Toxicidad por interferón alfa y neuropatía óptica bilateral reversible: una retirada a tiempo / Interferon-alpha toxicity and reversible bilateral optical neuropathy: A timely withdrawal of the drug

CASO CLÍNICO: Paciente que acude por pérdida crónica de visión bilateral indolora en el que destaca el uso de Interferón alfa (IFNα) y ribavirina para un trasplante hepático. Con un fondo de ojo normal, la sospecha de neuropatía óptica retrobulbar viene confirmada por la prolongación de la latencia de los potenciales evocados visuales. Sin antecedentes de riesgo y con un estudio sistémico normal, la mejoría clínica y de las pruebas electrofisiológicas tras retirar el fármaco señalan al IFNα como causa de la afectación del nervio óptico bilateral. DISCUSIÓN: El IFNα es un tratamiento usado en enfermedades virales y neoplásicas. Actualmente es formulado como Interferón alfa pegilado (IFNα-p) para reducir toxicidad y mejorar su tolerancia. Sus efectos secundarios más comunes son síndrome gripal, astenia y pérdida de peso. La afectación ocular es rara y la neuropatía óptica es una complicación infrecuente siendo más frecuente la retinopatía en el inicio del tratamiento. La hipótesis más aceptada como causa de la toxicidad es la existencia de complejos inmunes circulantes. Así pues es de vital importancia para el oftalmólogo conocer la toxicidad de este fármaco para saber retirar a tiempo el mismo, evitando una posible pérdida visual irreversible

CLINICAL CASE: A patient with chronic, painless, bilateral loss of vision, after significant intake of interferon (IFNα) and ribavirina due to liver transplant. Ocular fundus is normal. A suspected retrobulbar optic neuropathy is confirmed by a prolongation of the latency of the patient's visual evoked potential. There being no prior record of risk factors and with the patient's systemic analysis giving normal results, the clinical improvement and the electro-physiological tests conducted after the drug was withdrawn point to interferon as negatively affecting the bilateral optic nerve. Discussion: Interferon-α is used in the treatment of viral and neoplastic illnesses. Currently the drug is formulated as Interferon alfa pegilado (IFNα-p) in order to reduce toxicity and increase tolerance. The most common secondary effects are flu symptoms, asthenia and weigh loss. Affected ocular tissue is rare and optic neuropathy is also an infrequent complication: retinopathy at the beginning of treatment is, however, more frequent. The most widely accepted hypothesis as to the cause of toxicity is the presence of circulating immune complexes. It is, therefore, essential for ophthalmologists to be aware of the toxicity of this drug in order to be able to withdraw it in good time, thus preventing potentially irreversible sight loss

[Interferon-alpha toxicity and reversible bilateral optical neuropathy: a timely withdrawal of the drug]. / Toxicidad por interferón alfa y neuropatía óptica bilateral reversible: una retirada a tiempo.

Clinical case A patient with chronic, painless, bilateral loss of vision, after significant intake of interferon (IFNα) and ribavirina due to liver transplant. Ocular fundus is normal. A suspected retrobulbar optic neuropathy is confirmed by a prolongation of the latency of the patient's visual evoked potential. There being no prior record of risk factors and with the patient's systemic analysis giving normal results, the clinical improvement and the electro-physiological tests conducted after the drug was withdrawn point to interferon as negatively affecting the bilateral optic nerve. Discussion Interferon-α is used in the treatment of viral and neoplastic illnesses. Currently the drug is formulated as Interferon alfa pegilado (IFNα-p) in order to reduce toxicity and increase tolerance. The most common secondary effects are flu symptoms, asthenia and weigh loss. Affected ocular tissue is rare and optic neuropathy is also an infrequent complication: retinopathy at the beginning of treatment is, however, more frequent. The most widely accepted hypothesis as to the cause of toxicity is the presence of circulating immune complexes. It is, therefore, essential for ophthalmologists to be aware of the toxicity of this drug in order to be able to withdraw it in good time, thus preventing potentially irreversible sight loss.

[Corrective techniques of lacrimal obstruction in the vertical system]. / Técnicas correctoras de la obstrucción del sistema lagrimal en el sistema vertical.

PURPOSE: To describe current surgical techniques of dacryocystorhinostomy (DCR) and to compare their effectiveness by analysing the advantages and disadvantages between external, endonasal and transcanalicular surgery. PATIENTS AND METHODS: A total of 91 DCRs were analysed using a retrospective, cross-sectional and multicentre study in 75 patients who had symptoms of nasolacrimal duct obstruction. Of these, 28 were operated using external DCR, 31 endonasal technic, and 32 transcanalicular DCR with diode laser. Outcomes were evaluated subjectively using patient symptoms for the grade of epiphora and the results from the syringing before and after surgery. RESULTS: External DCR was performed in 28 cases, with 19 cases asymptomatic (67.85%), and 20 patients had a patent tract (71.42%). Endonasal DCR was performed in 31 cases, of which 19 cases were asymptomatic (61.29%), and 21 showed patency of the nasolacrimal duct (67.74%). A transcanalicular technique was performed in 32 cases, with absence of epiphora in 24 patients (75%), and the syringing was successful in 24 of them (75%). CONCLUSIONS: Any of these 3 surgery techniques would be an adequate treatment for lacrimal obstruction, due to the significant development of endonasal and transcanalicular techniques in recent decades. With improvement, we could use either endonasal or transcanalicular techniques with diode laser with the same lever of effectiveness as the classic external approach, with the advantages of minimally invasive surgery.

Técnicas correctoras de la obstrucción del sistema lagrimal en el sistema vertical / Corrective techniques of lacrimal obstruction in the vertical system

Objetivo: Describir las técnicas quirúrgicas actuales de dacriocistorrinostomía, y comparar la efectividad de cada una de ellas analizando las ventajas y desventajas de la cirugía externa, la cirugía por vía endonasal y por vía transcanalicular. Pacientes y métodos. Se realizó un estudio retrospectivo, transversal y multicéntrico en el que se practicaron un total de 91 DCR en 75 pacientes con clínica de obstrucción lagrimal, de las cuales 28 fueron realizadas con la técnica externa, 31 con la técnica endonasal, y 32 con la técnica transcanalicular con láser diodo. En todos los pacientes se valoró el grado de epifora subjetiva y la permeabilidad de la vía lagrimal mediante la siringación previa y posterior a la cirugía. Resultados: De las 28 DCR realizadas con la técnica externa, permanecieron asintomáticos 19 casos (67,85%), y la vía era permeable al alta en 20 (71,42%). Con la técnica endonasal de las 31 DCR practicadas fueron 19 los casos que permanecieron asintomáticos (61,29%) y 21 tenían la vía permeable al alta (67,74%). Y en la técnica transcanalicular el número de pacientes con ausencia de epifora al alta fue de 24 de las 32 intervenciones realizadas (75%), y la siringación fue permeable en 24 de ellos (75%). Conclusiones: Cualquiera de las tres técnicas quirúrgicas puede emplearse como un adecuado tratamiento para la obstrucción de la vía lagrimal, teniendo la técnica endonasal y la transcanalicular un importante desarrollo en las últimas décadas. Con su desarrollo y perfeccionamiento, se podrían igualar los resultados de la cirugía mínimamente invasiva frente a la técnica clásica, con las ventajas que esto supondría(AU)

Purpose: To describe current surgical techniques of dacryocystorhinostomy (DCR) and to compare their effectiveness by analysing the advantages and disadvantages between external, endonasal and transcanalicular surgery. Patients and methods: A total of 91 DCRs were analysed using a retrospective, cross-sectional and multicentre study in 75 patients who had symptoms of nasolacrimal duct obstruction. Of these, 28 were operated using external DCR, 31 endonasal technic, and 32 transcanalicular DCR with diode laser. Outcomes were evaluated subjectively using patient symptoms for the grade of epiphora and the results from the syringing before and after surgery. Results: External DCR was performed in 28 cases, with 19 cases asymptomatic (67.85%), and 20 patients had a patent tract (71.42%). Endonasal DCR was performed in 31 cases, of which 19 cases were asymptomatic (61.29%), and 21 showed patency of the nasolacrimal duct (67.74%). A transcanalicular technique was performed in 32 cases, with absence of epiphora in 24 patients (75%), and the syringing was successful in 24 of them (75%). Conclusions: Any of these 3 surgery techniques would be an adequate treatment for lacrimal obstruction, due to the significant development of endonasal and transcanalicular techniques in recent decades. With improvement, we could use either endonasal or transcanalicular techniques with diode laser with the same lever of effectiveness as the classic external approach, with the advantages of minimally invasive surgery(AU)

[Iridoschisis associated to congenital syphilis: serological confirmation at the 80's]. / Iridosquisis asociada a sífilis congénita: confirmación serológica a los 80.

CLINICAL CASE: Female in her eighties is admitted suffering from unilateral ocular pain. On examination we observed, as well as corneal abrasion, a bilateral iridoschisis with a frayed iris, unfolded between its stromal layers. DISCUSSION: This rare case is related either to senile degenerative change or to angle-closure glaucoma. However, it is also associated with congenital syphilis with or without the presence of interstitial keratitis. Infant conjunctivitis and a "salt and pepper" appearance of the fundus oculi complete the diagnosis. It is confirmed that the patient had suffered from congenital late syphilis, cured by the age of 80: this confirmation is reached by treponemal (RPR-) and non-treponemal (TPHA+) serological tests.

Iridosquisis asociada a sífilis congénita: confirmación serológica a los 80 / Iridoschisis associated to congenital syphilis: serological confirmation at the 80's

Caso clínico: Mujer octogenaria que acude pordolor ocular unilateral. En la exploración observamos,además de una abrasión corneal, una iridosquisisbilateral con un iris desflecado, desdobladoentre sus capas estromales.Discusión: Esta rara entidad está relacionada conlos cambios degenerativos seniles o al glaucoma deángulo cerrado. Sin embargo, también es asociado ala sífilis congénita con o sin la coexistencia de queratitisintersticial. Las conjuntivitis en la infancia yel fondo de ojo en «sal y pimienta» complementanel diagnóstico de sospecha. Confirmándose, a los80 años una sífilis congénita tardía curada, por lostest serológicos treponémicos (RPR-) y no treponémicos(TPHA+)(AU)

Clinical case: Female in her eighties is admittedsuffering from unilateral ocular pain. On examinationwe observed, as well as corneal abrasion, abilateral iridoschisis with a frayed iris, unfoldedbetween its stromal layers.Discussion: This rare case is related either to seniledegenerative change or to angle-closure glaucoma.However, it is also associated with congenital syphiliswith or without the presence of interstitial keratitis.Infant conjunctivitis and a «salt and pepper» appearanceof the fundus oculi complete the diagnosis.It is confirmed that the patient had suffered fromcongenital late syphilis, cured by the age of 80: thisconfirmation is reached by treponemal (RPR-) andnon-treponemal (TPHA+) serological tests(AU)

[Pterygium surgery: comparative study of conjunctival autograft with suture versus fibrin adhesive]. / Cirugía del pterigión: estudio comparativo entre autoinjerto conjuntival con sutura y con adhesivo tisular.

PURPOSE: To compare recurrence rate, complications, and biomicroscopical findings after conjunctival autograft pterygium surgery with the use of a fibrin glue (Tissucol Duo, Baxter AG, Vienna, Austria) or suture (7-0 silk). METHODS: Patients with nasal pterygium were included in two groups of conjunctival autograft surgery. In 9 of them the graft was sutured to the surrounding conjunctiva and in 8 of them the graft was fixed to the conjunctiva using fibrin glue. RESULTS: 17 patients (17 eyes) 41.2% women and 58.8% men were surgically treated. Mean patient age was 59.8 years. Five of the patients presented recurrence for simple excision and 12 presented primary pterygium. The extent of corneal invasion was 2 to 4 mm. In the suture group, 33.3% of the patients experienced pain after surgery compared to none in the fibrin glue group. In the suture group, 44.4% of the patients presented inflammation after surgery compared to none in the glue group. One patient from the glue group lost the graft and presented a recurrence one month later. CONCLUSIONS: The use of fibrin glue in pterygium surgery reduces patient symptoms, inflammation and discomfort. The rate of recurrence seems to be similar in both procedures.

Cirugía del pterigión: estudio comparativo entre autoinjerto conjuntival con sutura y con adhesivo tisular / Pterygium sugery: comparative study of conjuctival autograft with suture versus fibrin adhesive

Objetivo: Comparar la tasa de recurrencias, complicacionesy hallazgos biomicroscópicos despuésde cirugía de pterigión con autoinjerto conjuntivalusando adhesivo tisular (Tissucol Duo®, BaxterAG, Viena, Austria) o sutura (seda 7-0).Material y métodos: Se han incluido en el estudiopacientes con pterigión nasal en dos grupos de cirugíade autoinjerto conjuntival: en 9 de ellos el injertose sutura a conjuntiva y en 8 de ellos se fija conadhesivo tisular.Resultados: Se intervinieron 17 ojos de 17 pacientes,41,2% mujeres y 58,8% hombres con edadmedia de 59,8 años. 5 ojos presentaban recurrenciade resección simple y 12 de ellos presentaban pterigiónprimario. El tamaño de la invasión cornealosciló entre 2 y 4 mm. 33,3% de los pacientes delgrupo de sutura presentaron molestias después de lacirugía frente a ninguno en el grupo de adhesivo.44,4% de los pacientes presentaron inflamación trasla cirugía frente a ninguno en el grupo de sutura. Enuno de los pacientes del grupo del adhesivo se produjo una pérdida del injerto causando una posteriorrecidiva del pterigión.Conclusiones: El uso de adhesivo tisular reduce lossíntomas postquirúrgicos así como la inflamación yel disconfort. La tasa de recurrencias parece sersimilar con los dos procedimientos(AU)

Purpose: To compare recurrence rate, complications,and biomicroscopical findings after conjunctivalautograft pterygium surgery with the use of afibrin glue (Tissucol Duo®, Baxter AG, Vienna,Austria) or suture (7-0 silk).Methods: Patients with nasal pterygium wereincluded in two groups of conjunctival autograftsurgery. In 9 of them the graft was sutured to thesurrounding conjunctiva and in 8 of them the graftwas fixed to the conjunctiva using fibrin glue.Results: 17 patients (17 eyes) 41.2% women and58.8% men were surgically treated. Mean patient agewas 59.8 years. Five of the patients presented recurrencefor simple excision and 12 presented primary pterygium.The extent of corneal invasion was 2 to 4 mm. Inthe suture group, 33.3% of the patients experiencedpain after surgery compared to none in the fibrin gluegroup. In the suture group, 44.4% of the patients presentedinflammation after surgery compared to none inthe glue group. One patient from the glue group lost thegraft and presented a recurrence one month later. Conclusions: The use of fibrin glue in pterygiumsurgery reduces patient symptoms, inflammationand discomfort. The rate of recurrence seems to besimilar in both procedures(AU)

[Congenital retinal macrovessels: a discovery by chance]. / Macrovasos congénitos retinianos: un hallazgo casual.

CLINICAL CASE: Congenital retinal macrovessels, where an aberrant retinal vessel, usually a venule, is present in the posterior pole and may cross the avascular foveal region, are seen rarely. DISCUSSION: Most of these cases are unilateral and stable with excellent visual prognosis and are detected on routine examination. Foveal cysts, hemorrhages and displaced foveola may also be seen. These entities must be distinguished from racemose angiomas, capillary hemangiomas of the retina and even when associated with neurological symptoms, should be considered as part of the Wyburn-Masson syndrome.

Macrovasos congénitos retinianos: un hallazgo casual / Congenital retinal macrovessels: a discovery by chance

Caso clínico: Los macrovasos congénitos retinianos son raros, son ramas aberrantes, vénulas en su mayoría, localizadas en el polo posterior que de forma típica cruzan la zona avascular foveal. Discusión: En la mayoría de los casos son lesiones unilaterales y estables, sin repercusión visual por lo que su diagnóstico es casual. En ocasiones se asocian a localizaciones atípicas de la fóvea, quistes foveales e incluso hemorragias. Por lo general debe realizarse un diagnóstico diferencial con otras entidades vasculares retinianas como el hemangioma capilar, angioma racemoso e incluso si se acompaña de síntomas neurológicos descartar el síndrome de Wyburn-Masson

Clinical case: Congenital retinal macrovessels, where an aberrant retinal vessel, usually a venule, is present in the posterior pole and may cross the avascular foveal region, are seen rarely. Discussion: Most of these cases are unilateral and stable with excellent visual prognosis and are detected on routine examination. Foveal cysts, hemorrhages and displaced foveola may also be seen. These entities must be distinguished from racemose angiomas, capillary hemangiomas of the retina and even when associated with neurological symptoms, should be considered as part of the Wyburn-Masson syndrome (Arch Soc Esp Oftalmol 2008; 83: 273-276)

[Double intubation technique for the treatment of epiphora in complicated cases]. / Técnica de doble intubación para el tratamiento de la epífora en casos complicados.

PURPOSE: The aim of this study is to present a surgical technique used to treat epiphora secondary to difficult cases of lacrimal pathway obstruction after fractures, previous surgery or anatomic abnormalities. METHODS: From January 2001 to December 2002 we treated 27 patients with complicated lacrimal pathway obstruction secondary to fractures (10 cases), previous nasal surgery (4 cases), failure of a previous ipsilateral dacryocystorhinostomy (DCR; 6 cases), or failure of a previous contralateral DCR (7 cases). A DCR through an external approach was performed by placing a double concentric intubation in the lacrimal sac and nasal fossa, with the additional introduction of an interpositional silicone structure within a third hollow tube anchored to the sac entrance. RESULTS: The results were evaluated according to the absence of tearing, the emptiness of the lacrimal meniscus, and the permeability of the lacrimal system after forced liquid infusion. Globally, the technique was effective in 85 percent of cases. The results were satisfactory in 90% of cases of postraumatic epiphora, in 75% of patients with previous surgery, in 83% of patients with previous ipsilateral DCR, and in 71% of patients with failed DCR in the contralateral eye. CONCLUSIONS: The double intubation technique is a good option in lower lacrimal system obstructions when conventional techniques have a high index of failure.

Técnica de doble intubación para el tratamiento de la epífora en casos complicados / Double intubation technique for the treatment of epiphora in complicated cases

Objetivo: Presentar un sistema para corregir quirúrgicamentela epífora ante obstrucciones del sistemalagrimal que se presentan de difícil resoluciónpor alteraciones en fosa nasal, traumatismos o cirugíaprevia.Métodos: Se realiza una dacriocistorrinostomía(DCR) por vía externa, colocando una doble intubaciónconcéntrica a nivel de saco lagrimal y fosanasal introduciendo un elemento de interposiciónmacizo de silicona en otro cilindro hueco, ancladoen la abertura del saco. Se practicó la técnica en 27casos durante los años 2001 y 2002, en pacientesafectados por traumatismos faciales con fracturaósea que compromete el sistema lagrimal (diezcasos), con cirugía nasal previa (cuatro casos), conDCR fallida previa en el mismo lado (seis casos), ycon DCR previa fallida en ojo contralateral (sietecasos).Resultados: Son valorados según la ausencia delagrimeo, el vaciamiento del menisco lagrimal, y lapermeabilidad objetivable del sistema lagrimalmediante paso forzado de líquido. Los resultadosglobales indican una tasa de eficacia de la técnica de un 85%. El análisis por grupos refleja una eficaciadel 90% en pacientes con traumatismo facialprevio, del 75% en pacientes sometidos a cirugíanasal previa, del 83% en operados de DCR previaen el mismo ojo, y del 71% en operados de DCRcon mal resultado en el ojo contralateral.Conclusiones: El método presentado nos pareceuna buena solución en los casos de obstruccionesbajas del sistema lagrimal de pacientes con patologíaprevia, en los que sospechamos un fracaso alenfrentarnos a la cirugía convencional de repermeabilización

Purpose: The aim of this study is to present a surgical technique used to treat epiphora secondary to difficult cases of lacrimal pathway obstruction after fractures, previous surgery or anatomic abnormalities. Methods: From January 2001 to December 2002 we treated 27 patients with complicated lacrimal pathway obstruction secondary to fractures (10 cases), previous nasal surgery (4 cases), failure of a previous ipsilateral dacryocystorhinostomy (DCR ;6 cases), or failure of a previous contralateral DCR (7 cases). A DCR through an external approach was performed by placing a double concentric intubation in the lacrimal sac and nasal fossa, with the additional introduction of an interpositional silicone structure within a third hollow tube anchored to the sac entrance. Results: The results were evaluated according to the absence of tearing, the emptiness of the lacrimal meniscus, and the permeability of the lacrimal system after forced liquid infusion. Globally, the technique was effective in 85 percent of cases. The results were satisfactory in 90% of cases of pos-traumatic epiphora, in 75% of patients with previous surgery, in 83% of patients with previous ipsilateral DCR, and in 71% of patients with failed DCR in the contralateral eye. Conclusions: The double intubation technique is a good option in lower lacrimal system obstructions when conventional techniques have a high index of failure

[Treatment of palpebral ptosis with frontal suspension: a comparative study of different materials]. / Estudio comparativo de diferentes materiales empleados en la suspensión al frontal en casos de ptosis palpebral.

PURPOSE: The aim of this study was to compare the results of three materials used for frontal muscle suspension in the treatment of palpebral ptosis. METHODS: Sixty-six eyes in 46 patients with palpebral ptosis were operated with a modified Fox technique. The suspension was performed with autologous fascia lata in 18 cases (group 1), cryopreserved fascia lata in 23 cases (group 2), silicone in 15 cases (group 3), and PTFE in 20 cases (group 4). The results were evaluated according to the height symmetry of the palpebral opening and the improvement in visual capacity. RESULTS: The results were considered satisfactory in 16 patients (88%) in group 1, 19 cases (82%) in group 2, 12 cases (80%) in group 3, and 18 cases (90%) in group 4. Complications included the loss of correction with recurrent palpebral ptosis requiring revision surgery, or foreign body granuloma formation. The highest complication rate occurred in group 4 (40%), and the lowest in group 1 (5%). Two thirds of the patients with recurrent ptosis were included in the group of younger patients. CONCLUSIONS: Autologous or homologous fascia lata is superior to silicone or PTFE when used as a suspension material in the treatment of palpebral ptosis.

[The use of a prolene double mesh for orbital wall reconstruction]. / Utilización de doble malla de prolene para reconstrucción de la pared orbitaria.

CASE REPORT: Patient with a recurrent carcinoma of the nasal fossae affecting the internal orbital wall. The intraorbital content was not affected. The orbital wall was reconstructed with a prolene double mesh anchored to the periosteum. DISCUSSION: Prolene mesh as a substitute of the orbital wall. Good stability and isolation of the intraorbital structures were observed. Ocular motility was completely normal after surgery without prolene mesh displacements. The prolene double mesh is a good surgical option to replace missing bone in the reconstruction of the internal orbital wall.

Estudio comparativo de diferentes materiales empleados en la suspensión al frontal en casos de ptosis palpebral / Treatment of palpebral ptosis with frontal suspension: a comparative study of different materials

Objetivo: Realizar un estudio comparativo de los diferentes materiales utilizados en la suspensión al frontal en casos de ptosis palpebral.Métodos: Se intervienen 66 ojos (46 pacientes) mediante la técnica de Fox modificada, en el grupo 1 (18 casos) utilizando fascia lata autóloga, en el grupo 2 (23 casos) utilizando fascia lata criopreservada, en el grupo 3 (15 casos) utilizando silicona y en el grupo 4 (20 casos) utilizando PTFE. Se realiza un seguimiento postoperatorio de al menos dos años, analizando la eficacia del método y las complicaciones.Resultados: La eficacia obtenida, considerando como tal la liberación del eje visual y la simetría en la altura de la hendidura palpebral en el grupo 1 es de un 88% (16 casos), en el grupo 2 de un 82% (19 casos), en el grupo 3 de un 80% (12 casos) y en el grupo 4 de un 90% (18 casos). Las complicaciones, considerando como tales la necesidad de reintervención por descenso de párpado, o la formación de granulomas fue de un 40% (ocho casos) en el grupo 4, de un 33% (cinco casos) en el grupo 3, de un 17% (cuatro casos) en el grupo 2, y del 5% (un caso) en el grupo 1. El 74% de los casos que descendieron pertenecían al grupo de menor edad.Conclusiones: La fascia lata, autóloga o procedente de banco resulta un material superior, para su empleo en la suspensión, a la silicona y al PTFE

Purpose: The aim of this study was to compare the results of three materials used for frontal muscle suspension in the treatment of palpebral ptosis. Methods: Sixty-six eyes in 46 patients with palpebral ptosis were operated with a modified Fox technique. The suspension was performed with autologous fascia lata in 18 cases (group 1), criopreserved fascia lata in 23 cases (group 2), silicone in 15 cases (group 3), and PTFE in 20 cases (group 4). The results were evaluated according to the height symmetry of the palpebral opening and the improvement in visual capacity. Results: The results were considered satisfactory in 16 patients (88%) in group 1, 19 cases (82%) in group 2, 12 cases (80%) in group 3, and 18 cases (90%) in group 4. Complications included the loss of correction with recurrent palpebral ptosis requiring revision surgery, or foreign body granuloma formation. The highest complication rate occurred in group 4 (40%), and the lowest in group 1 (5%). Two thirds of the patients with recurrent ptosis were included in the group of younger patients. Conclusions: Autologous or homologous fascia lata is superior to silicone or PTFE when used as a suspension material in the treatment of palpebral ptosis

Utilización de doble malla de prolene para reconstrucción de la pared orbitaria / The use of a prolene double mesh for orbital wall reconstruction

Caso clínico: Paciente con carcinoma recidivante de fosa nasal que invade pared orbitaria interna, sin afectar al contenido orbitario. Se emplea, para la reconstrucción, una malla doble de prolene anclada a periostio.Discusión: El prolene es un material adecuado para sustituir la pared orbitaria, proporcionando estabilidad a la órbita sin afectar a su contenido. Tras la cirugía la motilidad ocular es normal y la malla no tiene desplazamiento. Ésta es una buena opción para reemplazar el hueso extirpado en los casos en que sea necesario realizar una reconstrucción de la pared orbitaria interna

Case report: Patient with a recurrent carcinoma of the nasal fossae affecting the internal orbital wall. The intraorbital content was not affected. The orbital wall was reconstructed with a prolene double mesh anchored to the periosteum. Discussion: Prolene mesh as a substitute of the orbital wall. Good stability and isolation of the intraorbital structures were observed. Ocular motility was completely normal after surgery without prolene mesh displacements. The prolene double mesh is a good surgical option to replace missing bone in the reconstruction of the internal orbital wall

[Orbital vasculonervous network and orbital surgical compartments by high field magnetic resonance]. / Dotación vasculonerviosa y espacios anatomoquirúrgicos de la órbita por resonancia magnética de alto campo.

PURPOSE: To elucidate the possibilities and indications of high-resolution magnetic resonance imaging (MRI) in the study of the orbit and its contents. METHODS: Orbital anatomy was studied in sliced specimens of fifteen fresh frozen cadavers and the results were compared with those obtained in thirty asymptomatic subjects who underwent a magnetic resonance with 1.5 Tesla equipment. The information obtained was used to interpret the findings in twenty-two patients with various orbital diseases. RESULTS: High-resolution MRI allows visualization of structures difficult to assess previously, like the cerebrospinal fluid (CSF) surrounding the optic nerve, the complete intraorbital route and the exit of the third cranial nerve, the ophthalmic artery and the intraorbital relationships of the sixth cranial nerve, which can be clearly differentiated from the lateral rectus muscle. CONCLUSIONS: High-resolution MRI is a very useful tool for the study of the orbit and its content. It provides accurate diagnoses through non-invasive procedures and facilitates the planning of the surgical approaches by improving the visualization of pathologic orbital structures. lcarlos@correo.uniovi.es

Dotación vasculonerviosa y espacios anatomoquirúrgicos de la órbita por resonancia magnética de alto campo / Orbital vasculonervous network and orbital surgical compartments by high field magnetic resonance

Objetivo: Conocer las posibilidades de la Resonancia Magnética de alto campo en el estudio de la órbita y su contenido. Métodos: Se han realizado cortes anatómicos en 15 cadáveres a fin de analizar las estructuras orbitarias y vecinas, comparando éstas con los hallazgos obtenidos en 30 sujetos sanos a los que fue realizada una Resonancia Magnética (RM) con equipo dotado de 1.5 TESLA. Asimismo se incorporaron al estudio comparativo un grupo de 22 pacientes portadores de patología orbitaria diversa. Resultados: Se pueden identificar con este tipo de sistema de exploración estructuras hasta ahora difícilmente asequibles, tales como el L.C.R. que acompaña al fascículo óptico, la salida y recorrido completos del III par craneal, la arteria oftálmica y las relaciones del VI par craneal en el interior de la órbita, que con este método puede ser bien diferenciable de la estructura del músculo recto externo. Conclusiones: La Resonancia Magnética de alto campo o de alta resolución es un procedimiento de exploración muy útil para el estudio de la órbita y su contenido, lo cual permite avanzar en el diagnóstico por métodos escasamente invasivos y facilita la preparación de los abordajes quirúrgicos, al mostrar con buena nitidez el estado de las diferentes estructuras orbitarias afectadas por patología (AU)

Purpose: To elucidate the possibilities and indications of high-resolution magnetic resonance imaging (MRI) in the study of the orbit and its contents. Methods: Orbital anatomy was studied in sliced specimens of fifteen fresh frozen cadavers and the results were compared with those obtained in thirty asymptomatic subjects who underwent a magnetic resonance with 1.5 Tesla equipment. The information obtained was used to interpret the findings in twenty-two patients with various orbital diseases. Results: High-resolution MRI allows visualization of structures difficult to assess previously, like the cerebrospinal fluid (CSF) surrounding the optic nerve, the complete intraorbital route and the exit of the third cranial nerve, the ophthalmic artery and the intraorbital relationships of the sixth cranial nerve, which can be clearly differentiated from the lateral rectus muscle. Conclusions: High-resolution MRI is a very useful tool for the study of the orbit and its content. It provides accurate diagnoses through non-invasive procedures and facilitates the planning of the surgical approaches by improving the visualization of pathologic orbital structures (AU)

Acerca de las suturas ajustables en cirugía oculoplástica / About the adjustable sutures in ophthalmic plastic surgery

No disponible