Archivos de la Sociedad Espanola de Oftalmologia最新文献

Purpose: To determine the effectiveness of intense pulsed light (IPL) therapy in improving symptoms in patients with a diagnosis of evaporative dry eye disease secondary to Meibomian gland dysfunction (MGD) refractory to conventional treatment.

Methods: Pseudo-experimental, analytical, prospective, longitudinal, interventional study. Patients aged 18-74 years with a diagnosis of dry eye disease refractory to conventional dry eye treatment with the presence of DGM were included. A total of 4 IPL sessions were performed at days 0, 15, 45 and 75. At each visit, ocular surface disease index (OSDI) data and 1-10 analog scale were taken as objective evidence of symptomatic status.

Results: Sixty three patients were included, median age was 43 years, 61.5% were female, 42.9% of patients used one conventional treatment for dry eye prior to IPL therapy and 57.1% of patients used two or more treatments. Sixty three patients completed at least one IPL session, 45 had two sessions, 32 had three sessions and 18 had four sessions. After the fourth session symptomatic improvement was 50.8% based on the OSDI scale, and 71.4% based on the analogous symptom scale.

Conclusion: This study demonstrates that IPL therapy is effective in symptomatic improvement in patients with MGD diagnosis refractory to conventional treatment, showing that after four sessions in at least 50% of patients both with the OSDI measurement and with the ocular surface symptomatology analog scale.

Objective: To describe the demographic and clinical characteristics of thyroid orbitopathy (TO) in a population in Spain.

Method: It is a retrospective observational study of patients with TO treated at a tertiary hospital center. We gathered demographic data, ophthalmological symptoms, laterality, symmetry, recurrences, activity according to the Clinical Activity Score scale, severity according to the European Group On Graves' Orbitopathy (EUGOGO), thyroid function and antibody levels. Statistical significance was defined for P values <0.05.

Results: 156 patients with TO were included. 128 (82.1%) women, the female/male sex ratio was 4.57:1. The cumulative incidence was 7.47 cases per 100,000 inhabitants/year. The mean age was 50.7 ± 13.2 years. 70 (44.9%) patients were smokers. 62 (39.7%) patients had a family history of thyroid dysfunction. Hyperthyroidism occurred in 90 (57.7%) patients, hypothyroidism in 34 (21.8%) patients, and euthyroidism in 32 (20.5%) patients. Thyroid-stimulating immunoglobulin was elevated in 107 (68.5%) patients. The TO was bilateral in 149 (95.51%) and symmetrical in 99 (66%). Active TO occurred in 28 (17.9%) patients. 110 (70.5%) TO were mild, 41 (26.3%) moderate-severe and 5 (3.2%) very severe. Moderate-severe TO was higher in smokers compared to non-smokers (32.9% vs. 20.9%, p = 0.524).

Conclusions: TO in our population follows similar patterns to other countries: female sex, mild, bilateral and symmetrical. In smokers, TO may present more severely.

Congenital simple hamartoma of the retinal pigment epithelium (CSHRPE) is a very rare benign tumor (usually diagnosed in a routine fundus examination), which presents as a small, pigmented nodular lesion in the macular area. We present 3 clinical cases of CSHRPE located in the macular region observed casually and diagnosed thanks to autofluorescence and especially optical coherence tomography, non-invasive tests. We want to point out the importance of carrying out the differential diagnosis of this lesion, especially with malignant tumors, to avoid unnecessary procedures and the importance of following up, since they are usually asymptomatic but are sometimes associated with complications such as traction and exudation.

The amniotic membrane (hAM) plug is a treatment option for patients with large refractory or myopic macular holes (MH). The aim of this retrospective case series is to present the anatomical and functional changes during their follow-up that ranges from 10 to 45 months. Out of the ten eyes enrolled, 6 were idiopathic MH and 4 were myopic MH. Notably, 3 of the myopic MH cases were further complicated by posterior pole retinal detachment. Remarkably, 3 patients improved their best-corrected visual acuity, 5 mantained it and 2 worsened it. All the MH closed. Over this period, three instances of hAM plug misplacement following gas absorption required a secondary surgery employing another hAM. In conclusion, the hAM plug seems to be a safe technique and a treatment option for these patients. Further investigations are needed to comprehensively understand the long-term effects of hAM on the retina.

Presentation of a clinical case of cavernous venous malformation with an unusual location and clinical presentation, detailing its clinical, radiological characteristics, diagnosis, and therapeutic management. The case involves a 37-year-old man with intense headache and incidental diagnosis of infraorbital nerve neurofibroma by imaging tests. After surgical removal and pathological anatomy study, he was finally diagnosed with cavernous venous malformation of the infraorbital canal. Orbital cavernous venous malformation can present unusual manifestations that complicate its diagnosis. The combination of clinical symptoms and imaging tests is usually sufficient for diagnosis, but in cases of unusual clinical presentation, the role of pathological anatomy is essential.

The macular hole is a prevalent pathology whose types and causes are due to various reasons. Sometimes it can coexist with other diseases such as age-related macular degeneration. Its pathophysiological basis may have a common relationship with the degenerative lamellar foramen. Optical coherence tomography plays a fundamental role in understanding its genesis. In this work, we present the case of a 60-year-old patient with age-related macular degeneration, who consults due to decreased visual acuity in the left eye. The ophthalmological examination revealed a drusenoid detachment of the retinal pigment epithelium in the foveal area, visible by optical coherence tomography, in addition to multiple drusen in both eyes. Image follow-up showed regression of the detachment at the end of 60 days with the formation of a lamellar hole in its place. A follow-up was done for 24 months.

Objetives: Analyze the etiology of infectious keratitis in our hospital MATERIAL AND METHODS: Retrospective study in which the medical records of patients were reviewed in which a keratitis-producing microorganism was detected during the last 9 years (January 2014-December 2022). The sample was obtained by corneal scraping and seeded in non-selective media. Bacterial and fungal identification was carried out by mass spectrometry and viral identification by polymerase chain reaction (PCR). Sensitivity was obtained using disk-plate antibiograms, E-test or broth microdilution systems.

Results: A total of 433 samples of corneal scrapings belonging to 416 patients were processed. Of the total samples, 196 were positive (44,3%). The average age was 55 years, with 51% being women. Regarding the etiology, we found the following isolates: Gram-positive bacteria (N = 83) (44%), highlighting Staphylococcus aureus (N = 33), coagulase-negative staphylococci (N = 26), being Staphylococcus epidermidis the most frequent (N = 19). Gram-negative bacteria (N = 67) (35%), including: Pseudomonas aeruginosa (N = 31), 42% associated with the use of contact lenses and Enterobacterales (N = 16). Anaerobes (N = 19), which 18 isolates were Cutibacterium acnes. Regarding viral etiology (N = 10): herpes simple type 1 (N = 7). Varicella-zoster virus (N = 3). Finally, the fungal etiology (N = 13), highlighting Candida spp. (N = 10) CONCLUSIONS: The main agents of infectious keratitis are Staphylococcus aureus and Pseudomonas aeruginosa. The causative agent was detected in 44,3% of the samples, so microbiological analysis of these samples is highly advisable.

Bilateral Acute Iris Transillumination (BAIT) syndrome is characterized by a severe pigment dispersion with secondary iris atrophy and increased intraocular pressure (IOP). We report two cases of female patients aged 31 and 37 years respectively with a diagnosis of BAIT syndrome who required management for ocular hypertension secondary to pigment dispersion syndrome including medical therapy and surgical management in one case. It is important to consider BAIT syndrome as a differential diagnosis in pigment dispersion syndrome or pseudo-uveitis cases because of the need for timely management to prevent visual loss secondary to glaucomatous optic neuropathy.