Triage prehospitalario: nociones básicas para profesionales no entrenados / Pre-hospital Triage: Basic Notions for Non-Trained Professionals

Dado que el triage es útil y necesario en la atención de urgencias, pero que no todos los profesionales están preparados para realizarlo, el propósito de este trabajo es proporcionar la información básica necesaria sobretriage para que un profesional de Enfermería recién graduado pueda desarrollar una actuación adecuada en caso de accidentes con múltiples víctimas (AMV).Para ello, se hace una descripción de la historia del triage, una diferenciación entre el triage hospitalario/extrahospitalario y se facilita una introducción a dos métodos de clasificación simples, como son el Start y el Short que, aunque están pensados para personal no sanitario, constituyen un muy buen punto de partida para todo aquel profesional sin la experiencia requerida para el afrontamiento de este tipo de situaciones, por la facilidad y simplicidad que poseen para ser recordados en momentos de estrés y caos, como ocurre en los AMV, situaciones ante la que se desbordan la capacidad habitual de asistencia (AU)

Given that triage is useful and necessary in Emergency Care, but not all professionals are trained for it, the objective of this paper is to provide the required basic information about triage so that a recently qualified Nursing Professional is able to act adequately in case of accidents with multiple victims (AMVs).To that end, the history of triage is described, a differentiation is made between hospital / extra-hospital triage, and an introduction to two simple classification methods, Start and Short, is provided. These have been designed for non-healthcare professionals, but they represent a very good point of start for all staff without the experience required to face this type of situations, due to their ease and simplicity to be remembered in times of stress and chaos, such as AMVs, which are situations exceeding the usual capacity of care (AU)

Prospective study of cooperation and satisfaction in glaucoma surgery under sub-Tenon's anesthesia.

OBJECTIVES: To evaluate the analgesic effect as well as patient cooperation and satisfaction with sub-tenon's anesthesia in glaucoma surgery. MATERIAL AND METHODS: Prospective uncontrolled study. Fifty-three patients who underwent glaucoma surgery, with or without cataract extraction, with sub-Tenon's anesthesia have been studied. Satisfaction and cooperation were evaluated on a qualitative scale. The pain level was quantified using a numerical scale from 1 (no pain) to 10 (unsupportable pain). RESULTS: The mean pain score at the different periods was: 2.13 (standard deviation [SD] 1.47) on administering anesthesia, 1.74 (SD 1.27) during the surgery, 1.63 SD (1.23) immediately after the procedure, 1.38 (SD 0.38) 30 min later, and 1.38 (SD 0.63) when leaving the recovery unit. The postoperative satisfaction was "fairly or very satisfied" in 92.6% of the cases for both the surgeons and the patients. Twenty-four patients complained during the surgery, 15 of them at the conjunctival suture; in these cases additional anesthesia was administered, and, in 4 cases, intravenous paracetamol was given. Pain scores were significatively higher during the surgery (P=.033), and immediately after the procedure (P=.027) in trabeculectomy than in deep sclerectomy patients. CONCLUSIONS: The good analgesic level reached led to a high level of patient and surgeon satisfaction, even in longer procedures such as deep sclerectomy combined with cataract extraction, or implantation of drainage devices. Pain scores were significatively higher in trabeculectomy than in deep sclerectomy patients.

Manejo extrahospitalario de pacientes con comportamientos autolíticos / Extrahospital handling of patients with autolytic behaviors

El suicidio, gesto autolítico o ideación autolítica, es un problema sociocultural y sanitario de gran envergadura, y ha sufrido un aumento en los últimos 45 años del 60% en la población mundial. La definición de conducta suicida hace referencia a una serie de comportamientos relacionados con ideas de suicidio, tentativa de suicidio y suicidio consumado. La Clasificación Internacional de Enfermedades CIE 10 define el suicidio como un acto con resultado letal, deliberadamente iniciado y realizado por el sujeto, sabiendo o esperando el resultado letal y donde la muerte es un instrumento para obtener cambios deseables en la actividad consciente y en el medio social. La necesidad de aprender a reconocer y manejar los sentimientos y conductas que los pacientes con comportamiento sautolíticos pueden provocar en los profesionales y que pueden interferir en la adecuada evaluación y asistencia de estos pacientes es otro de los objetivos que no deben nunca olvidarse, a fin de disminuir la ansiedad del profesional, del paciente y del entorno de este. El propósito de este artículo consiste en describir, a modo de guía rápida de intervención, los diversos pasos a realizar tanto en la detección como en el manejo de posibles comportamientos autolíticos, así como a identificar las diversas opciones a seguir cuando se responde a un aviso de un paciente que ha realizado o quiere realizar un gesto autolítico (AU)

Suicide, autolytic gesture or autolytic ideation is a huge sociocultural and healthcare problem and has undergone a 60% rise in the worldwide population over the past 45 years. The definition of suicidal behavior makes reference to a number of behaviors related to ideas of suicide, attempted suicide and completed suicide. The ICD-10 International Classification of Diseases defines suicide as an act with a lethal outcome, deliberately attempted and completed by the individual, knowing or expecting the lethal outcome and in which death is a means of achieving desired changes in the conscious activity and in the social environment. The need of learning to recognize and handle the feelings and behaviors which patients with autolytic behaviors can cause in professionals and which can interfere in the proper assessment and care of these patients is another of the objectives which must never be overlooked so as to reduce the anxiety of the professional, the patient and the patient’s environment. The purpose of this article consists of describing, as a guide for rapid intervention, the different steps to take for both identifying and handling possible autolytic behaviors, as well as identifying the different options to be followed answering a call from apatient who has carried out or wants to carry out an autolytic ges (AU)

Estudio prospectivo sobre colaboración y satisfacción en cirugía de glaucoma con anestesia subtenoniana / Prospective study of cooperation and satisfaction in glaucoma surgery under sub-Tenon's anesthesia

Objetivos: Valorar el efecto analgésico así como la colaboración y satisfacción de los pacientes en la cirugía de glaucoma con anestesia subtenoniana. Material y métodos: Estudio prospectivo no controlado. Se estudiaron datos de 53 pacientes operados de glaucoma, asociado o no a cirugía de catarata, bajo anestesia subtenoniana, valorándose de manera cualitativa la satisfacción y colaboración, así como el grado de analgesia mediante una escala numérica de 1 (no dolor) a 10 (máximo). Resultados: La calificación media del dolor ha sido: 2,13 desviación estándar (DE): 1,47 al administrar la anestesia, 1,74 DE: 1,27 durante la intervención, 1,63 DE: 1,23 en el postoperatorio inmediato, 1,38 DE: 0,38 a los 30min y 1,38 DE: 0,63 al alta. El grado de satisfacción fue «bastante o muy satisfecho» en el 92,6% de los casos, tanto para pacientes como para cirujanos. En 24 casos el paciente refirió molestias, 15 de ellos durante la sutura conjuntival, requiriendo anestesia adicional y en cuatro casos, paracetamol sistémico. La puntuación del dolor fue significativamente mayor durante la cirugía (p=0,033) y en el postoperatorio inmediato (p=0,027) en los pacientes operados de trabeculectomía que en la esclerectomía profunda no penetrante (EPNP). Conclusiones: El buen nivel analgésico conseguido favoreció un alto grado de satisfacción por parte de cirujanos y pacientes, incluso en procedimientos de larga duración como esclerectomía profunda no penetrante combinada con facoemulsificación e implantes de dispositivos de drenaje. El dolor percibido por los pacientes durante la cirugía y postoperatorio inmediato fue mayor en la trabeculectomía que en la EPNP(AU)

Objectives: To evaluate the analgesic effect as well as patient cooperation and satisfaction with sub-tenon's anesthesia in glaucoma surgery. Material and methods: Prospective uncontrolled study. Fifty-three patients who underwent glaucoma surgery, with or without cataract extraction, with sub-Tenon's anesthesia have been studied. Satisfaction and cooperation were evaluated on a qualitative scale. The pain level was quantified using a numerical scale from 1 (no pain) to 10 (unsupportable pain). Results: The mean pain score at the different periods was: 2.13 (standard deviation [SD] 1.47) on administering anesthesia, 1.74 (SD 1.27) during the surgery, 1.63 SD (1.23) immediately after the procedure, 1.38 (SD 0.38) 30min later, and 1.38 (SD 0.63) when leaving the recovery unit. The postoperative satisfaction was “fairly or very satisfied” in 92.6% of the cases for both the surgeons and the patients. Twenty-four patients complained during the surgery, 15 of them at the conjunctival suture; in these cases additional anesthesia was administered, and, in 4 cases, intravenous paracetamol was given. Pain scores were significatively higher during the surgery (P=.033), and immediately after the procedure (P=0.027) in trabeculectomy than in deep sclerectomy patients. Conclusions: The good analgesic level reached led to a high level of patient and surgeon satisfaction, even in longer procedures such as deep sclerectomy combined with cataract extraction, or implantation of drainage devices. Pain scores were significatively higher in trabeculectomy than in deep sclerectomy patients(AU)

[Herpetic endotheliitis and trabeculitis with delayed corneal involvement]. / Endotelitis y trabeculitis herpética con afectación corneal tardía.

CASE REPORT: A 62-year-old man with previous renal transplant and immunosuppressive treatment presented with decreased visual acuity (20/100) in his left eye, corneal oedema and intraocular pressure of 46 mmHg. One month later an inferior marginal dendritic keratitis appeared. Corneal scraping and real-time polymerase chain reaction showed herpes simplex virus (HSV). DISCUSSION: The autoimmune corneal endotheliopathy or acute idiopathic corneal endotheliitis is characterised by corneal stromal oedema and keratic precipitates. HSV might be secreted from the trabeculum, innervated by the trigeminal nerve. This hypothesis is supported by the clinical observation that the corneal stromal oedema usually starts from the periphery.

Endotelitis y trabeculitis herpética con afectación corneal tardía / Herpetic endotheliitis and trabeculitis with delayed corneal involvement

Caso clínico: Varón de 62 años de edad con trasplante renal y tratamiento inmunosupresor que acude por disminución de la visión (20/100) en ojo izquierdo, edema corneal y presión intraocular de 46mmHg. Un mes después aparece queratitis dendrítica marginal inferior. El raspado corneal y la proteína C reactiva demuestran la presencia de un virus del herpes simple (HVS). Discusión: La epiteliopatía corneal autoinmunitaria o endotelitis idiopática corneal se caracteriza por edema corneal y precipitados queráticos. Se cree que el HVS podría ser secretado desde el trabeculum, inervado por el nervio trigémino, apoyado clínicamente por la progresión del edema estromal desde la periferia(AU)

Case report: A 62-year-old man with previous renal transplant and immunosuppressive treatment presented with decreased visual acuity (20/100) in his left eye, corneal oedema and intraocular pressure of 46mmHg. One month later an inferior marginal dendritic keratitis appeared. Corneal scraping and real-time polymerase chain reaction showed herpes simplex virus (HSV). Discussion: The autoimmune corneal endotheliopathy or acute idiopathic corneal endotheliitis is characterised by corneal stromal oedema and keratic precipitates. HSV might be secreted from the trabeculum, innervated by the trigeminal nerve. This hypothesis is supported by the clinical observation that the corneal stromal oedema usually starts from the periphery(AU)

[Intermediate-term outcome of glaucoma drainage devices]. / Resultados a medio plazo de los dispositivos de drenaje para glaucoma.

OBJECTIVE: To study the intermediate-term results of glaucoma drainage devices (DDG) with respect to control of intraocular pressure (IOP), control of glaucoma, and maintenance of pre-operative visual acuity. METHODS: This was a retrospective cohort study of 86 eyes in 77 patients in whom a DDG was implanted, using descriptive statistics and survival analysis. RESULTS: Success was achieved in 53 eyes (61.6%), complete (without treatment) in 34 eyes (39.5%) and qualified (needing treatment) in 19 eyes (22.1%). In the 33 eyes where the DDG treatment was unsuccessful, poor IOP control occurred in 13 eyes - (15.1%), and complications occurred in 20 eyes (23.2%) resulting in a severe reduction or loss of visual acuity (plate exposure, suprachoroidal hemorrhage, retinal detachment). IOP control was obtained in 66 eyes (76.7%), 47 of them without treatment (54.6%), although on 13 occasions the overall treatment failed due to complications occurring. Despite IOP control, glaucoma progression occurred in 7 eyes (8.1%). Preoperative vision was maintained in 46 eyes (53.5%), but decreased by 3 or more lines in 20 eyes (46.5%); bullous kerathopathy was the most frequent cause of the worsening. Loss of light perception occurred in 21 eyes (24.4%) and 4 eyes (4.6%) were eviscerated. CONCLUSIONS: DDG are an effective surgical option for control of IOP when conventional surgery has a poor prognosis, but they are associated with an increased risk of serious complications and loss of visual acuity in a significant proportion of cases.

Resultados a medio plazo de los dispositivos de drenaje para glaucoma / Intermediate-term outcome of glaucoma drainage devices

Objetivos: Analizar los resultados a medio plazo de los dispositivos de drenaje para glaucoma (DDG) en cuanto a control de la presión intraocular (PIO), del glaucoma y del mantenimiento de la visión preoperatoria. Métodos: Estudio de cohortes retrospectivo de 86 ojos de 77 pacientes en los que se ha implantado un DDG. Se ha empleado estadística descriptiva y análisis de supervivencia. Resultados: Se han considerado como éxito 53 ojos (61,6%), completo (sin tratamiento) en 34 ojos (39,5%); y relativo (con tratamiento) en 19 ojos (22,1%). Las causas de fracaso han sido: mal control de la PIO en 13 ojos - (15,1%), y complicaciones en 20 ojos (23,2%) con reducción severa o pérdida de visión (extrusión del reservorio, hemorragia supracoroidea, desprendimiento de retina). Se ha obtenido control de la PIO en 66 ojos (76,7%), en 47 de ellos sin tratamiento (54,6%), aunque 13 de estos han sido fracasos por complicaciones. A pesar del control de la PIO, en siete ojos (8,1%) se ha observado progresión del glaucoma. En cuanto a la visión, en 46 ojos (53,5%) se ha mantenido estable y en 40 ha disminuido 3 o más líneas (46,5%), siendo la causa más frecuente la descompensación correvisioneal. En 21 ojos (24,4%) se ha perdido la percepción de la luz, y cuatro ojos (4,6%) han sido eviscerados. Discusión: Los DDG son una opción quirúrgica eficaz para el control de la PIO en ojos con mal pronóstico para la cirugía convencional de glaucoma, pero presentan complicaciones graves y deterioro visual en un porcentaje elevado de casos

Objective: To study the intermediate-term results of glaucoma drainage devices (DDG) with respect to control of intraocular pressure (IOP), control of glaucoma, and maintenance of pre-operative visual acuity. Methods: This was a retrospective cohort study of 86 eyes in 77 patients in whom a DDG was implanted, using descriptive statistics and survival analysis. Results: Success was achieved in 53 eyes (61.6%), complete (without treatment) in 34 eyes (39.5%) and qualified (needing treatment) in 19 eyes (22.1%). In the 33 eyes where the DDG treatment was unsuccessful, poor IOP control occurred in 13 eyes - (15.1%), and complications occurred in 20 eyes (23.2%) resulting in a severe reduction or loss of visual acuity (plate exposure, suprachoroidal hemorrhage, retinal detachment). IOP control was obtained in 66 eyes (76.7%), 47 of them without treatment (54.6%), although on 13 occasions the overall treatment failed due to complications occurring. Despite IOP control, glaucoma progression occurred in 7 eyes (8.1%). Preoperative vision was maintained in 46 eyes (53.5%), but decreased by 3 or more lines in 20 eyes (46.5%); bullous kerathopathy was the most frequent cause of the worsening. Loss of light perception occurred in 21 eyes (24.4%) and 4 eyes (4.6%) were eviscerated. Conclusions: DDG are an effective surgical option for control of IOP when conventional surgery has a poor prognosis, but they are associated with an increased risk of serious complications and loss of visual acuity in a significant proportion of cases

¿Mitomicina C o 5-FU en la manipulación con aguja de ampollas fracasadas?. Réplica / Mitomycin C versus 5-FU in failing blebs needling. Reply

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[Needle revision of late failing filtering blebs after glaucoma surgery]. / Repermeabilización mediante revisión con aguja de ampollas de filtración con fracaso tardío tras cirugía de glaucoma.

PURPOSE: To evaluate the results of bleb needling in eyes subjected to filtering surgery six months or more previously. METHODS: A retrospective study of 23 eyes in 21 patients subjected to bleb needling performed by means of a 25G needle, 6 months to 23 years after failed filtering surgery (mean 67.3 months). The mean number of bleb needlings was 1.2 and the mean number of 5-fluorouracil subconjunctival injections was 3.9. RESULTS: The mean intraocular pressure (IOP) before needling was 26 mmHg and the mean anti-glaucoma medications was 1.3 per eye. The mean postoperative IOP was 16.3 mmHg and mean anti-glaucoma medications 0.7. A diffuse filtering bleb was evident in 12 eyes (54.5%). The results of needling were worse in eyes subjected to previous surgery for glaucoma or other failed bleb needling procedures (75% failure). CONCLUSION: Needle revision of the filtering bleb is a simple and safe technique that offers good results even years after a filtering surgery had been performed. It should be considered before other medical or surgical treatments in patients with a previously functioning bleb and a permeable sclerectomy site at gonioscopy.

Repermeabilización mediante revisión con aguja de ampollas de filtración con fracaso tardío tras cirugía de glaucoma / Needle revision of late failing filtering blebs after glaucoma surgery

Objetivo: Analizar los resultados de la cistitomía de la ampolla de filtración en ojos operados de cirugía filtrante de glaucoma seis meses antes o más. Material y métodos: Estudio retrospectivo de 23 ojos de 21 pacientes en los que se ha realizado revisión de la ampolla de filtración con una aguja de 25 G, entre 6 meses y 23 años tras cirugía filtrante (media 67,3 meses). Se realizaron una media de 1,2 cistitomías por ojo y 3,9 inyecciones de 5-fluorouracilo subconjuntival. Resultados: De una presión intraocular (PIO) media preoperatoria de 26 mmHg y 1,3 fármacos hipotensores hemos pasado a una PIO media postoperatoria de 16,3 mmHg y una media de 0,7 fármacos, con una ampolla de filtración difusa en 12 casos (54,5%). Los resultados fueron peores en ojos con cirugía previa de glaucoma u otra cistitomía previa fracasada (75% fracaso). Conclusiones: La revisión con aguja es una técnica sencilla y segura que ofrece buenos resultados incluso años después de una cirugía filtrante, y debe ser considerada de manera previa a la reinstauración de tratamiento médico o quirúrgico en los pacientes operados de glaucoma con fracaso tardío de una ampolla de filtración previamente funcionante y esclerectomía abierta en la gonioscopia

Purpose: To evaluate the results of bleb needling in eyes subjected to filtering surgery six months or more previously. Methods: A retrospective study of 23 eyes in 21 patients subjected to bleb needling performed by means of a 25G needle, 6 months to 23 years after failed filtering surgery (mean 67.3 months). The mean number of bleb needlings was 1.2 and the mean number of 5-fluorouracil subconjunctival injections was 3.9. Results: The mean intraocular pressure (IOP) before needling was 26 mmHg and the mean anti-glaucoma medications was 1.3 per eye. The mean postoperative IOP was 16.3 mmHg and mean antiglaucoma medications 0.7. A diffuse filtering bleb was evident in 12 eyes (54.5%). The results of needling were worse in eyes subjected to previous surgery for glaucoma or other failed bleb needling procedures (75% failure). Conclusion: Needle revision of the filtering bleb is a simple and safe technique that offers good results even years after a filtering surgery had been performed. It should be considered before other medical or surgical treatments in patients with a previously functioning bleb and a permeable sclerectomy site at gonioscopy

Long-term persistence of fascia lata patch graft in glaucoma drainage device surgery.

PURPOSE: Conjunctival erosion in glaucoma drainage device surgery can be prevented by the use of patch grafts to cover the extraocular portion of the tube. Several materials can be used, among them human preserved fascia lata. METHODS: The authors present a case of a failed Ahmed glaucoma valve due to encapsulation of the bleb, in which the fascia lata patch placed to cover the tube was removed 32 months later, during the implantation of a second glaucoma drainage device. RESULTS: Histopathologic examination of the fascia lata patch demonstrated its persistence, without degradation or cellular infiltration. CONCLUSIONS: Human preserved fascia lata is a suitable material for tube covering in glaucoma drainage device surgery, with long-term survival.

Long-term persistence of fascia lata patch graft in glaucoma drainage device surgery.

PURPOSE: Conjunctival erosion in glaucoma drainage device surgery can be prevented by the use of patch grafts to cover the extraocular portion of the tube. Several materials can be used, among them human preserved fascia lata. METHODS: The authors present a case of a failed Ahmed glaucoma valve due to encapsulation of the bleb, in which the fascia lata patch placed to cover the tube was removed 32 months later, during the implantation of a second glaucoma drainage device. RESULTS: Histopathologic examination of the fascia lata patch demonstrated its persistence, without degradation or cellular infiltration. CONCLUSIONS: Human preserved fascia lata is a suitable material for tube covering in glaucoma drainage device surgery, with long-term survival.

[Glaucoma drainage device obstruction]. / Obstrucción del tubo de los dispositivos de drenaje.

PURPOSE: To determine the pathophysiology and to discuss possible solutions for tube obstruction since this is a frequent complication in glaucoma drainage device surgery. MATERIAL AND METHODS: 81 eyes with a glaucoma drainage device (GDD) fitted by our Department during the last twelve years (1991-2002) were retrospectively reviewed and eleven cases of tube obstruction were detected. The treatments included Nd-Yag laser, anterior vitrectomy, blood clot removal and intracamerular rTPA. RESULTS: The obstruction was proximal in ten cases and distal in one. Of the former, the obstruction was caused by a blood clot in six cases, by vitreous in three cases and by a fibrinous membrane in one case. The nature of the distal obstruction was not determined. One case of vitreous obstruction occurred after a posterior capsulotomy with Nd-Yag laser two years after positioning the GDD. Complete success was achieved in five cases, and partial success in three where antiglaucoma therapy had to be maintained postoperatively. Complete failure was found in the other three cases. CONCLUSIONS: The material which most frequently caused the tube obstruction was blood and although in some cases this may resolve spontaneously, clot removal with forceps or rTPA intracameral injection may be helpful. In vitreous obstruction, Nd-Yag laser may temporariril clear the tube, but extensive anterior vitrectomy is required to maintain long-term permeability. We suggest carrying out a small posterior capsulotomy in pseudophakic patients with a GDD.

Obstrucción del tubo de los dispositivos de drenaje / Glaucoma drainage device obstruction

Propósito: Determinar la patofisiología y presentar posibles soluciones a la obstrucción del tubo de los dispositivos de drenaje para glaucoma (DDG), ya que es una complicación frecuente en esta cirugía. Material y métodos: Se realizó una revisión retrospectiva de 81 ojos a los que se les había implantado un DDG durante un período de doce años (1991-2002) y se identificaron once casos de obstrucción del tubo. Los tratamientos empleados fueron: lavado de cámara anterior con extracción de coágulo, rTPA intracamerular, vitreolísis con láser Nd-Yag y vitrectomía anterior. Resultados: En diez casos la obstrucción fue proximal, debida a coágulos de sangre en seis ojos, vítreo en tres ojos y una membrana de fibrina en un ojo. En un caso la obstrucción fue distal, no pudiéndose identificar la causa. Un caso de obstrucción por vítreo se produjo tras realizar una capsulotomía posterior con láser Nd-Yag, dos años después de la colocación del DDG. Obtuvimos éxito en cinco casos, en tres éxito parcial que requirió mantener el tratamiento antiglaucomatoso. En tres casos el resultado fue fracaso. Conclusiones: La causa más frecuente de obstrucción del tubo fue sangre y aunque se puede resolver espontáneamente, la inyección de rTPA intracameral o el lavado de cámara anterior con extracción del coágulo son tratamientos eficaces. En la obstrucción por vítreo, una vitrectomía anterior amplia es más eficaz que la vitreolisis con láser Yag. Es recomendable realizar una capsulotomía posterior pequeña en pacientes pseudofáquicos con un DDG(AU)

Purpose: To determine the pathophysiology and to discuss possible solutions for tube obstruction since this is a frequent complication in glaucoma drainage device surgery. Material and Methods: 81 eyes with a glaucoma drainage device (GDD) fitted by our Department during the last twelve years (1991-2002) were retrospectively reviewed and eleven cases of tube obstruction were detected. The treatments included Nd-Yag laser, anterior vitrectomy, blood clot removal and intracamerular rTPA. Results: The obstruction was proximal in ten cases and distal in one. Of the former, the obstruction was caused by a blood clot in six cases, by vitreous in three cases and by a fibrinous membrane in one case. The nature of the distal obstruction was not determined. One case of vitreous obstruction occurred after a posterior capsulotomy with Nd-Yag laser two years after positioning the GDD. Complete success was achieved in five cases, and partial success in three where antiglaucoma therapy had to be maintained postoperatively. Complete failure was found in the other three cases. Conclusions: The material which most frequently caused the tube obstruction was blood and although in some cases this may resolve spontaneously, clot removal with forceps or rTPA intracameral injection may be hepful. In vitreous obstruction, Nd-Yag laser may temporariril clear the tube, but extensive anterior vitrectomy is required to maintain long-term permeability. We suggest carrying out a small posterior capsulotomy in pseudophakic patients with a GDD(AU)

[Management of encapsulated blebs after glaucoma drainage device surgery]. / Manejo de las ampollas encapsuladas tras implantación de dispositivos de drenaje en cirugía de glaucoma.

PURPOSE: We analyse the different options for the management of encapsulated blebs after glaucoma drainage device surgery, specially subconjunctival 5-fluouracil (5-FU) injections with or without associated needling. METHODS: Retrospective review of 20 eyes with encapsulated blebs following glaucoma drainage device surgery. All of the eyes received topical corticosteroids associated to digital massage. Subconjunctival 5-FU was necessary in 10 eyes, associated to needling of the bleb in 5 of them and to capsule excision in 2. RESULTS: Fifteen eyes were considered successes (complete in 10 eyes and uncomplete in 5). Eight of them had been treated with 5-FU (80% success in the 5-FU treated eyes group), associated to needling and/or capsule excision in 4 of them. The remaining 7 eyes were only treated conservatively (70% success with corticoid therapy and digital pressure). CONCLUSIONS: We have obtained in our study very good results using subconjunctival 5-FU injections, associated in complicated or refractory cases to needling revision, in eyes with encapsulated blebs after glaucoma drainage device surgery, with no major complications (Arch Soc Esp Oftalmol 2002; 77: 429-434).

Manejo de las ampollas encapsuladas tras implantación de dispositivos de drenaje en cirugía de glaucoma / Management of encapsulated blebs after glaucoma drainage device surgery

Objetivos: Estudiamos las posibilidades terapéuticas de las ampollas encapsuladas tras la implantación de dispositivos de drenaje en cirugía de glaucoma, y en particular la administración de 5-fluouracilo (5-FU) subconjuntival con o sin cistitomía transconjuntival asociada. Métodos: Revisión retrospectiva de 20 casos de ampolla encapsulada tras implantación de dispositivo de drenaje. En todos los casos se realizó tratamiento con corticoterapia tópica y presión digital. En 10 casos fue necesario administrar 5-FU subconjuntival, asociado a cistitomía transconjuntival en 5 casos y a resección quirúrgica de la cápsula en 2. Resultados: Quince ojos se consideraron éxitos (total en 10 y parcial en 5), de los cuales 8 fueron tratados con 5-FU (80 por ciento de éxito en los tratados con 5-FU), asociado a cistitomía transconjuntival y/o exéresis de la ampolla en 4 de ellos. En los otros 7 éxitos el tratamiento fue exclusivamente médico (70 por ciento de éxito tras corticoterapia y presión digital). Conclusiones: En el tratamiento de la ampolla encapsulada tras implantación de dispositivos de drenaje, la administración de 5-FU subconjuntival, asociada en los casos complejos o refractarios a cistitomía transconjuntival, ha resultado efectiva en nuestra serie, consiguiéndose un buen control a largo plazo de la presión intraocular, y sin complicaciones significativas (AU)

[Incidence of encapsulated bleb after filtering surgery]. / Incidencia de ampolla encapsulada tras cirugía filtrante.

OBJECTIVE: To determine the incidence of encapsulated bleb (EB) after filtering surgery, and the risk factors for the development of this complication, especially those related with the surgical procedure. METHODS: Ninety eyes that were submitted to trabeculectomy were prospectively studied. Lens extraction was associated in 56 eyes (62.9%). All patients were followed up for at least 3 months. RESULTS: There were clinical characteristics of encapsulation in 29 eyes (32.3%) and EB with a peak IOP of 25 mmHg or higher in 14 eyes (15.7%). The incidence of EB formation was 20.5% in men and 11.8% in women (p.044). The incidence of EB was higher in the trabeculectomy group alone (24.2%) than in the group in which it was associated to cataract surgery (10.5%) (p.003). There were clinical characteristics of encapsulation in 40.7% of primary open angle glaucoma (p.041). EB was significantly associated with an increased failure rate (21.4%) when compared to normal blebs (5.55% failure rate) (p<.001). CONCLUSIONS: The encapsulated bleb is significantly more frequent in the male gender and thick conjunctivas and in trabeculectomy alone versus trabeculectomy associated to cataract surgery. It means a significantly greater risk of failure after surgery in the short term.

Incidencia de ampolla encapsulada tras cirugía filtrante / Incidence of encapsulated bled after filtering surgery

Objetivo: Determinar la incidencia de encapsulación de la ampolla tras cirugía filtrante, así como factores de riesgo para esta complicación, especialmente relacionados con la técnica quirúrgica. Material: Estudio prospectivo sobre 90 pacientes operados consecutivamente de trabeculectomía, asociada en 56 casos (62,9 por ciento) a extracción de catarata. Resultados: Hemos hallado signos clínicos de encapsulación en 29 ojos (32,3 por ciento) y ampolla encapsulada manifiesta (con aumento de la TO) en 14 ojos (15,7 por ciento). La incidencia de ampolla encapsulada ha sido del 20,5 por ciento en los varones frente al 11,8 por ciento en las mujeres (p ,044), y del 24,2 por ciento en las trabeculectomías frente al 10,5 por ciento con cirugía asociada de catarata (p ,003). Existían signos de encapsulación en el 40,7 por ciento de los glaucomas primarios de ángulo abierto (p ,041). La ampolla encapsulada empeora los resultados de la cirugía, con un 5,55 por ciento de fracaso en los ojos con ampolla no encapsulada frente al 21,4 por ciento en las encapsuladas (p<,001). Conclusiones: La ampolla encapsulada es significativamente más frecuente en los varones y conjuntivas gruesas, y en la trabeculectomía más que en la cirugía combinada y supone mayor riesgo de fracaso de la cirugía a corto plazo. (AU)

Propionibacterium acnes endophthalmitis in Ahmed glaucoma valve.

PURPOSE: To report a case of Propionibacterium acnes endophthalmitis in a patient with an Ahmed glaucoma valve. CASE REPORT: A nine-year-old boy with bilateral congenital glaucoma, with an Ahmed glaucoma valve implanted in the left eye, had recurrent conjunctival dehiscence and endophthalmitis. RESULTS: Vitreous cultures demonstrated the presence of Propionibacterium acnes. CONCLUSIONS: This is the first reported case of Propionibacterium acnes endophthalmitis in an Ahmed glaucoma valve and the second one in a glaucoma drainage device. We strongly recommend using a patch graft to prevent and treat tube exposure. Conjunctival grafts may be useful to close the conjunctiva when there is marked scarring to prevent patch exposure and melting or extrusion.