PurposeTo report the conservative management of a penetrating ocular trauma caused by a nail gun with a six-month follow up.ObservationsA 21 year-old healthy female suffered an ocular penetrating trauma with a nail gun. She presented with a metallic foreign body that partially entered her left eye through the nasal sclera via pars plana, 3 mm posterior to the limbus, but did not reach the retina. Surgical removal of the foreign body and closure of the scleral wound, without vitrectomy, was performed 16 h after the injury. Intravitreal prophylactic antibiotic was administered. Retinal atrophy developed in the areas that had commotio retinae at presentation, but no further complications were observed.Conclusions and importancePars plana vitrectomy may not be necessary in all penetrating ocular traumas with intraocular foreign body, as long as the foreign body is accessible from the exterior of the eye and there are no other conditions (such as vitreous hemorrhage, retinal detachment, endophthalmitis, etc) that are an indication for vitrectomy.
COMUNICACIONES BrEVES resumen Las vasculitis retinianas secundarias son manifestaciones oculares poco frecuentes de diversas enfermedades con compo-nente autoinmune, como granulomatosis con poliangitis, enfermedad de Behcet, sarcoidosis, lupus eritematoso sistémico y esclerosis múltiple, entre otras. Debido a las repercusiones sistémicas el diagnóstico correcto es de mayor importancia. Los síntomas oftalmológicos más frecuentes son visión borrosa y miodesopsias. En algunos casos se observan signos oftalmo-lógicos altamente sugestivos de ciertas enfermedades como la imagen de periflebitis retiniana en «gota de cera» de la sarcoidosis y el hipopion en la enfermedad de Behcet. Las manifestaciones sistémicas son esenciales para el diagnóstico por lo cual se deben reconocer las principales características de las enfermedades frecuentemente involucradas. Palabras clave: Vasculitis retinianas secundarias. Sarcoidosis. Enfermedad de Behcet. Lupus eritematoso sistémico. Esclerosis múltiple. Abstract Secondary retinal vasculitis are unusual ocular manifestations of several autoimmune diseases, such as granulomatosis with polyangiitis, Behcet disease, sarcoidosis, systemic lupus erythematosus and multiple sclerosis, among others. As a consequence of systemic repercussions the correct diagnosis is of greater importance. The most frequent ophthalmological symptoms are blurry vision and floaters. In some cases highly suggestive ophthalmological signs of certain diseases might be presented, such as retinal periphlebitis also known as "candle wax drippings'' image of sarcoidosis and the hypophion in Behcet disease. Systemic manifestations are essential for a correct diagnosis, therefore main features of the frequently involved diseases shall be identified.
COMUNICACIONES BrEVES resumen
PurposeTo report a case of occlusive retinal vasculopathy, secondary to hyperhomocysteinemia.ObservationsA 43-year-old male was examined at the retina outpatient clinic due to complaints of bilateral decrease in visual acuity. The patient underwent a comprehensive ophthalmological examination, wide-field fundus photographs and fluorescein angiography, as well as spectral domain optical coherence tomography with enhanced-deep imaging. The patient had a significant medical history of chronic kidney disease and progressive bilateral vision loss over the last two years, which worsened in the left eye during the past 3 months. Fundus examination revealed a vitreous hemorrhage in the left eye and bilateral proliferative retinopathy. Blood glucose and systemic blood pressure were unremarkable. Plasma homocysteine was reported at >500 μmol/L, which is higher than the corrected reference range by age.Conclusion and ImportanceHyperhomocysteinemia is a rare but well-known disease, capable of accelerating atherosclerotic disease and generating a prothrombotic state that can lead to multiple systemic complications. Despite its low incidence, the disease should be part of the differential diagnosis in patients with bilateral proliferative retinopathy, in the absence of diabetes mellitus and systemic hypertension.
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