André Luiz Land Curi

Blindness and total ophthalmoplegia after aesthetic polymethylmethacrylate injection: case report

Microspheres of polymethyl-methacrylate (PMMA) are exciting new soft-tissue fillers that are becoming increasing popular for facial rejuvenation. Some reports of side effects of this procedure are basically in respect to dermal reaction, with late-onset granulomatous lesion with giant cells and vacuoles. We report blindness and total ophthalmoplegia after PMMA injection into glabellar area in a healthy woman and review the literature.

Retinal Granuloma Caused by Sporothrix schenckii

PURPOSE To describe an unusual case of disseminated sporotrichosis with intraocular involvement. DESIGN Interventional case report. RESULTS An 18-year-old man presented with disseminated ulcerated skin lesions. Fundus examination showed fluffy opacities in the vitreous and a retinal granuloma in the left eye. Biopsy of the skin lesion and lymph node showed the presence of numerous fungus cells. Culture was positive for the diagnosis of disseminated sporotrichosis. CONCLUSION Although intraocular infection due to Sporothrix schenckii is uncommon, it can occur in case of disseminated sporotrichosis. Systemic therapy is a successful means to control skin and ocular sporotrichosis.

Diffuse Unilateral Subacute Neuroretinitis (DUSN)

Diffuse unilateral subacute neuroretinitis (DUSN) is an ocular infectious disease caused by one of 2 different sized and as of yet unidentified nematodes capable of infiltrating the subretinal space. It occurs mainly in children and young adults and the clinical course is characterized by periods of activity and remission. The intraocular inflammation tends to be diffuse and in the acute phase is accompanied by swelling of the optic disc, focal retinitis, and choroiditis. In the chronic phase, optic nerve atrophy occurs if the nematode is not destroyed.

Unusual presentation of cat scratch disease in HIV+ patient

Intraocular cat scratch disease may present with different clinical features including neuroretinitis, retinitis, retinal infiltrates, arterial and vein occlusions. Most of the cases show spontaneous recovery without therapy.1 There are only few reports of intraocular cat scratch disease in HIV+ patients. We report an unusual case of cat scratch disease presenting as helioid unifocal choroiditis in an HIV+ patient that showed good response to systemic therapy. A 30 year old homosexual HIV+ man was referred to the uveitis department complaining of blurred vision in the left eye. He was taking zidovudine, lamivudine, ritonavir, and saquinavir. His last CD4+ count was 128 cells ×106/l and viral load 1 300 000. His visual acuities were 6/6 in the right eye and counting fingers in the left. There was no …

MULTIMODAL IMAGING OF SYPHILITIC MULTIFOCAL RETINITIS.

PURPOSE To describe multimodal imaging of syphilitic multifocal retinitis. METHODS Observational case series. RESULTS Two patients developed multifocal retinitis after treatment of unrecognized syphilitic uveitis with systemic corticosteroids in the absence of appropriate antibiotic therapy. Multimodal imaging localized the foci of retinitis within the retina in contrast to superficial retinal precipitates that accumulate on the surface of the retina in eyes with untreated syphilitic uveitis. Although the retinitis resolved after treatment with systemic penicillin in both cases, vision remained poor in the patient with multifocal retinitis involving the macula. CONCLUSION Treatment of unrecognized syphilitic uveitis with corticosteroids in the absence of antitreponemal treatment can lead to the development of multifocal retinitis. Multimodal imaging, and optical coherence tomography in particular, can be used to distinguish multifocal retinitis from superficial retinal precipitates or accumulations.

Posterior scleritis in Cogan's syndrome.

Purpose: To describe an unusual case of atypical Cogans syndrome with features of posterior scleritis. Methods: Interventional case report. Results: A 53-year-old man presented with bilateral posterior scleritis, along with sensorineural hearing loss and systemic vasculitis. Systemic corticosteroid therapy was started with resolution of ophthalmic findings and improvement of vestibuloauditory symptoms. Conclusions: In the setting of atypical Cogans syndrome, ophthalmic manifestations may be the first sign of disease.

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.

HIV Manifestations of Posterior Segment

Human immunodeficiency virus (HIV) is a retrovirus that is responsible for HIV infection and acquired immunodeficiency syndrome (AIDS). Immunocompromised individuals due to HIV are prone to develop many ocular manifestations. These manifestations can be in the form of HIV microangiopathy affecting approximately 50 % of HIV-infected population and is expressed as cotton wool spots, Roth spots, microaneurysms, and hemorrhages in the posterior pole. Other HIV manifestations of the posterior segment can be due to opportunistic infections – viral, bacterial, or fungal –which can be sight threatening.

Retinal and Choroidal Manifestations of Fungal Diseases

An increased number of fungal infections of the eye have been reported in the past few decades, in part because of increased clinical awareness and improved laboratory techniques. The increase reflects more significantly the widespread use of antibiotics, immunosuppression, chemotherapy, and ocular prosthetic devices. Despite their ubiquitous nature, only a limited number of fungal species produce infections of the eye, and an even smaller number cause fungal retinitis or endophthalmitis. The major causes of fungal retinitis are Candidaspecies, Aspergillusspecies, Blastomyces dermatitidis, Coccidioides immitis, Cryptococcus neoformans, Histoplasma capsulatum, and Sporothrix schenckii.

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.