Evolution of optic nerve and retina alterations in a child with indirect traumatic neuropathy as assessed by optical coherence tomography / Evolução das alterações no nervo óptico e na retina em criança com neuropatia traumática indireta avaliadas com tomografia de coerência óptica

ABSTRACT Herein, we describe the case of a 4-year-old child with indirect traumatic optic neuropathy and serial changes of the optic nerve head and retinal nerve fiber layer (RNFL) documented using optical coherence tomography (OCT). Visual acuity improved despite progressive RNFL thinning and optic disc pallor. We concluded that OCT may be useful for monitoring axonal loss but may not predict the final visual outcome.

RESUMO Descrição do caso de uma criança de 4 anos de idade com neuropatia óptica traumática indireta, cujas alterações no nervo óptico e na camada de fibras nervosas da retina foram documentadas com tomografia de coerência óptica seriadas. A acuidade visual apresentou melhora apesar da diminuição progressiva da camada de fibras nervosas e da palidez do disco óptico. Em conclusão, a tomografia de coerência óptica pode ser útil para monitorar a perda axonal na neuropatia óptica traumática indireta, sem no entanto, predizer o desfecho visual.

Um novo olhar da retinopatia hipertensiva: a aplicação prática de novas tecnologias / A new look at hypertensive retinopathy: the practical application of new technologies

O exame de fundo de olho tem importância histórica e mantém sua relevância nos dias atuais, por possibilitar de maneira não invasiva, observar e avaliar o “interior” do corpo humano, além de ser um importante marcador de lesão de órgão-alvo em hipertensos. O surgimento de tecnologias de aquisição de imagens digitais permitiu acessar o fundo de olho de maneira mais simples, com grande definição, muitas vezes não necessitando dilatação da pupila. Isso tornou a observação do fundo de olho, que outrora era realizada apenas por pessoas com treinamento especial, fosse feita com extrema facilidade e quase sem treinamento. Estas “facilidades” permitiram que inúmeros artigos científicos fossem realizados, estabelecendo características do fundo de olho como relevante marcador de lesão de órgão-alvo em hipertensos. A incorporação de tecnologias virtuais na prática da medicina facilitará o acesso dos pacientes, reduzirá custos e certamente irá revolucionar a relação médico-paciente nos próximos anos.

Eye fundus examination is of historical importance, and maintains its relevance nowadays, by enabling non-intrusive observation and evaluation “inside” the human body, as well as being an important marker of target organ damage in hypertensive patients. The emergence of technologies for digital image acquisition have enabled easier access to the eye fundus, with greater definition, and often without having to dilate the pupil. As a result, eye fundusexamination, once carried out only by people with special training, is now performed with extreme ease and almost no training. These “facilities” have led to numerous scientific articles, establishing the characteristics of the eye fundus as a relevant marker of target organ damage in hypertensive patients. The incorporation of virtual technologies into the practiceof medicine will facilitate patient access, reduce costs, and without doubt, revolutionize the doctor-patient relationship in the coming years.

Fundus autofluorescence in blunt ocular trauma / Autofluorescência do fundo de olho no trauma ocular contuso

Purpose: To describe the findings of fundus autofluorescence (FAF) imaging in patients with blunt ocular trauma. Methods: In this non-interventional retrospective study, we reviewed medical records and imaging examination results. The data analyzed included gender, age, laterality, trauma etiology, time between trauma and imaging, visual acuity, changes in the retinal periphery, fundus examination results, and FAF imaging findings. FAF imaging was performed using a Topcon TRC-50DX Retinal Camera (Tokyo, Japan). Results: Eight eyes from 8 patients were studied. The mean age was 27.6 years (range, 19-43 years). Men (n=7) were more frequently affected by blunt ocular trauma than women (n=1). Physical aggression was the most common trauma etiology (n=3), followed by accidents with fireworks (n=2). Other causes were car accidents (n=1), occupational trauma caused by a grinder (n=1), or being hit by a stone (n=1). Visual acuity ranged from 20/80 to light perception. Traumatic pigment epitheliopathy (TPE) was identified in 5 cases, choroidal rupture in 3 cases, subretinal hemorrhage in 3 cases, and Purtscher's retinopathy in 1 case. Hypoautofluorescence was observed in cases of choroidal rupture, recent subretinal hemorrhage, and intraretinal hemorrhage, and in two cases of TPE. Hyperautofluorescence was observed in cases of old subretinal hemorrhage and at the edge of the lesion in two cases of choroidal rupture. Mild hyperautofluorescence was observed in the posterior pole in Purtscher's retinopathy. Three cases of TPE exhibited hypoautofluorescence with diffuse hyperautofluorescent areas. Conclusion: FAF imaging is a non-invasive method for assessing changes in the posterior segment of the eye resulting from blunt ocular trauma. Furthermore, this technique provides valuable information. We described the findings of FAF imaging in cases of TPE, choroidal rupture, subretinal hemorrhage, and Purtscher's retinopathy. .

Objetivo: Descrever os achados do exame de autofluorescência do fundo de olho (AFF) em pacientes vítimas de trauma ocular contuso. Métodos: Estudo retrospectivo, não intervencionista, realizado através da revisão de prontuários e exames de imagem. Os dados analisados foram: sexo, idade, lateralidade, etiologia do trauma, tempo decorrente entre o trauma e a realização do exame, acuidade visual, alterações na periferia da retina, diagnóstico fundoscópico e achados ao exame de AFF (realizada no aparelho Topcon TRC-50DX Retinal Camera). Resultados: Oito olhos de 8 pacientes foram estudados. A idade média foi de 27,6 anos (de 19 a 43 anos), o sexo masculino (n=7) foi mais acometido do que o feminino (n=1), agressão física foi a etiologia mais comum do trauma (n=3), seguido de acidente com fogos de artifício (n=2). Outras causas foram acidente automobilístico (n=1), trauma ocupacional com lixadeira (n=1) e pedrada (n=1). A acuidade visual variou de 20/80 a percepção luminosa. Epiteliopatia pigmentar traumática (EPT ) foi identificada em 5 casos, rotura de coroide em 3, hemorragia subretiniana em 3 e retinopatia de Purtscher em 1 caso. Hipoautofluorescência foi observada nos casos de rotura de coroide, hemorragia subretiniana recente, hemorragia intrarretiniana e em 2 casos de EPT. Hiperautofluorescência foi visualizada nos casos de hemorragia subretiniana em degradação, na borda de 2 casos de roturas de coroide e discretamente no polo posterior na retinopatia de Purtcher. Três casos de EPT apresentaram hipoautofluorescência com pontos hiperautofluorescentes difusos. Conclusão: O exame de AFF permite avaliar as alterações do segmento posterior do olho decorrentes do trauma ocular contuso de forma não invasiva, somando informações valiosas. Foram descritos achados do exame ...

Functional impairment with minimal macular damage in femtosecond laser plasma injury: case report / Comprometimento funcional com dano macular mínimo em lesão com plasma de laser de femtosegundo: relato de caso

A 26 years old female patient was examined twenty-four hours after observing laser-induced plasma formation in a process of nanoparticle production complaining of bilateral central scotoma. The ophthalmologic evaluation included dilated fundus observation, fluorescein angiography, and optical coherence tomography (OCT). In the first assessment, visual acuity was 20/20 in the right eye and 20/25 in the left eye. Ophthalmologic evaluation revealed colour changes in the macular region of both eyes. Optical coherence tomography showed a central interruption of the photoreceptor layer in both eyes and fluorescein angiography was normal. In subsequent appointments acuity was always 20/20 in both eyes. Abnormal optical coherence tomography findings disappeared in less than 5 months, but subjective complaints of scotoma in the left eye remained. Extra care must be taken in this type of experiment by, for example, reducing the time that the retina is directly exposed to the plasma radiation.

Uma paciente de 26 anos foi examinada 24 horas após observar a formação de plasma induzido por laser em um processo de produção de nanopartículas, referindo escotoma central bilateral. A avaliação oftalmológica incluiu observação dilatada da retina, angiofluoresceinografia e tomografia de coerência óptica (OCT). Na primeira avaliação, a acuidade de 20/20 no olho direito e 20/25 no olho esquerdo. A avaliação oftalmológica revelou mudanças de coloração da região macular de ambos os olhos. A tomografia de coerência óptica mostrou uma interrupção central da camada de fotorreceptores em ambos os olhos, e a angiografia fluoresceínica foi normal. Nas consultas subsequentes a acuidade sempre foi 20/20 em ambos os olhos. Os achados da tomografia de coerência óptica anormais desapareceram em menos de cinco meses, mas as queixas subjetivas de escotoma no olho esquerdo permaneceram. Cuidado extra deve ser tomado para este tipo de experiência, por exemplo, reduzindo o tempo em que a retina é diretamente exposta à radiação de plasma.

Light-induced retinal injury enhanced neurotrophins secretion and neurotrophic effect of mesenchymal stem cells in vitro / Lesão de retina induzida por luz aumentou a secreção de neurotrofinas e o efeito neurotrófico das células primordiais mesenquimais in vitro

PURPOSE: To investigate neurotrophins expression and neurotrophic effect change in mesenchymal stem cells (MSCs) under different types of stimulation. METHODS: Rats were exposed in 10,000 lux white light to develop light-induced retinal injury. Supernatants of homogenized retina (SHR), either from normal or light-injured retina, were used to stimulate MSCs. Quantitative real time for polymerase chain reaction (RT-PCR) and enzyme-linked immunosorbent assay (ELISA) were conducted for analysis the expression change in basic fibroblast growth factor (bFGF), brain-derived neurotrophic factor (BDNF) and ciliary neurotrophic factor (CNTF) in MSCs after stimulation. Conditioned medium from SHR-stimulated MSCs and control MSCs were collected for evaluation their effect on retinal explants. RESULTS: Supernatants of homogenized retina from light-injured rats significantly promoted neurotrophins secretion from MSCs (p<0.01). Conditioned medium from mesenchymal stem cells stimulated by light-injured SHR significantly reduced DNA fragmentation (p<0.01), up-regulated bcl-2 (p<0.01) and down-regulated bax (p<0.01) in retinal explants, displaying enhanced protective effect. CONCLUSIONS: Light-induced retinal injury is able to enhance neurotrophins secretion from mesenchymal stem cells and promote the neurotrophic effect of mesenchymal stem cells.

OBJETIVO: Investigar a expressão de neurotrofinas e mudança no efeito neurotrófico de células-tronco mesenquimais (MSCs) sob diferentes tipos de estimulação. MÉTODOS: Os ratos foram expostos em 10.000 lux de luz branca para desenvolver a lesão da retina induzida por luz. Os sobrenadantes de homogeneizado de retina (SHR) quer a partir de retina normal ou da lesada por luz, foram usados para estimular as células-tronco mesenquimais. O RT-PCR quantitativa e ELISA foram realizados para análise da alteração de expressão do fator básico de crescimento de fibroblastos (bFGF), do fator neurotrófico derivado do cérebro (BDNF) e do fator neurotrófico ciliar (CNTF) em MSCs após a estimulação. O meio condicionado de células-tronco mesenquimais estimuladas por SHR e controles foram coletadas para avaliação de seu efeito sobre os explantes de retina. RESULTADOS: SHR de retinas de rato lesadas por luz promoveram aumento significativo de secreção de neurotrofinas em MSCs (p<0,01). O meio condicionado de SHR lesado por luz reduziu significativamente a fragmentação do DNA de MSCs (p<0,01), elevação de Bcl-2 (p<0,01) e redução de bax (p<0,01) em explantes de retina, mostrando um aumento do efeito protetor. CONCLUSÕES: A lesão da retina induzidos pela luz é capaz de aumentar a secreção de neurotrofinas e promover o efeito neurotrófico de células-tronco mesenquimais.

Complimentary imaging technologies in blunt ocular trauma

We describe complimentary imaging technologies in traumatic chorioretinal injury. Color and fundus autofluorescence [FAF] images were obtained with a non-mydriatic retinal camera. Optical coherence tomography [OCT] helped obtain detailed images of retinal structure. Microperimetry was used to evaluate the visual function. A 40-year-old man sustained blunt ocular trauma with a stone. Color fundus image showed a large chorioretinal scar in the macula. Software filters allowed detailed illustration of extensive macular fibrosis. A 58-year-old man presented with blunt force trauma with a tennis ball. Color fundus imaging showed a crescentric area of macular choroidal rupture with fibrosis. FAF imaging delineated an area of hypofluorescence greater on fundus imaging. OCT showed chorioretinal atrophy in the macula. Microperimetry delineated an absolute scotoma with no response to maximal stimuli. Fundus imaging with digital filters and FAF illustrated the full extent of chorioretinal injury, while OCT and microperimetry corroborated the structure and function correlations.

Modulation of Retinal Wound Healing by Systemically Administered Bone Marrow-Derived Mesenchymal Stem Cells

PURPOSE: To evaluate whether systemically injected bone marrow-derived mesenchymal stem cells (MSCs) can be incorporated into neuroretinal tissues and play an important role in retinal wound healing in the laser-induced retinal trauma model. METHODS: Retinotomies were made by applying an Nd:YAG laser to rat retina. On the first day after the injuries, cell suspensions that were obtained from the same line of rat (containing 1 x 10(6) green fluorescence protein [GFP]-marked bone marrow-derived MSCs) were injected through a tail vein in the experimental group and phosphate buffer solution (PBS) was injected in the same way in the control group. Fundus photographs were taken serially for fundus examination and eyeballs were enucleated for histological studies that were conducted at five and seven weeks after MSC and PBS injection. After the tissues were prepared, the retinotomy sites were observed with routine histological staining and confocal microscopy. RESULTS: Retinal detachment resolved in the experimental group, whereas it progressed in the control group. The retinotomy sites closed partially with identifiable GFP positive cells 5 weeks after MSC injection. At 7 weeks after MSC injection, complete healing without retinal detachment and plentiful GFP positive cells were observed at the transitional zone between damaged and normal retina. CONCLUSIONS: Systemically administered GFP-marked MSCs may be incorporated into the neuroretinal tissues and play an important role in the wound modulation of physically damaged retinal tissues.

Padronização do eletrorretinograma de campo total em cães / Full field electrorretinogram standartization in dogs

Eletrorretinograma (ERG) é o meio diagnóstico objetivo e não-invasivo para avaliar a função retiniana e detectar precocemente, em várias espécies, lesões nas suas camadas mais externas. As indicações mais comuns para ERG em cães são: avaliação pré-cirúrgica de pacientes com catarata, caracterização de distúrbios que causam cegueira, além de servir como importante modelo para o estudo da distrofia retiniana que acomete o homem. Vários são os fatores que podem alterar o ERG tais como: eletrorretinógrafo, fonte de estimulação luminosa, tipo do eletrodo, tempo de adaptação ao escuro, tamanho pupilar, opacidade de meios e protocolo de sedação ou anestesia; além da espécie, raça e idade. Objetivou-se com este estudo padronizar o ERG para cães submetidos à sedação, seguindo o protocolo da International Society for Clinical Electrophysiology of Vision (ISCEV), utilizando Ganzfeld e eletrodos Burian Allen. Foram realizados 233 eletrorretinogramas em cães, 147 fêmeas e 86 machos, com idades entre um e 14 anos. Dos 233 cães examinados, 100 apresentavam catarata em diferentes estágios de maturação, 72 eram diabéticos e apresentavam catarata madura ou hipermadura, 26 apresentaram eletrorretinograma compatível com degeneração retiniana progressiva, três apresentaram eletrorretinograma compatível com síndrome da degeneração retiniana adquirida subitamente e 32 não apresentaram lesão retiniana capaz de atenuar as respostas do ERG, sendo considerados normais quanto à função retiniana. A sedação foi capaz de produzir boa imobilização do paciente sem rotacionar o bulbo ocular, permitindo adequada estimulação retiniana bilateralmente, com auxílio do Ganzfeld. O sistema eletrodiagnóstico Veris registrou com sucesso e simultaneamente de ambos os olhos, as cinco respostas preconizadas pela ISCEV. Como o ERG de campo total tornou-se exame fundamental na rotina oftalmológica, sua padronização é indispensável quando se objetiva comparar resultados de laboratórios distintos...

Electroretinogram (ERG) is an objective non invasive diagnostic method to evaluate retinal function which permits the early detection of lesions at retinal external layers, even before the appearance of clinical signs. In dogs, ERG is mostly utilized for preoperative evaluation in patients presenting cataracts; characterization of disturbances causing blindness, among the utilization of dogs as animal models in scientific research. Several factors interfere in ERG responses, such as the ERG machine, light stimulation, electrode, time spent on dark adaptation, pupil size, means opacity, sedation or anesthetization, species, breed and age. The purpose of this study was to standardize the full field ERG in sedated dogs, according to the International Society for Clinical Electrophysiology of Vision (ISCEV) protocol, using Ganzfeld and bipolar electrodes. Two hundred thirty threes ERGs were performed in 147 female and 86 male with ages from 1 to 14 years old. Among those 233 dogs, 100 presented cataracts in different stages of maturation, 72 were diabetic and presented mature or hypermature cataracts, 26 presented ERG compatible to progressive retinal degeneration, 3 presented ERG compatible to sudden acquired retinal degeneration syndrome; for 32 dogs no abnormal ERG was registered and they were considered as having normal retinal function. Sedation was capable to induce a good immobilization with no bulb rotation, resulting uniform retinal stimulation, using Ganzfeld. Veris system successfully registered all 5 ISCEV responses, simultaneously from both eyes, at the same time. Full field ERG became a fundamental ophthalmic exam, then, its standardization is mandatory to allow comparison between ERGs from different laboratories. The reliability and reproducibility of this protocol has shown very good responses, using ISCEV protocol, Veris system, Ganzfeld and Burian Allen electrodes in sedated dogs.

Características del trauma ocular asociadas con la necesidad de cirugía retiniana de urgencia / Ocular trauma characteristics associated with urgent retinal surgery

Objetivo: Identificar las características del sistema de clasificación de lesiones mecánicas oculares más frecuentes en ojos que requieren cirugía retiniana de urgencia y evaluar su valor predictivo, para determinar su utilidad en el pronóstico temprano. Material y métodos: Se evaluaron retrospectivamente pacientes atendidos entre 1998 y 2007 y se asignaron a uno de dos grupos: 1 (con lesiones que requerían cirugía retiniana de urgencia) y 2 (sin ellas). Se determinó la proporción e intervalos de confianza (IC) de 95 % que representaba el grupo 1; se identificaron las características más frecuentes en el grupo 1 y su proporción se comparó con la del grupo 2 mediante χ2 y razón de momios. Se determinaron los valores predictivos de cada característica para identificar al grupo 1. Resultados: 238 ojos, edad promedio de los pacientes de 27.5 años; 10 ojos se asignaron al grupo 1 (4.2 %, IC 95 % = 1.65-6.75) y 228 al 2. Las características más frecuentes del grupo 1 fueron globo abierto (90 %), tipo A abierto (50 %), tipo C abierto (30 %), grado 4 (70 %) y zona III (70 %). El valor predictivo positivo fue de 60 % para trauma abierto tipo C, y menor a 50 % en el resto de las características. Conclusiones: Aunque existieron características asociadas significativamente con la necesidad de cirugía retiniana de urgencia, su valor predictivo fue insuficiente por la baja proporción de ojos que requería esta intervención, por lo que se sugiere utilizar como parámetro de referencia al globo abierto o la pérdida visual, independientemente de las lesiones existentes.

BACKGROUND: The most common features of the system for classifying ocular injuries of the eye in patients who require urgent retinal surgery were identified, and their predictive value was estimated in order to determine whether they are useful in detecting these patients. METHODS: Patients with ocular trauma between 1998 and 2007 were retrospectively evaluated and assigned to one of two groups: group 1 (with injuries that required urgent retinal surgery) and group 2 (without those injuries). The rate and 95% confidence intervals (CI) that group 1 accounted for were identified. The rate of the most common features in group 1 was identified and compared with their rate in group 2 using chi(2) and odds ratio. Predictive values of those features for detecting group 1 were calculated. RESULTS: Two hundred thirty eight eyes (mean age: 27.5 years) were included. Ten eyes were assigned to group 1 (4.2%, 95% CI 1.6-6.7) and 228 eyes were assigned to group 2. The most frequent features in group 1 were open globe (90%), type A open globe (50%), type C open globe (30%), grade 4 (70%) and zone III (70%). The positive predictive value was 60% for type C open globe, and <50% for the remaining features. CONCLUSIONS: Although some clinical features had a statistical and clinical association with the need for urgent retinal surgery, their predictive value was insufficient because the rate of eyes that required this intervention was low. The results suggest that open globe and visual loss should be used as referral criteria, regardless of the injuries found.

Estudo experimental da inibição da proliferação vitreorretiniana pelo uso da hiperecina / Experimental study of vitreoretinal proliferation inhibition by the use of hypericin

OBJETIVOS: Induzir a produção de membranas vitreorretinianas em modelo de trauma ocular animal. Avaliar a inibição do desenvolvimento da proliferação vitreorretiniana (PVR) com o uso de hiperecina. MÉTODOS: Estudo Experimental. Foram utilizados 19 coelhos machos pigmentados adultos com peso entre 2.000 e 3.000 gramas. Todos submetidos a modelo de trauma com dispase associada à diatermia da retina para indução de membranas de PVR. Separados randomicamente para receberem hiperecina (10 µM em 0,1 ml) ou solução salina (0,1 ml) como placebo. Avaliados clinicamente no sétimo, décimo quarto, vigésimo primeiro e vigésimo oitavo dias de pós-operatório com oftalmoscopia indireta e retinografia colorida digitalizada. O grau de PVR foi classificado em estágios (de 0 a 7) segundo Hida e colaboradores. RESULTADOS: A formação de membranas esteve presente em 79 por cento dos olhos, sendo 100 por cento nos olhos do grupo placebo e 60 por cento nos olhos do grupo tratamento (hiperecina). A comparação entre as médias dos estágios de PVR entre os grupos mostrou diferença estatisticamente significativa, com valor p=0,0321 pelo teste Wilcoxon. CONCLUSÕES: O modelo de trauma com uso de dispase e diatermia da retina produz membranas vitreorretinianas. A hiperecina mostrou-se eficaz na diminuição do aparecimento e progressão do PVR.

PURPOSE: To produce proliferative vitreoretinopathy (PVR) in an animal ocular trauma model. To evaluate the inhibition of (PVR) emergence and progression by hypericin. METHODS: Experimental Study. Nineteen pigmented male adult rabbits weighing between 2,000 and 3,000 grams were used in this study. All of them were submitted to trauma model with dispase and retinal diathermy to induce PVR membranes formation. They were randomly assigned to receive hypericin (10 µM in 0.1 ml) or saline solution (0.1 ml) as placebo. They were evaluated clinically in the seventh, fourteenth, twenty-first and twenty-eighth postoperative days with indirect ophthalmoscopy and digital color retinography. The PVR degree was classified according to Hida (0 to 7). RESULTS: Membranes formation was present in 79 percent of the eyes; being 100 percent in the eyes of placebo group and 60 percent in the eyes of treatment group (hypericin). The comparison between PVR phases averages within the groups showed a statistically significant difference between the two groups, with a p value of 0.0321 for Wilcoxon test. CONCLUSIONS: The trauma model with dispase and retinal diathermy produces vitreoretinal membranes. Hypericin was considered effective in PVR emergence and progression decrease.

Sistemas de análisis digital de imágenes en el glaucoma / Systems of imaging digital systems in case of glaucoma

A la luz del desarrollo tecnológico actual incorporado a la Oftalmología, no se concibe el seguimiento riguroso del Glaucoma sin el uso de los sistemas de análisis digital de imágenes de la papila y de la capa de fibras neurorretinianas. Se realiza una revisión bibliográfica sobre los aportes de la Polarimetría Láser de Barrido (GDx VCC, Carl Zeiss Meditec, Dublin, CA), la Tomografia Confocal Láser (Heidelberg Retina Tomograph HRT, Heidelberg Engineering Inc.) y la Meditec, Alemania) en el diagnóstico y seguimiento del Glaucoma. Se considera que las mensuraciones objetivas brindadas deben ser incorporadas de forma eficiente e intuitiva para sacarles el máximo de provecho en beneficio de los pacientes.

Now a day we can´t consider the strict follow up in Glaucoma without the use of the digital analysis of image system of the optic nerve head and the retinal nerve fiber layer. This is a review about some contributions of Scanning Laser Polarimetry (GDx VCC, Carl Zeiss Meditec, Dublin, CA), Confocal Scanning Laser (Heidelberg Retina Tomograph HRT, Heidelberg Engineering Inc.) and Optical Coherence Tomography (Stratus OCT, Carl Zeiss Meditec, Alemania) in the diagnosis and follow up of Glaucoma. It´s considered that objective measurement giving by them must be incorporate in the rigorous analysis of each glaucomatous patient.

Retinal incorporation and differentiation of mesenchymal stem cells intravitreally injected in the injured retina of rats / Incorporação e diferenciação retiniana de células tronco mesenquimais intravítreas em ratos

PURPOSE: To evaluate the pattern of retinal integration and differentiation of mesenchymal stem cells (MSCs) injected into the vitreous cavity of rat eyes with retinal injury. METHODS: Adult rat retinas were submitted to laser damage followed by transplantation of DAPI-labeled BM-MSCs grafts. To assess the integration and differentiation of BM-MSCs in laser-injured retina, host retinas were evaluated 2.4 and 8 weeks after injury/transplantation. RESULTS: Our results demonstrated that the grafted cells survived in the retina for at least 8 weeks and almost all BM-MSCs migrated and incorporated into the neural retina, specifically in the outer nuclear layer (ONL), inner nuclear layer (INL) and ganglion cell layer (GCL) while a subset of grafted cells were found in the subretinal space posttransplantation. At 8 weeks immunohistochemical analysis with several retinal specific markers revealed that the majority of the grafted cells expressed rhodopsin, a rod photoreceptor marker, followed by parvalbumin, a marker for bipolar and amacrine cells. A few subsets of cells were able to express a glial marker, glial fibrillary acidic protein. However, grafted cells failed to express pan-cytokeratin, a retinal pigment epithelium marker. CONCLUSIONS: These results suggest the potential of BM-MSCs to differentiate into retinal neurons. Taken together, these findings might be clinically relevant for future mesenchymal stem cell therapy studies concerning retinal degeneration repair.

OBJETIVO: Avaliar o padrão de integração e diferenciação retiniana de células tronco mesenquimais (CTM) injetadas na cavidade vítrea de ratos portadores de lesões retinianas. MÉTODOS: Ratos Wistar adultos foram submetidos a múltiplas lesões retinianas utilizando-se YAG laser e injeção intravítrea de células tronco mesenquimais. A fim de se avaliar a integração e diferenciação retiniana, o tecido retiniano lesado pelo YAG laser / tratado pelas células tronco, foi avaliado 2, 4 e 8 semanas após a lesão. RESULTADOS: As células injetadas na cavidade vítrea sobreviveram na retina por pelo menos 8 semanas e quase todas células tronco mesenquimais migraram e incorporaram-se na retina neural, especificamente nas camadas nucleares externa e interna e camada de células ganglionares. Uma pequena quantidade de células foi encontrada no espaço sub-retiniano. A análise imuno-histoquímica de 8 semanas mostrou que a maioria das células injetadas expressou rodopsina (marcador para fotorreceptores), parvalbumina (marcador para células bipolares e amácrinas), GFAP (marcador de células gliais). As células injetadas não expressaram a pancitoqueratina, que é a marcadora de células do epitélio pigmentar da retina. CONCLUSÕES: Ocorre aparente diferenciação e incorporação de células tronco mesenquimais na retina de ratos após injeção intravitrea destas células.

Estudo experimental da aplicação retiniana do laser infravermelho via transescleral sob condições de baixa visibilidade / Transscleral infrared laser retinal photocoagulation experimental study under low visibility conditions

OBJETIVOS: Pesquisa experimental, com laser de diodo infravermelho, para estimar a segurança, a reprodutibilidade e a permeabilidade da parede ocular à sua atuação clínica, quando aplicado via transescleral, em condições de baixa visibilidade. MÉTODOS: Submetemos olhos de coelhos pigmentados da raça Nova Zelândia à fotocoagulação retiniana por laser de diodo infravermelho. No olho direito, realizamos fotocoagulação via transescleral sob parâmetros de potência e tempo pré-determinados clinicamente. No olho esquerdo, foram repetidos os mesmos valores da potência e tempo usados no olho direito, desta vez, via transpupilar. Imediatamente e após 2 meses, estudos clínicos baseados na retinografia e histopatológicos foram realizados. RESULTADOS: A permeabilidade da parede ocular, quando da aplicação do laser de diodo infravermelho via transescleral, variou entre 58,95 e 63,87 por cento. A média da permeabilidade da parede ocular a 300 mW (63,14 por cento) mostrou-se significativamente superior àquela da permeabilidade da parede ocular encontrada a 500 mW (59,11 por cento), (P<0,05). CONCLUSÕES: Este estudo sugere a existência da relação dose-resposta em relação aos parâmetros empregados na aplicação do laser de diodo infravermelho via transescleral, com permeabilidade da parede ocular mensurável e reprodutível. Nenhuma rotura, hemorragia ou descolamento da retina ou vítreo foi constatado aos exames subseqüentes às aplicações do laser de diodo infravermelho, o que torna o uso da fotocoagulação via transescleral, no modelo experimental, seguro, mesmo sob condições de baixa visibilidade dos meios.

PURPOSE: Retinal photocoagulation under poor visualization condition is often required. Transscleral infrared laser can be used as an alternative to regular transpupillary treatment. Based upon retinographic measurements, we proposed to estimate the reproducibility as well as ocular wall permeability rate for this treatment. Our primary goal was to evaluate whether this technique can deliver adequate photocoagulation at predetermined parameters without direct retinal visualization. METHODS: In New Zealand pigmented rabbits, optimal transscleral infrared diode laser settings were administered to the right eye. With the same parameters, transpupillary photocoagulation was repeated in the left eye. Retinographic and clinical examinations were performed immediately and two months later. RESULTS: Ocular wall permeability rate varied between 58.95 and 63.87 percent. Average permeability using a power of 300 mW (63.14 percent) was found to be higher than that encountered before its enhancement up to 500 mW (59.11 percent), (P<0.05). CONCLUSIONS: Setting parameters showed dose-response effect. No retinal hole or retinal detachment was noticed in any rabbit. Transscleral infrared photocoagulation appeared to be a reproducible and secure method in the experimental model.

Combined aniridic intraocular lens implantation and vitreoretinal surgery.

A 45-year-old man presented with post-traumatic aniridia. We describe the combined surgery done to treat both aniridia and epiretinal membrane simultaneously. A combined aniridia intraocular lens and vitreoretinal surgery was done. The case report highlights the advantage of combined surgery in terms of cost factor and surgical time.

Perfil clínico e eletrorretinográfico da comoção retiniana / Clinical and electroretinographic profile of commotio retinae

OBJETIVO: Traçar perfil clínico, anatômico e funcional da comoção retiniana. MÉTODOS: Pacientes com trauma ocular contuso e quadro fundoscópico de comoção retiniana unilateral há menos de 72 horas foram submetidos ao exame de acuidade visual, biomicroscopia, oftalmoscopia binocular indireta, retinografia, angiografia fluoresceínica, tomografia de coerência óptica e eletrorretinografia de campo total. A eletrorretinografia foi repetida após 15 e 30 dias. A angiografia após 30 dias. RESULTADOS: Foram incluídos 16 pacientes no estudo. No primeiro exame, havia diferença estatisticamente significante entre o olho atingido e o olho controle na amplitude de todas as respostas, sem alteração da relação b/a, e na latência da resposta de cones isolados e do flicker a 30 Hz. No segundo exame, manteve-se a diferença para os potenciais oscilatórios, que desapareceu no último exame. Na angiofluoresceinografia, todos os olhos acometidos mostravam áreas de hiperfluoresceência por transmissão alternadas com áreas de hipofluorescência por bloqueio. Este defeito mantém-se após 30 dias. A tomografia de coerência óptica mostrou diminuição da refletividade na camada dos fotorreceptores. CONCLUSÕES: As alterações encontradas refletiram acometimento de fotorreceptores e de células ganglionares, mas não da camada de células bipolares, além de mobilização precoce de pigmento do epitélio pigmentado da retina. As alterações eletrorretinográficas desapareceram após 30 dias do trauma.

PURPOSE: To investigate clinical, anatomic and electroretinographic changes in eyes that suffered blunt ocular trauma with commotio retinae. METHODS: Patients who presented commotio retinae after unilateral blunt ocular trauma less then 72 hours before were submitted to visual acuity testing, biomicroscopy, binocular indirect ophthalmoscopy, fluorescein angiography, optical coherence tomography and full-field electroretinography. Full-field ERG was repeated after 15 and 30 days. RESULTS: Sixteen patients were included in the study. On the first examination there was a statistically significant difference between affected and fellow eye in all response amplitudes, without b/a ratio alteration, and a delay in single-flash cone response and 30-Hz flicker implicit time. On the second examination, the difference between the eyes remained for oscillatory potentials, but disappeared on the last examination. In fluorescein angiography, all patients presented mottled hyperfluorescence and hypofluorescent areas, due to alterations in the pigment barrier. On optical coherence tomography, we found optically empty spaces at the site of the lesion. CONCLUSION: Found changes suggested photoreceptor and ganglion cells, but not Müller cell functional alterations, as well as pigment mobilization. These changes disappeared 30 days after the trauma.

Household ocular injuries: a case series

To determine the nature and types of household eye injuries. We prospectively analyzed data from 100 consecutive patients with household eye injuries [104 eyes] referred to emergency room of Farabi Eye Hospital during October2003. Standardized international classification of ocular trauma [Birmingham Eye Trauma Terminology] was used for classification. Household ocular trauma represented 4.85% of all ocular emergencies [2061 patients] referred to the emergency room during that period. Male to female ratio was 1.13 and mean age was 26 +/- 18 years [range, 1-73]. The cornea was involved in 50.0% and the sclera, lens, and retina each was involved in 4.8%. There was severe visual loss [best-corrected distance visual acuity <20/200 due to trauma] in 4% of the patients. The most frequent household ocular injury was globe injury [93.7%] including mechanical [72.1% closed and 4.8% open], chemical [14.4%] and thermal [1.9%] injuries. Closed mechanical injuries were the most common type of household ocular injury in our series. Considering the high rate of household eye trauma, more effective preventive measures should be taken at home

A Case of Photic Retinal Injury Associated with Exposure to Plasma Arc Welding

PURPOSE: To report of photic retinopathy induced by plasma arc welding, and the OCT (optical coherence tomography) results of damaged retinal lesions. METHODS: We describe a case report of a 37-year-old male, working in the steel industry, who presented with central scotoma in both eyes. RESULTS: On his first visit, one day after performing plasma arc welding with protective gear at work, his best corrected vision was 0.7 for both eyes. Ophthalmic examination of the fundus showed a round yellow lesion with an approximate size of 300 micrometers superonasal to the fovea of both eyes. On his next visit, one month later, his vision had recovered to 1.0, his symptoms had improved, and the ophthalmoscopic examination of the fundus revealed that the round yellow spots had disappeared from both eyes. CONCLUSIONS: To our knowledge, this is the first report of photic retinopathy induced by plasma arc welding, and the OCT (optical coherence tomography) results of damaged retinal lesions have not previously been reported. For these reasons, we report this case.