[Thyroid ophthalmopathy: clinical activity determination of thyroid ophthalmopathy as a prognostic factor of immunosuppressive treatment response]. / Oftalmopatía tiroidea: determinación de parámetros de actividad clínica de la oftalmopatía tiroidea como factor pronóstico de respuesta al tratamiento inmunosupresor.

OBJECTIVE: To determine the usefulness of the clinical, biochemical and thyroid imaging parameters in patients with thyroid-associated ophthalmopathy, in predicting their response to immunosuppressive treatment. METHODS: This retrospective study of 16 patients with thyroid ophthalmopathy considered a number of variables including sex, age, thyroid hormone levels, treatment of the thyroid dysfunction, clinical activity score (CAS), severity (NOSPECS) of the ophthalmopathy, signs in standardized A-mode ultrasonography, in CAT and/or NMR, and previously used treatments and their effectiveness. RESULTS: The average age of the patients was 50.81 (S.D: 11.89) years; there were 5 males (31.3%) and 11 females (68.8%). The ophthalmopathy was classified as active in 10/16 patients (62.5%) and inactive in 6/16 (37.5%); and as moderate in 9/16 (56.25%) and severe in 7/16 (43.75%) according to the severity defined in NOSPECS. Ultrasonography was diagnostic in 100% of the cases. The severity decreased significantly (p < or =0.05), however the clinical activity decrease did not reach significance (p=0.38) during immunosuppressive therapy. Better results were obtained during treatment of patients with a higher CAS (p=0.04) and in those with more severe ophthalmopathy (p=0.02). There was a tendency for the patients with higher levels of TSI to respond better to the treatment (p=0.06). CONCLUSIONS: The CAS is the best parameter to quantify the activity of the disease and predicting the response to treatment. The higher the CAS and the more severe the ophthalmopathy, the better the response to treatment. No association existed between thyroid function and the activity or severity of the ophthalmopathy; or the effectiveness of treatment.

Oftalmopatía tiroidea: determinación de parámetros de actividad clínica de la oftalmopatía tiroidea como factor pronóstico de respuesta al tratamiento inmunosupresor / Thyroid ophthalmopathy: clinical activity determination of thyroid ophthalmopathy as a pronostic factor of immunosupressive treatment response

Objetivo: Determinar los parámetros clínicos, bioquímicos y de imagen que permitan conocer qué pacientes con oftalmopatía tiroidea van a responder al tratamiento y valorar su eficacia.Métodos: Estudio retrospectivo de datos apareados de 16 pacientes con oftalmopatía tiroidea. Se recogieron las variables: sexo, edad, tratamiento de la disfunción tiroidea, puntuación de actividad clínica (PAC) y de severidad (NOSPECS) de la oftalmopatía, niveles hormonales; signos ecográficos, en TAC y/o RMN; tratamientos empleados y eficacia de los mismos.Resultados: La edad media de la muestra fue de 50,81 (D.E.: 11,89) años; 5 varones (31,3%) y 11 mujeres (68,8%), con seguimiento medio de 6,4 meses. La oftalmopatía fue clasificada en activa en 10/16 pacientes (62,5% )e inactiva en 6/16 (37,5%); y en moderada 9/16 (56,25%) y leve 7/16 (43,75%) según criterios de severidad NOSPECS. La ecografía fue diagnóstica en el 100% de los casos.La severidad se redujo de modo significativo (p <= 0,05) mientras que la actividad clínica de forma no significativa (p=0,38). Se observó mejor respuesta al tratamiento en los pacientes con mayor PAC (p=0,04) y con oftalmopatía más severa (p=0,02). Existe tendencia a que los pacientes con mayores niveles de TSI respondan mejor al tratamiento (p=0,06).Conclusiones: La PAC es el mejor parámetro para cuantificar la actividad de la enfermedad y predecir la respuesta al tratamiento inmunosupresor.La PAC y la severidad de la oftalmopatía elevadas se asocian con mejor respuesta al tratamiento. No existe asociación de la función tiroidea con la actividad ni con la severidad de la oftalmopatía; la eficacia del tratamiento es independiente de la función tiroidea

Objective: To determine the usefulness of the clinical, biochemical and thyroid imaging parameters in patients with thyroid-associated ophthalmopathy, in predicting their response to immunosuppressive treatment. Methods: This retrospective study of 16 patients with thyroid ophthalmopathy considered a number of variables including sex, age, thyroid hormone levels, treatment of the thyroid dysfunction, clinical activity score (CAS), severity (NOSPECS) of the ophthalmopathy, signs in standardized A-mode ultrasonography, in CAT and/or NMR, and previously used treatments and their effectiveness. Results: The average age of the patients was 50.81 (S.D: 11.89) years; there were 5 males (31.3%) and 11 females (68.8%). The ophthalmopathy was classified as active in 10/16 patients (62.5%) and inactive in 6/16 (37.5%); and as moderate in 9/16 (56.25%) and severe in 7/16 (43.75%) according to the severity defined in NOSPECS. Ultrasonography was diagnostic in 100% of the cases. The severity decreased significantly (p <= 0.05), however the clinical activity decrease did not reach significance (p=0.38) during immunosuppressive therapy. Better results were obtained during treatment of patients with a higher CAS (p=0.04) and in those with more severe ophthalmopathy (p=0.02). There was a tendency for the patients with higher levels of TSI to respond better to the treatment (p=0.06). Conclusions: The CAS is the best parameter to quantify the activity of the disease and predicting the response to treatment. The higher the CAS and the more severe the ophthalmopathy, the better the response to treatment. No association existed between thyroid function and the activity or severity of the ophthalmopathy; or the effectiveness of treatment

[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

Tumores vasoproliferativos del fondo de ojo / Vasoproliferative tumors of the ocular fundus

Objetivo: Establecer el diagnóstico diferencial con el melanoma de coroides y otros tumores malignos. Métodos: Presentamos una revisión de 5 tumores vasoproliferativos vistos en nuestro Servicio desde 1993; el diagnóstico fue clínico, y se realizó fundamentalmente mediante oftalmoscopia y ecografía oftálmica. Resultados: En 3 de los 5 casos (vistos antes de 1995) se optó por realizar tratamiento mediante braquiterapia con hilos de Iridio192 ante la sospecha de que se tratara de un melanoma de coroides; en los otros 2 casos se procedió a la observación periódica y tratamiento de la patología asociada y complicaciones que determinan en último extremo la agudeza visual final. Conclusiones: Es importante establecer el diagnóstico diferencial con el melanoma de coroides y otros tumores malignos, ya que su tratamiento y pronóstico son diferentes (AU)

No disponible

[Vasoproliferative tumors of the ocular fundus]. / Tumores vasoproliferativos del fondo de ojo.

PURPOSE: To establish the differential diagnosis from choroidal melanoma and other malignant tumors. METHODS: We report 5 patients with vasoproliferative tumors studied in our Hospital since 1993; diagnosis was mainly based on clinic appearance of the lesions. Each patient had undergone indirect ophthalmoscopy and ocular echography. RESULTS: Three upon five cases (studied before 1995) were treated with brachytherapy with Ir(192) because they were suspected to be choroidal melanomas. Periodical observation and treatment of associated complications was the treatment of choice in two other cases in which these complications determined the final visual acuity. CONCLUSION: It is important to establish the differential diagnosis between choroidal melanoma and other malignant tumors, as their prognosis and treatment are different.