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Diabetic macular edema can occur at any stage of diabetic retinopathy. It represents the main cause of vision loss in diabetes type I and II with a prevalence of 3-10% in diabetic patients of the Instituto Mexicano del Seguro Social (IMSS). Our aim is to elaborate treatment guidelines and provide recommendations for the use of intravitreal ranibizumab for diabetic medical edema at IMSS. Nine retina specialists and 10 ophthalmologists from IMSS high specialty medical units gathered to discuss the bibliographic evidence for the safety and efficacy of ranibizumab for this disease, in order to create consensus on its use in the institution. Intravitreal ranibizumab injection should be used on patients presenting diffuse or cystic diabetic macular edema who have strict metabolic control and visual acuity between 20/30 and 20/200 ETDRS, as well as structural features, such as inferior foveal limit of 280 µm and ischemic areas no larger than 50% of the central foveal area. Treatment regime should consist of a loading charge of three monthly injections of ranibizumab 0.5 mg, followed by monthly follow-ups and treatment as needed according to anatomic and functional criteria. This consensus decision-making process on the criteria to treat and re-treat patients with this drug will result in better health outcomes than those currently observed among patients with diabetic macular edema at IMSS.

El edema macular diabético se presenta en cualquier etapa de la retinopatía diabética y representa la principal causa de pérdida de visión en las diabetes tipo I y II, con una prevalencia que va del 3 al 10% en pacientes diabéticos del Instituto Mexicano del Seguro Social (IMSS). El objetivo de este trabajo es elaborar una guía de tratamiento y recomendaciones para el uso de ranibizumab intravítreo en pacientes con edema macular diabético en el IMSS. Se llevó a cabo una reunión de expertos (9 retinólogos y 10 oftalmólogos) de las unidades médicas de alta especialidad del IMSS para realizar una revisión crítica de la eficacia y seguridad del ranibizumab para esta enfermedad y llegar a un consenso sobre el uso de este antiangiogénico en la institución. Las inyecciones de ranibizumab intravítreo se aplicarían a pacientes con edema macular diabético del tipo difuso o quístico, con un control metabólico estricto, agudeza visual en un rango de 20/30 a 20/200 ETDRS y criterios estructurales, como el límite foveal inferior a 280 µm y zonas isquémicas de no más del 50% de la zona central foveal. El esquema de tratamiento consistiría en una dosis de carga de tres inyecciones mensuales de ranibizumab de 0.5 mg y posteriormente seguimiento mensual y tratamiento por razón necesaria según criterios anatómicos y funcionales. El consenso sobre los criterios de tratamiento y retratamiento con este medicamento garantizará mejores resultados clínicos en pacientes con edema macular diabético en el IMSS.

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BACKGROUND: The management of orbitary fractures is one of the most challenging in facial trauma; the variety of reconstruction materials for its treatment is broad and is constantly improving, but despite this there is no consensus for its use or literature that sustains it. OBJECTIVE: To present the use and design of a preformed bone implant as an alternative for the reconstruction of orbital floor fractures in the pediatric age group. CLINICAL CASE: A 7-year old male who suffered a right hemifacial contusion trauma with clinical and tomographic diagnosis of right pure blowout type orbital floor fracture with inferior rectus muscle entrapment and right post-traumatic palpebral ptosis. Successful surgical reconstruction was performed 7 days later with a pre-constructed bone cement implant. Eight weeks after surgery the patient presented with mild residual palpebral ptosis, no ocular movement limitations and no diplopia. CONCLUSIONS: The use of a bone cement implant can be considered appropriate for the reconstruction of these fractures, as another alternative to be used by the ophthalmologist among the variety of all the other materials used for this purpose. We consider that our optimism based on the results obtained in this case obligates us to increase the number of patients treated in order to gather more evidence and do larger follow up.

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OBJECTIVE: To assess whether preretinal hemorrhage (PRH) is associated with the presence and severity of retinopathy of prematurity (ROP) in high-risk patients. METHOD: Prospective cohort study, patients referred to the Department of Ophthalmology for ROP screening during October-November 2016 were evaluated weekly on 4 occasions to assess the relationship with PRH and the development of ROP as well as degree of severity associated. We used absolute, median frequencies with minimum and maximum values, χ2 test and Mann-Whitney U-test, as well as relative risk with 95% confidence interval. RESULTS: A total of 30 patients, in the first week 11 females (36%) and 4 males (13%) had PRH; in the 2nd week 13 patients (43%) presented PRH and 14 (46%) developed ROP; on the 3rd week there were no changes; in the last week 8 presented HPR (26%) and 11 patients (36%) with ROP. Stage I severity occurred more frequently. Statistical significance (p = 0.040) was found in the presence of PRH and the development of ROP in the first week with. CONCLUSIONS: HPR is a risk factor for the development of ROP during the first weeks of life and is associated with stages of mild severity.

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OBJECTIVE: To evaluate the effectiveness of trabeculectomy trabeculotomy in the reduction of intraocular pressure in patients with primary congenital glaucoma. MATERIAL AND METHODS: A pre-experimental before and after study was conducted with several measurements after; patients with intraocular pressure≥21 mmHg were included, of both sexes, and children under six years, which had ​​the trabeculotomy trabeculectomy. Success was defined as the reduction of intraocular pressure<21 mmHg within three months after the procedure. For the descriptive analysis, medians with ranges and quartiles 25 and 75 were used. For the inferential analysis, we conducted a visual graphic and analysis of variance for repeated measures of Friedman. A value of p<0.05 was considered as significant. The software used was SPSSv15. RESULTS: 16 eyes were included with intraocular pressure 27.75 mmHg (23-40), vertical and horizontal corneal diameter of 14 mm (12-16), who had undergone trabeculectomy with mitomycin C trabeculectomy; at three months after surgery the intraocular pressure was 12.5 mmHg (8.5-23) (p<0.001) and no changes were observed in the corneal diameters. An eye with a flat anterior chamber was observed as an adverse effect. Thirteen eyes required topical hypotensors to achieve the target intraocular pressure. CONCLUSIONS: The treatment with trabeculectomy trabeculotomy in primary congenital glaucoma is effective in the reduction of the intraocular pressure.

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OBJECTIVE: to demonstrate whether patients undergoing capsulotomy Nd: YAG laser developed intraocular hypertension after the procedure. METHODS: prospective, pre-experimental before and after 2 measurements with post-test in patients with posterior capsular opacity from the Ophthalmology Service. Measurements of intraocular pressure (IP) before capsulotomy Nd: YAG laser, and three hours and one week later. RESULTS: we studied 47 patients, 29.8 % were men and 70.2 % women. We compared between visual acuity before and one week later (Wilcoxon test p = 0.00). IP after three hours and one week later, comparisons with Friedman test were done (p =0. 002). We compared the IP prior and one week later (Wilcoxon test, with p =0.815). IP before and three hours later were obtained (p = 0.001) and IP three hours and one week later ( p = 0.004). CONCLUSIONS: we found an increase in IP in the first hours after the capsulotomy Nd: YAG laser, which decrease gradually until reaching the values presented before the procedure, in not more than a week period. It is a quick and safe procedure to treat posterior capsular opacity.

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