Complicaciones de los pacientes con uveítis en un estudio poblacional español: proyecto UveCAM / Complications of uveitis in a Spanish population, UveCAM study

Objetivo Estimar la frecuencia poblacional de complicaciones de uveítis y evaluar sus principales factores de riesgo en los pacientes con uveítis del estudio UveCAM. Pacientes y método Desarrollo de complicaciones de los 386 pacientes con uveítis de toda el área sanitaria de la provincia de Toledo (estudio UveCAM) durante el periodo de un año. Descripción de complicaciones y estudio de los posibles determinantes mediante modelos de regresión multivariante. Resultados Se dispuso de información sobre el desarrollo de complicaciones en 371 de los 386 pacientes del estudio. El 45,8% de los pacientes presentó al menos una complicación, siendo las más frecuentes las sinequias posteriores (19,0%), la hipertensión ocular (14,0%), el edema macular (7,5%), la membrana epirretiniana (6,9%), el glaucoma (6,6%), la atrofia iridiana (5,6%) y las cataratas (5,5%). El riesgo de complicaciones aumenta con la edad, las formas intermedias y panuveítis, y las de evolución crónica o recurrente. Conclusión Las uveítis se asocian con una elevada frecuencia de complicaciones, especialmente en pacientes de edad avanzada, con localización intermedia o posterior del proceso inflamatorio y con evolución crónica o recurrente (AU)

Objective To estimate the population frequency of uveitis complications and to evaluate their main risk factors in the patients with uveitis from the UveCAM study. Patients and methods Development of complications in 386 patients with uveitis in the whole health area of the province of Toledo (UveCAM study) during a period of one year. Description of complications and study of their possible determinants by means of multivariate regression models. Results Information on the development of complications was available in 371 of the 386 patients of the UveCAM study. 45.8% of patients had at least one complication, the most frequent were posterior synechiae (19.0%), ocular hypertension (14.0%), macular oedema (7.5%), epiretinal membrane (6.9%), glaucoma (6.6%), iridian atrophy (5.6%), and atrophy (5.6%) and cataracts (5.5%). The risk of complications increases with age, intermediate and panuveitis locations, and those of chronic or recurrent evolution. Conclusion Uveitis is associated with a high frequency of complications, especially in older patients, with intermediate or posterior localization of the inflammatory process, and chronic or recurrent evolution (AU)

Complications of uveitis in a Spanish population, UveCAM study.

OBJECTIVE: To estimate the population frequency of uveitis complications and to evaluate their main risk factors in the patients with uveitis from the UVECAM study. PATIENTS AND METHODS: Development of complications in 386 patients with uveitis in the whole health area of the province of Toledo (UVECAM study) during a period of 1 year. Description of complications and study of their possible determinants by means of multivariate regression models. RESULTS: Information on the development of complications was available in 371 of the 386 patients of the UVECAM study. The most frequent complications were posterior synechiae (19.0%), ocular hypertension (14.0%), macular edema (7.5%), epirretinal membrane (6.9%), glaucoma (6.6%), iridian atrophy (5.6%) and cataract (5.5%). The risk of complications increases with age, intermediate and panuveitis locations, and those of chronic or recurrent evolution. CONCLUSION: Uveitis is associated with a high frequency of complications, especially in older patients, with intermediate or posterior localization of the inflammatory process and chronic or recurrent evolution.

Epidemiology of Uveitis in a Spanish Region: Prevalence and Etiology.

OBJECTIVE: To estimate the prevalence of uveitis and to describe its etiologic and anatomical patterns based on a population study carried out in a Spanish region. MATERIAL AND METHODS: A cross-sectional, descriptive, population-based multicenter study was conducted. The selection criteria consisted of having a diagnosis of uveitis. All data were collected from existing information in medical records.Clinical information was collected in all cases that had a diagnosis of uveitis, regardless of its etiology, in participating centers from the date of the study to the end of the following year. All patients underwent a complete ophthalmological examination, which included assessment of their visual acuity, biomicroscopy, applanation tonometry, and indirect ophthalmoscopy. RESULTS: During the study, 389 cases of uveitis were registered. The prevalence was 58.7 (95% confidence interval [CI] 53.0-64.9). The mean age was 47.0 ± 20.6 years and 57.8% were women. The most prevalent anatomical pattern was anterior uveitis (54.2; 95% CI 48.1-60.8). For adults, the idiopathic group constituted the highest prevalence (31.7; 95% CI: 27.1-36.9), while autoimmune etiology was most frequent for children (10.6; 95% CI: 5.8-17.7). CONCLUSION: The results of this population-based study offer a representative estimate of the magnitude of uveitis in this area of Spain.

Trasplante autólogo de limbo como nuevo tratamiento de la distrofia corneal epitelial de Lisch / Keratolimbal autograft transplantation as a possible new treatment of Lisch epithelial corneal dystrophy

CASO CLÍNICO: Presentamos el caso de una mujer de 64 años con agudeza visual de 20/40 en su ojo derecho, debida a una opacificación grisácea y plumosa con microquistes en el epitelio corneal, compatible con una distrofia epitelial de Lisch. Se trató secuencialmente con varios desbridamientos epiteliales, lente de contacto y mitomicina C, a pesar de los cuales, recidivaba. La extirpación de un sector limbar y el trasplante de limbo autólogo obtuvieron buenos resultados y sin recurrencia. CONCLUSIÓN: El trasplante autólogo de limbo tras extirpar la zona de limbo afectado puede ser considerado como una nueva opción terapéutica en el tratamiento de la distrofia epitelial de Lisch asimétrica, cuando otros tratamientos han fallado

CASE REPORT: The case concerns 64-year-old woman with visual acuity of 20/40 in the right eye. Slit-lamp examination revealed a grey, feathery corneal opacification with intraepithelial microcysts compatible with Lisch epithelial corneal dystrophy (LECD). It was treated with epithelial debridements, contact lenses and mitomycin C, but the opacification recurred within months. The removal of limbus sector and autologous limbal transplantation (KLAT) were used successfully without recurrence. Conclusions: After removal of damaged limbus, KLAT should be considered as a treatment option for asymmetric LECD when other treatments have failed

Keratolimbal autograft transplantation as a possible new treatment of Lisch epithelial corneal dystrophy. / Trasplante autólogo de limbo como nuevo tratamiento de la distrofia corneal epitelial de Lisch.

CASE REPORT: The case concerns 64-year-old woman with visual acuity of 20/40 in the right eye. Slit-lamp examination revealed a grey, feathery corneal opacification with intraepithelial microcysts compatible with Lisch epithelial corneal dystrophy (LECD). It was treated with epithelial debridements, contact lenses and mitomycin C, but the opacification recurred within months. The removal of limbus sector and autologous limbal transplantation (KLAT) were used successfully without recurrence. CONCLUSIONS: After removal of damaged limbus, KLAT should be considered as a treatment option for asymmetric LECD when other treatments have failed.

Efusión uveal inducido por escitalopram / Uveal effusion induced by escitalopram

CASO CLÍNICO: Mujer de 73 años en tratamiento con escitalopram que presentó glaucoma agudo de ángulo cerrado secundario a efusión uveal tras duplicar la dosis de dicho fármaco 3 días antes. Evolucionó favorablemente tras la suspensión del antidepresivo además de tratamiento hipotensor tópico y prednisona vía oral. DISCUSIÓN: La efusión uveal secundaria a fármacos es un síndrome infrecuente. Se puede acompañar de miopización y glaucoma agudo por cierre angular. El diagnóstico correcto y la suspensión del fármaco conducen a la resolución de esta nosología

CASE REPORT: A 73 year-old woman with depression treated with escitalopram developed acute secondary angle closure glaucoma related to uveal effusion after duplicating the drug dose 3 days before. She evolved favorably once the antidepressant treatment was suspended and a new treatment with topical hypotensive therapy and oral prednisone was used. DISCUSSION: The uveal effusion syndrome associated to medicines is rare; it may be associated with acute myopic shift and acute angle closure glaucoma. The correct diagnosis and discontinuation of the drug lead to the resolution of this nosology

[Uveal effusion induced by escitalopram]. / Efusión uveal inducido por escitalopram.

CASE REPORT: A 73 year-old woman with depression treated with escitalopram developed acute secondary angle closure glaucoma related to uveal effusion after duplicating the drug dose 3 days before. She evolved favorably once the antidepressant treatment was suspended and a new treatment with topical hypotensive therapy and oral prednisone was used. DISCUSSION: The uveal effusion syndrome associated to medicines is rare; it may be associated with acute myopic shift and acute angle closure glaucoma. The correct diagnosis and discontinuation of the drug lead to the resolution of this nosology.

A case-control study of post-operative endophthalmitis diagnosed at a Spanish hospital over a 13-year-period.

A retrospective case-control study of patients who had undergone cataract extraction at a Spanish hospital over a 13-year period was conducted to identify the risk factors for developing post-operative endophthalmitis (POE). During the study period, the type of antibiotic prophylaxis was changed from subconjunctival gentamicin to the addition of both vancomycin and gentamicin to the irrigating solution. The overall incidence of POE was 0·19% (35 cases/18 287 operations). For the period prior to the change in antibiotic prophylaxis, the incidence rate of POE was 3·4 cases/1000 operations while in the latter period the incidence rate decreased to 0·34 cases/1000 operations. All patients who presented a virulent microorganism had a final visual acuity worse than 20/200. The only significant risk factor identified was the type of prophylaxis used (odds ratio 1·97, 95% confidence interval 0·94-4·14, P = 0·07). There were no significant differences between cases and controls although choice of surgeon approached significance.

Ambliopía secundaria a quiste de iris / Amblyopia secondary to iris cyst

CASO CLÍNICO: Varón de 5 años de edad con ambliopía anisometrópica meridional secundaria a quiste de epitelio pigmentario de iris. Es evaluado mediante biomicroscopia ultrasónica (BMU) y tomografía de coherencia óptica de polo anterior (OCT Visante). DISCUSIÓN: La OCT de polo anterior, aunque con limitaciones, es una herramienta útil en la evaluación de lesiones de polo anterior. Puede ser preferible, en la infancia, a la BMU

CLINICAL CASE: A 5 year-old child diagnosed with moderate anisometropic amblyopia secondary to primary cyst of iris pigment epithelium. He was evaluated with ultrasound biomicroscopy (BMU) and optical coherence tomography (OCT) of anterior segment. DISCUSSION: The OCT, although with some limitations, is a useful tool to study the anterior segment. It is probably more recommendable than BMU in the childhood (AU)

Macroadenoma del epitelio no pigmentado del cuerpo ciliar / Macroadenoma of the non-pigmented ciliary epithelium

CASO CLÍNICO: Se describen los hallazgos clínicos y la cirugía conservadora de un paciente con un adenoma no pigmentado del cuerpo ciliar. El adenoma presentaba un tamaño de 5 × 7 mm. El paciente fue intervenido con una cirugía conservadora mediante iridociclectomía parcial asociada a esclerouvectomía lamelar. DISCUSIÓN: Los adenomas del cuerpo ciliar clínicamente pueden imitar a los melanomas amelanóticos. La cirugía conservadora del globo ocular permite realizar un diagnóstico y un tratamiento del paciente manteniendo la función visual

CASE REPORT: We report the clinical features and surgery of a patient with an adenoma of the non-pigmented ciliary epithelium. The adenoma measured 5 × 7 mm. The patient underwent radical ocular surgery consisting of partial iridocyclectomy associated to lamellar sclerouvectomy. DISCUSSION: Adenomas of ciliary body can mimic clinically amelanotic melanomas. We present details of the patient's medical records and review the literature. Clinically, adenoma in ciliary body can mimic amelanotic melanomas. Conservative surgery of the eye allows diagnosis and treatment, maintaining visual function

[Microbiological study of infectious endophthalmitis with positive culture within a 13 year-period]. / Estudio microbiológico de los casos de endoftalmitis infecciosa con cultivo positivo en un periodo de 13 años.

INTRODUCTION: Our objectives are to describe the microbial spectrum and antimicrobial susceptibility of isolates from patients with culture-proven endophthalmitis. MATERIAL AND METHODS: Retrospective study of patients with microbiological diagnosis of endophthalmitis treated at the Ophthalmology Department of the General Hospital La Mancha Centro in the period 1996-2008. The identification of isolates was performed using the automated VITEK-2® and Api galleries (bioMérieux, Spain SA). The antimicrobial susceptibility was performed by the VITEK-2® system (bioMérieux, Spain SA), E-test strips (MIC Test Strip, Liofilchem, Italy) and Sensititre® YeastOne trading system (Trek Diagnostic Systems, Ohio, USA) for Candida species. RESULTS: Forty four (70%) of 63 cases of endophthalmitis were culture positive. Gram-positive bacteria were much more common than gram-negative bacteria in both postoperative endophthalmitis (POE) and post-traumatic endophthalmitis (PTE). Staphylococcus epidermidis was predominant in POE, while Bacillus sp. predominated in the PTE; furthermore, the 75% of total fungal isolates corresponded to postraumatic cases. The isolated strains showed 100% susceptibility to vancomycin, ceftazidime and amikacin, while resistance to ciprofloxacin was greater than 15%. The empirical antifungal therapy failed in 50% of cases. The visual prognosis was significantly less favorable in the PTE. CONCLUSIONS: Based on the susceptibility of our isolates, vancomycin, ceftazidime and amikacin are good choices for empirical treatment of endophthalmitis, unlike ciprofloxacin. We recommend conducting antifungal prophylaxis after penetrating ocular trauma in a rural environment.

Amblyopia secondary to iris cyst.

CLINICAL CASE: A 5 year-old child diagnosed with moderate anisometropic amblyopia secondary to primary cyst of iris pigment epithelium. He was evaluated with ultrasound biomicroscopy (BMU) and optical coherence tomography (OCT) of anterior segment. DISCUSSION: The OCT, although with some limitations, is a useful tool to study the anterior segment. It is probably more recommendable than BMU in the childhood.

[Macroadenoma of the non-pigmented ciliary epithelium]. / Macroadenoma del epitelio no pigmentado del cuerpo ciliar.

CASE REPORT: We report the clinical features and surgery of a patient with an adenoma of the non-pigmented ciliary epithelium. The adenoma measured 5 × 7 mm. The patient underwent radical ocular surgery consisting of partial iridocyclectomy associated to lamellar sclerouvectomy. DISCUSSION: Adenomas of ciliary body can mimic clinically amelanotic melanomas. We present details of the patient's medical records and review the literature. Clinically, adenoma in ciliary body can mimic amelanotic melanomas. Conservative surgery of the eye allows diagnosis and treatment, maintaining visual function.

Toxicidad corneal por amantadina / Corneal toxicity due to amantadine

Caso clínico: Mujer de 64 años en tratamiento con amantadina durante 2 años por enfermedad de Parkinson, que presentó edema corneal bilateral de inicio brusco. Inicialmente se trató como una endotelitis herpética sin mejoría, al desconocer la medicación empleada por la enferma. Finalmente el edema se resolvió tras la suspensión del fármaco. Discusión: El hidrocloruro de amantadina puede producir disfunción endotelial. El edema corneal puede ser reversible tras su suspensión, pero la densidad endotelial permanece baja. Sería necesario realizar un control oftalmológico previo al inicio del tratamiento para valorar el riesgo/beneficio del mismo, sobre todo en los pacientes que presenten baja densidad endotelial o un endotelio alterado (AU)

Case report: A 64 year-old female with Parkinson disease treated with amantadine for two years who suddenly suffered bilateral corneal oedema. It was initially treated as herpetic endotheliitis without improvement as we lacked information on her chronic treatment. The corneal oedema finally resolved after withdrawing the drug. Discussion: Amantadine hydrochloride may produce endothelial dysfunction. Once the amantadine treatment is stopped, the corneal oedema may be reversible but endothelial density remains low. An ophthalmologist examination should be performed before the initiation of amantadine treatment in order to establish a risk: benefit ratio, especially in those patients with low endothelial density or any endothelial anomaly (AU)

Técnica de extracción de esclera donante mediante extrusión del globo ocular / Technique for removing donor sclera by eyeball extrusion

Objetivo: Describir una técnica quirúrgica de extracción escleral en ojo de donante tras la escisión del botón corneoescleral. Conclusiones: La técnica de extrusión es una técnica fácil de realizar, que permite la extracción escleral completa facilitando además su limpieza total y el aislamiento de la retina y del tejido uveal. Esta técnica podría tener un papel importante en el estudio anatómico y morfológico de las estructuras oculares(AU)

Purpose: To describe a surgery technique for removing donor sclera tissue after corneo-scleral button excision. Results: The extrusion technique is easy to perform. It allows the complete scleral extraction its total clean up to be performed, as well as making easier to isolate the retina and uveal tissue. This technique could have an important role in the anatomical and morphological study of ocular structures(AU)

[Corneal toxicity due to amantadine]. / Toxicidad corneal por amantadina.

CASE REPORT: A 64 year-old female with Parkinson disease treated with amantadine for two years who suddenly suffered bilateral corneal oedema. It was initially treated as herpetic endotheliitis without improvement as we lacked information on her chronic treatment. The corneal oedema finally resolved after withdrawing the drug. DISCUSSION: Amantadine hydrochloride may produce endothelial dysfunction. Once the amantadine treatment is stopped, the corneal oedema may be reversible but endothelial density remains low. An ophthalmologist examination should be performed before the initiation of amantadine treatment in order to establish a risk: benefit ratio, especially in those patients with low endothelial density or any endothelial anomaly.

[Technique for removing donor sclera by eyeball extrusion]. / Técnica de extracción de esclera donante mediante extrusión del globo ocular.

PURPOSE: To describe a surgery technique for removing donor sclera tissue after corneo-scleral button excision. RESULTS: The extrusion technique is easy to perform. It allows the complete scleral extraction its total clean up to be performed, as well as making easier to isolate the retina and uveal tissue. This technique could have an important role in the anatomical and morphological study of ocular structures.

[Argon laser iridoplasty as treatment of plateau-like iris configuration secondary to multiple ciliary body cysts: long-term follow-up by ultrasound biomicroscopy]. / Iridoplastia con láser argón como tratamiento del iris plateau secundario a múltiples quistes del cuerpo ciliar: seguimiento a largo plazo con biomicroscopía ultrasónica.

CASE REPORT: We present a 37 year-old man with secondary angle closure by neuroepithelial ciliary body cysts. An argon laser peripherical iridoplasty was performed and ultrasound biomicroscopy (UBM) was employed to follow-up. Initially, the patient had a favorable response to treatment, but six months later the cysts and the secondary closed angle reappeared. DISCUSSION: Argon laser peripheral iridoplasty has been proposed as treatment of plateau-like iris configuration resulting from neuroepithelial ciliary body cysts. However, the cysts and, the secondary closed angle could recur in a long-term (Arch Soc Esp Oftalmol 2009; 84: 569-572).

Estudio de la tracción vitreorretiniana periférica mediante HRA-II con lente de Staurenghi 230 / Peripheral vitreoretinal traction exploration by Staurenghi 230 lens and HRA-II

Objetivo: Comunicar una nueva técnica de exploraciónde la retina periférica en pacientes con desprendimientoagudo de vítreo posterior.Material y métodos: En una muestra de 65 pacientesdiagnosticados de desprendimiento agudo devítreo posterior se estudia la retina periféricamediante el HRA-II combinado con la lente panfunduscópicade Staurenghi SLO 230. El objetivode esta técnica es la detección y localización de desgarrosretinianos y de tracciones vítreo-retinianas.Resultados: En nuestro estudio, utilizando la oftalmoscopíaindirecta con indentación escleral encontramosen 11 pacientes al menos un desgarro retiniano.El HRA-II combinado con la lente de campoamplio fue capaz de detectar el 100% de dichaslesiones. Además, mediante esta técnica, se pudolocalizar en 6 pacientes áreas de tracción vítreo retiniana,mostradas como zonas oscuras en la imageninfrarroja de fondo de ojo. Ninguno de los 65pacientes refirió dolor ni fotofobia durante la exploracióncon esta lente de contacto. Los desgarrosretinianos y las áreas de tracción fueron tratadoscon fotocoagulación con láser argón creando una adhesión coriorretiniana. En 2 pacientes se encontraronnuevos desgarros retinianos durante el seguimiento,siendo detectados tanto por oftalmoscopiaindirecta como por el HRA-II con la lente panfunduscópica.Conclusión: El HRA-II con la lente de campoamplio SLO 230 puede complementar la exploraciónde pacientes con desprendimiento agudo devítreo posterior y ayudar a la detección de zonastraccionadas de la retina que podrían dar lugar a undesgarro retiniano (AU)

Purpose: To report a new technique to explore peripheralvitreous-retinal tractions in patients withacute posterior vitreous detachment.Material and methods: A population of 65patients with acute posterior vitreous detachmentwas studied by panfunduscopic SLO 230 lens andHRA-II to detect peripheral retinal tears and vitreous-retinal tractions.Results: In our study, using indirect ophthalmoscopicexploration, we identified eleven patients with atleast one retinal tear. HRA-II combined with theStaurenghi SLO 230 lens was capable of detecting100% of these lesions. In addition, by means of thistechnology, we identified dark retinal zones thatcorresponded to peripheral retinal traction in sixpatients. None of the 65 patients complained of painor photophobia during the exploration with this contactlens. Retinal tears and peripheral vitreous-retinaltraction were treated by argon laser photocoagulationto create a firm chorioretinal adhesion. In twopatients we found new retinal tears in the follow-up,with these new lesions detected by indirect ophthalmoscopyand HRA-II with SLO 230 lens. Conclusion: HRA-II with the panfunduscopicStaurenghi SLO 230 lens can complement theexploration of patients with acute posterior vitreousdetachment and can help to detect tractional zonesthat could develop into retinal tears(AU)

Iridoplastia con láser argón como tratamiento del iris plateau secundario a múltiples quistes del cuerpo ciliar: seguimiento a largo plazo con biomicroscopía ultrasónica / Argon laser iridoplasty as treatment of plateau-like iris configuration secondary to multiple ciliary body cysts: long-term follow-up by ultrasound biomicroscopy

Caso clínico: Varón de 37 años de edad diagnosticadode cierre angular secundario a quistes neuroepitelialesdel cuerpo ciliar. Se trató mediante iridoplastiaperiférica con láser argón y se realizó seguimientomediante biomicroscopía ultrasónica(BMU). Inicialmente se consiguió una resolucióndel cuadro, pero a los 6 meses los quistes y el cierreangular secundario reaparecieron.Discusión: La iridoplastia periférica con láserargón se ha propuesto como tratamiento en situacionesde bloqueo angular secundario a quistes neuroepitelialesdel cuerpo ciliar. Sin embargo, losquistes y, secundariamente el cierre angular, podríanrecidivar a largo plazo(AU)

Case report: We present a 37 year-old man withsecondary angle closure by neuroepithelial ciliarybody cysts. An argon laser peripherical iridoplastywas performed and ultrasound biomicroscopy(UBM) was employed to follow-up. Initially, thepatient had a favorable response to treatment, butsix months later the cysts and the secondary closedangle reappeared.Discussion: Argon laser peripheral iridoplasty hasbeen proposed as treatment of plateau-like iris configurationresulting from neuroepithelial ciliarybody cysts. However, the cysts and, the secondaryclosed angle could recur in a long-term(AU)