Eduardo Ferrari Marback

Protein expression of VEGF, IGF-1 and FGF in retroocular connective tissues and clinical correlation in Graves' ophthalmopathy

PURPOSEnTo investigate the immunohistochemical expression (IGF-1, EGFr, EGF, c-erbB-2/HER-2/neu, PDGF-A, PDGF-B, FGF and VEGF) in patients with Graves ophthalmopathy.nnnMETHODSnTwenty-four samples (Graves ophthalmopathy patients) underwent lateral rectus muscle and surrounding fibrous and adipose tissue biopsy. The control group was obtained by strabismus surgery. Correlation between clinical-ophthalmologic, endocrinological, ultrasonographic findings, and immunohistochemical expression was performed.nnnRESULTSnIGF-1: There were 7 positive cases (29.2%). There was a direct relation with higher CAS (clinical activity score) in all of them and if only CAS equal or higher than 5 was considered, this was 54.5%. FGF: There was expression in 5 cases (20.8%) with a direct relation in all those with higher CAS (>5) (45.4%). VEGF: There were two positive cases (8.3%) for VEGF in endothelial cells, in these cases the patients also presented CAS higher than 5. There was no expressions of all growth factors in the control group.nnnCONCLUSIONSnAll patients, except one, with positive expression of FGF, IGF-1 and VEGF showed CAS greater than 5, suggesting in this way an important role of these growth factors in the pathogenesis and severity of Graves ophthalmopathy. However, statistical analysis revealed only significant association between IGF-1 and male sex (P=0.034). Low ultrasound reflectivity and endocrine status may not correlate directly with disease activity or with immunoexpression of growth factors and c-erbB-2/HER-2/neu.

Optical coherence tomography findings in acute phase of branch retinal artery occlusion: case report

PURPOSEnto report a case of branch retinal artery occlusion in the acute phase, using optical coherence tomography to evaluate the morphologic changes. A 27 year-old man had a sudden superior scotoma in the right eye, with fundus examination compatible with inferior temporal branch retinal artery obstruction. The optical coherence tomography revealed increase in thickness and hyper-reflectivity of the inner retinal layers in affected area, with decreased reflectivity of photoreceptor and retinal pigment epithelial layers. The optical coherence tomography findings are consistent with intracellular edema, and not with secondary vascular leakage of extracellular fluid, according to histopathological theories of retinal ischemia and necrosis that occurs after retinal artery occlusion.

Anterior capsule staining using 0.025% trypan blue in cataracts without red reflex

Purpose: To describe the use of anterior capsule staining in cataracts without red reflex using a 0.025% trypan blue solution. Methods: Six eyes of 6 patients with cataracts without red reflex were submitted to phacoemulsification using a direct injection of 0.2 to 0.5 ml of 0.025% trypan blue in the anterior chamber previous to viscoelastic injection. All patients had an ophthalmologic examination prior to surgery, as well as pre and postoperative corneal endothelial cell count. Results: In all cases the capsule became stained with a faint blue color that enabled an adequate visibility of the flap during the continuous curvilinear anterior capsulotomy (CCC). There were no intra-or postoperative complications. The endothelial cell loss varied between 1.8% and 26.6% (mean 12.8%). Conclusion: Staining the anterior capsule with 0.025% trypan blue solution allows a good visibility of the capsular flap and facilitates the confection of CCC in cataracts without red reflex.

Foreign body after pterygium surgery simulating an epibulbar tumor.

A 60-year-old woman was referred for evaluation of a rapidly growing conjunctival neoplasm after pterygium surgery. The lesion proved to be a foreign body granuloma, with exogenous material that seemed to be cotton mesh, probably used for tamponade of subconjunctival bleeding that was unintentionally left in place.

Teratoma cístico da órbita: estudo clínico patológico: relato de caso

We report on a case of an congenital orbital tumor of impressive size, occurring in a newborn. The patient underwent orbital exenteration with a histopathologic diagnosis of cystic teratoma. The clinicopathological aspects of such a rare disease are commented.

Síndrome de compressão orbitária relacionada à anemia falciforme

Objetivo: Relatar caso raro de sindrome de compressao orbitaria bilateral secundaria a hematoma subperiosteo em crianca portadora de anemia falciforme. Metodos: Relato de caso de crianca aos 08 anos de idade, com anemia falciforme (eletroforese de hemoglobina - SS) e sindrome de compressao orbitaria bilateral assimetrica apresentando-se com hematomas extradurais espontâneos, proptose e dor em ambos os olhos. Evoluiu com remissao completa dos sinais e sintomas em 20 dias apenas com tratamento sintomatico. Sao apresentados os exames de imagem da fase aguda e apos resolucao do quadro clinico. Conclusao: Anemia falciforme deve ser incluida entre as causas de sindrome de compressao orbitaria.

Síndrome do bloqueio capsular precoce relato de caso e especulação sobre o tamanho da parte óptica da lente como fator de risco

Apresentamos um caso de sindrome de bloqueio capsular precoce, tratado por reintervencao cirurgica no segundo dia de pos-operatorio. Comentamos as principais caracteristicas da sindrome, os possiveis fatores predisponentes, as opcoes de tratamento e a importância do seu correto reconhecimento. Nos tambem especulamos sobre outro possivel fator de risco, lentes intraoculares com parte optica de 6mm ou maiores.

Granuloma conjuntival causado por fibras sintéticas

Objetivo: Relatar caso de granuloma de conjuntiva por fibras sinteticas. Relato do Caso: Paciente de seis anos, sexo feminino com historia de tumoracao em conjuntiva tarsal inferior do olho direito ha seis meses. Foi realizada exerese da lesao. O laudo anatomo-patologico mostrou reacao inflamatoria granulomatosa do tipo corpo estranho com celulas gigantes multinucleadas fagocitando material birrefringente, compativel com fibras sinteticas. Discussao: O granuloma de fibras sinteticas de conjuntiva e raro e descrito principalmente em criancas, com acometimento unilateral, em conjuntiva tarsal inferior ou fundo de saco inferior. O frequente contato com material de pelucia nesta faixa etaria tem sido apontado como fator etiologico. Granuloma de fibras sinteticas de conjuntiva deve ser considerado no diagnostico diferencial de lesoes tumorais de conjuntiva em criancas.

Granular Cell Tumor Located in the Bulbar Subconjunctival Space

Aim: To report an unusual case of granular cell tumor. Methods: Case report. Results: A 14-year-old male presented with a bulbar conjunctival yellowish nonmovable mass, in the left eye. The tumor was removed and histopathologic evaluation revealed a granular cell tumor. Conclusion: Granular cell tumor can occur at the bulbar subconjunctival space.

Optic Disc Pyogenic Granuloma

Aim: The aim of this paper was to report a rare presentation of adenoid cystic carcinoma. Method: This is a case report presenting clinical, radiographic, and histopathologic findings. Results: A 72-year-old female with no reported ocular symptoms was found to have an incidental right orbital mass on imaging. Additional studies revealed multiple liver lesions, which were biopsied and found to be consistent with adenoid cystic carcinoma. She was then referred to the ophthalmology service, where ocular examination demonstrated 2.5 mm of right proptosis with elevation and abduction deficits. Diplopia could be elicited in extreme upgaze and right lateral gaze. An excisional biopsy of the orbital mass was performed, with histopathology confirming the diagnosis of primary adenoid cystic carcinoma of the lacrimal gland, thereby also supporting the initial suspicion that the hepatic adenoid cystic carcinoma lesions represented metastases. Conclusion: The authors describe a rare presentation of adenoid cystic carcinoma of the lacrimal gland, initially asymptomatic, with metastatic lesions restricted to the liver at the time of diagnosis. Three previous cases of adenoid cystic carcinoma with isolated metastatic hepatic lesions at the time of diagnosis have been reported; all of these cases localized the primary tumor to the salivary glands.