Ocular Toxocariasis: Beyond Typical Patterns through the New Imaging Technologies.

PURPOSE: To report five cases of ocular Toxocariasis (OT) in which ultrawide-field (UWF) imaging was helpful in diagnosis and assessment. OT is an underdiagnosed condition triggered by the ocular invasion of Toxocara larvae. Typical features are peripheral granuloma or endophthalmitis. METHODS: A retrospective case series of 10 outpatients were studied by complete ophthalmologic examination and complementary tests. UWF retinal imaging, fundus autofluorescence (FAF) and spectral-domain optical coherence tomography (SDOCT) were retrospectively analyzed. Five patients with suspected OT were included. RESULTS: UWF imaging and FAF was able to detect all retinal lesions in a single rapid capture. Two patients showed positive serology for Toxocara. An image suggesting the larva in the vitreous cavity was shown in one patient. Antihelmintic 15 treatment along with steroids was prescribed in two patients. CONCLUSION: UWF imaging and SDOCT provide a more efficient approach and follow-up in OT, raising final standards of care.

Réplica: Oclusión venosa central de la retina isquémica como posible diagnóstico diferencial de la retinopatía Purtscher-like / Reply: Ischemic central retinal venous occlusion as a possible differential diagnosis of Purtscher-like retinopathy

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Estudio multimodal y tratamiento de la retinopatía tipo Purtscher / Response to anti-VEGF therapy in macular oedema secondary to acute retinal necrosis

Paciente de 52 años con múltiples factores de riesgo cardiovascular remitido por pérdida visual unilateral, aguda e indolora. En la fundoscopia destaca importante inflamación papilar con tortuosidad a este nivel y hemorragias. Las pruebas de imagen muestran edematización tanto del disco óptico como macular y afectación en capas internas retinianas. La angiografía con fluoresceína y la angiografía por tomografía de coherencia óptica de control muestran áreas de isquemia central y periférica. Dados los hallazgos clínicos y los antecedentes del paciente, se llega al diagnóstico de retinopatía de tipo Purtscher y se decide tratamiento con dexametasona intravítrea. La retinopatía de tipo Purtscher es una entidad de rara frecuencia que se presenta en pacientes con múltiples enfermedades sistémicas pero sin antecedentes traumáticos, lo que la diferencia de la retinopatía de Purtscher. En el pronóstico es importante el diagnóstico y la intervención precoz. No existen protocolos terapéuticos, pero con la terapia intravítrea con dexametasona se han obtenido buenos resultados

A 52-year-old patient with multiple cardiovascular risk factors referred for unilateral, acute, and painless visual loss. In the fundoscopic image there was significant papillary inflammation with tortuosity at this level and haemorrhages. Ophthalmological examination showed papillary inflammation, macular oedema, and involvement in retinal inner layers. The control fluorescein angiography and optical coherence tomography angiography showed areas of central and peripheral ischaemia. Given the clinical findings and background of the patient, the diagnosis of Purtscher-like retinopathy was reached and treatment with intravitreal dexamethasone was decided. Purtscher-like retinopathy is a rare entity that occurs in patients with multiple systemic pathologies, but without a traumatic background, which differentiates it from Purstcher's retinopathy. The diagnosis and early intervention are important in the prognosis. There are no therapeutic protocols, but good results have been obtained with intravitreal therapy with dexamethasone

Multimodal imaging and treatment of Purtscher-like retinopathy. / Estudio multimodal y tratamiento de la retinopatía tipo Purtscher.

A 52-year-old patient with multiple cardiovascular risk factors referred for unilateral, acute, and painless visual loss. In the fundoscopic image there was significant papillary inflammation with tortuosity at this level and haemorrhages. Ophthalmological examination showed papillary inflammation, macular oedema, and involvement in retinal inner layers. The control fluorescein angiography and optical coherence tomography angiography showed areas of central and peripheral ischaemia. Given the clinical findings and background of the patient, the diagnosis of Purtscher-like retinopathy was reached and treatment with intravitreal dexamethasone was decided. Purtscher-like retinopathy is a rare entity that occurs in patients with multiple systemic pathologies, but without a traumatic background, which differentiates it from Purstcher's retinopathy. The diagnosis and early intervention are important in the prognosis. There are no therapeutic protocols, but good results have been obtained with intravitreal therapy with dexamethasone.

[Neuro-ophthalmological manifestations of pituitary adenomas. The usefulness of optical coherence tomography]. / Manifestaciones neurooftalmológicas de los adenomas hipofisarios. Valor de la tomografía de coherencia óptica.

INTRODUCTION: Pituitary adenomas are a frequently occurring pathology that require multidisciplinary management by several different specialists. Their neuro-ophthalmological manifestations vary widely and sometimes appear as the presenting symptom. AIM: To gather the main ophthalmological signs and symptoms of these tumours so that specialists who find themselves before any of them will suspect this pathology. DEVELOPMENT: This survey was based on the clinical experience of the neuro-ophthalmological unit at the Hospital Clinic de Barcelona, with over 350 patients who had suffered from pituitary tumours. A bibliographical search was also carried out on Medline for papers published on pituitary adenomas in the literature in both English and Spanish. We focused mainly on those that reported on the ophthalmological manifestations of such tumours. A number of articles were found dealing with isolated ophthalmological manifestations of these tumours, many of them as presenting symptoms. We also found review articles in English. Apart from oculomotor disorders and other less common findings, visual field defects stand out as the guiding symptom of this condition. CONCLUSIONS: Improved diagnostic techniques are allowing pituitary tumours to be detected at increasingly earlier stages, but cases are still seen with neuro-ophthalmological symptoms as the presenting symptoms. Familiarity with these syndromes is crucial. In addition to the clinical and visual field examination, optical coherence tomography is particularly useful for the diagnosis and follow-up of these patients. Prospective studies are needed to establish factors for predicting the visual recovery in these patients.

Manifestaciones neurooftalmológicas de los adenomas hipofisarios. Valor de la tomografía de coherencia óptica / Neuro-ophthalmological manifestations of pituitary adenomas. The usefulness of optical coherence tomography

Introducción. Los adenomas hipofisarios son una patología frecuente. Requieren un tratamiento multidisciplinario entre varios especialistas. Sus manifestaciones neurooftalmológicas son muy variadas, y en ocasiones aparecen como síntoma de presentación. Objetivo. Reunir los principales signos y síntomas oftalmológicos de estos tumores, para que todo especialista sospeche esta patología cuando se encuentre ante alguno de ellos. Desarrollo. Esta revisión se ha desarrollado sobre la base de la experiencia clínica de la unidad de neurooftalmología del Hospital Clínic de Barcelona, con más de 350 pacientes afectos de tumores hipofisarios. Asimismo, se ha realizado una búsqueda bibliográfica en Medline de los artículos publicadossobre adenomas hipofisarios en lengua castellana e inglesa. Se centró principalmente en aquéllos que se referían a las manifestaciones oftalmológicas de dichos tumores. Se encontraron numerosos artículos referentes a manifestaciones oftalmológicas aisladas de estos tumores, muchas de ellas como inicio. También se encontraron artículos de revisión en lengua inglesa.Aparte de las alteraciones oculomotoras y otros hallazgos menos frecuentes, destacan las alteraciones campimétricas como síntoma guía de esta patología. Conclusiones. Los tumores hipofisarios se detectan cada vez más temprano debido a la mejora en las técnicas diagnósticas, pero aún se observan casos con síntomas neurooftalmológicos como inicio. Resulta crucialel conocimiento de estos síndromes. Además de la exploración clínica y la campimetría, la tomografía de coherencia óptica resulta de gran valor para el diagnóstico y el seguimiento de estos pacientes. Se necesitan estudios prospectivos para establecerfactores pronósticos de recuperación visual en estos pacientes

Introduction. Pituitary adenomas are a frequently occurring pathology that require multidisciplinary management by several different specialists. Their neuro-ophthalmological manifestations vary widely and sometimes appear as the presenting symptom. Aim. To gather the main ophthalmological signs and symptoms of these tumours so that specialists who find themselves before any of them will suspect this pathology. Development. This survey was based on the clinical experience of the neuro-ophthalmological unit at the Hospital Clínic de Barcelona, with over 350 patients who had suffered from pituitary tumours. A bibliographical search was also carried out on Medline for papers published on pituitary adenomas in the literature in both English and Spanish. We focused mainly on those that reported on the ophthalmological manifestations ofsuch tumours. A number of articles were found dealing with isolated ophthalmological manifestations of these tumours, many of them as presenting symptoms. We also found review articles in English. Apart from oculomotor disorders and other less common findings, visual field defects stand out as the guiding symptom of this condition. Conclusions. Improved diagnostictechniques are allowing pituitary tumours to be detected at increasingly earlier stages, but cases are still seen with neuroophthalmological symptoms as the presenting symptoms. Familiarity with these syndromes is crucial. In addition to the clinical and visual field examination, optical coherence tomography is particularly useful for the diagnosis and follow-up ofthese patients. Prospective studies are needed to establish factors for predicting the visual recovery in these patients

Oftalmía simpática y uso intraocular de aceite de silicona / Sympathetic ophthalmia and intraocular silicone oi

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[Pathology of the retina in patients with AIDS]. / Patología de la retina en pacientes con SIDA.

Changes in the fundus oculi are usually seen in patients with well-defined clinical features of the acquired immunodeficiency syndrome (AIDS). The commonest pathology of the retina, seen in 40-75% of the patients with advanced AIDS, is known as 'the microvascular complex of the retina associated with AIDS', and is characterized by the presence of cotton-wool exudates and retinal haemorrhages. Many of these lesions are casual findings on examination of the fundus oculi. Cytomegalic (CMV) retinitis appears in 20-30% of AIDS patients, and diagnosis is important so that treatment with foscarnet or ganciclovir may be started early to conserve vision. Occasionally necrotizing retinitis appears due to the varicella zoster virus, following the typical skin condition. There is little response to acyclovir treatment. Retinitis due to toxoplasma is much less common than cerebral toxoplasmosis. The retinal lesions are predominantly neuritic and respond well to treatment with antitoxoplasma. Other rarer causes of ocular disorders in AIDS are syphilis, tuberculosis, cryptococcus and lymphoma.