Eficacia de la azatioprina en la enfermedad ocular inflamatoria no infecciosa resistente a tratamiento esteroidal sistémico / Role ofAzathioprine in steroid resistant non infectious ocular inflammatory diseases

Background: Topical and systemic steroids are the first line of treatment of non infectious inflammatory ocular disease. Immunosuppresants are reserved as a second line treatment. Aim: To evaluate the role ofAzathioprine (AZA) as a coadyuvant immunosuppressive treatment for non infectious ocular inflammatory diseases (OIDs) resistant to systemic steroid therapy in a retrospective, noncomparative interventional case series. Patients and methods: Patients using oral Prednisone due to an active or recurrent OID, without clinical response, and not receiving any other immunosuppressive treatment were studied. A standard protocol of oral Prednisone (0.5 mg/kg/ day) and oral AZA (2-3 mg/kg/day) during one year was used. Ocular and systemic monthly evaluations were done including relapse rate, steroid dosage, inflammatory score and visual acuity. Results: Thirty patients (10 male) aged 18-75 years (mean 44 years) were studied. Three had bilateral anterior uveitis, one had pars planitis, four had diffuse uveitis, eight Vogt-Koyanahi-Harada syndrome, three Behget's disease, three necrotizing scleritis and eight had retinochoroidopathy A complete initial response was observed in 26 patients (87 percent). The time of response was between 1 to 6 months (mean 2.65 months). Seventeen percent of these had a relapse 6 to 12 months after AZA was started. In 61 percent, visual acuity improved. The ocular inflammatory score decreased in 86.5 percent. Eleven patients had mild controlled side effects that did not require discontinuation of AZA. Conclusions: Combined systemic steroid and oral AZA therapy is safe and effective in controlling steroid resistant non infectious inflammatory ocular diseases.

Desprendimiento retinal por impacto de pelota grande / Retinal detachment by impact of a big soccer-ball

Se describen las características clínicas y los resultados quirúrgicos en un grupo de 41 pacientes con un desprendimiento retinal inducido por un pelotazo en el juego del fútbol (39 pacientes), baloncesto (1 paciente) y voleibol (1 paciente). El período de latencia entre el trauma y el desprendimiento retinal fue inferior a 1 semana en 18 casos, sugiriendo que los desgarros se generan en el momento del impacto La mayor parte de los pacientes presentaban diálisis y desgarros superotemporales. Desgarro en herradura sólo se observó en un ojo miope. El impacto provocó un desgarro retinal gigante en un ojo alto miope. Se obtuvo la reaplicación retinal quirúrgica en 38 de 41 casos (92.7%). 60% de los casos mostraron maculopatía de grado variable. La visión final fue inferior a 0.1 en 6 casos con retina aplicada. Estos casos presentaban un desprendimiento retinal muy antiguo o una severa maculopatía