Laura Gil-Arribas

Retinal and Optic Nerve Degeneration in Patients with Multiple Sclerosis Followed up for 5 Years

PURPOSE To quantify retinal nerve fiber layer (RNFL) changes in patients with multiple sclerosis (MS) and healthy controls with a 5-year follow-up and to analyze correlations between disability progression and RNFL degeneration. DESIGN Observational and longitudinal study. PARTICIPANTS One hundred patients with relapsing-remitting MS and 50 healthy controls. METHODS All participants underwent a complete ophthalmic and electrophysiologic exploration and were re-evaluated annually for 5 years. MAIN OUTCOME MEASURES Visual acuity (Snellen chart), color vision (Ishihara pseudoisochromatic plates), visual field examination, optical coherence tomography (OCT), scanning laser polarimetry (SLP), and visual evoked potentials. Expanded Disability Status Scale (EDSS) scores, disease duration, treatments, prior optic neuritis episodes, and quality of life (QOL; based on the 54-item Multiple Sclerosis Quality of Life Scale score). RESULTS Optical coherence tomography (OCT) revealed changes in all RNFL thicknesses in both groups. In the MS group, changes were detected in average thickness and in the mean deviation using the GDx-VCC nerve fiber analyzer (Laser Diagnostic Technologies, San Diego, CA) and in the P100 latency of visual evoked potentials; no changes were detected in visual acuity, color vision, or visual fields. Optical coherence tomography showed greater differences in the inferior and temporal RNFL thicknesses in both groups. In MS patients only, OCT revealed a moderate correlation between the increase in EDSS and temporal and superior RNFL thinning. Temporal RNFL thinning based on OCT results was correlated moderately with decreased QOL. CONCLUSIONS Multiple sclerosis patients exhibit a progressive axonal loss in the optic nerve fiber layer. Retinal nerve fiber layer thinning based on OCT results is a useful marker for assessing MS progression and correlates with increased disability and reduced QOL.

Effect of cataract surgery on optical coherence tomography measurements and repeatability in patients with non-insulin-dependent diabetes mellitus.

PURPOSE To evaluate the effect of uncomplicated cataract phacoemulsification on macular and retinal nerve fiber layer (RNFL) thickness using two spectral-domain optical coherence tomography (OCT) instruments, Cirrus OCT and Spectralis OCT, in patients having non-insulin-dependent diabetes mellitus (NIDDM) without retinopathy, and to assess the reliability of the OCT measurements before and after cataract surgery. METHODS The study included 35 eyes of 35 patients having NIDDM without retinopathy (20 men and 15 women, mean age 69.8 years, range, 48-80 years) who underwent cataract phacoemulsification. One month before and 1 month after surgery, visual acuity and three repetitions of scans using the RNFL and macular analysis protocols of the Cirrus and Spectralis OCT instruments were performed. The differences between the two visits were analyzed by Students t-test for paired samples. Repeatability of OCT measurements was evaluated by calculating the coefficients of variation for each of the parameters recorded and for each visit. RESULTS RNFL thicknesses provided by Cirrus and Spectralis OCT and macular measurements provided by Cirrus OCT differed significantly between the two visits. Macular thicknesses provided by Spectralis OCT before and after surgery were not significantly different. OCT repeatability was better after surgery with lower coefficients of variation for scans performed after surgical removal of the cataract. CONCLUSIONS The presence of cataracts affects RNFL and macular measurements performed with OCT in NIDDM patients without retinopathy. The repeatability of the images significantly improved after cataract phacoemulsification.

Influence of Cataract Surgery on Optical Coherence Tomography and Neurophysiology Measurements in Patients With Retinitis Pigmentosa

PURPOSE To evaluate the effect of uncomplicated cataract phacoemulsification on the measurements of visual evoked potentials (VEP), pattern electroretinogram (PERG), and macular and retinal nerve fiber layer (RNFL) using 2 spectral-domain optical coherence tomography (OCT) instruments, the Cirrus OCT (Carl Zeiss Meditech) and Spectralis OCT (Heidelberg Engineering), in patients with retinitis pigmentosa (RP), and to assess the reliability of the OCT measurements before and after cataract surgery. DESIGN Observational cross-sectional study. METHODS Thirty-five eyes of 35 patients with RP (20 men and 15 women, 45-66 years) who underwent cataract phacoemulsification were studied. At 1 month before and 1 month after surgery, visual acuity, VEP, PERG, and 3 repetitions of scans using the RNFL and macular analysis protocols of the Cirrus and Spectralis OCT instruments were performed. The differences in measurements between the 2 visits were analyzed. Repeatability of OCT measurements was evaluated by calculating the coefficients of variation. RESULTS VEP amplitude, RNFL thicknesses provided by Cirrus and Spectralis, and macular measurements provided by Cirrus OCT differed between the 2 visits. VEP latency, PERG measurements, and macular thicknesses provided by the Spectralis OCT before surgery did not differ significantly from those after surgery. The OCT repeatability was better after surgery, with lower coefficients of variation for scans performed after surgical removal of the cataract. The nuclear, cortical, and posterior subcapsular types of cataracts did not show different repeatability. CONCLUSIONS The presence of cataracts affects VEP amplitude, RNFL, and macular measurements performed with OCT in eyes with RP. Image repeatability significantly improves after cataract phacoemulsification.

Retinal and Optic Disc Alterations in Alzheimers Disease: the Eye as aPotential Central Nervous System Window

Pathologic changes in the retina and optic nerve are observed in patients with Alzheimer´s disease (AD), even in early stages of the dementia. In our clinical ophthalmology practice, we use optical coherence tomography (OCT), a noninvasive, rapid, objective, and reliable technology that enables for quantification of the retinal nerve fiber layer (RNFL), namely the retinal ganglion cell axons that eventually form the optic nerve. The opportunity to analyze a part of the central nervous system by such a simple exploration led to several studies demonstrating thinning of the RNFL and central retina in AD patients compared with healthy subjects. Here we present some of our investigations in AD patients using Spectral Domain-OCT. Our results suggest that axonal loss secondary to pathologic alterations in the brains of AD patients can be observed by OCT. We also analyzed the association between retinal and RNFL thicknesses and neurologic characteristics, disease duration and severity, and found that mean RNFL thickness was significantly correlated with disease duration, indicating that the progression of AD is associated with a progressive loss of ganglion cells.

Anestesia tópica de contacto para cirugía de estrabismo

OBJECTIVE To analyze the effectiveness and usefulness of contact topical anesthesia in strabismus surgery in adult patients. MATERIAL AND METHODS A prospective study was conducted on 20 patients undergoing strabismus surgery using contact topical anesthesia and sedation with remifentanil. The intensity of pain was recorded using a numeric pain rating scale at the time of anesthesia implementation, during the surgical procedure, 30 min afterwards, and during the first postoperative day. The incidence of oculocardiac reflex, postoperative nausea and vomiting, corneal ulcers, patient satisfaction (numerically from 0 to 10) and the degree of residual ocular deviation were also assessed. RESULTS The operation was performed successfully in all patients. Average pain intensity was 1.40 ± 1.73 during anesthesia implementation, 4.20 ± 2.57 during the surgical procedure, 2.50 ± 2.54 30 min after surgery, and 3.55 ± 2.89 during the first postoperative day. Oculocardiac reflex was observed in 7 patients (35%), postoperative nausea and vomiting in 4 (20%), and corneal ulcer in 4 (20%). The patient satisfaction was 9.53 ± 2.51. More than two-thirds (70%) of patients had a residual ocular deviation less than 10 prism diopters. CONCLUSIONS Contact topical anesthesia is a safe and effective alternative for strabismus surgery in adult patients. Contact topical anesthesia provides adequate pain control, lower incidence of postoperative nausea and vomiting and oculocardiac reflex, and optimal setting of ocular alignment.