Bacterial endophthalmitis following anti-VEGF intravitreal injections: a retrospective case series.

BACKGROUND: To describe the incidence of endophthalmitis and the treatment outcomes of acute bacterial endophthalmitis following intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections in a Brazilian hospital. The analysis was based on the timing of infection after intravitreal injection, culture results, visual acuity, and the presence of epiretinal membrane after a 1-year follow-up period, spanning nine years. METHODS: This retrospective case series, conducted over a 9-year period, aimed to evaluate the treatment outcomes of acute endophthalmitis following intravitreal Bevacizumab injections. The inclusion criteria involved a chart review of 25 patients who presented clinical signs of acute endophthalmitis out of a total of 12,441 injections administered between January 2011 and December 2019. Negative culture results of vitreous samples or incomplete data were excluded. Ultimately, 23 patients were enrolled in the study. Eight patients were treated with intravitreal antibiotic injections (IVAI) using vancomycin 1.0 mg/0.05mL and ceftazidime 2.25 mg/0.05mL, while 15 patients underwent pars plana vitrectomy (PPV) followed by intravitreal antibiotic injections at the end of surgery (IVAIES). The main outcome measures were the efficacy of controlling the infection with IVAI as a standalone therapy compared to early PPV followed by IVAIES. Data collected included pre-infection and one-year post-treatment best corrected visual acuity (BCVA), optical coherence tomography (OCT) abnormalities, and enucleation/evisceration rates. To compare groups, Mann-Whitney and ANOVA tests were employed for statistical analysis. RESULTS: The incidence rate of bacterial endophthalmitis was 0.185% (1/541 anti-VEGF injections), with the highest infection rates observed in 2014 and 2017. Patients presented clinical symptoms between 2 and 7 days after injection. The most common isolated organisms were coagulase-negative Staphylococci and Streptococci spp. Treatment outcomes showed that both IVAI and PPV + IVAIES effectively controlled the infection and prevented globe atrophy. After one year, the PPV group with BCVA better than Light Perception had a significantly better BCVA compared to the IVAI group (p 0.003). However, PPV group had higher incidence of epiretinal membranes formation compared to the IVAI group. (P 0.035) CONCLUSION: Anti-VEGF injections carry a risk of developing acute bacterial endophthalmitis. Isolated antibiotic therapy could be an effective treatment to control the infection, but performing PPV + IVAIES as a primary treatment showed promising results in terms of improving BCVA after one year, despite a higher rate of epiretinal membrane formation. Further studies are needed to confirm these findings.

Ophthalmology emergency department visits in a Brazilian tertiary hospital over the last 11 years: data analysis.

PURPOSE: This study aimed to describe the visits profile to Hospital São Paulo's ophthalmology emergency department, a 24-hour public open-access tertiary-care service in São Paulo, Brazil, that belongs to Federal University of São Paulo, over the last 11 years. METHODS: A cross-sectional retrospective study was conducted, including all patients (n=634,726) admitted to the ophthalmology emergency department of Hospital São Paulo between January 2009 and December 2019. RESULTS: From 2009 to 2019, the number of patients' presentations increased to 39.2%, with considerable visits variation across the period. The median age was 38 ± 20.4 years. Males represented 53.3%, and single-visit patients represented 53.1%. A total of 79.5% of patients' presentations occurred from 7 am to 5 pm, and 80.8% of patients' presentations occurred during regular weekdays. The most frequent diagnoses were conjunctivitis, blepharitis, keratitis, hordeolum/chalazion, and corneal foreign body. CONCLUSIONS: Over the study period, presentations significantly increased in number, with nonurgent visits predominance, and a low number of single-visit patients. Our results demonstrate the ophthalmic visits profile and can lead to changes in the public health system to improve the quality of care and ophthalmology emergency access in São Paulo city.

Ophthalmology emergency department visits in a Brazilian tertiary hospital over the last 11 years: data analysis / Análise dos dados de atendimentos de um serviço de emergência oftalmológica em um hospital terciário brasileiro nos últimos 11 anos

ABSTRACT Purpose: This study aimed to describe the visits profile to Hospital São Paulo's ophthalmology emergency department, a 24-hour public open-access tertiary-care service in São Paulo, Brazil, that belongs to Federal University of São Paulo, over the last 11 years. Methods: A cross-sectional retrospective study was conducted, including all patients (n=634,726) admitted to the ophthalmology emergency department of Hospital São Paulo between January 2009 and December 2019. Results: From 2009 to 2019, the number of patients' presentations increased to 39.2%, with considerable visits variation across the period. The median age was 38 ± 20.4 years. Males represented 53.3%, and single-visit patients represented 53.1%. A total of 79.5% of patients' presentations occurred from 7 am to 5 pm, and 80.8% of patients' presentations occurred during regular weekdays. The most frequent diagnoses were conjunctivitis, blepharitis, keratitis, hordeolum/chalazion, and corneal foreign body. Conclusions: Over the study period, presentations significantly increased in number, with nonurgent visits predominance, and a low number of single-visit patients. Our results demonstrate the ophthalmic visits profile and can lead to changes in the public health system to improve the quality of care and ophthalmology emergency access in São Paulo city.

RESUMO Objetivos: O objetivo do estudo é avaliar o perfil das visitas ao Pronto-Socorro de Oftalmologia (PS) do Hospital São Paulo, serviço público de atendimento terciário aberto 24 horas em São Paulo - Brasil, pertencente à Universidade Federal de São Paulo, nos últimos 11 anos. Métodos: Foi realizado um estudo transversal retrospectivo, com base em todos os pacientes (n=634.726) admitidos no pronto-socorro de oftalmologia do Hospital São Paulo entre janeiro de 2009 e dezembro de 2019. Resultados: De 2009 a 2019, houve um aumento no influxo de 39,2% com importante variação nos atendimentos ao longo dos anos, a mediana de idade foi de 38 ± 20,4 anos, o sexo masculino representou 53,3% e os pacientes únicos representaram 53,1%. Verificou-se que 79,5% das visitas ocorreram das 7h às 17h e 80,8% nos dias da semana. Os diagnósticos mais frequentes foram conjuntivite aguda seguida de blefarite, ceratite, hordéolo / calázio e corpo estranho corneano. Conclusão: Ao longo do período de análise do estudo, houve importante aumento nas apresentações, com predominância de atendimentos não urgentes e baixa proporção de pacientes com uma única visita. Nossos resultados evidenciam o perfil das consultas oftalmológicas, podendo gerar mudanças no sistema público de saúde visando a melhoria da qualidade do atendimento e acesso às emergências oftalmológicas na cidade de São Paulo.

Evisceration and enucleation cases in the ophthalmologic emergency department of a tertiary Brazilian hospital / Casos de evisceração e enucleação em departamento de urgência oftalmológica de um hospital terciário Brasileiro

ABSTRACT Purpose: To analyze the epidemiological profiles of evisceration and enucleation cases in the ophthalmologic emergency department of a Brazilian tertiary hospital. Methods: Patients treated in the ophthalmologic emergency department of Hospital São Paulo (Universidade Federal de São Paulo) during the period 2013 to 2018 were retrospectively evaluated. Urgent cases of evisceration or enucleation surgery were included, and elective cases were excluded. The following information was extracted from the patients' medical records: demographic data, immediate and associated reasons for the surgical procedure, informed visual acuity, symptom duration until ophthalmologic care, complications, distance from the residence to the tertiary hospital, and time of hospitalization. Results: In total, 61 enucleations and 121 eviscerations were included in this study. The patients had a mean age of 63.27 ± 18.68 years. Of the patients, 99 were male (54.40%), and 83 were female (45.60%). The indications for evisceration or enucleation were corneal perforation with (44.50%) and without (23.63%) signs of infection, endophthalmitis (15.38%), ocular trauma (14.29%), neoplasia (0.55%), burn accident (1.10%), and phthisis bulbi (0.55%). The self-reported visual acuity was no light perception (87.36%) or light perception (1.10%). However, 3.30% of the patients did not cooperate with the examination, and no information on visual acuity was available for the remaining 8.24%. The mean symptom duration before ophthalmologic care was sought was 18.32 days. Two patients had sympathetic ophthalmia after evisceration. Conclusions: More eviscerations than enucleations were performed throughout the study period. The most common demographic characteristics were age >60 years and male sex. The main indications for urgent evisceration and enucleation procedures were corneal perforation with and without infection, endophthalmitis, and ocular trauma. The findings from this study could guide clinicians in performing preventive measures to avoid destructive eye procedures.

RESUMO Objetivo: Analisar o perfil epidemiológico dos casos de evisceração e enucleação no pronto-socorro oftalmológico de um hospital terciário brasileiro. Métodos: Análise retrospectiva dos casos tratados no pronto-socorro oftalmológico do Hospital São Paulo (Universidade Federal de São Paulo) entre os anos de 2013 a 2018. Os casos urgentes de evisceração e enucleação foram incluídos e os casos eletivos foram excluídos. A análise dos prontuários médicos foi baseada em: dados demográficos, causas imediatas e associadas ao procedimento, acuidade visual informada, duração dos sintomas antes do atendimento oftalmológico, complicações, distância da residência até o hospital e tempo de hospitalização. Resultados: 61 enucleações e 121 eviscerações foram incluídas no estudo. Os pacientes tinham uma média de idade de 63,27 ± 18,68 anos; 99 eram do sexo masculino (54,50%) e 83 do sexo feminino (45,60%). As indicações de evisceração e enucleação foram: perfuração corneana com (44,50%) e sem (23,63%) sinais infecciosos, endoftalmite (15,38%), trauma ocular (14,29%), neoplasia (0,55%), queimadura (1,10%) e phthisis bulbi (0,55%). A acuidade visual informada foi de ausência de percepção luminosa (87,36%), percepção luminosa (1.10%), ausência de colaboração (3,30%) e sem dados informados (8,24%). A média de tempo até a busca pelo serviço oftalmológico foi de 18,32 dias. Houve 2 casos de oftalmia simpática após evisceração. Conclusões: Eviscerações foram predominantemente realizadas em comparação a enucleações em todo o período de estudo. As características demográficas mais comuns foram idade >60 anos e sexo masculino. As principais indicações para procedimentos urgentes de evisceração e enucleação foram perfuração corneana com e sem infecção, endoftalmite e trauma ocular. Este estudo poderia guiar medidas preventivas para evitar procedimentos oculares destrutivos.

White dot syndrome in a patient with presumed ocular tuberculosis: a case report.

BACKGROUND: This manuscript describes a case of a patient with presumed ocular tuberculosis masquerading as multiple evanescent white dot syndrome. CASE PRESENTATION: A 32-year-old male patient presented with a complaint of reduced visual acuity in the left eye. Retinal fundus exam of the left eye revealed gray-whitish deep lesions predominantly nasal to the optic disc. The lesions were more clearly identifiable on fundus autofluorescence (FAF) imaging, fluorescein angiography (FA) and en face optical coherence tomography (OCT). FA also indicated retinal vasculitis and papillitis. Swept-source OCT B-scan demonstrated loss of the ellipsoid layer in the regions corresponding to the lesions detected by FAF. A positive tuberculin skin test (TST) confirmed presumed tuberculosis, and a related WDS diagnosis was made. Specific antituberculosis therapy was instituted with favorable anatomical recovery and visual outcome. CONCLUSION: Multiple evanescent white dot syndrome (MEWDS) may be manifestation of presumed ocular tuberculosis, and multimodal retinal exams can provide a better understanding of atypical diseases and their follow-up.

Evisceration and enucleation cases in the ophthalmologic emergency department of a tertiary Brazilian hospital.

PURPOSE: To analyze the epidemiological profiles of evisceration and enucleation cases in the ophthalmologic emergency department of a Brazilian tertiary hospital. METHODS: Patients treated in the ophthalmologic emergency department of Hospital São Paulo (Universidade Federal de São Paulo) during the period 2013 to 2018 were retrospectively evaluated. Urgent cases of evisceration or enucleation surgery were included, and elective cases were excluded. The following information was extracted from the patients' medical records: demographic data, immediate and associated reasons for the surgical procedure, informed visual acuity, symptom duration until ophthalmologic care, complications, distance from the residence to the tertiary hospital, and time of hospitalization. RESULTS: In total, 61 enucleations and 121 eviscerations were included in this study. The patients had a mean age of 63.27 ± 18.68 years. Of the patients, 99 were male (54.40%), and 83 were female (45.60%). The indications for evisceration or enucleation were corneal perforation with (44.50%) and without (23.63%) signs of infection, endophthalmitis (15.38%), ocular trauma (14.29%), neoplasia (0.55%), burn accident (1.10%), and phthisis bulbi (0.55%). The self-reported visual acuity was no light perception (87.36%) or light perception (1.10%). However, 3.30% of the patients did not cooperate with the examination, and no information on visual acuity was available for the remaining 8.24%. The mean symptom duration before ophthalmologic care was sought was 18.32 days. Two patients had sympathetic ophthalmia after evisceration. CONCLUSIONS: More eviscerations than enucleations were performed throughout the study period. The most common demographic characteristics were age >60 years and male sex. The main indications for urgent evisceration and enucleation procedures were corneal perforation with and without infection, endophthalmitis, and ocular trauma. The findings from this study could guide clinicians in performing preventive measures to avoid destructive eye procedures.

Obstructive sleep apnea and the retina: a review.

CITATION: This review's objective was to synthesize the literature on the repercussions of obstructive sleep apnea (OSA) in the retinal vascular system. Two independent investigators conducted a search using the MEDLINE/PubMed database using the following terms: sleep apnea syndrome, obstructive sleep apnea, retina, vascular tortuosity, central serous chorioretinopathy, diabetes mellitus, and subfoveal choroidal thickness. Patients with OSA present increased vascular tortuosity compared with patients without OSA, decreased parafoveal and peripapillary vessel density, and increased retinal vein occlusion incidence. In central serous chorioretinopathy patients and patients who are poor responders to intravitreal anti-VEGF (-vascular endothelial growth factor) treatment for macular edema, OSA is more frequent. Macular choroidal thickness alterations are controversial, and OSA may worsen diabetic maculopathy, thus being a risk factor for diabetic retinopathy, proliferative diabetic retinopathy, and macular edema. OSA is a prevalent syndrome with many systemic vascular changes. The retina and choroid are the most affected ocular structures, with primarily vascular changes. New noninvasive technologies such as optical coherence tomography and optical coherence tomography angiography could help to better understand retinal structures and help clarify the ophthalmological repercussions of OSA. CITATION: Nakayama LF, Tempaku PF, Bergamo VC, et al. Obstructive sleep apnea and the retina: a review. J Clin Sleep Med. 2021;17(9):1947-1952.

Bartonella hanselae retinitis patient evaluated with multimodal retinal exams.

BACKGROUND: Cat scratch disease is a systemic infectious illness caused by the bacterium Bartonella henselae. The most common ophthalmological involvement due to infection by Bartonella is Parinaud oculoglandular syndrome, whereas the most common posterior segment findings are neuroretinitis and subsequent late macular star. Moreover, other findings, such as retinal or subretinal lesions, intermediate uveitis and angiomatous lesions, may be present. CASE PRESENTATION: A 37-year-old female patient with retinal findings and serological confirmation of Bartonella infection was evaluated via multimodal retinal exams. The patient received treatment with doxycycline 100 mg twice daily for 2 weeks. One month after treatment, complete improvement of her visual scotoma symptoms was confirmed. A swept-source optical coherence tomography exam also showed decreases in the size and intraretinal extension of the lesion. Improvement of light perception at the affected area was confirmed by microperimetry. CONCLUSIONS: Bartonella henselae infection, particularly retinitis, can present a variable spectrum of clinical and ophthalmological findings. Multimodal retinal exams can clearly identify lesion characteristics, thus providing important information for diagnosis and the evaluation of lesion improvement after antibiotic treatment.

Twelve-Year-Old Girl with Acute Macular Neuroretinopathy: A Multimodal Retinal Evaluation.

We report a 12-year-old female patient with acute macular neuroretinopathy assessed with multimodal retinal exams. Initial fluorescein angiogram and optical coherence tomography angiography (OCT-A) were both normal, and after 4 months OCT-A showed abnormal vascular flow with normal flow in superficial retina layers, choroid, and choriocapillaris.

Six-year epidemiological analysis of post traumatic endophthalmitis in a Brazilian hospital.

BACKGROUND: To evaluate the epidemiology of endophthalmitis cases related to ocular trauma, including visual acuity during and 1 year after trauma, source of trauma and method of treatment. METHODS: A retrospective study analyzed the epidemiological data of patients with a clinical presentation of endophthalmitis after ocular penetrating trauma between January 2012 and January 2017 at Escola Paulista de Medicina/UNIFESP, a hospital in São Paulo, SP, Brazil. RESULTS: A total of 453 patients with antecedent open globe trauma were evaluated, among these, 30 patients with suspected endophthalmitis. All patients were male. The time interval between trauma and ophthalmological evaluation and collection of vitreous and aqueous material was 1 day in 36.66%, 2-7 days in 43.44%, 7-14 days in 10% and more than 15 days in 10% of patients; 66.66% had positive cultures. 11 patients had intraocular foreign body. One year after trauma, visual acuity was classified as no light perception (NLP) in 33.33%, light perception in 6.66%, hand motion in 13.33%, counting fingers in 13.33%, and better than 20/400 in 20% of patients. Considering presence of intraocular foreign body, initial visual acuity and symptoms onset time, only initial visual acuity showed as better prognostic factor in final visual acuity. CONCLUSION: Endophthalmitis is a severe ocular inflammatory condition that may lead to irreversible vision loss. Initially only one patient had visual acuity of NLP, but after 1 year, 33% showed visual acuity of NLP, and only 20% had visual acuity better than 20/400, what is consistent with a severe infection with a guarded prognosis. The high incidence of endophthalmitis after ocular penetrant trauma justifies distinct treatment and greater attention.

The retinal foveal avascular zone as a systemic biomarker to evaluate inflammatory bowel disease control.

BACKGROUND: Inflammatory bowel disease (IBD) is a systemic inflammatory disease and is classified as Crohn's disease (CD) or ulcerative colitis (UC) depending on the extent of gastrointestinal tract involvement. IBD can be associated with extraintestinal findings, such as fever, weight loss, arthralgia, and mucocutaneous lesions, as well as hepatic, renal and ophthalmological involvement. Clinical parameters and colonoscopy are used to establish the criteria for controlled or non-controlled disease and subsequent definition of treatment. Our objective in the present study was to compare the area of the foveal avascular zone (FAZ) in patients with a diagnosis of IBD during remission and active disease. METHODS: 144 eyes of 72 patients with IBD were evaluated via a complete ophthalmological exam. Fundus photography and optical coherence tomography/angiography (OCT/OCTA) were performed with a Topcon Triton. The macula and posterior pole were evaluated by binocular indirect ophthalmoscopy and fundus biomicroscopy. The area of the FAZ was determined via manual delimitation of superficial retinal vascular layers from OCTA with image6.net software. To establish disease activity, we considered the Mayo Score, fecal calprotectin levels, colonoscopy results and clinical parameters. All retinal parameters were evaluated in a blinded manner. Means were compared between groups using the Mann-Whitney test. RESULTS: The participants had a mean age of 42.26 years and included 28 males (38.88%) and 44 females (61.11%). Among the participants, 37 had a diagnosis of CD (51.38%), and 35 had a diagnosis of UC (48.61%). Twenty-five patients (34.72%) had active disease, and 47 (65.27%) were in remission. The area of the FAZ did not differ significantly between the CD and UC groups (p = 0.91 for the right eye and p = 0.76 for the left eye) but did differ significantly between the remission and active disease groups (p = 0.01 for the right eye and p = 0.02 for the left eye). DISCUSSION: Our study is the first to evaluate the area of the FAZ in patients with IBD via swept-source OCTA. The area of the FAZ did not differ significantly in either eye between the CD and UC groups. However, patients classified as having active disease according to clinical parameters and colonoscopy presented a significant decrease in the area of the FAZ compared with patients in remission. The area of the FAZ is an ophthalmological parameter that can be obtained non-invasively and is increased in ischemic diseases such as diabetic retinopathy. The FAZ may decrease due to vascular engorgement or increased systemic inflammation. This parameter can be used to help determine whether a patient is in remission or active IBD, thus potentially reducing the need for invasive exams during disease follow-up.

A case of late-onset capsular block syndrome and its surgical treatment / Um caso de síndrome de bloqueio capsular tardio e uma abordagem cirúrgica

ABSTRACT - Capsular block syndrome is a rare complication of phacoemulsification surgery with continuous curvilinear capsulorhexis and intraocular lens implantation. Here, we report a case of very late-onset capsular block syndrome that developed 13 years after cataract extraction and present the surgical approach used for its successful treatment.

RESUMO - Síndrome do bloqueio capsular é uma complicação incomum da cirurgia de facoemulsificação com capsulorrexis curvilínea contínua e implante de lente intraocular. Nós relatamos um caso de síndrome de bloqueio capsular de início tardio que se desenvolveu após 13 anos da extração da catarata e apresenta a abordagem cirúrgica utilizada para o sucesso do tratamento.

A case of late-onset capsular block syndrome and its surgical treatment.

Capsular block syndrome is a rare complication of phacoemulsification surgery with continuous curvilinear capsulorhexis and intraocular lens implantation. Here, we report a case of very late-onset capsular block syndrome that developed 13 years after cataract extraction and present the surgical approach used for its successful treatment.

FREQUENCY OF OPHTHALMOLOGICAL POSTERIOR SEGMENT FINDINGS IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE.

BACKGROUND: Inflammatory bowel disease is a systemic inflammatory disease classified as Crohn disease or ulcerative colitis. It could present extra intestinal findings, such as fever, weight loss, arthralgia, mucocutaneous lesions, hepatic, renal and ophthalmological involvement. Among ophthalmological findings, posterior segment findings are present in less than 1% of patients with inflammatory bowel disease, however, these findings could bring definitive visual impairment. OBJECTIVE: Our study objective was to evaluate ocular posterior segment findings is patients with inflammatory bowel disease, through retinal mapping, color fundus retinography, optical coherence tomography (OCT) and OCT angiography, and compare our results to literature. METHODS: We evaluated eighty patients with inflammatory bowel disease through complete ophthalmological examination and posterior segment assessment. Color fundus retinography, OCT and OCT angiography was performed with Topcon Triton (Topcon ® , Tokyo, Japan). Macula and posterior pole were evaluated with binocular indirect ophthalmoscopy and fundus biomicroscopy. RESULTS: Participants mean age was 44.16 years (18.08-68.58), 28 (35%) male patients and 52 (65%) female patients. Thirty-five (44%) with diagnosis of Crohn disease, 41 (52%) patients with diagnosis of ulcerative colitis and 3 (4%) had non-conclusive Crohn disease or ulcerative colitis classification. We found abnormal exams in 21 (26.25%) patients. CONCLUSION: Our study found similar prevalence of ophthalmological posterior segment commitment compared to previous literature prevalence. The findings were predominantly unrelated to inflammatory bowel disease, rather than primarily related to it. The most prevalent, and non-previous reported, finding was increased arteriolar tortuosity, probably occurs due to systemic vascular impairment in inflammatory bowel disease.

Optical coherence tomography (OCT) angiography of central retinal artery occlusion in the patent cilioretinal artery: a case report.

Here we report the case of a 78-year-old male patient with a 2-day history of low visual acuity and fundus and who was diagnosed with central retinal artery occlusion. In addition, the patient had an allergy to fluorescein. A fundus examination of the left eye found a pink optic disc with blurred margins, diffuse pallor in the retina with arterial attenuation, and a normal band of the retinal area in the macular region. Optical coherence tomography revealed increased thickness of the inner retina. Optical coherence tomography angiography (OCT-A) revealed a decreased flow signal in the superficial layers, with reduced flow signal in the choriocapillaris. OCT-A is a valuable alternative during the follow-up period in patients with central retinal artery occlusion, particularly in those with an allergy to contrast agents. The use of this as a non-invasive examination can improve the prognosis of patients and future studies investigating the treatment of central retinal artery occlusion.

Frequência de achados oftalmológicos de segmento posterior em pacientes com doença inflamatória intestinal / Frequency of ophthalmological posterior segment findings in patients with inflammatory bowel disease

ABSTRACT BACKGROUND: Inflammatory bowel disease is a systemic inflammatory disease classified as Crohn disease or ulcerative colitis. It could present extra intestinal findings, such as fever, weight loss, arthralgia, mucocutaneous lesions, hepatic, renal and ophthalmological involvement. Among ophthalmological findings, posterior segment findings are present in less than 1% of patients with inflammatory bowel disease, however, these findings could bring definitive visual impairment. OBJECTIVE: Our study objective was to evaluate ocular posterior segment findings is patients with inflammatory bowel disease, through retinal mapping, color fundus retinography, optical coherence tomography (OCT) and OCT angiography, and compare our results to literature. METHODS: We evaluated eighty patients with inflammatory bowel disease through complete ophthalmological examination and posterior segment assessment. Color fundus retinography, OCT and OCT angiography was performed with Topcon Triton (Topcon ® , Tokyo, Japan). Macula and posterior pole were evaluated with binocular indirect ophthalmoscopy and fundus biomicroscopy. RESULTS: Participants mean age was 44.16 years (18.08-68.58), 28 (35%) male patients and 52 (65%) female patients. Thirty-five (44%) with diagnosis of Crohn disease, 41 (52%) patients with diagnosis of ulcerative colitis and 3 (4%) had non-conclusive Crohn disease or ulcerative colitis classification. We found abnormal exams in 21 (26.25%) patients. CONCLUSION: Our study found similar prevalence of ophthalmological posterior segment commitment compared to previous literature prevalence. The findings were predominantly unrelated to inflammatory bowel disease, rather than primarily related to it. The most prevalent, and non-previous reported, finding was increased arteriolar tortuosity, probably occurs due to systemic vascular impairment in inflammatory bowel disease.

RESUMO CONTEXTO: As doenças inflamatórias intestinais são doenças inflamatórias sistêmicas que podem ser divididas em doença de Crohn ou retocolite ulcerativa. Além do quadro intestinal, elas podem apresentar sintomas extra intestinais como febre, perda de peso, artralgia, lesões mucocutâneas, acometimento hepatobiliar, acometimento renal e oftalmológico. Entre os achados oftalmológicos descritos, alterações de segmentos posterior são encontrados em menos de 1% dos pacientes com doença inflamatória intestinal, porém, tais achados podem levar à baixa acuidade visual definitiva. OBJETIVO: O objetivo do nosso trabalho foi avaliar alterações em segmento posterior através de retinografia colorida, mapeamento de retina, tomografia de coerência óptica e OCT angiography e comparar nossos resultados com o da literatura. MÉTODOS: Foram avaliados 80 pacientes com doença inflamatória intestinal. Todos os pacientes foram submetidos a exame oftalmológico completo e a avaliação do segmento posterior. Foi realizada tomografia de coerência óptica em aparelho Triton (Topcon, Tokyo, Japan), retinografia colorida e OCT angiography. Mácula e polo posterior foram avaliados através de oftalmoscopia binocular indireta e biomicroscopia de fundo. RESULTADOS: Entre os participantes, a média de idade foi de 44,16 anos (18,08-68,58), 28 (35%) participantes do sexo masculino e 52 (65%) do sexo feminino. Trinta e cinco (44%) pacientes com diagnóstico de doença de Crohn, 41 (52%) pacientes com diagnóstico de retocolite ulcerativa e 3 (4%) pacientes em que não era possível classificar como doença de Crohn ou retocolite ulcerativa. Entre as avaliações de polo posterior, foram encontrados achados em exame de 21 pacientes, o que corresponde a 26,25% dos casos. CONCLUSÃO: Nosso estudo encontrou resultados de prevalência de achados em exame de segmento posterior semelhante aos estudos prévios da literatura. Os achados foram de forma predominante não primariamente relacionados à doença inflamatória intestinal. O achado mais prevalente, e não previamente reportado, foi aumento de tortuosidade arteriolar, que provavelmente ocorre por envolvimento vascular sistêmico nas doenças inflamatórias intestinais.

Optical coherence tomography (OCT) angiography of central retinal artery occlusion in the patent cilioretinal artery: a case report / Avaliação de paciente com oclusão de artéria central da retina com artéria cilioretiniana patente através de angiografia por tomografia de coerência óptica (OCT-A): um relato de caso

ABSTRACT Here we report the case of a 78-year-old male patient with a 2-day history of low visual acuity and fundus and who was diagnosed with central retinal artery occlusion. In addition, the patient had an allergy to fluorescein. A fundus examination of the left eye found a pink optic disc with blurred margins, diffuse pallor in the retina with arterial attenuation, and a normal band of the retinal area in the macular region. Optical coherence tomography revealed increased thickness of the inner retina. Optical coherence tomography angiography (OCT-A) revealed a decreased flow signal in the superficial layers, with reduced flow signal in the choriocapillaris. OCT-A is a valuable alternative during the follow-up period in patients with central retinal artery occlusion, particularly in those with an allergy to contrast agents. The use of this as a non-invasive examination can improve the prognosis of patients and future studies investigating the treatment of central retinal artery occlusion.

RESUMO Paciente de 78 anos do sexo masculino com história de dois dias de baixa acuidade visual em olho esquerdo e exame fundoscópico sugestivo de oclusão da artéria retiniana, além de história de alergia a fluoresceína sódica. Em exame de fundoscopia de olho esquerdo pode ser observado disco óptico róseo, mal delimitado, palidez difusa da retina, com banda em área macular apresentando cor rósea preservada. A tomografia de coerência óptica apresentava aumento de espessura de retina interna em áreas de palidez e espessura e camadas preservadas em área poupada. A tomografia de coerência óptica-A mostrou sinal diminuído em camadas superficiais, com sinal de fluxo diminuído em coriocapilar. A tomografia de coerência óptica-A é uma alternativa válida para seguimento de pacientes com oclusão da artéria retiniana, em casos de alergia ao contraste ou contra indicação ao exame. O exame é não invasivo e pode melhorar não somente a avaliação dos pacientes nos dias de hoje como aumenta possibilidades em futuros estudos e tratamentos da oclusão da artéria retiniana.