Juliana Lambert Oréfice

Vitreoretinal morphology in active ocular toxoplasmosis: a prospective study by optical coherence tomography

Aim: To investigate the third generation optical coherence tomography (OCT3) findings in patients with active ocular toxoplasmosis. Methods: A prospective observational case series, including 15 patients with active ocular toxoplasmosis in at least one eye evaluated at a single centre. Vitreoretinal morphological features at baseline and changes within a 24-week follow-up interval on OCT3 were evaluated. Results: The active ocular toxoplasmosis lesion was classified clinically as punctate (n = 6), focal (n = 6) or satellite (n = 3). Retinal layers were hyper-reflective at the active lesion site, and some degree of retinal pigment epithelium-choriocapillaris/choroidal optical shadowing was seen in all patients. In general, the retina was thinned at the active lesion site in eyes with punctate lesions and thickened in eyes with focal and satellite lesions. When detected by OCT3, the posterior hyaloid appeared thickened. While focally detached over punctate lesions, the posterior hyaloid was partially detached, but still attached to the lesion in focal and satellite lesions. Additional findings (not detected on clinical examination) include diffuse macular oedema (n = 6), vitreomacular traction (n = 3) and maculoschisis (n = 1). During follow-up, a decrease in retinal thickness and focal choriocapillaris/choroidal relative hyper-reflectivity were observed at the former lesion site, and posterior vitreous detachment progressed/occurred in all patients. Conclusion: OCT3 enabled identification of morphological features underestimated on clinical examination in patients with ocular toxoplasmosis, which may expand the clinical spectrum of the disease. Further studies are needed to verify the relevance of OCT3 in assisting with the diagnosis and management of ocular toxoplasmosis.

Spectral optical coherence tomography findings in patients with ocular toxoplasmosis and active satellite lesions (MINAS Report 1)

Purpose:  To characterize the active retinochoroiditis lesion observed in patients with the classic clinical presentation of ocular toxoplasmosis (OT) utilizing spectral optical coherence tomography (SOCT).

Increased Submacular Choroidal Thickness in Active, Isolated, Extramacular Toxoplasmosis

origin of the blood circulation of the brain and choroid through the internal carotid artery may play a role. Taking into account that choroidal thickness depends on choroidal blood vessel filling and considering the choroidal blood circulation as an extracranial part of the cerebral blood system may make one infer that decreased cerebral blood circulation may have an effect on both a decreased cognitive function and a reduced choroidal thickness. Our results should be interpreted with limitations in mind; it is not fully clear how well the Mini Mental Status Examination test applied in our study to assess cognitive function. In conclusion, thicker SFCT (or a lesser degree of fundus tessellation) was associated with higher cognitive function and vice versa, after adjusting for ocular and systemic parameters. These results suggest that more research is needed to explore the association between a leptochoroid and a reduced cerebral function.

Subretinal pigment epithelial infiltrates in primary vitreoretinal lymphoma

A 67-year-old woman with chronic bilateral intraocular inflammation associated with vitreous cells and subretinal pigment epithelium (RPE) infiltrates (A–B) underwent a chorioretinal biopsy in the left eye after three negative vitreous biopsies. Sub-RPE deposits on spectral domain optical coherence tomography (C) corresponded to collections of diffuse large B-cell lymphoma cells on histopathogy (D–E) and immunohistochemistry (F–H).

Subconjunctival Indocyanine Green Identifies Lymphatic Vessels

vitreous cavity. Strong glial fibrillary acidic protein positivity confirms the diagnosis. Thickening of the vessel walls, perivascular pigment, intralesional cysts, and calcareous deposits (calcospherites) are also detectable. Massive retinal gliosis is characteristically encountered in phthisical eyes after trauma, surgery, or inflammation and in other conditions such as retinopathy of prematurity or Coats disease.3 Our patient’s MRG was probably a poorly modulated reparative response to an unexplained preceding hemorrhage in the eye. The smaller retinal vasoproliferative tumors are also seen in such settings, implying that they too are usually reactive.5,6 We doubt there is any intrinsic retinal property in NF1 that is conducive to MRG. Studies of MRG have preliminarily shown polyclonality, further supporting a reactive lesion.3 Immunostains for p53 and Ki-67 here are close to negative, whereas they are positive (>10% of cells) in astrocytic neoplasms.6 Retinoblastomas can be distinguished from MRG with imaging studies by virtue of the former’s more prominent calcifications, from medulloepitheliomas that have ciliary region cysts, and from pediatric melanomas, which preferentially arise in the anterior segment of the eye.

Multimodal Imaging Assisting the Early Diagnosis of Cat-Scratch Neuroretinitis

Abstract To describe how a multifocal fundus imaging system assisted the early diagnosis of cat scratch neuroretinitis in a case of a 27-year-old male with unilateral visual loss, neuroretinitis, and a peripapillary angiomatous lesion. Multimodal fundus imaging analysis was an essential contributor to the clinical diagnosis of cat scratch neuroretinitis during the early stage of the disease.

Proposed physiopathological mechanisms and potential therapeutic targets for central serous chorioretinopathy

Central serous chorioretinopathy manifests as idiopathic serous detachment of the neurosensory retina, occasionally associated with small retinal pigment epithelium detachments in the macular area. The actual pathobiological mechanisms are not completely understood, but a strong association with endogenous or exogenous hypercortisolism is presumed. Although the clinical presentation may vary widely, visual symptoms are generally mild, unspecific and transitory. In rare circumstances the condition can evolve to significant and permanent visual impairment related to severe manifestations, relapsing or chronic episodes and secondary complications. Symptoms tend to resolve spontaneously in 3–6 months, but recurrences are expected to occur in up to 50% of the cases. Ancillary examinations may assist the diagnosis and identification of associated complications. While focal leaks at the level of the retinal pigment epithelium are highlighted on fluorescein angiography, indocyanine green angiography reveals widespread fundus involvement with multiple regions of choroidal hyperpermeability. Several therapeutic approaches have been proposed in unfavorable (persistent central serous chorioretinopathy) cases. In this article the proposed physiopathological mechanisms are discussed, leading to new insights into the clinical diagnosis and multidisciplinary management of this somewhat paradoxal disease.

Serum levels of neurotrophic factors in active toxoplasmic retinochoroiditis

Toxoplasmic retinochoroiditis (TR) is the most common identifiable cause of posterior uveitis in Brazil. Response to treatment and clinical presentation may vary significantly. We assessed serum levels of brain-derived neurotrophic factor (BDNF), glial cell line-derived neurotrophic factor (GDNF), nerve growth factor (NGF), neurotrophin (NT)-3, and NT-4/5 in patients with active TR, before and after TR treatment. METHODS Twenty patients with active lesion and 15 healthy controls were enrolled in the study. Serum concentration of neurotrophic factors was determined by enzyme-linked immunosorbent assay. RESULTS BDNF levels were significantly higher in patients before treatment when compared with controls (p=0.0015). There was no significant difference in pro-BDNF, NGF, GDNF, NT-3, and NT-4/5 levels between TR patients and controls. Treatment did not affect the levels of these factors. CONCLUSION BDNF may be released in the context of the active TR inflammatory response.

New Imaging Techniques

Recent advances in ophthalmic imaging have enabled unprecedented documentation of ocular fundus findings in patients with diseases affecting the retina and choroid, leading to new insights and improved understanding of the pathophysiological basis of intraocular inflammatory diseases. Evaluation of the retinal pigment epithelium status by fundus autofluorescence represents a typical example of modern fundus imaging techniques, which are now incorporated into the diagnostic arsenal of the specialist in uveitis.