Neovascularización coroidea secundaria a estrías angioides: un caso familiar / Choroidal neovascularization secondary to angioid streaks: A familial case report

CASO CLÍNICO: Se expone el caso de dos hermanos que presentaron neovascularización coroidea asociada a estrías angioides. Ambos pacientes fueron tratados con una inyección mensual de ranibizumab (Lucentis®) intravítrea durante tres meses. La visión se estabilizó y la angiografía fluoresceínica mostró resolución completa de la neovascularización coroidea. Durante el seguimiento, no observamos recurrencia del cuadro. DISCUSIÓN: El uso de ranibizumab intravítreo en caso de neovascularización coroidea asociada a estrías angioides ha mostrado resultados favorables. No obstante, serán necesarias series de casos mayores que nos permitan conocer la verdadera eficacia de este tratamiento

CASE REPORT: We report a familial case of 2 brothers that suffered choroidal neovascularization (CNV) secondary to angioid streaks. They were both treated with a monthly intravitreal injection of ranibizumab (Lucentis®) for 3 months. Visual acuity was stabilized and fluorescein angiography revealed complete resolution of CNV. Neither recurrent CNV lesion nor new hemorrhages were reported during the follow-up period. Discussion: The use of intravitreal ranibizumab for the treatment of CNV in patients with angioid streaks has shown favorable results. However, further studies with a longer follow-up and larger number of patients are necessary to more precisely determine the results of this therapy

[Choroidal neovascularization secondary to angioid streaks: A familial case report]. / Neovascularización coroidea secundaria a estrías angioides: un caso familiar.

CASE REPORT: We report a familial case of 2 brothers that suffered choroidal neovascularization (CNV) secondary to angioid streaks. They were both treated with a monthly intravitreal injection of ranibizumab (Lucentis(®)) for 3 months. Visual acuity was stabilized and fluorescein angiography revealed complete resolution of CNV. Neither recurrent CNV lesion nor new hemorrhages were reported during the follow-up period. DISCUSSION: The use of intravitreal ranibizumab for the treatment of CNV in patients with angioid streaks has shown favorable results. However, further studies with a longer follow-up and larger number of patients are necessary to more precisely determine the results of this therapy.

[Sauvé-Kapandji procedure in distal radioulnar joint disorders]. / Procedimiento de Sauvé-Kapandji en los trastornos de la articulación radiocubital distal.

OBJECTIVE: To evaluate the functional and subjective results of the Sauvé-Kapandji procedure as a treatment for distal radioulnar joint disorders. MATERIAL AND METHOD: A retrospective study was conducted on 27 patients treated using the Sauvé-Kapandji technique from January 2001 to March 2012. The aetiología, age, sex, laterality, articular movement, radiographical signs of joint degeneration, and cubitus varus, were analysed. The Mayo Clinic wrist assessment scale and the DASH questionnaire were used for the postoperative evaluation. The mean follow-up was 24 months (6-48 months). The mean age was 47.2 years, with 66.7% females, and 55% the dominant side. RESULTS: At one year after surgery, 16 cases had mild or no pain (59.2%), 8 cases with moderate (29.6%) and 3 cases with severe pain (11.1%). The pronation-supination went from a pre-operative average of 96.8° to 136.4° postoperative, operatorios, which was a significant statistical difference (Wilcoxon test). The radioulnar ratio went from an pre-operative average of +2.6mm to -0.39 mm postoperative. Full functional recovery was observed in 48%. A grip strength of 50.6%, compared to the contralateral wrist was achieved. CONCLUSIONS: The Sauvé-Kapandji technique could avoid the complications common in other procedures, such as cubital-carpal migration. Our study agrees with that in the literature with good results as regards the range of joint movement, with an acceptable improvement in pain compared to the previous stage, but it also demonstrates the frequent loss of grip strength and instability of the proximal radio-ulnar joint.

[Radiologic study on postnatal ossification of the first metatarsal bone]. / Estudio radiológico sobre la osificación postnatal del primer metatarsiano.

BACKGROUND: Classical descriptions of the ossification of the first metatarsal bone show the existence of a single proximal secondary ossification nucleus, mimicking the typical ossification of a phalanx. However, there are studies that show the presence of a second distal ossification nucleus and discuss its nature: epiphysis or pseudoepiphysis. The objective of the study is to establish the prevalence of such distal nucleus, determine its role in the growth of the radius and its relation with different qualitative variables. MATERIAL AND METHODS: We conducted a retrospective study that included 971 dorsoplantar images from 225 patients. We analyzed the presence of such nucleus, the age of appearance and closure, the relation with different qualitative variables and their contribution to the longitudinal growth of the first metatarsal bone. RESULTS: The distal ossification nucleus appears in 40% of all images and in 81.1% of cases ages 4-7 years. Mean age of appearance is 3.07 years, while physeal closure occurs at a mean of 7.67 years. We found a significantly higher frequency of physeal closure in children, patients with Egyptian type foot, flat foot, and index-plus and Egyptian type foot combinations. The definitive length of the first metatarsal bone is greater in patients with a distal ossification nucleus. CONCLUSIONS: We may state the presence of the distal ossification nucleus of the first metatarsal bone that behaves as a fertile growth cartilage.

[HIV retinal vasculitis]. / Vasculitis retiniana por VIH.

CASE REPORT: We present a case of a 47 year-old woman, infected with human immunodeficiency virus (HIV) diagnosed 5 years ago without receiving any treatment, who had floaters in her left eye. A peripheral retinal vasculitis was discovered and confirmed by an angiography. No source of infection was found, antiretroviral and corticosteroid treatment was given, with a complete resolution of the vasculitis. DISCUSSION: From 70-80% of positive untreated HIV patients develop ocular complications, with intraocular inflammation in more than half of them. Intraocular inflammation can be associated with opportunistic infections, tumours and as in our case, secondary to the HIV. Antiretroviral therapy is the proper treatment in these patients.

Vasculitis retiniana por VIH / HIV retinal vasculitis

Caso clínico: Mujer de 47 años con infección por el virus de la inmunodeficiencia humana(VIH) de 5 años de evolución sin tratamiento que acude por miodesopsias. Se le halla unfoco de vasculitis retiniana periférica en el ojo izquierdo (OI) confirmado angiográficamente.Se descarta otra patología infecciosa por parte de Medicina Interna y se inicia tratamientoantirretroviral y corticoideo sistémico, con resolución del foco de vasculitis.Discusión: Entre un 70 y un 80% de los pacientes positivos para VIH sin tratamiento desarrollancomplicaciones oculares, con inflamación intraocular en más de la mitad de ellos.La inflamación intraocular puede ser debida a infecciones oportunistas, neoplasias y, comoen nuestro caso, secundarias al propio virus. En estos pacientes el tratamiento antirretroviralconsigue la resolución del cuadro(AU)

Case report: We present a case of a 47 year-old woman, infected with humanimmunodeficiency virus (HIV) diagnosed 5 years ago without receiving any treatment, whohad floaters in her left eye. A peripheral retinal vasculitis was discovered and confirmed byan angiography. No source of infection was found, antiretroviral and corticosteroidtreatment was given, with a complete resolution of the vasculitis.Discussion: From 70-80% of positive untreated HIV patients develop ocular complications,with intraocular inflammation in more than half of them. Intraocular inflammation can beassociated with opportunistic infections, tumours and as in our case, secondary to the HIV.Antiretroviral therapy is the proper treatment in these patients(AU)

Cambios morfológicos maculares tras cirugía de cataratas: factores de riesgo / Morphological macular changes after cataract surgery: risk factors

Objetivos: Analizar cambios en la morfologíamacular tras cirugía no complicada de cataratas y sucorrelación con la edad y la hipertensión arterial.Métodos: Se realizaron medidas del volumenmacular total (TMV), volumen foveal (FOVOL) yespesor foveal (FOV) con OCT3 Stratus® enpacientes sometidos a cirugía de catarata antes de lacirugía, el día después y un mes después de la misma.Los datos fueron analizados utilizando SPSS15.0 software.Resultados: Se incluyeron 114 ojos de 114 pacientes.Los valores medios de TMV, FOVOL y FOV enel subgrupo con Signal Strength por encima de 6,antes de la cirugía de catarata fueron6,59 DE 0,67 μm3; 0,16 DE 0,02 μm3 and204,97 DE 29,79 μm. Un mes después de la cirugíade cataratas las mediciones fueron TMV:6,93 DE 0,56 μm3; FOVOL: 0,17 DE 0,06 μm3 yFOV: 218,07 DE 87,60 μm. Encontramos diferenciasestadísticamente significativas (P<0,05) en elvolumen macular total, no así en el espesor o volumenfoveal. El grupo de pacientes menores de 74años mostraron un mayor incremento en TMV. Lospacientes con hipertensión arterial no mostraron un mayor incremento en TMV ni FOV que aquellos sinhipertensión arterial.Conclusiones: Encontramos un edema macularsub-morfológico un mes después de la cirugía nocomplicada de cataratas, siendo la edad un factor deriesgo para desarrollar un mayor incremento enTMV. Por otro lado la hipertensión arterial no pareceser un factor de riesgo para que se produzcandichos cambios(AU)

Objective: To analyze morphological macularchanges after uncomplicated cataract surgery andtheir correlation with age and arterial hypertension.Methods: Total macular volume (TMV), fovealvolume (FOVOL) and foveal thickness (FOV) inpatients who had undergone cataract surgery weremeasured using OCT3 Stratus® before surgery, theday after the intervention and one month later. Thedata were analyzed using SPSS 15.0 software.Results: The study group was composed of 114eyes from 114 patients. The mean TMV, FOVOLand FOV in the subgroup of patients with signalstrength over 6 before cataract surgery were 6.59(SD0.67) μm3; 0.16 (SD0.02) μm3 and 204.97(SD29.79) μm. One month after surgery the measurementswere TMV: 6.93 (SD0.56) μm3; FOVOL:0.17 (SD0.06) μm3 and FOV: 218.07 (SD87.60)μm. We found statistically significant differences(P<0.05) in TMV, but not in FOVOL or FOV. Thegroup of patients under 74 years showed a greaterincrease in TMV. Patients with arterial hypertensiondid not show an increase in TMV or FOV comparedto patients without arterial hypertension. Conclusions: We found a sub-morphologicalmacular oedema one month after uncomplicatedcataract surgery, with age being a risk factor fordeveloping a greater increase in TMV. Arterialhypertension does not seem to be a risk factor forthese changes(AU)

[Retinal nerve fiber layer changes after cataract surgery measured by OCT: a pilot study]. / Cambios en el espesor de la capa de fibras nerviosas tras cirugía de cataratas medidos con OCT: un estudio piloto.

PURPOSE: To analyze changes in peripapillary retinal nerve fiber layer (RNFL) after cataract surgery. METHODS: The average RFNL thickness of patients who underwent cataract surgery was measured using the optical coherence tomography (OCT) III Stratus(R) before surgery, the day after and one month later. The data were analyzed using the SPSS 12.0 software. We used paired two tail student's t test for comparisons. RESULTS: The study group was composed by 74 eyes of 74 patients. The RNFL thickness average was 90.71 microm (SD: 19.93), 88.30 microm (SD: 20.59) and 97.45 microm (SD: 14.30), before cataract surgery (AVGT0), the day after surgery (AVGT1) and one month later (AVGT2) respectively. We did not find statistically significant difference between AVGT0 and AVGT1 (P=0.37); however, statistically significant difference between AVGT1 and AVGT2 (P= 0.002) as well as in the image signal quality between AVGT0 and AVGT2 (P= 0.0001). CONCLUSIONS: The RNFL average thickness measured by OCT III Stratus showed an increase one month after cataract surgery. This phenomenon is accompanied with an improvement in signal quality.

[Corneal melting and topical nonsteroidal anti-inflammatory drug (NSAID). A case report]. / Relación entre anti-inflamatorios no esteroideos (AINES) y queratolisis. A propósito de un caso.

PURPOSE: To study the relationship between the use of nonsteroidal anti-inflammatory drug (NSAID) and the corneal melting. CASE REPORT: We report a case of keratolysis after vitreoretinal surgery and topical use of ketorolac tromethamine (Acular). DISCUSSION: It is proposed the multifactorial etiology in the cases of corneal melting related to the use of NSAID and it is recommended an reasonable use of them in each situation and to check the possible comorbility of other agents.

Cambios en el espesor de la capa de fibras nerviosas tras cirugía de cataratas medidos con OCT: un estudio piloto / Retinal nerve fiber layer changes after cataract surgery measured by OCT: a pilot study

Objetivos: Analizar cambios en el espesor de lacapa de fibras nerviosas de la retina (CFNR) peripapilartras cirugia de cataratas.Metodos: Medicion del espesor medio de laCFNR de pacientes sometidos a cirugia de cataratasutilizando tomografia de coherencia optica(OCT) III StratusR antes de la cirugia, un dia despuesde la intervencion y transcurrido un mes. Losdatos fueron analizados mediante el programainformatico SPSS 12.0. Los resultados fueroncomparados empleando el test pareado de doscolas t de Student.Resultados: El grupo de estudio estaba compuestode 74 ojos de 74 pacientes. El espesor medio de laCFNR antes de la cirugia de cataratas (AVGT0) fue90,71 ƒÊm (DE: 19,93), el dia despues de la cirugia(AVGT1) fue 88,30 ƒÊm (DE: 20,59); y un mes despues(AVGT2) 97,45 ƒÊm (DE: 14,30). No se encontrarondiferencias estadisticamente significativasentre AVGT0 y AVGT1 (P=0,37); sin embargo,dicha diferencia si se encontro entre AVGT1 yAVGT2 (P= 0,002). Tambien se encontro diferenciaestadísticamente significativa en la calidad de señalde la señal entre AVGT0 y AVGT2 (P=0,0001).Conclusiones: El espesor medio de la capa defibras nerviosas experimenta un incremento cuandoes medido mediante OCT III Stratus® un mes tras lacirugía de cataratas. Este fenómeno se acompaña deuna mejoría en la calidad de la señal(AU)

Purpose: To analyze changes in peripapillary retinalnerve fiber layer (RNFL) after cataract surgery.Methods: The average RFNL thickness of patientswho underwent cataract surgery was measuredusing the optical coherence tomography (OCT) IIIStratusR before surgery, the day after and onemonth later. The data were analyzed using the SPSS12.0 software. We used paired two tail studentLs ttest for comparisons.Results: The study group was composed by 74 eyesof 74 patients. The RNFL thickness average was90.71 ƒÊm (SD: 19.93), 88.30 ƒÊm (SD: 20.59) and97.45 ƒÊm (SD: 14.30), before cataract surgery(AVGT0), the day after surgery (AVGT1) and onemonth later (AVGT2) respectively. We did not findstatistically significant difference between AVGT0and AVGT1 (P=0.37); however, statistically significantdifference between AVGT1 and AVGT2 (P=0.002) as well as in the image signal quality betweenAVGT0 and AVGT2 (P= 0.0001).Conclusions: The RNFL average thickness measuredby OCT III StratusR showed an increase one month after cataract surgery. This phenomenon isaccompanied with an improvement in signal quality(AU)

Relación entre anti-inflamatorios no esteroideos (AINEs) y queratolisis. A propósito de un caso / Corneal melting and topical nonsteroidal anti-inflammatory drug (NSAID). A case report

Objetivo: Establecer la posible relación entre eluso de los antiinflamatorios no esteroideos (AINEs)tópicos y la queratolisis.Caso clínico: Se presenta un caso de queratolisistras cirugía vitreorretiniana y uso tópico de ketorolacotrometamol (Acular®).Discusión: Se plantea la etiología multifactorial enlos casos de queratolisis asociados al uso de AINEsy recomendando un uso de los mismos adecuado acada situación, valorando la posible comorbilidad de otros agentes(AU)

Purpose: To study the relationship between the useof nonsteroidal anti-inflammatory drug (NSAID)and the corneal melting.Case report: We report a case of keratolysis aftervitreoretinal surgery and topical use of ketorolactromethamine (Acular®).Discussion: It is proposed the multifactorial etiologyin the cases of corneal melting related to theuse of NSAID and it is recommended an reasonableuse of them in each situation and to check the possiblecomorbility of other agents(AU)

[Morphological macular changes after cataract surgery: risk factors]. / Cambios morfológicos maculares tras cirugía de cataratas: factores de riesgo.

OBJECTIVE: To analyze morphological macular changes after uncomplicated cataract surgery and their correlation with age and arterial hypertension. METHODS: Total macular volume (TMV), foveal volume (FOVOL) and foveal thickness (FOV) in patients who had undergone cataract surgery were measured using OCT3 Stratus before surgery, the day after the intervention and one month later. The data were analyzed using SPSS 15.0 software. RESULTS: The study group was composed of 114 eyes from 114 patients. The mean TMV, FOVOL and FOV in the subgroup of patients with signal strength over 6 before cataract surgery were 6.59 (SD0.67) microm(3); 0.16 (SD0.02) microm(3) and 204.97 (SD29.79) microm. One month after surgery the measurements were TMV: 6.93 (SD0.56) microm(3); FOVOL: 0.17 (SD0.06) microm(3) and FOV: 218.07 (SD87.60) microm. We found statistically significant differences (P<0.05) in TMV, but not in FOVOL or FOV. The group of patients under 74 years showed a greater increase in TMV. Patients with arterial hypertension did not show an increase in TMV or FOV compared to patients without arterial hypertension. CONCLUSIONS: We found a sub-morphological macular oedema one month after uncomplicated cataract surgery, with age being a risk factor for developing a greater increase in TMV. Arterial hypertension does not seem to be a risk factor for these changes.

Paquimeningitis hipertrófica y alteraciones oftalmológicas: descripción de dos casos clínicos / Hypertrophic pachymeningitis and ophthalmological disturbances: description of two case reports

Caso clínico: Presentamos dos casos de paquimeningitis hipertrófica con alteraciones oftalmológicas asociadas. Uno de los pacientes presentó paquimeningitis hipertrófica presuntamente secundaria a neurosarcoidosis focal y paresia del sexto par. La segunda paciente presentó paquimeningitis hipertrófica crónica idiopática (tipo poco frecuente) difusa con alteraciones de la motilidad ocular y en la visión. Discusión: La paquimeningitis hipertrófica es una patología con un amplio espectro de etiologías y manifestaciones clínicas, que debe ser tenida en cuenta en el diagnóstico de alteraciones de la motilidad ocular

Case reports: We report two cases of hypertrophic pachymeningitis with ophthalmological disturbances. One patient suffered from hypertrophic pachymeningitis supposedly secondary to a focal neurosarcoidosis and had a sixth nerve paresis. The second patient suffered from a diffuse idiopathic hypertrophic chronic pachymeningitis (a rare form) and displayed disturbances in vision and ocular motility. Discussion: Hypertrophic pachymeningitis is a condition with a wide spectrum of etiologies and clinical manifestations, and needs to be considered as the cause in patients with alterations in ocular motility (Arch Soc Esp Oftalmol 2008; 83: 497-500)

[Hypertrophic pachymeningitis and ophthalmological disturbances: description of two case reports]. / Paquimeningitis hipertrófica y alteraciones oftalmológicas: descripción de dos casos clínicos.

CASE REPORTS: We report two cases of hypertrophic pachymeningitis with ophthalmological disturbances. One patient suffered from hypertrophic pachymeningitis supposedly secondary to a focal neurosarcoidosis and had a sixth nerve paresis. The second patient suffered from a diffuse idiopathic hypertrophic chronic pachymeningitis (a rare form) and displayed disturbances in vision and ocular motility. DISCUSSION: Hypertrophic pachymeningitis is a condition with a wide spectrum of etiologies and clinical manifestations, and needs to be considered as the cause in patients with alterations in ocular motility

[Eclipse retinopathy: three case reports]. / Retinopatía por eclipse. A propósito de tres casos.

CASE REPORT: We present the evolution of eclipse retinopathy in 3 patients who came to our hospital after the eclipse of October 2005 and had foveal lesions and visual field alterations. DISCUSSION: Eclipse retinopathy is a maculopathy that occurs after exposure to intense solar radiation, such as occurs during an eclipse, and is produced by a photochemical mechanism. Although the macular changes and symptoms are usually reversible, residual defects at the level of the EPR and scotoma in visual fields can occur. For these reasons the most appropriate treatment is prevention by means of public awareness campaigns.

[Brown-McLean syndrome after insertion of an anterior chamber intraocular lens: description of one case]. / Síndrome de Brown-McLean con lente intraocular de cámara anterior: descripción de un caso.

CASE REPORT: We report one case of Brown-McLean syndrome. DISCUSSION: In this case, a 71-year-old male developed a Brown-McLean syndrome after implantation of an anterior chamber lens in one aphakic eye. A phacoemulsification procedure was performed in the other eye without development of corneal clearance alterations in the next 7 years. The cause of Brown-McLean syndrome is still unexplained. It is possible that it could develop in eyes with a genetic predisposition when these eyes are exposed to certain conditions, such as insertion of an anterior chamber lens.

Síndrome de Brown-McLean con lente intraocular de cámara anterior: descripción de un caso / Brown-McLean syndrome after insertion of an anterior chamber intraocular lens: description of one case

Caso clínico: Se presenta un caso de síndrome de Brown-McLean. Discusión: Un varón de 71 años de edad desarrolló un síndrome de Brown-McLean tras el implante de una lente de cámara anterior en un ojo afáquico. Se realizó facoemulsificación en el ojo contralateral sin desarrollo de alteraciones en la transparencia corneal. El síndrome de Brown-McLean tiene un origen incierto todavía. Probablemente, se desarrolle en ojos con predisposición genética expuestos a ciertas condiciones, como por ejemplo lentes de cámara anterior

Case report: We report one case of Brown-McLean syndrome. Discussion: In this case, a 71-year-old male developed a Brown-McLean syndrome after implantation of an anterior chamber lens in one aphakic eye. A phacoemulsification procedure was performed in the other eye without development of corneal clearance alterations in the next 7 years. The cause of Brown-McLean syndrome is still unexplained. It is possible that it could develop in eyes with a genetic predisposition when these eyes are exposed to certain conditions, such as insertion of an anterior chamber lens