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Objective To compare objective ocular redness measured using OCULUS Keratograph 5 M before and after 0.2% brimonidine instillation in glaucoma patients under topical hypotensive treatment.Methods 60 eyes from 60 subjects diagnosed with glaucoma or ocular hypertension under hypotensive ocular topical treatment were analyzed. Basal Ophthalmological examination was performed. Outcome variables were OCULUS Keratograph 5 M redness scores (RS) before and after 0.2% brimonidine instillation; overall, bulbar temporal (BT), bulbar nasal (BN), limbar temporal (LT), and limbar nasal (LN); non-invasive average tear film breakup time (Nia-BUT), non-invasive first tear film breakup time (Nif-BUT) and meibography. In addition, the following clinical data were collected: intraocular pressure, type, duration, amount, and preservatives/or not of hypotensive treatment, fluorescein corneal staining score and lower tear meniscus height.Results All eyes were under topical medication. All redness scores were reduced after brimonidine instillation, mean RS differences were BT 0.82?±?0.62, BN hyperemia 1.03?±?0.55, LN hyperemia 0.84?±?0.49, LT hyperemia 0.71?±?0.50 and total hyperemia 0.91?±?0.52 (all p??0.392) and between patient with combination therapy and monotherapy 0.16?±?0.14 (p?>?0.258).Conclusion A significant reduction of conjunctival hyperemia was objectively found in glaucoma patients under topical hypotensive treatment before and after brimonidine instillation. Its fast and long-lasting effect may be useful preoperatively in glaucoma patients to reduce intraoperative bleeding and associated complications.

Through this research study, we aim to shed light into the discussion on the role that marketing strategies and policies plays in the attainment of SDGs. Companies that promote sustainability through their marketing initiatives have been proven to achieve greater appreciation than those that do not. Moreover, actions performed by organisations in different sectors within the sustainability framework demand the need to create a clear and comprehensive scheme that helps combine and clarify the typology of these actions and their contribution to SDGs. The main objective of this research is to understand the specific role played by marketing strategies in the achievement and progress towards a more sustainable world using the systematic review methodology. The major finding is to understand where the research on the topic is focused regarding the economic sector (secondary sector), the addressed goal (Goal 12), and the main marketing strategies and actions considered (being 'marketing orientation' the most mentioned and 'price' the least). In addition, this study provides some implications for researchers, managers and policy makers, related to the understanding of the SDGs, the actions to be taken and the relevance of citizens' education.

Purpose The aim of this study is to analyze the distribution of visual field (VF) mean defect (MD) in six subgroups of glaucoma patients at baseline and follow-up.Methods We assessed glaucoma patients treated in a Spanish tertiary care setting with a follow-up of at least 10 months. We have included 1036 visual fields and the following glaucoma subtypes: open-Angle Glaucoma (OAG); Angle-Closure Glaucoma (ACG); Congenital Glaucoma (CG); Ocular hypertension (OHT); Pseudoexfoliative Glaucoma (PSXG); Pigmentary Glaucoma (PG). We have calculated the baseline MD and the progression MD. We have stratified the MD progression in slow(MD rate > −0.5 dB/year); moderate(MD rate between −0.5 and −1 dB/year) fast(MD rate between −1 and −2 dB/year) and catastrophic(<−2 dB/year) progression and their glaucoma subtype.Results The glaucoma types with the worse baseline MD were CG and PG. We found significant differences after comparing the baseline MD of CG and OAG, ACG, OHT and between PG and OHT. Concerning the MD progression rate: OAG 73.54% showed slow MD progression rate; 9.85% fast; 7.3% moderate and 9.3% catastrophic. ACG 82.22% slow; 8.89% moderate; 2.22% fast and 6.67% catastrophic. CG 68.83% slow; 9.09% fast; 7.79% moderate and 14.29% catastrophic. OHT 88.6% slow; 6.14% moderate; 4.39% fast and 0.88% catastrophic. PSXG 63.24% slow, 13.24% moderate; 8.8% fast and 14.7% catastrophic. PG 89.29% slow; 3.57% moderate and 7.1% fast.Conclusions The CG requires special attention because of its aggressive presentation and progression.

La mielopatía cervical degenerativa representa una entidad patológica producida por la estenosis del canal medular cervical, resultando en una compresión crónica de la médula espinal, variable y progresiva. El abordaje quirúrgico de la columna cervical puede realizarse por vía anterior y/o vía posterior. Respecto al abordaje posterior, existen 2 técnicas fundamentales: laminoplastia y laminectomía con fijación posterior (LFP). En la literatura actual existe controversia acerca de cuál de las 2 técnicas permite obtener mejores resultados postoperatorios. El objetivo es el estudio de las diferencias entre laminoplastia y LFP desde el punto de vista clínico y radiológico. Se realiza un estudio de una cohorte histórica de 39 pacientes (12 LFP y 27 laminoplastia) intervenidos en un período de 10 años en el Hospital Universitario La Paz con un seguimiento de 12 meses tras la cirugía. Se analizan y comparan los resultados clínicos mediante la escala de Nurick y la Escala Japanese Orthopaedic Association modificada (mJOA) y los resultados radiológicos mediante el ángulo de Cobb, eje sagital vertical, T1 Slope y el alineamiento (medido mediante Cobb-T1 Sloppe). Se observan diferencias significativas en la mejoría postoperatoria de la escala Nurick (p = 0,008) y mJOA (p = 0,018) en el grupo de laminoplastia. En LFP se objetiva una tendencia a una mejoría mayor, pero no se alcanza la significación estadística debido al bajo tamaño muestral de este grupo. No se objetivan diferencias estadísticamente significativas en cuanto a la variables radiológicas. Respecto al total de complicaciones, se observó un número mayor en el grupo de laminoplastia (7 casos) frente a LFP (un caso), pero no se vieron diferencias estadísticamente significativas. La laminoplastia y la LFP son ambos procedimientos seguros y efectivos en el tratamiento de la mielopatía cervical degenerativa. Los hallazgos de nuestro estudio demuestran una mejoría clínica estadísticamente significativa en base a las escalas de Nurick y mJOA en el grupo de laminoplastia. No se observan diferencias significativas en cuanto a complicaciones ni variables radiológicas entre ambas técnicas. Cervical degenerative myelopathy is a variable and progressive degenerative disease caused by chronic compression of the spinal cord. Surgical approaches for the cervical spine can be performed anteriorly and/or posteriorly. Regarding the posterior approach, there are 2 fundamental techniques: laminoplasty and laminectomy with posterior fixation (LPF). There is still controversy concerning the technique in terms of outcome and complications. The aim of the present work is to analyze from the clinical and radiological point of view these 2 techniques: laminoplasty and LPF. A historical cohort of 39 patients was reviewed (12 LFP and 27 laminoplasty) including patients operated in a 10 years period at the Hospital Universitario La Paz with a follow-up of 12 months after surgery was carried out. The clinical results were analyzed and compared using the Nurick scale and the modified Japanese Orthopaedic Association Scale (mJOA) and the radiological results using the Cobb angle, Sagittal Vertical Axis, T1 Slope and alignment (measured by Cobb-T1 Sloppe). Significant differences were observed in the postoperative improvement of the Nurick scale (P =.008) and mJOA (P =.018) in the laminoplasty group. In LFP there is a tendency to a greater improvement, but statistical significance is not reached due to the low sample size of this group. No statistically significant differences were observed in the radiological variables. Regarding the total number of complications, a higher number was observed in the laminoplasty group (7 cases) versus LFP (one case), but no statistically significant differences were observed. Laminoplasty and LFP are both safe and effective procedures in the treatment of cervical degenerative myelopathy. The findings of our study demonstrate statistically significant clinical improvement based on the Nurick and mJOA scales with laminoplasty. No significant differences in terms of complications or radiological variables were observed between the 2 techniques. [ABSTRACT FROM AUTHOR]

Our objective is to share our experience in neurogenic tumors of the sacral area, an uncommon disease, and assess approaches, intraoperative techniques, complications and clinical course of patients in a case series.

El objetivo del presente caso es describir una variación en la técnica quirúrgica del Preserflo Microshunt colocándolo en la cámara posterior para minimizar el riesgo de pérdida de células endoteliales en casos con endotelio comprometido.

Un buen conocimiento anatómico del cerebelo es fundamental para llevar a cabo abordajes al IV ventrículo (frecuentes en la neurocirugía pediátrica) de forma segura, evitando secuelas como el mutismo cerebeloso.

Nuestro sistema visual ha evolucionado para proveernos una imagen de la escena que nos rodea informándonos de su textura, color, movimiento y profundidad con una enorme capacidad de resolución tanto espacial como temporal, y a esta finalidad la formación de imágenes (FI) dedica la inmensa mayoría de nuestras células ganglionares de la retina (CGR) y gran parte de nuestra corteza cerebral. Por otra parte, una proporción minúscula de las CGR, además de recibir información de fotorreceptores clásicos conos y bastones, expresan melanopsina y son intrínsecamente fotosensibles (CGRif). Estas CGRif se dedican a funciones visuales no formadoras de imágenes (NFI), de las que somos inconscientes, pero que resultan imprescindibles para aspectos relacionados con nuestra fisiología cotidiana como la puesta en hora de nuestros ritmos circadianos y nuestro reflejo fotomotor, entre otras muchas. Desde el descubrimiento de las CGRif se pensó que las funciones FI y NFI eran compartimentos distintos regulados por diferentes CGR, pero este concepto ha evolucionado en los últimos años con el descubrimiento de nuevos tipos de CGRif que inervan regiones subcorticales FI y, por tanto, presentan funciones FI. Hoy se conocen 6 tipos diferentes de CGRif que se denominan M1-M6 y difieren en sus propiedades morfológicas, funcionales, moleculares, proyecciones centrales y responsabilidades en comportamientos visuales. En este trabajo revisamos el sistema visual melanopsínico, el campo de investigación más activo en visión y cuyo conocimiento ha crecido exponencialmente durante las últimas 2décadas, desde que se descubrieron por primera vez las CGR que dan origen a esta vía.

ABSTRACTIntroduction: Preservative-free (PF) medications represent a valuable treatment strategy in the lifelong management of glaucoma. By removing preservative toxicity, PF formulations provide tangible clinical benefits to glaucoma patients worldwide. They improve tolerability and adherence, leading to a positive impact in long-term intraocular pressure (IOP) control.Areas covered: A critical review of the subject is provided, including selected evidence on the safety and tolerability of currently available topical PF formulations. Cumulative evidence confirms that topical PF medications are at least equally efficacious to their preserved equivalents. There is convincing short-term evidence for superior tolerability and safety of PF formulations compared to preserved medications. The long-term benefits and success of PF therapy requires further elucidation.Expert opinion: Successful stepwise administration of medical therapy for glaucoma remains elusive. There is a greater risk for ocular toxicity and therapy failure with preserved topical glaucoma therapy. Currently available and emerging PF therapy options potentially optimize lifelong stepwise glaucoma therapy and may enhance outcome. To avert complications from preservatives leading to poor adherence, ideally, future antiglaucoma therapy should become 100% PF. There are still key aspects of PF therapy that warrant further investigation.

Elaborar un nuevo nomenclátor de actos y procedimientos médicos en oftalmología, basado en la Clasificación Internacional de Enfermedades CIE-9-MC. Establecer los principios generales y definir los criterios de baremación, indicadores cuantitativos y escalas de valoración. Determinar los algoritmos necesarios para el cómputo de las tarifas retributivas por acto médico.

Objectives: To analyze the reproducibility of the new iC100 rebound tonometer, to compare its results with the applanation tonometry and iCare PRO and to evaluate the preference between them.Materials and methods: For the study of reproducibility, 15 eyes of 15 healthy Caucasian subjects were included. Three measurements were taken each day in three separate sessions. For the comparative study, 150 eyes of 150 Caucasian subjects were included (75 normal subjects and 75 patients with glaucoma). Three consecutive measurements were collected with each tonometer, randomizing the order of use. The discomfort caused by each tonometer was evaluated using the visual analogue scale.Results: No statistically significant differences were detected between sessions. In the comparison between tonometers, the measurements with iC100 were statistically lower than those of Perkins (−1.35 ± 0.417, p= 0.004) and that iCare PRO (−1.41 ± 0.417, p= 0.002). The difference between PRO and Perkins was not statistically significant (p= 0.990). The mean time of measurement (in seconds) with iC100 was significantly lower than with Perkins (6.74 ± 1.46 vs 15.53 ± 2.01, p< 0.001) and that PRO (6.74 ± 1.46 vs 11.53 ± 1.85, p< 0.001). Visual analogue scale score with iC100 was lower than Perkins (1.33 ± 0.99 vs 1.73 ± 1.10, p< 0.05). In total, 61.7% preferred iC100 against Perkins.Conclusion: The reproducibility of this instrument has been proven good. iC100 underestimates intraocular pressure compared to applanation tonometry at normal values and tends to overestimate it in high intraocular pressure values. Most of the subjects preferred iC100 tonometer.

To compare corneal densitometry and topography variables in patients with primary congenital glaucoma (PCG) and healthy subjects.

Objective: To assess incidence and risk factors of cataract extraction in patients with primary congenital glaucoma, surgical outcome, and complications.Material and method: Retrospective cohort study, in which 108 patients with primary congenital glaucoma were included. Data collected were need for cataract extraction and at what age, intraocular pressure at diagnosis of primary congenital glaucoma, required antiglaucomatous surgeries, possible mutation in the CYP1B1 gene, and final visual acuity. Among the patients who required cataract extraction were visual acuity, intraocular pressure, and complications, evaluated preoperatively and postoperatively. The data were analysed with STATA.Results: A total of 198 eyes of 108 patients were included, with a median follow-up of 8 years (range: 5–53). In all, 32 eyes (16.2%) of 24 patients (22%) required cataract extraction. The median age for cataract extraction was 12.94 years (interquartile range: 2.42–22). The main identified risk factors associated with cataract extraction were antiglaucomatous surgeries (hazard ratio 1.48, p< 0.001) and valvular implant (hazard ratio 2.78, p< 0.001). Lens was implanted in 30/32 eyes and the main complications were intraocular pressure decontrol (n= 13), capsular fibrosis (n= 7), corneal decompensation (n= 4), lens subluxation (n= 4), and endophthalmitis (n= 1). Visual acuity improvement was observed after cataract extraction in 66.67% of eyes.Conclusions: There is a high incidence of cataract surgery in patients with primary congenital glaucoma, but generally outside of pediatric age. A greater risk of cataract extraction was identified in those patients with a greater number of antiglaucomatous surgeries, especially after valvular implantation. Despite the high rate of complications related to cataract extraction in primary congenital glaucoma, good visual improvement was observed after surgery.

Objective: To evaluate the potential utility of perfusion density measurements to discriminate patients with arterial hypertension by cardiovascular risk category.Methods: In this cross-sectional study, one eye per subject was evaluated (N = 73). The study cohort was divided into three groups according to the clinical criteria established by the European Guidelines for Arterial Hypertension: 26 controls, 24 patients with low cardiovascular risk, and 23 patients with very high cardiovascular risk. All patients were examined using RS-3000 Advance optical coherence tomography angiography to analyze macular and peripapillary perfusion density.Results: There were no differences among the three risk groups by sex or age. Decreased macular perfusion density was found at the level of the superficial and deep plexuses (p ⩽ 0.047). No differences were observed in peripapillary perfusion density (p = 0.18).Conclusion: Optical coherence tomography angiography can detect changes in macular perfusion density in patients with hypertension and high cardiovascular risk and might represent a supportive imaging method in the evaluation of the cardiovascular risk in hypertensive patients.

The prognosis of one hemisphere malignant infarction creates doubt among neurosurgeons about decompressive hemicraniectomy indication. What results are achieved in the short to medium term? Are families satisfied with the surgery once the patient is at home? In the present study, we analyze our experience in this matter during the last thirteen years.

El pronóstico en los infartos malignos de un hemisferio siembra dudas entre los neurocirujanos a la hora de indicar una hemicraniectomía descompresiva. ¿Qué resultados a corto y medio plazo se obtienen? ¿Están las familias satisfechas con la cirugía una vez el enfermo se encuentra en su domicilio? En el presente trabajo analizamos nuestra experiencia en esta materia en los últimos 13 años.

Analizar la correlación entre el grosor de la capa de fibras nerviosas peripapilar (cpRNFL) y el grosor de las capas internas de la retina con el defecto medio del campo visual (DM) en pacientes con glaucoma congénito primario (GCP).

Introduction This study was designed to examine the capacity of intraoperative optical coherence tomography (OCT) to predict the postimplant position of the glaucoma drainage device PreserfloTM.Methods 13 eyes (mean age 65.42 (14.89) years) underwent PreserfloTM (Santen, Osaka, Japan) placement. Before surgery, participants were subjected to a comprehensive ophthalmic examination (intraocular pressure (IOP), cup to disk ratio (C/D), visual field, OCT, endothelial cell count). Anterior segment OCT scans were obtained intraoperatively using a Rescan 700 OCT system (Carl Zeiss Meditec, Inc., Oberkochen, Germany). One day postsurgery, anterior segment OCT using the Spectralis OCT (Heidelberg Engineering GmbH) was performed in a sitting position to capture the same chamber cross-section as before. The main outcome variables were tube-endothelium distance (T-E) and tube length (TL) in the anterior chamber measured using both OCT systems. Correlation between intraoperative and office measurements was examined through Pearson correlation (r) and intraclass correlation coefficients (ICC).Results Mean intraoperative and in-office T-E were 625.26 (SD 366.60) versus 561.16 (SD 364.62) µm respectively (p= 0.540). Intraoperative and in-office anterior chamber TL were 1386 (SD 701.82) and 1433.91 (SD 713.55) µm, respectively (p= 0.029). Excellent correlation was observed between both sets of T-E (r= 0.992; p= 0.008) and TL (r= 0.984; p= 0.016) values. Both OCT systems showed good agreement yielding ICCs of 0.992 (p< 0.001) for T-E and 0.995 (p= 0.001) for TL.Discussion Excellent correlation was observed between our intraoperative and postoperative OCT measurements. These results support the usefulness of intraoperative OCT to confirm the correct position of an implanted PreserfloTM microshunt.

Los quistes de inclusión epitelial (QIE) representan una patología ocular muy poco frecuente con una fisiopatología aún no del todo conocida. Consisten en el crecimiento de células epiteliales de la superficie ocular dentro del segmento anterior del ojo en forma de quistes. Aunque se han publicado casos en la literatura sobre este tipo de lesiones, ninguno de ellos se ha relacionado con la cirugía de glaucoma hasta la fecha. Describimos 2 casos de QIE después del implante de dispositivos de drenaje de glaucoma. El primer caso se trata de un varón de 86 años con glaucoma primario de ángulo abierto que desarrolló un QIE 3 años después de la extracción de PRESERFLO® MicroShunt (Santen, Osaka, Japón), y el segundo, una mujer de 9 años con glaucoma secundario a uveítis por artritis idiopática juvenil que desarrolló un QIE debajo del tubo de la válvula Ahmed en el postoperatorio. Los QIE son proliferaciones benignas que se desarrollan tras heridas penetrantes o estímulos inflamatorios importantes. Requieren seguimiento para detectar complicaciones tempranas y evitar posteriores cirugías mutilantes en caso de ser necesaria su extracción.

Lumbar spine surgery causes a muscular injury during its approach that could worsen long-term postoperative functional results. This study aims to analyse the postoperative paraspinal atrophy associated with two types of intervention.

La cirugía de columna lumbar produce una lesión muscular durante su abordaje que podría empeorar los resultados funcionales postoperatorios a largo plazo. Este estudio pretende analizar la atrofia paraespinal postoperatoria asociada a dos tipos de intervenciones.

Evaluar el efecto del glaucoma en la función visual, la calidad de vida en los niños y la calidad de vida percibida por los cuidadores en niños de hasta 16 años.

El tumor fibroso solitario (TFS) es un tumor poco frecuente de origen mesenquimal, que se localiza principalmente en pleura. De extraordinaria infrecuencia es su localización a nivel intraespinal, siendo la región torácica la más frecuente.

Los quistes intraneurales son lesiones benignas de contenido mucinoso que se ubican dentro del epineuro de algunos nervios periféricos, de etiopatogenia controvertida. La mayoría se localizan a nivel de los miembros inferiores. Cuando aparece en los miembros superiores, el nervio más frecuentemente afectado es el cubital. De extraordinaria infrecuencia es el síndrome de atrapamiento del nervio supraescapular debido a la formación de un quiste intraneural del mismo. Con este artículo, aportamos un nuevo caso y realizamos una revisión de la literatura de los quistes intraneurales localizados en el nervio supraescapular.

En relación con la progresión del glaucoma, la presión intraocular (PIO) elevada es el principal factor de riesgo sobre el que se puede actuar. Las estrategias farmacológicas destinadas a reducir la PIO tienen como objetivo la reducción de la producción de humor acuoso (HA) y/o el aumento de su drenaje a través de la vía uveoescleral. Sin embargo, en la actualidad no hay ninguna estrategia farmacológica de primera elección que de forma principal esté destinada a facilitar la salida de HA por la vía convencional. La producción de óxido nítrico (NO) a nivel ocular tiene lugar en las rutas de flujo de HA y en el músculo ciliar, modulando la respuesta celular en situaciones de PIO elevada.