Retinopatía por radiación secundaria a tratamiento de carcinoma de seno maxilar: un caso dramático / Radiation retinopathy secondary to treatment of maxillary sinus carcinoma: a dramatic case

Caso clínico: Un varón de 53 años consulta por pérdida de visión en ojo derecho tras irradiación de carcinoma de seno maxilar derecho. La exploración funduscópica muestra hemorragias, exudados, edema macular e isquemia retiniana periférica, compatibles con una retinopatía por radiación. La evolución es tórpida a pesar de tratamiento con láser e inyecciones intravítreas de bevacizumab, finalizando en evisceración del ojo afecto. Discusión: La retinopatía por radiación debe tenerse en cuenta ante cualquier pérdida de visión tras irradiación de cabeza y cuello. El seguimiento oftalmológico a largo plazo de estos pacientes es fundamental para conseguir un diagnóstico precoz (AU)

Clinical case: A 53-year old male presented with visual impairment in right eye after irradiation of right maxillary sinus carcinoma. Funduscopy shows radiation retinopathy: haemorrhages, exudates, macular oedema, and peripheral retinal ischaemia. A poor outcome was achieved despite laser treatment and intravitreal injections of bevacizumab, resulting in evisceration of the affected eye. Discussion: Radiation retinopathy must be considered in any loss of vision after head and neck irradiation. Ophthalmological long-term follow-up of these patients is essential for an early diagnosis (AU)

Radiation retinopathy secondary to treatment of maxillary sinus carcinoma: a dramatic case. / Retinopatía por radiación secundaria a tratamiento de carcinoma de seno maxilar: un caso dramático.

CLINICAL CASE: A 53-year old male presented with visual impairment in right eye after irradiation of right maxillary sinus carcinoma. Funduscopy shows radiation retinopathy: haemorrhages, exudates, macular oedema, and peripheral retinal ischaemia. A poor outcome was achieved despite laser treatment and intravitreal injections of bevacizumab, resulting in evisceration of the affected eye. DISCUSSION: Radiation retinopathy must be considered in any loss of vision after head and neck irradiation. Ophthalmological long-term follow-up of these patients is essential for an early diagnosis.

Edema de papila y obstrucción de arteria y vena central de la retina como manifestación inicial de una recaída leucémica / Unilateral optic disk edema with central retinal artery and vein occlusions as the presenting signs

CASO CLÍNICO: Varón con amaurosis en ojo derecho y diagnóstico previo de leucemia linfoblástica aguda con cromosoma Philadelphia positivo (LAL Ph+). Presenta edema sectorial del disco óptico y, posteriormente, obstrucción de arteria y vena central de la retina. Se realiza panfotocoagulación retiniana y tratamiento radioterápico holocraneal. A los 4 meses sufre recaída hematológica, siendo finalmente exitus. DISCUSIÓN: La afectación del nervio óptico puede presentarse como único hallazgo en una recurrencia de una LAL, precediendo incluso a la recaída hematológica. Constituye por tanto una urgencia no solo visual sino, sobre todo, vital, que precisa de un tratamiento intensivo muchas veces complementado con radioterapia

CLINICAL CASE: A 39-year-old man with Philadelphia chromosome-positive acute lymphoblastic leukemia (LAL Ph+) developed progressive vision loss to no light perception in his right eye. He had optic disk edema and later developed central artery and vein occlusions. Pan-photocoagulation, as well as radiotherapy of the whole brain were performed in several fractions. Unfortunately the patient died of hematological relapse 4 months later. DISCUSSION: Optic nerve infiltration may appear as an isolated sign of a leukemia relapse, even before a hematological relapse occurs. Leukemic optic neuropathy is a critical sign, not only for vision, but also for life, and radiotherapy should be immediately performed before irreversible optic nerve damage occurs

Unilateral optic disk edema with central retinal artery and vein occlusions as the presenting signs of relapse in acute lymphoblastic leukemia.

CLINICAL CASE: A 39-year-old man with Philadelphia chromosome-positive acute lymphoblastic leukemia (LAL Ph+) developed progressive vision loss to no light perception in his right eye. He had optic disk edema and later developed central artery and vein occlusions. Pan-photocoagulation, as well as radiotherapy of the whole brain were performed in several fractions. Unfortunately the patient died of hematological relapse 4 months later. DISCUSSION: Optic nerve infiltration may appear as an isolated sign of a leukemia relapse, even before a hematological relapse occurs. Leukemic optic neuropathy is a critical sign, not only for vision, but also for life, and radiotherapy should be immediately performed before irreversible optic nerve damage occurs.

Epiretinal membrane surgery: anatomic and functional outcomes.

OBJECTIVE: To study the influence of anatomic preoperative characteristics (based on the parameter, foveal central thickness, measured by optical coherence tomography) and functional characteristics (based on the parameter, best corrected visual acuity, [BCVA]) on functional recovery after epiretinal membrane (ERM) surgery. METHODS: A total of 88 eyes (of 86 patients), on whom a vitrectomy due to ERM was performed during a 3 years period were reviewed in this longitudinal, prospective study. An analysis was made of, ERM aetiology, BCVA, presence or absence of metamorphopsia, lens status, and central foveal thickness. Data relating to surgery and local complications, changes in BCVA, and changes in foveal central thickness were collected during the follow-up period. RESULTS: An improvement was in observed in BCVA in 82%, as well as a decrease in foveal thickness in 79% of the eyes which underwent surgery, both of these being statistically significant (P<.01). However, most of the patients showed different grades of oedema and/or macular thickening in the postoperative period. A significant correlation was found between preoperative and postoperative BCVA (P=.001), and also between preoperative and postoperative central foveal thickness (P=.004), but not between BCVA and foveal thickness. CONCLUSIONS: There is functional recovery in terms of BCVA in more than 80% of the patients after ERM surgery. Most of the eyes showed persistent macular thickening, but this did not seem to have influenced the final BCVA. The best determinant of postoperative functional recovery (postoperative visual acuity) is, in our experience, the preoperative BCVA, and not the macular thickness.

Cirugía de las membranas epirretinianas: resultados anatómicos y funcionales / Epiretinal membrane surgery: anatomic and functional outcomes

Objetivo: Estudiar la implicación de las características preoperatorias anatómicas (según el parámetro del grosor foveal central, determinado mediante tomografía de coherencia óptica) y funcionales (según el parámetro de la mejor agudeza visual corregida, [MAVC]) en la recuperación funcional tras la cirugía de las membranas epirretinianas maculares (MEM). Métodos: En este estudio prospectivo, longitudinal se incluyeron 88 ojos (de 86 pacientes), intervenidos mediante vitrectomía debido a MEM, en un período de 3 años. Se analizaron: etiología de la MEM, MAVC, existencia o no de metamorfopsia, estado del cristalino, y grosor foveal central. Asimismo se recogieron los datos relativos a la cirugía y las complicaciones derivadas de la misma, así como los cambios observados en la MAVC y en el grosor foveal a lo largo del período de seguimiento. Resultados: Se produjo mejoría de la MAVC en el 82% de los casos, así como una disminución del grosor foveal en el 79% de los casos intervenidos, ambos estadísticamente significativos (p<0,01). Sin embargo, la mayor parte de los pacientes exhibieron grados variables de edema y/o engrosamiento macular en el postoperatorio. Se halló correlación significativa entre la MAVC preoperatoria y postoperatoria (p=0,001), así como entre el grosor foveal central preoperatorio y postoperatorio (p=0,004), pero no entre la MAVC y el grosor foveal. Conclusiones: Se produce una recuperación funcional en términos de MAVC en más del 80% de los pacientes tras cirugía de MEM. La mayor parte de los ojos muestran persistencia del engrosamiento macular, si bien este no parece tener influencia en la agudeza visual final. El mejor determinante de recuperación funcional postoperatoria (agudeza visual postoperatoria) parece ser, en nuestra experiencia, la agudeza visual preoperatoria y no el grosor macular(AU)

Objective: To study the influence of anatomic preoperative characteristics (based on the parameter, foveal central thickness, measured by optical coherence tomography) and functional characteristics (based on the parameter, best corrected visual acuity, [BCVA]) on functional recovery after epiretinal membrane (ERM) surgery. Methods: A total of 88 eyes (of 86 patients), on whom a vitrectomy due to ERM was performed during a 3 years period were reviewed in this longitudinal, prospective study. An analysis was made of, ERM aetiology, BCVA, presence or absence of metamorphopsia, lens status, and central foveal thickness. Data relating to surgery and local complications, changes in BCVA, and changes in foveal central thickness were collected during the follow-up period. Results: An improvement was in observed in BCVA in 82%, as well as a decrease in foveal thickness in 79% of the eyes which underwent surgery, both of these being statistically significant (P<0.01). However, most of the patients showed different grades of oedema and/or macular thickening in the postoperative period. A significant correlation was found between preoperative and postoperative BCVA (P=0.001), and also between preoperative and postoperative central foveal thickness (P=0.004), but not between BCVA and foveal thickness. Conclusions: There is functional recovery in terms of BCVA in more than 80% of the patients after ERM surgery. Most of the eyes showed persistent macular thickening, but this did not seem to have influenced the final BCVA. The best determinant of postoperative functional recovery (postoperative visual acuity) is, in our experience, the preoperative BCVA, and not the macular thickness(AU)

[Intravitreal triamcinolone acetonide use in diffuse persistent diabetic macular edema]. / Uso de triamcinolona intravítrea en el tratamiento del edema macular diabético difuso persistente.

PURPOSE: To determine the efficacy of intravitreal triamcinolone injections (iv TA) for diffuse persistent diabetic macular oedema (DMO) based on the functional parameter of modification in best corrected visual acuity (BCVA) and the anatomic parameter of quantitative changes in central macular thickness, as determined by optical coherence tomography (OCT). The secondary outcome is to analyse the safety of the procedure. METHODS: In this retrospective study, 16 patients (22 eyes) were included over a period of six months. Type and time of evolution of diabetes mellitus, previous treatments, BCVA, lens status, intraocular pressure (IOP) and central macular thickness, were analysed. During the follow-up period were collected: number of injections, changes in BCVA, IOP, central macular thickness, and complications observed. RESULTS: Improvement in BCVA was recorded in 30.77%, 47.37% and 52.63%, at one, three and six months, respectively (P<.05 at 3 months). The IOP increased in 57.69% at one month, and 75 and 47.05%, at 3 and 6 months, respectively (P<.05 at 3 months). Progression of cataracts was found in 22.72%. No cases of endophthalmitis were observed. CONCLUSIONS: Intravitreal TA is a good therapeutic option for patients with persistent DMO, increasing BCVA and decreasing central macular thickness in the short term, with a percentage of clinical resolution of more than 70%. However, due to the transient effect, and potential adverse effects, it should be administered to selected refractory cases with caution.

Uso de triamcinolona intravítrea en el tratamiento del edema macular diabético difuso persistente / Intravitreal triamcinolone acetonide use in diffuse persistent diabetic macular edema

Propósito: Explorar la eficacia de las inyecciones de triamcinolona intravítrea (TA iv) en el edema macular diabético (EMD) difuso persistente, según el parámetro funcional de la modificación en la mejor agudeza visual corregida (MAVC) y el parámetro anatómico del cambio cuantitativo en el espesor foveal central, determinado por tomografía de coherencia óptica (OCT). El objetivo secundario es analizar la seguridad del procedimiento. Métodos: En este estudio retrospectivo se incluyeron 16 pacientes (22 ojos), en un periodo de seis meses. Se analizó tipo y tiempo de evolución de la diabetes mellitus, tratamientos previos, MAVC, estado del cristalino, presión intraocular (PIO) y espesor macular central. A lo largo del seguimiento se recogieron datos relativos al número de inyecciones, así como a cambios en MAVC, PIO, grosor foveal, y complicaciones observadas. Resultados: Se produjo mejoría en la MAVC en el 30,77, 47,37 y 52,63%, al mes, 3 y 6 meses, respectivamente (p<0,05 a los 3 meses). Se observó incremento de la PIO en el 57,69% al mes, y en el 75% y 47,05%, a los 3 y 6 meses (p<0,05 a los 3meses). Se cuantificó una disminución en el grosor foveal al mes, 3 y 6 meses (p<0,05). Se observó progresión de catarata en 22,72%. No se apreció ningún caso de endoftalmitis. Conclusiones: La TA iv es una buena opción terapeútica para los pacientes con EMD persistente, mejorando la MAVC y reduciendo el grosor macular a corto plazo, con porcentajes de resolución clínica de más del 70%. Sin embargo, su efecto transitorio y sus potenciales efectos adversos hacen que deba administrarse en casos refractarios con precaución(AU)

Purpose: To determine the efficacy of intravitreal triamcinolone injections (iv TA) for diffuse persistent diabetic macular oedema (DMO) based on the functional parameter of modification in best corrected visual acuity (BCVA) and the anatomic parameter of quantitative changes in central macular thickness, as determined by optical coherence tomography (OCT). The secondary outcome is to analyse the safety of the procedure. Methods: In this retrospective study, 16 patients (22 eyes) were included over a period of six months. Type and time of evolution of diabetes mellitus, previous treatments, BCVA, lens status, intraocular pressure (IOP) and central macular thickness, were analysed. During the follow-up period were collected: number of injections, changes in BCVA, IOP, central macular thickness, and complications observed. Results: Improvement in BCVA was recorded in 30.77%, 47.37% and 52.63%, at one, three and six months, respectively (P<.05 at 3 months). The IOP increased in 57.69% at one month, and 75 and 47.05%, at 3 and 6 months, respectively (P<.05 at 3 months). Progression of cataracts was found in 22.72%. No cases of endophthalmitis were observed. Conclusions: Intravitreal TA is a good therapeutic option for patients with persistent DMO, increasing BCVA and decreasing central macular thickness in the short term, with a percentage of clinical resolution of more than 70%. However, due to the transient effect, and potential adverse effects, it should be administered to selected refractory cases with caution(AU)

Bevacizumab intravítreo en la neovascularización secundaria a degeneración macular asociada a la edad / No disponible

No disponible

[Posterior segment intraocular foreign bodies. Clinical and epidemiological features]. / Cuerpos extraños intraoculares del segmento posterior. Aspectos clínicos y epidemiológicos.

OBJECTIVES: To evaluate the epidemiologic factors, associated ocular involvement and visual results in patients with intraocular foreign bodies lodged in the posterior segment. METHODS: In this retrospective study, the clinical records of 21 patients admitted to the hospital with intraocular foreign bodies between August 1994 and March 1998 were reviewed and evaluated in regards to age, gender, type of injury, foreign body nature, need for surgical intervention, complications and final visual acuity. RESULTS: All the patients were males, with a mean age of 38.7 years and an average follow-up period of 15.04 months. The foreign bodies were caused by work accidents in 2/3 of the cases and 71.4% involved ferromagnet metal. Sixteen patients underwent vitrectomy to remove the intraocular foreign body. Final visual acuity was equal to or greater than 0.4 in 57.9% of the patients and there was no light perception in 15.7%. The principal late complications were retinal detachment (19.04%), pthisis bulbi (14.2%) and cataracts (9.5%). CONCLUSIONS: Most of the intraocular foreign bodies are found in young males as a consequence of work accidents. Most patients require vitrectomy to remove the foreign body and even though good visual results are obtained in many cases, other cases suffer severe visual loss.

Cuerpos extraños intraoculares del segmento posterior. Aspectos clínicos y epidemiológicos / Posterior segment intraocular foreign bodies. Clinical and epidemiological features

Objetivos: Evaluar los factores epidemiológicos, grado de afectación ocular y resultados funcionales en los pacientes con cuerpos extraños intraoculares del segmento posterior. Métodos: En este estudio retrospectivo, se revisaron las historias clínicas de 21 pacientes atendidos en nuestro servicio entre agosto del 94 y marzo del 98 y se analizaron su edad, sexo, tipo de herida, naturaleza del cuerpo extraño intraocular, necesidad de cirugía, complicaciones y resultados funcionales. Resultados: Todos los pacientes eran varones, con una edad media de 38,7 años y un tiempo de seguimiento medio de 15,04 meses. Los cuerpos extraños procedían de accidentes laborales en las 2/3 partes y el 71,4 por ciento eran metálicos ferromagnéticos. 16 pacientes precisaron vitrectomía con extracción del cuerpo extraño por pars plana. La agudeza visual final fue igual o mayor de 0,4 en 57,9 por ciento de pacientes. Las principales complicaciones tardías fueron el desprendimiento de retina (19,04 por ciento de pacientes), ptisis bulbi (14,2 por ciento) y cataratas (9,5 por ciento).Conclusiones: Los cuerpos extraños intraoculares afectan sobre todo a varones jóvenes como consecuencia de accidentes laborales. La mayoría precisan una vitrectomía para extraer el cuerpo extraño y, aunque en muchos casos los resultados funcionales son buenos, en otros casos conllevan una pérdida importante de agudeza visual (AU)