RESUMEN

TÉCNICA QUIRÚRGICA: La maniobra del tapón especular o «bubble mirror technique» consiste en la estabilización de la cámara anterior con una combinación de aire y viscoelástico colocados estratégicamente. En la interfase aire-viscoelástico de este taponamiento surge una línea donde se refleja, como en un espejo, el ángulo camerular. DISCUSIÓN: El tapón especular aporta 3 beneficios a la cirugía del glaucoma con implante Ex-PRESS: 1) efecto tapón del viscoelástico, que proporciona estabilidad a la cámara anterior, impidiendo su colapso; 2) efecto tono de la burbuja de aire; y 3) efecto especular de la interfase, que permite al cirujano el control visual del ángulo camerular durante la implantación del Ex-PRESS

SURGICAL TECHNIQUE: The bubble mirror technique consists of the stabilization of the anterior chamber by means of a plug made with a combination of conveniently placed air and viscoelastic material. A line arises at interface between the air and viscoelastic where the anterior chamber angle reflected can be seen as in a mirror (bubble mirror). DISCUSSION: The viscoelastic-air plug offers three advantages in glaucoma surgery with the Ex-PRESS implant: 1) plug effect of viscoelastic, giving stability to the anterior chamber and preventing it from collapsing; 2) toning effect of the air bubble; and 3) specular effect at the interface, which allows the surgeon to visually control the chamber angle during the Ex-PRESS implantation

Asunto(s)

RESUMEN

SURGICAL TECHNIQUE: The bubble mirror technique consists of the stabilization of the anterior chamber by means of a plug made with a combination of conveniently placed air and viscoelastic material. A line arises at interface between the air and viscoelastic where the anterior chamber angle reflected can be seen as in a mirror (bubble mirror). DISCUSSION: The viscoelastic-air plug offers three advantages in glaucoma surgery with the Ex-PRESS implant: 1) plug effect of viscoelastic, giving stability to the anterior chamber and preventing it from collapsing; 2) toning effect of the air bubble; and 3) specular effect at the interface, which allows the surgeon to visually control the chamber angle during the Ex-PRESS implantation.

Asunto(s)

RESUMEN

INTRODUCTION: Viscocanalostomy is an option in the surgical treatment of glaucoma. This non-penetrating technique favours aqueous drainage through the Schlemm channel while avoiding filtering blebs and their related pathologies. Complications associated to this surgery are unusual, one of which is Decemet's membrane detachment (DMD) CLINICAL CASE: A 64 year-old female diagnosed with open-angle chronic glaucoma, whose had undergone a viscocanalostomy of the left eye. In the immediate postoperative period we noticed a hemorrhagic DMD in the lower temporal quadrant. After adopting a wait and see attitude, we did not find improvement 15 days after surgery and corneal edema was established with vision decrease. We proceeded to a surgical reapplication by means of Descemet's membrane micropuncture and SF6 injection into the anterior chamber and achieving an anatomical and functional improvement DISCUSSION: We believe that the intrusion of viscoelastic material into the supradescemetic was a consequence of the high-pressure during the high-density hyaluronate injection. Hemorrhagic DMD management is mainly determined by its location, size and evolution. In our case, the posterior endothelial micropuncture and descematopexy by means of 20% SF6 injection into the anterior chamber was useful in resolving this complication.

Asunto(s)

RESUMEN

Introducción: La viscocanalostomía constituye una alternativa en el tratamiento quirúrgicodel glaucoma. Esta técnica no penetrante favorece el drenaje del acuoso a través del canalde Schlemm evitando la aparición de ampollas de filtración y de las patologías relacionadascon éstas. Las complicaciones asociadas a esta cirugía son escasas; una de ellas es eldesprendimiento de la membrana de Descemet (DMD).Caso clínico: Mujer de 64 años diagnosticada de glaucoma crónico de ángulo abierto cuyoojo izquierdo fue intervenido mediante viscocanalostomía. En el posoperatorio inmediatoapareció un DMD hemorrágico en el cuadrante temporal inferior. Tras adoptar inicialmenteuna actitud expectante, a los 15 días de la cirugía no se objetivó mejoría del DMD y seinstauró un edema corneal que produjo disminución de la visión. Se procedió a la reaplicaciónquirúrgica del defecto mediante micropunción de la membrana de Descemet e inyecciónde SF6 en cámara anterior. Se consiguió una mejoría anatómica y funcional delcuadro.Discusión: Pensamos que la salida del material viscoelástico al espacio supradesceméticofue consecuencia de la alta presión en el proceso de inyección del hialuronato de alta densidad.El manejo de un DMD hemorrágico está condicionado fundamentalmente por sulocalización, tamaño y evolución. La actuación diferida mediante micropunción endotelialy posterior descematopexia por medio de inyección en cámara anterior de SF6 al 20% resultóde utilidad para solucionar esta complicación(AU)

Introduction: Viscocanalostomy is an option in the surgical treatment of glaucoma. Thisnon-penetrating technique favours aqueous drainage through the Schlemm channel whileavoiding filtering blebs and their related pathologies. Complications associated to thissurgery are unusual, one of which is Decemet’s membrane detachment (DMD)Clinical case: A 64 year-old female diagnosed with open-angle chronic glaucoma, whose hadundergone a viscocanalostomy of the left eye. In the immediate postoperative period wenoticed a hemorrhagic DMD in the lower temporal quadrant. After adopting a wait and seeattitude, we did not find improvement 15 days after surgery and corneal edema wasestablished with vision decrease. We proceeded to a surgical reapplication by means ofDescemet’s membrane micropuncture and SF6 injection into the anterior chamber andachieving an anatomical and functional improvementDiscussion: We believe that the intrusion of viscoelastic material into the supradescemeticwas a consequence of the high-pressure during the high-density hyaluronate injection.Hemorrhagic DMD management is mainly determined by its location, size and evolution.In our case, the posterior endothelial micropuncture and descematopexy by means of 20%SF6 injection into the anterior chamber was useful in resolving this complication(AU)

Asunto(s)

RESUMEN

PURPOSE: To evaluate postoperative outcomes and success after combined phacoemulsification and glaucoma surgery with Ex-PRESS miniature implant compared with combined surgery with standard trabeculectomy. METHODS: In this prospective series of 40 consecutive eyes we compared 20 eyes in 17 patients treated with combined phacoemulsification and glaucoma filtering surgery with the Ex-PRESS miniature glaucoma implant under a scleral flap with 20 matched control eyes in 20 patients who underwent combined cataract and glaucoma surgery with trabeculectomy. RESULTS: The average follow-up was 9.7 months (range 4.5 to 15) for the Ex-PRESS group and 10.3 months (range 3.5 to 14.5) for the trabeculectomy group. The mean IOP was significantly higher in the early postoperative period in the Ex-PRESS group compared with the trabeculectomy group. Complications rate in the early postoperative period was significantly higher in the trabeculectomy group. No significant differences were objectified in success between both groups after the first week. DISCUSSION: The Ex-PRESS implant is an effective and safe alternative to standard trabeculectomy in selected cases which makes possible to reduce remarkably the classic early postoperative complications associated with trabeculectomy.

Asunto(s)

RESUMEN

el éxito tras cirugía combinada mediante facoemulsificacióne implante Ex-PRESS comparado concirugía combinada con trabeculectomía estándar.Métodos: En esta serie prospectiva de 40 ojos consecutivoscomparamos 20 ojos de 17 pacientes tratadosmediante facoemulsificación combinada concirugía filtrante de glaucoma con implante de válvulaEx-PRESS bajo un colgajo escleral con 20ojos controles en 20 enfermos que fueron sometidosa facoemulsificación combinada con trabeculectomíaestándar.Resultados: El tiempo de seguimiento medio fuede 9,7 meses (rango: 4,5-15) en el grupo Ex-PRESSy 10,3 meses (rango 3,5-14,5) en el grupo trabeculectomía.La PIO media fue significativamentesuperior en el postoperatorio precoz en el grupo Ex- PRESS comparada con el de trabeculectomía. Latasa de complicaciones en dicho período resultósuperior en el grupo sometido a trabeculectomía.No se objetivaron diferencias significativas en latasa de éxito entre ambos grupos más allá de la primera semana.Conclusiones: El implante Ex-PRESS constituyeuna alternativa eficaz y segura a la trabeculectomíaen casos seleccionados que permite disminuir notablementelas clásicas complicaciones postquirúrgicasprecoces asociadas a la trabeculectomía(AU)

Purpose: To evaluate postoperative outcomes andsuccess after combined phacoemulsification andglaucoma surgery with Ex-PRESS miniatureimplant compared with combined surgery withstandard trabeculectomy.Methods: In this prospective series of 40 consecutiveeyes we compared 20 eyes in 17 patients treatedwith combined phacoemulsification and glaucomafiltering surgery with the Ex-PRESS miniatureglaucoma implant under a scleral flap with 20 matchedcontrol eyes in 20 patients who underwentcombined cataract and glaucoma surgery with trabeculectomy.Results: The average follow-up was 9.7 months(range 4.5 to 15) for the Ex-PRESS group and 10.3months (range 3.5 to 14.5) for the trabeculectomygroup. The mean IOP was significantly higher inthe early postoperative period in the Ex-PRESSgroup compared with the trabeculectomy group.Complications rate in the early postoperative periodwas significantily higher in the trabeculectomygroup. No significant differences were objectifiedin success between both groups after the first week. Discussion: The Ex-PRESS implant is an effectiveand safe alternative to standard trabeculectomy inselected cases which makes possible to reduceremarkably the classic early postoperative complicationsassociated with trabeculectomy(AU)

Asunto(s)

RESUMEN

PURPOSE/METHOD: A female patient underwent retinographic control and presented a pattern of myelinated nerve fibers in both eyes. Two years later, patient underwent a second retinographic control showing 10/10 glaucomatous cupping in her right eye. This was associated to loss of myelinated nerve fibers. RESULTS/CONCLUSIONS: Etiology, characteristics, associations and other causes of loss of myelinated retinal nerve fibers in chronic glaucoma are reviewed. This is the second of two photograph documented cases where loss of myelinated nerve fibers is associated to an open angle primary glaucoma.

Asunto(s)

RESUMEN

Objetivo/método: Presentamos el caso de una paciente con glaucoma crónico simple que fue sometida a un control retinográfico con el fin de documentar la existencia de fibras nerviosas retinianas mielinizadas peripapilares en ambos ojos. Al cabo de años, acudió de nuevo a nuestra consulta apreciándose una atrofia óptica glaucomatosa con excavación 10/10 en su ojo derecho, asociado a la desaparición de las fibras de mielina. Resultado/conclusiones: Revisamos la etiología, características y asociaciones de las fibras retinianas mielinizadas, así como otras causas asociadas a su desaparición. Aportamos las retinografías de la desaparición de estas fibras de mielina en nuestra paciente. Éste es el segundo caso documentado fotográficamente de la desaparición de fibras de mielina asociado a glaucoma primario de ángulo abierto (AU)

Asunto(s)