Evolución de la técnica «avance de colgajo frontal» en la ptosis congénita / Evolution of the «frontal flap advancement» in congenital ptosis

El tratamiento de la ptosis congénita con mala función del elevador se basa habitualmente en una suspensión del párpado superior al músculo frontal mediante diversos tipos de materiales autógenos o aloplásticos. Sin embargo, el empleo de dichos materiales conlleva una serie de complicaciones, lo cual dio lugar a la búsqueda de una técnica quirúrgica mediante la que, sin necesidad de ningún material adicional, se enlazaran músculo frontal y tarso; el avance de colgajo frontal. No obstante, es una técnica menos conocida y que todavía no está estandarizada, por lo que a lo largo del tiempo se han ido describiendo variaciones para mejorar los resultados estéticos y funcionales. El objetivo de esta revisión bibliográfica es repasar en detalle las distintas variaciones de la técnica quirúrgica y obtener la mejor opción con o sin la combinación de las diferentes versiones empleadas hasta el momento. Según los resultados observados, se podría deducir que la cirugía con mejores resultados estéticos y funcionales sería la siguiente; una única incisión en el surco palpebral para realizar una disección suborbicular hasta alcanzar reborde orbitario. Realización de lipectomía si lo precisa. A continuación, disección roma del músculo frontal y formación de colgajo en «U». Avance de la aponeurosis del elevador si se trata de una ptosis grave. Finalmente, sutura sin polea del colgajo frontal al tarso con tres puntos no reabsorbibles tratando de mantener el contorno simétrico al ojo contralateral y con una altura de 1,5mm por encima del limbo corneal (AU)

The treatment of congenital ptosis with poor levator activity is often based upon the union of the superior eyelid to the frontalis muscle by using different materials as potential grafts. Nevertheless, theses grafts may lead some complications. In order to avoid them, a new technic has been described using an advancement flap of the frontalis muscle, that is tided to the upper tarsus, eliminating the need of a graft. Although, it is not yet a standard procedure, reason why many variants has been recently described with the objective of improving the aesthetical and functional results. The goal of this systematic review is to conscientiously evaluate these variants with the propose of determining which one gives the best results in terms of safety, functional and aesthetical outcomes. From the review of the published procedures, we conclude that the best technique in terms of functional and aesthetical results is: sub-orbicularis dissection via lid crease incision reaching the orbital margin, followed by blunt dissection of the frontalis muscle and creation of a “U” shaped flap (that might be associated to a levator advancement in severe cases), finally, the frontalis flap is stitched to the upper end of the tarsus taking care to maintain a symmetrical contour when compared to the contralateral eye. The final eyelid margin height should be 1.5mm above the sclero-corneal limbus (AU)

Evolution of the «frontal flap advancement¼ in congenital ptosis.

The treatment of congenital ptosis with poor levator activity is often based upon the union of the superior eyelid to the frontalis muscle by using different materials as potential grafts. Nevertheless, theses grafts may lead some complications. In order to avoid them, a new technic has been described using an advancement flap of the frontalis muscle, that is tided to the upper tarsus, eliminating the need of a graft. Although, it is not yet a standard procedure, reason why many variants has been recently described with the objective of improve the aesthetical and functional results. The goal of this systematic review is to conscientiously evaluate these variants with the propose of determine which one gives the best results in terms of safety, functional and aesthetical outcomes. From the review of the published procedures, we conclude that the best technique in terms of functional and aesthetical results is: sub-orbicularis dissection via lid crease incision reaching the orbital margin, followed by blunt dissection of the frontalis muscle and creation of a "U" shaped flap (that might be associated to a levator advancement in severe cases), finally, the frontalis flap is stitched to the upper end of the tarsus taking care to maintain a symmetrical contour when compared to the contralateral eye. The final eyelid margin height should be 1.5 mm above the sclero-corneal limbus.

Efecto de la suplementación oral con una fórmula que contiene ácido R-lipoico en pacientes con glaucoma / Effect of an oral supplementation with a formula containing R-lipoic acid in glaucoma patients

OBJETIVO: Analizar la seguridad y efectividad de la administración oral de un suplemento comercializado que contiene ácido alfa-R-lipoico, taurina, vitaminas C y E, luteína, zeaxantina, zinc, cobre y ácido docosahexaenoico en pacientes con glaucoma primario de ángulo abierto (GPAA) y sujetos control. MATERIAL Y MÉTODOS: Se realizó un estudio prospectivo de casos y controles que incluyó 30 participantes de ambos sexos, divididos en: pacientes con GPAA (n = 15) y sujetos sanos (GC; n = 15) asignados a tomar durante 6 meses los preparados NuaDHA Visión(R) (1 comp/día) + NuaDHA 1000 (2 comps/día). Los participantes fueron entrevistados, examinados oftalmológicamente, extrayendo sangre periférica que fue procesada para analítica convencional y determinación de actividades prooxidante (malonildialdehído) y estado antioxidante total. El análisis estadístico se realizó mediante el programa SPSS 22.0. RESULTADOS: Tras 6 meses de suplementación, los niveles plasmáticos de estado antioxidante total aumentaron significativamente (1,073 ± 0,090 mM vs. 1,276 ± 0,107 mM; p = 0,028), disminuyendo en paralelo los de malonildialdehído (7,066 ± 1,070 μM vs. 2,761 ± 0,462 μM; p = 0,005) en el GGPAA. El malonildialdehído también descendió significativamente en el GC (6,17 ± 1,336 vs. 2,51 ± 0,391; p = 0,028). Los pacientes con GPAA mostraron valores del test de Schirmer notablemente mayores (20-30%) y mejoraron subjetivamente los signos/síntomas de ojo seco, frente a los resultados del GC. CONCLUSIONES: Las formulaciones que contienen vitaminas antioxidantes, ácido alfa-R-lipoico y ácido docosahexaenoico administradas durante 6 meses consecutivos contrarrestaron el estrés oxidativo, y estabilizaron los parámetros morfológicos/funcionales de la superficie ocular y del glaucoma, sin presentar efectos adversos o intolerancias

OBJECTIVE: To analyse the safety and effectiveness of the oral administration of a commercialised supplement containing R-alpha lipoic acid, taurine, vitamins C and E, lutein, zeaxanthin, zinc, copper and docosahexaenoic acid, in patients with primary open angle glaucoma (POAG), and in control subjects. MATERIAL AND METHODS: A prospective study of cases and controls was carried out, including 30 participants of both genders that were divided into: POAG Group (n = 15) and a control group (CG; n = 15), assigned to the oral intake of NuaDHA preparations Vision(R) (1 pill/day) + NuaDHA 1000 (2 pills/day) for 6 months. Participants were interviewed, ophthalmologically examined, and peripheral blood was taken for routine analysis and the determination of the pro-oxidant (malondialdehyde) and total antioxidant status. Statistical analysis was performed using the SPSS 22.0 program. RESULTS: After 6 months of supplementation, there was a significant increase in the plasma total antioxidant status (1.073 ± 0.090 mM vs 1.276 ± 0.107 mM, P = .028), along with a parallel decrease in malondialdehyde (7.066 ± 1.070 μM vs 2.771 ± 0.462μM, P = .005) in the POAG group. The malondialdehyde also decreased in the control group (6.17 ± 1.336 vs. 2.51 ± 0.391, P = .028). The Schirmer test improved (20-30%) and the subjective dry eye signs/symptoms noticeably decreased in the POAG group versus the CG. CONCLUSIONS: Formulations containing antioxidant vitamins, R-alpha lipoic acid and docosahexaenoic acid, administered for 6 consecutive months, counteracted the oxidative stress by further stabilising the morphological/functional parameters of both the ocular surface and the glaucoma, without presenting with adverse effects or intolerances

Effect of an oral supplementation with a formula containing R-lipoic acid in glaucoma patients. / Efecto de la suplementación oral con una fórmula que contiene ácido R-lipoico en pacientes con glaucoma.

OBJECTIVE: To analyse the safety and effectiveness of the oral administration of a commercialised supplement containing R-alpha lipoic acid, taurine, vitamins C and E, lutein, zeaxanthin, zinc, copper and docosahexaenoic acid, in patients with primary open angle glaucoma (POAG), and in control subjects. MATERIAL AND METHODS: A prospective study of cases and controls was carried out, including 30 participants of both genders that were divided into: POAG Group (n=15) and a control group (CG; n=15), assigned to the oral intake of NuaDHA preparations Vision® (1 pill/day)+NuaDHA 1000 (2 pills/day) for 6 months. Participants were interviewed, ophthalmologically examined, and peripheral blood was taken for routine analysis and the determination of the pro-oxidant (malondialdehyde) and total antioxidant status. Statistical analysis was performed using the SPSS 22.0 program. RESULTS: After 6 months of supplementation, there was a significant increase in the plasma total antioxidant status (1.073±0.090mM vs 1.276±0.107mM, P=.028), along with a parallel decrease in malondialdehyde (7.066±1.070µM vs 2.771±0.462µM, P=.005) in the POAG group. The malondialdehyde also decreased in the control group (6.17±1.336 vs. 2.51±0.391, P=.028). The Schirmer test improved (20-30%) and the subjective dry eye signs/symptoms noticeably decreased in the POAG group versus the CG. CONCLUSIONS: Formulations containing antioxidant vitamins, R-alpha lipoic acid and docosahexaenoic acid, administered for 6 consecutive months, counteracted the oxidative stress by further stabilising the morphological/functional parameters of both the ocular surface and the glaucoma, without presenting with adverse effects or intolerances.

Identificación de nuevos genes candidatos para la retinopatía en diabéticos tipo 2. Estudio Valencia sobre Retinopatía Diabética (EVRD). Informe n.° 3 / Identification of new candidate genes for retinopathy in type 2 diabetics. Valencia Study on Diabetic Retinopathy (VSDR). Report number 3

OBJETIVO: Identificar genes implicados en los mecanismos patogénicos de la retinopatía diabética no proliferante, como estrés oxidativo, alteración de la matriz extracelular y/o apoptosis, para valorar el riesgo de desarrollo de la misma en una población de diabéticos tipo2 (DM2). MATERIAL Y MÉTODOS: Estudio de casos y controles en 81 participantes del Estudio Valencia sobre Retinopatía Diabética (EVRD), de ambos sexos y con edades comprendidas entre los 25 y 85 años, clasificados en: 1) grupo DM2 (n = 49), con RD (+RD; n = 14) y sin RD (−RD; n = 35), y 2)grupo control (GC; n=32). Se realizó entrevista personal, examen oftalmológico estandarizado y extracción de sangre que se procesó para analizar el ADN y determinar la expresión de: TP53, MMP9 y SLC23A2 en todos los participantes. El programa estadístico utilizado fue el SPSS v22.0. RESULTADOS: Los genes TP53 y MMP9 aumentaron su expresión en el grupo DM2 respecto al GC, aunque solo de manera significativa el gen MMP9 (TP53: 10,40 ± 1,20 vs. 8,23 ± 1,36, p = 0,084; MMP9: 1,45 ± 0,16 vs. 0,95 ± 0,16, p = 0,036) y el gen SLC23A2 disminuyó significativamente sus niveles en DM2 vs. GC (5,58 ± 0,64 vs. 11,66 ± 1,90, p = 0,026). Al subdividir el grupo DM2 según presencia de retinopatía, la expresión de los genes TP53, MMP9 y SLC23A2 mostró diferencias significativas entre los grupos DM2−RD, DM2+RD y GC (TP53: 9,95 ± 1,47 vs. 11,52 ± 2,05 vs. 8,23 ± 1,36, p = 0,038; MMP9: 1,47 ± 0,20 vs. 1,41 ± 0,27 vs. 0,95 ± 0,16, p = 0,021; SLC23A2: 5,61 ± 0,77 vs. 5,51 ± 1,21 vs. 11,66 ± 1,90, p = 0,018). CONCLUSIONES: Los genes reguladores de apoptosis (TP53) e integridad de la matriz extracelular (MMP9) podrían estar implicados en la susceptibilidad para el desarrollo/progresión de la RD, así como el gen SLC232A2 (transportador del ácido ascórbico) puede comportarse como protector del riesgo de padecer/progresar en la retinopatía

OBJECTIVE: To identify genes involved in the pathogenic mechanisms of non-proliferative diabetic retinopathy (NPDR), among which include oxidative stress, extracellular matrix changes, and/or apoptosis, in order to evaluate the risk of developing this retinal disease in a type2 diabetic (DM2) population. MATERIAL AND METHODS: A case-control study was carried out on 81 participants from the Valencia Study on Diabetic Retinopathy (VSDR) of both genders, with ages 25-85 years. They were classified into: (I) DM2 group (n = 49), with DR (+DR; n = 14) and without DR (-DR; n = 35), and (II) control group (GC; n = 32). The protocols included a personal interview, standardised ophthalmological examination, and blood collection (to analyse the DNA for determining the gene expression (TP53, MMP9, and SLC23A2) in the study groups. Statistical analyses were performed using the SPSS v22.0 program. RESULTS: The TP53 and MMP9 genes showed a higher expression in the DM2 group compared to the GC, although the difference was only significant for the MMP9 gene (TP53: 10.40 ± 1.20 V. 8.23 ± 1.36, P = .084; MMP9: 1.45 ± 0.16 vs. 0.95 ± 0.16, P = .036), and the SLC23A2 gene showed a significant lower expression in the DM2 vs CG (5.58 ± 0.64 vs. 11.66±1.90, P=.026). When sub-dividing the DM2 group according to the presence of retinopathy, the expression of the TP53, MMP9 and SLC23A2 genes showed significant differences between the DM2−RD, DM2+RD and GC groups (TP53: 9.95 ± 1.47 vs. 11.52 ± 2.05 vs. 8.23 ± 1.36, P = .038; MMP9: 1.47 ± 0.20 vs. 1.41 ± 0.27 vs. 0.95 ± 0.16, P = .021; SLC23A2: 5.61 ± 0.77 vs. 5.51 ± 1.21 vs. 11.66 ± 1.90, P = .018). CONCLUSIONS: Genes involved in extracellular matrix integrity (MMP9) and/or apoptosis (TP53), could be considered potential markers of susceptibility to the development/progression of NPDR. Interestingly, the SLC232A2 gene (ascorbic acid transporter) can be considered a protector of the risk of the development/progression of the retinopathy

Identification of new candidate genes for retinopathy in type 2 diabetics. Valencia Study on Diabetic Retinopathy (VSDR). Report number 3. / Identificación de nuevos genes candidatos para la retinopatía en diabéticos tipo 2. Estudio Valencia sobre Retinopatía Diabética (EVRD). Informe n.° 3.

OBJECTIVE: To identify genes involved in the pathogenic mechanisms of non-proliferative diabetic retinopathy (NPDR), among which include oxidative stress, extracellular matrix changes, and/or apoptosis, in order to evaluate the risk of developing this retinal disease in a type2 diabetic (DM2) population. MATERIAL AND METHODS: A case-control study was carried out on 81 participants from the Valencia Study on Diabetic Retinopathy (VSDR) of both genders, with ages 25-85years. They were classified into: (i)DM2 group (n=49), with DR (+DR; n=14) and without DR (-DR; n=35), and (ii)control group (GC; n=32). The protocols included a personal interview, standardised ophthalmological examination, and blood collection (to analyse the DNA for determining the gene expression (TP53, MMP9, and SLC23A2) in the study groups. Statistical analyses were performed using the SPSS v22.0 program. RESULTS: The TP53 and MMP9 genes showed a higher expression in the DM2 group compared to the GC, although the difference was only significant for the MMP9 gene (TP53: 10.40±1.20 vs. 8.23±1.36, P=.084; MMP9: 1.45±0.16 vs. 0.95±0.16, P=.036), and the SLC23A2 gene showed a significant lower expression in the DM2 vs CG (5.58±0.64 vs. 11.66±1.90, P=.026). When sub-dividing the DM2 group according to the presence of retinopathy, the expression of the TP53, MMP9 and SLC23A2 genes showed significant differences between the DM2-RD, DM2+RD and GC groups (TP53: 9.95±1.47 vs. 11.52±2.05 vs. 8.23±1.36, P=.038; MMP9: 1.47±0.20 vs. 1.41±0.27 vs. 0.95±0.16, P=.021; SLC23A2: 5.61±0.77 vs. 5.51±1.21 vs. 11.66±1.90, P=.018). CONCLUSIONS: Genes involved in extracellular matrix integrity (MMP9) and/or apoptosis (TP53), could be considered potential markers of susceptibility to the development/progression of NPDR. Interestingly, the SLC232A2 gene (ascorbic acid transporter) can be considered a protector of the risk of the development/progression of the retinopathy.

Nuevos horizontes para el tratamiento del glaucoma. I: neuroinflamación e inflamasomas / New horizons for the treatment of glaucoma. I: Neuroinflammation and inflammasomes

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