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Ferrer Novella, I. González Viejo, V. Pueyo Royo, R. Martínez Fernández, M. Galdós Iztueta, J. Peralta Calvo, J. Abelairas Gómez, P. Tejada Palacios, N. Martín Begué, Ch. Wolley-Dod, S. Alarcón Portabella, A. Serra Castanera, M. Morales Ballús, M.A. Harto Castaño, R. Martinez-Costa Perez, F.J. Rodriguez-Hurtado, J.L. García Serrano, J. Escudero Gómez, C. Morales Guillén, M.T. Pastor Ramos, A. Galván Ledesma, B. Balboa Huguet, E. García Robles, J.M. Gallardo Galera, B. Cabrera Marrer, J. Castellano Solanes, L. Cordovés Dorta, P. Vals Quintana, M.A. Gil Hernandez, S. Perez-Torres, L. Cortazar Galarza, M.A. Ardanaz Aldave, M. Bové Guri, M.J. Blanco Teijeiro, P. Mera Yañez, J. Garcia Campos" "autores" => array:36 [ 0 => array:2 [ "nombre" => "C." "apellidos" => "Ferrer Novella" ] 1 => array:2 [ "nombre" => "I." "apellidos" => "González Viejo" ] 2 => array:2 [ "nombre" => "V." "apellidos" => "Pueyo Royo" ] 3 => array:2 [ "nombre" => "R." "apellidos" => "Martínez Fernández" ] 4 => array:2 [ "nombre" => "M." "apellidos" => "Galdós Iztueta" ] 5 => array:2 [ "nombre" => "J." "apellidos" => "Peralta Calvo" ] 6 => array:2 [ "nombre" => "J." "apellidos" => "Abelairas Gómez" ] 7 => array:2 [ "nombre" => "P." "apellidos" => "Tejada Palacios" ] 8 => array:2 [ "nombre" => "N." "apellidos" => "Martín Begué" ] 9 => array:2 [ "nombre" => "Ch." "apellidos" => "Wolley-Dod" ] 10 => array:2 [ "nombre" => "S." "apellidos" => "Alarcón Portabella" ] 11 => array:2 [ "nombre" => "A." "apellidos" => "Serra Castanera" ] 12 => array:2 [ "nombre" => "M." "apellidos" => "Morales Ballús" ] 13 => array:2 [ "nombre" => "M.A." "apellidos" => "Harto Castaño" ] 14 => array:2 [ "nombre" => "R." "apellidos" => "Martinez-Costa Perez" ] 15 => array:2 [ "nombre" => "F.J." "apellidos" => "Rodriguez-Hurtado" ] 16 => array:2 [ "nombre" => "J.L." "apellidos" => "García Serrano" ] 17 => array:2 [ "nombre" => "J." "apellidos" => "Escudero Gómez" ] 18 => array:2 [ "nombre" => "C." "apellidos" => "Morales Guillén" ] 19 => array:2 [ "nombre" => "M.T." "apellidos" => "Pastor Ramos" ] 20 => array:2 [ "nombre" => "A." "apellidos" => "Galván Ledesma" ] 21 => array:2 [ "nombre" => "B." "apellidos" => "Balboa Huguet" ] 22 => array:2 [ "nombre" => "E." "apellidos" => "García Robles" ] 23 => array:2 [ "nombre" => "J.M." "apellidos" => "Gallardo Galera" ] 24 => array:2 [ "nombre" => "B." "apellidos" => "Cabrera Marrer" ] 25 => array:2 [ "nombre" => "J." "apellidos" => "Castellano Solanes" ] 26 => array:2 [ "nombre" => "L." "apellidos" => "Cordovés Dorta" ] 27 => array:2 [ "nombre" => "P." "apellidos" => "Vals Quintana" ] 28 => array:2 [ "nombre" => "M.A." "apellidos" => "Gil Hernandez" ] 29 => array:2 [ "nombre" => "S." "apellidos" => "Perez-Torres" ] 30 => array:2 [ "nombre" => "L." "apellidos" => "Cortazar Galarza" ] 31 => array:2 [ "nombre" => "M.A." "apellidos" => "Ardanaz Aldave" ] 32 => array:2 [ "nombre" => "M." "apellidos" => "Bové Guri" ] 33 => array:2 [ "nombre" => "M.J." "apellidos" => "Blanco Teijeiro" ] 34 => array:2 [ "nombre" => "P." "apellidos" => "Mera Yañez" ] 35 => array:2 [ "nombre" => "J." "apellidos" => "Garcia Campos" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S036566911200408X" "doi" => "10.1016/j.oftal.2012.07.030" "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/S036566911200408X?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579413000790?idApp=UINPBA00004N" "url" => "/21735794/0000008800000005/v1_201307100543/S2173579413000790/v1_201307100543/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Short communication</span>" "titulo" => "Exudative retinal detachment and primary pulmonary hypertension" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "189" "paginaFinal" => "192" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "J.L. Sánchez-Sevila, M. Martínez-Rubio, I. López-Meca, J. Belmonte-Martínez" "autores" => array:4 [ 0 => array:4 [ "nombre" => "J.L." "apellidos" => "Sánchez-Sevila" "email" => array:1 [ 0 => "sanchez.se@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Martínez-Rubio" ] 2 => array:2 [ "nombre" => "I." "apellidos" => "López-Meca" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "Belmonte-Martínez" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Oftalmología, Hospital General Universitario de Alicante, Alicante, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Desprendimiento de retina exudativo e hipertensión pulmonar primaria" ] ] "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" => 776 "Ancho" => 915 "Tamanyo" => 109612 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Complete resolution of the exudative detachment in the left eye 48<span class="elsevierStyleHsp" style=""></span>h after beginning treatment.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Exudative retinal detachment can be due to different ocular and extraocular causes. Primary pulmonary hypertension is a disease of unknown etiology that can exhibit a diversity of ophthalmological expressions as the result of diminished venous flow caused by increased systemic venous pressure.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Case report</span><p id="par0010" class="elsevierStylePara elsevierViewall">Female, 60, who visited the Emergency Service due to blurred vision in the left eye with a few hours of evolution and without the relevant symptoms. She did not refer arterial hypertension history or diabetes mellitus.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The ophthalmic assessment gave a visual acuity of 1 in the right eye and of 0.1 in the left eye which did not improve with correction. Under biomicroscopic exploration, the anterior pole was observed to be normal, the same as the right eye ocular fundus. However, the left eye exhibited retina detachment in the macular area and temporal retinal area (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) compatible with serous detachment. After 24–36<span class="elsevierStyleHsp" style=""></span>h of the blurred vision onset, fluorescein angiography and optic coherence tomography (OCT, Stratus Carl Zeiss) were taken. The angiography showed contrast aggregation in the perimacular area of the left eye which was more evident in late phases (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). The OCT in the right eye was normal, while the left eye exhibited neurosensory detachment at the macular level with subfoveal liquid and intraretinal edema (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). After performing a new anamnesis, the patient referred dyspnea when carrying out medium efforts as well as lower limb edema under one year of evolution. Accordingly, the cardiology and pneumology services were consulted. A systemic study revealed the existence of pulmonary hypertension, whereupon treatment was established with furosemide (approximately 48<span class="elsevierStyleHsp" style=""></span>h after the onset of diminished vision). The retina detachment resolved entirely 48<span class="elsevierStyleHsp" style=""></span>h after beginning the diuretic treatment (<a class="elsevierStyleCrossRefs" href="#fig0020">Figs. 4 and 5</a>). After completing the study, it was concluded that the condition was primary pulmonary hypertension and vasodilating therapy was established. Three months after the episode, the visual acuity in the left eye is of 0.9 and the patient remains stable, in follow-up by pneumology.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="fig0025"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Discussion</span><p id="par0020" class="elsevierStylePara elsevierViewall">Primary pulmonary hypertension is a disease of unknown etiology characterized by an increase of pulmonary pressure above 25<span class="elsevierStyleHsp" style=""></span>mmHg at rest and of 30<span class="elsevierStyleHsp" style=""></span>mmHg while exercising due to vasoconstriction of the pulmonary vascular Tree.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Predisposing genetic factors associated to familial cases with dominant autosomic inheritance has been identified.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3–5</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In what concerns pathogeny, histological and functional alterations of endothelial cells of pulmonary blood vessels have been identified.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Pulmonary hypertension gives rise to right side cardiac insufficiency, increase of systemic, orbitary and episcleral venous pressure with outgoing venous flow reduction, producing ocular complications.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Said ocular expressions include dilatation of the conjunctival and episcleral veins,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> central retina vein occlusion, foveal effusion with choroidal detachment, intraocular pressure increase (open angle secondary glaucoma) and exudative retinal detachment.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a> In addition, cases with subacute myopia and exophthalmos have been described.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Exudative detachment arises due to the inability of the retinal pigment epithelium to pump the excess liquid which accumulates in the subretinal space due to increased hydrostatic pressure in the choriocapillary.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Therapeutic options are based on vasodilating therapy, support therapy and pulmonary transplant as the last resource.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Diuretics have a beneficial effect on patients with pulmonary hypertension, particularly in those with right ventricle failure and systemic venous congestion as in the patient of this report.</p><p id="par0055" class="elsevierStylePara elsevierViewall">The significance of this case resides in the role of the ophthalmologist to suspect major systemic diseases on the basis of ocular signs.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conflict of interests</span><p id="par0060" class="elsevierStylePara elsevierViewall">No conflict of interest has been declared by the authors.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:2 [ "identificador" => "xres208470" "titulo" => array:3 [ 0 => "Abstract" 1 => "Case report" 2 => "Discussion" ] ] 1 => array:2 [ "identificador" => "xpalclavsec195752" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres208469" "titulo" => array:3 [ 0 => "Resumen" 1 => "Caso clínico" 2 => "Discusión" ] ] 3 => array:2 [ "identificador" => "xpalclavsec195753" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Case report" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Conflict of interests" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2011-04-08" "fechaAceptado" => "2012-04-08" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec195752" "palabras" => array:5 [ 0 => "Pulmonary hypertension" 1 => "Exudative retinal detachment" 2 => "Primary pulmonary hypertension" 3 => "Dyspnea" 4 => "Furosemide" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec195753" "palabras" => array:5 [ 0 => "Hipertensión pulmonar" 1 => "Desprendimiento de retina exudativo" 2 => "Hipertensión pulmonar primaria" 3 => "Disnea" 4 => "Furosemida" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Case report</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A 60-year-old woman who was seen in the emergency department due to sudden loss of vision in left eye. The fundoscopy study showed exudative retinal detachment. The patient referred to dyspnea and peripheral edema of one-year duration during the anamnesis. The systematic study revealed the existence of pulmonary hypertension, and she was given diuretic treatment (furosemide). After 48<span class="elsevierStyleHsp" style=""></span>h the detachment was resolved. Subsequent studies identified a primary pulmonary hypertension.</p> <span class="elsevierStyleSectionTitle" id="sect0015">Discussion</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Exudative retinal detachment can be the first clinical sign of a serious disease like primary pulmonary hypertension. The ophthalmologist can be the first to detect this disease.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0025">Caso clínico</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Mujer de 60 años que acudió de urgencia por pérdida súbita de visión en ojo izquierdo. El estudio fundoscópico mostró desprendimiento de retina exudativo. En la anamnesis refería disnea de un año de evolución y edemas periféricos. El estudio sistémico reveló la existencia de hipertensión pulmonar recibiendo tratamiento diurético (furosemida). El desprendimiento se resolvió a las 48<span class="elsevierStyleHsp" style=""></span>h. Estudios posteriores determinaron una hipertensión pulmonar primaria.</p> <span class="elsevierStyleSectionTitle" id="sect0030">Discusión</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">El desprendimiento de retina exudativo puede ser el primer signo clínico de una enfermedad grave como la hipertensión pulmonar primaria. El oftalmólogo puede ser el primero en detectar esta enfermedad.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Sánchez-Sevila JL, et al. Desprendimiento de retina exudativo e hipertensión pulmonar primaria. Arch Soc Esp Oftalmol. 2013;88:189–92.</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" => 772 "Ancho" => 915 "Tamanyo" => 130577 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Exudative retina detachment in the left eye.</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" => 780 "Ancho" => 914 "Tamanyo" => 73850 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Left eye fluorescein angiography with aggregation of perimacular contrast in late phases.</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" => 1057 "Ancho" => 2099 "Tamanyo" => 892166 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Left eye optic coherence tomography with neurosensory detachment at the macular level and intraretinal edema.</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" => 776 "Ancho" => 915 "Tamanyo" => 109612 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Complete resolution of the exudative detachment in the left eye 48<span class="elsevierStyleHsp" style=""></span>h after beginning treatment.</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" => 1076 "Ancho" => 1999 "Tamanyo" => 720940 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Left eye optic coherence tomography 48<span class="elsevierStyleHsp" style=""></span>h after beginning treatment showing the resolution of the detachment at the macular level and of the intraretinal edema.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hipertensión pulmonar primaria y su tratamiento" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "C. 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