[Bilateral recurrent autoimmune optical neuropathy in childhood]. / Neuropatía óptica autoinmune recidivante bilateral en la infancia.

CLINICAL CASE: A ten year-old girl, after a Yersinia gastroenteritis, developed an optic neuritis in the left eye. She was not treated and resulted ultimately in optic atrophy on the affected side. Six months later a similar episode occurred in the contralateral eye. On this occasion corticosteroid therapy was given. During this therapy the neuritis diminished; however the patient had three relapses, so it was decided to give her immunosuppressive treatment with azathioprine and continue this indefinitely. DISCUSSION: After considering the differential diagnoses of bilateral recurrent optical neuritis in childhood, we concluded that it was most likely to have an autoimmune basis. After considering the benefits and risks of the long-term treatment, we believe immunosuppressive therapy is most useful in controlling the disease allowing corticosteroid therapy to be reduced.

Sarcomatoid carcinoma and orbital apex syndrome.

PURPOSE: To report a case of sarcomatoid carcinoma and orbital apex syndrome in a previously healthy adult. METHODS: A previously healthy 45-year-old man presented with exophthalmos of the left eye and a mass visible through his left nostril. A biopsy was performed and immunohistochemistry was used to confirm the diagnosis of the tumor. The patient was treated with chemotherapy and radiotherapy. RESULTS: After treatment, we observed a substantial reduction in the size of the mass, but side effects of treatment developed. The visual acuity of the left eye was no light perception. Eight months later, the patient presented with bone and liver metastases, and he died 4 months later. CONCLUSIONS: Sarcomatoid carcinoma is an aggressive tumor that can produce compressive symptoms with very poor visual and survival prognoses. A cranio-orbital computed tomography scan should be performed when patients present with symptoms of conjunctivitis and orbital apex syndrome.

[Central serous chorioretinopathy as a complication of epitheliopathy under treatment with glucocorticoids]. / Coroidopatía serosa central como complicación de epitelitis en tratamiento con corticoides.

CASE REPORT: We present cases of two patients who were examined in our department with the diagnosis of epitheliopathy following treatment with oral and topical glucocorticoids. They were referred because of loss of visual acuity. The ophthalmic examination established the diagnosis of central serous chorioretinopathy and it was decided to stop treatment with glucocorticoids. DISCUSSION: The pathogenesis of the central serous chorioretinopathy is still imprecisely known, but it has been related to several situations characterized by exposure to high levels of endogenous or exogenous glucocorticoids. Both of these cases provide more evidence of the potential association between corticosteroids and the acute manifestations of central serous chorioretinopathy.

Coroidopatía serosa central como complicación de epitelitis en tratamiento con corticoides / Central serous chorioretinopathy as a complication of epitheliopathy under treatment with glucocorticoids

Caso clínico: Se presentan 2 pacientes que acuden a la consulta con el diagnóstico de epitelitis multifocal en tratamiento con corticoides vía oral y vía tópica. Como sintomatología refieren disminución de agudeza visual. A la exploración se diagnostica una coriorretinopatía serosa central y se suspende el tratamiento con corticoides.Discusión: La etiopatogenia de la coriorretinopatía serosa central permanece aún desconocida aunque se ha relacionado con diversas situaciones caracterizadas por la exposición a niveles elevados de glucocorticoides (CTC) endógenos o exógenos. Los dos casos que presentamos constituyen una evidencia más de que el tratamiento con corticoides puede precipitar o agravar esta patología

Case report: We present cases of two patients who were examined in our department with the diagnosis of epitheliopathy following treatment with oral and topical glucocorticoids. They were referred because of loss of visual acuity. The ophthalmic examination established the diagnosis of central serous chorioretinopathy and it was decided to stop treatment with glucocorticoids.Discussion: The pathogenesis of the central serous chorioretinopathy is still imprecisely known, but it has been related to several situations characterized by exposure to high levels of endogenous or exogenous glucocorticoids. Both of these cases provide more evidence of the potential association between corticosteroids and the acute manifestations of central serous chorioretinopathy

[Intraocular pressure measurement using the Proview tonometer]. / Medición de presión intraocular con el tonómetro Proview.

PURPOSE: To evaluate a new ocular tonometer (Proview) which functions by visualizing a phosphene after putting pressure on the upper eyelid. To ascertain its accuracy and reproducibility with respect to the Goldmann tonometer (GT). METHODS: A study on both eyes of 110 non-selected patients was performed. One measurement with GT and three subsequent measurements with Proview were taken by the same investigator. The number of failed attempts to visualize the phosphene was recorded. We evaluated each eye separately to observe the possible learning effect. RESULTS: The intraocular pressure (IOP) mean with Proview is 5 mm Hg higher than the GT (p < 0.001). The coefficient of correlation between both instruments is low (R = 0.67; R(2) = 0.45) in the right eye (RE). The difference between maximum and minimum values of the 3 measurements taken with the Proview was 3.21 (SD: 1.73) mm Hg in RE. The failed attempts to see the phosphene were 5.14 (SD: 2.39) in RE and 4.93 (SD: 2.78) in left eye (p > 0.05). CONCLUSIONS: The Proview(R) tonometer showed low accuracy and reproducibility in comparison with the GT. This tonometer requires a long learning process before phosphene visualization. The results demonstrated that this tonometer is not clinically useful, except in patients with serious corneal diseases which make measurement with GT very difficult.

Medición de presión intraocular con el tonómetro Proview® / Intraocular pressure measurement using the Proview® tonometer

Objetivo: Valorar un nuevo tonómetro ocular (Proview®) basado en la visualización de un fosfeno tras la presión del tonómetro sobre el párpado superior. Conocer su exactitud y reproducibilidad respecto del tonómetro Goldmann (TG).Material y Métodos: Estudio realizado en ambos ojos de 110 pacientes consecutivos y no seleccionados. Se realizó primero la medición con TG y posteriormente 3 medidas con Proview®. Todas las mediciones fueron realizadas por el mismo investigador. Se anotó el número de intentos hasta conseguir una visualización del fosfeno. Se valoró separadamente cada ojo para conocer el posible efecto aprendizaje.Resultados: La media de la tensión ocular (TO) con Proview® es 5 mm Hg más alta que con el TG (p<0,001). El coeficiente de correlación entre ambos aparatos es bajo (R= 0,67; R2=0,45) en ojo derecho (OD). La diferencia entre el valor máximo y el mínimo de las 3 medidas con el Proview® es de 3,21 mm Hg (DE: 1,73) en OD. La media de intentos hasta ver el fosfeno es de 5,14 (DE: 2,39) en OD y de 4,93 (DE: 2,78) en OI (p<0,05).Conclusiones: El tonómetro Proview® presenta una baja exactitud y reproducibilidad en comparación con el TG. Requiere un cierto proceso de aprendizaje hasta visualizar el fosfeno. Los resultados no parecen aconsejar su uso rutinario en clínica, excepto quizá en pacientes con enfermedades graves en la córnea que impidan la medición con el tonómetro de aplanación

Purpose: To evaluate a new ocular tonometer (Proview®) which functions by visualizing a phosphene after putting pressure on the upper eyelid. To ascertain its accuracy and reproducibility with respect to the Goldmann tonometer (GT).Methods: A study on both eyes of 110 non-selected patients was performed. One measurement with GT and three subsequent measurements with Proview® were taken by the same investigator. The number of failed attempts to visualize the phosphene was recorded. We evaluated each eye separately to observe the possible learning effect.Results: The intraocular pressure (IOP) mean with Proview® is 5 mm Hg higher than the GT (p0.05).Conclusions: The Proview® tonometer showed low accuracy and reproducibility in comparison with the GT. This tonometer requires a long learning process before phosphene visualization. The results demonstrated that this tonometer is not clinically useful, except in patients with serious corneal diseases which make measurement with GT very difficult

Azoor. Tras una lesión por latigazo cervical / Azoor after cervical sprain

Objetivo/Método: Se presenta un caso clínico de una paciente de 30 años que sufrió un accidente de tráfico en el cual fue diagnosticada de contractura cervical. Aproximadamente un mes después, la paciente percibe un escotoma en la región externa del campo visual del ojo izquierdo. Resultado/Conclusiones: La TAC craneal, potenciales visuales evocados, test de los colores y RNM fueron normales. El estudio mediante oftalmoscopía, campimetría y OCT, sirvió para realizar el diagnóstico de retinopatía zonal externa aguda oculta (AZOOR) (AU)

[AZOOR. After whiplash injury]. / Azoor. Tras una lesión por latigazo cervical.

PURPOSE/METHOD: To present a case of a 30 years old woman that suffered a car accident one year ago, diagnosed of cervical sprain. One month after the accident, the patient saw a black stein in the outer side of the visual field on the left eye. RESULTS/CONCLUSIONS: Brain CAT, evocate visual potentials, color test and MRI were within of the normality. According with the ophthalmic examination, visual field test and OCT (optical coherence tomography), the diagnosis was acute zonal occult outer retinopathy (AZOOR).