Partial regression of peripapillary myelinated nerve fibers after non-arteritic anterior ischemic optic neuropathy / Regressão parcial das fibras nervosas peripapilares mielinizadas após neuropatia óptica isquêmica anterior não arterítica

ABSTRACT A 71-year-old woman presented a non-arteritic anterior ischemic optic neuropathy in an optic nerve with previously registered superonasal peripapillary myelinated nerve fibers. Her past medical history was significant for controlled systemic hypertension, hyperlipidemia, and diabetes mellitus. The physiologic cup was absent in both optic discs. Non-arteritic anterior ischemic optic neuropathy mainly affected the temporal and inferior sectors of the peripapillary retinal nerve fiber layer, as could be demonstrated by retinal nerve fiber layer optical coherence tomography and optic disc optical coherence tomography angiography. Unlike other published reports, just a slight regression of the myelinated nerve fibers was observed after 1 year of follow-up. This occurred because ischemia mainly affected the temporal and inferior peripapillary sectors, whereas myelinated nerve fibers were superonasal to the optic disc.

RESUMO Uma mulher de 71 anos de idade apresentou neuropatia óptica isquêmica anterior não arterítica no nervo óptico com fibras nervosas peripapilares mielinizadas previamente registradas. Seu histórico médico foi significativo para hipertensão arterial sistêmica controlada, hiperlipidemia e diabetes mellitus. Em ambos os discos ópticos, a tacícula fisiológica esteve ausente. A neuropatia óptica isquêmica anterior não arterítica afetou principalmente os setores temporal e inferior da camada de fibras nervosas da retina peripapilar, como demonstrado pela tomografia de coerência óptica da camada de fibras nervosas da retina e pela angiotomografia de coerência óptica do disco óptico. Ao contrário de outros relatórios publicados, apenas uma ligeira regressão das fibras nervosas mielinizadas foi observada após um ano de acompanhamento. Isto pode ser explicado pelo fato da isquemia ter afetado principalmente os setores temporal e inferior peripapilares, enquanto as fibras nervosas de mielina eram nasal superior ao disco óptico.

Características epidemiológicas y clínicas de pacientes con glaucoma crónico simple / Epidemiologic and clinic characteristics of patients with chronic simple glaucoma i: en

Introducción: El glaucoma es una de las enfermedades oculares de mayor prevalencia a escala mundial y se caracteriza por presión intraocular elevada, cambios en la papila y alteraciones en el campo visual. Objetivo: Caracterizar a pacientes con glaucoma crónico simple según variables epidemiológicas y clínicas. Método: Se realizó un estudio observacional, descriptivo y transversal de 96 pacientes con glaucoma primario de ángulo abierto, quienes fueron atendidos en la consulta de oftalmología del Policlínico Docente Alberto Fernández Montes de Oca del municipio de San Luis, en la provincia de Santiago de Cuba, desde enero hasta julio del 2019. Resultados: En la serie prevalecieron el sexo masculino, el grupo etario de 60 a 69 años y los pacientes de piel negra, además de la hipertensión arterial y ocular como factores de riesgo asociados. Por otra parte, la mayoría de los afectados presentaron agudeza visual entre 1,0-0,6, cifras de presión intraocular entre 16-21 mmHg y excavación papilar entre 0,6-0,7, con daños importantes en el campo visual. Conclusiones: Las características epidemiológicas y clínicas de los pacientes con glaucoma primario de ángulo abierto resultaron útiles para establecer el pronóstico y trazar pautas terapéuticas efectivas, a fin de evitar la fase avanzada de la enfermedad y los daños irreversibles que se producen en el nervio óptico.

Introduction: Glaucoma is one of the most prevalent eye diseases worldwide and is characterized by high intraocular pressure, changes in the papilla and visual field alterations. Objective: To characterize patients with chronic simple glaucoma according to epidemiologic and clinical variables. Methods: An observational, descriptive and cross-sectional study of 96 patients with primary open-angle glaucoma was carried out, who were assisted in the Ophthalmology Service of Alberto Fernández Montes de Oca Teaching Polyclinic of San Luis municipality, in Santiago de Cuba province, from January to July, 2019. Results: In the series there was a prevalence of the male sex, the 60 to 69 age group, and dark-skinned patients, besides hypertension and ocular hypertension as associated risk factors. On the other hand, most of those affected presented visual acuteness between 1.0-0.6, intraocular pressure figures between 16-21 mmHg and papillary excavation between 0.6-0.7, with important damage in the visual field. Conclusions: The epidemiologic and clinical characteristics of patients with primary open-angle glaucoma were useful to establish the prognosis and trace effective therapeutic guidelines, in order to avoid the advanced phase of the disease and the irreversible damage that occurs in the optic nerve.

Factor de crecimiento nervioso en neuropatía óptica traumática

La neuropatía óptica traumática (TON) es una entidad asociada al trauma facial y craneal, y constituye una causa importante para el desarrollo de la ceguera; es una complicación grave del trauma craneofacial que daña directa (dTON) o indirectamente (iTON) el nervio óptico (ON), cuya incidencia global de TON es de 0,7 a 2,5 %. El objetivo del presente estudio es presentar el caso de un paciente que padecía de TON y a la vez de una afección bilateral asimétrica, y que fue tratado con el factor de crecimiento nervioso mNGF. Este medicamento fue el primero que se descubrió y demostró eficacia en mantener la supervivencia de las neuronas centrales y periféricas y facilitar su crecimiento, diferenciación y regeneración. Se trata de un paciente de 13 años, sexo masculino, quien acude a la emergencia del Instituto Nacional de Ciencias Neurológicas y, posteriormente, su seguimiento clínico es por consultorio de Neuroftalmología, con un cuadro de amaurosis traumática, producto de un traumatismo encéfalo craneano con hematoma epidural, que recibió dos ciclos de tratamiento con factor de crecimiento nervioso. Luego del primer ciclo de tratamiento, se evidenció hiporreactividad de ambos ojos; al finalizar el segundo ciclo de tratamiento, se observó un aumento considerable de la agudeza visual. El mNGF está aprobado y comercializado en China desde el año 2015 y es un producto que ha demostrado su eficacia y seguridad en varios ensayos clínicos. Por ello, el presente estudio pretende convertir al factor de crecimiento nervioso como el tratamiento prometedor de iTON; en ese sentido, se necesita de amplias investigaciones clínicas en este caso en particular.

Traumatic optic neuropathy (TON) is an entity associated with facial and cranial trauma, and a leading cause of blindness. It is a severe complication of craniofacial trauma that directly (DTON) or indirectly (ITON) damages the optic nerve (ON) and whose global incidence is 0.7 to 2.5 %. The objective of this study is to present the case of a patient who suffered from TON and, at the same time, an asymmetrical bilateral condition, and was treated with nerve growth factor (NGF). This drug was the first to be discovered and demonstrate efficacy in maintaining the survival of central and peripheral neurons and facilitating their growth, differentiation and regeneration. A 13-year-old male patient attended the emergency room of Instituto Nacional de Ciencias Neurológicas and was later followed up at the Neuro-Ophthalmology Service. He was diagnosed with post-traumatic amaurosis caused by traumatic brain injury and epidural hematoma, and received two treatment cycles of NGF. After the first treatment cycle, hyporeactivity of both eyes occurred. And, at the end of the second treatment cycle, visual acuity improved significantly. NGF has been approved and marketed in China since 2015 and is a product that has demonstrated its efficacy and safety in several clinical trials. Therefore, this study aims to make NGF a promising ITON treatment; in that sense, further clinical research is needed in this particular case.

Autoimmune optic neuropathy as the differential diagnosis of neuromyelitis optica spectrum disorders / Neuropatia óptica autoimune como diagnóstico diferencial do espectro da neuromielite óptica

ABSTRACT Optic neuritis is an important cause of decreased vision due to inflammation of the optic nerve. In view of its complex etiology, a thorough clinical evaluation is essential. Autoimmune optic neuropathy, a rare form of optic neuritis, is associated with progressive, painless, and severe visual loss. Severity depends on the inflammatory and ischemic components of the condition. Autoimmune optic neuropathy is ideally diagnosed with autoimmune disease markers (usually elevated levels of antinuclear antibodies). The treatment is immunosuppression with high doses of corticosteroids. Corticoid dependence is a characteristic of autoimmune optic neuropathy. In this report, we describe a patient with autoimmune optic neuropathy and discuss the importance of laboratory parameters and magnetic resonance imaging findings in the diagnosis of the disease.

RESUMO A Neurite óptica é uma importante causa de diminuição da visão devido à inflamação do nervo óptico. Por apresentar diversas etiologias faz-se necessário ampla investigação. A neuropatia óptica autoimune corresponde a uma doença rara que se manifesta com perda visual aguda, indolor e grave. A gravidade está associada a sua fisiopatogenia com componentes inflamatório e isquêmico. A positividade para marcadores de doenças autoimunes, mais comumente a elevação da titulação de anticorpos antinucleares, são fatores determinantes para o diagnóstico da neuropatia óptica autoimune. O tratamento é feito através de imunossupressão, com necessidade de altas doses de corticoide. Neste relato iremos descrever um paciente com neuropatia óptica autoimune. Discutiremos sobre a importância dos parâmetros laboratoriais e os achados de imagem da ressonância magnética para o diagnóstico.

Perdas visuais agudas: uma revisão dos últimos 10 anos de causas não infecciosas e não maculares / Acute visual loss: a review from the last 10 years of non-infectious and non-macular causes

Objetivo: o conhecimento das principais causas de perda visual aguda possibilita o diagnóstico precoce do paciente, o que favorece o tratamento mais rápido e eficaz, a fim de preservar a acuidade visual. Neste artigo de revisão, as principais causas não infeciosas e não oriundas da mácula são abordadas, a fim de buscar e revisar os tópicos mais pertinentes sobre cada tema, como as manifestações clínicas e os tratamentos mais utilizados. Métodos: trata-se de uma revisão de literatura, com 30 artigos selecionados e revisados da plataforma MEDLINE. Resultados: as causas de perda visual aguda discutidas são cinco. Primeiro, as por baixa acuidade visual, súbita, unilateral, sem dor e sem hiperemia: hemorragia vítrea, descolamento de retina, oclusão vascular de retina e neuropatia óptica isquêmica anterior. Posteriormente, por baixa acuidade visual, súbita, unilateral, com dor e sem hiperemia: neurite óptica. Por meio deste estudo, alguns fatores de risco podem ser evidenciados e os principais tratamentos destacados. Conclusão: o diagnóstico precoce das perdas visuais agudas deve ser realizado, com os exames físicos adequados, como a fundoscopia e os exames complementares necessários solicitados. Além disso, o encaminhamento ao oftalmologista é de extrema importância para minimizar sequelas e evitar complicações.

Objective: The knowledge of the main causes of acute visual loss enables the early diagnosis of the patient, which favors faster and more effective treatment in order to preserve visual acuity. In this review article, the main non-infectious causes not originating from the macula are addressed in order to search and review the most relevant topics on each theme, such as the clinical manifestations and the most used treatments. Methods: This is a literature review with 30 articles selected and reviewed from the MEDLINE platform. Results: Five causes of acute visual loss are discussed. First, those for sudden, unilateral, without pain, and without hyperemia low visual acuity are reviewed: vitreous hemorrhage, retinal detachment, retinal vascular occlusion, and anterior ischemic optic neuropathy. Subsequently, one due to low visual acuity, sudden, unilateral, with pain and without hyperemia is evaluated: optic neuritis. Through this study, some risk factors and main treatments can be highlighted. Conclusion: The early diagnosis of acute visual loss should be performed with appropriate physical exams, such as fundoscopy and the necessary complementary exams. In addition, referral to an ophthalmologist is extremely important to minimize sequelae and avoid complications.

Resolución de neuropatía óptica y oft almoplegía después del tratamiento quirúrgico de un mucocele / Resolution of optic neuropathy and ophthalmoplegia following mucocele ethmoidectomy and drainage

Introducción: Los mucoceles de senos paranasales pueden afectar la órbita, más frecuentemente cuando su localización es frontoethmoidal originando un efecto de masa. Objetivo: Reportar el compromiso orbitario y riesgo para la visión permanente en un caso de mucocele. Diseño del estudio: Reporte de caso Resumen del caso: Paciente femenina con proptosis unilateral progresiva de larga data, disminución progresiva de la agudeza visual y oft almoplegía. La tomografía computarizada de la órbita reveló un mucocele del seno etmoidal comprimiendo el nervio óptico y el ápex de la órbita. Posterior al manejo quirúrgico, etmoidectomia y drenaje del mucocele, se presenta una marcada mejoría de la función del nervio óptico, motilidad ocular y proptosis. Conclusión: Es muy raro que los mucoceles etmoidales afecten el nervio óptico sin embargo hay algunas características que los pueden llevar a afectar la visión: infección asociada, compromiso de las celdillas etmoidales posteriores o un mucocele gigante con tratamiento tardío. Es importante conocer los signos y síntomas oft almológicos que nos pueden ayudar a diagnosticar el compromiso orbitario por mucocele en etapas tempranas. Esta patología se debe atender de manera multidisciplinaria con especialistas en órbita y otorrinolaringología.

Background: Orbital involvement of sinus mucoceles, especially frontoethmoidal may result in orbital mass eff ect. Objective: Describe orbital involvement and potential for visual loss in a case with mucocele. Study design: Case report Case summary: Th ese is a patient with longstanding unilateral proptosis, progressive decrease in visual acuity and ophthalmoplegia. Orbital computed tomography (CT) revealed a large ethmoidal sinus mucocele compressing the optic nerve and orbital apex. Improvement in optic nerve function, motility and proptosis resulted from ethmoidectomy and mucocele drainage. Conclusion: Although frontoethmoidal mucoceles seldom aff ect the optic nerve, there may be cases with potential to aff ect vision; this may occur more frequently when a coexistent infection is present, when the posterior ethmoid cell is involved or when a giant mucocele is present and treatment is delayed. Th is pathology must be addressed in a multidisciplinary manner with otolaryngologists and orbit specialists.

Importância do raciocínio etiológico e topográfico de lesões: relato de neuropatia óptica traumática conduzida como acidente vascular cerebral / Importance of etiological and topographic injury reactions: report of a traumatic optic neuropathy conducted as a cerebrovascular accident

Introdução: O trauma ocular ou periocular pode afetar o nervo óptico e causar baixa acuidade visual ou alteração de campo visual. Essa lesão, denominada neuropatia óptica, quando de etiologia traumática, pode ser classificada como direta, através da compressão, perfuração ou laceração do nervo óptico por ação de corpos estranhos, fraturas do assoalho da órbita ou hemorragias, e indireta, quando a partir de um trauma externo ao globo ocular há lesão por transmissão da onda de choque ou desaceleração, levando à lesão do nervo óptico pelo estiramento de suas fibras ou edema comprometendo sua vascularização, comum nos acidentes automobilísticos e nas quedas. Descrição do Caso: O presente estudo objetiva relatar um caso de neuropatia óptica traumática conduzida erroneamente como acidente vascular cerebral em uma paciente do sexo feminino de 29 anos, com história de queda da própria altura. Discussão: A investigação feita pela história clínica, evolução do quadro e novos achados fundoscópicos permitiu o diagnóstico correto e melhor orientação da paciente. Conclusão: O conhecimento da neuropatia óptica traumática e da anatomia da via óptica têm extrema importância no raciocínio topográfico e etiológico das lesões traumáticas que cursam com comprometimento visual, poupando o paciente de possíveis intervenções invasivas e desnecessárias (AU)

Introduction: Eye or periocular trauma can affect the optic nerve and cause low visual acuity or visual field alteration. This lesion, called optic neuropathy, when of traumatic etiology, can be classified as direct, through compression, perforation or laceration of the optic nerve by action of foreign bodies, fractures of the orbit floor or hemorrhages, and indirect, when from an external trauma to the eyeball there is injury by transmission of the shock wave or deceleration, leading to optic nerve injury by stretching its fibers or edema compromising its vascularization, common in automobile accidents and falls. Case Report: The present study aims to describe a case of traumatic optic neuropathy mistakenly conducted as a stroke in a 29-yearold female patient with a history of falling from his own height. Discussion: The investigation was possible because of the clinical history, evolution of the condition and new fundoscopic findings that allowed the correct diagnosis and better orientation of the patient. Conclusion: Knowledge of traumatic optic neuropathy and anatomy of the optical pathway have extreme importance in the topographic and etiological reasoning of traumatic lesions that present with visual impairment, saving the patient from possible interventions invasive and unnecessary. (AU)

Descompresión orbitaria endoscópica transnasal en orbitopatía tiroidea severa / Transnasal endoscopic orbital decompression in severe thyroid orbitopathy

RESUMEN La orbitopatía tiroidea es una enfermedad autoinmune, en la que una reacción inflamatoria genera aumento de la presión orbitaria con protrusión de su contenido. A menudo es autolimitada y sus síntomas más frecuentes son retracción palpebral, exoftalmo y diplopía. Existen casos severos con compromiso de la agudeza visual por compresión del nervio óptico. El diagnóstico es clínico, pero debe complementarse con una tomografía computarizada. Su tratamiento depende de la gravedad y actividad de la enfermedad, siendo los procedimientos quirúrgicos, como la descompresión orbitaria, de elección en exoftalmo y neuropatía óptica compresiva. El pilar de tratamiento en la orbitopatía tiroidea severa es la cirugía descompresiva. Se han descrito múltiples técnicas, pero con limitaciones. La descompresión endoscópica transnasal, es considerada actualmente el procedimiento de elección, ya que permite una buena visualización de la pared medial, con resultados comparables y menores complicaciones, respecto a métodos tradicionales. Describimos un caso de oftalmopatía tiroidea severa, con exoftalmo, diplopía y disminución de la agudeza visual, en la que se realizó una descompresión endoscópica con muy buenos resultados.

ABSTRACT Thyroid orbitopathy is an autoimmune disease in which an inflammatory reaction generates increased orbital pressure with protrusion of its contents. It is often self-limiting and its most frequent symptoms are eyelid retraction, exophthalmos and diplopia. There are severe cases with compromised visual acuity due to compression of the optic nerve. The diagnosis is clinical, but must be complemented with a computed tomography scan. Its treatment depends on the severity and activity of the disease and the surgicals procedures such as orbital decompression is the best choice in exophthalmos and compressive optic neuropathy. The treatment in severe thyroid orbitopathy is decompressive surgery. Multiple techniques have been described, but with limitations. The transnasal endoscopic decompression is currently considered the gold standard, since it allows a good visualization of the medial wall with comparable results and less complications, compared to traditional methods. We present a case of severe thyroid ophthalmopathy, with exophthalmos, diplopia and decreased visual acuity, in which a transnasal endoscopic decompression was performed with very good outcomes.

Factores predictivos de ceguera en pacientes con glaucoma crónico simple / Predictive factors of blindness in patients with simple chronic glaucoma

Se realizó un estudio analítico de casos y controles para estimar la carga causal de la hipertensión ocular y el espesor corneal central como factores predictivos de ceguera en 300 pacientes con glaucoma crónico simple, pertenecientes al Policlínico Frank País García de Santiago de Cuba, durante el 2016. Se seleccionaron 40 casos (ciegos) y 260 controles (no ciegos). Los datos se procesaron a través del sistema de base de datos IBM SPSS Statistics 21 para Windows. Para la regresión logística hubo 88,3 por ciento de probabilidad de aciertos en el resultado de la variable dependiente, por lo cual se asumió que fue 2,74 veces más probable desarrollar la ceguera en los pacientes que presentaron presión intraocular alta y 2,38 veces en aquellos con un espesor corneal central disminuido que en quienes no mostraron estos factores de riesgo, cuando las demás variables independientes se mantuvieron constantes

An analytic cases and controls study to estimate the causal load of the ocular hypertension and the central corneal thickness as predictive factors of blindness was carried out in 300 patients with simple chronic glaucoma, belonging to Frank País García Polyclinic in Santiago de Cuba, during the 2016. Forty cases were selected (blind patients) and 260 controls (not blind patients). The data were processed through the database system IBM SPSS Statistics 21 for Windows. For the logistical regression there was 88,3 percent of probability of successes in the result of the dependent variable, reason why it was assumed that it was 2,74 times more probable to develop blindness in patients who presented high intraocular pressure and 2,38 times in those with a decreased central corneal thickness than in those who didn't show these risk factors, when the other independent variables remained constant

Caracterización estructural y funcional de la neuropatía óptica inflamatoria autoinmune / Structural and Functional Description of Autoimmune Inflammatory Optic Neuropathy

Introducción: la neuritis óptica es una inflamación del nervio óptico de variada etiología relacionada con algunas entidades como procesos inflamatorios y enfermedades sistémicas. Objetivo: caracterizar la estructura y función en la neuropatía óptica inflamatoria autoinmune. Métodos: estudio descriptivo de serie de casos en el Hospital Clínico Quirúrgico Lucía Iñiguez Landín en el 2012. El universo estuvo constituido por 18 pacientes con neuropatía óptica inflamatoria. La muestra incluyó 12 pacientes con etiología autoinmune. Se distribuyó a los pacientes según diagnóstico etiológico y topográfico. Se realizó funduscopia y tomografía láser confocal. Se realizó valoración funcional del nervio óptico según potenciales evocados visuales. Resultados: predominó la etiología desmielinizante y la forma topográfica anterior, de los ocho pacientes de la variedad topográfica anterior, siete tenían esclerosis múltiple y un caso se debió a lupus eritematoso sistémico. La variedad desmielinizante posterior se observó en dos casos. El mayor número de pacientes presentó aumento del grosor de la capa de fibras nerviosas retinianas según resultado de la funduscopia y la tomografía confocal. Los resultados con tomografía láser coincidieron con los obtenidos por funduscopia, los ocho casos con topografía anterior presentaron grosor aumentado de la capa de fibras nerviosas retinianas y los dos casos de topografía posterior mostraron un grosor normal. El mayor número de pacientes presentó aumento de la latencia y amplitud normal de los potenciales evocados, la mayoría de los casos presentaron latencia aumentada (9 casos para el 75,0%) y tres mostraron latencia muy aumentada (25,0%). La amplitud fue normal en ocho pacientes y en cuatro estaba disminuida. De ellos (34%), dos correspondieron a neuritis óptica anterior. Conclusiones: se corroboró la relación estructura función en el daño del nervio óptico en la neuropatía inflamatoria de causa autoinmune.

Introduction: optic neuritis is an inflammation of the optic nerve of varied etiology related to some conditions such as inflammatory processes and systemic diseases. Objective: to describe structure and function in autoimmune inflammatory optic neuropathy. Methods: a descriptive of a series of cases study at Lucía Iñiguez Landín Surgical Clinical Hospital in 2012 was done. The universe consisted of 18 patients with inflammatory optic neuropathy. The sample included 12 patients with autoimmune etiology. The patients were distributed according to etiological and topographical diagnosis. Funduscopy and confocal laser tomography were performed. Functional evaluation of the optic nerve was performed according to visual Evoked Potentials. Results: demyelinating etiology and anterior topographic etiology predominated, of the eight patients of the topographic variety, seven had multiple sclerosis and one case was due to systemic lupus erythematosus. The posterior demyelinating variety was observed in two cases. The greatest number of patients presented increased thickness of the retinal nerve fiber layer as a result of funduscopy and confocal tomography. The results with laser tomography coincided with those obtained by funduscopy, the eight cases with anterior topography showed increased thickness of the retinal nerve fiber layer and the two cases of posterior topography showed a normal thickness. The greater number of patients presented increased latency and normal amplitude of the evoked potentials, the majority of cases presented increased latency (9 cases for 75.0%) and three showed a very increased latency (25.0%). The amplitude was normal in eight patients and in four it diminished. Of these (34%), two corresponded to anterior optic neuritis. Conclusions: the relationship structure in the optic nerve damage in autoimmune inflammatory neuropathy was corroborated.

Nonarteritic anterior ischemic optic neuropathy following pars plana vitrectomy for macular hole treatment: case report / Neuropatia óptica isquêmica anterior não arterítica pós vitrectomia pars plana para tratamento do buraco macular: relato de caso

ABSTRACT Herein, we report a case of nonarteritic anterior ischemic optic neuropathy (NAION) following uneventful pars plana vitrectomy for macular hole treatment. A 56-year-old previously healthy woman presented with a full-thickness macular hole in right eye (OD) and small cup-to-disc ratios in both eyes. Five days after surgery, she noticed sudden painless loss of vision in OD and was found to have an afferent pupillary defect and intraocular pressure of 29 mmHg. Fundus examination showed right optic disc edema and the resolution of a macular hole with an inferior altitudinal visual field defect. Erythrocyte sedimentation rate, C-reactive protein levels, and general physical examination findings were normal. She was treated with hypotensive eyedrops and oral prednisone, resulting in mild visual improvement and a pale optic disc. A combination of face-down position and increased intraocular pressure due to a small optic disc cup were considered as potential mechanisms underlying NAION in the present case. Vitreoretinal surgeons should be aware of NAION as a potentially serious complication and be able to recognize associated risk factors and clinical findings.

RESUMO Nosso objetivo é descrever a ocorrência de neuropatia óptica isquêmica anterior não-arterítica (NOIA-NA) após vitrectomia posterior para tratamento do buraco macular. Uma mulher de 56 anos de idade previamente hígida apresentou buraco macular de espessura total no olho direito (OD) e uma relação escavação disco pequena em ambos os olhos. No quinto dia de pós-operatório ela notou uma perda visual súbita e indolor OD associado a presença de um defeito pupilar aferente relativo e pressão intraocular de 29 mmHg neste mesmo olho. A avaliação do fundo de olho revelou a presença de edema de disco óptico e buraco macular fechado OD associado a presença de defeito de campo visual altitudinal inferior. A velocidade de hemossedimentação e a dosagem da proteína C reativa foram normais, assim como o exame físico geral. A paciente foi tratada com colírios hipotensores e prednisona oral e evoluiu com discreta melhora visual e palidez de disco óptico. Acreditamos que a combinação de posição de cabeça virada para baixo associado a um aumento da pressão intraocular em um paciente com relação escavação disco pequena são os possíveis mecanismos para a ocorrência de NOIA-NA neste presente caso. Os cirurgiões de retina e vítreo devem estar atentos a esta possível grave complicação e reconhecer os seus fatores de risco relacionados assim como sua apresentação clinica.

Neurite óptica isquêmica devida à dose inédita de sildenafila / Ischemic optic neuritis due to unprecedented dose of sildenafil

No presente relato de caso, os autores ressaltam aspectos gerais, neuro-oftalmológicos e psicodinâmicos de um paciente que apresentou neurite óptica isquêmica não arterítica devida ao uso de dose inédita da sildenafila.

In this case report, the authors emphasize general, neuro-ophthalmological and psychodynamic aspects, of a patient who developed non-arteritic ischemic optic neuropathy due to the use of unprecedented dose of sildenafil.

Neuropatía óptica postraumática, presentación de un caso / Post-traumatic optic neuropathy: case presentation

Introducción: la neuropatía óptica postraumática (NOP) es una entidad en la cual se presenta una lesión del nervio óptico secundaria a un traumatismo directo o indirecto. Puede ser muy fácil de diagnosticar cuando existe la sospecha clínica y se encuentran alteraciones funcionales pupilares. Existen varios estudios que pueden resultar útiles como auxiliares diagnósticos. El objetivo de presentar este caso clínico es el analizar un paciente con diagnóstico de NOP con afección bilateral, con estudio de tractografía positivo para lesión del nervio óptico, con el fin de enfatizar la necesidad de evaluar siempre funcionalmente los ojos en un paciente con traumatismo craneal y conocer la utilidad o no del tratamiento con corticoides en altas dosis. Caso clínico: hombre de 28 años de edad con antecedente de ingesta de licor, es asaltado y sufre traumatismo craneoencefálico con pérdida de la conciencia. A las 16 horas del evento únicamente percibía luz. Se inició tratamiento con corticoides intravenosos ante la sospecha de una neuropatía óptica postraumática. La tractografía de nervios ópticos demostró la presencia de lesión. Conclusiones: el análisis de este caso indica la necesidad de identificar la neuropatía óptica traumática, incluso en ausencia de signos anatómicos. Se debe implementar tempranamente tratamiento a base de corticoesteroides.

Introduction: post traumatic Optic Neuropathy (PON) is an entity in which a lesion of the optic nerve occurs after a direct or indirect trauma. It can be very easy to diagnose when there is clinical suspicion and functional pupillary abnormalities are present. There are several studies available that may be useful as diagnostic aids. The purpose of presenting this case report is to analyze a patient diagnosed with PON with bilateral involvement, with positive tractography study of the optic nerve, in order to emphasize the need to assess functionally the eyes of a patient with head trauma and to establish how useful or not a treatment with high-doses of corticosteroids can be. Clinical case: a 28 year old male with a history of intake of liquor, is assaulted and presented head trauma with loss of consciousness. At 16 hours after the accident there only was light perception. Treatment was initiated with intravenous corticosteroids suspicion of posttraumatic optic neuropathy. Tractography of the optic nerve showed the presence of injury. Conclusions: the analysis of this case indicates the need to identify Postraumatic Optic Neuropathy even in the absence of ocular abnormalities. Early treatment with corticosteroids must be implemented.

Neuritis óptica atípica en un adulto joven: un desafío diagnóstico / Atypical optic neuritis in a young adult: a diagnostic challenge

Optic neuritis is an inflammatory disease of the optic nerve and is classified into typical and atypical: the first, may be associated with diagnostic or future risk of developing multiple sclerosis (MS). However, the differential diagnosis is extensive and prognosis and treatment depend on the cause. The purpose of this paper is to present a case of demyelinating optic neuritis and discuss the diagnosis step confrontation.

La neuritis óptica es una enfermedad inflamatoria del nervio óptico y se clasifica en típica y atípica: la primera, se puede asociar al diagnóstico o riesgo futuro de desarrollo de esclerosis múltiple (EM). Sin embargo, el diagnóstico diferencial es extenso y el tratamiento y pronóstico dependen de la causa. El propósito del presente trabajo es presentar un caso clínico sobre neuritis óptica desmielinizante y discutir paso a paso el enfrentamiento diagnóstico.

El glaucoma: un problema de salud mundial por su frecuencia y evolución hacia la ceguera / Glaucoma: a world health problem for its frequency and clinical course toward blindness

El glaucoma es una enfermedad ocular que constituye un problema de salud por su gravedad y frecuencia, pues ocupa el segundo lugar como causa de ceguera irreversible en el mundo y el primero en Cuba. Muchas de sus formas clínicas son asintomáticas, de manera que el nervio óptico va deteriorándose con lentitud y hace que los pacientes acudan al oftalmólogo en estadios avanzados del proceso morboso. La neuropatía glaucomatosa limita sustancialmente las capacidades de los enfermos para actuar y disfrutar plenamente de la vida, a lo cual se suma que su repercusión socioeconómica es enorme, por lo que hoy representa una prioridad médica en numerosos países.

Glaucoma is an ocular disease which constitutes a health problem due to its severity and frequency, because it occupies the second place as cause of irreversible blindness in the world and the first cause in Cuba. Many of its clinical ways are asymptomatic, so that the optic nerve deteriorates slowly and make patients to go to the ophthalmologist in advanced stages of the morbid process. The glaucomatous neuropathy limits considerably the capacities of the sick persons to act and to enjoy the life fully, to what it is added that its socioeconomic repercussion is enormous, so that today it represents a medical priority in numerous countries.

Neuropatía óptica isquémica anterior no arterítica simulando un edema macular posterior a cirugía de catarata / Nonarteritic anterior ischemic optic neuropathy masquerading as macular edema after cataract surgery

Introducción: la neuropatía óptica isquémica anterior no arterítica y el edema macular son con frecuencia causas de pérdida visual después de una cirugía ocular no complicada. Objetivo: identificar estas dos entidades es muy importante, ya que la conducta a seguir y el pronóstico de ambos es bien diferente. Caso clínico: se reporta una paciente femenina de 74 años con pérdida visual aguda en el posoperatorio de cirugía de catarata. El Servicio de Retina lo reporta como edema macular que responde a la terapia esteroidea, a pesar de esto la visión no mejora. Al realizar el estudio neuro-oftalmológico se constata atrofia óptica parcial secundaria a una neuropatía óptica isquémica anterior no arterítica. Conclusiones: la asociación de estos eventos es infrecuente, pero en estas circunstancias el edema macular que puede ocurrir en la isquemia del nervio óptico, puede simular el de la respuesta inflamatoria a una cirugía

Introduction: nonarteritic anterior ischemic optic neuropathy and macular edema are frequent causes of loss of vision after uncomplicated ocular surgery. Objective: to identify these two conditions is very important since the behaviors to be adopted and the prognosis are quite different. Clinical case: a 74 years-old female patient with acute loss of vision during the postoperative period of a cataract surgery. The Retinal Service classified it as macular edema which had to be treated with steroid therapy, but her vision did not improve. After the corresponding neurophthalmologic study, it is confirmed that there is partial optic atrophy secondary to nonarteritic anterior ischemic optic neuropathy. Conclusions: the association of these events is uncommon; however under these circumstances, the macular edema that may occur in the optic nerve ischemia can masquerade as inflammatory reaction to surgery

Neuropatía óptica hereditaria de Leber / Leber´s hereditary optic neuropathy

La neuropatía óptica hereditaria de Leber es una enfermedad de herencia materna que se caracteriza por la pérdida subaguda, indolora y bilateral, aunque por lo general no siempre al unísono de la visión central. Predomina en hombres jóvenes y es causada por mutaciones puntuales del ADN mitocondrial. Esta es una de las neuropatías ópticas hereditarias más frecuentes y altamente invalidante, cuyo diagnóstico de certeza lo constituyen los estudios moleculares. El propósito de esta revisión es alertar en cuanto a su diagnóstico y posible incremento en condiciones ambientales favorecedoras. Se realizó una búsqueda automatizada de artículos científicos relacionados con el tema, en PUBMED e Hinari, que resultó en 37 publicaciones realizadas durante los años 1988-2010. Se estudiaron y discutieron aspectos de la enfermedad tales como antecedentes históricos, factores de riesgo, epidemiología, genética, características clínicas, diagnóstico y tratamiento; además de profundizar en su estado actual en nuestro contexto. En Cuba actualmente se conoce de la existencia de varias familias que padecen la neuropatía óptica hereditaria de Leber. El alza de la incidencia probablemente se debió a las condiciones medioambientales que favorecen o son factores de riesgo de esta entidad, como ocurrió durante la pasada epidemia de neuropatía óptica en Cuba. Cada día se producen más avances en el campo de la genética, que permiten identificar un número mayor de mutaciones asociadas a esta entidad. Esto unido al conocimiento de las características clínicas de la enfermedad ha permitido identificar las familias afectadas y actuar sobre los factores de riesgo.

Leber´s hereditary optic neuropathy is a maternally inherited disease characterized by subacute, painless and bilateral loss of the central vision, although not always at the same time. It predominates in young men and is caused by mitochondrial DNA spot mutations. This is one of the most common hereditary and highly disabling optic neuropathy, the precise diagnosis of which is based on the molecular studies. The purpose of this article was to alert specialists on the possible diagnosis and increase of this impairment under favorable environmental conditions. A computerized search of scientific articles related to the subject was made in Hinari and PUBMED, which resulted in 37 publications during the years 1988 through 2010. Several disease aspects such as historical background, risk factors, epidemiology, genetics, clinical features, diagnosis and treatment were studied and discussed, in addition to delving into current status of the disease in our country. Several Cuban families are presently known to be affected by Leber´s hereditary optic neuropathy. The rise of incidence was probably due to environmental conditions that favor or are risk factors for this entity, as occurred during the last epidemic of optic neuropathy in Cuba. Every day there are more advances in the field of genetics that allows identifying a higher number of mutations associated with this disease. This event together with advanced knowledge of its clinical features has made it possible to identify the affected families and to control the risk factors.

Neuropatía óptica traumática / Traumatic optic neuropathy

La neuropatía óptica traumática, en sus múltiples variantes, constituye una entidad poco frecuente. Se puede definir como aquella lesión del nervio óptico que aparece tras un episodio traumático. Puede clasificarse según su topografía y mecanismos productores. A pesar de un mejor entendimiento en los últimos años de sus mecanismos productores, su tratamiento continúa siendo un tema extremadamente controversial.

Traumatic optic neuropathy, in its different modalities, is a rare entity. It is the damage of the optic nerve resulting from a traumatic episode. The classification depends on its topography and causative mechanisms. Although there has been better understanding of the causative mechanisms in the last few years, the management is still an extremely controversial topic.

Neuropatia óptica isquêmica posterior como complicação pós-cirurgia de blefaroplastia / Posterior ischemic optic neuropathy as a complication after blepharoplasty surgery

Descrevemos um caso de perda visual unilateral em paciente de 80 anos após cirurgia de blefaroplastia bilateral superior e inferior com o olho direito apresentando intensa hemorragia pré-orbitária. O exame oftalmológico apresentou quadro clínico de neuropatia óptica isquêmica posterior com hemianopsia superior e ressonância magnética de órbita normal. Comentamos alguns possíveis mecanismos e análise da evolução da camada de fibras nervosas retinianas pela tomografia de coerência óptica.

A case of unilateral visual loss and right eye presenting intense pre-orbital bleeding was described in patient 80 years old, after upper and lower bilateral blepharoplasty surgery. Ophthalmologic examination showed clinical profile of posterior ischemic optic neuropath with superior hemianopsia and magnetic resonance imaging (MRI) of normal orbit. Comments are made on possible mechanism involved in the process as well as analysis on the evolution of the retinal nerve layer by optical coherence tomography.