La profilaxis con antibióticos tópicos no es indispensable después del retiro de cuerpos metálicos extraños de la córnea

Objetivo: Valorar la incidencia de infección corneal en pacientes con cuerpos extraños corneales metálicos después de su retiro sin uso de antibióticos tópicos profilácticos. Métodos: Se incluyeron prospectivamente 120 pacientes con cuerpos extraños corneales metálicos. En todos los casos se retiraron los cuerpos extraños metálicos y el pulimiento del herrumbre anular se realizó en caso necesario. Lubricante en ungüento o en gotas fueron administrados en cada paciente. Se ocluyó con parche en caso indicado. Se siguió cada caso hasta obtener cicatrización total del área afectada. Se valoró la incidencia de infección corneal. Resultados: Ningún paciente desarrollo infección corneal. Conclusiones: El uso de antibióticos tópicos profilácticos después de retirar cuerpos extraños corneales metálicos no es indispensable

Behaviour of disc oedema during and after amiodarone optic neuropathy: case report

A 73-year-old woman with atrial fibrillation treated with Amiodarone presented with Optic Disc oedema in right eye (OD). Using Optical Coherence Tomography (OCT) we describe the impact of this neuropathy on Retinal Nerve Fibre Layer (RNFL). At diagnosis RNFL average was of 188 µm OD and 77 µm in the left eye (OS), six months after discontinuation of the drug decreased to 40 µm in OD and 76 µm in OS. The RNFL average of OD presented a transient increase during the acute oedema that returned to normal levels during the first month after discontinuation of the drug and fell dramatically to 44 µm at the second month and 40 µm at the sixth month. We show there is axonal loss after amiodaroneassociated optic neuropathy measured with OCT. The OCT may be used in these patients to document changes in RNFL in the follow-up

Combined therapy in diabetic macular edema

Purpose: To determine the effectiveness of three different combinations for the ‘‘loading phase’’ in the treatment of diabetic macular edema (DME), using bevacizumab (BVZ), triamcinolone (TCL) and subthreshold macular photocoagulation (SMPC). Methods: Experimental, longitudinal, prospective, comparative and blind. Patients were randomly assigned to three treatment branches: Group 1: BVZ + SMPC (12 eyes), Group 2: SMPC + BVZ + TCL (7 eyes), Group 3: BVZ + TCL (11 eyes). Treatment with BVZ and TCL was given every 4 weeks for 3 months, SMPC was applied once at the beginning of treatment. Initial and final measurements of best corrected visual acuity (BCVA), central macular thickness (CMT) and intraocular pressure (IOP) were tested. Results: The improvement in BCVA and the reduction in CMT was statistically superior in group of BVZ + SMPCwhen compared to the other groups. There were no differences in IOP. Conclusions: Combined therapies in the ‘‘loading phase’’are a good option when treating DME. Although the group with BVZ + SMPC obtained the best results, further studies with longer followup and a higher number of participants to establish this combined therapy as the first treatment option are required

Short-term outcomes after the loading phase of intravitreal bevacizumab and subthreshold macular laser in non-center involved diabetic macular edema

AIM: To compare the effectiveness of intravitreal bevacizumab and subthreshold macular photocoagulation (SMP), for the treatment of non-center involved diabetic macular edema (non-CI DME). METHODS: Prospective, randomized, controlled clinical study included patients with type 2 diabetes, non-CI DME and best-corrected visual acuity (BCVA) of 0.30 logMAR or better. Each eye was randomized into three groups: group 1, monthly intravitreal bevacizumab; group 2, single SMP; group 3, single SMP and monthly bevacizumab. Main outcome measures were BCVA, and macular thickness measured with optical coherence tomography as macular central subfield thickness (CST), macular area of greater thickness (MAGT) and total macular volume (TMV). Results were analyzed after 3mo. RESULTS: A total of 32 eyes were included. Group 3 improved in BCVA (0.19±0.16 to 0.12±0.14 logMAR; P=0.041) and in TMV (7.90±0.57 to 7.65±0.73 mm3; P=0.025). Group 1 improved in MAGT (325±26.26 to 298.20±44.85 μm; P=0.022) and TMV (7.79±0.57 to 7.50±0.56 mm3, P=0.047). Group 2 didn’t show significant improvement of any variable. CONCLUSION: The loading phase of bevacizumab as monotherapy or combined with SMP is superior to SMP as monotherapy in providing short-term visual and anatomical improvement in non-CI DME

Sex and Age Morphometric Variations in Bony Nasolacrimal Duct and Fossa for Lacrimal Gland in Mexican Population

SUMMARY: Primary acquired nasolacrimal duct obstruction is greater in women over 40 years and has been associated with morphometric variations in the osseous nasolacrimal duct, which varies according to age and sex. The objective is to determine variations regarding sex and age of the nasolacrimal duct and osseous fossa for lacrimal gland. One hundred sixteen dry orbits from Mexican population were analyzed; subdivided into four groups based on age and sex. The length, transverse and anteroposterior diameters of the bone entrance of the nasolacrimal duct, and the length and width of the fossa for lacrimal gland were determined. Statistical tests were applied to determine the significance of the differences found between groups. The nasolacrimal duct in women had shorter length than men in both age groups. The entrance had a wider transverse diameter in women than men independently of age and its anteroposterior diameter was shorter in men under 40 years than over 40 years. The fossa for lacrimal gland was larger in women under 40 years than in men of same age group and women over 40 years old. The lower third of the was wider in women under 40 years than in women over 40 years. Our study confirms significant differences between sex and age groups in some of the morphometric measurements of bony nasolacrimal duct and fossa for lacrimal gland in Mexican population. Comparative studies with and without clinical illness are needed to clarify if the bony characteristics of those structures participate in the etiopathogenesis and distribution differences observed in sex, age and ethnicity of thisillness. KEY WORDS: Nasolacrimal duct; Fossa for lacrimal gland; Morphometry; Primary acquired nasolacrimal duct obstructio

Reduced corneal endothelial cell density after toxic anterior segment syndrome (TASS) caused by inadvertent intraocular ointment migration: A case report

Introduction and importance: Toxic anterior segment syndrome (TASS) is an acute sterile inflammation of the anterior segment which may occur after surgery. This case presents endothelial cell density (ECD) loss due to months of TASS caused by intraocular migration of ocular ointment. The chronicity of this case and the clinical consequences are rare in the literature. Case presentation: A Colombian 71-year-old man developed TASS secondary to intraocular ointment migration after uneventful cataract surgery with phacoemulsification and intraocular lens placement in the capsular bag. The main complaint for the patient was a chronic red eye, no pain or visual disturbance were reported, rheumatologic diseases were discarded. It was documented the presence of intraocular ointment in the anterior chamber, over the iris and in the anterior chamber angle. The ECD was reduced secondary to TASS and the longterm presence of ointment moving in the anterior chamber, so it had to be removed. Clinical discussion: It is important to avoid using ocular ointment after intraocular surgeries to avoid the risk of ointment migration into the anterior chamber. Intraocular ointments should be removed promptly to reduce ECD loss as documented in the present case report in which after ointment elimination ECD remains stable for 7 years. Conclusion: Topical ointments should not be used after routine cataract surgery because of the risk of intraocular ointment migration and subsequent risk of developing TASS and reduced ECD

Corneal Melting after Collagen Cross-Linking for Keratoconus in a Thin Cornea of a Diabetic Patient Treated with Topical Nepafenac: A Case Report with a Literature Review

Purpose: To report the case of a 50-year-old woman with diabetes that presented with corneal melting and perforation 6 weeks after collagen cross-linking (CxL) for keratoconus (KC) and postoperative use of nepafenac eye drops, a nonsteroidal anti-inflammatory drug (NSAID). Methods: This is a case report of a patient with diabetes, KC and a thin cornea that had undergone left eye corneal CxL at a different hospital followed by postoperative use of nepafenac eye drops for 6 weeks. Results: The patient presented for the first time to our clinic with left corneal melting, perforation and iris prolapse 6 weeks after corneal CxL and topical nepafenac use. She was treated with a left eye tectonic penetrating keratoplasty, extracapsular cataract extraction, intraocular lens implantation and pupilloplasty. Conclusions: The corneal melting and perforation in this patient was associated with multiple risk factors: (1) nepafenac eye drop use, (2) CxL in a cornea thinner than 400 µm and (3) diabetes. The recommended corneal thickness limits should be respected. Topical NSAIDs should be used with caution if used as postoperative treatment after corneal CxL and in patients with diabetes, epithelial defect or delayed healing, because of the possible increased risk for corneal melting when multiple risk factors are observed