Aportaciones del "big data / Contributions of "big data"

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Vitreous tamponades in highly myopic eyes.

The use of endotamponade agents has gained a major role in the management of macular complications of high myopia. Myopic foveoschisis and macular hole are the main macular complication of pathologic myopia, this growing condition that is a main cause of visual loss, especially in patients at a younger age. We discuss the physical properties and advantages and disadvantages of the main ocular tamponade agents used in the treatment of these diseases.

Efecto de la cirugía de estrabismo de larga evolución en los potenciales evocados visuales binoculares / Effect of surgery on longstanding strabismus on binocular visual evoked potential

ObjetivoAnalizar el efecto de la cirugía sobre los potenciales evocados visuales binoculares (PEVB), en adultos con estrabismo de larga evolución.MétodoEstudio prospectivo en 40 pacientes adultos con historia antigua de estrabismo. Registramos la respuesta de potenciales evocados visuales binocular y monocular, en el preoperatorio y a los 3 meses de la cirugía. Analizamos la función visual binocular mediante los test de Worth y TNO antes y después de la cirugía.ResultadosNo se encontraron diferencias entre la desviación posquirúrgica y los resultados de los PEVB tras la cirugía p=0,82. La media de los PEVB y el porcentaje de incremento de respuesta evocada visual binocular posquirúrgicos (10,5, y 27,14%), fueron superiores a los prequirúrgicos (9,87 y 16,6%), p=0,32 y 0,17 respectivamente. Respecto al TNO hubo diferencias en los resultados tras la cirugía (p=0,03) y en la comparación con la desviación posquirúrgica (p=0,02); sin embargo no la hubo entre el TNO y los PEVB posquirúrgicos (p=0,29). Existió diferencia en los resultados del test de Worth tras la cirugía y en la comparación con la desviación y los PEVB (p=0,00, p=0,01 y p=0,07).ConclusionesLa cirugía de estrabismo en adultos corrige la desviación y parece mejorar la respuesta evocada visual binocular, pero no hemos podido confirmar este hecho. Los datos obtenidos no permiten considerar que los PEVB sean un test objetivo para la valoración de la función binocular, si bien podría haber relación entre los PEVB y la respuesta al TNO(AU)

PurposeTo analyse the effect of surgery on binocular visual evoked potential (BVEP) in adults with longstanding strabismus.MethodsA prospective study was performed on 40 patients with a history of longstanding strabismus. Visual evoked potentials to binocular and monocular pattern reversal stimulation were recorded before surgery and 3 months after surgery. Binocular visual function was analysed by Worth and TNO tests before and after surgery.ResultsWe did not find any differences between deviation and BVEP postoperatively (P=0.82). The mean of BVEP and the percentage of increment of the BVEP response (10.5 and 27.14%) were larger postoperatively, than preoperatively (9.87 and 16.6%), P=0.32 and P=0.17, respectively. There were differences in the TNO results after surgery (P=0.03) and when compared with postoperative deviation (P=0.02), but not between TNO and BVEP postoperatively (P=0.29). There were differences in the Worth results after surgery, and comparing with deviation and BVEP (P=0.00, P=0.01 and P=0.07).ConclusionsSurgery in adults with longstanding strabismus could improve the deviation and seemed to improve BVEP response, but this point could not be confirmed. The results are not enough to show that the BVEP would be an objective test for binocular function evaluation, although there could be a relationship between BVEP and the TNO response(AU)

[Effect of surgery on longstanding strabismus on binocular visual evoked potential]. / Efecto de la cirugía de estrabismo de larga evolución en los potenciales evocados visuales binoculares.

PURPOSE: To analyse the effect of surgery on binocular visual evoked potential (BVEP) in adults with longstanding strabismus. METHODS: A prospective study was performed on 40 patients with a history of longstanding strabismus. Visual evoked potentials to binocular and monocular pattern reversal stimulation were recorded before surgery and 3 months after surgery. Binocular visual function was analysed by Worth and TNO tests before and after surgery. RESULTS: We did not find any differences between deviation and BVEP postoperatively (P = 0.82). The mean of BVEP and the percentage of increment of the BVEP response (10.5 and 27.14%) were larger postoperatively, than preoperatively (9.87 and 16.6%), P = 0.32 and P = 0.17, respectively. There were differences in the TNO results after surgery (P = 0.03) and when compared with postoperative deviation (P = 0.02), but not between TNO and BVEP postoperatively (P = 0.29). There were differences in the Worth results after surgery, and comparing with deviation and BVEP (P = 0.00, P = 0.01 and P = 0.07). CONCLUSIONS: Surgery in adults with longstanding strabismus could improve the deviation and seemed to improve BVEP response, but this point could not be confirmed. The results are not enough to show that the BVEP would be an objective test for binocular function evaluation, although there could be a relationship between BVEP and the TNO response.

[Painful incomplete third-nerve palsy caused by an internal carotid-communicating posterior artery aneurysm]. / Parálisis dolorosa incompleta del III nervio causada por un aneurisma de la carótida interna-comunicante posterior.

CLINICAL CASE: A 38-year-old woman presented acute-onset, painful incomplete third-nerve palsy caused by an internal carotid-posterior communicating artery (IC-PC) aneurysm. We describe the differential diagnosis with Tolosa-Hunt syndrome and the results after endovascular treatment. DISCUSSION: The presence of pupil-sparing third-nerve palsy may not exclude the presence of an IC-PC aneurysm and orbital magnetic resonance imaging and/or computed tomography imaging must be performed in these cases. The prompt recovery after endovascular treatment is consistent with previous reports.

Parálisis dolorosa incompleta del III nervio causada por un aneurisma de la carótida interna-comunicante posterior / Painful incomplete third-nerve palsy caused by an internal carotid-communicating posterior artery aneurysm

Caso clínico: Mujer de 38 años que presentó de forma aguda una parálisis incompleta y dolorosa del III par causada por un aneurisma de la carótida interna-comunicante posterior (CI-CP). Describimos el diagnóstico diferencial con el Síndrome Tolosa-Hunt y los resultados tras tratamiento endovascular. Discusión: La presencia de una parálisis del III par sin afectación pupilar no excluye la presencia de un aneurisma de la CI-CP. La realización de una resonancia nuclear magnética orbitaria y/o angio-tomografía axial computerizada es obligada en estos casos. La rápida recuperación tras tratamiento endovascular es consistente con otros trabajos previos

Clinical case: A 38-year-old woman presented acute-onset, painful incomplete third-nerve palsy caused by an internal carotid-posterior communicating artery (IC-PC) aneurysm. We describe the differential diagnosis with Tolosa-Hunt syndrome and the results after endovascular treatment. Discussion: The presence of pupil-sparing third-nerve palsy may not exclude the presence of an IC-PC aneurysm and orbital magnetic resonance imaging and/or computed tomography imaging must be performed in these cases. The prompt recovery after endovascular treatment is consistent with previous reports (Arch Soc Esp Oftalmol 2009; 84: 43-46)

[Conjunctival inclusion cyst after strabismus surgery by hang-back recession]. / Quiste conjuntival de inclusión tras cirugía de estrabismo según técnica de retroinserción en asa.

CASE REPORT: A 24-year-old woman, with a history of infantile esotropia and DVD operated on in infancy, had strabismus surgery performed by us. Four months later she presented with a cystic lesion that recurred after drainage and medical treatment. Complete excision of the cystic lesion was therefore performed. DISCUSSION: The epithelial cells implanted on the sclera at the time of the most recent surgery may have been the origin of inclusion cyst which developed after the strabismus surgery. This suggests a possible relationship with the scleral suture as the mechanism of cyst formation, independent of the muscle position. Complete excision is the recommended treatment for large cysts.

Quiste conjuntival de inclusión tras cirugía de estrabismo según técnica de retroinserción en asa / Conjunctival inclusion cyst after strabismus surgery by hang-back recession

Caso clínico: Mujer de 24 años con antecedentes de endotropía congénita más DVD operada en la infancia. Se realiza intervención quirúrgica y cuatro meses tras la cirugía presenta una lesión quística que recidiva tras drenaje y tratamiento médico. Se realiza exéresis completa de la lesión. Discusión: El origen de los quistes de inclusión conjuntivales tras cirugía de estrabismo sería la implantación escleral de células epiteliales. Sugerimos la relación con la sutura escleral como mecanismo de formación, independientemente de la posición del músculo. El tratamiento de elección en los quistes de gran tamaño es la resección completa

Case report: A 24-year-old woman, with a history of infantile esotropia and DVD operated on in infancy, had strabismus surgery performed by us. Four months later she presented with a cystic lesion that recurred after drainage and medical treatment. Complete excision of the cystic lesion was therefore performed. Discussion: The epithelial cells implanted on the sclera at the time of the most recent surgery may have been the origin of inclusion cyst which developed after the strabismus surgery. This suggests a possible relationship with the scleral suture as the mechanism of cyst formation, independent of the muscle position. Complete excision is the recommended treatment for large cysts

[Acute concomitant esotropia and hysterical amblyopia]. / Endotropía comitante aguda y ambliopía histéricas.

CASE REPORT: The authors present the case of a 26-year-old woman, in her 29th week of pregnancy, who developed intermittent esotropia and diplopia. Six months later, the process was associated with visual loss and an accommodative spasm which did not improve with cycloplegia and refraction. The symptoms remained unchanged two years later. DISCUSSION: Acute concomitant esotropia may have no obvious underlying cause, but it has been associated with disruption of fusion, myopia, neurological problems and decompensation of a pre-existing phoria or monofixation syndrome. A physical or emotional debilitating illness may precede the onset of the problem. In our case, a neurologic origin was excluded and a diagnosis of hysterical neurosis and acute concomitant esotropia with hysterical amblyopia or functional visual loss was established.

Endotropía comitante aguda y ambliopía histéricas / Acute concomitant esotropia and hysterical amblyopia

Caso clínico: Paciente de 26 años embarazada de 29 semanas con endotropía comitante aguda y diplopía intermitentes. Tras seis meses de evolución presenta disminución de agudeza visual relacionada con un espasmo acomodativo, pero que no mejora con cicloplejía y refracción. La clínica permanece invariable 2 años después.Discusión: La causa de endotropía comitante aguda puede no ser obvia, pero con frecuencia se asocia a disrupción de fusión, miopía, procesos neurológicos y descompensación de foria o síndrome de monofijación preexistentes. Cuadros físicos o emocionales debilitantes también pueden preceder al comienzo de la desviación. En este caso, se descartaron procesos neurológicos y se diagnosticó neurosis de renta y endotropía comitante aguda con ambliopía histérica o pérdida de visión funcional

Case report: The authors present the case of a 26-year-old woman, in her 29th week of pregnancy, who developed intermittent esotropia and diplopia. Six months later, the process was associated with visual loss and an accommodative spasm which did not improve with cycloplegia and refraction. The symptoms remained unchanged two years later. Discussion: Acute concomitant esotropia may have no obvious underlying cause, but it has been associated with disruption of fusion, myopia, neurological problems and decompensation of a pre-existing phoria or monofixation syndrome. A physical or emotional debilitating illness may precede the onset of the problem. In our case, a neurologic origin was excluded and a diagnosis of hysterical neurosis and acute concomitant esotropia with hysterical amblyopia or functional visual loss was established

[Hyperthyroidism and hemodialysis]. / Hipertiroidismo y hemodiálisis.

We present the case, clinical following and successful therapy of a patient undergoing maintenance hemodialysis that presents hyperthyroidism secondary to Jod Basedow phenomenon associated to multinodular goitre previous. This case is an unusual complication for subjects in regular hemodialysis (in the bibliography revised only three cases were described in the past years) and of difficulty therapeutic management being our limited experience. In our patient, the antiseptic application with iodo solutions in the arteriovenous fistula could be representing the main cause for the hyperthyroidism. Conventional carbimazole doses keep controlling the thyroid hyper-function. Afterwards the definitive treatment with radioiodine was a safe and effective method for a long-term control.

Dynamic register in ocular ultrasonography: combining A- and B-scan techniques.

We present the results obtained after studying two groups of patients with dynamic register techniques, using A-scan, standardised A-scan following Ossoinig's procedure and B-scan. One group comprised 50 patients with retinal detachment and proliferative vitreoretinopathy while the other consisted of 15 patients with choroidal melanoma. In the group of patients with retinal detachment and proliferative vitreoretinopathy 90% of cases demonstrated waves with 100% amplitude on A-scan when the ultrasound beam was directed perpendicularly over the detached retina. Likewise in these same 90% of cases we observed a small split in the wave peak during the after movements. Conversely on B-scan 80% of these patients with retinal detachment and proliferative retinopathy showed retinal mobility. In the group of patients with choroidal melanoma rapid spontaneous movements were detected in the internal echoes on A-scan and standardised A-scan. Moreover in 3 of the 15 cases (those of greatest size) movement could also be detected on B-scan.