Long-lasting disabling photophobia after uneventful cataract surgery.

The case concerns a 54-year-old woman, with a history of fibromyalgia and normal preoperative ocular and systemic study, who presented with a long-lasting disabling photophobia, after sequential bilateral cataract surgery without complications. Photophobia was accompanied by good uncorrected VA, with no pain or subjective eye discomfort, without migraine or indicators of psychic conflict. It was refractory to any prescribed treatment of the ocular surface, finally responding to oral anticonvulsants (carbamazepine) that are frequently used in neuropathic pain. To the best of our knowledge this is the first reported case of a long-lasting disabling photophobia without pain and good VA after cataract surgery.

Fotofobia invalidante de larga duración tras cirugía no complicada de cataratas / Long-lasting disabling photophobia after uneventful cataract surgery

Paciente mujer, de 54 años, con antecedente de fibromialgia y estudio preoperatorio ocular y sistémico normal, que presenta fotofobia invalidante de larga duración, tras cirugía bilateral secuencial de cataratas sin complicaciones. La fotofobia se acompañaba de buena AV no corregida, sin dolor ni molestias subjetivas oculares y sin migraña ni indicadores de conflictos psíquicos. Fue refractaria a cualquier tratamiento de la superficie ocular pautado, respondiendo finalmente a anticonvulsivantes orales (carbamazepina) frecuentemente utilizados en dolor de tipo neuropático. Según nuestro conocimiento es el único caso descrito de fotofobia invalidante de larga duración sin dolor y buena AV tras cirugía de cataratas (AU)

The case concerns a 54-year-old woman, with a history of fibromyalgia and normal preoperative ocular and systemic study, who presented with a long-lasting disabling photophobia, after sequential bilateral cataract surgery without complications. Photophobia was accompanied by good uncorrected VA, with no pain or subjective eye discomfort, without migraine or indicators of psychic conflict. It was refractory to any prescribed treatment of the ocular surface, finally responding to oral anticonvulsants (carbamazepine) that are frequently used in neuropathic pain. To the best of our knowledge this is the first reported case of a long-lasting disabling photophobia without pain and good VA after cataract surgery (AU)

Cirugía del pterygium y adhesivo de fibrina: evitar la dehiscencia / Pterygium surgery and fibrin glue: Avoiding dehiscence

OBJETIVO/MÉTODO: Se pretende un doble objetivo: valorar en qué casos de pterygium intervenidos con tissucol se produce dehiscencia del injerto y aplicar y valorar la eficacia de una variante quirúrgica destinada a evitar dicha complicación en los casos de riesgo previamente identificados. La primera fase es un estudio retrospectivo de 42 cirugías. En la segunda fase, prospectiva, aplicamos la variante de la técnica en 14 pterygium. Resultados/conclusiones: Se identifican como grupos de riesgo predisponentes a padecer dehiscencia del injerto los pterygium recidivados, los pterygium anchos, y cirugías complicadas. Con la variante quirúrgica aplicada no ocurrieron nuevas dehiscencias, y su aplicación no reportó complicaciones añadidas

OBJECTIVE/METHOD: The purpose of the study is to evaluate those cases of pterygium surgery with fibrin sealant that produced dehiscence of the graft, and then apply and evaluate the efficacy of a different surgical technique in an attempt eliminate this complication in previously identified cases of high risk. The first phase is a retrospective study of 42 cases of pterygium surgery. In the second phase, the variation in the surgical technique was prospectively used in 14 cases of pterygium surgery. Results/conclusions: Cases of recurrent pterygium, broad pterygium, and complicated surgery were identified as the groups with a risk of suffering dehiscence of the graft. With the variant applied surgery no dehiscence occurred when using the variation in surgical technique, with no added complications

[Pterygium surgery and fibrin glue: avoiding dehiscence]. / Cirugía del pterygium y adhesivo de fibrina: evitar la dehiscencia.

OBJECTIVE/METHOD: The purpose of the study is to evaluate those cases of pterygium surgery with fibrin sealant that produced dehiscence of the graft, and then apply and evaluate the efficacy of a different surgical technique in an attempt eliminate this complication in previously identified cases of high risk. The first phase is a retrospective study of 42 cases of pterygium surgery. In the second phase, the variation in the surgical technique was prospectively used in 14 cases of pterygium surgery. RESULTS/CONCLUSIONS: Cases of recurrent pterygium, broad pterygium, and complicated surgery were identified as the groups with a risk of suffering dehiscence of the graft. With the variant applied surgery no dehiscence occurred when using the variation in surgical technique, with no added complications.

[Comparison of the effectiveness of two different pharmacologic approaches to prevent intraoperative floppy iris syndrome]. / Comparación de la efectividad de dos estrategias farmacológicas para la prevención del síndrome de iris flácido intraquirúrgico.

OBJECTIVE: To compare the effectiveness of two strategies to prevent the appearance of intraoperative floppy iris syndrome (IFIS) in patients exposed to a-blockers. METHODS: We compared retrospectively the presence and severity of the appearance of IFIS in 29 patients subjected to cataract surgery, establishing two groups of 12 patients (22 eyes) and 17 patients (33 eyes). The strategy applied to group one consisted of suspending the exposure to a-blockers for at least one week prior to the intervention, the topical application of 1% atropine three times a day for two days before the intervention and the use of intracameral lidocaine. The strategy for group two consisted of suspending use of the drug for at least one week before the intervention and the intracameral application at the beginning of surgery of a solution of physiological serum, adrenaline and lidocaine. RESULTS: Six patients from group one showed no evidence of IFIS, 2 exhibited bilateral mild symptoms, 2 bilateral moderate and 2 unilateral severe symptoms of IFIS. In total, 45.5% eyes suffered from IFIS. In group two, only 3 eyes (9.1%) from 2 patients exhibited mild symptoms. Statistical analysis showed a significant difference between both groups (p=0.002). If only those exhibiting moderate and severe symptoms are taken into account the result was highly statistically significant (p=0.0002). CONCLUSION: The study shows a greater statistical effectiveness of the strategy applied to group two compared to the strategy applied to group one (Arch Soc Esp Oftalmol 2009; 84: 549-556).

Comparación de la efectividad de dos estrategias farmacológicas para la prevención del síndrome de iris flácido intraquirúrgico / Comparison of the effectiveness of two different pharmacologic approaches to prevent intraoperative floppy iris syndrome

Objetivo: Comparar la efectividad de dos estrategiasdiseñadas para prevenir la aparición del síndromede iris flácido intraquirúrgico (IFIS) en pacientesexpuestos a α-bloqueantes.Métodos: Comparamos retrospectivamente la presenciay severidad de aparición del síndrome en 29pacientes intervenidos de cataratas, estableciendodos grupos de 12 pacientes (22 ojos) y 17 pacientes(33 ojos). La estrategia aplicada al grupo uno consistióen suspender le exposición a los α-bloqueantesun mínimo de una semana antes de la intervención,atropina tópica 1% 3 veces al día desde dosdías antes, y adrenalina intracamerular. La estrategiadel grupo dos fue la suspensión del fármaco unmínimo de una semana antes y la aplicación intracamerularal inicio de la cirugía de una solución formadapor suero fisiológico, adrenalina y lidocaína.Resultados: En el grupo uno 6 pacientes no tuvieronIFIS, 2 padecieron IFIS leve bilateral, 2 moderadobilateral y 2 severo (unilaterales); es decir, un45,5% de ojos lo padecieron. En el grupo dos, 3 ojos (9,1%) de dos pacientes lo padecieron en gradoleve. Existen diferencias estadísticamente significativasen los dos grupos (p=0,002). Si consideramosque un paciente sufre el síndrome sólo cuandotiene un grado moderado o grave, también existendiferencias significativas entre la proporción decasos con IFIS en el grupo uno con respecto al grupodos (p=0,0002).Conclusiones: El estudio demuestra la mayor efectividadestadísticamente significativa de la estrategiaaplicada en el grupo dos comparada a la aplicada al grupo uno(AU)

Objective: To compare the effectiveness of twostrategies to prevent the appearance of intraoperativefloppy iris syndrome (IFIS) in patients exposedto α-blockers.Methods: We compared retrospectively the presenceand severity of the appearance of IFIS in 29patients subjected to cataract surgery, establishingtwo groups of 12 patients (22 eyes) and 17 patients(33 eyes). The strategy applied to group one consistedof suspending the exposure to α-blockers for atleast one week prior to the intervention, the topicalapplication of 1% atropine three times a day for twodays before the intervention and the use of intracamerallidocaine. The strategy for group two consistedof suspending use of the drug for at least oneweek before the intervention and the intracameralapplication at the beginning of surgery of a solutionof physiological serum, adrenaline and lidocaine.Results: Six patients from group one showed noevidence of IFIS, 2 exhibited bilateral mildsymptoms, 2 bilateral moderate and 2 unilateral severe symptoms of IFIS. In total, 45.5% eyes sufferedfrom IFIS. In group two, only 3 eyes (9.1%)from 2 patients exhibited mild symptoms. Statisticalanalysis showed a significant difference betweenboth groups (p=0.002). If only those exhibitingmoderate and severe symptoms are taken intoaccount the result was highly statistically significant(p=0.0002).Conclusion: The study shows a greater statisticaleffectiveness of the strategy applied to group twocompared to the strategy applied to group one(AU)

[Intraocular lens power calculation in complicated cases: the "Silguero"method]. / Cálculo de lente intraocular en casos complicados: el método "Silguero".

PURPOSE: To report a new method for intraocular lens (IOL) calculation in patients treated by corneal refractive surgery, in whom the application of other methods is not possible because of the absence of necessary data. This method is also applicable in other situations where the IOL calculation is difficult and in cases of IOL exchange because of unexpected refractive difficulties. METHODS: We performed phaco-emulsifications, refracting the patient's eye before IOL implantation, using the refraction data in aphakia as the only variable for the application of the formula, which itself is based on the existing correlation between the graduation of glasses (12 mm) and the IOL power at the lens level. The formula has been applied in 3 patients in whom no other calculation method was applicable. RESULTS: After the appropriate intervention, the 3 patients presented a spherical equivalent below 1 diopter. CONCLUSION: We believe this formula is valid in some situations where other formulas cannot be applied because of the absence of the necessary variables.

Cálculo de lente intraocular en casos complicados: el método «Silguero» / Intraocular lens power calculation in complicated cases: the «Silguero» method

Objetivo: Mostrar un nuevo método para el cálculo de la lente intraocular (LIO) en pacientes intervenidos de cirugía refractiva corneal en los que la aplicación de otros métodos no es posible por la falta de datos. También es aplicable en otras situaciones de alta dificultad en el cálculo de la LIO y en casos de intercambio de LIO por sorpresa refractiva.Métodos: Se realiza la facoemulsificación y antes de implantar la LIO se refracciona al paciente, utilizando el dato de la refracción en afaquia como única variable para la aplicación de nuestra fórmula, que se basa en la correspondencia existente entre la graduación en gafas (12 mm) y la potencia de la LIO a nivel de plano cristaliniano. Se ha aplicado en tres pacientes en los que ningún método de cálculo era aplicable.Resultados: Los tres pacientes han quedado con un equivalente esférico inferior a 1 dioptría.Conclusiones: Creemos que esta fórmula es válida para algunas situaciones en que otras fórmulas no pueden ser aplicadas por falta de variables

Purpose: To report a new method for intraocular lens (IOL) calculation in patients treated by corneal refractive surgery, in whom the application of other methods is not possible because of the absence of necessary data. This method is also applicable in other situations where the IOL calculation is difficult and in cases of IOL exchange because of unexpected refractive difficulties. Methods: We performed phaco-emulsifications, refracting the patient’s eye before IOL implantation, using the refraction data in aphakia as the only variable for the application of the formula, which itself is based on the existing correlation between the graduation of glasses (12 mm) and the IOL power at the lens level. The formula has been applied in 3 patients in whom no other calculation method was applicable. Results: After the appropriate intervention, the 3 patients presented a spherical equivalent below 1 diopter. Conclusion: We believe this formula is valid in some situations where other formulas cannot be applied because of the absence of the necessary variables

[Repair of Descemet's membrane detachment after cataract surgery]. / Reparación del desprendimiento de membrana de Descemet tras cirugía de cataratas.

PURPOSE/METHODS: We present two cases of Descemet's membrane detachment, the first one after extracapsular cataract extraction with scleral tunnel incision and the other after clear corneal incision used for phacoemulsification cataract extraction. These two cases were treated with intracameral injection of 20% sulfur hexafluoride gas (SF(6)). RESULTS/CONCLUSIONS: Both cases responded satisfactorily to treatment. After four months of follow-up, the corneas remain clear with a visual acuity of 0.9 and 0.8, respectively. The relative facility of the 20% sulfur hexafluoride gas (SF(6)) technique, its safety, and good prognosis, makes it the treatment of choice in this disease.

Reparación del desprendimiento de membrana de Descemet tras cirugía de cataratas / Repair of Descemet's membrane detachment after cataract surgery

Objetivo/métodos: Presentamos dos casos de desprendimiento de membrana de Descemet tras cirugía extracapsular con incisión escleral tunelizada y facoemulsificación con incisión en córnea clara, tratados con inyección intracameral de hexafluoruro de azufre (SF[6]) al 20 por ciento. Resultados/conclusiones: Ambos casos respondieron de manera satisfactoria al tratamiento. Tras 4 meses de seguimiento las córneas permanecen claras y la agudeza visual es de 0,9 y 0,8 respectivamente. La relativa facilidad de la técnica de inyección de SF[6] al 20 por ciento, su inocuidad y buen pronóstico, convierten a este procedimiento en la terapia de elección (AU)

Hemangiopericitoma orbitario: un caso en el espacio intraconal / Orbital hemangiopericytoma: an intraconal case

Objetivo/métodos: Presentamos un caso de hemangiopericitoma orbitario en un muchacho de 14 años. Se detallan los hallazgos radiológicos de la tomografía axial computerizada (TAC), resonancia magnética nuclear (RMN), y ultrasonografía.Resultados/conclusiones: El diagnóstico por imagen mostró una masa sólida bien circunscrita de localización intraconal. Macroscópicamente el tumor era de coloración púrpura, muy vascularizado y encapsulado. El examen histológico reveló un hemangiopericitoma de grado intermedio, con hipercelularidad y moderado número de mitosis. Destacamos la rareza del hemangiopericitoma orbitario, especialmente cuando se localiza dentro del cono muscular (AU)

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