Fotofobia intercrítica en el paciente migrañoso. Propuesta de criterios diagnósticos / Intercritical photophobia in the migraineous patient. Proposal for diagnostic criteria

Introducción: La fotofobia es un síntoma de intolerancia anómala a la luz sin sensación de dolor que requiere de una anamnesis y una exploración para el diagnóstico de una etiología subyacente.Procedimiento básico: El presente artículo se centra en 30 casos clínicos con fotofobia intensa aislada y su revisión de la bibliografía. Objetivo: El objetivo consiste en establecer unos criterios diagnósticos de la fotofobia. Resultados: La etiología de la fotofobia parece encontrarse a nivel de las células ganglionares de la retina intrínsecamente fotosensibles, conocidas como las células de la melanopsina, y a un nivel neuroquímico mediado por el péptido relacionado con la calcitonina y el péptido pituitario activador de la ciclasa. Conclusión: El tratamiento de la fotofobia podría consistir en anticuerpos monoclonales contra los péptidos relacionados con la calcitonina y/o el péptido pituitario activador de la ciclasa.(AU)

Introduction: Photophobia is a symptom of abnormal light intolerance without pain sensation that requires an anamnesis and an examination to diagnose an underlying etiology. Basic procedure: This article focuses on 30 clinical cases with isolated intense photophobia and on the review of the literature. Objective: The purpose of this article is to establish diagnostic criteria for photophobia. Results: The etiology of photophobia appears to be at the level of the intrinsically photosensitive retinal ganglion cells known as melanopsin cells and at a neurochemical level mediated by calcitonin-related peptide and the pituitary activating peptide cyclase. Conclusion: The treatment of photophobia could consist of monoclonal antibodies against calcitonin-related peptide and/or pituitary activating peptide cyclase.(AU)

Dependence of corneal hysteresis on non-central corneal thickness in healthy subjects.

OBJECTIVE: To evaluate the dependence of corneal hysteresis (CH) on non-central corneal thickness. METHODS: Cross-sectional study of 1561 eyes of 1561 healthy volunteers with IOP less than 21mmHg, open angles on gonioscopy and no prior eye surgeries or local or systemic diseases. Pentacam-Scheimpflug technology was employed to segment the cornea into 6 circular zones centered on the apex (zones 1-6) and to determine the mean corneal thickness of these areas. CH was measured with ORA. Univariate and multivariate linear regression models adjusted for age and sex were created to model the dependence of CH on corneal thickness in zones 1 to 6. RESULTS: In the univariate linear regression models, we found that CH was dependent on mean corneal thickness of zone 1 (B=0,004; R2=0.95%; P<0.001), zone 2 (B=0,004; R2=0.57%; P=0.002), zone 4 (B=0,005; R2=1.50%; P<0.001) and zone 6 (B=0,003; R2=0.92%; P<0.001). Similar results were obtained in the multivariate model (R2=3.46%; P<0.001). CONCLUSION: This study suggests a significant dependence of CH on non-central corneal thickness. The model of corneal thickness segmentation into circular zones centered on the corneal apex is able to explain 3.47% of the variation in CH measurements.

Intercritical photophobia in the migrainous patient. Proposal for diagnostic criteria.

INTRODUCTION: Photophobia is a symptom of abnormal light intolerance without pain sensation that requires an anamnesis and an examination to diagnose an underlying etiology. BASIC PROCEDURE: This article focuses on 30 clinical cases with isolated intense photophobia and on the review of the literature. OBJECTIVE: The purpose of this article is to establish diagnostic criteria for photophobia. RESULTS: The etiology of photophobia appears to be at the level of the intrinsically photosensitive retinal ganglion cells known as melanopsin cells and at a neurochemical level mediated by calcitonin-related peptide and the pituitary activating peptide cyclase. CONCLUSION: The treatment of photophobia could consist of monoclonal antibodies against calcitonin-related peptide and/or pituitary activating peptide cyclase.

Optic neuropathy by ethambutol in a patient with multiple sclerosis.

We present the clinical case of a patient who developed a toxic optic neuropathy due to ethambutol in the context of a tuberculosis reactivation and who also had a personal history of multiple sclerosis. The objective is to highlight the importance of making a good differential diagnosis of this adverse effect and of knowing its main clinical, campimetric and tomographic manifestations and characteristics. Furthermore, since the reversibility of damage is still discussed in the literature, early diagnosis is essential. For this purpose, it is important to inform the patient of the possible symptoms and to carry out an ophthalmological examination and colour tests before starting treatment to assess whether there is progression.

Neuropatía óptica por etambutol en paciente con esclerosis múltiple / Optic neuropathy by ethambutol in a patient with multiple sclerosis

Presentamos el caso clínico de una paciente que desarrolló una neuropatía óptica tóxica por etambutol en el contexto de una reactivación tuberculosa y que, además, presentaba como antecedentes personales una esclerosis múltiple. El objetivo es destacar la importancia de realizar un buen diagnóstico diferencial de este efecto adverso y de conocer sus manifestaciones y características clínicas, campimétricas y tomográficas principales. Además, dado que la reversibilidad del daño sigue siendo discutida en la bibliografía, es esencial el diagnóstico precoz para lo que es importante informar al paciente de los posibles síntomas, así como llevar a cabo una exploración oftalmológica y test cromáticos antes de comenzar el tratamiento para valorar si hay progresión.

We present the clinical case of a patient who developed a toxic optic neuropathy due to ethambutol in the context of a tuberculosis reactivation and who also had a personal history of multiple sclerosis. The objective is to highlight the importance of making a good differential diagnosis of this adverse effect and of knowing its main clinical, campimetric and tomographic manifestations and characteristics. Furthermore, since the reversibility of damage is still discussed in the literature, early diagnosis is essential. For this purpose, it is important to inform the patient of the possible symptoms and to carry out an ophthalmological examination and colour tests before starting treatment to assess whether there is progression.

Bilateral solar maculopathy in a patient with bipolar disorder.

A case of solar maculopathy is described in a 36-year-old man with a history of bipolar disorder. The patient reported directly looking at the sun for several hours in the setting of a bipolar disorder decompensation. The visual acuity was 0.3 in both eyes (BE). Intraocular pressure and anterior segment were normal. In the fundus exam, a peri-macular halo with loss of the foveolar reflex was observed in BE. The macular optical coherence tomography revealed a disruption of the ellipsoid line and the retinal pigment epithelium. Bilateral central defects were seen in the Humphrey 24-2 visual field. After 6 months of follow-up, the visual clinical picture remains stable with the same degree of visual acuity. Solar maculopathy is a disorder due to the phototoxic effects of radiation, which cause a decrease in visual acuity by disrupting the retinal photoreceptor layer.

Maculopatía solar bilateral en un paciente con trastorno bipolar / Bilateral solar maculopathy in a patient with bipolar disorder

Se describe el caso clínico de un varón de 36 años, con antecedentes de trastorno bipolar, que fue diagnosticado de maculopatía solar en ambos ojos (AO). El paciente refería visión directa del sol, mantenida y en múltiples ocasiones, coincidiendo con descompensación del trastorno bipolar. En la exploración oftalmológica completa presentaba una agudeza visual de 0,3 en AO, con presión intraocular y biomicroscopia normales. En el fondo de ojo se objetivó un halo perimacular con pérdida del reflejo foveolar en AO. En la tomografía de coherencia óptica macular se halló una disrupción de la línea de elipsoides y del epitelio pigmentario de la retina de AO y en la campimetría visual defectos centrales en AO. Tras 6 meses de seguimiento, la clínica visual continúa estable con el mismo grado de agudeza visual. La maculopatía solar es una afectación debida a los efectos fototóxicos de la radiación por exposición directa al sol que cursa con disminución de la agudeza visual, siendo característica en la tomografía de coherencia óptica la disrupción en la capa de fotorreceptores (AU)

A case of solar maculopathy is described in a 36-year-old man with a history of bipolar disorder. The patient reported directly looking at the sun for several hours in the setting of a bipolar disorder decompensation. The visual acuity was 0.3 in both eyes (BE). Intraocular pressure and anterior segment were normal. In the fundus exam, a peri-macular halo with loss of the foveolar reflex was observed in BE. The macular optical coherence tomography revealed a disruption of the ellipsoid line and the retinal pigment epithelium. Bilateral central defects were seen in the Humphrey 24-2 visual field. After 6 months of follow-up, the visual clinical picture remains stable with the same degree of visual acuity. Solar maculopathy is a disorder due to the phototoxic effects of radiation, which cause a decrease in visual acuity by disrupting the retinal photoreceptor layer (AU)

Congenital retinal macrovessels: Case presentation.

We present an uncommon case of a unilateral congenital retinal macrovessel documented with retinography, perimetry, fluorescein angiography and macular optical coherence tomography. In the case presented the macrovessel crossed the horizontal meridian, between macula and optic disk. A literature review has been performed on congenital retinal macrovessels, possible structural and visual alterations they may cause and their association with other pathologies.

Macrovasos congénitos retinianos: presentación de un caso / Congenital retinal macrovessels: Case presentation

Presentamos un caso de macrovaso congénito retiniano estudiado mediante retinografía, campo visual, angiografía fluoresceínica y tomografía óptica de coherencia macular. El macrovaso atravesaba el meridiano horizontal, nasalmente entre papila y mácula. Además, se realiza una revisión de los macrovasos congénitos retinianos, las alteraciones visuales y estructurales que causan su asociación con otras enfermedades y su diagnóstico diferencial (AU)

We present an uncommon case of a unilateral congenital retinal macrovessel documented with retinography, perimetry, fluorescein angiography and macular optical coherence tomography. In the case presented the macrovessel crossed the horizontal meridian, between macula and optic disk. A literature review has been performed on congenital retinal macrovessels, possible structural and visual alterations they may cause and their association with other pathologies (AU)

Comparación entre el tonómetro de rebote IC200 y el tonómetro de aplanación Perkins en sujetos sanos y pacientes con glaucoma congénito / Comparision of intraocular pressure measured using the new icare 200™ rebound tonometer and the Perkins™ applanation tonometer in healthy subjects and in patients with primary congenital glaucoma

Objetivo Comparar las medidas de presión intraocular (PIO) obtenidas con el tonómetro de rebote iCare 200 (IC200) con las obtenidas mediante la versión portátil del tonómetro de aplanación Goldmann, Perkins (GAT) en pacientes con glaucoma congénito primario (GCP) y en sujetos sanos. Material y métodos Se incluyeron 42 sujetos sanos (G1) y 40 pacientes con GCP (G2). Se incluyó un ojo por paciente. Se recogieron las variables clínicas de interés: sexo, edad, grosor corneal central (GCC) y se midió la PIO mediante los tonómetros IC200 y GAT en el mismo orden, en consulta. Se estudió la concordancia entre tonómetros mediante el coeficiente de correlación intraclase y el gráfico de Bland Altman. La influencia de las variables se analizó mediante test de regresión lineal. Resultado Las medias de PIO obtenidas mediante IC200 y GAT fueron: G1=15,91 (2,57) vs. 15,06 (2,12) mmHg (diferencia de medias, DM=0,84 (0,50) mmHg; p=0,101) y en el G2=20,10 (6,37) vs.19,12 (5,62) (DM=0,98 [1,36]; p=0,474). Se observó excelente concordancia entre IC200/GAT en ambos los grupos (coeficiente de correlación intraclase=G1: 0,875 [IC 95%: 0,768-0,933; p<0,001]; G2: 0,924 [IC 95% 0,852-0,961; p<0,001]), así como la influencia del GCC en la diferencia entre tonómetros en el G1 (B=0,021; IC 95%: 0,005-0,037; p=0,008), sin significación estadística en el G2. Conclusión Se ha encontrado una excelente concordancia entre ambos tonómetros, IC200 y GAT tanto en sujetos sanos como en pacientes con GCP, con una tendencia a la sobreestimación de la PIO de IC200 sobre Perkins. No se ha demostrado la influencia del GCC en los pacientes con GCP (AU)

Objective To compare intraocular pressure (IOP) measurements obtained using the Icare 200™ (IC200) rebound tonometer and the hand-held version of the Goldmann Applanation Tonometer (Perkins™ tonometer, GAT) in patients with primary congenital glaucoma (PCG) and in healthy subjects Material and method a total of 42 eyes of healthy subjects (G1) and 40 patients with PCG (G2) were analysed. The following clinical data were collected: gender, age, Cup/Disc ratio, central corneal thickness (CCT). IOP was determined in the examination room using the IC200 and GAT tonometers, in the same order Agreement between both tonometers was determined using the intraclass correlation coefficient (ICC) and Bland-Altman plot. A linear regression analysis was used to establish the IOP was affected by the studied variables. Results Mean IOP between both tonometers (IC200 minus GAT) was: G1=15.91 (2.57) mmHg vs. 15.06 (2.12) mmHg (mean difference, MD=0.84 (0.50) mmHg; P<.101) and G2=20.10 (6.37) vs.19.12 (5.62) (MD=0.98 (1.36); P=.474). Excellent agreement was found between IC200 and GAT in both groups (ICC=G1: 0.875 (95% CI; 0.768-0.933; P<.001); G2: 0.924 (95% CI; 0.852-0.961; P<.001), and there was a statistically significant correlation between the IOP difference measured with IC200 and GAT and CCT in G1 (B=0.021; 95% CI; 0.005–0.037; P=.008), but was not statistically significant in G2. Conclusion There was excellent agreement between the IC200 and GAT tonometers, both in healthy subjects and PCG, with a trend to overestimate IOP when measured with IC200. There was no influence by CCT on IOP measurements in patients with PGC (AU)

Traumatismos deportivos en oftalmología. Un estudio descriptivo en un hospital terciario / Sports injuries in opthalmology. A descriptive study in a tertiary hospital / Lesões esportivas em oftalmologia. Estudo descritivo em hospital terciário

OBJETIVO: Determinar las características clínicas y epidemiológicas de los traumatismos deportivos oculares de la población asistencial de un hospital terciario de Madrid. MÉTODO: Recopilación retrospectiva de los datos clínicos de los pacientes que acudieron al servicio de urgencias del Hospital Clínico San Carlos en el periodo enero 2015-diciembre 2017 y que habían sufrido un traumatismo ocular durante la práctica de algún deporte. RESULTADOS: Se incluyeron en el estudio un total de 54 pacientes. 47 (87.04%) fueron hombres. La edad media fue de 27.26 años ± 13.01 años de desviación estándar. El deporte que causó más traumatismos entre los pacientes incluidos en el estudio fue el fútbol, seguido de deportes de raqueta, fuerza y combate y baloncesto. La iritis traumática fue el diagnóstico más frecuente, seguido de lesión periocular, lesiones de polo anterior, conmoción retiniana, lesiones regmatógenas, fractura orbitaria y desprendimiento de retina. El 87.04% de los cuadros se resolvieron con tratamiento médico. CONCLUSIONES: La mayoría de los traumatismos oculares deportivos son leves y se resuelven apenas con tratamiento médico. Se deben excluir diagnósticos más graves que requieran de un tratamiento más específico. Las campañas de prevención de daños deben ir encaminadas a los grupos con mayor riesgo de presentarlos

OBJECTIVE: The purpose of this article is to determine the clinical and epidemiologic characteristics of ocular sports injuries in a tertiary hospital of Madrid. METHOD: The study was based on a retrospective record of clinical data of patients who underwent clinical exploration after ocular sport injury between January 2015 and December 2017 in Clinic Hospital San Carlos. RESULTS: A total of 54 patients were recruited from which 47 (87.04%) were males. The mean age was 27.26 years ± 13.01 years Standard Deviation. The sport with the most frequent cause of ocular injury was soccer, followed by racket sports, fight sports and basketball. Traumatic iritis was the most frequent diagnosis, followed by periocular lesions, anterior segment lesions, conmotio retinae, rhegmatogenous lesions, orbital fracture and retinal detachment. Medical treatment solved 87.04% of the cases. CONCLUSIONS: Most of the sports related to ocular injuries were minor cases and they could be solved with only medical treatment. More severe diagnosis must be investigated for more specific treatments, thought. Prevention strategies must be focused in higher risk groups

OBJETIVO: O objetivo deste artigo é determinar as características clínicas e epidemiológicas das lesões oculares desportivas num hospital terciário de Madrid. MÉTODO: O estudo foi baseado num registo retrospectivo de dados clínicos de doentes que foram submetidos a exploração clínica depois duma lesão desportiva ocular entre Janeiro de 2015 e Dezembro de 2017 no Hospital Clínico San Carlos. RESULTADOS: Foram recrutados 54 doentes, dos quais 47 (87.04%) eram do sexo masculino. A idade média foi de 27.26 anos ± 13.01 anos de desvio padrão. O desporto que mais frequentemente causou lesões oculares foi o futebol, seguido dos desportos de raquete, luta desportiva e basquetebol. A irite traumática foi o diagnóstico mais frequente, seguida de lesões perioculares, lesões do segmento anterior, conmotio retinae, lesões regmatogénicas, fractura orbital e descolamento da retina. O tratamento médico resolveu 87.04% dos casos. CONCLUSÕES: A maioria dos desportos relacionados com lesões oculares foram casos menores e só puderam ser resolvidos com tratamento médico. É necessário investigar um diagnóstico mais rigoroso para tratamentos mais específicos. As estratégias de prevenção devem ser centradas nos grupos de maior risco