RESUMEN
ABSTRACT Pigment dispersion syndrome is associated with clinical features such as Krukenberg's spindles, trabecular pigmentation, Scheie's stripe and Zentmayer's ring. Another less common feature of this syndrome is retrolental pigment deposits due to anterior hyaloid detachment or a defect in the Wieger's ligament. We present two cases of pigment deposits on the posterior lens capsule. In both cases, there is bilateral dispersion of pigment throughout the anterior segment. The retrolental deposits are unilateral in the first case and bilateral in the second. Both patients report a history of ocular trauma. This is a possible important clinical sign of pigment dispersion syndrome, rarely described.
RESUMO A síndrome de dispersão pigmentar associa-se a sinais clínicos característicos como fuso de Krukenberg, hiperpigmentação da malha trabecular, linha de Scheie e anel de Zentmeyer. Um sinal menos comum dessa síndrome é o depósito de pigmento posterior ao cristalino, que ocorre por um descolamento da hialoide anterior ou um defeito no ligamento de Wieger. Apresentamos dois casos de depósitos de pigmento posterior à cápsula posterior do cristalino. Em ambos os casos, existia dispersão bilateral de pigmento por todo o segmento anterior. No primeiro caso, os depósitos eram unilaterais e, no segundo, estavam presentes em ambos os olhos. Este pode corresponder a um sinal potencialmente importante da síndrome de dispersão pigmentar, raramente descrito.
Asunto(s)
Humanos , Femenino , Anciano , Anciano de 80 o más Años , Trastornos de la Pigmentación/etiología , Pigmentación , Síndrome de Exfoliación/complicaciones , Cápsula Posterior del Cristalino/patología , Enfermedades del Cristalino/etiología , Epitelio Pigmentado Ocular/diagnóstico por imagen , Síndrome , Agudeza Visual , Enfermedades del Cristalino/diagnósticoRESUMEN
ABSTRACT A 27-year-old man presented with a complaint of decreased visual acuity in the right eye. Best-corrected visual acuity was 20/60 in the right eye and 20/20 in the left eye. Right eye fundoscopy revealed mild vitritis, multifocal yellowish lesions, and macular serous retinal detachment. Left eye evaluation was normal. Acute posterior multifocal placoid pigment epitheliopathy was diagnosed in the right eye. Complementary exams revealed a strong reaction to the Mycobacterium tuberculosis purified protein derivative test, thus treatment for tuberculosis was initiated. Baseline fluorescein angiography of the right eye revealed early hypofluorescence and late staining of the lesions. Optical coherence tomography of the right eye demonstrated the accumulation of subretinal and intraretinal fluid associated with cystoid macular edema. During follow-up, the retinal fluid and cysts disappeared, which was followed by disorganization of foveal interdigitation and ellipsoid zones. This is the second described case of unilateral acute posterior multifocal placoid pigment epitheliopathy in a patient with a strong positive result to the M. tuberculosis purified protein derivative test.
RESUMO Um homem de 27 anos apresentou uma queixa de diminuição da acuidade visual no olho direito. A acuidade visual melhor corrigida foi 20/60 no olho direito e 20/20 no olho esquerdo. A fundoscopia do olho direito revelou vitreíte leve, lesões amareladas multifocais e descolamento seroso da retina em região macular. A avaliação do olho esquerdo foi normal. Epiteliopatia pigmentar placóide multifocal posterior aguda foi diagnosticada no olho direito. Os exames complementares revelaram forte reação ao teste do derivado proteico purificado Mycobacterium tuberculosis, iniciando terapia antibiótica contra tuberculose. A angiografia fluoresceínica basal do olho direito revelou hipofluorescência precoce e tardia das lesões. A tomografia de coerência óptica do olho direito demonstrou fluído sub- e intrarretiniano associado a edema macular cistóide. Durante o seguimento, os fluídos e cistos retinianos desapareceram, seguido da desorganização das zonas de interdigitação e elipsóide em região foveal. Este é o segundo caso descrito de epiteliopatia pigmentar placóide multifocal posterior aguda unilateral em um paciente com um forte resultado positivo para o teste tuberculínico.
Asunto(s)
Humanos , Masculino , Adulto , Epitelio Pigmentado Ocular/diagnóstico por imagen , Enfermedades de la Retina/diagnóstico , Tuberculosis Ocular/diagnóstico , Enfermedades de la Retina/tratamiento farmacológico , Prednisona/uso terapéutico , Angiografía con Fluoresceína , Agudeza Visual , Tuberculosis Ocular/tratamiento farmacológico , Enfermedad Aguda , Tomografía de Coherencia Óptica , Antiinflamatorios/uso terapéutico , Antibióticos Antituberculosos/uso terapéuticoRESUMEN
A 27-year-old man presented with a complaint of decreased visual acuity in the right eye. Best-corrected visual acuity was 20/60 in the right eye and 20/20 in the left eye. Right eye fundoscopy revealed mild vitritis, multifocal yellowish lesions, and macular serous retinal detachment. Left eye evaluation was normal. Acute posterior multifocal placoid pigment epitheliopathy was diagnosed in the right eye. Complementary exams revealed a strong reaction to the Mycobacterium tuberculosis purified protein derivative test, thus treatment for tuberculosis was initiated. Baseline fluorescein angiography of the right eye revealed early hypofluorescence and late staining of the lesions. Optical coherence tomography of the right eye demonstrated the accumulation of subretinal and intraretinal fluid associated with cystoid macular edema. During follow-up, the retinal fluid and cysts disappeared, which was followed by disorganization of foveal interdigitation and ellipsoid zones. This is the second described case of unilateral acute posterior multifocal placoid pigment epitheliopathy in a patient with a strong positive result to the M. tuberculosis purified protein derivative test.
Asunto(s)
Epitelio Pigmentado Ocular/diagnóstico por imagen , Enfermedades de la Retina/diagnóstico , Tuberculosis Ocular/diagnóstico , Enfermedad Aguda , Adulto , Antiinflamatorios/uso terapéutico , Antibióticos Antituberculosos/uso terapéutico , Angiografía con Fluoresceína , Humanos , Masculino , Prednisona/uso terapéutico , Enfermedades de la Retina/tratamiento farmacológico , Tomografía de Coherencia Óptica , Tuberculosis Ocular/tratamiento farmacológico , Agudeza VisualRESUMEN
Abstract We report a case of a middle-aged woman who developed acute, bilateral, symmetrical, slightly transilluminating depigmentation of the iris and pigment discharge into the anterior chamber following the use of oral moxifloxacin for bacterial sinusitis. She had been misdiagnosed as having autoimmune uveitis, treated with steroids and tropicamide, and underwent severe ocular hypertension and glaucoma despite posterior correct diagnosis.
Resumo Relato de um caso de uma paciente do sexo feminino de meia idade que desenvolveu despigmentação bilateral simultânea aguda com dispersão de pigmentos na câmara anterior e discreta transiluminação após o uso de moxifloxacino oral para tratamento de sinusite bacteriana. Ela Havia sido diagnosticada com uveite autoimune e tratada com corticosteroide tópico e tropicamida e evoluiu com hipertensão ocular grave e glaucoma apesar de ,posteriormente, o diagnóstico ter sido correto.
Asunto(s)
Humanos , Femenino , Adulto , Glaucoma/etiología , Hipertensión Ocular/etiología , Enfermedades del Iris/complicaciones , Epitelio Pigmentado Ocular/diagnóstico por imagen , Trastornos de la Pigmentación/diagnóstico por imagen , Malla Trabecular/patología , Transiluminación , Iridociclitis/diagnóstico , Glaucoma/tratamiento farmacológico , Glaucoma/diagnóstico por imagen , Iris/diagnóstico por imagen , Hipertensión Ocular/tratamiento farmacológico , Hipertensión Ocular/diagnóstico por imagen , Enfermedad Aguda , Fotofobia , Tomografía de Coherencia Óptica , Pruebas del Campo Visual , Tartrato de Brimonidina/administración & dosificación , Microscopía con Lámpara de Hendidura , Moxifloxacino/efectos adversos , Gonioscopía , Enfermedades del Iris/inducido químicamente , Enfermedades del Iris/diagnóstico por imagen , Cámara Anterior/patología , Antihipertensivos/administración & dosificaciónRESUMEN
PURPOSE: To evaluate the potential benefit and complications of indocyanine green-mediated photothrombosis (IMP) in the management of patients with persistent central serous chorioretinopathy (CSC). METHODS: Interventional noncomparative case series. Eleven patients with CSC presenting with persistent subretinal fluid in optical coherence tomography (OCT) four months after presentation and decrease in visual acuity (VA) were submitted to a single IMP session with 2 mg/kg body weight ICG and application of 5.6 W/cm(2) light at 810 nm. A continuous follow-up was provided with best-corrected ETDRS VA assessment, and angiographic and OCT documentation 72 hours before and at 2 days, 1 and 2 weeks, 1, 3, 6, and 12 months after treatment. RESULTS: Pretreatment VA levels ranged from 20/32 - 1 to 20/100 (mean, 20/63 + 2 [logMAR equivalent, 0.460 +/- 0.155]); post treatment levels ranged from 20/25 - 2 to 20/20 (mean, 20/20 - 2 [logMAR equivalent, 0.038 +/- 0.048]). Ten out of eleven patients presented with VA levels of >/=20/25 2 weeks after treatment; the mean logMAR VA change of 0.345 at that time was statistically significant (p < 0.05, Friedman test). OCT disclosed resolution of persistent subretinal fluid in all eyes. No recurrence was observed after 12 months of follow-up. Complications included transient retinal whitening in two patients, and associated occlusion of retinal capillaries in one. CONCLUSIONS: Photothrombosis using low-intensity 810 nm light to direct laser energy continuously at the active leakage sites after intravenous ICG infusion induced rapid VA recovery in patients with persistent CSC; accordingly, restoration of the macular architecture was evidenced on OCT, and no recurrence was noted 12 months after IMP.