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Resumen Introduccion El sindrome de desgaste profesional, mas conocido por su traduccion inglesa de sindrome de burnout, hace referencia al cansancio fisico y psicologico que sufre un trabajador como consecuencia de su actividad laboral. Se caracteriza por cansancio emocional, despersonalizacion y falta de realizacion personal. Objetivo Determinar la prevalencia del sindrome de burnout entre los oftalmologos andaluces, tanto adjuntos como residentes, analizando su relacion con diversas variables sociodemograficas. Material y metodos Estudio descriptivo con caracter transversal. Se incluyeron dentro de un formulario de Google® todas las variables sociodemograficas a estudiar junto al cuestionario estandarizado Maslach Burnout Inventory-Human Services Survey (MBI-HSS). Este formulario se remitio a la comunidad oftalmologica andaluza por diferentes medios electronicos (Sociedad Andaluza de Oftalmologia, aplicaciones moviles de mensajeria instantanea, etc.). Resultados Ciento cuarenta y dos oftalmologos contestaron el cuestionario, con una distribucion similar por sexos, y una edad media de 43,77 anos, cumpliendo criterios de burnout ocupacional el 67,61% de ellos. Su prevalencia fue mayor entre los oftalmologos jovenes con menos anos de practica clinica, divorciados/separados, aquellos con menor numero de hijos, pertenecientes a centros de la provincia de Huelva, trabajadores de ambitos rurales/comarcales, aquellos con actividad publica exclusiva, adjuntos con contratos eventuales y residentes de 4.° ano. En cuanto a subespecialidades, la prevalencia resulto mayor entre los que se dedican a cornea-superficie ocular-cirugia refractiva. Conclusiones Este trabajo objetiva por primera vez en Andalucia el desgaste profesional de los oftalmologos. El hecho de que dos terceras partes de la muestra estudiada cumplan criterios de sindrome de burnout evidencia la necesidad de implementar mejoras en las condiciones asistenciales y profesionales de nuestro colectivo.

Introduction Burnout syndrome refers to the physical and psychological fatigue suffered by workers as a result of their professional activity. It has three main characteristics: emotional exhaustion, depersonalization and lack of personal fulfillment. Purpose To determine the prevalence of burnout syndrome among Andalusian ophthalmologists, both consultants and residents, analyzing its relationship with several sociodemographic variables. Material and methods Descriptive cross-sectional study. All the sociodemographic variables were included in a Google® form together with the standardized questionnaire Maslach Burnout Inventory-Human Services Survey (MBI-HSS). This form was sent to the Andalusian ophthalmological community by different electronic means (Andalusian Society of Ophthalmology, instant messaging mobile apps, etc.). Results 142 ophthalmologists answered the form, with a similar distribution by sex and a mean age of 43,77 years, with 67,1% of them meeting criteria of burnout syndrome. Its prevalence was higher among young ophthalmologists, with fewer years of clinical practice, divorced / separated, those with fewer children, belonging to centers in the province of Huelva, workers in rural / regional areas, those with exclusive public activity, consultants with temporary contracts and four-year residents. Regarding subspecialties, its prevalence was higher among those who focused on cornea-ocular surface-refractive surgery. Conclusions This study quantify for the first time in Andalusia the prevalence of burnout syndrome among ophthalmologists. The fact that two thirds of the analyzed sample meet criteria proves the need to implement improvements in the clinical and professional conditions of our group.

A 37-year-old-man from Nicaragua was referred to our Oculoplastics and Orbit Unit due to a large dark vascularized lesion in his left eye (Figure 1A). It appeared during his childhood after a chemi...

[Aim] To assess the relationship between choroidal thickness and renal function in diabetic patients., [Methods] Cross-sectional retrospective clinical study of 42 eyes of 21 ocular treatment-na?ve diabetic patients. Demographic data included: age, sex, type and course of diabetes. Ocular data included: severity of diabetic retinopathy; retinal thickness at the central macular region, as well as choroidal thickness at the central and paracentral quadrants, using automatically generated maps by swept-source optical coherence tomography; presence of cystic macular edema; and ocular axial length (AXL). Lab-test parameters included: glycated hemoglobin (HbA1c), albuminuria, albumin/creatinine ratio in urine, and glomerular filtration rate., [Results] A significant negative correlation was mainly observed between several choroidal thicknesses, age (P, [Conclusion] Choroidal thickness can represent an additional tool to help clinicians predicting the renal status in ocular treatment-naïve diabetic patients., OFTARED “RD16/0008/0010”, funded by Instituto de Salud Carlos III, integrated in the national I+D+i 2013-2016 and co-funded by European Union (ERDF/ESF, “Investing in your future”).

Resumen Paciente de 5 anos de edad con diagnostico de retinoblastoma hereditario bilateral tratada con radioterapia en el ojo izquierdo (OS) y enucleacion del ojo derecho (OD). Despues de 3 anos sin evidencia de progresion presenta una nueva masa tumoral en la orbita derecha, con compromiso del techo, cuyo diagnostico anatomopatologico tras su exeresis mediante abordaje neuroquirurgico resulto ser de tumor oseo de celulas gigantes. Los tumores oseos primarios de la orbita como el tumor de celulas gigantes son una entidad poco frecuente. Los estudios radiologicos y anatomopatologicos resultan esenciales para establecer el diagnostico diferencial de las lesiones que asientan en la orbita.

A case is presented of a 5 year-old patient with bilateral hereditary retinoblastoma treated with radiotherapy in the right eye and enucleation of the left eye. After three years without evidence of progression, the patient presented with a right orbital mass that compromised the frontal bone. After surgical excision, the histology analysis was consistent with a diagnosis of giant cell tumour. Primary orbital bone neoplasms, such as giant cell tumours, are extremely rare. Both radiological and histopathology studies are essential to establish the differential diagnosis of orbital mass lesions.

PRÉCIS: We present our results with “teleoculoplastics-teleorbit” during the coronavirus pandemic.

Background Partial lamellar sclerouvectomy was designed more than 30 years ago by Jerry and Carol Shields, in order to remove melanomas that involved the ciliary body and/or the choroid, while leaving intact the outer portion of the sclera and the overlying sensory retina [ 1 ]. Methods We present two cases of iris-ciliary body melanoma with different size. The performed surgery was a partial lamellar sclerouvectomy plus iridectomy, complemented by intraoperative juxtalimbar ruthenium-106 brachytherapy. Results Both cases achieved anatomical success without developing chronic ocular hypotony in the postoperative period, an infrequent but possible complication [ 2 ]. Even one of them reached a best-corrected visual acuity of 0.7 after silicone oil removal and intravitreal implant of dexamethasone because of secondary macular edema. The other remains stable with counting fingers vision. In this case, the poor functional outcome might be influenced by larger size and longer evolution of the tumor, as well as the uncontrolled arterial hypertension and older age of the patient. Discussion Intraoperative ophthalmic brachytherapy may have a beneficial effect not only over neoplastic activity [ 2 ], but also over early choroidal detachments. Its pro-fibrotic/hemostatic stimulus should be further examined by comparative studies with larger cohorts, either prospectively or retrospectively. Other protective factors could be the utilization of equine pericardial grafts for covering scleral defects as well as leaving high-density silicone oil. Another key aspect is to maintain low blood pressure levels during these procedures in order to avoid intraocular hemorrhages [ 3 ], especially when the patient exceeds the sixth decade, so the anaesthesiologist will also play a decisive role in the operating room. We prefer to anticipate the likely development of lens opacification after this operation [ 4 ], performing cataract surgery at the beginning and using a Cionni capsular tension ring due to a probable zonular instability. Pars plana vitrectomy would also remove peripheral vitreoretinal tractions and seal the retina preventing a detachment. Conclusion As can be observed during the surgical video, a wide range of complications could occur during a partial lamellar sclerouvectomy. Tackle them ahead of time is crucial to achieve anatomical and functional success.

In this manuscript, as members of a National Reference Unit in Ocular Oncology, we present succinctly our preferred surgical technique for iris-ciliary body melanomas. We attach a video describing the steps we usually follow [Video Clip 1], in which an impressive image of an intravitreal air bubble through the hyaloid membrane can be observed [Fig. 1].

Resumen Caso clinico Mujer de 31 anos intervenida de cataratas congenitas siendo aun lactante, que desarrolla posteriormente un glaucoma maligno bilateral refractario a tratamiento medico-quirurgico, hasta alcanzar el estado actual terminal con queratopatia en banda severa. Por este motivo, se realiza con fines esteticos una queratopigmentacion quirurgica intraestromal con la novedad de emplear envases monodosis esteriles de tinta para tatuaje cutaneo, sin hallarse efectos secundarios ni otras complicaciones. Discusion La queratopigmentacion o tatuaje corneal constituye actualmente el ultimo recurso en pacientes que no toleran las lentes cosmeticas o intraoculares y en los que el trasplante corneal esta contraindicado.

Case report A 31-year-old woman who had undergone surgery for a congenital cataract as a newborn developed bilateral malignant glaucoma, which was refractory to medical-surgical treatment. The patient currently has terminal glaucoma and severe band keratopathy. For esthetic purposes, we performed intrastromal keratopigmentation surgery using ink for skin tattoos supplied in sterile single-dose vessels. No secondary effects or complications were observed. Discussion Keratopigmentation or corneal tattooing can now be used as a last resort in patients who are unable to tolerate cosmetic contact or intraocular lenses, or in whom corneal transplant is contraindicated.

Purpose To present the different evolution of 2 cases of endophthalmitis caused by Fusarium solani, an aggressive filamentous fungus, depending on the medical and surgical treatment performed. Methods We present 2 cases of endophthalmitis caused by Fusarium solani. Topical, intrastromal, intravitreal, and systemic antifungal treatment (natamycin, voriconazole, amphotericin B) failed in both cases. Corneal perforation took place in one of them, being unsuccessfully treated with cyanoacrylate and several amniotic membrane transplants. It became necessary to perform a hot penetrating keratoplasty (PK) in both patients. The lenses were removed, and the microbiological analysis showed their colonization by Fusarium solani. In one of the cases, a second PK and a more aggressive pars plana vitrectomy (PPV) were performed after corneal recurrence detected by confocal microscopy, as well as the following therapeutic intra- and postoperative maneuvers: anterior chamber washing with povidone-iodine 5% for 1 min; iridectomy of the infiltrated regions; aspiration of the fungal colonies with vitrector; several air/fluid/amphotericin/voriconazole exchanges during PPV; endodiathermy and endophotocoagulation of the chorioretinitis foci; and intrascleral angle injections of voriconazole and amphotericin. Results These were the only cases of endophthalmitis caused by Fusarium attended to at our hospital during the last 10 years. In the case in which PPV was performed without those maneuvers, endophthalmitis rapidly recurred in a more aggressive way, so finally it became necessary to eviscerate the globe. On the other hand, in the patient who underwent PPV with the specific surgical maneuvers and postoperative procedures described above, we could preserve the eye and even a vision of hand motion without an intraocular lens. Conclusions The main objectives of these surgical procedures are to control the fungal infection and to preserve the ocular globe. It is essential to eliminate all ocular structures (iris, lens, vitreous, etc.) affected by this strain of fungus in order to reduce the risk of recurrence. When indicated, early surgery with the appropriate maneuvers detailed above may make an evisceration unnecessary and even recover some visual acuity.

ResumenObjetivoEn tiempos de merma de recursos, pretendemos con este estudio «auditar» el esfuerzo económico y humano realizado en nuestro hospital desde 2003 con la terapia fotodinámica (TFD) en la degeneración macular asociada a la edad.MétodosEstudio descriptivo de coste-beneficio que analiza 301 ojos de 252 pacientes con degeneración macular asociada a la edad neovascular tratada mediante TFD entre septiembre de 2003 y diciembre de 2006. Se analiza el cambio en la mejor agudeza visual corregida (MAVC), la variación del tamaño lesional en la angiografía fluoresceínica y el coste económico por ojo tratado en comparación con diferentes tratamientos antiangiogénicos intravítreos.ResultadosGlobalmente a lo largo del período de seguimiento, a pesar del tratamiento con TFD, las lesiones han sufrido un aumento de tamaño de 0.315±1.144mm, mientras que la MAVC de estos pacientes ha experimentado un empeoramiento de −0.022±0.078. El crecimiento lesional medio ha sido mayor en: varones, edad≤75 años, patrón angiográfico clásico y tamaño lesional inicial≤3mm. Se ha encontrado un mayor empeoramiento medio de la MAVC en: localización yuxtafoveal, tamaño lesional inicial≤3mm; MAVC inicial>0.1. El coste económico medio ha sido superior en: patrón angiográfico clásico; localización subfoveal; tamaño lesional inicial≤3mm.ConclusionesSi sumamos la menor probabilidad global de empeoramiento de la MAVC en comparación con los estudios existentes y un coste anual razonable, podríamos considerar que la TFD se ha aplicado de forma rentable en nuestro hospital, aunque sin olvidar que la verteporfina no mejora la pérdida de visión como sí hacen los antiangiogénicos, solo logra frenarla.AbstractObjectiveHaving the resources been diminished nowadays, our main aim through this study is to audit both economic and human efforts made at our hospital in photodynamic therapy (PDT) applied to exudative age-related macular degeneration since 2003.MethodsCost-benefit descriptive study which analyzes 301 eyes from 252 patients suffering from neovascular age-related macular degeneration treated with PDT between September 2003 and December 2006. It is analysed the change of the best-corrected visual acuity (BCVA), the variation of the lesion size in the fluorescein angiography and the economic cost per eye compared to different intravitreal antiangiogenic treatments.ResultsOverall, despite the PDT, lesions increased in size (0.315±1.144mm) during the follow-up period, in which patients BCVA did also experienced a deterioration (−0.022±0.078). Mean lesion growth has been higher in: men; age ≤75 years; classic angiographic pattern; initial lesion size≤3mm. Mean BCVA deterioration has been worse in: juxtafoveal localization; initial lesion size≤3mm; initial BCVA>0.1. Mean expense per eye has been higher in: classic angiographic pattern; subfoveal localization; initial lesion size≤3mm.ConclusionsPDT has been applied profitably at our hospital if we put together the global lower chance of BCVA deterioration compared to other existing studies and a reasonable annual cost, without forgetting that verteporfin can just stop loss of vision and not improving it as antiangiogenics do.