Archivos de la Sociedad Espanola de Oftalmologia最新文献

{"title":"Orbital spindle cell neoplasm with neural differentiation: diagnostic challenges in the absence of molecular confirmation.","authors":"V M Asensio-Sánchez, J Rodriguez-Espinosa, L De Juan-Hernández, A Vela-Martín, M E García-Lagarto","doi":"10.1016/j.oftale.2026.502649","DOIUrl":"10.1016/j.oftale.2026.502649","url":null,"abstract":"<p><p>Orbital spindle cell tumors with neural differentiation represent an uncommon and diagnostically challenging entity in clinical practice. We report the case of an 82-year-old man with a history of treated rectal adenocarcinoma, who presented with progressive orbital pain and right-sided proptosis. Computed tomography revealed a soft tissue mass located at the orbital apex, without evidence of bone erosion. Orbital exenteration was performed, and histopathological examination demonstrated an infiltrative high-grade spindle cell neoplasm with a fascicular growth pattern, moderate pleomorphism, and increased mitotic activity. Immunohistochemical analysis showed diffuse positivity for S100 and SOX10, with negative staining for melanocytic, muscular, epithelial, and vascular markers. The Ki-67 proliferative index was elevated (approximately 50%). H3K27me3 immunostaining was not available. Overall, the morphological and immunophenotypic findings were consistent with a spindle cell neoplasm with neural differentiation, suggestive of a malignant peripheral nerve sheath tumor (MPNST, malignant peripheral nerve sheath tumor). This case highlights the diagnostic limitations of these neoplasms in the absence of molecular confirmation and underscores the importance of clinicoradiologic-pathologic correlation in anatomically complex locations such as the orbit. This case emphasizes that, in the absence of molecular confirmation, the diagnosis of MPNST should be considered as an integrative hypothesis based on multidisciplinary correlation. From a surgical standpoint, this case underscores the role of radical procedures such as orbital exenteration in infiltrative orbital apex tumors with suspected high-grade malignancy and extensive involvement of deep orbital structures and neurovascular compromise.</p>","PeriodicalId":93886,"journal":{"name":"Archivos de la Sociedad Espanola de Oftalmologia","volume":" ","pages":"502649"},"PeriodicalIF":0.0,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148882909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radial lattice degenerations and foveal hypoplasia: Late diagnosis of Stickler syndrome in a patient without high myopia","authors":"M. Puchol-Rizo,&nbsp;J. Suárez-Baraza,&nbsp;A. Muñoz-Gallego","doi":"10.1016/j.oftale.2026.502554","DOIUrl":"10.1016/j.oftale.2026.502554","url":null,"abstract":"<div><div>Stickler syndrome is a rare connective tissue disorder with multisystem involvement. We describe the diagnosis and management of Stickler syndrome in a 39-year-old woman with unclassified bone-muscle dysplasia and no prior ocular history, presenting with floaters. Fundus examination showed radial lattice degenerations in both eyes and optical coherence tomography revealed bilateral foveal hypoplasia. Despite not having high myopia (only −4 Diopters in each eye), those funduscopic findings made us investigate further disease. A genetic test was made, and she was found to be heterozygous for the likely pathogenic variant c.1069-2A &gt; T in the COL2A1 gene. Therefore, our patient was finally diagnosed with Stickler syndrome type 1. This case emphasizes the need to consider Stickler syndrome in adults with vitreoretinal degeneration and foveal hypoplasia, even in the absence of high myopia.</div></div>","PeriodicalId":93886,"journal":{"name":"Archivos de la Sociedad Espanola de Oftalmologia","volume":"101 9","pages":"Article 502554"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147719245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Case report: The diagnostic and surgical value of UBM in phacolytic glaucoma secondary to traumatic lens subluxation","authors":"G.U. Fonseca-Aguirre,&nbsp;E.J. Briceño-Souza,&nbsp;C.A. Gómez-Valdivia","doi":"10.1016/j.oftale.2026.502555","DOIUrl":"10.1016/j.oftale.2026.502555","url":null,"abstract":"<div><div>This case report highlights the diagnostic and surgical value of ultrasound biomicroscopy (UBM) in managing phacolytic glaucoma with traumatic lens subluxation, a rare combination requiring differentiation from other lens-induced glaucomas. UBM precisely identified three pathognomonic features: (1) subluxated lens with reduced thickness yet open angles, (2) cortical liquefaction, and (3) zonular insufficiency, thus overcoming the limitations of conventional imaging modalities. The patient underwent successful phacoemulsification with capsular tension ring implantation, achieving 20/20 vision and normalized intraocular pressure (IOP) at 1-month follow-up.</div></div>","PeriodicalId":93886,"journal":{"name":"Archivos de la Sociedad Espanola de Oftalmologia","volume":"101 9","pages":"Article 502555"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147719247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multifocal intraocular lenses in refractive lens exchange: Guidelines to optimize their use and indications","authors":"H.B. Dick,&nbsp;R.D. Gerste,&nbsp;S. Taneri","doi":"10.1016/j.oftale.2026.502615","DOIUrl":"10.1016/j.oftale.2026.502615","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>Refractive lens exchange (RLE) with presbyopia-correcting intraocular lenses (IOLs) can provide high levels of spectacle independence, but the procedure is unforgiving. Small residual refractive errors, ocular surface instability, undiagnosed corneal or macular disease, capsule-related IOL malposition, and mismatched expectations are common pathways to postoperative dissatisfaction. The literature on multifocal and extended-range optics is now complemented by consensus documents and functional classification frameworks that help standardize terminology and reduce “marketing-driven” decision making.</div></div><div><h3>Materials and methods</h3><div>This narrative review aims to define practical indications for multifocal IOL use in RLE, clarify borderline cases, summarize the level of evidence supporting current recommendations, and present a staged algorithm for management of dissatisfaction. Priority was given to international consensus statements, systematic reviews/meta-analyses, randomized or comparative studies, large contemporary cohorts, and focused case series dealing with dissatisfaction, neuroadaptation failure, and IOL exchange. The literature was organized around the terms refractive lens exchange, refractive lensectomy, multifocal intraocular lens, trifocal, extended depth of focus, enhanced monofocal, dysphotopsia, neuroadaptation failure, and lens exchange, with emphasis on contemporary evidence available up to January 2026.</div></div><div><h3>Results</h3><div>The evidence can be translated into two clinic-ready workflows. The first is a preoperative selection pathway that starts with patient goals, prioritizes optical quality, treats astigmatism aggressively, and reserves range-first optics for eyes and expectations that can tolerate their trade-offs. The second is a symptom-first rescue pathway built on a strict reversible-first and YAG-last sequence. Borderline eyes are best handled with conservative category selection or deferred surgery. Contemporary exchange series show that persistent neuroadaptation failure may be successfully managed either by exchange to monofocal optics or by exchange to another multifocal platform with a different optical profile, provided that refraction, ocular surface disease, posterior-segment pathology, and IOL position have already been addressed.</div></div><div><h3>Conclusion</h3><div>Multifocal IOLs remain valuable in RLE, but success depends more on indication discipline and rescue sequencing than on lens marketing labels. A structured algorithm, clear counseling, and explicit documentation of rescue options improve safety, readability, and everyday clinical usefulness.</div></div>","PeriodicalId":93886,"journal":{"name":"Archivos de la Sociedad Espanola de Oftalmologia","volume":"101 9","pages":"Article 502615"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148378469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Redox-inflammation pathways in ocular disease: Targets for nutritional modulation","authors":"P.K.V. Kavyasree,&nbsp;K. Jayadevan,&nbsp;M. Abdullah,&nbsp;A. Therayil","doi":"10.1016/j.oftale.2026.502581","DOIUrl":"10.1016/j.oftale.2026.502581","url":null,"abstract":"<div><div>Visual impairment remains a major global health burden caused by diverse ocular diseases, including age-related macular degeneration, diabetic retinopathy, glaucoma, uveitis, and ocular surface disorders. Despite differing etiologies, growing evidence identifies oxidative stress and chronic inflammation as a shared pathogenic axis affecting both anterior and posterior ocular segments. High metabolic demand, sustained light exposure, dense mitochondrial content, and limited antioxidant defences render ocular tissues particularly susceptible to redox imbalance. Excess reactive oxygen species induce cellular injury and activate redox-sensitive inflammatory signalling, promoting neurodegeneration, microvascular dysfunction, immune-mediated damage, and progressive vision loss. This review summarises key mechanisms underlying redox–inflammatory crosstalk in ocular tissues, highlighting mitochondrial dysfunction, Nrf2–Keap1 antioxidant responses, NF-κB-driven inflammation, and MAPK and PI3K–Akt signalling as central molecular integrators. Tissue-specific responses in the retina, retinal pigment epithelium, trabecular meshwork, uveal tract, and ocular surface demonstrate how shared mechanisms generate distinct disease phenotypes. The modulatory potential of bioactive nutrients, including omega-3 fatty acids, carotenoids, and polyphenols, is critically discussed. Although preclinical evidence is strong, clinical outcomes remain variable, underscoring the need for precision nutrition strategies and mechanism-based clinical trial design.</div></div>","PeriodicalId":93886,"journal":{"name":"Archivos de la Sociedad Espanola de Oftalmologia","volume":"101 9","pages":"Article 502581"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148038577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diplopia and papilledema secondary to thrombosis of the longitudinal venous sinus due to Leiden factor V thrombophilia in a young patient","authors":"J. Dalma-Weiszhausz,&nbsp;V. Franco-Cárdenas,&nbsp;J.P. Dávila-González","doi":"10.1016/j.oftale.2026.502541","DOIUrl":"10.1016/j.oftale.2026.502541","url":null,"abstract":"<div><div>We describe the ophthalmic findings in a case of cerebral venous thrombosis in a young patient. Observations: A five-year-old female presents with acute onset irritability, somnolence, diplopia, and headache. Ophthalmic exam showed normal vision, large esotropia with a VI nerve palsy and papilledema. MRI demonstrated longitudinal sinus thrombosis associated with Leiden factor V thrombophilia and an asymptomatic pulmonary thrombosis. Anticoagulant therapy was initiated resolving the diplopia and the disc edema, although MRI evidence of the sinus thrombosis persisted. Venous sinus thrombosis should be included in the differential diagnosis of cranial hypertension.</div></div>","PeriodicalId":93886,"journal":{"name":"Archivos de la Sociedad Espanola de Oftalmologia","volume":"101 9","pages":"Article 502541"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147719228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rho kinase inhibitors: Balance between endothelial homeostasis recovery and reticulated or honeycomb epitheliopathy","authors":"N. Ruiz del Rio,&nbsp;M.A. Galotto Lopez,&nbsp;E. Gracia Rovira","doi":"10.1016/j.oftale.2026.502576","DOIUrl":"10.1016/j.oftale.2026.502576","url":null,"abstract":"","PeriodicalId":93886,"journal":{"name":"Archivos de la Sociedad Espanola de Oftalmologia","volume":"101 9","pages":"Article 502576"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148019348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-efficiency analysis of the Quixote® tele-ophthalmology programme at Hospital Universitario de Jerez","authors":"J. Benitez-del-Castillo,&nbsp;V. Kosaka-Zanabria,&nbsp;F. González-del-Valle,&nbsp;J.A. Córdoba-Doña,&nbsp;G. Caraballo-Rodríguez,&nbsp;M. Rodriguez-Herrera","doi":"10.1016/j.oftale.2026.502589","DOIUrl":"10.1016/j.oftale.2026.502589","url":null,"abstract":"<div><h3>Background and objective</h3><div>To calculate the cost per patient of ophthalmological care for patients referred from primary care under a telematic model (Quixote® project), compared with conventional face-to-face care at the <em>Hospital Universitario de Jerez</em>, within the Jerez, Sierra de Cádiz, and Northwest Coast Health Area (Spain).</div></div><div><h3>Material and methods</h3><div>Comparative analysis of direct costs of telematic ophthalmological care versus the traditional face-to-face model, alongside a retrospective observational evaluation of efficiency after implementation of the Quixote® project. Outcomes included accessibility (mean waiting time in days for ophthalmological care, cumulative primary care waiting list) and patient satisfaction.</div></div><div><h3>Results</h3><div>The direct cost of complete care using the telematic model was ;22.47 per patient compared with ;32.5 per patient for the face-to-face model. Among 4288 patients evaluated in the Quixote® project at HUJ, 2659 patients (62%) required referral for face-to-face hospital assessment, while 1629 (37.9%) were discharged. The mean waiting time for patients referred from primary care decreased from 89 days to 39 days (−56.8%; 95%CI, 53.8%–58.5%; <em>P</em> &lt; .0001). The cumulative waiting list decreased from 4606 to 1684 patients (−64%; 95%CI, 61.7%–66.3%; <em>P</em> &lt; .0001).</div></div><div><h3>Conclusions</h3><div>Implementation of the Quixote® tele-ophthalmology program is a cost-efficient strategy for delivering ophthalmological care. It improves patient throughput from primary care, reduces waiting lists, optimizes hospital resources, and facilitates early detection of relevant diseases.</div></div>","PeriodicalId":93886,"journal":{"name":"Archivos de la Sociedad Espanola de Oftalmologia","volume":"101 9","pages":"Article 502589"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148341482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bacterial contamination map of high-touch surfaces in a hospital ophthalmology department: A cross-sectional study","authors":"V.M. Asensio-Sánchez,&nbsp;A. Frontela,&nbsp;T. Nebreda-Mayoral,&nbsp;M. Cuervo-Abarquero","doi":"10.1016/j.oftale.2026.502591","DOIUrl":"10.1016/j.oftale.2026.502591","url":null,"abstract":"<div><h3>Background and objectives</h3><div>Bacterial contamination of high-touch surfaces can facilitate healthcare-associated infections, particularly in ophthalmology, where frequent contact with diagnostic devices occurs. The aim of this study was to evaluate and characterize bacterial load on high-touch surfaces in a hospital ophthalmology department, identifying critical areas and predominant bacterial groups.</div></div><div><h3>Material and methods</h3><div>Cross-sectional observational study conducted in a tertiary hospital, sampling 150 surfaces across consultation rooms, emergency areas, waiting rooms, administrative areas, and critical points. Surfaces were sampled using sterile swabs and cultured on nutrient agar. After incubation at 37 °C for 48 h, bacterial load was quantified as colony-forming units per square centimeter (CFU/cm²). Bacterial identification was performed using Gram staining and conventional biochemical tests. Comparisons between areas were analyzed using ANOVA; <em>P</em> &lt;  .05.</div></div><div><h3>Results</h3><div>Significant differences in bacterial load were observed among areas; <em>P</em> &lt;  .001, with higher values in consultation rooms (104 ± 37 CFU/cm²) and critical points (118 ± 42 CFU/cm²). The most contaminated surfaces were slit-lamp chin rests, keyboards and mice, touch screens, and tonometer cones. Coagulase-negative staphylococci predominated (79%), followed by <em>Staphylococcus aureus</em> (14%) and Gram-negative bacilli (9%).</div></div><div><h3>Conclusions</h3><div>Frequently touched surfaces in ophthalmology departments exhibit high bacterial loads, underscoring the need for differentiated cleaning protocols, periodic audits, and staff training to reduce cross-contamination and improve patient safety.</div></div>","PeriodicalId":93886,"journal":{"name":"Archivos de la Sociedad Espanola de Oftalmologia","volume":"101 9","pages":"Article 502591"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148334982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Under pressure: Foveal mountain peak sign and macular hole after ruptured RAM","authors":"I.A. Domínguez-Varela,&nbsp;M.A. López-Montoy,&nbsp;G.E. Enriquez-Vera","doi":"10.1016/j.oftale.2026.502553","DOIUrl":"10.1016/j.oftale.2026.502553","url":null,"abstract":"<div><div>To describe a case of a macular hole (MH) secondary to a submacular hemorrhage caused by a ruptured retinal arterial macroaneursym (RAM). An individual case and its observations were examined. Initial examination revealed no visible MH due to the hemorrhagic clot. Two weeks later, a full-thickness MH measuring 340 μm was detected. Pneumatic displacement with sulfur hexafluoride (SF6) was performed to reduce hemorrhagic toxicity and potentially promote spontaneous closure. However, after three months, the MH persisted with no evidence of closure, and visual acuity remained reduced (20/150). The Foveal mountain peak sign (FMP) was identified as a useful predictive indicator of MH formation. MHs secondary to ruptured RAMs and submacular hemorrhages may be initially obscured by hemorrhagic clots, complicating early diagnosis. The FMP sign can aid in predicting MH development. Given the risk of persistent MH and visual impairment, especially when the RAM rupture is close to the fovea (&lt;1500 μm), early surgical intervention should be considered.</div></div>","PeriodicalId":93886,"journal":{"name":"Archivos de la Sociedad Espanola de Oftalmologia","volume":"101 9","pages":"Article 502553"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147719231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}