Clinical-epidemiological characteristics of keratoconus in Asturias.

INTRODUCTION: Keratoconus is the most frequent corneal ectasia and second most common cause of keratoplasty worldwide. The clinical and epidemiological characteristics of keratoconus have rarely been studied in Spain, and to date, no study has been done in Asturias. MATERIAL AND METHODS: A cross-sectional study was conducted to analyze all cases of keratoconus diagnosed in the first consultations of the Cornea and Surface section of the Hospital Universitario Central de Asturias (Oviedo) and Hospital Universitario de Cabueñes (Gijón) between 2017 and 2020. Demographic data, visual acuity and corneal topography were collected. RESULTS: A total of 112 patients (42.0% women and 58.0% men) were included. The mean age was 36.84 ±â€¯15.59, with 39.3% being older than 40 years. 31.8%, 28.0%, 15.0%, and 25.2% were in stages I, II, III and IV, Amsler-Krumeich scale, respectively. Corneal segments were implanted in 7.5% of patients, cross-linking was performed in 4.7%, and keratoplasty was performed in 13.2%. CONCLUSION: Approximately 40% of keratoconus cases are detected at advanced stages and another 40% are detected at an age over 40 years. 13% of these patients require keratoplasty, which is why it is frequently performed in our setting. Therefore, early diagnosis before irreversible visual loss is necessary.

Junctional scotoma. A case report. / Escotoma juncional. A propósito de un caso.

The case concerns a 55 year-old female patient with progressive visual decrease in her right eye that showed a junctional scotoma in the visual field study. A magnetic resonance scan was performed, which showed a right middle cerebral artery aneurysm with ipsolateral chiasmatic involvement.

[Orbit xanthogranulomatosis. Erdheim-Chester disease]. / Xantogranulomatosis orbitaria. Enfermedad de Erdheim-Chester.

CASE REPORT: A patient was studied because of upper lid bilateral edema and xanthelasmae-like lesions after three years of evolution. During the ophthalmologic examination orange-yellowish lesions and two symmetrical tumours were observed on the temporal part of both upper lids. Corticoid-therapy was undertaken which reduced the size of the tumours, however the size increased again after the discontinuation of treatment. A biopsy was performed and lid xanthogranulomatosis was diagnosed. Other systemic examinations were normal. DISCUSSION: Erdheim-Chester disease is a xanthogranulomatosis that can affect ocular and periorbital structures. Combination of xanthelasmae-like lesions and bilateral orbital masses should make us consider this process and try to locate any associated systemic conditions.

[Choroidal metastasis from renal cell carcinoma]. / Metástasis coroidea de carcinoma renal.

CASE REPORT: A fifty-two year-old man who came to our emergency room because of gradual loss of vision in his right eye. He had suffered right nefrectomy for renal cell carcinoma seven years previously and pneumectomy for metastasis in his right lung three months ago. In the fundus examination a choroidal mass was found in his right eye, suggesting metastasis. Treatment was enucleation of the affected eye. During the first year there was no progression, but in the last six months it has re-appeared. DISCUSSION: Choroidal metastasis of renal cell carcinoma is rare and can appear years after treating the primary tumour. Its symptoms are variable, and its shape is not very characteristic so it can be difficult to make a differential diagnosis.