RESUMO
PURPOSE: This study sought to compare the long-term outcomes of surgeries for retinal detachment (RD) secondary to viral or parasitic infectious retinitis. METHODS: A total of 47 eyes that received pars plana vitrectomy with or without scleral buckling due to RD secondary to polymerase chain reaction-proven viral (cytomegalovirus, varicella zoster virus, and herpes zoster virus) or parasitic (toxoplasma and toxocara) retinitis from October 1, 2006, to June 30, 2023, in a single medical center were retrospectively enrolled. RESULTS: Mean follow-up period was 59.03 ± 55.24 months in viral retinitis and 34.80 ± 33.78 months in parasitic retinitis after primary reattachment surgery. During follow-up, nine eyes (24.3%) with viral retinitis and five eyes (50.0%) with parasitic retinitis developed retinal redetachment. Visual acuity success at final follow-up was achieved in 19 eyes (51.4%) with viral retinitis and six eyes (60.0%) with parasitic retinitis (p = 0.64). The incidence of retinal redetachment during the 1st postoperative year was significantly higher in parasitic retinitis compared with viral retinitis (crude incidence, 0.21 vs. 0.85; p = 0.02). Hazard ratio analysis adjusted for age and sex showed 4.58-fold (95% confidence interval, 1.22-17.27; p = 0.03) increased risk of retinal redetachment in parasitic retinitis compared with viral retinitis during the 1st postoperative year. Tamponade with silicone oil and preoperative diagnostic vitrectomy were associated with significantly decreased risk of retinal redetachment in patients with parasitic retinitis. CONCLUSIONS: Compared with RD secondary to viral retinitis, RD secondary to parasitic retinitis showed higher incidence of retinal redetachment during the 1st postoperative year. Tamponade with silicone oil and preoperative diagnostic vitrectomy were associated with significantly decreased risk of retinal redetachment in patients with parasitic retinitis.
Assuntos
Infecções Oculares Parasitárias , Infecções Oculares Virais , Descolamento Retiniano , Retinite , Acuidade Visual , Vitrectomia , Humanos , Descolamento Retiniano/cirurgia , Descolamento Retiniano/etiologia , Descolamento Retiniano/diagnóstico , Feminino , Masculino , Estudos Retrospectivos , Vitrectomia/métodos , Adulto , Seguimentos , Pessoa de Meia-Idade , Infecções Oculares Parasitárias/diagnóstico , Infecções Oculares Parasitárias/parasitologia , Infecções Oculares Parasitárias/cirurgia , Infecções Oculares Parasitárias/complicações , Infecções Oculares Virais/diagnóstico , Infecções Oculares Virais/virologia , Infecções Oculares Virais/complicações , Retinite/diagnóstico , Retinite/parasitologia , Retinite/cirurgia , Retinite/virologia , Recurvamento da Esclera/métodos , Adulto Jovem , Adolescente , Incidência , Idoso , Resultado do Tratamento , Fatores de Tempo , CriançaRESUMO
Purpose: To describe the distinguishing features of retinitis-like lesions seen in vitreoretinal lymphoma (VRL) from viral and toxoplasma retinitis.Methods: In this multicenter, retrospective study, we reviewed charts and imaging of consecutive patients with VRL. The associated features and the characteristics of retinitis-like lesions were assessed and compared with those of viral and toxoplasmic retinochoroiditis. Primary outcome measures were the unique features of VRL retinitis-like lesions.Results: Out of 76 eyes of 38 patients with VRL, retinitis-like lesions were identified in 6 eyes and confirmed on OCT. Distinctive features of VRL retinitis-like lesions were massive retinal thickening, associated sub-retinal pigment epithelium infiltrates and partial restoration of retinal layers after specific therapy.Conclusion: VRL can present with retinitis-like lesions that have distinctive OCT features on presentation as well as healing that can help to differentiate them from other lookalike etiologies and can guide further diagnostic and therapeutic interventions.
Assuntos
Linfoma Intraocular/diagnóstico , Neoplasias da Retina/diagnóstico , Retinite/diagnóstico , Corpo Vítreo/patologia , Idoso , Idoso de 80 Anos ou mais , Infecções Oculares Parasitárias/diagnóstico , Infecções Oculares Parasitárias/parasitologia , Infecções Oculares Virais/diagnóstico , Infecções Oculares Virais/virologia , Feminino , Humanos , Linfoma Intraocular/parasitologia , Linfoma Intraocular/virologia , Masculino , Pessoa de Meia-Idade , Neoplasias da Retina/parasitologia , Neoplasias da Retina/virologia , Retinite/parasitologia , Retinite/virologia , Estudos Retrospectivos , Tomografia de Coerência ÓpticaRESUMO
DUSN is an infectious ocular disease that can lead to severe visual impairment and blindness. It usually occurs in young healthy individuals and depending on the stage of the disease, clinical presentation may range from mild vitritis and multifocal gray-white lesions in outer retina to optic atrophy.Parasites of different sizes and species have been proposed as the etiological agent of this disease. Thus, it is hypothesized that different infectious worms may be considered as the likely cause of a both autoimmune and toxic form of nematode retinopathy.Most patients present with already severe visual impairment and in the later stages of the disease, where the likelihood of improvement is low, despite therapy. In cases of early diagnosis, prompt treatment, whether with oral antihelmintic or direct photocoagulation of the worm, patients may show considerable visual improvement and have a more favorable prognosis.
Assuntos
Infecções Oculares Parasitárias/complicações , Granuloma/complicações , Macula Lutea/patologia , Retinite/etiologia , Toxoplasma/isolamento & purificação , Toxoplasmose Ocular/complicações , Acuidade Visual , Adolescente , Diagnóstico Diferencial , Infecções Oculares Parasitárias/diagnóstico , Infecções Oculares Parasitárias/parasitologia , Angiofluoresceinografia/métodos , Fundo de Olho , Granuloma/diagnóstico , Granuloma/parasitologia , Humanos , Macula Lutea/parasitologia , Masculino , Retinite/diagnóstico , Retinite/parasitologia , Tomografia de Coerência Óptica , Toxoplasmose Ocular/diagnóstico , Toxoplasmose Ocular/parasitologiaRESUMO
BACKGROUND AND OBJECTIVE: To report a unique case series of diffuse unilateral subacute neuroretinitis (DUSN) patients imaged with optical coherence tomography angiography (OCTA). PATIENTS AND METHODS: In this retrospective case series, multimodal imaging was performed in four patients with DUSN at the time of patient visit. The study patients underwent standard clinical treatment for DUSN. RESULTS: The clinical findings were consistent with the diagnosis of DUSN. Cross-sectional OCT showed disruption of outer retinal layers in the foveal area and an irregular structure of the outer plexiform layer. En face OCT revealed hyperreflective spots and a large hyperreflective lesion in the foveal area correspondent to the outer retina disruption seen on cross-sectional OCT. OCTA demonstrated decreased vascular perfusion in both the superficial and deep retinal capillary plexuses along with choriocapillaris preservation. CONCLUSION: OCTA may provide a more detailed assessment of the retinal microvascular changes, allowing a more precise anatomical-functional correlation in DUSN. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:76-83.].
Assuntos
Infecções Oculares Parasitárias/diagnóstico , Angiofluoresceinografia , Vasos Retinianos/patologia , Retinite/diagnóstico , Tomografia de Coerência Óptica , Doença Aguda , Administração Oral , Adolescente , Adulto , Albendazol/uso terapêutico , Antiprotozoários/uso terapêutico , Criança , Estudos Transversais , Infecções Oculares Parasitárias/tratamento farmacológico , Infecções Oculares Parasitárias/parasitologia , Feminino , Humanos , Masculino , Imagem Multimodal , Vasos Retinianos/efeitos dos fármacos , Retinite/tratamento farmacológico , Retinite/parasitologia , Estudos Retrospectivos , Acuidade Visual/fisiologia , Adulto JovemRESUMO
ABSTRACT Purpose: To evaluate the prevalence, clinical characteristics, and types of optic nerve involvement in patients with ocular toxoplasmosis. Methods: For this retrospective cross-sectional study, we examined all patients with active ocular toxoplasmosis referred to our Uveitis Section during the last 12 years, and we included patients with optic nerve involvement in the study. The primary outcome was the prevalence of optic nerve involvement, and secondary outcomes included the types of optic nerve involvement and the final best-corrected visual acuity after treatment. Results: The prevalence of optic nerve involvement was 14.4%, with the leading cause being the activation of a juxtapapillary lesion (70.5%). We found papillitis in two eyes and neuroretinitis in two eyes (11.7% for each). We only detected one optic nerve involvement secondary to a distant active lesion (5.8%). Sixteen patients (94.1%) had unilateral ocular toxoplasmosis. The overall final best-corrected visual acuity after treatment was 10/10 (LogMAR = 0.0) excluding the three patients with a juxtapapillary scar involving the macula. Conclusions: Optic nerve involvement was common in patients with ocular toxoplasmosis. The main type of optic nerve involvement was caused by activation of an old juxtapapillary lesion. Treatment was quickly effective, but the best-corrected visual acuity was dependent on the presence of a scar in the papillomacular bundle.
RESUMO Objetivos: Avaliar a prevalência, características clínicas e tipos de acometimento do nervo óptico em pacientes com toxoplasmose ocular. Métodos: Para este estudo retrospectivo transversal, examinamos todos os pacientes com toxoplasmose ocular ativa encaminhados ao nosso Setor de Uveíte nos últimos 12 anos, e incluímos pacientes com comprometimento do nervo óptico no estudo. O resultado primário foi a prevalência do envolvimento do nervo óptico, e os resultados secundários incluíram os tipos de envolvimento do nervo óptico e a acuidade visual final melhor corrigida após o tratamento. Resultados: A prevalência de acometimento do nervo óptico foi 14,4%, sendo a principal causa a ativação de uma lesão justapapilar (70,5%). Encontramos papilite em dois olhos e neuroretinite em dois olhos (11,7% para cada um). Apenas detectamos um comprometimento do nervo óptico secundário a uma lesão ativa distante (5,8%). Dezesseis pacientes (94,1%) apresentavam toxoplasmose ocular unilateral. A acuidade visual final com melhor correção após o tratamento foi 10/10 (LogMAR= 0,0) excluindo os três pacientes com uma cicatriz justapapilar envolvendo a mácula. Conclusões: O comprometimento do nervo óptico foi comum em pacientes com toxoplasmose ocular. O principal tipo de comprometimento do nervo óptico foi causado pela ativação de uma lesão justapapilar antiga. O tratamento foi rapidamente eficaz, mas a acuidade visual final com melhor correção foi dependente da presença de uma cicatriz no feixe papilomacular.
Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto , Adulto Jovem , Doenças do Nervo Óptico/parasitologia , Doenças do Nervo Óptico/patologia , Toxoplasmose Ocular/patologia , Nervo Óptico/patologia , Nervo Óptico/diagnóstico por imagem , Retinite/parasitologia , Retinite/patologia , Fatores de Tempo , Turquia/epidemiologia , Acuidade Visual , Doenças do Nervo Óptico/tratamento farmacológico , Doenças do Nervo Óptico/epidemiologia , Papiledema/parasitologia , Papiledema/patologia , Toxoplasmose Ocular/tratamento farmacológico , Prevalência , Estudos Transversais , Estudos Retrospectivos , Tomografia de Coerência Óptica/métodos , Centros de Atenção TerciáriaRESUMO
Purpose: To analyze the patterns and causes of intraocular inflammation in patients attending uveitis referral clinics in Egypt. Methods: The study included 454 patients with uveitis examined both at the Department of Ophthalmology, Alexandria Faculty of Medicine, and tertiary uveitis referral clinics in Cairo and the International Eye Clinic in Upper Egypt, between August 2013 and March 2016. All patients had a comprehensive ocular examination and systemic work-up. Standard diagnostic criteria for uveitis syndromes were employed for all patients and ancillary ocular or systemic investigations were ordered as required by the suspected uveitis entity. Results: The mean age at presentation was 30 years (range: 4-75). The male to female ratio was 1.1:1. Panuveitis was the most common anatomic pattern (43%), followed by anterior (40.7%), posterior (9%), and intermediate uveitis (7.3%). Anterior uveitis was most commonly attributed to pediatric parasitic anterior chamber granulomas (22.2%). Intermediate uveitis was most commonly idiopathic (81.8%). Toxoplasma retinitis was the most common cause of posterior uveitis (31.7%). Behçet disease was the most common cause of panuveitis followed by Vogt-Koyanagi-Harada (VKH) disease (45.6% and 22.1%, respectively). Among non-infectious etiologies, Behçet disease was the most frequent etiology (28.6%), while for infectious causes, herpetic uveitis was found to be the most frequent cause (39.8%). Conclusions: In this uveitis patient population from Egypt, panuveitis was the most commonly encountered anatomic diagnosis. Behçet disease was the most common identified cause of uveitis followed by VKH disease. Herpes-related uveitides and parasitic granulomas represented the most evident causes of infectious uveitis.
Assuntos
Síndrome de Behçet/complicações , Toxoplasmose Ocular/complicações , Uveíte/epidemiologia , Uveíte/etiologia , Síndrome Uveomeningoencefálica/complicações , Adolescente , Adulto , Distribuição por Idade , Idoso , Criança , Pré-Escolar , Estudos de Coortes , Egito/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Retinite/parasitologia , Estudos Retrospectivos , Distribuição por Sexo , Uveíte/diagnósticoRESUMO
We report the first case of Trypanosoma cruzi-associated retinitis diagnosed using 28s ribosomal DNA sequencing. The case highlights the utility of broad-range molecular diagnostics for detecting rare and unsuspected ocular pathogens. Ocular involvement in Chagas disease is also discussed.
Assuntos
Doença de Chagas/complicações , Doença de Chagas/diagnóstico , Hospedeiro Imunocomprometido , Retinite/parasitologia , Trypanosoma cruzi/isolamento & purificação , Idoso , DNA de Protozoário/genética , DNA Ribossômico/genética , Humanos , Masculino , Técnicas de Diagnóstico Molecular , Mieloma Múltiplo/complicações , Reação em Cadeia da Polimerase , Retinite/diagnóstico , Análise de Sequência de DNARESUMO
Two patients (a 37-year-old man and a 28-year-old woman) who had choroidal neovascular membrane (CNVM) secondary to inactive toxoplasma retinochoroiditis scarring were evaluated. Multimodal imaging including fluorescein angiography, optical coherence tomography (OCT), and OCT angiography (OCTA) was used. CNVM secondary to inactive toxoplasma retinochoroiditis scarring was detected. Representative images of CNVM were demonstrated in the outer retinal layer and choriocapillary layer on OCTA. OCTA, a relatively new technique, is useful in the diagnosis of the CNVMs secondary to retinochoroiditis. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:509-511.].
Assuntos
Neovascularização de Coroide/diagnóstico , Corioidite/complicações , Infecções Oculares Parasitárias/complicações , Angiofluoresceinografia/métodos , Retinite/complicações , Tomografia de Coerência Óptica/métodos , Toxoplasmose Ocular/complicações , Adulto , Animais , Antígenos de Protozoários/imunologia , Corioide/irrigação sanguínea , Neovascularização de Coroide/etiologia , Corioidite/diagnóstico , Corioidite/parasitologia , Infecções Oculares Parasitárias/diagnóstico , Feminino , Humanos , Masculino , Retinite/diagnóstico , Retinite/parasitologia , Toxoplasma/imunologia , Toxoplasmose Ocular/diagnósticoRESUMO
Diffuse unilateral subacute neuroretinitis (DUSN) is an ocular disease caused by a subretinal nematode worm. The authors present a unique case of a 9-year-old girl with DUSN due to presumed Baylisascaris procyonis, given the size of the worm and previous raccoon exposure. The worm was located in the inner retina and treated with laser photocoagulation and albendazole. At the 1-week follow-up, the worm was still mobile despite being inactive immediately after the initial laser treatment and required a more prolonged laser session. This case serves to highlight the importance of close follow-up in patients with DUSN to ensure the worm is inactivated. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:686-690.].
Assuntos
Infecções Oculares Parasitárias/diagnóstico , Fotocoagulação a Laser , Infecções por Nematoides/diagnóstico , Guaxinins/parasitologia , Retina/diagnóstico por imagem , Retinite/diagnóstico , Animais , Criança , Infecções Oculares Parasitárias/parasitologia , Infecções Oculares Parasitárias/cirurgia , Feminino , Humanos , Infecções por Nematoides/parasitologia , Infecções por Nematoides/cirurgia , Retina/parasitologia , Retinite/parasitologia , Retinite/cirurgia , Tomografia de Coerência ÓpticaRESUMO
A 52-yr-old male was referred for progressive visual loss in the left eye. The decimal best-corrected visual acuity (BCVA) was 0.01. Fundus examination revealed diffuse retinal pigment epithelial degeneration, focal yellow-white, infiltrative subretinal lesion with fuzzy border and a live nematode within the retina. Diffuse unilateral subacute neuroretinitis (DUSN) was diagnosed and the direct laser photocoagulation was performed to destroy the live nematode. During eight months after treatment, BCVA gradually improved to 0.2 along with the gradual restoration of outer retinal layers on SD-OCT. We report on the first case of DUSN in Korea. DUSN should be included in the differential diagnosis of unexplained unilateral visual loss in otherwise healthy subjects.
Assuntos
Infecções Oculares Parasitárias/terapia , Nematoides/patogenicidade , Epitélio Pigmentado da Retina/parasitologia , Retinite/parasitologia , Retinite/terapia , Animais , Cegueira/diagnóstico , Cegueira/parasitologia , Infecções Oculares Parasitárias/diagnóstico , Infecções Oculares Parasitárias/parasitologia , Fundo de Olho , Humanos , Terapia a Laser/métodos , Fotocoagulação/métodos , Masculino , Pessoa de Meia-Idade , República da Coreia , Epitélio Pigmentado da Retina/patologia , Retinite/diagnóstico , Acuidade VisualRESUMO
BACKGROUND/AIMS: To determine if patients with inactive chorioretinitis lesions who experience chronic toxoplasmic uveitis test PCR positive for Toxoplasma in their ocular fluids. METHODS: Two patients undergoing long-term anti-toxoplasmic treatment developed chronic uveitis and vitritis. They underwent therapeutic and diagnostic pars plana vitrectomy. Patient specimens were tested for toxoplasmosis by real-time PCR and nested PCR. Patient specimens were also tested for the presence of Toxoplasma antibodies that recognise allelic peptide motifs to determine parasite serotype. RESULTS: Patients tested positive for Toxoplasma by real-time PCR at the B1 gene in the vitreous and aqueous humours of patient 1, but only the vitreous of patient 2. Patients were not parasitemic by real-time PCR in plasma and blood. During surgery, only old hyperpigmented toxoplasmic scars were observed; there was no sign of active retinitis. Multilocus PCR-DNA sequence genotyping at B1, NTS2 and SAG1 loci established that two different non-archetypal Toxoplasma strains had infected patients 1 and 2. A peptide-based serotyping ELISA confirmed the molecular findings. CONCLUSIONS: No active lesions were observed, but both patients possessed sufficient parasite DNA in their vitreous to permit genotyping. Several hypotheses to explain the persistence of the vitritis and anterior uveitis in the absence of active retinitis are discussed.
Assuntos
Anticorpos Antiprotozoários/sangue , Retinite/parasitologia , Toxoplasma/isolamento & purificação , Toxoplasmose Ocular/parasitologia , Uveíte/parasitologia , Corpo Vítreo/parasitologia , Anti-Infecciosos/uso terapêutico , Antiprotozoários/uso terapêutico , Doença Crônica , DNA de Protozoário , Ensaio de Imunoadsorção Enzimática , Feminino , Técnicas de Genotipagem , Glucocorticoides/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Prednisona/uso terapêutico , Reação em Cadeia da Polimerase em Tempo Real , Retinite/tratamento farmacológico , Retinite/imunologia , Sorotipagem , Toxoplasma/genética , Toxoplasma/imunologia , Toxoplasmose Ocular/tratamento farmacológico , Toxoplasmose Ocular/imunologia , Combinação Trimetoprima e Sulfametoxazol , Uveíte/tratamento farmacológico , Uveíte/imunologia , VitrectomiaRESUMO
Ocular infections after a heart transplant are rare; but when present, they generally appear during the first year after surgery. Ocular infections may cause significant loss of vision and morbidity if not diagnosed early. For that reason, heart transplant patients should undergo a routine visual examination during follow-up. We report our experience regarding the followup and treatment of a case of toxoplasma retinitis diagnosed in one of our heart transplant recipients.
Assuntos
Infecções Oculares Parasitárias/parasitologia , Transplante de Coração/efeitos adversos , Infecções Oportunistas/parasitologia , Retinite/parasitologia , Toxoplasma/isolamento & purificação , Toxoplasmose/parasitologia , Antibacterianos/uso terapêutico , Infecções Oculares Parasitárias/diagnóstico , Infecções Oculares Parasitárias/tratamento farmacológico , Infecções Oculares Parasitárias/imunologia , Humanos , Hospedeiro Imunocomprometido , Imunossupressores/efeitos adversos , Masculino , Pessoa de Meia-Idade , Infecções Oportunistas/diagnóstico , Infecções Oportunistas/tratamento farmacológico , Infecções Oportunistas/imunologia , Retinite/diagnóstico , Retinite/tratamento farmacológico , Retinite/imunologia , Fatores de Risco , Fatores de Tempo , Toxoplasmose/diagnóstico , Toxoplasmose/tratamento farmacológico , Toxoplasmose/imunologia , Resultado do TratamentoRESUMO
This study evaluated the morphometric implications in C57BL/6 mouse retina infected by Toxoplasma gondii, ME 49 strain. Twenty C57BL/6 female mice were divided into group 1 (n=8, intraperitoneally infected with 30 cysts of T. gondii ME 49 strain) and group 2 (n=12 non-infected controls). The eyes were enucleated on the 60th day after infection, fixed and processed for light microscopy. Changes in retinal thickness and in the perimeter/area ratio (P/A) of the retinal layers were analyzed by digital morphometry. We considered that P/A was the measurement of retinal architecture distortion induced by toxoplasmosis. This study considered the ganglion cells and nerve fiber layers as a monolayer, thus six layers of retina were evaluated: photoreceptors (PRL), outer nuclear (ONL), outer plexiform (OPL), inner nuclear (INL), inner plexiform (IPL) and ganglion cells/nerve fiber monolayer (GNL). Histological analysis of infected mouse retina showed inflammatory infiltrate, necrosis, glial reaction and distortion of the retina architecture. It also presented increased thickness (167.8±24.9µm versus 121.1±15.4µm, in controls) and increased retinal thickness within the retinitis foci (187.7±16.6µm versus 147.9±12.2µm out of the retinitis foci). A statistically significant difference in P/A was observed between infected and uninfected mouse retinas. The same was observed in PRL, OPL, INL and GNL. Retinal morphometry may be used to demonstrate differences between infected and uninfected mouse retinas.
Assuntos
Retina/patologia , Retinite/patologia , Toxoplasmose Animal/patologia , Toxoplasmose Ocular/patologia , Animais , Feminino , Processamento de Imagem Assistida por Computador , Camundongos , Camundongos Endogâmicos C57BL , Necrose , Retina/parasitologia , Retinite/parasitologiaRESUMO
BACKGROUND: Live intraocular nematode is a rare occurrence. Nematode can migrate actively within the eye, creating visual symptoms and damaging ocular tissue. CASE PRESENTATION: A 26-year old man presented with painless reduced vision of the left eye for one week duration. It was associated with floaters. Visual acuity on the left eye was hand movement. Anterior segment examination was normal with normal intra-ocular pressure. Fundus examination showed a live nematode lying subretinally at the macular area with macular oedema and multifocal chorioretinal lesions at peripheral retina. There was no vitritis, vasculitis or any retinal hemorrhage. Systemic examination revealed normal findings and laboratory studies only showed leucocytosis with normal eosinophil count and negative serum toxocara antibody. The diagnosis of introcular nematode with diffuse unilateral subacute neuroretinitis was made. He was treated with oral anti-helminths and a course of oral steroid at a reducing dose. The nematode had died evidenced by its immobility during the treatment and finally disintegrated, leaving macular oedema with mottling appearance and mild hyperpigmentation. Multifocal chorioretinal lesions had also resolved. However despite treatment his visual acuity during follow-up had remained poor. CONCLUSIONS: Cases of intraocular nematode, though not commonly encountered, continue to present the ophthalmologist with the problem of diagnosis and management and hence poorer prognosis to the patient.
Assuntos
Infecções Oculares Parasitárias , Infecções por Nematoides , Retinite/parasitologia , Doença Aguda , Adulto , Albendazol/uso terapêutico , Animais , Anti-Helmínticos/uso terapêutico , Infecções Oculares Parasitárias/complicações , Infecções Oculares Parasitárias/tratamento farmacológico , Infecções Oculares Parasitárias/patologia , Fundo de Olho , Humanos , Edema Macular/parasitologia , Masculino , Movimento , Nematoides/fisiologia , Infecções por Nematoides/complicações , Infecções por Nematoides/tratamento farmacológico , Infecções por Nematoides/patologia , Retinite/patologia , Retinite/fisiopatologia , Acuidade VisualRESUMO
The diagnosis of ocular toxoplasmosis is mainly clinical, based in the presence of focal necrotizing retinochoroiditis often associated with a preexistent chorioretinal scar, and variable involvement of the vitreous, retinal blood vessels, optic nerve, and anterior segment of the eye. Recognition of this clinical spectrum of toxoplasmic retinochoroiditis is crucial, but other infectious, noninfectious, and neoplastic entities should also be considered in the differential diagnosis. Investigations such as serological tests, polymerase chain reaction of ocular fluids, and assessment of intraocular antibody synthesis are helpful in uncertain cases. This article provides an overview of the differential diagnosis of ocular toxoplasmosis, focusing on the most important entities to be considered and emphasizing distinctive features of each one of them in the clinical setting. Ocular toxoplasmosis has multiple clinical manifestations, which partially overlap with those of other entities and these should be carefully considered when making the differential diagnosis, particularly in less typical cases.
Assuntos
Toxoplasmose Ocular/diagnóstico , Coriorretinite/congênito , Coriorretinite/diagnóstico , Coriorretinite/parasitologia , Diagnóstico Diferencial , Endoftalmite/diagnóstico , Endoftalmite/microbiologia , Infecções Oculares Bacterianas/diagnóstico , Infecções Oculares Fúngicas/diagnóstico , Neoplasias Oculares/diagnóstico , Herpes Simples , Herpes Zoster , Humanos , Linfoma/diagnóstico , Macula Lutea/patologia , Doenças Retinianas/diagnóstico , Doenças Retinianas/virologia , Síndrome de Necrose Retiniana Aguda/diagnóstico , Síndrome de Necrose Retiniana Aguda/parasitologia , Neoplasias da Retina/diagnóstico , Retinite/parasitologia , Sífilis/diagnóstico , Tuberculose Ocular , Uveíte Posterior/diagnóstico , Uveíte Posterior/microbiologia , Corpo VítreoRESUMO
A 14-year-old girl presenting with visual loss in both eyes was diagnosed to have healed toxoplasma retinochoroiditis in the right eye with active choroidal neovascularization (CNV) secondary to toxoplasmosis in the left. She underwent combination photodynamic therapy (PDT) and intravitreal bevacizumab as primary treatment. PDT was performed as per the 'Treatment of Age-related Macular Degeneration by Photodynamic therapy' study protocol and was followed by intravitreal bevacizumab after 2 days. CNV regressed at 8 weeks of follow-up and remained stable at 8 months of follow-up. The initial visual acuity improved from 20/120 to 20/30. Combination therapy with PDT and intravitreal bevacizumab appears to be effective in the treatment of CNV secondary to toxoplasma retinochoroiditis.
Assuntos
Inibidores da Angiogênese/administração & dosagem , Anticorpos Monoclonais/administração & dosagem , Neovascularização de Coroide/etiologia , Corioidite/parasitologia , Fotoquimioterapia , Retinite/parasitologia , Toxoplasmose Ocular/complicações , Adolescente , Anticorpos Monoclonais Humanizados , Bevacizumab , Neovascularização de Coroide/tratamento farmacológico , Corioidite/complicações , Quimioterapia Combinada , Feminino , Seguimentos , Humanos , Injeções Intravítreas , Retinite/complicaçõesRESUMO
Our purpose is to report a case of diffuse unilateral subacute neuroretinitis (DUSN) in which an ophthalmoscopically visible worm was found and optical coherence tomography (OCT) scans allowed the precise localization of the parasite in the intraretinal layers. Our findings suggest that the parasite moves in the inner portions of the retina possibly explaining the severe degenerative neural changes that it causes.
Nosso objetivo é relatar um caso de neurorretinite subaguda unilateral difusa (DUSN), onde uma larva oftalmoscopicamente visível foi detectada e, através do escaneamento pela tomografia de coerência óptica (OCT), foi possível estabelecer a localização precisa do parasita entre as camadas da retina. Nossos resultados sugerem que o movimento do parasita nas camadas mais internas da retina possa explicar as graves alterações neuronais degenerativas encontradas.
Assuntos
Humanos , Masculino , Adulto Jovem , Infecções Oculares Parasitárias/parasitologia , Infecções por Nematoides/diagnóstico , Retinite/parasitologia , Tomografia de Coerência ÓpticaRESUMO
PURPOSE: To report the findings of optical coherence tomography (OCT) in three cases of diffuse unilateral subacute neuroretinitis (DUSN). METHODS: Three young patients with confirmed diagnosis of diffuse unilateral subacute neuroretinitis were followed-up using Stratus® OCT. RESULTS: Optical coherence tomography findings included retinal nerve fiber layer atrophy and focal edema where the worm was initially lodged. In two patients we could identify the worm by optical coherence tomography as an area of hiper-reflectivity. The worms were laser photocoagulated and post-treatment optical coherence tomography scanning revealed improvement of edema, nerve fiber layer thinning and a retinal hyper-reflectivity where laser had been applied. CONCLUSION: The main finding reported here is the potential of optical coherence tomography in detecting the presence of retinal nerve fiber layer atrophy and focal retinal edema in areas affected by the worm. Optical coherence tomography can be used to distinguish diffuse unilateral subacute neuroretinitis from other mimicking diseases like punctate outer retinitis, when there are no retinal fiber layer atrophy.
OBJETIVO: Demonstrar os achados da tomografia de coerência óptica em três casos de neurorretinite subaguda difusa unilateral (DUSN). MÉTODOS: Os pacientes com diagnóstico confirmado de neurorretinite subaguda difusa unilateral realizaram seguimento pré e pós-tratamento por meio da tomografia de coerência óptica, Stratus® OCT. RESULTADOS: Os achados marcantes da tomografia de coerência óptica foram a atrofia das camadas de fibras nervosas da retina e edema da retina localizado em áreas nas quais a larva esteve. Em dois pacientes pôde-se localizar a larva no espaço sub-retiniano por meio da tomografia de coerência óptica, que se traduziu por pequena área densa (hiperrefletividade). As larvas foram fotocoaguladas a laser e os achados da tomografia de coerência óptica após o tratamento demonstrou melhora do edema, afinamento das camadas de fibras nervosas e hiperrefletividade no local da aplicação do laser. CONCLUSÃO: Os principais achados na tomografia de coerência óptica foram a atrofia difusa das camadas de fibras nervosas e o edema localizado nas áreas afetadas pela larva. A tomografia de coerência óptica pode ser usado para diferenciar neurorretinite subaguda difusa unilateral de doenças que a simulam, como retinite punteada externa, que não manifesta alterações das camadas de fibras nervosas.
Assuntos
Adolescente , Criança , Feminino , Humanos , Masculino , Infecções Oculares Parasitárias/diagnóstico , Fotocoagulação , Fibras Nervosas/patologia , Retinite/diagnóstico , Doença Aguda , Atrofia , Infecções Oculares Parasitárias/patologia , Infecções Oculares Parasitárias/cirurgia , Seguimentos , Fibras Nervosas/parasitologia , Retinite/parasitologia , Retinite/patologia , Retinite/cirurgia , Tomografia de Coerência Óptica , Acuidade VisualAssuntos
Inibidores da Angiogênese/administração & dosagem , Anticorpos Monoclonais/administração & dosagem , Neovascularização de Coroide/tratamento farmacológico , Neovascularização de Coroide/etiologia , Corioidite/parasitologia , Retinite/parasitologia , Toxoplasmose , Adulto , Anticorpos Monoclonais Humanizados , Bevacizumab , Corioidite/complicações , Feminino , Humanos , Injeções , Fotoquimioterapia , Recidiva , Retinite/complicações , Triancinolona Acetonida/administração & dosagem , Acuidade Visual/efeitos dos fármacos , Corpo VítreoRESUMO
BACKGROUND: Acquired multifocal white retinal lesions in an immunosuppressed patient are diagnostically challenging. METHODS: Case report of a 34-year-old woman who underwent bone marrow transplantation for chronic myelogenous leukemia. Four months after the transplant, while on relatively high doses of immunosuppressive drugs, she developed bilateral multifocal retinitis versus leukemic retinal infiltration. Fine-needle aspiration biopsy was performed on one eye in an attempt to establish a cytological diagnosis. RESULTS: The aspirate was found to contain individual crescent-shaped intraretinal organisms and cysts, consistent with the diagnosis of toxoplasmic retinitis. The patient was started immediately on an anti-toxoplasmosis regimen consisting of sulfadiazine, pyrimethamine, and folinic acid. Follow-up examinations revealed complete inactivation of the retinitis and no delayed complications of the biopsy. CONCLUSION: Fine-needle aspiration biopsy can be a useful diagnostic tool in selected patients with acquired retinal infiltrates.