Keratoacanthoma (KA) and Squamous Cell Carcinoma (SCC) are entities that often have been difficult to differentiate. Current thought establishes that Keratoacanthoma behaves similarly to a lowgrade squamous cell carcinoma. We present a case of an 80 year old female which history of present illness as well as clinical impression mimics Keratoacathoma (KA), but on histopathological examination resulted in Squamous Cell Carcinoma (SCC). We posit the use of novel histopathological and cytological advances, such as TGF-β sequencing and TGF-Alpha staining in assessing the specimen. Subtle differences should guide treatment for patients that need further resection and that might have orbital involvement.

Resumen Introducción: La arteritis de células gigantes (ACG) es una inflamación granulomatosa y necrotizante de arterias de mediano y gran calibre de etiología desconocida. La pérdida de visión rápidamente progresiva es una de sus complicaciones más graves dada su potencial bilateralidad e irreversibilidad. La enfermedad de Crohn (EC) es debida a la inflamación transmural y segmentaria del tracto gastrointestinal. Ambas entidades poseen una baja incidencia en nuestro medio, siendo excepcional la coexistencia de éstas simultáneamente en el mismo paciente. Caso clínico: Mujer de 77 años de edad con antecedentes personales de EC en tratamiento activo con Infliximab que acudió por disminución súbita de agudeza visual (AV) por su ojo izquierdo (OI). A la exploración oftalmológica la AV por su OI era de cuenta dedos a 30 cm y mostraba un defecto pupilar aferente relativo izquierdo muy manifiesto. Funduscópicamente el OI mostró un edema de papila pálido con hemorragias peripapilares. La paciente refería síntomas de ACG y alteraciones analíticas compatibles, por lo que tras ser diagnosticada de neuritis óptica isquémica anterior arterítica se procedió a la administración de dosis altas de glucocorticoides experimentando una mejoría analítica y clínica, aunque la pérdida de función visual fue permanente. Conclusiones: El Infliximab es un farmaco anti-TNFα empleado en la EC activa en casos refractarios al tratamiento corticoideo. Existen datos que sugieren que puede ejercer un efecto beneficioso en la inhibicion de la ACG al estar implicado el TNFα en la etiopatogenia de ambos cuadros. Sin embargo, en nuestra paciente no fue suficiente como medicacion previa y preciso dosis altas de corticoides, previniendo asi la bilateralidad del cuadro de ACG. Palabras clave: Neuropatia óptica isquémica anterior; arteritis células gigantes; enfermedad de Crohn;, Infliximab. Abstract Introduction: Giant Cell Arteritis (GCA) is a granulomatous and necrotizing inflammation of medium and large calibre arteries due to unknown etiology. Rapidly progressive loss of vision is one of the most serious complications given its irreversibility. Crohn's disease (CD) is a segmental and transmural inflammation of the gastrointestinal tract. Both entities have a low impact in our environment and it is exceptional the coexistence of these conditions in the same patient. Clinical case: We present a 77 year old woman with a personal history of CD in active treatment with Infliximab who showed a sudden visual loss in her left eye (LE). In the ophthalmological examination, the visual acuity was counting fingers at 30 cm and we observed a very clear left relative afferent papillary defect. Fundus showed a papiledema with peripapillary haemorrhages. The patient reported symptoms and laboratory abnormalities compatibles with GCA, so after being diagnosed of arteritic anterior ischemic optic neuritis we proceeded to the administration of high doses of glucocorticoids leading to analytical and clinical improvement, although the visual loss was permanent. Conclusion: Infliximab is an anti-TNFα drug used in active CD in cases refractory to corticosteroid treatment, data suggest that may have a beneficial effect on GCA inhibition because TNFα participate in the pathogenesis of both diseases. However, in our patient, it was not enough and she needed high doses of corticosteroids to avoid the bilateralism of the disease.

A 25-year-old woman presented with blurry vision, headache, nausea, and syncope. Humphrey visual field testing revealed bitemporal defects, but magnetic resonance imaging was negative for chiasmal pathology. Macular optical coherence tomography showed focal parafoveal disruption of the photoreceptor inner segment/outer segment junction and infrared imaging showed hyporeflective macular lesions in both eyes. Our case demonstrates a diagnosis of acute macular neuroretinopathy that presented with bitemporal visual field defects. To our knowledge, bitemporal visual field loss, mimicking chiasmal pathology, has not been reported previously in association with acute macular neuroretinopathy.

Resumen La enfermedad de Best es una distrofia macular que se caracteriza por un acúmulo de lipofuscina sobre el epitelio pigmentario de la retina. Existen cinco estadios diferentes basados en el examen del fondo de ojo incluyendo la neovascularización coroidea. Describimos el caso de un varón de 59 años que acude al servicio de oftalmología por disminución de agudeza visual en ambos ojos. El examen del fondo de ojo reveló lesiones viteliformes en ambas máculas. La angiofluorescinografía mostró una membrana neovascular coroidea en el ojo izquierdo. Confirmando el electrooculograma la enfermedad de Best. La aparición de neovascularización coroidea en la enfermedad de Best es una complicación infrecuente que puede ocurrir en etapas tardías. Las opciones terapéuticas más efectivas son la terapia antiangiogénica y la terapia fotodinámica con veteporfirina. Palabras clave: Enfermedad de Best; neovascularización coroidea; Ranibizumab inyección intravítrea. Abstract Best's Disease is a macular dystrophy characterized by a lipofuscin accumulation on the retinal pigment epithelium. Five stages have been described based on fundus examination, including choroidal neovascularization. We report a case of a 59-years-old male, presented to the Department of Opthalmology with visual loss in both eyes. Fundus examination revealed vitelliform lesions in both maculas. Fluorescein angiography showed a choroidal neovascularization in the left eye. The electrooculogram confirmed the diagnosis of Best's disease. Choroidal neovascularization is a rare complication of Best's Disease in late stages. The most effective therapeutic options are photodynamic therapy with veteporfirin and antiangiogenic therapy

Relapsing Polychondritis (RP) is a rare, recurrent and autoimmune multisystem disorder affecting cartilaginous structures, such as auricles, joints, nasal septum, larynx and tracheobronchial tree. Ocular manifestations may be observed in 42,3-65% of cases. Episcleritis and scleritis are the most common findings. However, RP is frequently misdiagnosed, leading to potentially severe, debilitating and, sometimes, fatal disease. There is no established standardized therapeutic protocol for RP. Current medical therapy is largely empiric and based on case reports. The aim of this paper is to document one case of ocular involvement in RP disease, emphasizing clinical and imaging findings that can help to establish an early diagnosis.

Secondary injuries caused by lightning strikes are not frequent; however, survivors have important sequel in organs and tissues. We describe two cases. The first one with lightning-induced maculopathy and the other case involving lens damage. This paper discusses factors that determine the extent of injuries and review the management for each one. The study and data collection complained with local legislation and with the principles of the Declaration of Helsinki.

Ten years after Baerveldt™ implantation, a woman underwent immunosuppressive therapy for necrotizing scleritis. She subsequently developed symptoms suggestive of endophthalmitis in the setting of tube exposure. Cultures isolated fungal Paraconiothyrium. She underwent two vitrectomies with anterior chamber washouts, Baerveldt™ device removal, and intraocular and systemic antifungal therapy. The endophthalmitis has since resolved.

Purpose: To describe a rare bilateral corneal ring-shaped opacity, not categorized as corneal dystrophy or degeneration occurring without any associated ocular or systemic disease. Methods: Case report and review of the literature. Results: The authors describe the clinical history and examination of an 80 years old man, with an asymptomatic bilateral and symmetrical ring-shaped corneal opacity in the deep stroma of the corneal mid-periphery. The surrounding corneal stroma was clear, and the tear film, epithelium and its basement membrane, Descemet’s membrane and endothelium were normal. This rare corneal anomaly was discovered by chance and its etiology is unknown. Conclusions: These rings may result from deposits of unknown origin or possibly a rare corneal dystrophy.

Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis that still remains a public health problem in many countries. Its incidence in industrialized countries has been increasing during recent years due to HIV infection and immigration. Tuberculosis affects primarily the lung and lymph nodes but has the potential to infect almost every organ system and unusual presentations raise difficulties in differential diagnosis. The authors report a rare case of tuberculosis affecting the nasolacrimal system.

We report a case in which the vitreous was inadvertently stained with trypan blue during cataract surgery.

Neisseria gonorrhoeae is a important cause of ophthalmia neonatorum, and it can cause multiple complications in the newborn, including corneal perforation, panophtalmitis and blindness. We report a case of 1 month old newborn with bilateral infectious conjunctivitis and corneal unilateral commitment, with positive culture for gonococcus. ACT showed intraocular inflammatory involvement of the left eye. It is managed with intravenous antibiotic therapy, evolving with opacification , vascularization , progressive thinning of the cornea and athalamia of the left eye. It undergoes surgery for corneal patch and anterior chamber reshaping. During follow-up, eye ultrasound examination showed normal right eye and a smaller axial length and choroidal thickening of the left eye. RESUMEN Neisseria gonorrhoeae es una causa importante de oftalmía neonatal, pudiendo causar múltiples complicaciones en el recién nacido, incluyendo perforación corneal, panoftalmitis y ceguera. Se presenta caso de recién nacido de 1 mes de vida, con conjuntivitis infecciosa bilateral y compromiso corneal unilateral, además de cultivo positivo para gonococo. Tomografía axial computarizada de órbita mostró compromiso inflamatorio intraocular del ojo izquierdo. Se manejó con terapia antibiótica endovenosa, evolucionando con opacificación, vascularización, adelgazamiento progresivo de la córnea y atalamia del ojo izquierdo. Se sometió a cirugía para parche corneal y reformación de cámara anterior. Durante seguimiento, ecografía ocular mostró un examen normal del ojo derecho y una menor longitud axial y engrosamiento coroideo del ojo izquierdo.

Our purpose is to report a clinical case of bilateral macular edema caused by malignant hypertension in a 35-year old male. Patient presented with bilateral low visual acuity, massive macular edema, retinal hemorrhages and papilledema. Soon after he was diagnosed with other target-organ lesions, on heart and kidneys. After 6 months of controlled blood pressure, an increase in visual acuity and a small decrease of macular edema, we effectively treated the lower vision eye with two intravitreal ranibizumab injections, improving anatomy and function on both eyes. Even though we only treated one eye with ranibizumab, the contralateral eye also improved visual acuity and central macular thickness. This probably happened due to systemic absorption of ranibizumab. To the best of our knowledge, this is the first report of ranibizumab use in macular edema due to malignant hypertension.