Chronic fluid misdirection syndrome of aqueous humor after phacoemulsification: diagnosis, treatment and asscociated factors. / Síndrome de mala dirección del humor acuoso crónico tras facoemulsificación: diagnóstico, tratamiento y factores a tener en cuenta.

The chronic fluid misdirection syndrome of aqueous humor is a rare and serious condition if not treated promptly. The case is presented of a woman attending the emergency department with an intraocular pressure of 43.00mmHg and shallow anterior chamber in her left eye. As clinical history of interest, she had cataract surgery in that eye several weeks before. Following the suspicion of malignant glaucoma, a capsulotomy and iridotomy were performed with an unfavourable outcome. For this reason, it was decided to perform a central vitrectomy, but the patient did not respond to this surgical treatment either. A second surgery was then performed with peripheral vitrectomy, anterior hyaloidectomy, zonulectomy, and iridectomy, obtaining good results. Finally, a decrease in intraocular pressure, and an opening of camerular angle were achieved. Thus, if malignant glaucoma is not resolved in medical consultation with iridotomy and capsulotomy, a vitrectomy, creating a unique chamber that restores the fluid mechanics of the aqueous humor, will be needed.

[Update of diabetic retinopathy for Primary Care physicians: Towards an improvement of telematic medicine]. / Actualización de la retinopatía diabética para médicos de atención primaria: hacia una mejora de la medicina telemática.

Diabetic retinopathy (DR) is considered the most common cause of blindness in the working-age population in industrialised countries, with diabetic macular oedema being the most common reason of decreased visual acuity in diabetics. According to the results of large multicentre studies, blindness prevention for RD involves conducting periodic check-ups, which include examinations of the back of the eye, so they can be treated in time. The use of non-mydriatic cameras and telemedicine have been shown to be useful in this regard (sensitivity>80% and specificity>90%). If this procedure is followed, the first retinography should be performed 5 years from diagnosis in type 1 diabetics and immediately after diagnosis in type 2 diabetics. Therefore the role of the Primary Care physician is crucial to enable early diagnosis of this disease.