Púrpura de Henoch-Schönlein con compromiso ocular en un adulto: Reporte de caso y revisión de la literatura / Henoch-Schönlein purpura with ocular manifestations in adult: Case report and review of the literature

La púrpura de Henoch Schönlein es una vasculitis sistémica que afecta vasos pequeños, predominantemente en niños. Los eventos trombóticos son una rara complicación, y en la literatura solo algunos casos se han reportado. Entre éstos, un caso de oclusión de arteria central de la retina bilateral y un caso de oclusión de vena central de la retina, ambos pacientes con diagnóstico de púrpura de Henoch Schönlein, el segundo dos semanas después a iniciar hemodiálisis. Describimos el caso de un paciente adulto con diagnóstico de púrpura de Henoch Schönlein e hipertensión arterial, en insuficiencia renal crónica estadio V, en hemodiálisis hacía 20 días, quien se presentó con disminución de agudeza visual de 15 días de evolución en ojo derecho. Los hallazgos al examen ocular fueron edema del disco, edema macular, tortuosidad vascular, hemorragias en cuatro cuadrantes, se consideró una oclusión de vena central de la retina. Requirió terapia antiangiogénica y fotocoagulación laser con buena evolución.

Henoch Schönlein purpura is a systemic vasculitis that affects small vessels and mainly aff ecting children. Thrombotic events are a rare complication, and only a few cases have been reported. Among these a case of bilateral central retinal arterial occlusion in patients with Henoch Schönlein purpura, and a case of central retinal vein occlusion in a patient with Henoch Schönlein purpura over a two weeks period of hemodialysis. We describe the case of an adult patient diagnosed with Henoch Schönlein purpura and arterial hypertension, chronic renal failure in hemodialysis for 20 days; who presents with decreased visual acuity for 15 days in the right eye. The findings were disc edema, macular edema, vascular tortuosity, haemorrhages in four quadrants. Central retinal vein occlusion was considered and antiangiogenic therapy and laser photocoagulation was performed with good response.

[New perspectives in the approach to central retinal vein occlusion]. / Nuevas perspectivas en el abordaje de la oclusión de vena central de la retiniana.

OBJECTIVE: The COPERNICUS and GALILEO trials were designed to evaluate the safety and efficacy of intravitreal injection of 2mg of aflibercept in the treatment of macular edema secondary to central retinal vein occlusion. MATERIAL AND METHOD: Two phase III randomized, double-masked trials: COPERNICUS in North America (188 patients) and galileo in Europe and Asia (177 patients). In COPERNICUS, the patients in the treatment group received monthly injections of 2mg aflibercept for 6 months and later continued with strict PRN treatment with monthly follow-up every 6 months and with a minimum of 3-monthly follow up for 1 year. Patients in the placebo group could receive treatment after the sixth month, with similar treatment regimens and follow-up to the treatment group. In contrast, in galileo, the placebo group received no PRN treatment until 1 year of follow-up and during the first 6 months, followup visits were bi-monthly. RESULTS: The treatment group in COPERNICUS showed a mean improvement of 13 letters versus the placebo group (1.5 letters) at week 100 of follow-up. In galileo, the mean best corrected visual acuity at 76 weeks were 13.7 and 6.6 in the treatment and placebo groups, respectively. CONCLUSIONS: Early treatment with intravitreal afliberceptin achieves better results than when treatment is delayed by 6 months or 1 year. The visual benefits obtained with the drug are affected by the reduction in the frequency of monitoring during follow-up.

[Management of aflibercept in routine clinical practice]. / Manejo de aflibercept en la práctica clínica habitual.

Aflibercept is a new anti-vegf drug that, unlike ranibizumab and bevacizumab blocks both vegf-A and placental growth factor. Moreover, it binds with much greater strength and affinity to human VEGF-A165 than other endogenous vegf receptors, conferring it with a more extended effect and allowing a lower frequency of intravitreal injections. This facilitates the adoption of fixed treatment regimens other than monthly or individual regimens such as "treat and extend". Aflibercept is indicated for the treatment of neovascular (exudative) age-related macular degeneration (ARMD), visual alteration due to macular edema secondary to central retinal vein occlusion (CRVO) and visual alteration due to diabetic macular edema (DME). The present article reviews the management of aflibercept in routine clinical practice, based on the specifications of its new core data sheet, which includes all the therapeutic indications in which its use has been approved and evaluating the distinct alternatives and treatment regimens after the initial loading doses.

[Central retinal vein occlusion as the first symptom of ovarian cancer]. / Oclusión de vena central de la retina como primera manifestación de cáncer de ovario.

CASE REPORT: A healthy 57-year-old woman presented with decreased vision in her right eye. Dilated fundus examination revealed central retinal vein occlusion (CRVO). The laboratory test results for hypercoagulability state showed an abnormal protein S. A few months later she developed an ovarian malignancy. DISCUSSION: This case illustrates an association between CRVO and ovarian tumour. Coagulation disorders in cancer may be a mechanism for CRVO.