Queratoplastia endotelial automatizada con pelado de membrana de Descemet (DSAEK). Revisión sistemática sobre efectividad y seguridad / Descemet's stripping automated endothelial keratoplasty (DEAEK). Systematic review of clinical-effectiveness and safety

OBJETIVOS: Realizar una revisión sistemática sobre la eficacia/efectividad, seguridad y costes de la queratoplastia endotelial automatizada con pelado de la membrana de Descemet (DSAEK) en pacientes con fracaso endotelial corneal. MÉTODO: Búsqueda exhaustiva de la bibliografía en las principales bases de datos biomédicas entre enero y mayo de 2012. RESULTADOS: De 485 artículos localizados se incluyeron 16 series de casos y un estudio de coste-efectividad. Se observó una mejoría tras la intervención en la agudeza visual corregida y sin corregir, alcanzándose valores de 0,6 a 0,8 y de 0,5 respectivamente. El astigmatismo no fue significativo en relación con los valores basales. Las principales complicaciones fueron la dislocación-desprendimiento del injerto (1,5-23%), el fracaso primario (0-12%) y el rechazo endotelial (0,8-8,5%). CONCLUSIONES: En la distrofia de Fuchs y en la queratopatía bullosa, la DSAEK mejora la agudeza visual corregida y sin corregir en relación con los valores preintervención. El astigmatismo originado tras la DSAEK no fue significativo. Las complicaciones más importantes están relacionadas con la viabilidad del injerto, siendo la más frecuente la dislocación-desprendimiento y en menor medida el rechazo endotelial. Los estudios que evalúan la DSAEK son series de casos, en su mayoría retrospectivas. La calidad de este tipo de trabajos no es elevada y presenta limitaciones

OBJECTIVE: To conduct a systematic review of the efficacy/effectiveness, safety and cost of Descemet's stripping automated endothelial keratoplasty (DSAEK) technique in patients with corneal endothelial failure. METHODS: Comprehensive literature search conducted in the main biomedical databases from January-May 2012. RESULTS: Following a critical perusal of the total of 485 abstracts retrieved, 16 case series and one economic evaluation study were included. Corrected distance visual acuity and uncorrected distance visual acuity improved after treatment with DSAEK, attaining values of 0.6 to 0.8 and 0.5 respectively. The degree of post-DSAEK astigmatism was not significant with respect to baseline values. The main complications were graft dislocation-detachment (1.5-23%), primary failure (0-12%) and endothelial rejection (0.8-8.5%). CONCLUSIONS: In Fuchs' dystrophy and bullous keratopathy, data on the effectiveness of DSAEK indicate post-intervention improvement in uncorrected and corrected distance visual acuity. Astigmatism arising after DSAEK was not significant. The most significant post-DSAEK complications are linked to the viability of the graft, with the most frequent complications being dislocation-detachment and, to a lesser extent, endothelial rejection. The studies that assess DSAEK are case series, and for the most part retrospective. The quality of this type of studies is both low and limited

[Descemet's stripping automated endothelial keratoplasty (DEAEK). Systematic review of clinical-effectiveness and safety]. / Queratoplastia endotelial automatizada con pelado de membrana de Descemet (DSAEK). Revisión sistemática sobre efectividad y seguridad.

OBJECTIVE: To conduct a systematic review of the efficacy/effectiveness, safety and cost of Descemet's stripping automated endothelial keratoplasty (DSAEK) technique in patients with corneal endothelial failure. METHODS: Comprehensive literature search conducted in the main biomedical databases from January-May 2012. RESULTS: Following a critical perusal of the total of 485 abstracts retrieved, 16 case series and one economic evaluation study were included. Corrected distance visual acuity and uncorrected distance visual acuity improved after treatment with DSAEK, attaining values of 0.6 to 0.8 and 0.5 respectively. The degree of post-DSAEK astigmatism was not significant with respect to baseline values. The main complications were graft dislocation-detachment (1.5-23%), primary failure (0-12%) and endothelial rejection (0.8-8.5%). CONCLUSIONS: In Fuchs' dystrophy and bullous keratopathy, data on the effectiveness of DSAEK indicate post-intervention improvement in uncorrected and corrected distance visual acuity. Astigmatism arising after DSAEK was not significant. The most significant post-DSAEK complications are linked to the viability of the graft, with the most frequent complications being dislocation-detachment and, to a lesser extent, endothelial rejection. The studies that assess DSAEK are case series, and for the most part retrospective. The quality of this type of studies is both low and limited.

Natalizumab y leucoencefalopatía multifocal progresiva: adecuación a las recomendaciones del Ministerio de Sanidad de España / Natalizumab and progressive multifocal leukoencephalopathy: in compliance with the recommendations of the Spanish Ministry of Health

Introducción y Objetivo: Valorar el seguimiento de las recomendaciones emitidas por el ministerio de sanidad dirigidas a minimizar el riesgo de aparación de Leucoencefalopatía Multifocal Progresiva (LMP) asociada al tratamiento con natalizumab por parte de los profesionales sanitarios de nuestro centro. Material y método: Revisión del 100% de pacientes diagnosticados de Esclerosis Múltiple a tratamiento con natalizumab (septiembre 2008-junio 2013). Resultados: 34 pacientes. La duración de tratamiento fue inferior a 1 año en 10 pacientes, entre 1 y 2 años para 11 pacientes y superior a 2 años en 13 pacientes. Se encuentran 24 resultados de serología VJC: positiva 14 y negativa10. Ningún paciente había recibido inmunosupresores y en el 100% de ellos se realizaron resonancias. Fueron informados acerca del riesgo de desarrollar LMP 18 pacientes, 10 con serología VJC positiva llevando 7 de ellos más de dos años a tratamiento con natalizumab. Discusión: Los facultativos se ajustan a las recomendaciones en la gran mayoría de los pacientes sin embargo, la información previa al inicio de tratamiento y una vez alcanzados los 2 años no se realiza de manera extendida. Sería adecuado realizar una estratificación de riesgo en función de presencia o ausencia de determinados factores que permitiría una selección segura y eficaz de la terapia para EM más adecuada para cada paciente

Introduction and Objective: To judge the follow-up of the recommendations made by the Ministry of Health. These recommendations are aimed at minimizing the risk of Progressive Multifocal Leukoencephalopathy (PML) occurrence, which is associated with natalizumab treatments provided by the neurologists of our centre. Methods: Check-up of 100% of the patients diagnosed with multiple sclerosis being treated with natalizumab (September 2008-June 2013). Results: During the study period 34 patients received at least one dose of natalizumab. The duration of the treatment was less than one year for 10 patients between 1 and 2 years for 11 patients, and more than 2 years for 13 patients. 24 results of JCV serology were found, 14 of which were positive and 10, negative. No patient had been given immunosuppressant drugs and resonance tests were done on 100% of them. 18 patients were informed at the risk of developing PML, among whom ten had positive JCV serology. Seven of them, had been treated with natalizumab for more than two years. Discussion: Doctors are following the recommendations with the vast majority of patients. Nevertheless, the information that precedes the treatment and once that the second year of it is reached is not generally provided. Due to the fact that there are currently no tools to predict an individual’s risk of developing PML, it would be appropriate to carry out a risk stratification based on the presence or absence of certain factors that would allow a safe and effective choice of the most appropriate multiple sclerosis therapy for each patient

Atherogenic dyslipidemia in patients with established coronary artery disease.

BACKGROUND AND AIMS: Patients with stable coronary heart disease (CHD) and atherogenic dyslipidemia (AD) have a high-risk of recurrence and are those who derive most benefit from treatment with lipid-lowering agents. The aim of this study was to examine the prevalence of AD in patients with stable coronary heart disease and to investigate associated factors. METHODS: Cross-sectional study involving 7823 subjects admitted for a coronary event between 6 months and 10 years previously. AD was considered to be the concurrent presence of low HDL-cholesterol (<1.03 mmol/L [40 mg/dL] in males, <1.29 mmol/L [50 mg/dL] in females) and elevated triglycerides (≥1.7 mmol/L [150 mg/dL]). RESULTS: Mean age was 65.3 (10.1) years, 73.6% were males and 80.3% were receiving treatment with statins. Low HDL-cholesterol was observed in 26.3% of the participants, 39.7% had elevated triglyceride concentration and 13.0% had AD. The percentage of AD in patients with criteria for metabolic syndrome was 30.9%. Factors associated directly and independently with the presence of AD in the multivariate analysis were female sex, history of coronary syndrome without ST elevation or coronary revascularization, presence of atrial fibrillation, body mass index, LDL-cholesterol, systolic blood pressure and blood glucose levels, while age and glomerular filtration rate were significantly and inversely associated with AD. CONCLUSION: A significant proportion of patients with coronary disease could benefit from interventions aimed at increasing HDL-cholesterol and reducing triglycerides.

[Prevalence of metabolic syndrome in patients with stable coronary disease: therapeutic objectives and utilization of cardiovascular drugs]. / Prevalencia de síndrome metabólico en pacientes con enfermedad coronaria estable: objetivos terapéuticos y utilización de fármacos cardiovasculares.

OBJECTIVE: The achievement of the therapeutic objectives in patients with ischemic heart disease and metabolic syndrome is unknown. This study has aimed to evaluate whether the prevalence of risk factors, the prescription rate of evidence-based cardiovascular therapies and the attainment of therapeutic goals differ in coronary patients with and without the metabolic syndrome (MS). METHODS: A multicenter, cross-sectional study carried out with the participation of 7,600 patients with stable coronary heart disease (mean age 65.3 years, 82% males, 37.7% with MS) attended in primary care. Data on drug prescription and goal attainment were extracted from clinical records. MS was defined according to the National Cholesterol Education Program (NCEP) criteria. RESULTS: Patients with MS had a higher prevalence of cardiovascular risk factors and cardiovascular disease. They also had a higher prescription rate of blood-pressure lowering drugs, statins and antidiabetic agents, without differences in the rate of use of antithrombotics and beta-blockers. After adjusting for cardiovascular risk factors and co-morbidity, only fibrates and angiotensin II receptor blockers were used more frequently in MS patients. A lower percentage of subjects with MS achieved therapeutic goals of LDL cholesterol (23.4% vs 27.7%, P<.001), blood pressure (29.1% vs 52.2%, P<.001) and, in diabetics, of glycated hemoglobin (54.7% vs 75.9%, P<.001). CONCLUSION: Patients with stable coronary disease and MS do not reach therapeutic objectives as frequently as those without MS, in spite of receiving a higher amount of cardiovascular drugs.

Prevalencia de síndrome metabólico en pacientes con enfermedad coronaria estable: objetivos terapéuticos y utilización de fármacos cardiovasculares / Prevalence of metabolic syndrome in patients with stable coronary disease: therapeutic objectives and utilization of cardiovascular drugs

Objetivo. La consecución de objetivos terapéuticos en pacientes con cardiopatía isquémica crónica y síndrome metabólico (SM) es desconocida. El objetivo del estudio fue analizar en pacientes con enfermedad coronaria estable si la prevalencia de los factores de riesgo, la utilización de fármacos cardiovasculares y la consecución de objetivos terapéuticos eran diferentes en función de la presencia o no del SM. Métodos. Estudio transversal multicéntrico en el que participaron 7.600 sujetos con enfermedad coronaria estable atendidos en Atención Primaria. Para el diagnóstico del SM se utilizaron los criterios del National Colesterol Educational Programm – Adult Treatment Programm III (NCEP-ATP III). Resultados. La edad media fue 65,3 años (hombres, 82%). El 37,7% cumplía criterios de SM. Los pacientes con SM tenían una significativa mayor prevalencia e intensidad de los factores de riesgo, así como una mayor comorbilidad cardiovascular. Además, utilizaban con mayor frecuencia antihipertensivos, hipolipemiantes e hipoglucemiantes, no existiendo diferencias en antitrombóticos y betabloqueantes. Tras ajustar por los factores de riesgo y la comorbilidad solo los fibratos y los antagonistas del receptor de la angiotensina II eran utilizados más frecuentemente por los pacientes con SM. Los objetivos terapéuticos de colesterol-LDL (23,4% versus 27,7%, p<0,001), de presión arterial (29,1% versus 52,2%, p<0,001) y de hemoglobina glucada en diabéticos (54,7% versus 75,9%, p<0,001), se alcanzaron menos frecuentemente en los pacientes con SM. Conclusión. Los pacientes con enfermedad coronaria estable y SM alcanzan unos objetivos terapéuticos con menor frecuencia que los enfermos sin SM, a pesar de recibir una mayor cantidad de fármacos(AU)

Objective. The achievement of the therapeutic objectives in patients with ischemic heart disease and metabolic syndrome is unknown. This study has aimed to evaluate whether the prevalence of risk factors, the prescription rate of evidence-based cardiovascular therapies and the attainment of therapeutic goals differ in coronary patients with and without the metabolic syndrome (MS). Methods. A multicenter, cross-sectional study carried out with the participation of 7,600 patients with stable coronary heart disease (mean age 65.3 years, 82% males, 37.7% with MS) attended in primary care. Data on drug prescription and goal attainment were extracted from clinical records. MS was defined according to the National Cholesterol Education Program (NCEP) criteria. Results. Patients with MS had a higher prevalence of cardiovascular risk factors and cardiovascular disease. They also had a higher prescription rate of blood-pressure lowering drugs, statins and antidiabetic agents, without differences in the rate of use of antithrombotics and beta-blockers. After adjusting for cardiovascular risk factors and co-morbidity, only fibrates and angiotensin II receptor blockers were used more frequently in MS patients. A lower percentage of subjects with MS achieved therapeutic goals of LDL cholesterol (23.4% vs 27.7%, P<.001), blood pressure (29.1% vs 52.2%, P<.001) and, in diabetics, of glycated hemoglobin (54.7% vs 75.9%, P<.001). Conclusion. Patients with stable coronary disease and MS do not reach therapeutic objectives as frequently as those without MS, in spite of receiving a higher amount of cardiovascular drugs(AU)

Cambio en la normativa de dispensación de inmunosupresores en el paciente sometido a un trasplante renal / No disponible

No disponible

Tratamiento farmacológico de las dislipemias / Pharmacological treatment of dyslipidemias

No disponible

No disponible

[Loiasis. Approach to a form of ocular parasitosis]. / Loiasis. Aproximación a una forma de parasitosis ocular.

CASE REPORT: We present the case of a man from Cameroon who was referred because of the presence of a worm in both eyes, intermittently, over a five-year period. Slit-lamp examination revealed a creeping worm under the conjunctiva. Its surgical removal enabled microbiologic confirmation of a mature form of Loa-Loa. DISCUSSION: Loiasis is a parasitic disease endemic in Africa. Because of the increase of African emigration to Spain, the possibility of this condition must be considered in Spain.

Loiasis. Aproximación a una forma de parasitosis ocular / Loiasis. Approach to a form of ocular parasitosis

Caso clínico: Presentamos el caso de un camerunés que refiere la presencia de un gusano en ambos ojos de forma intermitente desde hace 5 años. El examen biomicroscópico reveló la existencia de un gusano reptante subconjuntival. El análisis microbiológico tras su extracción quirúrgica confirmó que se trataba de una forma adulta de Loa-Loa. Discusión: La loiasis es una enfermedad parasitaria endémica en África. El reconocimiento de la enfermedad tiene interés debido al incremento de la emigración africana hacia España

Case report: We present the case of a man from Cameroon who was referred because of the presenceof a worm in both eyes, intermittently, over afive-year period. Slit-lamp examination revealed a creeping worm under the conjunctiva. Its surgical removal enabled microbiologic confirmation of amature form of Loa-Loa. Discussion: Loiasis is a parasitic disease endemic in Africa. Because of the increase of African emigration to Spain, the possibility of this condition must be considered in Spain

[Present situation of antibiotic resistances in tonsillar infections]. / Situación actual de las resistencias a antibióticos en infecciones amigdalares.

OBJECTIVE: To obtain the main responsible organisms, its sensitivity and resistances to antibiotics in tonsillitis. MATERIAL AND METHODS: We have studied the post-surgical tonsils, carrying out a microbiologic study, its culture and sensitivity. RESULTS: The most frequent isolated organisms were Staphylococcus aureus (29.3%), followed by Streptococcus pyogenes (23.4%), and Haemophilus influenzae (12.1%). The highest resistances were for the S. aureus (penicillin 91%, erythromycin 18% and 5% to the rest of the beta-lactams), followed by H. influenzae (50% clarithromycin, 30% amoxyciIlin and 2% cephalosporins) and S. pyogenes (28% erytromycin, 10% clindamycin and 3% penicillin). CONCLUSIONS: We noticed the minimal resistance found to cephalosporins, and for this reason they appear to be the safest option, except in children under five years old, in which amoxicillin is still the first line treatment, because the causative agent is S. pyogenes, sensitive to that antibiotic.

Situación actual de las resistencias a antibióticos en infecciones amigdalares / Present situation of antibiotic resistances in tonsillar infections

Objetivo: Obtener los principales microorganismos y resistencias a antibióticos en infecciones amigdalares. Material y métodos: Realizamos un estudio microbiológico con antibiograma de amígdalas palatinas postquirúrgicas. Resultados: Los microorganismos más aislados han sido el Staphylococcus aureus (29,3%) seguido del Streptococcus pyogenes (23,4%), y del Haemophilus influenzae (12,1%). Las mayores resistencias fueron para el S. aureus (91% a la penicilina, 18% a la eritromicina y un 5% al resto de β-lactámicos), seguido del H. influenzae (50% a la claritromicina, 30% a la amoxicilina y 2% a cefalosporinas) y por último el S. pyogenes (28% a la eritromicina, 10% a la clindamicina y 3% a la penicilina). Conclusiones: Destacamos la mínima resistencia encontrada a las cefalosporinas por lo que parece ser el grupo antibiótico más seguro, excepto en los niños menores de 5 años en los cuales la amoxicilina sigue siendo de primera elección dado que están provocadas por S. pyogenes sensibles a dicho antibiótico

Objective: To obtain the main responsible organisms, its sensitivity and resistances to antibiotics in tonsillitis. Material and methods: We have studied the post-surgical tonsils, carrying out a microbiologic study, its culture and sensitivity. Results: The most frequent isolated organisms were Staphylococcus aureus (29.3%), followed by Streptococcus pyogenes (23.4%), and Haemophilus influenzae (12.1%). The highest resistances were for the S. aureus (penicillin 91%, erythromycin 18% and 5% to the rest of the β-lactams), followed by H. influenzae (50% clarithromycin, 30% amoxycillin and 2% cephalosporins) and S. pyogenes (28% erytromycin, 10% clindamycin and 3% penicillin). Conclusions: We noticed the minimal resistance found to cephalosporins, and for this reason they appear to be the safest option, except in children under five years old, in which amoxicillin is still the first line treatment, because the causative agent is S. pyogenes, sensitive to that antibiotic

Percepciones y opiniones del médico de atención primaria sobre el consumo de alcohol / The perceptions and opinions of primary health care physicians on alcohol consumption

Objetivo: Determinar las actitudes, aptitudes y motivaciones del médico de atención primaria de la salud (APS) respecto al consumo del alcohol. Material y métodos: Estudio observacional, descriptivo, de tipo transversal. 158 de los 299 médicos de APS del sistema público de Salud de Lugo (España), respondieron a una encuesta anónima que recogía variables epidemiológicas básicas, de opinión respecto al consumo de alcohol, y valoración de la actividad desarrollada en APS. Resultados: La media de edad fue de 42,6 años, siendo el 50 por ciento varones. El 98,1 por ciento consideraba que se bebía demasiado, el 67,7 por ciento que se consumía más que en el resto del país y el 62 por ciento que el consumo se había incrementado. El 34,2 por ciento creía que el ámbito adecuado para su abordaje es una red específica, sólo el 2,5 por ciento estaba plenamente satisfecho con la labor que desarrollan. El 84,2 por ciento reconoce no haber recibido suficiente formación. Conclusiones: El médico de APS vive el consumo de alcohol como un problema creciente a la vez que como un hábito social. Existe una deficiente formación con un muy bajo nivel de satisfacción del profesional de APS (AU)

Confusión sobre la independencia de un factor pronóstico: a propósito de la presión de pulso / Confusion about the independence of a prognostic factor: concerning pulse pressure

No disponible

[Satisfaction and recovery of normal activity with rizatriptan 10 mg. Results from the open, prospective, observational 4M study]. / Satisfacción y retorno a la actividad normal con 10 mg de rizatriptán. Resultados del estudio abierto, prospectivo y observacional 4M.

BACKGROUND: To evaluate the impact of the treatment with rizatriptan 10 mg (Maxalt) on the return to normal activity and satisfaction with treatment in the general population with migraine. PATIENTS AND METHOD: We conducted an open, prospective study in patients with migraine (International Headache Society [IHS] criteria) who were followed for up to 3 migraine attacks. We measured the degree of functional disability at 0 and 2 hours after treatment, and satisfaction at 24 hours. Other domains of satisfaction were evaluated after three migraine attacks. The relationship between baseline pain severity, satisfaction after 24 hours and functional disability was analyzed. RESULTS: 2,469 patients were enrolled who experienced 6,323 migraine attacks. A return to normal activity was achieved two hours after treatment in 67% of all attacks treated with rizatriptan 10 mg. The percentage of attacks causing severe functional disability decreased from 39% before therapy to 3.6% two hours after treatment. In more than 90% of moderate or severe attacks, a normal or slightly impaired functional capacity was restored two hours after treatment. In 76.3% of the attacks the patients were fully or very satisfied 24 hours after treatment with rizatriptan 10 mg. After treating three migraine attacks, the proportion of patients fully or very satisfied with rizatriptan was over 79% for all the domains explored. CONCLUSIONS: The patients were highly satisfied after 24 hours and following three migraine attacks treated with rizatriptan 10 mg. In more than two-thirds of the attacks treated with rizatriptan 10 mg, the patients returned to normal activity two hours after treatment.

Satisfacción y retorno a la actividad normal con 10 mg de rizatriptán. Resultados del estudio abierto, prospectivo y observacional 4M / Satisfaction and recovery of normal activity with rizatriptan 10 mg. Results from the open, prospective, observational 4M study

FUNDAMENTOS: Evaluar el impacto del tratamiento con 10 mg de rizatriptán (Maxalt®) sobre el retorno a la actividad normal y la satisfacción con el tratamiento en la población migrañosa general. PACIENTES Y MÉTODO: Estudio abierto, prospectivo, en pacientes con migraña (criterios de la International Headache Society [IHS]) durante 3 crisis. Se midió el grado de incapacidad funcional de 0 a 2 h tras el tratamiento y la satisfacción a las 24 h.Otros dominios de satisfacción fueron evaluados tras 3 crisis de migraña. Se analizó la relación entre intensidad basal del dolor, la satisfacción a las 24 h y la incapacidad funcional. RESULTADOS: Se reclutó a 2.469 pacientes que sufrieron un total de 6.323 crisis de migraña. El 67 per cent de las crisis tratadas con 10 mg de rizatriptán había retornado a la actividad normal a las 2 h del tratamiento. El porcentaje de crisis con incapacidad funcional grave descendió del 39 per cent antes del tratamiento al 3,6 per cent a las 2 h de éste. Más del 90 per cent de las crisis moderadas o graves había recuperado una capacidad funcional normal o levemente alterada a las 2 h del tratamiento. Los pacientes estaban completamente o muy satisfechos a las 24 h del tratamiento con 10 mg de rizatriptán en el 76,3 per cent de las crisis. Tras tratar 3 crisis de migraña, el porcentaje de pacientes que estuvieron totalmente o muy satisfechos con rizatriptán fue superior al 79 per cent en todos los dominios explorados. CONCLUSIONES: Los pacientes se sintieron muy satisfechos a las 24 h y tras 3 crisis tratadas con 10 mg de rizatriptán. Más de dos tercios de las crisis tratadas con 10 mg de rizatriptán recobraron una actividad normal a las 2 h del tratamiento (AU)

[Ocular decompression retinopathy after trabeculectomy]. / Retinopatía por descompresión ocular tras la trabeculectomía.

PURPOSE: Two cases of ocular decompression retinopathy associated with glaucoma filtering surgery are described. CONCLUSIONS: Both patients were young males, intraocular pressures were 35 and 40 mm Hg before surgery. The retinal haemorrhages resolved, and in the only case where it was possible to estimate the visual acuity, it had improved significantly. In the few cases that were reported, most involve young males with markedly high intraocular pressures before surgery and occasionally myopic.

Retinopatía por descompresión ocular tras la trabeculectomía / Ocular decompression retinopathy after trabeculectomy

Objetivo/métodos: Se describen dos casos de retinopatía de la descompresión ocular tras la cirugía filtrante para el glaucoma. Resultados/conclusiones: Ambos pacientes eran varones jóvenes con presión intraocular previa a la cirugía de 35 y 40 mmHg. Las hemorragias retinianas evolucionaron reabsorbiéndose y en el único paciente en el que fue posible estimar la agudeza visual se observó una marcada mejoría. En el pequeño número de casos publicados se observa que con frecuencia afecta a varones jóvenes con tensiones oculares muy altas previas a la cirugía y ocasionalmente miopes (AU)