Efusión uveal inducido por escitalopram / Uveal effusion induced by escitalopram

CASO CLÍNICO: Mujer de 73 años en tratamiento con escitalopram que presentó glaucoma agudo de ángulo cerrado secundario a efusión uveal tras duplicar la dosis de dicho fármaco 3 días antes. Evolucionó favorablemente tras la suspensión del antidepresivo además de tratamiento hipotensor tópico y prednisona vía oral. DISCUSIÓN: La efusión uveal secundaria a fármacos es un síndrome infrecuente. Se puede acompañar de miopización y glaucoma agudo por cierre angular. El diagnóstico correcto y la suspensión del fármaco conducen a la resolución de esta nosología

CASE REPORT: A 73 year-old woman with depression treated with escitalopram developed acute secondary angle closure glaucoma related to uveal effusion after duplicating the drug dose 3 days before. She evolved favorably once the antidepressant treatment was suspended and a new treatment with topical hypotensive therapy and oral prednisone was used. DISCUSSION: The uveal effusion syndrome associated to medicines is rare; it may be associated with acute myopic shift and acute angle closure glaucoma. The correct diagnosis and discontinuation of the drug lead to the resolution of this nosology

[Uveal effusion induced by escitalopram]. / Efusión uveal inducido por escitalopram.

CASE REPORT: A 73 year-old woman with depression treated with escitalopram developed acute secondary angle closure glaucoma related to uveal effusion after duplicating the drug dose 3 days before. She evolved favorably once the antidepressant treatment was suspended and a new treatment with topical hypotensive therapy and oral prednisone was used. DISCUSSION: The uveal effusion syndrome associated to medicines is rare; it may be associated with acute myopic shift and acute angle closure glaucoma. The correct diagnosis and discontinuation of the drug lead to the resolution of this nosology.

[Argon laser iridoplasty as treatment of plateau-like iris configuration secondary to multiple ciliary body cysts: long-term follow-up by ultrasound biomicroscopy]. / Iridoplastia con láser argón como tratamiento del iris plateau secundario a múltiples quistes del cuerpo ciliar: seguimiento a largo plazo con biomicroscopía ultrasónica.

CASE REPORT: We present a 37 year-old man with secondary angle closure by neuroepithelial ciliary body cysts. An argon laser peripherical iridoplasty was performed and ultrasound biomicroscopy (UBM) was employed to follow-up. Initially, the patient had a favorable response to treatment, but six months later the cysts and the secondary closed angle reappeared. DISCUSSION: Argon laser peripheral iridoplasty has been proposed as treatment of plateau-like iris configuration resulting from neuroepithelial ciliary body cysts. However, the cysts and, the secondary closed angle could recur in a long-term (Arch Soc Esp Oftalmol 2009; 84: 569-572).

Iridoplastia con láser argón como tratamiento del iris plateau secundario a múltiples quistes del cuerpo ciliar: seguimiento a largo plazo con biomicroscopía ultrasónica / Argon laser iridoplasty as treatment of plateau-like iris configuration secondary to multiple ciliary body cysts: long-term follow-up by ultrasound biomicroscopy

Caso clínico: Varón de 37 años de edad diagnosticadode cierre angular secundario a quistes neuroepitelialesdel cuerpo ciliar. Se trató mediante iridoplastiaperiférica con láser argón y se realizó seguimientomediante biomicroscopía ultrasónica(BMU). Inicialmente se consiguió una resolucióndel cuadro, pero a los 6 meses los quistes y el cierreangular secundario reaparecieron.Discusión: La iridoplastia periférica con láserargón se ha propuesto como tratamiento en situacionesde bloqueo angular secundario a quistes neuroepitelialesdel cuerpo ciliar. Sin embargo, losquistes y, secundariamente el cierre angular, podríanrecidivar a largo plazo(AU)

Case report: We present a 37 year-old man withsecondary angle closure by neuroepithelial ciliarybody cysts. An argon laser peripherical iridoplastywas performed and ultrasound biomicroscopy(UBM) was employed to follow-up. Initially, thepatient had a favorable response to treatment, butsix months later the cysts and the secondary closedangle reappeared.Discussion: Argon laser peripheral iridoplasty hasbeen proposed as treatment of plateau-like iris configurationresulting from neuroepithelial ciliarybody cysts. However, the cysts and, the secondaryclosed angle could recur in a long-term(AU)

[Exploration of the anterior segment by optical coherence tomography-3]. / Exploración del segmento anterior mediante tomografía óptica de coherencia 3.

PURPOSE: To show the utility of optical coherence tomography (OCT) for studying the anterior segment and to explain its potential advantages as compared to ultrasonic biomicroscopy (UBM). MATERIALS AND METHODS: We have described the findings in 5 patients with different pathologies of the anterior segment, all of whom were studied with UBM and OCT-3 adjusted for the anterior segment. There were 2 cases of an acute attack of closed angle glaucoma, 1 case of rubeosis iridis, 1 case of penetrating ocular trauma and 1 case of a primary stromal iris cyst. RESULTS: OCT was found to be as useful as UBM in detecting angle closure in patients affected by an acute attack of glaucoma. In addition, OCT was more comfortable for the patient and faster than UBM in obtaining images, with the exploration mean time using OCT being less than five minutes while that with UBM was over ten minutes. OCT has also been demonstrated to be a safe and valuable non-contact examination in other iris pathologies such as rubeosis iridis, for checking the permeability of iridotomies and even for studying iris masses such as primary stromal iris cysts. In these entities OCT may reach a higher resolution than ultrasonic biomicroscopy. CONCLUSION: OCT-3, with an adjustable focus, can obtain images from the scleral angle, as well as from other ocular structures like the iris, thus assisting in the diagnosis of numerous pathologies.

[Monolayered amniotic membrane transplantation as a palliative treatment for bullous keratopathy]. / Injerto de membrana amniótica monocapa como tratamiento paliativo de la queratopatía bullosa.

PURPOSE: To determine the efficacy of monolayered amniotic membrane transplantation for short and medium-term symptomatic improvement in those cases of bullous keratopathy where a penetrating keratoplasty is not indicated. METHODS: Amniotic membrane transplantation was performed in five patients with symptomatic bullous keratopathy in which penetrating keratoplasty was not indicated. Data about bandage contact lens need before and after surgery, existence of ocular pain, occurrence and extension of bullae, epithelial defects, and persistence of amniotic membrane, were obtained at days 4 and 14, and months 1, 2, 4 and 6 after surgery. RESULTS: No pain, bullae or epithelial defects were present at day 14 in any patient. However, progressive dissolvement of the amniotic membrane was accompanied with more bullae and pain. At 6th month, 4 of 5 patients required bandage contact lens. CONCLUSION: Amniotic membrane transplantation alleviates short-term symptomatic bullous keratopathy and preserves corneal anatomy. Six months after surgery, anatomical and symptomatic improvement does not avoid the need of bandage contact lens.

Injerto de membrana amniótica monocapa como tratamiento paliativo de la queratopatía bullosa / Monolayered amniotic membrane transplantation as a palliative treatment for bullous keratopathy

Objetivo: Comprobar la eficacia del injerto de membrana amniótica en monocapa en la mejoría sintomática a corto y medio plazo de la queratopatía bullosa no susceptible de queratoplastia. Sujetos y métodos: Se realizó injerto de membrana amniótica en cinco pacientes con queratopatía bullosa no susceptibles de queratoplastia. Se valoró la necesidad de lente terapéutica pre y post operatoria, la existencia de dolor, la presencia de bullas (y número de cuadrantes a los que afectaba), de defectos epiteliales, y de restos de membrana amniótica a los 4 y 14 días, y a los 1, 2, 4, y 6 meses de la cirugía. Resultados: A los 14 días ningún paciente presentaba dolor, defecto epitelial o bullas. Sin embargo, la desaparición progresiva de la membrana iba acompañada de aumento de la sintomatología y de las bullas. A los 6 meses, 4 de 5 pacientes necesitaban la utilización de lente terapéutica. Conclusiones: El injerto de membrana amniótica reduce la sintomatología de la queratopatía bullosa a corto plazo y preserva la anatomía corneal. A los 6 meses de la cirugía, la mejoría anatómica y sintomática no evita la necesidad de la utilización de lente de contacto terapéutica (AU)