Epibulbar simple cartilaginous choristoma associated with unique pigmented multicystic component.

PURPOSE: To report an atypical presentation of an epibulbar simple cartilaginous choristoma with a unique pigmented multicystic component. CASE DESCRIPTION: A 69-year-old African American female presented for evaluation of a right nasal epibulbar lesion that had progressed over the prior year. Slit-lamp evaluation revealed an immobile, mildly pigmented multicystic lesion measuring 6.0 × 4.5 mm that involved the nasal bulbar conjunctiva and the plica semilunaris. The lesion appeared benign, without feeder vessels or features of epithelial dysplasia. Given its recent growth and the patient's cosmetic concerns, the lesion was excised with ocular surface reconstruction. Histopathological evaluation disclosed a well-circumscribed nodule of well-differentiated cartilage in the substantia propria, consistent with a simple cartilaginous choristoma. The overlying conjunctival stroma contained multiple cysts lined by focally pigment epithelium. The patient recovered well from surgery, with satisfactory cosmetic results. CONCLUSIONS: Our case of epibulbar simple cartilaginous choristoma includes a prominent superficial component of pigmented epithelial cysts, which has not been previously reported in the literature. This augments our knowledge on the spectrum of presentations of cartilaginous choristomas and underscores the importance of histopathological evaluation for definitive diagnosis.

Bilateral acute depigmentation of the iris (BADI) and bilateral acute iris transillumination (BAIT): A case series from a center in Brazil.

Bilateral acute depigmentation of the iris and bilateral acute iris transillumination (BAIT) are similar clinical entities. The former causes acute-onset depigmentation of the iris stroma without transillumination, whereas the latter causes depigmentation of the iris pigment epithelium with transillumination. The etiopathogenesis of these conditions is not yet fully understood, but the proposed causes include the use of systemic antibiotics (especially moxifloxacin) and viral triggers. We present a case series of five female patients with a mean age of 41 (32-45) years, all of whom suffered acute onset of bilateral pain and redness of the eyes after moxifloxacin use (oral or topical). It is important for ophthalmologists to be aware of the two forms of iris depigmentation since this case series suggests that SARS-CoV-2 or its empirical treatment with moxifloxacin may trigger iris depigmentation. If this is the case, clinicians will likely see increased incidences of bilateral acute depigmentation of the iris and bilateral acute iris transillumination during and after the COVID-19 pandemic.

Bilateral acute depigmentation of the iris: a case report / Despigmentação aguda bilateral da íris: um relato de caso

ABSTRACT Bilateral acute depigmentation of the iris (BADI) is a new clinical entity of unknown etiology and is characterized by bilateral, symmetrical, and simultaneous depigmentation of the iris with focal or diffuse stromal atrophy; this condition generally has a good prognosis. We present a case of a 26-year-old woman who noted a spontaneous change in the iris color in both eyes in the last 2 months. The ophthalmological findings were atrophy of the iris stroma and pigmentation of the trabecular meshwork, without affecting the pigmented epithelium of the iris. Her intraocular pressure was normal and the visual acuity was 20/20 in both eyes.

RESUMO A despigmentação aguda bilateral da íris (DABI) é uma nova entidade clínica caracterizada pela despigmentação bilateral, simétrica e simultânea da íris, com atrofia focal ou difusa do seu estroma, geralmente com bom prognóstico. Apresentamos o caso de uma mulher de 26 anos de idade que procurou atendimento médico em nosso serviço com queixa de mudança espontânea na cor da íris de ambos os olhos nos últimos dois meses. Os achados oftalmológicos observados durante o exame clínico foram atrofia do estroma da íris e pigmentação da malha trabecular, sem afetar o epitélio pigmentado da íris. A pressão intraocular era normal e acuidade visual de 20/20 em ambos os olhos.

No todo tumor hiperpigmentado es melanoma: adenoma del epitelio pigmentario del cuerpo ciliar / Not every pigmented tumour is melanoma: Adenoma of the ciliary body pigment epithelium

El diagnóstico diferencial entre melanoma y seudomelanoma requiere de múltiples estudios clínicos y de la experiencia en los pequeños detalles. Presentamos el caso de un varón de 57 años con un adenoma del epitelio pigmentario del cuerpo ciliar, al cual se le realizó una enucleación por la sospecha diagnóstica de melanoma coroideo

Differential diagnosis between a melanoma and a pseudomelanoma requires many years of experience and ocular studies, and requires paying attention to the smallest details. The case is presented of a 57 year-old male with an adenoma of the ciliary body pigment epithelium that was treated with an enucleation of the eye due to a suspicion of a choroidal melanoma

Coroidite serpiginosa macular: relato de caso / Macular serpiginous choroiditis: case report

A coroidite serpiginosa é uma doença rara, que pode causar perda visual irreversível quando a mácula é atingida. Este artigo relata um caso de coroidite serpiginosa com acometimento macular isolado, submetido a tratamento com injeções subtenoniana e intravítrea de triancinolona. Os aspectos clínicos e diagnósticos diferenciais desta doença ocular são discutidos, assim como, os achados de angiografia fluoresceínica e tomografia de coerência óptica de alta resolução.

Serpiginous choroiditis is a rare ocular inflammatory disease that can lead to permanent vision loss due to macular involvement. This article reports a case of a patient with macular serpiginous choroiditis submitted to subtenon and intravitreal triamcinolone injections. The clinical aspects and differential diagnosis of this ocular disease, including fluorescein angiogram and high-resolution optical coherence tomography are discussed.

Tomografía de coherencia óptica en la distrofia macular viteliforme tipo 2 / Optical coherence tomography in vitelliform macular dystrophy type 2

Caso clínico: Presentamos el caso de un niño de 10 años con una distrofia macular viteliforme bilateral, en progresión, y el padre con estadios finales en ambos ojos; se estudia la evolución con la tomografía óptica de coherencia. Discusión: La tomografía óptica de coherencia es una herramienta útil y no invasiva, que permite complementar el diagnóstico y el seguimiento de los pacientes, aportando datos morfológicos de la lesión así como cambios secundarios en la retina adyacente. Demuestra la localización del material amarillento depositado bajo la retina sensorial

Case report: We report the case of a 10-year-old boy with a progressive bilateral vitelliform macular dystrophy, and his father with terminal stage disease in both eyes; we studied the development and progression of this condition with optical coherence tomography. Discussion: Optical coherence tomography is a useful noninvasive tool that complements other diagnostic modalities and improves the follow up assessment. It provides additional information on the morphology of the lesion as well as identifying secondary changes in the adjacent retina. It also demonstrates the location of any yellowish material under the sensory retina (Arch Soc Esp Oftalmol 2008; 83: 501-504)

Epitelitis retiniana aguda. A propósito de un caso / Acute retinal pigment epitheliitis: a case report

Caso clínico: Se presenta el caso de varón de 45 años que acudió por urgencias con pérdida de visión en ojo izquierdo tras cuadro gripal. No otros datos de interés. La visión del ojo izquierdo fue ligeramente inferior al ojo derecho. La oftalmoscopia mostró pequeñas lesiones anaranjadas en área macular y foveolar. Se realizó una angiografía fluoresceínica cuyos hallazgos fueron compatibles con el diagnóstico de Epitelitis Retiniana Aguda. Discusión: La epitelitis retiniana aguda es un cuadro clínico que afecta a pacientes jóvenes y suele estar precedido de un proceso vírico. Su resolución es espontánea y precoz

Clinical case: We report the case of a 45-year-old male who attended our emergency service with loss of vision in his left eye after an attack of influenza. The vision in his left eye was slightly inferior to that in the right eye. Ophthalmoscopy showed small orange lesions in the macular and foveolar area. Fluorescein angiography was carried out producing features like an acute retinal epitheliitis. Discussion: Acute retinal epitheliitis is a clinical picture seen in younger patients often following a viral illness. Spontaneous resolution usually occurs

The white dot syndromes

Several entities must be considered when a patient presents with a white dot syndrome. In most cases these can be distinguished from one another based on the appearance or distribution of the lesions, the clinical course, or patient variables such as age, sex, laterality, and functional and image examinations. In this paper we review the distinctive and shared features of the white dot syndromes, highlighting the clinical findings, diagnostic test results, proposed etiologies, treatment, and prognosis.

Várias doenças devem ser consideradas quando nos deparamos com paciente com uma entidade clínica incluída no grupo das "síndromes dos pontos brancos retinianos". O diagnóstico diferencial na maioria das vezes é baseado na aparência e/ou na distribuição das lesões, no curso clínico, ou por algumas variáveis relacionadas ao paciente, tais como idade, sexo, lateralidade, bem como por meio de exames funcionais e de imagem. O presente artigo revisa os achados clínicos das doenças que fazem parte do grupo das "síndromes dos pontos brancos retinianos", enfatizando as similaridades e as diferenças entre essas entidades. Os exames complementares, bem como a etiologia, o tratamento e o prognóstico de cada uma delas são descritos e comentados.

Ocular masquerade syndrome due to intraocular lymphoma - two forms of retinal pigment epithelium involvement: case reports

Ocular masquerade syndrome was diagnosted in two patients with chronic uveitis. The patients presented non-Hodgkin's lymphoma as the final diagnosis two forms of intraocular retinal pigment epithelium involvement was seen. One case was flecks of the retinal pigment epithelium and another case was a solid retinal pigment epithelium detachment. These unusual presentations of non-Hodgkin's lymphoma is an alert to all involved in lymphoma care.

Os autores apresentam dois casos de pacientes com linfoma não-Hodgkin, diagnosticados inicialmente como uveite crônica de etiologia não determinada. Os exames posteriores a partir da presença de outros sinais e sintomas demonstraram a presença de linfoma não-Hodgkin nestes pacientes. Um dos pacientes apresentava "flecks" ao nível do epitélio pigmentar da retina e o outro paciente apresentava descolamento sólido do epitélio pigmentar da retina. Estas formas de envolvimento do epitélio pigmentar da retina não são usuais em linfoma não-Hodgkin.

Epiteliopatía pigmentaria placoide posterior multifocal aguda. Estudio de 16 casos / Acute posterios multifocal placoid pigment epitheliopathy. Study of 16 cases

Objetivo: La Epiteliopatía Pigmentaria Placoide Posterior Multifocal Aguda (EPPPMA) es una enfermedad infrecuente que afecta a individuos jóvenes y de probable etiología inflamatoria. El objetivo del estudio es analizar las principales características clínicoepidemiológicas de esta enfermedad en una serie de pacientes. Métodos: Se presenta un estudio retrospectivo de 16 pacientes diagnosticados de EPPPMA. Se han estudiado sus características demográficas (edad, sexo) y clínicas: evolución de la agudeza visual y del cuadro retiniano, enfermedades sistémicas asociadas y respuesta al tratamiento. Se han recogido datos angiográficos, autofluoresecencia y tomografía de coherencia óptica (OCT) en algunos pacientes. Resultados: La edad media en nuestra serie es de 26,75 años sin preferencias por el sexo. La media de agudeza visual final en nuestra serie ha sido de 0,73. Cuatro pacientes presentaron enfermedad sistémica asociada a la EPPPMA. 11 pacientes recibieron tratamiento con corticoesteroides (un paciente corticoesteroides e inmunosupresores) y cinco no recibieron tratamiento. Conclusiones: En nuestra serie la edad media se encuentra por debajo de los 30 años y no hubo diferencias en cuanto al sexo, siendo estos resultados congruentes con lo descrito en la literatura. El pronóstico visual es bueno independientemente del tratamiento, aunque hay casos de mal pronóstico visual, especialmente aquellos con afectación foveal precoz

Objective: Acute Posterior Multifocal Placoid Pigment Epitheliopathy (APMPPE) is a rare disease with a probable inflammatory component which mostly affects young patients. The aim of our study was to analyse the demographic and clinical features of this disease in a group of 16 patients. Methods: Sixteen patients with APMPPE were included in this study. We analyzed their demographic data (age, sex) and the most relevant clinical findings: visual acuity and retinal disease outcome, association with other systemic diseases and response to treatment. We also collected data from fluorescence angiography, autofluorescence and optical coherence tomography (OCT) in some of the patients. Results: Average age at diagnosis was 26.75 years with no sex predilection. Average final visual acuity (Snellen Scale) in our study was 0.73. Four patients presented with a systemic disease related to the APMPPE. Eleven patients were treated with oral steroids (one patient with steroids and cytotoxic agents) while the remaining 5 patients received no treatment. Conclusions: In our patients, the average age at diagnosis was less than 30 years, with no sex predilection, as previously described by many authors. The visual outcome is usually good regardless of the treatment given, although there are cases with a bad visual outcome, especially those with foveal involvement when initially seen

Avaliação da perimetria macular em pacientes com degeneração macular relacionada à idade por meio do oftalmoscópio de rastreamento a laser / Evaluation of macular perimetry in patients with age-related macular degeneration using the scanning laser ophthalmoscope

OBJETIVOS: Verificar a relação entre alterações anatômicas (drusas duras, drusas moles, hiperpigmentação, neovasos, descolamento do epitélio pigmentado da retina, hipopigmentação e atrofia coriorretiniana) e a sensibilidade à luz em pacientes com degeneração macular relacionada à idade (DMRI); analisar a sensibilidade macular em áreas com ausência de lesões anatômicas nos pacientes com DMRI comparando-as ao grupo de controles, para avaliar a existência ou não de lesão funcional em área sem lesão anatômica. MÉTODOS: Estudo comparativo, descritivo e analítico, de corte transversal. O grupo de casos foi formado por 31 indivíduos portadores de DMRI com idade entre 51 e 88 anos. O grupo de controles ficou composto por 31 indivíduos considerados "sadios", não portadores de DMRI com idade entre 61 e 80 anos. Os grupos foram pareados por sexo e idade. Realizou-se a perimetria macular estática, vermelho-vermelho, com o oftalmoscópio de rastreamento a laser (ORL). Os resultados da perimetria macular foram correlacionados à lesão anatômica identificada no local correspondente pelo laser infravermelho e fotografias coloridas. RESULTADOS: As áreas com neovasos ou atrofia apresentaram sensibilidade significantemente diferente em relação às áreas com ausência de lesões anatômicas nos pacientes com DMRI. Houve perda funcional significativa em áreas com ausência de lesões anatômicas nos pacientes com DMRI em relação ao grupo de controles. CONCLUSÕES: Áreas com neovasos ou atrofia podem ser fatores individuais de piora da sensibilidade macular localizada. Pode ocorrer perda funcional mesmo sem lesão anatômica aparente nos pacientes com DMRI.

PURPOSES: To evaluate the correlation between anatomical changes (hard druses, soft druses, hyperpigmentation, new vessels, detachment of retinal pigment epithelium, hypopigmentation and chorioretinal atrophy) and light sensitivity in patients with age-related macular degeneration (ARMD); analyze macular sensitivity in areas with no anatomical lesions in patients with ARMD and compared them to the control group in order to detect if there was any functional lesion in areas with no anatomical changes. METHODS: A cross-sectional, comparative, descriptive and analytic study was performed. The case group consisted of 31 subjects with ARMD aged between 51 and 88 years. The control group consisted of 31 "healthy" subjects, without ARMD aged between 61 and 80 years. The groups were matched for gender and age. We performed static macular perimetry, red-red, using a scanning laser ophthalmoscope (SLO). Results of macular perimetry were correlated with the anatomic lesion identified in the same site by infrared laser and color photographs. RESULTS: Areas with new vessels or atrophy showed a significantly different sensitivity in relation to areas without anatomical lesions in patients with ARMD. There was significant functional loss in areas with no anatomical lesions in patients with ARMD in relation to the control group. CONCLUSIONS: Areas with new vessels or atrophy could be distinct factors for worsening of the localized macular sensitivity. There might be functional loss even in areas with no apparent anatomical changes in ARMD patients.

Neurorretinopatía macular aguda / Acute macular neuroretinopathy

Caso clínico: Mujer de 22 años que refería la aparición brusca de escotomas centrales en ambos ojos tras cuadro catarral de vías respiratorias altas. En el fondo del ojo (FO) presentaba unas manchas redondeadas parafoveales de color marrón rojizo. Los campos visuales presentaban unos escotomas centrales que se correspondían con la localización de las lesiones retinianas. Discusión: La neurorretinopatía macular aguda (NMA) es una uveítis posterior idiopática, poco frecuente, sin tratamiento efectivo y de la que existen diversas teorías sobre su patogenia

Clinical case: A 22-year-old woman complained of symptoms consistent with the sudden onset of central scotomas in both eyes after a flu-like illness. The typical reddish brown macular lesions of acute macular neuroretinopathy were evident in the parafoveal area of both eyes. Visual field examination revealed central scotomas in both eyes that corresponded in location to the retinal injuries. Discussion: Acute macular neuroretinopathy is a rare idiopathic posterior uveitis for which no effective treatment is available. Several pathogenic theories are postulated

Coroidoretinopatia central serosa / Central serous chorioretinopathy

O autor descreve os achados clínicos e novs métodos diagnósticos da coroidoretinopatia central serosa. Discute os estudos experimentais e clínicos relacionados à patogênese da doença e apresenta as alternativas de tratamento e prognóstico da coroidoretinopatia central serosa, baseado em levantamento bibliográfico.

Oncocitoma de carúncula ocular / Oncocytoma of the lacrimal caruncle

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Hipertrofia congénita del epitelio pigmentado de la retina en un paciente con tumor hipofisario / Congenital hypertrophy of the retinal pigment epithelium in a patient with a pituitary tumour

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Hamartoma do epitélio pigmentar e retina / Hamartoma of the pigment epithelium and retina

Hamartomas do epitélio pigmentar e retina säo lesöes raras do pólo posterior. Apresentamos um caso e revisamos os aspectos clínicos , oftalmoscópicos, achados à fluoresceinografia angiográfica e o diagnóstico diferencial deste tumor

Um caso para biópsia da retina? / A case for retinal biopsy?

É apresentado um caso de provável localizaçäo macular, acarretando reduçäo acentuada da visäo e estrabismo convergente

Hamartoma de retina e epitélio pigmentar da retina: a propósito de dois casos / Harmatoma of the retina and retinal pigment epithelium

Harmatomas do epitélio pigmentar e da retina säo lesöes raras do pólo posterior. Säo aqui apresentados dois casos e revisados os aspectos clínicos, oftalmoscópicos, ecográficos, angiográficos e o diagnóstico diferencial deste tumor

Epiteliopatia pigmentar placóide multifocal posterior aguda: relato de dois casos / Acute postorior multifocal pigment epitheliopathy: report of two cases

Os autores apresentam dois casos de epiteliopatia pigmentar placóide multifocal posterior aguda, doença idiopática e inflamatória, geralmente de evoluçäo benigna, caracterizada por múltiplas lesöes arredondadas, amarelo-esbranquiçadas ao nível do epitélio pigmentarretiniano. Sua patogênese é pouco entendida e a controvérsia persiste se ela representa primariamente uma disfunçäo do epitélio pigmentar retiniano ou uma doença vascular coroideana. Os autores discutem os achados oftalmológicos assim como apresentam uma revisäo bibliográfica dessa condiçäo.