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Biomedical subjects

Gonzalo Muñoz

Publications and source records attributed to Gonzalo Muñoz.

At least 19 recordsLinked to original sources

Insulin restores glucose inhibition of adenosine transport by increasing the expression and activity of the equilibrative nucleoside transporter 2 in human umbilical vein endothelium.

L-Arginine transport and nitric oxide (NO) synthesis (L-arginine/NO pathway) are stimulated by insulin, adenosine or elevated extracellular D-glucose in human umbilical vein endothelial cells (HUVEC). Adenosine uptake via the human equilibrative nucleoside transporters 1 (hENT1) and 2 (hENT2) has been proposed as a mechanism regulating adenosine plasma concentration, and therefore its vascular effects in human umbilical veins. Thus, altered expression and/or activity of hENT1 or hENT2 could lead to abnormal physiological plasma adenosine level. We have characterized insulin effect on adenosine transport in HUVEC cultured in normal (5 mM) or high (25 mM) D-glucose. Insulin (1 nM) increased overall adenosine transport associated with higher hENT2-, but lower hENT1-mediated transport in normal D-glucose. Insulin increased hENT2 protein abundance in normal or high D-glucose, but reduced hENT1 protein abundance in normal D-glucose. Insulin did not alter the reduced hENT1 protein abundance, but blocked the reduced hENT1 and hENT2 mRNA expression induced by high D-glucose. Insulin effect on hENT1 mRNA expression in normal D-glucose was blocked by N(G)-nitro-L-arginine methyl ester (L-NAME, NO synthase inhibitor) and mimicked by S-nitroso-N-acetyl-L,D-penicillamine (SNAP, NO donor). L-NAME did not block insulin effect on hENT2 expression. In conclusion, insulin stimulation of overall adenosine transport results from increased hENT2 expression and activity via a NO-independent mechanism. These findings could be important in hyperglycemia-associated pathological pregnancies, such as gestational diabetes, where plasma adenosine removal by the endothelium is reduced, a condition that could alter the blood flow from the placenta to the fetus affecting fetus growth and development.

Adenosine↗

Spherical aberration and contrast sensitivity after cataract surgery with the Tecnis Z9000 intraocular lens.

PURPOSE: To determine whether implantation of an intraocular lens (IOL) with a modified prolate anterior surface (Tecnis Z9000, AMO) results in reduced spherical aberration and improved contrast sensitivity after cataract surgery. SETTING: Hospital NISA Virgen del Consuelo, Valencia, Spain. METHODS: In an intraindividual randomized prospective study of 30 patients with bilateral cataract, the Tecnis Z9000 IOL was compared with 2 IOLs with spherical surfaces, the AR40e (AMO) and the Stabibag (Ioltech). Ocular aberrations for a 4.0 mm pupil and 6.0 mm pupil were measured with a Hartmann-Shack aberrometer. Quality of vision was measured by visual acuity and contrast sensitivity under mesopic and photopic conditions. RESULTS: Eyes with the Tecnis Z9000 IOL had significantly less spherical aberration and a greater Strehl ratio after surgery. Significant reduction in coma aberration was also found in some cases. Refraction, visual acuity, and contrast sensitivity were not significantly different between the 3 IOL groups. CONCLUSION: A significant reduction in spherical aberration after Tecnis Z9000 IOL implantation was achieved, but visual acuity and contrast sensitivity were not affected by the aspheric silicone IOL compared to spherical acrylic IOLs.

Aged↗

Femtosecond laser in situ keratomileusis after radial keratotomy.

PURPOSE: To assess the safety, efficacy, and predictability of femtosecond laser in situ keratomileusis (LASIK) in eyes with previous radial keratotomy (RK). SETTING: Hospital Virgen del Consuelo de Valencia, Valencia, and Vissum Instituto Oftalmológico de Alicante, Alicante, Spain. METHODS: This prospective study comprised 11 eyes of 7 patients with residual low myopia after previous RK who had surgery with the IntraLase femtosecond laser (IntraLase Corp.) and the Star 2 excimer laser (Visx, Inc.). Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), defocus equivalent, refraction, flap thickness, flap diameter, and intraoperative complications were evaluated over a minimum 6-month follow-up. RESULTS: Although the RK incisions opened in all eyes when the flap was lifted, LASIK was successfully completed in all cases. Mean flap thickness was 119 microm +/- 13 (SD). There were no cases of slipped flaps, microstriae, or epithelial ingrowth. Defocus equivalent was reduced from a mean of 2.51 +/- 0.62 diopters (D) to 0.52 +/- 0.28 D; 7 eyes (63.6%) were within +/-0.50 D, and 11 eyes (100%) were within +/-1.00 D. All eyes had 20/40 or better UCVA, although 2 eyes (18.1%) lost 1 line of BSCVA. CONCLUSIONS: The femtosecond laser was safely used to create thin LASIK flaps in eyes with previous RK. An increased postoperative inflammatory response may explain the loss of BSCVA in some cases. Efficacy and predictability of the procedure were comparable to those of LASIK after RK with mechanical microkeratomes.

Adult↗

Transient light-sensitivity syndrome after laser in situ keratomileusis with the femtosecond laser Incidence and prevention.

PURPOSE: To describe the incidence of transient light-sensitivity syndrome (TLSS) after laser in situ keratomileusis (LASIK) with the femtosecond laser and to identify preventive strategies. SETTING: Hospital NISA Virgen del Consuelo, Valencia, Spain. METHODS: The first 765 eyes operated on with the 15 KHz femtosecond laser were prospectively analyzed for subjective complaints and clinical findings compatible with TLSS. Intraoperative settings, postoperative treatment, and development of complications were analyzed. RESULTS: Overall, TLSS developed in 10 eyes (incidence 1.3%). However, the incidence decreased from 2.8% to 0.4% when aggressive topical steroids were used during the first 3 postoperative days. Postoperative interface inflammation and postoperative use of a low-dose topical steroid regimen were associated with a higher incidence of TLSS. CONCLUSIONS: Transient light-sensitivity syndrome is a relatively uncommon complication related to the use of the femtosecond laser. Postoperative interface inflammation may increase the probability of developing TLSS, whereas an aggressive postoperative steroid regimen seemed to provide protection against it.

Adult↗

LASIK in patients with rheumatic diseases: a pilot study.

PURPOSE: To investigate the safety of LASIK in patients with a known history of controlled rheumatic diseases. DESIGN: Retrospective consecutive observational clinical study. PARTICIPANTS: Forty-two eyes (22 patients) known to have had a history of rheumatic diseases underwent LASIK. All patients had a history of controlled rheumatic diseases, including rheumatoid arthritis, systemic lupus erythematosus, dermatomyositis, scleroderma, ankylosing spondylitis, psoriatic arthritis, inflammatory bowel disease, arthritis, or Behçet's disease. METHODS: Assessments were made preoperatively and at 1, 3, and 6 months postoperatively and included visual acuity (VA), refraction, keratometric readings, slit-lamp biomicroscopy, and corneal topography. All the patients underwent LASIK. Postoperative treatment included a topical steroid-antibiotic combination. MAIN OUTCOME MEASURES: Visual acuity, refraction, keratometric readings, and slit-lamp biomicroscopy findings at 1, 3, and 6 months postoperatively. RESULTS: LASIK was performed uneventfully on all patients. The mean pre-LASIK spherical equivalent (SE) was -5.39+/-2.25, and the sixth month postoperative SE was -0.15+/-0.38 diopters (D) (P<0.001). Uncorrected VA 6 months after the LASIK procedure was 20/25. Enhancement procedures were performed in 6 of 42 eyes (14.3%) at variable times after the primary procedure. Postoperative follow-up showed development of a moderate degree of dry eye syndrome in 4 eyes (9.5%). Corneal haze, melting, flap, or interface complications were not observed in any of the study eyes. CONCLUSIONS: In this small series, we found good outcomes when correcting refractive errors using LASIK in selected patients with controlled rheumatic diseases. In this series, a favorable postoperative visual outcome was obtained with no operative or postoperative vision-threatening complications.

Adult↗

Artisan iris-claw phakic intraocular lens followed by laser in situ keratomileusis for high hyperopia.

PURPOSE: To evaluate safety, efficacy, predictability, stability, complications, and patient satisfaction after Artisan phakic intraocular lens (IOL) implantation followed by laser in situ keratomileusis (LASIK) for the correction of high hyperopia. SETTING: Instituto Oftalmólogico de Alicante, Alicante, Spain. METHODS: This prospective trial included 39 eyes with a mean preoperative spherical equivalent (SE) of 7.39 diopters (D) +/- 1.30 (SD) and a cylinder between 0 and -4.25 D. The Artisan iris-fixated phakic IOL (Ophtec) for hyperopia was implanted, and LASIK was performed 6 to 8 months later. The best corrected visual acuity (BCVA), uncorrected visual acuity (UCVA), refraction, endothelial cell loss (ECL), endothelium morphologic analysis, and patient satisfaction were recorded. The minimum follow-up was 12 months. RESULTS: At 1 year, 37 eyes (94.9%) were within +/-1.00 D of emmetropia and 31 eyes (79.5%) were within +/-0.50 D. Thirty-five eyes (89.7%) achieved a UCVA of 0.5 or better. There was a statistically significant decrease in BCVA after phakic IOL implantation, but this effect was corrected after LASIK. Nine eyes (23.1%) lost 1 line of BCVA; 7 eyes (17.9%) gained at least 1 line. One eye (2.6%) showed a change in SE greater than 1.0 D over the follow-up period. The mean ECL was 10.9%, but morphologic analysis suggested no additional damage caused by LASIK over that produced by phakic IOL surgery. Overall patient satisfaction was high. CONCLUSIONS: The combination of Artisan phakic IOL implantation and LASIK safely, predictably, and effectively reduced high hyperopia. A loss of 1 line of BCVA should be expected in about one third of eyes implanted with this IOL. Halos and glare at night remain a potential problem.

Adult↗

Keratectasia after bilateral laser in situ keratomileusis in a patient with previous radial and astigmatic keratotomy.

We describe a case of bilateral keratectasia after laser in situ keratomileusis (LASIK) in a patient with previous radial keratotomy and astigmatic keratotomy. The best spectacle-corrected visual acuity (BSCVA) was 20/25 in both eyes. After uneventful LASIK was performed in both eyes for low myopic astigmatism, the patient presented with progressive myopia and astigmatism and a BSCVA of 20/50 in both eyes. Videokeratography showed progressive deformation of the cornea, increasing K-values over 50.0 diopters, and irregular astigmatism. The best corrected visual acuity in both eyes improved to 20/25 with rigid poly(methyl methacrylate) contact lenses.

Adult↗

Comparison of contrast sensitivity and color discrimination after clear and yellow intraocular lens implantation.

PURPOSE: To compare contrast sensitivity and color vision in patients in whom blue-light filtering and non-yellow-tinted intraocular lenses (IOLs) were implanted. SETTING: Refractive Surgery Unit, Hospital NISA Valencia al Mar, Valencia, Spain. METHODS: Forty eyes of 20 patients were enrolled in a blue-light filtering fellow-eye control study; patients were implanted with a yellow-tinted IOL (AcrySof Natural, Alcon) in 1 eye and a non-yellow-tinted IOL (AcrySof SA60AT, Alcon) in the fellow eye after cataract surgery. Three months postoperatively, monocular contrast sensitivity function was measured with the CSV 1000-E contrast sensitivity chart at distance and the color discrimination with the Farnsworth-Munsell 100 Hue test. RESULTS: Eyes implanted with blue-light filtering IOLs showed similar contrast sensitivity to that in fellow eyes implanted with non-yellow-tinted IOLs (P>.1). Both types of IOLs showed normal contrast sensitivity values (normalized log-contrast sensitivity about 1.0). There were no statistically significant differences in chromatic discrimination between the 2 types of IOLs (P = .56). CONCLUSION: The use of blue-light filtering IOLs is more advisable because they are capable of protecting the retina against ultraviolet light without disturbance of contrast sensitivity and chromatic vision, which produces subjective impairment in visual function.

Aged↗

Blue-light filtering intraocular lens in patients with diabetes: contrast sensitivity and chromatic discrimination.

PURPOSE: To evaluate potential changes in contrast sensitivity and color discrimination in diabetic patients who had cataract surgery and implantation of the blue-light filtering AcrySof Natural (SN60AT) intraocular lens (IOL) compared with an ultraviolet-only filtering (AcrySof SA60AT) IOL. SETTING: Refractive Surgery Unit, Hospital NISA Valencia al Mar, Valencia, Spain. METHODS: Forty-four eyes of 22 diabetic patients were enrolled in a blue-light filtering fellow-eye control study. Patients received yellow-tinted IOLs (AcrySof Natural) in 1 eye and non-yellow-tinted IOLs (AcrySof SA60AT) in the fellow eye. Three months after surgery, monocular contrast sensitivity function was measured with the CSV 1000-E contrast sensitivity chart at distance and color discrimination was tested with the Farnsworth-Munsell 100-hue test. RESULTS: Eyes implanted with the blue-light filtering IOLs showed better contrast sensitivity values than fellow eyes implanted with non-yellow-tinted IOLs (P<.05). The blue-light filtering IOL did not modify chromatic discrimination compared with the non-yellow-tinted IOL (P = .62). In the blue-yellow axis discrimination study, the eyes implanted with the AcrySof Natural IOL had statistically significant better color vision (P = .008). CONCLUSIONS: In diabetic patients, the AcrySof Natural IOL provides better contrast sensitivity than the AcrySof SA60AT. The blue-light filter of the AcrySof Natural IOL did not cause chromatic discrimination defects based on total error scores and improved color vision in the blue-yellow chromatic axis in diabetic patients.

Aged↗

Bitoric laser in situ keratomileusis for astigmatism.

PURPOSE: To evaluate the efficacy, predictability, and safety of bitoric laser in situ keratomileusis (LASIK) for the correction of mixed astigmatism. SETTING: Instituto Oftalmológico de Alicante, Alicante, Spain. METHODS: This prospective study included 28 eyes of 21 patients with mixed astigmatism who had bitoric LASIK using the Hansatome microkeratome (Bausch & Lomb Surgical) and the Chiron Technolas 217 excimer laser (Bausch & Lomb Surgical). The main outcome measures were uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), defocus equivalent, blur strength, and refraction. RESULTS: Six months after bitoric LASIK, the mean UCVA was 0.70 +/- 0.23 (SD). The percentage of eyes with a UCVA of 20/40 or better was 78.6% and of 20/20, 21.4%. There was a statistically significant increase in the mean BCVA from 0.71 +/- 0.19 before surgery to 0.83 +/- 0.15 at 6 months (P =.0004). Three eyes (10.7%) lost 1 line of BCVA; 19 eyes (67.9%) gained 1 or more lines. The mean preoperative astigmatism of -4.04 +/- 1.13 diopters (D) was reduced to -0.67 +/- 0.79 D after surgery. The defocus equivalent was less than 1.00 D in 75.0% of eyes and less than 0.50 D in 64.3%. Vector analysis showed that the mean achieved correction was 97.4% of the intended correction. CONCLUSIONS: Bitoric LASIK was a safe, effective, and predictable procedure in the treatment of mixed astigmatism. It is a means to improving BCVA in a significant percentage of patients.

Adult↗

Corneal aberrations after astigmatic keratotomy combined with laser in situ keratomileusis.

PURPOSE: To evaluate the optical aberrations in the cornea before and after astigmatic keratotomy (AK) combined with laser in situ keratomileusis (LASIK) in a group of patients with high myopic astigmatism. SETTING: Refractive Surgery Unit, NISA Hospital Virgen del Consuelo, Valencia, Spain. METHODS: Twelve patients (24 eyes) with high myopic astigmatism (from 3.50 to 6.00 diopters) participated in the study. Astigmatic keratotomy was performed as the first step to reduce astigmatism; after 2 months, the residual refractive error was corrected with LASIK. Videokeratography measurements were conducted before and after each procedure. Topography maps were used to calculate the wavefront corneal aberrations for a 6.0 mm pupil diameter. RESULTS: Total, coma-like, and spherical-like aberrations increased significantly from preoperatively to post LASIK (x6.34, x2.52, and x10.50, respectively; P<.01). Astigmatic keratotomy significantly increased coma-like (x4.04; P<.01) and spherical-like (x5.66; P<.01) aberrations. After LASIK, the coma-like aberration was significantly reduced (x0.62; P =.008) and the spherical-like aberration was significantly increased (x1.86; P<.01). CONCLUSION: Astigmatic keratotomy increased higher-order corneal aberrations, both coma-like and spherical-like, whereas LASIK performed after AK increased the spherical-like aberration and reduced the coma-like aberration.

Adult↗

Postblink changes in total and corneal ocular aberrations.

OBJECTIVE: The purpose of this study was to determine objectively the changes in optical aberrations induced by the progressive tear film irregularity after a blink and their effects on retinal image quality. DESIGN: Prospective, consecutive, nonrandomized comparative trial (self-controlled). PARTICIPANTS: Twenty healthy subjects. MAIN OUTCOME MEASURES: Corneal and total ocular aberrations were determined in 20 subjects at various time intervals (approximately 0, 10, and 20 seconds) after a blink. Corneal and total aberrations were measured with an Orbscan II topographer (Orbtek Inc, Salt Lake City, UT) and a Zywave aberrometer (Bausch & Lomb, Irvine, CA), respectively. All data were decomposed using Zernike polynomials to yield the root mean square wavefront deviations, in micrometers (microm), for different pupil diameters (3.5, 4.5, 5.5, and 6.5 mm). A merit function (Mf), defined as the volume under the 2-dimensional modulation transfer function as computed from the total wavefront error, was taken as the image quality metric. RESULTS: Both corneal and total aberrations (third order and higher) showed a statistically significant increase with time after the blink for all pupil diameters except 3.5 mm. The magnitude of the increase was greater at larger pupil diameters. For a 6.5-mm pupil, the aberrations increased on average by a factor of 2.5 (total) and 2.5 (corneal). Increases in total aberration were related closely to increases in corneal aberration (P<0.0001). For a 6.5-mm pupil, after 20 seconds, the reduction in optical quality (Mf) among the subjects studied was 21+/-8%. CONCLUSIONS: After a blink, the gradual increase in optical aberration associated with the increasingly irregular tear film may cause a progressive reduction in the optical quality of the eye. These changes in aberration with time may partly limit the improvements in visual performance that are achievable by customized corneal ablation.

Adult↗

Ulcerative keratitis caused by Serratia marcescens after laser in situ keratomileusis.

We report 2 cases of severe corneal infections caused by Serratia marcescens after laser in situ keratomileusis (LASIK). Twenty-four hours after LASIK, 2 patients developed infectious keratitis, 1 bilaterally. In each eye, the corneal flap was edematous, ulcerated, and detached from the stromal bed. Treatment included removal of the necrotic flap and aggressive antibiotic therapy. Cultures from corneal exudates were positive for S marcescens. After 1 year, both patients had a loss of best corrected visual acuity (BCVA) ranging from 20/40 to 20/22 because of irregular astigmatism. Overrefraction with a hard contact lens resulted in a BCVA of 20/20 in the 3 affected eyes. Slitlamp examination showed trace subepithelial haze without severe corneal scarring. Videokeratography disclosed areas of paracentral inferior steepening resembling keratoconus. Refraction and videokeratography remained stable after 6 months of follow-up. Ulcerative keratitis caused by S marcescens is a potential complication of LASIK. Bilateral involvement may occur if bilateral simultaneous surgery is performed.

Adult↗

Temporal changes in optical quality of air-tear film interface at anterior cornea after blink.

PURPOSE: To examine temporal changes in the optical quality of the air-tear film interface at the anterior cornea after a blink. METHODS: Corneal aberrations were determined in fifteen healthy subjects at 1 second time intervals after a blink, up to a total elapsed time of 15 seconds. Corneal aberrations were obtained from corneal elevation maps measured using a Tomey TMS-2N topographer and custom software. All data were decomposed using Zernike polynomials to yield the root mean square (RMS) wavefront deviations, in micrometers, for two pupil diameters (3 and 7 mm). RESULTS: Total wavefront aberration decreased slightly with time in the first few seconds after a blink for both pupil diameters, reaching a minimum after approximately 6 seconds. Thereafter aberrations increased steadily, exceeding the immediate postblink level after approximately 10 seconds. CONCLUSIONS: In normal subjects, the contribution of the anterior cornea to the overall ocular aberration remains reasonably stable over the normal interblink interval (approximately 4 seconds) but rises to levels which could perceptibly degrade retinal image quality under circumstances where the interblink interval is increased to exceed 10 seconds, as may occur during the use of visual display screens or when performing difficult tasks.

Adult↗

Cataract after minor trauma in a young patient with an iris-fixated intraocular lens for high myopia.

PURPOSE: To report a case of traumatic cataract in a young patient with an iris-fixated phakic intraocular lens (PIOL). DESIGN: Interventional case report. METHOD: A 32-year-old woman with bilateral iris-fixated PIOLs for high myopia presented with a cortical cataract 2 weeks after minor ocular trauma. Ultrasound biomicroscopy and endothelial cell count were performed before and after cataract surgery. RESULTS: The distance between the PIOL and the crystalline lens was 0.82 mm; the distance between the PIOL and the corneal endothelium was 2.30 mm. Endothelial cell count was 2,500 cells/mm(2) before surgery and 2,476 cells/mm(2) at 1 year follow-up. CONCLUSIONS: Patients with iris-fixated PIOLs are at risk of rapid cataract progression after minor ocular traumatism.

Adult↗

Angle-supported phakic intraocular lenses followed by laser-assisted in situ keratomileusis for the correction of high myopia.

To evaluate the safety, effectiveness, predictability, and stability of the combination of angle-supported phakic intraocular lens (PIOL) implantation and laser-assisted in situ keratomileusis (LASIK) for the correction of high myopia. Noncomparative interventional case series. At the Instituto Oftalmológico de Alicante, Spain, 24 consecutive eyes of 12 patients with a preoperative spherical equivalent between -9 and -26 diopters were studied. Implantation of an angle-supported PIOL was done as the first surgery. Laser-assisted in situ keratomileusis was performed at least 6 months after PIOL surgery, once stability of topography and refraction were proved. Main outcome measures were uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), refraction, applanation tonometry, and corneal endothelial study (cell density, hexagonality, and coefficient of variation), with a minimum follow-up of 12 months after LASIK. The mean spherical equivalent refraction decreased from -15.17 +/- 5.15 diopters before PIOL implantation to -1.33 +/- 1.18 diopters after PIOL surgery and to 0.01 +/- 0.53 12 months after LASIK. Uncorrected visual acuity was 0.39 +/- 0.12 after PIOL surgery, increasing to 0.65 +/- 0.23 12 months after LASIK. There was an increase in 20/40 or better UCVA from 16.6% after PIOL surgery alone to 83.3% after addition of LASIK. At final follow-up, spherical equivalent was within +/- 1 diopter of emmetropia in 22 eyes (91.7%) and in 18 eyes (75%) within +/- 0.50 diopters. Vector analysis demonstrated that astigmatic components of refractive error after PIOL surgery were well corrected by LASIK. At final follow-up the mean endothelial cell loss was 4.88% (P <.001). There were no statistically significant differences between mean endothelial cell count, percentage of hexagonality, or coefficient of variation before LASIK and 12 months after LASIK, suggesting that no corneal endothelial damage was produced by LASIK itself. No sight-threatening complications occurred through the follow-up period. The combination of angle-supported PIOL implantation and LASIK appears to be a safe, effective, predictable, and stable procedure for the correction of high myopia. This paper emphasizes the benefits of adding LASIK to the use of PIOL alone.

Adult↗