Evaluación del músculo ciliar y del grosor escleral anterior en miopes altos mediante tomografía de coherencia óptica / Assessment of the ciliary muscle and scleral anterior thickness in high myopia by optical coherence tomography

Propósito: Evaluar las dimensiones del músculo ciliar (MC) y del grosor escleral anterior (AST) in vivo en miopes altos mediante tomografía de coherencia óptica de fuente de barrido (SS-OCT) y comparar con sujetos emétropes e hipermétropes.MétodosEstudio transversal en el que se incluyeron 34 miopes altos (≥−6dioptrías [D]), 90 emétropes (−1 a +1D) y 38 hipermétropes (≥+3,5D). Se midieron el grosor del MC (CMT) y el AST en los cuadrantes temporal y nasal a 1, 2 y 3mm del espolón escleral utilizando la SS-OCT. Además, se evaluó la longitud del MC (CML).ResultadosLas dimensiones tanto del CML como del CMT en cualquiera de sus puntos de medida fueron mayores en miopes altos y en emétropes que en hipermétropes, tanto en el cuadrante nasal como en el temporal (p<0,001). Sin embargo, no existieron diferencias entre miopes magnos y emétropes para ninguno de los parámetros (p≥0,076), salvo para el CMT a 3mm en temporal (p<0,001). No existieron diferencias en el AST entre miopes altos, emétropes e hipermétropes, en ninguno de los puntos de medida ni cuadrantes estudiados (p>0,05).ConclusionesLa SS-OCT permite medir el MC in vivo, no observándose diferencias en sus dimensiones entre miopes altos y emétropes, pero sí que fueron menores en hipermétropes. En la medida de la esclera anterior no se observaron diferencias entre los tres grupos analizados según la refracción. (AU)

Purpose: To assess ciliary muscle (CM) and anterior scleral thickness (AST) dimensions in vivo in high myopia using swept-source optical coherence tomography (SS-OCT) and to compare with emmetropic and hyperopic subjects.MethodsCross-sectional study that included 34 high myopic patients (≥−6 diopters [D]), 90 emmetropes (−1 to +1D) and 38 hyperopic patients (≥+3.5D). CM thickness (CMT) and AST were measured in the temporal and nasal quadrants at 1, 2, and 3mm from the scleral spur using SS-OCT. In addition, the length of the CM (CML) was evaluated.ResultsThe dimensions of the CML and the CMT at any of their measurement points were greater in high myopes and emmetropes than in hyperopes, both in the nasal and temporal quadrants (P<.001). However, there were no differences between high myopes and emmetropes for any of the parameters (P≥.076) except for the CMT at 3mm in the temporal quadrant (P<.001). There were no differences in the AST between high myopes, emmetropes and hyperopes, in any of the measurement points or quadrants studied (P>.05).ConclusionsThe SS-OCT allows to measure the CM in vivo, not observing differences in its dimensions between high myopes and emmetropes, but they were smaller in hyperopes. In the measurement of the anterior sclera, no differences were observed between the three groups analyzed according to refraction. (AU)

Assessment of the ciliary muscle and scleral anterior thickness in high myopia by optical coherence tomography.

PURPOSE: To assess ciliary muscle (CM) and anterior scleral thickness (AST) dimensions in vivo in high myopia using swept-source optical coherence tomography (SS-OCT) and to compare with emmetropic and hyperopic subjects. METHODS: Cross-sectional study that included 34 high myopic patients (≥ -6 diopters [D]), 90 emmetropes (-1 to +1 D) and 38 hyperopic patients (≥ +3.5 D). CM thickness (CMT) and AST were measured in the temporal and nasal quadrants at 1, 2, and 3 mm from the scleral spur using SS-OCT. In addition, the length of the CM (CML) was evaluated. RESULTS: The dimensions of the CML and the CMT at any of their measurement points were greater in high myopes and emmetropes than in hyperopes, both in the nasal and temporal quadrants (P < .001). However, there were no differences between high myopes and emmetropes for any of the parameters (P ≥ .076) except for the CMT at 3 mm in the temporal quadrant (P < .001). There were no differences in the AST between high myopes, emmetropes and hyperopes, in any of the measurement points or quadrants studied (P > .05). CONCLUSIONS: The SS-OCT allows to measure the CM in vivo, not observing differences in its dimensions between high myopes and emmetropes, but they were smaller in hyperopes. In the measurement of the anterior sclera, no differences were observed between the three groups analyzed according to refraction.

Melanoma del cuerpo ciliar en un adulto joven: reporte de caso / Ciliary body melanoma in a young adult: a case report

Resumen Reporte de un caso: Femenino de 29 años de edad sin comorbilidades, con baja visual progresiva en ojo derecho de 1 mes de evolución. A la exploración oftalmológica agudeza visual de ese ojo en 20/80, conjuntiva bulbar superior con vaso centinela, masa retroiridiana color naranja vascularizada que subluxa el cristalino hacia inferior. Por ultrabiomicroscopía se evidencia una masa en domo dependiente del cuerpo ciliar de 4.87x5.74mm con reflectividad interna media y regular. Se realiza primeramente BAAF reportando melanoma, después se hace enucleación con resultado histopatológico de melanoma amelanótico. Posterior, se realiza implante de prótesis cosmética y se encuentra en seguimiento por oncología sin presentar datos de actividad tumoral después de 4 años. Discusión: Los melanomas uveales son la causa más común de tumores malignos intraoculares primarios en adultos, localizados principalmente en coroides (90%), siendo extremadamente rara su aparición en el cuerpo ciliar (6%) e iris (4%). El abordaje de un tumor del cuerpo ciliar debe incluir una anamnesis y exploración física completa con estudios paraclínicos adecuados para poder discernir entre los diagnósticos diferenciales. El ultrasonido ocular es el estudio auxiliar más importante ya que brinda características típicas propias del tumor. El tratamiento continúa basado en el COMS con un pronóstico sombrío. Los factores de mal pronóstico son presencia de metástasis, tamaño del tumor, extensión extraocular y estirpe epitelioide. Limitaciones: No se contaban con todas las alternativas de tratamiento. Originalidad: Caso inusual en pacientes jóvenes y por su sitio.

Abstract: Case report: 29-year-old female with no comorbidities, with progressive vision loss in the right eye of 1 month's evolution. On ophthalmological examination, visual acuity was 20/80, superior bulbar conjunctiva with sentinel vessel, vascularised orange retroiridian mass generating a lens subluxation inferiorly. Ultrabiomicroscopy revealed a dome-shaped mass dependent on the ciliary body measuring 4.87x5.74mm with medium and regular internal reflectivity. A FNA was done and melanoma was reported, then enucleation was performed with histopathological findings of amelanotic melanoma. Subsequently, a cosmetic prosthesis was implanted and the patient has been followed up by oncology with no evidence of tumour activity after 4 years. Discussion: Uveal melanomas are the most common cause of primary intraocular malignant tumours in adults, mainly located in the choroid (90%), being extremely rare in the ciliary body (6%) and iris (4%). The approach to a ciliary body tumour should include a complete anamnesis and physical examination with appropriate paraclinical studies to be able to discern between differential diagnoses. Ocular ultrasound is the most important ancillary study as it provides typical features of the tumour. Treatment is still based on COMS and the prognosis remains poor. Poor prognostic factors are the presence of metastases, tumour size, extraocular extension and epithelioid lineage. Limitations: Not all treatment alternatives were available. Originality: Unusual case in young patients and because of its site.

Glaucoma de ángulo cerrado secundario a quistes del cuerpo ciliar tratado con ciclofotocoagulación transescleral subliminal. A propósito de un caso / Angle-closure glaucoma secondary to ciliary body cysts treated with subliminal transscleral cyclophotocoagulation. Report of a case

El glaucoma de ángulo cerrado secundario a quistes del cuerpo ciliar es una entidad infrecuente. Se han descrito diferentes modalidades de tratamiento tanto farmacológicas como quirúrgicas. Entre estas, la ciclofotocoagulación transescleral subliminal es una alternativa comprometedora por menores complicaciones oculares y la misma eficacia reductora de la presión intraocular. Presentamos el caso de una mujer de 33 años con antecedente de hipertensión ocular de 6 años de evolución sin control y glaucoma de un mes de evolución, tratada con múltiples fármacos e intervenciones quirúrgicas, con persistencia de la presión intraocular elevada. Acudió a consulta por presentar dolor ocular y fotofobia de ojo derecho de 3 días de evolución previos a su visita. Se le realizó una ultrabiomicroscopia, encontrando quistes en el cuerpo ciliar por lo que se optó por la realización de ciclofotocoagulación transescleral subliminal, consiguiendo una reducción de la presión intraocular mantenida en el seguimiento a los 3 meses (AU)

Angle-closure glaucoma secondary to ciliary body cysts is a rare condition. Different pharmacological and surgical treatment modalities have been described. Among these, subliminal transscleral cyclophotocoagulation is a promising alternative due to fewer ocular complications and the same intraocular pressure reducing efficacy. The case is presented of a 33-year-old woman with a 6-year history of uncontrolled ocular hypertension, and a one-month history of glaucoma, treated with multiple drugs and surgical interventions, with persistent elevated intraocular pressure. She came to the clinic due to eye pain and photophobia of the right eye of 3 days onset prior to her visit. An ultrasound biomicroscopy was performed, finding cysts in the ciliary body. It was then decided to perform subliminal transscleral cyclophotocoagulation, achieving a reduction in intraocular pressure, which was maintained after three months of follow-up (AU)

Angle-closure glaucoma secondary to ciliary body cysts treated with subliminal transscleral cyclophotocoagulation. Report of a case.

Angle-closure glaucoma secondary to ciliary body cysts is a rare condition. Different pharmacological and surgical treatment modalities have been described. Among these, subliminal transscleral cyclophotocoagulation is a promising alternative due to fewer ocular complications and the same intraocular pressure reducing efficacy. The case is presented of a 33-year-old woman with a 6-year history of uncontrolled ocular hypertension, and a one-month history of glaucoma, treated with multiple drugs and surgical interventions, with persistent elevated intraocular pressure. She came to the clinic due to eye pain and photophobia of the right eye of 3 days onset prior to her visit. An ultrasound biomicroscopy was performed, finding cysts in the ciliary body. It was then decided to perform subliminal transscleral cyclophotocoagulation, achieving a reduction in intraocular pressure, which was maintained after three months of follow-up.

Angle-closure glaucoma secondary to ciliary body cysts treated with subliminal transscleral cyclophotocoagulation. Report of a case. / Glaucoma de ángulo cerrado secundario a quistes del cuerpo ciliar tratado con ciclofotocoagulación transescleral subliminal. A propósito de un caso.

Angle-closure glaucoma secondary to ciliary body cysts is a rare condition. Different pharmacological and surgical treatment modalities have been described. Among these, subliminal transscleral cyclophotocoagulation is a promising alternative due to fewer ocular complications and the same intraocular pressure reducing efficacy. The case is presented of a 33-year-old woman with a 6-year history of uncontrolled ocular hypertension, and a one-month history of glaucoma, treated with multiple drugs and surgical interventions, with persistent elevated intraocular pressure. She came to the clinic due to eye pain and photophobia of the right eye of 3 days onset prior to her visit. An ultrasound biomicroscopy was performed, finding cysts in the ciliary body. It was then decided to perform subliminal transscleral cyclophotocoagulation, achieving a reduction in intraocular pressure, which was maintained after three months of follow-up.

Meduloepitelioma de cuerpo ciliar. Reporte de un caso y revisión de la literatura / Ciliary body medulloepithelioma. Case report and literature review

Introducción: Se presenta el caso de un paciente de 10 años de edad a quien se le realizó el diagnóstico de meduloepitelioma de cuerpo ciliar con posterior enucleación. Objetivo: Presentar las principales características clínicas, abordaje diagnostico y terapéutico de un paciente con meduloepitelioma de cuerpo cilar, realizando una revisión de la literatura existente de esta patología. Diseño del estudio: Reporte de caso. Resumen del caso: Paciente masculino de 10 años de edad que presentó perdida de agudeza visual asociada a dolor ocular, al examen oftalmológico se encontró masa en cámara anterior. Se realizó biopsia de lesión iridiana diagnosticándose meduloepitelioma de cuerpo ciliar con posterior enucleación. Conclusión: Se presentó el caso de un niño con meduloepitelioma de cuerpo ciliar, exponiéndose las manifestaciones clínicas, su diagnóstico y tratamiento, así como la revisión de la literatura existente.

Background: We present the case of a 10-year-old patient who underwent a diagnosis of ciliary body medulloepithelioma with subsequent enucleation. Objective: To present the main clinical characteristics, diagnostic and therapeutic aproach of a patient with a ciliary body medulloepithelioma, carrying out a review of the existing literature of this pathology. Study design: Case report. Case summary: A 10-year-old male patient presented with loss of visual acuity associated with ocular pain. Ophthalmological examination revealed a mass in the anterior chamber. A biopsy of an iris lesion was made, diagnosing a ciliary body medulloepithelioma with subsequent enucleation. Conclusion: The case of a child with ciliary body medulloepithelioma was presented, exposing the clinical manifestations, their diagnosis and treatment, as well as the review of the existing literature.

Melanoma or glaucoma? A case report. / ¿Melanoma o glaucoma? A propósito de un caso.

CASE REPORT: The case is presented of a patient referred to us with suspicion of a ciliary body melanoma due to a pigmented lesion in iris root of left eye, associated with high intraocular pressure, despite maximal topical and systemic medication. The systematic workup revealed unilateral changes in the corneal endothelium, compatible with an iridocorneal syndrome. An Ahmed® valve was inserted, achieving sustained control of intraocular pressure and visual field defects. DISCUSSION: Iridocorneal syndromes are a wide and heterogeneous group of diseases, in which endothelial cells grow over the trabeculum, leading to an increase in intraocular pressure. Due to the nature of the disease, tube shunt surgery may be the best option in its treatment. Systematic workup is crucial, since the differential diagnosis may include potentially blinding and even life threatening conditions.

[Mesectodermal leiomyoma. Unusual tumor of the ciliary body]. / Leiomioma mesoectodérmico. Un tumor poco frecuente del cuerpo ciliar.

BACKGROUND: Mesectodermal leiomyoma is a benign tumor of smooth muscle of the ciliary body, which is derived from the neural crest. CLINICAL CASE: We report the case of a 35-year-old Mexican woman with visually impaired and blurred vision of the right eye of 2 months duration. The clinical and imaging presuntional diagnosis was adenoma of the non pigmented epithelium of the ciliary body and it was surgically resected. Microscopically, the tumor was composed of cells with round nuclei and scant cytoplasm without atypia or mitosis, arranged in a fibrillary background. The immunohistochemical markers for vimentin, muscle specific actin, smooth muscle actin and calponin were strongly positive in the cytoplasm of the neoplastic cells, while for glial fibrillary acidic protein and S-100 protein were negative in the same cellular population. CONCLUSIONS: Mesectodermal leiomyoma of the ciliary body is benign tumor of smooth muscle extremely rare in this location. Until now, there are just 25 previous reported cases in the literature and, the main differential diagnosis is uveal malignant melanoma, therefore some eyes were enucleated. The ultrabiomicroscopy, A and B-scan imaging studies are useful in the evaluation, however, is mandatory the microsocpic examination with routine and histochemical stains as well as the use of immunohistochemical markers such as vimentin, specific muscle actin, smooth muscle actin andcalponin to stablish the smooth muscle origin of this neoplasm, and rule out other malignant neoplams such as malignant melanoma.

Antecedentes: el leiomioma mesoectodérmico es un tumor benigno excepcional que se origina en el músculo liso del cuerpo ciliar y deriva de la cresta neural. Caso clínico: se comunica el caso de una mujer de 35 años, con disminución de la agudeza visual y visión borrosa de 2 meses de evolución en el ojo derecho. El diagnóstico presuncional clínico e imagenológico fue: adenoma del epitelio no pigmentado del cuerpo ciliar, por lo que se resecó quirúrgicamente. Microscópicamente, el tumor estaba formado por células de núcleos redondos de escaso citoplasma sin atipia ni mitosis, dispuestas en una matriz fibrilar. Los inmunomarcadores para vimentina, actina músculo específica, actina de músculo liso y calponina fueron todos positivos en el citoplasma de las células neoplásicas, excepto de los inmunomarcadores para la proteína ácida gliofibrilar y la proteína S-100 que resultaron negativos en la misma población celular. Conclusiones: el leiomioma mesoectodérmico del cuerpo ciliar es un tumor benigno de músculo liso extremadamente raro en esta localización. Hasta el momento, sólo hay 25 casos informados en la bibliografía médica y su principal diagnóstico diferencial es melanoma uveal, motivo por el que algunos ojos se enuclearon. Los estudios de ultrabiomicroscopia y ecografía modos A y B son útiles en la evaluación; sin embargo, es obligado el estudio microscópico con tinciones de rutina, y el uso de marcadores inmunohistoquímicos, como los utilizados en este caso para establecer la naturaleza del músculo liso de esta neoplasia y descartar algunas otras, como el melanoma.

[Macroadenoma of the non-pigmented ciliary epithelium]. / Macroadenoma del epitelio no pigmentado del cuerpo ciliar.

CASE REPORT: We report the clinical features and surgery of a patient with an adenoma of the non-pigmented ciliary epithelium. The adenoma measured 5 × 7 mm. The patient underwent radical ocular surgery consisting of partial iridocyclectomy associated to lamellar sclerouvectomy. DISCUSSION: Adenomas of ciliary body can mimic clinically amelanotic melanomas. We present details of the patient's medical records and review the literature. Clinically, adenoma in ciliary body can mimic amelanotic melanomas. Conservative surgery of the eye allows diagnosis and treatment, maintaining visual function.

[Pigmented ciliary body tumours: benign or malignant?]. / Tumor pigmentado del cuerpo ciliar: ¿benigno o maligno?

CASES REPORT: We report the cases of 2 women with a pigmented tumour in the ciliary body, one a melanocytoma and the other a melanoma, with different clinical manifestations. The first one presented with decreased visual acuity associated with recent growth of the tumour, as well as sectorial opacities of the lens and subluxation. The second one is asymptomatic and has been kept under observation for more than 30 years. DISCUSSION: Although the definitive diagnosis of a pigmented tumour of the ciliary body is only achieved by the histopathology study, the group of clinical features is a determining factor when a conservative treatment is indicated.