Retinitis necrotizante aguda. A propósito de un caso / Acute necrotizing retinitis. Case report

RESUMEN La retinitis necrotizante aguda, es una necrosis retinal de todas las capas de la retina. Se caracteriza por necrosis fibrinoides de la pared de los vasos y oclusión vascular. Se presentó un caso de una paciente de 42 años de edad, con pérdida brusca de la visión del ojo derecho, con una semana de evolución. Al examen oftalmológico se observó haze vítreo 2+, edema sucio del disco óptico, con borramiento de todos sus bordes. Presencia de exudación blanca-amarillenta retiniana extensa, en toda la periferia y área ecuatorial asociada a hemorragias intraretinianas. Se realizó además del examen fundoscòpico toma de muestra de humor acuoso para reacción en cadena de la polimerasa y angiografía fluoresceínica. Los signos fundoscópicos de la paciente, así como las anomalías detectadas en la angiografía fluoresceínica sugirieron el diagnóstico clínico de síndrome de necrosis retinal aguda. Se confirmó el diagnóstico etiológico viral, semanas después por el resultado de polimerasa. Se practicó la terapéutica médica y fotocoagulación laser focal retiniano correspondiente, asociado a cirugía del desprendimiento de retina mixto mediante vitrectomía pars plana y se logró la re aplicación de la retina.

ABSTRACT The acute necrotizing retinitis is a retinal necrosis of all the retinal layers. It is characterized by fibrinoid necrosis of the vases' wall and vascular occlusion. The case presented is the case of a female patient aged 42 years, who suffers sudden loss of the left eye vision, with a week of evolution. At the ophthalmologic examination it was observed a 2+ vitreous haze, dirty edema of the optic disk, with effacement of all of its margins. There it was an extended white-yellowish retinal exudation in the entire periphery and the equatorial area, associated to intra-retinal hemorrhages. Besides the funduscopic examination, it was taken a sample of the aqueous humor for a polymerase chain reaction (PCR) and fluorescein angiography. The patient's funduscopic signs, and also the anomalies detected in the fluorescein angiography suggested the clinical diagnosis of acute retinal necrosis syndrome. After several weeks, the viral etiologic diagnosis was confirmed by polymerase chain reaction. It was practiced the correspondent medical therapeutics and focal retinal laser coagulation associated to mixt retinal detachment through pars plana vitrectomy; the retina reapplication was achieved.

Manejo de la uveítis asociada a espondiloartropatías / Managment of uveitis associated to spondiloarthropaties

Alrededor de un tercio de los afectados por espondiloartropatías hará uveítis. Casi siempre serán uveítis anteriores, agudas, unilaterales y autolimitadas, que alter-narán entre uno y otro ojo. El tratamiento de elección es el corticoide tópico du-rante la crisis, que habitualmente resolverá en un plazo no mayor a doce semanas. Hay varias estrategias para reducir la frecuencia e intensidad de las crisis, las que han sido evaluadas en pequeños estudios en sujetos con tres o más episodios anuales. Han sido beneficiosos el metotrexato, sulfasalazina y antiinflamatorios no esteroidales (AI-NEs), estos últimos en dosis de dos veces por día, no así los AINEs en toma única diaria. Los agentes biológicos anti factor de necrosis tumoral (anti-TNF por su sigla en in-glés), excepto el etanercept, se asocian a muy altos índices de prevención de recidivas en estudios observacionales, pero los estudios comparativos sólo se han hecho para uveítis no-anteriores.

About one third of all subjects affected by spondiloarthropaties will suffer from uve-itis. These will happen to be acute, anterior, unilateral and self-limited uveitis attacks, alternating between one and other eye. First choice treatment consists of topical cor-ticosteroid during the episode that will usually resolve in no more than twelve weeks. There are several useful strategies to reduce the frequency and intensity of the uveitis at-tacks. These have been studied in small trials with reduced number of subjects suffering from three or more episodes per year. They have shown a beneficial effect for methotrex-ate, sulfasalazine and non-steroidal anti-inflammatory drugs (NSAIDs), these last when prescribed twice a day, without proven benefit from taking single daily doses of NSAIDs. Anti-tumor necrosis factor (anti-TNF) biologic agents, except for etanercept, are asso-ciated to a huge reduction in the frequency of uveitis attacks in observational studies, but comparative trials available have addressed non-anterior uveitis exclusively.

Isolation of IgG Antibodies to Toxocara in Ankylosing Spondylitis Patients with Acute Anterior Uveitis

PURPOSE: Since few reports had been published on the prevalence of toxocariasis in ankylosing spondylitis (AS) patients with acute non-granulomatous anterior uveitis (ANGAU), the aim of this work was to determine the presence of antibodies against Toxocara canis in AS patients with ANGAU. METHODS: Thirty-six patients (14 female and 22 male) with AS were enrolled in the study. The history of ANGAU was accepted only if diagnosed by an ophthalmologist. The detection of IgG antibodies to T. canis was determined by enzyme-linked immunosorbent assay. In addition, antibodies to Ascaris lumbricoides were also tested to verify non-specific reactions. RESULTS: The prevalence of ANGAU in the AS patients was 58% (21 / 36), and 38% (8 / 21) of the patients with ANGAU were positive for antibodies to Toxocara, while 7% (1 / 15) of AS patients without ANGAU were positive for T. canis (p = 0.038, two tails; mid-p exact). No antibodies were detected to A. lumbricoides antigens in the serum samples of patients with AS. CONCLUSIONS: These data suggest that the seroprevalence of antibodies to T. canis is high in Mexican patients with AS-associated uveitis, suggesting a chronic asymptomatic toxocariosis, which could be associated with the pathogenesis of ANGAU; however, further larger-scale studies are needed to confirm this observation.

Clinical Features of Ocular Toxoplasmosis in Korean Patients

We report here the records of 10 consecutive Korean patients (10 eyes) with ocular toxoplasmosis which showed the typical clinical manifestations with seropositivity for Toxoplasma gondii specific IgG antibodies by micro-ELISA between 2006 and 2010. Nine patients were males and 1 was female; their age was 50.5+/-13.8 years. The most common accompanying signs were vitritis (100%), anterior uveitis (70%), and scattered white deposit (80%). Pre-existing retinochoroidal scar was found in 1 (10%) patient. All patients received antiparasitic chemotherapy and systemic corticosteroid treatment, which resolved the presenting attack and recovered the visual acuity better than initial one in 9 patients and worse in 1. Optic atrophy, cataract, and retinal neovascularization were observed during the follow-up period and recurrence was detected in 3 eyes (30%) 6 to 20 months after the initial attack. In Korea, although rarely detected and reported, ocular toxoplasmosis needs more attention in clinical field of retinal diseases.

Anterior uveitis and congenital fibrosis of the extraocular muscles in a patient with Noonan syndrome.

We describe a patient with Noonan syndrome who presented with Human Leukocyte Antigen B27-associated recurrent acute anterior uveitis and manifestations of congenital fibrosis of the extraocular muscles, which has not been reported before.

Herpes simplex uveitis

BACKGROUND: Uveitis in herpes simplex virus (HSV) ocular disease is usually associated with corneal stromal disease. It has generally been believed that herpetic uveitis in the absence of corneal disease is very rare. When seen it is usually attributed to varicella zoster virus (VZV) infections. The diagnosis of uveitis caused by herpes simplex is often not diagnosed resulting in inadequate treatment and a poor visual result. METHODS: Seven patients from a large uveitis practice who presented with a clinical picture of: anterior uveitis and sectoral iris atrophy without keratitis, a syndrome highly suggestive of herpetic infection, are reported. Polymerase chain reaction (PCR) was done in the aqueous of four of them and was positive for HSV. One patient had bilateral disease. Most of the patients also had severe secondary glaucoma. RESULTS: Of the seven patients presented five had no history of any previous corneal disease. Two had a history of previous dendritic keratitis which was not active at the time of uveitis development. One patient with bilateral disease was immunosuppressed at the time when the uveitis developed. Six of the seven patients had elevated intraocular pressures at the time of uveitis and five required glaucoma surgery. Intractable glaucoma developed in two patients leading to rapid and severe visual loss despite aggressive management. CONCLUSION: Findings suggest that uveitis without corneal involvement may be a more frequent manifestation of ocular herpes simplex disease than previously thought. Absence of corneal involvement delays a correct diagnosis and may worsen visual outcome. Primary herpetic uveitis (when there is no history of previous corneal disease) seems to be more severe than the uveitis in patients with previous corneal recurrences. The associated glaucoma may be a devastating complication

A Case of Choroideremia with Recurrent Anterior Uveitis

Choroideremia is a rare hereditary disease with characteristic fundus that causes night blindness and peripheral visual field loss. The authors encounter choroideremia accompanied by recurrent uveitis. This paper is designed to give a description of the condition, along with an investigation of the literature. Ophthalmological tests and treatments were performed. Characteristic fundus, night blindness, peripheral visual field loss, electroretinography and other manifestations led us to a diagnosis of choroideremia. The anterior uveitis was managed with medication.

Incidência e etiologia de uveítes em Curitiba / Incidence and etiology of uveitis in Curitiba

Objetivo: Determinar a incidência e a etiologia dos casos de uveítes em Curitiba-PR. Métodos: Foram estudados 68 casos de uveítes em Curitiba, PR, atendidos no ambulatório de oftalmologia no período de janeiro a abril de 1998 procurando estabelecer o diagnóstico a partir de ampla investigaçäol clínica e laboratorial. Resultados: Em nosso estudo, contatamos que a uveíte posterior foi a mais encontrada (49 por cento), seguindo-se a panuveíte (29 por cento) e, com menor freqüência, a uveíte anterior (22 por cento). A etiologia mais freqüente para as uveítes posteriores foi a toxoplasmose, responsável por 88 por cento dos casos. Entre as panuveítes, novamente a toxoplasmose prevaleceu, com 85 por cento e, dentro das uveítes anteriores, a principal causa foi a espondilite anquilosante com 20 por cento. Conclusäo: Em Curitiba, há um predomínio de uveítes posteriores e panuveítes, sendo a causa mais comum a toxoplasmose. No entanto, enfatiza-se que existem outras causas importantes de uveítes que devem ser lembradas pelo oftalmologista na investigaçäo clínica.

Toxoplasmose adquirida ganglionar associada á uveíte anterior granulomatosa sem retinocoroidite / Ganglionar acquired toxoplasmosis associated with granulomatous anterior uveites without retinochoroiditis

Os autores relatam um caso de toxoplasmose ganglionar associada com uveíte anterior granulomatosa sem lesäo retiniana e tentam, neste estudo, explicar a fisiopatologia deste achado. É a primeira publicaçäo sobrea presença cancomitante de toxoplasmose ganglionar com iridocicle granulomatosa sem retinocoroidite em paciente imunocompatente.

Isolamento de Sporotrhix schenckii no humor aquoso de uma paciente com uveíte anterior granulomatosa - parte II / S. schenckii isolation from the aqueous humor in a case of anterior uveites

Os autores relatam o isolamento de Sporothrix schenckii no humor aquoso de uma paciente de 12 anos, portadora de esporotricase cutânea e extracutânea sistêemico. A dificuldade de tratamento dessa forma de apresentaçäo da micose é discutida e comparada com a literatura, apesar dos dados serem escassos.

Eosinofilia en enfermos de uveitis anterior aguda / Eosinophilia in patients presenting with acute anterior uveitis

Se realizo un estudio prospectivo en 50 enfermos de uveitis anterior aguda con el proposito de describir en los mismos la eosinofilia ocular y en sangre. En el estudio se corrobora que en la totalidad de los casos con sensibilidad alergica demostrada, aparece eosinofilia ocular y en sangre. Sin embargo, en aquellos en que la etiologia fue una colecistopatia con giardiasis cronica asociada, aparece eosinofilia ocular en el 79,0 por ciento. Es destacable que en los pacientes cuya causa fue un poco septico,toxoplasmosis o enfermedad autoinmune, no se contato eosinofilia. En dicha investigacion se valora la importancia del eosinofilo en los pacientes con uveitis anterior aguda, cuya causa probable es alergica, infecciosa o autoinmunitaria

Soluçäo de ringer com lactato como possível causa de uveíte anterior pós-facectomia / Severe anterior segment reactions following cataract extraction: the possible role of a ringer lactate solution

O autor relata uma série de 16 pacientes submetidos a facectomia extracapsular com implante de lente intra-ocular, onde sete apresentaram reaçäo inflamatória severa de segmento anterior. As cirurgias foram realizadas em dois hospitais sendo o problema notado em apenas um deles. É discutida a possibilidade de soluçäo de Ringer com lactato ser a causa da reaçäo inflamatória observada.

Síndrome nefritis intersticial aguda y uveítis / Interstitial nephritis syndrome and uveitis

Un niño de 9 años ingresó al hospital por anemia severa (hematocrito 18%) y enrojecimiento del ojo derecho, comprobándose en oftalmología que sufría uveítis. La velocidad de sedimentación de los eritrocitos (VHS) era 101 mm * h, ureico 91 mg/dl, depuración plasmática de creatinina 9 ml/min * 1,73 m*, concentraciones séricas de IgG e IgM 2.368 mg/dl y 263 mg/dl respectivamente, sobre los márgenes normales para su edad, con IgA apenas detectable y reducción de las poblaciones de células T. Los ensayos de factor reumatoide, anticuerpos antinucleares y antimúsculo liso dieron resultados negativos. Las actividades de las fracciones C3 y C4 del complemento sérico y el sedimento de orina eran normales. La muestra de la biopsia renal incluía 25 glomérulos, uno totalmente esclerótico, dos con fibrosis periglomerular y los restantes sólo con leve aumento de la matriz mesangial. Había, además, intensa infiltración inflamatoria del intersticio, con estructuras granulomatosas que incluían células gigantes, semejantes observables en reacciones por cuerpos extraños, y cristales PAS positivos en el interior de los lúmenes tubulares. A pesar del empleo de tratamiento esteroidal, el que se complicó al final con un granuloma inflamatorio intracerebral que curó en coincidencia con el uso de antibióticos por vía parenteral, el paciente evolucionó hacia la insuficiencia renal crónica y actualmente está siendo sometido a hemodiálisis, con perspectivas de transplante renal. La uveítis fue tratada con colirios de atropina y esteroides, curando con secuelas mínimas

Sífilis ocular em pacientes infectados pelo HIV: relato de 2 casos e revisäo de literatura / Ocular syphilis in patients infected by HIV: a report of 2 cases and literature revision

Existe uma correlaçäo epidemiológica importante entre AIDS e sífilis. A infecçäo pelo vírus da imunodeficiência humana (HIV) acelera o curso natural da sífilis, fazendo com que estágios mais avançados da doença sejam atingidos mais precocemente. Os autores relatam 2 novos casos da associaçäo sífilis ocular/AIDS e fazem uma revisäo dos 22 casos anteriormente publicados. Discutem a possibilidade de alteraçäo das respostas imunológicas e enfatizam a alta incidência de neurossífilis, sugerindo que sempre se faça a análise do líquor quando se constatar essa associaçäo

Clinical manifestations of iridocyclitis in leprosy.

Iridocyclitis--an inflammation of the iris and ciliary body occurs in lepromatous spectrum of leprosy of long duration. It is usually bilateral, has a very chronic course with acute exacerbations which are suppressed with the help of corticosteroids and other antiinflammatory drugs--Mydriatic to keep the Pupil dilated and also an antibiotic to take care of secondary infection which may be present. It is a major cause of blindness, due to its secondary damaging effects on the various ocular tissues. Medical and Paramedical Workers attending these patients must be made aware of the chronicity of the iridocyclitis so that regular referrals for examination of the eyes including slit lamp examination could be done and the activity of the disease and its complications detected early and treated. This chronic variety of iridocyclitis often gets less medical attention because of its insidious onset and minimal clinical signs in early stages, except by slit lamp examination. 57 patients suffering from iridocyclitis attending the ophthalmic department of S.L.R. & T.C. Karigiri were followed up carefully over a period of 2 1/2 years to study the clinical manifestations of iridocyclitis, it's complications and management.