ABSTRACT
BACKGROUND: We describe a 75-year-old woman who experienced vision loss in her left eye due to biopsy-proven giant cell arteritis (GCA). She subsequently developed pachymeningitis causing refractory headaches and bilateral optic neuropathy and maculopathy. METHODS: Case report with literature review. RESULTS: Eighteen months after the initial diagnosis of GCA, imaging studies in our patient demonstrated pachymeningeal enhancement, and meningeal biopsy confirmed lymphoplasmacytic tissue infiltrates with low frequencies of IgG4+ plasma cells. Laboratory investigation revealed the presence of 3 antiretinal antibodies and antimyeloperoxidase antibodies, consistent with autoimmune retinopathy. Treatment with B-cell-depleting anti-CD20 antibodies suppressed meningeal inflammation and prevented further vision loss. CONCLUSIONS: This case illustrates that bilateral vision loss and chronic headaches in patients with GCA may result from retina-directed autoimmunity and pachymeningitis.
Subject(s)
Blindness/etiology , Giant Cell Arteritis/etiology , Meningitis/complications , Optic Atrophy/complications , Retinal Diseases/complications , Aged , Autoantibodies/blood , Autoantigens/immunology , Blindness/diagnosis , Blindness/drug therapy , Computed Tomography Angiography , Female , Giant Cell Arteritis/diagnosis , Giant Cell Arteritis/drug therapy , Glucocorticoids/therapeutic use , Humans , Immunosuppressive Agents/therapeutic use , Meningitis/diagnosis , Meningitis/drug therapy , Methotrexate/therapeutic use , Optic Atrophy/diagnosis , Optic Atrophy/drug therapy , Prednisone/therapeutic use , Retina/immunology , Retinal Diseases/diagnosis , Retinal Diseases/drug therapyABSTRACT
PURPOSE: To determine the prevalence of refractive error (RE), the proportion of those with uncorrected RE, and factors associated with uncorrected RE in Latino adults. DESIGN: Population-based, cross-sectional study. PARTICIPANTS: A random sample of 4509 Latinos aged ≥40 years from Arizona with both ophthalmic evaluation and questionnaire. METHODS: A case of RE was defined as a subject wearing prescription glasses for distance vision whose presenting visual acuity (PVA) was ≥20/25, or a subject with PVA <20/25 in at least 1 eye who improved ≥2 lines after subjective refraction and whose refractive correction met these cutoffs: sphere < -0.5 diopters (D) or >1.0 D or cylinder ≥ +1.0 D. Among those with RE, those who on refraction achieved ≥2 line improvement in at least 1 eye (definition 1) or in both eyes (definition 2) were classified as uncorrected RE. A questionnaire on access to care, acculturation, and socioeconomic variables was used. MAIN OUTCOME MEASURES: Prevalence of RE and proportion of uncorrected RE. RESULTS: The prevalence of RE was 64% in at least 1 eye and 51% in both eyes. Of participants with RE in at least 1 eye, 35% have uncorrected RE. Of those with RE in both eyes, 19% have uncorrected RE. Compared with participants with corrected RE, those with uncorrected RE in at least 1 eye were more likely to have lower levels of acculturation (odds ratio [OR] 1.2; 95% confidence interval [CI], 1.1-1.4 per unit decrease) and education (OR 1.6 for ≤6 years vs. >12 years; 95% CI, 1.2-2.2). Uncorrected RE was also associated with not having insurance (OR 1.4; 95% CI, 1.1-1.6), with a low family income (OR 1.4; 95% CI, 1.1-1.7 for <$20,000/year), and with time since last health care visit (OR 1.4; 95% CI, 1.1-1.7 for >1 year vs. <6 months). CONCLUSIONS: In our sample of Latinos, the proportion of uncorrected RE is high and suggests that one third of those with RE may benefit from new glasses. Indices of marginalization are associated with uncorrected RE and could be targeted for future interventions.
Subject(s)
Hispanic or Latino/ethnology , Refractive Errors/ethnology , Adult , Age Distribution , Aged , Aged, 80 and over , Arizona/epidemiology , Cross-Sectional Studies , Female , Health Services Accessibility , Humans , Male , Middle Aged , Prevalence , Refraction, Ocular/physiology , Refractive Errors/diagnosis , Refractive Errors/therapy , Sex Distribution , Surveys and Questionnaires , Visual Acuity/physiologyABSTRACT
Los hemangiomas subglóticos son tumores benignos de la niñez que pueden poner en peligro la vida del paciente, ya que el volumen del tumor interfiere con la ventilación. Se insiste en la dificuldad que existe para su diagnóstico por la sintomatología variada que pueden presentar, así como en la elección de las diferentes formas de tratamiento medico o quirúrgico. Para el tratamiento del hemangioma subglótico existen diferentes métodos, por lo que se ha elegido la resección endoscópica por medio del rayo laser; se ha utilizado hasta la fecha en tales pacientes, con reducción del tamaño de los tumores y aumento de la luz laríngea, lo que ha permitido la obturación de las cánulas y su retiro
