Thermography in clinical ophthalmic oncology / Termografia em oncologia oftalmológica clínica

ABSTRACT Purpose: The aim of this study was to present our own experience with the use of thermography as a complementary method for the initial diagnosis and differentiation of intraocular tumors, as well as for the evaluation of the efficacy of treatment of intraocular melanomas. Methods: The study group comprised 37 patients with intraocular tumors, including 9 with uveal melanoma, 8 with uveal melanoma after I125 brachytherapy, 12 with a focal metastasis to the uvea, and 8 with retinal capillary hemangioblastoma. A FLIR T640 camera was used to capture images in the central point of the cornea, eye area, and orbital cavity area. Results: Eyes with uveal melanoma had higher temperature compared with the fellow normal eye of the patient in the range of all measured parameters in the regions of interest. In the group of patients with melanoma after unsuccessful brachytherapy, higher temperature was observed at the central point of the cornea. In patients with tumor regression, all measured parameters were lower in the affected eye. We observed lower tempe­ratures in the range of all tested parameters and areas in eyes with choroidal metastases. Eyes with diagnosed intraocular hemangioblastoma were characterized by higher parameters for the regions of interest versus eyes without this pathology. Conclusions: A thermographic examination of the eye can be used as an additional first-line diagnostic tool for the differentiation of intraocular tumors. Thermography can be a helpful tool in monitoring the treatment outcome in patients with intraocular melanoma.

RESUMO Objetivo: O objetivo deste estudo foi de apresentar a nossa experiência no uso da termografia como método complementar para o diagnóstico inicial e a diferenciação de tumores intraoculares, bem como para a avaliação da eficácia do tratamento de melanomas intraoculares. Métodos: O grupo estudado compunha-se de 37 pacientes com tumores intraoculares, sendo 9 com melanoma uveal, 8 com melanoma uveal após braquiterapia com I125, 12 com metástases focais na úvea e 8 com hemangioblastoma capilar retiniano. As imagens do ponto central da córnea, da área do olho e da área da cavidade orbital foram obtidas com uma câmera FLIR T640. Resultados: Os olhos dos pacientes com melanoma uveal tinham temperaturas mais elevadas do que as dos olhos normais dos mesmos, em toda a faixa dos parâmetros medidos nas regiões de interesse. No grupo de pacientes com melanoma após braquiterapia mal sucedida, encontrámos temperaturas maiores no ponto central da córnea. Nos pacientes com regressão do tumor, todos os parâmetros medidos foram menores no olho acometido. Encontrámos temperaturas mais baixas em toda a faixa dos parâmetros testados e das áreas medidas nos olhos com metástases na coroide. Os olhos com hemangioblastoma intraocular diagnosticado caracterizaram-se por parâmetros mais elevados nas regiões de interesse, em comparação com olhos sem essa patologia. Conclusões: O exame termográfico do olho pode usar-se como ferramenta de diagnóstico adicional de triagem na diferenciação de tumores intraoculares. A termografia pode ser uma ferramenta útil no acompanhamento do des­fe­cho do tratamento em pacientes com melanoma intraocular.

Two Cases of Uveo-meningeal Syndrome

PURPOSE: We report two cases of uveo-meningeal syndrome involving the retina, uvea, and optic disc in both eyes after viral meningitis. CASE SUMMARY: A 16-year-old female was referred to our department with blurred vision in both eyes. She was hospitalized in the pediatric ward with viral meningitis. She showed a norma best-corrected visual acuity (BCVA) and normal intraocular pressure in both eyes, but had severe inflammation in the anterior chamber on slit lamp examination, and optic disc edema and multiple whitish lesions on fundus examination. She was treated with intravenous antibiotic injections and steroid eye drops. After close observation, inflammation in the anterior chamber, optic disc edema, and the multiple whitish lesions in the retina were improved. A 27-year-old male who was treated for viral meningitis at the neurology department was referred to us with blurred vision in both eyes. His BCVAs were 0.7 (right eye) and 0.6 (left eye). The intraocular pressure was normal in both eyes. Slit lamp examination revealed inflammation in the anterior chamber and optic disc edema, and a fundus examination revealed multiple infiltrations. He received treatment for presumed herpes virus infection. After close observation, inflammation in the anterior chamber, optic disc edema, and multiple infiltrations with hemorrhage in the retina were improved. CONCLUSIONS: Clinicians should consider the possibility of uveo-meningeal syndrome, which can cause inflammation in the uvea,retina, and optic disc simultaneous with viral meningitis accompanying blurred vision.

Corneoconjunctival manifestations of lymphoma in three dogs

An 8-year-old Shih Tzu, a 5-year-old Maltese, and a 10-year-old Maltese presented with conjunctival hyperemia and peripheral corneal edema. Severe conjunctival thickening with varying degrees of corneal extension was observed. Cytological examination showed many large lymphocytes with malignant changes in the conjunctiva which was consistent with findings in fine-needle aspiration samples taken from regional lymph nodes. They were diagnosed as having Stage V multicentric lymphoma. When conjunctival thickening is observed in canine patients with multicentric lymphoma, conjunctival metastasis with infiltration of neoplastic lymphoid cells should be included in the differential diagnosis.

Eye Globe Abnormalities on MR and CT in Adults: An Anatomical Approach

Eye globe abnormalities can be readily detected on dedicated and non-dedicated CT and MR studies. A primary understanding of the globe anatomy is key to characterising both traumatic and non-traumatic globe abnormalities. The globe consists of three primary layers: the sclera (outer), uvea (middle), and retina (inner layer). The various pathological processes involving these layers are highlighted using case examples with fundoscopic correlation where appropriate. In the emergent setting, trauma can result in hemorrhage, retinal/choroidal detachment and globe rupture. Neoplasms and inflammatory/infective processes predominantly occur in the vascular middle layer. The radiologist has an important role in primary diagnosis contributing to appropriate ophthalmology referral, thereby preventing devastating consequences such as vision loss.

Ocular Manifestations of Systemic Lupus Erythematosus / 한양의대학술지

Systemic lupus erythematosus (SLE) is a complex connective tissue disease involving multiple organs including various ocular structures including the eyelid, orbit, ocular adnexa, sclera, cornea, retina, uvea, and optic nerve. Keratoconjunctivitis sicca is the most common ocular manifestation resulting in patients that suffer from dry eye symptoms, whereas severe vaso-occlusive lupus retinopathy is the most vision-threatening condition associated with the disease. SLE is a serious systemic disease that may first present with ocular manifestations. In addition, ocular manifestations are often associated with severe systemic inflammation and can be a marker for systemic prognosis. Thus, it is important for ophthalmologists to be aware of the association of visual disorders with SLE to detect and treat the ocular manifestations of SLE.

Effects of morphine on the expression of cytokines and inflammatory mediators in a rabbit model of endotoxin-induced experimental uveitis / Efeitos da morfina na expressão de citocinas e de mediadores inflamatórios em coelhos com uveítes experimental induzida por endotoxina

ABSTRACT Purpose: To evaluate the effects of 1% morphine instillation on clinical parameters, aqueous humor turbidity, and expression levels of tumor necrosis factor alpha (TNF-α), interleukin-1 beta (IL-1beta), prostaglandin E2 (PGE2), and myeloperoxidase (MPO) in rabbits with endotoxin-induced experimental uveitis. Methods: Twenty four New Zealand white rabbits were divided into four groups (n=6 each): control (CG), morphine (MG), naloxone (NG), and morphine-naloxone (MNG) groups. Under dissociative anesthesia, 0.1 mL of solution containing 0.2 µg of lipopolysaccharide (LPS) endotoxin from the Salmonella typhimurium cell wall was injected in the vitreous chamber. Clinical evaluations (conjunctical hyperemia, chemosis blepharospasm, and ocular discharge) and laser flaremetry were performed before (baseline), and 10 and 20 hours after induction of uveitis. Rabbits were subsequently euthanized and eyes were enucleated to quantify expression levels of TNF-α, IL-1 beta, PGE2, and MPO. Results: No significant differences in clinical parameters and flare values were observed between the study groups. TNF-α and IL-1 beta levels increased significantly in the CG, MG, NG, and MNG groups compared to baseline (P<0.05). Significant differences in PGE2 levels were observed between the MG and NMG groups (P<0.05). A trend toward increased MPO activity was observed in response to uveitis induction; however, this trend did not reach statistical significance (P>0.05). Conclusions: Morphine has no effect on clinical parameters, flare, or expression levels of inflammatory mediators in a rabbit model of uveitis induced by intravitreal injection of LPS.

RESUMO Objetivo: Estudaram-se os efeitos da instilação de morfina 1% sobre parâmetros clínicos, turbidez do humor aquoso e expressão de fator de necrose tumoral alfa (TNF-alfa), de interleucina-1 beta (IL-1beta), de prostaglandina E2 (PGE2) e de mieloperoxidase (MPO), em olhos de coelhos com uveíte induzida por endotoxina. Material e Métodos: Vinte e quatro coelhos da raça Nova Zelândia Branco foram distribuídos em quatro grupos (n=6, em cada): grupo controle (GC), morfina (GM), naloxona (GN) e morfina-naloxona (GMN). Sob anestesia dissociativa, injetou-se 0,1 mL de solução contendo 0,2 µg de lipossacarídeo (LPS) endotóxico da parede celular de Salmonella typhimurium na câmara vítrea. Realizou-se avaliação clínica (hiperemia conjuntival, quemose, blefaroespasmo e secreção ocular) e a flaremetria a “laser” antes (basal) e após 10 e 20 horas da indução da uveíte. No final, os coelhos foram submetidos à eutanásia e os olhos com uveíte foram enucleados para a quantificação dos níveis de TNF-alfa, IL-1 beta, PGE2 e MPO. Diferenças foram consideradas significativas quando p<0,05. Resultados: Os grupos da pesquisa não diferiram quanto aos parâmetros clínicos e os valores de “flare”. Observou-se elevação significativa nos níveis de TNF-alfa e de IL-1 beta, comparativamente ao basal, nos grupos GC, GM, GN e GMN (p<0,05). Valores de PGE2 variaram entre os grupos GM e GNM (p<0,05). A atividade de MPO aumentou após a indução da uveíte, porém, sem significância estatística (p>0,05). Conclusões: A morfina não atuou sobre parâmetros clínicos, “flare” e expressão dos mediadores inflamatórios estudados, quando instilada em olhos de coelhos com uveíte induzida por injeção intravítrea de LPS.

Intraocular lymphoma in Korea: the Consortium for Improving Survival of Lymphoma (CISL) study

BACKGROUND: Intraocular lymphoma (IOL) is a rare malignant lymphoma that most closely resembles a diffuse large B-cell lymphoma, and it is a subtype of primary central nervous system lymphoma (PCNSL). IOL is located inside the eye in the retina, uvea, and/or optic nerve. We retrospectively analyzed IOL patient data to identify treatment patterns and survival rates in Korea. METHODS: Cytological confirmation for a diagnosis of IOL was performed for all patients. The clinical data collected from medical records included Ann Arbor stage, International Prognostic Index, performance status, date of diagnosis, treatment modality and response, date of relapse, and date of last follow-up. RESULTS: Twenty patients who were diagnosed with IOL, between December 2007 and June 2014 at multiple centers in Korea, were included in the analysis. Four patients were diagnosed with IOL alone, not involving the CNS. Two patients with isolated IOL later developed PCNSL. Nine patients developed CNS lesions before the onset of ocular lymphoma. Five patients had simultaneous onset in the eye and CNS. Twelve patients were treated by intravitreal injection of methotrexate for IOL. The median progression-free survival (PFS) for patients was 19.7 months (95% CI, 8.7-30.7 mo). The estimated 3-year overall survival (OS) for all patients was 75.1%. CONCLUSION: Treatment for IOL patients included radiotherapy and intraocular chemotherapy. IOL patients showed favorable PFS and OS. These patients would require long-term follow-up to identify relapse and adverse effects of radiotherapy or intraocular chemotherapy.

Prognostic implications of cytopathologic classification of melanocytic uveal tumors evaluated by fine-needle aspiration biopsy / Implicação prognóstica da classificação citopatológica dos tumores melanocíticos da úvea avaliados pela biópsia aspirativa com agulha fina

PURPOSE: Determine whether cytopathologic classification of melanocytic uveal tumors evaluated by fine-needle aspiration biopsy (FNAB) is a significant prognostic factor for death from metastasis. METHODS: Retrospective analysis of cases of clinically diagnosed uveal melanoma evaluated by fine-needle aspiration biopsy from 1980 to 2006. Main outcome evaluated was death from metastasis. Associations between baseline clinical variables and cytopathologic classification were evaluated using cross-tabulation. Prognostic significance of cytopathologic classification was evaluated by Kaplan-Meier and Cox proportional hazards analysis. RESULTS: Of 302 studied biopsies, 260 (86.1%) yielded sufficient cells for cytopathologic classification. Eighty of the 260 patients who had a sufficient specimen have already died (P=0.021), 69 from metastatic uveal melanoma. Cell type assigned by cytopathology was strongly associated with metastasis/metastatic death in this series (P=0.0048). Multivariate analysis showed cytopathologic classification to be an independently significant prognostic factor for metastatic death (P=0.0006). None of the 42 patients whose tumor yielded insufficient aspirates (sampled in at least two sites) have developed metastasis or died of metastasis thus far. CONCLUSION: In this series, cytopathology of fine-needle aspiration biopsy samples obtained from uveal melanomas was strongly prognostic of death from metastasis. Insufficiently aspirates (2 or more sites sampled) proved to be prognostic of a favorable outcome (i.e., not developing metastasis).

OBJETIVO: Determinar se a classificação citopatológica de tumores melanocíticos da úvea avaliados pela biópsia aspirativa com agulha fina (BAAF) é um fator prognóstico significativo para óbito por metástases. Métodos: Análise retrospectiva de casos diagnosticados clinicamente como melanoma uveal e avaliados pela biópsia aspirativa com agulha fina entre 1980 e 2006. O evento principal analisado foi óbito por metástase. Associações entre variáveis clínicas à apresentação e classificação citopatológica foram avaliadas usando tabulação cruzada. Significância prognóstica da classificação citopatológica foi avaliada por análise de riscos proporcionais de Cox e Kaplan-Meier. RESULTADOS: Das 302 biópsias estudadas, 260 (86,1%) renderam um número suficiente de células para classificação citopatológica. Oitenta dos 260 pacientes que obtiveram um espécime suficiente (adequado) foram a óbito (P=0,021), 69 destes por melanoma uveal metastático. O tipo celular designado pela citopatologia apresentou forte associação com metástase/óbito por metástase nessa série (P=0,0048). Análise multivariada mostrou que a classificação citopatológica foi um fator prognóstico independente significativo para o óbito por metástase (P=0,0006). Nenhum dos 42 pacientes cujos tumores renderam um aspirado insuficiente (quando foram amostrados pelo menos 2 sítios) desenvolveu metástase e foi a óbito por metástase até o presente momento. CONCLUSÃO: Nessa série, a citopatologia dos espécimes obtidos pela biópsia aspirativa com agulha fina de melanomas uveais foi fortemente prognóstica para óbito por metástase. Os aspirados insuficientes (se duas ou mais áreas foram amostradas) provou ser um resultado prognóstico favorável (i.e., de não desenvolvimento de metástases).

Twenty-five gauge vitrectomy in uveitis / Vitrectomia 25-gauge em uveítes

PURPOSE: To evaluate anatomical and functional results of 25-gauge transconjunctival sutureless pars plana vitrectomy in patients with uveitis. METHODS: Vitrectomy was performed on 20 eyes with residual vitritis secondary to infectious and noninfectious uveitis. Patients were evaluated 1 week before surgery and after surgery at day 1, week 1, week 4 and week 12. Visual acuity (VA), intraocular pressure, anterior chamber cells and flare and vitreous haze were measured. RESULTS: Mean VA improved from 2.06 ± 0.94 logMAR before surgery to 0.58 ± 0.46 logMAR at week 12 (p<0.05). No case required conversion to standard 20-gauge instrumentation or suture placement, no intraoperative complications were noted. Transient postoperative hypotony was seen in three eyes. One patient with toxoplasmic retinochoroiditis had a relapse during follow-up. CONCLUSION: 25-gauge vitrectomy has proven its efficacy on cleansing vitreous opacities and improving visual acuity on patients with residual vitritis secondary to uveitis with minimal postoperative inflammation and complications.

OBJETIVO: Avaliar os resultados anatômicos e funcionais da vitrectomia via pars plana 25-gauge transconjuntival sem sutura em pacientes com uveítes. MÉTODOS: Realizou-se vitrectomia em 20 olhos com vitreíte residual secundária a uveíte infecciosa e não infecciosa. Os pacientes foram avaliados uma semana antes e após a cirurgia, no primeiro dia, 1ª, 4ª e 12ª semana. Acuidade visual (AV), pressão intraocular, células e "flare" na câmara anterior e "haze" vítreo foram medidos. RESULTADOS: A AV média melhorou de 2,06 ± 0,94 logMAR antes da cirurgia para 0,58 ± 0,46 logMAR na 12ª semana (p<0,05). Nenhum caso necessitou de conversão para instrumentos de 20-gauge ou realização de sutura e não foram observadas complicações intraoperatórias. Hipotonia transitória foi observada em três olhos. Um paciente com retinocoroidite por toxoplasmose teve recidiva durante o acompanhamento. CONCLUSÃO: Vitrectomia 25-gauge provou sua eficácia na remoção do vítreo opacificado e na melhora da AV em pacientes com vitreíte residual secundária a uveítes, com mínima inflamação pós-operatória e complicações.

Uveítis como manifestación secundaria a infecciones de la cavidad bucal: revisión de la literatura / Uveitis representations as secondary to infections the oral cavity: review of the literature

La uveítis es una patología ocular que se define como la inflamación del tracto úveal, pudiendo estar asociada a la inflamación de otras estructuras oculares o adyacentes a la cavidad orbitaria. La etiología puede incluir infecciones o alteraciones en el sistema inmune y puede ser primariamente ocular o asociada a una enfermedad sistémica. Su incidencia es proporcional tanto en hombres como en mujeres dependiendo a la enfermedad que se encuentre asociada. El método de diagnóstico se realiza a través de exámenes radiográficos, de laboratorio y el examen clínico, tanto oftálmico como odontológico. De acuerdo a la sintomatología manifestada en el paciente, se orienta el tratamiento a seguir.

Uveítis is an eye condition that is defined as inflammation of the úveal tracto and can be associated with inflammation of other ocular structures or adjacent to the orbital cavity. The possible causes include infections or alterations in the immune system and can be primarily visual or associated with a systemic disease. It´s incidence is proportional in men and women, and it depends on the disease it's associated to. Medical and Dental diagnosis is generaly made by physical and radiographic examination, along with laboratory tests. The treatment will depend on the symptoms of the patient.

case of atypical idiopathic choroidal effusion syndrome

Uveal effusion syndrome is characterized by annular ciliochoroidal detachment, shifting non-rhegmatogenous retinal detachment, unremarkable inflammation in the anterior eye segment and normal intraocular pressure. A 36-year-old Caucasian hypermetropic male presented in the eye casualty with a week history of curtain like effect in front of his left eye associated with worsening of vision and flashing lights. Left fundus examination revealed retinal detachment with smooth shaped elevation superonasaly and detached retina inferiorly confirmed on ultrasound B-scan with no tobacco dust in the anterior vitreous. Diagnosis of uveal effusion syndrome was made. Lamellar sclerectomies in the two quadrants were performed. Fourteen months postoperatively, the left eye choroidal effusion gradually settled down and at 18 months the retina flattened. Early diagnosis, close follow-up, and appropriate management are mandatory to improve or maintain visual function in such patients

A Case of Vogt-Koyanagi-Harada Syndrome with Vertigo and Hearing Loss / 대한이비인후과학회지

Vogt-Koyanagi-Harada (VKH) syndrome is an uncommon multisystem autoimmune disease affecting the melanocytes located in the uvea, inner ear, skin, hair, and meninges. The syndrome is frequently reported by ophthalmologists since the most consistent finding is uveitis. Hearing loss, tinnitus and vertigo are the symptoms of VKH syndrome. The authors report one case of VKH syndrome with hearing loss and vertigo with related literature.

Delayed-Onset Expulsive Suprachoroidal Hemorrhage Due to a Trauma after Removal of Penetrating Keratoplasty Suture

PURPOSE: To report a case of delayed-onset expulsive suprachoroidal hemorrhage due to trauma after removal of a penetrating keratoplasty suture. CASE SUMMARY: A 66-year-old man had penetrating keratoplasty for bullous keratopathy performed in his left eye. After 1 year, the continuous suture was removed for adjustment of astigmatism. Four days after removal of the suture, the patient struck his left eye with the back of his hand, although at the time of injury he had no specific symptoms. Two days later, the patient noticed abrupt pain, decreased visual acuity, and massive hemorrhage in his left eye. Examination revealed an inferior wound dehiscence of approximately 8 clock hours (2 thru 10 o'clock) with prolapsed intraocular contents such as the uvea and retina. The patient underwent cornea graft resuturing with resection of ocular contents, which could not be repositioned. Although bleeding was controlled after the operation, vision was lost in his left eye. After two months, according to decrement of intraocular hematoma, the patient had a phthisis bulbi with low intraocular pressure in his left eye. CONCLUSIONS: Persistent low intraocular pressure due to wound leakage through the graft-host junction likely resulted in delayed onset of expulsive suprachoroidal hemorrhage. The risk of traumatic corneal graft rupture after penetrating keratoplasty is significant and is associated with a poor visual outcome and eyeball viability. Therefore, patients should be cautioned. In addition, the importance of eye examination after trauma should be emphasized.

Exoresection and endoresection for uveal melanoma

Surgical resection of uveal melanomas is an alternative eye-salvaging approach to the more commonly used irradiation techniques. There are two surgical resection techniques: Transscleral resection or "Exoresection" via a partial lamellar sclerouvectomy and "Endoresection" via a pars plana vitrectomy. While exoresection is more applicable to anteriorly located tumors with ciliary body and/or iris involvement, endoresection is more suitable for posteriorly located tumor without ciliary body involvement. Both approaches are suitable for large tumors with >8 mm in thickness. In general, eyes containing these large tumors have a very dismal prognosis regarding long-term visual function, eye retention, and irradiation-induced side effects. By removing the tumor burden from the eye, histopathologic and cytogenetic information of the tumor is available and complications associated with the so-called toxic tumor syndrome are avoided. However, both types of surgical resection are challenging surgical procedures, bearing the risk of early and late postoperative complications

A Case of Sarcoidosis with Pancytopenia as Resulting from Bone Marrow Involvement / 결핵및호흡기질환

Sarcoidosis is a granulomatous disease that can involve any organ, although it primarily involves the lungs, intrathoracic lymph nodes, skin, and eyes. We present a case of sarcoidosis with pancytopenia, resulting from bone marrow involvement. A 35-year-old man was admitted to hospital for chronic cough and blurred vision. On chest computed tomography, there were multiple pulmonary nodules and mediastinal lymph nodes enlargement. As the patient also showed pancytopenia, we performed a bone marrow biopsy, as well as a transbronchial lung biopsy. Both biopsies showed non-caseating granulomas. We diagnosed the patient with sarcoidosis with pulmonary, bone marrow, uvea, liver and spleen involvement. After oral steroid therapy, the patient's symptoms as well as his pancytopenia improved. We present this case to demonstrate the significance of bone marrow biopsy in cases of sarcoidosis with pancytopenia, as well the possibility of clinical improvement with steroid treatment.

A Case of Plexiform Neurofibroma with Severe Ptosis and Proptosis

PURPOSE: We present a case of plexiform neurofibroma that extensively invaded cranial and temporal bone, eyelid, orbit and uveal tissues, showing signs of severe ptosis and proptosis and symptoms of headache and ocular pain. METHODS: A 24-year old woman visited our clinic with pain and progressive proptosis, which had persisted for 2 weeks. She had a history of congenital neurofibromatosis. There were multiple Cafe-au-lait spots on her extremities, trunk, and face. Also, she had severe ptosis in her upper left eyelid, proptosis, and a distorted and asymmetric facial form. The cornea was markedly edematous. An enhanced computed tomography scan revealed an uncertain circumscribed soft tissue mass with enlargement of the eyeball and orbit, coupled with sphenoid wing dysplasia and herniation of the dura mater into the orbit due to expansion and bony destruction of the superior orbital wall. Under general anesthesia, the patient underwent excision and histopathologic biopsy of intraocular neurofibroma through evisceration. RESULTS: The tumor had black-colored multilobular nodules whose dimensions were 1.5x1.2x0.4 cm. After a histopathologic examination, the tumor was determined to be a pigmentary hamartoma of the uvea. Based on the clinical and histologic findings, we diagnosed the patient with plexiform neurofibroma with type I neurofibromatosis.

Sympathetic ophthalmia : a blinding complication of ocular injury.

Sympathetic Ophthalmia is a rare and blinding ocular complication due to ocular injury. This condition in a male patient aged 25 years, is reported. The role of early recognition and management of this condition to preserve good vision is discussed.

Malária ocular: estudo histopatológico experimental das alterações coriorretinianas / Ocular malaria: experimental histopathological study of choroidal and retinal changes

OBJETIVO: Realizar análise histopatológica dos tecidos uveal e retiniano em modelo murino que fortemente se assemelha ao desenvolvimento de malária cerebral humana, correlacionando as alterações oculares com achados encontrados em órgãos-alvo como o cérebro. MÉTODOS: Utilizamos camundongos de linhagem isogênica CBA/J por desenvolverem malária e evoluírem para forma grave ou cerebral quando inoculados com Plasmodium berghei (ANKA). Foi realizada inoculação via intraperitoneal e a parasitemia obtida diariamente. Para correlacionarmos as alterações com a evolução da malária, os camundongos foram sacrificados no 3º, 7º e 9º dia de infecção. Após a enucleação, o globo ocular foi fixado em solução de Bouin e incluído em parafina. Os cortes foram corados com hematoxilina-eosina, tricrômica de Gomori e Giemsa. RESULTADOS: Foram observados acúmulos de pigmentos maláricos (hemozoína) em diversas estruturas oculares, na fase inicial da doença, até alterações endoteliais de vasos retinianos, adesão de monócitos na parede vascular e congestão do lúmen vascular por hemácias parasitadas (seqüestro) em tecido uveal na fase tardia da infecção. Os níveis de parasitemia mostraram curva ascendente e significativa por volta do sétimo dia. Neste modelo observamos alterações semelhantes àquelas encontradas em outros órgãos-alvo como o cérebro. CONCLUSÕES: O modelo de malária murina permite a correlação dos achados oculares com outros órgãos-alvo da infecção. O seqüestro de células vermelhas parasitadas, na fase tardia, é responsável pela maioria das alterações oculares da malária, provavelmente com base nos fenômenos obstrutivos similares aos processos que envolvem o sistema nervoso central.