Hisashi Suzuki

Surgical treatment of macular detachment secondary to congenital pit of the optic disc: case report

The authors describe a patient with macular detachment in the right eye, secondary to congenital pit of the optic disc, submitted to vitrectomy, drainage of the subretinal fluid, perfluorocarbon, endolaser and perfluoropropane gas (C3F8). A sample of the vitreous humor was taken for comparative analysis with the subretinal fluid. Results of retinography, optical coherence tomography, and illustrations of the surgical procedure are presented. Optical coherence tomography revealed the detachment resolved 6 months after surgery. Visual acuity improved from 20/400 to 20/30. This surgical technique can lead to successful reattachment of the macula and improvement of central vision. Additionally, a qualitative and comparative analysis showed a similar biochemical composition of the subretinal fluid and the vitreous. Despite technical limitations, this analysis can confirm the pathophysiology of the disease, suggesting that the subretinal fluid may originate from the vitreous cavity in macular detachment secondary to congenital pit of the optic disc.

Obstrução arterial retiniana periférica associada com hiper-homocisteinemia: relato de caso

Hyperhomocysteinemia is a risk factor for thromboembolic events of the retina associated with vascular venous or arterial occlusion. We describe a patient with occlusion of the peripheral arteriolar network without active vasculitis, associated with neovascular proliferation, peripheral vitreous-retinal traction and relapsing vitreous hemorrhage. The high serum homocysteine level resulting from vitamin B12 and folic acid deficiency, without further changes in the coagulation cascade including the test for Leidens Factor V, indicates hyperhomocysteinemia as a direct causal factor in this clinical condition. Despite a high PPD, Eales Disease, a major differential diagnosis, was not fully considered, since it is established by exclusion. The patient was treated with photocoagulation and vitamin supplements and the condition was successfully controlled. Patients with retinal vascular obstruction should have their total plasma homocysteine levels measured, since this modifiable risk factor can be easily treated with dietary approaches including vitamin supplementation.

Vasculopatia coroidiana polipóide idiopática - Relato de cinco casos

Idiopathic polypoidal choroidal vasculopathy is a recently described entity related to recurrent serosanguinolent detachments of the retinal pigment epithelium and neurosensory retina due to a choroidal vasculopathy characterized by the formation of a branching vascular network with nodular lesions in the juxtapapillary temporal region. The authors describe a series of five cases with clinical characteristics compatible with this disorder. Mean age was 66 years (51-79 years), one black patient and three (60%) males. Mean follow-up time was 13.4 months (three months to 2 years). Epidemiological and clinical data are discussed.

Subconjunctival and topical application of recombinant tissue plasminogen activator in rabbits

PURPOSE To quantify fibrin degradation products after topical and subconjunctival administration of recombinant tissue plasminogen activator in rabbits. METHODS Fibrin formation was induced in the anterior chamber in 25 rabbits. Subsequently, five rabbits received an injection of r-TPA (positive control) in the anterior chamber, another 10 received a subconjunctival injection of r-TPA, and the remaining 10 received instillations of topical r-TPA. Afterwards, samples of aqueous humor were collected and semi-quantitative analysis of fibrin degradation products (FDP) was performed. RESULTS No statistical differences were noted between the treatment and control groups at any time point. Fibrin degradation products semi-quantification showed statistical improvement in the control group and the subconjunctival group. CONCLUSION Fibrin degradation products were observed in the anterior chamber after subconjunctival administration of r-TPA. However, it was probably not sufficient to cause fibrin degradation. Topical r-TPA did not effectively absorb anterior chamber fibrin.

Carcinoma metastático de íris: descrição de 2 casos

Descrevemos 2 casos de carcinoma metastático para o segmento anterior ocular. Apesar da raridade desta patologia é importante suspeitar de tal diagnóstico ao avaliar tumorações em segmento anterior e proceder a investigação clínica adequada. Nos 2 casos descritos, a hipótese diagnóstica de metástase foi feita pelo exame oftalmológico. Os pacientes não apresentavam queixa sistêmica e não tinham o diagnóstico do tumor primário. Em um dos casos, o diagnóstico foi confirmado pela biópsia aspirativa, sugerindo ser um instrumento valioso no diagnóstico desta patologia.