[Angiomatous choroidal and orbital lesions in a patient with Sturge Weber syndrome]. / Síndrome de Sturge Weber: combinación de lesiones angiomatosas coroideas y orbitarias en un paciente.

CASE REPORT: We present the case of a 34-year-old man with Sturge-Weber syndrome, who presented to the emergency room with left ocular pain and left chronic exophthalmos. He suffered an acute glaucoma secondary to pupillary block consequent upon an anterior lens subluxation. Orbital contrast Magnetic Resonance Imaging (MRI) was performed and he underwent intracapsular lens extraction. DISCUSSION: The MRI showed T2 enhanced lesions in the left meninges, choroid, and orbit, compatible with cavernous hemangiomas, as well as a dilated superior ophthalmic vein. Intraocular pressure after cataract surgery was 10 mm Hg, and visual acuity was less than 20/200.

Síndrome de Sturge Weber: combinación de lesión angiomatosas coroideas y orbitarias en un paciente / Angiomatous choroidal and orbital lesions in a patient with Sturger Weber syndrome

Caso clínico: Se presenta el caso de un varón de 34 años afecto de síndrome de Sturge-Weber que acude a urgencias por dolor ocular y exoftalmos izquierdo. Presentaba un glaucoma agudo por bloqueo pupilar debido a luxación anterior de cristalino. Se realiza resonancia nuclear magnética (RMN) con contraste y extracción intracapsular de cristalino. Discusión: La RMN muestra lesiones hipercaptantes en T2 e isocaptante en T1 en meninges, coroides y órbita izquierdas compatibles con hemangiomas cavernosos, así como dilatación de vena oftálmica superior izquierda. La presión intraocular tras la cirugía es de 10 mm Hg y la agudeza visual es menor de 20/200

Case report: We present the case of a 34-year-old man with Sturge-Weber syndrome, who presented to the emergency room with left ocular pain and left chronic exophthalmos. He suffered an acute glaucoma secondary to pupillary block consequent upon an anterior lens subluxation. Orbital contrast Magnetic Resonance Imaging (MRI) was performed and he underwent intracapsular lens extraction. Discussion: The MRI showed T2 enhanced lesions in the left meninges, choroid, and orbit, compatible with cavernous hemangiomas, as well as a dilated superior ophthalmic vein. Intraocular pressure after cataract surgery was 10 mm Hg, and visual acuity was less than 20/200

Sida y oftalmología: una visión actual / AIDS and ophthalmology: a contemporary view

La aparición del Síndrome de InmunodeficienciaAdquirida (SIDA) significó una revolución en medicina,de la que no es ajena la Oftalmología: la presencia rutinariade patologías oftalmológicas hasta el momentoexcepcionales, como la retinitis por citomegalovirus(CMV), y la aparición de otras nuevas como la necrosisretiniana externa progresiva (NREP). La utilizacióngeneralizada de la terapia anterretroviral de gran actividad(TARGA), desde la segunda mitad de la décadade los 90, produce un punto de inflexión a partir delcual la mejoría inmunológica de los pacientes coninfección por el virus de la inmunodeficiencia humana(VIH) provoca la disminución de casos con patologíaoftalmológica asociada a inmunodepresión (retinopatíaVIH, retinitis por CMV, NREP…), y la mejoría espontáneade cuadros hasta entonces de evolución tórpida(sarcoma de Kaposi ocular, Molluscum palpebral…).Por contra, el continuo aumento de prevalencia de sífilisen estos pacientes se traduce en un aumento delnúmero de casos de sífilis ocular, no asociados a inmunodepresión.También aparecen nuevas alteraciones oftalmológicasrelacionadas con la TARGA: la uveítis por recuperacióninmune en pacientes con retinitis CMV en remisióncompleta y el enoftalmos por atrofia de la grasaorbitaria en el contexto de la lipodistrofia, asociada aantirretrovirales.En la actualidad deben realizarse controles oftalmológicospreventivos en pacientes con inmunodepresiónsevera hasta confirmar un recuento de linfocitosCD4 por encima de 100 células/ml. Si además presentanretinopatía VIH, es aconsejable una revisión mensualhasta la recuperación inmune, dado el mayor riesgo deinfección por CMV

The appearance of the Acquired ImmuneDeficiency Syndrome (AIDS) meant a revolution inmedicine, which has also affected Ophthalmology: theroutine presence of ophthalmological pathologieswhich until then had been exceptional, such as retinitisdue to cytomegalovirus (CMV), and the appearance ofother new pathologies such as progressive outerretinal necrosis (PORN). The generalised use of highactivity antiretroviral therapy (HAART) in the secondhalf of the 1990s represented a turning point, sincewhen the immunological improvement of patients withHuman Immunodeficiency Virus (HIV) resulted in a fallin the cases with ophthalmological pathologyassociated to immunodepression (HIV retinopathy,retinitis due to CMV, PORN…), and the spontaneousimprovement of symptoms which until then had had atorpid evolution (Kaposi’s ocular sarcoma, PalpebralMolluscum…). On the other hand, the continuousincrease in the prevalence of syphilis in these patientsmeans an increase in the number of cases of ocularsyphilis unassociated with immunodepression.New ophthalmological alterations also appear thatare related to HAART: uveitis due to immune recoveryin patients with CMV retinitis in complete remissionand the enophthalmos due to the atrophy of orbital fatin the context of lipodystrophy, associated withantiretrovirals.At present preventive ophthalmological checksmust be carried out on patients with severeimmunodepression until a count of lymphocytes above100 cells/ml is confirmed. If they also show HIVretinopathy, a monthly check up is advisable untilimmune recovery, given the greater risk of infection byCMV (AU)

[Cryptococcal choroiditis in a patient with acquired immunodeficiency syndrome]. / Coroiditis criptocócica en un paciente con síndrome de inmunodeficiencia adquirida.

PURPOSE/METHODS: We report the case of a 31 year old male with presumed cryptococcal choroiditis associated with cryptococcal meningitis and AIDS. Multiple yellowish-whitish small choroidal lesions, retinal hemorrhages and cotton-wool spots appeared in the posterior pole associated with vision loss. We also carried out differential diagnosis with other frequent diseases and a review of the treatments. RESULTS/CONCLUSIONS: Cryptococcus neoformans is an opportunistic fungus with a predilection for infecting the meninges in patients with Acquired Immunodeficiency Syndrome AIDS (10%). Ocular manifestation usually includes cranial nerve palsies or papilledema secondary to increased intracranial pressure. Cryptococcal choroiditis is less frequent (5% of patients with meningitis).

Coroiditis criptocócica en un paciente con Síndrome de Inmunodeficiencia Adquirida / Cryptococcal choroiditis in a patient with acquired Immunodeficiency Syndrome

Objetivo/Método: Presentamos el caso de un paciente de 31 años con presunta coroiditis criptocócica que ocurrió en el seno de una meningitis criptocócica y SIDA. Múltiples lesiones pequeñas blanco-amarillentas aparecieron bilateralmente en coroides, así como abundantes hemorragias y exudados algodonosos asociados a disminución de agudeza visual. También realizamos diagnóstico diferencial con otras entidades frecuentes y revisión de los tratamientos. Resultados/Conclusiones: Criptococos neoformans es un hongo oportunista con predilección por afectación meníngea en SIDA (10 por ciento). Las manifestaciones oculares normalmente son por afectación de los pares craneales o por papiledema secundario al aumento de presión intracraneal (hasta en un 50 por ciento de los casos). La coroiditis criptocócica ocurre menos frecuentemente (5 por ciento de pacientes con meningitis) (AU)

Purpose/Methods: We report the case of a 31 year old male with presumed cryptococcal choroiditis associated with cryptococcal meningitis and AIDS. Multiple yellowish-whitish small choroidal lesions, retinal hemorrhages and cotton-wool spots appeared in the posterior pole associated with vision loss. We also carried out differential diagnosis with other frequent diseases and a review of the treatments. Results/Conclusions: Cryptococcus neoformans is an opportunistic fungus with a predilection for infecting the meninges in patients with Acquired Immunodeficiency Syndrome AIDS (10%). Ocular manifestation usually includes cranial nerve palsies or papilledema secondary to increased intracranial pressure. Cryptococcal choroiditis is less frequent (5% of patients with meningitis) (AU)

Propionibacterium acnes endophthalmitis in Ahmed glaucoma valve.

PURPOSE: To report a case of Propionibacterium acnes endophthalmitis in a patient with an Ahmed glaucoma valve. CASE REPORT: A nine-year-old boy with bilateral congenital glaucoma, with an Ahmed glaucoma valve implanted in the left eye, had recurrent conjunctival dehiscence and endophthalmitis. RESULTS: Vitreous cultures demonstrated the presence of Propionibacterium acnes. CONCLUSIONS: This is the first reported case of Propionibacterium acnes endophthalmitis in an Ahmed glaucoma valve and the second one in a glaucoma drainage device. We strongly recommend using a patch graft to prevent and treat tube exposure. Conjunctival grafts may be useful to close the conjunctiva when there is marked scarring to prevent patch exposure and melting or extrusion.

Intravitreal ganciclovir treatment in progressive outer retinal necrosis.

PURPOSE: To report two patients with progressive outer retinal necrosis, which is presumed to be caused by the varicella-zoster virus in patients with acquired immunodeficiency syndrome (AIDS). METHOD: Case report. RESULTS: The patients were treated with intravenous foscarnet, 60 mg per kg of body weight three times per week, without response. Remission of retinal necrosis occurred with the commencement of intravitreal ganciclovir treatment, 400 mg two times per week. Laser photocoagulation was performed in both cases. Neither patient developed retinal detachment. CONCLUSIONS: Intravitreal ganciclovir treatment combined with systemic antiviral agent therapy in patients with progressive outer retinal necrosis may delay progress of the disease. Early photocoagulation may prevent the development of retinal detachment if retinal necrosis is controlled.

Tuberculous choroiditis and acquired immunodeficiency syndrome.

Tuberculosis is a common illness among patients with acquired immunodeficiency syndrome (AIDS), and therefore, choroidal tubercles are expected to be found in these patients. Nevertheless, this association (AIDS-induced choroidal tuberculosis) is infrequently reported in the literature. We report four cases of patients with AIDS and tuberculosis who did not have any visual complaints and in whom a routine funduscopic examination disclosed the presence of choroidal nodules. These lesions were not accompanied by vitritis, iridocyclitis, or any sign of uveitis as has been reported in cases of tuberculous choroiditis in patients with AIDS by others in the literature.

Fluconazole in the management of endophthalmitis in disseminated candidosis of heroin addicts.

Seven heroin addicts were treated with fluconazole for endophthalmitis. All the patients had cutaneous lesions: deep-seated scalp nodules and/or pustulosis in hairy zones. One patient had an abscess at the venipuncture site. Candida albicans was isolated from all the extraocular sites in all the patients. Five patients were treated with 400 mg of intravenous fluconazole on the first day, followed by 200 mg (i.v.) for one week and finally 200 mg daily orally for a further two weeks. Two patients were treated exclusively with oral fluconazole (400 mg on the first day, followed by 200 mg daily for three consecutive weeks). Tolerance to fluconazole was good and it was not necessary to stop treatment for any patient. All the cutaneous lesions stabilized and healed. The eye lesions cleared completely in all cases, except in one patient in whom vitrectomy was indicated, and in whom there was a poor response to the exclusive treatment with fluconazole and associated corticosteroids.

Keratomycosis due to Scedosporium apiospermum.

Although no overt injury occurred, a corneal abscess without hypopyon developed in a normal, 25-year-old female, living in a suburban area of Madrid, following a period of intensive garden work. Direct examination of the corneal scrapings on one occasion showed septate, branched hyphal elements. When scrapings were cultured on Sabouraud glucose and brain heart infusion agars a pure culture of Scedosporium apiospermum was repeatedly isolated. The patient responded successfully to treatment with miconazole ointment, although a residual immune ring of the cornea remained and final visual acuity was 6/10.