Estudio de la capa de fibras nerviosas de la retina mediante tomografía de coherencia óptica y polarimetría láser en pacientes con esclerosis múltiple: correlación con la función visual y los hallazgos de la resonancia magnética

Introducción: La tomografía de coherencia óptica (OCT) y la polarimetría láser (GDx) son técnicas exploratorias de la capa de fibras nerviosas de la retina (CFNR). Hipótesis: En los pacientes con EM, el posible daño estructural de la CFNR y su correspondiente alteración de la función visual sería un reflejo del daño del SNC y por lo tanto se correlacionaría con las alteraciones de la resonancia magnética (RM) y la discapacidad Material y métodos: El estudio se ha realizado con 96 pacientes con diferentes formas clínicas de EM y con 59 pacientes en el grupo control. A todos los pacientes se les realizó pruebas para estudiar la función visual (AV, sensibilidad al contraste, visión cromática, perimetría automatizada computarizada y potenciales evocados visuales (PEV)), OCT, GDx, RM y valoración de la discapacidad con la Expanded Disability Status Scale (EDSS). Resultados: Los pacientes con EM presentaron una disminución del grosor de la CFNR, medido con OCT y GDx, con respecto a los sujetos sanos. La disminución del grosor promedio de la CFNR se correlacionó con la disminución de la AV y sensibilidad al contraste, la alteración de la visión cromática y campimétrica y el aumento de la latencia de la onda P100 de los PEV. La atrofia cerebral, estimada mediante el índice bicaudado, es mayor en los pacientes con EM que en los sujetos sanos. Tanto la atrofia cerebral como número de lesiones observadas en la RM de los pacientes con EM se correlacionaron con la disminución del grosor de la CFNR. Conclusiones: La tomografía de coherencia óptica (OCT) y la polarimetría láser (GDx) son útiles para medir el grosor de la CFNR en pacientes con EM. El daño estructural de la CFNR se correlaciona con el daño en el SNC

Cortical blindness secondary to posterior reversible encephalopathy syndrome, recovered by successful blood pressure management

We report a case of cortical blindness secondary to posterior leukoencephalopathy syndrome, which was successfully treated by blood pressure management. A 66-year-old white man presented at the emergency room complaining of severe frontal headache, disorientation, and progressive blurred vision. The initial physical examination disclosed a blood pressure of 200/176 mmHg. One hour later the patient exhibited mental confusion and bilateral blindness. Computed tomography and magnetic resonance imaging were performed, and a systemic workup was conducted, resulting in a diagnosis of posterior leukoencephalopathy syndrome. This syndrome is a rare manifestation of systemic hypertension that requires proper diagnosis and management to avoid irreversible brain damage. Early recognition of this condition and prompt control of the patient’s blood pressure are essential because they may bring about a reversal of the syndrome, which may otherwise result in permanent brain damageRelatamos um caso de cegueira cortical secundário à síndrome de leucoencefalopatia posterior recuperado pelo controle bem sucedido da pressão arterial. Um homem branco de 66 anos de idade compareceu à emergência com queixa de dor de cabeça frontal severa, desorientação e embaçamento progressivo da visão. O exame físico inicial revelou uma pressão arterial de 200/176 mmHg. Uma hora depois, o paciente apresentou confusão mental e cegueira bilateral. Após a tomografia e a ressonância nuclear magnética, o tratamento sistêmico foram realizados e o diagnóstico de síndrome da leucoencefalopatia posterior foi realizado. A síndrome de leucoencefalopatia posterior é uma manifestação rara de hipertensão sistêmica que requer um diagnóstico e gerenciamento adequados para evitar danos cerebrais irreversíveis. O reconhecimento precoce desta condição e o controle imediato da pressão arterial são essenciais porque podem levar à reversão da síndrome, o que, de outra forma, pode resultar em dano cerebral permanenteThis study was supported by a grant from ISCIII (RETICS Oftared, RD16/0008/003) cofunded by FEDERS

Computer aided volumetric assessment of orbital structures in patients with Graves' orbitopathy: correlation with serum thyroid antiperoxidase antibodies and disease activity

Introduction: Graves' disease is an autoimmune disorder. Goiter and Graves' orbitopathy are frequently seen clinically. It would be helpful for the diagnosis, grading, prognosis, and treatment of this condition if it was possible to find serum biomarkers to establish a connection between the plasma levels of these compounds and orbital changes. Methods: A retrospective study was performed by revising the medical records of 44 patients with Graves' orbitopathy and 15 controls. The Osirix software (Pixmeo, Geneva, Switzerland) was used for manual orbital measurements. Plasma levels of Graves' orbitopathy substances were obtained in the analytical review of the patients. Results: A greater muscle volume was observed in patients with Graves' orbitopathy in relation to the control group (p < 0.001). The clinical activity score (CAS) was associated to total muscle mass (p = 0.013) and retrorbital fat (p = 0.048). Our results indicated a direct relationship between serum concentrations of anti-thyroid peroxidase antibodies and inferior rectus thickening (p = 0.036); however, we did not observe a positive correlation between other muscle volumes and serum concentrations of various thyroid-related substances. Conclusions: This study is the first that uses Osirix measurement software to manually assess orbital features in patients with Graves' orbitopathy. These measurements were compared to the outcomes of tests performed in a laboratory. Among several serum biomarkers, anti-thyroid peroxidase appears to be a reliable biomarker that correlates positively with inferior rectus muscle thickness in patients with thyroid eye disease. This may help to improve the management of this diseaseOpen Access funding provided thanks to the CRUE-CSIC agreement with Springer Nature. This work was financially supported by ISCIII (RETICS RD16/0008/0003) and the European Union (European Regional Development Fund—ERDF)S

Improvement of Prostaglandin-Associated Periorbitopathy after Discontinuing Treatment

Objectives:To report that the periorbital changes induced by prostaglandin analogue (PGA) eye drops are partially reversible after discontinuing treatment.Materials and Methods:Nine patients with prostaglandin-associated periorbitopathy seen in a referral oculoplastic practice were included in this study, eight with unilateral glaucoma and one with bilateral open-angle glaucoma. All of them had been treated with topical PGA for at least one year, before the treatment was discontinued for cosmetic reasons.Results:In all cases, there were evident periocular differences between the treated eye and the fellow eye, consisting mainly of deepening of the upper eyelid sulcus and eyelid fat pad reduction. One year after discontinuing the PGA eye drops, improvement of these features was observed.Conclusion:Clinicians and patients should be aware of the side effects of topical PGA therapy on periorbital tissues, and that these side effects can partially regress after discontinuation of the medication

Eyelid Kaposi Sarcoma in an HIV-negative Patient

Kaposi sarcoma (KS) is a low-grade, multicentric vascular neoplasm. Most commonly, it involves the skin, but it can occur at any site on the body. The cutaneous lesions are often located on the lower legs, genitalia, oral mucosa, and face. KS is categorized in four different types: classic, endemic, epidemic or AIDS associated, and transplantation associated. We report a case of HIV-negative, classic KS located on the eyelid. The eyelid lesion was completely excised, and after a 1-year follow-up, no recurrences were observed. Ocular involvement by KS in a patient who is serologically negative for HIV is extremely rare