Análisis de superficie ocular en pacientes diagnosticados de ictiosis X / Ocular surface analysis in patients diagnosed with X-linked ichthyosis

Se estudió a 7 pacientes (14 ojos) diagnosticados de ictiosis X mediante test de Schirmer, biomicroscopia, tonometría, recuento endotelial, tomografía de coherencia óptica, Pentacam, analizador de superficie ocular y microscopia confocal. La edad media fue 33,83 ± 20,17 años (rango: 7-64 años). Los hallazgos más frecuentes en biomicrocoscopia fueron disfunción de glándulas de Meibomio (83,3%) y opacidades corneales estromales (33%). El tiempo de rotura de la película lagrimal se encontró acortado en el 25% de los ojos. La microscopia confocal (2 ojos) reveló queratocitos activados con partículas hiperreflectivas en su interior en estroma anterior y fuera de ellos en estroma posterior. Creemos que la extensión del uso de la microscopia confocal permitirá conocer mejor la enfermedad corneal asociada a ictiosis X y nuevas características de estos pacientes

Seven patients (14 eyes) diagnosed with X-linked ichthyosis were studied using the Schirmer test, biomicroscopy, tonometry, endothelial count, optical coherence tomography, Pentacam®, ocular surface analyser, and confocal microscopy. The mean age was 33.83 ± 20.17 years (range: 7-64 years). The most frequent findings in biomicroscopy were Meibomian glands dysfunction (83.3%) and stromal corneal opacities (33%). The tear break-up time was found shortened in 25% of the eyes. Confocal microscopy (both eyes) revealed activated keratocytes with hyper-reflective particles inside them in the anterior stroma and outside them in the posterior stroma. It is believed that the inclusion of the use of confocal microscopy will help in a better understanding of the corneal pathology associated with ichthyosis X, as well as new characteristics of these patients

Ocular surface analysis in patients diagnosed with X-linked ichthyosis. / Análisis de superficie ocular en pacientes diagnosticados de ictiosis X.

Seven patients (14 eyes) diagnosed with X-linked ichthyosis were studied using the Schirmer test, biomicroscopy, tonometry, endothelial count, optical coherence tomography, Pentacam®, ocular surface analyser, and confocal microscopy. The mean age was 33.83±20.17 years (range: 7-64 years). The most frequent findings in biomicroscopy were Meibomian glands dysfunction (83.3%) and stromal corneal opacities (33%). The tear break-up time was found shortened in 25% of the eyes. Confocal microscopy (both eyes) revealed activated keratocytes with hyper-reflective particles inside them in the anterior stroma and outside them in the posterior stroma. It is believed that the inclusion of the use of confocal microscopy will help in a better understanding of the corneal pathology associated with ichthyosis X, as well as new characteristics of these patients.

Retinoblastoma: la importancia de su diagnóstico precoz / Retinoblastoma: The importance of early diagnosis

INTRODUCCIÓN: El retinoblastoma es el tumor intraocular maligno más frecuente en la infancia y tanto su curación como las secuelas derivadas del mismo dependen fundamentalmente de un diagnóstico precoz. En la actualidad, no existe consenso en su manejo diagnóstico y terapéutico. PACIENTES Y MÉTODOS: Estudio descriptivo, retrospectivo, no aleatorizado, de serie de casos (39 pacientes-58 ojos), tratados durante el período 2006-2013 en nuestro servicio, nombrado centro de Referencia Regional de Tumores por la Agencia de Calidad del SNS. RESULTADOS: El signo más frecuente de comienzo es la leucocoria (71,8%), seguido de estrabismo (17,9%). Todos los casos de tumoración bilateral presentaban mutación germinal del gen RB1 y un 20% tenían antecedentes familiares. El 55% de los pacientes presentaron estadio E, y el 90% precisó tratamiento quimioterápico. Un 57% de los que presentaban estadios leves, conservaron su ojo respecto al 43% que lo conservó en estadios avanzados. CONCLUSIONES: Este análisis consta de 58 ojos, sin que existan estudios previos en nuestra comunidad y pocas series tan numerosas en todo el país. Basado en tratamiento no estandarizados, eligiendo el más adecuado según las características del tumor. El manejo multidisciplinar, formado por oftalmología, oncología pediátrica, oncología radioterápica y radiofísica, es fundamental para la elección de tratamiento más correcta. La quimiorreducción junto a tratamientos de consolidación ofrece resultados esperanzadores en el control de los mismos, sobre todo en los de menor severidad. La enucleación continúa siendo de elección en las estadificaciones más avanzadas con afectación vítrea, poniendo de manifesto la importancia de su diagnóstico precoz

INTRODUCTION: Retinoblastoma is the most frequent malignant intraocular tumour in childhood, and both its cure and the sequelae arising from it, mainly depend on an early diagnosis. There is currently no consensus on its diagnostic and therapeutic management. PATIENTS AND METHODS: A descriptive, retrospective, and non-randomised study was conducted on a series of cases (39 patients -58 eyes), treated during the period 2006-2013, in the Regional Reference Centre for Tumours of the National Health Service Quality Agency. RESULTS: The most frequent presentation sign is leukocoria (71.8%), followed by strabismus (17.9%). All cases of bilateral tumour had a germline mutation of the RB1 gene, and 20% had a family history. Stage E was observed in 55% of the patients, and 90% required chemotherapy treatment. The eye was maintained in 57% of those who had mild stages, compared to 43% who maintained it in advanced stages. CONCLUSIONS: This analysis included 58 eyes. There are no previous studies in our community and there are few series so numerous throughout the country. Based on non-standardised treatment, the most appropriate is chosen according to the characteristics of the tumour. The multidisciplinary management, formed by ophthalmology, paediatric oncology, radiotherapy, and radiophysical oncology, is fundamental for the selection of the most appropriate treatment. Chemo-reduction, along with consolidation treatments, offers encouraging results in the control of these tumours, especially in those of less severity. Enucleation continues to be the method of choice in the most advanced staging with vitreous involvement, with the importance of early diagnosis being highlighted

Retinoblastoma: The importance of early diagnosis. / Retinoblastoma: la importancia de su diagnóstico precoz.

INTRODUCTION: Retinoblastoma is the most frequent malignant intraocular tumour in childhood, and both its cure and the sequelae arising from it, mainly depend on an early diagnosis. There is currently no consensus on its diagnostic and therapeutic management. PATIENTS AND METHODS: A descriptive, retrospective, and non-randomised study was conducted on a series of cases (39 patients -58 eyes), treated during the period 2006-2013, in the Regional Reference Centre for Tumours of the National Health Service Quality Agency. RESULTS: The most frequent presentation sign is leukocoria (71.8%), followed by strabismus (17.9%). All cases of bilateral tumour had a germline mutation of the RB1 gene, and 20% had a family history. Stage E was observed in 55% of the patients, and 90% required chemotherapy treatment. The eye was maintained in 57% of those who had mild stages, compared to 43% who maintained it in advanced stages. CONCLUSIONS: This analysis included 58 eyes. There are no previous studies in our community and there are few series so numerous throughout the country. Based on non-standardised treatment, the most appropriate is chosen according to the characteristics of the tumour. The multidisciplinary management, formed by ophthalmology, paediatric oncology, radiotherapy, and radiophysical oncology, is fundamental for the selection of the most appropriate treatment. Chemo-reduction, along with consolidation treatments, offers encouraging results in the control of these tumours, especially in those of less severity. Enucleation continues to be the method of choice in the most advanced staging with vitreous involvement, with the importance of early diagnosis being highlighted.

Auditoría de la cirugía de catarata senil en Cádiz: resultados visuales y complicaciones / Audit of cataract surgery in Cadiz: visual outcomes and complications

OBJETIVO: Dar a conocer los resultados y complicaciones de la cirugía de catarata senil en Cádiz. A falta de auditorías nacionales, comparamos nuestros resultados con la más reciente auditoría europea EUREQUO (2013) y con la auditoría británica RCOphth NOD (2015). MÉTODOS: Estudio longitudinal, prospectivo, antes-después de 312 pacientes intervenidos de cataratas en los Hospitales Universitarios Puerta del Mar y Puerto Real, en 2013-14. Variables recogidas: características sociodemográficas, agudeza visual (AV), síntomas secundarios a la catarata, comorbilidad ocular, tiempo de espera, preparación del cirujano (adjunto vs. residente), tasa y tipos de complicaciones quirúrgicas. RESULTADOS: La edad media de los pacientes fue de 73,92 ± 7,31 años. El 98,3% partieron de una AV ≥ 0,60 logMAR (≤ 0,25 decimal). La AV media preoperatoria fue de 1,01 logMAR (0,92-1,10), equivalente a 0,20 decimal (0,18-0,21). La tasa de complicaciones fue del 6,7%, con un 3,8% de roturas de cápsula posterior y un 2,8% de descompensaciones corneales. No se registraron casos de endoftalmitis. La AV media postoperatoria fue de 0,28 logMAR (0,22-0,33), equivalente a 0,67decimal (0,64-0,70). El 78,8% de los pacientes intervenidos adquirieron una AV ≤ 0,3 logMAR tras la cirugía (≥ 0,50 decimal), y el 27,6% una AV ≤ 0,0 logMAR (≥1,0decimal). CONCLUSIONES: Obtuvimos resultados inferiores a los del EUREQUO y a los del RCO phth NOD, donde se reporta una AV posquirúrgica ≤ 0,3 logMAR (≥ 0,50 decimal) en el 98 y en el 89% de los pacientes, respectivamente. Sin embargo, las poblaciones estudiadas son diferentes. Esperamos con nuestro estudio animar a otros hospitales públicos españoles a realizar auditorías y compartir resultados, como herramienta de autocrítica y mejora

OBJECTIVE: To publish the outcomes and complications of age-related cataract surgery in Cadiz (Spain). Due to the lack of national audits, a comparison was made between the results obtained here and those of the most recent European audit, EUREQUO (2013), and the British audit RCOphth NOD (2015). METHODS: A prospective, longitudinal, before-after study of 312 patients undergoing cataract surgery in the University Hospitals of Puerta del Mar and Puerto Real (Cadiz), in 2013-14. Outcome measurements included sociodemographic characteristics, visual acuity (VA), symptoms secondary to cataract, ocular comorbidity, waiting time, expertise of surgeon (consultant vs. trainee), rate and type of surgical complications. RESULTS: The median age at surgery was 73.92 ± 7.31. Almost all (98.3%) of patients at consultation had a VA ≥ 0.60 logMAR, with a mean pre-surgical VA of 1.01logMAR (0.92-1.10). There was a 6.7% complication rate, with 3.8% posterior capsule ruptures and 2.8% corneal decompensations. No cases of endophthalmitis occurred. The mean post-operative VA was 0.28 logMAR (0.22-0.33). More than three-quarters (78.8%) of cases achieved a post-operative VA ≤ 0.3 logMAR, and 27.6% of cases achieved a VA ≤ 0.0 logMAR. CONCLUSIONS: Our success rate was inferior to the EUREQUO and RCOphth NOD studies, with the percentage of patients acquiring a postoperative VA ≤0.3 logMAR being 98% and 89%, respectively. However, the populations were not comparable. It is hoped that this study will encourage other public hospitals in Spain to undertake audits and share their results, in order to provide a tool for constructive criticism and quality improvement initiatives

Audit of cataract surgery in Cadiz: visual outcomes and complications. / Auditoría de la cirugía de catarata senil en Cádiz: resultados visuales y complicaciones.

OBJECTIVE: To publish the outcomes and complications of age-related cataract surgery in Cadiz (Spain). Due to the lack of national audits, a comparison was made between the results obtained here and those of the most recent European audit, EUREQUO (2013), and the British audit RCOphth NOD (2015). METHODS: A prospective, longitudinal, before-after study of 312 patients undergoing cataract surgery in the University Hospitals of Puerta del Mar and Puerto Real (Cadiz), in 2013-14. Outcome measurements included sociodemographic characteristics, visual acuity (VA), symptoms secondary to cataract, ocular comorbidity, waiting time, expertise of surgeon (consultant vs. trainee), rate and type of surgical complications. RESULTS: The median age at surgery was 73.92±7.31. Almost all (98.3%) of patients at consultation had a VA ≥0.60logMAR, with a mean pre-surgical VA of 1.01logMAR (0.92-1.10). There was a 6.7% complication rate, with 3.8% posterior capsule ruptures and 2.8% corneal decompensations. No cases of endophthalmitis occurred. The mean post-operative VA was 0.28logMAR (0.22-0.33). More than three-quarters (78.8%) of cases achieved a post-operative VA ≤0.3logMAR, and 27.6% of cases achieved a VA ≤0.0logMAR. CONCLUSIONS: Our success rate was inferior to the EUREQUO and RCOphth NOD studies, with the percentage of patients acquiring a postoperative VA ≤0.3logMAR being 98% and 89%, respectively. However, the populations were not comparable. It is hoped that this study will encourage other public hospitals in Spain to undertake audits and share their results, in order to provide a tool for constructive criticism and quality improvement initiatives.

Effectiveness and safety of nutritional supplements in the treatment of hereditary retinal dystrophies: a systematic review.

The hereditary retinal dystrophies (HRDs) are a group of genetically determined disorders that result in loss of the visual function. There is a lack of standard pharmacological treatments or widely accepted nutritional recommendations. The objective of this review is to summarise the scientific evidence on the effectiveness and safety of nutritional supplements for the treatment of HRDs. We conducted a scientific literature search on Medline and PreMedline, EMBASE, SCI-EXPANDED, SSCI, and The Cochrane Library up to August 2014. Experimental, quasi-experimental and controlled observational studies were selected. Eight studies were ultimately included, seven on retinitis pigmentosa (RP) and one on Best disease. Vitamin A, vitamin E, docosahexaenoic acid (DHA), lutein and ß-carotene were assessed. A 15 000 IU daily dose of vitamin A was reported to have shown a small protective effect on the progression of RP, as was the use of the carotenoids lutein and ß-carotene. Different DHA doses has no effect on RP or Best disease. No supplement showed severe adverse effects in the selected studies although strong evidence of toxicity exists for high doses of vitamin A and ß-carotene in certain populations. The selected studies concluded that there may be a small beneficial effect of vitamin A, lutein and ß-carotene on the progression of RP. The limited evidence available indicates some well-designed additional studies on combined supplements strategies may achieve more robust conclusions. Moreover, the scarcity of evidence available on the treatment of HRD other than RP with nutritional supplements supports the need for further research efforts.

Variaciones en la técnica del trasplante limbar autólogo / Variations in the technique for autologous limbal transplantation

OBJETIVO: Presentar los resultados del uso de un único segmento de autoinjerto limbar combinado con trasplante de membrana amniótica y epiteliectomías conjuntivales sectoriales secuenciales postoperatorias en 2 pacientes con insuficiencia límbica unilateral total. CONCLUSIONES: Un solo segmento de autoinjerto limbal junto con el trasplante de membrana amniótica puede ser suficiente para restaurar una superficie corneal estable, siendo en ocasiones necesario realizar en el postoperatorio epiteliectomías conjuntivales secuenciales en zonas remanentes de epitelio anómalo

OBJECTIVE: To present the results on the use of a single block limbal autograft, combined with amniotic membrane transplantation and sectoral sequential postoperative epitheliectomy of the conjunctiva in 2 patients with unilateral total limbal stem cell deficiency. CONCLUSIONS: A single block limbal autograft combined with amniotic membrane transplantation may be sufficient to restore a stable corneal surface, but sometimes sequential sectoral conjunctival epitheliectomy may be required to treat anomalous epithelial remnants

Variations in the technique for autologous limbal transplantation. / Variaciones en la técnica del trasplante limbar autólogo.

OBJECTIVE: To present the results on the use of a single block limbal autograft, combined with amniotic membrane transplantation and sectoral sequential postoperative epitheliectomy of the conjunctiva in 2 patients with unilateral total limbal stem cell deficiency. CONCLUSIONS: A single block limbal autograft combined with amniotic membrane transplantation may be sufficient to restore a stable corneal surface, but sometimes sequential sectoral conjunctival epitheliectomy may be required to treat anomalous epithelial remnants.

Técnica combinada de vitrectomía con biopsia y citología en el diagnóstico de tumor intraocular / Combined choroidal biopsy and cytology for diagnosis of intraocular tumour

Caso clínico: Ninguna técnica de biopsia intraocular es inocua y todas tienen posibilidad de falsos negativos por la dificultad para obtener una muestra suficiente. Paciente con sospecha de melanoma tras biopsia negativa con vitrectomía 25 G. Se realiza biopsia coriorretiniana modificada en la que además de extraerse un fragmento mediante cirugía bimanual, se obtiene material de la lesión con vitreotomo para realizar citología, confirmando el diagnóstico de sospecha de melanoma de coroides. Discusión: La asociación de una citología obtenida con vitreotomo de una lesión coroidea asociada a la escisión de un fragmento de la lesión puede mejorar la eficacia de la biopsia intraocular (AU)

Clinical case: No intraocular biopsy technique is free of risk and all have the possibility of giving false negatives due to the difficulty in obtaining a sufficient sample. A modified chorioretinal biopsy was performed on a patient with suspected choroidal melanoma after negative biopsy with 25G vitrectomy. In addition to removing a solid fragment of tumor material using bimanual surgery, material from the lesion was obtained with the vitreotome to perform cytology, which confirmed the diagnosis of melanoma. Discussion: Cytology obtained through the vitreotome in association with removing a solid sample of the choroidal lesion may improve the efficiency of intraocular biopsy (AU)

[Combined choroidal biopsy and cytology for diagnosis of intraocular tumour]. / Técnica combinada de vitrectomía con biopsia y citología en el diagnóstico de tumor intraocular.

CLINICAL CASE: No intraocular biopsy technique is free of risk and all have the possibility of giving false negatives due to the difficulty in obtaining a sufficient sample. A modified chorioretinal biopsy was performed on a patient with suspected choroidal melanoma after negative biopsy with 25G vitrectomy. In addition to removing a solid fragment of tumor material using bimanual surgery, material from the lesion was obtained with the vitreotome to perform cytology, which confirmed the diagnosis of melanoma. DISCUSSION: Cytology obtained through the vitreotome in association with removing a solid sample of the choroidal lesion may improve the efficiency of intraocular biopsy.

[Training and clinical activity of Spanish retinologists: a preliminary approach. Retina 2 project. Descriptive analysis]. / Formación y actividad clínica de los retinólogos en España: un primer acercamiento. Proyecto retina 2. Análisis descriptivo.

PURPOSE: To create a database of Spanish ophthalmologists mainly dedicated to retinal pathology care, describing their training period characteristics and their daily activity (clinical and surgical). METHODS: A postal questionnaire was sent to 504 possible retinologists identified through the information supplied by the Spanish Ophthalmological Society and the Spanish Vitreous-Retina Society, with a minimum of 3 retinologists per Autonomous Region. RESULTS: 267 (52.9% of the sample population) responses were collected and processed. Most of the respondents had started their residency after 1980 (82.4%). Ninety-four percent had received specific training in retinal pathology, mostly during the residency period (82.1%) and from more experienced colleagues (62.9%). Official fellowships were held in a minority of cases (around 12%). Twelve percent of retinologists performed retinal surgery only, 14.6% performed anterior segment surgery, and 60.7% performed both types of surgery. CONCLUSIONS: Despite not having taken into consideration non-response bias, this study provides the first reported data on the professional profile of Spanish retinologists.

Formación y actividad clínica de los retinólogos en España: un primer acercamiento. Proyecto Retina 2. Análisis descriptivo / Training and clinical activity of spanish retinologists: A preliminary approach. Retina 2 project. Descriptive analysis

Objetivo: Obtener un listado de oftalmólogos españolesdedicados a la patología retiniana y describiralgunas características de su formación específica yde su actividad clínica cotidiana.Método: Se ha enviado una encuesta por correopostal a 504 probables retinólogos identificados apartir de la información proporcionada por lasSociedades Española de Oftalmología y de Retina yVítreo y un conjunto mínimo de tres retinólogos decada Comunidad Autónoma.Resultados: Se han obtenido 267 respuestas(52,9% de la población). El 83% obtuvo su especialidaddespués de 1980. El 94% ha recibido formaciónespecífica, sobre todo durante la residencia(82,1%) y de compañeros más expertos (67,7%). La realización de masteres oficiales es muy minoritaria (solo un 16,7% tienen al menos un master).El 12% se dedica en exclusiva a la patología quirúrgica,el 24,7% a la médica y el 62,9% combinanambas actividades. Un 22,5% opera patología retiniana,un 14,6% realiza cirugía del segmento anteriory un 60,7% combina ambas.Conclusiones: A pesar de no haberse tenido encuenta el sesgo de la no repuesta, se dispone de losprimeros datos sobre el perfil y la actividad de losdenominados retinólogos, en España(AU)

Purpose: To create a database of Spanish ophthalmologistsmainly dedicated to retinal pathologycare, describing their training period characteristicsand their daily activity (clinical and surgical).Methods: A postal questionnaire was sent to 504possible retinologists identified through the informationsupplied by the Spanish OphthalmologicalSociety and the Spanish Vitreous-Retina Society,with a minimum of 3 retinologists per AutonomousRegion.Results: 267 (52.9% of the sample population) responseswere collected and processed. Most of therespondents had started their residency after 1980(82.4%). Ninety-four percent had received specifictraining in retinal pathology, mostly during the residency period (82.1%) and from more experiencedcolleagues (62.9%). Official fellowships were heldin a minority of cases (around 12%). Twelve percentof retinologists performed retinal surgery only,14.6% performed anterior segment surgery, and60.7% performed both types of surgery.Conclusions: Despite not having taken into considerationnon-response bias, this study provides thefirst reported data on the professional profile ofSpanish retinologists(AU)

Surgical outcomes for primary rhegmatogenous retinal detachments in phakic and pseudophakic patients: the Retina 1 Project--report 2.

AIMS: To compare anatomical and functional outcomes for 546 phakic and pseudophakic primary rhegmatogenous retinal detachments (RDs) treated by pars plana vitrectomy or scleral buckling. METHODS: Prospective, non-randomised, interventional study in 15 centres in Spain and Portugal, with data from RDs consecutively treated from January 2005 to May 2007. Cases with preoperative proliferative vitreoretinopathy grade C-1 or higher and perforating trauma were excluded. Minimum follow-up was 3 months. Twenty-seven pre-, intra- and post-surgical variables for each patient were analysed. Multivariate analysis was carried out by logistic regression analysis with stepwise selection of variables. RESULTS: Data from 546 patients were analysed. Global anatomical success was 94.7%. Logistic regression analysis showed that only the development of postoperative proliferative vitreoretinopathy was associated with a poor anatomical outcome. The poorest functional results were associated with macular involvement, extension of RD, previous RD surgery, time of evolution of RD, and age of patient. Hierarchical log-linear analysis showed no effect of the lens status (phakic versus pseudophakic) on the functional results. However, pars plana vitrectomy was most often performed in pseudophakic eyes and resulted in a worse final visual acuity (p<0.001). CONCLUSIONS: No differences in anatomical success between phakic and pseudophakic eyes were found in this series. Pars plana vitrectomy was most often performed in pseudophakic eyes and had a greater probability of a worse final visual acuity than scleral buckling.

Interaction between surgical procedure for repairing retinal detachment and clinical risk factors for proliferative vitreoretinopathy.

PURPOSE: To asses risk factors of proliferative vitreoretinopathy (PVR) and a model for predicting it. METHODS: Observational, case-control. 335 patients with non-complicated retinal detachment (RD) were included: 134 developed PVR (Cases); 201 patients did not (Controls). Risk factors for PVR were identified by multivariate analysis. Influence of variables was assayed according to the surgical approach. By logistic regression analysis a model to predict the risk of developing PVR and odds ratio (OR) values for each clinical factor were estimated. RESULTS: Risk was higher in patients > 70 years and with intraocular pressure lower than 14 (OR: 3.84; CI 95%: 2.04-7.30) and in retinal breaks larger than "1 clock hour" (OR: 2.54; CI: 1.28-5.05), extended retinal detachments (OR: 4.01; CI: 1.98-8.10) and reinterventions (OR: 1.55; CI: 1.14-9.22). Scleral surgery also was a risk factor (OR: 3.89; CI: 2.12-7.14) and aphakia/pseudophakia when scleral surgery is performed (OR: 3.33; CI: 1.54-7.22). A model to predict PVR was proposed with these results. CONCLUSIONS: Surgical approach modifies risk factors of PVR, and should be taken into account to improve the models for predicting it.

[Retinal shortening: the most severe form of proliferative vitreoretinopathy (PVR)]. / Acortamiento retiniano: la forma más grave de la vitreorretinopatía proliferante (VRP).

PURPOSE: To identify the clinical characteristics of patients developing retinal shortening due to intraretinal PVR. METHODS: Observational and retrospective cohort study on 110 PVR patients operated on between 2000 and 2001. During surgery, after removing epiretinal membranes and ruling out the presence of subretinal membranes, a perfluorocarbon liquid was injected. Those cases in which retinal flattening was not accomplished, were considered intraretinal PVR (group 1). Those in which retinal flattening allowed endolaser application, were taken as the control group (group 2). Clinical features of both groups were compared by chi-square test. RESULTS: 60 cases (54.5%, CI 95%: 40.5-68.5) showed retinal shortening (group 1). In 24 cases (21.8%, CI 95%: 12.9-30.7) complete retinal flattening was accomplished (group 2). In 26 cases (23.6%), evaluation was inconclusive. In 9 out of the 60 cases of group 1 (15%) a retinectomy was necessary to reattach the retina. Differences between both groups were not statistically significant for any of the clinical variables. However, the number of retinal detachments of more than 60 days of evolution was significantly higher in retinectomized eyes (20.7%) than in group 1 (3.7%) (p=0.04). CONCLUSIONS: Retinal shortening is a relatively frequent phenomenon in PVR. Further studies are necessary to characterize this clinical presentation of PVR and its pathogenesis.

Acortamiento retiniano: la forma más grave de la vitreorretinopatía proliferante (VRP) / Retinal shortening: the most severe form of proliferative vitreoretinopathy (PVR)

Objetivo: Identificar las características clínicas de los pacientes que presentan una VRP con acortamiento retiniano no producido por membranas perirretinianas. Método: Estudio observacional, retrospectivo, de una cohorte de 110 pacientes intervenidos por VRP en 2000 y 2001. Durante la cirugía, tras eliminar las membranas epirretinianas y comprobar que no existían subretinianas, se inyectó un perfluorocarbono líquido. Los ojos en los que no se consiguió la reaplicación retiniana se catalogaron como VRP intrarretiniana (grupo 1). Los casos en los que se consiguió una reaplicación que permitió la aplicación de endoláser sin realizar otras maniobras, constituyeron el grupo control (grupo 2). Se han comparado las características clínicas preoperatorias de ambos grupos mediante el test de la chi- cuadrado. Resultados: 60 casos (54,5 por ciento, IC 95 por ciento: 40,5-68,5) se incluyeron en el grupo 1 y 24 casos (21,8 por ciento, IC 95 por ciento: 12,9-30,7) en el grupo 2. En los casos restantes, 26 (23,6 por ciento), la evaluación presentó dudas. En 9 (15 por ciento) de los 60 casos del grupo 1 fue necesario realizar una retinectomía. No hubo diferencias estadísticamente significativas en ninguna de las variables preoperatorias comparadas entre ambos grupos. Únicamente se observó un mayor número de casos con larga evolución (más de 2 meses) entre los pacientes del grupo 1 que requirieron una retinectomía (20,7 por ciento), que en los que no fue necesaria (3,7 por ciento) (p=0,04). Conclusión: La aparición de fenómenos de acortamiento retiniano es frecuente en la VRP. Son necesarios más estudios para caracterizar mejor esta presentación clínica de la VRP y para conocer los mecanismos patogénicos que la provocan (AU)

[Clinical risk factors for postoperative proliferative vitreoretinopathy (PVR). A prospective study]. / Factores clínicos de riesgo para el desarrollo de la vitreorretinopatía proliferante (VRP) postquirúrgica. Estudio prospectivo.

PURPOSE: To identify clinical risk factors for development of postoperative PVR, to determine the incidence of this complication and its time of onset by a prospective multicentric study. METHODS: A multicentric and prospective study of 223 patients with rhegmatogenous retinal detachment (RD) was conducted. Logistic regression analysis was used to identify risk factors for PVR among 83 variables related to preoperative, intraoperative and postoperative characteristics. RESULTS: 22 out of 223 RD developed PVR (incidence 9.9%, confidence interval 95%: 5.9-13.9). After logistic regression analysis, four variables showed an odds ratio higher than 1.0 (RD affecting 4 quadrants, cryopexy, aphakia/pseudophakia and those RD in which an encircling band was implanted). None of these factors showed a <

> value lower than 0.05. Most of postoperative PVR (77.2%) appeared in the first month after surgery. CONCLUSIONS: This study establishes the incidence of PVR, and its time of onset, but it was not effective to identify clinical risk factors with a high level of confidence.

Factores clínicos de riesgo para el desarrollo de la vitreorretinopatía proliferante (VRP) postquirúrgica. Estudio prospectivo / Clinical risk factors for postoperative proliferative vitreoretinopathy (PVR). A prospective study

Objetivo: Identificar los factores de riesgo de VRP, la incidencia y el momento de aparición de esta complicación en una serie prospectiva de desprendimientos de retina regmatógenos (DR).Métodos: Se ha realizado un estudio multicéntrico y prospectivo de 223 casos de DR. Se han incluido 83 variables referentes a características preoperatorias, intraoperatorias y postquirúrgicas. Se ha efectuado un análisis de regresión logística. Resultados: De los 223 casos de DR, 22 desarrollaron una VRP (incidencia 9,9 por ciento, intervalo de confianza al 95 por ciento: 5,9-13,9). Se han detectado 4 factores con una 'odds-ratio' superior a 1,0 (la existencia de un DR de 4 cuadrantes, el empleo de crioterapia, la afaquia o pseudofaquia y la necesidad de utilizar cerclaje). Ninguno de estos factores ha presentado una p<0,05. El 77,2 por ciento de los VrP aparecieron en el primer mes tras la cirugía. Conclusiones: Este estudio ha permitido establecer la incidencia de la VRP, y su tiempo de aparición, aunque no ha resultado efectivo para establecer asociaciones positivas con los factores de riesgo (AU)

[Comparison of different techniques for cytologic analysis of vitreous specimens]. / Comparación de diferentes técnicas de análisis citológico en muestras vítreas.

PURPOSE: To assess the efficacy of four methods to study the cytology of vitreous samples, and to evaluate the most efficient for routine analysis and immunocytochemical staining. METHODS: Diluted and undiluted vitreous samples of 87 consecutive patients suffering vitreoretinal surgery for different diseases were analysed. The specimens were centrifugated and then processed through four different procedures: agar sandwich (29 cases), direct paraffin embedding (33 cases), cytospin preparations (82 cases) and cytoblock (8 cases). RESULTS: Evaluable material was obtained in: agar sandwich 18 out of 29 cases (62%), direct paraffin embedding 32 out of 33 cases (96.9%), cytospin 72 out of 82 cases (87.8%) and cytoblock 1 out of 8 cases (12.5%). CONCLUSIONS: Direct paraffin embedding and cytospin are the most efficient procedures for routine purposes. Agar sandwich technique seems to be useful for studying small pieces of tissue. Direct paraffin embedding and agar sandwich technique seems to be valuable for immunocytochemistry. After 8 cases processed with cytoblock, our experience did not show valuable results for processing vitreous samples.