Epiteliopatía en limpiaparabrisas en pacientes con blefaroespasmo o espasmo hemifacial

ObjectiveTo evaluate the presence of wiper epitheliopathy in patients with blepharospasm and/or hemifacial spasm before and 4 weeks after routine treatment with botulinum toxin.MethodsProspective study comprising 31 eyes of 20 patients with neurological diagnosis of hemifacial spasm (9 eyes of 9 patients) and essential blepharospasm (22 eyes of 11 patients). Various ocular surface parameters were assessed before and 4 weeks after infiltration with botulinum toxin using the OSDI questionnaire, Schirmer's test, tear break-up time, fluorescein and lissamine green staining assessed with the Oxford test and the degree of involvement of the palpebral wiper.Results100% of the patients had palpebral wiper involvement before (30% mild and 70% moderate) and after toxin treatment (100% mild). 75% of patients had mild-normal OSDI before treatment, after treatment it was 80%. The tear break-up time was 7.2 ± 0.2 sg before and 7.5 ± 0.7 sg after treatment. Schirmer's test was 11.4 ± 5.5 and 12.5 ± 5.5 mm before and after treatment. The Oxford test was initially pathological in 69.3% of patients, after 4 weeks it was pathological in only 54%.ConclusionWiper epitheliopathy is present in 100% of patients with blepharospasm and/or hemifacial spasm. The main pathophysiological mechanism that triggers it in these patients is the increase in the coefficient of friction, as tear volume and stability are normal.     

Ectasia corneal post-LASIK en pacientes con diferencias significativas en las lecturas queratométricas de ambos ojos

ObjectivesA study is made on the incidence of corneal ectasia after laser in situ keratomileusis (LASIK) in patients with large differences in mean keratometry (MK) readings between both eyes (OU). Visual outcomes were also evaluated.MethodsThe medical records of 164,603 patients (315,259 eyes) who underwent LASIK from January 2003 to December 2011 were reviewed in order to identify patients with a difference in MK of ≥ 1.25 D between OU. The main outcome measures were incidence of ectasia after LASIK, and visual outcome.ResultsA total of 35 eyes that met the inclusion criteria were found. Functional and visual results were those expected for myopia studies. After a minimum follow-up of 2 years, no corneal ectasia was found in 3 eyes (2 patients).ConclusionsThe possibility of finding a patient with an asymmetry in MK and normal topography is low (0.021%), and it does not seem to be a contraindication of LASIK. Although no corneal ectasia was found in this case series, and as it is a potentially sight-threatening complication, patients with very different MK between OU should be studied carefully before undergoing LASIK.     

Hemorragia supracoroidea espontánea bilateral en un paciente en tratamiento con heparina de bajo peso molecular

We present the case of an 81-year-old woman who developed a bilateral spontaneous suprachoroidal hemorrhage while under treatment with sodium enoxaparin. Temporal suspension of anticoagulant therapy led to an improvement of the choroidal hemorrhage. After three months follow-up, there was a complete reabsorption of the choroidal detachments, but there was a persistent vitreous hemorrhage in the right eye, which had been more severely affected. Pars plana vitrectomy with air tamponade was successfully performed in the right eye. Vision improved to 20/50 in the right eye and 20/20 in the left eye.Suprachoroidal hemorrhage is a rare condition with a poor visual prognosis. Reports on the development of suprachoroidal hemorrhage in patients with no predisposing ocular conditions are scarce, and in none were both eyes affected. The case reported herein is, to the best of our knowledge, the first case of bilateral, simultaneous suprachoroidal hemorrhage without predisposing ocular factors due to treatment with anticoagulants, with a favourable visual outcome.     

Prevalencia de Demodex spp. en pestañas de una población universitaria en Santiago,Chile

ObjectiveTo determine the presence of Demodex spp. in the eyelashes’ pilosebaceous unit in volunteers of one campus of a private university.Materials and methodsThe volunteers underwent anamnesis, biomicroscopic study and samples were taken of 8 eyelashes, 2 of each eyelid of both eyes. The eyelashes were mounted on a slide and observed under a light microscope to determine the presence and quantity of mites.Results200 volunteers were recruited, determining the prevalence of Demodex spp. in 54 (27%) of them. Of the positive cases, 40 (74.1%) presented signs and/or symptoms of blepharitis, 43 (79.7%) presented the mite in one eye and an average infestation rate of 0.65 Demodex spp. per eyelash was obtained.ConclusionsApproximately one in four of the volunteers studied without a diagnosis of blepharitis was a carrier of the parasite, of which a significant percentage presented some type of sign and/or symptom of this pathology which was related to a higher rate of infestation (p < 0.05).     

Canaliculitis por Gemella haemolysans en aislamiento único

Case report

An 84 year-old woman was referred for evaluation of a painless swelling with small purulent discharge in her left upper canaliculus, and an associated epiphora of one-month duration. The patient was diagnosed with acute primary canaliculitis. She was treated with topical and oral antibiotics, as well as topical corticoids for three months, with little response. Surgical treatment with left upper canaliculotomy and curettage was then performed, and Gemella haemolysans was identified from the curetted material. The patient had no recurrence of the disease two months after the surgery.

Tratamiento antiangiogénico en fondo de distrofia de Sorsby sin mutación en gen de TIMP-3

Case reportThe case is presented of a 32-year-old man referring to metamorphopsia and blurred vision in both eyes for 3 days. Best corrected visual acuity of 20/32 in the right eye and 20/25 in the left eye. Fundus examination revealed the presence of drusen-like deposits, suggestive of Sorsby's fundus dystrophy (SFD) and choroidal neovascularization (CNV) bilaterally. The patient received intravitreal ranibizumab. Visual acuity improved to 20/20 in both eyes at 6-months follow-up, and results of fundus examination showed complete regression of neovascularization. No mutations were found in the TIMP-3 gene.DiscussionThe known mutations in TIMP-3 may not be extended to all patients with SFD. The use of intravitreal ranibizumab may be considered as a therapeutic option in CNV secondary to SFD.     

Tubérculo coroideo asintomático en un paciente con enfermedad de Crohn en tratamiento con adalimumab

Introduction

Adalimumab, an anti-tumour necrosis factor alpha therapy for active Crohn's disease (CD), is associated with increased risks of tuberculosis infection.

La visión binocular en el glaucoma

ObjectiveTo describe the possible impairment of binocular vision in primary open angle glaucoma (POAG) patients.MethodA cross-sectional study was conducted on 58 glaucoma patients, 76 ocular hypertensives and 82 normal subjects. They were examined with a battery of binocular tests consisting of the measurement of phoria angles, amplitudes of fusion (AF), near point of convergence (NPC) assessment, an evaluation of suppression (Worth test), stereoacuity according to Titmus, and TNO tests.ResultsThe patients with glaucoma showed significantly increased phoria angles, especially in near vision, compared with the ocular hypertensives and controls (P=.000). AF were reduced mainly in near distances compared to hypertensives and controls (P=.000). The NPC of glaucoma was higher than the other two groups (P=.000). No differences were found in the near-distance suppression test between the three groups (P=.682), but there were differences in the distance vision of patients with glaucoma compared to hypertensives (OR=3.867, 95% CI; 1.260-11.862; P=.008) and controls (OR= 5.831, 95% CI; 2.229-15.252; P=.000). The stereoacuity of patients with glaucoma was reduced in both tests (P=.001).ConclusionsPOAG is mostly associated with, an increased exophoria in near vision, a decreased AF in near vision, a far-distance NPC, central suppression in far-vision, and a loss of stereoacuity. These changes do not seem to appear early as they were not observed in hypertensive patients versus controls.     

Ranibizumab intravítreo en el tratamiento de membrana neovascular subretiniana en un caso de coroidopatía puntata interna

Case reportWe report the case of a 28-year old woman suffering loss of visual acuity in her left eye, who presented an image suggestive of a subretinal neovascular membrane in her left eye, and bilateral retinal lesions compatible with punctate inner choroidopathy (PIC). She was treated with intravitreal ranibizumab obtaining excellent results.DiscussionThe differential diagnosis must be made between PIC and the rest of “white dot syndromes” and the presumed ocular histoplasmosis syndrome (POHS). Antiangiogenic drugs may be a good alternative for the treatment of such diseases when they develop a subretinal neovascular membrane.     

Manejo del cristalino subluxado en pacientes jóvenes

ObjectivesTo evaluate visual outcomes in patients treated for lens subluxation. Secondary objectives are to report best corrected visual acuity (BCVA) in LogMAR and compare the outcomes of patients managed conservatively with those treated surgically.MethodsRetrospective comparison of BCVA in patients under 50 years-old with lens subluxation, managed conservatively or surgically.ResultsA total of 49 eyes of 28 patients were included. Demographic characteristics were similar in both groups. Twenty eyes were treated surgically (40.8%) compared to 29 with medical treatment (59.2%). Marfan syndrome (79.6%) was diagnosed in 39 eyes. LogMAR BCVA post intervention was 0.35 ± 0.31 for medical treatment and 0.39 ± 0.32 for the surgical group, with no significant differences (P=.63). Improvements in LogMAR lines were 2.7 ± 4.2 and 4.11 ± 4.2 (P=.35), respectively. Two eyes in the surgery group developed ocular hypertension (0.04%), none with retinal detachment.ConclusionsThe final BCVA showed no significant differences in this group of patients. BCVA depends on the visual potential of the rehabilitated eye rather than a specific type of intervention.     

Endoresektion von großen uvealen Melanomen nach Protonenbestrahlung

PURPOSE: Large uveal melanomas located close to the optic nerve and/ or to the fovea have an unfavourable prognosis with regard to visual preservation and eye retention, due to the high incidence of radiation and tumour necrosis induced complications. Endoresection of the tumour after proton beam irradiation, is an alternative approach, aiming to reduce the incidence of ocular morbidity caused by tumour necrosis after sole radiotherapy. PATIENTS AND METHODS: 32 patients with large uveal melanomas (mean tumour thickness: 9.1 mm, mean tumour volume: 0.77 cc), received a primary proton beam irradiation (60 CGE) and underwent subsequent endoresection via a 3-port pars plana vitrectomy. The median pretreatment visual acuity was 0.2. The mean follow-up was 13.9 months. RESULTS: The postoperative visual acuity after 12 months was 0.12 (median, mean visual acuity loss 0.08). The probability of developing radiation retinopathy or papillopathy within the first year after treatment was 35% and 28% respectively and the probability of enucleation was 9% within the first postoperative year. No tumour recurrences were observed and 2 patients developed liver metastases. CONCLUSIONS: Endoresection following irradiation of large uveal melanomas located close to the optic nerve and/ or the fovea seems to be a useful and safe alternative to the traditional irradiation or enucleation. The incidence of complications following our approach seems to be lower when compared to radiation alone, where tumour necrosis is a substantial problem.     

Loiasis ocular en paciente con hipereosinofilia crónica

Case ReportWe present a case of ocular loiasis with a subconjunctival filaria, 5.5 cm long, and a severe microfilaremia, 1 microfilaria/ml, on a previously asymptomatic woman from Equatorial Guinea, with a past medical history of hypereosinophilia of unknown origin.DiscussionOcular loiasis is an imported infestation with a very low rate in our country. Nevertheless, chronic infestation in immigrants coming from endemic areas of Africa may increase the rate of this disease in our country.