OCT Variability Prevents Their Use as Robust Biomarkers in Multiple Sclerosis.

OBJECTIVE: To evaluate the agreement between the peripapillary retinal nerve fiber layer (pRNFL) and foveal thickness (FT) measurements among three different spectral domain-optical coherence tomography (SD-OCT) instruments in a sample of multiple sclerosis (MS) patients and a healthy age-matched control group. METHODS: An observational cross-sectional study with three groups: healthy subjects and MS patients w/w a previous clinical diagnosis of optic neuritis (ON) was conducted. The pRNFL and FT were measured using three different SD-OCT instruments (OCT PRIMUS 200 and OCT CIRRUS 500 SD-OCT [Carl Zeiss Meditec] and OCT 3D 2000 [Topcon]). RESULTS: Twenty eyes from 10 healthy subjects matched in age with MS patients without a previous history of eye disease and 62 MS eyes from 31 MS patients (29 eyes without history of ON and 33 eyes with history of ON) were enrolled. Healthy subjects and MS patients without ON did not show differences between the pRNFL and FT thickness (P>0.99) with any of the instruments. However, MS eyes with a previous episode of ON showed thinner pRNFL and FT (P<0.01). PRIMUS and CIRRUS OCT showed better agreement of the pRNLF and FT in both healthy and MS eyes. However, 3D OCT showed less agreement in the pRNFL measurement with CIRRUS in both healthy and MS eyes. INTERPRETATION: Although OCT is a valuable technology to improve MS patient assessment, differences between devices must be taken into account. It is necessary to create an international group that standardizes the measurement conditions and above all that provides reference bases for normal subjects.

Episcleral brachytherapy as an effective alternative in vasoproliferative tumors.

The aim of this study is to assess the results of episcleral brachytherapy as treatment of retinal vasoproliferative tumors (RVTs) in a referral Intraocular Tumors Unit (ITU). A retrospective review of all patients diagnosed with vasoproliferative tumors of the retina and treated with episcleral brachytherapy in the ITU, University Hospital of Valladolid between 2009 and 2015 was done. Five patients accomplished the inclusion criteria. All of them presented associated exudation and secondary retinal detachments (RD). Four patients had received prior treatments. Decreased tumor size and exudation regression was found in all cases after treatment. Visual acuity remained stable or increased in all patients. No recurrences have been found after twelve-months follow up. The results of the present study suggest that episcleral brachytherapy is an efficient and safe option in the management of vasoproliferative tumors, especially when large tumor or extensive subretinal fluid is present. In these cases episcleral brachytherapy could be considered as a first line treatment.

[Migraine as a vascular risk factor]. / La migraña como factor de riesgo vascular.

INTRODUCTION: Migraine and stroke are associated with a higher frequency than expected. Numerous studies have shown a significant, but controversial, association between migraine and vascular disease, not only in cerebral but also in other arterial beds. The full spectrum of this relationship includes coexisting stroke and migraine, stroke with clinical features of migraine and migraine-induced stroke. Why migraine is a risk factor and how it leads to stroke is not entirely understood, possibly because the mechanisms involved are multiple, complex and interrelated. AIM: Emphasizing the most recent papers, we review critically the current knowledge about the causal relationship between migraine and vascular disease and discuss its pathophysiology. DEVELOPMENT: Migraine is an independent risk factor for stroke, especially for young women with frequent migraine with aura attacks, who smoke and use oral contraceptives. Migraine has also been associated with lesions in the white matter and in other vascular territories. Potential pathogenic mechanisms include endothelium and vascular smooth muscle dysfunction, hypercoagulability, cortical spreading depression, genetic factors, patent foramen ovale, unfavourable vascular risk profile, arterial dissection and migraine-specific treatment. CONCLUSION: Considering that cerebrovascular disease is a major cause of disability and mortality and that migraine is a risk factor for vascular disease, understanding the relationship between migraine and vascular disease is necessary to reduce risks and optimize management and treatment.

La migraña como factor de riesgo vascular / Migraine as a vascular risk factor

Introducción. Migraña e ictus se asocian con una frecuencia superior a lo esperable. Aunque controvertida, múltiples estudios demuestran una asociación significativa entre migraña y patología vascular no sólo cerebral, sino también en otros lechos arteriales. El espectro de la relación entre migraña e ictus comprende relaciones de coexistencia, semejanza y causalidad. Los mecanismos por los que la migraña llega a ser un factor de riesgo vascular y conduce al desarrollo de un ictus no son del todo conocidos, posiblemente porque sean múltiples, complejos e interrelacionados entre sí. Objetivo. Poniendo énfasis en los artículos más recientes, se revisa críticamente el estado actual acerca de la relación de causalidad entre migraña y enfermedad vascular, y se discute su fisiopatología. Desarrollo. La migraña es un factor de riesgo independiente de ictus, especialmente en el subgrupo de población comprendido por mujeres jóvenes, con migraña con aura, crisis frecuentes, fumadoras y en tratamiento con anticonceptivos orales. Además, se asocia con lesiones de la sustancia blanca y patología vascular en otros territorios arteriales. Disfunción del endotelio y musculatura vascular, hipercoagulabilidad, depresión propagada cortical, factores genéticos, foramen oval permeable, perfil desfavorable de riesgo vascular, disección arterial y el tratamiento específico de migraña se postulan como mecanismos patogénicos. Conclusiones. Si la enfermedad cerebrovascular es una importante causa de invalidez y mortalidad, y la migraña es un factor de riesgo de enfermedad vascular, comprender la relación entre migraña y enfermedad vascular es necesario para reducir riesgos y optimizar su manejo y tratamiento (AU)

Introduction. Migraine and stroke are associated with a higher frequency than expected. Numerous studies have shown a significant, but controversial, association between migraine and vascular disease, not only in cerebral but also in other arterial beds. The full spectrum of this relationship includes coexisting stroke and migraine, stroke with clinical features of migraine and migraine-induced stroke. Why migraine is a risk factor and how it leads to stroke is not entirely understood, possibly because the mechanisms involved are multiple, complex and interrelated. Aim. Emphasizing the most recent papers, we review critically the current knowledge about the causal relationship between migraine and vascular disease and discuss its pathophysiology. Development. Migraine is an independent risk factor for stroke, especially for young women with frequent migraine with aura attacks, who smoke and use oral contraceptives. Migraine has also been associated with lesions in the white matter and in other vascular territories. Potential pathogenic mechanisms include endothelium and vascular smooth muscle dysfunction, hypercoagulability, cortical spreading depression, genetic factors, patent foramen ovale, unfavourable vascular risk profile, arterial dissection and migraine-specific treatment. Conclusion. Considering that cerebrovascular disease is a major cause of disability and mortality and that migraine is a risk factor for vascular disease, understanding the relationship between migraine and vascular disease is necessary to reduce risks and optimize management and treatment (AU)

Evolución natural de una disección carotídea bilateral espontánea con cuatro pseudoaneurismas asociados / Natural history of spontaneous bilateral carotid dissection with four associated pseudoaneurysms

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