Oxigenoterapia transcorneal como tratamiento de hifema persistente en un paciente con anemia de células falciformes / Transcorneal oxygen therapy for persistent hyphema in a patient with sickle cell disease

CASO CLÍNICO: Paciente varón de 10 años, de raza negra, con antecedente de traumatismo leve en ojo izquierdo; presenta agudeza visual corregida de 0,2 en escala de Snellen, hifema con altura de 1 mm, presión intraocular (PIO) de 12 mmHg en ese ojo, con incremento de PIO a 20 mmHg a las 72 h. Con el resultado positivo del estudio de drepanocitos, se decide tratamiento médico con oxigenoterapia transcorneal. Se logra el aclaramiento de la cámara anterior, con agudeza visual corregida de 0,8 y la reducción de la PIO a 8 mmHg. DISCUSIÓN: En los pacientes con hifema persitente en el contexto de una drepanocitosis, la oxigenoterapia transcorneal es una buena alternativa terapéutica. Se obtienen resultados satisfactorios inmediatos con la disminución de la PIO y el aclaramiento de la cámara anterior

CLINICAL CASE: The case concerns a 10-year-old boy of African origin, who suffered a mild ocular trauma to the left eye. Upon examination, the best visual acuity was 0.2 using the Snellen scale, with a 1mm height hyphema, intraocular pressure (IOP) of 12 mmHg on left eye, with an increase up to 20 mmHg within 72 h. With a positive test for sickle cell disease, it was decided to treat medically with transcorneal oxygen therapy. Clearing of the anterior chamber was achieved, with and improvement in the best visual acuity to 0.8, and lowering of IOP to 8 mmHg. DISCUSSION: In the context of patients with persistent hyphema with sickle cell trait, transcorneal oxygen therapy is an effective alternative therapy. Achieving immediate and favourable results by lowering the IOP and improving the clearing of the anterior chamber

Transcorneal oxygen therapy for persistent hyphema in a patient with sickle cell disease. / Oxigenoterapia transcorneal como tratamiento de hifema persistente en un paciente con anemia de células falciformes.

Clinical case The case concerns a 10-year-old boy of African origin, who suffered a mild ocular trauma to the left eye. Upon examination, the best visual acuity was 0.2 using the Snellen scale, with a 1mm height hyphema, intraocular pressure (IOP) of 12mmHg on left eye, with an increase up to 20mmHg within 72h. With a positive test for sickle cell disease, it was decided to treat medically with transcorneal oxygen therapy. Clearing of the anterior chamber was achieved, with and improvement in the best visual acuity to 0.8, and lowering of IOP to 8mmHg. DISCUSSION: In the context of patients with persistent hyphema with sickle cell trait, transcorneal oxygen therapy is an effective alternative therapy. Achieving immediate and favourable results by lowering the IOP and improving the clearing of the anterior chamber.

Manejo de la perforación conjuntival y Seidel tardío poscirugía XEN® / Management of conjunctival perforation and late Seidel after XEN® surgery

Caso clínico: Mujer de 78 años con antecedentes de cirugía XEN®. A los 18 meses de seguimiento se observa perforación conjuntival a nivel del implante, decidiéndose intervención quirúrgica. En esta se constató un trayecto subconjuntival corto (0,5 mm). Se intenta, sin éxito, extraerlo mediante tracción, sin embargo, el XEN® se rompe con facilidad. Finalmente se decide seccionarlo hasta nivel escleral, y suturar la conjuntiva. Durante la primera semana poscirugía existe disminución de la presión intraocular (6 mmHg), para posteriormente aumentar progresivamente hasta 25, optándose por iniciar tratamiento médico. Discusión: La exposición conjuntival del XEN® es una complicación rara, pero potencialmente grave. Para evitarla es importante una técnica quirúrgica meticulosa durante su implantación. En caso de suceder es importante identificar la causa. Si es debida al trayecto subconjuntival corto, una alternativa terapéutica es la sección del implante a este nivel para evitar nuevas complicaciones (AU)

Clinical case: The case concerns a 78 year-old woman with a history of XEN® surgery, in whom a conjunctival perforation was observed at the implant level at 18-months of follow-up, for which surgical intervention was decided. During surgery a short subconjunctival portion was found (0.5 mm). An unsuccessful attempt was made to extract it by traction, but the XEN® broke easily. Finally, it was decided to cut it to scleral level, and suture the conjunctiva. During the first week there was a decrease in intraocular pressure (6 mmHg), to subsequently increase to 25, and deciding to start medical treatment. Discussion: Conjunctival exposure of the XEN® stent is a rare but potentially serious complication. To avoid it, a meticulous surgical technique is important when implanting it. If this occurs, it is important to identify the cause. If it is due to a short subconjunctival portion, a therapeutic alternative is to cut the implant at this level to avoid further complications (AU)

Management of conjunctival perforation and late Seidel after XEN® surgery. / Manejo de la perforación conjuntival y Seidel tardío poscirugía XEN®.

CLINICAL CASE: The case concerns a 78 year-old woman with a history of XEN® surgery, in whom a conjunctival perforation was observed at the implant level at 18-months of follow-up, for which surgical intervention was decided. During surgery a short subconjunctival portion was found (0.5mm). An unsuccessful attempt was made to extract it by traction, but the XEN® broke easily. Finally, it was decided to cut it to scleral level, and suture the conjunctiva. During the first week there was a decrease in intraocular pressure (6mmHg), to subsequently increase to 25, and deciding to start medical treatment. DISCUSSION: Conjunctival exposure of the XEN® stent is a rare but potentially serious complication. To avoid it, a meticulous surgical technique is important when implanting it. If this occurs, it is important to identify the cause. If it is due to a short subconjunctival portion, a therapeutic alternative is to cut the implant at this level to avoid further complications.