CEFALIUM-INDUCED BILATERAL TRANSIENT MYOPIA, RETINAL FOLDS, AND FOCAL CHOROIDAL DELAY.

PURPOSE: To describe a case of acute bilateral transient myopia, retinal folds, and island of choroidal delay associated with oral administration of Cefalium, a medication commonly prescribed in Brazil for migraine that combines acetaminophen 500 mg, caffeine 40 mg, dihydroergotamine mesylate 1 mg, and metoclopramide hydrochloride 10 mg. METHODS: A 21-year-old woman with bilateral blurred vision 1 day after the use of Cefalium. The main outcomes measures were BCVA, ocular fundus, ocular coherence tomography, and angiography findings. RESULTS: The patient developed bilateral myopia, retinal folds, and focus choroidal delay 1 day after the administration of oral cefalium. Ocular fundus examination and ocular coherence tomography revealed retinal folds in the internal surface of the retina. Angiography showed focus areas of hypofluorescence in both eyes. Seven days after Cefalium was suspended, all clinical symptoms had resolved, with full recovery from the abnormal findings on ocular fundus, ocular coherence tomography, and angiography. CONCLUSION: This is the first report that identified and described bilateral transient myopia, retinal folds, and focus choroidal delay secondary the use of Cefalium.

Congenital simple hamartoma of the retinal pigment epithelium: a case report.

We report the case of a 56-year-old woman who presented for a routine ophthalmological examination without visual symptoms and had a unilateral black retinal lesion that was detected by clinical examination. Fluorescein angiography and optical coherence tomography findings were compatible with a congenital simple hamartoma of the retinal pigment epithelium. It is very important to detect this tumor and differentiate it from other pigmented fundus lesions that can compromise visual function or result in systemic conditions such as those caused by malignant tumors.

Congenital simple hamartoma of the retinal pigment epithelium: a case report / Hamartoma congênito simples do epitéilo pigmentado da retina: relato de caso

We report the case of a 56-year-old woman who presented for a routine ophthalmological examination without visual symptoms and had a unilateral black retinal lesion that was detected by clinical examination. Fluorescein angiography and optical coherence tomography findings were compatible with a congenital simple hamartoma of the retinal pigment epithelium. It is very important to detect this tumor and differentiate it from other pigmented fundus lesions that can compromise visual function or result in systemic conditions such as those caused by malignant tumors.

Relato de um caso de paciente feminina de 56 anos que compareceu a uma consulta oftalmológica de rotina sem sintomas visuais e apresentando uma lesão retiniana preta, unilateral, detectada ao exame clínico. As características da angiografia fluoresceínica e da tomografia de coerência óptica foram compatíveis com hamartoma congênito simples do epitélio pigmentado da retina. É muito importante detectar este tumor e diferenciá-lo de outras lesões fundoscópicas pigmentadas que podem comprometer a função visual ou, além disso, afetar o paciente sistemicamente como em tumores malignos.

[Optical coherence tomography to evaluate peripapillary retinal nerve fiber layer in chloroquine patients]. / Tomografia de coerência óptica na avaliação da camada de fibras nervosas peripapilar nos usuários de cloroquina.

PURPOSE: To evaluated the retinal nerve fiber layer in chloroquine patients with optical coherence tomography (OCT). METHODS: Nerve fibers layer thickness was measured by a proprietary OCT Stratus through the fast retinal nerve fiber layer protocol in ninety-four eyes of 48 patients exposed to chloroquine for at least one year with no apparent macular disorder. Cumulative dose, maximum daily dose (mg/kg/day) and time of chloroquine use were correlated with the retinal nerve fiber layer thickness. Data were compared with a control group of 30 patients who did not use chloroquine. All patients underwent a complete ophthalmologic examination including visual acuity, refraction, intraocular pressure, fundoscopy, angiography and measurement of cup-to-disc ratio. RESULTS: The average thickness of retinal nerve fiber layer between antimalaric users (107.60 +/- 13.25 microm) and the control group (99.05 +/- 13.08 microm) had a statistically significant difference (p=0.0137). Furthermore, a positive association of the peripapillary thickness measurements between temporal, upper and lower quadrants of both groups was found. Twelve clock hours retinal nerve fiber layer analysis detected at least one focal defect in more than 50% of the medication users. Particularly, a statistical correlation with the maximum daily dose was found in patients with focal defects (p=0.0120). CONCLUSION: Optical coherence tomography is effective in detecting nerve fiber layer loss in chloroquine patients without apparent fundus changes. Thus, optical coherence tomography may contribute to the early diagnosis of chloroquine retinopathy.

Tomografia de coerência óptica na avaliação da camada de fibras nervosas peripapilar nos usuários de cloroquina / Optical coherence tomography to evaluate peripapillary retinal nerve fiber layer in chloroquine patients

OBJETIVO: Analisar a camada de fibras nervosas nos usuários de cloroquina com a tomografia de coerência óptica (OCT). MÉTODOS: A espessura da camada de fibras nervosas foi mensurada pelo Stratus OCT® através do protocolo scan rápido da camada de fibras nervosas em 94 olhos de 48 pacientes usuários de cloroquina a pelo menos um ano e sem alteração macular aparente. A dose cumulativa e dose diária máxima (mg/kg/dia) e o tempo de uso da cloroquina foram correlacionadas com a espessura da camada de fibras nervosas. Os dados formam comparados com um grupo controle de 30 pacientes não usuários de cloroquina. Todos os pacientes foram submetidos a um exame oftalmológico completo incluindo medida da acuidade visual, refração, pressão intraocular, fundoscopia, retinografia e medida da escavação de papila. RESULTADOS: Comparação entre a média da espessura da camada de fibras nervosas entre usuários do antimalárico (107,60 ± 13,25 µm) e o grupo controle (99,05 ± 13,08 µm) teve uma associação estatisticamente significativa (p=0,0137). Também foi encontrada essa associação entre os quadrantes temporal, superior e inferior da camada de fibras nervosas peripapilar dos dois grupos. Ao analisar a camada de fibras nervosas através das 12 h do relógio detectou-se pelo menos um defeito focal em mais de 50 por cento dos usuários da medicação. Nos pacientes com o defeito focal foi observado uma relação com a dose diária máxima (p=0,0120). CONCLUSÃO: A tomografia de coerência óptica demonstrouse eficaz na detecção da diminuição da camada de fibras nervosas em usuários de cloroquina sem alterações fundoscópicas aparentes. Dessa forma, a tomografia de coerência óptica pode contribuir para o diagnóstico mais precoce da retinopatia por cloroquina.

PURPOSE: To evaluated the retinal nerve fiber layer in chloroquine patients with optical coherence tomography (OCT). METHODS: Nerve fibers layer thickness was measured by a proprietary OCT Stratus® through the fast retinal nerve fiber layer protocol in ninety-four eyes of 48 patients exposed to chloroquine for at least one year with no apparent macular disorder. Cumulative dose, maximum daily dose (mg/kg/day) and time of chloroquine use were correlated with the retinal nerve fiber layer thickness. Data were compared with a control group of 30 patients who did not use chloroquine. All patients underwent a complete ophthalmologic examination including visual acuity, refraction, intraocular pressure, fundoscopy, angiography and measurement of cup-to-disc ratio. RESULTS: The average thickness of retinal nerve fiber layer between antimalaric users (107.60 ± 13.25 µm) and the control group (99.05 ± 13.08 µm) had a statistically significant difference (p=0.0137). Furthermore, a positive association of the peripapillary thickness measurements between temporal, upper and lower quadrants of both groups was found. Twelve clock hours retinal nerve fiber layer analysis detected at least one focal defect in more than 50 percent of the medication users. Particularly, a statistical correlation with the maximum daily dose was found in patients with focal defects (p=0.0120). CONCLUSION: Optical coherence tomography is effective in detecting nerve fiber layer loss in chloroquine patients without apparent fundus changes. Thus, optical coherence tomography may contribute to the early diagnosis of chloroquine retinopathy.

[Antiphospholipid syndrome and bilateral retinal artery and vein occlusion: case report]. / Síndrome do anticorpo antifosfolípide causando oclusão bilateral de artérias e veias centrais da retina: relato de caso.

The antiphospholipid syndrome (APS) has been related to venous and arterial thrombosis of large and small vessels. Ocular vessels can also be involved causing transient visual loss, diplopia, ischemic optic neuropathy and central artery and venous occlusion. We describe here a case of antiphospholipid syndrome with occlusion of central retinal artery and vein to call the attention to this diagnosis.

Síndrome do anticorpo antifosfolípide causando oclusão bilateral de artérias e veias centrais da retina: relato de caso / Antiphospholipid syndrome and bilateral retinal artery and vein occlusion: case report

A síndrome do anticorpo antifosfolípide (SAF) tem sido associada a trombose de vasos arteriais e periféricos e de grande ou pequeno calibre. Também os vasos oculares estão sujeitos à ação destes auto-anticorpos que podem promover o aparecimento de perda visual transitória, diplopia, neuropatia óptica isquêmica e oclusão de artéria ou veia da retina. É descrito aqui, um caso de síndrome do anticorpo antifosfolípide com oclusão de vasos centrais arteriais e venosos da retina no intuito de chamar a atenção para este tipo de diagnóstico.

The antiphospholipid syndrome (APS) has been related to venous and arterial thrombosis of large and small vessels. Ocular vessels can also be involved causing transient visual loss, diplopia, ischemic optic neuropathy and central artery and venous occlusion. We describe here a case of antiphospholipid syndrome with occlusion of central retinal artery and vein to call the attention to this diagnosis.