Study of perfusion changes in the optic disc of patients with fibromyalgia syndrome using new colorimetric analysis software.

PURPOSE: We measured the amount of hemoglobin at the optic nerve head of fibromyalgia (FM) patients using new colorimetric analysis software. We also investigated whether perfusion defects of the optic nerve head in patients with FM lead to tissue atrophy and corresponding retinal nerve fiber layer (RNFL) thinning measured by optical coherence tomography (OCT). METHODS: We recruited for this cross-sectional study 118 FM patients and 76 sex- and age-matched healthy controls. All subjects underwent a complete neuro-ophthalmologic examination, which also included visual field testing using the Spark strategy in an Easyfield perimeter, and OCT examinations using the Spectralis. One photograph of the optic disc was obtained using a Cirrus™ Photo 800 multi-modality imager. We analyzed fundus photographs using Laguna ONhE software, a new method that allows hemoglobin levels to be measured at the optic nerve head. We compared hemoglobin percentages in different sectors of the nerve head and RNFL thicknesses between the two groups. RESULTS: Mean hemoglobin percentages and hemoglobin content in all optic nerve head sectors calculated by the Laguna ONhE program were significantly lower in FM patients than in healthy controls, and the main differences were detected in the outer ring, which corresponds with the neuroretinal rim. However, only the differences in the superotemporal RNFL were statistically significant. Correlations between the RNFL thickness and the percentage of hemoglobin in the different sectors were weak. CONCLUSION: Optic disc perfusion was decreased in patients with FM, especially within the neuroretinal rim, without clear involvement in the RNFL.

Grepafloxacin concentration in ocular tissues after intravenous infusion in rabbits with intraocular inflammation.

PURPOSE: To determine the penetration of grepafloxacin into ocular tissues during experimental ocular inflammation. METHODS: 10 albino and 10 pigmented rabbits underwent a continuous intravenous infusion of the drug 24 h after injecting Salmonella typhimurium toxin intravitreously, creating ocular inflammation. The animals were killed and grepafloxacin levels were determined in plasma and ocular tissues using high performance liquid chromatography. RESULTS: Grepafloxacin levels achieved a steady-state plasma concentration of 1.5 microg/ml. The drug diffused more towards vascularized tissues (chorioretina and iris) in both albino and pigmented rabbits with a tissue/serum ratio higher than 1. Grepafloxacin showed more affinity to pigmented tissue, rising levels of 40,000-50,000 ng/g in the chorioretina and iris in pigmented animals. After inflammation, grepafloxacin intraocular penetration increased in albino animals with levels exceeding the minimum inhibitory concentration for the most common ocular pathogens. CONCLUSION: Grepafloxacin intraocular penetration is higher in pigmented tissues. Ocular inflammation increases the drug penetration into the vitreous.

Terapia fotodinámica en neovascularización coroidea / Photodynamic therapy for treatment of choroidal neovaoscularization

Objetivo: Valorar la eficacia de la terapia fotodinámica (TFD) en el tratamiento de neovascularización subretiniana (NVSR) causada por DMAE (degeneración macular asociada a la edad) y miopía. Material y método: Se estudiaron 102 pacientes con neovascularización coroidea yuxta o subfoveolar tratados con TFD en los que se valoró: Agudeza visual (AV), examen oftalmoscópico y angiografía fluoresceínica. El retratamiento se realizó cuando fue necesario cada tres meses. Resultados: La etiología de la neovascularización coroidea fue: 75,5% por DMAE y 24,5% miópica. El tiempo de seguimiento medio fue de 15,94 meses (9-33). Un 88% de las NVSR eran angiográficamente clásicas en los miopes y un 40% en las DMAE. La supervivencia de la membrana resultó significativa en función del tipo de NVSR, presentando una mejor evolución en los pacientes miopes (p=0,0018). La AV mejoró en 48% de los pacientes miopes y en 28,6% de las DMAE. No se objetivaron complicaciones severas atribuibles al tratamiento. Conclusiones: La TFD es un tratamiento moderadamente efectivo y sin complicaciones para el tratamiento de la NVSR sub/yuxta foveolar(AU)

Purpose: To evaluate the efficacy of photodynamic therapy with photodynamic therapy (PDT) in the management of choroidal neovascularization (CNV) in age-related macular degeneration (AMD) and myopia. Methods: 102 eyes with subfoveal or yuxtafoveal CNV underwent visual acuity (VA) testing, ophthalmic examination, and fluorescein angiography. Retreatment of persistent CNV was done after three months. Results: CNV was caused by AMD in 75.5% of patients, pathologic myopia in 24.5%. Follow up ranged from 9 to 33 months (mean: 15.94 months). 88% of CNV caused by pathologic myopia was classic and 40% was in lesions caused by AMD. CNV survival was shorter in lesions caused by pathologic myopia with a significant difference (p=0.0018). VA improved in 48% of lesions caused by pathologic myopia and in 28.6% of lesions caused by AMD. We did not observe any severe complication caused by PDT. Conclusion: PDT is a moderately effective treatment without complications in treating subfoveal CNV(AU)

[Idiopathic polypoidal choroidal vasculopathy]. / Vasculopatía coroidea polipoidal idiopática.

PURPOSE: To evaluate the incidence, clinical features and evolution of polypoidal choroidal vasculopathy (PCV) in our population. METHODS: Retrospective study of patients diagnosed with exudative and/or hemorrhagic maculopathy including age-related macular degeneration in the last two years and who have undergone a complete ophthalmologic exploration and videoangiography with fluorescein and indocyanine green. RESULTS: 250 patients were included in the study, 8 patients (3.2%) had clinical and angiographic criteria of PCV. The mean age was 68 years-old, 62.5% were men and 85.7% were caucasian. Ninety percent of cases presented clinically as a predominantly hemorrhagic macular detachment. The initial clinical diagnosis before indocyanine green angiography was exudative age-related macular degeneration in 90% of cases. The mean visual acuity was 0.2 at baseline and after follow-up. Laser treatment was performed in 4 eyes, achieving good anatomic and visual acuity results in 2 of them; both eyes of one patient were treated by photodynamic therapy with poor angiographic and functional outcome. CONCLUSIONS: Polypoidal choroidal vasculopathy is a clinical entity which is relatively frequent among patients previously diagnosed with exudative maculopathy. Indocyanine green angiography increases the number of correct diagnoses. Treatment must be individualized depending on the location of the lesions and the severity of the disease.

[Serpiginous choroiditis: clinical course and treatment]. / Coroiditis serpiginosa: evolución clínica y tratamiento.

PURPOSE: To evaluate the clinical evolution and treatment of serpiginous choroiditis in 11 diagnosed patients. METHODS: Retrospective study of 11 cases diagnosed with serpiginous choroiditis in our area, from 1980 to the present. We analyzed age at onset of symptoms, systemic diseases, ophthalmological symptoms at presentation, the location of lesions, initial and final visual acuity, recurrences, treatment régime and development of subretinal neovascularization. A complete ophthalmological examination and fluorescein angiograms were performed in all of them. RESULTS: The mean period of follow-up was 4 years. Average age was 56 years, predominantly in men (10/1). Five patients had known ischemic cardiopathy and systemic hypertension, one patient underwent a kidney transplant. All of them were treated with oral prednisone (1-1.5 mg/kg/daily) in the active stages. Three patients received triple therapy (prednisone, cyclosporine and azathioprine) that did not prevent the recurrences. Five patients developed a subretinal neovascularization, bilateral in three of them. CONCLUSIONS: The serpiginous choroiditis is a rare entity and the visual outcome prognosis is determined by the macular involvement. Men are predominantly affected in our series and corticosteroid treatment is effective in acute inflammatory episodes. Recurrences could not be prevented by triple therapy with immunosuppressive agents in our three patients.

[Photodynamic therapy for treatment of choroidal neovascularization]. / Terapia fotodinámica en neovascularización coroidea.

PURPOSE: To evaluate the efficacy of photodynamic therapy with photodynamic therapy (PDT) in the management of choroidal neovascularization (CNV) in age-related macular degeneration (AMD) and myopia. METHODS: 102 eyes with subfoveal or yuxtafoveal CNV underwent visual acuity (VA) testing, ophthalmic examination, and fluorescein angiography. Retreatment of persistent CNV was done after three months. RESULTS: CNV was caused by AMD in 75.5% of patients, pathologic myopia in 24.5%. Follow up ranged from 9 to 33 months (mean: 15.94 months). 88% of CNV caused by pathologic myopia was classic and 40% was in lesions caused by AMD. CNV survival was shorter in lesions caused by pathologic myopia with a significant difference (p=0.0018). VA improved in 48% of lesions caused by pathologic myopia and in 28.6% of lesions caused by AMD. We did not observe any severe complication caused by PDT. CONCLUSION: PDT is a moderately effective treatment without complications in treating subfoveal CNV.

Histological toxicity of grepafloxacin after intravitreal injection.

PURPOSE: To determine the intravitreal levels of grepafloxacin after intravitreal injection of 80 microg and to evaluate the retinal toxicity after intravitreal injection of different doses of grepafloxacin in rabbit eyes. METHODS: Fifteen female New Zealand white rabbits and 15 female pigmented 'Gigantes de España' rabbits were injected with 80 microg of grepafloxacin into the vitreous cavity. The grepafloxacin concentration was determined with HPLC after 2, 4, 8, 12 and 24 h. Eighteen female rabbits (9 New Zealand white rabbits and 9 pigmented 'Gigantes de España' rabbits) were used for a study of toxicity. The rabbits were divided into 6 treatment groups: group 1 (3 pigmented rabbits) received an intravitreal injection of 80 microg of grepafloxacin in 0.1 ml of saline solution, group 2 (3 white rabbits) 80 microg of grepafloxacin in 0.1 ml, group 3 (3 pigmented rabbits) 800 microg of grepafloxacin, group 4 (3 white rabbits) 800 microg of grepafloxacin, group 5 (3 pigmented rabbits) and group 6 (3 white rabbits) 0.1 ml of saline solution. Clinical examination was performed prior to injection and 24 h and 10 days after surgery. The animals were sacrificed 10 days after the injection, and the eyes were enucleated and fixed for histopathology. The specimens were stained with hematoxylin-eosin and toluidine blue. RESULTS: No relevant complications were found during the clinical follow-up. All the eyes showed no abnormalities in the histologic evaluation. CONCLUSION: Grepafloxacin can be considered as a safe alternative for intravitreal injection for the treatment of intraocular infections.

[Photodynamic therapy for choroidal neovascularization not caused by age related macular degeneration or pathologic myopia]. / Terapia fotodinámica en membrana neovascular subretiniana no relacionada con degeneración macular asociada a la edad o miopía patológica.

PURPOSE: To assess the effects of photodynamic therapy (PDT) with verteporfin on visual acuity (VA) and fluorescein angiography, in patients with subfoveal choroidal neovascularization (CNV) not secondary to age related macular degeneration (AMD) or pathologic myopia. METHODS: 113 eyes from 104 patients underwent PDT due to subfoveal CNV from July 2001 to June 2002. In this study only those patients with CNV not related to AMD or pathologic myopia were included. Fluorescein angiography and visual acuity were evaluated. RESULTS: 9 eyes from 8 patients (8.03%) showed distinct causes of CNV: 3 were idiopathic cases, 1 suffered angioid streaks, 1 was secondary to laser photocoagulation due to diabetic retinopathy, 2 had polypoidal choroidal vasculopathy and 2 central serous choroiditis. Regarding VA results, 77.7% improved or mantained the previous VA. Angiography resolution was observed in 55.5% of the cases (80% with just one PDT session). Average follow up was 10.5 months. Systemic or local complications were not observed. CONCLUSION: PDT may be useful in the treatment of different types of CNV due to causes other than AMD or high myopia.

Terapia fotodinámica en membrana neovascular subretiniana no relacionada con degeneración macular asociada a la edad o miopía patológica / Photodynamic therapy for choroidal neovascularization not caused by age related macular degeneration or pathologic myopia

Objetivo: Valorar los efectos de la terapia fotodinámica (TFD) en la agudeza visual (AV) y la angiografía en pacientes con neovascularización subretiniana (NVSR) foveal no debida ni a degeneración macular asociada a la edad (DMAE) ni a miopía patológica. Material y Métodos: Se evaluaron de un total de 104 pacientes (113 ojos) a los que se les realizó TFD por NVSR foveal, desde julio de 2001 a junio de 2002, aquellos cuya causa no era DMAE o miopía patológica. Se valoró la evolución angiográfica y de la agudeza visual (AV). Resultados: 9 ojos de 8 pacientes presentaban otras causas de NVSR (8,03 por ciento): 3 idiopáticas, 1 en estrías angioides, 1 secundaria a fotocoagulación láser en retinopatía diabética, 2 en vasculopatia coroidea polipoidal y 2 en coroiditis serosa central. El 77,7 por ciento presentó estabilización o mejoría en su AV y el 55,5 por ciento presentó resolución angiográfica, el 80 por ciento de ellos con una sola sesión de TFD. El tiempo de seguimiento medio fue de 10,5 meses. No se objetivaron complicaciones ni a nivel local ni sistémico. Conclusión: La TFD puede ser de utilidad en NVSR no debidas a DMAE o miopía patológica (AU)

Purpose: To assess the effects of photodynamic therapy (PDT) with verteporfin on visual acuity (VA) and fluorescein angiography, in patients with subfoveal choroidal neovascularization (CNV) not secondary to age related macular degeneration (AMD) or pathologic myopia. Methods: 113 eyes from 104 patients underwent PDT due to subfoveal CNV from July 2001 to June 2002. In this study only those patients with CNV not related to AMD or pathologic myopia were included. Fluorescein angiography and visual acuity were evaluated. Results: 9 eyes from 8 patients (8.03%) showed distinct causes of CNV: 3 were idiopathic cases, 1 suffered angioid streaks, 1 was secondary to laser photocoagulation due to diabetic retinopathy, 2 had polypoidal choroidal vasculopathy and 2 central serous choroiditis. Regarding VA results, 77.7% improved or mantained the previous VA. Angiography resolution was observed in 55.5% of the cases (80% with just one PDT session). Average follow up was 10.5 months. Systemic or local complications were not observed. Conclusion: PDT may be useful in the treatment of different types of CNV due to causes other than AMD or high myopia (AU)

[Topical versus contact anaesthesia in conventional trabeculectomy. Prospective randomised study]. / Anestesia tópica versus anestesia de contacto en la trabeculectomía convencional. Estudio prospectivo aleatorizado.

PURPOSE: To compare the pain rates, comfort levels and safety between conventional topical anaesthesia and the application of a long lasting lidocaine soaked film or contact anaesthesia. METHODS: Fifty patients undergoing conventional trabeculectomy with or without Mitomycin-C were included. One half received topical anaesthesia and the other half contact anaesthesia in a random fashion. Pain and discomfort rates before, during and after surgery were evaluated on a scale from 0 to 5, also, surgeon subjective stress and complications observed were included in the clinical protocol. RESULTS: Significant differences were found between both groups regarding pain rates, during and after surgery, and surgeon stress level. Sedation and change of anesthesic method were required more frequently by the patients included in the topical anaesthesia group. CONCLUSIONS: Topical anaesthesia provides sufficient level of anaesthesia for performing a trabeculectomy. Nevertheless pain rate differences between contact and conventional topical anaesthesia were patent during and after surgery. Contact anaesthesia appears to be a valid and practical alternative in a wide range of patients undergoing glaucoma surgery.

Anestesia tópica versus anestesia de contacto en la trabeculectomía convencional. Estudio prospectivo aleatorizado / Topical versus contact anaesthesia in conventional trabeculectomy. Prospective randomised study

Objetivo: Comparar los niveles de anestesia, confort y seguridad para el paciente entre la anestesia tópica simple y la aplicación del mismo agente anestésico de forma prolongada utilizando un vehículo poroso, o anestesia de contacto. Métodos: Se incluyeron un total de 50 pacientes, programados para trabeculectomía simple con o sin antimitóticos, de forma consecutiva. La mitad de ellos se asignaron, de forma aleatoria, al grupo de anestesia tópica y la otra mitad al grupo de anestesia de contacto. Se valoraron el nivel de dolor o molestia en los diferentes momentos de la cirugía (con una escala de 0 a 5), el nivel de stress del cirujano y las complicaciones. Resultados: Se encontraron diferencias significativas entre ambos grupos relativas al nivel de dolor durante y tras la cirugía y al nivel de stress del cirujano. La necesidad de sedación y reconversión anestésica fue mayor en el grupo de anestesia tópica simple. Conclusiones: La anestesia tópica presenta unos aceptables niveles de anestesia en la trabeculectomía, a pesar de ello, las diferencias de niveles de dolor entre la anestesia tópica simple y la de contacto son evidentes, tanto en el momento de la cirugía como tras la misma, siendo la anestesia de contacto una alternativa válida y aplicable en una amplio rango de pacientes sometidos a cirugía de glaucoma (AU)

[Benefit of scanning laser ophthalmoscopy for detecting retinal nerve fiber layer defects in patients with intraocular hypertension]. / Utilidad de la oftalmoscopia láser de barrido en la detección de defectos en la capa de fibras nerviosas retinianas en pacientes con hipertensión ocular.

PURPOSE: To compare the ability to identify RNFL alterations between standard images and SLO images in a group of patients suffering from ocular hypertension. METHODS: We evaluated RNFL in sixty patients with ocular hypertension and with normal perimetry, by using standard photography and SLO. Two different independent observers evaluated the images on two different ocassions. RESULTS: We studied 118 eyes, twelve eyes were rejected because of the low quality of the images. Four cases of diffuse atrophy and five patients with wedge shaped defects were observed using both methods. Statistical analysis showed no differences between both exploration techniques or between observers. CONCLUSIONS: RNFL study with SLO seems to be at least as reliable as standard photography as a method to evaluate RNFL defects. SLO has also proved to be much easier, and faster than traditional methods.

Utilidad de la oftalmoscopia láser de barrido en la detección de defectos en la capa de fibras nerviosas retinianas en pacientes con hipertensión ocular / Benefit of scanning laser ophthalmoscopy for detecting retinal nerve fiber layer defects in patients with intraocular hypertension

Objetivos: Comparar la capacidad para identificar alteraciones en la capa de fibras nerviosas retinianas (CFNR) en pacientes hipertensos oculares, entre la fotografía tradicional y el examen con SLO (scanning laser ophthalmoscope) u oftalmoscopia de barrido. Material y métodos: En 60 pacientes hipertensos oculares con perimetrías normales valoramos el aspecto de CFNR mediante fotografía tradicional y SLO. Dos observadores independientes en dos ocasiones distintas valoraron las imágenes. Resultados: Se estudiaron 118 ojos y se rechazaron 12 ojos por mala calidad de las imágenes. Se observaron 4 casos de atrofia difusa y 5 sectores. El análisis estadístico mostró que no había diferencias estadísticamente significativas entre los observadores y los dos métodos empleados. Conclusión: El estudio de CFNR con SLO demuestra ser tan fiable como el análisis fotográfico tradicional de CFNR y más fácil y rápido que los métodos tradicionales (AU)

[A case of punctate inner choroidopathy: differential diagnosis]. / A propósito de un caso de coroidopatía puntata interna: diagnóstico diferencial.

CASE REPORT: We present the case of a 27-year old woman suffering from a chorioretinal inflammatory disease that was diagnosed as punctate inner choroidopathy (PIC) after a complete ophthalmic evaluation. DISCUSSION: PIC must be taken into consideration when evaluating a patient with a white dot syndrome.

A propósito de un caso de coroidopatía puntata interna: diagnóstico diferencial / A case of punctate inner choroidopathy: differential diagnosis

Caso clínico: Presentamos el caso de una joven de 27 años con una enfermedad inflamatoria coriorretiniana que tras su estudio es diagnosticada de una coroidopatía punctata interna (PIC).Discusión: La PIC debe diferenciarse de otras patologías similares a veces de diagnóstico diferencial difícil, que son denominadas bajo el sobrenombre de 'síndromes de puntos blancos' (AU)

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[Dynamic angiography in age related macular degeneration]. / Angiografía dinámica: diagnóstico y tratamiento en la degeneración macular asociada a la edad.

PURPOSE: To evaluate the utility of dynamic angiography with fluorescein and indocyanine green with scanning laser ophthalmoscope (SLO) in exudative age-related macular degeneration. METHOD: We retrospectively studied 95 patients with exudative age-related macular degeneration (ARMD) between April 98 and April 01. RESULTS: We studied 102 eyes of 95 patients with ARMD. Mean age was 75.3 years with a mean follow-up time of 16.8 months. We found an occult or mixed angiographic membrane pattern with fluorescein angiography in 85 eyes (83.3%). Angiography with indocyanine green showed choroidal neovascular membranes in 94 of 102 eyes (92.1%). The most frequent location found was sub-foveal (53.2%). Laser photocoagulation was used in 55 eyes and photodynamic therapy in 5 eyes. In 17 eyes laser treatment failed to close the membrane. CONCLUSION: Dynamic angiography with fluorescein or indocyanine green allowed neovascular membrane identification in more than 90% of the cases of ARMD. Successful treatment was achieved in 42% of cases.

Angiografía dinámica: diagnóstico y tratamiento en la degeneración macular asociada a la edad / Dynamic angiography in age related macular degeneration

Propósito: Confirmar la utilidad del estudio angiográfico dinámico con fluoresceína e indocianina verde, utilizando un láser confocal de barrido, en el diagnóstico y tratamiento de la degeneración macular asociada a la edad (DMAE) de tipo exudativo. Método: Se han revisado las historias clínicas y angiografías de 95 pacientes diagnosticados de DMAE exudativa en Nuestro Servicio, desde abril del 98 a abril del 2001.Resultados: La edad media de los 95 pacientes estudiados fue de 75,3 años, con un tiempo medio de seguimiento de 16,8 meses. De los 102 ojos evaluados, la angiografía fluoresceínica (AGF) mostró un patrón de membrana oculta o mixta en 85 ojos (83,3 por ciento). Mediante la angiografía con indocianina verde (AVI) se localizó membrana neovascular en 94 de los 102 ojos (92,1 por ciento). La localización más frecuente de la membrana neovascular fue la sub-foveal (53,2 por ciento de los casos). Se aplicó tratamiento láser argón en 55 ojos y terapia fotodinámica en 5 ojos; en total 58,8 por ciento de los ojos pudieron tratarse. En 17 de estos ojos no se consiguió el cierre de la membrana neovascular. Conclusiones: La angiografía dinámica con fluoresceína e indocianina verde permite la localización de membrana neovascular en más del 90 por ciento de los casos de DMAE exudativa. El tratamiento con éxito de los neovasos se pudo realizar en 42 por ciento de los casos (AU)

[A case of primary toxoplasmosis in an immunocompetent patient]. / Toxoplasmosis primaria en paciente inmunocompetente.

CASE REPORT: A case of an immunocompetent patient presenting primary systemic toxoplasma infection involving the eye (condition seen in less than 3% of primary infections). The patient showed reactivation of this primary focus two years later. DISCUSSION: Diagnosis of toxoplasm retinitis is based on a typical lesion consisting in an area of active retinitis adjacent to an inactive corioretinal scar. Differential diagnosis must consider other causes of retinal coroiditis in primary infection cases: sarcoidosis, tuberculosis, syphilis as well as viral and fungal infections. Ocular toxoplasmosis was confirmed by serum tests.