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PURPOSE: To describe a case of stellate nonhereditary idiopathic foveomacular retinoschisis associated with outer retinal layer defect treated with pars plana vitrectomy, internal limiting membrane removal, and C3F8 tamponade. METHODS: Spectral-domain optical coherence tomography (Heidelberg Engineering, Heidelberg, Germany) scans of a 46-year-old woman with unilateral stellate nonhereditary idiopathic foveomacular retinoschisis were acquired at baseline and 1, 3, 6, and 12 months after surgery. RESULTS: Pars plana vitrectomy was performed after phacoemulsification. The vitreous was circumcised, and the internal limiting membrane was removed with a Tano brush, releasing tangential forces. The patient experienced progressive recovery of the outer retinal layers and improvement of visual acuity during follow-up. CONCLUSION: Stellate nonhereditary idiopathic foveomacular retinoschisis may be associated with outer retinal layer defect and severe vision loss. Pars plana vitrectomy with internal limiting membrane removal and C3F8 infusion seems to be a safe and feasible treatment in such cases, with potentially good anatomical and functional outcome.
Assuntos
Retinosquise , Feminino , Humanos , Pessoa de Meia-Idade , Retina , Retinosquise/complicações , Retinosquise/diagnóstico , Retinosquise/cirurgia , Estudos Retrospectivos , Tomografia de Coerência Óptica/métodos , Acuidade Visual , VitrectomiaRESUMO
BACKGROUND: The purpose of this study was to determine the value of spectral domain optical coherence tomography (SD-OCT) in assessing patients with diffuse unilateral subacute neuroretinitis (DUSN). METHODS: This was an observational case series with clinical imaging correlation performed at the Retina and Vitreous Institute of Londrina and State University of Londrina, Paraná, Brazil. The series comprised ten consecutive patients with a confirmed diagnosis of DUSN, ie, seven patients with late-stage disease and three with early-stage disease, who were assessed by SD-OCT for mean macular, retinal nerve fiber layer, and choroidal thickness using enhanced depth imaging software. RESULTS: Comparing the affected eye with the healthy fellow eye, significant diffuse atrophy of the retinal layers with a decrease in mean macular (P=0.004) and retinal nerve fiber layer (P=0.002) thickness was found in all cases. There was no difference in choroidal thickness (P=0.262). CONCLUSION: The correlation of SD-OCT results with central vision and funduscopic findings may explain the profound loss of visual function in patients with DUSN.
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PURPOSE: To document the intraretinal migration of presumed toxocara larvae mimicking punctate inner choroidopathy, idiopathic choroidal neovascularization, and diffuse unilateral subacute neuroretinitis. METHODS: Sequential color photographs, fluorescein angiograms, and optical coherence tomography were performed in three unrelated adult patients with presumed ocular toxocariasis. RESULTS: Characteristic fundoscopic manifestations simulating punctate inner choroidopathy, idiopathic choroidal neovascularization, and diffuse unilateral subacute neuroretinitis were reported in these patients, respectively. CONCLUSION: Presumed toxocara larvae must be included as a potential cause of different inflammatory diseases as a result of its migration through the retinal layers.
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The anti-tumor necrosis factor (TNF) monoclonal antibody infliximab inhibits the pleiotropic actions of TNF and is widely used for the treatment of inflammatory diseases, such as uveitis. A pathogenetic role of TNF in ocular inflammatory conditions has recently emerged. The authors describe a patient with collagen mixed disease who had decreased vision in the left eye. Fundus examination disclosed bilateral peripheral vasoproliferative tumors and macular edema in the left eye. The patient underwent treatment with infliximab intravenously for his systemic condition. Regression of the vasoproliferative tumors in both eyes and improvement of macular edema in the left eye was observed. Although the data are limited, anti-TNF antibodies such as infliximab may be useful in the treatment of retinal vascular tumors.
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Anti-Inflamatórios/uso terapêutico , Anticorpos Monoclonais/uso terapêutico , Hemangioma/tratamento farmacológico , Neoplasias da Retina/tratamento farmacológico , Adulto , Hemangioma/diagnóstico , Humanos , Infliximab , Edema Macular/tratamento farmacológico , Masculino , Descolamento Retiniano/tratamento farmacológico , Neoplasias da Retina/diagnóstico , Fator de Necrose Tumoral alfa/antagonistas & inibidoresRESUMO
BACKGROUND: Unilateral acute idiopathic maculopathy (UAIM) is a rare entity, in which an inflammatory process involves the macular retinal pigment epithelium (RPE) and outer retina. It represents a wide spectrum of ocular findings not consistently present in all patients, which may lead to difficulties in the recognition of the condition. METHODS: This observational case report presents the third-generation optical coherence tomography (StratusOCT) and multifocal electroretinogram (mfERG) findings in a 31-year-old woman with UAIM in the acute phase as well as two months later, and discusses the role of StratusOCT in the diagnosis. RESULTS: In the acute phase, StratusOCT demonstrated abnormal heterogeneous hyperreflectivity and thickening at the level of the outer retina and RPE in the foveal region. Two months after the initial presentation, StratusOCT examination showed a subfoveal area of homogeneous hyperreflectivity that extended from the RPE to the outer retinal layers with posterior shadowing, and sparse points of hyperreflectivity at several different levels of the neurosensory retina, including its superficial layers. The foveal retinal thickness during the acute phase was thicken compared with that after resolution. Seven days after the initial evaluation, mfERG showed severely reduced N1-P1 amplitudes with normal latencies in the region corresponding to the affected area of the papillomacular bundle and fovea. Two months later, mfERG results were normal. CONCLUSIONS: StratusOCT provided valuable information, allowing for the exclusion of other disorders that might mimic UAIM. mfERG findings were consistent with transient outer retinal dysfunction as the cause of visual loss. We are unaware of previous reports of UAIM studied by these methods and could find no reference to them in a computerized search using MEDLINE.
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Eletrorretinografia/métodos , Epitélio Pigmentado Ocular/patologia , Retina/patologia , Doenças Retinianas/diagnóstico , Tomografia de Coerência Óptica/métodos , Doença Aguda , Adulto , Feminino , Angiofluoresceinografia , HumanosRESUMO
PURPOSE: To investigate the clinical features, visual function outcomes, and adverse events in patients with diffuse unilateral subacute neuroretinitis (DUSN) treated with high-dose oral albendazole. DESIGN: Interventional case series. METHODS: Twelve Brazilian patients, aged 7 through 36 years, with active DUSN in the early or late clinical stage, were recruited for this study between 1999 and 2001. A small variant motile worm was found in 4 (33.3%) of these cases. All patients were treated exclusively with high-dose oral albendazole (400 mg/d) for 30 days. RESULTS: Improvement of visual acuity, visual field, and active ocular inflammatory signs was observed in all patients after 4 weeks of treatment (median follow-up: 3 years). Also, during the first weeks of treatment, evidence of worm inactivation was documented for the four patients with visible worms. No adverse drug side effects were observed in any of our cases during follow-up. CONCLUSION: High-dose oral albendazole seems to be safe and beneficial for patients with DUSN.