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1.
Arch. Soc. Esp. Oftalmol ; 98(5): 276-280, mayo 2023. tab
Article in Spanish | IBECS | ID: ibc-219936

ABSTRACT

Objetivo Analizar la prevalencia de signos tomográficos no exudativos (signo de cebolla, seudoedema, tubulación de la retina externa, seudoquistes, hendiduras subretinianas y atrofia macular) en pacientes con degeneración macular asociada a la edad neovascular. Material y métodos Un total de 174 ojos de pacientes con degeneración macular asociada a la edad neovascular que no habían recibido tratamiento previo fueron incluidos en el estudio. Se valoró la agudeza visual, la actividad de la neovascularización y la aparición o no de los distintos signos objeto de estudio en los tiempos 0 (visita inicial), 4 meses, un año, año y medio y a los 2 y 3 años de seguimiento. Se evaluaron también: la edad, el sexo, el ojo afecto y el tipo de neovascularización (1, 2, 3, polipoidea o mixta). Los análisis se han realizado mediante el software estadístico R (versión 3.3.2) y el paquete glmmADMB (versión 0.8.3.3). Resultados La presencia de seudoquistes y tubulación de la retina externa va en aumento a lo largo del seguimiento. El signo de cebolla comienza con una frecuencia ascendente hasta los 12 meses, posteriormente desciende a los 18 meses y vuelve a incrementarse a los 24 meses. En cuanto al seudoedema, mantiene un incremento hasta los 18 meses para finalmente descender. Las hendiduras subretinianas son el signo más raro, presentándose en el 1,1% en la primera visita. Finalmente, la atrofia macular, presente en el 12,6% de los ojos inicialmente, se encuentra en el 25% a los 2 años. Conclusión Los seudoquistes, la tubulación de la retina externa y la atrofia macular fueron los signos más prevalentes, mientras que las hendiduras subretinianas fueron los más infrecuentes (AU)


Objective To analyze the prevalence of non-exudative tomographic signs (onion sign, pseudoswelling, external retinal tubulation, pseudocysts, subretinal clefts and macular atrophy) in patients with neovascular age-related macular degeneration. Material and methods A total of 174 eyes of patients with neovascular age-related macular degeneration who had not received previous treatment were included in the study. Visual acuity, neovascularization activity, and the appearance or not of the different signs under study were assessed at times 0 (initial visit), 4 months, one year, year and a half, and at 2 and 3 years of follow-up. The following were also evaluated: age, sex, affected eye and type of neovascularization (1, 2, 3, polypoid or mixed). The analysis were performed using the statistical software R (version 3.3.2) and the glmmADMB package (version 0.8.3.3). Results The presence of pseudocysts and external retinal tubulation increases throughout the follow-up. The onion sign begins with an ascending frequency up to 12 months, then decreases at 18 months and increases again at 24 months. Regarding pseudowelling, it maintains an increase until 18 months to finally decrease. Subretinal clefts is the rarest sign, presenting in 1.1% on the first visit. Finally, macular atrophy, present in 12.6% of the eyes initially, is found in 25% after 2 years. Conclusion Pseudocysts, external retinal tubulation and macular atrophy were the most prevalent signs, while subretinal clefts were the most infrequent (AU)


Subject(s)
Aged, 80 and over , Wet Macular Degeneration/diagnostic imaging , Macular Degeneration/diagnostic imaging , Retinal Neovascularization , Tomography, Optical Coherence , Longitudinal Studies , Retrospective Studies , Visual Acuity
2.
Arch Soc Esp Oftalmol (Engl Ed) ; 98(5): 276-280, 2023 May.
Article in English | MEDLINE | ID: mdl-37037324

ABSTRACT

OBJECTIVE: To analyse the prevalence of non-exudative tomographic signs (onion sign, pseudoswelling, external retinal tubulation, pseudocysts, subretinal clefts and macular atrophy) in patients with neovascular age-related macular degeneration. MATERIAL AND METHODS: A total of 174 eyes of patients with neovascular age-related macular degeneration who had not received previous treatment were included in the study. Visual acuity, neovascularization activity, and the appearance or not of the different signs under study were assessed at times 0 (initial visit), 4 months, one year, year and a half, and at 2 and 3 years of follow-up. The following were also evaluated: age, sex, affected eye and type of neovascularization (1, 2, 3, polypoid or mixed). The analysis were performed using the statistical software R (version 3.3.2) and the glmmADMB package (version 0.8.3.3). RESULTS: The presence of pseudocysts and external retinal tubulation increases throughout the follow-up. The onion sign begins with an ascending frequency up to 12 months, then decreases at 18 months and increases again at 24 months. Regarding pseudowelling, it maintains an increase until 18 months to finally decrease. Subretinal clefts is the rarest sign, presenting in 1.1% on the first visit. Finally, macular atrophy, present in 12.6% of the eyes initially, is found in 25% after 2 years. CONCLUSION: Pseudocysts, external retinal tubulation and macular atrophy were the most prevalent signs, while subretinal clefts were the most infrequent.


Subject(s)
Macular Degeneration , Tomography, Optical Coherence , Humans , Tomography, Optical Coherence/methods , Fluorescein Angiography , Retina/pathology , Macular Degeneration/diagnostic imaging , Macular Degeneration/pathology , Atrophy/pathology
3.
Arch Soc Esp Oftalmol (Engl Ed) ; 97(3): 172-175, 2022 Mar.
Article in English | MEDLINE | ID: mdl-35248400

ABSTRACT

We describe two cases of ocular complications secondary to Diode laser assisted eyebrow epilation. Both included patients were women who underwent an eyebrow epilation procedure with Diode laser. A few hours after the procedure they started complaining with photophobia and blurred vision. They were diagnosed with anterior acute uveitis and treated with topical steroids and mydriatics. During the follow-up the presence of sequelae derived from the laser procedure (mydriasis and corectopia in both patients, cataract in the second one) was confirmed. Laser hair removal of the eyebrows can induce irreversible eye damage. Complete and reliable information regarding the potential side effects of this procedure and proper use of appropriate safety devices is mandatory. We point out the importance of the potential ocular side effects associated with these cosmetic devices.


Subject(s)
Cataract , Hair Removal , Pupil Disorders , Cataract/etiology , Eyebrows , Female , Hair Removal/adverse effects , Hair Removal/methods , Humans , Lasers, Semiconductor/adverse effects , Pupil Disorders/etiology
4.
Arch. Soc. Esp. Oftalmol ; 97(3): 172-175, mar. 2022.
Article in Spanish | IBECS | ID: ibc-208836

ABSTRACT

Se describen dos casos clínicos de complicaciones oftalmológicas secundarias a depilación con láser diodo de las cejas.Los dos pacientes incluidos son mujeres que, horas después de someterse a un procedimiento de depilación con láser diodo en la zona de las cejas, presentan fotofobia y visión borrosa. Ambas son diagnosticadas de uveítis anterior aguda y tratadas con corticoides tópicos y midriáticos. En el seguimiento se constata la presencia de secuelas (midriasis y corectopia en ambas pacientes, catarata en la segunda) derivadas del procedimiento láser.El tratamiento con láser depilatorio de las cejas puede inducir daños oculares irreversibles. Es necesario informar a los usuarios de estas técnicas de los riesgos que conllevan y utilizar dispositivos de seguridad.Destacamos la importancia de los efectos secundarios oftalmológicos derivados del uso de estos láseres (AU)


We describe two cases of ocular complications secondary to Diode laser assisted eyebrow epilation.Both included patients were women who underwent an eyebrow epilation procedure with Diode laser. A few hours after the procedure they started complaining with photophobia and blurred vision. They were diagnosed with anterior acute uveitis and treated with topical steroids and mydriatics. During the follow-up the presence of sequelae derived from the laser procedure (mydriasis and corectopia in both patients, cataract in the second one) was confirmed.Laser hair removal of the eyebrows can induce irreversible eye damage. Complete and reliable information regarding the potential side effects of this procedure and proper use of appropriate safety devices is mandatory.We point out the importance of the potential ocular side effects associated with these cosmetic devices (AU)


Subject(s)
Humans , Female , Adult , Eyebrows , Hair Removal/adverse effects , Lasers, Semiconductor/adverse effects , Uveitis, Anterior/etiology , Mydriasis/etiology , Photophobia/etiology , Cataract/etiology
5.
Article in English, Spanish | MEDLINE | ID: mdl-33298354

ABSTRACT

We describe two cases of ocular complications secondary to Diode laser assisted eyebrow epilation. Both included patients were women who underwent an eyebrow epilation procedure with Diode laser. A few hours after the procedure they started complaining with photophobia and blurred vision. They were diagnosed with anterior acute uveitis and treated with topical steroids and mydriatics. During the follow-up the presence of sequelae derived from the laser procedure (mydriasis and corectopia in both patients, cataract in the second one) was confirmed. Laser hair removal of the eyebrows can induce irreversible eye damage. Complete and reliable information regarding the potential side effects of this procedure and proper use of appropriate safety devices is mandatory. We point out the importance of the potential ocular side effects associated with these cosmetic devices.

6.
Arch Soc Esp Oftalmol (Engl Ed) ; 95(6): 300-310, 2020 Jun.
Article in English, Spanish | MEDLINE | ID: mdl-32409243

ABSTRACT

OBJECTIVE: Minimize exposure to the SARS-CoV-2, reduce the chances of cross-transmission between patients and healthcare personnel, and prevent the development of postoperative complications from the management of patients with eye diseases during the 2019 coronavirus disease pandemic (COVID-19). METHODS: COVID-19 literature review and consensus establishment between different Spanish ophthalmology societies in order to provide guidelines and recommendations of maximum resources primarily conditioned by the state of alert, confinement and social distancing that occurs in Spain since March 16, 2020. RESULTS: The recommendations will promote the adoption of action and protection measures for eye care in outpatient clinics, surgical areas and hospitalization, for unconfirmed (asymptomatic and symptomatic) and confirmed COVID-19 patients. Measures must be adapted to the circumstances and availability of personal protective equipment in each of the centers and Autonomous Communities, which will be updated according to the pandemic phases and the measures adopted by the Spanish Government. CONCLUSIONS: During the COVID-19 pandemic, attention to the potential health risks to the population caused by coronavirus should prevail over the possible progression of the common eye diseases. Ophthalmologists and other eye care professionals must assume a possible progression of these diseases due to the impossibility of adequate patient follow-up.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Coronavirus Infections/transmission , Eye Diseases/diagnosis , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Pandemics , Pneumonia, Viral/epidemiology , Pneumonia, Viral/transmission , Postoperative Complications/prevention & control , Antimalarials/therapeutic use , Asymptomatic Diseases , Blood Safety , COVID-19 , Chloroquine/therapeutic use , Contact Lenses , Coronavirus Infections/diagnosis , Coronavirus Infections/prevention & control , Disease Progression , Eye Diseases/therapy , Humans , Hydroxychloroquine/therapeutic use , Ophthalmologic Surgical Procedures/adverse effects , Ophthalmologic Surgical Procedures/methods , Ophthalmology , Pandemics/prevention & control , Pneumonia, Viral/diagnosis , Pneumonia, Viral/prevention & control , Risk Factors , SARS-CoV-2 , Societies, Medical , Spain , Symptom Assessment/methods , Withholding Treatment
7.
Arch. Soc. Esp. Oftalmol ; 94(8): 413-416, ago. 2019. ilus
Article in Spanish | IBECS | ID: ibc-185630

ABSTRACT

Presentamos 3 pacientes con clínica de disminución de agudeza visual, papilitis y desarrollo de estrella macular al cabo de unas semanas. En todos ellos, las pruebas complementarias arrojaron resultados irrelevantes. Dado este contexto, fueron diagnosticados de neurorretinitis estrellada idiopática de Leber (NEIL) y se pautó tratamiento con corticoides, así como antibióticos en 2de ellos. Evolucionaron favorablemente, aunque con signos de atrofia papilar en los ojos afectos. El diagnóstico de la neurorretinitis estrellada idiopática de Leber puede resultar complejo, dado el amplio espectro de enfermedades que descartar. A esto se suma un período de tiempo en el que puede no haber aparecido la estrella macular, motivo que no debe hacer excluir su diagnóstico. El uso de antibióticos o corticoides como medida terapéutica es controvertido dado su buen curso clínico, aunque parece razonable en casos severos. Otro punto controvertido es el uso rutinario de pruebas complementarias, principalmente aquellas que pueden resultar agresivas o caras, que deben ser utilizadas de forma racional


Three cases of patients with decreased visual acuity and papillitis at onset with subsequent macular star development after a few weeks are presented. Complementary tests were unremarkable in all included patients. Based on this clinical context, they were diagnosed with Leber's idiopathic stellate neuroretinitis, were treated with corticosteroids, as well as with antibiotics in 2 cases. All patients showed favourable outcomes, although signs of papillary atrophy were observed in the affected eyes. Leber's idiopathic stellate neuroretinitis diagnosis can be challenging due to the wide spectrum of conditions that have to be ruled out. In addition, macular star may appear later on, which should not exclude its diagnosis. Use of antibiotics and/or corticosteroids is controversial considering its benign nature, but should be considered in selected severe cases. Moreover, the routine use of complementary tests should be carefully evaluated, mainly those that can be aggressive and/or expensive, which should be rationally used


Subject(s)
Humans , Male , Female , Adolescent , Adult , Papilledema/diagnostic imaging , Retinitis/diagnostic imaging , Adrenal Cortex Hormones/therapeutic use , Anti-Bacterial Agents/therapeutic use , Doxycycline/therapeutic use , Macula Lutea/diagnostic imaging , Macula Lutea/pathology , Papilledema/complications , Papilledema/drug therapy , Retinitis/complications , Retinitis/drug therapy , Tomography, Optical Coherence , Vision Disorders/etiology , Visual Acuity
8.
Arch Soc Esp Oftalmol (Engl Ed) ; 94(8): 413-416, 2019 Aug.
Article in English, Spanish | MEDLINE | ID: mdl-31053369

ABSTRACT

Three cases of patients with decreased visual acuity and papillitis at onset with subsequent macular star development after a few weeks are presented. Complementary tests were unremarkable in all included patients. Based on this clinical context, they were diagnosed with Leber's idiopathic stellate neuroretinitis, were treated with corticosteroids, as well as with antibiotics in 2cases. All patients showed favourable outcomes, although signs of papillary atrophy were observed in the affected eyes. Leber's idiopathic stellate neuroretinitis diagnosis can be challenging due to the wide spectrum of conditions that have to be ruled out. In addition, macular star may appear later on, which should not exclude its diagnosis. Use of antibiotics and/or corticosteroids is controversial considering its benign nature, but should be considered in selected severe cases. Moreover, the routine use of complementary tests should be carefully evaluated, mainly those that can be aggressive and/or expensive, which should be rationally used.


Subject(s)
Papilledema/diagnostic imaging , Retinitis/diagnostic imaging , Adolescent , Adrenal Cortex Hormones/therapeutic use , Adult , Anti-Bacterial Agents/therapeutic use , Doxycycline/therapeutic use , Female , Humans , Macula Lutea/diagnostic imaging , Macula Lutea/pathology , Male , Papilledema/complications , Papilledema/drug therapy , Retinitis/complications , Retinitis/drug therapy , Tomography, Optical Coherence , Vision Disorders/etiology , Visual Acuity
9.
Arch. Soc. Esp. Oftalmol ; 91(5): 232-235, mayo 2016. ilus
Article in Spanish | IBECS | ID: ibc-151394

ABSTRACT

CASO CLÍNICO: Presentamos el caso de una mujer de 45 años sin antecedentes de interés y con una pérdida súbita de visión en su ojo izquierdo secundaria a una uveítis posterior bilateral. Tras despistaje, se diagnosticó de coriorretinitis placoide posterior aguda sifilítica, y recibió tratamiento con penicilina intravenosa. Discusión: Existen múltiples manifestaciones oculares de la sífilis que pueden simular cuadros y etiologías muy diversas. El tratamiento anti-treponémico normalmente produce una rápida y positiva respuesta en pacientes afectos. El diagnóstico precoz y certero de estos pacientes es por tanto crucial aunque, en ocasiones, los daños anatómicos y funcionales son irreversibles


CLINICAL CASE: We report the case of a 45-year-old woman, with unremarkable past medical history, who presented with acute visual loss in her left eye due to bilateral posterior uveitis. After the screening, she was diagnosed with acute syphilitic placoid chorioretinitis and was treated with intravenous penicillin. DISCUSSION: Clinical manifestations of ocular syphilis are extremely heterogeneous and may mimic several aetiologies. Anti-treponema treatment usually induces a quick and positive response in affected patients. Prompt and proper diagnosis of these patients is crucial, although anatomical and functional damage may persist


Subject(s)
Humans , Female , Middle Aged , Treponema pallidum/physiology , Treponema pallidum/pathogenicity , Panuveitis/therapy , Panuveitis/etiology , Panuveitis/pathology , Chorioretinitis/diagnosis , Chorioretinitis/etiology , Chorioretinitis/therapy , Syphilis/complications , Syphilis/diagnosis , Syphilis/prevention & control , Prevalence , Diagnosis, Differential , Central Serous Chorioretinopathy/complications , Central Serous Chorioretinopathy/diagnosis , Central Serous Chorioretinopathy/etiology , Adrenal Cortex Hormones/administration & dosage , Adrenal Cortex Hormones/pharmacology , Adrenal Cortex Hormones/therapeutic use
10.
Arch Soc Esp Oftalmol ; 91(5): 232-5, 2016 May.
Article in English, Spanish | MEDLINE | ID: mdl-26920946

ABSTRACT

CLINICAL CASE: We report the case of a 45-year-old woman, with unremarkable past medical history, who presented with acute visual loss in her left eye due to bilateral posterior uveitis. After the screening, she was diagnosed with acute syphilitic placoid chorioretinitis and was treated with intravenous penicillin. DISCUSSION: Clinical manifestations of ocular syphilis are extremely heterogeneous and may mimic several aetiologies. Anti-treponema treatment usually induces a quick and positive response in affected patients. Prompt and proper diagnosis of these patients is crucial, although anatomical and functional damage may persist.


Subject(s)
Chorioretinitis/microbiology , Eye Infections, Bacterial , Syphilis , Chorioretinitis/diagnosis , Chorioretinitis/drug therapy , Eye Infections, Bacterial/diagnosis , Eye Infections, Bacterial/drug therapy , Female , Humans , Middle Aged , Penicillins/therapeutic use , Syphilis/diagnosis , Syphilis/drug therapy
11.
Tissue Antigens ; 86(5): 373-6, 2015 Nov.
Article in English | MEDLINE | ID: mdl-26373706

ABSTRACT

This study was undertaken to investigate the possible genetic association of functional CTLA4 polymorphisms with susceptibility to non-anterior uveitis. Four hundred and seventeen patients with endogenous non-anterior uveitis and 1517 healthy controls of Spanish Caucasian origin were genotyped for the CTLA4 polymorphisms rs733618, rs5742909 and rs231775, using predesigned TaqMan(©) allele discrimination assays. PLINK software was used for the statistical analyses. No significant associations between the CTLA4 polymorphisms and susceptibility to global non-anterior uveitis were found. It was also the case when the potential association of these genetic variants with the anatomical localization of the disease, such as intermediate, posterior or panuveitis, was assessed. Our results do not support a relevant role of these CTLA4 polymorphisms in the non-anterior uveitis genetic predisposition.


Subject(s)
Genetic Predisposition to Disease , Polymorphism, Genetic , Uveitis/genetics , Adult , CTLA-4 Antigen , Female , Humans , Male , Spain , White People
12.
Arch. Soc. Esp. Oftalmol ; 90(1): 30-32, ene. 2015. ilus
Article in Spanish | IBECS | ID: ibc-136349

ABSTRACT

CASO CLÍNICO: Se presenta el caso de un varón inmunocompetente que acude a nuestro servicio con escleritis adyacente a limbo y queratitis intersticial en ojo izquierdo. A los pocos días se observa nueva úlcera de aspecto dendritiforme en ojo derecho y empeoramiento bilateral progresivo hasta presentar uveítis granulomatosa en ambos ojos. En el estudio etiológico destacan títulos positivos de IgM para virus herpes simple en suero. DISCUSIÓN: Ante un cuadro de queratouveítis bilateral de tórpida evolución con tratamiento convencional, es necesario descartar el origen herpético debido a las diferentes presentaciones de este virus


CASE REPORT: We report the case of an immunocompetent male who presented with a limbal-adjacent scleritis and interstitial keratitis in the left eye. A few days later a new dendritiform ulcer in his right eye and bilateral progressive worsening with granulomatous uveitis in both eyes were observed. A thorough review of systems revealed positive serum IgM titles for herpes simplex virus. DISCUSSION: In the context of a bilateral keratouveitis refractory to conventional treatment it is mandatory to rule out the herpetic origin based on the different forms of clinical presentation of this virus


Subject(s)
Humans , Male , Keratitis, Herpetic/diagnosis , Keratitis, Herpetic/pathology , Necrosis/enzymology , Necrosis/pathology , Corneal Opacity/metabolism , Pharmaceutical Preparations/administration & dosage , Keratitis, Herpetic/complications , Keratitis, Herpetic/transmission , Necrosis/diagnosis , Necrosis/prevention & control , Corneal Opacity/diagnosis , Pharmaceutical Preparations/supply & distribution
13.
Arch Soc Esp Oftalmol ; 90(1): 30-2, 2015 Jan.
Article in Spanish | MEDLINE | ID: mdl-25443215

ABSTRACT

CASE REPORT: We report the case of an immunocompetent male who presented with a limbal-adjacent scleritis and interstitial keratitis in the left eye. A few days later a new dendritiform ulcer in his right eye and bilateral progressive worsening with granulomatous uveitis in both eyes were observed. A thorough review of systems revealed positive serum IgM titles for herpes simplex virus. DISCUSSION: In the context of a bilateral keratouveitis refractory to conventional treatment it is mandatory to rule out the herpetic origin based on the different forms of clinical presentation of this virus.


Subject(s)
Keratitis, Herpetic/diagnosis , Uveitis/etiology , Acyclovir/therapeutic use , Adult , Antibodies, Viral/blood , Antiviral Agents/therapeutic use , Corneal Opacity/etiology , Corneal Ulcer/etiology , Granuloma/etiology , Humans , Immunocompetence , Immunoglobulin M/blood , Keratitis, Herpetic/drug therapy , Keratitis, Herpetic/immunology , Male , Scleritis/etiology , Simplexvirus/immunology , Simplexvirus/physiology , Virus Activation
14.
Arch. Soc. Esp. Oftalmol ; 88(9): 339-344, sept. 2013. ilus, tab
Article in Spanish | IBECS | ID: ibc-116602

ABSTRACT

Objetivo: Describir el grado de coincidencia con el diagnóstico de presunción así como los resultados clínicos obtenidos a largo plazo tras el tratamiento antituberculoso (ATT) en un grupo de pacientes con uveítis tuberculosas presuntas (UTBP) que afectaban al segmento posterior. Métodos: Estudio retrospectivo. Serie de pacientes. Resultados: Se incluyeron a 17 pacientes con distintos tipos de uveítis del segmento posterior, crónicas, refractarias o de reciente diagnóstico y diversas manifestaciones clínicas, en los que, tras establecerse el diagnóstico de UTBP, se completó ATT. La media de seguimiento fue de 34 meses (rango 2-60). Hubo control de la inflamación en 14/17 pacientes (82,3%) durante el periodo de tratamiento y solo 4/17 pacientes (23,5%) experimentaron una recidiva de su enfermedad a lo largo del periodo de seguimiento tras ATT. Todos los pacientes que sufrieron recidivas (4/4), pero ninguno de los que no las sufrieron (0/13) requirieron terapia inmunosupresora de algún tipo tras ATT. La respuesta al ATT sirvió para confirmar el diagnóstico de UTBP en 14/17 pacientes (82,3%). Conclusiones: En pacientes con sospecha de UTBP que afecta al segmento posterior, el ATT puede ser una eficaz medida para confirmar el diagnóstico y resolver el cuadro inflamatorio. En este contexto, el ATT puede ofrecer otras potenciales ventajas como prevenir futuras reactivaciones de tuberculosis secundarias a tratamiento inmunosupresor o disminuir la frecuencia o la severidad de recaídas en algunos pacientes. La confirmación de estas y otras ventajas requiere trabajos prospectivos, aleatorizados con mayor número de pacientes (AU)


Objective: To determine the level of agreement with the presumed diagnosis and long term clinical outcomes after antituberculous therapy (ATT) in a group of patients with presumed tuberculous uveitis (PTU) affecting the posterior segment. Methods: Retrospective case series. Results: A total of 17 patients with chronic refractory or newly diagnosed uveitis affecting the posterior segment were included. All included patients were diagnosed with PTU and received ATT. Median follow-up after ATT was 34 months (range 2-60). Complete control of inflammation was observed in 14/17 patients (82.3%) during the treatment period, and only 4/17 patients (23.5%) had a uveitis relapse over the entire follow-up period after ATT. All patients who had uveitis relapses (4/4), but none from the remaining group (0/13), required immunosuppressive therapy of some kind after ATT. The response to ATT was able to confirm diagnosis of PTU in 14/17 (82.3%) included patients. Conclusion: When a clinical suspicion of PTU affecting the posterior segment exists, ATT may be highly effective for both confirming the diagnosis and resolving the inflammatory process. Thus, ATT may offer additional advantages, such as preventing latent-tuberculosis reactivations due to immunosuppressive therapy, and decreasing the number and/or severity of uveitis relapses in some patients. Prospective, randomized studies including a larger number of patients are required to support these and other potential advantages of ATT in such patients (AU)


Subject(s)
Humans , Uveitis, Posterior/drug therapy , Tuberculosis, Ocular/drug therapy , Mycobacterium tuberculosis/pathogenicity , Choroiditis/etiology , Antitubercular Agents/therapeutic use , Retrospective Studies
15.
Arch Soc Esp Oftalmol ; 88(9): 339-44, 2013 Sep.
Article in Spanish | MEDLINE | ID: mdl-23988040

ABSTRACT

OBJECTIVE: To determine the level of agreement with the presumed diagnosis and long term clinical outcomes after antituberculous therapy (ATT) in a group of patients with presumed tuberculous uveitis (PTU) affecting the posterior segment. METHODS: Retrospective case series. RESULTS: A total of 17 patients with chronic refractory or newly diagnosed uveitis affecting the posterior segment were included. All included patients were diagnosed with PTU and received ATT. Median follow-up after ATT was 34 months (range 2-60). Complete control of inflammation was observed in 14/17 patients (82.3%) during the treatment period, and only 4/17 patients (23.5%) had a uveitis relapse over the entire follow-up period after ATT. All patients who had uveitis relapses (4/4), but none from the remaining group (0/13), required immunosuppressive therapy of some kind after ATT. The response to ATT was able to confirm diagnosis of PTU in 14/17 (82.3%) included patients. CONCLUSION: When a clinical suspicion of PTU affecting the posterior segment exists, ATT may be highly effective for both confirming the diagnosis and resolving the inflammatory process. Thus, ATT may offer additional advantages, such as preventing latent-tuberculosis reactivations due to immunosuppressive therapy, and decreasing the number and/or severity of uveitis relapses in some patients. Prospective, randomized studies including a larger number of patients are required to support these and other potential advantages of ATT in such patients.


Subject(s)
Antitubercular Agents/therapeutic use , Tuberculosis, Ocular/drug therapy , Uveitis, Posterior/drug therapy , Anti-Bacterial Agents/therapeutic use , Drug Therapy, Combination , Humans , Immunocompromised Host , Immunosuppressive Agents/adverse effects , Isoniazid/therapeutic use , Panuveitis/diagnosis , Panuveitis/drug therapy , Pyrazinamide/therapeutic use , Recurrence , Remission Induction , Retrospective Studies , Rifampin/therapeutic use , Treatment Outcome , Tuberculosis, Ocular/diagnosis , Uveitis, Posterior/diagnosis
16.
Eye (Lond) ; 26(3): 468-77, 2012 Mar.
Article in English | MEDLINE | ID: mdl-22222264

ABSTRACT

AIM: To explore immunoregulatory and anti-inflammatory pathways specifically targeted by a subcutaneous anti-TNFαdrug-adalimumab-which might be relevant for controlling refractory uveitis. DESIGN: Non-randomized pilot intervention study on the effects of adalimumab on Treg populations and plasma VEGF levels in refractory uveitis patients. Inflammatory and immunological parameters were measured in 12 patients before therapy, and 1 and 6 months after therapy, and analyzed in the context of ophthalmological outcomes. The results were compared with those obtained in 10 systemic prednisone-treated uveitis patients. RESULTS: After 1 month of treatment, all patients responded, with 67% of adalimumab group and 80% of the corticosteroid group achieving inactivity (P=0.5). Unlike steroid-treated patients, a significant increase in T-regulatory CD4(+) CD25(high) Foxp3(+) CD127(-) cells was observed in adalimumab patients after 1 month of treatment, and maintained after 6 months (P=0.003). A significant adalimumab-specific drop in plasma VEGF was observed after 1 and 6 months of treatment (P=0.019). In every single patient, Tregs but not VEGF correlated with disease activity. CONCLUSIONS: In refractory uveitis patients treated with adalimumab, clinical efficacy may be mediated through upregulation of Tregs in addition to modulation of VEGF-mediated inflammatory pathways. These biological properties, which were not observed in patients treated with corticosteroids, may reflect the specificity of TNF-αtargeting.


Subject(s)
Anti-Inflammatory Agents/pharmacology , Antibodies, Monoclonal, Humanized/pharmacology , T-Lymphocytes, Regulatory/drug effects , Uveitis/drug therapy , Vascular Endothelial Growth Factor A/blood , Adalimumab , Adolescent , Adult , Female , Humans , Male , Middle Aged , Pilot Projects , T-Lymphocytes, Regulatory/immunology , T-Lymphocytes, Regulatory/metabolism , Uveitis/blood , Uveitis/immunology , Young Adult
17.
Eye (Lond) ; 26(2): 252-8, 2012 Feb.
Article in English | MEDLINE | ID: mdl-22094296

ABSTRACT

To assess the effectiveness of ketorolac vs control for prevention of acute pseudophakic cystoid macular edema (CME). The following databases were searched: Medline (1950-June 11, 2011), The Cochrane Library (Issue 2, 2011), and the TRIP Database (up to 11 June 2011), using no language or other limits. Randomized controlled clinical trials (RCTs) were included that consisted of patients with acute pseudophakic cystoid macular edema, those comparing ketorolac with control, and those having at least a minimum follow-up of 28 days. In the four RCTs evaluating ketorolac vs control, treatment with ketorolac significantly reduced the risk of CME development at the end of treatment (≈ 4 weeks) compared to control (P=0.008; 95% confidence interval (0.03-0.58)). When analyzed individually, each individual study was statistically nonsignificant in its findings with the exception of one study. When the pooled relative risk was calculated, the large sample size of this systematic review led to overall statistical significance, which is attributable to the review's large sample size and not to the individual studies themselves. In this systematic review of four RCTs, two of which compared ketorolac with no treatment and two of which evaluated ketorolac vs placebo drops, treatment with ketorolac significantly reduced the risk of developing CME at the end of ≈ 4 weeks of treatment compared with controls. These results, however, should be interpreted with caution considering the paucity of large randomized clinical trials in the literature.


Subject(s)
Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Ketorolac/therapeutic use , Macular Edema/drug therapy , Pseudophakia/complications , Acute Disease , Anti-Inflammatory Agents, Non-Steroidal/administration & dosage , Cataract Extraction/adverse effects , Humans , Ketorolac/administration & dosage , Macular Edema/prevention & control , Postoperative Complications/prevention & control , Randomized Controlled Trials as Topic , Visual Acuity
18.
Arch Soc Esp Oftalmol ; 85(10): 341-4, 2010 Oct.
Article in Spanish | MEDLINE | ID: mdl-21168060

ABSTRACT

CLINICAL CASE: We report the case of a 67 year old female complaining of decreased vision and diagnosed with the Heidenhain variant of sporadic Creutzfeldt-Jakob disease. Her past medical history was unremarkable. She died less than three months after the onset. DISCUSSION: The Heidenhain variant of sporadic Creutfeld-Jakob disease should be suspected in patients suffering from early visual disturbances, unremarkable ophthalmic examination, and subsequent rapid decline of their cognitive function. A complete neurological exam including electroencephalogram recordings and magnetic resonance is mandatory. These patients share a common genotype (PRNP codon 129 MM) associated with a clinically typical disease course.


Subject(s)
Creutzfeldt-Jakob Syndrome/diagnosis , Vision Disorders/etiology , Aged , Akinetic Mutism/etiology , Akinetic Mutism/pathology , Basal Ganglia/diagnostic imaging , Basal Ganglia/pathology , Cerebral Cortex/chemistry , Cerebral Cortex/pathology , Creutzfeldt-Jakob Syndrome/classification , Creutzfeldt-Jakob Syndrome/complications , Creutzfeldt-Jakob Syndrome/diagnostic imaging , Disease Progression , Electroencephalography , Fatal Outcome , Female , Hallucinations/etiology , Humans , Magnetic Resonance Imaging , Neurologic Examination , Prions/analysis , Tomography, Emission-Computed, Single-Photon , Visual Acuity , Visual Fields
19.
Arch. Soc. Esp. Oftalmol ; 85(12): 410-413, dic. 2010. ilus, tab
Article in Spanish | IBECS | ID: ibc-88241

ABSTRACT

Caso clínicoSe presentan cuatro casos de pacientes con deterioro de agudeza visual y lesiones retinocoroideas compatibles con toxoplasmosis ocular en los que el diagnóstico de retinocoroiditis toxoplásmica activa o membrana neovascular coroidea se basó en un cribaje diagnóstico específicamente diseñado para ello.DiscusiónEn el contexto de un cuadro clínico compatible, con cicatrices coriorretinianas sugestivas e inflamación escasa o ausente, las membranas coroideas neovasculares pueden simular cuadros de retinocoroiditis toxoplásmica activa y viceversa. Un exhaustivo estudio oftalmológico, serológico e inmunológico (del humor acuoso) puede facilitar el diagnóstico, permitiendo una adecuada toma de decisión terapéutica(AU)


Clinical caseWe report four patients with both decreased visual acuity and retinochoroidal lesions compatible with ocular toxoplasmosis in which a diagnosis of active toxoplasmic retinochoroiditis or choroidal neovascular membrane was made based on a specifically designed diagnostic screening.DiscussionIn the context of a compatible clinical picture, with retinochoroidal scars and low grade or absence of inflammation, choroidal neovascular membranes may mimic active toxoplasmic retinochoroiditis and vice-versa. A thorough ophthalmic, serological, and immunological examination (in ocular fluids) may help in the differential diagnosis allowing for proper therapeutic decision-making(AU)


Subject(s)
Humans , Female , Adult , Choroiditis/pathology , Choroidal Neovascularization/etiology , Toxoplasmosis, Ocular/complications , Uveitis/etiology , Antibodies, Monoclonal/therapeutic use
20.
Arch. Soc. Esp. Oftalmol ; 85(10): 341-344, oct. 2010. ilus
Article in Spanish | IBECS | ID: ibc-89422

ABSTRACT

Caso clínicoPresentamos el caso de una mujer de 67 años con disminución de agudeza visual bilateral que fue diagnosticada de enfermedad de Creutzfeldt-Jakob esporádico en su variante Heidenhain. No presentaba antecedentes de interés. La paciente falleció tres meses después del inicio del cuadro.DiscusiónLa variante Heidenhain de la enfermedad de Creutzfeldt-Jakob esporádico debe sospecharse en todo paciente aquejado de alteraciones visuales y examen oftalmológico inespecífíco, que experimente deterioro cognitivo posterior. Es necesario un examen neurológico completo que incluya electroencefalograma y resonancia magnética. Estos pacientes comparten un mismo genotipo (codón 129 MM en gen PRNP) asociado a un curso clínico característico(AU)


Clinical caseWe report the case of a 67 year old female complaining of decreased vision and diagnosed with the Heidenhain variant of sporadic Creutzfeldt-Jakob disease. Her past medical history was unremarkable. She died less than three months after the onset.DiscussionThe Heidenhain variant of sporadic Creutfeld-Jakob disease should be suspected in patients suffering from early visual disturbances, unremarkable ophthalmic examination, and subsequent rapid decline of their cognitive function. A complete neurological exam including electroencephalogram recordings and magnetic resonance is mandatory. These patients share a common genotype (PRNP codon 129 MM) associated with a clinically typical disease course(AU)


Subject(s)
Humans , Female , Aged , Creutzfeldt-Jakob Syndrome/classification , Creutzfeldt-Jakob Syndrome/complications , Creutzfeldt-Jakob Syndrome/diagnosis , Creutzfeldt-Jakob Syndrome/epidemiology , Creutzfeldt-Jakob Syndrome/etiology , Creutzfeldt-Jakob Syndrome/pathology , Visual Field Tests/adverse effects , Visual Acuity , Magnetic Resonance Spectroscopy , Electroencephalography , Vision Disorders/complications , Vision Disorders/diagnosis , Creutzfeldt-Jakob Syndrome/cerebrospinal fluid
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