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Bilateral neuroretinitis and membranous lupus nephritis: 2 infrequent manifestations in juvenile lupus
Neurorretinitis bilateral y nefritis lúpica membranosa: dos manifestaciones infrecuentes en el lupus juvenil
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Retinografía al mes del inicio de la inmunosupresión: se observa edema de papila bilateral con estrella macular parcial en OI y escasos exudados maculares en OD. B. Angiografía fluoresceínica: hiperfluorescencia papilar con filtración en el tiempo arteriovenoso en AO. C. Retinografía a los 7 meses del inicio de la inmunosupresión: se observa papila de bordes netos sin exudados maculares.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Dorronsoro, S. Bronfen, L. Alconcher, L. Lucarelli" "autores" => array:4 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Dorronsoro" ] 1 => array:2 [ "nombre" => "S." "apellidos" => "Bronfen" ] 2 => array:2 [ "nombre" => "L." "apellidos" => "Alconcher" ] 3 => array:2 [ "nombre" => "L." "apellidos" => "Lucarelli" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173579423000099" "doi" => "10.1016/j.oftale.2023.01.002" "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/S2173579423000099?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365669122002775?idApp=UINPBA00004N" "url" => "/03656691/0000009800000003/v1_202303011349/S0365669122002775/v1_202303011349/es/main.assets" ] ] "itemSiguiente" => array:18 [ "pii" => "S2173579423000075" "issn" => "21735794" "doi" => "10.1016/j.oftale.2023.01.001" "estado" => "S300" "fechaPublicacion" => "2023-03-01" "aid" => "2065" "copyright" => "Sociedad Española de Oftalmología" "documento" => "article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Arch Soc Esp Oftalmol. 2023;98:180-4" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Short communication</span>" "titulo" => "Orbital ophthalmomiasis due to <span class="elsevierStyleItalic">Dermatobia hominis</span> in an immunosuppressed patient from the ecuadorian andean area" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "180" "paginaFinal" => "184" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Oftalmomiasis orbitaria por <span class="elsevierStyleItalic">Dermatobia hominis</span> en un paciente inmunosuprimido en un área andina ecuatoriana" ] ] "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" => 2165 "Ancho" => 3175 "Tamanyo" => 567655 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0145" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Computerised tomography of the orbit. <span class="elsevierStyleBold">A.</span> Axial section with soft tissue window showing a large number of intraocular and intraorbital larvae associated with destruction of ocular and periocular tissue (yellow circle). <span class="elsevierStyleBold">B–C.</span> Sagittal and coronal section respectively with bone window, showing a large number of intraorbital hypodense images near the orbital apex compatible with larvae.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Ortiz, D. Osorio, P. Díaz, W. Cofre, L. Montenegro, T. Muñoz" "autores" => array:6 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Ortiz" ] 1 => array:2 [ "nombre" => "D." "apellidos" => "Osorio" ] 2 => array:2 [ "nombre" => "P." "apellidos" => "Díaz" ] 3 => array:2 [ "nombre" => "W." "apellidos" => "Cofre" ] 4 => array:2 [ "nombre" => "L." "apellidos" => "Montenegro" ] 5 => array:2 [ "nombre" => "T." "apellidos" => "Muñoz" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579423000075?idApp=UINPBA00004N" "url" => "/21735794/0000009800000003/v1_202303021216/S2173579423000075/v1_202303021216/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2173579423000105" "issn" => "21735794" "doi" => "10.1016/j.oftale.2022.11.006" "estado" => "S300" "fechaPublicacion" => "2023-03-01" "aid" => "2070" "copyright" => "Sociedad Española de Oftalmología" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Arch Soc Esp Oftalmol. 2023;98:170-4" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Short communication</span>" "titulo" => "Spontaneous corneal clearance after graft detachment in DMEK" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "170" "paginaFinal" => "174" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Aclaramiento corneal espontáneo tras desprendimiento del injerto en DMEK" ] ] "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" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2446 "Ancho" => 2508 "Tamanyo" => 453790 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Slit-lamp (A), specular microscopy (B) and AC-OCT images (C) of the recipient cornea, four months after DMEK surgery. While a fibrotic DMEK graft (yellow arrows) spans the anterior chamber of the eye, creating a pseudo anterior chamber, the cornea is clear, with a visual acuity of 20/25 (0.8). The eye is pseudophakic with a retropupillary iris-claw lens in-situ (white arrows) <span class="elsevierStyleBold">(C).</span> Note that the central, re-endothelialized recipient cornea is clear and of normal thickness, while the peripheral cornea, where the graft is attached, shows oedema. This may be a typical sign of an upside-down graft position since the endothelium (on the anterior side of the graft) is dysfunctional in the periphery, while the central cornea is re-endothelialized through the migration of endothelial cells from the graft onto the recipient posterior stroma. The specular microscopy showed an endothelial cell count 1204 cells/mm<span class="elsevierStyleSup">2</span> and the coefficient of variation was 77.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "L. Fernández-Vega-Cueto, C. Lisa, K. Vasanthananthan, D. Madrid-Costa, J.F. Alfonso, G.R.J. Melles" "autores" => array:6 [ 0 => array:2 [ "nombre" => "L." "apellidos" => "Fernández-Vega-Cueto" ] 1 => array:2 [ "nombre" => "C." "apellidos" => "Lisa" ] 2 => array:2 [ "nombre" => "K." "apellidos" => "Vasanthananthan" ] 3 => array:2 [ "nombre" => "D." "apellidos" => "Madrid-Costa" ] 4 => array:2 [ "nombre" => "J.F." "apellidos" => "Alfonso" ] 5 => array:2 [ "nombre" => "G.R.J." "apellidos" => "Melles" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0365669122002787" "doi" => "10.1016/j.oftal.2022.11.003" "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/S0365669122002787?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579423000105?idApp=UINPBA00004N" "url" => "/21735794/0000009800000003/v1_202303021216/S2173579423000105/v1_202303021216/en/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Short communication</span>" "titulo" => "Bilateral neuroretinitis and membranous lupus nephritis: 2 infrequent manifestations in juvenile lupus" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "175" "paginaFinal" => "179" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "M. Dorronsoro, S. Bronfen, L. Alconcher, L. Lucarelli" "autores" => array:4 [ 0 => array:4 [ "nombre" => "M." "apellidos" => "Dorronsoro" "email" => array:1 [ 0 => "marianeladorronsoro@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "S." "apellidos" => "Bronfen" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "L." "apellidos" => "Alconcher" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "L." "apellidos" => "Lucarelli" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Oftalmología, Hospital Interzonal General Dr. José Penna, Bahía Blanca, Buenos Aires, Argentina" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Nefrología Infantil, Hospital Interzonal General Dr. José Penna, Bahía Blanca, Buenos Aires, Argentina" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Neurorretinitis bilateral y nefritis lúpica membranosa: dos manifestaciones infrecuentes en el lupus juvenil" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1777 "Ancho" => 1305 "Tamanyo" => 221672 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A. Fundus photograph one month after the start of immunosuppression: bilateral papillary edema with partial macular star in the left eye and scant macular exudates in the right eye. B. Fluorescein angiography: papillary hyperfluorescence with leakage in the arteriovenous time in BE. C. Fundus photograph 7 months after the start of immunosuppression: clear papilla with no macular exudates.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Systemic lupus erythematosus (SLE) is a chronic multisystem autoimmune disease with a broad range of clinical expressions, predominantly affecting women of childbearing age. The prevalence in children is one per 100,000<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>. Various genetic, hormonal, environmental and immunological factors are involved in its pathogenesis<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Renal involvement occurs in 40%–80% of SLE patients, with involvement ranging from microhematuria/proteinuria to renal failure. About 90% of SLE patients have some type of kidney injury, with diffuse proliferative lupus nephritis (LN) (class <span class="elsevierStyleSmallCaps">iii-iv</span>) being the most common. Membranous LN (class <span class="elsevierStyleSmallCaps">v</span>) with massive proteinuria is a rare form<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a>.</p><p id="par0015" class="elsevierStylePara elsevierViewall">SLE can affect any part of the eye and its adnexa, through inflammatory or thrombotic processes. Ocular manifestations have been reported in approximately one third of SLE patients, the most frequent being keratoconjunctivitis sicca, followed by scleritis, episcleritis, lupus retinopathy and lupus choroidopathy. Neuroretinitis (NR) is very rare, with very few cases reported in the literature. Ocular involvement may correlate with disease activity and precede other systemic symptoms<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>.</p><p id="par0020" class="elsevierStylePara elsevierViewall">A case of bilateral NR in a 15-year-old female patient with newly diagnosed SLE and membranous NL is presented.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Clinical case</span><p id="par0025" class="elsevierStylePara elsevierViewall">Female, 15, previously healthy, referred to our hospital for abdominal pain, nausea, vomiting, diarrhoea and weight loss of 4 months’ duration, followed by butterfly wing erythema, erythematous lesions on the arms, eyelid and lower limb eedema, arthralgia, morning stiffness and bilateral blurred vision. No history of fever or headache. On examination she was always normotensive. Suspecting nephrotic syndrome secondary to SLE, blood and urine tests were requested, finding normal hemogram and renal function, hypercholesterolaemia, hypertriglyceridemia, hypoalbuminemia, hypocomplementemia (C3: 31 mg/dl; C4: 10 mg/dl), increased ESR (greater than 120 mm/h), positive ANA (titre 1/1.280), positive anti-DNA antibody (titre 1/160), positive anti-Sm antibody, normal antiphospholipid antibodies, massive proteinuria and microhaematuria. Abdominal ultrasound showed free fluid in the abdomen and bilateral laminar pleural effusion. Echocardiogram was normal. Given these findings, the diagnosis of SLE was confirmed according to the ACR and EULAR criteria of 2019<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Ultrasound-guided renal biopsy was indicated, which established the diagnosis of membranous LN, class <span class="elsevierStyleSmallCaps">v</span> according to the ISN/RPS classification<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Treatment was started with meprednisone 60 mg/day (Deltisone B, Elea Phoenix, S. A., Los Polvorines, Buenos Aires, Argentina), hydroxychloroquine 400 mg/day (Evoquin, Ivax Argentina, S. A., Villa Adelina, Buenos Aires, Argentina), mycophenolate mofetil 2 g/day (CellCept, Productos Roche, S. A. Química e Industrial, Argentina), enalapril (Lotrial, Roemmers, Olivos, Buenos Aires, Argentina), losartan (Losacor, Roemmers, Olivos, Buenos Aires, Argentina), calcium carbonate (Calcio Base Efervescente, Investi Farma, S. A., Ciudad Autónoma de Buenos Aires, Argentina) and vitamin D (Raquiferol D3, Roemmers, Olivos, Buenos Aires, Argentina).</p><p id="par0040" class="elsevierStylePara elsevierViewall">Ophthalmological evaluation was requested, which revealed best corrected visual acuity of 8/10 in BE, isochoric pupils, preserved photomotor and consensual reflexes, preserved extrinsic ocular motility, normal intraocular pressure, absence of cells in the anterior chamber and vitreous cavity, and bilateral papilla edema with partial macular star more evident in the left eye, findings compatible with bilateral NR (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">Studies were ordered and performed 3 months later. Fluorescein angiography showed papillary hyperfluorescence with early arteriovenous time leakage increasing at later angiogram times in BE (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B). Macular optical coherence tomography, computerised visual field and brain MRI were normal.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Systemic treatment was continued and complete remission of extrarenal symptoms was achieved 3 months after start of treatment.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Four months after starting treatment, the patient developed severe cellulitis on her right thigh, which required admission and intravenous antibiotic treatment. This infection exacerbated the proteinuria and led to a temporary decrease in immunosuppression. Once the infectious process was overcome, immunosuppressants were resumed at previous doses.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Within 6 months of starting immunosuppression, the nephrotic syndrome subsided and proteinuria gradually improved and disappeared by 1 year.</p><p id="par0065" class="elsevierStylePara elsevierViewall">In what concerns the ophthalmological picture, macular exudates disappeared 2 months after the start of immunosuppression, visual acuity reached 10/10 in BE at 3 months and papillary edema slowly decreased until it disappeared completely at 7 months (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C).</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0070" class="elsevierStylePara elsevierViewall">SLE is a rare disease in paediatrics; it should always be suspected in the presence of nephrotic syndrome in adolescents, especially female, as secondary causes are more frequent at this age.</p><p id="par0075" class="elsevierStylePara elsevierViewall">NL occurs in about 50%–82% of children with SLE, and within this, the membranous class accounts for 8%–20% of cases in adults, with an unknown frequency in paediatrics. In membranous NL, half of the patients with hematuria also have proteinuria and often develop nephrotic syndrome, as seen in this case. The response to treatment is usually later than in proliferative forms; however, it has a better prognosis, with a renal survival of 85% at 5 years<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,7</span></a>. Such a situation was observed in this patient, who required one year to achieve complete clinical improvement.</p><p id="par0080" class="elsevierStylePara elsevierViewall">NR is an inflammatory disorder of the optic disc presenting with the triad of decreased vision, optic disc edema and characteristic macular star formation. The condition is usually unilateral, but can be bilateral in both immunocompetent and immunocompromised patients. When bilateral, ocular involvement is usually asymmetric. Pathophysiologically, there is swelling and exudation of the deep capillaries of the optic disc, with subsequent accumulation of fluid in the peripapillary retina and macula. Subsequently, the edema gradually resolves leaving lipoprotein deposits (hard exudates) within the outer plexiform layer, which appear star-shaped due to the radial arrangement of Henle’s fibres within this layer. The macular star may be partial or complete; when partial, it is usually present in the nasal macula<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,9</span></a>.</p><p id="par0085" class="elsevierStylePara elsevierViewall">NR can be classified according to its etiology as infectious, non-infectious or inflammatory, and idiopathic (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>)<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,10</span></a>. Cat scratch disease, caused by infection with the bacterium <span class="elsevierStyleItalic">Bartonella henselae</span>, is the most common cause and accounts for two-thirds of cases. Fifty percent of cases have no identifiable cause and are idiopathic Leber’s NR<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">Typically, optic disc edema precedes the macular star by 1–3 weeks, and both resolve in approximately 8–12 weeks<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8–10</span></a>. In our patient, the slow resolution of optic disc edema may be related to the delayed therapeutic response of her underlying disease, given the histological type of her renal disease, as well as the transient decrease in immunosuppression required by its infectious intercurrence.</p><p id="par0095" class="elsevierStylePara elsevierViewall">The differential diagnosis of NR should include malignant hypertension, which can occur in these cases and produce bilateral papillary edema with lipid exudation similar to that described at<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a>. This patient’s blood pressure was always within normal parameters, so this differential diagnosis was ruled out.</p><p id="par0100" class="elsevierStylePara elsevierViewall">Most of the literature does not mention SLE as a cause of NR and vice versa, NR as an ophthalmological manifestation of SLE. Only a few case reports have been published, some of them associated with antiphospholipid syndrome, making SLE with membranous LN and NR a very rare association.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusion</span><p id="par0105" class="elsevierStylePara elsevierViewall">Unlike the other microvascular networks, the retinal microvasculature can be directly examined by fundoscopy, and these findings may be comparable with the microangiopathic status in the brain as well as in the rest of the body. As fundoscopy is a simple and accessible test, it should be part of the initial evaluation in every patient with SLE. Perhaps the low prevalence of ophthalmological manifestations has been underestimated due to lack of screening.</p><p id="par0110" class="elsevierStylePara elsevierViewall">In addition to funduscopic examination, other supplementary examinations such as OCT angiography, fluorescein angiography and indocyanine green angiography may reveal vascular changes in the superficial and deep retinal plexuses and in the choroid, which may not be clinically apparent in SLE-associated chorioretinal involvement. Said studies (OCT angiography, fluorescein angiography and indocyanine green angiography) can be performed with DRI OCT-1 Triton plus, 3D Optical Coherence Tomography, Topcon Corporation, Tokyo, Japan (Note: Indocyanine green angiography is not performed in Argentina).</p><p id="par0115" class="elsevierStylePara elsevierViewall">In conclusion, when faced with a patient with bilateral NR, SLE should be considered among the differential diagnoses. It responds to immunosuppressive treatment for SLE and has an excellent long-term prognosis.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Funding</span><p id="par0120" class="elsevierStylePara elsevierViewall">The authors did not receive funding to carry out their research.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conflict of interest</span><p id="par0125" class="elsevierStylePara elsevierViewall">No conflicts of interest were declared by the authors.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres1856524" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1614332" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1856525" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1614333" "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" => "Conclusion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Funding" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflict of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2022-09-29" "fechaAceptado" => "2022-12-15" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1614332" "palabras" => array:5 [ 0 => "Systemic lupus erythematosus" 1 => "Neuroretinitis" 2 => "Eye involvement" 3 => "Lupus nephritis" 4 => "Nephrotic syndrome" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1614333" "palabras" => array:5 [ 0 => "Lupus eritematoso sistémico" 1 => "Neurorretinitis" 2 => "Compromiso ocular" 3 => "Nefritis lúpica" 4 => "Síndrome nefrótico" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Fifteen-year-old female patient, previously healthy, referred to our center for presenting abdominal pain, vomiting, diarrhea, malar erythema, palpebral and lower limb edema, arthralgia, morning stiffness and bilateral blurred vision. Laboratory and imaging studies together with the clinic allowed the diagnosis of nephrotic syndrome secondary to systemic lupus erythematosus. Ophthalmology examination revealed a visual acuity of 8/10 in both eyes and bilateral disc edema with partial macular star, findings compatible with bilateral neuroretinitis. Renal biopsy established the diagnosis of membranous lupus nephritis. Immunosuppressive treatment was started, obtaining gradual clinical improvement.</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Although systemic lupus erythematosus with membranous lupus nephritis and neuroretinitis is a very infrequent association, when faced with a patient with bilateral neuroretinitis, we must consider systemic lupus erythematosus within the differential diagnoses.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Joven de 15 años, previamente sana, se presentó con dolor abdominal, vómitos, diarrea, eritema malar, edema palpebral y en miembros inferiores, artralgias, rigidez matinal y visión borrosa bilateral. Estudios de laboratorio y por imágenes junto con la clínica permitieron realizar el diagnóstico de síndrome nefrótico secundario a lupus eritematoso sistémico. Al examen oftalmológico se constató 8/10 de visión en ambos ojos y edema de papila bilateral con estrella macular parcial, hallazgos compatibles con una neurorretinitis bilateral. La biopsia renal estableció el diagnóstico de nefritis lúpica membranosa. Se inició tratamiento inmunosupresor, con mejoría clínica gradual.</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Si bien el lupus eritematoso sistémico con nefritis lúpica membranosa y neurorretinitis es una asociación muy infrecuente, frente a un paciente con neurorretinitis bilateral debemos considerar al lupus eritematoso sistémico dentro de los diagnósticos diferenciales.</p></span>" ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1777 "Ancho" => 1305 "Tamanyo" => 221672 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A. Fundus photograph one month after the start of immunosuppression: bilateral papillary edema with partial macular star in the left eye and scant macular exudates in the right eye. B. Fluorescein angiography: papillary hyperfluorescence with leakage in the arteriovenous time in BE. C. Fundus photograph 7 months after the start of immunosuppression: clear papilla with no macular exudates.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:1 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Infectious</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Bacterial: cat-scratch disease, tuberculosis, syphilis, leptospirosis, salmonellosis, typhoid, Lyme disease, actinomycosis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Viral: chickenpox, herpes simplex, herpes zoster, Epstein-Barr, influenza A, hepatitis B, mumps, measles, rubella, zika, chikungunya, West Nile virus. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Parasitic: toxoplasmosis, toxocariasis, unilateral subacute diffuse neuroretinitis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Fungal: histoplasmosis, coccidioidomycosis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Inflammatory</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sarcoidosis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>LES \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Behçet’s disease \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>IRVAN syndrome \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Polyarteritis nodosa \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Takayasu’s arteritis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Vogt-Koyanagi-Harada Syndrome \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Inflammatory bowel disease \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Idiopathic</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Leber’s idiopathic stellate neuroretinitis \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Causes of neuroretinitis.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lupus eritematoso sistémico (I)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "E. Rabadán Rubio" 1 => "V. Emperiale" 2 => "P. Pretel Ruiz" 3 => "N. García Castaneda" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Medicine." "fecha" => "2021" "volumen" => "13" "paginaInicial" => "1739" "paginaFinal" => "1750" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Rivera Hernández F, Romera AM, Villabón P, Sanchez-Escudero P, Anaya Fernández S, González López L, et al. Lupus Eritematoso Sistémico. Nefropatía Lupica. En: Lorenzo V, López Gómez JM (Eds). Nefrología al día. ISSN: 2659-2606. Available from: <a target="_blank" href="https://www.nefrologiaaldia.org/263">https://www.nefrologiaaldia.org/263</a>." ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Membranous lupus nephritis: a clinical review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S. Almaani" 1 => "S.V. Parikh" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/j.ackd.2019.08.009" "Revista" => array:6 [ "tituloSerie" => "Adv Chronic Kidney Dis." 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"fecha" => "2020" "volumen" => "12" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Kidney outcomes for children with lupus nephritis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "L. Oni" 1 => "R.D. Wright" 2 => "S. Marks" 3 => "M.W. Beresford" 4 => "K. Tullus" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00467-020-04686-1" "Revista" => array:6 [ "tituloSerie" => "Pediatr Nephrol." 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Chauhan" ] ] ] ] ] "host" => array:2 [ 0 => array:1 [ "Libro" => array:4 [ "titulo" => "StatPearls [Internet]" "fecha" => "2022" "editorial" => "StatPearls Publishing" "editorialLocalizacion" => "Treasure Island (FL)" ] ] 1 => array:1 [ "WWW" => array:1 [ "link" => "https://www.ncbi.nlm.nih.gov/books/NBK570627/" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Neuroretinitis: review of the literature and new observations" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "V. Purvin" 1 => "S. Sundaram" 2 => "A. Kawasaki" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/WNO.0b013e31820cf78a" "Revista" => array:6 [ "tituloSerie" => "J Neuroophthalmol." "fecha" => "2011" "volumen" => "31" "paginaInicial" => "58" "paginaFinal" => "68" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21317731" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Neuroretinitis: a review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A. Abdelhakim" 1 => "N. Rasool" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/ICU.0000000000000527" "Revista" => array:6 [ "tituloSerie" => "Curr Opin Ophthalmol." "fecha" => "2018" "volumen" => "29" "paginaInicial" => "514" "paginaFinal" => "519" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30148725" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735794/0000009800000003/v1_202303021216/S2173579423000099/v1_202303021216/en/main.assets" "Apartado" => array:4 [ "identificador" => "76120" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Shorts communications" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735794/0000009800000003/v1_202303021216/S2173579423000099/v1_202303021216/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579423000099?idApp=UINPBA00004N" ]
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