4 research outputs found
Recommendations for ophthalmologic practice during the easing of COVID-19 control measures
In the context of the COVID-19 pandemic, this paper provides recommendations for medical eye care during the easing of control measures after lockdown. The guidelines presented are based on a literature review and consensus among all Spanish Ophthalmology Societies regarding protection measures recommended for the ophthalmologic care of patients with or without confirmed COVID-19 in outpatient, inpatient, emergency and surgery settings. We recommend that all measures be adapted to the circumstances and availability of personal protective equipment at each centre and also highlight the need to periodically update recommendations as we may need to readopt more restrictive measures depending on the local epidemiology of the virus. These guidelines are designed to avoid the transmission of SARS-CoV-2 among both patients and healthcare staff as we gradually return to normal medical practice, to prevent postoperative complications and try to reduce possible deficiencies in the diagnosis, treatment and follow-up of the ophthalmic diseases. With this update (5th) the Spanish Society of Ophthalmology is placed as one of the major ophthalmology societies providing periodic and systematized recommendations for ophthalmic care during the COVID-19 pandemic
Pterigi贸n: caso cl铆nico y revisi贸n
We present the case of a 32-year old Cuban who first consulted at our clinic for recurrent pterygium, OS. At our service, we did a pterygium excision with orthotopic conjunctival autoplasty. 4 months later, there was a second recurrence for which we did an excision with buccal mucosal graft. After six months, a third recurrence occurred along with ptosis and restrictive diplop铆a, for which we decided to do an excision with eccentric lamellar keratoplasty and buccal mucosal graft. Pterygia are non-involutional corneal degenerations presenting as a wing-like fibrovascular growth of the bulbar conjunctiva驴s connective tissue onto the cornea. Recent studies showing over expression of matrix metalloproteinases due to stimulation by interleukins and tumor necrosis factors support the concept that the alteration of basal limbal epithelial cells is a key factor in the pathogenesis. Careful assessment and individualized patient treatment are mandatory to prevent vision threatening complicationsPresentamos un caso de un var贸n de 32 a帽os que acudi贸 a nuestra consulta afecto de pterigi贸n recidivante, OI. Se practic贸 extirpaci贸n del pterigion con autoplastia conjuntival. 4 meses post-op, recidiva. Se practica una segunda cirug铆a en nuestro centro extirpando el pterigi贸n recidivante con transplante de mucosa bucal. 6 meses despu茅s, nueva recidiva (tercera) con ptosis y diplop铆a restrictiva practicandole de nuevo una extirpaci贸n con transplante laminar exc茅ntrico mas transplante de mucosa bucal. El pterigi贸n es una degeneraci贸n corneal no involutivas que presenta una proliferaci贸n fibrovascular del tejido conjuntival que crece desde la conjuntiva bulbar hacia la cornea. Investigaciones recientes mostrando una sobreproducci贸n de ciertas metaloproteinasas de la matriz debido a una estimulaci贸n inflamatoria de interleukinas y de factores necrosis tumoral soporta la noci贸n de que la alteraci贸n de c茅lulas epiteliales basales limbares posee un papel primordial en la patogenia. Se trata de un examen cauteloso y un tratamiento individualizado para prevenir las complicaciones de la extirpaci贸n del pterigi贸n
Evoluci贸n a largo plazo del astigmatismo tras queratoplastia penetrante en queratocono : evidencia de recurrencia tard铆a /
Prop贸sito: Evaluar mediante un estudio retrospectivo la evoluci贸n refractiva y biomicrosc贸pica de un grupo de pacientes operados de queratoplastia penetrante por queratocono. Demostrar la presencia de la recurrencia de la enfermedad a muy largo plazo. Hip贸tesis: Al ser el queratocono una enfermedad de origen multifactorial en la que intervienen factores gen茅ticos, bioqu铆micos y medioambientales que afectan al tejido corneal, se plantea la hip贸tesis de una posible recurrencia de la enfermedad a largo plazo provocando cambios refractivos, biomicrosc贸picos e histopatol贸gicos similares a la enfermedad inicial. Fundamentos: Se describen los hallazgos caracter铆sticos del queratocono, las t茅cnicas diagn贸sticas empleadas en su detecci贸n, los factores etiopatog茅nicos implicados en su origen, la evoluci贸n hist贸rica de la enfermedad en la cl铆nica oftalmol贸gica, las terap茅uticas m茅dicas y quir煤rgicas empleadas antiguamente y en la actualidad as铆 como se explica en detalle la t茅cnica quir煤rgica de la queratoplastia penetrante empleada en el grupo de pacientes analizado, sus resultados y los m茅todos de an谩lisis de la evoluci贸n astigm谩tica y refractiva a lo largo del tiempo. Pacientes y m茅todos: Se analiza la evoluci贸n refractiva y queratom茅trica del astigmatismo corneal, los cambios anat贸micos y los hallazgos histopatol贸gicos cuando fue posible en una serie de 80 pacientes operados de queratoplastia penetrante por queratocono avanzado con un seguimiento comprendido entre 15 y 25 a帽os tras la operaci贸n. Resultados: se observaron cambios refractivos muy significativos a partir del d茅cimo a帽o de seguimiento en un 70% de los pacientes, junto con hallazgos biomicrosc贸picos e histopatol贸gicos compatibles con queratocono en las c贸rneas receptoras estudiadas. Conclusiones: el queratocono puede recurrir con una frecuencia significativa en la c贸rnea receptora y en la uni贸n con el injerto a muy largo plazo tras un trasplante corneal. Se debe informar de esta posibilidad a los pacientes en los que se proponga este tratamiento quir煤rgico en la actualidadPurpose: To evaluate the refractive and biomicroscopic changes in a series of patients in which a penetrating keratoplasty had been previously performed to treat advanced keratoconus. To demonstrate the recurrence of the disease in the long-term follow up. Hypotesis: Keratoconus is a multifactorial corneal disease in which genetical, biochemical and environmental factors have been implicated, the hypotesis of a possible long-term recurrence of the disease inducing refractive, slit lamp and histopathological findings is proposed. Foundations: The classical symptoms and signs of keratoconus, diagnostic examinations, etiopathogenic factors, historical evolution of the disease in the ophthalmological community, the medical and surgical therapies used throughout history and at present are presented. A detailed explanation of the technique of penetrating keratoplasty used in the analyzed series of patients is fully described, as well as its results and the methods to analyze the evolution of astigmatism during the long post-operative follow up period. Patient and methods: The refractive and keratometric changes thru time of corneal astigmatism, the anatomical slit lamp findings and histopathological findings in a series of 80 patients previously operated with penetrating keratoplasty for keratoconus are analyzed. The follow-up time was between 15 and 25 years after the surgical procedure. Results: Significant refractive changes in astigmatism were observed starting 10 years after the surgery in 70% of the patients, together with slit lamp and histopathological findings consistent with the diagnosis of recurrence of keratoconus in the studied recipient corneas. Conclusions: Keratoconus is a corneal disease that can recur in a significant percentage of cases in the recipient cornea and in the donor-host junction long after a penetrating keratoplasty. Patients that are going to be treated with this surgical technique should be informed about these late changes
Queratitis por acanthamoeba: estudio retrospectivo
Purpose: To analize the diagnosis and treatment驴s evolution of acanthamoeba keratitis (AK) in our center in recent years. Methods: We have studied 21 cases of AK in which the diagnosis was confirmed by anatomopathological tests. We驴ve studied these variables: age, gender, job, diagnosis date, visual acuity when diagnosed, period of time between starting the symptomatology and specific treatment, contact lenses (CL) wearer and swiming with them, clinical signs, treatment applied and illness evolution. Results: We found that of 21 patients we studied, 17 were CL wearers, 14 of them were soft. The most frequent presumption diagnosis the patient came to our center with was herpetic keratitis in 15 cases. Diagnosis was made in all cases by anatomopathological tests, 9 cases by corneal biopsy and 13 cases by recipient驴s cornea studies in pacients who requiered penetrating keratoplasty. Conclusion: To have the knowledge of this entity and its suspicion in CL wearers is very important to avoid an unfavourably evolution. Early diagnosis and an appropiated treatment can avoid it. Contact lenses wearers should know disinfectant measures in order to avoid risky situations.Objetivo: Analizar la evoluci贸n sufrida en el diagn贸stico y tratamiento de la queratitis por acanthamoeba en nuestro centro en los 煤ltimos 13 a帽os. M茅todos: Hemos estudiado 21 casos de dicha patolog铆a en los cuales el examen anatomopatol贸gico confirm贸 el diagn贸stico. Se analizan variables como la edad, sexo, ocupaci贸n laboral, fecha del diagn贸stico, AV en el momento del diagn贸stico y AV final, tiempo entre el inicio del cuadro y tratamiento espec铆fico, uso de lentes de contacto (LC) y ba帽o con ellas, signos cl铆nicos, tratamiento empleado y evoluci贸n del cuadro. Resultados: Hallamos que de 21 pacientes, 17 eran portadores de LC, 14 de las cuales eran hidrof铆licas. El diagn贸stico de presunci贸n m谩s frecuente con el que el paciente acudi贸 a nuestro servicio fue el de queratitis herp茅tica en 15 casos. El diagn贸stico se estableci贸 en todos los casos por estudio anatomopatol贸gico, tanto por biopsia corneal (9 casos) como por estudio del bot贸n corneal en aquellos que requirieron queratoplastia penetrante (QP) (13 casos). Conclusiones: El conocimiento de esta patolog铆a y su sospecha en pacientes portadores de LC es fundamental para evitar una evoluci贸n desfavorable. El diagn贸stico precoz y un tratamiento adecuado pueden evitarlo. El conocimiento por parte de los usuarios de las medidas de desinfecci贸n y evitar situaciones de riesgo es b谩sico en la prevenci贸n de dicha entidad