Large colloid drusen analyzed with structural en face optical coherence tomography / Análise de drusas grandes coloidais através de OCT en face estrutural

ABSTRACT Drusen are extracellular deposits between the basal lamina of the retinal pigment epithelium (RPE) and the inner collagenous layer of Bruch's membrane. Large colloid drusen (LCD) are located below the RPE and are characterized by multiple, large, dome-shaped RPE detachments, with marked attenuation of the ellipsoid zone overlaying the drusen. This report presents the structural en face optical coherence tomography (OCT) findings of LCD and relates them to findings from fluorescein and indocyanine green angiography. We describe the case of a 55-year-old woman who presented with the chief complaint of a 5-year history of progressively worsening vision. Her best-corrected visual acuities were 20/40 and 20/400 in the right eye and the left eye, respectively. Fundus examination showed large bilateral, symmetrical, sub-retinal, yellowish lesions compatible with LCD. We describe the structural en face OCT characteristics and angiographic findings from this patient.

RESUMO Drusas são depósitos extracelulares localizados entre a lâmina basal do epitélio pig mentado da retina (RPE) e a camada colágena interna da membrana de Bruch. Drusas grandes coloidais (LCD) estão localizadas abaixo do EPR, e são caracterizadas por múltiplos descolamentos cupuliformes do EPR com atenuação da zona elipsoide sobrejacente às drusas. O objetivo deste relato é apresentar os achados de tomografia de coerência óptica (OCT en face estrutural em uma paciente com LCD, bem como correlacioná-los com angiografia fluoresceínica e angiografia com indocianina verde. Descrevemos o caso de uma paciente do sexo feminino, 55 anos, que referiu baixa acuidade visual em ambos os olhos há 5 anos. Sua acuidade visual corrigida era de 20/40 no olho direito e 20/400 no olho esquerdo. Ao exame fundoscópico a paciente apresentava lesões compatíveis com drusas grandes coloidais. As características tomográficas e angiográficas também são descritas neste relato de caso.

Drusenoid retinal pigment epithelium detachments / Descolamento do epitélio pigmentar da retina tipo drusenóide

The authors make a review of drusenoid retinal pigment epithelium detachments(DPDs), a form of retinal pigment epithelium detachment(PED) that evolves from confluent and large soft drusen.Drusenoidretinal pigment epithelial detachments are a recognized element of the "dry" AMD. Until now, no treatment is indicated in drusenoid PEDs. The authors describe the clinical characteristics of drusenoid retinal pigment epithelium detachments (DPEDs) and make a review of the DPEDs related in the international literature. We related in this revision paper the multimodal advanced image exams in two cases of dusenoid retinal pigment epithelium detachments (DPEDs) and the general characteristics of thisfinding associated with Dry Macular degeneration.Upon examination of the ocular fundusDPEDs emerge as well-circumscribed yellow or yellow–white elevations of the RPE that are usually found within the macula.They may show scalloped borders and a slightly irregular surface. When visualized using fluorescein angiography (FA),DPEDs are typically described as faint hyper-fluorescent in the early phase followed by a slow increase in fluorescence throughout the transit stage of the study without late leakage. With optical coherence tomography (OCT), drusenoid PEDs usually show a smooth contour of the detached hyperreflective RPE band that may have an undulating appearance.Drusenoid PEDs encompass far above the ground possibility type of "dry" AMD that develops in relationship with large confluent soft drusen.At this point no treatment is utilized in drusenoid retinal pigment epithelium detachment(DPEDs).

Os autores fazem uma revisão do descolamento do epitélio pigmentar tipo drusenoide e apresentam dois casos desta patologiaassociada à degeneração macular relacionadaà idade descrevendo seus achados em avançados exames com imagem da retina.Neste artigo de revisão da literatura sobre os achados característicos dodescolamento do epitélio pigmentar tipodrusenoide e sua evolução descrevemos os achados de dois casosassociados à degeneração macular relacionada à idade, forma seca, utilizando exames como SD-OCT, fundusautofluorescencia e angiografia com indocianinaverde, além de retinografiacolorida e fluoresceínica. Odescolamento do epitélio pigmentar tipo druside evolui á partir de drussas moles confluentes presentes na degeneração macular relacionada à idade e é também associado a outras doenças retinianas. Até este momento não há tratamento para esta forma da doença.

Molecular genetic analysis and clinical phenotype of a pedigree with familial dominant drusen / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To analyze clinical features and mutations of EFEMP1 gene in a Chinese pedigree with familial dominant drusen.</p><p><b>METHODS</b>Clinical features of the pedigree were studied with fundus photography, fundus fluorescein angiography and optical coherence tomography. Molecular genetic analysis was performed on the patients and unaffected individuals from the family. All coding exons of the EFEMP1 gene were amplified by polymerase chain reaction (PCR) and sequenced. The results were compared with wild-type sequences from NCBI. The proband who had suffered from choroidal neovascularization and preretinal hemorrhage received an intravitreal injection of an anti-vascular endothelial growth factor (VEGF) preparation.</p><p><b>RESULTS</b>A heterozygous mutation C>T (R345W) was identified in exon 10 of the EFEMP1 gene in two affected individuals from the family. The same mutation was not detected in unaffected family members and 100 healthy individuals. Postoperative follow-up of the patient receiving intravitreal injection of anti-VEGF drug showed that visual acuity was improved and fundus appeared to be stable.</p><p><b>CONCLUSION</b>The R345W mutation in EFEMP1 is responsible for the dominant drusen in this family. Intravitreal injection of anti-VEGF drug is a promising treatment for the improvement in vision.</p>

Grid laser photocoagulation in the treatment of serous avascular pigment epithelial detachment in age-related macular degeneration / Fotocoagulação a laser em "grid" no tratamento do descolamento do epitélio pigmentado seroso avascular associado à degeneração macular relacionada à idade

Purpose: Describe the outcomes of thermal laser photocoagulation in three cases of retinal pigment epithelium detachment associated to age-related macular degeneration. Methods: Three patients with avascular retinal pigment epithelium detachment were treated with green diode laser photocoagulation. Mild macular grid laser application, similar to the treatment of diabetic macular edema was performed after an unsuccessful intravitreal anti-angiogenic treatment. Results: After one year of the laser treatment, two cases reached anatomic resolution, with complete absorption of sub-epithelium serum fluid and improvement of the visual acuity. There was stability of the visual acuity and sub-epithelium fluid reduction, which, however, was partial in the third case. No complications related to the treatment occurred until the conclusion of this study. Conclusions: Macular photocoagulation in grid pattern produced regression of avascular serous pigment epithelium detachment associated with age-related macular degeneration in a short follow-up period. Although long term prospective studies with an increased sample are necessary, it is a method that can be applied in selected patients, with absence of sub-retinal neovascularization or sub-epithelium fibrovascular component. .

Objetivos: Descrever os resultados da aplicação de laser térmico em três casos de descolamento do epitélio pigmentado da retina associado à degeneração macular relacionada à idade. Métodos: Três pacientes com descolamento do epitélio pigmentado seroso avascular receberam tratamento com fotocoagulação a laser de diodo verde. A aplicação em forma de "grid" macular suave, semelhante ao tratamento de edema macular diabético foi realizada após tratamento sem sucesso com antiangiogênico intravítreo. Resultados: Após um ano da aplicação do laser, dois casos obtiveram resolução anatômica, com absorção total do fluido seroso sub-epitelial e melhora da acuidade visual. Houve estabilidade da acuidade visual e redução parcial do fluido sub-epitelial no terceiro caso. Não ocorreram complicações relacionadas ao tratamento até a conclusão deste estudo. Conclusões: A fotocoagulação a laser em "grid" macular produziu regressão do descolamento do epitélio pigmentado seroso avascular associado à degeneração macular relacionada à idade no seguimento de curto prazo. Apesar de necessitar de estudos prospectivos de longo seguimento e com maior tamanho de amostra, trata-se de um método que pode ser aplicado em pacientes selecionados, com ausência de neovascularização sub-retiniana ou componente sub-epitelial fibrovascular. .

Most common clinical features of age related macular degeneration in Pakistan

To document the most common clinical symptoms and signs in patients diagnosed with ARM and ARDM. Observational study. The study was conducted at Retina clinic, Al-Shifa Trust Eye Hospital, Rawalpindi. Patients with age related macular degeneration were randomly selected over a period of 6 months. A pre-tested structured questionnaire was filled by a consultant in retina clinic. Patients were asked about the presenting symptoms already enlisted in the questionnaire. The pupil was dilated till adequate retinal examination was possible and the clinical signs observed and documented. 209 eyes of 106 patients were examined. 18 were having age related maculopathy, 80 had atrophic type of ARMD and 111 were having exudative ARMD. The patients were having gradual blurring of central vision [91%], reading difficulty [28%] and metamorphopsia [9.6%] as the most common presenting symptoms. Macular drusen were the most common feature of maculopathy. Also, macular drusen were the most common clinical feature of eyes with Dry ARMD. Eyes with wet ARMD were having choroidal neo-vascular membrane [CNV] in 86% of cases and pigment epithelial detachment [PED] in rest of the 14%. There is need for making an organized screening protocol of macular degeneration for our population at risk. Every patient complaining of gradual blurring of vision and metamorphopsia should be examined for signs of ARMD. Macular drusen, hypo and hyper-pigmentation of RPE, CNV with exudation and hemorrhage or fibro-glial scar and PED must be identified on retinal examination for proper diagnosis and management of the ARMD

Long-term effect of prophylactic laser treatment for bilateral soft drusen / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Large drusen is a known risk factor for the development of late complications of age-related macular degeneration (AMD) and drusen reduction has been found by our previous study. To prospectively evaluate the efficacy and safety of prophylactic laser treatment in Chinese patients with bilateral soft drusen, we examined the structure and function of the macula 8 years after treatment.</p><p><b>METHODS</b>Ten patients with more than 10 soft drusen (> 125 mm) and best corrected visual acuity ≥ 20/25 in each eye participated in the study. One eye, with relatively more drusen, was exposed to an argon laser (514 nm) to achieve a barely visible retinal lesion. The contralateral eye was used as a control. Fluorescein angiography, Amsler tests, Fourier-domain optical coherence tomography and visual evoked potential tests were carried out 8 years later.</p><p><b>RESULTS</b>No choroidal neovascularization was seen in the laser-treated eyes or control eyes. There were no significant differences in visual acuity or P100 latency and amplitude between the laser treated eyes and contralateral eyes (t = 1.685, 1.184; P > 0.05). The thickness of the retinal pigment epithelium of the treated eyes was less than that of the contralateral eyes (t = -4.540; P < 0.05). The full retinal thickness in treated eyes was slightly, but insignificantly, reduced relative to contralateral eyes (t = -1.746; P > 0.05).</p><p><b>CONCLUSIONS</b>The treatment was associated with a reduction in retinal pigment epithelium thickness elevation compared with the contralateral eyes. Macular function was not impaired.</p>

Degeneración macular relacionada a la edad / Age-related macular degeneration

La degeneración macular relacionada a la edad es la causa más frecuente de pérdida de visión irreversible en personas mayores de 60 años. Son factores de riesgo la edad, la genética, el tabaquismo y la obesidad abdominal. Su primera manifestación visible son las drusas, acumulación de productos provenientes de la degradación incompleta de la digestión de segmentos de fotoreceptores por el epitelio pigmentario. La administración de antioxidantes y zinc disminuye el riesgo de pérdida severa de visión en un 25 por ciento en pacientes con drusas. El proceso puede evolucionar a la atrofia de fotoreceptores y epitelio pigmentario (forma seca) o a la aparición de vasos de neoformación que invaden el espacio subretinal, son sangre y líquido subretinal (forma húmeda). La primera es de comienzo insidioso y lentamente progresiva. La segunda produce pérdida brusca de visión central. No existe hoy día un tratamiento eficaz para la forma seca. La forma neovascular no tratada tiene un pobre pronóstico conduciendo a ceguera legal. Sin embargo, la terapia antiangiogénica con inyecciones intravitreas repetidas de bloqueadores del factor de crecimiento endotelial (VEGF) permite la estabilización o mejoría de visión en la mayoría de los pacientes

Age-related macular degeneration (AMD) is the leading cause of irreversible blindness in persons over 60 years of age. Risk factors are age, genetics, smoking and abdominal obesity. Drusen are the first visible sign of the disease, as yellow deposits lying deep in the retina. Drusen are accumulation of residual bodies due to incomplete digestion of the outer segments of the photoreceptors by the retinal pigment epithelium. In patients with drusen, the administration of antioxidants and zinc, reduces the risk of severe loss of vision by 25 percent. The disease may progress to atrophy of the retinal pigment epithelium ("dry AMD") or to a neovascular form, with invasion of the subretinal space by sprouts of coroidal neovascularization, with blood and subretinal fluid ("wet AMD"). The dry form is a slowly progressive disease, with patches of retinal pigment epithelium and photoreceptor atrophy. Patients with the wet form experience sudden loss of vision. There is no proven effective treatment for the dry form today. Neovascular AMD has a poor prognosis if left untreated, resulting in legal blindness. However, antiangiogenic therapy with anti-vascular endotelial growth factor modalities, administered in repeated intravitreal injections, allows stabilization or improvement of visual acuity in most cases.

Fundus autofluorescence and optical coherence tomography findings in choroidal melanocytic lesions

To establish the characteristics of secondary retinal and retinal pigment epithelial [RPE] changes associated with the presence of choroidal melanoma and choroidal nevus as documented by optical coherence tomography [OCT] and fundus autofluorescence [FAF]. PubMed review of major English publications examining the correlation between clinical characteristics of choroidal melanoma and nevus with OCT and FAF findings. The intrinsic properties of choroidal melanoma, as well as overlying RPE changes, drusen, and lipofuscin are best characterized by FAF, while OCT is more sensitive for the identification of subretinal and intraretinal fluid as well as a trophy, degeneration, and photoreceptor loss in the neurosensory retina. Secondary retinal changes associated with choroidal melanocytic lesions can be documented by OCT and FAF. OCT evident changes are observed more often with choroidal melanoma than choroidal nevus. OCT is better suited to identify the overlying retinal detachment and edema, even before these findings are clinically apparent. FAF is most useful in documenting the presences of lipofuscin, a finding that represents one of the important criteria in differentiating small choroidal melanoma from benign choroidal nevus

Historia natural de retinopatía diabética en un estudio a largo plazo en pacientes con diabetes tipo 1. Factores de riesgo para progresión a enfermedad proliferante / Natural history of diabetic retinopathy in a retrospective cohort of type 1 diabetics

Background: Diabetic retinopathy is one of the most common causes of blindness among adults. Aim: To report the natural history of diabetic retinopathy among Chilean patients with type 1 diabetes followed for a mean of 18 years. Material and methods: Retrospective review of medical records of 39 patients aged 26 to 70 years, (20 females, 78 eyes) with type 1 diabetes controlled by the same ophthalmologist from 1971 to 2008. A questionnaire was sent to each patient and their treating physician to request information about the evolution of the disease and metabolic control. Results: The questionnaire was answered by 24 patients (62 percent) and 21 attending physicians (54 percent). Small hard drusen were observed in 25 patients (64 percent). In 12 cases the drusen were detected before the development of any type of retinopathy. Eleven women became pregnant and retinopathy progressed in four of them. Twently three patients (59 percent) developed proliferative diabetic retinopathy (PDR). Patients with PDR had a significantly longer duration of diabetes and worse glycemic control. There was a higher frequency of diabetic nephropathy in the PDR group, but only 13 patients out of 23 with PDR had nephropathy. The retinopathy progressed to high risk PDR two years after successful kidney-pancreas transplantation in one patient. Conclusions. In patients with type 1 diabetes mellitus, small hard drusen may be the initial manifestation of diabetic retinopathy. Risk factors for progression to PDR were duration of diabetic and poor glycemic control. Nephropathy was more prevalent in patients with PDR, but a significant group of PDR patients did not have demonstrable nephropathy (RevMéd Chile 2009; 137:1145-52).

Photodynamic Therapy Treatment for Eyes with Drusenoid Pigment Epithelium Detachment

We report the clinical course of photodynamic therapy (PDT) in a patient with drusenoid pigment epithelium detachment (PED). A patient with drusenoid PED underwent PDT follow-up was carried out at one week, one month, three months, six months and one year after treatment. Fundus exam, optical coherence tomography (OCT) and fluorescein angiography were performed. After the PDT, drusen and PED were gradually diminished over one year. However, pure serous PED eventually developed at the same location of the drusenoid PED. The results of the PDT, on drusenoid PED, were initially effective, but not completely successful. Therefore, PDT may be considered as an alternative treatment option for drusenoid PED.

Avaliação da perimetria macular em pacientes com degeneração macular relacionada à idade por meio do oftalmoscópio de rastreamento a laser / Evaluation of macular perimetry in patients with age-related macular degeneration using the scanning laser ophthalmoscope

OBJETIVOS: Verificar a relação entre alterações anatômicas (drusas duras, drusas moles, hiperpigmentação, neovasos, descolamento do epitélio pigmentado da retina, hipopigmentação e atrofia coriorretiniana) e a sensibilidade à luz em pacientes com degeneração macular relacionada à idade (DMRI); analisar a sensibilidade macular em áreas com ausência de lesões anatômicas nos pacientes com DMRI comparando-as ao grupo de controles, para avaliar a existência ou não de lesão funcional em área sem lesão anatômica. MÉTODOS: Estudo comparativo, descritivo e analítico, de corte transversal. O grupo de casos foi formado por 31 indivíduos portadores de DMRI com idade entre 51 e 88 anos. O grupo de controles ficou composto por 31 indivíduos considerados "sadios", não portadores de DMRI com idade entre 61 e 80 anos. Os grupos foram pareados por sexo e idade. Realizou-se a perimetria macular estática, vermelho-vermelho, com o oftalmoscópio de rastreamento a laser (ORL). Os resultados da perimetria macular foram correlacionados à lesão anatômica identificada no local correspondente pelo laser infravermelho e fotografias coloridas. RESULTADOS: As áreas com neovasos ou atrofia apresentaram sensibilidade significantemente diferente em relação às áreas com ausência de lesões anatômicas nos pacientes com DMRI. Houve perda funcional significativa em áreas com ausência de lesões anatômicas nos pacientes com DMRI em relação ao grupo de controles. CONCLUSÕES: Áreas com neovasos ou atrofia podem ser fatores individuais de piora da sensibilidade macular localizada. Pode ocorrer perda funcional mesmo sem lesão anatômica aparente nos pacientes com DMRI.

PURPOSES: To evaluate the correlation between anatomical changes (hard druses, soft druses, hyperpigmentation, new vessels, detachment of retinal pigment epithelium, hypopigmentation and chorioretinal atrophy) and light sensitivity in patients with age-related macular degeneration (ARMD); analyze macular sensitivity in areas with no anatomical lesions in patients with ARMD and compared them to the control group in order to detect if there was any functional lesion in areas with no anatomical changes. METHODS: A cross-sectional, comparative, descriptive and analytic study was performed. The case group consisted of 31 subjects with ARMD aged between 51 and 88 years. The control group consisted of 31 "healthy" subjects, without ARMD aged between 61 and 80 years. The groups were matched for gender and age. We performed static macular perimetry, red-red, using a scanning laser ophthalmoscope (SLO). Results of macular perimetry were correlated with the anatomic lesion identified in the same site by infrared laser and color photographs. RESULTS: Areas with new vessels or atrophy showed a significantly different sensitivity in relation to areas without anatomical lesions in patients with ARMD. There was significant functional loss in areas with no anatomical lesions in patients with ARMD in relation to the control group. CONCLUSIONS: Areas with new vessels or atrophy could be distinct factors for worsening of the localized macular sensitivity. There might be functional loss even in areas with no apparent anatomical changes in ARMD patients.

Acometimento intra-ocular na doença de Erdheim-Chester - primeiro relato na literatura: relato de caso / Intraocular involvement in Erdheim-Chester disease - first report in the literature: case report

A doença de Erdheim-Chester (DEC) tem causa desconhecida e se caracteriza por ser granulomatosa e infiltrativa, com proliferação de histiócitos contendo colesterol e particular acometimento ósseo. À histologia, é semelhante à histiocitose de células Langerhans, salvo na análise imuno-histoquímica. Pela primeira vez é descrito o acometimento intra-ocular nesta doença. MPSG, 46 anos, sexo feminino, apresentou-se com proptose do olho direto. Referia úlceras no palato duro, osteoesclerose bilateral e simétrica na diáfise tibial e fibular e nódulo na mama direita (biópsia: infiltrado rico em histiócitos xantomatosos e perfil imuno-histoquímico com CD68 +, S-100 e CD1a negativos, compatível com DEC). À RNM, tumoração extraconal justa-bulbar temporal superior na órbita direita, hiperintensa em T1 e próxima da glândula lacrimal. Em cada olho, visão 20/20, com numerosas drusas nas arcadas e na região macular similares às drusas laminares basais, além de duas regiões placóides elevadas com infiltrado alaranjado sub-retiniano e hiperfluorescentes na angiografia na região peridiscal inferior e justamacular temporal do olho direito. Dois anos depois, surgiram membranas neovasculares sub-retinianas em ambos os olhos. O OD manteve visão 20/20 com pequenas alterações campimétricas e o OE evoluiu com grande cicatriz disciforme e visão de vultos. Esta descrição pioneira demonstra características in vivo dos granulomas histiocíticos da DEC, e alerta para possíveis complicações intra-oculares.

Erdheim-Chester disease (ECD) is a granulomatous and infiltrative disorder of unknown etiology with proliferation of cholesterol-containing histiocytes and peculiar bone involvement. It is very similar to Langerhans cell histiocytosis (LCH) on histology but with a different immunohistochemical profile. This is the first report of intraocular involvement in this disease. MPSG, a 46 y.o. woman, presented with proptosis of the OD. She referred ulcerated lesions on the hard palate, symmetrical and bilateral osteosclerosis of the fibulae and tibiae and a nodule in the right breast (biopsy: xantomatous histiocytic infiltrate CD68+, S-100 and CD1a negative on immunohistochemistry compatible with ECD). MRI studies demonstrated an extraconal tumor in the juxta-bulbar temporal portion of the right orbit close to the lacrimal gland and hyperintense on T1. Vision was 20/20 OU, with numerous drusen in the posterior pole, similar to basal laminar drusen. Two regions of orange subretinal infiltrates that showed progressive staining on the angiogram were seen in the peripapillary region and also close to the fovea in the OD. Choroidal neovascular membranes were seen 2 years later in OU leading to severe visual loss in the OS and to a slight visual field loss in the OD, which retained 20/20 vision. This pioneer report depicts in vivo characteristics of histiocytic granulomas in ECD. Caution should be taken with patients with ECD as potentially blinding intraocular complications may arise.

Therapeutic effect of macular grid photocoagulation in treatment of nonexudative age-related macular degeneration

To investigate the effect of prophylactic subthreshold laser macular grid photocoagulation on drusen area and to evaluate the visual outcome and incidence of choroidal neovascularization in patients with soft drusen maculopathy. In a nonrandomized nonmasked clinical trial, 18 patients [36eyes] with bilateral soft drusen maculopathy were studied. For each patient, one eye was treated with 48 subthreshold [invisible end-point] applications of 532-nm KTP-laser in a macular grid pattern and the fellow eye was observed. Soft drusen areas were calculated and compared between the two groups at baseline and follow-up visits at 3, 6, 12, and 30 months of therapy. Best corrected visual acuity was also compared in observed and laser-treated eyes. Reduction of drusen area, change in visual acuity, and rate of CNV were assessed in both groups. At baseline, there was no significant difference in the mean drusen surface area between the two groups [P=0.90]. The mean surface area of soft drusen in treated eyes was6.51 mm[2] after 30 months and 7.58 mm[2] [P=0.50] in the control eyes. There was a trend towards reduction in the mean soft drusen area after 30 months from baseline in laser-treated eyes [6.51 vs6.97 mm[2]]. In treated eyes, there was no statistically significant difference between the mean best corrected visual acuity at the baseline [0.28 logMAR] and after 30 months [0.32 logMAR] [P=0.40]. Subthreshold macular grid photocoagulation with 532-nm KTP-laser did not seem to reduce drusen surface area significantly and did not improve best corrected visual acuity after 30 months. No exudative lesion developed in laser-treated eyes

Descolamento viteliforme macular associado a drusas da lâmina basal: relato de caso / Vitelliform macular detachment associated with basal laminar drusen: case report

Lesão viteliforme da mácula é mais observada nas distrofias de Best e foveomacular do adulto. No presente estudo, os autores relatam caso raro de descolamento viteliforme macular associado a drusas da lâmina basal, acompanhado no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo há aproximadamente quatro anos, avaliado periodicamente com exames complementares. Os autores descrevem aspectos relevantes desta doença como etiopatogenia, evolução, diagnósticos diferenciais e tratamento.

Age-related changes in the macula. A histopathological study of fifty Indian donor eyes.

PURPOSE: Age-related macular degeneration (ARMD) is clinically less common in India compared to the West. Therefore, clinicians are unfamiliar with histopathologic evidence of age-related macular changes in the Indian population. METHODS: Fifty consecutive human donor eyes removed for corneal grafting were studied for gross, microscopic and histochemical features of age-related changes in the macula in the Indian population. A horizontal block was cut from the globe including the optic disc, and the macula. Six sections, 6 microns thick, were cut from three levels in the macula at a distance of 140 microns. These were stained with haemotoxylin-eosin, periodic acid-Schiff, Mallory, Masson trichrome, alcian blue and von Kossa stains. The presence of basal laminar deposits, drusen and thickening and calcification of Bruch's membrane in the macula were assessed at 400 x magnification using a modified version of Sark's classification. RESULTS: Twenty-four donor eyes (48%) had some form of age-related macular change. These included basal laminar deposits, hard drusen, soft drusen, extensive retinal pigment epithelium atrophy of the macula, and disciform degeneration of macula. A combination of changes was often seen. Age-related changes were more common in the seventh and eighth decade. CONCLUSION: Our study shows that histological changes characteristic of the early stages of age-related macular degeneration are fairly common in the Indian population. However, advanced macular changes are significantly rare.

Características das drusas na angiografia fluoresceínica em pacientes com a fase inicial da degeneração macular relacionada à idade / Drusen behavior during fluorescein angiography in the early stages of age-related macular degeneration

Objetivo: Analisar as características das drusas nas fases iniciais, da Degeneração Macular Relacionada à Idade (DMRI), através da angiografia fluoresceínica. Local: Universidade Federal de Pelotas - RS e Curso de Especialização em Oftalmologia Prof. Ivo Corrêa-Meyer. Métodos: Para tanto, 90 exames de pacientes com este diagnóstico foram coletados, sempre, com o mesmo padrão técnico. O estudo é transversal, compreendendo o período entre 1985 e 1998. As imagens incluíram o momento antes do clarão coroídeo e obedeceram a seqüência de uma foto a cada 1-2s, no máximo, até a fase venosa tardia. Os angiogramas foram todos digitalizados para facilitar as análises que incluíram a observação do número, tipos, distribuição e fluorescência das drusas. Resultados: As drusas foram numericamente mais prevalentes, seguidas pelos quadros mistos, sendo a distribuição dispersa a morfologia mais encontrada, sem relação ao sexo ou idade. Número superior a 20 drusas ocorreu em 57,8 por cento. Fluorescência igual, maior ou menor que a coróide adjacente foi observada na mesma proporção de casos. Conclusão: Nas fases iniciais da DMRI predominam as drusas duras sobre as moles, geralmente em número superior a 20, distribuídas de forma dispersa, podendo ter fluorescência igual, menor ou maior que a coróide circunjacente.

Distrofias maculares hereditarias / Hereditary macular dystrophies

Se hace una breve revisión de las distrofias maculares hereditarias y su clasificación. Existe un gran número de ellas reportado en la literatura, pero prácticamente el 90 por ciento de todas lo ocupan la enfermedad de Stargardt y la enfermedad de Best; la primera de estas ocupa casi las tres cuartas partes del total; de estas dos se hace una descripción somera. Se hace énfasis de los elementos clínicos de diagnóstico, así como de las pruebas electrofisiológicas necesarias para su confirmación. De las distrofias restantes se hace sólo mención.

Retinopatía hipertensiva / Hypertensive retinopathy

Se denomina Retinopatia Hipertensiva, a los cambios que sufren los vasos del árbol vascular retinal producidos por la hipertensión. Es de suma importancia considerar por separado dos aspectos de la hipertensión sistématica: su gravedad y su duración. La gravedad se refleja por el grado de retinopatía y los cambios vasculares hipertensivos; la duración se refleja por el grado de retinopatia y los cambios vasculares arterioescleróticos

Reabsorçäo de drusas moles após fotocoagulaçäo a laser: relato de dois casos / Soft drusen resorption after photocoagulation: description of two cases

As drusas moles säo precursoras da degeneraçäo macular senil atrófica e exsudativa. A reabsorçäo dessas drusas maculares em resposta à fotocoagulaçäo a laser tem sido descrita em trabalhos anteriores. No presente estudo mostramos dois casos em que houve reabsorçäo das drusas tratadas e näo tratadas por fotocoagulaçäo, apresentando também melhora da acuidade visual. O olho contra-lateral näo recebeu nenhum tratamento e mostrou-se inalterado durante o período de observaçäo. A fotocoagulaçäo das drusas pode reduzir significativamente a presença das mesmas no pólo posterior