64 results on '"Juan Carlos Serna-Ojeda"'
Search Results
2. Trans-epithelial accelerated corneal cross-linking for keratoconus in children
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Andrew Olivo-Payne, Juan Carlos Serna-Ojeda, Erick Hernandez-Bogantes, Alexandra Abdala-Figuerola, Lucero Pedro-Aguilar, Alejandro Lichtinger, Arturo Ramirez-Miranda, Alejandro Navas, and Enrique O. Graue-Hernandez
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1921 ,corneal cross-linking ,keratoconus ,accelerated cross-linking ,pediatric keratoconus ,Ophthalmology ,RE1-994 - Abstract
The aim of the study is to evaluate the safety and efficacy of trans-epithelial accelerated corneal cross-linking (TE-ACXL) in children with progressive keratoconus. Retrospective, case-series of 23 eyes of 14 children who underwent TE-ACXL. Evaluations were performed at baseline and 1, 3, 6, 12 and 18mo postoperatively. Mean follow-up time of 23.82±3.15mo and mean age was 13.7±1.4y (range 11 to 16y). Mean preoperative uncorrected distance visual acuity changed from 0.92±0.45 logMAR (20/160) to 0.71±0.40 logMAR (20/100) (P=0.001). Mean keratometry (Km) changed from 53.87± 6.03 to 53.00±5.81 (P=0.001). Pachymetry did not have significant changes at last follow-up (P=0.30). The mean preoperative sphere was -5.58±2.48 and -4.89±4.66 D (P=0.11) at last follow-up; refractive cylinder from -5.58±2.48 to -5.02±2.23 (P=0.046). In conclusion, tomographic and refractive stability are shown in over 91% of eyes with pediatric progressive keratoconus who underwent TE-ACXL.
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- 2017
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3. Increased Expression of TLR4 in Circulating CD4+T Cells in Patients with Allergic Conjunctivitis and In Vitro Attenuation of Th2 Inflammatory Response by Alpha-MSH
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Jane E. Nieto, Israel Casanova, Juan Carlos Serna-Ojeda, Enrique O. Graue-Hernández, Guillermo Quintana, Alberto Salazar, and María C. Jiménez-Martinez
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allergic conjunctivitis ,TLR4 ,alpha-MSH ,Biology (General) ,QH301-705.5 ,Chemistry ,QD1-999 - Abstract
Ocular allergic diseases are frequently seen in ophthalmological clinical practice. Immunological damage is mediated by a local Th2 inflammatory microenvironment, accompanied by changes in circulating cell subsets, with more effector cells and fewer T regulatory cells (Tregs). This study aimed to evaluate the involvement of toll-like receptor 4 (TLR4) and α-melanocyte stimulating hormone (α-MSH) in the immune regulation associated with perennial allergic conjunctivitis (PAC). We performed an Ag-specific stimulation during 72 h of culturing with or without lipopolysaccharide (LPS) or α-MSH in peripheral blood mononuclear cells (PBMC), analyzing the cell subsets and cytokines induced by the stimuli. We also determined α-MSH in tear samples from healthy donors (HD) or PAC patients. Our findings demonstrate an immunological dysregulation characterized by an increased frequency of CD4+TLR4+ in the PBMC of patients with PAC, compared to HD. Most of these CD4+TLR4+ cells were also CD25+, and when α-MSH was added to the culture, the percentage of CD4+CD25+FoxP3+ increased significantly, while the percentage of CD69+ cells and cytokines IL-4 and IL-6 were significantly decreased. In tears, we found an increased concentration of α-MSH in PAC patients, compared with HD. These findings indicate a novel mechanism involved in controlling ocular allergic diseases, in which α-MSH diminishes the concentration of IL-6 and IL-4, restoring the frequency of Tregs and down-regulating CD4 activation. Moreover, we demonstrated the involvement of CD4+TLR4+ cells as an effector cell subset in ocular allergy.
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- 2020
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4. Intraoperative flap complications in lasik surgery performed by ophthalmology residents
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Lorena Romero-Diaz-de-Leon, Juan Carlos Serna-Ojeda, Alejandro Navas, Enrique O Graue-Hernández, and Arturo Ramirez-Miranda
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Laser in situ keratomileusis ,Intraoperative Complications ,Academic Training ,Refractive Surgery ,Ophthalmology ,RE1-994 - Abstract
Purpose: To report the rate of flap-related complications in LASIK surgery performed by in-training ophthalmology residents and to analyze the risk factors for these complications. Methods: We analyzed 273 flap dissections in 145 patients from March 2013 to February 2014. We included all LASIK surgeries performed by 32 ophthalmology residents using a Moria M2 microkeratome. All the flap-related complications were noted. Comparison between both groups with and without complications was performed with an independent Student's t-test and relative risks were calculated. Results: There were 19 flap-related complications out of the 273 flap dissections (6.95%). The most common complication was incomplete flap dissection (n = 10; 3.66%), followed by free-cap (n = 5; 1.83%), and flap-buttonhole (n = 2; 0.73%). There was no significant difference between the complicated and uncomplicated cases in terms of the right versus the left eye, pachymetry results, white-to-white diameter, and spherical equivalent. But this difference was significant for mean keratometry (P = 0.008), K-min (P = 0.01), and K-max (P = 0.03) between these groups. Final visual acuity after rescheduling laser treatment was similar in both groups. Relative risks for flap-related complications were 2.03 for the first LASIK surgery (CI 95% 0.64 to 6.48; P = 0.22) and 1.26 (CI 95% 0.43 to 3.69; P = 0.66) for the surgeon's flap-related complications. Female gender presented an odds ratio of 2.48 (CI 95% 0.68 to 9.00; P = 0.16) for complications. Conclusion: Flap-related complications are common intraoperative event during LASIK surgery performed by in-training ophthalmologists. Keratometries and surgeon's first procedure represent a higher probability for flap related complications than some other biometric parameters of patient's eye.
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- 2016
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5. Hypertensive Retinopathy as the First Manifestation of Advanced Renal Disease in a Young Patient: Report of a Case
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Karen Janeth Arriozola-Rodríguez, Juan Carlos Serna-Ojeda, Virginia Alejandra Martínez-Hernández, and José Luis Rodríguez-Loaiza
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Chronic renal failure ,Renal disease ,Hypertension ,Hypertensive retinopathy ,Ophthalmology ,RE1-994 - Abstract
The purpose of this paper was to report the case of a 23-year-old patient suffering from bilateral acute visual loss who received the diagnosis of hypertensive retinopathy. After systemic evaluation, he was diagnosed with bilateral renal disease and chronic renal failure, requiring a kidney transplantation to manage the systemic illness, followed by gradual improvement of his visual acuity.
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- 2015
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6. Síndrome de Axenfeld-Rieger: Hallazgos clínicos, ecográficos y en ultrabiomicroscopia
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Juan Enrique Almendárez-Reyna, Juan Carlos Serna-Ojeda, Pamela Cepeda-Vázquez, Dulce María Vargas-Romero, Wilson Koga-Nakamura, Mariana Takane-Imay, and M.a Cristina González-González
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Síndrome de Axenfeld-Rieger ,Axenfeld-Rieger ,Catarata ,Ultrabiomicroscopia ,Ecografía ,Embriotoxón posterior ,Ophthalmology ,RE1-994 - Abstract
El 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.
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- 2015
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7. Glaucoma maligno en paciente con cirugía previa de catarata traumática e implante valvular: reporte de caso
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Juan Carlos Serna-Ojeda, Dalia Consuelo Guadarrama-Vallejo, Jessica Daniela Valencia-Aguirre, Jorge Córdova-Cervantes, Humberto Matiz-Moreno, and Vincent Korder-Ortega
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Glaucoma maligno ,Facoemulsificación ,Implante valvular ,Glaucoma secundario ,Catarata traumática ,Glaucoma ,Ophthalmology ,RE1-994 - Abstract
El glaucoma maligno es un glaucoma secundario asociado con un bloqueo ciliar y dirección equivocada del flujo del humor acuoso. Se presenta el caso de un paciente masculino de 19 años con antecedente de explosión de filtro metálico en ojo derecho. Se encuentra con una presión intraocular de 52 mmHg y cristalino luxado a cámara anterior. Se inicia terapia máxima para glaucoma y se realiza facoemulsificación con posterior colocación de válvula de Ahmed, y 3 semanas después de la cirugía presenta hallazgos clínicos compatibles con glaucoma maligno. Se presenta el seguimiento del paciente y los estudios de imagen indicados
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- 2015
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8. Clinical and Echographic Long-Term Follow-Up of a Retinal Macrocyst: A Case Report
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Juan Carlos Serna-Ojeda, Christian Denisse Pinkus-Herrera, Maria Victoria Moreno-Londono, Jose Luis Rodriguez-Loaiza, and Maria Cristina Gonzalez-Gonzalez
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Retinal macrocyst ,Retinal detachment ,B-mode echography ,A-mode echography ,Ophthalmology ,RE1-994 - Abstract
The purpose of this paper is to report the case of a 62-year-old male diagnosed with a retinal macrocyst secondary to a long-standing retinal detachment in his right eye. At fundoscopy examination, an oval, elevated retinal lesion in the superior nasal quadrant was noted. Ultrasonography was performed, with a B-mode echography showing an oval, anechoic image and a standardized A-mode echography with a reflectivity spike higher than 98%, which was compatible with a retinal macrocyst. The patient refused surgical treatment for the retinal detachment and was followed for 14 months with stable visual acuity and no clinical or echographic changes.
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- 2014
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9. Síndrome de Vogt-Koyanagi-Harada
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Juan Carlos Serna-Ojeda and Miguel Pedroza-Seres
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Vogt-Koyanagi-Harada ,panuveítis ,vitiligo. ,Medicine ,Medicine (General) ,R5-920 - Abstract
El síndrome de Vogt-Koyanagi-Harada es una enfermedad con hallazgos dermatológicos, neurológicos y auditivos, asociada con una panuveítis granulomatosa bilateral. Presentamos el caso de una mujer de 42 años de edad que inició con manifestaciones oftalmológicas, y en el seguimiento a largo plazo desarrolló los hallazgos dermatológicos clásicos.
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- 2016
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10. Interferon alpha-2b in giant ocular surface squamous neoplasia
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Erick Hernandez-Bogantes, Juan Carlos Serna-Ojeda, Alejandro Lichtinger, and Enrique O Graue-Hernández
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Conjunctival neoplasia ,interferon ,squamous neoplasia ,Ophthalmology ,RE1-994 - Published
- 2016
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11. Short-Term Results Analysis in the Allogenic Transplantation of Limbal Stem Cells Expanded on Amniotic Membrane in Patients with Bilateral Limbal Stem Cell Deficiency
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Alejandro Navas, Mariana Garcia-Mejia, Enrique O Graue-Hernandez, Juan Carlos Serna-Ojeda, and Yonathan Garfias
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Male ,0301 basic medicine ,Pathology ,Non-Randomized Controlled Trials as Topic ,medicine.medical_treatment ,Corneal Diseases ,Cornea ,0302 clinical medicine ,Pharmacology (medical) ,Prospective Studies ,Aniridia ,Stem Cells ,Epithelium, Corneal ,Stem-cell therapy ,Allogenic transplantation ,Middle Aged ,Treatment Outcome ,Female ,Stem cell ,Ocular surface ,Adult ,medicine.medical_specialty ,ATP Binding Cassette Transporter, Subfamily B ,Adolescent ,Limbus Corneae ,Limbal stem cell deficiency ,Young Adult ,03 medical and health sciences ,medicine ,Humans ,Transplantation, Homologous ,In patient ,Amnion ,Mexico ,Pharmacology ,business.industry ,Tumor Suppressor Proteins ,medicine.disease ,eye diseases ,Transplantation ,Ophthalmology ,030104 developmental biology ,Case-Control Studies ,030221 ophthalmology & optometry ,sense organs ,business ,Corneal Injuries ,Follow-Up Studies ,Stem Cell Transplantation ,Transcription Factors - Abstract
Purpose: The objective of this study was to describe the short-term results of allogenic transplantation of limbal stem cells expanded on amniotic membrane for the ocular surface reconstruction. Methods: Prospective nonrandomized, nonmasked study in a single ophthalmological center. Ten patients with bilateral total limbal stem cell deficiency (LSCD) were included. Expression and presence of ABCB5 and Δp63α in amniotic membrane-cultured limbal epithelial stem cells were analyzed, in relationship with clinical changes after allogenic transplantation. An objective evaluation was performed to determine corneal transparency and superficial vascularization. Results: In a median follow-up time of 11.6 months, 7 patients (70%) were considered as failure compared with the preoperative status. ABCB5 and Δp63α are expressed in similar amount in the limbal epithelial cells expanded in vitro and transplanted in patients with bilateral LSCD. Conclusions: Transplantation of allogenic epithelial limbal cells expanded in amniotic membrane could be considered in patients with LSCD due to burns or congenital etiologies such as aniridia, but its benefit is limited for patients with immunologic diseases.
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- 2020
12. The Aurolab Keratoprosthesis (KPro) versus the Boston Type I Kpro: 5-year Clinical Outcomes in 134 Cases of Bilateral Corneal Blindness
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Juan Carlos Serna-Ojeda, Sirisha Senthil, Rajeev R Pappuru, Bhupesh Bagga, Virender S Sangwan, and Sayan Basu
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Male ,medicine.medical_specialty ,Time Factors ,Visual acuity ,Keratoprosthesis ,Visual Acuity ,Blindness ,Prosthesis Design ,Corneal Diseases ,Limbal stem cell deficiency ,Cornea ,Corneal blindness ,Primary outcome ,Humans ,Medicine ,Effective treatment ,Child ,Aged ,Retrospective Studies ,business.industry ,Retrospective cohort study ,Prostheses and Implants ,Middle Aged ,Functional recovery ,Surgery ,Ophthalmology ,Treatment Outcome ,Child, Preschool ,Female ,Artificial Organs ,medicine.symptom ,business ,Follow-Up Studies - Abstract
Purpose To compare the clinical outcomes of Boston Type I keratoprosthesis (Boston Kpro) with its low-cost version, the Aurolab Kpro (auroKPro). Design Retrospective comparative case series. Methods This study included 134 eyes of 130 patients with severe bilateral corneal blindness but with wet ocular surfaces. The patients underwent either Boston Kpro (n = 78) or auroKPro (n = 56) implantation based on the device availability and patient's affordability. The primary outcome measurements were anatomical retention (defined as absence of device extrusion, exchange, or explantation) and functional recovery of 20/200 or better visual acuity at yearly time points until 5-years of follow-up. Results Limbal stem cell deficiency was the most common indication (60.5%) for surgery, followed by multiple failed grafts (35%). Both groups were comparable at baseline with respect to indications for surgery and associated ocular co-morbidities (P > 0.05). The overall anatomical retention rates were similar in the Boston Kpro (55 of 78, 70.5%) and auroKPro (35 of 56, 62.5%) groups (P = 0.11). Kaplan-Meier survival rates at 5 years of follow-up were greater for the Boston Kpro with respect to both anatomical retention (63 ± 6% vs. 43.4 ± 10%, respectively; P = 0.057) and functional recovery (42.4 ± 6% vs. 32.2 ± 7%, respectively; P = 0.345), but these differences were not statistically significant. Complications such as intraoperative device breakage (7%) and postoperative extrusions (12.5%) were significantly more common with the auroKPro (P = 0.023). Conclusions Both the auroKPro and the Boston Kpro are effective treatment options for patients with severe bilateral corneal blindness. The auroKPro can be considered an alternative to the Boston Kpro when affordability or availability of the Boston Kpro is a limiting factor.
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- 2019
13. Increased Expression of TLR4 in Circulating CD4+T Cells in Patients with Allergic Conjunctivitis and In Vitro Attenuation of Th2 Inflammatory Response by Alpha-MSH
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Juan Carlos Serna-Ojeda, Jane E Nieto, Maria C. Jiménez-Martínez, Enrique O Graue-Hernandez, Alberto Salazar, Guillermo Quintana, and Israel Casanova
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0301 basic medicine ,CD4-Positive T-Lymphocytes ,Lipopolysaccharides ,Male ,Lipopolysaccharide ,Stimulation ,lcsh:Chemistry ,chemistry.chemical_compound ,0302 clinical medicine ,Medicine ,IL-2 receptor ,TLR4 ,Receptor ,Child ,lcsh:QH301-705.5 ,Spectroscopy ,Cells, Cultured ,Conjunctivitis, Allergic ,FOXP3 ,General Medicine ,Allergic conjunctivitis ,Computer Science Applications ,Up-Regulation ,Female ,Adolescent ,Peripheral blood mononuclear cell ,Catalysis ,Article ,Inorganic Chemistry ,03 medical and health sciences ,Th2 Cells ,Humans ,Physical and Theoretical Chemistry ,Molecular Biology ,030201 allergy ,business.industry ,Interleukin-6 ,Organic Chemistry ,medicine.disease ,Toll-Like Receptor 4 ,allergic conjunctivitis ,030104 developmental biology ,chemistry ,lcsh:Biology (General) ,lcsh:QD1-999 ,alpha-MSH ,Case-Control Studies ,Immunology ,Interleukin-4 ,business - Abstract
Ocular allergic diseases are frequently seen in ophthalmological clinical practice. Immunological damage is mediated by a local Th2 inflammatory microenvironment, accompanied by changes in circulating cell subsets, with more effector cells and fewer T regulatory cells (Tregs). This study aimed to evaluate the involvement of toll-like receptor 4 (TLR4) and &alpha, melanocyte stimulating hormone (&alpha, MSH) in the immune regulation associated with perennial allergic conjunctivitis (PAC). We performed an Ag-specific stimulation during 72 h of culturing with or without lipopolysaccharide (LPS) or &alpha, MSH in peripheral blood mononuclear cells (PBMC), analyzing the cell subsets and cytokines induced by the stimuli. We also determined &alpha, MSH in tear samples from healthy donors (HD) or PAC patients. Our findings demonstrate an immunological dysregulation characterized by an increased frequency of CD4+TLR4+ in the PBMC of patients with PAC, compared to HD. Most of these CD4+TLR4+ cells were also CD25+, and when &alpha, MSH was added to the culture, the percentage of CD4+CD25+FoxP3+ increased significantly, while the percentage of CD69+ cells and cytokines IL-4 and IL-6 were significantly decreased. In tears, we found an increased concentration of &alpha, MSH in PAC patients, compared with HD. These findings indicate a novel mechanism involved in controlling ocular allergic diseases, in which &alpha, MSH diminishes the concentration of IL-6 and IL-4, restoring the frequency of Tregs and down-regulating CD4 activation. Moreover, we demonstrated the involvement of CD4+TLR4+ cells as an effector cell subset in ocular allergy.
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- 2020
14. LVP keratoprosthesis: anatomical and functional outcomes in bilateral end-stage corneal blindness
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Bhupesh Bagga, Virender S Sangwan, Juan Carlos Serna-Ojeda, Swapnil Bhalekar, Sayan Basu, and Ritu Nagpal
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medicine.medical_specialty ,genetic structures ,Keratoprosthesis ,business.industry ,Mucous membrane ,eye diseases ,Sensory Systems ,03 medical and health sciences ,Cellular and Molecular Neuroscience ,Ophthalmology ,Corneal blindness ,0302 clinical medicine ,medicine.anatomical_structure ,Primary outcome ,Cornea ,030221 ophthalmology & optometry ,medicine ,Stage (cooking) ,business ,Ocular surface ,030217 neurology & neurosurgery ,Survival analysis - Abstract
PurposeTo describe the anatomical and functional outcomes of the novel LVP keratoprosthesis (Kpro), developed as an alternative to the modified osteo-odonto keratoprosthesis (MOOKP), in eyes with end-stage corneal blindness where conventional corneal surgeries are contraindicated.MethodsThis prospective case series included 58 eyes of 56 patients (12 children and 44 adults) with severe bilateral keratopathy and completely dry, dermalised ocular surfaces who underwent unilateral LVP Kpro implantation from 2012 to 2016. In this two-stage procedure, an ocular surface labial mucous membrane grafting was performed, followed for 3 months by the implantation of the device under the engrafted mucosal flap. The primary outcome measures were anatomical retention rate and improvement in best corrected visual acuity (BCVA). The secondary outcome measure was rate of occurrence of complications.ResultsMean postoperative follow-up was 2.5±1.1 years. Kaplan-Meier survival analysis showed an anatomical retention rate of 90.8%±3.9% at 1 year, 80%±5.7% at 2 years and 76.6%±6.5% at 3–5 years. The survival rates were comparable in children and adults (91% vs 72% at 5 years, p=0.258). About 61.5% of eyes maintained 20/400 or better vision and median BCVA improved from perception of light to 20/70 at 1 year postoperatively (pConclusionThe LVP Kpro is an effective procedure for the treatment of end-stage corneal blindness in completely dry eyes. The LVP Kpro can be particularly useful in situations where the MOOKP is contraindicated or difficult to perform.
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- 2018
15. Objective and subjective results following implantation of the FineVision trifocal intraocular lens in Mexican patients
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Juan Carlos Serna-Ojeda, Eduardo Chávez-Mondragón, Karla Zuñiga-Posselt, and Ivo Ferreira-Rios
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Adult ,Male ,medicine.medical_specialty ,Eye Diseases ,genetic structures ,medicine.medical_treatment ,media_common.quotation_subject ,Visual Acuity ,Objective analysis ,Spherical equivalent ,Intraocular lens ,Cataract Extraction ,Prosthesis Design ,Contrast Sensitivity ,03 medical and health sciences ,0302 clinical medicine ,Lens Implantation, Intraocular ,Ophthalmology ,Aberrometry ,Humans ,Medicine ,Contrast (vision) ,Prospective Studies ,Mexico ,Dioptre ,Aged ,media_common ,Lenses, Intraocular ,Monocular ,business.industry ,Middle Aged ,Cataract surgery ,eye diseases ,Patient Satisfaction ,030221 ophthalmology & optometry ,Female ,business ,030217 neurology & neurosurgery - Abstract
To evaluate objective and subjective results after bilateral implantation of a diffractive trifocal intraocular lens (IOL) in a Mexican population. Prospective, interventional case series involved 15 cataract surgery patients who underwent bilateral implantation of the trifocal Micro F lens FineVision IOL (PhysIOL, Liege, Belgium). Objective analysis involved assessment of monocular uncorrected distance (UDVA), near (UNVA) at 30 and 40 cm, and intermediate visual acuity (UIVA) at 50, 60, and 70 cm, preoperatively, and at postoperative months 1, 3, and 6. Higher-order aberrations were assessed via aberrometry. Contrast sensitivity was determined via modulation transfer function. Subjective outcomes were assessed using the National Eye Institute Visual Functioning Questionnaire-25 (VFQ-25). At postoperative month 6, mean monocular UDVA was 0.06 ± 0.11 logMAR, and UNVA was 0.03 ± 0.04 logMAR at 30 cm and 0.05 ± 0.08 logMAR at 40 cm. Mean UIVA at 50, 60, and 70 cm was 0.12 ± 0.06, 0.13 ± 0.08, and 0.04 ± 0.08 logMAR, respectively. Spherical equivalent at postoperative month 3 was 0.23 ± 0.4 diopters (D). Aberrometry revealed a mean RMS of 0.18 microm and PSF of 0.19 (Strehl ratio). VFQ-25 questionnaire results showed a mean score of 93.64 ± 4.19 points (maximum 100 points). Vision during distance and near activities was reported as “excellent.” Adverse events were reported as occurring “never to occasionally.” Implantation of a diffractive trifocal IOL in a Mexican population appears safe and effective, both objectively and subjectively. Good uncorrected visual acuity outcomes were achieved at far, near, and intermediate distances. Overall patient satisfaction was excellent.
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- 2017
16. Chiasmal syndrome: Clinical characteristics in patients attending an ophthalmological center
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Aline Astorga-Carballo, Juan Carlos Serna-Ojeda, and Mayra Fabiola Camargo-Suarez
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Diplopia ,medicine.medical_specialty ,Visual acuity ,genetic structures ,business.industry ,Medical record ,Chiasmal syndrome ,medicine.disease ,Pallor ,eye diseases ,03 medical and health sciences ,Ophthalmology ,0302 clinical medicine ,lcsh:Ophthalmology ,lcsh:RE1-994 ,030221 ophthalmology & optometry ,medicine ,Etiology ,Optic nerve ,Original Article ,medicine.symptom ,business ,Bitemporal hemianopsia ,030217 neurology & neurosurgery - Abstract
Purpose: To present the clinical characteristics of a group of patients with the diagnosis of chiasmal syndrome who attended a large ophthalmological institute. Methods: Retrospective, observational clinical study with the review of medical records of patients with a diagnosis of chiasmal syndrome. The following variables were assessed: demographic characteristics, chief complaint upon presentation, best-corrected visual acuity (BCVA), presence or absence of diplopia, pupillary responses, optic nerve head morphology, etiology, and results from the ancillary tests including Ishihara test, Goldmann visual field (GVF) perimetry and neuroimaging. Results: A total of 104 met the inclusion criteria, with a median age of 52Â years (range 4â86Â years). Fifty-four patients (51.9%) were referred to our institution with a diagnosis of a causative etiology for chiasmal syndrome, while in 50 (48.1%) the diagnosis was performed at our center. The most common presenting symptom was low visual acuity in 57 patients (54.8%), and the most common GVF defect was bitemporal hemianopsia in 39 patients (78 eyes, 39.8%). Pupillary abnormalities were present in 58 patients (55.7%), the optic nerve revealed pallor at any degree in 67 patients (64.4%) and the Ishihara test was affected in 65 patients (62.5%). The most common diagnosis was pituitary macroadenoma. Conclusion: The ophthalmologist participates in the diagnosis and rehabilitation of patients with chiasmal syndrome. Low visual acuity is the most common symptom at presentation, and bitemporal hemianopia the most frequent GVF defect. Examination of the optic nerve head and pupillary responses, and ancillary tests including Ishihara test and neuroimaging are relevant for diagnosis. Keywords: Chiasmal syndrome, Intracranial tumor, Perimetry, Ishihara test, Bitemporal hemianopsia
- Published
- 2017
17. Anterior segment optical coherence tomography angle and vault analysis after toric and non-toric implantable collamer lens V4c implantation in patients with high myopia
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Andrew Olivo-Payne, Guillermo Garcia-De la Rosa, Arturo Ramirez-Miranda, Arturo Gomez-Bastar, Enrique O Graue-Hernandez, Maria Sandra Salazar-Ramos, Juan Carlos Serna-Ojeda, Alejandro Navas, and Alejandro Lichtinger
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Adult ,Male ,Phakic Intraocular Lenses ,medicine.medical_specialty ,Mesopic vision ,Visual Acuity ,Young Adult ,03 medical and health sciences ,Cellular and Molecular Neuroscience ,0302 clinical medicine ,Lens Implantation, Intraocular ,Optical coherence tomography ,Anterior Eye Segment ,Ophthalmology ,Cornea ,Humans ,Medicine ,In patient ,Prospective Studies ,Iridocorneal angle ,Implantable collamer lens ,Analysis of Variance ,medicine.diagnostic_test ,business.industry ,High myopia ,Mean age ,Sensory Systems ,Surgery ,medicine.anatomical_structure ,Myopia, Degenerative ,030221 ophthalmology & optometry ,Female ,business ,Tomography, Optical Coherence ,030217 neurology & neurosurgery - Abstract
ObjectiveTo assess anterior segment changes, including iridocorneal angle and vault, after toric and non-toric implantable collamer lens (ICL) V4c (STAAR Surgical AG) implantation under different lighting conditions.MethodsLongitudinal, prospective, case series. Patients with high myopia (>6 dioptres) underwent toric and non-toric ICL V4c implantation. Optical coherence tomography measurements were taken under different lighting conditions preoperatively and at 1 week and 1, 6 and 12 months of follow-up.ResultsSeventy-six eyes of 42 patients underwent ICL V4c implantation. Mean age was 27.4 years (±5.14 years, range 20 to 39 years). The average iridocorneal angle showed a statistically significant decrease (pConclusionThere is a significant reduction in the iridocorneal angle after ICL V4c implantation. Furthermore, there is a change under mesopic conditions in both the iridocorneal angle and vault during long-term follow-up.
- Published
- 2017
18. Esclerodermatomiositis con manifestaciones oculares predominantes
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M. Pedroza-Seres, Juan Carlos Serna-Ojeda, and L.F. Flores-Suárez
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Ophthalmology - Abstract
Resumen Antecedentes La esclerodermatomiositis es un sindrome de superposicion que tiene manifestaciones dermatologicas, musculares y articulares, y que puede presentar afeccion ocular. Caso clinico Se presenta el caso de una mujer de 57 anos en quien la exploracion oftalmologica hizo evidente adelgazamiento escleral 360 grados, celularidad anterior y vitrea. La exploracion fisica orientada y los estudios de laboratorio permitieron sustentar el diagnostico de esclerodermatomiositis, por lo que se trato de forma sistemica. Conclusion La esclerodermatomiositis es una enfermedad rara, cuyo diagnostico implica estudio clinico y de laboratorio, y su manejo debe ser multidisciplinario, donde las manifestaciones oculares inflamatorias pueden estar presentes.
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- 2017
19. Sclerodermatomyositis, ocular manifestations
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M. Pedroza-Seres, Juan Carlos Serna-Ojeda, and L.F. Flores-Suárez
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030203 arthritis & rheumatology ,medicine.medical_specialty ,Pathology ,genetic structures ,Anti-nuclear antibody ,medicine.diagnostic_test ,business.industry ,Physical examination ,Overlap syndrome ,General Medicine ,medicine.disease ,Dermatology ,eye diseases ,Scleroderma ,03 medical and health sciences ,0302 clinical medicine ,Scleral thinning ,030221 ophthalmology & optometry ,medicine ,Clinical case ,business ,Myositis ,Rare disease - Abstract
Background Sclerodermatomyositis is an overlap syndrome of myositis and scleroderma, with dermatological, muscular and joint involvement, but may also present with ocular manifestations. Clinical case A 57 year-old woman presented with ophthalmological manifestations, including scleral thinning 360°, and the presence of cells in the anterior and posterior chamber. Oriented physical examination and laboratory studies led to the diagnosis, with the need for systemic treatment. Conclusion Sclerodermatomyositis is a rare disease. Its diagnosis needs thorough clinical and laboratory studies, and its management should be multidisciplinary when inflammatory ocular manifestations may be present.
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- 2017
20. Outcomes of cataract surgery with/without vitrectomy in patients with pars planitis and immunosuppressive therapy
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Aida Jimenez-Corona, Juan Carlos Serna-Ojeda, Tania Albavera-Giles, and Miguel Pedroza-Seres
- Subjects
Adult ,Male ,medicine.medical_specialty ,Visual acuity ,Adolescent ,genetic structures ,medicine.medical_treatment ,Visual Acuity ,Intraocular lens ,Vitrectomy ,Cataract ,Young Adult ,03 medical and health sciences ,Cellular and Molecular Neuroscience ,0302 clinical medicine ,Lens Implantation, Intraocular ,Ophthalmology ,medicine ,Humans ,Pars Planitis ,Child ,Retrospective Studies ,Immunosuppression Therapy ,Phacoemulsification ,business.industry ,Cataract surgery ,eye diseases ,Sensory Systems ,Posterior segment of eyeball ,Treatment Outcome ,Child, Preschool ,030221 ophthalmology & optometry ,Female ,medicine.symptom ,Complication ,business ,Immunosuppressive Agents ,030217 neurology & neurosurgery ,Follow-Up Studies - Abstract
The purpose of this study was to evaluate the characteristics and outcomes of cataract surgery with/without vitrectomy in patients with pars planitis who received immunosuppressive therapy. This was a retrospective case series, single-center study. Twenty-two patients with pars planitis who received immunosuppressive therapy were included, with a median age at presentation of 9.5 years, having had cataract surgery. The following data was collected: age at presentation and at cataract surgery, time of follow-up, best-corrected visual acuity (BCVA) before the surgery and at 1 week, 1 and 6 months after the procedure, immunosuppressive therapy, complications and causes for failed visual improvement. The variables associated with an improvement in visual acuity were evaluated. All patients had phacoemulsification with intraocular lens implantation. The most common immunosuppressive therapy used for the patients was methotrexate in nine patients (40.9%). The BCVA improved from a median of 20/400 to 20/100 after 6 months of follow-up (p = 0.0005); 14 patients (63.6%) improved two lines of vision or more. No significant risk factors were found for the association with improvement in visual acuity after the surgery. No improvement in visual acuity was attributed to posterior segment manifestations or amblyopia; the most common complication was posterior capsule opacification in 11 eyes (50%). The median follow-up after the surgery was 32 months. Phacoemulsification was the procedure for all the patients. Visual acuity improved in patients with pars planitis treated with immunosuppressive drugs who underwent cataract surgery, except for the patients with posterior segment complications or amblyopia.
- Published
- 2017
21. Practice Patterns in the Management of Primary Pterygium: A Survey Study
- Author
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Alejandro Navas, Juan Carlos Serna-Ojeda, Arturo Ramirez-Miranda, Enrique O Graue-Hernandez, Mark J. Mannis, Aida Jimenez-Corona, and Andrea Córdoba
- Subjects
Adult ,Male ,medicine.medical_specialty ,Ophthalmologic Surgical Procedures ,Astigmatism ,Pterygium ,Cornea ,03 medical and health sciences ,0302 clinical medicine ,Recurrence ,Surveys and Questionnaires ,medicine ,Adjuvant therapy ,Humans ,Practice Patterns, Physicians' ,Fibrin glue ,Aged ,Retrospective Studies ,Ophthalmologists ,business.industry ,Cosmesis ,Retrospective cohort study ,Middle Aged ,medicine.disease ,eye diseases ,Surgery ,Ophthalmology ,medicine.anatomical_structure ,030221 ophthalmology & optometry ,Observational study ,Female ,sense organs ,business ,030217 neurology & neurosurgery - Abstract
Purpose To characterize cornea specialists' current practice preferences in the management of primary pterygium. Methods A 25-item survey regarding indications for surgery, surgical technique, use of adjuvant therapy, type and duration of postoperative therapy, and treatment of early recurrences was designed and sent to members of the Cornea Society through the kera-net listserv. Results In total, 199 cornea specialists completed the questionnaire. More than 90% considered that surgery should be performed when there is proximity of the pterygium to the visual axis, pain or redness, eye movement restriction, or induction of astigmatism. Cosmesis was considered as an indication by 41.7% of the participants. The most frequent technique for pterygium excision was complete resection including the base and a moderate quantity of Tenon capsule followed by autologous conjunctival or limbal-conjunctival graft. The preferred graft fixation method in this survey was fibrin glue (61.2%). Most respondents reported a recurrence rate of less than 5% and no use of adjuvant agents to prevent recurrence. When early recurrence did occur, the preferred agents were corticosteroids. Conclusions This study reflects the preferences of cornea experts regarding primary pterygium treatment and may serve as a guide for the management of this pathology.
- Published
- 2019
22. Pain Management in Corneal Collagen Crosslinking for Keratoconus: A Comparative Case Series
- Author
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Juan Carlos Serna-Ojeda, Omar Santana-Cruz, José Luis Mercado-Orozco, Alejandro Lichtinger, Alejandro Navas, Enrique O Graue-Hernandez, Natalia Quiroz-Casian, and Edgar González-Mendoza
- Subjects
Adult ,Male ,Keratoconus ,medicine.medical_specialty ,Gabapentin ,Adolescent ,Postoperative pain ,Administration, Oral ,Cornea ,Young Adult ,Ophthalmology ,Surveys and Questionnaires ,medicine ,Humans ,Pharmacology (medical) ,Prospective Studies ,Pain Measurement ,Pharmacology ,Analgesics ,Pain, Postoperative ,business.industry ,Anti-Inflammatory Agents, Non-Steroidal ,Pain management ,medicine.disease ,body regions ,Ketorolac ,Cross-Linking Reagents ,Treatment Outcome ,Female ,Collagen ,business ,medicine.drug - Abstract
Purpose: To compare management of postoperative pain after corneal collagen crosslinking (CXL) with oral gabapentin or ketorolac. Methods: Prospective interventional comparative case serie...
- Published
- 2019
23. Management of Herpes Simplex Virus Keratitis in the Pediatric Population
- Author
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Juan Carlos Serna-Ojeda
- Subjects
Microbiology (medical) ,medicine.medical_specialty ,business.industry ,MEDLINE ,Herpesvirus 1, Human ,medicine.disease_cause ,medicine.disease ,Dermatology ,Keratitis ,Infectious Diseases ,Herpes simplex virus ,Pediatrics, Perinatology and Child Health ,Keratitis, Herpetic ,Medicine ,Humans ,business ,Child ,Pediatric population - Published
- 2019
24. Therapeutic Penetrating Keratoplasty
- Author
-
Juan Carlos Serna-Ojeda
- Subjects
Ophthalmology ,medicine.medical_specialty ,Tissue and Organ Procurement ,business.industry ,Corneal Perforation ,MEDLINE ,Medicine ,Humans ,business ,Keratoplasty, Penetrating ,Tissue Donors ,Surgery - Published
- 2019
25. Characteristics of Sympathetic Ophthalmia in a Single International Center
- Author
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Juan Carlos Serna-Ojeda, Miguel Pedroza-Seres, Pablo Jose Guzman-Salas, and Ethel Beatriz Guinto-Arcos
- Subjects
medicine.medical_specialty ,Ocular surgery ,Ocular trauma ,Referral ,medicine.medical_treatment ,0211 other engineering and technologies ,02 engineering and technology ,Single Center ,Article ,03 medical and health sciences ,0302 clinical medicine ,Sympathetic ophthalmia ,Prednisone ,Ophthalmology ,Panuveitis ,medicine ,021110 strategic, defence & security studies ,business.industry ,Phacoemulsification ,medicine.disease ,eye diseases ,Surgery ,030221 ophthalmology & optometry ,Presentation (obstetrics) ,business ,Uveitis ,medicine.drug - Abstract
Aim: To report the main features of sympathetic ophthalmia in a referral ophthalmology center. Methods: Retrospective clinical study. We reviewed clinical records of patients with diagnosis of sympathetic ophthalmia attending the Uveitis Department from 2007 to 2013. Patients were selected by clinical criteria. Descriptive statistics were used to assess variables. Results: Twenty patients were included for analysis, 13 males and 7 females. Mean follow up was 1 year. The median age of presentation was 50 years. Fifty percent had history of ocular trauma and 50% had history of intraocular surgery, of which 40% underwent phacoemulsification. The time between injury and onset of symptoms ranged from 1 to 456 months. Most common ocular manifestations were mutton fat keratic precipitates and anterior chamber inflammation. All patients received oral prednisone as single or combined therapy. Sixty percent of the sympathizing eyes improved two or more lines of vision and 20% lost two or more lines of vision. Conclusion: This report from a single center adds to the body of literature of sympathetic ophthalmia occurring in a specific population. Our data found a high proportion of patients with sympathetic ophthalmia after phacoemulsification.
- Published
- 2016
26. Intraoperative flap complications in lasik surgery performed by ophthalmology residents
- Author
-
Juan Carlos Serna-Ojeda, Alejandro Navas, Arturo Ramirez-Miranda, Enrique O Graue-Hernandez, and Lorena Romero-Diaz-de-Leon
- Subjects
medicine.medical_specialty ,Visual acuity ,medicine.medical_treatment ,03 medical and health sciences ,0302 clinical medicine ,lcsh:Ophthalmology ,Microkeratome ,Ophthalmology ,Refractive surgery ,medicine ,Laser in situ keratomileusis ,Intraoperative Complications ,Academic Training ,Refractive Surgery ,business.industry ,LASIK ,Odds ratio ,eye diseases ,Surgery ,Dissection ,lcsh:RE1-994 ,Relative risk ,030221 ophthalmology & optometry ,Original Article ,medicine.symptom ,business ,Complication ,030217 neurology & neurosurgery - Abstract
Purpose: To report the rate of flap-related complications in LASIK surgery performed by in-training ophthalmology residents and to analyze the risk factors for these complications. Methods: We analyzed 273 flap dissections in 145 patients from March 2013 to February 2014. We included all LASIK surgeries performed by 32 ophthalmology residents using a Moria M2 microkeratome. All the flap-related complications were noted. Comparison between both groups with and without complications was performed with an independent Student's t -test and relative risks were calculated. Results: There were 19 flap-related complications out of the 273 flap dissections (6.95%). The most common complication was incomplete flap dissection ( n = 10; 3.66%), followed by free-cap ( n = 5; 1.83%), and flap-buttonhole ( n = 2; 0.73%). There was no significant difference between the complicated and uncomplicated cases in terms of the right versus the left eye, pachymetry results, white-to-white diameter, and spherical equivalent. But this difference was significant for mean keratometry ( P = 0.008), K-min ( P = 0.01), and K-max ( P = 0.03) between these groups. Final visual acuity after rescheduling laser treatment was similar in both groups. Relative risks for flap-related complications were 2.03 for the first LASIK surgery (CI 95% 0.64 to 6.48; P = 0.22) and 1.26 (CI 95% 0.43 to 3.69; P = 0.66) for the surgeon's flap-related complications. Female gender presented an odds ratio of 2.48 (CI 95% 0.68 to 9.00; P = 0.16) for complications. Conclusion: Flap-related complications are common intraoperative event during LASIK surgery performed by in-training ophthalmologists. Keratometries and surgeon's first procedure represent a higher probability for flap related complications than some other biometric parameters of patient's eye.
- Published
- 2016
27. Hypertensive Retinopathy as the First Manifestation of Advanced Renal Disease in a Young Patient: Report of a Case
- Author
-
Juan Carlos Serna-Ojeda, José Luis Rodríguez-Loaiza, Virginia Alejandra Martínez-Hernández, and Karen Janeth Arriozola-Rodríguez
- Subjects
medicine.medical_specialty ,Pediatrics ,Visual acuity ,business.industry ,Published online: December, 2015 ,Disease ,medicine.disease ,Renal disease ,Ophthalmology ,lcsh:Ophthalmology ,Hypertensive retinopathy ,lcsh:RE1-994 ,Hypertension ,Chronic renal failure ,medicine ,Patient report ,medicine.symptom ,Intensive care medicine ,business ,Kidney transplantation - Abstract
The purpose of this paper was to report the case of a 23-year-old patient suffering from bilateral acute visual loss who received the diagnosis of hypertensive retinopathy. After systemic evaluation, he was diagnosed with bilateral renal disease and chronic renal failure, requiring a kidney transplantation to manage the systemic illness, followed by gradual improvement of his visual acuity.
- Published
- 2015
28. Small Incision Lenticule Extraction (SMILE) Complications
- Author
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Enrique O Graue-Hernandez, Jorge L. Alió, Felipe Soria, and Juan Carlos Serna-Ojeda
- Subjects
medicine.medical_specialty ,business.industry ,Collateral damage ,Medicine ,Small incision lenticule extraction ,Fast recovery ,business ,Surgery - Abstract
Surgeries in every specialty are always challenging, with two main goals: 1. Become minimally invasive 2. Fast recovery with less collateral damage
- Published
- 2018
29. Post-keratoplasty Endophthalmitis by Multidrug-resistant Pseudomonas Aeruginosa With Positive Culture of the Contralateral Donor Cornea: A Case Report
- Author
-
V.M. Bautista-de Lucio, C. Rodriguez-Quintanilla, Enrique O Graue-Hernandez, Juan Carlos Serna-Ojeda, Diana Gabriela Ponce-Angulo, Lucero Pedro-Aguilar, Alejandro Navas, and Herlinda Mejia-Lopez
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Transplants ,Drug resistance ,medicine.disease_cause ,Cornea ,Corneal Transplantation ,03 medical and health sciences ,0302 clinical medicine ,Endophthalmitis ,Postoperative Complications ,Ophthalmology ,medicine ,Humans ,Donor cornea ,Pseudomonas Infections ,Corneal transplantation ,Aged ,Transplantation ,Pseudomonas aeruginosa ,business.industry ,Multidrug resistant Pseudomonas aeruginosa ,Drug Resistance, Microbial ,medicine.disease ,Tissue Donors ,Vitreous Body ,medicine.anatomical_structure ,030221 ophthalmology & optometry ,Positive culture ,Surgery ,sense organs ,business ,030217 neurology & neurosurgery - Abstract
Purpose The aim of this paper is to present the case report of a patient developing endophthalmitis after penetrating keratoplasty caused by a multidrug-resistant Pseudomonas aeruginosa, detected only in the contralateral donor tissue. Case Report A 77-year-old man underwent an uneventful penetrating keratoplasty with a preoperative culture-negative donor cornea; however, the fellow cornea grew multidrug-resistant Pseudomonas aeruginosa. The patient developed and was treated for endophthalmitis after penetrating keratoplasty, and aqueous and vitreous taps grew P. aeruginosa with antibiotic resistance identical to the isolate from the mate cornea. Sequence analysis of the 16S ribosomal gene from the two isolates and confirmation analyzing the sequence of P. aeruginosa heat shock protein gene (groES) were performed showing the same strain for both organisms. Conclusion This case report documents the presence of the same multidrug-resistant P. aeruginosa causing endophthalmitis after penetrating keratoplasty and in the contralateral donor tissue, suggesting that we must be cautious in deciding to transplant tissues with positive culture in the contralateral donor cornea.
- Published
- 2017
30. Adenoma of the Nonpigmented Ciliary Body and Iris Epithelium in Mexican Mestizo Patients
- Author
-
Blanca C. Flores-Sánchez, Enrique Ariza-Camacho, Juan Carlos Serna-Ojeda, Abelardo A. Rodríguez-Reyes, Emiliano Fulda-Graue, and Alberto Collado-Solórzano
- Subjects
Pathology ,medicine.medical_specialty ,education.field_of_study ,Adenoma ,business.industry ,Mexican mestizo ,Population ,Ciliary epithelium ,medicine.disease ,Resection ,Ciliary body ,medicine.anatomical_structure ,medicine ,Immunohistochemistry ,education ,business ,Case Series and Brief Reports ,Iris epithelium ,General Nursing - Abstract
The adenoma of the nonpigmented ciliary epithelium is a benign rare tumor, which may present with different clinical characteristics and requires resection along with histopathologic analysis and the identification of specific immunohistochemical markers for an accurate diagnosis. Here, we report a case series of 4 patients in a Mexican mestizo population with this diagnosis, their clinical features, the ultrasound imaging characteristics and the histopathological and immunohistochemical findings.
- Published
- 2015
31. Intraocular Infection with a Trematode
- Author
-
Pablo Jose Guzman-Salas and Juan Carlos Serna-Ojeda
- Subjects
Male ,medicine.medical_specialty ,genetic structures ,Adolescent ,business.industry ,MEDLINE ,Vision Disorders ,General Medicine ,Trematode Infections ,Eye infection ,eye diseases ,Surgery ,Intraocular Infection ,Decreased Visual Acuity ,medicine ,Animals ,Humans ,sense organs ,Eye Infections, Parasitic ,Trematoda ,business - Abstract
A 17-year-old boy from a rural town in Mexico presented with decreased visual acuity and pain in his right eye. Slit-lamp examination, shown in a video, revealed an intraocular infection with a trematode.
- Published
- 2017
32. Trans-epithelial accelerated corneal cross-linking for keratoconus in children
- Author
-
Juan Carlos Serna-Ojeda, Arturo Ramirez-Miranda, Alexandra Abdala-Figuerola, Alejandro Navas, Enrique O Graue-Hernandez, Alejandro Lichtinger, Andrew Olivo-Payne, Erick Hernandez-Bogantes, and Lucero Pedro-Aguilar
- Subjects
Keratoconus ,medicine.medical_specialty ,Distance visual acuity ,pediatric keratoconus ,genetic structures ,keratoconus ,law.invention ,corneal cross-linking ,03 medical and health sciences ,0302 clinical medicine ,lcsh:Ophthalmology ,law ,Ophthalmology ,Medicine ,accelerated cross-linking ,Keratometer ,business.industry ,Brief Report ,Mean age ,medicine.disease ,eye diseases ,lcsh:RE1-994 ,030221 ophthalmology & optometry ,sense organs ,business ,030217 neurology & neurosurgery - Abstract
The aim of the study is to evaluate the safety and efficacy of trans-epithelial accelerated corneal cross-linking (TE-ACXL) in children with progressive keratoconus. Retrospective, case-series of 23 eyes of 14 children who underwent TE-ACXL. Evaluations were performed at baseline and 1, 3, 6, 12 and 18mo postoperatively. Mean follow-up time of 23.82±3.15mo and mean age was 13.7±1.4y (range 11 to 16y). Mean preoperative uncorrected distance visual acuity changed from 0.92±0.45 logMAR (20/160) to 0.71±0.40 logMAR (20/100) (P=0.001). Mean keratometry (Km) changed from 53.87± 6.03 to 53.00±5.81 (P=0.001). Pachymetry did not have significant changes at last follow-up (P=0.30). The mean preoperative sphere was -5.58±2.48 and -4.89±4.66 D (P=0.11) at last follow-up; refractive cylinder from -5.58±2.48 to -5.02±2.23 (P=0.046). In conclusion, tomographic and refractive stability are shown in over 91% of eyes with pediatric progressive keratoconus who underwent TE-ACXL.
- Published
- 2017
33. [Periocular foreign body: Two clinical cases with different management short title: periocular foreign body]
- Author
-
María Sandra, Salazar-Ramos, Juan Carlos, Serna-Ojeda, Osiris, Olvera-Morales, and José Luis, Tovilla-Canales
- Subjects
Adult ,Male ,Humans ,Female ,Wounds, Penetrating ,Child ,Foreign Bodies ,Orbit - Abstract
In many cases, the presence of periocular foreign bodies continues to be a diagnostic challenge and a dilemma regarding their management in most cases. The key lies in the type of material of the foreign body and its location in the orbit to determine its management.We present two cases of periocular foreign body; a description of the clinical presentation and their treatment are given in each case. A review and discussion of treatment is also included.It is important to know the indications for the medical and surgical management for periocular foreign bodies to offer an individualized and direct treatment for each patient.
- Published
- 2017
34. [Simulation training in ophthalmology]
- Author
-
Juan Carlos, Serna-Ojeda, Enrique O, Graue-Hernández, Pablo José, Guzmán-Salas, and José Luis, Rodríguez-Loaiza
- Subjects
Ophthalmology ,Education, Medical, Graduate ,Humans ,Computer Simulation ,Ophthalmologic Surgical Procedures - Abstract
Simulation in medicine is an indispensable tool to improve doctors' responses to different situations, enhancing their performance. However, simulation in ophthalmology is a very recent trend, mainly because of the high complexity of developing newer teaching tools, with the need for highly realistic models, mostly in surgical ophthalmic simulation.The whole development of simulation in ophthalmology, from the very first attempts that used basic models, to the newer virtual reality models, allows for a comprehensive, faster, and more efficient development of skills necessary in basic and advance procedures in ophthalmology, creating a better learning environment, improving costs, and developing a very promising panorama, in which simulation can be incorporated in teaching programs all around the globe.Simulation in ophthalmology allows for better results in the formation of ophthalmologists, and it is becoming a new tool to achieve better results in medical and surgical procedures, thus improving outcomes and quality of care.
- Published
- 2017
35. Vortex Pattern of Corneal Deposits in Granular Corneal Dystrophy Associated With the p.(Arg555Trp) Mutation in TGFBI
- Author
-
Aleck E. Cervantes, Juan Carlos Serna-Ojeda, Jaffer M. Kattan, Arturo Ramirez-Miranda, Eung Kweon Kim, Ricardo F Frausto, Juan Carlos Zenteno, Anthony J. Aldave, Anushree Sharma, Marisa Cruz-Aguilar, and Enrique O Graue-Hernandez
- Subjects
0301 basic medicine ,Male ,Pathology ,medicine.medical_specialty ,Heterozygote ,Adolescent ,Corneal Stroma ,DNA Mutational Analysis ,Mutation, Missense ,Biology ,Polymerase Chain Reaction ,Article ,03 medical and health sciences ,Exon ,Young Adult ,0302 clinical medicine ,Corneal Opacity ,Gene Frequency ,Transforming Growth Factor beta ,Cornea ,medicine ,Missense mutation ,Humans ,Child ,Mexico ,Corneal epithelium ,Aged, 80 and over ,Corneal Dystrophies, Hereditary ,Extracellular Matrix Proteins ,Slit Lamp ,Heterozygote advantage ,Middle Aged ,medicine.disease ,Phenotype ,eye diseases ,Pedigree ,Granular corneal dystrophy ,Ophthalmology ,030104 developmental biology ,medicine.anatomical_structure ,Italy ,030221 ophthalmology & optometry ,Female ,TGFBI - Abstract
Purpose To describe 2 unrelated families with multiple members demonstrating a less commonly recognized vortex pattern of corneal deposits confirmed to be granular corneal dystrophy type 1 (GCD1) after identification of the p.(Arg555Trp) mutation in the transforming growth factor β-induced gene (TGFBI). Methods A slit-lamp examination was performed on individuals from 2 families, one of Mexican descent and a second of Italian descent. After DNA extraction from affected individuals and their unaffected relatives, TGFBI screening was performed. Results Eight of 20 individuals in the Mexican family and 20 of 55 in the Italian family demonstrated corneal stromal opacities. Seven of the 8 affected individuals in the Mexican family and 4 of the 20 affected individuals in the Italian family demonstrated a phenotype characterized by a "sea fan" or vortex pattern of superficial stromal corneal deposits originating from the inferior aspect of the cornea. Screening of TGFBI in both families revealed a heterozygous missense mutation [p.(Arg555Trp)] in exon 12, confirming the diagnosis of GCD1. Conclusions Our findings demonstrate that GCD1 may present with a vortex pattern of anterior stromal deposits. Although this pattern of dystrophic deposits is not recognized by clinicians as a typical phenotype of GCD1, it is consistent with the production of the majority of the TGFBI protein by the corneal epithelium.
- Published
- 2017
36. Clinical and Echographic Long-Term Follow-Up of a Retinal Macrocyst: A Case Report
- Author
-
Christian Denisse Pinkus-Herrera, José Luis Rodríguez-Loaiza, Juan Carlos Serna-Ojeda, Maria Cristina Gonzalez-Gonzalez, and Maria Victoria Moreno-Londono
- Subjects
medicine.medical_specialty ,Visual acuity ,Long term follow up ,Retinal lesion ,Retinal macrocyst ,chemistry.chemical_compound ,Quadrant (abdomen) ,Macrocyst ,lcsh:Ophthalmology ,Ophthalmology ,Published online: June, 2014 ,medicine ,business.industry ,A-mode echography ,Retinal detachment ,Retinal ,medicine.disease ,Surgery ,chemistry ,lcsh:RE1-994 ,medicine.symptom ,Ultrasonography ,business ,B-mode echography - Abstract
The purpose of this paper is to report the case of a 62-year-old male diagnosed with a retinal macrocyst secondary to a long-standing retinal detachment in his right eye. At fundoscopy examination, an oval, elevated retinal lesion in the superior nasal quadrant was noted. Ultrasonography was performed, with a B-mode echography showing an oval, anechoic image and a standardized A-mode echography with a reflectivity spike higher than 98%, which was compatible with a retinal macrocyst. The patient refused surgical treatment for the retinal detachment and was followed for 14 months with stable visual acuity and no clinical or echographic changes.
- Published
- 2014
37. Diagnóstico de conjuntivitis folicular aguda: un análisis retrospectivo de 5 años en un centro de referencia
- Author
-
M. Álvarez-López, P. Nuñez-Rivera, Juan Carlos Serna-Ojeda, and J. Quevedo-Martínez
- Subjects
Ophthalmology - Abstract
Resumen Objetivo y metodos Para determinar la frecuencia de la conjuntivitis folicular aguda, se analizo de manera retrospectiva los expedientes medicos en un centro de referencia en Mexico durante un periodo de 5 anos. Resultados y conclusiones Un total de 859.986 consultas oftalmologicas fueron otorgadas, de las cuales 8.930 fueron diagnosticadas con conjuntivitis folicular aguda (1,03% del total). En la mayoria de los meses hubo un rango entre 100 y 200 pacientes. En agosto de 2012 se observo un aumento con 308 casos, disminuyendo despues de 2 meses. Nuestro estudio no demostro una mayor frecuencia por mes, con excepcion del ano 2012 que presento un pico en la incidencia durante el tercer trimestre.
- Published
- 2015
38. Diagnosis of acute follicular conjunctivitis: A 5-year retrospective analysis in a referral center
- Author
-
J. Quevedo-Martínez, Juan Carlos Serna-Ojeda, M. Álvarez-López, and P. Nuñez-Rivera
- Subjects
medicine.medical_specialty ,Pediatrics ,business.industry ,Acute follicular conjunctivitis ,Medical record ,Incidence (epidemiology) ,medicine ,Retrospective analysis ,Referral center ,General Medicine ,Third trimester ,business ,Surgery - Abstract
Objective and methods A retrospective analysis was performed using the medical records in a referral center in Mexico over a period of 5 years, in order to determine the frequency of acute follicular conjunctivitis. Results and conclusions A total of 859,986 ophthalmology consultations were given, from which 8,930 were diagnosed with acute follicular conjunctivitis (1.03% of the total). The number of patients diagnosed range between 100 and 200 in the majority of months. In August 2012 an increase was observed with 308 cases, and then decreasing after two months. This study did not demonstrate a highest frequency by month, with exception of year 2012 that showed a peak incidence in the third trimester.
- Published
- 2015
39. [Vogt-Koyanagi-Harada syndrome]
- Author
-
Juan Carlos, Serna-Ojeda and Miguel, Pedroza-Seres
- Subjects
Adult ,Panuveitis ,Retinal Detachment ,Vitiligo ,Humans ,Female ,Uveomeningoencephalitic Syndrome - Abstract
The Vogt-Koyanagi-Harada syndrome is a disease with dermatological, neurologic and auditory findings, associated with a bilateral granulomatous panuveitis. We present the case of a 42-year-old woman who started with ophthalmic manifestations, and in a late follow-up she developed the characteristic dermatological findings.
- Published
- 2016
40. Long-term Outcomes of Pediatric Penetrating Keratoplasty for Herpes Simplex Virus Keratitis
- Author
-
Enrique O Graue-Hernandez, Juan Carlos Serna-Ojeda, Arturo Ramirez-Miranda, Denise Loya-Garcia, Alejandro Navas, and Alejandro Lichtinger
- Subjects
Male ,medicine.medical_specialty ,Visual acuity ,Time Factors ,genetic structures ,Adolescent ,Visual Acuity ,Hand motion ,medicine.disease_cause ,Keratitis ,03 medical and health sciences ,0302 clinical medicine ,Recurrence ,Ophthalmology ,medicine ,Long term outcomes ,Humans ,Simplexvirus ,030212 general & internal medicine ,Single institution ,Child ,Retrospective Studies ,business.industry ,Graft Survival ,Infant ,Retrospective cohort study ,Consecutive case series ,medicine.disease ,eye diseases ,Surgery ,Herpes simplex virus ,Child, Preschool ,030221 ophthalmology & optometry ,Keratitis, Herpetic ,Female ,medicine.symptom ,business ,Keratoplasty, Penetrating ,Follow-Up Studies - Abstract
PurposeTo analyze the characteristics and long-term outcomes of patients that underwent pediatric penetrating keratoplasty (PPK) for herpes simplex virus (HSV) keratitis.DesignRetrospective, interventional, consecutive case series.MethodsObservational report of outcomes and findings for 9 patients with history of HSV keratitis that underwent PPK and were followed in a single institution. Difference between the median preoperative and final best-corrected visual acuity (BCVA) was assessed and the outcomes are reported.ResultsWe included 9 eyes; median age at the moment of the PPK was 14 years. The median initial BCVA was 20/400 (range 20/60 to hand motion) and final was 20/50 (range 20/30 to 20/400) (P < .05). Follow-up was a median of 94 months. Complications in these patients included glaucoma (1), graft rejection (1), recurrence of disease (1), and amblyopia (3). No graft failures were present.ConclusionThe long-term outcomes with PPK for HSV keratitis in children provide improvement in BCVA when not compromised by amblyopia.
- Published
- 2016
41. Rituximab in the Treatment of Refractory Noninfectious Scleritis
- Author
-
Luis Felipe Flores-Suárez and Juan Carlos Serna-Ojeda
- Subjects
medicine.medical_specialty ,Immunologic Factors ,business.industry ,medicine.disease ,Dermatology ,03 medical and health sciences ,Ophthalmology ,0302 clinical medicine ,Refractory ,030221 ophthalmology & optometry ,Medicine ,Humans ,Rituximab ,030212 general & internal medicine ,business ,Scleritis ,medicine.drug - Published
- 2016
42. Non-traumatic corneal perforations: aetiology, treatment and outcomes
- Author
-
Enrique O Graue-Hernandez, Juan Carlos Serna-Ojeda, Andrew Olivo-Payne, Lucero Pedro-Aguilar, Denise Loya-Garcia, and Aida Jimenez-Corona
- Subjects
Adult ,Male ,medicine.medical_specialty ,Distance visual acuity ,genetic structures ,Adolescent ,Perforation (oil well) ,Eye Infections ,Visual Acuity ,law.invention ,03 medical and health sciences ,Cellular and Molecular Neuroscience ,Young Adult ,0302 clinical medicine ,law ,Non traumatic ,Cornea ,medicine ,Humans ,Medical history ,Cyanoacrylates ,Child ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Corneal Perforation ,Corneal perforation ,Middle Aged ,medicine.disease ,Bandages ,eye diseases ,Sensory Systems ,Surgery ,Ophthalmology ,medicine.anatomical_structure ,Cyanoacrylate ,Child, Preschool ,030221 ophthalmology & optometry ,Etiology ,Regression Analysis ,Female ,sense organs ,business ,030217 neurology & neurosurgery ,Keratoplasty, Penetrating - Abstract
Purpose To report aetiology, characteristics, treatment and main outcomes of non-traumatic corneal perforations in a single referral centre. Methods A retrospective review of clinical records of patients diagnosed with non-traumatic corneal perforation. The analysed data included demographic characteristics, medical history, initial and final corrected distance visual acuity (CDVA), perforation aetiology, size, location, initial therapy, surgical treatment, ocular integrity and complications. A comparison between non-infectious and infectious groups was performed. Different variables were analysed through a multiple logistic regression analysis for the probability to have at least one more procedure. Results We included 127 eyes of 116 patients with a mean age of 50 years and a mean follow-up of 11 months. The initial CDVA was 3.00 logarithm of the minimum angle of resolution (logMAR) and the final CDVA was 2.30 logMAR (p>0.5). Regarding treatment, of the 49 eyes with an initial cyanoacrylate patch, 35 eyes (71.4%) had at least one more procedure performed (p>0.001). In comparison, of the 49 eyes with an initial tectonic penetrating keratoplasty (PK), 33 (67.3%) eyes remained stable while 16 (32.7%) eyes needed one or more interventions (p=0.004). In a multiple logistic regression analysis, an initial cyanoacrylate patch represented a probability of 4.7 times to require a subsequent procedure in comparison with an initial PK. Overall, globe integrity was achieved in 96.1% of the cases. Conclusions Corneal perforations represent an important cause of ocular morbidity. The use of a cyanoacrylate patch is useful as an initial therapy in corneal perforations; however, procedures such as PK are often necessary to achieve anatomical success, especially in non-infectious aetiologies.
- Published
- 2016
43. Paralysis of the orbicularis muscle of the eye using botulinum toxin type A in the treatment for dry eye
- Author
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Angel Nava-Castaneda and Juan Carlos Serna-Ojeda
- Subjects
0301 basic medicine ,Male ,medicine.medical_specialty ,genetic structures ,Eye Movements ,Dry Eye Syndromes ,Placebo ,03 medical and health sciences ,Subcutaneous injection ,0302 clinical medicine ,Ophthalmology ,Paralysis ,medicine ,Humans ,Prospective Studies ,Botulinum Toxins, Type A ,Prospective cohort study ,Aged ,Ophthalmoplegia ,Blinking ,business.industry ,General Medicine ,Middle Aged ,Botulinum toxin ,eye diseases ,Oculomotor Muscle ,030104 developmental biology ,medicine.anatomical_structure ,Neuromuscular Agents ,Oculomotor Muscles ,030221 ophthalmology & optometry ,Female ,sense organs ,Eyelid ,medicine.symptom ,business ,medicine.drug ,Follow-Up Studies - Abstract
Purpose To evaluate the efficacy of botulinum toxin type A injection to cause orbicularis eyelid muscle paralysis to improve dry eye signs and symptoms. Methods A prospective, randomized, comparative eye-to-eye and interventional study was performed. Patients with dry eye symptoms and positive fluorescein corneal staining were included. Randomly one eyelid received a subcutaneous injection of botulinum toxin in the medial orbicularis muscle portion of the lower eyelid, and the other eye received placebo. The subjective evaluation was achieved with a questionnaire assessing symptoms, quality of vision and ocular comfort level. The objective evaluation included the measurement of the tear film break-up time (TBUT), Schirmer's test and corneal and conjunctival staining. Results Twenty patients were included with a mean age of 59.5 years. Two weeks after the botulinum toxin injection, all patients showed a decrease in the horizontal movement of the lower eyelid when blinking. The eyes in the active treatment group showed better scores compared with the sham group in four symptoms 4 weeks after the treatment. The TBUT was higher at 1 and 3 months in the active treatment group. The corneal and conjunctival staining were significantly lower in the active treatment group at 1 and 3 months, and the Schirmer's test showed better measurements in the same group at 2 weeks, 1 month and 3 months. There were no adverse events reported. Conclusions The injection of botulinum toxin A in the medial part of the lower eyelid is an effective and safe procedure that temporally improves some of the signs and symptoms of patients with dry eye.
- Published
- 2016
44. Smaller needles, lower risks?: Occupational HIV risk for healthcare professionals
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Juan Carlos Serna-Ojeda, EO Graue-Hernandez, and A Navas
- Subjects
medicine.medical_specialty ,Health professionals ,business.industry ,Health Policy ,medicine.medical_treatment ,Treatment outcome ,030204 cardiovascular system & hematology ,Hiv risk ,03 medical and health sciences ,Health personnel ,0302 clinical medicine ,Infectious Diseases ,Family medicine ,medicine ,Pharmacology (medical) ,030212 general & internal medicine ,Occupational exposure ,Post-exposure prophylaxis ,business - Published
- 2017
45. Herpes simplex virus keratitis: an update of the pathogenesis and current treatment with oral and topical antiviral agents - comment
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Juan Carlos Serna-Ojeda and Enrique O Graue-Hernandez
- Subjects
business.industry ,medicine.disease_cause ,medicine.disease ,Virology ,Keratitis ,Pathogenesis ,03 medical and health sciences ,Ophthalmology ,0302 clinical medicine ,Herpes simplex virus ,Topical antiviral ,030221 ophthalmology & optometry ,medicine ,business ,030217 neurology & neurosurgery - Published
- 2016
46. Dry eye symptoms and associated risk factors among adults aged 50 or more years in Central Mexico
- Author
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Aida Jimenez-Corona, Jesus Arrieta-Camacho, Juan Carlos Serna-Ojeda, Alejandro Navas, Enrique O Graue-Hernandez, and Carlos Estrada-Reyes
- Subjects
Male ,Cross-sectional study ,Population ,Dry Eye Syndromes ,Symptom assessment ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Prevalence ,Humans ,Medicine ,dry eye symptoms ,education ,Mexico ,Aged ,education.field_of_study ,business.industry ,lcsh:Public aspects of medicine ,Dry Eye Questionnaire 5 ,Public Health, Environmental and Occupational Health ,lcsh:RA1-1270 ,Middle Aged ,Cross-Sectional Studies ,030221 ophthalmology & optometry ,Population study ,Female ,Symptom Assessment ,business ,Alcohol consumption ,030217 neurology & neurosurgery ,Demography - Abstract
Objective. To determine the prevalence of dry eye symptoms (DES) and associated risk factors among adults in Tlaxcala, Mexico. Materials and methods. A cross-sectional population-based study that included 1 508 individuals aged ≥50 years who answered the Dry Eye Questionnaire (DEQ- 5), with a score ranging between 0 and 22; the following categories were defined: no DES (
- Published
- 2018
47. Carcinoma de células escamosas de conjuntiva
- Author
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Joaquín Hernández-Orgaz, Juan Carlos Serna-Ojeda, and Osiris Olvera-Morales
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Pathology ,medicine.medical_specialty ,Conjunctiva ,medicine.anatomical_structure ,Epidermoid carcinoma ,business.industry ,Medicine ,Basal cell ,General Medicine ,business ,Ocular surface - Abstract
El carcinoma de células escamosas de conjuntiva es una neoplasia de la superficie ocular que puede presentarse con distintos patrones macroscópicos. Presentamos el caso de un hombre de 75 años de edad que acude con esta tumoración de larga evolución, involucrando de forma importante su visión.
- Published
- 2017
48. Rituximab in the treatment of refractory scleritis in patients with granulomatosis with polyangiitis (Wegener's)
- Author
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Claudia Recillas-Gispert, Juan Carlos Serna-Ojeda, and Luis Felipe Flores-Suárez
- Subjects
Adult ,Male ,medicine.medical_specialty ,Immunologic Factors ,Myeloblastin ,B-Lymphocyte Subsets ,Drug Resistance ,Cellular and Molecular Neuroscience ,Young Adult ,stomatognathic system ,Refractory ,Medicine ,Humans ,In patient ,Infusions, Intravenous ,Glucocorticoids ,Retrospective Studies ,Wegener s ,business.industry ,Granulomatosis with Polyangiitis ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Flow Cytometry ,Dermatology ,Sensory Systems ,Ophthalmology ,Rituximab ,Female ,business ,Granulomatosis with polyangiitis ,Scleritis ,medicine.drug - Abstract
The purpose of this descriptive study was to evaluate the clinical response to rituximab (RTX) in patients with scleritis due to granulomatosis with polyangiitis (GPA), in patients who had proved refractory to treatment with systemic glucocorticoids and immunosuppressive agents.Retrospective analysis of interventional case series. Single referral center study. Eight patients (12 affected eyes) due to scleritis secondary to GPA, refractory to conventional treatment were included to receive RTX as therapy for remission induction. RTX was administered as a 1-g infusion every 2 weeks, for a total of 2 g. Patient follow-up included clinical evaluation (systemic and ophthalmologic), B-cell subset (CD19, CD20, CD22) counts, proteinase-3 anti-neutrophil cytoplasmic antibody (PR-3 ANCA), and Birmingham Vasculitis Activity Score for Wegener's granulomatosis (BVAS-WG). Outcomes were response to treatment and achievement of remission, as well as number of ocular relapses.The main indication for treatment was refractory necrotising anterior scleritis. Four weeks after completion of treatment with RTX, all patients showed clear clinical improvement, with no further progression. In all patients, an absolute depletion of B cells was confirmed in the first 6 weeks after treatment. Seven patients (87.5 %) achieved remission of inflammatory activity in 7 months or less. However, three patients experienced ocular relapse, which comprised reactivation of the anterior scleritis, uveitis, and posterior scleritis, and two patients required a second dose of RTX, with immediate improvement.RTX is useful in the treatment of refractory necrotising scleritis in patients with GPA. Of note, in those who relapse after remission, RTX can be successfully used for retreatment.
- Published
- 2015
49. Herpes Simplex Virus Disease of the Anterior Segment in Children
- Author
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Aida Jimenez-Corona, Enrique O Graue-Hernandez, Juan Carlos Serna-Ojeda, Arturo Ramirez-Miranda, and Alejandro Navas
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Male ,Pediatrics ,medicine.medical_specialty ,Visual acuity ,Adolescent ,Interstitial keratitis ,Administration, Topical ,Acyclovir ,Administration, Oral ,Eye Infections, Viral ,Disease ,Herpesvirus 1, Human ,Dendritic Keratitis ,medicine.disease_cause ,Antiviral Agents ,Polymerase Chain Reaction ,Anterior Eye Segment ,medicine ,Humans ,Child ,Retrospective Studies ,business.industry ,Viral culture ,Infant ,Retrospective cohort study ,Keratitis, Dendritic ,Surgery ,Ophthalmology ,Herpes simplex virus ,Child, Preschool ,DNA, Viral ,Keratitis, Herpetic ,Female ,medicine.symptom ,business - Abstract
PURPOSE To analyze the clinical presentation, characteristics, treatment, recurrences, and final outcomes and complications of herpes simplex virus (HSV) disease of the anterior segment in patients aged 17 years or younger. METHODS This is an observational and retrospective study with review of the medical records of all the children diagnosed with herpes simplex infection of the anterior segment at an ophthalmologic referral center, from 2002 to 2012. The diagnosis was made on the basis of the history and examination of patients and in specific cases by viral culture and the polymerase chain reaction. Main outcome measurements included final visual acuity, bilateral disease, and recurrence. Recurrent disease was analyzed with Kaplan-Meier curves. RESULTS A total of 103 patients were included with a median age at presentation of 9 years. Of them, 6 had bilateral and simultaneous disease. The median follow-up time was 18 months (range, 18 days-12 years). The most common clinical manifestations were epithelial dendritic keratitis in 42 eyes (38.5%) and interstitial keratitis in 39 eyes (35.7%), with 15 patients presenting multiple forms of HSV disease. The median final visual acuity in the group of patients was 20/40. Recurrent disease was evident in 42 (38.5%) of the eyes, with a median recurrence time of 15 months (95% confidence interval, 8.1-26.2 months). CONCLUSIONS In this study, epithelial dendritic and interstitial keratitis were the most frequent forms of disease in the pediatric population with HSV of the anterior segment. A high rate of recurrent disease was present.
- Published
- 2015
50. Contents Vol. 1, 2015
- Author
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Anna M. Stagner, Michael K. Yoon, Sander R. Dubovy, Miguel N. Burnier, Brian R. Gastman, Alberto Collado-Solórzano, J. Antonio Bermudez-Magner, Juan Carlos Serna-Ojeda, Vasco Bravo-Filho, Enrique Ariza-Camacho, Madhura Joag, Natalia Vila, Druckerei Stückle, Pablo Zoroquiain, Blanca C. Flores-Sánchez, Hardeep Singh Mudhar, Carol L. Karp, Arun D. Singh, Frederick A. Jakobiec, Ian G. Rennie, Patrick Logan, Maria Eugenia Orellana, Emiliano Fulda-Graue, Mengensatzproduktion, Rafael I. Barraquer, Javier Elizalde, Samir Jabbour, Jose Antonio Bermudez-Magner, Nabeel Shalabi, Jianhua Wang, Angela Ding, Colleen M. Cebulla, Jordan Thompson, Katharine S. Sears, Anita Gupta, Zanna I. Currie, Abelardo A. Rodríguez-Reyes, Anat Galor, Dimosthenis Mantopoulos, Hassan Aziz, and Sachin M. Salvi
- Subjects
Pathology ,medicine.medical_specialty ,business.industry ,Medicine ,business ,General Nursing - Published
- 2015
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