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There are different etiologies related to glaucoma, with the involvement of different systems in the origin and development of the disease.We performed a literature review.The data is divided, with an emphasis on five main topics: systemic disease, neurodegenerative disease, genetic disease, immunological disease, and aging of the trabecular meshwork. Older and recent important findings of each subject are reported to establish a relationship with glaucoma, and mention is made of some of the current research lines.Glaucoma is a multifactorial disease with complex interaction of events at various levels of the organism. Study of the etiology should guide the search for new therapies.

A 12 year-old girl patient with a history of ventriculoperitoneal shunt placement at the age of 6 months presented with progressive bilateral decrease in visual acuity. Ophthalmologic examination was consistent with bilateral papilledema. No other systemic manifestations of increased intracranial pressure were evident and laboratory work-up excluded other inflammatory or infectious processes. We present here an interesting case of a patient with ophthalmologic manifestations as the initial finding of ventriculoperitoneal shunt dysfunction.

Interferon alpha-2b has become an ideal topical chemotherapeutic agent to treat selective cases of ocular surface squamous neoplasia (OSSN) due to its efficacy and low toxicity. We present a case series in which interferon alpha-2b achieved primary immunoreduction or immunotherapy in giant OSSN avoiding or minimizing the need of extensive surgery.

Aim To evaluate the clinical course of the patients with pars planitis that received immunosuppressive drugs. Methods We retrospectively analysed the data of 10 years from 374 patients with pars planitis in a large reference centre in Mexico City and included 49 patients (92 eyes). Results Median age at presentation was 8 years. 35 patients (71.4%) were male and 43 patients (87.7%) had bilateral disease. Diverse immunosuppressive medications were used, mainly methotrexate (69.4%) and azathioprine (63.3%) with 18 patients requiring more than one drug. The main indications for starting immunosuppressive therapy were lack of response to initial treatment and advance disease at presentation. The results showed good response with steroid reduction (69.3% of patients), visual acuity improvement (51% of patients) and inflammatory disease reduction (59.1% of patients). In 25 patients (51%), steroids were started previous to immunosuppressors and in 24 (49%) at the same time without significant difference in clinical improvement (p=0.210) or visual outcome (p=0.498). Thirteen patients (26.5%) presented mild adverse effects. The median of the final visual acuity was 20/40. The median follow-up time was 44 months (range 13–115 months). Conclusions Immunosuppressive therapy allows an adequate control of inflammatory disease in pars planitis, with clinical and visual improvement and steroid dose reduction.

The purpose of the study was to determine the clinical presentation, mode of injury, surgical, and postoperative outcomes in adult patients with traumatic cataract. This is a clinical, observational, and retrospective study with review of records of patients in the period 2010–2012. Eighty patients were included, of whom 67 (83.75 %) were male. The mean age at presentation was 46 years (range 18–82 years). Sixty-four patients (80 %) had a closed-globe blunt ocular trauma and 16 (20 %) had an open-globe penetrating trauma. Seventy-seven (96.25 %) patients underwent phacoemulsification; 13.7 % (n = 11) required placement of capsular tension rings and 22.5 % (n = 18) automated anterior vitrectomy. In 53 % of the cases the intraocular lens (IOL) was placed in the capsular bag. Forty-seven patients (58.75 %) achieved a best-corrected visual acuity of 20/40 or better. In 57 (71.25 %) the final refraction was obtained, with a mean spherical equivalent of −0.56D (range −3.50D to +2.00 D). The improvement in visual acuity was significantly higher when the IOL was placed in the capsular bag compared to when it was placed in the sulcus (average difference of 0.667, p = 0.001). The most common mechanism of trauma is closed globe. Phacoemulsification was the procedure most common performed, with the IOL placed most commonly in the capsular bag. The final best-corrected visual acuity in most patients was 20/40 or better. Placing the IOL in the capsular bag represented an improvement in visual acuity compared to placement in the sulcus.

Medical simulation has added new possibilities to the classical tools used for the teaching of medicine.Knowing the advantages of the use of simulators in medical training allows us to understand the need that exists to be updated in this issue that is rapidly developing. In this manuscript we review the impact of medical error in patient safety and the learning curve in medicine.Use of medical simulation in teaching presents multiple benefits, and its scope reaches physicians and surgeons, students and nonmedical personnel. Mexico has been incorporating simulation centers in health institutions and universities.

The recent pandemic influenza AH1N1 virus made it clear that planning for medical disaster response is critical.To know the responsiveness of a sample of highly specialized hospitals in Mexico to a medical disaster, with the previous pandemic influenza AH1N1 as reference.A survey was conducted among the Medical Directors of a sample of highly specialized hospitals, covering: previous experience with the pandemic influenza, space considerations, material resources, staff, logistics, and current general perspectives. Descriptive statistics were used for analysis.A 95% response was obtained from the institutions (19 hospitals). Of these, 47.4% considered that the medical institution was not ready to respond to pandemic influenza. The median surge capacity for the Intensive Care Unit beds was 30% (range 0 to 32 beds). The least reserve in medication was found in the antivirals (26.3%). Only 47.4% considered having enough intensive care nurses and 57.9% enough respiratory technicians; 42.1% would not have an easy access to resources in an emergency.Prevention is key in responsiveness to medical disasters, and therefore the basic steps for planning strategies must be considered.

ResumenEl síndrome de Axenfeld-Rieger es una entidad de origen genético que se caracteriza por diversos hallazgos oculares. En este artículo se presenta el caso de una paciente de 54 años de edad que es diagnosticada con este síndrome y en cuya exploración se hace evidente la presencia de catarata de manera bilateral, así como alteraciones en la movilidad ocular. Se describen los hallazgos clínicos, ecográficos y por ultrabiomicroscopia, y además se hace una revisión de la literatura sobre el tema.AbstractThe Axenfeld-Rieger syndrome is a genetic entity characterized by various ocular findings. In this article we present the case of a 54-year-old patient who is diagnosed with this syndrome and that within its examination the presence of bilateral cataracts and ocular motility abnormalities are evident. The clinical, echographic and ultrabiomicroscopy findings are described, and also a review of the literature is included.