Exudación lipídica masiva y desprendimiento de retina tras braquiterapia y termoterapia transpupilar combinada en melanoma de coroides / Massive lipid exudation and retinal detachment after combined brachytherapy and transpupillary thermotherapy in choroidal melanoma

Caso clínico: Varón de 59 años con melanoma coroideo en ojo izquierdo. Se realiza tratamiento con braquiterapia mediante placa (iodo-125), apareciendo exudación masiva, desprendimiento de retina y grandes placas de depósitos lipídicos una semana después. Se monitoriza la evolución mediante funduscopia y ecografía mensualmente y una vez reabsorbido el fluido subretiniano se realiza termoterapia transpupilar (TTT) de la masa tumoral irradiada, 9 meses tras la intervención. Tres meses después se producen roturas retinianas con siembra vítrea que hacen necesaria la enucleación. Discusión: La terapia combinada con placas de braquiterapia y TTT puede asociar complicaciones severas que requieran la enucleación (AU)

Case report: A 59 year-old male with choroidal melanoma in the left eye who underwent plaque brachytherapy (iodine 125). One week after surgery, massive exudation with retinal detachment and lipid exudation was observed. Evolution was assessed with funduscopy and ultrasound every month. Nine months after surgery transpupillary thermotherapy (TTT) was performed over the fluid-free irradiated residual tumour. Three months after this procedure, new retinal breaks appeared in the treated area with vitreous seeding that required enucleation. Discussion: Combined treatment with plaque brachytherapy and TTT may associate severe complications that may require enucleation of the involved eye (AU)

Massive lipid exudation and retinal detachment after combined brachytherapy and transpupillary thermotherapy in choroidal melanoma.

CASE REPORT: A 59 year-old male with choroidal melanoma in the left eye who underwent plaque brachytherapy (iodine 125). One week after surgery, massive exudation with retinal detachment and lipid exudation was observed. Evolution was assessed with funduscopy and ultrasound every month. Nine months after surgery transpupillary thermotherapy (TTT) was performed over the fluid-free irradiated residual tumour. Three months after this procedure, new retinal breaks appeared in the treated area with vitreous seeding that required enucleation. DISCUSSION: Combined treatment with plaque brachytherapy and TTT may associate severe complications that may require enucleation of the involved eye.

The human parahippocampal region: I. Temporal pole cytoarchitectonic and MRI correlation.

The temporal pole (TP) is the rostralmost portion of the human temporal lobe. Characteristically, it is only present in human and nonhuman primates. TP has been implicated in different cognitive functions such as emotion, attention, behavior, and memory, based on functional studies performed in healthy controls and patients with neurodegenerative diseases through its anatomical connections (amygdala, pulvinar, orbitofrontal cortex). TP was originally described as a single uniform area by Brodmann area 38, and von Economo (area TG of von Economo and Koskinas), and little information on its cytoarchitectonics is known in humans. We hypothesize that 1) TP is not a homogenous area and we aim first at fixating the precise extent and limits of temporopolar cortex (TPC) with adjacent fields and 2) its structure can be correlated with structural magnetic resonance images. We describe here the macroscopic characteristics and cytoarchitecture as two subfields, a medial and a lateral area, that constitute TPC also noticeable in 2D and 3D reconstructions. Our findings suggest that the human TP is a heterogeneous region formed exclusively by TPC for about 7 mm of the temporal tip, and that becomes progressively restricted to the medial and ventral sides of the TP. This cortical area presents topographical and structural features in common with nonhuman primates, which suggests an evolutionary development in human species.

Retinal nerve fiber layer atrophy is associated with physical and cognitive disability in multiple sclerosis.

BACKGROUND: Studying axonal loss in the retina is a promising biomarker for multiple sclerosis (MS). Our aim was to compare optical coherence tomography (OCT) and Heidelberg retinal tomography (HRT) techniques to measure the thickness of the retinal nerve fiber layer (RNFL) in patients with MS, and to explore the relationship between changes in the RNFL thickness with physical and cognitive disability. We studied 52 patients with MS and 18 proportionally matched controls by performing neurological examination, neuropsychological evaluation using the Brief Repetitive Battery-Neuropsychology and RNFL thickness measurement using OCT and HRT. RESULTS: We found that both OCT and HRT could define a reduction in the thickness of the RNFL in patients with MS compared with controls, although both measurements were weakly correlated, suggesting that they might measure different aspects of the tissue changes in MS. The degree of RNFL atrophy was correlated with cognitive disability, mainly with the symbol digit modality test (r=0.754, P<0.001). Moreover, temporal quadrant RNFL atrophy measured with OCT was associated with physical disability. CONCLUSION: In summary, both OCT and HRT are able to detect thinning of the RNFL, but OCT seems to be the most sensitive technique to identify changes associated with MS evolution.

[Traumatic submacular hemorrhage treated with rt-PA and SF6]. / Hemorragia submacular traumática tratada con rt-PA y SF6.

CASE REPORT: This patient was afflicted by a traumatic submacular hemorrhage. A posterior vitrectomy was performed and intravitreal rt-PA and SF6 were administered. Four weeks later, the visual acuity had increased from 0.1 to 0.8. No complications due to the treatment with rt-PA were reported. DISCUSSION: It is known that waiting for the spontaneous blood removal in such cases results in a poor visual acuity recovery due to a toxic effect of the blood products. Both rt-PA and the SF6 are useful for the treatment of submacular hemorrhages secondary to age-related macular degeneration, and this case report has shown they are also useful to lyse traumatic blood clots, thus contributing to a better recovery of visual acuity.

Hemorragia submacular traumática tratada con rt-PA y SF6 / Traumatic submacular hemorrhage treated with rt-PA and SF6

Caso clínico: Paciente que presenta hemorragia submacular de origen traumático. Se realiza vitrectomía posterior y administración intravítrea de rt- PA y SF6. A las cuatro semanas la agudeza visual había pasado de 0,1 a 0,8. El paciente no presentó ninguna complicación derivada del tratamiento con rt-PA. Discusión: Debido a que la sangre es tóxica para la retina esperar a su reabsorción espontánea comporta una pobre recuperación visual. El rt-PA administrado junto al SF6 es útil para el tratamiento de hemorragias submaculares secundarias a degeneración macular asociada a la edad, pero también puede ser útil para la lisis de coágulos hemáticos traumáticos favoreciendo la recuperación de la agudeza visual

Case report: This patient was afflicted by a traumatic submacular hemorrhage. A posterior vitrectomy was performed and intravitreal rt-PA and SF6 were administered. Four weeks later, the visual acuity had increased from 0.1 to 0.8. No complications due to the treatment with rt-PA were reported. Discussion: It is known that waiting for the spontaneous blood removal in such cases results in a poor visual acuity recovery due to a toxic effect of the blood products. Both rt-PA and the SF6 are useful for the treatment of submacular hemorrhages secondary to age-related macular degeneration, and this case report has shown they are also useful to lyse traumatic blood clots, thus contributing to a better recovery of visual acuity

Antioxidantes y DMAE / Antioxidants and ARMD

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[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.

[Optical coherence tomography in central retinal artery occlusion]. / Tomografía óptica de coherencia en oclusión de arteria central de la retina.

CLINICAL CASES: Three eyes with central retinal artery occlusion (CRAO) have been studied. Optical coherence tomography (OCT) was performed in each of them. Ophthalmoscopic signs of CRAO were equivocal in the three eyes. However, the presence of a hyporeflective signal in the OCT scan could be seen clearly in each of them. DISCUSSION: The presence of a hyporeflective band between the neurosensory retina and the retinal pigment epithelium in OCT images, that persist for several months after a CRAO episode, is useful in establishing the diagnosis in these patients.

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

Caso clínico: Niña de 10 años, que tras gastroenteritis por Yersinia debuta con neuritis óptica en ojo izquierdo. No recibe tratamiento y evoluciona a atrofia óptica. A los 6 meses presentó un episodio en el ojo contralateral, instaurándose tratamiento corticoideo. Durante su disminución progresiva sufre tres recaídas. Se decide instaurar tratamiento con inmunosupresores, manteniéndose estable desde entonces sin efectos secundarios. Discusión: Tras descartar las múltiples causas de neuritis óptica bilateral recidivante en una niña, se concluye que la etiología era autoinmune. Valorando los beneficios y riesgos del tratamiento con inmunosupresores creemos que permiten el control de la enfermedad y el ahorro corticoideo (AU)

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 (AU)

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.

Tomografía óptica de coherencia en oclusión de arteria central de la retina / Optical coherence tomography in central retinal artery occlusion

Casos clínicos: Presentamos tres ojos afectados de obstrucción de arteria central de la retina (OACR). En todos ellos realizamos exploración con tomografía óptica de coherencia (OCT). Dependiendo del tiempo de evolución del cuadro clínico, los signos oftalmoscópicos de OACR eran más o menos evidentes. Sin embargo, la presencia de una banda hiporreflectante en las imágenes de OCT pudo objetivarse en todos los casos. Discusión: La presencia en las imágenes de OCT de una banda hiporreflectante por debajo de la retina neurosensorial en los casos de OACR, que persiste incluso meses después del inicio del cuadro clínico, resulta útil en el diagnóstico de esta patología retiniana

Clinical cases: Three eyes with central retinal artery occlusion (CRAO) have been studied. Optical coherence tomography (OCT) was performed in each of them. Ophthalmoscopic signs of CRAO were equivocal in the three eyes. However, the presence of a hyporeflective signal in the OCT scan could be seen clearly in each of them. Discussion: The presence of a hyporeflective band between the neurosensory retina and the retinal pigment epithelium in OCT images, that persist for several months after a CRAO episode, is useful in establishing the diagnosis in these patients

Optical coherence tomography to monitor photodynamic therapy in pathological myopia.

AIM: To evaluate the role of optical coherence tomography (OCT) in determining choroidal neovascularisation (CNV) activity before and after photodynamic therapy (PDT) in patients with pathological myopia. METHODS: 33 patients (33 eyes) with pathological myopia and being treated with PDT were included. Every 3 months all patients were evaluated and presence or absence of leakage on fluorescein angiography, presence of intraretinal or subretinal fluid on OCT, and macular and choroidal neovascular complex thickness on OCT, were determined at each examination. RESULTS: The macular thickness decreased significantly after PDT at 6 months (p = 0.001) and at 12 months follow up (p = 0.01). However, no significant changes in CNV thickness were measured after PDT at 6 months of follow up (p = 0.418) and at 12 months of follow up (p = 0.521). Once the diagnosis of CNV associated with pathological myopia was established, before treatment, OCT had a sensitivity of 96.96% for detecting CNV activity. After treatment, OCT had a good sensitivity (95.23%) and a moderate specificity (69,69%) in determining CNV activity, which resulted in a diagnostic efficiency (proportion of correct results) of 79.62%. CONCLUSIONS: OCT appears to be useful for indicating CNV activity. Therefore, it may serve as a complementary technique for deciding the need for PDT and re-treatment in patients with pathological myopia.

[Branch retinal vein occlusion treated by intravitreal triamcinolone]. / Triamcinolona intravítrea en el tratamiento de la oclusión de rama venosa retiniana.

CLINICAL CASES: Five eyes with branch retinal vein occlusion (BRVO) were treated with intravitreal injection of 4 mg of triamcinolone. Four cases showed good visual acuity and macular thickness evolution after one dose. The remaining one case suffered a relapse three months later. Therefore a second injection was performed in that case. DISCUSSION: Several treatments have been suggested to manage macular edema in BRVO. Intravitreal triamcinolone may be a therapeutic option to increase visual acuity and decrease macular thickness in patients with macular edema secondary to BRVO.

Triamcinolona intravítrea en el tratamiento de la oclusión de rama venosa retiniana / Branch retinal vein occlusion treated by intravitreal triamcinolone

Casos clínicos: Presentamos cinco ojos con obstrucción de rama venosa retiniana (ORVR) que fueron tratados mediante la inyección intravítrea de 4 mg de triamcinolona. En cuatro de los casos la evolución de la agudeza visual y del grosor macular fue satisfactoria tras una inyección de triamcinolona. Uno de los casos presentó una recidiva tres meses después y requirió una segunda inyección de triamcinolona.Discusión: El edema macular secundario a ORVR es una causa frecuente de disminución de agudeza visual. Se han propuesto diversas alternativas terapeúticas para ésta patología. La inyección intravítrea de triamcinolona parece ser una opción terapeútica válida en estos casos

Clinical cases: Five eyes with branch retinal vein occlusion (BRVO) were treated with intravitreal injection of 4 mg of triamcinolone. Four cases showed good visual acuity and macular thickness evolution after one dose. The remaining one case suffered a relapse three months later. Therefore a second injection was performed in that case. Discussion: Several treatments have been suggested to manage macular edema in BRVO. Intravitreal triamcinolone may be a therapeutic option to increase visual acuity and decrease macular thickness in patients with macular edema secondary to BRVO

[Benign concentric annular macular dystrophy]. / Distrofia macular anular benigna.

CLINICAL CASES: Two cases of benign concentric macular dystrophy are described. In one case, ophthalmologic examination, fluorescein angiogram and visual field measurement were performed. The presence of a juxtafoveal fibrosis in the other patient, indicate that choroidal neovascularization may be associated with this type of macular dystrophy. DISCUSSION: Benign concentric macular dystrophy is an entity with well-defined ophthalmoscopic and angiographic characteristics. Usually the prognosis is good. Rarely, choroidal neovascularization can be associated with this macular dystrophy.

Distrofia Macular anular benigna / Benign concentric annular macular dystrophy

Casos clínicos: Se presentan dos casos clínicos afectos de distrofia macular anular benigna. En el primero de ellos pudimos completar la exploración oftalmoscópica y angiográfica con la realización de campimetría. En el segundo caso describimos la existencia de un área de fibrosis yuxtafoveal que refleja la posible aparición de membranas neovasculares coroideas en pacientes con esta forma de distrofia macular.Discusión: La distrofia macular anular benigna es una patología bilateral con características oftalmoscópicas y angiográficas bien definidas y que habitualmente conlleva un pronóstico visual favorable. Excepcionalmente puede asociarse la aparición de neovascularización coroidea que comprometa de forma importante la agudeza visual

Clinical cases: Two cases of benign concentric macular dystrophy are described. In one case, ophthalmologic examination, fluorescein angiogram and visual field measurement were performed. The presence of a juxtafoveal fibrosis in the other patient, indicate that choroidal neovascularization may be associated with this type of macular dystrophy.Discussion: Benign concentric macular dystrophy is an entity with well-defined ophthalmoscopic and angiographic characteristics. Usually the prognosis is good. Rarely, choroidal neovascularization can be associated with this macular dystrophy

[Adult-onset foveomacular vitelliform dystrophy]. / Distrofia foveomacular viteliforme del adulto.

CLINIC CASES: Four cases of adult-onset foveomacular vitelliform dystrophy are shown. In two cases we were able to complete the exploration under optical coherence tomography. One of the patients developed spontaneous disappearance of the subfoveal deposit in her right eye along with an important decrease in her visual acuity. DISCUSSION: Adult-onset foveomacular vitelliform dystrophy is characterized by yellowish round-shaped bilateral, lesions in the subfoveal area. Optical coherence tomography reveal the presence of a slightly elevated lesion wich affects the retinal pigment epithelium and the external layers of neurosensory retina.

[Transpupillary thermotherapy in occult subretinal neovascularization in age-related macular degeneration. Preliminary results]. / Termoterapia transpupilar en neovascularización subretiniana oculta secundaria a degeneración macular asociada a la edad. Primeros resultados.

PURPOSE: To determine the efficacy of transpupillary thermotherapy (TTT) to treat choroidal neovascularization (CNV) in patients with age-related macular degeneration (ARMD). PATIENTS AND METHODS: Eight patients (ten eyes) with occult CNV were treated by TTT. A 810 nm diode laser was used to perform TTT. The diode laser was delivered through a panfunduscopic contact lens. RESULTS: Three eyes showed a visual acuity improvement and a decrease in exudation on fluorescein angiography. Four eyes remained stable. Nevertheless, lesions worsened after treatment in three cases. One of these cases suffered an overtreatment. CONCLUSIONS: TTT may be a useful therapy in some cases of CNV in patients with age-related macular degeneration. Randomized and multicentric studies are necessary to stablish precise indications of this therapy.