Archivos de la Sociedad Espanola de Oftalmologia最新文献

Acute macular neuroretinopathy (AMN) is an uncommon entity that affects the outer layer of the retina and usually presents itself as an acute paracentral scotoma. It is mostly seen in young women and the course is usually self-limited. The diagnosis is established by a multimodal image, with optical coherence tomography (OCT) being the preferred technique. The origin is thought to be linked to a possible dysregulation in the flow of the deep vascular plexus of the retina or the choriocapillaris. A clinical case of an AMN in a young woman associated with a migraine attack is presented, highlighting the importance of considering this disease in the differential diagnosis of visual disorders associated with migraines. A physiological and pathological basis between migraine and NMA is suggested.

Background and objective: Exposure keratopathy (EPK) is characterized by punctate erosions of the corneal epithelium, mainly located in the lower third of the cornea. In the Pediatric Intensive Care Unit (PICU), an incidence of 19-25 % has been reported. The objective of this study was to describe the frequency, risk factors, and time to resolution of exposure keratitis in PICU patients.

Materials and methods: Descriptive, observational, longitudinal, prospective study. The association of keratitis due to exposure to risk factors was evaluated using the Chi square test and determining the OR and 95% confidence interval.

Results: 81 patients admitted to the PICU between March and September 2023 were included, 46 (56.79%) developed PEK, 67.39% (31/46) grade 1 and 26.08% (12/46) grade 3. The median time Resolution was 3 days, interquartile range (2-5). A significant difference was observed between patients with and without PEK in the requirement for mechanical ventilation 86.13% vs., 54.29% p = 0.01, OR = 6.905 (2.20-21.64), sedation 100% vs., 85.71%, p = 0.02, in the duration of sedation 5 days vs. 2.5 days (p = 0.024), neuromuscular relaxation 21.74% vs., 0%, p = 0.002, Lagoftalmos 86.94% vs., 31.43% p < 0.00001, OR = 13.33 (4.42-40.17), chemosis 15.21% vs., 0%, p = 0.014 and days of stay in the PICU median 7 (5-11) vs. 3 (2-6), p < 0.00001.

Conclusions: The frequency of QPE observed was 56.79%, higher than that previously reported in the literature in the pediatric population. Mechanical ventilation, sedation, duration of sedation, Lagoftalmos chemosis and days of stay in the PICU were identified as risk factors.

Type 1 Neovascularization with Aneurysmal Dilations (N1a), is a retinal disorder characterized by choroidal vascular abnormalities. Clinically, it is characterized by an exudative maculopathy with multiple recurrent serosanguineous pigment epithelial detachments. This disease is more frequent in women aged 55-65 years. However, we present an exceptional case of N1a in a 26-year-old woman, who responded favorably to Aflibercept. To our knowledge, this is the first reported case of a young female patient under 30 with N1a. The patient has responded very favourably to anti-VEGF therapy with three intravitreal injections of Aflibercept. This being the reason for we provide an update on anti-VEGF therapeutic options for N1a.

A 61-year-old man presented hyperacute endophthalmitis due to Proteus mirabilis after a pars plana vitrectomy. In the first examination (24 h after surgery), visual acuity (VA) was of hand movement, biomicroscopy showed edematous cornea, Tyndall ++++ and fibrin membrane, with vitritis and impossibility of visualizing retina details. Treatment with intravitreal injections was performed. Despite the treatment, the patient's symptoms worsened, and he began with poor general condition, fever, and leukocytosis, requiring hospitalization and intravenous treatment because of a diagnosis of secondary meningitis due to post-surgical endophthalmitis. The patient required enucleation of the affected eye without prosthesis placement. Even though post-surgical bacterial endophthalmitis is usually an infection confined to the eye, this clinical case demonstrates the possibility of the infection spreading to the rest of the body, potentially endangering the patient's life.

A 55-year-old woman with a history of severe endometriosis, followed at our center for 16 years due to multiple episodes of horizontal binocular diplopia, was diagnosed with recurrent paresis of the VI cranial nerve of her right eye. Magnetic resonance imaging revealed localized pachymeningitis in her right cavernous sinus. Initial episodes were treated with botulinum toxin. Subsequently, she declined treatment during inter-crisis periods because she remains asymptomatic. Idiopathic hypertrophic pachymeningitis is a rare condition of unknown cause, characterized by chronic inflammation of the meninges resulting in localized or diffuse dural thickening. Clinical manifestations vary widely, from generalized processes with complex neurological symptoms to localized processes with monosymptomatic expression, as presented in this case.