Corticodependent bilateral trochleitis.

Trochleitis is usually a transient and non-disabling inflammation of the trochlea of superior oblique. The case is presented of a difficult to manage bilateral trochleitis in a 29-year-old woman. After an exhaustive aetiological study with neuro-imaging tests, as well as an analysis of autoimmunity and infection, no underlying cause was found. Multiple injections of corticosteroids were required in both eyes, with a partial effect. Surgical intervention was finally decided in order to visually examine the trochlea, take biopsies, and inject methylprednisolone. These were effective in relieving the symptoms. This case is exceptional due to it involving both eyes and its severity, and represented a therapeutic challenge for the clinical team.

Trocleítis bilateral corticodependiente / Corticodependent bilateral trochleitis

La trocleítis es habitualmente una inflamación transitoria, unilateral y no incapacitante de la tróclea del oblicuo superior. Presentamos el caso de una trocleítis bilateral en mujer de 29 años de evolución tórpida. Tras estudio etiológico exhaustivo con pruebas de neuroimagen, análisis de autoinmunidad e infeccioso no se encontró ninguna causa subyacente. Precisó múltiples infiltraciones en ambos ojos con efecto parcial. Finalmente se decidió intervención quirúrgica para exploración visual de la tróclea, toma de biopsias e infiltración de metilprednisolona que resultaron eficaces en el alivio sintomático. Este caso es excepcional por su bilateralidad y severidad, suponiendo un desafío terapéutico para el equipo clínico (AU)

Trochleitis is usually a transient and non-disabling inflammation of the trochlea of superior oblique. The case is presented of a difficult to manage bilateral trochleitis in a 29-year-old woman. After an exhaustive aetiological study with neuro-imaging tests, as well as an analysis of autoimmunity and infection, no underlying cause was found. Multiple injections of corticosteroids were required in both eyes, with a partial effect. Surgical intervention was finally decided in order to visually examine the trochlea, take biopsies, and inject methylprednisolone. These were effective in relieving the symptoms. This case is exceptional due to it involving both eyes and its severity, and represented a therapeutic challenge for the clinical team (AU)

[Appraisal of the formation of afterimages by means of a new computer application in patients with demyelinating optic neuropathies]. / Valoracion de la formacion de postimagenes mediante una nueva aplicacion informatica en pacientes con neuropatias opticas desmielinizantes.

INTRODUCTION: The perception of colour is one of the visual functions affected by optic neuritis. Most of the tests currently available for evaluating dichromatism are based on assessing the hue, but no clinical studies have been conducted to investigate the formation of afterimages on the retina of these patients. AIMS: To evaluate the dichromatism acquired in demyelinating optic neuritis by means of the formation of afterimages on the retina. SUBJECTS AND METHODS: This is an observation-based, cross-sectional, case-control study. The cases are patients with at least one bout of optic neuritis and confirmed multiple sclerosis. A healthy age- and sex-paired control was selected for each case. The main variable is the capacity to see afterimages after saturation of the retinal photoreceptor cells. A specific computer application was developed to evaluate this phenomenon. RESULTS: The sample consisted of 30 cases and 30 controls (63% females; mean age: 33 years; range: 18-48 years). The cases showed less probability of seeing the afterimage (36.6% of the cases, while none of the controls failed to see an afterimage) and, if it was seen, it remained for less time. The ROC curve shows a sensitivity of 86.3% and a specificity of 83.3%. The odds ratio was 5 (95% confidence interval: 2.21-11.3) for the probability of seeing the afterimage in controls versus cases. CONCLUSIONS: Patients with at least one episode of optic neuritis presented a lower capacity to observe afterimages. The test is therefore useful in the assessment and follow-up of functional damage in demyelinating optic neuropathies.

TITLE: Valoracion de la formacion de postimagenes mediante una nueva aplicacion informatica en pacientes con neuropatias opticas desmielinizantes.Introduccion. En las neuritis opticas se afecta, entre otras funciones visuales, la percepcion del color. La mayoria de las pruebas existentes para evaluar discromatopsias se basa en evaluar el matiz, pero no se ha estudiado clinicamente la formacion de postimagenes en la retina en estos pacientes. Objetivo. Evaluar la discromatopsia adquirida en las neuritis opticas desmielinizantes mediante la formacion de postimagenes en la retina. Sujetos y metodos. Estudio observacional, transversal, de casos y controles. Los casos son pacientes con al menos un episodio de neuritis optica y esclerosis multiple confirmada. Se selecciono un control sano por cada caso, emparejado por edad y sexo. La variable principal es la capacidad de ver postimagenes tras saturar los fotorreceptores retinianos. Para evaluar dicho fenomeno se desarrollo una aplicacion informatica especifica. Resultados. La muestra comprende 30 casos y 30 controles (63% mujeres; edad media: 33 años; rango: 18-48 años). Los casos mostraron menor probabilidad de ver la postimagen (el 36,6% de los casos y ningun control no veian postimagen) y, en caso de verla, una menor permanencia de ella. La curva ROC muestra una sensibilidad del 86,3% y una especificidad del 83,3%. La odds ratio era de 5 (intervalo de confianza al 95%: 2,21-11,3) para la probabilidad de ver la postimagen en los controles frente a los casos. Conclusiones. Los pacientes con al menos un episodio de neuritis optica presentan una menor capacidad de observar postimagenes, por lo que la prueba es util para la evaluacion y el seguimiento del daño funcional en neuropatias opticas desmielinizantes.