RESUMEN
ABSTRACT We report a case of bilateral acute depigmentation of the iris in which satisfactory intraocular pressure control was obtained after resolution of the acute disease with a trabecular implant (iStent®). A 62-year-old woman presented with bilateral simultaneous acute eye pain, photophobia, increased intraocular pressure (34 mmHg), circulating pigment in the anterior chamber, areas of depigmentation in the iris, and posterior synechiae. She had received oral amoxicillin-clavulanate and moxifloxacin for pneumonia 2 months previously. Bilateral acute depigmentation of the iris was suspected as well as a viral etiology. She received oral acetazolamide, aciclovir, and prednisone, besides topical prednisolone, betaxolol, brimonidine, dorzolamide, and atropine. The disease gradually resolved in 4 months but, after 1 year, she developed bilateral cataracts, and still needed three drugs for intraocular pressure control (16/18 mmHg). Cataract-iStent® combined surgery was performed in both eyes. One year after surgery, intraocular pressure was 11/12 mmHg, without medication. iStent® was safe and effective on this secondary glaucoma.
RESUMO Relatamos um caso de despigmentação aguda bilateral da íris, no qual obtivemos adequado controle da pressão intraocular com o implante do iStent®, após resolução da fase aguda da doença. Paciente feminina, 62 anos, atendida com quadro agudo, bilateral e simultâneo de dor ocular, fotofobia, hipertensão ocular (34 mmHg), pigmentos circulantes na câmara anterior, áreas de despigmentação iriana e sinéquias posteriores. Havia recebido amoxicilina-clavulanato e moxifloxacina orais para pneumonia 2 meses antes. Suspeitando-se de despigmentação aguda bilateral da íris ou de etiologia viral, recebeu acetazolamida, aciclovir e prednisona orais, e colírios prednisolona, betaxolol, brimonidina, dorzolamida e atropina. O quadro se resolveu gradualmente em 4 meses, porém, após 1 ano, desenvolveu catarata bilateral e ainda usava 3 colírios hipotensores (pressão intraocular 16/18 mmHg). A cirurgia combinada de catarata-iStent® foi realizada em ambos os olhos. Um ano depois, a pressão intraocular mantinha-se 11/12 mmHg, sem medicação. O iStent® foi seguro e eficaz no controle deste glaucoma secundário.
RESUMEN
We report a case of bilateral acute depigmentation of the iris in which satisfactory intraocular pressure control was obtained after resolution of the acute disease with a trabecular implant (iStent®). A 62-year-old woman presented with bilateral simultaneous acute eye pain, photophobia, increased intraocular pressure (34 mmHg), circulating pigment in the anterior chamber, areas of depigmentation in the iris, and posterior synechiae. She had received oral amoxicillin-clavulanate and moxifloxacin for pneumonia 2 months previously. Bilateral acute depigmentation of the iris was suspected as well as a viral etiology. She received oral acetazolamide, aciclovir, and prednisone, besides topical prednisolone, betaxolol, brimonidine, dorzolamide, and atropine. The disease gradually resolved in 4 months but, after 1 year, she developed bilateral cataracts, and still needed three drugs for intraocular pressure control (16/18 mmHg). Cataract-iStent® combined surgery was performed in both eyes. One year after surgery, intraocular pressure was 11/12 mmHg, without medication. iStent® was safe and effective on this secondary glaucoma.
RESUMEN
Uveitis encompasses a heterogeneous and complex group of conditions characterized by intraocular inflammation, frequently affecting young individuals and representing an important cause of irreversible blindness worldwide. Animal models have been critical to understand etiology and pathogenesis of uveitis, being also employed to assess new therapeutic strategies, preceding human studies. However, there is still a need of developing and studying different models, due to the difficulties in recapitulating all forms of human uveitis effectively. Although corticosteroids are usually the first-line therapy for non-infectious uveitis, their long-term use is limited by potentially serious side effects in all possible delivery routes. Thus, thalidomide, a drug with anti-inflammatory and antiangiogenic properties, was investigated in a novel experimental model of uveitis, induced by Mycobacterium bovis Calmette-Guérin Bacillus (BCG), in rabbits. The experimental protocol consisted of two subcutaneous injections of BCG, followed by two intravitreal injections of the same antigen, inducing panuveitis. Animals were treated with a single intravitreal injection of thalidomide suspension or PBS. Clinical manifestations of uveitis improved after intravitreal thalidomide, involving both anterior and posterior segments. Protein content, N-acetyl-b-glucosaminidase (NAG) and myeloperoxidase (MPO) activities were elevated in ocular tissues after disease induction, further decreasing post-treatment with intravitreal thalidomide. This therapeutic response was also confirmed on ocular electrophysiology, as well as histopathology. This experimental model induced panuveitis in rabbits using a low-cost mycobacterial antigen, with intraocular inflammation subsequently improving after treatment. Intravitreal thalidomide may be a potential alternative to treat intraocular inflammation in corticosteroid-sparing therapies.