The ghost of the great imitator: prognostic factors for poor outcome in syphilitic uveitis.

BACKGROUND: Syphilitic uveitis is reemerging globally, may lead to any type of intraocular inflammation, and is potentially sight-threatening. We aim to characterize clinical features and prognostic factors in patients with syphilitic posterior uveitis. METHODS: Retrospective chart review at two tertiary university-based referral centers in Brazil. Clinical data, laboratory results, and treatment outcomes were analyzed. Statistical analysis was performed using Fisher's exact test for categorical variables and Mann-Whitney U test for continuous variables. RESULTS: Forty-four patients (81 eyes) were consecutively diagnosed with syphilitic posterior uveitis between March 2011 and April 2013.Thirty-one were male (70.5%) and the mean age was 43.8 years (range 15-81). HIV confection was disclosed in 12 patients (29.3%). The most prevalent finding was vitritis (85.2%), followed by retinal involvement (76.4%) and optic disc abnormalities (63.5%). After treatment, mean visual acuity improved from 1.2 (20/320) to 0.6 (20/80; median 20/30), but 19 eyes (23.5%) persisted with ≤ 1.0 (20/200). Factors associated with final visual acuity ≤ 1.0 despite therapy were prior use of systemic corticosteroids (p = 0.001), higher Venereal Disease Research Laboratory titers (p = 0.004), longer duration of symptoms (p = 0.024), and worse initial VA (p < 0.001). CONCLUSIONS: Syphilitic uveitis is reemerging. Delayed diagnosis and inadvertent use of systemic corticosteroids are potentially modifiable prognostic factors to be considered for possibly improving outcomes.

Tonic pupil in leprosy / Pupila tônica em doença de Hansen

Pupil abnormalities in leprosy usually result from chronic iritis with loss of stroma, iris miosis, a sluggish reaction to light, and poor dilation in response to anticholinergic mydriatics. We report two patients with long-standing lepromatous leprosy who developed tonic pupils characterized by mydriasis, absence of reaction to light and hypersensitivity to weak cholinergic solution. Examination revealed iritis and iris atrophy. In both cases, instillation of dilute 0.1% pilocarpine caused miosis in the affected eyes. Tonic pupil occurs in many conditions, but its association with leprosy had not been previously reported.

Anormalidades da pupila em pacientes com doença de Hansen, ocorrem mais comumente devido a irite crônica com perda do estroma iriano, miose, diminuição da reação à luz, e dificuldade de dilatação em resposta a colírios anticolinérgicos. Relatamos dois pacientes com doença de Hansen na forma lepromatosa que desenvolveram pupilas tônicas, caracterizadas por midríase, ausência de reação a luz e para perto e hipersensibilidade a fraca concentração de solução colinérgica. O exame revelou irite e atrofia iriana. Em ambos os casos a instilação de pilocarpina 0,1% causou miose nos olhos afetados. A pupila tônica tem sido relatada em muitas condições, mas sua associação com doença de Hansen ainda não havia sido descrita.

Tonic pupil in leprosy.

Pupil abnormalities in leprosy usually result from chronic iritis with loss of stroma, iris miosis, a sluggish reaction to light, and poor dilation in response to anticholinergic mydriatics. We report two patients with long-standing lepromatous leprosy who developed tonic pupils characterized by mydriasis, absence of reaction to light and hypersensitivity to weak cholinergic solution. Examination revealed iritis and iris atrophy. In both cases, instillation of dilute 0.1% pilocarpine caused miosis in the affected eyes. Tonic pupil occurs in many conditions, but its association with leprosy had not been previously reported.

Morphometric changes in C57BL/6 mice retina infected by Toxoplasma gondii ME 49 strain.

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.

Tuberculose intraocular / Intraocular tuberculosis

A Tuberculose (TB) é uma doença infecciosa causada pelo Mycobacterium tuberculosis (Mtb), que acomete principalmente os pulmões. Ela pode acometer qualquer parte do olho, porém o local mais acometido é a úvea. A incidência de envolvimento de TB ocular e em outros sítios é de 1 por cento a 2 por cento. Alguns autores descrevem várias alterações intraoculares, tendo apresentações clínicas das mais variadas, uveíte anterior, posterior, intermediária e panuveíte. Nesta revisão iremos tratar especificamente de TB intraocular, discutindo sobre as diversas manifestações, diagnóstico e tratamento.

Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis (Mtb), which attacks mainly the lungs. This disease can also attack any part of the eye; however, the more attacked ocular site is the uvea. The incidence of involvement of ocular and other sites TB is of 1 percent to 2 percent. Some authors describe several intraocular alterations, presenting the most varied clinical presentations, such as anterior, posterior, and intermediate uveitis, as well as panuveitis. In this revision, we will approach specifically the intraocular TB, discussing about its different manifestations, diagnosis, and treatment.

Imunologia da retinocoroidite toxoplásmica / Immunology of the toxoplasmic retinochoroiditis

A infecção pelo Toxoplasma gondii é uma importante causa de doença ocular, tanto em indivíduos imunocomprometidos como em imunocompetentes. A patogênese da destruição retinocoroidiana associada a essa infecção ainda não está totalmente esclarecida. Nesta revisão, discute-se o papel do sistema imune no controle da infecção pelo Toxoplasma, especialmente, no olho.

Toxoplasma gondii infection is an important cause of ocular disease in both immunocompromised and immunocompetent subjects. The pathogenesis of retinochoroidal lesion associated with this infection is not fully understood. In this review, the role of the immune system in the control of Toxoplasma infection, especially in the eye, is discussed.

Cat-scratch disease: ocular manifestations and visual outcome.

To describe the intra-ocular manifestations of cat-scratch disease (CSD) found at two uveitis reference centers in Brazil. Retrospective case series study. Review of clinical records of patients diagnosed with CSD in the Uveitis Department of São Geraldo Hospital and the Ophthalmology Department of the Instituto de Pesquisa Clínica Evandro Chagas-FIOCRUZ, from 2001 to 2008. In the 8-year period, 24 patients with the diagnosis of CSD were identified. Twelve patients were male and 12 female. The mean age was 27.04 years (range 7-56). Sixteen patients (66.6%) presented with a history of a cat scratch and all patients reported cat exposure. Visual acuity ranged from counting fingers to 1.0 in the affected eye. Thirteen patients presented with bilateral disease. Sixteen (66.6%) patients complained of systemic symptoms, including fever, lymphadenopathy, liver and spleen enlargement and rash. All patients presented with serum antibodies (IgG) to Bartonella henselae. Thirty-seven eyes were affected. The most common findings were small areas of retinal infiltrates which occurred in 11 eyes (29.7%) and angiomatous lesions which occurred in nine eyes (24.3%). Neuroretinitis occurred in only six eyes (16.2%). The most common findings of CSD in our study were retinal infiltrates and angiomatous lesions. CSD patients may present with significant visual loss. Patients may benefit from systemic treatment with antibiotics.

Artrite idiopática juvenil em um serviço de reumatologia: Belo Horizonte, Minas Gerais / Juvenile idiopathic arthritis in a department of rheumatology:Belo Horizonte, Minas Gerais

O termo artrite idiopática juvenil (AIJ) descreve um grupo clinicamente heterogêneo de artrites com mais de seis semanas de duração, de causa desconhecida e início até os 16 anos de idade. Objetivo: descrever o perfil clínico de um grupo de pacientes com diagnóstico de AIJ. Métodos: os prontuários de 72 indivíduos foram revistos com o objetivo de classificá-los conforme critérios propostos pelo ILAR. Os dados obtidos foram comparados com a literatura. Resultados: eram 37 crianças (51,4%) do sexo masculino e 35 do sexo feminino, com mediana de idade de 164,5 meses; 23 (31,9%) estavam classificados como sistêmicos, 25 (34,7%) como oligoarticulares, três (4,2%) poliarticulares fator reumatoide positivo, 13 (18,1%) poliarticulares fator reumatoide negativo, três (4,2%) com artrite psoriásica, quatro (5,6%) com artrite associada à entesite e um (1,4%) com doença indiferenciada. O fator reumatoide foi positivo em 10 (13,9%) e o FAN em 14 (19,4%). Uveíte crônica foi encontrada em quatro (5,6%) crianças, todas do sexo feminino (p=0,05), com doença iniciada antes dos quatro anos de idade (p=0,03) e com FAN positivo (p < 0,001). Conclusão: sabe-se que há diferenças na prevalência e na distribuição dos subtipos de AIJ dependendo da origem da população. Os dados analisados neste estudo, o primeiro do gênero em nosso país, indicaram importantes diferenças entre os diversos grupos geográficos/étnicos acometidos pela AIJ, sugerindo a influência de fatores genéticos, associados ou não a fatores ambientais, que deverão ser estudados e confirmados posteriormente, na expressão da AIJ.

The term Juvenile Idiopathic Arthritis (JIA) describes an arthritis clinically heterogeneous group of over six week?s duration, unknown causes and beginning up to 16 years old. Objective: to describe the clinic profile of a patients? group with JIA diagnosis. Methods: the records of 72 individuals were reviewed with the aim of classifying them according to the ILAR proposed criteria. The collected data were compared with the literature. Results: there was 37 male children (51,4%) and 35 female, with the mean age of 164,5 months; 23 (31,9%) were classified as systemic, 25 (34,7%) as oligoarticular, three (4,2%) as polyarticular positive rheumatoid factor, 13 (18,1%) polyarticular negative rheumatoid factor, three (4,2%) psoriatic arthritis, four (5,6%) with arthritis associated to enthesitis and one (1,4%) with indifferenced disease. The rheumatoid factor was positive in 10 (13,9%) and the FAN in 14 (19,4%). Chronic uveitis was found in four (5,6%) children, all female (p=0,05), with the disease started before four years old (p=0,03) and with positive FAN (p < 0,001). Conclusion: it is known that there are differences in the prevalence and distribution of the JIA subtypes depending on the population origins. The data analyzed in this study, the first of the kind in our country, indicate relevant differences between the several geographic / ethnical groups affected by the JIA, suggesting the influence of docugenetic factors, whether associated or not to environmental factors, which must be further studied and confirmed.

[Immunology of the toxoplasmic retinochoroiditis]. / Imunologia da retinocoroidite toxoplásmica.

Toxoplasma gondii infection is an important cause of ocular disease in both immunocompromised and immunocompetent subjects. The pathogenesis of retinochoroidal lesion associated with this infection is not fully understood. In this review, the role of the immune system in the control of Toxoplasma infection, especially in the eye, is discussed.

[Posterior scleritis: clinical features, systemic association, treatment and evolution of 23 patients]. / Esclerite posterior: características clínicas, associação sistêmica, tratamento e evolução de 23 pacientes.

PURPOSE: To document the clinical features, systemic association, treatment and evolution of 23 patients with posterior scleritis evaluated in the Uveitis service of the Federal University of Minas Gerais. METHODS: 23 patients were identified with the diagnosis of posterior scleritis. Signals and symptoms, visual acuity, B-mode ultrasonography signals, systemic associations, treatment and evolution were described and analyzed. RESULTS: Sixteen patients were female and seven were male with mean age of 44,7 years. Posterior scleritis occurred in association with anterior scleritis in 10 patients, unilateral involvement in 17 patients and simultaneous bilateral involvement in 6 patients. Posterior scleritis in association with systemic disease occurred in 8 patients (Cogan's syndrome, TBC, Wegener, Herpes simplex and Zoster, Apergilosis, inflamatory bowel disease and Sarcoidosis). The main symptoms were ocular pain and decrease of visual acuity and the main signal was retinal serous detachment. Increase of thickness choroidal tissue was the main signal in B-mode ultrasonography in 18 patients and the principal kind of treatment was the use of systemic corticosteroids. Only 4 patients required systemic immunosuppressive drugs. CONCLUSIONS: Posterior scleritis still represents a diagnostic challenge and is often associated with life threatening systemic disease and vision threatening ocular complications. Knowledge of posterior scleritis may aid in determining timely and accurate diagnosis and treatment of both ocular and any systemic conditions associated, thus decreasing morbidity and mortality. Elevated suspicion rate is always required to detect this condition.

Esclerite posterior: características clínicas, associação sistêmica, tratamento e evolução de 23 pacientes / Posterior scleritis: clinical features, systemic association, treatment and evolution of 23 patients

OBJETIVOS: Documentar características clínicas, associações sistêmicas, tratamento e evolução de 23 pacientes com esclerite posterior, examinados no serviço de uveítes da Universidade Federal de Minas Gerais. MÉTODOS: Revisão de todos os pacientes com esclerite atendidos neste serviço, de 1999 até 2006, para identificar aqueles com esclerite posterior. Identificados 23 pacientes, registrados e analisados os dados com relação aos sinais e sintomas oculares, visão, alterações na ecografia, manifestações sistêmicas, tratamento e evolução. RESULTADOS: Dezesseis pacientes do sexo feminino e 7 do sexo masculino com média de idade de 44,7 anos. Esclerite posterior ocorreu associada à esclerite anterior em 10 pacientes, envolvimento unilateral em 17 pacientes e, bilateral simultâneo, em 6 pacientes. Esclerite posterior associada à doença sistêmica ocorreu em 8 pacientes (síndrome de Cogan, tuberculose, granulomatose de Wegener, herpes simples e zoster, aspergilose, retocolite-ulcerativa e sarcoidose). A principal queixa foi dor ocular seguida de embaçamento visual e o sinal fundoscópico que predominou foi o descolamento seroso de retina. O achado mais comum na ecografia foi espessamento da parede escleral observado em 18 pacientes e a principal forma de tratamento, o uso de corticóide sistêmico. Somente 4 pacientes necessitaram de imunossupressor. CONCLUSÃO: Esclerite posterior é doença de difícil diagnóstico e pode ser potencialmente devastadora. Análises estatísticas são incapazes de revelar outras características específicas da esclerite posterior, características clínicas dos pacientes e evolução da doença que poderiam ajudar na identificação dos casos com maior risco de perda visual ou com maior probabilidade de doença sistêmica.

PURPOSE: To document the clinical features, systemic association, treatment and evolution of 23 patients with posterior scleritis evaluated in the Uveitis service of the Federal University of Minas Gerais. METHODS: 23 patients were identified with the diagnosis of posterior scleritis. Signals and symptoms, visual acuity, B-mode ultrasonography signals, systemic associations, treatment and evolution were described and analyzed. RESULTS: Sixteen patients were female and seven were male with mean age of 44,7 years. Posterior scleritis occurred in association with anterior scleritis in 10 patients, unilateral involvement in 17 patients and simultaneous bilateral involvement in 6 patients. Posterior scleritis in association with systemic disease occurred in 8 patients (Cogan's syndrome, TBC, Wegener, Herpes simplex and Zoster, Apergilosis, inflamatory bowel disease and Sarcoidosis). The main symptoms were ocular pain and decrease of visual acuity and the main signal was retinal serous detachment. Increase of thickness choroidal tissue was the main signal in B-mode ultrasonography in 18 patients and the principal kind of treatment was the use of systemic corticosteroids. Only 4 patients required systemic immunosuppressive drugs. CONCLUSIONS: Posterior scleritis still represents a diagnostic challenge and is often associated with life threatening systemic disease and vision threatening ocular complications. Knowledge of posterior scleritis may aid in determining timely and accurate diagnosis and treatment of both ocular and any systemic conditions associated, thus decreasing morbidity and mortality. Elevated suspicion rate is always required to detect this condition.

[Scleritis: clinical characteristics, systemic associations, treatment and outcome in 100 patients]. / Esclerite: características clínicas, associação sistêmica, tratamento e evolução de 100 pacientes.

PURPOSE: To document the clinical features, systemic association, treatment and evolution of 100 patients with scleritis evaluated at the Uveitis Service of the Federal University of Minas Gerais. PATIENTS AND METHODS: 100 patients were identified with the diagnosis of scleritis. Signals and symptoms, visual acuity, B-mode ultrasonography signals, systemic associations, treatment and evolution were described and analyzed. RESULTS: 69 patients were female and 31 were male. Diffuse and nodular anterior scleritis occurred in 71 patients, necrotizing anterior scleritis in 3, posterior scleritis in 24 and escleromalacia perforans in 2 patients. Unilateral involvement occurred in 79 patients and bilateral involvement in 21 patients. The main symptoms were ocular pain and redness and the main signal in posterior scleritis was the serous detachment of the retina. Scleritis in association with systemic disease occurred in 35 patients and the principal kind of treatment was the use of oral NSAIDs. Only 18 patients required systemic immunosuppressive drugs. Ocular complications were detected in 35 patients. CONCLUSIONS: Scleritis may represent a diagnostic challenge and is often associated with life threatening systemic disease and vision threatening ocular complications. Knowledge of scleritis may aid in determining timely and accurate diagnosis and treatment of both the ocular and any associated systemic conditions, thus decreasing morbidity and mortality.

Esclerite: características clínicas, associação sistêmica, tratamento e evolução de 100 pacientes / Scleritis: clinical characteristics, systemic associations, treatment and outcome in 100 patients

OBJETIVOS: Documentar características clínicas, associações sistêmicas, tratamento e evolução de 100 pacientes com esclerite, examinados no serviço de uveítes da Universidade Federal de Minas Gerais. PACIENTES E MÉTODOS: Identificados 100 pacientes com esclerite, registrados e analisados dados com relação às queixas dos mesmos, sinais oculares, visão, alterações ecográficas, manifestações sistêmicas, tratamento e evolução. RESULTADOS: Sessenta e nove pacientes eram mulheres e 31 homens. Esclerite anterior difusa e nodular ocorreu em 71 pacientes, esclerite anterior necrosante em 3, esclerite posterior em 24 e escleromalácia perfurans em 2 pacientes. Envolvimento unilateral em 79 e bilateral em 21 pacientes. A principal queixa foi dor ocular e o sinal fundoscópico predominante na esclerite posterior foi o descolamento seroso de retina. Em 13 pacientes a esclerite determinou o encontro de doença sistêmica e a principal forma de tratamento foi com droga anti-inflamatória não-esteróide oral. Dezoito pacientes precisaram de tratamento imunossupressor para o controle do quadro ocular e a incidência de complicação ocular foi de 35%. DISCUSSÃO: Esclerite é doença rara, às vezes de difícil diagnóstico e potencialmente devastadora, todos os esforços devem ser necessários para um diagnóstico rápido e correto dessa doença. O conhecimento sobre a esclerite, suas formas de apresentação, associações sistêmicas, tratamento e evolução são fundamentais para que possamos fazer este diagnóstico correto e conduzir o quadro ocular da maneira mais adequada possível tendo sempre como objetivo final o controle do quadro escleral e preservação da visão do paciente.

PURPOSE: To document the clinical features, systemic association, treatment and evolution of 100 patients with scleritis evaluated at the Uveitis Service of the Federal University of Minas Gerais. PATIENTS AND METHODS: 100 patients were identified with the diagnosis of scleritis. Signals and symptoms, visual acuity, B-mode ultrasonography signals, systemic associations, treatment and evolution were described and analyzed. RESULTS: 69 patients were female and 31 were male. Diffuse and nodular anterior scleritis occurred in 71 patients, necrotizing anterior scleritis in 3, posterior scleritis in 24 and escleromalacia perforans in 2 patients. Unilateral involvement occurred in 79 patients and bilateral involvement in 21 patients. The main symptoms were ocular pain and redness and the main signal in posterior scleritis was the serous detachment of the retina. Scleritis in association with systemic disease occurred in 35 patients and the principal kind of treatment was the use of oral NSAIDs. Only 18 patients required systemic immunosuppressive drugs. Ocular complications were detected in 35 patients. CONCLUSIONS: Scleritis may represent a diagnostic challenge and is often associated with life threatening systemic disease and vision threatening ocular complications. Knowledge of scleritis may aid in determining timely and accurate diagnosis and treatment of both the ocular and any associated systemic conditions, thus decreasing morbidity and mortality.

[Imunogenetics in the uveítes]. / Imunogenética das uveítes.

Cytokines are molecules involved in intercellular communication in immune and inflammatory responses, playing an important role in uveitis. Genetic polymorphisms responsible for the production of certain cytokines have been associated with the occurrence and the severity of uveitis. Therefore, the present study has the purpose of describing these possible associations, pointing out the individual genetic background in the prognosis of uveitis.

Imunogenética das uveítes / Imunogenetics in the uveítes

Citocinas são moléculas envolvidas na comunicação intercelular nas respostas inflamatória e imune, desempenhando papel relevante nas uveítes. Polimorfismos dos genes responsáveis pela produção de determinadas citocinas têm sido relacionados com a ocorrência e a gravidade de algumas uveítes. Portanto, o presente trabalho tem como objetivo relatar essas possíveis associações, salientando o aspecto individual genético no prognóstico das uveítes.

Cytokines are molecules involved in intercellular communication in immune and inflammatory responses, playing an important role in uveitis. Genetic polymorphisms responsible for the production of certain cytokines have been associated with the occurrence and the severity of uveitis. Therefore, the present study has the purpose of describing these possible associations, pointing out the individual genetic background in the prognosis of uveitis.

Tuberculous uveitis at a referral center in southeastern Brazil.

OBJECTIVE: To describe the occurrence of tuberculous uveitis (TBU) at a referral center in the state of Minas Gerais, Brazil. METHODS: A total of 16 consecutive patients (>15 years of age) who underwent diagnostic evaluation of uveitis between January of 2001 and July of 2004 at the Minas Gerais State Referral Center were selected for study. Demographic and clinical data, as well as data related to screening for toxoplasmosis, syphilis, and rheumatologic diseases, together with the results of tuberculin skin testing and HIV testing, were collected. RESULTS: Of the16 patients evaluated, 11 (69%) were found to have TBU. A history of contact with pulmonary tuberculosis was reported by 8 (72%) of the 11 patients with TBU and by 1 (20%) of the 5 with non-TBU. Although the odds ratio for this association was 10.67 (95% CI: 0.59-398.66), the p value was borderline significant (p = 0.078). There was no difference between the patients with TBU and those with non-TBU in terms of the status of ocular inflammation or the tuberculin skin testing results. All of the patients were HIV negative and were monitored for two years. CONCLUSION: In this study, a history of contact with pulmonary tuberculosis proved to be useful in diagnosing TBU.

Tuberculous uveitis at a referral center in southeastern Brazil / Uveíte por tuberculose em um centro de referência no Sudeste do Brasil

OBJETIVO: Descrever a ocorrência de uveíte por tuberculose (UTB) em um centro de referência em Minas Gerais, Brasil. MÉTODOS: Um total de 16 pacientes (idade > 15 anos) atendidos consecutivamente de janeiro de 2001 a julho de 2004 no Centro de Referência de Uveíte do Estado de Minas Gerais para avaliação diagnóstica de uveíte foi selecionado para este estudo. Foram coletados dados demográficos e clínicos, assim como dados sobre avaliação para toxoplasmose, sífilis e doenças reumatológicas, teste tuberculínico e sorologia anti-HIV. RESULTADOS: Dos 16 pacientes, 11 (69 por cento) tinham UTB. História prévia de contato com tuberculose pulmonar foi relatada por 72 por cento (8/11) dos pacientes do grupo com UTB e por 20 por cento (1/5) dos pacientes do grupo sem UTB. Embora a razão de chances para essa associação tenha sido de 10,67 (IC95 por cento: 0,59-398,66), o valor de p apresentou significância limítrofe (0,078). Não houve diferença quanto ao quadro ocular inflamatório e ao resultado do teste tuberculínico entre os pacientes com UTB e os sem UTB. Todos os pacientes tinham sorologia negativa para o HIV e foram acompanhados por 2 anos. CONCLUSÕES: Neste estudo, a história prévia de contato com tuberculose pulmonar foi de grande ajuda para o diagnóstico da UTB.

OBJECTIVE: To describe the occurrence of tuberculous uveitis (TBU) at a referral center in the state of Minas Gerais, Brazil. METHODS: A total of 16 consecutive patients (>15 years of age) who underwent diagnostic evaluation of uveitis between January of 2001 and July of 2004 at the Minas Gerais State Referral Center were selected for study. Demographic and clinical data, as well as data related to screening for toxoplasmosis, syphilis, and rheumatologic diseases, together with the results of tuberculin skin testing and HIV testing, were collected. RESULTS: Of the16 patients evaluated, 11 (69 percent) were found to have TBU. A history of contact with pulmonary tuberculosis was reported by 8 (72 percent) of the 11 patients with TBU and by 1 (20 percent) of the 5 with non-TBU. Although the odds ratio for this association was 10.67 (95 percent CI: 0.59-398.66), the p value was borderline significant (p = 0.078). There was no difference between the patients with TBU and those with non-TBU in terms of the status of ocular inflammation or the tuberculin skin testing results. All of the patients were HIV negative and were monitored for two years. CONCLUSION: In this study, a history of contact with pulmonary tuberculosis proved to be useful in diagnosing TBU.

[The role of chemokines in uveitis]. / O papel das quimiocinas nas uveítes.

Inflammation is part of the physiological process that aims at repairing the damage produced by different causes such as infection, trauma, and autoimmune disease. However, when this physiological process is not regulated, it can contribute to the increase in tissue damage. Chemokines and their receptors are major factors involved in the process of cell migration into inflamed tissues. In the ocular diseases, mainly in uveitis, such proteins have been identified as important mediators of the inflammation process. This review discusses the role of chemokines in several ocular diseases, with emphasis on the uveitic process.

O papel das quimiocinas nas uveítes / The role of chemokines in uveitis

A inflamação é parte do processo fisiológico que visa reparar o dano tecidual causado por infecção, trauma, auto-imunidade. Quando este processo fisiológico encontra-se alterado, pode contribuir para o aumento do dano tecidual. As quimiocinas e seus receptores são importantes elementos envolvidos no processo de migração celular para os tecidos inflamados. Nas doenças oculares, principalmente nas uveítes, estas proteínas estão sendo identificadas como importantes mediadores da resposta inflamatória. Esta revisão visa discutir o papel das quimiocinas em diversas doenças oculares, dando ênfase aos processos uveíticos.

Inflammation is part of the physiological process that aims at repairing the damage produced by different causes such as infection, trauma, and autoimmune disease. However, when this physiological process is not regulated, it can contribute to the increase in tissue damage. Chemokines and their receptors are major factors involved in the process of cell migration into inflamed tissues. In the ocular diseases, mainly in uveitis, such proteins have been identified as important mediators of the inflammation process. This review discusses the role of chemokines in several ocular diseases, with emphasis on the uveitic process.

Ocular manifestations in Dengue fever.

PURPOSE: To report a case of Dengue fever resulting in permanent visual loss in both eyes due to retinal capillary occlusion. METHODS: Case report. RESULTS: Severe permanent visual loss occurred in a patient with Dengue fever. Dilated fundus exam showed vascular sheathing with associated retinal hemorrhages at the equator and cotton wool spots in the maculae of both eyes. Fluorescein angiography revealed areas of capillary nonperfusion at the equator and in the macula. The diagnosis of Dengue fever was confirmed by serology detecting IgM antibodies to the Dengue virus. CONCLUSION: Ocular abnormalities may be seen in patients with Dengue fever, therefore ophthalmoscopy should be performed in patients presenting with severe forms of the disease.