Discrimination of glaucomatous from non-glaucomatous optic neuropathy with swept-source optical coherence tomography.

OBJECTIVE: To assess the ability of optic nerve head (ONH) parameters, peripapillary retinal nerve fiber layer (pRNFL), and macular ganglion cell layer (GCL) thickness measurements with swept-source optical coherence tomography (SS-OCT), to discriminate between glaucomatous and non-glaucomatous optic neuropathy (GON and NGON). METHODS: This retrospective cross-sectional study involved 189 eyes of 189 patients, 133 with GON and 56 with NGON. The NGON group included ischemic optic neuropathy, previous optic neuritis, and compressive, toxic-nutritional, and traumatic optic neuropathy. Bivariate analyses of SS-OCT pRNFL and GCL thickness and ONH parameters were performed. Multivariable logistic regression analysis was employed to obtain predictor variables from OCT values, and the area under the receiver operating characteristic curve (AUROC) was calculated to differentiate between NGON and GON. RESULTS: Bivariate analyses showed that the overall and inferior quadrant of the pNRFL was thinner in the GON group (P=0.044 and P<0.01), while patients with NGON had thinner temporal quadrants (P=0.044). Significant differences between the GON and NGON groups were identified in almost all the ONH topographic parameters. Patients with NGON had thinner superior GCL (P=0.015), but there were no significant differences in GCL overall and inferior thickness. Multivariate logistic regression analysis demonstrated that vertical cup-to-disc ratio (CDR), cup volume, and superior GCL provided independent predictive value for differentiating GON from NGON. The predictive model of these variables along with disc area and age achieved an AUROC=0.944 (95% CI 0.898-0.991). CONCLUSIONS: SS-OCT is useful in discriminating GON from NGON. Vertical CDR, cup volume, and superior GCL thickness show the highest predictive value.

Impacto del síndrome de iris flácido intraoperatorio (IFIS) en cirugía de cataratas mediante facoemulsificación: análisis de 622 casos / Impact of intraoperative floppy IRIS syndrome in cataract surger by phacoemulsification: Analysis of 622 cases

Introducción Los síndromes de pupila estrecha, incluido el síndrome de iris flácido intraoperatorio (IFIS), aumentan el riesgo de complicaciones durante la cirugía de cataratas si no se realiza una correcta planificación quirúrgica. La tamsulosina se asocia a un incremento muy significativo del riesgo de IFIS, debido a la inactivación prolongada de los receptores alfa-1 adrenérgicos en la fibra muscular lisa del iris. Material y métodos Estudio prospectivo observacional unicéntrico, llevado a cabo en el Hospital de l’Esperança - Parc de Salut Mar.ResultadosSe incluyeron 622 ojos de 502 pacientes, de los cuales 337 (62%) eran mujeres. La media de edad de la muestra era de 74,8 años. Se observaron 61 casos de IFIS (11%), de los cuales 13 recibían tratamiento con tamsulosina y uno con doxazosina. Se observaron 23 casos de IFIS en pacientes mujeres. La ratio mujer:hombre fue de aproximadamente 1:3. Se observaron 19 casos (3%) de IFIS severo, de los cuales 6 recibían tratamiento con alfa-antagonistas, sin correlación estadísticamente significativa.La media del tiempo quirúrgico fue de 13,80min (desviación estándar [DE]: 4,01min) en pacientes sin IFIS y de 16,93min (DE: 4,32min) en pacientes con IFIS. La relación entre la duración del procedimiento quirúrgico en minutos y la presencia de IFIS fue estadísticamente significativa, aplicando un test t-Student «a dos colas» o bilateral con un p valor de 0,01. Conclusión Independientemente del grado de severidad, el diagnóstico de IFIS alarga el tiempo quirúrgico en cirugía de cataratas. Esto supone otra evidencia más que apoya la utilización de tratamientos antagonistas adrenérgicos menos alfa-1 selectivos que la tamsulosina o la realización de la cirugía de cataratas antes de iniciar dichos tratamientos. (AU)

Background Small pupil syndromes, including intraoperative-floppy iris syndrome (IFIS), increase the risk of complications during cataract surgery if proper surgical planning is not performed. Tamsulosin is associated with a very significant increase in the risk of IFIS, due to the prolonged inactivation of alpha-1 adrenergic receptors in the smooth muscle fiber of the iris. Material and methods Single-center prospective observational study, carried out at the Hospital de l’Esperança – Parc de Salut Mar.ResultsSix hundred and twenty-two eyes of 502 patients were included, of which 337 (62%) were women. The mean age of the sample is 74.8 years. Sixty-one cases of IFIS (11%) were observed, of which 13 received treatment with Tamsulosin and 1 with Doxazosin. Twenty-three cases of IFIS were observed in female patients. The female:male ratio was approximately 1:3. Nineteen cases (3%) of severe IFIS were observed, of which 6 received treatment with alpha-antagonists, with no statistically significant correlation.The mean surgical time was 13.80min (standard deviation – SD: 4.01min) in patients without IFIS and 16.93min (SD: 4.32min) in patients with IFIS. The relationship between the duration of the surgical procedure in minutes and the presence of IFIS was statistically significant, applying a ‘two-tailed’ or bilateral t-Student test with a p value of 0.01. Conclusion Regardless of the degree of severity, the diagnosis of IFIS lengthens the surgical time in cataract surgery. This represents yet another piece of evidence that supports the use of less selective alpha-1 adrenergic antagonist treatments than tamsulosin or the performance of cataract surgery before starting these treatments. (AU)

Impact of intraoperative floppy IRIS syndrome in cataract surgery by phacoemulsification: Analysis of 622 cases.

BACKGROUND: Small pupil syndromes, including IFIS, increase the risk of complications during cataract surgery if proper surgical planning is not performed. Tamsulosin is associated with a very significant increase in the risk of IFIS, due to the prolonged inactivation of alpha-1 adrenergic receptors in the smooth muscle fiber of the iris. MATERIAL AND METHODS: Single-center prospective observational study, carried out at the Hospital de l'Esperança - Parc de Salut Mar. RESULTS: 622 eyes of 502 patients were included, of which 337 (62%) were women. The mean age of the sample is 74.8 years. 61 cases of IFIS (11%) were observed, of which 13 received treatment with Tamsulosin and 1 with Doxazosin. 23 cases of IFIS were observed in female patients. The female:male ratio was approximately 1:3. 19 cases (3%) of severe IFIS were observed, of which 6 received treatment with alpha-antagonists, with no statistically significant correlation. The mean surgical time was 13.80 min (Standard Deviation - SD: 4.01 min) in patients without IFIS and 16.93 min (SD: 4.32 min) in patients with IFIS. The relationship between the duration of the surgical procedure in minutes and the presence of IFIS was statistically significant, applying a 'two-tailed' or bilateral t-Student test with a p value of 0.01. CONCLUSION: Regardless of the degree of severity, the diagnosis of IFIS lengthens the surgical time in cataract surgery. This represents yet another piece of evidence that supports the use of less selective alpha-1 adrenergic antagonist treatments than Tamsulosin or the performance of cataract surgery before starting these treatments.

Macular optical coherence tomography for screening of pathology prior to cataract surgery: An approach based on tele-evaluation.

BACKGROUND: To assess the benefit of macular spectral-domain optical coherence tomography (SD-OCT) as a part of the routinary preoperative study of patients undergoing cataract surgery. METHODS: A prospective single-center study study was performed. Consecutive patients with normal biomicroscopic funduscopy, moderate cataract and no history of ophthalmological pathologies were enrolled. All patients underwent macular SD-OCT. The obtained images were analysed by a general ophthalmologist and two retina specialists. Incidence of macular pathology and its relation to age and comorbidities were assessed. RESULTS: Eight-hundred and thirty-six eyes of 419 patients were enrolled in this study. All images were analysed telematically by a general ophthalmologist. Forty-nine eyes were excluded due to insufficient quality of the obtained images. Abnormal images were observed in 156 eyes (18.6%), including age-related macular degeneration in 68 (8.2%), epiretinal membrane (ERM) in 67 (8.0%), cystoid macular edema in 3 eyes (0.4%), among others. Diagnostics with severe impact on patient visual prognosis were observed in 16 eyes (3.82%) from 12 patients. The relationship between incidence of macular pathologies and age or comorbidities was not statistically significant. To assess accuracy of the first observer, images were subsequently analysed by two retinologists. The kappa index of concordance was 0.80 and 0.85. CONCLUSIONS: Implementing a systematic macular SD-OCT as a preoperative test prior to cataract surgery would improve quality of postoperative visual prognosis information. A general ophthalmologist would be suitable to screen for pathology through macular OCT images.

Infectious postoperative endophthalmitis after cataract surgery performed over 7 years. The role of azithromycin versus ciprofloxacin eye drops.

OBJECTIVE: Although topical antibiotics have been used as antimicrobial prophylaxis after ocular surgery, recent studies have determined that intracameral cefuroxime at the end of surgery significantly reduce the risk to suffer an infection and suggest that the use of topical antibiotics in the prophylaxis of infectious postoperative endophthalmitis (IPOE) is controversial. Moreover, there is no evidence to confirm the higher effectiveness of topical ciprofloxacin, considered the standard of care, or topical azithromycin in preventing IPOE of cataract surgeries. METHODS: IPOE topical prophylaxis was performed with two different strategies: with azithromycin from January 1st, 2010 to December 31st, 2014 (group I) and with ciprofloxacin from January 1st, 2015 to January 31st, 2017 (group II). Patient characteristics and clinical signs and symptoms of IPOE from all consecutive cataract surgeries performed over a 7-year period were collected. RESULTS: A total of 15,146 cataract surgeries were conducted; 10,756 in group I and 4,390 in group II. Two cases of IPOE in each group were diagnosed, showing a 0.019% and 0.046% rate respectively, with no statistically significance. IPOE cases were related with aging, systemic and ocular comorbidities or with a complicated cataract surgery. CONCLUSIONS: The benefit of the application of topical antibiotics after cataract surgery is questionable when intracameral cefuroxime prophylaxis is performed and no better effectiveness with ciprofloxacin or azithromycin was observed.

Seguridad clínica y reclamaciones por responsabilidad profesional en Oftalmología / Clinical safety and professional liability claims in Ophthalmology

Introducción: La seguridad del paciente es una prioridad a nivel internacional. Las sociedades científicas y demás organizaciones en el campo de la Oftalmología han intensificado sus esfuerzos en materia de seguridad del paciente. Estos esfuerzos se han relacionado con la gestión del aseguramiento de la responsabilidad profesional médica mediante el análisis de las reclamaciones, como herramienta para aprender del error. Material y método: Revisión de la evolución en materia de seguridad clínica y responsabilidad profesional médica en la especialidad de Oftalmología. Resultados: La Oftalmología tiene una frecuencia elevada de reclamación y un riesgo elevado de indemnización en caso de producirse la reclamación. Determinadas reclamaciones, suscitadas por un error de cirugía o un defecto de información, tienen un riesgo especialmente elevado de indemnización y se precisa aumentar los esfuerzos para la prevención de estos eventos potencialmente evitables. El especialista en Oftalmología, como cualquier otro facultativo, está sujeto a la normativa legal vigente y una formación adecuada obligatoria en los aspectos médico-legales del ejercicio sería esencial. Conclusiones: Los profesionales deben tomar conciencia de los aspectos fundamentales de la responsabilidad profesional médica, así como aspectos específicos como la medicina defensiva o la seguridad del paciente. El conocimiento de estos aspectos médico-legales de la práctica clínica ayuda a allanar el camino hacia una carrera profesional satisfactoria y segura y ayuda a incrementar la seguridad del paciente. El objetivo de esta revisión es contribuir a esta formación en beneficio de pacientes y profesionales (AU)

Introduction: Patient safety is an international public health priority. Ophthalmology scientific societies and organisations have intensified their efforts in this field. As a tool to learn from errors, these efforts have been linked to the management of medical professional liability insurance through the analysis of claims. Material and methods: A review is performed on the improvements in patient safety, as well as professional liability issues in Ophthalmology. Results: There is a high frequency of claims and risk of economic reparation of damage in the event of a claim in Ophthalmology. Special complaints, such as wrong surgery or lack of information, have a high risk of financial compensation and need strong efforts to prevent these potentially avoidable events. Studies focused on pathologies or specific procedures provide information of special interest to sub-specialists. The specialist in Ophthalmology, like any other doctor, is subject to the current legal provisions and appropriate mandatory training in the medical-legal aspects of health care is essential. Conclusions: Professionals must be aware of the fundamental aspects of medical professional liability, as well as specific aspects, such as defensive medicine and clinical safety. The understanding of these medical-legal aspects in the routine clinical practice can help to pave the way towards a satisfactory and safe professional career, and help in increasing patient safety. The aim of this review is to contribute to this training, for the benefit of professionals and patients (AU)

Clinical safety and professional liability claims in Ophthalmology. / Seguridad clínica y reclamaciones por responsabilidad profesional en Oftalmología.

INTRODUCTION: Patient safety is an international public health priority. Ophthalmology scientific societies and organisations have intensified their efforts in this field. As a tool to learn from errors, these efforts have been linked to the management of medical professional liability insurance through the analysis of claims. MATERIAL AND METHODS: A review is performed on the improvements in patient safety, as well as professional liability issues in Ophthalmology. RESULTS: There is a high frequency of claims and risk of economic reparation of damage in the event of a claim in Ophthalmology. Special complaints, such as wrong surgery or lack of information, have a high risk of financial compensation and need strong efforts to prevent these potentially avoidable events. Studies focused on pathologies or specific procedures provide information of special interest to sub-specialists. The specialist in Ophthalmology, like any other doctor, is subject to the current legal provisions and appropriate mandatory training in the medical-legal aspects of health care is essential. CONCLUSIONS: Professionals must be aware of the fundamental aspects of medical professional liability, as well as specific aspects, such as defensive medicine and clinical safety. The understanding of these medical-legal aspects in the routine clinical practice can help to pave the way towards a satisfactory and safe professional career, and help in increasing patient safety. The aim of this review is to contribute to this training, for the benefit of professionals and patients.

[Subfoveal perfluorocarbon liquid. Two new cases]. / Perfluorocarbono líquido subfoveal. Dos nuevos casos.

PURPOSE/METHODS: Subfoveal perfluorocarbon liquid (SPCL) causes vision loss and central scotoma. We present two clinical cases with this complication and we review the 5 clinical cases reported in the literature to analyse their potential prognostic factors. RESULTS/CONCLUSIONS: SPCL extraction involves an early visual acuity recovery and a central scotoma disappearance. The visual acuity recovery degree does not depend on the patient's age, the onset visual acuity or the evolution time when this last one is less than 3 months.

Perfluorocarbono líquido subfoveal. Dos nuevos casos / Subfoveal perfluorocarbon liquid. Two new cases

Objetivo/método: El perfluorocarbono líquidosubfoveal (PCLS) produce disminución de la visióny un escotoma central. Se presentan dos casos conesta complicación y se revisan los cinco casos descritosen la literatura mundial para valorar la existenciao no de factores pronóstico.Resultados/conclusiones: La extracción del(PCLS) comporta una pronta recuperación de laagudeza visual con la desaparición del escotomacentral. El grado de recuperación de la visión nodepende de la edad del paciente, de la agudezavisual inicial ni del tiempo de evolución cuandoeste es inferior a tres meses(AU)

Purpose/methods: Subfoveal perfluorocarbonliquid (SPCL) causes vision loss and central scotoma.We present two clinical cases with this complicationand we review the 5 clinical cases reported inthe literature to analyse their potential prognosticfactors.Results/conclusions: SPCL extraction involves anearly visual acuity recovery and a central scotomadisappearance. The visual acuity recovery degreedoes not depend on the patient’s age, the onsetvisual acuity or the evolution time when this lastone is less than 3 months(AU)

[Spherical aberration influence in visual function after cataract surgery: prospective randomized trial]. / Influencia de la aberración esférica en la función visual tras cirugía de catarata: ensayo prospectivo aleatorio.

PURPOSE: We compare the contrast sensitivity and visual acuity obtained with an anterior surface modified prolate intraocular lens (Tecnis Z9000) with the contrast sensitivity and visual acuity obtained with a standard acrylic foldable intraocular lens (Acrysof SA60 AT). METHODS: In this prospective trial, 64 patients presenting for cataract surgery were randomized to receive in both eyes either the Tecnis Z9000 intraocular lens or the the Acrysof SA60AT intraocular lens: 32 Tecnis Z9000 and 32 Acrysof SA60AT. Visual acuity and contrast sensitivity were monocular and binocularly tested in all of them preoperatively and three months after surgery. RESULTS: The Tecnis Z9000 intraocular lens provided statistically significantly better monocular (Tecnis group: 0.85; Acrysof group: 0.78; p < 0.01) and binocular (Tecnis group: 0.95; Acrysof group: 0.86; p < 0.02) visual acuity. The contrast sensitivity mean was also greater in Tecnis group in monocular and binocular conditions, but without statistical signification. CONCLUSION: Visual acuity and contrast sensitivity after cataract surgery improved in both groups. But monocular and binocular visual acuity was statistically significantly better only in Tecnis group. The contrast sensitivity mean values were greater in Tecnis group but without statistically significant differences.

Influencia de la aberración esférica en la función visual tras cirugía de catarata: ensayo prospectivo aleatorio / Spherical aberration influence in visual function after cataract surgery: prospective randomized trial

Propósito: Comparar los resultados obtenidos tras la implantación de una lente con óptica prolata modificada (Tecnis Z9000) con los de una lente plegable acrílica convencional (Acrysof SA60 AT) en cuanto a agudeza visual y sensibilidad al contraste.Métodos: En este estudio prospectivo 64 pacientes fueron aleatorizados para recibir en sus dos ojos el mismo tipo de lente intraocular: 32 Tecnis Z9000 y 32 Acrysof SA60AT. La agudeza visual y sensibilidad al contraste se evaluó monocular y binocularmente en todos ellos antes de la cirugía y a los tres meses de evolución.Resultados: La agudeza visual monocular fue mejor en el grupo Tecnis (0,85) que en el Acrysof (0,78) (p<0,01). En condiciones de binocularidad también resultó superior la AV en el grupo Tecnis (0,95) que en el Acrysof (0,86) (p<0,02). La sensibilidad media al contraste también es superior para el grupo Tecnis tanto monocular como binocularmente pero no alcanza significación estadística.Conclusión: En ambos grupos se produjo una mejoría de la agudeza visual y sensibilidad al contraste después de la cirugía de catarata pero el implante Tecnis se asoció con una agudeza visual significativamente mejor tanto monocular como binocularmente. Los valores medios de sensibilidad al contraste son superiores en el grupo Tecnis pero la diferencia no es estadísticamente significativa

Purpose: We compare the contrast sensitivity and visual acuity obtained with an anterior surface modified prolate intraocular lens (Tecnis Z9000) with the contrast sensitivity and visual acuity obtained with a standard acrylic foldable intraocular lens (Acrysof SA60 AT).Methods: In this prospective trial, 64 patients presenting for cataract surgery were randomized to receive in both eyes either the Tecnis Z9000 intraocular lens or the the Acrysof SA60AT intraocular lens: 32 Tecnis Z9000 and 32 Acrysof SA60AT. Visual acuity and contrast sensitivity were monocular and binocularly tested in all of them preoperatively and three months after surgery.Results: The Tecnis Z9000 intraocular lens provided statistically significantly better monocular (Tecnis group: 0.85; Acrysof group: 0.78; p<0.01) and binocular (Tecnis group: 0.95; Acrysof group: 0.86; p<0.02) visual acuity. The contrast sensitivity mean was also greater in Tecnis group in monocular and binocular conditions, but without statistical signification.Conclusion: Visual acuity and contrast sensitivity after cataract surgery improved in both groups. But monocular and binocular visual acuity was statistically significantly better only in Tecnis group. The contrast sensitivity mean values were greater in Tecnis group but without statistically significant differences