Retinal angiography and colour Doppler of retrobulbar vessels in Takayasu arteritis.

OBJECTIVE: Takayasu arteritis (TA) is a chronic, granulomatous, idiopathic, inflammatory disease that primarily affects large vessels. The objective of this study was to evaluate and describe the ocular manifestations of TA, correlating the resistivity and pressure in retrobulbar vessels by colour Doppler and retinal angiography. DESIGN: Cross-sectional study. PARTICIPANTS: Twenty-one patients with TA, 42 eyes, and 21 patients without TA (42 eyes) as control subjects. METHODS: This study was performed in clinical practice. Patients with TA received complete ophthalmologic examination, fluorescein and indocyanine green angiography, and colour Doppler ultrasound to evaluate blood flow in the retrobulbar vessels. RESULTS: A statistical correlation was found between peak systolic velocity (PSV) in the ophthalmic artery (OA) and Heidelberg retinal angiography (HRA) examination results (p = 0.006), and resistivity index (RI) in the OA was abnormal in patients with long (average, 14 years) versus short (average, 5.5 years) onset time of the disease (p = 0.035). RI in the central retinal artery (CRA) was abnormal in patients with a long time of disease onset (mean 14.4 years) versus those with a short time (mean 4.6 years) of onset (p = 0.006). CONCLUSIONS: The longer the onset of the disease, the more commonly the RI showed changes in the OA and CRA, and, to a lesser extent, in the short posterior ciliary artery. When abnormalities are observed in the HRA examination, abnormal PSV in the OA may be present. Doppler blood flow evaluation and HRA may have predictive value in all patients with TA as part of serial monitoring.

Evolução da esclerite nodular com biomicroscopia ultrassônica: relato de caso / Evolution of nodular scleritis with ultrasound biomicroscopy: case report

Estabelecer padrão evolutivo de um caso de esclerite nodular à ultrassonografia de alta frequência durante o tratamento. Mulher, 27 anos, com manifestação inicial de uveíte intermediária, edema macular bilateral após tratamento clínico com corticosteroide tópico e via oral. Após quatro meses, observou-se a formação de um nódulo escleral no olho direito quando foi submetido à ultrassonografia de alta frequência (Paradigm, transdutor de 50 MHz, técnica de imersão). A lesão do olho direito foi caracterizada à ultrassonografia de alta frequência como uma lesão nodular da parede anterior temporal inferior associada à redução localizada da espessura da escleral. Após a injeção intravítrea de triancinolona para tratamento do edema macular, observou-se a regressão clínica do nódulo escleral no olho direito, mantendo reduzida a espessura escleral. A ultrassonografia de alta frequência auxiliou no diagnóstico da esclerite nodular durante as fases de tratamento e na identificação da sua sequela característica, o afinamento escleral.

To stablish evolutionary pattern of a case of nodular scleritis with high frequency ultrasound during treatment. Twenty-seven year old female, initial manifestation of intermediate uveitis, bilateral macular edema after clinical treatment with topical and oral steroids. After four months, we observed the formation of a scleral nodule in the right eye when patient underwent high frequency ultrasound (Paradigm, 50 MHz transducer, immersion technique). The lesion in right eye was characterized at high frequency ultrasound as a nodular lesion located at the anterior inferior temporal wall associated with localized reduction of scleral thickness. After intravitreal injection of triamcinolone for treatment of macular edema, clinical regression of the scleral nodule was observed in right eye, maintaining reduced scleral thickness. High frequency ultrasound assisted in the diagnosis of nodular scleritis during the phases of treatment and in the identify its characteristic sequel feature, the scleral thinning.

[Evolution of nodular scleritis with ultrasound biomicroscopy: case report]. / Evolução da esclerite nodular com biomicroscopia ultrassônica: relato de caso.

To establish evolutionary pattern of a case of nodular scleritis with high frequency ultrasound during treatment. Twenty-seven year old female, initial manifestation of intermediate uveitis, bilateral macular edema after clinical treatment with topical and oral steroids. After four months, we observed the formation of a scleral nodule in the right eye when patient underwent high frequency ultrasound (Paradigm, 50 MHz transducer, immersion technique). The lesion in right eye was characterized at high frequency ultrasound as a nodular lesion located at the anterior inferior temporal wall associated with localized reduction of scleral thickness. After intravitreal injection of triamcinolone for treatment of macular edema, clinical regression of the scleral nodule was observed in right eye, maintaining reduced scleral thickness. High frequency ultrasound assisted in the diagnosis of nodular scleritis during the phases of treatment and in the identify its characteristic sequel feature, the scleral thinning.

[Idiopathic retinal, vasculitis, aneurysms and neuroretinitis (IRVAN): case report]. / Retinite idiopática, vasculite, aneurismas e neurorretinite (IRVAN): relato de caso.

A case of a 14 year-old boy that was admitted complaining of bilateral ocular visual blurring for 2 years is reported. The ophthalmological examination disclosed bilateral mild optic disc hyperemia and swelling, retinal exudation, few retinal hemorrhages, multiple aneurysms, as well as vasculitis. Fluorescein angiography showed extensive peripheral retinal ischemia, dilatations and hyperfluorescence of the vessels walls, and leakage of the optic disc in the late phases in both eyes. This rare case represents an entity characterized by peripheral retinal vascular occlusion, retinal vasculitis, multiple posterior retinal aneurysms, and neuroretinitis (IRVAN). Systemic evaluation and laboratory work-up did not suggest any systemic abnormality. Panretinal laser photocoagulation was performed in both eyes, and the patient was treated with oral prednisone with maintenance of the visual acuity after 1 year of follow-up. Laser treatment should be considered when angiographic evidence of widespread retinal no perfusion is present, and before the development of signs of retinal neovascularization.

Retinite idiopática, vasculite, aneurismas e neurorretinite (IRVAN): relato de caso / Idiopathic retinal, vasculitis, aneurysms and neuroretinitis (IRVAN): case report

Relatamos caso de um paciente de 14 anos, sexo masculino, que foi admitido com queixa de embaçamento visual bilateral há dois anos. Ao exame oftalmológico observou-se leve hiperemia e edema de disco óptico bilateral, exsudação retiniana, poucas hemorragias retinianas, múltiplos aneurismas, assim como sinais de vasculite. A angiofluoresceinografia demonstrou isquemia periférica extensa, dilatações e hiperfluorescência das paredes dos vasos, e vazamento tardio do disco óptico nas fases finais do exame em ambos os olhos. Este caso representa uma rara entidade caracterizada por oclusão retiniana vascular periférica, vasculite retiniana, múltiplos aneurismas retinianos e neurorretinite (IRVAN). Avaliação sistêmica e laboratorial não revelaram nenhuma anormalidade. O paciente foi submetido à panfotocoagulação de retina com laser de argônio em ambos os olhos, e iniciado tratamento com prednisona via oral, com manutenção da acuidade visual de 20/25 depois de um ano de acompanhamento. O tratamento com laser deve ser considerado quando houver qualquer evidência angiográfica de má perfusão retiniana, e antes do desenvolvimento de qualquer sinal de neovascularização de retina.

A case of a 14 year-old boy that was admitted complaining of bilateral ocular visual blurring for 2 years is reported. The ophthalmological examination disclosed bilateral mild optic disc hyperemia and swelling, retinal exudation, few retinal hemorrhages, multiple aneurysms, as well as vasculitis. Fluorescein angiography showed extensive peripheral retinal ischemia, dilatations and hyperfluorescence of the vessels walls, and leakage of the optic disc in the late phases in both eyes. This rare case represents an entity characterized by peripheral retinal vascular occlusion, retinal vasculitis, multiple posterior retinal aneurysms, and neuroretinitis (IRVAN). Systemic evaluation and laboratory work-up did not suggest any systemic abnormality. Panretinal laser photocoagulation was performed in both eyes, and the patient was treated with oral prednisone with maintenance of the visual acuity after 1 year of follow-up. Laser treatment should be considered when angiographic evidence of widespread retinal no perfusion is present, and before the development of signs of retinal neovascularization.

Alterações oftalmológicas decorrentes do tratamento do lúpus eritematoso sistêmico juvenil / Ocular changes due to the treatment of juvenile systemic lupus erythematosus

OBJETIVO: Avaliar retrospectivamente as alterações oftalmológicas de crianças e adolescentes com lúpus eritematoso sistêmico juvenil (LESJ) em um serviço de reumatologia pediátrica terciário. MÉTODOS: Avaliamos 117 pacientes com LESJ (85,5% do gênero feminino, 60,7% não caucasoides) com média de idade de 10,4 anos e média de tempo de evolução da doença de 5,4 anos que preenchiam no mínimo quatro critérios de classificação do LES de acordo com o American College of Rheumatology de 1997. Aplicamos um protocolo que continha dados clínicos e demográficos, queixas e alterações oftalmológicas, idade do início, tempo de uso e dose cumulativa das medicações. RESULTADOS: Dos 117 pacientes, 24 (20,5%) apresentaram alterações oftalmológicas. Destes, 16 apresentaram alteração de fundo de olho associada a hipertensão arterial sistêmica e/ou uso de cloroquina, quatro apresentaram catarata, dois apresentaram glaucoma e dois apresentaram catarata e glaucoma. A média de idade do aparecimento das alterações oftalmológicas foi de 14,1 anos. Os pacientes com alterações oftalmológicas receberam, estatisticamente, maiores doses e tempos de pulsoterapia de glicocorticoide em relação aos pacientes sem alterações oftalmológicas [1,5 (0,4-1,6) versus 1 (0,2-1,6) mg/kg, P = 0,003; 25,7 (2-99) versus 17,8 (1-114) meses, P = 0,0001; respectivamente]. CONCLUSÃO: Verificamos alta prevalência de alterações oftalmológicas relacionadas principalmente ao tratamento do LESJ, o que demonstra a necessidade de avaliações regulares mesmo em pacientes assintomáticos, visando ao diagnóstico e intervenção precoces e à diminuição da morbidade ocular relacionada a essa doença.

OBJECTIVE: To assess retrospectively the ocular changes in children and adolescents with juvenile systemic lupus erythematosus (JSLE) in a tertiary pediatric rheumatology service. METHODS: This study assessed 117 JSLE patients (85.5% female, 60.7% non-Caucasian), who met at least four criteria of the 1997 SLE classification of the American College of Rheumatology. Their mean age was 10.4 years, and their mean time of disease progression was 5.4 years. A protocol containing clinical and demographic data, ophthalmologic complaints and changes, age of onset, duration of medication use, and cumulative medication dose was applied. RESULTS: Of the 117 patients, 24 (20.5%) had ocular changes. Sixteen of them had abnormal fundoscopy associated with systemic hypertension and/or use of chloroquine; four had cataract; two had glaucoma; and two had cataract and glaucoma. The mean age of ocular change onset was 14.1 years. Patients with ocular changes received statistically higher and longer doses of glucocorticoid pulse therapy as compared with patients without ocular changes [1.5 (0.4 to 1.6) versus 1 (0.2 to 1.6) mg/kg, P = 0.003; 25.7 (2-99) versus 17.8 (1-114) months, P = 0.0001, respectively]. CONCLUSION: A high prevalence of ocular changes relating mainly to the treatment of JSLE was observed. This demonstrates the need for regular ophthalmologic examinations even in asymptomatic patients, aiming at the early diagnosis and intervention, and at decreasing the ocular morbidity related to that disease.

Ocular changes due to the treatment of juvenile systemic lupus erythematosus.

OBJECTIVE: To assess retrospectively the ocular changes in children and adolescents with juvenile systemic lupus erythematosus (JSLE) in a tertiary pediatric rheumatology service. METHODS: This study assessed 117 JSLE patients (85.5% female, 60.7% non-Caucasian), who met at least four criteria of the 1997 SLE classification of the American College of Rheumatology. Their mean age was 10.4 years, and their mean time of disease progression was 5.4 years. A protocol containing clinical and demographic data, ophthalmologic complaints and changes, age of onset, duration of medication use, and cumulative medication dose was applied. RESULTS: Of the 117 patients, 24 (20.5%) had ocular changes. Sixteen of them had abnormal fundoscopy associated with systemic hypertension and/or use of chloroquine; four had cataract; two had glaucoma; and two had cataract and glaucoma. The mean age of ocular change onset was 14.1 years. Patients with ocular changes received statistically higher and longer doses of glucocorticoid pulse therapy as compared with patients without ocular changes [1.5 (0.4 to 1.6) versus 1 (0.2 to 1.6) mg/kg, P = 0.003; 25.7 (2-99) versus 17.8 (1-114) months, P = 0.0001, respectively]. CONCLUSION: A high prevalence of ocular changes relating mainly to the treatment of JSLE was observed. This demonstrates the need for regular ophthalmologic examinations even in asymptomatic patients, aiming at the early diagnosis and intervention, and at decreasing the ocular morbidity related to that disease.

Utilizaçäo da técnica da reaçäo da cadeia de polimerase no diagnóstico diferencial das uveítes causadas por toxoplasma gondii, herpes epstein barr e microbacteria sp em pacientes com e sem infecçäo pelo vírus da imunodeficiência humana / Polimerase chain reaction analysis for diagnosis of uveitis caused by toxoplasma, herpes simplex and varicella zoster, citomegalovirus, epstein barr virus, and micobacteria sp in patients with and without infection of human immunodeficiency virus

Foram estudados 24 olhos de 24 pacientes, sendo 16 infectados pelo HIV e 4 HIV negativos em estudo clínico prospectivo. Do total de pacientes estudados, 20 apresentavam diagnóstico clínico de uveíte e 4 não apresentavam uveíte (grupo controle). Todos os pacientes foram submetidos a exame oftalmológico, sorológico, radiológico e cutâneos. Foram realizados exames do PCR nas amostras de soro, humor aquoso e humor vítreo para detecção do DNA dos seguintes agentes etiológicos: Toxoplasma gondii, vírus herpes simples e zoster, vírus Epstein Barr, micobacteriose sp e citomegalovírus. Dos 20 pacientes com uveíte, 12 (60 por cento) possuíam hipótese diagnostica de CMV e em l destes a hipótese era de infecção associada de CMV e toxoplasmose. A sensibilidade e especificidade do teste do PCR no soro para o CMV foi de 25 por cento e 87,50 por cento respectivamente. Dos 12 pacientes com hipótese diagnostica de CMV, 3 (25 por cento) foram confirmados pelo PCR no aquoso e 9 (75 por cento) foram negativos. Dos 8 pacientes com outras hipóteses diagnosticas, l (l2,5 por cento) foi positivo para o CMV e 7 (87,50 por cento) foram negativos para CMV. Em dois casos onde a hipótese diagnostica era de CMV encontramos PCR positivo para CMV, EBV, Toxoplasma gondii em um caso e CMV e EBV em outro. A sensibilidade e especificidade do teste do PCR no vítreo para o CMV foi de 50 e 100 por cento respectivamente. Dos 12 pacientes com hipótese diagnostica de CMV, 6 (50 por cento) foram confirmados pelo PCR no vítreo, 9 (75 por cento) foram negativos. Dos 8 pacientes com outras hipóteses diagnosticas, todos foram negativos para CMV. Em um caso encontramos a associação de CMV e HSV. A sensibilidade e especificidade do teste do PCR no soro para o Toxoplasma gondii foi de O e 93,75 por cento respectivamente. Dos 4 pacientes com hipótese diagnostica de toxoplasmose, nenhum foi confirmado pelo PCR no aquoso. Dos 16 pacientes com outras hipóteses diagnosticas, l (6,25 por cento) foi positivo e 15 (93,75 por cento) foram negativo para Toxoplasma gondii. Em um caso onde a hipótese diagnostica era de toxoplasmose encontramos PCR positivo para EBV e Toxoplasma gondii. A sensibilidade e especificidade do teste do PCR no vítreo para o Toxoplasma gondii foi de 50 e 93,75 por cento respectivamente. Dos 4 pacientes com hipótese diagnostica de toxoplasmose 2 (50 por cento) foram confirmados pelo PCR no vítreo e 2 (50 por cento) foram negativos. Dos 16 pacientes com...(au)