Alteraciones retinocoroideas y cáncer pulmonar: primer reporte en población mexicana / Retinochoroidal findings and lung cancer: first report in mexican population

Introducción: El cáncer pulmonar (CP) es el tumor con mayor frecuencia y mortalidad a nivel mundial. Casos de metástasis coroideas y retinopatía asociada a cáncer han sido publicados en CP, sin embargo no existen estudios en población mexicana que describan las posibles alteraciones retinocoroideas y su relación con el estadio de CP. Objetivo: Evaluar a pacientes con CP para determinar la presencia de alteraciones en el segmento posterior y su relación con el estadio del mismo. Materiales y métodos: Estudio transversal y descriptivo de 50 pacientes (100 ojos) con CP. Datos demográficos: edad, sexo, tipo histológico, tiempo de evolución, estadio, tratamiento y comorbilidades. Variables de medición: agudeza visual (LogMAR), biomicroscopía del segmento anterior, registro fotográfico de retina, fluorangiografía retiniana, tomografía de coherencia óptica y electrorretinograma. Cada paciente fue evaluado por dos oftalmólogos. Resultados: Un total de 26 hombres y 24 mujeres fueron evaluados, el promedio de edad fue de 65 años, el tiempo medio del diagnóstico de CP fue de 6 meses siendo el adenocarcinoma el principal tipo histológico (70%), al momento de la evaluación 50% presentaban estadio II y 30% estadio IV. Las alteraciones del segmento posterior encontradas fueron: metástasis coroideas (16%), metástasis retinianas (10%), retinopatía asociada a cáncer (6%) y oclusiones vasculares (4%). La mayoría de los pacientes con alteraciones retinocoroideas se encontraban en estadio IV. Conclusiones: En el CP pueden encontrarse oclusiones vasculares, retinopatía asociada a cáncer y metástasis a coroides y retina con una incidencia mayor a la publicada en la literatura, siendo más frecuentes en estadios avanzados de la enfermedad aunque pueden encontrarse desde el estadio II en pacientes asintomáticos

Introduction: Lung cancer (LC) is the most common tumour, and the leading cause of cancer-related death worldwide. Although cases of choroidal metastasis and cancer-associated retinopathy have been reported in LC, no studies have been conducted on the Mexican population to describe retinochoroidal findings during the course of LC, and the relationship with its stage. Objective: To evaluate patients with a diagnosis of LC, and to describe the posterior segment findings in relationship to the stage of LC. Materials and methods: A cross-sectional and descriptive study was conducted on 50 patients with LC (100 eyes). The demographic data included age, gender, histological type, evolution time, stage, treatment, and comorbidities. The measurement variables included visual acuity (LogMAR), anterior segment biomicroscopy, retinal photography, fluorescein retinal angiography, optical coherence tomography, and electroretinogram. All patients were evaluated by two ophthalmologists. Results: The study included a total of 26 men and 24 women, with a mean age of 65 years, and a mean time from LC diagnosis of 6 months. The principal histological type was adenocarcinoma (70%), and most (50%) were in stage II at the time of evaluation, with 15 (30%) patients having a metastasis (stage IV). The changes in the posterior segment included choroidal metastasis (16%), retinal metastasis (10%), cancer-associated retinopathy (6%), and vascular occlusions (4%). The majority of patients who presented with posterior segment alterations were in stage IV. Conclusions: Vascular occlusions, cancer-associated retinopathy, choroidal and retinal metastases may be found in LC, with an incidence higher than that reported in the literature, especially in advanced stages of LC, although they can be found from stage II in asymptomatic patients

Oclusión mixta de arteria y vena central de la retina; primera manifestación de lupus en paciente pediátrico / Combined central retinal artery and vein occlusion; first manifestation of lupus in a pediatric patient

La oclusión combinada de arteria y vena central de la retina es poco común en adultos y aún más rara en pacientes jóvenes, siendo las vasculitis y los trastornos tromboembólicos las principales etiologías identificadas. La mayoría de los pacientes tiene un pronóstico sombrío debido al inevitable desarrollo de pérdida visual irreversible y glaucoma neovascular (GNV). Presentamos el caso de un paciente de 14 años de edad que acudió aquejando pérdida visual súbita e indolora en el ojo izquierdo. La mejor agudeza visual corregida fue de percepción de luz, mostrando una exploración oftalmológica y fluorangiográfica característica de oclusión mixta de arteria y vena central de la retina del ojo izquierdo. Las alteraciones encontradas en la exploración física y en los estudios de laboratorio permitieron el diagnóstico de lupus eritematoso sistémico (LES) y síndrome antifosfolípidos. El paciente recibió tratamiento con esteroides y anticoagulante por vía oral, presentando hemorragia vítrea 7 días después debido a tiempos de coagulación prolongados. Para prevenir la aparición de GNV, se inició tratamiento con ranibizumab intravítreo y posteriormente se realizó vitrectomía y endofotocoagulación retiniana. De acuerdo con nuestro conocimiento, este es el primer caso de un paciente masculino pediátrico con LES y oclusión mixta publicado en la literatura, y a su vez el primer caso tratado con antiangiogénicos que no ha desarrollado GNV a 12 meses de seguimiento

Combined central retinal artery and vein occlusion is uncommon in adults and even more so in young people. The main origins are vasculitis and thromboembolic disorders. The prognosis is poor due to irreversible visual loss and the development of neovascular glaucoma (NVG). A 14 year-old male arrived at the clinic complaining of sudden and painless visual loss in the left eye. Best corrected visual acuity was light perception with clinical and fluoro-angiographic findings characteristic of combined central retinal artery and vein occlusion in his left eye. The findings in the systemic and laboratory studies led to a diagnosis of systemic lupus erythematosus (SLE) and antiphospholipid syndrome. The patient received treatment with steroids and oral anticoagulant. Seven days later, due to prolonged coagulation time, he presented with a vitreous haemorrhage. He was then treated with intravitreal ranibizumab in order to prevent NVG. Afterwards, vitrectomy and retinal endophotocoagulation were performed. To the best of our knowledge, this is the first presentation of a male, paediatric with SLE and combined occlusion to be published in the literature, and is also the first case treated with antiangiogenic agents that has not developed NVG at 12 months of follow-up

Retinochoroidal findings and lung cancer: first report in mexican population. / Alteraciones retinocoroideas y cáncer pulmonar: primer reporte en población mexicana.

INTRODUCTION: Lung cancer (LC) is the most common tumour, and the leading cause of cancer-related death worldwide. Although cases of choroidal metastasis and cancer-associated retinopathy have been reported in LC, no studies have been conducted on the Mexican population to describe retinochoroidal findings during the course of LC, and the relationship with its stage. OBJECTIVE: To evaluate patients with a diagnosis of LC, and to describe the posterior segment findings in relationship to the stage of LC. MATERIALS AND METHODS: A cross-sectional and descriptive study was conducted on 50 patients with LC (100 eyes). The demographic data included age, gender, histological type, evolution time, stage, treatment, and comorbidities. The measurement variables included visual acuity (LogMAR), anterior segment biomicroscopy, retinal photography, fluorescein retinal angiography, optical coherence tomography, and electroretinogram. All patients were evaluated by two ophthalmologists. RESULTS: The study included a total of 26 men and 24 women, with a mean age of 65 years, and a mean time from LC diagnosis of 6 months. The principal histological type was adenocarcinoma (70%), and most (50%) were in stage II at the time of evaluation, with 15 (30%) patients having a metastasis (stage IV). The changes in the posterior segment included choroidal metastasis (16%), retinal metastasis (10%), cancer-associated retinopathy (6%), and vascular occlusions (4%). The majority of patients who presented with posterior segment alterations were in stage IV. CONCLUSIONS: Vascular occlusions, cancer-associated retinopathy, choroidal and retinal metastases may be found in LC, with an incidence higher than that reported in the literature, especially in advanced stages of LC, although they can be found from stage II in asymptomatic patients.

Combined central retinal artery and vein occlusion; first manifestation of lupus in a pediatric patient. / Oclusión mixta de arteria y vena central de la retina; primera manifestación de lupus en paciente pediátrico.

Combined central retinal artery and vein occlusion is uncommon in adults and even more so in young people. The main origins are vasculitis and thromboembolic disorders. The prognosis is poor due to irreversible visual loss and the development of neovascular glaucoma (NVG). A 14 year-old male arrived at the clinic complaining of sudden and painless visual loss in the left eye. Best corrected visual acuity was light perception with clinical and fluoro-angiographic findings characteristic of combined central retinal artery and vein occlusion in his left eye. The findings in the systemic and laboratory studies led to a diagnosis of systemic lupus erythematosus (SLE) and antiphospholipid syndrome. The patient received treatment with steroids and oral anticoagulant. Seven days later, due to prolonged coagulation time, he presented with a vitreous haemorrhage. He was then treated with intravitreal ranibizumab in order to prevent NVG. Afterwards, vitrectomy and retinal endophotocoagulation were performed. To the best of our knowledge, this is the first presentation of a male, paediatric with SLE and combined occlusion to be published in the literature, and is also the first case treated with antiangiogenic agents that has not developed NVG at 12 months of follow-up.

Alteraciones oftalmológicas del segmento posterior en pacientes con cáncer testicular en población latino-mestiza del Hospital General de México / Ophthalmological changes of the posterior segment in patients with testicular cancer in a mixed-race population of the General Hospital of Mexico

INTRODUCCIÓN: En la actualidad la curación del tumor testicular es factible en más del 95% de los pacientes y en el 80% de los que tienen metástasis. Hasta hoy no existe ningún estudio o series de casos que describan las alteraciones oculares del segmento posterior asociadas a cáncer testicular. OBJETIVO: Evaluar a pacientes con diagnóstico de cáncer testicular para determinar la presencia de alteraciones en el segmento posterior y su relación con el estadio. MATERIAL Y MÉTODO:Estudio observacional, transversal y escriptivo de 21 pacientes masculinos (42 ojos) con diagnóstico de cáncer testicular. Se registró edad, tipo histológico, tiempo de evolución, estadio, tratamiento y comorbilidades, así como medición de la agudeza visual (LogMAR), biomicroscopia del segmento anterior, registro fotográfico de polo posterior y retina periférica. RESULTADOS: La edad promedio fue de 29 años (18-43 años), el 100% de los pacientes fueron tratados quirúrgicamente, el tipo histológico más frecuente fue el seminoma clásico (42,8%) seguido por el tumor germinal mixto (38%) el estadio II se presentó en el 42,8% al momento de la evaluación, el 23,8% presentaron metástasis a distancia. Las alteraciones del segmento posterior fueron: tortuosidad vascular (14,2%), retinopatía asociada a cáncer (9,5%), metástasis a coroides (9,5%), cambios pigmentarios del epitelio pigmentario de la retina (9,5%) y metástasis a retina (4,7%). CONCLUSIONES: Es posible encontrar cambios a nivel de epitelio pigmentario de la retina, tortuosidad vascular, retinopatía asociada al cáncer y metástasis a coroides y/o retina

INTRODUCTION: The curing of a testicular tumour is currently feasible in more than 95% of patients, and in 80% of those with metastases. Until now, there has been no study or series of cases that describe the ocular changes of the posterior segment associated with testicular cancer. OBJECTIVE: To evaluate patients with a diagnosis of testicular cancer in order to determine the presence of changes in the posterior segment and the relationship to the stage. MATERIAL AND METHOD: An observational, cross-sectional, and descriptive study was conducted on 21 male patients (42 eyes) with a diagnosis of testicular cancer. Age, histological type, time of evolution, stage, treatment, and comorbidities were recorded, as well as visual acuity measurement (LogMAR), biomicroscopy of the anterior segment, and photographic records of the posterior pole and peripheral retina. RESULTS: The mean age was 29 years (18-43 years). All (100%) of the patients were treated surgically. The most frequent histological type was classic seminoma (42.8%), followed by the mixed germinal tumour (38.0%). At the time of evaluation, 42.8% of patients had a stage II, and 23.8% had distant metastasis. The changes in the posterior segment were: vascular tortuosity (14.2%), retinopathy associated with cancer (9.5%), choroidal metastasis (9.5%), pigmentary changes of the retinal pigment epithelium (9.5%), and retinal metastasis (4.7%). CONCLUSIONS: It is possible to find changes at the level of retinal pigment epithelium, as well as vascular tortuosity, retinopathy associated with cancer, and choroidal and/or retina metastases

Ophthalmological changes of the posterior segment in patients with testicular cancer in a mixed-race population of the General Hospital of Mexico. / Alteraciones oftalmológicas del segmento posterior en pacientes con cáncer testicular en población latino-mestiza del Hospital General de México.

INTRODUCTION: The curing of a testicular tumour is currently feasible in more than 95% of patients, and in 80% of those with metastases. Until now, there has been no study or series of cases that describe the ocular changes of the posterior segment associated with testicular cancer. OBJECTIVE: To evaluate patients with a diagnosis of testicular cancer in order to determine the presence of changes in the posterior segment and the relationship to the stage. MATERIAL AND METHOD: An observational, cross-sectional, and descriptive study was conducted on 21 male patients (42 eyes) with a diagnosis of testicular cancer. Age, histological type, time of evolution, stage, treatment, and comorbidities were recorded, as well as visual acuity measurement (LogMAR), biomicroscopy of the anterior segment, and photographic records of the posterior pole and peripheral retina. RESULTS: The mean age was 29 years (18-43 years). All (100%) of the patients were treated surgically. The most frequent histological type was classic seminoma (42.8%), followed by the mixed germinal tumour (38.0%). At the time of evaluation, 42.8% of patients had a stage II, and 23.8% had distant metastasis. The changes in the posterior segment were: vascular tortuosity (14.2%), retinopathy associated with cancer (9.5%), choroidal metastasis (9.5%), pigmentary changes of the retinal pigment epithelium (9.5%), and retinal metastasis (4.7%). CONCLUSIONS: It is possible to find changes at the level of retinal pigment epithelium, as well as vascular tortuosity, retinopathy associated with cancer, and choroidal and/or retina metastases.

Toxicidad de memantina intravítrea en retina de conejos / Intravitreal memantine retinal toxicity in rabbits

OBJETIVO: Valorar histopatológicamente si existe toxicidad en la retina de conejos, posterior a la aplicación intravítrea de memantina. MÉTODOS: Se utilizaron 16 ojos de 16 conejos raza Nueva Zelanda de 3 kg, divididos en 4 grupos de 4 conejos cada uno. Al grupo A se le aplicó una dosis de 70 ng/ml de memantina intravítrea, al grupo B se le aplicó una dosis de 150 ng/ml de memantina intravítrea, al grupo C se le aplicó una dosis de 400 ng/ml de memantina intravítrea, y al grupo D se le aplicó 1 ml de solución salina balanceada. Se enucleó el ojo inyectado en la mitad de cada grupo a los 15 días, y el resto del grupo se enucleó a los 30 días posterior a la inyección. Posterior a la enucleación, cada ojo fue colocado en formaldehido al 10%. Se realizó análisis histopatológico a cada uno de los ojos enucleados. Los animales fueron tratados de acuerdo a los estatutos de la Association for Research on Vision and Ophthalmology (ARVO). RESULTADOS: Los grupos A, B y D no presentaron alteraciones histopatológicas tras 15 y 30 días de enucleación. El grupo C presentó alteración a nivel de la capa de fotorreceptores a los 15 y 30 días posterior a la enucleación. CONCLUSIONES: La memantina intravítrea a dosis de 70 mg/dl y 150 mg/dl no es tóxica a nivel estructural en la retina. La memantina a dosis de 400 mg/dl es tóxica a nivel estructural en la retina. La memantina podría ser considerada en el futuro para el tratamiento de distrofias de retina. Diversos estudios deberán ser realizados al respecto

OBJECTIVE: To histologically evaluate whether the intravitreal application of memantine produces retinal toxicity in rabbits. METHODS: A cross-sectional design, experimental, descriptive study was performed on 16 eyes of 16 New Zealand rabbits of 3 kg, divided in 4 groups of 4 rabbits. A dose of 70 ng/ml of intravitreal memantine was administered in Group A, a dose of 150 ng/ml in Group B, a dose of 400 ng/ml in Group C, and Group D received 1 ml of balanced salt solution. The injected eye of half of each group was enucleated 15 days after the injection, and the rest within 30 days after injection. Following enucleation, each eye was placed in 10% formaldehyde. Histopathological analysis was performed on all enucleated eyes. The animals were treated according to the guidelines of the Association for Research on Vision and Ophthalmology (ARVO). RESULTS: Groups A, B and D did not show any histopathological changes after their enucleation at 15 and 30 days. Group C showed changes in the photoreceptor layer after enucleation at 15 and 30 days. CONCLUSIONS: In our study, it was observed that memantine concentrations at 70 ng/ml and 150 ng/ml are safe when administered intravitreally; however, doses of 400 ng/ml produced retinal structural changes. This research should continue to assess its clinical usefulness

Intravitreal memantine retinal toxicity in rabbits.

OBJECTIVE: To histologically evaluate whether the intravitreal application of memantine produces retinal toxicity in rabbits. METHODS: A cross-sectional design, experimental, descriptive study was performed on 16 eyes of 16 New Zealand rabbits of 3 kg, divided in 4 groups of 4 rabbits. A dose of 70 ng/ml of intravitreal memantine was administered in Group A, a dose of 150 ng/ml in Group B, a dose of 400 ng/ml in Group C, and Group D received 1 ml of balanced salt solution. The injected eye of half of each group was enucleated 15 days after the injection, and the rest within 30 days after injection. Following enucleation, each eye was placed in 10% formaldehyde. Histopathological analysis was performed on all enucleated eyes. The animals were treated according to the guidelines of the Association for Research on Vision and Ophthalmology (ARVO). RESULTS: Groups A, B and D did not show any histopathological changes after their enucleation at 15 and 30 days. Group C showed changes in the photoreceptor layer after enucleation at 15 and 30 days. CONCLUSIONS: In our study, it was observed that memantine concentrations at 70 ng/ml and 150 ng/ml are safe when administered intravitreally; however, doses of 400 ng/ml produced retinal structural changes. This research should continue to assess its clinical usefulness.