[Severe and reversible optic neuropathy by ethambutol and isoniazid]. / Neuropatía óptica severa y reversible por etambutol e isoniazida.

Ethambutol and isoniazid are antimicrobial agents used to treat multi-drug-resistant tuberculosis. The most commonly recognized toxic effect of these drugs is optic neuropathy, usually manifesting as a decrease in visual acuity, deficits in colour vision and cecocentral scotomas. This study presents the case of a 59-year-old Nigerian woman diagnosed of multi-drug-resistant tuberculosis who developed a severe bilateral optic neuropathy induced by ethambutol and isoniazid. Ophthalmologic examination revealed normal intraocular pressure, normal funduscopic examination and normal biomicroscopy. Automated visual field revealed 360º peripheral constriction and central scotoma. Magnetic resonance images of the brain and orbits were normal. Ten months after suspending treatment, the patient recovered complete visual function. Visual loss is a rare complication that can be related to ethambutol and isoniazid toxicity. Both eyes are usually symmetrically affected with deficits in colour vision and cecocentral scotoma. For successful treatment of visual loss, it is important to make a differential diagnosis between infection and adverse effects of anti-TB drugs. Ophthalmological examination is thus important before and after treatment.

[Whole body PET/CT imaging for detection of metastatic choroidal melanoma]. / PET/TC de cuerpo completo para la detección de metástasis de melanoma coroideo.

Choroidal melanoma is the most common primary intraocular cancer in adults. Metastases are most commonly found in the liver and are rapidly fatal despite aggressive therapy. These metastases have been reported in the follow-up to 50 % of uveal melanoma. However, recent reports have shown that liver ultrasonography and liver function tests have low sensitivity in the diagnosis of metastatic uveal melanoma. The study reports on a patient with a history of choroidal melanoma. Preoperative medical evaluation, including CT imaging of the abdomen, complete blood count and liver enzymes proved negative. A PET/CT was requested and showed lesions in the liver and lungs. Whole-body PET/CT revealed melanoma metastases. The PET/CT is a sensitive tool for the detection and localization of hepatic and extrahepatic metastatic choroidal melanoma.

Neuropatía óptica severa y reversible por etambutol e isoniazida / Severe and reversible optic neuropathy by aethambutol and isoniazid

El etambutol e isoniacida son tuberculostáticos para la tuberculosis multirresistente cuyo efecto adverso es la neuropatía óptica, con pérdida de visión, alteración de percepción de los colores y escotomas cecocentrales. Se presenta el caso de una mujer nigeriana de 59 años con antecedentes de tuberculosis miliar que desarrolló neuropatía óptica bilateral severa secundaria aetambutol e isoniacida. La presión intraocular, fondo de ojo y polo anterior eran normales. La campimetría mostraba constricción periférica de 360º y escotoma central. La resonancia magnética craneal y orbitaria fue normal. Diez meses tras suspender el tratamiento recuperó la visión con mejoría del campo visual. La toxicidad de los antituberculosos se puede asociar en raras ocasiones a la pérdida de visión. Ambos ojos se suelen afectar de forma simétrica mostrando déficits en la percepción de colores y escotomas cecocentrales. Para establecer el tratamiento de esta pérdida de visión hay que hacer diagnóstico diferencial entre infección tuberculosa y efecto adverso de los fármacos. Por ello es fundamental la exploración oftalmológica antes y durante el tratamiento (AU)

Ethambutol and isoniazid are antimicrobial agents used to treat multi-drug-resistant tuberculosis. The most commonly recognized toxic effect of these drugs is optic neuropathy, usually manifesting as a decrease in visual acuity, deficits in colour vision and cecocentral scotomas. This study presents the case of a 59-year-old Nigerian woman diagnosed of multi-drug-resistant tuberculosis who developed a severe bilateral optic neuropathy induced by ethambutol and isoniazid. Ophthalmologic examination revealed normal intraocular pressure, normal funduscopic examination and normal biomicroscopy. Automated visual field revealed 360º peripheral constriction and central scotoma. Magnetic resonance images of the brain and orbits were normal. Ten months after suspending treatment, the patient recovered complete visual function. Visual loss is a rare complication that can be related to ethambutol and isoniazid toxicity. Both eyes are usually symmetrically affected with deficits in colour vision and cecocentral scotoma. For successful treatment of visual loss, it is important to make a differential diagnosis between infection and adverse effects of anti-TB drugs. Ophthalmological examination is thus important before and after treatment (AU)

PET/TC de cuerpo completo para la detección de metástasis de melanoma coroideo / Whole body PET/CT imaging for detection of metastatic choroidal melanoma

El melanoma coroideo es el tumor maligno ocular primario más frecuente en los adultos y las metástasis más frecuentes son a nivel hepático con un mal pronóstico a pesar de los tratamientos. Estas metástasis se han descrito hasta en el 50 % de los melanomas coroideos. Estudios recientes muestran que la ecografía hepática y las analíticas hepáticas tienen baja sensibilidad en el diagnóstico de las metástasis hepáticas de los melanomas de úvea. Exponemos el caso de un paciente con historia de melanoma coroideo. La exploración preoperatoria, incluyendo TC de abdomen, analítica sanguínea y enzimas hepáticos resultó normal. En un PET/TC realizado mostró lesiones en el hígado y pulmones. El PET/TC de cuerpo entero mostró metástasis de un melanoma uveal. El PET/TC es una herramienta útil para la detección de las metástasis hepáticas y extrahepáticas (AU)

Choroidal melanoma is the most common primary intraocular cancer in adults. Metastases are most commonly found in the liver and are rapidly fatal despite aggressive therapy. These metastases have been reported in the follow-up to 50 % of uveal melanoma. However, recent reports have shown that liver ultrasonography and liver function tests have low sensitivity in the diagnosis of metastatic uveal melanoma. The study reports on a patient with a history of choroidal melanoma. Preoperative medical evaluation, including CT imaging of the abdomen, complete blood count and liver enzymes proved negative. A PET/CT was requested and showed lesions in the liver and lungs. Whole-body PET/CT revealed melanoma metastases. The PET/CT is a sensitive tool for the detection and localization of hepatic and extrahepatic metastatic choroidal melanoma (AU)

[Optical coherence tomography and macular phototoxicity]. / OCT y fototoxicidad macular.

CASE REPORT: Ocular examinations and optical coherence tomography (OCT) were performed in three patients with retinal phototoxicity lesions. Fluorescein angiography depicted a window defect. OCT exhibited hyporeflectivity at the outer foveal retina and fragmentation of the inner reflective layers, corresponding to the junction between the inner and outer photoreceptor segments. DISCUSSION: Retinal damage after light exposure has a rapid onset and shows different patterns in OCT examination. OCT findings suggest that decreased visual acuity may be associated with full-thickness photoreceptors and retinal pigment epithelium (RPE) involvement. OCT is a useful tool for objective assessment of retinal pathology in phototoxicity cases where fundus changes may be minimal or absent.

OCT y fototoxicidad macular / Optical coherence tomography and macular phototoxicity

Caso clínico: Se realiza una exploración ocular y tomografía de coherencia óptica (OCT) en tres pacientes con lesiones fototóxicas retinianas. Las angiografías fluoresceínicas muestran un defecto ventana. La OCT muestra hiporreflectividad en la porción externa de la fóvea y fragmentación de las capas más internas entre la porción interna de los fotorreceptores y los segmentos externos. Discusión: Las lesiones retinianas tras exposición a la luz aparecen precozmente mostrando diferentes patrones en la OCT. La OCT sugiere que la disminución de visión asocia una lesión de fotorreceptores y epitelio pigmentario retiniano (EPR). La OCT es útil para objetivar la retinopatía fototóxica donde los cambios oftalmoscópicos pueden estar ausentes o ser mínimos

Case report: Ocular examinations and optical coherence tomography (OCT) were performed in three patients with retinal phototoxicity lesions. Fluorescein angiography depicted a window defect. OCT exhibited hyporeflectivity at the outer foveal retina and fragmentation of the inner reflective layers, corresponding to the junction between the inner and outer photoreceptor segments. Discussion: Retinal damage after light exposure has a rapid onset and shows different patterns in OCT examination. OCT findings suggest that decreased visual acuity may be associated with full-thickness photoreceptors and retinal pigment epithelium (RPE) involvement. OCT is a useful tool for objective assessment of retinal pathology in phototoxicity cases where fundus changes may be minimal or absent (Arch Soc Esp Oftalmol 2008; 83: 267-272)

[Ocular manifestations of systemic diseases]. / Manifestaciones oculares de las enfermedades sistémicas.

A great number of systemic diseases can exhibit ocular manifestations during their evolution. These ocular alterations may cause symptoms by themselves, but can also be useful in diagnosing or monitoring the evolution of the systemic condition. The main characteristics of several systemic diseases exhibiting some kind of ocular sign are highlighted. These diseases will be described in detail in this issue.

[Diabetic macular edema]. / Edema macular diabético.

Diabetic macular edema is the principal cause of visual loss in patients with diabetes mellitus. Its complexity, together with the appearance of new methods of diagnosis and new alternatives for treatment, mean that the approach to this disease is an important challenge for ophthalmologists. This article describes its pathophysiology, clinical manifestations, classification, diagnosis and treatment, with special emphasis on the new diagnostic methods and on the different therapeutic options.

[Asymptomatic vasoproliferative retinal tumor]. / Tumor vasoproliferativo de la retina asintomático.

PURPOSE/METHOD: A case of vasoproliferative retinal tumor is described. The main differential diagnoses must be excluded and the therapeutic possibilities defined. RESULTS/CONCLUSIONS: Vasoproliferative retinal tumors are infrequent benign retinal lesions of gliovascular composition. The differential diagnoses needing consideration are a retinal hemangioma associated with von Hippel-Lindau disease, an amelanotic choroidal melanoma and an ocular metastasis from a tumor elsewhere. Treatment must be performed in those cases where the sight is threatened.

Tumor vasoproliferativo de la retina asintomático / Asimptomatic vasoproliferative retianla tumor

Objetivo/Método: Se describe un caso de tumor vasoproliferativo de la retina. Se analizan las principales entidades con las que se debe establecer el diagnóstico diferencial y la actitud terapéutica.Resultados/Conclusiones: Los tumores vasoproliferativos de la retina son lesiones retinianas benignas poco frecuentes de composición gliovascular. El diagnóstico diferencial se debe realizar con los hemangiomas retinianos de la enfermedad de von Hippel-Lindau, con el melanoma coroideo amelanótico y con las metástasis oculares. El tratamiento se debe efectuar en aquellos casos que presenten alteraciones que puedan comprometer la visión

Purpose/method: A case of vasoproliferative retinal tumor is described. The main differential diagnoses must be excluded and the therapeutic possibilities defined. Results/conclusions: Vasoproliferative retinal tumors are infrequent benign retinal lesions of gliovascular composition. The differential diagnoses needing consideration are a retinal hemangioma associated with von Hippel-Lindau disease, an amelanotic choroidal melanoma and an ocular metastasis from a tumor elsewhere. Treatment must be performed in those cases where the sight is threatened

[Bilateral traumatic retinopathy associated to whiplash injury]. / Retinopatía traumática bilateral asociada a latigazo cervical.

CASE REPORT: A 20-year old female complained of a paracentral scotoma after having suffered a whiplash injury. Eye fundus examination and fluorescein angiography suggested the diagnosis of traumatic retinopathy. DISCUSSION: There is not a clear explanation to justify the development of traumatic retinopathy after an indirect ocular trauma. Some authors favour a mixed mechanism, mechanic and vascular, to explain these alterations. We consider that a vascular aetiology is the most possible explanation for the development of traumatic retinopathy.

[Cytomegalovirus retinitis after highly active antiretroviral therapy: a case report]. / Retinitis por citomegalovirus tras terapia antirretroviral altamente activa: a propósito de un caso.

CASE REPORT: An HIV infected patient with cytomegalovirus retinitis with a CD4 lymphocyte count of 498 cells/mm3 after a good response to highly active antiretroviral therapy is described. COMMENT: Some aspects of the immune system after highly active antiretroviral therapy remain unknown. CD4 T lymphocyte count might not be a good marker to identify some patients at risk of developing cytomegalovirus retinitis after this therapy.

Retinitis por citomegalovirus tras terapia antirretroviral altamente activa: a propósito de un caso / Cytomegalovirus retinitis after highly active antiretroviral therapy: a case report

Caso clínico: Se describe a un paciente HIV positivo que desarrolló retinitis por citomegalovirus con un recuento de linfocitos CD4 de 498 células/mm3 tras una buena respuesta a la terapia antirretroviral altamente activa. Discusión: Algunos aspectos del funcionamiento del sistema inmune tras la terapia antirretroviral altamente activa permanecen desconocidos. El recuento de linfocitos CD4 podría no ser un buen marcador para detectar algunos pacientes con riesgo de sufrir retinitis por citomegalovirus tras este tratamiento (AU)

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Coroideremia: manifestaciones en varón afectado y mujer portadora / Choroideremia: manifestations in affected male and female carrier

Caso clínico: Se describen los fenotipos oculares de un varón afectado y una mujer portadora de coroideremia.Discusión: La coroideremia es una enfermedad degenerativa de la retina que se caracteriza por una atrofia casi total de la coriocapilar, el epitelio pigmentario retiniano y la retina neurosensorial. Su herencia es recesiva ligada al sexo, afectando a los varones y actuando las mujeres como transmisoras. Sus manifestaciones clínicas son disminución de la visión nocturna, alteración en fases tardías de la visión central, constricción periférica en los campos visuales y electrorretinograma anómalo desde las fases precoces (AU)

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Lesiones fototóxicas inducidas por la luz de Xenon / Xenon light induced phototoxicity lesions

Caso clínico: Dos pacientes sometidas a cirugía combinada de catarata y membrana epirretiniana mediante facoemulsificación y vitrectomía posterior desarrollan un moteado hipopigmentado retiniano que alterna con zonas de acúmulo de pigmento y es diagnosticado como lesiones fototóxicas producidas por la luz de Xenon. Discusión: Los factores que determinan la aparición de estas lesiones son: intensidad lumínica, tiempo de exposición, longitud de onda utilizada y distancia endoiluminador-retina. A pesar del efecto protector foveal, debemos modular estos factores y evitar que aparezcan estas alteraciones (AU)

[Xenon light induced phototoxic lesions]. / Lesiones fototóxicas inducidas por la luz de xenon.

CASE REPORT: Two female patients underwent combined surgery of cataract and epiretinal membrane by facoemulsification and posterior vitrectomy. After surgery they developed mottled hypo and hyperpigmented retinal alterations diagnosed as Xenon light induced phototoxicity lesions. DISCUSSION: Factors associated with the appearance of this lesions are: light power, exposure time, wavelength and endoilluminator-retina distance. In spite of the foveal protective effect, we must act over these factors to avoid the development of retinal alterations.

[Choroideremia: manifestations in affected male and female carrier]. / Coroideremia: manifestaciones en varón afectado y mujer portadora.

CASE REPORT: Ocular phenotypes in an affected male and a female carrier with choroideremia are described. COMMENT: Choroideremia is a degenerative retinal disease recognized in the late stages by a near total absence of the choriocapillaris, retinal pigment epithelium and neurosensory retina. Inheritance is X-linked recessive, with males being affected and females acting as carriers. Clinical manifestations include decreased night vision, central vision affected in late stages, peripheral constriction in the visual field and abnormal electroretinogram early in the course of the disease.