Unequal burden of Zika-associated microcephaly among populations with public and private healthcare in Salvador, Brazil.

OBJECTIVES: To describe the differences in clinical presentation and relative disease burden of congenital Zika syndrome (CZS)-associated microcephaly at 2 large hospitals in Salvador, Brazil that serve patients of different socioeconomic status (SES). METHODS: Clinical and serologic data were collected prospectively from pregnant women and their infants, who delivered at 2 study centers during the 2015-2016 Zika virus (ZIKV) epidemic in Salvador, Brazil. RESULTS: Pregnant women from Salvador, Brazil delivering in a low SES hospital had 3 times higher ZIKV exposure rate than women at a high SES hospital. However, different SES hospitals had similar prevalence of infants with CZS-associated microcephaly (10% vs 6%, p = 0.16) after controlling for ZIKV exposure in their mothers. CONCLUSIONS: Our study supports the positive association between low SES, high maternal ZIKV exposure, and high rates of CZS-associated microcephaly.

An outbreak of forty five cases of Pseudomonas aeruginosa acute endophthalmitis after phacoemulsification / Surto de quarenta e cinco casos de endoftalmite aguda por Pseudomonas aeruginosa após facoemulsificação

PURPOSE: To describe an outbreak of Pseudomonas aeruginosa endophthalmitis post cataract surgery. Clinical findings, treatment and outcome are discussed. METHODS: Clinical charts review of forty-five patients treated for endophthalmitis in a two-day period. The patients underwent primary vitrectomy, anterior chamber irrigation and intravitreous antibiotic injection. Cultures from vitreous and anterior chamber samples were performed in all patients. RESULTS: Forty-five patients (twenty-three men and twenty-two women) were identified. The average age was 71.2 years (range, 56-83 years). The right eye (62%) was affected more often than the left eye (38%). The median interval between surgery and endophthalmitis onset was 5.5 days (range, 5-6 days). The visual acuity at the diagnosis was better than 20/40 in one patient (2%), from 20/40 to 20/200 in one patient (2%), from 20/400 to counting fingers in two patients (4%), hand movements in eleven patients (24%), and light perception in thirty patients (68%). Pseudomonas aeruginosa was the isolated agent in twenty-six vitreous samples and in three anterior chamber samples. Overall, one patient (2%) achieved a final visual acuity better than 20/40; eight patients (18%) achieved a final visual acuity from 20/40 to 20/200; six patients (13%) achieved a final visual acuity from 20/400 to counting fingers; eleven patients (25%) achieved a final acuity of hand movements; thirteen patients (29%) achieved a final acuity of light perception and six (13%) patients had no light perception at the last examination. None of these eyes underwent evisceration or enucleation in a three-month follow-up period. CONCLUSION: Even with all the safety that cataract surgery has achieved, today, endophthalmitis remains a risk and a fearful complication of this procedure. In the present study, it was impossible to identify the source of the outbreak.

OBJETIVO: Descrever surto de endoftalmite por Pseudomonas aeruginosa após facectomia. Os achados clínicos, o tratamento e o resultado são discutidos. MÉTODOS: Revisão dos prontuários de quarenta e cinco pacientes tratados para endoftalmite em um período de dois dias. Todos os pacientes foram tratados por vitrectomia primária, irrigação da câmara anterior e injeção vítrea de antibióticos. Culturas do vítreo e de amostras de câmara anterior foram realizadas em todos os pacientes. RESULTADOS: Quarenta e cinco pacientes (23 homens e 22 mulheres) foram identificados. A idade média foi 71,2 anos (variação, 56-83 anos). O olho direito (62%) foi mais afetado do que o esquerdo (38%). O intervalo médio entre a cirurgia e a apresentação da endoftalmite foi de 5,5 dias (intervalo de 5-6 dias). A acuidade visual no momento do diagnóstico foi melhor que 20/40 em um paciente (2%), de 20/40 a 20/200 em um paciente (2%), de 20/400 para contar dedos em dois pacientes (4%), movimento de mão em onze pacientes (24%), percepção de luz em trinta pacientes (68%). Pseudomonas aeruginosa foi o agente isolado em 26 amostras de vítreo e em três amostras da câmara anterior. No geral, um paciente (2%) obteve acuidade visual final melhor que 20/40, oito pacientes (18%) obtiveram acuidade visual final de 20/40 a 20/200, seis pacientes (13%) obtiveram acuidade visual final de 20/400 para contar os dedos; onze pacientes (25%) obtiveram acuidade visual final de movimento de mão; treze pacientes (29%) obtiveram acuidade visual final de percepção de luz e seis (13%) pacientes não havia percepção luminosa no último exame. Nenhum olho foi submetido à evisceração ou enucleação em três meses de acompanhamento. CONCLUSÃO: Mesmo com toda a segurança da cirurgia de catarata nos dias atuais, endoftalmite permanece um risco e uma complicação temível deste procedimento. No presente estudo não foi possível identificar a fonte do surto.

An outbreak of forty five cases of Pseudomonas aeruginosa acute endophthalmitis after phacoemulsification.

PURPOSE: To describe an outbreak of Pseudomonas aeruginosa endophthalmitis post cataract surgery. Clinical findings, treatment and outcome are discussed. METHODS: Clinical charts review of forty-five patients treated for endophthalmitis in a two-day period. The patients underwent primary vitrectomy, anterior chamber irrigation and intravitreous antibiotic injection. Cultures from vitreous and anterior chamber samples were performed in all patients. RESULTS: Forty-five patients (twenty-three men and twenty-two women) were identified. The average age was 71.2 years (range, 56-83 years). The right eye (62%) was affected more often than the left eye (38%). The median interval between surgery and endophthalmitis onset was 5.5 days (range, 5-6 days). The visual acuity at the diagnosis was better than 20/40 in one patient (2%), from 20/40 to 20/200 in one patient (2%), from 20/400 to counting fingers in two patients (4%), hand movements in eleven patients (24%), and light perception in thirty patients (68%). Pseudomonas aeruginosa was the isolated agent in twenty-six vitreous samples and in three anterior chamber samples. Overall, one patient (2%) achieved a final visual acuity better than 20/40; eight patients (18%) achieved a final visual acuity from 20/40 to 20/200; six patients (13%) achieved a final visual acuity from 20/400 to counting fingers; eleven patients (25%) achieved a final acuity of hand movements; thirteen patients (29%) achieved a final acuity of light perception and six (13%) patients had no light perception at the last examination. None of these eyes underwent evisceration or enucleation in a three-month follow-up period. CONCLUSION: Even with all the safety that cataract surgery has achieved, today, endophthalmitis remains a risk and a fearful complication of this procedure. In the present study, it was impossible to identify the source of the outbreak.

Optical coherence tomography findings in acute phase of branch retinal artery occlusion: case report.

PURPOSE: to report a case of branch retinal artery occlusion in the acute phase, using optical coherence tomography to evaluate the morphologic changes. A 27 year-old man had a sudden superior scotoma in the right eye, with fundus examination compatible with inferior temporal branch retinal artery obstruction. The optical coherence tomography revealed increase in thickness and hyper-reflectivity of the inner retinal layers in affected area, with decreased reflectivity of photoreceptor and retinal pigment epithelial layers. The optical coherence tomography findings are consistent with intracellular edema, and not with secondary vascular leakage of extracellular fluid, according to histopathological theories of retinal ischemia and necrosis that occurs after retinal artery occlusion.

Optical coherence tomography findings in acute phase of branch retinal artery occlusion: case report / Achados da tomografia de coerência óptica na fase aguda da oclusão de ramo da artéria central da retina: relato de caso

PURPOSE: to report a case of branch retinal artery occlusion in the acute phase, using optical coherence tomography to evaluate the morphologic changes. A 27 year-old man had a sudden superior scotoma in the right eye, with fundus examination compatible with inferior temporal branch retinal artery obstruction. The optical coherence tomography revealed increase in thickness and hyper-reflectivity of the inner retinal layers in affected area, with decreased reflectivity of photoreceptor and retinal pigment epithelial layers. The optical coherence tomography findings are consistent with intracellular edema, and not with secondary vascular leakage of extracellular fluid, according to histopathological theories of retinal ischemia and necrosis that occurs after retinal artery occlusion.

O objetivo é demonstrar alterações morfológicas retinianas por meio da tomografia de coerência óptica na oclusão de ramo de artéria central da retina na fase aguda. Homem de 27 anos apresentando escotoma súbito no campo superior de olho direito, com exame fundoscópico compatível com oclusão de ramo ínfero-temporal da artéria central da retina. A tomografia de coerência óptica revelou aumento da espessura e hiperrefletividade das camadas internas da retina, com redução da refletividade das camadas de fotorreceptores e epitélio pigmentar da retina. Os achados na tomografia de coerência óptica são compatíveis com edema intracelular, e não com fluido extracelular secundário a extravasamento vascular, reforçando teorias histopatológicas da isquemia e necrose retiniana, que ocorrem após oclusão arterial retiniana.

Use of topical dorzolamide for patients with X-linked juvenile retinoschisis: case report.

X-linked juvenile retinoschisis (XLRS) is a recessively inherited vitreoretinal degeneration characterized by macular pathology and splitting of the neuroretinal layers that is associated with alterations in the XLRS1 gene. There have been no therapeutic interventions known to be effective for patients with X-linked juvenile retinoschisis, but some studies are trying to determine the importance of dorzolamide for the treatment of foveal lesions in this disease. The authors, using optical coherence tomography, describe findings in a patient with X-linked juvenile retinoschisis, before and after a topical use of dorzolamide. Besides the improvement in his visual acuity, further studies are required to elucidate the real prevalence of nonresponse to dorzolamide and the frequency with which there may be a recurrence of foveal cystic changes during continued treatment.

Use of topical dorzolamide for patients with X-linked juvenile retinoschisis: case report / Uso da dorzolamida tópica em pacientes com retinosquise juvenil ligada ao X: relato de caso

X-linked juvenile retinoschisis (XLRS) is a recessively inherited vitreoretinal degeneration characterized by macular pathology and splitting of the neuroretinal layers that is associated with alterations in the XLRS1 gene. There have been no therapeutic interventions known to be effective for patients with X-linked juvenile retinoschisis, but some studies are trying to determine the importance of dorzolamide for the treatment of foveal lesions in this disease. The authors, using optical coherence tomography, describe findings in a patient with X-linked juvenile retinoschisis, before and after a topical use of dorzolamide. Besides the improvement in his visual acuity, further studies are required to elucidate the real prevalence of nonresponse to dorzolamide and the frequency with which there may be a recurrence of foveal cystic changes during continued treatment.

A retinosquise juvenil ligada ao X (XLRS) é uma degeneração vítreo-retiniana hereditária e recessiva caracterizada por lesão macular e delaminação das camadas de fibras nervosas da retina, que está associada com alterações no gene XLRS1. Nenhuma intervenção terapêutica tem se mostrado efetiva em pacientes com retinosquise juvenil ligada ao X, mas alguns estudos estão tentando determinar a importância da dorzola mida no tratamento das lesões foveais desta doença. Os autores, usando a tomografia de coerência óptica, descrevem os achados em um paciente com retinosquise juvenil ligada ao X, antes e após o uso de dorzolamida tópica. Apesar da melhora na acuidade visual do paciente estudado, outros estudos são necessários para uma melhor elucidação da real prevalência dos pacientes não responsivos ao tratamento com dorzolamida, bem com a recorrência das lesões císticas a longo prazo.