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Objective: To evaluate the changes over two years in the retinal nerve fibre layer (RNFL) of patients with multiple sclerosis (MS). To compare the ability of optical coherence tomography (OCT), scanning laser polarimetry (GDx), visual evoked potentials (VEP) and visual field examination to detect axonal loss in these patients., Material and Methods: Fifty eyes of MS patients without episodes or optic neuritis during follow-up were enrolled in this study. All patients underwent a complete ophthalmic examination that included visual acuity (VA), colour vision, refractive evaluation, visual field examination, OCT, GDx and VEP. All the patients were re-evaluated over a period of 12 and 24 months. Correlations between parameters were analysed by Pearson's test., Results: There were changes in the RNFL thickness in MS patients with a 12 and 24-month follow-up. Differences between baseline and 2-year evaluation were statistically significant (p ≤ 0.05, t test) in the mean, superior and inferior RNFL thickness and macular volume provided by OCT, while no significant differences were found using functional parameters (VA, colour vision, visual field and VEP) and GDx. The greater differences were obtained in the inferior RNFL thickness (113.67 frente a 105.39 μm, p < 0.001). Correlations were observed between structural parameters using GDx and TCO., Conclusions: Progressive axonal loss can be detected in the optic nerve of MS patients. Measurements provided by TCO are useful tools to evaluate structural abnormalities in the RNFL and changes in macular volume, however these changes were not detected using functional tests or GDx., (Copyright © 2010 Sociedad Española de Oftalmología. Publicado por Elsevier España. Published by Elsevier Espana.. All rights reserved.)

Purpose: To determine the relationship between the structural parameters of the retinal nerve fiber layer (RNFL) obtained by using the scanning laser polarimetry with variable corneal compensation (GDx VCC) and the results of standard automated perimetry (SAP), in normal, ocular hypertensive, preperimetric glaucomas and glaucoma subjects., Methods: A total of 423 eyes of 423 consecutive subjects were prospectively included in the study and classified depending on the basal intraocular pressure, optic nerve head appearance and SAP results into four groups: 87 normal eyes, 192 ocular hypertensive eyes, 70 preperimetric glaucomas and 74 glaucomatous eyes. Pearson's correlation coefficients, between mean deviation (MD), pattern standard deviation, number of points altered in each quadrant, and number of points altered at different probability levels of SAP and structural parameters of RNFL obtained by using GDx VCC, were calculated in the different diagnostic groups. In the glaucoma group correlations between the 52 points tested by 24- 2 SITA standard and GDx parameters were also calculated. Regression curves were plotted for the strongest correlations., Results: Weak or non-significant correlations were found in the normal, ocular hypertensive and preperimetric glaucoma groups. However, the glaucoma group presented weak to moderate correlations between several GDx VCC parameters and the SAP variables analysed. The strongest correlation was observed between the standard deviation TSNIT and the MD (0.460)., Conclusions: RNFL parameters measured with the GDx VCC presented weak to moderate correlations with the visual field indices and the number of altered points in the glaucoma group.

Purpose: To determine the correlations between optic nerve head (ONH) parameters measured with the Heidelberg Retina Tomograph (HRT), and the main outcomes of standard automated perimetry (SAP) in normal, ocular hypertensive, glaucoma suspects and glaucomatous subjects., Methods: Four hundred and twenty-three patients were enrolled in the study and classified into four groups depending on baseline intraocular pressure, optic nerve head morphology, and SAP results: 87 normal eyes, 192 ocular hypertensive eyes, 70 glaucoma suspects and 74 glaucomatous eyes. In the different diagnostic groups, Pearson's correlation coefficients were calculated between ONH parameters and mean deviation, pattern standard deviation (PSD), number of altered points in each quadrant of the visual field (superior-nasal, inferior-nasal, superior-temporal and inferior-temporal), number of points altered at different probability levels, and threshold values at each point of SAP., Results: In the normal and ocular hypertensive groups, only a few weak correlations were found between HRT and SAP parameters. The strength and number of significant correlations increased in the suspected glaucoma group. The glaucoma group had the strongest correlations, particularly between cup/disc ratio and rim/disc ratio with MD (r=0.479) and between rim area and PSD (r=0.444)., Conclusions: Weak to moderate correlations were found between some ONH parameters obtained with the HRT and SAP results in the glaucoma group.

Objective: To evaluate the efficacy of intravitreal Ranibizumab as treatment for choroidal neovascularisation due to pathological myopia., Materials and Methods: A retrospective, non-comparative study of 18 eyes treated with intravitreal injections of Ranibizumab. Ten eyes had been treated previously with photodynamic therapy and eight received Ranibizumab as first therapy. After thorough ophthalmologic examination, fluorescein angiography (FAG) and optical coherence tomography (OCT), intraocular injection of Ranibizumab was performed. In subsequent monthly follow ups and taking into account visual acuity, presence or absence of metamorphopsia, biomicroscopy and OCT examination, further treatment was decided., Results: Eighteen eyes from 16 patients were finally included. Patients were followed up for a minimum of 6 months. The mean age at initial treatment was 56.4 years. Mean refractive error was -13.3 diopters. Regarding FAG, all neovascular membranes were classical and sub or juxtafoveal localised. At the end of the sixth month after treatment fourteen eyes (77.7%) showed better visual acuity ranging from one or more lines on the Snellen chart, eleven eyes (61.1%) improved two lines or more, three eyes (16.6%) did not show any change and one eye (5.5%) worsened by one line. At 6 months the mean best-corrected visual acuity improved from 0.25 to 0.46 (p= 0.001). The mean central macular thickness decreased from 344.9 to 212.6 (p=0.015)., Conclusions: Ranibizumab may be a good therapeutic option as treatment for choroidal neovascularisation due to pathological myopia; it improved visual acuity and anatomical features, even in non-responders to photodynamic therapy (Arch Soc Esp Oftalmol 2009; 84: 507-514).

Objectives: To evaluate long-term intraocular pressure results after trabeculectomy in low risk patients. Therefore differences among glaucoma type and previous medical treatment will be evaluated., Methods: A retrospective follow-up study, ranging between 3 and 20 years, was carried out on 965 trabeculectomy surgeries without any surgical- failure factor. Follow-up was carried-out one day, one week, one month, three months, six months and annually after surgery until the last visit. Primary open angle (POAG) (671 eyes), pseudoexfoliative (PSXG) (156 eyes) and chronic closure angle glaucomas (CCAG) (138 eyes) were included. IOP under 21 Hg mm without medical treatment was considered absolute success, relative success included those eyes with pressures under 21 and one or two daily antiglaucomatous drops., Results: Mean IOP ranged between 15 and 17 Hg mm. Mean IOP decreased from 30.7 to 37.4%. Relative success ten years after surgery was better in POAG; whereas absolute success resulted to be similar in POAG and PSXG. The group of patients less treated before surgery showed greater rate of absolute and relative success., Conclusions: Trabeculectomy alone is an efficient technique in long-term tensional control for uncomplicated eyes. The group of patients less treated before surgery and POAG showed greater rate success.

Case Reports: We present four cases: two males with Horner Syndrome, who were diagnosed by means of apraclonidine 0.5% and cocaine 4% tests respectively. Two children with anisocoria, one of whom had Horner Syndrome confirmed with apraclonidine 1% and the other, in whom an apraclonidine test ruled out this syndrome but in whom pilocarpine 0.125% confirmed Adie's pupil., Discussion: Apraclonidine drops (1% and 0.5%) may aid in the diagnosis of Horner Syndrome and are easier to obtain than cocaine.

Purpose: To study refractive errors in children with relatively serious congenital myogenic ptosis and to carry out a comparative study in relation to control children in our population., Methods: We included 35 children with simple congenital myogenic ptosis, 27 of them had minor ptosis, 3 moderate ptosis and 5 serious ptosis. Thirty-five children were also in the control group. One eye of every subject was included, the worst eye in subjects of the ptosis group and an eye selected at random in control group subjects. A comparative study of refractive data in every group was carried out, using the Student's t-test, ANOVA and Chi square or Yates correction tests., Results: We obtained significant differences between children with ptosis and controls in average spherical equivalent (3.08/1.49), in average absolute sphere (2.80/1.42) and in average absolute cylinder (0.81/0.31) (p<0.05). We also observed a relation between the presence of astigmatism and the seriousness of ptosis (chi2=6.88>5.99), and between the need for optical correction and the presence of ptosis (chi2=15.92>3.84)., Conclusions: Children with simple congenital myogenic ptosis in our enviroment have greater refractive errors than control children. Ptosis children require optical correction more frequently than control. The more serious the ptosis, the more likelihood there is of having astigmatism.

Purpose: To compare the optic nerve parameters measured by confocal scanning laser in normal, ocular hypertensive and glaucomatous eyes; and in groups of ocular hypertensive eyes, classification of these according to the optic nerve appearance and to short-wavelength automated perimetry (SWAP) results., Methods: 101 eyes of 101 normal subjects, 247 eyes of 247 ocular hypertensive subjects and 102 eyes of 102 glaucomatous subjects were studied. Subjects were classified based on intraocular pressure and standard automated perimetry (AP) performance. Hypertensive subjects were classified into ocular hypertensive and preperimetric glaucoma, and into ocular hypertensive with normal SWAP and hypertensive with pathological SWAP findings. Every patient underwent evaluation of the optic nerve, AP, SWAP and confocal scanning laser ophthalmoscopy (HRT II), resulting in the acquisition of topographic parameters of the optic nerve, which were then compared between the different groups., Results: Significant differences (p<0.05) were found between normal subjects and glaucomatous eyes in all optic nerve parameters except disc area (2.23/2.1), height variation contour (0.41/0.39) and average variability (0.05/0.04). Ocular hypertensive eyes showed an overlap when compared with normal and glaucoma groups. No differences were found between normal subjects and those with ocular hypertension in mean retinal nerve fiber layer thickness (0.24/0.24) or between those with ocular hypertension and glaucoma in mean cup depth (0.28/0.3). Nevertheless, when those with ocular hypertension were segregated based on clinical evaluation of optic nerve or SWAP performance, the ability to define the presence of structural glaucoma damage improved significantly., Conclusions: HRT enables moderate discrimination between normal, ocular hypertensive and glaucoma subjects. The use of diagnostic tests to detect early glaucomatous damage (such as short-wavelength automated perimetry) in ocular hypertensive eyes improves the ability of HRT to discriminate glaucoma.

Purpose: To assess the diagnostic ability of scanning laser polarimetry (GDx VCC) to differentiate between normal and glaucomatous eyes., Methods: 417 eyes of 417 consecutive subjects were prospectively selected. They were classified into 60 healthy controls, 218 ocular hypertensive eyes, 68 glaucoma suspects, and 71 glaucomatous eyes, depending on intraocular pressure, optic nerve head morphology and standard automated perimetry results. All underwent a scanning laser polarimetry with the GDx VCC. Retinal nerve fiber layer (RNFL) parameters of the GDx-VCC were compared among the four groups. Receiver operating characteristic (ROC) curves were plotted between normal and glaucomatous eyes. The best parameters were defined according to the area under the ROC curve and the best sensitivity/specificity balance., Results: Most parameters of GDx-VCC exhibited differences between the glaucoma group and the rest of the groups. Some parameters were also different between healthy patients and glaucoma suspects. The best parameter was the nerve fiber indicator (NFI; area under the ROC curve: 0.876). NFI, superior normalized area, and inferior normalized area yielded the highest sensitivities at 85% and 90% fixed specificity., Conclusions: Most RNFL parameters measured with the GDx-VCC provided good diagnostic ability for open-angle glaucoma. The best GDx-VCC parameter in differentiating between normal and glaucomatous eyes was the NFI.

Purpose: To assess the diagnostic usefulness of four linear discriminant functions for Heidelberg retina tomograph (HRT) II obtained in our population., Methods: 450 eyes of 450 patients were studied. Eyes were classified as those of healthy subjects (101), those with ocular hypertension (126), those suspected to have glaucoma (121) or those with glaucoma (103). Intraocular pressure, optic nerve head appearance in stereophotographs, and standard automated perimetry results were assessed. ANOVAs among the groups were calculated for all global parameters and the 4 formulas. Receiver operating characteristic (ROC) curves were plotted for the 4 multivariate functions designed in our hospital and the areas under the ROC curves were compared. Sensitivity at 80% and 90% fixed specificities were also calculated., Results: All functions discriminated well between healthy and glaucoma suspects, and between healthy and glaucomatous eyes. At 90% fixed specificity, sensitivities ranged from 54% to 60% in differentiating between healthy and glaucoma suspects, and from 65% to 68% in discriminating between control and glaucoma subjects. No differences were found between the areas under the ROC curves of these functions., Conclusions: The evaluated linear discriminant functions increased the diagnostic ability of HRT II isolated parameters in detecting glaucoma. These functions performed better than the HRT-provided discriminant functions.

Purpose: To compare the central corneal thickness, measured with an ultrasound pachymeter, in normal subjects, those with ocular hypertension, glaucoma suspects and patients with preperimetric glaucoma., Methods: 61 normal eyes (control group), 131 eyes with ocular hypertension, 62 glaucoma suspects (optic nerve head morphology compatible with glaucoma) and 36 patients with preperimetric glaucoma (abnormal short-wavelength automated perimetry) were prospectively and consecutively selected. Scatter plots of central corneal thickness, against the intraocular pressure values were calculated for each of the study groups. Ultrasound pachymetry measurements were compared between those with normal eyes and the other groups., Results: Ocular hypertensive subjects had higher pachymetry values than the control group (p=0.009). No differences were found in the central corneal thickness between normal eyes and those who were glaucoma suspects, and between normal and preperimetric glaucomatous eyes. A mild direct logarithmic correlation was evident between central corneal thickness and the Goldmann tonometry result in the ocular hypertensive group., Conclusions: Ocular hypertensive subjects had thicker corneas than the other groups studied. Glaucoma suspects and preperimetric glaucoma patients had similar corneal thickness to the control group.

Purpose: To correlate the optic nerve head topographic parameters measured by the Heidelberg Retina Tomograph II (HRT) with the perimetric indices of standard automated perimetry (SAP)., Methods: This study included 101 normal subjects, 247 ocular hypertensive eyes (increased intraocular pressure with normal SAP) and 102 glaucomatous subjects (IOP above 21 mm Hg and abnormal standard automated perimetry). Only one eye was randomly chosen from each subject for the study. The visual field was evaluated by means of Humphrey Field Analyzer (24-2 full threshold strategy). The HRT II (Heidelberg Engineering) was used to acquire and measure the optic disc topographic parameters. Pearson correlations between topographic data and perimetric indices were performed for the total sample and each group of patients. The distribution of values obtained in the samples was normal., Results: A significant correlation was found between several optic disc parameters and the global indices of SAP. Rim area, rim volume, cup/disc area ratio, rim/disc area ratio, cup shape measurement, RNFL cross-sectional area, and discriminant functions FSM and RB, showed the strongest correlation with the visual field indices in the total and glaucoma groups (RIM AREA: total group: r=0.32; p=4.14x10(-11)/glaucoma group: r=0.28; p=0.004. RIM VOLUME: total group: r=0.26; p=1.55x10(-7)/glaucoma group: r=0.26; p=0.006). The ocular hypertensive group showed few significant correlations., Conclusions: The correlations found between standard automated perimetry and HRT defined topographic parameters allow a better understanding of glaucomatous damage and make decision-making easier.

Purpose: To determine the correlations between structural parameters of the optic nerve head and the retinal nerve fiber layer (RNFL) obtained by using a Heidelberg Retina Tomograph II (HRT II), optic coherence tomography (OCT), and laser polarimetry (GDX-VCC) and the perimetric indices of standard automated perimetry (SAP) in normal, ocular hypertensive and glaucomatous subjects., Methods: Three hundred and eighty-nine patients were enrolled in the study and classified into three separate groups: 43 with normal eyes, 274 with ocular hypertensive eyes and 72 with glaucomatous eyes. Subjects were classified according to the basal intraocular pressure and the SAP results. Pearson's correlation coefficients were calculated between the global perimetric indices, mean deviation (MD) and pattern standard deviation (PSD), and structural parameters of the RNFL and optic disc obtained by using HRT II, OCT and GDX-VCC in the different diagnostic groups., Results: Mild to moderate correlations were found between the structural parameters measured by HRT, OCT and GDX and the global perimetric indices, in the glaucoma group. Mild or no significant correlations were found in the normal and ocular hypertensive groups. Correlations were stronger for MD than for PSD. Parameters based on the study of the retinal nerve fiber layer showed stronger correlations than those based on the study of the optic nerve head., Conclusions: The relationship between structural and functional measurements in glaucoma is weak and therefore the results of these ancillary tests should be interpreted together to increase diagnostic accuracy.

Case Report: Two cases of bilateral ocular toxicity following chloroquine therapy in two women with systemic lupus erythematosus are presented., Discussion: Retinal toxicity due to chloroquine is an uncommon iatrogenic disease. It is dose-dependent. New cases are still being described despite the application of ophthalmic screening techniques.

Purpose: To evaluate the diagnostic ability of three digital imaging technologies (HRT-II, OCT and GDx VCC) in detecting glaucomatous damage., Methods: A total of 427 eyes from 427 subjects were included in this cross-sectional study. Each subject was classified as healthy, ocular hypertensive or glaucomatous, according to intraocular pressure levels, standard automated perimetry and optic disc morphology. All of them underwent examination by means of HRT, OCT and GDx VCC. Receiver operating characteristic (ROC) curves were plotted and sensitivities at fixed specificities (85% and 95%) were calculated for each parameter assessed., Results: The parameters with the higher diagnostic ability were: FSM discriminant function from HRT-II (AUC=0.899), retinal nerve fiber layer average thickness from OCT (AUC=0.929) and NFI from GDx VCC (AUC=0.879), with no statistically significant differences between them., Conclusion: The HRT-II, OCT and GDx VCC provide measurements of the retinal nerve fiber layer and the optic nerve head with high discriminating ability in open-angle glaucoma.

Purpose: To evaluate the reproducibility of repeated quantitative measurements of optic nerve head topography and retinal nerve fiber layer thickness., Methods: This study included 32 normal subjects, 41 patients with ocular hypertension and 33 patients with glaucoma. The study groups were defined by the intraocular pressure levels, optic disc stereo-photographs and perimetric performance. Optic disc and retinal nerve fiber layer assessments were performed by ocular coherence tomography (OCT III, Zeiss Instruments). OCT examination was repeated three times in each subject and the coefficient of variability was elaborated for each parameter and group of the study, and compared among them., Results: The average retinal nerve fiber layer thickness measurement showed the best reproducibility figures with a coefficient of variability of 5.9%. The inferior quadrant and the 10, 6 and 7 clock-hours (coefficients of variability 6.3%, 7.4%, 7.5% and 8.6% respectively) showed higher reproducibility. The optic nerve head assessment showed the best reproducibility for the cup-to-disc ratios (vertical, horizontal and area ratios), with a coefficient of variability of 5.0%, 4.2% and 6.6% respectively. Although differences among groups were barely statistically significant, the glaucoma group showed coefficients of variability higher than the other two groups., Conclusions: Optic nerve head analysis and retinal nerve fiber layer thickness can be reproducibly assessed by OCT. The reproducibility of the device supports its potential use for ocular hypertension follow-up, although its use in glaucoma patients may present difficulties in some parameters.

Purpose: To evaluate the diagnostic ability of the Moorfields regression analysis (MRA; neuroretinal rim sector-based analysis) by means of confocal scanning laser., Methods: 200 eyes were included in this study: 101 normal subjects and 99 glaucoma patients (standard automated perimetry with glaucomatous defects -MD or CPSD with p<0.02 or a cluster of three or more points with p<0.05 or a cluster of two or more points with p<0.01 or abnormal Glaucoma Hemifield Test). All subjects underwent a full ophthalmic evaluation, visual field evaluation by means of a Humphrey Field Analyzer, 24-2 full threshold strategy, and optic disc topography by Heidelberg retina tomograph (HRT-II). The outcome parameters were sensitivity and specificity of the MRA for each sector., Results: The highest sensitivity in detecting structural defects based on MRA (p<0.05) was observed in the nasal-superior sector (48%) and nasal-inferior sector (45%); however the highest specificity was found in the temporal-superior (98%) and inferior (98%) sectors. The highest sensitivity for MRA (p<0.01) was found in the temporal-inferior sector (31%) and nasal-superior sector (30%) while the temporal-superior and inferior-sectors showed the highest specificity (100%). The diagnosis of glaucoma based on the presence of any sector alteration showed sensitivity figures of 67% with p<0.05 and 46% with p<0.01 and specificity values of 84% with p<0.05 and 96% with p<0.01., Conclusions: The analysis of the distribution of the neuroretinal rim by means of HRT-II contributes effectively to the diagnosis of glaucoma based on perimetry in a sample derived from a Spanish population.

Purpose: To evaluate the efficacy of photodynamic therapy with photodynamic therapy (PDT) in the management of choroidal neovascularization (CNV) in age-related macular degeneration (AMD) and myopia., Methods: 102 eyes with subfoveal or yuxtafoveal CNV underwent visual acuity (VA) testing, ophthalmic examination, and fluorescein angiography. Retreatment of persistent CNV was done after three months., Results: CNV was caused by AMD in 75.5% of patients, pathologic myopia in 24.5%. Follow up ranged from 9 to 33 months (mean: 15.94 months). 88% of CNV caused by pathologic myopia was classic and 40% was in lesions caused by AMD. CNV survival was shorter in lesions caused by pathologic myopia with a significant difference (p=0.0018). VA improved in 48% of lesions caused by pathologic myopia and in 28.6% of lesions caused by AMD. We did not observe any severe complication caused by PDT., Conclusion: PDT is a moderately effective treatment without complications in treating subfoveal CNV.

Purpose: To evaluate efficacy and reliability of local intra-arterial fibrinolysis (LIF) in Retinal Central Artery Occlusion (RCAO)., Material and Method: We have studied 12 patients with RCAO. Seven patients (group I) were treated with conventional therapy and 5 patients (group II) underwent treatment with urokinase via transcutaneous femoral catheter into the ophthalmic artery. Thereafter patients received heparin sulfate for 3 days., Results: Mean follow up was 14 months and mean time from onset of symptoms to the beginning of therapy was 11 hours. One patient in group I showed improvement of visual acuity (from counting fingers to 0.1). In all patients in group II there was angiographic evidence of improved perfusion of retinal arteries and 4 patients (80%) showed improvement in visual acuity. The best results were obtained when LIF was performed before 10 hours after onset of symptoms. No complications were observed after the fibrinolysis treatment., Conclusion: LIF in ophtalmic arteries for the treatment of RCAO reduces dosage of fibrinolytic agents and becomes a safe and useful treatment during the first hours post RCAO.

Purpose: To determine width and shape of neuro-retinal rim in normal hypertensive subjects and patients with glaucomatous damage., Material and Method: Patients underwent a perimetry and a photographic retinal nerve fiber evaluation. Patients were divided in three groups: normal subjects (n=34), ocular hypertension subjects (n=38) and glaucoma patients (n=34). Neuro-retinal rim was measured using 40 degrees stereoscopic photographs with center in the optic nerve head based on a biomorphometry technique., Results: In normal subjects neuro-retinal rim appeared wider in the lower pole, followed by the upper, nasal and temporal aspects. Optic nerve fiber layer showed a decreased thickness in hypertensive and glaucoma patients, particularly in sectors of the temporal aspect of the optic nerve (p<0.05)., Conclusions: A Planimetry study of the optic nerve is able to detect alterations in normal neuro-retinal rim configuration and can as well detect thinning of the rim, particularly in temporal, upper and lower areas.

Purpose: To assess the differences in neuroretinal rim shape in ocular hypertensive patients (normal white-white automated perimetry) with and without perimetric injury in the short wave length automated perimetry (blue-yellow)., Material and Methods: 72 eyes from 72 hypertensive ocular patients with normal achromatic automated perimetry examination were included. Forty eyes had normal short wave length automated perimetries while 32 subjects presented an abnormal condition. The neuroretinal rim morphology was quantified by means of a planimetric study from the papillary images obtained with confocal laser scanning., Results: The subjects with abnormal blue-yellow perimetry showed a decrease in the neuroretinal rim area in the inferior and temporal positions. The differences were significant (p<0.05) at the 9 o'clock position (below the middle line) and almost significant (p<0.10) at the 10 o'clock position., Conclusions: There are differences in the neuroretinal rim shape in ocular hypertensive subjects with normal achromatic perimetry according to whether there are abnormalities in the blue-yellow perimetry.

Purpose: The effects of contact transscleral cyclophotocoagulation with diode laser for refractory glaucoma have been analyzed., Methods: A diode laser system was used to treat twenty one eyes with refractory glaucoma. The mean follow-up was 22.24+/-9.89 months. All the eyes were treated with 15 laser spots placed over 270 degrees, 1 mm posterior to the limbus, using 3.0 J (1.0 W X 3.0 sg)., Results: The mean preoperative intraocular pressure was 40.95+/-11.76 mmHg and the mean intraocular pressure at the end of the follow-up was 24.28+/-7.80 mmHg (p<0.5). An intraocular pressure below 21 mmHg was obtained in 10 out the 13 eyes (76.92%). Six of the 8 painful eyes had pain relief (75.00%). The principal complications included a decreased visual acuity in 5 eyes and chronic uveitis in 2 patients., Conclusions: These results suggest that semiconductor diode transscleral cyclophotocoagulation can be used successfully to reduce intraocular pressure in the treatment of refractory glaucoma.

Purpose: To assess the effect of nicardipine (NCP) on fibroblast migration and proliferation, and its cellular toxicity., Methods: In vitro wound repair was assessed in confluent fibroblast monolayer. Mechanical round wounds were performed in the monolayers and the cultures were incubated in fresh media plus NCP. The cell-free area was monitored after 0, 18, 24 and 48 hours. Groups of treatment: Group 1, Sham. Group 2, NCP 10(-4)M in the media. Group 3, NCP 7.5x10(-5)M. Group 4, NCP 5x10(-5)M. Group 5, NCP 2.5x10(-5)M. Group 6, NCP 10(-5)M. Group 7, NCP 10(-6)M. Group 8, NCP 10(-7)M. Group 9, NCP 10(-3)M. Each experiment consisted of three tests that were repeated four times., Results: The fibroblast migration and proliferation was inhibited at 5x10(-5)M or higher doses. The proliferation after 48 hours with NCP 2.5x10(-5)M was statistically inferior to the control group and groups 7, 8, and 9. NCP 5x10(-5)M or higher doses showed cellular atypia and cell death., Conclusions: NCP effectively inhibits fibroblastic wound repair process at doses 2.5x10(-5)M and shows toxicity at doses over 5x10(-5)M.

Purpose: To evaluate and compare the effect of acid tocopherol succinate (ATS) on fibroblast migration and proliferation., Methods: In vitro wound repair was determined in confluent fibroblast monolayer. Conjunctival fibroblasts were incubated with serum-deprived medium for 24 hours. After this time an artificial wound was made and the cells were incubated with fresh medium plus the doses of ATS to be tested. The cell free area was monitored at 0, 18, 24 and 48 hours. Groups of treatment: Group 1: ethanol 0.1%. Group 2: ATS 25 microM dissolved in ethanol (final concentration 0.1%) Group 3: ATS 50 microM in ethanol 0.1%. Each experiment was carried out in triplicate and repeated 4 times., Results: There were no differences among the groups during the first 24 hours. ATS showed significantly larger cell-free area at 48 hours. There were no signs of cellular toxicity., Conclusions: 25 microM and 50 microM ATS inhibit fibroblast proliferation without cellular toxicity.

Purpose: To study the antiinflammatory effect of topical pranoprofen on the lipoxygenase metabolism of the arachidonic acid in albino rabbits., Methods: Endotoxin-induced uveitis (EIU) was produced in albino rabbits by intravitreal injection in the right eye with 10 microg of Salmonella typhymurium lipopolysacharide A in 5 microl saline solution. We have used 5 groups of 12 animals each. Control group (G-I) was injected with 5 microl of saline solution and 5 microl of ET solution were injected in the remaining groups. Groups III, IV and V were treated with topical pranoprofen 2 hours before intravitreal injection, immediately after and every 6, 4 and 2 hours respectively. The animals were sacrificed 24 hours after the ET administration. Cellular and B4 leukotrien concentration in the aqueous humour was determined., Results: The groups treated with pranoprofen showed a significant decrease in the cellular concentration in relation to the group of endotoxin (G-II). We did not observe any difference in the B4 leukotriene concentration between ET group and topical pranoprofen groups., Conclusion: Topical pranoprofen has not increased the lipoxygenase metabolism of the arachidonic acid.

Purpose: To determine the variability of disc and cup area measurements in digital images obtained with scanning laser ophthalmoscope., Methods: 10 sets of images of 4 optic discs (normal, myopic, ocular hypertensive and glaucomatous) were obtained with the Rodenstock scanning laser ophthalmoscope. Images focused at different depths were used by 2 operators (with and without experience in planimetry) to determine the disc and cup areas by means of an image analysis program (Visilog). This study was performed in 10 images obtained from the same optic nerve (inter-image analysis) and 10 times in the same image of each optic nerve (intra-image analysis)., Results: The variability of all the measurements was under 5%. Disc area measurements were lower than cup area determination. The experienced operator obtained lower variability. The myopic optic disc images were less reproducible than the other groups of images., Conclusions: The planimetric analysis of optic nerve head digital images obtained with scanning laser ophthalmoscope is reproducible and allows quantification of optic disc areas.

Purpose: To investigate the demographic characteristics, clinical findings and long-term outcome of central serous chorioretinopathy (CSC)., Methods: This study examined retrospectively the clinical stories and fluorescein angiographies of 113 patients with CSC and a minimum follow-up of 12 months., Results: A total of 113 patients was examined; 90 were men and 23 women. Bilateral involvement was found in 13 cases. In 85.7% of the eyes (Group I) resolution was completed in months and mean final visual acuity (VA) was 79.3/100, while 14.3% of the eyes (Group II) showed a chronic evolution, with diffuse retinal pigment epithelipathy and mean final VA of 47.2/100. The mean age of the patients in Group II was significantly higher; male:female ratio was also higher in this Group. Bilateral involvement occurred in 6% of patients from Group I and in 46.6% in Group II., Conclusions: Chronic CSC affected less than 15% of the patients. Mean age in this group of patients was higher than in patients with a classic CSC, most of the cases were men, bilateral involvement was present in nearly 50% of the cases and 50% of them suffered a significant visual permanent impairment.

Purpose: To study the effectiveness of Yag capsulotomy, therapeutic vitreal aspiration and intravitreal injection of antibiotics combination on the treatment of chronic postoperative endophthalmitis., Methods: Six patients with symptoms of refractory postoperative endophthalmitis after extracapsular cataract extraction, with an intraocular lens were treated following a protocol that included: YAG capsulotomy, vitreal aspiration and intravitreal injection of antibiotics., Results: In four cases -66%- the micro-organism was isolated -three cases of coagulase- negative staphylococci and one case Corynebacterium spp. In all the cases the inflammatory process decreased, and a noticeable improvement of visual acuity was achieved. No recurrent cases were observed (two patients died before the end of the study)., Conclusions: As way of conclusion we can state that the initial capsulotomy allows the destruction of the infection reservoir in order to eradicate the agent. This endophthalmitis therapeutic alternative is effective, easy and reliable for the ophthalmologist.

Purpose: We studied the antiinflammatory effect of topical Ketorolac-Tromethamine on a model of endotoxin-induced uveitis in albino rabbits., Methods: Endotoxin-induced uveitis was produced by intravitreal injection in the right eye of 10 ng lipopolysaccharide (LPS) A Salmonella typhimurium endotoxin in 5 microl saline solution. We have used 60 animals (5 groups of 12 animals each). Control group (G-I) was injected with saline (5 microl); endotoxin group (G-II) was injected with 10 ng of endotoxin; groups III, IV and V were injected with the same amount of endotoxin and treated with topical ketorolac-tromethamine every 6, 4 and 2 hours respectively. The animals were sacrificed 24 hours after endotoxin administration. We determined the ocular clinical signs and inflammatory cells and protein concentration in the aqueous humor., Results: In all the groups treated with Ketorolac-Tromethamine we observed a significant reduction (p<0.05) in all parameters studied when compared with those of the endotoxin group (G-II)., Conclusion: Topical Ketorolac-Tromethamine has demonstrated a significant reduction of endotoxin-induced-uveitis inflammation.