Glaucoma neovascular. A propósito de un caso / Neovascular glaucoma. A case report

Se presenta un paciente masculino de 60 años de edad, con antecedentes de padecer diabetes mellitus tipo II complicada con retinopatía diabética, así como glaucoma neovascular de tórpida evolución en el ojo izquierdo. Acude a consulta de glaucoma en el Centro Oftalmológico del Hospital Universitario Clínico- Quirúrgico «Arnaldo Milián Castro» de Villa Clara por presentar visión borrosa y molestias oculares en su ojo derecho. Al examen oftalmológico de dicho ojo se observa: disminución de la visión, sangramiento activo proveniente de vaso iridiano, edema corneal, rubeosis iridiana, hipertensión ocular y al fondo de ojo retinopatía diabética; se realizan complementarios hemáticos que muestran cifras de glicemia elevada (20 mmol/l). Se plantea el diagnóstico de glaucoma neovascular del ojo derecho en el curso de una diabetes mellitus tipo II descompensada. Se le indica tratamiento médico - quirúrgico y se logra una evolución favorable.

We present a 60-year-old male patient with a history of type II diabetes mellitus complicated by diabetic retinopathy, as well as neovascular glaucoma of torpid evolution in his left eye. He came to the glaucoma consultation in the Ophthalmological Center at "Arnaldo Milián Castro" Clinical and Surgical University Hospital in Villa Clara due to blurred vision and ocular discomfort in his right eye. Decreased vision, active bleeding from the iris vessel, corneal edema, iris rubeosis, ocular hypertension was observed in such eye at ophthalmological examination and diabetic retinopathy at eye fundus; blood tests were performed showing elevated glycemia figures (20 mmol /l). The diagnosis of neovascular glaucoma of the right eye is stated in the course of a decompensated type II diabetes mellitus. Medical and surgical treatment is indicated and a favourable evolution is achieved.

El efecto del uso prolongado y nocturno de las lentes de contacto en la córnea. A propósito de un caso de descompensación corneal y descenso del recuento endotelial / The effect of prolonged and nocturnal use of contact lenses on the cornea: About a case of corneal decompensation and decreased endothelial count

El edema corneal y la disminución del recuento de células endoteliales son complicaciones relacionadas con la hipoxia crónica de bajo grado, que experimentan los usuarios de lentes de contacto, principalmente debido al uso prolongado y nocturno. Este caso muestra el ejemplo de un paciente que presenta problemas de visión borrosa en ambos ojos, y a quien se le realizó un examen oftalmológico completo que incluyó fotografías, topografía corneal y conteo de células endoteliales. Posteriormente se revisa el metabolismo corneal, la etiopatogenia y las complicaciones derivadas del uso de lentes de contacto (AU)

Corneal edema and decreased endothelial cell count are complications related to chronic low-grade hypoxia experienced by contact lens wearers, primarily due to prolonged and overnight wear. This case shows the example of a patient who has blurred vision problems in both eyes and who underwent a complete ophthalmologic examination that included photographs, corneal topography and endothelial cell count. Subsequently, the corneal metabolism, the etiopathogenesis and the complications derived from the use of contact lenses are reviewed (AU)

The effect of prolonged and nocturnal use of contact lenses on the cornea: about a case of corneal decompensation and decreased endothelial count.

Corneal edema and decreased endothelial cell count are complications related to chronic low-grade hypoxia experienced by contact lens wearers, primarily due to prolonged and overnight wear. This case shows the example of a patient who has blurred vision problems in both eyes and who underwent a complete ophthalmologic examination that included photographs, corneal topography and endothelial cell count. Subsequently, the corneal metabolism, the etiopathogenesis and the complications derived from the use of contact lenses are reviewed.

Ocular toxicity after inadvertent overdose of intracameral cefuroxime during cataract surgery.

PURPOSE: To describe intracameral toxic effects of cefuroxime at a higher dose than recommended in cataract surgery. METHODS: Retrospective study of 8 eyes of 8 patients who inadvertently received 12.5 mg/0.1 ml of intracameral cefuroxime due to a dilution error, at the end of the cataract surgery. All patients underwent a strict ophthalmology follow-up for 6 months. RESULTS: All patients presented with a marked anterior segment inflammation with corneal oedema that resolved completely in all cases (between 5 days and 3 months). At 6 months of follow-up a statistically significant difference was found in the corneal endothelial cell density when compared with the fellow eye (P = .038), being <1000 cells/mm2 in 3 cases. Three patients (37.5%) showed early macular oedema, with subfoveal ellipsoid layer disruption in one case as a permanent sequel. One patient developed an optic neuropathy with associated afferent pupillary defect. CONCLUSIONS: Although 1 mg/0.1 ml of intracameral cefuroxime has been shown to reduce the incidence of endophthalmitis, its overdose can have potentially toxic eye effects in both anterior and posterior segments.

Toxicidad ocular tras sobredosificación accidental de cefuroxima intracameral en cirugía de catarata / Ocular toxicity after inadvertent overdose of intracameral cefuroxime during cataract surgery

Objetivo Describir los efectos de la inyección de cefuroxima intracameral a una dosis más alta de la recomendada en cirugía de catarata. Métodos Estudio retrospectivo de 8 ojos de 8 pacientes operados de catarata en un mismo día que recibieron 12,5mg/0,1ml de cefuroxima intracameral de forma inadvertida al finalizar la cirugía, por un error en la dilución. A todos los pacientes se les realizó un seguimiento oftalmológico estrecho durante 6 meses. Resultado Todos los pacientes presentaron una inflamación marcada del segmento anterior con edema corneal que se resolvió en todos los casos (entre 5 días y 3 meses). A los 6 meses de seguimiento se constató una diferencia significativa en el recuento endotelial corneal de dichos ojos al compararlo con el ojo contralateral (p=0,038), siendo<1000cels/mm2 en 3 casos. Tres pacientes (37,5%) presentaron un edema macular precoz, dejando como secuela permanente la disrupción de la capa elipsoidal a nivel subfoveal en uno de los casos. Uno de los pacientes desarrolló una neuropatía óptica con defecto pupilar aferente asociado. Conclusiones Aunque la inyección de cefuroxima en cámara anterior a dosis de 1mg/0,1ml ha demostrado disminuir la incidencia de endoftalmitis, su sobredosificación puede tener efectos oculares potencialmente perjudiciales tanto en el segmento anterior como en el posterior (AU)

Purpose To describe intracameral toxic effects of cefuroxime at a higher dose than recommended in cataract surgery. Methods Retrospective study of 8 eyes of 8 patients who inadvertently received 12.5mg/0.1ml of intracameral cefuroxime due to a dilution error, at the end of the cataract surgery. All patients underwent a strict ophthalmology follow-up for 6 months. Results All patients presented with a marked anterior segment inflammation with corneal oedema that resolved completely in all cases (between 5 days and 3 months). At 6 months of follow-up a statistically significant difference was found in the corneal endothelial cell density when compared with the fellow eye (P=.038), being<1000 cells/mm2 in 3 cases. Three patients (37.5%) showed early macular oedema, with subfoveal ellipsoid layer disruption in one case as a permanent sequel. One patient developed an optic neuropathy with associated afferent pupillary defect. Conclusions Although 1mg/0.1ml of intracameral cefuroxime has been shown to reduce the incidence of endophthalmitis, its overdose can have potentially toxic eye effects in both anterior and posterior segments (AU)

Ocular toxicity after inadvertent overdose of intracameral cefuroxime during cataract surgery. / Toxicidad ocular tras sobredosificación accidental de cefuroxima intracameral en cirugía de catarata.

PURPOSE: To describe intracameral toxic effects of cefuroxime at a higher dose than recommended in cataract surgery. METHODS: Retrospective study of 8 eyes of 8 patients who inadvertently received 12.5mg/0.1ml of intracameral cefuroxime due to a dilution error, at the end of the cataract surgery. All patients underwent a strict ophthalmology follow-up for 6 months. RESULTS: All patients presented with a marked anterior segment inflammation with corneal oedema that resolved completely in all cases (between 5 days and 3 months). At 6 months of follow-up a statistically significant difference was found in the corneal endothelial cell density when compared with the fellow eye (P=.038), being<1000 cells/mm2 in 3 cases. Three patients (37.5%) showed early macular oedema, with subfoveal ellipsoid layer disruption in one case as a permanent sequel. One patient developed an optic neuropathy with associated afferent pupillary defect. CONCLUSIONS: Although 1mg/0.1ml of intracameral cefuroxime has been shown to reduce the incidence of endophthalmitis, its overdose can have potentially toxic eye effects in both anterior and posterior segments.

Facoemulsificación y edema corneal en pacientes con córnea guttata / Phacoemulsification and corneal edema in cornea guttata patients

RESUMEN Objetivo: Relacionar la severidad del edema corneal posfacoemulsificación en pacientes con córnea guttata, sin riesgo o bajo riesgo de edema posquirúrgico según densidad celular, con la dureza del cristalino y los parámetros facodinámicos. Métodos: Se realizó un estudio descriptivo, prospectivo, de 42 pacientes con córnea guttata, sin riesgo o bajo riesgo de edema posquirúrgico según densidad celular, sometidos a facoemulsificación por el mismo cirujano en el Instituto Cubano de Oftalmología "Ramón Pando Ferrer", desde abril del año 2016 a abril de 2017. Se relacionó la severidad del edema corneal con la dureza del cristalino y los parámetros facodinámicos. Resultados: Predominaron los pacientes con 70 años o más (52,4 por ciento) y el sexo femenino (64,3 por ciento). A las 24 horas de operados, el edema corneal estuvo ausente en el 54,8 por ciento y se presentó leve (26,2 por ciento) o mínimo (19,0 por ciento). A los 7 días, el 71,4 por ciento tenía la córnea transparente. Fue más frecuente en la periferia y en la zona paracentral temporal (36,8 por ciento). Aquellos con dureza de cristalino NO2 NC2 no presentaron edema corneal. A los 7 días solo el 11,9 por ciento mantenía edema leve, asociado a cristalinos NO4 NC4 o superior. El edema corneal se presentó asociado al grupo en el que se usó un poder de ultrasonido entre 10 y 20 (36,0 por ciento). Conclusiones: La mayoría de los pacientes con córnea guttata, considerados sin riesgo o bajo riesgo de edema posquirúrgico según la densidad celular, no presentan edema posfacoemulsificación(AU)

ABSTRACT Objective: Determine the relationship between the severity of corneal edema in cornea guttata patients undergoing phacoemulsification considered to be at no risk or low risk for postsurgical edema in terms of cell density, and crystalline lens hardness and phacodynamic parameters. Methods: A descriptive prospective study was conducted of 42 cornea guttata patients considered to be at no risk or low risk for postsurgical edema in terms of cell density, who underwent phacoemulsification performed by the same surgeon at Ramón Pando Ferrer Cuban Institute of Ophthalmology from April 2016 to April 2017. Corneal edema severity was related to crystalline lens hardness and phacodynamic parameters. Results: A predominance was found of patients aged 70 years and over (52.4 percent) and the female sex (64.3 percent). Twenty-four hours after surgery corneal edema was not observed in 54.8 percent and where it was present it was either mild (26.2 percent) or minimum (19.0 percent). At 7 days 71.4 percent of the patients had a transparent cornea. It was more common on the periphery and in the temporal paracentral area (36.8 percent). Patients with NO2 NC2 crystalline lens hardness did not have corneal edema. At 7 days only 11.9 percent had mild edema associated to NO4 NC4 or higher crystalline lenses. Corneal edema was associated to the group in which an ultrasound power level between 10 and 20 (36.0 percent) was used. Conclusions: Most cornea guttata patients considered to be at no risk or low risk for postsurgical edema in terms of cell density do not develop postphacoemulsification edema(AU)

Actualización terapéutica de la queratopatía bullosa pseudoafáquica / Therapeutic update on pseudophakic bullous keratopathy

RESUMEN La queratopatía bullosa pseudoafáquica o edema corneal crónico pseudoafáquico del paciente operado por cataratas con implante de lente intraocular es un proceso en el que la córnea se edematiza y pierde su función óptica, con síntomas dolorosos e irritativos de lagrimeo, ojo rojo, probabilidad de inflamación y ulceración corneal por infección secundaria. Se observan en esta afección multicausal dos grupos de pacientes. En uno de ellos el daño estructural corneal y ocular ha sido excesivo y no existe expectativa de mejora visual. El otro grupo aún conserva la potencialidad de recuperación de la agudeza visual. En el intento de solucionar esta afección se han empleado diversos tratamientos con fundamentos diferentes y resultados acordes con el desarrollo técnico y científico en que fueron aplicados. Es propósito de esta actualización describir y adecuar las posibilidades que los oftalmólogos puedan aplicar como terapéutica en sus respectivos niveles de actuación(AU)

ABSTRACT Pseudophakic bullous keratopathy or chronic pseudophakic corneal edema in patients undergoing cataract surgery with intraocular lens implantation is a process in which the cornea edematizes and loses optical function, with painful and irritating lacrimation symptoms, red eye, probable inflammation and corneal ulceration due to secondary infection. Sufferers of this multicausal condition are divided into two groups: In one of them structural corneal and ocular damage has been extreme and no visual improvement is expected, whereas in the other visual acuity recovery is still possible. In an attempt to heal this condition various treatments have been used with different rationales and results according to the scientific and technological development of the setting where they were applied. The present update is aimed at describing and adjusting the possible therapies that ophthalmologists may use in their respective fields of activity(AU)

Fuchs' dystrophy associated with radial keratotomy: Lamellar or perforating keratoplasty? / Distrofia de Fuchs asociada a queratotomía radial: ¿queratoplastia penetrante o lamelar?

CASE REPORT: A 70 year-old male patient with a history of radial keratotomy suffering from Fuchs' dystrophy and a cataract. The patient received a two-step surgery: lens phacoemulsification and intraocular lens implant, followed by descemet stripping automated endothelial keratoplasty in both eyes, four months later. There were no complications apart from a recurrent cystoid macular oedema in both eyes. The best corrected visual acuity was 20/40 both eyes, and the patient was satisfied. DISCUSSION: Descemet stripping automated endothelial keratoplasty may be considered as an alternative to penetrating keratoplasty in the case of endothelial dysfunction and radial keratotomy in patients with no corneal ectasia or significant stromal opacity.

UUnilateral corneal edema caused by a hidden foreign body. / Edema corneal unilateral causado por un cuerpo extraño oculto.

CASE REPORT: A middle-aged adult male was referred to our institution due to unilateral corneal edema for a possible corneal transplant. At first, the patient denied a history of trauma. A small foreign body, which had been overlooked by the primary ophthalmologist, was detected by gonioscopy, embedded in the anterior chamber angle. It was successfully surgically removed and visual results were good. DISCUSSION: In any patient with unilateral unexplained corneal edema, it is necessary to rule out the presence of a foreign body in the anterior chamber.

El uso de válvulas de Ahmed en el tratamiento del glaucoma refractario en niños / Use of Ahmed valves in the treatment of refractory glaucoma in children

Objetivo: evaluar la efectividad del implante de la válvula de Ahmed (VA) en niños desde los 2 años de vida hasta los 16 años de edad, que presentaron glaucoma refractario al tratamiento quirúrgico convencional, atendidos en el Hospital Garrahan durante el periodo comprendido entre el 1 de enero de 2006 hasta el 30 de Junio de 2014. Resultados: Se incluyeron 16 ojos de 13 pacientes con un total de 17 VA colocadas. La presión intraocular (PIO) promedio de las tres últimas tomas antes de la colocación de la VA fue de 25,38 mm Hg con un rango de 19,33 mm Hg a 39,33 mm Hg. Todos estos pacientes se encontraban con tratamiento farmacológico tópico y nueve pacientes (69,2%) estaban medicados con acetazolamida vía oral. Trece ojos de 16 incluidos en este trabajo (81,25%) recibieron más de una cirugía filtrante previa. Los 3 ojos (18,75%) no operados previamente eran glaucomas secundarios a uveítis; se decidió colocar el dispositivo de drenaje de primera elección. Un solo ojo (6,25%) incluido en la presente serie requirió la colocación de una segunda VA. La PIO promedio al año de cirugía de la válvula fue de 13,36 mm Hg. y en los pacientes a los que se logró seguir por cinco años la PIO se mantuvo por debajo de 20 mm Hg. Ninguno de los pacientes a los que se les colocó válvula necesitó inhibidores de la anhidrasa carbónica por vía oral. Un 64,72% de los ojos a los que se les colocó VA no necesitó medicación para regular la PIO. Del 35,28% de los 17 ojos posquirúrgicos que debieron usar medicación tópica encontramos que un ojo (5,88%) requirió una droga, cuatro ojos (23,52%) demandaron el uso de dos drogas y un solo ojo (5,88%) necesitó tres drogas tópicas para mantener su PIO menor a 20 mm Hg. Las complicaciones posquirúrgicas tardías de la colocación de VA fueron en cuatro casos (23,5%) quistes conjuntivales perivalvulares, en uno (5,88%) hubo exposición del tubo que requirió su reposicionamiento, un caso (5,88%) presentó alteraciones de la motilidad ocular y otro (5,88%) desprendimiento de retina. Conclusión: La colocación de la VA es efectiva para el tratamiento del glaucoma infantil refractario porque se consiguió una disminución del 100% de la presión intraocular, con y sin medicación coadyuvante en los diversos controles de nuestro grupo de pacientes estudiados. El 64,7% de los pacientes no necesitó medicación tópica posterior a la cirugía y ninguno de ellos necesitó tratamiento con medicación sistémica para regular la PIO (AU)

Objective: To assess the effectiveness of Ahmed valve (AV) implantation in children between 2 and 16 years of age with glaucoma refractory to conventional surgical treatment seen at the Garrahan Hospital from January 1, 2006 to June 30, 2014. Results: 16 eyes of 13 patients were included of a total of 17 AV implanted. Mean intraocular pressure (IOP) of the last three taken before AV placement was 25.38 mm Hg with a range of 19.33 mm Hg to 39.33 mm Hg. All the patients were receiving topical drug treatment and nine (69.2%) received oral acetazolamide. Thirteen of 16 eyes included in the study (81.25%) underwent more than one previous filtration surgery. The three eyes (18.75%) that did not undergo surgery had glaucoma secondary to uveitis; a first-choice drainage device was placed. Only one eye (6.25%) included in this series required placement of a second AV. Mean IOP one year after implantation of the valve was 13.36 mm Hg and in those patients followed-up for five years IOP remained below 20 mm Hg. None of patients in whom an AV was implanted needed oral carbonic anhydrase inhibitors. Overall, 64.72% of the eyes with an AV implant did not need medication to regulate IOP. Postsurgically, of 35.28% of 17 eyes that needed topical medication, we found that one eye (5,88%) required one drug, four eyes (23.52%) needed two drugs, and only one eye (5.88%) needed three drugs to maintain IOP below 20 mm Hg. Late surgical complications of AV placement were perivalvular conjunctival cysts in four cases (23.5%), exposition of the tube that needed repositioning in one case (5.88%), alterations of ocular movements in one (5.88%), and retinal detachment in another (5.88%). Conclusion: AV implantation is effective in the treatment of refractory childhood glaucoma as it decreases IOP by 100% with or without coadjuvant medication in the follow-up of our patients. Of all patients, 64.7% did not need topical medication after surgery and none of the patients needed systemic medication to regulate IOP (AU)

Ictiosis congénita: manifestaciones oftalmológicas / Congenital ichthyosis: ophthalmological manifestations

Objetivos: Describir las manifestaciones oftalmológicas de la ictiosis congénita. Materiales y Métodos: Estudio retrospectivo de 8 pacientes con ictiosis lamelar congénita atendidos en el servicio de oftalmología del Hospital de Pediatría Prof. Dr. Juan P. Garrahan. Se analizaron: edad, sexo, posicionamiento de los párpados, la presencia de lagoftalmos, alteraciones de la superficie ocular y tratamientos tópicos y quirúrgicos instaurados para la patología ocular. Resultados: Se estudiaron 16 ojos de 8 pacientes, 7 de sexo masculino y 1 de sexo femenino. Cinco pacientes presentaron ictiosis lamelar clásica y 2 eritrodermia congénita ictiosiforme (EIC). La edad media de los pacientes fue de 30,6 meses (r= 15 días y 108 meses). Los hallazgos oftalmológicos observados fueron: queratitis y lagoftalmos en el 50% de los pacientes, ectropión en el 37,5% y absceso corneal en ambos ojos de 1 paciente. Todos los pacientes fueron tratados de primera instancia con lubricantes, 2 se trataron con eritromicina tópica ante la presencia de secreción y sólo 1 paciente requirió tratamiento con colirio fortificado y colocación de membrana amniótica. Conclusión: la ictiosis congénita produce alteraciones en los párpados y en la superficie corneal con alto riesgo de secuelas y pérdida visual. Los controles periódicos son indispensables para poder prevenir las lesiones y sus complicaciones (AU)

Aim: To describe the ophthalmological manifestations of congenital ichthyosis. Material and Methods: A retrospective study of eight patients with congenital lamellar ichthyosis was conducted at the Department of Ophthalmology of the Pediatric Hospital Prof. Dr. Juan P. Garrahan. Age, sex, eyelid position, presence of lagophthalmos, ocular surface alterations, as well as topical and surgical eye treatment were analyzed. Results: 16 eyes of 8 patients, 7 male and 1 female, were studied. Five patients had classical lamellar ichthyosis and two had congenital ichthyosiform erythroderma (CIE). Mean age of the patients was 30.6 months (r, 15 days to 108 months). Ophthalmological findings were: keratitis and lagophthalmos in 50% of patients, ectropion in 37.5%, and corneal abscess in both eyes in one patient. All patients were initialy treated with artificial tears, two were treated with topical erythromycin because of secretion, and only one patient needed treatment with fortified eye drops and placement of amniotic membrane. Conclusion: Congenital ichthyosis causes disorders of the eyelids and corneal damage with a high risk of sequelae and vision loss. Periodic controls are necessary to prevent the lesions and their complications (AU)

Overnight corneal swelling with high and low powered silicone hydrogel lenses.

PURPOSE: To compare central corneal swelling after eight hours of sleep in eyes wearing four different silicone hydrogel lenses with three different powers. METHODS: Twenty-nine neophyte subjects wore lotrafilcon A (Dk, 140), balafilcon A (Dk, 91), galyfilcon A (Dk, 60) and senofilcon A (Dk, 103) lenses in powers -3.00, -10.00 and +6.00 D on separate nights, in random order, and on one eye only. The contra-lateral eye (no lens) served as the control. Central corneal thickness was measured using a digital optical pachometer before lens insertion and immediately after lens removal on waking. RESULTS: For the +6.00 D and -10.00 D, lotrafilcon A induced the least swelling and galyfilcon A the most. The +6.00 D power, averaged across lens materials, induced significantly greater central swelling than the -10.00 and -3.00 D (Re-ANOVA, p<0.001), (7.7±2.9% vs. 6.8±2.8% and 6.5±2.5% respectively) but there was no difference between -10.00 and -3.00 D. Averaged for power, lotrafilcon A induced the least (6.2±2.8%) and galyfilcon A the most (7.6±3.0%) swelling at the center (Re-ANOVA, p<0.001). Central corneal swelling with +6.00 D was significantly greater than -10.00 D lens power despite similar levels of average lens transmissibility of these two lens powers. CONCLUSIONS: The differences in corneal swelling of the lens wearing eyes are consistent with the differences in oxygen transmission of the silicone hydrogel lenses. In silicone hydrogel lenses central corneal swelling is mainly driven by central lens oxygen transmissibility.

Edema corneal durante el uso diario de lentes de contacto blandos de alta y baja transmisibilidad / Corneal edema for daily wear of soft contact lenses of high and low transmissibility

Objetivo: determinar el comportamiento en el espesor corneal durante 30 días con lentes alta y baja transmisibilidad (Dk/t). Materiales y métodos: se estudiaron 26 ojos de 13 sujetos no usuarios de lentes de contacto, en el ojo derecho se adaptó un lente de alto Dk, lotrafilcon A y en el ojo izquierdo un lente de bajo Dk, vasurfilcon A, durante 30 días en uso diario. Antes de la adaptación se midió el espesor corneal con el Pentacam de Oculus, el examen se repitió durante el primer día a las 4 y 8 horas y posteriormente a los 3, 8, 15, 20, 25 y 30 días. En cada control se midió el espesor corneal después de 8 horas de uso. Se usó Anova, t de Student y el coeficiente de correlación de Pearson. Resultados: Durante el uso diario por 30 días con el lotrafilcon A se encontraron diferencias significativas (p<0,05) en el edema (0,76 ± 2,05 %) a los 8 días de uso. Con vasurfilcon A se presentó incremento a partir de las 4 horas de uso siendo estadísticamente significativo (p<0,05) el edema (1,27 ± 1,64) a los 3 días uso. anova demostró diferencias significativas (p<0,05) en el porcentaje de edema durante el mes de uso de cada tipo de lente pero no en la varianza intergrupos (p>0,05). Conclusión: Los lentes lotrafilcon A y vasurfilcon A en uso diario no indujeron cambios significativos en el espesor corneal, con edemas inferiores al 2 %.

Objective: To determine the behavior in corneal thickness during 30 days using high and low lens transmissibility (Dk/t). Materials and methods: 26 eyes of 13 non contact lens wearers were studied. On the right eye, a high Dk lens was adapted, lotrafilcon A and in the left eye a low Dk lens, vasurfilcon A, for 30 days in daily use. Before adaptation, the corneal thickness was measured with the Oculus Pentacam, the test was repeated on the first day within 4 and 8 hours and then within 3, 8, 15, 20, 25 and 30 days. In each control, the corneal thickness was measured after 6 hours of use. The Anova test was used, as well as the Student’s t test and the Pearson correlation coefficient. Results: During daily use for 30 days with lotrafilcon A, significant differences (p<0.05) in edema (0.76 ± 2.05 %) were found within 8 days of use. With vasurfilcon A, increment occurred after 4 hours of use, being statistically significant (p<0.05), edema (1.27 ± 1.64) within 3 days of use. anova showed significant differences ( <0.05) in the percentage of edema during the month of use of each type of lens, but not in the intergroup variance (p>0.05). Conclusion: The lotrafilcon A and vasurfilcon A lenses in daily use did not induce significant changes in corneal thickness,with edemas lower than 2 %.

Resultados de la aplicación de queratectomía fototerapéutica en adultos mayores con queratopatía bullosa / Results of the application of phototherapeutic keratectomy in the elderly with Bullous Keratopathy

Fundamento: en muchos países se han realizado estudios sobre los beneficios de la queratectomía fototerapéutica en las afecciones corneales; se han encontrado escasas referencias en nuestro país que aborden los resultados de la aplicación del láser de excímeros en los adultos mayores aquejados de queratopatía bullosa.Objetivo: valorar los resultados de la aplicación de la queratectomía fototerapéutica en adultos mayores con queratopatía bullosa.Métodos: estudio de serie de casos realizado durante el año 2009, en el Departamento de Córnea del Hospital General Universitario Dr. Gustavo Aldereguía Lima de Cienfuegos, que incluyó 16 adultos mayores con queratopatía bullosa no tributaria a queratoplastia penetrante. Después de tener en cuenta los principios éticos y una evaluación biomédica, se les realizó la queratectomía fototerapéutica. Se indicó tratamiento y se llevó a cabo el seguimiento con una valoración de síntomas y signos hasta el tercer mes.Resultados: en el posoperatorio la sintomatología disminuyó y el signo más frecuente fue el haze (38 por ciento) seguido de las alteraciones visuales (25 por ciento) y del leve incremento en la agudeza visual mejor corregida.Conclusiones: la aplicación de queratectomía fototerapéutica en pacientes no tributarios a trasplante de córnea contribuye a mejorar el estado ocular, disminuye los síntomas y mejora la agudeza visual(AU)

Background: Many countries have conducted studies on the benefits of phototherapeutic keratectomy in corneal diseases; few references have been found in our country to address the results of the application of the excimer laser in the elderly suffering from bullous keratopathy.Objective: To assess the results of the application of phototherapeutic keratectomy in the eldrly with bullous keratopathy. Methods: A case series study was conducted in 2009, in the Cornea Department of the Dr. Gustavo Aldereguía Lima General University Hospital of Cienfuegos. It included 16 elderly with bullous keratopathy not leading to penetrating keratoplasty. After considering the ethical and biomedical assessment, phototherapeutic keratectomy was performed. Treatment was indicated and follow up was performed with an assessment of symptoms and signs until the third month.Results: In the postoperative stage symptoms decreased and the most frequent sign was the haze followed by slight increase in best corrected visual acuity. Conclusions: The application of phototherapeutic keratectomy in patients that did not apply for cornea transplant helps improving eye condition, reduces symptoms and improves visual acuity(AU)