Pseudophakic macular edema in nondiabetic and diabetic patients without diabetic retinopathy treated with intravitreal dexamethasone implant.

BACKGROUND: The purpose of this study was to compare the impact of intravitreal dexamethasone (DEX) implant during a 12-month period in nondiabetic and diabetic patients without diabetic retinopathy (DR) as a treatment for refractory pseudophakic cystoid macular edema (PCME) following prior treatment with topical nepafenac 0.1% and prednisolone 1%. METHODS: Forty-two consecutive medical records of patients diagnosed with PCME after uneventful cataract surgery were included. The outcomes measured included best corrected visual acuity (BCVA) and central foveal thickness (CFT). Linear regression analysis was statistically applied. RESULTS: Following topical treatment, nondiabetic and diabetic subjects presented a mean ± SD gain of - 0.11 ± 0.11 and - 0.18 ± 0.11 BCVA logMAR and a CFT reduction of - 43.42 ± 53.66 µm and - 58.76 ± 36.28 µm, respectively. The mean BCVA gain at month 12 subsequent to DEX implantation was - 0.35 ± 0.17 in nondiabetic (p < 0.001) and - 0.55 ± 0.26 in diabetic patients (p < 0.001), with CFT reductions of - 195.71 ± 93.23 µm (p < 0.001) and - 260.81 ± 198.69 µm (p < 0.001), respectively. Patients who responded with better VA after topical treatment presented better visual outcomes at month 12 following DEX implantation (r2 = 0.46; rho = - 0.71, p < 0.01). CONCLUSION: Nondiabetic and diabetic patients without DR demonstrated similar results after DEX implant after combined topical therapy, suggesting that selected diabetic patients may have a response comparable to that of nondiabetic patients with PCME.

INTRAVITREAL DEXAMETHASONE IMPLANT MIGRATION INTO THE ANTERIOR CHAMBER: A Multicenter Study From the Pan-American Collaborative Retina Study Group.

PURPOSE: To establish the prevalence and risk factors for intravitreal dexamethasone implant migration into the anterior chamber in eyes with macular edema. METHODS: This was a multicenter, retrospective, observational chart review of data that included patients with macular edema who had been treated with at least one intravitreal dexamethasone injection. Patients with incomplete chart information during the follow-up period were excluded. RESULTS: The prevalence of implant migration in 468 patients, considering the number of injections, was 1.6%, with significant associations between implant migration and cataract surgery (P = 0.043) and intraocular lens status (P = 0.005) and a trend toward statistical significance (P = 0.057) with vitrectomy. A higher rate of implant migration into the anterior chamber was observed in vitrectomized eyes (4.8%) when compared with patients who did not undergo a vitrectomy (1.6%). The implants that migrated were removed with forceps with/without viscoelastic expression or with 20-gauge cannulas connected to the vitreous cutter machine. CONCLUSION: The risk of implant migration into the anterior chamber was 1.6%. Risk factors were a history of cataract surgery or vitrectomy and aphakia. When anterior migration occurs, rapid removal is advised, especially if corneal edema is present.

Spontaneous closure of macular hole following blunt trauma.

Ocular trauma can result in macular hole and it can lead to complete loss of central vision. We are reporting a case of traumatic macular hole associated with retinal hemorrhages and choroidal ruptures with spontaneous resolution and total vision recovery.

Unilateral uveitis with vitreous haze following zoledronic Acid therapy for osteoporosis.

Zoledronic acid is widely used in the treatment of osteoporosis and other bone diseases. However, patients may experience adverse effects involving the anterior segment of the eye following intravenous infusion. This paper reports a rare case of uveitis involving the vitreous cavity following the intravenous administration of zoledronic acid.

Optic neuritis complicating herpes zoster ophthalmicus in an immunocompetent patient / Zoster optic neuritis in immunocompentent

A 58-year-old woman presented with rash over the left side of the face and intense acute uveitis. Following careful review of the symptoms and dilated fundus examination unilateral optic neuritis was discovered. The rash was typical of varicella zoster dermatitis. Patients presenting with herpes zoster ophthalmicus should always undergo dilated fundus examination, as there is a potential risk of unexpected posterior segment inflammation. Early diagnosis and prompt treatment can avoid visual sequelae.

Paciente de 58 anos de idade apresentando erupção cutânea no lado esquerdo da face e intensa uveíte unilateral. Após cuidadosa revisão dos sintomas e exame de fundo do olho foi detectada neurite óptica. O rash era típico de dermatite por varicella zoster. Pacientes apresentando quadro de herpes zoster oftálmico devem ser submetidos ao exame de fundo do olho devido ao risco de inesperada inflamação do segmento posterior. Diagnóstico precoce e tratamento imediato podem evitar danos visuais.

Controvérsias sobre o tratamento do neuroblastoma metastático (IV-S) em lactente / Controversies of the treatment of metastatic neuroblastoma (IV-S) in infants

Objetivos: Descrever caso de neuroblastorna em sua forma menos freqüente (estágio IV-S), com metástases avançadas em fígado e medula óssea em lactente de cinco meses, relatando as divergências entre as opiniões dos autores de uma extensa revisão de literatura em relação às condutas e aos resultados. Descrição: Lactente de cinco meses apresentou-se com febre e hepatomegalia a esclarecer. Ultra-sonografia abdominal demonstrou fígado com dimensões aumentadas, ecotextura heterogénea às custas de numerosas imagens hipoecóicas difusamente distribuídas e, na supra-renal direita, massa hiperecóica de contornos bem definidos, medindo, aproximadamente, 65 cm³. Biópsia de medula óssea e de fígado revelou neoplasia maligna de pequenas células redondas e azuis compatíveis com neuroblastoma. O tratamento consistiu de sete ciclos de quimioterapia. seguida pela ressecção do tumor. O exame anátomo-patológico evidenciou ganglioneuroblastoma, "intermixed". Comentários: Não na uma padronização de conduta em relação ao neuroblastoma estadiado como IV-S. Alguns autores sugerem que não se deve tratar esse tumor em pacientes menores de um ano, peia alta taxa de regressão espontânea. Outros consideram a quimioterapia a conduta mais adequada. A ressecção cirúrgica imediata ou após a quimioterapia é também controversa.

Objectives: A case of neuroblastoma in its less frequent form (stage IV-S) with advanced metastases in liver and bone marrow in a five-month-old infant is described. Description: The patient presented fever and hepatomegaly. Abdominal ultrasonography showed liver with augmented dimensions, heterogeneous echotexture due to numerous and diffusely distributed hypoechoic images. A 65 cm³ hyperechoic mass in right adrenal, with well-defined contours was detected. Biopsy of bone marrow and liver revealed malignant neoplasm of small round blue cells, compatible with neuroblastoma. Treatment consisted of seven chemotherapy cycles followed by tumor resection. Histological examination revealed intermixed ganglioneuroblastoma, Comments: A discussion on different approaches to treatment of I V-S stage neuroblastoma is made.

Nódulo pulmonar esquistossomótico simulando neoplasia: relato de caso / Pulmonary schistosomotic nodule simulating neoplasia: case report

Paciente sadio em que, ao exame de rotina, foi detectado nódulo pulmonar esquistossomótico com verme adulto, 25 anos após o tratamento específico com oxamniquine® e distante da região endêmica. O nódulo simulava clinicamente neoplasia.

[Pulmonary schistosoma nodule simulating neoplasia: case report]. / Nódulo pulmonar esquistossomótico simulando neoplasia: relato de caso.

Healthy patient in which during ordinary examination a pulmonary schistosomotic nodule with an adult parasite, was detected 25 years far from endemic region and after specific treatment with oxamniquine. Clinically the nodule simulated neoplasia.