Purpose Retinitis pigmentosa (RP) is a group of inherited dystrophies with great clinical genetic and evolutionary heterogeneity. We report a patient with retinitis pigmentosa who presented a bilateral intermediate uveitis with cystoid macular edema associated and no other systemic disease. Methods A 16 year old man with a history of Retinosis pigmentosa since birth presented blurred vision associated with a bilateral intermediate uveitis. The visual acuity was 0,4, Tyndall ++, and intense vitritis with snowballs in both eyes. All systemic examinations were normal (analytics, autoimmunity and serology tests). Results Patient was treated with orals corticosteroids maintained in decreasing doses. Response to treatment was favorable, but then macular edema appeared. Due to the inability to control uveitis symptoms with steroids, azathioprine was associated and response has been favorable with resolution of macular edema and decreasing inflammation. Conclusion RP includes a large group of degenerative and hereditary diseases that may be associated with a number of ocular complications. Intermediate uveitis is a rare complication described but can cause decreased vision and requiring monitoring and appropriate treatment for their control.
Purpose The chronic relapsing inflammatory optic neuropathy (CRION) is a recurrent optic neuropathy not associated with any demyelinating or systemic desease, characterized by the need for prolonged immunosuppressive therapy to prevent relapse. Methods We report the case of a 32 year old man who presented three episodes of optic neuritis in the left eye over a period of 8 months. Each episode remitted quickly with intravenous steroids and resorted after gradual withdrawal thereof. The initial visual acuity in left eye was counting fingers, had relative afferent pupillary defect and diffuse edema of the optic nerve. All systemic examinations were normal (analytics, and serology tests, imaging studies, lupus anticoagulant, ECA and autoimmunity tests). Results After CRION suspected, corticosteroid treatment was decided at a dose of 1mg/kg/day maintained in decreasing doses associated with azathioprine, and response to treatment was favorable, with no new episodes. Actually, visual acuity is 7/10 , there are palidness optic disc and inferior visual field lost in perimetry due to optic neuritis. Conclusion CRION is a recurrent optic neuritis, corticoid dependent, not associated with any neurological deficit or autoimmune disease. Severe visual loss, associated with persistence of pain after onset of visual loss and frequent recurrences should make us suspect this entity.
Purpose The use of the frontalis muscle in a direct attachment is an alternative to the traditional techniques of frontalis muscle flap advancement. This new variant, which is considered the most physiological, shows better functional results, but it may associate entropion as adverse effect. Methods Through a unique incision on the eyelid crease or making another incision on the superciliar area, a flap of frontalis muscle is created and attached to the tarsal plate with a non‐resorbable suture. It is important to attach the flap to the upper third of the tarsal plate for a correct elevation of the eyelid. A lower union otherwise could create long term complications principally residuary progressive entropion, which until now was only seen after traditional techniques of aponeurosis reinsertion of elevator muscle. We present two case reports showing severe ptosis after frontalis muscle flap direct suspension in which a medium third of the tarsal plate union was performed. Results Both patients showed progressive entropion which needed correction through surgery. Conclusion To prevent entropion in the frontalis muscle flap direct advancement, the muscle flap should be attached to the upper third of the tarsal plate, which allows physiological distribution of the tractional force in spite of maintaining the vertical vector, preventing the eyelid margin inversion.
Purpose The corpus callosum (CC), with its central position in the cerebrum, has an essential role in relaying sensory, motor, and cognitive information from homologous brain regions across cerebral hemispheres. Corpus callosum agenesis (CCA) is a rare congenital malformation which is caused by an alteration in embryonic development. Methods We report the case of a 3 year old child who was diagnosed of complete corpus callosum agenesis with a normal karyotype. The neurological findings were spastic tetraparesis with dystonia, several delayed psychomotor and epilepsy. In ophthalmology examination he presented esotropia, bilateral optic nerve hypoplasia, delayed visual evoked potential flash type and altered corneal sensibility in both eyes which is manifested clinically by recurrent corneal ulcers and epithelial disruption associated with stromal edema. Results After Neurotrophic keratopathy suspected, treatment with autologous serum was decided and response to treatment was favorable in both eyes with closure of ulcers and good management of symptoms. CCA has also been described in association with other ocular abnormalities such as optic nerve hypoplasia, retinal detachments, cataracts, morning glory syndrome, iris and optic nerve colobomas, among many others. Conclusion In all patients diagnosed with agenesis of the corpus callosum, the possible alteration of corneal sensitibility is a fact that will be suspected to perform early diagnosis and appropriate treatment and follow‐up.
Purpose To present the case report of a patient with multiple myeloma who develops orbital infiltration in the left side due to the myeloma. Methods A 53‐year‐old male with the diagnosis of IgA‐kappa multiple myeloma 3 years ago, stage III B in the staging system of Durie and Salmon, who has increased the volume in the left upper eyelid region in recent months. On examination the patient had moderate ptosis without affecting the pupillary axis, exophthalmos of 22.5 mm, hypotropia in primary position of gaze and limitation of supraversion left eye. Radiological and histological findings confirmed the existence of orbital extension of multiple myeloma at the supero‐internal quadrant. Results The patient has received several lines of chemotherapy treatment and autologous bone marrow transplantation without systemic or orbital improvement. Because of its systemic poor condition has been rejected surgical treatment and radiotherapy to the orbital level. Conclusion Although orbital involvement is rare and there are few reports in the literature, a patient with multiple myeloma who presents proptosis and / or increased the orbital volume, we must consider orbital infiltration by myeloma however, definitive diagnosis is histological.
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