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ABSTRACT This report describes a case of retinal racemose hemangioma that first presented as a vitreous hemorrhage. The authors present the case of a 47-year-old woman with a sudden 5-day painless visual loss in her left eye. At the first visit, the best-correct visual acuities were 20/20 in the right eye and hand motions in the left eyes. Ultrasonography showed an attached retina and a massive vitreous hemorrhage. Pars plana vitrectomy was performed and a dilatation of large vessels was detected bulging from the optic disc. The best-correct visual acuities on day 30 postoperatively was 20/25 in the left eye. Fundus angiography and spectral-domain optical coherence tomography angiography showed anomalous arteriovenous communications with no intervening capillaries. The diagnosis was racemose hemangioma, an arteriovenous malformation of group 2 retina based on the Archer classification.
RESUMO Este relato descreve um caso de hemangioma racemoso da retina que se apresentou inicialmente como hemorragia vítrea. Os autores apresentam o caso de uma mulher de 47 anos com perda visual súbita e indolor 5 dias antes no olho esquerdo. Na primeira visita, a melhor acuidade visual corrigida foi de 20/20 no olho direito e movimentos das mãos no olho esquerdo. A ultrassonografia mostrou uma retina aderida e uma hemorragia vítrea maciça. Foi realizada vitrectomia pars plana, sendo detectada proliferação de grandes vasos salientes do disco óptico. A acuidade visual no dia 30 de pós-operatório foi de 20/25 no olho esquerdo. A angiografia de retina e a angiotomografia de coerência óptica de domínio espectral mostraram comunicações arteriovenosas anômalas sem capilares intermediários. O diagnóstico foi hemangioma racemoso, uma malformação arteriovenosa da retina do grupo 2 com base na classificação de Archer.
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Humanos , Feminino , Pessoa de Meia-Idade , Malformações Arteriovenosas/complicações , Vasos Retinianos/anormalidades , Hemorragia Vítrea/etiologia , Angiografia , Hemangioma/complicações , Malformações Arteriovenosas/cirurgia , Malformações Arteriovenosas/diagnóstico , Doenças Retinianas , Vasos Retinianos/diagnóstico por imagem , Vitrectomia , Hemorragia Vítrea/cirurgia , Hemorragia Vítrea/diagnóstico , Ultrassonografia , Tomografia de Coerência Óptica , Hemangioma/cirurgia , Hemangioma/diagnósticoRESUMO
BACKGROUND: To evaluate the impact of age-related macular degeneration (AMD) on the quality of life (QoL) in a Brazilian population using The National Eye Institute-Visual Function Questionnaire-25 (NEI-VFQ-25). METHODS: This observational study included 462 participants from the Departments of Ophthalmology of the University of Campinas and Conderg-Divinolândia. The NEI-VFQ-25 questionnaire and Rasch analysis were used to assess the vision-related quality of life (VRQoL). Patients with macular neovascularization were interviewed at enrollment and after three loading doses of intravitreal anti-vascular endothelial growth factor (anti-VEGF) treatment. RESULTS: One hundred thirty-three patients were excluded because they had another ophthalmic disease, for a total of 349 patients included in the study (177 in the AMD group, 172 in the control group; 56.4% were women; mean ± standard deviation age, 70.6 ± 9.5 years). Most NEI-VFQ-25 subscale scores were significantly lower in the AMD group compared with the control group. The Rasch-calibrated NEI-VFQ-25 median score in the visual-functioning component was 56.41 for the AMD group and 61.53 for the control group, a difference of ± 4.00 (P = 0.0001). Separate analyses of the sociodemographic and ocular characteristics showed that the NEI-VFQ-25 scores were affected mostly by family income, educational level, descent, diet (vegetables/fruits), physical activity, and visual acuity (VA). The longitudinal component assessed a different group of 48 patients with exudative disease treated with anti-VEGF drugs. The mean logarithm of the minimum angle of resolution change in VA in treated eyes was a 0.16 decrease (P = 0.01). The mean change in the optical coherence tomography macular thickness was a 36.74-µm decrease (P = 0.012) from baseline to 4 months. The mean NEI-VFQ-25 scores improved significantly from baseline to follow-up at 4 months in almost all subscales. CONCLUSIONS: In a Brazilian community, patients with AMD had a worse VRQoL than controls. The AMD severity and bilaterality were associated with decreased NEI-VFQ-25 scores. Higher family income, educational level, descent, and lifestyle significantly improved several subscales of the NEI-VFQ-25 questionnaire. Treated patients with exudative AMD had improvements in the VA, macular thickness, and most NEI-VFQ-25 subscale scores.
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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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PURPOSE: Diabetic retinopathy (DR) is one of the most important microvascular complications in both type 1 and type 2 diabetes. In Brazil, its proliferative form is the second cause of irreversible blindness among adults of working age. Despite the strong association of DR with disease duration and degree of chronic hyperglycemia, genetic predisposition has been recognized as a possible trigger in the development of this complication. Recent studies have demonstrated that the development of DR in patients with type 1 diabetes is associated with the occurrence of polymorphisms at the 5'-end of the aldose reductase gene (ALR2). There are no reports investigating these polymorphisms in type 1 diabetes Brazilian patients. The aim of this study was to investigate the relationship between the AC(n) repeat and C(-106)T polymorphisms of the ALR2 gene with the susceptibility to the development of DR in Brazilian patients with type 1 diabetes. METHODS: We selected 64 patients who had diabetes for at least 10 years from Santa Casa de São Paulo and State University of Campinas. The study group was divided into the following: Group 1, patients with no evidence of diabetic retinopathy; group 2, patients with nonproliferative diabetic retinopathy (NPDR); and group 3, patients with proliferative diabetic retinopathy (PDR), confirmed by fundoscopy. The AC(n) microsatellite region was evaluated through polymerase chain reaction (PCR) and automated genotyping and the C(-106)T substitution through polymerase chain reaction/restriction fragment length polymorphism (RFLP). RESULTS: When each allele of the AC(n) polymorphism was evaluated, the Z allele (24 repeats) was significantly associated with the development of PDR (p=0.014). The C allele of the C(-106)T substitution wasn't associated with the susceptibility to this microvascular complication (p=0.153). When the Z and C allele were concomitantly evaluated regarding their presence or absence a positive correlation was observed for the presence of both alleles and the development of PDR. CONCLUSIONS: In our sample of Brazilian patients with type 1 diabetes, the presence of the AC(n) polymorphism Z allele may be considered a risk factor for the development of PDR. The C allele of the C(-106)T polymorphism, in association with the Z allele, also increased the risk for the development of PDR, but when it was analyzed by itself there was no association with the complication.
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Aldeído Redutase/genética , Diabetes Mellitus Tipo 1/genética , Retinopatia Diabética/genética , Predisposição Genética para Doença , Polimorfismo Genético , Adolescente , Adulto , Brasil , Criança , Citosina , Feminino , Haplótipos , Humanos , Masculino , Pessoa de Meia-Idade , Sequências Repetitivas de Ácido Nucleico , TiminaRESUMO
OBJECTIVE: To analyze the efficacy of the panoramic viewing system (PVS) Reinverting Operating Lens System (ROLS) and the plano-concave Landers lens system in pars plana vitectomy (PPV). METHODS: The authors retrospectively analyzed the records of 117 PPV, 87 patients, performed between December 1996 and August 1998. The PPV was divided into two groups. Group 1 included 54 surgeries, with the Landers system. Group 2 included 63 surgeries with the ROLS. RESULTS: There were no statistical significant differences between the two groups, regarding pre and postoperative parameters. Surgeries employing the Landers system had an average time significantly higher than the ROLS group (p<0.001). When the surgical time was analyzed according to the disease, surgeries lasted significantly longer when the Landers system was used (p<0.05), except for the Uveitis group (p= 0.262). Surgeries in group 2 required less air-fluid and lens exchanges, less use of perfluorocarbon liquid (PFCL), and less need for scleral depression during the procedure. CONCLUSION: The use of ROLS significantly reduced the time for PPV, lowering the need for air-fluid exchange, lens exchange, PFCL use, and scleral depression. The PVS ROLS offered several advantages over the Landers plano-concave lens system during the surgery, without changing the final results.
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Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Doenças Retinianas/cirurgia , Vitrectomia , Idoso de 80 Anos ou maisRESUMO
As anemias sideroblásticas representam um grupo de moléstias heterogêneas. O seu tratamento é restrito e baseado em transfusões de sangue. Relatos descrevem um potencial benefício no uso da cloroquina na anemia sideroblástica (AS). Neste estudo, seis pacientes com AS foram tratados pelo período de seis meses com 300g/dia de cloroquina. Epigastralgia foi um sintoma freqüente nos pacientes do estudo obrigando à interrupção do tratamento em dois deles. A necessidade transfusional permaneceu a mesma em dois pacientes e não ocorreu em nenhum paciente o aumento dos níveis de hemoglobina ou a redução do percentual de sideroblastos em anel. A ausência de resultados e os efeitos colaterais sugerem que o uso de cloroquina seja inadequado para o tratamento de AS.
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Humanos , Anemia Sideroblástica , Cloroquina/administração & dosagemRESUMO
O acometimento orbitário inicial nos linfomas não-Hodgkin é incomum. Os tipos histopatológicos neste local, geralmente são os de baixo grau de malignidade, com formas localizadas e de boa evolução. Estudamos 6 casos de linfoma de localização ocular primária, atendidos no Hospital das Clínicas da UNICAMP no período de janeiro de 1988 a dezembro de 1992. Três pacientes do sexo masculino e 3 do sexo feminino, com idade entre 37 e 82 anos, média de 62 anos. Todos os pacientes tinham doença localizada, linfomas não-Hodgkin de baixo grau de malignidade (estadio I E) e tiveram a hipótese diagnóstica inicial através do exame oftalmológico. Todos apresentavam acometimento unilateral, com hiperemia da conjuntiva e proptose em 55 dos 6 casos. A acuidade visual não apresentou piora ou melhora significativa com o tratamento realizado, durante um seguimento médio de 17 meses. Não foram detectadas alterações fundoscóppicas relacionadas com a doença. A localização e extensões das lesões foram confirmadas com CT da órbita. Quanto ao tipo histológico, eram 5 casos de imunocitoma linfoplasmocítico e 1 caso de imunocitoma polimórfico. A radioterapia provou ser um tratamento efetivo nestes casos, com boa resposta, morbidade pequena e tolerável.