SWEPT SOURCE OPTICAL COHERENCE TOMOGRAPHY EVALUATION OF CHORIORETINAL CHANGES IN HYPERTENSIVE CHOROIDOPATHY RELATED TO HELLP SYNDROME.

PURPOSE: To report a case of hypertensive choroidopathy with detailed chorioretinal images obtained using swept source optical coherence tomography. METHODS: We report the case of a 36-year-old pregnant woman who presented with extensive bilateral exudative retinal detachments (visual acuity of hands movement bilaterally), high blood pressure, and severe alteration of the laboratory test results resulting in the diagnosis of HELLP syndrome. The baby was delivered by emergency cesarean section and the patient was hospitalized in the intensive care unit. RESULTS: Two weeks later, exudative retinal detachments improved substantially and bilateral Elschnig spots were present in the posterior fundus. Swept source optical coherence tomography revealed serous retinal detachment, multiple pigmentary epithelial detachments (PEDs), a thickened subfoveal choroid (437 and 466 µm), and fibrinous material between the neurosensory retina and retinal pigment epithelium in the B-scans of both eyes. En face swept source optical coherence tomography allowed a more precise evaluation of the multiple and confluent PEDs. Six weeks later, despite some focal areas of thickened retinal pigment epithelium, the serous retinal detachment, PEDs, and fibrinous material resolved bilaterally and visual acuity and choroidal thickness returned to normal range (361 and 366 µm). En face swept source optical coherence tomography revealed a dramatic improvement of PEDs in terms of extension and distribution. CONCLUSION: Swept source optical coherence tomography detected serous retinal detachment, PEDs, increased subfoveal choroidal thickness, and fibrinous material under the neurosensory retina in the acute phase of hypertensive choroidopathy. En face OCT is useful for monitoring the evolution of confluent PEDs in hypertensive choroidopathy.

Tumor fibroso solitario intrapulmonar / Intrapulmonary solitary fibrous tumor

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Sympathetic ophthalmia after surgical resection of iridociliary melanoma. A case report.

BACKGROUND: We report a case of sympathetic ophthalmia with systemic findings following resection of a malignant melanoma of the iris and ciliary body, and describe the treatment and clinical outcome. METHODS: A 49-year-old man underwent sector iridocyclectomy of a malignant iridociliary melanoma of the right eye. Five weeks later, he was diagnosed with sympathetic ophthalmia. Snellen's best-corrected visual acuity, fluorescein angiography, electroretinography, cerebrospinal fluid analysis and audiometry were performed. High-dose systemic steroid and immunosuppressive (cyclosporine and azathioprine) therapy was prescribed. Two months later chorioretinitis and macular edema persisted, and intravitreous triamcinolone was injected into the right eye. RESULTS: Five weeks after resection of an iridociliary melanoma, our patient had reported acute bilateral vision loss. Visual acuity was hand motion in both eyes. Examination showed bilateral granulomatous uveitis, diffuse choroiditis with Dalen-Fuchs nodules, papillitis and vitritis. On fluorescein angiography multiple hyperfluorescent dots, which coalesced in areas of exudative retinal detachment, were evident. The patient presented meningismus with pleocytosis on cerebrospinal fluid analysis, and sensorineural deafness. Sympathetic ophthalmia was diagnosed. High-dose intravenous steroids followed by oral prednisone at a tapering dose and immunosuppressive agents (cyclosporine and azathioprine), topical steroids in both eyes and intravitreal steroids in the right eye were administered. Phacoemulsification and intraocular lens implantation were performed to treat a dense cataract of the right eye. After 24 months of follow-up, best-corrected visual acuity was 20/200 in the right eye and 20/25 in the left; no signs of intraocular inflammation were observed and neurological signs had resolved. Low maintenance doses of systemic steroids and immunosuppressive agents were administered up to month 18 of follow-up to avoid recurrence. CONCLUSIONS: Sympathetic ophthalmia is a rare, but severe disease that can occur after resection of iridociliary melanoma. High-dose steroid therapy and supplementation with immunosuppressive agents early in the course of the disease was effective in resolving the condition.

Síndrome de Sjögren primario: características clínicas e inmunológicas de 114 pacientes / Primary Sjögren's syndrome: clinical and immunological characteristics of 114 patients

FUNDAMENTO: Analizar las características clínicas, evolutivas e inmunológicas de una serie de 114 pacientes diagnosticados de síndrome de Sjögren primario. Evaluar las diferencias clínicas en función de los criterios diagnósticos utilizados y la asociación del síndrome de Sjögren primario con procesos linfoproliferativos. PACIENTES Y MÉTODO: Se incluyeron 114 pacientes (108 mujeres y 6 varones) diagnosticados de síndrome de Sjögren primario. Todos cumplían los criterios diagnósticos propuestos por el Grupo de Estudio de la Comunidad Europea, y 76 cumplían los criterios de San Diego. RESULTADOS: La edad media de los pacientes fue de 51 años, con un tiempo medio de seguimiento clínico de 7,3 años. El síntoma más frecuente de inicio de la enfermedad (70 por ciento) fue la xerostomía/xeroftalmía (síndrome seco). Entre las manifestaciones extraglandulares, se observó afección articular en un 42 por ciento de los pacientes, neurológica en un 35 por ciento, pulmonar en el 21 por ciento y hepática en el 13 por ciento. Once pacientes (9 por ciento) presentaron fenómenos vasculíticos y 3 (2 por ciento), un proceso linfoproliferativo. No se apreciaron diferencias estadísticamente significativas en los síntomas de inicio de la enfermedad, en la frecuencia de afección glandular y extraglandular, ni en la gravedad de la enfermedad entre los pacientes diagnosticados según los criterios europeos frente a los de San Diego. La presencia del virus de la hepatitis C (VHC) se asoció de forma significativa con la vasculitis (p < 0,001; odds ratio [OR]: 20,6; intervalo de confianza [IC] del 95 por ciento, 3,2-129) y con procesos linfoproliferativos (p < 0,001). CONCLUSIONES: El curso clínico del síndrome de Sjögren no varía en función de los criterios diagnósticos. Existe asociación entre la vasculitis y los procesos linfoproliferativos con el VHC, lo que confiere unas características diferenciales a este subgrupo de pacientes (AU)