Acute panendothelial retinal leakage in a patient with diabetes mellitus type 1 with a poor metabolic control.

Ophthalmological diabetic complications are one of the main causes of blindness worldwide, so careful diagnostic and management is important. The screening plans implemented in our population made possible an early diagnosis and treatment, trying to reduce the consequences. Diabetic retinopathy is widely known, however we present the case of a rare retinal condition, acute panedothelial retinal leakage. It typically affects patients with type 1 DM and poor glycemic control. Its diagnosis is important since a strict metabolic control is sufficient for its resolution, avoiding aggressive therapies.

Multimodal imaging in multiple evanescent white dot syndrome and new insights in pathogenesis.

PURPOSE: To report the multimodal imaging in multiple evanescent white dot syndrome (MEWDS) during the acute and convalescent stages in order to better understand the focus of the inflammatory process. METHODS: Retrospective cohort study of 4 patients with MEWDS. Each patient underwent: enhanced depth imaging-optical coherence tomography (EDI-OCT), fundus autofluorescence (FAF), fluorescein angiography (FA), indocyanine green angiography (ICGA) and en-face OCT and OCT angiography (OCT-A). Choroidal subfoveal thickness (CST) was measured manually. All patients were studied in the acute stage and convalescent stage after disappearance of OCT abnormalities and resolution of visual symptoms. RESULTS: Four MEWDS patients with a mean age of 23.5years were studied (range: 16-33years). Two patients were women. Initial mean visual acuity (VA) was 80.25 ETDRS. Final mean VA was 84.25 ETDRS. OCT imaging showed disruption of the ellipsoid zone and a slightly elevated RPE layer with overlying hyperreflective material, all of which corresponded to hyperautofluorescent FAF lesions. FA revealed multiple hyperautofluorescent lesions, correlated with hypocyanescent spots on the late ICGA. OCT-A showed normal superficial and deep retinal capillary plexus as well as choriocapillaris. The disease was self-limited in all the cases, with a mean time of 9weeks to resolution (range: 4-16). CONCLUSION: The pathophysiology of MEWDS is still debated. We believe that there is still not enough evidence to implicate the outer retina as the primary cause. For now, we suggest that this transient disease is the consequence of choriocapillaris hypoperfusion, but further studies are required to elucidate this hypothesis.

Capilaropatía edematosa aguda en un paciente con diabetes mellitus tipo 1 con mal control metabólico / Acute panendothelial retinal leakage in a patient with diabetes mellitus type 1 with a poor metabolic control

Las complicaciones oftalmológicas derivadas de la diabetes son una de las principales causas de ceguera en edad laboral a nivel mundial, por lo que es importante un manejo minucioso. Gracias a los planes de cribado implantados en nuestra población, es posible un diagnóstico y tratamiento precoz con el fin de disminuir las secuelas. La retinopatía diabética (RD) es una entidad conocida por todos nosotros, no obstante, presentamos el caso de una rara afectación retiniana, la capilaropatía edematosa aguda. Típicamente afecta a pacientes con diabetes mellitus tipo 1 (DM1) y mal control glucémico. Es importante su diagnóstico puesto que llevar un estricto control metabólico es suficiente para la resolución de la misma, evitando terapias agresivas (AU)

Ophthalmological diabetic complications are one of the main causes of blindness worldwide, so careful diagnostic and management is important. The screening plans implemented in our population made possible an early diagnosis and treatment, trying to reduce the consequences. Diabetic retinopathy is widely known, however we present the case of a rare retinal condition, acute panedothelial retinal leakage. It typically affects patients with diabetes mellitus (DM) type 1 and poor glycemic control. Its diagnosis is important since a strict metabolic control is sufficient for its resolution, avoiding aggressive therapies (AU)

Acute panendothelial retinal leakage in a patient with diabetes mellitus type 1 with a poor metabolic control. / Capilaropatía edematosa aguda en un paciente con diabetes mellitus tipo 1 con mal control metabólico.

Ophthalmological diabetic complications are one of the main causes of blindness worldwide, so careful diagnostic and management is important. The screening plans implemented in our population made possible an early diagnosis and treatment, trying to reduce the consequences. Diabetic retinopathy is widely known, however we present the case of a rare retinal condition, acute panedothelial retinal leakage. It typically affects patients with diabetes mellitus (DM) type 1 and poor glycemic control. Its diagnosis is important since a strict metabolic control is sufficient for its resolution, avoiding aggressive therapies.

Pseudoxantoma elástico infantil en paciente con beta-talasemia / Pseudoxanthoma elasticum in childhood in patient with Beta-thalassaemia

El pseudoxantoma elástico (PXE) es una enfermedad hereditaria rara, que cursa con alteraciones del tejido conectivo, debido a una alteración en el cromosoma 16p del gen ABCC6. Desde una perspectiva clínica, da lugar a manifestaciones predominantemente cutáneas, cardiacas y oftalmológicas. La asociación de β-talasemia y cuadros clínicos compatibles con PXE (síndromes PXE-like) ha sido descrita en la literatura en pacientes con β-talasemia mayor e intermedia, que es indistinguible clínicamente del PXE clásico. Presentamos el caso de un niño de 10 años con beta-talasemia minor y lesiones características de PXE. Cabe destacar el beneficio de la imagen multimodal para el diagnóstico y seguimiento de las lesiones

Pseudoxanthoma elasticum (PXE) is a rare genetic disorder characterised by elastic tissue alterations and caused by mutations in a single gene, ABCC6, on chromosome 16p that includes manifestations that are predominantly cutaneous, ocular and cardiovascular. PXE-like lesions in association with β-thalassemia have previously been reported in the literature in patients with Beta-thalassaemia intermediate and major, being clinically indistinguishable from classic PXE. The case is presented of a 10-year-old boy with β-thalassaemia minor and characteristic lesions of PXE. It is worth noting the benefit of multimodal imaging in the diagnosis and monitoring of the lesions

Pseudoxanthoma elasticum in childhood in patient with ß-thalassaemia. / Pseudoxantoma elástico infantil en paciente con ß-talasemia.

Pseudoxanthoma elasticum (PXE) is a rare genetic disorder characterised by elastic tissue alterations and caused by mutations in a single gene, ABCC6, on chromosome 16p that includes manifestations that are predominantly cutaneous, ocular and cardiovascular. PXE-like lesions in association with ß-thalassemia have previously been reported in the literature in patients with ß-thalassaemia intermediate and major, being clinically indistinguishable from classic PXE. The case is presented of a 10-year-old boy with ß-thalassaemia minor and characteristic lesions of PXE. It is worth noting the benefit of multimodal imaging in the diagnosis and monitoring of the lesions.

Oclusión de la arteria central de la retina iatrogénica tras angiografía de sustracción digital cerebral / Iatrogenic retinal central artery occlusion after a cerebral digital subtraction angiography

La angiografía de sustracción digital (ASD), es una técnica empleada en el diagnóstico de alteraciones vasculares cerebrales. La oclusión de arteria central de la retina (OACR) es una complicación descrita tras la realización de técnicas endovasculares que implican la movilización de placas arterioscleróticas produciendo émbolos. Presentamos el caso de un varón que inicia una pérdida de agudeza visual durante la ASD. En la funduscopia presenta palidez y mancha rojo cereza, y la angiografía es compatible con la presencia de un trombo en la salida de la arteria central de la retina. Se diagnostica una OACR que se trata sin éxito mediante masaje ocular, hipotensores tópicos, acetazolamida vía oral y paracentesis de cámara anterior, obteniendo una agudeza visual final inferior a 0,05. La OACR, pese a ser una complicación rara, se debe por su mal pronóstico considerar en la realización de procedimientos neuro-radiológicos como la ASD

Digital subtraction angiography (DSA) is a technique used in interventional radiology for the diagnosis of vascular cerebral conditions. Central retinal artery occlusion (CRAO) is a complication of endovascular procedures that involve atherosclerotic plaque removal with subsequent embolisation. The case is presented on a patient who noticed a sudden vision loss during a DSA. Funduscopy showed retinal pallor and a cherry red spot. The angiography showed a structure suggesting the presence of an embolus in the central retinal artery. The patient was diagnosed with a CRAO, and unsuccessfully treated with ocular massage, topical hypotensive drugs, oral acetazolamide, and anterior chamber paracentesis, with a final visual acuity of 0.05. Central retinal artery occlusion is a rare complication, but due to its poor prognosis, it must be considered when performing neuroradiological procedures such as DSA

Seguimiento de retinitis candidiásica mediante tomografía de coherencia óptica de dominio espectral / Spectral domain optical coherence tomography for monitoring candida retinitis

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Iatrogenic retinal central artery occlusion after a cerebral digital subtraction angiography. / Oclusión de la arteria central de la retina iatrogénica tras angiografía de sustracción digital cerebral.

Digital subtraction angiography (DSA) is a technique used in interventional radiology for the diagnosis of vascular cerebral conditions. Central retinal artery occlusion (CRAO) is a complication of endovascular procedures that involve atherosclerotic plaque removal with subsequent embolisation. The case is presented on a patient who noticed a sudden vision loss during a DSA. Funduscopy showed retinal pallor and a cherry red spot. The angiography showed a structure suggesting the presence of an embolus in the central retinal artery. The patient was diagnosed with a CRAO, and unsuccessfully treated with ocular massage, topical hypotensive drugs, oral acetazolamide, and anterior chamber paracentesis, with a final visual acuity of 0.05. Central retinal artery occlusion is a rare complication, but due to its poor prognosis, it must be considered when performing neuroradiological procedures such as DSA.

Leishmaniasis cutánea inducida por anti-factor de necrosis tumoral en paciente con artritis psoriásica y uveítis / Anti-tumour necrosis factor-induced cutaneous leishmaniasis in patient with psoriatic arthritis and uveítis

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Toxicidad macular precoz tras 2 meses de tratamiento con hidroxicloroquina / Early macular toxicity following 2 months of hydroxychloroquine therapy

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Vitreolisis neumática en tracción vitreomacular sintomática: caso clínico / Pneumatic vitreolysis for symptomatic vitreomacular traction: case report

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Cuando todo lo demás falla: queratoplastia tectónica con córnea silico-disecada en paciente con alto riesgo de perforación corneal / When all else fails: Tectonic keratoplasty with silica gel re-dried cornea in a patient with high risk of corneal perforation

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Nuevos hallazgos peripapilares en el síndrome de Alport: caso clínico / New peripapillary findings in Alport syndrome: A case report

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