Mário Junqueira Nóbrega

Toxoplasmosis retinochoroiditis after photodynamic therapy and intravitreal triamcinolone for a supposed choroidal neovascularization: a case report

The purpose is to report a complication after photodynamic therapy (PDT) and intravitreal triamcinolone for a presumed choroidal neovascularization in age-related macular degeneration. Photodynamic therapy and intravitreal triamcinolone were used in an 84-year-old man with choroidal neovascularization in the left eye. Forty-five days after therapy, the patient returned with a severe necrotizing uveitis in the posterior pole and vitritis. Laboratory investigation disclosed a high anti-Toxoplasma IgG titer. Therapy with pyrimethamine, sulfadiazine and folinic acid resulted in total lesion healing although central vision was lost. Intravitreal triamcinolone may have had an influence on the exacerbation of retinochoroiditis in the posterior pole of the patient. Although rare, this complication may not be disregarded in the cases that require intraocular corticosteroids for treatment of several conditions, especially in patients who had previously suffered from toxoplasmosis infection.

Prevalência de tracoma em crianças pré-escolares e escolares da periferia da cidade de Joinville, Estado de Santa Catarina, Brasil

Joinville e a maior cidade do Estado de Santa Catarina. Gracas ao seu desenvolvimento industrial, principalmente nos ultimos 15 anos, a cidade tem recebido muitos migrantes vindos de area rurais, na maioria dos Estados de Santa Catarina e Parana. Um estudo de prevalencia de tracoma foi realizado entre 2.822 criancas pre-escolares e escolares, com idade variando de 3 meses a 15 anos (media igual a 8,4 anos), que frequentavam 6 instituicoes educacionais publicas localizadas em diferentes regioes da periferia de Joinville. 53,2% das criancas eram do sexo masculino. O tracoma foi avaliado de acordo com o esquema simplificado de gradacao da OMS. A prevalencia de TF foi de 7.9% e a de TS foi de 1,1%. Nao se observou TI, TT ou CO. 65% das criancas tracomatosas eram procedentes de centros urbanos e 35% eram de areas rurais. A citologia com a coloracao pelo anticorpo monoclonal fluorescente foi positiva em 57% dos casos de TF

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.

Tomografia de coerência óptica em osteoma de coróide: relato de caso

The authors present a case of choroidal osteoma diagnosed in a 62-year-old male patient. A well-defined and slightly elevated lesion located in the posterior pole of the right eye associated with internal vasculature and choroidal neovascularization at its superior and inferior temporal edge were suspicious of the tumor. Confirmation of diagnosis was obtained with A and B ecography and computed tomography. Optical coherence tomography showed high reflectivity through its thickness as well as elevation of the RPE-choriocapillaris complex at the choroidal neovascularization site. Although the literature and the present case show several different tomographical findings, optical coherence tomography can help establishing the diagnosis of choroidal osteoma.

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.

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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Bilateral acute depigmentation of the iris: a case report

Bilateral acute depigmentation of the iris (BADI) is a new clinical entity of unknown etiology and is characterized by bilateral, symmetrical, and simultaneous depigmentation of the iris with focal or diffuse stromal atrophy; this condition generally has a good prognosis. We present a case of a 26-year-old woman who noted a spontaneous change in the iris color in both eyes in the last 2 months. The ophthalmological findings were atrophy of the iris stroma and pigmentation of the trabecular meshwork, without affecting the pigmented epithelium of the iris. Her intraocular pressure was normal and the visual acuity was 20/20 in both eyes.

Fechamento espontâneo de buraco de mácula em olhos previamente vitrectomizados: relato de dois casos

The spontaneous closure of a full-thickness macular hole (MH) developed after vitrectomy is very uncommon. We report a small series of cases (two patients) with this presentation. The first patient developed a MH 1 month after vitrectomy for an epirrretinal membrane and, the second one, 3 weeks after vitrectomy for rhegmatogenous retinal detachment. The MHs resolved spontaneously 2 months and 1 month after their documentation by optical coherence tomography(OCT), respectively. In this case report, we review the literature on spontaneous closure of MHs and discuss possible mechanisms for this rare event.