Sínquise cintilante ou colesterolosis bulbi de câmara anterior em paciente lactente / Synchisis scintillans or cholesterolosis bulbi of the anterior chamber in an infant patient

Este trabalho tem por objetivo relatar um caso de sínquise cintilante de câmara anterior em lactente sem causa elucidada. O paciente apresentou desvio no olhar desde o nascimento. Antecedentes pessoais e familiares sem anormalidades. Ao exame em OE: Esotropia constante, nistagmo horizontal, leucocoria e microftalmia, já em OD: sem anormalidades. Ultrassonografia (USG) em OE: redução do comprimento axial, retina aplicada e vítreo hiperecogênico. Aventaram-se hipóteses de persistência de vítreo primário hiperplásico, catarata congênita e retinoblastoma, e solicitou-se tomografia de crânio e cavidade orbitária (TC). Paciente retornou após 6 meses trazendo resultado da TC cuja única alteração evidenciada era OE com áreas hiperatenuantes e sem sinais de calcificação. Ao exame em OD: reflexo pupilar direto positivo e consensual negativo e em OE: hiperemia conjuntival, análise de reflexo pupilar, inviabilizada por presença de sínquises cintilantes de coloração ocre na câmara anterior, que não estava presente no exame inicial. Solicitou-se nova USG, evidenciando: ecos puntiformes na cavidade vítrea, sugerindo hemorragia, espessamento de hialoide posterior, retina aplicada e coroide com espessura aumentada. A sínquise cintilante ou “colesterolosis bulbi” é um processo degenerativo comumente secundário a trauma, inflamação ou hemorragia intraocular. Cursa com deposição de cristais de colesterol (provenientes do cristalino em degeneração ou do próprio vítreo) na cavidade vítrea, espaço sub-retiniano e, mais raramente, na câmara anterior. Sugerese que o fenômeno decorra de traumas, catarata de longa duração, hifema, glaucoma secundário ou descolamento de retina e mais raramente, de uveítes, neoplasias ou vasculopatias. Até o presente, não há relato na literatura de sínquise cintilante de câmara anterior envolvendo um lactente.

The propose of this article is presenting a case report of Synchisis scintillans of the anterior chamber in an infant patient without any elucidation. The patient’s initial complaint was “strabismus since birth”. There was not found any other personal or family abnormalities. On examination: OS: Esotropia maintained, horizontal nystagmus, microphthalmia and leukocoria. OD: no abnormalities. Ultrasonography (USG) OS: reduction of the axial length, retinal applied and hyperechoic vitreous. Raised hypotheses were persistence of hyperplastic primary vitreous, congenital cataract and retinoblastoma, and there was also requested cranial and orbital cavity tomography (TC). The patient returned after six months with TC showing as sole evidenced hyperattenuating areas without signs of calcification on OS. On examination: OD showing direct pupillary reflex positive and consensual pupillary reflex negative. OS: conjunctival hyperemia and analysis of pupillary reflex frustrated by the presence of sparkling colored ocher in the anterior chamber. We asked for a new USG, which showed: punctate echoes in the vitreous cavity, suggesting hemorrhage; thickening of the posterior hyaloids; choroid and retina were attached, both with increased thickness. The synchisis scintillans or “colesterolosis bulbi” is a degenerative process commonly secondary to trauma, inflammation or intraocular hemorrhage. Evolves with deposition of cholesterol crystals (from degeneration of the lens or vitreous itself) in the vitreous cavity, subretinal space and rarely, in the anterior chamber. There are evidences that the phenomenon could arise from severe trauma, long-term cataract, hyphema, glaucoma or retinal detachment and, even more rarely, uveitis, neoplasias or vascular disorders. Until this case, there was no report of Synchisis scintillans in the anterior chamber involving an infant.

An experimental study of fibrinous mem-bane formation on posterior chamber intraocular lens / 眼科

The pathological changes and morphological features of fibrinous membrane formation on the posterior chamber lens were studied in rabbits with Irj ght microscopy and scanning electron microscopy. It was found that there were fibrinous membrane, inflammatory cells and pigment deposits on the intraocular lens (IOL) surface. On the 1st postoperative day fi rinous membrane on IOL was formed, on the 7th postoperative day enlarged markedly, on the 14th postoperative day reduced in size. It is und fothat the fibrinous exudate is the basic constituent of the membrane. The membrane on the surface of IOL is composed of fibrin along with macrophages, fibroblastlike cells and giant cells,and eventually fibrosis occurs. The fibrinous membrane and inflmmatory cells on IOL accumulate primarily on the lens edge, optical portion, positioning hole of IOL, and haptic-optic junction. It is suggestedthat fibrinous membrane formation on IOL is closely related to the irritation of PMMA IOL, the breakdown of blood-aqueous barrier and the immune response.