Epiteliopatía en limpiaparabrisas en pacientes con blefaroespasmo o espasmo hemifacial

ObjectiveTo evaluate the presence of wiper epitheliopathy in patients with blepharospasm and/or hemifacial spasm before and 4 weeks after routine treatment with botulinum toxin.MethodsProspective study comprising 31 eyes of 20 patients with neurological diagnosis of hemifacial spasm (9 eyes of 9 patients) and essential blepharospasm (22 eyes of 11 patients). Various ocular surface parameters were assessed before and 4 weeks after infiltration with botulinum toxin using the OSDI questionnaire, Schirmer's test, tear break-up time, fluorescein and lissamine green staining assessed with the Oxford test and the degree of involvement of the palpebral wiper.Results100% of the patients had palpebral wiper involvement before (30% mild and 70% moderate) and after toxin treatment (100% mild). 75% of patients had mild-normal OSDI before treatment, after treatment it was 80%. The tear break-up time was 7.2 ± 0.2 sg before and 7.5 ± 0.7 sg after treatment. Schirmer's test was 11.4 ± 5.5 and 12.5 ± 5.5 mm before and after treatment. The Oxford test was initially pathological in 69.3% of patients, after 4 weeks it was pathological in only 54%.ConclusionWiper epitheliopathy is present in 100% of patients with blepharospasm and/or hemifacial spasm. The main pathophysiological mechanism that triggers it in these patients is the increase in the coefficient of friction, as tear volume and stability are normal.     

Loiasis ocular en paciente con hipereosinofilia crónica

Case ReportWe present a case of ocular loiasis with a subconjunctival filaria, 5.5 cm long, and a severe microfilaremia, 1 microfilaria/ml, on a previously asymptomatic woman from Equatorial Guinea, with a past medical history of hypereosinophilia of unknown origin.DiscussionOcular loiasis is an imported infestation with a very low rate in our country. Nevertheless, chronic infestation in immigrants coming from endemic areas of Africa may increase the rate of this disease in our country.     

Oclusión coexistente de vena y arteria central de la retina en un paciente con psoriasis en tratamiento con ustekinumab

A 44 year-old Caucasian male with a history of plaque psoriasis currently being treated with ustekinumab presented with sudden loss of vision in his left eye. Fundus examination showed central retinal vein occlusion coexisting with central retinal artery occlusion. Posterior examination revealed mild polycythemia, being the underlying cause unknown.     

Papiloflebitis en varón joven con enfermedad de Buerger

Clinical case

A 27-year-old male with sudden visual loss of OD. He had a past history of heavy smoking, as well as a chronic ischaemia of his left lower limb of one-year onset. This led to a diagnosis of Buerger's disease, which is an inflammatory thrombotic disorder that affects small and medium vessels. The visual acuity (VA) of OD was 0.9, and in the funduscopy a very congestive papilla was observed, along with venous tortuosity, scattered retinal haemorrhages, but without macular oedema. He progressed favourably, with a complete recovery of VA.

Doble recubrimiento con membrana amniótica en estrabismo restrictivo

The management of restrictive strabismus remains an unresolved problem today.A case of severe restrictive strabismus after a consecutive exotropia surgery is presented. We describe the exitosus managment through a technique consist of wrapping with amniotic membrane the affected muscle where we add a second amniotic membraneA graft in the reconstruction of the ocular surface.     

Biomicroscopia confocal en 4 pacientes con distrofia corneal policromática

Introduction

Polychromatic corneal dystrophy is an unusual pre-descemet dystrophy, about which there are very few publications. The findings are presented in a case series of four patients with polychromatic corneal dystrophy, using a slit lamp, specular biomicroscopy, and confocal microcospy.

Respuesta a ranibizumab en pacientes con degeneración macular húmeda con tracción vitreomacular

PurposeThe purpose of the present study is to compare the responses to ranibizumab between wet age-related macular degeneration patients, with and without accompanying vitreomacular traction syndrome.MethodsOur database of optical coherence tomography files was searched for eyes of age-related macular degeneration patients that had been treated with ranibizumab, and that had evidence of vitreomacular traction. A control group was selected from the same database for comparison.The case history of each selected individual was reviewed for data regarding the evolution of visual acuity in that patient, and the number of intravitreal injections that had been required to date.ResultsFrom a database of 373 eyes, clear images of vitreomacular traction were obtained for a total of 18 eyes.The mean follow-up period was 20.6 months (SD = 10.6, range = 10.4-31.7).Patients in the vitreomacular traction group had been given an average of 5.1 injections versus an average of 4.2 injections in patients in the control group.The mean changes in visual acuity (which was measured using ETDRS charts) were -15 letters and -4 letters in the vitreomacular traction and control groups (P=.07), respectively.ConclusionsAfter ranibizumab treatment, age-related macular degeneration patients with accompanying vitreomacular traction showed a tendency to have a poorer prognosis in terms of visual acuity than patients without this finding. In addition, higher numbers of intravitreal injections were required to obtain clinical responses in patients with vitreomacular traction.     

Hemorragia supracoroidea espontánea bilateral en un paciente en tratamiento con heparina de bajo peso molecular

We present the case of an 81-year-old woman who developed a bilateral spontaneous suprachoroidal hemorrhage while under treatment with sodium enoxaparin. Temporal suspension of anticoagulant therapy led to an improvement of the choroidal hemorrhage. After three months follow-up, there was a complete reabsorption of the choroidal detachments, but there was a persistent vitreous hemorrhage in the right eye, which had been more severely affected. Pars plana vitrectomy with air tamponade was successfully performed in the right eye. Vision improved to 20/50 in the right eye and 20/20 in the left eye.Suprachoroidal hemorrhage is a rare condition with a poor visual prognosis. Reports on the development of suprachoroidal hemorrhage in patients with no predisposing ocular conditions are scarce, and in none were both eyes affected. The case reported herein is, to the best of our knowledge, the first case of bilateral, simultaneous suprachoroidal hemorrhage without predisposing ocular factors due to treatment with anticoagulants, with a favourable visual outcome.     

Ectasia corneal post-LASIK en pacientes con diferencias significativas en las lecturas queratométricas de ambos ojos

ObjectivesA study is made on the incidence of corneal ectasia after laser in situ keratomileusis (LASIK) in patients with large differences in mean keratometry (MK) readings between both eyes (OU). Visual outcomes were also evaluated.MethodsThe medical records of 164,603 patients (315,259 eyes) who underwent LASIK from January 2003 to December 2011 were reviewed in order to identify patients with a difference in MK of ≥ 1.25 D between OU. The main outcome measures were incidence of ectasia after LASIK, and visual outcome.ResultsA total of 35 eyes that met the inclusion criteria were found. Functional and visual results were those expected for myopia studies. After a minimum follow-up of 2 years, no corneal ectasia was found in 3 eyes (2 patients).ConclusionsThe possibility of finding a patient with an asymmetry in MK and normal topography is low (0.021%), and it does not seem to be a contraindication of LASIK. Although no corneal ectasia was found in this case series, and as it is a potentially sight-threatening complication, patients with very different MK between OU should be studied carefully before undergoing LASIK.     

Posibilidad de terapia génica en pacientes con enfermedades retinianas hereditarias

ObjectiveTo evaluate the possibility of gene therapy in patients with inherited ocular conditions and established genetic diagnosis. The secondary objectives were to determine the genetic diagnostic rate and to update the list of genes for which there are ongoing clinical trials or preclinical studies that could allow for gene therapy.MethodsObservational, retrospective, multicentric study of 177 patients with inherited ocular conditions that underwent genetic testing.ResultsOf 177 patients with genetic testing, 146 were enrolled for this study. Disease-causing variants were identified in 117 patients (variant detection rate of 80.1%). Pathogenic variants were found in 47 genes, with ABCA4 being the most common gene (17.9%), followed by CRB1 (11.9%). 64.1% of patients with a genetic diagnosis have a variant in genes for which gene therapy has been studied and only 40.1% have a variant in genes with studies for gene therapy in clinical phase.ConclusionsGenetic testing has opened new horizons in the management of patients with hereditary ocular diseases. About two-thirds of the patients had pathogenic variants in genes for which gene therapy has been evaluated. However, many studies are in the pre-clinical phase. The expectations of patients undergoing genetic study and their families should be managed accordingly.     

Cambio a ranibizumab en edema macular diabético refractario al tratamiento con bevacizumab

Aim

To determine the efficacy of switching to ranibizumab in patients with diabetic macular oedema refractory to treatment with bevacizumab, and to evaluate the outcomes when switching back to bevacizumab.

Terapia intravítrea con aflibercept en ojos con coriorretinopatía serosa central crónica: resultados a corto plazo

Objectives

To evaluate the short term efficacy and tolerability results of intravitreal aflibercept injection as a treatment option for eyes with chronic central serous chorioretinopathy (CSCR).

Alteraciones en el nervio óptico y retina en pacientes con COVID-19. Una revisión teórica

The objective of this research is to identify and systematize the medical conditions generated by SARS-CoV-2 on the optic nerve and retina of young, adult, and elderly adults who suffered from COVID-19 in the period 2019-2022. A theoretical documentary review (TDR) was conducted within the framework of an investigation to determine the current state of knowledge of the subject under study. The TDR includes the analysis of publications in the scientific databases PubMed/Medline, Ebsco, Scielo and Google. A total of 167 articles were found, of which 56 were studied in depth, and these evidence the impact of COVID-19 infection on the retina and optic nerve of infected patients, both during the acute phase and in subsequent recovery. Among the reported findings, the following stand out: anterior and posterior non-arteritic ischemic optic neuropathy, optic neuritis, central or branch vascular occlusion, paracentral acute medial maculopathy, neuroretinitis, as well as concomitant diagnoses such as possible Vogt-Koyanagi-Harada disease, multiple evanescent white dot syndrome (MEWDS), Purtscher-like retinopathy, among others.     

Tratamiento con ciclosporina al 0,1% (Ikervis®) en conjuntivitis corticodependiente asociada a dupilumab

Dupilumab is a drug that has recently been approved by the Food and Drug Administration (FDA) and European Medical Agency (EMA) for the treatment of moderate-to-severe atopic dermatitis in adults. An increase in frequency of conjunctivitis related to dupilumab treatment has been reported in recent publications and clinical trials. We report two steroid-dependent cases satisfactorily treated with cyclosporine 0.1% (Ikervis®). To our knowledge there are no reported cases of dupilumab-associated conjunctivitis treated with cyclosporine 0.1% (Ikervis®).     

Necrosis retiniana como manifestación de aspergilosis invasiva en un paciente tratado con ruxolitinib

A 30 year-old man with acute myeloblastic leukaemia and secondary myelodysplastic syndrome developed graft-versus-host disease. The patient was treated with ruxolitinib. After being treated for 3 months with ruxolitinib, an inhibitor of Janus kinase, he developed Aspergillus retinal necrosis resistant to common treatment.Treatment with Janus kinase inhibitors may lead to an increased incidence of opportunistic infections. Janus kinase inhibitor administration may result in poor treatment efficacy.     

Complicaciones y agudeza visual en los pacientes con uveítis en una unidad multidisciplinar de referencia del norte de España

ObjectiveTo describe uveitis complications and visual acuity in a cohort of 500 patients in a multidisciplinary unit in northern Spain.Material and methodsRetrospective-prospective study of complications and visual acuity of 500 adult patients evaluated in the Multidisciplinary Unit of the Navarra Hospital Complex from the period January 2010 until March 2015. An analysis was made of the complications, visual acuity and visual loss, with a follow-up of one-year. A comparative study was also made of the complications with 2 previous series published in Madrid and Holland.ResultsModerate-severe visual loss was 13.5% in the right eye, and 13% in the left eye. Visual loss was associated with an age of 65 years or above. Complications were observed in 35% of patients, and cataract was the most frequent complication (10%), followed by synechiae (8%), and macular oedema (5%). Compared with the 2 other series, the present cohort showed a higher proportion of cataracts.ConclusionsVisual loss was associated with older age and cataract was the most common complication in our study.