ABSTRACT
This study correlates fluorescein angiography (FA) and indocyanine green angiography (ICGA) to histopathologic findings in a patient with sympathetic ophtalmia. A male with a perforated trauma in right eye presented after two months a decrease in visual acuity of the left eye. FA and ICGA were performed and the images were correlated with the histopathologic findings of the enucleated eye; FA showed background areas of homogeneous hypofluorescence in the arterial and venous phases, as well as areas of granular progressive hyperfluorescence and leakage from the optic disc. ICGA showed areas of hypofluorescence in the early and intermediate phases of the examination, which persisted until the late phase. During the early phase, there was also diffuse hypofluorescence caused by blockage that allowed observation of areas of partial choroidal circulation. The histopathology of the enucleated right eye showed diffuse choriocapillaris edema and inflammation of the choroids, focal areas of hyperplasia of the retinal pigment epithelium (RPE) as well as foci of epithelioid cells located between the choroid and the RPE. Furthermore, lymphocytic infiltration of the episcleral veins and retinal detachment were present. The hyperfluorescence observed on FA was correlated to retinal detachment and optic nerve inflammation. The hypofluorescence noted on FA and ICGA corresponded to the presence of blocking inflammatory cells (Dalen-Fuchs-like nodules) and to diffuse choriocapillaris edema.
O objetivo deste relato de caso foi correlacionar achados da histopatologia com a angiografia por fluoresceína (AF) e por indocianina verde (AIV) em um paciente com oftalmia simpática. Após dois meses de trauma perfurante no olho direito, o paciente apresentou baixa acuidade visual no olho esquerdo (OE). A AF do OE mostrou áreas de hipofluorescência homogênea na fase arterial e venosa, áreas de progressiva hiperfluorescência granular e vazamento do disco. A AIV mostrou áreas de hipofluorescência na fase inicial à tardia. A histopatologia foi realizada após evisceração do olho direito e demonstrou difuso edema da coriocapilar, inflamação da coróide, áreas focais de hiperplasia do epitélio pigmentar da retina, focos de células epitelióides entre a coróide e o epitélio pigmentar da retina, além da infiltração linfocitária das veias episclerais e descolamento de retina. A hiperfluorescência observada na AF foi correlacionada com o descolamento de retina e inflamação do nervo óptico. A hipofluorescência na AF e AIV correspondeu à presença de células inflamatórias (nódulos de Dalen-Fuchs) e edema coriocapilar difuso.
Subject(s)
Humans , Male , Middle Aged , Coloring Agents , Indocyanine Green , Ophthalmia, Sympathetic/pathology , Choroidal Neovascularization/diagnosis , Eye Evisceration , Fluorescein Angiography , Optic Neuritis/diagnosis , Retinal Detachment/diagnosisABSTRACT
This study correlates fluorescein angiography (FA) and indocyanine green angiography (ICGA) to histopathologic findings in a patient with sympathetic ophthalmia. A male with a perforated trauma in right eye presented after two months a decrease in visual acuity of the left eye. FA and ICGA were performed and the images were correlated with the histopathologic findings of the enucleated eye; FA showed background areas of homogeneous hypofluorescence in the arterial and venous phases, as well as areas of granular progressive hyperfluorescence and leakage from the optic disc. ICGA showed areas of hypofluorescence in the early and intermediate phases of the examination, which persisted until the late phase. During the early phase, there was also diffuse hypofluorescence caused by blockage that allowed observation of areas of partial choroidal circulation. The histopathology of the enucleated right eye showed diffuse choriocapillaris edema and inflammation of the choroids, focal areas of hyperplasia of the retinal pigment epithelium (RPE) as well as foci of epithelioid cells located between the choroid and the RPE. Furthermore, lymphocytic infiltration of the episcleral veins and retinal detachment were present. The hyperfluorescence observed on FA was correlated to retinal detachment and optic nerve inflammation. The hypofluorescence noted on FA and ICGA corresponded to the presence of blocking inflammatory cells (Dalen-Fuchs-like nodules) and to diffuse choriocapillaris edema.
Subject(s)
Coloring Agents , Indocyanine Green , Ophthalmia, Sympathetic/pathology , Choroidal Neovascularization/diagnosis , Eye Evisceration , Fluorescein Angiography , Humans , Male , Middle Aged , Optic Neuritis/diagnosis , Retinal Detachment/diagnosisABSTRACT
Os autores apresentam um caso de oftalmia simpática grave pós-facoemulsificaçäo que foi tratado com imunossupressäo sistêmica e enucleaçäo do olho simpatizante. A paciente evoluiu com resoluçäo do quadro inflamatório e melhora da acuidade visual. Os autores discutem quadro clínico, diagnóstico, fisiopatologia e aspectos terapêuticos da oftalmia simpática.
Subject(s)
Humans , Female , Adult , Eye Enucleation , Immunosuppression Therapy , Ophthalmia, Sympathetic/pathology , Ophthalmia, Sympathetic/therapy , Uveitis/diagnosis , Uveitis/pathology , Uveitis/therapyABSTRACT
Estudo de um caso de oftalmia simpática pós-vitrectomia via pars plana, cujo quadro clínico no olho simpatizante caracterizou-se por iridociclite näo granulamatosa, turvaçäo vítrea, hiperemia do disco óptico e descolamento seroso de retina. O período de latência entre a vitrectomia e o início dos sintomas foi de 70 dias. Apresentamos, no presente caso, aspectos terapêuticos abordando a necessidade do uso de drogas imunossupressoras. Trata-se do primeiro caso, de nosso conhecimento, de oftalmia simpática pós-vitrectomia via pars plana relatado na literatura nacional
Subject(s)
Humans , Female , Adult , Immunosuppressive Agents/pharmacology , Immunosuppressive Agents/therapeutic use , Iridocyclitis/complications , Iridocyclitis/immunology , Ophthalmia, Sympathetic/surgery , Ophthalmia, Sympathetic/diagnosis , Ophthalmia, Sympathetic/pathology , Ophthalmia, Sympathetic/therapyABSTRACT
Este trabalho consiste em uma avaliaçäo clínica percentual de um total de 15 pacientes (10 homens e 5 mulheres), que foram estudados no sentido da idade, cor, prazo de aparecimento dos sinais inflamatórios no olho näo traumatizado e das causas da Oftalmia simpática (trauma acidental, cirúrgico ou pós-evisceraçäo). Comenta também sobre o aspecto "Evisceraçäo x Enucleaçäo", sobre o estudo ecográfico e, por fim, sobre o tratamento efetuado pelo autor, que consiste na Pulsoterapia com o coricóide
Subject(s)
Humans , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Male , Female , Ophthalmia, Sympathetic , Ophthalmia, Sympathetic/etiology , Ophthalmia, Sympathetic/pathology , Ophthalmia, Sympathetic/therapyABSTRACT
La oftalmía simpática es una uveítis difusa bilateral granulomatosa, secundaria a un traumatismo ocular penetrante accidental o quirúrgico. Se considera de origen inmunológico. La forma de presentación clínica posterior es rara. Evoluciona con recurrencias. Requiere del tratamiento corticoesteroidaly/o inmunosupresor. Su histopatología muestra infiltración linfocitaria y de células epiteloideas uveal difusa con diversas otras respuestas histológicas agregadas. Se presenta un caso clínico en una mujer miope de 47 años, portadora de desprendimiento de retina, intervenida con cirugía vitreo-retinal que, un año y medio más tarde, hace una oftalmía simpática, cuyo estudio histopátologico confirmóla sospecha clínica