Clinical and imaging features of congenital and acquired isolated inferior rectus muscle hypofunction.

BACKGROUND: Inferior rectus (IR) underaction may arise from various causes that are distinguishable through imaging. We investigated clinical and imaging characteristics of congenital and acquired causes of IR underaction. METHODS: Cases of IR underaction were selected from data prospectively collected in a study of orbital imaging in strabismic patients. RESULTS: Review identified 3 cases of congenital IR underaction (2 with bilateral IR aplasia and 1 with unilateral IR hypoplasia), 12 acquired cases, including 4 due to denervation (2 idiopathic, 1 after multiple strabismus surgeries, 1 after head trauma), and 8 cases of direct IR damage (5 with orbital trauma and 3 with previous surgery, including 2 sinus surgery and 1 laser blepharoplasty). Of the 23 cases, 11 adults had high-resolution magnetic resonance imaging, and 2 children had computed tomography. Imaging identified the anatomic diagnosis in congenital cases; in acquired cases, imaging helped to identify atrophy and exclude alternative orbital causes; and in direct mechanical damage, imaging clarified the mechanism of underaction, extent of IR damaged, and the degree of retained contractility. Patients with congenital IR absence or hypoplasia exhibited A pattern exotropia that was typically absent in isolated acquired denervation or direct IR damage. CONCLUSIONS: Orbital imaging demonstrates a variety of abnormalities in patients with congenital or acquired IR hypofunction, helping to clarify the underlying mechanism and guide management

TRIIAL national reports Belgium, Hungary, Italy, Poland, Portugal, Romania, Slovenia, Spain, The Netherlands

Recent constitutional and legislative changes in several member states are questioning core features of EU rule of law. For the first time ever, the EU institutions have proposed activation of the preventive mechanism in Article 7 TEU against Poland and Hungary, and the European Commission has launched the rule of law conditionality mechanism against Hungary. The jurisprudence of the CJEU finding numerous violations of judicial independence and fundamental rights undermining the rule of law in Europe is growing at a fast pace. Moreover, many preliminary references show the willingness of national courts to engage in judicial dialogue with the CJEU, relying on it to provide harmonised standards and guidelines on the rule of law. However, the future of such interactions is undermined by recent decisions of supreme and constitutional courts limiting the rights of domestic courts to use the preliminary reference procedure and prohibiting their obligation to give effect to EU law based on a tendentious understanding of national constitutional identity. In this context, the TRIIAL project has embarked on an ambitious research quest, which resulted in the present Edited Working Paper. It consists of nine country reports which cover the most relevant issues concerning judicial independence, impartiality, accountability, mutual trust and the rule of law in the jurisdictions of the project partners: Belgium, the Netherlands, Hungary, Romania, Italy, Portugal, Poland, Spain and Slovenia. The country reports primarily build on case law identified and analysed during the TRIIAL project and published in the CJC database. They outline the current state of affairs and challenges the member states face in the topics covered by TRIIAL exposing and analysing specific pressing issues, especially ones that are not yet covered in other reports such as the European Commission’s Rule of Law report.

Oftalmía Neonatal secundaria a Neisseria Gonorrhoeae: Reporte de un caso clínico y revisión de la literatura.

Neisseria gonorrhoeae es una causa importante de oftalmía neonatal, pudiendo causar múltiples complicaciones en el recién nacido, incluyendo perforación corneal, panoftalmitis y ceguera. Se presenta caso de recién nacido de 1 mes de vida, con conjuntivitis infecciosa bilateral y compromiso corneal unilateral, además de cultivo positivo para gonococo. TAC mostró compromiso inflamatorio intraocular del ojo izquierdo. Se manejó con terapia antibiótica endovenosa, evolucionando con opacificación, vascularización, adelgazamiento progresivo de la córnea y atalamia del ojo izquierdo. Se sometió a cirugía para parche corneal y reformación de cámara anterior. Durante seguimiento, ecografía ocular mostró un examen normal del ojo derecho y una menor longitud axial y engrosamiento coroideo del ojo izquierdo

Comparison of the clinical efficacy of two different immunosuppressive regimens in patients with chronic Vogt-Koyanagi-Harada disease

Purpose: To prospectively compare 2 immunosupressive regimens in patients with active Vogt-Koyanagi-Harada disease in spite of systemic glucocorticoid treatment. Methods: Forty-four patients were diagnosed between 1998 and 2005. Twenty-one developed chronic intraocular inflammation in spite of glucocorticoid treatment and were randomized to receive either prednisone and azathioprine (AZA) (n = 12) or prednisone and cyclosporine (CyA) (n = 9). Results: In the AZA group Tyndall score decreased from 1.21±1.10 to 0.29±0.62 (p<.01), and visual acuity (LogMAR) improved from 0.32±0.35 to 0.09±0.16 (p<.001). In the CyA group Tyndall score decreased from 1.67±1.08 to 0.16±0.51 (p<.001), and visual acuity improved from 0.41±0.40 to 0.25±0.42 (p<.001). Patients in the AZA group needed a significantly higher average prednisone dose and total cumulative dose than those in the CyA group, p<.01 for each comparison. Conclusions: Both regimens showed a good clinical efficacy, but CyA seems to be a bet