Atrofia coriorretiniana pigmentada paravenosa de presentación unifocal y unilateral / Unifocal and unilateral pigmented paravenous retinochoroidal atrophy

La atrofia coriorretiniana pigmentada paravenosa es una entidad infrecuente, asociada a enfermedades autoinmunes y otras complicaciones oculares, generalmente multifocal, bilateral y simétrica. Se presenta el caso clínico de una paciente con artritis reumatoide que acude por dolor de varios días. Presenta disminución de agudeza visual de ojo izquierdo, escleritis nodular y atrofia coriorretiniana con acumulación de pigmento en espículas óseas en arcada vascular temporal inferior y agujero macular lamelar. El ojo derecho no presenta alteraciones. La autofluorescencia del ojo izquierdo muestra hipoautofluorescencia de bordes definidos en la lesión. La angiografía con fluoresceína evidencia hiperfluorescencia compatible con degeneración del epitelio pigmentario retiniano y bloqueo en las áreas de pigmento. El campo visual revela un defecto altitudinal en hemicampo superior. Este caso describe una atrofia coriorretiniana pigmentada paravenosa atípica unifocal y unilateral. Se debe conocer esta variante para realizar un correcto diagnóstico diferencial, así como proporcionar una información pronóstica adecuada (AU)

Paravenous pigmented chorioretinal atrophy is a generally multifocal, bilateral and symmetric rare entity associated with autoimmune diseases and other ocular complications. We present the clinical case of a patient with rheumatoid arthritis who attended for pain of several days. He presented decreased visual acuity of the left eye, nodular scleritis and chorioretinal atrophy with pigment accumulation in bone spicules in the inferior temporal vascular arcade and lamellar macular hole. The right eye shows no alterations. LE autofluorescence shows a hypoautofluorescence lesion with defined edges. Fluorescein angiography shows hyperfluorescence consistent with retinal pigmentary epithelial degeneration and blockage in pigment areas. The visual field reveals a defect in the superior hemifield. This case describes an atypical unifocal and unilateral paravenous pigmented chorioretinal atrophy. This variant must be known to make a correct differential diagnosis, as well as to provide adequate prognostic information (AU)

Unifocal and unilateral pigmented paravenous retinochoroidal atrophy.

Paravenous pigmented chorioretinal atrophy (PPRCA) is a generally multifocal, bilateral and symmetric rare entity associated with autoimmune diseases and other ocular complications. We present the clinical case of a patient with rheumatoid arthritis who attended for pain of several days. He presented decreased visual acuity of the left eye (LE), nodular scleritis and chorioretinal atrophy with pigment accumulation in bone spicules in the inferior temporal vascular arcade and lamellar macular hole (AML). The right eye shows no alterations. LE autofluorescence (AF) shows a hypoautofluorescence lesion with defined edges. Fluorescein angiography (FAG) shows hyperfluorescence consistent with retinal pigmentary epithelial degeneration and blockage in pigment areas. The visual field (VC) reveals a defect in the superior hemifield. This case describes an atypical unifocal and unilateral PPRCA. This variant must be known to make a correct differential diagnosis, as well as to provide adequate prognostic information.

[Comparing central corneal thickness measured using ultrasound pachymetry and the Pentacam in healthy subjects and patients with primary open-angle glaucoma]. / Comparaison de l'épaisseur cornéenne centrale mesurée par pachymétrie ultrasonore et par Pentacam chez les patients sains et les patients avec glaucome primaire à angle ouvert.

PURPOSE: To determine the capacity for measurement of central corneal thickness by ultrasound pachymetry and by Pentacam (pachymetry at the pupillary axis and minimum corneal pachymetry) to discriminate between healthy controls and patients with primary open-angle glaucoma. METHODS: Measurements of the left eyes of 123 control subjects and 128 glaucomatous patients were taken. Differences between the two data sets for each variable were identified using a t-test for independent samples. Three univariate binary logistic regression models (to discriminate between glaucoma and controls) were constructed, in which the predictive variables were the determinations of corneal thickness. RESULTS: All variables showed a normal distribution. Controls and patients failed to differ significantly in terms of ultrasound pachymetry but did differ in terms of pupillary axis thickness (mean difference 22.01µm in favour of controls; 95% CI: 5.61-34.15) and minimum corneal thickness (mean difference 21.65µm in favour of controls; 95% CI: 3.05-32.25). The logistic regression model for ultrasound pachymetry was not significant (P=0.051) but significant discriminatory capacity was shown for pupillary axis thickness (expB=0.987; 95% CI: 0.99-0.993; sensitivity: 58.5%; specificity: 64.8%) and minimum corneal thickness (expB=0.987; 95% CI: 0.981-0.994; sensitivity: 61.9%; specificity: 63.1%). CONCLUSIONS: Central corneal thickness measurement by Pentacam, while not an ad hoc diagnostic test for glaucoma, showed a similar yet not inappreciable capacity to discriminate between glaucoma patients and controls.

[Comparison of Goldmann applanation and dynamic contour tonometry measurements: effects of corneal morphometry]. / Concordancia entre la tonometría de aplanación de Goldmann y la tonometría de contorno dinámico: efectos de la morfometría corneal.

OBJECTIVES: To compare intraocular pressure (IOP) measurements made by Goldmann applanation tonometry (GAT) and dynamic contour tonometry (DCT). METHODS: IOPs were measured by GAT and DCT in 63 eyes of 63 healthy subjects. A comparison was made by intraclass correlation coefficient. Passing-Bablok plot was constructed to establish the existence of systematic and/or proportional biases. Multivariate regression analysis was used to examine whether the measurements of both instruments were affected by the power of the steepest and flattest corneal axes, their orientation, age or central corneal thickness (CCT). RESULTS: The intra-class correlations (ICCs) were 0.57 (95% confidence interval (95% CI): 0.29-0.74). Mean differences were 1.68 (DCT minus GAT) (95% CI: 0.92-2.44). Passing-Bablok analysis (X=DCT, Y=GAT) revealed a systematic bias (A=-14.35, 95% CI: -24.51-[-9.14]) and a proportional bias (B=1.74, 95% CI: 1.43-2.26). Multivariate regression analysis revealed that the DCT was independent of the corneal characteristics analysed while GAT was biased by CCT (B=0.042, 95% CI: 0.002-0.082). CONCLUSIONS: While GAT was biased by corneal CCT; DCT readings were independent of corneal morphometry.

Concordancia entre la tonometría de aplanación de Goldmann y la tonometría de contorno dinámico: efectos de la morfometría corneal / Comparison of Goldmann applanation and dynamic contour tonometry measurements: effects of corneal morphometry

Objetivos: Determinar la concordancia entre la presión intraocular (PIO) medida mediante tonometría de aplanación de Goldmann (TAG) y tonometría de contorno dinámico (TCD).MétodosLa PIO se midió mediante TAG y TCD en 63 ojos de 63 voluntarios sanos. La concordancia se determinó mediante coeficiente de correlación intraclase (CCI). Se empleó el método de Passing-Bablok para establecer la presencia de sesgos proporcionales y/o sistemáticos. El análisis de regresión multvariable se empleó para determinar si las diferencias estaban condicionadas por la potencia de los ejes mayor y menor de la córnea, por su orientación, por el grosor corneal central (GCC) y por la edad.ResultadosEl CCI fue 0,57 (intervalo de confianza [IC] al 95%: 0,29-0,74). La diferencia media entre los dos instrumentos fue 1,68mmHg (TCD menos TAG) (IC 95%: 0,92-2,44). El análisis de Passing-Bablok (X=DCT, Y=GAT) reveló la presencia de un sesgo sistemático (A=-14,35, IC 95%: -24,51-[-9,14]) y otro proporcional (B=1,74, IC 95%: 1,43-2,26). El análisis de regresión multivariable mostró una total independencia del TCD de las características corneales mientras que la TAG estaba afectada por el GCC (B=0,042 CI 95%: 0,002-0,082).ConclusionesLa TCD se mostró independiente de las características morfométricas de la córnea mientras que la TAG se afectó por el GCC (AU)

Objectives: To compare intraocular pressure (IOP) measurements made by Goldmann applanation tonometry (GAT) and dynamic contour tonometry (DCT).MethodsIOPs were measured by GAT and DCT in 63 eyes of 63 healthy subjects. A comparison was made by intraclass correlation coefficient. Passing-Bablok plot was constructed to establish the existence of systematic and/or proportional biases. Multivariate regression analysis was used to examine whether the measurements of both instruments were affected by the power of the steepest and flattest corneal axes, their orientation, age or central corneal thickness (CCT).ResultsThe intra-class correlations (ICCs) were 0.57 (95% confidence interval (95% CI): 0.29-0.74). Mean differences were 1.68 (DCT minus GAT) (95% CI: 0.92-2.44). Passing-Bablok analysis (X=DCT, Y=GAT) revealed a systematic bias (A=-14.35, 95% CI: -24.51-[-9.14]) and a proportional bias (B=1.74, 95% CI: 1.43-2.26). Multivariate regression analysis revealed that the DCT was independent of the corneal characteristics analysed while GAT was biased by CCT (B=0.042, 95% CI: 0.002-0.082).ConclusionsWhile GAT was biased by corneal CCT; DCT readings were independent of corneal morphometry (AU)

Specificity of the program threshold noiseless trend for perimetric progression analysis.

PURPOSE: To evaluate the specificity of the Threshold Noiseless Trend program (TNT), designed to measure progression in visual fields, using four procedures. MATERIALS AND METHODS: A. In 63 eyes with ocular hypertension, whose last examination showed no perimetric or morphological defects, we performed a mean of 7.70 +/- 1.71 follow-up examinations during 2.2 +/- 0.6 years. B. In 81 glaucomatous eyes examined twice with a bracketing strategy (Octopus 1-2-3 perimeter), we calculated mean threshold value and long-term fluctuation. We simulated 12 different visual fields, adding a random component to simulate an equivalent fluctuation of amplitude. C. Seventy-two glaucomatous eyes, with and without progression, were examined 7.76 +/- 1.25 times during 4.88 +/- 1.39 years using the Humphrey-Sita Standard strategy. Visual field tests were randomly disordered and analyzed using TNT. D. 1221 eyes were examined 7.19 +/- 3.5 times during 3.50 +/- 1.45 years (10,407 visual fields) using TOP-G1 program. We detected progression in 204 eyes using TNT. They were re-evaluated after random disordering of visual field tests. RESULTS: The four procedures indicated specificity > or = 95% as from the seventh examination; this reduced to 90% in experiment C with six examinations, and in experiments A and C with five examinations. CONCLUSIONS: The specificity of TNT may be considered to be over 95% with a large number of examinations, and 90-100% with fewer examinations. At least five examinations are required for a basic interpretation of progression, and preferably more than six to guarantee the specificity of the result.