Antonio Marcelo Barbante Casella

Clinical and Tomographic Features of Macular Punctate Outer Retinal Toxoplasmosis

Fuchs endothelial dystrophy had DSAEK in the left eye for bullous keratopathy after cataract surgery and trabeculectomy in 1997. Preoperatively, the BSCVA in this eye was 20/200. On the first postoperative day, characteristic interface wavelike deposit accumulation was visualized on slitlamp examination despite corneal edema (Figure 2). A short trial of intensive steroids (from 4 times initially to 8 times per day) was tried without any evidence of deposit appearance. No evidence of interface fluid was found using anterior segment optical coherence tomography (Visante; Carl Zeiss Meditec, Dublin, California). At the 1-year follow-up examination, interface deposits remained stable. Despite complete resolution of the corneal edema, the patient’s uncorrected and best spectaclecorrected visual acuity did not improve (20/200).

Prevalence of age-related macular degeneration in Japanese immigrants and their descendants living in Londrina (PR) - Brazil

PURPOSE To determine the prevalence of early and late-stage age-related macular degeneration (ARMD) and its association with risk factors such as age, gender, smoking, body mass index, hypertension and diabetes history, cataracts and pseudophakia. DESIGN Population-based cross-sectional study in an elderly Japanese-Brazilian population from Londrina (Paraná, Brazil). METHODS The study included 483 (80.5%) of the 600 registered members of a local association for Japanese immigrants and their descendants, aged 60 years and up. The presence of early and late-stage age-related macular degeneration was determined using the standard protocol and the international classification system. RESULTS The mean age of the study subjects was 71 years. The overall prevalence of age-related macular degeneration was 15.1% (CI 95%; 12-18.7). The prevalence of early-stage age-related macular degeneration was 13.8% (CI 95%; 10.9-17.3), geographic atrophy was present in 0.4% and neovascular age-related macular degeneration in 0.8%. Age-related macular degeneration was significantly (p=0.004) and linearly (p=0.001) associated with age. CONCLUSION Our study population displays a prevalence of early and late-stage age-related macular degeneration and component lesions similar to those of other Western countries, and data suggest a higher prevalence than that reported for populations in Japan. Since the age-related macular degeneration prevalence tends to rise as the population ages, studies identifying risk factors and exploring prevention methods are becoming increasingly important.

Retinal nerve fiber layer atrophy as relevant feature for diffuse unilateral subacute neuroretinitis (DUSN): case series

PURPOSE To report the findings of optical coherence tomography (OCT) in three cases of diffuse unilateral subacute neuroretinitis (DUSN). METHODS Three young patients with confirmed diagnosis of diffuse unilateral subacute neuroretinitis were followed-up using Stratus OCT. RESULTS Optical coherence tomography findings included retinal nerve fiber layer atrophy and focal edema where the worm was initially lodged. In two patients we could identify the worm by optical coherence tomography as an area of hiper-reflectivity. The worms were laser photocoagulated and post-treatment optical coherence tomography scanning revealed improvement of edema, nerve fiber layer thinning and a retinal hyper-reflectivity where laser had been applied. CONCLUSION The main finding reported here is the potential of optical coherence tomography in detecting the presence of retinal nerve fiber layer atrophy and focal retinal edema in areas affected by the worm. Optical coherence tomography can be used to distinguish diffuse unilateral subacute neuroretinitis from other mimicking diseases like punctate outer retinitis, when there are no retinal fiber layer atrophy.

Curvularia lunata Endophthalmitis

PURPOSE The aim of this study was to report a case of a 52-year-old man with a rare fungal endophthalmitis after penetrating ocular trauma with a fish hook. RESULTS The patient was submitted to wound repair and hook extraction. Three weeks after the trauma, a cataract extraction with phacoemulsification and in-the-bag intraocular lens implantation was performed. After the development of endophthalmitis, vitrectomy and lens explantation with positive culture for Curvularia lunata were carried out. The infection was controlled with the administration of systemic itraconazole and intraocular voriconazole. CONCLUSIONS The use of intravitreal voriconazole injection is a viable option in cases of Curvularia fungal endophthalmitis.

Effect of Olmesartan on Leukocyte Recruitment in Choroid–Sclera Complex in Hypercholesterolemia Model

PURPOSE Demonstrate that the blockade of angiotensin II AT-1 receptors, through the systemic administration of olmesartan, can reduce the MCP-1 expression and the resulting macrophage accumulation in the choroid and sclera of hypercholesterolemic rabbits. METHODS Thirty-two New Zealand rabbits were divided into 3 groups: group I (GI) was fed a standard rabbit diet; group II (GII) was fed a hypercholesterolemic diet; and group III (GIII) was fed a hypercholesterolemic diet plus olmesartan. Serum levels of total cholesterol, triglyceride, HDL cholesterol, and blood glucose were determined in fasting rabbits at the beginning of the experiment and on the day of euthanasia. The choroid and sclera were submitted to morphometric analysis as well as immunohistochemical analysis with MCP-1 and RAM-11 (macrophage marker) antibodies. RESULTS No abnormality was detected in GI. Group II and III had significant increases in choroid-sclera complex thicknesses when compared with group I (P<0.001). GII showed a significant increase in immunoreactivity for MCP-1 in relation to GI (P=0.001) and GIII (P=0.004). GII showed a significant increase in immunoreactivity for RAM-11 of the choroid-sclera complex in relation to GI (P<0.001) and GIII (P=0.034). A significant increase in immunoreactivity for RAM-11 was observed in GIII in relation to GI (P=0.008). CONCLUSION Olmesartan reduced the MCP-1 expression and the resultant macrophage accumulation in the choroid-sclera complex of hypercholesterolemic rabbits.

Estudo experimental da inibição da proliferação vitreorretiniana pelo uso da hiperecina

PURPOSE: To produce proliferative vitreoretinopathy (PVR) in an animal ocular trauma model. To evaluate the inhibition of (PVR) emergence and progression by hypericin. METHODS: Experimental Study. Nineteen pigmented male adult rabbits weighing between 2,000 and 3,000 grams were used in this study. All of them were submitted to trauma model with dispase and retinal diathermy to induce PVR membranes formation. They were randomly assigned to receive hypericin (10 µM in 0.1 ml) or saline solution (0.1 ml) as placebo. They were evaluated clinically in the seventh, fourteenth, twenty-first and twenty-eighth postoperative days with indirect ophthalmoscopy and digital color retinography. The PVR degree was classified according to Hida (0 to 7). RESULTS: Membranes formation was present in 79% of the eyes; being 100% in the eyes of placebo group and 60% in the eyes of treatment group (hypericin). The comparison between PVR phases averages within the groups showed a statistically significant difference between the two groups, with a p value of 0.0321 for Wilcoxon test. CONCLUSIONS: The trauma model with dispase and retinal diathermy produces vitreoretinal membranes. Hypericin was considered effective in PVR emergence and progression decrease.

Evaluation of patients with diffuse unilateral subacute neuroretinitis by spectral domain optical coherence tomography with enhanced depth imaging

Background The purpose of this study was to determine the value of spectral domain optical coherence tomography (SD-OCT) in assessing patients with diffuse unilateral subacute neuroretinitis (DUSN). Methods This was an observational case series with clinical imaging correlation performed at the Retina and Vitreous Institute of Londrina and State University of Londrina, Paraná, Brazil. The series comprised ten consecutive patients with a confirmed diagnosis of DUSN, ie, seven patients with late-stage disease and three with early-stage disease, who were assessed by SD-OCT for mean macular, retinal nerve fiber layer, and choroidal thickness using enhanced depth imaging software. Results Comparing the affected eye with the healthy fellow eye, significant diffuse atrophy of the retinal layers with a decrease in mean macular (P=0.004) and retinal nerve fiber layer (P=0.002) thickness was found in all cases. There was no difference in choroidal thickness (P=0.262). Conclusion The correlation of SD-OCT results with central vision and funduscopic findings may explain the profound loss of visual function in patients with DUSN.

Immediate retinal detachment after laser in situ keratomileusis.

PURPOSE We report a case of rhegmatogenous retinal detachment immediately (first postoperative day) after the refractive surgery of laser in situ keratomileusis (LASIK). CASE REPORT A 50-year-old man underwent bilateral LASIK; on the first postoperative day, he presented with decreased visual acuity due to retinal detachment with vitreous hemorrhage in the left eye. There were two horseshoe tears posterior to the equator and one peripheral operculated hole, all temporally located. Four months later, he presented with vitreous hemorrhage and a horseshoe tear temporal posterior to the equator in the right eye. RESULTS Surgical treatment was done, and the retina reattached immediately after surgery and remained stable thereafter in both eyes. Six months after surgery, visual acuity was 20/30 in the left eye and 20/40 in the right eye. CONCLUSION Although the cause/effect relationship between LASIK and retinal detachment has not yet been established, occurrence of immediate postoperative retinal detachment may represent a strong temporal suggestion of its association.

Retinopatia solar após ritual religioso na cidade de Londrina

PURPOSE: To present a series of patients with solar retinopathy after direct solar observation during a religious ritual in Londrina City, Parana, Brazil. METHODS: 24 patients with visual alterations were evaluated after their participation in a religious ritual. Data of the initial and final visit after 6 months of follow-up are presented and include best corrected visual acuity, refraction, color fundus picture, macular biomicroscopy, Amslers screen and contrast sensibility. RESULTS: A total of 24 cases was reported. Of these, 21 (87.5%) were females and 3 (12.5%) males. Age varied from 18 to 46 years. A total of 43 eyes were damaged. The lesion was bilateral in 19 (79.2%) patients and in 5 (20.8%) it was unilateral. The initial visual acuity ranged from 20/20 to 20/70, and the final visual acuity was 20/25 or better in 40 (93%) eyes. Of these, 33 (76.7%) eyes reached 20/20 or the last follow-up visit. Only 2 (4.6%) eyes presented alteration in the sensibility to contrast and 3 (6.9%) remained with persistent scotoma. CONCLUSION: This is the largest series of solar retinopathy after religious ritual. The cases herein presented showed a quite favorable evolution. However recovery of visual acuity is not complete, once scotoma and residual metamorphopsia persisted in a few patients.