Hypertensive choroidopathy and adrenal carcinoma: A new association. / Coroidopatía hipertensiva y carcinoma adrenal: una nueva asociación.

A 17 year-old Caucasian female presented with decreased vision, with no other symptoms reported at that time. Ophthalmological examination revealed typical signs of hypertensive choroidopathy, Elschnig spots, and Siegrist streaks. Further medical examination found high blood pressure (220/155mmHg), with a metastatic hormone-secreting adrenal carcinoma being the underlying cause of these alterations. To our knowledge, this is the first reported case of hypertensive choroidopathy associated with adrenal carcinoma.

Intravitreal therapies for non-neovascular age-related macular degeneration with intraretinal or subretinal fluid. / Terapias intravítreas en degeneración macular asociada a la edad no neovascular con fluido intrarretiniano o subretiniano.

OBJECTIVE: To evaluate the efficacy of intravitreal therapies in cases of atrophic age-related macular degeneration (AMD) with subretinal or intraretinal fluid. METHODS: A retrospective review was made of the clinical charts of patients diagnosed with atrophic AMD with subretinal or intraretinal fluid. Fundus photographs and spectral-domain optical coherence tomography images were examined, and an analysis was made on the presence of fluid and its density. Neovascularisation was ruled out by fluorescein and/or indocyanine green angiography. RESULTS: The study included 14 eyes from 13 patients with a mean age of 72.64 years and a mean follow-up of 80.5 weeks. Intraretinal fluid was observed in 6 eyes (42.9%), while subretinal fluid was shown in 8 eyes (57.1%), with high density in 4 eyes (28.5%), and low density in 4 eyes (28.5%). Snellen best-corrected visual acuity improved from 0.37 at baseline to 0.56 at the final visit (P=.002). Central subfield thickness (microns) significantly decreased (P<.001) from 291.0 at baseline to 228.9 at the final visit. Eight eyes received ranibizumab, 5eyes received bevacizumab, and one case received triamcinolone. CONCLUSIONS: Cases of atrophic AMD may present with subretinal or intraretinal fluid in the absence Neovascularisation. Further studies are required to analyse the value of this finding as a risk factor of developing advanced forms of AMD, as well as the efficacy of intravitreal therapies.

Neutrophil gelatinase-associated lipocalin is a biomarker of acute-on-chronic liver failure and prognosis in cirrhosis.

BACKGROUND & AIMS: Acute-on-chronic liver failure (ACLF) is a syndrome that occurs in cirrhosis characterized by organ failure(s) and high mortality rate. There are no biomarkers of ACLF. The LCN2 gene and its product, neutrophil gelatinase-associated lipocalin (NGAL), are upregulated in experimental models of liver injury and cultured hepatocytes as a result of injury by toxins or proinflammatory cytokines, particularly Interleukin-6. The aim of this study was to investigate whether NGAL could be a biomarker of ACLF and whether LCN2 gene may be upregulated in the liver in ACLF. METHODS: We analyzed urine and plasma NGAL levels in 716 patients hospitalized for complications of cirrhosis, 148 with ACLF. LCN2 expression was assessed in liver biopsies from 29 additional patients with decompensated cirrhosis with and without ACLF. RESULTS: Urine NGAL was markedly increased in ACLF vs. no ACLF patients (108(35-400) vs. 29(12-73)µg/g creatinine; p<0.001) and was an independent predictive factor of ACLF; the independent association persisted after adjustment for kidney function or exclusion of variables present in ACLF definition. Urine NGAL was also an independent predictive factor of 28day transplant-free mortality together with MELD score and leukocyte count (AUROC 0.88(0.83-0.92)). Urine NGAL improved significantly the accuracy of MELD in predicting prognosis. The LCN2 gene was markedly upregulated in the liver of patients with ACLF. Gene expression correlated directly with serum bilirubin and INR (r=0.79; p<0.001 and r=0.67; p<0.001), MELD (r=0.68; p<0.001) and Interleukin-6 (r=0.65; p<0.001). CONCLUSIONS: NGAL is a biomarker of ACLF and prognosis and correlates with liver failure and systemic inflammation. There is remarkable overexpression of LCN2 gene in the liver in ACLF syndrome. LAY SUMMARY: Urine NGAL is a biomarker of acute-on-chronic liver failure (ACLF). NGAL is a protein that may be expressed in several tissues in response to injury. The protein is filtered by the kidneys due to its small size and can be measured in the urine. Ariza, Graupera and colleagues found in a series of 716 patients with cirrhosis that urine NGAL was markedly increased in patients with ACLF and correlated with prognosis. Moreover, gene coding NGAL was markedly overexpressed in the liver tissue in ACLF.

Orbital involvement by non-Hodgkin lymphoma NK T cells.

CLINICAL CASE: The case is presented of 37 year-old male with a history of nasal obstruction with right rhinorrhea, headache, hearing loss and right exophthalmos of 4 months progression. The MRI revealed that the ethmoidal and maxillary sinuses contained inflammatory tissue extending into the orbital region. The biopsy confirmed a non-Hodgkin lymphoma of natural killer (NK) T cells. DISCUSSION: Non-Hodgkin's T NK lymphoma is a rare tumor in the orbital area that requires an early detection and multi-disciplinary care to ensure appropriate monitoring and treatment.

[Necrobiotic xanthogranuloma. Differential diagnosis, treatment and systemic involvement. Case report]. / Xantogranuloma necrobiótico. Diagnóstico diferencial, tratamiento e implicaciones sistémicas. A propósito de un caso.

CASE REPORT: A 48-year-old male was referred to our hospital for further evaluation of eyelid edema with bilateral yellowish ulcerated nodules. Suspecting a xanthogranulomatosis, imaging tests and biopsy were performed with diagnosis of necrobiotic xanthogranuloma. IgG monoclonal gammapathy was diagnosed in a systemic study. Systemic corticosteroids and cyclosporine were initiated unsuccessfully; therefore intra-lesional injections of triamcinolone were started, which controlled the orbital disease. DISCUSSION: Necrobiotic xanthogranuloma is a rare condition that usually affects the eyelids and anterior orbit. Its diagnosis is important as it is associated with malignant lymphoproliferative processes. Intra-lesional corticosteroids were effective in our patient.

[Orbital alveolar rhabdomyosarcoma masked by ethmoid sinusitis in a 25-year-old]. / Rabdomiosarcoma alveolar orbitario enmascarado por sinusitis etmoidal en un adulto de 25 años.

CASE REPORT: A 25-year-old woman with right subacute sinusitis, complained about discomfort in her right eye. Clinical manifestations and computed tomography were suggestive of sub-periosteal orbital ethmoid wall abscess, for which the patient underwent urgent drainage. A solid tumor was found, with a positive biopsy for alveolar rhabdomyosarcoma. Complete remission and resolution of orbital symptoms were achieved with chemotherapy and radiation therapy. DISCUSSION: Alveolar orbital rhabdomyosarcoma in adults is uncommon. Rhabdomyosarcoma has a high risk of spreading. It can simulate a sinusitis, as in our patient, early diagnosis and early treatment being especially important in these patients.

[Orbital abscess after peribulbar anesthesia in a frontoethmoidal mucocele]. / Absceso orbitario tras anestesia peribulbar en mucocele frontoetmoidal.

CLINIC CASE: Peribulbar anesthesia is used in daily practice during cataract surgery. It is a safe technique, but not without complications. We present the case of a man who had an orbital abscess secondary to peribulbar anesthesia that led to the perforation of an unknown frontoethmoidal mucocele. DISCUSSION: Orbital abscess secondary to an iatrogenic mucocele perforation after anesthesia is a periorbital complication not described. The detection of the orbital process, intensive medical treatment and monitoring for signs of deterioration are vital in preventing serious complications.

Analysis of factors that determine the diagnostic yield of temporal artery biopsy.

PURPOSE: To analyse the diagnostic yield of temporal artery biopsy in the diagnosis of giant cell arteritis, and to correlate these results with the clinical and laboratory features which indicate it, in an attempt to increase the efficiency of this technique and try to "save biopsies". METHODS: A retrospective cohort study including suspected giant cell arteritis cases in which a temporal artery biopsy was performed. The data recorded included demographic, clinical and laboratory information. RESULTS: A total of 38 patients were analysed. The biopsy was positive in 68.42% of cases. Multivariate analysis revealed visual symptoms and a high C-reactive protein as parameters with a high diagnostic efficiency. CONCLUSIONS: Our study supports the fact that temporal artery biopsy should be undertaken when there is strong clinical suspicion. Visual symptoms and high C-reactive protein are considered as a high efficiency indicators to biopsy.

[Towards the new spectral-domain optical coherence tomography based classification of age-related macular degeneration]. / Hacia la nueva clasificación de la degeneración macular asociada a la edad basada en la tomografía de coherencia óptica de dominio espectral.

INTRODUCTION: Age-related macular degeneration (AMD) is major social and health problem in industrialised societies. The contribution of the new diagnostic techniques, mainly spectral-domain optical coherence tomography (SD-OCT), has led to a better understanding of this disease. AIM: To review the current clinical classification of AMD, to describe the new tomographic classification of wet AMD, and to review the new topographical findings in dry AMD. DEVELOPMENT: There are two classically described forms of AMD: dry and wet; there are also three progressive stages of severity: early, intermediate and advanced. This purely clinical stratification does not take into account any criteria based on SD-OCT. On the other hand, a new SD-OCT based classification has been proposed for choroidal neovascularisations secondary to AMD: types 1 (equivalent to occult), 2 (equivalent to classic), and 3 (equivalent to retinal angiomatous proliferation). Finally, SD-OCT offers exclusive and valuable information on the evaluation of dry AMD as regards subretinal drusenoid deposits, drusenoid pigment epithelium detachments, drusen coalescence, or the appearance of subretinal fluid in absence of choroidal neovascularisation. CONCLUSIONS: Dry AMD exhibits a range of tomographical signs that also have their own relative risk of progression to advance stages of the disease. We need an international consensus in order to follow-up and treat in the best way all those patients with AMD, not only with the wet but also with the dry form.

[Influence of pregnancy on refractive parameters after LASIK surgery]. / Influencia del embarazo sobre los parámetros refractivos tras cirugía laser in situ keratomileusis.

OBJECTIVES: Different ocular changes and complications of refractive surgery such as photorefractive keratectomy (PRK) due to pregnancy have been described in the last few years. However there is no information about the possible problems of laser in situ keratomileusis (LASIK) in pregnant women. Our objective was to study how physiological changes secondary to pregnancy could alter the refractive situation in pregnant women who have undergone LASIK surgery. We show the results obtained due to the changes between the first two trimesters of the pregnancy. METHODS: A prospective and observational study was conducted in which one study group, made up of 9 patients who had undergone LASIK surgery before becoming pregnant, was compared with a control group of 9 patients with non-surgically corrected refractive problems. The following measurements were made in both groups in the first and second trimesters of the pregnancy; visual acuity, the best corrected visual acuity, tonometry, ocular anatomical characteristics by biometry, and refractive and corneal study by Pentacam(®). RESULTS: Signicant changes were observed in the cylinder and spherical equivalent between the two trimesters in both groups. Visual acuity and spherical equivalent show a strong trend towards worsening, which was more significant in the study group. The patients of this group who had a larger pre-surgical defect showed lower modifications during the six first months of pregnancy. CONCLUSIONS: The majority of women who require laser refractive surgery are are between 20-30 years old, thus in many cases corneal surgery is followed by at least one pregnancy, with different possible ophthalmological effects. The conclusions that may be derived from this study are that the assessment of the refractive changes in surgically operated corneas may be biomechanically weakened on being subjected to physiological hormone stimulation as happens during gestation.

[Intraocular levels of pigment epithelium-derived factor in patients with active uveitis]. / Niveles intraoculares del factor derivado del epitelio pigmentario en pacientes con uveítis activa.

OBJECTIVE: Pigment epithelium-derived factor (PEDF) is an antiangiogenic/neurotrophic dual functional factor, and recently it was also shown to mediate antioxidative and anti-inflammatory action. The purpose of this study was to evaluate the levels of PEDF in the aqueous humor in eyes with idiopathic acute anterior uveitis (IAAU). METHODS: A comparative control study. Aqueous humor was collected from 20 eyes of 20 patients with IAAU. The control group included 20 aqueous humor samples from 20 patients who underwent a cataract surgery and without any other ocular or systemic diseases. Levels of PEDF were determined with the ELISA test. RESULTS: Concentration of PEDF in aqueous humor was remarkably higher in patients with IAAU than in control subjects (Mann-Whitney U test, P<.001). Levels of PEDF were 6,291,637.70±8,564,836.48 pg/ml (mean±SD) in eyes with IAAU and 449,178.10±158,670.19 pg/ml in the eyes of the control group. CONCLUSION: The aqueous humor PEDF levels are increased in eyes with IAAU and may be increased as self-protection against inflammation.

[Multidisciplinary management of an anaplastic sebaceous carcinoma of the eyelid in a 40-year-old woman]. / Abordaje multidisciplinar de un carcinoma sebáceo anaplásico palpebral en una paciente de 40 años.

CASE REPORT: A 40-year-old woman was referred to our department due to an apparent indolent anterior blepharitis with an indurated node in her right upper eyelid, which had persisted for months. It was believed to be a chalazion associated with an ipsilateral swollen pre-aurical lymph node, which had not responded to conventional treatment. The extemporaneous biopsy was reported as sebaceous carcinoma. Complete exeresis was performed on that eyelid and it was reconstructed with a palate mucosa graft and a glabelar flap. A radical neck dissection was performed later, in order to remove the lymph nodes that appeared necrotic in several lymphatic areas. A biopsy was also performed on the lower eyelid, which was reported as positive for carcinomatous infiltration, and therefore it was treated with Curie-therapy. DISCUSSION: The precocity in diagnosing sebaceous carcinomas of the eyelids is the main prognostic factor. The reconstruction in cases with need of complete eyelid exeresis is feasible by means of a palate mucosa graft. In our case, both the anaplastic character and the high aggressiveness of the neoplasm were a therapeutic challenge.