Dacriocistorrinostomía láser endocanalicular y sus modificaciones: revisión sistemática de técnicas y tasa de éxito / Endocanalicular Laser Dacryocystorhinostomy and its modifications: A systematic review of techniques and success rates

Objetivo El objetivo principal de este trabajo es revisar los artículos que hacen referencia a la técnica de la dacriocistorrinostomía láser (DCRL) para la obstrucción adquirida de la vía lagrimal (OACN), así como sus modificaciones, a través de una exhaustiva revisión bibliográfica. Material y método Se realizó una revisión sistemática de las publicaciones relacionadas con cirugía láser de la vía lagrimal desde el año 2000 hasta marzo de 2021 en las bases de datos MEDLINE, EMBASE y Cochrane Library. Los términos de búsqueda en idioma español e inglés fueron: «Endocanalicular laser», dacryocystorhinostomy or «primary DCR-L» or «laser» and «tear ducts». Resultados Tras someter los artículos a los criterios de inclusión y exclusión, obtuvimos 49 artículos: 21 estudios retrospectivos y 28 estudios prospectivos. El resultado bibliométrico obtenido garantiza, para la presente revisión, una recomendación de nivel C según la escala Scottish Intercollegiate Guidelines Network. Conclusiones Actualmente la DCRL clásica tiene tasas de éxito menores que las DCRL modificadas, por lo que sugerimos el uso de estas últimas. Preferimos la DCRL con MMC-IS o bien la DCRL con técnicas de endoscopia asociadas, sin poder decantarnos por ninguna opción en particular, puesto que las tasas de éxito son muy similares. Dejamos a criterio del cirujano la elección, dependiendo del manejo de las técnicas endonasales. Son necesarios más estudios, con mayor seguimiento, y mejor definidos para clarificar cuál es la mejor técnica DCRL (AU)

Objective The main objective of this work is to review the articles that refer to transcanalicular diode laser dacryocystorhinostomy (TCL-DCR) in acquired nasolacrimal duct obstruction (NLDO), as well as its modifications. Material and methods A systematic review of publications related to TCL-DCR of the lacrimal duct from 2000 to March 2021 was carried out in the MEDLINE, EMBASE and Cochrane Library databases. The search terms in Spanish and English were: «Endocanalicular laser», dacryocystorhinostomy or «primary DCR-L» or «laser» and «tear ducts». Results After subjecting the articles to the inclusion and exclusion criteria, we got 49 articles: 21 retrospective and 28 prospective studies. The bibliometric result obtained guaranteed, for this review, a level C recommendation according to the Scottish Intercollegiate Guidelines Network scale. Conclusions Currently, the classic TCL-DCR has lower success rates than its modifications, so we suggest using the latter. We prefer TCL-DCR with IS-MMC or TCDL associated with endoscopy techniques, without being able to opt for any option, since their success rates are very similar. We leave the choice to the discretion of the surgeon, depending on the management skills of endonasal techniques. More studies, with longer follow-up, and better defined criteria are necessary to clarify which is the best TCL-DCR technique (AU)

Eficacia de la hialuronidasa retrobulbar en el tratamiento de la ceguera provocada por rellenos cosméticos. Revisión sistemática / Effectiveness of retrobulbar hyaluronidase in the treatment of visual loss caused by periocular hyaluronic acid injection. A systematic review

Introducción La pérdida visual relacionada con la inyección periocular de rellenos con fines cosméticos es infrecuente pero muy grave. Como recomendaciones protocolizadas ante la pérdida visual por inyección intravascular inadvertida de ácido hialurónico se encuentran, entre otras, la inyección de hialorunidasa en el espacio retroocular. Es de esperar que, dada la creciente demanda de tratamientos de rellenos estéticos y la gran heterogeneidad de profesionales que pueden administrarlos, el número de casos y complicaciones relacionadas con estos procedimientos se incremente de manera sustancial. Objetivo Evaluar si existe evidencia científica para recomendar la inyección retroocular de hialuronidasa en el tratamiento de pérdidas visuales relacionadas con la inyección periocular de ácido hialurónico cosmético. Material y métodos Hemos realizado una búsqueda de artículos publicados en inglés y español siguiendo la declaración PRISMA sobre el uso de hialuronidasa retrobulbar para revertir la pérdida de visión producida por los rellenos de ácido hialurónico. Los artículos revisados incluyeron los casos clínicos y las investigaciones experimentales. Identificamos a un total de 13 pacientes en esta revisión siguiendo unos criterios de inclusión y exclusión definidos. Finalmente, incluimos 15 artículos en el estudio, 13 de ellos fueron casos/series de casos. Los 2artículos restantes son estudios experimentales en animales con grupo control, en los que, tras provocar una oclusión selectiva de la arteria oftálmica, se administran inyecciones seriadas de hialuronidasa retroocular con control de la función visual. Resultados De los 15 artículos incluidos en el estudio, recogimos los datos de un total de 17 pacientes que, tras inyección de ácido hialurónico facial por motivos estéticos, presentaron una disminución brusca de la visión y en los que se inyectaron dosis variables de hialuronidasa retroocular (AU)

Introduction Blindness after periocular cosmetic filler injection is a rare but devastating complication. Complication management protocols recommend injecting retrobulbar hyaluronidase if visual loss related to accidental intravascular injection of hyaluronic acid occurs. Given the dramatic increase in cosmetic filler injections and the variety of professionals that can deliver them, it is reasonable to assume that the incidence of complications will rise significantly. Objective To evaluate if there is evidence-based efficacy of retrobulbar hyaluronidase injection in visual loss secondary to periocular cosmetic filler injection. Material and methods The authors performed a search of English and Spanish language articles following the PRISMA statement published on the use of retrobulbar hyaluronidase to reverse vision loss precipitated by hyaluronic acid gel fillers. Articles reviewed included case reports/series and experimental investigations. We identified a total of 13 patients in this review following defined inclusion and exclusion criteria. Finally, we included 15 articles in the study, 12 of them were cases / case series. The 2remaining articles are experimental studies in animals with a control group, in which after causing selective occlusion of the ophthalmic artery, serial injections of retroocular hyaluronidase are administered with control of visual function. Results Of the 15 articles included in the study, we studied 17 patients treated with retrobulbar hyaluronidase for hyaluronic acid-induced blindness. Improvement was demonstrated in 3 cases. Animal studies demonstrate variable data are provided regarding the recovery of visual acuity. Conclusions There is no confirmed evidence of retrobulbar hyaluronidase injection effectiveness in treating visual loss due to accidental intravascular injection of hyaluronic acid. More studies are needed to show the efficacy of hyaluronidase as a treatment for blindness caused by hyaluronic acid (AU)

Effectiveness of retrobulbar hyaluronidase in the treatment of visual loss caused by periocular hyaluronic acid injection. A systematic review.

INTRODUCTION: Blindness after periocular cosmetic filler injection is a rare but devastating complication. Complication management protocols recommend injecting retrobulbar hyaluronidase if visual loss related to accidental intravascular injection of hyaluronic acid occurs. Given the dramatic increase in cosmetic filler injections and the variety of professionals that can deliver them, it is reasonable to assume that the incidence of complications will rise significantly. OBJECTIVE: To evaluate if there is evidence-based efficacy of retrobulbar hyaluronidase injection in visual loss secondary to periocular cosmetic filler injection. MATERIAL AND METHODS: The authors performed a search of English and Spanish language articles following the PRISMA statement published on the use of retrobulbar hyaluronidase to reverse vision loss precipitated by hyaluronic acid gel fillers. Articles reviewed included case reports/series and experimental investigations. We identified a total of 13 patients in this review following defined inclusion and exclusion criteria. Finally, we included 15 articles in the study, 12 of them were cases / case series. The 2 remaining articles are experimental studies in animals with a control group, in which after causing selective occlusion of the ophthalmic artery, serial injections of retroocular hyaluronidase are administered with control of visual function. RESULTS: Of the 15 articles included in the study, we studied 17 patients treated with retrobulbar hyaluronidase for hyaluronic acid-induced blindness. Improvement was demonstrated in 3 cases. Animal studies demonstrate variable data are provided regarding the recovery of visual acuity. CONCLUSIONS: There is no confirmed evidence of retrobulbar hyaluronidase injection effectiveness in treating visual loss due to accidental intravascular injection of hyaluronic acid. More studies are needed to show the efficacy of hyaluronidase as a treatment for blindness caused by hyaluronic acid.

Endocanalicular Laser Dacryocystorhinostomy and its modifications: A systematic review of techniques and success rates.

OBJECTIVE: the main objective of this work is to review the articles that refer to transcanalicular diode laser dacryocystorhinostomy (TCL-DCR) in acquired nasolacrimal duct obstruction (NLDO), as well as its modifications. MATERIAL AND METHODS: A systematic review of publications related to TCL-DCR of the lacrimal duct from 2000 to March 2021 was carried out in the MEDLINE, EMBASE and COCHRANE LIBRARY databases. The search terms in Spanish and English were: «Endocanalicular laser¼, dacryocystorhinostomy or «primary DCR-L¼ or «laser¼ and «tear ducts¼. RESULTS: After subjecting the articles to the inclusion and exclusion criteria, we got 49 articles: 21 retrospective and 28 prospective studies. The bibliometric result obtained guaranteed, for this review, a level C recommendation according to the Scottish Intercollegiate Guidelines Network scale. CONCLUSIONS: Currently, the classic TCL-DCR has lower success rates than its modifications, so we suggest using the latter. We prefer TCL-DCR with IS-MMC or TCDL associated with endoscopy techniques, without being able to opt for any option, since their success rates are very similar. We leave the choice to the discretion of the surgeon, depending on the management skills of endonasal techniques. More studies, with longer follow-up, and better defined criteria are necessary to clarify which is the best TCL-DCR technique.

Xantogranuloma orbitario del adulto como causa de inflamación palpebral recidivante / Adult orbital xanthogranuloma as a cause of recurrent palpebral swelling

El xantogranuloma orbitario del adulto es un raro trastorno inflamatorio idiopático incluido dentro de las enfermedades xantogranulomatosas orbitarias, con posible asociación a otras condiciones sistémicas. Presentamos el caso de una mujer de 43 años que presentó una masa profunda de crecimiento rápido en el párpado superior derecho con antecedentes de nódulos amarillentos no ulcerativos en el párpado superior, bilaterales, y 2 blefaroplastias superiores previas. Se realizó biopsia-extirpación de la lesión orbitaria anterior, siendo los hallazgos anatomopatológicos compatibles con xantogranuloma histiocítico del adulto. El estudio sistémico fue negativo y la paciente se encuentra asintomática sin tratamiento. Las enfermedades xantogranulomatosas orbitarias constituyen una entidad rara potencialmente grave, por lo que el oftalmólogo debe de estar familiarizado con esta enfermedad para poder realizar un diagnóstico precoz a través de la anamnesis, exploración y la histología de lesiones que en ocasiones pueden simular xantelasmas palpebrales

Orbital adult-onset xanthogranuloma is a rare idiopathic inflammatory disorder included in the group of orbital xanthogranulomatous diseases with possible systemic associations. A 43 year-old woman presented with a deep fast-growing mass on the right upper eyelid. She had a past medical history of bilateral non-ulcerative nodules on the upper eyelid and two cosmetic upper lid blepharoplasties. An excisional biopsy was performed and the histopathology analysis confirmed the diagnosis of adult histiocytic xanthogranuloma. The systemic work up was negative and the patient is asymptomatic without treatment. Orbital xanthogranulomatous diseases are rare, but potentially life-threatening disorders. The ophthalmologist must be aware of this disease in order to make an early diagnosis using the anamnesis, clinical examination, and histology of the periocular lesions that may resemble palpebral xanthelasmas

Adult orbital xanthogranuloma as a cause of recurrent palpebral swelling. / Xantogranuloma orbitario del adulto como causa de inflamación palpebral recidivante.

Orbital adult-onset xanthogranuloma is a rare idiopathic inflammatory disorder included in the group of orbital xanthogranulomatous diseases with possible systemic associations. A 43 year-old woman presented with a deep fast-growing mass on the right upper eyelid. She had a past medical history of bilateral non-ulcerative nodules on the upper eyelid and two cosmetic upper lid blepharoplasties. An excisional biopsy was performed and the histopathology analysis confirmed the diagnosis of adult histiocytic xanthogranuloma. The systemic work up was negative and the patient is asymptomatic without treatment. Orbital xanthogranulomatous diseases are rare, but potentially life-threatening disorders. The ophthalmologist must be aware of this disease in order to make an early diagnosis using the anamnesis, clinical examination, and histology of the periocular lesions that may resemble palpebral xanthelasmas.

Endoglin co-expression with eNOS, SMAD2 and phosphorylated SMAD2/3 in normocholesterolemic and hypercholesterolemic mice: an immunohistochemical study.

Endoglin, a homodimeric transmembrane glycoprotein, is a part of the transforming growth factor-beta (TGF-beta) receptor cascade. It has been demonstrated that endoglin can affect TGF-beta signaling and eNOS expression by affecting SMAD proteins in vitro. We planned to go one step forward and evaluate whether endoglin is co-expressed with SMAD2, phosphorylated SMAD2/3 protein and eNOS in endothelium of normocholesterolemic C57BL/6J mice, and in advanced atherosclerotic lesions in hypercholesterolemic apoE/LDLr-deficient mice by means of fluorescence immunohistochemistry. Female C57BL/6J mice were fed with a chow diet (standard laboratory diet) for 12 weeks after weaning (at the age of 4 weeks). Two-month-old female apoE/LDLr-deficient mice were fed the western type diet (atherogenic diet) containing 21% fat (11% saturated fat) and 0.15% cholesterol for 2 months. Immunohistochemical analysis of endoglin, SMAD2, phosphorylated SMAD2/3 and eNOS expression was performed in mice aortic sinus. Immunohistochemical analysis showed the expression of endoglin in intact endothelium in both C57BL/6J and apoE/LDLr-deficient mice and in endothelium covering the atherosclerotic lesion in apoE/LDLr-deficient mice. Fluorescence immunohistochemistry revealed co-expression of endoglin with SMAD2, phosphorylated SMAD2/3 and eNOS in intact aortic endothelium in C57BL/6J mice. Moreover, strong co-localization of endoglin, SMAD2, phosphorylated SMAD2/3 and eNOS was also detected in endothelium covering atherosclerotic lesions in apoE/LDLr-deficient mice. In conclusion, we suggest that endoglin, SMAD2, phosphorylated SMAD2/3 and eNOS may be important in vessel endothelium homeostasis underlying their role in atherogenesis.