Unusual case of retinal arterial branch occlusion: possible variant of Sneddon syndrome.

Sneddon's syndrome (SS) manifests through multiple strokes and livedo reticularis. Livedoid vasculopathy (VL) is characterized by a long history of foot and leg ulceration and histopathology indicating a thrombotic process. Arterial retinal branch occlusion is described in a 52-year-old male with VL. He did not present noticeable laboratory abnormalities, such as antiphospholipid antibodies, or a history of strokes. Retinal artery occlusion accompanied by VL could be a variant of Sneddon's syndrome. Optical coherence tomography angiography revealed a reduction in the macula's vascular layers in the asymptomatic eye, indicating localized microvascular changes as an evolving marker in the pathogenesis of SS.

Oclusión de la arteria central de la retina tras inyección facial de ácido hialurónico / Central retinal artery occlusion following facial injection of hyaluronic acid

Mujer de 57 años sin premorbilidades que acude por pérdida de visión súbita e indolora en el ojo derecho (OD). La agudeza visual mejor corregida fue de contar dedos a 10cm. En el OD se observó un defecto pupilar aferente relativo. El examen de fondo de ojo en el OD fue sugestivo de oclusión central de la arteria retiniana. La evaluación sistémica fue normal. Lo más interesante en este caso es que un edema hemorrágico en la región glabelar derecha fue la base de la sospecha diagnóstica. La paciente reconoció la pérdida de visión a las 24horas de la inyección de ácido hialurónico como tratamiento de rejuvenecimiento facial (AU)

A 57-year-old woman with no premorbidities presented with symptoms of sudden painless vision loss in the right eye (RE). Best-corrected visual acuity in the RE was counting fingers to 10cm. A relative afferent pupillary defect was observed in the RE. Ocular fundus examination of RE was suggestive of central retinal artery occlusion. Systemic evaluation was normal. The most interesting fact in this case is that a hemorrhagic edema in the right glabellar region was the basis for the diagnostic suspicion. The patient recognized the loss of vision 24hours after hyaluronic acid injection as a facial rejuvenation treatment (AU)

Central retinal artery occlusion following facial injection of hyaluronic acid.

A 57-year-old woman with no premorbidities presented with symptoms of sudden painless vision loss in the right eye (RE). Best-corrected visual acuity in the RE was counting fingers to. A relative afferent pupillary defect was observed in the RE. Ocular fundus examination of RE was suggestive of central retinal artery occlusion. Systemic evaluation was normal. The most interesting fact in this case is that a hemorrhagic edema in the right glabellar region was the basis for the diagnostic suspicion. The patient recognized the loss of vision 24 h after hyaluronic acid injection as a facial rejuvenation treatment.

Visual acuity loss and sixth nerve palsy as the only manifestations of slit ventricle syndrome.

The case is presented of a girl diagnosed with obstructive hydrocephalus due to pilomyxoid astrocytoma, which required a ventriculoperitoneal shunt (VPS) at the age of 5 years and 10 months. Two months later, magnetic resonance imaging of the brain did not show ventriculomegaly or other signs of increased intracranial pressure. At the age of 6 years and 2 months, a rapid onset of bilateral visual acuity loss developed and she was diagnosed with slit ventricle syndrome. Despite valve revisions of the VPS, she developed an abrupt decline of visual acuity to hand motion at 10 cm. Fundus examination revealed bilateral optic atrophy. She did not report any other systemic symptoms suggesting increased intracranial pressure, such as headache, nausea, vomiting, lethargy, irritability, or altered levels of consciousness.

Pérdida de agudeza visual y parálisis de VI nervio craneal como únicas manifestaciones de un síndrome de colapso ventricular / Visual acuity loss and sixth nerve palsy as the only manifestations of slit ventricle syndrome

Se describe una niña con hidrocefalia obstructiva por un astrocitoma pilomixoide, que requirió implantar una derivación ventrículo-peritoneal (DVP) a los 5 años y 10 meses de edad. Dos meses después, la resonancia magnética cerebral no mostró ventriculomegalia ni otros signos de aumento de la presión intracraneal. A la edad de 6 años y 2 meses desarrolló una rápida disminución de la agudeza visual bilateral siendo diagnosticada de síndrome de colapso ventricular. A pesar de las revisiones valvulares de la DVP, se produjo una disminución abrupta de la agudeza visual a movimientos de mano a 10cm. El examen del fondo de ojo reveló atrofia óptica bilateral. No refirió otros síntomas sistémicos que sugirieran un aumento de la presión intracraneal, como dolor de cabeza, náuseas, vómitos, letargia, irritabilidad o niveles alterados de conciencia.

The case is presented of a girl diagnosed with obstructive hydrocephalus due to pilomyxoid astrocytoma, which required a ventriculoperitoneal shunt (VPS) at the age of 5 years and 10 months. Two months later, magnetic resonance imaging of the brain did not show ventriculomegaly or other signs of increased intracranial pressure. At the age of 6 years and 2 months, a rapid onset of bilateral visual acuity loss developed and she was diagnosed with slit ventricle syndrome. Despite valve revisions of the VPS, she developed an abrupt decline of visual acuity to hand motion at 10cm. Fundus examination revealed bilateral optic atrophy. She did not report any other systemic symptoms suggesting increased intracranial pressure, such as headache, nausea, vomiting, lethargy, irritability, or altered levels of consciousness.

Visual acuity loss and sixth nerve palsy as the only manifestations of slit ventricle syndrome. / Pérdida de agudeza visual y parálisis de VI nervio craneal como únicas manifestaciones de un síndrome de colapso ventricular.

The case is presented of a girl diagnosed with obstructive hydrocephalus due to pilomyxoid astrocytoma, which required a ventriculoperitoneal shunt (VPS) at the age of 5 years and 10 months. Two months later, magnetic resonance imaging of the brain did not show ventriculomegaly or other signs of increased intracranial pressure. At the age of 6 years and 2 months, a rapid onset of bilateral visual acuity loss developed and she was diagnosed with slit ventricle syndrome. Despite valve revisions of the VPS, she developed an abrupt decline of visual acuity to hand motion at 10cm. Fundus examination revealed bilateral optic atrophy. She did not report any other systemic symptoms suggesting increased intracranial pressure, such as headache, nausea, vomiting, lethargy, irritability, or altered levels of consciousness.

Bilateral ankyloblepharon: more than a simple malformation. / Anquilobléfaron bilateral: Algo más que una simple malformación.

"Ankyloblepharon filiforme adnatum" is a congenital anomaly characterized by partial or complete adhesion of upper and lower eyelids. The lid margins remain fused until the end of the fifth month of gestational age. Complete separation usually is completed about the seventh fetal month. Ankyloblepharon may be an isolated manifestation or may be associated with abnormalities in other organs and / or systems. The case is presented on a newborn male with family history of hypohydrotic ectodermal dysplasia (mother and maternal grandfather). It revealed extensible bands of skin in right and in left eye. Apart from this, he presented cleft lip, complete absence of palate, nail and ungueal dysplasia and supernumerary nipples.

Unilateral pattern of macular dystrophy and associated systemic pathology. / Distrofia macular en patrón unilateral y enfermedad sistémica asociada.

Retinal pattern dystrophies are a heterogeneous group of generally bilateral and symmetrical maculopathies that, curiously, can be associated with different systemic diseases. This article describes a patient with unilateral pattern dystrophies, as well as associated McArdle disease and idiopathic pulmonary fibrosis.

Bilateral and multifocal central serous chorioretinopathy after injecting triamcinolone into a chalazion. / Coriorretinopatía serosa central bilateral y multifocal después de inyectar triamcinolona en un chalazión.

We present a case of bilateral and multifocal central serous chorioretinopathy that developed one month after an intra-chalazion triamcinolone acetonide injection. Central serous chorioretinopathy spontaneously resolved during observation 3 months after diagnosis. We believe that central serous chorioretinopathy can occur as a complication of administration of depot corticosteroids even at a low dose.

Unusual ocular clinical manifestation of leptospirosis. / Manifestación clínica ocular inusual de la leptospirosis.

CLINICAL CASE: An uncommon case is presented of a 15 year-old girl with bilateral, multiple serous detachments of retina and retinal pigment epithelium. With clinical and laboratory (IgG 1/160 and IgM 1/160, using an indirect immunofluorescence assay) diagnoses of leptospirosis, a complete ophthalmic examination, fluorescein angiography, autofluorescence and optical coherence tomography were performed, and the patient was followed for two years. DISCUSSION: Bilateral, multiple serous detachments of retina and retinal pigment epithelium can be a complication of systemic leptospirosis, a zoonotic disease caused by Leptospira. Without a detailed medical history it may be underdiagnosed, mainly because it can mimic other more common diseases. It may be prudent to ask patients regarding contact with pets.

Colour vision abnormality as the only manifestation of normal pressure hydrocephalus. / Anormalidad en la visión del color como única manifestación de hidrocefalia normotensiva.

CLINICAL CASE: The case is presented of a 73-year-old male patient who referred to having black and white vision. Computed tomography showed normal pressure hydrocephalus (NPH). Magnetic resonance imaging was not performed because the patient refused to undergo further examinations. DISCUSSION: Achromatopsia may be the first or only NPH symptom. It may be prudent to ask patients with NPH regarding colour vision.

Asymptomatic choroidal tubercle in a patient with Crohn's disease on adalimumab treatment. / Tubérculo coroideo asintomático en un paciente con enfermedad de Crohn en tratamiento con adalimumab.

INTRODUCTION: Adalimumab, an anti-tumour necrosis factor alpha therapy for active Crohn's disease (CD), is associated with increased risks of tuberculosis infection. CASE REPORT: The case is presented of a 48 year-old male with active CD on treatment with adalimumab. After three months, he developed a miliary pulmonary tuberculosis infection, with a solitary non-reactive choroidal tubercle temporal-superior to the optic disc being found in an ophthalmological study. Fluorescein angiography showed late hyperfluorescence in a staining pattern. Optic coherence tomography showed a flat mass without serous retinal detachment. The choroidal tubercle slowly regressed with antituberculosis therapy. DISCUSSION: Choroidal tubercles with no vitreo-retinal symptomatology can be present in patients with CD and on treatment with adalimumab.