Tratamiento de la epífora funcional con toxina botulínica tipo A frente a la tira tarsal en un ensayo aleatorizado / Treatment for functional epiphora with botulinum toxin-A versus lateral tarsal strip in a randomized trial

Objetivo Comparar la eficacia de la inyección de toxina botulínica A (TBA) en la glándula lagrimal con la tira tarsal lateral (TTL) en la epífora funcional. Material y método Ensayo clínico aleatorizado. Diseño secuencial, paralelo y no ciego. Pacientes de 18 años o más con epífora funcional con un mínimo de 3 en la escala de Munk (EM) se incluyeron a grupo de TBA o TTL. Los cambios en la EM, el test de Schirmer y la calidad de vida se evaluaron a la semana 6 y hasta la semana 30. Se obtuvo el tiempo medio sin epífora y los acontecimientos adversos. Resultados El análisis final incluyó 25 pacientes, 12 (21 ojos) se asignaron a TBA (5U/0,05mL) y 13 (20 ojos) a TTL. A la semana 6 hubo un mayor descenso en la EM en el grupo de TBA frente a TTL (−2.48 vs. −1.55, p=0,0152) y a la semana 12 (−2,68 vs. −1,69, p=0,0267). Se observó un descenso significativo en el test de Shirmer a las semanas 2, 12 y 30 con TBA. La calidad de vida mejoró después de ambas intervenciones, sin diferencias significativas. El tiempo medio sin epífora en el grupo TBA fue de 26,2 semanas (7,7-36,6) y en el grupo TTL de 24,8 semanas (6,7-37,6), p=0,9368. Se observó ptosis temporal en un 25% (3/12) en el grupo TBA y un 23% (3/13) de molestias de la cicatriz quirúrgica en el grupo TTL, p=0,722. Ningún acontecimiento adverso fue severo. Conclusión La inyección de TBA en la glándula lagrimal es efectiva y segura en el tratamiento de la epífora funcional, con mayor descenso en la EM a las 6 y 12 semanas comparado con la TTL (AU)

Objective To compare the efficacy of botulinum toxin A (BoNTA) injection into the lacrimal gland versus lateral tarsal strip (LTS) for functional epiphora Material and methods Randomized clinical trial. Sequential, parallel, non-blinded study design. Patients aged 18 years or older with functional epiphora and a minimum score of 3 in Munk Scale (MS) were randomized to BoNTA or LTS group. Changes in MS, Schirmer test and quality of life were assessed at week 6 and during follow-up until week 30. The mean time without epiphora and the adverse events were recorded. Results The final analysis included 25 patients, 12 (21 eyes) assigned to BoNTA (5U/0.05mL) and 13 (20 eyes) to LTS. At 6 weeks there was an improvement in the MS in BoNTA versus LTS group (−2.48 vs. −1.55, P=.0152) and at 12 weeks (−2.68 vs. −1.69, P=.0267). A significant decrease was noted in the Schirmer test at week 2, 12 and 30 with BoNTA. The quality of life improved after both interventions without statistical significance. The mean duration of effectiveness in BoNTA group was 26.2 weeks (range 7.7-36.6) and in LTS group was 24.8 weeks (range 6.7-37.6), P=.9368. The main adverse events were temporary eyelid ptosis in 25% (3/12) of the BoNTA group and surgical scar discomfort in 23% (3/13) of the LTS group, P=.722. No adverse events were classified as severe. Conclusion BoNTA injection into the lacrimal gland is a safe and effective treatment for functional epiphora, with a greater decrease in MS at 6 and 12 weeks compared with LTS (AU)

Treatment for functional epiphora with botulinum toxin-A versus lateral tarsal strip in a randomized trial.

INTRODUCTION: To compare the efficacy of botulinum toxin A (BoNTA) injection into the lacrimal gland versus lateral tarsal strip (LTS) for functional epiphora. METHODS: Randomized clinical trial. Sequential, parallel, non-blinded study design. Patients aged 18 years or older with functional epiphora and a minimum score of 3 in Munk Scale (MS) were randomized to BoNTA or LTS group. Changes in Munk scale, Schirmer test (ST) and quality of life (QoL) were assessed at week 6 and during follow-up until week 30. The mean time without epiphora and the adverse events (AE) were recorded. RESULTS: The final analysis included 25 patients, 12 (21 eyes) assigned to BoNTA (5U/0.05 mL) and 13 (20 eyes) to LTS. At 6 weeks there was an improvement in the MS in BoNTA versus LTS group (-2.48 vs -1.55, P = .0152) and at 12 weeks (-2.68 vs -1.69, P = .0267). A significant decrease was noted in the ST at week 2, 12 and 30 with BoNTA. The QoL improved after both interventions without statistical significance. The mean duration of effectiveness in BoNTA group was 26.2 weeks (range 7.7-36.6) and in LTS group was 24.8 weeks (range 6.7-37.6), P = .937. The main AE were temporary eyelid ptosis in 25% (3/12) of the BoNTA group and surgical scar discomfort in 23% (3/13) of the LTS groups, P = .722. No AE were classified as severe. CONCLUSION: BoNTA injection into the lacrimal gland is a safe and effective treatment for functional epiphora, with a greater decrease in MS at 6 and 12 weeks compared with LTS.

Membrana amniótica en el tratamiento quirúrgico de diplopía posblefaroplastia / Amniotic membrane in the surgical treatment of post-blepharoplasty diplopia

Presentamos 2 casos consecutivos de diplopía vertical tras cirugía de blefaroplastia. Se trata de 2 mujeres de 41 y 63 años que presentaron diplopía binocular vertical tras blefaroplastia inferior bilateral con abordaje transconjuntival. La diplopía se presentó en ambos casos en el postoperatorio inmediato, siendo en uno de los casos estable y en otro progresiva. Con la sospecha de estrabismo restrictivo se planteó explorar los músculos extraoculares afectados, eliminar las adherencias y recubrimiento de los vientres musculares con membrana amniótica. La diplopía posblefaroplastia es una complicación infrecuente, pero muy grave, dadas las expectativas de estos pacientes. La literatura describe, hasta la fecha, resultados poco satisfactorios en su manejo. Consideramos que el recubrimiento muscular con membrana amniótica puede aportar mejores resultados en el manejo quirúrgico de estos pacientes, debido a su efecto antiinflamatorio y antiadherencial

Two consecutive cases are presented of vertical diplopia after blepharoplasty. They concern two women aged 41 and 63 years with vertical binocular diplopia after bilateral lower blepharoplasty using a trans-conjunctival approach. The diplopia was presented in both cases in the immediate postoperative period, being stable in one of the cases and progressive in the other. With the suspicion of restrictive strabismus, it was decided to explore the affected extra-ocular muscles, eliminate adhesions and coat the muscular bellies with amniotic membrane. Post-blepharoplasty diplopia is an uncommon, but very serious complication, given the expectations of these patients. The current literature reports unsatisfactory results in its management. In this study, it is considered that the muscular covering with amniotic membrane can provide better results in the surgical management of these patients, due to its anti-inflammatory and anti-adherence effect

Amniotic membrane in the surgical treatment of post-blepharoplasty diplopia. / Membrana amniótica en el tratamiento quirúrgico de diplopía posblefaroplastia.

Two consecutive cases are presented of vertical diplopia after blepharoplasty. They concern two women aged 41 and 63 years with vertical binocular diplopia after bilateral lower blepharoplasty using a trans-conjunctival approach. The diplopia was presented in both cases in the immediate postoperative period, being stable in one of the cases and progressive in the other. With the suspicion of restrictive strabismus, it was decided to explore the affected extra-ocular muscles, eliminate adhesions and coat the muscular bellies with amniotic membrane. Post-blepharoplasty diplopia is an uncommon, but very serious complication, given the expectations of these patients. The current literature reports unsatisfactory results in its management. In this study, it is considered that the muscular covering with amniotic membrane can provide better results in the surgical management of these patients, due to its anti-inflammatory and anti-adherence effect.

Estrés oxidativo y orbitopatía de Graves / Oxidative stress and Graves’ orbitopathy

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[Idiopathic loss of lateral tarsal suspension]. / Desinserción tarsal lateral bilateral idiopática.

CASE: A 53-year-old man who showed a loss of tarsal suspension in the lateral third of both lower eyelids underwent lateral canthoplasty with a good post-operative result. DISCUSSION: Disinsertion of the union of the inferior tarsus with the lateral canthus, of unknown cause, is a very uncommon finding that has almost never been reported in the world literature. There are two cases described of eyelid elastolysis with loss of lateral tarsal suspension, as in our case, but both showed eyelid skin atrophy and had histopathologic confirmation. Our case did not have skin atrophy.

Desinserción tarsal lateral bilateral idiopática / Idiopathic loss of lateral tarsal suspension

Caso clínico: Varón de 53 años, que presentaba ausencia de tarso en tercio externo del párpado inferior de ambos ojos. Se realizó cantoplastia lateral, con buen resultado postoperatorio. Discusión: La dehiscencia de la unión del tarso inferior con el canto lateral sin causa conocida es un hallazgo muy infrecuente y que apenas tiene reflejo en la literatura. Están descritos dos casos de elastólisis de los párpados que asociaban ausencia de la suspensión tarsal lateral, pero ambos presentaban atrofia de la piel palpebral con alteración del componente elástico de la piel, confirmada histológicamente, mientras que en este caso la piel era normal

Case: A 53-year-old man who showed a loss of tarsal suspension in the lateral third of both lower eyelids underwent lateral canthoplasty with a good post-operative result. Discussion: Disinsertion of the union of the inferior tarsus with the lateral canthus, of unknown cause, is a very uncommon finding that has almost never been reported in the world literature. There are two cases described of eyelid elastolysis with loss of lateral tarsal suspension, as in our case, but both showed eyelid skin atrophy and had histopathologic confirmation. Our case did not have skin atrophy

[Amaurosis secondary to frontal traumatism]. / Amaurosis secundaria a traumatismo frontal.

CASE REPORT: We present the case of a patient diagnosed with amaurosis of the right eye secondary to a right frontal contusion. The energy of the impact was projected from the orbital ceiling to the minor wing of the sphenoid bone. This bone was fractured, thus reducing the optic canal diameter and damaging the optic nerve. DISCUSSION: In our case, we describe a mixed mechanism of injury, that is to say, a frontal contusion indirectly transmitted to the optic canal and a direct lesion of the optic nerve secondary to the movement of the minor wing of the sphenoid bone into the optic canal.

Amaurosis secundaria a traumatismo frontal / Amaurosis secondary to frontal traumatism

Se describe el caso de un pacienteque sufre amaurosis del ojo derecho secundaria atraumatismo contuso frontal derecho. La energía seproyectó por el techo de la órbita hacia el ala menordel esfenoides, cuya fractura redujo el diámetro delcanal óptico lesionando el nervio óptico.Discusión: El mecanismo de producción en el casoclínico que se presenta es mixto al tratarse de untraumatismo frontal cerrado que se ha transmitidoindirectamente hacia el canal óptico y una lesióndirecta del nervio óptico al desplazarse el ala menordel esfenoides en el interior del canal óptico

Case report: We present the case of a patient diagnosed ;;with amaurosis of the right eye secondary to ;;a right frontal contusion. The energy of the impact ;;was projected from the orbital ceiling to the minor ;;wing of the sphenoid bone. This bone was fractured, ;;thus reducing the optic canal diameter and ;;damaging the optic nerve. ;;Discussion: In our case, we describe a mixed ;;mechanism of injury, that is to say, a frontal contusion ;;indirectly transmitted to the optic canal and a ;;direct lesion of the optic nerve secondary to the ;;movement of the minor wing of the sphenoid bone ;;into the optic canal