Purpose: To present three male patients with subfoveal perfluorocarbon liquid after surgery for retinal detachment with macular involvement. Design: Interventional case series. Methods: Perfluorocarbon liquid extraction was performed by retinotomy and aspiration with a 25 or 38 gauge cannula. Results: Four months later, anatomic restoration was achieved, without rests of perfluorocarbon liquid, but with a severe defect in photoreceptors. Visual acuity remained unchanged. Conclusion: Subfoveal perfluorocarbon liquid extraction in patients with previous surgery of retinal detachment with macular involvement may imply bad functional outcomes, probably due to a previous damage of pigment epithelium and photoreceptors, aggravated by perfluorocarbon liquid toxicity. Resumen Objetivo: Presentar tres varones entre 43 y 63 años, con presencia de perfluorocarbono líquido subfo-veal tras cirugía de desprendimiento de retina con afectación macular. Métodos: Se realizó extracción mediante retinoto-mía y aspiración con cánula de 25 o 38 gauge. Resultados: A los 4 meses, se consiguió restauración anatómica, sin restos de perfluorocarbono líquido subfoveal, pero con defecto severo en los fotorreceptores. La agudeza visual no experimentó cambios significativos. Conclusión: La extracción de perfluorocarbono líquido subfoveal en pacientes intervenidos previamente de desprendimiento de retina con afectación macular suele conllevar un mal pronóstico funcional, posiblemente en relación con un daño previo de las células del epitelio pigmentario y los fotorreceptores, agravado por la toxicidad del perfluorocarbono líquido.

Combined venous lymphatic malformation is a benign, nonhereditary vascular anomaly. These unencapsulated hamartomas can be associated with spontaneous, recurrent hemorrhage leading to prop-tosis and pain. We describe a patient with this lesion to discuss the various management strategies and surgical challenges encountered with this condition.

Purpose: To evaluate the torsional effect of superior oblique muscle tenectomy. Design: Case report. Methods: Case report of a patient with horizontal strabismus and bilateral superior oblique muscle overaction, submitted to bilateral superior oblique tenectomy. Objective access of ocular torsion was performed using retinogra-phy and a computer software (Autocad 2009®). Results: The preoperative angle was 7.57 in the right eye and 0.66 in the left eye. Postoperative angle of torsion was 4.22 in the right eye and -1.50 the left eye. Conclusion: The presented case report suggests that superior oblique tenectomy has an extortion effect, decreasing the intorsion detected in case of superior oblique overaction. Resumo Objetivo: Avaliar objetivamente o efeito torcional da tenectomia do músculo oblíquo superior. Desenho: Relato de caso. Métodos: Estudo de paciente portador de estrabismo horizontal e hiperfungào bilateral dos oblíquos superiores, submetido à tenectomia bilateral. A medida objetiva da to-rgào ocular foi realizada mediante exame retinográfico e de um programa de computador (Autocad 2009®). Resultados: O ángulo de torgáo no período pré-operatòrio era de 7,57° no olho direito e de 0,66° no olho esquerdo. No período pòs-operatòrio, o ángulo de torgáo encontrado foi de 4,22° no olho direito e -1,50° no olho esquerdo. Conclusáo: O presente estudo suge-re que a tenectomia do músculo oblíquo superior tem efeito extorsor, diminuindo a intorgáo encontrada nos casos de hiperfungáo deste músculo.

Purpose: To describe surgical outcomes and the resulting fusion and stereopsis in patients submitted to surgery of congenital esotropia and its relationship with the surgical timing. Design: Interventional case series Methods: We performed a study in patients submitted to the surgery of congenital esotropia in the Pediatric Ophthalmology Service of the Cuban Ophthal-mological Institute Ramón Pando Ferrer”, from January 2007 to May 2010. The following variables were analyzed: preoperative angle of deviation, postoperative ocular alignment, ocular alignment stability, surgical timing, fusion and stereopsis. Results: In 96% of the cases, orthotropy or aesthetically acceptable alignment at 8 weeks after surgery was achieved. Moreover, 73% maintained this alignment after one year of the surgery. 57.7 % of the patients got fusion and 30.8 % achieved stereopsis, in a range of 3000 at 400”. Children over 18 months old had a risk five times bigger of not developing fusion and four times bigger of not developing stereopsis than those operated before that age. Conclusions: Early surgery is important to improve the visual functional results in patients with congenital esotropia. RESUMEN Objetivo: Describir los resultados quirúrgicos y la obtención de fusión y estereopsia en operados de esotropía congénita y su relación con la edad quirúrgica. Diseño: Serie intervencional de casos. Método: Estudio de serie de casos, en pacientes operados de esotropía congénita en el servicio de Oftalmología Pediátrica del Instituto Cubano de Oftalmología “Ramón Pando Ferrer”, en el período comprendido entre enero del 2007 a mayo del 2010. Se analizaron las siguientes variables: ángulo de desviación preoperatorio, alineamiento ocular postoperatorio, estabilidad del alineamiento ocular, edad quirúrgica, fusión y estereopsia. Resultados: En el 96% de los casos se logró orto-tropía o alineamiento estéticamente aceptable a las ocho semanas del post operatorio y al año de la cirugía el 73% mantuvo este alineamiento. El 57,7% de los pacientes alcanzó fusión y el 30,8 % logró estereopsia, en un rango de 3000 a 400”. Los niños operados después de los 18 meses tuvieron un riesgo cinco veces mayor de no desarrollar fusión y cuatro veces mayor de no desarrollar estereopsia que los operados antes de esa edad. Conclusiones: La cirugía temprana resulta importante para mejorar los resultados funcionales visuales en los operados de esotropía congénita.

Purpose: To assess sensibility and specificity, positive and negative predictive values and probability of false-positive and false-negative of the water-drinking test, ibopamine test, frequency doubling perimetry, short-wave automated perimetry and daily curve of intraocular pressure in glaucoma suspects. Design: Cross-sectional study Methods: Glaucoma suspect eyes and normal control eyes from age-matched individuals, both with normal standard achromatic perimetry, were submitted to water-drinking test, ibopamine test, frequency doubling perimetry, short-wave automated perimetry and daily curve of intraocular pressure. Results: We included 45 Glaucoma suspect and 30 normal control eyes. Sensibility and specificity were respectively 75.6% and 100% for daily curve of intraocular pressure; 35.6% and 80% for ibopamine test; 22.2% and 96.7% for short-wave automated peri-metry; 15.6% and 96.7% for water-drinking test; 8.9% and 100% for frequency doubling perimetry. Positive and negative predictive values of the same workups were: 100% and 99.5%; 3.5% and 98.4%; 12% and 98.4%; 8.7% and 98.2%; 100% and 98.2%. False-positive and false-negative probabilities were: 0% and 0.5%; 96.5% and 1.6%; 91.3% and 0%; 88.0% and 1.6%; 0% and 1.9%. Conclusions: The daily curve of intraocular pressure presented the highest sensibility with the highest positive predictive value. Frequency doubling perime-try presented a very low probability of false-negative. Ibopamine test, water-drinking test and short-wave automated perimetry presented a very high probability of false-positive.

Vascular endothelial growth factor (VEGF) plays a major role in the patho-genesis of diabetic retinopathy. Its inhibition by bevacizumab, a monoclonal antibody against all VEGF isoforms, has been shown to be beneficial in the management of both diabetic macular edema (DME) and proliferative diabetic retinopathy (PDR). Our group has previously demonstrated that multiple intra-vitreal injections of bevacizumab of either 1.25 or 2.5 mg in eyes with DME result in a reduction of macular edema and an improvement in visual acuity. We did not observe any differences in the outcomes between eyes treated with the lower and higher doses of bevacizumab. We also studied the effect of intravitreal bevacizumab in eyes with PDR. Intravitreal bevacizumab is capable of inducing regression of retinal and optic disc neovascularization. However this regression is not permanent and panretinal photocoagulation is needed to consolidate treatment. Caution should be exercised in eyes with advanced PDR since a rapid involution of the fibrovascular proliferation may lead to the development or the progression of a tractional retinal detachment. Thus when using intravitreal be-vacizumab as an adjuvant in diabetic vitrectomies, surgery should be scheduled no more than 4 days after injection. Resumen El factor de crecimiento vascular endotelial (VEGF) juega un rol protagónico en la patogénesis de la retino-patía diabética. Su inhibición por el Bevacizumab, un anticuerpo monoclonal contra todas las isoformas del VEGF, ha demostrado ser benéfica en el manejo tanto del edema macular diabético (EMD) como de la retinopatía diabética proliferativa (RDP). Nuestro grupo ha previamente demostrado que múltiples inyecciones intravítreas tanto de 1,25 o 2,5 mg de bevacizumab en ojos con EMD resultan en la reducción del edema macular y mejoría en la agudeza visual. No se observó diferencia alguna entre los resultados de los ojos tratados con dosis más bajas o altas del bevacizumab. Se estudió también el efecto del bevacizumab intravítreos en ojos con RDP. El bevacizumab intravítreo es capaz de inducir regresión de la neovascularización de la retina y disco óptico. Sin embargo, esta regresión no es permanente y la fotocoagulación panretiniana o vitrectomía son ne-cesarías para consolidar el tratamiento. Se debe tener cautela en ojos con RDP avanzada debido a que la rápida involución de las proliferaciones fibrovasculares pueden conllevar al desarrollo o progresión de un desprendimiento de retina traccional. Por lo tanto al utilizar el bevacizumab intravítreo como adyuvante en la vitrectomía de pacientes diabéticos, la cirugía no debe ser programada más de 4 días después de dicha inyección.