Efectividad del consejo médico para dejar de fumar en pacientes con orbitopatía de Graves / Effectiveness of oral counselling for smoke cessation in Graves orbitopathy patients

Objetivo: El tabaco es un factor de riesgo en la orbitopatía de Graves (GO) y es modificable. El consejo médico para dejar de fumar se ha incluido en todas las guías de práctica clínica de esta enfermedad, aunque su efectividad no ha sido evaluada. El objetivo de este estudio es conocer el cambio producido en el hábito tabáquico en pacientes con GO tras una recomendación verbal para dejar de fumar. Material y métodos: Se estudió una cohorte retrospectiva de pacientes con GO. Todos los pacientes recibieron consejo médico sobre la importancia de dejar de fumar en la primera consulta del oftalmólogo. Entre 2013 y 2014 se atendió a 33 pacientes en la consulta, que fueron preguntados sobre el cambio en su hábito tabáquico en 2015. La variable principal de estudio fue el número de cigarros fumados al día antes y después de las consultas en endocrinología y oftalmología. Aparte, se recogieron otros datos personales médicos y socioeconómicos. Resultados: El número medio de cigarros fumados fue de 13,6 (DE 9,66) y 6,3 (DE 7,73) antes y después de la primera consulta en oftalmología, respectivamente (test t pareado, p < 0,05). El 42,42% de los pacientes dejó de fumar y el 30,3% disminuyó el consumo de cigarrillos. Los pacientes que consiguieron dejar de fumar presentaban con mayor frecuencia formas de enfermedad de Graves activas y graves, tenían trabajos estables y estaban apoyados por sus familiares y amigos. Conclusión: Un consejo fuerte y firme recomendando dejar de fumar es efectivo en pacientes con GO. Esta enfermedad afecta seriamente la calidad de vida de los pacientes, lo que hace que sean más susceptibles de cambiar a la hora de modificar sus hábitos

Objective: Smoking is an important risk factor for Graves orbitopathy (GO) and it is modifiable. The advice to stop smoking has been included in all the clinical practice guidelines of GO. However, the effectiveness of this practice remains unknown. The purpose of this study is to assess the change in the smoking habit in patients affected with GO after an oral counselling for smoking cessation. Material and methods: A retrospective cohort of GO patients was studied. The patients received a significant oral counsel during the first consultation with the ophthalmologist. 33 GO patients were explored in the ophthalmology clinic during 2013 and 2014 and the study was done throughout a telephone questionnaire in 2015. The main outcome was the number of cigarettes smoked daily before and after consultation with the endocrinologist and the ophthalmologist. Other medical and socioeconomic factors were recorded. Results: The mean number of cigarettes that were smoked was 13.6 (SD 9.66) and 6.3 (SD 7.73) before and after the consultation done at the ophthalmology office (T-test paired, P = 0.0006). 42.42% achieved smoking cessation and 30.3% decreased their smoking habit. Patients who stopped smoking suffered usually from active and severe GO, had more stable jobs and received greater support from their relatives and friends. Conclusion: A firm and strong oral counsel held for smoke cessation was effective in GO patients. This disease deeply affects patients’ quality of life, making them more prone to change their habits

Effectiveness of oral counselling for smoke cessation in Graves orbitopathy patients. / Efectividad del consejo médico para dejar de fumar en pacientes con orbitopatía de Graves.

OBJECTIVE: Smoking is an important risk factor for Graves orbitopathy (GO) and it is modifiable. The advice to stop smoking has been included in all the clinical practice guidelines of GO. However, the effectiveness of this practice remains unknown. The purpose of this study is to assess the change in the smoking habit in patients affected with GO after an oral counselling for smoking cessation. MATERIAL AND METHODS: A retrospective cohort of GO patients was studied. The patients received a significant oral counsel during the first consultation with the ophthalmologist. 33 GO patients were explored in the ophthalmology clinic during 2013 and 2014 and the study was done throughout a telephone questionnaire in 2015. The main outcome was the number of cigarettes smoked daily before and after consultation with the endocrinologist and the ophthalmologist. Other medical and socioeconomic factors were recorded. RESULTS: The mean number of cigarettes that were smoked was 13.6 (SD 9.66) and 6.3 (SD 7.73) before and after the consultation done at the ophthalmology office (T-test paired, P=0.0006). 42.42% achieved smoking cessation and 30.3% decreased their smoking habit. Patients who stopped smoking suffered usually from active and severe GO, had more stable jobs and received greater support from their relatives and friends. CONCLUSION: A firm and strong oral counsel held for smoke cessation was effective in GO patients. This disease deeply affects patients' quality of life, making them more prone to change their habits.

Carcinoma sebáceo simulando un chalazión en paciente joven / Sebaceous carcinoma mimicking a chalazion in a young patient

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¿Es el sistema tiempos quirúrgicos estándar (TQE) aplicable a la oftalmología actual del sistema sanitario público? / Is the standard operating times system applicable to ophthalmology in the public health system?

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¿Esperamos lo suficiente? / Do we expect enough?

No disponible

Inferior sclerotomies without subretinal fluid drainage for exudative retinal detachment in diffuse retinal pigment epitheliopathy.

PURPOSE: To evaluate the efficacy of inferior sutureless sclerotomies without subretinal fluid drainage for the treatment of bullous exudative retinal detachment secondary to diffuse retinal pigment epitheliopathy. METHODS: A retrospective interventional case series of eyes treated with two inferior postequatorial full-thickness sclerotomies without subretinal fluid drainage. Patients were placed in an upright position 24 hours after surgery. Main outcomes were visual acuity and retinal reattachment rate. RESULTS: Three eyes with recent diagnoses of diffuse retinal pigment epitheliopathy and bullous inferior retinal detachment were included in the study. In all cases, a very thick sclera was evident during surgery. The day after surgery the retina was completely attached in the three eyes. Preoperative visual acuity was light perception, 20/200, and counting fingers. After surgery, visual acuity improved to 20/200, 20/70, and 20/50, respectively. No intra- or postoperative complications occurred. CONCLUSIONS: The performance of inferior sutureless sclerotomies without a draining procedure in cases of diffuse retinal pigment epitheliopathy with inferior bullous retinal detachment is a simple and effective technique. It achieves retinal reattachment the day after surgery, allowing laser photocoagulation of the leaking lesions disclosed in fluorescein angiography.

Cup-to-disc ratio: agreement between slit-lamp indirect ophthalmoscopic estimation and stratus optical coherence tomography measurement.

PURPOSE: To determine agreement between slit-lamp indirect ophthalmoscopy and Stratus optical coherence tomography (OCT) when assessing cup-to-disc ratios (CDRs). METHODS: Twenty-five ocular hypertensive subjects and 56 patients with primary open-angle glaucoma were included. Estimation of vertical (VCDR) and horizontal (HCDR) cup-to-disc ratio with slit-lamp ophthalmoscopy was made by three glaucoma specialists along with OCT scanning of optic nerve head. Agreement between OCT and specialists was measured by intraclass correlation coefficients (ICC), Bland and Altman's scatterplots, and a regression coefficient of the average difference. RESULTS: The mean VCDR and HCDR was significantly higher (P<0.001) with OCT than that estimated by the specialists, with the difference ranging from 0.08 to 0.11, and from 0.13 to 0.18, respectively, depending on the specialist. Difference was higher (P<0.001) for cuppings below 0.3, and looses significance for larger VCDR cuppings (above 0.7). ICC for VCDR was 0.87 among specialists, and ranges from 0.82 to 0.75 when comparing OCT and specialists. ICC for HCDR was 0.83 among specialists and 0.74 between OCT and specialists. When data were plotted according to the Bland-Altman method, as the cupping increased, the agreement also increased. CONCLUSIONS: There is very good agreement among the specialists when estimating CDRs by stereoscopic slit-lamp biomicroscopy. OCT shows higher values than the specialists; the greatest differences occurred when assessing small CDRs and the differences diminished as the cupping increased. These two methods of measurement are not interchangeable, and the difference must be considered, especially in discs with smaller CDRs.

[Double scleral covering evisceration]. / Evisceración con doble cobertura escleral.

PURPOSE: To describe a surgical technique for evisceration that allows the use of large size implants, reducing risk of exposure. MATERIAL AND METHODS: We analize the results of 22 eviscerations with Medpor implants with double scleral covering. RESULTS: We managed to use implants of 20 and 22 mm, sometimes in very small anophthalmic cavities, without complications. CONCLUSIONS: Double scleral covering evisceration is a surgical technique that allows the use of large size implants, reducing the risk of exposure.

Evisceración con doble cobertura escleral / Double scleral covering evisceration

Objetivos: Describir una técnica quirúrgica de evisceración que permitiendo colocar implantes de gran tamaño, disminuye el riesgo de exposición de los mismos. Método: Se valora el resultado de 22 evisceraciones en las que se ha colocado un implante de MEDPOR con doble cobertura escleral. Resultados: Se ha podido colocar implantes de 20 y 22 mm de diámetro en algunos ojos con cavidades esclerales muy pequeñas sin ninguna complicación. Conclusión: La evisceración con doble cobertura escleral, es una técnica quirúrgica que nos permite colocar implantes biointegrables del tamaño deseado, independientemente de la cavidad escleral de que dispongamos, y disminuye las posibilidades de exposición del mismo. (AU)