Microcystic Adnexal Carcinoma. A Rare Entity.

Background: Microcystic adnexal carcinoma is a rare malignant tumour derived from sweat glands, locally aggressive, but with low rate of lymphatic or metastatic spread. Tends to affect the deep dermis, without affection of epidermis. Surgery remains as the first line treatment. Case Report: We present a case of a 46-year-old woman with a slow growing lesion of the upper lip, with biopsy diagnosis of microcystic adnexal carcinoma. She underwent a resection and reconstruction with local advancement flaps. The final anatomopathological study showed an adnexal epithelial neoplasm with imprecise borders, poorly delimited, non-encapsulated, growing in plaque-like formation from the superficial dermis into the adipose tissue, perineural invasion, without epidermal infiltration. Discussion: It is an extremely rare malignant tumour, appearing as a solitary papule or plaque affecting the central face, that often affect middle-aged caucasic, female patients. Usual local aggressive nature, characterized by small nests and strands of cells in deep dermis and perineural-invasion images, absent in superficial tissue. An incisional biopsy is need to make a correct diagnosis. Due to its rarity there is no consensus on the best management and follow-up. The microcystic adnexal carcinoma should be taken into consideration in the differential diagnosis. Key words:Microcystic adnexal carcinoma, lip, histopathology.

Genetic testing for inherited ocular conditions in a developing country.

Background: Inherited ocular conditions are a frequent cause of blindness. Gene therapy has encouraged the development of genetic testing, currently able to detect up to 80% of mutations in contrast to the 5% sensitivity achieved a few decades ago.Materials and methods: One hundred sixty-three patients with suspected genetic ocular disorders who were referred to a single clinician between August 2014 and August 2019 underwent a thorough ophthalmologic examination. Those diagnosed with congenital cataract, retinoblastoma, anterior segment dysgenesis, autoimmune retinal disease, posterior microphthalmia, or cobalamin C deficiency were excluded, along with patients who opted against genetic testing. Included probands were classified into a diagnostic clinical category and offered genetic testing. Blood samples were sent to foreign accredited diagnostic laboratories, followed by clinical interpretation of the results.Results: Of the 163 patients referred, 104 were enrolled in the study. Median age at disease onset was 2 years (range, 0 to 43 years). A molecular diagnosis was established at a median age of 10 years (range, 0.4 to 50 years). Disease-causing genotypes were identified in 82 of the probands, indicating a mutation detection rate of 78.8%. Mutations were identified in 38 genes, ABCA4 being the most commonly affected (23% of mutations), followed by CRB1 (13% of mutations). Whole-exome sequencing was performed in 6 patients, resulting in a definite diagnosis in 3 (50%).Conclusions: Molecular testing for inherited ocular conditions is feasible in developing countries by sending samples to certified foreign laboratories, with a mutation detection rate comparable to published values in developed countries. Further studies to identify more disease-causing genes may improve the overall sensitivity.

Preoperative intravitreal bevacizumab for proliferative diabetic retinopathy patients undergoing vitrectomy - First update. / Efecto del uso preoperatorio de bevacizumab intravítreo en pacientes con retinopatía diabética proliferativa sometidos a vitrectomía- Primera actualización.

UPDATE: This Living FRISBEE (Living FRIendly Summary of the Body of Evidence using Epistemonikos) is an update of the summary published in December 2014. INTRODUCTION: Proliferative diabetic retinopathy can cause severe vision loss and even blindness if left untreated. Vitrectomy is often required in the treatment of more severe cases. Preoperative administration of bevacizumab, a humanized anti-vascular endothelial growth factor would improve intraoperative variables that facilitate surgery and improve postoperative course. METHODS: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS: We identified five systematic reviews including 16 studies overall, of which 14 were randomized trials. We concluded the preoperative use of intravitreal bevacizumab reduces the rate of vitreous hemorrhage in the early postoperative period, and probably also in the late postoperative period, but its effect on visual acuity is not clear. Furthermore, it probably decreases the surgical time and may decrease the incidence of iatrogenic retinal breaks. Although we are uncertain whether preoperative bevacizumab decreases intraoperative bleeding, it may reduce the need for endodiathermy.

ACTUALIZACIÓN: Este resumen Epistemonikos (Living FRISBEE: Living FRIendly Summary of the Body of Evidence using Epistemonikos) es una actualización del resumen publicado en diciembre de 2014. INTRODUCCIÓN: La retinopatía diabética proliferativa conlleva un alto riesgo de ceguera si no es tratada de manera oportuna. El tratamiento muchas veces incluye la vitrectomía. El uso preoperatorio de bevacizumab, un anti-factor de crecimiento endotelial vascular, podría mejorar variables intraoperatorias que facilitan la cirugía y mejorarían el curso postoperatorio. MÉTODOS: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos cinco revisiones sistemáticas que en conjunto incluyeron 16 estudios primarios, de los cuales 14 corresponden a ensayos aleatorizados. Concluimos que el uso preoperatorio de bevacizumab disminuye la incidencia de hemorragia vítrea en el postoperatorio temprano y probablemente también en el postoperatorio tardío, pero no está claro su efecto sobre la agudeza visual. Además, probablemente disminuye el tiempo quirúrgico, podría disminuir la incidencia de roturas retinianas iatrogénicas, y si bien no está claro que disminuya la ocurrencia de sangrado intraoperatorio, podría disminuir la necesidad de uso de endodiatermia.

Guidelines on Diabetic Eye Care: The International Council of Ophthalmology Recommendations for Screening, Follow-up, Referral, and Treatment Based on Resource Settings.

Diabetes mellitus (DM) is a global epidemic and affects populations in both developing and developed countries, with differing health care and resource levels. Diabetic retinopathy (DR) is a major complication of DM and a leading cause of vision loss in working middle-aged adults. Vision loss from DR can be prevented with broad-level public health strategies, but these need to be tailored to a country's and population's resource setting. Designing DR screening programs, with appropriate and timely referral to facilities with trained eye care professionals, and using cost-effective treatment for vision-threatening levels of DR can prevent vision loss. The International Council of Ophthalmology Guidelines for Diabetic Eye Care 2017 summarize and offer a comprehensive guide for DR screening, referral and follow-up schedules for DR, and appropriate management of vision-threatening DR, including diabetic macular edema (DME) and proliferative DR, for countries with high- and low- or intermediate-resource settings. The guidelines include updated evidence on screening and referral criteria, the minimum requirements for a screening vision and retinal examination, follow-up care, and management of DR and DME, including laser photocoagulation and appropriate use of intravitreal anti-vascular endothelial growth factor inhibitors and, in specific situations, intravitreal corticosteroids. Recommendations for management of DR in patients during pregnancy and with concomitant cataract also are included. The guidelines offer suggestions for monitoring outcomes and indicators of success at a population level.

Mycophenolate Mofetil Therapy in Refractory Inflammatory Eye Disease.

PURPOSE: To study the efficacy and incidence of treatment-related side effects of mycophenolate mofetil (MMF) therapy in patients with noninfectious inflammatory eye diseases. METHODS: Retrospective cohort study of 27 Chilean patients treated for noninfectious inflammatory eye diseases using MMF therapy over a 10-year period. Main outcome measures were: ability to control ocular inflammation and to taper prednisone to ≤10 mg daily (treatment success); incidence of treatment-related side effects. RESULTS: The proportion of patients with sustained control of inflammation was 81.48% at 6 months. Additionally 55.56% and 22.22% of patients succeeded in tapering their prednisone to 5-10 mg/day and <5 mg/day, at 6 months. Two patients developed a neoplasia during MMF therapy; however, this cohort is too small to interpret the significance of this relation to MMF treatment. CONCLUSIONS: MMF seems to be an effective corticosteroid-sparing agent with an acceptable safety profile.

Carcinoma linfoepitelial primario de glándula parótida / Primary lymphoepithelial carcinoma of the parotid gland

No disponible

Bilateral diffuse uveal melanocytic proliferation associated with renal cell carcinoma.

PURPOSE: To report a case of bilateral diffuse uveal melanocytic proliferation associated with an asymptomatic renal cell carcinoma. DESIGN: Clinical case report. METHODS: A 70-year-old man presented with a 7-month history of bilateral visual loss. Ophthalmoscopic examination, fluorescein angiography, ocular coherence tomography, and a search for underlying systemic malignancy were performed. RESULTS: Examination revealed multiple melanocytic uveal proliferations in both eyes. Fluorescein angiography revealed a pattern of multiple areas of early hyperfluorescence, and ocular coherence tomography showed serous detachment of the central retina. Abdominal computerized tomography scans showed a large tumor in the left kidney and nodular involvement in the right kidney. Pathologic examination revealed a clear cell carcinoma of the kidney. CONCLUSION: A literature review revealed a total of 40 cases of bilateral diffuse uveal melanocytic proliferation. To our knowledge, this is the first case to be associated with renal cell carcinoma.

Comparison of the clinical efficacy of two different immunosuppressive regimens in patients with chronic vogt-koyanagi-harada disease.

PURPOSE: To prospectively compare 2 immunosupressive regimens in patients with active Vogt-Koyanagi-Harada disease in spite of systemic glucocorticoid treatment. METHODS: Forty-four patients were diagnosed between 1998 and 2005. Twenty-one developed chronic intraocular inflammation in spite of glucocorticoid treatment and were randomized to receive either prednisone and azathioprine (AZA) (n = 12) or prednisone and cyclosporine (CyA) (n = 9). RESULTS: In the AZA group Tyndall score decreased from 1.21 +/- 1.10 to 0.29 +/- 0.62 (p < .01), and visual acuity (LogMAR) improved from 0.32 +/- 0.35 to 0.09 +/- 0.16 (p < .001). In the CyA group Tyndall score decreased from 1.67 +/- 1.08 to 0.16 +/- 0.51 (p < .001), and visual acuity improved from 0.41 +/- 0.40 to 0.25 +/- 0.42 (p < .001). Patients in the AZA group needed a significantly higher average prednisone dose and total cumulative dose than those in the CyA group, p < .01 for each comparison. CONCLUSIONS: Both regimens showed a good clinical efficacy, but CyA seems to be a better glucocorticoid-sparing agent than AZA.

[Retrospective review of 44 Chilean patients with Behçet disease]. / Enfermedad de Behçet en Chile: Análisis clínico de 44 casos.

BACKGROUND: Behçet's disease (BD) is a rare multisystemic inflammatory disease that is potentially disabling and may cause death. AIM: To describe the characteristics of BD patients from two Chilean centers. PATIENTS AND METHOD: Retrospective review of the clinical records of patients with BD attended in two rheumatology services between 1985 and 2007. The "Behçet's Disease Research Committee of Japan" (BDCJ) and the "International Study Group for Behçet's Disease" (ISG) diagnostic criteria were applied. RESULTS: We found 44 cases (25 males), diagnosed as BD. The mean age at the onset of symptoms was 26+/- 12 years. According to BDCJ criteria, 13 patients had complete BD, 24 had incomplete BD and 7 had a suspected BD. Thirty two patients fulfilled the ISG criteria. Forty two patients (95%) had oral ulcers, 33 (75%) had genital ulcers and 29 (66%) had ophthalmological involvement. Eleven and three patients had symptoms of central and peripheral nervous system involvement, respectively. No gender differences were detected. CONCLUSIONS: The clinical characteristics of these patients were similar to those described abroad, except for a higher frequency of peripheral nervous system involvement and a lower rate of arthritis.

[Natural history of diabetic retinopathy in a retrospective cohort of type 1 diabetics]. / Historia natural de retinopatía diabética en un estudio a largo plazo en pacientes con diabetes tipo 1. Factores de riesgo para progresión a enfermedad proliferante.

BACKGROUND: Diabetic retinopathy is one of the most common causes of blindness among adults. AIM: To report the natural history of diabetic retinopathy among Chilean patients with type 1 diabetes followed for a mean of 18 years. MATERIAL AND METHODS: Retrospective review of medical records of 39 patients aged 26 to 70 years, (20 females, 78 eyes) with type 1 diabetes controlled by the same ophthalmologist from 1971 to 2008. A questionnaire was sent to each patient and their treating physician to request information about the evolution of the disease and metabolic control. RESULTS: The questionnaire was answered by 24 patients (62%) and 21 attending physicians (54%). Small hard drusen were observed in 25 patients (64%). In 12 cases the drusen were detected before the development of any type of retinopathy. Eleven women became pregnant and retinopathy progressed in four of them. Twenty three patients (59%) developed proliferative diabetic retinopathy (PDR). Patients with PDR had a significantly longer duration of diabetes and worse glycemic control. There was a higher frequency of diabetic nephropathy in the PDR group, but only 13 patients out of 23 with PDR had nephropathy. The retinopathy progressed to high risk PDR two years after successful kidney-pancreas transplantation in one patient. CONCLUSIONS: In patients with type 1 diabetes mellitus, small hard drusen may be the initial manifestation of diabetic retinopathy. Risk factors for progression to PDR were duration of diabetic and poor glycemic control. Nephropathy was more prevalent in patients with PDR, but a significant group of PDR patients did not have demonstrable nephropathy.

Enfermedad de Behçet en Chile: Análisis clínico de 44 casos / Retrospective review of 44: Chilean patients with Behçet disease

Background: Behget's disease (BD) is a rare multisystemic inflammatory disease that is potentially disabling and may cause death. Aim: To describe the characteristics of BD patients from two Chilean centers. Patients and method: Retrospective review of the clinical records of patients with BD attended in two rheumatology services between 1985 and 2007. The "Behget's Disease Research Committee of Japan" (BDCJ) and the "International Study Group for Behget's Disease" (ISG) diagnostic criteria were applied. Results: We found 44 cases (25 males), diagnosed as BD. The mean age at the onset of symptoms was 26± 12 years. According to BDCJ criteria, 13 patients had complete BD, 24 had incomplete BD and 7 had a suspected BD. Thirty two patients fulfilled the ISG criteria. Forty two patients (95 percent) had oral ulcers, 33 (75 percent) had genital ulcers and 29 (66 percent) had ophthalmological involvement. Eleven and three patients had symptoms of central and peripheral nervous system involvement, respectively. No gender differences were detected. Conclusions: The clinical characteristics of these patients were similar to those described abroad, except for a higher frequency of peripheral nervous system involvement and a lower rate of arthritis.

Historia natural de retinopatía diabética en un estudio a largo plazo en pacientes con diabetes tipo 1. Factores de riesgo para progresión a enfermedad proliferante / Natural history of diabetic retinopathy in a retrospective cohort of type 1 diabetics

Background: Diabetic retinopathy is one of the most common causes of blindness among adults. Aim: To report the natural history of diabetic retinopathy among Chilean patients with type 1 diabetes followed for a mean of 18 years. Material and methods: Retrospective review of medical records of 39 patients aged 26 to 70 years, (20 females, 78 eyes) with type 1 diabetes controlled by the same ophthalmologist from 1971 to 2008. A questionnaire was sent to each patient and their treating physician to request information about the evolution of the disease and metabolic control. Results: The questionnaire was answered by 24 patients (62 percent) and 21 attending physicians (54 percent). Small hard drusen were observed in 25 patients (64 percent). In 12 cases the drusen were detected before the development of any type of retinopathy. Eleven women became pregnant and retinopathy progressed in four of them. Twently three patients (59 percent) developed proliferative diabetic retinopathy (PDR). Patients with PDR had a significantly longer duration of diabetes and worse glycemic control. There was a higher frequency of diabetic nephropathy in the PDR group, but only 13 patients out of 23 with PDR had nephropathy. The retinopathy progressed to high risk PDR two years after successful kidney-pancreas transplantation in one patient. Conclusions. In patients with type 1 diabetes mellitus, small hard drusen may be the initial manifestation of diabetic retinopathy. Risk factors for progression to PDR were duration of diabetic and poor glycemic control. Nephropathy was more prevalent in patients with PDR, but a significant group of PDR patients did not have demonstrable nephropathy (RevMéd Chile 2009; 137:1145-52).

[Role of Azathioprine in steroid resistant non infectious ocular inflammatory diseases]. / Eficacia de la azatioprina en la enfermedad ocular inflamatoria no infecciosa resistente a tratamiento esteroidal sistémico.

BACKGROUND: Topical and systemic steroids are the first line of treatment of non infectious inflammatory ocular disease. Immunosuppresants are reserved as a second line treatment. AIM: To evaluate the role of Azathioprine (AZA) as a coadyuvant immunosuppressive treatment for non infectious ocular inflammatory diseases (OIDs) resistant to systemic steroid therapy in a retrospective, noncomparative interventional case series. PATIENTS AND METHODS: Patients using oral Prednisone due to an active or recurrent OID, without clinical response, and not receiving any other immunosuppressive treatment were studied. A standard protocol of oral Prednisone (0.5 mg/kg/ day) and oral AZA (2-3 mg/kg/day) during one year was used. Ocular and systemic monthly evaluations were done including relapse rate, steroid dosage, inflammatory score and visual acuity. RESULTS: Thirty patients (10 male) aged 18-75 years (mean 44 years) were studied. Three had bilateral anterior uveitis, one had pars planitis, four had diffuse uveitis, eight Vogt-Koyanahi-Harada syndrome, three Behget's disease, three necrotizing scleritis and eight had retinochoroidopathy A complete initial response was observed in 26 patients (87%). The time of response was between 1 to 6 months (mean 2.65 months). Seventeen percent of these had a relapse 6 to 12 months after AZA was started. In 61 %, visual acuity improved. The ocular inflammatory score decreased in 86.5%. Eleven patients had mild controlled side effects that did not require discontinuation of AZA. CONCLUSIONS: Combined systemic steroid and oral AZA therapy is safe and effective in controlling steroid resistant non infectious inflammatory ocular diseases.

Eficacia de la azatioprina en la enfermedad ocular inflamatoria no infecciosa resistente a tratamiento esteroidal sistémico / Role ofAzathioprine in steroid resistant non infectious ocular inflammatory diseases

Background: Topical and systemic steroids are the first line of treatment of non infectious inflammatory ocular disease. Immunosuppresants are reserved as a second line treatment. Aim: To evaluate the role ofAzathioprine (AZA) as a coadyuvant immunosuppressive treatment for non infectious ocular inflammatory diseases (OIDs) resistant to systemic steroid therapy in a retrospective, noncomparative interventional case series. Patients and methods: Patients using oral Prednisone due to an active or recurrent OID, without clinical response, and not receiving any other immunosuppressive treatment were studied. A standard protocol of oral Prednisone (0.5 mg/kg/ day) and oral AZA (2-3 mg/kg/day) during one year was used. Ocular and systemic monthly evaluations were done including relapse rate, steroid dosage, inflammatory score and visual acuity. Results: Thirty patients (10 male) aged 18-75 years (mean 44 years) were studied. Three had bilateral anterior uveitis, one had pars planitis, four had diffuse uveitis, eight Vogt-Koyanahi-Harada syndrome, three Behget's disease, three necrotizing scleritis and eight had retinochoroidopathy A complete initial response was observed in 26 patients (87 percent). The time of response was between 1 to 6 months (mean 2.65 months). Seventeen percent of these had a relapse 6 to 12 months after AZA was started. In 61 percent, visual acuity improved. The ocular inflammatory score decreased in 86.5 percent. Eleven patients had mild controlled side effects that did not require discontinuation of AZA. Conclusions: Combined systemic steroid and oral AZA therapy is safe and effective in controlling steroid resistant non infectious inflammatory ocular diseases.

[Markers of thrombophilia in patients with retinal vein thrombosis]. / Determinación de factores trombofílicos en pacientes con trombosis venosas retinianas.

BACKGROUND: Thrombophilia is an alteration of hemostasis that increases the risk to venous or arterial thrombosis. This condition may be the underlying cause of retinal vein thrombosis. AIM: To study the presence of thrombophilia in patients with retinal vein thrombosis. PATIENTS AND METHODS: Prospective study of 55 patients aged 22 to 86 years, with retinal vein thrombosis (central or branch). Antithrombin III, coagulant protein C, functional protein S, resistance to activated C protein, homocysteine, prothrombin G20210A gene, lupus anticoagulant and anticardiolipin antibodies were measured in all. RESULTS: Seventeen patients had thrombophilic markers (antiphospholipid syndrome in seven, hyperhomocysteinemia in six and resistance to protein C in three). Of these 17 patients, 53% had high blood pressure, 35% an abnormal serum lipid profile and 23% a personal history of thrombosis. The thrombosis was central in 12 (ischemic in four) and of a branch in five (ischemic in two). CONCLUSIONS: Thrombophilic markers must be assessed in patients with retinal vein thrombosis.

Proposed international clinical diabetic retinopathy and diabetic macular edema disease severity scales.

PURPOSE: To develop consensus regarding clinical disease severity classification systems for diabetic retinopathy and diabetic macular edema that can be used around the world, and to improve communication and coordination of care among physicians who care for patients with diabetes. DESIGN: Report regarding the development of clinical diabetic retinopathy disease severity scales. PARTICIPANTS: A group of 31 individuals from 16 countries, representing comprehensive ophthalmology, retina subspecialties, endocrinology, and epidemiology. METHODS: An initial clinical classification system, based on the Early Treatment Diabetic Retinopathy Study and the Wisconsin Epidemiologic Study of Diabetic Retinopathy publications, was circulated to the group in advance of a workshop. Each member reviewed this using e-mail, and a modified Delphi system was used to stratify responses. At a later workshop, separate systems for diabetic retinopathy and macular edema were developed. These were then reevaluated by group members, and the modified Delphi system was again used to measure degrees of agreement. MAIN OUTCOME MEASURES: Consensus regarding specific classification systems was achieved. RESULTS: A five-stage disease severity classification for diabetic retinopathy includes three stages of low risk, a fourth stage of severe nonproliferative retinopathy, and a fifth stage of proliferative retinopathy. Diabetic macular edema is classified as apparently present or apparently absent. If training and equipment allow the screener to make a valid decision, macular edema is further categorized as a function of its distance from the central macula. CONCLUSIONS: There seems to be a genuine need for consistent international clinical classification systems for diabetic retinopathy and diabetic macular edema that are supported with solid evidence. The proposed clinical classification systems provide a means of appropriately categorizing diabetic retinopathy and macular edema. It is hoped that these systems will be valuable in improving both screening of individuals with diabetes and communication and discussion among individuals caring for these patients.

Estudio clínico virológico en un grupo de niños chilenos con herpes ocular: análisis genómico de las cepas / Clinic-virological study in chilean children with ocular herpes: genomic analysis of strains

Se estudiaron todos los niños menores de 15 años, con diagnóstico clínico de herpes ocular, efectuado por oftalmólogos de servicios oftalmológicos de la Facultad de Medicina de la Universidad de Chile y de un centro oftalmológico privado, desde abril de 1995 a abril de 1996, en Santiago de Chile. Se consignó información clínico epidemiológica, examen clínico y se obtuvieron mediante torulado muestras de conjuntiva y/o córnea del ojo afectado, conjuntiva del ojo sano y mucosa oral, utilizando una técnica estándar. Se efectuó aislamiento viral en células VERO (ATCCL81). En caso de detectarse efecto citopático, el aislado viral se propagó y almacenó para su estudio. Se efectuó identificación y tipificación viral con anticuerpos tipo específicos marcados con fluoresceína (DAKO). Se efectuó amplificación génica y análisis con enzimas de restricción. Resultados: se determinó que 14/15 aislados correspondían a herpes simplex tipo I (HSV-I) y uno a HSV-2, el cual muy probablemente correspondió a una infección perinatal por este virus. Las cepas de HSV-I presentaron patrones genómicos distintos entre sí y con la cepa de referencia norteamericana HSV-IF. La forma de presentación más frecuente fue de blefaritis herpética, seguida por la dendrita corneal, tanto en el primer espisodio clínico como en las recurrencias y en estas últimas, tiende a presentarse la misma forma clínica. La tasa de recurrencia es mayor que en la población adulta. La infección fue unilateral con la excepción de un caso con distintas formas de presentación en cada ojo y aislamiento simultáneo bilateral. En dos casos fue posible detectar excreción oral del virus subclínica

Larva migrans ocular por Toxocara: análisis de 31 casos / Ocular larva migrans by Toxocara: analysis of 31 cases

Se presentan 31 casos de Toxocariasis ocular, de los cuales 15 fueron observados en niños menores de 10 años y 16 en pacientes mayores de esa edad. En total hubo 23 casos en mujeres y 8 en hombres. En el 79,3% los pacientes tenían perros en el hogar y en el 44,5% gatos. La causa más frecuente de consulta fue la disminución de visión y el estrabismo. Demoraron en promedio 4 meses en consultar. En el examen de fondo de ojo se encontró un granuloma periférico unido a la papila por banda glial o tubo retinal en el 64% de los casos, uveítis en el 48,2%, granuloma periférico aislado en el 23,6% y granuloma de polo posterior en el 9,7%. El test de ELISA para toxocariasis resultó positivo en el 88% y, si se considera desde la dilución 1:32 la positividad baja a 64%. La cifra absoluta de eosinófilos en sangre periférica fue normal en el 50% de los casos, estuvo levemente aumentada en el 42,3% y fue muy alta en sólo el 7,7% de ellos. La mayoría de los pacientes fue tratada con tiabendazol, algunos con albendazol, y prednisona. En los controles post tratamiento se comprobó la desaparición de la inflamación ocular en casi todos, la fibrosis ocular persiste igual y en 3 pacientes apareció desprendimiento de la retina y en otros 3 cataratas. Ninguno de los casos requirió tratamiento quirúrgico de enucleación ocular