0000000000908380
AUTHOR
Manuel Díaz-llopis
Ahmed valve, suture-less implantation: A new approach to an easier technique.
Purpose Tissue adhesives have been used in ophthalmology instead of sutures to minimize the operating time. This case series investigated the effectiveness and safety of use of cyanoacrylate in Ahmed valve implantation through pars plana for refractory glaucoma. Patients and methods Seventeen eyes of 17 patients with refractory glaucoma underwent Ahmed valve scleral suture-less implantation through pars plana with a cyanoacrylate suture of the plate. Refractory glaucoma was defined as intraocular pressure (IOP) ≥ 21 mm Hg with antiglaucoma eye drops, good adherence to treatment, and no previous glaucoma surgery. IOP control and development of complications were evaluated during the follow-u…
Tratamiento Focal Macular guiado por el mapa de grosor retiniano del HD-OCT Cirrus® versus Angiografía Fluoresceínica en las Oclusiones Venosas de la Retina
Macular laser photocoagulation guided by spectral-domain optical coherence tomography versus fluorescein angiography for diabetic macular edema.
Roberto Gallego-Pinazo1,2, Ana Marina Suelves-Cogollos1, Rosa Dolz-Marco1, J Fernando Arevalo3, Salvador García-Delpech1, J Luis Mullor4, Manuel Díaz-Llopis1,2,51Department of Ophthalmology, Hospital Universitario La Fe, Valencia, Spain; 2Centro de Investigación Biomédica en Red de Enfermedades Raras, Valencia, Spain; 3Retina and Vitreous Service, Clinical Ophthalmology Center, Caracas, Venezuela; 4Unit of Experimental Ophthalmology, Hospital Universitario La Fe, Valencia, Spain; 5University of Valencia, Faculty of Medicine, Valencia, SpainBackground: The aim of this study was to compare the efficacy of spectral-domain optical coherence tomography…
Crystallization After Intravitreous Foscarnet Injections
Need to consensus for novel findings by optical coherence tomography in patients with age-related macular degeneration
Altered antioxidant-oxidant status in the aqueous humor and peripheral blood of patients with retinitis pigmentosa.
Retinitis Pigmentosa is a common form of hereditary retinal degeneration constituting the largest Mendelian genetic cause of blindness in the developed world. It has been widely suggested that oxidative stress possibly contributes to its pathogenesis. We measured the levels of total antioxidant capacity, free nitrotyrosine, thiobarbituric acid reactive substances (TBARS) formation, extracellular superoxide dismutase (SOD3) activity, protein, metabolites of the nitric oxide/cyclic GMP pathway, heme oxygenase-I and inducible nitric oxide synthase expression in aqueous humor or/and peripheral blood from fifty-six patients with retinitis pigmentosa and sixty subjects without systemic or ocular …
Serum vitamin E levels negatively correlate with severity of age-related macular degeneration.
Age-related macular degeneration (AMD) pathogenesis has been related to UV radiation and other factors that may promote increased oxidative damage to the retina. Patients with different AMD grading (n = 25) were compared with an age-matched group of AMD-free subjects (n = 15), both groups older than 60 years. A modification of the AMD grading system is proposed that allows patient grading and not single eye grading. AMD patients showed statistically significant lower serum levels of vitamin E and Zn than AMD-free subjects. Moreover, a negative correlation (Spearman's correlation coefficient r = -0.815, P < 0.001) could be established between AMD grading of both the patients' eyes and serum …
Ethanol-Induced Oxidative Stress Modifies Inflammation and Angiogenesis Biomarkers in Retinal Pigment Epithelial Cells (ARPE-19): Role of CYP2E1 and its Inhibition by Antioxidants
The retinal pigment epithelium (RPE) plays a key role in retinal health, being essential for the protection against reactive oxygen species (ROS). Nevertheless, excessive oxidative stress can induce RPE dysfunction, promoting visual loss. Our aim is to clarify the possible implication of CYP2E1 in ethanol (EtOH)-induced oxidative stress in RPE alterations. Despite the increase in the levels of ROS, measured by fluorescence probes, the RPE cells exposed to the lowest EtOH concentrations were able to maintain cell survival, measured by the Cell Proliferation Kit II (XTT). However, EtOH-induced oxidative stress modified inflammation and angiogenesis biomarkers, analyzed by proteome array, ELIS…
Oral propranolol and intravitreal ranibizumab for refractory serous macular detachment secondary to retinal capillary hemangioblastoma
Imaging Quality of Bifocal Piggyback Intraocular Lens versus ReSTOR and TECNIS Multifocal Lenses
Purpose The imaging quality provided by a piggyback integrated by a monofocal intraocular lens (IOL) + a bifocal IOL of zero power and +3.75 diopters of addition is compared with the optics quality of a simple multifocal IOL of the same power and addition. Methods The imaging quality was evaluated by determining the modulation transfer function (MTF), using an artificial eye simulating in vivo conditions of the anterior chamber, including an artificial cornea and a wet cell containing physiologic solution where the IOL was positioned. The MTFs of the bifocal piggyback for near and distance vision were measured, with pupil diameters of 3 and 5 mm, and compared with the MTFs of an equivalent …
Rituximab in refractory Vogt-Koyanagi-Harada disease.
Introduction Vogt–Koyanagi–Harada (VKH) prognosis depends on early recognition and treatment; chronic disease may be developed when either delayed or inadequate treatment is performed, whereas other cases despite correct treatment are refractory to different drugs and also become chronic. We report a case of refractory VKH controlled with rituximab treatment. Case report A 41-year-old female with painful visual loss and headache was examined. (VA 0.4 in RE and hand movements (HM) in LE). Retinal examination demonstrated multiple serous retinal detachments in both eyes. High-dose oral steroids were started, followed by progressive tapering of prednisone. New acute anterior and posterior rela…
Goldmann Applanation Tonometry Using Sterile Disposable Silicone Tonometer Shields
Abstract Purpose: Placement of a sterile single-use cover over the tonometer tip may be a convenient and safe alternative method to repeated chemical disinfection. This study was undertaken to evaluate the accuracy and performance of Goldmann applanation tonometry using a sterile disposable silicone tonometer shield over the biprism tip. Methods: The same investigator measured intraocular pressure in 120 eyes with and without the shield. The eyes were tested randomly first with either the uncovered or the covered tonometer to control for the possible effects of repeated tonometry influencing measurement differences. Readings were recorded independently in a masked fashion. Results: The intr…
Local safety of repeated intravitreal Ozurdex
Sir, The article entitled ‘Twelve-month experience with Ozurdex for the treatment of macular edema associated with retinal vein occlusion'1 highlights the significant cataract progression in eyes receiving more than one Ozurdex implant. We retrospectively reviewed the charts of all patients with macular edema secondary to retinal vein occlusion (RVO) refractory to current therapies and treated with Ozurdex from April 2010 until March 2012. The mean age of patients with branch RVO (n=33) was 72.4. In eyes receiving a second Ozurdex implant, four out of the five phakic eyes showed progression of cataract requiring surgery. We registered one case of anterior chamber migration resulting in a bu…
Beals&ndash;Hecht syndrome and choroidal neovascularization
PURPOSE To describe a case of choroidal neovascularization (CNV) in a female diagnosed with Beals-Hecht syndrome. METHODS A retrospective, interventional case is described in a 26-year-old female complaining of metamorphopsia and visual loss in her left eye (counting fingers). The fluorescein angiogram and the optical coherence tomography supported the diagnosis of CNV. Intravitreal ranibizumab was administered. RESULTS After the third intravitreal ranibizumab, her visual acuity improved to 0.8 and the morphology of the macular area was restored. CONCLUSIONS To our knowledge this is the first report of CNV in Beals-Hecht syndrome treated with ranibizumab. Self-monitoring by periodically per…
Kyrieleis&acute; vasculitis in acute retinal necrosis
Ester Franc&eacute;s-Mu&ntilde;oz1, Roberto Gallego-Pinazo1, Ruth L&oacute;pez-Lizcano1, Salvador Garc&iacute;a-Delpech1, J Luis Mullor3, Manuel D&iacute;az-Llopis1,21Department of Ophthalmology, Hospital La Fe, Valencia, Spain; 2University of Valencia, Valencia, Spain; 3Unit of Experimental Ophthalmology. Fundaci&oacute;n para la Investigaci&oacute;n del Hospital Universitario La Fe. Valencia, Valencia, SpainAbstract: We report the first case in the literature of Kyrieleis&acute; vasculitis related to acute retinal necrosis by Varicella zoster virus in a 76-year-old woman with bilateral involvement. In our patient the arterial lesions appeared 15 days after …
Analysis of the Ush2a Gene in Medaka Fish (Oryzias latipes)
Patients suffering from Usher syndrome (USH) exhibit sensorineural hearing loss, retinitis pigmentosa (RP) and, in some cases, vestibular dysfunction. USH is the most common genetic disorder affecting hearing and vision and is included in a group of hereditary pathologies associated with defects in ciliary function known as ciliopathies. This syndrome is clinically classified into three types: USH1, USH2 and USH3. USH2 accounts for well over one-half of all Usher cases and mutations in the USH2A gene are responsible for the majority of USH2 cases, but also for atypical Usher syndrome and recessive non-syndromic RP. Because medaka fish (Oryzias latypes) is an attractive model organism for ge…
New insights into the genetic component of non-infectious uveitis through an Immunochip strategy.
BACKGROUND: Large-scale genetic studies have reported several loci associated with specific disorders involving uveitis. Our aim was to identify genetic risk factors that might predispose to uveitis per se, independent of the clinical diagnosis, by performing a dense genotyping of immune-related loci.METHODS: 613 cases and 3693 unaffected controls from three European case/control sets were genotyped using the Immunochip array. Only patients with non-infectious non-anterior uveitis and without systemic features were selected. To perform a more comprehensive analysis of the human leucocyte antigen (HLA) region, SNPs, classical alleles and polymorphic amino acid variants were obtained via impu…
Safety and Efficacy of Ranibizumab in Macular Edema following Retinal Vein Occlusion.
Macular edema is the leading cause of visual impairment in patients with retinal vein occlusion. Limited improvements may be obtained with laser photocoagulation or intravitreal triamcinolone. However, according to the data provided by randomized clinical trials, intravitreal injections of ranibizumab (Lucentis; Genentech, South San Francisco, CA) constitute a new effective and safe option for the management of these vision-threatening diseases. The aim of the present review is to summarize the clinical evidence of ranibizumab for macular edema due to retinal vein occlusions.
Serous Macular Detachment Associated with Dome-Shaped Macula and Tilted Disc
Introduction: An entirely new type of staphyloma has been recently described as dome-shaped macula (DSM). It is characterized by an abnormal convex macular contour within the concavity of a posterior staphyloma. We found DSM associated with serous macular detachment (SMD) and tilted disc in two consecutive cases. Case Reports: Case 1: A 37-year-old female presented to our department because of sudden onset blurred vision in her right eye (OD). The best-corrected visual acuity (BCVA) was 0.5 in both eyes. Funduscopy evidenced bilateral tilted disc associated with posterior staphyloma. Optical coherence tomography (OCT) demonstrated a DSM with SMD in her OD. After 15 months of follow-up, BCVA…
Prophylaxis of Pseudophakic Cystoid Macular Edema with Intraoperative Pegaptanib
The purpose of this study was to determine the efficacy of an intraoperative intravitreal pegaptanib injection during phacoemulsification in preventing the development of pseudophakic cystoid macular edema (CME) following cataract surgery.This prospective, controlled pilot study was carried out at the Department of Ophthalmology, Nuevo Hospital Universitario y Politécnico La Fe, Valencia (Spain). Five hundred patients with cataract and healthy retina were included in the study. Patients were assigned in a 1:1 ratio to receive an intraoperative intravitreal pegaptanib injection (n=250) or not (control group, n=250) associated with standardized phacoemulsification surgery and postoperative tr…
Oxidative stress and its downstream signaling in aging eyes
María Dolores Pinazo-Durán,1,* Roberto Gallego-Pinazo,2,* Jose Javier García-Medina,1,3,* Vicente Zanón-Moreno,1,4 Carlo Nucci,5 Rosa Dolz-Marco,2 Sebastián Martínez-Castillo,2 Carmen Galbis-Estrada,1 Carla Marco-Ramírez,1 Maria Isabel López-Gálvez,6,* David J Galarreta,6,* Manuel Díaz-Llópis4,*1Ophthalmic Research Unit "Santiago Grisolía", Valencia, Spain; 2Department of Ophthalmology, Macula Section, The University and Polytechnic Hospital La Fe, Valencia, Spain; 3Department of Ophthalmology, University Hospital Reina Sofia, Murcia, Spain; 4Faculty of Medicine, University of Valencia, Spain; 5Uni…
Abordaje multidisciplinar de un carcinoma sebáceo anaplásico palpebral en una paciente de 40 años
Caso clínico: Mujer de 40 años remitida a nuestro servicio por persistencia durante meses de un cuadro de blefaritis anterior de aspecto indolente con aparición de un nódulo indurado en el párpado superior derecho filiado como chalazion refractario al tratamiento convencional, asociado a adenopatía preauricular ipsilateral. La biopsia extemporánea se informó como carcinoma sebáceo. Procedimos a la exéresis completa de dicho párpado y a su reconstrucción con injerto de mucosa palatina y colgajo glabelar. Posteriormente se practicó un vaciamiento cervical radical por la presencia de adenopatías de aspecto necrótico en diversos territorios linfáticos. Se biopsió el párpado inferior que resultó…
Evaluation of the improvement of sensibility with the new IOL Master software version 5.4.3
Purpose To evaluate the improvement of sensibility of the new IOL-Master version 5.4.3 compared with the version 4.08. Methods 214 eyes of 115 patients were examined in a cataract preoperative evaluation making use of both IOL-Master software versions 5.4.3 and 4.08. The type and severity of the lens opacification was assessed by slitlamp biomicroscopy. Results In 182 of the eyes examined both versions were capable to determine the AL; in 29 the version 4.01 could not determine AL whereas the version 5.4.3 was able to measure it; these cases showed posterior capsular cataract (16), dense nuclear cataract (11), posterior synechiae (1) and asteroid hyalosis (1). Finally, the AL of 3 eyes coul…
Differential Effects of Dry Eye Disorders on Metabolomic Profile by 1H Nuclear Magnetic Resonance Spectroscopy
We used1H NMR spectroscopy to analyze the metabolomic profile of reflex tears from patients with dry eye disorders (DEDs). 90 subjects were divided into 2 groups: (1) patients with DEDs (DEDG;n = 55) and (2) healthy subjects (CG;n = 35). Additionally, the DEDG was subdivided into 2 subgroups based on DED severity: mild-to-moderate and moderate (n = 22andn = 33, resp.). Personal interviews and systematized ophthalmologic examinations were carried out. Reflex tears (20–30 μL) were collected by gently rubbing in the inferior meniscus of both eyelids with a microglass pipette and stored at −80°C until analysis. NMR spectra were acquired using a standard one-dimensional pulse sequence with water…
Comparison of the acute effects of anti-TNF-alpha drugs on a uveitis experimental model.
To compare histopathological and biochemical effects of the anti-TNF-alpha drugs adalimumab and infliximab in a uveitis experimental model.Histopathological evaluation was performed 24 h after endotoxin (200 microg into the footpad) and drug administration, as well as biochemical analysis of oxidative stress-related markers in the aqueous humor.Severe inflammation was found in rat anterior chamber of the eye 24 h after endotoxin. Only infliximab administration partially prevented the endotoxin-induced disruption of the blood-aqueous barrier, as well as the increase in Rantes and MCP-1 concentration in aqueous humor. Both drugs ameliorated the histopathological score after endotoxin. Biochem…
Fulminant bilateral Haemophilus influenzae keratitis in a patient with hypovitaminosis A treated with contaminated autologous serum
We report on a patient with hypovitaminosis A treated with autologous serum (AS) who had bilateral infectious ulcers positive for Haemophilus influenzae. The patient suffered a perforation of his right eye and total healing of his left eye with a residual leukoma. In cases of severe malnutrition, serum levels of vitamins and bacteriostatic and growth factors are reduced, so AS would not only be ineffective but also increase the risk of secondary corneal infection. The prophylactic use of a topical antibiotic would be useful in treatment with AS, especially in patients who do not use and adequately store the eye drops, as in our patient.
Macular toxoplasmosis and intravitreal clindamycin: An alternative to oral treatment
Specific association of IL17A genetic variants with panuveitis.
Background/aims A pathogenic role of Th17 cells in uveitis has become clear in recent years. Therefore, in the present study, we aimed to evaluate the possible influence of the IL 17A locus on susceptibility to non-anterior uveitis and its main clinical subgroups. Methods Five IL17A polymorphisms (rs4711998, rs8193036, rs3819024, rs2275913 and rs7747909), selected by tagging, were genotyped using TagMan assays in 353 Spanish patients with non-anterior uveitis and 1851 ethnically matched controls. Results The case/control analysis yielded a consistent association between two of the analysed genetic variants, rs8193036 and rs2275913, and the presence of panuveitis under a dominant model (p(FD…
Vitrectomía enzimática por inyección intravítrea de plasmina autóloga como tratamiento inicial de las membranas epirretinianas maculares y el síndrome de tracción vitreomacular
espanolObjetivo: Determinar si la inyeccion intravitrea de plasmina es efectiva en el tratamiento de las membranas epirretinianas maculares (MEM) y el sindrome de traccion vitreomacular (STVM), sin necesidad de asociar vitrectomia quirurgica. Material y metodo Diseno: Estudio piloto prospectivo, de intervencion, serie de casos. Pacientes: Siete pacientes, cuatro con membrana epirretiniana macular y tres con sindrome de traccion vitreomacular. Tratamiento: Inyeccion intravitrea de 0,2 ml de plasmina autologa bajo anestesia topica. La plasmina fue obtenida por un metodo simplificado modificado por adiccion de uroquinasa. Principales medidas: Grado de separacion de la membrana epirretiniana de…
Image quality with multifocal intraocular lenses and the effect of pupil size
Purpose To analyze the image quality with a refractive and 2 hybrid refractive–diffractive multifocal intraocular lenses (IOLs) in vitro to determine the IOL modulation transfer function (MTF) following the EN-ISO international standard for distance and near vision and to study the IOLs' behavior with different pupil sizes. Setting Fundacion Oftalmologica del Mediterraneo, Valencia, Spain. Methods This study evaluated 4 IOLs: the hybrid refractive–diffractive AcrySof ReSTOR SN60D3 (Alcon) and Tecnis ZM900 (AMO), the refractive ReZoom NXG (AMO), and the monofocal AcrySof SN60WF (Alcon). The MTF was calculated from the cross-line spread function recorded with the OPAL Vector System (Image Sci…
Metotrexato como tratamiento en el penfigoide ocular cicatricial moderado
Resumen Caso clinico Una mujer de 73 anos se presenta con historia de molestias inespecificas y fotofobia en ambos ojos (AO) de un ano de evolucion. A la exploracion se observa un simblefaron bilateral y acortamiento de fondos de saco. El analisis inmunohistoquimico (IHQ) confirma la presencia de un deposito lineal de Ig G, Ig M y C3 a lo largo de la membrana basal conjuntival. Ante el diagnostico de penfigoide ocular cicatricial (POC) se pauta tratamiento sistemico mediante metotrexato (MTX) subcutaneo. Discusion Consideramos dicho tratamiento una alternativa inmunosupresora inicial muy eficaz en pacientes con inflamacion conjuntival moderada y en casos de rapida progresion.
Beneficial Effect of Docosahexanoic Acid and Lutein on Retinal Structural, Metabolic, and Functional Abnormalities in Diabetic Rats
To assess the effect of docosahexanoic acid (DHA) and lutein (both compounds with anti-inflammatory and antioxidant properties) on experimental diabetic retinopathy.Male Wistar rats were studied: non-diabetic controls, untreated diabetic controls, and diabetic rats were treated with DHA and lutein or the combination of DHA + insulin and lutein + insulin for 12 weeks. Oxidative stress and inflammatory markers, apoptosis, and functional tests were studied to confirm biochemical and functional changes in the retina of diabetic rats. Malondialdehyde (MDA), glutathione concentrations (GSH), and glutathione peroxidase activity (GPx) were measured as oxidative stress markers. TUNEL assay and caspa…
Lentes de contacto y cálculo de lente intraocular: sorpresa refractiva usando el método biométrico de no contacto IOLMaster
Early lipoic acid intake protects retina of diabetic mice
The aim of this study was to test the effect of lipoic acid treatment on the retina after a short diabetic insult. Diabetes was induced by alloxan and mice were divided into sub-groups; control, diabetic, diabetic+insulin and all groups received+/-lipoic acid (100 mg/kg body weight) for 3 weeks. GSH content, MDA concentration, GPx activity were measured and electroretinograms (ERG) were recorded. Early administration of lipoic acid to diabetic mice prevented the statistically significant decreases of GSH content and GPx activity and normalized MDA concentration. Moreover, lipoic acid restored electroretinogram b-wave amplitude of diabetic animals to control values. Lipoic acid has a protect…
Aqueous Humor Levels of Vascular Endothelial Growth Factor in Retinitis Pigmentosa
PURPOSE To determine the level of vascular endothelial growth factor A (VEGF-A) in aqueous humors of patients with retinitis pigmentosa (RP). METHODS A prospective, comparative control study. Aqueous humor was collected from 16 eyes of 16 patients with RP. The level of VEGF-A was determined with a commercially available enzyme-linked immunosorbent assay kit. The control group comprised 16 aqueous samples from 16 patients about to undergo cataract surgery and without any other ocular or systemic diseases. RESULTS The concentration of VEGF-A in aqueous humor was markedly lower in patients with RP than in control subjects (Mann-Whitney U test, P < 0.001). The level of VEGF-A was 94.9 +/- 99.8 …
Methotrexate as a treatment in ocular cicatricial moderate pemphigoid.
Abstract Clinical case A 73 year-old woman presented with a history of non-specific symptoms and photophobia in both eyes of 1 year progression. The examination revealed a bilateral symblepharon and fornix shortening. Immunohistochemical analysis confirmed the presence of linear deposits of IgG, IgM and C3 along the conjunctival basement membrane. With the diagnosis of ocular cicatricial pemphigoid, systemic treatment with subcutaneous methotrexate was prescribed. Discussion We consider such treatment a very effective initial immunosuppressive alternative in patients with moderate conjunctival inflammation and in cases of rapid progression.
Study of USH1 Splicing Variants through Minigenes and Transcript Analysis from Nasal Epithelial Cells
Usher syndrome type I (USH1) is an autosomal recessive disorder characterized by congenital profound deafness, vestibular areflexia and prepubertal retinitis pigmentosa. The first purpose of this study was to determine the pathologic nature of eighteen USH1 putative splicing variants found in our series and their effect in the splicing process by minigene assays. These variants were selected according to bioinformatic analysis. The second aim was to analyze the USH1 transcripts, obtained from nasal epithelial cells samples of our patients, in order to corroborate the observed effect of mutations by minigenes in patient’s tissues. The last objective was to evaluate the nasal ciliary beat fre…
Update on intravitreal anti-tumor necrosis factor alpha therapies for ocular disorders
Abstract Tumor necrosis factor alpha (TNF-?) is an important pro-inflammatory cytokine associated with a variety of ocular diseases. The currently available TNF-? inhibitors are etanercept, infliximab, adalimumab, golimumab, and certolizumab. Experimental and clinical studies on the intravitreal use of these agents have been reported with etanercept, infliximab, and adalimumab: etanercept has shown limited efficacy in scarce reports; infliximab has been associated with local safety concerns but appears to benefit certain cases; adalimumab has shown no efficacy in cases of age-related macular degeneration (AMD) or diabetic macular edema (DME), but the combination with bevacizumab may be effe…
Signature of Circulating Biomarkers in Recurrent Non-Infectious Anterior Uveitis. Immunomodulatory Effects of DHA-Triglyceride. A Pilot Study
The purpose of this study was to identify circulating biomarkers of recurrent non-infectious anterior uveitis (NIAU), and to address the anti-inflammatory effects of triglyceride containing docosahexaenoic acid (DHA-TG). A prospective multicenter study was conducted in 72 participants distributed into: patients diagnosed with recurrent NIAU in the quiescence stage (uveitis group (UG)
Management of macular edema due to branch retinal vein occlusion with intravitreal injections of pegaptanib sodium
Purpose To evaluate the efficacy of Pegaptanib Sodium as single therapy for macular edema due to non-ischemic branch retinal vein occlusion. Methods In this uncontrolled prospective pilot study 17 patients have been included with non-ischemic branch retinal vein occlusion. All of them showed macular edema in the OCT with central foveal thickness higher than 350 microns (mean, 541 +/- 140) and decrease in visual acuity lower than 0,5 Snellen ETDRS charts notation (mean, 0,16+/-0,14). After an initial injection of Pegaptanib Sodium evaluations were programmed every 5 weeks and further retreatments were developed in cases with macular thickness higher than 300 microns. No other therapies were …
Treatment of refractory uveitis with adalimumab: a prospective multicenter study of 131 patients.
To evaluate adalimumab therapy in refractory uveitis.Prospective case series.A total of 131 patients with refractory uveitis and intolerance or failure to respond to prednisone and at least 1 other systemic immunosuppressive drug participated.Patients received a 40 mg adalimumab subcutaneous injection every other week for 6 months. The associated immunosuppressants were tapered after administering 3 adalimumab injections (week 6).Degree of anterior and posterior chamber inflammation (Standardization of Uveitis Nomenclature Working Group criteria), immunosuppression load (as defined by Nussenblatt et al), visual acuity (logarithm of the minimal angle of resolution [logMAR]), and macular thic…
Rapid Regression of Exudative Maculopathy in Idiopathic Retinitis, Vasculitis, Aneurysms and Neuroretinitis Syndrome after Intravitreal Ranibizumab
The idiopathic retinitis, vasculitis, aneurysms and neuroretinitis syndrome is a rare retinal vascular disorder characterized by multiple leaking aneurysmal dilations, retinal vasculitis, neuroretinitis and peripheral vascular ischemia. Visual loss mainly occurs due to the development of retinal neovascularization and/or exudative maculopathy. Although the treatment of choice has not yet been established, retinal photocoagulation seems to be the best option to control the disease and to prevent its progression. Herein, we report a case of idiopathic retinitis, vasculitis, aneurysms and neuroretinitis syndrome with both retinal neovascularization and macular exudation successfully managed wi…
Nanog Regulates Primordial Germ Cell Migration Through Cxcr4b
Abstract Gonadal development in vertebrates depends on the early determination of primordial germ cells (PGCs) and their correct migration to the sites where the gonads develop. Several genes have been implicated in PGC specification and migration in vertebrates. Additionally, some of the genes associated with pluripotency, such as Oct4 and Nanog, are expressed in PGCs and gonads, suggesting a role for these genes in maintaining pluripotency of the germ lineage, which may be considered the only cell type that perpetually maintains stemness properties. Here, we report that medaka Nanog (Ol-Nanog) is expressed in the developing PGCs. Depletion of Ol-Nanog protein causes aberrant migration of …
Efficacy and safety of the pars plana clip in the Ahmed valve device inserted via the pars plana in patients with refractory glaucoma
Manuel Diaz-Llopis1,2,3, David Salom1,3, Salvador Garc&iacute;a-Delpech1,2,3, Patricia Udaondo1,3, Jose Maria Millan3,5, J Fernando Arevalo61Department of Ophthalmology, La Fe University Hospital of Valencia, Valencia, Spain; 2Department of Ophthalmology of the Valencia University, Valencia, Spain; 3Biomedical Network Research Centre on Rare Diseases (CIBERER), Valencia, Spain; 4Catholic University San Vicente Martir, Valencia, Spain; 5Department of Genetics, La Fe University Hospital of Valencia, Valencia, Spain; 6Clinica Oftalmologica Centro Caracas, Retina and VItreous Service, Caracas, DC, VenezuelaPurpose: To evaluate the efficacy and safety of the pars plana clip (PPC) in the Ahme…
Pattern Dystrophy of the Macula in a Case of Steinert Disease
<b><i>Introduction:</i></b> Myotonic dystrophies are typically associated with ocular complications like ptosis, weakness of the ocular muscle and cataracts, but also with less recognized retinal changes. <b><i>Case Report:</i></b> A 41-year-old female with type 1 myotonic dystrophy complained of progressive vision loss. Slit lamp examination revealed the presence of typical bilateral polychromatic cataract with posterior subcapsular component. Dilated fundus examination was remarkable for bilateral macular depigmented changes. Multimodal imaging analysis of the macula suggested the presence of a butterfly-shaped pattern dystrophy. <b>&l…
CD4/CD8 Ratio in Aqueous Humor in Uveitis
Dear Editor,We present a case series report with a simple and reproducible method for anterior uveitis investigation. This method uses the CD4/CD8 ratio in aqueous humor, analyzed by flow cytometry...
Tratamiento inicial y único del edema macular asociado a oclusiones de rama venosa retiniana con fármacos antiangiogénicos: Estudio piloto comparativo
Bleeding Follicular Conjunctivitis due to Influenza H1N1 Virus
Influenza H1N1 or A virus is a new virus serotype capable of human-to-human transmission. This infection causes a flu syndrome similar to that of seasonal influenza, with only one case of conjunctivitis described and no clinical details or microbiological confirmation. Its diagnosis is performed by PCR of pharyngeal smear of the patients affected. We report the first well-documented case in the medical literature of conjunctivitis by H1N1 virus.
Chronic alcohol feeding induces biochemical, histological, and functional alterations in rat retina.
Aims: Ethanol consumption originates a wide spectrum of disorders, including alteration of visual function. Oxidative stress is included among the mechanisms by which alcohol predisposes nervous tissue to injury. Retina, which is the neurosensorial eye tissue, is particularly sensitive to oxidative stress. Methods: In this study we analyze the effect of long-term alcohol consumption on oxidative stress parameters of the rat retina, and its correlation to retinal function, as well as to the expression of the antiapoptotic protein Bcl-2. We also study the protective effect of ebselen, a synthetic selenoorganic antioxidant. Results: Herein we show that ethanol has a toxic effect on rat retina …
Vitrectomía enzimática por inyección intravítrea de plasmina autóloga como tratamiento inicial del edema macular diabético difuso
espanolObjetivo: Determinar si la inyeccion intravitrea de plasmina es efectiva en el tratamiento del edema macular diabetico difuso (EMDD). Diseno: Estudio piloto prospectivo, comparativo, de intervencion, serie de casos. Pacientes: Dieciocho pacientes con edema macular diabetico bilateral, recibieron como primera actuacion terapeutica una inyeccion intravitrea de plasmina en un ojo, sirviendo el ojo contralateral como control. Tratamiento: Inyeccion intravitrea de 0,2 ml de plasmina autologa bajo anestesia topica. La plasmina fue obtenida por un metodo simplificado. Principales medidas: Engrosamiento macular central (EMC) medido por tomografia de coherencia optica (OCT) y agudeza visual (…
El grosor macular podría ser un predictor de la probabilidad de recidiva de los edemas maculares por oclusiones venosas de la retina tratados mediante inyecciones intravítreas repetidas de antiangiogénicos
Plasmina autóloga intravítrea sin asociar vitrectomía: Vitreolisis farmacológica, método perfeccionado con uroquinasa
Q fever: a new ocular manifestation
P Udaondo1,3, S Garcia-Delpech1,2, D Salom1,2, M Garcia-Pous1, M Diaz-Llopis1,21Department of Ophthalmology, Nuevo Hospital Universitario y Politecnico La Fe, Valencia, Spain; 2Faculty of Medicine, Universitat de Val&egrave;ncia, Valencia, Spain; 3Universidad Cardenal Herrera CEU, Valencia, SpainAbstract: Q Fever is a zoonosis caused by Coxiella burnetii. Ocular manifestations are rare in this infection. We describe the case of a man complaining of an intense retro-orbital headache, fever, arthralgia, and bilateral loss of vision, who showed an anterior uveitis accompanied by exudative bilateral inferior retinal detachment and optic disk edema. At the beginning, a Vogt&ndash;Koyanag…
Patients undergoing long-term treatment with antihypertensive eye drops responded positively with respect to their ocular surface disorder to oral supplementation with antioxidants and essential fatty acids
Carmen Galbis-Estrada,1,* Maria D Pinazo-Dur&aacute;n,1,* Jorge Cant&uacute;-Dibildox,2 Carla Marco-Ram&iacute;rez,1 Manuel D&iacute;az-Ll&oacute;pis,1,3 Javier Ben&iacute;tez-del-Castillo21Ophthalmic Research Unit Santiago Grisolia, Department of Surgery/Ophthalmology, Faculty of Medicine, University of Valencia, Valencia, Spain; 2Department of Ophthalmology, Hospital of Jerez, Jerez de la Frontera, C&aacute;diz, Spain; 3University and Polytechnic Hospital La Fe, Valencia, Spain*These authors contributed equally to this workBackground: Glaucoma and dry eye disorders (DEDs) are frequent comorbidities. The antioxidant and anti-inflammatory properties of essential …
Abordaje multidisciplinar de un carcinoma sebáceo anaplásico palpebral en una paciente de 40 años
Resumen Caso clinico Mujer de 40 anos remitida a nuestro servicio por persistencia durante meses de un cuadro de blefaritis anterior de aspecto indolente con aparicion de un nodulo indurado en el parpado superior derecho filiado como chalazion refractario al tratamiento convencional, asociado a adenopatia preauricular ipsilateral. La biopsia extemporanea se informo como carcinoma sebaceo. Procedimos a la exeresis completa de dicho parpado y a su reconstruccion con injerto de mucosa palatina y colgajo glabelar. Posteriormente se practico un vaciamiento cervical radical por la presencia de adenopatias de aspecto necrotico en diversos territorios linfaticos. Se biopsio el parpado inferior que …
Exosomes derived from stimulated monocytes promote endothelial dysfunction and inflammation in vitro
During the last few years, the scientific community interest on the role of extracellular vesicles (EVs) in physiology and pathophysiology of several human diseases has increased exponentially (1). These vesicles present the capability of transferring different kind of molecules (lipids, RNAs, DNA, protein…) between cells and may exert some effects on the cell phenotype. The content of these vesicles can vary depending on the cell type of origin (2). Although nowadays there is no consensus regarding the appropriate nomenclature, three well-known types of vesicles can be categorized on the basis of size and biogenesis: apoptotic bodies (>1 µm), microvesicles (150 nm–1 µm, budding from plasma…
Intravitreal Docosahexaenoic Acid in a Rabbit Model: Preclinical Safety Assessment
PurposeThe purpose of the present study was to evaluate the retinal toxicity of a single dose of intravitreal docosahexaenoic acid (DHA) in rabbit eyes over a short-term period.MethodsSixteen New Zealand albino rabbits were selected for this pre-clinical study. Six concentrations of DHA (Brudy Laboratories, Barcelona, Spain) were prepared: 10 mg/50 µl, 5 mg/50 µl, 2'5 mg/50 µl, 50 µg/50 µl, 25 µg/50 µl, and 5 µg/50 µl. Each concentration was injected intravitreally in the right eye of two rabbits. As a control, the vehicle solution was injected in one eye of four animals. Retinal safety was studied by slit-lamp examination, and electroretinography. All the rabbits were euthanized one week a…
Liposomally-entrapped ganciclovir for the treatment of cytomegalovirus retinitis in AIDS patients
Treatment of retinitis by cytomegalovirus (CMV) in AIDS patients requires frequent repetitive injections of intravitreal ganciclovir (GCV). This study was undertaken to establish experimentally whether the intravitreal application of liposomally-entrapped GCV could prolong intraocular therapeutic levels when compared with the intravitreal injection of free GCV, and the clinical effectiveness of this approach in AIDS patients. Intraocular concentration of GCV was determined by means of an ELISA test in rabbit vitreous 2, 3, 7, and 14 days after a single intravitreal injection of either different doses of the free drug (0.2-20 mg) or 1 mg of liposomally-entrapped GCV. After 72 h, only the vit…
<p>A randomized multicenter study comparing seawater washes and carmellose artificial tears eyedrops in the treatment of dry eye syndrome</p>
Purpose To investigate the safety and efficacy of sterile isotonic seawater washes vs standard treatment with carmellose artificial tears in dry eye syndrome (DES). Patients and methods This is a randomized multicenter prospective study with 12 weeks of follow-up. A group of patients with DES (N=60) were treated with seawater spray (Quinton®) five times daily, and another similar group (N=60) were treated with carmellose artificial tears eyedrops (Viscofresh® 0.5%) five times a day. The parameters studied and measured were as follows: Ocular Surface Disease Index questionnaire score, Schirmer I test (without anesthesia) score, tear osmolarity (TearLab®), tear breakup time, tear meniscus hei…
Capsulorrexis asistida mediante azul brillante (BBG) para cirujanos en formación
Role of oxygen and nitrogen species in experimental uveitis: anti-inflammatory activity of the synthetic antioxidant ebselen.
This study was aimed at examining the role of oxygen and nitrogen reactive species in a model of experimental uveitis upon intravitreal injection of bacterial endotoxin to albino New Zealand rabbits. The inflammatory response was evaluated in terms of: (i) the integrity of the blood aqueous barrier (protein and cell content in samples of aqueous humor), (ii) histopathological changes of the eyes, (iii) clinical evaluation (with a score index based on clinical symptoms), and (iv) the concentration of malondialdehyde (MDA), in aqueous humor, as a marker of oxidative stress. Betamethasone was used as reference treatment, superoxide dismutase as quencher of superoxide anion, L-N(G)-nitro-L-argi…
Beals–Hecht syndrome and choroidal neovascularization
Purpose: To describe a case of choroidal neovascularization (CNV) in a female diagnosed with Beals–Hecht syndrome. Methods: A retrospective, interventional case is described in a 26-year-old female complaining of metamorphopsia and visual loss in her left eye (counting fingers). The fluorescein angiogram and the optical coherence tomography supported the diagnosis of CNV. Intravitreal ranibizumab was administered. Results: After the third intravitreal ranibizumab, her visual acuity improved to 0.8 and the morphology of the macular area was restored. Conclusions: To our knowledge this is the first report of CNV in Beals–Hecht syndrome treated with ranibizumab. Self-monitoring by periodically…
Rediscovering the macula of high myopia in the xxi century
Femtosecond laser-assisted superficial keratectomy as a treatment for bilateral band keratopathy
Update on the principles and novel local and systemic therapies for the treatment of non-infectious uveitis.
Ocular inflammatory disorders constitute a sight-threatening group of diseases that might be managed according to their severity. Their treatment guidelines experience constant changes with new agents that improve the results obtained with former drugs. Nowadays we can make use of a five step protocol in which topical, periocular and systemic corticosteroids remain as the main therapy for non-infectious uveitis. In addition, immunosuppresive drugs can be added in order to enhance the anti-inflammatory effects and to play the role of corticosteroid-sparing agents. These can be organized in four other steps: cyclosporine and methotrexate in a second one; azathioprine, mycophenolate and tacrol…
Curcumin as a therapeutic option in retinal diseases
Este artículo se encuentra disponible en la siguiente URL: https://www.mdpi.com/2076-3921/9/1/48 Este artículo pertenece al número especial "Natural products in health promotion and disease prevention". En este artículo también participa: Vincent M. Villar. The retina is subjected to oxidative stress due to its high vascularization, long time light exposition and a high density of mitochondria. Oxidative stress can lead to pathological processes, like cell apoptosis, angiogenesis and inflammation ending in retinal pathologies. Curcumin, a major bioactive component obtained from the spice turmeric (Curcuma longa) rhizome has been used for centuries in Asian countries for cooking and for curi…
Efficacy of the antioxidant ebselen in experimental uveitis.
Inflammation results in the production of free radicals. In a model of experimental uveitis upon subcutaneous injection of endotoxin to Lewis rats, i.e., endotoxin-induced experimental uveitis (EIU), we have evaluated the status of the antioxidant capacity of ocular tissues. EIU results in a decrease of glutathione (GSH) content and glutathione peroxidase (GPx) activity in whole eye homogenates 24-h after endotoxin administration. Furthermore, an increase in malondialdehyde (MDA) content was observed in these same samples, thus confirming the involvement of oxidative stress in the pathophysiology of the process. In view of the ability of the antioxidant ebselen as GPx enzyme mimic, we teste…
Síndrome de Brown McLean y lentes refractivas fáquicas de cámara anterior
Intravitreal ranibizumab for symptomatic drusenoid pigment epithelial detachment without choroidal neovascularization in age-related macular degeneration
Roberto Gallego-Pinazo,1,2 Ana Marina Suelves-Cogollos1, Ester Franc&eacute;s-Mu&ntilde;oz,1 J Mar&iacute;a Mill&aacute;n,2,3 J Fernando Arevalo,4 J Luis Mullor,5 Manuel D&iacute;az-Llopis,1,2,61Department of Ophthalmology, Hospital Universitario La Fe, Valencia, Spain; 2Centro de Investigaci&oacute;n Biom&eacute;dica en Red de Enfermedades Raras, Valencia, Spain; 3Department of Genetics, Hospital Universitario La Fe, Valencia, Spain; 4Retina and Vitreous Service, Cl&iacute;nica Oftalmol&oacute;gica Centro Caracas, Caracas, Venezuela; 5Unit of Experimental Ophthalmology, Fundaci&oacute;n para la Investigaci&oacute;n del Hospital Universitario La F…
Intravitreal pegaptanib sodium for refractory pseudophakic macular oedema.
Evaluate the efficacy of intravitreal pegaptanib sodium (Macugen®) in refractory pseudophakic cystoid macular oedema (CME). Prospective, nonrandomized, interventional case series. Four eyes of four patients with refractory pseudophakic CME to pars plana vitrectomy and intravitreal bevacizumab and triamcinolone, were treated with pegaptanib sodium, with a mean follow up of 4 months. Pre- and postinfection examinations included assessment of best-corrected visual acuity (BCVA) using the Early Treatment Diabetic Retinopathy Study chart (ETDRS), fluorescein angiography (FA), and optical coherence tomography (OCT). Visual acuity increased in all patients after intravitreal pegaptanib sodium. OCT…
Intravitreal therapies for non-neovascular age-related macular degeneration with intraretinal or subretinal fluid
OBJECTIVE: To evaluate the efficacy of intravitreal therapies in cases of atrophic age-related macular degeneration (AMD) with subretinal or intraretinal fluid. METHODS: A retrospective review was made of the clinical charts of patients diagnosed with atrophic AMD with subretinal or intraretinal fluid. Fundus photographs and spectral-domain optical coherence tomography images were examined, and an analysis was made on the presence of fluid and its density. Neovascularisation was ruled out by fluorescein and/or indocyanine green angiography. RESULTS: The study included 14 eyes from 13 patients with a mean age of 72.64 years and a mean follow-up of 80.5 weeks. Intraretinal fluid was observed …
Towards the new spectral-domain optical coherence tomography based classification of age-related macular degeneration
Abstract Introduction Age-related macular degeneration (AMD) is major social and health problem in industrialised societies. The contribution of the new diagnostic techniques, mainly spectral-domain optical coherence tomography (SD-OCT), has led to a better understanding of this disease. Aim To review the current clinical classification of AMD, to describe the new tomographic classification of wet AMD, and to review the new topographical findings in dry AMD. Development There are two classically described forms of AMD: dry and wet; there are also three progressive stages of severity: early, intermediate and advanced. This purely clinical stratification does not take into account any criteri…
Intravitreal pegaptanib for refractory macular edema secondary to retinal vein occlusion
Patricia Udaondo1,2, Salvador Garcia-Delpech1,3, David Salom1,3, Maria Garcia-Pous1,3, Manuel Diaz-Llopis1,31Nuevo Hospital Universitario y Politecnico La Fe, Valencia, Spain; 2University Cardenal Herrera CEU, Valencia, Spain; 3Faculty of Medicine, University of Valencia, Valencia, SpainPurpose: To assess the efficacy of intravitreal Pegaptanib sodium (Macugen&reg;) injection in the management of refractory macular edema secondary to branch retinal vein occlusion.Methods: This is a prospective, nonrandomized, interventional case series. Five eyes of five patients with macular edema refractory to either bevacizumab or triamcinolone were treated with intravitreal injection of Pegaptanib s…
Magnification of the retinal image through an intraocular Galilean telescope
The intraocular Galilean telescope is a good solution for incrementing the visual capabilities of patients with age-related macular degeneration. Nevertheless, some problems arise with the use of the intraocular telescopes available at present; these problems are originated by two main factors: the use of the same power values for the lenses in all types of eyes and the fact that the values of the distance between lenses into the eye are not the most suitable ones. As a result, a high residual refraction is produced in many implanted eyes. We propose a method for predicting outcomes in order to select patients for this technique and, moreover, for choosing the optimum power for the positive…
Bacterial Contamination of Anterior Chamber Fluid Following Non-complicated Cataract Surgery
Objective: To study the anterior chamber contamination during non-complicated cataract surgery and its relationship with normal conjuctival organisms. Setting: Ophthalmology Department, La Fe Hospital, University of Valencia. Patients: Forty patients who had undergone cataract extraction using either ECCE, phacoemulsification or nucleus fracture methods. Results: Positive cultures of aqueous humour were obtained in 32.5% of cases. The most commonly isolated organism was Staphylococcus coagulase-negative. Only in 7.7% of cases was the microorganism found in the conjunctiva the same as that found in the anterior chamber. The inoculum size ranged between 20 and 160 colonies/ml. One of the case…
Retinal neurodegenerative changes in the adult insulin receptor substrate-2 deficient mouse.
Abstract Insulin receptor substrate-2 (Irs2) mediates peripheral insulin action and is essential for retinal health. Previous investigations have reported severe photoreceptor degeneration and abnormal visual function in Irs2-deficient mice. However, molecular changes in the Irs2 − / − mouse retina have not been described. In this study, we examined retinal degenerative changes in neuronal and glial cells of adult (9- and 12-week old) Irs2 − / − mice by immunohistochemistry. 9-week old Irs2 − / − mice showed significant thinning of outer retinal layers, concomitant to Muller and microglial cell activation. Photoreceptor cells displayed different signs of degeneration, such as outer/inner…
Intravitreal clindamycin and dexamethasone for zone 1 toxoplasmic retinochoroiditis at twenty-four months.
Purpose To report the anatomic and functional outcomes of intravitreal clindamycin and dexamethasone for the treatment of zone 1 toxoplasmic retinochoroiditis (TRC). Patients had 1 or more of the following indications for local therapy: intolerance to oral medication, contraindication to oral medication because of pregnancy, lack of response despite oral antimicrobial treatment, or treatment with concomitant oral and local therapy to avoid or limit foveal or optic disc involvement. Design Noncomparative, retrospective, multicentric interventional case series. Participants We reviewed the medical records of 12 consecutive patients (eyes) with posterior pole (zone 1) TRC who were treated week…
Noninfectious uveitis: strategies to optimize treatment compliance and adherence.
Noninfectious uveitis includes a heterogenous group of sight-threatening ocular and systemic disorders. Significant progress has been made in the treatment of noninfectious uveitis in recent years, particularly with regard to the effective use of corticosteroids and non-corticosteroid immunosuppressive drugs, including biologic agents. All of these therapeutic approaches are limited, however, by any given patient's ability to comply with and adhere to their prescribed treatment. In fact, compliance and adherence are among the most important patient-related determinants of treatment success. We discuss strategies to optimize compliance and adherence.
Oxidative stress in retinal pigment epithelium cells increases exosome secretion and promotes angiogenesis in endothelial cells.
10 páginas, 5 figuras
Smoking and age-related macular degeneration: review and update.
Age-related macular degeneration (AMD) is one of the main socioeconomical health issues worldwide. AMD has a multifactorial etiology with a variety of risk factors. Smoking is the most important modifiable risk factor for AMD development and progression. The present review summarizes the epidemiological studies evaluating the association between smoking and AMD, the mechanisms through which smoking induces damage to the chorioretinal tissues, and the relevance of advising patients to quit smoking for their visual health.
Altas dosis de azul brillante G intravítreo
Intravitreal foscarnet for cytomegalovirus retinitis in a patient with acquired immunodeficiency syndrome.
We treated a patient who had acquired immunodeficiency syndrome and cytomegalovirus retinitis of the left eye. After anesthetic had been topically administered, the patient received intravitreal injections of 1,200 micrograms of foscarnet. Plasma and vitreous foscarnet levels were measured by high-performance liquid chromatography. Systemic absorption of the drug was not evident. Elimination half-life from the vitreous after one injection was 54.0 hours. Vitreous levels remained above the mean 50% inhibition value for cytomegalovirus for approximately 56 hours and above the mean inhibition value for human immunodeficiency virus for approximately 241 hours. The patient's visual acuity improv…
Metastatic Anterior Chamber Non-Hodgkin Lymphoma in a Patient With Acquired Immunodeficiency Syndrome
Purpose To alert ophthalmologists to the possibility of metastatic anterior chamber intraocular non-Hodgkin lymphoma in patients with acquired immunodeficiency syndrome (AIDS). Methods We examined a 19-year-old man with AIDS who had an anterior uveitis with pseudohypopyon and a history of 2 months of malaise. A specimen of the lesion was obtained with a 25-gauge needle for pathologic examination. RESULTS: Systemic exploration showed hepatomegaly. Abdominal computed tomography showed multiple lesions in the liver and spleen. Fine-needle aspiration disclosed a high-grade non-Hodgkin lymphoma. The result of a fine-needle aspiration obtained from a lesion in the anterior chamber was consistent …
Síndrome de Horner como manifestación de disección carotídea
Caso Clínico: Un varón de 42 años se presenta con ptosis y miosis izquierda después de una historia de cefalea homolateral de 20 días de evolución, que empeora progresivamente durante los últimos días. Una angioresonancia revela disección de la arteria carótida interna. Discusión: El «síndrome de Horner doloroso» destaca como una urgencia médica por posible manifestación de una disección carotídea. Consideramos que el perfecto conocimiento de las urgencias neurooftalmológicas es de gran necesidad para el médico oftalmólogo y que estas requieren una atención multidisciplinaria para asegurar un seguimiento y tratamiento adecuado. Clinical Case: A 42-year-old man presented with ptosis and mios…
Mutational screening of the USH2A gene in Spanish USH patients reveals 23 novel pathogenic mutations
Abstract Background Usher Syndrome type II (USH2) is an autosomal recessive disorder, characterized by moderate to severe hearing impairment and retinitis pigmentosa (RP). Among the three genes implicated, mutations in the USH2A gene account for 74-90% of the USH2 cases. Methods To identify the genetic cause of the disease and determine the frequency of USH2A mutations in a cohort of 88 unrelated USH Spanish patients, we carried out a mutation screening of the 72 coding exons of this gene by direct sequencing. Moreover, we performed functional minigene studies for those changes that were predicted to affect splicing. Results As a result, a total of 144 DNA sequence variants were identified.…
Clinical magnification and residual refraction after implantation of a double intraocular lens system in patients with macular degeneration
Purpose To evaluate the efficacy of a standard double intraocular lens (IOL) system (IOL-Vip) in patients with low vision and central scotoma due to macular degeneration and assess the predictability of the residual refraction and magnification. Setting Ophthalmology Department, Hospital General Universitario, Valencia, Spain. Methods This interventional prospective noncomparative case series comprised 13 consecutive surgical procedures in 10 patients with central scotoma. Follow-up was 12 months. Evaluation included the difference between preoperative and postoperative best corrected visual acuity (BCVA), refraction, position of the IOLs, endothelial cell density, and occurrence of postope…
Síndrome de Horner como manifestación de disección carotídea
Resumen Caso Clinico Un varon de 42 anos se presenta con ptosis y miosis izquierda despues de una historia de cefalea homolateral de 20 dias de evolucion, que empeora progresivamente durante los ultimos dias. Una angioresonancia revela diseccion de la arteria carotida interna. Discusion El «sindrome de Horner doloroso» destaca como una urgencia medica por posible manifestacion de una diseccion carotidea. Consideramos que el perfecto conocimiento de las urgencias neurooftalmologicas es de gran necesidad para el medico oftalmologo y que estas requieren una atencion multidisciplinaria para asegurar un seguimiento y tratamiento adecuado.
Penetration of 2% cyclosporin eyedrops into human aqueous humour.
The penetration into the eye and the systemic absorption of 2% cyclosporin eye drops were determined by polarisation immunofluorescent assay of cyclosporin in the aqueous humour and plasma of 30 patients at the time of cataract surgery. The results were then compared with the corresponding results after oral administration at a dosage of 5 mg/kg/day to three further patients. The maximum intraocular concentration (24 (SD 9) mg/l) was achieved four hours after topical administration. This level was slightly less than that found in aqueous humour (28 (SD 10) mg/l) 12 hours after systemic administration of the drug at a dosage of 5 mg/kg/day. Both these levels are below the minimum therapeutic…
Propranolol e inyecciones intravítreas de ranibizumab en el desprendimiento seroso macular secundario a hemangioblastoma retiniano capilar
Superdiluted atropine at 0.01% reduces progression in children and adolescents. A 5 year study of safety and effectiveness
Abstract Objective To confirm the clinical security and effectiveness of the daily application of 0.01% superdiluted atropine eyedrops in the progression of myopia in children. Material and methods A total of 200 children 9–12 years of age were randomized into a treated group and a control without treatment. Refraction under cycloplegia was performed. Results Myopia progression of the treated group was −0.14 ± 0.35 versus −0.65 ± 0.54 in the control group without treatment. Only 2% of patients were forced to stop treatment due to side effects. Conclusion Atropine superdiluted atropine 0.01% eyedrops is effective and well tolerated, and reduced myopia progression by 25%.
Nitric oxide synthesis is related to astroglial cell cycle in the mouse retina via p53 gene regulation
Purpose To analyze the influence of p53 gene in retinal astrocytes morphology and function. Methods Adult mice of the strain C57BL/6 were distributed into two groups: 1) wild type TP53, as the controls (cp53; n=20) and 2) mice with an extra copy of p53 (sp53; n=22). Both eyeballs were enucleated, after death by ether narcosis, to obtain the retinas. Right retinas were frozen (-85oC) until processing to assess nitric oxide (NO) synthesis. Left retinas were obtained and proccesed to perform immunohistochemical localization of the glial fibrillary acidic protein (GFAP). Data are expressed as the mean ± SD. Statistical analysis was carried out using Student’s t-test. Confidence interval was tak…
Tonometría de rebote versus Goldmann versus Neumotonómetro
Acute endothelial failure after cosmetic iris implants (NewIris®)
We report a case of an acute endothelial failure after the implantation of a new cosmetic, colored, artificial iris diaphragm implant called NewIris(®). A 21-year-old woman came to us complaining of progressive loss of vision and pain after NewIris lenses had been implanted. Decreased visual acuity, corneal edema, and increased intraocular pressure in both eyes appeared only 3 weeks after the surgery. The lenses were removed as soon as possible but had already severely affected the endothelial cell count. NewIris implants are an alternative to cosmetic contact lenses, but they are not as safe as other phakic anterior chamber intraocular lenses, nor are they a good option for the patient.
Metabolomic changes in the rat retina after optic nerve crush.
Purpose To identify metabolic pathways and metabolites affected by optic nerve crush that can act as predictors of the disease or therapeutic targets. Methods The left optic nerve of adult rats was intraorbitally crushed and retinas were dissected 24 hours or 14 days after the lesion (n = 10 per group). Metabolic profiling analysis was carried out by Metabolon, Inc. A total of 195 metabolites were unambiguously detected. Data were normalized and the regulated metabolites were identified after comparing the different conditions. Metabolite concentration changes were analyzed using single and multivariate statistical analysis to detect discriminatory metabolites. Functional clustering and met…
Diclofenac sodium and cyclosporin A inhibit human lens epithelial cell proliferation in culture.
• Purpose: To investigate the effect of diclofenac sodium salt and cyclosporin A (CsA) on human lens epithelial cell (HLEC) growth in culture. • Methods: Cultures of HLEC were obtained from anterior capsules from extracapsular cataract surgery. Third-passage cells were seeded in 96-well plates in 0.1 ml culture medium. Cytotoxicity was estimated by the tetrazolium test in confluent monolayers after 24 h exposure to a wide range of concentrations of diclofenac and CsA. The effect of subcytotoxic concentrations of diclofenac and CsA on HLEC proliferation in subconfluent cultures was evaluated after 24 and 72 h of exposure. To investigate the relationship between PGEZ synthesis and the inhibit…
Plasmina autóloga para inyección intravítrea sin vitrectomía asociada: método simplificado de preparación con streptokinasa
Necrobiotic xanthogranuloma. Differential diagnosis, treatment and systemic involvement. Case report
Abstract Case report A 48-year-old male was referred to our hospital for further evaluation of eyelid edema with bilateral yellowish ulcerated nodules. Suspecting a xanthogranulomatosis, imaging tests and biopsy were performed with diagnosis of necrobiotic xanthogranuloma. IgG monoclonal gammapathy was diagnosed in a systemic study. Systemic corticosteroids and cyclosporine were initiated unsuccessfully; therefore, intra-lesional injections of triamcinolone were started, which controlled the orbital disease. Discussion Necrobiotic xanthogranuloma is a rare condition that usually affects the eyelids and anterior orbit. Its diagnosis is important as it is associated with malignant lymphoproli…
Levels of thrombopoietin in aqueous humor of patients with noninfectious acute anterior uveitis
Jos&eacute;-Juan Mondejar,1,4 David Salom,1,3 Salvador Garcia-Delpech,1,2 Manuel Diaz-Llopis11Ophthalmology Department, School of Medicine, University of Valencia, 2Ophthalmology Department, Hospital Universitario La Fe, 3Ophthalmology Department, Hospital de Manises, Valencia, 4Ophthalmology Department, Hospital General Universitario de Alicante, Alicante,&nbsp;SpainPurpose: To measure thrombopoietin (TPO) levels in the serum and aqueous humors of patients with noninfectious acute anterior uveitis.Methods: A prospective, comparative, controlled study. Serum and aqueous humors were obtained from the eyes of 16 patients with noninfectious acute anterior uveitis. TPO levels were measu…
Oral Propranolol for Circumscribed Choroidal Hemangioma
Introduction: Several therapeutic approaches have been developed to treat choroidal hemangioma. However, all these therapies are associated with a potential risk of damaging the overlying retina. Case Report: We report a case of circumscribed choroidal hemangioma (CCH) in a 59-year-old man refractory to laser treatment. Visual acuity was 20/200 and a serous macular detachment was present. The CCH was treated with oral propanolol, whereupon visual acuity improved to 20/20 and the macular detachment resolved without systemic or local adverse effects. Discussion: Propanolol is a β-blocker commonly used in cardiology that may induce endothelium vasoconstriction and inhibit endothelial prolifera…
Terapias intravítreas en degeneración macular asociada a la edad no neovascular con fluido intrarretiniano o subretiniano
Resumen Objetivo Evaluar la eficacia de las terapias intravitreas en casos de degeneracion macular asociada a la edad (DMAE) atrofica con fluido intra- o subretiniano. Metodos Revisamos, de forma retrospectiva, las caracteristicas de pacientes diagnosticados de DMAE atrofica con fluido intra- o subretiniano. Examinamos las retinografias y las imagenes de tomografia de coherencia optica de dominio espectral analizando en ellas la presencia de fluido y su densidad. Descartamos la existencia de neovascularizacion coroidea mediante angiografia con fluoresceina o con verde de indocianina. Resultados Se incluyeron 14 ojos de 13 pacientes con una edad media de 72,64 anos y un seguimiento medio de …
Optical analysis to predict outcomes after implantation of a double intraocular lens magnification device.
Purpose To analyze the effect of different optical parameters of the eye on the outcomes of implantation of a double intraocular lens (IOL) magnification device in patients with low vision. Setting Fundacion Oftalmologica del Mediterraneo, Valencia, Spain. Methods The eye's refraction and magnification before and after surgery were evaluated using a theoretical eye model based on paraxial optics approximation. Four parameters on which refraction and magnification are dependent were evaluated: anterior chamber depth (ACD), axial length (AL), mean keratometry (Km), and the distance between the 2 implanted IOLs. The 4 variables were analyzed separately in the first stage. Next, different combi…
Multilayer amniotic membrane transplantation in severe ocular graft versus host disease
To clarify the usefulness of multilayer amniotic membrane transplantation in an unusual case of calcareous corneal degeneration in a patient with graft-versus-host disease.A 20-year-old Caucasian woman had bilateral calcareous corneal degeneration of one year of evolution, secondary to graft-versus-host disease. Treatment for both eyes with topical steroids and antibiotic ointment was not successful. Right eye had a spontaneous corneal perforation, and a three-layer circle amniotic membrane graft was applied to the whole cornea.During a follow-up period of 20 months we observed stability of the corneal epithelium and stroma. The amniotic membrane-covered area showed rapid epithelization, re…
INTRAVITREAL BEVACIZUMAB FOR CHOROIDAL NEOVASCULARIZATION IN AGE-RELATED MACULAR DEGENERATION: 5-Year Results of The Pan-American Collaborative Retina Study Group.
To report the long-term anatomical and functional outcomes of patients with choroidal neovascularization secondary to age-related macular degeneration treated with intravitreal bevacizumab (IVB).Retrospective case series. Patients diagnosed with subfoveal choroidal neovascularization secondary to age-related macular degeneration that were treated with at least 1 intravitreal injection of 1.25 mg of IVB and had a minimum follow-up of 60 months. Patients underwent best-corrected Snellen visual acuity testing, optical coherence tomography, and ophthalmoscopic examination at baseline and follow-up visits.Two hundred and forty-seven consecutive patients (292 eyes) were included. The mean number …
Intravitreal Plasmin Without Associated Vitrectomy as a Treatment for Refractory Diabetic Macular Edema
To determine the effectiveness of a low-dose intravitreal injection of autologous plasmin enzyme (APE), without the performance of a vitrectomy, as a treatment for refractory diffuse diabetic macular edema (DDME).Prospective, comparative, interventional case series.Sixteen patients with bilateral DDME who had not responded to prior laser photocoagulation. All patients received an injection in 1 eye, while the other eye served as a control.Intravitreal 0.2 mL APE injection under topical anesthesia. The APE was obtained using a simplified method.Central macular thickness (CMT) at 1 and 6 months, determined by optical coherence tomography (OCT) and best corrected visual acuity (BCVA).All patie…
Celecoxib for recurrent sclerouveitis after syphilitic panuveitis. A case report
Purpose To report a case of recurrent ocular inflammation after optimal therapy of bilateral syphilitic panuveitis responding to oral celecoxib. Methods A case report was conducted. Results A 76-year-old man presented with painful blurry vision in both eyes. Ocular examination disclosed bilateral panuveitis. Serological testing confirmed blood and cerebrospinal fluid syphilitic involvement. After 2 weeks of intravenous penicillin therapy, recurrent episodic sclerouveitis was observed. Conclusion Ocular inflammation after healing of infectious uveitis is a rare ophthalmic sequela. In an immunocompetent patient, either re-infection or immune uveitis should be evoked. Non-steroidal therapeutic…
Microarray-based mutation analysis of 183 Spanish families with Usher syndrome.
PURPOSE. The purpose of this study was to test the ability of the genotyping microarray for Usher syndrome (USH) to identify the mutations responsible for the disease in a cohort of 183 patients with USH. METHODS. DNA from 183 patients with Usher syndrome from the Spanish population was analyzed using a genotyping microarray containing 429 previously identified disease-associated variants in eight USH genes. Mutations detected by the array were confirmed by direct sequencing. Haplotype analysis was also performed in families carrying common Spanish mutations. RESULTS. The genotyping microarray identified 43 different variants, divided into 32 disease causative and 11 probably non-pathologic…
Kyrieleis’ vasculitis in acute retinal necrosis
We report the first case in the literature of Kyrieleis' vasculitis related to acute retinal necrosis by Varicella zoster virus in a 76-year-old woman with bilateral involvement. In our patient the arterial lesions appeared 15 days after the initial presentation.
Adult Coats’ Disease Successfully Managed with the Dexamethasone Intravitreal Implant (Ozurdex®) Combined with Retinal Photocoagulation
Purpose: To report a case of Coats’ disease managed with the dexamethasone intravitreal implant Ozurdex® (Allergan, Inc., Irvine, Calif., USA) combined with retinal photocoagulation. Methods: A 46-year-old female with 20/200 visual acuity was diagnosed with Coats’ disease with secondary retinal vasoproliferative tumor. An initial approach was performed with an intravitreal injection of the sustained-release dexamethasone implant Ozurdex. After reattachment of the retina, the telangiectatic vessels were treated with laser photocoagulation. Results: The patient’s visual acuity improved to 20/25 after the intravitreal Ozurdex. No further recurrences of exudation were evident through the 12-mon…
Prophylaxis of Macular Edema with Intravitreal Ranibizumab in Patients with Diabetic Retinopathy after Cataract Surgery: A Pilot Study
The purpose of this study was to evaluate the effectiveness of intravitreal ranibizumab (Lucentis, Genentech, South San Francisco, Calif, USA) combined with cataract surgery for the prevention of clinically significant macular edema (CSME) in patients with diabetic retinopathy (DR). This prospective interventional case series included fifty-four eyes of 54 patients with a previous diagnosis of nonproliferative diabetic retinopathy (NPDR) without macular edema preoperatively. Subjects were assigned in a 1 : 1 ratio to receive an intraoperative intravitreal ranibizumab injection (n=27) or not (control group,n=27) associated with standardised phacoemulsification surgery. The main outcome measu…
Ocular Surface and Tear Film Changes in Older Women Working with Computers
The aim of this work is to investigate changes in the ocular surface (OS) and tear film (TF) by means of questionnaire-based subjective symptoms, TF break-up time, Schirmer test, and TF analysis in women working with computers and to analyze the effects of the oral supplementation with antioxidants/omega 3 fatty acids (A/ω3) in the OS outcomes. Women aged 40–65 years (n=148) were recruited at the Administrative Offices of Valencia (Spain) and distributed into two age groups, 40–52 years (AGE1;n=87) and 53–65 years (AGE2;n=61), and then subdivided according to being (or not) computer users (CUG; NCUG) during the workday. Homogeneous subgroups were randomly assigned (or not) to the daily inta…
Branch retinal vein occlusion associated with the 20210 G-to-A prothrombin variant.
Purpose To describe a case of branch retinal vein occlusion (BRVO) in a patient who tested positive for the 20210 A allele of the prothrombin (PT) gene. Methods A 48-year-old man had visual loss in the right eye secondary to BRVO confirmed by ophthalmoscopy and fluorescein angiography. His medical history was not remarkable for common risk factors for retinal occlusive diseases. Results Laboratory tests for hypercoagulability were positive for PT 20210 A variant. The patient's family tested negative for the PT variant. Conclusions Laboratory tests for coagulopathy, including the PT 20210 A variant, should be added to the examination of patients with central or BRVO, especially if most commo…
Outcomes of cataract surgery in diabetic patients: results of the Pan American Collaborative Retina Study Group
Purpose: This study was designed to evaluate the visual and anatomical outcomes after cataract surgery in diabetic patients with different intraoperative therapeutic strategies. Methods: The research design comprised of a multicentric, retrospective, interventional study conducted at 6 centers in Argentina, Brazil, Costa Rica, Puerto Rico, Spain, and Venezuela. We included 138 diabetic patients with at least 6-month follow-up following phacoemulsification and intraocular lens implantation. Best-corrected visual acuity (BCVA) and central subfield thickness were collected at baseline and at 1-, 2-, 3-, and 6-month follow-up. Of these, 42 cases were not treated with any intraoperative coadjuva…