Presentación atípica de un adenoma pleomorfo de la glándula lagrimal con focos de necrosis / Atypical presentation of lacrimal gland pleomorphic adenoma with necrotic foci

CASO CLÍNICO: Varón de 48 años que acude por dolor en región periorbitaria superior izquierda, con sospecha de dacrioadenitis. Tras mejoría clínica y sospecha de dacriops se decide extirpar dicha lesión. La anatomía patológica diagnostica un adenoma pleomorfo de la glándula lagrimal con áreas de necrosis. DISCUSIÓN: La forma de presentación de un adenoma pleomorfo suele ser asintomática. Sin embargo, la presencia de dolor en este caso puede estar relacionada con la necrosis observada en el estudio histológico. Aunque no está descrito en glándulas lagrimales, sí que existen referencias de necrosis de adenomas pleomorfos de glándulas salivares con dolor en la presentación

CLINICAL CASE: The case is presented of 48 year-old male complaining of a painful left upper eyelid and swelling of the lacrimal gland, with a suspicion of dacryoadenitis. Removal was decided after dacriops suspicion. Histopathology diagnosed a pleomorphic adenoma of the lacrimal gland, with areas of necrosis. DISCUSSION: Lacrimal gland pleomorphic adenoma usually presents as a slowly progressive painless mass. However, painful presentation in this case might be related with necrotic foci found in the histopathological examination. Although not described in lacrimal glands, pleomorphic adenomas have already been reported in the major and minor salivary glands, and these patients also presented with a painful mass

[Atypical presentation of lacrimal gland pleomorphic adenoma with necrotic foci]. / Presentación atípica de un adenoma pleomorfo de la glándula lagrimal con focos de necrosis.

CLINICAL CASE: The case is presented of 48 year-old male complaining of a painful left upper eyelid and swelling of the lacrimal gland, with a suspicion of dacryoadenitis. Removal was decided after dacriops suspicion. Histopathology diagnosed a pleomorphic adenoma of the lacrimal gland, with areas of necrosis. DISCUSSION: Lacrimal gland pleomorphic adenoma usually presents as a slowly progressive painless mass. However, painful presentation in this case might be related with necrotic foci found in the histopathological examination. Although not described in lacrimal glands, pleomorphic adenomas have already been reported in the major and minor salivary glands, and these patients also presented with a painful mass.

Changes in lamina cribrosa and prelaminar tissue after deep sclerectomy.

AIM: To determine the response of the lamina cribrosa (LC) and prelaminar tissue to a reduction of intraocular pressure (IOP) after nonpenetrating deep sclerectomy (NPDS) using enhanced depth imaging (EDI) spectral domain optical coherence tomography (SD-OCT). METHODS: A total of 28 eyes from 28 patients presenting with primary open angle glaucoma who underwent NPDS were studied. SD-OCT scans using EDI technology were obtained before surgery and 1 week, 1 month, and 3 months postoperatively. The OCT device was set to image a 15 × 10° vertical rectangle centred on the optic disc. The scan closest to the optic nerve head (ONH) centre was selected for analysis. The vertical distances from three equidistant points on the reference line (Bruch's membrane opening) to the anterior prelaminar tissue surface and the anterior and posterior surfaces of the LC were measured. RESULTS: The IOP decreased from 18.7 ± 4.3 to 9.1 ± 4.0 at the first week, 11.4 ± 3.7 at 1 month, and 13.1 ± 3.6 mm Hg at 3 months postoperatively (P<0.001). There was a significant reduction of the ONH cupping at 1 week (22.3%, P<0.001), 1 month (13.7%, P<0.001), and 3 months (9.8%, P=0.001) after surgery. Anterior displacement of the LC was slight but statistically significant at 1 week (4.5%, P=0.003), 1 month (3.8%, P=0.014), and 3 months postoperatively (3.3%, P=0.010). IOP reduction was significantly correlated with a reduction of ONH cupping and anterior displacement of LC at the first week and first month (P<0.05). CONCLUSIONS: Cupping reversal after NPDS is mainly due to changes in prelaminar tissue thickness, whereas the LC changes in position are less pronounced.

Efecto de la capsulotomía posterior con láser neodymium: YAG. Valoración de seguridad en el grosor foveal, la presión intraocular y el recuento de células endoteliales en pacientes pseudofáquicos con opacidad de cápsula posterior / Effect of posterior neodymium: YAG capsulotomy. Safety evaluation of macular foveal thickness, intraocular pressure and endothelial cell loss in pseudophakic patients with posterior capsule opacification

Objetivos: Determinar el efecto de la capsulotomía posterior en el grosor macular, presión intraocular (PIO) y pérdida de células endoteliales en pacientes pseudofáquicos que presentaban opacidad de la cápsula posterior, utilizando el ojo adelfo de cada paciente como control. Métodos: Se realizó un estudio prospectivo observacional en 31 pacientes pseudofáquicos con opacidad de la cápsula posterior en un ojo, utilizando el ojo adelfo como control durante un periodo de 3 meses. Se excluyó a los pacientes que presentaban otras enfermedades oculares o cirugías intraoculares aparte de la facoexéresis. A todos los pacientes se les realizó una capsulotomía posterior con láser Nd: YAG. El examen ocular, que se realizó previamente a la capsulotomía y en revisiones a la semana, al mes y a los 3 meses, incluía: agudeza visual mejor corregida (AVMC), PIO, tomografía de coherencia óptica macular (OCT) y recuento endotelial. Resultados: Se utilizaron ecuaciones de estimación generalizadas para valorar el efecto de la capsulotomía ajustado en función de situación basal y tiempo de seguimiento. No se encontró asociación significativa entre la capsulotomía y la PIO (p = 0,597), el grosor macular (p = 0,085) o el recuento endotelial (densitometría (p = 0,422), tamaño celular medio (p = 0,299), coeficiente de variación (p = 0,495), porcentaje de células hexagonales (0,093) y paquimetría (p = 0,423). Un incremento significativo de la AVMC se observó en la revisión a los 3 meses (p < 0,001). Conclusiones: Este estudio indica que, tras la capsulotomía posterior, la AVMC mejora significativamente, sin observarse cambios significativos en PIO, grosor macular o recuento endotelial. La capsulotomía con Nd:YAG es un procedimiento seguro en pacientes que no presenten enfermedades oculares asociadas (AU)

Objective: To determine the effect of posterior capsulotomy on macular thickness, intraocular pressure and endothelial cell loss in pseudophakic patients with posterior capsule opacification using the other eye of every patient as a control. Methods: An observational prospective study was conducted on 31 pseudophakic patients with posterior capsular opacification in one eye, using the other eye as a control. Patients did not suffer any other ocular pathology. All patients were treated by posterior capsular opacification with Nd: YAG capsulotomy, and followed up for a three-month period. The ocular examination included, best corrected visual acuity (BCVA), intraocular pressure (IOP),macular optical coherence tomography (OCT), and endothelial cell assessment (including densitometry, cell size and coefficient of variation, hexagonal cell percentage and pachymetry),which were determined in both eyes before treatment, and one week, one month and 3 months after capsulotomy. Results: Generalized estimating equations (GEE) were used to assess the capsulotomy effect adjusted by corresponding baseline measurements and time. No association was found between capsulotomy and IOP (P =0.597), macular thickness (P =0.085) or ECA (densitometry (P =0.422), average size of cells (P =0.299), variation coefficient (P =0.495), hexagonal cell percent (P =0.093) and corneal pachymetry (P =0.423). A significant increase of 0.15 Snellen units in BCVA was found during the 3-month follow-up period (P <0.001).Conclusion: This study shows that after Nd: YAG capsulotomy, BCVA improves significantly without any IOP, OCT or ECA changes during the three-month follow-up. Nd: YAG capsulotomy is a safe procedure in pseudophakic patients without any other ocular pathology (AU)

[Effect of posterior neodymium:YAG capsulotomy. Safety evaluation of macular foveal thickness, intraocular pressure and endothelial cell loss in pseudophakic patients with posterior capsule opacification]. / Efecto de la capsulotomía posterior con láser neodymium:YAG. Valoración de seguridad en el grosor foveal, la presión intraocular y el recuento de células endoteliales en pacientes pseudofáquicos con opacidad de cápsula posterior.

OBJECTIVE: To determine the effect of posterior capsulotomy on macular thickness, intraocular pressure and endothelial cell loss in pseudophakic patients with posterior capsule opacification using the other eye of every patient as a control. METHODS: An observational prospective study was conducted on 31 pseudophakic patients with posterior capsular opacification in one eye, using the other eye as a control. Patients did not suffer any other ocular pathology. All patients were treated by posterior capsular opacification with Nd:YAG capsulotomy, and followed up for a three-month period. The ocular examination included, best corrected visual acuity (BCVA), intraocular pressure (IOP), macular optical coherence tomography (OCT), and endothelial cell assessment (including densitometry, cell size and coefficient of variation, hexagonal cell percentage and pachymetry), which were determined in both eyes before treatment, and one week, one month and 3 months after capsulotomy. RESULTS: Generalized estimating equations (GEE) were used to assess the capsulotomy effect adjusted by corresponding baseline measurements and time. No association was found between capsulotomy and IOP (P=.597), macular thickness (P=.085) or ECA (densitometry (P=.422), average size of cells (P=.299), variation coefficient (P=.495), hexagonal cell percent (P=.093) and corneal pachymetry (P=.423). A significant increase of 0.15 Snellen units in BCVA was found during the 3-month follow-up period (P<.001). CONCLUSION: This study shows that after Nd:YAG capsulotomy, BCVA improves significantly without any IOP, OCT or ECA changes during the three-month follow-up. Nd:YAG capsulotomy is a safe procedure in pseudophakic patients without any other ocular pathology.