Daniel da Rocha Lucena

Intravitreal injection versus subtenon infusion of triamcinolone acetonide during cataract surgery in patients with refractory diabetic macular edema.

Purpose: The purpose of this study was to compare the effectiveness of intravitreal injection (IVT) versus posterior subtenon infusion (STI) of triamcinolone acetonide performed during phacoemulsification cataract surgery in eyes with refractory diffuse diabetic macular edema. Methods: Twenty-four eyes of 24 patients with refractory diffuse diabetic macular edema scheduled to undergo phacoemulsification cataract surgery were randomly assigned to receive either a 4-mg IVT (n = 12) or a 40-mg STI (n = 12) of triamcinolone acetonide during cataract surgery. Comprehensive ophthalmic evaluation, including best-corrected visual acuity, intraocular pressure, and central macular thickness measured with optical coherence tomography, was performed at baseline and at 1, 4, 8 ± 1, 12 ± 2, and 24 ± 2 weeks postoperatively. Results: Ten patients from the IVT group and 9 patients from the STI group completed the 24-week study visit. Mean baseline best-corrected visual acuity (logarithm of the minimum angle of resolution) was 20/259 and 20/222 in the IVT and STI groups, respectively (t = 0.41; P = 0.3407). A significant improvement in best-corrected visual acuity was observed only in the IVT group at 4 weeks (mean difference ± standard error, improved to 20/116; P = 0.0437), 8 weeks (20/110; P = 0.0355), and 12 weeks (20/121; P = 0.0471) postoperatively. There was no significant change from baseline in mean intraocular pressure in either group. Mean ± standard error baseline central macular thickness was 474.1 ± 42.4 &mgr;m and 490.8 ± 70.8 &mgr;m in the IVT and STI groups, respectively (t = 0.21; P = 0.5807). The central macular thickness reductions after surgery at all study follow-up visits were significantly greater in the IVT group than in the STI group (P < 0.05). Conclusion: These data suggest that IVT is more effective than STI of triamcinolone acetonide for the management of refractory diffuse diabetic macular edema in eyes undergoing phacoemulsification. Further investigation of a larger number of patients with longer follow-up is necessary to confirm these findings.

Roturas retinianas em retinocoroidite por toxoplasmose: série de casos

This study is a retrospective case series aiming to evaluate the relation between toxoplasmic retinochoroiditis scars and the occurrence of retinal tears. Ten patients with retinal tear and toxoplasmic retinochoroiditis examined at the School of Medicine of Ribeirão Preto Clinics Hospital, between January 2007 and April 2008, were included. Fisher test and qui-square test with significance level of p<0.05 were used. Eight cases (80%) had retinal detachment. Twelve tears were found and localized mostly in the temporal superior periphery (6 cases, 50%). No statistically significant association between retinal tear and chorioretinal scar localization was observed considering five retinal quadrants (p=0.0828) or three zones (p=0.2507). The occurrence of retinal tears in patients with uveitis may be related to early posterior vitreous detachment caused by the intraocular inflammatory process. No correlation was observed between the localization of retinal tears and chorioretinal scars in this study, which suggests a causative factor not directly related to the presence of a scar.

Proliferative sickle cell retinopathy associated with sickle cell trait and gestational diabetes: case report.

Proliferative sickle cell retinopathy is an uncommon complication in individuals with sickle cell trait (AS). However, the risk for proliferative retinopathy development is increased in patients with AS hemoglobinopathy associated with systemic conditions or ocular trauma. A case of a patient with AS hemoglobinopathy who developed proliferative sickle cell retinopathy after the occurrence of gestational diabetes and pregnancy-induced hypertension is reported. Hemoglobin electrophoresis revealed presence of A2 5.0%, S 35.0% and A 53.2%. The present case emphasizes the importance of evaluating systemic comorbidities in patients with sickle cell trait during pregnancy since sickle cell retinopathy can progress rapidly, as well as the importance of regular eye fundus examination in these patients.

Síndrome de Vogt-Koyanagi-Harada incompleta associada a HLA DRB1*01 em criança de quatro anos de idade: relato de caso

Vogt-Koyanagi-Harada syndrome is chronic systemic autoimmune disease with ocular, nervous, auditory and tegumental manifestations. We report here the case of a child with onset of symptoms at four years and two months of age, with positive HLA DRB1*01.

Ultrasonography-guided scleral buckle retinopexy and cryotherapy: case report

If the ocular media are clear, indirect binocular ophthalmoscopy allows retinal detachment and retinal tear identification and treatment under direct visualization. However, if opacities are present preventing direct fundus examination, ultrasonography becomes the most important tool for evaluating the posterior segment. In addition, ultrasonography can be useful in retinal tear treatment by guiding cryotherapy. In this article we describe a rhegmatogenous retinal detachment treatment technique applied to a patient with corneal opacity. Cryopexy and circumferential and radial buckle positioning were guided by ultrasonography, resulting in retinal attachment during the 6-month follow-up period.

Avaliação ultra-sonográfica da avulsão do nervo óptico utilizando as sondas de 10 MHz e 20 MHz: relato de caso

Traumatic optic nerve avulsion is a rare event. A case of complete unilateral optic nerve avulsion after blunt ocular trauma without major damage to other ocular structures is reported. B-scan ultrasonography with 10 and 20 MHz probes proved to be helpful in diagnosing the optic nerve lesion, whereas orbital computed tomography was inconclusive. The prognosis is ominous and it is dependent on the initial visual acuity, which was no light perception in this case. There is no efficient treatment for complete optic nerve avulsion, and no specific treatment was performed in this case.

Atrofia girata de coróide e retina: relato de caso

PURPOSE: To report a case of gyrate atrophy confirmed by biochemical blood analysis. METHODS: Best corrected visual acuity was evaluated. Biomicroscopy of the anterior segment, indirect ophthalmoscopy, fluorescein angiography and computerized visual fields were performed. Color vision was assessed and plasma ornithine level was determined. RESULTS: 22-year-old white female with high myopia, visual acuity of 20/100 in both eyes. Biomicroscopy showed posterior subcapsular cataract in both eyes. Retinography showed well-delineated atrophic lesions of the choroid and retina in the mid-periphery and around the optic nerve in both eyes. Blood aminoacid determination showed high levels of ornithine. CONCLUSION: We describe here a typical case of girate atrophy of the retina and choroid, a rare disease associated with high levels of plasma ornithine.

Study of asphericity coefficient and longitudinal spherical aberration surface corneal

Objective: To correlate the asphericity coefficient (Q) with longitudinal spherical aberration (LSA) of the corneal surface, also correlating each of these variables with the average keratometry Methods: An observational study was conducted by collecting preoperative data from the medical records of individuals candidate cataract surgery, i.e., patient sex and age, as well as Q, LSA of the corneal surface and mean keratometry (Km). Patients who had been subjected to any corneal surgical procedure who would alter Q, LSA and Km measuements were excluded. The corneanl topograph selected, fixedly, a 4.5 mm area of the anterior surface of the cornea for the measurement of Q and LSA, having the pupillary axis as the central point, since the occurrence of LSA is relevant in dim environments in individuals with a pupil wider than 3 mm Results: The sample consisted of 70 eyes of 35 individuals, 24 of them women (68.6%) and 11 men (31.4%) ranging in age from 48 to 89 years (mean: 69.97 ± 8.29). Km ranged from 41.00 to 46.50 D, with a mean of 43.94 ± 1.48D, and mean Q of the corneal surface was -0.15 ± 0.15. Six corneas showed a spherical design (Q= 0.0) and only one showed an aspheric design with Q = -0.50, generating an LSA of 0.0. Mean LSA of the corneal surface was +0.33 ± 0.14 μm. Only one eye showed an LSA equal to 0.0μm, and five showed an LSA of +0.10 to +0.30μm. No eye showed a negative LSA of the corneal surface. There was no correlation between Km and Q (r = -0.005 / p = 0.965) or between Km and LSA (r = 0.167 / p = 0.170). A correlation (r = 0.962 / p = 0.000) was observed between Q and LSA Conclusion: There was a correlation between Q and LSA of the corneal surface. There was no correlation between the sphericity coefficient or longitudinal spherical aberration with the average keratometry.

Correlation between cup-to-disc ratio and cup/retrobulbar optic nerve diameter proportion assessed by high-resolution ultrasound in glaucomatous eyes

PURPOSE To investigate the correlation between the measurements of the cup/retrobulbar optic nerve diameter (C/OND) proportion obtained by high-resolution 20-MHz B-mode ultrasound (US) and those of the cup/disc ratio (C/D) obtained by fundus biomicroscopy (BIO) and optical coherence tomography (OCT). METHODS Thirty eyes of 15 glaucomatous patients with any C/D proportion were studied. All patients underwent examination of the vertical C/D by BIO with a 78D lens and time-domain OCT analysis, as well as the vertical C/OND proportion using 20-MHz US measurements. All data were analyzed by correlation and agreement tests. RESULTS The Spearman test showed a strong correlation between C/D results obtained by BIO and the measurements of C/OND (US) (r=0.788, p<0.0001), and with C/D obtained by OCT (r=0.8529, p<0.0001). However, comparison of C/D results obtained with OCT to those obtained by with C/OND (US) showed only a moderate correlation (r=0.6727, p<0.0001). Bland-Altman analysis did not show good agreement between C/D (BIO) and C/OND (US). CONCLUSIONS The results demonstrate that B-mode ultrasound examination with a 20 MHz probe can be a good additional method for the evaluation of the C/D ratio in glaucomatous patients, and may be considered as an alternative gross tool in glaucomatous patients with optic media opacities.