Prevalência de cicatrizes coriorretinianas em exames angiográficos / Prevalence of chorioretinal scars in angiographics exams

RESUMO A toxoplasmose é uma zoonose que tem como agente etiológico o Toxoplasma gondii, que se caracteriza por ser uma doença infecciosa de distribuição mundial. Considera-se que no mundo existam mais de 2 bilhões de pessoas infectadas pela toxoplasmose. É bem conhecido que a toxoplasmose é uma causa frequente de cicatriz coriorretiniana. Nesse grupo de doenças, o exame angiográfico (ou angiofluoresceinografia de retina) é de fundamental importância para o diagnóstico. Objetivo: Realizar um levantamento da prevalência de cicatrizes coriorretinianas em angiografias em serviço privado na região de Cascavel (PR), Brasil. Métodos: Realização um estudo retrospectivo, transversal, com levantamento de documentos fonte, onde foram analisados 8719 laudos de angiografias de retina realizadas no Instituto da Visão na cidade de Cascavel (PR), Brasil, entre os anos de 2000 a 2011, sendo selecionados como primeiro diagnóstico de cada paciente, completando um total de 4928 exames válidos. As alterações encontradas foram classificadas de acordo com o tipo de cicatriz visualizada, e divididas conforme frequência percentual. Resultados: Observou-se uma prevalência de cicatrizes de 6,38%, sendo que o percentual de cicatriz coriorretiniana encontrado foi de 6,14%. Conclusão: A baixa prevalência de cicatrizes coriorretinianas encontrada na região de Cascavel (PR), Brasil, quando comparada à de Erechim (RS), Brasil, se deve a diversos fatores, tanto climáticos, socioculturais e institucionais. Além das cicatrizes coriorretinianas, que representaram o maior número entre as cicatrizes, foram encontrados outros subtipos cicatriciais com prevalências menores.

ABSTRACT Toxoplasmosis is a zoonosis whose etiologic agent is Toxoplasma gondii, which is characterized as an infectious disease of worldwide distribution. There are thought to be more than 2 billion people globally infected with toxoplasmosis. It is well known that toxoplasmosis is a frequent cause of chorioretinal scarring. In this group of diseases, the angiographic examination (or retinal fluorescein angiography) is very important for diagnosis. Objective: To perform a survey on the prevalence of chorioretinal scars in angiography at a private clinic in the area of Cascavel, Paraná State, Brazil. Methods: This was a retrospective, cross-sectional study with collection of data from source documents, involving the analysis of 8,719 reports of retinal angiograms performed at the Instituto da Visão of Cascavel, Brazil, between the years 2000-2011. The first diagnosis of each patient was selected, completing a total of 4,928 valid exams. The changes were classified according to the type of visualized scarring, and divided as percentage frequency. Results: We observed a prevalence of 6.38% scars, and the percentage of chorioretinal scars was found to be 6.14%. Conclusion: The low prevalence of chorioretinal scars found in the region of Cascavel, Brazil, when compared with the region of Erechim (Rio Grande do Sul State), Brazil, is due to climatic, sociocultural and institutional factors. Besides the chorioretinal scars, which represent the largest group of scars, other subtypes of scars with lower prevalence were found.

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. .

Intravitreal bevacizumab therapy for idiophatic juxtafoveolar retinal telangiectasis associated with serous macular detachment / Tratamento com injeção intravítrea de bevacizumabe para telangiectasia justafoveolar idiopática associada a descolamento seroso macular

The authors describe a 50-year-old woman with group 2 juxtafoveolar retinal telangiectasis and macular detachment treated with a single-dose of intravitreous bevacizumab injection. There was an improvement in her visual acuity, with a decrease in retinal thickness showed by the optical coherence tomography and fluorescein leakage in the angiography on follow-up visits. No adverse events were observed as a result of the treatment used. After one year of follow-up, the vision remained stable and macular detachment did not recur.

Os autores descrevem uma paciente do sexo feminino com 50 anos de idade portadora de telangiectasia justafoveolar idiopática tipo 2, associada a descolamento macular e tratada com injeção intravítrea de bevacizumabe, dose única. Houve uma melhora da acuidade visual com diminuição da espessura retiniana documentada por tomografia de coerência óptica e angiografia fluoresceínica durante seu acompanhamento. Não observou-se efeitos adversos em consequência do tratamento. Após um ano de acompanhamento, sua visão permaneceu estável e o descolamento macular não recorreu.

Alternativa de rehabilitación visual en pacientes con baja visión por afecciones maculares / Visual rehabilitation alternative for patients with low visión caused by macular illnesses

Objetivo: evaluar los resultados de una modalidad de rehabilitación visual en pacientes con baja visión por afecciones maculares. Método: se realizó un estudio experimental, tipo serie de casos 20 pacientes en el Instituto Cubano de Oftalmología Ramón Pando Ferrer. Se indicó la realización de ejercicios de localización y relleno. Antes de la rehabilitación y después, se estudió la agudeza visual mejor corregida de cerca con cartilla de Zeiss, velocidad de lectura, presencia de fatiga y rastreo. Resultado: la agudeza visual mejor corregida de cerca mejoró en 16 pacientes que representó el 80 por ciento de los casos estudiados, la velocidad de lectura se incrementó del 73 al 86,5 como promedio; no presentaron fatiga y fue más efectivo el rastreo después de la realización de ejercicios de localización y relleno. Conclusión: la alternativa en la rehabilitación visual de pacientes de baja visión secundaria a afecciones maculares mediante de la realización de ejercicios de localización y relleno, mejora la capacidad visual de los mismos

Objectives: to evaluate the results of a visual rehabilitation modality in a group of patients with low vision due to macular illnesses.Methods: an experimental case series-type study was conducted in 20 patients at Ramon Pando Ferrer Cuban Institute of Ophthalmology. To this end, making locating and filling exercises was indicated. Before and after rehabilitation, best corrected near visual acuity was measured by using Zeiss chart in addition to reading speed, fatigue and tracking were also studied.Results: the best corrected near visual acuity improved in 16 patients accounting for 80 percent of studied cases; the reading speed increased from 73 to 86.5 as average; there was no fatigue observed and tracking was more effective after making the indicated exercises.Conclusions: the visual rehabilitation alternative for patients with low vision due to macular illnesses, based on location and filling exercises, leads to improvement of their visual capacity

Spectral-domain Optical Coherence Tomography of Combined Hamartoma of the Retina and Retinal Pigment Epithelium in Neurofibromatosis

A 5-year-old girl was diagnosed with neurofibromatosis type 2 (NF-2) due to multiple neurofibromas, cafe-au-lait spots, and schwannomas of the brain. During ophthalmologic evaluation, a posterior subcapsular cataract and a gray-green colored subretinal lesion were found in right eye. Fluorescein angiography (FA) revealed a combined hamartoma of the retina and retinal pigment epithelium (CHRRPE). At age 9, she underwent cataract surgery. At this time FA and spectral-domain optical coherence tomography (SD-OCT) were taken. The SD-OCT showed an elevated hyperreflective mass in the retina with prominent attenuation of the inner and outer retina, but minimal attenuation in the photoreceptor layers. The underlying retina appeared to be disorganized and thick (791 microm). This is the first case report of SD-OCT imaging of a CHRRPE associated with NF-2 in a pediatric patient. By using SD-OCT in this patient, we could obtain detailed tumor characteristics, and SD-OCT may be helpful in the diagnosis and management of CHRRPE.

Desarrollo de un nanosistema para la liberación de fármacos intravítreo / Development of intravitreal nanosistema for drugs release

La inyección intravítrea ha sido la vía de administración más eficaz para el tratamiento de enfermedades vitreorretinianas. Su práctica continua, no es agradable para los pacientes y a su vez podría causar complicaciones indeseadas. El presente trabajo tuvo como objetivo desarrollar un nanosistema de liberación polímero-terapéutico (conjugado)/nanopartícula, utilizando Dextrano y Quitosano como polímeros transportadores biodegradables, hidrosolubles y compatibles a nivel ocular así como Hemisuccinato de Metilprednisolona como fármaco modelo. Primeramente, el fármaco fue capaz de unirse covalentemente a dos Dextranos de pesos moleculares 10 y 70 kDa. En función del contenido del componente activo y perfil de liberación, se seleccionó el Hemisuccinato de Metilprednisolona-Dextrano 10 kDa para elaborar las nanopartículas de Quitosano por el método de gelificación iónica empleando tripolifosfato sódico como agente entrecruzante. Por último, las nanopartículas fueron cubiertas con lactosa aplicando el secado por atomización. Se evaluó morfología, distribución de tamaño de las partículas, carga superficial, contenido y eficacia de captura del fármaco. Las partículas esféricas presentaron superficies lisas y uniformes. El pH tuvo influencia en el tamaño de las partículas observándose una distribución bimodal a pHs ≈ pKa del Quitosano y unimodal con un rango entre 130 - 170 nm a pHs < pKa. La variación de los potenciales Zeta entre los compuestos involucrados en la reacción, indicaron la posible ocurrencia de la misma. Al comparar la liberación del conjugado con las Nanopartículas a pH fisiológico, se observó que la encapsulación retrasó la liberación del fármaco alrededor de un 50%. Las nanopartículas recubiertas formaron micropartículas de 1.780 ± 0,5 nm, lo que favoreció su dispersibilidad en agua. Este nuevo nanosistema, evidenció su posible potencial en el desarrollo de formulaciones de liberación intravítrea, que reduzca la frecuencia de administración, ofreciendo una excelente alternativa que proporcione un mayor grado de satisfacción y mejore la calidad de vida del paciente.

Ranibizumab for choroidal neovascular membrane in a rare case of Bietti's crystalline dystrophy: A case report.

We report a rare case of Bietti's crystalline dystrophy presenting with choroidal neovascular membrane (CNVM) which was treated with three injections of intravitreal ranibizumab. The CNVM underwent scarring after the injections with stabilization of visual acuity at a follow-up period of 12 months suggesting that intravitreal ranibizumab may have a role in the management of CNVM in these rare cases.

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.

Intravitreal ranibizumab for the treatment of choroidal neovascularization secondary to ocular toxoplasmosis.

The purpose of the study was to report a case of choroidal neovascularization (CNV) secondary to ocular toxoplasmosis in an 18-year-old female patient. She was treated with a single intravitreal injection of ranibizumab. The CNV resolved as confirmed by fluorescein angiography and optical coherence tomography (OCT). The visual acuity improved to 20/30, which was maintained till the last follow-up visit at two years, without requisition of a repeat injection.

Massive retinal gliosis: An unusual case with immunohistochemical study.

Massive retinal gliosis (MRG) is a rare, benign intraocular condition that results from the proliferation of well-differentiated glial cells. Immunohistochemically, these cells show positivity for glial fibrillary acid protein (GFAP), neuron specific enolase (NSE), and S-100 protein. We encountered a case of a 45-year-old female with loss of vision in the left eye. She had a history of trauma to that eye two years ago. Enucleation was carried out, because malignancy was suspected due to retinal calcification. On the basis of light microscopy and immunohistochemistry (IHC) performed on the enucleated eye, it was diagnosed as massive retinal gliosis.

Myopia and inflammation

The correlation between myopia and intraocular inflammation has rarely been explored. The aim of this article is to review myopic changes induced by inflammatory diseases and inflammatory diseases related to myopia, followed by a discussion on inflammatory choroidal neovascularization. Clinical cases are used to illustrate these conditions. The review does not include inflammatory conditions caused by surgical interventions employed for treatment of myopia. Uveitic conditions that can induce a myopic shift include sclero-choroidal inflammation, lens induced myopia due to steroid cataracts, juvenile idiopathic arthritis [JIA] induced myopia, and transient drug induced myopia due to sulfonamides and acetazolamide used for treatment of ocular toxoplasmosis and inflammatory cystoid macular edema, respectively. Most inflammatory conditions related to myopia are conditions involving the choriocapillaris. These include multifocal choroiditis and/or punctate inner choroiditis, multiple evanescent white dot syndrome and acute idiopathic blind spot enlargement. It can be hypothesized that fragility of the choriocapillaris due to particular anatomic changes due to myopia, together with unknown immunogenetic factors predispose myopic eyes to primary inflammatory choriocapillaropathies

Resolution of macular edema in Coats' disease with intravitreal bevacizumab.

A 13-year-old boy was referred because of visual deterioration in his right eye. The visual acuity was two meters of counting fingers. Indirect ophthalmoscopy and biomicroscopy revealed exudative macular edema as well as tumor-like telangiectatic vessels and exudation in temporal periphery. With diagnosis of Coats' disease (stage II) confirmed by fluorescein angiography, three intravitreal injections of bevacizumab were performed at 6-week intervals. One year after the last injection, there was a significant resolution of macular edema as well as visual acuity improvement to 20/20. This is the first case report in which a distinct improvement in macular edema was observed with intravitreal bevacizumab in Coats' disease.

Proliferative sickle cell retinopathy associated with sickle cell trait and gestational diabetes: case report / Retinopatia falciforme proliferativa associada a traço falciforme e diabetes gestacional: relato de caso

Proliferative sickle cell retinopathy is an uncommon complication in individuals with sickle cell trait (AS). However, the risk for proliferative retinopathy development is increased in patients with AS hemoglobinopathy associated with systemic conditions or ocular trauma. A case of a patient with AS hemoglobinopathy who developed proliferative sickle cell retinopathy after the occurrence of gestational diabetes and pregnancy-induced hypertension is reported. Hemoglobin electrophoresis revealed presence of A2 5.0 percent, S 35.0 percent and A 53.2 percent. The present case emphasizes the importance of evaluating systemic comorbidities in patients with sickle cell trait during pregnancy since sickle cell retinopathy can progress rapidly, as well as the importance of regular eye fundus examination in these patients.

Retinopatia falciforme proliferativa é uma complicação incomum em indivíduos com traço falciforme, havendo, porém, risco aumentado de desenvolver retinopatia proliferativa em pacientes com hemoglobinopatia AS associada a condições sistêmicas ou trauma ocular. Neste artigo será apresentado um caso de paciente com diabetes gestacional, hipertensão arterial sistêmica associada à gravidez e traço falciforme. Eletroforese de hemoglobinas revelou a presença de A2 5,0 por cento, S 35,0 por cento e A 53,2 por cento. Este caso ressalta a importância da avaliação de comorbidades sistêmicas em pacientes com traço falciforme no período gestacional, uma vez que pode ocorrer rápida progressão da retinopatia falciforme, devendo-se realizar também exames regulares do fundo de olho nestes pacientes.

Glaucoma neovascular: reporte de un caso / Neovascular glaucoma: a case report

El glaucoma neovascular es una forma de glaucoma secundario, de difícil tratamiento y pronóstico, como consecuencia de una isquemia retiniana. Puede ser identificado con un mejor conocimiento de las características de la enfermedad. Se presenta un caso típico secundario probablemente a una retinopatía diabética, con manifestaciones clínicas y de medios diagnósticos evidentes, se expone su evolución, tratamiento y pronóstico.

The neovascular glaucoma is a form of secondary glaucoma, of difficult treatment and prognosis, as a result of an ischemia retinae. It can be identified with a better knowledge of the characteristics of the disease. A typical secondary case probably to a diabetic retinopathy is presented, with clinical manifestations and diagnostic evident means, it is exposed its evolution, treatment and prognosis.

Detecção de perda neural localizada através da redução da espessura macular na tomografia de coerência óptica: relato de caso / Localized neural loss detected by macular thickness reduction using optical coherence tomography: case report

Paciente de 22 anos, sexo masculino, notou mancha central no olho esquerdo durante um episódio da cefaléia de forte intensidade há aproximadamente 6 meses. Referia diagnóstico de enxaqueca com aura, apresentando crises recorrentes desde os 15 anos de idade. O exame oftalmológico revelou perda da camada de fibras nervosas da retina na região do feixe papilomacular do olho esquerdo. A tomografia de coerência óptica demonstrou importante redução da espessura macular, acompanhada de redução localizada da camada de fibras nervosas da retina no setor temporal do disco óptico no olho esquerdo. Avaliação sistêmica, exames de imagem e avaliação cardiovascular nada revelaram e a causa da perda da perda visual foi atribuída a possível enxaqueca retiniana, embora um evento isquêmico de outra natureza não pudesse ser descartado. Nosso caso é interessante porque demonstra que a tomografia de coerência óptica pode ser útil na detecção de perda neural localizada não apenas pela medida da camada de fibras nervosas da retina, mas também pela avaliação da espessura macular.

A 22-year-old man developed a central scotoma in the left eye during an episode of severe headache 6 months previously. He had a diagnosis of migraine headaches with aura since age 15. Ophthalmic examination showed retinal nerve fiber layer thickness reduction on the papilomacular bundle in the left eye and unremarkable in the right. Optical coherence tomography documented severe macular thickness reduction and a mild and localized retinal nerve fiber layer loss on the temporal side of the optic disc in the left eye. Systemic investigation, neuroimaging and cardiovascular studies were non-revealing. The cause of his visual loss was possibly related to retinal migraine, although an ischemic episode of another origin could not be excluded. Our case is interesting because it draws attention to the fact that optical coherence tomography may be able to identify localized neural loss not only by measuring peripapillary retinal nerve fiber layer but also by means of macular thickness measurements.

An unusual presentation of lupus retinopathy.

We have described an unusual presentation of lupus retinopathy in the form of macular arterio-arterial and arterio-venular shunts with extensive macular ischemia as a presenting sign.

Resolution of Severe Macular Edema in Adult Coats' Disease with Intravitreal Triamcinolone and Bevacizumab Injection

A 47 year old male patient visited our hospital with the chief complaint of deterioration of the visual acuity in the left eye. The fundus examination revealed thick hard exudates, multiple aneurysms and telangiectasias of the retinal vessels in the posterior pole. Fluorescein angiography demonstrated massive leakage over an area of the aneurysms. Optical coherence tomography (Stratus OCT; Zeiss-Humphrey, Dubin, CA) revealed diffuse and marked thickening of the retina. Laser photocoagulation was performed under the diagnosis of Coats' disease. However, the treatment could not be performed satisfactorily. On the first and 6th weeks, an intravitreal injection of bevacizumab and triamcinolone acetonide was administered, and laser photocoagulation was again attempted. The effectiveness of eachagent on retinal edema was evaluated at the follow-up performed at 1, 2, 5, 7, 10 weeks and 6 months after the injection. At one week after the intravitreal bevacizumab injection, there was no improvement. An intravitreal injection of triamcinolone acetonide was performed 6 weeks after the initial diagnosis,which resulted in a reduction in the thickness of the macular edema. Therefore, laser photocoagulation was performed sufficiently on telangiectasias. The follow-up at 6 months showed a relative increase in the macular edema, but there was reduced leakage from the telangiectasias compared with the previous angiograph.

The Relationship between the Breast Arterial Calcification Detected by Mammography and the Hypertensive Retinopathy in Hypertensive Women

OBJECTIVE: The purpose of this study was to investigate the relationship between the breast arterial calcification (BAC) detected by mammograms and the hypertensive retinopathy (HR) in hypertensive women who underwent ophthalmologic examination. MATERIALS AND METHODS: Screening mammography was performed in 99 hypertensive women and these women also underwent an ophthalmologic examination. The presence of arterial calcification and the number of calcified blood vessels in each breast were evaluated. The grade of HR was determined. The presence of BAC and the number of blood vessels involved was compared according to the presence of HR and the grade of HR. RESULTS: Among the 99 patients, HR was detected in 70 patients, and of these 70 patients, 42 patients had grade I HR and 28 had grade II HR. BAC was detected in 54 cases. Forty-six patients with HR (66%) and eight patients without HR (27%) were diagnosed with BAC after they underwent mammographic examination. The prevalence of BAC in the subjects who had HR was statistically higher than that in those subjects who did not have HR (p 0.05). The positive predictive value of the BAC detected on mammography for HR was 0.80 in those subjects who were > or = 60 years old. CONCLUSION: The detection of BAC by mammography is associated with an increased risk of HR, and particularly for patients after the age of 60. The findings of BAC may be related to hypertensive end-organ damage, and performing mammograms might contribute to predicting the presence of ophthalmologic hypertensive complications in these patients.

Tuberous sclerosis with portal vein thrombosis, protein C and S deficiency.

A 29-year-old lady with a bad obstetric history and portal vein thrombosis, presented to the Skin OPD for facial lesions. On examination, angiofibromas on face, shagreen patch and periungual fibromas were observed. She also had dental pits and a retinal hamartoma. Investigations revealed hamartomas in the brain and kidney. Hematological work-up showed protein C and S deficiency with Factor V Leiden positivity. Except for the cutaneous symptoms, the patient did not have any clinical manifestations in other organs affected by tuberous sclerosis. A similar association of tuberous sclerosis with protein C deficiency has been reported in only one case in literature.