Maria Teresa B.C. Bonanomi

Idiopathic juxtafoveolar retinal telangiectasis: clinical pattern in 19 cases.

Background: Idiopathic juxtafoveolar telangiectasis (IJT) is a rare retinal vasculopathy of adulthood that may cause central loss of visual acuity. The purpose of this paper is to evaluate the type and distribution of fundus changes in patients with this disorder. Methods: Medical records of 19 patients with IJT using the Gass & Blodi classification were studied. Eight patients in group 1A (42%) and 11 in group 2A (58%) were analyzed. By projecting color photographs we divided the macula into four quadrants and studied the fundus changes in each one. Results: All patients in group 1A presented unilateral disease with easily seen telangiectasis, lipid deposits and cystic macular edema. The mean age of this group was 55.8 years. Five (63%) patients were male and 3 (37%) were female. All patients in group 2A, 2 males (18%) and 9 females (82%), had bilateral disease evidenced by fluorescein angiography. The mean age of this group was 54.5 years. Fundoscopic findings included: intraretinal pigment plaques, grayish coloring of the macular retina, superficial crystalline deposits, right-angle venules, subretinal and intraretinal neovascularization. Conclusions: All patients in this survey were adults. In group 1A, men were affected 2 times more often than women, and the main affected macular quadrant was the inferior temporal, followed by the inferior nasal. In group 2A, women were affected 4 times more often than men and all eyes had inferior and superior temporal macular quadrant involvement.

Funduscopic alterations in SS and SC hemoglobinopathies. Study of a Brazilian population.

Fundus changes in sickle cell disease are well studied and documented according to their clinical and angiographic aspects. Sickle cell retinopathy was studied in a Brazilian population of 63 patients (41 with SS hemoglobinopathy, and 22 with SC hemoglobinopathy). All ophthalmoscopic changes observed in our patients were more frequent in the SC group with the exception of atrophic retinal tears, found only in the SS group. Proliferative retinopathy including its complications was seen in 54.54% of the eyes of the SC group, and in only 14.64% of the eyes of the SS group. Decreased vision is consequently greater in the SC group. Despite the great frequency of funduscopic changes in both groups, only 1 patient suffered irreversible visual loss due to retinal detachment operated on without success.

Retinal thickness assessed by optical coherence tomography (OCT) in pseudophakic macular edema

PURPOSE To evaluate the usefulness of the optical coherence tomography (OCT) retinal map in angiographic pseudophakic macular edema (ACME). METHODS This is a prospective analysis of a group of 36 pseudophakic eyes at the fifth postoperative week, submitted to optical coherence tomography 2 macular map and fluorescein angiography on the same day and, a control group of twenty-two 20/20 vision eyes with a minimum 6-month postoperative period, submitted to optical coherence tomography 2 macular map only. Exclusion criteria were diabetes, any macular pathology and unreadable optical coherence tomography or angiogram. The angiograms were divided into three groups according to the edema intensity: Group I: level 0 (absence of angiographic pseudophakic macular edema); group II: levels 1 and 2 (incomplete and complete perifoveal angiographic pseudophakic macular edema respectively) and group III: levels 3 and 4 (up to one disc diameter and greater than one disc diameter angiographic pseudophakic macular edema area respectively). The nine zones of the optical coherence tomography macular map were compared between the control and the three subgroups of the study group and, between group I and groups II and III. RESULTS Among the 36 eyes, 23 (64%) were classified as group I, 10 (28%) as group II and three (8%) as group III. The mean thickness of the fovea zone was 185+/-15 microm for the control group, 189+/-24 microm for group I, 213+/-33 microm for group II and 455+/-38 microm for group III. Significant differences: between group III and the control or group I for all zones (p<0.01) and, between group II and control or group I for the fovea and temporal inner zones (p<0.05). CONCLUSION The optical coherence tomography retinal map is useful in angiographic pseudophakic macular edema diagnosis.

Injeção intravítrea de triancinolona no tratamento da telangiectasia retiniana justafoveolar idiopática

Case report of one idiopathic juxtafoveal telangiectasis (IJT) 1A patient whose right eye was treated with a 4 mg intravitreal triamcinolone acetonide injection. The outcome was evaluated by visual acuity and optic coherence tomography. The visual acuity and the caliper retinal thickness before triamcinolone injection were respectively 20/100 and 569 µm, and 20/60 and 371 µm after three weeks and 20/100 and 614 µm after six week of follow-up. The stabilization of the vascular wall due to the intravitreal triamcinolone injection leads to a transitory improvement in vision and reduction in macular edema in the TJI 1A eyes. No permanent help by the photocoagulation could be shown.

Avaliação oftalmológica tardia em portadores de retinopatia diabética

OBJECTIVE: To assess the delay in the ophthalmic examination of patients affected with severe diabetic retinopathy but no visual complaint. METHODS: A transversal analytical study was conducted of 44 visually asymptomatic diabetic patients. All were eligible to retinal panphotocoagulation in at least one eye. Duration and type of the disease as well as time of the first ophthalmic examination were established. RESULTS: Of the 44 patients, 6 (13.7%) had diabetes type 1 and 38 (86.3%) had diabetes type 2. Proliferative diabetic retinopathy was present in 24 (54.5%) and severe or very severe non proliferative retinopathy was present in 20 (45.5%). Best visual acuity ranged from 0.5 to 1.0 (mean 0.83 ± 0.17) according to the Snellen chart. The time interval between diagnosis of diabetes and the first ophthalmic examination ranged from 7 to 19.5 years (13.2 ± 5.12) for diabetes type 1 and from 3 months to 18 years (5.2± 4.81) for diabetes type 2. CONCLUSION: Advanced diabetic retinopathy may be detected at different times of the ophthalmic examination in both types of diabetes. Although the mean interval between the diagnosis and the first examination is 13 years for diabetes type 1 and 5 years for diabetes type 2, this severe kind of retinopathy occurred as early as three months after diagnosis of diabetes. This points to the need for an earlier ophthalmic examination in the case of this disease.

A study of idiophatic vitreomacular traction syndrome with optical coherence tomography images: cases report

PURPOSE To evaluate the features of idiophatic vitreomacular traction syndrome (VMT) with ocular coherence tomography (OCT--Stratus), before and after vitrectomy; to identify situations where ocular coherence tomography provides additional information on disease morphology and pathogenesis. METHODS Comparative retinal ocular coherence tomography imaging was performed in four patients with different stages of vitreomacular traction syndrome. RESULTS Standard-resolution ocular coherence tomography Stratus provides vitreous-retinal images that help the management and treatment of vitreomacular traction syndrome. CONCLUSIONS Standard-resolution ocular coherence tomography allows good visualization of the architectural morphology of the vitreous and retina in vitreomacular traction syndrome. It helps understanding its pathogenesis, planning its treatment, clinical or surgical, and evaluating retinal structural alterations after surgery.

Estabilidade visual na retinopatia diabética tratada por panfotocoagulação com laser

PURPOSE: To evaluate the effect of laser treatment in the visual acuity caused by advanced diabetic retinopathy without visual complaints. METHODS: A descriptive observational study was developed in advanced diabetic retinopathy patients not presenting visual complaints. The patients were submitted to argon laser panretinal photocoagulation after ophthalmological examination as well as retinography and retinal angiofluoresceinography. The same initial exams were repeated between third and fifth months after the treatment. The non-parametric Wilcoxon test was employed for statistical evaluation between the visual acuities before and after the treatment. RESULTS: The sample involved 67 eyes of 44 patients. Of these 67 eyes, 37 (55.2%) presented proliferative diabetic retinopathy and 30 (44.8%) showed severe and severe non proliferative diabetic retinopathy. The visual acuity before the treatment ranged from 0.5 to 1.0 (mean 0.81 ± 0.16). There was no significant statistical difference between the visual acuity (p= 0.057) before and after the treatment during the follow-up period of five months. CONCLUSION: The visual stability after panretinal argon laser photocoagulation indicated the need of this treatment in early phases of diabetic retinopathy in order to preserve the visual function.

Telangiectasia retiniana justafoveolar idiopática do grupo 2A: hiperpigmentação macular incomum em dois pacientes

Introducao: Telangiectasias retinianas justafoveolares idiopaticas (TJI) do grupo 2A ocorrem na 5a ou 6a decada de vida, em ambos os sexos. A diminuicao da visao esta associada a alteracoes caracteristicas na macula que incluem depositos de pigmento. Objetivo: Descrever dois pacientes com achados incomuns de pigmentacao macular. Metodo: Relato de caso e discussao. Resultados: Observacao de grandes placas de pigmento na macula de dois pacientes. Nos dois casos houve confusao diagnostica com coriorretinite macular cicatrizada. Em um caso demonstrou-se o aumento da quantidade de pigmento em um periodo de oito anos. Conclusao: A TJI do grupo 2A pode ser de diagnostico dificil. A suspeita clinica deve ser feita pelo aspecto caracteristico das placas de pigmento na macula.

Therapeutic approach for retinal vasoproliferative tumor

RESUMO Roberta C. Bonanomi Faculdade de Medicina da Universidade de São Paulo FMUSP São Paulo, SP. Maria T. B. C. Bonanomi Faculdade de Medicina da Universidade de São Paulo FMUSP São Paulo, SP. Otacilio O. Maia Hospital São Rafael, Salvador BA. Sergio L. G. Pimentel Faculdade de Medicina da Universidade de São Paulo FMUSP São Paulo, SP. Abordaje terapéutico en tumor vasoproliferativo de la retina

Tumor vasoproliferativo primário da retina associado a edema macular cistóide: relato de caso

Retinal vasoproliferative tumor is a rare and benign disease that presents with an exsudative lesion in the retinal periphery. The lesion can be classified as primary (idiopathic) or secondary to a number of previous retinal injuries. Diagnosis is based on a careful ophthalmic examination. Therapeutic options include observation, cryotherapy, laser photocoagulation and brachytherapy. We present a case of idiopathic retinal vasoproliferative tumor associated with macular edema. The aspects of the tumor on fundus examination, fluorescent angiography, echography and optic coherence tomography are discussed.