Fausto Uno

Optical Coherence Tomography Evaluation of Idiopathic Macular Hole Treatment by Gas-assisted Posterior Vitreous Detachment

PURPOSE To report a case of idiopathic macular hole, with vitreoretinal traction confirmed by optical coherence tomography that was successfully treated by a single intravitreous perfluoropropane (C(3)F(8)) gas bubble injection. METHODS Case report. A 65-year-old patient with idiopathic macular hole (stage 2, one eye) received an intravitreous gas injection and was prospectively followed with optical coherence tomography. RESULTS A complete posterior vitreous detachment was achieved within 6 weeks after gas injection. Visual acuity improved from 20/80 to 20/25 by 10 months of follow-up. Optical coherence tomography disclosed vitreoretinal traction release and macular hole closure. No complications were related to the procedure. CONCLUSION This simple procedure can assist a complete posterior vitreous detachment with relief of the hyaloid-foveolar traction, facilitating macular hole closure.

Ultrasound biomicroscopy in recently postoperative 23-gauge transconjunctival vitrectomy sutureless self-sealing sclerotomy.

Purpose: To evaluate the ultrasound biomicroscopy (UBM) images of recent postoperative 23-gauge vitrectomy using single- and 2-step techniques. Methods: Twelve consecutive eyes were randomized and submitted to 23-gauge sutureless transconjunctival vitrectomy surgery divided in 2 groups: 1) using a beveled trocar to insert the microcannula (single step) and 2) using a stiletto blade to perform first a tunnel incision and then insert the microcannula (2 steps). All patients underwent 3-port vitrectomy with a straight angled incision of 20° to 30°. Ultrasound biomicroscopy examination was performed after 8 days to 10 days of surgery to locate and document the sclerotomy sites. Results: All patients had at least two diameters of the incision measured, and all wounds were constructed obliquely. Single-step sclerotomy mean size was 375.40 μm ± 83.70 μm (range, 280.4–695 μm) and coefficient of variation (CV) was 0.21. Two-step sclerotomy mean size was 315.5 μm ± 56.8 μm (range, 253.2–362.5 μm; CV = 0.26; P = 0.556). Two patients had an intraocular 5,000 centistokes silicone oil injection, one for each group. Only in the single-step incision was silicone oil observed in the wound. Conclusion: Twenty-three-gauge single- and two-step sclerotomies showed no statistical difference in site diameter at UBM. Postoperative UBM examination allowed the evaluation of the wound architecture. A large sample size comparing both surgical techniques should provide a statistical difference.

Vasculopatia polipoidal idiopática da coróide

Objetivo: Descrever os achados da tomografia de coerencia optica, angiofluoresceinografia e indocianinografia na vasculopatia polipoidal idiopatica da coroide. Metodos: Realizou-se analise criteriosa dos exames complementares de angiofluoresceinografia e indocianinografia, comumente utilizados para o diagnostico, assim como da tomografia de coerencia optica, em quatro olhos de uma serie de tres pacientes com vasculopatia polipoidal idiopatica da coroide. Resultados: Os quatro olhos mostraram lesoes sub-retinianas vermelho-alaranjadas, sendo que dois casos apresentaram descolamento hemorragico do epitelio pigmentado da retina, alem de manifestacoes exsudativas e hemorragicas associadas. A angiofluoresceinografia revelou dilatacoes aneurismaticas em ramificacoes anormais de vasos da coroide em apenas 1 caso, ao contrario da indocianinografia que claramente demonstrou as lesoes em todos os casos. A tomografia de coerencia optica confirmou descolamento hemorragico espontâneo do epitelio pigmentado da retina em 2 casos. Conclusao: A indocianinografia e o exame de escolha no diagnostico da vasculopatia polipoidal da coroide, mas em alguns casos a associacao com a tomografia de coerencia optica e angiofluoresceinografia pode ser util no diagnostico e seguimento.Purpose: To describe the role of the optical coherence tomography, fluorescein and indocyanine green angiography findings in the diagnosis of idiopathic polypoidal choroidal vasculopathy (IPCV). Methods: A series of four eyes of three patients thought to have IPCV were examined and evaluated by optical coherence tomography, fluorescein and indocyanine green angiographies. Results: Fluorescein angiography was highly important for the diagnosis only in case 1. Indocyanine green angiography showed a branching network of the vessels with marginal vascular dilatations in all cases. Optical coherence tomography showed hemorrhagic detachment of the retinal pigment epithelium contiguous with the anterior delimitation of the polypoidal elements in two cases. Conclusion: The association of clinical manifestations with fluorescein and indocyanine green angiographies and optical coherence tomography can be useful in the differential diagnosis of exudative maculopathies, particularly IPCV with serohemorrhagic manifestations.

Videoangiografia digital com a fluoresceína sódica e indocianina verde na doença hipertensiva específica da gestação

Objetivo: Descrever os achados oftalmoscopicos e videoangiograficos com a fluoresceina sodica e indocianina verde (ICG-V) na doenca hipertensiva especifica da gestacao (DHEG). Metodos: Quatro pacientes do sexo feminino, portadoras de DHEG foram submetidas a exame oftalmologico e angiofluoresceinografia (AF) e adicionalmente, em duas pacientes, foi realizada videoangiografia digital com indocianinografia verde (ICG-V). Resultados: Todas as pacientes apresentaram descolamento seroso da retina bilateral que regrediu espontaneamente com a estabilizacao do quadro clinico hipertensivo. Na AF notaram-se multiplas areas de nao-perfusao coroidea precoce e pontos hiperfluorescentes por vazamento e acumulo do corante no espaco subretiniano nas areas do descolamento. Areas de hiperfluorescencia transmitida por defeito em janela e hipofluorescencia por bloqueio pigmentario apos a resolucao do descolamento associados a alteracoes pigmentarias foram encontradas tardiamente. A ICG-V evidenciou hipoperfusao coroidea precoce e multiplos pontos de vazamento e acumulo tardio do corante. Conclusoes: A DHEG geralmente apresenta bom prognostico visual apos a resolucao do quadro, embora em alguns casos possa haver baixa visual associada a alteracoes pigmentarias maculares. A ICG-V mostra com maior precisao o envolvimento vascular da coroide na fisiopatologia do descolamento seroso da retina, sugerido previamente por estudos angiofluoresceinograficos.

Charcot-Marie-Tooth disease and posterior scleritis: a case report

Objetivo: Descrever a associacao entre doenca de Charcot-Marie-Tooth (DCMT) e esclerite posterior. Metodologia: Relato de caso de uma paciente do sexo feminino, 16 anos de idade, com baixa de acuidade visual e dor em ambos os olhos. Resultados: O exame oftalmologico revelou esclerite posterior, observada tambem por ultra-som e angiofluoresceinografia. Deformidades de pernas e pes foram identificadas na paciente e em seus familiares. O diagnostico de DCMT na paciente estudada foi confirmado por estudos eletrofisiologicos. Conclusoes: A presenca de esclerite posterior em paciente com DCMT nao e descrita na literatura, nao se encontrando tambem relatos de outras doencas oculares inflamatorias, nestes pacientes.