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array:24 [ "pii" => "S2173579417300427" "issn" => "21735794" "doi" => "10.1016/j.oftale.2017.02.008" "estado" => "S300" "fechaPublicacion" => "2017-09-01" "aid" => "1108" "copyright" => "Sociedad Española de Oftalmología" "copyrightAnyo" => "2016" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Arch Soc Esp Oftalmol. 2017;92:406-11" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2 "PDF" => 2 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0365669116302246" "issn" => "03656691" "doi" => "10.1016/j.oftal.2016.10.020" "estado" => "S300" "fechaPublicacion" => "2017-09-01" "aid" => "1108" "copyright" => "Sociedad Española de Oftalmología" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Arch Soc Esp Oftalmol. 2017;92:406-11" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 44 "formatos" => array:2 [ "HTML" => 37 "PDF" => 7 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Artículo original</span>" "titulo" => "Obstrucción de la arteria ciliorretiniana durante el embarazo" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "406" "paginaFinal" => "411" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Cilioretinal obstruction during pregnancy" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figura 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1224 "Ancho" => 1800 "Tamanyo" => 193391 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Caso 2. A) La fundoscopia del ojo derecho demostró un área de infarto retiniano en la zona interpapilomacular debido a la oclusión de la arteria ciliorretiniana. B) La OCT muestra el edema intrarretiniano a nivel de la lesión. C) El campo visual demostró un escotoma de centrocecal en el mismo ojo.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J. Vila-Arteaga, M.M. Suriano, A. Martínez-Lajara" "autores" => array:3 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "Vila-Arteaga" ] 1 => array:2 [ "nombre" => "M.M." "apellidos" => "Suriano" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Martínez-Lajara" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173579417300427" "doi" => "10.1016/j.oftale.2017.02.008" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579417300427?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365669116302246?idApp=UINPBA00004N" "url" => "/03656691/0000009200000009/v1_201708280004/S0365669116302246/v1_201708280004/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2173579417301408" "issn" => "21735794" "doi" => "10.1016/j.oftale.2017.07.002" "estado" => "S300" "fechaPublicacion" => "2017-09-01" "aid" => "1147" "copyright" => "Sociedad Española de Oftalmología" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Arch Soc Esp Oftalmol. 2017;92:412-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 3 "HTML" => 3 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "High prevalence of <span class="elsevierStyleItalic">Demodex spp.</span> infestation among patients with posterior blepharitis: Correlation with age and cylindrical dandruff" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "412" "paginaFinal" => "418" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Alta prevalencia de infestación por <span class="elsevierStyleItalic">Demodex spp</span>. en pacientes con blefaritis posterior: correlación con edad y caspa cilíndrica" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1438 "Ancho" => 1660 "Tamanyo" => 138911 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Microphotograph with 100× magnification, showing eyelid (P) with hair follicle (FP), adult specimens of <span class="elsevierStyleItalic">Demodex folliculorum</span> (black arrows) and nympth (N). Reference bar: 250<span class="elsevierStyleHsp" style=""></span>μm.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "D. López-Ponce, F. Zuazo, C. Cartes, D. Salinas-Toro, C. Pérez-Valenzuela, F. Valenzuela, L. Traipe-Castro, R.O. López-Solís" "autores" => array:8 [ 0 => array:2 [ "nombre" => "D." "apellidos" => "López-Ponce" ] 1 => array:2 [ "nombre" => "F." "apellidos" => "Zuazo" ] 2 => array:2 [ "nombre" => "C." "apellidos" => "Cartes" ] 3 => array:2 [ "nombre" => "D." "apellidos" => "Salinas-Toro" ] 4 => array:2 [ "nombre" => "C." "apellidos" => "Pérez-Valenzuela" ] 5 => array:2 [ "nombre" => "F." "apellidos" => "Valenzuela" ] 6 => array:2 [ "nombre" => "L." "apellidos" => "Traipe-Castro" ] 7 => array:2 [ "nombre" => "R.O." "apellidos" => "López-Solís" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0365669117300229" "doi" => "10.1016/j.oftal.2017.01.001" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365669117300229?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579417301408?idApp=UINPBA00004N" "url" => "/21735794/0000009200000009/v2_201708291316/S2173579417301408/v2_201708291316/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S2173579417301111" "issn" => "21735794" "doi" => "10.1016/j.oftale.2017.02.013" "estado" => "S300" "fechaPublicacion" => "2017-09-01" "aid" => "1173" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Arch Soc Esp Oftalmol. 2017;92:403-5" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 4 "formatos" => array:2 [ "HTML" => 1 "PDF" => 3 ] ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "<span class="elsevierStyleItalic">Too much Ophthalmology?</span> Ophthalmology in the era of over-diagnosis and over-treatment" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "403" "paginaFinal" => "405" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "<span class="elsevierStyleItalic">Too much Ophthalmology?</span> La oftalmología en la era del sobrediagnóstico y el sobretratamiento" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "R. Vallès Fernández, J. González Martín-Moro, N. Prat Gil, J.M. Bonet Simó, D. Mingo-Botín" "autores" => array:5 [ 0 => array:2 [ "nombre" => "R." "apellidos" => "Vallès Fernández" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "González Martín-Moro" ] 2 => array:2 [ "nombre" => "N." "apellidos" => "Prat Gil" ] 3 => array:2 [ "nombre" => "J.M." "apellidos" => "Bonet Simó" ] 4 => array:2 [ "nombre" => "D." "apellidos" => "Mingo-Botín" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0365669117300692" "doi" => "10.1016/j.oftal.2017.02.009" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365669117300692?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579417301111?idApp=UINPBA00004N" "url" => "/21735794/0000009200000009/v2_201708291316/S2173579417301111/v2_201708291316/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Cilioretinal obstruction during pregnancy" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "406" "paginaFinal" => "411" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "J. Vila-Arteaga, M.M. Suriano, A. Martínez-Lajara" "autores" => array:3 [ 0 => array:3 [ "nombre" => "J." "apellidos" => "Vila-Arteaga" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 1 => array:4 [ "nombre" => "M.M." "apellidos" => "Suriano" "email" => array:1 [ 0 => "mayerlingsuriano@yahoo.it" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 2 => array:3 [ "nombre" => "A." "apellidos" => "Martínez-Lajara" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] ] ] ] "afiliaciones" => array:5 [ 0 => array:3 [ "entidad" => "Hospital Universitario y Politécnico La Fe, Valencia, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Clínica Vila Grupo Innova Ocular, Valencia, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Hospital General Universitario de Castellón, Castellón, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Universitat Jaume I, Castellón, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Hospital de Dénia-Marina Salud, Alicante, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Obstrucción de la arteria ciliorretiniana durante el embarazo" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0020" "etiqueta" => "Fig. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1224 "Ancho" => 1790 "Tamanyo" => 202964 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Case 2. (A) Right eye funduscopy showed retinal infarct area in the inter-papillomacular zonal due to cilioretinal retinal artery occlusion. (B) OCT shows intraretinal edema at the level of the lesion. (C) Visual field showing centrocecal scotoma in the same eye.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The cilioretinal artery (CRA) is present in 26–49.5% of patients<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">1–4</span></a> and between 15 and 40.2% of eyes.<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">1–10</span></a> The incidence in the Chinese population is of 35%<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">11</span></a> and 6.9% in India.<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">12</span></a> Of all the retinal arterial obstructions, only 5% occur in isolation in the CRA. There are several forms of CRA obstruction, although in pregnant females it is extremely rare in the absence of other associated risk factors. In fact, there are only 2 published cases. Two cases of CRA occlusion in 2 pregnant patients without known risk factors are presented below.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><p id="par0010" class="elsevierStylePara elsevierViewall">A retrospective study of all patients diagnosed with CRA obstruction in the workplace of the authors during the period between January 2007 and May 2012. Collected variables comprised age, reason for the consultation, visual acuity (VA), biomicroscopy, ocular fundus, angiography, optical coherence tomography (OCT), campimetry, results of systemic studies including hemogram, coagulation profile, globular sedimentation rate, electrolytes and screening for thrombophilia, carotid and cardiac eco-Doppler.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0015" class="elsevierStylePara elsevierViewall">In the series of the study, 135 patients had a diagnostic of retinal arterial occlusion, of whom 20 (14.8%) were CRA occlusion, and 2 of these (1.48%) were pregnant females.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The first case was a 34-year-old female with 20 weeks gestation who visited due to seeing a spot in the right eye since 3 days before, without VA reduction or other relevant antecedents. Ophthalmological exploration produced VA of one in both eyes and normal anterior pole, while ocular fundus showed a cotton-like exudate isolated in the papillomacular array having 15<span class="elsevierStyleHsp" style=""></span>mm diameter with visualization of a white funnel in one CRA branch. OCT showed intraretinal edema in the lesion and campimetry revealed a central scotoma (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Fluorescein angiography was not performed as this procedure was not recommended during pregnancy.<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">13</span></a> A comprehensive systemic study was performed (arterial pressure, hemogram, coagulation, biochemistry, globular sedimentation rate, C-reactive protein, lymphocyte subpopulation, angiotensin converting enzyme, homocysteine, rheumatoid factor, antinuclear antibodies, neutrophile anti-cytoplasmic antibodies, anticardiolipin antibodies, serology for <span class="elsevierStyleItalic">Rickettsia typhi</span>, rubeola, Epstein–Barr virus, varicella-zoster virus, cytomegalovirus and herpes simplex virus types 1 and 2 in order to discard risk factors associated to embolism, thrombophilia or vasculitic origin of the occlusion. All results were normal. Echocardiography, electrocardiogram and carotid and supra-aortic trunk echography were reported as normal. The retinal edema disappeared after 5 weeks, leaving a retinal atrophy area in the zone of the exudate, with scotoma reduction and a depression in the Bebie curve (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). After giving birth, fluorescein angiography was performed which did not reveal any alteration, thus demonstrating the resolution of the condition (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">The second case was a 13-year-old female with a 16-week pregnancy, without relevant antecedents. The patient visited the Emergency Dept. due to spot vision in the right eye with one day evolution. Ophthalmological exploration produced VA of one in both eyes with normal anterior pole. Right eye funduscopy exhibited retinal infarct area in the inter-papillomacular area due to CRA occlusion. OCT showed intraretinal edema at the level of the lesion. Visual field showed centrocecal scotoma in the same eye (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>). The same tests as in the previous patient were performed, including a comprehensive systemic study, all of which yielded normal results. Patient symptoms improved the 4th week. After giving birth, ocular fundus exploration revealed remaining lesion in the papillomacular nerve fibers adjacent to the former exudate, evidenced in OCT as nerve fiber thinning, and a nonspecific residual scotoma in the visual field (<a class="elsevierStyleCrossRef" href="#fig0025">Fig. 5</a>).</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="fig0025"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0030" class="elsevierStylePara elsevierViewall">The presence of CRA is one of the most common vascular alterations of the retina. Its presence or absence depends on genetic factors, with 71.4% inheritance.<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">10</span></a> CRA may vary in the number and diameter, length, origin and location of emergence of the optic nerve.<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">12,14–18</span></a> CRA are derived directly from the short posterior ciliary arteries or from choroidal circulation, and provide a variable vascularization area of the internal retina and the macula. Commonly, it is a single artery but it is also possible to find several CRA, although this is not frequent.<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">8</span></a> In the majority of cases, the anomalous artery emerges from the temporal edge of the optic disc (88.2%) and in other less frequent cases it could be nasal (11.8%).<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">10</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">When said artery is present, the vascularization of the internal retina depends from the central retinal artery and from the CRA. Frequently, the latter provides vascularization of the macular and papillomacular zone of the internal retina. In one reported case, the CRA provided vascularization for the entire upper hemi-retina<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">19</span></a> and in another case the entire retinal circulation was provided by the CRA.<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">20</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">A study by Justice and Lehmann<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">1</span></a> that included 2000 eyes for identifying CRA with ocular fundus stereo photographs and fluorescein angiography reported 14.6% of cases with bilateral CRA.</p><p id="par0045" class="elsevierStylePara elsevierViewall">In the case of the 2 pregnant patients of this study, CRA obstruction was isolated and both exhibited good VA, the edema and retinal exudates disappeared and the scotoma diminished after 5 weeks in the first case and 4 weeks in the second. There are 3 forms of CRA obstruction, the most common is the isolated form (40–45% of cases) which has better prognosis. Approximately 90% of cases maintain VA of 0.5 and 60% maintain a VA of 1 and 2 with scotoma reduction as in the present 2 cases. Another form of presentation is associated with central retinal vein occlusion (40%). In this case, the obstruction is due to the perfusion pressure of the central retinal artery which is higher than that of the CRA and causes the obstruction. In what concerns prognosis, 70% achieve a VA of 0.5 or higher. The third CRA obstruction form is associated to ischemic optical neuropathy (15% of cases). In this form it is necessary to discard giant cell atheritis. This form of CRA obstruction has the poorest prognostic, with VA remaining between 0.05 and no perception of light.<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">6,21–24</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">In general, atherosclerosis and arterial hypertension are the most frequent predisposing factors for retinal arterial obstruction. In a study carried out with 21 patients between 22 and 38 years of age, Greven et al.<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">25</span></a> reported that the most common cause of retinal artery occlusion was valvular cardiopathy in 4 cases, while the rest were caused by hyper coagulability and embolism. CRA can also occur in local ocular diseases such as retinitis.<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">26</span></a> In the present cases, the systematic study for discarding arterial obstruction causes included arterial pressure, hemogram, coagulation, biochemistry, sedimentation rate(checkup velocidad de sedimentation globular), C-reactive protein, lymphocyte subpopulation, angiotensin converting enzyme, homocysteine, rheumatoid factor, antinuclear antibodies, neutrophile anti-cytoplasm antibodies, anticardiolipin antibodies, serology for <span class="elsevierStyleItalic">R. typhi</span>, rubeola, Epstein–Barr virus, varicella-zoster virus, cytomegalovirus and herpes simplex virus types one and 2 together with echocardiography, electrocardiogram and carotid and supra-aortic trunk echography. All of these tests were negative.</p><p id="par0055" class="elsevierStylePara elsevierViewall">CRA obstruction pathogeny in young individuals has been related to systemic vasculitis and central retinal vein occlusion. However, embolism is a rare cause.<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">27–30</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">As described above, the patients of this report were pregnant. What is known about this condition is that it does not predispose to arterial embolism, even in hyper-coagulability conditions.<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">29</span></a> None of said patients received hormone treatment prior to pregnancy that could influence an occlusive condition.</p><p id="par0065" class="elsevierStylePara elsevierViewall">A literature search found only 2 published cases of CRA obstruction during pregnancy. One of these was bilateral in the context of the antiphospholipid syndrome<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">31</span></a> while the other was a monolateral CRA occlusion in a healthy pregnant female.<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">29</span></a> To date, the actual CRA obstruction incidence in pregnant patients is unknown, possibly due to the low frequency thereof.</p><p id="par0070" class="elsevierStylePara elsevierViewall">In conclusion, even though the authors were unable to find any risk factor that could account for the CRA obstruction in both pregnant patients, it is known that pregnancy is regarded to be a hyper-coagulability condition. More studies are necessary to determine the pathogeny of CRA obstruction during pregnancy.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflict of interests</span><p id="par0075" class="elsevierStylePara elsevierViewall">No conflict of interests was declared by the authors.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres888060" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Purpose" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec873997" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres888059" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec873996" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Materials and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflict of interests" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-08-06" "fechaAceptado" => "2016-10-13" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec873997" "palabras" => array:3 [ 0 => "Cilioretinal artery occlusion" 1 => "Pregnancy" 2 => "Retinal artery occlusion" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec873996" "palabras" => array:3 [ 0 => "Oclusión de la arteria ciliorretiniana" 1 => "Embarazo" 2 => "Oclusión arterial retiniana" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Purpose</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To determine the number of patients diagnosed over a 5-year period with isolated occlusion of the cilioretinal artery (CRAO) whilst pregnant, as well as to describe the outcomes and ophthalmological sequelae of this condition in pregnant woman.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A retrospective study of the medical records.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">From the 135 patients diagnosed with retinal arterial occlusion of all of our series, 20 (14.8%) had CRAO, and 2 (1.48%) of these were pregnant. Case 1: a 34 year-old pregnant woman with a centrocaecal scotoma and visual acuity of 20/20 in right eye. Fundus examination: a soft exudate in the papillomacular bundle with retinal edema and embolism on a cilioretinal artery branch. The exudate and edema disappeared after 5 weeks, and the scotoma was reduced. Case 2: a 30 year-old pregnant woman, with normal visual acuity in right eye, and a centrocaecal scotoma. Fundoscopy: an area of retinal interpapillomacular infarction due to cilioretinal artery occlusion. The fundus returned to normal in 4 weeks, with an improvement of the scotoma.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The etiology of CRAO is usually associated with carotid disease or other thromboembolic events related to hypercoagulable states and autoimmunity. Pregnancy is considered a hypercoagulable state, and it is not known if it is a risk factor for arterial embolism. Further studies are required to determine the correlation between pregnancy and CRAO.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Purpose" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Conocer la incidencia de obstrucción aislada de la arteria ciliorretiniana (OACR) en nuestra serie, a lo largo de 5 años, y describir la incidencia, evolución y secuelas oftalmológicas de esta entidad en el embarazo.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio retrospectivo, descriptivo, observacional de serie de casos.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">De los 135 pacientes diagnosticados de oclusión arterial retiniana del total de nuestra serie, 20 (14,8%) presentaban OACR, de los cuales 2 (1,48%) eran mujeres embarazadas. Caso 1: mujer embarazada de 34 años, con escotoma centrocecal y agudeza visual de 1 en ojo derecho. Fondo de ojo: exudado algodonoso en el haz papilomacular con edema retiniano y émbolos en una de las ramas de la arteria ciliorretiniana. A las 5 semanas el exudado y el edema habían desaparecido, con reducción del escotoma. Caso 2: mujer embarazada de 30 años, que presenta de forma brusca escotoma centrocecal en el ojo derecho con agudeza visual de 1. Fondo de ojo: exudación lipídica y mancha algodonosa en haz interpapilomacular secundarias a la OACR. A las 4 semanas habían desaparecido los hallazgos en fondo de ojo, con resolución completa de la sintomatología.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La etiología de la OACR suele estar relacionada con enfermedad carotídea u otros procesos tromboembólicos relacionados con estados de hipercoagulabilidad y autoinmunidad. El embarazo es considerado un estado de hipercoagulación, sin embargo, no se ha podido demostrar que se trate de un factor de riesgo <span class="elsevierStyleItalic">per se</span> para desarrollar embolia arterial. Por tanto, se necesitan estudios adicionales para conocer la correlación entre embarazo y OACR.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Vila-Arteaga J, Suriano MM, Martínez-Lajara A. Obstrucción de la arteria ciliorretiniana durante el embarazo. Arch Soc Esp Oftalmol. 2017;92:406–411.</p>" ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1125 "Ancho" => 1800 "Tamanyo" => 238145 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Case 1. (A, B) Right eye ocular fundus showed isolated soft exudate in the papillomacular area with a diameter of 1.5<span class="elsevierStyleHsp" style=""></span>mm and the presence of a white funnel in a cilioretinal artery branch. (C) OCT shows intraretinal edema at the level of the lesion. (D) central scotoma can be seen in visual field.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1398 "Ancho" => 800 "Tamanyo" => 159552 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Case 1. After 5 weeks the retinal edema disappeared in ocular fundus and OCT, leaving a retinal atrophy area at the site of the exudate.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 610 "Ancho" => 1800 "Tamanyo" => 70221 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Case 1. Five weeks after giving birth, fluorescein angiography was taken with normal results.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Fig. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1224 "Ancho" => 1790 "Tamanyo" => 202964 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Case 2. (A) Right eye funduscopy showed retinal infarct area in the inter-papillomacular zonal due to cilioretinal retinal artery occlusion. (B) OCT shows intraretinal edema at the level of the lesion. (C) Visual field showing centrocecal scotoma in the same eye.</p>" ] ] 4 => array:7 [ "identificador" => "fig0025" "etiqueta" => "Fig. 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 683 "Ancho" => 1300 "Tamanyo" => 121625 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Case 2. After giving birth, (A) ocular fundus showed remaining lesion in papillomacular nerve fibers adjacent to the former exudate. (B) OCT evidenced said lesion, showing nerve fiber thinning.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:31 [ 0 => array:3 [ "identificador" => "bib0160" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cilioretinal arteries. 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