Acácio Muralha

Indocyanine-green angiography in acute idiopathic exudative polymorphous vitelliform maculopathy.

1. Marin JF, Tolentino FI, Refojo MF, Schepens CL. Long-term complications of the MAI hydrogel intrascleral buckling implant. Arch Ophthalmol 1992;110:86–88. 2. Hwang KI, Lim JI. Hydrogel exoplant fragmentation 10 years after scleral buckling surgery. Arch Ophthalmol 1997;115: 1205–1206. 3. Roldan-Pallares M, del Castillo Sanz JL, Awad-El Susi S, Refojo MF. Long-term complications of silicone and hydrogel explants in retinal reattachment surgery. Arch Ophthalmol 1999;117:197–201. 4. Shami MJ, Abdul-Rahim AS. Intrusion of a scleral buckle: a late complication of retinal reattachment surgery. Retina 2001; 21:195–197. 5. Ho PC, Chan IM, Refojo MF, Tolentino FI. The MAI hydrophilic implant for scleral buckling: a review. Ophthalmic Surg 1984;15:511–515.

Transpupillary thermotherapy in the treatment of circumscribed choroidal hemangiomas

Purpose: To evaluate the efficacy of transpupillary thermotherapy (TTT) for the treatment of serous retinal detachment secondary to circumscribed choroidal hemangiomas (CCH). Material and methods: Four eyes of four consecutive patients who presented decreased vision due to serous macular detachment secondary to CCH were enrolled in this study. After informed consent was obtained, the four eyes were treated with TTT. All the patients underwent pretreatment ocular examination, which included fluorescein angiography and ultrasonography. TTT was applied using a diode laser at 810 nm with a spot size of 4.3 mm. The diode laser was transmitted through a contact lens. The end-point of the treatment was a detectable light-gray appearance of the entire lesion. The patients were re-examined monthly during the first 6 months, and regularly thereafter. Results: Within 3 months of treatment all eyes had already demonstrated decreased exudation on clinical examination and on fluorescein angiography. Reduction in tumor prominence was observed in all eyes by A–B ultrasonography. Three patients showed an improvement in visual acuity (VA) over a period of 6 months. Case 2 from 20/60 to 20/25; case 3 from 20/400 to 20/50 and case 4 from 20/80 to 20/20. The VA in case 1 remained unchanged (counting fingers). No recurrences were observed within a mean follow-up of 14.5 months. Conclusions: TTT showed no deleterious side effects in treating serous macular detachment secondary to CCH, and must be regarded as a therapeutic alternative to manage selected cases.

Transpupillary Thermotherapy in the Treatment of Choroidal Metastasis from Breast Carcinoma

Background: Most patients who develop metastatic carcinoma to the choroid are managed by local radiation or chemotherapy. Since transpupillary thermotherapy (TTT) is currently gaining attention as an optional treatment for choroidal melanomas and hemangiomas, we sought to determine whether TTT is suitable for treatment of solitary choroidal metastasis at the posterior pole. Method: We report on a patient with decreased vision due to a serous macular detachment in a eye with a solitary choroidal metastasis from breast carcinoma, who was managed by TTT. Results: After two months of follow up, total re-absorption of the serous macular detachment was achieved and the patient recovered full visual acuity in the treated eye. The choroidal mass became atrophic and hyperpigmentation of the retinal pigment epithelium and retinal folds in the macular region were observed. After six months of TTT, the ocular picture remained unchanged. Conclusion: TTT can be considered an acceptable therapeutic option for solitary choroidal metastasis associated with serous retinal detachment.

Retinopatia associada ao uso de didanosina

Os autores descrevem um caso de paciente adulto infectado com o virus da imunodeficiencia humana (HIV) que apresentou retinopatia toxica secundaria ao uso da didanosina (DDI). A didanosina e inibidor da transcriptase reversa utilizado no tratamento da sindrome da imuno-deficiencia adquirida (AIDS). A associacao da didanosina com retinopatia e bem estabelecida em criancas, porem e bastante rara em adultos.

Flecked retina in systemic large-cell non-Hodgkin's lymphoma: case report

We report on a patient with a past medical history of successfully treated systemic large-cell non-Hodgkins lymphoma (SNHL), who presented with multifocal yellowish retinal infiltrates (flecked retina) involving the post-equatorial retina of one eye. Fluorescein angiography revealed that the retinal infiltrates were hypofluorescent throughout the examination. The correct diagnosis of this ocular picture was important because the retinal lesions indicated central nervous system recurrence of systemic large-cell non-Hodgkins lymphoma.

Evolução da retinite por citomegalovirus após suspensão de terapia de manutenção em pacientes com recuperação imunológica após HAART

Purpose: To establish safety parameters for stopping anti-CMV maintenance therapy in patients who had immune recovery after highly active antiretroviral therapy. Methods: The anti-CMV maintenance therapy was stopped in 24 patients who presented with inactive CMV retinitis, CD4+ > 200 cells./mm3 and indetectlabe viral load. The pa-tients were examined every 15 days with indirect ophthal-moscopy after maintenance therapy discontinuation until december 1998. Results: None of the 24 patients presented retinitis reactvation or progression. All of them kept CD4+ counts above 200 cells/mm3. One patient presented a viral load of 4000, the others maintained indetectable viral load. The average follow-up was 10,5 months. Conclusion: We believe that our established parameters are safe to stop anti-CMV maintenance therapy although other studies should be performed. Routine ophthalmologic exa- mination,CD4+ count and the viral load are fundamental in the follow-up of patients with inactive CMV retinitis after stopping maintenance therapy.

Vitrectomia em necrose progressiva da retina (P.O.R.N. syndrome) em Aids

Apresenta-se um paciente com AIDS e retinite por varicella-zoster virus (P.O.R.N. syndrome), com descolamento total de retina em olho esquerdo e pequena area de necrose retiniana periferica em olho direito. Foi realizado vitrectomia, endofotocoagulacao e injecao de oleo de silicone na cavidade vitrea precocemente no olho direito e aciclovir EV (30 mg/dia) como tentativa de prevenir o descolamento de retina e a progressao da sindrome neste olho. No pos operatorio imediato a visao do paciente era de 20/20. No entanto, em 21 dias a visao era de vultos nos dois olhos e 45 dias apos o paciente retornava amaurotico.