Primary Cancer Sites and Clinical Features of Choroidal Metastasis in Mexican Patients.

PURPOSE: To describe the primary cancer sites and clinical features of choroidal metastasis in Mexican patients. METHODS: This was a retrospective, observational, and multi-center study. Data were recollected from 6 ophthalmological hospitals in Mexico from patients with choroidal metastasis diagnosed from 2000 to 2018. RESULTS: Seventy-eight patients were studied: 43 were female and 35 were male. Mean age at presentation was 57.6 years. Overall, primary cancer sites were: 1) breast: 27 cases (34.6%); 2) lung: 19 cases (24.3%); 3) unknown: 8 cases (10.2%); 4) gastrointestinal: 7 cases (8.9%); 5) renal: 5 cases (6.4%); 6) testicular: 3 cases (3.8%); 7) ovary: 3 Cases (3.8%); 8) prostate: 2 cases (2.5%); 9) thyroid: 2 cases (2.5%); 10) carcinoid: 1 case (1.2%); and 11) multiple myeloma: 1 case (1.2%). Divided by gender, for women, the main three sites were: breast, unknown, and ovary. For men, the main three sites were: lung, gastrointestinal, and testicular. Oldest cases were breast cancer (87 and 85 years); youngest cases were testicular (23 and 25 years). Solitary lesions were observed in 56 cases (71.7%); multiple lesions were observed in 22 cases (28.2%). Forty-two cases had a white or yellowish color, while 6 cases presented an orange color. CONCLUSION: Primary cancer sites and clinical features of choroidal metastasis in Mexican patients show important differences from other populations previously studied, mainly the presence of a higher proportion of gastrointestinal and renal cancer, as well as higher incidence of ovarian and testicular cancer. These types of cancer, although not as common as breast or lung, need to be taken into account when studying Mexican patients living abroad.

Retinopatía del prematuro: controversias en el uso de antiangiogénicos intraoculares / Retinopathy of prematurity: controversies in the usage of intraocular antiangiogenics

El aumento en la sobrevida de los recién nacidos prematuros, las características del cuidado neonatal y la escasez de programas para la prevención, detección y tratamiento de la retinopatía del prematuro provocan que esta enfermedad sea la principal causa de ceguera infantil prevenible en México. El advenimiento de agentes antiangiogénicos de uso oncológico, y su uso -no autorizado, aunque con buenos resultados- en el tratamiento de enfermedades vaso proliferativas en la retina del paciente adulto, así como la presencia de reportes anecdóticos en la literatura y series de casos con serias fallas metodológicas han sugerido su utilización en el tratamiento de la retinopatía del prematuro. Desafortunadamente, estos agentes, utilizados indiscriminadamente, presentan absorción sistémica y causan efectos secundarios en el organismo del paciente prematuro. Además, no existen estudios de seguimiento a largo plazo que garanticen la seguridad de su uso en esta población. El presente artículo describe la situación en nuestro país y advierte sobre los riesgos de estos medicamentos en la población de pacientes prematuros.

The increase in survival rates among preterm infants, characteristics of neonatal care for such infants and a lack of suitable programs for preventing, detecting and treating retinopathy of prematurity (ROP) are factors that have made this disease the main cause of preventable blindness among children in Mexico. The advent of antiangiogenic agents in cancer treatment and their off-label use with favorable results in the treatment of proliferative vessel disease of the retina among adult patients, as well as anecdotal reports in the literature and a series of cases showing serious methodological flaws, have prompted their use in the treatment of retinopathy of prematurity. Unfortunately, these agents used indiscriminately in our country have a systemic absorption and secondary effects on the preterm patient's body. There are no long-term monitoring studies that guarantee their safe use in this segment of the population. This article describes the situation in our country and warns of the risks posed by the use of this type of drug on the preterm infant population.

Laser-ranibizumab treatment for retinopathy of prematurity in umbral-preumbral disease. Three years of experience.

BACKGROUND: The "Early Treatment for Retinopathy of Prematurity Cooperative" reported a failure rate of 55.2% using laser in zone 1 for treatment of retinopathy of prematurity (ROP). We need to offer better alternatives for those patients. We undertook this study to evaluate the efficacy of combined laser-ranibizumab therapy for ROP with threshold-prethreshold and "plus disease" and to study development of the newborn. METHODS: This is a prospective, experimental, longitudinal and open study including newborns of either <32 weeks of gestation or with a birth weight <1500 g, with threshold-prethreshold retinopathy or "plus disease." The effect of treatment was analyzed and development of the newborn was determined. RESULTS: We studied 34 eyes of 17 patients. Age at birth was 29.9 ± 2.6 weeks. Birth weight was 1,120 ± 253 g. The statistics demonstrated an important relationship between severity of retinopathy and early birth age, along with a high probability of threshold-prethreshold disease at 29.4 weeks of age or 1204 g birth weight. The Bayley scale reported normal development in 23.5% of cases, global retardation in 23.5%, psychomotor retardation but normal mental behavior in 29.4%, and mental retardation but normal psychomotor development in 23.5%. We demonstrated regression of retinopathy in all cases. Persistence of vascular tortuosity was present in 17.6% of cases without vascular dilatation, and vitreous membrane development was demonstrated in 11.7% of patients. CONCLUSIONS: Laser-ranibizumab treatment has allowed a better control of retinopathy for threshold-prethreshold and "plus disease" in this group of patients.

Visuomotor functions and intelligence subsequent to strabismus treatment. Second phase.

BACKGROUND: Strabismus has been related to different alterations of brain functions and learning in children. Early treatment for visuomotor functions may improve the executive areas of intelligence. We undertook this study to demonstrate changes of visuomotor function and intelligence in children after strabismus treatment. METHODS: This is a prospective study of patients with strabismus, before and after treatment. We applied the Human Figure Test, Visuomotor Bender Test, and Intelligence Test. RESULTS: We included nine children with an average age of 8.7 years (± 2.4 years). Stereopsis result was 724 arc sec. Visual acuity was 0.16 logMAR ± 0.15. Verbal intelligence was 91.1 ± 11, executive intelligence (EI) was 86.7 ± 8, and global intelligence (GI) was 91 ± 10. Correlation coefficient of EI was significantly related to stereopsis (-0.2), visual acuity (-0.1) and Bender (-0.1). GI results were higher than statistical prognosis (88.16 for x = 90). CONCLUSIONS: We demonstrated improvement in binocularity and psychoadaptive areas related to EI after strabismus and amblyopia treatment.

[Skew deviation. Strabismological diagnosis and treatment alternatives].

BACKGROUND: We undertook this study to analyze diagnostic and treatment alternatives in patients with skew deviation (SD). METHODS: This is a prospective, observational and longitudinal study of patients with SD. The study took place in a third-level medical center during the period from September 2007 to May 2008. Strabismological exploration, multidisciplinary diagnosis and treatment alternatives were analyzed. RESULTS: Ten patients presenting SD were studied. Diagnoses were multiple sclerosis, arteriovenous malformation, epilepsy, hydrocephalus, ischemic encephalopathy, cortical atrophy, hypoplasia of corpus callosum and thalamic hemorrhage. Psychomotor retardation was present in 80%. Other diagnoses were Cogan apraxia, Parinaud syndrome, see-saw nystagmus, Foville syndrome, and hemiplegic alterations. Related strabismuses were exotropia (5), esotropia (3), hypertropia (2), and dissociated vertical deviation (1). Lesions of II, III and VII cranial nerves were found. CONCLUSIONS: Complete strabological study allows a better diagnosis of the lesion and consequently relapsing disease in order to achieve a better treatment according to each patient. Optical rehabilitation and botulinum applications are especially indicated.

Desviación oblicua: diagnóstico estrabológico y alternativas de tratamiento / Skew deviation: strabismological diagnosis and treatment alternatives

Objetivo: Analizar las posibilidades de diagnóstico y tratamiento en pacientes con skew deviation (SD) o estrabismo con desviación oblicua. Material y métodos: Estudio prospectivo, observacional y longitudinal de pacientes con SD, de septiembre de 2007 a mayo de 2008. Se realizó exploración estrabológica, estudio multidisciplinario y se evaluaron alternativas terapéuticas. Resultados: Se estudiaron 10 pacientes con SD. Edad 11.5 + 13.6 años. Los diagnósticos neurológicos fueron esclerosis múltiple, malformación arteriovenosa, epilepsia, hidrocefalia, encefalopatía isquémica, atrofia cortical, hipoplasia de cuerpo calloso y hemorragia talámica. Se encontró retraso psicomotor en 80 %, además se asoció a apraxia de Cogan, síndrome de Parinaud, nistagmo en see-saw, síndrome de Foville y hemiplejía. Los estrabismos relacionados fueron exotropía en cinco, endotropía en tres, hipertropía en dos, desviación vertical disociada en uno. Se encontró lesión a II, III y VII nervios craneales. Conclusiones: El estudio estrabológico adecuado permite un mejor diagnóstico de la lesión en SD y con ello vigilar la evolución neurológica del paciente. El tratamiento debe incluir la rehabilitación óptica y el manejo del estrabismo, principalmente con toxina botulínica.

BACKGROUND: We undertook this study to analyze diagnostic and treatment alternatives in patients with skew deviation (SD). METHODS: This is a prospective, observational and longitudinal study of patients with SD. The study took place in a third-level medical center during the period from September 2007 to May 2008. Strabismological exploration, multidisciplinary diagnosis and treatment alternatives were analyzed. RESULTS: Ten patients presenting SD were studied. Diagnoses were multiple sclerosis, arteriovenous malformation, epilepsy, hydrocephalus, ischemic encephalopathy, cortical atrophy, hypoplasia of corpus callosum and thalamic hemorrhage. Psychomotor retardation was present in 80%. Other diagnoses were Cogan apraxia, Parinaud syndrome, see-saw nystagmus, Foville syndrome, and hemiplegic alterations. Related strabismuses were exotropia (5), esotropia (3), hypertropia (2), and dissociated vertical deviation (1). Lesions of II, III and VII cranial nerves were found. CONCLUSIONS: Complete strabological study allows a better diagnosis of the lesion and consequently relapsing disease in order to achieve a better treatment according to each patient. Optical rehabilitation and botulinum applications are especially indicated.

[Pattern dystrophies of the retinal pigment epithelium]. / Distrofias del epitelio pigmentario de la retina en patrón.

Pattern dystrophies are defined as a group of diseases genetically determined and characterized by pigment epithelium changes that are seen on fundus examination, such as various line and dot patterns. We present a review of these pathologies including a comparative table reporting the main characteristics as well as some representative figures of each one in order to facilitate diagnosis.

Distrofias del epitelio pigmentario de la retina en patrón / Pattern dystrophies of the retinal pigment epithelium

Las distrofias en patrón son patologías de la retina genéticamente determinadas que se caracterizan por anormalidades en el epitelio pigmentario que se visualizan en el fondo de ojo conformando diversos patrones de puntos o líneas. Realizamos una revisión detallada de las diversas variedades de presentación y sus características más importantes, e incluimos una secuencia fotográfica de las más representativas.

Pattern dystrophies are defined as a group of diseases genetically determined and characterized by pigment epithelium changes that are seen on fundus examination, such as various line and dot patterns. We present a review of these pathologies including a comparative table reporting the main characteristics as well as some representative figures of each one in order to facilitate diagnosis.

[Study of vitreoretinal dystrophies in a Mexican population]. / Estudio de las distrofias vitreorretinianas en población mexicana.

BACKGROUND: We undertook this study to demonstrate the incidence of vitreoretinal dystrophies in a Mexican population. METHODS: This was a retrospective, observational, descriptive, transverse study. We analyzed the files of patients treated at the Retina Department of a medical center for state employees (ISSSTE) from January 1991 to December 2006 to obtain the incidence of vitreoretinal dystrophies. RESULTS: We studied 36,300 patient files. We found an incidence of 0.008% for familial exudative vitreoretinal dystrophy, 0.008% for X-linked juvenile retinoschisis, 0.005% for Wagner disease and 0.005% for Goldmann-Favre disease. We present here a representative case of each type of dystrophy. CONCLUSIONS: Vitreoretinal dystrophies are uncommon diseases and are difficult to diagnose. Even though their incidence is low, the poor evolution to blindness requires identification of early signs in order to offer timely and opportune treatment.

[Study of depression and sensorial functions in children with strabismus. First phase]. / Análisis de las funciones sensoriomotoras y depresión en niños con estrabismo. Primera fase.

BACKGROUND: We undertook this study to demonstrate the visuomotor alterations, intelligence level and depression changes in children with recurrent strabismus. METHODS: Children with recurrent strabismus were studied with the Human Figure Test, Lauretta Bender Visuomotor Test, Intelligence Level of Weschler, WISC-R, and WPPSI. Complete exploration of strabismus was made. RESULTS: We included nine children aged 6.8 years (SD 2). Overfunction of oblique muscles and dissociated strabismus were related to recurrence of strabismus. Stereovision was present in five cases previous to recurrence (rate: 170 sec of arc), and three lost this with recurrence of strabismus. Psychological test determined difficulties in socialization and signs of aggression, including data on depression and "dullness." Bender Test showed relevant defects in fine hand movement, level: 5.4 (SD 1.7). Santucci evaluation for Bender was 3.83 (SD 2.1). Correlation coefficient between values was significant for Santucci evaluation and stereovision (0.89). Global Intelligence Coefficient was 88.1 (SD 12), which was subnormal and poorer in executive function (84). CONCLUSIONS: We have demonstrated relevant alterations in visuomotor abilities in patients with strabismus, especially related to stereovision deficiency, effect on learning, intelligence and depression.

Análisis de las funciones sensoriomotoras y depresión en niños con estrabismo: primera fase / Study of depression and sensorial functions in children with strabismus: first phase

BACKGROUND: We undertook this study to demonstrate the visuomotor alterations, intelligence level and depression changes in children with recurrent strabismus. METHODS: Children with recurrent strabismus were studied with the Human Figure Test, Lauretta Bender Visuomotor Test, Intelligence Level of Weschler, WISC-R, and WPPSI. Complete exploration of strabismus was made. RESULTS: We included nine children aged 6.8 years (SD 2). Overfunction of oblique muscles and dissociated strabismus were related to recurrence of strabismus. Stereovision was present in five cases previous to recurrence (rate: 170 sec of arc), and three lost this with recurrence of strabismus. Psychological test determined difficulties in socialization and signs of aggression, including data on depression and "dullness." Bender Test showed relevant defects in fine hand movement, level: 5.4 (SD 1.7). Santucci evaluation for Bender was 3.83 (SD 2.1). Correlation coefficient between values was significant for Santucci evaluation and stereovision (0.89). Global Intelligence Coefficient was 88.1 (SD 12), which was subnormal and poorer in executive function (84). CONCLUSIONS: We have demonstrated relevant alterations in visuomotor abilities in patients with strabismus, especially related to stereovision deficiency, effect on learning, intelligence and depression.

Estudio de las distrofias vitreorretinianas en población mexicana / Study of vitreoretinal dystrophies in a Mexican population

BACKGROUND: We undertook this study to demonstrate the incidence of vitreoretinal dystrophies in a Mexican population. METHODS: This was a retrospective, observational, descriptive, transverse study. We analyzed the files of patients treated at the Retina Department of a medical center for state employees (ISSSTE) from January 1991 to December 2006 to obtain the incidence of vitreoretinal dystrophies. RESULTS: We studied 36,300 patient files. We found an incidence of 0.008% for familial exudative vitreoretinal dystrophy, 0.008% for X-linked juvenile retinoschisis, 0.005% for Wagner disease and 0.005% for Goldmann-Favre disease. We present here a representative case of each type of dystrophy. CONCLUSIONS: Vitreoretinal dystrophies are uncommon diseases and are difficult to diagnose. Even though their incidence is low, the poor evolution to blindness requires identification of early signs in order to offer timely and opportune treatment.

Disfuncionalidad neuronal y psicomotora como resultado del retraso del tratamiento de la ambliopía / Neuronal and psychomotor malfunction secondary to delayed amblyopia treatment

BACKGROUND: A review of neuronal and psychomotor alterations related to delay of amblyopia treatment was carried out. METHODS: We reviewed various studies to explain the anomalies of visual cortex because of the prevalence of anomalous stimulus in patients with amblyopia. RESULTS: Visual pathways are developed embryologically. The newborn has ocular dominance columns ready to be stimulated, but visual alterations present at this time will generate neuronal changes in visual cortex. CONCLUSIONS: Delay of amblyopia treatment with anomalous visual stimulus will provoke organic changes in visual cortex, inducing alterations of brain functions depending on binocularity. Memory and learning have also been related to this condition.

[Neuronal and psychomotor malfunction secondary to delayed amblyopia treatment]. / Disfuncionalidad neuronal y psicomotora como resultado del retraso del tratamiento de la ambliopía.

BACKGROUND: A review of neuronal and psychomotor alterations related to delay of amblyopia treatment was carried out. METHODS: We reviewed various studies to explain the anomalies of visual cortex because of the prevalence of anomalous stimulus in patients with amblyopia. RESULTS: Visual pathways are developed embryologically. The newborn has ocular dominance columns ready to be stimulated, but visual alterations present at this time will generate neuronal changes in visual cortex. CONCLUSIONS: Delay of amblyopia treatment with anomalous visual stimulus will provoke organic changes in visual cortex, inducing alterations of brain functions depending on binocularity. Memory and learning have also been related to this condition.

[Evolution of threshold retinopathy of prematurity after argon laser treatment under indirect ophthalmoscopy]. / Evolución de los pacientes con retinopatía de prematuro en estadio umbral tratados con láser de argón mediante oftalmoscopia indirecta.

BACKGROUND: We undertook this study to evaluate the long-term effects of threshold retinopathy of prematurity (ROP) treatment using Argon laser under indirect ophthalmoscopy, as well as to analyze ocular diseases in those patients. METHODS: This is a descriptive, observational, longitudinal and prospective study carried out from March 1991 to February 2005, including patients with threshold retinopathy of prematurity for treatment using Argon laser under indirect ophthalmoscopy. Related ocular diseases were also reported. Descriptive statistics were applied. RESULTS: Follow-up was maintained for 14 years, 6.50 +/- 1.39 (CI 95%, p < 0.05), and 170 patients were studied. Weight was 1216.50 +/- 152.03 g (CI 95%, p < 0.05). Retinopathy was not present in 42% (72), in stage I-III, 46% (78), and threshold stage, 12% (20). Forty eyes were treated with Argon laser. After treatment, no progressive disease was found in 92.75%. We found high myopia in 20%, macular displacement 7.5%, strabismus 35%, retinal detachment (5%), optical nerve atrophy 5%, and ocular atrophy 5%. CONCLUSIONS: We were able to demonstrate that Argon laser treatment under indirect ophthalmoscopy has been effective in the control of threshold disease. The most important related ocular diseases were strabismus and myopia. Long-term monitoring has permitted us to initiate timely treatment for ocular diseases related to prematurity.

[Prevalence of premature retinopathy. 12-year detection in hospital "20 de Noviembre"]. / Prevalencia de retinopatía del prematuro. 12 años de detección en el Centro Médico 20 de Noviembre.

BACKGROUND: We undertook this study to determine the prevalence of premature retinopathy in a third level care hospital. METHODS: We carried out a descriptive, observational, longitudinal and prospective study from March 1991 to February 2004, including newborns with low birthweight of <1500 g and <35 weeks of gestation, evaluating the peripheral retina under pharmacological midryasis weekly during 4 weeks starting the 4th week of extrauterine life. The ROP international classification was used. RESULTS: Within our 12-year study, 2558 children were born, 62% were full term and 38% were premature. From 735 live premature births, 170 fulfilled inclusion criteria: 42% (72) did not present changes regarding retinopathy with a prevalence of 9.79, 46% (78) were in stages I-III with a prevalence of 10.61, and 12% (20) were in umbral stage with a prevalence of 2.72%. CONCLUSIONS: The prevalence of premature retinopathy in a third level hospital was 10.61% in stages I-III and 2.72% in umbral stage. This has allowed the evaluation of the peripheral retinal and the ability to plan treatment in the umbral stage to prevent future complications of blindness from disease progression in these cases.

[Metabolic changes in brain cortex related with the strabismus treatment. Preliminary results with SPECT]. / Cambios metabólicos en la corteza cerebral relacionados con el tratamiento de estrabismo. Resultados preliminares con SPECT.

OBJECTIVE: Our aim was to demonstrate metabolic changes occurring in brain cortex during strabismus treatment. MATERIAL AND METHODS: Single photon emission computed tomography (SPECT) of brain was made in patient with strabismus. The study only included congenital esotropia and excluded patients with other anomalies. Strabismus treatment was carried out with botulinum toxin or surgery. Brain SPECT was done prior to and after treatment. Changes were analyzed and related with strabismus response. RESULTS: We studied three children with congenital and variable esotropia for a total of three cases. In Case 1, basal SPECT showed hypoperfusion in left frontal lobe (7.38). Response to botulinum toxin was good for correcting strabismus and obtaining binocularity from third month. Control SPECT showed correction of perfusion of frontal lobe (-1.19). With Case 2, we observed hypoactivity in left parietal area (8.59); after botulinum treatment, strabismus was corrected and binocularity was demonstrated, while control SPECT showed increase of hypoactivity levels (5.95). Finally, in Case 3, strabismus was corrected at surgery with binocularity. Basal SPECT demonstrated very important hypoactivity in right hemisphere, especially in areas 3, 4, and 5 areas (-0.7, -3.71, and -11.09, respectively); in addition, positive changes after treatment were demonstrated (9.78, 6.44, and 3.22, respectively). CONCLUSIONS: Metabolic changes in brain cortex took place in congenital esotropia with SPECT. In all cases, brain SPECT could demonstrate changes after treatment with improvement of different areas, and good response of motor and sensorial state. This apparently is the first report concerning metabolic changes of brain cortex related with strabismus under treatment, and demonstrates the importance of brain cortex in genesis, evolution, and stability of visual functions and with regard to the failure of these in patients with strabismus.

Epiteliopatía retiniana pigmentaria difusa (Epiteliopatía en reguero) / Difuse retinal pigment epitheliopathy

Objetivo: Presentar la secuencia angiofluoresceinográfica retinal de pacientes con epiteliopatía pigmentaria retiniana difusa (EPRD). Material y métodos: Se analizaron cinco pacientes en quienes su estudio angio-fluoresceinográfic retinal mostraron las características propias de esa entidad. Resultados: Los casos que se presentan coinciden con las características clínicas y fluorangiográficas de la EPRD que surge como consecuencia de un desprendimiento seroso de la retina neurosensorial condicionando cambios en el epitelio pigmentado de la retina, dando la imagen de "escurrimiento" o "reguero" del material de contraste durante el estudio. Conclusiones: El diagnóstico de esta entidad se realiza con estudio angio-fluoresceinográfico retinal en el que la toma de imágenes de la periferia de la retina son importantes para delimitar el escurrimiento.

Utilidad del tratamiento con radioterapia externa en pacientes con degeneración macular relacionada con la edad / Utility of external radiotherapy treatment in patients with agerelated macular degeneration

Objetivos: Determinar si dosis bajas de radiación alteran el curso natural de la neovascularización subfoveal en pacientes con degeneración macular relacionada con la edad (DMRE). Material y métodos: Se estudiaron pacientes con DMRE tipo húmeda determinándose edad, sexo, agudeza visual, transparencia del cristalino, campimetría computadorizada, extensión de la membrana por angiofloresceinografía y ultrasonido modo A y B. Se trataron con acelerador lineal de rayos X con dosis total de 1,500 cGy, fraccionada en 10 sesiones de 150 cGy, con haz de fotones de alta energía de 10 megaelectrón-volts. Seguimiento 18 meses. Resultados: Se trataron 34 pacientes con DMRE. La capacidad visual se mantuvo estable en 80 por ciento de los casos y 7 pacientes (20 por ciento) presentaron mejoría de una línea de visión, el campo visual se mantuvo estable en 82 por ciento, y el 18 por ciento mejoró; 6 pacientes mostraron un aumento en la opacidad del cristalino. El ultrasonido modo AB demostró reducción del grosor de la membrana neovascular subfoveal en un 34 por ciento (p<0,01). El área de extensión de la membrana también se redujo en 37.23 por ciento (p<0,05). Finalmente la respuesta global al tratamiento fue calificada como buena en el 55.8 por ciento y moderada para el 44.11 por ciento de los casos. Conclusión: Demostramos la utilidad de la radioterapia externa como un tratamiento alternativo para detener el crecimiento de la membrana neovascular subretiniana, manteniendo campo periférico, en pacientes con DMRE de tipo húmedo, cambiando la evolución natural de la enfermedad.