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Gema Rebolleda

Publications and source records attributed to Gema Rebolleda.

11 recordsLinked to original sources
PubMed2006

Evaluation of changes in peripapillary nerve fiber layer thickness after deep sclerectomy with optical coherence tomography.

PURPOSE: To detect and quantify changes, using optical coherence tomography (OCT), in the peripapillary retinal nerve fiber layer (RNFL) thickness in patients with glaucoma who underwent deep sclerectomy. DESIGN: Prospective, controlled, interventional case series. PARTICIPANTS: Thirty-four consecutive patients who underwent monocular deep sclerectomy (surgery group) and medically treated fellow eyes (control group). METHODS: Quantitative analysis of the peripapillary RNFL by OCT and automated perimetry were performed before surgery and 6 months after surgery in both eyes. MAIN OUTCOME MEASURES: The changes in RNFL thickness overall and by quadrant were evaluated and studied with respect to age, preoperative visual field test global indices, postoperative changes in intraocular pressure (IOP), and postoperative changes in visual field global indices. Changes observed in RNFL thickness were compared between eyes after surgery and in fellow eyes. RESULTS: The IOP decreased from a baseline mean of 23.6+/-5.1 mmHg to 11.7+/-2.9 mmHg (P<0.001) 6 months after surgery at the time of OCT testing. The mean percent IOP change was 48.4+/-15.7%. No significant changes in the mean RNFL thickness overall or by quadrant were observed after surgery or in the mean deviation (MD) and pattern standard deviation after surgery. There was no significant difference in the RNFL thickness between eyes in the surgery group and those in the control group. The mean preoperative visual field MD was significantly (P = 0.006) worse in eyes with a postoperative decrease in the overall RNFL thickness compared with those with an increase in the RNFL thickness. No correlation was found between RNFL thickness changes and age or changes in the visual field global indices. There was no significant difference between eyes with an IOP reduction of more than 50% and those with a reduction in IOP less than 30% (P = 0.514). CONCLUSIONS: The authors found no significant changes in the peripapillary RNFL thickness measured 6 months after deep sclerectomy. The only significant factor related to RNFL thickness changes after surgery was the preoperative visual field MD (P = 0.038).

Adult↗
PubMed2006

Optical coherence tomography versus automated perimetry for follow-up of optic neuritis.

PURPOSE: To evaluate the usefulness of optical coherence tomography (OCT) for follow-up of optic neuritis (ON) compared with subjective visual function tests. METHODS: Twelve patients with ON underwent a complete ophthalmological evaluation at initial diagnosis, including best corrected visual acuity (VA), visual fields testing and OCT examination. These examinations were repeated periodically over 6 months. Retinal nerve fibre layer (RNFL) thickness evolution was analysed and correlated with VA and visual field mean deviation. RESULTS: Six months after ON, mean RNFL in the affected eye decreased significantly compared with that in the fellow eye (24.54%). A significant correlation was found between RNFL thinning and final VA (r = 0.807, p = 0.005), with a 1-line drop in VA for every 5.4-micro m decrease. All patients with an altered visual field had an abnormal RNFL value; of the seven patients with normal visual fields, 57% had an abnormal RNFL value (p < 5%). CONCLUSIONS: Optical coherence tomography can detect axonal damage as early as the third month after an isolated initial episode of ON, even in the presence of normal visual fields. Mean RNFL thinning is correlated with final VA.

Adult↗
PubMed2005

Comparison of lidocaine 2% gel versus retrobulbar anaesthesia for implantation of Ahmed glaucoma drainage.

PURPOSE: To compare patient comfort and the efficacy of lidocaine 2% gel versus retrobulbar anaesthesia for Ahmed glaucoma implant surgery. PATIENTS AND METHODS: This prospective study included 32 eyes of 32 patients scheduled to undergo implantation of an Ahmed glaucoma drainage device for refractory glaucoma in one institution, randomized to receive either topical lidocaine 2% gel or retrobulbar anaesthesia. Sixteen eyes were randomized to each group. Patient assessment of pain was recorded during delivery of anaesthesia, during surgery and after surgery, using a visual analogue pain scale. The need for additional anaesthesia during tissue manipulation was recorded. Surgeon assessments of operative conditions, patient co-operation and intraoperative complications were also recorded. RESULTS: The patients in the retrobulbar group reported significantly more discomfort during administration of the anaesthetic agent than the patients in the topical anaesthesia group (p = 0.000). There was no significant difference in patient-reported pain scores intraoperatively (p = 0.317) or postoperatively (p = 0.875). Surgeon assessment showed similar levels of patient co-operation in both groups (p = 0.615). The overall operating conditions were overwhelmingly positive in each group (p = 0.186). The mean duration of surgery was significantly longer in the topical group compared with the retrobulbar group (p = 0.049). CONCLUSIONS: Lidocaine 2% gel is a safe alternative to retrobulbar anaesthesia for Ahmed drainage implant surgery and avoids the significantly greater pain associated with the administration of retrobulbar anaesthesia. It provides a reasonably safe and comfortable surgical environment and is well tolerated by patients.

Aged↗
PubMed2005

Capsular bag distension syndrome after combined cataract and glaucoma surgery.

PURPOSE: To report four cases of capsular bag distension syndrome (CBDS) after combined cataract and glaucoma surgery. METHODS: We describe the clinical features and evolution of each case after individual treatment. CASE REPORTS: We report four cases of CBDS after phacoemulsification, combined with trabeculectomy in two cases and with an Ahmed aqueous drainage device implantation in the other two cases. The space between the intraocular lens (IOL) and the posterior capsule was occupied by an optically clear liquid in two cases and by a turbid liquid in the other two cases, with posterior bowing of the capsule into the anterior vitreous. A myopic shift and anterior chamber shallowing occurred in three cases. After posterior Nd:YAG laser capsulotomy, the CBDS resolved in three cases. In case 1, a surgical posterior capsulotomy and anterior vitrectomy were necessary. DISCUSSION: Capsular bag distension syndrome should be included in the differential diagnosis of a shallow anterior chamber after combined cataract and glaucoma surgery.

Aged↗
PubMed2004

Refractive changes after phacoemulsification combined with deep sclerectomy assisted by corneal topography.

PURPOSE: To evaluate the corneal surgically induced refractive change (SIRC) after phacoemulsification and deep sclerectomy. SETTING: Glaucoma Unit, Department of Ophthalmology, Hospital Ramon y Cajal, Madrid, Spain. METHODS: This prospective study comprised 38 eyes of 35 patients with a mean age of 77 years having phacoemulsification using a right clear corneal approach (temporal approach and nasal approach in the right eye and the left eye, respectively) combined with a deep sclerectomy and placement of a reticulated hyaluronic acid implant in the superior quadrant. Computerized keratography was performed preoperatively and 1 month and 3 months postoperatively. The SIRC was calculated at each follow-up by the Holladay-Cravy-Koch method and was expressed vectorially in 3 Cartesian coordinates to facilitate statistical analysis. RESULTS: The magnitude of the resulting mean SIRC components was very small. No significant change was observed in any vectorial component 1 month and 3 months postoperatively. Overall, 47.4% of patients had an induced with-the-rule astigmatism change at 3 months (range 0.03 to 1.67 diopters [D]); however, the mean change was less than 0.50 D and not statistically significant. The mean spherical postoperative change was greater in left eyes than in right eyes (P = .05). No statistically significant changes between the right eye and left eye were observed in the astigmatism vectorial components. CONCLUSIONS: Overall, the refractive change after phacoemulsification combined with deep sclerectomy was mild and not clinically significant. The greater mean spherical change in left eyes than in right eyes might be related to the phacoemulsification approach.

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PubMed2002

Phacoemulsification in eyes with functioning filtering blebs: a prospective study.

OBJECTIVE: To evaluate the effect of phacoemulsification on intraocular pressure (IOP) control in eyes with a previous functioning filtering bleb and no glaucoma medication. DESIGN: Prospective, nonrandomized comparative (self-controlled) trial. PARTICIPANTS: Forty-seven patients (49 eyes) who underwent phacoemulsification after successful trabeculectomy, with at least 12 months of follow-up. INTERVENTION: Clear corneal phacoemulsification and implantation of a foldable intraocular lens in eyes that underwent a previous successful trabeculectomy. The time between both procedures was always greater than 1 year. MAIN OUTCOME MEASURES: Preoperative and postoperative IOP, the number of glaucoma medications, bleb appearance, and visual acuity were recorded at each follow-up examination. Success was defined as no need for glaucoma medications, bleb needling, or further glaucoma surgery for IOP control after phacoemulsification. Preoperative and intraoperative factors were evaluated for an association with postoperative failure using Kaplan-Meier survival analysis. RESULTS: The mean (+/- standard deviation) IOP before phacoemulsification was 12.24 (+/- 4.68) mmHg, and it increased 3.94, 3.76, 1.39, 2.04, and 1.57 mmHg on the first postoperative day, after 1, 6, and 12 months, and at the last visit, respectively. At each interval, the mean IOP was significantly higher than the preoperative value (P = 0.000, 0.000, 0.049, 0.01, and 0.01, respectively). Nevertheless, the mean IOP after phacoemulsification was always lower than before trabeculectomy (P = 0.000). At the last visit, glaucoma medication was required in 17 eyes (34.7%). The success rates after phacoemulsification were 83.6%, 68.2%, and 55.7% at 6 months and 1 and 2 years, respectively (Kaplan-Meier survival analysis). The number of glaucoma medications used increased at all follow-up visits (P < 0.005). Bleb size decreased after phacoemulsification (P = 0.000). An IOP before phacoemulsification of greater than 10 mmHg was associated with postoperative failure (P = 0.002). Similarly, bleb failure and the need for glaucoma medication were associated with higher IOPs before phacoemulsification. CONCLUSIONS: Phacoemulsification significantly increased IOP and the number of glaucoma medications in eyes with preexisting functioning filtering blebs. Eyes with higher IOPs before phacoemulsification had worsened postoperative IOP control and bleb failure.

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