ABSTRACT
La neurorretinitis como manifestación de la enfermedad por arañazo de gato se presenta en el 1-2 % de los pacientes con afecciones oculares porBartonella henselae. Las manifestaciones oculares suelen suceder a las sistémicas, aunque pueden aparecer en ausencia de estas. La presencia de exudado macular en forma de estrella es característico y sugestivo de dicha infección. Se presenta el caso de un paciente de 14 años de edad, previamente sano, con disminución de la agudeza visual de 15 días de evolución, que ingresó por sospecha de neuritis óptica izquierda con edema de papila. El seguimiento oftalmológico reveló la aparición de la lesión característica en "estrella macular" que permitió arribar al diagnóstico de infección por B. henselae, confirmándose luego con serología positiva
Neurorretinitis as a manifestation of cat scratch disease occurs in 1-2 % of patients with Bartonella Henselae eye disease. Ocular manifestations tend to follow systemic ones, although they can appear in their absence. The presence of star-shaped macular exudate is characteristic and suggestive of this infection. We report a case of a 14-year-old healthy boy, with 15 days of decreased visual acuity, who was admitted for suspected left optic neuritis with papilledema. Ophthalmological examination revealed the characteristic "macular star" that led to the diagnosis of infection by Bartonella Henselae, later confirmed by positive serology.
Subject(s)
Humans , Male , Adolescent , Retinitis/diagnosis , Cat-Scratch Disease/complications , Cat-Scratch Disease/diagnosis , Papilledema , Bartonella henselae , Physical ExaminationABSTRACT
Resumen Bartonella henselae es el agente etiológico de la enfermedad por arañazo de gato (EAG), infección endémica en Chile. Típicamente se presenta como una linfadenopatía regional autolimitada y menos frecuentemente con compromiso sistémico y manifestaciones extraganglionares: en hígado, bazo, hueso, ojo, entre otros. Se presentan tres casos de infección atípica por Bartonella henselae en las que se evidenció compromiso ocular, manifestado como una neurorretinitis. Esta revisión destaca la importancia de la búsqueda activa de complicaciones oculares en pacientes con compromiso sistémico por Bartonella henselae, implicando un cambio en el tratamiento y pronóstico de la enfermedad.
Abstract Bartonella henselae is cat scratch disease's etiological agent, which is considered an endemic infection in Chile. It typically presents as a self-limited regional lymphadenopathy and less frequently with systemic involvement and extranodal or atypical manifestations: hepatosplenic, ocular or musculoskeletal involvement, among others. We present three cases of atypical cat scratch disease with ocular compromise, as neurorretinitis. This review highlights the importance of the active search for ocular complications in patients with disseminated cat scratch disease, leading to possible change in treatment and prognosis of the disease.
Subject(s)
Humans , Retinitis/diagnosis , Bartonella henselae , Cat-Scratch Disease/complications , Cat-Scratch Disease/diagnosis , ChileABSTRACT
Abstract The differential diagnosis of optic neuritis is broad and varied. We report the case of a 24-year-old Brazilian man who presented with five-week history of fever, malaise, myalgia, severe fatigue, tender right preauricular lymphadenopathy, and acute vision blurring associated with right optic disc swelling and exudates in a macular star pattern. His illness developed soon after an infestation of fleas broke out among his cats. Diagnosis of ocular bartonellosis was confirmed by serological and molecular analyses targeting amplification of Bartonella spp. htrA gene. Signs and symptoms only improved after initiation of antimicrobial therapy.
Subject(s)
Humans , Animals , Male , Cats , Young Adult , Retinitis/microbiology , Bartonella henselae/isolation & purification , Retinitis/diagnosis , Retinitis/drug therapy , Doxycycline/therapeutic use , Anti-Bacterial Agents/therapeutic useABSTRACT
ABSTRACT Recurrent idiopathic neuroretinitis is an inflammatory optic neuropathy characterized by optic nerve edema and macular star, associated with painless and recurrent episodes of visual loss, poor visual prognosis, and visual field defects related to nerve fiber layer injury. The disorder is sometimes mistaken for atypical optic neuritis. However, early diagnosis is important for visual recovery. Long-term immunosuppression has been shown to reduce the rate of recurrence and protect against severe and irreversible vision loss.
RESUMO Neurorretinite recorrente idiopática é uma neuropatia óptica inflamatória caracterizada por edema do nervo óptico e estrela macular associada a episódios recorrentes de perda visual indolor, baixo prognóstico visual e desfeitos de campo visual relacionados a injúria da camada de fibras nervosas. Essa condição pode ser confundida com neurite óptica atípica e seu correto diagnóstico é importante para o prognóstico visual, uma vez que a imunossupressão continua previne episódios recorrentes que podem levar a perda visual severa e irreversível.
Subject(s)
Humans , Male , Adult , Retinitis/diagnosis , Optic Neuritis/diagnosis , Recurrence , Retinitis/complications , Retinitis/pathology , Vision Disorders/etiology , Visual Acuity , Optic Neuritis/pathology , Tomography, Optical Coherence , Diagnosis, Differential , Exudates and Transudates , Visual Field Tests , Macula Lutea/metabolism , Macula Lutea/pathologyABSTRACT
La toxoplasmosis ocular recurrente es la forma más común de toxoplasmosis ocular. Las lesiones se localizan adyacentes a una cicatriz coriorretinal resultado de una infección previamente adquirida. La retinitis por toxoplasma provoca una respuesta inflamatoria variable, ocasionando vasculitis, vitreítis, coroiditis y uveítis anterior. El diagnóstico se realiza examinando el fondo de ojo, y su etiología debe considerarse cuando en un adulto joven inmunocompetente, se observa en la fundoscopía la presencia de una lesión retinal focal, asociada a una cicatriz coriorretinal. La retinografía permite documentar los hallazgos observados en el fondo de ojo. El examen serológico para identificar anticuerpos anti toxoplasma de clase IgM e IgG solo confirma la exposición al parásito pero no constituyen pruebas diagnósticas confirmatorias. Se presentan 3 casos de toxoplasmosis ocular recurrente en pacientes adultos cuyos diagnósticos se realizaron mediante el examen fundoscópico y la retinografía.
Recurrent ocular toxoplasmosis is the most common form of ocular toxoplasmosis. Lesions are located adjacent to a chorioretinal scar as a result of a previously acquired infection. Toxoplasma retinitis produces a variables inflammatory response, leading to vasculitis, vitreitis, choroiditis and anterior uveities. Diagnosis is performed by fundoscopy and its ethiology must be considered when fundoscopy shows the presence of a focal retinal lesion associated to a chorioretinal scar in a young immunocompetent adult. Retinography allows documenting findings from the fundoscopy. Serological examination to identify anti toxoplasma antibodies classes IgM and IgG only confirms exposure to the parasite but do not constitute confirmatory diagnostic evidence. We present 3 cases of recurrent ocular toxoplasmosis in adult patients that were diagnosis by fundoscopic examination and retinography
Subject(s)
Humans , Adult , Middle Aged , Retinitis/diagnosis , Uveitis/diagnosis , Uveitis/therapy , Toxoplasmosis/diagnosis , Toxoplasmosis, Ocular/diagnosis , Toxoplasmosis, Ocular/therapy , Chorioretinitis/diagnosis , OphthalmoscopesABSTRACT
A 52-yr-old male was referred for progressive visual loss in the left eye. The decimal best-corrected visual acuity (BCVA) was 0.01. Fundus examination revealed diffuse retinal pigment epithelial degeneration, focal yellow-white, infiltrative subretinal lesion with fuzzy border and a live nematode within the retina. Diffuse unilateral subacute neuroretinitis (DUSN) was diagnosed and the direct laser photocoagulation was performed to destroy the live nematode. During eight months after treatment, BCVA gradually improved to 0.2 along with the gradual restoration of outer retinal layers on SD-OCT. We report on the first case of DUSN in Korea. DUSN should be included in the differential diagnosis of unexplained unilateral visual loss in otherwise healthy subjects.
Subject(s)
Animals , Humans , Male , Middle Aged , Blindness/diagnosis , Eye Infections, Parasitic/diagnosis , Fundus Oculi , Laser Therapy/methods , Light Coagulation/methods , Nematoda/pathogenicity , Republic of Korea , Retinal Pigment Epithelium/parasitology , Retinitis/diagnosis , Visual AcuityABSTRACT
A 52-yr-old male was referred for progressive visual loss in the left eye. The decimal best-corrected visual acuity (BCVA) was 0.01. Fundus examination revealed diffuse retinal pigment epithelial degeneration, focal yellow-white, infiltrative subretinal lesion with fuzzy border and a live nematode within the retina. Diffuse unilateral subacute neuroretinitis (DUSN) was diagnosed and the direct laser photocoagulation was performed to destroy the live nematode. During eight months after treatment, BCVA gradually improved to 0.2 along with the gradual restoration of outer retinal layers on SD-OCT. We report on the first case of DUSN in Korea. DUSN should be included in the differential diagnosis of unexplained unilateral visual loss in otherwise healthy subjects.
Subject(s)
Animals , Humans , Male , Middle Aged , Blindness/diagnosis , Eye Infections, Parasitic/diagnosis , Fundus Oculi , Laser Therapy/methods , Light Coagulation/methods , Nematoda/pathogenicity , Republic of Korea , Retinal Pigment Epithelium/parasitology , Retinitis/diagnosis , Visual AcuityABSTRACT
No abstract available.
Subject(s)
Humans , Male , Middle Aged , Anti-Bacterial Agents/therapeutic use , Diagnosis, Differential , Electroretinography , Eye Infections, Bacterial/diagnosis , Fluorescein Angiography , Penicillin G Benzathine/therapeutic use , Retinitis/diagnosis , Scotoma/diagnosis , Syphilis/diagnosis , Syphilis Serodiagnosis , Tomography, Optical Coherence , Visual Acuity/physiologyABSTRACT
A neurorretinite subaguda difusa unilateral (DUSN) é uma forma de uveíte que pode potencialmente levar à cegueira. No Brasil e em outras partes da América do Sul, a neurorretinite subaguda difusa unilateral cada vez mais é considerada uma causa importante de uveíte posterior em crianças e em adultos jovens e saudáveis. Se diagnosticada e tratada ainda em fase inicial, permite uma resolução dos sintomas com melhora da acuidade visual. Caso progrida para a fase tardia, poderá acarretar uma perda visual significativa. Nesse estudo, por meio de uma revisão da literatura, descreve-se as principais características desta doença, incluindo os seguintes aspectos: histórico, etiologia, fisiopatologia, quadro clínico, diagnóstico, diagnóstico diferencial e tratamento.
Diffuse unilateral subacute neuroretinitis (DUSN) is a form of uveitis that can potentially lead to blindness. In Brazil and other parts of South America, diffuse unilateral subacute neuroretinitis is an important cause of posterior uveitis in children and healthy young adults. If diagnosed and treated in early stage, allows a resolution of symptoms with improvement of visual acuity. If the disease progresses to the late stage, can result in significant visual loss. In this study, through a literature review, we describe the main characteristics of this disease, including the following aspects: history, etiology, physiopathology, clinical features, diagnosis, differential diagnosis and treatment.
Subject(s)
Animals , Humans , Eye Infections, Parasitic , Retinitis , Diagnosis, Differential , Eye Infections, Parasitic/diagnosis , Eye Infections, Parasitic/physiopathology , Eye Infections, Parasitic/therapy , Larva , Retinitis/diagnosis , Retinitis/physiopathology , Retinitis/therapy , Uveitis/diagnosis , Visual AcuityABSTRACT
Se reporta el caso de un varón de 36 años con neurorretinitis por Bartonella henselae, cuyo seguimiento periódico fue realizado con tomografía de coherencia óptica (TCO). El inicio de la enfermedad se caracterizó por disminución de agudeza visual (AV) unilateral, indolora, de inicio brusco en ojo derecho (OD), asociado a cuadro febril. El examen fundoscópico mostró edema en polo posterior, extendiéndose desde el disco óptico hasta la región macular en OD. La TCO confirmó el engrosamiento macular y del disco óptico así como la presencia de fluido macular subretinal. Los estudios sistémicos fueron normales con excepción del hemograma por presencia de leucocitosis y serología positiva a Bartonella henselae. El seguimiento tomográfico permitió valorar la disminución del edema macular, con la correspondiente mejora de la agudeza visual y ausencia de complicaciones asociadas. Este reporte describe la utilidad del seguimiento con TCO en un paciente con neurorretinitis por Bartonella henselae.
The case of a 36 year-old male with neuroretinitis caused by Bartonella henselae is reported, whose periodic follow-up was done through optical coherence tomography (OCT). The onset of this disease was characterized by unilateral low visual acuity (VA), painless, of sudden onset, in the right eye (RE), associated to l febrile symptom. The funduscopic examination showed edema in the posterior pole which extended from the optical disc to the macular region in the RE. The OCT confirmed macular and optical disc thickening, as well as the presence of subretinal macular fluid. Systemic studies were normal except for a blood count due to the presence of leukocytosis and positive for Bartonella henselae. The follow up with CT Scan helped to evaluate the decrease in macular edema, with the subsequent improvement of visual acuity and absence of related complications. This report describes the utility of the follow up with OCT in a patient with neuroretinitis caused by Bartonella henselae.
Subject(s)
Adult , Humans , Male , Cat-Scratch Disease/diagnosis , Retinitis/diagnosis , Retinitis/microbiology , Tomography, Optical Coherence , Follow-Up StudiesABSTRACT
Relatamos caso de um paciente de 14 anos, sexo masculino, que foi admitido com queixa de embaçamento visual bilateral há dois anos. Ao exame oftalmológico observou-se leve hiperemia e edema de disco óptico bilateral, exsudação retiniana, poucas hemorragias retinianas, múltiplos aneurismas, assim como sinais de vasculite. A angiofluoresceinografia demonstrou isquemia periférica extensa, dilatações e hiperfluorescência das paredes dos vasos, e vazamento tardio do disco óptico nas fases finais do exame em ambos os olhos. Este caso representa uma rara entidade caracterizada por oclusão retiniana vascular periférica, vasculite retiniana, múltiplos aneurismas retinianos e neurorretinite (IRVAN). Avaliação sistêmica e laboratorial não revelaram nenhuma anormalidade. O paciente foi submetido à panfotocoagulação de retina com laser de argônio em ambos os olhos, e iniciado tratamento com prednisona via oral, com manutenção da acuidade visual de 20/25 depois de um ano de acompanhamento. O tratamento com laser deve ser considerado quando houver qualquer evidência angiográfica de má perfusão retiniana, e antes do desenvolvimento de qualquer sinal de neovascularização de retina.
A case of a 14 year-old boy that was admitted complaining of bilateral ocular visual blurring for 2 years is reported. The ophthalmological examination disclosed bilateral mild optic disc hyperemia and swelling, retinal exudation, few retinal hemorrhages, multiple aneurysms, as well as vasculitis. Fluorescein angiography showed extensive peripheral retinal ischemia, dilatations and hyperfluorescence of the vessels walls, and leakage of the optic disc in the late phases in both eyes. This rare case represents an entity characterized by peripheral retinal vascular occlusion, retinal vasculitis, multiple posterior retinal aneurysms, and neuroretinitis (IRVAN). Systemic evaluation and laboratory work-up did not suggest any systemic abnormality. Panretinal laser photocoagulation was performed in both eyes, and the patient was treated with oral prednisone with maintenance of the visual acuity after 1 year of follow-up. Laser treatment should be considered when angiographic evidence of widespread retinal no perfusion is present, and before the development of signs of retinal neovascularization.
Subject(s)
Adolescent , Humans , Male , Aneurysm/diagnosis , Retinal Vessels , Retinal Vasculitis/diagnosis , Retinitis/diagnosis , Aneurysm/therapy , Fluorescein Angiography , Retinal Vasculitis/therapy , Retinitis/therapy , SyndromeABSTRACT
Behçet disease is an idiopathic, multisystem disorder characterized by recurrent episodes of orogenital ulceration and vasculitis of the veins and arteries of all calibers. Ocular involvement may affect the conjunctiva, sclera, uveal tract, vitreous, blood vessels, and retina. Many theories have pointed toward an autoimmune response behind its pathogenesis, which may be triggered by exposure to an infectious agent. Frosted branch angiitis is characterized by vascular inflammation, sheathing, retinal edema, and retinal hemorrhages. The disease may be idiopathic in a majority of the cases or may be associated with ocular and systemic pathology. Association between Behηet disease, Frosted branch angiitis, and neuroretinitis is not reported in literature. This uncommon combination reflects the varied systemic and ocular manifestations in Behηet disease, especially in patients who are not diagnosed and treated in time. We hereby report a case of bilateral frosted branch angiitis and neuroretinitis in a young male from Middle-east, suffering from Behçet disease.
Subject(s)
Adult , Antirheumatic Agents/administration & dosage , Behcet Syndrome/complications , Behcet Syndrome/diagnosis , Behcet Syndrome/drug therapy , Colchicine/administration & dosage , Drug Administration Schedule , Fundus Oculi , Humans , Injections, Intravenous , Magnetic Resonance Imaging , Male , Prednisone/administration & dosage , Prednisone/analogs & derivatives , Retinal Hemorrhage/diagnosis , Retinal Hemorrhage/etiology , Retinitis/diagnosis , Retinitis/etiology , Silymarin/administration & dosage , Vasculitis/diagnosis , Vasculitis/etiology , Vasculitis/pathologyABSTRACT
A number of inflammatory, infectious, neoplastic and idiopathic disorders affect the eye and the central nervous system [CNS] concurrently or at different time frames. These conditions pose a diagnostic challenge to the clinician since they may present with similar ocular and neurological manifestations. The purpose of this review is to describe major neurological syndromes including multiple sclerosis, Vogt-Koyanagi-Harada disease, other autoimmune syndromes, and several infectious diseases which may affect the eye. This article may serve as a guide for the diagnosis and treatment of such disorders. It should be noted that these conditions have been viewed from a neurologist's perspective thereby neurologic involvement is stressed
Subject(s)
Humans , Uveitis/diagnosis , Uveitis/etiology , Retinitis/diagnosis , Meningitis/etiology , Neurologic ManifestationsABSTRACT
To report a case of idiopathic retinal vasculitis, aneurysms and neuroretinitis [IRVAN] syndrome associated with positive perinuclear antineutrophil cytoplasmic antibody [P-ANCA]. A 51-year-old man presented with loss of vision in his right eye since many years ago and blurred vision in his left eye over the past year. Ophthalmologic examination revealed optic atrophy and old vascular sheathing in the right eye and blurred disc margin, macular exudation, flame shaped hemorrhages, retinal vascular sheathing and multiple aneurysms at arterial bifurcation sites in the left eye, findings compatible with IRVAN syndrome. On systemic workup, the only notable finding was P-ANCA positivity. IRVAN syndrome may be a retinal component of P-ANCA associated vasculitis
Subject(s)
Humans , Male , Antibodies, Antineutrophil Cytoplasmic , Aneurysm/diagnosis , Retinitis/diagnosis , Retinal Vessels , Fluorescent Antibody Technique, Indirect , Intraocular PressureABSTRACT
La infección por Bartonella henselae se presenta característicamente con adenopatías regionales y fiebre de intensidad variable, entidad conocida como enfermedad por arañazo de gato. Alrededor de 5 a 10 por ciento de los casos desarrolla compromiso ocular, entre los que destacan el síndrome óculo-glandular de Parinaud, la neuro-retinitis y la retino-coroiditis focal. A continuación se presentan dos pacientes con infección aguda por B. henselae y compromiso ocular. Ambos recibieron tratamiento y evolucionaron con recuperación completa de la visión.
Cat scratch disease is the main clinical presentation of Bartonella henselae infection. However, ocular manifestations of bartonellosis occur in about 5 to 10 percent of the patients, mainly presenting as neuroretinitis, choroiditis or oculoglandular syndrome of Parinaud. We describe two patients with documented B. henselae infection and typical ocular compromise. Both patients were treated and had a favorable visual outcome.
Subject(s)
Adult , Animals , Cats , Humans , Male , Cat-Scratch Disease/complications , Eye Infections, Bacterial/microbiology , Retinitis/microbiology , Anti-Bacterial Agents/therapeutic use , Bartonella henselae/isolation & purification , Cat-Scratch Disease/diagnosis , Cat-Scratch Disease/drug therapy , Eye Infections, Bacterial/diagnosis , Fundus Oculi , Retinitis/diagnosisABSTRACT
PURPOSE: To report the findings of optical coherence tomography (OCT) in three cases of diffuse unilateral subacute neuroretinitis (DUSN). METHODS: Three young patients with confirmed diagnosis of diffuse unilateral subacute neuroretinitis were followed-up using Stratus® OCT. RESULTS: Optical coherence tomography findings included retinal nerve fiber layer atrophy and focal edema where the worm was initially lodged. In two patients we could identify the worm by optical coherence tomography as an area of hiper-reflectivity. The worms were laser photocoagulated and post-treatment optical coherence tomography scanning revealed improvement of edema, nerve fiber layer thinning and a retinal hyper-reflectivity where laser had been applied. CONCLUSION: The main finding reported here is the potential of optical coherence tomography in detecting the presence of retinal nerve fiber layer atrophy and focal retinal edema in areas affected by the worm. Optical coherence tomography can be used to distinguish diffuse unilateral subacute neuroretinitis from other mimicking diseases like punctate outer retinitis, when there are no retinal fiber layer atrophy.
OBJETIVO: Demonstrar os achados da tomografia de coerência óptica em três casos de neurorretinite subaguda difusa unilateral (DUSN). MÉTODOS: Os pacientes com diagnóstico confirmado de neurorretinite subaguda difusa unilateral realizaram seguimento pré e pós-tratamento por meio da tomografia de coerência óptica, Stratus® OCT. RESULTADOS: Os achados marcantes da tomografia de coerência óptica foram a atrofia das camadas de fibras nervosas da retina e edema da retina localizado em áreas nas quais a larva esteve. Em dois pacientes pôde-se localizar a larva no espaço sub-retiniano por meio da tomografia de coerência óptica, que se traduziu por pequena área densa (hiperrefletividade). As larvas foram fotocoaguladas a laser e os achados da tomografia de coerência óptica após o tratamento demonstrou melhora do edema, afinamento das camadas de fibras nervosas e hiperrefletividade no local da aplicação do laser. CONCLUSÃO: Os principais achados na tomografia de coerência óptica foram a atrofia difusa das camadas de fibras nervosas e o edema localizado nas áreas afetadas pela larva. A tomografia de coerência óptica pode ser usado para diferenciar neurorretinite subaguda difusa unilateral de doenças que a simulam, como retinite punteada externa, que não manifesta alterações das camadas de fibras nervosas.
Subject(s)
Adolescent , Child , Female , Humans , Male , Eye Infections, Parasitic/diagnosis , Light Coagulation , Nerve Fibers/pathology , Retinitis/diagnosis , Acute Disease , Atrophy , Eye Infections, Parasitic/pathology , Eye Infections, Parasitic/surgery , Follow-Up Studies , Nerve Fibers/parasitology , Retinitis/parasitology , Retinitis/pathology , Retinitis/surgery , Tomography, Optical Coherence , Visual AcuityABSTRACT
Posterior uveitic entities are varied entities that are infective or non-infective in etiology. They can affect the adjacent structures such as the retina, vitreous, optic nerve head and retinal blood vessels. Thorough clinical evaluation gives a clue to the diagnosis while ancillary investigations and laboratory tests assist in confirming the diagnosis. Newer evolving techniques in the investigations and management have increased the diagnostic yield. In case of diagnostic dilemma, intraocular fluid evaluation for polymerase chain testing for the genome and antibody testing against the causative agent provide greater diagnostic ability.
Subject(s)
Anti-Inflammatory Agents/therapeutic use , Choroiditis/complications , Choroiditis/diagnosis , Diagnosis, Differential , Fluorescein Angiography/methods , Fundus Oculi , Humans , Infections/complications , Prognosis , Retinitis/complications , Retinitis/diagnosis , Tomography, Optical Coherence/methods , Uveitis, Posterior/diagnosis , Uveitis, Posterior/drug therapy , Uveitis, Posterior/etiologyABSTRACT
PURPOSE: To measure retinal nervous fiber layer (RNFL) thickness using OCT3 (Carl-Zeiss) in patients with diffuse unilateral subacute neuroretinitis (DUSN) with or without live worm and correlate it with visual acuity. METHODS: RNFL thickness, using RNFL thickness 3.4 program and best corrected visual acuity were measured in patients with DUSN between January 2005 and December 2006. RESULTS: Thirty-eight patients, aged 9 - 42 years were selected, of whom 20 had live worm. Mean RNFL was 71.55 ± 27.26 in the DUSN eye and 103.07 ± 20.66 in the contralateral eye (p<0.001). Pearson's correlation between visual acuity and RNFL was r= -0.522 (p<0.001) in the DUSN eye and r= -0.097 (p=0.509) in the contralateral eye. CONCLUSION: RNFL thickness in DUSN patients is directly proportional to visual acuity. Further research is needed to reinforce the correlation between visual acuity and thickness of the nerve fibers in patients with DUSN to follow them after the treatment.
OBJETIVO: Avaliar o uso do OCT3 (Carl-Zeiss) para medir a espessura da camada de fibras nervosas em pacientes com neuroretinite unilateral subaguda difusa (DUSN) e correlacionar com a acuidade visual. MÉTODOS: Foi medido a espessura da camada de fibras nervosas, utilizando programa "RNFL thickness 3.4" e a melhor acuidade visual de pacientes com DUSN entre janeiro de 2005 e dezembro 2006. RESULTADOS: Trinta e oito pacientes, com idade entre 9-42 anos foram selecionados para este estudo, sendo que 20 casos apresentavam larva viva localizada. A média da RNFL foi 71,55 ± 27,26 nos olhos com DUSN e 103,07 ± 20,66 nos olhos contralaterais (p<0,001). Correlação de Pearson entre a acuidade visual e a espessura da camada de fibras nervosas foi r= -0,522 (p<0,001) nos olhos com DUSN e r= -0,097 (p=0,509) nos olhos contralaterais. CONCLUSÃO: A espessura da camada de fibras nervosas de pacientes com DUSN apresenta uma correlação diretamente proporcional com a acuidade visual. Novos estudos são necessários para reforçar a correlação entre a acuidade visual e a espessura da camada de fibras nervosas nos pacientes com DUSN com a finalidade de acompanhar os pacientes após o tratamento.
Subject(s)
Adolescent , Adult , Child , Female , Humans , Male , Young Adult , Nerve Fibers/pathology , Retinitis/pathology , Tomography, Optical Coherence , Acute Disease , Retinitis/diagnosis , Visual Acuity , Young AdultABSTRACT
Chikungunya fever is a relatively rare from of vector-borne viral fever caused by chikungunya virus and spread by bites of the Aedes aegypti and Aedes albopictus mosquito. Epidemics of chikungunya fever have been reported in the past from different parts of the world. Although the virus had been passive for quite some time, recent reports of outbreaks of chikungunya fever in several parts of Southern India have confirmed the re-emergence of this virus. Symptoms of this infection include abrupt onset of fever, chills, and headache, rash, severe joint pain, conjunctival injection and photophobia. Ocular manifestations have been recently reported with this infection. We report a case of a 48-year-old female patient, who presented with defective vision two weeks after a serology proven chikungunya infection. There was bilateral neuroretinitis with peripapillary cotton wool spots. These findings should be kept in mind as an ocular manifestation of chikungunya virus infection.
Subject(s)
Alphavirus Infections/diagnosis , Antibodies, Viral/blood , Chikungunya virus/genetics , Enzyme-Linked Immunosorbent Assay , Eye Infections, Viral/diagnosis , Female , Fluorescein Angiography , Functional Laterality , Glucocorticoids/therapeutic use , Humans , Immunoglobulin M/analysis , Middle Aged , Optic Neuritis/diagnosis , Polymerase Chain Reaction , Prednisolone/therapeutic use , RNA, Viral/analysis , Retinitis/diagnosis , Visual AcuityABSTRACT
A 35-year-old male with a history of chikungunya fever, presented with diminution of vision in the right eye of one-week duration. His best corrected visual acuity (BCVA) was counting fingers 2 meters and 20/20 (Snellens) in the right and left eyes respectively. A diagnosis of neuroretinitis was made in the right eye while left eye showed features of retinitis. ELISA (serum) and polymerase chain reaction (aqueous) were positive for herpes simplex virus. The lesions did not show any response to antiviral or steroid treatment and appeared to be self-limiting. At five months follow-up, lesions had resolved well with BCVA of 20/120 and 20/20 in the right and left eyes respectively.