RESUMO
We review two cases of ocular manifestations of Rickettsia conorii infection in children. A girl who presented unilateral visual loss with focal retinitis and macular oedema and a boy with unilateral central scotoma and bilateral anterior uveitis. Progressive functional and anatomic recovery was observed after oral antibiotics and steroids were initiated.
Assuntos
Febre Botonosa/complicações , Edema Macular/microbiologia , Retinite/microbiologia , Escotoma/microbiologia , Uveíte Anterior/microbiologia , Transtornos da Visão/microbiologia , Febre Botonosa/tratamento farmacológico , Criança , Feminino , Humanos , Edema Macular/tratamento farmacológico , Masculino , Retinite/tratamento farmacológico , Rickettsia conorii , Uveíte Anterior/tratamento farmacológicoRESUMO
PURPOSE: To assess the safety and efficacy of intravitreal dexamethasone implants in the treatment of macular edema secondary to infectious uveitis. METHODS: We retrospectively reviewed clinical records from three uveitis referral units in Spain. The main outcome measures were rate of reactivation of infection, improvements in visual acuity and resolution of macular edema, as measured by optical coherence tomography. RESULTS: We included eight eyes from seven patients with a median age of 64 years (30-75). Etiologies of the infections were Herpes simplex virus-type 1, Varicela-Zoster virus, Treponema pallidum, Brucella mellitensis, Borrelia burgdorferi, Toxoplasma gondii, and cytomegalovirus. Median visual acuity was 20/160 (20/30-20/400) at baseline and 20/70 (20/25-20/200) at the last follow-up visit. Mean macular thickness was 516 µm (115) at baseline and 266.3 µm (40) at the last follow-up visit. Visual acuity improved in 100% of the eyes and none of the eyes showed macular edema at the last follow-up visit. Five patients required reinjections of the implant. Only one patient required antiglaucoma drops for a temporary increase in ocular pressure. There were no cases of reactivation of the infectious ocular disease. Median follow-up time was 18 months. CONCLUSION: In this small case series of eyes with macular edema secondary to infectious uveitis, treatment with dexamethasone intravitreal implants was not associated with reactivation of the infectious ocular disease. Furthermore, significant improvements in visual acuity and macular thickness were observed in our patients.
Assuntos
Dexametasona/administração & dosagem , Glucocorticoides/administração & dosagem , Edema Macular/tratamento farmacológico , Uveíte/tratamento farmacológico , Adulto , Idoso , Dexametasona/efeitos adversos , Implantes de Medicamento , Feminino , Glucocorticoides/efeitos adversos , Humanos , Injeções Intravítreas , Edema Macular/diagnóstico por imagem , Edema Macular/microbiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia de Coerência Óptica , Resultado do Tratamento , Uveíte/diagnóstico por imagem , Uveíte/microbiologiaAssuntos
Bartonella henselae , Doença da Arranhadura de Gato/complicações , Doença da Arranhadura de Gato/diagnóstico , Retinite/microbiologia , Transtornos da Visão/diagnóstico , Transtornos da Visão/microbiologia , Adolescente , Antibacterianos/uso terapêutico , Doença da Arranhadura de Gato/tratamento farmacológico , Diagnóstico Diferencial , Doxiciclina/uso terapêutico , Feminino , Seguimentos , Humanos , Edema Macular/diagnóstico , Edema Macular/tratamento farmacológico , Edema Macular/microbiologia , Retinite/diagnóstico , Retinite/tratamento farmacológico , Rifampina/uso terapêutico , Transtornos da Visão/tratamento farmacológico , Acuidade VisualAssuntos
Inibidores da Angiogênese/uso terapêutico , Anticorpos Monoclonais Humanizados/uso terapêutico , Bartonella henselae/isolamento & purificação , Doença da Arranhadura de Gato/tratamento farmacológico , Infecções Oculares Bacterianas/tratamento farmacológico , Edema Macular/tratamento farmacológico , Adulto , Anticorpos Antibacterianos/sangue , Bartonella henselae/imunologia , Doença da Arranhadura de Gato/diagnóstico , Doença da Arranhadura de Gato/microbiologia , Infecções Oculares Bacterianas/diagnóstico , Infecções Oculares Bacterianas/microbiologia , Feminino , Angiofluoresceinografia , Humanos , Imunoglobulina G/sangue , Injeções Intravítreas , Edema Macular/diagnóstico , Edema Macular/microbiologia , Ranibizumab , Tomografia de Coerência Óptica , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Acuidade VisualRESUMO
A 15-year-old girl being treated with imatinib for chronic myelogenous leukemia (CML) presented with acute vision loss in her right eye accompanied by swelling of the right side of her neck. On examination, she was found to have disk and macular edema of the right eye. Fine-needle aspiration and excisional biopsies of an enlarged submandibular lymph node were negative for malignancy. Although initial serologies were equivocal for Bartonella henselae, repeat serologies performed 1 week later upon the appearance of a macular star were positive. This is the first reported case of B. henselae in a patient with CML.
Assuntos
Bartonella henselae/isolamento & purificação , Doença da Arranhadura de Gato/microbiologia , Infecções Oculares Bacterianas , Leucemia Mielogênica Crônica BCR-ABL Positiva/complicações , Retinite/microbiologia , Adolescente , Antibacterianos/uso terapêutico , Anticorpos Antibacterianos/sangue , Antineoplásicos/uso terapêutico , Bartonella henselae/imunologia , Benzamidas , Doença da Arranhadura de Gato/diagnóstico , Doença da Arranhadura de Gato/tratamento farmacológico , Doxiciclina/uso terapêutico , Infecções Oculares Bacterianas/diagnóstico , Infecções Oculares Bacterianas/tratamento farmacológico , Infecções Oculares Bacterianas/microbiologia , Feminino , Angiofluoresceinografia , Humanos , Mesilato de Imatinib , Imunoglobulina G/sangue , Leucemia Mielogênica Crônica BCR-ABL Positiva/tratamento farmacológico , Edema Macular/microbiologia , Imageamento por Ressonância Magnética , Papiledema/microbiologia , Piperazinas/uso terapêutico , Pirimidinas/uso terapêutico , Retinite/diagnóstico , Retinite/tratamento farmacológico , Tomografia de Coerência ÓpticaRESUMO
PURPOSE: To report a case of post-streptococcal retinal vasculitis. DESIGN: Review of a case. METHODS: Review of patient chart and fluorescein angiography. RESULTS: A 17 year old African American female presented with moderate vitritis and macular edema in the right eye and retinal vessel sheathing in both eyes. CONCLUSIONS: Although CNS vasculitis is well recognized as a post-streptococcal syndrome, this case illustrates that retinal vasculitis can also occur in this setting, and can resolve with oral steroid therapy.
Assuntos
Vasos Retinianos , Infecções Estreptocócicas , Vasculite/microbiologia , Administração Oral , Adolescente , Feminino , Angiofluoresceinografia , Humanos , Inflamação/microbiologia , Edema Macular/microbiologia , Faringite/microbiologia , Radiografia , Escarlatina , Esteroides/administração & dosagem , Esteroides/uso terapêutico , Uveíte/microbiologia , Vasculite/diagnóstico , Vasculite/tratamento farmacológico , Vênulas/diagnóstico por imagem , Corpo VítreoRESUMO
PURPOSE: To report an atypical case of chorioretinopathy in a patient with bilateral renal transplantations. METHODS: A 55-year-old female was referred for management of birdshot chorioretinopathy. Ophthalmologic examination revealed bilateral yellowish, chorioretinal lesions with adjacent hemorrhages. RESULTS: Angiography demonstrated lesions with hyperfluorescence, leakage, and diffuse macular edema. OCT showed intraretinal edema. Laboratory evaluation revealed IgG antibodies for Bartonella hensalae. Treatment with oral ciprofloxacin led to regression of lesions, resolution of macular edema, and improvement in visual acuity. CONCLUSION: Multifocal chorioretinal lesions associated with B. hensalae can be atypical ophthalmic manifestations of cat-scratch disease (CSD), which may occur in immunosuppressed patients. Recognition of underlying disease and appropriate therapy can lead to improved outcomes.
Assuntos
Angiomatose Bacilar , Coriorretinite/microbiologia , Hospedeiro Imunocomprometido , Angiomatose Bacilar/tratamento farmacológico , Anti-Infecciosos , Formas Bacterianas Atípicas , Bartonella henselae , Coriorretinite/diagnóstico , Ciprofloxacina/uso terapêutico , Feminino , Angiofluoresceinografia , Humanos , Transplante de Rim , Edema Macular/microbiologia , Pessoa de Meia-Idade , Tomografia de Coerência ÓpticaAssuntos
Glucocorticoides/efeitos adversos , Ceratite/microbiologia , Edema Macular/microbiologia , Triancinolona Acetonida/efeitos adversos , Idoso , Córnea/patologia , Cristalização , Humanos , Injeções/efeitos adversos , Ceratite/tratamento farmacológico , Ceratite/patologia , Edema Macular/cirurgia , MasculinoRESUMO
PURPOSE: To describe an infrequent presentation of ocular tuberculosis. DESIGN: Retrospective observational case report. METHODS: A 61-year-old woman presented with decreased vision in her right eye and cystoid macular edema resistant to periocular corticosteroid treatment. There were no other findings. RESULTS: Diagnosis of probable underlying tuberculosis uveitis with macular edema as the only ocular manifestation was established based on a clinical history of possible tuberculosis during her infancy. Additionally, there were residual findings in the patient's chest x-ray, a positive Mantoux reaction, and Mycobacterium tuberculosis in sputum. Specific treatment was implemented for nine months. Cystoid macular edema resolved completely, visual acuity improved (20/20), and no remission occurred during two years of follow-up. CONCLUSIONS: In cases of idiopathic cystoid macular edema, tuberculosis should be considered as a potential cause. When treated, both are curable.