Abstract Introduction: Fundus autofluorescence (FAF) has shown sensitivity in the detection of macular edema. Objectives: To evaluate indices formed with FAF and retinal anatomical-functional variables in patients with diabetic macular edema (DME) treated with Ziv-aflibercept (Ziv-AFL). Methods: Twenty-nine eyes of 15 DME patients who received Ziv-AFL intravitreal injections were included. Best-corrected visual acuity (BCVA), contrast sensitivity (CS), optical coherence tomography (OCT), and FAF were evaluated before treatment and at one and two months. OCT variables were central subfield thickness (CST), macular volume (MV), and macular cube average thickness (MCAT). FAF/BCVA, FAF/CS, FAF/CST, FAF/MV and AF/MCAT indices baseline values were obtained. Analysis was performed with Spearman's rank correlation coefficient and linear regression analysis. Results: There was a significant correlation between baseline FAF/BCVA index and BCVA at second month (rs = -0.78, p = 0.000), between baseline FAF/CS index and BCVA at second month (rs = -0.68, p = 0.0009), and between baseline FAF/CS index and MV at first month of follow-up (rs = 0.64, p = 0.002). Conclusions: In DME, composite indices with baseline FAF predict variables such as BCVA in the follow-up of patients receiving ziv-AFL.

Resumen Introducción: La autofluorescencia retiniana (AF) ha mostrado sensibilidad en la detección del edema macular. Objetivos: Evaluar índices formados con la AF y variables anatomofuncionales retinianas en pacientes con edema macular diabético (EMD) tratados con ziv-aflibercept (ziv-AFL). Métodos: Fueron incluidos 29 ojos de 15 pacientes con EMD que recibieron inyecciones intravítreas de ziv-AFL. Se evaluó agudeza visual mejor corregida (AVMC), sensibilidad al contraste (SC), tomografía de coherencia óptica (TCO) y AF, antes del tratamiento, así como al primer y segundo mes de iniciado este. Las variables de la TCO fueron grosor foveal central (GFC), volumen macular (VM) y grosor promedio macular (GPM). Se obtuvieron los valores basales de AF/AVMC, AF/SC, AF/GFC, AF/VM y AF/GPM. Se realizó análisis con el coeficiente de correlación de rangos de Spearman y análisis de regresión lineal. Resultados: Hubo una correlación significativa entre el índice AF/AVMC basal y la AVMC en el segundo mes (rs = −0.78, p = 0.000), entre el índice AF/SC basal y la AVMC en el segundo mes (rs = −0.68, p = 0.0009) y entre AF/SC basal y el VM en el primer mes de seguimiento (rs = 0.64, p = 0.002). Conclusiones: En el EMD, los índices compuestos con AF basales predicen variables como AVMC en el seguimiento de pacientes que reciben ziv-AFL.

Resumen El edema macular diabético (EMD) representa la causa principal de pérdida de la visión en pacientes con diabetes mellitus. Se trata de una enfermedad compleja que demanda a los oftalmólogos y retinólogos una amplia experiencia para lograr una oportuna detección, un certero diagnóstico y un adecuado tratamiento. En la actualidad se cuenta con diversas y novedosas alternativas de tratamiento que deben ser evaluadas a la par que las características y las necesidades de cada paciente para brindarle los mayores beneficios. En este documento se describen las características y la evidencia científica que respaldan algunos de estos tratamientos, así como la propuesta del Grupo de Consenso para el tratamiento más apropiado de los pacientes con EMD de acuerdo con sus características y perfiles.

Abstract Diabetic macular edema (DME) represents the leading cause of vision loss in patients with diabetes mellitus. It is a complex disease that demands extensive experience from ophthalmologists and retinologists to achieve a timely detection, an accurate diagnosis and adequate treatment. At present, there are various and innovative treatment alternatives that must be evaluated along with the characteristics and needs of each patient to provide the greatest benefits. This document describes the characteristics and scientific evidence that support some of these treatments, as well as the Consensus Group's proposal for the most appropriate treatment of patients with DME according to their characteristics and profiles.

Abstract Objective: To assess the correlation between fundus autofluorescence (FAF) and optical coherence tomography (OCT) and fluorescein angiography (FA) parameters in patients with diabetic macular edema (DME). Methods: Study design: non-comparative case series. Thirty-seven eyes of 20 patients with DME were included. Patients underwent best-corrected visual acuity and contrast sensitivity determination, assessment of central subfield thickness (CST), macular volume (MV), and macular cube average thickness (MCAT) by spectral-domain OCT, as well as FAF and FA imaging. SD-OCT EMD and foveal FAF patterns (decreased, normal, increased single-spot, and increased multiple-spot) were evaluated. Fisher exact test, interobserver variability, and Kruskall-Wallis test were used for statistical analysis. Results: A statistically significant difference was observed between the four FAF foveal patterns in the MV (p = 0.03), and in the MCAT groups (p = 0.01). Post-hoc analysis with the U-Mann-Whitney test showed a statistically significant difference between decreased FAF and normal FAF patterns, and between decreased FAF and increased multiple-spot FAF patterns (p < 0.05) in the MV and MCAT groups. Foveal capillary leakage by FA was observed in a higher proportion of eyes in the increased single-spot and multiple-spot FAF patterns (p = 0.03). Conclusions: Flash camera FAF shows changes regarding MV, MCAT, and the presence of foveal capillary leakage in patients with DME. It is relevant to establish the value of FAF in the assessment of DME.

Resumen Objetivo: Evaluar la asociación entre la autofluorescencia de retina (AF) y las variables estructurales de la tomografía de coherencia óptica (OCT) y de la angiografía con fluoresceína (FA) en pacientes con edema macular diabético (EMD). Métodos: El diseño del estudio fue una serie de casos no comparativa. A 37 ojos de 20 pacientes con EMD se les realizó la determinación de la agudeza visual mejor corregida y la sensibilidad al contraste, y la determinación del grosor foveal central, grosor promedio macular (GPM), volumen macular (VM) y patrones de EMD mediante OCT de dominio espectral (OCT-DE). Se tomaron imágenes de AF y de FA. Se evaluó el patrón de AF foveal (disminuida, normal, aumentada unifocal y aumentada multifocal). Se efectuó prueba exacta de Fisher, variabilidad interobservador y prueba de Kruskall-Wallis como análisis estadístico. Resultados: Se encontró una diferencia estadísticamente significativa entre los cuatro patrones de AF en el VM (p = 0.03) y en el GPM (p = 0.014). El análisis post hoc mostró, en el VM, una diferencia estadísticamente significativa entre el patrón de AF disminuida y el de AF normal (p < 0.05), así como entre el patrón de AF disminuida y el de AF aumentada multifocal (p < 0.05). La fuga de la red capilar perifoveal por FA se presentó en mayor proporción en los patrones de AF aumentada tanto uni como multifocal (p = 0.032). Conclusiones: Existen cambios en la AF con cámara de flash, en pacientes con EMD asociados con el GPM, el VM y a la fuga de red capilar perifoveal. Es importante establecer el valor de la AF en la evaluación del EMD.

ABSTRACT A report is presented of the use of crosslinking as treatment for Acanthamoeba keratitis in a series of 7 patients attending the Cornea Service for multitreated keratitis. Corneal biopsy was performed, which was cultured in Page solution. The patients were treated with a PACK-CXL protocol for more than 5 minutes and subjected to UV-A light exposure. Edema of the new epithelium was 2 crosses at 24 hours and disappeared 2 weeks after the procedure in all cases. Basal de-epithelialization percentage at diagnosis was 75.7%. Best corrected visual acuity ranged between 20/20 and 20/30. It is concluded that the use of crosslinking in patients with Acanthamoeba keratitis in its initial stages could be a safe and effective therapeutic option.

RESUMEN Se reporta el uso del crosslinking como tratamiento de la queratitis por Acanthamoeba en una serie de 7 pacientes quienes acudieron al Servicio de Córnea por queratitis multitratadas. Se les realizó biopsia corneal, la cual se cultivó en solución de Page. Los pacientes fueron tratados con un protocolo de PACK-CXL durante más de 5 minutos y fueron sometidos a la exposición a la luz UV-A. El edema del nuevo epitelio era de 2 cruces a las 24 horas, y desapareció a las dos semanas del procedimiento en todos los casos. El porcentaje de desepitelización basal al momento del diagnóstico fue de 75,7 %. La agudeza visual mejor corregida fue de entre 20/20 y 20/30. Se concluye que el uso de crosslinking en pacientes con Acanthamoeba en fases inicales pudiera ser una opción terapéutica segura y efectiva.

Introduction: Patients with diabetic macular edema can develop fundus autofluorescence alterations; thus far, these alterations have been more widely studied with scanning or confocal laser systems. Objective: To describe and classify fundus autofluorescence abnormal patterns in patients with diabetic macular edema using the fundus autofluorescence system with a flash camera. Method: Observational, retrospective, cross-sectional, descriptive study. Fundus autofluorescence digital images of non-comparative cases with untreated diabetic macular edema, obtained and stored with a flash camera system, were assessed. Inter-observer variability was evaluated. Results: 37 eyes of 20 patients were included. Lens opacity was the most common cause of inadequate image quality. Five different fundus autofluorescence patterns were observed: decreased (13%), normal (40%), single-spot hyper-autofluorescent (17 %), multiple-spot hyper-autofluorescent (22 %) and plaque-like hyper-autofluorescent (8 %). The kappa coefficient was 0.906 (p = 0.000). Conclusions: Different fundus autofluorescence phenotypic patterns are observed with flash camera systems in patients with diabetic macular edema. A more accurate phenotypic classification could help establish prognostic factors for visual loss or for the design of clinical trials for diabetic macular edema.

Abstract Background: Pupillary block induced by silicon oil in vitrectomized patients is a common condition usually treated with Nd-YAG laser iridotomy or with surgical removal of silicon oil. Case report: A case of silicone oil pupillary block glaucoma successfully treated with a 30 G needle transfixion technique is described. We performed a non-complicated vitrectomy surgery for retinal detachment with proliferative vitreoretinopathy that included lensectomy, inferior peripheral iridectomy, and silicone oil injection. After surgery, the iridectomy became occluded with fibrous tissue and the intraocular pressure raised to 50 mmHg. After an initial Nd-YAG iridotomy was unsuccessful, we passed a 30 Ga needle through the sclerocorneal limbus and cut the fibrous tissue that blocked the iridectomy. This procedure restored the aqueous humor flow through the iridectomy, pushed back the silicone oil bubble into the vitreous cavity and lowered the intraocular pressure to normal levels. Conclusions: 30 Ga needle transfixion technique could be an effective, low cost, simple alternative for the treatment of silicone oil pupillary block in aphakic patients.

Resumen Antecedentes: El bloqueo pupilar secundario a aceite de silicón en pacientes vitrectomizados es una condición frecuente que normalmente se trata con apertura de la iridectomía con láser Nd-YAG o con el retiro del aceite de silicón. Caso clínico: Se describe un caso de glaucoma secundario a bloqueo pupilar por aceite de silicón tratado satisfactoriamente con técnica de transfixión con aguja de calibre 30. Realizamos una cirugía de vitrectomía sin complicaciones para el tratamiento de un desprendimiento de retina con vitreorretinopatía proliferativa, que incluyó lensectomía, iridectomía periférica inferior e inyección de aceite de silicón. Después de la cirugía, la iridectomía se ocluyó con tejido fibroso y la presión intraocular se incrementó a 50 mmHg. Después de que una iridotomía inicial con láser Nd-YAG no tuvo éxito, pasamos una aguja de calibre 30 a través del limbo esclerocorneal y cortamos el tejido fibroso que bloqueaba la iridectomía. Este procedimiento restauró el flujo de humor acuoso a través de la iridectomía, desplazando la burbuja de aceite de silicón a la cavidad vítrea, y la presión intraocular descendió a valores normales. Conclusiones: La técnica de transfixión con aguja de calibre 30 puede ser una alternativa efectiva, simple y de bajo costo para el tratamiento del bloqueo pupilar con aceite de silicón en pacientes con afaquia.

RESUMO Relatamos a abordagem transoperatória e o desfecho em curto prazo de um paciente que sofreu uma avulsão traumática do ramo da artéria ciliorretiniana durante o tratamento cirúrgico de uma oclusão do ramo arterial ciliorretiniano com embolectomia intraocular. O paciente foi submetido a uma vitrectomia pars plana com embolectomia in situ. A artéria bloqueada foi incisada com uma tesoura vertical de 25 Ga e a manipulação do êmbolo foi feita com pinça microcirúrgica. Durante a extração do êmbolo, a artéria ciliorretiniana ocluída e seu ramo foram inadvertidamente avulsionados e rasgados com sangramento intenso subsequente. Laser e endodiatermia foram utilizados para hemostasia aguda. As manobras criaram uma anastomose retinocoroidiana não intencional. Melhora do campo visual foi observada três meses após a cirurgia. No caso de uma embolectomia cirúrgica complicada com a avulsão da artéria, a formação de uma anastomose retinocoroidiana e reperfusão da artéria ocluída pode ocorrer juntamente com a melhora do campo visual em alguns casos.

ABSTRACT We report the trans-operative approach and short-term outcome for a patient who suffered a traumatic avulsion of the cilioretinal artery branch during the surgical management of a cilioretinal arterial branch occlusion with intraocular embolectomy. The patient underwent a pars plana vitrectomy with in situ embolectomy. The blocked artery was incised using 25 Ga vertical scissors, and embolus manipulation was performed using microsurgical forceps. During embolus extraction, the occluded cilioretinal artery and its branch were inadvertently avulsed and torn with subsequent intense bleeding. Laser and endodiathermy were used for acute hemostasis. The maneuvers created an unintended retinochoroidal anastomosis. Visual-field improvement was noted three months after the surgery. In the event of a complicated surgical embolectomy with the avulsion of the artery, the formation of a retinochoroidal anastomosis and reperfusion of the occluded artery may occur along with the improvement of the visual field in some cases.

RESUMO A cirurgia bilateral simultânea de catarata ganhou popularidade entre cirurgiões oftalmológicos em muitos países. Este estudo examina o caso de um paciente de 77 anos que desenvolveu endoftalmite bilateral por Pseudomonas aeruginosa após uma cirurgia bilateral simultânea de catarata. Vitrectomia bilateral imediata e injeção de antibióticos intravítreos foram realizadas. Em última análise, ambos os olhos foram eviscerados devido à dor refratária ao tratamento e sem percepção de luz.

ABSTRACT Bilateral simultaneous cataract surgery (BSCS) has gained popularity among eye surgeons in many countries. This study examines the case of a 77-year-old patient who developed bilateral Pseudomonas aeruginosa endophthalmitis following bilateral simultaneous cataract surgery. Immediate bilateral vitrectomy and intravitreal antibiotics injection were performed. Ultimately, both eyes were eviscerated due to pain refractory to treatment and no light perception.

Abstract The main aim of this paper is to try to give an answer to the question whether or not the formal concepts of Wittgenstein's Tractatus Logico-Philosophicus are ontological categories. My ans wer is that 'they are not'. Thus, after presenting a definition of 'ontology' (§2), and different readings of the initial propositions of the Tractatus (§3), I present the notion of formal or logical concept, as well as different interpretations with regard to the role of these concepts in the Tractatus (§4). Later, and bearing in mind what has been said in the previous sections, I give (I) my own reading of the initial propositions in terms of conceptual or grammatical expressions, (II) the distinction both in extension and in intension between the notions of formal or logical concept and ontological category, and (III) the dissolution of ontology, but not of logic (§5). Lastly, I present the final conclusions that summarize the core aspects of the preceding discussion (§6).

Resumen En este trabajo trato de dar respuesta a la cuestión acerca de si los conceptos formales del Tractatus Logico-Philosophicus de Wittgenstein son o no categorías ontológicas. Mi respuesta es que no. Así, después de ofrecer una definición de 'ontologia' (§2) y diferentes lecturas sobre las proposiciones iniciales del Tractatus (§3), presento la noción de concepto formal o lógico, así como diferentes interpretaciones en relación con el papel de esos conceptos en el Tractatus (§4). Después, y teniendo en consideración lo dicho en las secciones precedentes, presento (I) mi propia lectura de las proposiciones iniciales en términos de expresiones conceptuales o gramaticales, (II) la distinción tanto en extensión como en intensión de las nociones de concepto formal o lógico y categoría ontológica y (III) la disolución de la ontologia, que no de la lógica (§5). Finalmente ofrezco unas conclusiones finales que recogen aspectos centrales de la discusión precedente (§6).

Resumen En este artículo me propongo discutir si la propiedad de la recursión supone una buena explicación de la especificidad humana. Para ello, analizaré dos aproximaciones al estudio del lenguaje humano: las concepciones computacional y antropológica. La principal conclusión de este trabajo es doble. Por un lado, la recursión no es una buena explicación de la esencia humana. Por otro, lo que sí es específicamente humano es la construcción de una mitología, análoga a la metafísica, revestida en este caso con el lenguaje de la ciencia.

Abstract My major aim in this paper is to discuss whether the property of recursion provides a good explanation of human specificity. In so doing, I will analyze two approaches to the study of natural language: the computational and the anthropological conceptions. The main conclusion of this work is twofold. On the one hand, I argue that recursion is not a good explanation of human essence. On the other hand, what is, indeed, specifically human is the construction of a mythology with a metaphysical slant, in this particular case, in the guise of the language of science.

This work intends to show in a clear and concise way that there is a double conceptual dissociation between 'recursion' and 'self-embedding', two terms which are frequently conflated in the specialized literature. It will show that recursion does not imply self-embedding and that self-embedding does not imply recursion either. The discussion will be focused on the Chomskyan program, since this has been one particular domain where recursion has been worse understood, especially by Chomsky's critics.

Este trabajo pretende presentar de forma clara y concisa la (doble) disociación conceptual entre 'recursión' y 'auto-inclusión' tan frecuentemente confundidos en la literatura especializada. Se mostrará que la recursión no implica auto-inclusión y que la auto-inclusión no implica tampoco recursión. El ámbito de discusión será el programa chomskiano, dado que ha sido uno de los ámbitos donde la recursión ha sido peor interpretada, fundamentalmente por sus críticos.