Actualización en técnicas de paquimetría

El propósito de este trabajo es describir, mediante una revisión bibliográfica, las técnicas actuales para realizar la paquimetría y discutir las ventajas y limitaciones de las mismas. Actualmente, existen numerosas técnicas para medir el espesor corneal: paquimetría ultrasónica tradicional, biomicroscopía ultrasónica, microscopía especular, microscopía confocal, topografía de barrido con hendidura, topografía con cámara de Scheimpflug, tomografía de coherencia óptica y reflectometría óptica de baja coherencia. La paquimetría ultrasónica tradicional es la técnica de referencia debido a su facilidad de uso, portabilidad y bajo coste. No obstante, cuenta con ciertos inconvenientes como el contacto sonda-córnea o la habilidad del evaluador, limitaciones que intentan suplir las técnicas modernas mediante técnicas de no contacto. En la práctica clínica la paquimetría es de especial relevancia en la evaluación corneal en cirugía refractiva, diagnóstico y seguimiento de ectasias corneales, e interpretación de la tonometría para el diagnóstico de glaucoma.Grado en Óptica y Optometrí

Sensibilidad corneal y secreción del moléculas inflamatorias en usuarios de lentes de contacto hidrofílicas sintomáticos y asintomáticos

Propósito: El objetivo de este estudio ha sido encontrar diferencias en la sensibilidad corneal y los niveles de citoquinas en lágrima en usuarios de lentes de contacto hidrofílicas asintomáticos y sintomáticos. Materiales y Métodos: Se reclutaron 47 pacientes portadores de lentes de contacto (LC) hidrofílicas, 23 asintomáticos y 24 sintomáticos en función del cuestionario CLDEQ, así como un grupo no portadores de lentes de contacto, (n=19). Se evaluaron mediante estesiometría con el estesiómetro de gas de Belmonte los umbrales de sensibilidad corneal mecánica, térmica al calor, térmica al frío. Se recogió por capilaridad una muestra de 4 l de lágrima en el que se analizaron los niveles de las citoquinas EGF, fractalquina (FKN), interleuquina (IL)- 10, IL-1β, IL-1RA, IL-2, IL-4, IL-6, IL-8, MCP-1, TNF-α, y de la metaloproteinasa (MMP)-9 mediante tecnología XMAP en un Luminex 100. Los grupos se han analizado comparando, por un lado, No usuarios y usuarios de LC; y por otro, no usuarios de LC, usuarios de LC asintomáticos y usuarios de LC sintomáticos. También se han llevado a cabo estudios de correlaciones entre las distintas variables medidas Resultados: No se encontraron diferencias significativas entre los distintos grupos para ninguna de las variables medidas. Se encontraron las siguientes correlaciones significativas: en el grupo sujetos no usuarios de LC correlaciona positivamente el umbral mecánico con EGF (p<0,01), el umbral al calor con el cuestionario OSDI (p<0,05), y el umbral al frío con IL-8 (p<0,05), y negativamente el umbral mecánico con el umbral al calor (p<0,05) y con el cuestionario OSDI (p<0,01); en el grupo de usuarios de LC (teniendo en cuenta asintomáticos y sintomáticos) correlaciona negativamente el umbral mecánico con el umbral al calor (p<0,05) y el cuestionario OSDI con EGF (p<0,05); y dentro de estos, en el grupo de usuarios de LC asintomáticos correlaciona negativamente el cuestionario OSDI con EGF (p<0,05). Conclusiones: No se han encontrado diferencias en la sensibilidad corneal mecánica y térmica, calor y frío, ni en las secreciones de moléculas inflamatorias tales como EGF, FKN, IL-10, IL-1RA, IL-6, IL-8, MCP-1 y MMP-9 entre no usuarios y usuarios de LC en condiciones basales (al menos 24h sin porte de LC), ni entre no usuarios, usuarios de LC asintomáticos y usuarios de LC sintomáticos. Se requieren más estudios para comprender mejor la sensibilidad corneal y secreción de moléculas inflaminflamatorias de la película lagrimal durante el porte de LC en estos grupos de usuarios de LC.otroMáster en Investigación en Ciencias de la Visió

Relationship between the main components of the crystalline lens and the anterior chamber depth after cataract formation

Producción CientíficaPurpose To assess the relationship between anterior chamber depth (ACD) and lens thickness (LT), as well as its three main components (anterior and posterior cortex and nucleus thickness), in cataractous and non-cataractous eyes, depending on the axial length (AxL). Methods Anterior and posterior cortex and nucleus thickness of the crystalline lens, ACD, and AxL were measured using optical low-coherence reflectometry in cataractous and non-cataractous eyes. They were also classified into hyperopia, emme- tropia, myopia, and high myopia, depending on AxL; thus, eight subgroups were created. A minimum sample size of 44 eyes (of 44 patients) for each group was recruited. Linear models were fitted for the whole sample and each AxL subgroup to assess if there were differences in the relationships between the crystalline lens variables and ACD, including age as a covariate. Results Three hundred seventy cataract patients (237 females, 133 males) and 250 non-cataract controls (180 females, 70 males), aged 70.5 ± 9.4 and 41.9 ± 15.5 years, respectively, were recruited. The mean AxL, ACD, and LT for the cataractous and non-cataractous eyes were 23.90 ± 2.05, 24.11 ± 2.11, 2.64 ± 0.45, and 2.91 ± 0.49, 4.51 ± 0.38, 3.93 ± 0.44 mm, respec- tively. The inverse relationship of LT, anterior and posterior cortex, and nucleus thickness with ACD was not significantly (p ≥ 0.26) different between cataractous and non-cataractous eyes. Further subclassification of the sample depending on AxL showed that the inverse relationship between the posterior cortex and ACD was no longer significant (p > 0.05) for any non-cataractous AxL group. LT, anterior and posterior cortex, and nucleus thickness was not significantly (p ≥ 0.43) different between cataractous and non-cataractous eyes for the whole sample, and all AxL groups after adjusting for age. Conclusions The presence of cataracts does not modify the inverse relationship of the LT, anterior and posterior cortex, and nucleus with ACD. And this relationship does not seem to depend importantly on AxL. Besides, the possible differences in LT, anterior and posterior cortex, and nucleus between cataractous and non-cataractous eyes may not be caused by lens opacification, but possibly by the progressive lens growth due to aging.Ministerio de Economía y Competitividad (Instituto de Salud Carlos III) through Research Projects (RETICS RD16/008/0001)Publicación en abierto financiada por el Consorcio de Bibliotecas Universitarias de Castilla y León (BUCLE), con cargo al Programa Operativo 2014ES16RFOP009 FEDER 2014-2020 DE CASTILLA Y LEÓN, Actuación:20007-CL - Apoyo Consorcio BUCL

EVO+ Implantable Collamer Lens KS-aquaPORT Location, Stability, and Impact on Quality of Vision and Life

Purpose: To determine the longitudinal variation in the KS-aquaPORT central hole location of the phakic EVO+I Implantable Collamer Lens (ICL) (STAAR Surgical) and analyze its influence on visual performance, quality of vision (QoV), and quality of life (QoL). Methods: A prospective study was performed including 36 patients who had EVO+ ICL implantation. The KS-aquaPORT central hole location (Cartesian and polar coordinates) was determined with respect to the pupil center and visual axis. The effect of time (6-month follow-up) on central hole location was analyzed using linear mixed models. The effect of the KS-aquaPORT location on visual performance, QoV, and QoL parameters was assessed with multivariate regression models. Results: With respect to the visual axis, no significant changes in KS-aquaPORT location were found during follow-up. With respect to the pupil center, the X-coordinate and radius of KS-aquaPORT location showed modest, but significant (P ≤ .05) differences between 1-week and 3-month postoperative visits, and between 1-week and 6-month visits. X-coordinate variation was significant (P = .022) between 1-and 6-month visits. With respect to the visual axis, greater KS-aquaPORT decentration was associated with worse visual acuity (X-coordinate: P = .004; radius: P = .006), and inferior decentration with longer xenon-type glare photostress recovery time (P = .021). With respect to the pupil center, a lower radius was associated with better QoV scores (P ≤ .01) and temporal decentration produced higher ring-shaped dysphotopsia (P = .007). Conclusions: EVO+ ICL KS-aquaPORT location appears to be clinically stable up to 6 months postoperatively. A central location of the EVO+ ICL KS-aquaPORT hole is preferred because it allows reduced perception of dysphotopic phenomena that can result in better QoV.This study was supported in part by the Spanish Ministry of Economy and Competitiveness (Instituto de Salud Carlos III) through Research Projects RETICS RD16/008/0001 (Oftared); EM-P was supported by Junta de Castilla y León and European Social Fund (EDU/1100/2017)

Effect of the EVO+ Visian Phakic Implantable Collamer Lens on Visual Performance and Quality of Vision and Life

Purpose: To assess the effect of EVO+ (V5) Visian implantable collamer lens implantation on mesopic visual performance, quality of vision (QoV), and quality of life (QoL). Design: Prospective interventional case series. Methods: Thirty-six eyes of 36 participants who underwent EVO+ implantation for myopia were evaluated preoperatively and at postoperative visits at 1 week and 1, 3, and 6 months. Visual acuity (VA) and mesopic contrast sensitivity (CS) with and without halogen- and xenon-type glare sources were evaluated at each visit. Subjective QoV was assessed with the QoV questionnaire and QoL assessed with the Quality of Life Impact of Refractive Correction (QIRC) questionnaire at each visit. Ring-shaped dysphotopsia was also assessed at each postoperative visit. Linear, cumulative link and logit mixed models were fitted to analyze the effect of the EVO+. Results: Following EVO+ implantation, VA significantly (P ≤ .012) improved at the 4 postoperative visits. Mesopic CS progressively improved at 1, 3, and 6 months postoperatively (P ≤ .012). Halogen glare CS decreased at 1 week and halogen and xenon glare CS improved at 6 months (P ≤ .016). Photostress recovery time after halogen glare improved at 3 and 6 months (P ≤ .004). QoV scores improved at 1 week and 3 and 6 months (P ≤ .001). QIRC scores improved postoperatively (P < .001). Ring-shaped dysphotopsia decreased at 3 and 6 months (P ≤ .007). Conclusions: EVO+ implantation provides good mesopic visual performance, QoV, and QoL during up to 6 months follow-up. Some activities performed under mesopic conditions with glare sources may be affected during the first postoperative week. Ring-shaped dysphotopsia is negligibly bothersome 6 months after surgery.This study was supported in part by the Spanish Ministry of Economy and Competitiveness (Instituto de Salud Carlos III) through Research Projects RETICS RD16/008/0001 (Oftared); EM-P was supported by Junta de Castilla y León and European Social Fund (EDU/1100/2017)

End-of-day dryness, corneal sensitivity and blink rate in contact lens wearers

Purpose: To study the relationship among the variables intensity ofthe end-of-day (EOD) dryness, corneal sensitivity and blink rate in soft contact lens (CL) wearers. Methods: Thirty-eight soft CL wearers (25 women and 13 men; mean age 27.1 ± 7.2 years) were enrolled. EOD dryness was assessed using a scale of 0–5 (0, none to 5, very intense). Mechanical and thermal (heat and cold) sensitivity were measured using a Belmonte’s gas esthesiometer. The blink rate was recorded using a video camera while subjects were wearing a hydrogel CL and watching a film for 90 min in a controlled environmental chamber. Results: A significant inverse correlation was found between EOD dryness and mechanical sensitivity (r: −0.39; p = 0.02); however, there were no significant correlations between EOD dryness and thermal sensitivity. A significant (r: 0.56; p < 0.001) correlation also was observed between EOD dryness and blink rate, but no correlations were found between blink rate and mechanical or thermal sensitivity. Conclusions: CL wearers with higher corneal sensitivity to mechanical stimulation reported more EOD dryness with habitual CL wear. Moreover, subjects reporting more EOD dryness had an increased blink rates during wear of a standard CL type. The increased blink rate could act to improve the ocular surface environment and relieve symptom

Effect of environmental conditions on the concentration of tear inflammatory mediators during contact lens wear

Purpose: To analyze the influence of environmental conditions on the concentrations of tear inflammatory mediators during contact lens (CL) wear. Methods: Fifty-four CL wearers completed 4 visits combining the bilateral use of omafilcon A or comfilcon A CL and a 90-minute exposure to 2 environmental conditions: standard [50% relative humidity (RH), 23°C, 930 mb] or adverse (5% RH, localized air flow, 23°C, 750 mb). Four microliters of tears was collected by capillarity from each subject. Changes in concentration of epidermal growth factor (EGF); interleukin (IL)-1 receptor antagonist, IL-1b, IL-2, IL-4, IL-6, and IL-8; tumor necrosis factor (TNF) a; monocyte chemoattractant protein-1; and matrix metalloproteinase (MMP)-9 were analyzed. The effects of the environment, CL type, and symptoms were evaluated using a 3-way mixed analysis of variance with repeated measures. Results: Under the standard condition, EGF significantly increased [0.36; 95% confidence interval (CI), 0.08 to 0.64], and IL-1b (20.48; 95% CI, 20.84 to 20.12) and IL-2 (20.48; 95% CI, 20.87 to 20.09) significantly decreased. Under the adverse condition, IL-6 significantly increased (0.35; 95% CI, 0.09 to 0.62). Comparing conditions, EGF change was significantly lower (P = 0.02) and IL-1b, IL-2, IL-6, and TNF-a changes were significantly higher (P # 0.04) under the adverse condition. Additionally, IL-1b significantly decreased with comfilcon A (20.51; 95% CI, 20.88 to 20.15), being significantly lower (P = 0.01) than the change with omafilcon A (0.06; 95% CI, 20.23 to 0.35). Conclusions: The secretion of several tear inflammatory mediators during CL wear differs depending on the environmental conditions and the CL type used. These outcomes might help to understand the effect of the environment and CL materials on the ocular surface of CL wearersPartially supported by the Junta de Castilla y Leon and the European Social Fund through Project VA317-11 (scholarship)

The desiccation of LasTablas de Daimiel (1750-1987): agricultural changes and environmental impact based on interpretation of the sedimentary record

El Parque Nacional de lasTablas de Daimiel es un humedal de importancia internacional sometido a una fuerte presión agraria desde el siglo XVIII.El impacto de dicha presión ha sido analizado a partir del estudio de los sedimentos acumulados en el interior del humedal. Se han encontrado varias anomalías sedimentarias que separan al humedal de su comportamiento natural.Se han establecido cuatro épocas de alteración importantes:el primer proyecto de desecación en la dé cada de 1750;el aumento de la superficie cultivada en el entorno durante la segunda mitad del siglo XIX;el intento de desecación promovido durante la Segunda República; y la degradación definitiva en la segunda mitad del siglo XX.Estas perturbaciones han sido corroboradas por fuentes historiográficas,concluyendo que los sucesivos proyectos de desecación desde el siglo XVIII, los cambios en la agricultura española contemporánea, la deforestación del entorno y la expansión del regadío han transformado el humedal.Located in a semi-arid zone of the central Iberian Peninsula, the Tablas de Daimiel National Park is a wetland of international significance that has experienced intense agricultural pressure since the eighteenth century.The impact of this is recorded in the sediments within the wetland,which have been studied by means of surveys.Several sediment anomalies have been found that were caused by an increase in agricultural activities, distinguishing this wetland from natural sedimentary behaviour. Four phases of significant disturbance have been established:the first drainage project in the 1750s,an increase in cultivated area in the surrounding land during the second half of the nineteenth century, a drainage attempt during the Spanish Second Republic and a final degradation in the second half of the twentieth century.Dated with some uncertainty due to the laboratory methods used,these disturbances have been corroborated by historical sources.In conclusion, one can establish that deforestation in the surrounding land,changes in land use,continual ploughing and drainage projects are all crucial in explaining the impoverishment of this wetland.Depto. de Geodinámica, Estratigrafía y PaleontologíaFac. de Ciencias GeológicasTRUEMinisterio de Economía y Competitividad (MINECO)pu

Caracterización sociodemográfica de pacientes alcohólicos ingresados para tratamiento de deshabituación

Introducción:En la actualidad, el consumode alcohol constituye un grave problema a nivel mundial, pues se le considera unadroga capaz de destruir al ser humano en su integridad física, mental, social y espiritual.Objetivo:Caracterizar sociodemográficamente a los pacientes alcohólicos ingresados para tratamiento de deshabituación en el servicio de adicciones del Hospital Provincial Psiquiátrico de Manzanillo durante el 2017.Diseño Metodológico:Se realizó un estudio observacional descriptivo retrospectivo sobre los pacientes alcohólicos ingresados para tratamiento de deshabituación de enero a diciembre de 2017. La muestra de estudio estuvo constituida por 34 pacientes.Resultados:El 100 % de los pacientes fueron de sexo masculino. La edad predominante fue la comprendida entre 50-59 años con 29,4 %. El 73,5 % de los pacientes eran de procedencia urbana. La mayoría de los pacientes tenía como nivel educacional el preuniversitario terminado representando el 41,2 % del total. El 55,9 % de los pacientes estaban sin vínculo laboral. El estado civil más frecuente fue el de soltero representado por el 67,6 % del total.El 61,8 % de los pacientes reconocían ser alcohólicos. La vía sociocultural fue la vía de iniciación y mantenimiento del consumo más empleada con el 50 % del total.Conclusiones:Todos los pacientes fueron de sexo masculino, predominando la edad comprendida entre 50-59, de procedencia urbana, con nivel educacional preuniversitario terminado, sin vínculos laborales y solteros.La mayoría de los pacientes reconocían ser alcohólicos.La vía sociocultural fue la vía de iniciación y mantenimiento del consumo más empleada.