Recurrence of Ocular Toxoplasmosis after Vitrectomy: Case Report and Review.

PURPOSE: The purpose of this study is to report one case of ocular toxoplasmosis (OT) recurrence after vitrectomy and review the scientific basis about it. CASE REPORT: A 58-year-old male patient with previous OT, properly treated, underwent vitrectomy due to macular hole. During follow-up, patient evolved with recurrence of the OT. After 1 year, patient presents visual acuity of 20/200 and extensive macular scar. CONCLUSION: There is no consensus on using perioperative antiparasitic therapy aiming recurrence prophylaxis. Studies with better statistical design are necessary to evaluate the recurrence risk after ocular surgeries and the possible recommendation of prophylaxis, especially in countries where the strains are more virulent and the recurrence more common.

Acute Retinal Necrosis: Is The Current Valacyclovir Regimen Adequate?

Acute Retinal Necrosis (ARN) is a potentially devastating form of Uveitis. Antivirals are the mainstay treatment for this syndrome. In this letter, we question the current oral Valacyclovir dosage, based on the experience we had with a recent unresponsive ARN case.

Coroidopatia no lúpus eritematoso sistêmico / Choroidopathy in systemic lupus erythematosus

Resumo O Lúpus Eritematoso sistêmico (LES) é uma doença autoimune que pode afetar o olho de diversas formas. A coroidopatia lúpica é rara e apresenta-se com descolamento seroso de retina, descolamento do epitélio pigmentar da retina (EPR) e epiteliopatia pigmentar. A maioria dos casos está associada à atividade sistêmica da doença, podendo ser considerada um fator de gravidade e necessidade de imunossupressão intensa. Geralmente apresenta bom prognóstico visual com o tratamento adequado do LES, apesar de alguns casos evoluírem com danos irreversíveis na retina externa e EPR. Descrevemos um caso de coroidopatia secundaria ao LES com atividade multisistêmica com boa evolução após tratamento clínico com imunossupressão sistêmica.

Abstract Systemic lupus erythematosus (SLE) is an autoimmune disease in which can affect the eye in different ways. Lupus choroidopathy is rare and include retinal pigment epithelium (RPE) detachment and/or serous retinal detachment and pigment epitheliopathy. Most cases are associated with systemic disease activity and can be considered a factor of gravity and need for intense immunosuppression. Usually has good visual prognosis with proper treatment of SLE, although some cases may have irreversible damage to the outer retina and RPE. We describe a case of choroidopathy secondary to SLE during its multisystem activity with good clinical outcome after treatment with systemic immunosuppression.

Yellowish dots in the retina: a finding of ocular syphilis?

Here we report the occurrence of pale yellowish perivascular preretinal dots in 12 patients with ocular syphilis. A case series of these patients was examined between March and October 2012 at the Uveitis Sector of Universidade Federal de São Paulo. After diagnostic confirmation of syphilis, fundus photographs and optical coherence tomography (OCT) were performed to verify the localization of the dots, and patients were treated with IV crystalline penicillin for 14 days. The study comprised 11 men (91.6%), 19 eyes, median presentation age of 38.1 years, and panuveitis as the main clinical manifestation (seven patients, 58.3%), being bilateral in four. Ten patients were taking oral prednisone (83.3%). Serum panels performed by the Venereal Disease Research Laboratory (VDRL) showed positive results in eight patients (66.7%), whereas VDRL cerebrospinal fluid (CSF) tests were negative in seven of nine collected (77.8%). However, serum FTA-Abs was positive in 100% of patients, and eight patients (66.7%) had HIV infection. The best corrected visual acuity (BCVA) presented after treatment improved in 10 eyes (55.6%), did not change in seven eyes (38.9%), and worsened in one eye (5.6%). Although not yet acknowledged in the literature as a typical manifestation of ocular syphilis, these are very common findings in clinical practice. We believe that preretinal dots are due to perivasculitis secondary to treponema infection. It is important recognize them and remember that syphilis can present in several forms, including the one presented in this study.

Yellowish dots in the retina: a finding of ocular syphilis? / Pontos amarelados na retina: um achado da sífilis ocular?

Here we report the occurrence of pale yellowish perivascular preretinal dots in 12 patients with ocular syphilis. A case series of these patients was examined between March and October 2012 at the Uveitis Sector of Universidade Federal de São Paulo. After diagnostic confirmation of syphilis, fundus photographs and optical coherence tomography (OCT) were performed to verify the localization of the dots, and patients were treated with IV crystalline penicillin for 14 days. The study comprised 11 men (91.6%), 19 eyes, median presentation age of 38.1 years, and panuveitis as the main clinical manifestation (seven patients, 58.3%), being bilateral in four. Ten patients were taking oral prednisone (83.3%). Serum panels performed by the Venereal Disease Research Laboratory (VDRL) showed positive results in eight patients (66.7%), whereas VDRL cerebrospinal fluid (CSF) tests were negative in seven of nine collected (77.8%). However, serum FTA-Abs was positive in 100% of patients, and eight patients (66.7%) had HIV infection. The best corrected visual acuity (BCVA) presented after treatment improved in 10 eyes (55.6%), did not change in seven eyes (38.9%), and worsened in one eye (5.6%). Although not yet acknowledged in the literature as a typical manifestation of ocular syphilis, these are very common findings in clinical practice. We believe that preretinal dots are due to perivasculitis secondary to treponema infection. It is important recognize them and remember that syphilis can present in several forms, including the one presented in this study.

Relatar a ocorrência de pontos amarelo-esbranquiçados perivasculares pré-retinianos em 12 pacientes com sífilis ocular. Série de casos de 12 pacientes examinados entre março e outubro de 2012 no setor de uveítes da UNIFESP. Após confirmação diagnóstica de sífilis ocular, retinografias e OCT (optical coherence tomography) foram realizados para verificar a localização dos pontos e os pacientes foram tratados com penicilina cristalina IV por 14 dias. Dados demográficos incluíram 11 homens (91,6%), 19 olhos, mediana de idade de 38,1 anos, e a manifestação clínica principal foi panuveíte (7 pacientes, 58,3%), sendo bilateral em 4. Dez fizeram uso de prednisona oral (83,3%). VDRL (Venereal Disease Research Laboratory) sanguíneo foi positivo em 8 pacientes (66.7%), VDRL no líquor foi negativo em 7 de 9 coletados (77,8%), FTA-Abs sanguíneo foi positivo em 100% e 8 pacientes (66,7%) eram HIV positivos, AV após tratamento melhorou em 10 olhos (55,6%), não se alterou em 7 (38,9%) e piorou em 1 olho (5,6%). Embora ainda não reconhecida na literatura como uma manifestação típica da sífilis ocular, este achado é muito comum na prática clínica. Acreditamos que esses pontos são devidos a perivasculite secundária à infecção pelo treponema. É importante os reconhecer e lembrar que a sífilis pode se apresentar de várias formas, incluindo essa apresentada aqui.

Infectious keratitis in patients undergoing Boston Type 1 keratoprosthesis (Boston KPro) procedure: case series.

Description of two cases of infectious keratitis in patients after Boston Type 1 keratoprosthesis (Boston KPro) implantation. The first case refers to a patient that had the device indicated due to limbal deficiency secondary to severe dry eye who presented a fungal infection by Aerobasidium pullulans that was successfully treated with amphotericin B eye drops. The second case reports a patient with Boston KPro implantation due to previous corneal transplant rejection showing bacterial keratitis in the fourth postoperative month. The etiologic agent was identified as Streptococcus sp and topical treatment with vancomycin was effective. The importance of postoperative surveillance in Boston KPro eyes is discussed.

Retratamento de LASIK com fotoablação personalizada versus fotoablação convencional utilizando o LADAR: Alcon / LASIK retreatment with customized versus conventional photo-ablation using LADAR: Alcon

OBJETIVO:Avaliar os resultados do retratamento convencional (LADAR, Alcon) e do retratamento personalizado(LADARWave, Alcon) em olhos submetidos a LASIK primário convencional. MÉTODOS: Estudo retrospectivo de revisão de prontuários consecutivos, de 38 olhos em 38 pacientes, submetidos a retratamento de LASIK para correção de miopia e astigmatismo. Os olhos operados foram divididos em dois grupos iguais. No primeiro grupo foi realizado o retratamento personalizado e, no outro, o retratamento convencional. As seguintes variáveis foram comparadas: acuidade visual de alto contraste e refração manifesta. A qualidade visual foi estimada e comparada através de inquérito subjetivo proposto aos pacientes. RESULTADOS: Não houve diferença estatística entre os grupos comparando-se as variáveis estudadas. O equivalente esférico pós-retratamento foi de 0,36 no grupo convencional e de 0,47 no personalizado (p=0,079). A acuidade visual de Snellen foi de 0,91 e 0,87, respectivamente, com p=0,07. O total de aberrações pré-operatório foi maior do que o pós-operatório no grupo personalizado (p<0,001). Já no grupo convencional não houve esta diferença para nenhuma aberração avaliada. As queixas de glare (p=0,117), fotofobia (p=0,987) e flutuação da visão (p=0,545) foram estatisticamente semelhantes entre os grupos. CONCLUSÃO: Comparando-se as cirurgias personalizada e convencional para o retratamento de LASIK primário com o LADAR, Alcon, não houve diferença estatística em relação à quantidade e qualidade visual. Apesar disso, houve maior porcentagem de pacientes com queixas em relação à qualidade visual no grupo submetido à cirurgia convencional. A cirurgia personalizada parece ter maior capacidade em reduzir o total de aberrações do que a cirurgia convencional.

OBJECTIVE: To evaluate the results of conventional (Ladar, Alcon) and customized (LADARWave, Alcon) retreatment ineyes undergoing conventional primary LASIK. METHODS: Retrospective revision of consecutive clinical report forms of 38 eyes of 38 patients who underwent LASIK retreatment for myopia and astigmatism. The operated eyes were divided into two equal groups. In the first was performed customized retreatment and, in the other, conventional retreatment. The following variables were compared: high contrast visual acuity and manifest refraction. The visual quality was estimated and compared using subjective survey offered to patients. RESULTS: There was no statistical difference between the groups when comparing the variables studied. The spherical equivalent after retreatment was 0.36 in the conventional group and 0.47 in the custom (p = 0.079). Snelen visual acuity was 0.91 and 0.87, respectively (p = 0.07). The preoperative total aberrations was higher than the postoperative period in custom group (p <0.001). In the conventional group there was no difference for any aberration evaluated. Complaints of glare (p = 0.117), photophobia (p = 0.987) and vision fluctuation (p = 0.545) were statistically similar between the two groups. CONCLUSION: Comparing the custom and conventional surgery for primary LASIK retreatment with LADAR, Alcon, there wasno statistical difference in the quantity and quality of vision. Nevertheless, there was a higher percentage of patients with complaints in relation to the visual quality in the group undergoing conventional surgery. Custom surgery seems to have greater capacity to reduce the total aberrations than conventional.

Infectious keratitis in patients undergoing Boston Type 1 keratoprosthesis (Boston KPro) procedure: case series / Ceratite infecciosa em pacientes submetidos ao implante de ceratoprótese Boston Tipo I: série de casos

Description of two cases of infectious keratitis in patients after Boston Type 1 keratoprosthesis (Boston KPro) implantation. The first case refers to a patient that had the device indicated due to limbal deficiency secondary to severe dry eye who presented a fungal infection by Aerobasidium pullulans that was successfully treated with amphotericin B eye drops. The second case reports a patient with Boston KPro implantation due to previous corneal transplant rejection showing bacterial keratitis in the fourth postoperative month. The etiologic agent was identified asStreptococcus sp and topical treatment with vancomycin was effective. The importance of postoperative surveillance in Boston KPro eyes is discussed.

Descrição de dois casos de ceratite infecciosa em pacientes submetidos a implante de ceratoprótese Boston Tipo 1 (Boston KPro). O primeiro caso refere-se a uma paciente na qual o dispositivo foi indicado por deficiência límbica secundária a olho seco grave, no qual foi identificado infecção fúngica por aerobasidium pullulans, tratada com sucesso com colírio de anfotericina B. O segundo caso reporta uma paciente com implante de Boston KPro por falências de transplantes de córnea prévios, que apresentou ceratite bacteriana no quarto mês pós-operatório. O agente etiológico identificado foi Streptococcus sp e o tratamento tópico com vancomicina foi eficaz. Discute-se a importância da vigilância pós-operatória em olhos submetidos ao implante de ceratoprótese.