Glaucoma avanzado. Guía de práctica clínica / Advanced glaucoma. Clinical practice guideline

objetivo Realización de una guía de práctica clínica actualizada que sirva de orientación para la detección, el manejo y el tratamiento de pacientes con glaucoma avanzado en la edad adulta. Métodos Tras la definición de los objetivos y alcance de la guía se constituyó el grupo de trabajo que formuló las preguntas clínicas estructuradas siguiendo el formato PICO (Patient, Intervention, Comparison, Outcomes). Se realizó una revisión de la literatura publicada hasta el momento, incluyendo guías de práctica clínica internacionales, utilizándose las herramientas AMSTAR-2 (Assessment of Multiple systematic Rewiews) y «Risk of Bias» de Cochrane para la evaluación de la calidad de la información de forma independiente por, al menos, 2 revisores. El nivel de evidencia y la elaboración del grado de recomendación se establecieron siguiendo la metodología del Scottish Intercollegiate Guidelines Network (SIGN). Resultados Se presentan recomendaciones con sus correspondientes niveles de evidencia que pueden ser de utilidad para la detección, el seguimiento y el tratamiento de pacientes con glaucoma avanzado en la edad adulta. Conclusiones A pesar de que la evidencia científica existente es escasa y el nivel de evidencia para muchas de las preguntas planteadas no es muy alto, esta guía de práctica clínica ofrece una revisión actualizada de las recomendaciones existentes para el manejo del glaucoma avanzado en el adulto (AU)

Objective To present an update clinical practice guideline that serve as a guide for the detection, evaluation and treatment of adults patients with advanced glaucoma. Methods After defining the objectives and scope of the guide, the working group was formed and structured clinical questions were formulated following the PICO (Patient, Intervention, Comparison, Outcomes) format. Once all the existing clinical evidence had been independently evaluated with the AMSTAR-2 (Assessment of Multiple systematic Rewiews) and Cochrane «Risk of bias» tools by at least 2 reviewers, recommendations were formulated following the Scottish Intercollegiate methodology Guideline Network (SIGN). Results Recommendations with their corresponding levels of evidence that may be useful in the diagnosis, monitoring and treatment of adults patients with advanced glaucoma. Conclusions Despite the fact that for many of the questions the level of scientific evidence available is not very high, this clinical practice guideline offers an updated review of the different existing aspects related to the evaluation and management of advanced glaucoma (AU)

Progresión en glaucoma. Guía de práctica clínica / Glaucoma progression. Clinical practice guide

Objetivo Ofrecer una serie de recomendaciones generales que sirvan de orientación en la evaluación y el manejo de la progresión glaucomatosa en la práctica clínica diaria a partir de la evidencia clínica de calidad existente. Métodos Tras la definición de los objetivos y del alcance de la guía se constituyó el grupo de trabajo que formuló las preguntas clínicas estructuradas siguiendo el formato PICO (Patient, Intervention, Comparison, Outcomes). Una vez evaluada toda la evidencia clínica existente con las herramientas AMSTAR2 (Assessment of Multiple systematic Rewiews) y Risk of bias de Cochrane de forma independiente por al menos dos revisores, se pasó a la formulación de recomendaciones siguiendo la metodología del Scottish Intercollegiate Guideline Network (SIGN). Resultados Se presentan recomendaciones con sus correspondientes niveles de evidencia que pueden ser de utilidad para la detección y el seguimiento de la progresión glaucomatosa con los distintos métodos disponibles y para el tratamiento de los pacientes. Conclusiones A pesar de que para muchas de las preguntas el nivel de evidencia científica disponible no es muy alto, esta guía de práctica clínica ofrece una revisión actualizada de los diferentes aspectos existentes relacionados con la evaluación y el manejo de la progresión glaucomatosa (AU)

Objective To provide general recommendations that serve as a guide for the evaluation and management of glaucomatous progression in daily clinical practice based on the existing quality of clinical evidence. Methods After defining the objectives and scope of the guide, the working group was formed and structured clinical questions were formulated following the PICO (Patient, Intervention, Comparison, Outcomes) format. Once all the existing clinical evidence had been independently evaluated with the AMSTAR2 (Assessment of Multiple Systematic Reviews) and Cochrane «Risk of bias» tools by at least two reviewers, recommendations were formulated following the Scottish Intercollegiate Guideline network (SIGN) methodology. Results Recommendations with their corresponding levels of evidence that may be useful in the interpretation and decision-making related to the different methods for the detection of glaucomatous progression are presented. Conclusions Despite the fact that for many of the questions the level of scientific evidence available is not very high, this clinical practice guideline offers an updated review of the different existing aspects related to the evaluation and management of glaucomatous progression (AU)

Advanced glaucoma. Clinical practice guideline.

OBJECTIVE: To present an update clinical practice guideline that serve as a guide for the detection, evaluation and treatment of adults patients with advanced glaucoma. METHODS: After defining the objectives and scope of the guide, the working group was formed and structured clinical questions were formulated following the PICO (Patient, Intervention, Comparison, Outcomes) format. Once all the existing clinical evidence had been independently evaluated with the AMSTAR 2 (Assessment of Multiple systematic Rewiews) and Cochrane "Risk of bias" tools by at least two reviewers, recommendations were formulated following the Scottish Intercollegiate methodology. Guideline Network (SIGN). RESULTS: Recommendations with their corresponding levels of evidence that may be useful in the diagnosis, monitoring and treatment of adults patients with advanced glaucoma. CONCLUSIONS: Despite the fact that for many of the questions the level of scientific evidence available is not very high, this clinical practice guideline offers an updated review of the different existing aspects related to the evaluation and management of advanced glaucoma.

Glaucoma progression. Clinical practice guide.

OBJECTIVE: To provide general recommendations that serve as a guide for the evaluation and management of glaucomatous progression in daily clinical practice based on the existing quality of clinical evidence. METHODS: After defining the objectives and scope of the guide, the working group was formed and structured clinical questions were formulated following the PICO (Patient, Intervention, Comparison, Outcomes) format. Once all the existing clinical evidence had been independently evaluated with the AMSTAR 2 (Assessment of Multiple Systematic Reviews) and Cochrane "Risk of bias" tools by at least two reviewers, recommendations were formulated following the Scottish Intercollegiate Guideline network (SIGN) methodology. RESULTS: Recommendations with their corresponding levels of evidence that may be useful in the interpretation and decision-making related to the different methods for the detection of glaucomatous progression are presented. CONCLUSIONS: Despite the fact that for many of the questions the level of scientific evidence available is not very high, this clinical practice guideline offers an updated review of the different existing aspects related to the evaluation and management of glaucomatous progression.

Ocular toxicity after inadvertent overdose of intracameral cefuroxime during cataract surgery.

PURPOSE: To describe intracameral toxic effects of cefuroxime at a higher dose than recommended in cataract surgery. METHODS: Retrospective study of 8 eyes of 8 patients who inadvertently received 12.5 mg/0.1 ml of intracameral cefuroxime due to a dilution error, at the end of the cataract surgery. All patients underwent a strict ophthalmology follow-up for 6 months. RESULTS: All patients presented with a marked anterior segment inflammation with corneal oedema that resolved completely in all cases (between 5 days and 3 months). At 6 months of follow-up a statistically significant difference was found in the corneal endothelial cell density when compared with the fellow eye (P = .038), being <1000 cells/mm2 in 3 cases. Three patients (37.5%) showed early macular oedema, with subfoveal ellipsoid layer disruption in one case as a permanent sequel. One patient developed an optic neuropathy with associated afferent pupillary defect. CONCLUSIONS: Although 1 mg/0.1 ml of intracameral cefuroxime has been shown to reduce the incidence of endophthalmitis, its overdose can have potentially toxic eye effects in both anterior and posterior segments.

Toxicidad ocular tras sobredosificación accidental de cefuroxima intracameral en cirugía de catarata / Ocular toxicity after inadvertent overdose of intracameral cefuroxime during cataract surgery

Objetivo Describir los efectos de la inyección de cefuroxima intracameral a una dosis más alta de la recomendada en cirugía de catarata. Métodos Estudio retrospectivo de 8 ojos de 8 pacientes operados de catarata en un mismo día que recibieron 12,5mg/0,1ml de cefuroxima intracameral de forma inadvertida al finalizar la cirugía, por un error en la dilución. A todos los pacientes se les realizó un seguimiento oftalmológico estrecho durante 6 meses. Resultado Todos los pacientes presentaron una inflamación marcada del segmento anterior con edema corneal que se resolvió en todos los casos (entre 5 días y 3 meses). A los 6 meses de seguimiento se constató una diferencia significativa en el recuento endotelial corneal de dichos ojos al compararlo con el ojo contralateral (p=0,038), siendo<1000cels/mm2 en 3 casos. Tres pacientes (37,5%) presentaron un edema macular precoz, dejando como secuela permanente la disrupción de la capa elipsoidal a nivel subfoveal en uno de los casos. Uno de los pacientes desarrolló una neuropatía óptica con defecto pupilar aferente asociado. Conclusiones Aunque la inyección de cefuroxima en cámara anterior a dosis de 1mg/0,1ml ha demostrado disminuir la incidencia de endoftalmitis, su sobredosificación puede tener efectos oculares potencialmente perjudiciales tanto en el segmento anterior como en el posterior (AU)

Purpose To describe intracameral toxic effects of cefuroxime at a higher dose than recommended in cataract surgery. Methods Retrospective study of 8 eyes of 8 patients who inadvertently received 12.5mg/0.1ml of intracameral cefuroxime due to a dilution error, at the end of the cataract surgery. All patients underwent a strict ophthalmology follow-up for 6 months. Results All patients presented with a marked anterior segment inflammation with corneal oedema that resolved completely in all cases (between 5 days and 3 months). At 6 months of follow-up a statistically significant difference was found in the corneal endothelial cell density when compared with the fellow eye (P=.038), being<1000 cells/mm2 in 3 cases. Three patients (37.5%) showed early macular oedema, with subfoveal ellipsoid layer disruption in one case as a permanent sequel. One patient developed an optic neuropathy with associated afferent pupillary defect. Conclusions Although 1mg/0.1ml of intracameral cefuroxime has been shown to reduce the incidence of endophthalmitis, its overdose can have potentially toxic eye effects in both anterior and posterior segments (AU)

Ocular toxicity after inadvertent overdose of intracameral cefuroxime during cataract surgery. / Toxicidad ocular tras sobredosificación accidental de cefuroxima intracameral en cirugía de catarata.

PURPOSE: To describe intracameral toxic effects of cefuroxime at a higher dose than recommended in cataract surgery. METHODS: Retrospective study of 8 eyes of 8 patients who inadvertently received 12.5mg/0.1ml of intracameral cefuroxime due to a dilution error, at the end of the cataract surgery. All patients underwent a strict ophthalmology follow-up for 6 months. RESULTS: All patients presented with a marked anterior segment inflammation with corneal oedema that resolved completely in all cases (between 5 days and 3 months). At 6 months of follow-up a statistically significant difference was found in the corneal endothelial cell density when compared with the fellow eye (P=.038), being<1000 cells/mm2 in 3 cases. Three patients (37.5%) showed early macular oedema, with subfoveal ellipsoid layer disruption in one case as a permanent sequel. One patient developed an optic neuropathy with associated afferent pupillary defect. CONCLUSIONS: Although 1mg/0.1ml of intracameral cefuroxime has been shown to reduce the incidence of endophthalmitis, its overdose can have potentially toxic eye effects in both anterior and posterior segments.

Las gotas de silicona tras inyecciones intravítreas: un efecto adverso incómodo en nuestras consultas / Silicone oil droplets after intravitreal injections: An uncomfortable adverse effect in our consultations

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Faco-esclerectomía profunda no perforante como tratamiento de la hipertensión ocular secundaria al implante intravítreo de dexametasona / Phaco-non-penetrating deep sclerectomy in ocular hypertension secondary to dexamethasone intravitreal implant

OBJETIVO: Evaluar las características y la evolución de los pacientes que requirieron cirugía filtrante de glaucoma (esclerectomía profunda no perforante) para controlar la hipertensión ocular (HTO) secundaria al implante intravítreo de 0,7 mg de dexametasona (Ozurdex(R)). MÉTODOS: Serie de casos observacional retrospectiva de pacientes tratados mediante Ozurdex(R) en un hospital terciario universitario entre mayo 2011 y abril 2016. RESULTADOS: El 1,10% (4/363) de los pacientes tratados con Ozurdex(R) requirieron faco-esclerectomía profunda no perforante (FEPNP) para controlar la HTO secundaria refractaria a tratamiento médico hipotensor. Los 4 casos comenzaron el tratamiento tópico hipotensor o aumentaron su tratamiento hipotensor previo desde el primer implante intravítreo de Ozurdex(R). Todos los casos habían recibido 3 o más inyecciones de Ozurdex(R) antes de que se requiriera la realización de la FEPNP para el control de la PIO. Tras el tratamiento quirúrgico, en todos los casos se alcanzó una PIO óptima sin necesidad de tratamiento tópico adicional. Dos pacientes requirieron retratamiento con nuevas inyecciones de Ozurdex(R) después de la FEPNP, manteniéndose la PIO dentro de los límites normales sin necesidad de tratamiento. CONCLUSIONES: Esta es la primera serie de casos que aporta información acerca de los favorables resultados de la FEPNP como tratamiento de la HTO secundaria a implante intravítreo de Ozurdex(R). Los 4 casos presentan una PIO controlada sin tratamiento tras la cirugía. El retratamiento con Ozurdex(R) en aquellos pacientes que se han sometido a FEPNP es posible, manteniéndose un buen control de la PIO

PURPOSE: To evaluate the characteristics and progression of patients treated with a 0.7 mg dexamethasone intravitreal implant (Ozurdex(R)) and required glaucoma filtering surgery (phaco-non-penetrating deep sclerectomy) to control ocular hypertension (OHT). METHODS: A retrospective observational study including patients treated with Ozurdex(R) in a tertiary-care university hospital from May 2011 to April 2016. RESULTS: In five years of follow-up, 1.10% (4/363) of patients treated with 0.7 mg dexamethasone intravitreal implant required phaco-non-penetrating deep sclerectomy (PNPDS) to control OHT refractory to topical treatment. All four patients started or increased previous antihypertensive topical treatment since the first dexamethasone intravitreal implant. Three or more dexamethasone intravitreal implants were injected in the four cases before intraocular pressure (IOP) became uncontrolled and PNPDS was performed. All four patients have a successfully controlled IOP without treatment after PNPDS. Two patients required additional treatment with dexamethasone intravitreal implants after PNPDS, maintaining IOP under control without treatment. CONCLUSIONS: To the best of our knowledge, this is the first study describing the successful results of PNPDS in OHT secondary to dexamethasone intravitreal implant. All four patients have achieved controlled IOP without treatment. Re-treatment with dexamethasone intravitreal implant in those patients who underwent PNPDS is also possible, and IOP remains controlled

Phaco-non-penetrating deep sclerectomy in ocular hypertension secondary to dexamethasone intravitreal implant. / Faco-esclerectomía profunda no perforante como tratamiento de la hipertensión ocular secundaria al implante intravítreo de dexametasona.

PURPOSE: To evaluate the characteristics and progression of patients treated with a 0.7mg dexamethasone intravitreal implant (Ozurdex®) and required glaucoma filtering surgery (phaco-non-penetrating deep sclerectomy) to control ocular hypertension (OHT). METHODS: A retrospective observational study including patients treated with Ozurdex® in a tertiary-care university hospital from May 2011 to April 2016. RESULTS: In five years of follow-up, 1.10% (4/363) of patients treated with 0.7mg dexamethasone intravitreal implant required phaco-non-penetrating deep sclerectomy (PNPDS) to control OHT refractory to topical treatment. All four patients started or increased previous antihypertensive topical treatment since the first dexamethasone intravitreal implant. Three or more dexamethasone intravitreal implants were injected in the four cases before intraocular pressure (IOP) became uncontrolled and PNPDS was performed. All four patients have a successfully controlled IOP without treatment after PNPDS. Two patients required additional treatment with dexamethasone intravitreal implants after PNPDS, maintaining IOP under control without treatment. CONCLUSIONS: To the best of our knowledge, this is the first study describing the successful results of PNPDS in OHT secondary to dexamethasone intravitreal implant. All four patients have achieved controlled IOP without treatment. Re-treatment with dexamethasone intravitreal implant in those patients who underwent PNPDS is also possible, and IOP remains controlled.

Queratitis por Stenotrophomonas maltophilia tratada con trimetoprima-sulfametoxazol / Stenotrophomonas maltophilia keratitis treated with trimethoprim-sulfamethoxazole

CASO CLÍNICO: Mujer de 84 años con defecto epitelial persistente e infiltrado estromal denso tras trasplante corneal. El análisis microbiológico reveló una Stenotrophomonas maltophilia (S. maltophilia), resistente a todos los antibióticos salvo a trimetoprima-sulfametoxazol (TMP/SMX) Se consiguió su resolución tras 3 semanas de tratamiento con TMP/SMX tópico y oral. DISCUSIÓN: S. maltophilia es un microorganismo oportunista raramente descrito en oftalmología. Se asocia con conjuntivitis, queratitis, escleritis, dacriocistitis, celulitis y endoftalmitis, con importante morbilidad. El tratamiento es complicado por sus múltiples resistencias a antibióticos de amplio espectro. El TMP/SMX en monoterapia puede considerarse como una opción de tratamiento para estas queratitis

CASE REPORT: An 84 year-old woman with persistent epithelial defect and a dense stromal infiltrate post-corneal transplantation. According to the microbiological results, it was due to a Stenotrophomonas maltophilia (S. maltophilia) resistant to all antibiotics except trimethoprim-sulfamethoxazole (TMP/SMX). Healing was achieved after three weeks of treatment with oral and topical TMP/SMX. DISCUSSION: S. maltophilia is an opportunistic microorganism rarely described in ophthalmology. It is associated with conjunctivitis, keratitis, scleritis, dacryrocystitis, cellulitis, and endophthalmitis with significant morbidity. Treatment is complicated because of its resistances to broad-spectrum antibiotics. TMP/SMX monotherapy can be considered an option of treatment for this type of keratitis

Desprendimiento neurosensorial macular recurrente en fístula carótido-cavernosa / Recurrent neurosensory macular detachment in carotid-cavernous fistula

CASO CLÍNICO: Varón de 46 años, acudió a Urgencias por disminución de agudeza visual y exoftalmos en ojo derecho. Aquejaba cefalea, diplopía de 4 meses de evolución e historia de desprendimiento neurosensorial (DNS) resuelto espontáneamente un mes antes. Presentaba tortuosidad de vasos conjuntivales y epiesclerales y nuevo DNS macular derecho. La sospecha de fístula carótido-cavernosa quedó confirmada mediante angiotomografía computarizada (angio-TC). Durante su ingreso la fístula se cerró espontáneamente. Al mes, el DNS había desaparecido. DISCUSIÓN: La fístula carótido-cavernosa debe incluirse en el diagnóstico diferencial de los DNS maculares. El DNS puede desaparecer espontáneamente al cerrarse la fístula

CASE REPORT: A 46 year-old man was seen in the emergency department complaining of vision loss and exophthalmos in his right eye. He also complained of headache, diplopia of 4 months onset, and neurosensory detachment that resolved spontaneously the month before. The study revealed tortuous conjunctival and episcleral vessels and neurosensory macular detachment in his right eye. A carotid-cavernous fistula was confirmed by computed tomography angiography. The fistula closed spontaneously during the hospitalization. One month later, the neurosensory detachment disappeared again. DISCUSSION: Carotid-cavernous fistula should be included in the differential diagnosis of neurosensory macular detachments. These neurosensory detachments can resolve spontaneously 11 the fistula is closed

Stenotrophomonas maltophilia keratitis treated with trimethoprim-sulfamethoxazole.

CASE REPORT: An 84 year-old woman with persistent epithelial defect and a dense stromal infiltrate post-corneal transplantation. According to the microbiological results, it was due to a Stenotrophomonas maltophilia (S. maltophilia) resistant to all antibiotics except trimethoprim-sulfamethoxazole (TMP/SMX). Healing was achieved after three weeks of treatment with oral and topical TMP/SMX. DISCUSSION: S. maltophilia is an opportunistic microorganism rarely described in ophthalmology. It is associated with conjunctivitis, keratitis, scleritis, dacryrocystitis, cellulitis, and endophthalmitis with significant morbidity. Treatment is complicated because of its resistances to broad-spectrum antibiotics. TMP/SMX monotherapy can be considered an option of treatment for this type of keratitis.

[Recurrent neurosensory macular detachment in carotid-cavernous fistula]. / Desprendimiento neurosensorial macular recurrente en fístula carótido-cavernosa.

CASE REPORT: A 46 year-old man was seen in the emergency department complaining of vision loss and exophthalmos in his right eye. He also complained of headache, diplopia of 4 months onset, and neurosensory detachment that resolved spontaneously the month before. The study revealed tortuous conjunctival and episcleral vessels and neurosensory macular detachment in his right eye. A carotid-cavernous fistula was confirmed by computed tomography angiography. The fistula closed spontaneously during the hospitalization. One month later, the neurosensory detachment disappeared again. DISCUSSION: Carotid-cavernous fistula should be included in the differential diagnosis of neurosensory macular detachments. These neurosensory detachments can resolve spontaneously 11 the fistula is closed.