[Impression cytology study of dry eyes in patients with congenital aniridia]. / Estudio del ojo seco en pacientes con aniridia congénita, mediante citología de impresión.

PURPOSE: To evaluate the long-term results of ocular surface reconstruction by means of medical treatment, limbal transplantation or amniotic membrane transplantation in patients with congenital aniridia. MATERIAL AND METHODS: Thirty-six eyes from 18 consecutive patients with aniridia were studied by clinical tests (Schirmer test, break-up time and vital rose bengal staining) and impression cytology. Thirteen patients were treated with lubricant drops for ocular dryness. Two eyes from 2 patients also received limbal transplantation, and other 4 eyes underwent amniotic membrane transplantation. RESULTS: Corneal and conjunctival epithelium improved in all patients treated with lubricant drops. Ocular surface epithelium condition was worse in those patients not receiving artificial tears. After 12 months of limbal transplantation, clinical and morphological results showed a significant corneal recovery of at least two grades of squamous metaplasia in comparison with the previous situation. We also carried out amniotic membrane transplantation in patients with aniridia. The improvement was initially observed after 2 months and by the sixth month there was a significant improvement in clinical signs and symptoms, with normal corneal cells next to altered ones. CONCLUSIONS: All the aniridic patients showed dry eye. Treatment with lubricant drops is necessary to decrease the squamous metaplasia process. Limbal transplantation and amniotic membrane implantation are needed for effective corneal surface reconstruction in patients with aniridia, which is followed by a significant improvement of the dry eye.

Estudio del ojo seco en pacientes con aniridia congénita, mediante citología de impresión / Impression cytology study of dry eyes in patients with congenital aniridia

Objetivos: Evaluar la sequedad ocular en pacientes con aniridia congénita antes y después de la reconstrucción de la superficie ocular a largo plazo sometidos a un tratamiento médico, a un transplante limbal o a un implante de membrana amniótica. Material y Métodos: Se estudiaron 36 ojos pertenecientes a 18 pacientes consecutivos con aniridia congénita mediante pruebas clínicas (prueba de Schirmer, tiempo de ruptura de la película lagrimal y tinción vital con rosa de bengala) y la citología de impresión. Trece pacientes se trataron continuamente con lágrimas artificiales por sequedad ocular. En 2 ojos de 2 pacientes se añadió el transplante limbal y en otros 4 ojos de transplante de membrana amniótica a la córnea. Resultados: El epitelio corneal y conjuntival de todos los pacientes mejoró con el tratamiento médico de lágrimas artificiales. Los pacientes que no utilizaron lágrimas artificiales presentaron peor estado del epitelio de la superficie ocular. El transplante de limbo después de 12 meses mostró una recuperación corneal significativa, de al menos dos grados de metaplasia escamosa respecto a antes de la cirugía. El efecto clínico del implante de membrana amniótica empezó a notarse a los 2 meses de la intervención quirúrgica y al cabo de 6 meses hubo una mejoría significativa en los signos y síntomas clínicos, con la aparición de células epiteliales corneales prácticamente normales junto a otras aún alteradas. Conclusiones: Todos los pacientes con aniridia mostraron signos citológicos de ojo seco. El tratamiento con lagrimas artificiales es necesario en pacientes con aniridia para controlar el grado de metaplasia escamosa. El transplante limbal y el de membrana amniótica son necesarios para la reconstrucción efectiva de la superficie corneal en pacientes con aniridia, permitiendo a su vez que el ojo seco mejore significativamente (AU)

¿Por qué deben evitarse los términos nictalopía y hemeralopía? (II)

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¿Por qué deben evitarse los términos nictalopía y hemeralopía? (I)

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Measuring the lacunar sulci as a new indicator of shrinkage of the ocular surface.

PURPOSE: To present a new indicator that measures the sulci of the lacrimal lake of the eye according to the degrees of ocular abduction at which they vanish. This new approach will help determine the severity and progression of mucosal retraction in ocular surface diseases. METHODS: A total of 181 eyes of 94 healthy persons, 130 eyes of 65 patients with Sjogren's syndrome, and 30 eyes of 15 patients with ocular pemphigoid were examined using the slit lamp. We recorded the vanishing point of the three main lacunar sulci (plico-bulbar, plicocaruncular and dermo-caruncular) while abducting. RESULTS: In healthy persons, the average vanishing points for the first and second lacunar sulci were respectively, 53.20 +/- 12.3 and 54.50 +/- 9.8. In patients with Sjogren's syndrome, 49.53 degrees +/- 10.81 and 53.17 degrees +/- 7.28 and in patients with incipient ocular cicatricial pemphigoid, 42.69 degrees +/- 14.33 and 44.46 degrees +/- 16.85. Statistical significance was p < 0.005. CONCLUSIONS: The lacunar sulci are shallower and vanish sooner in ocular cicatricial pemphigoid and Sjogren syndrome than in normals. Investigating the vanishing point of the lacunar sulci while abducting is useful for grading the shrinkage of the conjunctiva, caruncle and medial canthus.

Treatment of dry eye by blocking the lacrimal canaliculi.

Occlusion of the lacrimal canaliculi improves the objective signs and subjective symptoms of dry eye. In this review, methods of occlusion are classified as surgical, thermal and tamponade. Surgical methods include dacryocystectomy, canalicular ligature, canalicular offset, canalicular excision, transfer of the punctum to dry dock, punctal tarsorrhaphy and punctal patch. Thermal methods include cautery, diathermy and laser burn. Tamponade methods use absorbable inserts of hydroxypropyl cellulose, gelatin, collagen and catgut, and nonabsorbable inserts of silicone (punctum plugs, canalicular plugs), polyethylene, cyanoacrylate, and others. The characteristics of all these methods are analyzed.