Mácula en cúpula asociada a la retinocoroidosis miópica. Utilidad de la espironolactona / Dome shaped macula associated with myopic retinochoroidosis. Use of spironolactone

Casos clínicos: Se presentan los casos de 3 mujeres de 22, 36 y 55 años de edad con retinocoroidosis miópica bilateral. Las pacientes presentan disminución de agudeza visual unilateral, tonometría y biomicroscopia bilateral normal. En la funduscopia se evidencia maculopatía unilateral, y en la tomografía de coherencia óptica (OCT), mácula en cúpula con desprendimiento neurosensorial (DNS). Iniciado tratamiento con espironolactona, en todos los casos se comprueba mejoría por OCT. Discusión: Se discute el mecanismo etiopatogénico de la mácula en cúpula. La OCT se demuestra como técnica fundamental en el seguimiento de esta patología. Tras la evidencia mostrada, se postula tratamiento inicial con espironolactona (AU)

Cases reports: The cases are presented of three women of 22, 36 and 55 years old with bilateral myopic retinochoroidosis. They had unilateral decreased visual acuity, normal bilateral tonometry, and biomicroscopy. Funduscopy showed bilateral and unilateral myopic maculopathy, and Optical Coherence Tomography (OCT) showed a dome shaped macula with neurosensory detachment. Treatment was started with spironolactone and an improvement by OCT was shown in all cases. Discussion: The etiopathogenic mechanism of the dome shaped macula is discussed. OCT demonstrated to be the fundamental test in the follow-up of this condition. After the evidence shown, initial treatment with spironolactone is suggested (AU)

Facoemulsificación versus iridotomía láser en el glaucoma primario de ángulo cerrado. Una decisión difícil / Phacoemulsification versus laser iridotomy in primary angle closure glaucoma. A difficult decision

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Dome shaped macula associated with myopic retinochoroidosis. Use of spironolactone. / Mácula en cúpula asociada a la retinocoroidosis miópica. Utilidad de la espironolactona.

CASES REPORTS: The cases are presented of three women of 22, 36 and 55 years old with bilateral myopic retinochoroidosis. They had unilateral decreased visual acuity, normal bilateral tonometry, and biomicroscopy. Funduscopy showed bilateral and unilateral myopic maculopathy, and Optical Coherence Tomography (OCT) showed a dome shaped macula with neurosensory detachment. Treatment was started with spironolactone and an improvement by OCT was shown in all cases. DISCUSSION: The etiopathogenic mechanism of the dome shaped macula is discussed. OCT demonstrated to be the fundamental test in the follow-up of this condition. After the evidence shown, initial treatment with spironolactone is suggested.

Espironolactona, alternativa terapéutica en el tratamiento de la epiteliopatía difusa crónica / Spironolactone, a therapeutic alternative in the treatment of diffuse retinal pigment epitheliopathy

CASOS CLÍNICOS: Se presentan 2 casos clínicos de epiteliopatía difusa crónica (EDC) con respuesta favorable a espironolactona. En el primer paciente se visualizan regiones de desprendimiento neurosensorial (DNS), y en el segundo múltiples DNS, quistes intrarretinianos secundarios y desprendimiento del epitelio pigmentario de la retina. DISCUSIÓN: Tras el tratamiento con espironolactona, se observa mejoría de la agudeza visual y de las alteraciones estructurales en ambos pacientes (disminución del DNS y quistes intrarretinianos). Los fármacos antagonistas de los receptores de aldosterona usados para formas persistentes de coriorretinopatía central serosa (CRCS) tienen resultados alentadores, y podrían ser una alternativa terapéutica en la EDC

CASE REPORT: Two cases are presented of patients with chronic diffuse epitheliopathy (CDE) that showed a favourable response when treated with spironolactone. The first patient had regions of neurosensory detachment (DNS) and the second, multiple DNS, secondary intra-retinal cysts and retinal pigment epithelium detachment. DISCUSSION: After treatment with spironolactone, both patients showed a visual acuity improvement and structural changes (reduced neurosensory retinal detachment and cystoid degeneration). Aldosterone receptor agonists (ARA) used for persistent forms of chronic central serous chorioretinopathy show encouraging results and could represent a therapeutic alternative for CDE

Spironolactone, a therapeutic alternative in the treatment of diffuse retinal pigment epitheliopathy. / Espironolactona, alternativa terapéutica en el tratamiento de la epiteliopatía difusa crónica.

CASE REPORT: Two cases are presented of patients with chronic diffuse epitheliopathy (CDE) that showed a favourable response when treated with spironolactone. The first patient had regions of neurosensory detachment (DNS) and the second, multiple DNS, secondary intra-retinal cysts and retinal pigment epithelium detachment. DISCUSSION: After treatment with spironolactone, both patients showed a visual acuity improvement and structural changes (reduced neurosensory retinal detachment and cystoid degeneration). Aldosterone receptor agonists (ARA) used for persistent forms of chronic central serous chorioretinopathy show encouraging results and could represent a therapeutic alternative for CDE.

Delving into cornerstones of hypersensitivity to antineoplastic and biological agents: value of diagnostic tools prior to desensitization.

BACKGROUND: Evidence regarding drug provocation test (DPT) with antineoplastic and biological agents is scarce. Our aim was to assess the usefulness of including DPT as a paramount gold standard diagnostic tool (prior to desensitization). METHODS: Prospective, observational, longitudinal study with patients who, during a 3-year period, were referred to the Desensitization Program at Ramon y Cajal University Hospital. Patients underwent a structured diagnostic protocol by means of anamnesis, skin tests (ST), risk assessment, and DPT. Oxaliplatin-specific IgE was determined in oxaliplatin-reactive patients (who underwent DPT regardless of oxaliplatin-specific IgE results). Univariate analysis and multivariate analysis were used to identify predictors of the final diagnosis among several variables. RESULTS: A total of 186 patients were assessed. A total of 104 (56%) patients underwent DPT. Sixty-four percent of all DPTs were negative (i.e., hypersensitivity was excluded). Sensitivity for oxaliplatin-specific IgE (0.35 UI/l cutoff point) was 34%, specificity 90.3%, negative predictive value 45.9%, positive predictive value 85%, negative likelihood ratio 0.7, and positive likelihood ratio 3.5. CONCLUSIONS: These are the first reported data based on more than 100 DPTs with antineoplastic and biological agents (paclitaxel, oxaliplatin, rituximab, infliximab, irinotecan, and other drugs). Implementation of DPT in diagnostic protocols helps exclude hypersensitivity (in 36% of all referred patients), and avoids unnecessary desensitizations in nonhypersensitive patients (30-56% of patients, depending on culprit-drug). Drug provocation test is vital to validate diagnostic tools; consequently, quality data are shown on oxaliplatin-specific IgE and oxaliplatin-ST in the largest series of oxaliplatin-reactive patients reported to date (74 oxaliplatin-reactive patients). Identifying phenotypes and predictors of a diagnosis of hypersensitivity may be helpful for tailored plans.

Desensitizing Oxaliplatin-Induced Fever: A Case Report

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Hypersensitivity and desensitization to antineoplastic agents: outcomes of 189 procedures with a new short protocol and novel diagnostic tools assessment.

BACKGROUND: Desensitization to antineoplastic agents is becoming a standard of care. Efforts to establish and improve these techniques are being made at many institutions. Our aims are to evaluate a new rapid desensitization protocol designed to be shorter (approximately 4 h) and safer (reducing hazardous drugs exposure risks) and to assess the oxaliplatin-specific immunoglobulin E (IgE) as a novel diagnostic tool. METHODS: Prospective, observational, longitudinal study with patients who, for a 1-year period, suffered reactions to antineoplastic agents and were referred to the Desensitization Program at Ramon y Cajal University Hospital (RCUH). Patients were included or excluded as desensitization candidates after anamnesis, skin testing, risk assessment, and graded challenge. Specific IgE was determined in oxaliplatin-reactive patients. Candidate patients were desensitized using the new RCUH rapid desensitization protocol. RESULTS: Of 189 intravenous rapid desensitizations, 188 were successfully accomplished in the 23 patients who met inclusion criteria for desensitization (of 58 referred patients). No breakthrough reactions occurred in 94% of desensitizations, and most breakthrough reactions were mild. In 10 oxaliplatin-reactive patients, 38 desensitizations were successfully accomplished. Sensitivity for oxaliplatin-specific IgE was 38% (0.35UI/l cutoff point) and 54% (0.10UI/l cutoff point); specificity was 100% for both cutoff points. CONCLUSIONS: In the hands of a Desensitization Program, managed by drug desensitization experts, this new protocol has proven an effective therapeutic tool for hypersensitivity to several antineoplastic agents (oxaliplatin, carboplatin, paclitaxel, docetaxel, cyclophosphamide, and rituximab); moreover, it improves safety handling of hazardous drugs. We report the first large series of oxaliplatin desensitizations. Oxaliplatin-specific IgE determination could be helpful.