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Un caso inusual de oclusión de rama arterial retiniana: posible variante del síndrome de Sneddon 视网膜分支动脉闭塞的不寻常病例:可能是斯内登综合征的变种。
Q3 Medicine Pub Date : 2024-05-01 DOI: 10.1016/j.oftal.2024.01.007
V.M. Asensio-Sánchez

Sneddon's syndrome (SS) manifests through multiple strokes and livedo reticularis. Livedoid vasculopathy (LV) is characterized by a long history of foot and leg ulceration and histopathology indicating a thrombotic process. Arterial retinal branch occlusion is described in a 52-year-old male with LV. He did not present noticeable laboratory abnormalities, such as antiphospholipid antibodies, or a history of strokes. Retinal artery occlusion accompanied by LV could be a variant of Sneddon's syndrome. Optical coherence tomography angiography revealed a reduction in the macula's vascular layers in the asymptomatic eye, indicating localized microvascular changes as an evolving marker in the pathogenesis of SS.

斯内登综合征(SS)表现为多发性中风和活体网状组织病。韧带血管病(LV)的特征是长期足部和腿部溃疡,组织病理学显示为血栓形成过程。一名 52 岁的男性患者患有视网膜动脉分支闭塞症。他没有明显的实验室异常,如抗磷脂抗体,也没有中风病史。视网膜动脉闭塞伴左视网膜病变可能是斯内登综合征的一种变异。光学相干断层扫描血管造影术显示,无症状眼的黄斑血管层减少,表明局部微血管变化是斯内登综合征发病机制中一个不断发展的标志。
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引用次数: 0
Estudio multimodal de las metástasis coroideas difusas 弥漫性脉络膜转移的多模式研究
Q3 Medicine Pub Date : 2024-05-01 DOI: 10.1016/j.oftal.2024.01.005
R. García-Gil, A. Feliciano-Sánchez, R. Martínez-Costa Pérez
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引用次数: 0
Reflexiones acerca de la obligada y urgente necesidad de actualizar el programa oficial de la especialidad de oftalmología 对更新官方眼科专业教学大纲的必要性和紧迫性的思考
Q3 Medicine Pub Date : 2024-05-01 DOI: 10.1016/j.oftal.2023.10.012
J. González-Martín-Moro , A. Fernández Hortelano , R. Cobo-Soriano
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引用次数: 0
Imagen en retromodo para el diagnóstico de drusas del disco óptico: una serie de casos 用于诊断视盘色素沉着的 Retromode 成像:一个病例系列
Q3 Medicine Pub Date : 2024-05-01 DOI: 10.1016/j.oftal.2023.12.009
J.M. Lopez , M. Rabinovich , C.-J. Mehanna , G. Ricciotti , E. Crincoli , O. Semoun , A. Miere , E.H. Souied

Objective

We aimed to compare the detectability of optic disc drusen (ODD), using various non-invasive imaging techniques, including the novel retro-mode imaging (RMI), as well as to analyze the morphological characteristics of ODD on RMI.

Methods

This study involved 7 patients with bilateral ODD, totaling 14 eyes. Multimodal imaging techniques, including multicolor fundus photography (MC), near-infrared reflectance (NIR), green and blue light fundus autofluorescence (G-FAF and B-FAF, respectively), and RMI were used to examine the eyes. FAF was used as the primary method of identifying ODD, and each method's detection rate was compared by two observers. Quantitative measurements of ODD included the number of ODD visualized by the RMI technique, the perimeter (P) and area (A) of ODD were identified.

Results

The average age of the patients included was 49.28 ± 23.16 years, with 5 of the 7 being men. RMI was able to detect ODD in all cases, with a sensitivity of 100%, compared to MC (sensitivity 60.71%), NIR (sensitivity 60.71%), B-FAF (sensitivity 100%), G-FAF (sensitivity 100%). RMI was the only imaging technique capable of assessing ODD morphology and quantifying ODD.

Conclusions

RMI is a promising imaging modality for diagnosing superficial ODD, providing valuable information on the distribution, location, and size of ODD. We suggest the incorporation of RMI as a complementary tool for diagnosing and monitoring ODD in combination with other multimodal imaging methods.

方法 本研究涉及 7 例双侧视盘色素沉着(ODD)患者,共 14 只眼睛。研究采用了多模态成像技术,包括多色眼底照相(MC)、近红外反射(NIR)、绿光和蓝光眼底自动荧光(分别为 G-FAF 和 B-FAF)以及 RMI。FAF 是识别 ODD 的主要方法,每种方法的检出率由两名观察者进行比较。ODD 的定量测量包括 RMI 技术观察到的 ODD 数量、ODD 的周长(P)和面积(A)。与 MC(灵敏度为 60.71%)、NIR(灵敏度为 60.71%)、B-FAF(灵敏度为 100%)和 G-FAF(灵敏度为 100%)相比,RMI 能够检测出所有病例的 ODD,灵敏度为 100%。结论RMI 是一种很有前途的诊断浅表 ODD 的成像模式,可提供有关 ODD 分布、位置和大小的有价值信息。我们建议结合其他多模态成像方法,将 RMI 作为诊断和监测 ODD 的辅助工具。
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引用次数: 0
Resultados a largo plazo del tratamiento de la degeneración macular asociada a la edad neovascular mediante fármacos antiangiogénicos: revisión de la bibliografía 抗血管生成药物治疗新生血管性老年黄斑变性的长期疗效:文献综述
Q3 Medicine Pub Date : 2024-05-01 DOI: 10.1016/j.oftal.2023.11.004
J.E. Enríquez-Fuentes , C. Oribio-Quinto , M.A. Pascual-Santiago , A.D. Alarcón-García , J.I. Fernández-Vigo

Age-related macular degeneration (AMD) is one of the main causes of visual acuity (VA) loss in people over 50 years of age worldwide, with neovascular AMD (nAMD) accounting for 80% of cases of severe vision loss due to this disease. Anti-vascular endothelial growth factor (anti-VEGF) drugs have been used for the treatment of this disease for more than a decade, changing drastically the visual prognosis of these patients. However, initial studies reporting data on outcomes were short term. Currently, there are different series published on the long-term results of AMD after treatment with anti-VEGF, and the aim of this review is to synthesize these results. The mean follow-up of the included studies was 8.2 years (range 5-12 years). The mean initial VA was 55.3 letters in the Early Treatment Diabetic Retinopathy Study (ETDRS) (range 45.6-65) and the mean final VA was 50.1 letters (range 33.0-64.3), with a mean loss of 5.2 letters. At the end of follow-up, 29.4% of the patients maintained a VA > 70 letters. The 67.9% of patients remained stable at the end of follow-up (< 15 letter loss), with a severe loss (≥ 15 letters) of 30.1%. Fibrosis and atrophy were the main causes of long-term VA loss, occurring at the end of follow-up in 52.5% and 60.5%, respectively.

老年性黄斑变性(AMD)是导致全球 50 岁以上人群视力下降的主要原因之一,其中新生血管性黄斑变性(nAMD)占该疾病导致的严重视力下降病例的 80%。十多年来,抗血管内皮生长因子(anti-VEGF)药物一直被用于治疗这种疾病,极大地改变了这些患者的视力预后。然而,最初报告疗效的研究数据都是短期的。目前,关于抗血管内皮生长因子(anti-VEGF)治疗后AMD的长期疗效,已有不同的系列研究发表,本综述旨在对这些结果进行总结。纳入研究的平均随访时间为 8.2 年(5-12 年不等)。早期治疗糖尿病视网膜病变研究(ETDRS)的平均初始视力为 55.3 个字母(范围 45.6-65),平均最终视力为 50.1 个字母(范围 33.0-64.3),平均损失 5.2 个字母。随访结束时,29.4% 的患者视力保持在 70 个字母以上。67.9%的患者在随访结束时视力保持稳定(视力下降 15 个字母),视力严重下降(视力下降≥ 15 个字母)的患者占 30.1%。纤维化和萎缩是造成长期视力损失的主要原因,分别有 52.5% 和 60.5% 的患者在随访结束时发生了纤维化和萎缩。
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引用次数: 0
Membranas subretinianas en anillo de servilleta en la vitreorretinopatía proliferativa 增殖性玻璃体视网膜病变中的餐巾环视网膜下膜
Q3 Medicine Pub Date : 2024-05-01 DOI: 10.1016/j.oftal.2024.03.002
K. Arun, A. Makuloluwa
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引用次数: 0
Re-Descemet Membrane Endothelial Keratoplasty (DMEK) con preservación del injerto original tras free roll en cámara anterior: a propósito de un caso 前房游离滚动后保留原移植物的再去角膜内皮角膜移植术(DMEK):病例报告
Q3 Medicine Pub Date : 2024-04-01 DOI: 10.1016/j.oftal.2024.01.003
A. Arnaiz Camacho, S. Martín Nalda, T. Pablos Jiménez, S. García Hidalgo, A. Pairó Salvador, M.A. Zapata Victori

Introduction

Lamellar keratoplasties have had a great impact in the management of corneal edema due to endothelial dysfunction. Minimally invasive transplant techniques such as descemet membrane endothelial keratoplasty (DMEK) have helped to reduce the morbidity involved in performing penetrating keratoplasty in this type of patient. Even so, these are complex techniques that are not free of complications and require a long line of surgical learning and an even more demanding experience in postoperative management.

Clinical case

An 89-year-old woman suffering from Fuchs endothelial dystrophy and undergoing combined cataract and DMEK surgery presented stromal edema predominantly inferior and sectoral detachment of the graft 24 h after the intervention. After re-bubbling in consultations and 4 days later, the graft was observed rolled and free in the anterior chamber.

She underwent re-DMEK with preservation of the original graft after 24 h, with de-epithelialization to optimize visualization. The graft was stained with trypan blue and the posterior stroma was protected with air. The graft was reimplanted under intraocular maneuvers and with an air bubble.

Twenty four hours after surgery, the adhered graft was observed, with a great decrease in stromal edema. One month later, the patient had a clear cornea, persistent complete graft adhesion, and visual acuity of 0.9.

Conclusion

The discovery of free roll in the anterior chamber after DMEK surgery constitutes the most complex form of graft detachment. Corneal edema as well as the arrangement of the different intraocular structures are conditions to be considered for the surgical resolution of this complication. In many cases, surgical repositioning of the graft is feasible, which means saving costs without the need to use new donor corneal tissues.

导言梁状角膜移植术在治疗内皮功能障碍引起的角膜水肿方面产生了巨大影响。微创移植技术,如去斑膜内皮角膜移植术(DMEK),有助于降低此类患者进行穿透性角膜移植术的发病率。临床病例 一位 89 岁的妇女患有 Fuchs 内皮营养不良症,接受了白内障和去角质膜内皮角膜移植术联合手术,术后 24 小时出现基质水肿(主要是下部)和移植物扇形脱落。在会诊中再次泡水后,4 天后,观察到移植物在前房内翻滚和游离。她接受了再次 DMEK 手术,24 小时后保留了原来的移植物,并进行了去表皮处理,以优化视野。移植物用胰蓝染色,后基质用空气保护。术后 24 小时,观察到粘连的移植物,基质水肿明显减轻。一个月后,患者的角膜变得清澈,移植物持续完全粘附,视力达到 0.9。 结论 DMEK 手术后在前房中发现游离辊是最复杂的移植物脱离形式。角膜水肿以及不同眼内结构的排列是手术解决这一并发症时需要考虑的条件。在许多情况下,手术重新定位移植物是可行的,这意味着无需使用新的供体角膜组织就能节省成本。
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引用次数: 0
Ectropión congénito en síndrome de Noonan 努南综合征的先天性外翻
Q3 Medicine Pub Date : 2024-04-01 DOI: 10.1016/j.oftal.2023.12.008
M. Dorronsoro, M. Bertino, J.M. Suarez, G.J. Morocho Hermosa, S.J. Vivante, J.P. Aldecoa

Case report

Ten-year-old female patient, with facial dysmorphia, scoliosis, short stature, muscular hypotonia, patent foramen ovale and maturational delay, presented for correction of bilateral congenital ectropion. Ophthalmological examination revealed bilateral lower eyelid ectropion, euryblepharon and lagophthalmos, with a positive Bell's phenomenon. She was treated with full-thickness autologous skin grafts on the lower eyelids with bilateral lateral canthoplasty, resolving the ectropion and improving eyelid occlusion. Subsequently, a genetic study was performed that revealed a mutation in the PTPN11 gene and allowed, together with the clinical picture, to make the diagnosis of Noonan syndrome.

Discussion

Noonan syndrome is a multisystem genetic disorder with a wide variety of phenotypes, which usually presents with ocular and periocular disorders. Eyelid ectropion, a distinctive feature of this patient, is a rare ophthalmological manifestation of this syndrome that can be corrected with full-thickness skin graft and lateral canthoplasty.

病例报告十岁的女患者面部畸形、脊柱侧弯、身材矮小、肌张力低下、卵圆孔未闭和发育迟缓,前来接受双侧先天性眼睑外翻矫正术。眼科检查发现她双侧下眼睑外翻、眼睑外翻和眼睑下垂,贝尔现象阳性。她接受了下眼睑全厚自体皮肤移植手术和双侧眼睑外翻成形术,解决了眼睑外翻问题,并改善了眼睑闭合。讨论努南综合征是一种多系统遗传性疾病,具有多种表型,通常表现为眼部和眼周疾病。眼睑外翻是该患者的一个显著特征,是该综合征的一种罕见眼部表现,可以通过全厚皮肤移植和外侧眼睑成形术进行矫正。
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引用次数: 0
Queratoconjuntivitis por virus Monkeypox 猴痘病毒角结膜炎
Q3 Medicine Pub Date : 2024-04-01 DOI: 10.1016/j.oftal.2024.01.008
B. Son-Camey , G. Allendes Urquiza , R. Montejano-Milner , R. Cañones-Zafra
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引用次数: 0
Cavitación coroidea asociada a coloboma macular. Estudio multimodal. Imagen en face 黄斑部胶质瘤伴发的脉络膜空洞症。多模态研究。面部图像
Q3 Medicine Pub Date : 2024-04-01 DOI: 10.1016/j.oftal.2023.12.006
N. Ruiz del Rio, F. García Ibor, D. Hernández Pérez, A.M. Duch Samper

Intrachoroidal cavitation is a finding identified with OCT initially described in myopic patients, it also appears in non-myopic patients. It can occur in both the peripapillary area and the posterior pole. Macular coloboma is a defect of embryonic development of the posterior pole, in structural OCT the absence of the retinal pigment epithelium and choroidal vessels is essential. In this case, intrachoroidal cavitation circumscribes the macular coloboma, in the absence of an intercalary membrane. The face image allows us to assess the relationship between the two structures as well as their magnitude.

脉络膜内空洞最初是在近视患者身上发现的,但也出现在非近视患者身上。它既可发生在毛细血管周围,也可发生在后极。黄斑部胶质瘤是后极部胚胎发育的缺陷,在结构性 OCT 中,视网膜色素上皮和脉络膜血管的缺失至关重要。在这个病例中,由于没有闰膜,脉络膜内空化包围了黄斑部胶质瘤。通过面像,我们可以评估这两个结构之间的关系及其大小。
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引用次数: 0
期刊
Archivos De La Sociedad Espanola De Oftalmologia
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