[Photodynamic therapy with verteporfin in choroidal neovascularization after refractive surgery]. / Terapia fotodinámica con verteporfina en neovascularización coroidea después de cirugía refractiva.

PURPOSE: To analyze the results obtained with Photodynamic Therapy (PDT) to treat subfoveal and juxtafoveal Choroidal Neovascularization (CNV) in patients with high myopia corrected by Laser-Assisted in situ Keratomileusis (LASIK) or by implanting a Phakic Intraocular Lens (PIOL). METHODS: We analyzed the results from 14 highly myopic eyes corrected by LASIK (seven cases) or by PIOL implantation (seven cases), which later developed CNV and were treated by PDT with verteporfin. RESULTS: Mean Best Corrected Visual Acuity (BCVA) after refractive surgery was 0.45 SD 0.17 (range, 0.2 to 0.8), with residual spherical equivalent (RSE) -0.5 SD 1.8 D (range, 1 to 5.5 D). After CNV appearance, BCVA was 0.10 SD 0.19 (range, 0.025 to 0.7). CNV was treated in all cases by PDT (mean, 2.0 SD 0.8 treatments). After CNV closure, the mean BCVA improved up to 0.22 SD 0.18 (range, 0.1 to 0.63) (RSE -1.4 SD 1.4 D, range, 0.5 to -4 D). Differences in RSE after refractive surgery and after PDT, and differences between BCVA after CNV appearance and final were not statistically significant (p=0.82 and p=0.06, respectively, Student's t test paired data). CONCLUSION: We consider that PDT is effective in achieving closure of CNV in myopic patients after refractive surgery without inducing changes in spherical equivalent.

[Corneal intra-epithelial neoplasia (CIN). Treatment by combined excision and antimetabolite therapy]. / Neoplasia intraepitelial corneal (CIN). Tratamiento mediante exéresis y antimetabolitos.

CASE REPORT: We present two clinical cases of corneal intra-epithelial neoplasia defined histopathologically. DISCUSSION: We sought to establish the importance of treatment with Mitomycin-C in two cases of corneal intra-epithelial neoplasia. The differential diagnosis was established based on the evolutionary character of the process, as well as specific histopathological aspects of these entities. In both cases, treatment with Mitomycin-C before, during and after surgery contributed to the decrease in the size of the lesion and to their cure without relapse.

Neoplasia intraepitelial corneal (CIN). Tratamiento mediante exéresis y antimetabolitos / Corneal intra-epithelial neoplasia (CIN). Treatment by combined excision and antimetabolite therapy

Caso clínico: Se presentan dos casos clínicos de neoplasia intrapitelial corneal diagnosticados mediante estudio histopatológico.Discusión: Se pretende establecer la importancia del tratamiento con Mitomicina C en dos casos de neoplasia intraepitelial corneal. Se establece el diagnóstico diferencial en base a los caracteres evolutivos del proceso, así como a los diferentes aspectos histopatológicos específicos de estas entidades. En ambos casos el tratamiento con Mitomicina C pre, intra y postoperatorio contribuyó a la disminución en el tamaño de la lesión y a su curación sin recidivas

Case Report: We present two clinical cases of corneal intra-epithelial neoplasia defined histopathologically. Discussion: We sought to establish the importance of treatment with Mitomycin-C in two cases of corneal intra-epithelial neoplasia. The differential diagnosis was established based on the evolutionary character of the process, as well as specific histopathological aspects of these entities. In both cases, treatment with Mitomycin-C before, during and after surgery contributed to the decrease in the size of the lesion and to their cure without relapse

MICS: una nueva etapa en la cirugía de la catarata / Micro incision cataract surgery time has arrived

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ADAL-1®: nuevo adhesivo sintético de uso en cirugía del estrabismo. Réplica / ADAL-1®: a new synthetic adhesive for use in strabismus surgery. Reply

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[Bioadhesives in ocular surgery]. / Bioadhesivos en cirugía ocular.

PURPOSE: To evaluate the histological inflammatory activity that bioadhesives such as fibrin, cyanoacrylate, unsutured valved closure and suturing, generate when applied on scleral tissue. METHODS: We used a total of 80 eyes of 80 white rabbits which we divided into 8 groups of ten eyes each and distributed according to the two periods of time (1 week and 30 days) and four technique used for closure: 10/0 nylon suture, sutureless self-sealing, cyanoacrylate glue (Histoacryl), and fibrin glue (Tissucol). ANOVA was used for the statistical study of histological inflammation. Descriptive statistical analysis was used for the study of the degree of healing. RESULTS: After 7 days, the fibrin bioadhesive led to greater inflammatory response than did the other techniques (p<0.001). The cyanoacrylate adhesive caused less inflammatory activity than did suturing material (p<0.005). On day 30, the inflammatory reaction generated by the fibrin and cyanoacrylate adhesives was greater than of the suturing and self valved closure technique (p<0.005). After 7 days, the degree of healing with the suture, sutureless technique and cyanoacrylate adhesive was incomplete, while healing was moderate with the fibrin glue. After 30 days the degree of healing with cyanoacrylate glue was incomplete. At this time the degree of healing, with the suture, sutureless technique and fibrin adhesive was complete. CONCLUSIONS: Fibrin causes greater inflammatory reaction than do the other techniques. The cyanoacrylate adhesive shows a biological tolerance identical to the suture technique. This shows that cyanoacrylate bioadhesives are a viable alternative to suturing in scleral surgery.

Bioadhesivos en cirugía ocular / Bioadhesives in ocular surgery

Objetivo: Evaluar la actividad inflamatoria histológica que los bioadhesivos de fibrina, cianoacrilato, cierre valvulado sin sutura y material de sutura generan al ser aplicados en el tejido escleral. Métodos: Utilizamos un total de 80 ojos de 80 conejos albinos, que clasificamos en 8 grupos de 10 ojos cada uno, distribuidos según los dos tiempos (1semana y 30 días) y las cuatro técnicas utilizadas: sutura de nylon 10/0, cierre autovalvulado sin sutura, adhesivo de cianoacrilato (Histoacryl®) y de f¦brina (Tissucol®). El análisis estadístico del grado de inflamación histológica fue realizado con el test del análisis factorial de la Varianza (ANOVA). El estudio sobre el grado de cicatrización se realizó mediante análisis estadístico descriptivo. Resultados: A los 7 días, el bioadhesivo de fibrina indujo una respuesta inflamatoria superior al resto de técnicas (p<0,001). El adhesivo de cianoacrilato demostró una actividad inflamatoria inferior a la sutura (p<0,005). A los 30 días la reacción inflamatoria generada por los adhesivos de fibrina y cianoacrilato superó a la presentada por las técnicas con sutura y cierre autovalvulado (p<0,005). A los 7 días, se observa una respuesta cicatricial incompleta con las técnicas con sutura, sin sutura y con cianoacrilato, y moderada con la técnica de fibrina. El grado de cicatrización observado con la técnica con cianoacrilato es incompleto al cabo de los 30 días. En este tiempo, el grado de cicatrización con las técnicas sin sutura, con sutura y con fibrina es completo. Conclusiones: El bioadhesivo de fibrina demuestra ser una sustancia más inflamatoria que el resto de técnicas. El adhesivo de cianoacrilato presenta una tolerancia biológica semejante a la sutura. Según esto, los bioadhesivos de cianoacrilato pueden constituir una alternativa al material de sutura en cirugía escleral (AU)

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[Suture of skin lacerations using LAT gel (lidocaine, adrenaline, tetracaine)]. / Sutura de laceraciones cutáneas con gel LAT (lidocaína, adrenalina, tetracaína).

PURPOSE: Our aim is to assess the effectiveness and possible use od a new gel formulation for a LAT solution in minor lacerations repair and to propose its use for daily practice in surgical repair of skin lacerations near ocular structures like eyelids, eyebrows or forhead. METHOD: Fifty patients presenting skin lacerations of various origins and locations complying with inclusion criteria were topically anesthesized using LAT gel previous to suturing. Concentrations in final gel solution were as follows: Tetracaine 1.0%. Lidocaine 1.5% and Adrenaline 0.1%. Effectiveness of anaesthesia was assessed by means of various pain evaluation scales filled by patients and physician. RESULTS: Lidocaine infiltration was performed if any sign of pain was observed. 277 sutures were performed. Lidocaine infiltration was needed in five patients (10%) all of those evidencing lacerations in hands or fingers; no laceration in any facial area nor scalp needed any supplementary lidocaine infiltration. Of the total 254 sutures not needing infiltration, 19 (7.49%) elicited a painful response. 97% of all sutures placed in face and scalp elicited a less painful response and this difference was statistically significant against locations other than head. An average dose of 0.82 ml. of LAT was used in our study (consisting in 12.3 mg of Lidocaine, 8.2 mg of Tetracaine an 0.82 mg of Adrenalin). CONCLUSION: LAT gel is an effective alternative for the repair of wounds needing minor surgical procedures, it provides anaesthesia for lacerations in face and scalp of children and adults.

Sutura de laceraciones cutáneas con gel LAT (lidocaína, adrenalina, tetracaína) / Sutures of skin laceration using LAT gel (lidocaine, adrenaline, tetracaine)

Objetivo: Nuestro propósito es evaluar la eficacia y posibles usos de la formulación de un nuevo gel anestésico para reparar lesiones incisas en piel, tan cercanas a nuestra práctica diaria en estructuras perioculares (ceja, párpado, frente,...).Métodos: Se suturaron 50 laceraciones de otros tantos pacientes tras anestesia tópica con gel LAT. Las concentraciones utilizadas fueron tetracaína 1 por ciento, lidocaína 1,5 por ciento y adrenalina 0,1 por ciento. La eficacia del efecto anestésico se valoró mediante diferentes escalas de dolor. Se realizó infiltración con lidocaína si aparecía algún signo de dolor. Resultados: Se realizaron 277 puntos de sutura. La infiltración con lidocaína fue necesaria en 5 pacientes (10 por ciento), todos ellos con laceraciones en manos o dedos, no precisó infiltración ninguna lesión en la zona de la cara. De los 254 puntos en los que la infiltración no fue necesaria 19 (7,49 por ciento) presentaron respuesta dolorosa. El 97 por ciento de todas las suturas localizadas en cuero cabelludo o en territorio facial no presentaron respuesta dolorosa. La dosis media de LAT gel utilizada en nuestro estudio fue de 0,82 ml (12,3 mg de lidocaína; 8,2 mg de tetracaína y 0,82 mg de adrenalina). Conclusión: Como conclusión debemos reseñar que el gel LAT es una alternativa para la sutura de lesiones que requieren intervención mínima, suministrando anestesia en áreas de cara y cuero cabelludo en niños y adultos (AU)

[Comparative study between different conjunctival tissue adhesives]. / Estudio comparativo entre diferentes adhesivos conjuntivales.

PURPOSE: To evaluate efficacy and clinical and histopathological tolerance of a new acrylic tissue adhesive (ADAL-2) compared to sutures (Vicryl) and other available tissue adhesives (Tisuacryl) for their use in conjunctival surgery. METHODS: This was an experimental study performed in New Zealand albino rabbits with conjunctival dissection and closure by ADAL-2. Groups treated with Vicryl and Tisuacryl were compared regarding efficacy, clinical, and histological tolerance at 7, 28 and 42 days. RESULTS: Efficacy was similar in the three methods of conjunctival repositioning evaluated. Tolerance to ADAL-2 was similar to that of Vicryl suture and tolerance to ADAL-2 was superior to that to Tisuacryl. Histopathological results with ADAL-2 and Tisuacryl are similar. CONCLUSIONS: ADAL-2 tissue adhesive is an efficient and very well tolerated alternative for conjunctival closure in ophthalmic surgery.

Estudio comparativo entre diferentes adhesivos conjuntivales / Comparative study between different conjunctival tissue adhesives

Objetivo: Evaluar la efectividad y tolerancia clínica e histológica de un nuevo adhesivo acrílico (ADAL-2®), comparándolo con suturas (Vicryl®) y otro adhesivo comercializado (Tisuacryl®) para su uso en cirugía conjuntival. Material y métodos: Estudio experimental en conejo albino. Disección conjuntival y sellado de la misma mediante ADAL-2®. Comparación con grupos tratados con Vicryl® y Tisuacryl®. Estudio de la eficacia, tolerancia clínica e histopatológica a los 7, 28 y 42 días. Resultados: Eficacia similar de los tres métodos evaluados de reposicionamiento conjuntival. Tolerancia de ADAL-2® similar a la sutura de Vicryl®. Tolerancia de ADAL2® superior a Tisuacryl®. Similitud de los resultados histopatológicos entre ADAL-2® y Tisuacryl®. Conclusión: ADAL-2® representa una alternativa eficaz y de tolerancia óptima para el sellado conjuntival. (AU)

[ADAL-1(R): a new synthetic adhesive for use in strabismus surgery]. / ADAL-1(R): Nuevo adhesivo sintético de uso en cirugía del estrabismo.

PURPOSE: To evaluate the efficacy and tolerance of ADAL-1(R), a new adhesive in strabismus surgery. METHODS: Three groups of 10 eyes each of 30 albino rabbits underwent superior rectus muscle recession 4 mm, 1(st) group of 10 eyes using the new adhesive, sacrified after one week, 2(nd) group of 10 eyes also with ADAL-1(R), sacrificed after one month and the 3(rd) group (control) of 10 eyes using Dexon 6/0 suture, sacrificed after one month. Clinical evaluation was done at the 1(st) postoperative day, at one week and at one month. The presence of residue of the adhesive, its hardness and the condition of the muscle were all studied after sacrificing the animal. Descriptive study was done for the 1(st) and the 2(nd) group, within the 2(nd) group significant changes along the follow up period were studied using the Friedman test and also differences between the 2(nd) and the suture group were examined using the Fisher's Exact Test. RESULTS: The inflammatory reaction was evaluated between absent and mild in 80% of the cases, both in the 2(nd) and the control group. In the ADAL-1(R) group there were significant statistical differences between 1(st) and 4(th) week (p=0.0002). In the 2(nd) group, 80% of the muscles were attached to the planed position and 20% were slightly displaced, while in the control group 90% of the muscles were attached to the planed position, and 10% were slightly displaced, however there is no significant difference between the two groups p=0.5 (Fisher's Exact Test). CONCLUSION: ADAL-1(R), a new adhesive, could replace sutures in strabismus surgery, giving rise to a rapid and efficient adhesion between muscles and sclera and well tolerated by the ocular tissues.

ADAL-1®: Nuevo adhesivo sintético de uso en cirugía del estrabismo / ADAL-1®: A new synthetic adhesive for use in strabismus surgery

Objetivo: Valorar la eficacia y la tolerancia de un nuevo adhesivo de base cianoacrílica para la unión de la musculatura extraocular a esclera en la cirugía del estrabismo. Materiales y métodos: Se ha utilizado el conejo albino de raza neozelandesa como animal de experimentación operados con recesión 4 mm del recto superior. Se han realizado 3 grupos de 10 ojos cada uno (10 conejos). 1.er grupo unión del músculo o esclera mediante adhesivo ADAL-1® sacrificado a la semana de evolución. 2.º grupo: unión músculo a esclera mediante ADAL-1® sacrificado al mes de evolución y 3.er grupo unión de músculo a esclera mediante sutura Dexon 6/0 al mes de evolución como grupo control. Se valoró mediante el índice inflamatorio: la inflamación, secreción y erosión conjuntival al 1.er, al 7.º y al 28 día de evolución. Tras sacrificar el animal se estudió la presencia o no de adhesivo, consistencia y estado muscular. Estudio estadístico mediante Test de Friedman y Test Exacto de Fisher. Resultados: La reacción inflamatoria se valoró entre ausente y ligera en el 80 por ciento de los casos en los grupos 2.º y 3.º, existiendo una diferencia significativa entre 1.ª semana y 4.ª semana con una p=0,0002 entre los grupos 1.º y 2.º. En cuanto a la eficacia, el 80 por ciento de los músculos se encuentran adheridos a la posición deseada y 20 por ciento ligeramente desplazados entre 0,5 y 1 mm en el grupo del adhesivo. En el grupo control el 90 por ciento de los músculos estaba en el sitio deseado y un 10 por ciento ligeramente desplazado. No existiendo diferencias estadísticamente significativas (p=0,5, Fisher's Exact Test). Conclusiones: Este nuevo adhesivo ADAL-1® totalmente de síntesis, es capaz de substituir las suturas en cirugía del estrabismo, generando uniones eficaces y rápidas siendo bien toleradas por los tejidos oculares y substituidos por tejido cicatricial normal. (AU)

Brown-Sequard syndrome associated with Horner's syndrome after a penetrating trauma at the cervicomedullary junction.

STUDY DESIGN: Case report of a 21-year-old man that had concurrence of Brown-Sequard syndrome and Horner's syndrome after a penetrating trauma in the neck. OBJECTIVES: This report analyzes the location of lesions that cause a combination of Horner's and Brown-Sequard syndrome. It is important to know the anatomic structure of spinal cord and the sympathetic nerve chain. SETTING: Spinal Cord Unit, Department of Physical Medicine and Rehabilitation, Hospital La Fe, Valencia, Instituto Oftalmologico de Alicante, Alicante, Spain. METHODS: Description of a single patient case report. RESULTS: The clinical findings and MRI showed a good correlation. The Horner's syndrome was confirmed with a 4% cocaine test. The patient received a conservative treatment with high-dose steroid therapy (NASCIS-3). CONCLUSION: The patient presented with Brown-Sequard syndrome and Horner's syndrome. Clinical examination and MRI made a quick and correct diagnosis. The patient recovered completely after the conservative treatment.

Nuevo adhesivo Adal-1®: Determinación de su fuerza tensil en la unión de tejido muscular y esclera / New bioadhesive adal-1®: determination of its tensile strength to join muscle tissue to sclera

Objetivo: Medir de forma cuantitativa la fuerza tensil que se debe realizar para separar el músculo unido a esclera mediante el adhesivo ADAL-1®.Métodos: En cirugía de estrabismo, con sección del músculo recto superior. Se han realizado 4 grupos distintos (5 ojos cada uno), utilizando el conejo albino de raza neozelandesa, y ojos de cordero cadáver. Se ha utilizado la sutura Dexon® 6/0 como grupo control. Se ha valorado la fuerza tensil mediante un dinamómetro, en 2 tiempos: 1.º Tiempo inmediato tras la adhesión (grupos I y II), 2.º a los 7 días de la adhesión (grupos III y IV).Resultados: Evaluados mediante el paquete informático SPSS 6.0. El valor medio de la fuerza tensil en el grupo I, fue, de X=1,23ñ0,17 Newtons. En el grupo II una media de X=0,793ñ0,02. En el grupo III, X=1,01ñ0,17, mientras que en el grupo IV, la media fue, de X=0,89ñ0,09 Newtons. Existiendo diferencias estadísticamente significativas entre los grupos I y II, con una P=0,004. No existiendo diferencias estadísticamente significativas entre los grupos III y IV con una P=0,129.Conclusiones: La unión entre la esclera y el músculo realizada con el adhesivo ADAL-1®, es tan resistente a la tracción como la realizada con la sutura Dexon® 6/0 (AU)

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Corneal wound healing after laser in situ keratomileusis in rabbits.

BACKGROUND: The aim of this study was to characterize the cell biology of wound healing in rabbit corneas subjected to laser in situ keratomileusis (LASIK). METHODS: Rabbit corneas underwent LASIK with various multizone photoablations or only a lamellar keratotomy followed by repositioning of the flap. We looked for indications for an active wound healing process. Immunohistochemistry for the extradomain A cellular fibronectin (EDA-cFn) or tenascin (Tn) and routine histology were examined. RESULTS: Four days after LASIK or lamellar keratotomy followed by repositioning of the flap, epithelial plugs and prominent keratocytes as well as Tn and EDA-cFn immunoreactions-indicative of a wound-healing process-appeared in the wound margins. Epithelial plugs were less conspicous, and prominent, presumably activated, keratocytes were no longer identified at the wound margin at 2.5 and 5 months after wounding. However, EDA-cFn and Tn immunoreactivities could still be observed. Only the stromal cells located in the periphery of the flap and in relatively close contact with the epithelium were surrounded by scar tissue expressing immunoreactivity for EDA-cFn or Tn. The central corneal stroma was devoid of scar tissue. CONCLUSION: Results indicate that the wound healing reaction after LASIK takes place only at the periphery of the microkeratome wound, leaving the central optical zone clear.

Recovery of corneal nerve morphology following laser in situ keratomileusis.

Morphological changes in the corneal nerves after laser in situ keratomileusis (LASIK) were investigated and the changes were compared with those observed after creation of the keratectomy flap without subsequent photoablation. After creating the hinged flap, a multizone excimer laser photoablation (myopic correction from 6.00 to 6.66 D; diameter 6 mm) was performed on 27 rabbit corneas. Seven of these 27 rabbits received an automated keratectomy without laser photoablation on the fellow eye. A histochemical acetylcholinesterase reaction was used to demonstrate the changes in the morphology of the corneal nerves 3 days, 2.5 and 5 months after the operations. In all specimens the deepest stromal nerve bundles showed normal morphology. Cut nerve trunks were found at the wound margins and at the level of the flap interphase in the stromal bed. At 3 days, both epithelial and basal epithelial/subepithelial nerves were found at the hinge of the flap but the rest of the flap showed a major loss of epithelial, basal epithelial/subepithelial and superficial stromal nerves. A few new regenerating thin nerve fibers were found to emerge from the cut stromal nerve trunks. They appeared to pass the wound margin into the flap area below the epithelium. At 2.5 and 5 months an increasing number of regenerating nerve leashes were observed to emerge from the cut stromal nerve trunks. They appeared to send anastomosing fibers among the neighboring stromal nerves. By this time the epithelial, basal epithelial/subepithelial and anterior stromal innervation had gained an almost normal nerve density and architecture. In the corneas with the flap only, the epithelial innervation was slightly better spared in the center of the flap, and the stromal changes were somewhat less prominent compared with the LASIK corneas.

[Morphometry (Sketch PC) of the corneal endothelium after injection of 5-fluorouracil into the anterior chamber]. / Morphométrie (Sketch P.C.) de l'endothélium cornéen après l'injection de 5-Fluorouracile dans la chambre antérieure.

We made a study of the effect on the corneal endothelium of rabbits of the introduction of 5-Fluorouracile into the anterior chamber. An EECC was performed on 24 rabbits, using BSS-Plus for right eye and 5-Fluorouracile dissolved in BSS-Plus for the left eye as irrigation solutions. We calculated the individual endothelial cell surface and form factor, finding no statistically significant differences between the two groups.