Reproducibilidad de la medición manual del grosor coroideo utilizando la tomografía de coherencia óptica / Reproducibility of manual choroidal thickness measurements using optical coherence tomography

OBJETIVO: La tomografía de coherencia óptica de dominio espectral (SD-OCT) es la herramienta de mayor utilidad para medir el grosor coroideo (GC). El GC puede estar aumentado tanto en las enfermedades oftalmológicas como en las sistémicas. No obstante, existen ciertas inquietudes en relación con la reproducibilidad y la validez externa de la OCT. El objetivo de este estudio fue determinar la variabilidad interobservador e intraobservador de la medición manual de la OCT. MÉTODOS: El GC fue medido de manera manual en la región central en 40 ojos de 21 sujetos (11 sanos y 10 con espondilitis anquilosante) utilizando RTVue-100 OCT (Optovue Inc., Fremont, CA, EE.UU.). Las mediciones fueron obtenidas por 9 oftalmólogos independientes de 6 centros diferentes. Para determinar la variabilidad interobservador se utilizó el cálculo del coeficiente de correlación intraclase (CCI). También la variabilidad intraobservador fue determinada en 2 de los oftalmólogos. RESULTADOS: La media del GC subfoveal fue de 364,9 ± 85,1μm (rango, 170-572). El CCI interobservador fue 0,823 (IC 95%, 0,749-0,888; p < 0,001). El CCI intraobservador fue 0,885 (IC 95%, 0,783-0,939; p < 0,001) y 0,925 (IC 95%, 0,859-0,960; p < 0,001). CONCLUSIONES: En este estudio la medición manual del GC ha demostrado buena concordancia. Los resultados sugieren que la medición manual con la OCT es un método válido para los estudios multicéntricos

PURPOSE: Spectral-domain optical coherence tomography (SD-OCT) is the most useful tool to measure choroidal thickness (CT). CT may be increased in ocular and systemic diseases. However, there are concerns relating reproducibility and external validity of OCT. The aim of this study was to assess the inter-observer and intra-observer variability of manual OCT measurements. METHODS: CT was manually measured in the central choroid of 40 eyes from 21 subjects (11 healthy and 10 with ankylosing spondylitis) using RTVue-100 OCT (Optovue Inc., Fremont, CA, EE.UU.). Measurements were performed by 9 independent ophthalmologists from 6 different centers. To assess the inter-observer variability, the intra-class correlation coefficient (ICC) method was calculated. Also, intra-observer variability was assessed in 2 of the ophthalmologists. RESULTS: The mean subfoveal CT was 364.9 ± 85.1μm (range, 170 to 572). The inter-observer ICC was 0.823 (CI 95%, 0.749 to 0.888, p < 0.001). The intra-observer ICCs were 0.885 (CI 95%, 0.783 to 0.939, p < 0.001) and 0.925 (CI 95%, 0.859 to 0.960. p < 0.001). CONCLUSIONS: In this study, manual measurements of CT with OCT showed a good concordance. These results suggest that manual OCT is a valid tool for multicenter studies

Reproducibility of manual choroidal thickness measurements using optical coherence tomography. / Reproducibilidad de la medición manual del grosor coroideo utilizando la tomografía de coherencia óptica.

PURPOSE: Spectral-domain optical coherence tomography (SD-OCT) is the most useful tool to measure choroidal thickness (CT). CT may be increased in ocular and systemic diseases. However, there are concerns relating reproducibility and external validity of OCT. The aim of this study was to assess the inter-observer and intra-observer variability of manual OCT measurements. METHODS: CT was manually measured in the central choroid of 40 eyes from 21 subjects (11 healthy and 10 with ankylosing spondylitis) using RTVue-100 OCT (Optovue Inc., Fremont, CA, EE.UU.). Measurements were performed by 9 independent ophthalmologists from 6 different centers. To assess the inter-observer variability, the intra-class correlation coefficient (ICC) method was calculated. Also, intra-observer variability was assessed in 2 of the ophthalmologists. RESULTS: The mean subfoveal CT was 364.9±85.1µm (range, 170 to 572). The inter-observer ICC was 0.823 (CI 95%, 0.749 to 0.888, p<0.001). The intra-observer ICCs were 0.885 (CI 95%, 0.783 to 0.939, p<0.001) and 0.925 (CI 95%, 0.859 to 0.960. p<0.001). CONCLUSIONS: In this study, manual measurements of CT with OCT showed a good concordance. These results suggest that manual OCT is a valid tool for multicenter studies.

Autologous serum eyedrops in the treatment of aniridic keratopathy.

OBJECTIVE: To study the effect of autologous serum eyedrop application in aniridic keratopathy. DESIGN: Prospective, consecutive, comparative, interventional case series. PARTICIPANTS: Twenty-six eyes from 13 patients (7 males and 6 females) with aniridic keratopathy treated with autologous serum eyedrops. METHODS: All patients underwent a complete ophthalmic examination. The ocular surface examinations included corneal impression cytologic analysis and tear film evaluation. The eyes were divided into 4 groups according to the Mackman classification. Ocular surface photography was used to evaluate the corneal surface and tear film before treatment and every 2 or 3 days until serum drops were stopped. Tear films were evaluated by tear film break-up time (BUT) (normal, 10 seconds or more), Schirmer's test with anesthesia (normal, 10 mm/5 minutes or more), tear meniscus level (normal, 0.5 mm or more), and rose bengal and fluorescein staining pattern of the cornea. Impression cytologic analysis was carried out both before starting the serum eyedrops treatment and a few days after its finalization. MAIN OUTCOMES MEASURES: Tear film production and stability, corneal epithelialization, and corneal epithelium squamous metaplasia. RESULTS: There were no local side effects from autologous serum treatment. Clinical manifestations and slit-lamp findings were in relation to the severity of keratopathy. All patients showed a subjective improvement of keratopathy symptoms after the autologous serum applications. The corneal epithelialization, corneal epithelial cell squamous metaplasia, and tear stability improved significantly with the treatment, but visual acuity, regression of vascular pannus, and subepithelial scarring showed only slight improvement with treatment. CONCLUSIONS: Autologous serum eyedrops improved the aniridic keratopathy in all patients, particularly in patients with light or moderate severity. In these patients, use of autologous serum eyedrops was superior to conventional therapy with substitute tears for improving the ocular surface and subjective comfort.

Different conjunctival adaptive response in patients with aqueous-deficient and with mucous-deficient dry eyes.

PURPOSE: To describe the different cellular adaptive patterns found in the conjunctival epithelium from patients with aqueous-deficient and mucous-deficient dry eyes. METHODS: The authors studied different conjunctival areas, by impression cytology and by biopsy, 50 eyes with facial nerve paralysis (FNP), 50 eyes with ocular cicatricial pemphigoid (OCP), and 50 eyes from patients with primarily Sjögren syndrome (1SS). RESULTS: Eyes with FNP from the first clinical grade showed a progressive alteration of the nonsecretory cells, with a significant decrease in density goblet cells, generally with a PAS-positive staining. Eyes with OCP, during clinical grades 1 and 2, showed a slow deterioration of the nonsecretory cells; but from clinical grade 3, there was a significant increase of the cellular size and the thickness of the conjunctiva. Goblet cells showed a significant decrease in density from clinical grade 1, generally with a PAS-negative staining. Eyes with 1SS during clinical grades 1 and 2 showed a progressive alteration of the nonsecretory cells, with a significant decrease in density goblet cells, and a PAS-positive staining. From clinical grade 3 appeared a significant increase of nonsecretory cellular size and thickness of conjunctiva, with a significant decrease in goblet cell counts, and a PAS-negative staining. CONCLUSIONS: Patients with FNP (a primarily aqueous-deficient alteration) follow completely the squamous metaplasia process. Patients with OCP (a primarily mucous-deficient syndrome) have a hypertrophy and hyperplasia process along the ocular surface. Patients with 1SS (a primarily aqueous-deficient and mucin-deficient alteration) have a squamous metaplasia process, but from clinical grade 3 also appears a hypertrophy and hyperplasia process.

[Use of autologous serum in ophthalmic practice]. / Aplicaciones del suero autólogo en oftalmología.

OBJECTIVE: To establish a protocol for the use of autologous serum in the ophthalmic practice. METHODS: Personal experience and a literature review. RESULTS: The use of autologous serum, in eye drop form, has been reported as a new treatment for several ocular surfaces diseases. These products have biomechanical and biochemical properties similar to normal tears. They contain components such as fibronectin, vitamin A and growth factors that have an epitheliotrophic effect on the ocular surface epithelial cells. CONCLUSIONS: The clinical studies performed showed a variable efficacy, with the preparative process and use of the autologous serum eye drops varying considerably between different studies.

Aplicaciones del suero autólogo en oftalmología / Use of autologous serum in ophthalmic practice

Objetivo: Establecer un protocolo razonado para la preparación y manejo de la terapia con suero autólogo en la práctica oftalmológica. Métodos: Revisión bibliográfica y experiencia personal. Resultados: La utilización de suero autólogo en colirio ha sido referida por muchos autores como una nueva forma de terapia en el manejo de enfermedades de la superficie ocular. El suero autólogo presenta unas propiedades mecánicas y bioquímicas similares a las de la lágrima, y como ésta contiene componentes como la fibronectina, vitamina A y factores de crecimiento que tienen un efecto epiteliotrófico sobre las células epiteliales de la superficie ocular. Conclusiones: Los distintos estudios publicados muestran una importante variabilidad tanto en la eficacia de esta terapia como en la metodología de preparación y aplicación

Objective: To establish a protocol for the use of autologous serum in the ophthalmic practice. Methods: Personal experience and a literature review. Results: The use of autologous serum, in eye drop form, has been reported as a new treatment for several ocular surfaces diseases. These products have biomechanical and biochemical properties similar to normal tears. They contain components such as fibronectin, vitamin A and growth factors that have an epitheliotrophic effect on the ocular surface epithelial cells. Conclusions: The clinical studies performed showed a variable efficacy, with the preparative process and use of the autologous serum eye drops varying considerably between different studies

Analysis of corneal surface evolution after moderate alkaline burns by using impression cytology.

PURPOSE: To compare corneal surface evolution after moderate alkaline burns by impression cytology in patients treated with medical therapy or with amniotic membrane transplantation (AMT). METHODS: A prospective study of 24 eyes from 18 patients (13 men and 5 women) with moderate alkaline burns was performed. All patients were divided according to the clinical ocular severity and the therapy used. Twelve eyes were treated surgically with AMT and the other 12 eyes received only medical therapy. Corneal cytology was obtained immediately after the burns, and 1, 2, 5, and 9 months later. We differentiated between samples obtained from affected areas and areas not affected by the burns. Cellular size, nuclear size, and nuclear-cytoplasmic (N:C) ratio were examined in corneal epithelial cells, as was the presence of goblet cells in corneal epithelium. RESULTS: Nuclear size, cellular size, and N:C ratio in non-burn-affected corneal areas had no significant alterations in comparison with normal eyes. In contrast, in burn-affected corneal areas, these parameters were significantly worse, and the presence of goblet cells in corneal epithelium was frequent 1 month after severe burns. Cellular size, nuclear size, N:C ratio, and corneal conjunctivalization improved during the study in all patients, but corneal reepithelialization occurred earlier in patients treated with AMT than in patients with only medical therapy. CONCLUSION: Morphologic and morphometric analysis of corneal cells by impression cytology after ocular burns permits the establishment of cellular reepithelialization patterns in relation with limbal deficiency level and with clinical ocular severity. AMT improves corneal reepithelialization earlier than medical therapy in moderate alkaline burns.

[Congenital aniridia keratopathy treatment]. / Manejo terapéutico de la queratopatía asociada a aniridia congénita.

OBJECTIVE: To attempt to review the aniridia keratopathy pathogenesis and establish a treatment protocol according to the severity of the symptoms. METHODS: Personal experience in aniridic keratopathy management and a bibliography review. RESULTS: The ocular manifestations of this anomaly include defects of the cornea, glaucoma, lens subluxation, cataracts, hypoplasia of the iris, fovea and optic nerve, amblyopia and nystagmus. The keratopathy occurs in a 20% of patients with aniridia. The correct PAX6 expression is necessary for normal corneal development, limbal stem cell activity and correct corneal epithelial cell migration and adhesion. CONCLUSIONS: The management of ocular surface diseases due to limbal stem cell deficiency in aniridia is complex but has changed in recent years, as an understanding of the limbal stem cells and their microenvironment has modified the therapeutic approach. The use of autologous serum eye drops, amniotic membrane transplantation, limbal transplantation or cultivated limbal cell transplantation have all been reported as a treatment for several ocular surface diseases.

Manejo terapéutico de la queratopatía asociada a aniridia congénita / Congenital aniridia keratopathy treatment

Objetivo: Revisar la patogenia de la queratopatía por aniridia y establecer un protocolo de tratamiento según su gravedad. Métodos: Revisión bibliográfica y experiencia personal en el manejo de pacientes con queratopatía por aniridia. Resultados: Las manifestaciones oculares de esta anomalía incluyen defectos a nivel corneal, glaucoma, subluxación del cristalino y cataratas, hipoplasia de iris, fóvea y nervio óptico, ambliopía y nistagmus. La queratopatía por aniridia ocurre en un 20% de los pacientes. La correcta expresión del gen PAX6 es necesaria para el normal desarrollo corneal y actividad de las células limbares así como la correcta migración y adhesión de las células epiteliales. Conclusiones: El manejo de los trastornos oculares debidos a la deficiencia limbal asociada a la aniridia es complejo pero ha cambiado en los últimos años. El concepto de célula madre limbal y de su microambiente ha modificado la aproximación terapéutica de estos pacientes. El empleo del suero autólogo, trasplante de membrana amniótica, trasplante de limbo o trasplante de células limbares cultivadas han sido utilizados en el tratamiento de distintos trastornos de la superficie ocular

Objective: To attempt to review the aniridia keratopathy pathogenesis and establish a treatment protocol according to the severity of the symptoms. Methods: Personal experience in aniridic keratopathy management and a bibliography review. Results: The ocular manifestations of this anomaly include defects of the cornea, glaucoma, lens subluxation, cataracts, hypoplasia of the iris, fovea and optic nerve, amblyopia and nystagmus. The keratopathy occurs in a 20% of patients with aniridia. The correct PAX6 expression is necessary for normal corneal development, limbal stem cell activity and correct corneal epithelial cell migration and adhesion. Conclusions: The management of ocular surface diseases due to limbal stem cell deficiency in aniridia is complex but has changed in recent years, as an understanding of the limbal stem cells and their microenvironment has modified the therapeutic approach. The use of autologous serum eye drops, amniotic membrane transplantation, limbal transplantation or cultivated limbal cell transplantation have all been reported as a treatment for several ocular surface diseases

[Corneal epithelium squamous metaplasia determination as diagnostic factor in limbal deficiency]. / Determinación del grado de metaplasia escamosa del epitelio corneal como factor diagnóstico de insuficiencia limbal.

PURPOSE: To determine the correlation between the squamous metaplasia grade of the corneal surface and the clinical severity of the limbal deficiency in patients with this disorder. METHODS: We studied 98 eyes of patients with limbal deficiency by impression cytology. These patients were divided into four groups in relation to their clinical severity: 14 eyes had no symptoms, 34 eyes showed a mild grade of limbal deficiency, 28 eyes had a moderate grade and 22 eyes had severe limbal deficiency. Corneal cytology was performed in each patient. Cellular size, nuclear size, nuclear changes and the nuclear-cytoplasmic (N:C) ratio were defined in corneal epithelial cells, in addition to evaluation for the presence of goblet cells in the corneal epithelium. RESULTS: In patients with limbal deficiency without symptoms, we found that the cellular size was 477 (SD140) microm2 and the N:C ratio was 1:5.25 (SD1.5). In patients with mild limbal deficiency, the cellular size was 764 (SD122.6) microm2 and the N:C ratio was 1:8.2 (SD1.4). These patients did not show corneal conjunctivalization. In patients with moderate limbal deficiency the cellular size was 1,162 (SD340.2) microm2 and the N:C ratio was 1:13.2 (SD3.6). Some patients showed corneal conjunctivalization that was defined by the presence of goblet cells in the corneal epithelium. In patients with severe limbal deficiency, the cellular size was 2,036 (SD382) microm2 and the N:C ratio was 1:23.6 (SD4.0). Corneal conjunctivalization was present in all of these patients. CONCLUSIONS: There was a correlation between limbal deficiency severity and squamous metaplasia grade defined by impression cytology. Impression cytology was very useful for the diagnosis of cases of mild or subclinical limbal deficiency.

Determinación del grado de metaplasia escamosa del epitelio corneal como factor diagnóstico de insuficiencia limbal / Corneal epithelium squamous metaplasia determination as diagnostic factor in limbal deficiency

Objetivos: Determinar si existe relación entre elgrado de metaplasia escamosa de la superficie cornealmediante citología de impresión y la gravedadclínica en pacientes con insuficiencia limbal.Métodos: Hemos estudiado mediante citología deimpresión 98 ojos de pacientes con insuficiencialimbal que fueron divididos en cuatro grupos segúnla gravedad clínica: 14 ojos no presentaban sintomatologíaalguna, 34 ojos presentaron un gradoleve de insuficiencia limbal, 28 ojos un gradomoderado y 22 ojos una insuficiencia limbal grave.A todos los pacientes se les realizó una citologíacorneal en la que se estudió el tamaño celular, tamañonuclear, alteraciones nucleares y relaciónnúcleo-citoplasma (N:C), así como la presencia decélulas caliciformes.Resultados: Los pacientes con insuficiencia limbalasintomática presentaron un tamaño celular mediode 477 DE 140 μm2, con una relación N:C de 1:5,25DE 1,5. Los pacientes con insuficiencia limbal levepresentaron un tamaño celular medio de 764 DE122,6 μm2 y una relación N:C de 1:8,2 DE 1,4. Ninguno de estos pacientes presentó conjuntivalizacióndel epitelio corneal. Los pacientes con insuficiencialimbal moderada presentaron un tamaño celularmedio de 1.162 DE 340 μm2 y una relación N:C de1:13,2 DE 3,6. Estos pacientes presentaron concierta frecuencia conjuntivalización del epitelio corneal,definida por la presencia de células caliciformes.Los pacientes con insuficiencia limbal gravepresentaron un tamaño celular medio de 2.036 DE382 μm2 y una relación N:C de 1:23,6 DE 4,0. Enestos pacientes la presencia de conjuntivalizaciónen la citología corneal fue la norma.Conclusiones: Existe una correlación entre la gravedadclínica de la insuficiencia limbal y el gradode metaplasia escamosa determinado mediante citologíade impresión corneal. La citología de impresiónes particularmente útil para el diagnóstico enlos casos de déficit limbal leve o subclínico

Purpose: To determine the correlation between the ;;squamous metaplasia grade of the corneal surface ;;and the clinical severity of the limbal deficiency in ;;patients with this disorder. ;;Methods: We studied 98 eyes of patients with limbal ;;deficiency by impression cytology. These ;;patients were divided into four groups in relation to ;;their clinical severity: 14 eyes had no symptoms, 34 ;;eyes showed a mild grade of limbal deficiency, 28 ;;eyes had a moderate grade and 22 eyes had severe ;;limbal deficiency. Corneal cytology was performed ;;in each patient. Cellular size, nuclear size, nuclear ;;changes and the nuclear-cytoplasmic (N:C) ratio ;;were defined in corneal epithelial cells, in addition ;;to evaluation for the presence of goblet cells in the ;;corneal epithelium. ;;Results: In patients with limbal deficiency without ;;symptoms, we found that the cellular size was 477 ;;(SD140) μm2 and the N:C ratio was 1:5.25 (SD1.5). ;;In patients with mild limbal deficiency, the cellular ;;size was 764 (SD122.6) μm2 and the N:C ratio was ;;1:8.2 (SD1.4). These patients did not show corneal conjunctivalization. In patients with moderate limbal ;;deficiency the cellular size was 1,162 (SD340.2) ;;μm2 and the N:C ratio was 1:13.2 (SD3.6). Some ;;patients showed corneal conjunctivalization that ;;was defined by the presence of goblet cells in the ;;corneal epithelium. In patients with severe limbal ;;deficiency, the cellular size was 2,036 (SD382) μm2 ;;and the N:C ratio was 1:23.6 (SD4.0). Corneal conjunctivalization ;;was present in all of these patients. ;;Conclusions: There was a correlation between limbal ;;deficiency severity and squamous metaplasia ;;grade defined by impression cytology. Impression ;;cytology was very useful for the diagnosis of cases ;;of mild or subclinical limbal deficiency

[Moderate limbal deficiency in patients with congenital aniridia treated with amniotic membrane transplantation]. / Trasplante de membrana amniótica en el tratamiento de la insuficiencia limbal moderada de pacientes con aniridia congénita.

PURPOSE: To study the ocular surface evolution by impression cytology and limbal biopsy in patients with congenital aniridia treated with amniotic membrane transplantation (AMT). METHODS: We studied 14 eyes of patients with congenital aniridia and moderate limbal deficiency that were treated with AMT. The morphology of the limbocorneal epithelium and stroma was examined by impression cytology and limbal biopsy. Impression cytology was performed prior to surgery and 3, 6, 9, 12 and 24 months after treatment. Limbal biopsy was performed before surgery and 9 months after AMT. RESULTS: Visual acuity showed a mean improvement of 0.3 at 24 months of follow-up. Corneal reepithelialization was completed by 2 months in all patients, however, after 9 months some patients showed persistent epithelial defects and chronic ulceration. Corneal clarity and peripheral neovascularization was markedly improved after 2 months. Impression cytology showed an improvement in squamous metaplasia at 3 and 6 months, however after nine months, until as late as 24 months, a progressive worsening was seen in epithelial cell metaplasia then being similar in extent to that before surgery. Limbal biopsy nine months after surgery showed a nearly normal epithelium and limbocorneal stroma. CONCLUSIONS: AMT is a very effective procedure, although its effect is transitory, for restoring the ocular surface integrity in patients with congenital aniridia and moderate limbal deficiency.

Trasplante de membrana amniótica en el tratamiento de la insuficiencia limbal moderada de pacientes con aniridia congénita / Moderate limbal deficiency in patients with congenital aniridia treated with amniotic membrane transplantation

Objetivos: Estudiar el comportamiento de la superficie ocular en pacientes con aniridia congénita tratados con trasplante de membrana amniótica (TMA), mediante citología de impresión y biopsia limbal.Métodos: Se estudiaron 14 ojos de pacientes con aniridia congénita con insuficiencia limbal moderada a los que se les realizó un TMA. Mediante citología corneal y biopsia limbal hemos estudiado la morfología del epitelio limbocorneal y de su estroma. La citología se realizó antes del transplante y a los 3, 6, 9, 12 y 24 meses después del trasplante. La biopsia limbal se realizó antes del trasplante y 9 meses después de éste.Resultados: La agudeza visual mejoró una media de 0,3 durante el estudio. La neovascularización corneal periférica mejoró antes de los dos meses así como la transparencia corneal. La epitelización de la córnea se completó antes de los dos meses en casi todos los pacientes, sin embargo, a partir del 8.º-9.º mes, algunos pacientes comenzaron a presentar defectos epiteliales y úlceras recurrentes. La citología de impresión mostró una importante mejoría en el grado de metaplasia escamosa en la citología de los 3 y 6 meses, mostrando a partir de la citología de los nueve meses un empeoramiento progresivo hasta los 24 meses en donde encontramos unas características celulares muy próximas a los valores previos a la cirugía. En la biopsia realizada a los nueve meses, el epitelio y estroma limbocorneal mostraron unas características muy próximas a la normalidad.Conclusiones: El TMA es un método efectivo, aunque transitorio, para restaurar la integridad de la superficie ocular en pacientes con aniridia que presentan una insuficiencia limbal moderada (AU)

Purpose: To study the ocular surface evolution by impression cytology and limbal biopsy in patients with congenital aniridia treated with amniotic membrane transplantation (AMT). Methods: We studied 14 eyes of patients with congenital aniridia and moderate limbal deficiency that were treated with AMT. The morphology of the limbocorneal epithelium and stroma was examined by impression cytology and limbal biopsy. Impression cytology was performed prior to surgery and 3, 6, 9, 12 and 24 months after treatment. Limbal biopsy was performed before surgery and 9 months after AMT. Results: Visual acuity showed a mean improvement of 0.3 at 24 months of follow-up. Corneal re-epithelialization was completed by 2 months in all patients, however, after 9 months some patients showed persistent epithelial defects and chronic ulceration. Corneal clarity and peripheral neovascularization was markedly improved after 2 months. Impression cytology showed an improvement in squamous metaplasia at 3 and 6 months, however after nine months, until as late as 24 months, a progressive worsening was seen in epithelial cell metaplasia then being similar in extent to that before surgery. Limbal biopsy nine months after surgery showed a nearly normal epithelium and limbocorneal stroma. Conclusions: AMT is a very effective procedure, although its effect is transitory, for restoring the ocular surface integrity in patients with congenital aniridia and moderate limbal deficiency (AU)

[Severe limbal deficiency treated by combined limbal allograft and amniotic membrane transplantation]. / Tratamiento de la insuficiencia limbal grave mediante cirugía combinada de trasplante de limbo y trasplante de membrana amniótica.

PURPOSE: To study the ocular surface evolution in patients with severe limbal deficiency treated with limbal allograft transplantation (LT) combined with amniotic membrane transplantation (AMT). METHODS: We studied 14 eyes with severe limbal deficiency, treated with LT combined with AMT (LT + AMT). We studied the morphology of the limbocorneal epithelium and stroma by impression cytology and limbal biopsy. RESULTS: Visual acuity showed a mean improvement of 0.4 at 24 months of follow-up. Corneal clarity and loss of neovascularization were markedly improved after 3 and 6 months, respectively. We did not find corneal conjuntivalization on cytology performed 6 months after surgery, except in a patient with chemical burn. Cytology and limbal biopsy performed nine months after surgery showed an epithelium and limbocorneal stroma near to normality. Squamous metaplasia was worse in patients with Stevens-Johnson syndrome and ocular cicatricial pemphigoid after 12 months, but was similar in patients with chemical burns and improved in patients with aniridia. CONCLUSIONS: LT + AMT is a very effective procedure for restoring the ocular surface integrity in patients with severe limbal deficiency. This combination improves the outcomes obtained with LT alone.

Tratamiento de la insuficiencia limbal grave mediante cirugía combinada de trasplante de limbo y trasplante de membrana amniótica / Severe limbal deficiency treated by combined limbal allograft and amniotic membrane transplantation

Objetivos: Estudiar mediante citología de impresión y biopsia limbal la evolución de la superficie ocular en pacientes con deficiencia limbal total tratados con alo-trasplante de limbo (TL) más trasplante de membrana amniótica (TMA).Métodos: Se estudiaron 14 ojos con insuficiencia limbal grave a los que se les realizó un alo-trasplante de limbo recubierto con membrana amniótica (TL + TMA). Mediante citología corneal y biopsia limbal hemos estudiado la morfología del epitelio limbocorneal y de su estroma.Resultados: La agudeza visual mejoró una media de 0,4 durante el estudio. La neovascularización corneal mejoró significativamente antes de los 6 meses y la transparencia corneal a partir del tercer mes. Salvo en el caso de un paciente con quemadura ocular, no encontramos conjuntivalización del epitelio corneal en ningún paciente en la citología realizada a los 6 meses. En la citología y biopsia de los nueve meses, el epitelio y estroma limbocorneal mostraron unas características muy próximas a la normalidad. En pacientes con SSJ y POC, el grado de metaplasia escamosa de las células del epitelio corneal empeoró a partir de los 12 meses, en pacientes con quemaduras oculares se mantuvo y mejoró ligeramente en el caso de pacientes con aniridia.Conclusiones: La combinación TL + TMA es un método muy efectivo para restaurar la integridad de la superficie ocular en casos de insuficiencia limbal grave. Esta combinación mejora los resultados que se obtienen sólo con la realización de un TL

Purpose: To study the ocular surface evolution in patients with severe limbal deficiency treated with limbal allograft transplantation (LT) combined with amniotic membrane transplantation (AMT). Methods: We studied 14 eyes with severe limbal deficiency, treated with LT combined with AMT (LT + AMT). We studied the morphology of the limbocorneal epithelium and stroma by impression cytology and limbal biopsy. Results: Visual acuity showed a mean improvement of 0.4 at 24 months of follow-up. Corneal clarity and loss of neovascularization were markedly improved after 3 and 6 months, respectively. We did not find corneal conjuntivalization on cytology performed 6 months after surgery, except in a patient with chemical burn. Cytology and limbal biopsy performed nine months after surgery showed an epithelium and limbocorneal stroma near to normality. Squamous metaplasia was worse in patients with Stevens-Johnson syndrome and ocular cicatricial pemphigoid after 12 months, but was similar in patients with chemical burns and improved in patients with aniridia. Conclusions: LT + AMT is a very effective procedure for restoring the ocular surface integrity in patients with severe limbal deficiency. This combination improves the outcomes obtained with LT alone

[But and Schirmer test comparative study in relation to dry eye etiology and severity]. / Estudio comparativo del test de Schirmer y But en relación con la etiología y gravedad del ojo seco.

PURPOSE: To determine possible differences between the Schirmer test and the tear break up time (BUT) in relation to the etiology and severity of the dry eye syndrome. METHODS: We present a prospective study of 206 eyes in 106 patients (38 males and 68 females). Both the Schirmer test and BUT were performed on all of them. We divided the patients into ten etiologic groups according to the Madrid triple classification of dry eye etiology and into four groups according to clinical severity. RESULTS: Both the Schirmer test and BUT results decrease according to the severity of symptoms and we found significant differences between clinical groups. In regard to etiology, we found lower values of the Schirmer test especially in immunological, senile and traumatic dry eye groups. BUT measures were lower in immunological, inflammatory and tantalic dry eye groups. CONCLUSIONS: Although we found differences between Schirmer test results and BUT values according to dry eye etiology, these differences were only statistically significant between the immunological group and the other groups. Differences between etiological groups decreased with worsening of the illness due to a general affectation of the lacrimal glands.

Estudio comparativo del test de Schirmer y BUT en relación con la etiología y gravedad del ojo seco / BUT and Schirmer test comparative study in relation to dry eye etiology and severity

Objetivo: Determinar si existen diferencias en el test de Schirmer y el tiempo de ruptura lagrimal (BUT) en relación con la etiología y gravedad del síndrome de sequedad ocular.Métodos: Realizamos un estudio prospectivo sobre 206 ojos pertenecientes a 106 pacientes (38 hombres y 68 mujeres), donde se mide el test de Schirmer y el BUT. La población estudiada se dividió en diez grupos etiológicos, según los criterios de la clasificación de Madrid, y en cuatro grupos atendiendo a parámetros de gravedad clínica.Resultados: Los valores del test de Schirmer y BUT disminuyeron con la gravedad del cuadro clínico, existiendo diferencias significativas entre los cuatro grupos clínicos. En cuanto a criterios etiológicos, el test de Schirmer se afectó sobre todo en ojo seco inmunopático, etario y traumático, mientras que el BUT lo hizo en ojo seco inmunopático, inflamatorio y tantálico.Conclusiones: Aunque existen diferencias en cuanto a los valores del test de Schirner y BUT según la etiología responsable del síndrome de sequedad ocular, éstas son sólo estadísticamente significativas entre el grupo de ojo seco inmunopático y el resto. Las diferencias entre grupos etiológicos tienden a disminuir con la gravedad del cuadro clínico como consecuencia de la afectación global de las distintas dacrioglándulas que se produce en casos de ojo seco moderado y grave (AU)

Purpose: To determine possible differences between the Schirmer test and the tear break up time (BUT) in relation to the etiology and severity of the dry eye syndrome. Methods: We present a prospective study of 206 eyes in 106 patients (38 males and 68 females). Both the Schirmer test and BUT were performed on all of them. We divided the patients into ten etiologic groups according to the Madrid triple classification of dry eye etiology and into four groups according to clinical severity. Results: Both the Schirmer test and BUT results decrease according to the severity of symptoms and we found significant differences between clinical groups. In regard to etiology, we found lower values of the Schirmer test especially in immunological, senile and traumatic dry eye groups. BUT measures were lower in immunological, inflammatory and tantalic dry eye groups. Conclusions: Although we found differences between Schirmer test results and BUT values according to dry eye etiology, these differences were only statistically significant between the immunological group and the other groups. Differences between etiological groups decreased with worsening of the illness due to a general affectation of the lacrimal glands (AU)

[A study of lacunar folds in relation to the etiology and severity of dry eye]. / Estudio de los pliegues lacunares en relación con la etiología y gravedad del ojo seco.

PURPOSE: To determine the diagnostic value of studying lacunar folds in relation to the different etiologies responsible for dry-eye syndrome. METHODS: We present a prospective study of 206 eyes from 106 patients (38 males and 68 females). In all patients the abduction degree was measured after instilling a fluorescein drop, which makes lacunar folds disappear. We divided the patients into ten etiological groups applying Madrid classification criteria. Patients were also divided into four groups according to clinical severity. RESULTS: We found the early disappearance of lacunar folds was more prevalent among patients with immunological dry eye. Early disappearance was less frequent in patients with tantalic, pharmacological, inflammatory and traumatic dry eye. The folds disappeared more rapidly in patients with greater clinical severity. CONCLUSIONS: The early disappearance of lacunar folds is a sign of conjunctival retraction manifest in patients with dry eye syndrome. The degree of conjunctival retraction degree varies according to the dry eye etiology and severity of the symptoms.

[Phthiriasis palpebrarum: diagnosis and treatment]. / Phthiriasis palpebral: diagnóstico y tratamiento.

Phthiriasis palpebrarum, caused by Phthirus pubis, is an uncommon cause of blepharoconjunctivitis; therefore, this condition is easily misdiagnosed. When diagnosed, genital involvement must be ruled out. Association with other venereal diseases is common. Affected children must be searched for sexual abuse. The number of diagnosed patients in our department has increased in recent years. We review the epidemiological, clinical and diagnostic features of phthriasis palpebrarum as well as the different treatment options to eradicate the parasite and to prevent infestations.

Phthiriasis palpebral: diagnóstico y tratamiento / Phthiriasis palpebrarum: diagnosis and treatment

La Phthiriasis palpebral, parasitación de las pestañas por Phtirus pubis, es una causa poco frecuente de blefaroconjuntivis, por lo que su diagnóstico puede pasarnos fácilmente desapercibido. Ante un paciente con Phthiriasis palpebral hemos de descartar la presencia de parásitos en otras localizaciones de su cuerpo e investigar la más que probable asociación con otras enfermedades de transmisión sexual. En niños se nos plantea además un importante reto medico-legal ya que puede tratarse de un caso de abuso sexual. En los últimos años hemos detectado un aumento en el número de casos diagnosticados en nuestro servicio. En el presente trabajo revisamos las características epidemiológicas, clínicas y diagnósticas de la phthiriasis palpebral así como las distintas medidas terapeúticas destinadas a la eliminación del parásito y a la prevención de infestaciones (AU)

Phthiriasis palpebrarum, caused by Phthirus pubis, is an uncommon cause of blepharoconjunctivitis; therefore, this condition is easily misdiagnosed. When diagnosed, genital involvement must be ruled out. Association with other venereal diseases is common. Affected children must be searched for sexual abuse. The number of diagnosed patients in our department has increased in recent years. We review the epidemiological, clinical and diagnostic features of phthriasis palpebrarum as well as the different treatment options to eradicate the parasite and to prevent infestations (AU)