Cirugía de catarata bilateral secuencia e inmediata / Immediate bilateral sequential cataract surgery

Propósito Existe una constante controversia entre la realización de la cirugía de la catarata de un ojo o de ambos ojos en la misma sesión quirúrgica. El objetivo de este estudio es revisar la evidencia científica sobre eficacia y seguridad, valorar la reducción de costes de la cirugía de catarata bilateral simultánea en el mismo día en comparación con la cirugía de la catarata secuencial en 2tiempos, así como comparar la tasa de complicaciones asociadas. Métodos Se ha hecho una búsqueda exhaustiva en las bases de datos PubMed y Web of Science para identificar artículos relevantes sobre cirugía de catarata bilateral secuencial desde el año 2000 hasta el 31 de diciembre de 2020. Resultados La literatura revisada muestra evidencias sólidas que demuestran la eficacia y seguridad de la cirugía de la catarata bilateral simultánea cuando se han seguido protocolos muy estrictos de esterilidad entre la cirugía de cada ojo. Bajo estas condiciones, en los estudios no se ha encontrado una mayor tasa de complicaciones postoperatorias que en la cirugía de catarata secuencial en 2tiempos. Conclusiones Existe evidencia sustancial de que la cirugía de catarata bilateral simultánea es una adecuada opción quirúrgica para la resolución de la catarata, que provoca una rápida rehabilitación visual y sin mayor número de complicaciones que la cirugía secuencial en 2tiempos cuando se extreman los protocolos de esterilidad entre los procedimientos de ambos ojos. Además, proporciona una reducción en el gasto sanitario. Existe un miedo psicológico a la realización de la cirugía bilateral por el potencial riesgo de complicaciones que afectaría a los 2ojos operados. Dentro del presente artículo discutimos la eficacia, seguridad, tasa de complicaciones y costes asociados en la cirugía de catarata bilateral simultánea en el mismo acto quirúrgico (AU)

Purpose There is a constant controversy between performing cataract surgery for one eye or for both eyes in the same surgical session. The objective of this study is to review the scientific evidence on the efficacy and safety, determine the reduction of costs of sequential bilateral cataract surgery on the same day compared to unilateral cataract surgery, as well as to compare the rate of associated complications. Methods A comprehensive search of the PubMed and Web of Science databases has been conducted to identify relevant articles on sequential bilateral cataract surgery from 2000 to 31 of December of 2020. Results Literature shows that there is strong evidence demonstrating the efficacy and safety of same-day sequential bilateral cataract surgery. Studies have not found a higher rate of postoperative complications compared to unilateral cataract surgery. Conclusions Same-day sequential bilateral cataract surgery is a good surgical option for the resolution of the cataract, provides rapid visual rehabilitation and without greater risks than unilateral surgery. It also provides a reduction in sanitary costs. There is a psychological fear of performing bilateral surgery due to the potential risk of complications that would affect both operated eyes. In this article we discuss the efficacy, safety, complications rate and associated costs in sequential bilateral cataract surgery in the same surgical act (AU)

Immediate bilateral sequential cataract surgery.

PURPOSE: There is a constant controversy between performing cataract surgery for one eye or for both eyes in the same surgical session. The objective of this study is to review the scientific evidence on the efficacy and safety, determine the reduction of costs of sequential bilateral cataract surgery on the same day compared to unilateral cataract surgery, as well as to compare the rate of associated complications. METHODS: A comprehensive search of the PubMed and Web of Science databases has been conducted to identify relevant articles on sequential bilateral cataract surgery from 2000 to 31 of December of 2020. RESULTS: Literature shows that there is strong evidence demonstrating the efficacy and safety of same-day sequential bilateral cataract surgery. Studies have not found a higher rate of postoperative complications compared to unilateral cataract surgery. CONCLUSIONS: Same-day sequential bilateral cataract surgery is a good surgical option for the resolution of the cataract, provides rapid visual rehabilitation and without greater risks than unilateral surgery. It also provides a reduction in sanitary costs. There is a psychological fear of performing bilateral surgery due to the potential risk of complications that would affect both operated eyes. In this article we discuss the efficacy, safety, complications rate and associated costs in sequential bilateral cataract surgery in the same surgical act.

Evidence in the prevention of the recurrence of herpes simplex and herpes zoster keratitis after eye surgery.

OBJECTIVE: Herpetic keratitis, either due to herpes simplex keratitis (HSK) or herpes zoster ophthalmicus (HZO), can recur after eye surgery.º Prophylaxis is postulated as necessary to avoid it. The objective of this study was to review the scientific evidence on the preventive methods used in the perioperative period in patients previously affected by HSK/HZO. METHODS: An exhaustive search was carried out in the PubMed and Web of Science databases to identify relevant articles on prophylaxis and risk of recurrence of HSK/HZO in patients undergoing eye surgery up to 31 December 2019. RESULTS: There is strong evidence that oral prophylaxis should be recommended after penetrating keratoplasty in patients who have previously had HSK/HZO. For other types of surgery, the evidence is less compelling. However, a latent period of inactivity should be considered between disease and oral prophylaxis. CONCLUSIONS: Penetrating and lamellar keratoplasty, corneal crosslinking, cataract surgery, and photorefractive and phototherapeutic surgery cause an alteration of the subbasal nerve plexus of the cornea. Due to surgical trauma, as well as the modulation of the ocular immune response caused by steroids applied in the postoperative period, it is possible to induce the reactivation of HSK/HZO, which is common in some cases. Within this article, we discuss the available evidence for HSK/HZO prophylaxis in eye surgery. Further studies are necessary to define the real risk of HSK/HZO recurrence after ocular surgeries, particularly in cataract surgery, and to confirm the efficacy of perioperative prophylaxis with anti-HSK/HZO antivirals.

Evidencia en la prevención de la recurrencia de queratitis por herpes simple y herpes zóster tras cirugía ocular / Evidence in the prevention of the recurrence of herpes simplex and herpes zoster keratitis after eye surgery

Propósito: La queratitis herpética, ya sea por herpes simple (HSK) o por herpes zóster oftálmico (HZO) puede presentar recaídas tras la cirugía ocular. Se postula como necesaria una profilaxis para evitarla. El objetivo de este estudio es revisar la evidencia científica sobre los métodos preventivos empleados en el período perioperatorio en pacientes previamente afectados de HSK/HZO.MétodosSe ha realizado una búsqueda exhaustiva en las bases de datos PubMed y Web of Science para identificar artículos relevantes sobre profilaxis y riesgo de recurrencia de HSK/HZO en pacientes sometidos a cirugía ocular hasta el 31 de diciembre de 2019.ResultadosHay pruebas sólidas de que la profilaxis oral debe recomendarse tras una queratoplastia penetrante en pacientes que hayan sufrido previamente HSK/HZO. Para otros tipos de cirugías, la evidencia es menos convincente; sin embargo, debe considerarse un período latente de inactividad entre la enfermedad y la profilaxis oral.ConclusionesLa queratoplastia penetrante y lamelar, crosslinking corneal, cirugía de catarata y cirugía fotorrefractiva y fototerapéutica provocan una alteración del plexo nervioso sub-basal de la cornea. Debido al traumatismo quirúrgico, así como a la modulación de la respuesta inmunológica ocular causada por los esteroides aplicados en el postoperatorio, es posible inducir la reactivación de HSK/HZO, siendo en algunos casos común. Dentro del presente artículo discutimos la evidencia disponible para la profilaxis de HSK/HZO en cirugía ocular. Son necesarios estudios adicionales para definir el riesgo real de recurrencia de HSK/HZO después de cirugías oculares, particularmente en cirugía de catarata y para confirmar la eficacia de la profilaxis perioperatoria con antivíricos anti HSK/HZO (AU)

Objective: Herpetic keratitis, either due to herpes simplex keratitis (HSK) or herpes zoster ophthalmicus (HZO), can recur after eye surgery.° Prophylaxis is postulated as necessary to avoid it. The objective of this study was to review the scientific evidence on the preventive methods used in the perioperative period in patients previously affected by HSK/HZO.MethodsAn exhaustive search was carried out in the PubMed and Web of Science databases to identify relevant articles on prophylaxis and risk of recurrence of HSK/HZO in patients undergoing eye surgery up to 31 December 2019.ResultsThere is strong evidence that oral prophylaxis should be recommended after penetrating keratoplasty in patients who have previously had HSK/HZO. For other types of surgery, the evidence is less compelling. However, a latent period of inactivity should be considered between disease and oral prophylaxis.ConclusionsPenetrating and lamellar keratoplasty, corneal crosslinking, cataract surgery, and photorefractive and phototherapeutic surgery cause an alteration of the subbasal nerve plexus of the cornea. Due to surgical trauma, as well as the modulation of the ocular immune response caused by steroids applied in the postoperative period, it is possible to induce the reactivation of HSK/HZO, which is common in some cases. Within this article, we discuss the available evidence for HSK/HZO prophylaxis in eye surgery. Further studies are necessary to define the real risk of HSK/HZO recurrence after ocular surgeries, particularly in cataract surgery, and to confirm the efficacy of perioperative prophylaxis with anti-HSK/HZO antivirals (AU)

Relación entre la condición física y el hábito de actividad física con la capacidad de atención selectiva en alumnos de enseñanza secundaria / Relação entre condição física e hábito de atividade física com capacidade de atenção seletiva em estudantes do ensino secundário / Relationship between physical fitness and the physical activity habit with the selective attention capacity in secondary school students

El objetivo del presente estudio fue analizar la relación entre las capacidades físicas, el hábito de realizar actividad física y la capacidad de atención selectiva en una muestra de estudiantes de enseñanza secundaria. La muestra fue configurada por un total de 97 participantes, concretamente 51 estudiantes de género femenino (n = 51) y 46 de género masculino (n = 46) de Barcelona (Cataluña) con edades comprendidas entre los 13 y los 15 años (13,7 ± 1,17). Para analizar la capacidad de atención selectiva se utilizó el Test de Percepción de Semejanzas y Diferencias (CARAS-R). Referente a la condición física, se evaluó la velocidad lineal (30 metros lisos), la fuerza de tren inferior (test de salto horizontal), la agilidad (test de10x5 metros) y la resistencia aeróbica (test de Luc-Léger). Finalmente el hábito de realización de actividad física se calculó con el Cuestionario internacional de actividad física en su formato adaptado para adolescentes (IPAQ-A). Los resultados mostraron que los participantes con un mayor rendimiento en el test de Luc-Léger, obtuvieron mejores puntuaciones en el test CARAS-R. Asimismo se obtuvo una correlación alta entre los registros del test de Luc-Léger y el test CARAS-R tanto para el género masculino como el femenino y una correlación alta entre el cuestionario IPAQ-A y el test CARAS-R en el género masculino. Dichos hallazgos, ponen de manifiesto la relación entre la atención selectiva y el nivel de condición física en adolescentes. En este sentido, se refuerza la importancia de practicar actividad física a esta edad, sugiriendo que el incremento de la condición física puede tener implicaciones positiva sobre la atención selectiva.

The aim of this study was to analyze the relationship between fitness, selective attention and the physical activity habit in high school students. The sample was configured by a total of 97 participants, 51 females (n = 51) and 46 males (n = 46) from Barcelona (Catalonia), aged between 13 and 15 years (13,7 ± 1,17). To analyze the selective attention capacity, it was used the Perception of Similarities and Differences Test (CARAS-R). Regarding physical fitness, linear velocity (30-meter dash test), lower body strength (board jump test), agility (10x5 meter test) and aerobic capacity (Luc-Léger test) were evaluated. Finally, the physical activity was calculated with the International Physical Activity Questionnaire adapted for adolescents (IPAQ-A). The results showed that the subjects with higher performance in the Luc-Léger test obtained better scores in the CARAS-R test. A high correlation was also obtained between the records of the Luc-Léger test and the CARAS-R test in both boys and girls and a high correlation between the IPAQ-A questionnaire and the CARAS-R test in boys. These findings highlight the relationship between selective attention and the fitness level in adolescents. In this sense, the importance of practicing physical activity at this age is reinforced, suggesting that the increase of physical condition may have positive implications on selective attention.

O objetivo do presente estudo foi analisar a relação entre habilidades físicas, atenção seletiva e o hábito de praticar atividade física numa amostra de estudantes do ensino médio. A amostra foi composta por um total de 97 sujeitos, especificamente 51 estudantes do sexo feminino (n = 51) e 46 do sexo masculino (n = 46) de Barcelona (Catalunha) com idades entre 13 e 15 anos (13,7 ± 1,17). Para analisar a capacidade de atenção seletiva, foi utilizado o Teste de Percepção de Diferenças e Diferenças (CARAS-R). A condição física foi avaliada através do teste de 30 metros de velocidade suave (velocidade linear), do teste de salto horizontal (força do corpo inferior), do teste de 10x5 metros (agilidade) e do teste de Luc-Léger (resistência). Por fim, o hábito de realizar atividade física foi calculado com o Questionário Internacional de Atividade Física, em formato adaptado para adolescentes (IPAQ-A). Os resultados mostraram que os sujeitos com maior desempenho no teste Luc-Léger obtiveram melhores pontuações no teste CARAS-R. Da mesma forma, foi obtida uma alta correlação entre os registros do teste Luc-Léger e o teste CARAS-R em meninos e meninas e uma alta correlação entre o questionário IPAQ-A e o teste CARAS-R em meninos. Os resultados revelam a relação entre a atenção seletiva e o nível de aptidão física em adolescentes. Nesse sentido, a importância da prática de atividade física nessa faixa etária é reforçada, sugerindo que o aumento da condição física pode ter implicações positivas na atenção seletiva. (AU)

Crystalline lens alterations in congenital aniridia.

Congenital aniridia is a rare genetic disease associated with mutations in the PAX6 gene. Changes in the lens in aniridia can be alterations of size and shape, of position - which generally reveal zonular weakness and determines subluxation of the lens - and mainly changes in transparency, cataracts, with variable morphology of polar, cortical, subcapsular, lamellar, and more rarely, nuclear cataract. Visual acuity and quality of vision in patients with congenital aniridia complicated by cataracts can be improved by carefully planned surgery, when lack of media transparency justifies surgical indication. Most patients have some improvement in visual acuity and quality of retinal image. Cataract surgery with aniridia is complicated by pathological changes due to the underlying cause of the aniridia. Challenges include corneal opacification, friable capsule and, above all, iris and pupil reconstruction. It can also determine late complications, such as secondary glaucoma or deterioration of pre-existent glaucoma, and corneal endothelial decompensation. After crystalline lens surgery in these patients, either by cataract or dislocation, for visual rehabilitation there are various techniques such as keratopigmentation, prosthetic iris devices or Morcher intraocular lenses with a black diaphragm. An appropriate individualised surgical plan should be selected depending on patient and surgical experience, in order to minimise complications and give the best chance of postoperative success.

Macular involvement in congenital aniridia.

This review updates the knowledge about the morphological assessment of the foveal hypoplasia in congenital aniridia and resumes the reported genotype-phenotype correlations known to date. Congenital aniridia is a pan ocular disease. Although iris absence is considered the hallmark of this entity, foveal hypoplasia is present in 94.7%-84% of patients. A foveal morphology assessed by optical coherence tomography in which external retina structures can be identified, with presence of the lengthening of photoreceptors outer segment and a greater external retinal thickness, is associated with a better visual outcome, regardless a foveal pit is identified or not. This analysis can be performed once the external retina has completed its differentiation, by 6 years old. PAX6 mutations that introduce premature termination codon, C terminal extension or PAX6 involving deletions have been related to lesser foveal differentiation. Better foveal differentiation has been associated to non-coding PAX6 mutations.

Macular involvement in congenital aniridia. / Alteraciones maculares en aniridia congénita.

This review updates the knowledge about the morphological assessment of the foveal hypoplasia in Congenital Aniridia and resumes the reported genotype-phenotype correlations known to date. Congenital Aniridia is a pan ocular disease. Although iris absence is considered the hallmark of this entity, foveal hypoplasia is present in 94.7-84% of patients. A foveal morphology assessed by optical coherence tomography in which external retina structures can be identified, with presence of the lengthening of photoreceptors outer segment and a greater external retinal thickness, is associated with a better visual outcome, regardless a foveal pit is identified or not. This analysis can be performed once the external retina has completed its differentiation, by 6 years old. PAX6 mutations that introduce premature termination codon, C terminal extension or PAX6 involving deletions have been related to lesser foveal differentiation. Better foveal differentiation has been associated to non-coding PAX6 mutations.

Crystalline lens alterations in congenital aniridia. / Alteraciones del cristalino en la aniridia congénita.

Congenital aniridia is a rare genetic disease associated with mutations in the PAX6 gene. Changes in the lens in aniridia can be alterations of size and shape, of position - which generally reveal zonular weakness and determines subluxation of the lens - and mainly changes in transparency, cataracts, with variable morphology of polar, cortical, subcapsular, lamellar, and more rarely, nuclear cataract. Visual acuity and quality of vision in patients with congenital aniridia complicated by cataracts can be improved by carefully planned surgery, when lack of media transparency justifies surgical indication. Most patients have some improvement in visual acuity and quality of retinal image. Cataract surgery with aniridia is complicated by pathological changes due to the underlying cause of the aniridia. Challenges include corneal opacification, friable capsule and, above all, iris and pupil reconstruction. It can also determine late complications, such as secondary glaucoma or deterioration of pre-existent glaucoma, and corneal endothelial decompensation. After crystalline lens surgery in these patients, either by cataract or dislocation, for visual rehabilitation there are various techniques such as keratopigmentation, prosthetic iris devices or Morcher intraocular lenses with a black diaphragm. An appropriate individualised surgical plan should be selected depending on patient and surgical experience, in order to minimise complications and give the best chance of postoperative success.