Archivos de la Sociedad Espanola de Oftalmologia最新文献

Purpose: To communicate the results and complications in a series of 17 proximal lacrimal pathway obstructions (PLPO) operated by conjunctivo-rhinostomy (CR) with Métaireau tube implantation.

Methods: Retrospective descriptive study including 16 patients (17 PLPO) operated with CR between April 2010 and June 2017. Surgeries were performed under general anesthesia. The Métaireau tube implantation, draining into the middle meatus, was carried out through a trans-caruncular osteotomy with a 14G Abbocath catheter under endoscopic control.

Results: Twelve women (75%) and four men (25%) were included. The median age was 57 years (range 32-78). The indication for surgery was constant epiphora (Munk 4) due to obstruction less than 8 mm from the punctum. The follow-up time was 28 months (range 2-85). Epiphora improved one month after the intervention (Munk 0.35 ± 1) and at the end of follow-up (Munk 1.50 ± 1.10) compared to baseline values (Munk 4). The most frequent postoperative symptoms were hyperemia (35%), discharge (24%), and tearing (24%). The detected signs were conjunctival folds and papillomas at the proximal end of the tube (35% and 24%, respectively) and tube malposition (18%). One patient developed restrictive strabismus. 41% of the cases required at least one surgery to reposition or remove the tube.

Conclusions: CR with Métaireau tube implantation is a therapeutic alternative for PLPO. Despite the good anatomic results, patients should be warned about the potential complications, which are frequent and may require reoperations.

We present 2 clinical cases of central retinal vein occlusion (CRVO) combined with cilioretinal artery occlusion (CRAO) in young patients with no cardiovascular risk factors (CVRF) or medical history of interest. An extensive etiological study with analytical and imaging tests was performed without finding relevant alterations. Finally, in the first case, the intake of 1 postcoital contraceptive pill was considered the triggering cause while, in the second case, the etiology was attributed to a previous infection by the SARS-Cov-2 virus. On both cases, antiplatelet treatment was initiated. In both patients the evolution was favorable, with good visual recovery.

Introduction: Within the characteristics of hypertensive glaucoma, it is distinguished by presenting elevated intraocular pressure (IOP) associated with a low ocular perfusion pressure (OPP). Changes in these parameters can be affected by systemic disease such chronic kidney disease (CKD). Likewise, there is a correlation in the prevalence of both pathologies in patients with similar characteristics, emphasizing the need to address glaucoma management in patients with CKD given the implications of the disease on ocular pathology. Furthermore, hemodialysis (HD) is the maintenance treatment for end-stage CKD, which can lead to transient increases in IOP contributing to ocular discomfort and potential glaucoma progression.

Methods: A search was conducted in PubMed and Epistemonikos databases, constructing a theoretical framework based on primary studies and similar case reports. Additionally, two cases of patients with CKD with severe ocular pain during HD are presented, compiling data from electronic medical records, including demographic data, clinical presentations, treatments, and post-treatment outcomes.

Results: Both patients received cyclodestructive treatment for symptomatic hypertensive glaucoma episodes during HD, showing favourable clinical outcomes after treatment, both in controlling IOP elevation and relieving ocular pain during hemodialysis sessions.

Discussion: This review sheds light on a relatively underexplored aspect of glaucoma treatment in CKD patients on HD, where cyclodiode laser therapy appears to be a promising option in cases where there is no recoverable visual acuity. However, since the evidence is still emerging, future prospective comparative studies are needed to provide further information to clinical practice.