Síndrome de Alicia en el País de las Maravillas secundario a infección por SARS-CoV-2 / Alice in Wonderland syndrome in SARS-CoV-2 infection

El síndrome de Alicia en el País de las Maravillas es un conjunto de trastornos complejos de la percepción visual con múltiples etiologías, siendo las infecciones las más frecuentes en Pediatría. Es un cuadro poco frecuente, pero es importante conocerlo por su carácter generalmente autolimitado. Presentamos el caso de un niño de 11 años que, a las 48 horas de infección por SARS-CoV-2, inició distorsión visual de la forma corporal, micropsias y macropsias. Se descartaron otras causas orgánicas, manteniéndose actitud expectante dada su evolución benigna. Se destaca la aparición de este síndrome en contexto clínico de infección por SARS-CoV-2, no habiendo sido descrita hasta ahora su asociación en la literatura. (AU)

The Alice in Wonderland syndrome is defined by the presence of visual perception disorders with several etiologies, being infectious the most frequent in pediatrics. It is a rare clinical condition, but it is important to recognize it because of the generally self-limited nature. We present an 11 years old child who presented visual body distortions, micropsia and macropsia 48 after SARS-CoV-2 infection. Other organic causes were discarded, maintaining an expectant treatment because of its benign evolution. It is noteworthy that this syndrome associated with SARS-CoV-2 infection has not yet been published. (AU)

Prevalence of computer vision syndrome: A systematic review and meta-analysis

Purpose This review aimed to estimate the prevalence of computer vision syndrome (CVS) in the general population and subgroups. Methods A search was conducted in the following the databases: PubMed, SCOPUS, EMBASE, and Web of Science until February 13, 2023. We included studies that assessed the prevalence of CVS in any population. The Joanna Briggs Institute's critical appraisal tool was used to evaluate the methodological quality. A meta-analysis of the prevalence of CVS was done using a random-effects model, assessing the sources of heterogeneity using subgroup and meta-regression analyses. Results A total of 103 cross-sectional studies with 66 577 participants were included. The prevalence of CVS was 69.0% (95% CI: 62.3 to 75.3; I2: 99.7%), ranging from 12.1 to 97.3% across studies. Point prevalence was higher in women than in men (71.4 vs. 61.8%), university students (76.1%), Africa (71.2%), Asia (69.9%), contact lens wearers (73.1% vs. 63.8%) in studies conducted before the COVID-19 pandemic (72.8%), and in those that did not use the CVS-Q questionnaire (75.4%). In meta-regression, using the CVS-Q scale was associated with a lower prevalence of CVS. Conclusion Seven out of ten people suffer from CVS. Preventive strategies and interventions are needed to decrease the prevalence of this condition which can affect productivity and quality of life. Future studies should standardize a definition of CVS. (AU)

Síndrome de nieve visual y su relación con la migraña / Visual snow syndrome and its relationship with migraine

Introducción El síndrome de nieve visual (SNV) es un trastorno del sistema nervioso central que implica la visión de forma constante de pequeños puntos blancos y negros en la totalidad del campo visual. Desarrollo El SNV puede presentarse desde la infancia hasta la tercera edad, siendo más frecuente en jóvenes y sin diferencia entre géneros. En sus criterios diagnósticos se incluye la presencia de nieve visual, pero también otros fenómenos visuales como palinopsia, fotofobia, nictalopía y otros fenómenos visuales persistentes. La fisiopatología del SNV es desconocida, pero se postulan como mecanismos la hiperexcitabilidad del córtex visual y una disfunción en el procesamiento visual de orden superior. La prevalencia de migraña en los pacientes con SNV es alta en comparación con la población general y cuando se presentan conjuntamente los síntomas son más severos. No se dispone de un tratamiento eficaz, pero el fármaco con mejores resultados es la lamotrigina, recomendándose únicamente en casos seleccionados con alta limitación funcional. Conclusiones El síndrome de nieve visual es una entidad poco conocida e infradiagnosticada, pero el creciente número de investigaciones durante los últimos años ha permitido definir unos criterios diagnósticos y acercarnos a su fisiopatología. Es una entidad íntimamente relacionada con la migraña, con solapamiento de síntomas y probablemente mecanismos fisiopatológicos comunes. (AU)

Introduction Visual snow syndrome (VSS) is a central nervous system disorder that consists of the constant perception of small black and white dots throughout the entire visual field. Development VSS can present from infancy to old age, with greater prevalence in the young population, and shows no difference between sexes. The diagnostic criteria include the presence of visual snow and such other visual phenomena as palinopsia, photophobia, nyctalopia, and other persistent visual phenomena. The pathophysiology of VSS is unknown, but hyperexcitability of the visual cortex and a dysfunction in higher-order visual processing are postulated as potential mechanisms. The prevalence of migraine among patients with VSS is high, compared to the general population, and symptoms are more severe in patients presenting both conditions. No effective treatment is available, but the drug with the best results is lamotrigine, which is recommended only in selected cases with severe functional limitation. Conclusions VSS is a little-known and underdiagnosed entity, but the increasing number of studies in recent years has made it possible to establish diagnostic criteria and begin studying its pathophysiology. This entity is closely related to migraine, with overlapping symptoms and probably shared pathophysiological mechanisms. (AU)

El espacio supracoroideo en pacientes afectados por retinosis pigmentaria / The suprachoroidal space in patients affected by retinitis pigmentosa

Antecedentes y objetivo: El espacio supracoroideo (SCS) es una estructura teórica que se sitúa entre el borde interno de la esclera y el límite externo del coroides. El SCS está siendo estudiado por sus posibles usos como vía para la administración de medicamentos y por técnicas quirúrgicas innovadoras para el tratamiento de muchas enfermedades retinianas. La retinitis pigmentosa (RP) es un grupo de trastornos hereditarios y progresivos caracterizados por el detrimento gradual de fotorreceptores que conduce a una discapacidad visual que se manifiesta típicamente como hemeralopía y pérdida progresiva del campo visual. El objetivo del estudio fue definir la morfología de los márgenes coroideos externos mediante el uso de tomografía de coherencia óptica de barrido (SS-OCT) en la RP.Materiales y métodosEstudio observacional retrospectivo diseñado para evaluar la presencia del ESC en la RP. Realizamos SS-OCT en un grupo de 55 pacientes afectados por RP (26 hombres y 29 mujeres, 110 ojos) con una edad media de 51,8±13,7 años. En el grupo de control incluimos a 28 sujetos sanos (6 hombres y 22 mujeres, 56 ojos) con una edad media de 48,8±16,6 años.ResultadosLas imágenes OCT permitieron delinear de manera precisa el margen coroideo externo y el margen escleral interno en los 110 ojos. En el grupo RP se detectó el ESC en 47 de los 110 ojos (42,7%), en el grupo de control se detectó el ESC en 11 ojos (19,6%).Los sujetos del grupo RP con SCS visibles presentaron un menor grosor retiniano (168,4 micrones) en comparación con aquellos con SCS visibles (211,2 micrones, p=0,007). (AU)

Background and objective: The suprachoroidal space (SCS) is a theoretical structure which can be demonstrated between the inner border of the sclera and the outer boundary of the choroid. SCS is being studied for its potential uses as a route for drug delivery and innovative surgical techniques for the treatment of many retinal diseases. Retinitis pigmentosa (RP) is a group of inherited eye disorders characterized by a gradual loss of photoreceptors, resulting in vision impairment, which typically presents as night blindness and progressive visual field loss. The purpose of the study is to define the morphology of outer choroidal margins by means of SS-OCT in RP.Material and methodThis is a retrospective observational study designed to evaluate the presence of SCS in RP. We performed swept source optical coherence tomography (SS-OCT) in a group of 55 patients affected by RP (26 males and 29 females, 110 eyes) with a mean age of 51.8±13.7 years. In the control group, we included 28 healthy subjects (6 males and 22 females, 56 eyes) with a mean age of 48.8±16.6 years.ResultsOCT scans allowed the outer choroidal margin and inner scleral margin to be delineated with certainty in all 110 eyes. In the RP group SCS was detected in 47 of 110 eyes (42.7%), in the control group SCS was detected in 11 eyes (19.6%).Subjects with SCS visible (RP group) had reduced retinal thickness (168.4μm) compared to those with not visible SCS (211.2μm, p=0.007). (AU)

Complejo anómalo vascular exudativo perifoveal (PEVAC) / Perifoveal exudative vascular anomalous complex (PEVAC)

Se presentan 3 casos de pacientes, con 66, 80 y 23años de edad, que presentaron una pérdida de visión unilateral. La tomografía de coherencia óptica (OCT) mostró edema macular junto con una lesión redondeada de pared hiperreflectiva y la angiografía con fluoresceína (AFG) de dos de ellos, dilataciones aneurismáticas perifoveales hiperfluorescentes con exudación. Ninguno de los casos mostró respuesta al tratamiento tras un año de seguimiento, diagnosticándose finalmente de complejo anómalo vascular exudativo perifoveal (PEVAC) (AU)

We present three cases of patients aged 66, 80 and 23, who presented unilateral vision loss. Optical coherence tomography (OCT) in all of them showed macular oedema and a rounded lesion with hyper-reflective wall, and fluorescein angiography (FAG) in two of them showed hyperfluorescent perifoveal aneurysmal dilations with exudation. None of the cases showed response to treatment after one year of follow-up, finally being diagnosed with perifoveal exudative vascular anomalous complex (PEVAC) (AU)

The impact of low vision on social function: The potential importance of lost visual social cues

Visual cues usually play a vital role in social interaction. As well as being the primary cue for identifying other people, visual cues also provide crucial non-verbal social information via both facial expressions and body language. One consequence of vision loss is the need to rely on non-visual cues during social interaction. Although verbal cues can carry a significant amount of information, this information is often not available to an untrained listener. Here, we review the current literature examining potential ways that the loss of social information due to vision loss might impact social functioning. A large number of studies suggest that low vision and blindness is a risk factor for anxiety and depression. This relationship has been attributed to multiple factors, including anxiety about disease progression, and impairments to quality of life that include difficulties reading, and a lack of access to work and social activities. However, our review suggests a potential additional contributing factor to reduced quality of life that has been hitherto overlooked: blindness may make it more difficult to effectively engage in social interactions, due to a loss of visual information. The current literature suggests it might be worth considering training in voice discrimination and/or recognition when carrying out rehabilitative training in late blind individuals. (AU)

Efectos neurológicos en trabajadores expuestos a tolueno. Revisión sistemática / Neurological effects in workers exposed to toluene. Systematic review

Introducción y objetivo: el tolueno es un disolvente orgánico derivado del benceno empleado en diversas indus-trias, con potenciales efectos nocivos para los trabajadores. Este estudio pretende conocer los posibles efectos neurológicos que presentan los trabajadores expuestos a tolueno.Material y métodos: revisión sistemática de estudios publicados en inglés y español entre enero/2000-diciem-bre/2021. Las bases de datos consultadas fueron MEDLINE, WOS, Scopus, Embase, LILACS, IBECS y Cochrane Li-brary. La calidad de los estudios se evaluó mediante la declaración STROBE y el nivel de evidencia mediante los criterios SIGN.Resultados: Se incluyeron 14 estudios observacionales (calidad entre 13-18, nivel de evidencia entre 2+ y 3). Ocho estudios examinaron síntomas neurológicos inespecíficos y alteraciones del comportamiento encontrando un au-mento de síntomas como cefalea, náuseas o vómitos, y una disminución del rendimiento motor y atención en tra-bajadores expuestos a tolueno (p<0,05). Cuatro estudios examinaron los efectos visuales, encontrando valores de Índice de Confusión de Color (CCI) más elevados en el grupo expuesto (p<0,05). Por último, dos estudios examina-ron los efectos del tolueno sobre la audición en co-exposición con ruido, observando en uno de ellos agravamiento de la pérdida auditiva en ambiente ruidoso (concentración media 33-164,6ppm), (p<0,001); mientras que en el otro estudio no se observaron efectos a concentraciones ≤50ppm.Conclusión: la exposición laboral a tolueno produce efectos neurológicos como síntomas inespecíficos, alteracio-nes del comportamiento, y efectos en la visión y en la audición. No obstante, es necesario realizar estudios con mejor diseño y calidad metodológica, ajustando factores de confusión y con mayor tamaño muestral (AU)

Introduction and objective: toluene is an organic solvent derived from benzene used in various industries, with potential harmful effects for workers. This study aims to determine the possible neurological effects of workers exposed to toluene.Material and methods: Systematic review of studies published in English and Spanish between January/2000-De-cember/2021. The databases consulted were MEDLINE, WOS, Scopus, Embase, LILACS, IBECS and Cochrane Library. Study quality was assessed using the STROBE statement and the level of evidence using the SIGN criteria.Results: 14 observational studies were included (quality between 13-18, level of evidence between 2+ and 3). Eight studies examined non-specific neurological symptoms and behavioral alterations, finding an increase in symptoms such as headache, nausea or vomiting, and a decrease in motor performance and attention in workers exposed to toluene (p<0.05). Four studies examined visual effects, finding higher Color Confusion Index (CCI) values in the exposed group (p<0.05). Finally, two studies examined the effects of toluene on hearing in co-exposure with noise observing in one of them aggravation of hearing loss in noisy environment (mean concentration 33-164.6ppm), (p<0.001); while in the other study no effects were observed at concentrations ≤50ppm.Conclusion: occupational exposure to toluene produces neurological effects such as nonspecific symptoms, behav-ioral alterations, and effects on vision and hearing. However, it is necessary to carry out studies with better design and methodological quality, adjusting for confounding factors and with a larger sample size (AU)

Convergence insufficiency: Review of clinical diagnostic signs

Convergence insufficiency (CI) is a common binocular vision (BV) disorder characterized by difficulty in maintaining motor fusion at near, which affects approximately 7.5 percent of the population. Diagnostic criteria for the disorder are inconsistent, ranging from one to many clinical signs. Methodology for clinical tests is inconsistent in measurement technique, visual targets, required repetitions, and normative values.This manuscript demonstrates the inconsistencies amongst published studies, and highlights the importance of consistent clinical diagnostic signs, measurement techniques, visual targets, and cut-off criteria. For each clinical sign, the recommended methodology for the procedure is described. Several studies do not take age into account when diagnosing CI in their cohorts. As such, the review emphasizes changes in diagnostic signs with age.This manuscript highlights the need for consistent and clear procedures and diagnostic criteria amongst clinicians and provides the basis for future studies in terms of diagnostic testing required for CI of varying age groups. (AU)

Accommodative and binocular vision dysfunctions in a Portuguese clinical population

Background: Several studies have suggested that accommodative and non-strabismic binocular dysfunctions are commonly encountered in optometric practice. This study aims to verify whether these findings apply to a Portuguese clinical population.MethodsThis study included consecutive nonpresbyopic subjects that came to two Portuguese optometric clinics over a period of six months. A complete visual exam was conducted and included the measurement of visual acuity (VA), refraction, near point of convergence (NPC), distance and near phoria, near and distance fusional vergences, amplitude of accommodation (AA), monocular accommodative facility (MAF), relative accommodation and lag of accommodation.Results156 subjects with a mean age of 24.9 ± 5.3 years (from 18 to 35 years old) participated in the study. Of all subjects, 32 % presented binocular vision and/or accommodative disorders accompanied or not by refractive errors. Moreover, 21.1 % had accommodative disorders, and 10.9 % had a binocular vision dysfunction. Accommodative insufficiency (11.5 %) was the most prevalent disorder, followed by convergence insufficiency (7.1 %) and accommodative infacility (5. 8 %).ConclusionsClinicians should be aware that about one third of the optometric clinical population could have accommodative and/or non-strabismic binocular disorders. Accommodative insufficiency was the most prevalent dysfunction presented in the studied population, followed by accommodative infacility and convergence insufficiency. (AU)

Comparación de las características físicas y motrices de personas con discapacidad visual totalmente baja visión / Comparison of physical and motoric characteristics of totally visually impaired and low vision individual

The purpose of this study is to compare the physical and motor characteristics of individuals with total visual impairment (TVI) and individuals with low vision (LVI). 250 participants (136 participants=TVI, 114 participants=LVI) bettween the age 10-19 participated in the study. Participants’ anthropometric features (age, height, weight, and BMI), balance, sitting reach, standing long jump, shuttle run, vertical jump, shuttle, hanging with bent arm, and handgrip strength were measured. Dr. Lovett's manual muscle strength measurement (MMSM) was used to determine the strength parameters. The strength of arm flexion strenght (FS), arm extension strenght (ES), leg FS, leg ES, hip FS, hip ES, back and abdominal strenght were measured. For statistical analysis the SPSS 25 was used. Therefore, Independent Sample T Test was used to determine the difference between the two groups. As a result of the statistical analyzes, a significant difference was found between TVI and LVI in balance, sit and reach, standing long jump, shuttle run, vertical jump, shuttle, handgrip strength, abdominal strength, back strength, hip FS, arm FS, and arm ES (p<0.05). LVI's motoric properties were better than TVI. There was no difference between groups in bent arm hanging (BAH), hip ES, leg FS and leg ES (p>0.05). As a result of the study, it was found that the degree of vision significantly affects physical and motor development. TVI develop slower than LVI in terms of physical and motor characteristics.This study was conducted to reveal the difference in motor characteristics between TVI and LVI. According to the results of this study; In order to prevent insufficient physical and motor development in TVI individuals in developmental age, it is recommended to be supported with sportive activities. The development of TVI individuals should be followed from early childhood and appropriate strategies should be developed. (AU)

El propósito de este estudio es comparar las características físicas y motoras de personas con discapacidad visual total (TVI) y personas con baja visión (LVI). 250 participantes (136 participantes=TVI, 114 participantes=LVI) entre 10-19 años participaron en el estudio. Se midieron las características antropométricas de los participantes (edad, altura, peso e IMC), el equilibrio, el alcance sentado, el salto de longitud de pie, la carrera de lanzadera, el salto vertical, la lanzadera, colgarse con el brazo doblado y la fuerza de agarre. Se utilizó la medición manual de la fuerza muscular (MMSM) del Dr. Lovett para determinar los parámetros de fuerza. Se midió la fuerza de flexión de brazo (FS), fuerza de extensión de brazo (ES), FS de pierna, ES de pierna, FS de cadera, ES de cadera, espalda y fuerza abdominal. Para el análisis estadístico se utilizó el SPSS 25. Por lo tanto, se utilizó la prueba T de muestra independiente para determinar la diferencia entre los dos grupos. Como resultado de los análisis estadísticos, se encontró una diferencia significativa entre TVI y LVI en equilibrio, sentarse y alcanzar, salto de longitud de pie, carrera lanzadera, salto vertical, lanzadera, fuerza de prensión manual, fuerza abdominal, fuerza de espalda, cadera FS, brazo FS y brazo ES (p<0,05). Las propiedades motoras de LVI fueron mejores que las de TVI. No hubo diferencia entre los grupos en brazo doblado colgando (BAH), cadera ES, pierna FS y pierna ES (p>0,05). Como resultado del estudio se encontró que el grado de visión afecta significativamente el desarrollo físico y motor. TVI se desarrolla más lentamente que LVI en términos de características físicas y motoras. Este estudio se realizó para revelar la diferencia en las características motoras entre TVI y LVI. Según los resultados de este estudio; Para prevenir un desarrollo físico y motor insuficiente en individuos TVI en edad de desarrollo, se recomienda apoyarlos con actividades deportivas. (AU)

Macrovaso coroideo y metamorfopsia persistente después de cirugía de membrana epirretiniana / Choroidal macrovessel and persistent metamorphopsia after epiretinal membrane surgery

Presentamos el caso de un hombre de 59 años con disminución de agudeza visual y metamorfopsia en ambos ojos en el contexto de membrana epirretiniana bilateral (MER) que fue intervenido con cirugía retinovítrea (cromovitrectomía más pelado de membrana limitante interna). Presentó recuperación de agudeza visual en su ojo izquierdo. Sin embargo, los resultados visuales de su ojo derecho no fueron satisfactorios, con persistencia de metamorfopsia en dicho ojo. El estudio con imagen multimodal que incluyó retinografía en color y filtro rojo, tomografía de coherencia óptica con imagen de profundidad mejorada (OCT-EDI), angiografía fluoresceínica (AF), angiografía verde de indocianina (ICGA), OCT-angiografía (OCTA) y OCT en-face fue útil para diagnosticar un macrovaso coroideo. Este recorría desde la fóvea hasta la mácula temporal. La OCT-EDI reveló que el macrovaso coroideo generaba una deformación foveal tanto de la zona elipsoide (ZE) como del epitelio pigmentario de retina (EPR). En este trabajo se discute si los cambios estructurales en la fóvea generados por el macrovaso coroideo están relacionados con la metamorfopsia persistente en el ojo afectado (AU)

We report the case of a 59-year-old man with decreased visual acuity and metamorphopsia in both eyes in the context of bilateral epiretinal membrane (ERM) who underwent retinovitreal surgery (chromovitrectomy plus peeling of internal limiting membrane). He recovered visual acuity in his left eye. However, the visual results of his right eye were not satisfactory, with persistence of metamorphopsia in that eye. The multimodal imaging study that included colour and red filter retinographies, enhanced depth imaging optical coherence tomography (EDI-OCT), fluorescein angiography (FA), indocyanine green angiography (ICGA), OCT angiography (OCTA) and OCT en face, were useful to diagnose a choroidal macrovessel. This ran from the fovea to the temporal macula. EDI-OCT revealed that the choroidal macrovessel generated a foveal deformation of both the ellipsoid zone (EZ) and the retinal pigment epithelium (RPE). This paper discusses whether structural changes in the fovea generated by the choroidal macrovessel are related to persistent metamorfopsia in the affected eye (AU)

Gestión, estrategias y adecuaciones educativas implementadas para una estudiante con discapacidad visual completa en la carrera de Kinesiología de la Universidad Austral de Chile: análisis de un caso / Management, strategies and educational adequations implemented for an undergraduate Kinesiology student with total visual disability of the Universidad Austral de Chile: analysis of a case

Introducción: La inclusión educativa es un desafío en la gestión del currículo de las instituciones de educación superior.Material y métodos.Informe de caso de una estudiante de Kinesiología con discapacidad visual que describe la gestión, las estrategias y las adecuaciones educativas implementadas.Resultados.Existió una variedad de adecuaciones educativas impulsadas por la gestión institucional. Deben implementarse actividades extraacadémicas y el quehacer autónomo.Conclusión.La gestión y las adecuaciones educativas permitieron, en gran medida, la participación de la estudiante en el proceso formativo universitario. (AU)

Introduction: Educational inclusion is a challenge in the management of the curriculum of higher education institution.Material and methods.Case report of a Kinesiology student with visual impairment that describes management, strategies and educational adjustments.Results.There was a variety of educational adjustments driven by institutional management. Extracurricular activities and autonomous work must be implemented.Conclusion.The management and educational adjustments greatly allowed the participation of the student in the university training process. (AU)

Optic neuritis as sign presentation of acute disseminated encephalomyelitis following Mycoplasma pneumoniae infection

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Disfagia como síntoma de presentación de síndrome de Alicia en el País de las Maravillas / Dysphagia as a presenting symptom of Alice in Wonderland syndrome

Varón de 6 años que acude a consulta de Gastroenterología infantil por cuadro de disfagia y ansiedad asociada con la alimentación. Tras descartarse esofagitis eosinofílica y enfermedad por reflujo gastroesofágico es diagnosticado de disfagia fóbica. El cuadro clínico progresa y cursa con disfagia nocturna asociada a macropsias y micropsias. Finalmente, presenta clínica diurna. Se descartan trastornos epilépticos y tumorales del sistema nervioso central y se realizan potenciales visuales evocados con amplitudes gigantes, siendo diagnosticado de síndrome de Alicia en el País de las Maravillas. La clínica digestiva y alucinatoria mejora de forma espontánea hasta la resolución (AU)

A 6-year-old male attended the Pediatric Gastroenterology office for dysphagia and anxiety associated with feeding, once eosinophilic esophagitis and gastroesophageal reflux disease were ruled out, he was diagnosed with phobic dysphagia. The symptoms progressed to nocturnal dysphagia associated with macropsias and micropsias and finally he presented with daytime symptoms. Epileptic and tumoral disorders of the central nervous system were ruled out and visual evoked potentials with giant amplitudes were performed, finally diagnosing Alice in Wonderland Syndrome. The digestive and hallucinatory symptoms improved spontaneously until resolution. (AU)

La cuestión está en el síndrome general (y la pérdida de visión) / The question is the general syndrome (and the vision loss)

We present the case of a man who refers weight loss, asthenia, andrectal bleeding. After the initial tests a rectal ulcer was found througha colonoscopy. After that, he consulted for acute loss of vision, withfindings in the ophthalmological explorations compatible with bilateralposterior uveitis. We propose the differential diagnosis of the rectalulcer in one hand and of the bilateral posterior uveitis in the other,with the aim of reaching a diagnosis which involves both alterations.

Presentamos el caso de un hombre que consulta por pérdida depeso, astenia y rectorragia. En los estudios iniciales se objetiva una úlcera rectal en la colonoscopia realizada. Posteriormente presenta pérdida de visión brusca, con hallazgos en la exploración oftalmológica compatibles con uveítis posterior bilateral.Se plantea el diagnóstico diferencial por un lado de la úlcera rectal ypor otro de la uveítis posterior bilateral para llegar a un diagnósticoque aúne ambas alteraciones.

Disminución de la agudeza visual tras un procedimiento odontológico: A propósito de un caso / Unilateral visual impairment after a dental procedure: Case report

El uso de anestésicos locales para la realización de procedimientos odontológicos es una práctica ampliamente extendida que puede causar efectos adversos. Sin embargo, muy infrecuentemente puede causar complicaciones oculares como diplopía, ptosis, visión borrosa, miosis, disminución de la agudeza visual o amaurosis. Presentamos un caso de un paciente varón de 26 años que se presentó a la consulta por una disminución de la agudeza visual en su ojo derecho 48h después de una intervención odontológica del lado ipsilateral, logrando una recuperación de la misma en los 6 meses posteriores, sin tratamiento alguno. Diferentes teorías que justifiquen la aparición de complicaciones oculares como consecuencia de esta clase de procedimientos han sido propuestas en la literatura. En nuestro caso, una inyección intravenosa inadvertida habría sido la causa posible del hecho (AU)

The use of intra-oral local anaesthetics for dental procedures is a widely extended practice that may cause side effects. As such, in rare cases it may cause ocular complications such as diplopia, ptosis, blurry vision, miosis, vision loss, or amaurosis. (Most of them are transient, recovering after several hours or days). A case is presented of a 26 year-old male patient who had visual impairment in the right eye 2 days after a dental procedure was performed. Six months later he had a complete restoration of the previous visual acuity, despite the fact that he had not received any treatment. Several ways have been proposed in the literature that may explain the appearance of ocular complications following these kinds of procedures. In this case, inadvertent intravenous injection is believed to have been the cause (AU)

A retrospective study of causes of visual impairment and use of low vision devices in the low vision clinic in Trinidad and Tobago

Purpose: To determine the causes of visual impairment and the use of low vision devices in patients attending the low vision clinic in Trinidad and Tobago.MethodsA retrospective study of the 222 patients attending the low vision clinic at the University of the West Indies, St Augustine Campus was conducted. The presenting visual acuity, causes of low vision and blindness, and prescribed low vision devices were recorded and analysed to determine the major causes of visual impairment and improvement in visual acuity with low vision aids.ResultsOut of the total 222 participants, 66.66% (n = 148) had low vision while the rest (33.33%, n = 74) were legally blind. Glaucoma was the major cause of low vision (31.08%) and blindness (28.38%) followed by diabetic retinopathy (20.94%, low vision and 20.27%, blindness). A total of 193 low vision devices were prescribed, 79.79% (n = 154) near devices and 20.20% (n = 39) distance devices. The low vision devices were effective in improving both near visual acuity (120 participants reading 1M or 2M) and distance visual acuity (VA better than 3/60).ConclusionThe major causes of vision impairment in Trinidad and Tobago were glaucoma and diabetic retinopathy and low vision devices are effective in improving visual acuity. A comprehensive approach to dealing with the causes of low vision and low vision services are required to mitigate the burden of visual impairment in the country. (AU)