Síndrome de hipermetropía adquirida con pliegues coroideos / Acquired hypermetropia syndrome with choroidal folds

Desde el primer reporte de pliegues coroideos, en el año 1884, el conocimiento sobre su etiología, el mecanismo de producción y su manejo se ha incrementado notablemente. Las causas de los pliegues coroideos abarcan un extenso número de condiciones muy variadas; entre ellas se encuentran los idiopáticos, la hipertensión intracraneana, algunas drogas como el topiramato, las infiltraciones difusas de la coroides por linfomas e hiperplasia linfoide, la hipotonía por contracción de tejido fibrovascular, los tumores coroideos y orbitarios (intraconales y extraconales), entre otras. Se presenta una paciente femenina de 57 años de edad quien acudió por vez primera a la Consulta de Oftalmología en el año 2008 por disminución lenta y progresiva de la agudeza visual de ambos ojos. El examen de fondo de ojo mostró discos ópticos con bordes definidos, buena coloración y presencia de pliegues coroideos radiales al disco en polo posterior de ambos ojos. La refracción arrojó una hipermetropía que fue en aumento en las consultas de seguimiento hasta el presente sin variar el aspecto del fondo de ojo. Se concluye que el caso presenta síndrome de hipermetropía adquirida con pliegues coroideos(AU)

Since the first reported case of choroidal folds in 1884, the understanding of their mechanisms, aetiologies, and management has expanded signally. With ophthalmoscopy, choroidal folds can be appreciated by the light and dark bands observed deep to the retina. While choroidal folds are visible on ophthalmoscopic examination, they are more easily identified using fluorescein angiography. A-scan ultrasound may reveal a shortened axial length. Common B-scan ultrasonographic findings include thickening of the choroid or flattening of the posterior aspect of the globe. Causes of choroidal folds are many, among them are idiophatic, increased intracranial pressure, diffusely infiltrative conditions (lymphomas and benign lymphoid hiperplasia), hypotony, drug induced (an unusual complication of certain medications such as Topiramate), contraction of fibrovascular tissue, choroidal neoplasms and orbital mass lesions (intraconal and extraconal tumours). We report a 57 years old woman who came to ophthalmogy consultation first in 2008 complaning of slowly progressive loss of vision. Fundoscopy showed well defined optic disc with radial choroidal folds of the posterior pole in both eyes. Manifest refraction showed hyperopia that increased in the following visits until the present. Fundoscopy showed not changes. Definitive diagnosis was syndrome of acquired hyperopia with choroidal folds(AU)

A Case of Mucosa-associated Lymphoid Tissue Lymphoma Discovered by Repetitive Intraocular Lens Dislocation

PURPOSE: To report a case where bilateral malignant retrobulbar lymphoma was diagnosed after repetitive intraocular lens dislocation to the anterior chamber. CASE SUMMARY: An 85-year-old male with a history of stroke who had undergone cataract surgery 10 years ago at another hospital presented with repeated intraocular lens (IOL) dislocations of both eyes into the anterior chamber. He had previously undergone IOL scleral fixation once in his left eye and twice in his right eye, but IOL dislocation was still repeatedly occurring. The best-corrected visual acuity was 0.4 in both eyes. Hertel exophthalmetry was 20 mm in his right eye and 18 mm in his left eye. Painless limitation of motion at supraduction was observed in the right eye. Funduscopy showed newly appeared choroidal folding in the right eye, so orbital computed tomography (CT) with contrast was performed. The CT scans showed bilateral homogenously enhancing retrobulbar masses. Biopsy of the masses showed a MALToma. After radiation therapy, the choroidal folds resolved and exophthalmetry improved to 10 mm in both eyes. No additional IOL dislocation occurred. During 2.5 years of follow-up, there was no evidence of recurrence or distant metastasis of the MALToma. CONCLUSIONS: Orbital lymphomas can cause lid edema, exophthalmos, strabismus, and diplopia, and can be diagnosed with imaging modalities such as CT. Final diagnosis involves biopsy and radiation therapy or chemotherapy. If IOL dislocation occurs repeatedly, it may result from an increase in retrobulbar pressure, and concurrent choroidal folding using funduscopy is strongly recommended for imaging to check for the presence of retrobulbar masses.

Choroidal Folds Secondary to an Orbital Tumor

Folding of the choroid, Bruchs membrane, and the overlying retina may occur in a variety of ocular and orbital diseases and after certain surgical procedures. A 34-year-old man experienced the decreased visual acuity and the protrusion and displacement in the right eye for at least 4 years. The protrusion of the patient was 13mm in the right eye and 6mm in the left eye with the aid of Hertels exophthalmometer. The right eye appeared downward deviation about 15 prism. The tumor located outside the muscle cone in the computed tomography and ultrasonography seemed to make the large choroidal folds involving the macula region. The retinal pigment epithelial atrophy was noted along long-standing choroidal folds. The tumor was removed by the lateral orbitotomy. The size of tumor was 20 x 15x 10mm. The postoperative protrusion was 6mm in the both eye. After removal of tumor, changes in the corneal refraction, visual acuity, and choroidal folds with the retinal pigment epithelial atrophy did not occur in comparison with the preoperative state.