrome is defined by peripheral corneal edema sparing the central cornea. We report a patient with bullous annular keratopathy following phacoemulsification and implantation of posterior chamber intraocular lens. The uncorrected and best corrected visual acuity was 20/30. The patient required the use of a bandage contact lens for almost 5 years to relieve the ocular discomfort. DISCUSSION: Anterior stromal puncture was performed using a cystotome. Two weeks after the procedure the ocular discomfort disappeared and the use of bandage contact lens was no longer required. Anterior stromal puncture is a simple procedure that is performed under the slit lamp, and can alleviate the symptoms in patients with Brown-McLean syndrome.

Deep anterior lamellar keratoplasty in post-laser in situ keratomileusis keratectasia.

We describe a technique using deep anterior lamellar keratoplasty (DALK) in 5 eyes that developed keratectasia after LASIK. The technique is based on surgical manipulation that allows visualization of the lamellar dissection depth using a posterior approach to reach the predescemetic space. The mirror effect, indentation effect, and folding effect were used to determine proximity to Descemet's membrane. The same diameter donor and recipient buttons were used to correct myopia. The donor button without Descemet's membrane was placed using 10-0 nylon sutures. No intraoperative or postoperative complications occurred. The mean best spectacle-corrected visual acuity changed from 0.16 diopter (D) +/- 0.05 (SD) (range 0.10 to 0.25 D) before DALK to 0.68 +/- 0.19 D (range 0.5 to 1.0 D) after DALK. Deep anterior lamellar keratoplasty may be a better alternative than penetrating keratoplasty for any pathology with healthy endothelium.

[Risk factors for atrial fibrillation after thoracic surgery]. / Factores de riesgo en el desarrollo de fibrilación auricular tras cirugía torácica.

OBJECTIVE: To determine the risk factors for atrial fibrillation after lung resection. PATIENTS AND METHODS: Between January 2002 and December 2003, 149 patients underwent lung resection in our hospital. For all these patients, clinical, surgical, analytical, and oncological data were prospectively collected. The data were subjected to univariate analysis. RESULTS: The mean (SD) age of the 127 men (85.2%) and 22 women (14.8%) who underwent lung resection was 61.8 (12.3) years (range, 17-79 years). Atrial fibrillation was documented in 17 patients (11.4%). Mortality at 30 days was 8.1%. The following risk factors for atrial fibrillation were identified: age 70 years or older (P<.0004), prior heart disease (P<.005), patients undergoing operations for lung cancer (P<.04), and type of resection--right bilobectomy (P<.05) and left pneumonectomy (P<.03). Hypertension, chronic obstructive pulmonary disease, and lung cancer stage were not risk factors. Likewise, systematic lymph node dissection and other forms of lung resection were not risk factors. CONCLUSIONS: After lung resection, atrial fibrillation is a common complication that seems to be associated with old age, history of heart disease, operations for lung cancer, left pneumectomy, and right bilobectomy. The identification of these risk factors may encourage prospective studies that assess the use of antiarrhythmic drugs to prevent atrial fibrillation during chest surgery.

Factores de riesgo en el desarrollo de fibrilación auricular tras cirugía torácica / Risk factors for atrial fibrillation alter thoracic surgery

Objetivo: Determinar los factores de riesgo en la fibrilación auricular (FA) tras la resección pulmonar. Pacientes y método: Entre enero de 2002 y diciembre de 2003 se realizaron en nuestro servicio 149 resecciones anatómicas pulmonares. Se recogieron prospectivamente las características clínicas, quirúrgicas, analíticas y oncológicas de todos los pacientes intervenidos. Se realizó un análisis univariante de todas las variables registradas. Resultados: La edad media (± desviación estándar) de los pacientes operados ­127 varones (85,2%) y 22 mujeres (14,8%)­ fue de 61,8 ± 12,3 años (rango: 17-79). Se detectaron 17 casos de FA (11,4%). La mortalidad a los 30 días fue del 8,1%. Se detectaron los siguientes factores de riesgo de presentar FA: edad >= 70 años (p < 0,0004), enfermedad cardíaca previa (p < 0,005), pacientes operados por carcinoma broncogénico (p < 0,04) y tipo de resección --­bilobectomía derecha (p < 0,05) y neumonectomía izquierda (p < 0,03)--­. No fueron factores de riesgo la hipertensión arterial, la enfermedad pulmonar obstructiva crónica, el estadio del carcinoma broncogénico, la disección mediastínica sistemática ni otro tipo distinto de resección pulmonar. Conclusiones: La aparición de FA después de la resección pulmonar anatómica es una complicación frecuente que parece asociarse en nuestra serie a edad avanzada, antecedentes de cardiopatía, intervención por carcinoma broncogénico, neumonectomía izquierda y bilobectomía derecha. La identificación de estos factores de riesgo puede ser de utilidad para iniciar estudios prospectivos encaminados a valorar el uso de fármacos antiarrítmicos para prevenir esta complicación

Objective: To determine the risk factors for atrial fibrillation after lung resection. Patients and methods: Between January 2002 and December 2003, 149 patients underwent lung resection in our hospital. For all these patients, clinical, surgical, analytical, and oncological data were prospectively collected. The data were subjected to univariate analysis. Results: The mean (SD) age of the 127 men (85.2%) and 22 women (14.8%) who underwent lung resection was 61.8 (12.3) years (range, 17-79 years). Atrial fibrillation was documented in 17 patients (11.4%). Mortality at 30 days was 8.1%. The following risk factors for atrial fibrillation were identified: age 70 years or older (P<.0004), prior heart disease (P<.005), patients undergoing operations for lung cancer (P<.04), and type of resection--right bilobectomy (P<.05) and left pneumonectomy (P<.03). Hypertension, chronic obstructive pulmonary disease, and lung cancer stage were not risk factors. Likewise, systematic lymph node dissection and other forms of lung resection were not risk factors. Conclusions: After lung resection, atrial fibrillation is a common complication that seems to be associated with old age, history of heart disease, operations for lung cancer, left pneumectomy, and right bilobectomy. The identification of these risk factors may encourage prospective studies that assess the use of antiarrhythmic drugs to prevent atrial fibrillation during chest surgery

[Spontaneous hemothorax caused by lung cancer]. / Hemotórax espontáneo por carcinoma broncogénico.

Spontaneous hemothorax is an extremely rare complication of malignant disease. We describe the case of a 26-year-old man with spontaneous hemothorax secondary to large-cell carcinoma of the lung, with liver and bone metastases. The patient died in the fifth week after hospitalization.

Hemotórax espontáneo por carcinoma broncogénico / Spontaneous hemothorax caused by lung cancer

El hemotórax espontáneo como forma de presentación de una enfermedad maligna es extremadamente raro. Describimos el caso de un varón de 26 años con un hemotórax espontáneo secundario a un carcinoma broncogénico de células grandes con metástasis hepáticas y óseas que falleció en la quinta semana de ingreso

Spontaneous hemothorax is an extremely rare complication of malignant disease. We describe the case of a 26-year-old man with spontaneous hemothorax secondary to large-cell carcinoma of the lung, with liver and bone metastases. The patient died in the fifth week after hospitalization