Hematoma endocapsular: complicación inusual tras facoemulsificación y esclerectomía profunda no perforante / Endocapsular haematoma: An unusual complication of phacoemulsification and non-penetrating deep sclerectomy

CASO CLÍNICO: Varón de 68 años con catarata y glaucoma primario de ángulo abierto no controlado con máximo tratamiento tópico en ojo derecho, intervenido de cirugía combinada de esclerectomía profunda no perforante y facoemulsificación. No presentó complicaciones intraoperatorias, pero en el postoperatorio inmediato acudió por disminución brusca de agudeza visual tras maniobra de Valsalva; se objetivó en la exploración un hematoma endocapsular. En ausencia de resolución espontánea, a los 3meses se realizó capsulotomía posterior con láser neodomio: YAG con mejoría visual inmediata y óptimo control de la presión intraocular. DISCUSIÓN: Se describe el primer caso de hematoma endocapsular como complicación de cirugía no perforante en glaucoma, manejado eficazmente con capsulotomía YAG

CASE REPORT: A 68-year-old male with a cataract and uncontrolled primary open angle glaucoma with maximal tolerated medication underwent non-penetrating deep sclerectomy combined with phacoemulsification surgery in right eye. There were no complications during the procedure, but shortly after the surgery, he lost visual acuity after a Valsalva manoeuvre due to an endocapsular haematoma. Neodymium:YAG laser posterior capsulotomy was performed for the treatment of an unresolving endocapsular haemorrhage at the third month of the follow-up, with immediate visual improvement and optimal control of intraocular pressure. DISCUSSION: To the best of our knowledge, this is the first reported case of endocapsular haematoma as a complication of non-penetrating glaucoma surgery that has been successfully solved by a YAG capsulotomy

Endocapsular haematoma: An unusual complication of phacoemulsification and non-penetrating deep sclerectomy. / Hematoma endocapsular: complicación inusual tras facoemulsificación y esclerectomía profunda no perforante.

CASE REPORT: A 68-year-old male with a cataract and uncontrolled primary open angle glaucoma with maximal tolerated medication underwent non-penetrating deep sclerectomy combined with phacoemulsification surgery in right eye. There were no complications during the procedure, but shortly after the surgery, he lost visual acuity after a Valsalva manoeuvre due to an endocapsular haematoma. Neodymium:YAG laser posterior capsulotomy was performed for the treatment of an unresolving endocapsular haemorrhage at the third month of the follow-up, with immediate visual improvement and optimal control of intraocular pressure. DISCUSSION: To the best of our knowledge, this is the first reported case of endocapsular haematoma as a complication of non-penetrating glaucoma surgery that has been successfully solved by a YAG capsulotomy.

Manejo de la membrana neovascular coroidea secundaria a toxoplasmosis ocular / Management of the neovascular choroidal membrane secondary to ocular toxoplasmosis

Paciente de 12 años diagnosticado de toxoplasmosis congénita sin tratamiento sistémico en el momento actual que acude por disminución de la agudeza visual (AV) en su ojo izquierdo (OI). A la exploración se objetiva una AV en su OI de 0,05 y al examen funduscópico un foco de coriorretinitis adyacente a una cicatriz macular pigmentada y una gran hemorragia subretiniana asociada. Tras confirmar el diagnóstico de membrana neovascular coroidea (MNVC) secundaria a toxoplasmosis ocular, se inicia tratamiento con fármacos anti-toxoplásmicos sistémicos y 2 dosis de anti-VEGF intravítreos separadas por un mes de diferencia. Finalmente, alcanza una AV en el OI de 0,4, y se logra una reabsorción de la hemorragia quedando una cicatriz pigmentada macular inactiva. El uso de anti-VEGF intravítreos en cuadros de toxoplasmosis ocular se han asociado a la reactivación de antiguas lesiones, por lo que se recomienda el uso profiláctico de fármacos anti-toxoplásmicos orales en estos casos

A 12-year-old patient diagnosed with congenital toxoplasmosis, with no systemic treatment at the time, who presented with a decreased visual acuity (VA) in his left eye (LE). On examination, VA in the LE was 0.05 and the fundus examination revealed a focus of chorioretinitis adjacent to a pigmented macular scar, as well as a large associated subretinal haemorrhage. After confirming the diagnosis of choroidal neovascular membrane secondary to ocular toxoplasmosis, treatment was started with systemic anti-toxoplasmosis drugs and two anti-VEGF intravitreal injections separated by one month. Finally, the patients had a VA in LE of 0.4, with reabsorption of the haemorrhage, leaving an inactive pigmented macular scar. The use of anti-VEGF intravitreal injections in cases of ocular toxoplasmosis has been associated with a reactivation of old lesions, so the prophylactic use of oral anti-toxoplasmosis drugs is recommended in these cases

Metástasis coroidea como primera manifestación de carcinoma papilar de tiroides: a propósito de un caso / Choroidal metastases as initial manifestation of a papillary thyroid carcinoma: A case report

Se presenta el caso de un varón de 78 años que consultó por disminución de visión en ojo derecho de meses de evolución. En la exploración funduscópica se detectó existencia de una masa coroidea de coloración amarillo-anaranjado, sin desprendimiento de retina asociado. La tomografía computarizada demostró presencia de una masa localizada en istmo tiroideo así como múltiples adenopatías y focos de diseminación de aspecto metastásico. La broncoscopia con biopsia pulmonar mostró hallazgos compatibles con diseminación metastásica. La punción-aspiración con aguja fina del nódulo tiroideo fue diagnóstica para un carcinoma papilar de tiroides subtipo células columnares y la tomografía por emisión de positrones confirmó secundarismo a carcinoma primario de tiroides. Se trató al paciente con tiroidectomía total y tratamiento sustitutivo tiroideo, y posteriormente tratamiento ablativo con radioyodo

The case is presented of 78 year-old who consulted due to decreased visual acuity in right eye for several months. Indirect ophthalmoscopy revealed an orange-yellow coloured choroidal mass at the posterior pole, without retinal detachment. Computed tomography showed a thyroid mass in the isthmus, as well as multiple pulmonary nodules and metastatic foci. The findings of transbronchial lung biopsy were compatible with metastatic dissemination. Fine-needle aspiration biopsy of thyroid nodule was diagnostic for a with columnar cell variant of papillary thyroid cancer. Positron emission tomography confirmed papillary thyroid carcinoma. The patient underwent total thyroidectomy and radioactive iodine therapy

Choroidal metastases as initial manifestation of a papillary thyroid carcinoma: A case report. / Metástasis coroidea como primera manifestación de carcinoma papilar de tiroides: a propósito de un caso.

The case is presented of 78 year-old who consulted due to decreased visual acuity in right eye for several months. Indirect ophthalmoscopy revealed an orange-yellow coloured choroidal mass at the posterior pole, without retinal detachment. Computed tomography showed a thyroid mass in the isthmus, as well as multiple pulmonary nodules and metastatic foci. The findings of transbronchial lung biopsy were compatible with metastatic dissemination. Fine-needle aspiration biopsy of thyroid nodule was diagnostic for a with columnar cell variant of papillary thyroid cancer. Positron emission tomography confirmed papillary thyroid carcinoma. The patient underwent total thyroidectomy and radioactive iodine therapy.

Management of the neovascular choroidal membrane secondary to ocular toxoplasmosis. / Manejo de la membrana neovascular coroidea secundaria a toxoplasmosis ocular.

A 12-year-old patient diagnosed with congenital toxoplasmosis, with no systemic treatment at the time, who presented with a decreased visual acuity (VA) in his left eye (LE). On examination, VA in the LE was 0.05 and the fundus examination revealed a focus of chorioretinitis adjacent to a pigmented macular scar, as well as a large associated subretinal haemorrhage. After confirming the diagnosis of choroidal neovascular membrane secondary to ocular toxoplasmosis, treatment was started with systemic anti-toxoplasmosis drugs and two anti-VEGF intravitreal injections separated by one month. Finally, the patients had a VA in LE of 0.4, with reabsorption of the haemorrhage, leaving an inactive pigmented macular scar. The use of anti-VEGF intravitreal injections in cases of ocular toxoplasmosis has been associated with a reactivation of old lesions, so the prophylactic use of oral anti-toxoplasmosis drugs is recommended in these cases.

Glaucoma agudo de ángulo cerrado inducido por topiramato con miopización aguda y estrías maculares: a propósito de un caso / Acute narrow-angle glaucoma induced by topiramate with acute myopia and macular striae: A case report

Presentamos el caso clínico de una mujer epiléptica de 29 años en tratamiento con topiramato 25 mg/día desde 9 días previos a la presentación del cuadro, que acude a urgencias por disminución de la agudeza visual (AV) tras incrementar la dosis a 50mg/día 2 días antes. En la exploración presenta un glaucoma agudo de ángulo cerrado (GAAC) bilateral y estrías maculares en ambos ojos (AO) objetivadas mediante retinografía y tomografía de coherencia óptica (OCT). El GAAC es un efecto secundario conocido y ampliamente descrito del topiramato, sin embargo, las estrías maculares que ocasionalmente acompañan al GAAC, aunque se han descrito anteriormente en otros casos, muy pocos las documentan mediante imágenes de retinografía y OCT. Es importante diferenciar un caso de GAAC inducido por topiramato de un caso de GAAC primario ya que difieren en su presentación clínica, mecanismo de acción y tratamiento. Su manejo inadecuado puede tener consecuencias potencialmente graves

We report the case of a 29-year-old epileptic woman who had been on treatment with topiramate 25 mg/day for 9 days. She was referred to the Emergency Department due to reduction in far visual acuity (VA) after increasing the dose to 50mg/day two days before. The ocular examination showed bilateral acute angle closure glaucoma (AACG) and macular striae in both eyes (AO) observed by Retinography and Optical Coherence Tomography (OCT). The AACG is a well-known side effect of topiramate, but the macular striae rarely accompanies it. Although macular striae have been previously described in other cases, very few document those using retinography and OCT images. Therefore, it is important to differentiate a case of AACG induced by topiramate from a case of primary AACG, since they differ in their clinical presentation, mechanism of action, and treatment. Mismanagement can have potentially serious consequences

Acute narrow-angle glaucoma induced by topiramate with acute myopia and macular striae: A case report. / Glaucoma agudo de ángulo cerrado inducido por topiramato con miopización aguda y estrías maculares: a propósito de un caso.

We report the case of a 29-year-old epileptic woman who had been on treatment with topiramate 25mg/day for 9 days. She was referred to the Emergency Department due to reduction in far visual acuity (VA) after increasing the dose to 50mg/day two days before. The ocular examination showed bilateral acute angle closure glaucoma (AACG) and macular striae in both eyes (AO) observed by Retinography and Optical Coherence Tomography (OCT). The AACG is a well-known side effect of topiramate, but the macular striae rarely accompanies it. Although macular striae have been previously described in other cases, very few document those using retinography and OCT images. Therefore, it is important to differentiate a case of AACG induced by topiramate from a case of primary AACG, since they differ in their clinical presentation, mechanism of action, and treatment. Mismanagement can have potentially serious consequences.