Enrique España-Gregori

Relationship among corneal biomechanics, refractive error, and axial length.

Purpose To evaluate the relationship between different ocular and corneal biomechanical parameters in emmetropic and ametropic healthy white children. Methods This study included 293 eyes of 293 healthy Spanish children (135 boys and 158 girls), ranging in age from 6 to 17 years. Subjects were divided according to the refractive error: control (emmetropia, 99 children), myopia (100 children), and hyperopia (94 children) groups. In all cases, corneal hysteresis (CH) and corneal resistance factor (CRF) were evaluated with the Ocular Response Analyzer system. Axial length (AL) and mean corneal power were also measured by partial coherence interferometry (IOLMaster), and central corneal thickness (CCT) and anterior chamber depth were measured by anterior segment optical coherence tomography (Visante). Results Mean (±SD) CH and CRF were 12.12 (±1.71) and 12.30 (±1.89) mm Hg, respectively. Mean (±SD) CCT was 542.68 (±37.20) &mgr;m and mean (±SD) spherical equivalent was +0.14 (±3.41) diopters. A positive correlation was found between CH and CRF (p < 0.001), and both correlated as well with CCT (p < 0.0001). Corneal resistance factor was found to decrease with increasing age (p = 0.01). Lower levels of CH were associated with longer AL and more myopia (p < 0.001 and p = 0.001, respectively). Higher values of CH were associated with increasing hyperopia. Significant differences in CH were found between emmetropic and myopic groups (p < 0.001) and between myopic and hyperopic groups (p = 0.011). There were also significant differences in CRF between emmetropic and myopic groups (p = 0.02). Multiple linear regression analysis showed that lower CH and CRF significantly associated with thinner CCT, longer AL, and flatter corneal curvature. Conclusions The Ocular Response Analyzer corneal biomechanical properties seem to be compromised in myopia from an early age, especially in high myopia.

Branch retinal vein occlusion during fingolimod treatment in a patient with multiple sclerosis.

F ingolimod (FTY720; Novartis) is a new oral drug that acts as a superagonist of the sphingosine-1-phosphate-1 receptor on thymocytes and lymphocytes, sequestering these cells in lymph nodes (1). This medication has been shown to be effective in the management of multiple sclerosis (2,3). The most frequent adverse events reported with fingolimod are nasopharyngitis, influenza, and headache, but cases of arterial vasospasm (4) and reversible cystoid macular edema (5) have also been described. A 47-year-old woman with a 9-year history of multiple sclerosis, who had been treated with fingolimod for the past 6 years, complained of sudden visual loss in her left eye. Visual acuity was 20/20 in the right eye and 20/40 in the left eye. Anterior segment evaluation was unremarkable. The right fundus was normal while a superotemporal branch retinal vein occlusion was noted in the left eye (Fig. 1). Spectral-domain optical coherence tomography (SD-OCT) revealed the presence of intraretinal cystic changes and thickening of the superior nasal macula with foveal involvement (Fig. 2A). The central foveal thickness measured 396 mm. Fluorescein angiography showed the blocking effect of the intraretinal hemorrhages and an area of delayed choroidal filling (Fig. 2B). There was no evidence of retinal vasculitis. Fingolimod was discontinued, and an intravitreal injection of ranibizumab (Lucentis; Novartis) was administered. A thorough evaluation for a coagulation FIG. 1. Left fundus showing a superotemporal branch retinal vein occlusion.

Corneal Biomechanics, Retinal Nerve Fiber Layer, and Optic Disc in Children

Purpose To evaluate the possible associations between corneal biomechanical parameters, optic disc morphology, and retinal nerve fiber layer (RNFL) thickness in healthy white Spanish children. Methods This cross-sectional study included 100 myopic children and 99 emmetropic children as a control group, ranging in age from 6 to 17 years. The Ocular Response Analyzer was used to measure corneal hysteresis (CH) and corneal resistance factor. The optic disc morphology and RNFL thickness were assessed using posterior segment optical coherence tomography (Cirrus HD-OCT). The axial length was measured using an IOLMaster, whereas the central corneal thickness was measured by anterior segment optical coherence tomography (Visante OCT). Results The mean (±SD) age and spherical equivalent were 12.11 (±2.76) years and −3.32 (±2.32) diopters for the myopic group and 11.88 (±2.97) years and +0.34 (±0.41) diopters for the emmetropic group. In a multivariable mixed-model analysis in myopic children, the average RNFL thickness and rim area correlated positively with CH (p = 0.007 and p = 0.001, respectively), whereas the average cup-to-disc area ratio correlated negatively with CH (p = 0.01). We did not observe correlation between RNFL thickness and axial length (p = 0.05). Corneal resistance factor was only positively correlated with the rim area (p = 0.001). The central corneal thickness did not correlate with the optic nerve parameters or with RNFL thickness. These associations were not found in the emmetropic group (p > 0.05 for all). Conclusions The corneal biomechanics characterized with the Ocular Response Analyzer system are correlated with the optic disc profile and RNFL thickness in myopic children. Low CH values may indicate a reduction in the viscous dampening properties of the cornea and the sclera, especially in myopic children.

Successful boric acid treatment of Aspergillus niger infection in an exenterated orbit.

Aspergillus niger infection of an exenterated orbit is a very rare occurrence. Treatment includes extensive surgical debridement with socket lavage with 0.6% hydrogen peroxide, oral itraconazole, and local amphotericin B. We describe a case of A. niger infection in an exenterated orbit, unresponsive to local amphotericin B, that was successfully treated with weekly boric acid irrigation. We conclude that local and conservative therapy with 2.5% boric acid solution in 70% ethanol is a useful option in the management of these cases.

Dacriocistitis por Candida Lusitaniae

espanolCaso clinico: Se presenta el caso de una mujer de 60 anos con episodios recurrentes de dacriocistitis aguda derecha que no cedian con tratamiento medico ni tras una dacriocistorrinostomia con intubacion bicanalicular. Presento tambien una dacriocistitis izquierda que requirio una dacriocistorrinostomia. Se tomaron muestras intraoperatorias y en el cultivo aparecio Candida Lusitaniae como germen responsable. Tras tratamiento topico con Anfotericina B, asociado a dacriocistorrinostomia, la clinica desaparecio. Discusion: La dacriocistitis por Candida Lusitaniae es muy rara. Cabria preguntarse si Candida Lusitaniae es el germen primario o la dacriocistitis podria ser por sobreinfeccion fungica debido al tratamiento antibiotico de las distintas dacriocistitis agudas sufridas. EnglishCase report: We report the case of a 60-year-old woman with recurrent dacryocystitis of the right lacrimal sac. She did not recover after medical treatment, nor after dacryocystorhinostomy with canalicular intubation. She also had dacryocystitis on the left side. The material that was obtained during surgery was grown in a culture medium and Candida Lusitaniae was identified as the responsible organism. All symptoms disappeared after topical treatment with amphotericin B and dacryocystorhinostomy. Discussion: Dacryocystitis caused by Candida Lusitaniae is very rare. We should always consider whether Candida Lusitaniae is responsible for the primary infection or is the agent resulting from a superadded infection caused by previous antibiotic therapy.

Corneo-scleral contact lens in a piggyback system for keratoconus: A case report

PURPOSE We describe a case of fitting a corneo-scleral contact lens with a multi-aspheric geometry design (MAGD CScL) on top of a daily silicone hydrogel lens (piggyback system) for keratoconus management. METHODS A 48-year-old man using soft toric contact lenses required an improvement in the unsatisfactory quality of his vision. He presented with bilateral asymmetric keratoconus with high myopia in the right eye (RE) and severe myopia in the left eye (LE). In addition, he had low vision in his LE because of a maculopathy. He was fitted with MAGD CScL to correct his irregular astigmatism. A diagnostic trial set was used in the fitting process and the patient was assessed according to a standardised fitting methodology. Visual acuity, corneal topography and contrast sensitivity were evaluated. The follow-up period was 1year. RESULTS The best spectacle-corrected visual acuity was 0.5 logMAR for the RE with -10 D/-5 D×60° and 2 logMAR for the LE with -20 D/-3 D×105°. After fitting MAGD CScL, visual acuity improved significantly to 0.1 logMAR for the RE and 1.3 logMAR for the LE, as well as contrast sensitivity. The fitting parameters of the base curve, diameter, and power were 7.05mm, 12.60mm, -18.50 D and 7.15mm, 12.60mm, -19 D for the RE and LE, respectively. Optimal fitting characteristics were found in terms of lens position and lens movement. To increase the time of MAGD CScL wear, they piggybacked on daily silicone hydrogel lenses of low power (-0.5 D). The patient reported being comfortable with this piggyback system for approximately 15h a day. After 1year of using the piggyback system, visual quality and wearing time were maintained. In addition, no adverse ocular effects were found during this period. CONCLUSION This case report shows that in this patient a MAGD CScL could be fitted successfully on a daily silicone hydrogel lens in a piggyback system for keratoconus management, providing good visual quality along with prolonged use times and without adverse effects on the cornea.

Blefaritis asociada al tratamiento con Cetuximab en adenocarcinoma colorrectal avanzado

espanolCaso clinico: Mujer de 52 anos diagnosticada de adenocarcinoma colorrectal, remitida a nuestro servicio por presentar tras iniciar tratamiento con Cetuximab reaccion adversa palpebral. Discusion: El Cetuximab es un anticuerpo monoclonal cuya diana es el receptor del factor de crecimiento epidermico. Ha sido incorporado recientemente al tratamiento de tumores, principalmente el cancer colorrectal metastatico y los tumores del area otorrinolaringologica. Su tolerancia es en principio mejor que la de los agentes quimioterapicos clasicos. Sin embargo, no esta exento de efectos secundarios. La toxicidad palpebral asociada a Cetuximab ha sido recientemente descrita, por lo que la patogenia no esta establecida claramente. EnglishCase report: A 52-year-old woman with advanced colorectal cancer was referred to us for treatment of Cetuximab-related ocular side-effects. Discussion: Cetuximab is a monoclonal antibody that specifically blocks epidermal growth factor receptor activity. It has recently been approved to treat some tumors such as metastatic colorectal cancer and some ORL cancers. Tolerance to it seems to be better than that to the classic chemotherapeutic agents. However it has several side-effects. Cetuximab-related eyelid toxicity has been recently described, though the pathogenesis has not yet been clearly established.

Granuloma piógeno en tapones lagrimales smart plug

espanolCaso clinico: Mujer de 65 anos, diagnosticada de ojo seco, acude por aparicion de tumoracion en canto interno con sensacion de cuerpo extrano. Tres anos antes se le habian implantado tapones lagrimales SmartPlug en ambos puntos lagrimales inferiores. Se aprecio un granuloma en el punto lagrimal inferior izquierdo que se extirpo. Dos semanas despues presento una recidiva lo que obligo a extraer el implante quedandose desde entonces asintomatica. Discusion: Estamos ante un granuloma piogeno en un implante punctal SMART PLUG, complicacion descrita clasicamente con los implantes de silicona, debido posiblemente a la irritacion cronica de los detritus acumulados. Esta complicacion obliga a extraer los tapones. EnglishCase report: We report the case of a 65-year-old woman with dry eye syndrome who was referred because of a red mass in the internal left canthus. Three years previously two Smart Plugs had been introduced into both lacrimal punctums of that eye. We diagnosed a pyogenic granuloma and removed it. Two weeks later a new granuloma developed so both the granuloma and the punctal plug were removed. The patient became asymptomatic following this latter procedure. Discussion: A pyogenic granuloma in a Smart Plug punctum is described. This rare complication is generally associated with the use of silicone punctal plugs, being possibly caused by the chronic irritation of the accumulated detritus and necessitating removal of the plug.

Optical Coherence Tomography Characterization of Macular Changes Secondary to Arteriovenous Fistula

ABSTRACT Arteriovenous fistulas (AVFs) are abnormal shunts between the arterial and venous vascular systems. These usually produce ocular pain, increased intraocular pressure (IOP), and diplopia. Less frequently, they may cause retinal changes with visual impairment. Our purpose is to illustrate different retinal manifestations of AVF. We report the multimodal imaging study of three cases with retinal changes due to AVF, showing neurosensory retinal detachment, macular oedema, and macular ischemia. In conclusion, AVF may appear with different ophthalmic alterations. While usually increased IOP and diplopia are our main concerns, retinal study is mandatory, since a myriad of morphologic abnormalities might be present.

Variations of OCT measurements corrected for the magnification effect according to axial length and refractive error in children

Purpose: The aim of this paper was to examine the distribution of macular, retinal nerve fiber layer (RNFL) thickness and optic disc parameters of myopic and hyperopic eyes in comparison with emmetropic control eyes and to investigate their variation according to axial length (AL) and spherical equivalent (SE) in healthy children. Methods: This study included 293 pairs of eyes of 293 children (145 boys and 148 girls), ranging in age from 6 to 17 years. Subjects were divided according to SE in control (emmetropia, 99 children), myopia (100 children) and hyperopia (94 children) groups and according to axial AL in 68 short ( 25.00mm, 36). Macular parameters, RNFL thickness and optic disc morphology were assessed by the CirrusTM HD-OCT. AL was measured using the IOL-Master system. Littmann’s formula was used for calculating the corrected AL-related ocular magnification. Results: Mean age (±SD) was 10.84±3.05 years; mean (±SD) SE was +0.14±0.51 D (range from −8.75 to +8.25 D) and mean AL (±SD) was 23.12±1.49. Average RNFL thickness, average macular thickness and macular volume decreased as AL and myopia increased. No correlations between AL/SE and optic disc parameters were found after correcting for magnification effect. Conclusions: AL and refractive error affect measurements of macular and RNFL thickness in healthy children. To make a correct interpretation of OCT measurements, ocular magnification effect should be taken into account by clinicians or OCT manufacturers.