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array:23 [ "pii" => "S2173579420302553" "issn" => "21735794" "doi" => "10.1016/j.oftale.2020.08.003" "estado" => "S200" "fechaPublicacion" => "2021-07-16" "aid" => "1816" "copyright" => "Sociedad Española de Oftalmología" "copyrightAnyo" => "2020" "documento" => "article" "crossmark" => 0 "subdocumento" => "crp" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0365669120303518" "issn" => "03656691" "doi" => "10.1016/j.oftal.2020.08.001" "estado" => "S300" "fechaPublicacion" => "2021-08-01" "aid" => "1816" "copyright" => "Sociedad Española de Oftalmología" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Arch Soc Esp Oftalmol. 2021;96:442-5" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Comunicación corta</span>" "titulo" => "Hemorragia supracoroidea secundaria a maniobra de Valsalva, importancia de la tomografía de coherencia óptica de profundidad mejorada en el diagnóstico diferencial" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "442" "paginaFinal" => "445" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Suprachoroidal hemorrhage due to Valsalva maneuver, importance of enhanced depth imaging optical coherence tomography in differential diagnosis" ] ] "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" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 370 "Ancho" => 1255 "Tamanyo" => 38212 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Aspecto de la hemorragia supracoroidea con OCT: presenta una superficie irregular de tipo festoneada con líquido subretiniano entre los lóbulos. A la izquierda imagen de autofluorescencia donde la lesión aparece isoautofluorescente.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "R. Castro Flórez, C. Azpitarte, G. Arcos Villegas, M. García Torre" "autores" => array:4 [ 0 => array:2 [ "nombre" => "R." "apellidos" => "Castro Flórez" ] 1 => array:2 [ "nombre" => "C." "apellidos" => "Azpitarte" ] 2 => array:2 [ "nombre" => "G." "apellidos" => "Arcos Villegas" ] 3 => array:2 [ "nombre" => "M." "apellidos" => "García Torre" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173579420302553" "doi" => "10.1016/j.oftale.2020.08.003" "estado" => "S200" "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/S2173579420302553?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365669120303518?idApp=UINPBA00004N" "url" => "/03656691/0000009600000008/v1_202107310537/S0365669120303518/v1_202107310537/es/main.assets" ] ] "itemSiguiente" => array:17 [ "pii" => "S217357942300155X" "issn" => "21735794" "doi" => "10.1016/j.oftale.2023.10.001" "estado" => "S200" "fechaPublicacion" => "2023-10-16" "aid" => "2161" "copyright" => "The Authors" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "ret" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:8 [ "idiomaDefecto" => true "titulo" => "WITHDRAWN: Retinitis pigmentosa: Significant improvement with photobiomodulation" "tienePdf" => "en" "tieneTextoCompleto" => 0 "tieneResumen" => "en" "contieneResumen" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "F. Luque-Mialdea, V. Molina-Seoane" "autores" => array:2 [ 0 => array:2 [ "nombre" => "F." "apellidos" => "Luque-Mialdea" ] 1 => array:2 [ "nombre" => "V." "apellidos" => "Molina-Seoane" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217357942300155X?idApp=UINPBA00004N" "url" => "/21735794/unassign/S217357942300155X/v2_202310230751/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S217357942030219X" "issn" => "21735794" "doi" => "10.1016/j.oftale.2020.07.009" "estado" => "S200" "fechaPublicacion" => "2020-11-15" "aid" => "1791" "copyright" => "Sociedad Española de Oftalmología" "documento" => "article" "crossmark" => 0 "subdocumento" => "crp" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Short communication</span>" "titulo" => "Multimodal imaging in acute idiopathic blind spot enlargement syndrome" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Imagen multimodal en el síndrome de aumento idiopático de mancha ciega" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 722 "Ancho" => 1505 "Tamanyo" => 297842 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">At debut, OCT-DE of the first case showed (A) a subfoveal column hyperreflectivity and focal loss of the outer limiting membrane and ellipsoid line at the nasal level (red arrow). The choroidal thinning (white arrow) at nasal level could be physiological and attributable to the patient’s myopia. Subfoveal hyperreflectivity resolved at two weeks (B) leaving a minimal sequel of subfoveal RPE thickening at 1.5 months (C). The outer nasal layers progressively recovered (B and C). In A-OCT 8<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>8 <span class="elsevierStyleItalic">en-face,</span> at ellipsoid layer level, hyperreflective points were observed surrounding the papilla (green arrow) at debut (D). After two weeks (E), these peripapillary hyperreflective points decreased but hyporeflective spots were observed (white arrow), which correlate with the disruption of the outer retina in autofluorescence. After 1.5 months (F), hyporeflective spots decreased and white peripapillary spots disappeared. The A-OCT 3<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>3 showed at choriocapillary level two apparent hypoperfusion spots in the debut of the disease (G), which correlate with the shadow of the subfoveal column hyperreflectivity.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Moll-Udina, I. Hernanz, M. Dotti, V. Llorenç, A. Adán" "autores" => array:5 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Moll-Udina" ] 1 => array:2 [ "nombre" => "I." "apellidos" => "Hernanz" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Dotti" ] 3 => array:2 [ "nombre" => "V." "apellidos" => "Llorenç" ] 4 => array:2 [ "nombre" => "A." "apellidos" => "Adán" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0365669120303105" "doi" => "10.1016/j.oftal.2020.07.014" "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/S0365669120303105?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217357942030219X?idApp=UINPBA00004N" "url" => "/21735794/unassign/S217357942030219X/v1_202011150602/en/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Short communication</span>" "titulo" => "Suprachoroidal hemorrhage due to Valsalva maneuver, importance of enhanced depth imaging optical coherence tomography in differential diagnosis" "tieneTextoCompleto" => true "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "R. Castro Flórez, C. Azpitarte, G. Arcos Villegas, M. García Torre" "autores" => array:4 [ 0 => array:4 [ "nombre" => "R." "apellidos" => "Castro Flórez" "email" => array:1 [ 0 => "raquel.castro@quironsalud.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "C." "apellidos" => "Azpitarte" ] 2 => array:2 [ "nombre" => "G." "apellidos" => "Arcos Villegas" ] 3 => array:2 [ "nombre" => "M." "apellidos" => "García Torre" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Fundación Jiménez Díaz, Madrid, 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" => "Hemorragia supracoroidea secundaria a maniobra de Valsalva, importancia de la tomografía de coherencia óptica de profundidad mejorada en el diagnóstico diferencial" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 554 "Ancho" => 1405 "Tamanyo" => 167956 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">EDI-OCT, the evolution of the hemorrhage in the suprachoroidal space can be seen. A) Appearance at diagnosis, showing hyporeflective choroidal thickening and the anteriorly displaced choriocapillary tissue with normal appearance; B) Four weeks later; C) Eight weeks later and D) Twelve weeks later, where complete resolution of the hemorrhage can be observed.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Suprachoroidal hemorrhage (SH) is a rare but potentially very serious disorder. Most cases are associated with hypotonia that occurs during or after ophthalmic surgery or after ocular trauma. However, spontaneous cases of SH associated with taking anticoagulants in elderly patients, high blood pressure or underlying ophthalmological conditions such as age-related macular degeneration, diabetic retinopathy, pathological myopia and polyproid choroidal vasculopathy have been described.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> Very few cases have been described in association with Valsalva manoeuvres with no underlying or associated systemic ophthalmological conditions.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Supracoroidal hemorrhage is the result of bleeding from the long and short posterior ciliary arteries or vortical veins in the supracoroid space. It can be caused by a fragility of the vascularisation of ciliary vessels (hypertension, arteriosclerosis, advanced age, myopia) due to sudden fluctuations in eye pressure that produce tears in the choroidal vessels (Valsalva manoeuvre) or by malignant hypertension.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">An imaging test that provides additional information in the differential diagnosis is Enhanced Depth Imaging Optical Coherence Tomography of (EDI-OCT) which improves the visualization of the choroids due to its greater penetrance.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Clinical case</span><p id="par0020" class="elsevierStylePara elsevierViewall">A 70-year-old woman who visited the authors’ clinic due to the appearance of a central green scotoma in her right eye (RE) after a Valsalva manoeuvre during defecation. She had no ophthalmological or personal history of interest except for arterial hypertension under treatment with Valsartan.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The best corrected visual acuity was 0.4 at RE and 1 at the left eye (LE). A greyish bilobulated mass appeared in the posterior pole and superotemporal quadrant of the ocular fundus. A small hemorrhage was also observed above the papilla. The LE fundus was normal (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">B-mode ultrasound showed a mass of 1<span class="elsevierStyleHsp" style=""></span>mm with medium-low reflectivity without other alterations. OCT showed a hyporeflective bilobulated choroidal lesion with an irregular surface of the scalloped type. Subretinal fluid (SRF) was observed between the lobes. The maximum thickness of the lesion from the Bruch membrane to the choroidoscleral junction was 1.310<span class="elsevierStyleHsp" style=""></span>mm. The lesion was isoautofluorescent and a hyperautofluorescent band was seen between the 2 lobes corresponding to the SRF (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">EDI-OCT showed anteriorly displaced choriocapillary tissue but with a normal thickness and appearance (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). The study was supplemented with fluorescein angiography (FA) and indocyanine green angiography (ICG). The latter did not show any vascular pattern suggesting choroidal tumour or underlying choroidal hemangioma.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">At this point, the funduscopic image and the OCT (especially the irregular contour of the lesion) gave rise to the suspicion of metastasis despite the Valsalva antecedent, so a systemic study was requested to rule out underlying oncological disease. The systemic study showed negative results, so with the probable diagnosis of suprachoroidal hemorrhage secondary to Valsalva manoeuvre it was decided to observe. Meanwhile, the patient was checked weekly at the authors’ practice with funduscopy and EDI-OCT, observing as from the first week a decrease in the thickness of the choroidal lesion, which finally resolved completely after 12 weeks (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>), enabling a final visual acuity recovery of 1.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0045" class="elsevierStylePara elsevierViewall">Suprachoroidal hemorrhage secondary to Valsalva manoeuvres without underlying ophthalmological condition is a very rare phenomenon. In many cases the differential diagnosis is a challenge, and it is often confused with a choroidal tumour. In an analysis of 12,000 patients sent to an eye oncology unit over a period of 25 years with a diagnosis of choroidal melanoma, 29 cases (0.24%) were found to be choroidal hemorrhages.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">There are certain clinical characteristics that can help to differentiate a hemorrhage from a choroidal tumour such as the presence of choroidal folds, absence of drusen, absence of lipofuscin and a more reddish colour.</p><p id="par0055" class="elsevierStylePara elsevierViewall">The images obtained in EDI-OCT are of great importance when making a differential diagnosis between suprachoroidal hemorrhage and tumour (small choroidal melanoma, metastasis).<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6–8</span></a> Firstly, in the hemorrhage, choroidal tissue appears anteriorly displaced, but with normal thickness and appearance, contrary to what happens in a tumour in which the choriocapillary tissue is compressed and difficult to visualise. The raised surface that appears in the hemorrhage has an irregular, scalloped appearance, which could be due to the retraction of the clot.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">The surface of choroidal melanomas is usually smooth and regular. In contrast, in choroidal metastases, the anterior contour may also appear irregular <span class="elsevierStyleItalic">(bumpy-lumpy).</span></p><p id="par0065" class="elsevierStylePara elsevierViewall">Subretinal fluid can be seen in some choroidal <span class="elsevierStyleItalic">nevi,</span> tumours (melanomas and metastases), and also in supracoroidal hemorrhages,<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,7,8</span></a> with SRF in supracoroidal hemorrhages indicating a recent exudative retinal detachment.</p><p id="par0070" class="elsevierStylePara elsevierViewall">On some occasions, idiopathic polypoid vasculopathy (IPV) can also present acutely in the form of a detachment of central serohemorrhagic pigment epithelium. IPV also features an increase in choroidal thickness measured with EDI-OCT, but the integrity of the RPE-photoreceptor complex and the absence of drusen and hemorrhagic images or polyps in the fundus facilitates the differential diagnosis.</p><p id="par0075" class="elsevierStylePara elsevierViewall">Suprachoroidal hemorrhages secondary to the Valsalva manoeuvre resolve spontaneously, with total or almost total recovery of previous visual acuity.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,9</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conflict of interest</span><p id="par0080" class="elsevierStylePara elsevierViewall">No conflict of interests was declared by the authors.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:3 [ "identificador" => "xres1550137" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1400027" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1550138" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1400028" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Clinical case" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Conflict of interest" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-05-02" "fechaAceptado" => "2020-08-11" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1400027" "palabras" => array:4 [ 0 => "Suprachoroidal hemorrhage" 1 => "Valsalva maneuver" 2 => "Choroidal tumor" 3 => "Enhanced depth imaging optical coherence tomography" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1400028" "palabras" => array:4 [ 0 => "Hemorragia supracoroidea" 1 => "Maniobra de Valsalva" 2 => "Tumor coroideo" 3 => "Tomografía de coherencia óptica de profundidad mejorada" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">We describe a case report of a spontaneous suprachoroidal hemorrhage, in which the enhanced depth imaging optical coherence tomography (OCT-EDI) is extremely useful in establish the differential diagnosis with a choroidal tumor.</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">A 70 year-old woman was referred with a central scotoma after a Valsalva maneuver. In the posterior pole we observed a grey bilobed subretinal mass with the appearance of a choroidal tumor. OCT-EDI revealed an optically dark region with a scalloped anterior tumor contour and subretinal fluid, the choroicapillaris appeared to be intact and displaced anteriorly. The diagnosis was a suprachoroidal hemorrhage and it resolved in 12 weeks.</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Spontaneous suprachoroidal hemorrhage is a rare condition and it can resemble choroidal tumor. OCT-EDI is a very valuable tool in the differentiation of hemorrhage from tumors.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Presentamos el caso clínico de una hemorragia supracoroidea espontánea, en el que la tomografía de coherencia óptica de profundidad mejorada (OCT-EDI) resulta de gran utilidad para el diagnóstico diferencial con un tumor coroideo.</p><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Una mujer de 70 años, con hipertensión arterial, acude por escotoma central tras maniobra de Valsalva. En el fondo de ojo observamos una masa bilobulada central, subretiniana y grisácea, que plantea diagnóstico diferencial con un tumor coroideo. En la OCT-EDI se observa una masa coroidea con superficie de tipo festoneado y líquido subretiniano, el tejido coriocapilar se encuentra desplazado anteriormente con apariencia normal. Diagnosticamos una hemorragia supracoroidea, que se resuelve espontáneamente en 12 semanas.</p><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">La hemorragia supracoroidea espontánea es muy poco frecuente y presenta una imagen que puede ser confundida con un tumor coroideo, la OCT-EDI es la prueba de imagen mas útil para el diagnóstico diferencial.</p></span>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Castro Flórez R, Azpitarte C, Arcos Villegas G, García Torre M. Hemorragia supracoroidea secundaria a maniobra de Valsalva, importancia de la tomografía de coherencia óptica de profundidad mejorada en el diagnóstico diferencial. Arch Soc Esp Oftalmol. 2020. <span class="elsevierStyleInterRef" id="intr0005" href="https://doi.org/10.1016/j.oftal.2020.08.001">https://doi.org/10.1016/j.oftal.2020.08.001</span></p>" ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 418 "Ancho" => 1255 "Tamanyo" => 59006 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">RE Retinography. A) At the time of diagnosis a grey-looking bilobulated mass is observed in the posterior pole and superotemporal quadrant; B) RE retinography 12 weeks later, when the mass has completely disappeared.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 370 "Ancho" => 1255 "Tamanyo" => 38212 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Appearance of suprachoroidal hemorrhage with OCT: it has an irregular scalloped surface with subretinal fluid between the lobes. The left image shows autofluorescence where the lesion appears isoautofluorescent.</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 554 "Ancho" => 1405 "Tamanyo" => 167956 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">EDI-OCT, the evolution of the hemorrhage in the suprachoroidal space can be seen. A) Appearance at diagnosis, showing hyporeflective choroidal thickening and the anteriorly displaced choriocapillary tissue with normal appearance; B) Four weeks later; C) Eight weeks later and D) Twelve weeks later, where complete resolution of the hemorrhage can be observed.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Spontaneous suprachoroidal hemorrhage; case report and review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S.F. Hsiao" 1 => "M.H. Shih" 2 => "F.C. 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