Radius-Maumenee syndrome: Beyond a diagnostic and therapeutic challenge. / Síndrome de Radius-Maumenee: más allá de un reto diagnóstico y terapéutico.

Radius-Maumenee syndrome (SRM) or idiopathic episcleral venous hypertension (HVEI) is an uncommon disorder that occurs with a dilation of the episcleral vessels and an increase in intraocular pressure (IOP). It is a syndrome that constitutes a diagnostic and therapeutic challenge for the ophthalmologist. A case is presented in which, despite making an early diagnosis and trying to plan a treatment aimed at avoiding choroidal effusion, its appearance was unavoidable, having to treat it twice with good functional results so far.

Efectos corneales de hipotensores oculares que contienen cloruro de benzalconio: análisis in vivo con microscopia confocal / The effects of ocular hypotensive drugs on the cornea: An in vivo analysis with confocal microscopy

Objetivo: Evaluar los efectos sobre la córnea humana de hipotensores oculares con cloruro de benzalconio (BAC). Métodos: Estudio prospectivo de cohortes, simple ciego realizado sobre 50 ojos de 50 pacientes. Los criterios de inclusión fueron: diagnóstico reciente de glaucoma o hipertensión ocular sin tratamiento previo, terapia antiglaucomatosa prescrita por un oftalmólogo y consentimiento para participar en el estudio. Los pacientes no fueron asignados al azar: el oftalmólogo decidió la mejor terapia de acuerdo a los datos clínicos. Se dividieron en dos grupos: uno expuesto a BAC (23 pacientes) y otro no expuesto (27 pacientes). La media de seguimiento fue de 22 semanas (rango 18-30). Se midió el cambio en la densidad celular antes y después de la terapia en: el epitelio basal, la capa basal del epitelio limbal y el endotelio. También se midió el cambio en la reflectividad estromal y el número de ramas del nervio del plexo subasal. La exposición a BAC era desconocida para el investigador principal. Resultados: Un mayor aumento en la densidad de la capa de células basales del epitelio se observó en la cohorte expuesta BAC (p < 0,05). No se detectaron diferencias significativas en la densidad del endotelio, las células del limbo, la reflectividad del estroma ni en el plexo nervioso subbasal. Edad, sexo, PIO, principio activo ni la concentración de BAC afectaron el sentido o la magnitud de las alteraciones encontradas en la superficie ocular. Conclusión: El tratamiento crónico antiglaucomatoso induce cambios en el epitelio corneal. Gotas sin conservantes mostraron una menor alteración de la superficie ocular por análisis de microscopia confocal. Los estudios futuros deben evaluar el impacto clínico de estos hallazgos histológicos (AU)

Purpose: To evaluate the effects of anti-glaucoma treatments containing benzalconium chloride(BAC) on the human cornea. Methods: A prospective single masked cohort study was conducted on the 50 eyes of 50patients. The inclusion criteria were: recently diagnosed glaucoma or ocular hypertension with previous treatment, or ophthalmologist-prescribed anti-glaucoma therapy, and oral consent to participate in the study. The patients were not randomised, as the ophthalmologist decided the best therapy according to clinical criteria. The patients were divided in 2 cohorts: one exposed to BAC (23 patients), and not exposed (27patients). The mean followup period was 22 weeks (range 18-30). The change in cell density before and after therapy was measured in: basal layer epithelium, basal layer of limbal epithelium and endothelium. The change in stromal reflectivity and the number of nerve branches in sub-basal nerve plexus was also measured. BAC exposure was blinded to the main researcher. Results: A greater increase in basal layer epithelium cell density was observed in BAC exposed cohort (P < 0.05). No significant differences were detected in the endothelium, limbal cell density, stromal reflectivity, or sub-basal nerve plexus. Age, sex, IOP, active ingredient or BAC concentration did not affect the direction or magnitude of the ocular surface alterations found. Conclusion: Chronic anti-glaucoma therapy induces changes in the corneal epithelium. Preservative free drops showed less disruption of the ocular surface by confocal microscopy analysis. Further studies should be conducted to evaluate the clinical impact of these histological findings (AU)

[The effects of ocular hypotensive drugs on the cornea: an in vivo analysis with confocal microscopy]. / Efectos corneales de hipotensores oculares que contienen cloruro de benzalconio: análisis in vivo con microscopia confocal.

PURPOSE: To evaluate the effects of anti-glaucoma treatments containing benzalconium chloride (BAC) on the human cornea. METHODS: A prospective single masked cohort study was conducted on the 50 eyes of 50 patients. The inclusion criteria were: recently diagnosed glaucoma or ocular hypertension with previous treatment, or ophthalmologist-prescribed anti-glaucoma therapy, and oral consent to participate in the study. The patients were not randomised, as the ophthalmologist decided the best therapy according to clinical criteria. The patients were divided in 2 cohorts: one exposed to BAC (23 patients), and not exposed (27 patients). The mean follow-up period was 22 weeks (range 18-30). The change in cell density before and after therapy was measured in: basal layer epithelium, basal layer of limbal epithelium and endothelium. The change in stromal reflectivity and the number of nerve branches in sub-basal nerve plexus was also measured. BAC exposure was blinded to the main researcher. RESULTS: A greater increase in basal layer epithelium cell density was observed in BAC exposed cohort (P<.05). No significant differences were detected in the endothelium, limbal cell density, stromal reflectivity, or sub-basal nerve plexus. Age, sex, IOP, active ingredient or BAC concentration did not affect the direction or magnitude of the ocular surface alterations found. CONCLUSION: Chronic anti-glaucoma therapy induces changes in the corneal epithelium. Preservative free drops showed less disruption of the ocular surface by confocal microscopy analysis. Further studies should be conducted to evaluate the clinical impact of these histological findings.

Función visual sin corrección óptica tras cirugía de cataratas / Uncorrected visual function after cataract surgery

Objetivo: Estudiar la relación entre la refracción tras cirugía de cataratas y el uso de corrección óptica en pacientes mayores de 65 años. Métodos: Estudio retrospectivo tipo casos y controles. Se reclutaron 40 sujetos jubilados mayores de 65 años que cumplieron los criterios de inclusión. Se recogió información clínica y se pidió a los pacientes que completaran un cuestionario validado de función visual (VF14) y otro de independencia de lentes. Se estudió la diferencia entre VF14 con y sin gafas (difVF14). Resultados: La muestra incluye 16 hombres y 24 mujeres, con una edad media de 74 años. Hubo una correlación significativa entre difVF14 y refracción postoperatoria, con menores valores de difVF14 asociados con la refracción posquirúrgica en el rango de −0,50 a −1,00 dioptrías (D) (DE 0,479 [IC95%; 0,286-0,804]). El cuestionario de la independencia de lentes no mostró una correlación significativa con la refracción postoperatoria. Conclusiones: Los pacientes con la refracción posquirúrgica entre −0,50 y −1,00 D mostraron una mejor función visual sin corrección óptica que aquellos con refracción fuera de ese rango. La emetropía a distancia y las lentes positivas para visión cercana pueden no ser el objetivo ideal para todos los pacientes. La refracción posquirúrgica debe ser individualizada para cada paciente de acuerdo a sus preferencias personales con el fin de lograr la mejor función visual y la mejor calidad de vida relacionada con la visión (AU)

Purpose: To study the relationship between refraction after cataract surgery and the use of spectacles in patients older than 65 years. Methods: Retrospective case control study. The study included 40 retired subjects older than 65 years-old who fulfilled our inclusion criteria. Clinical ophthalmic and optical information was collected, and patients were requested to complete a validated questionnaire of visual function (VF14) and a test of independence of spectacles. The difference between VF14 test results with and without glasses (difVF14) was calculated. Results: The study included 16 men and 24 women, with a mean age of 74 years. There was a significant correlation between difVF14 and postoperative refraction, with lower difVF14 values associated with postsurgical refraction in the range −0.50 to −1.00 D (OD 0.479 [95% CI; 0.286-0.804]). The questionnaire of independency of lenses did not show significant correlation with postoperative refraction. Conclusions: Patients with postsurgical refraction between −0.50 and −1.00 diopters displayed better visual function without glasses than those with refraction out of that range. Neutral distant refraction and positive lenses for near vision might not be the ideal solution for every patient. Postsurgical refraction should be individualized for each patient according to their personal preferences, in order to achieve the best visual function and the best vision-related quality of life (AU)

[Uncorrected visual function after cataract surgery]. / Función visual sin corrección óptica tras cirugía de cataratas.

PURPOSE: To study the relationship between refraction after cataract surgery and the use of spectacles in patients older than 65 years. METHODS: Retrospective case control study. The study included 40 retired subjects older than 65 years-old who fulfilled our inclusion criteria. Clinical ophthalmic and optical information was collected, and patients were requested to complete a validated questionnaire of visual function (VF14) and a test of independence of spectacles. The difference between VF14 test results with and without glasses (difVF14) was calculated. RESULTS: The study included 16 men and 24 women, with a mean age of 74 years. There was a significant correlation between difVF14 and postoperative refraction, with lower difVF14 values associated with postsurgical refraction in the range -0.50 to -1.00 D (OD 0.479 [95% CI; 0.286-0.804]). The questionnaire of independency of lenses did not show significant correlation with postoperative refraction. CONCLUSIONS: Patients with postsurgical refraction between -0.50 and -1.00 diopters displayed better visual function without glasses than those with refraction out of that range. Neutral distant refraction and positive lenses for near vision might not be the ideal solution for every patient. Postsurgical refraction should be individualized for each patient according to their personal preferences, in order to achieve the best visual function and the best vision-related quality of life.

[Integration of orbitary polyethilene implants (MEDPOR). Histologic study]. / Integración de los implantes orbitarios de polietileno (MEDPOR). Estudio histológico.

PURPOSE: We study the histological integration of high-density porous polyethylene orbital implants and its clinical meaning. METHODS: During the last 16 months we have used 14 implants of MEDPOR. Two were removed because of migration, the first one and partial extrusion, the second one, after 3 and 9 months since implantation, respectively. They were preserved and softened in formaldehyde for one month, and later processed for histological study. RESULTS: Macroscopically, a fibrous pseudocapsule firmly attached to the implant was seen. A fibrovascular tissue ingrowth covered the polyethylene porous surface and penetrated its total cross-sectional area. Occasional inflammatory cells were present. There was no evidence of macrophagical activity. CONCLUSIONS: We demonstrate a good fibrovascular integration of the implant at the time of extraction. This means that this material can be successfully used in anophthalmic socket surgery. However, new pathological and clinical studies are necessary to elucidate their biocompatibility in long follow-up time.

Integración de los implantes orbitarios de polietileno (MEDPOR). Estudio histológico / Integration of orbitary polyethilene (MEDPOR) implants. A histological study

Objetivos: Estudio histológico de la integración de los implantes porosos de polietileno de alta densidad (MEDPOR) y su significado clínico. Métodos: Durante los últimos 16 meses hemos empleado 14 implantes orbitarios de polietileno, de los cuales 2 tuvieron que ser retirados: uno por migración, a los 3 meses de su implante, y otro por extrusión parcial, a los 9 meses. Los implantes retirados se introdujeron durante un mes en formaldehído para conseguir su reblandecimiento y posteriormente se procesaron para su estudio histológico. Resultados: Macroscópicamente se observa una envoltura tisular firmemente adherida al material sintético. Al microscopio se objetiva crecimiento de tejido fibrovascular alrededor de la superficie porosa de polietileno que penetra hasta el centro del implante, con presencia ocasional de células inflamatorias. No se puede evidenciar lisis macrofágica del material de polietileno. Conclusiones: Se demuestra la buena integración fibrovascular del material de polietileno poroso en el tiempo de implantación estudiado, lo que prueba la biocompatibilidad del material para la reconstrucción de la cavidad orbitaria. Harán falta más estudios anatomopatológicos y clínicos que diluciden su evolución a largo plazo (AU)