Delayed-onset bleb-related endophthalmitis caused by Moraxella nonliquefaciens. / Endoftalmitis de inicio tardío asociada a ampolla de filtración por Moraxella nonliquefaciens.

Bleb-related endophthalmitis is rare and appears months or years after surgery. The causative agents are usually streptococci or gram-negative bacteria. There are few cases in the literature of endophthalmitis caused by Moraxella nonliquefaciens, and most are delayed-onset associated with blebitis after glaucoma filtration surgery. The case is presented of a 90-year-old patient with endophthalmitis in the right eye due to Moraxella nonliquefaciens associated with blebitis 10 years after glaucoma surgery. After treatment, disappearance of blebitis is observed 2weeks later and resolution of vitritis 29 days later, with recovery of vision to previous values (20/200). Endophthalmitis due to Moraxella nonliquefaciens is rare, and is associated with late onset blebitis after glaucoma filtration surgery. Despite the virulence of the clinical symptoms, the visual prognosis is usually favourable.

Bacterial keratitis due to Moraxella nonliquefaciens. / Queratitis bacteriana por Moraxella nonliquefaciens.

Moraxella keratitis can lead to important complications. Moraxella nonliquefaciens(M. nonliquefaciens) has the worst prognosis. Only three cases of corneal infections due to M. nonliquefaciens have been published. The case is presented of a 79-year-old man with bullous keratopathy, recently affected with severe infectious keratitis. Dense, deep, and central stromal infiltrates and hyphaema were detected. After the identification of M. nonliquefaciens in the culture, and given the progression of the condition, the initial empirical treatment was modified to topical ciprofloxacin and ceftazidime in accordance with the antibiogram, combining oral ciprofloxacin and amoxicillin-clavulanate. After 27 days, there was total resolution of the lesion, with central residual leucoma. Keratitis caused by M. nonliquefaciens is rare and must be suspected in elderly patients with local predisposing factors, such as corneal damage or previous eye surgery. Early antibiogram-guided treatment and close monitoring are important to avoid complications and poor compliance.

Hypertensive acute granulomatous anterior uveitis as a side effect of topical brimonidine. / Uveítis anterior aguda hipertensiva granulomatosa bilateral como efecto adverso a brimonidina tópica.

CLINICAL CASE: The case concerns an 81-year-old woman on treatment with a topical fixed combination of timolol and brimonidine who was diagnosed in the Emergency Department with acute anterior granulomatous hypertensive uveitis. The patient responded favourably to the withdrawal of the eye drops without showing any subsequent relapse. DISCUSSION: Uveitis due to brimonidine is a rare adverse effect, but it must be known. Once the diagnosis is suspected, the effective treatment is the withdrawal of brimonidine, with or without the addition of topical corticosteroids to control inflammation depending on the severity of the condition. It is a process with an excellent prognosis.

Analysis and follow-up of type 1 choroidal neovascularisation with optical coherence tomography-angiography after antiangiogenic treatment. / Análisis y seguimiento con angiografía por tomografía de coherencia óptica de neovascularización coroidea tipo 1 en degeneración macular tras tratamiento antiangiogénico.

AIM: To describe the characteristics of type 1 choroidal neovascularisation (CNV) in age-related macular degeneration (ARMD) using two different optical coherence tomography angiography (OCT-A) devices sequentially during a standard protocol of three intravitreal injections of an anti-vascular endothelial growth factor (anti-VEGF). METHODS: The study included 6 eyes with naïve neovascular ARMD. Macular OCT-A images were acquired using AngioPlex Cirrus HD-OCT 5000 (Carl Zeiss Meditec, Inc., Dublin, USA) and DRI OCT Triton SS-OCT Angio (Topcon, Medical Systems, Inc. Oakland, NJ, USA). The macular OCT-A scan covered an area of 3×3mm. Distinct morphological patterns and quantifiable features of the neovascular membranes were studied on en face projection images, which were taken at different stages of the follow-up. RESULTS: Treatment response could be estimated using the OCT-A criteria of CNV activity. Higher activity scores before treatment resulted in a greater decrease in the membrane area. The estimated net decline in area ranged from 83.5% to 1.4%. The OCT-A performed one-week after treatment revealed the greatest area reductions. CONCLUSIONS: OCT-A provides new possibilities for the non-invasive assessment of features of neovascular networks and CNV structural morphology. Newly described activity criteria can also guide therapeutic decisions, and help in evaluating responses. Quantitative and qualitative information can be provided with this technique. However, further software development and future investigation are essential to define the role of this tool on a daily basis.

Papillophlebitis versus paediatric venous thrombosis. A case with 46C/T polymorphism in the F12 coagulation gene. / Papiloflebitis versus trombosis venosa pediátrica. Un caso con polimorfismo C46T del gen F12 de la coagulación.

CLINICAL CASE: An 8 year-old boy with no known diseases, with sudden loss of visual acuity (VA) in the left eye (LE). EXAMINATION: VA 1 in right eye, and 0.1 in LE, discrete left relative afferent pupil defect (RAPD). Normal biomicroscopy. Funduscopy: congestive papilla, venous tortuosity, peripapillary haemorrhages with macular oedema in LE. The systemic study only revealed A C46Tpolymorphism in the F12 coagulation gene. He had a VA of 1 and normal funduscopy 8 months later. DISCUSSION: Papillophlebitis is an inflammatory and non-ischaemic central retinal vein occlusion, ophthalmoscopically similar to central retinal vein thrombosis. The systemic study is essential to rule out underlying diseases.