Vitrectomy and internal limiting membrane peeling for macular folds secondary to hypotony in myopes

Hypotony maculopathy (HM) changes may persist, and visual acuity remains poor, despite normalization of intraocular pressure (IOP). The aim of this study was to evaluate the visual and anatomical results of pars plana vitrectomy (PPV), internal limiting membrane (ILM) peeling, and 20% SF6 gas tamponade in five myopic patients with HM. This retrospective interventional study was conducted at the Barraquer Center of Ophthalmology, a tertiary care center in Barcelona, Spain, and included five eyes from five consecutive patients (aged 55.4±13.1 years) with HM caused by different conditions. All the patients were treated with 23-gauge PPV, ILM peeling, and 20% SF6 gas tamponade. Preoperative and postoperative evaluation was performed using anterior and posterior biomicroscopy and best corrected visual acuity (BCVA) by logMAR charts. Before surgery, median spherical equivalent was −13.1 (range −7, −19) diopters of myopia. Preoperatively, four cases presented IOP 6.5 mmHg was achieved over 16 (range 16-28) weeks, without resolution of HM; increased IOP was not achieved in the remaining case treated 2 weeks after diagnosis of HM. One case presented IOP >6.5 mmHg with HM for 28 weeks before surgery. Preoperative BCVA was 0.7 (range 0.26-2.3) logMAR, and 0.6 (range 0.3-0.7) logMAR and 0.5 (range 0.2-1) logMAR, respectively, at 4 and 12 months after surgery. There was no statistically significant difference between preoperative and postoperative BCVA. Hyper-pigmentation lines in the macular area were observed in three cases with hypotony. These lines progressed after surgery despite resolution of the retinal folds in the three cases, and BCVA decreased in parallel in two of these cases. PPV with ILM peeling followed by gas tamponade is a good alternative for the treatment of HM in myopic patients. However, persistent choroidal folds may compromise BCVA. We therefore recommend initiating treatment as early as possible

Aproximación a la fisiopatología de la retinopatía diabética : estudio de la fosforilación y nitrosilación de tirosinas de proteínas y péptidos inflamatorios y angiogénicos del humor vítreo /

Descripció del recurs: el 01 setembre 2012Esta tesis se presenta en forma de compendio de publicaciones según la normativa aprobada por la Comisión de Doctorado de la Universitat Autònoma de Barcelona. El núcleo principal se basa en artículos originales publicados en revistas indexadas. Los trabajos evalúan los niveles de fosforilación y nitrosilación de tirosinas de las interleuquinas del vítreo de pacientes afectos de retinopatía diabética. Para ello se han analizado muestras de vítreo de los mismos y se han comparado con pacientes no diabéticos Artículo 1 Tyrosine Phosphorylation of Vitreous Inflammatory and Angiogenic Peptides and Proteins in Diabetic Retinopathy Investigative Ophthalmology and Visual Science 2009; 50: 1378-1382 DOI:10.1167/iovs.08-2736 FACTOR IMPACTO ………………3,431 Objetivo Estudiar el grado de fosforilación de tirosinas en un amplio conjunto de péptidos y proteínas relacionados con procesos de angiogénesis y de inflamación en muestras de humor vítreo de pacientes diabéticos tipo 2 con Retinopatía diabética proliferativa. Comparar los resultados obtenidos con las muestras de vítreo de pacientes sin retinopatía diabética, de sexo y edades similares. Material y Método Estudio comparativo entre muestras obtenidas durante la VPP realizada por complicaciones derivadas de la RDP con las obtenidas en las VPP por agujero macular idiopático en los sujetos control. Estudio comparativo entre muestras obtenidas durante la VPP realizada por complicaciones derivadas de la RDP con las obtenidas en las VPP por agujero macular idiopático en los sujetos control. Obtención de las muestras de humor vítreo: Vitrectomía Pars Plana con intercambio de aire para la obtención de muestra no diluida , se realiza una centrifugación inmediata y se congela a - 80º C Se aplicaron técnicas de inmunoblot en un sistema de mini-array para la cuantificación de una amplia gama de quimioquinas, péptidos vasoactivos y proteínas con cuantificación de bandas software multi Gauge v 3.0 Los resultados se expresaron como el porcentaje de variación en comparación con sujetos control. Muestra: 8 pacientes afectos de Retinopatía diabética proliferativa Control: 8 pacientes con Agujero macular idiopático La cantidad total de proteínas analizadas fue similar en los pacientes y sujetos control (48). Fosfosforilación de tirosinas sin cambios significativos (p 0,05) en pacientes diabéticos respecto al grupo de control: Crecimiento regular del oncogén α (GRO α ) IL-2 , IL-3, IL-4 Interferón (FN- ϒ) Proteína quimiotáctica de monocitos (MCP-1-2-3) Factor de necrosis tumoral (TNF α , β) Factor de crecimiento epidérmico (EGF) Factor de crecimiento similar a la insulina (IGF) Trombopoyetina Factor de crecimiento vascular endotelial (VEGF) Factor de crecimiento derivado de las plaquetas (PDGF 88) Fosfosforilación de tirosinas con disminución moderada 15%-20% (p 0,05) en pacientes diabéticos respecto al grupo de control: Crecimiento regular del oncogén (GRO) Citoquina humana I-309 Interleuquina (IL-13) Factor estimulante de las colonias de monocitos Quimioquina derivada de los macrófagos Factor de las células madreThis thesis is presented in the form of a compendium of published articles in accordance with the doctorate commission of the Universitat Autónoma de Barcelona. The main body of this thesis comprises original research articles published in indexed journals. The main subject of the research is the evaluation of Phosphorylation and Nitrosylation of interleuquines in the vitreous of patients with diabetic retinopathy. Samples from diabetic patients were analysed and compared with a control group of not diabetic patients. Article 1 Tyrosine Phosphorylation of Vitreous Inflammatory and Angiogenic Peptides and Proteins in Diabetic Retinopathy Invest Ophthalmol .Vis Sci. 2009;50:1378-1382) DOI:10.1167/iovs.08-2736 Impact factor 3,431 .To evaluate the degree of phosphorylation of vitreous proteins in patients with type 2 diabetes mellitus and diabetic retinopathy compared with a group of control subjects without diabetes and of similar age and sex. METHODS. In samples obtained after vitrectomy for diabetic retinopathy in patients and for macular hole in control subjects, immunoblot techniques were applied to a mini-array system for quantification of a wide range of chemokines and vasoactive peptides and proteins. Antiphosphotyrosine antibody was used for tyrosine phosphorylation evaluation and results were expressed as the percentage of variation compared with that in control subjects. RESULTS. Samples from eight patients with type 2 diabetes and from eight control subjects were analyzed. The total quantity of proteins analyzed was similar in both patients and control subjects. Tyrosine phosphorylation was very significantly decreased (_20%, P _ 0.05) in diabetic patients with respect to the control group in growth-related oncogene, human cytokine I-309, interleukin-13, monocyte colony-stimulating factor, macrophage-derived chemokine, stem cell factor, transforming growth factor-_1, angiogenin, and oncostatin M. A significant decrease in phosphorylation (between 20% and 40%, P _ 0.05) was observed in epithelial neutrophil-activating peptide 78; granulocyte colony-stimulating factor; granulocyte-monocyte- stimulating colony factor; IL-5, -6, -7, -8, -10, and -12p40p70; monokine induced by interferon-_; macrophage inflammatory protein 1-; and normal T expressed and secreted cytokine (RANTES) in comparison with that in the control subjects. The greatest decrease in phosphorylation status was found in IL-1-_ and -1. CONCLUSIONS. Diabetic retinopathy is associated with a decrease in tyrosine phosphorylation of many vitreous proteins which may indicate an alteration in protein functionality or action even before significant quantitative variations. Article 2 Diabetic Retinopathy Is Associated with Decreased Tyrosine Nitrosylation of Vitreous Interleukins IL-1 , IL-1 , and IL-7 Ophthalmic Res 2011;46:169-174 DOI: 10.1159/000323812 Impact factor 1.29 Objective: To simultaneously evaluate tyrosine nitrosylation and phosphorylation levels of vitreous interleukins of patients with diabetic retinopathy, in which abnormal tyrosine phosphorylation has been previously described. ResearchDesign and Methods: Specific immunoprecipitation of interleukins IL-1 _ , IL-1 _ , IL-2 and IL-7 was carried out in samples obtained during vitrectomy performed for proliferative diabetic retinopathy in patients (n = 12) and for macular hole in controls (n = 12). Tyrosine nitrosylation and phosphorylation levels of the immunoprecipitated interleukins were analysed by Western blot with the respective specific antibodies and correlated. The results were also correlated with the total amount of immunoprecipitated interleukin protein. The mean phosphorylation/nitrosylation ratios of these proteins in vitreous humour of both the control group and diabetic patients were determined Results: Diabetes was associated with decreased tyrosine nitrosylation of IL-1, IL-1 and IL-7and an increased tyrosine phosphorylation/nitrosylation ratio with respect to controls in IL-1 (1.58 8 0.22 vs. 2.74 80.39, respectively; p 0.05) and IL-7 (2.15 8 0.01 vs. 3.26 80.57, respectively; p 0.05). No significant changes were observedin nitrotyrosine or in the tyrosine phosphorylation/ nitrosylation ratio of IL-2. Conclusions: Proliferative diabetic retinopathy is associated with concomitant and simultaneous changes in both tyrosine phosphorylation and tyrosine nitrosylation status of specific pro-inflammatory interleukins present in the vitreous fluid such as IL-1 , IL-1 and IL-7. These changes could be related to the increase in pro-inflammatory activity detected in diabetes-induced retinopathy. Main conclusions Diabetic retinopathy is associated with alterations in the tyrosine phosphorylation status of protein inflammatory interleukins group, which could be the pathophysiological basis of retinal involvement. Tyrosine nitrosylation is not the result of changes in phosphorylation. Alterations in interleukin-nitrosylation may have an implication in the pathogenesis of diabetic retinopathy. The phospho-dephosphorylation mechanisms and nitro-denitrosilatión could be therapeutic targets in the future. These findings open an future research, which could be based on experimental models in which they assessed the effects that changes in the mechanisms of phosphorylation / tyrosine nitrosylation on the occurrence or progression of diabetic retinopathy

Surgical mobilization of an arterial embolus in cilioretinal artery occlusion

We describe an effective surgical approach for the management of cilioretinal artery occlusion. A 23-G pars plana vitrectomy assisted with two soft tip cannulas was performed. One cannula pressed the cilioretinal artery branch directed toward the macula, distal to the location of the embolus, whereas the other cannula was used to gently swipe over the cilioretinal artery proximal to the occlusion. Anatomical and functional outcomes were evaluated by fundus examination, fluorescein angiography, Goldmann visual field, and best-corrected visual acuity (BCVA). It was possible to mobilize the embolus by mechanical displacement with 23-G soft-tip cannulas and disintegrate it, preventing the passage toward the branch directed to the macula. Restoration of retinal circulation was confirmed by fluorescein angiogram. The patient recovered his previous documented BCVA and visual field. The described technique can be considered as a new possibility for achieving a solution to cilioretinal artery occlusion or any other retinal artery occlusion

Anterior segment changes following intravitreal bevacizumab injection for treatment of neovascular glaucoma

The purpose of this study was to describe anterior segment changes in a prospective, interventional, noncomparative case series of patients with neovascular glaucoma secondary to proliferative diabetic retinopathy treated with intravitreal bevacizumab. Five consecutive patients with neovascular glaucoma and a refractory, symptomatic elevation of intraocular pressure and pronounced anterior segment congestion received intravitreal bevacizumab 1.25 mg/0.05 mL. Follow-up examinations were performed at 4-16 weeks by the same specialists, with testing performed at hour 48, week 1, and months 1, 3, and 6 after intravitreal bevacizumab. We observed a significant difference (P = 0.021) between initial and mean neovascularization at three months in all the quadrants. At three months, median intraocular pressure was 19 ± 5.38 (range 12-26) mmHg. In three of the five cases, diode laser cyclophotocoagulation was required, and in one case a trabeculectomy was performed. One patient showed complete synechial angle closure 48 hours after treatment which required cyclodestructive procedures to normalize intraocular pressure. Intravitreal bevacizumab achieves complete regression of neovascularization in neovascular glaucoma secondary to proliferative diabetic retinopathy, and this regression is stable when associated with treatment of the underlying disease and should be investigated more thoroughly as an adjunct in the management of neovascular glaucoma

Autologous platelet concentrate in surgery for macular detachment associated with congenital optic disc pit

To evaluate the anatomical and functional results obtained with pars plana vitrectomy (PPV) plus autologous platelet concentrate (APC) as a treatment for macular detachment associated with optic disc pit (ODP). We performed a prospective interventional study of 19 eyes of 19 consecutive patients with posterior macular detachment due to ODP. All patients underwent PPV, posterior hyaloid peeling, fluid-air exchange, injection of 0.05 mL of APC over the ODP and 15% perfluoropropane (C3F8) endotamponade. Postoperative measures included face-up positioning for 2 hours and then avoidance of the face-up position during the ensuing 10 days. All patients underwent complete ophthalmologic examination and optical coherence tomography preoperatively at 1 month, 3 months, 6 months, 9 months, and 12 months postoperatively and then annually. Outcome measures were best corrected visual acuity (BCVA) by logMAR, improvement of quality of vision, macular attachment, and resolution of intraretinal schisis-like separation. Preoperatively, the median BCVA was 0.70 (range: 0.30-1.70) and all patients showed improved visual acuity after surgery; BCVA was 0.22 (range: 0.07-0.52) at 12 months follow-up. All patients showed complete reabsorption of intraretinal fluid (median time: 3.5 months [range: 2-8 months]) and macular attachment at the end of follow-up (median: 60 months [range: 12-144 months]), with stable or improved visual acuity. No reoperations were needed and no major adverse events were recorded. For macular detachment associated with ODP, the combination of PPV, posterior hyaloid peeling, APC, and C3F8 tamponade is a highly effective alternative technique with stable anatomical and functional results

Aproximación a la fisiopatología de la retinopatía diabética. Estudio de la fosforilación y nitrosilación de tirosinas de proteínas y péptidos inflamatorios y angiogénicos del humor vítreo

Esta tesis se presenta en forma de compendio de publicaciones según la normativa aprobada por la Comisión de Doctorado de la Universitat Autònoma de Barcelona. El núcleo principal se basa en artículos originales publicados en revistas indexadas. Los trabajos evalúan los niveles de fosforilación y nitrosilación de tirosinas de las interleuquinas del vítreo de pacientes afectos de retinopatía diabética. Para ello se han analizado muestras de vítreo de los mismos y se han comparado con pacientes no diabéticos Artículo 1 Tyrosine Phosphorylation of Vitreous Inflammatory and Angiogenic Peptides and Proteins in Diabetic Retinopathy Investigative Ophthalmology and Visual Science 2009; 50: 1378–1382 DOI:10.1167/iovs.08-2736 FACTOR IMPACTO ………………3,431 Objetivo Estudiar el grado de fosforilación de tirosinas en un amplio conjunto de péptidos y proteínas relacionados con procesos de angiogénesis y de inflamación en muestras de humor vítreo de pacientes diabéticos tipo 2 con Retinopatía diabética proliferativa. Comparar los resultados obtenidos con las muestras de vítreo de pacientes sin retinopatía diabética, de sexo y edades similares. Material y Método Estudio comparativo entre muestras obtenidas durante la VPP realizada por complicaciones derivadas de la RDP con las obtenidas en las VPP por agujero macular idiopático en los sujetos control. Estudio comparativo entre muestras obtenidas durante la VPP realizada por complicaciones derivadas de la RDP con las obtenidas en las VPP por agujero macular idiopático en los sujetos control. Obtención de las muestras de humor vítreo: Vitrectomía Pars Plana con intercambio de aire para la obtención de muestra no diluida , se realiza una centrifugación inmediata y se congela a – 80º C Se aplicaron técnicas de inmunoblot en un sistema de mini-array para la cuantificación de una amplia gama de quimioquinas, péptidos vasoactivos y proteínas con cuantificación de bandas software multi Gauge v 3.0 Los resultados se expresaron como el porcentaje de variación en comparación con sujetos control. Muestra: 8 pacientes afectos de Retinopatía diabética proliferativa Control: 8 pacientes con Agujero macular idiopático La cantidad total de proteínas analizadas fue similar en los pacientes y sujetos control (48). Fosfosforilación de tirosinas sin cambios significativos (p< 0,05) en pacientes diabéticos respecto al grupo de control: Crecimiento regular del oncogén α (GRO α ) IL-2 , IL-3, IL-4 Interferón (FN- ϒ) Proteína quimiotáctica de monocitos (MCP-1-2-3) Factor de necrosis tumoral (TNF α , β) Factor de crecimiento epidérmico (EGF) Factor de crecimiento similar a la insulina (IGF) Trombopoyetina Factor de crecimiento vascular endotelial (VEGF) Factor de crecimiento derivado de las plaquetas (PDGF 88) Fosfosforilación de tirosinas con disminución moderada 15%-20% (p< 0,05) en pacientes diabéticos respecto al grupo de control: Crecimiento regular del oncogén (GRO) Citoquina humana I-309 Interleuquina (IL-13) Factor estimulante de las colonias de monocitos Quimioquina derivada de los macrófagos Factor de las células madreThis thesis is presented in the form of a compendium of published articles in accordance with the doctorate commission of the Universitat Autónoma de Barcelona. The main body of this thesis comprises original research articles published in indexed journals. The main subject of the research is the evaluation of Phosphorylation and Nitrosylation of interleuquines in the vitreous of patients with diabetic retinopathy. Samples from diabetic patients were analysed and compared with a control group of not diabetic patients. Article 1 Tyrosine Phosphorylation of Vitreous Inflammatory and Angiogenic Peptides and Proteins in Diabetic Retinopathy Invest Ophthalmol .Vis Sci. 2009;50:1378–1382) DOI:10.1167/iovs.08-2736 Impact factor 3,431 .To evaluate the degree of phosphorylation of vitreous proteins in patients with type 2 diabetes mellitus and diabetic retinopathy compared with a group of control subjects without diabetes and of similar age and sex. METHODS. In samples obtained after vitrectomy for diabetic retinopathy in patients and for macular hole in control subjects, immunoblot techniques were applied to a mini-array system for quantification of a wide range of chemokines and vasoactive peptides and proteins. Antiphosphotyrosine antibody was used for tyrosine phosphorylation evaluation and results were expressed as the percentage of variation compared with that in control subjects. RESULTS. Samples from eight patients with type 2 diabetes and from eight control subjects were analyzed. The total quantity of proteins analyzed was similar in both patients and control subjects. Tyrosine phosphorylation was very significantly decreased (_20%, P _ 0.05) in diabetic patients with respect to the control group in growth-related oncogene, human cytokine I-309, interleukin-13, monocyte colony-stimulating factor, macrophage-derived chemokine, stem cell factor, transforming growth factor-_1, angiogenin, and oncostatin M. A significant decrease in phosphorylation (between 20% and 40%, P _ 0.05) was observed in epithelial neutrophil-activating peptide 78; granulocyte colony-stimulating factor; granulocyte-monocyte– stimulating colony factor; IL-5, -6, -7, -8, -10, and -12p40p70; monokine induced by interferon-_; macrophage inflammatory protein 1-; and normal T expressed and secreted cytokine (RANTES) in comparison with that in the control subjects. The greatest decrease in phosphorylation status was found in IL-1-_ and -1. CONCLUSIONS. Diabetic retinopathy is associated with a decrease in tyrosine phosphorylation of many vitreous proteins which may indicate an alteration in protein functionality or action even before significant quantitative variations. Article 2 Diabetic Retinopathy Is Associated with Decreased Tyrosine Nitrosylation of Vitreous Interleukins IL-1 , IL-1 , and IL-7 Ophthalmic Res 2011;46:169–174 DOI: 10.1159/000323812 Impact factor 1.29 Objective: To simultaneously evaluate tyrosine nitrosylation and phosphorylation levels of vitreous interleukins of patients with diabetic retinopathy, in which abnormal tyrosine phosphorylation has been previously described. ResearchDesign and Methods: Specific immunoprecipitation of interleukins IL-1 _ , IL-1 _ , IL-2 and IL-7 was carried out in samples obtained during vitrectomy performed for proliferative diabetic retinopathy in patients (n = 12) and for macular hole in controls (n = 12). Tyrosine nitrosylation and phosphorylation levels of the immunoprecipitated interleukins were analysed by Western blot with the respective specific antibodies and correlated. The results were also correlated with the total amount of immunoprecipitated interleukin protein. The mean phosphorylation/nitrosylation ratios of these proteins in vitreous humour of both the control group and diabetic patients were determined Results: Diabetes was associated with decreased tyrosine nitrosylation of IL-1, IL-1 and IL-7and an increased tyrosine phosphorylation/nitrosylation ratio with respect to controls in IL-1 (1.58 8 0.22 vs. 2.74 80.39, respectively; p 0.05) and IL-7 (2.15 8 0.01 vs. 3.26 80.57, respectively; p 0.05). No significant changes were observedin nitrotyrosine or in the tyrosine phosphorylation/ nitrosylation ratio of IL-2. Conclusions: Proliferative diabetic retinopathy is associated with concomitant and simultaneous changes in both tyrosine phosphorylation and tyrosine nitrosylation status of specific pro-inflammatory interleukins present in the vitreous fluid such as IL-1 , IL-1 and IL-7. These changes could be related to the increase in pro-inflammatory activity detected in diabetes-induced retinopathy. Main conclusions Diabetic retinopathy is associated with alterations in the tyrosine phosphorylation status of protein inflammatory interleukins group, which could be the pathophysiological basis of retinal involvement. Tyrosine nitrosylation is not the result of changes in phosphorylation. Alterations in interleukin-nitrosylation may have an implication in the pathogenesis of diabetic retinopathy. The phospho-dephosphorylation mechanisms and nitro-denitrosilatión could be therapeutic targets in the future. These findings open an future research, which could be based on experimental models in which they assessed the effects that changes in the mechanisms of phosphorylation / tyrosine nitrosylation on the occurrence or progression of diabetic retinopathy

Factores de riesgo de recidiva postquirúrgica en las membranas neovasculares de etiología miópica

Purpose: To determine risk factors of postsurgical relapse before myopic neovascular membranes extraction (NVM). Methods: A retrospective study was made on 30 myopic patients younger than 50 years old who needed surgery. All the patients presented type 2 membranes (above RPE) and were operated by the same surgeon. Following variables were analyzed: age, gender, number of diopters, visual acuity (VA) before and after surgery, membrane location, postsurgical complications, and time between surgery and relapse when presented. VA improvement after reintervention was also analyzed, in case of relapse. Mean time follow up was 15,24 months (range between 3 and 51 months). We divided them on three groups dependin on the number of diopters: I ( 12 diopters), rejecting patients with less than 6 diopters. Results: Relapse index was 16.66% (5 cases) being the mean time 4.5 months (range between 2 and 7 months). VA improvement post-op was demonstrated with a high level of signification (p=0.002) by student t for paired data. We also studied the relation between sex and relapse incidence and no significative statistical differences were found (p=0.561). We compared relapse incidence between the three groups of patients and found that most of relapses appeared on the II group (10-12 D) (p=0.045). The main post-op complications were: asseptic endophtalmitis (3), retinal detachment (1), choroidal detachment (1). Conclusions: Myopic NVM excission is an effective surgical technique on VA improvement in this patients. We observed a major number of post-op relapses on 10-12 myopic diopters. Low diopters patients have less RPE alteration and so, a lower relapse index. On the other hand, high diopters patients have more choroidal atrophy and less vascularization, what reduces relapsing chance. Median myopia seems to be post op relapse risk factor on myopic NVM.Objetivo: Determinar los factores de riesgo de recidiva postquirúrgica tras la extracción de membranas neovasculares (MNV) miópicas. Material y Métodos: Se realizó un estudio retrospectivo sobre 30 pacientes miopes menores de 50 años con MNV que precisaron cirugía. Todos los pacientes presentaban membranas tipo 2 (por encima del EPR) y fueron intervenidos por el mismo cirujano. Se analizaron las siguientes variables: edad, sexo, número de dioptrías, agudeza visual antes y después de la cirugía, localización de la membrana, complicaciones postquirúrgicas, y período de tiempo entre la cirugía y la recidiva si ésta se producía. También se analizó la ganancia de agudeza visual tras reintervención en los casos de recidiva. El tiempo medio de seguimiento fue de 15,24 meses (rango entre 3 meses y 51 meses). Se dividió en 3 grupos según el número de dioptrías: I ( 12 dioptrías), descartando los pacientes con menos de 6 dioptrías. Resultados: El índice de recidiva fue del 16,66% (5 casos) y el tiempo medio de aparición fue de 4,5 meses (rango entre 2 y 7 meses). Se comprobó la mejoría de AV tras cirugía con un alto nivel de significación (p=0,0002) mediante la t de student para datos apareados. Se estudió la relación entre el sexo y la incidencia de recidiva no hallándose diferencias estadísticamente significativas (p=0,561). Se comparó la incidencia de recidiva en los 3 grupos de pacientes según número de dioptrías y se encontró que la mayoría de las recidivas se producían en los pacientes entre 10 y 12 dioptrías (p=0,045). Éstas fueron las principales complicaciones postquirúrgicas: endoftalmitis asépticas 3, desprendimiento de retina (DR) 1, desprendimiento de coroides (DC) 1. Conclusiones: La excisión de MNV de etiología miópica es una técnica eficaz en la mejora de la AV en estos pacientes Se ha observado que los pacientes con mayor índice de recidiva postquirúrgica son los comprendidos entre 10 y 12 dioptrías. Los pacientes con menor número de dioptrías tienen a su vez una menor alteración del EPR y por lo tanto un menor índice de recurrencia. Por otro lado, los pacientes con un elevado número de dioptrías tienen una mayor atrofia coroidea y disminución de la circulación coroidea, lo cual también reduce la posibilidad de recidiva. La miopía media parece ser un factor de riesgo de recidiva postquirúrgica de las MNV miópicas

Scleral Fixation of Posteriorly Dislocated Intraocular Lenses by 23-Gauge Vitrectomy without Anterior Segment Approach

Background. To evaluate visual outcomes, corneal changes, intraocular lens (IOL) stability, and complications after repositioning posteriorly dislocated IOLs and sulcus fixation with polyester sutures. Design. Prospective consecutive case series. Setting. Institut Universitari Barraquer. Participants. 25 eyes of 25 patients with posteriorly dislocated IOL. Methods. The patients underwent 23-gauge vitrectomy via the sulcus to rescue dislocated IOLs and fix them to the scleral wall with a previously looped nonabsorbable polyester suture. Main Outcome Measures. Best corrected visual acuity (BCVA) LogMAR, corneal astigmatism, endothelial cell count, IOL stability, and postoperative complications. Results. Mean follow-up time was 18.8 ± 10.9 months. Mean surgery time was 33 ± 2 minutes. Mean BCVA improved from 0.30 ± 0.48 before surgery to 0.18 ± 0.60 (p=0.015) at 1 month, which persisted to 12 months (0.18 ± 0.60). Neither corneal astigmatism nor endothelial cell count showed alterations 1 year after surgery. Complications included IOL subluxation in 1 eye (4%), vitreous hemorrhage in 2 eyes (8%), transient hypotony in 2 eyes (8%), and cystic macular edema in 1 eye (4%). No patients presented retinal detachment. Conclusion. This surgical technique proved successful in the management of dislocated IOL. Functional results were good and the complications were easily resolved

Intraocular pressure after myopic laser refractive surgery measured with a new Goldmann convex prism : correlations with GAT and ORA

The purpose of this study is to describe measurements using a newly developed modified Goldmann convex tonometer (CT) 1 year after myopic laser refractive surgery. Intraocular pressure (IOP) measurements were compared with IOP values obtained by Goldmann applanation tonometer (GAT), and Ocular Response Analyzer (ORA). Prospective double-masked study performed on thirty eyes of thirty patients that underwent laser in situ keratomileusis (LASIK; n = 19) or photorefractive keratectomy (PRK; n = 11). IOP was measured before and 3 and 12 months after surgery. Intraclass correlation coefficient (ICC) and Bland-Altman plot were calculated to assess the agreement between GAT, CT, IOPg (Goldmann-correlated IOP) and IOPcc (corneal-compensated IOP) from ORA. Twelve months after LASIK, IOP measured with CT showed the best correlation with IOP measured with GAT before surgery (GATpre) (ICC = 0.886, 95% CI: 0.703-0.956) (15.60 ± 3.27 vs 15.80 ± 3.22; p < 0.000). However, a moderate correlation was found for IOP measured with IOPcc and CT 12 months after LASIK (ICC = 0.568, 95% CI: − 0.185 - 0.843) (15.80 ± 3.22 vs 12.87 ± 2.77; p < 0.004). Twelve months after PRK, CT showed a weak correlation (ICC = − 0.266, 95% CI: − 3.896 - 0.663), compared to GATpre (17.30 ± 3.47 vs 16.01 ± 1.45; p < 0.642), as well as poor correlation (ICC = 0.256, 95% CI: − 0.332 - 0.719) with IOPcc (17.30 ± 3.47 vs 13.38 ± 1.65; p < 0.182). Twelve months after LASIK, IOP measured with CT strongly correlated with GAT before surgery and could therefore provide an alternative method for measuring IOP after this surgery. More studies regarding this new convex prism are needed to assess its accuracy