Birdshot retinochoroiditis in Brazil: a multicenter review of 40 patients.

BACKGROUND: Birdshot retinochoroiditis (BRC) is a rare and chronic bilateral uveitis mostly found in Caucasians. As few data are available about the clinical course of BRC in Hispanic patients, we aimed to report the clinical findings and the evolution of BRC in Brazilian patients. METHODS: This retrospective cohort multicenter nationwide study was performed by analyzing the records of patients with BRC diagnoses from Brazilian ophthalmological centers from April 1995 to May 2020. RESULTS: Forty patients (80 eyes) with a diagnosis of BRC were evaluated. The mean age was 53 years, and there was no sex predominance. All tested patients (34/40) were positive for HLA-A29. The diagnosis of BRC was made following the Levinson et al. criteria, and all ancillary tests were performed to exclude differential diagnoses. Clinical signs and symptoms, such as complications and treatment, were described. CONCLUSIONS: BRC evolution in Brazilian patients seems to have some peculiarities that diverge from the published literature available about Caucasians, as AS inflammation is higher in this population.

T cell immunoregulation in active ocular toxoplasmosis.

Toxoplasma gondii infection is an important cause of infectious ocular disease. The physiopathology of retinochoroidal lesions associated with this infection is not completely understood. The present study was undertaken to investigate cytokine production by T cells from individuals with active toxoplasmic retinochoroiditis (TR) comparing with controls. Eighteen patients with active TR and 15 healthy controls (6 controls IgG+ to Toxoplasma and 9 negative controls) were included in the study. Peripheral blood mononuclear cells were incubated in the presence or absence of T. gondii antigen (STAg), and stained against CD4, CD8, TNF, IL-10 and IFN-γ. Baseline expression of cytokines was higher in TR/IgG+ patients in comparison with controls. Cytokine expression was not increased by STAg in vitro stimulation in controls. After stimulation, TR/IgG+ patients' lymphocytes increased cytokine as compared to cultures from both controls. While T cells were the main source of IL-10, but also IFN-γ and TNF, other lymphocyte populations were relevant source of inflammatory cytokines. Interestingly, it was observed a negative correlation between ocular lesion size and IL-10 expression by CD4+ lymphocytes. This study showed that T cells are the main lymphocyte populations expressing IL-10 in patients with TR. Moreover, expression of IL-10 plays a protective role in active TR.

Multimodal Imaging Assisting the Early Diagnosis of Cat-Scratch Neuroretinitis.

To describe how a multifocal fundus imaging system assisted the early diagnosis of cat scratch neuroretinitis in a case of a 27-year-old male with unilateral visual loss, neuroretinitis, and a peripapillary angiomatous lesion. Multimodal fundus imaging analysis was an essential contributor to the clinical diagnosis of cat scratch neuroretinitis during the early stage of the disease.

Influence of the eye-tracking-based follow-up function in retinal nerve fiber layer thickness using fourier-domain optical coherence tomography.

PURPOSE: To evaluate the eye-tracking-based follow-up (EBF) function in the reproducibility of the peripapillary retinal nerve fiber layer (RNFL) thickness measurements obtained with Fourier-domain optical coherence tomography (Fd-OCT). METHODS: Thirty healthy subjects were imaged on an Fd-OCT device at the same visit by two examiners. Peripapillary circular scans in "high-speed" (HS) mode with the "automatic real time" (ART) set at 16 and in "high-resolution" (HR) mode with the ART off were obtained without and with the EBF function activated. RESULTS: Mean (± SD) global RNFL thickness was 105.1 (± 9.5) µm on HS mode and 105.4 (± 9.6) µm on HR mode. Interobserver analysis for global RNFL thickness revealed an intraclass correlation coefficient (ICC) greater than or equal to 0.96 for all but the HR mode without the use of EBF function (ICC = 0.73). Intraobserver analysis for global RNFL thickness revealed an ICC greater than 0.98 for all but the HR mode without the use of EBF function (ICC = 0.86). The interobserver and intraobserver analyses revealed the lowest ICC values for the temporal region on both HS and HR modes. Higher ICC values were obtained with the HS mode and when the EBF function was activated, particularly when using the HR mode. CONCLUSIONS: The EBF function had no influence in the reproducibility of the global peripapillary RNFL thickness measurements in healthy subjects on HS mode with ART on. However, reproducibility of the global RNFL thickness measurements on HR mode as well as of the temporal and temporal superior regions in both HS and HR modes was greater with the EBF function.

Spectral optical coherence tomography findings in patients with ocular toxoplasmosis and active satellite lesions (MINAS Report 1).

PURPOSE: To characterize the active retinochoroiditis lesion observed in patients with the classic clinical presentation of ocular toxoplasmosis (OT) utilizing spectral optical coherence tomography (SOCT). METHODS: Twenty-four patients with OT and satellite lesions underwent standardized ophthalmologic examination and multimodal fundus imaging. The SOCT findings observed at presentation were described. RESULTS: The mean age of the fourteen (58.3%) women and ten (41.7%) men was 27.6 years. The mean LogMAR ETDRS best-corrected visual acuity was 0.58 (Snellen equivalent, 20/80(+1) ). On SOCT evaluation, the posterior hyaloid was diffusely thickened in 23 (95.8%) of 24 eyes, increased hyper-reflective signals in the vitreous were observed in 18 (75.0%), and vitreal spherical hyper-reflective depositions were observed in 12 (50.0%) eyes. In all patients, at the active OT lesion site, the inner retinal layers were abnormally hyper-reflective with full-thickness disorganization of the retinal reflective layers (smudge effect); associated choriocapillaris/choroidal optical shadowing was observed in 22 (91.7%) eyes. The retina was thickened in 22 (91.7%) eyes, the retinal pigment epithelium-Bruch membrane reflective complex was focally increased or contained focal splits in 16 (66.7%) eyes and the choroid appeared thickened in 17 (70.8%) eyes. Disorganization of the outer retinal highly reflective layers adjacent to the active OT lesion was observed in all eyes. CONCLUSION: Full-thickness disorganization of the retinal reflective layers, generally associated with some degree of posterior optical shadowing, was observed in the active OT lesion in all patients. The posterior hyaloid was often thickened and, adjacent to the OT lesion, the outer retina was consistently altered.

Vitreoretinal morphology in active ocular toxoplasmosis: a prospective study by optical coherence tomography.

AIM: To investigate the third generation optical coherence tomography (OCT3) findings in patients with active ocular toxoplasmosis. METHODS: A prospective observational case series, including 15 patients with active ocular toxoplasmosis in at least one eye evaluated at a single centre. Vitreoretinal morphological features at baseline and changes within a 24-week follow-up interval on OCT3 were evaluated. RESULTS: The active ocular toxoplasmosis lesion was classified clinically as punctate (n = 6), focal (n = 6) or satellite (n = 3). Retinal layers were hyper-reflective at the active lesion site, and some degree of retinal pigment epithelium-choriocapillaris/choroidal optical shadowing was seen in all patients. In general, the retina was thinned at the active lesion site in eyes with punctate lesions and thickened in eyes with focal and satellite lesions. When detected by OCT3, the posterior hyaloid appeared thickened. While focally detached over punctate lesions, the posterior hyaloid was partially detached, but still attached to the lesion in focal and satellite lesions. Additional findings (not detected on clinical examination) include diffuse macular oedema (n = 6), vitreomacular traction (n = 3) and maculoschisis (n = 1). During follow-up, a decrease in retinal thickness and focal choriocapillaris/choroidal relative hyper-reflectivity were observed at the former lesion site, and posterior vitreous detachment progressed/occurred in all patients. CONCLUSION: OCT3 enabled identification of morphological features underestimated on clinical examination in patients with ocular toxoplasmosis, which may expand the clinical spectrum of the disease. Further studies are needed to verify the relevance of OCT3 in assisting with the diagnosis and management of ocular toxoplasmosis.

Third-generation optical coherence tomography findings in punctate retinal toxoplasmosis.

PURPOSE: To investigate optical coherence tomography (OCT) findings in patients with punctate retinal toxoplasmosis (PRT). DESIGN: Observational case series. SETTING: Tertiary ophthalmic referral center. STUDY POPULATION: Four patients with PRT consecutively evaluated between July 2004 and June 2005. OBSERVATION PROCEDURES: Clinical examination and OCT. MAIN OUTCOME MEASURES: Morphologic features at baseline and changes within a 24-week follow-up interval. RESULTS: Retinal layers were abnormally hyperreflective at the active lesion site and associated with some degree of retinal pigment epithelium-choriocapillaris/choroidal optical shadowing in all patients. The posterior hyaloid was thickened and focally detached (over the lesion). Additional findings include tractional maculopathy (n = 2) and diffuse macular edema (n = 1). During follow-up, focal choriocapillaris/choroidal relative hyperreflectivity was observed at the former lesion site, and posterior vitreous detachment progressed in all patients. CONCLUSIONS: Our findings suggest that OCT may enable identification of subtle morphologic features previously underappreciated in patients with PRT, which may provide new insights about the disease pathophysiologic mechanisms.

Relato de caso de endoftalmite pós-cirúrgica crônica por Aeromonas hydrophila / A case report of Aeromonas hydrophila chronic post operative endophthalmitis

Objetivo: Relatar um caso de endoftalmite pós-cirúrgica crônica por Aeromonas hydrophila. Local: Centro Oftalmológico de MG e Departamento de Uveítes do Hospital São Geraldo, UFMG. Método: Relato de caso. Resultado: Após tratamento cirúrgico instituído, baseado em biópsia vítrea para cultura bacteriológica, explantação de lente intra-ocular e saco capsular, vitrectomia posterior e injeção intravítrea de antimicrobianos (vancomicina e ceftazidima), obtivemos sucesso anatômico e funcional deste olho, com acuidade visual final de 0,5 com correção óptica. Conclusão: Este nosso relato demonstra o primeiro caso de endoftalmite pós-cirúrgica por Aeromonas hydrophila tratado com sucesso e alcançando boa recuperação anatômica e funcional do bulbo ocular.

Neurorretinite sub-aguda unilateral difusa: videoangiografia digital com indicianina verde e eletrorretinograma / Diffuse unilateral subacute neurorretinites: indocianine green videoangiographic findings and electroretinogram

Propósito: Avaliar o envolvimento da coróide em pacientes com neurorretinite sub-aguda unilateral (DUSN) por meio de videoangiografia digital com indocianina verde (ICG) e eletrorretinograma (ERG). Pacientes e métodos: Foram estudados cinco pacientes com quadro de DUSN no período de julho de 1997 a janeiro de 1998. Todos os pacientes foram submetidos a exames laboratoriais ( ELISA para toxocaríase e imunofluorescência para toxoplasmose, ao eletrorretiograma (ERG), á angiofluoresceinografia (AFG) e á videoangiografia digital com indocianina verde (ICV).

Estudo anatomo-patológico de membrans neovasculares sub-retinianas retiradas cirurgicamente / Pathologic features of surgically excised subretinal neovascular membranes

Objetivo: Analisar, por meio de microscopia óptica, seis membranas neovasculares sub-retinianas removidas cirurgicamente. Pacientes e Métodos: A remoçäo cirúrgica da membrana neovascular sub-retiana foi realizada em seis pacientes após estudo biomecroscópio e angiográfico completo. Essas membranas eram de origens diferentes, sendo quatro associadas à degeneraçäo macular relacionada à idade, uma relacionada à miopia e a outra idiopática. Todas foram examinadas por meio de microscopia óptica. Resultados: Em todas as amostras foi identificado tecido conjuntivo-fibroso e tecido vascular neoformado, com discreto infiltrado inflamatório. Três amostras demonstraram a presença de fragmentos de segmento externo de fotorreceptores. Conclusäo: conclui-se que a área da membrana neovascular sub-retiniana delimitada nas angiografias era menor que a sua extensäo total. Evidencia-se a presença de fotorreceptores em três membranas, o que demonstra a necessidade de estudos adicionais para determinar a freqüência desse achado, a possibilidade de eventuais modificaçöes na técnica cirurgíca e a avaliaçäo dos resultados pós-operatórios..

Uveíte anterior HLA B27 positivo com acometimento do segmento posterior / HLA B27 associated anterior uveitis posterior segment ocular manifestation

Os autores descrevem três casos de uveíte anteriores associadas às espondiloartropatias e ao HLAB27. Comenta-se a ocorrência do envolvimento do segmento posterior (vitreíte, edema e buraco macular, membranas epirretinianas, papilite, vasculite), sua gravidade e dificuldade de tratamento.