Clinical features of uveal effusion syndrome and the efficacy of sclerectomy in the treatment of uveal effusion syndrome / 中华眼底病杂志

Objective To observe the clinical features ofuveal effusion syndrome (UES) and the efficacy of sclerectomy in the treatment of UES.Methods A retrospective case series.Twenty patients (36 eyes) of UES with sclerectomy were enrolled in this study from June 2012 to December 2016 in Beijing Tongren Hospital.Among them,there were 12 males (22 eyes) and 8 females (14 eyes),with an average age of 37.8 years.All patients suffered from bilateral diseases,including 4 patients in single eye group and 16 patients in double eye group.Visual acuity,intraocular pressure,indirect ophthalmoscope,UBM,FFA combined with ICGA,A/B ultrasonography,axial length (AL) and scleral thickness were measured.All patients underwent lamellar sclerectomy,and those with exudative retinal detachment underwent four quadrant lamellar sclerectomy,followed by four quadrant full-thickness sclerectomy with the size of 1 mm × 2 mm in the center of the scleral bed.The follow-up time after operation was more than 6 months.Visual acuity,intraocular pressure and fundus examination were performed 1,3 and 6 months after operation with the same equipment and methods before operation.Results There was no obvious inflammation in the anterior chamber of all eyes,and intraocular pressure was 24-28 mmHg (1 mmHg =0.133 kPa) in 4 eyes (11.1％).Axial length of 8 eyes (22.2％) were 16-18 mm (true microphthalmia).12 eyes (33.3％) had scleral thickness ＞ 1.0-1.8 mm.Visual acuity ranged from hand movement to 0.05 in 20 eyes,0.1 to 0.3 in l0 eyes and＞0.3 in 6 eyes.Fundus examination showed peripheral choroidal and ciliary detachment;UBM examination showed annular peripheral ciliary and choroidal detachment.32 eyes (88.9％) were complicated with exudative retinal detachment.FFA examination showed that 14 eyes (38.9％) had leopard spot changes.Compared with preoperative vision,the visual acuity improved in 28 eyes (77.8％) and remained unchanged in 8 eyes (22.2％) after surgery.Thirty-two eyes with different degrees of retinal detachment were found before surgery.After surgery,ciliary body detachment,choroidal detachment and retinal detachment were restored.Six eyes (16.7％) recurred and underwent sclerectomy again.Conclusions The mild symptoms and recurrent attack are the characteristics of UES.Sclerectomy is an effective method to treat UES.

Topiramate-associated acute, bilateral, angle-closure glaucoma: case report / Glaucoma agudo de ângulo fechado, bilateral, desencadeado pelo topiramato: relato de caso

This paper describes a topiramate induced acute bilateral angle-closure glaucoma. This rare adverse effect is an idiosyncratic reaction characterized by uveal effusion and lens forward displacement, leading to increased intraocular pressure and vision loss. We describe a 55 year-old white woman with migraine, spasmodic torticollis and essential tremor, who developed bilateral acute angle-closure glaucoma, one week after starting topiramate 25 mg/day. She was seen at the Ophthalmology Emergency Department of the Fundação João Penido Burnier (Campinas, SP, Brazil) with a 4 hours history of blurry vision, ocular pain and bright flashes vision. Slit lamp examination revealed moderate conjunctival injection and corneal edema, and shallow anterior chambers. Intraocular pressure was 48 mmHg in both eyes. Fundoscopic examination findings were normal. She was treated with timolol, brimonidine, dorzolamide, pilocarpine, prednisone acetate eye drops and acetazolamide. One hour after those measures, as the intraocular pressure was 30 mmHg, she received a manitol intravenous injection and the intraocular pressure normalized. After 24 hours an iridotomy with Yag laser was performed. Topiramate was discontinued and she was totally recovered after one week.

Relato de um caso de glaucoma bilateral de ângulo fechado induzido pelo topiramato. Este raro efeito colateral é uma idiosincrasia causada por efusão uveal e deslocamento do cristalino para frente, causando aumento da pressão intraocular e perda visual. Descrevemos o caso de uma paciente de 55 anos com migrânea, torcicolo espasmódico e tremor essencial, que desenvolveu glaucoma bilateral de ângulo fechado uma semana após iniciar o uso de topiramato, 25 mg/dia. A paciente foi atendida no setor de Emergências Oftalmológicas da Fundação Penido Burnier (Campinas, SP, Brasil), com história de 4 horas de embaçamento visual, dor ocular e visão de flashes brilhantes. O exame com lâmpada de fenda revelou injeção conjuntival moderada, edema corneano e câmara anterior rasa em ambos os olhos. A pressão intraocular era de 48 mmHg bilateralmente e a fundoscopia era normal. Foi tratada com colírios de timolol, brimonidina, dorzolamida, pilocarpina e acetato de prednisona e acetazolamida via oral. Uma hora após essas medidas, a pressão intraocular era 30 mmHg, e a paciente recebeu uma injeção intravenosa de manitol, ocorrendo normalização da pressão intraocular após essa medida. Após 24 horas foi realizada iridectomia com Yag laser. O topiramato foi interrompido e ela se recuperou totalmente após uma semana.

Think twice before you go:some issues of corticosteroid application in the treatment of ocular fundus diseases / 中华眼底病杂志

Corticosteroids are widely used to treat ocular fundus diseases such as inflammatory disease,macular edema and choroidal neovascularization.To increase local drug concentration and reduce systemic side effects,corticosteroids are often delivered by periocular or intravitreal iniection.However there are still more and more clinical complications with the expanded scope of application of these drugs.In order to achieve the best risk-benefit ratio,fully understanding the pharmacological characteristics,indications,contraindications and complications of corticosteroid is critical for clinicians to prescribe this drug to their patients.

Alterações do segmento posterior na microftalmia: relato de casos / Posterior segment changes in microphthalmic eyes: case report

Microftalmia é a alteração de desenvolvimento caracterizada pela redução do tamanho do bulbo ocular. Pode estar associada a manifestações estruturais do segmento anterior e posterior. As alterações mais comuns do segmento anterior são as opacidades corneanas, o estreitamento e fechamento do ângulo da câmara anterior e a catarata, e as mais frequentes no segmento posterior são a efusão uveal, as dobras de retina, a alteração da vascularização capilar macular, a ausência de depressão foveal e a retinosquise periférica. Este estudo descreve o caso de três pacientes com microftalmo e manifestações no segmento posterior documentadas com tomografia de coerência óptica. O primeiro caso apresentou a síndrome de efusão uveal, com descolamento de coróide e de retina, tratada com cirurgia de esclerectomia parcial nos quatro quadrantes. No segundo caso, havia a dobra retiniana neurossensorial na fóvea e feixe papilomacular em ambos os olhos sem o envolvimento de epitélio pigmentado retiniano e coriocapilar. No terceiro paciente, o microftalmo estava acompanhado de ausência da depressão foveal, cujo principal diagnóstico diferencial é a hipoplasia foveal.

Microphthalmos is a developmental ocular disorder defined as a small eyeball. The condition can be associated with abnormalities of anterior and posterior segments. The most common anterior characteristics include corneal opacities, angle-closure and a shallow anterior chamber and cataract. The main findings of posterior segment are uveal effusion, retinal folds, abnormalities of macular capillar vascularization, absence of foveal depression and peripheral retinoschisis. Three patients with microphthalmos were assisted and their OCT features of posterior segment were analyzed. The first case had uveal effusion syndrome, choroidal and retinal detachment treated with parcial sclerectomy at the four quadrants. The other case presented with neurosensory retinal fold at fovea and papillomacular area in both eyes without involvement of retinal pigment epithelium layer and choriocapillaris. The third patient showed absence of foveal depression. The main diferencial diagnosis for this condition is foveal hypoplasia.

Efusão uveal associada à tuberculose presumida: relato de caso / Uveal effusion associated with presumed tuberculosis: case report

Os autores relatam a rara associação de efusão uveal e tuberculose ocular presumida em paciente do sexo masculino que apresentou melhora clínica com o uso sistêmico de prednisona 40 mg/d e rifampicina 600 mg/d. Descrevem, ainda, aspectos relevantes da efusão uveal, como etiopatogenia, evolução da doença, diagnóstico diferencial e tratamento, por meio de revisão da literatura.

The authors report a rare association of uveal effusion with presumed ocular tuberculosis in a male patient who presented clinical improvement with the systemic use of prednisone 40 mg/d and rifampicin 600 mg/d. In addition, relevant aspects of the uveal effusion such as the pathogenesis, evolution of the disease, differential diagnosis and treatment are described through a revision of the literature.

Metástase de coróide simulando síndrome de efusão uveal: relato de caso / Choroidal metastasis simulating uveal effusion syndrome: case report

Descrição de um caso de efusão uveal secundária a metástase de coróide e revisão dos principais diagnósticos diferenciais. Uma paciente com baixa da acuidade visual, no olho esquerdo, apresentou nódulos ao nível da coróide, dispersão pigmentar retiniana e descolamento seroso da retina. O exame angiofluoresceinográfico demonstrou padrão "leopard spots", semelhante ao encontrado nos casos de efusão uveal. A ecografia ocular demonstrou a presença do descolamento seroso da retina, presença de espessamento e nódulos na coróide e a tomografia de coerência óptica evidenciou ruptura do epitélio pigmentado da retina, presença de nodulações coroidianas hiperrefletivas e áreas de descolamento de retina seroso. Após ser submetido a exames diagnósticos de imagem, constatou-se a presença de nódulo único no ápice pulmonar esquerdo. As metástases de coróide podem levar a um quadro similar à síndrome de efusão uveal. Esta possibilidade deve sempre ser pensada diante de um quadro de efusão uveal atípica e avaliação sistêmica para pesquisa de carcinoma deverá ser solicitada.

We report a case of choroidal metastasis simulating uveal effusion syndrome. This patient with uveal metastasis from lung carcinoma presented with decreased vision in the left eye. Fundoscopic examination revealed pigmentary clumping, multiple choroidal nodules and serous retinal detachment. Fluorescein angioraphy revealed a leopard spots pattern similar to uveal effusion syndrome. Ultrasound revealed the presence of choroidal nodules with moderate internal reflectivity, choroidal thickening and serous retinal detachment. Optical coherence tomography showed retinal pigment epithelium tear and hyper-reflective nodules within the choroid and areas of serous retinal detachment. Image investigation demonstrated the presence of a solitary pulmonary nodule at the left apical lung. Choroidal metastasis can lead to a scenario that simulates uveal effusion syndrome. This possibility must be considered when having an atypical uveal effusion symptomatoloy and a systemic screening for systemic cancer should be performed.

O papel das quimiocinas nas uveítes / The role of chemokines in uveitis

A inflamação é parte do processo fisiológico que visa reparar o dano tecidual causado por infecção, trauma, auto-imunidade. Quando este processo fisiológico encontra-se alterado, pode contribuir para o aumento do dano tecidual. As quimiocinas e seus receptores são importantes elementos envolvidos no processo de migração celular para os tecidos inflamados. Nas doenças oculares, principalmente nas uveítes, estas proteínas estão sendo identificadas como importantes mediadores da resposta inflamatória. Esta revisão visa discutir o papel das quimiocinas em diversas doenças oculares, dando ênfase aos processos uveíticos.

Inflammation is part of the physiological process that aims at repairing the damage produced by different causes such as infection, trauma, and autoimmune disease. However, when this physiological process is not regulated, it can contribute to the increase in tissue damage. Chemokines and their receptors are major factors involved in the process of cell migration into inflamed tissues. In the ocular diseases, mainly in uveitis, such proteins have been identified as important mediators of the inflammation process. This review discusses the role of chemokines in several ocular diseases, with emphasis on the uveitic process.

Glaucoma agudo bilateral em paciente jovem secundário ao uso de topiramato: relato de caso / Bilateral acute angle closure glaucoma in a young patient receiving oral topiramate: case report

Topiramato é droga derivada das sulfas e utilizada sistemicamente como anticonvulsivante. Pode produzir efusão uveal e causar glaucoma agudo por fechamento angular pelo deslocamento da íris e do cristalino anteriormente, com miopização transitória. O processo cede com a suspensão da droga, se identificado precocemente. Os autores relatam, pela primeira vez na literatura científica nacional, um caso no qual a efusão uveal ocorreu após a administração de topiramato para tratamento de enxaqueca. Paciente branca de 40 anos foi examinada no setor de emergência do Hospital Banco de Olhos de Porto Alegre apresentando cefaléia intensa, dor ocular e diminuição da visão em ambos os olhos. Referia uso de topiramato desde dez dias antes do início dos sintomas. O exame biomicroscópico mostrava injeção conjuntival, quemose e câmara anterior rasa nos dois olhos. A pressão intra-ocular era de 40 mmHg no olho direito e 38 mmHg no olho esquerdo. Os achados fundoscópicos estavam normais nos dois olhos. A ultra-sonografia ocular mostrou efusão uveal e descolamento de coróide bilateral nos dois olhos. Foi realizado o diagnóstico de efusão uveal relacionada com o uso de topiramato. A medicação foi suspensa com melhora do quadro clínico e da acuidade visual três dias após a apresentação inicial. A efusão uveal induzida por drogas ocorre raramente. O topiramato pode causar edema do corpo ciliar e relaxamento da zônula, com conseqüente deslocamento anterior do diafragma irido-cristaliniano, causando miopização aguda e fechamento angular. Como o mecanismo de fechamento angular não envolve bloqueio pupilar, iridectomias periféricas e o uso de mióticos tópicos não são efetivos nesses casos. Houve regressão completa do quadro após a suspensão da medicação.

This paper reports a clinical case of uveal effusion in both eyes causing bilateral acute angle closure glaucoma in a young patient after oral administration of topiramate, a new anticonvulsivant medication. Rarely, some drugs have produced uveal effusions, forward shift of the iris-lens diaphragm, transient myopia and secondary angle closure glaucoma. A 40-year old white woman was seen at the emergency department of the "Hospital Banco de Olhos de Porto Alegre (RS)" - Brazil, with severe headaches and blurry vision in both eyes. Her medications included topiramate, started 10 days before. Slit lamp examination revealed conjunctival injection, chemosis and shallow anterior chambers. Intraocular pressure measured 40 and 38 mmHg. Fundoscopic examination findings were normal. Ultrasound scan was performed and demonstrated separation between the choroidal layer and the sclera. A diagnosis of bilateral uveal effusion associated with the use of oral topiramate was made. Topiramate was then discontinued. The patient reported symptomatic improvement by the third day after initial examination. Symptoms were resolved and visual acuity returned to normal. Topiramate may cause ciliary body edema and relaxation of zonules, which induces a forward shift of the lens-iris diaphragm with acute myopia and angle closure. As the mechanism of angle closure does not involve pupillary block, peripheral iridectomy and topical miotics are not useful in the treatment of this type of secondary angle-closure glaucoma. Drug-induced uveal effusions occur rarely. The patient improved after topiramate discontinuation.

Serum melanoma-inhibiting activity protein in uveal melanoma / 中华眼底病杂志

Objective To detect the level of serum melanoma-inbibiting activity (MIA) in patients with uveal melanomas, and investigate the value of MIA in diagnosing and inspecting uveal melanomas. Methods Enzyme-linked immunosorbent assay (ELISA) was used to detect the concentrations of MIA in peripheral serum of 27 patients with uveal melanoma, 6 with melanocyte tumor, 7 with other ocular tumors and 16 healthy individuals, respectively. Results The concentration of MIA in patients with uveal melanoma was significantly higher than that in the healthy ones (16 individuals) and the patients with adenoma of non pigmented ciliary epithelium (4 patients), retinoblastoma (2 patients), and retinal angioma 91 patient). The concnetration of MIA in patients with uveal melanoma without scleral infiltration or remote metastasis was obviously lower than that in the patients with scleral infiltration or remote metastasis, but didn′t differ much from which in the patients with melanocyte tumor. In the patients with uveal melanoma without infiltration or remote metastasis, there was no significant difference of MIA level between patients with spindle cell and mixed and epithelioid cell. Conclusion The level of serum MIA may be an effective index in diagnosing uveal melanoma, which can monitor the metastasis of uveal melanoma.

Ciliary body epithelial cysts / 眼科

Among 1352 eyes examined histologically, ciliary body epithelial cycts, single or multiple, were found in 198 eyes. The cysts were of 3 categories: the nonpigmented, the pigmented and the interepithelial cysts, the nonpigmented being the most common. The first two categories originated from the inner layer of the optic cup while the interepithelial variety resulted from separation of the two layers of the optic cup.