Oncocitoma de la carúncula: caso clínico / Oncocytoma of the caruncle: a case report

Caso clínico: Se presenta el caso de una mujer de 79 años con una pequeña lesión en el canto interno de su ojo derecho desde hacía 6 meses. Se procedió a la extirpación quirúrgica y análisis histológico de la lesión, con el diagnóstico de oncocitoma de carúncula. Discusión: Los oncocitomas oculares son neoplasias benignas raras que se localizan en la carúncula, conjuntiva, glándula lagrimal y saco lagrimal. Están compuestos de células que derivan de los epitelios glandulares. Aunque es infrecuente, este tumor debería conocerse, especialmente en personas mayores, ya que excepcionalmente puede progresar a adenocarcinoma (AU)

Case report: We describe a 79 year-old woman who had a small lesion on the inner corner of her right eye for the last 6 months. The lesion was surgically excised and histologically analysed, with a diagnosis of oncocytoma of the caruncle. Discussion: Ocular oncocytomas are rare benign neoplasms found in the caruncle, conjunctiva, lacrimal gland and lacrimal sac. They are composed of transformed epithelial cells of the ducts. Although rare, this tumour should be recognized especially in the elderly because of the exceptional development of adenocarcinoma (AU)

[Oncocytoma of the caruncle: a case report]. / Oncocitoma de la carúncula: caso clínico.

CASE REPORT: We describe a 79 year-old woman who had a small lesion on the inner corner of her right eye for the last 6 months. The lesion was surgically excised and histologically analysed, with a diagnosis of oncocytoma of the caruncle. DISCUSSION: Ocular oncocytomas are rare benign neoplasms found in the caruncle, conjunctiva, lacrimal gland and lacrimal sac. They are composed of transformed epithelial cells of the ducts. Although rare, this tumour should be recognized especially in the elderly because of the exceptional development of adenocarcinoma.

[Idiopathic polypoidal choroidal vasculopathy]. / Vasculopatía coroidea polipoidal idiopática.

PURPOSE: To evaluate the incidence, clinical features and evolution of polypoidal choroidal vasculopathy (PCV) in our population. METHODS: Retrospective study of patients diagnosed with exudative and/or hemorrhagic maculopathy including age-related macular degeneration in the last two years and who have undergone a complete ophthalmologic exploration and videoangiography with fluorescein and indocyanine green. RESULTS: 250 patients were included in the study, 8 patients (3.2%) had clinical and angiographic criteria of PCV. The mean age was 68 years-old, 62.5% were men and 85.7% were caucasian. Ninety percent of cases presented clinically as a predominantly hemorrhagic macular detachment. The initial clinical diagnosis before indocyanine green angiography was exudative age-related macular degeneration in 90% of cases. The mean visual acuity was 0.2 at baseline and after follow-up. Laser treatment was performed in 4 eyes, achieving good anatomic and visual acuity results in 2 of them; both eyes of one patient were treated by photodynamic therapy with poor angiographic and functional outcome. CONCLUSIONS: Polypoidal choroidal vasculopathy is a clinical entity which is relatively frequent among patients previously diagnosed with exudative maculopathy. Indocyanine green angiography increases the number of correct diagnoses. Treatment must be individualized depending on the location of the lesions and the severity of the disease.

[Serpiginous choroiditis: clinical course and treatment]. / Coroiditis serpiginosa: evolución clínica y tratamiento.

PURPOSE: To evaluate the clinical evolution and treatment of serpiginous choroiditis in 11 diagnosed patients. METHODS: Retrospective study of 11 cases diagnosed with serpiginous choroiditis in our area, from 1980 to the present. We analyzed age at onset of symptoms, systemic diseases, ophthalmological symptoms at presentation, the location of lesions, initial and final visual acuity, recurrences, treatment régime and development of subretinal neovascularization. A complete ophthalmological examination and fluorescein angiograms were performed in all of them. RESULTS: The mean period of follow-up was 4 years. Average age was 56 years, predominantly in men (10/1). Five patients had known ischemic cardiopathy and systemic hypertension, one patient underwent a kidney transplant. All of them were treated with oral prednisone (1-1.5 mg/kg/daily) in the active stages. Three patients received triple therapy (prednisone, cyclosporine and azathioprine) that did not prevent the recurrences. Five patients developed a subretinal neovascularization, bilateral in three of them. CONCLUSIONS: The serpiginous choroiditis is a rare entity and the visual outcome prognosis is determined by the macular involvement. Men are predominantly affected in our series and corticosteroid treatment is effective in acute inflammatory episodes. Recurrences could not be prevented by triple therapy with immunosuppressive agents in our three patients.

[Photodynamic therapy for choroidal neovascularization not caused by age related macular degeneration or pathologic myopia]. / Terapia fotodinámica en membrana neovascular subretiniana no relacionada con degeneración macular asociada a la edad o miopía patológica.

PURPOSE: To assess the effects of photodynamic therapy (PDT) with verteporfin on visual acuity (VA) and fluorescein angiography, in patients with subfoveal choroidal neovascularization (CNV) not secondary to age related macular degeneration (AMD) or pathologic myopia. METHODS: 113 eyes from 104 patients underwent PDT due to subfoveal CNV from July 2001 to June 2002. In this study only those patients with CNV not related to AMD or pathologic myopia were included. Fluorescein angiography and visual acuity were evaluated. RESULTS: 9 eyes from 8 patients (8.03%) showed distinct causes of CNV: 3 were idiopathic cases, 1 suffered angioid streaks, 1 was secondary to laser photocoagulation due to diabetic retinopathy, 2 had polypoidal choroidal vasculopathy and 2 central serous choroiditis. Regarding VA results, 77.7% improved or mantained the previous VA. Angiography resolution was observed in 55.5% of the cases (80% with just one PDT session). Average follow up was 10.5 months. Systemic or local complications were not observed. CONCLUSION: PDT may be useful in the treatment of different types of CNV due to causes other than AMD or high myopia.

Terapia fotodinámica en membrana neovascular subretiniana no relacionada con degeneración macular asociada a la edad o miopía patológica / Photodynamic therapy for choroidal neovascularization not caused by age related macular degeneration or pathologic myopia

Objetivo: Valorar los efectos de la terapia fotodinámica (TFD) en la agudeza visual (AV) y la angiografía en pacientes con neovascularización subretiniana (NVSR) foveal no debida ni a degeneración macular asociada a la edad (DMAE) ni a miopía patológica. Material y Métodos: Se evaluaron de un total de 104 pacientes (113 ojos) a los que se les realizó TFD por NVSR foveal, desde julio de 2001 a junio de 2002, aquellos cuya causa no era DMAE o miopía patológica. Se valoró la evolución angiográfica y de la agudeza visual (AV). Resultados: 9 ojos de 8 pacientes presentaban otras causas de NVSR (8,03 por ciento): 3 idiopáticas, 1 en estrías angioides, 1 secundaria a fotocoagulación láser en retinopatía diabética, 2 en vasculopatia coroidea polipoidal y 2 en coroiditis serosa central. El 77,7 por ciento presentó estabilización o mejoría en su AV y el 55,5 por ciento presentó resolución angiográfica, el 80 por ciento de ellos con una sola sesión de TFD. El tiempo de seguimiento medio fue de 10,5 meses. No se objetivaron complicaciones ni a nivel local ni sistémico. Conclusión: La TFD puede ser de utilidad en NVSR no debidas a DMAE o miopía patológica (AU)

Purpose: To assess the effects of photodynamic therapy (PDT) with verteporfin on visual acuity (VA) and fluorescein angiography, in patients with subfoveal choroidal neovascularization (CNV) not secondary to age related macular degeneration (AMD) or pathologic myopia. Methods: 113 eyes from 104 patients underwent PDT due to subfoveal CNV from July 2001 to June 2002. In this study only those patients with CNV not related to AMD or pathologic myopia were included. Fluorescein angiography and visual acuity were evaluated. Results: 9 eyes from 8 patients (8.03%) showed distinct causes of CNV: 3 were idiopathic cases, 1 suffered angioid streaks, 1 was secondary to laser photocoagulation due to diabetic retinopathy, 2 had polypoidal choroidal vasculopathy and 2 central serous choroiditis. Regarding VA results, 77.7% improved or mantained the previous VA. Angiography resolution was observed in 55.5% of the cases (80% with just one PDT session). Average follow up was 10.5 months. Systemic or local complications were not observed. Conclusion: PDT may be useful in the treatment of different types of CNV due to causes other than AMD or high myopia (AU)

Mutación C677TT de la metilentetrahidrofolato reductasa, homocisteína y trombofilia / C677TT mutation in methylentetrahydrofolate reductasa, homocystein and thrombofilia

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[Cup-to-disk ratio asymmetry: diagnostic value in glaucoma]. / Asimetría papilar: valor diagnóstico en el glaucoma.

PURPOSE: To assess visual field abnormalities in suspected glaucoma patients showing evident asymmetry in cup-to-disk ratio. MATERIAL AND METHOD: Twenty two hypertensive eyes in 11 subjects evidencing lateral differences in cup-to-disk ratio of more than 2/10 were included in the study. Conventional and short wavelength automated perimetry (SWAP) was performed with a Humphrey field analyser. A retinal nerve fiber layer (RNFL) study was also performed. RESULTS: Differences in IOP were 1.23 mmHg (p<0.05). No differences were evidenced in conventional automated perimetry between both eyes. Average sensitivity (SWAP) showed significantly lower (p<0.05) in those ayes with greater cup-to-disk ratio. RNFL showed a higher rate of defects in eyes with a higher cup-to-disk ratio. CONCLUSION: Lateral differences in cup-to-disk ratio indicate structural glaucomatous damage which is related to IOP levels. Associated functional loss was evidenced with SWAP (Arch Soc Esp Oftalmol 2002; 77: 17-22).

[Ocular cyanoacrylate injury]. / Agresión con cianocrilato.

UNLABELLED: PURPOSE/MATERIAL AND METHOD: Cyanoacrylate tissue adhesive is indicated when a small corneal perforation is present. We report the case of a 23 year-old man who was attacked being thrown cyanoacrylate to both of his eyes. RESULTS/CONCLUSION: Wound healing has been laborious, however performed with low morbidity. This case is reported for being a bilateral injury and after finding no precedented cases in the literature.

Asimetría papilar: valor diagnóstico en el glaucoma / Cup-to-disk ratio asymmetry: diagnostic value in glaucoma

Objetivo: Evaluar los posibles cambios en la función visual presentes en pacientes sospechosos de glaucoma con marcadas asimetrías papilares. Material y método: Se han estudiado 22 ojos de 11 sujetos sospechosos de glaucoma (cifras de presión ocular mayores de 21 mmHg) que presentaban una asimetría papilar entre ambos ojos. Mediante un analizador de campo Humphrey se realizó un estudio de perimetría automatizada convencional y de perimetría automatizada de longitud de onda corta (PALOC).Resultados: La diferencia de PIOmedia entre los ojos con mayor excavación y los ojos con menor excavación papilar fue de 0,82 dB, existiendo diferencias estadísticamente significativas (p<0,05). No se han encontrado diferencias en los umbrales de sensibilidad, entre los grupos estudiados, en la perimetría automatizada convencional. Sin embargo el umbral de sensibilidad media fue significativamente (p<0,05) menor en los ojos con mayor excavación papilar en la PALOC. Conclusiones: La presencia de una asimetría papilar constituye un signo de daño glaucomatoso estructural relacionado con los valores de presión intraocular, y acompañado de cambios funcionales evidenciados a través de la PALOC (AU)

Agresión con cianocrilato / Ocular cyanoacrylate injury

Objetivo/Método: El cianocrilato se utiliza en oftalmología para el tratamiento de pequeñas perforaciones corneales. Presentamos el caso de un varón de 23 años que fue agredido con el lanzamiento sobre ambos ojos de un pegamento cuyo componente fundamental es el cianocrilato. Resultados/Conclusiones: A pesar de la aparatosidad de la situación y la laboriosidad de la extracción de las placas, la morbilidad fue baja. Sin embargo, ya que las referencias bibliográficas en oftalmología sólo se refieren a las instilaciones accidentales y a la rareza de bilateralidad del caso, aportamos este caso clínico junto con una revisión de la bibliografía (AU)