XEN® 45 en el manejo quirúrgico del glaucoma en fases tempranas: estudio nacional de consenso según metodología Delphi / XEN-45 in the management of Early Glaucoma Surgery: A National Delphi Consensus Study

Antecedentes y objetivo: Las recomendaciones sobre el manejo general del glaucoma y el uso de cirugías mínimamente-invasivas y microincisionales en fases tempranas son limitadas. El objetivo de este estudio fue establecer un consenso sobre el manejo del glaucoma, centrándose en el implante XEN 45 (AbbVie Inc., North Chicago, IL, EE. UU.). Métodos: Se utilizó un método Delphi. El comité científico dirigió el estudio, identificó el panel de expertos y participó en la elaboración del cuestionario. Se invitó a 51 expertos a completar, en una escala Likert de 9 puntos, un cuestionario de 89 ítems que cubría 3 bloques temáticos. Se realizaron 2 rondas Delphi. Se logró consenso si≥66,6% de los expertos llegaron a un acuerdo o desacuerdo. Resultados: Los panelistas acordaron 84 ítems relacionados con la calidad de vida, el algoritmo terapéutico y el perfil del paciente, y el manejo quirúrgico pre y postoperatorio. Los panelistas consideraron el implante XEN idóneo para tratar el glaucoma en diferentes etapas y para diferentes perfiles de pacientes: pacientes jóvenes/ancianos/con comorbilidades-significativas, glaucoma-miópico, pacientes con fracaso quirúrgico previo y con postoperatorio complejo. El implante XEN se consideró un paso terapéutico previo a la cirugía filtrante clásica y una posible primera opción quirúrgica en pacientes ancianos con comorbilidades y presión intraocular descontrolada. El implante XEN permite al paciente retomar sus actividades diarias más rápidamente que las cirugías filtrantes convencionales y reducir y/o eliminar los tratamientos tópicos. Conclusiones: Este consenso según la metodología Delphi proporcionó una serie de recomendaciones generales para el tratamiento del glaucoma, incluidas aquellas relacionadas con la calidad de vida del paciente, el algoritmo terapéutico y el perfil del paciente, y específicas con respecto al uso del implante XEN.(AU)

Background and objective: Recommendations on general glaucoma management and the use of early minimally invasive and microincisional surgeries are limited. This study aimed to establish consensus regarding glaucoma management, focusing on the XEN-45 gel stent implant. Methods: A Delphi consensus-driven process was used. The scientific committee led the study, identified the expert panel, and participated in elaborating the questionnaire. Fifty-one panelists were invited to complete, on a nine-point Likert scale, an 89-item questionnaire covering three topic blocks. Two Delphi rounds were performed. Consensus was achieved if ≥66.6% of panelists reached agreement or disagreement. Results: Panelists agreed on 84 items related to the patients’ quality of life, the therapeutic algorithm and patient profile, and surgical and pre- and post-operative management. Panelists agreed on the suitability of XEN stent implants to treat glaucoma at different stages and for different patient profiles: young patients, elderly or with significant comorbidities, and with myopic glaucoma, patients who failed previous surgeries, and with previous poor post-operative experience. XEN surgery was considered a therapeutic step prior to classic filtering surgery and a possible first surgical option in elderly patients with comorbidities and uncontrolled intraocular pressure. XEN surgery allows the patient to return to routine daily activities faster than conventional filtering surgeries and to reduce and/or eliminate topical treatments. Conclusions: This Delphi-driven consensus resulted in a series of general recommendations for glaucoma management, including those related to patient quality of life, therapeutic algorithm, and patient profile, and specific ones regarding the use of XEN stent gel surgery.(AU)

XEN-45 in the management of early glaucoma surgery: A national Delphi consensus study.

BACKGROUND AND OBJECTIVE: Recommendations on general glaucoma management and the use of early minimally invasive and microincisional surgeries are limited. This study aimed to establish consensus regarding glaucoma management, focusing on the XEN-45 gel stent implant. METHODS: A Delphi consensus-driven process was used. The scientific committee led the study, identified the expert panel, and participated in elaborating the questionnaire. Fifty-one panelists were invited to complete, on a nine-point Likert scale, an 89-item questionnaire covering three topic blocks. Two Delphi rounds were performed. Consensus was achieved if ≥66.6% of panelists reached agreement or disagreement. RESULTS: Panelists agreed on 84 items related to the patients' quality of life, the therapeutic algorithm and patient profile, and surgical and pre- and post-operative management. Panelists agreed on the suitability of XEN stent implants to treat glaucoma at different stages and for different patient profiles: young patients, elderly or with significant comorbidities, and with myopic glaucoma, patients who failed previous surgeries, and with previous poor post-operative experience. XEN surgery was considered a therapeutic step prior to classic filtering surgery and a possible first surgical option in elderly patients with comorbidities and uncontrolled intraocular pressure. XEN surgery allows the patient to return to routine daily activities faster than conventional filtering surgeries and to reduce and/or eliminate topical treatments. CONCLUSIONS: This Delphi-driven consensus resulted in a series of general recommendations for glaucoma management, including those related to patient quality of life, therapeutic algorithm, and patient profile, and specific ones regarding the use of XEN stent gel surgery.

Síndrome de Radius-Maumenee: más allá de un reto diagnóstico y terapéutico / Radius-Maumenee syndrome: Beyond a diagnostic and therapeutic challenge

El síndrome de Radius-Maumenee (SRM) o hipertensión venosa epiescleral idiopática (HVEI) es un trastorno infrecuente que cursa con una dilatación de los vasos epiesclerales y un aumento de la presión intraocular (PIO). Es un síndrome que constituye un reto diagnóstico y terapéutico para el oftalmólogo. Presentamos un caso en el que, a pesar de hacer un diagnóstico precoz, e intentar planificar un tratamiento orientado a eludir la efusión coroidea, no hemos podido evitar su aparición, teniendo que enfrentarnos a ella en 2 ocasiones con buenos resultados funcionales hasta el momento

Radius-Maumenee syndrome (SRM) or idiopathic episcleral venous hypertension (HVEI) is an uncommon disorder that occurs with a dilation of the episcleral vessels and an increase in intraocular pressure (IOP). It is a syndrome that constitutes a diagnostic and therapeutic challenge for the ophthalmologist. A case is presented in which, despite making an early diagnosis and trying to plan a treatment aimed at avoiding choroidal effusion, its appearance was unavoidable, having to treat it twice with good functional results so far

Radius-Maumenee syndrome: Beyond a diagnostic and therapeutic challenge. / Síndrome de Radius-Maumenee: más allá de un reto diagnóstico y terapéutico.

Radius-Maumenee syndrome (SRM) or idiopathic episcleral venous hypertension (HVEI) is an uncommon disorder that occurs with a dilation of the episcleral vessels and an increase in intraocular pressure (IOP). It is a syndrome that constitutes a diagnostic and therapeutic challenge for the ophthalmologist. A case is presented in which, despite making an early diagnosis and trying to plan a treatment aimed at avoiding choroidal effusion, its appearance was unavoidable, having to treat it twice with good functional results so far.

[Appraisal of the formation of afterimages by means of a new computer application in patients with demyelinating optic neuropathies]. / Valoracion de la formacion de postimagenes mediante una nueva aplicacion informatica en pacientes con neuropatias opticas desmielinizantes.

INTRODUCTION: The perception of colour is one of the visual functions affected by optic neuritis. Most of the tests currently available for evaluating dichromatism are based on assessing the hue, but no clinical studies have been conducted to investigate the formation of afterimages on the retina of these patients. AIMS: To evaluate the dichromatism acquired in demyelinating optic neuritis by means of the formation of afterimages on the retina. SUBJECTS AND METHODS: This is an observation-based, cross-sectional, case-control study. The cases are patients with at least one bout of optic neuritis and confirmed multiple sclerosis. A healthy age- and sex-paired control was selected for each case. The main variable is the capacity to see afterimages after saturation of the retinal photoreceptor cells. A specific computer application was developed to evaluate this phenomenon. RESULTS: The sample consisted of 30 cases and 30 controls (63% females; mean age: 33 years; range: 18-48 years). The cases showed less probability of seeing the afterimage (36.6% of the cases, while none of the controls failed to see an afterimage) and, if it was seen, it remained for less time. The ROC curve shows a sensitivity of 86.3% and a specificity of 83.3%. The odds ratio was 5 (95% confidence interval: 2.21-11.3) for the probability of seeing the afterimage in controls versus cases. CONCLUSIONS: Patients with at least one episode of optic neuritis presented a lower capacity to observe afterimages. The test is therefore useful in the assessment and follow-up of functional damage in demyelinating optic neuropathies.

TITLE: Valoracion de la formacion de postimagenes mediante una nueva aplicacion informatica en pacientes con neuropatias opticas desmielinizantes.Introduccion. En las neuritis opticas se afecta, entre otras funciones visuales, la percepcion del color. La mayoria de las pruebas existentes para evaluar discromatopsias se basa en evaluar el matiz, pero no se ha estudiado clinicamente la formacion de postimagenes en la retina en estos pacientes. Objetivo. Evaluar la discromatopsia adquirida en las neuritis opticas desmielinizantes mediante la formacion de postimagenes en la retina. Sujetos y metodos. Estudio observacional, transversal, de casos y controles. Los casos son pacientes con al menos un episodio de neuritis optica y esclerosis multiple confirmada. Se selecciono un control sano por cada caso, emparejado por edad y sexo. La variable principal es la capacidad de ver postimagenes tras saturar los fotorreceptores retinianos. Para evaluar dicho fenomeno se desarrollo una aplicacion informatica especifica. Resultados. La muestra comprende 30 casos y 30 controles (63% mujeres; edad media: 33 años; rango: 18-48 años). Los casos mostraron menor probabilidad de ver la postimagen (el 36,6% de los casos y ningun control no veian postimagen) y, en caso de verla, una menor permanencia de ella. La curva ROC muestra una sensibilidad del 86,3% y una especificidad del 83,3%. La odds ratio era de 5 (intervalo de confianza al 95%: 2,21-11,3) para la probabilidad de ver la postimagen en los controles frente a los casos. Conclusiones. Los pacientes con al menos un episodio de neuritis optica presentan una menor capacidad de observar postimagenes, por lo que la prueba es util para la evaluacion y el seguimiento del daño funcional en neuropatias opticas desmielinizantes.

Estudio comparativo sobre eficacia y seguridad de bevacizumab frente a mitomicina C como adyuvantes a trabeculectomía / Comparison study on the efficacy and safety of bevacizumab versus mitomycin C as adjuvants in trabeculectomy

OBJETIVO: Comparar la eficacia y seguridad de bevacizumab como adyuvante a la trabeculectomía frente a mitomicina C. MÉTODO: Se diseñó un estudio comparativo prospectivo no aleatorizado de 180 días de duración con 49 ojos de 45 pacientes: 22 ojos en el grupo de bevacizumab (BVZ) y 27 ojos en el grupo de mitomicina C (MMC). Se estableció como éxito completo: presión intraocular (PIO) menor de 18 mmHg sin fármacos adyuvantes. Se realizaron controles en los días 1, 7, 30, 90 y 180 poscirugía. Se evaluaron: agudeza visual, PIO media en cada una de las visitas, procedimientos adicionales y número de fármacos necesarios para el control de la PIO poscirugía, así como posibles complicaciones posquirúrgicas tanto locales como sistémicas. RESULTADOS: Al final del estudio en la PIO media postoperatoria fue 13,4 ± 3,5 mmHg (rango 8-20) en el grupo del BVZ y de 11,6 ± 2,6 mmHg (rango 7-17) en el grupo de la MMC sin encontrar diferencias estadísticamente significativas (p = 0,08). Se alcanzó el éxito completo al final del seguimiento en un 77,2% (17 de 22) de los pacientes en el grupo de BVZ y en un 96,2% (26 de 27) en el grupo de MMC, siendo esta diferencia estadísticamente significativa (p = 0,024). Un mayor número de pacientes requirió fármacos adicionales para el control de la presión en el grupo de BVZ al final del seguimiento: 0,36 ± 0,72 fármacos frente a 0,03 ± 0,19 fármacos en el de la MMC (p = 0,018). Se encontraron 3 casos de ampollas avasculares en el grupo del BVZ y ninguno en el grupo de MMC. Ningún paciente desarrolló complicaciones derivadas del uso de los medicamentos. CONCLUSIONES: Bevacizumab parece ser un fármaco eficaz y seguro como adyuvante a trabeculectomía, sin embargo la reducción de la presión es algo mayor con la MMC con una menor necesidad de medicación hipotensora. Existe la posibilidad de formación de ampollas avasculares con el uso de bevacizumab intraoperatorio

OBJECTIVE: The objective of this study is to compare the efficacy and safety of bevacizumab versus mitomycin C as an adjuvant anti-scarring agent in Trabeculectomy. METHODS: A prospective, comparative, non-randomized, interventional study was conducted on a case series. A total of 49 eyes of 45 patients with uncontrolled glaucoma were recruited: 22 eyes in the bevacizumab (BVZ) group, and 27 eyes in the mitomycin C (MMC) group. Complete success was defined as intraocular pressure (IOP) less than 18 mmHg without any antiglaucoma medications. Follow-up visits were made on 1, 7, 30, 90 and 180 days after the surgery. Visual acuity, mean IOP, number of antiglaucoma medications and additional procedures to control IOP were recorded at each follow up visit. Local and systemic complications were also noted. RESULTS: At the end of the follow-up there were no significant differences in mean IOP between groups: mean IOP was 13.4 ± 3.5 mmHg (range 8-20) in the BVZ group and 11.6 ± 2.6 mmHg (range 7-17) in the MMC group (P=.08). Complete success was achieved in 77.2% (17 out of 22) in the BVZ group and 96.2% (26 out of 27) in the MMC group, which was a statistically significant difference (P=.024). More patients required antiglaucoma medications to control IOP in the BVZ group at the end of the study: 0.36 ± 0.72 medications versus 0.03 ± 0.19 medications in the MMC group (P=.018). Three patients developed avascular cystic blebs in the BVZ group. None of the patients suffered any ocular or systemic complications related to the use of these agents. CONCLUSION: Bevacizumab could be a safe and effective anti-scarring agent; however IOP reduction appears to be greater with MMC, and also less antiglaucoma medications are needed with this anti-scarring agent. Bevacizumab could favor the formation of avascular cystic blebs

[Comparison study on the efficacy and safety of bevacizumab versus mitomycin C as adjuvants in trabeculectomy]. / Estudio comparativo sobre eficacia y seguridad de bevacizumab frente a mitomicina C como adyuvantes a trabeculectomía.

OBJECTIVE: The objective of this study is to compare the efficacy and safety of bevacizumab versus mitomycin C as an adjuvant anti-scarring agent in Trabeculectomy. METHODS: A prospective, comparative, non-randomized, interventional study was conducted on a case series. A total of 49 eyes of 45 patients with uncontrolled glaucoma were recruited: 22 eyes in the bevacizumab (BVZ) group, and 27 eyes in the mitomycin C (MMC) group. Complete success was defined as intraocular pressure (IOP) less than 18 mmHg without any antiglaucoma medications. Follow-up visits were made on 1, 7, 30, 90 and 180 days after the surgery. Visual acuity, mean IOP, number of antiglaucoma medications and additional procedures to control IOP were recorded at each follow up visit. Local and systemic complications were also noted. RESULTS: At the end of the follow-up there were no significant differences in mean IOP between groups: mean IOP was 13.4 ± 3.5mmHg (range 8-20) in the BVZ group and 11.6 ± 2.6 mmHg (range 7-17) in the MMC group (P=.08). Complete success was achieved in 77.2% (17 out of 22) in the BVZ group and 96.2% (26 out of 27) in the MMC group, which was a statistically significant difference (P=.024). More patients required antiglaucoma medications to control IOP in the BVZ group at the end of the study: 0.36 ± 0.72 medications versus 0.03 ± 0.19 medications in the MMC group (P=.018). Three patients developed avascular cystic blebs in the BVZ group. None of the patients suffered any ocular or systemic complications related to the use of these agents. CONCLUSION: Bevacizumab could be a safe and effective anti-scarring agent; however IOP reduction appears to be greater with MMC, and also less antiglaucoma medications are needed with this anti-scarring agent. Bevacizumab could favor the formation of avascular cystic blebs.

Efectos corneales de hipotensores oculares que contienen cloruro de benzalconio: análisis in vivo con microscopia confocal / The effects of ocular hypotensive drugs on the cornea: An in vivo analysis with confocal microscopy

Objetivo: Evaluar los efectos sobre la córnea humana de hipotensores oculares con cloruro de benzalconio (BAC). Métodos: Estudio prospectivo de cohortes, simple ciego realizado sobre 50 ojos de 50 pacientes. Los criterios de inclusión fueron: diagnóstico reciente de glaucoma o hipertensión ocular sin tratamiento previo, terapia antiglaucomatosa prescrita por un oftalmólogo y consentimiento para participar en el estudio. Los pacientes no fueron asignados al azar: el oftalmólogo decidió la mejor terapia de acuerdo a los datos clínicos. Se dividieron en dos grupos: uno expuesto a BAC (23 pacientes) y otro no expuesto (27 pacientes). La media de seguimiento fue de 22 semanas (rango 18-30). Se midió el cambio en la densidad celular antes y después de la terapia en: el epitelio basal, la capa basal del epitelio limbal y el endotelio. También se midió el cambio en la reflectividad estromal y el número de ramas del nervio del plexo subasal. La exposición a BAC era desconocida para el investigador principal. Resultados: Un mayor aumento en la densidad de la capa de células basales del epitelio se observó en la cohorte expuesta BAC (p < 0,05). No se detectaron diferencias significativas en la densidad del endotelio, las células del limbo, la reflectividad del estroma ni en el plexo nervioso subbasal. Edad, sexo, PIO, principio activo ni la concentración de BAC afectaron el sentido o la magnitud de las alteraciones encontradas en la superficie ocular. Conclusión: El tratamiento crónico antiglaucomatoso induce cambios en el epitelio corneal. Gotas sin conservantes mostraron una menor alteración de la superficie ocular por análisis de microscopia confocal. Los estudios futuros deben evaluar el impacto clínico de estos hallazgos histológicos (AU)

Purpose: To evaluate the effects of anti-glaucoma treatments containing benzalconium chloride(BAC) on the human cornea. Methods: A prospective single masked cohort study was conducted on the 50 eyes of 50patients. The inclusion criteria were: recently diagnosed glaucoma or ocular hypertension with previous treatment, or ophthalmologist-prescribed anti-glaucoma therapy, and oral consent to participate in the study. The patients were not randomised, as the ophthalmologist decided the best therapy according to clinical criteria. The patients were divided in 2 cohorts: one exposed to BAC (23 patients), and not exposed (27patients). The mean followup period was 22 weeks (range 18-30). The change in cell density before and after therapy was measured in: basal layer epithelium, basal layer of limbal epithelium and endothelium. The change in stromal reflectivity and the number of nerve branches in sub-basal nerve plexus was also measured. BAC exposure was blinded to the main researcher. Results: A greater increase in basal layer epithelium cell density was observed in BAC exposed cohort (P < 0.05). No significant differences were detected in the endothelium, limbal cell density, stromal reflectivity, or sub-basal nerve plexus. Age, sex, IOP, active ingredient or BAC concentration did not affect the direction or magnitude of the ocular surface alterations found. Conclusion: Chronic anti-glaucoma therapy induces changes in the corneal epithelium. Preservative free drops showed less disruption of the ocular surface by confocal microscopy analysis. Further studies should be conducted to evaluate the clinical impact of these histological findings (AU)

[The effects of ocular hypotensive drugs on the cornea: an in vivo analysis with confocal microscopy]. / Efectos corneales de hipotensores oculares que contienen cloruro de benzalconio: análisis in vivo con microscopia confocal.

PURPOSE: To evaluate the effects of anti-glaucoma treatments containing benzalconium chloride (BAC) on the human cornea. METHODS: A prospective single masked cohort study was conducted on the 50 eyes of 50 patients. The inclusion criteria were: recently diagnosed glaucoma or ocular hypertension with previous treatment, or ophthalmologist-prescribed anti-glaucoma therapy, and oral consent to participate in the study. The patients were not randomised, as the ophthalmologist decided the best therapy according to clinical criteria. The patients were divided in 2 cohorts: one exposed to BAC (23 patients), and not exposed (27 patients). The mean follow-up period was 22 weeks (range 18-30). The change in cell density before and after therapy was measured in: basal layer epithelium, basal layer of limbal epithelium and endothelium. The change in stromal reflectivity and the number of nerve branches in sub-basal nerve plexus was also measured. BAC exposure was blinded to the main researcher. RESULTS: A greater increase in basal layer epithelium cell density was observed in BAC exposed cohort (P<.05). No significant differences were detected in the endothelium, limbal cell density, stromal reflectivity, or sub-basal nerve plexus. Age, sex, IOP, active ingredient or BAC concentration did not affect the direction or magnitude of the ocular surface alterations found. CONCLUSION: Chronic anti-glaucoma therapy induces changes in the corneal epithelium. Preservative free drops showed less disruption of the ocular surface by confocal microscopy analysis. Further studies should be conducted to evaluate the clinical impact of these histological findings.

Bevacizumab (Avastin®) intracamerular en el manejo quirúrgico del glaucoma neovascular / Intracameral bevacizumab (Avastin ®) in the management of neovascular glaucoma surgery

Propósito: Describir una serie de casos con glaucoma neovascular que fueron tratados con bevacizumab intracamerular previo a la cirugía filtrante. Diseño: Descriptivo, retrospectivo, tipo serie de casos. Métodos: Cinco ojos de cinco pacientes con glaucoma neovascular de cualquier causa candidatos a cirugía filtrante recibieron previamente una inyección de bevacizumab (1,25mg/0,05ml) intracamerular como tratamiento de la neovascularización angular. Se describen los resultados observados a la semana y a las 4 semanas poscirugía. Resultados: Bevacizumab produjo una regresión importante de los neovasos y de la presión intraocular. Se detectó un único caso de sangrado postoperatorio. Conclusiones: Bevacizumab intracamerular previo a cirugía filtrante de glaucoma disminuyó la neovascularización del segmento anterior y la presión intraocular a las 4 semanas de su administración y resultó eficaz en impedir el sangrado intra- y postoperatorio. También constituye una prometedora vía de investigación para prevenir las complicaciones quirúrgicas(AU)

Purpose: To describe a case series of neovascular glaucoma treated with intracameral bevacizumab prior to filtering surgery. Design: Descriptive, retrospective case series. Methods: Five eyes of 5 patients with neovascular glaucoma due to any cause candidates to filtering surgery who had previously received an injection of intracameral bevacizumab (1.25mg/0.05ml) as treatment for neovascularization of anterior chamber. Results observed one week and 4 weeks postsurgery are reported. Results: Bevacizumab produced regression of the angle neovascularization and the intraocular pressure. Only one case of postoperative bleeding was detected. Conclusions: Intracameral bevacizumab prior to filtering surgery of neovascular glaucoma diminished the neovascularization and intraocular pressure after 4 weeks of its administration and was effective in preventing intraoperative and postoperative bleeding. It also constitutes a promising way of investigation to prevent surgical complications(AU)

[Intracameral bevacizumab (Avastin®) in the management of neovascular glaucoma surgery]. / Bevacizumab (Avastin®) intracamerular en el manejo quirúrgico del glaucoma neovascular.

PURPOSE: To describe a case series of neovascular glaucoma treated with intracameral bevacizumab prior to filtering surgery. DESIGN: Descriptive, retrospective case series. METHODS: Five eyes of 5 patients with neovascular glaucoma due to any cause candidates to filtering surgery who had previously received an injection of intracameral bevacizumab (1.25 mg/0.05 ml) as treatment for neovascularization of anterior chamber. Results observed one week and 4 weeks postsurgery are reported. RESULTS: Bevacizumab produced regression of the angle neovascularization and the intraocular pressure. Only one case of postoperative bleeding was detected. CONCLUSIONS: Intracameral bevacizumab prior to filtering surgery of neovascular glaucoma diminished the neovascularization and intraocular pressure after 4 weeks of its administration and was effective in preventing intraoperative and postoperative bleeding. It also constitutes a promising way of investigation to prevent surgical complications.

[Congenital cataracts: complications and functional results according to different surgical techniques]. / Cataratas congénitas: complicaciones y resultados funcionales según diferentes técnicas quirúrgicas.

PURPOSE: To evaluate visual results, refractive error and complications in a series of congenital cataracts treated with different surgical techniques. METHODS: Retrospective review of 51 eyes with congenital cataracts which were surgically treated between 1989 and 2005. Eleven were unilateral cataracts and 40 were bilateral cataracts. Thirty-three eyes were treated with a primary intraocular lens (IOL) and 18 were aphakic eyes. RESULTS: The best outcomes were observed in bilateral cataracts and in those that received early primary IOL. Three eyes achieved 0.8-1, two eyes achieved 0.6-0.7. All of them were eyes with primary IOL. Seventeen percent of unilateral cataracts and 23.8% of bilateral cataracts achieved 0.4 or better. The most serious complication was visual axis opacification (VAO), 27 of 51 eyes developed VAO. Fifty percent of eyes with primary IOL and 63% of aphakic eyes developed VAO. The VAO developed sooner in the IOL group (6.5 months on average). There was a high myopic shift in 3 eyes. There was a significantly greater myopic shift in the unilateral cases. CONCLUSIONS: The best acuities were achieved in the eyes which had been treated with early primary IOL, but they had a higher rate of complications (VAO), thus requiring reoperation. Final refraction in the unilateral group was significantly more myopic than in the bilateral group.

Cataratas congénitas: complicaciones y resultados funcionales según diferentes técnicas quirúrgicas / Congenital cataracts: complications and functional results according to different surgical techniques

Objetivo: Evaluar los resultados funcionales, el error refractivo y las complicaciones de unaserie de cataratas congénitas que fueron intervenidas mediante diferentes técnicas.Métodos: Se realizó un análisis retrospectivo de 51 ojos con cataratas congénitas que fueronintervenidas quirúrgicamente entre 1989 y 2005. Once cataratas eran unilaterales y 40 eranbilaterales. En 33 ojos se empleó lente intraocular primaria (LIO) mientras que en 18 no seempleó LIO.Resultados: Los mejores resultados funcionales se observaron en cataratas bilaterales intervenidasquirúrgicamente empleando LIO primaria de forma precoz. Tan sólo 3 ojos consiguieronagudeza visual (AV) de 0,8-1, dos ojos 0,6-0,7. Todos ellos fueron ojos con LIO primaria.El 17% de las cataratas unilaterales y el 23,8% de las bilaterales consiguieron AV de0,4 o mejor. La complicación más importante fue la opacificación del eje visual (OEV) queocurrió en 27 de los 51 ojos. El 50% de los ojos con LIO primaria y el 63% de los ojos afáquicosdesarrollaron OEV. La OEV se desarrolló antes en el grupo de LIO primaria (con unamedia de 6,5 meses de edad). Tan sólo se observó un error miópico alto en 3 ojos. Se observóun error miópico significativamente mayor en las cataratas unilaterales.Conclusiones: Los mejores resultados funcionales se consiguieron en ojos intervenidos conLIO primaria de forma precoz, sin embargo estas cataratas presentaron una tasa mayor deOEV que requirieron tratamiento quirúrgico. La refracción final en el grupo de cataratasunilaterales fue significativamente más miópica que en el grupo de cataratas bilaterales(AU)

Purpose: To evaluate visual results, refractive error and complications in a series ofcongenital cataracts treated with different surgical techniques.Methods: Retrospective review of 51 eyes with congenital cataracts which were surgicallytreated between 1989 and 2005. Eleven were unilateral cataracts and 40 were bilateralcataracts. Thirty-three eyes were treated with a primary intraocular lens (IOL) and 18 wereaphakic eyes.Results: The best outcomes were observed in bilateral cataracts and in those that receivedearly primary IOL. Three eyes achieved 0.8-1, two eyes achieved 0.6-0.7. All of them wereeyes with primary IOL. Seventeen percent of unilateral cataracts and 23.8% of bilateralcataracts achieved 0.4 or better. The most serious complication was visual axis opacification(VAO), 27 of 51 eyes developed VAO. Fifty percent of eyes with primary IOL and 63% ofaphakic eyes developed VAO. The VAO developed sooner in the IOL group (6.5 months onaverage). There was a high myopic shift in 3 eyes. There was a significantly greater myopicshift in the unilateral cases.Conclusions: The best acuities were achieved in the eyes which had been treated with earlyprimary IOL, but they had a higher rate of complications (VAO), thus requiring reoperation.Final refraction in the unilateral group was significantly more myopic than in the bilateralgroup(AU)

[Pediatric cataracts: epidemiology and diagnosis. Retrospective review of 79 cases]. / Cataratas pediátricas: estudio epidemiológico y diagnóstico. Análisis retrospectivo de 79 casos.

PURPOSE: To determine the epidemiology, diagnosis and treatment features in a group of pediatric patients with cataracts treated at our hospital. The aim was to improve the visual prognosis in these patients. METHODS: 79 children with cataracts were reviewed retrospectively during an 18 year period (1986-2004). This involved patients with congenital cataracts and those who acquired them later. Most of the latter group had a traumatic etiology (90%). RESULTS: The etiology of most cataracts was idiopathic (68%) for the congenital group and traumatic (90%) for the acquired group. Congenital cataracts were frequently nuclear in type (31%) with 56% being bilateral. 27% of the congenital group were associated with dysmorphic eye features, the most frequent being microphthalmos. The most frequent presenting feature was leucokoria, seen in 44% of patients. 75% of congenital cataracts were diagnosed within one month of clinical manifestation. 58% of the congenital cataracts were treated by surgery and 50% of these were performed within one month of the diagnosis. 90% of the acquired cataracts were treated surgically, and 95% of these were performed less than one month after diagnosis. CONCLUSIONS: We attained a prompt diagnosis and treatment in a high percentage of cases. Prompt diagnosis and treatment will determine the visual prognosis of these patients. We must continue trying to shorten this period of time in order that all children with this condition are diagnosed and treated urgently and efficiently.

Cataratas pediátricas: estudio epidemiológico y diagnóstico. Análisis retrospectivo de 79 casos / Pediatric cataracts: epidemiology and diagnosis. Retrospective review of 79 cases

Objetivo: Determinar las características epidemiológicas, diagnósticas y terapéuticas de un grupo de cataratas de nuestro medio con el propósito de mejorar el pronóstico visual de estos pacientes. Métodos: Estudio retrospectivo de 79 casos de cataratas pediátricas durante un periodo de 18 años (1986-2004). Hemos diferenciado dos grupos etiológicos de trabajo: cataratas congénitas y cataratas adquiridas. Resultados: La causa más frecuente entre las congénitas fue la idiopática (68%) y la más frecuente de las adquiridas fue traumática (90%). La morfología más frecuente de las congénitas fue la nuclear 0,31 (31%). El 56% de las cataratas congénitas fueron bilaterales. El 27% de las cataratas congénitas se asociaban a otras anomalías oculares y la más frecuente fue el microftalmos. El signo clínico de presentación más frecuente de las cataratas congénitas fue la leucocoria, en 0,44 (44%). El 75% (0,75) de las cataratas congénitas de nuestro medio tardan menos de un mes en diagnosticarse desde la manifestación clínica. El 58% (0,58) de las cataratas congénitas se trataron con cirugía y el 50% de ellas tardaron menos de 1 mes en operarse. El 90% (0,9) de las adquiridas se trataron con cirugía y el 95% de ellas tardaron menos de un mes en operarse. Conclusiones: En nuestra serie conseguimos un diagnóstico y tratamiento precoz en un alto porcentaje de pacientes. El pronóstico visual de estos niños viene determinado por la precocidad en el diagnóstico y el tratamiento, es por ello que debemos continuar intentando acortar este período de tiempo y conseguir que todos los niños sean diagnosticados y tratados precozmente

Purpose: To determine the epidemiology, diagnosis and treatment features in a group of pediatric patients with cataracts treated at our hospital. The aim was to improve the visual prognosis in these patients. Methods: 79 children with cataracts were reviewed retrospectively during an 18 year period (1986- 2004). This involved patients with congenital cataracts and those who acquired them later. Most of the latter group had a traumatic etiology (90%). Results: The etiology of most cataracts was idiopathic (68%) for the congenital group and traumatic (90%) for the acquired group. Congenital cataracts were frequently nuclear in type (31%) with 56% being bilateral. 27% of the congenital group were associated with dysmorphic eye features, the most frequent being microphthalmos. The most frequent presenting feature was leucokoria, seen in 44% of patients. 75% of congenital cataracts were diagnosed within one month of clinical manifestation. 58% of the congenital cataracts were treated by surgery and 50% of these were performed within one month of the diagnosis. 90% of the acquired cataracts were treated surgically, and 95% of these were performed less than one month after diagnosis. Conclusions: We attained a prompt diagnosis and treatment in a high percentage of cases. Prompt diagnosis and treatment will determine the visual prognosis of these patients. We must continue trying to shorten this period of time in order that all children with this condition are diagnosed and treated urgently and efficiently

[Needle revision of late failing filtering blebs after glaucoma surgery]. / Repermeabilización mediante revisión con aguja de ampollas de filtración con fracaso tardío tras cirugía de glaucoma.

PURPOSE: To evaluate the results of bleb needling in eyes subjected to filtering surgery six months or more previously. METHODS: A retrospective study of 23 eyes in 21 patients subjected to bleb needling performed by means of a 25G needle, 6 months to 23 years after failed filtering surgery (mean 67.3 months). The mean number of bleb needlings was 1.2 and the mean number of 5-fluorouracil subconjunctival injections was 3.9. RESULTS: The mean intraocular pressure (IOP) before needling was 26 mmHg and the mean anti-glaucoma medications was 1.3 per eye. The mean postoperative IOP was 16.3 mmHg and mean anti-glaucoma medications 0.7. A diffuse filtering bleb was evident in 12 eyes (54.5%). The results of needling were worse in eyes subjected to previous surgery for glaucoma or other failed bleb needling procedures (75% failure). CONCLUSION: Needle revision of the filtering bleb is a simple and safe technique that offers good results even years after a filtering surgery had been performed. It should be considered before other medical or surgical treatments in patients with a previously functioning bleb and a permeable sclerectomy site at gonioscopy.

Repermeabilización mediante revisión con aguja de ampollas de filtración con fracaso tardío tras cirugía de glaucoma / Needle revision of late failing filtering blebs after glaucoma surgery

Objetivo: Analizar los resultados de la cistitomía de la ampolla de filtración en ojos operados de cirugía filtrante de glaucoma seis meses antes o más. Material y métodos: Estudio retrospectivo de 23 ojos de 21 pacientes en los que se ha realizado revisión de la ampolla de filtración con una aguja de 25 G, entre 6 meses y 23 años tras cirugía filtrante (media 67,3 meses). Se realizaron una media de 1,2 cistitomías por ojo y 3,9 inyecciones de 5-fluorouracilo subconjuntival. Resultados: De una presión intraocular (PIO) media preoperatoria de 26 mmHg y 1,3 fármacos hipotensores hemos pasado a una PIO media postoperatoria de 16,3 mmHg y una media de 0,7 fármacos, con una ampolla de filtración difusa en 12 casos (54,5%). Los resultados fueron peores en ojos con cirugía previa de glaucoma u otra cistitomía previa fracasada (75% fracaso). Conclusiones: La revisión con aguja es una técnica sencilla y segura que ofrece buenos resultados incluso años después de una cirugía filtrante, y debe ser considerada de manera previa a la reinstauración de tratamiento médico o quirúrgico en los pacientes operados de glaucoma con fracaso tardío de una ampolla de filtración previamente funcionante y esclerectomía abierta en la gonioscopia

Purpose: To evaluate the results of bleb needling in eyes subjected to filtering surgery six months or more previously. Methods: A retrospective study of 23 eyes in 21 patients subjected to bleb needling performed by means of a 25G needle, 6 months to 23 years after failed filtering surgery (mean 67.3 months). The mean number of bleb needlings was 1.2 and the mean number of 5-fluorouracil subconjunctival injections was 3.9. Results: The mean intraocular pressure (IOP) before needling was 26 mmHg and the mean anti-glaucoma medications was 1.3 per eye. The mean postoperative IOP was 16.3 mmHg and mean antiglaucoma medications 0.7. A diffuse filtering bleb was evident in 12 eyes (54.5%). The results of needling were worse in eyes subjected to previous surgery for glaucoma or other failed bleb needling procedures (75% failure). Conclusion: Needle revision of the filtering bleb is a simple and safe technique that offers good results even years after a filtering surgery had been performed. It should be considered before other medical or surgical treatments in patients with a previously functioning bleb and a permeable sclerectomy site at gonioscopy

[Neoplasms of the caruncle. Clinicopathologic study of 40 cases]. / Tumores de carúncula. Estudio clínico-patológico de 40 casos.

PURPOSE: To determine the type and frequency of the neoplasms on the lachrymal caruncle and to compare the results with other published case series. METHODS: Retrospective study of forty cases of lesions of the lachrymal caruncle, surgically treated during a 13-year period (1991-2003) are presented. There were 19 females and 21 males. The mean age was 42.1, SD 19.5 years. RESULTS: Ten different histopathologic types of lesions were found. The most frequent lesion was the nevus (40%), and the second, the papilloma (30%). Thirty-seven neoplasms (92.5%) were benign, 2 (5%) premalignant and 1 (2.5%) malignant. The clinical diagnosis was accurate in 87.5% of the cases. CONCLUSION: In this case series, we confirm the low frequency of caruncular neoplasms as well as the wide variety of histopathologic types found in this location. There was a wide range of ages and we did not find any evident sex predominance. Malignant lesions were uncommon, with only one case of basal cell carcinoma. Our results are similar to those of other case series.

Tumores de carúncula: Estudio clínico-patológico de 40 casos / Neoplasms of the caruncle clinicopathologic study of 40 cases

Objetivo: Determinar el tipo y frecuencia de las lesiones que se pueden presentar en la carúncula lagrimal y comparar los resultados con otras series publicadas. Métodos: Estudio retrospectivo sobre 40 casos de lesiones de carúncula tratadas quirúrgicamente de forma consecutiva durante un periodo de 13 años (1991-2003). Diecinueve eran mujeres y 21 hombres. La edad media fue de 42,1 DE 19,5 años. Resultados: Se encontraron 10 tipos histológicos diferentes de lesiones. La lesión más frecuente fue el nevus (40%) y la segunda el papiloma (30%). Su naturaleza fue benigna en 37 casos (92,5%), premaligna en dos (5%) y maligna en una (2,5%). El diagnóstico clínico fue correcto en el 87,5% de los casos. Conclusiones: En esta serie comprobamos la baja frecuencia de las lesiones de la carúncula así como la gran variedad de tipos histológicos. Encontramos un amplio rango de edad pero no una clara predominancia según el sexo. Las lesiones malignas fueron excepcionales y sólo hubo un caso de carcinoma de células basales. Nuestros resultados fueron similares a los de otras series(AU)

Purpose: To determine the type and frequency of the neoplasms on the lachrymal caruncle and to compare the results with other published case series. Methods: Retrospective study of forty cases of lesions of the lachrymal caruncle, surgically treated during a 13-year period (1991-2003) are presented. There were 19 females and 21 males. The mean age was 42.1, SD 19.5 years. Results: Ten different histopathologic types of lesions were found. The most frequent lesion was the nevus (40%), and the second, the papilloma (30%). Thirty-seven neoplasms (92.5%) were benign, 2 (5%) premalignant and 1 (2.5%) malignant. The clinical diagnosis was accurate in 87.5% of the cases. Conclusion: In this case series, we confirm the low frequency of caruncular neoplasms as well as the wide variety of histopathologic types found in this location. There was a wide range of ages and we did not find any evident sex predominance. Malignant lesions were uncommon, with only one case of basal cell carcinoma. Our results are similar to those of other case series(AU)