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objetivo Realización de una guía de práctica clínica actualizada que sirva de orientación para la detección, el manejo y el tratamiento de pacientes con glaucoma avanzado en la edad adulta. Métodos Tras la definición de los objetivos y alcance de la guía se constituyó el grupo de trabajo que formuló las preguntas clínicas estructuradas siguiendo el formato PICO (Patient, Intervention, Comparison, Outcomes). Se realizó una revisión de la literatura publicada hasta el momento, incluyendo guías de práctica clínica internacionales, utilizándose las herramientas AMSTAR-2 (Assessment of Multiple systematic Rewiews) y «Risk of Bias» de Cochrane para la evaluación de la calidad de la información de forma independiente por, al menos, 2 revisores. El nivel de evidencia y la elaboración del grado de recomendación se establecieron siguiendo la metodología del Scottish Intercollegiate Guidelines Network (SIGN). Resultados Se presentan recomendaciones con sus correspondientes niveles de evidencia que pueden ser de utilidad para la detección, el seguimiento y el tratamiento de pacientes con glaucoma avanzado en la edad adulta. Conclusiones A pesar de que la evidencia científica existente es escasa y el nivel de evidencia para muchas de las preguntas planteadas no es muy alto, esta guía de práctica clínica ofrece una revisión actualizada de las recomendaciones existentes para el manejo del glaucoma avanzado en el adulto (AU)

Objective To present an update clinical practice guideline that serve as a guide for the detection, evaluation and treatment of adults patients with advanced glaucoma. Methods After defining the objectives and scope of the guide, the working group was formed and structured clinical questions were formulated following the PICO (Patient, Intervention, Comparison, Outcomes) format. Once all the existing clinical evidence had been independently evaluated with the AMSTAR-2 (Assessment of Multiple systematic Rewiews) and Cochrane «Risk of bias» tools by at least 2 reviewers, recommendations were formulated following the Scottish Intercollegiate methodology Guideline Network (SIGN). Results Recommendations with their corresponding levels of evidence that may be useful in the diagnosis, monitoring and treatment of adults patients with advanced glaucoma. Conclusions Despite the fact that for many of the questions the level of scientific evidence available is not very high, this clinical practice guideline offers an updated review of the different existing aspects related to the evaluation and management of advanced glaucoma (AU)

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OBJECTIVE: To present an update clinical practice guideline that serve as a guide for the detection, evaluation and treatment of adults patients with advanced glaucoma. METHODS: After defining the objectives and scope of the guide, the working group was formed and structured clinical questions were formulated following the PICO (Patient, Intervention, Comparison, Outcomes) format. Once all the existing clinical evidence had been independently evaluated with the AMSTAR 2 (Assessment of Multiple systematic Rewiews) and Cochrane "Risk of bias" tools by at least two reviewers, recommendations were formulated following the Scottish Intercollegiate methodology. Guideline Network (SIGN). RESULTS: Recommendations with their corresponding levels of evidence that may be useful in the diagnosis, monitoring and treatment of adults patients with advanced glaucoma. CONCLUSIONS: Despite the fact that for many of the questions the level of scientific evidence available is not very high, this clinical practice guideline offers an updated review of the different existing aspects related to the evaluation and management of advanced glaucoma.

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OBJETIVO: Realización de una guía de práctica clínica actualizada sobre el tratamiento médico, láser y quirúrgico del glaucoma por cierre angular primario (GCAP) en el adulto. MÉTODOS: Tras la formulación de preguntas clave utilizando el esquema PICO (Paciente/Problema, Intervención, Comparación, Outcome/Resultado), se realiza una revisión de la literatura publicada hasta el momento, incluyendo guías de práctica clínica internacionales, utilizándose las herramientas AMSTAR y «Risk of Bias» para la evaluación de la calidad de la información. El nivel de evidencia y la elaboración del grado de recomendación se establecieron siguiendo el sistema Scottish Intercollegiate Guidelines Network (SIGN). RESULTADOS: Siguiendo la metodología expuesta, se presentan recomendaciones de tratamiento médico, láser y quirúrgico en el GCAP del adulto y los niveles de evidencia. CONCLUSIONES: Aunque el nivel de evidencia científica para muchas de las preguntas planteadas no es muy alto, se presenta una revisión actualizada de las recomendaciones terapéuticas en el GCAP del adulto. Entre las limitaciones para la aplicación de estas recomendaciones se encuentra que la mayoría de los estudios han sido realizados en población de origen asiático, y que la eficacia se mide casi exclusivamente en términos de reducción de tensión ocular y no en parámetros de función visual, calidad de vida o coste-efectividad

OBJECTIVE: To present a clinical practice guideline update on the medical, laser, and surgical treatment of primary angle closure glaucoma (PACG) in adults. METHODS: Following the formulation of key questions using the PICO scheme (Patient/Problem, Intervention, Comparison, Outcome), a systematic review was performed on the literature published to date, including international clinical practice guidelines. The AMSTAR and Risk of Bias tools were used for evaluating the quality of the information. The level of evidence and grade of recommendation was established following the Scottish Intercollegiate Guidelines Network (SIGN) system. RESULTS: Following the above methodology, recommendations of medical, laser and surgical treatment in adult PACG and levels of evidence are presented. CONCLUSIONS: Although the level of scientific evidence for many of the questions raised is not very high, a review is presented on updated treatment recommendations for adult PACG. Among the limitations for the implementation of these recommendations is that most studies have been conducted in Asian populations, and that the effectiveness is measured almost exclusively in terms of reducing intraocular pressure, and does not include visual function, quality of life or cost-effectiveness parameters

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OBJECTIVE: To present a clinical practice guideline update on the medical, laser, and surgical treatment of primary angle closure glaucoma (PACG) in adults. METHODS: Following the formulation of key questions using the PICO scheme (Patient/Problem, Intervention, Comparison, Outcome), a systematic review was performed on the literature published to date, including international clinical practice guidelines. The AMSTAR and Risk of Bias tools were used for evaluating the quality of the information. The level of evidence and grade of recommendation was established following the Scottish Intercollegiate Guidelines Network (SIGN) system. RESULTS: Following the above methodology, recommendations of medical, laser and surgical treatment in adult PACG and levels of evidence are presented. CONCLUSIONS: Although the level of scientific evidence for many of the questions raised is not very high, a review is presented on updated treatment recommendations for adult PACG. Among the limitations for the implementation of these recommendations is that most studies have been conducted in Asian populations, and that the effectiveness is measured almost exclusively in terms of reducing intraocular pressure, and does not include visual function, quality of life or cost-effectiveness parameters.

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CASE REPORT: We present a case of decompression retinopathy with retinal haemorrhages, optic nerve haemorrhages, maculopathy, and decreased visual acuity after trabeculectomy with mitomycin-C. DISCUSSION: Decompression retinopathy is a potential complication after glaucoma surgery but has been rarely reported in the world literature. Although these four characteristics have been described separately, in this patient all four occurred together.

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Caso clínico: Se presenta un caso de retinopatía por descompresión caracterizado por hemorragias retinianas, edema de papila, edema macular y disminución brusca de la agudeza visual en el postoperatorio inmediato de una trabeculectomía con mitomicina C. Discusión: La retinopatía por descompresión es una complicación que aparece con poca frecuencia tras la cirugía de glaucoma. Aunque estas características han sido descritas en la literatura de forma separada, en el presente artículo se describen de manera conjunta en un solo caso clínico

Case report: We present a case of decompression retinopathy with retinal haemorrhages, optic nerve haemorrhages, maculopathy, and decreased visual acuity after trabeculectomy with mitomycin-C. Discussion: Decompression retinopathy is a potential complication after glaucoma surgery but has been rarely reported in the world literature. Although these four characteristics have been described separately, in this patient all four occurred together (Arch Soc Esp Oftalmol 2008; 83: 373-376)

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PURPOSE: To evaluate the results of a protocol described for mitomycin C (MMC) use in trabeculectomy or combined surgery (phacoemulsification and trabeculectomy). METHODS: A total of 143 eyes (60 trabeculectomies and 83 combined surgeries) of 124 patients were divided into four groups: group 1 (without MMC); group 2 (with 0.1 mg/ml MMC); group 3 (with 0.2 mg/ml MMC), and group 4 (with 0.4 mg/ml MMC). Two-minute MMC was used in every case in groups 2, 3 and 4. The results were analysed after 1 year of follow-up. Intraocular pressure (IOP) and complications were evaluated. Successful IOP control was defined when IOP was <21 mmHg and <16 mmHg if advanced glaucoma was present, always without additional medical treatment. RESULTS: Mean preoperative IOP decreased from 24.60 mmHg (SD 1.40 mmHg) to 13.47 mmHg (SD 0.37 mmHg) (p < 0.00001), 12 months postoperatively. Control in IOP was achieved in 79.02% of eyes. No significant differences were found in final mean IOP values (p > 0.196) or in postoperative complications (p > 0.120) in groups 2, 3 and 4. CONCLUSION: With the protocol described, a selection of concentration of MMC has been made in different clinical forms of glaucoma. No significant differences in IOP control and postoperative complications were noticed among the groups.

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