Archivos de la Sociedad Espanola de Oftalmologia最新文献

英文中文

Telemedicine characteristics using WhatsApp™ in ophthalmology WhatsAppTM在眼科远程医疗中的应用特点。

Archivos de la Sociedad Espanola de Oftalmologia

Pub Date : 2026-01-01 DOI: 10.1016/j.oftale.2025.502431

C. Sevillano , V. Rodríguez López

Background and objective

Telemedicine allows for shorter diagnostic times and is cost-effective. One of the most widely used instant messaging applications in our field is WhatsApp™. We analyze the use of this application in our specialty, to determine whether it is useful for everyday use in our clinical practice.

Material and methods

All teleconsultations from 2024 carried out through this application to the same mobile phone were collected. The origin, the reason for consultation and the most frequent diagnoses, as well as the characteristics of the applicants, were analyzed.

Results

Of the 206 teleconsultations, 65% became from the patient himself. The average age of the applicants was 42.66, with 38% being men. 81% were seeking a diagnosis, whose most frequent pathologies were conjunctivitis and ametropias. WhatsApp™ allows for fast and effective communication, although they are young patients due to a probable digital divide. In our experience, it has allowed us to avoid face-to-face consultations (77%) and, more importantly, to bring forward some potentially serious ones quickly.

Conclusions

It is a cost-effective, fast tool that adds advantages to our daily clinical practice.

背景和目的：远程医疗可以缩短诊断时间，并且具有成本效益。在我们的领域使用最广泛的即时通讯应用程序之一是WhatsApp TM。我们分析这个应用程序在我们专业的使用情况，以确定在我们的临床实践中是否对日常使用有用。材料和方法：收集2024年以来通过该应用程序对同一手机进行的所有远程咨询。分析了本病的发病原因、就诊原因和最常见的诊断，以及患者的特点。结果：206次远程问诊中，65%来自患者本人。申请者的平均年龄为42.66岁，其中男性占38%。81%的患者寻求诊断，其最常见的病理是结膜炎和屈光不正。WhatsAppTM允许快速有效的沟通，尽管他们是年轻的患者，因为可能存在数字鸿沟。根据我们的经验，它使我们能够避免面对面的磋商（77%），更重要的是，能够迅速提出一些潜在的严重问题。结论：它是一种经济、快速的工具，为我们的日常临床实践增添了优势。

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引用次数: 0

Stellate Multiform Amelanotic Choroidopaty and the importance of its diagnosis to avoid overtreatment 星状多形态无色变性脉络膜病变及其诊断对避免过度治疗的重要性。

Archivos de la Sociedad Espanola de Oftalmologia

Pub Date : 2026-01-01 DOI: 10.1016/j.oftale.2025.502451

E. Gracia-Rovira , V. Miralles Pechuán , D. Hernandez Pérez , E. Cervera Taulet , A.-M. Duch Samper , J. Montero Hernández

SMACH (Stellate Multiform Amelanotic Choroidopathy) is a rare entity that should be considered for differential diagnosis of choroidal lesions with subretinal fluid, particularly in young patients. We present the case of a 15-year-old male with a yellow-orange choroidal lesion in the right eye, initially misinterpreted as an infection process due to the presence of a cutaneous erythema and environmental exposure. Multimodal imaging — including OCT, en-face OCT, and ICG — was essential in identifying the hallmark features of SMACH: dendriform projections, choroidal hyperreflectivity in absence of pachyvessels or deep vascular alteration, and a stellate hypofluorescent pattern. The self-limited nature of the subretinal fluid and the absence of inflammatory signs supported the diagnosis. Recognizing SMACH avoided unnecessary treatments such as anti-VEGF therapy or corticosteroids. This is Spain’s first case, it underscores the importance of early diagnosis through multimodal imaging to prevent overtreatment and to improve both visual and emotional outcomes for the patient.

SMACH（星状多形态无色变性脉络膜病）是一种罕见的疾病，在视网膜下积液脉络膜病变的鉴别诊断中应予以考虑，特别是在年轻患者中。我们报告一例15岁男性右眼黄橙色脉络膜病变，由于皮肤红斑和环境暴露，最初被误解为感染过程。多模式成像（包括OCT、正面OCT和ICG）对于识别SMACH的标志性特征至关重要：树突状突出、脉络膜高反射率（无厚血管或深部血管改变）和星状低荧光模式。视网膜下液的自限性和无炎症体征支持诊断。识别SMACH避免了不必要的治疗，如抗vegf治疗或皮质类固醇。这是西班牙的第一例病例，它强调了通过多模态成像进行早期诊断的重要性，以防止过度治疗，并改善患者的视觉和情感结果。

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引用次数: 0

New horizons in the treatment of non-infectious uveitis 非感染性葡萄膜炎治疗的新视野。

Archivos de la Sociedad Espanola de Oftalmologia

Pub Date : 2026-01-01 DOI: 10.1016/j.oftale.2025.502430

A. Fonollosa , A. Adán

引用次数: 0

The simultaneous treatment of post-traumatic aphakia, aniridia, and astigmatism 同时治疗创伤后无晶状体、无虹膜和散光。

Archivos de la Sociedad Espanola de Oftalmologia

Pub Date : 2026-01-01 DOI: 10.1016/j.oftale.2025.502444

I. Jürgens , A. Dyrda

To present a case of a 20-year-old female who underwent a novel surgical technique for post-traumatic aphakia, aniridia, and astigmatism. Prior to surgery, the artificial iris (AI) (Customflex Artificial Iris, HumanOptics) was sutured to a toric intraocular lens (IOL) (Carlevale, Soleko), folded, and then implanted in the sulcus through a small corneal incision. The procedure was complication-free and resulted in favorable functional and cosmetic outcomes. The Carlevale IOL provides stable support for the AI, effectively addressing post-traumatic aphakia, aniridia, and astigmatism. This technique ensures excellent centration, six-point fixation in the sulcus, and improved visual and aesthetic results.

报告一位20岁的女性，她接受了一种新的手术技术来治疗创伤后失光、无虹膜和散光。手术前，将人工虹膜（AI）（Customflex artificial iris, HumanOptics）与环形人工晶状体（IOL）（Carlevale, Soleko）缝合，折叠，然后通过角膜小切口植入沟内。该手术无并发症，结果良好的功能和美容效果。Carlevale人工晶状体为人工智能提供稳定的支持，有效解决创伤后无晶状体、无虹膜和散光问题。该技术确保了良好的定位，在沟内的六点固定，并改善了视觉和美学效果。

引用次数: 0

Subconjunctival seeding of ciliary body melanoma after trabeculectomy: A surgical pitfall 小梁切除术后睫状体黑色素瘤的结膜下播种：一个手术陷阱。

Archivos de la Sociedad Espanola de Oftalmologia

Pub Date : 2026-01-01 DOI: 10.1016/j.oftale.2025.502434

Y.S. Atlıhan

A rare case of ciliary body melanoma (CBM) with subconjunctival extension following prior trabeculectomy is presented. The 66-year-old female patient experienced recurrent ocular discomfort and subconjunctival pigmentation in the left eye. Clinical evaluation identified a pigmented subconjunctival mass, secondary glaucoma, and evidence of previous filtration surgery. Imaging and histopathology confirmed CBM with extraocular extension, and the patient subsequently underwent enucleation; the postoperative recovery was uneventful.

This case underscores the importance of considering intraocular tumors such as CBM in patients presenting with unilateral secondary glaucoma, especially prior to filtration surgery. Surgical manipulation in undiagnosed CBM may facilitate tumor dissemination beyond the eye, emphasizing the necessity of comprehensive preoperative evaluation.

本文报告一例罕见的睫状体黑色素瘤（CBM）在小梁切除术后出现结膜下延伸。66岁女性患者反复眼部不适，左眼结膜下色素沉着。临床评估发现结膜下有色素性肿块，继发性青光眼和既往滤过手术的证据。影像学和组织病理学证实CBM伴眼外扩张，患者随后行去核术；术后恢复顺利。本病例强调了单侧继发性青光眼患者考虑眼内肿瘤如CBM的重要性，特别是在滤过手术之前。未确诊CBM的手术操作可能促进肿瘤向眼外扩散，强调术前综合评估的必要性。

引用次数: 0

Sleep-disordered breathing in patients with total bilateral blindness: A 10-year prospective study 全双侧失明患者的睡眠呼吸障碍：一项10年前瞻性研究。

Archivos de la Sociedad Espanola de Oftalmologia

Pub Date : 2026-01-01 DOI: 10.1016/j.oftale.2025.502453

V.M. Asensio-Sánchez , A. Prieto , V. Roig

Background and objective

Obstructive sleep apnea (OSA) is common in the general population and is associated with major cardiovascular consequences and impaired quality of life. The absence of light perception in patients with total bilateral blindness (TBB) promotes circadian desynchronization, which may increase the risk of OSA. The aim of this study was to assess the prevalence of OSA and other sleep-disordered breathing conditions in patients with TBB.

Patients and methods

This was a prospective observational study conducted over a 10-year period, including 19 patients with TBB of various etiologies. Clinical interviews, validated questionnaires (STOP-BANG, ESS), and in-laboratory overnight polysomnography were performed.

Results

Moderate to severe OSA was present in 63.2% (12/19) of patients, with a predominance among males. Significant alterations in sleep architecture were observed, along with a high frequency of circadian desynchronization (non-24-h sleep–wake disorder).

Conclusions

Patients with TBB show a significantly higher prevalence of OSA compared with the general population, probably related to circadian desynchronization secondary to the absence of light perception. These findings support the need for systematic screening for sleep-disordered breathing in this population, given its impact on quality of life and cardiovascular risk.

背景和目的：阻塞性睡眠呼吸暂停（OSA）在普通人群中很常见，并与主要心血管后果和生活质量受损有关。全双侧失明（TBB）患者的光感知缺失促进昼夜节律不同步，这可能增加OSA的风险。本研究的目的是评估阻塞性睡眠呼吸暂停和其他睡眠呼吸障碍在TBB患者中的患病率。患者和方法：这是一项为期10年的前瞻性观察研究，包括19例不同病因的TBB患者。临床访谈，验证问卷（STOP-BANG， ESS）和实验室夜间多导睡眠图进行。结果：63.2%（12/19）的患者存在中度至重度OSA，以男性为主。观察到睡眠结构的显著改变，以及高频率的昼夜节律不同步（非24小时睡眠-觉醒障碍）。结论：与普通人群相比，TBB患者的OSA患病率明显更高，可能与继发于光感知缺失的昼夜节律不同步有关。鉴于睡眠呼吸障碍对生活质量和心血管风险的影响，这些发现支持了对这一人群进行系统筛查的必要性。

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引用次数: 0

Bilateral paraophthalmic carotid artery aneurysm presenting with visual loss. 双侧眼旁颈动脉动脉瘤表现为视力丧失。

Archivos de la Sociedad Espanola de Oftalmologia

Pub Date : 2025-12-31 DOI: 10.1016/j.oftale.2025.502443

I C Iglesias Cabrero

Carotid-ophthalmic aneurysms, though comprising only 4% of cerebral aneurysms, can lead to progressive visual deterioration by compressing the visual pathways, and early intervention is essential to prevent permanent vision loss. When suspected, urgent angiographic imaging should be requested. This report highlights an uncommon but treatable cause of progressive visual impairment due to optic nerve compression by a carotid aneurysm.

眼颈动脉瘤虽然只占脑动脉瘤的4%，但可通过压迫视觉通路导致进行性视力恶化，早期干预对于防止永久性视力丧失至关重要。如有怀疑，应要求紧急血管造影。本报告强调一个罕见但可治疗的原因进行性视力损害由于视神经压迫颈动脉瘤。

引用次数: 0

Diagnostic value of superficial macular vascular density in detecting early changes of primary open-angle glaucoma. 浅表黄斑血管密度对原发性开角型青光眼早期病变的诊断价值。

Archivos de la Sociedad Espanola de Oftalmologia

Pub Date : 2025-12-29 DOI: 10.1016/j.oftale.2025.502433

I Piloto Díaz, E B Cuétara Lugo, M J Pérez Benítez, F Y Fumero González, O Hernández Echevarría, L Fernández Argones

Background and objectives: Glaucoma is the leading cause of irreversible blindness worldwide and early diagnosis is essential to preserve the visual health of the population. The objective of this study is to estimate the diagnostic value of macular superficial vascular density in the detection of early changes in primary open-angle glaucoma.

Materials and methods: Observational, analytical, and cross-sectional study in 222 eyes (215 participants) and three study groups: negative control (111 healthy subjects), mild glaucoma (55 patients), and positive control (56 patients). CIRRUS™ 5000 technology (version 11.0) was used. To make both eyes equivalent, transposition was performed on the vertical axis in the left eye. The apparent macular vascular density (6 × 6 mm) was obtained by image processing in sectors of interest using the Python algorithm. Areas under the curve with negative control groups and mild glaucoma were calculated.

Results: Both groups were similar in age, sex, systemic diseases and ocular biometry. Vascular densities showed low diagnostic capacity (AUC = 0.56-0.65). The apparent macular vascular densities in outer rings 240-300° and 205-245° (respectively AUC = 0.90 and 0.89) showed better diagnostic capacity (p < 0.05) than neuroretinal ring area, minimum ganglion cell thickness (AUC = 0.82; both) and retinal nerve fiber layer thickness (AUC = 0.79).

Conclusions: Superficial macular vascular density in areas of anatomical interest for glaucomatous damage is the best parameter of optical coherence tomography for the detection of early changes in primary open-angle glaucoma.

背景和目的：青光眼是世界范围内不可逆失明的主要原因，早期诊断对于保持人群的视力健康至关重要。本研究的目的是评估黄斑浅血管密度对原发性开角型青光眼早期病变的诊断价值。材料和方法：222只眼睛（215名参与者）的观察性、分析性和横断面研究，分为三个研究组：阴性对照（111名健康受试者）、轻度青光眼（55名患者）和阳性对照（56名患者）。使用CIRRUS™5000技术（版本11.0）。为了使两只眼睛相等，在左眼的纵轴上进行换位。使用Python算法在感兴趣的扇区进行图像处理，获得表观黄斑血管密度（6 x 6 mm）。计算阴性对照组和轻度青光眼的曲线下面积。结果：两组在年龄、性别、全身性疾病和眼部生物特征方面相似。血管密度诊断能力较低（AUC = 0.56 ~ 0.65）。外环240 ~ 300°和205 ~ 245°的表观黄斑血管密度（AUC分别为0.90和0.89）具有较好的诊断能力(p)。结论：青光眼损伤解剖感兴趣区域的浅表黄斑血管密度是光学相干断层扫描检测原发性开角型青光眼早期病变的最佳参数。

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引用次数: 0

Topical insulin: where are we heading? 局部胰岛素：我们要去哪里？

Archivos de la Sociedad Espanola de Oftalmologia

Pub Date : 2025-12-27 DOI: 10.1016/j.oftale.2025.502438

B Burgos-Blasco, J A Gegúndez Fernández, J M Benítez Del Castillo, D Díaz Valle

引用次数: 0

Case report: Sea Fan Retinopathy, an ocular anomaly of interest. 病例报告：海扇视网膜病变，眼部异常感兴趣。

Archivos de la Sociedad Espanola de Oftalmologia

Pub Date : 2025-12-27 DOI: 10.1016/j.oftale.2025.502439

J E Renteria Matiz, D A Celedon Dabian, M J Mateus Parra, M A Estévez Flórez, M S Cuesta Pedraza

This case highlights the significance of ocular manifestations in systemic diseases and their diagnostic implications. The patient is a male of African descent who presented to the emergency department with a sudden, painless decrease in visual acuity in the right eye (OD). He also reported a possible history of congenital anemia that had never been previously diagnosed or managed. Fundoscopic examination revealed a grade ++ vitreous hemorrhage in the right eye, along with areas of peripheral neovascularization located between zones M11-M8 and M2-M3, associated with both temporal and nasal retinal neovascularization, as well as temporal peripheral traction in the left eye (OS). These findings were suggestive of "sea fan" retinopathy, likely related to sickle cell anemia. This diagnostic impression was confirmed by the Internal Medicine and Hematology departments, who based on paraclinical findings initiated hydroxyurea treatment.

本病例强调眼部表现在全身性疾病中的重要性及其诊断意义。患者为非洲裔男性，因右眼视力突然无痛性下降（OD）到急诊科就诊。他还报告了可能的先天性贫血史，以前从未被诊断或治疗过。眼底检查显示右眼++级玻璃体出血，伴有周围血管形成区位于M11-M8区和M2-M3区之间，伴有颞部和鼻腔视网膜新生血管形成，以及左眼颞部周围牵拉（OS）。这些发现提示“海扇”视网膜病变，可能与镰状细胞性贫血有关。这一诊断印象得到内科和血液科的证实，他们根据临床旁的发现开始了羟基脲治疗。

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