ABSTRACT
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Subject(s)
Humans , Child , Brain Diseases/complications , Vision Disorders/etiology , Vision Disorders/diagnosis , Vision Disorders/therapyABSTRACT
CASE REPORT: An 11 year-old girl with progressive muscle weakness due to dermatomyositis and hemophagocytic lymphohistiocytosis in which multiple cotton exudates, venous tortuosity and flame haemorrhages are detected in the funduscopic examination, leading to the diagnosis of Purtscher-like retinopathy. DISCUSSION: Purstcher's retinopathy is a microvascular disorder with clinical signs of probable thrombotic origin. Its treatment is controversial, with systemic corticosteroids being the most widespread choice.
Subject(s)
Blindness/complications , Dermatomyositis/complications , Lymphohistiocytosis, Hemophagocytic/complications , Retinal Diseases/complications , Child , Female , HumansABSTRACT
CASE REPORT: A 7 year-old boy with Xeroderma Pigmentosum (XP) and who presents a recurrent conjunctival atypical fibroxanthoma after two surgeries. This is the third procedure and the patient is treated with a surgical excision of the tumour and cryotherapy at the surgical bed. Due to the risk of recurrence, topical Mitomycin C 0,02% was added at post-operative care achieving a good clinical outcome. DISCUSSION: Surgical exeresis with cryotherapy and topical Mitomycin C is an effective treatment for a case of an atypical fibroxanthoma with a high potential for recurrence and invasion. An ophthalmologic follow-up is required for these patients, as well as general paediatric care and support aids.
Subject(s)
Conjunctival Diseases/etiology , Xanthomatosis/etiology , Xeroderma Pigmentosum/complications , Child , Conjunctival Diseases/surgery , Humans , Male , Recurrence , Xanthomatosis/surgeryABSTRACT
CASO CLÍNICO: Un lactante de 10 meses fue remitido para estudio de leucocoria izquierda de un mes de evolución. En la exploración se detectó un retinoblastoma que ocupaba el área macular. Fue tratado con quimioterapia intraarterial con 6 mg de melfalán, sin requirir posteriores intervenciones para el control de la enfermedad. DISCUSIÓN: El melfalán es un agente quimioterápico muy efectivo, con uso limitado por la toxicidad sistémica que genera. La quimioterapia intraarterial permite la liberación selectiva en la arteria oftálmica, lo que limita la toxicidad sistémica. Esta combinación de eficacia, seguridad y precisión la hacen una alterativa terapéutica atractiva para el manejo del retinoblastoma
CASE REPORT: A 10-month old infant was referred for the study of a leukocoria of the left eye of one month onset. On examination, a retinoblastoma occupying the macular area was detected. Treatment with intra-arterial chemotherapy (melphalan 6 mg) was performed, with no further intervention required for disease control. DISCUSSION: Melphalan is an effective chemotherapeutic agent. However, its use is limited by the systemic toxicity that may occur. Intra-arterial chemotherapy allows the selective release of melphalan into the ophthalmic artery, thus limiting its systemic toxicity. This combination of efficiency, safety and accuracy makes it an attractive therapeutic alternative for the management of retinoblastoma
Subject(s)
Humans , Infant , Male , Retinoblastoma/complications , Retinoblastoma/diagnosis , Retinoblastoma/therapy , Melphalan/therapeutic use , Drug Therapy/trends , Drug Therapy , Retinoblastoma/drug therapy , Retinoblastoma/prevention & control , RetinoblastomaABSTRACT
CASE REPORT: A 10-month old infant was referred for the study of a leukocoria of the left eye of one month onset. On examination, a retinoblastoma occupying the macular area was detected. Treatment with intra-arterial chemotherapy (melphalan 6 mg) was performed, with no further intervention required for disease control. DISCUSSION: Melphalan is an effective chemotherapeutic agent. However, its use is limited by the systemic toxicity that may occur. Intra-arterial chemotherapy allows the selective release of melphalan into the ophthalmic artery, thus limiting its systemic toxicity. This combination of efficiency, safety and accuracy makes it an attractive therapeutic alternative for the management of retinoblastoma.
Subject(s)
Antineoplastic Agents, Alkylating/therapeutic use , Melphalan/therapeutic use , Retinal Neoplasms/drug therapy , Retinoblastoma/drug therapy , Antineoplastic Agents, Alkylating/administration & dosage , Humans , Infant , Infusions, Intra-Arterial , Male , Melphalan/administration & dosage , Ophthalmic Artery , Radiography, Interventional , Remission Induction , Retinal Neoplasms/diagnostic imaging , Retinoblastoma/diagnostic imagingABSTRACT
OBJECTIVE: The aim of this article is to study the effect of unilateral congenital cataract surgery on ocular growth and corneal flattening. METHODS: This is a cross-sectional study of 59 patients operated on due to a unilateral congenital cataract. The median age of the patients at the time of diagnosis was 17 months (interquartile range, 5-39 months). The median age at cataract the time of surgery was 28 months (interquartile range, 8-52 months), and the mean follow-up between cataract surgery and assessments was 149.7±69.9 months (range, 30-319 months). Axial length and corneal curvature were measured in both operated and non-operated eyes, comparing the results between them. RESULTS: There were no statistically significant differences for axial length growth or corneal flattening between operated and non-operated eyes: axial length (P=.327, Student t test) and corneal curvature (P=.078, Student t test). A sub-analysis was performed using the visual acuity and the age of the patient at the time of surgery. The only statistically significant data (P=.007, Student t test) was a lower axial length in operated eyes compared to non-operated eyes, in the non-deep-amblyopia group. CONCLUSIONS: No significant axial length growth modifications were observed between operated and non-operated eyes. Only the non-deep-amblyopia group presented with a lower axial length in the operated eyes compared to non-operated eyes. No significant differences in corneal flattening were found between groups after unilateral congenital cataract surgery.
Subject(s)
Cataract Extraction , Cataract/congenital , Cornea/ultrastructure , Eye/growth & development , Amblyopia/etiology , Amblyopia/pathology , Anthropometry , Aphakia, Postcataract/complications , Cataract/complications , Cataract Extraction/adverse effects , Child , Child, Preschool , Contact Lenses , Cross-Sectional Studies , Female , Follow-Up Studies , Humans , Infant , Lens Implantation, Intraocular , Male , Pseudophakia/complicationsABSTRACT
OBJECTIVE: To prepare a protocol for the treatment of retinopathy of prematurity (ROP) agreed by the majority of Spanish ophthalmologists dedicated to this topic. MATERIAL AND METHOD: A draft of the protocol was produced taking into account the experience of the participants and up to date publications. This draft was corrected by all the ophthalmologists participating in the project, and the final document was agreed by all of them. RESULTS: We present general guidelines as an aid for the treatment of ROP, including treatment criteria, treatment methods, a calendar of action, and follow-up. CONCLUSIONS: It is important to have a common working protocol for the treatment of ROP to improve care and to avoid mistakes. Although individual Hospitals may adapt the protocol to their daily activity, it is recommended that there is a minimal working protocol agreed by most of professionals dedicated to pediatric ophthalmology in Spain.
Subject(s)
Retinopathy of Prematurity/therapy , Clinical Protocols , Humans , Practice Guidelines as Topic , SpainABSTRACT
OBJECTIVE: To prepare a retinopathy of prematurity (ROP) screening program as agreed by most of Spanish ophthalmologists dedicated to this topic. MATERIALS AND METHODS: A draft of the protocol was produced taking into account the experience of the participants and current publications. This draft was corrected by all the ophthalmologists participating in the project and the final document produced was agreed by all of them. RESULTS: We present general guidelines to help in the screening of ROP, including treatment criteria, treatment methods, and a calendar of action. CONCLUSIONS: It is important to have a common working protocol in the screening of ROP to improve the action and to avoid mistakes. Although individual Hospitals may adapt the protocol to their daily activity, it is recommended that there is a minimal working protocol agreed by most of professionals dedicated to pediatric ophthalmology in Spain.
Subject(s)
Neonatal Screening/standards , Retinopathy of Prematurity/diagnosis , Clinical Protocols , Humans , Infant, Newborn , Practice Guidelines as Topic , SpainSubject(s)
Lymphangioma , Orbital Neoplasms , Child , Female , Humans , Lymphangioma/diagnosis , Orbital Neoplasms/diagnosisABSTRACT
OBJECTIVE: To evaluate the effectiveness of various surgical procedures in the management of posterior capsule and anterior vitreous on the prevention of visual axis opacification. SUBJECTS, MATERIAL AND METHODS: We retrospectively reviewed 120 eyes operated for unilateral congenital cataracts, with a median age at the time of cataract surgery of 21 months (interquartile range, 6-52 months). The eyes were divided into 3 groups: group 1 (eyes with intact posterior capsule, n=39), group 2 (eyes with posterior continuous curvilinear capsulorhexis, n=38), group 3 (eyes with posterior continuous curvilinear capsulorhexis and anterior vitrectomy, n=43). RESULTS: To determine the effect of posterior continuous curvilinear capsulorhexis on visual axis opacification we compared group 2 with group 1 (chi-square Pearson test, P=.281), therefore in this study the implementation of the posterior continuous curvilinear capsulorhexis did not show any decreases in the incidence of visual axis opacification. To study the effect of posterior continuous curvilinear capsulorhexis associated anterior vitrectomy, we compared group 3 with group 1 (chi-square Pearson test, P=.014), demonstrating that the combination of both techniques (posterior continuous curvilinear capsulorhexis and anterior vitrectomy) decreases the incidence of visual axis opacification. CONCLUSION: Posterior continuous curvilinear capsulorhexis as a single technique did not show any decrease in the incidence of visual axis opacification. Posterior continuous curvilinear capsulorhexis together with anterior vitrectomy are required to prevent visual axis opacification and to decrease reoperation rate.
Subject(s)
Capsule Opacification/prevention & control , Capsulorhexis/methods , Cataract/congenital , Postoperative Complications/prevention & control , Vitrectomy/methods , Child , Child, Preschool , Female , Humans , Infant , Male , Retrospective Studies , Treatment OutcomeABSTRACT
OBJETIVO: Analizar las secuelas psicológicas de los supervivientes a largo plazo de cáncer pediátrico. Relacionar los cambios producidos tanto en aspectos cognitivos (cociente intelectual) como emocionales (ansiedad y depresión) con las variables diagnósticas, terapéuticas y las secuelas sensoriales (visuales y auditivas). MÉTODOS: Se evaluaron un total de 138 supervivientes, 73 pacientes de leucemia aguda y 65 pacientes de tumor sólido (nefroblastoma y tumores del sistema nervioso simpático) diagnosticados antes de los 15 años, cuyo tiempo transcurrido después del diagnóstico fue al menos de 10 años y el tiempo fuera de tratamiento superior a 2 años. Los datos de filiación y sociales de los supervivientes, progenitores y hermanos, el diagnóstico, el número de recaídas y el tratamiento administrado se registraron a partir de la historia clínica y entrevista personal en el momento de la evaluación. Los aspectos cognitivos y emocionales estudiados y los instrumentos de medición utilizados fueron el cociente intelectual (escala de inteligencia de Wechsler para niños [WISC] y adultos [WAIS]), ansiedad estado-riesgo (State-Trait Anxiety Inventory para adultos [STAI] y State-TraitAnxiety Inventory for children [STAIC]) y sintomatología depresiva (subescala de depresión del Minnesota Multiphasic Personality Inventory [MMPI-D]). La evaluación oftalmológica incluyó la agudeza visual, biomicroscopia en lámpara de hendidura, medición de la presión intraocular y examen del fondo de ojo. La evaluación auditiva consistió en audiograma tonal liminal explorando las frecuencias de 125 a 8.000 Hz. RESULTADOS: Los cocientes intelectuales total, verbal y manipulativo para el total de supervivientes fueron, respectivamente, 102, 106 y 105. El 5 por ciento obtuvo una puntuación inferior a 70 (deficiente mental) y el 6,5 por ciento superior a 129 (superdo-tado). La puntuación de los supervivientes de tumor sólido fue superior a la de los supervivientes de leucemia craneoirradiados en dosis 4Gy (108 frente a 98; p 50,03) y similar a la de los supervivientes de leucemia craneoirradiados en dosis más bajas (102 casos) o no irradiados (109). El cociente intelectual se relacionó de forma positiva con la edad al diagnóstico y de manera negativa con la dosis acumulada de metotrexato intratecal y la dosis de irradiación craneal. Los supervivientes de leucemia que presentaron al menos una recaída obtuvieron un cociente intelectual 14 puntos inferior al de los supervivientes de leucemia en primera remisión completa. Las áreas cognitivas más afectadas fueron la comprensión, la aritmética, la capacidad de atención, la memoria auditiva y visual, el razonamiento causal y la coordinación visuomotora. No encontramos una relación significativa entre las secuelas visuales y auditivas y el desarrollo cognitivo, posiblemente por la escasa gravedad de las mismas. La prevalencia de depresión fue superior a la de la población general y la de ansiedad inferior. CONCLUSIÓN: El cociente intelectual (CI) se encontró dentro de los límites de normalidad, y su deterioro se relacionó con la irradiación craneal, la edad en el momento del diagnóstico y la presencia de recaídas. En el plano emocional, afrontaron el cáncer de manera adecuada, siendo la sintomatología depresiva más prevalente y prácticamente ausente la ansiedad (AU)
Subject(s)
Child , Child, Preschool , Adolescent , Male , Female , Humans , Survivors , Evaluation Study , NeoplasmsABSTRACT
Examinamos 37 pacientes diagnosticados de lepra estudiando sus alteraciones en anejos y córnea. De ellos eran formas lepromatosas, 2 borderline lepromatosas, 2 borderline tuberculoide y 2 tuberculoides. La mayor parte se encontraban entre la 6ª y 7ª década. En 6 casos no encontramos lesiones de ningún tipo. En los restantes observamos una disminución de la agudeza visual directemante relacionada con la duración de la enfermedad. el hallazgo más frecuente fue la madarosis supraciliar, seguido de la falta parcial de pestañas y madarosis. Debilidad del orbicular y/o lagoftalmos encontramos en 6 casos. La opacidades debidas a queratopatías leprosas típicas, queratopatía "en banda", por oxposición pannus y lepromas corneales, fueron los hallazgos corneales más frecuentes. La presencia de neovascularización fue detectada en 5 pacientes. Concluimos destacando la importancia del estudio de la lepra en oftalmología.
