Tratamiento de la hiperpigmentación periocular con fuentes de luz / Treatment of periorbital hyperpigmentation using light devices

El tratamiento de la ojera supone una de las demandas más habituales en la consulta de estética para mejorar la imagen de cansancio, tristeza o envejecimiento que perciben nuestros pacientes. Además, se trata de un problema de etiología multifactorial y frente al que disponemos de un amplio abanico de tratamientos.El objetivo de la presente revisión es analizar la mejor evidencia disponible para el tratamiento de la ojera hiperpigmentada con fuentes de luz. Se han revisado 208 artículos que cumplían los criterios de búsqueda, incluyendo finalmente 14 para dar plena consideración en la revisión.Múltiples fuentes de luz han demostrado ser eficaces para el tratamiento de la pigmentación periorbitaria. Los resultados más prometedores se obtienen con luz pulsada intensa y láser rubí en combinación con despigmentantes. Para el tratamiento de la pigmentación junto con redensificación y disminución de arrugas destacan el láser CO2 y el láser erbium:yttrium scandium gallium garnet. Los láseres neodymium-doped yttrium aluminium garnet, alejandrita y diodo fueron los que reportaron resultados más moderados con su uso aislado. El tratamiento adyuvante con despigmentantes mejora resultados y reduce la incidencia de hiperpigmentación postinflamatoria.Es necesaria una mejor estandarización en la medida de los resultados en los cambios de la pigmentación. Además, sería recomendable realizar ensayos clínicos con resultados objetivables y que combinen varias fuentes de luz para el tratamiento no solo de la pigmentación periorbitaria, sino de la ojera de forma integral. (AU)

The treatment of dark circles is one of the most common request from the patients attending to the esthetics clinic. A tired, sad or aged appearance is perceived by our patients. Moreover, it is a multifactorial problem and we could treat it with a wide range of treatments.With this systematic review, we want to check the best available evidence regarding the treatment of periorbital hyperpigmentation using light devices. We have reviewed 208 papers, including 14 of them for full consideration.Several light sources have demonstrated to be effective treating pigmented dark circles. The best results have been reported using intense pulsed light and rubi laser together with depigmenting substances. If we want to treat periocular hyperpigmentation, soft wrinkles, rhytides and skin density we should use carbon dioxide laser or erbium:yttrium scandium gallium garnet. The neodymium-doped yttrium aluminium garnet, alexandrite and diode lasers were the ones giving the worst outcome regarding pigmentation treatment. The concomitant use of depigmenting treatment may help getting better results and reducing the rate of post-inflammatory hyperpigmentation.A better standardization and measuring of the obtained results is needed regarding pigmentation changes. We must keep on investigating on this topic with new clinical trials measuring objective results and combining different light devices for a multifactorial treatment of the dark circles. (AU)

Treatment of periorbital hyperpigmentation using light devices.

The treatment of dark circles is one of the most common request from the patients attending to the esthetics clinic. A tired, sad or aged appearance is perceived by our patients. Moreover, it is a multifactorial problem and we could treat it with a wide range of treatments. With this systematic review, we want to check the best available evidence regarding the treatment of periorbital hyperpigmentation using light devices. We have reviewed 208 papers, including 14 of them for full consideration. Several light sources have demonstrated to be effective treating pigmented dark circles. The best results have been reported using intense pulsed light and rubi laser together with depigmenting substances. If we want to treat periocular hyperpigmentation, soft wrinkles, rhytides and skin density we should use carbo dioxide laser or Erbium:Yttrium Scandium Gallium Garnet. The Neodymium-Doped Yttrium Aluminium Garnet, alexandrite and diode lasers were the ones giving the worst outcome regarding pigmentation treatment. The concomitant use of depigmenting treatment may help getting better results and reducing the rate of post inflammatory hyperpigmentation. A better standardization and measuring of the obtained results is needed regarding pigmentation changes. We must keep on investigating on this topic with new clinical trials measuring objective results and combining different light devices for a multifactorial treatment of the dark circles.

Queratouveítis y conjuntivitis causadas por Euphorbia ingens. Revisión de un caso / Keratouveitis and conjunctivitis caused by Euphorbia ingens: A case review

Euphorbia ingens es una planta ubicua, que contiene una savia lechosa. Puede accidentalmente dañar los ojos de los humanos por su naturaleza cáustica, causando conjuntivitis, queratitis, uveítis, estafiloma anterior y cicatrización corneal en pacientes no tratados. Presentamos el caso de un paciente cuyo ojo entró en contacto con esta savia lechosa, causándole conjuntivitis, defecto epitelial corneal y uveítis. Después de un tratamiento intensivo, su ojo se recuperó completamente. Recomendamos el uso de guantes y gafas protectoras antes de manipular este tipo de plantas (AU)

Euphorbia ingens is a ubiquitous plant who has a milky sap. It can accidentally harm human's eye by its caustic nature, causing conjunctivitis, keratitis, uveitis, anterior staphyloma and corneal scarring in untreated patients. We present the case of a patient whose eye came into contact with the milky sap. He suffered conjunctivitis, corneal epithelial defect and uveitis. After intensive treatment, his eye made a complete recovery. We recommend gloves and protecting glasses before handling these types of plants (AU)

Diagnóstico diferencial de las reacciones inflamatorias tras uso de medicación intravítrea en degeneración macular asociada a la edad: estéril vs. infeccioso / Differential diagnosis of endophthalmitis after intravitreal drug injection for age related macular degeneration: Sterile vs. infectious

El interés por las complicaciones inflamatorias tras la inyección intravítrea de fármacos antiangiogénicos ha aumentado tras la comercialización de brolucizumab y el desarrollo de nuevas moléculas como el abicipar pegol. Dichos fármacos se asocian a una tasa de complicaciones inflamatorias mayor a los antiangiogénicos clásicos. En este contexto resulta clave el diferenciar procesos infecciosos y estériles para realizar un tratamiento efectivo y precoz. El solapamiento del cuadro clínico entre procesos infecciosos y estériles, la baja tasa de positividad en los cultivos y la heterogeneidad en la terminología son barreras para el correcto diagnóstico y reporte de las complicaciones inflamatorias tras la inyección de medicación antiangiogénica intravítrea. Los cuadros estériles comienzan de forma precoz tras la inyección, dentro de las primeras 48 h, o alrededor de 20 días después en los casos de vasculitis asociada a brolucizumab. Los procesos infecciosos comienzan como promedio en el tercer día tras la inyección, y hasta una semana después de la misma. La disminución grave de la agudeza visual, el dolor severo, la hiperemia severa, el hipopion y un mayor grado de inflamación intraocular deben orientar hacia procesos infecciosos. En los casos en que exista duda sobre la etiología de la inflamación, debe procederse a un control muy estrecho del paciente o al tratamiento antimicrobiano empírico junto con la toma de muestra para evitar complicaciones derivadas de una endoftalmitis infecciosa. Por el contrario, los fenómenos estériles deben ser tratados con observación en los casos más leves o corticoterapia adaptada a la gravedad de inflamación en los casos más graves (AU)

The recent release of brolucizumab and the development of new antiangiogenic molecules as abicipar pegol has increased the interest towards inflammatory complications after intravitreal drug injection. Those drugs are associated to a higher rate of inflammatory adverse events compared to classic drugs. In this context it is essential to differentiate between sterile and infectious cases for a fast and effective treatment. The clinical similarities between infectious and sterile cases, the high rate of culture negative patients and the heterogeneity in the terminology used are obstacles for a correct diagnosis and report of these complications. Sterile cases appear early after the injection, before 48h; or 20 days after in brolucizumab-related vasculitis cases. Infectious cases show up around the third day after injection and up to a week after it. A severe visual impairment, severe pain, severe hyperemia, hypopyon and a more severe intraocular inflammatory process are signs of a likely infectious origin. If the cause of the inflammation is uncertain we must follow up the patient closely or “tap and inject” antimicrobial agents in order to prevent the eventual complications of an infectious endophthalmitis. On the other hand, sterile endophthalmitis might be observed in mild cases or treated with steroids according to the severity of the inflammation (AU)

Differential diagnosis of endophthalmitis after intravitreal drug injection for age related macular degeneration: sterile vs. infectious.

The recent release of brolucizumab and the development of new antiangiogenic molecules as abicipar pegol has increased the interest towards inflammatory complications after intravitreal drug injection. Those drugs are associated to a higher rate of inflammatory adverse events compared to classic drugs. In this context it is essential to differentiate between sterile and infectious cases for a fast and effective treatment. The clinical similarities between infectious and sterile cases, the high rate of culture negative patients and the heterogeneity in the terminology used are obstacles for a correct diagnosis and report of these complications. Sterile cases appear early after the injection, before 48 h; or 20 days after in brolucizumab-related vasculitis cases. Infectious cases show up around the third day after injection and up to a week after it. A severe visual impairment, severe pain, severe hyperemia, hypopyon and a more severe intraocular inflammatory process are signs of a likely infectious origin. If the cause of the inflammation is uncertain we must follow up the patient closely or "tap and inject" antimicrobial agents in order to prevent the eventual complications of an infectious endophthalmitis. On the other hand, sterile endophthalmitis might be observed in mild cases or treated with steroids according to the severity of the inflammation.

Keratouveitis and conjunctivitis caused by Euphorbia ingens: A case review.

Euphorbia ingens is a ubiquitous plant who has a milky sap. It can accidentally harm human´s eye by its caustic nature, causing conjunctivitis, keratitis, uveitis, anterior staphyloma and corneal scarring in untreated patients. We present the case of a patient whose eye came into contact with the milky sap. He suffered conjunctivitis, corneal epithelial defect and uveitis. After intensive treatment, his eye made a complete recovery. We recommend gloves and protecting glasses before handling these types of plants.

Xantogranuloma orbitario del adulto como causa de inflamación palpebral recidivante / Adult orbital xanthogranuloma as a cause of recurrent palpebral swelling

El xantogranuloma orbitario del adulto es un raro trastorno inflamatorio idiopático incluido dentro de las enfermedades xantogranulomatosas orbitarias, con posible asociación a otras condiciones sistémicas. Presentamos el caso de una mujer de 43 años que presentó una masa profunda de crecimiento rápido en el párpado superior derecho con antecedentes de nódulos amarillentos no ulcerativos en el párpado superior, bilaterales, y 2 blefaroplastias superiores previas. Se realizó biopsia-extirpación de la lesión orbitaria anterior, siendo los hallazgos anatomopatológicos compatibles con xantogranuloma histiocítico del adulto. El estudio sistémico fue negativo y la paciente se encuentra asintomática sin tratamiento. Las enfermedades xantogranulomatosas orbitarias constituyen una entidad rara potencialmente grave, por lo que el oftalmólogo debe de estar familiarizado con esta enfermedad para poder realizar un diagnóstico precoz a través de la anamnesis, exploración y la histología de lesiones que en ocasiones pueden simular xantelasmas palpebrales

Orbital adult-onset xanthogranuloma is a rare idiopathic inflammatory disorder included in the group of orbital xanthogranulomatous diseases with possible systemic associations. A 43 year-old woman presented with a deep fast-growing mass on the right upper eyelid. She had a past medical history of bilateral non-ulcerative nodules on the upper eyelid and two cosmetic upper lid blepharoplasties. An excisional biopsy was performed and the histopathology analysis confirmed the diagnosis of adult histiocytic xanthogranuloma. The systemic work up was negative and the patient is asymptomatic without treatment. Orbital xanthogranulomatous diseases are rare, but potentially life-threatening disorders. The ophthalmologist must be aware of this disease in order to make an early diagnosis using the anamnesis, clinical examination, and histology of the periocular lesions that may resemble palpebral xanthelasmas

Glaucoma maligno tras implante XEN45 / Malignant glaucoma after XEN45 implant

En el tratamiento del glaucoma de ángulo abierto ha surgido el concepto de cirugía mínimamente invasiva intentando reducir el tratamiento tópico crónico, retrasar cirugía más invasiva y disminuir el número de complicaciones. El XEN45 utiliza la vía de drenaje subconjuntival para reducir la presión intraocular. Presentamos el caso de una paciente que fue sometida a cirugía de facoemulsificación, implante de lente intraocular y dispositivo XEN45. Cuatro días después presentó episodio agudo de glaucoma maligno con atalamia grado 3 que requirió vitrectomía pars plana e implante secundario de válvula de Ahmed. La menor tasa de complicaciones de la cirugía mínimamente invasiva de glaucoma ha incrementado su uso. Sin embargo, no está exenta de complicaciones graves requiriendo incluso un abordaje multidisciplinar como en el caso del glaucoma maligno que presentamos

Minimally invasive glaucoma surgery for chronic open-angle glaucoma treatment tries to reduce the amount of chronic topical drug treatment, delaying invasive glaucoma surgery and diminishing the number of surgical complications. XEN45 uses subconjunctival drainage in order to reduce intraocular pressure. The report is presented of a patient following phacoemulsification, intraocular lens implantation and XEN45 implant. After four days acute malignant glaucoma was observed, with stage 3 athalamia requiring pars plana vitrectomy and secondary Ahmed valve implantation. The lower rate of complications due to minimally invasive glaucoma surgery has increased its use. Nevertheless, it is not free of severe adverse events, even requiring a multidisciplinary approach as in our malignant glaucoma report

Adult orbital xanthogranuloma as a cause of recurrent palpebral swelling. / Xantogranuloma orbitario del adulto como causa de inflamación palpebral recidivante.

Orbital adult-onset xanthogranuloma is a rare idiopathic inflammatory disorder included in the group of orbital xanthogranulomatous diseases with possible systemic associations. A 43 year-old woman presented with a deep fast-growing mass on the right upper eyelid. She had a past medical history of bilateral non-ulcerative nodules on the upper eyelid and two cosmetic upper lid blepharoplasties. An excisional biopsy was performed and the histopathology analysis confirmed the diagnosis of adult histiocytic xanthogranuloma. The systemic work up was negative and the patient is asymptomatic without treatment. Orbital xanthogranulomatous diseases are rare, but potentially life-threatening disorders. The ophthalmologist must be aware of this disease in order to make an early diagnosis using the anamnesis, clinical examination, and histology of the periocular lesions that may resemble palpebral xanthelasmas.

Malignant glaucoma after XEN45 implant. / Glaucoma maligno tras implante XEN45.

Minimally invasive glaucoma surgery for chronic open-angle glaucoma treatment tries to reduce the amount of chronic topical drug treatment, delaying invasive glaucoma surgery and diminishing the number of surgical complications. XEN45 uses subconjunctival drainage in order to reduce intraocular pressure. The report is presented of a patient following phacoemulsification, intraocular lens implantation and XEN45 implant. After four days acute malignant glaucoma was observed, with stage 3 athalamia requiring pars plana vitrectomy and secondary Ahmed valve implantation. The lower rate of complications due to minimally invasive glaucoma surgery has increased its use. Nevertheless, it is not free of severe adverse events, even requiring a multidisciplinary approach as in our malignant glaucoma report.