Rasgo de zónula anterior larga, lecciones aprendidas acerca de una infrecuente forma de cierre angular secundario: comunicación de un caso / Long anterior zonule trait, lessons learned about an uncommon form of secondary angle closure: A case report

Una mujer de raza negra de 62 años de edad que presentaba glaucoma crónico de ángulo estrecho no controlado en tratamiento con tres fármacos fue sometida a faco-esclerectomía profunda no perforante (facoEPNP) de su ojo izquierdo (OI). Durante la cirugía se puso de manifiesto que presentaba rasgo de zónula larga. Precisó goniopunción y desbridamiento de la ampolla posteriormente, presentando una sinequia de iris en la goniopunción que pudo ser reducida de forma conservadora. Este rasgo debe sospecharse en aquellos pacientes que presentan un ángulo estrecho combinado con un síndrome de dispersión pigmentaria. El manejo de la hipertensión ocular y el glaucoma que puede aparecer asociado a este rasgo no está protocolizado. En esta comunicación se reflexiona acerca de la mejor actuación ante esta infrecuente forma de glaucoma.(AU)

A 62-year-old black woman with uncontrolled chronic narrow-angle glaucoma on 3-drug therapy underwent phaco-non-perforating deep sclerectomy of her left eye. During surgery it was revealed that she had long zonule trait. She later required goniopuncture and conjuntival needling, presenting an iris synechia on the goniopuncture that could be reduced conservatively. Long anterior zonule trait should be suspected in those patients presenting with a combination of narrow angle and pigment dispersion syndrome. The management of ocular hypertension and glaucoma associated to this trait is not protocolized. This communication discusses on the best action in this rare form of glaucoma.(AU)

Long anterior zonule trait, lessons learned about an uncommon form of secondary angle closure: a case report.

A 62-year-old black woman with uncontrolled chronic narrow-angle glaucoma on 3-drug therapy underwent phaco-non-perforating deep sclerectomy of her left eye. During surgery it was revealed that she had long zonule trait. She later required goniopuncture and conjuntival needling, presenting an iris herniation in the goniopuncture that could be reduced conservatively. Long anterior zonule trait should be suspected in those patients presenting with a combination of narrow angle and pigment dispersion syndrome. The management of ocular hypertension and glaucoma associated to this trait is not protocolized. This communication discusses on the best action in this rare form of glaucoma.

Pneumoconjuntiva como signo indicador de permeabilidad tras implantación de un dispositivo XEN(R) / Pneumo-conjunctiva as an indicator of patency after implantation of a XEN(R) stent

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Síndrome de iris flácido intraoperatorio tras tratamiento con duloxetina: ¿casualidad, asociación o causalidad? / Intraoperative floppy iris syndrome after treatment with duloxetine: coincidence, association, or causality?

CASO CLÍNICO: Se presenta un caso de síndrome de iris flácido intraoperatorio (IFIS) severo en una paciente que había recibido tratamiento con duloxetina. DISCUSIÓN: Aunque el agente etiológico principal es la tamsulosina, se han descrito casos de IFIS supuestamente secundarios a fármacos pertenecientes a diversos grupos farmacológicos. Los autores utilizan este caso para realizar un análisis crítico de todas estas asociaciones anecdóticas comunicadas en la literatura

CASE REPORT: The case is presented of a severe Intraoperative Floppy Iris Syndrome (IFIS) in a patient that had been treated with duloxetine. DISCUSSION: Tamsulosin is the main etiological agent involved in IFIS. However several cases of IFIS, supposedly secondary to drugs of different groups have recently been reported in the literature. The authors use this case report as a means to discuss why most of these cases should be considered anecdotal evidence

[Intraoperative floppy iris syndrome after treatment with duloxetine: coincidence, association, or causality?]. / Síndrome de iris flácido intraoperatorio tras tratamiento con duloxetina: ¿casualidad, asociación o causalidad?

CASE REPORT: The case is presented of a severe Intraoperative Floppy Iris Syndrome (IFIS) in a patient that had been treated with duloxetine. DISCUSSION: Tamsulosin is the main etiological agent involved in IFIS. However several cases of IFIS, supposedly secondary to drugs of different groups have recently been reported in the literature. The authors use this case report as a means to discuss why most of these cases should be considered anecdotal evidence.

Intraoperative floppy-iris syndrome.

OBJECTIVE: Intraoperative-floppy iris syndrome (IFIS) has been recently described. It has been demonstrated that this new syndrome complicates cataract surgery. In this paper we have reviewed the syndrome, and offer practical information specially related to the origin and management of this syndrome and we offer practical information. MATERIAL AND METHODS: A review of the related medical literature using PubMed and Cochrane databases. Combining the search terms tamsulosin, cataract, IFIS and intraoperative floppy iris syndrome, more than 200 articles were found. Eighty-two of them were obtained and analysed. In the remaining only the abstract could be studied. RESULTS: The aetiological association between IFIS and tamsulosin (and to a lesser degree between IFIS and other alpha-antagonists) is well established. Other aetiological associations are doubtful. Most of the literature is centred on cataract surgery. However, a similar syndrome has been described during trabeculectomy. A possible association between these drugs and choroidal detachments has also been described. Undoubtedly tamsulosin treatment makes cataract surgery more difficult and increases the probability of intraoperative complications. Protocols to manage the syndrome have not yet been developed. Intracameral injection of alpha-adrenergic agonists seems to be useful. However there is no evidence of the usefulness of discontinuing the drug or using preoperative mydriatics. CONCLUSION: The aetiological and clinic features of the syndrome are well established. More studies are needed to provide scientific evidence on the most appropriate way to cope with this syndrome.

Síndrome del iris flácido intraoperatorio / Intraoperative floppy-iris syndrome

Objetivos: Recientemente se ha descrito el síndrome del iris flácido intraoperatorio (IFIS). Este síndrome complica la cirugía de catarata. Con este trabajo pretendemos revisar el síndrome, y ofrecer información práctica, especialmente en relación con los aspectos etiológicos y terapéuticos del mismo. Material y métodos: Revisión de la literatura biomédica relacionada, utilizando las bases de datos PubMed y Cochrane. Combinando los términos tamsulosin, cataract, IFIS e intraoperative floppy iris syndrome se identifican más de 200 artículos. Ochenta y 2 pudieron ser localizados y estudiados. En los restantes se estudió el resumen. Resultados: La asociación etiológica con la tamsulosina, y en menor medida con los restantes antagonistas de los receptores alfa, está bien establecida. Otras posibles asociaciones etiológicas son más dudosas. Aunque la mayor parte de los artículos se centran en la cirugía de catarata, también se ha documentado la aparición de un síndrome similar durante trabeculectomía, y se ha descrito la asociación de los antagonistas alfa con desprendimientos coroideos. El consumo de tamsulosina hace más difícil la cirugía de catarata y aumenta la probabilidad de que se produzcan complicaciones. La forma más adecuada de manejar el síndrome no está protocolizada. La inyección intracamerular de un agonista alfa adrenérgico mejora el comportamiento del iris. No existe evidencia científica de que suspender el fármaco o el uso de midriáticos preoperatorios resulte útil. Conclusiones: Los aspectos etiológicos y clínicos del síndrome están bien establecidos. Se precisan estudios que aporten evidencia científica sobre la forma más adecuada de manejar este síndrome(AU)

Objective: Intraoperative-floppy iris syndrome (IFIS) has been recently described. It has been demonstrated that this new syndrome complicates cataract surgery. In this paper we have reviewed the syndrome, and offer practical information specially related to the origin and management of this syndrome and we offer practical information. Material and methods: A review of the related medical literature using PubMed and Cochrane databases. Combining the search terms tamsulosin, cataract, IFIS and intraoperative floppy iris syndrome, more than 200 articles were found. Eighty-two of them were obtained and analysed. In the remaining only the abstract could be studied. Results: The aetiological association between IFIS and tamsulosin (and to a lesser degree between IFIS and other alpha-antagonists) is well established. Other aetiological associations are doubtful. Most of the literature is centred on cataract surgery. However, a similar syndrome has been described during trabeculectomy. A possible association between these drugs and choroidal detachments has also been described. Undoubtedly tamsulosin treatment makes cataract surgery more difficult and increases the probability of intraoperative complications. Protocols to manage the syndrome have not yet been developed. Intracameral injection of alpha-adrenergic agonists seems to be useful. However there is no evidence of the usefulness of discontinuing the drug or using preoperative mydriatics. Conclusion: The aetiological and clinic features of the syndrome are well established. More studies are needed to provide scientific evidence on the most appropriate way to cope with this syndrome(AU)