Fernando José De Novelli

Aspectos clínicos e tomográficos dos microburacos maculares

OBJETIVO: Descrever os aspectos clinicos e tomograficos do microburaco macular. METODOS: Estudaram-se pacientes portadores de microburaco macular de forma retrospectiva e observacional. Apurou-se historia clinica, medida de acuidade visual, biomicroscopia de polo posterior, retinografia, angiofluoresceinografia retiniana e tomografia de coerencia optica. RESULTADOS: Examinaram-se oito olhos de sete pacientes portadores de microburaco macular. A idade variou entre 26 e 63 anos (media de 48,8 anos). Seis pacientes eram do sexo feminino (85,7%). Cinco pacientes apresentaram o microburaco macular no olho direito (62,5%). Quanto a sintomatologia, cinco individuos referiram diminuicao da acuidade visual (71,4%), um referiu escotoma central (14,3%) e um nao apresentou queixas visuais (14,3%). A angiofluoresceinografia retiniana nao mostrou alteracoes maculares em cinco dos olhos (71,4%). A tomografia de coerencia optica, os oito olhos apresentaram uma lesao foveal hiporrefletiva e menor do que 100 micra, que acometia as camadas mais profundas da retina neurossensorial. CONCLUSAO: Microburaco macular e um pequeno defeito lamelar presente na camada externa profunda da retina, que e evidente a biomicroscopia macular como uma lesao arredondada avermelhada de tamanho diminuto, levando a pouca repercussao na funcao visual, sem carater progressivo. A historia clinica, a acuidade visual, a biomicroscopia de fundo e a tomografia de coerencia optica sao os principais elementos para a deteccao e o estudo dos mecanismos fisiopatologicos responsaveis pela sua origem e evolucao.

Surgical Removal Of Epiretinal Membrane With And Without Removal Of Internal Limiting Membrane: Comparative Study of Visual Acuity, Features of Optical Coherence Tomography, and Recurrence Rate

Purpose: To study and compare visual acuity, foveal thickness, outer limiting layer, ellipsoid zone, and recurrence rate in patients undergoing removal of the epiretinal membrane with and without the removal of the internal limiting membrane (ILM). Methods: Sixty-three patients who had the epiretinal membrane removed by a single surgeon were randomly assigned into 2 groups: Group 1 without additional removal of the ILM and Group 2 with removal of the ILM. Patients were followed up and evaluated at the first month, third month, and sixth month, postoperatively. Results: Patients from both groups had a gradual improvement in their vision over time. There was no significant difference in the improvement in visual acuity between the two groups. About tomographic assessment of alterations, no significant differences were found between the groups; however, Group 1 had a higher relapse rate (17%) compared with Group 2 (3.6%) (P = 0.09). Conclusion: Epiretinal membrane removal with and without ILM peeling shows similar functional and anatomical improvements, but the group in which the ILM was not removed seemed to have a higher recurrence rate.

Combined branch retinal vein and artery occlusion in toxoplasmosis.

A 22-year-old man complained of low visual acuity and pain in his left eye for five days. His ophthalmological examination revealed 2+ anterior chamber reaction and a white, poorly defined retinal lesion at the proximal portion of the inferotemporal vascular arcade. There were retinal hemorrhages in the inferotemporal region extending to the retinal periphery. In addition, venous dilation, increased tortuosity, and ischemic retinal whitening along the inferotemporal vascular arcade were also observed. A proper systemic work-up was performed, and the patient was diagnosed with ocular toxoplasmosis. He was treated with an anti-toxoplasma medication, and his condition slowly improved. Inferior macular inner and middle retinal atrophy could be observed on optical coherence tomography as a sequela of ischemic injury. To our knowledge, this is the first report of combined retinal branch vein and artery occlusion in toxoplasmosis resulting in a striking and unusual macular appearance.

Alterações do segmento posterior na microftalmia: relato de casos

Microphthalmos is a developmental ocular disorder defined as a small eyeball. The condition can be associated with abnormalities of anterior and posterior segments. The most common anterior characteristics include corneal opacities, angle-closure and a shallow anterior chamber and cataract. The main findings of posterior segment are uveal effusion, retinal folds, abnormalities of macular capillar vascularization, absence of foveal depression and peripheral retinoschisis. Three patients with microphthalmos were assisted and their OCT features of posterior segment were analyzed. The first case had uveal effusion syndrome, choroidal and retinal detachment treated with parcial sclerectomy at the four quadrants. The other case presented with neurosensory retinal fold at fovea and papillomacular area in both eyes without involvement of retinal pigment epithelium layer and choriocapillaris. The third patient showed absence of foveal depression. The main diferencial diagnosis for this condition is foveal hypoplasia.

Condições de adaptação e venda de lentes de contato em óticas do estado de São Paulo

Purpose: To evaluate contact lens (CL) adaptation and sales in optician stores of 4 cities in Sao Paulo State, Brazil. Methods: A study was performed in view of the answers to a questionnaire applied by four medical students to optician stores selling contact lenses in four cities of the state of Sao Paulo. The researchers evaluated the need of medical prescriptions for contact lens sales, the specialist in charge of selling and/or adapting contact lenses, the types of lenses sold/adapted, the equipment used in the contact lens tolerance test, the patients behavior facing contact lens complications during adaptation or during its use; the information given about possible signs and symptoms of risk and the patients hygiene, as well as the number of hours of contact lens wear and their wearing during sleep. Results: Of the 198 investigated optician stores, 121 (61.11%) sell contact lenses. In 112 (92.56%) of the stores, medical prescription was not required for the purchase of lenses. In these stores, the contact lens degrees were determined by measuring glass lenses in 69 (61.61%) of the cases and by verbal report in 28 (25.00%) cases. Concerning equipment, 102 (91.07%) of the stores had lensometers, 41 (36.61%) had keratometers and 14 (12.50%) had slit lamp. Soft disposable contact lenses were displayed for sale/adaptation in 66 (54.55%) of the stores, so were soft extended and daily use contact lenses in 68 (56.20%) stores and hard contact lenses, in 54 (44.63%) stores. In 103 (85.12%) stores, tolerance test was done, and the responsible persons for seeing the patient and for monitoring were professionals who called them selves contact lens fitters in 78 (64.46%) of these stores, the shop assistant in 20 (16.53%), the optician in 12 (9.92%) and the ophthalmologist in 9 (7.44%). As to complications due to contact lens adaptation, 66 (54.55%) stores mentioned that they would happen only if they happened on the tolerance test; in 35 (28.93%) stores, an ophthalmologist was advised for treatment and in 20 (16.53%) stores, a return was suggested for information on treatment. Only in 15 (13.39%) stores, professionals warned about possible risk symptoms and in 13 (11.61%) stores, they were concerned about diseases, which contraindicate contact lens wear. In 105 (93.75%) of the stores, professionals did not pay full attention to contact lens hygiene, wearing hours and lens wearing during sleep. Conclusion: Of the 198 investigated stores, 61.11% sell contact lenses, and 92.56% did not require medical prescription; 14.88% did not perform any kind of tolerance test and the remaining 85.12% performed tests which are normally not sufficient to detect alterations induced by contact lenses. There was no concern about contraindications, risk signs and symptoms, evaluation of possible complications resulting from contact lens wear. Neither was there concern about the least hygiene care during the tolerance test. Professionals, who call themselves contact lens fitters, shop assistants, opticians and ophthalmologists, which were responsible for adaptation give no appropriate instructions about contact lens wear and, in many cases, none about contact lens hygiene.

Surgical outcomes of rhegmatogenous retinal detachment associated with ocular toxoplasmosis

PURPOSE To evaluate the anatomical and functional outcomes of surgical treatment of retinal detachment secondary to ocular toxoplasmosis. METHODS A retrospective analysis of data from patients who had undergone vitreoretinal surgery for retinal detachment secondary to ocular toxoplasmosis was conducted. The parameters that were analyzed include surgical procedures, anatomical outcomes, visual acuity, and postoperative complications. RESULTS This study included 22 patients, of which 13 were female (59.1%). The mean age was 28.5 years (SD ± 14.5, range 12-78 years) and the follow-up period varied from 1 to 163 months (mean 64 months). The mean baseline best-corrected visual acuity (BCVA) was 2.0 logMAR (SD ± 1.0). A total of 31 surgeries were performed, and the retina was reattached in 15 patients (68.2%) immediately after the first surgery and in 20 patients (90.9%) at a later point. The mean postoperative BCVA improved to 1.3 logMAR (SD ± 0.9) (p<0.05). Nineteen patients (86.4%) underwent cataract surgery with intraocular lens implant, and 12 patients (60.0%) underwent silicone oil removal. Five patients (22.7%) exhibited elevated intraocular pressure, and 1 patient (4.5%) developed hypotonia. CONCLUSION Surgical treatment of retinal detachment secondary to ocular toxoplasmosis resulted in considerable anatomical and functional improvement. Although PPV with silicone oil injection demonstrated the best outcomes, it is not reasonable to conclude that this is the best surgical approach given the small number of patients included in this study.

A New Method of Subretinal Injection of Tissue Plasminogen Activator and Air in Patients With Submacular Hemorrhage.

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Ophthalmologic findings in hepatitis C patients treated with pegylated interferon α-2b and ribavirin

PURPOSE To identify the effect of pegylated interferon ƒ¿-2b and ribavirin treatment in the ocular fundus examination, visual acuity, and visual field. METHODS Prospective observational study was performed at the Hepatology Clinic of Sao Jose Regional Hospital and at the Vitreoretinal Department at the Sadalla Amin Ghanem Eye Hospital in patients with chronic hepatitis C before and during treatment with pegylated interferon ƒ¿-2b together with ribavirin. RESULTS Six (37.5%) of 16 patients developed retinopathy during the treatment, two of which (12.5%) presented retinal hemorrhage, and four patients (6 eyes) presented cotton-wool spots (25%) that regressed during the treatment. One patient (6.25%) presented transient decrease in visual acuity during the treatment and recovered spontaneously without specific therapy. CONCLUSION Recommended treatment methods for hepatitis C may cause transient retinopathy, commonly without any damage to visual function in most patients. Although ocular involvement is rare, follow-up with an ophthalmologist is recommended during the course of the hepatitis C medication.

Associação de microburaco macular e fosseta de papila

A fosseta de papila do nervo optico e o microburaco macular sao duas patologias raras, cuja probabilidade de coexistencia se torna extremamente baixa, embora nao haja relacao fisiopatologica entre ambas, descreveremos um caso de associacao das mesmas, acometendo comumente um olho, a fim de analisar as manifestacoes clinicas, os exames de OCT, angiografia, retinografia, biomocroscopia, o tratamento e a correlacao entre ambas patologias.