RESUMEN
Aim: To present clinical picture and treatment of anterior idiopathic necrotizing scleritis. Methods: Clinical and laboratory examination; B-scan ultrasound; tissue biopsy and histological analysis, were performed. Results: Herewith we depict a case of 74 year old man, with unilateral granulomatous, anterior, necrotizing scleritis. Etiology has, through extensive testing, both laboratorial and clinical, not been proven and thus the patient has been classified as having idiopathic scleritis. Complications on both anterior (anterior uveitis) and posterior (subretinal granulomatous infiltrates with localized retinal detachment) segments of the eye are a consequence of granulomatous necrotizing scleritis. Both tissue biopsy of granulomatous scleral infiltrates and histological analysis showed that this is the case of granulomatous, partially necrotizing scleritis with some elements of vasculitis. Progression of granulomatous scleral infiltrates into the eye has also been shown through clinical examination and B-scan ultrasound, and depicted subretinal lesion of medium reflectivity that is in contact with the epibulbar lesion. Retinal detachment in this area had progressed and required excessive laser photocoagulation barrage and resulted in absorption of subretinal fluid. Positive therapeutic outcome was achieved through the use Methotrexate and corticosteroids. Conclusion: Granulomatous infiltrates that spread towards the subretinal space and result in localized retinal detachment are a rare complication that may occur during the evolution of necrotizing scleritis and require regular monitoring and followup. Treatment, both pharmaceutical and laser photocoagulation, should be adjusted in order to affect progression and prevent possible complications of the disease.
RESUMEN
PURPOSE: To investigate the effect of localized retinal detachment on both the detached and attached regions, and to determine the effect of triamcinolone on Muller cell gliosis. METHODS: Pars plana vitrectomy was performed in both eyes of 12 pigmented rabbits. A dome shaped retinal detachment was made by injecting sodium hyaluronate into the subretinal space. Triamcinolone (5 mg) was applied intravitreally to one eye (12 eyes). The detached retinal area and the neighboring attached region were studied by light and electron microscopy 3, 7, and 28 days after surgery. Tissues were prepared in 5 um sections for hematoxylin-eosin staining and immunohistochemistry with antibody to glial fibrillary acidic protein (GFAP). RESULTS: In addition to the well-known degeneration of photoreceptor cells in the detached retina, an incomplete but severe loss of ganglion cell axons occurs in both the detached and the attached regions. The total retinal thickness gradually decreased in the detached areas, while the thickness of the inner retinal layers remained virtually unchanged over several weeks. Gliotic alterations were apparent in both the detached and non-detached retinal areas, and intravitreal triamcinolone did not alter these gliotic alterations of Muller cells. CONCLUSIONS: It is noteworthy that progressive retinal destruction also occurs in the attached retina after local detachment. This may account for visual impairment in strikingly large areas of the visual field, even after retinal reattachment.