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A 42-year-old female patient had vision loss and chronic epiphora in her left eye. Her best-corrected visual acuity was 10/10 in the right eye and 0.3/10 in the left eye. The anterior segment examination results were normal. In fundus examination, choroidal folds were detected. Optical coherence tomography showed elevation on the macula and choroidal folds. Ultrasonography revealed a T-sign. Magnetic resonance imaging revealed an ethmoidal mucocele that compresses the orbital tissues. Surgical treatment was performed in the otorhinolaryngology department. Postoperatively, choroidal folds recovered, and the best-corrected visual acuity improved, but subretinal fluid accumulated. During the follow-up period without any treatment, subretinal fluid totally disappeared. RESUMO Paciente do sexo feminino, 42 anos, com perda visual e epífora crônica no olho esquerdo. Sua acuidade visual melhor corrigida foi de 10/10 no olho direito e 0,3/10 no olho esquerdo. O exame do segmento anterior foi normal. No exame de fundo de olho, foram detectadas pregas coroidais. A tomografia de coerência óptica revelou elevação na mácula e pregas coroidais. A ultrassonografia revelou sinal T. A imagem de ressonância magnética mostrou mucocele etmoidal que comprime os tecidos orbitários. O Departamento de Otorrinolaringologia realizou o tratamento cirúrgico. No pós-operatório, as dobras coroidais se recuperaram, a acuidade visual melhor corrigida foi melhorada, mas ocorreu líquido sub-retiniano. Durante o período de acompanhamento sem qualquer tratamento, o líquido sub-retiniano recuperou-se totalmente.

Introduction: The aim of this study is to assess and compare the long-term clinical efficacy of anti-VEGF drugs using the Imaculaweb registry. Methods: In this observational study based on the Imaculaweb registry, outcome measures were the number of injections, the change in mean visual acuity (VA) and central macular thickness (CMT), and the time between diagnosis and the first injection. Results: In total, 126 eyes of 109 patients were included in the study. The mean VA was 49.4 ± 21.4, 54.1 ± 22.2, 51.6 ± 24.9, and 48.3 ± 25.7 letters at baseline and at the 1-, 2-, and 3-year follow-ups, respectively. Significant VA increases (p = 0.0002 for the first year and p = 0.045 for the second year) were documented at years 1 and 2 but not at year 3 (p = 0.8). The mean number of injections was 5.2, 2.6, and 2.3 at the 1-, 2-, and 3-year follow-ups, respectively. In the first year, 30% of the patients received at least 7 injections, while only 6.4% received p < 0.0001). Conclusion: Imaculaweb turned out to be an effective tool to collect and share clinical data as well as to monitor patient outcome.

RESUMEN Presentamos el caso de un paciente con foseta del disco óptico, quien presentó una disminución de la agudeza visual secundaria a desprendimiento seroso de retina. Se decidió realizar una inyección intravítrea de 0.3ml de gas C3F8 (100%), seguida de fotocoagulación con láser de argón en el borde temporal de la foseta, logrando reaplicación total de la retina, con reabsorción de todo el líquido subretiniano visible en la tomografía de coherencia optica (OCT) luego de 400 días. Además hubo una mejoría significativa en la agudeza visual. ABSTRACT We present the case of a patient with an optic disk pit, presenting with great loss of visual acuity secondary to serous retinal detachment. The management chosen was an intravitreal injection of 0.3 mL of C3F8 (100%), followed by argon laser photocoagulation on the temporal edge of the pit, ), achieving total retinal reattachment , and reabsorption of all subretinal fluid visible at optical coherence tomography after 400 days, in addition to great improvement in visual acuity.

The thermal effects of laser cutting machines could damage the macula. A few studies in the literature have described macular injury induced by industrial laser burns. The aim of this study was to report the clinical, visual, and optical coherence tomography findings in a gold refinery worker with laser-induced maculopathy. A 21-year-old male gold refinery worker had vision loss in his right eye after using a laser cutting machine without wearing laser eye protection gear. At the first visit (24 h later), his best-corrected visual acuity was 7/10 in the right eye and 10/10 in the left eye. The anterior segment examination was normal. In fundus examination, focal, round, and yellowish lesion was detected within the fovea. The optical coherence tomography findings were foveal outer retinal disruptions and irregularities extending from the outer plexiform layer to the retina pigment epithelium. After 4 months, the best-corrected visual acuity had improved to 1.0, and the optical coherence tomography findings had resolved Os efeitos térmicos das máquinas de corte a laser podem danificar a mácula. Poucos estudos na literatura tem descrito a lesão macular por queimadura a laser industrial. Neste estudo, objetivamos relatar os achados clínicos, visuais e de tomografia de coerência óptica em um trabalhador de refinaria de ouro com maculopatia induzida por laser. O trabalhador da refinaria de ouro de 21 anos teve perda de visão no olho direito depois de usar uma máquina de corte a laser sem usar equipamento protetor ocular para laser. Sua acuidade visual melhor corrigida foi de 7/10 no olho direito e 10/10 no olho esquerdo na primeira consulta (24h depois). O exame do segmento anterior estava normal. No exame de fundo de olho, lesões focais, redondas e amareladas foram detectadas dentro da fóvea. Os achados da tomografia de coerência óptica revelaram rupturas na fóvea da retina externa e irregularidades estendendo-se da camada plexiforme externa ao epitélio pigmentar da retina. Após 4 meses, a acuidade visual melhor corrigida melhorou para 1,0 e os achados da tomografia de coerência óptica foram revigorados. Q4 WOS:000723149600015 34468557

Los nitritos inhalados, conocidos comúnmente como “poppers”, son una droga recreativa ampliamente consumida debido principalmente a su disponibilidad, bajo coste y a que son considerados como de bajo riesgo. Su consumo está muy extendido por diferentes grupos poblacionales, alcanzándose la mayor prevalencia de uso en la población de hombres homosexuales. Pese a ser considerados de bajo riesgo por los usuarios, su consumo da lugar a la aparición de efectos secundarios tanto a nivel agudo como crónico. Cabe destacar los efectos a nivel ocular ya que en los últimos años han aumentado los casos de maculopatía por poppers descritos en la literatura, y en ello radica que el objetivo principal de la presente revisión sea poner de manifiesto la relación entre el consumo de poppers y la pérdida de visión. Este aumento en la detección podría deberse al desarrollo de técnicas como la OCT ya que el signo característico de la maculopatía es la interrupción de la zona elipsoide. Se describen un total de 92 pacientes distribuidos en 2 casos pioneros, 9 casos aislados y 8 series de casos, concluyéndose que podría existir una relación entre el grado de exposición a los nitritos inhalados y la gravedad de la maculopatía, así como una menor posibilidad de mejora y recuperación del paciente. Sería conveniente llevar a cabo una anamnesis exhaustiva con el objetivo de obtener un diagnóstico diferencial frente a otras patologías, así como sería idóneo el seguimiento de los pacientes durante un mayor período de tiempo. Actualmente, pese a que se han propuesto diversas hipótesis, el mecanismo fisiopatológico de la maculopatía por poppers es desconocido y no existe ningún tratamiento específico aparte de la abstinencia en el consumo, lo cual hace necesario un mayor esfuerzo de investigación en este ámbito. Universidad de Sevilla. Doble Grado en Farmacia y en Óptica y Optometría

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INTRODUCTION: The term <> refers to products made of volatile alkyl nitrites used for recreational practices. CLINICAL CASE: 40 year old man reported blurred vision in both eyes and photophobia, and admitted regular use of <>. Best corrected visual acuity was 0.63/1 in both eyes. Bilateral yellowish vitelliform macular lesions were present in both eyes in the funduscopy, as well as a disruption of the IS/OS line in the optical coherence tomography. DISCUSSION: This is the first case of <> registered in Spain. Clinical findings and symptoms are similar to previous reported cases.

INTRODUÇÃO: Os derivados das 4-aminoquinolonas vêm sendo utilizados desde sua industrialização na terapêutica da malária, das doenças reumatológicas e dermatológicas. Essas drogas apresentam reações adversas sistêmicas e oculares. As reações adversas sistêmicas afetam o sistema gastrointestinal, sistema nervoso, sistema muscular esquelético e a pele, e as oculares são: fotofobia, córnea verticilata, poliose, catarata, paralisia dos músculos extraoculares, uveíte anterior, maculopatia tóxica, neurite óptica. OBJETIVO: Revisão bibliográfica das complicações do uso de cloroquina e derivados. Analisar evolução e estágio atual da propedêutica. Sugerir conduta prática no mapeamento precoce dos sinais de toxicidade. MÉTODOS: Revisão bibliográfica através da pesquisa no banco de dados MEDLINE, PUBMED, LILACS e SciELO. DISCUSSÃO: São descritos todos os exames que podem ser utilizados para mapeamento das reações adversas oculares, tais quais: exame oftalmológico completo, com ênfase na biomicroscopia e oftalmoscopia binocular indireta, campo visual computadorizado, tela de Amsler, visão de cores, exames eletrofisiológicos, polarimetria e tomografia de coerência óptica. É feita a descrição do quadro de maculopatia enfocando epidemiologia, fatores de risco, histopatologia e propedêutica. É descrita a estrutura química e as diferenças entre os derivados das 4-aminoquinolonas. CONCLUS��O: Todo paciente em uso de cloroquina e seus derivados devem ser acompanhados e documentados desde seu início e até atingir a dose cumulativa acima de 100 gramas. Quanto maior a dose cumulativa, maior deve ser a nossa preocupação com o seguimento desse paciente.INTRODUCTION: Byproducts of 4-aminoquinolones are being used since its industrialization in the treatment of malaria, rheumatic and dermatologic diseases. These drugs present systemic and ocular adverse events. Systemic adverse reactions affect the gastrointestinal, nervous and skeletal muscular systems and the skin. Ocular adverse reactions are: photophobia, cornea verticillata, poliosis, cataract, extraocular muscle palsy, anterior uveitis, toxic maculopathy and optical neuritis. PURPOSE: Bibliography review of complications due to the use of chloroquine and its derivatives. To analyze the current practice and propedeutics' evolution. To suggest practical managements for early toxicity signs. METHODS: Bibliographic review through research on MEDLINE, PUBMED, LILACS and SciELO database. DISCUSSION: All exams that can be used to screen ocular adverse reactions are described, such as: complete ophthalmologic exam, with emphasis on biomicroscopy and indirect binocular ophthalmoscopy, computerized visual field, Amsler grid testing and color vision testing, electrophysiological exams, polarimetry and optical coherence tomography. A description of maculopathy is presented, focusing on epidemiology, risk factors, histopathology and propedeutics. Chemical structure and the differences between 4-aminoquinolone derivatives are described. CONCLUSION: All patients using chloroquine and its derivatives must be followed-up and documented since the beginning of the therapy until they reach a cumulative dose above 100 grams. The higher the cumulative dose, the more we must be concerned with patient follow-up.

INTRODUÇÃO: Os derivados das 4-aminoquinolonas vêm sendo utilizados desde sua industrialização na terapêutica da malária, das doenças reumatológicas e dermatológicas. Essas drogas apresentam reações adversas sistêmicas e oculares. As reações adversas sistêmicas afetam o sistema gastrointestinal, sistema nervoso, sistema muscular esquelético e a pele, e as oculares são: fotofobia, córnea verticilata, poliose, catarata, paralisia dos músculos extraoculares, uveíte anterior, maculopatia tóxica, neurite óptica. OBJETIVO: Revisão bibliográfica das complicações do uso de cloroquina e derivados. Analisar evolução e estágio atual da propedêutica. Sugerir conduta prática no mapeamento precoce dos sinais de toxicidade. MÉTODOS: Revisão bibliográfica através da pesquisa no banco de dados MEDLINE, PUBMED, LILACS e SciELO. DISCUSSÃO: São descritos todos os exames que podem ser utilizados para mapeamento das reações adversas oculares, tais quais: exame oftalmológico completo, com ênfase na biomicroscopia e oftalmoscopia binocular indireta, campo visual computadorizado, tela de Amsler, visão de cores, exames eletrofisiológicos, polarimetria e tomografia de coerência óptica. É feita a descrição do quadro de maculopatia enfocando epidemiologia, fatores de risco, histopatologia e propedêutica. É descrita a estrutura química e as diferenças entre os derivados das 4-aminoquinolonas. CONCLUSÃO: Todo paciente em uso de cloroquina e seus derivados devem ser acompanhados e documentados desde seu início e até atingir a dose cumulativa acima de 100 gramas. Quanto maior a dose cumulativa, maior deve ser a nossa preocupação com o seguimento desse paciente. INTRODUCTION: Byproducts of 4-aminoquinolones are being used since its industrialization in the treatment of malaria, rheumatic and dermatologic diseases. These drugs present systemic and ocular adverse events. Systemic adverse reactions affect the gastrointestinal, nervous and skeletal muscular systems and the skin. Ocular adverse reactions are: photophobia, cornea verticillata, poliosis, cataract, extraocular muscle palsy, anterior uveitis, toxic maculopathy and optical neuritis. PURPOSE: Bibliography review of complications due to the use of chloroquine and its derivatives. To analyze the current practice and propedeutics' evolution. To suggest practical managements for early toxicity signs. METHODS: Bibliographic review through research on MEDLINE, PUBMED, LILACS and SciELO database. DISCUSSION: All exams that can be used to screen ocular adverse reactions are described, such as: complete ophthalmologic exam, with emphasis on biomicroscopy and indirect binocular ophthalmoscopy, computerized visual field, Amsler grid testing and color vision testing, electrophysiological exams, polarimetry and optical coherence tomography. A description of maculopathy is presented, focusing on epidemiology, risk factors, histopathology and propedeutics. Chemical structure and the differences between 4-aminoquinolone derivatives are described. CONCLUSION: All patients using chloroquine and its derivatives must be followed-up and documented since the beginning of the therapy until they reach a cumulative dose above 100 grams. The higher the cumulative dose, the more we must be concerned with patient follow-up.

espanolCaso Clinico: Se presenta el caso clinico de un varon de 30 anos con una distrofia foveomacular viteliforme del adulto bilateral simetrica, que de forma simultanea desarrolla una coriorretinopatia central serosa (CRCS) y en el que se aprecia la coexistencia de multiples puntos blancos en la proximidad de las arcadas vasculares temporales. La angiografia fluoresceinica demuestra la alteracion mixta de ambos tipos de fotorreceptores, asi como la lesion aguda de la CRCS en el polo posterior OI. Discusion: La distrofia foveomacular del adulto es una alteracion hereditaria del polo posterior que no suele evolucionar con complicaciones agudas. La aparicion de una coriorretinopatia central no es habitual. EnglishCase report: The clinical case of a 30 year-old male patient with a bilateral and symmetric adult-onset foveomacular vitelliform dystrophy is presented. The simultaneous onset of a central serous chorioretinopathy (CSCR) with multiple white dots in the proximity of the temporal vascular arcades is documented. Fluorescein angiography showed a combined alteration of both types of photoreceptors, and the acute lesion of the CSCR at the posterior pole of the eye. Discussion: Adult-Onset Foveomacular Vitelliform Dystrophy is a hereditary condition which results in an alteration of the posterior pole of the eye, but is not usually associated with any acute complications. The onset of a CSCR, as seen in this case, is unusual 2008; 83: 505-508).

Caso Clínico: Se presenta el caso clínico de un varón de 30 años con una distrofia foveomacular viteliforme del adulto bilateral simétrica, que de forma simultánea desarrolla una coriorretinopatía central serosa (CRCS) y en el que se aprecia la coexistencia de múltiples puntos blancos en la proximidad de las arcadas vasculares temporales. La angiografía fluoresceínica demuestra la alteración mixta de ambos tipos de fotorreceptores, así como la lesión aguda de la CRCS en el polo posterior OI. Discusión: La distrofia foveomacular del adulto es una alteración hereditaria del polo posterior que no suele evolucionar con complicaciones agudas. La aparición de una coriorretinopatía central no es habitual. Case report: The clinical case of a 30 year-old male patient with a bilateral and symmetric adult-onset foveomacular vitelliform dystrophy is presented. The simultaneous onset of a central serous chorioretinopathy (CSCR) with multiple white dots in the proximity of the temporal vascular arcades is documented. Fluorescein angiography showed a combined alteration of both types of photoreceptors, and the acute lesion of the CSCR at the posterior pole of the eye. Discussion: Adult-Onset Foveomacular Vitelliform Dystrophy is a hereditary condition which results in an alteration of the posterior pole of the eye, but is not usually associated with any acute complications. The onset of a CSCR, as seen in this case, is unusual.

Caso clínico: Se presenta un caso de retinopatía por descompresión caracterizado por hemorragias retinianas, edema de papila, edema macular y disminución brusca de la agudeza visual en el postoperatorio inmediato de una trabeculectomía con mitomicina C. Discusión: La retinopatía por descompresión es una complicación que aparece con poca frecuencia tras la cirugía de glaucoma. Aunque estas características han sido descritas en la literatura de forma separada, en el presente artículo se describen de manera conjunta en un solo caso clínico. Case report: We present a case of decompression retinopathy with retinal haemorrhages, optic nerve haemorrhages, maculopathy, and decreased visual acuity after trabeculectomy with mitomycin-C. Discussion: Decompression retinopathy is a potential complication after glaucoma surgery but has been rarely reported in the world literature. Although these four characteristics have been described separately, in this patient all four occurred together.

espanolCaso clinico: Se presenta un caso de retinopatia por descompresion caracterizado por hemorragias retinianas, edema de papila, edema macular y disminucion brusca de la agudeza visual en el postoperatorio inmediato de una trabeculectomia con mitomicina C. Discusion: La retinopatia por descompresion es una complicacion que aparece con poca frecuencia tras la cirugia de glaucoma. Aunque estas caracteristicas han sido descritas en la literatura de forma separada, en el presente articulo se describen de manera conjunta en un solo caso clinico. EnglishCase report: We present a case of decompression retinopathy with retinal haemorrhages, optic nerve haemorrhages, maculopathy, and decreased visual acuity after trabeculectomy with mitomycin-C. Discussion: Decompression retinopathy is a potential complication after glaucoma surgery but has been rarely reported in the world literature. Although these four characteristics have been described separately, in this patient all four occurred together.

Caso clínico: Mujer de 22 años que refería la aparición brusca de escotomas centrales en ambos ojos tras cuadro catarral de vías respiratorias altas. En el fondo del ojo (FO) presentaba unas manchas redondeadas parafoveales de color marrón rojizo. Los campos visuales presentaban unos escotomas centrales que se correspondían con la localización de las lesiones retinianas. Discusión: La neurorretinopatía macular aguda (NMA) es una uveítis posterior idiopática, poco frecuente, sin tratamiento efectivo y de la que existen diversas teorías sobre su patogenia. Clinical case: A 22-year-old woman complained of symptoms consistent with the sudden onset of central scotomas in both eyes after a flu-like illness. The typical reddish brown macular lesions of acute macular neuroretinopathy were evident in the parafoveal area of both eyes. Visual field examination revealed central scotomas in both eyes that corresponded in location to the retinal injuries. Discussion: Acute macular neuroretinopathy is a rare idiopathic posterior uveitis for which no effective treatment is available. Several pathogenic theories are postulated.

El propósito de esta tesis doctoral es valorar la eficacia de un nuevo tratamiento, la termoterapia transpupilar (TTT), en la degeneración macular asociada a la edad (DMAE) exudativa. Se trata de una patología que constituye la principal causa de pérdida de visión en los pacientes mayores de 65 años. Dicha pérdida de visión está ocasionada por la formación de una neovascularización coroidea (NVC), la cual puede ser clásica (es decir, bien definida en la angiografía fluoresceínica) u oculta (mal definida en la angiografía fluoresceínica).Inicialmente se realiza una revisión de la literatura. En ella se profundiza en algunos conceptos teóricos relacionados con esta enfermedad: su etiopatogenia, epidemiología y factores de riesgo. Para ilustrar los principales aspectos de la clínica, se presenta una serie de ejemplos que ayudan a destacar los conceptos más prácticos como son los signos, síntomas y métodos diagnósticos. Finalmente, se revisan los diferentes tratamientos para la DMAE, pero sólo se consideran los derivados de estudios aleatorizados y controlados. Otro apartado que consta es la investigación clínica, donde se realizan tres estudios con fines distintos. El primero de ellos es retrospectivo (estudio histórico) y su objetivo es valorar por medio de una casuística propia la historia natural de las NVC ocultas secundarias a la DMAE. El segundo estudio es prospectivo (estudio piloto). Su objetivo es confirmar la seguridad de la TTT. Aunque sus resultados visuales son similares al anterior, una pequeña proporción de pacientes no sufre cambios en su agudeza visual. El tercer estudio que se realiza es aleatorizado y controlado, a doble ciego. Su objetivo consiste en buscar una evidencia fiable que determine la eficacia real de la TTT en estas lesiones ocultas. Sus resultados demuestran que este tratamiento no es inferior al placebo en ninguna de las variables estudiadas, relacionadas con la función visual. La importancia de este último estudio, no sólo está basada en sus resultados, sino también en que constituye la primera serie a doble ciego que existe en la literatura acerca de la TTT en la NVC oculta asociada a la DMAE. Hasta este momento las evidencias disponibles sólo provenían de estudios no aleatorizados. Aunque los resultados obtenidos no indican un efecto de cuantía en el grupo tratado (correspondiente al ensayo aleatorizado y controlado), la seguridad que demuestra este tratamiento le confiere dos posibilidades de investigación. Por una parte, dado que la agudeza visual muestra una mejora progresiva en el tiempo, este estudio se puede considerar de cohorte, lo que le concede la oportunidad de continuar con el seguimiento. La segunda posibilidad constituye una apertura a una nueva vía de investigación, basada en tratamientos combinados con distintos mecanismos de acción. Con este fin se puede aprovechar la acción angioclusiva de la TTT, con un afecto antiangiogénico derivado de otros fármacos. En conclusión, esta tesis doctoral se basa en dos ensayos clínicos sucesivos, cuyos resultados convergen en un tercero, de tipo aleatorizado y controlado. Este diseño ha permitido obtener evidencias fiables, antes no descritas, que contribuirán a evitar la aplicación empírica de este tratamiento., The purpose of this doctoral thesis is to assess the efficacy of a new treatment, transpupillary thermotherapy (TTT), in exudative age-related macular degeneration (AMD). This pathology is the main cause of vision loss in patients over 65. The vision loss is caused by choroidal neovascularisation (CNV), which may be classic (i.e., well defined in fluorescein angiography) or occult (poorly defined in fluorescein angiography).The thesis begins with a review of the literature, going into detail in some theoretical concepts related to this disease: etiopathogenesis, epidemiology and risk factors. To illustrate the main clinical aspects, a number of examples are given that highlight the most practical concepts, such as signs, symptoms and diagnostic methods. The various treatments for AMD are also reviewed, but limited to those derived from randomised controlled trials.Another section is devoted to clinical research and includes three studies with different aims. The first is retrospective (historical study), in which the author's own clinical cases are used to assess the natural history of occult CNV secondary to AMD.The second is a prospective study (pilot study) carried out to confirm the safety of TTT. Although the vision outcomes are similar to the previous study, a small proportion of patients had no change in their visual acuity.The third study is a double-blind randomised controlled trial that consists of finding reliable evidence to determine the real efficacy of TTT in these occult lesions. Its results show that this treatment is not inferior to placebo in any of variables related to visual function that were studied.The importance of this last study is not only its results but also that it is the first double-blind series in the literature on TTT in occult CNV associated with AMD. Up to this point, the available evidence came only from non-randomised trials.Although the results do not indicate an amount effect in the treatment group (in the randomised controlled study), the demonstrated safety of this treatment gives it two possibilities for research. On the one hand, since visual acuity shows progressive improvement over time, it can be considered a cohort study, which provides the opportunity to continue the follow-up.The second possibility is an opening to a new research path based on combined treatments with different mechanisms of action. In this way the vessel-occlusion action of TTT can be utilised together with an anti-angiogenic effect of drugs.In conclusion, this doctoral thesis is based on two successive clinical trials whose results converge in a third randomised controlled study. This design has provided reliable evidence not described before, which will contribute to avoiding the empirical application of this treatment.

espanolCaso clinico: Mujer de 22 anos que referia la aparicion brusca de escotomas centrales en ambos ojos tras cuadro catarral de vias respiratorias altas. En el fondo del ojo (FO) presentaba unas manchas redondeadas parafoveales de color marron rojizo. Los campos visuales presentaban unos escotomas centrales que se correspondian con la localizacion de las lesiones retinianas. Discusion: La neurorretinopatia macular aguda (NMA) es una uveitis posterior idiopatica, poco frecuente, sin tratamiento efectivo y de la que existen diversas teorias sobre su patogenia. EnglishClinical case: A 22-year-old woman complained of symptoms consistent with the sudden onset of central scotomas in both eyes after a flu-like illness. The typical reddish brown macular lesions of acute macular neuroretinopathy were evident in the parafoveal area of both eyes. Visual field examination revealed central scotomas in both eyes that corresponded in location to the retinal injuries. Discussion: Acute macular neuroretinopathy is a rare idiopathic posterior uveitis for which no effective treatment is available. Several pathogenic theories are postulated.

espanolCaso clinico: Se describen dos casos de retinopatia toxica bilateral en dos mujeres tratadas con cloroquina durante varios anos por un lupus eritematoso sistemico. Discusion: La retinopatia toxica por cloroquina es una enfermedad infrecuente, iatrogenica y dosis dependiente, pero a pesar de ser conocida desde hace anos y de realizarse revisiones oftalmologicas periodicas, siguen apareciendo nuevos casos. EnglishCase report: Two cases of bilateral ocular toxicity following chloroquine therapy in two women with systemic lupus erythematosus are presented. Discussion: Retinal toxicity due to chloroquine is an uncommon iatrogenic disease. It is dose-dependent. New cases are still being described despite the application of ophthalmic screening techniques.

espanolCaso clinico: Se describe una mujer de 16 anos con epilepsia severa que desarrollo una hemianopsia homonima izquierda despues de tomar topiramato 125 mg durante 12 semanas y una mujer epileptica de 24 anos que presento una maculopatia bilateral despues de tomar 150 mg de topiramato durante 8 semanas. Discusion: Se identifican dos reacciones oculares adversas al topiramato. Ambas precisan retirar el tratamiento, aunque la maculopatia por topiramato es irreversible. EnglishCase reports: We describe 2 patients who developed ocular side effects during treatment with topiramate. One was a 16-year-old woman with generalized seizures who developed a homonymous hemianopia after using topiramate 125 mg per day for 12 weeks, and the other was a 24-year-old epileptic female who developed a bilateral maculopathy after using topiramate 150 mg per day for 8 weeks. Discussion: We identified two severe ocular adverse reactions from topiramate. Both reactions necessitated discontinuing the treatment, but the topiramate-associated maculopathy was irreversible.

Caso clínico: Se describe una mujer de 16 años con epilepsia severa que desarrolló una hemianopsia homónima izquierda después de tomar topiramato 125 mg durante 12 semanas y una mujer epiléptica de 24 años que presentó una maculopatía bilateral después de tomar 150 mg de topiramato durante 8 semanas. Discusión: Se identifican dos reacciones oculares adversas al topiramato. Ambas precisan retirar el tratamiento, aunque la maculopatía por topiramato es irreversible. Case reports: We describe 2 patients who developed ocular side effects during treatment with topiramate. One was a 16-year-old woman with generalized seizures who developed a homonymous hemianopia after using topiramate 125 mg per day for 12 weeks, and the other was a 24-year-old epileptic female who developed a bilateral maculopathy after using topiramate 150 mg per day for 8 weeks. Discussion: We identified two severe ocular adverse reactions from topiramate. Both reactions necessitated discontinuing the treatment, but the topiramate-associated maculopathy was irreversible.

espanolObjetivo: Determinar la utilidad del electrorretinograma multifocal (mfERG) en la evaluacion clinica de la respuesta al tratamiento con terapia fotodinamica (TFD) en pacientes con neovascularizacion coroidea (NVC) secundaria a degeneracion macular asociada a la edad (DMAE). Metodos: Se ha realizado un estudio prospectivo en 23 ojos de 22 pacientes con NVC predominantemente clasica. Al inicio se realizo una medicion de la agudeza visual mediante optotipos de Colenbrander, exploracion biomicroscopica (BMC), retinografia, angiografia fluoresceinica (AGF), campimetria de Humphrey 24-2 y mfERG. Todos los pacientes fueron tratados mediante TFD. Se ha repetido la exploracion de la agudeza visual, BMC, campimetria y mfERG a los dos y a los seis meses del tratamiento y se ha realizado una AGF tras un intervalo entre los cuatro y seis meses del inicio del estudio. Resultados: La agudeza visual permanece estable o mejora en todos los pacientes incluidos en el estudio. El estudio campimetrico nos ofrece resultados erraticos y poco fiables debido a la mala fijacion que presentan estos pacientes. La densidad de respuesta de las ondas N1 y P1 del mfERG en los anillos centrales no muestra variaciones significativas despues del tratamiento, sin embargo mejora en los anillos 3 (p=0,000), 4 y 5 (p=0,008). Conclusiones: El mfERG es una prueba de utilidad en el seguimiento de la NVC puesto que nos permite medir objetivamente la sensibilidad retiniana en pacientes con maculopatias tratadas con terapia fotodinamica. Por otra parte obtenemos un mapa de sensibilidades de la retina central en el que podemos valorar la extension y la profundidad de la lesion. EnglishPurpose: To assess the value of multifocal electroretinogram (mfERG) in clinical evaluation of the response of patients with choroidal neovascularization (CNV), secondary to age-related macular degeneration, to photodynamic therapy (PDT) Methods: We designed a prospective non-comparative case series and enrolled 23 eyes of 22 patients with predominantly classic CNV. The initial evaluation included clinical examination with measurement of visual acuity (Colenbrander), biomicroscopic evaluation (BMC), retinography, fluorescein angiography (FA), Humphrey 24-2 visual field examination and mfERG. All patients were treated with PDT. Clinical follow-up was performed two and six months after treatment with visual acuity evaluation, BMC, visual field assessment and mfERG. FA was repeated after an interval of between four and six months in all patients. Results: Visual acuity remained stable or improved in all patients included in the study. Visual field examination gave erratic and unreliable results because of patients’ unstable fixation. N1 and P1 wave peak amplitudes in the central rings did not change significantly after treatment but they improved in rings 3 (p=0.000), 4 and 5 (p=0.008). Conclusions: Multifocal ERG is a useful tool for the clinical follow-up of CNV. It offers interesting non-subjective data of retinal sensitivity of patients with macular diseases treated with PDT. In addition we obtained a central retinal sensitivity map where we were able to evaluate the extent and depth of retinal damage.

RESUMO A Síndrome de Axenfeld-Rieger representa um espectro de anomalias de desenvolvimento caracterizadas por alterações da periferia da córnea, íris e seio camerular, além de malformações ósseas e dentárias. Existem algumas descrições esparsas de anormalidades de fundo de olho, porém estas não foram documentadas. Nós descrevemos, pela primeira vez, um caso de Síndrome de Axenfeld-Rieger associada à maculopatia bilateral do tipo "bull's eye".

RESUMO A Síndrome de Axenfeld-Rieger representa um espectro de anomalias de desenvolvimento caracterizadas por alterações da periferia da córnea, íris e seio camerular, além de malformações ósseas e dentárias. Existem algumas descrições esparsas de anormalidades de fundo de olho, porém estas não foram documentadas. Nós descrevemos, pela primeira vez, um caso de Síndrome de Axenfeld-Rieger associada à maculopatia bilateral do tipo "bull's eye". SUMMARY The Axenfeld-Rieger syndrome mesodermal dysgenesis represents a spectrum of developmental disorders characterized by abnormalities of the peripheral cornea, íris and anterior chamber angle associated with developmental defects of the teeth and facial banes. Sparse descriptions of fundus abnormalities have been made, but none have been well documented. We report, to our knowledge for the first time, a case of Axenfeld-Rieger syndrome associated with bilateral "bull's eye" maculopathy.

ResumenLa degeneración macular relacionada a la edad es la causa más frecuente de pérdida de visión irreversible en personas mayores de 60 años. Son factores de riesgo la edad, la genética, el tabaquismo y la obesidad abdominal. Su primera manifestación visible son las drusas, acumulación de productos provenientes de la degradación incompleta de la digestión de segmentos de fotoreceptores por el epitelio pigmentario. La administración de antioxidantes y zinc disminuye el riesgo de pérdida severa de visión en un 25% en pacientes con drusas. El proceso puede evolucionar a la atrofia de fotoreceptores y epitelio pigmentario (forma seca) o a la aparición de vasos de neoformación que invaden el espacio subretinal, son sangre y líquido subretinal (forma húmeda). La primera es de comienzo insidioso y lentamente progresiva. La segunda produce pérdida brusca de visión central. No existe hoy día un tratamiento eficaz para la forma seca.La forma neovascular no tratada tiene un pobre pronóstico conduciendo a ceguera legal.Sin embargo, la terapia antiangiogénica con inyecciones intravitreas repetidas de bloqueadores del factor de crecimiento endotelial (VEGF) permite la estabilización o mejoría de visión en la mayoría de los pacientes.SummaryAge-related macular degeneration (AMD) is the leading cause of irreversible blindness in persons over 60 years of age. Risk factors are age, genetics, smoking and abdominal obesity. Drusen are the first visible sign of the disease, as yellow deposits lying deep in the retina. Drusen are accumulation of residual bodies due to incomplete digestion of the outer segments of the photoreceptors by the retinal pigment epithelium. In patients with drusen, the administration of antioxidants and zinc, reduces the risk of severe loss of vision by 25%. The disease may progress to atrophy of the retinal pigment epithelium (“dry AMD”) or to a neovascular form, with invasion of the subretinal space by sprouts of coroidal neovascularization, with blood and subretinal fluid (“wet AMD”). The dry form is a slowly progressive disease, with patches of retinal pigment epithelium and photoreceptor atrophy. Patients with the wet form experience sudden loss of vision. There is no proven effective treatment for the dry form today.Neovascular AMD has a poor prognosis if left untreated, resulting in legal blindness. However, antiangiogenic therapy with anti-vascular endotelial growth factor modalities, administered in repeated intravitreal injections, allows stabilization or improvement of visual acuity in most cases.

Congenital retinoschisis is an X-linked recessive inherited disease. It causes the splitting of the retina’s neurosensory layers from the remaining of the sensory retina, presenting itself as a “stellate” or “bicycle-wheel” maculopathy, vitreous hemorrhage and retinal detachment. We report three cases of congenital retinoschisis, two of them brothers. optical coherence tomography was used when evaluating the cases. It was impossible to differentiate retinoschisis from retinal detachment in one of the cases through optical coherence tomography due to lack of patient collaboration. We then performed laser photocoagulation to mark and follow-up the affected area.

RESUMO A Sindrome de Axenfeld-Rieger representa um espectro de anomalias de desenvolvimento caracterizadas por alteracoes da periferia da cornea, iris e seio camerular, alem de malformacoes osseas e dentarias. Existem algumas descricoes esparsas de anormalidades de fundo de olho, porem estas nao foram documentadas. Nos descrevemos, pela primeira vez, um caso de Sindrome de Axenfeld-Rieger associada a maculopatia bilateral do tipo "bull's eye".

RESUMEN Las fosetas congénitas papilares son poco comunes. Se trata de una entidad caracterizada típicamente por depresiones papilares unilaterales, ovales, de color blanco grisáceo. Reportamos un caso con dicha entidad asociada al desprendimiento seroso tratado con fotocoagulación. Se realizó un estudio descriptivo a una paciente femenina de 14 años quien refirió pérdida de visión del ojo izquierdo de un mes de evolución. Se realizó fotocoagulación láser al borde yuxtapapilar temporal de la foseta, con evoluciones al mes y a los 3, 6, 9, 12 y 24 meses posteriores, mediante tomografía de coherencia óptica, mejor agudeza visual corregida y oftalmoscopia. Se logró progresiva disminución del desprendimiento macular y mejoría de la agudeza visual desde el primer mes de control. A los 9 meses se observó normal arquitectura macular en la tomografía de coherencia óptica y mejoría de la agudeza visual a 20/25 (95 VAR), con iguales resultados en los controles a los 12 y 24 meses. La terapéutica con fotocoagulación puede resultar eficiente, simple, mínimamente invasiva y económica para la maculopatía asociada a la foseta papilar.