Resumen La hemorragia retrobulbar es un sangrado en la región intraorbitaria retroseptal que genera un síndrome compartimental orbitario. Se presenta el caso de una mujer de 86 años que acudió a Urgencias por dolor ocular y pérdida de visión en ojo izquierdo de seis horas de evolución. Presentaba tratamiento anticoagulante con 300 mg/día de Dabigatrán por fibrilación auricular como único antecedente médico. La exploración clínica fue compatible con hemorragia retrobulbar, diagnóstico confirmado por TAC urgente, realizándose de forma inmediata una cantotomía con cantolisis. Se realizó RMN orbitaria que descartó la existencia de malformaciones arteriovenosas como factor desencadenante, diagnosticándose de hemorragia retrobulbar espontánea asociada a consumo de anticoagulantes. La singularidad de este caso radica en formar parte del pequeño porcentaje de hemorragias retrobulbares que no se asocian a causa traumática ni postquirúrgica así como en ilustrar una localización muy poco frecuente de sangrado asociado a anticoagulación.
PurposeDry eye disease (DED) has a multifactorial etiology, including insufficient tear production and/or excessive tear evaporation linked to multiple conditions. A preservative‐free eye drop formulation containing sodium hyaluronate and trehalose (SH‐THL, Thealoz® Duo) capitalizes on the bioprotectant properties of trehalose. This study evaluated the improvement of ocular surface disease (OSD), dry eye signs and symptoms, treatment satisfaction in patients with DED receiving SH‐THL.MethodsMulti‐center, international, non‐interventional prospective survey lasting 84 days with up to 2 post‐baseline visits in up to 310 adult subjects with clinically confirmed DED requiring artificial tears. Clinical signs with Schirmer Test, tear Break Up Time, hyperemia, dry eye symptoms with OSDI® scale and the five‐item dry eye questionnaire (DEQ‐5) as well as patient satisfaction were assessed at baseline, visit 1 (28 days) and 2 (84 days). SH‐THL was to be instilled when needed. The number of eye drops instilled per day was determined using the Kali Care Drop Meter (n=42).ResultsData from 238 patients were analyzed. 83.2% were women, the mean age was 57.9 ± 15.1 years. At baseline, the overall OSDI was 42.2 ± 19.9 and 61.3% of patients had severe OSDI. The DEQ‐5 score was 12.4±4.1 and the patient treatment satisfaction score was 6.4 ± 2.1. The OSDI significantly improved (p < 0.001) after 84 days. The DEQ‐5 score significantly improved at visit 1, persisting until visit 2 (both p < 0.001) with a statistically significant (p = 0.002) difference between visit 1 and 2. Patient satisfaction with treatment significantly improved (p < 0.001) at visit 1 and 2 compared to baseline. All clinical signs significantly improved after 84 days of SH‐THL.ConclusionsResults confirm that continued use of eye drops containing SH‐THL reduced DED signs and symptoms, OSDI scores, and result in a very high patient satisfaction.
Purpose Objectives: To evaluate progressive changes in visual function parameters in patients with Fuchs endotelial dystrophy (FED) who underwent Descemet membrane endotelial keratoplasty (DMEK) and to compare visual results after DMEK with visual function parameters in healthy subjects without corneal pathology. Methods Methods: Fourteen patients (14 eyes) with FED who underwent DMEK surgery were included in the study. All subjects underwent best corrected visual acuity (BCVA) evaluation using the ETDRS optotype in photopic and scotopic conditions, and contrast sensitivity (CS) assessment using the CSV 1000 and the Pelli Robson tests in different lighting conditions, preoperatively, at 1 and 6 months after surgery. Fourteen eyes of 14 healthy controls were evaluated using the same protocol and compared with the patients’ final postsurgery data. Results Results: A significant improvement in all visual function parameters was observed in patients 1 month (p < 0.05) and 6 months (p < 0.05) after DMEK, compared with preoperative levels. Healthy controls had significantly higher BCVA in photopic and scotopic conditions (p = 0.02, p = 0.044, respectively), better CS in spatial frequencies of 6 cpd (p < 0.001); 12 cpd (p = 0.006) and 18 cpd (p = 0.006) measured with the CSV 1000 test, and CS as measured with the Pelli Robson test (p = 0.002). No significant differences were observed between patients and healthy controls in the spatial frequency of 3 cpd (photopic, p = 0.704; mesopic, p = 0.596; mesopic with glare, p = 0.989). Conclusions Conclusions: DMEK improves visual function parameters in patients with FED in the first month after surgery. Patients who underwent DMEK present similar CS to healthy subjects in lower frequencies. However, BCVA and CS in medium and high frequencies remain significantly lower than those values found in healthy corneas.
Purpose and Objectives To evaluate progressive changes in visual quality parameters in patients who underwent DMEK for Fuchs endotelial dystrophy (FED), and to compare the visual quality results with healthy controls without corneal pathology. Methods Fourteen eyes with FED who underwent DMEK were evaluated for corneal topographic changes using Pentacam (OCULUS, Iberia SL), preoperatively, at 1 month and at 6 months after surgery. Mean keratometry (Km), corneal density (1‐2 mm, central and total), high order aberrations (HOA), low order aberrations (LOA) and total aberrations (total RMS) were analyzed in the anterior and posterior cornea. Fourteen healthy subjects were evaluated using the same protocol and compared with the patient's final evaluation data. Results Significant improvement was observed in patients at 1 month after surgery in the posterior Km (p=0.005), central posterior density (p=0.034), 1‐2 mm posterior density (p=0.006) and central anterior density (p=0.045), and anterior LOA (p=0.026) and total aberrations (p=0.020). After 6 months all densities (anterior and posterior) had improved compared to preoperative results (p<0.05) as well as all posterior aberrations (total, HOA and LOA, p<0.05). Posterior and anterior Km values and corneal densities did not show significant differences compared to healthy subjects (p>0.05). Corneal aberrations (anterior and posterior)remained significantly higher in DMEK subjects (p>0.05) Conclusions DMEK surgery improves corneal visual quality parameters in FED patients after the first month postoperatively. Corneal density and mean keratometry values are not different from healthy corneas at 6 months after DMEK. However, despite corneal aberrations decrease after surgery they remain higher than those values found in healthy corneas.
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