Document downloaded from http://www.elsevier.es, day 18/06/2017. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited.
a r c h s o c e s p o f t a l m o l . 2 0 1 6;9 1(1):48–52
49
Fig. 2 – Retinal angiography: hyperfluorescence lesions in early times and hyperfluorescence in late times.
caused by hypersensitivity, with the focus of the disease being
in the intestine. Said hypersensitivity could explain the rest of
systemic signs and symptoms such as fever and arthralgia. On
the other hand, it was suspected that the bacteria had directly
invaded the intraocular space. In the case of the present
patient, an aggravating factor was the steroid treatment during three months before the onset of the intestinal clinic,
which led us to suspect that immunosuppression caused by
steroids could be the trigger that activated the remaining
symptoms. Ocular involvement in the form of Birdshot-like
retinochoroidopathy could be one of the ocular expressions of
Whipple’s disease and might even be the initial onset.
Acknowledgments
The authors wish to acknowledge all their colleagues working
in the Uveitis Multidisciplinary Unit of the Navarra Hospital
Complex of Pamplona.
references
1. Puechal X. Wipple’s disease. Ann Rheum Dis. 2013;72:797–803.
2. Nishimura JK, Cook BE Jr, Jonh M, Pach JM. Whipple disease
presenting as posterior uveitis without prominent
gastrointestinal symptoms. Am J Ophthalmol. 1998;126:
130–2.
3. Avila MP, Jalkh AE, Feldman E, Feldman E, Trempe CL,
Schepens CL. Manifestations of Whipple’s disease in the
posterior segment of the eye. Arch Ophthalmol. 1984;102:
384–90.
P. Fanlo-Mateo a,∗ , H. Heras-Mulero b , F. Jimenez-Bermejo a ,
M. Montes-Díaz c
a
Unidad Multidisciplinar de Uveítis, Servicio de Medicina Interna,
Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain
b Unidad Multidisciplinar de Uveítis, Servicio de Oftalmología,
Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain
c
Servicio de Anatomía Patológica, Complejo Hospitalario
de Navarra, Pamplona, Navarra, Spain
author.
E-mail address: [email protected] (P. Fanlo-Mateo).
2173-5794/© 2015 Sociedad Española de Oftalmología.
Published by Elsevier España, S.L.U. All rights reserved.
∗ Corresponding
Location of the uncinate process with respect
to the lacrimal fossa夽,夽夽
Localización de la apófisis unciforme respecto a la fosa lagrimal
Dear Sir,
The uncinate process is a hook-shaped bony process extending craneo-caudally from the most anterior part of the
ethmoid comprising a thin bone plate arising out of the anterior extremity of the middle meatus.1
For a number of years, diode laser endocanalicular dacryocystorhinostomy is utilized as an alternative to the external
or endonasal pathway in some patients. On the basis of the
clinical observation that, when performing endocanalicular
dacryocystorhinostomy, it is sometimes difficult to see the
posterior osteotomy due to said uncinate process, we decided
夽
Please cite this article as: Cifuentes-Canorea P, Troyano-Rivas JA. Localización de la apófisis unciforme respecto a la fosa lagrimal. Arch
Soc Esp Oftalmol. 2016;91:49–50.
夽夽
Presented as an oral communication at the 24th Congress of the Ocular and Orbitary Surgery Society of Spain and is a free communication at the 90th Congress of the Ophthalmology Society of Spain.
Document downloaded from http://www.elsevier.es, day 18/06/2017. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited.
50
a r c h s o c e s p o f t a l m o l . 2 0 1 6;9 1(1):48–52
to approach a study to describe the anatomy of the uncinate
process in relation to the lacrimal fossa.
We considered a descriptive retrospective study analyzing the location of the insertion of the uncinate process in
computerized axial tomography of 30 consecutive patients,
discarding those whose nasal involvement could interfere
with the assessment of the insertion. In all the patients the
insertion of the uncinate process was assessed at three levels: superior, medium and inferior in relation to the lacrimal
fossa, classifying said insertion at each level as retrolacrimal
(posterior to the lacrimal bone), lacrimal (at the lacrimal bone),
maxillary or in the middle turbinate.
Overall, all 30 patients were analyzed (13 males and
17 females) finding the following percentages of uncinate process insertion at the upper level: retrolacrimal 10%, lacrimal
10%, maxillary 23.3% and turbinate 56.7%. At the middle level:
retrolacrimal 20%, lacrimal 36.7%, maxillary 40% and turbinate
3.3%. At the inferior level: retrolacrimal 36.7%, lacrimal 50%
and maxillary 13.3%.
Said results closely match similar studies in a large percentage of which the uncinate process is inserted at the level
of the lacrimal or maxillary bone.2
Even though in external dacryocystorhinostomy (DCR) the
location of the uncinate process is possibly irrelevant, the relevance thereof has been suggested in endonasal DCR making
it appropriate to perform uncinectomy as the percentage of
complications is low and associated to higher rates of success
according to some studies.3
The purpose of our work was to make an anatomical
description of the uncinate process insertion and its relationship with the lacrimal fossa. Future research should
determine the importance of associating uncinectomy in
cases in which the uncinate process could hinder the visualization of osteotomy in diode laser endocanalicular DCR.
Our hypothesis is that maxillary insertion and even
some lacrimal insertion cases could have a poor prognostic if uncinectomy prior to laser endocanalicular DCR is not
performed, as the uncinate process prevents adequate manipulation of the osteotomy being performed. However, in our
view, retrolacrimal insertion cases would be most favored
because there would be no obstacle between the surgeon’s eye
and the osteotomy.
references
1. Yoon JH, Kim KS, Jung DH, Kim SS, Koh KS, Oh CS, et al.
Fontanelle and uncinate process in the lateral wall of the
human nasal cavity. Laryngoscope. 2000;110:281–5.
2. Fayet B, Assoline R, Zerbib MM. Surgical anatomy of the
lacrimal fossa. A prospective computed tomodensiometry
scan analysis. Ophtalmology. 2005;112:1119–281.
3. Fayet B, Racy E, Assouline M. Systematic unciformectomy for a
standardized endonasal dacryocystorhinostomy.
Ophthalmology. 2002;109:530–6.
P. Cifuentes-Canorea ∗ , J.A. Troyano-Rivas
Servicio de Oftalmología, Departamento de Órbita y Oculoplastia,
Hospital Clínico San Carlos, Madrid, Spain
∗ Corresponding
author.
E-mail address: [email protected] (P. Cifuentes-Canorea).
2173-5794/© 2015 Sociedad Española de Oftalmología.
Published by Elsevier España, S.L.U. All rights reserved.
From physiological vascular tortuosity to the
tortuositas vasorum retinae夽
De la tortuosidad vascular fisiológica a la tortuositas vasorum retinae
Dear Sir,
The central retinal artery–a branch of the ophthalmic
artery–penetrates the ocular globe in the thickness of the optic
nerve. It emerges from the nerve in the center of the papilla
and it divides in two branches, one ascending and the other
descending which in turn branch out in numerous ramifications extending throughout the retina up to the ora serrata. The
veins follow the reverse path and from the junction thereof the
retina central vein arises in a similar and parallel structure.1
However, retinal neovascularization may exhibit several
congenital variants which are regarded within normal ranges
and do not imply any potential complication excepting some
diagnostic doubts based on physiological variance. Ranging
from an increased number of vessels up to increased vascular patency or uneven disposition thereof with pre-papillary
crosses or loops, said congenital variants are numerous, highly
variable and asymptomatic.
Of note among congenital retinal vascularization variants
we have physiological vascular tortuosity (PVT) and tortuositas vasorum retinae (RVT). In PVT, retinal blood vessels acquire
a sinuous corkscrew appearance (Fig. 1). This particular
arrangement of vessels is appreciated mainly in the posterior
pole, where the thinner vessels are arranged at right angles
夽
Please cite this article as: Santos-Bueso E, Muñoz-Hernández AM, Díaz-Valle D, Gegúndez-Fernández JA, Benítez del Castillo JM. De la
tortuosidad vascular fisiológica a la tortuositas vasorum retinae. Arch Soc Esp Oftalmol. 2016;91:50–52.