Diathermy for 23-gauge sclerotomy: a functional and morphologic study to avoid ocular hypotony.

PURPOSE: To evaluate diathermy to minimize sclerotomy leakage during small-gauge vitrectomy and prevent ocular hypotony. METHODS: This observational prospective study included 327 patients (327 eyes) who underwent diathermy to close the sclerotomy sites during 23-gauge pars plana vitrectomy (PPV). All patients were operated by a single surgeon (ED) and evaluated at 30 and 60 days postoperatively. Patients with glaucoma, topical/systemic steroids use exceeding 30 days, ocular inflammation, or trauma were excluded. Chi-square, Kruskal-Wallis, Fisher Exact test, and multivariate statistical analyses were performed to evaluate potential risk factors. The primary outcomes were open sclerotomies, leakage, and ocular hypotony. RESULTS: Sclerotomies remained open in 12 (3.6%) and 2 (0.6%) patients, respectively, at 30 and 60 days postoperatively, revealing no case of ocular hypotony. Leakage only occurred in four patients (1.2%) during week 1 postoperatively. Multivariate analysis indicated that additional vitreoretinal surgeries and longer surgeries were risk factors for persistent sclerotomy opening. CONCLUSION: Diathermy was safe and feasible to close sclerotomies. Vitreoretinal surgery reoperations and longer surgeries were the most significant (P<0.05) risk factors for persistent sclerotomy opening, which may be functionally closed without evidence of leakage or ocular hypotony.

Autofluorescência em um caso de distrofia macular anular concêntrica benigna / Fundus autofluorescence in a case of benign concentric annular macular dystrophy

Resumo A distrofia macular anular concêntrica benigna (DMACB) é uma patologia retiniana rara e provavelmente subdiagnosticada em nosso meio, que se caracteriza por um defeito retiniano em bull's eye sem uso prévio de antimaláricos, associado à preservação relativa da acuidade visual. Devido à escassez de publicações sobre o tema, existem poucos dados referentes aos resultados dos exames complementares nesta patologia. No presente artigo, apresenta-se a descrição da autofluorescência em um caso clássico de DMACB, ainda inédita na literatura, podendo acrescentar achados importantes para auxiliar no diagnóstico e seguimento da doença.

Abstract The benign concentric annular macular dystrophy (BCAMD) is a very rare and probably underdiagnosed eye disease, characterized by a retinal fault in bull's eye pattern, without the association with antimalarial use, but related with good visual acuity. Since there aren't many publications about this condition, is hard to find data regarding the results of complementary examination. In this article, is presented the description of fundus autofluorescence in a classic BCAMD case, yet unpublished, and capable of helping the diagnosis and follow-up of this pathology.

Epiteliopatia pigmentária retiniana difusa - Apresentação de casos clínicos / Difuse retinal pigment epitheliopathy. Case presentations

Objetivo: Apresentação de dois casos atípicos de coriorretinopatia cerosa central idiopática (CSCI). Local: Departamento de Oftalmologia, Hospital Universitário Clementino Fraga Filho. Faculdade de Medicina da Universidade Federal do Rio de Janeiro - UFRJ. Métodos: Dois pacientes do sexo masculino, com queixa de importante redução da acuidade visual, foram submetidos à propedêutica oftalmológica para investigação diagnóstica. Resultados: Os pacientes apresentavam duas diferentes formas atípicas de evolução de CSCI. Conclusões: A epiteliopatia pigmentária retiniana difusa, como uma manifestação incomum de CSCI, deve ser considerada como diagnóstico diferencial em pacientes portadores de maculopatias bilaterais em faixas etárias mais elevadas.

Retinal detachment in eyes undergoing pars plana vitrectomy for removal of retained lens fragments.

PURPOSE: To investigate the incidence and outcomes of retinal detachment (RD) associated with retained lens fragments removed by pars plana vitrectomy (PPV). DESIGN: Retrospective, noncomparative, interventional consecutive case series. PARTICIPANTS: All patients who underwent PPV for retained lens material after cataract surgery at Bascom Palmer Eye Institute between January 1, 1990, and December 31, 2001. METHODS: Demographic and clinical data were extracted from patients' medical records. MAIN OUTCOME MEASURES: Incidence of retinal detachment, reattachment rate, and visual acuity outcome. RESULTS: RD occurred in 44 of 343 (12.8%) patients, including 25 (7.3%) before or during PPV and 19 (5.5%) after PPV. The RD was macula-on in 22 of 44 (50%) patients and macula-off in 22 of 44 (50%) patients. The RD was associated with a giant retinal tear in 7 of 44 (15.9%) patients, limited suprachoroidal hemorrhage in 3 of 44 (6.8%) patients, and endophthalmitis in 4 of 44 (9.1%) patients. Retinal reattachment was achieved in 40 of 44 (90.9%) patients; 14 of 44 (31.8%) patients underwent one or more additional procedures for recurrent detachment. Final visual acuity in the patients in this series was >/=20/40 in 8 of 44 (18%), 20/50 to 20/100 in 13 of 44 (30%), 20/200 to 5/200 in 13 of 44 (30%), and <5/200 in 10 of 44 (23%). In the 36 patients with vision less than 20/40, the primary causes of decreased vision were attributed to prior history of RD in 8 of 36 (22.2%), corneal edema in 7 of 36 (19.4%), cystoid macular edema in 5 of 36 (13.9%), persistent retinal detachment in 4/36 (11.1%), preexisting primary open-angle glaucoma in 4 of 36 (11.1%), age-related macular degeneration in 3 of 36 (8.3%), epiretinal membrane in 2 of 36 (5.5%), macular hole in 1 of 36 (2.7%), optic atrophy in 1 of 36 (2.7%), and irregular astigmatism in 1 of 36 (2.7%) patients. CONCLUSIONS: RD is a frequent complication in eyes undergoing PPV for removal of retained lens fragments. Despite favorable retinal reattachment rates, visual acuity outcomes are often poor in these eyes and are associated with other comorbidities such as corneal edema and cystoid macular edema. Poor initial visual acuity and the presence of a retinal tear at the time of PPV were associated with a higher rate of RD after PPV.

Local anesthesia with intravenous sedation for surgical repair of selected open globe injuries.

PURPOSE: To report factors associated with the use of local anesthesia with intravenous sedation (local anesthesia/sedation) rather than general anesthesia for surgery for open globe injuries in adult reparable eyes. DESIGN: Retrospective, nonrandomized, comparative case series. METHODS: Medical records were reviewed of all patients with open globe injuries repaired at Bascom Palmer Eye Institute between 1995 and 1999. "Adult reparable eyes" (eyes in patients >/=18 years of age, not treated with primary enucleation or evisceration, followed up >/=2 months) were included. RESULTS: In all, 220 eyes of 218 patients met inclusion criteria. General anesthesia was employed in 80 of 200 (36%) and local anesthesia/sedation in 140 of 220 (64%). Patients who had local anesthesia/sedation were significantly more likely to have an intraocular foreign body (31% vs 14%; P =.010, chi-square test), better presenting visual acuity (1.8 logMAR [logarithm of the minimum angle of resolution] units vs 2.5 logMAR units; P <.001, t test), more anterior wound location (75% corneal/limbal vs 65%; P =.003, chi-square), shorter wound length (6.3mm vs 10.8mm; P <.001, t test), and dehiscence of previous surgical wound (26% vs 12%; P =.021, chi-square) and were significantly less likely to have an afferent pupillary defect (22% vs 51%; P <.001, chi-square). There was no anesthesia-related complication in either group. The local anesthesia/sedation group had a shorter mean operating time than did the general anesthesia group (78 minutes vs 117 minutes; P <.001, t test). The general anesthesia group had a longer mean follow-up than the local anesthesia/sedation group (20.2 months vs 13.9 months, respectively; P =.002, t test). Change in visual acuity between the presenting and final examinations was similar for open globe injuries repaired with general anesthesia compared with local anesthesia/sedation (0.94 vs 0.72 logMAR units of visual acuity, respectively; P =.16, t test). CONCLUSIONS: Local anesthesia/sedation is a reasonable alternative to general anesthesia for selected patients with open globe injuries.

Lesão macular viteliforme - relato de caso / Viteliform macular lesion - case report

Objetivo: Apresentar o caso de um paciente de 75 anos de idade, com baixa de acuidade visual, apresentando uma lesão macular viteliforme simétrica em ambos os olhos. Local: Hospital Universitário Clementino Fraga Filho da UFRJ - Universidade do Brasil. Método: Relato de Caso. Resultados: O exame oftalmológico de um paciente masculino, de 75 anos, revelou diminuição da acuidade visual, lesões amareladas e arredondadas bilaterais e simétricas na região foveal, uma angiografia fluoresceínica que revelou defeito em janela, e um EOG subnormal e ausência de história familiar. As principais hipóteses: Distrofia Foveomacular Viteliforme e Doença Macular Relacionada à Idade são discutidas baseadas na história clínica e epidemiológica, e exames complementares como angiografia fluoresceínica, ERG e EOG. Conclusão: Apenas com a evolução clínica e o seguimento poderá ser revelado o diagnóstico de certeza deste paciente. Este caso mostra que em Oftalmologia muitas vezes encontraremos doenças de fisiopatologias distintas que levam a aspecto oftalmoscópico muito semelhante.

Late-onset persistent retinal microvascular changes after bone marrow transplantation: 3-year follow-up

Purpose: To describe a case of persistent retinopathy after bone marrow transplantation in the absence of radiation therapy. Methods: Case Report. Results: A 42 year-old man developed bilateral visual loss 15 months after receiving a bone marrow transplantation for acute leukemia. The patient was treated with a high dose of cyclosporin A and oral corticosteroids. No radiation therappy was given. Late-onset, multiple, bilateral cotton-wool spots developed 15 months after the bone marrow transplantation and still persist. After three years other cotton-wool spots arose in the absence of any immunosuppresive therapy. Conclusions: Bone marrow transplantation microvasculopathy of the retina may be related to certain combinations of chemotherapy drugs or immunosuppresion itself and may persist in the absence of these immunosuppressive drugs.

Videoangiografia digital com indocianina verde na coriorretinopatia esclopetária / Digital indocyanine green videonagiography in chorioretinitis sclopetaria

Objetivos: Descrever os aspectos clínicos, oftalmológicos e da videoangiografia digital com fluoresceína sódica e indocianina verde (VDIV) na coriorretinopatia esclopetária. Pacientes e métodos: Nove pacientes com o diagnóstico de coriorretinopatia esclopetária foram submetidos à avaliaçäo oftalmológica e, em 6 casos, complementada com a realizaçäo da videoangiografia digital com fluoresceína sódica e indocianina verde (VDIV). Resultados: O quadro oftalmoscópico típico encontrado foi de densas cicatrizes coriorretinianas, hemorragia vítrea e proliferaçäo fibroglial. Em um paciente também foi encontrada avulsäo do nervo óptico. Os achados da angiofluoresceinografia e da DVIV säo semelhantes, com extensas áreas de hipofluorescência por näo perfusäo, por bloqueio pigmentário e pelo tecido fibroglial nas áreas de cicatrizes coriorretinianas. Nos casos de traumatismo recente, onde há quebra de barreiras vasculares, pode ser observada hiperfluorescência por vazamento do contraste e hipofluorescência por bloqueio hemorrágico em ambos os métodos. Conclusöes: A coriorretinopatia esclopetária apresenta espectro variável dependendo do tipo de agente (arma, calibre, projétil, trajeto) e da sua interaçäo com os diversos tecidos oculares com diferentes resistências ao trauma. Embora o diagnóstico da coriorretinopaita esclopetária seja clinico-oftalmológico, este estudo descreve as alteraçöes da VDIV em uma série de casos complementando a avaliaçäo do paciente no trauma ocular.

Videoangiografia digital com fluoresceína sódica e indoccianina verde na doença hipertensiva específica da gestaçäo / Digital fluorescein and indocyanine green videoangiography in pregnancy toxemia

Descrever os achados oftalmoscópicos e videoangiográficos com fluoresceína sódica e indocianina verde (ICG-V) na doença hipertensiva específica da gestaçäo (DHEG). Métodos: Quatro pacientes do sexto feminino, portadoras de DHEG foram submetidas a exame oftamológico e angiofluoresceinografia (AF) e adicionalmente, em duas pacientes, foi realizada videoangiografia digital com indocianina verde (ICG-V). Resultados: Todas as pacientes apresentaram, descolamento seroso da retina bilateral que regrediu espontaneamente com a estabilizaçäo do quadro clínico hipertensivo. Na AF notaram-se múltiplas áreas de näo-perfusäo coróidea precoce e pontos hiperfluorescentes por vazamento e acúmulo do corante no espaço subretiniano nas áreas do descolamento. Areas de hiperfluorescência transmitida por defeito em janela e hipofluorescência por bloqueio pigmentário após a resoluçäo do descolamento associados a alteraçöes pigmentárias foram encontradas tardiamente. A ICG-V evidenciou hipoperfusäo coróidea precoce e múltiplos pontos de vazamento e acúmulo tardio do corante.

Videoangiografia digital com indocianina verde em trauma ocular contuso / Digital indocyaninegreen videoangiography in blunt ocular trauma

Os autores descrevem as observaçöes da videoangiografia digital com indocianina verde (ICG-V) em 8 pacientes com história de trauma ocular contuso e alteraçöes no segmento posterior. Dentre as lesöes observadas, a rotura de coróide foi a mais frequente ocorrendo em 75 por cento dos casos (6 pacientes). A ICG-V permitiu melhor identificaçäo e delimitaçäo das roturas em relaçäo à angiofluoresceinografia, sendo um método útil para a complementaçäo da avaliaçäo ocular. As lesöes associadas a pior acuidade visual apresentavam acometimento foveal e näo eram tratáveis