Management of corneal neurotrophic ulcers with Cacicol®-RGTA (ReGeneraTing Agent): a case series. / Manejo de las úlceras corneales neurotróficas con Cacicol®- ReGeneraTing Agent: serie de casos.

PURPOSE: Neurotrophic corneal ulcers are difficult to treat, and the conventional treatment often results in failure. A new matrix regenerating agent ("ReGeneraTing Agents"), Cacicol® (Laboratoires Théa), has demonstrated good results over the last few years. Therefore, the aim of this study was to evaluate the response to Cacicol® in a series of cases with neurotrophic corneal ulcers. METHODS: Retrospective case series looking at 11 patients with corneal ulcers unresponsive to conventional therapy that underwent treatment with Cacicol®. One cycle included 1 drop every two days for 5 days. RESULTS: The range of conventional therapy prior to Cacicol® was 0-91 days. On introducing Cacicol® 82% (9/11) of the cases were cured, and 18% (2/11) failed, requiring an amniotic membrane transplant or penetrating keratoplasty. The healing only required one cycle of Cacicol® in 67% (6/9) of the patients. More than one cycle of Cacicol® was needed in 45% (5/11) patients. One corneal bacterial ulcer responded favourably and one case related to Acanthamoeba did not respond. Most of the patients improved or maintained their visual acuity. CONCLUSION: Cacicol® was a useful therapy in a high number of difficult neurotrophic corneal ulcers, including corneal infections. Some cases may require more than one cycle of Cacicol® or used as first-line treatment in order to achieve the desired result.

ADenoVirus Initiative Study in Epidemiology (ADVISE): Results of a multicentric epidemiology study in Spain. / ADenoVirus Initiative Study in Epidemiology (ADVISE): resultados de un estudio epidemiológico multicéntrico en España.

OBJECTIVE: Non-interventional, observational, epidemiology study to assess clinical characteristics and frequency of adenovirus conjunctivitis diagnosed by AdenoPlus® in patients who presented with signs and symptoms of acute conjunctivitis. Safety aspects during use of the test were analyzed as well. METHOD: This analysis presents the data obtained from the 386 patients enrolled in Spain. Patients had to present with acute signs and symptoms of conjunctivitis ≤7days. The minimum age was 1year old. Patients who had already used local antiviral therapies, topical steroids or immuno-modulators were not allowed to enter the study. A standardized questionnaire was used to collect patient's ocular history and test results. RESULTS: A total of 386 patients were recruited in 22 sites, being analyzed 329 patients. Among them, the percentage of "AdenoPlus® positive" was 36,2% (119/329). Before the test was performed, in 84,1% of the cases, investigators believed that the conjunctivitis was of viral origin but only 50,3% of the investigators had their clinical assessment confirmed by the test. Patients who tested positive for adenoviral conjunctivitis presented higher percentages of signs and symptoms than the rest of the patients. CONCLUSIONS: None of the signs or symptoms could be qualified as pathognomonic of the disease, being difficult for the clinicians to perform an accurate diagnosis. AdenoPlus® test is an antigen based immunoassay test that detects the presence of adenovirus directly from tears, and it can be an useful tool to help early differential diagnosis in patients with conjunctivitis signs and symptoms lasting for less than or equal to 7days.

Visual snow in a paediatric patient. / Nieve visual en un paciente pediátrico.

CASE REPORT: The case is presented of an 11 year-old girl referring to a one year history of photophobia and continuously seeing white spots in both eyes. The patient had a visual acuity of unity in both eyes, and a normal eye examination, and was referred to the Neuro-ophthalmology Unit. Once complete laboratory and imaging tests ruled out the possibility of any neurological pathology, she was diagnosed with visual snow (VS). DISCUSSION: VS is an isolated symptom, possibly part of the migraine aura, that is referred by patients reporting numerous and constant white dots moving in the visual field of BE. It can significantly interfere with patient's daily activities by altering their quality of life, and ending up as a misdiagnosis. Paediatric patients also present a diagnostic challenge due to the complex interpretation that the presence of VS involves in them.

Arteriovenous malformation of the iris. Two cases. / Malformación arteriovenosa iridiana. Dos casos.

CASE REPORT: A 50-year-old patient was seen during a regular follow up. The main complaint was decreased near-sight vision. Biomicroscopy showed a vascular malformation on the temporal sector of the iris in the left eye, diagnosed as an arteriovenous malformation. A second case of similar features is also presented. DISCUSSION: The vascular malformations of the iris may be asymptomatic and go unnoticed or cause recurrent spontaneous hyphemas. Treatment must be individualised and may range from observation to photocoagulation with laser, or even surgery.