RESUMO
Objective: To describe the development of retinal pigment epithelium (RPE) atrophy after uncomplicated pars plana vitrectomy (PPV) with epiretinal membrane (ERM) and/or internal limiting membrane (ILM) peeling in 2 patients. Cases description: Case 1: A 79-years-old female with diagnosis of a full-thickness macular hole in her right eye (OD) with best corrected visual acuity (BCVA) of: 20/100 and left eye (OS): 20/70. After surgery she developed large RPE hyperplasia and presented hand movement that did not improve with pinhole. Case 2: A 69-years-old female patient who had ERM in her OS with BCVA of 20/30 in both eyes (OU). PPV was assisted with brilliant blue (BB) to better visualize the ILM. During follow-up visits we evidenced RPE atrophy in the zone where peeling was done. In the last control after 2-years, her visual acuity was 20/40 that did not improve with pinhole. Discussion: There are three possible mechanisms to explain this complication: toxic damage, mechanical trauma during the membrane removal with forceps, or a combination of both. In our cases, a combination of them is probably the cause of the presence of RPE atrophy. Conclusion: Vitrectomy with membrane removal is successful in most cases with low rate of complications. Because RPE atrophy is infrequent, our suggestion is to continue performing this technique and if possible, it should be done without dye staining to minimize risks. Abbreviations: ERM = epiretinal membrane, ILM = internal limiting membrane, MH = macular hole, RPE = Retinal pigment epithelium, OD = right eye, BCVA = Best corrected visual acuity, OS = left eye, OU = both eyes, IOL = intraocular lens, OCT = Optical coherence tomography, BB = Brilliant blue, TB = Trypan blue, ICG = indocyanine green.
Assuntos
Membrana Epirretiniana , Perfurações Retinianas , Idoso , Atrofia , Membrana Basal/cirurgia , Membrana Epirretiniana/diagnóstico , Membrana Epirretiniana/cirurgia , Feminino , Humanos , Perfurações Retinianas/diagnóstico , Perfurações Retinianas/etiologia , Perfurações Retinianas/cirurgia , Epitélio Pigmentado da Retina , Estudos Retrospectivos , Tomografia de Coerência Óptica , Vitrectomia/efeitos adversos , Vitrectomia/métodosRESUMO
El carcinoma medular de tiroides es un tumor poco frecuente y con baja prevalencia, derivado de las células C parafoliculares secretoras de calcitonina. De comportamiento agresivo suele invadir ganglios linfáticos, tejido glandular adyacente y hacer metástasis a hueso, pulmón e hígado. Presentamos una paciente de 26 años con dicho tumor metastático a pulmón e hígado. A pesar del manejo quirúrgico y médico concomitante persiste con actividad de la enfermedad y niveles elevados de calcitonina. Llama la atención la escasa sintomatología.
Medullary thyroid carcinoma is a rare malignancy with low prevalence. It arises from the parafollicular calcitonin- producing C-cells. It may have an aggressive course spreading to regional lymph nodes and glandular tissue and distant metastases may involve bone, lung and liver. Here, we present the case of a 26-year old female patient with such a malignancy with lung and liver metastases. Despite surgical and pharmacological management her disease remains active with high calcitonin levels. Remarkably, scarce or no symptoms are noted.