[Macular hole surgery without postoperatory <> down positioning. Pilot study]. / Cirugía de agujero macular sin posición <> postoperatoria. Estudio piloto.

PURPOSE: To evaluate the visual and anatomical outcomes of macular hole surgery using phacoemulsification, vitrectomy and intraocular gas tamponade without the use of postoperative face down positioning. METHODS: Phacoemulsification with an intraocular lens implant, followed by vitrectomy with internal limiting membrane peeling and perfluoropropane (C3F8), was performed in patients with stage 3 or 4 macular holes. After surgery, patients had to avoid the supine position for 15 days. Patients with a gas level <50% during the first week had a fluid-gas exchange. Visual acuity and closure of the macular hole were evaluated after 1 year of follow-up. RESULTS: 20 eyes of 20 patients, aged 60 to 75 years (median age 68 years), were included in this study. The best initial visual acuity ranged from 0.05 to 0.13 (ETDRS), with the median being 0.06. The final visual acuity was 0.05 to 0.30 with a median of 0.10. A statistically significant improvement (p=0.001, Wilcoxon) was found. The anatomic postoperative results revealed 90% (n=18) of the macular holes were closed while 10% (n=2) were not. CONCLUSIONS: Macular hole surgery has, in general, good results and patients can achieve improvement in their visual acuity without the need for uncomfortable and unbearable post operative posture positions.

[Choroidal effusion and retinal detachment after capsulotomy with YAG-LASER]. / Desprendimiento seroso de coroides y desprendimiento de retina posterior capsulotomía con YAG-LASER.

CASE REPORT: A 74-year-old woman presented complaining of blurred vision in her left eye. She had an anterior chamber lens in both eyes and an opaque posterior capsule in her left eye, for which a YAG-LASER capsulotomy was performed. Thirteen days later she re-presented with a choroidal effusion and a retinal detachment requiring surgery. DISCUSSION: There is no consensus as to the exact time at which a capsulotomy should be done. Timing of the procedure requires evaluation as a whole and consideration of the potential complications of IOL dislocation, recurrent uveitis, ocular hypertension and the most devastating choroidal effusion and retinal detachment.

Cirugía de agujero macular sin posición «boca abajo» postoperatoria. Estudio piloto / Macular hole surgery without postoperatory «face fown» positioning. Pilot study

Objetivos: Evaluar los resultados visuales y anatómicosen el tratamiento del agujero macular confacoemulsificación, vitrectomía y gas intraocularsin mantenimiento de posición boca abajo en elpostoperatorio.Material y metodos: Se realizó cirugía de facoemulsificacióncon implante de lente intraocular,vitrectomía con pelado de la membrana limitanteinterna y gas perfluoropropano (C3F8) al 17% enpacientes con diagnóstico de agujero macular gradosIII y IV. En el postoperatorio se indicó evitar laposición supina durante 15 días. Se realizó intercambioliquido gas en los pacientes con menos del50% de gas a la primera semana. Se evaluó la mejoríade la agudeza visual y el porcentaje de cierre delagujero macular después de un año de seguimiento.Resultados: Se incluyeron 20 ojos de 20 pacientescon edad entre 60 y 75 años con una mediana de 68años. La mejor agudeza visual corregida (AVcc)inicial varió de 0,05 a 0,13 con una mediana de0,06. La AVcc final estuvo entre 0,05 a 0,3 con una clasificamedianade 0,10. Al comparar la agudeza visual inicialy final se encontró una mejoría estadísticamentesignificativa de p=0.001(Wilcoxon). Los resultadospostoperatorios en cuanto al estado anatómicofinal del agujero macular fueron exitosos en el 90%(n= 18) y sin éxito en el 10% (n=2).Conclusiones: La cirugía de agujero macular esgeneralmente beneficiosa y los pacientes puedenmejorar su visión sin ser necesario el mantenimientode posiciones incomodas e intolerables paraalgunos pacientes

Purpose: To evaluate the visual and anatomical outcomes of macular hole surgery using phacoemulsification, vitrectomy and intraocular gas tamponade without the use of postoperative face down positioning. Methods: Phacoemulsification with an intraocular lens implant, followed by vitrectomy with internal limiting membrane peeling and perfluoropropane (C3F8), was performed in patients with stage 3 or 4 macular holes. After surgery, patients had to avoid the supine position for 15 days. Patients with a gas level <50% during the first week had a fluid-gas exchange. Visual acuity and closure of the macular hole were evaluated after 1 year of follow-up. Results: 20 eyes of 20 patients, aged 60 to 75 years (median age 68 years), were included in this study. The best initial visual acuity ranged from 0.05 to 0.13 (ETDRS), with the median being 0.06. The final visual acuity was 0.05 to 0.30 with a median of 0.10. A statistically significant improvement (p=0.001, Wilcoxon) was found. The anatomic postoperative results revealed 90% (n=18) of the macular holes were closed while 10% (n=2) were not. Conclusions: Macular hole surgery has, in general, good results and patients can achieve improvement in their visual acuity without the need for uncomfortable and unbearable post operative posture positions

Desprendimiento seroso de coroides y desprendimiento de retina posterior capsulotomía con YAG-LÁSER / Choroidal effusion and retinal detachment after capsulotomy with YAG-LASER

Caso Clínico: Mujer de 74 años, que acudió porvisión borrosa. Pseudofaca con lente intraocular decámara anterior en ambos ojos, y opacidad de cápsulaposterior de ojo izquierdo, se realizó capsulotomíacon YAG-LASER. A los trece días presentadesprendimiento coroideo y desprendimiento deretina que requirió intervención quirúrgica.Discusión: El indicador para realizar una capsulotomíamás usado es la disminución de la agudezavisual sin que exista una indicación precisa decuando realizarla. Sin embargo; se deben de teneren cuenta las posibles complicaciones como son:desprendimiento de retina regmatógeno, dislocacióndel lente, uveítis recurrente, hipertensión oculary complicaciones devastadoras como es el desprendimientoseroso de coroides y desprendimientode retina

Case report: A 74-year-old woman presented complaining ;;of blurred vision in her left eye. She had an ;;anterior chamber lens in both eyes and an opaque ;;posterior capsule in her left eye, for which a YAGLASER ;;capsulotomy was performed. Thirteen days ;;later she re-presented with a choroidal effusion and ;;a retinal detachment requiring surgery. ;;Discussion: There is no consensus as to the exact ;;time at which a capsulotomy should be done. ;;Timing of the procedure requires evaluation as a ;;whole and consideration of the potential complications ;;of IOL dislocation, recurrent uveitis, ocular ;;hypertension and the most devastating choroidal ;;effusion and retinal detachment

[Vitreous surgery in paediatric population. Visual and anatomic outcomes]. / Cirugía vítreo-retiniana en pacientes pediátricos. Resultados anatómicos y visuales.

PURPOSE: To determine the anatomic and visual outcome of children that had undergone vitreoretinal surgery. METHOD: 229 clinical files where analyzed at our center, were included 73 patients, 77 eyes. We considered those who were 18 years old or younger and had undergone retinal surgery, retinopathy of prematurity (ROP) was excluded. RESULTS: The mean age was 10 years; the main indication for surgery was retinal detachment. Trauma and congenital and developmental abnormalities where found in 80% of the ocular pathology involved. 90.9% of the patients had an initial visual acuity of light perception to counting fingers. Final visual acuity ranged from counting fingers to 1.0 in 41.6%. There was no statistical significance between initial visual acuity and the final (p = 0.782) neither was the time of surgery and the final visual acuity (p = 0.454). 12.5% presented total retinal detachment and the macula was involved in 63.6% of all patients. Vitrectomy and retinopexy was the preferred surgery. Silicon oil was used in 58.4%. Retinal attachment was achieved in 63% of the patients after 6 months. CONCLUSION: In this kind of patients the ocular characteristics of the vitreous, made the surgery a very difficult procedure, and the final success include the visual rehabilitation.

Cirugía vítreo-retiniana en pacientes pediátricos. Resultados anatómicos y visuales / Vitrous surgery in paediatric population visual and anatomic outcomes

Objetivos: Determinar los resultados anatómicos y visuales en pacientes menores de 18 años sometidos a cirugía vítreo-retiniana.Método: Se revisaron 229 expedientes de nuestro centro, se incluyeron 73 pacientes, 77 ojos.Se consideraron a pacientes menores de 18 años con antecedente de cirugía vítreo-retiniana excluyendo aquéllos con retinopatía del prematuro.Resultados: El promedio de edad fue de 10 años, la indicación de cirugía más frecuente fue el desprendimiento de retina. Las alteraciones congénitas y el trauma constituyeron más del 80% de la patología ocular encontrada. El 90,9% de los pacientes tuvieron capacidad visual inicial de percepción de luz a cuenta dedos. La capacidad visual final de cuenta dedos a 1,0 correspondió al 41,6%. No fue estadísticamente significativa la diferencia entre la agudeza visual inicial y final (p=0,782) así como tampoco el tiempo de cirugía y la agudeza visual final (p=0,454). El 12,5% de los pacientes presentó desprendimiento total de retina y 63,6% tuvieron afectación macular. La cirugía preferida fue la vitrectomía con retinopexia. En el 63% de los pacientes la retina permaneció aplicada después de 6 meses. Conclusiones: El procedimiento quirúrgico es difícil en estos pacientes por las características propias del vítreo; el éxito final no solo es quirúrgico sino incluye la rehabilitación visual total del paciente

Purpose: To determine the anatomic and visual outcome of children that had undergone vitreoretinal surgery.Method: 229 clinical files where analyzed at our center, were included 73 patients, 77 eyes. We considered those who were 18 years old or younger and had undergone retinal surgery, retinopathy of prematurity (ROP) was excluded.Results: The mean age was 10 years; the main indication for surgery was retinal detachment. Trauma and congenital and developmental abnormalities where found in 80% of the ocular pathology involved. 90.9% of the patients had an initial visual acuity of light perception to counting fingers. Final visual acuity ranged from counting fingers to 1.0 in 41.6%. There was no statistical significance between initial visual acuity and the final (p=0.782) neither was the time of surgery and the final visual acuity (p=0.454). 12.5% presented total retinal detachment and the macula was involved in 63.6% of all patients. Vitrectomy and retinopexy was the preferred surgery. Silicon oil was used in 58.4%. Retinal attachment was achieved in 63% of the patients after 6 months.Conclusion: In this kind of patients the ocular characteristics of the vitreous, made the surgery a very difficult procedure, and the final success include the visual rehabilitation