Parálisis facial periférica recidivante como manifestación inicial del síndrome de Melkersson-Rosenthal / Recurrent peripheral facial palsy as an initial manifestation of Melkersson-Rosenthal syndrome

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Amiloidosis conjuntival primaria y conjuntivitis alérgica / Primary conjunctival amyloidosis and allergic conjunctivitis

La amiloidosis conjuntival primaria es una enfermedad rara, de etiopatogenia desconocida, secundaria al depósito de material amiloide en la sustancia propia conjuntival produciendo una tumoración. En el caso que presentamos, la concurrencia de conjuntivitis alérgica y el rascado ocular crónico podrían ser los desencadenantes de la producción desmesurada de inmunoglobulinas. El depósito localizado de cadenas ligeras de inmunoglobulinas insolubles en la sustancia propia conjuntival genera esta masa conjuntival

Primary conjunctival amyloidosis is a rare disease of unknown origin, secondary to the deposit of amyloid material within the conjunctiva itself, producing a tumour. In the case presented, the concurrence of allergic conjunctivitis and chronic eye scratching could be triggers of the excessive production of immunoglobulins. The deposit of insoluble immunoglobulin light chains located within the conjunctiva itself causes this conjunctival mass

Tomografía de coherencia óptica de segmento anterior de alta resolución como método de diagnóstico diferencial entre neoplasia intraepitelial córneo-conjuntival y pterygium / High resolution anterior segment optical coherence tomography for differential diagnosis between corneo-conjunctival intraepithelial neoplasia and pterygium

OBJETIVO: Valorar si la tomografía de coherencia óptica de segmento anterior (OCT-SA) es un método de diagnóstico no invasivo adecuado para diferenciar lesiones córneo-conjuntivales benignas (pterygium) de las premalignas (neoplasia intraepitelial córneo-conjuntival [CIN]). MATERIAL Y MÉTODOS: Estudio observacional, analítico y transversal de 22 ojos con diagnóstico de sospecha de pterygium y CIN durante 2 años. Con la OCT-SA se estudiaron las características morfológicas y se compararon espesores epiteliales (EE) y grado de extensión sobre la superficie corneal (GIC). Posteriormente se confirmó el diagnóstico con el estudio histopatológico tras exéresis quirúrgica. RESULTADOS: La edad media de los pacientes con pterygium (n = 18) fue de 52,67 ± 15 años y 74 ± 12 años en los sujetos con CIN (n = 4) (p < 0,021). En los pterygium, la OCT-SA mostró EE normal, adelgazado o levemente aumentado (77,4 ± 26 μm), además de aumento del tejido subepitelial en forma de cuña. Los CIN presentaron un aumento del EE (262,5 ± 124 μm), que era fuertemente hiperreflectivo, con transición abrupta entre epitelio sano y patológico. El análisis de los EE en OCT-SA entre pterygium y CIN reveló diferencias estadísticamente significativas (p < 0,002). La curva ROC reveló una sensibilidad y especificidad del 100% de la OCT-SA en la diferenciación entre CIN y pterygium, utilizando EE de 141μm como punto de corte. CONCLUSIÓN: La OCT-SA es una herramienta útil para la diferenciación entre pterygium y CIN, ya que proporciona características morfológicas típicas. Un aumento del espesor del EE córneo-conjuntival mayor de 141 μm en OCT-SA sugiere una sensibilidad y especificidad del 100% para diagnosticar CIN

OBJECTIVE: To assess if anterior segment optical coherence tomography (AS-OCT) is a noninvasive diagnostic method suitable to differentiate benign corneo-conjunctival lesions (pterygium) from premalignant lesions (corneo-conjunctival intraepithelial neoplasia, CIN). MATERIAL AND METHODS: An observational, analytical and cross-sectional study was conducted in 22 eyes with conjunctival lesions clinically suspicious for pterygium and CIN during two years. Morphological differences between both lesions were studied with AS-OCT; epithelial thicknesses (EE) and extension length on corneal surface (GIC) were compared between both groups. A surgical excision of the lesion was performed for histopathological diagnosis. RESULTS: Mean age of patients with pterygium (n = 18) was 52.67 ± 15 y.o and 74 ± 12 y.o in subjects with CIN (n = 4) (p < 0.021). In pterygia, AS-OCT showed typical features (normal, thinning or slightly thickened EE; 77.4 ± 26 μm), in addition to an increase in wedge-shaped subepithelial tissue. Patients with CIN had a mean thickened EE (262.5 ± 124μm) and strongly hyperreflective, with abrupt transition between normal and pathological epithelium. Analysis of EE between subjects with pterygium and CIN revealed statistically significant differences (p < 0.002). ROC curve revealed a 100% sensitivity and specificity of OCT-SA in differentiation between CIN and pterygium, using 141μm as cutoff point of EE. CONCLUSION: AS-OCT is a useful tool for the differentiation between pterygium and CIN able to provide typical morphological characteristics. An EE greater than 141 μm in AS-OCT suggests a sensitivity and specificity of 100% for the diagnosis of CIN

Morfología de las glándulas de Meibomio valorada por meibografía en pacientes con displasia ectodérmica hipohidrótica / Morphology of the Meibomian gland evaluated using meibography in patients with hypohidrotic ectodermal displasia

Introducción: La displasia ectodérmica hipohidrótica (DEH) es una enfermedad rara caracterizada por la anormal formación de los tejidos derivados del ectodermo. La hipoplasia de las glándulas de Meibomio es una de las manifestaciones oftalmológicas más frecuentes en estos pacientes. Se planteó estudiar la morfología de las glándulas de Meibomio mediante meibografía en un grupo de pacientes con DEH y compararlo con un control. Métodos: Se incluyeron 14 ojos de 7 pacientes diagnosticados de DEH. Y un grupo control con 32 ojos de 16 pacientes. Se les realizó un estudio meibográfico mediante el analizador corneal CA-800 de Topcon®. Se usó una escala meibográfica para valorar el grado de atrofia glandular. Grado 0, sin alteraciones, grado 1 afectación < 25% de ácinos glandulares, grado 2 atrofia entre el 25 y 50%, grado 3, entre el 51-75% y grado 4, alteración > 75%. En la comparación estadística se utilizaron los test no paramétricos de Mann-Whitney. Resultados: Todos los pacientes con DEH mostraron algún grado de afectación. El 57% presentó atrofia severa > 75%. El 35,8% presentó un grado 3 y el 7,2% grado 2. El grado medio de atrofia glandular en DEH fue de 3 (rango 1-4). En el grupo control el 62,5% no presentaron afectación alguna, grado 0. El 28,1% grado 1 y el 9,4% un grado 2. El grado medio de atrofia glandular fue de 0 (0,2). Se encontraron diferencias estadísticamente significativas entre los grupos. Conclusiones: La meibografía es una prueba diagnóstica sencilla que permite diferenciar entre pacientes sanos y con DEH

Introduction: Hypohidrotic ectodermal dysplasia (HED) is a rare disease that results from the abnormal development of the ectodermal germ layer in early embryogenesis. In these patients, hypoplasia of Meibomian glands is one of the most frequent ophthalmological manifestations. The main aim of this study is to evaluate the usefulness of meibography for the morphology of Meibomian glands in a group of patients with HED, and to compare it with a control group. Methods: A total of 14 eyes of 7 patients diagnosed with HED were included, and 32 eyes of 16 patients were included as a control group. The meibographic study was carried out using CA-800 Corneal Analyser (Topcon®). Grading of images was assessed by a meibomian gland atrophy score: grade 0, no alterations; grade 1, ≤25% gland atrophy; grade 2, 25% to 50% gland atrophy; grade 3, 51% to 75% gland atrophy; and grade 4 >75% gland atrophy. Both groups were compared using the Mann-Whitney U non-parametric test. Results: All patients with HED showed some degree of gland atrophy, with 57% showing severe atrophy (>75% of gland atrophy), 35.8% with a grade 3, and 7.2% grade 2. The mean grade of glandular atrophy in HED was 3 (1-4). In the control group, 62.5% had no involvement (grade 0), with 28.1% showing grade 1 and 9.4% grade 2 gland atrophy. The mean glandular atrophy grade within the control group was 0 (0-2). There were statistically significant differences between both groups. Conclusions: Meibography is a simple diagnostic tool that allows to differentiate between patients without disease and those with HED

Linfoma linfocítico primario de glándula lagrimal / Primary lymphocytic lymphoma of lacrimal gland

CASO CLÍNICO: Presentamos un caso de linfoma linfocítico de células pequeñas primario de glándula lagrimal en un varón diagnosticado de síndrome antifosfolípido primario. Estos infrecuentes linfomas se presentan habitualmente en la clínica como diseminaciones secundarias a una leucemia linfocítica crónica, siendo rara su localización primaria en la órbita. DISCUSIÓN: Los linfomas no Hodgkin son un grupo muy heterogéneo de tumores. Aunque el tratamiento en su estadio IE suele ser radioterapia, debido a su asociación con un síndrome antifosfolípido, se realizó tratamiento sistémico con rituximab

CASER REPORT: We report a case of primary small-cell lymphocytic lacrimal gland lymphoma in a male diagnosed with primary antiphospholipid syndrome. These rare lymphomas are usually presented in the clinic as disseminations secondary to chronic lymphocytic leukaemia, and the primary site is rare in the orbit. DISCUSSION: Non-Hodgkin lymphomas are a heterogeneous group of tumours. Although treatment in the IE stage is usually radiotherapy, due to its association with antiphospholipid syndrome, systemic treatment with rituximab was administered

[Topographic and pachymetric changes caused by prolonged use contact lenses]. / Alteraciones topográficas y paquimétricas inducidas por el uso de lentes de contacto de porte prolongado.

PURPOSE: To evaluate the topographic and pachymetric alterations caused by soft contact lenses for prolonged use and DK/t >100 after wearing them continuously for 3 weeks. METHODS: Our study included 24 eyes of 12 patients aged between 19 and 32 years who were given the new Night & Day contact lens to wear. Various topographic parameters -central corneal power, corneal radii at 3, 5 and 7 mm and simulated keratometry- were analyzed together with pachymetry before the lenses were put in and the 1st and 21st day after insertion. Wilcoxon's test for matched-pairs is used for the comparison, and vectorial analysis to evaluate the sphere, cylinder and axis of the astigmatism caused by the lens. RESULTS: The mean refraction of the patient was of -3.28 D. The initial mean central corneal power was 42.5 D. There were no significant differences in central corneal power and radii after 21 days of use of the lens. The initial mean pachymetry was of 541.46 micrometer and 557.64 micrometer after 24 h of use. There were significant differences in the pachymetry after the use of the lens. CONCLUSIONS: No significant topographic alterations were produced following prolonged use of the contact lenses (21 days). The corneal thickness after wearing the lens was <5% in all cases.

[Development of a new topographic index of corneal regularity]. / Desarrollo de un nuevo índice topográfico de regularidad corneal.

PURPOSE: To develop a new topographic index that quantifies corneal surface micro irregularities. METHODS: One hundred and fifty five eyes from 128 patients, with a mean age of 29,2 years were evaluated by corneal topography and divided into three groups. One group was composed of 50 eyes from patients with regular corneas, a second group included 45 eyes with corneal macro irregularities, and a third group included 60 eyes with corneal micro irregularities. With the values of the radii of curvature obtained in the numeric map of the corneal topography, we calculated an algorithm that could quantify differences in dioptric power between points that were very near each other. We used descriptive statistics to analyze each group, and Scheffé multiple comparison of means to compare between the different groups. RESULTS: The mean irregularity index was in group I below 1, in group II between 3 and 4, and in group III eyes with corneal micro irregularities higher than 7. CONCLUSIONS: The new index that we have developed is able to quantify corneal micro irregularities of the corneal surface and its value increases in the presence of corneal micro irregularities.