ABSTRACT
Atopy has been long used as the screening method for airway allergy. Nevertheless, aeroallergens can trigger respiratory symptoms not only in atopic patients (atopic respiratory allergy, ARA), but also in non-atopic subjects (local respiratory allergy, LRA). Moreover, ARA and LRA can coexist in the same patient, and this clinical scenario has been called dual respiratory allergy (DRA). When the clinical history cannot determine the relevance of sensitizations in ARA patients, nasal, conjunctival or bronchial allergen challenges (NAC, CAC, and BAC, respectively) should be conducted. Moreover, these tests are required to identify patients with LRA and DRA. The clarification of the allergic triggers of airway diseases has a profound impact on the management strategies the patients can be offered. Importantly, allergen immunotherapy (AIT) remains as the only disease-modifying intervention for ARA. Recent data indicate that AIT might have a similar effect on LRA patients. Nevertheless, AIT success relies largely on the correct phenotyping of allergic individuals, and NAC, CAC, and BAC are very helpful tools in this regard. In this review, we will summarize the main indications and methodology of CAC, NAC, and BAC. Importantly, the clinical implementation of these tests might translate into precision medicine approaches and better health outcomes for patients with airway allergy.
Subject(s)
Hypersensitivity, Immediate , Hypersensitivity , Humans , Allergens/adverse effects , Hypersensitivity/diagnosis , Hypersensitivity/therapy , Hypersensitivity/etiology , Desensitization, Immunologic/methods , Hypersensitivity, Immediate/etiologyABSTRACT
In immunocompromised patients, toxoplasmosis may have atypical presentation with bilateral, extensive or multifocal involvement. We report a case series of atypical toxoplasmic retinocoroiditis in patients with malignant hematological diseases who are usually immunosuppressed. Four patients were diagnosed of atypical toxoplasmic retinochoroiditis, all of them had immunosuppression (100%) and half of them (50%) had received a bone marrow transplant. The polymerase chain reaction for toxoplasma was positive in 75% of cases, and in one case (25%) the diagnosis was made with clinical and serological criteria. One patient presented ocular toxoplasmosis despite being on prophylactic treatment with atovaquone. Patients with atypical ocular toxoplasmosis and hematological diseases are generally immunocompromised, but they do not always have history of a bone marrow transplant. The presentation may be due to a primary infection or a reactivation of the disease. The aqueous humor and/or vitreous polymerase chain reaction allow confirming the diagnosis to perform a proper treatment.
ABSTRACT
Objetivo: Estudiar la eficacia y perfil de seguridad de la vitretomía diagnóstica en pacientes con uveítis no filiada. Métodos: Estudio observacional descriptivo retrospectivo de 29 pacientes (37 ojos) con panuveítis no filiada en los que se realizó vitrectomía diagnóstica. Las características clínicas y demográficas fueron recogidas. Se estudiaron los métodos de extracción de muestras y las técnicas de procesado aplicadas para el diagnóstico. Resultados: De los 29 pacientes analizados 18 (62%) eran hombres. La media de edad fue de 63,11 años (desviación estándar: 14,55). El síntoma inicial más frecuente fue la disminución de agudeza visual, la agudeza visual media fue de 20/40 excluyendo 8 ojos en los que resultó inferior a 20/200. Veintiún pacientes presentaban alteración unilateral. Se realizó extracción de muestra en seco a todos los pacientes. Además, fueron empleadas las siguientes técnicas de toma de muestras: 5 biopsias retinianas, 5 muestras diluidas, 1 aspirado de absceso subretiniano, 1 aspirado de humor acuoso. Con respecto al procesado de las muestras la técnica más utilizada fue la citología en 25 ojos, seguida de la reacción en cadena de la polimerasa en 11 ojos, el cultivo en 10 ojos. El diagnóstico etiológico fue encontrado en 94,5% de los casos, siendo el principal linfoma, seguido de toxoplasmosis. Conclusión: La vitrectomía diagnóstica es útil para la identificación de la inflamación oftalmológica. Pueden utilizarse diferentes técnicas de obtención de muestras y procesado de las mismas
Objective: To study the results and safety of diagnostic vitrectomy in patients with unknown etiology panuveitis. Methods: A retrospective descriptive observational study was carried out in which a total of 29 patients (37 eyes) were included, who underwent a vitreous biopsy due to acute intraocular inflammatory processes. In all, demographic and clinical data were collected. We studied the specific samples extraction methods and their diagnosic processing. Results: Of the 29 patients analyzed, 18 were men. Mean of age was 63.11 years old (standard deviation: 14.55). The most frequent initial symptom was visual acuity decrease, with mean initial visual acuity being 20/40, excluding 8 eyes that had vision lower than 20/200. 21 presented unilateral ocular involvement. Vitrectomy was performed in all of them obtaining a dry sample. Vitrectomy was performed in all of the patients obtaining a dry sample. Moreover, the following techniques were done: 5 retinal biopsies, obtaining 5 muestras diluidas, 1 subretinal abscess aspirate and 1 aqueous humor aspirate. The most frequent processing technique that was used was cytology in 25 eyes, followed by PCR (polymerase chain reaction) in 11 eyes and culture in 10 eyes. Diagnosis was achieved in 94.5% of patients. Main diagnosis found was lymphoma, followed by toxoplasmosis. Conclusions: Diagnostic vitrectomy is very important in ophthalmic inflammation identification. Different techniques for obtaining and processing can be used
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Panuveitis/etiology , Vitrectomy/methods , Adrenal Cortex Hormones/administration & dosage , Amyloidosis/diagnosis , Aspergillosis/diagnosis , Candida albicans/isolation & purification , Candidiasis/diagnosis , Granuloma, Foreign-Body/diagnosis , Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis , Panuveitis/drug therapy , Polymerase Chain Reaction , Retrospective Studies , Specimen Handling/methods , Toxoplasmosis, Ocular/diagnosis , Visual Acuity , Vitrectomy/adverse effects , Whipple Disease/diagnosisSubject(s)
Macular Degeneration/chemically induced , Melanoma/drug therapy , Protein Kinase Inhibitors/adverse effects , Proto-Oncogene Proteins B-raf/metabolism , Skin Neoplasms/drug therapy , Humans , Melanoma/pathology , Neoplasm Metastasis , Protein Kinase Inhibitors/therapeutic use , Skin Neoplasms/pathologyABSTRACT
OBJECTIVE: To study the results and safety of diagnostic vitrectomy in patients with unknown etiology panuveitis. METHODS: A retrospective descriptive observational study was carried out in which a total of 29 patients (37 eyes) were included, who underwent a vitreous biopsy due to acute intraocular inflammatory processes. In all, demographic and clinical data were collected. We studied the specific samples extraction methods and their diagnosic processing. RESULTS: Of the 29 patients analyzed, 18 were men. Mean of age was 63.11 years old (standard deviation: 14.55). The most frequent initial symptom was visual acuity decrease, with mean initial visual acuity being 20/40, excluding 8 eyes that had vision lower than 20/200. 21 presented unilateral ocular involvement. Vitrectomy was performed in all of them obtaining a dry sample. Vitrectomy was performed in all of the patients obtaining a dry sample. Moreover, the following techniques were done: 5 retinal biopsies, obtaining 5 muestras diluidas, 1 subretinal abscess aspirate and 1 aqueous humor aspirate. The most frequent processing technique that was used was cytology in 25 eyes, followed by PCR (polymerase chain reaction) in 11 eyes and culture in 10 eyes. Diagnosis was achieved in 94.5% of patients. Main diagnosis found was lymphoma, followed by toxoplasmosis. CONCLUSIONS: Diagnostic vitrectomy is very important in ophthalmic inflammation identification. Different techniques for obtaining and processing can be used.
Subject(s)
Panuveitis/etiology , Vitrectomy/methods , Adrenal Cortex Hormones/administration & dosage , Adult , Aged , Aged, 80 and over , Amyloidosis/diagnosis , Aspergillosis/diagnosis , Candida albicans/isolation & purification , Candidiasis/diagnosis , Female , Granuloma, Foreign-Body/diagnosis , Humans , Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis , Male , Middle Aged , Panuveitis/drug therapy , Polymerase Chain Reaction , Retrospective Studies , Specimen Handling/methods , Toxoplasmosis, Ocular/diagnosis , Visual Acuity , Vitrectomy/adverse effects , Whipple Disease/diagnosisABSTRACT
No disponible
Subject(s)
Humans , Retinal Diseases , Retinal Vein Occlusion , Diagnosis, Differential , Fluorescein Angiography , Multimodal ImagingABSTRACT
Se presentan dos casos clínicos de metástasis orbitaria. El primero es el de un varón de 63 años con pérdida de agudeza visual reciente asociada a diplopía binocular. Las pruebas de neuroimagen revelan una tumoración de características agresivas con extensión intraconal e invasión ósea. El estudio sistémico nos lleva al diagnóstico de carcinoma broncogénico microcítico en estadio IV. El segundo caso corresponde a una mujer de 69 años con cáncer de mama en estadios precoces que presenta alteraciones de motilidad ocular y proptosis. Mediante tomografía computarizada se evidencia infiltración tumoral de musculatura extraocular. El estudio anatomopatológico confirma el diagnóstico de metástasis orbitaria. La enfermedad metastásica orbitaria es una entidad relativamente infrecuente, con presentación clínica variada y pronóstico desfavorable. Constituye un reto diagnóstico que se debe sospechar en pacientes con factores de riesgo para enfermedad tumoral y recurrir a las técnicas de imagen para definir la extensión y severidad del cuadro
Two clinical cases of orbital metastasis are presented. The first is a 63 year-old male with a recent loss of visual acuity associated with binocular diplopia. Neuroimaging tests revealed a tumour of aggressive features with intraconal extension and bone invasion. The systemic study led to the diagnosis of stage IV small cell bronchogenic carcinoma. The second case is a 69 year-old woman with breast cancer in early stages that showed alterations in ocular motility and proptosis. Computed tomography showed tumour infiltration of extraocular musculature. The anatomo-pathological study confirmed the diagnosis of orbital metastasis. Orbital metastatic disease is a relatively infrequent entity with varied clinical presentation and an unfavourable prognosis. It constitutes a diagnostic challenge that should be suspected in patients with risk factors for tumour disease and imaging techniques used to define the extent and severity of the condition
Subject(s)
Humans , Male , Female , Aged , Carcinoma, Bronchogenic/pathology , Orbital Neoplasms/diagnosis , Orbital Neoplasms/secondary , Breast Neoplasms/pathology , Tomography, X-Ray Computed , Neoplasm Staging , Biopsy, Fine-Needle , Visual AcuityABSTRACT
Paciente de 52 años con múltiples factores de riesgo cardiovascular remitido por pérdida visual unilateral, aguda e indolora. En la fundoscopia destaca importante inflamación papilar con tortuosidad a este nivel y hemorragias. Las pruebas de imagen muestran edematización tanto del disco óptico como macular y afectación en capas internas retinianas. La angiografía con fluoresceína y la angiografía por tomografía de coherencia óptica de control muestran áreas de isquemia central y periférica. Dados los hallazgos clínicos y los antecedentes del paciente, se llega al diagnóstico de retinopatía de tipo Purtscher y se decide tratamiento con dexametasona intravítrea. La retinopatía de tipo Purtscher es una entidad de rara frecuencia que se presenta en pacientes con múltiples enfermedades sistémicas pero sin antecedentes traumáticos, lo que la diferencia de la retinopatía de Purtscher. En el pronóstico es importante el diagnóstico y la intervención precoz. No existen protocolos terapéuticos, pero con la terapia intravítrea con dexametasona se han obtenido buenos resultados
A 52-year-old patient with multiple cardiovascular risk factors referred for unilateral, acute, and painless visual loss. In the fundoscopic image there was significant papillary inflammation with tortuosity at this level and haemorrhages. Ophthalmological examination showed papillary inflammation, macular oedema, and involvement in retinal inner layers. The control fluorescein angiography and optical coherence tomography angiography showed areas of central and peripheral ischaemia. Given the clinical findings and background of the patient, the diagnosis of Purtscher-like retinopathy was reached and treatment with intravitreal dexamethasone was decided. Purtscher-like retinopathy is a rare entity that occurs in patients with multiple systemic pathologies, but without a traumatic background, which differentiates it from Purstcher's retinopathy. The diagnosis and early intervention are important in the prognosis. There are no therapeutic protocols, but good results have been obtained with intravitreal therapy with dexamethasone
Subject(s)
Humans , Male , Middle Aged , Retinal Diseases/drug therapy , Dexamethasone/administration & dosage , Glucocorticoids/administration & dosage , Combined Modality Therapy , Laser Coagulation , Intravitreal Injections , Fluorescein Angiography , Tomography, Optical Coherence , Treatment OutcomeABSTRACT
A 52-year-old patient with multiple cardiovascular risk factors referred for unilateral, acute, and painless visual loss. In the fundoscopic image there was significant papillary inflammation with tortuosity at this level and haemorrhages. Ophthalmological examination showed papillary inflammation, macular oedema, and involvement in retinal inner layers. The control fluorescein angiography and optical coherence tomography angiography showed areas of central and peripheral ischaemia. Given the clinical findings and background of the patient, the diagnosis of Purtscher-like retinopathy was reached and treatment with intravitreal dexamethasone was decided. Purtscher-like retinopathy is a rare entity that occurs in patients with multiple systemic pathologies, but without a traumatic background, which differentiates it from Purstcher's retinopathy. The diagnosis and early intervention are important in the prognosis. There are no therapeutic protocols, but good results have been obtained with intravitreal therapy with dexamethasone.
Subject(s)
Retinal Diseases/diagnostic imaging , Retinal Hemorrhage/diagnostic imaging , Dexamethasone/administration & dosage , Glucocorticoids/administration & dosage , Humans , Intravitreal Injections , Male , Middle Aged , Papilledema/diagnostic imaging , Retinal Diseases/drug therapyABSTRACT
Two clinical cases of orbital metastasis are presented. The first is a 63 year-old male with a recent loss of visual acuity associated with binocular diplopia. Neuroimaging tests revealed a tumour of aggressive features with intraconal extension and bone invasion. The systemic study led to the diagnosis of stage IV small cell bronchogenic carcinoma. The second case is a 69 year-old woman with breast cancer in early stages that showed alterations in ocular motility and proptosis. Computed tomography showed tumour infiltration of extraocular musculature. The anatomo-pathological study confirmed the diagnosis of orbital metastasis. Orbital metastatic disease is a relatively infrequent entity with varied clinical presentation and an unfavourable prognosis. It constitutes a diagnostic challenge that should be suspected in patients with risk factors for tumour disease and imaging techniques used to define the extent and severity of the condition.
Subject(s)
Breast Neoplasms/pathology , Carcinoma, Ductal, Breast/secondary , Carcinoma/secondary , Lung Neoplasms/pathology , Orbital Neoplasms/secondary , Aged , Carcinoma/diagnostic imaging , Carcinoma, Ductal, Breast/diagnostic imaging , Female , Humans , Male , Middle Aged , Orbital Neoplasms/diagnostic imagingABSTRACT
No disponible
Subject(s)
Humans , Male , Middle Aged , Iris Neoplasms/complications , Adenocarcinoma/etiology , Adenocarcinoma/secondary , Iris/diagnostic imaging , Iris/pathology , Iris Neoplasms/diagnostic imaging , Iris Neoplasms/drug therapy , Lung Neoplasms/complications , Lung Neoplasms/pathology , Bronchoscopy/methods , Adrenal Cortex Hormones/therapeutic use , Prednisone/therapeutic use , Administration, TopicalABSTRACT
Objetivos y métodos: Nuestro objetivo es describir una variante multifocal en la presentación de la enfermedad de Best. Las lesiones en esta enfermedad pueden variar en forma y tamaño, algunas llegan a medir un diámetro de disco y presentan un contorno irregular. Describimos el caso de un varón de 21 años que fue remitido por pérdida visual progresiva. Confirmamos su baja agudeza visual y realizamos un examen completo, donde pudimos apreciar flecks maculares con pigmento amarillento en su periferia. Sospechamos de una enfermedad de Best multifocal y realizamos los test genéticos pertinentes. La enfermedad de Best multifocal es parecida a la forma clásica, aunque suele cursar con electrooculograma normal y sin antecedentes familiares de la misma. Conclusión: La enfermedad de Best multifocal debe ser sospechada en el caso de lesiones múltiples vitelorruptivas cercanas al polo posterior. Las pruebas genéticas constituyen la clave diagnóstica (AU)
Objectives and methods: Our objective is to describe a multifocal vitelliform presentation of Best's disease. The lesions in this disease may vary in size and shape, some may be a disc diameter in size, and often have some irregularity in their contour. The case is described of a 21-year-old male patient referred to our ophthalmology department due to a progressive loss of vision. His poor visual acuity was confirmed, and a complete examination was performed, in which macular flecks were observed, with yellow pigment arranged in oval distribution near their periphery. Due to the suspicion of Best's multifocal disease, genetic tests were performed. Multifocal vitelliform disease with the same features as those in Best's disease occurs most frequently in patients with a normal electro-oculogram (EOG), and a normal family history. Conclusion: Best's multifocal disease must be suspected in case of multiple vitelliruptive lesions close to the posterior pole. Genetic testing is essential for its diagnosis (AU)
Subject(s)
Humans , Male , Young Adult , Vitelliform Macular Dystrophy/genetics , Electrooculography/methods , Genetic Testing/methods , Genetic Diseases, Inborn/genetics , Vision Disorders/diagnosis , Retinal Dystrophies/diagnosis , Tomography, Optical Coherence , Diagnosis, Differential , Genetic TherapySubject(s)
Adenocarcinoma of Lung/secondary , Iris Neoplasms/secondary , Lung Neoplasms/diagnosis , Adenocarcinoma of Lung/diagnosis , Adenocarcinoma of Lung/diagnostic imaging , Fatal Outcome , Humans , Iris Neoplasms/diagnostic imaging , Lung Neoplasms/diagnostic imaging , Male , Middle Aged , Peritoneal Neoplasms/secondary , Tomography, Optical Coherence , Tomography, X-Ray Computed , Uveitis, Anterior/etiologyABSTRACT
OBJECTIVES AND METHODS: Our objective is to describe a multifocal vitelliform presentation of Best's disease. The lesions in this disease may vary in size and shape, some may be a disc diameter in size, and often have some irregularity in their contour. The case is described of a 21-year-old male patient referred to our ophthalmology department due to a progressive loss of vision. His poor visual acuity was confirmed, and a complete examination was performed, in which macular flecks were observed, with yellow pigment arranged in oval distribution near their periphery. Due to the suspicion of Best's multifocal disease, genetic tests were performed. Multifocal vitelliform disease with the same features as those in Best's disease occurs most frequently in patients with a normal electro-oculogram (EOG), and a normal family history. CONCLUSION: Best's multifocal disease must be suspected in case of multiple vitelliruptive lesions close to the posterior pole. Genetic testing is essential for its diagnosis.
