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Case Report: A 25-year-old woman, with metamorphopsia in her left eye of one year onset. The examination revealed a bilateral cystoid macular oedema (CME) and vascular attenuation. We describe the diagnostic tests, as well as differential diagnosis and treatment response with carbonic anhydrase inhibitors., Discussion: The retinitis pigmentosa sine pigment is a subtype of atypical retinitis pigmentosa characterised by the absence of pigment deposits. The night blindness is milder, and perimetric and electroretinographic impairment is lower. CME is an important cause of central vision loss, and responds to anhydrase carbonic inhibitors., (Copyright © 2012 Sociedad Española de Oftalmología. Published by Elsevier Espana. All rights reserved.)

Case Report: A 70-year-old male patient diagnosed with bilateral adult-onset vitelliform dystrophy presented with a sudden decrease of vision in his left eye associated with the appearance of an occult type of neovascular membrane. It was treated with intravitreal ranibizumab due to juxtafoveal location of the membrane. Two injections were needed to induce total regression of the lesion., Discussion: Intravitreal ranibizumab may be effective to induce morphological and functional improvement in cases of choroidal neovascularization secondary to adult-onset vitelliform foveomacular dystrophy. Further case series are required to confirm this observation., (Copyright © 2011 Sociedad Española de Oftalmología. Published by Elsevier Espana. All rights reserved.)

Case: A 55-year-old male was diagnosed with exudative-hemorrhagic maculopathy, with no signs observed of drusen or pigmentary epithelium defects suggestive of age-related macular degeneration (ARMD). Fluorescein angiography (FA) and indocyanine green choroidal angiography (ICGA) showed retinal angiomatous proliferation (RAP). Afferent arteriole and retinal drainage venule connection was also observed. Treatment with a single Photodynamic Therapy provided an optimal outcome., Discussion: RAP is a form of neovascular ARMD described in recent years; it consists of an angiomatous proliferation that originates from the retinal capillary system and extends posteriorly into the subretinal space. Our patient showed typical RAP findings without any sign of ARMD

Case Reports: Three cases of pigmentary epithelial tears are described in this study. One of them was related to previous extrafoveal photocoagulation, whereas the other two were idiopathic. Fluorescein angiography (FA) and optical coherence tomography (OCT) were performed to confirm the clinical diagnosis., Discussion: Few studies using OCT to assess pigmentary retinal epithelial (RPE) tears have been published in the world literature. The main findings of our study included hyper-reflectant line breaks, choroidal hyper-reflectance due to the lack of RPE and RPE double layering where it was folded. Images were frequently associated with RPE tears and neurosensorial retinal detachment.

Purpose: To determine the incidence of cystoid macular edema (CME) by means of clinical evaluation and subclinical assessment by means of ocular coherence tomography (OCT), and to compare the incidence between diabetic and non-diabetic groups of patients., Methods: Prospective study of 260 consecutive cataract surgeries operated from September 2004 to March 2005. The procedures were performed by means of phacoemulsification plus intraocular acrylic lens implantation. Group A: 208 eyes of non-diabetic patients; Group B: 42 eyes of patients with diabetes and Group C: 10 eyes of diabetic patients with macular edema that received an intravitreal injection of triamcinolone at the end of surgery. Postoperative follow-up visits were performed 6 days (basal visit), 5 weeks and 12 weeks after surgery. Each visit included posterior pole biomicroscopy and OCT., Results: Central macular thickness measured by OCT was significantly increased in group B compared with group A (241.6 versus 204.6 microm; p<0.001). No clinical evidence of CME was found in group A, although 4 eyes (1.92%) showed macular thickness equal to or greater than 43.74 microm (2 standard deviations of the basal value for group A). In group B, clinical evidence of CME was found in 6 eyes, with decreased visual acuities (14.2%). The differences between these groups were statistically significant (p<0.001). The 10 eyes that received an intravitreal injection of triamcinolone after the surgical procedure showed a mean decrease in central retinal thickness of 77 microm after 12 weeks postoperative., Conclusions: This study has shown a low incidence of clinical CME. OCT showed increased macular thickness in both groups of patients in a small percentage of cases, and significantly increased macular thickness in diabetic patients.

Purpose: To evaluate the efficacy of photodynamic therapy with photodynamic therapy (PDT) in the management of choroidal neovascularization (CNV) in age-related macular degeneration (AMD) and myopia., Methods: 102 eyes with subfoveal or yuxtafoveal CNV underwent visual acuity (VA) testing, ophthalmic examination, and fluorescein angiography. Retreatment of persistent CNV was done after three months., Results: CNV was caused by AMD in 75.5% of patients, pathologic myopia in 24.5%. Follow up ranged from 9 to 33 months (mean: 15.94 months). 88% of CNV caused by pathologic myopia was classic and 40% was in lesions caused by AMD. CNV survival was shorter in lesions caused by pathologic myopia with a significant difference (p=0.0018). VA improved in 48% of lesions caused by pathologic myopia and in 28.6% of lesions caused by AMD. We did not observe any severe complication caused by PDT., Conclusion: PDT is a moderately effective treatment without complications in treating subfoveal CNV.

Purpose: To evaluate the incidence, clinical features and evolution of polypoidal choroidal vasculopathy (PCV) in our population., Methods: Retrospective study of patients diagnosed with exudative and/or hemorrhagic maculopathy including age-related macular degeneration in the last two years and who have undergone a complete ophthalmologic exploration and videoangiography with fluorescein and indocyanine green., Results: 250 patients were included in the study, 8 patients (3.2%) had clinical and angiographic criteria of PCV. The mean age was 68 years-old, 62.5% were men and 85.7% were caucasian. Ninety percent of cases presented clinically as a predominantly hemorrhagic macular detachment. The initial clinical diagnosis before indocyanine green angiography was exudative age-related macular degeneration in 90% of cases. The mean visual acuity was 0.2 at baseline and after follow-up. Laser treatment was performed in 4 eyes, achieving good anatomic and visual acuity results in 2 of them; both eyes of one patient were treated by photodynamic therapy with poor angiographic and functional outcome., Conclusions: Polypoidal choroidal vasculopathy is a clinical entity which is relatively frequent among patients previously diagnosed with exudative maculopathy. Indocyanine green angiography increases the number of correct diagnoses. Treatment must be individualized depending on the location of the lesions and the severity of the disease.

Purpose: To evaluate the clinical evolution and treatment of serpiginous choroiditis in 11 diagnosed patients., Methods: Retrospective study of 11 cases diagnosed with serpiginous choroiditis in our area, from 1980 to the present. We analyzed age at onset of symptoms, systemic diseases, ophthalmological symptoms at presentation, the location of lesions, initial and final visual acuity, recurrences, treatment régime and development of subretinal neovascularization. A complete ophthalmological examination and fluorescein angiograms were performed in all of them., Results: The mean period of follow-up was 4 years. Average age was 56 years, predominantly in men (10/1). Five patients had known ischemic cardiopathy and systemic hypertension, one patient underwent a kidney transplant. All of them were treated with oral prednisone (1-1.5 mg/kg/daily) in the active stages. Three patients received triple therapy (prednisone, cyclosporine and azathioprine) that did not prevent the recurrences. Five patients developed a subretinal neovascularization, bilateral in three of them., Conclusions: The serpiginous choroiditis is a rare entity and the visual outcome prognosis is determined by the macular involvement. Men are predominantly affected in our series and corticosteroid treatment is effective in acute inflammatory episodes. Recurrences could not be prevented by triple therapy with immunosuppressive agents in our three patients.

Purpose: To assess the effects of photodynamic therapy (PDT) with verteporfin on visual acuity (VA) and fluorescein angiography, in patients with subfoveal choroidal neovascularization (CNV) not secondary to age related macular degeneration (AMD) or pathologic myopia., Methods: 113 eyes from 104 patients underwent PDT due to subfoveal CNV from July 2001 to June 2002. In this study only those patients with CNV not related to AMD or pathologic myopia were included. Fluorescein angiography and visual acuity were evaluated., Results: 9 eyes from 8 patients (8.03%) showed distinct causes of CNV: 3 were idiopathic cases, 1 suffered angioid streaks, 1 was secondary to laser photocoagulation due to diabetic retinopathy, 2 had polypoidal choroidal vasculopathy and 2 central serous choroiditis. Regarding VA results, 77.7% improved or mantained the previous VA. Angiography resolution was observed in 55.5% of the cases (80% with just one PDT session). Average follow up was 10.5 months. Systemic or local complications were not observed., Conclusion: PDT may be useful in the treatment of different types of CNV due to causes other than AMD or high myopia.

Diffuse interface keratitis is a new clinical entity. It is becoming significantly more common due to the increasing of laser assisted in situ keratomileusis (LASIK) procedures. The knowledge we have about this uncommon but potentially sight-threatening complication is expanding. It appears in the early postoperatory LASIK, even in well-executed procedures. In this review we present an updated strategy for the diagnose and treatment of this syndrome, based on our own experience and an updated literature review. Early identification, evaluation, staging, and appropriate intervention, may help preventing visual loss associated with this entity.

Purpose: To evaluate the utility of dynamic angiography with fluorescein and indocyanine green with scanning laser ophthalmoscope (SLO) in exudative age-related macular degeneration., Method: We retrospectively studied 95 patients with exudative age-related macular degeneration (ARMD) between April 98 and April 01., Results: We studied 102 eyes of 95 patients with ARMD. Mean age was 75.3 years with a mean follow-up time of 16.8 months. We found an occult or mixed angiographic membrane pattern with fluorescein angiography in 85 eyes (83.3%). Angiography with indocyanine green showed choroidal neovascular membranes in 94 of 102 eyes (92.1%). The most frequent location found was sub-foveal (53.2%). Laser photocoagulation was used in 55 eyes and photodynamic therapy in 5 eyes. In 17 eyes laser treatment failed to close the membrane., Conclusion: Dynamic angiography with fluorescein or indocyanine green allowed neovascular membrane identification in more than 90% of the cases of ARMD. Successful treatment was achieved in 42% of cases.

Case Report: A case of an immunocompetent patient presenting primary systemic toxoplasma infection involving the eye (condition seen in less than 3% of primary infections). The patient showed reactivation of this primary focus two years later., Discussion: Diagnosis of toxoplasm retinitis is based on a typical lesion consisting in an area of active retinitis adjacent to an inactive corioretinal scar. Differential diagnosis must consider other causes of retinal coroiditis in primary infection cases: sarcoidosis, tuberculosis, syphilis as well as viral and fungal infections. Ocular toxoplasmosis was confirmed by serum tests.

Unlabelled: PURPOSE/MATERIAL AND METHOD: Cyanoacrylate tissue adhesive is indicated when a small corneal perforation is present. We report the case of a 23 year-old man who was attacked being thrown cyanoacrylate to both of his eyes., Results/conclusion: Wound healing has been laborious, however performed with low morbidity. This case is reported for being a bilateral injury and after finding no precedented cases in the literature.

Purpose: To determine the different angiographic patterns of neovascular membranes with indocyanine green in age-related macular degeneration (ARMD) and to establish the phase in which neovascularizations can be visualized most frequently., Material and Method: We studied 56 eyes from 55 patients with a diagnosis of ARMD between April 98 and April 99. All patients underwent indocyanine green (ICG) and fluorescein digital videoangiography. We evaluated the pattern and the moment of identification of the neovascular membrane with both procedures., Results: We found that 13 out of 56 eyes (23.2%) presented well-defined subretinal neovascularization in fluorescein videoangiography while 43 (76.8%) showed an occult pattern. ICG videoangiography was able to identify choroidal neovascularization in 89.3% of cases. The following patterns were found: Type I: visible neovascularization (17.9%), Type II: well-defined membranes with hypofluorescent margin (33.9%), Type III: high fluorescent focal membranes (hot-spots) (8.9%), Type IV: hyperfluorescent plaques that appeared only in late phases (10.7%), Type V: mixed types (17.9%). A high percentage of choroidal neovascularization was observed in early or medium phases of the angiogram (85.4%)., Conclusions: Choroidal neovascularization in ARMD can appear with different patterns in the ICG videoangiographic study. The most frequently found pattern was that of well-defined membranes with a hypofluorescent margin. A high percentage of cases can be already visualized in the early phases of the angiogram.

Purpose: We studied if tobramycin associated to sodium diclofenac modifies the drug effect of the latter on arachidonic acid metabolism in an endotoxin induced uveitis (EIU) model in albino rabbits., Methods: Experimental uveitis was induced by intravitreal injection of a 10 ng lipopolysaccharide A Salmonella typhimurium endotoxin dissolved in 5 microl saline solution in the right eye of experimental animals. We have used 48 animals (4 groups of 12 animals each). The control group (G-I) was injected with saline solution (5 microl); the endotoxin group (G-II) was injected with 5 microl of ET; group III and IV were injected with the same amount of ET and treated with topical sodium diclofenac (1%) (Group III) and tobramycin and sodium diclofenac (0.3%) (Group IV) two hours before the administration of endotoxin and then every two hours until 24 hours, when we determined E2 prostaglandin and B4 leukotriene concentration in aqueous humor obtained by paracentesis of the anterior chamber., Results: We observed how the E2 prostaglandin concentration was reduced in the two treatment groups compared with the endotoxin group (p<0.01). However, there were no differences between groups III and IV (p>0.01). There was a mild increase of B4 leukotriene in both treatment groups, which was not significant in relationship to the endotoxin group (p>0.01). No differences were found between the two treatment groups (p>0.01)., Conclusion: Using the association of tobramycin does not affect the action of sodium diclofenac in arachidonic acid metabolism in endotoxin induced uveitis.

Purpose: To study the different clinical presentation of the idiopathic juxtafoveolar retinal telangiectasis and its treatment with argon laser., Material and Method: We studied retrospectively nine eyes of eight patients, seen from 1990 to 1997, with diagnosis of idiopathic juxtafoveolar retinal telangiectasis. They have been studied with fluorescein angiography and treated with argon laser., Result: The most frequent clinical presentation was large areas of retinal telangiectasis affecting the horizontal rafe temporal to the macula. The diagnosis was stabilised as regards clinical manifestation and after ruling out other causes. Six out of eight patient with visual disfunction for macular edema and exudation improved considerably after laser photocoagulation. In 3 patients the vascular abnormalities were progressive after the treatment., Conclusions: The idiopathic juxtafoveolar retinal telangiectasis with exudation is an uncommon disease, that causes visual disturbance, but may be treated with laser photocoagulation.

Purpose: To study the effect of topical ketorolac-tromethamine in the arachidonic acid metabolism on a model of endotoxin induced uveitis (EIU) in albino rabbits., Methods: EIU was produced by intravitreal injection in the right eye with 10 ng LPS A Salmonella typhimurium endotoxin in 5ul saline solution. We used 60 animals (5 groups of 12 animals each). Control group (G-I) was injected with saline (5 ul); endotoxin group (G-II) was injected with 10 ng of ET; group III, IV and V were injected with the same amount of ET and treated with topical ketorolac-tromethamine every 6, 4 and 2 hours respectively. The animals were sacrificed 24 hours after the ET administration and we determined E2 prostaglandin and B4 leukotriene concentration in the aqueous humor., Results: In all treated groups with ketorolac-tromethamine we observed a significant reduction (p<0.05) in aqueous humor concentration of E2 prostaglandin without increase of the B4 leukotriene concentration comparing with endotoxin group., Conclusions: Ketorolac tromethamine produced an inhibition of ciclooxigenase metabolism of arachidonic acid without increase of lypoxygenase pathway.

Purpose: To study the antiinflammatory effect of topical pranoprofen on the lipoxygenase metabolism of the arachidonic acid in albino rabbits., Methods: Endotoxin-induced uveitis (EIU) was produced in albino rabbits by intravitreal injection in the right eye with 10 microg of Salmonella typhymurium lipopolysacharide A in 5 microl saline solution. We have used 5 groups of 12 animals each. Control group (G-I) was injected with 5 microl of saline solution and 5 microl of ET solution were injected in the remaining groups. Groups III, IV and V were treated with topical pranoprofen 2 hours before intravitreal injection, immediately after and every 6, 4 and 2 hours respectively. The animals were sacrificed 24 hours after the ET administration. Cellular and B4 leukotrien concentration in the aqueous humour was determined., Results: The groups treated with pranoprofen showed a significant decrease in the cellular concentration in relation to the group of endotoxin (G-II). We did not observe any difference in the B4 leukotriene concentration between ET group and topical pranoprofen groups., Conclusion: Topical pranoprofen has not increased the lipoxygenase metabolism of the arachidonic acid.

Purpose: To evaluate the efficiency and predictability of a multifactorial probability model to assess the risk of developing glaucomatous visual field defects and to determine the correlation between retinal nerve fiber layer (RNFL) photographs and short-wavelength automated perimetry (SWAP) in a population of patients suspected of having glaucoma., Methods: One hundred and sixty eyes belonging to 83 patients with ocular hypertension [ocular pressure figures over 21 mmHg and normal conventional automated perimetry (AP) (white-white)] were included in the study. The risk of developing glaucomatous defects was assessed by a multifactorial model that includes intraocular pressure. vertical cup-to-disk ratio, age and family background. RNFL photographs and SWAP tests were also performed., Results: SWAPs were pathological in 57 cases (35.6% of the sample); 23% of the perimetries were abnormal in the low-risk group while the moderate and high risk groups showed abnormal perimetries 38% and 56% respectively. The RNFL defects at the different risk levels were consistent with the SWAP results. The multiple regression analysis of the four variables included in the model showed the relationship among the risk factors, evaluated globally, and the presence of glaucomatous damage evaluated by RNFL and SWAP (p<0.001)., Conclusions: The usefulness of this probability model as predictive indicator of subsequent glaucomatous damage is based on the good correlation between the risk scale and the RNFL and SWAP assessments. These techniques evaluate structural (RNFL) and functional (SWAP) changes in early stages of the glaucomatous disease.

Purpose: To determine the distribution of sensitivity thresholds of short-wavelength automated perimetry (SWAP) in the central visual field, analysing their variability depending on the eccentricity, in normal subjects., Methods: 128 eyes of 128 normal subjects were analyzed. They underwent a SWAP examination. A lineal regression model was used to establish a <> (SVF). The SVF determines the threshold distribution and its variability., Results: The regression analysis obtained a SVF, age-corrected, which considers the influence of age in the different points of the visual field. The threshold distribution showed higher inter-subject deviations as eccentricity increased (p<0.001)., Conclusions: The determination of variability of the threshold sensitivity deviations in the different points of the central visual field allows future development of perimetric algorythms for SWAP.