The effect of the acceleration/deceleration trauma in angioid streaks: A pathogenic hypothesis. / Efecto del traumatismo por aceleración/desaceleración en estrías angioides: hipótesis patogénica.

CASE REPORT: A 59-year-old male with acceleration/deceleration cranial trauma (ADT), caused by a car accident. After one month, he presented with loss of visual acuity in the right eye. A fluorescein angiography test was performed and it detected centrifugal hyperfluorescent lines from the optic nerve head, a characteristic compatible with the diagnosis of angioid streaks. The loss of visual acuity was demonstrated by the discovery of a juxtafoveal choroidal neovascular membrane (CNV). CONCLUSION: ADT can cause hyper-extension of the eyeball in its equator line, producing the rupture of fragile structures such as the Bruch membrane (MB) in patients with angioid streaks and the subsequent formation of CNV.

[Scleral surgery of retinal detachment without drainage of subretinal fluid and no cryotherapy]. / Cirugía escleral del desprendimiento de retina sin crioterapia ni drenaje del líquido subretiniano.

PURPOSE: To evaluate anatomic and functional results in patients treated for uncomplicated rhegmatogenous retinal detachment (RD) with scleral surgery without the use of subretinal fluid (SRF) drainage and using no cryotherapy. MATERIAL AND METHOD: We present a retrospective study of 76 patients who underwent RD scleral surgery without cryotherapy or SRF drainage. We analyze postoperative outcomes and the incidence of intraoperative and postoperative complications. RESULTS: The average of our retinal reapplications totals 90.78%, which is similar to those described by other types of surgical techniques, while our intraoperative and postoperative complications are dramatically reduced including improvement of functional results. CONCLUSIONS: Scleral surgery for retinal detachment using no drainage of subretinal fluid nor cryotherapy is a useful technique for the treatment of RD.

[Bilateral acute retinal necrosis due to herpes simplex virus in inmunocompetent people and acyclovir resistance]. / Necrosis retiniana aguda bilateral por herpes simple en individuo inmunocompetentes y resistencia a aciclovir.

CASE REPORT: A twenty-eight year old woman with necrotitizing retinitis and herpes simplex virus type 1 isolated in aqueous humor with polymerase chain reaction (PCR). An Acyclovir and corticosteroid therapy was started with unsuccessful response, Foscarnet was added getting quiescence of lesions. DISCUSSION: Acute Retinal Necrosis Syndrome (ARNS), induced by a virus of the herpes family, could develop in immunocompetent people. A characteristic clinical case with uveitis and vitritis, white retinitis areas and occlusive vasculitis is reported. Antiviral therapy with acyclovir and antiinflammatory treatment must be established quickly. Foscarnet can effectively treat ARNS in inmunocompetent patients. In spite of therapy, this is a potentially blinding retinal disease.

Necrosis retiniana aguda bilateral por herpes simple en individuo inmunocompetentes y resistencia a aciclovir / Bilateral acute retinal necrosis due to herpes simplex virus in inmunocompetent people and acyclovir resistance

Caso clínico: Mujer sana de 28 años con retinitis necrotizante bilateral y aislamiento de virus herpes simple tipo 1 en humor acuoso mediante reacción cadenas polimerasa (PCR). Se establece tratamiento con Aciclovir y corticoides intravenosos, sin obtener respuesta adecuada, se añade Foscarnet logrando la quiescencia de las lesiones. Discusión: El síndrome de necrosis retiniana aguda (SNRA) inducido por virus herpes, afecta tanto a inmunocompetentes como inmunodeprimidos. La clínica característica consta de uveítis con vitritis, focos de retinitis blanquecinos y vasculitis oclusiva. La terapia antiviral con aciclovir y antiinflamatorios debe instaurarse rápidamente. La terapia con Foscarnet puede ser efectiva en SNRA en pacientes inmunocompetentes. A pesar del tratamiento desemboca en una potencial ceguera (AU)

[Retinal thrombosis in young patients. Immunological and clinical aspects]. / Trombosis retiniana en pacientes jóvenes. Aspectos inmunológicos y clínicos.

OBJECTIVES: To ascertain preexisting medical conditions, clinical evolution of retinopathy, and associated immunological disorders in a series of young patients suffering from retinal thrombosis, and to determine the prevalence of antiphospholipid antibodies. METHODS: Twenty two patients younger than 50 years, who had presented an acute retinal thrombotic episode, were studied prospectively with a general physical, ophthalmoscopic and immunological examination, placing special emphasis on the detection of antiphospholipid antibodies (anticardiolipin antibodies and lupus anticoagulant). RESULTS: No baseline disease stood out significantly over the others, and the most frequent risk factor found was systemic arterial hypertension (5/22%). No associated risk factor was found in nine cases (41%), and more than two factors were found in six cases (27%). Most of the vascular occlusions affected the venous vessels (18/81%), and five of them were associated with vasculitis. The ophthalmologic follow-up showed a rapid evolution to retinal neovascularization in 11 cases. Our data show many immunologically altered values, there being nine cases (41%) of the series with more than four parameters altered. The antiphospholipid assay showed a high prevalence of anticardiolipin antibodies (5/23%), and two patients were diagnosed of primary antiphospholipid syndrome. The lupus anticoagulant was negative in all patients. CONCLUSIONS: The high prevalence of anticardiolipin antibodies and immunologic abnormalities found in the retinal thrombosis younger patients leads us to recommend the systematic immunological study in these subjects. It has relevant diagnostic and therapeutic implications in a population with no evident associated risk factors and a greater severity of retinopathy.

[Vitrectomy for vitreomacular traction syndrome]. / Vitrectomía en el síndrome de tracción vitreomacular.

PURPOSE: To describe the clinical characteristics of the vitreomacular traction syndrome and to evaluate the results of vitreous surgery for this syndrome. METHODS: We retrospectively studied 5 consecutive symptomatic eyes with vitreomacular traction syndrome, which underwent vitrectomy and posterior hyaloid stripping. RESULTS: Intraoperative observation confirmed partial posterior vitreous separation. After surgery visual acuity improved in four eyes and remained in one eye. All eyes were followed for at least 3 months. Complications of vitreous surgery included progression of nuclear sclerosis (3 eyes) and retinal rupture (1 eye). CONCLUSION: Vitreomacular traction syndrome can produce visual deficit. Vitrectomy surgery to release macular traction allows resolution of macular cystoid changes and improvement of visual acuity.