Valentín Huerva

Short-term mitomycin C followed by long-term interferon α2β for conjunctiva-cornea intraepithelial neoplasia

Purpose: To report a case of extensive conjunctiva-cornea intraepithelial neoplasia (CIN) treated topically with mitomycin C (MMC) and interferon (INF)-α2β without surgical resection. Methods: Case report. Results: An 82-year-old woman showed an extensive gelatinous red mass in the bulbar conjunctiva with invasion into the caruncle, inferior fornix, and tarsal conjunctiva and extending for 270° of the corneal surface. A diagnosis of CIN was made by surgical biopsy. Surgical excision with safety margins carried the risk of limbal stem cell depletion. A conservative treatment strategy was used with 2 cycles of topical MMC (0.02%), followed by INF-α2β eye drops at a dose of 1 million IU/mL, 4 times a day until tumor disappearance. Total resolution was noted after 75 days of treatment with INF, with no clinical evidence of limbal stem cell deficiency. After 1 year of monitoring, no signs of CIN recurrences were observed. Conclusion: MMC (0.02%), followed by INF-α2β (1 million IU/mL) 4 times a day, is an effective treatment against highly extensive CIN, in cases where surgical resection with safety margins is unfeasible.

Assessment of Corneal Biomechanical Properties and Intraocular Pressure in Myopic Spanish Healthy Population

Purpose. To examine biomechanical parameters of the cornea in myopic eyes and their relationship with the degree of myopia in a western healthy population. Methods. Corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann correlated intraocular pressure (IOP), and corneal compensated IOP (IOPcc) were measured using the ocular response analyzer (ORA) in 312 eyes of 177 Spanish subjects aged between 20 and 56 years. Refraction was expressed as spherical equivalent (SE), which ranged from 0 to −16.50 diopters (D) (mean: −3.88 ± 2.90 D). Subjects were divided into four groups according to their refractive status: group 1 or control group: emmetropia (−0.50 ≤ SE < 0.50); group 2: low myopia (−0.75 ≤ SE < 3.00 D); group 3: moderate myopia (−3.00 ≤ SE ≤ −6.00 D); and group 3: high myopia (SE greater than −6.00 D). We analyzed the relationship between corneal biomechanics measured with ORA and SE. Results. CH in the emmetropia, low myopia, moderate myopia, and high myopia groups was 11.13 ± 0.98, 11.49 ± 1.25, 10.52 ± 1.54, and 10.35 ± 1.33 mmHg, respectively. CH in the highly myopic group was significantly lower than that in the emmetropic group (P = 0.07) and low myopic group (P = 0.035); however, there were no differences with the moderate myopic group (P = 0.872). There were no statistically significant differences regarding IOP among the four groups (P > 0.05); nevertheless, IOPcc was significantly higher in the moderately myopic (15.47 ± 2.47 mmHg) and highly myopic (16.14 ± 2.59 mmHg) groups than in the emmetropia (15.15 ± 2.06 mmHg) and low myopia groups (14.53 ± 2.37 mmHg). No correlation between age and the measured parameters was found. CH and IOPcc were weakly but significantly correlated with SE (r = 0.171, P = 0.002 and r = −0.131, P = 0.021, resp.). Conclusions. Present study showed only a very weak, but significant, correlation between CH and refractive error, with CH being lower in both moderately and highly myopic eyes than that in the emmetropic and low myopic eyes. These changes in biomechanical properties of the cornea may have an impact on IOP measurement, increasing the risk of glaucoma.

The Role of Inflammation in the Pathogenesis of Macular Edema Secondary to Retinal Vascular Diseases

Macular edema (ME) is a nonspecific sign of numerous retinal vascular diseases. This paper is an updated overview about the role of inflammatory processes in the genesis of both diabetic macular edema (DME) and ME secondary to retinal vein occlusion (RVO). We focus on the inflammatory mediators implicated, the effect of the different intravitreal therapies, the recruitment of leukocytes mediated by adhesion molecules, and the role of retinal Müller glial (RMG) cells.

The relationship between floppy eyelid syndrome and obstructive sleep apnoea

Purpose To determine the prevalence of eyelid hyperlaxity and floppy eyelid syndrome (FES) in obstructive sleep apnoea (OSA), and the presence of OSA in FES. Participants One-hundred and fourteen patients who had been consecutively admitted for OSA evaluation and 45 patients with FES in which sleep studies were recorded. Methods Subjects underwent eyelid laxity measurement, slit-lamp examination and polysomnography. Results Eighty-nine patients were diagnosed of OSA. Fourteen patients with OSA had FES (16%) and 54/89 (60.67%) had eyelid hyperlaxity. Two of the 25 non-OSA patients had FES (8%) and 8 of 25 (32%) had eyelid hyperlaxity. There was a significantly higher incidence of eyelid hyperlaxity in OSA than in non-OSA patients (p=0.004). Thirty-eight of the 45 patients with FES were diagnosed of OSA (85%) and 65% had severe OSA. Conclusions OSA might be an independent risk factor for eyelid hyperlaxity and severe OSA is common in patients with FES.

Comparison of anterior segment measurements with optical low-coherence reflectometry and rotating dual Scheimpflug analysis

Purpose To compare the anterior segment measurements obtained with optical low‐coherence reflectometry (OLCR) (Lenstar LS 900, version 2.1.1) and rotating dual Scheimpflug analysis (Galilei G1, version 3). Setting Private practice, Policlinic Lleida, Lleida, Spain. Design Prospective comparative observational study. Methods The following measurements were performed in patients requiring a preoperative study for a refractive procedure or cataract surgery and healthy volunteers from the clinic’s staff: central corneal thickness (CCT), anterior chamber depth (ACD), horizontal limbal distance (white‐to‐white distance [WTW]), pupil diameter, keratometry (K) readings at the steepest meridian (steep K) and the flattest meridian (flat K), corneal astigmatism power, and plus astigmatic cylinder. Measurements were taken using the OLCR device and rotating dual Scheimpflug analyzer. The main outcome measure was the degree of agreement between steep K, flat K, astigmatism power, cylinder axis, CCT, ACD, WTW, and pupil diameter measurements. Results The study enrolled 100 eyes of 100 subjects. Steep K, flat K, corneal astigmatism power, cylinder axis, and WTW measurements with the OLCR device and Scheimpflug analyzer showed narrow 95% limits of agreement (LoA), which implies good agreement (P > .05, Bland‐Altman plot analysis). In contrast, the range and 95% LoA for CCT, ACD, and pupil diameter values were statistically significantly different (P<.05, Bland‐Altman plot analysis). Conclusion In clinical practice, the OLCR device and the rotating dual Scheimpflug analyzer system can be used interchangeably for WTW measurements and K readings but not for CCT, ACD, and pupil diameter values. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

Isolated medial rectus muscle rupture after a traffic accident

A 30-year-old male suffered an orbital trauma due to a traffic accident. At the Emergency Unit, the patient presented with avulsion of the upper left eyelid in the medial canthus, wounds in the lower eyelid and the inferior canaliculus, conjunctival laceration, proptosis and palpebral hematomas. The patient reported persistent diplopia. During the examination, exotropia and total absence of adduction were observed. Computerized tomography (CT) revealed a discontinuity at the left medial rectus. No orbital fractures were identifiable. The medial rectus was still attached to its anatomic insertion at the globe. The discontinuity was suggestive of laceration or rupture of this muscle at approximately 10–12 mm from its insertion. Surgical exploration revealed total rupture of the medial rectus at approximately 12 mm from its insertion. The posterior edge of the damaged muscle was found and sutured to its anterior edge with 6-0 polyglactin. The following day, the eyes were completely straight and the patient did not mention any signs of diplopia. Botulinum toxin injection into the ipsilateral lateral rectus was not necessary. After six months of follow-up, the patient still reported no diplopia. When muscular laceration is suspected after an orbital trauma, early CT is recommended. The only procedures that assure a significant recovery of the normal function of the eye are early muscle repair and avoidance, if possible, of transposition surgery.

Pterygium surgery by means of conjunctival autograft: long term follow-up

PURPOSE To demonstrate the long term of follow-up of the recurrence rate after conjunctival autograft for pterygium surgery. METHODS A total of 112 patients operated for pterygium with conjunctival autografts and with more than one year follow-up were registered. Patients were called for voluntary examinations of their respective ocular surface statuses. Completing the study was only possible in 44 cases. Seven had bilateral pterygium. (N=51 operated pterygium). RESULTS The mean follow-up time was 49.06 months. In 29.45% of the cases, attachment was performed using non-absorbable sutures (nylon 10/0), while fibrin glue was used in 70.55% of the cases. Six cases of recurrence (11.76%) were found. The recurrence rate between primary and recurrent pterygium, and between sutures and fibrin glue proved to be not statistically significant; p>0.05. There were no significant differences between women and men with respect to recurrence. The median of age in the recurrence group was 40 years old, in contrast to 55 in the non-recurrence group; p=0.01517. All of these recurrences were associated with patients of Hispanic origins (from Latin America); p=0.001506. CONCLUSIONS After a long follow-up period after autograft pterygium surgery, there were no statistically significant differences in recurrence rates for the application of sutures as opposed to fibrin glue; similarly, there were no statistically significant differences between the use of autograft in primary and recurrent pterygium. The greatest risk factors for recurrence were young age and Hispanic ethnicity.

Noonan's syndrome with keratoconus and optic disc coloboma

We report the case of a 14-year-old girl with multiple findings characteristic of Noonans syndrome, including short stature, mild mental retardation, facial, skeletal and renal abnormalities. In addition, ophthalmic examination revealed a keratoconus in the left eye and a right optic disc coloboma. To date, only two cases of Noonans syndrome with keratoconus have been reported, and this is the second case of this syndrome with optic disc coloboma. To our knowledge, this is the first report of Noonans syndrome associated with unilateral keratoconus and contralateral optic disc coloboma. In view of the large number of patients with Noonans syndrome reported to date and the rarity of these ocular abnormalities, it is most likely that this association is fortuitous. Ocular findings reported in patients with Noonans syndrome are reviewed.

Floppy eyelid syndrome in obstructive sleep apnea syndrome

This section is intended to tap into a relatively unique feature of sleep science: images with great educational and conceptual content (e.g., electroencephalograms, electromyograms, polysomnograms, portable devices, actigrams, scans including functional images, pathology specimens, brain slice preparations, fluorescent microscopy and other cutting edge techniques). Please see our web site’s (http://ees.elsevier.com/sleep/) Guide for Authors for instructions. We hope this section will be enriched by the contributions of our colleagues who wish to offer stimulating opportunities for discussion and new insights into the field of sleep.

The “Flying Saucer” Sign on Spectral Domain Optical Coherence Tomography in Chloroquine Retinopathy

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