[Dacryocystorhinostomy in adolescents and young adults]. / Dacriocistorrinostomía en adolescentes, jóvenes y adultos.

OBJECTIVE: To study the relative frequency, causes, anatomical and functional outcomes and complications of dacryocystorhinostomy (DCR) in patients between the second and fifth decade of life. METHOD: A retrospective, nonrandomized, interventional study of a clinical series of 12 patients who underwent DCR from March 2007 to March 2009, performed by a single surgeon, with an age range between 10 and 48 years. Recorded data included age at surgery, date of surgery, gender, affected side, cause of obstruction, surgical technique, outcome and complications. The relative frequency of such cases over the total was calculated. RESULTS: DCR in patients between 13-48 years old represented 14.11% of the total (12:85). In this group 88.8% were females and in 75% surgery was on the right side. The most frequent cause of obstruction was low idiopathic obstruction (58.33%) whereas 41.66% were secondary. An external DCR was performed on 66.67% of patients and the rest were endonasal DCR. Anatomical success was achieved with resolution of symptoms in 91.6% of patients. One case had a hypertrophic scar. CONCLUSION: Adolescents and young adults represent a significant percentage of cases undergoing DCR surgery. Both the external and endoscopic approach is shown to be a valid alternative for treating these patients, with good results and low incidence of complications.

Dacriocistorrinostomía en adolescentes, jóvenes y adultos / Dacryocystorhinostomy in adolescents and young adults

ObjetivoEstudiar la frecuencia relativa, causas, resultados anatómicos, funcionales y complicaciones de la dacriocistorrinostomía (DCR) en pacientes entre la segunda y quinta décadas de la vida.MétodoEstudio retrospectivo, no aleatorizado, intervencional de una serie de casos clínicos, de 12 pacientes intervenidos de DCR desde marzo de 2007 hasta marzo de 2009, realizadas por un cirujano único, con un rango de edad comprendido entre los 10 y los 48 años. Registrándose edad, día de cirugía, género lateralidad, causa de la obstrucción de conducto nasolagrimal (OCNLG), técnica quirúrgica, resultado de la intervención y complicaciones. Se calculó la frecuencia relativa de estos casos respecto del total.ResultadosLa DCR en pacientes entre 13 y 48 años representaba el 14,11% del total (12:85). En este grupo el 88,8% eran mujeres y en la cirugía el 75% estaba en el lado derecho. La causa más frecuente de obstrucción fue la obstrucción baja idiopática (58,33%), mientras que 41,66% eran secundarias. En el 66,67% de los pacientes una DCR externa se llevó a cabo y el resto fue DCR endonasal. En el 91,6% de los pacientes se logró éxito anatómico con la resolución de los síntomas. Un caso presentó cicatriz hipertrófica.ConclusiónLos adolescentes y adultos jóvenes representan un porcentaje significativo de casos que reciben cirugía DCR. Tanto el abordaje externo como el endoscópico representan una alternativa válida para el tratamiento de estos pacientes con buenos resultados y baja incidencia de complicaciones(AU)

ObjectiveTo study the relative frequency, causes, anatomical and functional outcomes and complications of dacryocystorhinostomy (DCR) in patients between the second and fifth decade of life.MethodA retrospective, nonrandomized, interventional study of a clinical series of 12 patients who underwent DCR from March 2007 to March 2009, performed by a single surgeon, with an age range between 10 and 48years. Recorded data included age at surgery, date of surgery, gender, affected side, cause of obstruction, surgical technique, outcome and complications. The relative frequency of such cases over the total was calculated.ResultsDCR in patients between 13-48years old represented 14.11% of the total (12:85). In this group 88.8% were females and in 75% surgery was on the right side. The most frequent cause of obstruction was low idiopathic obstruction (58.33%) whereas 41.66% were secondary. An external DCR was performed on 66.67% of patients and the rest were endonasal DCR. Anatomical success was achieved with resolution of symptoms in 91.6% of patients. One case had a hypertrophic scar.ConclusionAdolescents and young adults represent a significant percentage of cases undergoing DCR surgery. Both the external and endoscopic approach is shown to be a valid alternative for treating these patients, with good results and low incidence of complications(AU)

Quiste dermoide en la infancia bajo el diagnóstico de ptosis / Dermoid cyst in chidhood, diagnosed as ptosis

Caso clínicoNiño de 4 años diagnosticado por su pediatra de ptosis congénita en ojo izquierdo a los 2 años. En su valoración oftalmológica inicial, únicamente se aprecia discreta asimetría entre los párpados superiores. Es en consultas posteriores cuando aparece discreta hipotropia del ojo izquierdo, y un astigmatismo creciente que hacen sospechar sobre patología orbitaria. La RMN confirma la presencia de una masa compatible con un quiste dermoide.ConclusiónDebido al crecimiento lento de estos tumores, sólo un seguimiento de la clínica y la ayuda de pruebas de imagen, llevará al diagnóstico y al tratamiento definitivo mediante extirpación quirúrgica(AU)

Clinical caseA four year-old boy, diagnosed of palpebral ptosis since he was 2 by his paediatrician. At the initial ophthalmological revies he had asymmetrical upper eyelids. In the follow-up a mild ocular hypotrophy appeared in his left eye and an increasing astigmatism, which made us suspect an orbital disease. The MRI confirmed a mass, compatible with a dermoid cyst.ConclusionDue to the slow growth of these tumours, it is only with clinical follow-up and the aid of imaging techniques that we may achieve the diagnosis and offer a definitive treatment with surgical extirpation(AU)

Xantogranulomatosis orbitaria / Orbital xanthogranulomatosis

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[Primary localized conjunctival amyloidosis: two case reports]. / Amiloidosis primaria conjuntival: análisis de dos casos.

CASE REPORTS: Two male patients, 21 and 61 years old presenting with hyperemia resistant to topical treatment. Ocular examination showed reddish conjunctival mass, painless, highly vascularized in bulbar conjunctiva. The conjunctival biopsy revealed the presence of amyloid within the conjunctiva itself. CONCLUSIONS: Primary localized conjunctival amyloidosis is a rare disease. Diagnosis consists of biopsy in order to detect amyloid material in the conjunctival tissue together with a systemic evaluation in order to rule out the presence of primary systemic amyloidosis.

Amiloidosis primaria conjuntival: análisis de dos casos / Primary localized conjunctival amyloidosis: two case report

Caso clínico: Se presentan dos pacientes varones de 21 y 61 años de edad con hiperemia resistente al tratamiento tópico. En el examen ocular se observó una masa rosada, no dolorosa y muy vascularizada, en conjuntiva bulbar. La biopsia excisional diagnóstica reveló la presencia de amiloide en la sustancia propia conjuntival.Conclusiones: La amiloidosis conjuntival primaria es una enfermedad rara. El diagnóstico consiste la realización de una biopsia detectando material amiloide en el tejido conjuntival junto con un examen sistémico que descarte la presencia de una amiloidosis primaria sistémica

Case Reports: Two male patients, 21 and 61 years old presenting with hyperemia resistant to topical treatment. Ocular examination showed reddish conjunctival mass, painless, highly vascularized in bulbar conjunctiva. The conjunctival biopsy revealed the presence of amyloid within the conjunctiva itself.Conclusions: Primary localized conjunctival amyloidosis is a rare disease. Diagnosis consists of biopsy in order to detect amyloid material in the conjunctival tissue together with a systemic evaluation in order to rule out the presence of primary systemic amyloidosis

[Symptomatic ciliary body melanocytoma: melanocytomalytic glaucoma]. / Melanocitoma de cuerpo ciliar sintomático: glaucoma melanocitomalítico.

CASE REPORT: A 33 year-old female with an asymptomatic pigmented mass in the iridocorneal angle of her right eye, arising from the ciliary body is presented. Ciliary body melanocytoma was suspected and conservative management recommended. After 36 months of follow-up the patient developed pain, inflammatory reaction and uncontrollable ocular hypertension, which was diagnosed as melanocytomalytic glaucoma. Tumor was removed by external iridecyclectomy and the histopathologic findings revealed necrotic melanocytoma. DISCUSSION: Ciliary body melanocytoma is a rare benign pigmented tumor that may present extension to the anterior chamber. Differential diagnosis mainly includes ciliary body melanoma, which carries a different prognosis and treatment.

Melanocitoma de cuerpo ciliar sintomático: glaucoma melanocitomalítico / Symptomatic ciliary melanocytoma: Melanocytomalytic Glaucoma

Caso Clínico: Mujer de 33 años de edad con masa pigmentada, asintomática en ángulo iridocorneal de ojo derecho originada en cuerpo ciliar. Diagnóstico de sospecha de melanocitoma de cuerpo ciliar se decidió observación. Después de 36 meses de seguimiento presenta dolor, reacción inflamatoria y aumento incontrolable de presión intraocular que se diagnostica de glaucoma melanocitomalítico. Se realiza escisión del tumor mediante iridociclectomía «ab-externo» y el estudio histopatológico demostró melanocitoma necrótico. Discusión: El melanocitoma de cuerpo ciliar es un tumor pigmentado benigno, poco frecuente que puede presentar extensión a cámara anterior. El diagnóstico diferencial se realiza fundamentalmente con melanoma de cuerpo ciliar, que implica un diferente tratamiento y pronóstico(AU)

Case Report: A 33 year-old female with an asymptomatic pigmented mass in the iridocorneal angle of her right eye, arising from the ciliary body is presented. Ciliary body melanocytoma was suspected and conservative management recommended. After 36 months of follow-up the patient developed pain, inflammatory reaction and uncontrollable ocular hypertension, which was diagnosed as melanocytomalytic glaucoma. Tumor was removed by external iridecyclectomy and the histopathologic findings revealed necrotic melanocytoma. Discussion: Ciliary body melanocytoma is a rare benign pigmented tumor that may present extension to the anterior chamber. Differential diagnosis mainly includes ciliary body melanoma, which carries a different prognosis and treatment(AU)

[Choroidal melanoma in ocular melanosis]. / Melanoma de coroides en melanosis óculi.

CASES: We present four cases of ocular melanosis. Choroidal melanoma was detected in all of them. Three eyes had decreased visual acuity and were enucleated because of their large, active tumours. In the fourth case the melanoma was detected in a routine examination and we were able to apply a preserving treatment with I125 brachytherapy. DISCUSSION: Melanosis oculi is often underestimated as a risk factor for uveal melanoma and glaucoma. Ophthalmic surveillance, every 6 or 12 months is important, in patients with ocular melanocytosis for early detection of high risk diseases.

Melanoma de coroides en melanosis óculi / Choroidal melanoma in ocular melanosis

Se presentan cuatro casos de pacientes con signos clínicos de melanosis óculi. En todos se diagnosticó melanoma de coroides. Tres acudieron con disminución de visión en ojo afecto y fueron enucleados por presentar tumores grandes y activos. En el cuarto caso el melanoma fue descubierto en una revisión rutinaria y se pudo aplicar un tratamiento conservador con braquiterapia con I125. Discusión: La melanosis óculi está infravalorada como factor de riesgo para melanoma y glaucoma. Es necesaria una revisión oftalmológica cada 6 ó 12 meses para la detección precoz de enfermedades de alto riesgo en estos pacientes (AU)

Tratamiento de la orbitopatía de Graves / Treatment of Graves ophthalmopathy

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