Medición de presión intraocular con el tonómetro Proview®

Purpose: To evaluate a new ocular tonometer (Proview®) which functions by visualizing a phosphene after putting pressure on the upper eyelid. To ascertain its accuracy and reproducibility with respect to the Goldmann tonometer (GT). Methods: A study on both eyes of 110 non-selected patients was performed. One measurement with GT and three subsequent measurements with Proview® were taken by the same investigator. The number of failed attempts to visualize the phosphene was recorded. We evaluated each eye separately to observe the possible learning effect. Results: The intraocular pressure (IOP) mean with Proview® is 5 mm Hg higher than the GT (p0.05). Conclusions: The Proview® tonometer showed low accuracy and reproducibility in comparison with the GT. This tonometer requires a long learning process before phosphene visualization. The results demonstrated that this tonometer is not clinically useful, except in patients with serious corneal diseases which make measurement with GT very difficul

Variabilidad en la presentación del Síndrome de Brown-McLean

Case report: We report two aphakic patients with Brown-McLean syndrome. Discussion: One patient was affected by Marfan syndrome, after having undergone lens subluxation surgery and aphakia 23 years previously. The other patient was aphakic due to cataract surgery with complications three years before. Our cases demonstrate that this syndrome can show a variety of clinical characteristics, but peripheral corneal edema is always present. A full understanding of the clinical signs of presentation is of great importance in order to detect this syndrom

Comparison of dynamic contour tonometry (Pascal®) with pneumotonometry and Goldmann tonometry

To compare the intraocular pressure measurements as defined by the Pascal tonometer, the Goldmann tonometer and the pneumotonometer. METHODS: This was an observational clinical study, which included two hundred and five randomly selected subjects recruited from the Ophthalmology Department. The intraocular pressure measurements were performed with each tonometry technique in a randomized order. RESULTS: The Pascal's intraocular pressure measurement was significantly higher than that measured by the other two tonometers (p<0.05). The quality data of Pascal was: optimum in 27.3% (56 of 205 patients), acceptable in 42% (86 of 205 patients) and unacceptable in 23.4% (48 of 205 patients). In 7.3% (15 of 205 patients) it was impossible to obtain any measurement using Pascal. A weak correlation coefficient between the Pascal and the Goldmann, and between Pascal and the pneumotonometer was found. The Bland-Altman method of measurement using these tonometers showed a high degree of discordance. CONCLUSION: As reported by others authors, the Pascal's intraocular pressure measurement is higher than that of the Goldmann tonometer. The measurement differs from 0.7 to 4.4 mmHg. In corneas with pathology, it is very difficult or even unacceptable to measure the intraocular pressure using the Pascal tonometer

Optical coherence tomography in central retinal artery occlusion

CLINICAL CASES: Three eyes with central retinal artery occlusion (CRAO) have been studied. Optical coherence tomography (OCT) was performed in each of them. Ophthalmoscopic signs of CRAO were equivocal in the three eyes. However, the presence of a hyporeflective signal in the OCT scan could be seen clearly in each of them. DISCUSSION: The presence of a hyporeflective band between the neurosensory retina and the retinal pigment epithelium in OCT images, that persist for several months after a CRAO episode, is useful in establishing the diagnosis in these patient

Amniotic membrane transplantation with fibrin glue as treatment of refractory conjunctivochalasis

Case report: A 63-year-old man with bilateral conjunctivochalasis presented with tearing, irritation, foreign body sensation and a delayed fluorescein clearance test. After no symptomatic improvement with topical treatment, surgery was carried out, with amniotic membrane transplantation and fibrin sealant. Discussion: Conjunctivochalasis is a frequent disorder that shares symptoms with dry eye syndrome. When there is no response to topical treatment, surgical treatment is needed. The surgical technique described by Tseng, and based on amniotic membrane transplantation without suture, resulted in a very useful response, due to less inflammation and a rapid resolution and improvement of symptom

Oftalmopatía tiroidea: determinación de parámetros de actividad clínica de la oftalmopatía tiroidea como factor pronóstico de respuesta al tratamiento inmunosupresor

Objective: To determine the usefulness of the clinical, biochemical and thyroid imaging parameters in patients with thyroid-associated ophthalmopathy, in predicting their response to immunosuppressive treatment. Methods: This retrospective study of 16 patients with thyroid ophthalmopathy considered a number of variables including sex, age, thyroid hormone levels, treatment of the thyroid dysfunction, clinical activity score (CAS), severity (NOSPECS) of the ophthalmopathy, signs in standardized A-mode ultrasonography, in CAT and/or NMR, and previously used treatments and their effectiveness. Results: The average age of the patients was 50.81 (S.D: 11.89) years; there were 5 males (31.3%) and 11 females (68.8%). The ophthalmopathy was classified as active in 10/16 patients (62.5%) and inactive in 6/16 (37.5%); and as moderate in 9/16 (56.25%) and severe in 7/16 (43.75%) according to the severity defined in NOSPECS. Ultrasonography was diagnostic in 100% of the cases. The severity decreased significantly (p ≤ 0.05), however the clinical activity decrease did not reach significance (p=0.38) during immunosuppressive therapy. Better results were obtained during treatment of patients with a higher CAS (p=0.04) and in those with more severe ophthalmopathy (p=0.02). There was a tendency for the patients with higher levels of TSI to respond better to the treatment (p=0.06). Conclusions: The CAS is the best parameter to quantify the activity of the disease and predicting the response to treatment. The higher the CAS and the more severe the ophthalmopathy, the better the response to treatment. No association existed between thyroid function and the activity or severity of the ophthalmopathy; or the effectiveness of treatmen

Neuropatía óptica autoinmune recidivante bilateral en la infancia

Clinical case: A ten year-old girl, after a Yersinia gastroenteritis, developed an optic neuritis in the left eye. She was not treated and resulted ultimately in optic atrophy on the affected side. Six months later a similar episode occurred in the contralateral eye. On this occasion corticosteroid therapy was given. During this therapy the neuritis diminished; however the patient had three relapses, so it was decided to give her immunosuppressive treatment with azathioprine and continue this indefinitely. Discussion: After considering the differential diagnoses of bilateral recurrent optical neuritis in childhood, we concluded that it was most likely to have an autoimmune basis. After considering the benefits and risks of the long-term treatment, we believe immunosuppressive therapy is most useful in controlling the disease allowing corticosteroid therapy to be reduced (Arch Soc Esp Oftalmol 2006; 81: 607-610)

Aceite de silicona para el tratamiento de la maculopatía hipotónica

Case report: We report a case of a man who developed hypotonic maculopathy after vitreoretinal surgery for anterior proliferative vitreoretinopathy. After an injection of intravitreal triamcinolone, the ocular pressure did not increase, therefore silicone oil was injected. After this, the visual acuity increased and the choroidal and retinal folds regressed. Discussion: Hypotonic maculopathy is a frustrating problem, often resulting in poor visual acuity. There are not many effective treatments. The injection of silicone oil could be an alternative to increase the intraocular pressure and re-establish the normal anatomy of the eye, improving the visual acuity in some patient

Hemorragia submacular traumática tratada con rt-PA y SF6

This patient was afflicted by a traumatic submacular hemorrhage. A posterior vitrectomy was performed and intravitreal rt-PA and SF6 were administered. Four weeks later, the visual acuity had increased from 0.1 to 0.8. No complications due to the treatment with rt-PA were reported. DISCUSSION: It is known that waiting for the spontaneous blood removal in such cases results in a poor visual acuity recovery due to a toxic effect of the blood products. Both rt-PA and the SF6 are useful for the treatment of submacular hemorrhages secondary to age-related macular degeneration, and this case report has shown they are also useful to lyse traumatic blood clots, thus contributing to a better recovery of visual acuity

Oxidative stress and histological changes in a model of retinal phototoxicity in rabbits

Photochemical damage occurs after an exposure to high energy radiation within the visible spectrum of light, causing morphological changes in the retina and the formation of superoxide anion. In this study we created a model of phototoxicity in rabbits. Animals were exposed to a light source for 120 minutes and were sacrificed immediately or one week after exposure. Outer nuclear layer and neurosensory retina thickness measurements and photoreceptor counting were performed. Caspase-1 and caspase-3 were assessed by immunohistochemistry. Dihydroethidium was used to evaluate in situ generation of superoxide and thiobarbituric acid reactive substances were measured in retinal homogenates as indicators of lipid peroxidation. The total antioxidant capacity and oxidative ratio were also determined. Retinas from rabbits exposed to light showed higher levels of lipid peroxidation than the unexposed animals and a decrease in outer nuclear layer and neurosensory retina thickness. Our study demonstrates that light damage produces an increase in retinal oxidative stress immediately after light exposure that decreases one week after exposure. However, some morphological alterations appear days after light exposure including apoptotic phenomena. This model may be useful in the future to study the protective effect of antioxidant substances or new intraocular lenses with yellow filters