The objective of this paper is to review the main findings of the largest studies on the etiopathogenesis and microbiology of the development of dacryocystitis and to formulate clinical and surgical guidelines based on said studies and on our experience at Cruces Hospital, the Basque Country, Spain. The most common sign of this entity is the distal nasolacrimal duct obstruction, and this should be treated to prevent clinical relapse. The time when surgery should be indicated mainly depends on the clinical signs and symptoms, age and general status of a patient. Given the germs isolated in cases of dacryocystitis, antibiotic therapy against Gram positive (S. aureus, S. pneumoniae, S. epidermidis) and Gram negative bacteria (H. influenzae, P. aeruginosa) should be administered, orally in adults and intravenously in pediatric patients, prior to surgery. Gentamicin and amoxicillin-clavulanic acid have been found to be effective against the bacteria commonly implicated in the etiopathogenesis of this entity.

This study questions the generalized use of prophylactic antibiotics for external dacryocystorhinostomy, while providing evidence to indicate their use for patients who have had prior episodes of mucocele, mucopyocele, or acute dacryocystitis.

Ocular abnormalities associated with Alagille Syndrome are variable and can affect most ocular structures. Although severe visual threat or progressive ocular disease associated with Alagille syndrome have not yet been described, our patient has shown a marked decrease in visual acuity and a clear progression of the chorioretinal atrophy.

Intraoperative floppy-iris syndrome occurred in 67% of the patients treated with tamsulosin. The only postoperative secondary effect was a lower pupil reactivity in patients taking tamsulosin.

DisCoVisc is a new viscosurgical device with both cohesive and dispersive properties, which avoids using two different viscoelastics to improve the performance at different surgical stages. DisCoVisc has been shown to be more transparent and provides better anterior chamber maintenance when compared with Healon. Healon was more easily aspirated due to its cohesive character.

resuMenobjetivo. Estudiar la prevalencia de retinopatía diabética mediante retinógrafo no midriático y valorar su utilidad como método de cribaje en la comarca de Donostialdea.Métodos. Se realizó un estudio prospectivo incluyendo 2.444 pacientes diabéticos derivados por su médico de atención primaria y/o endocrinólogo. Se realizó una retinografía con cámara no midriática en los 45 grados centrales, agudeza visual y tonómetro de no contacto en todos los pacientes. La información se derivó al hospital para ser evaluado por un oftalmólogo especialista en retina.resultados. El 15,02% de los pacientes eran diabéticos en tratamiento dietético, el 62,55% eran diabéticos no insulinodependientes y el 22,43% eran diabéticos insulinodependientes. Observamos una prevalencia de retinopatía diabética del 9,36%. El 5,27% presentó retinopatía diabética no proliferativa (RDNP) leve, el 2,21% RDNP moderada, el 1,67% RDNP severa y el 0,12% RD proliferativa. El 8,22% presentó hipertensión ocular.conclusiones. Se observa una baja prevalencia de RD en los pacientes de nuestra muestra. La utilización de telemedicina con cámara no midriática es un arma importante para el diagnóstico precoz de la retinopatía diabética y puede aplicarse a otras patologías oftalmológicas como el glaucoma.Palabras clave. Telemedicina. Retinopatía diabética. Retinógrafo no midriático. aBstract objectives. To establish the prevalence of diabetic retinopathy (RD) diagnosed after non-mydriatic retinography and to evaluate its utility as a screening test in the area of San Sebastián. Methods.A prospective study including 2,444 diabetic patients sent by their primary attention doctors and/ or their endocrinologists. All patients underwent nonmydriatic retinography in the central 45 degrees; visual acuity was explored, as well as IOP through non-contact tonometry. The retinographies and information obtained were sent to our hospital and were revised by an ophthalmologist from the Retina Department.results. Fifteen point zero two (15.02%) of the patients suffered from diabetes and were under dietary treatment, 62.55% suffered from non-insulin-dependant diabetes, and 22.43% suffered from insulin-dependant diabetes. The prevalence of diabetic retinopathy was 9.36%; 5.27% mild non-proliferative diabetic retinopathy (DR); 2.21% moderate-non-proliferative DR; 1.67 % severe non-proliferative DR; and 0.05% proliferative-diabetic retinopathy. Eight point two two (8.22%) of the sample studied was diagnosed with ocular hypertension.conclusions. We observed a low prevalence of DR in our sample. Use of non-mydriatic retinopathy in telemedicine plays an important role in the early diagnosis of diabetic retinopathy and it can be applied to other ophthalmic diseases. Los autores manifiestan que no tienen intereses comerciales ni han recibido apoyo económico para la realización del trabajo.

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RESUMENCaso clínico: Se presenta el caso de un paciente de 24 años con una epiteliopatía multifocal placoide posterior bilateral aguda, confirmada mediante angiografía fluoresceínica . Al mes de seguimiento, el paciente presentó diplopia por paresia del VI par craneal derecho. Discusión: La epiteliopatía multifocal placoide posterior, es una entidad que se engloba dentro de los síndromes de puntos blancos. Se considera una patología benigna, aunque en ocasiones se asocian alteraciones neurológicas que pueden manifestarse incluso meses después del episodio. Nuestro paciente presentó una paresia del VI. par como complicación neurológica, hecho no descrito en la literatura.Palabras clave: Epiteliopatía multifocal placoide bilateral aguda, parálisis del VI par craneal. ABSTRACT Clinical case:We report the case of a 24-year-old patient who attended our hospital with an acute posterior multifocal placoid pigment epitheliopathy (APMPPE) which was later confirmed by fluorescein angiography. One month after presentation the patient developed a right VI nerve palsy. Discussion: APMPPE is an acute-onset bilateral inflammatory disease causing impaired vision. Although it is thought to be benign, neurologic manifestations have been described even months after presentation. There is no previous report of APMPPE associated with VI nerve palsy (Arch Soc Esp Oftalmol 2009; 84: 159-162).