Glaucoma e óleo de silicone / Glaucoma and silicone oils

RESUMO O óleo de silicone é um importante tampão utilizado na retinopexia cirúrgica de casos graves de descolamento de retina. O aumento da pressão intraocular e o desenvolvimento de glaucoma secundário são frequentes complicações da sua utilização. A depender do período de aparecimento, diversos mecanismos justificam a ocorrência de tais complicações. Compreender os fatores de riscos e a patogênese do aumento da pressão intraocular associada a aplicação de óleo de silicone em cirurgia retiniana ajuda a orientar o tratamento adequado para cada paciente. O objetivo deste artigo é revisar a literatura sobre a patogenia, a incidência, os fatores de risco e o tratamento desta condição clínica.

ABSTRACT Silicone oil has been an important intraocular tamponade in retinopexy in cases of complicated retinal detachment surgery. The increase of intraocular pressure and development of secondary glaucoma are a known complication of its use. A variety of mechanisms have been proposed for the pathogenesis, depending on the onset. This article aims to review the literature about pathogenesis, the incidence and risk factors, as well as the treatment of this pathology.

Inyección de gas intravítreo combinada con fotocoagulación con láser de argón para el tratamento de la maculopatía de la foseta del disco óptico sin vitrectomía / Intravitreal gas injection combined with argon laser photocoagulation for treatment of optic disc pit maculopathy without vitrectomy

RESUMEN Presentamos el caso de un paciente con foseta del disco óptico, quien presentó una disminución de la agudeza visual secundaria a desprendimiento seroso de retina. Se decidió realizar una inyección intravítrea de 0.3ml de gas C3F8 (100%), seguida de fotocoagulación con láser de argón en el borde temporal de la foseta, logrando reaplicación total de la retina, con reabsorción de todo el líquido subretiniano visible en la tomografía de coherencia optica (OCT) luego de 400 días. Además hubo una mejoría significativa en la agudeza visual.

ABSTRACT We present the case of a patient with an optic disk pit, presenting with great loss of visual acuity secondary to serous retinal detachment. The management chosen was an intravitreal injection of 0.3 mL of C3F8 (100%), followed by argon laser photocoagulation on the temporal edge of the pit, ), achieving total retinal reattachment , and reabsorption of all subretinal fluid visible at optical coherence tomography after 400 days, in addition to great improvement in visual acuity.

Novel low-cost approach to the treatment of ocular surface squamous neoplasia using pattern scanning laser photocoagulation / Nova abordagem de baixo custo para neoplasia escamosa da superficie ocular usando fotocoagulação tipo pattern scanning

ABSTRACT Purpose: To evaluate the safety and 12-month effect of treatment with pattern scanning laser photocoagulation for ocular surface squamous neoplasia in a low-resource setting with extremely limited access to an operating room. Methods: Adult patients with a clinical diagnosis of ocular surface squamous neoplasia underwent a complete ophthalmologic examination. After topical anesthesia and instillation of toluidine blue 1%, the lesion was treated using pattern scanning photocoagulation for a duration time that varied from 20 to 100 ms and power from 600 to 1,800 mW. Patients were examined on a weekly basis for the first month and underwent weekly retreatment of the remaining lesions, as necessary. Patients had a minimum follow-up of 12 months. Results: Thirty-eight patients (38 eyes) were included. All patients had clinical ocular surface squamous neoplasia that was confirmed by impression cytology. The age of patients ranged from 40 to 83 years (average: 65.5 years) and 28 of them were males (74%). The patients were divided into two groups: group I (immunocompetent) and group II (immuno­suppressed). In group I, 23 patients (74%) presented complete response with lesion control after laser treatment alone. In group II, two of seven patients (28%) showed treatment response during the follow-up. The average number of treatments was 2.5 (one to six laser treatments). Procedures were well tolerated. Conclusion: Short-term results of the laser photocoagulation approach for the treatment of ocular surface squamous neoplasia conjunctival lesions were favorable, with a 74% success rate observed in immunocompetent patients. This novel strategy is a less resource-intensive alternative that could demonstrate its usefulness in settings with shortages in operating rooms and in recurrent cases. Studies with longer follow-ups and larger sample sizes are warranted to confirm our findings and evaluate the effectiveness of laser treatment in association with topical chemotherapy.

RESUMO Objetivo: Avaliar a segurança e o efeito de 12 meses de tratamento com fotocoagulação pelo pattern scanning laser para neoplasia escamosa da superfície ocular em um ambiente com poucos recursos e acesso extremamente limitado a um tratamento cirúrgico. Métodos: Pacientes adultos com diagnóstico de neoplasia escamosa de superfície ocular foram submetidos a exame oftalmológico completo. Após anestesia tópica e instilação de azul de toluidina 1%, a lesão foi tratada com laser por um tempo de duração que variou de 20 a 100 ms e potência de 600 a 1800 mW. Os pacientes foram examinados semanalmente durante o primeiro mês e fo­ram retratados semanalmente das lesões restantes, conforme necessário. Os pacientes tiveram um seguimento mínimo de 12 meses. Resultados: Trinta e oito pacientes (38 olhos) foram incluídos no estudo. Todos os pacientes apresentaram neoplasia escamosa da superfície ocular clínica, confirmada por citologia de impressão. A idade dos pacientes variou entre 40 e 83 anos (média de 65.5 anos) e 28 deles eram do sexo masculino (74%). Os pacientes foram divididos em dois grupos: Grupo I (imunocompetente) e grupo II (imunossuprimido). No grupo I, 23 pacientes (74%) apresentaram resposta completa com o controle da lesão após o tratamento com laser. No grupo II, dois dos sete pacientes (28%) apresentaram resposta ao tratamento durante o acompanhamento. A média de aplicações de laser foi de 2,5 (1 a 6 aplicações). Os procedimentos foram bem tolerados. Conclusões: Os resultados a curto prazo da abordagem de fotocoagulação a laser para o tratamento das lesões conjuntivais de neoplasia escamosa de superfície ocular foram favoráveis, com uma taxa de sucesso de 74% observada em pacientes imunocompetentes. Essa nova estratégia é uma alternativa menos intensiva em recursos que pode demonstrar sua utilidade em ambientes com escassez de salas cirúrgicas e em casos recorrentes. Estudos com acompanhamentos mais longos e amostras maiores são necessários para confirmar nossos achados e avaliar a eficácia do tratamento a laser asso­ciado à quimioterapia tópica.

Retinopatía del prematuro: actualización en detección y tratamiento / Retinopathy of the premature: update in screening and treatment

Resumen: La Retinopatía del Prematuro (RDP) es una alteración proliferativa de los vasos sanguíneos de la retina inmadura, que afecta principalmente a los recién nacidos de muy bajo peso (RNMBP) y de menor edad gestacional. El objetivo de esta revisión es describir a qué niño se debe efectuar la detección de esta enfermedad y analizar los recientes avances en su tratamiento. La detección de RDP está dirigida principalmente a los RNMBP y a < de 32 semanas de edad gestacional, pero también se ha propuesto un criterio según edad postmenstrual. Además de la fotocoagulación con láser, tratamiento estándar en la actualidad, se han desarrollado nuevas terapias, como los agentes anti factor de crecimiento vas cular endotelial (VEGF), que se han utilizado exitosamente en la retinopatía umbral, especialmente localizada en zona I, con menos efectos adversos y mejores resultados oculares a futuro. que la fo tocoagulación con láser. En los últimos años, se han realizado ensayos clínicos con propranolol oral como tratamiento de la RDP, principalmente en la etapa pre-umbral (etapa 2 o 3 en zona II ó III). Este bloqueador beta-adrenérgico puede prevenir la progresión de la retinopatía en RNMBP de etapa pre- umbral a umbral y/o evitar la necesidad de terapias invasivas, como la fotocoagulación con láser o la administración intravítrea de agentes anti-VEGF. La fotocoagulación con láser continúa siendo el tra tamiento de elección en la RDP. Los agentes anti-VEGF y el propranolol oral, evitarían la progresión de esta patología de etapa pre-umbral a umbral, y podrían complementar el tratamiento de la RDP.

Abstract: Retinopathy of Prematurity (ROP) is a proliferative disorder of the blood vessels of the immature retina, which affects mainly very-low-birth-weight infants (VLBW). The objective of this review is to describe to which infant the screening examination of this disease should be performed and to analy ze the recent advances in the treatment of this disease, which have emerged in the last decade. The detection of this disease is mainly focused on VLBW infants and newborns < 32 weeks of gestational age. In addition to laser photocoagulation, standard treatment today, new therapies have appeared, such as the anti-VEGF agents, which have been successfully used in the threshold ROP, especially located in zone I. This therapy is less harmful than laser photocoagulation and with better ocular results in the future. In recent years, oral propranolol has been used as a treatment for ROP in clinical trials, mainly in the pre-threshold stage (stage 2 or 3 in zone II or III). This drug is a beta-adrenergic blocker that can prevent the progression of retinopathy in pre-threshold to threshold stage and/or avoid the need for invasive therapies, such as laser photocoagulation or intravitreal administration of anti-VEGF agents. Laser photocoagulation continues to be the standard treatment for ROP. New treatments have emerged for ROP, such as anti-VEGF agents and oral propranolol, which could pre vent the progression of this disease from the pre-threshold to the threshold stage.

Retinal Toxicity Following the Injection Ganciclovir into Silicone Oil-filled Eye to Treat Acute Retinal Necrosis

PURPOSE: To report a case of retinal toxicity after an intravitreal ganciclovir injection to treat acute retinal necrosis in an eye filled with silicone oil.CASE SUMMARY: A 56-year-old male presented with ocular pain and visual loss in his right eye. His best-corrected visual acuity was 20/25, inflammatory cells in the anterior chamber, multiple retinitis lesions and retinal vessel occlusions in the peripheral retina and vitreous opacity were showed. Acute retinal necrosis was suspected, anterior chamber polymerase chain reaction (PCR) test was done. Aciclovir 2,400 mg/day intravenously and ganciclovir 2.0 mg were administered by intravitreal injection. After 4 days, retinitis was worsened and PCR test was positive for varicella zoster virus. Ganciclovir intravitreal injections were increased twice a week. After 16 days, retinal detachment occurred, so scleral encircling, vitrectomy, laser photocoagulation, and silicone oil tamponade were conducted. Ganciclovir 1.0 mg was injected at the end of surgery. The patient's visual acuity decreased to hand motion, and multiple crystal deposits with multiple retinal hemorrhages were observed in the right eye the next day. Visual acuity did not recover and optical coherent tomography showed that the macula was thinned.CONCLUSIONS: Visual loss seemed to be related with the retinal toxicity of ganciclovir. The increased local concentration due to the silicone oil tamponade is thought to have caused the toxicity.

Transscleral Cyclopexy Using Partial-Thickness Scleral Flap for Repairing Cyclodialysis Cleft: a Case Report

PURPOSE: To report a case of a cyclodialysis cleft that was successfully managed with gonioscopically guided transscleral cyclopexy using partial-thickness scleral flap. CASE SUMMARY: A 44-year-old man complaining of blurred vision in the left eye after blunt trauma was referred to our hospital. The intraocular pressure (IOP) was 4 mmHg and the visual acuity was counting finger. Gonioscopy examination revealed cyclodialysis cleft from 3 to 6 o'clock and fundus examination revealed macular folds. After the failure of conservative medical therapy and laser photocoagulation, gonioscopically guided transscleral cyclopexy using partial-thickness scleral flap was performed. Four months later, the IOP was 18 mmHg, the visual acuity was 0.8, and fundus examination showed the disappearance of the macular folds. CONCLUSIONS: Transscleral cyclopexy using partial-thickness scleral flap is a safe and effective method to treat hypotony maculopathy due to cyclodialysis and to minimize pupil distortion.

Dipeptidyl Peptidase-4 Inhibitors versus Other Antidiabetic Drugs Added to Metformin Monotherapy in Diabetic Retinopathy Progression: A Real World-Based Cohort Study

BACKGROUND: To investigate the effects of dipeptidyl peptidase-4 inhibitor (DPP4i) as add-on medications to metformin on progression of diabetic retinopathy (DR) in patients with type 2 diabetes mellitus, compared with sulfonylurea (SU) or thiazolidinedione (TZD). METHODS: We identified 4,447 patients with DPP4i, 6,136 with SU, and 617 with TZD in addition to metformin therapy from the database of Korean National Health Insurance Service between January 2013 and December 2015. Cox proportional hazards regression models were used to calculate hazard ratios (HRs) for DR progression. The progression of DR was defined by the procedure code of panretinal photocoagulation, intravitreal injection or vitrectomy; or the addition of diagnostic code of vitreous hemorrhage, retinal detachment, or neovascular glaucoma. RESULTS: The age and sex-adjusted HR of DR progression was 0.74 for DPP4i add-on group compared with SU add-on group (95% confidence interval [CI], 0.62 to 0.89). This lower risk of DR progression remained significant after additional adjustments for comorbidities, duration of metformin therapy, intravitreal injections and calendar index year (HR, 0.80; 95% CI, 0.66 to 0.97). CONCLUSION: This population-based cohort study showed that the use of DPP4i as add-on therapy to metformin did not increase the risk of DR progression compared to SU.

Choroidal Effusion after Consecutive General Anesthesia

PURPOSE: To report a case of extensive choroidal effusion following the Valsalva maneuver under consecutive general anesthesia. CASE SUMMARY: A 41-year-old man who underwent panretinal photocoagulation with proliferative diabetic retinopathy had pars plana vitrectomy and endolaser photocoagulation under general anesthesia due to vitreous hemorrhage. Urology cooperated as the patient had hematuria; the day after the operation, he was transferred to the urology department. Two days after vitrectomy, the patient had an urgent transurethral bladder tumor resection under general anesthesia with suspicion of bladder tumor. At 6 days postoperatively, extensive choroidal effusion was observed from 8 to 10 o'clock on fundus examination and ultrasonography. On day 23 after urological surgery, the choroidal effusion had disappeared without treatment. CONCLUSIONS: Consecutive general anesthesia requires caution, as it is not only burdensome to the body as a whole but may also cause choroidal effusion in the eye.

Utilizing a Previous Silicone Band Track in Recurred Retinal Detachment

PURPOSE: We report a case of utilizing a previous silicone band track in the reoperation of scleral encircling. CASE SUMMARY: An 8-year-old male presented with rhegmatogenous retinal detachment in the right eye. Five days after this diagnosis, he received scleral buckling surgery and cryopexy to seal the retinal tear. One month after surgery, a fundus examination showed subretinal fluid at the inferior site of the scleral buckle. He underwent scleral encircling surgery and a cryopexy procedure. The patient has had an uneventful postoperative course, and the retina has remained attached over a follow-up period of 9 months. However, exotropia and hypotropia developed in the right eye. Diagnosis of restrictive strabismus due to tissue adhesion around the silicone band was made. The encircling band was therefore removed and laser photocoagulation was performed 360° around the retina. Twenty-four hours after surgery, a fundus examination showed subretinal fluid. He received 360° scleral encircling surgery not using the 360° conjunctival peritomy. After confirming a previous encircling tract using #0-0 polydioxanone as a guide, #5-0 Nylon was tied to the end of the guide and inserted through the encircling tract with the end sutured with the silicone band. The silicone band was inserted into the encircling tract by pulling the #5-0 Nylon as a guide. Ophthalmoscopy revealed an attached retina with indentation of the scleral buckle at 360°. CONCLUSIONS: For reoperation in patients who previously underwent scleral encircling surgery, using the previous scleral encircling tract may be effective in cases with conjunctival and tissue adhesion.

Central Serous Chorioretinopathy with Peripapillary Retinoschisis

PURPOSE: To report a case of central serous chorioretinopathy with peripapillary retinoschisis. CASE SUMMARY: A 64-year-old male presented with abnormal color vision of the left eye, which occurred 6 months prior to his visit. At the initial visit, a funduscopic examination revealed retinal elevation with suspected serous retinal detachment around the optic disc in the left eye. Spectral domain optical coherence tomography showed subretinal fluid on the nasal side of the optic disc and retinoschisis on the temporal side of the optic disc in the left eye. Fluorescein angiography revealed multiple leakages in the left eye. Indocyanine green angiography revealed choroidal vascular hyperpermeability in both eyes. Based on these results, the patient was diagnosed with chronic central serous chorioretinopathy and was treated with argon laser photocoagulation at the leakage points. After 8 weeks of laser therapy, optical coherence tomography indicated that there was no retinoschisis or subretinal fluid in the macula, nasal, or temporal sides of the optic disc. CONCLUSIONS: Peripapillary retinoschisis due to central serous chorioretinopathy improves with argon laser photocoagulation at leakage sites.

Analysis of Choroidal Thickness and Vascular Density Using Optical Coherence Tomography Angiography after Laser Photocoagulation

PURPOSE: To evaluate the changes in choroidal thickness and superficial vascular density of the macula and optic disc using optical coherence tomography angiography after laser photocoagulation. METHODS: We conducted a retrospective chart review of 25 eyes of diabetic retinopathy patients who underwent panretinal photocoagulation. The macula and optic disc were divided into nine areas, and the vascular density of each area was quantitatively measured using optical coherence tomography angiography. The changes in vascular density and choroidal thickness were analyzed before laser photocoagulation and at 1 week after, 1 month after, and 3 months after treatment. RESULTS: In the panretinal photocoagulation group, the average vascular densities of the macula were 13.5 ± 3.6 mm⁻¹ before treatment, and 14.7 ± 3.1 mm⁻¹ after 1 week, 13.7 ± 2.6 mm⁻¹ after 1 month, and 12.8 ± 3.8 mm⁻¹ after 3 months of treatment. The average vascular densities of the optic disc were 14.7 ± 5.2 mm⁻¹ before treatment, and 14.1 ± 4.7 mm⁻¹ after 1 week, 14.8 ± 5.3 mm⁻¹ after 1 month, and 15.0 ± 4.7 mm⁻¹ after 3 months of treatment. The average subfoveal choroidal thicknesses were 327.5 ± 57.9 µm before treatment, and 334.4 ± 52.5 µm after 1 week, 291.2 ± 52.9 µm after 1 month, and 286.3 ± 44.4 µm after 3 months of treatment. CONCLUSIONS: The vascular density of the macula increased temporarily after 1 week of treatment but decreased afterwards. The vascular density of the optic disc decreased after 1 week of laser treatment but increased over time. The subfoveal choroidal thickness increased after 1 week of laser treatment but decreased afterwards.

Diabetic Nephropathy in Type 2 Diabetic Retinopathy Requiring Panretinal Photocoagulation

PURPOSE: To investigate the risk factors of diabetic nephropathy in patients with diabetic retinopathy requiring panretinal photocoagulation (PRP) and the visual prognosis. METHODS: A retrospective review of electronic medical records was conducted at Seoul St. Mary's Hospital, comprising 103 patients with type 2 diabetes mellitus and diabetic retinopathy who underwent PRP from 1996 to 2005. Patients with type 1 diabetes mellitus, non-diabetic renal disease, non-diabetic retinal disease, visually significant ocular disease, high-risk proliferative diabetic retinopathy, and advanced diabetic retinopathy were excluded. The patients were divided into three groups: no nephropathy (group 1, n = 45), microalbuminuria (group 2, n = 16), and advanced nephropathy (group 3, n = 42). Duration of diagnosis of retinopathy and nephropathy, glycosylated hemoglobin, visual acuity, complications, and treatment history were investigated. RESULTS: The mean glycosylated hemoglobin of group 3 (8.4 ± 1.2) was higher than that of group 1 (7.7 ± 1.0) or group 2 (7.7 ± 1.0) (p = 0.04). Mean interval from PRP to diagnosis of nephropathy was 8.8 ± 6.0 years in group 2 and 8.7 ± 4.9 years in group 3. The significant decrease in visual acuity in group 3 (28 eyes, 35.9%) was significantly higher than that in group 1 (15 eyes, 18.1%, p = 0.01) or group 2 (6 eyes, 20.7%, p = 0.03). Only vitreous hemorrhage showed a significantly higher incidence in groups 2 and 3 than in group 1 (p = 0.02). Multivariate regression analysis revealed that female sex and lower glycosylated hemoglobin were significantly associated with a protective effect on development of nephropathy. CONCLUSIONS: In the clinical setting, many patients with PRP-requiring diabetic retinopathy develop nephropathy an average of 8 to 9 years after PRP. Male sex and higher glycosylated hemoglobin could be risk factors of nephropathy.

Refractive Outcomes of 4-Year-old Children after Intravitreal Anti-vascular Endothelial Growth Factor versus Laser Photocoagulation for Retinopathy of Prematurity

PURPOSE: To compare long-term refractive outcomes associated with intravitreal anti-vascular endothelial growth factor (VEGF) versus laser photocoagulation treatment for retinopathy of prematurity (ROP). METHODS: A total of 52 eyes from 27 ROP patients treated at two tertiary referral-based hospitals from August 2006 to December 2013 were reviewed. The primary outcome was refractive error measured at the age of 4 years, accounting for within-patient inter-eye correlation. Secondary outcomes included the recurrence rate and treatment complications. RESULTS: The mean age at refraction was 4.7 ± 0.3 years in the laser group (n = 30) and 4.4 ± 0.3 years in the anti-VEGF group (n = 22). No significant differences were noted in gestational age, birthweight, post-menstrual age at treatment, or ROP stage/zone distribution between groups. Mean spherical equivalent was also not significantly different (−1.0 diopters in the laser group and −0.3 diopters in the injection group, p = 0.603). Clustered regression analysis revealed that only gestational age was significantly correlated with mean spherical equivalent (p < 0.001; 95% confidence interval, −0.007 to −0.002). Recurrence was noted in four eyes (13.3%) in the laser group, but this difference was not significant (p = 0.128). There were no major systemic complications reported in either group. CONCLUSIONS: Treatment type, whether laser or anti-VEGF injection, does not appear to influence long-term refractive outcomes in ROP. Concern regarding refractive outcomes should not be the most important factor when selecting ROP treatment modality.

Lesões vasculares orais: avaliações clínicas, diagnósticas e terapêuticas / Lesiones vasculares bucales: evaluaciones clínicas, diagnósticas y terapéuticas / Oral vascular lesions: clinical, diagnostic and therapeutic evaluations

Introdução: As patologias vasculares acometem com alta incidência as regiões de cabeça e pescoço. Quando essas acometem a região oral, nota-se predileção por lábios, língua e comissura bucal, com predominância no sexo feminino. Objetivo: Analisar sobre as lesões vasculares orais, enfatizando as características clínicas, métodos de diagnósticos e abordagem terapêutica. Métodos: Trata-se de uma revisão literária, com busca bibliográfica, realizada nas bases de dados eletrônicos PubMED/Medline, Lilacs, Science Direct e SciELO (Scientific Eletronic Library), utilizando os descritores: Hemangioma, Malformações vasculares, escleroterapia e fotocoagulação, em português, inglês e espanhol, obtendo 262 artigos completos, dos quais 18 foram utilizados como base científica apropriada para tal tema, obedecendo aos critérios de inclusão e exclusão. Resultados: As lesões vasculares orais caracterizam-se clinicamente como lesões únicas do tipo nódular ou mancha, cuja coloração varia do vermelho intenso ao roxo e de tamanho variável. Para diagnosticar essas lesões, utilizam-se comumente exames clínicos associados à diascopia, sem na maioria dos casos necessitarem de exames complementares. A intervenção terapêutica justifica-se devido às deformidades estéticas, possíveis sangramentos, ulcerações e infecções. Para tais alterações, existem diversas modalidades terapêuticas, incluindo escleroterapia, crioterapia, remoção cirúrgica e terapia de fotocoagulação a laser. Conclusão: As lesões vasculares orais exibem caracteristicas clinicas peculiares, apresentando-se como nódulos ou manchas, cuja coloração varia do vermelho intenso ao roxo. A diascopia é a manobra semiotécnica mais utilizada e confiável para o estabelecimento do diagnóstico clínico dessas lesões. A utilização de soluções esclerosantes apresenta-se como o tratamento mais descrito na literatura, seguido da fotocoagulação a laser(AU)

Introducción: Las enfermedades vasculares afectan con alta incidencia las regiones de cabeza y cuello. Cuando estas afectan la región bucal, se nota predilección por labios, lengua y comisura bucal, con predominio en el sexo femenino. Objetivo: Analizar sobre las lesiones vasculares bucales, enfatizando en las características clínicas, los métodos de diagnóstico y el enfoque terapéutico. Métodos: Se realizó una revisión bibliográfica en las bases de datos PubMED/Medline, Lilacs, Science Direct e SciELO. Se utilizaron los descriptores hemangioma, malformaciones vasculares, escleroterapia y fotocoagulación, en portugués, inglés y español. Se obtuvieron 262 artículos completos, de los cuales 18 fueron utilizados como base científica apropiada para tal tema, según los criterios de inclusión y exclusión. Resultados: Las lesiones vasculares bucales se caracterizan clínicamente como lesiones únicas del tipo nódular o mancha, cuya coloración varía del rojo intenso al púrpura y de tamaño variable. Para diagnosticar estas lesiones, se utilizan comúnmente exámenes clínicos asociados a la diascopia, sin que en la mayoría de los casos necesiten exámenes complementarios. La intervención terapéutica se justifica debido a las deformidades estéticas, posibles sangrados, ulceraciones e infecciones. Para estas alteraciones existen diversas modalidades terapéuticas, incluyendo escleroterapia, crioterapia, remoción quirúrgica y terapia de fotocoagulación láser. Conclusiones: Las lesiones vasculares bucales muestran características clínicas peculiares, presentándose como nódulos o manchas, cuya coloración varía del rojo intenso al púrpura. La diacopia es la maniobra semiotécnica más utilizada y confiable para el establecimiento del diagnóstico clínico de estas lesiones. El uso de soluciones claras se presenta como el tratamiento más descrito en la literatura, seguido de la fotocoagulación láser(AU)

Introduction: Vascular disorders affect the head and neck regions with high incidence. When they affect the oral region, there is a predilection for lips, tongue and mouth commissure, predominantly in the female. Objective: To analyze oral vascular lesions, emphasizing the clinical characteristics, diagnostic methods and therapeutic approach. Methods: A bibliographic review was carried out in the databases PubMED/Medline, Lilacs, Science Direct andSciELO (Scientific Electronic Library). We used the descriptors hemangioma, vascular malformations, sclerotherapy and photocoagulation, in Portuguese, English and Spanish. We obtained 262 complete articles, of which 18 were used as appropriate scientific basis for this topic, based on the inclusion and exclusion criteria. Results: Oral vascular lesions are clinically characterized as single lesions of the nodes or blotches, whose color varies from deep red to purple and are of variable size. In order to diagnose these lesions, clinical examinations associated with the periodontal disease are commonly used, although in most cases they do not require complementary examinations. The therapeutic intervention is justified due to aesthetic deformities, possible bleeding, ulcerations and infections. For such changes, there are several therapeutic modalities, including sclerotherapy, cryotherapy, surgical removal and laser photocoagulation therapy. Conclusions: Oral vascular lesions show peculiar clinical characteristics, presenting as nodules or spots, whose coloration varies from intense red to purple. Diascopy is the most used and reliable semi-technical method for establishing the clinical diagnosis of these lesions. The use of sclerosing solutions is the most described treatment in the literature, followed by laser photocoagulation(AU)

Coats disease associated with vasoproliferative tumor treated with cryotherapy and intravitreal injections of triamcinolone / Doença de Coats associada a tumor vasoproliferativo tratada com crioterapia e injeções intravítreas de triancinolona

Abstract Report of a case of Coats disease associated with retinal vasoproliferative tumor in a young female patient with two peripheral vascularized tumors and lipid exudation involving the macula and peripapillary region with serous retinal detachment areas and pre-papillary fibrous proliferation. The proposed and performed treatment was the intravitreal injection of triamcinolone acetonide to decrease the tumor exudation, followed by photocoagulation of the peripheral areas of telangiectasia without subretinal fluid and cryotherapy of the tumors. Despite that this is a rare and difficult to treat combination, in this case report, success was obtained in receding the tumor masses and reapplying the retina, leading to anatomic and visual stabilization.

Resumo Relato de um caso de Doença de Coats associada a tumor vasoproliferativo de retina em uma paciente jovem com duas tumorações vascularizadas periféricas e exsudação lipídica acometendo mácula e região peripapilar com áreas de descolamento de retina seroso e proliferação fibrosa pré-papilar. O tratamento proposto e realizado foi a injeção intra-vítrea de triancinolona para diminuir a exsudação do tumor, seguida de fotocoagulação periférica das áreas de telangiectasia sem fluido subretiniano e criocoagulação dos tumores. Apesar de se tratar de uma associação rara e de difícil tratamento, neste relato de caso, obteve-se êxito em regredir as massas tumorais e reaplicar a retina, levando à estabilização anatômica e visual.

Quiste óseo aneurismático en el húmero distal. Reporte de un caso y tratamiento actual / Aneurysmal bone cyst in distal humerus. Case report and current treatment

El quiste óseo aneurismático es una lesión ósea benigna que se presenta a edad temprana; su comportamiento suele ser agresivo por lo cual, la resección quirúrgica y la prevención de su recidiva son los pilares fundamentales de el tratamiento. Presentamos el caso de una paciente de 6 años de edad residente en Gualaceo, Ecuador, con masa de crecimiento progresivo y deformante en el codo izquierdo. Por las características de los exámenes de imagen y el cuadro sintomático se dignostica quiste óseo aneurismático que fue tratado con cirugía de resección intralesional y terapia adyuvante (fresado de alta velocidad, coagulación térmica y crioterapia). Se confirmó el diagnostico mediante el estudio histopatológico posquirúrgico

The aneurysmal bone cyst is a benign osseous lesion of presentation at an early age whose behavior is usually aggressive, so its surgical resection and the prevention of its recurrence is the fundamental pillar for the treatment. We present the case of a girl of 6 years of age living in Gualaceo, Ecuador, with a mass of progressive and deforming growth in the left elbow. By characteristics in the imaging tests and clinical picture it was considered as an aneurysmal bone cyst which was treated with intralesional resection surgery and adjuvant therapy (high speed burr, thermal coagulation and cryotherapy). The diagnosis was confirmed with postoperative histopathological study

Hallazgos en el fondo de ojo de boxeadores cubanos activos asintomáticos / Funduscopy findings in Cuban active asymptomatic boxers

Objetivo: determinar los hallazgos del fondo de ojo en los boxeadores cubanos activos asintomáticos en dos grupos de estudio. Métodos: se efectuó un estudio observacional descriptivo y transversal en los boxeadores de la preselección nacional de boxeo, a quienes se les realizó un fondo de ojo anual, con pupila dilatada y oftalmoscopia binocular indirecta con depresión escleral, en el Servicio de Vítreo-Retina del Instituto Cubano de Oftalmología "Ramón Pando Ferrer". Se tomaron dos grupos, el primero comprendido entre los años 1995 y 2000 (115) y el segundo grupo después de formar parte de la franquicia de los domadores de Cuba en los años 2015 - 2016 (38), donde se realizaron cambios en el estilo de la competencia. Resultados: en los dos grupos estudiados la agudeza visual sin corrección fue mayor de 0,8. En ambos grupos se observó un aumento de la visibilidad de las fibras a nivel del vítreo periférico. Más de la mitad de los ojos de los atletas tenían una retina normal. El desprendimiento de retina se presentó en 1,3 y 2,6 por ciento, respectivamente. Existían lesiones en la retina periférica pero la frecuencia fue baja. No existieron diferencias significativas en ambos grupos. El tratamiento más frecuente realizado en los ojos con lesiones retinales en los dos grupos fue la fotocoagulación focal con láser de argón. Conclusiones: el chequeo anual oftalmológico de los boxeadores garantiza un diagnóstico precoz y un tratamiento oportuno profiláctico o quirúrgico. Así se alarga la vida profesional activa de los boxeadores y se mantiene una buena calidad de vida al concluir su vida deportiva(AU)

Objective: determine funduscopy findings in Cuban active asymptomatic boxers from two study groups. Methods: across-sectional observational descriptive study was conducted with boxers from the national boxing trial team, who underwent annual funduscopy with dilated pupils and indirect binocular ophthalmoscopy with scleral depression at the Vitreous-Retina Service of Ramón Pando Ferrer Cuban Institute of Ophthalmology. Two groups were formed: one corresponding to the period 1995-2000 (115) and the other after being part of the Cuban Domadores (Tamers) team in 2015-2016 (38), when changes were made to competition styles. Results: in the two groups studied, uncorrected visual acuity was above 0.8. In both an increase was observed in the visibility of peripheral vitreous fibers. More than half of the athletes' eyes had a normal retina. Retinal detachment was present in 1.3 percent and 2.6 percent, respectively. There were lesions on the peripheral retina, but their frequency was low. No significant differences were found in the groups. The most common treatment indicated in the two groups for eyes with retinal lesions was argon laser focal photocoagulation. Conclusions: annual ophthalmological examination of boxers ensures early diagnosis and timely prophylactic or surgical treatment with the purpose of lengthening their active professional life and maintaining a good quality of life upon retirement(AU)

Fetoscopic laser photocoagulation for twin-to-twin transfusion syndrome treatment: initial experience in tertiary reference center in Brazil

OBJECTIVE: To evaluate the initial maternal and perinatal outcomes of fetoscopic laser photocoagulation for the treatment of twin-to-twin transfusion syndrome (TTTS) in a referral center in Brazil. METHODS: This prospective observational study analyzed 24 fetoscopic laser photocoagulation procedures at 18–26 weeks of gestation. TTTS severity was determined using the Quintero classification. Blood vessels that crossed the interamniotic membrane were nonselectively photocoagulated. The χ2 test and Mann-Whitney U test were used for the statistical analysis. RESULTS: The mean (±standard deviation) age of pregnant women, gestational age at surgery, surgical time, gestational age at birth, and newborn weight were 32.2±4.1 years, 20.7±2.9 weeks, 51.8±16.7 minutes, 30.5±4.1 weeks, and 1,531.0±773.1 g, respectively. Using the Quintero classification, there was a higher percentage of cases in stage III (54.2%), followed by stages IV (20.8%), II (16.7%), and I (8.3%). Ten (41.7%) donor fetuses died and 14 (58.3%) donor fetuses survived until the end of gestation. Placental insertion location (anterior vs. posterior) did not affect the incidence of iatrogenic septostomy, surface bleeding, and premature rupture of membranes until the end of gestation. The death rate of donor and recipient fetuses before 24th gestational week increased with severity of TTTS. CONCLUSION: The maternal and perinatal outcomes resulting from the implementation of a new minimally invasive surgical technique are in line with those obtained in major centers worldwide, considering the learning curves and infrastructures.

Poor Prognosis in Idiopathic Thrombocytopenic Purpura-associated Retinopathy

PURPOSE: To report a case of retinopathy in a patient with chronically resistant idiopathic thrombocytopenic purpura (ITP) associated with a poor prognosis. CASE SUMMARY: A 52-year-old female presented with a complaint of decreased visual acuity, which was 0.63 in both eyes. The patient had received a splenectomy, was receiving systemic treatment for chronic ITP, and had a history of diabetes mellitus and hypertension. Multiple retinal and subretinal hemorrhages and Roth spots were found on fundus examination. Fluorescein angiography revealed microaneurysms and hemorrhages in all four quadrants of the retina. The patient's platelet count was 38,000/µL. The patient was diagnosed with non-proliferative diabetic retinopathy and ITP-associated retinopathy, and underwent panretinal photocoagulation. Sudden visual loss was noted 4 months later, at which time the patient's visual acuity was 0.1 in both eyes, and her platelet count was 7,000/µL. For 2 years, the patient's platelet count was not controlled, and remained between 12,000–19,000/µL despite active medical treatment. Macular edema did not improve with intravitreal triamcinolone, dexamethasone, and bevacizumab. Retinal hemorrhages were not absorbed and visual acuity decreased to light perception in the right eye and counting fingers in the left eye. CONCLUSIONS: ITP-associated retinopathy was associated with a poor prognosis when the systemic disease was not controlled.