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.

Oct angiography compared to fluorescein angiography, indocyanine green angiography and optical coherence tomography in the detection of choroidal neovascularization in pigment epithelial detachment.

PURPOSE: To evaluate the agreement between multimodal imaging-MI (fluorescein angiography, indocyanine green angiography, optical coherence tomography) and optical coherence tomography angiography (OCTA) in the detection of choroidal neovascularization (CNV) in patients with pigment epithelial detachment with subretinal/intraretinal fluid (PED+F) compared to patients with PED without subretinal/intraretinal fluid (PED-F). METHODS: Twenty-two eyes of 15 patients were divided into two groups (PED+F and PED-F). All patients underwent MI and OCTA with manual and automatic segmentation. MI findings were compared to OCTA findings and then analysed. RESULTS: In the PED+F group (10 eyes), all studied eyes demonstrated CNV in MI. In manual segmentation OCTA assessment, 9 of 10 eyes (90%) were detected with CNV. When evaluated by automatic segmentation, 8 of 10 eyes (80%) revealed the presence of CNV. In the PED-F (12 eyes) group, all eyes did not demonstrate CNV in MI and OCTA evaluations, either by manual or automatic segmentation. The agreement between MI and OCTA shows concordance (k: 0.908; 95% CI, 0.491-1.000); the evaluation of the agreement between the automatic and manual segmentation also shows concordance (k: 0.904; 95% CI, 0.488-1.000). CONCLUSION: The solid agreement between the multimodal imaging regarding the ability of OCTA to identify possible initial CNV in a patient with PED-F was observed. Accuracy was 95.45%. In addition, the agreement between manual and automatic segmentation to identify CNV on OCTA was also shown.

Benign familial fleck retina: multimodal imaging including optical coherence tomography angiography.

This report presents multimodal imaging of a 27-year-old woman diagnosed with benign familial fleck retina (OMIM 228980), an uncommon disorder. Fundus photographs revealed retinal flecks that affected her post-equatorial retina but spared the macular area. Fundus autofluorescence and infrared imaging demonstrated a symmetrical pattern of yellow-white fleck lesions that affected both eyes. Her full-field electroretinogram and electrooculogram were normal. An optical coherence tomography B-scan was performed for both eyes, revealing increased thickness of the retinal pigmented epithelium leading to multiple small pigmented epithelium detachments. The outer retina remained intact in both eyes. Spectral-domain optical coherence tomography angiography with split-spectrum amplitude decorrelation algorithm and 3 × 3 mm structural en face optical coherence tomography did not show macular lesions. Benign familial fleck retina belongs to a heterogenous group of so-called flecked retina syndromes, and should be considered in patients with yellowish-white retinal lesions without involvement of the macula.

Benign familial fleck retina: multimodal imaging including optical coherence tomography angiography / Benign familial fleck retina: estudo multimodal incluindo OCT angiography

ABSTRACT This report presents multimodal imaging of a 27-year-old woman diagnosed with benign familial fleck retina (OMIM 228980), an uncommon disorder. Fundus photographs revealed retinal flecks that affected her post-equatorial retina but spared the macular area. Fundus autofluorescence and infrared imaging demonstrated a symmetrical pattern of yellow-white fleck lesions that affected both eyes. Her full-field electroretinogram and electrooculogram were normal. An optical coherence tomography B-scan was performed for both eyes, revealing increased thickness of the retinal pigmented epithelium leading to multiple small pigmented epithelium detachments. The outer retina remained intact in both eyes. Spectral-domain optical coherence tomography angiography with split-spectrum amplitude decorrelation algorithm and 3 × 3 mm structural en face optical coherence tomography did not show macular lesions. Benign familial fleck retina belongs to a heterogenous group of so-called flecked retina syndromes, and should be considered in patients with yellowish-white retinal lesions without involvement of the macula.

RESUMO O objetivo do presente relato é demonstrar um estudo multimodal de um paciente com diagnóstico de Benign Familial Fleck Retina (BFFR) (OMIM 228980), uma alteração retinana muito rara. Retinografia colorida demonstrou "flecks" na retina posterior ao equador, poupando mácula. Tanto autofluorescência quando imagem "infrared," nota-se padrão simétrico de lesões amareladas em ambos os olhos. Eletrorretinograma padrão de campo total e EOG não evidenciaram alterações. SD OCT B-scan demostrou pequenos e múltiplos descolamentos do epitélio pigmentado (EPR), com retina externa intacta em ambos os olhos. Angiografia por OCT com "split-spectrum amplitude decorrelation algorithm" e "structural" "en face" OCT 3 x 3 mm não apontaram anormalidades na mácula. BFFR pertence ao heterogêneo grupo chamado "flecked retina syndromes," devendo ser considerada em pacientes com flecks retinianos poupando mácula.

En face and OCT angiography findings in macular retinoschisis

Abstract The diagnosis of macular retinoschisis is often complex and demands complementary exams to be confirmed. This is the report of a case of a 27 years old man diagnosed with macular retinoschisis, in which En face OCT and OCT angiography were used to identify and demonstrate the typical patterns of the disease, as well as distinguish them from the findings of cystoid macular edema.

Diabetic Macular Ischemia Diagnosis: Comparison between Optical Coherence Tomography Angiography and Fluorescein Angiography.

Purpose. To compare fluorescein angiography (FA) and optical coherence tomography angiography (OCTA) images of foveal avascular zone (FAZ) in patients with diabetic retinopathy (DR) with and without diabetic macular ischemia (DMI). Methods. The Wilcoxon signed-rank test was used to compare area measurements and p values of <0.05 were considered statistically significant. FA and OCTA images were independently graded by 2 observers that reached agreement regarding quantitative DMI according established protocols. The ischemic area was divided into "large" macular ischemia (superior to 0.32 mm2) and "small" (inferior to 0.32 mm2) groups. Quantitative analyses of the FAZ were performed using custom software. Results. Thirty-four eyes from 34 diabetic patients were enrolled. Subjects with DMI presented a mean area on FA and OCTA of 0.68 ± 0.53 mm2 and 0.58 ± 0.35 mm2, respectively (p = 0.1374). Patients without DMI presented a mean area on FA and OCTA of 0.19 ± 0.67 mm2 and 0.20 ± 0.79 mm2, respectively (p = 0.9594). The ICC for the FAZ measurements between the 2 observers on FA and OCTA was 0.96 and 0.92, respectively. Conclusion. OCTA represents a novel technique for the diagnosis of DMI and it may become an alternative to FA for this purpose.

Initial experience with ocriplasmin in the treatment of vitreomacular traction.

This study aimed to report the clinical and structural outcomes of intravitreal ocriplasmin in the treatment of vitreomacular interface disorders in two tertiary centers in Brazil. A retrospective study was performed by reviewing medical records and spectral domain optical coherence tomography (SD-OCT) findings of seven patients who were treated with a single ocriplasmin injection. A total of 57.14% of patients achieved resolution of vitreomacular traction as evidenced by SD-OCT. Regarding our functional results, 87.71% maintained or improved visual acuity after follow-up. To the best of our knowledge, this is the first study reporting initial results of ocriplasmin therapy in Brazil.

Dexamethasone 0.7 mg implants in the management of pseudophakic cystoid macular edema.

Pseudophakic cystoid macular edema (PCME) is a common complication following cataract surgery. Although majority of patients with PCME remain asymptomatic, it remains an important cause of vision loss after cataract surgery. The pathogenesis of PCME remains unclear, but most authors agree that inflammation plays a major role in its development. There is no standard algorithm for treatment procedures for PCME. A biodegradable 0.7 mg dexamethasone intravitreal implant can be used to deliver medication into the posterior segment of eyes. This drug acts on all inflammatory mediators and has been approved for the treatment of macular abnormalities secondary to retinal vein occlusion and for non-infectious posterior uveitis. In this case series, we report six patients who presented with PCME and were treated with a 0.7 mg dexamethasone intravitreal implant. Favorable anatomical outcomes were demonstrated by spectral domain-optical coherence tomography images.

Initial experience with ocriplasmin in the treatment of vitreomacular traction / Experiência inicial com ocriplasmina no tratamento da tração vitreorretiniana

ABSTRACT This study aimed to report the clinical and structural outcomes of intravitreal ocriplasmin in the treatment of vitreomacular interface disorders in two tertiary centers in Brazil. A retrospective study was performed by reviewing medical records and spectral domain optical coherence tomography (SD-OCT) findings of seven patients who were treated with a single ocriplasmin injection. A total of 57.14% of patients achieved resolution of vitreomacular traction as evidenced by SD-OCT. Regarding our functional results, 87.71% maintained or improved visual acuity after follow-up. To the best of our knowledge, this is the first study reporting initial results of ocriplasmin therapy in Brazil.

RESUMO O objetivo desse estudo é relatar os resultados iniciais, tanto do ponto de vista funcional quanto anatômico, no tratamento das doenças da interface vítreo-macular com a ocriplasmina em 2 serviços terciários no Brasil. Um estudo retrospectivo foi realizado através de revisão de prontuários, além de análise de achados em tomografia de coerência óptica de domínio espectral (SD-OCT) em 7 pacientes tratados com uma única injeção intravítrea de ocriplasmina. Em nosso estudo 57,14% dos pacientes apresentaram resolução da tração vítreo-macular no SD-OCT. Em relação aos resultados funcionais, 87,71% dos pacientes mantiveram, ou melhoraram sua acuidade visual durante o acompanhamento. Para nosso conhecimento, trata-se do primeiro estudo em nosso país, mostrando resultados iniciais com ocriplasmina em pacientes tratados no Brasil.

Dexamethasone 0. 7 mg implants in the management of pseudophakic cystoid macular edema / Implante de 0, 7 mg de dexametasona no tratamento do edema macular cistóide do pseudofácico

ABSTRACT Pseudophakic cystoid macular edema (PCME) is a common complication following cataract surgery. Although majority of patients with PCME remain asymptomatic, it remains an important cause of vision loss after cataract surgery. The pathogenesis of PCME remains unclear, but most authors agree that inflammation plays a major role in its development. There is no standard algorithm for treatment procedures for PCME. A biodegradable 0.7 mg dexamethasone intravitreal implant can be used to deliver medication into the posterior segment of eyes. This drug acts on all inflammatory mediators and has been approved for the treatment of macular abnormalities secondary to retinal vein occlusion and for non-infectious posterior uveitis. In this case series, we report six patients who presented with PCME and were treated with a 0.7 mg dexamethasone intravitreal implant. Favorable anatomical outcomes were demonstrated by spectral domain-optical coherence tomography images.

RESUMO O edema macular cistóide do pseudofácico (PCME) é uma frequente complicação no acompanhamento pós-operatório da cirurgia de catarata. Embora a maioria dos pacientes apresente-se sem sintomas, PCME ainda permanece como importante causa de baixa visão após facectomia. Sua patogênese ainda permanece obscura, porém, autores sugerem que fatores que promovem maior inflamação possuem papel fundamental em sua origem. Não há um algoritmo padrão no manejo do PCME. O implante biodegradável de dexametasona 0,7 mg surgiu como possível arma terapêutica, após aplicação intra-vítrea. Essa droga consegue agir sobre mediadores inflamatórios, além de já ter sido aprovada no tratamento do edema de macula secundário à oclusões venosas da retina, e uveítes posteriores de origem não infecciosa. Na seguinte série de casos, relatamos a evolução de 6 pacientes com PCME, submetidos a terapia com implante de dexametasona 0,7 mg. A melhora anatômica foi documentada com imagens de SD OCT.

Benign concentric annular macular dystrophy

The purpose of the authors is to show clinical findings of a patient with benign concentric annular macular dystrophy, which is an unusual condition, and part of the “bull’s eye” maculopathy differential diagnosis. An ophthalmologic examination with color perception, fluorescein angiography, and ocular electrophysiology was performed.

O objetivo dos autores é detalhar o quadro clínico de um paciente com distrofia macular anular concêntrica benigna, quadro raro, que compõe o diagnóstico diferencial das maculopatias em alvo. Realizou-se avaliação oftalmológica com auxílio de testes de percepção de cores, angiofluoresceinografia e eletrofisiologia ocular.