Grosor coroideo en la retinosis pigmentaria

La coroides como estructura vascular ocular, se encuentra implicada en la fisiopatología de diversas patologías oftalmológicas. Recientemente se ha observado que su espesor se encuentra alterado en diferentes enfermedades coriorretinianas, y además su flujo se encuentra reducido en la Retinosis Pigmentaria. Por lo que planteamos una tesis para el estudio del grosor coroideo en esta distrofia coriorretiniana. Los objetivos de la misma fueron determinar cuantitativamente el grosor coroideo mediante tomografía de coherencia óptica (Cirrus-HD-OCT®) en pacientes con Retinosis Pigmentaria y en sujetos sanos; y su posterior comparación entre ambos grupos. Secundariamente se analizó su posible correlato anatomofuncional en los pacientes con Retinosis Pigmentaria. Para ello, se seleccionó un grupo de pacientes con Retinosis Pigmentaria (41 pacientes) y un grupo de sujetos sanos (32 controles). Los criterios de inclusión en el grupo de pacientes fueron: sujetos caucásicos mayores de edad, con funduscopia típica de Retinosis Pigmentaria y con confirmación electrofisiológica. Los criterios de exclusión, en ambos grupos fueron: presencia de errores refractivos superiores a 6 dioptrías esféricas y/o 2 dioptrías cilíndricas, antecedentes de otras enfermedades oftalmológicas/sistémicas coadyuvantes y conjunción esclero-coroidea no visible en la tomografía; y se excluyeron específicamente del grupo de pacientes, aquellos enfermos con formas sindrómicas de Retinosis Pigmentaria. Finalmente, los grupos objeto de estudio estuvieron compuestos por 75 ojos de 40 pacientes (47,24±8,11 años) y 54 ojos de 31 controles (45,85±8,99 años). El grosor coroideo fue medido mediante Cirrus-HD-OCT®. Se realizaron 9 mediciones centradas en el umbo desde las 2000µm nasales a las 2000µm temporales cada 500µm, en la tomografía de cada sujeto estudio, y el grosor coroideo analizado fue el resultado de la media aritmética de tres mediciones sucesivas. Además, cada paciente con Retinosis Pigmentaria fue sometido a una exploración completa oftalmológica (agudeza visual, campimetría, retinografía, autofluorescencia y medición de la línea de segmentos internos y externos de los fotorreceptores (IS/OS)). Finalmente, los análisis estadísticos utilizados fueron el test t-Student para variables independientes y el test de correlación de Pearson, calculados mediante el software SPSS 17.0. Se observó que el grosor coroideo se encontraba adelgazado significativamente en todos los puntos de medición (p<0,001) en el grupo de pacientes con Retinosis Pigmentaria comparado con el grupo control. Se analizó el patrón de distribución del espesor coroideo en los pacientes con Retinosis Pigmentaria y en los sujetos sanos, observándose una tendencia hacia el adelgazamiento coroideo nasal en ambos grupos, existiendo diferencias significativas sólo a 2000µm nasales entre los sujetos sanos y los enfermos (p<0,001; one-way ANOVA; test de Scheffe post-hoc). A su vez, se observó que el grosor coroideo macular se encontraba positivamente correlacionado con los hallazgos de la exploración anatomofuncional en los pacientes con Retinosis Pigmentaria: los datos campimétricos (p<0,05), la agudeza visual [p<0,05; excepto en el punto de medición subumbo donde no fue estadística la relación (p=0,13)], la longitud IS/OS (p<0,05), y la autofluorescencia preservada (p<0,01). A su vez, el grosor coroideo estuvo negativamente correlacionado con la edad en ambos grupos (sanos p<0,01; pacientes p<0,05). El presente estudio sugiere que el grosor coroideo se encuentra adelgazado en la Retinosis Pigmentaria medido mediante Cirrus-HD-OCT®. Además, sugiere que el grosor coroideo se correlaciona positivamente con mejores resultados anatomofuncionales en los pacientes con Retinosis Pigmentaria, pudiendo ser una nueva variable de medición anatomofuncional objetiva en el estudio de esta distrofia coriorretiniana.  The choroid is involved in ocular diseases, as an integral constituent in the functioning of the eye. Recently, different author have observed that choroidal thickness is altered in different chorioretinal diseases; in addition, it has been documented a decreased choroidal blood flow in Retinitis Pigmentosa. Therefore we have designed this study to analyze the choroidal thickness in this chorioretinal dystrophy. The aim of the present study were to measure choroidal thickness by using optical coherence tomography (Cirrus-HD-OCT®) in patients with Retinitis Pigmentosa and in healthy subjects; and to compare both groups. Secondarily, we analyzed the possible the functional value of choroidal thickness in patients with Retinitis Pigmentosa. 41 patients with Retinitis Pigmentosa and 32 healthy subjects were included. The inclusion criteria for the Retinitis Pigmentosa group were: Caucasian subjects older than 18 years; typical Retinitis Pigmentosa fundus appearance; electrophysiological findings suggestive of Retinitis Pigmentosa. A control group with healthy Caucasian subjects was recruited. The exclusion criteria were: patients with syndromic Retinitis Pigmentosa forms; control subjects and patients with: refractive error over +/-6 spherical or +/-2 cylindrical diopters; history of other ophthalmological diseases, and/or invisible scleral-choroidal junction. Finally, 75 eyes of 40 patients (47.24 ± 8.11 years) and 54 eyes of 31 healthy controls (45.85 ± 8.99 years) were analyzed. Choroidal thickness was measured by Cirrus-HD-OCT®. Nine measurements were taken from 2000 µm nasally to 2000 µm temporally, every 500µm, and the subfoveolar point was the central measurement point. The choroidal thickness value for each point was the average result of three different measurements. In addition, each Retinitis Pigmentosa patient underwent a complete ophthalmologist exploration and the next values were collected: best corrected visual acuity, visual field values (low vision index, preserved visual field degrees), autofluorescence measurements (hyperautofluorescence macular ring diameter and preserved autofluorescence diameter) and the IS/OS band length. Finally, statistical analysis included t-Student test for independent samples, and Pearson correlation test, using SPSS 17.0 software. Choroidal thickness statistically reduced at each measurement point in Retinitis Pigmentosa patients (p<0.001). The choroidal pattern distribution was also analyzed to investigate possible differences between control subjects and Retinitis Pigmentosa patients. A progressive thinning pattern toward the nasal sector was observed in both groups. In fact, the choroidal distribution pattern differed statistically only at the 2000 µm measurement point nasally (p<0.001; one-way ANOVA; a post-hoc Scheffe test). Furthermore, macular choroidal thickness was positively correlated with better anatomical and functional finding in Retinitis Pigmentosa patients: macular choroidal thickness was statistically correlated with visual acuity [p<0.05, except for subfoveolar point where the correlation was not statistical (p=0.13)], preserved autofluorescence diameter (p<0.01), visual field values (p<0.05) and IS/OS band length (p<0.05). Age and choroidal thickness were negatively correlated in both groups (control group p<0.01, Retinitis Pigmentosa patients p<0.05). The present study suggests that choroidal thickness decreases in Retinitis Pigmentosa patients as seen by Cirrus-HD-OCT®. In addition, this study suggests that thicker macular choroidal thickness is correlated with better visual function in Retinitis Pigmentosa patients. Thus, choroidal thickness may be a new objective anatomical-functional measurement in the evaluation of this chorioretinal dystrophy

Oral Propranolol for Circumscribed Choroidal Hemangioma

Introduction: Several therapeutic approaches have been developed to treat choroidal hemangioma. However, all these therapies are associated with a potential risk of damaging the overlying retina. Case Report: We report a case of circumscribed choroidal hemangioma (CCH) in a 59-year-old man refractory to laser treatment. Visual acuity was 20/200 and a serous macular detachment was present. The CCH was treated with oral propanolol, whereupon visual acuity improved to 20/20 and the macular detachment resolved without systemic or local adverse effects. Discussion: Propanolol is a β-blocker commonly used in cardiology that may induce endothelium vasoconstriction and inhibit endothelial proliferation. It has been shown to be effective in infantile facial hemangiomas, and proved safe and effective for the CCH in our patient. Further studies are needed to confirm our observation

Bleeding Follicular Conjunctivitis due to Influenza H1N1 Virus

Influenza H1N1 or A virus is a new virus serotype capable of human-to-human transmission. This infection causes a flu syndrome similar to that of seasonal influenza, with only one case of conjunctivitis described and no clinical details or microbiological confirmation. Its diagnosis is performed by PCR of pharyngeal smear of the patients affected. We report the first well-documented case in the medical literature of conjunctivitis by H1N1 virus

Aqueous humor neutrophil gelatinase-associated lipocalin levels in patients with idiopathic acute anterior uveitis

Purpose: The purpose of this study was to evaluate the levels of neutrophil gelatinase-associated lipocalin (NGAL) in the aqueous humor in eyes with idiopathic acute anterior uveitis (AAU). Methods: A comparative control study. Aqueous humor was collected from 20 eyes of 20 patients with idiopathic AAU. The control group included 20 aqueous samples from 20 patients about to undergo cataract surgery and without any other ocular or systemic diseases. The level of NGAL was determined with a commercially available ELISA kit. Results: The concentration of NGAL in aqueous humor was markedly higher in patients with idiopathic AAU than in control subjects (Mann–Whitney U test, p<0.001). The level of NGAL was 139,197.38±183,426.36 (mean±SD) pg/ml in eyes with AAU and 3,169.96±1,595.78 pg/ml in the eyes of the control group. Conclusions: The aqueous humor NGAL level is increased in eyes with idiopathic AAU. These results imply that NGAL is associated with the regulation of inflammation in patients with AAU and could be used as a biomarker of ocular inflammation and immunomodulatory treatment response.Medicin

Fulminant bilateral Haemophilus influenzae keratitis in a patient with hypovitaminosis A treated with contaminated autologous serum

Empar Sanz-Marco1, Manuel Diaz-Llopis1&amp;ndash;3, Maria J Lopez-Prats1, Salvador Garcia-Delpech1,4, Patricia Udaondo11Ophthalmology, La Fe University Hospital of Valencia, Valencia, Spain; 2Faculty of Medicine, University of Valencia, Valencia, Spain; 3Biomedical Research Center for Rare Diseases Network (CIBERER), Valencia, Spain; 4Faculty of Medicine, Catholic University of Valencia, Valencia, SpainAbstract: We report on a patient with hypovitaminosis A treated with autologous serum (AS) who had bilateral infectious ulcers positive for Haemophilus influenzae. The patient suffered a perforation of his right eye and total healing of his left eye with a residual leukoma. In cases of severe malnutrition, serum levels of vitamins and bacteriostatic and growth factors are reduced, so AS would not only be ineffective but also increase the risk of secondary corneal infection. The prophylactic use of a topical antibiotic would be useful in treatment with AS, especially in patients who do not use and adequately store the eye drops, as in our patient.Keywords: Haemophilus influenzae, hypovitaminosis A, bilateral infectious ulcer