Papilitis y neurorretinitis de etiología tuberculosa / Papillitis and neuroretinitis of tuberculous etiology

Varón de 57 años con tuberculosis miliar que refirió pérdida visual por ojo derecho, al mes de iniciar un régimen antituberculoso de 4 fármacos. En la exploración se objetivó un edema papilar sectorial inferior que fue atribuido a etiología isquémica. Se le retiró el etambutol y se le administraron 60mg diarios de prednisona oral en pauta descendente. Al mes y medio, presentó una pérdida súbita de visión en el ojo izquierdo. En el fondo de ojo se observó un edema de papila acompañado de un desprendimiento neurosensorial de la fóvea, sin más signos uveíticos acompañantes. Le fue intensificado el tratamiento con moxifloxacino y se redujeron los corticoides, objetivándose una resolución del desprendimiento macular, pero con atrofia óptica. Es posible la afectación tuberculosa aislada del nervio óptico en el contexto de una tuberculosis miliar. En este caso, la actitud terapéutica adoptada ante la papilitis inicial, al ser interpretada como isquémica, pudo favorecer la aparición de la neurorretinitis en el ojo adelfo

A 57-year-old man with miliary tuberculosis reported visual loss in his right eye, a month after starting a four-drug antituberculous treatment regimen. On exploration, an inferior segmental optic disc edema was objectived and it was attributed to ischemic aetiology. Ethambutol was withdrawn and 60mg of oral prednisone daily were given with a tapering dosage. One and a half months later, he presented a sudden loss of vision in his left eye. In fundoscopy, a papillary edema accompanied by a foveal neurosensory detachment was observed but with no more accompanying uveitic signs. Treatment was intensified with moxifloxacin and corticosteroids were reduced, showing a resolution of the macular detachment but with optic atrophy. Isolated tuberculous involvement of the optic nerve may possible in the context of miliary tuberculosis. In this case, the adopted therapeutic approach to the initial papillitis, which was interpreted as ischemic, could favour the appearance of a neuroretinitis in the fellow eye

Optic nerve head drusen in black patients.

BACKGROUND: Several studies have suggested racial differences in the prevalence of optic nerve head drusen (ONHD). We aimed to determine the percentage of patients with ONHD who are black and to describe the clinical, ophthalmoscopic, and perimetric findings in these patients. METHODS: We conducted a retrospective chart review of all patients with ONHD seen at our institution between 1989 and 2010. Only black patients with ONHD confirmed on either funduscopy or B-scan ultrasonography were included. Demographic and clinical findings in these patients were recorded and analyzed. RESULTS: Of the 196 patients with confirmed ONHD, 10 (5.1%) were black. This included 7 females and 3 males with ages ranging from 8 to 61 years. Six of the 10 patients had bilateral ONHD. The ONHD were buried in 11 of 16 eyes and exposed in 5 of 16 eyes. Fifteen of 16 eyes with ONHD had small cupless optic nerve heads. Visual fields were normal in 4 of 16 eyes with ONHD. In the remainder, visual field defects included an enlarged blind spot (5 eyes), constricted field (5 eyes), nasal defect (2 eyes), central defect (1 eye), and generalized depression (1 eye). Visual field defects were present in 4 of 5 eyes (80%) with exposed ONHD and 8 of 11 eyes (72.7%) with buried ONHD. None of the patients were related, and none of their examined family members had exposed ONHD on funduscopic examination. CONCLUSIONS: ONHD are rare in blacks, possibly due to the presence of a larger cup-to-disc ratio or a lack of predisposing genetic factors. Visual field defects are common in black patients with both exposed and buried ONHD.

Ocular manifestations and prognosis of shaken baby syndrome in two Japanese children's hospitals.

PURPOSE: To distinguish the profiles of patients and ophthalmologic features and to describe the prognosis of shaken baby syndrome (SBS) in Japan. METHODS: Charts of child abuse cases involving retinal hemorrhage at Kanagawa Children's Medical Center and the National Center for Child Health and Development between January 1997 and December 2007 were retrospectively reviewed. The mean follow-up period was 22.2 months (range, 0-115 months). RESULTS: Twenty-one boys and 11 girls were identified. The mean age at the initial visit was 7.0 months (range, 4 days to 17 months). Four boys died during hospitalization. Seventeen eyes of ten patients (31%) had vitreous hemorrhage; 16 eyes of eight patients (25%) had a more favorable ocular prognosis with no apparent complications. Eight infants (25%) had been born prematurely. The mean maternal age was 29.9 years, and mothers were the primary perpetrator in 19 cases (59%). CONCLUSIONS: The clinical features of SBS in Japan are comparable to those in the Western literature. However, we have also found some idiosyncratic features in Japanese SBS cases; the mother is more frequently the perpetrator and abusive parents are older than in the United States, possibly reflecting current trends in Japan toward later marriage.