Systemic sarcoidosis presenting as acute rapidly progressive proptosis / Sarcoidose sistêmica apresentando-se como proptose aguda rapidamente progressiva

ABSTRACT Sarcoidosis is a generalized systemic chronic inflammation that rarely involves the orbit. As a chronic inflammation, sarcoidosis typically manifests with an insidious onset and slowly progressive course. We report a case of acute-onset proptosis resulting from a rapidly growing diffuse orbital mass that simulated malignant growth, which was biopsy proven to be the first manifestation of systemic sarcoidosis. The patient demonstrated complete resolution of proptosis and systemic involvement with long-term corticosteroid treatment.

RESUMO A sarcoidose é uma inflamação sistêmica generalizada que raramente envolve a órbita. Sendo uma inflamação crônica, a sarcoidose geralmente se manifesta com um início insidioso e uma evolução lentamente progressiva. Neste artigo, é relatado um caso de proptose de início agudo, resultante de uma massa orbitária difusa de rápido crescimento, simulando um crescimento maligno, mas cuja biópsia comprovou ser a primeira manifestação de uma sarcoidose sistêmica. O paciente apresentou resolução completa da proptose e do envolvimento sistêmico com tratamento de longo prazo com corticosteroides.

Systemic sarcoidosis presenting as acute rapidly progressive proptosis.

Sarcoidosis is a generalized systemic chronic inflammation that rarely involves the orbit. As a chronic inflammation, sarcoidosis typically manifests with an insidious onset and slowly progressive course. We report a case of acute-onset proptosis resulting from a rapidly growing diffuse orbital mass that simulated malignant growth, which was biopsy proven to be the first manifestation of systemic sarcoidosis. The patient demonstrated complete resolution of proptosis and systemic involvement with long-term corticosteroid treatment.

Diagnosis of the origin of an epibulbar melanocytic tumor with molecular genomics.

BACKGROUND: Uveal melanoma (UM) and conjunctival melanoma (CM) are distinct entities with different etiologies and genetic background. We present a case of an atypical subconjunctival melanoma arising from a blue nevus. PATIENTS AND METHODS: A 61-year-old female presented with a partially melanocytic epibulbar mass with surrounding episcleral pigmented spots. The lesion was detached from the overlying conjunctiva without an intraocular component. Excisional biopsy revealed a predominantly epithelioid melanoma, that was suggested to be metastasic, although there was no evidence of a primary melanoma elsewhere. RESULTS: Molecular analysis identified GNAQ and BAP1 pathogenic variants, which strongly suggested the diagnosis as a primary epibulbar melanoma arising from episcleral blue nevus. CONCLUSION: This case demonstrates the value of tumor molecular analysis using Next Generation Sequencing (NGS) for differentiating the origin of an unusually located ocular melanoma.

Retinal perfusion changes in radiation retinopathy.

PURPOSE: To investigate retinal blood flow and oxygen saturation changes in patients diagnosed with retinopathy following plaque radiation treatment to treat choroidal melanoma. METHODS: Eight patients (mean age 55.75 years, SD 12.58 years) who have developed unilateral ischaemic radiation-related retinopathy as confirmed by wide-field fluorescein angiography were recruited for the study. The fellow eye with no other ocular or retinal pathology was used as control. Both eyes underwent measurement of total retinal blood flow (TRBF) and retinal blood oxygen saturation using prototype methodologies of Doppler Spectral Domain Optical Coherence Tomography (OCT) and Hyperspectral Retinal Camera, respectively. RESULTS: The average TRBF in the retinopathy eye was significantly lower compared to the fellow eye (33.48 ± 12.73 µl/min versus 50.37 ± 15.26 µl/min; p = 0.013). The arteriolar oxygen saturation (SaO2 ) and venular oxygen saturation (SvO2 ) were higher in the retinopathy eye compared to the fellow eye (101.11 ± 4.26%, versus 94.45 ± 5.79%; p = 0.008) and (62.96 ± 11.05% versus 51.24 ± 6.88%, p = 0.051), respectively. CONCLUSION: The ionizing radiation seems to have an impact on the TRBF, SaO2 and SvO2 , clinically presenting similar to a rapidly developing diabetic retinopathy. The results show an altered retinal vascular physiology in patients with radiation-related retinopathy.

Experiencia de cirugía dinámica en corrección de estrabismo horizontal / Dynamics surgery experience in horizontal strabismus correction

Objetivo: Describir nuestra experiencia con la técnica de cirugía dinámica para la corrección de estrabismo horizontal en el Complejo Hospitalario Metropolitano Dr. AAM con los pacientes operados de enero de 2002 a mayo de 2004. Metodología: Estudio descriptivo, retrospectivo, longitudinal del paciente con estrabismo horizontal sometidos a cirugía dinámica con evaluaciones post operatorias al primer mes, a los seis meses y al año. Se tomaron como variables tipo y grado de desviación pre y post operatoria, monocularidad-alternancia y la presencia de complicaciones postquirúrgicas. Resultados: Los resultados postquirúrgicos fueron satisfactorios tanto en el 1er mes, a los seis meses como al año (98 por ciento, 96 por ciento y 85 por ciento, respectivamente). Tanto los pacientes operados con diagnóstico de estrabismos monoculares como los alternantes mostraron resultados satisfactorios post operatorios al mes, a los 6 meses y al año. El porcentaje de complicaciones en nuestra serie fue de 11,7 por ciento (9 casos), con un predominio del estrabismo residual (6,5 por ciento). Conclusiones: En general, los resultados de la cirugía dinámica fueron satisfactorios en este estudio, tanto en el 1er mes (98 por ciento), a los 6 meses (96 por ciento) como al año (85 por ciento) post operatorios. No se encontraron diferencias significativas entre las evaluaciones al 1er mes, a los 6 meses y al año, lo que podría sugerir una tendencia a la estabilidad del resultado quirúrgico. No se encontraron diferencias significativas en los resultados post quirúrgicos de los pacientes tanto con estrabismos monoculares como con estrabismos alternantes.

Objective: To describe our experience on the technique of the dynamic surgery for the correction of horizontal strabismus in the Metropolitan Hospitalary Complex Dr. A.A.M. with patients operated between January of 2002 and may of 2004. Methodology: This is a descriptive, retrospective, longitudinal study of patients with horizontal strabismus who underwent dynamic surgery with post-operative evaluations at the first, sixth and twelfth month. Variables studied were: type and degree and pre and post-operative complications. Results: The post-operative results were satisfactory at the first, sixth and twelfth month, and they were 98 percent, 96 percent and 85 percent respectively. Operated patients with diagnosis of monocular strabismus as well patients who alternated, showed satisfactory results post-operatively at the first, sixth and twelfth month. The percentage of complications in our series was 11.7 percent (9 cases), with a predominance of residual strabismus. (6,5 percent) Conclusions: In general, the results of the dynamic surgery were satisfactory in this study, at the first month (98 percent), at the sixth month (96 percent) and at the twelfth month (86 percent) post-operatively. We did not find significant differences at the first, sixth or twelfth month, and this could suggest a tendency towards of stability the surgical result. We did not find significant differences in the post-operative results of patients with monocular strabismus or alternate strabismus.