[Treatment with photodynamic therapy of circumscribed choroidal hemangioma]. / Tratamiento mediante terapia fotodinámica del hemangioma coroideo circunscrito.

CASE REPORTS: The clinical characteristics of three patients with circumscribed choroidal haemangioma and subfoveal exudation detected by optical coherence tomography are described in this paper. The three patients were successfully treated with photodynamic therapy. DISCUSSION: Photodynamic therapy is the most adequate therapeutic option for circumscribed choroidal hemangioma associated with subfoveal exudation. Some questions such as whether attempts should be made to obtain a complete tumour regression, laser settings or the way the spots must be applied remain unresolved.

Tratamiento mediante terapia fotodinámica del hemangioma coroideo circunscrito / Treatment with photodynamic therapy of circumscribed choroidal hemangioma

Casos clínicosSe presentan las características clínicas de tres pacientes con hemangioma coroideo circunscrito y exudación subfoveal, detectada mediante tomografía óptica de coherencia, tratados con éxito mediante terapia fotodinámica.DiscusiónLa terapia fotodinámica es actualmente la alternativa terapéutica más efectiva para tratar los hemangiomas coroideos circunscritos asociados a exudación subfoveal. Respecto a la utilización de este tratamiento quedan por definir algunas cuestiones como son si se debe buscar o no la desaparición total de la masa tumoral, los parámetros de láser más adecuados en estos casos o la forma de aplicación de los impactos(AU)

Case reportsThe clinical characteristics of three patients with circumscribed choroidal haemangioma and subfoveal exudation detected by optical coherence tomography are described in this paper. The three patients were successfully treated with photodynamic therapy.DiscussionPhotodynamic therapy is the most adequate therapeutic option for circumscribed choroidal hemangioma associated with subfoveal exudation. Some questions such as whether attempts should be made to obtain a complete tumour regression, laser settings or the way the spots must be applied remain unresolved(AU)

[Outbreak of toxic anterior segment syndrome after vitreous surgery]. / Brote de síndrome tóxico del segmento anterior después de cirugía vítrea.

CASE REPORT: An outbreak of Toxic Anterior Segment Syndrome after vitreoretinal surgery is reported. Two patients underwent exclusively vitrectomy while the other three patients were operated of vitrectomy and some other anterior segment procedure. DISCUSSION: Toxic Anterior Segment Syndrome is a sterile postoperative inflammation due to any non infectious substance that reaches the anterior segment during surgery. It occurs in outbreaks and while most of the cases have been reported after anterior segment procedures, this case demonstrates that development after vitreoretinal surgery is also a possibility.

Brote de síndrome tóxico del segmento anterior después de cirugía vítrea / Outbreak of toxic anterior segment syndrome after vitreous surgery

Caso clínico: Se describe un brote de SíndromeTóxico del Segmento Anterior después de cirugíavítrea. Dos pacientes habían sido intervenidosexclusivamente mediante vitrectomía mientras quelos otros tres fueron sometidos a vitrectomía yalgún otro procedimiento del segmento anterior.Discusión: El Síndrome Tóxico del SegmentoAnterior es una inflamación postoperatoria estérilprovocada por alguna sustancia no infecciosa quealcanza el polo anterior durante la cirugía. Sueleocurrir en brotes y aunque la mayoría de los casoshan sido descritos después de cirugía del segmentoanterior, los casos que presentamos demuestran quees posible su aparición tras cirugía vítrea(AU)

Case report: An outbreak of Toxic Anterior SegmentSyndrome after vitreoretinal surgery is reported.Two patients underwent exclusively vitrectomywhile the other three patients were operated of vitrectomyand some other anterior segment procedure.Discussion: Toxic Anterior Segment Syndrome is asterile postoperative inflammation due to any noninfectious substance that reaches the anterior segmentduring surgery. It occurs in outbreaks and whilemost of the cases have been reported after anteriorsegment procedures, this case demonstrates thatdevelopment after vitreoretinal surgery is also a possibility(AU)

Síndrome tóxico del segmento anterior: investigación de un brote / Toxic anterior segment syndrome (TASS): studying an outbreak

Introducción: En los últimos años se ha descrito una complicación asociada a la cirugía de cataratas, el síndrome tóxico del segmento anterior. Es un proceso inflamatorio que aparece en las primeras horas tras la cirugía, de carácter no infeccioso y que generalmente se resuelve bien con corticoides tópicos si el tratamiento se instaura con prontitud. En el presente trabajo se describe este síndrome y se analizan las posibles causas de un brote que tuvo lugar en nuestro centro y que afectó a 5 pacientes. Métodos: Se creó un grupo de investigación en el centro que revisó todos los procedimientos implicados, puesto que las causas del síndrome pueden ser múltiples. Se analizaron desde los métodos de lavado y esterilización de material hasta los medicamentos y sustancias utilizadas que pudieron ser causa del brote. Entre estos últimos, se revisaron las sustancias elaboradas en el servicio de farmacia, en especial la solución salina irrigadora, utilizada en todos los casos. Resultados: Los resultados bioquímicos, microbiológicos, de pH, osmolaridad y de endotoxinas indicaron que las soluciones elaboradas en el servicio de farmacia eran correctas. Discusión: Dado que los resultados de los análisis de las sustancias empleadas eran correctos, corroborados con su reintroducción sin efecto adverso alguno, se llegó a la conclusión de que el brote más bien estaría relacionado con el proceso de lavado previo a la esterilización del instrumental utilizado en la cirugía, ya que no se estaban siguiendo las recomendaciones de uso de agua destilada y estéril para este fin, sino que, por el contrario, se estaba utilizando agua corriente de la red (AU)

Introduction: An effect associated with cataract surgery known as Toxic Anterior Segment Syndrome (TASS) has been reported in recent years. It is an inflammatory non-infectious process which appears within the first few hours after surgery and generally resolves well with topical steroids if the course of treatment is started promptly. In this paper we describe the syndrome and analyze the possible causes for the TASS outbreak that occurred in our hospital and affected 5 patients. Methods: As the syndrome may be due to multiple causes, the members of a research team created at the hospital reviewed all the procedures involved. The washing and sterilization methods applied to the materials were analyzed, as well as the drugs and substances used which might have caused the outbreak. We verified the substances prepared by the Pharmacy Department, specially the irrigating solution which was used in all the cases. Results: According to the results obtained in the biochemical, micro-biological, pH, osmolarity and endotoxins assays, the solutions prepared by the Pharmacy Department were all correct. Discussion: Since the results obtained in the analyses of the substances used were correct and no adverse effect was observed after the re-administration of the substances, we may conclude that the outbreak would be related to the washing process performed previously to the sterilization of the instrumentation used in the surgery, mainly because the recommendation to use distilled and sterile water for this purpose was not followed and, on the contrary, tap water continued to be used (AU)

[Toxic Anterior Segment Syndrome (TASS): studying an outbreak]. / Síndrome tóxico del segmento anterior: investigación de un brote.

INTRODUCTION: An effect associated with cataract surgery known as Toxic Anterior Segment Syndrome (TASS) has been reported in recent years. It is an inflammatory non-infectious process which appears within the first few hours after surgery and generally resolves well with topical steroids if the course of treatment is started promptly. In this paper we describe the syndrome and analyze the possible causes for the TASS outbreak that occurred in our hospital and affected 5 patients. METHODS: As the syndrome may be due to multiple causes, the members of a research team created at the hospital reviewed all the procedures involved. The washing and sterilization methods applied to the materials were analyzed, as well as the drugs and substances used which might have caused the outbreak. We verified the substances prepared by the Pharmacy Department, specially the irrigating solution which was used in all the cases. RESULTS: According to the results obtained in the biochemical, micro-biological, pH, osmolarity and endotoxins assays, the solutions prepared by the Pharmacy Department were all correct. DISCUSSION: Since the results obtained in the analyses of the substances used were correct and no adverse effect was observed after the re-administration of the substances, we may conclude that the outbreak would be related to the washing process performed previously to the sterilization of the instrumentation used in the surgery, mainly because the recommendation to use distilled and sterile water for this purpose was not followed and, on the contrary, tap water continued to be used.

[Diabetic macular edema]. / Edema macular diabético.

Diabetic macular edema is the principal cause of visual loss in patients with diabetes mellitus. Its complexity, together with the appearance of new methods of diagnosis and new alternatives for treatment, mean that the approach to this disease is an important challenge for ophthalmologists. This article describes its pathophysiology, clinical manifestations, classification, diagnosis and treatment, with special emphasis on the new diagnostic methods and on the different therapeutic options.

Edema macular diabético / Diabetic macular edema

El edema macular diabético representa la primeracausa de pérdida visual en los pacientes con diabetesmellitus. Su complejidad, unida a la aparición de nuevosmétodos de diagnóstico así como de novedosasalternativas de tratamiento, hace que el enfoque deesta enfermedad suponga un importante reto para eloftalmólogo. A lo largo de este artículo se describen supatofisiología, manifestaciones clínicas, clasificación,diagnóstico y tratamiento, haciendo especial énfasis enlos nuevos métodos diagnósticos y en las diferentesopciones terapéuticas

Diabetic macular edema is the principal cause ofvisual loss in patients with diabetes mellitus. Itscomplexity, together with the appearance of newmethods of diagnosis and new alternatives fortreatment, mean that the approach to this disease isan important challenge for ophthalmologists. Thisarticle describes its pathophysiology, clinicalmanifestations, classification, diagnosis andtreatment, with special emphasis on the newdiagnostic methods and on the different therapeuticoptions