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Aniridia is a congenital bilateral ocular disorder with dominant autosomal inheritance. More than 50% of patients will develop aniridic glaucoma (AG) during their lives. Open angle glaucoma is more common in aniridia, but a closed angle mechanism has been described in relation with anterior rotation of the rudimentary iris, occluding trabecular meshwork. Diagnosis and follow-up of AG is difficult in relation with the presence of keratopathy, nystagmus and foveal hypoplasia. Central corneal thickness usually measures more than 600 microns, which prevents achieving a reliable value of intraocular pressure. Medical treatment of AG is not different from the rest of glaucoma. It is recommended to use preservative free formulations, and combined therapy is often required. Surgical treatment is needed in many cases. There is no consensus on the first line surgery for AG, but in open angle AG, angle surgery is usually first choice, and glaucoma drainage devices are the next preferred surgical technique. In closed angle AG glaucoma drainage devices are usually the first choice, with trabeculectomy as the second preferred surgical technique.

Resumen La aniridia es un trastorno ocular bilateral congenito de herencia habitualmente autosomica dominante, mas infrecuentemente recesiva asociada al sindrome de Gillespie. Mas de un 50% de pacientes con este trastorno van a presentar glaucoma aniridico (GA) a lo largo de su vida. En la mayoria de los casos es de angulo abierto, pero tambien puede producirse un mecanismo de cierre angular por rotacion progresiva del munon de iris que ocluye la malla trabecular. El diagnostico y seguimiento de glaucoma se ve complicado por la presencia de alteraciones asociadas como queratopatia, nistagmo e hipoplasia foveal. El espesor corneal central frecuentemente es mayor de 600 micras, lo que dificulta aun mas disponer de un valor fiable de tension ocular. El tratamiento medico del GA no difiere del resto de glaucomas, recomendandose evitar conservantes y siendo frecuente la necesidad de terapia combinada. Es muy comun que los pacientes con GA precisen cirugia. Aunque no existe consenso sobre la cirugia de primera linea, en el GA de angulo abierto suele ser indicada como primera linea la cirugia angular, seguida por los dispositivos de drenaje, y en el GA por cierre angular suelen ser indicados preferentemente los dispositivos de drenaje seguidos por la trabeculectomia.

Resumen Objetivo Describir los efectos de la inyeccion de cefuroxima intracameral a una dosis mas alta de la recomendada en cirugia de catarata. Metodos Estudio retrospectivo de 8 ojos de 8 pacientes operados de catarata en un mismo dia que recibieron 12,5 mg/0,1 ml de cefuroxima intracameral de forma inadvertida al finalizar la cirugia, por un error en la dilucion. A todos los pacientes se les realizo un seguimiento oftalmologico estrecho durante 6 meses. Resultados Todos los pacientes presentaron una inflamacion marcada del segmento anterior con edema corneal que se resolvio en todos los casos (entre 5 dias y 3 meses). A los 6 meses de seguimiento se constato una diferencia significativa en el recuento endotelial corneal de dichos ojos al compararlo con el ojo contralateral (p = 0,038), siendo Conclusiones Aunque la inyeccion de cefuroxima en camara anterior a dosis de 1 mg/0,1 ml ha demostrado disminuir la incidencia de endoftalmitis, su sobredosificacion puede tener efectos oculares potencialmente perjudiciales tanto en el segmento anterior como en el posterior.

To report outcomes of strabismus surgery in thyroid eye disease using intraoperative bow-knot adjustable sutures under topical anaesthesia and calculate prediction models for surgical correction and postoperative drift depending on surgical dose-response.We retrospectively reviewed patients operated on from 2016 to 2021. A satisfactory outcome was defined as no diplopia with maintenance of vertical (5 PD) and horizontal (10 PD) stable alignment at primary gaze. Subjective diplopia corrected with prisms within successful motor alignment was defined as a fair result. Otherwise, the result was considered to be poor.A total of 73 patients were included (60 females, 82%). Mean preoperative horizontal and vertical deviations were 26.9 PD (19.1 SD), and 11.8 PD (7.6 SD), respectively. Mean horizontal drift was -3.2 PD (5.2 SD), whereas mean vertical drift was -3.4 PD (3.3 SD). A linear regression established a dose-response of 2.37 PD/mm for each medial rectus recession (p0.0001; rMuscle recession with intraoperative adjustable sutures is effective for the treatment of thyroid eye disease strabismus. Predictable dose-responses could be achieved with a drift toward overcorrection. Undercorrection proportional to the planned surgical dose should be the immediate postoperative target of choice. Other variables such as orbital decompression and concurrent vertical and horizontal surgery do not correlate with dose-response and postoperative drift. However, further studies are necessary to validate our findings.

Purpose To create a new list of medical procedures in ophthalmology based on the International Classification of Diseases ICD-9-CM. To establish the general principles that define criteria, quantitative indicators, and scales. To develop the algorithms needed to calculate fees for medical procedures. Methods The out-of-date processes were removed from the list, and new techniques were added, descriptors were modified, procedures with similar descriptions were grouped together, and others were relocated to other group according to surgical complexity conditions. The criteria to calculate the medical fees were defined: training and complexity (U), proficient responsibility (R), and health value (V), with their respective quantitative indicators: period of training necessary to master a technique, frequency of complications that worsen the preoperative situation, and days of incapacity for work due to the process. The Relative Value Unit (RVU) was defined as the score sum of R, V and U. The final fee per medical procedure was calculated as the product of the RVU by its unit cost and by the weighting coefficient (WC). Results A new catalogue was prepared with 161 medical procedures, grouped into consultations, diagnostic procedures (DX.PR), therapeutic procedures (TX.PR), and surgical interventions, increasing in complexity from group 0 to group 8. The following characters were described for each one of the procedures: OMC and ICD-9-MC code, descriptor term, group, proposed modification: no changes or minimums in the descriptors, grouping of acts by similar definitions, change of origin group, new procedures, and procedures removed. The indicators for assessment were also scored: U between 1−4 points, and R and V between 0−3 points. Using their sum, the number of RVUs per medical procedure (between 1 and 10) was calculated which, together with the unit cost of the RVU and the WC (between 0.05 and 1), will determine the final rate. Conclusions The new standardised ophthalmological nomenclature updates and improves the old classification, adapting the procedures to the descriptors included in the ICD-9-CM, and incorporating all the new techniques. Additionally, the declaration of the general principles allows defining new criteria, quantitative indicators, rating scales, and algorithms to calculate fees for medical procedures.

Resumen Objetivo Elaborar un nuevo nomenclator de actos y procedimientos medicos en oftalmologia, basado en la Clasificacion Internacional de Enfermedades CIE-9-MC. Establecer los principios generales y definir los criterios de baremacion, indicadores cuantitativos y escalas de valoracion. Determinar los algoritmos necesarios para el computo de las tarifas retributivas por acto medico. Metodos Sobre el nomenclator vigente, se eliminaron los procesos obsoletos, anadieron otros nuevos, modificaron descriptores, agruparon procedimientos con descripciones similares y trasladaron de grupo otros, por razones de complejidad quirurgica. Se definieron los criterios de baremacion para el calculo de las retribuciones medicas: formacion y complejidad (U), responsabilidad profesional (R) y valor salud (V), con sus indicadores cuantitativos, respectivamente: periodo de formacion necesario para dominar una tecnica, frecuencia de complicaciones que agravan la situacion preoperatoria, y dias de incapacidad laboral que ocasiona el proceso. Se definieron las Unidades Relativas de Valor (URV) como la suma de puntos de U, R y V. La tarifa final por acto medico se calculara como el producto del numero de URV por su coste unitario y por el coeficiente de ponderacion (CP). Resultados Se elaboro un nuevo nomenclator con 161 actos medicos agrupados en consultas, procedimientos diagnosticos (PR.DX), procedimientos terapeuticos (PR.TX) e intervenciones quirurgicas (IQ) crecientes en complejidad desde el grupo 0 hasta el grupo 8. Para cada uno de los actos se describieron los siguientes caracteres: codigos OMC y CIE-9-MC, termino descriptor, grupo, modificacion propuesta: sin cambios o minimos en los descriptores, agrupacion de actos por definiciones similares, cambio de grupo de origen, actos eliminados y nuevos procedimientos. Asimismo, fueron puntuados los tres criterios de baremacion: U entre 1-4, R entre 0-3 y V entre 0-3. Mediante su suma se calcularon el numero de URV por acto medico (entre 1 y 10), que junto con el coste unitario de la URV y el CP (entre 0,05 y 1) determinaran la tarifa final. Conclusiones El nuevo nomenclator de oftalmologia actualiza y mejora el catalogo antiguo, adecuando los procedimientos a los descriptores recogidos en la CIE-9-MC e incorporando todas las tecnicas actuales. Adicionalmente, la declaracion de los principios generales permite definir nuevos criterios de baremacion, indicadores cuantitativos, escalas de valoracion y algoritmos de computo de las tarifas por acto medico.

Age-related macular degeneration and especially neovascular age-related macular degeneration is the leading cause of low vision in developed countries. Even though the introduction of anti-VEGF drugs in recent years completely changed the management of this condition, its cost, the need for repeated intravitreal injections, and loss of efficacy in the long term are still issues to deal with. Currently, a new generation of novel therapies under development is attempting to address some of these limitations. Some of the most prominent among them are new anti-VEGFs such as brolucizumab or abicipar, drugs against angiopoietin-2 receptor such as faricimab, sustained-release systems, or tyrosine kinase inhibitors. As regards dry age-related macular degeneration, neuroprotection, the complement pathway, and stem cell therapy are the most promising targets currently under investigation.

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.

Resumen Objetivo El tabaco es un factor de riesgo en la orbitopatia de Graves (GO) y es modificable. El consejo medico para dejar de fumar se ha incluido en todas las guias de practica clinica de esta enfermedad, aunque su efectividad no ha sido evaluada. El objetivo de este estudio es conocer el cambio producido en el habito tabaquico en pacientes con GO tras una recomendacion verbal para dejar de fumar. Material y metodos Se estudio una cohorte retrospectiva de pacientes con GO. Todos los pacientes recibieron consejo medico sobre la importancia de dejar de fumar en la primera consulta del oftalmologo. Entre 2013 y 2014 se atendio a 33 pacientes en la consulta, que fueron preguntados sobre el cambio en su habito tabaquico en 2015. La variable principal de estudio fue el numero de cigarros fumados al dia antes y despues de las consultas en endocrinologia y oftalmologia. Aparte, se recogieron otros datos personales medicos y socioeconomicos. Resultados El numero medio de cigarros fumados fue de 13,6 (DE 9,66) y 6,3 (DE 7,73) antes y despues de la primera consulta en oftalmologia, respectivamente (test t pareado, p Conclusion 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 mas susceptibles de cambiar a la hora de modificar sus habitos.

Resumen Objetivo Minimizar la exposicion al virus SARS-CoV-2, reducir las posibilidades de transmision cruzada entre pacientes y personal sanitario, y evitar el desarrollo de complicaciones postoperatorias por la atencion a pacientes con enfermedades oculares durante la pandemia de enfermedad por coronavirus 2019 (COVID-19). Metodos Elaboracion de un documento de revision del estado del conocimiento sobre COVID-19 y consenso entre diferentes sociedades oftalmologicas espanolas y afines, al objeto de proporcionar guias y recomendaciones de maximos recursos primariamente condicionadas por el estado de alerta, confinamiento y distanciamiento social que acontece en Espana desde el 16 de marzo de 2020. Resultados Las recomendaciones promoveran la adopcion de medidas de actuacion y proteccion para el desarrollo de la actividad asistencial en consultas externas, area quirurgica y hospitalizacion, tanto para pacientes no confirmados –asintomaticos y sintomaticos– como confirmados de COVID-19. Deberan ser adaptadas a las circunstancias y disponibilidad de equipos de proteccion individual en cada uno de los centros y Comunidades Autonomas, debiendo ser actualizadas en funcion de las fases de la pandemia y de las medidas que adopte el Gobierno de la nacion. Conclusiones Durante la pandemia COVID-19, la atencion a los potenciales riesgos de salud para la poblacion ocasionados por el coronavirus debera prevalecer sobre la posible progresion de enfermedades oculares comunes. Tanto medicos oftalmologos como restantes profesionales de la salud ocular deberan asumir una posible progresion de dichas enfermedades ante la imposibilidad de un seguimiento adecuado de los pacientes.

Resumen La respuesta negativa del electrorretinograma de campo completo se define como una disminucion de la onda b con conservacion de la onda a (ratio b/a Este hallazgo puede verse de forma bilateral y simetrica en diferentes enfermedades hereditarias como la ceguera nocturna estacionaria congenita, la retinosquisis juvenil ligada a X y las distrofias musculares de Duchenne y Becker. Por otro lado, tambien se puede encontrar de forma unilateral en enfermedades adquiridas como algunos tipos de retinitis inmunomediadas (retinocoroiditis en perdigonada o Birdshot), retinopatias autoinmunes, retinopatia asociada a cancer/melanoma o toxicidad retiniana. El objetivo de esta revision es resumir las caracteristicas de las afecciones en las que puede observarse este hallazgo, de gran utilidad en el diagnostico diferencial de enfermedades de la retina.

The definition of the negative response of the full field electroretinogram is the presence of a b-wave with less amplitude than the a-wave (b/a ratio

Resumen Objetivos El aumento de la calidad y de la esperanza de vida y el hecho de que el glaucoma se diagnostique cada vez mas precozmente hace preguntarse a muchos pacientes si afectan a su enfermedad determinados deportes, actividades o aficiones. El objetivo de este trabajo es establecer unas guias para aconsejar a los pacientes con base en la evidencia cientifica de los trabajos publicados. Metodos Revision de todos los trabajos publicados sobre glaucoma y deportes u otras actividades. Los trabajos fueron clasificados segun el nivel de evidencia cientifica basada en la clasificacion del Oxford Centre for Evidence-Based Medicine. Resultados Las actividades aerobicas son beneficiosas para el paciente. Se han de evitar deportes o tecnicas de relajacion tipo yoga con maniobras de Valsalva o colocacion de la cabeza en posicion inferior. Tambien se deben evitar los cambios bruscos en altura. El calor intenso no parece influir en el glaucoma, pero el frio intenso puede afectar a pacientes con disregulacion vascular. Las actividades de vision proxima disminuyen levemente la presion intraocular. El uso de instrumentos de viento puede elevar la presion intraocular dependiendo de la tecnica utilizada. Conclusiones Ciertos deportes y actividades pueden tener una influencia en la aparicion o la progresion del glaucoma. Los especialistas en glaucoma deben tener informacion adecuada sobre la evidencia cientifica de las publicaciones para poder aconsejar apropiadamente a los pacientes.

Resumen Objetivos Establecer guias para aconsejar a los pacientes respecto a la relacion entre dieta y habitos de vida y glaucoma. Metodos Revision de los trabajos publicados sobre glaucoma y la dieta, la ingesta de suplementos, el consumo de drogas o el tabaco, el sueno, el embarazo y la hipertension. Los trabajos fueron clasificados segun el Oxford Center for Evidence-Based Medicine. Resultados La evidencia sobre la relacion entre la dieta o el uso de suplementos y la incidencia o la progresion del glaucoma es insuficiente para justificar una recomendacion. Si bien algunos estudios en glaucoma de tension normal sugieren que el Ginkgo biloba podria reducir la progresion, no permiten recomendar su uso generalizado. Los estudios sobre tabaco no demuestran claramente una relacion entre consumo de tabaco e incidencia del glaucoma. La marihuana no es un tratamiento util para el glaucoma. Los resultados sobre la relacion entre la apnea del sueno y glaucoma son heterogeneos, pero si parece conveniente que los pacientes con grado moderado o severo de apnea sean evaluados para descartar glaucoma. El embarazo no suele afectar al curso de la enfermedad, pero varios medicamentos hipotensores pueden ser nocivos para el feto. La hipotension nocturna es un factor de riesgo de empeoramiento del glaucoma. Conclusiones Ciertas costumbres, circunstancias o enfermedades pueden tener una influencia en la aparicion o progresion del glaucoma. Es importante conocer la evidencia cientifica existente para poder aconsejar adecuadamente a los pacientes.

Purposes The increase in quality and life expectancy, often leads to many patients asking the glaucoma specialist whether some sports, activities or hobbies would affect their illness. The aim of this article is to establish guidelines for patients, based on the scientific evidence of published papers. Methods Review of all published articles on glaucoma and sports or other activities. The papers were classified according to the level of scientific evidence based on the Oxford Centre for Evidence-Based Medicine classification. Results Aerobic sports are beneficial for the patient. Yoga indoor sports or relaxation techniques should be avoided if Valsalva maneuvers are performed or the head is placed very low. Also, the patients must avoid sudden changes in height. Intense heat does not seem to lead to progression of glaucoma, but intense cold can affect patients with vascular dysregulation. Activities using the near vision slightly reduce the intraocular pressure. The use of wind instruments may raise intraocular pressure, depending on the technique used. Conclusions Certain sports and activities may have an influence on the onset or progression of glaucoma. Glaucoma specialists should have adequate information about the scientific evidence in the publications, in order to properly advise the patients.

Case report A 35-year-old man suffered a severe hypotension maculopathy after being kicked in his left eye. He presented a broad area of iridodialysis. Gonioscopy, ultrasound biomicroscopy and optic coherence tomography were not able to locate the suspected cyclodialysis. Medical treatment was ineffective. Five months later the patient received transcleral diode laser cyclophotocoagulation with clinical resolution. Discussion Transscleral diode laser constitutes an effective treatment, with low iatrogenia, that can solve cases of ocular hypotension, even when the location of the cyclodialysis has not been determined.

Resumen Casos clinicos Mujer de 81 anos y varon de 63, que desarrollan un hematoma pre-descemetico (HPD) tras una esclerectomia profunda no perforante (EPNP), la primera durante la cirugia y el segundo durante el postoperatorio precoz. Se describe la tecnica quirurgica que permite tanto la evacuacion del hematoma como la preservacion de la integridad de la membrana trabeculo-descemetica. Se presentan los hallazgos de OCT de segmento anterior tras la cirugia. Discusion Describimos los primeros casos del HPD tras EPNP, manejados exitosamente con una membranotomia ab interno de Descemet. Se debe estar alerta ante esta rara complicacion, potencialmente amenazadora para la vision.

Case presentation An 81 year-old woman and a 63 year-old man developed a pre-Descemet haematoma after deep sclerectomy (DS), the former during the surgery itself and the latter during the early post-operative period. The surgical technique is described that led to the evacuation of the haematoma and the preservation of the integrity of trabeculo-Descemet membrane. The anterior-segment OCT findings after surgery are also presented. Conclusions These are the first reported cases of pre-Descemet haematoma after DS that have been successfully repaired by an ab interno Descemet membranotomy. Surgeons should be aware of this rare, but potentially sight-threatening, complication.

Buried optic nerve head drusen are one of the most common causes of pseudo-papilloedema. In this review, we have chronologically addressed several useful traits in the differential diagnosis of a true papilloedema, using the different features of optical coherence tomography (OCT). The specificity of these features has improved at the same time as the improvement in penetration capability and resolution of newer OCT devices. Spectral domain OCT, and more specifically the enhanced depth imaging (EDI) technology, represents a turning point in directly visualise drusen, to quantify their size and to recognise their impact on neighbouring structures inside the optic nerve head.

It has been suggested that autoantibodies may induce axonal damage in multiple sclerosis (MS). Optical coherence tomography (OCT) showed that thinning of peripapillary retinal nerve fiber layer (RNFL) and ganglion cell layer/inner plexiform (GCIPL) measurements reflect axonal loss in the disease. We investigated whether the intrathecal synthesis of lipid-specific oligoclonal IgM bands (LS-OCMB) associates with thinning of these structures in MS patients.58 consecutive MS patients and 70 age-matched healthy controls were assessed. LS-OCMB was studied in cerebrospinal fluid by isoelectric focusing and immunoblotting. RNFL and GCIPL imaging were quantified by spectral domain OCT.RNFL and GCIPL were significantly reduced in MS patients compared to controls (p0.01). RNFL thickness was further reduced in LS-OCMB positive MS patients compared to LS-OCMB negative MS subjects mainly in papillomacular bundle (p0.05), temporal and inferior quadrants (p0.05) and inferotemporal sector (p=0.01).The presence of LS-OCMB associates with increased retinal axonal loss in MS. This reinforces the relationship found between the intrathecal synthesis of IgM and the axonal damage observed in immunological and pathological studies even in normal-appearing white matter. OCT seems an optimal tool to monitor axonal damage in LS-OCMB positive patients, relevant for therapeutic decisions and quantification of the effects of new neuroprotective treatments.

Objective To present a clinical practice guideline update on the medical, laser, and surgical treatment of primary angle closure glaucoma (PACG) in adults. Methods Following the formulation of key questions using the PICO scheme (Patient/Problem, Intervention, Comparison, Outcome), a systematic review was performed on the literature published to date, including international clinical practice guidelines. The AMSTAR and Risk of Bias tools were used for evaluating the quality of the information. The level of evidence and grade of recommendation were established following the Scottish Intercollegiate Guidelines Network (SIGN) system. Results Following the above methodology, recommendations of medical, laser and surgical treatment in adult PACG and levels of evidence are presented. Conclusions Although the level of scientific evidence for many of the questions raised is not very high, a review is presented on updated treatment recommendations for adult PACG. The limitations for the implementation of these recommendations is include two criteria: (a) most studies have been conducted in Asian populations, and (b) the effectiveness is measured almost exclusively in terms of reducing intraocular pressure, but limitations do not include visual function, quality of life or cost-effectiveness parameters.

Resumen Objetivo Realizacion de una guia de practica clinica actualizada sobre el tratamiento medico, laser y quirurgico del glaucoma por cierre angular primario (GCAP) en el adulto. Metodos Tras la formulacion de preguntas clave utilizando el esquema PICO (Paciente/Problema, Intervencion, Comparacion, Outcome/Resultado), se realiza una revision de la literatura publicada hasta el momento, incluyendo guias de practica clinica internacionales, utilizandose las herramientas AMSTAR y «Risk of Bias» para la evaluacion de la calidad de la informacion. El nivel de evidencia y la elaboracion del grado de recomendacion se establecieron siguiendo el sistema Scottish Intercollegiate Guidelines Network (SIGN). Resultados Siguiendo la metodologia expuesta, se presentan recomendaciones de tratamiento medico, laser y quirurgico en el GCAP del adulto y los niveles de evidencia. Conclusiones Aunque el nivel de evidencia cientifica para muchas de las preguntas planteadas no es muy alto, se presenta una revision actualizada de las recomendaciones terapeuticas en el GCAP del adulto. Entre las limitaciones para la aplicacion de estas recomendaciones se encuentra que la mayoria de los estudios han sido realizados en poblacion de origen asiatico, y que la eficacia se mide casi exclusivamente en terminos de reduccion de tension ocular y no en parametros de funcion visual, calidad de vida o coste-efectividad.

Purpose A study was designed to determine and describe the changes induced in the anterior segment of the eye and the intraocular pressure (IOP) after laser peripheral iridotomy (LPI) versus phacoemulsification in primary angle closure suspects (PACS) and primary angle closure (PAC). Methods Forty-seven eyes (47 patients) with Shaffer gonioscopy 0-II were included and split into 2 groups: cataract surgery (n = 29) or LPI (n = 18), depending on the lens sclerosis and visual acuity. Tonometry, gonioscopy, funduscopy, and automated measurements of the anterior chamber by Pentacam were performed before the intervention, and one and 3 months after the technique. Results Phacoemulsification reduces IOP after one and 3 months ( P P P P = .4), and 15.52 (SD: 2.95) vs 16.05 (SD: 2.46) in the third month ( P = .5). There were no significant differences in the antiglaucoma drugs. Shaffer gonioscopy grading was greater in the phacoemulsification group vs in the LPI group one and 3 months after the intervention ( P = .01). The highest difference between both techniques was found in the superior quadrant. The anterior chamber depth, angle and volume by Pentacam were wider in the phacoemulsification group after one and 3 months ( P Conclusions Although phacoemulsification and LPI could both be effective techniques in the prevention of pupillary block in PAC, faster and greater amplitude of the angle and the anterior chamber can be obtained after phacoemulsification than after LPI.

Resumen Objetivo Describir los cambios en el segmento anterior y en la presion intraocular (PIO) entre la iridotomia periferica laser (IPL) y la facoemulsificacion en pacientes con sospecha de cierre angular primario (PACS) y cierre angular primario (PAC). Metodo Se seleccionaron 47 ojos de 47 pacientes que presentaban un angulo 0-II (Shaffer) en la gonioscopia y se excluyo a los pacientes con lesiones glaucomatosas. Segun la esclerosis cristaliniana y la agudeza visual se separaron en 2 grupos: IPL (n = 18) o facoemulsificacion (n = 29). Se realizo tonometria, gonioscopia, funduscopia y medidas de la camara anterior (CA) con Pentacam antes de cada intervencion, al mes y a los 3 meses. Resultados La facoemulsificacion redujo la PIO al mes y a los 3 meses (p La apertura angular mediante gonioscopia fue mayor en el grupo de facoemulsificacion (p Conclusiones Tanto la IPL como la facoemulsificacion son tecnicas efectivas para prevenir el bloqueo pupilar en PAC, pero con la facoemulsificacion se obtiene mayor amplitud del angulo y de la CA de forma precoz.

Objective To evaluate primary cultures from human conjunctiva supplemented with fetal bovine serum, autologous serum, and platelet-rich autologous serum, over human amniotic membrane and lens anterior capsules. Methods One-hundred and forty-eight human conjunctiva explants were cultured in CnT50 ® supplemented with 1, 2.5, 5 and 10% fetal bovine serum, autologous serum and platelet-rich autologous serum. Conjunctival samples were incubated at 37 °C, 5% CO 2 and 95% HR, for 3 weeks. Results The typical phenotype corresponding to conjunctival epithelial cells was present in all primary cultures. Conjunctival cultures had MUC5AC-positive secretory cells, K19-positive conjunctival cells, and MUC4-positive non-secretory conjunctival cells, but were not corneal phenotype (cytokeratin K3-negative) and fibroblasts (CD90-negative). Conclusions Conjunctiva epithelial progenitor cells were preserved in all cultures; thus, a cell culture in CnT50 ® supplemented with 1–5% autologous serum over human amniotic membrane can provide better information of epithelial cell differentiation for the conjunctival surface reconstruction.

a b s t r a c t Objective: To determine the effect of posterior capsulotomy on macular thickness, intraocular pressure and endothelial cell loss in pseudophakic patients with posterior capsule opacification using the other eye of every patient as a control. Methods: An observational prospective study was conducted on 31 pseudophakic patients with posterior capsular opacification in one eye, using the other eye as a control. Patients did not suffer any other ocular pathology. All patients were treated by posterior capsular opacification with Nd:YAG capsulotomy, and followed up for a three-month period. The ocular examination included best corrected visual acuity (BCVA), intraocular pressure (IOP), macular optical coherence tomography (OCT), and endothelial cell assessment (including densitometry, cell size and coefficient of variation, hexagonal cell percentage and pachymetry), which were determined in both eyes before treatment, and one week, one month and 3 months after capsulotomy. Results: Generalized estimating equations (GEE) were used to assess the capsulotomy effect adjusted by corresponding baseline measurements and time. No association was found between capsulotomy and IOP (p = 0.597), macular thickness (p = 0.085) or ECA densitometry (p = 0.422), average size of cells (p = 0.299), variation coefficient (p = 0.495), hexagonal cell percent (p = 0.093) and corneal pachymetry (p = 0.423). A significant increase of 0.15 Snellen units in BCVA was found during the 3-month follow-up period (p < 0.001). Conclusion: This study shows that after Nd:YAG capsulotomy, BCVA improves significantly without any IOP, OCT or ECA changes during the three-month follow-up. Nd:YAG capsulotomy is a safe procedure in pseudophakic patients without any other ocular pathology.

The objective of this review is to describe the clinical and epidemiological characteristics of adenoviral conjunctivitis, as well as to present a practical update on its diagnosis, treatment and prophylaxis. There are two well-defined adenoviral keratoconjunctivitis clinical syndromes: epidemic keratoconjunctivitis and pharyngoconjunctival fever, which are caused by different adenovirus serotypes. The exact incidence of adenoviral conjunctivitis is unknown. However, cases are more frequent during warmer months. Contagion is possible through direct contact or fomites and the virus is extremely resistant to different physical and chemical agents. The symptomatology of conjunctival infection is similar to any other conjunctivitis, with a higher incidence of pseudomembranes. In the cornea, adenoviral infection may lead to keratitis nummularis. Diagnosis is mainly clinical, but its etiology can be confirmed using cell cultures, polymerase chain reaction or immunochromatography. Multiple treatments have been tried for this disease, but none of them seem to be completely effective. Prevention is the most reliable way to control this contagious infection.

Propósito: Estudiar los cambios hemodinámicos retrobulbares mediante ecografía doppler color, en pacientes hipertensos oculares (HTO) en tratamiento con Combigan® versus placebo. Método: Treinta pacientes randomizados en 2 grupos paralelos fueron incluidos en un estudio prospectivo y a doble ciego; quince de ellos en tratamiento con Combigan® y quince en tratamiento con placebo, durante un periodo de 3 meses. Se obtuvieron medidas de la presión intraocular (PIO) y del flujo sanguíneo a nivel de la arteria central de la retina (ACR) y la arteria oftámica en el momento basal y a los 3 meses. Resultados: Combigan® redujo significativamente la PIO tras tres meses de tratamiento (p=0,001). Los parámetros hemodinámicos basales fueron similares entre los grupos placebo y tratamiento. Los pacientes tratados con Combigan® mostraron un descenso estadísticamente significativo del índice de resistencia de la ACR (p=0,007). Conclusiones: Los pacientes tratados durante 3. meses con Combigan® mostraron un descenso estadísticamente significativo del índice de resistenciade la ACR que podría explicarse por el descenso de PIO. Purpose: This study was undertaken to compare the ocular haemodynamic effects of Combigan® versus placebo in patients with ocular hypertension (OHT). Methods: Thirty patients with OHT were included in a controlled, randomised, double blind study in two parallel groups; 15 were randomised to receive Combigan® and 15 to receive placebo for a period of 3 months. At baseline and at 3 months retrobulbar blood flowmeasurements of the ophthalmic artery (OA) and central retinal artery (CRA) were taken using colour Doppler imaging (CDI) ultrasound, concurrently with intraocular pressure (IOP). Results: Combigan® significantly reduced IOP after 3 months of treatment (P = 0.001), whereas placebo showed no significant change in IOP. The baseline haemodynamic parameters were similar between treatment and placebo groups. Patients treated with Combigan® showed a statistically significant decrease in CRA resistive index (P = 0.007). Conclusions: Patients treated for 3 months with Combigan® showed a significant decrease of CRA resistive index that could be explained by the decrease in IOP.

Objetivo: Evaluar el efecto de la administración tópica de la combinación fija bimatoprost (0,3 mg/ml)/maleato de timolol (5 mg/ml) sobre el flujo sanguíneo retrobulbar en pacientes con hipertensión ocular (HTO). Pacientes y métodos: Veinte pacientes con HTO fueron incluidos en este estudio prospectivo, doble ciego y aleatorizados a recibir tratamiento con bimatoprost/timolol o placebo durante 12 semanas. Las pruebas se llevaron a cabo en la primera visita y a las 12 semanas. Se registraron la agudeza visual, presión intraocular (PIO), examen en lámpara de hendidura, perimetría estática automática, presión arterial sistémica y frecuencia cardíaca. Mediante ecografía doppler color (EDC) se midieron los parámetros del flujo sanguíneo retrobulbar de la arteria oftálmica (AO) y arteria central de la retina (ACR). Resultados: La combinación fija bimatoprost/timolol redujo significativamente la PIO (p < 0,0001), además de conseguir un incremento significativo de la velocidad diastólica final (VDF) en la ACR (p = 0,03). En el grupo de pacientes tratados con bimatoprost/timolol se observó una correlación estadísticamente significativa entre la PIO y la VDF a las 12 semanas de tratamiento (r = -0,511, p = 0,045). No hubo cambios significativos en las presiones arteriales sistólica (p = 0,54) y diastólica (p = 0,67) ni en la frecuencia cardíaca (p = 0,10) durante el período de tratamiento. Conclusiones: La combinación fija bimatoprost/timolol redujo significativamente la PIO en pacientes con HTO. El único cambio observado en la hemodinámica retrobulbar fue un incremento de la VDF en la ACR, probablemente relacionado con la reducción de la PIO.

Objetivo: Evaluar el efecto de la administración tópica de la combinación fija bimatoprost (0,3 mg/ml)/maleato de timolol (5 mg/ml) sobre el flujo sanguíneo retrobulbar en pacientes con hipertensión ocular (HTO). Pacientes y métodos: Veinte pacientes con HTO fueron incluidos en este estudio prospectivo, doble ciego y aleatorizados a recibir tratamiento con bimatoprost/timolol o placebo durante 12 semanas. Las pruebas se llevaron a cabo en la primera visita y a las 12 semanas. Se registraron la agudeza visual, presión intraocular (PIO), examen en lámpara de hendidura, perimetría estática automática, presión arterial sistémica y frecuencia cardíaca. Mediante ecografía doppler color (EDC) se midieron los parámetros del flujo sanguíneo retrobulbar de la arteria oftálmica (AO) y arteria central de la retina (ACR). Resultados: La combinación fija bimatoprost/timolol redujo significativamente la PIO (p < 0,0001), además de conseguir un incremento significativo de la velocidad diastólica final (VDF) en la ACR (p = 0,03). En el grupo de pacientes tratados con bimatoprost/timolol se observó una correlación estadísticamente significativa entre la PIO y la VDF a las 12 semanas de tratamiento (r = -0,511, p = 0,045). No hubo cambios significativos en las presiones arteriales sistólica (p = 0,54) y diastólica (p = 0,67) ni en la frecuencia cardíaca (p = 0,10) durante el período de tratamiento. Conclusiones: La combinación fija bimatoprost/timolol redujo significativamente la PIO en pacientes con HTO. El único cambio observado en la hemodinámica retrobulbar fue un incremento de la VDF en la ACR, probablemente relacionado con la reducción de la PIO. Purpose: To investigate the effects of topical bimatoprost (0.3 mg/ml)/timolol maleate (5 mg/ ml) fixed combination on retrobulbar blood flow in patients with ocular hypertension (OHT). Patients and methods: Twenty consecutive patients with OHT were prospectively randomised to either bimatoprost/timolol or placebo during a 12 weeks double masked treatment trial. Examinations were performed at baseline and after 12 weeks of treatment. Visual acuity, intraocular pressure (IOP), slit-lamp examination, automated static perimetry, systemic blood pressure and heart rate were all recorded. Retrobulbar blood flow measurements of the ophthalmic artery (AO) and central retinal artery (CRA) were measured by colour Doppler imaging. Results: IOP was significantly decreased by bimatoprost/timolol fixed combination (p < 0.0001). Bimatoprost/timolol fixed combination therapy resulted in a significant increase in end diastolic velocity (EDV) of the CRA (p = 0.03). In patients treated with bimatoprost/timolol a statistically significant correlation between IOP and EDV was observed after 12 weeks of treatment (r = -0.511, p = 0.045). The systolic (p = 0.54) and diastolic (p = 0.67) blood pressures and heart rate (p = 0.10) did not show statistically significant differences during the study period. Conclusions: Topical bimatoprost/timolol fixed combination significantly reduced IOP in patients with OHT. However, the only significant change observed in retrobulbar haemodynamics was an increase in EDV of the CRA, probably associated with a reduction in IOP.

To detect and quantify changes, using optical coherence tomography (OCT), in the peripapillary retinal nerve fiber layer (RNFL) thickness in patients with glaucoma who underwent deep sclerectomy.Prospective, controlled, interventional case series.Thirty-four consecutive patients who underwent monocular deep sclerectomy (surgery group) and medically treated fellow eyes (control group).Quantitative analysis of the peripapillary RNFL by OCT and automated perimetry were performed before surgery and 6 months after surgery in both eyes.The changes in RNFL thickness overall and by quadrant were evaluated and studied with respect to age, preoperative visual field test global indices, postoperative changes in intraocular pressure (IOP), and postoperative changes in visual field global indices. Changes observed in RNFL thickness were compared between eyes after surgery and in fellow eyes.The IOP decreased from a baseline mean of 23.6+/-5.1 mmHg to 11.7+/-2.9 mmHg (P0.001) 6 months after surgery at the time of OCT testing. The mean percent IOP change was 48.4+/-15.7%. No significant changes in the mean RNFL thickness overall or by quadrant were observed after surgery or in the mean deviation (MD) and pattern standard deviation after surgery. There was no significant difference in the RNFL thickness between eyes in the surgery group and those in the control group. The mean preoperative visual field MD was significantly (P = 0.006) worse in eyes with a postoperative decrease in the overall RNFL thickness compared with those with an increase in the RNFL thickness. No correlation was found between RNFL thickness changes and age or changes in the visual field global indices. There was no significant difference between eyes with an IOP reduction of more than 50% and those with a reduction in IOP less than 30% (P = 0.514).The authors found no significant changes in the peripapillary RNFL thickness measured 6 months after deep sclerectomy. The only significant factor related to RNFL thickness changes after surgery was the preoperative visual field MD (P = 0.038).

Objective To evaluate the effect of phacoemulsification on intraocular pressure (IOP) control in eyes with a previous functioning filtering bleb and no glaucoma medication. Design Prospective, nonrandomized comparative (self-controlled) trial. Participants Forty-seven patients (49 eyes) who underwent phacoemulsification after successful trabeculectomy, with at least 12 months of follow-up. Intervention Clear corneal phacoemulsification and implantation of a foldable intraocular lens in eyes that underwent a previous successful trabeculectomy. The time between both procedures was always greater than 1 year. Main outcome measures Preoperative and postoperative IOP, the number of glaucoma medications, bleb appearance, and visual acuity were recorded at each follow-up examination. Success was defined as no need for glaucoma medications, bleb needling, or further glaucoma surgery for IOP control after phacoemulsification. Preoperative and intraoperative factors were evaluated for an association with postoperative failure using Kaplan-Meier survival analysis. Results The mean (± standard deviation) IOP before phacoemulsification was 12.24 (± 4.68) mmHg, and it increased 3.94, 3.76, 1.39, 2.04, and 1.57 mmHg on the first postoperative day, after 1, 6, and 12 months, and at the last visit, respectively. At each interval, the mean IOP was significantly higher than the preoperative value ( P = 0.000, 0.000, 0.049, 0.01, and 0.01, respectively). Nevertheless, the mean IOP after phacoemulsification was always lower than before trabeculectomy ( P = 0.000). At the last visit, glaucoma medication was required in 17 eyes (34.7%). The success rates after phacoemulsification were 83.6%, 68.2%, and 55.7% at 6 months and 1 and 2 years, respectively (Kaplan-Meier survival analysis). The number of glaucoma medications used increased at all follow-up visits ( P P = 0.000). An IOP before phacoemulsification of greater than 10 mmHg was associated with postoperative failure ( P = 0.002). Similarly, bleb failure and the need for glaucoma medication were associated with higher IOPs before phacoemulsification. Conclusions Phacoemulsification significantly increased IOP and the number of glaucoma medications in eyes with preexisting functioning filtering blebs. Eyes with higher IOPs before phacoemulsification had worsened postoperative IOP control and bleb failure.

Objetivo: La tonometría de rebote ha sido recientemente adaptada para su utilización en humanos. El objetivo de nuestro estudio es determinar la precisión del tonómetro de rebote (TRB) ICare® en comparación con el tonómetro de aplanación Goldmann (TAG). Métodos: Se reclutaron pacientes de la Unidad de Glaucoma de nuestro centro. En cada paciente se midió la presión intraocular (PIO) con el TRB sin anestésico y tras diez minutos con el TAG. Se empleó la paquimetría para determinar el grosor corneal central (ECC). Resultados: Se reclutaron 68 pacientes (132 ojos). La media de PIO obtenida con el TRB fue de 18,9 [Desviación estándar (DE) 7,2 mmHg] y de 15,5 (DE 5,7 mmHg) con el TAG (p

Purpose To evaluate the accuracy of 3 spectral-domain (SD) optical coherence tomography (OCT) devices (Topcon 3D-1000 [Topcon]; Cirrus HD [Carl Zeiss Meditec, Inc], and Spectralis OCT [Heidelberg Engineering]) before and after mydriasis for the diagnosis of diabetic macular edema. Design Cross-sectional study. Methods Sixty-two eyes of 62 consecutive patients with diabetes without recent loss of vision referred for retinal control were assessed. Two scans were performed for each SD OCT instrument. Central retinal thickness was measured before and after pupil dilation. Pupil dynamic was studied using pMetrics pupillometer (iVIS Technologies), and lens opacity was measured by Pentacam densitometry (Oculus). The diagnostic accuracy of SD OCT devices was assessed by sensitivity, specificity, and area under the receiver operating characteristic curve. Logistic regression analysis was used to assess the effect of pupil size and lens opacity on the reliability of SD OCT in the acquisition of adequate images. Results The area under the receiver operating characteristic curve for the Topcon 3D OCT device was 0.84, that for the Cirrus HD OCT device was 0.93, and that for the Spectralis OCT device was 0.91. Significant differences in area under the receiver operating characteristic curve before and after pupillary dilatation were not found. Sensitivity and specificity associated with the cutoff value for the best performance were 82% and 74% for the Topcon 3D OCT device, 90% and 87% for the Cirrus HD OCT device, and 90% and 84% for the Spectralis OCT device, respectively. The Topcon 3D OCT device had an 11.3% segmentation algorithm failure rate for the central millimeter of the fovea, and the nuclear lens density was significantly greater in these eyes than in those without failure (17.1 ± 1.1 mm vs 10.4 ± 0.2 mm; P Conclusions SD OCT is a useful tool to detect and to measure diabetic macular edema without the need for pupil dilatation.