Association of retinal detachment with age 50 years or younger at onset in patients with acute retinal necrosis.

BACKGROUND: Due to the guarded prognosis of acute retinal necrosis (ARN), it is relevant to develop a strategy to early categorize those patients in a higher risk of worse outcomes. The purpose of this study is to describe clinical features and predictive factors for retinal detachment (RD) in patients with ARN. METHODS: Retrospective observational case series of 34 adult patients (38 eyes) with ARN examined between January 2005 and July 2015 in the National Eye Institute (Bethesda, USA), the Department of Ophthalmology, University of Chile (Santiago, Chile), and APEC (CDMX, Mexico). RESULTS: A total of 16 males and 18 females with a mean age at presentation of 44.5 ± 16.8 years were included. Twenty-seven patients (79.4%) received intravenous acyclovir as first-line treatment, and 7 patients received either oral antiviral (4 patients) or oral plus intravitreal antiviral (3 patients). All subjects were treated with prednisone, with a mean initial dose of 57.7 ± 16.3 mg per day. Seventeen patients (50.0%) developed retinal detachment. An association of retinal detachment with age at onset was observed (p = 0.04), with patients younger than 50 years presenting a higher risk (OR = 14.86, p = 0.0009). Additionally, patients in this higher risk group had more inflammation in both anterior chamber and vitreous (p = 0.04 and 0.03, respectively). No other predictive factor for retinal detachment was found in the present study. CONCLUSIONS: RD represents an important complication in patients with ARN. Younger patients may be at higher risk of this complication, possibly secondary to the presence of a higher level of inflammation.

Spindle-Shaped Neurons in the Human Posteromedial (Precuneus) Cortex.

The human posteromedial cortex (PMC), which includes the precuneus (PC), represents a multimodal brain area implicated in emotion, conscious awareness, spatial cognition, and social behavior. Here, we describe the presence of Nissl-stained elongated spindle-shaped neurons (suggestive of von Economo neurons, VENs) in the cortical layer V of the anterior and central PC of adult humans. The adapted "single-section" Golgi method for postmortem tissue was used to study these neurons close to pyramidal ones in layer V until merging with layer VI polymorphic cells. From three-dimensional (3D) reconstructed images, we describe the cell body, two main longitudinally oriented ascending and descending dendrites as well as the occurrence of spines from proximal to distal segments. The primary dendritic shafts give rise to thin collateral branches with a radial orientation, and pleomorphic spines were observed with a sparse to moderate density along the dendritic length. Other spindle-shaped cells were observed with straight dendritic shafts and rare branches or with an axon emerging from the soma. We discuss the morphology of these cells and those considered VENs in cortical areas forming integrated brain networks for higher-order activities. The presence of spindle-shaped neurons and the current discussion on the morphology of putative VENs address the need for an in-depth neurochemical and transcriptomic characterization of the PC cytoarchitecture. These findings would include these spindle-shaped cells in the synaptic and information processing by the default mode network and for general intelligence in healthy individuals and in neuropsychiatric disorders involving the PC in the context of the PMC functioning.

Dendritic and Spine Heterogeneity of von Economo Neurons in the Human Cingulate Cortex.

The human cingulate cortex (CC), included in the paralimbic cortex, participates in emotion, visceral responses, attention, cognition, and social behaviors. The CC has spindle-shaped/fusiform cell body neurons in its layer V, the von Economo neurons (VENs). VENs have further developed in primates, and the characterization of human VENs can benefit from the detailed descriptions of the shape of dendrites and spines. Here, we advance this issue and studied VENs in the anterior and midcingulate cortex from four neurologically normal adult subjects. We used the thionin technique and the adapted "single-section" Golgi method for light microscopy. Three-dimensional (3D) reconstructions were carried out for the visualization of Golgi-impregnated VENs' cell body, ascending and descending dendrites, and collateral branches. We also looked for the presence, density, and shape of spines from proximal to distal dendrites. These neurons have a similar aspect for the soma, but features of spiny dendrites evidenced a morphological heterogeneity of CC VENs. Only for the description of this continuum of shapes, we labeled the most common feature as VEN 1, which has main dendritic shafts but few branches and sparse spines. VEN 2 shows an intermediate aspect, whereas VEN 3 displays the most profuse dendritic ramification and more spines with varied shapes from proximal to distal branches. Morphometric data exemplify the dendritic features of these cells. The heterogeneity of the dendritic architecture and spines suggests additional functional implications for the synaptic and information processing in VENs in integrated networks of normal and, possibly, neurological/psychiatric conditions involving the human CC.

Diabetes Mellitus-Associated Uveitis: Clinical Features in a Chilean Series.

PURPOSE: To describe clinical features of patients with diabetes mellitus-associated uveitis (DMAU). METHODS: Retrospective analysis of clinical records of patients with uveitis and diabetes mellitus (DM) presented in an uveitis referral centre in Chile. Demographic data, comorbidities, complete ophthalmic examination, and treatments were analyzed. RESULTS: We found 72 patients with uveitis and DM: 16 with DMAU and poorly regulated DM (22%), 15 with DMAU and well-controlled DM (21%), and 41 with uveitis due to established other causes than DM (57%). Patients with DMAU in poorly regulated diabetes, presented inflammation of 3-4+ cells in 33%, a fibrinous reaction in 28%, hypopyon in 17% and posterior synechiae in 83%, compared with 5%, 0%, 0%, and 50% in the group with well-controlled DM, respectively (p < 0.05). Most DMAU patients responded well to topical or periocular steroids. CONCLUSION: Patients with DMAU with poorly regulated DM present a more severe inflammation compared with patients with DMAU with well-controlled DM.

[Plastic beauty, eugenics and physical education in Chile: a commentary on the work "Characteristics of physical education", by Luis Bisquertt (1930)]. / Belleza plástica, eugenesia y educación física en Chile: presentación de la fuente "Aspectos de la educación física", de Luis Bisquertt (1930).

The article seeks to introduce and contextualize the work "Characteristics of physical education" ("Aspectos de la educación física"), by Luis Bisquertt, which emphasizes the effort to ameliorate racial aspects in Chile, in 1930, thru physical education eugenics, whose body paradigm were the Hellenic classical statues. One of the key concepts of this document is plastic beauty, whose meaning overlaps with the idea of normality and sanity, creating pathologies on those bodies that were considered outside of the athletic standards, a situation that was aggravated by the sedentary conditions of modern times.

El siguiente texto busca presentar y contextualizar la fuente "Aspectos de la educación física", de Luis Bisquertt, poniendo énfasis en la búsqueda del mejoramiento racial en Chile de 1930, a partir de la educación física eugénica, cuyo paradigma corporal serían las estatuas clásicas helénicas. Uno de los conceptos centrales de este documento es el de belleza plástica, cuyo sentido se encuentra totalmente imbricado a la idea de normalidad y sanidad, patologizando aquellos cuerpos que no se enmarquen en el canon atlético, situación extendida por las características sedentarias de la modernidad.

Belleza plástica, eugenesia y educación física en Chile: presentación de la fuente "Aspectos de la educación física", de Luis Bisquertt (1930) / Plastic beauty, eugenics and physical education in Chile: a commentary on the work "Characteristics of physical education", by Luis Bisquertt (1930)

Resumen El siguiente texto busca presentar y contextualizar la fuente "Aspectos de la educación física", de Luis Bisquertt, poniendo énfasis en la búsqueda del mejoramiento racial en Chile de 1930, a partir de la educación física eugénica, cuyo paradigma corporal serían las estatuas clásicas helénicas. Uno de los conceptos centrales de este documento es el de belleza plástica, cuyo sentido se encuentra totalmente imbricado a la idea de normalidad y sanidad, patologizando aquellos cuerpos que no se enmarquen en el canon atlético, situación extendida por las características sedentarias de la modernidad.

Abstract The article seeks to introduce and contextualize the work "Characteristics of physical education" ("Aspectos de la educación física"), by Luis Bisquertt, which emphasizes the effort to ameliorate racial aspects in Chile, in 1930, thru physical education eugenics, whose body paradigm were the Hellenic classical statues. One of the key concepts of this document is plastic beauty, whose meaning overlaps with the idea of normality and sanity, creating pathologies on those bodies that were considered outside of the athletic standards, a situation that was aggravated by the sedentary conditions of modern times.

Mycophenolate Mofetil Therapy in Refractory Inflammatory Eye Disease.

PURPOSE: To study the efficacy and incidence of treatment-related side effects of mycophenolate mofetil (MMF) therapy in patients with noninfectious inflammatory eye diseases. METHODS: Retrospective cohort study of 27 Chilean patients treated for noninfectious inflammatory eye diseases using MMF therapy over a 10-year period. Main outcome measures were: ability to control ocular inflammation and to taper prednisone to ≤10 mg daily (treatment success); incidence of treatment-related side effects. RESULTS: The proportion of patients with sustained control of inflammation was 81.48% at 6 months. Additionally 55.56% and 22.22% of patients succeeded in tapering their prednisone to 5-10 mg/day and <5 mg/day, at 6 months. Two patients developed a neoplasia during MMF therapy; however, this cohort is too small to interpret the significance of this relation to MMF treatment. CONCLUSIONS: MMF seems to be an effective corticosteroid-sparing agent with an acceptable safety profile.

Comparison of the clinical efficacy of two different immunosuppressive regimens in patients with chronic vogt-koyanagi-harada disease.

PURPOSE: To prospectively compare 2 immunosupressive regimens in patients with active Vogt-Koyanagi-Harada disease in spite of systemic glucocorticoid treatment. METHODS: Forty-four patients were diagnosed between 1998 and 2005. Twenty-one developed chronic intraocular inflammation in spite of glucocorticoid treatment and were randomized to receive either prednisone and azathioprine (AZA) (n = 12) or prednisone and cyclosporine (CyA) (n = 9). RESULTS: In the AZA group Tyndall score decreased from 1.21 +/- 1.10 to 0.29 +/- 0.62 (p < .01), and visual acuity (LogMAR) improved from 0.32 +/- 0.35 to 0.09 +/- 0.16 (p < .001). In the CyA group Tyndall score decreased from 1.67 +/- 1.08 to 0.16 +/- 0.51 (p < .001), and visual acuity improved from 0.41 +/- 0.40 to 0.25 +/- 0.42 (p < .001). Patients in the AZA group needed a significantly higher average prednisone dose and total cumulative dose than those in the CyA group, p < .01 for each comparison. CONCLUSIONS: Both regimens showed a good clinical efficacy, but CyA seems to be a better glucocorticoid-sparing agent than AZA.

[Retrospective review of 44 Chilean patients with Behçet disease]. / Enfermedad de Behçet en Chile: Análisis clínico de 44 casos.

BACKGROUND: Behçet's disease (BD) is a rare multisystemic inflammatory disease that is potentially disabling and may cause death. AIM: To describe the characteristics of BD patients from two Chilean centers. PATIENTS AND METHOD: Retrospective review of the clinical records of patients with BD attended in two rheumatology services between 1985 and 2007. The "Behçet's Disease Research Committee of Japan" (BDCJ) and the "International Study Group for Behçet's Disease" (ISG) diagnostic criteria were applied. RESULTS: We found 44 cases (25 males), diagnosed as BD. The mean age at the onset of symptoms was 26+/- 12 years. According to BDCJ criteria, 13 patients had complete BD, 24 had incomplete BD and 7 had a suspected BD. Thirty two patients fulfilled the ISG criteria. Forty two patients (95%) had oral ulcers, 33 (75%) had genital ulcers and 29 (66%) had ophthalmological involvement. Eleven and three patients had symptoms of central and peripheral nervous system involvement, respectively. No gender differences were detected. CONCLUSIONS: The clinical characteristics of these patients were similar to those described abroad, except for a higher frequency of peripheral nervous system involvement and a lower rate of arthritis.

Enfermedad de Behçet en Chile: Análisis clínico de 44 casos / Retrospective review of 44: Chilean patients with Behçet disease

Background: Behget's disease (BD) is a rare multisystemic inflammatory disease that is potentially disabling and may cause death. Aim: To describe the characteristics of BD patients from two Chilean centers. Patients and method: Retrospective review of the clinical records of patients with BD attended in two rheumatology services between 1985 and 2007. The "Behget's Disease Research Committee of Japan" (BDCJ) and the "International Study Group for Behget's Disease" (ISG) diagnostic criteria were applied. Results: We found 44 cases (25 males), diagnosed as BD. The mean age at the onset of symptoms was 26± 12 years. According to BDCJ criteria, 13 patients had complete BD, 24 had incomplete BD and 7 had a suspected BD. Thirty two patients fulfilled the ISG criteria. Forty two patients (95 percent) had oral ulcers, 33 (75 percent) had genital ulcers and 29 (66 percent) had ophthalmological involvement. Eleven and three patients had symptoms of central and peripheral nervous system involvement, respectively. No gender differences were detected. Conclusions: The clinical characteristics of these patients were similar to those described abroad, except for a higher frequency of peripheral nervous system involvement and a lower rate of arthritis.

Producción de enzima fitasa de aspergillus ficuum con residuos agroindustriales en fermentación sumergida y sobre sustrato sólido / Phytase production by aspergillus ficuum in submergida y sobre sustrato solido

Se describe la producción de fitasa mediante cultivos del tipo sumergido (SmF) y sobre sustrato sólido (SSF) con Aspergillus ficuum DSM 932 en medios de cultivos basados en residuos de la agroindustria. La actividad enzimática fitásica se usó como medida indirecta de la producción de la enzima. En SmF, pH 5,3 y 25 ºC, se trabajó en fermentadores de diferentes volúmenes y con el mayor se operó con diferentes niveles de aireación y agitación. En SSF a 25 ºC se usaron placas de Petri. En SmF con un medio basado en cereales se presentó la mejor actividad neta (0,25 FTU/mL) al sexto día para 300 rpm y 0,5 vvm. En SSF, la torta de canola resultó ser el mejor sustrato con una actividad fitásica neta máxima al tercer día de 6,79 FTU/mL de extracto, equivalente a 33,96 FTU/g de sustrato sólido o 56,43 FTU/g de sustrato seco. Aplicando tecnologías de membrana se concentró un extracto de fitasa a partir de una SmF en medio basado en cereales y también fue posible purificar 6,33 veces un extracto de fitasa producido en SSF con torta de canola, diafiltrando tres veces consecutivas el retenido de 100 kDa. La enzima fitasa de la cepa A. ficuum DSM 932 mostró tener un tamaño ≥ 100 kDa.

Phytase production by submerged fermentation (SmF) and solid state fermentation (SSF) using Aspergillus ficuum DSM 932 in agro-waste-based culture media is described here. Phytase enzyme activity was used for the indirect measurement of enzyme production. Fermentation was carried out in SmF, pH 5.3 at 25 ºC with two fermenters having different volumes; the largest one had different levels of aeration and agitation. Petri dishes were used for SSF at 25 °C. A cereal-based medium obtained the best net activity (0.25 FTU mL-1) for SmF on the sixth day at 300 rpm at 0.5 vvm. Canola cake was the best substrate for SSF, having maximum net phytase activity on the third day: 6.79 FTU mL-1 extract, equivalent to 33.96 FTU g-1 solid substrate or 56.43 FTU g-1 dry substrate. A phytase extract was concentrated from an SmF-based medium in cereals by applying membrane technologies. A phytase extract produced in SSF with canola cakes was purified 6.33 times using three consecutive diafiltrations of the 100 kDa retentate. A. ficuum DSM 932 phytase was ≥ 100 kDa in size.

[Role of Azathioprine in steroid resistant non infectious ocular inflammatory diseases]. / Eficacia de la azatioprina en la enfermedad ocular inflamatoria no infecciosa resistente a tratamiento esteroidal sistémico.

BACKGROUND: Topical and systemic steroids are the first line of treatment of non infectious inflammatory ocular disease. Immunosuppresants are reserved as a second line treatment. AIM: To evaluate the role of Azathioprine (AZA) as a coadyuvant immunosuppressive treatment for non infectious ocular inflammatory diseases (OIDs) resistant to systemic steroid therapy in a retrospective, noncomparative interventional case series. PATIENTS AND METHODS: Patients using oral Prednisone due to an active or recurrent OID, without clinical response, and not receiving any other immunosuppressive treatment were studied. A standard protocol of oral Prednisone (0.5 mg/kg/ day) and oral AZA (2-3 mg/kg/day) during one year was used. Ocular and systemic monthly evaluations were done including relapse rate, steroid dosage, inflammatory score and visual acuity. RESULTS: Thirty patients (10 male) aged 18-75 years (mean 44 years) were studied. Three had bilateral anterior uveitis, one had pars planitis, four had diffuse uveitis, eight Vogt-Koyanahi-Harada syndrome, three Behget's disease, three necrotizing scleritis and eight had retinochoroidopathy A complete initial response was observed in 26 patients (87%). The time of response was between 1 to 6 months (mean 2.65 months). Seventeen percent of these had a relapse 6 to 12 months after AZA was started. In 61 %, visual acuity improved. The ocular inflammatory score decreased in 86.5%. Eleven patients had mild controlled side effects that did not require discontinuation of AZA. CONCLUSIONS: Combined systemic steroid and oral AZA therapy is safe and effective in controlling steroid resistant non infectious inflammatory ocular diseases.

Eficacia de la azatioprina en la enfermedad ocular inflamatoria no infecciosa resistente a tratamiento esteroidal sistémico / Role ofAzathioprine in steroid resistant non infectious ocular inflammatory diseases

Background: Topical and systemic steroids are the first line of treatment of non infectious inflammatory ocular disease. Immunosuppresants are reserved as a second line treatment. Aim: To evaluate the role ofAzathioprine (AZA) as a coadyuvant immunosuppressive treatment for non infectious ocular inflammatory diseases (OIDs) resistant to systemic steroid therapy in a retrospective, noncomparative interventional case series. Patients and methods: Patients using oral Prednisone due to an active or recurrent OID, without clinical response, and not receiving any other immunosuppressive treatment were studied. A standard protocol of oral Prednisone (0.5 mg/kg/ day) and oral AZA (2-3 mg/kg/day) during one year was used. Ocular and systemic monthly evaluations were done including relapse rate, steroid dosage, inflammatory score and visual acuity. Results: Thirty patients (10 male) aged 18-75 years (mean 44 years) were studied. Three had bilateral anterior uveitis, one had pars planitis, four had diffuse uveitis, eight Vogt-Koyanahi-Harada syndrome, three Behget's disease, three necrotizing scleritis and eight had retinochoroidopathy A complete initial response was observed in 26 patients (87 percent). The time of response was between 1 to 6 months (mean 2.65 months). Seventeen percent of these had a relapse 6 to 12 months after AZA was started. In 61 percent, visual acuity improved. The ocular inflammatory score decreased in 86.5 percent. Eleven patients had mild controlled side effects that did not require discontinuation of AZA. Conclusions: Combined systemic steroid and oral AZA therapy is safe and effective in controlling steroid resistant non infectious inflammatory ocular diseases.

[Effectiveness of infliximab in patients with Behçet syndrome and severe uveoretinitis. Report of five cases]. / Eficacia del infliximab en pacientes con síndrome de Behçet portadores de úveo-retinitis grave.

The efficacy and safety of repeated administration of infliximab was evaluated in five patients (two men, three women) with Behçet syndrome accompanied by severe uveoretinitis. Ocular and extra ocular inflammation was suppressed in all patients during the observation period without any serious adverse reactions. The results in these patients suggests that TNF-á blockade is effective in patients with severe ocular Behçet syndrome.

Eficacia del infliximab en pacientes con síndrome de Behçet portadores de úveo-retinitis grave / Effectiveness of infliximab in patients with Behçet syndrome and severe uveoretinitis. Report of five cases

The efficacy and safety of repeated administration of infliximab was evaluated in five patients (two men, three women) with Behçet syndrome accompanied by severe uveoretinitis. Ocular and extra ocular inflammation was suppressed in all patients during the observation period without any serious adverse reactions. The results in these patients suggests that TNF-α blockade is effective in patients with severe ocular Behçet syndrome.

[Carotid cavernous fistula: the importance of its opportune diagnosis and treatment to prevent blindness]. / Fistula carótido-cavernosa: importancia de su diagnóstico y tratamiento oportunos para prevenir la ceguera.

A carotid cavernous fistula is an abnormal communication between a branch of the carotid artery and the cavernous sinus generating an arteriovenous fistula that can cause severe ocular damage. We hereby report two cases of carotid cavernous fistulas. A 69-year-old male with a 2-month history of right eyelid swelling and red eye aggrarated by diplopia, exophthalmus, and limitation of ocular movements one week before consulting. On admisson his visual acuity, in the right eye was good (0.5) and biomicroscopy showed arterialization of conjunctival vessels. All orbital CAT scan showed a dilatation of the superior orbital vein characteristic of carotid cavernous fistula. A balloon balloon tramponade of the fistula was performed too late (after 3 weeks) and the eye went blind. A 39-year-old female consulted for an acute proptosis of the right eye and severe visual loss. Biomicroscopy showed arterialization of the conjunctival vessels and the CAT scan disclosed a dilatation of the superior orbital vein. She was immediately subjected to a neuroradiological fistula closure with recovery of visual acuity to 1.0 (20/20). Our main purpose is to emphasize the importance of the opportune diagnosis and treatment of these fistulas to prevent visual loss and eventual blindness, as occurred in our first patient.

Implantes orbitarios porosos: experiencia clínica / porous orbital Implant: clinical experience

Objetivo: Evaluar pacientes enucleados a quienes se les colocaron implantes orbitarios de hidroxiapatita o de polietileno de alta densidad. Material y Método: Se incluyen pacientes sometidos a enucleación por cualquier causa que recibieron un implante poroso en forma primaria o secundaria. Se excluyen casos que fueron implantados con esferas de silicona, metilmetacrilato o vidrio y aquellos que recibieron injerto demorgraso. Se destaca revestimiento del implante intraoperatorio, complicaciones (secreción, ulceración superficie conjuntival,, reoperaciones, enoftalmol), motilidad protésica y éxito cosmético. Resultados: Son 32 pacientes, 32 ojos, 32 ojos, 18 hombres (56 por ciento), 14 mujeres (44 por ciento), seguidos por 1 año 7 meses (rango entre 1 mes hasta 7 años 11 meses), enucleados por causa tumoral en 19 (59 por ciento), (14 retinoblastomas (44 por ciento), 3 melanomas malignos (9 por ciento) y 2 carcinomas espinocelulares epibulbar (6 por ciento), 9 ojos traumatizados (28 por ciento), 3 ojos dolorosos (10 por ciento) y 1 (3 por ciento) microftalmo con quiste. Se colocaron 16 implantes de hidroxiapatita, 16 de polietileno de alta densidad y 1 de alúmina. 26 casos primarios (81 por ciento), 6 secundarios (19 por ciento). Las principales complicaciones post operatorias fueron secreción conjuntival, granulomas, síndrome de sulcus superior y ulceración de superficie conjuntival. La mortilidad del implante y de la prótesis fue aceptable en el 60 por ciento de los casos. Discución: El uso de implantes porosos constituye una encomiable alternativa para rehabilitar una cavidad anoftálmica. El buen resultado depende del estado de los tejidos perioculares, la cirugía cuidadosa, del mejoramiento del trabajo protésico, y finalmente del cuidado y mantención de la cavidad conjuntival por parte del paciente

Distribución de morbilidad en el departamento de uveítis: servicio de oftalmología del Hospital del Salvador, 1987-1991 / Distribution of morbidity in the uveitis department: oftalmology unit of the Salvador Hospital, 1987-1991

En 277 pacientes con uveítis, 176 mujeres (36,5 por ciento ), siguiendo la clasificación recomendada por el Grupo Internacional de Estudio de la Uveítis (I.U.S.G.) encontramos la siguiente distribución: 1. Anteriores en 126 (45,5 por ciento ); 2. Difusas en 68 (24,5 por ciento ); 3. Posteriores en 65 (23,5 por ciento ) y 4. Intermedias en 18 (6,5 por ciento ). El promedio general de edad fue de 39,2 años (2-78): para las anteriores de 43,2 años, para las difusas de 37 años, para las posteriores de 36,1 años y para las intermedias de 22,3 años. Se encontró la causa en 137 pacientes (49,4 por ciento ) siendo el diagnóstico más frecuente la toxoplasmosis con un 8 por ciento del total de uveítis. En las uveítis anteriores la etiología fue precisada en 41 casos (34,1 por ciento ) siendo las causas más frecuentes virus herpes, enfermedades reumáticas e iridociclitis HLA B27 positiva. En las uveítis difusas determinamos la etiología en 35 casos (51,5 por ciento ) siendo las causas más frecuentes el síndrome de Vogt-Koyanagi-Harada, la enfermedad de Behcet y la tuberculosis. En las uveítis posteriores determinamos la etiología en 43 casos (66,1) siendo las principales causas toxoplasmosis, toxocariasis y tuberculosis. Las uveítis intermedias fueron consideradas como de causa conocida

Nuestra experiencia en el síndrome de Vogt-Koyanagi-Harada / Our experience in the Vogt-Koyanagi-Harada syndrome

Los autores revisan 16 casos de Síndrome de Vogt-Koyanagi-Harada y comunican su experiencia clínica y terapéutica con estos pacientes. Parte de estos casos conforman otro grupo, también de 16 pacientes, presentados en el Congreso Mundial de Uveitis, Guarujá, Brasil, marzo 1988. Los hallazgos clínicos son los característicos de esta enfermedad. Su forma más frecuente de presentación es de una panuveítis con desprendimiento retinal seroso y cefaleas, y posterior desarrollo de alteraciones pigmentarias en el fondo del ojo. Hubo tres grupos terapéuticos, se destaca que los pacientes tratados con dosis altas de corticoides desde el comienzo de la enfermedad y eventual asociación a ciclofosfamida tuvieron buen resultado visual final: de 9 pacientes, 17 ojos quedaron con agudeza visual sobre 0,5 y sólo un ojo mantuvo agudeza visual bajo 0,1. En el resto de los pacientes, 7 en total, sólo un ojo mantuvo agudeza visual sobre 0,5 y 11 ojos quedaron con agudeza visual bajo 0,1. El deterioro de la agudeza visual se debe al compromiso macular por cicatrices coriorretinal y reacción glial y pigmentaria. Se describe un caso de shunt arteria coroidea-arteria retinal que sería el primer paciente descrito con este tipo de shunt en Síndrome de Vogt-Koyanagi-Harada