Closure of stage 2 macular hole with a low-dose intravitreal injection of perfluoropropane.

BACKGROUND: Idiopathic macular holes (IMH) are common and affect central vision. We demonstrate the effectiveness of 0.2 ml intravitreal perfluoropropane (C3F8) in Stage-2 IMH. CASE: A 61-year-old woman presented with blurred vision OD. Best-corrected visual acuity (BCVA) was 20/125 OD and 20/20 OS. Biomicroscopy of OD evidenced a Stage-2 IMH. Intravitreal C3F8 was injected and postural measures prescribed. Optical coherence tomography 1 week after revealed posterior vitreous detachment and vitreomacular traction resolution. Full anatomical and functional recovery was achieved at week 4 and remained stable during a 6-month follow-up (BCVA 20/20 OD). CONCLUSION: Intravitreal C3F8 as initial therapy for Stage 2 IMH represents a good alternative to vitrectomy for patients with IMH.

INTRODUCCIÓN: Los agujeros maculares idiopáticos (AMI) son comunes y afectan la visión central. Demostramos la efectividad de 0.2 ml de perfluoropropano (C3F8) intravítreo en AMI en estadio 2. CASO: Una mujer de 61 años presentó con visión borrosa súbita OD. Mejor agudeza visual corregida (MAVC) 20/125 OD y 20/20 en el OS. La biomicroscopía del OD evidenció un AMI en estadio 2. Se inyectó C3F8 intravítreo y se prescribieron medidas posturales. Una semana después, la tomografía de coherencia óptica reveló desprendimiento de vítreo posterior. La resolución de tracción vitreomacular con recuperación anatómica y funcional completa se logró a la semana 4 y se mantuvo estable durante un seguimiento de 6 meses (MAVC 20/20 OD). CONCLUSIÓN: El C3F8 intravítreo como terapia inicial para AMI en estadio 2 representa una buena alternativa a la vitrectomía vía pars plana en pacientes con AMI.

Effect of macular hole volume on postoperative central macular thickness.

PURPOSE: To evaluate the association between macular hole volume (MHV) and postoperative central macular thickness (CMT) using spectral-domain optical coherence tomography (SD-OCT). METHODS: Thirty-three eyes of 30 patients with a large full-thickness idiopathic macular hole with or without vitreomacular traction who underwent surgical intervention were included in this cross-sectional study. Complete ophthalmological examination, including SD-OCT, was performed for all participants during the pre- and postoperative visits. MHV was preoperatively measured using SD-OCT, which captured the widest cross-sectional image of the hole. For normal distribution analysis of the data, the Kolmogorov-Smirnov test was performed, and for statistical analyses, chi-square, Student's t-test, Mann-Whitney U test, and Pearson's correlation coefficient test were performed. RESULTS: Mean preoperative best-corrected visual acuity (BCVA) and MHV were found to be 0.99 ± 0.36 (range, 0.3-2.0) logMAR and 0.139 ± 0.076 (range, 0.004-0.318) mm3, respectively. Mean follow-up was 16.3 ± 14.3 (range, 3-50) months. No statistical correlations were found between MHV and postoperative BCVA (p=0.588) and between MHV and disease recurrence (p=0.544). A weak negative correlation existed between MHV and final CMT scores (p=0.04, r=-0.383). CONCLUSIONS: Greater MHV was found to be weakly associated with lower postoperative CMT scores.

Effect of macular hole volume on postoperative central macular thickness / O efeito do volume de buraco macular da espessura macular central pós-operatória

ABSTRACT Purpose: To evaluate the association between macular hole volume (MHV) and postoperative central macular thickness (CMT) using spectral-domain optical coherence tomography (SD-OCT). Methods: Thirty-three eyes of 30 patients with a large full-thickness idiopathic macular hole with or without vitreomacular traction who underwent surgical intervention were included in this cross-sectional study. Complete ophthalmological examination, including SD-OCT, was performed for all participants during the pre- and postoperative visits. MHV was preoperatively measured using SD-OCT, which captured the widest cross-sectional image of the hole. For normal distribution analysis of the data, the Kolmogorov-Smirnov test was performed, and for statistical analyses, chi-square, Student's t-test, Mann-Whitney U test, and Pearson's correlation coefficient test were performed. Results: Mean preoperative best-corrected visual acuity (BCVA) and MHV were found to be 0.99 ± 0.36 (range, 0.3-2.0) logMAR and 0.139 ± 0.076 (range, 0.004-0.318) mm3, respectively. Mean follow-up was 16.3 ± 14.3 (range, 3-50) months. No statistical correlations were found between MHV and postoperative BCVA (p=0.588) and between MHV and disease recurrence (p=0.544). A weak negative correlation existed between MHV and final CMT scores (p=0.04, r=-0.383). Conclusions: Greater MHV was found to be weakly associated with lower postoperative CMT scores.

RESUMO Objetivo: Avaliar a relação entre o volume do buraco macular (MHV) e a espessura macular central pós-operatória (CMT) por meio da tomografia de coerência óptica de domínio espectral (SD-OCT). Método: Trinta e três olhos de 30 pacientes com buracos maculares idiopáticos de espessura total grandes, com ou sem tração vitreorretiniana, que foram submetidos a intervenção cirúrgica foram incluídos neste estudo transversal. O exame oftalmológico completo, incluindo SD-OCT foi realizado nas visitas pré e pós-operatórias de todos os participantes. MHV foi medido a partir da imagem de SD-OCT pré-operatória que capturou a imagem mais larga da secção transversal do buraco. Após a análise distribuição nomral da população do estudo ter sido realizada com o teste Kolmogorov-Smirnov, os testes de qui-quadrado, t de Student, Mann-Whitney U e teste de correlação de Pearson foram utilizados para as estatísticas. Resultados: As médias pré-operatórias da melhor acuidade visual corrigida (BCVA) e MHV foram 0,99 ± 0,36 logMAR (variação de 0,3-2,0) e 0,139 ± 0,076 mm3 (variação de 0,004-0,318). O seguimento médio foi de 16,3 ± 14,3 meses (variação de 3-50). Não foram encontradas correlações estatísticas entre MHV e BCVA pós-operatória (p=0,588), bem como MHV e recorrência da doença (p=0,544). Uma fraca correlação negativa estava presente entre MHV e pontuações finais CMT (p=0,04, r=-0,383). Conclusões: Maior MHV foi fracamente relacionado com CMT mais baixo, no pós-operatório.

[Bilateral spontaneously reattached rhegmatogenous retinal detachment. Case report and differential diagnosis with pigmentary retinopathies]. / Desprendimiento bilateral de retina regmatógeno con resolución espontánea. Informe de un caso y diagnóstico diferencial con retinopatías pigmentarias.

BACKGROUND: A dark pigmentation of the ocular fundus presents in degenerative diseases such as retinitis pigmentosa; this disease must be distinguished from others whose evolution is not progressive, in order to estimate the functional prognosis of the patient. OBJECTIVE: To analyze the features which distinguish spontaneously reattached retinal detachment from other causes of ocular fundus pigmentation, in order to be able to identify it even in bilateral cases. CLINICAL CASE: A case of a female with chronic visual loss is presented, who was referred for evaluation with the diagnosis of a pigmented retinopathy. Clinical exploration discarded causes as retinitis pigmentosa, retinal inflammatory diseases or trauma. Based on the clinical features, on the topography of pigmentation and in the information provided by electroretinography, a bilateral spontaneous reattachment of rhegmatogenous retinal detachment was diagnosed made. Clinical features of this entity are discussed, as well as the diagnostic approach to distinguish it from other pigment retinopathies. CONCLUSION: Clinical features of spontaneously reattached retinal detachment allow the explorer to distinguish it from other causes of bilateral pigmentation, despite presenting bilaterally. Since the prognosis of the attached retina is better than that of a degenerative disease, the correct diagnosis makes rehabilitation easier.

Antecedentes: la pigmentación oscura en el fondo del ojo aparece en enfermedades degenerativas, como la retinosis pigmentaria; para poder estimar el pronóstico funcional del paciente esta afección debe distinguirse de otras de evolución no progresiva. En el desprendimiento de retina regmatógeno con resolución espontánea puede existir pigmentación oscura, pero es infrecuente que sea bilateral. Objetivo: analizar las características que distinguen al desprendimiento de la retina con resolución espontánea de otras causas de pigmentación en el fondo del ojo, para poder identificarlo también en casos bilaterales. Caso clínico: paciente femenina con baja visual crónica, referida para evaluación por una retinopatía pigmentaria bilateral. En la exploración clínica se descartaron causas como: retinosis pigmentaria, enfermedades inflamatorias de la retina y traumatismo. Por las características clínicas, la localización de la pigmentación y la información del electrorretinograma se integró el diagnóstico de desprendimiento de la retina regmatógeno, con resolución espontánea bilateral. Se discuten las características clínicas de esta enfermedad y el abordaje diagnóstico para distinguirlo de otras retinopatía pigmentarias. Conclusiones: las características clínicas del desprendimiento de retina con resolución espontánea permiten diferenciarlo de otras causas de pigmentación retiniana, aunque la presentación sea bilateral. El pronóstico de la retina no desprendida es mejor que en una enfermedad degenerativa, por lo que el diagnóstico correcto facilita la rehabilitación.

Fechamento espontâneo de buraco de mácula em olhos previamente vitrectomizados: relato de dois casos / Spontaneous closure of macular hole after pars plana vitrectomy: report of two cases

O fechamento espontâneo de buraco de mácula de espessura total é um fenômeno raro, especialmente em olhos vitrectomizados. Descrevemos nesse relato dois casos com essa apresentação. No primeiro caso, notou-se o buraco de mácula 1 mês após vitrectomia por membrana epirretiniana e, no segundo, 3 semanas após vitrectomia por descolamento de retina regmatogênico. O fechamento desses buracos ocorreu espontaneamente 2 meses e 1 mês após sua documentação, respectivamente. Feita a revisão bibliográfica e propostas teorias para explicar esta evolução atípica, o entendimento deste fenômeno pôde nos ajudar a refinar a indicação cirúrgica desta patologia.

The spontaneous closure of a full-thickness macular hole (MH) developed after vitrectomy is very uncommon. We report a small series of cases (two patients) with this presentation. The first patient developed a MH 1 month after vitrectomy for an epirrretinal membrane and, the second one, 3 weeks after vitrectomy for rhegmatogenous retinal detachment. The MHs resolved spontaneously 2 months and 1 month after their documentation by optical coherence tomography(OCT), respectively. In this case report, we review the literature on spontaneous closure of MHs and discuss possible mechanisms for this rare event.

[Giant retinal tears treated with lens sparing, bimanual 23 g vitrectomy without scleral buckle]. / Desgarros retinianos gigantes tratados con vitrectomía calibre 23, abordaje bimanual, sin cercaje escleral y sin tocar el cristalino.

BACKGROUND: A giant retinal tear is defined as a full thickness break in the neurosensory retina that extends circumferentially for 3 or more clock hours around the retina in the presence of a posterior vitreous detachment. It is one of the more complex surgical scenarios that a retina surgeon can face. There is no consensus on the ideal surgical technique; however, the "traditional" approach has been to perform a combined procedure including lensectomy, scleral buckle and vitrectomy. OBJECTIVE: To report the outcome over 2 years of five patients with giant retinal tears managed with lens sparing, bimanual 23-gauge vitrectomy without scleral buckle. METHODS: Retrospective analysis of patients with giant retinal tears managed with lens sparing, bimanual 23-gauge vitrectomy without scleral buckle. Included in the analysis were age, lens status, etiology and size of the tear, pre- and postoperative visual acuity, anatomic success, tamponade used, laser or criopexy where recorded. RESULTS: Three patients had high myopia, one secondary to blunt trauma and one with Wagner-Stickler syndrome were included in the analysis. The size of the tear varied from 120-280°. Anatomic success was achieved in all patients. One patient developed proliferative vitreoretinopathy and was re-operated and the retina remained attached. CONCLUSIONS: In this group of selected patients, lens-sparing bimanual 23-gauge vitrectomy without scleral buckle seems a safe and effective option in the management of retinal detachment associated with giant retinal tears. Further prospective and comparative studies are warranted to establish the role of this technique in the treatment of patients with this complex pathology.

Antecedentes: el desgarro retiniano gigante es la rotura del espesor total de la retina neurosensorial con extensión circunferencial de 3 o más husos horarios aunado a desprendimiento de vítreo posterior, y constituye uno de los escenarios quirúrgicos más complejos para el cirujano de retina y vítreo. No existe consenso en cuanto a su manejo; sin embargo, tradicionalmente se ha empleado un abordaje que combina lensectomía, cerclaje y vitrectomía. Objetivo: reportar la evolución a dos años de 5 pacientes con desgarro gigante tratados con vitrectomía 23 g, abordaje bimanual, sin lensectomía y sin cerclaje escleral. Material y métodos: estudio descriptivo, retrospectivo de pacientes con desgarro retiniano gigante, tratados con vitrectomía 23 g, abordaje bimanual, sin lensectomía ni cerclaje escleral. Se estudiaron la edad, estado del cristalino, etiología y extensión del desgarro, agudeza visual, resultado anatómico, taponamiento usado, criopexia o láser. Resultados: se incluyeron 3 pacientes con miopía alta, 1 con traumatismo contuso y 1 con síndrome de Wagner-Stickler. La extensión del desgarro fue de 120 a 280°. Todos con éxito anatómico y mejoría de la agudeza visual. Un paciente con vitreorretinopatía proliferativa se reintervino y la retina permaneció aplicada hasta el final del periodo analizado. Conclusiones: en este selecto grupo de pacientes la vitrectomía calibre 23 con abordaje bimanual, sin cerclaje escleral y sin tocar el cristalino, dio buenos resultados anatómicos y visuales en un seguimiento a dos años. Para establecer el papel que corresponde a esta técnica en el tratamiento de esta compleja patología se requieren estudios prospectivos y comparativos.

Macular hole: 10 and 20-MHz ultrasound and spectral-domain optical coherence tomography / Buraco macular: ultrassonografia de 10 e 20 MHz e tomografia óptica de domínio espectral

PURPOSE: Optical coherence tomography (OCT) is valuable for macula evaluation. However, as this technique relies on light energy it cannot be performed in the presence of opaque media. In such cases, the ultrasound (US) may predict some macular features. The aim of this study was to characterize images obtained by ultrasound with 10 and 20-MHz transducers comparing to OCT, as well as to analyze the relationship between the vitreous and retina in eyes with macular hole (MH). METHODS: 29 eyes of 22 patients with biomicroscopic evidence of MH at different stages were included. All patients were evaluated using ultrasonography with 10 and 20-MHz transducers and OCT. RESULTS: OCT identified signs of MH in 25 of 29 eyes. The remaining 4 cases not identified by US were pseudoholes caused by epiretinal membranes. In MH stages I (2 eyes) and II (1 eye), both transducers were not useful to analyze the macular thickening, but suggestive findings as macular irregularity, operculum or partial posterior vitreous detachment (PVD) were highlighted. In stages III (14 eyes) and IV (5 eyes), both transducers identified the double hump irregularity and thickening. US could measure the macular thickness and other suggestive findings for MH: operculum, vitreomacular traction and partial or complete PVD. In cases of pseudoholes, US identified irregularities macular contour and a discrete depression. CONCLUSION: 10-MHz US was useful for an overall assessment of the vitreous body as well as its relationship to the retina. The 20-MHz transducer allowed valuable information on the vitreomacular interface and macular contour. OCT provides superior quality for fine morphological study of macular area, except in cases of opaque media. In these cases, and even if OCT is not available, the combined US study is able to provide a valid evaluation of the macular area improving therapeutic approach.

OBJETIVO: A tomografia de coerência óptica (OCT) é um método diagnóstico valioso para estudo da mácula. Entretanto, por se basear na energia luminosa, não pode ser realizada quando existe opacidade de meios. Nesses casos, o ultrassom (US) pode predizer algumas características maculares. Este estudo teve como objetivos caracterizar imagens obtidas por US com transdutores de 10 e 20-MHz comparadas ao OCT, assim como analisar a relação vitreorretiniana em olhos com buraco macular (BM). MÉTODOS: Vinte e nove olhos de 22 pacientes com evidência biomicroscópica de BM em diferentes estágios foram incluídos. Todos os pacientes foram avaliados com ultrassonografia utilizando transdutores de 10 e 20-MHz e OCT de domínio espectral. RESULTADOS: OCT diagnosticou BM em 25 dentre 29 olhos estudados. Os 4 casos não identificados por US eram pseudoburacos decorrentes de membrana epirretiniana. Nos BM estágios I (2 olhos) e II (1 olho), ambos transdutores não foram úteis para analisar o espessamento macular, mas foram identificados sinais sugestivos como irregularidade macular, opérculo ou descolamento parcial do vítreo posterior (DVP). Nos estágios III (14 olhos) e IV (5 olhos), ambos transdutores identificaram irregularidade, dupla corcova e espessamento macular. O US foi capaz de medir a espessura macular e identificar outros indícios de BM, como opérculo, tração vitreorretiniana e DVP. Em pseudoburacos, o US identificou irregularidades no contorno macular e discreta depressão. CONCLUSÃO: US de 10-MHz foi útil para uma avaliação global do corpo vítreo e sua relação à retina. O US de 20-MHz forneceu informações importantes sobre a junção vitreorretiniana e contorno macular. OCT fornece qualidade superior para estudo morfológico da região macular, exceto em casos de opacidade de meios. Nesses casos, ou quando o exame tomográfico não for disponível, o estudo ultrassonográfico de 10 e 20-MHz é capaz de proporcionar análise válida da região macular e auxiliar na abordagem terapêutica.

Macular hole: 10 and 20-MHz ultrasound and spectral-domain optical coherence tomography.

PURPOSE: Optical coherence tomography (OCT) is valuable for macula evaluation. However, as this technique relies on light energy it cannot be performed in the presence of opaque media. In such cases, the ultrasound (US) may predict some macular features. The aim of this study was to characterize images obtained by ultrasound with 10 and 20-MHz transducers comparing to OCT, as well as to analyze the relationship between the vitreous and retina in eyes with macular hole (MH). METHODS: 29 eyes of 22 patients with biomicroscopic evidence of MH at different stages were included. All patients were evaluated using ultrasonography with 10 and 20-MHz transducers and OCT. RESULTS: OCT identified signs of MH in 25 of 29 eyes. The remaining 4 cases not identified by US were pseudoholes caused by epiretinal membranes. In MH stages I (2 eyes) and II (1 eye), both transducers were not useful to analyze the macular thickening, but suggestive findings as macular irregularity, operculum or partial posterior vitreous detachment (PVD) were highlighted. In stages III (14 eyes) and IV (5 eyes), both transducers identified the double hump irregularity and thickening. US could measure the macular thickness and other suggestive findings for MH: operculum, vitreomacular traction and partial or complete PVD. In cases of pseudoholes, US identified irregularities macular contour and a discrete depression. CONCLUSION: 10-MHz US was useful for an overall assessment of the vitreous body as well as its relationship to the retina. The 20-MHz transducer allowed valuable information on the vitreomacular interface and macular contour. OCT provides superior quality for fine morphological study of macular area, except in cases of opaque media. In these cases, and even if OCT is not available, the combined US study is able to provide a valid evaluation of the macular area improving therapeutic approach.

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

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

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

[Clinical and tomographic aspects of macular microholes]. / Aspectos clínicos e tomográficos dos microburacos maculares.

PURPOSE: To describe the clinical aspects and evaluate optical coherence tomography of macular microholes. METHODS: Seven patients were assessed (8 eyes) with microholes of the macula. All patients underwent complete eye examination, fundus photography, fluorescent angiography and OCT-3 imaging. RESULTS: Ages ranged from 26 to 69 years. Six patients were female (85.7%) and five of them had microhole in the right eye. The presenting symptom was decrease in visual acuity (71.3%) and central scotoma in (14.3%). Five eyes (71.4%) had no defects shown by fluorescent angiography. A defect in the outer retina was demonstrated in all eyes on optical coherence tomography. The lesions were nonprogressive. CONCLUSION: Macular microholes are small lamellar defects in the outer retina. The condition is nonprogressive, generally unilateral and compatible with good visual acuity. Fundus biomicroscopy associated with an optical coherence tomography are the main elements in the diagnosis and study of this pathology.

Aspectos clínicos e tomográficos dos microburacos maculares / Clinical and tomographic aspects of macular microholes

OBJETIVO: Descrever os aspectos clínicos e tomográficos do microburaco macular. MÉTODOS: Estudaram-se pacientes portadores de microburaco macular de forma retrospectiva e observacional. Apurou-se história clínica, medida de acuidade visual, biomicroscopia de polo posterior, retinografia, angiofluoresceinografia retiniana e tomografia de coerência óptica. RESULTADOS: Examinaram-se oito olhos de sete pacientes portadores de microburaco macular. A idade variou entre 26 e 63 anos (média de 48,8 anos). Seis pacientes eram do sexo feminino (85,7 por cento). Cinco pacientes apresentaram o microburaco macular no olho direito (62,5 por cento). Quanto à sintomatologia, cinco indivíduos referiram diminuição da acuidade visual (71,4 por cento), um referiu escotoma central (14,3 por cento) e um não apresentou queixas visuais (14,3 por cento). A angiofluoresceinografia retiniana não mostrou alterações maculares em cinco dos olhos (71,4 por cento). À tomografia de coerência óptica, os oito olhos apresentaram uma lesão foveal hiporrefletiva e menor do que 100 micra, que acometia as camadas mais profundas da retina neurossensorial. CONCLUSÃO: Microburaco macular é um pequeno defeito lamelar presente na camada externa profunda da retina, que é evidente à biomicroscopia macular como uma lesão arredondada avermelhada de tamanho diminuto, levando a pouca repercussão na função visual, sem caráter progressivo. A história clínica, a acuidade visual, a biomicroscopia de fundo e a tomografia de coerência óptica são os principais elementos para a detecção e o estudo dos mecanismos fisiopatológicos responsáveis pela sua origem e evolução.

PURPOSE: To describe the clinical aspects and evaluate optical coherence tomography of macular microholes. METHODS: Seven patients were assessed (8 eyes) with microholes of the macula. All patients underwent complete eye examination, fundus photography, fluorescent angiography and OCT-3 imaging. RESULTS: Ages ranged from 26 to 69 years. Six patients were female (85.7 percent) and five of them had microhole in the right eye. The presenting symptom was decrease in visual acuity (71.3 percent) and central scotoma in (14.3 percent). Five eyes (71.4 percent) had no defects shown by fluorescent angiography. A defect in the outer retina was demonstrated in all eyes on optical coherence tomography. The lesions were nonprogressive. CONCLUSION: Macular microholes are small lamellar defects in the outer retina. The condition is nonprogressive, generally unilateral and compatible with good visual acuity. Fundus biomicroscopy associated with an optical coherence tomography are the main elements in the diagnosis and study of this pathology.

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

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

Management of traumatic macular holes: case report.

Traumatic macular hole is a disease whose pathogenesis is not fully understood and the best treatment guideline is controversial. We report 2 cases of traumatic macular hole with different treatment approaches. In the first case, a 9-year-old boy presented with a traumatic macular hole secondary to blunt ocular trauma with a stone, and initial vision of 20/300. He underwent surgical repair and his final vision was 20/70 with hole closure after a 1 year follow-up. In the second case, a 20-year-old woman suffered a penetrating bullet wound on the left side of her forehead. The injury caused optic nerve head avulsion in the left eye with loss of light perception. The right eye had a traumatic macular hole and signs suggestive of sclopetaria chorioretinitis, with 20/60 vision. This case was initially observed and vision improved to 20/30 with reduction of the hole diameter. Vision and hole diameter remained stable after 8 months.

Management of traumatic macular holes: case report / Tratamento do buraco macular traumático: relato de caso

Traumatic macular hole is a disease whose pathogenesis is not fully understood and the best treatment guideline is controversial. We report 2 cases of traumatic macular hole with different treatment approaches. In the first case, a 9-year-old boy presented with a traumatic macular hole secondary to blunt ocular trauma with a stone, and initial vision of 20/300. He underwent surgical repair and his final vision was 20/70 with hole closure after a 1 year follow-up. In the second case, a 20-year-old woman suffered a penetrating bullet wound on the left side of her forehead. The injury caused optic nerve head avulsion in the left eye with loss of light perception. The right eye had a traumatic macular hole and signs suggestive of sclopetaria chorioretinitis, with 20/60 vision. This case was initially observed and vision improved to 20/30 with reduction of the hole diameter. Vision and hole diameter remained stable after 8 months.

O buraco macular traumático é doença cuja patogênese não é totalmente esclarecida e a melhor conduta terapêutica ainda é controversa. Relatamos 2 casos de buraco macular traumático para os quais adotamos condutas diferentes. No primeiro caso, um menino de 9 anos apresentou buraco macular traumático secundário a trauma ocular contuso com uma pedra, com visão inicial de 20/300. Foi submetido a tratamento cirúrgico e obteve visão final igual a 20/70 com buraco fechado após 1 ano de seguimento. No segundo caso, mulher de 20 anos sofreu traumatismo penetrante por projétil de arma de fogo na fronte, do lado esquerdo. O trauma causou avulsão do nervo óptico no olho esquerdo com perda de percepção luminososa neste olho. No olho direito apresentou buraco macular traumático e sinais sugestivos de coriorretinite esclopetária, com acuidade visual igual a 20/60. O caso foi inicialmente observado e a visão melhorou para 20/30 com diminuição do diâmetro do buraco. A visão e o diâmetro do buraco mantiveram-se estáveis por 8 meses.

[Functional outcome and macular index in macular hole patients who underwent surgery with internal limiting membrane removal]. / Resultado funcional e índice macular em portadores de buraco macular submetidos à cirurgia com remoção da membrana limitante interna.

PURPOSE: To evaluate the functional outcome and macular index in patients with macular hole who underwent surgery with internal limiting membrane removal. METHODS: Fifteen eyes of 15 patients with idiopathic macular hole stages 2, 3 or 4 were enrolled in this study. All patients underwent conventional macular hole surgery with trypan blue staining to remove the internal limiting membrane. The best-corrected visual acuity and cross-sectional images of macular hole measured by optical coherence tomography (OCT) were evaluated pre- and postoperatively. The macular hole index (ratio of hole height to base diameter of the hole) was calculated and correlated with minimum diameter of the macular hole and postoperative gain in visual acuity. RESULTS: Macular hole closure was observed in all operated patients. In 86.7%, there was a visual gain of at least three lines. Macular hole index was significantly negative correlated with the minimum diameter of the macular hole (r=0.811). There was no significant correlation between macular index and postoperative gain in visual acuity (r=0.351). CONCLUSION: Functional outcomes with internal limiting membrane removal were good in this group of patients. Macular index was compatible with spatial configuration of the macular hole, however visual outcomes were not predictable.

Resultado funcional e índice macular em portadores de buraco macular submetidos à cirurgia com remoção da membrana limitante interna / Functional outcome and macular index in macular hole patients who underwent surgery with internal limiting membrane removal

OBJETIVOS: Avaliar o resultado funcional e o índice macular dos portadores de buraco macular submetidos à cirurgia com remoção da membrana limitante interna. MÉTODOS: Quinze olhos de 15 pacientes com buraco macular estágios 2, 3 e 4 foram incluídos no estudo. Todos foram submetidos à cirurgia de buraco macular convencional com remoção da membrana limitante interna corada pelo azul de tripan. Melhor acuidade visual com correção e cortes transversais medidos por tomografia de coerência óptica (OCT) foram avaliados no pré- e pós-operatório. O índice macular (razão entre a altura e base do buraco macular) foi calculado e correlacionado com o diâmetro mínimo do buraco macular e o ganho de acuidade visual pós-operatória. RESULTADOS: Obteve-se fechamento do buraco macular em todos pacientes operados. Em 86,7 por cento, houve ganho de pelo menos três linhas de visão. O índice macular demonstrou correlação negativa significante com o diâmetro mínimo (r=0,811). Não foi observada correlação significante entre o índice macular e o ganho de acuidade visual pós-operatória (r=0,351). CONCLUSÃO: Os resultados funcionais na cirurgia do buraco macular com remoção da membrana limitante interna foram bons neste grupo de pacientes. O índice macular demonstrou ser compatível com a configuração espacial do buraco macular, porém não foi preditor de resultados visuais.

PURPOSE: To evaluate the functional outcome and macular index in patients with macular hole who underwent surgery with internal limiting membrane removal. METHODS: Fifteen eyes of 15 patients with idiopathic macular hole stages 2, 3 or 4 were enrolled in this study. All patients underwent conventional macular hole surgery with trypan blue staining to remove the internal limiting membrane. The best-corrected visual acuity and cross-sectional images of macular hole measured by optical coherence tomography (OCT) were evaluated pre- and postoperatively. The macular hole index (ratio of hole height to base diameter of the hole) was calculated and correlated with minimum diameter of the macular hole and postoperative gain in visual acuity. RESULTS: Macular hole closure was observed in all operated patients. In 86.7 percent, there was a visual gain of at least three lines. Macular hole index was significantly negative correlated with the minimum diameter of the macular hole (r=0.811). There was no significant correlation between macular index and postoperative gain in visual acuity (r=0.351). CONCLUSION: Functional outcomes with internal limiting membrane removal were good in this group of patients. Macular index was compatible with spatial configuration of the macular hole, however visual outcomes were not predictable.

[Use of anatomical measures of idiopathic macular hole obtained through optical coherence tomography as a predictive factor in visual results: a pilot study]. / Emprego das medidas anatômicas do buraco macular idiopático obtidas pela tomografia de coerência óptica como fator preditivo nos resultados visuais: um estudo piloto.

PURPOSE: To evaluate the anatomy of idiopathic macular hole (IMH) using Optical Coherence Tomography (OCT) and to construct a prognostic index that can be correlated with the visual outcomes and the anatomical closing. METHODS: Prospective study, in which 22 eyes with IMH had been evaluated through OCT in the daily postoperative period of IMH surgery. The Prognostic of Macular Hole Index (PMHI) was created which was correlated with the anatomical result and the postoperative visual acuity (VA) six months after surgery. RESULTS: Sixteen eyes (72.7%) got anatomical closing at the end of six months of follow-up. On analysis of PMHI, there was significant difference between group 1 (open MH) and group 2 (closed MH) (p=0.0018). The risk for failure of anatomical closing is 11 times greater when the diameter of the internal base is over 600 microm or IPBM is less than 0.6 (p=0.0495). Regarding final VA, it was observed that the IPBM had a significant negative correlation with AV (p=0.001). CONCLUSIONS: IPBM showed to be the best predictor of anatomical closing and postoperative visual acuity among the studied variables. It predicted 41% of the postoperative final visual acuity, leading us to believe that other factors, such as the time of history and the degeneration of photoreceptors in these older BM, can be involved in the visual outcomes.

Emprego das medidas anatômicas do buraco macular idiopático obtidas pela tomografia de coerência óptica como fator preditivo nos resultados visuais: um estudo piloto / Use of anatomical measures of idiopathic macular hole obtained through optical coherence tomography as a predictive factor in visual results: a pilot study

OBJETIVO: Avaliar a anatomia do buraco macular idiopático (BMI) a partir da tomografia de coerência óptica (OCT) e construir índice prognóstico que possa ser correlacionado com os resultados visuais e o fechamento anatômico. MÉTODOS: Estudo prospectivo, no qual 22 olhos com BMI foram avaliados pelo OCT no pré-operatório da cirurgia do BMI. Foi criado o índice prognóstico do buraco macular (IPBM) que foi correlacionado com o resultado anatômico e a acuidade visual pós-operatória seis meses após a cirurgia. RESULTADOS: Dezesseis olhos (72,7 por cento) obtiveram fechamento anatômico ao final de seis meses de acompanhamento. Na análise do IPBM, houve diferença significativa entre o grupo 1 (BM aberto) e o grupo 2 (BM fechado) (p=0,0018). O risco de insucesso para o fechamento anatômico é 11 vezes maior quando o diâmetro da base interna for superior a 600 µm ou o IPBM for inferior a 0,6 (p=0,0495). No que diz respeito à AV final, observou-se que o IPBM tem correlação negativa significante na AV (p=0,001). CONCLUSÃO: O IPBM se apresentou como o melhor preditor de fechamento anatômico e acuidade visual pós-operatória entre as variáveis aqui estudadas. Responde por 41 por cento da acuidade visual pós-operatória final, nos levando a crer que outros fatores, como o tempo de história e a degeneração dos fotorreceptores nestes BM mais antigos, possam estar envolvidos nos resultados visuais.

PURPOSE: To evaluate the anatomy of idiopathic macular hole (IMH) using Optical Coherence Tomography (OCT) and to construct a prognostic index that can be correlated with the visual outcomes and the anatomical closing. METHODS: Prospective study, in which 22 eyes with IMH had been evaluated through OCT in the daily postoperative period of IMH surgery. The Prognostic of Macular Hole Index (PMHI) was created which was correlated with the anatomical result and the postoperative visual acuity (VA) six months after surgery. RESULTS: Sixteen eyes (72.7 percent) got anatomical closing at the end of six months of follow-up. On analysis of PMHI, there was significant difference between group 1 (open MH) and group 2 (closed MH) (p=0.0018). The risk for failure of anatomical closing is 11 times greater when the diameter of the internal base is over 600 µm or IPBM is less than 0.6 (p=0.0495). Regarding final VA, it was observed that the IPBM had a significant negative correlation with AV (p=0.001). CONCLUSIONS: IPBM showed to be the best predictor of anatomical closing and postoperative visual acuity among the studied variables. It predicted 41 percent of the postoperative final visual acuity, leading us to believe that other factors, such as the time of history and the degeneration of photoreceptors in these older BM, can be involved in the visual outcomes.

Spontaneous separation in idiopathic vitreomacular traction syndrome associated with contralateral full-thickness macular hole.

PURPOSE: Vitreomacular traction syndrome (VMTS) and full-thickness macular hole are two different well-known entities that on follow-up may be subjected to clinical modifications. Precisely, a spontaneous separation of idiopathic VMTS occurred in three eyes of three patients relieving in addition traction of the posterior hyaloid that had led also to a focal macular retinal pigment epithelial detachment (RPE). An association to a full-thickness macular hole was observed in the contralateral eye of one of the patients. METHODS: This is a retrospective study of three patients evaluated with fluorescein angiography and documented with optical coherence tomography using the Stratus (OCT) model 3000, with scans analysis and protocols analysis, measuring the size and shape of vitreomacular adhesions, macular thickness changes before and after the spontaneous separation of the tractional posterior hyaloid adhesion. In addition, the vitreous was evaluated with contact lens slit lamp biomicroscopy and ultrasound. The associated contralateral macular hole in one of the patients was surgically treated. RESULTS: Two of the three eyes with spontaneous separation of the VMTS recovered 20/25 central visual acuity; the other eye maintained the initial 20/50 visual acuity. The treated macular hole recovered 20/100 corrected visual acuity. CONCLUSIONS: Spontaneous separation of posterior hyaloid is a possible outcome during follow-up of idiopathic VMTS that can be well evaluated and documented with OCT while macular fluorescein angiography may be silent in cases like these presently reported. Central vision recovery can be excellent following the spontaneous separation, which releases anterior-posterior traction including on the retinal pigment epithelium and decreases macular thickness as measured with OCT. Therefore, regarding management, the indication for vitrectomy should be delayed awaiting the spontaneous release of vitreomacular traction in 4 to 6 months. The association between idiopathic VMTS in one eye and full-thickness macular hole in the opposite eye of one patient is an important pathophysiologic consideration.

Quistes maculares nducidos por descarga eléctrica / Macular cyst induced by electric shock

En el presente caso se describe quistes maculares bilaterales secundarios a descarga eléctrica, los cuales fueron diagnosticados por medio de una Tomografía Óptica Coherente y donde se evidencio el diagnóstico diferencial entre quistes maculares y agujeros maculares siendo la OCT una útil herramienta en este caso.