External ophthalmomyiasis due to Dermatobia hominis. A case report. / Oftalmomiasis externa por Dermatobia hominis. A propósito de un caso.

CLINICAL CASE: A 46-year-old woman with no relevant medical history, native of Honduras and resident in Spain for one and a half months. The patient went to the Emergency Department due to inflammation of the upper eyelid of the right eye, with an area that simulated an abscess. This was drained (obtaining hardly any purulent content). Treatment was prescribed with oral and topical antibiotics, as well as an anti-inflammatory drug. One week later the patient returned, with improvement of the inflammatory signs, but with discomfort and corneal erosions. After eversion of the upper eyelid, a «worm¼ type parasite emerged from the tarsus. The extraction was completed with a clamp, and was later identified as Dermatobia hominis (Dh) by examination of a fresh specimen. The subsequent outcome of the patient was favourable. DISCUSSION: Preseptal cellulitis in patients from tropical and sub-tropical areas can be caused by Dh.

Acute bilateral serous central chorioretinopathy after emergency contraceptive therapy with ulipristal acetate. / Coriorretinopatía serosa central aguda bilateral tras terapia anticonceptiva de urgencia con acetato de ulipristal.

CASE REPORT: The case concerns a 31 year-old woman with no previous history who consulted due to decreased vision in both eyes. She mentioned taking 1 pill of ulipristal acetate (30mg) as an emergency contraceptive four days before the visual symptoms appeared. In the examination, a better corrected visual acuity of 0.6 was found in the right eye and 0.8 in left eye (by Snellen chart), and bilateral macular serous detachment. It was decided to observe, and 15 days later she showed a functional and anatomical improvement. DISCUSSION: Ulipristal acetate could lead to serous central chorioretinopathy due to its activity on the progesterone receptors present in choroidal and retinal pigment epithelium.

A case of aminoglycosides induced retinal toxicity treated with megadoses of steroids and an intravitreal dexamethasone implant (Ozurdex(®)). / Tratamiento de un caso de toxicidad retiniana por aminoglucósidos con megadosis de corticoides más implante de dexametasona intravítreo (Ozurdex(®)).

CASE REPORT: The case is described of a patient who had a sudden loss of vision in her right eye after glaucoma surgery. A diagnosis of retinal toxicity due to tobramycin (an aminoglycoside) was reached, which was characterised by retinal whitening with a red cherry stain, macular oedema, and vasculitis that progressed to papillary and macular atrophy with arteriolar sclerosis. Given the severity of symptoms an early attempt was made with megadoses of steroids and an intravitreal dexamethasone implant (Ozurdex®, Allergan S.A.), without response. DISCUSSION: Aminoglycoside toxicity is a rare, idiosyncratic, very serious complication for which there is no effective treatment.

[Recurrent and chronic central serous chorioretinopathy. Retina thickness evaluation one month after intravitreal bevacizumab injection]. / Coriorretinopatía serosa central recidivante y crónica. Estudio del espesor retiniano al mes del tratamiento con una inyección de bevacizumab intravítreo.

PURPOSE: To evaluate the efficacy of intavitreal injection of bevacizumab in patients with chronic central serous chorioretinopathy. METHODS: A study of 8 patients with central serous chorioretinopathy who were treated with intravitreal injection of bevacizumab. We studied the visual acuity with Snellens method and the foveal thickness, before and after the injection. RESULTS: The mean age of the patients was 50.25 years. After one month of follow-up, visual acuity before the injection was 0.431 ± 0.249 vision lines and after was 0.631 ± 0.310 vision lines (P=.017).The foveal thickness was 351.25 ± 78.492 µm and after treatment was 183.50 ± 22.640 µm (P=.012). CONCLUSIONS: Intravitreal bevacizumab can be an alternative treatment in patients with serous central chorioretinopathy as it leads to a better objective visual acuity and foveal thickness with optical coherence tomography.

[Retinal nerve fiber layer thickness analysis in children from 6 to 9 years of age]. / Análisis del espesor de la capa de fibras nerviosas en niños de 6 a 9 años.

PURPOSE: To establish a database of scanning laser polarimetry (GDx) parameters for children between 6 and 9 years of age and compare the results at each age. METHODS: The retinal nerve layer thickness of 116 children from one school was evaluated with GDx and the results were analyzed for each age and for the entire group to determinate the normal range for that population. RESULTS: In the global analysis of the software-derived GDx parameters, we obtained a TSNIT average of 59.43 (IC95% 58.41-60.45), a superior average of 71.35 (IC95% 69.99-72.70), an inferior average of 70.08 (IC95% 68.71-71.45), and a TSNIT Std. Deviation of 25.11 (IC95% 24.36-25.86). The results from the analysis for age were similar to the global results. CONCLUSIONS: Given the low level of cooperation required, GDx can be used without problem to study the retinal nerve fiber layer in 6-9-year-old children. GDx could provide objective information about the state of development of the retinal nerve fiber layer during this period of life.

[Limbal relaxing incisions and cataract surgery: our experience]. / Incisiones limbares relajantes y cirugía de la catarata: nuestra experiencia.

PURPOSE: To evaluate the reduction of pre-existing corneal astigmatism at the time of cataract surgery with limbal relaxing incisions (LRIs). METHODS: A prospective study of two groups of patients (treatment and control) with pre-existing astigmatism>or=1D was performed. The 30 patients in the control group had a temporal clear corneal phacoemulsification and the 32 patients of treatment group had combined temporal clear corneal phacoemulsification and LRIs. Holladay analysis was used to assess the efficacy of treatment. An astigmatism distribution and prevalence study in our population is also presented. RESULTS: Three months after surgery, the mean astigmatism change was -0.55D (-0.75 to -0.35) in the treatment group and 0.04D (-0.3 to 0.3) in the control group (p<.0001). CONCLUSIONS: LRI is a simple, safe and effective method not only for reducing pre-existing astigmatism during cataract surgery but in providing good unaided visual acuity.

[Simultaneous botulism in two brothers addicted to cocaine]. / Botulismo simultáneo en dos hermanos cocainómanos.

INTRODUCTION: Botulism is currently an uncommon disease in which the botulinum toxin causes a progressive muscular paralysis that can lead to the death due to a failure of respiratory muscles. CLINICAL CASE: Two brothers, both addicted to cocaine, came to the casualty department because of a decrease of near visual acuity and bilateral mydriasis. Two days later, they developed eyelid ptosis, asymmetric dysfunction of the extraocular muscles and vomiting. DISCUSSION: The presence of a paralysis of accommodation, with bilateral mydriasis that reacts to pilocarpine, makes it necessary to consider botulism as a possible cause.

[Somatostatin analogue treatment in Graves' ophthalmopathy: a case report]. / Tratamiento de la enfermedad de Graves con análogos de la somatostatina: caso clínico.

CASE REPORT: The effect of a somatostatin analogue in a patient with Graves' ophthalmopathy is presented, including data on the dose requirements and the results of therapy. DISCUSSION: There are few effective options for the management of Graves' ophthalmopathy, a cell-mediated immune co-morbidity of thyroid disease. Somatostatin analogues inhibit lymphocyte proliferation and activation, and accumulate in the orbital tissue during the active ophthalmopathy. Because of this, such therapy is able to inactivate the ophthalmopathy without complications occurring.

[Modification of the conjuntival flora with cleaning palpebral solutions]. / Modificación de la flora conjuntival por el empleo de soluciones de higiene palpebral.

OBJECTIVE: The aim of the present study is to evaluate the effectiveness of a solution of palpebral hygiene during the preoperative stage of cataract surgery. MATERIALS AND METHODS: We studied 286 patients divided in 5 groups. One control group that did not use the product, and the remaining 4, that used the product during 3, 4, 5 and 6 days. The design of the study was prospective, randomize and masked. We took a sample of the conjunctival fundus in the morning of the day of the surgery, before commencing treatment with eye drops. This sample was sown according to microbiological techniques and analyzed by the microbiology department. RESULTS: The best time for using palpebral hygiene solutions prior to cataract surgery is four to five days. If it is used at less than three days, it does not decrease the rate of positive cultures and if the solution is applied more than six days, microorganisms that are not part of the common conjunctival flora may appear. CONCLUSIONS: Palpebral hygiene products should not be used more than five consecutive days previous to surgery.

[First results after implanting 125 acrylic lenses (Acrysof MA60BM)]. / Primeros resultados tras el implante de 125 lentes acrílicas (Acrysof MA60BM).

PURPOSE: Analysis of the results obtained after the implantation of 125 AcrySof IOLs. METHODS: A retrospective study in 125 patients with cataracts was performed; 98 without previous eye diseases and 27 with previous eye disease (diabetic retinopathy, traumatic cataract, central corneal leucoma and glaucoma). The phacoemulsification technique chosen depended on the type of cataract (<>, <>). Patients were followed up for an average of 9 months. RESULTS: Functional results (best corrected visual acuity in patients suffering from pre-operative eye diseases were 0.5 or higher in 22.22% of cases, whereas in the group without any disease was higher in 100%. AcrySof was implanted in sulcus when the posterior capsule was ruptured. CONCLUSIONS: AcrySof is a soft acrylic IOL which can be very safely and effectively implanted, and it did not lead to complications nor to adverse effects in our study. It is a safe, foldable IOL for small incision and phacoemulsification cataract surgery.