Reproducibility of SD-OCT inner macular layer thickness measurements in children with primary congenital glaucoma.

PURPOSE: To examine the reproducibility of spectral domain optical coherence tomography (SD-OCT) segmented ganglion cell complex and circumpapillary retinal nerve fiber layer (cpRNFL) measurements in children with primary congenital glaucoma (PCG) in comparison with healthy children. METHODS: 12 children with PCG (G1) and 24 healthy children (G2) were recruited. The following SD-OCT measurements (Spectralis, Heidelberg Engineering) were made in one eye per child: total macular thickness (MT), thicknesses in several subfields and volumes of the three inner macular layers, macular retinal nerve fiber layer (mRNFL), ganglion cell layer (GCL), and inner plexiform layer (IPL) and cpRNFL thickness. In a single day, an expert operator obtained 3 circumpapillary and 3 macular measurements in each participant to determine intraoperator variability. Intraoperator repeatability was defined by the coefficient of variation (CoV) and intraclass correlation (ICC). RESULTS: ICC was excellent in both groups for cpRNFL measurements (G1 ICC=0.950 and G2 ICC=0.995) and for MT was excellent in G1 (ICC=0.957) and moderate in G2 (ICC=552). For the inner macular layer measurements, all ICCs were better in PCG group (mRNFL-ICC: 0.915 vs. 0.765; ICC-GCL: 0.584 vs. 0.263 and ICC-IPL: 0.979 vs. 0.742; G1 and G2 respectively). Greater CoV were recorded for macular measurements (from 0.71% to 9.82%) compared to cpRNFL measurements (from 0.52% to 1.50%). CONCLUSION: In children with PCG, Spectralis SD-OCT showed excellent intrasession repeatability for cpRNFL, MT, mRNFL and IPL measurements and moderated for GCL measurements. For all macular measurements, ICC were higher in children with PCG than healthy children.

Study of reliability and validity of VOG Perea® and GazeLab® and calculation of the variability of their measurements. / Estudio de la fiabilidad y la validez de los videooculógrafos VOG Perea® y GazeLab® y cálculo de los márgenes de variabilidad.

OBJECTIVE: To determine the reliability and validity of VOG Perea® (VP) and GazeLab® (GL), their correlation and concordance with cover test (CT), and define the margins of variability of the measurement of angle deviation in primary position. METHODS: Forty-four orthotropic patients were included. Alternating prism CT, an examination with VP, and GL were performed. Intraclass correlation coefficient (ICC) was calculated to determine the reliability, and mean comparison was used to study validity. Correlation coefficient (R) between CT and each video-oculographer was calculated. Bland-Altman diagrams were used to determine concordance. All measurements were expressed in prismatic dioptres (PD). RESULTS: The mean horizontal deviation was -0.571 PD with CT; 0.22 PD with VP and 0.4 PD with GL. ICC was 0.246 (95% CI: [-0.402]-0.595) in GL and 0.984 [95% CI: 0.970-0.992)] in VP. Mean comparison between CT and GL was -0.9286 (CI 95%: [-1.822]-[0.0355], P=.042) and -0.8423 (95% CI: [-1.7190]-0.03450, P=.0593) for CT-VP. Correlation coefficient for VP was R=0.5704 (95% CI: 0.319-0.747, P=.0001) and R=0.4539 (95% CI: 0.174-0.666, P=.0025) for GL. Margins of variability for a single horizontal measurement in primary position with VP were±5.22 PD and±2 DP for GL. CONCLUSION: Both VP and GL are reliable and valid devices. Margins of variability for a horizontal measurement are ±5.22 PD in VP and±2 PD in GL.

Corneal densitometry and topography in patients with primary congenital glaucoma.

OBJECTIVE: To compare corneal densitometry and topography variables in patients with primary congenital glaucoma (PCG) and healthy subjects. MATERIAL AND METHODS: Cross sectional study, consecutive recruitment with gender- and age-matched control group. Forty eyes of 40 patients in each group were studied with Pentacam corneal topography. The variables compared between the two groups were: intraocular pressure (IOP), visual acuity (VA) and Pentacam (Oculus, Wetzlar, Germany) corneal topography measurements: mean and maximum keratometry (Km, Kmax), cylinder (Cyl), anterior elevation apex (AEA), central anterior elevation (CAE), maximum anterior elevation (MAE), posterior elevation apex (PEA), central posterior elevation (CPE), maximum posterior elevation (MPE), pachymetry and anterior, mid-stromal and posterior corneal densitometry in the 0-2mm, 2-6mm, 6-10mm zones. RESULTS: Significant differences between patients and healthy controls were detected in the topographic variables MAE (P=0.002) and MPE (P<0.001), and in all the densitometry variables (anterior, mid-stromal, posterior for the 0-2mm, 2-6mm and 6-10mm zones) (P<0.001 each). In the PCG group, negative correlation was observed between VA and total densitometry (r=-0.49; P=0.004). CONCLUSION: Patients with PCG and healthy subjects display differences in corneal densitometry and topographic measurements. PCG patients show greater corneal density with an inverse relationship between visual acuity and higher elevation (anterior and posterior values).

Correlación entre el grosor de las capas internas de la retina y el defecto medio del campo visual en pacientes con glaucoma congénito primario / The correlation between the thickness of the inner macular layers and the mean deviation of the visual field in children with primary congenital glaucoma

Objetivos: Analizar la correlación entre el grosor de la capa de fibras nerviosas peripapilar (cpRNFL) y el grosor de las capas internas de la retina con el defecto medio del campo visual (DM) en pacientes con glaucoma congénito primario (GCP). Material y métodos: En este estudio transversal se incluyó a 41 pacientes diagnosticados de GCP. A todos los pacientes se les realizó una exploración oftalmológica completa incluyendo agudeza visual, presión intraocular, fondo de ojo, campo visual y tomografía de coherencia óptica (OCT) macular y peripapilar. Se utilizó la segmentación automática del OCT Spectralis para medir el grosor de la capa de fibras nerviosas macular (mRNFL), capa de células ganglionares (GCL) y plexiforme interna. Resultados: La edad media fue de 11,2 ± 3,86 años y el DM medio fue de 8,85 ± 6,76 dB. En un 46% de los pacientes el campo visual fue clasificado como normal y un 20% de los pacientes presentaba una restricción concéntrica del campo visual. Se encontró una correlación positiva entre la relación anillo/excavación y el DM (p = 0,004). La correlación ente el DM y el grosor de la cRNFL fue de r = -0,63 (p < 0,001) y de r = -0,69 con la GCL. Conclusiones: El grosor de las capas internas de la retina y el cpRNFL tiene una buena correlación con el defecto medio del campo visual en pacientes con glaucoma congénito primario

Purpose: To analyse the association between the thickness of the circumpapillary retinal nerve fibre layer (cpRNFL) and the thickness of the inner macular layers with the mean deviation of the visual field (MD) in children with primary congenital glaucoma (PCG). Material and methods: A total of 41 children with PGC were included in the study. They all had a complete ophthalmological examination, including visual acuity, intraocular pressure, funduscopy, Octopus(TM) visual field, as well as circumpapillar and macular spectral domain optical coherence tomography (SD-OCT). SD-OCT with automated segmentation was used to measure the thicknesses and volumes of the macular retinal nerve fibre layer (mRNFL), ganglion cell layer (GCL), and inner plexiform layer. Results: The mean age was 11.2 ± 3.86 years, and the mean MD was 8.85 ± 6.76 dB. The visual field was classified as normal in 46% of the patients, and 20% of the patients had a concentrical restriction of the visual field. A positive correlation was found between between the cup-to-disc ratio and the MD, r = 0.51 (P = .004). The correlation between the MD and the cpRNFL was r = -0.63 (P < .001), and r = -0.69 (P < .001) with the GCL. Conclusions: Inner macular layers thickness and cpRNFL thickness show a good correlation with the mean deviation of the visual field in children with primary congenital glaucoma

The correlation between the thickness of the inner macular layers and the mean deviation of the visual field in children with primary congenital glaucoma. / Correlación entre el grosor de las capas internas de la retina y el defecto medio del campo visual en pacientes con glaucoma congénito primario.

PURPOSE: To analyse the association between the thickness of the circumpapillary retinal nerve fibre layer (cpRNFL) and the thickness of the inner macular layers with the mean deviation of the visual field (MD) in children with primary congenital glaucoma (PCG). MATERIAL AND METHODS: A total of 41 children with PGC were included in the study. They all had a complete ophthalmological examination, including visual acuity, intraocular pressure, funduscopy, Octopus™ visual field, as well as circumpapillar and macular spectral domain optical coherence tomography (SD-OCT). SD-OCT with automated segmentation was used to measure the thicknesses and volumes of the macular retinal nerve fibre layer (mRNFL), ganglion cell layer (GCL), and inner plexiform layer. RESULTS: The mean age was 11.2±3.86 years, and the mean MD was 8.85±6.76dB. The visual field was classified as normal in 46% of the patients, and 20% of the patients had a concentrical restriction of the visual field. A positive correlation was found between between the cup-to-disc ratio and the MD, r=0.51 (P=.004). The correlation between the MD and the cpRNFL was r=-0.63 (P<.001), and r=-0.69 (P<.001) with the GCL. CONCLUSIONS: Inner macular layers thickness and cpRNFL thickness show a good correlation with the mean deviation of the visual field in children with primary congenital glaucoma.

Edema macular precoz y recurrente en paciente en tratamiento con fingolimod / Early and recurrent macular oedema in a patient treated with fingolimod

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Brinzolamida tópica en el nistagmo congénito: Estudio retrospectivo / Topical brinzolamide in congenital nystagmus: A retrospective study

Objetivo: Evaluar los efectos del tratamiento con brinzolamida tópica en la agudeza visual y en la intensidad del nistagmo en pacientes con nistagmo congénito. Material y métodos: Se diseñó un estudio retrospectivo en el que se revisaron las historias clínicas de 11 pacientes con nistagmo congénito. A todos los pacientes se les realizó una exploración oftalmológica completa y una videooculografía mediante VOG-Perea, antes y a los 3 días de iniciar el tratamiento con brinzolamida tópica (Azopt) cada 8horas. Cinco investigadores expertos evaluaron la intensidad del nistagmo de forma enmascarada mediante un vídeo antes y después del tratamiento. Por último, se registró la mejoría subjetiva de los pacientes. Resultados: Se encontraron diferencias estadísticamente significativas en la agudeza visual binocular de cerca previa y posterior al tratamiento. Se encontró un leve aumento de la frecuencia del nistagmo, que fue estadísticamente significativa en la mirada horizontal hacia la izquierda y con la mirada hacia abajo (p = 0,04, p = 0,03 significativo). El índice Kappa de concordancia entre los investigadores evaluando la intensidad del nistagmo fue de 0,014. Solo 2 de los pacientes notaron mejoría en la agudeza visual y un paciente notó mejoría en el aspecto estético. Conclusiones: A pesar de producirse una mejoría en el nistagmo, esta es leve, no apreciable cosméticamente por los pacientes en la mayoría de los casos, y no se relacionó con una mejoría significativa en la agudeza visual ni en la calidad de vida de los pacientes. Son necesarios nuevos estudios para evaluar los efectos de la brinzolamida tópica y establecer las posibles indicaciones terapéuticas en el nistagmo (AU)

Objective: To evaluate the effect of treatment with topical brinzolamide on visual acuity and nystagmus intensity in patients with congenital nystagmus. Material and methods: A retrospective study was designed in which the clinical records of 14 patients with congenital nystagmus were reviewed. All patients underwent a complete ophthalmological examination and a Perea video-oculography (VOG) before, and three days after, initiation of treatment with topical brinzolamide (Azopt). Five expert researchers evaluated the intensity of nystagmus by video before and after treatment. Finally, the subjective improvement of the patients was recorded. Results: Statistically significant differences were found in pre- and post-treatment binocular near visual acuity. A slight increase in the frequency of nystagmus was found, which was statistically significant with the horizontal gaze to the left and with the gaze downwards (P = .04, P = .03, respectively). The kappa index concordance between the researchers evaluating the intensity of nystagmus was 0.014. Only two of the patients noticed improvement in visual acuity, and one patient noticed improvement in the aesthetic aspect. Conclusions: In spite of an improvement in nystagmus, it was slight, not cosmetically appreciable by patients in most cases, and was not related to a significant improvement in visual acuity or in patient quality of life. Further studies are needed to evaluate the effects of topical brinzolamide, and to establish potential therapeutic indications in nystagmus (AU)

Topical brinzolamide in congenital nystagmus: A retrospective study. / Brinzolamida tópica en el nistagmo congénito: Estudio retrospectivo.

OBJECTIVE: To evaluate the effect of treatment with topical brinzolamide on visual acuity and nystagmus intensity in patients with congenital nystagmus. MATERIAL AND METHODS: A retrospective study was designed in which the clinical records of 14 patients with congenital nystagmus were reviewed. All patients underwent a complete ophthalmological examination and a Perea video-oculography (VOG) before, and three days after, initiation of treatment with topical brinzolamide (Azopt). Five expert researchers evaluated the intensity of nystagmus by video before and after treatment. Finally, the subjective improvement of the patients was recorded. RESULTS: Statistically significant differences were found in pre- and post-treatment binocular near visual acuity. A slight increase in the frequency of nystagmus was found, which was statistically significant with the horizontal gaze to the left and with the gaze downwards (P=.04, P=.03, respectively). The kappa index concordance between the researchers evaluating the intensity of nystagmus was 0.014. Only two of the patients noticed improvement in visual acuity, and one patient noticed improvement in the aesthetic aspect. CONCLUSIONS: In spite of an improvement in nystagmus, it was slight, not cosmetically appreciable by patients in most cases, and was not related to a significant improvement in visual acuity or in patient quality of life. Further studies are needed to evaluate the effects of topical brinzolamide, and to establish potential therapeutic indications in nystagmus.

Historia del tracoma / History of tracoma

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Pérdida visual no orgánica monocular secundaria a traumatismo craneoencefálico / Monocular non-organic visual loss after a cranioencephalic trauma

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Hipertensión intracraneal idiopática. Análisis mediante segmentación macular / Idiopathic intracranial hypertension. Analysis by macular segmentation

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Historia de la cirugía de cataratas (I): desde el abatimiento hasta la extracción / History of cataract surgery (I): From destruction to removal

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