ABSTRACT
Birdshot retinochoroidopathy (BSRC) is a distinct type of posterior uveitis originally described in the 1940s. Its characteristics include minimal anterior segment inflammation and diffuse posterior choroidopathy with vitritis and retinal vasculitis. The precise etiology of this disease is yet to be elucidated. However, various treatment modalities have been employed with the ultimate goal of durable remission of this vision threatening intraocular disease. The purpose of this review is not only to emphasize the importance of recognizing BSRC, but also to discuss the new discoveries, immune mediators, current and new therapies, and techniques applied to monitor and accomplish disease remission.
Retinocoroidopatia do tipo "birdshot" é um tipo de uveíte posterior originalmente descrita na década de 1940. Achados característicos incluem inflamação mínima do segmento anterior, retinocoroidopatia difusa associada à vitreíte e vasculite retiniana. A etiologia da doença ainda não foi completamente definida, entretanto várias modalidades de tratamento têm sido utilizadas com o objetivo de atingir a remissão. O objetivo desta revisão é enfatizar não só a importância do reconhecimento da doença como também discutir novas descobertas relacionadas a mediadores imunes, formas de tratamentos e como monitorar a doença.
Subject(s)
Humans , Retinal Diseases , Choroid Diseases , Chorioretinitis , Antibodies, Monoclonal, Humanized/therapeutic use , Retinal Diseases/diagnosis , Retinal Diseases/immunology , Retinal Diseases/drug therapy , Remission Induction , Fluorescein Angiography , HLA-A Antigens/immunology , Choroid Diseases/diagnosis , Choroid Diseases/immunology , Choroid Diseases/drug therapy , Chorioretinitis/diagnosis , Chorioretinitis/immunology , Chorioretinitis/drug therapy , Diagnosis, Differential , Drug Therapy, Combination , Electroretinography , Immunosuppressive Agents/therapeutic useABSTRACT
A 58-year-old woman presented with rash over the left side of the face and intense acute uveitis. Following careful review of the symptoms and dilated fundus examination unilateral optic neuritis was discovered. The rash was typical of varicella zoster dermatitis. Patients presenting with herpes zoster ophthalmicus should always undergo dilated fundus examination, as there is a potential risk of unexpected posterior segment inflammation. Early diagnosis and prompt treatment can avoid visual sequelae.
Paciente de 58 anos de idade apresentando erupção cutânea no lado esquerdo da face e intensa uveíte unilateral. Após cuidadosa revisão dos sintomas e exame de fundo do olho foi detectada neurite óptica. O rash era típico de dermatite por varicella zoster. Pacientes apresentando quadro de herpes zoster oftálmico devem ser submetidos ao exame de fundo do olho devido ao risco de inesperada inflamação do segmento posterior. Diagnóstico precoce e tratamento imediato podem evitar danos visuais.
Subject(s)
Humans , Female , Middle Aged , Chickenpox/complications , Optic Neuritis/diagnosis , Optic Neuritis/etiology , Herpes Zoster Ophthalmicus/complications , Herpes Zoster Ophthalmicus/diagnosis , Herpesvirus 3, Human/immunology , Optic Nerve/pathology , Optic Nerve/diagnostic imaging , Sulfonamides/therapeutic use , Timolol/therapeutic use , Virus Activation , Prednisone/therapeutic use , Fluorescein Angiography , Optic Neuritis/drug therapy , Optic Neuritis/virology , Uveitis, Anterior/diagnosis , Uveitis, Anterior/virology , Ocular Hypertension/etiology , Ocular Hypertension/drug therapy , Herpes Zoster Ophthalmicus/drug therapy , Herpes Zoster Ophthalmicus/virology , Adrenal Cortex Hormones/therapeutic use , Tomography, Optical Coherence , Slit Lamp Microscopy , Valacyclovir/therapeutic use , Fundus Oculi , Intraocular Pressure/physiology , Mydriatics/therapeutic useABSTRACT
Methods: This is a retrospective, noncomparative case series of four pregnant women who were treated for ocular toxoplasmosis during pregnancy. Results: All of the participants had violent and treatment-resistant toxoplasma retinochoroiditis during pregnancy, leaving three of them with decreased visual acuity in spite of aggressive therapy. Termination of pregnancy appeared to help the recovery in two patients. Conclusion: Pregnant state may provoke the recurrence of ocular toxoplasmosis.
Subject(s)
Female , Adult , Young Adult , Pregnancy , Toxoplasmosis , UveitisABSTRACT
La conjuntiva desempeña un papel muy importante en los procesos inflamatorios de las estructuras oculares externas, incluyendo a la misma conjuntiva, la córnea y la esclera. La quetoconjuntivitis cicatrizante crónica representa un grupo de enfermedades con manifestaciones clínicas similares, pero con un diagnóstico diferencial muy extenso y en el cual la confirmación diagnóstica por medio de los hallazgos inmunohistopatológicos de la conjuntiva es de crucial importancia para instituir un tratamiento adecuado. Lo mismo es cierto para la queratitis ulcerativa periférica y la excleritis necrotizante, en las cuales la historia clínica detalla, en conjunto con la biopsia conjuntival, representan las dos armas diagnósticas fundamentales. Además, esta última es el punto crítico en la toma de decisiones respecto a si instituir o no quimioterapia inmunosupresiva en estos casos. De esta manera, el estudio histopatológico e inmunopatológico de la conjuntiva representa una arma fundamental en el diagnóstico, en el tratamiento, así como en el entendimiento de la patogénesis de las enfermedades inflamatorias oculares externas de origen inmunológico.