Uso de sustituto semisintético de duramadre como injerto tras extrusión de prótesis en una cavidad anoftálmica / Use of semisynthetic dura mater substitute as a patch graft for prosthesis extrusion in anophthalmic socket

Presentamos un caso de una paciente de 3 años de edad con diagnóstico de retinoblastoma en el ojo izquierdo. El curso de la enfermedad obligó a la enucleación de dicho ojo e implantación de una prótesis. Dos años tras la cirugía, se produjo una extrusión parcial de la prótesis en la cavidad anoftálmica y se decidió emplear un sustituto semisintético de duramadre para cubrir el defecto. El uso de un sustituto semisintético de duramadre en este escenario específico no ha sido comunicado previamente

We present a case report of a three-year old patient diagnosed with retinoblastoma in her left eye. The course of the disease made enucleation of the latter eye and a prosthesis implant necessary. Two years after surgery, partial prosthesis extrusion occurred and a semisynthetic dura mater substitute was used as a patch graft to cover the defect. To our knowledge, semisynthetic dura mater substitutes' use in this scenario has not been previously reported

Use of semisynthetic dura mater substitute as a patch graft for prosthesis extrusion in anophthalmic socket. / Uso de sustituto semisintético de duramadre como injerto tras extrusión de prótesis en una cavidad anoftálmica.

We present a case report of a three-year old patient diagnosed with retinoblastoma in her left eye. The course of the disease made enucleation of the latter eye and a prosthesis implant necessary. Two years after surgery, partial prosthesis extrusion occurred and a semisynthetic dura mater substitute was used as a patch graft to cover the defect. To our knowledge, semisynthetic dura mater substitutes' use in this scenario has not been previously reported.

Análisis cualitativo de ampollas de filtración reparadas mediante tomografía de coherencia óptica de segmento anterior / Qualitative analysis of repaired filtering blebs with anterior segment-optical coherence tomography

Objetivo: Realizar un análisis cualitativo de las ampollas de filtración que han sido reparadas quirúrgicamente por presentar Seidel tardío. Métodos: Estudio de 10 ampollas de filtración que requirieron reparación quirúrgica mediante la OCT-SA Triton (Topcon(R)). Se analizó, a los 6 meses de la cirugía, el patrón morfológico y las estructuras internas de las mismas, así como el estado del recubrimiento. La obtención de las imágenes fue mediante longitudes de onda de 1.050 nm. Resultados: Según la clasificación de Hirooka, encontramos 3 patrones diferentes en la morfología de la ampolla que pudimos relacionar con la funcionalidad de la misma. En un 70% de los casos el recubrimiento fue completo, presentando quistes subepiteliales difusos (tipo quístico). Dos casos mostraron una retracción conjuntival completa, sin cobertura por Tenon. Las paredes estaban adelgazadas, mostrando una desestructuración de la ampolla (patrón difuso). En un tercer grupo, la imagen obtenida mostraba una retracción conjuntival parcial con cobertura por Tenon. Presentaba algún quiste subepitelial difuso y con paredes siguiendo un patrón laminar. Conclusión: Mediante la OCT-SA es posible estudiar de forma detallada las características de la ampolla y las de su cobertura en el caso de reparación con avance conjuntival por Seidel tardío. Permite visualizar precozmente la retracción de la conjuntiva que en la lámpara de hendidura no sería visible y predecir mediante la morfología de la ampolla la funcionalidad de la misma (AU)

Objective: To provide a qualitative analysis of filtering blebs after being surgically repaired due to late blebs leaks. Methods: Blebs were studied 6 months after surgical reparation using AS-OCT Triton (Topcon(R)). An analysis was made of the morphological pattern and internal structures of blebs, including the covering, in 10 patients. The images were obtained using OCTs at a wavelength of 1050 nm. Results: According to the Hirooka classification, three different patterns were found in the structure of blebs, which made it possible to correlate them with their functionality. A full covering was observed in 70% of the cases, and they showed sub-epithelial cysts (cystoid pattern). Two cases showed a full conjunctival retraction without Tenon's covering. The walls were thin, with a de-structured bleb (diffuse pattern) being visualised. In the third group, the image showed a partial conjunctival retraction with Tenon's covering. There were some sub-epithelial diffuse cysts with walls following a laminar pattern. Conclusion: Using AS-OCT, it is possible to study the bleb's characteristics in detail, as well as the cover, in the case of blebs requiring repair due to late leaks, using conjunctival advancement. It allows for the early visualisation of conjunctival retractions that were not visible in a slit lamp, and to predict the functionality of the blebs by their morphology (AU)

Hamartoma combinado de la retina y del epitelio pigmentario de la retina / Combined hamartoma of the retina and retinal pigment epithelium

No disponible

Análisis y seguimiento con angiografía por tomografía de coherencia óptica de neovascularización coroidea tipo 1 en degeneración macular tras tratamiento antiangiogénico / Analysis and follow-up of type 1 choroidal neovascularisation with optical coherence tomography-angiography after antiangiogenic treatment

Objetivo: Describir las características de la neovascularización coroidea (NVC) tipo 1 en pacientes con degeneración macular asociada a la edad (DMAE), utilizando la angiografía por tomografía de coherencia óptica (A-OCT) secuencialmente durante el transcurso de un protocolo estándar de 3 inyecciones intravítreas de fármaco anti-VEGF. Métodos: Seis ojos con DMAE neovascular no tratados previamente fueron incluidos. Se obtuvieron imágenes por A-OCT empleando AngioPlex Cirrus HD-OCT 5000 (Carl Zeiss Meditec, Inc., Dublin, EE. UU.) y DRI OCT Triton SS-OCT Angio (Topcon, Medical Systems, Inc. Oakland, NJ, EE. UU.). El área estudiada comprende un escáner macular de 3×3mm. Diferentes patrones morfológicos y aspectos cuantificables de las membranas neovasculares han sido evaluados con imágenes en proyección en face, que fueron tomadas en distintos tiempos del seguimiento de los pacientes. Resultados: El grado de respuesta al tratamiento fue estimado empleando criterios de actividad de NVC para A-OCT. Puntuaciones más altas en los ítems de actividad antes del tratamiento resultaron en mayores reducciones del área de las membranas. Los resultados finales de reducción de área oscilaron entre el 83,5 y el 1,4%. Las A-OCT realizadas a la semana de tratamiento revelaron los mayores porcentajes de reducción. Conclusiones: La A-OCT ofrece la posibilidad de analizar en profundidad las características morfológicas y estructurales en NVC de tipo 1. Los criterios de actividad permiten guiar decisiones terapéuticas y evaluar la respuesta al tratamiento. Con esta técnica puede obtenerse información útil tanto cualitativa como cuantitativa. Sin embargo, son necesarios avances en el desarrollo del software y en investigación para poder definir el papel de esta herramienta en la práctica diaria (AU)

Aim: To describe the characteristics of type 1 choroidal neovascularisation (CNV) in age-related macular degeneration (ARMD) using two different optical coherence tomography angiography (OCT-A) devices sequentially during a standard protocol of three intravitreal injections of an anti-vascular endothelial growth factor (anti-VEGF). Methods: The study included 6 eyes with naïve neovascular ARMD. Macular OCT-A images were acquired using AngioPlex Cirrus HD-OCT 5000 (Carl Zeiss Meditec, Inc., Dublin, USA) and DRI OCT Triton SS-OCT Angio (Topcon, Medical Systems, Inc. Oakland, NJ, USA). The macular OCT-A scan covered an area of 3×3mm. Distinct morphological patterns and quantifiable features of the neovascular membranes were studied on en face projection images, which were taken at different stages of the follow-up. Results: Treatment response could be estimated using the OCT-A criteria of CNV activity. Higher activity scores before treatment resulted in a greater decrease in the membrane area. The estimated net decline in area ranged from 83.5% to 1.4%. The OCT-A performed one-week after treatment revealed the greatest area reductions. Conclusions: OCT-A provides new possibilities for the non-invasive assessment of features of neovascular networks and CNV structural morphology. Newly described activity criteria can also guide therapeutic decisions, and help in evaluating responses. Quantitative and qualitative information can be provided with this technique. However, further software development and future investigation are essential to define the role of this tool on a daily basis (AU)

Papiloflebitis versus trombosis venosa pediátrica. Un caso con polimorfismo C46T del gen F12 de la coagulación / Papillophlebitis versus paediatric venous thrombosis. A case with 46C/T polymorphism in the F12 coagulation gene

Caso clínico: Niño de 8 años, sin enfermedades, con pérdida brusca de la agudeza visual (AV) en el ojo izquierdo (OI). Exploración: AV 1 en el OD y 0,1 en el OI, discreto DPAR izquierdo. Biomicroscopía normal. Fundoscopía: papila congestiva, tortuosidad venosa, hemorragias peripapilares con edema macular en el OI. El estudio sistémico únicamente reveló polimorfismo C46T del gen F12 de la coagulación. Ocho meses después: AV de 1 con fundoscopía normal. Discusión: La papiloflebitis es una oclusión de la vena central de la retina (VCR) inflamatoria no isquémica, oftalmoscópicamente semejante a las trombosis de VCR. El estudio sistémico es fundamental para descartar enfermedades subyacentes (AU)

Clinical case: An 8 year-old boy with no known diseases, with sudden loss of visual acuity (VA) in the left eye (LE). Examination: VA 1 in right eye, and 0.1 in LE, discrete left relative afferent pupil defect (RAPD). Normal biomicroscopy. Funduscopy: congestive papilla, venous tortuosity, peripapillary haemorrhages with macular oedema in LE. The systemic study only revealed A C46Tpolymorphism in the F12 coagulation gene. He had a VA of 1 and normal funduscopy 8 months later. Discussion: Papillophlebitis is an inflammatory and non-ischaemic central retinal vein occlusion, ophthalmoscopically similar to central retinal vein thrombosis. The systemic study is essential to rule out underlying diseases (AU)

Analysis and follow-up of type 1 choroidal neovascularisation with optical coherence tomography-angiography after antiangiogenic treatment. / Análisis y seguimiento con angiografía por tomografía de coherencia óptica de neovascularización coroidea tipo 1 en degeneración macular tras tratamiento antiangiogénico.

AIM: To describe the characteristics of type 1 choroidal neovascularisation (CNV) in age-related macular degeneration (ARMD) using two different optical coherence tomography angiography (OCT-A) devices sequentially during a standard protocol of three intravitreal injections of an anti-vascular endothelial growth factor (anti-VEGF). METHODS: The study included 6 eyes with naïve neovascular ARMD. Macular OCT-A images were acquired using AngioPlex Cirrus HD-OCT 5000 (Carl Zeiss Meditec, Inc., Dublin, USA) and DRI OCT Triton SS-OCT Angio (Topcon, Medical Systems, Inc. Oakland, NJ, USA). The macular OCT-A scan covered an area of 3×3mm. Distinct morphological patterns and quantifiable features of the neovascular membranes were studied on en face projection images, which were taken at different stages of the follow-up. RESULTS: Treatment response could be estimated using the OCT-A criteria of CNV activity. Higher activity scores before treatment resulted in a greater decrease in the membrane area. The estimated net decline in area ranged from 83.5% to 1.4%. The OCT-A performed one-week after treatment revealed the greatest area reductions. CONCLUSIONS: OCT-A provides new possibilities for the non-invasive assessment of features of neovascular networks and CNV structural morphology. Newly described activity criteria can also guide therapeutic decisions, and help in evaluating responses. Quantitative and qualitative information can be provided with this technique. However, further software development and future investigation are essential to define the role of this tool on a daily basis.

Qualitative analysis of repaired filtering blebs with anterior segment-optical coherence tomography. / Análisis cualitativo de ampollas de filtración reparadas mediante tomografía de coherencia óptica de segmento anterior.

OBJECTIVE: To provide a qualitative analysis of filtering blebs after being surgically repaired due to late blebs leaks. METHODS: Blebs were studied 6 months after surgical reparation using AS-OCT Triton (Topcon®). An analysis was made of the morphological pattern and internal structures of blebs, including the covering, in 10 patients. The images were obtained using OCTs at a wavelength of 1050nm. RESULTS: According to the Hirooka classification, three different patterns were found in the structure of blebs, which made it possible to correlate them with their functionality. A full covering was observed in 70% of the cases, and they showed sub-epithelial cysts (cystoid pattern). Two cases showed a full conjunctival retraction without Tenon's covering. The walls were thin, with a de-structured bleb (diffuse pattern) being visualised. In the third group, the image showed a partial conjunctival retraction with Tenon's covering. There were some sub-epithelial diffuse cysts with walls following a laminar pattern. CONCLUSION: Using AS-OCT, it is possible to study the bleb's characteristics in detail, as well as the cover, in the case of blebs requiring repair due to late leaks, using conjunctival advancement. It allows for the early visualisation of conjunctival retractions that were not visible in a slit lamp, and to predict the functionality of the blebs by their morphology.

Papillophlebitis versus paediatric venous thrombosis. A case with 46C/T polymorphism in the F12 coagulation gene. / Papiloflebitis versus trombosis venosa pediátrica. Un caso con polimorfismo C46T del gen F12 de la coagulación.

CLINICAL CASE: An 8 year-old boy with no known diseases, with sudden loss of visual acuity (VA) in the left eye (LE). EXAMINATION: VA 1 in right eye, and 0.1 in LE, discrete left relative afferent pupil defect (RAPD). Normal biomicroscopy. Funduscopy: congestive papilla, venous tortuosity, peripapillary haemorrhages with macular oedema in LE. The systemic study only revealed A C46Tpolymorphism in the F12 coagulation gene. He had a VA of 1 and normal funduscopy 8 months later. DISCUSSION: Papillophlebitis is an inflammatory and non-ischaemic central retinal vein occlusion, ophthalmoscopically similar to central retinal vein thrombosis. The systemic study is essential to rule out underlying diseases.

[Experimental study of the suture of the intraocular lens sutured to the ciliary sulcus. Needle passage and distance from the limbus]. / Estudio experimental de la sutura de las lentes intraoculares suturadas al sulcus ciliar. Paso de la aguja y distancia al limbo.

OBJECTIVE: To discover which technique is best to scleral suture fixation of the lens in the ciliary sulcus, based on two needle direction options: passing the needle from the outer part of the eyeball inwards or from the inner part outwards and to know at what distance the needle must be passed from the sclerocorneal limbus. MATERIAL AND METHODS: We used 40 cadaver eyes conserved in 10% formaldehyde. The needle was passed from the interior to the exterior of the eye, observing whether if it had crossed through the ciliary sulcus and the distance of the needle from the limbus. Stitches were also made, going from the exterior to the interior of the eyeball at a known distance from the limbus, either parallel to the iris or perpendicular to the sclera. RESULTS: When the needle was passed from the interior toward the exterior of the eye, it passed through the ciliary sulcus, exiting the eye at 1.50+/-0.16 mm from the limbus, in 80% of the cases. When the needle was passed from the exterior toward the interior of the globe perpendicularly to the sclera only 32.5% passed through the sulcus and when it was parallel to the iris only, only 40%. There is greater statistical probability that the needle will pass through the sulcus from the interior of the eyeball, exiting the limbus at approximately 1.5 mm. CONCLUSION: Since it is necessary to pass the suture through the sulcus in order to be able to place the lens haptics in the ciliary sulcus when suturing a posterior chamber lens to the sclera, it is best to pass the needle from the interior to the exterior of the eyeball and for the needle to exit at approximately 1.5 mm from the limbus.

Estudio experimental de la sutura de las lentes intraoculares suturadas al sulcus ciliar. Paso de la aguja y distancia al limbo / Experimental study of the suture of the intraocular lens sutured at the ciliary sulcus

Objetivo: Encontrar la mejor técnica para suturar una lente a la esclera a nivel del sulcus ciliar entre la opción de pasar la aguja desde el exterior hacia el interior del globo ocular o a la inversa y conocer cuál es la distancia a la que debe pasar la aguja respecto al limbo esclerocorneal. Material y métodos: Hemos utilizado 40 ojos de cadáver conservados en formaldehido al 10 per cent. Pasamos por un lado la aguja desde el interior hacia el exterior del ojo y consideramos si ha atravesado el sulcus ciliar y a qué distancia del limbo ha salido y por otro lado pasamos agujas desde el exterior hacia el interior del globo a una distancia del limbo conocida, bien paralelas al iris o bien perpendiculares a la esclera. Resultados: Cuando pasamos la aguja desde el interior hacia el exterior del ojo, en el 80 per cent de los casos atraviesa el sulcus ciliar, saliendo entonces a 1,50ñ0,16 mm del limbo. Cuando pasamos la aguja desde el exterior hacia el interior del globo perpendicularmente a la esclera sólo el 32,5 per cent atraviesa el sulcus ciliar y paralelamente al iris sólo el 40 per cent lo atraviesa. Es más probable pasar la aguja por el sulcus ciliar de forma estadísticamente significativa cuando lo hacemos desde el interior del globo ocular y sale aproximadamente 1,5 mm del limbo. Conclusión: Puesto que para conseguir situar los hápticos de la lente en el sulcus ciliar al suturar una lente de cámara posterior a la esclera hay que pasar previamente la sutura por el mismo, la mejor manera de conseguirlo es pasando la aguja desde el interior hacia el exterior del globo ocular y que ésta salga aproximadamente a 1,5 mm del limbo (AU)