Serous retinal detachment in pre-eclampsia: Case report and literature review / Descolamento seroso da retina na pré-eclâmpsia: Um caso clínico e revisão da literatura

Abstract Pre-eclampsia (PE) is an obstetric disease with a multifactorial cause that affects ∼ 5% of pregnant women. Vision can be affected with varying severity, and retinal detachment is a very rare complication. It tends to be bilateral, diagnosed postpartum, and more prevalent in women who are primiparous and/or undergo caesarean delivery. The condition typically resolves completely and rarely causes total visual loss in the affected women. Fluorescence angiographic findings support the hypothesis that retinal detachment in PE is secondary to choroidal ischemia from intense arteriolar vasospasm. The present article is related to a case of a 37-year-old pregnant woman who had PE associated with a progressive blurred vision, diagnosed by ophthalmology as serous macular detachment of the retina.

Resumo A pré-eclâmpsia (PE) é uma doença obstétrica com uma causa multifactorial que afeta ∼ 5% das grávidas. A visão pode ser afetada com uma gravidade variável, sendo o descolamento de retina uma complicação muito rara. Geralmente é bilateral e seroso, e a sua patogênese encontra-se relacionada com a isquemia coroidal, secundária a um intenso vaso espasmo arteriolar. A maioria dos doentes tem recuperação completa da visão com tratamento conservador. No presente artigo, é relatado um caso de uma grávida de 37 anos que desenvolveu PE com critérios de gravidade associada a um quadro de visão turva progressiva, diagnosticada pela oftalmologia como descolamento macular seroso da retina.

Descolamento seroso de coroide como manifestação tardia da síndrome de Vogt-Koyanagi-Harada / Serous choroidal detachment in chronic stage of Vogt-Koyanagi-Harada syndrome

Resumo Relatamos um caso atípico de uma paciente de 40 anos com apresentação completa da Síndrome de Vogt-Koyanagi-Harada (SVKH) que após 17 anos do diagnóstico inicial evoluiu com descolamento seroso de coroide. A paciente procurou atendimento com queixa de dor em olho esquerdo (OE). O exame oftalmológico revelou acuidade visual (AV) igual a de movimento de mãos, à biomicroscopia foi observada reação inflamatória granulomatosa na câmara anterior, a tonometria foi igual a 0 mmhg, e a fundoscopia indevassável pela pouca midríase e turvação de meios em OE. O descolamento seroso de coroide foi avaliado através de ultrassonografia ocular. A abordagem terapeutica intituida para paciente consistiu em prednisona 1mg/kg/dia via oral, dexametasona 1mg/mL e atropina 1% colírios. A evolução do quadro foi satisfatória, com melhora da AV para 20/40, ausência de reação inflamatória em câmara anterior, normalização da pressão intraocular e resolução do descolamento seroso de coroide em OE. Concluimos que a fase crônica da SVKH, apesar da manifestação classicamente descrita ser uveíte anterior, pode ter outras apresentações e o descolamento seroso da coroide é uma rara complicação.

Abstract We report an atypical case of a 40-year-old woman with complete presentation of Vogt-Koyanagi-Harada Syndrome (VKH) who presented with unilateral serous choroidal detachment 17 years after the diagnosis. The patient complained of pain in the left eye, the ophthalmologic examination revealed visual acuity (VA) equal to hand motion; biomicroscopy revealed a granulomatous inflammatory reaction in the anterior chamber, tonometry was equal to 0 mmhg, and the fundoscopy was impracticable. Serous choroidal detachment was assessed by ocular ultrasonography. The therapeutic approach proposed for the patient consisted of prednisone 1mg / kg / day orally, dexamethasone 1mg / mL and atropine 1% eye drops. The evolution of the condition was satisfactory, with VA improvement to 20/40, absence of inflammatory reaction in anterior chamber, normalization of intraocular pressure and resolution of serous choroidal detachment in OS. We conclude that the chronic phase of VKH, although classically described as anterior uveitis, may have other presentations and the serous choroid detachment is a rare complication.

Choroidal neovascularization silent on optical coherence tomography: report of two cases / Neovascularização de coroide silente a tomografia de coerência ótica: relato de dois casos

ABSTRACT Herein, we report two cases of vision loss after successful cataract surgery, associated with drusenoid retinal pigment epithelial detachment without features of choroidal neovascularization on optical coherence tomography along with angiographic examinations suggestive of choroidal neovascularization in which anatomical and functional improvements were achieved with intravitreal injections of anti-vascular endothelial growth factor.

RESUMO Relatamos dois casos de baixa visual após cirurgia bem sucedida de catarata, associada a descolamento drusenóide do epitélio pigmentar da retina (DPED) sem achados de neovascularização de coroide a tomografia de coerência óptica OCT (CNV silente ao OCT) e com exames angiográficos sugestivos de neovascularização da coroide (CNV), nos quais melhoras anatômicas e funcionais foram obtidas com aplicações intravítreas de anti-VEGF.

Comportamiento de las enfermedades oftalmológicas en pacientes con VIH-SIDA / Behavior of eye diseases in HIV-Aids patients

Objetivo: caracterizar las enfermedades oftalmológicas en pacientes con VIH-SIDA diagnosticadas en el Servicio de Uveítis e Inflamaciones Oculares del Instituto Cubano de Oftalmología Ramón Pando Ferrer. Métodos: se realizó un estudio descriptivo longitudinal retrospectivo en 39 ojos (24 pacientes) quienes cumplieron los criterios de inclusión y exclusión de la investigación. Las variables estudiadas fueron: edad, sexo, enfermedades oftalmológicas asociadas, lateralidad, agudeza visual y conteo de linfocitos TCD4+ al inicio y al final de la enfermedad oftalmológica, las complicaciones asociadas y la pérdida de la agudeza visual. Resultados: predominó el sexo masculino (83,3 por ciento) y el grupo etario entre 31 y 45 años, que representó el 45,8 por ciento de la muestra. Existió un gran deterioro visual desde el inicio de la enfermedad, sin mejorias significativas una vez estabilizada esta (p= 0,503). Las enfermedades oftalmológicas más frecuentes en orden de frecuencia fueron la sífilis ocular (32,1 por ciento), la retinitis por citomegalovirus (28,6 por ciento) y la toxoplasmosis (17,8 por ciento). El desprendimiento de retina (27,2 por ciento), las membranas epirretinales (22,7 por ciento) y las cataratas (18,2 por ciento) fueron las complicaciones más frecuentes. Conclusiones: la sífilis ocular es la enfermedad más frecuente en pacientes con VIH-SIDA y no guarda relación con el conteo CD4+. La retinitis por citomegalovirus se asocia a conteos de CD4+ bajos y provoca mayor cantidad de complicaciones. Más de la mitad de los ojos con enfermedades oftalmológicas en los pacientes con VIH- SIDA evolucionan a la ceguera(AU)

Objective: to characterize the eye diseases observed in HIV-AIDS patients diagnosed at the Uveitis and Eye Inflammation Service at "Ramon Pando Ferrer" Cuban Institute of Ophthalmology. Methods: retrospective, longitudinal and descriptive study of 39 eyes (24 patients, who met the inclusion and exclusion criteria of the research. The study variables were age, sex, associated eye diseases, laterality, visual acuity and TCD4+ lymphocyte count at the beginning and the end of the eye disease, the related complications and the loss of visual acuity. Results: males (83.3 percent) and the 31-45 y age group (45.8 percent) of the sample predominated. There was great visual deterioration since the onset of disease, without any significant improvement once the patient is stabilized (p= 0.503). The most common eye diseases were ocular syphilis (32.1 percent), cytomegalovirus retinitis (28.6 percent) and toxoplasmoxis (17.8 percent). Retinal detachment (27.2 percent), epiretinal membranes (22.7 percent) and cataract (18.2 percent) were the most frequent complications. Conclusions: Ocular syphilis is the most common disease in HIV-AIDS patients and is unrelated to CD4+ count. Cytomegalovirus retinitis is associated to low CD4+ counts and unleash higher number of complications. Over half of the eyes with diseases in HIV-AIDS patients evolved into blindness(AU)

Triancinolona intra-vítrea e clorpromazina retrobulbar como alternativas ao manejo do olho cego doloroso / Intravietrea trianciclone and retotubulbar chlorpromazine as alternative to blind paintful eye manegement

RESUMO Objetivo: O objetivo desde estudo foi avaliar a efetividade da triancinolona intra-vítrea e da clorpromazina retrobulbar como alternativas no manejo da dor ocular em olhos cegos. Métodos: Este foi um estudo prospectivo intervencionista não-randomizado de pacientes com olho cego doloroso não responsivo ao tratamento tópico e sem indicação de evisceração atendidos no Serviço de Oftalmologia do Hospital Governador Celso Ramos no ano de 2010. Após exame oftalmológico e ultrassonografia ocular modo B, os pacientes foram divididos em dois grupos. Pacientes do Grupo 1 possuíam glaucoma intratável e receberam injeção retrobulbar de clorpromazina 2,5ml, e pacientes do Grupo 2 possuíam olhos phthisicos com componente inflamatório e receberam injeção intra-vítrea de triancinolona 0,3ml. Foram realizadas avaliações com 1, 3 e 6 meses após o procedimento e a dor quantificada de forma subjetiva em uma escala de 0 a 10 (sem dor e com o máximo de dor, respectivamente). Resultados: Foram incluídos 38 olhos, sendo 15 no Grupo 1 e 21 no Grupo 2. Houve predomínio do sexo masculino e idade média de 54 anos. A causa mais prevalente de olho cego doloroso foi o glaucoma neovascular. Tanto a injeção de clorpromazina retrobulbar quanto a de triancinolona intra-vítrea mostraram-se eficazes no controle da dor ocular em olhos cegos no período do estudo (p<0,001). Ocorreu uma redução de 77,1% no uso de colírios (p<0,01) após a aplicação das medicações. Conclusão: Tanto a injeção de clorpromazina retrobulbar quanto a de triancinolona intra-vítrea mostraram resultados significativos no controle da dor ocular em olhos cegos, além de uma redução no uso de colírios. A clorpromazina é um medicamento de baixo custo, com melhor perfil de efeitos adversos e mostrou resultados discretamente melhores relação à triancinolona. Possíveis viéses identificados no estudo são o de tempo e seleção.

ABSTRACT Objective: The objective of this study was to evaluate the efficacy of intravitreal triamcinolone and retrobulbar chlorpromazine as alternatives in the management of ocular pain in blind eyes. Methods: This was a non-randomized interventional prospective study of patients with painful blind eye unresponsive to topical treatment and without indication of evisceration treated at the Hospital Governador Celso Ramos Ophthalmology Service in 2010. After ocular examination and ocular B mode ultrasound, patients were divided into two groups. Group 1 patients had intractable glaucoma and received retrobulbar injection of chlorpromazine 2.5ml, and Group 2 patients had phthisics eyes with inflammatory component and received intravitreal triamcinolone injection 0.3ml. Evaluations were performed at 1, 3 and 6 months after the procedure and quantified pain subjectively on a scale from 0 to 10 (no pain and maximum pain, respectively). Results: 38 eyes were included, 15 in Group 1 and 21 in Group 2. There was a predominance of males with a mean age of 54 years. The most prevalent cause of painful blind eye was the neovascular glaucoma. Any retrobulbar injection of chlorpromazine as the intravitreal triamcinolone shown to be effective in the control of ocular pain in the eye blind study period (p <0.001). There was a 77.1% reduction in eye drops (p <0.01) after application of medication. Conclusion: Both the retrobulbar injection chlorpromazine as the intravitreal triamcinolone showed significant results in the control of ocular pain in blind eyes, and a reduction in the use of eye drops. Chlorpromazine is a low cost product, with a better adverse effect profile and showed slightly better results compared to triamcinolone. Potential bias identified in the study are the time and selection.

Bilateral maculopathy following electrical burn: case report / Maculopatia bilateral após queimadura elétrica: relato de caso

CONTEXT: Electrical burns are an important etiology in dealing with patients suffering from burns. In situations of extensive deep lesions of multiple organs and systems affecting young and economically active people, there is a need for expensive multidisciplinary treatment, with a high socioeconomic cost for the community. Among the permanent injuries that explain this high cost, eye injuries stand out, since they are widely disabling. Although rare, lesions of the posterior segment of the eye are associated with higher incidence of major sequelae, and thus deserve special attention for dissemination and discussion of the few cases observed. CASE REPORT: The authors report the case of a patient who suffered high-voltage electrical burns and presented bilateral maculopathy, which evolved with a need for a surgical approach to repair retinal detachment and permanent low visual acuity. CONCLUSION: This report highlights the rarity of the etiology of maculopathy and the need for campaigns for prevention not only of burns in general, but also especially of electrical burns. .

CONTEXTO: As queimaduras elétricas representam etiologia importante na abordagem de pacientes vítimas de queimaduras. Lesões extensas e profundas de múltiplos órgãos e sistemas e o acometimento de população jovem economicamente ativa apontam para a necessidade de tratamento multidisciplinar dispendioso, com alto custo socioeconômico para as comunidades. Dentre as lesões permanentes que justificam esse alto custo, as oculares têm local de destaque, porque são amplamente incapacitantes. Embora raras, as lesões do segmento posterior do olho estão associadas a maior incidência de sequelas importantes, merecendo atenção especial para divulgação e discussão dos poucos casos observados. RELATO DE CASO: Os autores relatam o caso de paciente vítima de queimadura elétrica com fio de alta voltagem que apresentou maculopatia bilateral, evoluindo com necessidade de abordagem cirúrgica para correção de descolamento de retina e baixa acuidade visual permanente. CONCLUSÃO: Este relato destaca a raridade da etiologia da maculopatia e a necessidade de campanhas de prevenção não só das queimaduras em geral, mas especialmente das queimaduras elétricas. .

Microperimetry and optical coherence tomography in a case of traumatic macular hole and associated macular detachment with spontaneous resolution.

The association of macular detachment with posttraumatic macular hole is a known but rare occurrence. Spontaneously occurring resolution of the detachment and closure of the macular hole has been reported only once in the literature. We describe a similar rare event in a young male, the documentation of which was done serially by microperimetry (MP) and optical coherence tomography (OCT). A 17-year-old male presented with a decrease in vision following a closed globe injury to the left eye. A coexisting macular hole and macular detachment were detected in the affected eye. Serial follow-up with OCT and MP documented complete resolution of the macular hole and the macular detachment within 1 week of presentation. The case highlights that spontaneous resolution of traumatic macular hole and related macular detachment may occur and a waiting period is advisable before undertaking any corrective surgical procedure. The pathophysiologic mechanisms of causation and the resolution of posttraumatic macular hole-related retinal detachment are discussed.

Clinical Characteristics of Polypoidal Choroidal Vasculopathy Associated with Chronic Central Serous Chorioretionopathy

PURPOSE: To investigate the clinical characteristics of polypoidal choroidal vasculopathy (PCV) associated with chronic central serous chorioretinopathy (CSC). METHODS: We retrospectively reviewed the medical records of 246 PCV patients (283 eyes) between July 2004 and August 2009 and investigated the clinical characteristics of the PCV patients who had specific fundus findings of chronic CSC. RESULTS: Among PCV patients, 13 eyes (4.6%) of 13 PCV patients (5.3%) had fundus findings of chronic CSC. All of the PCV lesions had a solitary polyp located outside the atrophic retina, predominantly in the macular area (84.6%), most showed an exudative pattern (69.2%) and there were a few that showed a hemorrhagic pattern (30.8%). All of the lesions were smaller than 1 disc diameter. Most of the PCV lesions (76.9%) were cured with less than two treatments in a short period of 6.4 +/- 1.9 months; however, visual acuity deteriorated (61.5%) or was not changed (30.8%) in most of the cases. CONCLUSIONS: The PCV associated with chronic CSC had several clinical features such as a small exudative retinal lesion with a solitary polyp and frequent involvement of the macular area. Even though there was poor visual outcome due to the atrophic change, all of the PCV lesions were easily resolved in a short period with a simple treatment course and no recurrence.

Comparison of serum glycosylated hemoglobin levels in patients with diabetic cystoid macular edema with and without serous macular detachment.

Aim: A clinical comparative trial was conducted to compare the levels of glycosylated hemoglobin (HbA1c) in patients with diabetic cystoid macular edema (CME) with and without serous macula detachment (SMD). Materials and Methods: Thirty patients (group 1) with diabetic CME in both eyes, but without SMD, and 30 patients (group 2) with diabetic CME and SMD in both eyes documented by optical coherence tomography (OCT) and fundus fluorescein angiography (FFA), were included in the study. In addition to the measurement of central macular thickness by OCT and visual acuity (VA) (as logMAR) using the the early treatment diabetic retinopathy study (ETDRS) chart, the concentrations of HbA1c were measured by high performance liquid chromatography (HPLC). Statistical analysis was done by independent samples t test. Results: The mean logMAR VA was 0.8 ± 0.22 (1.0–0.5) in group 1and 0.7 ± 0.16 (1.0–0.6) in group 2. The mean central macular thickness, as determined by OCT, was 468.70 ± 70.44 μm (344–602 μm) in group 1 and 477.80 ± 73.34 μm (354–612 μm) in group 2. The difference between the groups was not statistically significant (P = 0.626). The mean HbA1c levels were 8.16 ± 0.99% in group 1 and 10.05 ± 1.66% in group 2. The difference between the groups was statistically significant (P < 0.001). Conclusions: The presence of SMD and high HbA1c levels in the patients with diabetic CME may be indirectly suggestive of retinal pigment epithelium dysfunction.

Alteraciones anatomofuncionales en la coriorretinopatía serosa central aguda, detectadas por tomografía de coherencia óptica y microperimetría / Anatomical and functional alterations detected by optical coherence tomography and microperimetry in the acute central serose chorioretinopathy

OBJETIVO: Determinar las alteraciones anatómicas y funcionales retinales en pacientes con coriorretinopatía serosa central aguda y su repercusión en los resultados visuales. MÉTODOS: Estudio observacional, transversal de 24 ojos con coriorretinopatía serosa central aguda, unilateral. Se realizó, Snellen, microperimetría y tomografía de coherencia óptica, y se calculó el grosor macular central. RESULTADOS: La agudeza visual mejor corregida media fue 0,5. Se encontró desprendimiento seroso neurosensorial en el 100 por ciento de los casos y desprendimiento del epitelio pigmentario en el 29,8 por ciento. El grosor retinal promedio por tomografía de coherencia óptica, fue 388,2 ± 112 Ám. La sensibilidad macular total promedio de 11,9 ±5,2 dB, con una sensibilidad macular central (2º) de 10,9 ± 4,87 dB, no se encontró diferencias significativas entre ellas (p= 0,23). Existió correlación inversa entre la sensibilidad central y el grosor macular (r = -0,76), lo que estadísticamente es significativo (p < 0,01); no se comportó de la misma manera la sensibilidad macular total y el grosor macular (r = -0,68). La localización de la fijación fue central en 86,9 por ciento y predominantemente central en 13,1 por ciento. El 91,3 por ciento tuvo una fijación estable y el 8,7 por ciento relativamente inestable. CONCLUSIONES: En la coriorretinopatía serosa central aguda la sensibilidad macular se ve afectada, estando relacionada con el grosor retinal. La localización y estabilidad de la fijación por lo general se conserva central y estable

OBJECTIVE: To determine the functional and anatomical alterations of the retina in patients with acute central serous chorioretinopathy. METHODS: Cross-sectional observational study of 24 eyes (24 patients) with acute unilateral central serous chorioretinopathy. Snelle´s chart, microperimetry and optical coherence tomography was used and the central macular thickness was estimated. RESULTS: The best average corrected visual acuity was 0.5. All the cases presented with neurosensoral serous detachment and pigmentary epithelium detachment was found in 29.8 percent. The average retinal thickness according to the optical coherence tomography figures was 388.2 ± 112 Ám. The average total macular sensitivity was 11.9 ± 5.2 dB, with central macular sensitivity (2o) of 10.9 ± 4.87 dB. There were no significant differences between them (p= 0.23). Central sensitivity and macular thickness were inversely correlated (r=-0.76), which is statistically significant; however, this did not occur in the correlation between the total macular sensitivity and the macular thickness (r = -0.68). The location of fixation was central in 86.9 percent and predominantly central in 13,1 percent of patients .Stable fixation was found in 91.3 percent whereas the relatively unstable was present in 8.7 percent. CONCLUSIONS: In central acute serous chorioretinopathy, the macular sensitivity is affected and is related with the retinal thickness. Location and stability of the fixation are central and stable in general

Ultrasonography-guided scleral buckle retinopexy and cryotherapy: case report / Retinopexia com "buckle" escleral e crioterapia guiada por ultrassom: relato de caso

If the ocular media are clear, indirect binocular ophthalmoscopy allows retinal detachment and retinal tear identification and treatment under direct visualization. However, if opacities are present preventing direct fundus examination, ultrasonography becomes the most important tool for evaluating the posterior segment. In addition, ultrasonography can be useful in retinal tear treatment by guiding cryotherapy. In this article we describe a rhegmatogenous retinal detachment treatment technique applied to a patient with corneal opacity. Cryopexy and circumferential and radial buckle positioning were guided by ultrasonography, resulting in retinal attachment during the 6-month follow-up period.

Quando os meios oculares são transparentes, oftalmoscopia binocular indireta permite a identificação de descolamento de retina e roturas, bem como seu tratamento sob visibilização direta. Porém, em olhos que apresentam opacidades de meios impedindo o exame oftalmoscópico, a ultrassonografia constitui o exame mais importante do segmento posterior do olho. Além disso, o tratamento de roturas retinianas também pode ser auxiliado pelo uso desse equipamento, orientando a crioterapia. Neste trabalho será apresentada técnica de tratamento de descolamento de retina regmatogênico, no qual a criopexia e o posicionamento dos "buckles" episclerais circunferencial e radial foram guiados pelo ultrassom em paciente com leucoma corneano. O tratamento resultou em aplicação retiniana durante o seguimento em seis meses.

Resultados de retinopexia neumática en pacientes con desprendimiento de retina atendidos en el CENAO-Managua 2005-2007 / Results of pneumatic retinopexy in patients with retinal detachment attended at the dinner-Managua 2005-2007

El presente trabajo se trata de un estudio descriptivo longitudinal, con el objetivo de conocer los resultados post- operatorios de los pacientes a los que se les ha intervenido por Desprendimiento de Retina (DR) con retinopexia neumática. Este estudio lo constituyeron 20 pacientes a quienes se les realizó retinopexia neumática por presentar desprendimiento de retina, de los cuales el 60% fueron del sexo masculino y el 40% restante del sexo femenino. La mayoría (70%) correspondieron a pacientes entre 40 y 59 años de edad, con una media de 55 años. La miopía alta, cirugía de retina con cerciaje fallido y pacientes pseudofáquicos, con y sin ruptura de la cápsula posterior, fueron los antecedentes que con mayor frecuencia presentó la población estudiada. Cabe mencionar que solamente el 30% de los pacientes no tenían ningún antecedente oftalmológico. La mayoría de estos pacientes (60%) acudieron con más de 30 días de evolución de los síntomas, sólo un 10% acudió con menos de una semana de evolución. Se observó que a mayor tiempo de evolución del desprendimiento retinal el paciente presentaba compromiso macular y por tanto una pobre agudeza visual preoperatoria. El 50% de los pacientes acudieron con desprendimiento de retina en dos cuadrantes, seguido con un 25% de pacientes que presentaron DR en un solo cuadrante, estos últimos correspondieron a pacientes cn poco tiempo de evolución y sin compromiso macular. En este estudio se observó que a medida que el tiempo de evolución era mayor o que el número o tamaño del desgarro era mayor, el desprendimiento de retina era más extenso. El 70% presentaban un desgarro al momento del diagnóstico, en relación a su forma, la más frecuente con el 74% fue en herradura, ninguno de ellos se extendía a más de 1 hora de reloj y todos ellos estaban ubicados entre las 10 1/2 a 2 1/2 horaria (superiores). En relación a las complicaciones, éstas se observaron sólo en el 15% que corresponde a tres casos con fracaso...

Macular Hole as a Risk Factor of Choroidal Detachment in Rhegmatogenous Retinal Detachment

PURPOSE: Choroidal detachment (CD) associated with rhegmatogenous retinal detachment (RRD) is a rare, but serious condition, which makes the prognosis worse. Previously reported risk factors for CD in RRD patients include high myopia, aphakia, pseudophakia, and advanced age. However, macular hole has not been discussed as an important factor in increasing the risk of CD in RRD patients. The purpose of this study was to evaluate macular hole as a risk factor for CD in eyes evidencing RRD. METHODS: The medical records of 480 patients with primary RRD were reviewed. We compared the CD incidence among the RRD patients in accordance with the presence or absence of macular holes. The relationship between gender, age, presence of systemic disease, refractive errors, lens status, intraocular pressure and the development of CD were also analyzed. RESULTS: The incidence (4/21 eyes, 19.0%) of CD in the RRD with macular hole was significantly higher than that (7/459 eyes, 1.5%) observed in the RRD without macular hole (p=0.010). The preoperative intraocular pressure (mean+/-SD; 2.5+/-1.3 mmHg) in the RRD with CD and macular hole was significantly lower than that (7.4+/-4.4 mmHg) observed in the cases of RRD with CD without macular hole (p=0.035). The eyes complicated by CD evidenced a higher prevalence of diabetes mellitus (p=0.024) than was observed in the eyes without CD. CONCLUSIONS: The retinal detachment combined with macular hole creates a predisposition toward the development of profound hypotony and CD.

Avaliação ultra-sonográfica do segmento posterior de olhos de cães diabéticos e não diabéticos portadores de catarata / Ultrasonographic evaluation of the eyes' posterior segment of diabetic and non-diabetic dogs with cataracts

A catarata impossibilita a passagem de luz dentro do olho, dificultando o exame físico direto das estruturas oculares. É necessária a identificação prévia de quaisquer alterações oculares que contra-indiquem a cirurgia de catarata. A ultra-sonografia, ou ecografia ocular, é um exame seguro, de baixo custo, não invasivo, de fácil realização, que completa o exame oftálmico. Foi realizada avaliação ultra-sonográfica, com transdutor linear, freqüência de 10 MHz, de 225 olhos de 123 cães, sendo cães controle (Grupo 1), 52 cães não diabéticos portadores de catarata (Grupo 2) e 35 cães diabéticos portadores de catarata (Grupo 3), todos eles atendidos no Hospital Veterinário da Universidade de São Paulo. Foram encontradas as seguintes alterações ultra-sonográficas no Grupo 1: degeneração vítrea em 43 por cento, descolamento de vítreo posterior em 7,7 por cento, hialose asteróide em 4,6 por cento dos olhos; no Grupo 2: degeneração vítrea em 58,9 por cento, descolamento de vítreo posterior em 8,4 por cento, hialose asteróide em 2,1 por cento, processo inflamatório e/ou hemorrágico em 2,1 por cento e descolamento de retina em 4,3 por cento dos olhos; e no Grupo 3: degeneração vítrea em 50,7 por cento, descolamento de vítreo posterior em 13,8 por cento, hialose asteróide em 12,3 por cento, processo inflamatório e/ou hemorrágico em 3,1 por cento e descolamento de retina em 3,1 por cento dos olhos. Concluiu-se, que (1) cães diabéticos, principalmente os que apresentam a doença há mais de 2 anos, tem maior predisposição para o desenvolvimento de hialose asteróide; (2) não houve diferença entre a freqüencia de descolamento de retina encontrada em cães diabéticos e não diabéticos; e (3) a ultra-sonografia ocular é em exame seguro, eficaz e importante na avaliação pré-operatória de cães portadores de catarata.

Cataracts jeopardize the light penetration into the eye and may restrain direct exam of eye structures. It is necessary to identify very early any eye disease that could cause the failure of cataract surgery. The ocular ultrasonography or echography is a safe, non invasive, inexpensive and easy procedure that complements ocular examination. Two hundred and twenty five eyes of 123 dogs were evaluated using a 10 Mhz linear transducer ultrasound. The dogs were divided into three groups, as there is Group 1: 36 healthy control dogs; Group 2: 52 non diabetic dogs with cataracts; and Group 3: 35 diabetic dogs with cataracts; all of them were patients of the Veterinary Teaching Hospital, University of Sao Paulo. The ultrasonographic findings were in Group 1: vitreous degeneration in 43 percent, posterior vitreous detachment in 7.7 percent, asteroid hyalosis in 4.6 percent of the eyes; in Group 2: vitreous degeneration in 58.9 percent, posterior vitreous detachment in 8.4 percent, asteroid hyalosis in 2.1 percent, inflammatory or haemorrhagic process in 2.1 percent, retinal detachment in 4.3 percent of the eyes; and in Group 3: vitreous degeneration in 50.7 percent, posterior vitreous detachment in 13.8 percent, asteroid hyalosis in 12.3 percent, inflammatory or haemorrhagic process in 3.1 percent, retinal detachment in 3.1 percent of the eyes. It could be concluded that (1) diabetic dogs, mainly the ones with diabetes for more than 2 years, have greater chances to develop asteroid hyalosis; (2) there were no significant differences in retinal detachment frequencies for the diabetic and non diabetic dogs; and (3) the ocular ultrasonography is a safe, effective and important exam for the pre-operatory evaluation of dogs with cataracts.

Primary 25-gauge transconjunctival sutureless vitrectomy in pseudophakic retinal detachment.

AIMS: There are few reports on 25-gauge transconjunctival sutureless vitrectomy (TSV) in cases of pseudophakic retinal detachment. We conducted this study to report the anatomic and functional outcomes of 25-gauge TSV in the treatment of primary pseudophakic retinal detachment (RD). DESIGN: Prospective, interventional case series. MATERIALS AND METHODS: Fifteen eyes of 15 patients with RD after cataract surgery with phacoemulsification were evaluated. Primary pseudophakic RDs with macular detachment and proliferative vitreoretinopathy Stage B or less were included in the study. Pars plana vitrectomy with the 25-gauge TSV system, perfluorocarbon liquid injection followed by air exchange, endolaser photocoagulation and sulfur hexafluoride gas (20%) injection were applied to all eyes. RESULTS: Mean follow-up time was 9.2 months (range, six to 12 months). Retinal reattachment with a single operation was achieved in 93% of eyes and with additional surgery, the retina was reattached in 100% of eyes. Preoperative visual acuity was less than 20/200 in all eyes (range, hand motions to 20/400). Postoperative visual acuity was 20/40 or better in eight eyes (53%) and between 20/50 and 20/200 in seven eyes (47%). No severe hypotony was encountered and no sutures were required to close the scleral and conjunctival openings. Postoperative complications were macular pucker in one eye (7%) and cystoid macular edema in another eye (7%). CONCLUSIONS: Primary 25-gauge TSV system appears to be an effective and safe procedure in the treatment of uncomplicated pseudophakic RD.

Tratamento do hemangioma de coróide e descolamento total da retina com vitrectomia posterior: relato de caso / Choroidal hemangioma with extensive retinal detachment treated with posterior vitrectomy: case report

Apresentar a evolução de um caso de hemangioma circunscrito da coróide associado a descolamento total da retina tratado com vitrectomia posterior e endofotocoagulação. Relato de caso intervencional. Paciente do sexo feminino, com 41 anos, apresentava mancha escura na visão do olho direito há uma semana, com progressão da mancha para o campo inferior e diminuição súbita da acuidade visual há dois dias. Ao exame oftalmológico, apresentava acuidade visual menor que 20/400 no olho direito. A fundoscopia do olho direito, observava-se elevação da retina neurossensorial nos quatro quadrantes e uma lesão sub-retiniana avermelhada no pólo posterior, com bordas pouco nítidas. O ultra-som do olho direito mostrava membranas móveis de alta refletividade na cavidade vítrea (retina) aderidas ao nervo óptico e presença de lesão sólida hiperecogênica, homogênea, no pólo posterior, com picos de média refletividade no seu interior, sugestiva de hemangioma de coróide Todos os exames sistêmicos foram normais. Optou-se pela vitrectomia posterior com endodrenagem, retinopexia, endofotocoagulação do tumor e colocação de gás C3F8. A retina manteve-se aplicada nos quinze primeiros dias da cirurgia, quando então apresentou novo descolamento inferior da retina sobre o tumor. Optou-se por nova vitrectomia posterior com endofotocoagulação e colocação de óleo de silicone. A paciente encontra-se no 6° mês de pós-operatório com a retina aplicada, óleo de silicone na cavidade vítrea, hemangioma com marcas de fotocoagulação (inativo?), acuidade visual igual a 20/400 no olho direito. A vitrectomia posterior surge como opção no tratamento do hemangioma da coróide associado a descolamentos extensos da retina, visando restabelecer a anatomia e diminuir as complicações funcionais tardias na retina.

To describe a case of circumscribed choroidal hemangioma with extensive retinal detachment treated with vitrectomy and endolaser photocoagulation. Interventional case report. A 41-year-old female patient was examined with a 7-day history of blurred vision and progression of visual loss in the right eye in the last 2 days. Ophthalmologic examination showed 20/400 visual acuity in the right eye and an extensive retinal detachment with an elevated red lesion on the posterior pole. Ocular ultrasound showed high a reflective membranes in the vitreous cavity (retinal detachment) and an homogeneous hiperecogenic solid lesion suggestive of choroidal hemangioma. Systemic investigation showed no abnormalities. Posterior pars plana vitrectomy with endophotocoagulation and injection of C3F8 gas was performed. After 15 days, an inferior retinal detachment was observed and the patient was submitted to a second vitrectomy with endophotocoagulation and silicon oil implant. After six months, the retina remains attached and the hemangioma shows no signs of exudation. Visual acuity remains 20/400. Posterior vitrectomy appears as an option for the treatment of circumscribed choroidal hemangiomas with extensive retinal detachment.