Línea de Scheie como primer signo de síndrome de dispersión pigmentaria / Scheie's line as a first sign of pigment dispersion síndrome

Mujer de 50 años que en una revisión de rutina fue diagnosticada de síndrome de dispersión pigmentaria (SDP) en el ojo derecho y glaucoma pigmentario en el ojo izquierdo. Presentaba una línea de pigmento en la unión vítreo-lenticular (línea de Scheie [LS]), así como la presión intraocular de 26 mmHg. La LS se desarrolla por el acúmulo de pigmento desprendido del iris en el SDP y acumulado en el ligamento de Wieger que constituye la unión vítreo-lenticular. La LS está considerada signo patognomónico de SDP

A 50 year old woman was diagnosed with pigment dispersion syndrome (PDS) in the right eye and pigmentary glaucoma in the left eye in a routine medical examination. A line of pigment was observed in the vitreo-lenticular interface (Scheie's line) of the left eye and with an intraocular pressure of 26 mmHg. The Scheie's line (SL) develops by the accumulation of detached iris pigment in PDS and accumulated in the ligament of Wieger that forms the vitreo-lenticular union. The SL is considered a pathognomonic sign of PDS

Scheie's line as a first sign of pigment dispersion syndrome. / Línea de Scheie como primer signo de síndrome de dispersión pigmentaria.

A 50 year old woman was diagnosed with pigment dispersion syndrome (PDS) in the right eye and pigmentary glaucoma in the left eye in a routine medical examination. A line of pigment was observed in the vitreo-lenticular interface (Scheie's line) of the left eye and with an intraocular pressure of 26mmHg. The Scheie's line (SL) develops by the accumulation of detached iris pigment in PDS and accumulated in the ligament of Wieger that forms the vitreo-lenticular union. The SL is considered a pathognomonic sign of PDS.

Nieve visual en un paciente pediátrico / Visual snow in a paediatric patient

Caso clínico: Presentamos el caso de una niña de 11 años que refería fotofobia y visión continua de puntos blancos por ambos ojos (AO) de un año de evolución. La agudeza visual era de la unidad en AO con el resto de la exploración oftalmológica normal. La paciente fue derivada a la Unidad de Neuroftalmología y, una vez descartada enfermedad neurológica mediante analítica completa y pruebas de imagen, fue diagnosticada de nieve visual (NV). Discusión: La NV es un síntoma aislado que posiblemente forma parte del aura migrañosa y es referida por los pacientes como visión de numerosos y constantes puntos blancos en movimiento en el campo visual de AO. Puede producir una interferencia importante en las actividades diarias de los pacientes al alterar su calidad de vida y puede concluir en diagnósticos erróneos. En el caso de los pacientes pediátricos, además, presenta una gran dificultad diagnóstica por la compleja interpretación que supone en estos pacientes la presencia de la NV (AU)

Case report: The case is presented of an 11 year-old girl referring to a one year history of photophobia and continuously seeing white spots in both eyes. The patient had a visual acuity of unity in both eyes, and a normal eye examination, and was referred to the Neuro-ophthalmology Unit. Once complete laboratory and imaging tests ruled out the possibility of any neurological pathology, she was diagnosed with visual snow (VS). Discussion: VS is an isolated symptom, possibly part of the migraine aura, that is referred by patients reporting numerous and constant white dots moving in the visual field of BE. It can significantly interfere with patient's daily activities by altering their quality of life, and ending up as a misdiagnosis. Paediatric patients also present a diagnostic challenge due to the complex interpretation that the presence of VS involves in them (AU)

Visual snow in a paediatric patient. / Nieve visual en un paciente pediátrico.

CASE REPORT: The case is presented of an 11 year-old girl referring to a one year history of photophobia and continuously seeing white spots in both eyes. The patient had a visual acuity of unity in both eyes, and a normal eye examination, and was referred to the Neuro-ophthalmology Unit. Once complete laboratory and imaging tests ruled out the possibility of any neurological pathology, she was diagnosed with visual snow (VS). DISCUSSION: VS is an isolated symptom, possibly part of the migraine aura, that is referred by patients reporting numerous and constant white dots moving in the visual field of BE. It can significantly interfere with patient's daily activities by altering their quality of life, and ending up as a misdiagnosis. Paediatric patients also present a diagnostic challenge due to the complex interpretation that the presence of VS involves in them.

Simulación en oftalmología secundaria a desprendimiento de retina crónico / Simulation in ophthalmology secondary to an chronic retinal detachment

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Hipertensión arterial secundaria a tratamiento con latanoprost / Hypertension secondary to treatment with latanoprost

CASO CLÍNICO: Mujer de 80 años intervenida mediante trabeculectomía por glaucoma primario de ángulo abierto en la que, debido al incremento tensional, se inició tratamiento con latanoprost. La monitorización de la tensión arterial (TA) demostró un incremento estadísticamente significativo de la TA tanto sistólica como diastólica coincidiendo con el uso del hipotensor tópico, que se resolvió al suspender voluntariamente el tratamiento, volviendo a elevarse al reintroducir la prostaglandina. DISCUSIÓN: Los análogos de las prostaglandinas disminuyen la presión intraocular al producir vasodilatación de las arterias ciliares y epiesclerales, aumentando el drenaje del humor acuoso. Los efectos cardiovasculares son poco frecuentes pero se han descrito por el efecto vasoconstrictor que puede desencadenarse como el incremento reversible de la TA de este caso

CASE REPORT: An 80 year old woman operated on by trabeculectomy for primary open-angle glaucoma due to increased pressure, who started treatment with latanoprost. Monitoring of blood pressure (BP) showed a statistically significant increase in both systolic and diastolic BP, coinciding with the use of topical hypotensive, which resolved by voluntarily suspending treatment, thus increasing again to reintroduce the prostaglandin. DISCUSSION: Prostaglandin analogs reduce intraocular pressure to produce vasodilation of the episcleral and ciliary arteries, increasing the outflow of aqueous humor. Cardiovascular effects are rare, but have been described by the vasoconstrictor effect that can trigger the reversible increase in BP, as in this case

Pérdida visual no orgánica. Serie de 5 casos / Non-organic visual loss. A series of 5 cases

La pérdida visual no orgánica es la presencia de sintomatología ocular sin una base orgánica que la justifique y que puede presentarse hasta en el 5% de los ni˜nos que acuden a la consulta de oftalmología ambulatoria. La sospecha y el manejo de esta situación son fundamentales para un diagnóstico adecuado, evitando no solo derivaciones innecesarias a otras especialidades, sino para evitar también el gasto sanitario, además de disminuir la angustia paterna por la posible presencia de enfermedad ocular en sus hijos

Non-organic visual loss is the presence of ocular symptoms without an organic base that justifies it, and can occur in up to 5% of the children attending Ophthalmology Outpatients. A suspicion and the management of this situation are essential for a proper diagnosis, not only to avoid unnecessary referrals to other specialties, but also to avoid health spending, in addition to reducing parental distress by the possible presence of eye disease in their children

[Hypertension secondary to treatment with latanoprost]. / Hipertensión arterial secundaria a tratamiento con latanoprost.

CASE REPORT: An 80 year old woman operated on by trabeculectomy for primary open-angle glaucoma due to increased pressure, who started treatment with latanoprost. Monitoring of blood pressure (BP) showed a statistically significant increase in both systolic and diastolic BP, coinciding with the use of topical hypotensive, which resolved by voluntarily suspending treatment, thus increasing again to reintroduce the prostaglandin. DISCUSSION: Prostaglandin analogs reduce intraocular pressure to produce vasodilation of the episcleral and ciliary arteries, increasing the outflow of aqueous humor. Cardiovascular effects are rare, but have been described by the vasoconstrictor effect that can trigger the reversible increase in BP, as in this case.

[Non-organic visual loss. A series of 5 cases]. / Pérdida visual no orgánica. Serie de 5 casos.

Non-organic visual loss is the presence of ocular symptoms without an organic base that justifies it, and can occur in up to 5% of the children attending Ophthalmology Outpatients. A suspicion and the management of this situation are essential for a proper diagnosis, not only to avoid unnecessary referrals to other specialties, but also to avoid health spending, in addition to reducing parental distress by the possible presence of eye disease in their children.

Cumplimiento del tratamiento del glaucoma / Glaucoma treatment compliance

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Retinopatía maligna / Malignant retinopathy

No disponible

Cirugía del glaucoma (dentro de la serie de Técnicas Quirúrgicas en Oftalmología) / No disponible

No disponible

Serological markers in inflammatory bowel disease: a review of their clinical utility.

BACKGROUND: Several antibodies, also called serological markers, are associated with specific forms, disease behavior and phenotype of inflammatory bowel disease (IBD). AIM: Summarize and analyze the evidence of the utility of serologic markers in IBD, making emphasis on their clinical utility and behavior between populations. MATERIAL AND METHODS: Relevant articles were located by computer-assisted search of PubMed (since January 1979 until December 2008). RESULTS: Anti-Saccharomyces cerevisiae antibodies (ASCA) and perinuclear Anti-neutrophil Cytoplasmic Antibodies (pANCA) are the best studied serological markers. Assessing both ASCA and pANCA allows a better differentiation of Crohn's disease (CD) from ulcerative colitis (UC) than by using the individual tests alone. The ASCA+/pANCA- phenotype is characteristic of CD, while the ASCA-/pANCA+ phenotype is found in UC. The interest on atypical ANCA is growing as it may be a useful tool to distinguish between different IBD forms. Newer markers derived from various microbial species of the gut and glycan markers are of interest as they offer new ways to stratify patients into serologic subgroups. These serological markers may act as prognostic indicators of the severity and behavior of IBD, but more studies are necessary to determine their utility. CONCLUSIONS: There is emerging evidence that combining serological markers may increase the accuracy of diagnosis of a specific form of IBD or its behavior, but the perfect assay or combination of antibodies has not been discovered. They have several limitations, therefore clinicians must be aware of the evidence on serological markers, interpret them with caution and always correlate with the clinical picture.

[Bilateral third cranial nerve palsy secondary to lung carcinoma metastasis]. / Parálisis bilateral del III nervio craneal por metástasis de carcinoma pulmonar.

CLINICAL CASE: A 58 year-old man with a known diagnosis of a large cell lung carcinoma, developed a progressive diplopia. His examination revealed a double oculomotor nerve palsy with dilated and poorly reactive pupils. A cranial magnetic resonance showed an unique and solitary lesion in the midbrain, which presumably affected to both oculomotor nucleus and fasciculus. There were not found additional extrathoracic manifestations. DISCUSSION: This case shows the possibility that a large cell lung carcinoma may cause a double oculomotor nerve palsy as the consequence of an isolated midbrain metastasis.

Parálisis bilateral del III nervio craneal por metástasis de carcinoma pulmonar / Bilateral third cranial nerve palsy secondary to lung carcinoma metastasis

Caso clínico: Un varón de 58 años, diagnosticadopreviamente de carcinoma pulmonar de célulasgrandes, desarrolló una diplopía de carácter progresivo.En la exploración se objetivó una doble parálisisoculomotora con pupilas midriáticas y pocoreactivas. En la resonancia magnética craneal seevidenció una metástasis única y solitaria a nivelmesencefálico, que afectaba a ambos núcleos y fascículosdel III nervio craneal, en ausencia de másmanifestaciones extratorácicas.Discusión: Este caso muestra la posibilidad de queun carcinoma pulmonar pueda causar una dobleparálisis oculomotora como consecuencia de unametástasis solitaria de localización mesencefálica(AU)

Clinical Case: A 58 year-old man with a knowndiagnosis of a large cell lung carcinoma, developeda progressive diplopia. His examination revealed adouble oculomotor nerve palsy with dilated andpoorly reactive pupils. A cranial magnetic resonanceshowed an unique and solitary lesion in the midbrain,which presumably affected to both oculomotornucleus and fasciculus. There were not foundadditional extrathoracic manifestations.Discussion: This case shows the possibility that alarge cell lung carcinoma may cause a double oculomotornerve palsy as the consequence of an isolatedmidbrain metastasis(AU)

Lacrimal sac metastases from renal cell carcinoma.

PURPOSE: To report the first case of metastasis from renal cell carcinoma to the lacrimal sac and review the therapeutic options. METHODS: We have reviewed the case of a woman who was operated on for a renal cell carcinoma that developed epiphora and a lacrimal sac tumor, which corresponded to a metastasis from her previous tumor. Although renal cell carcinoma shows a great tendency for distant metastasis, this is the first reported case of metastasis to the lacrimal sac. RESULTS: We comment on the rarity of the case and on the therapeutic alternatives for these cases according to the reviewed literature. CONCLUSION: Metastasis to the lacrimal sac are rather infrequent and should be borne in mind on the appearance of a tumor in this location in people with a history of malignancy.