In vitro amoebicidal effects of arabinogalactan-based ophthalmic solution.

The main corneal infections reported worldwide are caused by bacteria and viruses but, recently, the number of Acanthamoeba keratitis (AK) cases has increased. Acanthamoeba genus is an opportunistic free living protozoa widely distributed in environmental and clinical sources, with two life-cycle stages: the trophozoite and the cyst. AK presents as primary symptoms eye redness, epithelial defects, photophobia and intense pain. An early diagnosis and an effective treatment are crucial to avoid blindness or eye removal but, so far, there is no established treatment to this corneal infection. Diverse research studies have reported the efficacy of commercialized eye drops and ophthalmic solutions against the two life cycle stages of Acanthamoeba strains, that usually present preservatives such as Propylene Glycol of Benzalkonium chloride (BAK). These compounds present toxic effects in corneal cells, favouring the inflammatory response in the so sensitive eye tissue. In the present work we have evaluated the efficacy of nine proprietary ophthalmic solutions with and without preservatives (ASDA Dry Eyes Eyedrops, Miren®, ODM5®, Ectodol®, Systane® Complete, Ocudox®, Matrix Ocular®, Alins® and Coqun®) against the two life cycle stages of three Acanthamoeba strains. Our work has demonstrated the high anti-Acanthamoeba activity of Matrix Ocular®, which induces the programmed cell death mechanisms in Acanthamoeba spp. trophozoites. The high efficacy and the absence of ocular toxic effects of Matrix Ocular®, evidences the use of the Arabinogalactan derivatives as a new source of anti-AK compounds.

Focal laser for idiopathic macular telangectasia type 1 refractory to ozurdex, ranibizumab and aflibercept. / Láser focal para telangectasia macular idiopática tipo 1 refractario a ozurdex, ranibizumab y aflibercept.

We present a case of a woman with idiopathic macular telangiectasia type 1, characterized by the presence of a capillary macroanaeurysm associated with macular edema with a macular star pattern. Several differential diagnoses were proposed, in which the study with a multimodal image was key to clarify the diagnosis. In addition, the various treatments used and their effectiveness are discussed.

Detachment of retinal pigment epithelium in retinopathy due to malaria. / Desprendimiento del epitelio pigmentario de la retina en la retinopatía por malaria.

CASE REPORT: A 45-year-old man was diagnosed with malaria with neurological involvement. Two months later he referred metamorphopsia in the left eye. Malarial retinopathy was observed in the fundus examination. The Optic Coherence Tomography (OCT) of the macula showed parafoveal pigment epithelium detachment (DEP). Specific anti-malarial treatment was initiated, with the disappearance of the retinopathy being observed. DISCUSSION: Plasmodium falciparum is responsible for the retinopathy in neurological malaria. A funduscopic examination and macular OCT should be performed in these patients, as it is associated with a higher mortality when there is a retinal involvement.

MEK Retinopathy. Clinical case reports. / Retinopatía MEK. Casos clínicos.

CASE REPORTS: Three clinical cases are presented of MEK retinopathy associated with the combination of cobimetinib and vemurafenib characterised by alteration of the retinal pigment epithelium and neurosensory detachment. Two of the cases conserved the vision of the unit, and the third developed a large bilateral neurosensory detachment with final visual acuity of 0.6 for the right eye and 0.1 for the left one. DISCUSSION: The new therapeutic strategies against metastatic cutaneous melanoma condition the appearance of alterations of the pigmentary epithelium of the retina with serous detachments, leading to close monitoring with macular optical coherence tomography.

Genetic variant of Stickler's syndrome. / Variante genética del síndrome de Stickler.

CASES REPORTS: Three myopic components of a same family came for study because presented severely degraded vitreous, equatorial membranes, retinal pigment epithelium hyperplasia, vascular sheathed and sclerosis of peripheral predominance. A genetic study confirmed the diagnosis of Stickler syndrome with a variant in the mutation of the COL2A1 gene. DISCUSSION: Stickler's syndrome should be suspected in families with a characteristic phenotype with vitreous syneresis and alterations in the retina, but there may be genetic variants that do not express the classic phenotype.

Dome shaped macula associated with myopic retinochoroidosis. Use of spironolactone. / Mácula en cúpula asociada a la retinocoroidosis miópica. Utilidad de la espironolactona.

CASES REPORTS: The cases are presented of three women of 22, 36 and 55 years old with bilateral myopic retinochoroidosis. They had unilateral decreased visual acuity, normal bilateral tonometry, and biomicroscopy. Funduscopy showed bilateral and unilateral myopic maculopathy, and Optical Coherence Tomography (OCT) showed a dome shaped macula with neurosensory detachment. Treatment was started with spironolactone and an improvement by OCT was shown in all cases. DISCUSSION: The etiopathogenic mechanism of the dome shaped macula is discussed. OCT demonstrated to be the fundamental test in the follow-up of this condition. After the evidence shown, initial treatment with spironolactone is suggested.

Spironolactone, a therapeutic alternative in the treatment of diffuse retinal pigment epitheliopathy. / Espironolactona, alternativa terapéutica en el tratamiento de la epiteliopatía difusa crónica.

CASE REPORT: Two cases are presented of patients with chronic diffuse epitheliopathy (CDE) that showed a favourable response when treated with spironolactone. The first patient had regions of neurosensory detachment (DNS) and the second, multiple DNS, secondary intra-retinal cysts and retinal pigment epithelium detachment. DISCUSSION: After treatment with spironolactone, both patients showed a visual acuity improvement and structural changes (reduced neurosensory retinal detachment and cystoid degeneration). Aldosterone receptor agonists (ARA) used for persistent forms of chronic central serous chorioretinopathy show encouraging results and could represent a therapeutic alternative for CDE.

Bilateral solar retinopathy. Autofluorescence and optical coherence tomography. / Retinopatía solar bilateral. Autofluorescencia y tomografía de coherencia óptica.

CASE REPORT: A 33-year-old man referred decreased bilateral visual acuity for five years, with no history of interest. Military profession and probably previous sun exposure. Focal pigmented lesions in the macular area of the fundus were observed, with impairment of the photoreceptor layer in the fovea, observed by optical coherence tomography (OCT), in various sectors of the fovea. DISCUSSION: Solar retinopathy is associated with professions at risk of sun exposure. The diagnosis is based on autofluorescence and macular OCT, that later will provide key data to establish the cause.

Sarcoidosis. Debut as orbital pseudotumour.

CASE REPORT: 78 year-old female patient being investigated for a left orbital pseudotumour of 17 days onset. She had proptosis, pain, with no limitation of eye movements, periorbital oedema, and upper eyelid ptosis, compatible with an orbital pseudotumour. The MRI showed an upper outer left orbital mass adjacent to the side of eyeball and an increase in soft tissue at the level of lacrimal gland. The histopathology study of an eyelid lesion demonstrated the presence of non-caseating granulomas. DISCUSSION: A definitive diagnosis of orbital sarcoidosis was made. Oral treatment with corticosteroids and methotrexate achieved gradual control of the disease.

A combination of topical and systemic carbonic anhydrase in the treatment of chromosome X-linked retinoschisis.

CASE REPORT: A 17 year-old male patient, who since 2000 has referred to a progressive bilateral decrease in visual acuity. A "bicycle wheel" macula pattern was observed in his retina. The electroretinogram showed a decrease in the b-wave amplitude. The visual evoked potentials were normal. Optical coherence tomography showed bilateral macular edema. All this supported the diagnosis of X-linked retinoschisis. DISCUSSION: Genetic counseling was given and the pattern of X-linked inheritance was explained. A significant improvement of the macular thickness was observed after treatment with topical dorzolamide and oral acetazolamide.

[Lipoid pneumonia: presentation of a case]. / Neumonía lipoidea: a propósito de un caso.

We report a case of lipoid pneumonia treated in our Health Centre. It is a disease that occurs rarely, but is important in Primary Care. This condition has been known since 1925, when it was first described by Laughlen, who described a case of lipoid pneumonia secondary to an injection of oil in the nasopharyngeal area. Today it is a rarity, and it is most frequently associated with the use of oil-based nasal drops (which are now decreasing in use). Its aetiology may be endogenous or exogenous. Although the pathological diagnosis is generally the most important, sometimes a lesion in the chest X-ray can lead us to suspect it due to the patient's history. This was a case of acute lipoid pneumonia in a young patient, who periodically performed as a "fire eater".