Progresión en glaucoma. Guía de práctica clínica / Glaucoma progression. Clinical practice guide

Objetivo Ofrecer una serie de recomendaciones generales que sirvan de orientación en la evaluación y el manejo de la progresión glaucomatosa en la práctica clínica diaria a partir de la evidencia clínica de calidad existente. Métodos Tras la definición de los objetivos y del alcance de la guía se constituyó el grupo de trabajo que formuló las preguntas clínicas estructuradas siguiendo el formato PICO (Patient, Intervention, Comparison, Outcomes). Una vez evaluada toda la evidencia clínica existente con las herramientas AMSTAR2 (Assessment of Multiple systematic Rewiews) y Risk of bias de Cochrane de forma independiente por al menos dos revisores, se pasó a la formulación de recomendaciones siguiendo la metodología del Scottish Intercollegiate Guideline Network (SIGN). Resultados Se presentan recomendaciones con sus correspondientes niveles de evidencia que pueden ser de utilidad para la detección y el seguimiento de la progresión glaucomatosa con los distintos métodos disponibles y para el tratamiento de los pacientes. Conclusiones A pesar de que para muchas de las preguntas el nivel de evidencia científica disponible no es muy alto, esta guía de práctica clínica ofrece una revisión actualizada de los diferentes aspectos existentes relacionados con la evaluación y el manejo de la progresión glaucomatosa (AU)

Objective To provide general recommendations that serve as a guide for the evaluation and management of glaucomatous progression in daily clinical practice based on the existing quality of clinical evidence. Methods After defining the objectives and scope of the guide, the working group was formed and structured clinical questions were formulated following the PICO (Patient, Intervention, Comparison, Outcomes) format. Once all the existing clinical evidence had been independently evaluated with the AMSTAR2 (Assessment of Multiple Systematic Reviews) and Cochrane «Risk of bias» tools by at least two reviewers, recommendations were formulated following the Scottish Intercollegiate Guideline network (SIGN) methodology. Results Recommendations with their corresponding levels of evidence that may be useful in the interpretation and decision-making related to the different methods for the detection of glaucomatous progression are presented. Conclusions Despite the fact that for many of the questions the level of scientific evidence available is not very high, this clinical practice guideline offers an updated review of the different existing aspects related to the evaluation and management of glaucomatous progression (AU)

Glaucoma progression. Clinical practice guide.

OBJECTIVE: To provide general recommendations that serve as a guide for the evaluation and management of glaucomatous progression in daily clinical practice based on the existing quality of clinical evidence. METHODS: After defining the objectives and scope of the guide, the working group was formed and structured clinical questions were formulated following the PICO (Patient, Intervention, Comparison, Outcomes) format. Once all the existing clinical evidence had been independently evaluated with the AMSTAR 2 (Assessment of Multiple Systematic Reviews) and Cochrane "Risk of bias" tools by at least two reviewers, recommendations were formulated following the Scottish Intercollegiate Guideline network (SIGN) methodology. RESULTS: Recommendations with their corresponding levels of evidence that may be useful in the interpretation and decision-making related to the different methods for the detection of glaucomatous progression are presented. CONCLUSIONS: Despite the fact that for many of the questions the level of scientific evidence available is not very high, this clinical practice guideline offers an updated review of the different existing aspects related to the evaluation and management of glaucomatous progression.

Síndrome de Charles Bonnet secundario a crisis hipertensiva / Charles Bonnet syndrome secondary to hypertensive crisis

No disponible

Estudio de la relación entre miopía y personalidad / Study of the relationship between myopia and personality

Objetivo: Estudiar la correlación entre el error refractivo miópico y determinados rasgos de personalidad. Igualmente, se pretende determinar si existe correlación entre el grado de miopía y una mayor frecuencia de trastornos de la personalidad. Métodos: Estudio transversal observacional multicéntrico. La muestra la formaron 82 sujetos (26 hombres, 56 mujeres) mayores de 18 años con miopía (defecto esférico ≤ −0,5 D); 30 eran miopes magnos (<−6 D). Datos recogidos: edad y sexo, nivel de formación, resultado en el inventario de personalidad Neo PI-R, autorrefractometría, enfermedad miópica, tratamiento oftalmológico. Resultados: No se encontró correlación (rho de Spearman) estadísticamente significativa entre el defecto esférico y los rasgos de personalidad estudiados en el total de la muestra: neuroticismo (−0,057; p = 0,610), extraversión (−0,020; p = 0,857), apertura (−0,032; p = 0,774), amabilidad (−0,060; p = 0,592), responsabilidad (−0,034; p = 0,765). Al agruparlos por subgrupos de alta y baja significación (t-test), se halló una tendencia al aumento del defecto miópico con la extraversión, que resultó significativa (p = 0,002). Al comparar miopes magnos y el resto, se vio que existían diferencias significativas entre ambos grupos en cuanto a la enfermedad asociada (p < 0,001), el tratamiento recibido (p < 0,001) y el nivel de estudios ((p = 0,013), no así en las variables de personalidad: neuroticismo (p = 0,852), extraversión (p = 0,199), apertura (p = 0,560), amabilidad (p = 0,584), responsabilidad (p = 0,722). Conclusiones: Se encontró baja correlación entre miopía y personalidad. El grado de miopía no resultó diferente entre los grupos con diversos niveles de estudios. Los sujetos con enfermedad oftalmológica más grave asociada a la miopía presentaban puntuaciones más altas en neuroticismo, sin asociación significativa

OBJECTIVE: To study the correlation between the myopic refractive error and certain personality traits, and to determine whether there is a correlation between the degree of myopia and an increased frequency in personality disorders. METHODS: Cross-sectional observational multicenter study conducted on 82 subjects (26 men, 56 women) age over 18 years with myopia (spherical defect ≤ −0.5 D), with 30 subjects having high myopia (<−6 D). Data collected: age and gender, academic level, result in the Neo PI-R personality test, autorefractometry, myopic pathology, and ophthalmological treatment. RESULTS: Correlation (Spearman's) between the magnitude of the spherical defect and the 5 personality traits studied in the total sample was not statistically significant: neuroticism (−0.057; P=.610), extroversion (−0.020; P=.857), openness (−0.032; P=.774), kindness (−0.060; P=.592), and responsibility (−0.034;P=.765). By dividing them into subgroups of low and high significance (t-test), a significant (P=.002) upward trend of the myopic defect with increasing scores on extraversion was found. When comparing high myopic subjects to the non-high myopic ones, there were significant differences between the 2 groups in terms of the associated pathology (P=.001), received treatment (P=.001) and the level of studies (P=.013). There were no differences in the variables of personality: neuroticism (P=.852), extroversion (P=.199), openness (P=.560), kindness (P=.584), and responsibility (P=.722). CONCLUSIONS: A low correlation was found between myopia and personality. There was no difference in the degree of myopia between the groups with different education levels. Subjects with more severe ocular pathology associated with myopia had higher scores in neuroticism, without finding any significant association

Manejo farmacológico perioperatorio en pacientes con glaucoma / Perioperative pharmacological management in patients with glaucoma

PROPÓSITO DE LA REVISIÓN: Ante la necesidad de realizar una facoemulsificación, una cirugía filtrante o la combinación de ambas, pueden plantearse dudas sobre la conveniencia de mantener determinados fármacos antiglaucomatosos. El objetivo del presente trabajo es unificar criterios que puedan orientar la práctica clínica diaria y que permitan desarrollar algoritmos de actuación en el preoperatorio y el postoperatorio de la cirugía filtrante o de catarata. Protocolos propuestos. En el preoperatorio de la cirugía de catarata, el uso de antiinflamatorios no esteroideos queda a criterio del cirujano, recomendándose el formato de monodosis. Se plantea la suspensión de las prostaglandinas unos días antes de la cirugía. Los fármacos sin conservantes favorecen la mejor recuperación de la superficie ocular (SO) tras la cirugía de catarata. Una vez eliminados todos los aspectos modificadores de la presión intraocular (PIO), se debe reevaluar la PIO basal, prefiriendo los fármacos hipotensores sin conservantes, en caso de necesitarlos. La utilización de hipotensores oculares y corticoides libres de conservantes en el preoperatorio de la cirugía de glaucoma reduce el riesgo de fracaso quirúrgico. Se recomienda interrumpir las prostaglandinas. En el postoperatorio de la cirugía de glaucoma los corticoides constituyen el tratamiento antiinflamatorio de elección, siendo preferibles aquellos libres de conservantes. Al reintroducir un tratamiento antiglaucomatoso, se deben evitar los conservantes para no potenciar la cicatrización. CONCLUSIONES: el presente protocolo de consenso persigue la unificación de las pautas de actuación con el fin de disminuir la incidencia de acontecimientos adversos y maximizar el resultado quirúrgico

REVIEWS AIM: When a phacoemulsification, a filtration surgery or a combined surgery are necessary, questions about the convenience of continuing certain antiglaucomatous drugs could appear. The aim of this review article is to unify criteria that will guide daily clinical practice and including the developing algorithms of action in the preoperative and postoperative periods of filtration surgery and/or cataract surgery. Proposed protocols: In the preoperative period of cataract surgery, the use of non-steroidal anti-inflammatory drugs is at the discretion of the surgeon, with the monodose presentation being recommended. The suspension of prostaglandines a fewdays before the surgery should be considered. Preservative-free drugs ensure a better recovery of the ocular surface (OS) after cataract surgery. Once all modifying factors of the intraocular pressure (IOP) have been removed, baseline IOP should be evaluated again, choosing preservative-free antiglaucomatous drugs when needed. The use of preservative-free ocular antihypertensive drugs and steroids in the preoperative period of glaucoma surgery reduces the risk of surgical failure. The interruption of prostaglandines is recommended. In the postoperative period of glaucoma surgery, steroids are the anti-inflammatory treatment of choice, the preservative-free ones being preferred. When reintroducing antiglaucomatous treatment, preservatives should be avoided to prevent scarring. The appropriate perioperative management of patients with glaucoma is essential to obtain a correct control of IOP, improve the situation of the OS, prevent complications and improve the result of the filtration surgery and cataract surgery. CONCLUSIONS: this protocol aims to unify the different lines of action in order to decrease the incidence of adverse events and maximize the surgical outcome

Correlación de la relación excavación/papila óptica medida mediante HRT-III, SD-OCT y el dispositivo de colorimetría fotográfica Laguna OnhE / Correlating cup-to-disc ratios measured by HRT-III, SD-OCT and the new color imaging Laguna ON hE procedure

OBJETIVO: Estudiar la correlación existente entre la relación excavación/papila óptica (E/P) medida mediante el nuevo dispositivo de colorimetría fotográfica Laguna ONhE (Optic Nerve Hemoglobin), tomografía de coherencia óptica (OCT) de dominio espectral, tomografía retiniana con láser confocal (HRT) y valoración mediante retinografía. MÉTODOS: Un total de 154 ojos de 154 sujetos (52 controles, 36 hipertensos oculares y 66 con glaucoma primario de ángulo abierto) fueron estudiados de forma prospectiva determinándose el cociente E/P mediante Laguna ONhE, HRT-III (Heidelberg Engineering), OCT Spectralis (Heidelberg Engineering) y el análisis de fotografías de papilas por parte de un observador experto en glaucoma de forma enmascarada. RESULTADOS: Los coeficientes de correlación intraclase (CCI) globales fueron: 0,379 (IC 95%: 0,233-0,508) entre Laguna ONhE y HRT; 0,621 (IC 95%: 0,513-0,709) entre Laguna ONhE y OCT, y 0,558 (IC 95%: 0,398-0,678) entre Laguna ONhE y observador, siendo esta concordancia estadísticamente significativa en todos los casos. El mayor CCI se obtuvo entre OCT y observador: 0,715 (IC 95%: 0,605-0,795). CONCLUSIONES:La medida de E/P estimada por Laguna ONhE presenta buena correlación con la determinada por OCT y la valorada por un especialista en glaucoma. Las mejores correlaciones se encuentran entre OCT y experto. La concordancia fue buena entre Laguna ONhE, OCT y experto, siendo menor con HRT, que presenta una correlación menor con el resto de procedimientos

OBJECTIVE: To examine correlations between cup-to-disc (C/D) ratios determined by the new Laguna ONhE (optic nerve hemoglobin) color imaging procedure, spectral domain optical coherence tomography (OCT), confocal scanning laser tomography using Heidelberg retina tomography (HRT), and examining retinal images. METHODS: C/D ratio measurements were made on 154 eyes of 154 subjects (52 healthy controls, 36 with ocular hypertension and 66 with primary open-angle glaucoma) using the Laguna ONhE, HRT-III (Heidelberg Engineering) and OCT Spectralis (Heidelberg Engineering) instruments and photographs of the optic disc were examined by a blinded observer (experienced glaucoma specialist). RESULTS: Global intraclass correlation coefficients (ICC) were: 0.379 (95% CI: 0.233-0.508) for Laguna ONhE-HRT, 0.621 (95% CI: 0.513-0.709) for Laguna ONhE-OCT, and 0.558 (95% CI: 0.398-0.678) for the Laguna ONhE-observer, indicating significant agreement in each case (P<.001). The highest ICC was recorded for OCT- observer (0.715; 95% CI: 0.605-0.795). CONCLUSIONS: C/D ratios measured using the Laguna ONhE procedure correlated well with OCT measurements and retinography measurements made by an experienced observer. Best correlation was observed for OCT versus observer measurements. Agreement was good between the Laguna ONhE, OCT and observer measurements, and was somewhat lower between HRT and the remaining procedures

Study of the relationship between myopia and personality.

OBJECTIVE: To study the correlation between the myopic refractive error and certain personality traits, and to determine whether there is a correlation between the degree of myopia and an increased frequency in personality disorders. METHODS: Cross-sectional observational multicenter study conducted on 82 subjects (26 men, 56 women) age over 18 years with myopia (spherical defect ≤ -0.5 D), with 30 subjects having high myopia (<-6 D). DATA COLLECTED: age and gender, academic level, result in the Neo PI-R personality test, autorefractometry, myopic pathology, and ophthalmological treatment. RESULTS: Correlation (Spearman's) between the magnitude of the spherical defect and the 5 personality traits studied in the total sample was not statistically significant: neuroticism (-0.057; P=.610), extroversion (-0.020; P=.857), openness (-0.032; P=.774), kindness (-0.060; P=.592), and responsibility (-0.034; P=.765). By dividing them into subgroups of low and high significance (t-test), a significant (P=.002) upward trend of the myopic defect with increasing scores on extraversion was found. When comparing high myopic subjects to the non-high myopic ones, there were significant differences between the 2 groups in terms of the associated pathology (P=.001), received treatment (P=.001) and the level of studies (P=.013). There were no differences in the variables of personality: neuroticism (P=.852), extroversion (P=.199), openness (P=.560), kindness (P=.584), and responsibility (P=.722). CONCLUSIONS: A low correlation was found between myopia and personality. There was no difference in the degree of myopia between the groups with different education levels. Subjects with more severe ocular pathology associated with myopia had higher scores in neuroticism, without finding any significant association.

Perioperative pharmacological management in patients with glaucoma.

REVIEWS AIM: When a phacoemulsification, a filtration surgery or a combined surgery are necessary, questions about the convenience of continuing certain antiglaucomatous drugs could appear. The aim of this review article is to unify criteria that will guide daily clinical practice and including the developing algorithms of action in the preoperative and postoperative periods of filtration surgery and/or cataract surgery. PROPOSED PROTOCOLS: In the preoperative period of cataract surgery, the use of non-steroidal anti-inflammatory drugs is at the discretion of the surgeon, with the monodose presentation being recommended. The suspension of prostaglandines a fewdays before the surgery should be considered. Preservative-free drugs ensure a better recovery of the ocular surface (OS) after cataract surgery. Once all modifying factors of the intraocular pressure (IOP) have been removed, baseline IOP should be evaluated again, choosing preservative-free antiglaucomatous drugs when needed. The use of preservative-free ocular antihypertensive drugs and steroids in the preoperative period of glaucoma surgery reduces the risk of surgical failure. The interruption of prostaglandines is recommended. In the postoperative period of glaucoma surgery, steroids are the anti-inflammatory treatment of choice, the preservative-free ones being preferred. When reintroducing antiglaucomatous treatment, preservatives should be avoided to prevent scarring. The appropriate perioperative management of patients with glaucoma is essential to obtain a correct control of IOP, improve the situation of the OS, prevent complications and improve the result of the filtration surgery and cataract surgery. CONCLUSIONS: this protocol aims to unify the different lines of action in order to decrease the incidence of adverse events and maximize the surgical outcome.

[Correlating cup-to-disc ratios measured by HRT-III, SD-OCT and the new color imaging Laguna ONhE procedure]. / Correlación de la relación excavación/papila óptica medida mediante HRT-III, SD-OCT y el dispositivo de colorimetría fotográfica Laguna OnhE.

OBJECTIVE: To examine correlations between cup-to-disc (C/D) ratios determined by the new Laguna ONhE (optic nerve hemoglobin) color imaging procedure, spectral domain optical coherence tomography (OCT), confocal scanning laser tomography using Heidelberg retina tomography (HRT), and examining retinal images. METHODS: C/D ratio measurements were made on 154 eyes of 154 subjects (52 healthy controls, 36 with ocular hypertension and 66 with primary open-angle glaucoma) using the Laguna ONhE, HRT-III (Heidelberg Engineering) and OCT Spectralis (Heidelberg Engineering) instruments and photographs of the optic disc were examined by a blinded observer (experienced glaucoma specialist). RESULTS: Global intraclass correlation coefficients (ICC) were: 0.379 (95% CI: 0.233-0.508) for Laguna ONhE-HRT, 0.621 (95% CI: 0.513-0.709) for Laguna ONhE-OCT, and 0.558 (95% CI: 0.398-0.678) for the Laguna ONhE-observer, indicating significant agreement in each case (P<.001). The highest ICC was recorded for OCT- observer (0.715; 95% CI: 0.605-0.795). CONCLUSIONS: C/D ratios measured using the Laguna ONhE procedure correlated well with OCT measurements and retinography measurements made by an experienced observer. Best correlation was observed for OCT versus observer measurements. Agreement was good between the Laguna ONhE, OCT and observer measurements, and was somewhat lower between HRT and the remaining procedures.

Cambios refractivos post-keratomileusis láser in situ inducidos por hipertensión ocular aguda sin signos de ectasia corneal / Post-laser in situ keratomileusis refractive changes induced by glaucoma in the absence of keratectasia

CASO CLÍNICO: Se presenta el caso de un varón de 34 años de edad, con pérdida progresiva de visión en el ojo izquierdo, que fue diagnosticado de glaucoma pigmentario con una presión intraocular de 32 mmHg. Ocho años antes, el paciente había sido intervenido con cirugía refractiva (lasik). El tratamiento hipotensor condujo a cambios refractivos significativos acompañados de aplanamiento de la curvatura corneal. DISCUSIÓN: Proponemos que una elevada presión intraocular, actuando sobre una córnea previamente debilitada por la cirugía refractiva, puede producir alteraciones en la superficie corneal, induciendo cambios refractivos incluso en ausencia de ectasia corneal

CASE REPORT: We report the case of a 34 year-old man with progressive loss of visual acuity in his left eye, who was diagnosed with pigmentary glaucoma with an intraocular pressure of 32 mmHg. Eight years previously, the patient had undergone refractive surgery (LASIK). Hypotensive treatment led to a significant refractive change accompanied by flattening of the corneal curvature. DISCUSSION: We propose that a high intraocular pressure acting on a cornea weakened by refractive surgery can provoke corneal steepening, inducing refractive changes even in the absence of keratectasia

[Post-laser in situ keratomileusis refractive changes induced by glaucoma in the absence of keratectasia]. / Cambios refractivos post-keratomileusis láser in situ inducidos por hipertensión ocular aguda sin signos de ectasia corneal.

CASE REPORT: We report the case of a 34 year-old man with progressive loss of visual acuity in his left eye, who was diagnosed with pigmentary glaucoma with an intraocular pressure of 32mmHg. Eight years previously, the patient had undergone refractive surgery (LASIK). Hypotensive treatment led to a significant refractive change accompanied by flattening of the corneal curvature. DISCUSSION: We propose that a high intraocular pressure acting on a cornea weakened by refractive surgery can provoke corneal steepening, inducing refractive changes even in the absence of keratectasia.