Bilateral Ampiginous Choroiditis following Confirmed SARS-CoV-2 Infection.

INTRODUCTION: Ampiginous Choroiditis is a rare posterior uveitis that combines clinical features of Acute Multifocal Posterior Placoid Pigment Epitheliopathy and Serpiginous Chorioretinitis. Its pathophysiology is poorly understood and further studies are necessary to understand which mechanisms start the immunologic reaction. CASE REPORT: The purpose of this article is to report a well-documented case of Ampiginous Choroiditis following in seven days a RT-PCR confirmed SARS-CoV-2 infection, suggesting that the infection might have contributed as a trigger. CONCLUSION: Timely diagnosis and correct treatment are paramount to improve the visual outcomes, and the patient had successful response to systemic steroids.

[Serpiginous-Like Choroiditis: literature Review] / Coroiditis Serpiginosa-Like: revisión de Literatura

Objective: To provide a complete picture and to improve understanding of the serpiginous-like choroiditis caused by Mycobacterium Tuberculosis. Materials and methods: Literature review of serpiginous-like choroiditis. A number of scientific search engines were searched including Medline (PubMed), Scielo, and Cochrane Library. Using MeSH and DeCS terms. Results: 107 articles were obtained, of which 44 met inclusion criteria. Discussion: serpiginous-like choroiditis is described as its etiology, pathogenesis, ocular findings, diagnosis, differential diagnosis and treatment. Conclusions: Modern studies are needed to understand the pathophysiology, new diagnostic strategies, and future treatments of serpiginous-like choroiditis

Objetivo: Proporcionar una imagen completa y mejorar entendimiento de la coroiditis serpiginosa- like causada por Mycobacterium Tuberculosis Materiales y métodos: Revisión de literatura de coroiditis serpiginosa-like. Se realizó búsqueda en varios motores de búsqueda científica incluidos Medline (PubMed), Scielo y Cochrane Library. Usando términos MeSH y DeCS. Resultados: Se obtuvieron 107 artículos, de los cuales 44 cumplieron criterios de inclusión. Discusión: Se describe la coroiditis serpiginosa-like su etiología, patogénesis, hallazgos oculares, diagnostico, diagnóstico diferencial y tratamiento. Conclusiones: Son necesarios estudios modernos para entender más la fisiopatología, nuevas estrategias diagnósticas y futuros tratamientos de la coroiditis serpiginosa-like.

Manejo da coroidite interna punctata complicada por membrana neovascular sub-retiniana / Management of punctate inner choroidopathy complicated by subretinal neovascular membrane

RESUMO Este trabalho visou evidenciar a importância da detecção precoce da coroidite interna punctata e destacar sua fisiopatologia inflamatória e possíveis diagnósticos diferenciais dentro das white dot syndromes. O destaque foi dado principalmente à coroidite multifocal e à panuveíte, ao se demonstrar sua epidemiologia peculiar em mulheres jovens, caracterizar sua apresentação clínica típica na fundoscopia e explorar as vantagens e as desvantagens de realizar os exames complementares que fazem parte da análise multimodal útil para o diagnóstico (especialmente a angiografia fluoresceínica, a tomografia de coerência óptica e a indocianina verde). Descreve-se o caso de uma mulher de 28 anos diagnosticada com coroidite interna punctata com membrana neovascular coroidal em olho direito. O tratamento foi realizado com injeção intravítrea de aflibercepte e corticoterapia sistêmica 1mg/kg ao dia. Este relato é importante por permitir debater o manejo da coroidite interna punctata durante a gestação e a decisão de realizar o tratamento mediante uma diversidade de opções terapêuticas.

ABSTRACT This work aimed to demonstrate the importance of early detection of punctate inner choroidopathy, highlighting the pathophysiology of inflammation and the differential diagnoses among white dot syndromes. Special attention was given to multifocal choroiditis and panuveitis, by demonstrating the peculiar epidemiology in young women, characterizing the typical clinical presentation in ophthalmoscopy, and exploring the advantages and disadvantages of performing the complementary examinations, which are part of the multimodal analysis useful for diagnosis (particularly fluorescein angiography, optical coherence tomography, and indocyanine green). We report the case of a 28-year-old female, diagnosed as punctate inner choroidopathy with choroidal [N.T. no título aparece subretinal = subrretiniana] neovascular membrane in the right eye. She was treated with intravitreal injection of aflibercept and systemic corticosteroid 1 mg/kg/day. This case report is important for addressing the management of punctate inner choroidopathy during pregnancy, and the decision to carry out treatment considering diverse therapeutic options.

Esporotricose ocular: manifestações atípicas / Ocular sporotrichosis: atypical manifestations

Resumo A esporotricose humana e animal é uma infecção subaguda a crônica causada pelo fungo dimórfico Sporothrix schenckii. A esporotricose ocular tem ganhado destaque em função da epidemia de esporotricose urbana enfrentada pelo estado do Rio de Janeiro na última década e se apresenta classicamente como conjuntivite granulomatosa, mas formas atípicas podem ocorrer. Este artigo tem por objetivo relatar 2 casos atípicos de esporotricose ocular em pacientes imunocompetentes, ambos apresentando quadro clínico compatível com a síndrome oculoglandular de Parinaud associada à dacriocistite em um caso e presumivelmente à coroidite no outro caso.

Abstract Human and animal sporotrichosis is an infection caused by the dimorphic fungus Sporothrix schenckii, which is classified from subacute to chronic. Ocular sporotrichosis has been highlighted due to the epidemic of urban sporotrichosis faced by the state of Rio de Janeiro in the last decade and presents classically as granulomatous conjunctivitis, but atypical forms may occur. This article aims to report two atypical cases of ocular sporotrichosis in immunocompetent patients, both presenting a clinical picture compatible with Parinaud oculoglandular syndrome associated with dacryocystitis in one case and presumably to choroiditis in the other case.

Multimodal Evaluation of Patients with Acute Posterior Multifocal Placoid Pigment Epitheliopathy and Serpiginous Choroiditis.

PURPOSE: To evaluate retinal and choroidal changes in patients with non-granulomatous choroiditis using the multimodality imaging (MMI). METHODS: Eight eyes of four patients were analyzed. Three patients (six eyes) were diagnosed with serpiginous choroiditis (SC) and one patient (two eyes) with acute posterior multifocal placoid pigment epitheliopathy (APMPPE). The patients were imaged on the same day using the RTVue Avanti XR instrument OCT/OCTA (Optovue Inc, Fremont, CA), Heidelberg Retina Angiograph 2 FAF and FA (Heidelberg Engineering, Germany), and TRC50DXi Topcon FP (Topcon Medical Systems, Oakland, NJ). RESULTS: OCT angiography (OCTA) showed hypoperfusion in all the cases, reperfusion in choriocapillaris in two eyes after treatment and identified a choroidal neovascularization (CNV), which was not detected on the fluorescein angiography (FA). CONCLUSIONS: OCTA may be an effective noninvasive image modality to follow up these patients and may provide further information to help us to understand the pathophysiology and complications of these diseases.

Fundus autofluorescence and spectral domain optical coherence tomography in recurrent serpiginous choroiditis: case report.

PURPOSE: To report fundus autofluorescence (FA) and spectral domain optical coherence tomography (SDOCT) findings in serpiginous choroiditis. DESIGN: Case report. METHODS: SDOCT and FA imaging of a 37-year-old woman with bilateral recurrent serpiginous choroiditis. RESULTS: Active new lesions disclosed hyperautofluorescence, in contrast to hypoautofluorescent scarred lesions. SDOCT showed increased reflectance of the choroid and deeper retinal layers, along with disruption of the photoreceptor inner and outer segment junction in both active and inactive lesions. CONCLUSION: Autofluorescence imaging and SDOCT are useful noninvasive methods for the evaluation of serpiginous choroiditis. Autofluorescence imaging allows identification of recurrences and retinal pigment epithelium involvement in the follow-up of this disease.

Remote hypofluorescent dots in recurrent ocular toxoplasmosis on indocyanine green angiography

PURPOSE: To report the findings of indocyanine green angiography performed in patients with recurrent ocular toxoplasmosis. METHODS: Institutional prospective analysis of 23 eyes from 23 immunocompetent patients with recurrent ocular toxoplasmosis aged between 17 and 41 years. These patients underwent a complete ocular examination including indocyanine green angiography. RESULTS: Multiple hypofluorescent spots distant from the recurrent active lesion of retinochoroidal toxoplasmosis were found in 26.08 percent of the patients. We also found multiple hypofluorescent satellite dots in 69.56 percent of the patients. CONCLUSION: These remote dots seen suggest either a more widespread choroidal involvement in this disease and this can represent simply remote collections of inflammatory cells or subclinical infection.

OBJETIVOS: Relatar os achados da angiografia com indocianina verde, realizados em pacientes com recidiva de toxoplasmose ocular. MÉTODOS: Análise institucional e prospectiva de 23 olhos de 23 pacientes, imunocompetentes com idades entre 17 e 41 anos. Estes pacientes foram submetidos a exame oftalmológico de rotina e a angiografia com indocianina verde. RESULTADOS: Foram encontrados múltiplos pontos hipofluorescentes distantes da lesão ativa recidivada da toxoplasmose retino-coroidiana em 26,08 por cento dos casos, chamados por nós de pontos remotos e encontramos também, pontos hipofluorescentes circundando ou próximos da lesão ativa recidivada em 69,56 por cento dos casos. CONCLUSÃO: Os pontos hipofluorescentes distantes da lesão ativa recidivada, chamados de pontos remotos, não descritos previamente na doença, demonstram um maior envolvimento da coróide e podem significar coleções remotas de células inflamatórias ou infecção subclínica.

Bilateral acute acquired toxoplasmic retinochoroiditis after steroid therapy for hantavirus pulmonary syndrome: case report.

Description of a case of acute acquired ocular toxoplasmosis following hantavirus pulmonary syndrome. A 41-year-old man presenting hantavirus pulmonary syndrome, confirmed in the laboratory by detection of IgM antibodies to the virus, was submitted to high doses of intravenous corticosteroids for two months. After clinical improvement of hantavirus pulmonary syndrome the patient presented visual loss in both eyes that was secondary to a toxoplasmosis retinitis. The retinitis resolved with anti-toxoplasma therapy. Acquired toxoplasmic retinochoroiditis can occur following steroid therapy for hantavirus pulmonary syndrome.

Bilateral acute acquired toxoplasmic retinochoroiditis after steroid therapy for hantavirus pulmonary syndrome: case report

Description of a case of acute acquired ocular toxoplasmosis following hantavirus pulmonary syndrome. A 41-year-old man presenting hantavirus pulmonary syndrome, confirmed in the laboratory by detection of IgM antibodies to the virus, was submitted to high doses of intravenous corticosteroids for two months. After clinical improvement of hantavirus pulmonary syndrome the patient presented visual loss in both eyes that was secondary to a toxoplasmosis retinitis. The retinitis resolved with anti-toxoplasma therapy. Acquired toxoplasmic retinochoroiditis can occur following steroid therapy for hantavirus pulmonary syndrome.

Descrição de um caso de toxoplasmose ocular adquirida pós-síndrome pulmonar por hantavírus. Paciente com 41 anos do sexo masculino apresentando síndrome pulmonar por hantavírus, confirmado no laboratório pela detecção de anticorpos IGM para o vírus, foi submetido a altas doses de corticosteróides intravenosos durante dois meses. Após melhora clínica da síndrome pulmonar por hantavírus, apresentou perda visual em ambos os olhos secundária a retinite por toxoplasmose confirmada com sorologia (IGG e IGM positivo) A retinite resolveu após terapia sistêmica específica. A retinite por toxoplasmose pode ocorrer após terapia sistêmica com esteróide para síndrome pulmonar por hantavírus.

Remote hypofluorescent dots in recurrent ocular toxoplasmosis on indocyanine green angiography.

PURPOSE: To report the findings of indocyanine green angiography performed in patients with recurrent ocular toxoplasmosis. METHODS: Institutional prospective analysis of 23 eyes from 23 immunocompetent patients with recurrent ocular toxoplasmosis aged between 17 and 41 years. These patients underwent a complete ocular examination including indocyanine green angiography. RESULTS: Multiple hypofluorescent spots distant from the recurrent active lesion of retinochoroidal toxoplasmosis were found in 26.08% of the patients. We also found multiple hypofluorescent satellite dots in 69.56% of the patients. CONCLUSION: These remote dots seen suggest either a more widespread choroidal involvement in this disease and this can represent simply remote collections of inflammatory cells or subclinical infection.

Multifocal choroiditis in disseminated Cryptococcus neoformans infection.

PURPOSE: To report an uncommon case of multifocal choroiditis as the result of disseminated Cryptococcus neoformans infection in a patient who is HIV-positive. DESIGN: Interventional case report. METHODS: A 27-year-old HIV-positive woman with fever, headache, and vomiting was examined. Lumbar puncture was performed and revealed C neoformans infection. Her condition evolved with sudden bilateral blindness and deafness. Ophthalmologic examination revealed multiple yellowish choroidal lesions in the posterior pole of both eyes. RESULTS: Postmortem examination showed disseminated C neoformans infection. Histologic examination of the eyes confirmed the presence of C neoformans in the choroiditis. CONCLUSION: Multifocal choroiditis in C neoformans infection is a rare ophthalmic manifestation. The recognition of this condition by ophthalmologists can help physicians to diagnose a disseminated and fatal disease.

Coriopatía serpiginosa: descripción de un caso clínico / Choroidopathia serpiginosa: description of a clinical case

Choroiditis serpiginosa is an infrequent disorder, which is chronic, progressive, bilateral, and recurrent; in primary form it affects the pigmented epithelium of the retina and the choriocapillary layer within the eye. It typically begins juxtapapillary and progresses to extend centrifugally to the optic disc, usually affecting the macula and thus decreasing visual acuity. It's etiology is unknown and it debutes in acute form in adult patients, without preference for sex. It's treatment includes the use of systemic corticosteroids, non steroidal anti-inflammatory drug (NSAID), and immunosuppressant agents. In this paper we document the clinical case of a diabetic, 61 year old man, having the disease in an inactive phase with serious visual sequelae.

Coroiditis serpiginosa es un desorden poco frecuente, crónico, progresivo, bilateral y recurrente que efecta en forma primaria al epitelio pigmentario de la retina y la coriocapilar. Típicamente comienza yuxtapapilar y su progresión se extiende en forma centrífuga al disco óptico, afectando usualmente la mácula, disminuyendo así la agudeza visual. Su etiología es desconocida y debuta en forma aguda en pacientes de edad madura sin predilección por sexo. El tratamiento incluye el uso de corticoesteroides sistémicos, antiinflamatorios no esteroidales (AINES) y agentes inmunosupresores. Presentamos el caso clínico de un hombre diabético de 61 años con enfermedad en fase inactiva con secuelas visuales serias.

Coroidite criptocócica em síndrome de imunodeficiência adquirida / Crytococal choroiditis in acquired immunodeficiency syndrome

Objetivo: Decrever coroidite criptocócica em pacientes com Síndrome de Imunodeficiência Adquirida (AIDS).Métodos: Estudo retrospectivo de 1986 pacientes infectados pelo Vírus da Imunodeficiência humana (HIV), no período de abril de 1994 a dezembro de 1997, sendo 31 1,56 (por cento) com meningite criptocócica e manifestaçöes oculares. Destes, 4 pacientes com coroidite criptocócica e manifestaçöes oculares. Destes, 4 pacientes om coroidite criptocócica foram submetidos a exame oftalmológico, retinografia e angiofluoresceinografia. Resultados: A coroidite multifocal com 4 casos representou 12,9 (por cento) dos casos de criptococose ocular e 0,2 dos pacientes HIV positivos exsminados no período do estudo. Os 4 pacientes tiveram acometimento ocular bilateral, eram do sexo masculino com idade média de 29,75 anos e CD4 médio de 71,25 células/mm3. a acuidade visual em 7 olhos foi de 20/20 e em um olho de 20/100. Conclusäo: A corodite criptocócia é um acometimento raro em pacientes HIV positivos. O comprometimento coroidiano pelo Cryptococcus neoformans näo é indicativo de pior prognóstico da meningite criptocócica em pacientes com AIDS

Fibrose sub-retiniana progressiva e neurite óptica; descriçäo de um caso / Progressive subretinal fibrosis and optic neuritis; description of case

Descrevemos um caso raro de fibrose sub-retiniana progressiva subsequente à coroidite multifocal, associado a uma severa e dramática neurite óptica resistente à prednisona, à droga citotóxica e finalmente à ciclosporina. A literatura foi revista e discutida

Fungemia e coroidite por Cryptococcus neofarmans; relato em portador de SIDA / Fungemia and choroiditis by Cryptococcus neoformans; case report in an AIDS patient

Relatamos um caso de coroidite bilateral por C. neoformans em pacientes portador de SIDA

A oftalmoscopia e o fundo de olho / The ophtalmoscopic and the eyegrounds

Neste trabalho, os autores apresentam a técnica de oftalmoscopia, as características do fundo de olho normal e as alteraçöes fundoscópicas mais frequentes. Têm, por objetivo, facilitar o uso da técnica para Acadêmicos e médicos

Uveite tuberculosa: a propósito de 5 casos / Tuberculosis uveitis: a five-case report

Tuberculose é rara nos paises desenvolvidos (9,3/100000 nos EUA). Entretanto com o surgimento do vírus da imunodeficiência adquirida (HIV) a incidência tem aumentado. O diagnóstico definitivo de retinocoroidite tuberculosa requer demonstraçäo do bacilo nos tecidos e fluidos oculares e, portanto, o diagnóstico é usualmente presuntivo baseado em: 1) lesäo compatível no fundo de olho; 2) eliminaçäo de outras etiologias; 3) coexistência de infecçäo tuberculosa; 4) teste de Montoux positivo; 5) resposta clínica a teste terapêutico. Säo apresentados 5 casos com perda de visäo secundária a uveite tuberculose näo relacionada à AIDS. Os pacientes foram tratados com sucesso por uma associaçäo de pirazinamida 2g qD 2m, rifampicina 600mg qD 6m, e isoniazida 400mg qD 12m. Uma boa resposta, com melhora na acuidade visual ou reduçäo significativa na reaçäo inflamatória, foi obtida já no primeiro mês de tratamento. Enfatiza-se que tuberculose ainda é comum em diversas regiöes: no estado do Rio Grande do Sul a incidência é de 31/100000; na Asia e Africa é de 110 e 165/100000 respectivamente. Uveite tuberculosa deveria ser mais diagnosticada nessas regiöes

Coroidopatia peripapilar helicoidal geográfica / Geographic helicoid peripapilary choroidopathy

Este trabalho apresenta um caso de Coroidopatia Peripapilar Helicoidal Geográfica e define as características clínicas e angiofluoresceinográficas desta entidade, assim como discute o diagnóstico diferencial das anomalias peripapilares