Cleide Guimarães Machado

Idiopathic juxtafoveolar retinal telangiectasis: clinical pattern in 19 cases.

Background: Idiopathic juxtafoveolar telangiectasis (IJT) is a rare retinal vasculopathy of adulthood that may cause central loss of visual acuity. The purpose of this paper is to evaluate the type and distribution of fundus changes in patients with this disorder. Methods: Medical records of 19 patients with IJT using the Gass & Blodi classification were studied. Eight patients in group 1A (42%) and 11 in group 2A (58%) were analyzed. By projecting color photographs we divided the macula into four quadrants and studied the fundus changes in each one. Results: All patients in group 1A presented unilateral disease with easily seen telangiectasis, lipid deposits and cystic macular edema. The mean age of this group was 55.8 years. Five (63%) patients were male and 3 (37%) were female. All patients in group 2A, 2 males (18%) and 9 females (82%), had bilateral disease evidenced by fluorescein angiography. The mean age of this group was 54.5 years. Fundoscopic findings included: intraretinal pigment plaques, grayish coloring of the macular retina, superficial crystalline deposits, right-angle venules, subretinal and intraretinal neovascularization. Conclusions: All patients in this survey were adults. In group 1A, men were affected 2 times more often than women, and the main affected macular quadrant was the inferior temporal, followed by the inferior nasal. In group 2A, women were affected 4 times more often than men and all eyes had inferior and superior temporal macular quadrant involvement.

Single intravitreal bevacizumab injection effects on contrast sensitivity in macular edema from branch retinal vein occlusion

PURPOSE To evaluate the effect of a single intravitreal bevacizumab injection on visual acuity, contrast sensitivity and optical coherence tomography-measured central macular thickness in eyes with macular edema from branch retinal vein occlusion. METHODS Seventeen eyes of 17 patients with macular edema from unilateral branch retinal vein occlusion were treated with a single bevacizumab injection. Patients were submitted to a complete evaluation including best corrected visual acuity, contrast sensitivity and optical coherence tomography measurements before treatment and one and three months after injection. Visual acuity, contrast sensitivity and optical coherence tomography measurements were compared to baseline values. RESULTS Mean visual acuity measurement improved from 0.77 logMAR at baseline to 0.613 logMAR one month after injection (P=0.0001) but worsened to 0.75 logMAR after three months. Contrast sensitivity test demonstrated significant improvement at spatial frequencies of 3, 6, 12 and 18 cycles/degree one month after injection and at the spatial frequency of 12 cycles/degree three months after treatment. Mean ± standard deviation baseline central macular thickness (552 ± 150 µm) reduced significantly one month (322 ± 127 µm, P=0.0001) and three months (439 ± 179 µm, P=0.01) after treatment. CONCLUSIONS Bevacizumab injection improves visual acuity and contrast sensitivity and reduces central macular thickness one month after treatment. Visual acuity returns to baseline levels at the 3-month follow-up, but some beneficial effect of the treatment is still present at that time, as evidenced by optical coherence tomography-measured central macular thickness and contrast sensitivity measurements.

Fundus autofluorescence as a marker of disease severity in Vogt-Koyanagi-Harada disease.

icant past medical history presented to KK Women’s and Children’s Hospital, Singapore, on 21 October 2015 complaining of fever and a ‘black dot’ in her left upper eyelid for 3 days. She just returned from Malaysia with close contact with dogs during the trip. On examination, there was left upper eyelid erythema, oedema and the presence of a dog tick at the eyelid margin (Fig. 1A). Anterior segment examination was unremarkable. A procedure was performed under informed consent with topical tetracaine anaesthesia. Thermal energy was applied using a portable monopolar cautery device to the tick’s body (Fig. 1B), facilitating en bloc removal by inducing detachment of the tick. Microscopic examination of the organism revealed that it belonged to the genus Ixodes (Fig. 1C). There were no complications, and the patient recovered uneventfully. Ocular manifestations of ticks include conjunctivitis, keratitis, uveitis as well as embedment of the organism in the meibomian gland orifice presenting as a mass, oedema and erythema at the eyelid margin. Early removal of tick from its host is crucial as the risk of disease transmission increases significantly after 24 hr of attachment. Therefore, an efficient method of tick removal is crucial to avoid vector transmission of infectious diseases and localized inflammation and infection. There had been several methods of tick removal described in the literature. However, none of these methods is superior in terms of safety and efficacy profile (Fig. 1D). Many chemicals have been studied for tick removal. Compounds such as deodorized kerosene resulted in voluntary detachment in approximately 25% of the ticks that were treated (Knight et al. 1962). However, the use of chemical compounds can pose potential danger of toxicity to the ocular tissues. Chemical eradication of the organism may also precipitate regurgitation by the tick and transmission of infectious agents to its host (Flicek 2007). The use of forceps for direct mechanical tick removal could result in retained mouthparts in ocular tissues as well as fragmentation of its body which would then require further excision, complicating the removal process (Flicek 2007). Blepharoplasty incision allowing for an en bloc excision of the organism has been described (Love et al. 2001). However, this procedure is more invasive with a risk of ocular tissue loss and disruption of the ocular architecture. Tick removal using portable monopolar diathermy is a novel technique to the best of our knowledge. It is simple to perform, requiring only a few sequential thermal burns to the tick body to induce its detachment. This avoids trauma to the surrounding ocular tissues and need for excision. However, this technique might be more suitable for less tenacious ticks with shallow bites. Monopolar cautery for tick removal may be a superior and relative safe novel technique for en bloc removal of tick with minimal trauma to the surrounding ocular tissues.

Simvastatin in the treatment of elderly patients with primary hypercholesterolemia

Abstract Twenty elderly patients (14 women, 6 men) with primary hypercholesterolemia (total cholesterol >260 mg/dl) were treated for 42 months with simvastatin, a 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitor. Mean age was 69 ± 3 years (range, 65 to 72 years). Eighteen patients had coronary heart disease and two had transient cerebral ischemia; all patients were unresponsive to dietary changes. Clinical, ophthalmologic, and laboratory evaluations were performed periodically. Simvastatin dosages ranged from 2.5–20 mg/day initially, with maintenance doses from 5–40 mg/day (mean, 22 ± 12 mg/day). Total cholesterol (TC), plasma triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and very low-density lipoprotein cholesterol (VLDL-C) levels and TC:HDL-C and LDL-C:HDL-C ratios were determined during the placebo baseline period and active treatment period. When the placebo baseline period was compared with the final active treatment period significant reductions of TC levels (306.1 ± 22.7 and 213.1 ± 22.5; mean reduction = 30.2%) and LDL-C levels (223.3 ± 27.3 and 136.3 ± 20.3; mean reduction = 40.4%) were seen. There was a significant increase in HDL-C levels (49.9 ± 8.7 and 51.9 ± 8.9; mean increase = 5.1%). There were also significant reductions in TC:HDL-C and LDL-C:HDL-C ratios, of 6.2 ± 1.0 and 4.2 ± 0.8 (mean reduction = 34.0%) and 4.5 ± 0.9 and 2.7 ± 0.6 (mean reduction = 43.4%), respectively. Although a 20.4% reduction in TG levels (166.4 ± 53.7 to 117.5 ± 34.8) was seen, it was not statistically significant. In conclusion, simvastatin had significant effects on TC, LDL-C, and HDL-C levels as well as TC:HDL-C and LDL-C:HDL-C ratios compared with placebo and the reductions observed at the beginning of the study remained constant throughout the investigation. TG, VLDL-C, and HDL-C levels did not show uniform responses for all patients. There were no adverse effects requiring interruption of treatment. The present study confirms the validity of long-term therapy with simvastatin in the elderly.

Prophylaxis and treatment of cystoid macular edema after cataract surgery

O edema macular cistoide e uma das principais causas de baixa de visao apos cirurgia de catarata. O processo inflamatorio parece sero principal fator causal do edema. Sao considerados fatores de risco complicacoes cirurgicas, doencas retinianas previas, diabe tes, uveitese uso de colirios de prostaglandinas. O diagnostico e feito clinicamente, mas a angiografia fluoresceinica e a tomografia de coerenciaoptica tambem sao ferramentas importantes para detectar o edema e auxiliar no diagnostico diferencial. Apesar da profilaxia pre-operatoria nao ter evidencia cientifica, ela e preconizada especialmente nos casos com fatores de risco. O tratamento inicial e realizadocom associacao de corticoide e anti-inflamatorio nao hormonais topicos. Os casos cronicos e refratarios tem diversas alternativas detratamento, sendo o uso de triancinolona e antiangiogenicos intravitreos as mais utilizadas. Este artigo se propoe a discutir diversosaspectos do edema macular cistoide pseudofacico.

Effect of a Single Intravitreal Bevacizumab Injection on Contrast Sensitivity and Macular Thickness in Eyes with Macular Edema from Central Retinal Vein Occlusion: A Prospective, Nonrandomized, Three-Month Follow-Up Study

Purpose: To evaluate the results of intravitreal bevacizumab (IVB) injection on contrast sensitivity (CS), best-corrected visual acuity (BCVA), foveal thickness (FT) and macular volume (MV) as measured by optical coherence tomography in patients with macular edema (ME) from central retinal vein occlusion (CRVO). Methods: Sixteen consecutive eyes from 16 patients with ME from unilateral CRVO were treated with a single IVB injection. The CS, BCVA, FT and MV measurements were obtained before the treatment and 1 and 3 months after the injection. Results: CS demonstrated significant improvement at all spatial frequencies - 1.5, 3, 6, 12 and 18 cycles per degree (cpd) - 1 month after the injection and at 6 cpd at the 3-month follow-up. The mean BCVA measurements in log of the minimum angle of resolution (logMAR) units improved from 1.03 at baseline to 0.83 logMAR 1 month after the injection, but worsened to 0.97 logMAR at 3 months. The mean baseline FT ± standard deviation (SD; 620.06 ± 177.60 µm) was reduced significantly 1 month (270.93 ± 74.17 µm) and 3 months (535.56 ± 222.33 µm) after the treatment. The mean baseline MV ± SD (12,765.56 ± 3,769.70 mm3) was reduced significantly at the 1-month (8,324.93 ± 932.04 mm3) and 3-month (11,319.44 ± 3,044.74 mm3) follow-up visits. Conclusions: IVB improved CS, BCVA, FT and MV within a short time period (1 month). Although VA was not improved at 3 months, improvements were observed for CS, FT and MV, which indicates that, despite ME recurrence, there still was some benefit to visual function.