Retinoblastoma: la importancia de su diagnóstico precoz / Retinoblastoma: The importance of early diagnosis

INTRODUCCIÓN: El retinoblastoma es el tumor intraocular maligno más frecuente en la infancia y tanto su curación como las secuelas derivadas del mismo dependen fundamentalmente de un diagnóstico precoz. En la actualidad, no existe consenso en su manejo diagnóstico y terapéutico. PACIENTES Y MÉTODOS: Estudio descriptivo, retrospectivo, no aleatorizado, de serie de casos (39 pacientes-58 ojos), tratados durante el período 2006-2013 en nuestro servicio, nombrado centro de Referencia Regional de Tumores por la Agencia de Calidad del SNS. RESULTADOS: El signo más frecuente de comienzo es la leucocoria (71,8%), seguido de estrabismo (17,9%). Todos los casos de tumoración bilateral presentaban mutación germinal del gen RB1 y un 20% tenían antecedentes familiares. El 55% de los pacientes presentaron estadio E, y el 90% precisó tratamiento quimioterápico. Un 57% de los que presentaban estadios leves, conservaron su ojo respecto al 43% que lo conservó en estadios avanzados. CONCLUSIONES: Este análisis consta de 58 ojos, sin que existan estudios previos en nuestra comunidad y pocas series tan numerosas en todo el país. Basado en tratamiento no estandarizados, eligiendo el más adecuado según las características del tumor. El manejo multidisciplinar, formado por oftalmología, oncología pediátrica, oncología radioterápica y radiofísica, es fundamental para la elección de tratamiento más correcta. La quimiorreducción junto a tratamientos de consolidación ofrece resultados esperanzadores en el control de los mismos, sobre todo en los de menor severidad. La enucleación continúa siendo de elección en las estadificaciones más avanzadas con afectación vítrea, poniendo de manifesto la importancia de su diagnóstico precoz

INTRODUCTION: Retinoblastoma is the most frequent malignant intraocular tumour in childhood, and both its cure and the sequelae arising from it, mainly depend on an early diagnosis. There is currently no consensus on its diagnostic and therapeutic management. PATIENTS AND METHODS: A descriptive, retrospective, and non-randomised study was conducted on a series of cases (39 patients -58 eyes), treated during the period 2006-2013, in the Regional Reference Centre for Tumours of the National Health Service Quality Agency. RESULTS: The most frequent presentation sign is leukocoria (71.8%), followed by strabismus (17.9%). All cases of bilateral tumour had a germline mutation of the RB1 gene, and 20% had a family history. Stage E was observed in 55% of the patients, and 90% required chemotherapy treatment. The eye was maintained in 57% of those who had mild stages, compared to 43% who maintained it in advanced stages. CONCLUSIONS: This analysis included 58 eyes. There are no previous studies in our community and there are few series so numerous throughout the country. Based on non-standardised treatment, the most appropriate is chosen according to the characteristics of the tumour. The multidisciplinary management, formed by ophthalmology, paediatric oncology, radiotherapy, and radiophysical oncology, is fundamental for the selection of the most appropriate treatment. Chemo-reduction, along with consolidation treatments, offers encouraging results in the control of these tumours, especially in those of less severity. Enucleation continues to be the method of choice in the most advanced staging with vitreous involvement, with the importance of early diagnosis being highlighted

Retinoblastoma: The importance of early diagnosis. / Retinoblastoma: la importancia de su diagnóstico precoz.

INTRODUCTION: Retinoblastoma is the most frequent malignant intraocular tumour in childhood, and both its cure and the sequelae arising from it, mainly depend on an early diagnosis. There is currently no consensus on its diagnostic and therapeutic management. PATIENTS AND METHODS: A descriptive, retrospective, and non-randomised study was conducted on a series of cases (39 patients -58 eyes), treated during the period 2006-2013, in the Regional Reference Centre for Tumours of the National Health Service Quality Agency. RESULTS: The most frequent presentation sign is leukocoria (71.8%), followed by strabismus (17.9%). All cases of bilateral tumour had a germline mutation of the RB1 gene, and 20% had a family history. Stage E was observed in 55% of the patients, and 90% required chemotherapy treatment. The eye was maintained in 57% of those who had mild stages, compared to 43% who maintained it in advanced stages. CONCLUSIONS: This analysis included 58 eyes. There are no previous studies in our community and there are few series so numerous throughout the country. Based on non-standardised treatment, the most appropriate is chosen according to the characteristics of the tumour. The multidisciplinary management, formed by ophthalmology, paediatric oncology, radiotherapy, and radiophysical oncology, is fundamental for the selection of the most appropriate treatment. Chemo-reduction, along with consolidation treatments, offers encouraging results in the control of these tumours, especially in those of less severity. Enucleation continues to be the method of choice in the most advanced staging with vitreous involvement, with the importance of early diagnosis being highlighted.

[Distribution of met-enkephalin expression in the visual pathway. Experimental study by inmunocytochemistry]. / Distribución de la metencefalina en la vía óptica. Estudio experimental inmunocitoquímico.

PURPOSE: The localization and distribution of neuropeptide expression in the cat visual pathway can provide information about the function of that pathway. METHOD: Study of optic pathway in eight cats. Following extraction of the brain, slices were prepared using a microkeratome. The slices were examined by indirect immunocytochemistry using anti-metenkephalin as antibody to determine the presence or absence of this pentapeptide in the visual pathway. RESULTS: Met-enkephalin receptors in both cortical and subcortical regions of the brain were detected. This suggests that met-enkephalin could be involved in the visual mechanism. CONCLUSIONS: The presence of met-enkephalin receptors in both cortical and subcortical regions of the brain suggests that this pentapeptide could be involved in the visual mechanism.

Distribución de la metencefalina en la vía óptica. Estudio experimental inmunocitoquímico / Distribution o met-enkephalin expression in the visual pathway. Experimental study by inmunocytochemstry

Objetivo: Conocer la localización y distribución deneuropéptidos en la vía óptica, concretamente, ladeterminación de inmunorreactividad a met-encefalina,clave para la funcionalidad de dicha vía.Método: Se analizó la vía óptica de ocho gatos.Tras extracción quirúrgica; cortes con microqueratomoy procesamiento mediante inmunocitoquímicaindirecta, utilizando como anticuerpo la antimetencefalina,con el fín de detectar la presencia oausencia del pentapéptido en la vía óptica del gato.Resultados: Se detectaron receptores a met-encefalinaen áreas del encéfalo tanto corticales como subcorticales.Así, se considera la posible implicaciónde dicho pentapéptido en la funcionalidad de la víaóptica.Conclusiones: La presencia de receptores a metencefalinaen áreas del encéfalo tanto corticalescomo subcorticales, muestra la posible implicaciónde dicho neurotransmisor en la funcionalidad de lavía óptica (AU)

Purpose: The localization and distribution of neuropetideexpression in the cat visual pathway can provideinformation about the function of that pathway.Method: Study of optic pathway in eight cats.Following extraction of the brain, slices were preparedusing a microkeratome. The slices were examinedby indirect immunocytochemistry using antimetenkephalinas antibody to determine the presenceor absence of this pentapeptide in the visualpathway.Results: Met-enkephalin receptors in both corticaland subcortical regions of the brain were detected.This suggests that met-enkephalin could be involvedin the visual mechanism.Conclusions: The presence of met-enkephalinreceptors in both cortical and subcortical regions ofthe brain suggests that this pentapeptide could beinvolved in the visual mechanism(AU)

[Subconjunctival application of plasma platelet concentrate in the treatment of ocular burns. Preliminary results]. / Aplicación subconjuntival de concentrado de plaquetas plasmáticas en el tratamiento de quemaduras oculares. Resultados preliminares.

PURPOSE: The efficiency of the subconjunctival application of autologous platelet concentrate in patients with ocular burns was assessed. METHODS: This was carried out by analysing the effect of treatment in the eyes of 10 patients suffering from ocular burns as a result of work-related accidents. Two types of treatment were evaluated: the first group only received conventional topical medical treatment; and the second group, in addition, had subconjunctival injection of plasma platelet concentrate. The clinical condition of the patient and the period in which the disease prevented the patient from working were studied; monitoring was carried out until the burns had fully healed. RESULTS: Statistically significant differences were found between the group treated with subconjunctival autologous platelet concentrate and the group treated with conventional topical medications, with a shorter period of time in corneal and conjunctival healing, time on sick leave and time needed for full healing. CONCLUSIONS: Subconjunctival infiltration of autologous platelet concentrate should be considered as a straightforward, economical and possibly effective form of treatment for traumatic accidents (burns) of the ocular surface.

[Ocular hypertension in children treated with brimonidine 0.2%. A clinical study]. / Tratamiento de la hipertensión ocular infantil con colirio de brimonidina 0,2%.

PURPOSE: To evaluate the safety and efficacy of topical brimonidine 0.2% use in children. MATERIALS AND METHODS: A descriptive study of twelve successive children (21 eyes) who needed topical treatment of intraocular hypertension, and where the use of b-blockers was contraindicated. RESULTS: During treatment we observed an average decrease of IOP of 5 SD 1.8 mmHg (21% of basal IOP), but found more common local symptoms, with stinging being complained of in 52.4% of cases. Somnolence was also complained of in two cases.

Tratamiento de la hipertensión ocular infantil con colirio de brimonidina 0.2% / Ocular hypertension in children treated with brimonidine 0.2%. A clinical study

Objetivos: Se ha valorado la seguridad y eficaciade uso del colirio de brimonidina 0,2% en niños.Método: Se estudiaron doce niños con hipertensiónocular (21 ojos) y contraindicación del uso de betabloqueantes.Se realiza estudio descriptivo de casossucesivos de niños que necesitaban tratamientomédico tópico por hipertensión ocular.Resultados: En cuanto a la eficacia del tratamientose observa un descenso medio de la PIO de 5 DE1,8 mmHg (21% de la PIO basal) y en cuanto a laseguridad en el uso del medicamento se encontrócon síntomas más frecuentes a nivel local el escozoren un 52,38% de los casos y a nivel sistémico laaparición de somnolencia en dos casos

Purpose: To evaluate the safety and efficacy of topical brimonidine 0.2% use in children. Materials and methods: A descriptive study of twelve successive children (21 eyes) who needed topical treatment of intraocular hypertension, and where the use of b-blockers was contraindicated. Results: During treatment we observed an average decrease of IOP of 5 SD 1.8 mmHg (21% of basal IOP), but found more common local symptoms, with stinging being complained of in 52.4% of cases. Somnolence was also complained of in two cases

[Binocular vision in congenital glaucoma]. / La vision binoculaire dans le glaucome congénital.

We have studied binocular vision in a group of 189 patients suffering from congenital glaucoma, before and after treatment, as well as the elements upon which vision depends. Therapeutic modalities, including occlusion are discussed. We insist on the possibility of recovering binocular vision in congenital glaucoma.