Toxicidad corneal por depósitos endoteliales tras uso combinado prolongado de 2 antipsicóticos fenotiazínicos / Corneal toxicity with endothelial deposits after prolonged combined use of two phenothiazine antipsychotics

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Excavación focal coroidea asociada a membrana neovascular coroidea idiopática / Focal choroidal excavaction associated with idiopathic choroidal neovascularization

CASO CLÍNICO: Presentamos el caso de una mujer de 61 años, con una retinopatía de tipo Purtscher asociada a un fallo renal agudo. La exploración oftalmológica, angiografía fluoresceínica y tomografía de coherencia óptica fueron compatibles con una retinopatía de Purtscher-like. Las manifestaciones oculares precedieron al fracaso renal. El estudio sistémico y de laboratorio descartó su asociación con pancreatitis y otras enfermedades sistémicas. Finalmente se complicó con un glaucoma neovascular. DISCUSIÓN: La retinopatía de Purtscher-like rara vez precede a la enfermedad sistémica asociada. El diagnóstico precoz basado en las manifestaciones oftálmicas, podría contribuir al diagnóstico y tratamiento de la enfermedad de base y a la prevención de las posibles complicaciones

CASE REPORT: The case is reported of a 61 year-old woman with Purtscher-like retinopathy associated with acute renal failure. Ophthalmic examination, fluorescein-angiography, and optical coherence tomography were consistent with Purtscher-like retinopathy. Ophthalmic symptoms and signs preceded renal failure. Pancreatitis and other systemic diseases were ruled out. The patient developed a neovascular glaucoma. DISCUSSION: Purtscher-like retinopathy rarely precedes the associated systemic illness. Early diagnosis based on ophthalmic symptoms may help in the recognition and treatment of the disease, and prevent later complications

Retinopatía Purtscher-like previa a fallo renal agudo / Purtscher-like retinopathy preceding acute renal failure

CASO CLÍNICO: Presentamos el caso de una mujer de 61 años, con una retinopatía de tipo Purtscher asociada a un fallo renal agudo. La exploración oftalmológica, angiografía fluoresceínica y tomografía de coherencia óptica fueron compatibles con una retinopatía de Purtscher-like. Las manifestaciones oculares precedieron al fracaso renal. El estudio sistémico y de laboratorio descartó su asociación con pancreatitis y otras enfermedades sistémicas. Finalmente se complicó con un glaucoma neovascular. DISCUSIÓN: La retinopatía de Purtscher-like rara vez precede a la enfermedad sistémica asociada. El diagnóstico precoz basado en las manifestaciones oftálmicas, podría contribuir al diagnóstico y tratamiento de la enfermedad de base y a la prevención de las posibles complicaciones

CASE REPORT: The case is reported of a 61 year-old woman with Purtscher-like retinopathy associated with acute renal failure. Ophthalmic examination, fluorescein-angiography, and optical coherence tomography were consistent with Purtscher-like retinopathy. Ophthalmic symptoms and signs preceded renal failure. Pancreatitis and other systemic diseases were ruled out. The patient developed a neovascular glaucoma. DISSCUSIÓN: Purtscher-like retinopathy rarely precedes the associated systemic illness. Early diagnosis based on ophthalmic symptoms may help in the recognition and treatment of the disease, and prevent later complications

Síndrome de nefritis túbulo-intersticial y uveítis (TINU). Tratamiento con inmunosupresores / Tubulointerstitial nephritis and uveitis syndrome (TINU). Treatment with immunosuppressive therapy

CASO CLÍNICO: Presentamos 2 casos de síndrome de nefritis túbulo-intersticial y uveítis que necesitaron tratamiento con inmunosupresores para lograr el control de la uveítis. Al contrario de lo habitualmente descrito, la uveítis adquirió un carácter crónico, siendo necesario el tratamiento inmunosupresor. La nefritis sí respondió al tratamiento con corticoides. DISCUSIÓN: El síndrome de nefritis túbulo intersticial y uveítis constituye una condición infradiagnosticada que requiere un alto índice de sospecha diagnóstica, ya que no se acompaña de alteraciones específicas. La inflamación ocular cursa con frecuentes recurrencias, siendo necesario, en raras ocasiones, el tratamiento inmunosupreso

CASE REPORT: Two cases of tubulointerstitial nephritis and uveitis are presented. Immunosuppressive therapy was required to control the uveitis. Contrary to that usually described, uveitis became chronic, which made immunosuppressive therapy necessary. Nephritis was successfully treated with steroids. DISCUSSION: Tubulointerstitial nephritis and uveitis syndrome is an under-diagnosed disorder and requires clinical suspicion due to there being no specific laboratory study available. Recurrences and relapses of ocular inflammation are common. Immunosuppressive therapy is not often needed

Purtscher-like retinopathy preceding acute renal failure. / Retinopatía Purtscher-like previa a fallo renal agudo.

CASE REPORT: The case is reported of a 61 year-old woman with Purtscher-like retinopathy associated with acute renal failure. Ophthalmic examination, fluorescein-angiography, and optical coherence tomography were consistent with Purtscher-like retinopathy. Ophthalmic symptoms and signs preceded renal failure. Pancreatitis and other systemic diseases were ruled out. The patient developed a neovascular glaucoma. DISCUSSION: Purtscher-like retinopathy rarely precedes the associated systemic illness. Early diagnosis based on ophthalmic symptoms may help in the recognition and treatment of the disease, and prevent later complications.

Tubulointerstitial nephritis and uveitis syndrome (TINU). Treatment with immunosuppressive therapy. / Síndrome de nefritis túbulo-intersticial y uveítis (TINU). Tratamiento con inmunosupresores.

CASE REPORT: Two cases of tubulointerstitial nephritis and uveitis are presented. Immunosuppressive therapy was required to control the uveitis. Contrary to that usually described, uveitis became chronic, which made immunosuppressive therapy necessary. Nephritis was successfully treated with steroids. DISCUSSION: Tubulointerstitial nephritis and uveitis syndrome is an under-diagnosed disorder and requires clinical suspicion due to there being no specific laboratory study available. Recurrences and relapses of ocular inflammation are common. Immunosuppressive therapy is not often needed.

Focal choroidal excavaction associated with idiopathic choroidal neovascularization. / Excavación focal coroidea asociada a membrana neovascular coroidea idiopática.

CASE REPORT: The case is presented of a 45 year-old man with a focal choroidal excavation associated with choroidal neovascularisation not included in the area of excavation. Clinical features were analysed using retinography, fluorescein angiography, optical coherence tomography, and optical coherence tomography angiography. The patient was treated with 3 intravitreal injections of bevacizumab, with a good response. DISCUSSION: Focal choroidal excavation can be associated with choroidal neovascularization not included in the area of excavation. Multimodal imaging provides a complete description of clinical features, before and after treatment.

Uveítis unilateral asociada a nefropatía IgA / Unilateral uveitis associated with IgA nephropathy

Caso clínico: Presentamos el caso de un varón de 42 años de edad con varios episodios de uveítis unilateral en su ojo derecho. El examen oftalmológico mostró una uveítis anterior granulomatosa con vitritis. El estudio sistémico puso de manifiesto una proteinuria de rango no nefrótico y microhematuria. La biopsia renal reveló una nefropatía IgA. Discusión: Las uveítis y las glomerulonefritis podrían tener mecanismos inmunológicos comunes. En el diagnóstico diferencial de los pacientes con uveítis y nefropatías debería incluirse la nefropatía IgA (AU)

Case report: The case is presented of a 42 year-old man with episodes of unilateral uveitis in his right eye. Ophthalmic examination showed a granulomatous anterior uveitis with vitritis. Systemic investigations revealed non-nephrotic proteinuria and microhaematuria. A renal biopsy showed IgA nephropathy. Discussion: Uveitis and glomerulonephritis may have common immunological pathogenesis. IgA nephropathy should be a differential diagnosis in patients with uveitis and nephropathy (AU)

Coriorretinitis placoide posterior sifilítica como presentación inicial de neurosífilis temprana / Syphilitic posterior placoid chorioretinitis as initial presentation of early neurosyphilis

Caso clínico: Varón de 36 años con diagnóstico reciente de VIH con pérdida de visión de ojo izquierdo. En fundoscopia se observó placa amarillenta en mácula. Tras angiografía con fluoresceína, tomografía de coherencia óptica, angiotomografía de coherencia óptica, pruebas serológicas y examen de LCR se llegó al diagnóstico de neurosífilis y coriorretinitis placoide posterior sifilítica. Discusión: La coriorretinitis placoide posterior es una manifestación clínica poco frecuente de sífilis ocular. En todos los pacientes con coriorretinitis placoide posterior sifilítica debe descartarse la posibilidad de neurosífilis y coinfección con el VIH. El tratamiento temprano con penicilina intravenosa suele ser efectivo, con un buen resultado visual (AU)

Case report: A 36 year-old male with a recent HIV diagnosis, presented with loss of vision of his left eye. Ophthalmoscopy revealed a unilateral yellowish placoid lesion in the macula. After fluorescein angiography, optical coherence tomography, optical coherence tomography angiography, syphilis serology, and cerebrospinal fluid results, he was diagnosed with neurosyphilis and syphilitic posterior placoid chorioretinitis. Discussion: Acute syphilitic posterior placoid chorioretinitis is a rare ocular manifestation of syphilis. All patients with characteristic clinical and angiographic findings of acute syphilitic posterior placoid chorioretinitis should be tested for a neurosyphilis and human immunodeficiency virus co-infection. Early treatment with intravenous penicillin is usually effective with good visual results (AU)

Unilateral uveitis associated with IgA nephropathy. / Uveítis unilateral asociada a nefropatía IgA.

CASE REPORT: The case is presented of a 42 year-old man with episodes of unilateral uveitis in his right eye. Ophthalmic examination showed a granulomatous anterior uveitis with vitritis. Systemic investigations revealed non-nephrotic proteinuria and microhaematuria. A renal biopsy showed IgA nephropathy. DISCUSSION: Uveitis and glomerulonephritis may have common immunological pathogenesis. IgA nephropathy should be a differential diagnosis in patients with uveitis and nephropathy.

Tratamiento quirúrgico en un hamartoma combinado de retina y epitelio pigmentario / Surgical treatment in combined hamartoma of the retina and retinal pigment epithelium

CASO CLÍNICO: Presentamos el caso de un paciente varón de 39 años, con un hamartoma combinado de retina y epitelio pigmentario de retina. El paciente refería disminución progresiva de la visión y empeoramiento de la metamorfopsia. Se realizó una vitrectomía con pelado de la membrana epirretiniana, consiguiendo una mejoría de la agudeza visual y de la metamorfopsia, así como de la arquitectura retiniana en la tomografía de coherencia óptica. DISCUSIÓN: Algunos pacientes seleccionados con hamartomas combinados de retina y epitelio pigmentario podrían beneficiarse de la realización de una vitrectomía

CASE REPORT: The case is presented of a 39 year-old man with a combined hamartoma of the retina and retinal pigment epithelium, who experienced progressive visual loss and worsening of metamorphopsia. The patient underwent vitrectomy and epiretinal component peeling, with improvement in visual acuity, metamorphopsia, and retinal architecture, assessed by optical coherence tomography. DISCUSSION: Selected patients with combined hamartomas of the retina and retinal pigment epithelium may benefit from surgical management

Syphilitic posterior placoid chorioretinitis as initial presentation of early neurosyphilis. / Coriorretinitis placoide posterior sifilítica como presentación inicial de neurosífilis temprana.

CASE REPORT: A 36 year-old male with a recent HIV diagnosis, presented with loss of vision of his left eye. Ophthalmoscopy revealed a unilateral yellowish placoid lesion in the macula. After fluorescein angiography, optical coherence tomography, optical coherence tomography angiography, syphilis serology, and cerebrospinal fluid results, he was diagnosed with neurosyphilis and syphilitic posterior placoid chorioretinitis. DISCUSSION: Acute syphilitic posterior placoid chorioretinitis is a rare ocular manifestation of syphilis. All patients with characteristic clinical and angiographic findings of acute syphilitic posterior placoid chorioretinitis should be tested for a neurosyphilis and human immunodeficiency virus co-infection. Early treatment with intravenous penicillin is usually effective with good visual results.

Surgical treatment in combined hamartoma of the retina and retinal pigment epithelium. / Tratamiento quirúrgico en un hamartoma combinado de retina y epitelio pigmentario.

CASE REPORT: The case is presented of a 39 year-old man with a combined hamartoma of the retina and retinal pigment epithelium, who experienced progressive visual loss and worsening of metamorphopsia. The patient underwent vitrectomy and epiretinal component peeling, with improvement in visual acuity, metamorphopsia, and retinal architecture, assessed by optical coherence tomography. DISCUSSION: Selected patients with combined hamartomas of the retina and retinal pigment epithelium may benefit from surgical management.

Metástasis coroidea como signo de presentación de un adenocarcinoma de pulmón con respuesta a afatinib / Choroidal metastasis as a presenting manifestation of a lung adenocarcinoma with response to afatinib

CASO CLÍNICO: Presentamos el caso de un varón de 55 años, con un adenocarcinoma no microcítico de pulmón, que comenzó con una metástasis coroidea. El paciente mostraba disminución de la agudeza visual. El examen reveló una metástasis coroidea unilateral secundaria al tumor. Tras el tratamiento con afatinib, se consiguió la regresión completa. DISCUSIÓN: Las metástasis coroideas pueden ser la primera manifestación de un cáncer de pulmón. De ahí la importancia de una evaluación completa en pacientes con tumores coroideos. El afatinib se mostró efectivo en el tratamiento de las metástasis coroideas de un carcinoma de pulmón con mutación EFGR

CASE REPORT: We present the case of a 55-year-old man with a non-small cell lung adenocarcinoma, who presented with choroidal metastasis. The patient showed a decrease in visual acuity. His evaluation revealed unilateral choroidal metastasis secondary to carcinoma of the lung. The patient received afatinib with complete regression of choroidal metastasis after one year follow-up. DISCUSSION: Choroidal metastasis may be the initial sign of lung cancer. This case highlights the importance of a thorough systemic evaluation in patients with choroidal tumours. Afatinib was effective against choroidal metastasis of a lung adenocarcinoma with EFGR mutation

Tumoración orbitaria por extensión rinosinusal en un paciente con granulomatosis de Wegener / Orbital tumour due rhinosinusal extension in a patient with Wegener's granulomatosis

CASO CLÍNICO: Presentamos el caso de una mujer de 49 años, con una tumoración orbitaria por extensión rinosinusal, por granulomatosis de Wegener, sin respuesta a tratamientos inmunosupresores ni a terapia biológica. La paciente mostraba una marcada proptosis con diplopía y limitación de los movimientos oculares. DISCUSIÓN: Se realizó extirpación tumoral mediante abordaje nasal y orbitario, con extirpación de la tumoración orbitaria, dada su rápida progresión y refractariedad al tratamiento médico

CASE REPORT: The case is presented of a 49 year-old woman with an orbital mass originating from the rhinosinus. She had a history of Wegener's granulomatosis, refractory to both biological and immunosuppressive therapy. Clinical examination showed proptosis, diplopia, and restriction of ocular movements. DISCUSSION: Orbital mass resection was performed, due to its rapid growth, and lack of response to medical treatment

Choroidal metastasis as a presenting manifestation of a lung adenocarcinoma with response to afatinib. / Metástasis coroidea como signo de presentación de un adenocarcinoma de pulmón con respuesta a afatinib.

CASE REPORT: We present the case of a 55-year-old man with a non-small cell lung adenocarcinoma, who presented with choroidal metastasis. The patient showed a decrease in visual acuity. His evaluation revealed unilateral choroidal metastasis secondary to carcinoma of the lung. The patient received afatinib with complete regression of choroidal metastasis after one year follow-up. DISCUSSION: Choroidal metastasis may be the initial sign of lung cancer. This case highlights the importance of a thorough systemic evaluation in patients with choroidal tumours. Afatinib was effective against choroidal metastasis of a lung adenocarcinoma with EFGR mutation.

Orbital tumour due rhinosinusal extension in a patient with Wegener's granulomatosis. / Tumoración orbitaria por extensión rinosinusal en un paciente con granulomatosis de Wegener.

CASE REPORT: The case is presented of a 49 year-old woman with an orbital mass originating from the rhinosinus. She had a history of Wegener's granulomatosis, refractory to both biological and immunosuppressive therapy. Clinical examination showed proptosis, diplopia, and restriction of ocular movements. DISCUSSION: Orbital mass resection was performed, due to its rapid growth, and lack of response to medical treatment.