Approaches to the epidemiology of NOHL in the region of Madrid: Survey of neuro-ophthalmologists.

OBJECTIVE: To estimate the epidemiology of Leber's optic neuropathy (NOHL) in the Region of Madrid. MATERIAL AND METHODS: The neuro-ophthalmologists who work at public hospitals of the CAM were interviewed by telephone. They were asked about the number of patients with NOHL that they had diagnosed during the time that they had been responsible for the neuro-ophthalmology department of that public hospital. The time worked and the population attended by the hospital were used to calculate the number of inhabitant-years in follow-up by each center during the corresponding period. The basic information of each case (date of birth, mutation, date of visual loss) was registered to avoid duplications. RESULTS: Our work estimates a global incidence of 2.34 cases for 10,000,000 inhabitants-year and a prevalence estimated from incidence of one case for each 106.682 inhabitants. This prevalence was very similar in all the studied areas and considerably lower than that reported by other studies. CONCLUSION: This work constitutes the first approach to the epidemiology of this disease in Spain. The prevalence of LHON in the region of Madrid, is probably lower than that reported in the literature in other regions. The prevalence and the incidence were homogeneously low in the 26 studied areas.

Retinal arterial and venous obstruction as the first manifestation of an antiphospholipid antibody syndrome.

CASE REPORT: A 34 year-old woman presented with decrease in visual acuity in her right eye (RE). Her past medical history was unremarkable. Dilated fundus examination revealed a central venous occlusion and an obstruction of the cilioretinal artery. Given the patient age, a cardiology and haematology screen was obtained to rule out hypercoagulation disorders and thromboembolic disease. Antiplatelet, anticoagulant, and corticosteroid therapy were started. The laboratory result was positive for anticardiolipin and antiphospholipid antibody. A diagnosis of antiphospholipid syndrome (APS) was made. DISCUSSION: Antiphospholipid syndrome may cause thrombosis in any organ. The involvement of the retinal vessels may be the first manifestation of this entity. This diagnosis is important to prevent recurrent thrombotic events.

Effects of pterygium on the biomechanical properties of the cornea: a pilot study.

OBJECTIVE: To investigate the changes induced by a pterygium or its surgical removal on the biomechanical properties of the cornea and to determine factors that might affect these parameters. METHODS: This prospective pilot interventional, non-randomized, observer-masked study included 20 eyes of 20 patients with a unilateral primary pterygium (pterygium group) and 19 fellow healthy eyes (control group). The bare sclera technique with one-minute application of 0.02% mitomycin C intraoperatively was performed in all cases. The follow-up period was one month. The preoperative and postoperative biomechanical properties of the cornea were measured using the Reichert ocular response analyzer (ORA). RESULTS: The corneal hysteresis (CH) decreased significantly (P<.01) in eyes with a pterygium compared to the control eyes, while surgery did not significantly change the CH compared to preoperatively. There were no significant changes in the corneal resistance factor or the central corneal thickness. CONCLUSIONS: Primary active pterygium (grades 1 or 2) induce a reduction of corneal biomechanical features. Further studies are needed in populations, with longer follow-ups and bigger pterygium that may involve wider keratectomy to confirm our results.

Bilateral non-simultaneous optic neuropathy and unilateral macular edema in a patient with POEMS syndrome.

PURPOSE: To report a case of bilateral non-simultaneous optic neuropathy and unilateral macular edema in a patient with polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes (POEMS) syndrome. METHODS: A 61-year-old man with POEMS syndrome had bilateral anterior optic neuropathy and unilateral macular edema. RESULTS: Visual field testing showed bilateral superior altitudinal field defect. Fluorescein angiography revealed unilateral pooling of fluid consistent with cystoid macular edema. Optical coherence tomography (OCT) showed bilateral loss of retinal nerve fiber layer thickness. The erythrocyte sedimentation rate and C-reactive protein values were normal. The serum vascular growth factor measurement was elevated. CONCLUSIONS: This is the first reported case of ophthalmoscopic, angiographic, and OCT evidence of non-simultaneous optic neuropathy and macular edema in this syndrome. The increased vascular permeability could explain all these factors.

[Morphological macular changes after cataract surgery: risk factors]. / Cambios morfológicos maculares tras cirugía de cataratas: factores de riesgo.

OBJECTIVE: To analyze morphological macular changes after uncomplicated cataract surgery and their correlation with age and arterial hypertension. METHODS: Total macular volume (TMV), foveal volume (FOVOL) and foveal thickness (FOV) in patients who had undergone cataract surgery were measured using OCT3 Stratus before surgery, the day after the intervention and one month later. The data were analyzed using SPSS 15.0 software. RESULTS: The study group was composed of 114 eyes from 114 patients. The mean TMV, FOVOL and FOV in the subgroup of patients with signal strength over 6 before cataract surgery were 6.59 (SD0.67) microm(3); 0.16 (SD0.02) microm(3) and 204.97 (SD29.79) microm. One month after surgery the measurements were TMV: 6.93 (SD0.56) microm(3); FOVOL: 0.17 (SD0.06) microm(3) and FOV: 218.07 (SD87.60) microm. We found statistically significant differences (P<0.05) in TMV, but not in FOVOL or FOV. The group of patients under 74 years showed a greater increase in TMV. Patients with arterial hypertension did not show an increase in TMV or FOV compared to patients without arterial hypertension. CONCLUSIONS: We found a sub-morphological macular oedema one month after uncomplicated cataract surgery, with age being a risk factor for developing a greater increase in TMV. Arterial hypertension does not seem to be a risk factor for these changes.

[Band atrophy of the optic disc secondary to ventricular subependymoma compression]. / Atrofia de disco óptico en banda secundaria a compresión por subependimoma ventricular.

CASE REPORT: A 42-year-old man was diagnosed with band or "bow tie" optic atrophy with a right homonymous hemianopia. Computerized tomography (CT) revealed a calcified lesion in the left hippocampus. Craniotomy and tumor resection were performed. The biopsy revealed a subependymoma of the temporal horn of the left ventricular system. DISCUSSION: Optic tract lesions are uncommon clinical entities, in which homonymous hemianopia and contralateral band optic atrophy are characteristic. Subependymomas are infrequent and benign tumors that are typically associated with the ventricular system.

[Anisocoria related to bupropion in migraine]. / Anisocoria producida por bupropión en paciente migrañosa.

INTRODUCTION: Bupropion is used to help people stop smoking. This drug can cause visual alterations but, up to now, its use was not associated with anisocoria. CASE REPORT: A 40 year-old woman with a personal history of migraines, presented with monocular mydriasis during treatment with bupropion. Both pupils dilated equally after a 5% cocaine test, and constricted equally after a 0.025% Pilocarpine test. The anisocoria disappeared after the treatment with bupropion was withdrawn. DISCUSSION: Bupropion inhibits neural uptake of norepinephrine and dopamine. Patients with migraine could have a minor unilateral sympathetic pupillary deficit. This deficit could cause hypersensitivity in the oculosympathetic pathway that could be stimulated with bupropion treatment. This feature could explain the mydriasis in our patient. Another explanation could be that bupropion could unmask a physiological anisocoria.

[Combined topical plus subconjunctival anesthesia versus retrobulbar anesthesia in non-penetrating sclerectomy]. / Anestesia tópica más subconjuntival versus retrobulbar en la esclerectomía profunda no penetrante.

PURPOSE: To compare the safety and efficacy of topical plus subconjunctival versus retrobulbar anesthesia for primary non-penetrating sclerectomy supplemented with adjuntive 5-FU. METHODS: A prospective study of 30 consecutive patients who were randomized to receive subconjunctival (n = 14) or retrobulbar (n = 16) anesthesia was performed. Operating conditions, patient comfort, postoperative pain, total pain and surgical outcomes were evaluated. RESULTS: There were no differences in the operating conditions. The retrobulbar group reported significantly more pain during administration of the anesthetic agent than the subconjunctival group (P= 0.00). The subconjunctival group reported more discomfort during surgery than the retrobulbar group (P= 0.00); however, this feature was not a problem for the surgeon. No statistically significant differences were found in regard to the total pain experienced, the postoperative pain, nor the success rates of the operative procedure in either group. CONCLUSION: Topical/subconjunctival anesthesia is a safe and effective alternative to retrobulbar anesthesia for non penetrating sclerectomy supplemented with 5-FU.

Iris melanocytoma mimicking the Cogan-Reese syndrome with monocular pigment dissemination.

PURPOSE: To report a case of iris melanocytoma mimicking the Cogan-Reese syndrome. METHODS: A 37-year-old woman presented with pigmentary glaucoma in her left eye. There was diffuse pigmentary dispersion in the anterior segment, pedunculated pigmented nodules on the anterior iris surface, mild iris atrophy, and ectropion iridis. Neither intrinsic vasculature nor a sector cataract was found. The angle was open with marked trabecular pigmentation and no anterior synechiae. The intraocular pressure was 30 mmHg with maximum medical treatment and there was glaucomatous optic atrophy. The differential diagnosis included iris pigmented tumor and iridocorneal endothelial syndrome (Cogan-Reese syndrome). An iris biopsy was performed for diagnostic purposes. RESULTS: Histologic diagnosis after evaluation of the specimen was iris melanocytoma. CONCLUSIONS: This case presents signs considered quasi-pathognomonic of iridocorneal endothelial syndrome (Cogan-Reese syndrome): glaucoma, mild iris atrophy associated with pedunculated iris nodules, and ectropion iridis. Therefore, iris melanocytoma can present with features that mimic the Cogan-Reese syndrome.

Topical plus intracameral lidocaine versus retrobulbar anesthesia in phacotrabeculectomy: prospective randomized study.

PURPOSE: To compare the efficacy and safety of topical and retrobulbar anesthesia for phacotrabeculectomy. SETTING: Hospital Ramón y Cajal, Madrid, Spain. METHODS: This prospective study comprised 60 patients (60 eyes) having phacotrabeculectomy surgery. Patients were randomly assigned to 1 of 2 groups receiving topical anesthesia plus intracameral lidocaine 1% or retrobulbar anesthesia. Patients were asked to document the discomfort they experienced during the administration of the anesthetic agent, during surgery, and postoperatively using a numeric pain scale. Complications and surgical conditions were also evaluated. RESULTS: The retrobulbar group reported significantly more discomfort during administration of the anesthetic agent than the topical group (P < .001). The topical group reported significantly more discomfort intraoperatively (P < .01). Eyelid squeezing and eyeball movement were more common in the topical group; however, neither was a problem to the surgeon. There was no difference in surgical conditions (P = .38) or the postoperative pain scores between the 2 groups (P = .06). One patient receiving topical anesthesia developed a suprachoroidal hemorrhage intraoperatively. CONCLUSIONS: Topical anesthesia supplemented with intracameral lidocaine was an effective alternative to retrobulbar anesthesia for phacotrabeculectomy. Although the degree of patient discomfort was significantly higher during surgery under topical anesthesia, the method avoids the pain and complications associated with a retrobulbar injection.