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Biomedical subjects

G Rebolleda

Publications and source records attributed to G Rebolleda.

At least 19 recordsLinked to original sources
PubMed2006

Cup-to-disc ratio: agreement between slit-lamp indirect ophthalmoscopic estimation and stratus optical coherence tomography measurement.

PURPOSE: To determine agreement between slit-lamp indirect ophthalmoscopy and Stratus optical coherence tomography (OCT) when assessing cup-to-disc ratios (CDRs). METHODS: Twenty-five ocular hypertensive subjects and 56 patients with primary open-angle glaucoma were included. Estimation of vertical (VCDR) and horizontal (HCDR) cup-to-disc ratio with slit-lamp ophthalmoscopy was made by three glaucoma specialists along with OCT scanning of optic nerve head. Agreement between OCT and specialists was measured by intraclass correlation coefficients (ICC), Bland and Altman's scatterplots, and a regression coefficient of the average difference. RESULTS: The mean VCDR and HCDR was significantly higher (P<0.001) with OCT than that estimated by the specialists, with the difference ranging from 0.08 to 0.11, and from 0.13 to 0.18, respectively, depending on the specialist. Difference was higher (P<0.001) for cuppings below 0.3, and looses significance for larger VCDR cuppings (above 0.7). ICC for VCDR was 0.87 among specialists, and ranges from 0.82 to 0.75 when comparing OCT and specialists. ICC for HCDR was 0.83 among specialists and 0.74 between OCT and specialists. When data were plotted according to the Bland-Altman method, as the cupping increased, the agreement also increased. CONCLUSIONS: There is very good agreement among the specialists when estimating CDRs by stereoscopic slit-lamp biomicroscopy. OCT shows higher values than the specialists; the greatest differences occurred when assessing small CDRs and the differences diminished as the cupping increased. These two methods of measurement are not interchangeable, and the difference must be considered, especially in discs with smaller CDRs.

Early Diagnosis↗
PubMed2006

[Ultrasound biomicroscopy in deep sclerectomy with a new acrylic implant].

OBJECTIVE: To describe the ultrasound biomicroscopic (UBM) characteristics seen in patients who have undergone deep phaco-sclerectomy with a new acrylic implant (Esnoper). SUBJECTS, MATERIAL AND METHODS: UBM exploration was performed 12 months after deep phaco-sclerectomy in three patients with chronic open angle glaucoma. RESULTS: One year after surgery, all three patients had intraocular pressure levels under 15 mmHg and were on no treatment. All of them had an intrascleral space in UBM, in which the hyperechogenic implant was visible. CONCLUSIONS: The new non-absorbable implant has proven to be effective in these cases. Information provided by UBM is useful and assists in understanding the mechanism of action of deep sclerectomy.

Acrylic Resins↗
PubMed2005

Deep sclerectomy with mitomycin C in failed trabeculectomy.

AIM: To evaluate the success rate and complications associated with deep sclerectomy with mitomycin C (MMC) and a reticulated hyaluronic acid implant in previously failed trabeculectomy. METHODS: This prospective study included 20 eyes with a previously failed trabeculectomy, which were treated with deep sclerectomy with 0.2 mg/ml MMC application under the conjunctiva and superficial scleral flap. Intraocular pressure (IOP), glaucoma medications, visual acuity, and complications were recorded preoperatively and 1 day, 1 week, and 1, 3, 6, and 12 months postoperatively. RESULTS: The mean preoperative IOP was 25.8+/-7.3 mmHg; the IOP significantly decreased to 14.6+/-3.2 mmHg 1 year postoperative. At each interval, the mean IOP was significantly lower than preoperatively (P=0.000). At 1 year, the complete success rate (IOP<or=21 mmHg untreated) was 65% and the qualified success rate (IOP<or=21 mmHg with and without medication) was 100%. 12 patients (60%) achieved an IOP<or=15 mmHg with and without medication. No shallow or flat anterior chamber, endophthalmitis, or leakage developed. CONCLUSIONS: These data suggest that deep sclerectomy augmented with MMC is a safe surgical procedure that decreases IOP in eyes with a previously failed trabeculectomy.

Aged↗
PubMed2005

[SCA-7. Cone-rod dystrophy in the context of an hereditary ataxia].

CLINICAL CASE: A 21-year-old male presented with bilateral loss of visual acuity within the last year, and cerebellar ataxia since childhood. Two members of his family had a similar disorder. Examination showed bilateral central scotomas, as well as an electroretinogram pattern and optic coherence tomography images consistent with cone-rod dystrophy. Molecular analysis by PCR amplification and genotyping of the SCA7 gene established the diagnosis of SCA-7. DISCUSSION: SCA-7 is a polyglutamine expansion disorder and the only spinocerebellar ataxia that shows a cone-rod dystrophy phenotype, which probably results from interference with the action of specific cone-rod genes.

Adult↗
PubMed2004

[IOP spikes following contact transscleral diode laser cyclophotocoagulation].

PURPOSE: To evaluate the incidence of intraocular pressure (IOP) spikes after contact transscleral diode laser cyclophotocoagulation (cyclodiode) and to identify related risk factors. METHOD: Retrospective study of 116 eyes (110 patients) with refractory glaucoma who underwent cyclodiode. IOP measurement was obtained immediately before and one hour after cyclodiode. We defined an IOP spike as an increase equal or superior to 5 mmHg after laser treatment. We evaluated several potential pre-, intra- and post-operative factors related to the IOP spike occurrence. RESULTS: Mean IOP decreased one hour after cyclodiode 6.96 mmHg (SD: 8.36) (p<0.001). Overall, we observed 10.8% of IOP spikes. Age, sex, mean energy delivered, pop occurrence and iris colour were not associated with the postoperative IOP spike occurrence. The percentage of IOP spikes was higher in neovascular glaucoma (p=0.074). The IOP spike rate was also higher after retreatment, but the difference compared to the eyes which underwent cyclodiode for the first time was not significant. CONCLUSIONS: These preliminary results suggest that IOP spike prevention could be considered in neovascular glaucoma scheduled for cyclodiode

Aged↗
PubMed2003

[Frequency-doubling perimetry in retrochiasmatic disorders].

OBJECTIVE: To determine the ability of frequency doubling technology (FDT) to evaluate retrochiasmatic lesions. METHODS: 21 patients with characteristic retrochiasmatic visual field defects in automated perimetry (Humphrey field analyzer, 24-2 SITA) underwent FDT using C-20 screening and threshold tests. Two independent observers described the visual field defects, the degree of congruence and macular sparing of the three explorations. RESULTS: The visual field defect found in the 24-2 test was inferred in 63.2% and 70% of the eyes from the C-20 screening and C-20 threshold test respectively. The retrochiasmatic lesions were congruent in 45% of the cases in automated perimetry, 5.6% in C-20 screening and 15% in C-20 threshold test. Macular sparing was present in 45% of cases with automated perimetry, 89% with C-20 screening and 82% with C-20 threshold test. CONCLUSIONS: The FDT allows us to suspect retrochiasmatic lesions in more than one-half of patients, but it tends to underestimate the defects. It is not useful for detecting macular sparing or the evaluation of visual field congruence. Both FDT strategies offer similar results, so the C-20 screening test could be more advisable because of its speed (mean: 70 seconds). However, in retrochiasmatic lesions the FDT accuracy is considerably lower than the 24-2 SITA strategy.

Female↗
PubMed2003

[Frequency doubling perimetry in terminal visual field defects].

PURPOSE: To evaluate the Frequency Doubling Technology (FDT) in end-stage glaucomatous visual field defects. METHODS: FDT (C-20 threshold test) was performed in 22 consecutive patients presenting an end-stage visual field defect with 24-2 SITA (0 dB in more than 75% and less than 100% of the visual field). Comparisons of the percentage of non-abolished points, topographic correlation, test duration and global indexes were performed between C-20 and 24-2 SITA test. RESULTS: FDT sensitivity was 100%. C-20 test showed 13.7% more points with sensitivity greater than 0 dB compared to 24-2 test (P = 0.002). Two and a half less minutes were required for C-20 test performing (P<0.001). The mean value of Mean Defect was 11.48 dB better in FDT (P = 0,000). The mean value of the Pattern Standard Deviation was 5.37 dB (SD: 1.92) and 6.35 dB (SD: 3.61) for 24-2 and C-20 test respectively (P = 0.258). The inferotemporal quadrant was the best conserved in both perimetric strategies (Kappa agreement test value = 0.911; P<0.001). CONCLUSIONS: FDT showed greater ability than 24-2 test for end-stage visual field defects evaluation, with the advantage of being less time-consuming. Very good topographic correlation between both strategies was found. Further studies evaluating FDT reproducibility in severe glaucomatous visual field damage are necessary.

Adult↗
PubMed2003

[Ultrasonic biomicroscopic findings after spontaneous resolution of a traumatic cyclodialysis].

CASE REPORT: We present one patient that received a blunt trauma in his right eye that resulted in ocular hypotension and hypotony maculopathy. UBM demonstrated the presence of a cyclodialysis. Several months later the patient experienced spontaneous improvement. A new UBM documented the presence of an anterior synechia closing the cleft. DISCUSSION: Ciclodyalisis is an infrequent problem. There are several treatment options, including conservative treatment, laser cyclopexy or surgical cyclopexy. Sometimes an spontaneous closure of the cleft may occur.

Adult↗
PubMed2003

[Non-penetrating deep sclerectomy combined with phacoemulsification. Results and complications].

PURPOSE: To evaluate the efficacy and safety of phaco-deep nonpenetrating sclerectomy (PDNS) with reticulated hyaluronic acid implant for glaucoma combined surgery. MATERIAL AND METHODS: Noncomparative retrospective study of 39 eyes of 36 patients who underwent PDNS. Preoperative and 1, 7 days, 1, 3, 6 and 12 months after surgery data retrieved were best-corrected visual acuity, intraocular pressure (IOP), number of glaucoma medications and intra and postoperative complications. RESULTS: Mean preoperative IOP was 23.1 mm Hg (SD: 8.8). Statistically significant reduction in IOP was observed in all postoperative visits (P = 0.000); a mean IOP reduction of 8.63 mm Hg (SD: 8.55) and 6.88 mm Hg (SD: 5.46) was found 6 and 12 months after surgery respectively. Mean percentage of IOP reduction was 32.78% (SD: 21.30) and 27.74% (SD: 18.15) six and twelve months after surgery respectively. Mean preoperative number of glaucoma medications was 1.76 (SD: 0.85). In all postoperative visits a statistically significant reduction in the number of glaucoma medications was observed (P = 0.000). One year after PDNS, mean number of antiglaucoma drugs was 0.34 (SD: 0.60), and 71.9% of the eyes did not need any glaucoma medication. Predetermined target IOP was achieved in 84.2% of the eyes. A gain of almost 3 lines of mean VA was observed one year after surgery. Severe inflammatory reaction (7.7%) and hyphema (5.1%) were the most frequent observed complications. CONCLUSIONS: These preliminary results suggest that PDNS could be a safe and effective surgical technique for combining glaucoma and cataract surgery.

Aged↗
PubMed2003

[Extender-tube for Ahmed glaucoma valve implant].

CASE REPORT: We describe the case of a 16 year-old woman, with inflammatory glaucoma secondary to juvenile rheumatic arthritis, successfully treated by Ahmed glaucoma valve implant. Two years later, a severe increase of intraocular pressure related to anterior tube migration occurred. The Ahmed valve tube extender was successfully used to lengthen the tube. DISCUSSION: If the tube length is too short to reintroduce it into the eye, there are three surgical options: to use a tube extender, to insert the tube via the pars plana or to insert a new drainage implant. A piece of an angiocatheter or a silastic tube have been used for lengthening the tube of the valve implant; however the Ahmed valve tube extender design makes surgery easier and allows keeping the valve in the original place, minimizing the risk of postoperative migration.

Adolescent↗
PubMed2002

[Automated perimetry and neuro-ophthalmology. Topographic correlation].

Visual fields continue to be a key exploration for the diagnosis and follow-up of patients in neuro-ophthalmology. The pattern of visual field defects helps, and in many cases allows, the identification of brain damage location. Manual kinetic perimetry has been replaced by automated methods. 24-2 SITA (Humphrey Visual Field Analyser) and TOP (Octopus) are regarded as the standard perimetric explorations in neuro-ophthalmology. Goldmann perimetry remains as an useful exploration for temporal crescent detection in occipital lobe diseases, and it could be more accurate and consistent for studying lesions in the post-geniculate pathway. Frequency doubling perimetry could be useful for detecting neuro-ophthalmic visual field defects, but does not provide an accurate characterisation of the lesions. From the neuro-ophthalmic point of view, visual field defects could be divided in pre-chiasmatics, chiasmatics and post-chiasmatics. Pre-chiasmatic defects are strictly unilateral, do not respect the vertical meridian, often have a nasal step associated and are usually accompanied by ocular pathology detectable in an ophthalmic examination. The characteristic perimetric pattern of chiasmal disease is bi-temporal hemianopsia. Homonymous contralateral defects are the characteristic perimetric pattern of post-chiasmal disease, and their congruency increases when the lesions are closer to the occipital lobe. Neuroimage studies are mandatory in all patients with a perimetric defect pattern compatible with chiasmal or post-chiasmal lesions. Magnetic Resonance Imaging may be normal in a patient with homonymous defects in Alzheimer's disease, the Heidenhain variant of Creutzfeldt-Jakobs disease, carbon monoxide poisoning and mild occipital ischemia demonstrated by SPECT or PET imaging (Arch Soc Esp Oftalmol 2002; 77: 413-428).

Humans↗
PubMed2001

Topical plus intracameral lidocaine versus retrobulbar anesthesia in phacotrabeculectomy: prospective randomized study.

PURPOSE: To compare the efficacy and safety of topical and retrobulbar anesthesia for phacotrabeculectomy. SETTING: Hospital Ramón y Cajal, Madrid, Spain. METHODS: This prospective study comprised 60 patients (60 eyes) having phacotrabeculectomy surgery. Patients were randomly assigned to 1 of 2 groups receiving topical anesthesia plus intracameral lidocaine 1% or retrobulbar anesthesia. Patients were asked to document the discomfort they experienced during the administration of the anesthetic agent, during surgery, and postoperatively using a numeric pain scale. Complications and surgical conditions were also evaluated. RESULTS: The retrobulbar group reported significantly more discomfort during administration of the anesthetic agent than the topical group (P < .001). The topical group reported significantly more discomfort intraoperatively (P < .01). Eyelid squeezing and eyeball movement were more common in the topical group; however, neither was a problem to the surgeon. There was no difference in surgical conditions (P = .38) or the postoperative pain scores between the 2 groups (P = .06). One patient receiving topical anesthesia developed a suprachoroidal hemorrhage intraoperatively. CONCLUSIONS: Topical anesthesia supplemented with intracameral lidocaine was an effective alternative to retrobulbar anesthesia for phacotrabeculectomy. Although the degree of patient discomfort was significantly higher during surgery under topical anesthesia, the method avoids the pain and complications associated with a retrobulbar injection.

Administration, Topical↗