Diagnostic and therapeutic complexity of Susac syndrome.

A 40-year-old man who attended the emergency department with a scotoma in right eye. He mentioned hearing difficulties and headache for months and he had sensory and motor deficits in the previous days. In the ophthalmic examination, the right eye had areas of arterial occlusion. MRI revealed hyperintense lesions. The patient was diagnosed with Susac syndrome. He was treated with systemic steroids, however, it was not enough to control the condition. Rituximab and intravenous immunoglobulins were added, which allowed the improvement of neurological symptoms, but the alteration of the visual field and the hearing defect did not recover. Early diagnosis of this pathology is essential, since delaying treatment can cause irreversible consequences. Sometimes it is difficult given the wide variety of symptoms and the course of the disease. Ocular manifestations may raise suspicion when the general symptoms are nonspecific.

Lesión macular bilateral tras la manipulación de un láser femtosegundo / Bilateral macular injury caused by a femtosecond laser

CASO CLÍNICO: Se describe el caso de un varón de 35 años de edad diagnosticado en Urgencias de lesión macular bilateral tras la exposición de forma accidental a la luz de un láser femtosegundo industrial. DISCUSIÓN: Los trabajadores que usan láseres industriales deben proteger sus ojos de forma adecuada cuando manejen estos instrumentos. Si no es así, pueden producirse lesiones en la retina, que aunque se suelen resolver, en ocasiones son causa de pérdida de visión mantenida

CASE REPORT: We describe the case of a 35-year-old man who arrived in the Emergency Department with bilateral macular injury caused by accidental exposure to an industrial femtosecond laser. DISCUSSION: Workers operating industrial lasers must protect their eyes properly when handling these devices. Otherwise, retina damage may occur which usually is recoverable. However, sometimes this damage causes permanent visual loss

Síndrome de pseudo-duane paraneoplásico secundario a tumor de mama / Pseudo-duane's paraneoplasic syndrome secondary to breast tumor

Se describe el caso clínico de una mujer de 50 años con antecedentes personales de cáncer de mama, que refiere alteraciones de los movimientos oculares. En la exploración se observa una limitación de la abducción y estrechamiento de la hendidura palpebral en aducción en ambos ojos. RMN craneal y orbitaria normales. Marcadores tumorales con títulos bajos. Se realiza el diagnóstico de Síndrome de pseudo- Duane, ya que se trata de un síndrome restricitivo adquirido. En este caso, su presentación clínica es similar al síndrome Duane tipo I, siendo contradictorio a lo descrito en publicaciones previas. Por otra parte, este síndrome está relacionado en el tiempo con su patología oncológica y la RMN es normal, por lo que lo consideramos un síndrome paraneoplásico. Destacamos la originalidad del caso debido a su inusual etiología, y clínica (AU)

We report the case of a 50 years-old woman with history of breast tumor and anormal ocular motility. An examination of ocular motility revealed limited abduction and narrowing of the palpebral fissure on adduction. Orbital and cranial nuclear magnetic resonance were normal. Tumor markers had low levels. We think about her oncologic history because of the beginning of the sintomatology in this period of time. The diagnosis was Pseudo-Duane syndrome, wich is a restrictive acquired syndrome. Despite clinical presentation was similar to Duane I syndrome, it is enterely different from it. We highlight the originality of the case due to its inusual ethiology(only one case published previously) and its clinical presentation (AU)

Bilateral macular injury caused by a femtosecond laser.

CASE REPORT: We describe the case of a 35-year-old man who arrived in the Emergency Department with bilateral macular injury caused by accidental exposure to an industrial femtosecond laser. DISCUSSION: Workers operating industrial lasers must protect their eyes properly when handling these devices. Otherwise, retina damage may occur which usually is recoverable. However, sometimes this damage causes permanent visual loss.

[Morphometric changes of corneal endothelial cells in pseudoexfoliation syndrome and pseudoexfoliation glaucoma]. / Cambios morfométricos de las células del endotelio corneal en el síndrome pseudoexfoliativo y glaucoma pseudoexfoliativo.

OBJECTIVE: To evaluate the corneal endothelial morphometry and central corneal thickness (CCT) in pseudoexfoliative (PEX) eyes with and without glaucoma and to compare with normal eyes and eyes with primary open-angle glaucoma (POAG). METHOD: A total of 166 patients were included in this study: 36 eyes with pseudoexfoliation syndrome (PXS), 30 eyes with pseudoexfoliation glaucoma (PXG), 40 eyes with POAG, and 60 normal eyes. Corneal endothelial cell density (ECD), coefficient of variation (CV) in cell size, and percentage of hexagonal cells, were measured using a non-contact specular microscope, whereas CCT was measured with an ultrasonic pachymeter. RESULTS: ECD and percentage of hexagonal cells were lower in PEX groups and in the POAG group compared with normal eyes, while the CV in cell size was greater. There was a tendency for greater cell loss and morphological abnormalities of the corneal endothelial cells in PXG eyes compared to PXS eyes, when all pseudoexfoliative eyes were analyzed together. Changes in endothelial cells increased with age. There were no significant differences in mean CCT between the four groups. CONCLUSION: Endothelial cell density is significantly decreased, and pleomorphism and polymegathism of cells are increased in PEX eyes, particularly when intraocular pressure is high.

[Impact of Nd: YAG capsulotomy on quality of life in pseudophakic patients]. / Impacto de la capsulotomía Nd: YAG en la calidad de vida de pacientes pseudofáquicos.

OBJECTIVE: To determine whether visual acuity (VA) improvement in patients with posterior capsule opacification (PCO), accepted after the capsulotomy, is followed by positive changes in the perception of their quality of life. METHOD: A total of 130 patients with PCO were examined before and after capsulotomy. In addition to the ophthalmic examination, the EuroQol questionnaire was completed. We analyzed the influence of demographic characteristics on the outcome of the test. RESULTS: The mean binocular visual acuity (BVA) and the mean scores in the EuroQol dimensions and EQ-VAS improved significantly after capsulotomy. VA did not have the same effect on daily common tasks. After treatment, the problems in the usual activities dimension have seen the largest reduction. Mobility is still the dimension with more problems regarding patients after capsulotomy. CONCLUSIONS: Decreased VA induced by PCO is associated with difficulties performing daily living activities. Capsulotomy results in a gain in VA and functional ability of the majority of patients, improving the perception of their quality of life.