[Macular pucker surgery with and without delamination of the internal limiting membrane-a prospective randomized study]. / Macular-Pucker-Chirurgie mit und ohne Delamination der Membrana limitans interna ­ eine prospektive randomisierte Studie.

BACKGROUND: There is evidence that additional internal limiting membrane (ILM) removal reduces the recurrence rate after pucker surgery with a similar functional outcome. On the other hand, morphological changes of the inner retinal layers after ILM peeling have been described. The aim of this study was to compare the long-term data after vitrectomy with and without ILM delamination in order to uncover possible differences in morphological and functional results. METHODS: In a prospective study of 32 patients with idiopathic epiretinal membrane, 16 patients were randomized into each of 2 groups. Both groups underwent pars plana vitrectomy (ppV) with peeling of the epiretinal membrane. In group 1 no forced additional peeling of the ILM was performed and in group 2 the ILM or ILM residues were additionally removed after staining. The investigated parameters were visual acuity, central retinal thickness (CRT) in optical coherence tomography (OCT), metamorphopsia and surgical complications. The time points of the examinations were directly preoperative, after 1, 3 and 6 months and partly 8.4 years postoperatively. RESULTS: In group 1 (n = 15) the preoperative mean visual acuity improved from 0.54 logMAR to 0.38 logMAR after 6 months postoperatively (n = 13). Of this group 6 patients could be examined in the long-term course and the visual acuity improved further to 0.32 logMAR after 8 years. The CRT decreased from 473 µm preoperatively to 235 µm in the long-term interval. In group 2 (n = 15) the mean visual acuity preoperatively was 0.47 logMAR and improved 6 months postoperatively (n = 13) to 0.38 logMAR and in the long-term examination (n = 5) to 0.1 logMAR. The CRT in this group decreased from 417 µm preoperatively to 278 µm in the long-term interval. In group 1 one recurrence occurred in the follow-up period, in group 2 none. CONCLUSION: The study showed that there was no significant difference in visual acuity and CRT between the two groups neither after 6 months nor after 8 years of follow-up. The observed recurrence in the group without ILM delamination underlines the assumption that additional ILM peeling could reduce the recurrence rate.

[Does the micropulse laser have an effect on chronic CSC?] / Hat der Mikropulslaser bei chronischer CCS einen Effekt?

INTRODUCTION: Central serous chorioretinopathy (CSC) is the fourth most common cause of vision loss without an evidence-based treatment recommendation. A positive effect of micropulse laser (MPL) treatment has been described in the literature in recent years. This study aimed to reappraise these results in a patient population with chronic CSC. METHODS: Patients suffering from chronic CSC with a source point detectable in fluorescein angiography (longer than 3 months duration and unresponsive to treatment with eplerenone and carbonic anhydrase inhibitors) were identified and included in this prospective and consecutive case study. Patients were controlled with a yellow laser (577 nm) after 6 weeks, 12 weeks and then every 3 months. RESULTS: A total of 28 patients were included (28 eyes). The mean duration of anamnesis was 444 days (90-1412 days) and the mean duration of the observation period after MPL was 257 days (42-909 days). The foveal retinal thickness measured 351.7 ± 82.4 µm before, compared to 253.6 ± 86.48 µm after MPL (mean of all patients over the whole observation period). Visual acuity was 0.33 ± 0.21 logMAR prior to MPL and 0.30 ± 0.22 logMAR posttreatment. Of the patients two underwent a second MPL and three patients underwent photodynamic treatment (PDT) after insufficient clinical improvement and were consequently excluded from the study. CONCLUSION: Retinal thickness in this patient population with chronic CSC was significantly reduced after MPL treatment with no significant changes of visual acuity. No side effects of MPL were observed. Larger studies including control groups are warranted to quantify the effects of MPL further.

Consensus statement on the treatment of multiple sclerosis by the Spanish Society of Neurology in 2016. / Consenso para el tratamiento de la esclerosis múltiple 2016. Sociedad Española de Neurología.

With the advent of new disease-modifying drugs, the treatment of multiple sclerosis is becoming increasingly complex. Using consensus statements is therefore advisable. The present consensus statement, which was drawn up by the Spanish Society of Neurology's study group for demyelinating diseases, updates previous consensus statements on the disease. The present study lists the medications currently approved for multiple sclerosis and their official indications, and analyses such treatment-related aspects as activity, early treatment, maintenance, follow-up, treatment failure, changes in medication, and special therapeutic situations. This consensus statement includes treatment recommendations for a wide range of demyelinating diseases, from isolated demyelinating syndromes to the different forms of multiple sclerosis, as well as recommendations for initial therapy and changes in drug medication, and additional comments on induction and combined therapy and practical aspects of the use of these drugs.

[Intravitreal dexamethasone implant for treatment of persistent postoperative macular edema after vitrectomy]. / Intravitreales Dexamethason-Implantat zur Behandlung des persistierenden postoperativen Makulaödems nach Vitrektomie.

BACKGROUND: To date, there is no consensus about the management of persistent cystoid macular edema (CME) following vitrectomy. The aim of this study was to evaluate the efficacy and safety of intravitreal dexamethasone implants for the treatment of postoperative CME following vitrectomy. MATERIAL AND METHODS: In this multicenter study we retrospectively reviewed the data of 24 patients (25 eyes) who had been treated with intravitreal dexamethasone (Ozurdex®) for the management of persistent postoperative CME following pars plana vitrectomy. The main outcome measure was central retinal thickness (CRT in µm) as assessed by spectral domain optical coherence tomography (SD-OCT). Secondary outcome measures included change in best corrected visual acuity (BCVA) and the presence of metamorphopsia. RESULTS: All 19 eyes which were postoperatively examined within 4-8 weeks after implantation showed a significant decrease in CRT (mean 564 µm to 315 µm) and a reduction of metamorphopsias. Within the same period of time the BCVA improved in 15 out of 19 eyes (79%) which corresponds to an average visual improvement from 0.69 logMAR to 0.46 logMAR (P <0.0001). In eyes examined after 10-16 weeks a slight increase in the average CRT of 351 µm was observed, whereas the BCVA improved to 0.28 logMAR. After 4 months a decrease in average BCVA was noted. Out of 25 eyes 12 required further dexamethasone implantations between 1 and 4 times within the investigation period. The first repeat injections were performed an average of 7.3 months after the initial treatment. CONCLUSION: Our results suggest that intravitreal dexamethasone is a safe and effective treatment option for persistent CME following vitrectomy.

[Importance of the Watzke-Allen test in diagnostics and staging of macular holes]. / Bedeutung des Watzke-Allen-Tests in der Diagnostik und Stadieneinteilung von Makulaforamina.

BACKGROUND: The Watzke-Allen test (WAT) is a simple diagnostic tool designed for the diagnosis of full thickness macular holes (FTMH) but due to the rapid progress of imaging diagnostics it was replaced by spectral domain optical coherence tomography (SD-OCT) of macular pathologies. The aim of this study was to examine if the WAT is able to distinguish between the different FTMH stages. METHODS: In 57 eyes of 57 patients with clinical evidance of FTMH, the WAT was first performed followed by SD-OCT examination and a distinction was made between a negative (slit beam normal) and a positive sign (slit beam modified as groove and hourglass configuration or completely broken). RESULTS: In 49 out of 57 patients the WAT was positive (hourglass 46 patients and broken 3 patients). Based on the SD-OCT results the following diagnoses were made: lamellar macular holes (LMH, 3 patients), vitreomacular traction (VMT, 4 patients), small macular hole (≤ 250 µm, 5 patients), medium sized macular hole (250-400 µm, 11 patients) and large macular hole (≥ 400 µm, 34 patients). In 91 % of the patients with medium and large FTMH, the WAT was positive, whereas the WAT was positive in only 67 % of patients with small FTMH, VMT and LMH. The sensitivity for large and medium FTMH was 93 % but the specificity was only 33 %. CONCLUSION: The WAT was positive in a high percentage of patients with large and medium sized macular holes as well as patients with small macular holes and LMH. The sensitivity of certain indications for treatment was 93 % but the specificity was only 33 %; therefore, the WAT alone is not suitable for a certain preoperative differentiation of macular alterations.

[Progressive scotoma with perception of photopsia]. / Progredientes Skotom mit Photopsiewahrnehmung.

Acute annular outer retinopathy (AAOR) is a very rare variant of acute zonal occult outer retinopathy (AZOOR). Both variants are characterized by the perception of a progressive visual field defect and can be accompanied by photopsia. In contrast to AZOOR, a progressive whitish and annular demarcation of the involved retina is observed in AAOR using ophthalmoscopy. Optical coherence tomography (OCT) reveals morphological changes predominantly in the outer retinal layers. Although there is no proof of an effective therapy, in the case presented here further progression could be stopped by a combination of antiviral and immunosuppressive therapy.

Discontinuación y adherencia a largo plazo en la terapia con interferón beta en pacientes con esclerosis múltiple / Discontinuation and long-term adherence to beta interferon therapy in patients with multiple sclerosis

Objetivo Estudiar la frecuencia de discontinuación y el grado de adherencia en la primera línea de tratamiento con interferón beta (INFβ) en pacientes con esclerosis múltiple (EM), identificando sus causas y factores asociados. Método Estudio observacional retrospectivo que incluyó pacientes con EM clínicamente definida en tratamiento con INFβ durante el año 2001 en el área de pacientes externos de un servicio de farmacia hospitalaria. Se realizó un seguimiento desde el inicio del tratamiento hasta finales del año 2006. Las fuentes de datos utilizadas fueron la base de datos informatizada del área de pacientes externos, la historia clínica y los protocolos de solicitud de inicio y seguimiento de tratamiento para la EM. Se recopiló información sobre las características basales del paciente, tratamiento y continuidad del mismo. Resultados Se incluyeron 131 pacientes, a los que se les realizó un seguimiento medio de 7,4±2,6 años. El 64,1% fueron tratados con un solo fármaco durante todo el estudio. A los 2 años del inicio de la terapia con INFβ habían discontinuado la terapia el 9,9%, a los 5 años el 41,2% y a los 8 años y medio el 58,7%. Se mantenían más tiempo en tratamiento los hombres, pacientes con EM recurrente-remitente y tratados con INFβ1a-im, si bien solo fue significativo en los pacientes con 10 años o menos de evolución de la enfermedad al inicio del tratamiento. Las causas mayoritarias de discontinuación fueron la falta de efectividad (38,8%) y la aparición de efectos adversos (32,8%). Los pacientes adherentes discontinuaron menos el tratamiento (55,8 vs 75%).Conclusiones La continuidad a largo plazo en el tratamiento de la EM se ve reducida principalmente por la falta de efectividad y los efectos adversos. Una aproximación a la perspectiva del paciente puede ayudar a identificar aquellos con mayor riesgo de falta de adherencia para ayudar a optimizar la terapia(AU)

Objective To determine discontinuation rate and degree of adherence to first-line treatment with interferon-beta (INFβ) in patients with multiple sclerosis (MS), identifying causes and associated factors. Material and Method A retrospective observational study that included patients with MS treated with INFβ during 2001. The patients were followed-up from the beginning of treatment until the end of 2006. The data sources used were a computer database compiled in the outpatients’ area, medical records and application protocols for beginning and monitoring treatment for MS. Patient characteristics at baseline, treatment and continuity were included in the information collected. Results The study included 131 patients. Mean follow-up was 74±26 years. 641% of the patients were treated with only one drug during the study. At 2 years follow-up 99% of patients had discontinued INFβ therapy and at 5 years 412% had done so. Men, patients with relapsing-remitting MS and those treated with INFβ1a i.m. continued treatment for a longer period, but this was statistically significant only in patients with 10 years or less of disease progression at the beginning of therapy. Main causes of discontinuation were lack of efficacy (388%) and adverse effects (328%). Compliant patients presented lower discontinuation rates (558% vs. 75%).Conclusions treatment of MS patients with IFNβ is discontinued mainly due to lack of efficacy and adverse effects. Greater understanding of patients’ views can help to identify those at greatest risk of lack of adherence, thereby helping to improve treatment (AU)

[Discontinuation and long-term adherence to beta interferon therapy in patients with multiple sclerosis]. / Discontinuación y adherencia a largo plazo en la terapia con interferón beta en pacientes con esclerosis múltiple.

OBJECTIVE: To determine discontinuation rate and degree of adherence to first-line treatment with interferon-beta (INFß) in patients with multiple sclerosis (MS), identifying causes and associated factors. MATERIAL AND METHOD: A retrospective observational study that included patients with MS treated with INFß during 2001. The patients were followed-up from the beginning of treatment until the end of 2006. The data sources used were a computer database compiled in the outpatients' area, medical records and application protocols for beginning and monitoring treatment for MS. Patient characteristics at baseline, treatment and continuity were included in the information collected. RESULTS: The study included 131 patients. Mean follow-up was 74 ± 26 years. 641% of the patients were treated with only one drug during the study. At 2 years follow-up 99% of patients had discontinued INFß therapy and at 5 years 412% had done so. Men, patients with relapsing-remitting MS and those treated with INFß1a i.m. continued treatment for a longer period, but this was statistically significant only in patients with 10 years or less of disease progression at the beginning of therapy. Main causes of discontinuation were lack of efficacy (388%) and adverse effects (328%). Compliant patients presented lower discontinuation rates (558% vs. 75%). CONCLUSIONS: treatment of MS patients with IFNß is discontinued mainly due to lack of efficacy and adverse effects. Greater understanding of patients' views can help to identify those at greatest risk of lack of adherence, thereby helping to improve treatment.

[siRNA in macular degeneration]. / siRNA bei Makuladegeneration.

To date aptamers, recombinant antibodies and antibody fragments which interfere specifically in cellular signal transmission by binding transmitters before a signal can be triggered, are the approved therapeutics agents for treatment of ocular angiogenesis. These substances achieve an effective but in most cases temporary inhibition of vascular growth and permeability. Other alternatives to inhibit cellular communication, such as tyrosine kinase inhibition or especially post-transcriptional gene silencing by degradation of messenger RNA (mRNA) induced by small interfering RNA (siRNA) are being evaluated in ongoing studies. In this overview issues related to mechanisms and molecule design, as well as clinical applications and the first clinical experience in ophthalmology reported on siRNA will be discussed.

[Sexual dysfunction management in multiple sclerosis]. / Abordaje de la disfunción sexual en la esclerosis múltiple.

INTRODUCTION: Sexual dysfunction is a frequent disorder associated to multiple sclerosis, that contributes to the worsening of life quality of these patients. AIM: To ascertain how it is managed in a demyelinating disease unit. PATIENTS AND METHODS: It was done an anonymous poll to multiple sclerosis patients in a demyelinating disease unit. The following variables were analysed: age, sex, marital status, education degree, sexual dysfunction, vesical dysfunction, gait disturbances and duration of illness. RESULTS: 67 of 97 patients answered. 74.6% females. Average age was 43.7 years. Average developing time was 11.3 years. 58% of the patients had vesical dysfunction. 43% had sexual dysfunction. There was relation with statistical significance between sexual and vesical dysfunction but not among the rest of variables. 63% of the patients with sexual dysfunction had never talked about this problem with their doctors. That the patient talked about sexual dysfunction was related with the fact that the neurologist asked for or not, and if sexual dysfunction was an important problem for the patient. The neurologist had asked for dysfunction sexual symptoms to 30% of the patients, and this was more frequent if the patient was male and if he or she had gait disturbances. CONCLUSIONS: Sexual dysfunction is a frequent and important problem for patients with multiple sclerosis. According to our results, this problem is raised up in an insufficient manner as much for patients as for neurologists.

Abordaje de la disfunción sexual en la esclerosis múltiple / Sexual dysfunction management in multiple sclerosis

Introducción. La disfunción sexual es un trastorno frecuente asociado a la esclerosis múltiple (EM) y contribuye al empeoramiento de la calidad de vida de estos pacientes. Objetivo. Valorar cómo se aborda este tema en una unidad de enfermedades desmielinizantes. Pacientes y métodos. Encuesta de respuesta anónima a pacientes con EM de una unidad de enfermedades desmielinizantes. Variables analizadas: edad, sexo, estado civil, nivel de escolarización, disfunción sexual, disfunción vesical, trastornos de la marcha y tiempo de evolución. Análisis bivariante y regresión logística. Resultados. Respondieron 67 de 97 pacientes. El 74,6% eran mujeres. Edad media: 43,7 años. Tiempo medio de evolución: 11,3 años. El 58% tenía disfunción vesical. La disfunción sexual estaba presente en el 43% de los pacientes. Observamos relación estadísticamente significativa entre la disfunción sexual y la disfunción vesical, pero no con el resto de las variables analizadas. El 63% de los pacientes con disfunción sexual no había comentado nunca este problema con el neurólogo. Las variables que se relacionan de forma independiente con que el paciente hable con el especialista de disfunción sexual son que se le interrogue a este respecto y que sea un problema importante en relación con su enfermedad. El neurólogo había preguntado por síntomas de disfunción sexual al 30% de los pacientes y el hecho de preguntar se relacionó con que el paciente fuera varón y con que tuviera trastornos en la marcha. Conclusión. La disfunción sexual es un problema frecuente e importante para los pacientes con EM. Según nuestros resultados, se aborda de manera insuficiente

Introduction. Sexual dysfunction is a frequent disorder associated to multiple sclerosis, that contributes to the worsening of life quality of these patients. Aim. To ascertain how it is managed in a demyelinating disease unit. Patients and methods. It was done an anonymous poll to multiple sclerosis patients in a demyelinating disease unit. The following variables were analysed: age, sex, marital status, education degree, sexual dysfunction, vesical dysfunction, gait disturbances and duration of illness. Results. 67 of 97 patients answered. 74.6% females. Average age was 43.7 years. Average developing time was 11.3 years. 58% of the patients had vesical dysfunction. 43% had sexual dysfunction. There was relation with statistical significance between sexual and vesical dysfunction but not among the rest of variables. 63% of the patients with sexual dysfunction had never talked about this problem with their doctors. That the patient talked about sexual dysfunction was related with the fact that the neurologist asked for or not, and if sexual dysfunction was an important problem for the patient. The neurologist had asked for dysfunction sexual symptoms to 30% of the patients, and this was more frequent if the patient was male and if he or she had gait disturbances. Conclusions. Sexual dysfunction is a frequent and important problem for patients with multiple sclerosis. According to our results, this problem is raised up in an insufficient manner as much for patients as for neurologists

Complete resorption of retinal hemorrhages in idiopathic thrombocytopenic purpura.

PURPOSE: Idiopathic thrombocytopenic purpura (ITP) is characterized by refractory thrombocytopenia, production of autoantibodies, and persistent predisposition to bleeding affecting virtually all mucocutaneous tissues and various organs. METHODS: A 50-year-old man with chronic ITP and diabetic maculopathy developed massive preretinal, intraretinal, and numerous subretinal hemorrhages accompanied by impaired vision to 20/400. His platelet count was 1100/microL, hemoglobin concentration was 4.6 mg/dL, however his blood clotting and activated partial thromboplastin time (APTT) maintained a normal 26 sec. RESULTS: After a splenectomy the patient was placed on high-dose oral corticosteroids (40 mg/day), immunoglobulin, and CellCept. The platelet count was restored to 25,000/microL within months. Four months later the unaffected retina received a panretinal photocoagulation and intravitreal triamcinolone injection (25 mg). Two years after the thrombolytic event the hemorrhages resolved completely and the patient's vision recovered to 20/100. CONCLUSIONS: Repetitive treatments with immunoglobulins and high-dose corticosteroids may increase the platelet count, inducing a complete resorption of the retinal hemorrhages and visual recovery during a long-term follow-up.

[Subjective decrease of visual acuity after photodynamic therapy: documentation by optical coherence tomography and its correlation with visual acuity]. / Disminución de la agudeza visual tras terapia fotodinámica: estudio mediante tomografía de coherencia óptica y su correlación con la agudeza visual.

CASE REPORT: A 68-year-old patient complained of decreased visual acuity (VA) two days after photodynamic therapy (PDT) had been performed. VA decreased from the pre-operative value of 0.4 to 0.1 on the second postoperative day. With additional + 1.75 diopters, VA was 0.32. Optical coherence tomography (OCT) disclosed a subneuroretinal fluid accumulation causing a serous retinal detachment 600 microm in height. One week postoperatively, neither decreased vision nor retinal elevation were noted. DISCUSSION: The temporary subjective decreased VA could be predominantly reduced by adequate refraction. OCT and VA measurements excluded ischemia of the neuroretina or the choroid as a causative factor.

Disminución de la agudeza visual tras terapia fotodinámica: estudio mediante tomografía de coherencia óptica y su correlación con la agudeza visual / Subjective decrease of visual acuity after photodynamic therapy: documentation by optical coherence tomography and its correlation with visual acuity

Caso clínico: Paciente de 68 años con disminución de la agudeza visual (AV) dos días tras terapia fotodinámica. La refracción preoperatoria era de 0,4 y descendió a 0,1 al segundo día después del tratamiento. No obstante, con una adición de +1,75 dioptrías, la visión alcanzó 0,32. El examen mediante tomografía de coherencia óptica (OCT) reveló una acumulación de fluido subretiniano que originaba un desprendimiento seroso de la retina de 600 µm de grosor. Transcurridos 7 días se restablecieron la AV y el grosor retiniano.Discusión: La disminución temporal de la AV pudo ser corregida por medio de una adecuada refracción. Los hallazgos del OCT y la AV sirvieron para excluir una isquemia retiniana o coroidea como factores causales

Case report: A 68-year-old patient complained of decreased visual acuity (VA) two days after photodynamic therapy (PDT) had been performed. VA decreased from the pre-operative value of 0.4 to 0.1 on the second postoperative day. With additional + 1.75 diopters, VA was 0.32. Optical coherence tomography (OCT) disclosed a subneuroretinal fluid accumulation causing a serous retinal detachment 600 µm in height. One week postoperatively, neither decreased vision nor retinal elevation were noted. Discussion: The temporary subjective decreased VA could be predominantly reduced by adequate refraction. OCT and VA measurements excluded ischemia of the neuroretina or the choroid as a causative factor

Importancia y factores relacionados con la fatiga crónica en la esclerosis múltiple / Importance and factors related to chronic fatigue in multiple sclerosis

Introducción. La importancia de la fatiga en la esclerosis múltiple (EM) viene determinada por la elevada frecuencia con la que aparece y por ser una causa importante de incapacidad. Objetivo. Conocer los factores relacionados con la presencia de fatiga crónica en una serie hospitalaria de pacientes con EM. Pacientes y métodos. Se incluyeron pacientes con EM atendidos de forma consecutiva en la unidad de enfermedades desmielinizantes de un hospital terciario que cumplían los siguientes criterios: EM clínicamente definida (RR o SP), duración de la EM superior a 2 años y ausencia de recaídas en el último mes. Se analizaron las siguientes variables: fatiga crónica, datos demográficos generales, sistemas funcionales, EDSS, ISS, ESS, actividad de la enfermedad, escala de depresión de Hamilton, GHQ-28, índice de calidad de sueño de Pittsburg y tratamiento con interferón. Se llevó a cabo estudio estadístico utilizando análisis bivariante y multivariante mediante regresión logística. Resultados. La serie comprende 100 pacientes (72 mujeres y 28 varones). La edad media fue 39,27 años. Un 88 % de los casos tenían una EM RR y un 12 % EM SP. El tiempo medio de evolución fue 11,2 años. El EDSS medio fue de 2,54. Un 53 % de los casos presentó fatiga crónica. Las únicas variables que se asociaron de forma estadísticamente significativa con la presencia de fatiga crónica fueron la depresión y la disfunción del sueño diurna, de forma que la presencia de depresión multiplica por 3,6 la probabilidad de fatiga crónica y cada punto de más en el PSQI-7 la multiplica por 3,5. Conclusión. La depresión y la disfunción del sueño diurna son las únicas variables que se relacionan de forma independiente con la fatiga crónica entre los pacientes con EM

Introduction. The importance of fatigue in multiple sclerosis (MS) is determined by its high frequency and it is an important cause of disability. Objective. To determine factors that are related to the presence of chronic fatigue in patients with MS. Patients and methods. The series comprises patients with MS, consecutively attended in the demyelinizating diseases unit, who met the following criteria: clinically definite MS (RR or SP), MS duration of more than two years, and no relapses during the previous month. Analyzed variables were as follows: chronic fatigue, demographic data, functional systems, EDSS, ISS, ESS, disease activity, Hamilton, depression scale GHQ-28, PSQI, and interferon. Statistical study: bivariate and multivariate analysis by logistic regression. Results. A hundred patients were inclued, 72 female and 28 male. Mean age was 39.27 years. Of the 100 patients 88 had RR disease and 12 SP disease. MS mean duration was 11.2 years. Mean EDSS 2.54. Chronic fatigue was 53 %. The presence of depression increased the probability of chronic fatigue 3.6 fold, and every point in PSQI-7 increases it 3.5 fold. Conclusion. Depression and the PSQI-7 subscale (day sleep dysfunction) are the only variables independently related to chronic fatigue in patients with MS

Manifestaciones oftalmológicas del cáncer sistémicoen la edad infantil / Ophthalmological features of systemic cancer in children

Las metástasis orbitarias en la edad pediátrica pueden producirse por tumores sólidos como el neuroblastoma y el tumor de Ewing. También las enfermedades linforreticulares son otra importante causa de metástasis oculares en los niños (AU)

[Ophthalmological manifestations of systemic cancer in childhood]. / Manifestaciones oftalmológicas del cáncer sistémico en la edad infantil.

Metastases to the orbit in childhood may be due to solid tumors such as a neuroblastoma or Ewing's tumor. The lymphoreticular diseases are also a major cause of metastases to the eye in children.