Effects of pterygium on the biomechanical properties of the cornea: a pilot study.

OBJECTIVE: To investigate the changes induced by a pterygium or its surgical removal on the biomechanical properties of the cornea and to determine factors that might affect these parameters. METHODS: This prospective pilot interventional, non-randomized, observer-masked study included 20 eyes of 20 patients with a unilateral primary pterygium (pterygium group) and 19 fellow healthy eyes (control group). The bare sclera technique with one-minute application of 0.02% mitomycin C intraoperatively was performed in all cases. The follow-up period was one month. The preoperative and postoperative biomechanical properties of the cornea were measured using the Reichert ocular response analyzer (ORA). RESULTS: The corneal hysteresis (CH) decreased significantly (P<.01) in eyes with a pterygium compared to the control eyes, while surgery did not significantly change the CH compared to preoperatively. There were no significant changes in the corneal resistance factor or the central corneal thickness. CONCLUSIONS: Primary active pterygium (grades 1 or 2) induce a reduction of corneal biomechanical features. Further studies are needed in populations, with longer follow-ups and bigger pterygium that may involve wider keratectomy to confirm our results.

Efecto del pterigión en las propiedades biomecánicas de la córnea: estudio piloto / Effects of pterygium on the biomechanical properties of the cornea: a pilot study

Objetivo: Investigar los cambios inducidos en la biomecánica de la córnea por la presencia de pterigión o por su exéresis quirúrgica, así como determinar los factores que influyen sobre dichos parámetros. Métodos: Estudio piloto, intervencional y prospectivo, con observador enmascarado que incluía 20 ojos de 20 pacientes con pterigión primario unilateral (grupo pterigión) y 19 ojos adelfos sanos (grupo control). Se realizó una resección simple del pterigión con aplicación intraoperatoria de mitomicina C 0,02% durante un minuto sobre el lecho escleral. El periodo de seguimiento fue de un mes. Las propiedades biomecánicas de la córnea fueron determinadas preoperatoria y postoperatoriamente mediante el analizador de respuesta ocular Reichert (ORA). Resultados: La presencia de pterigión disminuyó significativamente la histéresis corneal (HC) en comparación con el grupo control (p<0,01). No encontramos diferencias estadísticamente significativas entre las medidas pre- y postoperatorias de la HC, del factor de resistencia corneal, ni del espesor corneal central. Conclusión: La presencia de un pterigión primario activo (grados 1 y 2) conduce a una reducción de las propiedades biomecánicas de la córnea. Serían necesarios nuevos estudios con un mayor tiempo de seguimiento y pterigiones más avanzados, con queratectomías más amplias para confirmar estos efectos(AU)

Objective: To investigate the changes induced by a pterygium or its surgical removal on the biomechanical properties of the cornea and to determine factors that might affect these parameters. Methods: This prospective pilot interventional, non-randomized, observer-masked study included 20 eyes of 20 patients with a unilateral primary pterygium (pterygium group) and 19 fellow healthy eyes (control group). The bare sclera technique with one-minute application of 0.02% mitomycin C intraoperatively was performed in all cases. The follow-up period was one month. The preoperative and postoperative biomechanical properties of the cornea were measured using the Reichert ocular response analyzer (ORA). Results: The corneal hysteresis (CH) decreased significantly (P<0.01) in eyes with a pterygium compared to the control eyes, while surgery did not significantly change the CH compared to preoperatively. There were no significant changes in the corneal resistance factor or the central corneal thickness. Conclusions: Primary active pterygium (grades 1 or 2) induce a reduction of corneal biomechanical features. Further studies are needed in populations, with longer follow-ups and bigger pterygium that may involve wider keratectomy to confirm our results(AU)

[Effectiveness of topical bevacizumab in bilateral primary lipid keratopathy]. / Eficacia de bevacizumab tópico en queratopatía lipoidea bilateral primaria.

CASE REPORT: A 75-year-old man with bilateral idiopathic lipid keratopathy underwent a penetrating keratoplasty in the left eye. One month later, there was deep corneal neovascularisation extending across the bed and the graft-host interface, with a whitish opacity surrounding the vessels. Topical bevacizumab (25mg/mL) was administered 4 times daily for 2 months with partial regression of corneal neovascularization. DISCUSSION: Topical bevacizumab may be useful in preventing a recurrence of lipid deposition after penetrating keratoplasty in patients with bilateral primary lipid keratopathy, although its long-term efficacy needs to be assessed.

Eficacia de bevacizumab tópico en queratopatía lipoidea bilateral primaria / Effectiveness of topical bevacizumab in bilateral primary lipid keratopathy

Caso clínico: Varón de 75 años con queratopatía lipoidea bilateral primaria. Es intervenido de queratoplastia penetrante en ojo izquierdo. Al mes se observa neovascularización corneal profunda extendiéndose sobre el lecho y la interfase injerto-huésped, con opacidad blanquecina alrededor de los neovasos. Se inicia tratamiento con bevacizumab tópico (25mg/mL) 4 veces/día durante 2 meses, con regresión parcial de la neovascularización corneal. Discusión: Bevacizumab tópico puede ser útil en la prevención de la recidiva de la queratopatía lipoidea tras queratoplastia penetrante en pacientes con queratopatía lipoidea bilateral primaria, aunque sería conveniente determinar su eficacia a largo plazo(AU)

Case report: A 75-year-old man with bilateral idiopathic lipid keratopathy underwent a penetrating keratoplasty in the left eye. One month later, there was deep corneal neovascularisation extending across the bed and the graft-host interface, with a whitish opacity surrounding the vessels. Topical bevacizumab (25mg/mL) was administered 4 times daily for 2 months with partial regression of corneal neovascularization. Discussion: Topical bevacizumab may be useful in preventing a recurrence of lipid deposition after penetrating keratoplasty in patients with bilateral primary lipid keratopathy, although its long-term efficacy needs to be assessed(AU)

[Sterile non-traumatic corneal perforation treated with Tachosil®]. / Perforación corneal no traumática estéril tratada con Tachosil®.

CASE REPORT: An 83 year-old male reported to the emergency room with red eye and ocular pain. The slit-lamp examination showed a central corneal perforation of 1mm in diameter, with no associated infection or inflammatory process. The patient had no history of trauma. It was decided to apply a patch of Tachosil(®) at the site of corneal perforation. After 36 hours of occlusion, a layer of fibrin covered the perforation, closing the defect. Successful healing of the corneal perforation was observed in the follow-up, with no recurrences of the process. CONCLUSIONS: Tachosil(®) is collagen sponge with human fibrin and human thrombin used in cardiological and neurosurgical surgery for haemostasis and the occlusion of vessels and meninges. We present the first indication in ophthalmology of Tachosil(®) as an effective alternative in the treatment of sterile non-traumatic corneal perforations less than 1.5 mm in size.

Perforación corneal no traumática estéril tratada con Tachosil® / Sterile non-traumatic corneal perforation treated with Tachosil®

Caso clínico: Varón de 83 años que acude a urgencias por dolor ocular en ojo derecho y enrojecimiento.En la exploración se objetivó una lesión perforante corneal central de 1mm dediámetro sin proceso infeccioso o inflamatorio concomitante ni antecedentes traumáticos.Procedimos al cierre urgente del defecto, aplicando un parche de Tachosil® sobre la zonaperforada. Tras 36 horas de oclusión un material fibrinoide ocluía la perforación cerrandoel defecto. En el posterior seguimiento no se presentaron recurrencias ni efectos adversospersistiendo el sellado completo del defecto.Conclusiones: Tachosil® es una esponja colágena de fibrinógeno y trombina humanos utilizadapara favorecer la hemostasia y la reparación tisular en cirugías cardíacas, urológicasy neuroquirúrgicas. Presentamos la primera indicación oftalmológica de Tachosil® comouna posible alternativa efectiva y de fácil uso en las perforaciones corneales no traumáticasestériles menores de 1,5mm(AU)

Case report: An 83 year-old male reported to the emergency room with red eye and ocularpain. The slit-lamp examination showed a central corneal perforation of 1mm in diameter,with no associated infection or inflammatory process. The patient had no history of trauma.It was decided to apply a patch of Tachosil® at the site of corneal perforation. After 36 hoursof occlusion, a layer of fibrin covered the perforation, closing the defect. Successful healingof the corneal perforationwas observed in the follow-up, with no recurrences of the process.Conclusions: Tachosil® is collagen sponge with human fibrin and human thrombin used incardiological and neurosurgical surgery for haemostasis and the occlusion of vessels andmeninges. We present the first indication in ophthalmology of Tachosil® as an effectivealternative in the treatment of sterile non-traumatic corneal perforations less than 1.5mmin size(AU)

[Bilateral conjunctival oedema as a symptom of adrenal adenocarcinoma]. / Quemosis conjuntival bilateral como síntoma de adenocarcinoma suprarrenal.

CLINICAL CASE: We present a case of a 67-year-old female suffering for bilateral conjunctival oedema that did not improve with antibiotic and antiinflammatory treatment. After a complete systemic examination she was diagnosed with an adrenal adenocarcinoma and treated by surgery and chemotherapy. The conjunctival chemosis subsequently improved. Unfortunately the patient died of respiratory failure due to metastasis. CONCLUSION: We emphasise the need of an exhaustive and complete examination by the ophthalmologist in cases of non-responders to topical antibiotic and antiinflammatory treatment in patients with bilateral conjunctival oedema, in order to make a correct diagnosis of systemic potentially lethal diseases.

Quemosis conjuntival bilateral como síntoma de adenocarcinoma suprarrenal / Bilateral conjunctival oedema as a symptom of adrenal adenocarcinoma

Caso clínicoSe presenta el caso de una paciente de 67 años que acude por edema conjuntival bilateral resistente a tratamiento tópico con antibióticos antiinflamatorios. Tras un completo examen sistémico llegamos al diagnóstico de adenocarcinoma suprarrenal que fue tratado mediante cirugía y quimioterapia, tras los cuales la quemosis mejoró. Desafortunadamente, la paciente falleció por insuficiencia respiratoria debido a metástasis.ConclusiónSe destaca la necesidad de realizar un examen exhaustivo y completo por el oftalmólogo en casos de pacientes con edema conjuntival bilateral no respondedores a tratamiento tópico con antibióticos y antiinflamatorios, para descartar enfermedades sistémicas potencialmente graves(AU)

Clinical caseWe present a case of a 67-year-old female suffering for bilateral conjunctival oedema that did not improve with antibiotic and antiinflammatory treatment. After a complete systemic examination she was diagnosed with an adrenal adenocarcinoma and treated by surgery and chemotherapy. The conjunctival chemosis subsequently improved. Unfortunately the patient died of respiratory failure due to metastasis.ConclusionWe emphasise the need of an exhaustive and complete examination by the ophthalmologist in cases of non-responders to topical antibiotic and antiinflammatory treatment in patients with bilateral conjunctival oedema, in order to make a correct diagnosis of systemic potentially lethal diseases(AU)

Análisis morfométrico del endotelio de la córnea tras aplicación intraoperatoria de mitomicina C en la resección simple de pterigión: un estudio piloto / Endothelial cells analysis after intraoperative mitomycin-C adjuvant pterygium simple excision surgery: a pilot study

Objetivo: Evaluar el efecto de la mitomicina C (MMC) sobre el endotelio corneal tras cirugíade pterigión.Método: Estudio clínico intervencional y prospectivo con observador enmascarado. Veintepacientes (20 ojos) con pterigión primario fueron intervenidos mediante resección simpledel pterigión y aplicación intraoperatoria de MMC al 0,02% durante 1 minuto. El endoteliocorneal fue evaluado pre- y postoperatoriamente a los 10 días, al mes y a los 3 meses, conmicroscopía especular. La densidad de las células del endotelio corneal, coeficiente devariación del tamaño celular y porcentaje de hexagonalidad celular fueron analizados.Resultados: Las medias de la densidad de células endoteliales antes y a los 3 meses de lacirugía fueron 2.240,37 desviación estándar (DE) 347,92 células/mm2 (rango: 1.020 a 2.703)y 2.283,86 DE 425,13 células/mm2 (rango: 1.001 a 2.837), respectivamente. Las medias delcoeficiente de variación antes y a los 3 meses de la cirugía fueron 32,63 DE 4,65 (rango: 22a 48) y 33,00 DE 4,75 (rango: 23 a 51), respectivamente. Las medias de los porcentajes dehexagonalidad celular antes y a los 3 meses de la cirugía fueron 54,58 DE 6,60 (rango: 46 a71) y 55,26 DE 8,89 (rango: 38 a 76), respectivamente. No se encontraron diferencias estadísticamentesignificativas en las comparaciones con el valor preoperatorio en ninguna delas variables analizadas.Conclusiones: La aplicación intraoperatoria de MMC al 0,02% durante 1 minuto en la resecciónsimple de pterigión no parece causar cambios sustanciales sobre la densidad de lascélulas del endotelio corneal a corto plazo(AU)

To study the effects of mitomycin-C (MMC) on the corneal endothelium afterpterygium surgery.Methods: Prospective, interventional, nonrandomized, observer-masked study. Twentypatients (20 eyes) with primary pterygium underwent surgery with pterygium simpleexcision followed by 0.02% MMC application for 1 minute. Preoperative, 10-day, 1-monthand 3-month postoperative specular microscopy were performed. Mean cell density,coefficient of variation of mean cell area and percentage of hexagonal cells weremeasured.Results: Mean endothelial cell densities before and 3 months after surgery were 2,240.37 SD347.92 cells/mm2 (range: 1,020 to 2,703) and 2,283.86 SD 425.13 cells/mm2 (range: 1,001 to2,837), respectively. Mean coefficient of variation before and 3 months after surgery were32.63 SD 4.65 (range: 22 to 48) and 33.00 SD 4.75 (range: 23 to 51), respectively. Meanpercentage of hexagonal cells before and 3 months after surgery were 54.58 SD 6.60 (range:46 to 71) and 55.26 SD 8.89 (range: 38 to 76), respectively. No statistically significantdifferences were found in any of the parameters studied when compared to thepreoperative values.Conclusions: A single intraoperative application of 0.02% MMC for 1 minute duringpterygium simple excision surgery does not seem to cause substantial changes in cornealendothelial cell density at 3 months(AU)

[Corneal melting and topical nonsteroidal anti-inflammatory drug (NSAID). A case report]. / Relación entre anti-inflamatorios no esteroideos (AINES) y queratolisis. A propósito de un caso.

PURPOSE: To study the relationship between the use of nonsteroidal anti-inflammatory drug (NSAID) and the corneal melting. CASE REPORT: We report a case of keratolysis after vitreoretinal surgery and topical use of ketorolac tromethamine (Acular). DISCUSSION: It is proposed the multifactorial etiology in the cases of corneal melting related to the use of NSAID and it is recommended an reasonable use of them in each situation and to check the possible comorbility of other agents.

Relación entre anti-inflamatorios no esteroideos (AINEs) y queratolisis. A propósito de un caso / Corneal melting and topical nonsteroidal anti-inflammatory drug (NSAID). A case report

Objetivo: Establecer la posible relación entre eluso de los antiinflamatorios no esteroideos (AINEs)tópicos y la queratolisis.Caso clínico: Se presenta un caso de queratolisistras cirugía vitreorretiniana y uso tópico de ketorolacotrometamol (Acular®).Discusión: Se plantea la etiología multifactorial enlos casos de queratolisis asociados al uso de AINEsy recomendando un uso de los mismos adecuado acada situación, valorando la posible comorbilidad de otros agentes(AU)

Purpose: To study the relationship between the useof nonsteroidal anti-inflammatory drug (NSAID)and the corneal melting.Case report: We report a case of keratolysis aftervitreoretinal surgery and topical use of ketorolactromethamine (Acular®).Discussion: It is proposed the multifactorial etiologyin the cases of corneal melting related to theuse of NSAID and it is recommended an reasonableuse of them in each situation and to check the possiblecomorbility of other agents(AU)

[Primary bilateral lipid keratopathy]. / Queratopatía lipoidea primaria bilateral.

CASE REPORT: Observational, case report study. A 45-year-old woman complained of bilateral irritation and photophobia since childhood. Slit-lamp examination revealed yellow-whitish deposits involving the deep stroma of the peripheral half of the cornea in both eyes. The evolution was slowly progressive with a moderate impairment of her visual acuity. DISCUSSION: Lipid deposits adopt symmetric and bilateral configurations; the absence of corneal vascularization and ocular pathology as well as any lipoprotein disorder support the diagnosis of primary lipid keratopathy. The slow progressing disease is also confirmed.

Reflexiones sobre la docencia de la oftalmología / Considerations about teaching in ophthalmology

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OCT: un nuevo concepto de diagnóstico / OCT: a new concept of diagnosis

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