Ambliopia severa na infância relacionada à persistência da vasculatura fetal / Severe childhood amblyopia associated to persistence of fetal vasculature

RESUMO A persistência do vítreo primário hiperplásico, atualmente referida como persistência da vasculatura fetal, é uma anomalia congênita que resulta da não regressão do vítreo vascular primário e do sistema da artéria hialoide durante a embriogênese. Trata-se de uma anomalia unilateral na maioria dos casos, esporádica e comumente não associada a nenhum outro achado sistêmico. Clinicamente, essa condição pode ser classificada em persistência anterior e em persistência posterior da vasculatura fetal. A condição anterior está relacionada ao sistema da artéria ciliar, enquanto a persistência da vasculatura posterior associa-se à artéria hialoide e pode apresentar anormalidades, com desfecho visual desfavorável. A detecção da persistência do vítreo primário hiperplásico é de suma importância, visto que é um diagnóstico diferencial para retinoblastoma. O relato de caso a seguir descreve o acompanhamento ambulatorial em um Serviço de Oftalmologia de uma criança do sexo masculino com persistência da vasculatura fetal unilateral e sem alterações sistêmicas.

ABSTRACT Hyperplastic primary vitreous persistence, currently referred to as fetal vasculature persistence, is a congenital anomaly that results from non-regression of the primary vascular vitreous and hyaloid artery system during embryogenesis. It is a unilateral anomaly in the vast majority of cases, sporadic and commonly not associated with any other systemic finding. Clinically, this condition can be classified into anterior and posterior persistence of fetal vasculature. The anterior condition is related to the ciliary artery system, while the persistence of the posterior vasculature is associated with the hyaloid artery, which may present abnormalities with an unfavorable visual outcome. Detecting persistent hyperplastic primary vitreous is of paramount importance, as it is a differential diagnosis for retinoblastoma. The following case report describes the outpatient follow-up at the ophthalmology service of the Federal University of Triângulo Mineiro (UFTM) of a male child with persistent unilateral fetal vasculature and no systemic changes.

A Developmental Mechanism of Spontaneous Reattachment in Rhegmatogenous Retinal Detachment

This retrospective observational case series on eyes from three patients was done to elucidate the developmental mechanism of spontaneous reattachment of rhegmatogenous retinal detachment (SRRRD). The study eyes of each patients showed evidence of retinal break and diffuse retinal pigmentary change. Ultrasound biomicroscopic examination revealed vitreous fibers attached to the area around the retinal break. Posterior vitreous attachment was confirmed in each eye. A thin fibrovascular membrane incompletely sealing the retinal break was noted in one case. We suggest that the vitreous attachment around the retinal break and the sealing of the break with adjacent vitreous fibers seem to be involved in the developmental mechanism of SRRRD.

Estudo comparativo entre imagens ultra-sonográficas obtidas com sondas de 10MHz e 20 MHz na avaliação de anormalidades do segmento posterior do globo ocular / Comparative study of ultrasound images obtained with 10MHz and 20 MHz probes in the evaluation of the abnormalities of the posterior segment of the globe

A ecografia se constitui em método importante na avaliação de anormalidades do segmento posterior do globo ocular. OBJETIVO: Comparar as vantagens e desvantagens da sonda de 10 e 20 MHz da ultra-sonografia B-scan, na avaliação de imagens do segmento posterior do globo ocular. MÉTODOS: Pacientes acompanhados no ambulatório do Hospital das Clínicas da USP (HCFMUSP) entre fevereiro de 2006 e abril de 2007 foram submetidos a exame ultra-sonográfico usando o aparelho CINE-Scan® (Quantel Medical Inc.) com sondas de 10 e 20 MHz. Os pacientes foram examinados por três oftalmologistas experientes, em decúbito dorsal, após instilação de colírio de tetracaína a 1 por cento, inicialmente com a sonda sobre as pálpebras e em seguida diretamente em contato com a esclera ou córnea. As imagens obtidas com sondas de 10 e 20 MHz foram comparadas entre si, durante e após a realização do exame. RESULTADOS: A sonda de 20 MHz mostrou-se superior na avaliação da detecção, forma e limites de estruturas do pólo posterior e a de 10 MHz avaliou com mais detalhes o humor vítreo. Não foram encontradas diferenças nas imagens obtidas com exame transpalpebral ou transescleral com a sonda de 10 MHz. Com a sonda de 20 MHz, as imagens obtidas em contato direto com o globo ocular apresentaram melhor qualidade. CONCLUSÕES: As sondas de 10 e 20 MHz têm diferentes intervalo de alcance ideal, assim como diferentes meios específicos de aquisição de melhores imagens.

The ultrasound is an important method in the evaluation of abnormalities of the posterior segment of the eye. PURPOSE: To compare the advantages and disadvantages of 10 and 20 MHz probe on B- scanning ultra-sonography in evaluation of vitreous and posterior pole diseases, providing recommendations for their use. METHODS: Patients from Hospital das Clinicas of the University of São Paulo (HC-FMUSP), attended between February 2006 and April 2007, were submitted to ultrasound exams using CINE-Scan® (Quantel Medical Inc) B-scan with 10 and 20MHz probe. The patients were examined by three experienced ophthalmologists, in horizontal dorsal position, after instillation of tetracaine 1 percent drops, first with the probe in direct contact with eyelids, and then with the probe placed directly in contact with the sclera or cornea. Theimages obtained were compared immediately during and after the examination. RESULTS: The 20 MHz probe reveled a superior resolution to study details, like shape and limits, on the posterior pole, and the 10 MHz probe provided better evaluation on vitreous humor. There were no differences if the exam was performed on eyelids or directly on sclera with the 10 MHz probe, but with the 20 MHz probe, the images had better resolution when the probe was used in direct contact with the eye. CONCLUSIONS: The 10 and 20 probes have different ideal range of reach, as different better specific means of image achieving.

Optical coherence tomography [OCT] as a prognostic tool before removal of idiopathic epimacular membrane [EMM]

Idiopathic Epimacular Membrane [macular pucker] is a mild manifestation of proliferative vitreo-retinopathic spectrum of disease. It is termed idiopathic if it happened in eyes without any previous ocular diseases. Surgery of Idiopathic EMM has been a common vitreo-retinal disease for many years, and several prognostic factors have been implicated in each removal. With the advance of Optical Coherence Tomography [OCT], it provides us with a detailed cross sectional study of the vitreo-retinal juncture and it is used as a well efficient prognostic tool, that we are aiming for evaluating its efficacy in this study. A prospective study including 30 eyes of Idiopathic EMM were included in this study. All the membranes were removed by standard 3-port vitrectomy with peeling of the EMM by diamond dusted needle. Best corrected visual acuity and standard OCT for the macula were done pre and post operatively 3 months after surgery. Among the 30 eyes that were included in this study, 18 were males [60%] and 12 were females [40%] with an age average of 48-72 with a mean of 61.4. There was a clinically significant improvement in best corrected visual acuity pre and post-operatively [as P=.957] and also there was a clinically significant improvement with the central foveal thickness by OCT on pre and post-operatively [as P=.878]. 6 eyes [20%] got a vision of 20/20 post-operatively and 25 eyes [83.33%] showed improvement than the pre-operative level. Also, all eyes [100%] showed improvement in their CFT, but none of them regained the normal foveal configuration. So, there is no positive correlation found between the best corrected visual acuity and the central foveal thickness, either pre-operative or post-operative. OCT is of great value and importance in detecting the abnormal vitreo-retinal relation, and also, in detecting the secondary effect on the underlying retina, like spaces, pseudohole, or even true hole formation with EMM formation which are more important than the thickness by itself before surgical removal of epimacular membrane