Peripapillary pachychoroidopathy. / Paquicoroidopatía peripapilar.

A study was made on 8 eyes of 5 patients between 47 and 65 years of age with peripapillary pachychoroidopathy. They all presented with a serous detachment of the neuroepithelium or retinal pigment epithelium in the nasal macular region that extended to the optic disc, with an increase in choroidal thickness at that level. An analysis was made of the choroidal thickness using high penetration optical coherence tomography, as well as their outcome in a period between 12 and 48 months. Peripapillary pachychoroidopathy is a distinct variant of the pachychoroid disease spectrum. It must be distinguished from other disorders, such as inflammatory or neuro-ophthalmological conditions, that may manifest in the vicinity of the optic disc. When faced with a patient with suspected pachychoroidopathy, a specific study of the papillary area should be considered using high penetration optical coherence tomography.

Características fundoscópicas en tres casos de hiperquilomicronemia familiar / Fundoscopic characteristics in three cases of familial hyperchylomicronaemia

CASO CLÍNICO: Presentamos tres casos de pacientes con hiperquilomicronemia familiar y lipemia retinalis, y analizamos de forma comparada las características fundoscópicas de cada uno de ellos. DISCUSIÓN: El aspecto característico del fondo retiniano en color salmón-pálido corresponde con grados severos de lipemia retinalis. Los hallazgos relativos a la tonalidad del árbol vascular en segmentos distales constituyen probablemente el dato exploratorio que mejor orienta el diagnóstico oftalmológico en niveles inferiores de hipertrigliceridemia

CASES REPORT: Three cases are presented of patients with familial hyperchylomicronaemia and lipaemia retinalis, in whom an analysis is made of the fundoscopic characteristics of each of them. DISCUSSION: The typical appearance of the retinal fundus is pale salmon coloured and corresponds to levels of severe lipaemia retinalis. As regards the findings, the vascular tree tonality is probably the best exploratory evidence to help in the ophthalmological diagnosis

Fundoscopic characteristics in three cases of familial hyperchylomicronaemia. / Características fundoscópicas en tres casos de hiperquilomicronemia familiar.

CASES REPORT: Three cases are presented of patients with familial hyperchylomicronaemia and lipaemia retinalis, in whom an analysis is made of the fundoscopic characteristics of each of them. DISCUSSION: The typical appearance of the retinal fundus is pale salmon coloured and corresponds to levels of severe lipaemia retinalis. As regards the findings, the vascular tree tonality is probably the best exploratory evidence to help in the ophthalmological diagnosis.

Hypertensive choroidopathy, retinopathy and optic neuropathy in renal transplantation failure. / Coroidopatía, retinopatía y neuropatía óptica hipertensiva en un paciente con fracaso de trasplante renal.

A 32 year-old man who presented with severe elevation of blood pressure after failure of kidney transplant. The patient had multiple serous retinal detachments, venous dilation, arteriolar narrowing, retinal haemorrhages, as well as optic disc oedema. Due to the impossibility of performing a fluorescein angiography, an angiotomography and en-face optical coherence tomography images were used to identify the vascular alterations in the retina, choroid, and choriocapillaris. Angiotomography and en face-optical coherence tomography mode images are very useful in cases where it is not possible to perform fluorescein angiography.

Retinopatía Purtscher-like previa a fallo renal agudo / Purtscher-like retinopathy preceding acute renal failure

CASO CLÍNICO: Presentamos el caso de una mujer de 61 años, con una retinopatía de tipo Purtscher asociada a un fallo renal agudo. La exploración oftalmológica, angiografía fluoresceínica y tomografía de coherencia óptica fueron compatibles con una retinopatía de Purtscher-like. Las manifestaciones oculares precedieron al fracaso renal. El estudio sistémico y de laboratorio descartó su asociación con pancreatitis y otras enfermedades sistémicas. Finalmente se complicó con un glaucoma neovascular. DISCUSIÓN: La retinopatía de Purtscher-like rara vez precede a la enfermedad sistémica asociada. El diagnóstico precoz basado en las manifestaciones oftálmicas, podría contribuir al diagnóstico y tratamiento de la enfermedad de base y a la prevención de las posibles complicaciones

CASE REPORT: The case is reported of a 61 year-old woman with Purtscher-like retinopathy associated with acute renal failure. Ophthalmic examination, fluorescein-angiography, and optical coherence tomography were consistent with Purtscher-like retinopathy. Ophthalmic symptoms and signs preceded renal failure. Pancreatitis and other systemic diseases were ruled out. The patient developed a neovascular glaucoma. DISSCUSIÓN: Purtscher-like retinopathy rarely precedes the associated systemic illness. Early diagnosis based on ophthalmic symptoms may help in the recognition and treatment of the disease, and prevent later complications

Uveitis and serous retinal detachment secondary to systemic dabrafenib and trametinib. / Uveítis y desprendimiento seroso de retina secundarios al tratamiento sistémico con dabrafenib y trametinib.

CASE REPORT: The case is presented of a 39-year-old woman with metastatic melanoma treated with dabrafenib and trametinib. She presented with a severe acute panuveitis with granulomatous anterior uveitis, vitritis, and multiple serous retinal detachments. Dabrafenib and trametinib were suspended, and treatment with a systemic and topical corticosteroid was started. A good response was obtained, with a recovery of visual acuity of 1.0 in both eyes within two weeks. DISCUSSION: Dabrafenib and trametinib can lead to severe uveitis. Treatment with corticosteroids and discontinuation of therapy with dabrafenib and trametinib led to an anatomical and functional improvement, and resolved the episode rapidly. Ophthalmologists must be aware of this toxicity, given the increasing use of those drugs.

Afectación retiniana tras inyección accidental intravítrea de mepivacaína y epinefrina / Retinal toxicity after accidental intravitreal injection of mepivacaine and adrenaline

Caso clínico: Varón de 32 años sin antecedentes de interés que sufre accidente de tráfico con trauma craneoencefálico leve, con herida inciso-contusa supraciliar izquierda que se extiende al párpado superior izquierdo sin pérdida de visión. Tras la inyección anestésica palpebral se produjo disminución de agudeza visual súbita del ojo izquierdo e hiposfagma localizado entre la I-III a 4 mm del limbo, con aumento de la presión intraocular. En el fondo de ojo se observó una lesión blanquecina con un punto hemorrágico central que se correspondía con el área del hiposfagma. Discusión: La infiltración anestésica durante la reparación palpebral puede complicarse con la penetración inadvertida del globo ocular. La mepivacaína y epinefrina intravítreas pueden causar lesiones maculares y retinianas por sí solas, así como por el aumento súbito de la presión intraocular (AU)

Case report: The case is presented of a 32 year-old male with no medical history of interest who suffered a traffic accident with mild traumatic brain injury. He had a left supraciliary incised and contused wound that extended to the left upper eyelid, with no loss of vision. After palpebral anaesthetic injection, there was a sudden visual acuity decrease in the left eye and hyposphagma located between I-III at 4 mm from the limbus, with increased intraocular pressure. A whitish lesion with a central haemorrhagic focus was observed in the ocular fundus, corresponding to the area where the hyposphagma was located. Discussion: Anaesthetic injection during palpebral repair may be complicated by inadvertent penetration of the eyeball. Intravitreal mepivacaine and adrenaline could cause macular and retinal lesions (AU)

Purtscher-like retinopathy preceding acute renal failure. / Retinopatía Purtscher-like previa a fallo renal agudo.

CASE REPORT: The case is reported of a 61 year-old woman with Purtscher-like retinopathy associated with acute renal failure. Ophthalmic examination, fluorescein-angiography, and optical coherence tomography were consistent with Purtscher-like retinopathy. Ophthalmic symptoms and signs preceded renal failure. Pancreatitis and other systemic diseases were ruled out. The patient developed a neovascular glaucoma. DISCUSSION: Purtscher-like retinopathy rarely precedes the associated systemic illness. Early diagnosis based on ophthalmic symptoms may help in the recognition and treatment of the disease, and prevent later complications.

Retinal toxicity after accidental intravitreal injection of mepivacaine and adrenaline. / Afectación retiniana tras inyección accidental intravítrea de mepivacaína y epinefrina.

CASE REPORT: The case is presented of a 32 year-old male with no medical history of interest who suffered a traffic accident with mild traumatic brain injury. He had a left supraciliary incised and contused wound that extended to the left upper eyelid, with no loss of vision. After palpebral anaesthetic injection, there was a sudden visual acuity decrease in the left eye and hyposphagma located between I-III at 4mm from the limbus, with increased intraocular pressure. A whitish lesion with a central haemorrhagic focus was observed in the ocular fundus, corresponding to the area where the hyposphagma was located. DISCUSSION: Anaesthetic injection during palpebral repair may be complicated by inadvertent penetration of the eyeball. Intravitreal mepivacaine and adrenaline could cause macular and retinal lesions.

Focal choroidal excavaction associated with idiopathic choroidal neovascularization. / Excavación focal coroidea asociada a membrana neovascular coroidea idiopática.

CASE REPORT: The case is presented of a 45 year-old man with a focal choroidal excavation associated with choroidal neovascularisation not included in the area of excavation. Clinical features were analysed using retinography, fluorescein angiography, optical coherence tomography, and optical coherence tomography angiography. The patient was treated with 3 intravitreal injections of bevacizumab, with a good response. DISCUSSION: Focal choroidal excavation can be associated with choroidal neovascularization not included in the area of excavation. Multimodal imaging provides a complete description of clinical features, before and after treatment.

Macrovaso retiniano asociado a telangiectasias periféricas retinianas e isquemia retiniana / Congenital retinal macrovessel associated with retinal peripheral telangiectasia and retinal ischaemia

Caso clínico: Presentamos el caso de una paciente de 16 años con un macrovaso retiniano congénito unilateral, con telangiectasias retinianas periféricas asociadas a zonas de isquemia. Discusión: Los macrovasos retinianos congénitos constituyen un hallazgo raro, no habiéndose descrito casos asociados a telangiectasias retinianas e isquemia periférica. Tras 21 meses de seguimiento, la paciente se mantiene estable, conservando la visión inicial y sin complicaciones adicionales (AU)

Clinical case: The case is presented of a 16 year-old girl with unilateral congenital retinal macrovessel associated with peripheral telangiectasia and retinal ischaemia. Discussion: Congenital retinal macrovessel is a rare finding. To the best of our knowledge this is the first report of this unusual presentation of congenital retinal macrovessel. After 21 months of follow up, visual acuity remained stable, and no complications developed (AU)

Congenital retinal macrovessel associated with retinal peripheral telangiectasia and retinal ischaemia. / Macrovaso retiniano asociado a telangiectasias periféricas retinianas e isquemia retiniana.

CLINICAL CASE: The case is presented of a 16 year-old girl with unilateral congenital retinal macrovessel associated with peripheral telangiectasia and retinal ischaemia. DISCUSSION: Congenital retinal macrovessel is a rare finding. To the best of our knowledge this is the first report of this unusual presentation of congenital retinal macrovessel. After 21 months of follow up, visual acuity remained stable, and no complications developed.

Unilateral uveitis associated with IgA nephropathy. / Uveítis unilateral asociada a nefropatía IgA.

CASE REPORT: The case is presented of a 42 year-old man with episodes of unilateral uveitis in his right eye. Ophthalmic examination showed a granulomatous anterior uveitis with vitritis. Systemic investigations revealed non-nephrotic proteinuria and microhaematuria. A renal biopsy showed IgA nephropathy. DISCUSSION: Uveitis and glomerulonephritis may have common immunological pathogenesis. IgA nephropathy should be a differential diagnosis in patients with uveitis and nephropathy.