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PURPOSE/MATERIAL AND METHOD: The present study shows two patients with ophthalmic sarcoid neuropathy without any physical evidence of systemic disease. The first patient (male, age 59) showed optic disk granuloma in his left eye and optic atrophy in his right eye. The second patient (female, age 45) suffered bilateral papilledema.Optic neuropathy in sarcoidosis occurs in 5% of patients but it is not generally identified as a sarcoid disease. Optic nerve disease appears as papilledema, atrophy, papillitis, infiltration or retrobulbar neuritis. Ocular abnormalities may be an initial finding in sarcoidosis.

Objetivo/Método: En este trabajo se describen dos pacientes con neuropatía óptica por sarcoidosis sin clínica sistémica evidente. El primer paciente (varón, 59 años) se presentó con un granuloma en la papila del ojo izquierdo y atrofia óptica en el derecho. El segundo paciente (mujer, 45 años) presentó un papiledema bilateral. Resultados/Conclusión: La neuropatía óptica en la sarcoidosis ocurre en el 5% de los pacientes, pero generalmente no se reconoce como una manifestación de dicha enfermedad. La neuropatía óptica se puede presentar como papiledema, atrofia, papilitis, infiltración y neuritis retrobulbar. Purpose/Material and Method: The present study shows two patients with ophthalmic sarcoid neuropathy without any physical evidence of systemic disease. The first patient (male, age 59) showed optic disk granuloma in his left eye and optic atrophy in his right eye. The second patient (female, age 45) suffered bilateral papilledema. Results/Conclusion: Optic neuropathy in sarcoidosis occurs in 5% of patients but it is not generally identified as a sarcoid disease. Optic nerve disease appears as papilledema, atrophy, papillitis, infiltration or retrobulbar neuritis. Ocular abnormalities may be an initial finding in sarcoidosis.

espanolObjetivo/Metodo: En este trabajo se describen dos pacientes con neuropatia optica por sarcoidosis sin clinica sistemica evidente. El primer paciente (varon, 59 anos) se presento con un granuloma en la papila del ojo izquierdo y atrofia optica en el derecho. El segundo paciente (mujer, 45 anos) presento un papiledema bilateral. Resultados/Conclusion: La neuropatia optica en la sarcoidosis ocurre en el 5% de los pacientes, pero generalmente no se reconoce como una manifestacion de dicha enfermedad. La neuropatia optica se puede presentar como papiledema, atrofia, papilitis, infiltracion y neuritis retrobulbar. EnglishPurpose/Material and Method: The present study shows two patients with ophthalmic sarcoid neuropathy without any physical evidence of systemic disease. The first patient (male, age 59) showed optic disk granuloma in his left eye and optic atrophy in his right eye. The second patient (female, age 45) suffered bilateral papilledema. Results/Conclusion: Optic neuropathy in sarcoidosis occurs in 5% of patients but it is not generally identified as a sarcoid disease. Optic nerve disease appears as papilledema, atrophy, papillitis, infiltration or retrobulbar neuritis. Ocular abnormalities may be an initial finding in sarcoidosis.

We report a case of Lyme disease with diplopia as the first manifestation, without systemic symptoms in contrast with other cases of this disease. The serodiagnosis was confirmed by ELISA analysis and evaluation of cerebrospinal fluid (CSF) antibodies. Symptoms readily vanished after the introduction of antibiotherapy.Lyme disease is an infectious multi-systemic disorder caused by Borrelia burgdorferi. Neuro-ophthalmological manifestations occur during the second stage of the illness in extremely variable clinical forms.

Caso clínico: Se presenta un caso de enfermedad de Lyme con diplopía como la primera manifestación del proceso sin síntomas sistémicos de presentación, en contra de lo publicado en otros casos de esta enfermedad. El serodiagnóstico se confirmó con el test ELISA y con la determinación de los anticuerpos en el líquido cefalorraquídeo (LCR). Los síntomas fueron desapareciendo después de la instauración del tratamiento antibiótico. Discusión: La enfermedad de Lyme es una enfermedad multisistémica causada por Borrelia burgdorferi. Las manifestaciones neuro-oftalmológicas ocurren durante el segundo estadio de la enfermedad y con una expresión clínica tremendamente variable. Case report: We report a case of Lyme disease with diplopia as the first manifestation, without systemic symptoms in contrast with other cases of this disease. The serodiagnosis was confirmed by ELISA analysis and evaluation of cerebrospinal fluid (CSF) antibodies. Symptoms readily vanished after the introduction of antibiotherapy. Discussion: Lyme disease is an infectious multi-systemic disorder caused by Borrelia burgdorferi. Neuro-ophthalmological manifestations occur during the second stage of the illness in extremely variable clinical forms.

espanolCaso clinico: Se presenta un caso de enfermedad de Lyme con diplopia como la primera manifestacion del proceso sin sintomas sistemicos de presentacion, en contra de lo publicado en otros casos de esta enfermedad. El serodiagnostico se confirmo con el test ELISA y con la determinacion de los anticuerpos en el liquido cefalorraquideo (LCR). Los sintomas fueron desapareciendo despues de la instauracion del tratamiento antibiotico. Discusion: La enfermedad de Lyme es una enfermedad multisistemica causada por Borrelia burgdorferi. Las manifestaciones neuro-oftalmologicas ocurren durante el segundo estadio de la enfermedad y con una expresion clinica tremendamente variable. EnglishCase report: We report a case of Lyme disease with diplopia as the first manifestation, without systemic symptoms in contrast with other cases of this disease. The serodiagnosis was confirmed by ELISA analysis and evaluation of cerebrospinal fluid (CSF) antibodies. Symptoms readily vanished after the introduction of antibiotherapy. Discussion: Lyme disease is an infectious multi-systemic disorder caused by Borrelia burgdorferi. Neuro-ophthalmological manifestations occur during the second stage of the illness in extremely variable clinical forms.

We describe a woman with optic disc pit and bilateral renal hypoplasia as a papillorenal syndrome. DNA analysis for PAX2 mutations revealed a heterozygous mutation (nucleotide 619 in exon 9). A first uncle and a cousin had the same PAX2 mutation.The association of optic nerve colobomas and renal anomalies comprises a autosomal dominant syndrome for mutations in the PAX2 gene. Ophthalmic and renal diseases are highly variable; the ophthalmologist must check for a renal problem when a coloboma is detected.

PURPOSE/MATERIAL AND METHOD: We present two cases of vascular ocular occlusion occurring during oral contraceptive use. Different contraceptive related risk factors are discussed.Although ocular complications are rare, they should be kept in mind since these drugs (contraceptives) are not recommended when vascular occlusion risk factors are present.

espanolCaso Clinico: Describimos el caso de una mujer con foseta papilar y una hipolasia renal bilateral, como sindrome papilorrenal. El analisis del DNA para las mutaciones del PAX2 determino una mutacion heterocigota (nucleotido 619 del exon 9). Un tio y un primo carnal eran portadores de la misma mutacion en el PAX2. Discusion: La asociacion de colobomas del nervio optico y anomalias renales forman parte de un sindrome autosomico dominante por mutaciones en el gen PAX2. La expresion de la enfermedad oftalmologica y renal es muy variable; los oftalmologos deben chequear la funcion renal cuando un coloboma sea detectado. EnglishCase report: We describe a woman with optic disc pit and bilateral renal hypoplasia as a papillorenal syndrome. DNA analysis for PAX2 mutations revealed a heterozygous mutation (nucleotide 619 in exon 9). A first uncle and a cousin had the same PAX2 mutation. Discussion: The association of optic nerve colobomas and renal anomalies comprises a autosomal dominant syndrome for mutations in the PAX2 gene. Ophthalmic and renal diseases are highly variable; the ophthalmologist must check for a renal problem when a coloboma is detected.

Our aim was to evaluate the utility of thrombolytic therapy administered outside tertiary hospital.We analyzed 80 consecutive patients with acute myocardial infarction admitted to the emergency area of primary hospital within 24 hours after the onset of symptoms and lastly transported to a coronary care unit (CCU) of a reference hospital. The thrombolytic protocol was performed by medicine department of primary hospital and the CCU of reference hospital.23 patients without (group A) and 57 with (group B) fibrinolytic therapy (APSAC 50 patients and streptokinase 7 patients) were analyzed. Group A patient were older (mean: 67 +/- 11 vs mean: 62 +/- 10 years; p = 0.01), and arrived later to emergency area (mean 254 +/- 284 vs mean 163 SD 161 min; p = 0.04) and to the coronary care unit (mean 561 +/- 371 vs mean 334 +/- 177 min; p = 0.0002). The guard physician decision to start or not the fibrinolytic therapy, was adequate in 86% of the patients (sensitivity 87%, predictive positive value 95%, specificity 83%). Complications on emergency area or during transport in group B were ventricular fibrillation in 9%, AV block (2-3 degree) in 9%, severe nonsustained ventricular arrhythmia in 11% and transitory hypotension in 23%. No death occurred before CCU admission. In group B, 35% patients was treated within the first 2 hours. The average time gain was 124 min (thrombolysis administration--CCU admission).On emergency area of primary hospital, thrombolytic therapy is feasible and safe when administered by well-equipped and well-trained medical emergence area and ambulance staff.