Complicaciones oculares asociadas a la fiebre por dengue / Ophthalmic complications associated to dengue fever

RESUMEN La infección por el virus del dengue va en aumento en las regiones tropicales de Asia, África y América. Se estima que se producen de 50 a 100 millones de casos de esta enfermedad al año. En los últimos tiempos han aumentado los reportes de manifestaciones oculares en estos pacientes, las cuales ocurren en un rango de 5 a 7 días posteriores al inicio de los síntomas, aunque también pueden ocurrir más tarde, y generalmente existe buen pronóstico visual. Se realiza una revisión bibliográfica con el objetivo de ampliar el conocimiento sobre un tema poco tratado en nuestro medio. Se consultaron fundamentalmente artículos científicos de revistas, publicados en las bases de datos PubMED y Cochrane, así como textos básicos que abordan este tema en los últimos 5 años, a través de Google académico como motor de búsqueda. Se constató que se han reportado manifestaciones oculares en pacientes con dengue que van desde hallazgos en el segmento anterior sin afectación visual, hasta cuadros más intensos que interesan las estructuras del polo posterior del ojo. La fisiopatología de estos hallazgos aún se encuentra en estudio y no existe consenso para su tratamiento. A pesar de que el pronóstico visual de estas alteraciones es bueno, se reportan casos donde no es así y se precisa mayor comprensión sobre la fisiopatología de estas para un abordaje terapéutico más adecuado en cada caso(AU)

ABSTRACT Infection by dengue virus is on the increase in tropical regions of Asia, Africa and America. It has been estimated that 50 to 100 million cases of this disease occur every year. Recent years have witnessed a rise in the number of reports of ocular manifestations in dengue patients. These manifestations appear 5 to 7 days after symptom onset, though they could also occur later, and the visual prognosis is generally good. A bibliographic review was conducted with the purpose of broadening knowledge about a topic not commonly dealt with in our environment. The search was mainly aimed at scientific papers from journals, published in the databases PubMed and Cochrane, as well as basic texts addressing the study topic in the last 5 years, using the search engine Google Scholar. Ocular manifestations were found to have been reported in dengue patients. These range from findings in the anterior segment without any visual alteration to more intense episodes affecting the structures of the posterior pole of the eye. The physiopathology of these findings is still being studied, and there is no consensus about its treatment. Despite the good visual prognosis of these alterations, cases have been reported of a different outcome. Therefore, a better understanding is required of their physiopathology to achieve a more appropriate therapy for each case(AU)

Repercusiones oculares del Síndrome de Alport: A propósito de dos casos / Alport syndrome. Report of two cases

Alport syndrome is an inherited progressive form of glomerular disease that is often associated with sensorineural hearing loss and ocular abnormalities. We report two men with Alport syndrome. Both had chronic kidney disease and consulted for long-term loss of visual acuity. One had auditory abnormalities. On the ophthalmological examination, both had anterior lenticonus and one had dot or fleck retinopathy. Those findings are described in up to 50% and 70% of men with X-linked Alport syndrome, respectively. Both patients had a family history of Alport syndrome or suggestive signs and symptoms.

Doença do Enxerto-versus-hospedeiro ocular: Revisão / Graft-versus-Host Disease: Review

Resumo Doença do Enxerto-versus-hospedeiro (do inglês Graft-versus-Host Disease - GVHD) é uma complicação importante e com altas taxas de morbidade e mortalidade nos pacientes submetidos ao transplante alogênico de células-tronco hematopoiéticas. O acometimento ocular, denominado GVHD ocular, pode acometer todas as estruturas dos olhos, porém a unidade lacrimal (glândulas lacrimais e superfície ocular) é o principal alvo da resposta inflamatória mediada por células T doadas. O desenvolvimento de doença do olho seco grave é a principal manifestação clínica ocular, e a associação de diversas opções terapêuticas se faz necessário. O objetivo desta revisão é descrever as manifestações clínicas, os critérios diagnósticos, o impacto na qualidade de vida, o tratamento atual e as perspectivas desta doença, que precisa de um acompanhamento multidisciplinar.

Abstract Graft-versus-host Disease (GVHD) is a major complication with high morbidity and mortality rates on patients undergoing hematopoietic stem cell transplantation. The ocular involvement, named ocular GVHD, may affect all structures of the eyes, but the lacrimal unit (lacrimal glands and ocular surface) is the main target of the inflammatory response mediated by the donor T cells. The development of dry eye disease is the main clinical ocular manifestation, and the association of a variety of therapeutics options is necessary. The aim of the review is to describe the clinical manifestations, diagnostic criteria, impact in quality of life, the current treatment and future perspectives of this disease that demands a multidisciplinary follow-up.

Vision status, ophthalmic assessment, and quality of life in the very old / Visão, avaliação oftalmológica e qualidade de vida em longevos

ABSTRACT Purpose: To determine the vision status, ophthalmic findings, and quality of life among the very elderly. Methods: This was a cross-sectional observational study of individuals aged 80 years and above. A comprehensive ophthalmic exam was performed with mea surement of both the presenting (PVA) and best-corrected visual acuity. The Quality of Life Short Form-36 (SF-36) and the Visual Function Questionnaire (VFQ-25) were also administered. Results: A total of 150 non-institutionalized participants were assigned to three age groups: 80-89 years (n=70), 90-99 years (n=50), and 100 years and older (n=30). PVA and best-corrected visual acuity were normal (≥20/30) in 20 (13.3%) and 37 participants (24.7%), respectively. Regarding PVA, mild visual impairment (<20/30 to ≥20/60) was found in in 53 (35.4%), moderate visual impairment (<20/60 to ≥20/200) in 50 (33.3%), severe visual impairment (<20/200 to ≥20/400) in 8 (5.3%), and blindness (<20/400) in 19 (12.7%) participants. Regarding best-corrected visual acuity, mild, moderate, and severe visual impairments were present in 55 (36.7%), 38 (25.3%), and 5 (3.3%) participants, respectively, and blindness was present in 15 (10%). The main causes of visual impairment/blindness were cataract (43.8%), refractive errors (21.5%), age-related macular degeneration (17.7%), and myopic degeneration (3.8%). SF-36 scores were worse in those with low visual acuity, while VFQ-25 domain scores were poorer in those with vision impairment/blindness. Conclusion: Vision impairment and blindness was present in three-quarters of this sample, but it was notable that adequate correction with spectacles improved visual acuity. This reinforces the need for regular ophthalmic care in elderly patients to improve their quality of life by optimizing vision.

RESUMO Objetivos: Determinar a visão, achados oftalmológicos e qualidade de vida em longevos. Métodos: Estudo observacional transversal em indivíduos com idade entre 80 anos ou mais. Realizado exame oftalmológico com medida da acuidade visual apresentada e da acuidade visual melhor corrigida. Foram administrados os questionários: Qualidade de Vida Forma Curta - 36 (SF-36) e Qualidade de Função Visual (VFQ-25). Resultados: Total de 150 indivíduos não-institucionalizados foram estudados, divididos em três faixas etárias: 80 a 89 anos (n=70); 90 a 99 anos (n=50) e 100 anos ou mais (n=30). Acuidade visual apresentada normal (≥20/30) foi encontrada em 20 (13,3%) participantes; deficiência visual leve (<20/30 a ≥20/60), em 53 (35,4%); deficiência visual moderada (< 20/60 a ≥20/200) em 50 (33,3%); deficiência visual grave (<20/200 para ≥20/400) em 8 (5,3%) e cegueira (<20/400) em 19 (12,7%). A acuidade visual com a melhor correção aumentou para 37 (24,7%) indivíduos normais; deficiência leve aumentou para 55 (36,7%); deficiência visual moderada diminuiu para 38 (25,3%); deficiência visual grave foi reduzida para 5 (3,3%) e cegueira foi reduzida para 15 (10%). As principais causas de deficiência visual/cegueira foram: catarata (43,8%) erro refrativo (21,5%), degeneração macular relacionada à idade (17,7%), e degeneração miópica (3,8%). A pontuação no Questionário de Qualidade de Vida foi pior naqueles com baixa visão para perto. No questionário VFQ -25 os domínios com menor pontuação ocorreram nos indivíduos com baixa visão/cegueira. Conclusão: Deficiência visual/cegueira mostrou-se presente em três quartos desta amostra de longevos. A prescrição de óculos adequados proporcionou melhora da acuidade visual, reforçando a necessidade de atendimento oftalmológico regular desses pacientes para assegurar a qualidade de vida e de visão.

Apoptosis y necroptosis en las enfermedades oftalmológicas / Apoptosis and necroptosis in ocular deseases

La apoptosis es un término relativamente reciente mediante el cual se denomina a un tipo de muerte celular programada, que se encuentra ligada a diferentes procesos patológicos (cáncer, enfermedades inflamatorias y degenerativas). Actualmente se considera otro tipo de muerte celular no programada, que es la necrosis, la cual ocurre por mecanismos no modulados y se menciona una variedad de esta última: la necroptosis. Ambos procesos (apoptosis y necroptosis) se encuentran presentes en la fisiopatología de algunas enfermedades oftalmológicas, lo que nos motivó a realizar una revisión bibliográfica renovada acerca del tema, con el objetivo de acrecentar el conocimiento sobre el tema y su relación con algunas enfermedades oftalmológicas en las que participan. Se revisaron textos básicos de Oftalmología y se localizaron artículos sobre el tema de los últimos 5 años a través Google como motor de búsqueda, el directorio LILACS y la consulta de las bases de datos PubMed y Hinari. Aún queda mucho por recorrer en el estudio de estos procesos que ocurren a nivel celular y que en ocasiones solo se han podido constatar a través de estudios de laboratorio y con modelos de animales. Su mayor comprensión puede constituir una vía para el surgimiento de nuevas terapéuticas antiapoptóticas y antinecroptóticas(AU)

Apoptosis is a relatively recent term to define a process of programmed cellular death related to different pathological processes (cancer, inflammatory and degenerative diseases). There is currently another process of non-programmed cellular death named necrosis, which occurs through non-modulated mechanisms and a variety is called necroptosis. Both processes (apoptosis and necroptosis) can be found in the physiopathology of some ophthalmological disorders, which prompted us to carry out an updated literature review on this topic. The objective was to increase the amount of knowledge on the topic and its relation to some of the ophthalmological disorders in which it is involved. Basic texts of ophthalmology were reviewed and articles published in the last five years were tracked down using Google as search engine, the LILACS directory and the consultation of the PubMed and Hinari databases. There is still much to be studied on these processes that take place at the cell level and that have only been verified through lab studies and with animal models. Better understanding of this process may pave the way for the emergence of new anti-apoptosis and anti-necroptosis therapies(AU)

Physiological and lifestyle factors contributing to risk and severity of peri-orbital dark circles in the Brazilian population

AbstractBACKGROUND:Peri-orbital dark circles are a cosmetic concern worldwide, and have been attributed to hyperpigmentation from allergy or atopic dermatitis, blood stasis, structural shadowing effects, and a thin epidermis/dermis under the eye. It is of interest to better understand lifestyle and demographic risk factors and the relative impact of melanin, blood and epidermal/dermal factors on the severity of Peri-orbital dark circles.OBJECTIVE:To compare by non-invasive imaging the impact of biological factors to a visual grading scale for Peri-orbital dark circles, and test the correlation of various demographic factors with Peri-orbital dark circles.METHODS:Subjects completed a lifestyle and health survey, and Peri-orbital dark circles severity was evaluated using standardized photographs. Hyperspectral image analysis was used to assess the contributions of melanin, blood volume, degree of blood oxygen saturation, and dermal scattering.RESULTS:Family history was the most significant risk factor for Peri-orbital dark circles. The average age of onset was 24 years, and earlier onset correlated with higher severity scores. Asthma was significantly associated with Peri-orbital dark circles scores, but self-reported allergy was not. In this study, sleep was not correlated with Peri-orbital dark circles scores. Hyperspectral imaging indicated that melanin was the dominant correlate for Peri-orbital dark circles severity, while oxygen saturation was secondary. The difference between under-eye and cheek measurements for ΔL*and ΔE* were the most significant instrumental parameters correlated with visual assessment of Peri-orbital dark circles severity.CONCLUSION:Although typically associated with lack of sleep, risk of Peri-orbital dark circles is primarily hereditary. The main factors contributing to the appearance of Peri-orbital dark circles are melanin and (deoxygenated) blood.

Assessment of Occupational Symptoms and Chemical Exposures for Nail Salon Technicians in Daegu City, Korea / 예방의학회지

OBJECTIVES: This study aimed to evaluate occupational symptoms and chemical exposures of nail salon technicians. METHODS: Work-related symptoms of nail salon technicians in Daegu City were surveyed using a researcher-administered questionnaire, and responses were compared to those of non-exposed office workers as controls. Personal exposure level of airborne volatile organic compounds was also monitored using passive samplers. RESULTS: A total of 159 subjects in 120 salons were interviewed. Average work-shift concentrations of 13 chemicals were measured for 50 workers from 30 salons using personal passive samplers. The most frequently reported respiratory or neurologic symptoms by nail shop technicians compared to controls were nose irritation (odds ratio [OR], 54.0; confidence interval [CI], 21.6 to 134.8), followed by headache (OR, 9.3; CI, 4.7 to 18), and throat irritation (OR, 4.3; CI, 2.2 to 8.5). For eyes and skin, 92% of respondents complained eye irritation (OR, 13.1; CI, 5.7 to 30.1). In musculoskeletal symptoms, workers reported pain or discomfort in shoulders (OR, 20.3; CI, 7.7 to 54) and neck (OR, 19.7; CI, 8.9 to 43.6). From personal measurements, the proportion of exceeding the Korean Occupational Exposure Limit was the highest for acetone with 64%, followed by toluene (50%), butyl acetate (46%), and methyl methacrylate (12%). However, the service was being provided without a proper ventilation system in most surveyed shops. CONCLUSIONS: Based on these findings, it is warranted to have appropriate local exhaust ventilation place to ensure adequate health protection of nail shop technicians as well as customers. At the same time, greater policy interests are warranted in nail care business to protect health of both workers and customers.

Profile of ocular and systemic characteristics in Möbius sequence patients from Brazil and Italy / Perfil de características oculares e sistêmicas de pacientes com a sequência de Möbius do Brasil e da Itália

PURPOSE: To compare the profiles and clinical findings of a series of patients with Möbius sequence from Brazil with a series from Italy. METHODS: This is a multicenter study, which includes 46 Möbius sequence patients from Brazil and 20 from Italy. Socio-demographic, gestational, and neonatal profile characteristics were collected from interviews with the guardians of the Möbius sequence patients and compared. The Möbius sequence patients were submitted to an ophthalmologic examination and systemic malformations were also evaluated. RESULTS: Misoprostol was used in the first trimester of pregnancy by 26 (56.5%) of the mothers of the Möbius sequence patients in the Brazilian series and was not used by any of the Italian mothers. The mean age of the Brazilian Möbius sequence patients was 89.95 ± 7.79 months and the mean age of the Italian patients was 102.6 ± 22.94 months (P=0.6105; Mann-Whitney test). Brazilian mothers had a significantly lower education level (P=0.0002; Fisher's exact test) and Italian mothers had significantly more stable relationships (p=0.0002; Fisher's exact test). The frequency of ocular and systemic abnormalities was similar in both series. CONCLUSION: Adverse events during pregnancy varied between both groups. A history of misoprostol use during early pregnancy was present only in Brazilian mothers, who had lower levels of education and less frequent stable marital statuses. Clinical findings were similar between both groups of patients.

OBJETIVO: Comparar o perfil de características oculares e sistêmicas de uma série de pacientes com sequência de Möbius do Brasil com uma da Itália. MÉTODOS: Esse estudo multicêntrico incluiu 46 pacientes com sequencia de Möbius do Brasil e 20 da Itália. As características dos perfis sociodemográfico, gestacional e neonatal foram coletadas a partir de entrevistas com os responsáveis dos pacientes e comparadas. Os pacientes foram submetidos a um exame oftalmológico e malformações sistêmicas foram avaliadas. RESULTADOS: O misoprostol foi usado no primeiro trimestre da gestação por 26 (56,5%) mães brasileiras e por nenhuma italiana. A média de idade dos pacientes brasileiros com sequência de Möbius foi de 89,95 ± 7,79 meses e dos italianos 102,6 ± 22,94 meses (P=0,6105; teste de Mann-Whitney). Mães brasileiras tinham significantemente menor escolaridade (P=0,0002; teste exato de Fisher) e mães italianas tinha relacionamentos estáveis mais frequentemente (P=0,0002; teste exato de Fisher). A frequência de anormalidades oculares e sistêmicas foi semelhante entre as séries. CONCLUSÃO: Eventos adversos durante a gestação variaram entre os grupos. O uso de misoprostol pelas mães precocemente na gestação foi relatado apenas por mães brasileiras, que tinham menor escolaridade e status conjugal estável menos frequentemente. Achados clínicos foram semelhantes entre os grupos.

Boston ocular surface prosthesis: An Indian experience.

Context: Boston ocular surface prosthesis (BOSP) is a scleral contact lens used in the management of patients who are rigid gas permeable (RGP) failures as with corneal ectasias such as keratoconus and in those patients who have ocular surface disease such as Stevens–Johnson syndrome (SJS). Aim: To report utilization of BOSP in a tertiary eye care center in India. Materials and Methods: We retrospectively reviewed charts of 32 patients who received BOSP from July 2008 to May 2009. Indications for fitting these lenses, improvement in visual acuity (VA) before and after lens fitting and relief of symptoms of pain and photophobia were noted. Paired t-test was used for statistical analysis using SPSS version 16.0 for Windows. Results: Thirty-two patients (43 eyes) received these lenses. These consisted of 23 eyes of 17 patients who failed RGP trials for irregular astigmatism and corneal ectasia such as keratoconus and post radial keratotomy and scar and 20 eyes of 15 patients with SJS. Mean age of RGP failures was 27.94 years. Pre- and post-BOSP wear mean LogMAR VA was 1.13 and 0.29, respectively, in RGP failures. The P value was statistically significant (P < 0.001). In patients with SJS, LogMAR VA was 0.84 ± 0.92 before and 0.56 ± 0.89 after lens wear. The P value was statistically significant (P < 0.001). VA improved by >2 lines in 7/20 eyes (35%) with SJS, with improvement in symptoms. Conclusion: BOSP improves VA in patients who have irregular astigmatism as in ectasias and RGP failures and improves vision and symptoms in patients with SJS.

Ocular findings in patients with systemic sclerosis

OBJECTIVE: To evaluate the frequency and characteristics of ocular manifestations in outpatients with systemic sclerosis. METHODS: In this cross-sectional study, 45 patients with systemic sclerosis were enrolled. Data regarding demographics, disease duration and subtype, age at diagnosis, nailfold capillaroscopic pattern and autoantibody profile were collected, and a full ophthalmic examination was conducted. Parametric (Student's t-test) and nonparametric (Mann-Whitney U test) tests were used to compare continuous variables. Fisher's exact test was used to compare categorical data. P values < 0.05 were considered significant. RESULTS: Twenty-three subjects (51.1 percent) had eyelid skin changes; 22 (48.9 percent) had keratoconjunctivitis sicca, 19 (42.2 percent) had cataracts, 13 (28.9 percent) had retinal microvascular abnormalities and 6 (13.3 percent) had glaucoma. Eyelid skin changes were more frequent in patients with the diffuse subtype of systemic sclerosis and were associated with a younger age and an earlier age at diagnosis. Cataracts were presumed to be age-related and secondary to corticosteroid treatment. There was no association between demographic, clinical or serological data and keratoconjunctivitis sicca. The retinal microvascular abnormalities were indistinguishable from those related to systemic hypertension and were associated with an older age and a severe capillaroscopic pattern. CONCLUSIONS: Eyelid skin abnormalities and keratoconjunctivitis sicca were the most common ocular findings related to systemic sclerosis. Some demographic and clinical data were associated with some ophthalmic features and not with others, showing that the ocular manifestations of systemic sclerosis are characterized by heterogeneity and reflect the differences in the implicated pathophysiological mechanisms.

Alergia ocular / Ocular allergy

En el presente artículo revisaremos los aspectos más relevantes de la alergia ocular: su epidemiología, fisiopatología, cuadros clínicos y su terapéutica. Se encontrará una descripción más detallada de la fisiopatología ya que es, sin duda, la base del éxito terapéutico

In the present article we will review the most important aspectsof ocular allergy: its epidemiology, physiopathology, clinicalcharacteristics and treatment. A more detailed description ofthe physiopathology is addressed because is the basis for asuccessful treatment.

Multiple transfused thalassemia major: Ocular manifestations in a hospital-based population.

Purpose: To study the ocular manifestations in multiple transfused beta-thalassemia major patients and assess the ocular side-effects of iron chelating agents. Materials and Methods: In this prospective observational study, 45 multiple transfused beta-thalassemia major children between six months and 21 years of age were enrolled and assigned groups according to the treatment regimens suggested. Group A received only blood transfusions, Group B blood transfusions with subcutaneous desferrioxamine, Group C blood transfusions with desferrioxamine and oral deferriprone and Group D blood transfusions with deferriprone. Ocular status at the time of enrolment was documented. Subjects were observed quarterly for one year for changes in ocular status arising due to the disease process and due to iron chelation therapy. Children with hemoglobinopathies other than beta-thalassemia major, congenital ocular anomalies and anemia due to other causes were excluded. Results: Ocular involvement was observed in 58% of patients. Lenticular opacities were the most common ocular finding (44%), followed by decreased visual acuity (33%). An increased occurrence of ocular changes was observed with increase of serum ferritin and serum iron levels as well as with higher number of blood transfusions received. Desferrioxamine seemed to have a protective influence on retinal pigment epithelium (RPE) mottling. Occurrence of lenticular opacities and RPE degeneration correlated positively with use of desferrioxamine and deferriprone respectively. Follow-up of patients for one year did not reveal any change in ocular status. Conclusion: Regular ocular examinations can aid in preventing, delaying or ameliorating the ocular complications of thalassemia.

Mudanças oculares durante a gestação / Ocular changes during pregnancy

A gestação pode causar várias alterações no funcionamento do olho humano, tanto nas condições sistêmicas quanto em doenças oculares, sendo seus efeitos divididos em três categorias: alterações fisiológicas, mudanças em doenças oculares pré-existentes e alterações patológicas. O presente texto propõe uma revisão bibliográfica sobre o tema. Os autores pesquisaram os bancos de dados do PubMed (MEDLINE) e LILACS.

Pregnancy can cause several alterations in human eye function in healthy condition as well in ocular disease; these effects on the eyes are divided into three categories: physiologic alterations, ocular diseases changes already existing before the pregnancy, and pathological alterations. The present text proposes a bibliographical revision on the theme. The authors researched PubMed (MEDLINE) and LILACS databases.

Estudio de compromiso ocular en pacientes con rosácea / Ocular involvement in patients with cutaneous rosacea

La rosácea cutánea (RC) es una enfermedad crónica relativamente común que puede presentarse con afectación ocular. La rosácea ocular es considerada una enfermedad bilateral, manifestándose en la mayoría de los casos en forma simultánea al compromiso cutáneo. El objetivo del estudio es determinar el compromiso ocular de pacientes portadores de RC comparados con un grupo control y la asociación de severidad entre el compromiso cutáneo y el ocular. Se analizó un total de 112 pacientes; un primer grupo de 70 pacientes portadores de RC en un período de dos años, y el segundo constituido por 42 controles sanos. Observamos que en nuestros pacientes con RC hay una alteración de la función lagrimal y no existe relación estadísticamente significativa entre la severidad del compromiso cutáneo y el compromiso ocular. Debido a que el compromiso ocular en la RC es subestimado, es importante la evaluación de síntomas oculares en los pacientes con RC para continuar un manejo bidisciplinario entre dermatólogos y oftalmólogos.

Cutaneous rosacea (CR) is a relatively common chronic disease that can occur with ocular involvement. Ocular rosacea is considered a bilateral entity that usually manifests simultaneously with cutaneous disease. The objective of this study is to determine ocular involvement in CR patients, compared with a control group, and to establish the association between severity of cutaneous and ocular involvement. 112 patients were analyzed; a first group of 70 patients with a two year story of CR, and the second group consisting of 42 healthy controls. At the end of the study, we observed that patients with CR had tear dysfunction and there was no statistically significant relationship between the severity of cutaneous and ocular involvement. Since eye involvement in CR is underestimated, we consider it important to investigate ocular symptoms in patients with CR and maintain multi-disciplinary management between dermatologists and ophthalmologists.

Un enfoque holístico de las enfermedades de la superficie ocular / A holistic approach for ocular surface diseases

La transparencia comeal es producto de un complejo sistema de interacciones. El conocimiento de estas es muy importante para establecer una terapia adecuada para patologías tan diversas como son la disfunción lagrimal, el haze comeal post PRK, y el rechazo comeal. La conjuntiva y el epitelio comeal indemnes son imprescindibles para mantener la función del sistema ocular. A su vez la integridad de estas estructuras depende de la integridad de párpados y lágrimas. Actualmente sabemos que la interacción entre estos cuatro componentes permite mantener en equilibrio la homeostasis de la superficie ocular. Asegurando la indemnidad de las células progenitoras límbicas. La alteración en cualquiera de estos factores produce ojo rojo, infecciones, mayor predisposición a úlceras, y alteraciones de la epitelización. Desequilibrios en el funcionamiento de este sistema se engloban hoy como enfermedades de la superficie ocular, y están dando origen a una nueva subespecialidad. Ya que los avances en el conocimiento de la fisiopatología de la lagrima y de su interacción con la come a, han permitido el desarrollo de una mirada más racional de la patología de este segmento creemos interesante revisar este conjunto de desordenes y proponer una aproximación terapéutica.

Comeal transparency is own to a complex system of interactions. Settle the right therapeutic approach in quite different pathologies as comeal haze, comeal rejection and tears disfunction, is related with the knowledge ofthese relationships. Comeal and conjunctival epithelium integrity is essential in ocular system function, as lids and tears . Nowadays we know that reciprocal relations between this items are essential in ocular surface homeostasis. Any disruption means the rise of redness, infections, ulcers predisposition, and disruptions in epithelization. Today all this malfunctions are known as Ocular Surface Pathologies rising a new subspeciality. Since new advances in tears physiology allows a rational approach to diagnosis and treatment ,we find useful to list out this disorders and proposing a therapeutic schedule.

Leucocorias na infância / Leukocoria in childhood

No presente trabalho, através de uma revisão bibliográfica, os autores pretendem abordar as causas mais comuns relacionadas a leucocorias na infância, abrangendo desde suas fisiopatologias até aos possíveis tratamentos. O estudo tem como público alvo estudantes de medicina, pediatras e médicos generalistas

The role of nitric oxide in ocular surface diseases

The role of nitric oxide (NO) in ocular surface diseases remains unknown. We investigated the conditions leading to increase NO generation in tears and the main sources of ocular surface tissue. We evaluated the possibility of a dual action (cell survival or cell death) depending on the amount of NO. The concentration of nitrite plus nitrate, the stable end-product of NO, was measured in the tears of various ocular surface diseases. We also examined the main source of nitric oxide synthase (NOS) using immunohistochemical staining & Western blot analysis. When cultured human corneal fibroblasts were treated with NO producing donor with or without serum, the viability of cells was studied. We found that sources of NO in ocular surface tissue primarily included corneal epithelium, fibroblasts, endothelium and inflammatory cells. Three forms of NOS (eNOS, bNOS, & iNOS) were expressed in experimentally induced inflammation. Cell death by NO revealed TUNEL positive staining, however in the EM finding, this NO specific cell death was an atypical necrosis showing perinuclear large vacuolization and mitochondrial swelling. In the fibroblasts culture system, the NO donor (SNAP, S-nitroso-N-acetyl-D, L-penicillamine) prevented the death of corneal fibroblasts caused by serum deprivation in a dose dependent manner up to 500 m SNAP, although a higher dose decreased cell viability. This study suggested that NO might act as a double-edged sword in ocular surface disease depending on the degree of inflammatory condition related with NO concentration.

Hipertiroidismo en la edad pediátrica. Con especial énfasis en la enfermedad de graves / Hypertiroidism in children. A review with emphasis in gravesï disease

El hipotiroidismo y el bocio eutiroideo son las entidades tiroideas que se presentan con mayor frecuencia en la edad pediátrica. El hipertiroidismo o tirotoxicosis se presenta en 15 por ciento de los pacientes pediátricos con disfunción tiroidea. La enfermedad de Graves es la causa más frecuente de hipertiroidismo en niños y adolescentes, y se caracteriza por la elevada producción de autoanticuerpos estimuladores del receptor de tirotropina, que inducen la secreción autónoma de hormonas tiroideas y sus efectos en los tejidos periféricos. La triada clásica de manifestaciones comprende la presencia de bocio, datos sistémicos de hipertiroidismo y oftalmopatía; la dermopatía es poco frecuente en este grupo de edad. En fases iniciales del padecimiento predominan los síntomas neuropsiquiátricos. El manejo en estos pacientes continúa siendo controversial. Ninguna de las modalidades de tratamiento ha mostrado superioridad. Se describen otras causas menos frecuentes de hipertiroidismo que deben considerarse en el diagnóstico diferencial.

Un caso de oftalmopatía tiroidea posterior a radiación del cuello / Case report of Graves' ophtalmopathy following neck radiotherapy

Objetivo. Presentar un caso de oftalmopatía de Graves (oftalmopatía tiroidea autoinmune) posterior a radioterapia en cuello, con buena respuesta al tratamiento médico. Caso. Fue un varón de 51 años de edad con linfoma de Hodgkin esdatio IIIB, tratado con quimio- y radio-terapia en manto que desarrolló oftalmopatía tiroidea autoinmune clase III. La tomografía axial computarizada de órbitas mostró cambios característicos de oftalmopatía tiroidea; las pruebas de función tiroidea, incluyendo anticuerpos y estimulación con hormona estimuladora de tirotrofina, fueron normales o negativas. El tratamiento con prednisona, seguido de radioterapia externa retrocular derecha, produjo desaparición de los síntomas y reducción de exoftalmus