Espolonectomía: una nueva modificación de la esclerectomía profunda no perforante / Spurectomy: A novel modification of non-penetrating deep sclerectomy

Objetivos Evaluar los resultados de una nueva modificación de la esclerectomía profunda no perforante (EPNP) denominada espolonectomía. Métodos Estudio retrospectivo no aleatorizado y comparativo que incluyó 98 ojos (grupoA) operados con espolonectomía, que consiste en la combinación de la escisión del espolón escleral con EPNP. El grupo control (B) incluyó 53 ojos operados con EPNP clásica. Durante 12meses se estudiaron la presión intraocular (PIO), los medicamentos antiglaucomatosos que requirieron y las complicaciones. Resultados La PIO media disminuyó de 25,69±8,11 preoperatoria a 15,73±4,16mmHg después de la cirugía en el grupoA (p<0,001). En el grupoB disminuyó de 26,66±5,93 preoperatoria a 18,19±5,93mmHg postoperatoria (p<0,001). Las diferencias entre grupos de la PIO postoperatoria fue estadísticamente significativa (p<0,001). A los 12meses después de la cirugía, el 13,27 y el 52,83% de ojos en los gruposA yB requirieron tratamiento antihipertensivo tópico (p<0,001). La tasa de éxito absoluto después de la cirugía fue del 87,5 y del 47,17% en los gruposA yB, con una tasa significativamente mayor de éxito relativo en el grupoB (p<0,001). No hubo diferencias significativas entre los grupos en la tasa de complicaciones (p=0,960). La complicación postoperatoria más frecuente fue la microperforación de la membrana trabeculo-descemética en ambos grupos. Conclusiones La espolonectomía es una técnica segura y eficaz en comparación con la EPNP convencional y parece una alternativa prometedora en el tratamiento quirúrgico del glaucoma, optimizando la eficacia del tratamiento y minimizando las complicaciones (AU)

Purpose To evaluate the outcomes of a novel modification of the non-penetrating deep sclerectomy (NPDS) approach for glaucoma management called spurectomy. Methods Observational comparative non-randomized retrospective study including 98 glaucomatous eyes of 76 patients operated on with the spurectomy technique consisting of the combination of the excision of the scleral spur with NPDS (groupA). A control group (groupB) including 53 glaucomatous eyes of 43 patients operated on with classical NPDS was also included. Changes in intraocular pressure (IOP) and medications required as well as complications were recorded in a 12-month follow-up. Results Mean IOP decreased from 25.69±8.11 preoperatively to 15.73±4.16mm Hg postoperatively in groupA (p<0.001). In groupB, mean IOP decreased from 26.66±5.93 preoperatively to 18.19±5.93mm Hg postoperatively (P<.001). Differences between groups in postoperative IOP was statistically significant (P<.001). At 12months after surgery, 13.27% and 52.83% of eyes in groupsA andB required topical antihypertensive therapy (P<.001). The rate of absolute success after surgery was 87.5% and 47.17% in groupsA andB, with significantly higher rate of relative success in groupB (P<.001). No significant differences among groups were found in the complication rate (P=.960). The most common postoperative complication was microperforation of the trabeculo-descemetic membrane in both groups. Conclusions Spurectomy is a safe and effective technique when compared with conventional NPDS and seems a promising alternative in the surgical management of glaucoma, optimizing the efficacy of the treatment and minimizing complications (AU)

Spurectomy: A novel modification of non-penetrating deep sclerectomy. / Espolonectomía: una nueva modificación de la esclerectomía profunda no perforante.

PURPOSE: To evaluate the outcomes of a novel modification of the non-penetrating deep sclerectomy (NPDS) approach for glaucoma management called spurectomy. METHODS: Observational comparative non-randomized retrospective study including 98 glaucomatous eyes of 76 patients operated on with the spurectomy technique consisting of the combination of the excision of the scleral spur with NPDS (groupA). A control group (groupB) including 53 glaucomatous eyes of 43 patients operated on with classical NPDS was also included. Changes in intraocular pressure (IOP) and medications required as well as complications were recorded in a 12-month follow-up. RESULTS: Mean IOP decreased from 25.69±8.11 preoperatively to 15.73±4.16mm Hg postoperatively in groupA (p<0.001). In groupB, mean IOP decreased from 26.66±5.93 preoperatively to 18.19±5.93mm Hg postoperatively (P<.001). Differences between groups in postoperative IOP was statistically significant (P<.001). At 12months after surgery, 13.27% and 52.83% of eyes in groupsA andB required topical antihypertensive therapy (P<.001). The rate of absolute success after surgery was 87.5% and 47.17% in groupsA andB, with significantly higher rate of relative success in groupB (P<.001). No significant differences among groups were found in the complication rate (P=.960). The most common postoperative complication was microperforation of the trabeculo-descemetic membrane in both groups. CONCLUSIONS: Spurectomy is a safe and effective technique when compared with conventional NPDS and seems a promising alternative in the surgical management of glaucoma, optimizing the efficacy of the treatment and minimizing complications.

Cilioretinal obstruction during pregnancy. / Obstrucción de la arteria ciliorretiniana durante el embarazo.

PURPOSE: To determine the number of patients diagnosed over a 5-year period with isolated occlusion of the cilioretinal artery (CRAO) whilst pregnant, as well as to describe the outcomes and ophthalmological sequelae of this condition in pregnant woman. METHODS: A retrospective study of the medical records. RESULTS: From the 135 patients diagnosed with retinal arterial occlusion of all of our series, 20 (14.8%) had CRAO, and 2 (1.48%) of these were pregnant. Case 1: A 34 year-old pregnant woman with a centrocaecal scotoma and visual acuity of 20/20 in right eye. Fundus examination: A soft exudate in the papillomacular bundle with retinal oedema and embolism on a cilioretinal artery branch. The exudate and oedema disappeared after 5 weeks, and the scotoma was reduced. Case 2: A 30 year-old pregnant woman, with normal visual acuity in right eye, and a centrocaecal scotoma. Fundoscopy: An area of retinal interpapillomacular infarction due to cilioretinal artery occlusion. The fundus returned to normal in 4 weeks, with an improvement of the scotoma. CONCLUSIONS: The aetiology of CRAO is usually associated with carotid disease or other thromboembolic events related to hypercoagulable states and autoimmunity. Pregnancy is considered a hypercoagulable state, and it is not known if it is a risk factor for arterial embolism. Further studies are required to determine the correlation between pregnancy and CRAO.

Plateau iris secondary to iridociliary cysts.

CASE REPORT: We present a case of plateau iris and glaucoma due to multiple unilateral iridociliary cysts. The patient was treated with iridotomy Nd: YAG laser and 360° iridoplasty, without achieving pressure control. Phacoemulsification improved the hypertension. Dynamic gonioscopy and OCT of the anterior chamber was also performed before and after treatment. DISCUSSION: Iridociliary cysts are a benign condition that can cause iris plateau configuration, and can produce a difficult to treat ocular hypertension. Cystotomy, peripheral iridoplasty, and other treatments have been proposed.

[Blepharoplasty: to suture or to use cyanoacrylate?]. / Blefaroplastia: ¿suturar o usar cianocrilato?

OBJECTIVE: To study the safety and surgical time required when using the tissue adhesive 2-ethyl-cyanoacrylate compared with conventional suture in upper lid blepharoplasty. METHOD: A retrospective study was performed on 40 eyes of 20 patients who underwent bilateral upper lid blepharoplasty. In 7 patients, continuous non-absorbable suture (6-0 nylon monofilament Ethilon(®), Ethicon Inc., Somerville, NJ) was used for closure of the incision and in 13 patients 2-ethyl-cyanoacrylate (Epiglue(®), Meyer -Haake, Germany) was used. The variables studied were intraoperative time required to close the incision, the cost of the material used and the incidence of infections and suture dehiscence. RESULTS: The average time taken to close the incision was 6.069 minutes with cyanoacrylate and 11.914 minutes with conventional suture (P<.05). The price of surgical material used was practically similar. No cases of infection or wound dehiscence were found. CONCLUSION: The closure of the incision in upper lid blepharoplasty using 2-ethyl-cyanoacrylate is a safe, effective, and faster, but not less expensive method than conventional suture.

Blefaroplastia: ¿suturar o usar cianocrilato? / Blepharoplasty: to suture or to use cyanoacrylate?

Objetivo: Estudiar la seguridad y el tiempo quirúrgico requerido al usar el adhesivo tisularetil-2-cianocrilato comparado con la sutura convencional en la blefaroplastia superior.Métodos: Se realizó un estudio retrospectivo en 40 ojos de 20 pacientes intervenidos deblefaroplastia superior bilateral. En 7 pacientes para el cierre de la incisión se utilizaronpuntos continuos de sutura no reabsorbible (monofilamento nailon (6-0 Ethilon®, EthiconInc., Somerville, NJ) y en 13 pacientes se usó etil-2-cianocrilato (Epiglue®,Meyer-Haake, Alemania).Las variables estudiadas fueron el tiempo intraoperatorio requerido para el cierrede la incisión, el coste del material utilizado y la incidencia de infecciones y/o dehiscenciade sutura.Resultados: El promedio del tiempo empleado para el cierre de la incisión con el cianocrilatofue de 6.069 minutos y de 11.914 minutos con la sutura convencional (p < 0,05). El precio delmaterial quirúrgico utilizado fue prácticamente similar.No hubo ningún caso de infeccioneso dehiscencia de herida.Conclusiones: El cierre de la incisión de la blefaroplastia superior con cianocrilato es un procedimientoefectivo, seguro, más rápido pero no menos costoso que la sutura convencional(AU)

Objective: To study the safety and surgical time required when using the tissue adhesive2-ethyl-cyanoacrylate compared with conventional suture in upper lid blepharoplasty.Method: A retrospective study was performed on 40 eyes of 20 patients who underwentbilateral upper lid blepharoplasty. In 7 patients, continuous non-absorbable suture (6-0 nylonmonofilament Ethilon®, Ethicon Inc., Somerville, NJ) was used for closure of the incisionand in 13 patients 2-ethyl-cyanoacrylate (Epiglue®, Meyer -Haake, Germany) was used. Thevariables studied were intraoperative time required to close the incision, the cost of thematerial used and the incidence of infections and suture dehiscence. Results: The average time taken to close the incision was 6.069 minutes with cyanoacrylateand 11.914 minutes with conventional suture (P < .05). The price of surgical material usedwas practically similar. No cases of infection or wound dehiscence were found.Conclusion: The closure of the incision in upper lid blepharoplasty using 2-ethylcyanoacrylateis a safe, effective, and faster, but not less expensive method thanconventional suture(AU)

Langerhans cell histiocytosis: oral/periodontal involvement in adult patients.

OBJECTIVE: Langerhans cell histiocytosis (LCH) is a clonal proliferative multisystem disease. Although bone and mucosae have been classified as non-risk organs, their involvement may increase the risk of disease progression. Oral and periodontal lesions are burdened with a significant impairment of quality of life for associated signs, symptoms and loss of function. Most of information regards paediatric disease; the disease in adults has received limited attention. SUBJECTS AND METHODS: A total of 31 adult patients affected by immuno-histopathology confirmed LCH have been prospectively examined; attention was paid to the occurrence and characterization of oral lesions. RESULTS: Twelve patients developed oral lesions. Posterior regions of jawbones were always affected; the involvement of anterior regions was not constant. Unifocal oral involvement was significantly associated with multisystemic disease while multifocal lesions were associated with unisystemic disease. Oral disease presented with soft tissue ulcers (50% of cases), gingival bleeding (66.7%), pain (83.4%), periodontal damage (50%), tooth mobility (16.7%), non-healing extraction socket (8.3%); 41.6% of patients complained of negative outcomes on quality of life. Oral lesions were easily handled with local measures. CONCLUSIONS: Posterior regions require attention; single oral lesions may be part of multisystemic disease; oral and periodontal lesions may be early signs of disease reactivation.