Browsing by Author "Rojas Alvarez, Eduardo"

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Clinical-surgical Characteristics of Patients with Macular Hole. Exilaser Ophthalmological Center. Cuenca, Ecuador. 2015-2019
(2023) Miotto Montesinos, Giuseppe Cornelio
Background: The macular hole (MH) is one of the least studied ophthalmological pathologies; satisfactory treatment has been achieved through the implementation of surgical techniques a few years ago and the study and analysis of its clinical-surgical characteristics are of vital importance to assess the success of surgery with intrinsic and extrinsic factors. Objective: Describe the clinical-surgical characteristics of patients diagnosed with a macular hole at the EXILASER Ophthalmological Center in Cuenca in the period 2015-2019. Methods: Descriptive, retrospective study. The study universe corresponds to 75 patients who attended the EXILASER Ophthalmological Center and were diagnosed with MH between January-2015 and December-2019. Results: 76.0% of the patients are women; 81.3% are between 60 and 79 years old; 96.0% reside in urban areas; 34.7% are dedicated to housework; 24.0% report cataracts; 26.7% have arterial hypertension; 84.0% presented loss of central vision; 80.0% had decreased visual acuity. 50.7% presented affection only in the right eye; 53.3% had a chronic evolution greater than one year; 33.3% presented grade III MH. 44.0% had surgery; 93.9% had anatomical surgical closure. The relationship between the degree of MH, time of evolution, and closure of the MH was not significant (p> 0.05). Conclusion: The success rate of MH closure after surgical intervention is greater than 90% with improvement in postoperative visual acuity. No significant association was found between the grade of the MH, time of evolution, and the closure of the MH.
Conventional PRK versus single-step transPRK in corneal refractive surgery with excimer laser
(2021) Miotto Montesinos, Giuseppe Cornelio; Rojas Alvarez, Eduardo; Torres Piedra, Diego Manolo; Torres Palacios, Nataly Carolina
Objective: To compare conventional alcohol-assisted PRK (aaPRK) and single-step transPRK in terms of clinical-refractive and surgical variables. Method: An observational, prospective, longitudinal study was carried out in 72 patients who were candidates for corneal refractive surgery with the excimer laser, with a diagnosis of compound myopic astigmatism, at the Exilaser Ophthalmological Center, Cuenca, Ecuador, from September to December 2019. Patients underwent surface surgery (transPRK or aaPRK). Data processing was performed with the SPSS program, version 21.0. For data comparison between both surgical techniques, the chi-square test was used, where P < 0.05 was considered statistically significant. Results: The average spherical equivalent was obtained for aaPRK (−0.14) and transPRK (−0.11) 3 months after the procedure (p = 0.34). UCVA average was 0.93 in aaPRK and 0.96 in transPRK, without statistically significant differences (p = 0.63). Surgical time was shorter in transPRK (720.31 s) compared to aaPRK (1080.85 s), with a statistically significant difference (p < 0.001). In transPRK there was less pain immediately after surgery, compared to aaPRK (p <0.05). Epithelial closure was achieved on day 6.27 for aaPRK and in day 3.62 for transPRK (average values; p = 0.02). conclusions: Single-step transepithelial PRK and aaPRK in patients who are candidates for refractive surgery showed very similar results 3 months after surgery in terms of uncorrected visual acuity, spherical equivalent and with minimal postoperative complications. TransPRK offers greater advantages to the patient regarding shorter surgical time, rapid epithelial closure and less pain in the immediate postoperative period.
Cornea confocal microscopy: utilities and perspectives
(IntechOpen, 2021) Rojas Alvarez, Eduardo
The cornea is the ocular refractive medium with the greatest refractive power of the eye. The study of it is of vital importance for the diagnosis and follow-up of ophthalmological diseases with the aim of achieving high standards of visual acuity in our patients. Confocal microscopy of the cornea allows in-depth study of it, quickly, safely, painlessly, obtaining high-resolution images of the corneal sublayers. This chapter summarizes the procedure for performing corneal confocal microscopy, the normal characteristics of the tissue with real images of our patients, as well as a brief explanation of the main applications of this technology in the study of corneal dystrophies (keratoconus), in refractive surgery, corneal transplantation, infectious keratitis, glaucoma filtration bulla, among other topics.
Corneal indices determined with pentacam in possible candidates for corneal refractive surgery
(2020) Rojas Alvarez, Eduardo; Miotto Montesinos, Giuseppe Cornelio; Torres Piedra, Diego Manolo; Torres Palacios, Nataly Carolina; Fosado Tellez, Osvaldo Alberto
Objective: To describe the level of correlation of clinical refractive variables with corneal indices in Pentacam Scheimpflug tomography, demonstrate the usefulness of the study of corneal indices in the diagnosis of keratoconus (KC), and identify the corneal indexes with the greatest influence on the diagnosis of KC. Methods: A descriptive, retrospective, and cross-sectional study was conducted in 69 patients (138 eyes) with refractive disorders, possible candidates for corneal refractive surgery, at the Exilaser Ophthalmological Center, Cuenca, Ecuador, from March to August 2019. Corneal indices were studied using Pentacam. Statistical correlation methods, Levene’s test, Fisher’s exact test, Cramérs’ V coefficient, and multiple correspondence analyses were used. Results: The variables refractive cylinder and central keratometry had a direct correlation with the corneal indices (p<0.001). An inverse correlation was obtained between central pachymetry and corneal indices (p<0.001). A high level of dependence on central KC index (CKI) (Cramér V = 0.785) and KC index (KI) (Cramér V = 0.775) was obtained with the diagnosis of KC. Conclusions: Pentacam is a valuable tool in the analysis of corneal indices for the diagnosis of KC, given its high level of correlation with clinical refractive variables. The selection of candidates for refractive surgery, even when there is no diagnosis of KC, is strengthened with the analysis of the corneal indices. The indices with the most intense level of dependence with the diagnosis of KC are, in order, the following indices: CKI, KI, vertical asymmetry, minimum radius, and variation of the surface
Intense regulated pulsed light (IRPL) for dry eye treatment
(Intechopen, 2023) Rojas Alvarez, Eduardo
IRPL was traditionally used for the treatment of a variety of dermatological diseases such as rosacea. However, third-generation equipment was created specifically for periocular application with multiple homogeneously sculpted pulses “It is the only IRPL device medically certified to treat Meibomian Gland Dysfunction.” Several hypotheses or effects of how the device works have been proposed. Ablation of the small telangiectatic vessels around the eyelid, elimination or reduction of the ectoparasite Demodex, which resides in the meibomian glands and consumes meibum secretions in patients who have rosacea, photomodulation of the glands stimulates cellular activity, improving the micro and macro structure of the meibomian glands. In addition, the modification would decrease the inflammation surrounding them.
Keratoconus in pediatric age: Clinical-refractive characteristics and evolution. Donum foundation medical specialties center. Cuenca. Ecuador. 2015-2018
(2019) Rojas Alvarez, Eduardo
© 2019 Sociedad Mexicana de Oftalmología. Objective: The objective of the study was to describe the clinical-refractive characteristics of keratoconus (KC) patients at pediatric age and their evolution, at the Donum Foundation Medical Center, Cuenca, Ecuador. Methods: An observational, prospective, and longitudinal study was carried out in 94 pediatric patients (188 eyes) diagnosed with KC, diagnosed in 2015 and followed up to 2018, in the Donum Foundation Medical Center, Cuenca, Ecuador. The arithmetic mean of the sample was obtained: mean keratometry, pachymetry at the thinnest point and refractive cylinder, at two moments. The analysis of variance of repeated measures was used for a factor with confidence interval adjustment by Bonferroni and p-value. Results: A statistically significant increase was obtained between the mean value of average keratometry of the sample (49.6 D), at the time of diagnosis, and the mean value of average keratometry at 3 years of follow-up (52.4 D). (p = 0.02; α = 0.05) A statistically significant decrease was obtained between the average pachymetry of the sample, at the time of diagnosis (482 μm), and the average pachymetry of the sample, at 3 years of follow-up (459 μm) (p = 0.03; α = 0.05). A statistically significant increase was obtained between the average refractive cylinder of the sample, at the time of diagnosis (4.6 D), and the average refractive cylinder of the sample, at 3 years of follow-up (5.1 D) (p = 0.01; α = 0.05). Conclusions: The modifications of keratometry, refractive cylinder, and pachymetry suggest progression of the disease in this age group, in a period of 3 years.
Microscopía confocal secuencial de regeneración nerviosa corneal en operado de miopía por PRK
(2018) Rojas Alvarez, Eduardo; González Sotero, Janet
Different moments of regeneration of the stromal nerves and sub-basal nerve plexus are observed in images taken at the same depth with the microscope Confoscan 4® (NIDEK). The stromal nerves are located in the anterior and middle stroma; they appear as linear, thin, reflective structures in different orientations, with a dichotomous pattern. No internal details of the nerves are observed1. In the sequence, the increase in reflectivity and nerve length during the first postoperative year is observed. The sub-basal nerves are located between the Bowman’s membrane and the basal epithelium. They appear as linear structures with homogeneous reflectivity, a dichotomous appearance with a Y shape, and fine interconnection fibers with an H shape1. The absence of lamellar cut influences that after PRK the preoperative characteristics of the sub-basal nerve plexus recover more quickly, and this recovery is complete one year after the surgery. The depth of ablation, the amount of stromal tissue removed and the depth of damage to the stromal nerves are closely related
Neurorretinitis atípica por toxoplasma con vítreo transparente
(2022) Fortún Campos, Abel
Purpose: Describe the clinical and tomographic findings of a case with atypical ocular toxoplasmosis. Case report: A 32-year-old male patient who began with decreased visual acuity in the left eye, with papillary edema and transparent vitreous, without a macular star. Presence of positive IgM for toxoplasmosis. Laboratory results, papillary optical coherence tomography and characteristics of the fibers of the optic nerve are shown. After treatment for toxoplasma was started, significant clinical improvement was obtained from the patient, verified with images of the fundus. Conclusions: Papillary edema due to toxoplasmosis with clean vitreous is not frequent in practice. However, it is a picture that must be taken into account in the differential diagnosis as an atypical presentation of ocular toxoplasmosis.
Queratocono en edad pediátrica: características clínico-refractivas y evolución. Centro de Especialidades Médicas Fundación Donum, Cuenca, Ecuador, 2015-2018
(2019) Rojas Alvarez, Eduardo
Objective: To describe the clinical-refractive characteristics of KC patients at pediatric age and their evolution, at the Donum Foundation Medical Center, Cuenca, Ecuador. Method: An observational, prospective and longitudinal study was carried out in 94 pediatric patients (188 eyes) diagnosed with KC, diagnosed in 2015 and followed up to 2018, in the Donum Foundation Medical Center, Cuenca, Ecuador. The arithmetic mean of the sample was obtained: mean keratometry, pachymetry at the thinnest point and refractive cylinder, at two moments. The analysis of variance (ANOVA) of repeated measures was used for a factor with confidence interval adjustment by Bonferroni and p value. Results: A statistically significant increase was obtained between the mean value of average keratometry of the sample (49.6 D), at the time of diagnosis, and the mean value of average keratometry at 3 years of follow-up (52.4 D). (p = 0.02; a = 0.05), a statistically significant decrease between the average pachymetry of the sample, at the time of diagnosis (482 µm), and the average pachymetry of the sample, at 3 years of follow-up (459 µm) (p = 0.03; a = 0.05) A statistically significant increase was obtained between the average refractive cylinder of the sample, at the time of diagnosis (4.6 D), and the average refractive cylinder of the sample, at 3 years of follow-up (5.1 D) (p = 0.01; a = 0.05). Conclusions: The modifications of keratometry, refractive cylinder and pachymetry suggest progression of the disease in this age group, in a period of 3 years.
Refractive and Topographic Parameters of the Belin/Ambrósio Module in Patients with Refractive Defects in Cuenca, Ecuador
(2023) Rojas Alvarez, Eduardo; Alvarez Guachichulca, Javier Santiago; Chavez Espinoza, David Sebastian
Objective: This study aimed to describe the refractive and topographic parameters of the Belin/Ambrósio module in patients with refractive defects at the Latino clinic in Cuenca, Ecuador, between 2017 to 2021. Methods: A descriptive, cross-sectional study was carried out. A database included anonymous cases of patients with refractive defects treated at the ophthalmological consultation of a Latino clinic from January, 2017 to June, 2021 was searched. Data was collected using a form containing study variables. Microsoft Excel and SPSS were used for data collection and analysis using frequencies, percentages, and measures of central tendency. Results: The sample consisted of 120 patients; 61.7% were women, and 38.3% were men. Moreover, 70.8% of patients were young adults. The pachymetry mean of the center of the pupil, apex, and position of lowest pachymetry was 521 µm, 520 µm, and 513 µm, respectively. The means of the flattest keratometry, curviest keratometry, and maximum keratometry were 43.30 D, 46.32 D, and 48.01 D, respectively. Conclusion: Cases distribution according to anterior and posterior elevation showed pathological values in more than 50% of the studied corneas. According to the average progression index, pathological elevation was found in 18.8% of the cases, and according to the average deviations, 25.4% presented corneal ectasia in different stages.
Resultados preliminares del tratamiento con luz pulsada intensa regulada en el síndrome de ojo seco
(2018) Miotto Montesinos, Giusseppe Cornelio; Rojas Alvarez, Eduardo; Torres Piedra, Diego Manolo
Objective: To describe the preliminary results of the use of Intense Regulated Pulsed Light (IRPL) in patients with Dry Eye Syndrome due to Meibomian Gland Dysfunction (MGD). Methods: A descriptive, longitudinal and prospective study was performed in 32 patients diagnosed with Dry Eye Syndrome, in which treatment with IRPL was applied between April-December 2017 at the Ophthalmological Center Exilaser, in Cuenca, Ecuador. Three treatment sessions were performed on Day 0, Day 15 and Day 45. Absolute and relative frequencies, Pearson test and Fischer test were used for statistical analyses. Results: After treatment with IRPL, tear film breakup time (BUT) greater than 10 seconds was observed in 87.5% of the patients, with a correlation between treatment application and a BUT greater than 10 seconds. There was a decrease in the signs observed in the eyelid margin; this decrease was more evident in blepharitis cases. In 81.3% of the cases, a gentle pressure was enough when performing the glandular expression, in order to obtain a clear liquid in 62.5% of the cases. All the OSDI test items showed improvement. Conclusions: Our results show an improvement of the clinical signs and symptoms of Dry Eye Syndrome due to MGD after a course of three IRPL sessions over a 45-day period. However, more IRPL studies with a longer follow-up are warranted.