[Visual fields defect as inicial presentation of neurosarcoidosis]. / Alteraciones campimétricas como manifestación inicial de una neurosarcoidosis.

CASE REPORT: A 29 year old man who suffered from progressive loss of peripherical vision in the previous few weeks. He was being studied for hormonal dysfunction. The visual field showed superior arciform defect in the right eye and a superior altitudinal defect in the left eye. The endocrinology study showed hypopituitarism secondary to a neurosarcoidosis. DISCUSSION: Neurosarcoidosis is very rare, and can produce irreversible visual fields defects. Prompt diagnosis and treatment are essential to maintain visual function.

Alteraciones campimétricas como manifestación inicial de una neurosarcoidosis / Visual fields defect as inicial presentation of neurosarcoidosis

Caso clínico: Varón de 29 años que refería alteraciones progresivas de la visión periférica en las últimas semanas. Se encontraba en estudio por disfunción hormonal. La campimetría presentaba un defecto arciforme superior, en ojo derecho y defecto altitudinal superior en ojo izquierdo y el estudio endocrinológico reveló disfunción hormonal secundaria a neurosarcoidosis. Discusión: La neurosarcoidosis es un cuadro muy poco frecuente que puede producir alteraciones visuales irreversibles. Su diagnóstico y tratamientos precoces son fundamentales para preservar la función visual (AU)

Case report: A 29 year old man who suffered from progressive loss of peripherical vision in the previous few weeks. He was being studied for hormonal dysfunction. The visual field showed superior arciform defect in the right eye and a superior altitudinal defect in the left eye. The endocrinology study showed hypopituitarism secondary to a neurosarcoidosis. Discussion: Neurosarcoidosis is very rare, and can produce irreversible visual fields defects. Prompt diagnosis and treatment are essential to maintain visual function (AU)

Ocular inflammatory signs observed in a cohort of Spanish patients with Behçet disease and ocular inflammation.

PURPOSE: To study the clinical characteristics of a cohort of Spanish patients diagnosed with Behcet disease and who also presented ocular inflammation. METHODS: Thirty cases of Behçet disease were studied retrospectively. The authors studied age distribution, distribution by sex, clinical course, laterality, type of uveitis, secondary glaucoma, corneal involvement, hypopyon, iris-lens synechiae, secondary cataract, cystoid macular edema (CME), and papillitis (optic neuritis). RESULTS: Fourteen of the patients were men and 16 were women (ratio 0.875:1). The mean age of the patients was 35.24 years (+/-10.917; 21-61 years). In 23 patients, the disease course was recurrent. In 9 patients, the disease manifested unilaterally. In 5 patients showing unilateral onset, the contralateral eye became affected. In 2 of the 30 patients, uveitis exclusively affected the anterior segment. In 8 patients, uveitis was solely posterior. There was one case of intermediate uveitis. The remaining 19 patients showed panuveitis. Three had focal chorioretinitis. One had diffuse chorioretinitis. Fifteen showed signs of diffuse vasculitis. Eight patients showed focal vasculitis. CONCLUSIONS: Women were slightly more affected than men, although the authors found no significant correlation between sex and the clinical variables examined. Apart from one unexpected case of intermediate uveitis, the observations are similar to those reported for other patient series.

[Articular diseases and uveitis]. / Enfermedades articulares y uveítis.

Ocular inflammation is a common clinical manifestation related to several autoimmune systemic disorders, specially spondyloarthropaties. In this group, there are different clinical diseases that are related to special uveitic patterns. Several discriminative patterns have been defined that closely link uveitis with certain systemic or ophthalmic diseases. Unilateral recurrent anterior acute uveitis is the most frequent form of uveitis related to spondyloarthropaties, and is sometimes the initial manifestation of an undiagnosed spondyloarthropaty. The collaboration of ophthalmologists, rheumatologists and internal medicine specialists is very important for the correct management and treatment of these patients.

Enfermedades articulares y uveítis / Articular diseases and uveitis

La inflamación ocular es una manifestación clínicafrecuente de múltiples enfermedades sistémicasautoinmunes, siendo de gran relevancia en las espondiloartropatías.Dentro del grupo de las espondiloartropatíasexisten diferentes entidades clínicas, asociándosea diferentes patrones de uveítis. Se han definidouna serie de patrones discriminativos que relacionanformas concretas de uveítis con determinadasenfermedades sistémicas u oculares. La uveítis anterioraguda unilateral recidivante es la más frecuente enlas espondiloartropatías, y puede ser la forma de iniciode una espondiloartropatía no diagnosticada previamente.La colaboración entre oftalmólogos y reumatólogoso internistas es fundamental para el correctomanejo y tratamiento de estos pacientes

Ocular inflammation is a common clinicalmanifestation related to several autoimmune systemicdisorders, specially spondyloarthropaties. In thisgroup, there are different clinical diseases that arerelated to special uveitic patterns. Severaldiscriminative patterns have been defined that closelylink uveitis with certain systemic or ophthalmicdiseases. Unilateral recurrent anterior acute uveitis isthe most frequent form of uveitis related tospondyloarthropaties, and is sometimes the initialmanifestation of an undiagnosed spondyloarthropaty.The collaboration of ophthalmologists,rheumatologists and internal medicine specialists isvery important for the correct management and treatment of these patients (AU)

Epiteliectomía conjuntival sectorial y trasplante de membrana amniótica en insuficiencia limbar parcial / Sectorial conjunctivl epitheliectomy and amniotic membrane transplantation for partial limbal stem cells deficiency

Caso clínico: Varón de 74 años de edad desarrolló una insuficiencia limbar parcial secundaria a una causticación en el ojo izquierdo. Fue tratado mediante la realización de una epiteliectomía sectorial conjuntival asociada a injerto de membrana amniótica. 3 semanas más tarde existía un epitelio corneal íntegro, estable y regular. Discusión: Este caso demuestra como la realización de una epiteliectomía sectorial asociada al injerto de membrana amniótica es un método eficaz y seguro para restaurar una superficie corneal estable en los casos de insuficiencia limbar parcial

Case report: A 74-year-old man developed a partial limbal stem cell deficiency secondary to a chemical injury in the left eye. He was treated with a sectorial conjunctival epitheliectomy and amniotic membrane transplantation. After 3 weeks there was an intact, smooth and stable corneal epithelium. Discussion: This case report emphasizes that conjunctival epitheliectomy and amniotic membrane transplantation appears to be a safe and effective method of restoring a stable corneal epithelium for cases of partial limbal stem cell deficiency

[Sectorial conjunctival epitheliectomy and amniotic membrane transplantation for partial limbal stem cells deficiency]. / Epiteliectomía conjuntival sectorial y trasplante de membrana amniótica en insuficiencia limbar parcial.

CASE REPORT: A 74-year-old man developed a partial limbal stem cell deficiency secondary to a chemical injury in the left eye. He was treated with a sectorial conjunctival epitheliectomy and amniotic membrane transplantation. After 3 weeks there was an intact, smooth and stable corneal epithelium. DISCUSSION: This case report emphasizes that conjunctival epitheliectomy and amniotic membrane transplantation appears to be a safe and effective method of restoring a stable corneal epithelium for cases of partial limbal stem cell deficiency.

[Ocular rupture associated with lens dislocation to the subconjunctival space]. / Estallido ocular con luxación de cristalino al espacio subconjuntival.

CASE REPORT: We present the case of a patient who suffered from rupture of her left eye due to moderate blunt trauma. The lens, which was dislocated to the nasal and superior subconjunctival space, was extracted and the wound explored and repaired; when the process had stabilized secondary vitrectomy and suture of an IOL to the sulcus were performed, achieving a final visual acuity of 0.3. DISCUSSION: Eye trauma is common and eye rupture may occur in those patients who have undergone ocular surgery or suffer from a debilitating condition of the eye. None of these predisposing factors existed in our case. Despite the seriousness of the problem, appropriate treatment achieved good visual function.

Estallido ocular con luxación de cristalino al espacio subconjuntival / Ocular rupture associated with lens dislocation to the subconjunctival space

Caso clínico: Se describe el caso de una paciente que sufre estallido del globo ocular izquierdo secundario a un traumatismo de moderada intensidad. Se produjo luxación del cristalino al espacio subconjuntival nasal superior. El cristalino fue extraído y al producirse la estabilidad del cuadro se realizó vitrectomía y sutura de lente intraocular a sulcus, alcanzando una agudeza visual de 0,3. Discusión: Los traumatismos oculares son muy frecuentes y el estallido ocular suele producirse en aquellos casos que presentan patología debilitante del globo ocular o antecedentes de cirugías previas, hechos que no se presentaban en nuestro caso. A pesar de la gravedad del cuadro, la paciente alcanzó una buena función visual final

Case report: We present the case of a patient who suffered from rupture of her left eye due to moderate blunt trauma. The lens, which was dislocated to the nasal and superior subconjunctival space, was extracted and the wound explored and repaired; when the process had stabilized secondary vitrectomy and suture of an IOL to the sulcus were performed, achieving a final visual acuity of 0.3. Discussion: Eye trauma is common and eye rupture may occur in those patients who have undergone ocular surgery or suffer from a debilitating condition of the eye. None of these predisposing factors existed in our case. Despite the seriousness of the problem, appropriate treatment achieved good visual function

Long-term treatment of refractory posterior uveitis with anti-TNFalpha (infliximab).

PURPOSE: To evaluate the long-term efficacy and safety of infliximab as treatment for noninfectious posterior uveitis. METHODS: An open-label clinical trial including seven patients (12 eyes) with posterior uveitis refractory to conventional treatment regimens with corticosteroids and at least one immunosuppressive agent. Three intravenous doses of 5 mg/kg of infliximab were administered at weeks 0, 2, and 6. Infliximab infusion was repeated in patients undergoing a relapse of uveitis after initial remission. Improvement was defined as amelioration of visual acuity or disappearance of retinal exudates and/or haemorrhages, decreased macular oedema and/or vitreous opacities. All patients were followed up for at least 36 months. RESULTS: Six of the seven patients (five diagnosed with Behçet's disease and one diagnosed with sarcoidosis) showed a significant improvement after the first infliximab dose. Only in one patient diagnosed with chronic idiopathic multifocal choroiditis did the drug have no effect, and this patient was withdrawn from the study. At the end of follow-up, one eye had lost one line of vision and three eyes showed improved vision. All eyes had improved in terms of signs of inflammation. No adverse effects of treatment were observed. CONCLUSION: Infliximab is efficient and safe for the long-term management of refractory posterior uveitis, especially in patients with predominant retinal vasculitis and vitritis.

Respiratory arrest after 0.75% bupivacaine retrobulbar block.

Respiratory arrest is an uncommon complication of retrobulbar anesthesia. We present a case in which it occurred following a 0.75% bupivacaine and 2% lidocaine retrobulbar block and analyze the possible causes. We conclude that the most important of these were the relatively high concentration and volume of the anesthetic and a faulty technique.