Glaucoma due to ciliary body cysts and pseudoplateau iris: a systematic review of the literature / Glaucoma associado a cistos de corpo ciliar e íris pseudoplateau: revisão sistemática da literatura

ABSTRACT The diagnosis of angle-closure glaucoma secondary to iridociliary cysts is challenging and lacks compiled literature support. We present a rare case of bilateral angle-closure glaucoma associated with pseudoplateau iris due to multiple ciliary cysts and conducted a systematic review of the literature to find similar case reports published between November 2006 and November 2016. Only 19 case reports present treatment modalities, and most cases required more than one therapeutic approach for controlling the intraocular pressure. Pseudoplateau iris attributed to iridociliary cysts should be considered in the differential diagnosis of patients with narrow angles, particularly those with ocular hypertension and glaucoma, in which management is complex. In addition to gonioscopy, ultrasound biomicroscopy is considered the conclusive method for accurate diagnosis.

RESUMO O diagnóstico de glaucoma de ângulo fechado secundário a cistos iridociliares é desafiador e não possui suporte da literatura compilada. Apresentamos um caso bilateral raro de glaucoma de ângulo fechado associado à íris pseudoplateau devido a cistos ciliares múltiplos e realizamos uma revisão sistemática da literatura de relatos de casos similares publicados entre novembro de 2006 e novembro de 2016. Apenas 19 relatos de casos apresentaram as modalidades de tratamento e na maioria deles foi necessário mais de uma abordagem terapêutica para controlar a pressão intra-ocular. Íris pseudoplateau atribuída a cistos iridociliários deve ser considerada no diagnóstico diferencial de pacientes com ângulos estreitos, particularmente aqueles com hipertensão ocular e glaucoma, em que o manejo é complexo. Além da go nioscopia, a biomicroscopia ultra-sônica é considerada o método conclusivo para o diagnóstico correto.

Full-thickness Sclerotomy for Uveal Effusion Syndrome

To report the surgical outcome of full-thickness sclerotomy in five cases of uveal effusion syndrome (UES). Full-thickness sclerotomy without sclerectomy was performed on five eyes of four patients with UES with or without nanophthalmos. In four of the eyes, exudative retinal detachment associated with UES resolved after the sclerotomy. The subretinal fluid in one eye, which had a normal axial length, was relieved after undergoing three sclerotomy procedures. Full-thickness sclerotomy without vortex vein decompression or sclerectomy is an effective surgical option for the management of significant UES.

Uveitis manifestaciones secundaria de infección en cavidad bucal: reporte de caso clínico / Uveitis: as a symthom of oral infection: report a case

La uveítis es una patología ocular que se define como la inflamación del tracto uveal del ojo, que pudiera estar asociada a la inflamación de otras estructuras oculares o adyacentes a la cavidad orbitaria, por la proximidad que hay entre los tejidos. En el campo odontológico la uveitis se manifiesta de manera secundaria ante infecciones focales, las cuales se caracterizan por presentar un foco séptico primario, en donde la infección se propaga a otras estructuras del macizo facial. Entre las lesiones que generan un foco infeccioso primario en cavidad bucal, se describen: quiste periapical, granuloma periapical, afecciones pulpares, pericoronaritis y enfermedad periodontal, siendo esta última motivo del caso clínico que se presenta a continuación

Uveitis is an eye condition that is defined as inflammation of the uveal tractor and may be associated with inflammation of other ocular structures or adjacent to the orbital cavity, and the proximity between the tissues. In the dental field uveitis manifests itself secondary to focal infections, which are characterized by a primary septic focus, where the infection spreads to other craniofacial structures. Among lesions that produce a primary infection in oral cavity, are described: periapical cyst, periapical granuloma, pulpal disease, and periodontal disease pericoronaritis, the latter being the occasion of the clinical case is presented below

Enfermedades inflamatorias de la úvea / Inflammatory diseases of the uvea

Se realizó un estudio descriptivo, transversal y prospectivo para determinar las características epidemiológicas de 55 pacientes con enfermedades inflamatorias de la úvea y atendidos en el Servicio de Oftalmología del Hospital Provincial Docente Saturnino Lora de la provincia de Santiago de Cuba, en el período de enero a diciembre del 2006. En la casuística predominaron los afectados por uveítis del segmento anterior, que presentaron mayor número de síntomas en general y por paciente. Se encontró una relación significativa entre los resultados de los exámenes inmunológicos y la presencia de la oftalmopatía, con predominio de la visión borrosa o disminución de la agudeza visual.

A descriptive, cross-sectional and prospective study was carried out to determine the epidemiological characteristics of 55 patients with inflammatory diseases of the uvea and who were assisted at the Ophthalmology Service of Saturnino Lora Teaching Provincial Hospital in Santiago de Cuba, from January to December, 2006. Those affected by uveitis of the previous segment that presented a higher number of symptoms in general and by patient prevailed in the case material. A significant relationship between the results of the immunologic tests and the presence of ophthalmopathy was found, with prevalence of blurred vision or decrease of visual acuity.

Castleman's Disease Presenting with Uveal Effusion Syndrome

We report a rare case of multicentric Castleman's disease that presented with ophthalmic involvement, along with a review of the literature. A 63-year-old male presented with decreased visual acuity in both eyes. Both eyes had serous elevations of the retinas with shifting subretinal fluid and annular choroidal detachment. No retinal breaks were found. Laboratory tests revealed pancytopenia, hypergammaglobulinemia, and an increased erythrocyte sedimentation rate. Chest and abdominal computed tomographies showed multiple lymphadenopathies in the mediastinum, abdomen, and in both inguinal areas. Histological examination of the inguinal lymph node biopsy was consistent with Castleman's disease. After combination chemotherapy, the serous elevations of both retinas and the annular choroidal detachments of both eyes disappeared. Ophthalmic involvement in Castleman's disease is very rare, and to the authors' knowledge, this is the first report of ophthalmic involvement of Castlemans's disease in Korea.

Alterações do segmento posterior na microftalmia: relato de casos / Posterior segment changes in microphthalmic eyes: case report

Microftalmia é a alteração de desenvolvimento caracterizada pela redução do tamanho do bulbo ocular. Pode estar associada a manifestações estruturais do segmento anterior e posterior. As alterações mais comuns do segmento anterior são as opacidades corneanas, o estreitamento e fechamento do ângulo da câmara anterior e a catarata, e as mais frequentes no segmento posterior são a efusão uveal, as dobras de retina, a alteração da vascularização capilar macular, a ausência de depressão foveal e a retinosquise periférica. Este estudo descreve o caso de três pacientes com microftalmo e manifestações no segmento posterior documentadas com tomografia de coerência óptica. O primeiro caso apresentou a síndrome de efusão uveal, com descolamento de coróide e de retina, tratada com cirurgia de esclerectomia parcial nos quatro quadrantes. No segundo caso, havia a dobra retiniana neurossensorial na fóvea e feixe papilomacular em ambos os olhos sem o envolvimento de epitélio pigmentado retiniano e coriocapilar. No terceiro paciente, o microftalmo estava acompanhado de ausência da depressão foveal, cujo principal diagnóstico diferencial é a hipoplasia foveal.

Microphthalmos is a developmental ocular disorder defined as a small eyeball. The condition can be associated with abnormalities of anterior and posterior segments. The most common anterior characteristics include corneal opacities, angle-closure and a shallow anterior chamber and cataract. The main findings of posterior segment are uveal effusion, retinal folds, abnormalities of macular capillar vascularization, absence of foveal depression and peripheral retinoschisis. Three patients with microphthalmos were assisted and their OCT features of posterior segment were analyzed. The first case had uveal effusion syndrome, choroidal and retinal detachment treated with parcial sclerectomy at the four quadrants. The other case presented with neurosensory retinal fold at fovea and papillomacular area in both eyes without involvement of retinal pigment epithelium layer and choriocapillaris. The third patient showed absence of foveal depression. The main diferencial diagnosis for this condition is foveal hypoplasia.

Efusão uveal associada à tuberculose presumida: relato de caso / Uveal effusion associated with presumed tuberculosis: case report

Os autores relatam a rara associação de efusão uveal e tuberculose ocular presumida em paciente do sexo masculino que apresentou melhora clínica com o uso sistêmico de prednisona 40 mg/d e rifampicina 600 mg/d. Descrevem, ainda, aspectos relevantes da efusão uveal, como etiopatogenia, evolução da doença, diagnóstico diferencial e tratamento, por meio de revisão da literatura.

The authors report a rare association of uveal effusion with presumed ocular tuberculosis in a male patient who presented clinical improvement with the systemic use of prednisone 40 mg/d and rifampicin 600 mg/d. In addition, relevant aspects of the uveal effusion such as the pathogenesis, evolution of the disease, differential diagnosis and treatment are described through a revision of the literature.

Metástase de coróide simulando síndrome de efusão uveal: relato de caso / Choroidal metastasis simulating uveal effusion syndrome: case report

Descrição de um caso de efusão uveal secundária a metástase de coróide e revisão dos principais diagnósticos diferenciais. Uma paciente com baixa da acuidade visual, no olho esquerdo, apresentou nódulos ao nível da coróide, dispersão pigmentar retiniana e descolamento seroso da retina. O exame angiofluoresceinográfico demonstrou padrão "leopard spots", semelhante ao encontrado nos casos de efusão uveal. A ecografia ocular demonstrou a presença do descolamento seroso da retina, presença de espessamento e nódulos na coróide e a tomografia de coerência óptica evidenciou ruptura do epitélio pigmentado da retina, presença de nodulações coroidianas hiperrefletivas e áreas de descolamento de retina seroso. Após ser submetido a exames diagnósticos de imagem, constatou-se a presença de nódulo único no ápice pulmonar esquerdo. As metástases de coróide podem levar a um quadro similar à síndrome de efusão uveal. Esta possibilidade deve sempre ser pensada diante de um quadro de efusão uveal atípica e avaliação sistêmica para pesquisa de carcinoma deverá ser solicitada.

We report a case of choroidal metastasis simulating uveal effusion syndrome. This patient with uveal metastasis from lung carcinoma presented with decreased vision in the left eye. Fundoscopic examination revealed pigmentary clumping, multiple choroidal nodules and serous retinal detachment. Fluorescein angioraphy revealed a leopard spots pattern similar to uveal effusion syndrome. Ultrasound revealed the presence of choroidal nodules with moderate internal reflectivity, choroidal thickening and serous retinal detachment. Optical coherence tomography showed retinal pigment epithelium tear and hyper-reflective nodules within the choroid and areas of serous retinal detachment. Image investigation demonstrated the presence of a solitary pulmonary nodule at the left apical lung. Choroidal metastasis can lead to a scenario that simulates uveal effusion syndrome. This possibility must be considered when having an atypical uveal effusion symptomatoloy and a systemic screening for systemic cancer should be performed.

A Case Report on the Change of the Refractive Power After a Blunt Trauma

PURPOSE: To determine the pathogenesis of transient myopia after blunt eye trauma. METHODS: In one patient, the refraction of both eyes (the left eye was injured, but the right eye was not) was measured with an autorefractometer. The cycloplegic refraction was measured at the early stage of trauma and again 3 months after the blunt eye injury. The angle and depth of the anterior chamber, the ciliary body, and the choroids were examined by ultrasound biomicroscopy (UBM) over 3 months. The depth of the anterior chamber, the thickness of the lens, and the axial length were measured by A-scan ultrasonography in both eyes. During the 3 months after the injury, we made comparisons between the menifest and the cycloplegic refractions, the depths of anterior chambers, the thickness of the lenses, the axial lengths, and the UBM-determined appearances of the angles and depths of the anterior chambers, the ciliary bodies, and the choroids in both eyes. RESULTS: We suspect that the depth reduction in the anterior chamber, the increase in anterior to posterior lens diameter, and the edema in the ciliary body are all related to the change in the refractive power following the blunt trauma. CONCLUSIONS: Ultrasound biomicroscopy (UBM) and ultrasonography of the anterior segment in the eye may be helpful to diagnose and confirm changes in the refractive power that occur after trauma.

A Case Report on the Change of the Refractive Power After a Blunt Trauma

PURPOSE: To determine the pathogenesis of transient myopia after blunt eye trauma. METHODS: In one patient, the refraction of both eyes (the left eye was injured, but the right eye was not) was measured with an autorefractometer. The cycloplegic refraction was measured at the early stage of trauma and again 3 months after the blunt eye injury. The angle and depth of the anterior chamber, the ciliary body, and the choroids were examined by ultrasound biomicroscopy (UBM) over 3 months. The depth of the anterior chamber, the thickness of the lens, and the axial length were measured by A-scan ultrasonography in both eyes. During the 3 months after the injury, we made comparisons between the menifest and the cycloplegic refractions, the depths of anterior chambers, the thickness of the lenses, the axial lengths, and the UBM-determined appearances of the angles and depths of the anterior chambers, the ciliary bodies, and the choroids in both eyes. RESULTS: We suspect that the depth reduction in the anterior chamber, the increase in anterior to posterior lens diameter, and the edema in the ciliary body are all related to the change in the refractive power following the blunt trauma. CONCLUSIONS: Ultrasound biomicroscopy (UBM) and ultrasonography of the anterior segment in the eye may be helpful to diagnose and confirm changes in the refractive power that occur after trauma.

Prevalência de cistos iridociliares em exames de biomicroscopia ultra-sônica / Iridociliary cysts on ultrasound biomicroscopic examinations

OBJETIVO: Relatar a prevalência de cistos iridociliares em olhos de pacientes submetidos à biomicroscopia ultra-sônica (UBM). MÉTODOS: Analisaram-se retrospectivamente as imagens de UBM de 1.557 pacientes examinados de setembro de 1995 a junho de 2004. O critério de inclusão foi a UBM ter sido realizada nos quatro quadrantes (superior, inferior, nasal e temporal) do globo ocular. Avaliaram-se e classificaram-se os cistos quanto: a) ao número em cada quadrante; b) ao quadrante de localização; c) à morfologia, medindo o maior diâmetro (vertical ou horizontal), a maior espessura da parede e a área da lesão cística; d) à área de recesso angular (ARA) para cada um dos quadrantes em que havia cisto; e) à hipótese diagnóstica e/ou indicação da UBM. Utilizou-se o "software" UBM Pro 2000 para medir o diâmetro, a espessura da parede, a área do cisto e a ARA. RESULTADOS: Foram encontrados 103 cistos em 56 pacientes correspondendo à prevalência de 4,9 por cento numa amostra de 1.132 pacientes selecionados. Dos 1.132 pacientes, 650 (57,4 por cento) eram do sexo feminino e 482 (42,6 por cento) eram do sexo masculino. Dos 56 pacientes com cisto, 37 (66,1 por cento) eram do sexo feminino e 19 (33,9 por cento) eram do sexo masculino. Dos 1.480 olhos examinados, 774 (52,3 por cento) eram olhos direitos e 706 (47,7 por cento) eram olhos esquerdos. Foram encontrados cistos em 38 (64,4 por cento) olhos direitos e 21 (35,6 por cento) olhos esquerdos. Não houve diferença estatisticamente significativa entre os sexos nem entre os olhos direito e esquerdo. Os cistos com maior média de diâmetro e área estavam localizados nos quadrantes temporal e superior, onde foram encontrados os menores valores de grau de abertura do seio camerular. CONCLUSÕES: Os cistos iridociliares são mais prevalentes nos quadrantes inferior e temporal. Os cistos de maior diâmetro e área situam-se nos quadrantes temporal e superior onde encontram-se menores valores médios de grau de abertura do seio camerular.A espessura da parede dos cistos é praticamente a mesma nos quatro quadrantes. Em 64,3% dos pacientes, a presença de cistos foi um achado ocasional do exame de UBM.

PURPOSE: To present the prevalence of iridociliary cysts in eyes of patients submitted to UBM examination. METHODS: We analyzed retrospectively the UBM images of 1157 patients in the period from September 1995 to June 2004. The inclusion criterion was the UBM examination had been made on the four quadrants (superior, inferior, nasal and temporal) of the eyes. The cysts were assessed and classified in relation to their number in each quadrant; localization and morphology. Using the UBM Pro 2000 software we took the measurements of the largest diameter, wall thickness and area of the cysts besides the angle recession area (ARA). RESULTS: The prevalence of the cysts was 4.9 percent. No statistical difference was found between the prevalence of cysts regarding gender or between the right and left eyes. They were more prevalent in the inferior (39.8 percent) and temporal (29.1 percent) quadrants. The cysts with the largest diameter and area were located in the temporal and superior quadrants. No difference was found in relation to cysts' wall thickness in all quadrants. CONCLUSIONS: No statistical difference was found between the prevalence of cysts as concerns gender or between the right and left eyes. However, the cysts were more prevalent in the inferior and temporal quadrants. The locations of the largest cysts are preferentially the temporal and superior quadrants. The angle recession area was smaller in the temporal and superior quadrants. The cysts' wall thickness is practically the same in all quadrants. The diagnosis of iridociliary cysts was an occasional finding in 64.3 percent of the patients.

Tratamento das uveítes / Uveitis treatment

O objetivo deste trtabalho sobre tratamento das uveítes foi tornar para o colega mais rápido o tratamento das várias etioloogias. Não obstante, é necessário antes do procedimento terapêutico o diagnóstico preciso, pois o tempo perdido no tratamento inadequado pode resultar em pior prognóstico visual e aumento da morbidadee e mortalidade.

Leiomioma mesectodérmico de íris e corpo ciliar - relato de caso / Mesectodermal leiomyoma of the iris and ciliary body: case report

Objetivo: Descrever um caso de leiomioma mesectodérmico de íris e corpo ciliar. Local: Hospital do Câncer - A. C. Camargo - Fundação Antônio Prudente. Método: Relato de caso e revisão da literatura. Relato de caso: O paciente apresentava uma lesão de aspecto sólido, arredondada, avermelhada, ricamente vascularizada em quadrante temporal inferior de íris de olho esquerdo. À biomicroscopia ultrassônica havia extensão ao corpo ciliar. As hipóteses diagnósticas foram: tumor metastático, melanoma amelanótico e outro tumor a esclarecer. Foi realizada a enucleação do olho acometido e o resultado anatomopatológico e imuno-histoquímico revelou leiomioma mesectodérmico de íris e corpo ciliar. Conclusão: O leiomioma mesectodérmico de trato uveal é um tumor benigno e raro. As decisões de conduta podem ser difíceis em função do seu aspecto, tamanho e localização.

The indocyanine green findings in idiopathic uveal effusion syndrome.

We report two cases clinically diagnosed as idiopathic uveal effusion syndrome, where indocyanine green angiogram suggest non-specific choroidal inflammation as the underlying cause. Treatment with non-steroidal anti-inflammatory drugs was beneficial.

Drogas parassimpaticolíticas na terapêutica ocular / Parasympatholytics drugs in ocular therapeutic

Os autores fazem uma revisao dos aspectos farmacológicos de drogas anticolinérgicas na terapia ocular. É demonstrado o fármaco de escolha para algumas situaçoes práticas dentro da clínica oftalmológica e também se procede a um estudo comparativo entre essas mesmas drogas. Com isso, procura-se trazer ao clínico uma visao prática do uso desses fármacos, o que, certamente, contribuirá para esclarecer alguma situaçoes do dia-a-dia da práxis médica.

A Case of Posterior Involvement of Eye in Leprosy Patient

Leprosy is a chronic systemic disease with ocular complications including lagophthalmos, uveal diseases, and corneal diseases. Blindness may result unless appropriate treatment is done. The authors report the ocular leprosy with generalized systemic nodules associated with severe proptosis, corneal opacity and retinal pathology.