[Management of intravitreal injections]. / Manejo de las inyecciones intravítreas.

PURPOSE: The intravitreal injection is a minimally invasive technique which has been proved to be an effective therapy in the management of numerous vitreoretinal diseases. Its use has been rapidly increased in the last few years due to new medications and indications. However, non-standardized performance of this procedure might cause severe complications, being of special concern intraocular infection. The aim of this Guide is to give ophthalmologists, with the information we have up to date, the guidelines needed to make this procedure safe. METHODS: 1. Reviewing the literature regarding evidence published up to date. 2. Consulting with experienced surgeons their common practice in this technique. 3. Contrasting the information from this Guide with those guides published in other countries. RESULTS: Although there is no complete consensus regarding the intravitreal injection procedure technique, the recommendations in this Guide are, up to date from our point of view, the most appropriate to prevent complications, specially infection. Of most importance are antisepsis with povidone iodine, the use of sterile material and gloves and an adequate injection technique. CONCLUSIONS: Large series published of intravitreal injections which took place in clinic settings applying a procedure technique as recommended in this Guide, presented a very low incidence of complications, specially endophthalmitis.

Manejo de las inyecciones intravítreas / Management of intravitreal injections

Objetivo: La inyección intravítrea es una técnicamínimanente invasiva de demostrada eficacia en eltratamiento de numerosas enfermedades vitreorretinianas.Su uso, gracias a nuevas medicaciones eindicaciones, se ha generalizado en los últimosaños. La práctica de esta técnica sin las precaucionesadecuadas, puede causar complicaciones graves,en especial la infección.La finalidad de esta Guía es difundir entre los oftalmólogosun compendio de recomendaciones estandarizadasque faciliten la administración de inyeccionesintravítreas, con las máximas medidas deseguridad y fiabilidad.Método: Se efectúa:1. Una revisión bibliográfica de la evidencia científicapublicada hasta la fecha.2. Consulta de práctica clínica habitual entre especialistascon experiencia acreditada.3. Contraste de nuestra información con la contenidaen las guías publicadas en otros países.Resultado: Aunque no hay un consenso absoluto,las maniobras recomendadas en esta Guía parecen,hasta el día de la fecha, las más adecuadas paraminimizar los riesgos de complicaciones, en especial la infección. Se consideran de particular importanciala antisepsis con povidona yodada, el uso deguantes y materiales estériles y una técnica adecuadade inyección.Conclusiones: Series muy grandes de inyeccionesintravitreas realizadas en consulta y aplicando lasmedidas aquí recomendadas, presentan una incidenciamuy baja de complicaciones, en especial la sospecha de infección intraocular(AU)

Purpose: The intravitreal injection is a minimallyinvasive technique which has been proved to be aneffective therapy in the management of numerousvitreoretinal diseases. Its use has been rapidlyincreased in the last few years due to new medicationsand indications. However, non-standardizedperformance of this procedure might cause severecomplications, being of special concern intraocularinfection.The aim of this Guide is to give ophthalmologists,with the information we have up to date, the guidelinesneeded to make this procedure safe.Methods: 1. Reviewing the literature regarding evidencepublished up to date.2. Consulting with experienced surgeons their commonpractice in this tecnique.3. Contrasting the information from this Guide withthose guides published in other countries.Results: Although there is no complete consensusregarding the intravitreal injection procedure technique,the recomendations in this Guide are, up todate from our point of view, the most appropriate toprevent complications, specially infection. Of mostimportance are antisepsis with povidone iodine, the use of sterile material and gloves and an adecuateinjection technique.Conclussions: Large series published of intravitrealinjections which took place in clinic settingsapplying a procedure tecnique as recomended inthis Guide, presented a very low incidente of complications,specially endophthalmitis(AU)

[Surgical solution to vitreous floaters visual problem]. / Solución quirúrgica al problema visual de los cuerpos vítreos flotantes.

PURPOSE: To evaluate the role of 25 gauge pars-plana vitrectomy (25G-PPV), after a careful patient selection, when we find highly annoying vitreous floaters and to question if this is an ethical therapeutic option. METHODS: A retrospective study of eight eyes (seven patients) aged 58+/-14 years old (range 42-78) high myopes and pseudophakes who underwent 25G-PPV. Clinical data and visual acuity were studied at six to twelve months follow-up. Health-related functioning and quality of life was measured with the 39-item National Eye Institute Visual Functioning Questionnaire (NEI VFQ-39). RESULTS: No complications were observed. All patients were satisfied. Safety at third month was 100% and 37.5% improved one or more lines of visual acuity. CONCLUSIONS: Vitreous floaters can be often undervaluated by ophthalmologists, resulting in no intervention. Conventional 20 gauge PPV after a carefully examination can be an effective option for some authors. 25G-PPV incorporates also advantages as the early recovery, with little complications in pseudophakic eyes.

Solución quirúrgica al problema visual de los cuerpos vítreos flotantes / Surgical solution to vitreous floaters visual problem

Objetivo: Valorar ante la presencia de cuerposvítreos flotantes (CVF) incapacitantes visualmente,la vitrectomia pars-plana a través de incisiones calibre25 G (VPP-25G) como solución quirúrgica trashaber realizado una exhaustiva valoración delpaciente, y cuestionar si esta opción terapéutica estécnica y éticamente correcta.Método: Estudio retrospectivo de los resultadosobtenidos en cuanto a rendimiento funcional y calidadde vida. Se valoraron siete pacientes (ocho ojos)todos miopes altos, pseudofáquicos, alguno de ellospost-lensectomia refractiva, intervenidos medianteVPP-25G. Edad media 58 ± 14 años (rango 42-78).Se evaluaron los datos clínicos y las agudezas visualesprevias y postoperatorias, con un seguimientoentre seis y doce meses, junto al grado de confortabilidada través del cuestionario NEI VFQ-39.Resultados: No se observaron complicaciones. Laseguridad a los tres meses fue del 100%. Todos lospacientes refirieron una mejoría en su calidad devida. El 37,5% mejoró su agudeza visual al menos una línea. Conclusiones: La presencia de CVF se traduce enunos síntomas que son frecuentemente infravaloradospor los oftalmólogos, lo que lleva a desaconsejarcualquier tipo de intervención. La VPP convencionalpor 20 G (tras una selección preoperatoriadel paciente en cuanto a criterios de riesgo quirúrgicoy psicológico), para diversos autores puede seruna opción terapéutica efectiva. La VPP-25G incorporaademás ventajas de recuperación postoperatoriaprecoz, con pocas complicaciones en ojos pseudofáquicos(AU)

Purpose: To evaluate the role of 25 gauge pars-planavitrectomy (25G-PPV), after a careful patientselection, when we find highly annoying vitreousfloaters and to question if this is an ethic therapeuticoption.Methods: A retrospective study of eight eyes(seven patients) aged 58 ± 14 years old (range42–78) high myopes and pseudophakes who underwent25G-PPV. Clinical data and visual acuity werestudied at six to twelve months follow-up. Healthrelatedfunctioning and quality of life was measuredwith the 39-item National Eye Institute VisualFunctioning Questionnaire (NEI VFQ-39).Results: No complications were observed. Allpatients were satisfied. Safety at third month was100% and 37.5% improved one or more lines ofvisual acuity.Conclusions: Vitreous floaters can be often undervaluatedby ophthalmologists, resulting in no intervention.Conventional 20 gauge PPV after a carefullyexamination can be an effective option forsome authors. 25G-PPV incorporates also advantapars-plana 25 gauge, pseudofaquia.ges as the early recovery, with little complicationsin pseudophakic eyes(AU)

[Newborn chronic follicular conjunctivitis]. / Conjuntivitis folicular crónica en el lactante.

CASE REPORT: A case of chronic follicular conjunctivitis in an infant presenting with ptosis and dacryorrhea is reported. Polymerase chain reaction (PCR) test identified Chlamydia trachomatis as the causative agent. The patient was treated with topic and systemic erythromycin. The infection was probably transmitted during delivery. DISCUSSION: Chronic follicular conjunctivitis in infants is very uncommon in our environment. The most sensitive and specific diagnostic test is PCR. It is necessary to identify the original focus of infection and to provide specific treatment to all the carriers as soon as possible to avoid and prevent chronic complications.

Conjuntivitis folicular crónica en el lactante / New born chronic follicular conjunctivitis

Caso clínico: Se presenta un caso de conjuntivitis folicular crónica del lactante que debuta como ptosis y dacriorragia. Mediante técnica de reacción en cadena de polimerasa (PCR) se diagnosticó Chlamydia trachomatis como agente etiológico y se trató con eritromicina tópica y sistémica. El contagio se produjo en el canal del parto. Discusión: La conjuntivitis de inclusión del lactante es muy infrecuente en nuestro medio. El método diagnóstico más sensible y específico es la PCR. Se debe identificar la fuente de contagio y hacer un tratamiento precoz y completo de todos los portadores para evitar las complicaciones de la cronicidad

Case report: A case of chronic follicular conjunctivitis in an infant presenting with ptosis and dacryorrhea is reported. Polymerase chain reaction (PCR) test identified Chlamydia trachomatis as the causative agent. The patient was treated with topic and systemic erythromycin. The infection was probably transmitted during delivery. Discussion: Chronic follicular conjunctivitis in infants is very uncommon in our environment. The most sensitive and specific diagnostic test is PCR. It is necessary to identify the original focus of infection and to provide specific treatment to all the carriers as soon as possible to avoid and prevent chronic complications (Arch Soc Esp Oftalmol 2008; 83: 559-562)

[Clinical trials on glaucoma: differences according to the medical or surgical nature of the treatment being evaluated]. / Ensayos clínicos sobre glaucoma: diferencias en función de que evalúen tratamientos médicos o quirúrgicos.

PURPOSE: To compare the quality of clinical trials on glaucoma between those evaluating the effectiveness of medical treatments and those evaluating surgical treatments. METHOD: Clinical trials on glaucoma published in seven international journals between January 1980 and December 1999 were selected. The papers were revised by researchers with a background in epidemiology using a standard qualitative questionnaire. Proportions were compared using Fisher's exact test. RESULTS: Sample size was pre-estimated in 19% of medical treatment trials and 2% of surgical trials (p=0.005); masking (72% vs. 9%; p<0.001) and intention-to-treat analysis (17 vs. 0 papers; p<0.001) were also more frequent in medical trials. Only 50% of the trials correctly described the patient flow. CONCLUSIONS: Quality in clinical trials on glaucoma medical treatment was higher than in surgical trials regarding sample size pre-estimation, masking and intention-to-treat analysis. However, both medical and surgical trials should improve in these aspects and in the patient flow description

[Analytic management in ophthalmology: towards a cost per hospital out- and in-patient]. / La contabilidad analítica en oftalmología: hacia el coste por paciente hospitalario.

PURPOSE: To determine the total annual cost of the activities in the Ophthalmology Department at the Hospital La Mancha-Centro, Homogeneous functional group (HFG) of the INSALUD, and to estimate the cost per patient/process of both ambulatory patients and hospital in-patients. METHODS: The study was designed over 1 year period, from January to December 1997, and applied by using analytic accounting in 17,857 patients seen at the out-patient ophthalmology clinic and 973 hospital in-patients who were classified by diagnosis-related groups (DRG) and sorted out by analysis of Case Mix index. RESULTS: We have determined the annual cost of our activity in both the ambulatory patient group and the hospital in-patient group classified by DRG and obtained the cost per process. CONCLUSIONS: To know systematically the annual cost of our medical and surgical activity is nowadays a necessary tool in the framework of the Total Quality Plan developed by the INSALUD's SIGNO Group since 1991. This leads us to the analytic management area and places us in the never ending search for the ideal model of cost per process determination.

La contabilidad analítica en oftalmología: hacia el coste por paciente hospitalario / Analytic management in ophthalmology: towards a cost per hospital out- and in patient

Objetivo: Establecer el coste total anual de enero a diciembre de 1997, del servicio de Oftalmología del Complejo Hospitalario 'La Mancha-Centro', Grupo Funcional Homogéneo o GFH en terminología del INSALUD y realizar una aproximación al coste por paciente/proceso, de los pacientes atendidos en consultas externas y de los pacientes ingresados para tratamiento médico o quirúrgico. Métodos: Hemos realizado el estudio mediante contabilidad analítica sobre 973 pacientes ingresados en nuestro hospital durante ese período de tiempo, clasificados mediante Grupos Relacionados por el Diagnóstico, GRDs, ordenados por su peso ponderado o análisis del índice de Case Mix, a los que hemos sumado 17,857 pacientes atendidos en consultas externas de nuestro hospital. Resultados: Hemos determinado el coste anual de nuestra actividad, en consultas externas y el de los pacientes ingresados para tratamiento médico-quirúrgico, ordenados por GRDs y hemos obtenido los costes por proceso que esta actividad ha generado mediante este procedimiento. Conclusiones: Conocer sistemáticamente el coste anual de nuestra actividad en sus vertientes médica y quirúrgica es hoy en día una herramienta necesaria, dentro de las actividades del plan de calidad total que el grupo SIGNO del INSALUD desarrolla desde el año 1991, acercándonos a los límites de la gestión analítica, en la búsqueda inacabada de la determinación del coste por proceso, motivo principal de este trabajo (AU)

Los grupos relacionados por el diagnóstico y el coste por servicio: una aproximación a la contabilidad analítica en oftalmología / Diagnosis related groups and cost by process: an approach to analytic accountancy in ophthalmology

Objetivo: Establecer el coste anual del Servicio de Oftalmología en el Hospital 'La Mancha-Centro', de acuerdo a su actividad de ingreso. Nuestro objetivo final es divulgar dentro de nuestra especialidad los términos de gestión. Métodos: Hemos realizado el estudio analítico de 766 pacientes en un año clasificados por Grupos Relacionados por el Diagnóstico (GRDs) en relación con el coste anual de esta actividad en nuestro servicio. Resultados: Hemos determinado el coste anual así como los GRDs de la muestra estudiada. El GRD más frecuente fue él número 39 (procedimientos sobre el cristalino), un 65 por ciento de la muestra. Hemos obtenido una estancia media más baja que la nacional en cada grupo. Conclusiones: Actualmente el estudio sistemático del coste anual en nuestra especialidad es una necesidad, ya que permite una correcta planificación futura atendiendo a los principales objetivos, un mejor uso de los recursos y conocer el impacto del servicio en la economía del hospital. El hospital moderno es una compañía de servicios y no relacionar la calidad asistencial con el coste puede causar la crisis del Sistema Nacional de Salud (AU)

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[Diagnosis related groups and cost by service: an approach to analytic accounting in ophthalmology]. / Los grupos relacionados por el diagnóstico y el coste por servicio: una aproximación a la contabilidad analítica en oftalmología.

PURPOSE: To establish the annual cost of the Ophthalmology Service in <> Hospital, according to its admission activity. Our last objective is to publish the management terms in our ophthalmology specialty. METHODS: We have done a one year analytic study of 766 patients classified into Diagnosis Related Groups (DRGs) in relation to the annual cost of this activity in our service. RESULTS: We have determined the annual cost of our service as well as the DRGs of the studied sample. The most frequent DRG was number 39 (crystalline procedures), 65% of the sample. We have obtained an average stay lower than the national average stay in each group. CONCLUSIONS: At present, this systematic study and evaluation of annual cost in our specialty is a necessity because it permits a correct future planning by ordering the main objectives, a better use of resources and to know the impact of the service in the economy of the hospital. The modern hospital is a service company and not relating the assistential quality with the cost may cause a crisis of the Health National System.