Pars plana vitrectomy and visual stimulation for treatment of vitreomacular traction secondary to toxoplasmosis retinochoroiditis in a 5-year-old child / Vitrectomia via pars plana e estimulação visual para tratamento da tração vitreomacular secundária à retinocoroidite por toxoplasmose em criança de 5 anos

ABSTRACT Objective: A unusual case of ocular toxoplasmosis with significant vitreomacular traction is reported. The patient improved significantly following pars plana vitrectomy combined with visual stimulation and occlusion therapy. Methods: The case of a 5-year-old girl with significant unilateral vision loss associated with vitreous condensation and macular traction is described. Results: Pars plana vitrectomy was carried out for vitreomacular traction release. This was followed by visual stimulation and occlusion therapy. Significant improvement was observed. Conclusion: Despite structural damage, the combination of properly indicated surgery and amblyopia management strategies allowed the achievement of maximum vision goals in this case, suggesting structural damage may be associated with functional amblyopia.

RESUMO Objetivo: Relata-se um caso de apresentação atípica de toxoplasmose ocular, com importante tração vitreomacular. A paciente apresentou melhora significativa após vitrectomia via pars plana, com estimulação visual e oclusão. Métodos: Descreve-se o caso de uma menina de 5 anos, com importante perda de visão unilateral associada à condensação vítrea e à tração macular. Resultados: Foi realizada vitrectomia via pars plana para alívio da tração vitreomacular, seguida de estimulação visual e oclusão. Foi observada melhora significativa. Conclusão: Apesar dos danos estruturais, a combinação de cirurgia bem indicada com estratégias de tratamento da ambliopia permitiu alcançar o máximo do potencial visual nesta paciente, sugerindo que os danos estruturais podem estar associados à ambliopia funcional.

Susceptibility to toxoplasmic retinochoroiditis is associated with HLA alleles reported to be implicated with rapid progression to AIDS.

BACKGROUND/AIMS: The frequency of HLA markers associated with rapid progression to AIDS was evaluated in Brazilian patients with AIDS exhibiting or not toxoplasmic retinochoroiditis (TRC). METHODS: 98 AIDS patients (25 with TRC, 43 with anti-T. gondii antibodies but without TCR, and 30 without anti-T. gondii antibodies and without TCR) were studied. RESULTS: The HLA-B35 was significantly increased in TRC group (p=0.0038). CONCLUSION: The presence of HLA-B35 may simultaneously predispose to progression to AIDS and TRC.

Roturas retinianas em retinocoroidite por toxoplasmose: série de casos / Retinal tears in toxoplasmic retinochoroiditis: case series

Trata-se de série retrospectiva de 10 pacientes com rotura retiniana e retinocoroidite por toxoplasmose atendidos no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, de janeiro de 2007 a abril de 2008, com objetivo de avaliar a relação entre lesões de retinocoroidite e a ocorrência de rotura retiniana. Foram utilizados teste de Fisher e qui-quadrado com nível de significância p<0,05. Oito casos (80 por cento) apresentaram descolamento de retina. Doze roturas foram identificadas, localizando-se principalmente na periferia temporal superior (6 casos, 50 por cento). Não foi observada relação estatisticamente significativa entre localização da rotura e da cicatriz coriorretiniana considerando a distribuição em cinco quadrantes (p=0,0828) ou em três zonas (p=0,2507). A ocorrência de roturas retinianas em pacientes com uveíte posterior pode estar relacionada ao descolamento precoce do vítreo posterior causado pelo processo inflamatório intraocular. Não foi observado neste estudo correlação entre a localização das roturas retinianas e as cicatrizes de coriorretinite, o que sugere um mecanismo não relacionado diretamente à cicatriz.

This study is a retrospective case series aiming to evaluate the relation between toxoplasmic retinochoroiditis scars and the occurrence of retinal tears. Ten patients with retinal tear and toxoplasmic retinochoroiditis examined at the School of Medicine of Ribeirão Preto Clinics Hospital, between January 2007 and April 2008, were included. Fisher test and qui-square test with significance level of p<0.05 were used. Eight cases (80 percent) had retinal detachment. Twelve tears were found and localized mostly in the temporal superior periphery (6 cases, 50 percent). No statistically significant association between retinal tear and chorioretinal scar localization was observed considering five retinal quadrants (p=0.0828) or three zones (p=0.2507). The occurrence of retinal tears in patients with uveitis may be related to early posterior vitreous detachment caused by the intraocular inflammatory process. No correlation was observed between the localization of retinal tears and chorioretinal scars in this study, which suggests a causative factor not directly related to the presence of a scar.

[Retinal tears in toxoplasmic retinochoroiditis: case series]. / Roturas retinianas em retinocoroidite por toxoplasmose: série de casos.

This study is a retrospective case series aiming to evaluate the relation between toxoplasmic retinochoroiditis scars and the occurrence of retinal tears. Ten patients with retinal tear and toxoplasmic retinochoroiditis examined at the School of Medicine of Ribeirão Preto Clinics Hospital, between January 2007 and April 2008, were included. Fisher test and qui-square test with significance level of p<0.05 were used. Eight cases (80%) had retinal detachment. Twelve tears were found and localized mostly in the temporal superior periphery (6 cases, 50%). No statistically significant association between retinal tear and chorioretinal scar localization was observed considering five retinal quadrants (p=0.0828) or three zones (p=0.2507). The occurrence of retinal tears in patients with uveitis may be related to early posterior vitreous detachment caused by the intraocular inflammatory process. No correlation was observed between the localization of retinal tears and chorioretinal scars in this study, which suggests a causative factor not directly related to the presence of a scar.

Interleukin-1 gene polymorphisms and toxoplasmic retinochoroiditis.

PURPOSE: It has been proposed that cytokine gene polymorphisms can predispose individuals to disease by enhancing inflammatory processes. Considering the relevance of interleukin-1 (IL-1) in the pathogenesis of toxoplasmic retinochoroiditis (TR), we investigated whether IL1A -889 C/T and IL1B +3954C/T promoter polymorphisms are associated with TR in humans. METHODS: We performed a cross-sectional study that involved 100 Brazilian TR patients and 100 age- and gender-matched control subjects. Genomic DNA was obtained from oral swabs of all participants and amplified using polymerase chain reaction (PCR) with specific primers flanking the locus -889 of IL1A and +3954 of IL1B. PCR products were submitted to digestion and analyzed by PAGE to distinguish C and T alleles. RESULTS: There was no significant difference in the genotype or allele distributions of the IL1A -889 C/T and IL1B +3954C/T polymorphisms in patients with TR when compared with controls. However, in a subgroup analysis, the frequency of genotype and allele distributions of IL1A -889 C/T differed significantly between TR patients with and without recurrent episodes. CONCLUSION: This study suggests that the genotypes related with a high production of IL-1a may be associated with the recurrence of TR.

Progressive subretinal fibrosis and multifocal granulomatous chorioretinitis.

We describe a case of progressive subretinal fibrosis and multifocal chorioretinitis along with its findings on both fluorescein and indocyanine green angiography. The progressive subretinal fibrosis syndrome is a severe subset of multifocal choroiditis. The clustering of lesions around the nerve optic head may mean that the disease is spread through the flow in and out of the eye around the optic nerve.

Progressive subretinal fibrosis and multifocal granulomatous chorioretinitis

Descrevemos um caso de fibrose sub-retiniana progressiva e corrioretinite multifocal granulomatosa junto com os achados de angiografia fluoresceínica e com indocianina verde e propomos uma nova fisiopatologia para a fibrose em anel justa-papilar. A síndrome de fibrose sub-retiniana progressiva é uma doença grave, rara e constitui um subtipo grave da coroidite multifocal. As múltiplas lesões com fibrose circundando o disco óptico podem significar que a doença é oriunda do fluxo do líquido céfalo-raqueano, ao redor do nervo óptico.

[Exudative bilateral retinal detachment and behavior changes in a patient with neurosyphilis: case report]. / Descolamento de retina exsudativo bilateral associado a alterações de comportamento em paciente com diagnóstico de neurossífilis: relato de caso.

PURPOSE: To report a case of bilateral retinal detachment associated with behavior changes. RESULTS: A 62-year-old, female patient presented agitated, complaining of progressive bilateral low vision for the 3 past months, along with anxiety and behavior changes. On examination, she had visual acuity of light perception in the right eye and conting fingers at 30 cm in the left eye; anterior chamber reaction; bilateral hyperemic and edematous optic disc and bilateral serous retinal detachment, yellow-white subretinal peripapillary plaques and subretinal and intraretinal exudation. On laboratory work-up, the patient had positive VDRL and FTA-Abs tests. Lumbar puncture was done; she had positive FTA-Abs and hemagglutination treponemal test on spinal fluid analysis. Neurosyphilis diagnosis was established, and the patient was admitted to the hospital for an intravenous penicillin course associated with oral prednisone (0.5 mg/kg). After 2 weeks, the patient showed marked improvement of her retinal findings, with reatachment of the retina and also an improvement of visual acuity. CONCLUSION: Syphilis is a pleomorphical disease, and may present as diffuse uveitis associated with bilateral exudative retinal detachment. Central nervous system involvement must always be evaluated and discarded; proper treatment may lead to visual function improvement and diminished sequelae.

Descolamento de retina exsudativo bilateral associado a alteracões de comportamento em paciente com diagnóstico de neurossífilis: relato de caso / Exudative bilateral retinal detachment and behavior changes in a patient with neurosyphilis: case report

OBJETIVO: Descrever caso de descolamento de retina bilateral associado a alteracões de comportamento. RESULTADO: Paciente de 62 anos, sexo feminino, apresentou-se com baixa de visão bilateral, progressiva, de 3 meses de duracão, associada a alteracões de comportamento e agitacão psicomotora. Ao exame oftalmológico apresentava acuidade visual de percepcão luminosa em olho direito; e conta dedos a 30 cm em olho esquerdo. A biomicroscopia evidenciou reacão de câmara anterior; à fundoscopia, apresentava edema e hiperemia do disco óptico bilateralmente, áreas extensas de descolamento de retina seroso, placas sub-retinianas amareladas peripapilares e exsudacão sub-retiniana e intra-retiniana em ambos os olhos. O exame sorológico para sífilis foi positivo (FTA-Abs e VDRL). A análise liquórica revelou FTA-Abs e teste de hemaglutinacão indireta positivos. Foi feito, então, diagnóstico de neurossífilis, e a paciente foi internada para antibioticoterapia endovenosa, e prednisona oral 40 mg/dia (0,5 mg/kg). Após 2 semanas, a paciente passou a apresentar melhora importante do quadro ocular com reabsorcão da exsudacão e melhora da acuidade visual. CONCLUSAO: A sífilis é doenca pleomórfica, podendo ter como manifestacão ocular uma uveíte difusa associada a descolamento de retina exsudativo bilateral. O envolvimento do sistema nervoso central deve sempre ser considerado e descartado, e o tratamento eficaz da doenca pode promover melhora da funcão visual e diminuir suas seqüelas.

Photodynamic therapy-treated choroidal neovascular membrane secondary to toxoplasmic retinochoroiditis.

PURPOSE: To report the result of photodynamic therapy with Visudyne (PDT) on a child with choroidal neovascular membrane (CNV) secondary to toxoplasmic retinochoroiditis. METHODS: An 11-year-old child with a unilateral lowering of visual acuity secondary to an extrafoveal choroidal neovascular membrane was submitted to PDT. RESULTS: One week after PDT, the patient's vision had improved from 10/160 to 20/70, with marked improvement in the angiographic findings. The CNV evolved with decreasing of leakage until 45 days after operation, when it regressed to a chorioretinal scar formation, with final vision of 20/25. CONCLUSION: PDT promoted an early recovery of visual acuity in an eye with choroidal neovascularization secondary to toxoplasmic retinochoroiditis.

[Toxoplasmic retinochoroiditis reactivated in the puberty]. / Retinocoroiditis toxoplasmósicas reactivadas en la pubertad.

By a clinical-infectious and ophthalmologic examination that includes serologic studies, we found that 17 cases of retinochoroiditis reactivated in the puberty.

Retinocoroiditis toxoplasmósicas reactivadas en la pubertad / Toxoplasmic retinochoroiditis reactivated in the puberty

Mediante el examen clínico infectológico, oftalmológico y serológico se comprobaron 17 casos de retinocoroiditis reactivadas en pacientes en desarrollo puberal. (Au)

Síndrome de Aicardi / Aicardi's syndrome

Se describen dos niñas con crisis epilépticas en los primeros meses de vida, que evolucionaron a espasmos infantiles; agenesia de cuerpo calloso; coriorretinopatía caracterizada por atrofia lacunar; severo retardo del desarrollo psicomotor y malformaciones vertebrales, asociación que corresponde al síndrome de Aicardi, de herencia dominante ligado al cromosoma X y probablemente producido por una mutación reciente. Puesto que los criterios mayores que definen el síndrome pueden verse también, cuando aparecen por separado, en otras afecciones genéticas o metabólicas, es necesario efectuar un cuidadoso diagnóstico diferencial

Candidemia com endoftalmite / Candidemia with choroidoretinitis

Um paciente com 43 anos, de cor negra, é internado com quadro de íleo e submetido a laparotomia exploradora. A oclusäo intestinal era conseqüente a bridas. Durante o ato cirúrgico, houve lesäo de intestino delgado, fazendo-se necessária a ileostomia. No pós-operatório apresentou abscesso de parede e fístula enterocutânea, precedidos de quadro febril. Iniciado gentamicina, cloranfenicol e hiperalimentaçäo parenteral. O cuadro febril, que fora debelado, reinstalou-se com calafrios e sem resposta ao novo esquema antimicrobiano. Quatro hemoculturas deram crescimento a Candida albicans e a imunodifusäo foi fortemente positiva. Iniciou-se ketoconazol, tendo sido sustada, em seguida, a hiperalimentaçäo parenteral. No olho esquerdo, apresentou turvaçäo vítrea e na coriorretina, lesöes metastáticas de candidemia. A seguir, foram constatadas sinéquias posteriores. Queixava-se, nesta fase, de turvaçäo visual intensa. Hemoculturas negativas. Continuava febril. Surgiram novas lesöes de coriorretinite, a despeito de utilizaçäo de anfotericina B. A melhor clínica, no entanto, foi acentuada neste curto espaço de tempo. Tomou apenas 125mg de anfotericina B que, por falta absoluta de veias, foi interrompida. Continuou a terapêutica com 5-fluorocitosina, tendo obtido plena recuperaçäo clínica e oftálmica. Säo revistos os aspectos gerais da candidemia com endoftalmite. Considerando a seriedade com que deve ser hoje encarado o envolvimento das estruturas oculares nesta patologia, lançamos um alerta para seu alto índice de mortalidade assim como para a possibilidade de cegueira definitiva