Hydrophilic acrylic intraocular lens clouding: a clinicopathological review.

PURPOSE: An analysis is made of a serious late complication (opacification) of different models of hydrophilic acrylic intraocular lenses (IOLs). METHODS: Seven lenses were explanted from seven patients treated for cataracts with phacoemulsification and implantation of different types of hydrophilic acrylic IOLs (five SC60B-OUV from MDR, one Aquasense from OII, and one H60M Hydroview lens from Bausch & Lomb) who developed important vision impairment in the late postoperative period (1 to 3 years) due to lens opacification. The explanted lenses were subjected to exhaustive study involving photographic analysis, scanning electron microscopy, and energy dispersive X-ray spectroscopy. RESULTS: Light and scanning electron microscopy revealed diffuse, variable-size granular deposits within the optic of the SC60B-OUV lens, and on the anterior and posterior optic surfaces of the H60M Hydroview lens, though without affecting the haptics in any of the models. Dispersive energy X-ray spectroscopy of the deposits revealed the presence mainly of calcium and phosphorus salts. CONCLUSIONS: Hydrophilic acrylic IOL opacification is a serious late complication of unknown etiology. The condition is more frequent among diabetic patients, and the only management option is IOL explantation and replacement with a lens of some other material. More frequent and longer follow-up is required of those patients wearing lenses for which cases of opacification have been documented, particularly in the presence of predisposing factors (diabetes, uveitis). Caution is required with new lenses, avoiding their generalized use until they have successfully passed the test of time.

Ahmed valve for elevated intraocular pressure associated with black diaphragm lenses for aniridia.

PURPOSE: To evaluate the Ahmed valve for decrease elevated pressure associated with black diaphragm lenses for aniridia. METHODS: Drainage devices are useful to obtain good control of intraocular pressure in patients with aniridia and the authors often use them because of the poor results of medical therapy or filtering surgery. However, when the elevated intraocular pressure is associated with black diaphragm lenses for aniridia, most authors decide to carry out a filtering technique. The current authors opted for the implantation of an Ahmed valve in three patients, two with traumatic aniridia and the other with a congenital case. Every patient had a different kind of black diaphragm lens for aniridia. RESULTS: The Ahmed valve controlled the intraocular pressure in levels below 20 mmHg for a follow-up year with no complications derived from its application. CONCLUSIONS: Ahmed valve implantation was the best technique to decrease intraocular pressure in patients with aniridia. The authors have used it successfully for cases with elevated pressure associated with black diaphragm lenses for aniridia.

Effect of unilateral congenital cataract surgery on ocular axial length growth and corneal flattening.

OBJECTIVE: The aim of this article is to study the effect of unilateral congenital cataract surgery on ocular growth and corneal flattening. METHODS: This is a cross-sectional study of 59 patients operated on due to a unilateral congenital cataract. The median age of the patients at the time of diagnosis was 17 months (interquartile range, 5-39 months). The median age at cataract the time of surgery was 28 months (interquartile range, 8-52 months), and the mean follow-up between cataract surgery and assessments was 149.7±69.9 months (range, 30-319 months). Axial length and corneal curvature were measured in both operated and non-operated eyes, comparing the results between them. RESULTS: There were no statistically significant differences for axial length growth or corneal flattening between operated and non-operated eyes: axial length (P=.327, Student t test) and corneal curvature (P=.078, Student t test). A sub-analysis was performed using the visual acuity and the age of the patient at the time of surgery. The only statistically significant data (P=.007, Student t test) was a lower axial length in operated eyes compared to non-operated eyes, in the non-deep-amblyopia group. CONCLUSIONS: No significant axial length growth modifications were observed between operated and non-operated eyes. Only the non-deep-amblyopia group presented with a lower axial length in the operated eyes compared to non-operated eyes. No significant differences in corneal flattening were found between groups after unilateral congenital cataract surgery.

Metastatic anterior chamber non-Hodgkin lymphoma in a patient with acquired immunodeficiency syndrome.

PURPOSE: To alert ophthalmologists to the possibility of metastatic anterior chamber intraocular non-Hodgkin lymphoma in patients with acquired immunodeficiency syndrome (AIDS). METHODS: We examined a 19-year-old man with AIDS who had an anterior uveitis with pseudohypopyon and a history of 2 months of malaise. A specimen of the lesion was obtained with a 25-gauge needle for pathologic examination. RESULTS: Systemic exploration showed hepatomegaly. Abdominal computed tomography showed multiple lesions in the liver and spleen. Fine-needle aspiration disclosed a high-grade non-Hodgkin lymphoma. The result of a fine-needle aspiration obtained from a lesion in the anterior chamber was consistent with the same diagnosis. CONCLUSION: An anterior chamber pseudohypopyon with uveitis can be the manifesting sign of a systemic lymphoma in a patient with AIDS and requires a thorough systemic evaluation.

Central retinal artery occlusion as the initial sign of aortic valve papillary fibroelastoma.

PURPOSE: We describe a central retinal artery occlusion in a young man who was subsequently found to have an aortic valve papillary fibroelastoma. METHODS: Case report with clinical, echocardiographic, and histopathologic observations. RESULTS: The aortic valve papillary fibroelastoma was successfully treated with tumor resection. CONCLUSION: Appropriate investigations in young patients with central retinal artery occlusion should therefore be conducted, including transthoracic and transesophageal echocardiography, to diagnose and treat this tumor, because failure to diagnose this tumor may result in further embolic events, including stroke and sudden death.

[A case of loss of retinal myelinated nerve fibers in a chronic glaucoma]. / Desaparición de fibras nerviosas mielinizadas retinianas en una paciente con glaucoma crónico.

PURPOSE/METHOD: A female patient underwent retinographic control and presented a pattern of myelinated nerve fibers in both eyes. Two years later, patient underwent a second retinographic control showing 10/10 glaucomatous cupping in her right eye. This was associated to loss of myelinated nerve fibers. RESULTS/CONCLUSIONS: Etiology, characteristics, associations and other causes of loss of myelinated retinal nerve fibers in chronic glaucoma are reviewed. This is the second of two photograph documented cases where loss of myelinated nerve fibers is associated to an open angle primary glaucoma.

[Treatment of conjunctival intraepithelial neoplasia with topical mitomycin C 0.02%]. / Tratamiento de las neoplasias conjuntivales intraepiteliales con colirio de mitomicina C al 0,02%

PURPOSE: To evaluate the efficacy of topical mitomycin C (MMC) 0.02% in treating conjunctival intraepithelial neoplasia (CIN). METHODS: Three patients with CIN were treated with topical MMC 0.02%. Our follow-up period was twelve months (range 8-18 months). RESULTS: CIN was resolved in all three cases without modifying the normal corneal and conjunctival architecture. CONCLUSIONS: Topical MMC 0.02% four times daily during two weeks is a useful alternative tool for the surgical management of CIN.

[Assessment of intra-operative techniques to prevent visual axis opacification in congenital cataract surgery]. / Valoración de técnicas intraoperatorias para la prevención de la opacificación del eje visual en la cirugía de cataratas congénitas.

OBJECTIVE: To evaluate the effectiveness of various surgical procedures in the management of posterior capsule and anterior vitreous on the prevention of visual axis opacification. SUBJECTS, MATERIAL AND METHODS: We retrospectively reviewed 120 eyes operated for unilateral congenital cataracts, with a median age at the time of cataract surgery of 21 months (interquartile range, 6-52 months). The eyes were divided into 3 groups: group 1 (eyes with intact posterior capsule, n=39), group 2 (eyes with posterior continuous curvilinear capsulorhexis, n=38), group 3 (eyes with posterior continuous curvilinear capsulorhexis and anterior vitrectomy, n=43). RESULTS: To determine the effect of posterior continuous curvilinear capsulorhexis on visual axis opacification we compared group 2 with group 1 (chi-square Pearson test, P=.281), therefore in this study the implementation of the posterior continuous curvilinear capsulorhexis did not show any decreases in the incidence of visual axis opacification. To study the effect of posterior continuous curvilinear capsulorhexis associated anterior vitrectomy, we compared group 3 with group 1 (chi-square Pearson test, P=.014), demonstrating that the combination of both techniques (posterior continuous curvilinear capsulorhexis and anterior vitrectomy) decreases the incidence of visual axis opacification. CONCLUSION: Posterior continuous curvilinear capsulorhexis as a single technique did not show any decrease in the incidence of visual axis opacification. Posterior continuous curvilinear capsulorhexis together with anterior vitrectomy are required to prevent visual axis opacification and to decrease reoperation rate.

Latent ocular deviations in patients with advanced AIDS.

The purpose of this study is to determine horizontal latent ocular deviations in patients with advanced AIDS (CD4+ count <0.050 x 10(9)/l) and to compare with normal values by means of the von Graefe technique. Twenty patients aged between 17 and 44 years with AIDS and aged-matched control groups were submitted to study. The AC/A ratio was also measured in both groups using the Gradient test. The AIDS patients showed a horizontal latent deviation value of 0.28+/-1.07delta exo at near (40 cm.) and 2.12+/-1.37delta eso at distance (6 m). The AC/A ratio obtained was 2.03+/-0.65. Statistically significant differences were obtained in relation to aged-matched control group at near and at distance (p<0.01). The horizontal latent ocular deviation at near and at distance in advanced AIDS patients showed lower values than the expected. The AC/A relationship also was lower. The results obtained in this study indicate that AIDS patients suffer a divergence insufficiency, which could add to other visual complaints such as blurred vision, photophobia, nyctalopia and reading difficulty.

Tratamiento de las neoplasias conjuntivales intraepiteliales con colirio de mitomicina C al 0,02 por ciento / Treatment of conjunctival intraepithelial neoplasia with topical mitomycin C 0.02 por ciento

Objetivo: Evaluar la eficacia del colirio de mitomicina C (MMC) al 0,02 por ciento en el tratamiento de las neoplasias conjuntivales intraepitaliales (NCI). Material y métodos: Hemos tratado a tres pacientes con NCI con colirio de MMC al 0,02 por ciento cuatro veces al día durante dos semanas. Seguidos durante 12 meses de media (rango de 6 a 18 meses). Resultados: En los tres pacientes conseguimos la eliminación de la NCI sin modificar la arquitectura corneal y conjuntival. Conclusiones: El colirio de MMC al 0,02 por ciento cuatro veces al día durante dos semanas puede ser una alternativa válida al tratamiento quirúrgico de las NCI (AU)

Desaparición de fibras nerviosas mielinizadas retinianas en una paciente con glaucoma crónico / A case of loss of retinal myelinated nerve fibers in a chronic glaucoma

Objetivo/método: Presentamos el caso de una paciente con glaucoma crónico simple que fue sometida a un control retinográfico con el fin de documentar la existencia de fibras nerviosas retinianas mielinizadas peripapilares en ambos ojos. Al cabo de años, acudió de nuevo a nuestra consulta apreciándose una atrofia óptica glaucomatosa con excavación 10/10 en su ojo derecho, asociado a la desaparición de las fibras de mielina. Resultado/conclusiones: Revisamos la etiología, características y asociaciones de las fibras retinianas mielinizadas, así como otras causas asociadas a su desaparición. Aportamos las retinografías de la desaparición de estas fibras de mielina en nuestra paciente. Éste es el segundo caso documentado fotográficamente de la desaparición de fibras de mielina asociado a glaucoma primario de ángulo abierto (AU)

Metástasis coroídea de carcinoma papilar de tiroides: subtipo tall cell / Choroidal metastasis of papillary thyroid carcinoma: tall cell subtypes

Se presenta un caso de metástasis coroidea de un cáncer papilar de tiroides. La metástasis es el mecanismo más frecuente de la aparición de patología ocular maligna. Sin embargo el tumor primario más frecuente es el de la mama y del pulmón seguido por riñón, testículo, próstata e intestino. El cáncer de tiroides es raro y menos frecuente aún es que envíe metástasis a la coroides. El paciente presentaba además metástasis a huesos largos, tórax y cerebro. La lesión coroidea fue tratada con radioterapia con mal resultado