Lateral rectus muscle biopsy as diagnosis of unknown metastatic breast cancer. / Biopsia del músculo recto lateral orbitario como diagnóstico de cáncer de mama metastásico no conocido.

The case concerns a 58 year-old female with no medical history of interest who consulted due to binocular diplopia of one week onset. It was associated with costal pain, dyspnoea, intense asthenia and weight loss of 2 months onset. In the blood analysis in the Emergency Department it showed hypercalcaemia, renal failure, and bicytopenia. The chest x-ray showed lytic bone lesions that initially lead to multiple myeloma with extra-osseous involvement. In addition to the corresponding study, in case of horizontal diplopia, a cranial CT scan without contrast was performed where an adjacent lesion to the lateral wall of the left orbit is observed. This was of soft tissue density, and included the external rectus muscle that exerts a mass effect on the optic nerve by displacing it medially. Many lytic bone diffuse lesions with salt and pepper pattern were found in the calotte. A rectus lateral muscle and bone biopsy of the sacral wing was performed, resulting in metastasis of carcinoma compatible with mammary origin. An atypical case is presented of horizontal diplopia in the context of a patient with a severe constitutional picture with no established diagnosis, in which the biopsy of the lateral rectum was key to the confirmation diagnosis.

External ophthalmomyiasis due to Dermatobia hominis. A case report. / Oftalmomiasis externa por Dermatobia hominis. A propósito de un caso.

CLINICAL CASE: A 46-year-old woman with no relevant medical history, native of Honduras and resident in Spain for one and a half months. The patient went to the Emergency Department due to inflammation of the upper eyelid of the right eye, with an area that simulated an abscess. This was drained (obtaining hardly any purulent content). Treatment was prescribed with oral and topical antibiotics, as well as an anti-inflammatory drug. One week later the patient returned, with improvement of the inflammatory signs, but with discomfort and corneal erosions. After eversion of the upper eyelid, a «worm¼ type parasite emerged from the tarsus. The extraction was completed with a clamp, and was later identified as Dermatobia hominis (Dh) by examination of a fresh specimen. The subsequent outcome of the patient was favourable. DISCUSSION: Preseptal cellulitis in patients from tropical and sub-tropical areas can be caused by Dh.

Acute bilateral serous central chorioretinopathy after emergency contraceptive therapy with ulipristal acetate. / Coriorretinopatía serosa central aguda bilateral tras terapia anticonceptiva de urgencia con acetato de ulipristal.

CASE REPORT: The case concerns a 31 year-old woman with no previous history who consulted due to decreased vision in both eyes. She mentioned taking 1 pill of ulipristal acetate (30mg) as an emergency contraceptive four days before the visual symptoms appeared. In the examination, a better corrected visual acuity of 0.6 was found in the right eye and 0.8 in left eye (by Snellen chart), and bilateral macular serous detachment. It was decided to observe, and 15 days later she showed a functional and anatomical improvement. DISCUSSION: Ulipristal acetate could lead to serous central chorioretinopathy due to its activity on the progesterone receptors present in choroidal and retinal pigment epithelium.

Keratitis secondary to Fusarium spp. in Spain 2012-2014. / Queratitis secundaria a Fusarium spp. en España 2012-2014.

OBJECTIVE: To describe the clinical-epidemiological characteristics of a case series of fungal keratitis associated with Fusarium spp.., in Spain during the years 2012 to 2014. METHODS: A retrospective study of a case series was conducted on a systematic random sample of 10% of patients identified in Health Centres of provincial capitals (n=250). The centres were asked whether they had been presented with cases of Fusarium spp. keratitis characterised by microbiological methods. Of the 23 centres that responded, 14 had detected cases, with 13 of them accepting to participate, and 11 of them completing the study. The latter being sent a previously validated questionnaire. The variables analysed were: age, gender, habitual residence, profession, disease and medical history (previous systemic and ocular diseases, previous eye surgeries), and their outcomes. RESULTS: The response rate was 92%, identifying 23 cases of Fusarium spp.. of which 21 (91.3%) of them lived in urban areas. The professions most affected by the disease included chefs, administrative, and technical, with 13 cases (56.5%). The treatment guidelines established to confirm the infection showed the combined use of topical antibiotics associated with antiviral and/or antifungal agents. The use of contact lenses (86.9%) was the main risk factor. DISCUSSION: This study showed that this is a rare disease in Spain, but that a large percentage of people who present with the disease are resident in urban areas, and they work in closed environments, focusing attention on microtraumas caused by use of contact lenses.

[Somatostatin analogue treatment in Graves' ophthalmopathy: a case report]. / Tratamiento de la enfermedad de Graves con análogos de la somatostatina: caso clínico.

CASE REPORT: The effect of a somatostatin analogue in a patient with Graves' ophthalmopathy is presented, including data on the dose requirements and the results of therapy. DISCUSSION: There are few effective options for the management of Graves' ophthalmopathy, a cell-mediated immune co-morbidity of thyroid disease. Somatostatin analogues inhibit lymphocyte proliferation and activation, and accumulate in the orbital tissue during the active ophthalmopathy. Because of this, such therapy is able to inactivate the ophthalmopathy without complications occurring.

[Retinal nerve fiber layer thickness analysis in children from 6 to 9 years of age]. / Análisis del espesor de la capa de fibras nerviosas en niños de 6 a 9 años.

PURPOSE: To establish a database of scanning laser polarimetry (GDx) parameters for children between 6 and 9 years of age and compare the results at each age. METHODS: The retinal nerve layer thickness of 116 children from one school was evaluated with GDx and the results were analyzed for each age and for the entire group to determinate the normal range for that population. RESULTS: In the global analysis of the software-derived GDx parameters, we obtained a TSNIT average of 59.43 (IC95% 58.41-60.45), a superior average of 71.35 (IC95% 69.99-72.70), an inferior average of 70.08 (IC95% 68.71-71.45), and a TSNIT Std. Deviation of 25.11 (IC95% 24.36-25.86). The results from the analysis for age were similar to the global results. CONCLUSIONS: Given the low level of cooperation required, GDx can be used without problem to study the retinal nerve fiber layer in 6-9-year-old children. GDx could provide objective information about the state of development of the retinal nerve fiber layer during this period of life.

[Limbal relaxing incisions and cataract surgery: our experience]. / Incisiones limbares relajantes y cirugía de la catarata: nuestra experiencia.

PURPOSE: To evaluate the reduction of pre-existing corneal astigmatism at the time of cataract surgery with limbal relaxing incisions (LRIs). METHODS: A prospective study of two groups of patients (treatment and control) with pre-existing astigmatism>or=1D was performed. The 30 patients in the control group had a temporal clear corneal phacoemulsification and the 32 patients of treatment group had combined temporal clear corneal phacoemulsification and LRIs. Holladay analysis was used to assess the efficacy of treatment. An astigmatism distribution and prevalence study in our population is also presented. RESULTS: Three months after surgery, the mean astigmatism change was -0.55D (-0.75 to -0.35) in the treatment group and 0.04D (-0.3 to 0.3) in the control group (p<.0001). CONCLUSIONS: LRI is a simple, safe and effective method not only for reducing pre-existing astigmatism during cataract surgery but in providing good unaided visual acuity.

[Simultaneous botulism in two brothers addicted to cocaine]. / Botulismo simultáneo en dos hermanos cocainómanos.

INTRODUCTION: Botulism is currently an uncommon disease in which the botulinum toxin causes a progressive muscular paralysis that can lead to the death due to a failure of respiratory muscles. CLINICAL CASE: Two brothers, both addicted to cocaine, came to the casualty department because of a decrease of near visual acuity and bilateral mydriasis. Two days later, they developed eyelid ptosis, asymmetric dysfunction of the extraocular muscles and vomiting. DISCUSSION: The presence of a paralysis of accommodation, with bilateral mydriasis that reacts to pilocarpine, makes it necessary to consider botulism as a possible cause.

[Octreotide scintigraphy in thyroid orbitopathy]. / Gammagrafía con octreótido en la orbitopatía distiroidea.

INTRODUCTION: Graves' disease, which has an autoimmune basis, is associated with the infiltration of activated lymphocytes into the retrobulbar tissues of the eye. These activated lymphocytes express somatostatin receptors on their surface which mediate the inflammatory response. OBJECTIVE: To evaluate the efficiency of (111) In-Octreotide scintigraphy in the identification of orbital activity in Graves' disease and the usefulness of treatment with a somatostatin analogue, based on a pre-established protocol within the Nuclear Medicine Department. METHODS: We studied a group of eighteen patients with symptomatic Graves' ophthalmopathy of between two months and four years duration. We injected 6 mCi of (111) In-Octreotide parenterally, and performed scintigraphy four and twenty-four hours later. Four patients, all in the active phase, showed orbital somatostatin receptors, for which they were treated with lanreotide 60 mg every fifteen days for three months. Patients were reviewed after 3 months treatment with a further scintigraphy and clinical study. RESULTS: In our study all four treated patients had less than sixteen months of ophthalmopathy, and three responded well to the treatment. CONCLUSION: Scintigraphy with Octreotide is a useful procedure allowing identification of patients in the active phase of the ophthalmopathy who are likely to respond well to treatment with somatostatin analogues.

[Optic nerve glioma in a case of neurofibromatosis-1 in a child]. / Glioma de nervio óptico en un caso de neurofibromatosis-1 infantil.

CLINICAL CASE: The case of a three-year-old patient with neurofibromatosis type I is presented. Ophthalmologic evaluation revealed, by means of magnetic resonance imaging, the presence of a silent glioma in the optic nerve of the left eye. DISCUSSION: Neurofibromatosis-1 can present in multiple ways to the ophthalmologist, with a glioma of the optic nerve being one of the most frequent central nervous system presentations in this illness. Generally the glioma affects the optic chiasm and its course is indolent, with conservative management and close monitoring usually being advised until progression is defined.

[First results after implanting 125 acrylic lenses (Acrysof MA60BM)]. / Primeros resultados tras el implante de 125 lentes acrílicas (Acrysof MA60BM).

PURPOSE: Analysis of the results obtained after the implantation of 125 AcrySof IOLs. METHODS: A retrospective study in 125 patients with cataracts was performed; 98 without previous eye diseases and 27 with previous eye disease (diabetic retinopathy, traumatic cataract, central corneal leucoma and glaucoma). The phacoemulsification technique chosen depended on the type of cataract (<>, <>). Patients were followed up for an average of 9 months. RESULTS: Functional results (best corrected visual acuity in patients suffering from pre-operative eye diseases were 0.5 or higher in 22.22% of cases, whereas in the group without any disease was higher in 100%. AcrySof was implanted in sulcus when the posterior capsule was ruptured. CONCLUSIONS: AcrySof is a soft acrylic IOL which can be very safely and effectively implanted, and it did not lead to complications nor to adverse effects in our study. It is a safe, foldable IOL for small incision and phacoemulsification cataract surgery.

[Modification of the conjuntival flora with cleaning palpebral solutions]. / Modificación de la flora conjuntival por el empleo de soluciones de higiene palpebral.

OBJECTIVE: The aim of the present study is to evaluate the effectiveness of a solution of palpebral hygiene during the preoperative stage of cataract surgery. MATERIALS AND METHODS: We studied 286 patients divided in 5 groups. One control group that did not use the product, and the remaining 4, that used the product during 3, 4, 5 and 6 days. The design of the study was prospective, randomize and masked. We took a sample of the conjunctival fundus in the morning of the day of the surgery, before commencing treatment with eye drops. This sample was sown according to microbiological techniques and analyzed by the microbiology department. RESULTS: The best time for using palpebral hygiene solutions prior to cataract surgery is four to five days. If it is used at less than three days, it does not decrease the rate of positive cultures and if the solution is applied more than six days, microorganisms that are not part of the common conjunctival flora may appear. CONCLUSIONS: Palpebral hygiene products should not be used more than five consecutive days previous to surgery.

[Recurrent and chronic central serous chorioretinopathy. Retina thickness evaluation one month after intravitreal bevacizumab injection]. / Coriorretinopatía serosa central recidivante y crónica. Estudio del espesor retiniano al mes del tratamiento con una inyección de bevacizumab intravítreo.

PURPOSE: To evaluate the efficacy of intavitreal injection of bevacizumab in patients with chronic central serous chorioretinopathy. METHODS: A study of 8 patients with central serous chorioretinopathy who were treated with intravitreal injection of bevacizumab. We studied the visual acuity with Snellens method and the foveal thickness, before and after the injection. RESULTS: The mean age of the patients was 50.25 years. After one month of follow-up, visual acuity before the injection was 0.431 ± 0.249 vision lines and after was 0.631 ± 0.310 vision lines (P=.017).The foveal thickness was 351.25 ± 78.492 µm and after treatment was 183.50 ± 22.640 µm (P=.012). CONCLUSIONS: Intravitreal bevacizumab can be an alternative treatment in patients with serous central chorioretinopathy as it leads to a better objective visual acuity and foveal thickness with optical coherence tomography.