Case report: A rare case of cyclodialysis after cataract surgery managed exclusively with medical therapy.

We present the case of a 68-year-old female who presented with a substantial cyclodialysis after phacoemulsification identified by anterior segment optical coherence tomography and ultrasound biomicroscopy. Gonioscopy is challenging because of its shallow anterior chamber. Due to lack of response to topical steroids and refusal by the patient for surgical treatment, topical steroids were tapered, and cycloplegic was initiated. After two weeks, the cyclodialysis cleft was closed on optical coherence tomography persisting residual subchoroidal fluid, topical treatment was mantained. Despite of this, visual acuity and hypotony were restored. Finally at 2 months visit subchoroidal fluid was reabsorbed and patient was discharged. Clinics should consider the possibility of cyclodialysis in cases of unjustified hypotony during postoperative period. In addition, we recommend performing anterior segment imaging which includes ultrasound biomicroscopy and optical coherence tomography, when the evaluation of angular structures is unfeasible. Finally, we propose medical management for severe cyclodialysis as the first option considering anti-inflammatory drugs could perpetrate the separation between scleral spur and ciliary muscle.

Evaluation of myopic cornea lenticules. A histochemical and clinical correlation.

In this work, we have analyzed the main clinical and corneal histological parameters that may be associated to the spherical equivalent (SE), age and gender of individuals with myopic refractive errors. For this purpose, 108 cornea stroma lenticules were obtained from patients subjected to ReLEx-SMILE myopia correction. Histological analyses were carried out and histochemistry and immunohistochemistry were used to quantify key histological components of the cornea stroma, including mature collagen fibers, reticular and elastic fibers, glycoproteins, proteoglycans, type-V collagen and several crystallins. Clinical and histological data were analyzed to determine their association with SE, age and gender. Results showed a significant correlation between the age range of the patients and the expression of crystallins CRY-α-A, CRY-λ1 and type-V collagen and between CRY-λ1 and corneal thickness, spherical diopters (D) and SE, although correlation between CRY-λ1 and SE was non-significant when age was controlled. Comparison of cases with low myopia and high/moderate myopia found statistical differences for D and lenticule thickness and diameter. The binary logistic regression analysis allowed us to construct a model using two clinical parameters (D and lenticule thickness). Parameters showing significant correlation with the age were the corneal radius, keratometry reading (K), OZ, CRY-α-A and type-V collagen, whereas SE, lenticule thickness, OZ, CRY-λ1 and type-V collagen showed statistically significant differences between the youngest and the oldest patients. A binary logistic regression analysis model was generated including 3 variables (D, cornea radius and OZ). No gender differences were found. The specific clinical and histological modifications found to be associated to the SE and age could be useful for a better understanding of the mechanisms involved in the genesis or progression of myopia and could establish the basement for future therapeutic options.

Meningoencefalitis herpética y sospecha de tuberculosis. ¿Coinfección, coincidencia o confusión? / Herpetic meningoencephalitis and suspected tuberculosis. Coinfection, coincidence or confusion?

La meningoencefalitis herpética y la meningitis tuberculosa constituyen dos enfermedades infecciosas graves del sistema nervioso central. En ambos casos, el pronóstico depende de la instauración precoz del tratamiento. Se presenta un caso clínico complejo en una niña de 4 años de edad, en el que la clínica y las pruebas complementarias no fueron suficientes para diferenciar ambas entidades. Sólo se obtuvo confirmación microbiológica de la presencia de virus herpes simple tipo 1 en el líquido cefalorraquídeo. No obstante, se decidió completar el tratamiento antituberculoso. El caso fue comentado a escala nacional con la Red Española de Estudio de la Tuberculosis Infantil (pTBred). No existió acuerdo unánime sobre la conveniencia o no de retirar la medicación antituberculosa (AU)

Herpetic meningoencephalitis and tuberculous meningitis are two severe infectious diseases affecting the central nervous system. In both cases, prognosis depends on early treatment. A four years old girl is presented as a complex clinical case. Symptoms and complementary tools were not enough to differentiate both infections. Only herpes simplex virus type 1 was confirmed in cerebrospinal fluid. However, to complete TB treatment was the final therapy decision. The case was nationally discussed with the Spanish Pediatric TB Research Network (pTBred). No unanimous agreement on whether or not to remove the TB medication was reached (AU)

¿Por qué no utilizamos amoxicilina-clavulánico por vía intravenosa en neonatos? / What about the use of intravenous amoxicillin-clavulanate in neonates?

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