Maculopatía paracentral aguda media y neurorretinopatía macular aguda / Paracentral Acute Middle Maculopathy and Acute Macular Neuroretinopathy

La neurorretinopatía macular aguda es una condición rara con patogenia microvascular. Se presenta con un inicio agudo con escotomas paracentrales correspondientes a lesiones paramaculares evidentes. Los avances en las imágenes multimodales permitieron caracterizar este trastorno de retina y crear nuevos conceptos. Serraf, en el 2013, identificó dos formas por medio de la tomografía de coherencia óptica dominio espectral: el tipo 1 conocido como maculopatía paracentral aguda media en la cual se observa una banda hiperreflectiva en la capa nuclear interna, y el tipo 2 en el cual la banda hiperreflectiva se ubica en la capa nuclear externa, que involucra la zona elipsoide y la zona de interdigitación con el epitelio pigmentario de la retina. Hasta el momento no existe cura; pero se puede actuar sobre los factores de riesgo. Por ser una condición rara y por no existir reportes hasta el momento en Cuba es que se presentan a continuación dos pacientes con cuadros clínicos similares de estas dos variantes; concluyendo la importancia que presentan las imágenes multimodales como medio auxiliar diagnóstico(AU)

Acute macular neuroretinopathy is a rare condition with complex pathogenesis and microvascular cause. It appears with acute onset, with paracentral scotomas corresponding to obvious paramacular lesions. Advances in multimodal imaging made it possible to characterize this retinal disorder and to create new concepts. Serraf, in 2013, identified two forms by spectral domain optical coherence tomography: type 1, known as paracentral acute middle maculopathy, in which a hyperreflective band is observed in the inner nuclear layer; and type 2, in which the hyperreflective band is located in the outer nuclear layer, involving the ellipsoid zone and the zone of interdigitation with the retinal pigment epithelium. Up to this moment, there is no cure; but it is possible to act on the risk factors. Because it is a rare condition and because there are no reports so far in Cuba, two patients with similar clinical pictures of these two variants are presented; concluding the importance of multimodal images as an auxiliary diagnostic tool(AU)

Punctate inner choroidopathy in a young Filipino female: A case report

@#A 30-year-old, monocular myopic female consulted for new onset scotoma on her left eye. Best corrected visual acuity was 20/20 for the left eye. Fundus exam revealed a hypopigmented lesion in the inferior juxtafoveal area with no overlying vitreous reaction/opacity. Spectral domain optical coherence tomography (SD-OCT) showed focal disruption and elevation of the inner choroid and retinal pigment epithelium (RPE), indicating punctate inner choroidopathy (PIC). OCT angiography (OCT-A) revealed the presence of a choroidal neovascular membrane (CNV) on RPE-RPE fit segmentation. The CNV and lesion resolved upon treatment with one intravitreal bevacizumab injection and oral prednisone 60 mg (1.2 mg/kg body weight) per day tapering over 2 months. This is the first reported case of PIC in a Filipino that was diagnosed and treated with the guidance of high-resolution SD-OCT and OCT-A. These diagnostic tests proved useful in identifying the lesions based on cross-sectional views of the retina, RPE and choroid.

Paracentral acute middle maculopathy in patient with atherosclerosis and angioplasty with stents in the coronary artery / Maculopatia média aguda paracentral em paciente com arterioesclerose e angioplastia com stent na artéria coronária

ABSTRACT Sophisticated imaging systems have helped to redefine the clinical presentation of acute macular neuroretinopathy and have markedly enhanced diagnostic sensitivity. The proposed mechanism of paracentral acute middle maculopathy is related to ischemia at the level of the superficial and deep retinal capillary plexi. This is a case report of a patient who developed an acute macular neuroretinopathy after an uneventful angioplasty with stents in the coronary artery.

RESUMO Sistemas de imagem sofisticados ajudaram a redefinir a apresentação clínica da neurorretinopatia macular aguda e têm sensibilidade diagnóstica marcadamente aumentada. A maculopatia média aguda paracentral tem sido relacionada à isquemia ao nível dos plexos capilares superficial e profundo da retina. Este é um relato de caso de paciente que desenvolveu uma neurorretinopatia macular aguda após uma cirurgia de angioplastia com stents da artéria coronária sem complicações.

Intravitreal and posterior subtenon triamcinolone acetonide for severe acute posterior multifocal placoid pigment epitheliopathy / Triancinolona intravítrea e sub-tenoniana para epiteliopatia pigmentar placóide multifocal posterior aguda grave

ABSTRACT A 21-year-old man presented with visual acuity of 20/200 in both eyes. The fundus picture, fluorescein angiography, and optical coherence tomography revealed severe bilateral acute posterior multifocal placoid pigment epitheliopathy and serous macular detachments. We treated the patient with triamcinolone acetonide, an intravitreal injection (4 mg/0.1 mL) in one eye and a posterior subtenon injection (40 mg/1 mL) in the other eye. Within 2 weeks the visual acuity was 20/80 in both eyes. At the 8-week follow-up visit his vision was 20/63 bilaterally. One year later the vision remained 20/63 in both eyes. In this patient, the triamcinolone acetonide injections, whether administered intravitreally or via the posterior subtenon route, achieved similar anatomic and functional recovery results.

RESUMO Um homem de 21 anos apresentou acuidade visual de 20/200 em ambos os olhos. O quadro de fundo de olho, angiofluoresceinografia e a tomografia de coerência óptica revelaram epiteliopatia pigmentar placóide multifocal posterior aguda e descolamento macular seroso. Tratamos o paciente com triancinolona acetonida, uma injeção intravítrea (4 mg/0,1 ml) em um olho e uma injeção subtenoniana posterior (40 mg/1 ml) no outro olho. Após 2 semanas, a acuidade visual foi de 20/80 em ambos os olhos. Na visita de acompanhamento de 8 semanas, sua visão foi de 20/63 bilateralmente. Um ano depois, a visão permaneceu 20/63 em ambos os olhos. Neste paciente, as injeções de triancinolona, administradas por via intravítrea ou por via subtenoniana posterior, obtiveram resultados semelhantes na recuperação anatômica e funcional.

Acute Zonal Occult Outer Retinopathy (AZOOR) in a patient with Hashimoto's thyroiditis / Retinopatia aguda zonal oculta externa em uma paciente com tireoidite de Hashimoto

ABSTRACT Acute zonal occult outer retinopathy (AZOOR) is a rare disease characterized by an acute damage of one or more external retinal zones leading to the visual field or the visual acuity impairment associated with small or no changes in the fundus examination.The main clinical symptoms are scotomas and the sudden onset of photopsias. Abnormal findings on electroretinography and visual field defects are critical for the diagnosis. Central vision is usually preserved and the stabilization occurs in six months in most cases. The objective of this article is to describe a 24-month follow-up of a patient with AZOOR and correlate the findings with the typical features of this disease.

RESUMO A retinopatia aguda zonal oculta externa (AZOOR) é uma doença rara, caracterizada por um dano agudo de uma ou mais zonas da retina externa que levam ao comprometimento do campo visual ou da acuidade visual, estando associada a pequenas ou nenhumas alterações no exame fundoscópico. Os principais sintomas clínicos são escotomas e o aparecimento súbito de fotopsias. Resultados anormais de defeitos de campo visual e eletrorretinografia são críticos para o diagnóstico. A visão central é geralmente preservada e a estabilização do quadro ocorre em seis meses na maioria dos casos. O objetivo deste artigo é descrever o "follow-up" de 24 meses de uma paciente com AZOOR e correlacionar os achados com as características típicas desta doença.

Serpiginous choroidopathy

Objective@#To describe a case of serpiginous choroidopathy.@*Methods@#This is a case report.@*Results@#A 61-year-old female with a 22-year history of gradual blurring of vision in the left eye sought consultation. Ten months prior, her left vision worsened, described as central scotoma that progressed inferiorly. Best-corrected vision was 20/20 (right) and counting fingers at 1 foot (left). Inferior hemifield scotoma was documented on Amsler grid testing of the left eye. Anteriorsegment findings were unremarkable. Retinal examination through a clear media revealed multiple contiguous hypopigmented patches radiating from the peripapillary area extending to the periphery in both eyes with extension to the superior fovea on the left. Fluorescein angiogram showed progressive faint hypofluorescence of the hypopigmented patches in both eyes with involvement of the superior fovea on the left. No active vessel leakage was noted. No treatment was given and regular Amsler monitoring was advised. Follow-up 3 and 6 months after revealed stable visual acuity and fluorescein angiogram (FA) findings. @*Conclusions@#This is a case of serpiginous choroidopathy with inactive pattern. There was unilateral decrease in central vision, scotoma, and retinal pigment epithelial atrophy in a serpentine pattern originating from the disc with macular involvement in one eye. FA aids in the diagnosis and monitoring of inflammatory activity as the presence of active leakage on the borders. Goals of management include monitoring, prevention of recurrences and progression, and rapid control of sequela with potential use of immunosuppressive therapy.