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.

Comparison of retinal nerve fiber layer measurements using Stratus OCT fast and regular scan protocols in eyes with band atrophy of the optic nerve and normal controls / Comparação das medidas da camada de fibras nervosas retinianas realizadas com os protocolos "fast" e "regular" do Stratus OCT em olhos com atrofia em banda do nervo óptico e controles normais

PURPOSE: To compare retinal nerve fiber layer (RNFL) measurements made with two different protocols of optical coherence tomography in eyes with band atrophy (BA) of the optic nerve and controls. METHODS: Twenty-nine eyes with BA from chiasmal compression and 30 normal eyes underwent RNFL scans using both the fast (256 A-scans) and the regular (512 A-scans) protocols. The two sets of measurements were compared. RESULTS: In eyes with BA, fast RNFL measurements were significantly greater compared with regular RNFL measurements in the superior and inferior quadrants and significantly smaller at the 30-degree segments located at the 3 and 6 o'clock meridians. In normal eyes, fast RNFL measurements of the total average, superior and inferior quadrants and the segments corresponding to the 1, 3, 4 and 12 o'clock meridians were significantly greater than regular protocol measurements. Measurements with both protocols were significantly different in eyes with BA compared to normal eyes. CONCLUSIONS: Although both fast and regular RNFL measurements were equally efficient at differentiating eyes with BA from controls the fast protocol yielded greater values in areas with thick RNFL and smaller values in areas with thin RNFL when compared with the regular scanning protocol. One should be aware of such differences when comparing measurements with both scanning protocols.

OBJETIVO: Comparar as medidas da camada de fibras nervosas da retina (CFNR) realizada com dois protocolos de exame da tomografia de coerência óptica (TCO) em olhos com atrofia em banda (AB) do nervo óptico e controles. MÉTODOS: Vinte nove olhos com AB e 30 olhos normais foram submetidos a TCO utilizando tanto o protocolo "fast" (256 scans A) como o "regular" (512 scans A). As medidas foram comparadas. RESULTADOS: Em olhos com AB, as medidas da CFNR com o protocolo "fast" foram significativamente maiores do que aquelas do protocolo "regular" nos quadrantes superior e inferior e significativamente menores nos segmentos de 30 graus localizados nos meridianos correspondentes às 3 e 6 horas. Nos olhos normais, as medidas com o protocolo "fast" correspondentes à média global, aos quadrantes superior e inferior e aos segmentos de 30 graus correspondentes aos meridianos situados à 1, 3, 4 e 12 horas foram significativamente maiores do que aquelas do protocolo "regular". As medidas com os dois protocolos foram significativamente diferentes em olhos com AB quando comparados aos olhos normais. CONCLUSÕES: Embora as medidas obtidas tanto com o protocolo "fast" como com o "regular" tenha sido igualmente eficientes na diferenciação de olhos com AB dos normais, o protocolo "fast" forneceu valores maiores em áreas com CFNR mais espessas, e menores em áreas com CFNR mais finas quando comparados com o protocolo "regular". Deve-se estar atento a estas diferenças quando se comparam as medidas obtidas com os dois protocolos de exame.

Rathke's cleft cyst--an uncommon cause of headache in a young boy.

Developmental disorders of the pituitary can present like a mass lesion in the region of the pituitary and produce pressure effects. Rathke's cleft cyst is one such developmental disorder of the pituitary which presents in early life producing pressure effects namely visual disturbances due to its proximity to optic chiasma, headache, and hormonal imbalance due to pituitary malfunction. In this case report a 19 years boy presented with symptoms of headache and gradual loss of vision over one year period. Neuro-imaging study demonstrated a cystic lesion in the region of the pituitary. Trans-sphenoidal hypophysectomy was performed. Histopathology of the biopsied material was suggestive of Rathke's cleft cyst. Following surgery the boy had a good visual recovery. So early diagnosis and removal of a Rathke's cleft cyst has a good prognosis as compared to a craniopharyngioma which is a very close differential diagnosis.

Evaluation of the etiology of ocular globe atrophy or loss

Este estudo investigou a etiologia dos casos de atrofia e perda do globo ocular em pacientes atendidos no ambulatório de prótese buco-maxilo-facial de duas Faculdades de Odontologia do estado de São Paulo. Um total de 238 pacientes e seus prontuários foram examinados, e a etiologia e incidência dos casos de atrofia e perda do globo ocular foram avaliados considerando gênero, faixa etária, lado afetado e tipo de cirurgia oftalmológica realizada. As perdas por etiologia traumática foram as de maior incidência (57,14%), seguidas das perdas por etiologia patogênica (36,13%) e com menor incidência para as perdas por causas congênitas (5,04%). Comparando-se os gêneros, houve predominância da população masculina (61.76%; p<0,01). A faixa etária mais freqüentemente atingida foi a de 21 a 40 anos (42.01%; p<0,01). Em todas as etiologias estudadas, a cirurgia mais empregada para remoção do globo ocular foi a enucleação (66.38%; p<0,01). Houve predominância da perda do globo ocular do lado esquerdo (55.04%), mas não houve diferença estatisticamente significante.

Optic disc morphometry with optical coherence tomography: comparison with planimetry of fundus photographs and influence of parapapillary atrophy and pigmentary conus.

PURPOSE: Optical coherence tomography (OCT) is an established method for visualising macular pathology and for measuring the thickness of parapapillary retinal nerve fibre layer. The purpose of the present study was to compare OCT measurements of the optic disc with those obtained by planimetry of fundus photographs and to investigate whether OCT measurements are influenced by the amount of parapapillary atrophy or pigmentary conus at the disc margin. MATERIALS AND METHODS: Eighty-two eyes of 41 randomly selected Asian-Indian subjects were included.The mean age was 44.2+/-14.3 years (mean+/-SD). All eyes underwent optic disc assessment by OCT (fast optical disc protocol) and digital 20 degree disc photos.. Planimetry of the discs were performed by outlining the disc and the cup. The amount of parapapillary atrophy (zone beta) was quantified as the number of clock-hours around the disc with adjacent parapapillary atrophy. The same procedure was performed to quantify the amount of pigmentary conus around the disc. RESULTS: Mean+/-SD disc size and mean+/-SD cup size in OCT measurements (2.37+/-0.51, 1.29+/-0.55) were significantly smaller than in photographic planimetry (2.83+/-0.62, 1.56+/-0.5: P<0.001, P<0.001). Optic discs with parapapillary atrophy (P=0.2) in their relative difference of disc sizes between OCT and planimetry. Similarly, optic discs with pigmentary conus (n=12) and discs without pigmentary conus (n=70) did not differ significantly (P=0.65). The relative difference in disc size between the two measurement modalities did not correlate with the amount of parapapillary atrophy (r=-0.17, P=0.29) or with the amount of pigmentary conus (r=-0.04, P=0.9). CONCLUSION: OCT analysis of the optic disc produces significantly smaller parameters, compared to the established method of optic disc planimetry. Neither presence, nor extent of parapapillary atrophy zone beta and pigmentary conus seems to produce a systematic error in measurements of disc size with the OCT.

Análise com Heidelberg Retina Tomograph da espessura da camada de fibras nervosas retinianas e do volume de escavaçäo papilar em zonas alfa e beta de atrofia para-papilar em pacientes glaucomatosos / An analysis with Heidelberg Retina Tomograph of the density of retinal fiber layers and of papilar cup volume in the alpha and beta zones of parapapillary athophy in glaucoma patients

Objetivo: Analisar e descrever os achados esteriométricos do disco óptico e da camada de fibras nervosas retiniadas em pacientes com zonas de atrofia para-papilar alfa e beta.Local: Serviço de Oftalmologia da clínica Dr.Fracoso Borges, Petrópolis, RJ.Material e métodos: Realizamos o exame de tomografia óptica neuroretiniana com Heidelberg Retina Tomograph(HRT) em dezesseis olhos com e sem área de atrofia para-papilar.Resultados: Observamos o aumento da média do volume de escavaçäo papilar e a diminuiçäo da média da espessura das fibras retiniadas nos olhos com presença de zona alfa e beta de atrofia para-papilar em relaçäo ao grupo controle com glaucoma.a amostragem näo evidenciou alteraçöes estatisticamente significativas entre os sois grupos.Conclusäo: O HRT revelou-se um exame preciso para detectar as alteraçöes da camada das fibras nervosas retinianas nos pacientes glaucomatosos com zonas de atrofia para-papilar, acrescido da importância de analisar simultaneamente as alteraçöes topográficas papilares.

Cockayne syndrome: a case with hyperinsulinemia and growth hormone deficiency

Cockayne syndrome is a rare autosomal recessive disorder of childhood characterized by cachectic dwarfism with senile-like appearance, mental retardation, photosensitive dermatitis, loss of adipose tissue, pigmentary degeneration of retina, microcephaly, deafness, skeletal and neurologic abnormalities. We describe here an 18 year old boy with Cockayne syndrome who had, in addition to the typical features of the disorder, fasting hyperinsulinemia and growth hormone deficiency.

Manifestaciones oftalmológicas en el SIDA / Ocular manifestations in AIDS

Durante un año fueron estudiados 61 pacientes consecutivos VIH positivos, con el fin de establecer la prevalencia de las manifestaciones oftalmológicas. 29 pacientes estaban en el estadio de SIDA (IV de la clasificación CDC) y 32 eran portadores asintomaticos. En la primera evaluación, se encontro compromiso oftalmológico en 15 de 29 pacientes con SIDA (51.72 por ciento); siendo los hallazgos:microangiopatia retinal no infecciosa 27.6 por ciento, infecciones oportunisticas 20.68 por ciento; Sarcoma de Kaposi 3.44 por ciento y Atrofia optica en 3.44 por ciento. De las infecciones oportunisticas encontradas en la primera visita, la mas importante fue la retinitis por citomegalovirus (CMV) en 10.34 por ciento. En portadores asintomaticos, uno presento microangiopatia retinal no infecciosa con presencia de manchas algodonosas retinales (3.1 por ciento). En el seguimiento de los pacientes con SIDA cuyo examen inicial era normal, 2 desarrollaron microangiopatia y 3 retinitis por CMV; mientras que de los pacientes que al inicio tenian microangiopatia retinal, 5 desarrollaron retinitis por CMV en la evolución. Tambien se observo un nuevo caso de Sarcoma de Kaposi conjuntival y uno de paralisis del VI par craneal y papilitis. Al termino de este estudio habiamos acumulado 9 casos de retinitis por CMV (31 por ciento) y compromiso oftalmológico en 19 de 29 pacientes con SIDA (65.51 por ciento). De los 32 portadores asintomaticos, uno desarrollo retinitis por CMV, debutando como SIDA con una manifestación ocular. Se concluye que elcompromiso oftalmológico en el SIDA es importante, por lo que es necesario un adecuado seguimiento oftalmológico en esta población