Archivos de la Sociedad Espanola de Oftalmologia最新文献

Introduction: Virtual clinics represent an innovative approach to the management of chronic diseases, particularly in ophthalmology, by optimizing resource allocation and alleviating the burden on traditional face-to-face (F2F) services. Despite their growing implementation, there is a lack of comprehensive studies assessing their efficiency. This study aims to compare the cost-effectiveness of the Virtual Retina Clinic (VRC) with F2F clinics in the follow-up of stable retinal diseases.

Material and methods: A cost-minimization analysis (AMC) was conducted by measuring resource utilization of patients in conventional F2F visits in 2019, and through the VRC in 2020. Our previous study on the VRC effectiveness demonstrated the equivalence of the results of the VRC and F2F approaches, as required for AMC, and a VRC sensitivity of 100% for detecting progression. The unit costs were obtained from the hospital´s accounting system. Furthermore, indirect costs related to labor productivity losses in patients and their companions were analyzed.

Results: No significant differences were found between the total direct direct costs of the VRC and conventional clinics in the follow-up of 481 patients with stable retinal diseases. The differences detected were that VRC staff costs were significantly lower (54.5% vs. 76.8% for F2F clinics) while its equipment costs were higher (32.8% vs. 10%). Overall, including the costs of productivity losses, the VRC is significantly less expensive than in-person care as it more than halves indirect costs.

Conclusion: This first study analyzing the costs of a VRC versus fully F2F clinics found that it is not more expensive for the follow-up of stable retinal diseases. Additionally, taking into account indirect costs, the VRC is less expensive, and once the equipment has been acquired, its costs are lower than those of conventional clinics.

Introduction and objectives: Despite correct alignment during surgery, postoperative lens rotation remains one of the main complications for toric lenses. This study aimed to evaluate the rotational stability in patients who underwent enVista Toric MX60T intraocular lens implantation and its relationship with the capsulorhexis morphology and preoperative ocular biometrics.

Materials and methods: 59 eyes of 59 patients with cataract and regular corneal astigmatism, who underwent uncomplicated phacoemulsification with enVista Toric MX60T intraocular lens implantation. Pre-op ocular biometrics were evaluated with the IOLMaster 700. 24 h post-surgery, perimeter, area, horizontal and vertical diameter, and circularity index of the capsulorhexis were taken with the ImageJ program through clinical photographs under pupillary dilation. OPD-Scan III was performed post-op at 24 h and at 1 month to quantify lens rotation.

Results: At 1 month post-op, the mean refractive cylinder was of 0.1 ± 0.61 diopters, and the mean lens rotation was of 5.00 ± 3.93 degrees. 52 % of lenses rotated 5° or less. Post-surgical uncorrected visual acuity was 20/30 or better in 64 % of eyes. Logistic regression showed a weak association regarding anterior chamber depth and IOL rotation at 24 h, however, this was not maintained at the 1 month visit. The rest of the parameters showed no correlation regarding lens rotation at any of the time periods.

Conclusions: The magnitude of rotation of the enVista Toric MX60T intraocular lens is not related to the capsulorhexis morphology or preoperative ocular biometrics. Further research is needed to assess variables that may affect lens rotation, to improve post-surgical visual and refractive outcomes.

Background and objective: To evaluate the efficacy of micropulse transscleral diode laser cyclophotocoagulation as a bridge therapy prior to angle surgery in pediatric glaucoma caused by angle dysgenesis in the context of Sturge-Weber Syndrome. The objective was to temporarily control intraocular pressure, thereby achieving the corneal transparency required for subsequent angle surgery.

Materials and methods: Three Sturge-Weber syndrome patients under one year old, with glaucoma caused by angle dysgenesis and corneal opacity, were treated with micropulse transscleral diode laser cyclophotocoagulation to improve corneal transparency before surgery. Two patients subsequently underwent trabeculotomy, while the third patient, who had a previous trabeculotomy, underwent a MIGS OMNI procedure.

Results: Micropulse transscleral diode laser cyclophotocoagulation temporarily lowered IOP values, improving corneal transparency and allowing the performance of subsequent surgical interventions.

Conclusion: The combination of micropulse transscleral diode laser cyclophotocoagulation as a bridge therapy followed by angle surgery, for example trabeculotomy or MIGS OMNI, represents a promising strategy for managing congenital glaucoma in pediatric patients with angle dysgenesis, particularly in the context of phakomatoses like Sturge-Weber Syndrome.

Background and purpose: To describe the results of isolated Harada-Ito or Fells modification surgery in the treatment of diplopia, torticollis and excyclotorsion secondary to superior oblique paresis (SOP).

Material and methods: Retrospective workup of subjects operated on since 2015-November 2024. The age, sex, etiology of SOP, preoperative and immediate and late postoperative excyclotorsion, pre- and postoperative vertical deviation and torticollis, as well as type of suture (resorbable or not) were collected. The time of evolution of the SOP and follow-up from surgery to data collection were recorded. The resolution or improvement of diplopia, excyclotorsion and torticollis were considered a good outcome.

Results: Eight cases were operated on (4 women). In six, the left eye, bilateral (1). The etiology of the SOP was neoplasia (2), trauma (1), ischemic (3), infectious (1), idiopathic (1). All had subjective excyclotorsion (between 5º-15º) that disappeared at the end of follow-up. The mean torsion correction was 7.87º ± 2.47º, with resorbable suture 7º ± 2.44º and non-resorbable 8.75 º ± 2.5º. Torticollis was observed before surgery in all 8 patients, which resolved after surgery except in one case. Preoperative vertical deviation ranged from a minimum of 2 pd to a maximum of 8 pd, resolving in seven cases. The preoperative diplopia resolved in 4 of the 8 cases and improved in the rest.

Conclusions: Harada-Ito surgery and Fells modification resolved or improved diplopia, symptomatic excyclotorsion and torticollis in patients diagnosed with SOP. Non-resorbable suture had a greater effect on extortion correction (not statistically significant) at the end of follow-up.