Alteraciones iridianas tras Queratoplastia endotelial automatizada con stripping de la Descemet / Iris alterations after DSAEK

OBJETIVO: Valoración de una serie de ojos que experimentaron cambios iridianos tras realización deDescemet Stripping and Automated Endothelial Keratoplasty (DSAEK). MÉTODOS: Estudio retrospectivo de una serie de ojos que desarrollaron alteraciones iridianas consistentes en ovalización pupilar, atrofia del iris, sinequias iridocorneales, pupila midriática y alteraciones pigmentarias tras realización de DSAEK en un hospital terciario. RESULTADOS: En la serie de los 32 primeros procedimientos de DSAEK realizados en un centro terciario, se objetivaron alteraciones iridianas de novo, únicas o combinadas en 12 ojos (37,5%). En 7 casos se observaron adherencias iridocorneales, corectopias en 9 ojos, 3 casos de atrofias de iris y un caso de pupila midriática arrefléxica. En los 12 ojos se observó dispersión de pigmento al nivel del lentículo periférico a largo plazo. Las alteraciones ocurrieron pasados los 3 meses desde la cirugía. En la evaluación de los factores implicados el glaucoma maligno había acontecido en un caso, 2 ojos requirieron reintervención quirúrgica, en uno mediante re-DSAEK, y en otro mediante explante de lente intraocular. Otros 2 casos presentaban cámaras anteriores más estrechas. No se encontró relación entre el espesor del lentículo de DSAEK en la periferia y la existencia de sinequias. CONCLUSIÓN: Las alteraciones iridianas en relación con DSAEK son posibles. Se pretende discutir la relación del aumento de la tensión ocular intraoperatoria en relación con el aire intracamerular y su relación con la isquemia y alteraciones secundarias del iris

OBJECTIVE: To evaluate a series of case that developed iris changes after performing Descemet's stripping automated endothelial keratoplasty (DSAEK). METHODS: Retrospective study of eyes that developed iris abnormalities, such as pupil ovalisation, iris atrophy, iridocorneal synechiae, mydriatic pupil, and pigmentary changes after performing DSAEK in a tertiary hospital. RESULTS: In a series of the first 32 DSAEK procedures performed, new single or mixed iris alterations were observed in 12 eyes (37.5%). Iris-corneal synechiae were observed in 7 eyes, corectopias in 9 eyes, iris atrophy in 3 cases, and one case developed an areflexic mydriatic pupil. Long-term pigment dispersion at the edge of the lenticule was observed in 12 eyes. The alterations occurred after three months from the surgery. In the evaluation of the associated factors, malignant glaucoma had occurred in 1 case, 2 eyes had required a second surgery, one case by re-DSAEK, and the other one by removing the intraocular lens due to lens opacification. Two cases had a shallow anterior chamber. No relationship was found between the thickness of the peripheral lenticule and the presence of synechiae. CONCLUSION: Iris changes regarding DSAEK are possible. A discussion is presented on the relationship between increased intraocular pressure due to air in anterior chamber and its relationship with ischaemia and secondary alterations in the iris

Iris alterations after DSAEK. / Alteraciones iridianas tras Queratoplastia endotelial automatizada con stripping de la Descemet.

OBJECTIVE: To evaluate a series of case that developed iris changes after performing Descemet's stripping automated endothelial keratoplasty (DSAEK). METHODS: Retrospective study of eyes that developed iris abnormalities, such as pupil ovalisation, iris atrophy, iridocorneal synechiae, mydriatic pupil, and pigmentary changes after performing DSAEK in a tertiary hospital. RESULTS: In a series of the first 32 DSAEK procedures performed, new single or mixed iris alterations were observed in 12 eyes (37.5%). Iris-corneal synechiae were observed in 7 eyes, corectopias in 9 eyes, iris atrophy in 3 cases, and one case developed an areflexic mydriatic pupil. Long-term pigment dispersion at the edge of the lenticule was observed in 12 eyes. The alterations occurred after three months from the surgery. In the evaluation of the associated factors, malignant glaucoma had occurred in 1 case, 2 eyes had required a second surgery, one case by re-DSAEK, and the other one by removing the intraocular lens due to lens opacification. Two cases had a shallow anterior chamber. No relationship was found between the thickness of the peripheral lenticule and the presence of synechiae. CONCLUSION: Iris changes regarding DSAEK are possible. A discussion is presented on the relationship between increased intraocular pressure due to air in anterior chamber and its relationship with ischaemia and secondary alterations in the iris.

[Post-traumatic striate melanokeratosis in a Caucasian woman]. / Melanoqueratosis estriada postraumática en mujer de raza blanca.

CLINICAL CASE: A fair-skinned woman presented marked striate melanokeratosis in her left eye related to recurrent corneal erosion. The source of pigmentation was a conjunctival melanosis. The conjunctival melanosis responded to treatment with topical mitomycin, while the corneal pigmentation persisted. DISCUSSION: Striate melanokeratosis is a condition described in dark-skinned patients who show a well-defined pigmentation of the limbal area, with only one case of striate melanokeratosis reported previously in a Caucasian person. The stimuli for this proliferation are corneal lesions or melanosis close to the limbus. Avoiding both stimuli are the main steps in its management.

Melanoqueratosis estriada postraumática en mujer de raza blanca / Post-traumatic striate melanokeratosis in a caucasian woman

Caso clínico: Se presenta el caso de una mujer deraza blanca y piel clara, con erosión corneal recurrentey con melanosis conjuntival en OI, que desarrollóuna opacidad corneal por melanoqueratosis estriada.La melanosis conjuntival se trató con mitomicinatópica, manteniendo la pigmentación corneal.Discusión: La melanoqueratosis estriada se presentaen personas de piel oscura, con un único casodescrito en personas de raza caucásica. Ésta se originapor daño corneal o por migración de pigmentodesde melanosis conjuntivales, debiendo tratarambas condiciones para detener la pigmentación corneal(AU)

Clinical case: A fair-skinned woman presented markedstriate melanokeratosis in her left eye related torecurrent corneal erosion. The source of pigmentationwas a conjunctival melanosis. The conjunctivalmelanosis responded to treatment with topicalmitomycin, while the corneal pigmentation persisted.Discussion: Striate melanokeratosis is a conditiondescribed in dark-skinned patients who show awell-defined pigmentation of the limbal area, withonly one case of striate melanokeratosis reportedpreviously in a Caucasian person. The stimuli forthis proliferation are corneal lesions or melanosisclose to the limbus. Avoiding both stimuli are themain steps in its management(AU)

[Topical cyclosporine in the treatment of ocular actinic prurigo]. / Ciclosporina tópica como tratamiento del prúrigo actínico ocular.

CASE REPORT: A 14-year-old girl from Peru suffered severe limbitis and conjunctivitis. She also presented with clinical skin features diagnosed as actinic prurigo (AP). Her symptoms were successfully controlled with sustained topical therapy of 2% Cyclosporine A. DISCUSSION: AP is an idiopathic photodermatosis that affects mainly the hispanic population of Latin America. There are ocular signs of severe limbitis and conjunctivitis (like atopic keratoconjunctivitis) in 45% of cases. Literature on the subject is very limited and currently topical cyclosporine seems to be the best therapy available.

Ciclosporina tópica como tratamiento del prúrigo actínico ocular / Topical cyclosporine in the treatment of ocular actinic prurigo

Caso clínico: Presentamos el caso de una mujer de 14 años latinoamericana, con una limbo-conjuntivitis severa. Habia sido diagnosticada de prúrigo actínico (PA) por el dermatólogo. Con el diagnóstico de PA ocular se inició tratamiento con colirio de ciclosporina A 2% con buena respuesta. Discusión: El PA es una fotodermatosis idiopática que afecta principalmente a la población mestiza de Latino América. Los ojos se ven afectados en el 45% de los casos, como una limbo-conjuntivitis severa semejante a la atópica. A pesar de la escasa bibliografía existente, la ciclosporina tópica representa la mejor alternativa en el tratamiento del PA ocular

Case report: A 14-year-old girl from Peru suffered severe limbitis and conjunctivitis. She also presented with clinical skin features diagnosed as actinic prurigo (AP). Her symptoms were successfully controlled with sustained topical therapy of 2% Cyclosporine A. Discussion: AP is an idiopathic photodermatosis that affects mainly the hispanic population of Latin America. There are ocular signs of severe limbitis and conjunctivitis (like atopic keratoconjunctivitis) in 45% of cases. Literature on the subject is very limited and currently topical cyclosporine seems to be the best therapy available

[Severe bilateral ocular affection caused by vitamin A deficiency]. / Afectación ocular severa bilateral por déficit de vitamina A.

CASE REPORT: We report a patient with alcohol-induced chronic pancreatitis, with associated caloric-protein malnutrition and lipid soluble vitamin deficiencies, along with peripheral ulcerative keratitis in the right eye and necrotizing stromal ulceration with hyphema in the left eye. DISCUSSION: Although uncommon in developed countries, Vitamin A deficiency must be considered when there is a bilateral corneal affection in alcoholic patients or in patients with gastrointestinal, pancreatic or biliary pathology.

Afectación ocular severa bilateral por déficit de vitamina A / Severe bilateral ocular affection caused by vitamin A deficiency

Caso clínico: Se presenta un paciente con pancreatitis crónica alcohólica con una queratitis ulcerativa periférica (QUP) en el ojo derecho (OD) y una úlcera estromal necrotizante e hifema en el ojo izquierdo (OI) asociadas a una malnutrición calórico-proteica con déficit de vitaminas liposolubles.Discusión: Aunque es raro en los países desarrollados, debe considerarse el déficit de vitamina A ante afectación corneal bilateral en pacientes alcohólicos, con patología gastrointestinal, pancreática o de la vía biliar

Case report: We report a patient with alcohol-induced chronic pancreatitis, with associated caloric-protein malnutrition and lipid soluble vitamin deficiencies, along with peripheral ulcerative keratitis in the right eye and necrotizing stromal ulceration with hyphema in the left eye. Discussion: Although uncommon in developed countries, Vitamin A deficiency must be considered when there is a bilateral corneal affection in alcoholic patients or in patients with gastrointestinal, pancreatic or biliary pathology

[Preseptal and orbital cellulitis in childhood: response to intravenous antibiotics]. / Celulitis preseptal y orbitaria en la infancia: respuesta a antibioterapia intravenosa.

PURPOSE: To evaluate retrospectively the response of preseptal and orbital cellulitis in children to empiric antibiotic treatment. METHOD: We included nine patients (five male and four female) admitted to our hospital between October 2002 and October 2003 because of preseptal or orbital cellulitis. RESULTS: Four patients (44.4%) responded to empiric antibiotic treatment (R); five (55.5%) did not respond (NR) and required a second antibiotic to resolve the infection. The presence of an upper respiratory infection was the most common associated disease in both groups, R and NR. However we also found two cases of acute dacryocystitis in the NR. Four patients (44.4%) were treated with cefotaxime intravenously with the infection resolving in three of these. Five patients (55.6%) were treated with cefuroxime intravenously as first empiric option, however only one patient responded. CONCLUSIONS: We found a high prevalence of acute dacryocystitis as a potential cause of the cellulitis. Children with preseptal and orbital cellulitis responded better to cefotaxime than to cefuroxime. The presence of acute dacryocystitis was associated with a lack of response to cefuroxime.

Celulitis preseptal y orbitaria en la infancia: respuesta a antibioterapia intravenosa / Preseptal and orbital cellulitis in childhood: response to intravenous antibiotics

Objetivo: Evaluar retrospectivamente la respuesta al tratamiento antibiótico empírico de las celulitis preseptales y orbitarias en niños.Método: Se incluyeron nueve pacientes (cinco hombres y cuatro mujeres) ingresados en nuestro hospital por celulitis preseptal u orbitaria desde octubre-02 a octubre-03.Resultados: Cuatro pacientes (44,4%) respondieron al tratamiento antibiótico empírico (R), y cinco (55,5%) no respondieron (NR) y necesitaron la asociación de un segundo antibiótico para resolver la infección.La presencia de infección respiratoria aguda de vías altas (IRA), fue la enfermedad más comunmente asociada en ambos grupos (R y NR). Sin embargo encontramos dos casos de dacriocistitis aguda en el grupo NR. Cuatro pacientes (44,4%) fueron tratados con cefotaxima iv, y cinco (55,5%) con cefuroxima iv como primera opción empírica. Conseguimos resolución de la infección en tres de cuatro pacientes tratados con cefotaxima. Sin embargo sólo un paciente de los cinco tratados con cefuroxima respondió.Conclusiones: Se ha encontrado una alta prevalencia de dacriocistitis aguda como causa potencial de la celulitis. Los niños con celulitis preseptal y orbitaria respondieron mejor a cefotaxima que a cefuroxima. La presencia de dacriocistitis aguda se asoció a falta de respuesta a la cefuroxima (AU)

Purpose: To evaluate retrospectively the response of preseptal and orbital cellulitis in children to empiric antibiotic treatment. Method: We included nine patients (five male and four female) admitted to our hospital between October 2002 and October 2003 because of preseptal or orbital cellulitis. Results: Four patients (44.4%) responded to empiric antibiotic treatment (R); five (55.5%) did not respond (NR) and required a second antibiotic to resolve the infection. The presence of an upper respiratory infection was the most common associated disease in both groups, R and NR. However we also found two cases of acute dacryocystitis in the NR. Four patients (44.4%) were treated with cefotaxime intravenously with the infection resolving in three of these. Five patients (55.6%) were treated with cefuroxime intravenously as first empiric option, however only one patient responded. Conclusions: We found a high prevalence of acute dacryocystitis as a potential cause of the cellulitis. Children with preseptal and orbital cellulitis responded better to cefotaxime than to cefuroxime. The presence of acute dacryocystitis was associated with a lack of response to cefuroxime (AU)

[Bilateral carotid occlusion in young woman. Clinical and hemodynamic ocular results]. / Oclusión carotídea en mujer joven. Consecuencias oculares clínicas y hemodinámicas.

CASE REPORT: We report the case of a 44-year-old woman, with a history of cigarette smoking (60 per day) and hyperthyroidism. She presented a bilateral ocular ischemic syndrome, and a bilateral occlusive carotid artery disease which showed reverse ophthalmic artery flow that resulted in a steal phenomenon, characterized by a shunt to the low resistance intracranial circuits and reduction of blood flow to the eyes. DISCUSSION: Young patients with severe bilateral occlusive carotid artery disease may be at greater risk of developing ocular ischemic syndrome, while this reverse flow decreases the patient's risk of stroke and death.

Oclusión carotídea en mujer joven. Consecuencias oculares clínicas y hemodinámicas / Bilateral carotid occlusion in young woman. Clinical and hemodynamic ocular results

Caso clínico: Describimos el caso de una mujer de 44 años, fumadora de 60 cig./día y con antecedentes de hipertiroidismo. Presentó un síndrome de isquemia ocular en ambos ojos (AO) por oclusión de carótidas internas que originó un flujo retrógrado en ambas arterias oftálmicas, produciendo un fenómeno de robo caracterizado por un shunt a los circuitos intracraneales de baja resistencia y una reducción en el aporte sanguíneo a los ojos. Discusión: Los pacientes jóvenes con obstrucción carotídea bilateral severa tienen mayor riesgo de desarrollar un síndrome de isquemia ocular, mientras este flujo retrógrado parece reducir su riesgo de infarto cerebral o muerte (AU)

Case report: We report the case of a 44-year-old woman, with a history of cigarette smoking (60 per day) and hyperthyroidism. She presented a bilateral ocular ischemic syndrome, and a bilateral occlusive carotid artery disease which showed reverse ophthalmic artery flow that resulted in a steal phenomenon, characterized by a shunt to the low resistance intracranial circuits and reduction of blood flow to the eyes. Discussion: Young patients with severe bilateral occlusive carotid artery disease may be at greater risk of developing ocular ischemic syndrome, while this reverse flow decreases the patient’s risk of stroke and death (AU)

[Prevalence of latent toxoplasma infection in HIV infection patients]. / Prevalencia de infección latente frente a toxoplasma en pacientes con infección VIH.

BACKGROUND: To know the prevalence of Toxoplasma gondii latent infection in HIV-1 infected patients and to compare it with the prevalence in a group of parenteral drug users, non-infected by HIV. METHODS: We study 255 HIV-1 patients revised in our hospital in the last 6 years. The control group were 116 drug addicts non-infected by HIV followed in an educational program of deshabituation. We tested IgG anti-toxoplasma by enzymatic inmunoessay (MEIA). An IgG plasma value of 6UI/ML or more was an indicative of toxoplasma previous infection. We used Chi Square and Yatchts correction tests for the statistical analysis, settling down a significance point of 95%. RESULTS: We founded 36.7% positive IgG anti-toxoplasma in the group on HIV-1 infected patients, non drugs addicts, against 30.9% in the group of HIV-1 drug addicts patients. (OR 0.77; 0.35 < OR < 1.66). The control group showed a Toxoplasma seroprevalence of 26.7%, without statistically significant against the drug addicts HIV group (OR = 1.55; 0.93 < OREGON < 2.59). CONCLUSIONS: The seroprevalence of Toxoplasma gondii latent infection in our study was similar to the european results. We didn't found a higher prevalence in HIV-1 patients than in patients non infected by HIV-1.

[Pourfour du Petit syndrome]. / Síndrome de Pourfour du Petit.

The Pourfour du Petit's syndrome is characterized by the unilateral appearance of mydriasis, lid retraction and exophthalmos. It suggests the existence of a localized oculosympathetic hyperactivity. It tends be to caused by injuries that suppose a stimulus of the sympathetics fibers at level of the proximal portion of the first dorsal root or in the cervical sympathetic chain. We report the clinical case of a young patient who developed a Pourfour du Petit's syndrome secondary to a small condrosarcoma of the proximal portion of the first rib. The observation of this syndrome is exceptional but its knowledge permits, by the great topographic value that possesses, a rapid identification of the causative injury.