Rasgo de zónula anterior larga, lecciones aprendidas acerca de una infrecuente forma de cierre angular secundario: comunicación de un caso / Long anterior zonule trait, lessons learned about an uncommon form of secondary angle closure: A case report

Una mujer de raza negra de 62 años de edad que presentaba glaucoma crónico de ángulo estrecho no controlado en tratamiento con tres fármacos fue sometida a faco-esclerectomía profunda no perforante (facoEPNP) de su ojo izquierdo (OI). Durante la cirugía se puso de manifiesto que presentaba rasgo de zónula larga. Precisó goniopunción y desbridamiento de la ampolla posteriormente, presentando una sinequia de iris en la goniopunción que pudo ser reducida de forma conservadora. Este rasgo debe sospecharse en aquellos pacientes que presentan un ángulo estrecho combinado con un síndrome de dispersión pigmentaria. El manejo de la hipertensión ocular y el glaucoma que puede aparecer asociado a este rasgo no está protocolizado. En esta comunicación se reflexiona acerca de la mejor actuación ante esta infrecuente forma de glaucoma.(AU)

A 62-year-old black woman with uncontrolled chronic narrow-angle glaucoma on 3-drug therapy underwent phaco-non-perforating deep sclerectomy of her left eye. During surgery it was revealed that she had long zonule trait. She later required goniopuncture and conjuntival needling, presenting an iris synechia on the goniopuncture that could be reduced conservatively. Long anterior zonule trait should be suspected in those patients presenting with a combination of narrow angle and pigment dispersion syndrome. The management of ocular hypertension and glaucoma associated to this trait is not protocolized. This communication discusses on the best action in this rare form of glaucoma.(AU)

Long anterior zonule trait, lessons learned about an uncommon form of secondary angle closure: a case report.

A 62-year-old black woman with uncontrolled chronic narrow-angle glaucoma on 3-drug therapy underwent phaco-non-perforating deep sclerectomy of her left eye. During surgery it was revealed that she had long zonule trait. She later required goniopuncture and conjuntival needling, presenting an iris herniation in the goniopuncture that could be reduced conservatively. Long anterior zonule trait should be suspected in those patients presenting with a combination of narrow angle and pigment dispersion syndrome. The management of ocular hypertension and glaucoma associated to this trait is not protocolized. This communication discusses on the best action in this rare form of glaucoma.

Neovascularización coroidea asociada a drusas del nervio óptico: caso clínico y revisión de la literatura / Choroidal neovascularisation associated with optic nerve head drusen: Case report and review of literatura

Varón de 21 años en seguimiento en el servicio de oftalmología por drusas del nervio óptico (DNO). En una revisión rutinaria se evidenció la presencia de neovascularización coroidea (NVC) bajo el haz papilomacular en el ojo derecho (OD). El paciente fue tratado con 2 inyecciones intravítreas de anti-vascular endothelial growth factor (anti-VEGF, por sus siglas en inglés) con buena respuesta. La aparición de NVC en el haz papilomacular es una complicación infrecuente en los pacientes con DNO. Estas NVC presentan una buena respuesta al tratamiento con inyecciones intravítreas de anti-VEGF

A 21-year-old man was seen for follow-up of optic nerve head drusen (ONHD) in the ophthalmology department. Funduscopy revealed the presence of choroidal neovascularisation (CNV) in the papillomacular bundle of his right eye (RE). The patient was successfully treated with two intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF). Peri-papillary choroidal neovascularisation in papillomacular bundle is a rare complication in patients with ONHD. These forms of CNV show a good response to anti-VEGF treatment

Choroidal neovascularisation associated with optic nerve head drusen: Case report and review of literature. / Neovascularización coroidea asociada a drusas del nervio óptico: caso clínico y revisión de la literatura.

A 21-year-old man was seen for follow-up of optic nerve head drusen (ONHD) in the ophthalmology department. Funduscopy revealed the presence of choroidal neovascularisation (CNV) in the papillomacular bundle of his right eye (RE). The patient was successfully treated with two intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF). Peri-papillary choroidal neovascularisation in papillomacular bundle is a rare complication in patients with ONHD. These forms of CNV show a good response to anti-VEGF treatment.

Pneumoconjuntiva como signo indicador de permeabilidad tras implantación de un dispositivo XEN(R) / Pneumo-conjunctiva as an indicator of patency after implantation of a XEN(R) stent

No disponible

Ojo rojo en tatuaje: Un curioso ojo rojo de etiología tuberculosa / Red-eyed-tatoo: An unusual red eye of tuberculous etiology

No disponible

¿De qué colores es el vestido? Revisión de una ilusión óptica atípica / Which are the colors of the dress? Review of an atypical optic illusion

OBJETIVO: En 2015 la fotografía de un vestido se hizo viral. Un porcentaje amplio de la población veía el vestido blanco y dorado (ByD) en tanto que otra parte importante de la población lo veía azul y negro (AyN). El objetivo de este trabajo es revisar la bibliografía publicada en relación con este tema. MATERIAL Y MÉTODOS: Se realizó una búsqueda bibliográfica en Pubmed y Google. El algoritmo utilizado fue: (color OR colour) AND (dress OR #thedress). La búsqueda se limitó a los años 2015-2017. No se limitó la búsqueda a una lengua concreta. La bibliografía de los artículos localizados se utilizó de forma secundaria para ampliar la búsqueda. RESULTADOS: El algoritmo utilizado localizó un total de 23 artículos relacionados con el tema. La mayor parte de los trabajos han sido publicados en revistas del ámbito de la percepción y analizan la cuestión desde el punto de vista de la constancia cromática. Los factores genéticos parecen tener un bajo peso en el modo en el que la imagen es percibida. La potencial influencia de factores oculares ha sido poco estudiada. CONCLUSIÓN: Esta ilusión ha recibido poca atención por parte de las revistas del ámbito de la oftalmología. Aunque sin duda la constancia cromática está implicada, de momento no se ha elaborado una teoría capaz de explicar el carácter dicotómico de esta ilusión óptica

OBJECTIVE: In 2015 the picture of a dress went viral on social media. A significant proportion of the population saw it as golden and white (G&W), while another significant proportion saw it as blue and black (B&B). The aim of this article is to review the related literature. MATERIAL AND METHODS: Bibliographic search conducted in Pubmed and Google. The algorithm used was: (color OR colour) AND (dress OR #thedress). The search was limited to the years 2015-2017. No language restrictions were used. The references of the located articles were used to widen the search. RESULTS: The search algorithm retrieved 23 articles related to the topic. Most of the works have been published in journals in the field of perception. Most works address the topic from the point of view of chromatic constancy. Genetic factors seem to have a low weight in the way the dress is perceived. There are few studies on the potential influence of ocular factors. CONCLUSION: This illusion has gained little attention in ophthalmology journals. Although colour constancy is certainly involved, there is still no theory available to explain the dichotomous character of this optical illusion

Which are the colors of the dress? Review of an atypical optic illusion. / ¿De qué colores es el vestido? Revisión de una ilusión óptica atípica.

OBJECTIVE: In 2015 the picture of a dress went viral on social media. A significant proportion of the population saw it as golden and white (G&W), while another significant proportion saw it as blue and black (B&B). The aim of this article is to review the related literature. MATERIAL AND METHODS: Bibliographic search conducted in Pubmed and Google. The algorithm used was: (color OR colour) AND (dress OR #thedress). The search was limited to the years 2015-2017. No language restrictions were used. The references of the located articles were used to widen the search. RESULTS: The search algorithm retrieved 23 articles related to the topic. Most of the works have been published in journals in the field of perception. Most works address the topic from the point of view of chromatic constancy. Genetic factors seem to have a low weight in the way the dress is perceived. There are few studies on the potential influence of ocular factors. CONCLUSION: This illusion has gained little attention in ophthalmology journals. Although colour constancy is certainly involved, there is still no theory available to explain the dichotomous character of this optical illusion.

Ciclodiálisis traumática tratada con láser ciclodiodo transescleral: evolución de la exploración del segmento anterior y posterior / Traumatic cyclodialysis treated with transscleral ciclodiode laser: Anterior and posterior segment evolution

Caso clínico: Paciente varón de 35 años de edad, que presentó un cuadro severo de maculopatía por hipotensión tras recibir una patada en el ojo izquierdo. Presentaba una zona amplia de iridodiálisis. La gonioscopia, biomicroscopia ultrasónica y tomografía de coherencia óptica no permitieron localizar la ciclodiálisis. Cinco meses después, ante la falta de respuesta al tratamiento médico, el paciente fue tratado con ciclofotocoagulación transescleral con láser de diodo, que produjo la resolución del cuadro clínico. Discusión: La ciclofotocoagulación transescleral con láser diodo constituye un tratamiento eficaz, produce poca iatrogenia y permite incluso resolver cuadros de hipotensión ocular producidos por ciclodiálisis que no han podido ser localizadas (AU)

Case report: A 35-year-old man suffered a severe hipotension maculopathy after being kicked in his left eye. He presented a broad area of iridodialisis. Gonioscopy, ultrasound biomicroscopy and optic coherence tomography were not able to locate the suspected cyclodialysis. Medical treatment was ineffective. Five months later the patient received transcleral diode laser cyclophotocoagulation with clinical resolution. Discussion: Transscleral diode laser constitutes an effective treatment, with low iatrogenia, that can solve cases of ocular hypotension, even when the location of the cyclodialysis has not been determined (AU)

Traumatic cyclodialysis treated with transscleral ciclodiode laser: Anterior and posterior segment evolution. / Ciclodiálisis traumática tratada con láser ciclodiodo transescleral: evolución de la exploración del segmento anterior y posterior.

CASE REPORT: A 35-year-old man suffered a severe hipotension maculopathy after being kicked in his left eye. He presented a broad area of iridodialisis. Gonioscopy, ultrasound biomicroscopy and optic coherence tomography were not able to locate the suspected cyclodialysis. Medical treatment was ineffective. Five months later the patient received transcleral diode laser cyclophotocoagulation with clinical resolution. DISCUSSION: Transscleral diode laser constitutes an effective treatment, with low iatrogenia, that can solve cases of ocular hypotension, even when the location of the cyclodialysis has not been determined.

[Effectiveness of topical bevacizumab in bilateral primary lipid keratopathy]. / Eficacia de bevacizumab tópico en queratopatía lipoidea bilateral primaria.

CASE REPORT: A 75-year-old man with bilateral idiopathic lipid keratopathy underwent a penetrating keratoplasty in the left eye. One month later, there was deep corneal neovascularisation extending across the bed and the graft-host interface, with a whitish opacity surrounding the vessels. Topical bevacizumab (25mg/mL) was administered 4 times daily for 2 months with partial regression of corneal neovascularization. DISCUSSION: Topical bevacizumab may be useful in preventing a recurrence of lipid deposition after penetrating keratoplasty in patients with bilateral primary lipid keratopathy, although its long-term efficacy needs to be assessed.

Eficacia de bevacizumab tópico en queratopatía lipoidea bilateral primaria / Effectiveness of topical bevacizumab in bilateral primary lipid keratopathy

Caso clínico: Varón de 75 años con queratopatía lipoidea bilateral primaria. Es intervenido de queratoplastia penetrante en ojo izquierdo. Al mes se observa neovascularización corneal profunda extendiéndose sobre el lecho y la interfase injerto-huésped, con opacidad blanquecina alrededor de los neovasos. Se inicia tratamiento con bevacizumab tópico (25mg/mL) 4 veces/día durante 2 meses, con regresión parcial de la neovascularización corneal. Discusión: Bevacizumab tópico puede ser útil en la prevención de la recidiva de la queratopatía lipoidea tras queratoplastia penetrante en pacientes con queratopatía lipoidea bilateral primaria, aunque sería conveniente determinar su eficacia a largo plazo(AU)

Case report: A 75-year-old man with bilateral idiopathic lipid keratopathy underwent a penetrating keratoplasty in the left eye. One month later, there was deep corneal neovascularisation extending across the bed and the graft-host interface, with a whitish opacity surrounding the vessels. Topical bevacizumab (25mg/mL) was administered 4 times daily for 2 months with partial regression of corneal neovascularization. Discussion: Topical bevacizumab may be useful in preventing a recurrence of lipid deposition after penetrating keratoplasty in patients with bilateral primary lipid keratopathy, although its long-term efficacy needs to be assessed(AU)

[Morphometric analysis of corneal endothelium after intravitreal ranibizumab (Lucentis) in age-related macular degeneration treatment]. / Análisis morfométrico del endotelio corneal tras ranibizumab intravítreo en la degeneración macular asociada a la edad.

PURPOSE: To determine the effect of intravitreal injection of 0.5mg ranibizumab on the corneal endothelium in patients with age-related macular degeneration (AMD). METHODS: Observational, prospective case series pilot study. Twenty-six eyes of 26 consecutive patients with AMD were evaluated. All participants received one monthly intravitreal injections of 0.5mg ranibizumab for three consecutive months. The follow-up period was 6 months. Central corneal specular microscopy was performed before injection and at 7 days and 6 months after the first intravitreal injection. The endothelial cell density, coefficient of variation of cell size, and percentage of hexagonal cells were analyzed and the central corneal thickness was measured. RESULTS: There were no significant differences in the endothelial cell densities, coefficients of variation of cell size and percentages of hexagonal cells before injection and at 7 days and 6 months after the first intravitreal ranibizumab injection (P>0.5). There was also no significant difference in central corneal thickness measurements through the follow-up period (P>0.5). CONCLUSIONS: Repeated intravitreal injections of 0.5mg ranibizumab do not seem to cause substantial changes in the corneal endothelium.

Análisis morfométrico del endotelio corneal tras ranibizumab intravítreo en la degeneración macular asociada a la edad / Morphometric analysis of corneal endothelium after intravitreal ranibizumab (Lucentis®) in age-related macular degeneration treatment

ObjetivoEvaluar el efecto de la inyección intravítrea de 0,5mg ranibizumab sobre el endotelio corneal en pacientes con degeneración macular asociada a la edad (DMAE).MétodoEstudio piloto de serie de casos, observacional y prospectivo con observador enmascarado. Veintiséis ojos (26 pacientes) con DMAE fueron evaluados. Todos los pacientes recibieron 1 inyección intravítrea mensual de 0,5mg de ranibizumab durante 3 meses consecutivos. El periodo de seguimiento fue de 6 meses. El endotelio corneal central fue evaluado antes, a los 7 días y a los 6 meses de la primera inyección de ranibizumab con microscopía especular. La densidad de las células endoteliales, coeficiente de variación del tamaño celular y porcentaje de hexagonalidad celular fueron analizados. También fue medido el espesor corneal central.ResultadosNo se encontraron diferencias estadísticamente significativas entre los valores preinyección y postinyección a los 7 días y 6 meses de la primera inyección de ranibizumab en las densidades de células endoteliales, coeficientes de variación del tamaño celular y porcentajes de hexagonalidad celular (p>0,5). Tampoco se encontraron modificaciones significativas en el espesor corneal central a lo largo del periodo de seguimiento (p>0,5).ConclusionesInyecciones intravítreas repetidas de 0,5mg ranibizumab no parecen causar cambios importantes sobre el endotelio corneal a los 6 meses de seguimiento(AU)

PurposeTo determine the effect of intravitreal injection of 0.5mg ranibizumab on the corneal endothelium in patients with age-related macular degeneration (AMD).MethodsObservational, prospective case series pilot study. Twenty-six eyes of 26 consecutive patients with AMD were evaluated. All participants received one monthly intravitreal injections of 0.5mg ranibizumab for three consecutive months. The follow-up period was 6 months. Central corneal specular microscopy was performed before injection and at 7 days and 6 months after the first intravitreal injection. The endothelial cell density, coefficient of variation of cell size, and percentage of hexagonal cells were analyzed and the central corneal thickness was measured.ResultsThere were no significant differences in the endothelial cell densities, coefficients of variation of cell size and percentages of hexagonal cells before injection and at 7 days and 6 months after the first intravitreal ranibizumab injection (P>0.5). There was also no significant difference in central corneal thickness measurements through the follow-up period (P>0.5).ConclusionsRepeated intravitreal injections of 0.5mg ranibizumab do not seem to cause substantial changes in the corneal endothelium(AU)

[Management of subretinal hemorrhage with r-TPA, SF-6 and ranibizumab]. / Tratamiento de una hemorragia subretiniana con r-TPA, SF6 y ranibizumab.

CASE REPORT: We present a case of a patient with subretinal hemorrhage treated with intravitreal r-TPA, SF-6 and ranibizumab. DISCUSSION: Subretinal hemorrhages secondary to age-related macular degeneration are associated with poor visual outcome. A wide variety of management approaches has been developed, but the prognosis of these patients has not been modified by any of them. The association of an intravitreal anti VEGF drug to r-TPA and gas, may improve its results as we add the treatment of the subjacent etiology to the pneumatic displacement.

[Primary cerebral lymphoma diagnosed by the ophthalmologist]. / Diagnóstico de linfoma cerebral primario por el oftalmólogo.

CASE REPORT: A 20-year-old male, HIV positive, with myodesopsias (floaters) in both eyes for two weeks. Fundus examination revealed bilateral papillary oedema with peripapilar flame-shaped haemorrhages. The neuroimaging tests showed a cerebral mass in the left parietal lobe. The biopsy confirmed the diagnosis of lymphoid neoplasm. DISCUSSION: Primary lymphoma is the most common malignancy of the central nervous system (CNS) in AIDS patients, although highly active antiretroviral therapy has reduced its incidence. The ophthalmologist plays an essential role in the diagnosis of CNS neoplasm.

Tratamiento de una hemorragia subretiniana con r-TPA, SF6 y ranibizumab / Management of subretinal hemorrhage with r-TPA, SF-6 and ranibizumab

Caso clínico: Se presenta el caso de un paciente con hemorragia subretiniana por degeneraciónmacular asociada a la edad (DMAE) tratada con activador del plasminógeno tisularrecombinante (r-TPA), hexafluoruro de azufre y ranibizumab.Discusión: Las hemorragias subretinianas secundarias a DMAE tienen mal pronóstico visual.A pesar de la gran cantidad de opciones terapéuticas planteadas para este proceso,ninguna ha conseguido mejorarlo. El desplazamiento de la hemorragia subretiniana conr-TPA y gas se ha aplicado en el tratamiento de esta afección. La asociación de un fármacoanti-VEGF intravítreo a esta técnica puede mejorar los resultados, al asociar un componenteterapéutico al desplazamiento físico de la hemorragia(AU)

Case report: We present a case of a patient with subretinal hemorrhage treated withintravitreal r-TPA, SF-6 and ranibizumab.Discussion: Subretinal hemorrhages secondary to age-related macular degeneration areassociated with poor visual outcome. A wide variety of management approaches has beendeveloped, but the prognosis of these patients has not been modified by any of them. Theassociation of an intravitreal anti VEGF drug to r-TPA and gas, may improve its results aswe add the treatment of the subjacent etiology to the pneumatic displacement(AU)

Diagnóstico de linfoma cerebral primario por el oftalmólogo / Primary cerebral lymphoma diagnosed by the ophthalmologist

Caso clínico: Paciente varón de 20 años, VIH positivo, con miodesopsias en ambos ojos de 2semanas de evolución. El examen fundoscópico reveló edema de papila bilateral con hemorragiasperipapilares en llama. El estudio de neuroimagen mostró la presencia de unamasa cerebral en el lóbulo parietal izquierdo. La biopsia confirmó el diagnóstico de neoplasiade estirpe linfoide.Discusión: El linfoma primario es la neoplasia más frecuente del sistema nervioso central(SNC) en pacientes con sida (síndrome de inmudeficiencia adquirida) aunque la terapiaantirretroviral de gran actividad ha disminuido su incidencia. Destacamos el papel del oftalmólogoen el diagnóstico de neoplasias del SNC(AU)

Case report: A 20-year-old male, HIV positive, with myodesopsias (floaters) in both eyes fortwo weeks. Fundus examination revealed bilateral papillary oedema with peripapilarflame-shaped haemorrhages. The neuroimaging tests showed a cerebral mass in the leftparietal lobe. The biopsy confirmed the diagnosis of lymphoid neoplasm.Discussion: Primary lymphoma is the most common malignancy of the central nervoussystem (CNS) in AIDS patients, although highly active antiretroviral therapy has reducedits incidence. The ophthalmologist plays an essential role in the diagnosis of CNSneoplasm(AU)