Outcomes of Intravitreal Bevacizumab in Choroidal Neovascularization in Vogt-Koyanagi-Harada Disease- A Prospective Study.

Purpose: To assess the effectiveness of intravitreal (IV) bevacizumab and the need for systemic immunosuppressive therapy (IMT) in choroidal neovascularization (CNV) in Vogt-Koyanagi-Harada disease (VKHD).Methods: CNV treatment consisted of three monthly IV bevacizumab injections as a loading dose; if intra/subretinal fluid (IRF) persisted, further injections were proceeded besides increment in systemic IMT. Outcome analyses at 3, 6, and 12 months were visual acuity, central foveal thickness, macular volume, IRF, and addition of IMT.Results: Seven eyes of six patients were included. Five patients (five eyes) completed a 12-month follow-up and received 12 IV bevacizumab injections. At the 12-month follow-up, visual acuity improved in four out of five eyes (p = .0568); all eyes had decreased macular volume (p = .0431) but they still had persistent IRF; and all cases needed IMT introduction/increment.Conclusion: Intravitreal bevacizumab in association with systemic IMT was effective for CNV in VKHD. Active CNV may indicate disease of inadequate clinical control.

Full-field electroretinogram behavior in Vogt-Koyanagi-Harada disease: a 24-month longitudinal study in patients from acute onset evaluated with multimodal analysis.

PURPOSE: To prospectively evaluate the dynamic changes of the full-field electroretinogram (ff-ERG) and its association with inflammatory signs in patients with Vogt-Koyanagi-Harada disease (VKHD) followed up after acute onset. METHODS: Twelve acute VKHD patients, who were followed up for at least 24 months, were enrolled at a tertiary center from June 2011 to January 2017. Treatment consisted of intravenous methylprednisolone followed by 1 mg/kg/day of oral prednisone with a slow tapering associated with late non-steroidal immunosuppressive therapy in previously defined cases. Inflammation was systematically evaluated with clinical and posterior segment imaging (PSI) exams (fluorescein angiography, FA, indocyanine green angiography, ICGA, enhanced depth imaging optical coherence tomography, EDI-OCT). A ff-ERG was performed upon enrollment as well as at predefined intervals. Scotopic ff-ERG parameters changes between the 12th and 24th months defined the ERG-stable or ERG-worsening groups. "Flare" was defined as an appearance or worsening of inflammatory signs (after the initial 6 months following disease onset) under the predefined treatment protocol. RESULTS: ff-ERG parameters initially improved in all eyes; in the evaluation between the 12th and 24th months, ff-ERG results were stable in 17 eyes (71 %) and worsened in 7 eyes (29 %). Subnormal ff-ERG results were observed in 15 eyes (62 %) at the 24th month. On the other hand, the flare was observed in 8 eyes (33 %) as cells in the anterior chamber and in 24 eyes (100 %) as any PSI inflammatory sign. The ERG-worsening group presented thicker subfoveal choroid at the first month (p = 0.001) and fluctuations in choroidal thickness more often during follow-up when compared to the ERG-stable group (p = 0.02). CONCLUSIONS: Scotopic ff-ERG parameters worsened between the 12th and 24th months in a quarter of the patients. Subclinical inflammation detected as an increase in CT seems to be related to worsening in visual function measured with ffERG.

Vogt-Koyanagi-Harada disease: review of a rare autoimmune disease targeting antigens of melanocytes.

Vogt-Koyanagi-Harada disease (VKHD) is a rare granulomatous inflammatory disease that affects pigmented structures, such as eye, inner ear, meninges, skin and hair. This disease is mainly a Th1 lymphocyte mediated aggression to melanocytes after a viral trigger in the presence of HLA-DRB1*0405 allele. The absence of ocular trauma or previous intraocular surgery sets VKHD appart from sympathetic ophthalmia, its main differential diagnosis. The disease has an acute onset of bilateral blurred vision with hyperemia preceded by flu-like symptoms. The acute uveitic stage is characterized by a diffuse choroiditis with serous retinal detachment and optic disc hyperemia and edema. Fluorescein angiography in this phase demonstrates multiple early hyperfluorescent points. After the acute uveitic stage, ocular and integumentary system pigmentary changes may appear. Ocular findings may be accompanied by lymphocytic meningitis, hearing impairment and/or tinnitus in a variable proportion of patients. Prompt diagnosis followed by early, aggressive and long-term treatment with high-dose corticosteroids is most often ensued by good visual outcomes. However, some patients may experience chronic uveal inflammation with functional eye deterioration. The current review discusses the general features of VKHD, including epidemiology, classification into categories, differential diagnosis and current therapeutic approaches.

Idiopathic polypoidal choroidal vasculopathy masquerading as choroidal tumors: one year follow-up of a peripheral lesion.

This case report describes peripheral idiopathic polypoidal choroidal vasculopathy (IPCV) with a collection of small aneurysmal dilations that masqueraded as choroidal tumors in an elderly patient. A 68-year-old African American woman was referred to us with a suspected diagnosis of asymptomatic vascular choroidal tumor and choroidal capillary hemangioma, affecting the temporal peripheral fundus. Upon examination, optical coherence tomography (OCT) revealed two large hemorrhagic pigment epithelium detachments (PED), and indocyanine green angiography (ICG) confirmed the diagnosis of IPCV. One year later, there was reduction in the hemorrhagic pigment epithelium detachments and the lesion took on a different appearance, resembling a choroidal osteoma. No treatment was necessary despite the presence of multiple polyps. IPCV is a rare condition that can resemble other choroidal diseases depending on the stage of presentation. OCT is the best tool to determine the characteristics of the lesions, and indocyanine green angiography should be used to confirm the diagnosis. Not all cases require treatment.

Idiopathic polypoidal choroidal vasculopathy masquerading as choroidal tumors: one year follow-up of a peripheral lesion / Vasculopatia polipoidal idiopática da coroide simulando tumores da coroide: um ano de seguimento de uma lesão periférica

ABSTRACT This case report describes peripheral idiopathic polypoidal choroidal vasculopathy (IPCV) with a collection of small aneurysmal dilations that masqueraded as choroidal tumors in an elderly patient. A 68-year-old African American woman was referred to us with a suspected diagnosis of asymptomatic vascular choroidal tumor and choroidal capillary hemangioma, affecting the temporal peripheral fundus. Upon examination, optical coherence tomography (OCT) revealed two large hemorrhagic pigment epithelium detachments (PED), and indocyanine green angiography (ICG) confirmed the diagnosis of IPCV. One year later, there was reduction in the hemorrhagic pigment epithelium detachments and the lesion took on a different appearance, resembling a choroidal osteoma. No treatment was necessary despite the presence of multiple polyps. IPCV is a rare condition that can resemble other choroidal diseases depending on the stage of presentation. OCT is the best tool to determine the characteristics of the lesions, and indocyanine green angiography should be used to confirm the diagnosis. Not all cases require treatment.

RESUMO Relato de um caso de vasculopatia polipoidal idiopática da coroide (IPCV) com múltiplas dilatações aneurismáticas em região temporal periférica da retina, em uma paciente idosa que assemelhou-se com alguns tumores de coroide no seguimento de um ano. Paciente de 68 anos da raça negra, assintomática, foi encaminhada com a hipótese diagnóstica de um tumor vascular de coroide e hemangioma capilar da coroide, em região temporal inferior periférica da retina. Ao exame de tomografia de coerência óptica (OCT) era observado dois grande descolamentos de epitélio pigmentado (DEP), sendo confirmado o diagnóstico de vasculopatia polipoidal idiopática da coroide pela angiografia com indocianina verde (ICG). Após um ano, houve absorção do descolamento do epitélio pigmentado hemorrágico assemelhando-se assim ao osteoma de coroide. Nenhum tratamento foi necessário apesar da quantidade dos pólipos. A vasculopatia polipoidal idiopática da coroide é uma doença rara que, dependendo do estágio da apresentação, pode se assemelhar com algumas doenças da coroide. A tomografia de coerência óptica pode ilustrar melhor as características das lesões e a ICG confirma o diagnóstico. Nem todos os casos necessitam ser tratados.

Ultra-high resolution optical coherence tomography analysis of bull's eye maculopathy in chloroquine users / Análise da maculopatia em bull's eye pela tomografia de coerência óptica de alta resolução em usuários de cloroquina

Purpose: Register and compare anatomical changes, structural and quantitative found in optical coherence tomography Stratus and Topcon 3D in chronic users of chloroquine. Methods: Five patients were diagnosed with toxic "bull's eye" maculopathy was submitted to macular optical coherence tomography examination (Stratus and Topcon 3D). Results: Both tools demonstrated an increase reflectivity of choriocapillaris unit just foveal retinal pigment epithelium atrophy. However, Topcon 3D provided to all patients better description of the line corresponding to the transition between inner and outer segments of photoreceptors. Using the possibility of assembling threedimensional images and subtraction selective retinal layers, we found a lesion with a target that reflects the greater thickness of retinal pigment epithelium in central and parafoveal region that is matched to preserve macular photoreceptors. Conclusion: it was observed better resolution and faster image capture by Topcon 3D than Stratus OCT, that provided more detailed analysis of the line corresponding to transition between outer and inner segment of photoreceptors in macular region. With Topcon 3D, it was possible to evaluate soundly the thickness of retinal pigment epithelium in central and parafoveal region that caused an increase reflectivity of choriocapillaris creating a image with a target unpublished before. .

Objetivo: Comparar e registrar as alterações quantitativas e qualitavivas na tomografia de coerência óptica nos pacientes com uso prolongado de cloroquina. Métodos: Avaliaram-se cinco pacientes com diagnóstico de bull’s eye no exame de tomografia de coerência óptica macular com dois modelos de aparelhos: Stratus e Topcon 3D. Resultados: Ambos aparelhos registraram aumento da refletividade coriocapilar foveal provocada pela atrofia do epitélio pigmentar da retina. Somente o Topcon 3D permitiu melhor visibilização da linha de transição entre o segmento interno e externo dos fotorreceptores. Este aparelho também permitiu a formação de imagens tridimensionais e subtração das camadas retinianas, com registro da diminuição da espessura do epitélio pigmentado da retina na região central e parafoveal macular. Conclusão: Foi possível observar a captação mais rápida e com melhor resolução das imagens geradas pelo Topcon 3D. A diminuição da espessura do epitélio pigmentado da retina, provocando o aumento da refletividade coriocapilar, com a formação de uma imagem linear circular cincundando a fóvea, foi mais detalhado pelos cortes realizados no Topcon 3D. .

Use of intravitreal bevacizumab or triamcinolone acetonide as a preoperative adjunct to vitrectomy for vitreous haemorrhage in diabetics / Injeção intravítrea de bevacizumabe ou triancinolona como adjuvantes da vitrectomia posterior no tratamento da hemorragia vítrea em diabéticos

PURPOSE: To evaluate the effect of preoperative intravitreal bevacizumab (IVB) or triamcinolone (IVT) on the rate of early postvitrectomy hemorrhage in proliferative diabetic retinopathy (PDR). METHODS: Eligible eyes were assigned randomly to 1 of 3 groups: the IVB group received 1.25 mg bevacizumab, the IVT group received 4,0mg triamcinolone and the control group underwent a sham procedure. The primary outcome measure was the incidence of early postvitrectomy hemorrhage. Secondary outcome measures included changes in visual acuity (BCVA) and adverse events. RESULTS: Twenty and seven eyes, 9 in each group were randomized. The incidence of vitreous hemorrhage was lower in the IVB group (p=0.18). Postoperative vitreous hemorrhage at 1 month also was less in the IVB group compared with the control group (p > 0.05). The rate of bleeding immediately after surgery was higher in IVT group with 4 (44.4%) cases. The overall mean visual acuity was 1.72 ± 0.37 logMAR preoperatively and 1.32 ± 0.73 logMAR in 6 months after surgery. Accessing visual acuity by group evidenced that the IVB group had initial mean logMAR VA of 1.87 and 1.57 logMAR VA at the six months (p = 0.84). In IVT group, initial mean VA was 1.75 logMAR and 0.96 logMAR VA at six months (p < 0.001). And in control group, the initial mean VA was 1.85 logMAR and 1.57 logMAR VA at six months (p= 0.34). CONCLUSION: Intravitreal injection of bevacizumab 1 week before vitrectomy seems to reduce the incidence of early postvitrectomy hemorrhage in diabetic patients. There was a better visual acuity outcome in the triamcinolone group.

OBJETIVO: Avaliar o efeito no pré-operatório da injecao intravítrea de bevacizumab (IVB) ou triancinolona (IVT) sobre a taxa de hemorragia precoce pos-vitrectomia na retinopatia diabética proliferativa. MÉTODOS: Os olhos foram distribuídos em três grupos: IVB - 1,25 mg bevacizumab, IVT - 4,0 mg de triancinolona e o grupo controle - simulação da injeção. O objetivo primário foi a avaliação da incidência da hemorragia precoce pós-vitrectomia. Os objetivos secundários incluíram mudanças na acuidade visual corrigida e eventos adversos relacionados à injeção. RESULTADOS: Dos Vinte e sete olhos, 9 foram randomizados em cada grupo. A incidência de hemorragia vítrea foi menor no grupo IVB (P=0,18). A hemorragia vítrea em 1 mês também foi menor no grupo IVB (P > 0,05). A taxa de sangramento pós-operatório imediato foi maior no grupo IVT com 4 (44,4%) dos casos. A média da acuidade visual (AV) foi de 1,72 ± 0,37 logMAR no pré-operatório e 1,32 ± 0,73 logMAR em 6 meses após a cirurgia. Analisando a AV por grupo evidenciamos que o grupo IVB tinha inicialmente AV média logMAR de 1,87 e AV logMAR de 1,57 em seis meses (p = 0,84). No grupo IVT, a média inicial de AV foi de 1,75 logMAR e 0,96 logMAR em seis meses (p < 0,001). E no grupo controle, a média inicial foi de 1,85 logMAR e 1,57 logMAR no seis meses (p = 0,34). CONCLUSÃO: A injeção intravítrea de bevacizumab antes da vitrectomia parece diminuir a incidência de hemorragia vítrea precoce pós-vitrectomia em diabéticos. Houve um melhor resultado na acuidade visual no grupo da triancinolona.

Relationship between diabetic retinopathy severity and the timespan between the endocrinopathy diagnosis and the first ophthalmic examination.

PURPOSE: To investigate whether the time interval between type 2 diabetes mellitus (DM) diagnosis and the first fundoscopic examination is related with the presence and the severity of diabetic retinopathy (DR) observed. METHODS: A survey of 105 type 2 DM patients referred to ophthalmologic evaluation in the "Hospital das Clinicas" (HC), University of São Paulo Medical School (USPMS). RESULTS: Regarding classification of DR in the 105 patients, 15 (14.28%) did not show signs of DR, and 90 (85.72%) exhibited them on fundoscopy. Sixty patients underwent laser therapy, and 46.66% reported poor control of DM. Only 15.23% of DM patients were adequately screened for DR on the first year of their DM diagnosis. Among the 36 patients (34.30%) examined within five years of DM diagnosis, 58.33% did not present or demonstrate signs of mild DR and 22.20% of proliferative DR; 30 patients underwent an ophthalmologic examination after more than eleven years of DM diagnosis, 21.62% did not exhibit signs of DR and 59.46% were classified as proliferative DR. CONCLUSION: This study showed a statistically significant relationship between the time interval from the diagnosis of type 2 DM and the first fundoscopic examination with the severity of DR.

Relationship between diabetic retinopathy severity and the timespan between the endocrinopathy diagnosis and the first ophthalmic examination / Relação entre a gravidade da retinopatia diabética e o tempo decorrido entre o diagnóstico da endocrinopatia e o primeiro exame oftalmológico

Purpose: To investigate whether the time interval between type 2 diabetes mellitus (DM) diagnosis and the first fundoscopic examination is related with the presence and the severity of diabetic retinopathy (DR) observed. Methods: A survey of 105 type 2 DM patients referred to ophthalmologic evaluation in the "Hospital das Clinicas" (HC), University of São Paulo Medical School (USPMS). Results: Regarding classification of DR in the 105 patients, 15 (14.28 percent) did not show signs of DR, and 90 (85.72 percent) exhibited them on fundoscopy. Sixty patients underwent laser therapy, and 46.66 percent reported poor control of DM. Only 15.23 percent of DM patients were adequately screened for DR on the first year of their DM diagnosis. Among the 36 patients (34.30 percent) examined within five years of DM diagnosis, 58.33 percent did not present or demonstrate signs of mild DR and 22.20 percent of proliferative DR; 30 patients underwent an ophthalmologic examination after more than eleven years of DM diagnosis, 21.62 percent did not exhibit signs of DR and 59.46 percent were classified as proliferative DR. Conclusion: This study showed a statistically significant relationship between the time interval from the diagnosis of type 2 DM and the first fundoscopic examination with the severity of DR.

Objetivo: Avaliar se o tempo de intervalo entre o diagnóstico do diabetes mellitus (DM) tipo 2 e o primeiro exame de fundo de olho está relacionado com a gravidade da retinopatia diabética (RD). Métodos: Inquérito realizado em 105 pacientes portadores de DM tipo 2 que foram referenciados para avaliação oftalmológica no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Resultados: Quanto à classificação da RD, dos 105 pacientes, 15 (14,28 por cento) não apresentavam sinais de RD e 90 (85,72 por cento) demonstraram presença de sinais de RD ao exame de fundo de olho. Somente 15,23 por cento dos pacientes avaliados foram examinados no primeiro ano do diagnóstico de DM. Sessenta pacientes foram submetidos à laserterapia, 46,66 por cento relataram mal controle do DM. Quando examinados em até 5 anos de diagnóstico de DM, 36 (34,30 por cento), pacientes, 58,33 por cento não apresentaram sinais ou demonstravam sinais de RD grau leve e 22,20 por cento RD proliferativa. Trinta pacientes receberam exame oftalmológico superior a 11 anos do diagnóstico de DM, 21,62 por cento não apresentavam sinais de RD e 59,46 por cento classificados com RD proliferativa. Conclusão: Este estudo demonstrou significância estatística na relação entre o intervalo de tempo do diagnóstico do DM tipo 2 e o primeiro exame de fundo de olho com a gravidade de RD.

[Intravitreous injection of bevacizumab and C3F8 gas for the treatment of submacular hemorrhage due to age-related macular degeneration: case reports]. / Injeção intravítrea de bevacizumab e gás C3F8 para tratamento da hemorragia submacular secundária a degeneração macular relacionada à idade: relato de casos.

The purpose of this case series is to describe if the intravitreal use of bevacizumab and perfluoropropane gas (C3F8) would be beneficial to the displacement of subretinal hemorrhage in patients with age-related macular degeneration (AMD). A retrospective study of 5 eyes that received concurrent intravitreal injection of bevacizumab and C3F8 was performed. The results were graded according to blood displacement under the fovea, best final visual acuity and intraoperative complications. At the initial presentation, mean age of patients was 72.6 +/- 8.9 years-old and duration of symptoms was 13 +/- 9.7 days. From the 5 patients, 3 (60%) were male and 2 (40%) female. The success of submacular hemorrhage full displacement was achieved in 4 patients. The mean preoperative visual acuity (VA) was 1.12 +/- 0.34 logMAR and the mean postoperative VA was 0.92 +/- 0.4 logMAR. No cases of retinal detachment, endophthalmitis, vitreous hemorrhage, uveitis, cataracts and increased intraocular pressure were noted during the follow-up period. Intravitreal bevacizumab and C3F8 injection, associated to prone position can be a valuable therapeutic option for eyes with neovascular age-related macular degeneration and subretinal hemorrhage to the blood displacement out of the foveal area.

Injeção intravítrea de bevacizumab e gás C3F8 para tratamento da hemorragia submacular secundária a degeneração macular relacionada à idade: relato de casos / Intravitreous injection of bevacizumab and C3F8 gas for the treatment of submacular hemorrhage due to age-related macular degeneration: case reports

O objetivo desta série de casos foi demonstrar se a aplicação de bevacizumab e gás perfluoropropano (C3F8) intravítreos beneficiariam o deslocamento da hemorragia sub-retiniana dos pacientes com degeneração macular relacionada à idade. Foi realizada uma série retrospectiva de 5 olhos que tinham recebido injeção intravítrea simultânea de bevacizumab e C3F8. Os resultados foram medidos pelo grau de deslocamento de sangue sob a fóvea, pela acuidade visual final e pelas complicações intraoperatórias. Na apresentação inicial, a idade média dos pacientes foi de 72,6 ± 8,9 anos e a duração média dos sintomas foi de 13 ± 9,7 dias. Dos 5 pacientes do estudo, 3 (60 por cento) eram homens e 2 (40 por cento) mulheres. O sucesso do deslocamento da hemorragia submacular foi alcançado em 4 pacientes. A média de acuidade visual pré-operatória foi de 1,12 ± 0,34 logMAR e pós-operatório foi de 0,92 ± 0,4 logMAR. Não foram observados nenhum caso de descolamento da retina, endoftalmite, hemorragia vítrea, uveíte, catarata e hipertensão ocular. A injeção intravítrea bevacizumab e C3F8, juntamente com a posição pronada pode ser uma valiosa opção terapêutica nos olhos com degeneração macular relacionada à idade neovascular e hemorragia sub-retiniana a fim de deslocar o sangue para fora da área foveal.

The purpose of this case series is to describe if the intravitreal use of bevacizumab and perfluoropropane gas (C3F8) would be beneficial to the displacement of subretinal hemorrhage in patients with age-related macular degeneration (AMD). A retrospective study of 5 eyes that received concurrent intravitreal injection of bevacizumab and C3F8 was performed. The results were graded according to blood displacement under the fovea, best final visual acuity and intraoperative complications. At the initial presentation, mean age of patients was 72.6 ± 8.9 years-old and duration of symptoms was 13 ± 9.7 days. From the 5 patients, 3 (60 percent) were male and 2 (40 percent) female. The success of submacular hemorrhage full displacement was achieved in 4 patients. The mean preoperative visual acuity (VA) was 1.12 ± 0.34 logMAR and the mean postoperative VA was 0.92 ± 0.4 logMAR. No cases of retinal detachment, endophthalmitis, vitreous hemorrhage, uveitis, cataracts and increased intraocular pressure were noted during the follow-up period. Intravitreal bevacizumab and C3F8 injection, associated to prone position can be a valuable therapeutic option for eyes with neovascular age-related macular degeneration and subretinal hemorrhage to the blood displacement out of the foveal area.

[Optical coherence tomography imaging in commotio retinae: case report]. / Tomografia de coerência óptica na commotio retinae: relato de caso.

The purpose of this case report was to correlate optical coherence tomography findings and visual outcomes of patients with different degrees of commotio retinae. A 20-year-old male and a 23-year-old male that presented with decreased vision due to Berlin's edema after blunt ocular trauma were evaluated by optical coherence tomography and retinography. The visual acuity in the affected eye was 20/25 in the first patient and counting fingers in the second one. The ophthalmic examination showed traumatic uveitis and fundoscopy revealed mild retinal opacification in the first case and severe opacification in the latter. The optical coherence tomography confirmed the reduction of foveal depression on the first case and the disarrangement of all retinal layers on the second. There has been complete functional and anatomical resolution by optical coherence tomography in the first patient, while the second evolved to permanent visual loss. Optical coherence tomography is a useful method in the evaluation of retinal trauma, helping to understand its physiopathology and to predict its prognosis through the anatomical analysis of the affected region.

Tomografia de coerência óptica na commotio retinae: relato de caso / Optical coherence tomography imaging in commotio retinae: case report

O objetivo deste relato é correlacionar achados à tomografia de coerência óptica e prognóstico visual de pacientes com commotio retina e de gravidades diferentes. Dois pacientes do sexo masculino, de 20 e 23 anos com baixa visual unilateral após trauma ocular contuso atribuível a edema de Berlin foram avaliados pela retinografia e tomografia de coerência óptica. A acuidade visual no olho afetado era de 20/25 no primeiro paciente e conta dedos a 2 metros no segundo. O exame oftalmológico revelou uveíte traumática e, na fundoscopia, evidenciaram-se opacificação retiniana moderada no primeiro caso e grave no segundo. A tomografia de coerência óptica confirmou discreta diminuição da depressão foveal no primeiro caso e desorganização das camadas retinianas no segundo. Houve resolução anatômica e funcional completa a tomografia de coerência óptica no primeiro paciente, enquanto o segundo evoluiu com baixa visual permanente e desorganização da arquitetura retiniana. A tomografia de coerência óptica é um exame complementar útil na avaliação do trauma retiniano, ajudando a entender sua fisiopatologia e predizer prognóstico a partir da análise anatômica da região acometida.

The purpose of this case report was to correlate optical coherence tomography findings and visual outcomes of patients with different degrees of commotio retinae. A 20-year-old male and a 23-year-old male that presented with decreased vision due to Berlin's edema after blunt ocular trauma were evaluated by optical coherence tomography and retinography. The visual acuity in the affected eye was 20/25 in the first patient and counting fingers in the second one. The ophthalmic examination showed traumatic uveitis and fundoscopy revealed mild retinal opacification in the first case and severe opacification in the latter. The optical coherence tomography confirmed the reduction of foveal depression on the first case and the disarrangement of all retinal layers on the second. There has been complete functional and anatomical resolution by optical coherence tomography in the first patient, while the second evolved to permanent visual loss. Optical coherence tomography is a useful method in the evaluation of retinal trauma, helping to understand its physiopathology and to predict its prognosis through the anatomical analysis of the affected region.

The effect of prostaglandin analogs and prostamide on central corneal thickness.

OBJECTIVE: The aim of this study was to verify the influence of prostaglandin analogs and prostamide on central corneal thickness (CCT). METHODS: A prospective analysis was done of CCT in glautomatous patients submitted to monotherapy with prostaglandin analogs (latanoprost 0.005% or travoprost 0.004%) or prostamide (bimatoprost 0.03%) during an 8-week period. A control group of patients without any ocular medication was also evaluated. CCT measurements were performed with a commercially available ultrasound pachymeter. A total of 73 patients were included in this study. Mean age was 68.5 +/- 9.2 (range, 48-85) years old. RESULTS: A statistically significant reduction in CCT was observed in all groups, except the control group (n = 21): Bimatoprost 0.03% group (n = 21): 544.41 +/- 35.4 vs. 540.35 +/- 35.9 microm (P = 0.039); travoprost 0.004% group (n = 17): 538.47 +/- 32.0 vs. 532.25 +/- 30.4 microm (P = 0.009); latanoprost 0.005% group (n = 14): 548.57 +/- 32.4 vs. 543.88 +/- 35.6 microm (P = 0.036). CONCLUSION: Topical therapy with prostaglandin analogs and bimatoprost is associated with CCT reduction over a period of at least 8 weeks.

Chloroquine-induced bull's eye maculopathy in rheumatoid arthritis: related to disease duration?

Chloroquine diphosphate has been used in the treatment of various rheumatic diseases, including rheumatoid arthritis. The most important of its side effects is retinopathy. If not diagnosed early, this lesion can evolve into irreversible bull's eye maculopathy and visual loss. The aim of this study was to define the outcome of chloroquine-induced maculopathy after cessation of chloroquine therapy and also to identify the risk factors involved in case of retinopathy evolution. The design of this cohort study was longitudinal and retrospective. Over the period spanning 2000 to 2005, out of 607 medical records of patients with rheumatoid arthritis followed in our Division of Rheumatology, 27 had been diagnosed with chloroquine-induced maculopathy through clinical funduscopy with pupil dilation. In all cases, there was immediate chloroquine intake cessation. After a mean time of 5 years, 16 of these patients were available for follow-up and underwent a new ophthalmologic evaluation by funduscopy, using biomicroscopy and angiofluorescein when necessary. Sequelae maculopathy were reconfirmed in all 16 cases, but progression to advanced stage (bull's eye maculopathy) was found in half of the cohort, even though chloroquine had been suspended. All patients complained of visual alterations, but without progression. Comparison between patient groups with and without bull's eye maculopathy revealed a statistically significant longer rheumatoid arthritis disease history in the former group. Also, the bull's eye group had higher dose intakes of chloroquine and over a longer period compared to the other group, but not statistically significant. This study corroborates the progression of maculopathy even after cessation of chloroquine intake, pointing out the need for careful screening in the high-risk patients. Furthermore, it indicates that duration of rheumatoid arthritis disease could be a possible factor linked to worse prognosis of chloroquine-induced maculopathy.

Correlation of asymmetric glaucomatous visual field damage and water-drinking test response.

PURPOSE: To determine whether there is a correlation between asymmetric glaucomatous visual field (VF) damage and water-drinking test (WDT) response. METHODS: A retrospective analysis was conducted of VF and WDT data from 101 patients with glaucoma in clinical therapy, who were receiving treatment with the same topical medication in both eyes, and asymmetric VF defect. Eyes were classified according to mean deviation (MD) into "better" and contralateral "worse" eyes. Maximum mean difference in basal IOP was 2 mm Hg between both eyes. The peak IOP and fluctuation obtained with the WDT were compared between both groups. For the statistical analysis, the Tukey post hoc multiple comparison test and paired t-test were used. RESULTS: Better and contralateral worse eyes presented mean MDs of -4.6 +/- 5.3 and -9.0 +/- 7.4 dB, respectively (P < 0.001). Mean basal IOPs were 13.9 +/- 3.3 and 13.9 +/- 3.1 mm Hg, respectively (P = 0.67). Mean maximum IOPs after water ingestion were 16.5 +/- 3.8 mm Hg in the group with less severe VF defect and 17.2 +/- 4.1 mm Hg in the contralateral group with worse visual fields (P < 0.001). Mean fluctuation (maximum IOP - minimum IOP after water ingestion) was 3.6 +/- 1.8 and 4.4 +/- 2.2 mm Hg (P < 0.001), respectively. CONCLUSION: Eyes with worse MDs presented higher IOP peaks and fluctuation after water ingestion. This study demonstrates a lower capacity of eyes with worse glaucomatous lesion to respond to a stimulus that leads to a transitory elevation of IOP.

Tumor vasoproliferativo primário da retina associado a edema macular cistóide: relato de caso / Idiopathic vasoproliferative tumor of the retina associated with macular edema: case report

Tumor vasoproliferativo da retina é doença rara, benigna, caracterizada por lesão exsudativa retiniana periférica. Pode ser de origem primária (idiopática) ou secundária a uma gama de acometimentos retinianos prévios. O exame oftalmológico cuidadoso se torna necessário para estabelecer o diagnóstico. As opções terapêuticas incluem: observação, crioterapia, fotocoagulação a laser e braquiterapia. No presente estudo, os autores ilustram um caso de tumor vasoproliferativo idiopático da retina associado a edema macular. Serão discutidos aspectos do tumor na fundoscopia, angiofluoresceinografia, ultra-sonografia e tomografia de coerência óptica.

[Idiopathic vasoproliferative tumor of the retina associated with macular edema: case report]. / Tumor vasoproliferativo primário da retina associado a edema macular cistóide: relato de caso.

Retinal vasoproliferative tumor is a rare and benign disease that presents with an exsudative lesion in the retinal periphery. The lesion can be classified as primary (idiopathic) or secondary to a number of previous retinal injuries. Diagnosis is based on a careful ophthalmic examination. Therapeutic options include observation, cryotherapy, laser photocoagulation and brachytherapy. We present a case of idiopathic retinal vasoproliferative tumor associated with macular edema. The aspects of the tumor on fundus examination, fluorescent angiography, echography and optic coherence tomography are discussed.