Maculopatía en ojo de buey por uso de cloroquina. Presentación de un caso / Maculopathy in bull's eye due to the use of chloroquine. Presentation of a case

RESUMEN Se reportó el caso de un paciente con maculopatía en ojo de buey, asociada al uso de cloroquina. El uso de cloroquina en patologías reumatológicas puede provocar daño retinal relacionado con la dosis y el tiempo de evolución del tratamiento. Puede provocar desde afectación visual leve hasta daño irreversible de la visión, lo que depende del tiempo en que se realice el diagnóstico. Se presentó una paciente de 72 años, con diagnóstico de artritis reumatoide desde hace 21 años y tratamiento con cloroquina desde hace 15. Acudió a consulta con disminución de la visión lenta y progresiva bilateral. En el examen oftalmológico de fondo de ojo se diagnosticó maculopatía en ojo de buey. Este diagnóstico se confirmó por estudios de autofluorescencia y por la tomografía de coherencia óptica (AU).

ABSTRACT A case is reported of a patient with maculopathy in bulls' eye associated to the use of chloroquine. The use of chloroquine associated with rheumatologic diseases can cause retinal damage related to the dose and the time of treatment evolution. It can cause from mild visual impairment to irreversible vision damage depending on the time the diagnosis is made. A 72-year-old female patient is presented with a diagnosis of rheumatoid arthritis for 21 years and treatment with chloroquine for 15 years. She assisted the consultation with a slow and progressive bilateral vision decrease; at the ophthalmological examination of the fundus a maculopathy in bull's eye was diagnosed, later confirmed by auto fluorescence and optical coherence tomography studies (AU).

Ceguera y trastornos neurológicos por monóxido de carbono: tratamiento efectivo con oxígeno hiperbárico en dos pacientes pediátricos / Blindness and neurological sequelae following carbon monoxide poisoning: effective treatment with hyperbaric oxygen

Se presentan dos pacientes que desarrollaron deterioro visual debido a una intoxicación por monóxido de carbono. Ellos fueron tratados con oxígeno hiperbárico y recuperaron no solo su visión, sino que, además, mejoraron su signo-sintomatología neurológica. Se cree que la implementación de oxígeno hiperbárico, incluso en un período tardío, será efectiva para revertir las secuelas neurológicas.

We present two patients who developed visual deterioration due to carbon monoxide poisoning. They were treated with hyperbaric oxygen and recovered not only their vision but also they improved neurological signs and symptoms. We believe that implementation of hyperbaric oxygen, even in a late period of time will be effective in reversing neurological sequela

Visual loss following cosmetic facial filler injection / Perda da visão após injeção de preenchimento facial para fins cosméticos

ABSTRACT Facial filler injection for soft-tissue augmentation, wrinkle reduction, and rejuvenation has recently become increasingly popular. This procedure is well accepted and widely performed because of its safety and excellent outcomes. However, complications may occur even in the most skilled hands. A 36-year-old female presented with immediate loss of vision in her right eye following the periocular injection of cosmetic hyaluronic acid facial filler into the glabellar region. The visual loss was accompanied by weakness of her left arm. Blindness may complicate cosmetic facial filler injection. The treating physician should have a firm knowledge of the facial vascular anatomy, and the patient should be aware of the potential blinding complications associated with facial filler injection.

RESUMO A injeção de preenchimento facial para o aumento de tecido mole, redução de rugas e rejuvenescimento tornou-se recentemente3 cada vez mais popular. Este procedimento é bem aceito e amplamente realizado devido à sua segurança e excelentes resultados. Porém, complicações podem ocorrer mesmo nas mãos mais habilidosas. Uma mulher de 36 anos apresentou perda da visão no seu olho direito imediatamente após uma injeção periocular de preenchimento facial à base de ácido hialurônico cosmético na região glabelar. A perda visual foi acompanhada de fraqueza no braço esquerdo. A cegueira pode ser uma complicação da injeção de preenchimento facial para fins cosméticos. O médico deve ter um sólido conhecimento da anatomia vascular da face e o paciente deve estar ciente das possíveis complicações associadas à injeção de preenchimento facial.

Carbon monoxide induced cortical visual loss: treatment with hyperbaric oxygen four years later

We present a patient who developed visual loss after carbon monoxide [CO] poisoning and was treated with hyperbaric oxygen. Clinical Presentation and Intervention: A 21-year-old woman poisoned with CO [with coma lasting 4 h and carboxyhemoglobin level 46%] developed seizures and cortical blindness 3 days after poisoning. Four years later, her visual acuity was 0.2 in both eyes. An 18F-fluorodeoxyglucose positron emission tomography [PET] scan showed reduced metabolism in the bilateral posterior temporal and occipital lobes. The patient received a total of 50 hyperbaric oxygen sessions over 3 months for visual loss and the visual acuity improved to 0.5 in both eyes. In addition, increased metabolism was detected in the brain in post-treatment PET scans. PET documented brain hypoperfusion 4 years after CO poisoning and hyperbaric oxygen therapy improved visual acuity. However, we cannot endorse routine use of hyperbaric oxygen for such patients, until results of further clinical trials demonstrate efficacy of hyperbaric oxygen in CO-induced chronic brain injury

Blindness and total ophthalmoplegia after aesthetic polymethylmethacrylate injection: case report

A injeção de polimetilmetacrilato (PMMA) é prática difundida na medicina estética como medida rejuvenecedora. No entanto, a injeção facial do PMMA carreia sérios riscos, especialmente se realizada na região glabelar. Descrevemos o caso de uma mulher que imediatamente após injeção glabelar de PMMA apresentou amaurose e oftalmoplegia total, revendo ainda a literatura pertinente.

Induction of blindness by formoguanamine hydrochloride in adult male roseringed parakeets (Psittacula krameri).

Formoguanamine (2,4-diamino-s-triazine) was known to be an effective chemical agent in inducing blindness in poultry chicks, but not in adult birds. The present study was undertaken to demonstrate the influences, if any, of this chemical on the visual performance and retinal histology in an adult sub-tropical wild bird the roseringed parakeet (Psittacula krameri). Formoguanamine (FG) hydrochloride was subcutaneously injected into adult parakeets at the dosage of 25 mg (dissolved in 0.75 ml physiological saline)/100 g body weight/day, for two consecutive days while the control birds were injected only with the placebo. The effects were studied after 10, 20, and 30 days of the last treatment of FG. Within 24 h of the treatment of FG, about 90% of the total birds exhibited lack of visual responses to any light stimulus and even absence of pupillary light reactions. The remaining birds became totally blind on the day following the last injection of FG and remained so till the end of investigation. At the microscopic level, conspicuous degenerative changes were noted in the outer pigmented epithelium and the photoreceptive layer of rods and cones in the retinas of FG treated birds. A significant reduction in the thickness of the outer nuclear layer was also found in the retinas of FG treated parakeets, compared to that in the control birds. However, the inner cell layers of the retina in the control and FG administered parakeets were almost identical. It deserves special mention that the effects of FG, noted after 30 days of last treatment, were not very different from those noted just after 10 days of treatment. Collectively, the results of the present investigation demonstrate that FG can be used as a potent pharmacological agent for inducing irreversible blindness through selective damage in retinal tissue even in the adult wild bird, thereby making FG treatment an alternative euthanasic device to a cumbersome, stressful, surgical method of enucleation of the ocular system for laboratory studies.

Secuelas motoras de la intoxicación por metanol: presentación de un caso clínico / Motor sequelae of methanol poisoning: presentation of a clinical case

Se presenta un caso clínico de intoxicación aguda por metanol con amaurosis y paraparesia espástica secuelares que no han respondido al tratamiento esteroidal oral ni intratecal. Se detallan los resultados de su estudio electroencefalográfico, electromiográfico y tomográfico axial computado que reveló hipodensidad putaminal bilateral con cisternas silvianas dilatadas. Se revisa en forma general la clínica y el tratamiento de la intoxicación aguda por metanol, señalando suas probables proyecciones a futuro. Se hace una revisión bibliográfica de las secuelas de la intoxicación por metanol, enfatizando las motoras descritas sólo a partir de 1950

Amaurosis tóxica por alcohol metilico: a propósito de un caso / Intoxication amaurosis by methyl alcohol: a propos of a case

Se hace una revisión bibliográfica por los autores de la literatura mundial acerca de la "Ambliopia tóxica", a propósito de un paciente tratado en este centro por exposición tóxica en su medio laboral, y es el resultado de ello la pérdida total de su visión y la consiguiente incapacidad laboral absoluta y permanente. Se recomienda hacer divulgación entre los obreros que trabajen con sustancias tóxicas y que les pueda traer como consecuencia esta grave afección

Fibroplasia retrocristaliniana: cegueira causada pelo oxigênio / Retrolental fibroplasia: blindness due to oxygen

O problema da fibroplasia retrocristaliniana está sendo indevidamente subestimado entre nós. Acreditam-se que os dados expostos comprovam esta assertiva e indica-se o recrudescimento da fibroplasia retrocristaliniana. Um exame minucioso da retina periférica é um meio eficaz para o reconhecimento das alteraçöes iniciais da fibroplasia retrocristaliniana, prevenindo problemas médico-legais. Os anestesiologistas têm papel importante na contra-indicaçäo de cirurgias eletivas em crianças com menos de 45 semanas de idade gestacional ou com peso inferior a 4,6 kg. A ventilaçäo de recém-nascidos deve ser feita com ar e rigoroso controle PaO2, que näo deve ultrapassar 10-12kPa (80-90 mmHg), deve ser feito por meio dos monitores transcutâneos de PaO2