Hemovítreo secundario a quiste iridociliar / Vitreous hemorrhage secondary to iridociliary cyst

CASO CLÍNICO: Varón de 18 años, presentó un hemovítreo inferior de causa desconocida. Se realizan múltiples pruebas, entre ellas ecografía oftálmica y angiofluoresceingrafía (AFG), no encontrándose justificación al sangrado. Finalmente se decide realizar una biomicroscopía ultrasónica (BMU) donde se aprecia un quiste iridociliar. DISCUSIÓN: Los quistes iridociliares son únicos o múltiples, primarios o secundarios. Los primarios suelen tener carácter benigno, por lo que no requieren tratamiento. Cuando el quiste alcanza un tamaño importante puede producir un iris meseta focal con o sin cierre angular. Nuestro caso describe una complicación inusual que habría que tener en cuenta ante un hemovítreo de origen desconocido

CASE REPORT: An 18-year-old man, presented a lower vitreous hemorrhage of unknown cause. Multiple tests are performed, including Ophthalmic Ultrasound and Fluorescein Angioghaphy (FA), they did not find justification of bleeding. Finally, we decide to do a Biomocroscopía Ultrasonic (UBM) showing an iridociliary cyst. DISCUSSION: The iridociliary cysts are single or multiple, primary or secondary. The primaries are usually benign so, they do not require treatment. When the cyst has a considerable size, it may produce a focal plateau iris with or without angle-closure. Our case reveals an unusual complication that should take notice of when you have an unknown vitreous hemorrhage

Vitreous hemorrhage secondary to iridociliary cyst.

CASE REPORT: An 18-year-old man, presented a lower vitreous hemorrhage of unknown cause. Multiple tests are performed, including Ophthalmic Ultrasound and Fluorescein Angioghaphy (FA), they did not find justification of bleeding. Finally, we decide to do a Biomocroscopía Ultrasonic (UBM) showing an iridociliary cyst. DISCUSSION: The iridociliary cysts are single or multiple, primary or secondary. The primaries are usually benign so, they do not require treatment. When the cyst has a considerable size, it may produce a focal plateau iris with or without angle-closure. Our case reveals an unusual complication that should take notice of when you have an unknown vitreous hemorrhage.

Macrovaso congénito retiniano: presentación atípica con baja visión y engrosamiento macular / Congenital retinal macrovessel: An atypical presentation with low vision and macular thickening

CASO CLÍNICO: Se presenta el caso de un varón de 35 años sin antecedentes de interés que consulta por mala visión del ojo izquierdo objetivada de forma fortuita, en el cual tras un completo estudio se llega al diagnóstico de macrovaso congénito retiniano con engrosamiento macular. DISCUSIÓN: Los macrovasos congénitos retinianos son una rara anomalía vascular cuyo diagnóstico suele ser casual ya que la repercusión visual es mínima. En los pocos casos en que se produce afectación visual importante, esta se debe a hemorragias maculares, quistes foveales, desprendimiento seroso macular o al propio transcurso del vaso por la zona avascular foveal

CASE REPORT: We report a case of a 35 year old male patient with no medical history, who experienced decreased vision in his left eye that he noticed by chance. After a complete ophthalmic examination, he was diagnosed with congenital retinal macrovessel with macular thickening. DISCUSSION: Congenital retinal macrovessels are rare vascular anomalies, in which the diagnosis is usually incidental as their visual impact is minimal. In the rare cases where there is a significant visual impairment, this is due to macular hemorrhages, foveal cysts, serous macular detachment, or the course of the vessel itself through the foveal avascular zone

[Congenital retinal macrovessel: an atypical presentation with low vision and macular thickening]. / Macrovaso congénito retiniano: presentación atípica con baja visión y engrosamiento macular.

CASE REPORT: We report a case of a 35 year old male patient with no medical history, who experienced decreased vision in his left eye that he noticed by chance. After a complete ophthalmic examination, he was diagnosed with congenital retinal macrovessel with macular thickening. DISCUSSION: Congenital retinal macrovessels are rare vascular anomalies, in which the diagnosis is usually incidental as their visual impact is minimal. In the rare cases where there is a significant visual impairment, this is due to macular hemorrhages, foveal cysts, serous macular detachment, or the course of the vessel itself through the foveal avascular zone.

[Scleral surgery of retinal detachment without drainage of subretinal fluid and no cryotherapy]. / Cirugía escleral del desprendimiento de retina sin crioterapia ni drenaje del líquido subretiniano.

PURPOSE: To evaluate anatomic and functional results in patients treated for uncomplicated rhegmatogenous retinal detachment (RD) with scleral surgery without the use of subretinal fluid (SRF) drainage and using no cryotherapy. MATERIAL AND METHOD: We present a retrospective study of 76 patients who underwent RD scleral surgery without cryotherapy or SRF drainage. We analyze postoperative outcomes and the incidence of intraoperative and postoperative complications. RESULTS: The average of our retinal reapplications totals 90.78%, which is similar to those described by other types of surgical techniques, while our intraoperative and postoperative complications are dramatically reduced including improvement of functional results. CONCLUSIONS: Scleral surgery for retinal detachment using no drainage of subretinal fluid nor cryotherapy is a useful technique for the treatment of RD.

[Bilateral acute retinal necrosis due to herpes simplex virus in inmunocompetent people and acyclovir resistance]. / Necrosis retiniana aguda bilateral por herpes simple en individuo inmunocompetentes y resistencia a aciclovir.

CASE REPORT: A twenty-eight year old woman with necrotitizing retinitis and herpes simplex virus type 1 isolated in aqueous humor with polymerase chain reaction (PCR). An Acyclovir and corticosteroid therapy was started with unsuccessful response, Foscarnet was added getting quiescence of lesions. DISCUSSION: Acute Retinal Necrosis Syndrome (ARNS), induced by a virus of the herpes family, could develop in immunocompetent people. A characteristic clinical case with uveitis and vitritis, white retinitis areas and occlusive vasculitis is reported. Antiviral therapy with acyclovir and antiinflammatory treatment must be established quickly. Foscarnet can effectively treat ARNS in inmunocompetent patients. In spite of therapy, this is a potentially blinding retinal disease.

Cirugía escleral del desprendimiento de retina sin crioterapia ni drenaje del líquido subretiniano / Scleral surgery of retinal detachment without drainage of subretinal fluid and no cryotherapy

Objetivo: Evaluar los resultados anatómicos y funcionales en pacientes con desprendimiento de retina (DR) regmatógeno no complicado, intervenidos mediante cirugía escleral sin drenaje de líquido subretiniano (LSR) ni crioterapia. Material y Métodos: Presentamos un estudio retrospectivo de 76 pacientes a los que se le realizó cirugía escleral del DR sin drenaje de LSR ni crioterapia. En el postoperatorio, cuando la retina está reaplicada, se practica fotocoagulación de las roturas retinianas. Se analizan los resultados postoperatorios y la incidencia de complicaciones intra y postoperatorias. Resultados: El porcentaje de reaplicaciones anatómicas es del 90,78 por ciento con una cirugía, similar al descrito por otras técnicas mientras que las complicaciones intra y postoperatorias se reducen y mejoran los resultados funcionales. Conclusiones: La cirugía escleral del DR sin drenaje del LSR ni crioterapia es una técnica valida en el tratamiento del DR regmatógeno no complicado (AU)

Necrosis retiniana aguda bilateral por herpes simple en individuo inmunocompetentes y resistencia a aciclovir / Bilateral acute retinal necrosis due to herpes simplex virus in inmunocompetent people and acyclovir resistance

Caso clínico: Mujer sana de 28 años con retinitis necrotizante bilateral y aislamiento de virus herpes simple tipo 1 en humor acuoso mediante reacción cadenas polimerasa (PCR). Se establece tratamiento con Aciclovir y corticoides intravenosos, sin obtener respuesta adecuada, se añade Foscarnet logrando la quiescencia de las lesiones. Discusión: El síndrome de necrosis retiniana aguda (SNRA) inducido por virus herpes, afecta tanto a inmunocompetentes como inmunodeprimidos. La clínica característica consta de uveítis con vitritis, focos de retinitis blanquecinos y vasculitis oclusiva. La terapia antiviral con aciclovir y antiinflamatorios debe instaurarse rápidamente. La terapia con Foscarnet puede ser efectiva en SNRA en pacientes inmunocompetentes. A pesar del tratamiento desemboca en una potencial ceguera (AU)

[Retinal thrombosis in young patients. Immunological and clinical aspects]. / Trombosis retiniana en pacientes jóvenes. Aspectos inmunológicos y clínicos.

OBJECTIVES: To ascertain preexisting medical conditions, clinical evolution of retinopathy, and associated immunological disorders in a series of young patients suffering from retinal thrombosis, and to determine the prevalence of antiphospholipid antibodies. METHODS: Twenty two patients younger than 50 years, who had presented an acute retinal thrombotic episode, were studied prospectively with a general physical, ophthalmoscopic and immunological examination, placing special emphasis on the detection of antiphospholipid antibodies (anticardiolipin antibodies and lupus anticoagulant). RESULTS: No baseline disease stood out significantly over the others, and the most frequent risk factor found was systemic arterial hypertension (5/22%). No associated risk factor was found in nine cases (41%), and more than two factors were found in six cases (27%). Most of the vascular occlusions affected the venous vessels (18/81%), and five of them were associated with vasculitis. The ophthalmologic follow-up showed a rapid evolution to retinal neovascularization in 11 cases. Our data show many immunologically altered values, there being nine cases (41%) of the series with more than four parameters altered. The antiphospholipid assay showed a high prevalence of anticardiolipin antibodies (5/23%), and two patients were diagnosed of primary antiphospholipid syndrome. The lupus anticoagulant was negative in all patients. CONCLUSIONS: The high prevalence of anticardiolipin antibodies and immunologic abnormalities found in the retinal thrombosis younger patients leads us to recommend the systematic immunological study in these subjects. It has relevant diagnostic and therapeutic implications in a population with no evident associated risk factors and a greater severity of retinopathy.

[Vitrectomy for vitreomacular traction syndrome]. / Vitrectomía en el síndrome de tracción vitreomacular.

PURPOSE: To describe the clinical characteristics of the vitreomacular traction syndrome and to evaluate the results of vitreous surgery for this syndrome. METHODS: We retrospectively studied 5 consecutive symptomatic eyes with vitreomacular traction syndrome, which underwent vitrectomy and posterior hyaloid stripping. RESULTS: Intraoperative observation confirmed partial posterior vitreous separation. After surgery visual acuity improved in four eyes and remained in one eye. All eyes were followed for at least 3 months. Complications of vitreous surgery included progression of nuclear sclerosis (3 eyes) and retinal rupture (1 eye). CONCLUSION: Vitreomacular traction syndrome can produce visual deficit. Vitrectomy surgery to release macular traction allows resolution of macular cystoid changes and improvement of visual acuity.

Trombosis retiniana en pacientes jóvenes. Aspectos inmunológicos y clínicos / Retinal thrombosis in young patients. Immunological and clinical aspects

Objetivos: Investigar en una muestra de pacientes jovenes con trombosis retiniana, las enfermedades sistémicas preexistentes, la evolución clínica de la retinopatía y las alteraciones inmunológicas asociadas, determinando la prevalencia de anticuerpos antifosfolípido. Métodos: La serie consta de 22 pacientes menores de 50 años a los que se les realiza prospectivamente una exploración clínica, oftalmológica e inmunológica con especial interés en la detección de anticuerpos antifosfolípido (anticuerpos anticardiolipina y anticoagulante lupico). Resultados: Ninguna enfermedad de base destacó significativamente sobre las demás siendo el factor de riesgo más frecuentemente encontrado la hipertensión arterial sistémica (5/22 per cent). En 9 casos (41 per cent) no se encontró ningun factor de riesgo asociado y en 6 (27 per cent) más de dos factores. La mayor parte de las oclusiones fueron venosas (18/81 per cent), cinco de las cuales se asociaron a vasculitis. El seguimiento oftalmologico mostró una evolución rápidamente progresiva a la neovascularización retiniana en 11 casos. Se encontraron numerosas alteraciones inmunológicas en la serie, 9 casos (41 per cent) con más de 4 parámetros alterados. El estudio de anticuerpos antifosfolípido mostró una elevada prevalencia en la serie de anticuerpos anticardiolípina (5/23 per cent), dos de ellos fueron diagnosticados de Sindrome antifosfolipido primario. El anticoagulante lúpico fué negativo en todos los casos. Conclusiones: La elevada prevalencia de anticuerpos anticardiolipina, y de alteraciones inmunológicas encontradas en los pacientes más jóvenes, nos llevan a recomendar el estudio sistemático inmunológico, en una población en la que no se asocian factores de riesgo evidentes y cuyo cuadro oftalmológico presenta una mayor gravedad (AU)

Vitrectomía en el síndrome de tracción vitreomacular / Vitrectomy for vitreomacular traction syndrome

Objetivo: Describir las características clínicas del síndrome de tracción vitreomacular y evaluar los resultados de la cirugía vítrea en este síndrome. Métodos: Hemos estudiado retrospectivamente 5 ojos sintomáticos consecutivos con síndrome de tracción vitreomacular, a los que se les realizó vitrectomía y separación de la hialoides posterior. Resultados: Intraoperatoriamente se confirmó el desprendimiento parcial del vítreo posterior. Tras la cirugía vítrea la agudeza visual mejoró en cuatro ojos y permaneció estable en uno. El período mínimo de seguimiento en todos los casos fue de 3 meses. Las complicaciones de la cirugía vítrea consistieron en progresión de la esclerosis nuclear (3 ojos) y rotura retiniana (1 ojo). Conclusión: El síndrome de tracción vitreomacular puede producir una importante pérdida de agudeza visual. La vitrectomía para relajar la tracción macular permite la resolución de los cambios cistoides de la mácula y la mejoría visual (AU)

A prospective search for ocular lesions in hospitalized patients with significant bacteremia.

The purpose of this study was to determine the prevalence, risk factors, and prognostic value of ocular lesions in unselected patients with bacteremia. A total of 202 bacteremic patients, 101 nonbacteremic septic patients, and 90 nonseptic control patients were compared in a prospective, controlled, observational study. Ocular lesions related to bacteremia were found in 12% of the bacteremic group, 5% of the septic group, and 2% of the control group. Ocular lesions were significantly more frequent in the bacteremic patients than in the control patients (P=.007). The severity of the clinical condition and the presence of fungemia predict independently a higher risk of ocular lesions. Mortality rates among bacteremic patients with and without ocular lesions were, respectively, 32% and 8% (P<.01; OR, 3.99). The asymptomatic nature of most ocular lesions in patients with bloodstream infections and the impossibility of amelioration in most cases lead us to recommend ophthalmologic examination for bacteremic patients only when prognostic information is needed.

Antiphospholipid antibodies and retinal thrombosis in patients without risk factors: a prospective case-control study.

PURPOSE: To determine the prevalence of antiphospholipid antibodies and other immunologic abnormalities in patients with occlusive retinal vascular events, exempt from conventional risk factors of retinal thrombosis. METHODS: Forty patients with retinal vascular occlusion (26 with retinal vein occlusions, eight with arterial occlusions, two with combined venous and arterial occlusions, and four with venous occlusions plus vasculitis), free of main accepted risk factors for retinal thrombosis, were prospectively screened for antiphospholipid antibodies (anticardiolipin-antibodies and lupus anticoagulant) and other immunologic abnormalities. Fourteen patients were younger than 50 years. Prevalence and mean values of antiphospholipid antibodies (aPL) were compared with those in a homogeneous control group of 40 patients. RESULTS: The prevalence of antiphospholipid antibodies in the study group was 22.5% (nine of 40). Comparison with control group prevalence (5% [two of 40]) showed a statistically significant difference (P = .04). Six patients in the study group disclosed positivity for IgG-anticardiolipin antibodies, one patient for IgM anticardiolipin antibodies, and two patients for both isotypes IgG and IgM anticardiolipin antibodies. The antibody assay for lupus anticoagulant was negative for all patients. Three patients were diagnosed as having primary antiphospholipid antibody syndrome and are undergoing systemic anticoagulant therapy. Relevant immunologic abnormalities were also found (27.5% with antinuclear antibodies, 35% with elevation of circulating immune complexes, 35% with complement deficiency, 30% with positive rheumatoid factor, and 17.5% with positive C-reactive protein). Thirteen patients (32.5%) had more than four parameters altered. No significant association was found between prevalence or mean values of anticardiolipin antibody and patients younger than 50 years. CONCLUSIONS: The high prevalence of anticardiolipin antibodies in patients with vaso-occlusive retinopathy exempt from conventional risk factors, and the relevant diagnostic and therapeutic implications, lead us to recommend a systematic search for specific antiphospholipid antibodies in such patients.