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Objective. The aim of this study was to assess the efficacy of anti-TNF-alpha therapy in refractory uveitis due to Behcet's disease (BD). Methods. We performed a multicentre study of 124 patients with BD uveitis refractory to conventional treatment including high-dose corticosteroids and at least one standard immunosuppressive agent. Patients were treated for at least 12 months with infliximab (IFX) (3-5 mg/kg at 0, 2 and 6 weeks and then every 4-8 weeks) or adalimumab (ADA) (usually 40 mg every 2 weeks). The main outcome measures were degree of anterior and posterior chamber inflammation, visual acuity, macular thickness and immunosuppression load. Results. Sixty-eight men and 56 women (221 affected eyes) were studied. The mean age was 38.6 years (S.D. 10.4). HLA-B51 was positive in 66.1% of patients and uveitis was bilateral in 78.2%. IFX was the first biologic agent in 77 cases (62%) and ADA was first in 47 (38%). In most cases anti-TNF-alpha drugs were used in combination with conventional immunosuppressive drugs. At the onset of anti-TNF-alpha therapy, anterior chamber and vitreous inflammation was observed in 57% and 64.4% of patients, respectively. In both conditions the damage decreased significantly after 1 year. At baseline, 50 patients (80 eyes) had macular thickening [optical coherence tomography (OCT) >250 mu m] and 35 (49 eyes) had cystoid macular oedema (OCT > 300 mu m) that improved from 420 mm (S.D. 119.5) at baseline to 271 mu m (S.D. 45.6) at month 12 (P < 0.01). The best-corrected visual acuity and the suppression load also showed significant improvement. After 1 year of follow-up, 67.7% of patients were inactive. Biologic therapy was well tolerated in most cases. Conclusion. Anti-TNF-alpha therapy is effective and relatively safe in refractory BD uveitis.

espanolCaso clinico: Varon de 55 anos, sin drusas ni alteraciones del epitelio pigmentario sugestivas de degeneracion macular asociada a la edad (DMAE), que presento maculopatia exudativo-hemorragica. La angiografia con fluoresceina e indocianina verde mostraron la proliferacion angiomatosa retiniana (PAR), la arteriola aferente y venula retinianas de drenaje. La respuesta fue optima a un unico tratamiento con terapia fotodinamica. Discusion: La PAR es una lesion descrita en los ultimos anos en el contexto de la DMAE, cuya principal caracteristica es la lesion neovascular formada a partir de capilares retinianos y su extension posterior al espacio subretiniano. Nuestro paciente presentaba los hallazgos tipicos de PAR sin DMAE. EnglishCase: 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.

espanolCasos clinicos: Se presentan 3 pacientes con desgarro de epitelio pigmentario retiniano (EPR). En dos de ellos, este se produjo de manera espontanea, estando el tercero en relacion con la fotocoagulacion de una neovascularizacion extrafoveal. Se realizaron angiografias (AGF) y estudio con tomografia optica de coherencia (OCT) que confirmaron el diagnostico. Discusion: Existen pocos estudios sobre OCT en desgarro del EPR. Las principales caracteristicas son: interrupcion de la linea hiperreflectante del EPR, hiperreflectividad de la coroides en la zona de ausencia de EPR y doble capa de EPR donde este esta replegado. Es frecuente el desprendimiento de EPR y neurosensorial asociado. EnglishCase 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.

espanolObjetivo: Detectar la incidencia de edema macular quistico (EMQ) tras cirugia de catarata tanto clinico como subclinico, mediante «ocular coherence tomography» (OCT) y comparar dicha incidencia entre un grupo de pacientes diabeticos y otro de no diabeticos. Material y metodos: Estudio prospectivo de 260 ojos intervenidos de forma consecutiva de catarata mediante facoemulsificacion con implante de lente intraocular acrilica, desde septiembre de 2004 a marzo de 2005. Grupo A: 208 ojos de pacientes no diabeticos, grupo B: 42 ojos de pacientes diabeticos, grupo C: 10 ojos de pacientes diabeticos con edema macular y que recibieron triamcinolona intravitrea (TAIV) al finalizar la cirugia. En cada revision efectuada a los 6 dias (basal), 5 semanas y 12 semanas se realizo biomicroscopia de polo posterior y OCT. Resultados: El espesor macular en la OCT, fue significativamente superior en el grupo B que en el grupo A (241,6 versus 204,6 µm p- 43,74 µm (2 DE del valor basal del grupo A). En el grupo B, seis ojos presentaron EMQ clinicamente significativo, con disminucion de agudeza visual (14,2%), en 12 ojos detectamos aumento del espesor macular (28,5%). Las diferencias entre grupos fueron significativas (p EnglishPurpose: 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 µm; p

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.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.

To study the effect of topical ketorolac-tromethamine in the arachidonic acid metabolism on a model of endotoxin induced uveitis (EIU) in albino rabbits.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.In all treated groups with ketorolac-tromethamine we observed a significant reduction (p0.05) in aqueous humor concentration of E2 prostaglandin without increase of the B4 leukotriene concentration comparing with endotoxin group.Ketorolac tromethamine produced an inhibition of ciclooxigenase metabolism of arachidonic acid without increase of lypoxygenase pathway.

La reconstrucción de la historia de la madre del conocido Estanislao Severo Zeballos es el objetivo de este artículo que se centra en la búsqueda del rol ejercido por Felisa Jordán durante la organización del Estado-Nación de la República Argentina. Zeballos divulgó algunos datos de su vida privada, como su parentesco con los Urquiza y los Ruiz Moreno, o su condición de propietario de 351.562 hectáreas en el Chaco Boreal gracias a la mediación que practicó en el transcurso de la firma del tratado boliviano-paraguayo que fijó la línea de statu-quo de 1907. Pero el relato más creativo del rosarino Estanislao fue la gestión de su madre Felisa Jordán de Zeballos en el marco del ámbito asociativo de la ciudad de Rosario. Para describir esta llamativa vinculación entre Zeballos y su madre Felisa Jordán me he centrado en dos fuentes documentales singulares que nos permiten abordar las prácticas asociativas, los espacios públicos y la proyección femenina en Argentina entre 1869 y 1872. En primer lugar en los documentos privados de las mujeres de élite de la Ciudad de Rosario, en particular las actas y la correspondencia de la asociación benéfica Damas de Caridad. Esta documentación signó durante años mi investigación sobre el Asilo de Huérfanos y Expósitos cuyo nombre fue modificado por Hogar del Huérfano por el peronismo, una institución que hoy día se encuentra en un futuro incierto. La secretaria de aquella asociación femenina fue la llamativa Felisa Jordán, la viuda del militar Estanislao Zeballos, que colaboraba activamente con la presidenta de la asociación Damas de Caridad, María de los Ángeles Rodríguez de Rosas, y con la tesorera Blanca Musch de Villegas en cuyo domicilio se reunieron por primera vez para formar la entidad en el año 1869, es decir, en plena Guerra de la Triple Alianza. La documentación de las hoy llamadas Damas de Protección al Huérfano se conserva en el archivo del Hogar del Huérfano, otrora denominado Hogar de Huérfanos y Expósitos, y hace referencia a aspectos de la vida cotidiana de la entidad, de la asociación femenina y de sus socias.