Tiago Eugênio Faria e Arantes

Structural and functional assessment in HIV-infected patients using optical coherence tomography and frequency-doubling technology perimetry.

PURPOSE To assess retinal nerve fiber layer (RNFL) and macular thickness using optical coherence tomography (OCT) on HIV-infected patients without ocular manifestations and to correlate these findings with frequency-doubling technology perimetry (FDT). DESIGN Cross-sectional study. METHODS setting: Single center. study population: Seventy-three patients (146 eyes) with clinically normal examination classified in 3 groups: group A, HIV-infected patients with CD4 count <100 cells/mm(3) for at least 6 months; group B, HIV-infected patients with CD4 count >100 cells/mm(3) since diagnosis; and group C, HIV-negative control subjects. observation procedures: Fast RNFL and fast macula scan strategies on Stratus OCT and Humphrey Matrix 24-2 full-threshold program. main outcome measures: OCT RNFL and macular thicknesses and FDT indices (mean deviation [MD], pattern standard deviation [PSD], and glaucoma hemifield test [GHT]). RESULTS Group A had a significantly thinner average RNFL, temporal outer macula, and inferior outer macula thicknesses when compared to groups B and C (P < .05). Statistically significant differences were observed in the FDT MD between groups A and C (P = .034) and in PSD in group A compared to groups B and C (P = .011). Eyes of HIV patients with GHT and PSD results outside normal confidence limits had thinner average RNFL thickness measures than eyes with results within normal limits in the same group of patients (P < .05). CONCLUSIONS HIV-infected patients with low CD4 count have a significant RNFL and macular thinning. Functional loss detected by FDT is related to RNFL thinning in HIV-infected patients.

Fundus Autofluorescence and Spectral Domain Optical Coherence Tomography in Recurrent Serpiginous Choroiditis: Case Report

Purpose: To report fundus autofluorescence (FA) and spectral domain optical coherence tomography (SDOCT) findings in serpiginous choroiditis. Design: Case report. Methods: SDOCT and FA imaging of a 37-year-old woman with bilateral recurrent serpiginous choroiditis. Results: Active new lesions disclosed hyperautofluorescence, in contrast to hypoautofluorescent scarred lesions. SDOCT showed increased reflectance of the choroid and deeper retinal layers, along with disruption of the photoreceptor inner and outer segment junction in both active and inactive lesions. Conclusion: Autofluorescence imaging and SDOCT are useful noninvasive methods for the evaluation of serpiginous choroiditis. Autofluorescence imaging allows identification of recurrences and retinal pigment epithelium involvement in the follow-up of this disease.

Optical coherence tomography of macular atrophy associated with microcephaly and presumed intrauterine Zika virus infection

This case report describes the retinal optical coherence tomography (OCT) findings in a microcephalic infant with macular atrophy presumably caused by intrauterine Zika virus infection. OCT demonstrated atrophy of the outer retinal layers and choriocapillaris, including the outer nuclear layer and ellipsoid zone, associated with retinal pigment epithelium hyper-reflectivity and increased OCT penetration into deeper layers of the choroid and sclera. A major concern associated with this infection is the apparent increased incidence of microcephaly in fetuses born to mothers infected with the Zika virus. It is becoming increasingly difficult to ignore the upsurge in congenital microcephaly observed in Brazil. Recently, ocular findings in infants with microcephaly associated with intrauterine Zika virus infection have been described. This is the first report of OCT imaging of macular atrophy in a child with presumed Zika virus infection-associated microcephaly.

Visual impairment from uveitis in a reference hospital of Southeast Brazil: a retrospective review over a twenty years period

PURPOSE To identify the frequency and causes of uveitis leading to visual impairment in patients referred to the Low Vision Service - Department of Ophthalmology - UNIFESP, over a twenty years period. METHODS In a retrospective study, medical records of 5,461 patients were reviewed. Data from the first clinical evaluation at the Low Vision Service were collected, patients age, gender and cause of visual impairment were analyzed. Patients with uveitis had their chart reviewed for anatomical classification and clinical diagnosis. RESULTS The mean age of the patients referred to the Low Vision Service was 42.86 years and the mean age of patients with uveitis diagnosis was 25.51 years. Retinal disorders were the most common cause of visual impairment (N=2,835 patients; 51.9%) followed by uveitis (862 patients, 15.7%). Uveitis was posterior in 792 patients (91.9% of uveitis) and toxoplasmosis was the most common diagnosis (765 patients, 88.7%). CONCLUSIONS In our study, uveitis represents the second cause of visual impairment in patients referred for visual rehabilitation and toxoplasmic retinochoroiditis was the most common clinical diagnosis. It affects a young working age population with a relevant social and economic impact, but the early diagnosis and treatment can improve the quality of life of these patients.

Twenty-five gauge vitrectomy in uveitis

PURPOSE To evaluate anatomical and functional results of 25-gauge transconjunctival sutureless pars plana vitrectomy in patients with uveitis. METHODS Vitrectomy was performed on 20 eyes with residual vitritis secondary to infectious and noninfectious uveitis. Patients were evaluated 1 week before surgery and after surgery at day 1, week 1, week 4 and week 12. Visual acuity (VA), intraocular pressure, anterior chamber cells and flare and vitreous haze were measured. RESULTS Mean VA improved from 2.06 ± 0.94 logMAR before surgery to 0.58 ± 0.46 logMAR at week 12 (p<0.05). No case required conversion to standard 20-gauge instrumentation or suture placement, no intraoperative complications were noted. Transient postoperative hypotony was seen in three eyes. One patient with toxoplasmic retinochoroiditis had a relapse during follow-up. CONCLUSION 25-gauge vitrectomy has proven its efficacy on cleansing vitreous opacities and improving visual acuity on patients with residual vitritis secondary to uveitis with minimal postoperative inflammation and complications.

Spectral domain optical coherence tomography and angiographic findings in central serous chorioretinopathy complicated by bilateral nonrhegmatogenous retinal detachment associated with systemic corticosteroids

Purpose: To report spectral domail optical coherence tomography (OCT) and angiographic findings in exudative retinal detachment complicating central serous chorioretinopathy. Design: interventional case report. Methods: 33-year old man with bilateral nonrhegmatogenous retinal detachment, misdiagnosed as uveitis, iatrogenically treated with systemic corticosteroids. Results: Discontinuation of corticotherapy led to anatomic and visual improvement. Fluorescein angiography demonstrated multiple leakage points; indocyanine green angiography disclosed large hyperfluorescent patches in the choroid and OCT demonstrated retinal detachment with dense subretinal deposits. Conclusion: The recognition of this atypical presentation with a combination of opthalmoscopic, angiographic and OCT findings may avoid inappropriate diagnosis and treatment with corticosteroids.

Flora bacteriana conjuntival após uso tópico de ciprofloxacino e gatifloxacino em cirurgia de catarata

PURPOSE: To evaluate alterations of the conjunctival flora after the use of 0.3% ciprofloxacin and gatifloxacin in the prophylaxis of patients undergoing cataract surgery. METHODS: 40 patients undergoing cataract surgery were distributed into two groups according to the use of antibiotic eye drops: Group A: 0.3% ciprofloxacin and Group B: 0.3% gatifloxacin. Both groups used antibiotic eye drops 1 hour before surgery and 14 days after surgery. Conjunctival material was collected at 5 time points: 1 hour before surgery, without any topical medication (t0); immediately before the application of povidone-iodine (PVPI) (t1), before the beginning of surgery, after povidone-iodine (t2), 14 days (t3) and 28 days after surgery (t4). RESULTS: Preoperative antibiotics reduced the positivity of the cultures before the use of PVPI in both groups, although in Group A this reduction was not significant (Group A - p=0.07 and Group B - p=0.04). The number of positive cultures was reduced in all groups after the use of povidone-iodine and on the 14th postoperative day (p<0.05). In t4 there was a reduction in the frequency of coagulase-negative Staphylococcus in Group A compared with Group B (p<0.05); the susceptibility to ciprofloxacin was also reduced in all groups, when compared with t0. CONCLUSIONS: Gatifloxacin eye drops applied one hour before surgery significantly reduced the number of positive conjunctival cultures. Both antibiotics reduced the conjunctival flora when administered in the postoperative period.

Local treatment of toxoplasmic retinochoroiditis with intravitreal clindamycin and dexamethasone.

PURPOSE To report the clinical outcomes of local treatment of toxoplasmic retinochoroiditis (TRC) with intravitreal injections of clindamycin and dexamethasone. METHODS STUDY POPULATION 16 eyes (16 patients) with active TRC sparing the macula and juxtapapillary area treated with intravitreal injections of clindamycin (1 mg) and dexamethasone (1 mg) without concomitant systemic antitoxoplasmic or anti-inflammatory therapy. Measured parameters: Best-corrected visual acuity (BCVA) was measured by an Early Treatment Diabetic Retinopathy Study (ETDRS) chart. BCVA and clinical characteristics of retinochoroiditis were assessed at baseline and at 1, 3, 6, and 12 months. PRIMARY OUTCOME MEASURES Resolution of retinochoroiditis and changes in BCVA. RESULTS Control of TRC was achieved in all cases with a mean interval of 2.48 ± 1.03 weeks (2-6 weeks). A single injection of intravitreal clindamycin and dexamethasone was performed in 12 patients, and four patients required two intravitreal injections, during the follow-up period. Fourteen eyes (87.5%) improved ≥ 2 ETDRS lines of BCVA, of two or more Early Treatment Diabetic Retinopathy Study lines, BCVA remained stable in two eyes (12.5%), and no patient had decreased BCVA at the end of the follow-up period. No ocular or systemic adverse events were observed. CONCLUSION Local treatment with intravitreal injections of clindamycin and dexamethasone without concomitant systemic therapy was associated with resolution of TRC in patients without macular or juxtapapillary involvement. Intravitreal clindamycin and dexamethasone may represent a viable treatment option in patients with allergies or inadequate responses to oral medications.

Retinal angiography and colour Doppler of retrobulbar vessels in Takayasu arteritis.

OBJECTIVE Takayasu arteritis (TA) is a chronic, granulomatous, idiopathic, inflammatory disease that primarily affects large vessels. The objective of this study was to evaluate and describe the ocular manifestations of TA, correlating the resistivity and pressure in retrobulbar vessels by colour Doppler and retinal angiography. DESIGN Cross-sectional study. PARTICIPANTS Twenty-one patients with TA, 42 eyes, and 21 patients without TA (42 eyes) as control subjects. METHODS This study was performed in clinical practice. Patients with TA received complete ophthalmologic examination, fluorescein and indocyanine green angiography, and colour Doppler ultrasound to evaluate blood flow in the retrobulbar vessels. RESULTS A statistical correlation was found between peak systolic velocity (PSV) in the ophthalmic artery (OA) and Heidelberg retinal angiography (HRA) examination results (p = 0.006), and resistivity index (RI) in the OA was abnormal in patients with long (average, 14 years) versus short (average, 5.5 years) onset time of the disease (p = 0.035). RI in the central retinal artery (CRA) was abnormal in patients with a long time of disease onset (mean 14.4 years) versus those with a short time (mean 4.6 years) of onset (p = 0.006). CONCLUSIONS The longer the onset of the disease, the more commonly the RI showed changes in the OA and CRA, and, to a lesser extent, in the short posterior ciliary artery. When abnormalities are observed in the HRA examination, abnormal PSV in the OA may be present. Doppler blood flow evaluation and HRA may have predictive value in all patients with TA as part of serial monitoring.

Fabry disease - importance of screening in cornea verticillata: case report

Fabry disease is an X-linked disease of glycosphingolipid (GL) metabolism. The accumulation of GL in tissues can affect multiple organ systems. Initial symptoms includes episodes of severe pain in the extremities, cornea verticillata and skin lesions. In late stages, kidney, heart and brain can be involved. This report attempts for importance of cornea verticillata in the diagnosis of Fabry disease in a young patient with pain in the lower limb extremities.