Jc Pastor Jimeno

Role of the intraocular irrigating solutions in the pathogenesis of the postvitrectomy retinal edema

Alterations in the vitreo-retinal barrier can modify the exchange of water taking place between the retina and the vitreous body and cause retinal edema to develop. To verify this fact, albino rabbits were subjected to vitrectomies perfusing various intraocular irrigating solutions for various durations. The following conclusions were drawn from these experiments: Ringers Lactate and physiological saline solutions are more edematogenous than BSS plus; the induced edema is more severe, the longer the perfusion.We have also confirmed that this edema is inhibited by topically administered indomethacin, which proves that in the rupture of blood-retinal barriers during the vitrectomy, prostaglandins play an important role.

Complicaciones corneales epiteliales de las vitrectomías: estudio retrospectivo

espanolObjetivo: Establecer la incidencia de las alteraciones corneales epiteliales, su evolucion y el resultado funcional final en una serie de vitrectomias realizadas durante un ano. Metodos: Se han revisado de forma retrospectiva 195 vitrectomias consecutivas realizadas en 2001. Los pacientes fueron evaluados al dia siguiente de la intervencion, en la primera semana del postoperatorio y semanalmente hasta completar 3 meses. Los resultados funcionales se han establecido al termino de ese periodo. Resultados: Del total de 195 ojos, 12 (6,1%) desarrollaron complicaciones corneales epiteliales tras la cirugia: 8 (4,1%) un defecto epitelial persistente y 4 (2%) fueron diagnosticados de queratitis herpetica necrotizante. De estos 12 pacientes 6 eran diabeticos, en los que las alteraciones corneales supusieron el 10,5% frente al 4,3% en no diabeticos (p=0,10). La mayoria de los defectos epiteliales persistentes curaron sin secuelas en un tiempo inferior a 2 meses. Todas las queratitis herpeticas dejaron como secuela un leucoma corneal y tardaron entre 3 y 4 meses en curar. Conclusiones: Los defectos epiteliales persistentes tras una vitrectomia son relativamente frecuentes, y afectan con mas frecuencia a los diabeticos. Pero ademas hay que descartar la recidiva de una infeccion herpetica, que puede cursar en forma de queratitis necrotizante. Esta relacion no ha sido descrita anteriormente y necesita un estudio mas extenso. EnglishPurpose: To establish the incidence, evolution and final visual outcome of corneal epithelial complications after vitrectomy in a consecutive series performed throughout a period of one year. Methods: 195 consecutive medical records of patients vitrectomized in 2001 have been retrospectively reviewed. Patients were clinically evaluated the day after vitrectomy, during the first week, and then weekly for 3 months (minimum follow-up). Functional results have been established at the end of this period. Results: 12 out of 195 eyes developed corneal epithelial complications after surgery (6.1%). Eight cases were diagnosed of persistent epithelial defect (4.1%), and four cases (2%) of necrotizing herpetic keratitis. Six out of 12 were diabetic. Corneal epithelial complications affected 10.5% of diabetic and 4.3% of non-diabetic patients (p=0.10). The majority of persistent epithelial defects healed without sequelae in less than two months. Herpetic keratitis required between 3 to 4 months to heal and caused corneal scarring in all cases. Conclusions: Persistent corneal epithelial defects after vitrectomy are a relatively frequent complication, mainly in diabetic patients. Recurrence of herpetic keratitis must also be kept in mind. This finding has not been previously reported and needs further studies.

Melanocitoma de cuerpo ciliar sintomático: glaucoma melanocitomalítico

espanolCaso Clinico: Mujer de 33 anos de edad con masa pigmentada, asintomatica en angulo iridocorneal de ojo derecho originada en cuerpo ciliar. Diagnostico de sospecha de melanocitoma de cuerpo ciliar se decidio observacion. Despues de 36 meses de seguimiento presenta dolor, reaccion inflamatoria y aumento incontrolable de presion intraocular que se diagnostica de glaucoma melanocitomalitico. Se realiza escision del tumor mediante iridociclectomia «ab-externo» y el estudio histopatologico demostro melanocitoma necrotico. Discusion: El melanocitoma de cuerpo ciliar es un tumor pigmentado benigno, poco frecuente que puede presentar extension a camara anterior. El diagnostico diferencial se realiza fundamentalmente con melanoma de cuerpo ciliar, que implica un diferente tratamiento y pronostico. EnglishA 33 year-old female with an asymptomatic pigmented mass in the iridocorneal angle of her right eye, arising from the ciliary body is presented. Ciliary body melanocytoma was suspected and conservative management recommended. After 36 months of follow-up the patient developed pain, inflammatory reaction and uncontrollable ocular hypertension, which was diagnosed as melanocytomalytic glaucoma. Tumor was removed by external iridecyclectomy and the histopathologic findings revealed necrotic melanocytoma. Discussion: Ciliary body melanocytoma is a rare benign pigmented tumor that may present extension to the anterior chamber. Differential diagnosis mainly includes ciliary body melanoma, which carries a different prognosis and treatment.

Roturas retinianas iatrogénicas en las vitrectomías: estudio retrospectivo

espanolObjetivo: Establecer la incidencia y las caracteristicas de las roturas retinianas iatrogenicas que se han producido en vitrectomias y proponer un protocolo de actuacion. Metodos: Se han revisado de forma retrospectiva 195 vitrectomias consecutivas realizadas en 2001. El seguimiento minimo de todos los casos ha sido de 3 meses. Resultados: Se han detectado roturas retinianas en 13 pacientes (6,6%). El tipo mas frecuente han sido las roturas perifericas con 8 casos. Hubo 4 casos de roturas posteriores y una dialisis retiniana. En 4 casos se produjo mas de una rotura. En 9 casos (70%) la vitrectomia se indico por lesiones derivadas de la diabetes mellitus. La mayoria (12) fueron detectadas durante la intervencion y todas tratadas con endolaser y/o frio (3 casos de localizacion inferior). En el postoperatorio, 7 casos (54%) desarrollaron un desprendimiento de retina de los que 2 pudieron ser reaplicados. Conclusiones: De las roturas retinianas iatrogenicas producidas por la vitrectomia, los desgarros perifericos son un poco mas frecuentes que los producidos en polo posterior. Son mas frecuentes en diabeticos y tienen mal pronostico ya que evolucionan con frecuencia a un desprendimiento de retina a pesar del tratamiento con endolaser o frio. EnglishPurpose: To establish the incidence and characteristics of iatrogenic retinal breaks occurring during vitrectomy and to propose a protocol for their management. Methods: Retrospective study of 195 consecutive vitrectomies performed in 2001. Minimum follow up was 3 months for all cases. Results: 13 patients with iatrogenic retinal breaks (6.6%) have been detected. In 8 cases the breaks affected the peripheral retina, in 4 cases they were located in the posterior pole and there was one retinal dialysis. In 4 cases there were more than one retinal break. 9 patients (70%) were vitrectomized for diabetic retinal complications. In 12 cases, the breaks were detected during surgery and treated with endolaser and/or cryoretinopexy (3 cases located inferiorly). Nevertheless 7 cases (54%) developed a retinal detachment, 2 of which could be reattached. Conclusions: Among iatrogenic retinal breaks produced during vitrectomy, the peripheral ones are slightly more frequent than the breaks in the posterior pole. Iatrogenic breaks occur more frequently in diabetic patients, having a bad prognosis and often developing a retinal detachment despite endolaser or cryoretinopexy.

Estudio experimental sobre la utilidad del aceite de copolímero de silicona-fluorsilicona (SiFO) en la cirugía vitreorretiniana

espanolObjetivo: Valorar la utilidad del aceite de copolimero de silicona-fluorsilicona (SiFO) como herramienta intraoperatoria y como sustitutivo vitreo en la cirugia vitreorretiniana. Metodos: Estudio de las caracteristicas de manipulacion quirurgica del SiFO, comparandolas con las del perfluorooctano (PFO). Se ha evaluado la transparencia de ambas sustancias objetivamente mediante espectrofotometria y subjetivamente; se ha observado su tendencia a la dispersion durante la inyeccion en solucion salina balanceada (BSS) y tras agitacion mecanica y manual; y se ha valorado la facilidad de inyeccion y aspiracion a traves instrumentos de pequeno calibre. Estudio de la tolerancia ocular al SiFO, comparandolo con el PFO, mediante inyeccion intravitrea en ojos de conejo, midiendo la presion intraocular, respuesta inflamatoria del segmento anterior, tendencia a la dispersion, y estudio histopatologico a los 7 y 14 dias. Resultados: El SiFO fue mas dificil de inyectar y aspirar que el PFO debido a su mayor viscosidad. El PFO sufrio una dispersion progresiva en el interior de la cavidad vitrea desde el segundo dia tras la inyeccion, mientras que el SiFO permanecio como una burbuja unica durante los 14 dias de seguimiento. Desde el punto de vista histopatologico, las dos sustancias indujeron una reaccion inflamatoria sobre la superficie de la retina inferior, con macrofagos microvacuolados y celulas gigantes de cuerpo extrano, que fueron de mayor tamano en los ojos portadores de SiFO. Conclusiones: El SiFO podria ser util como manipulador retiniano, aunque su principal inconveniente es la mayor dificultad de inyeccion y aspiracion comparado con el PFO. Como sustitutivo vitreo a corto plazo ha sido bien tolerado, pero serian necesarios estudios clinicos mas extensos. EnglishPurpose: To evaluate the usefulness of silicone-fluorsilicone copolymer oil (SiFO) as an intraoperative tool and a vitreous substitute in vitreoretinal surgery. Methods: Handling properties of SiFO were tested and compared with those of perfluorooctane (PFO). The transparency of both substances was measured by spectrophotometry and subjectively assessed. Their tendency to dispersion was observed during injection in balanced saline solution (BSS) and after mechanized and manual shaking. Ease of injection and aspiration through small-gauge instruments was evaluated. Ocular tolerance to SiFO and PFO was studied after intravitreal injection in rabbit eyes: intraocular pressure, anterior segment inflammatory response and dispersion were evaluated, and a histopathological study was performed. Results: Injection and aspiration of SiFO were more difficult than those of PFO because of its higher viscosity. PFO dispersed progressively into small droplets as early as two days after intravitreal injection, whereas SiFO remained as a single bubble for 14 days. Histopathologically both substances induced an inflammatory response over the inferior retina, with microvacuolated macrophages and foreign body giant cells, which were larger in eyes wearing SiFO. Conclusions: SiFO may be useful as an intraoperative tool, although its main drawback is a more difficult injection and aspiration compared to PFO. It has been well tolerated as a short-term vitreous substitute, but further clinical studies are needed.

Oftalmía simpática postvitrectomía tras traumatismo y taponamiento con perfluorocarbono líquido

espanolCaso clinico: Se describe un caso de oftalmia simpatica (OS) desarrollado tras un traumatismo contuso tratado mediante vitrectomia (que se complico con una hemorragia supracoroidea masiva) y taponamiento con perfluorocarbono liquido (PFCL). Discusion: La presentacion de OS en un paciente vitrectomizado tras un traumatismo ocular contuso grave con taponamiento intra-ocular prolongado con PFCL permitiria plantear la hipotesis de que la reaccion inflamatoria cronica producida por estos compuestos podria haber colaborado en el desarrollo de la OS. Sin embargo, existen otros posibles factores causales como el propio traumatismo, la vitrectomia en si o el desprendimiento de coroides con posible incarceracion de tejido uveal en las incisiones. EnglishCase report: We report a case of sympathetic ophthalmia (SO) developed after blunt trauma and vitrectomy (complicated with a massive suprachoroidal hemorrhage) using perfluorocarbon liquid (PFCL) for tamponade. Discussion: The presentation of SO in a vitrectomized patient after severe blunt trauma with extended intra-ocular tamponade with PFCL could support the hypothesis that chronic inflammation caused by PFCL could have contributed to the development of SO. Nevertheless, there are other possible causal factors such as the trauma, the vitrectomy itself or the choroidal detachment with possible uveal incarceration at wound sites.

Puede aumentar el riesgo de oftalmía simpática el uso intraocular de aceite de silicona

espanolCasos clinicos: Se describen dos casos de oftalmia simpatica (OS) presentados entre 1.456 pacientes vitrectomizados en 10 anos, ambos portadores de aceite de silicona intraocular. Discusion: La presentacion de OS unicamente en pacientes con silicona, el mayor tiempo de latencia con respecto a la media publicada y el hallazgo anatomopatologico de una reaccion granulomatosa a cuerpo extrano en el contexto clinico de una OS inducen a pensar que la inflamacion intraocular cronica causada por la silicona podria estar implicada en el desarrollo de la OS. No obstante, se necesitan series mas largas para confirmar esta posible relacion entre aceite de silicona y OS. EnglishClinical cases: We report two cases of SO (sympathetic ophthalmia) among 1,456 vitrectomies and 255 silicone oil injections performed since 1990. In both patients intraocular silicone oil was used. Both cases were clinically documented and one pathologically demonstrated. Discussion: No cases were reported among vitrectomies without silicone oil. We found a longer delay between injury and the onset of the disease in comparison to the literature. Pathological findings confirmed a foreign body granulomatous reaction. Chronic inflammation caused by silicone oil might be involved in the development of SO. Larger series are necessary to establish a possible relationship between silicone oil and SO.