Oftalmia simpática / Sympathetic ophthalmia

Resumo Relatar um caso de um paciente portador de Oftalmia Simpática (OS), com descolamento seroso da retina documentado através de tomografia de coerência óptica de domínio spectral (SD OCT), indocianina verde (ICG) e angiofluoreceinografia (AGF), que o diagnóstico foi realizado em uma consulta de rotina e iniciado tratamento clínico .

Abstract To report the case of a patient with sympathetic ophthalmia (OS), with serous detachment of retinal documented by spectral domain optical coherence tomography (OCT), indocyanine green (ICG) and angiofluorecephography (AGF). The diagnosis was made in a routine consultation and clinical treatment was initiated.

Evisceration surgery in a highly specialized center in Mexico: A retrospective study of 7 years of experience. / Cirugía de evisceración ocular en un centro de alta especialidad en México: estudio retrospectivo de 7 años de experiencia.

INTRODUCTION: Evisceration is currently becoming the technique of choice in the treatment of certain eye diseases, including, among others, painful blind eye and endophthalmitis. The most widely used implants are currently the hydroxyapatite and porous polyethylene for the rehabilitation of the anophthalmic socket. OBJECTIVE: To describe the indications, type of implant material used, and complications in evisceration surgery. METHODS: A retrospective, observational, descriptive study based on clinical records of patients that underwent evisceration between 2008 and 2015 in the Instituto Fundación Conde de Valenciana, Mexico. RESULTS: A total of 186 evisceration surgeries were performed, of which 52.7% of the patients were men. The mean age was 54 years. The right eye was eviscerated in 53% of cases, and 79.2% had a vision of no light perception. Most patients had preoperative pain. The most common diagnosis for which evisceration was performed was endophthalmitis. Phthisis bulbi was reported in 20 eyes. A primary implant was inserted in 86.81% of the cases, with 34.81% of the implants being made of porous polyethylene. Four cases showed extrusion of the implant, with 2 cases of porous polyethylene. The ocular prosthesis was tolerated in 91% of cases. There were no cases of sympathetic ophthalmia. CONCLUSION: Evisceration is shown to be a good alternative to enucleation in cases where the sclera can be preserved, showing a low incidence of sympathetic ophthalmia.

Epilens membrane simulating cataract in children with uveitis: a report of three cases / Membrana epicristaliniana simulando catarata em crianças com uveíte: relato de três casos

ABSTRACTHere we present the cases of three female children, of whom two were aged 6 years and one was aged 11 years. Two of the three children had bilateral uveitis and suspected cataract and Vogt-Koyanagi-Harada (VKH) disease. The third one had uveitis and suspected cataract in one eye and sympathetic ophthalmia (SO), and had undergone penetrating keratoplasty in the fellow eye following a trauma. After controlling the inflammation, we planned to perform phacoemulsification without intraocular lens implantation. However, intraoperatively, after removing the epilens membranes, the lenses appeared clear, and therefore phacoemulsification was not performed. During follow-up, the patients did not develop cataract, and visual acuity levels ranged from 20/30 to 20/100. Fundoscopy revealed VKH disease and SO. Ophthalmologists should not always assume that patients with uveitis have cataract; a transparent lens may exist behind the epilens membrane, allowing a less aggressive therapeutic approach.

RESUMOApresentamos os casos de três meninas (duas de seis anos e uma de onze anos), com uveíte bilateral e suspeita de catarata em ambos os olhos e doença de Vogt-Koyanagi-Harada (VKH) em dois casos. No terceiro caso, oftalmia simpática e suspeita de catarata em um olho e trauma com ceratoplastia penetrante no outro olho. Após controle da inflamação, indicou-se facoemulsificação sem LIO. No per-operatório, após retirada da membrana epicristaliniana, a transparência do cristalino foi percebida, não sendo realizada a facoemulsificação. No período de acompanhamento as pacientes não desenvolveram catarata e a acuidade visual variou de 20/30 a 20/100. O exame de fundoscopia reforçou o diagnóstico de VKH e oftalmia simpática. Portanto, é muito importante que o oftalmologista esteja sempre atento quando se deparar com um caso de uveíte com suspeita de catarata, porque, por trás da membrana epicristaliniana pode existir um cristalino transparente, o que leva a uma conduta terapêutica menos agressiva.

Fibrose sub-retiniana progressiva: relato de casos / Progressive subretinal fibrosis: case reports

A síndrome da fibrose sub-retinina é uma doença rara e considerada como parte de um grupo de condições que recebem a denominação de síndrome dos pontos brancos. No entanto, alguns autores a consideram como uma entidade distinta dessas outras doenças com características próprias. Com os casos apresentados, podemos observar muitas dessas características já descritas, como localização e aspecto clínico das lesões, sua evolução e o prognóstico visual final. Seu diagnóstico é muito importante a se considerar em diversos tipos de uveíte, pois o tratamento precoce pode evitar o acometimento bilateral.

The subretinal fibrosis syndrome is a rare disease and is considered part of a group of conditions that are denominated white dots syndrome. However, some authors consider it like a distinct entity from the others diseases with you own features. With these cases we can behold many features already described, like localization and clinical aspect of the lesion, your evolution and the final visual prognosis. It's diagnostic is very important to consider in a varied type of uveitis, because the treatment can avoid the bilateral involvement.

Aspectos da tomografia de coerência óptica na oftalmia simpática: relato de caso / Optical coherence tomography aspects of sympathetic ophthalmia: case report

A oftalmia simpática é uma panuveíte granulomatosa que se inicia após trauma ocular. O prognóstico é reservado e depende do diagnóstico e tratamento precoces. Os autores descrevem um caso de paciente portador de oftalmia simpática no qual foi realizada tomografia de coerência óptica e instituído tratamento precoce, e sugerem que a tomografia de coerência óptica possa corroborar como exame subsidiário no estudo das características da retina de pacientes portadores dessa doença, especialmente em casos de apresentação rara, com descolamento seroso da retina, como manifestação oftalmológica isolada.

The sympathetic ophthalmia is a granulomatous panuveitis that starts after ocular trauma. The prognosis is poor and depends of both early diagnosis and treatment. The authors describe one case of a patient with sympathetic ophthalmia using optical coherence tomography who was submitted to early treatment, and it suggests that the optical coherence tomography can corroborate as a ancillary method in the study of retina characteristics in sympathetic ophthalmia disease specially in cases of rare presentation, with serous retinal detachment as an isolated ophthalmological manifestation.

Sympathetic ophthalmia - histopathological correlation with fluorescein and indocyanine green angiography: case report / Oftalmia simpática - correlação da histopatologia com a angiografia por fluoresceína e indocianina verde: relato de caso

This study correlates fluorescein angiography (FA) and indocyanine green angiography (ICGA) to histopathologic findings in a patient with sympathetic ophtalmia. A male with a perforated trauma in right eye presented after two months a decrease in visual acuity of the left eye. FA and ICGA were performed and the images were correlated with the histopathologic findings of the enucleated eye; FA showed background areas of homogeneous hypofluorescence in the arterial and venous phases, as well as areas of granular progressive hyperfluorescence and leakage from the optic disc. ICGA showed areas of hypofluorescence in the early and intermediate phases of the examination, which persisted until the late phase. During the early phase, there was also diffuse hypofluorescence caused by blockage that allowed observation of areas of partial choroidal circulation. The histopathology of the enucleated right eye showed diffuse choriocapillaris edema and inflammation of the choroids, focal areas of hyperplasia of the retinal pigment epithelium (RPE) as well as foci of epithelioid cells located between the choroid and the RPE. Furthermore, lymphocytic infiltration of the episcleral veins and retinal detachment were present. The hyperfluorescence observed on FA was correlated to retinal detachment and optic nerve inflammation. The hypofluorescence noted on FA and ICGA corresponded to the presence of blocking inflammatory cells (Dalen-Fuchs-like nodules) and to diffuse choriocapillaris edema.

O objetivo deste relato de caso foi correlacionar achados da histopatologia com a angiografia por fluoresceína (AF) e por indocianina verde (AIV) em um paciente com oftalmia simpática. Após dois meses de trauma perfurante no olho direito, o paciente apresentou baixa acuidade visual no olho esquerdo (OE). A AF do OE mostrou áreas de hipofluorescência homogênea na fase arterial e venosa, áreas de progressiva hiperfluorescência granular e vazamento do disco. A AIV mostrou áreas de hipofluorescência na fase inicial à tardia. A histopatologia foi realizada após evisceração do olho direito e demonstrou difuso edema da coriocapilar, inflamação da coróide, áreas focais de hiperplasia do epitélio pigmentar da retina, focos de células epitelióides entre a coróide e o epitélio pigmentar da retina, além da infiltração linfocitária das veias episclerais e descolamento de retina. A hiperfluorescência observada na AF foi correlacionada com o descolamento de retina e inflamação do nervo óptico. A hipofluorescência na AF e AIV correspondeu à presença de células inflamatórias (nódulos de Dalen-Fuchs) e edema coriocapilar difuso.

Oftalmía simpática: A propósito de un caso / Sympathetic ophthalmia: Apropos of a case

Se presenta un paciente de 65 años de edad operado de extracción intracapsular del cristalino del ojo izquierdo (OI), sin accidentes, el cual al cabo de los 3 meses, comienza a presentar éstasis papilar bilateral; el chequeo cliniconeurológico realizado fue negativo. Se comenzó con dosis de 80 mg diarios de prednisona y a los 2 meses desarrolló panuveítis bilateral. Se decidió realizar extracción del cristalino por catarata patológica en ojo derecho (OD) y además comenzar con el uso de ciclosporina a 7 mg/kg en 2 tomas diarias y 10 mg de prednisona. Esta terapia se mantiene por 2 meses al cabo de los cuales el cuadro uveal bilateral desaparece completamente; queda con una agudeza visual en OD de 0,1 y de cuenta dedos en el OI. Después de 6 años de seguimiento el paciente no ha presentado ninguna recaída y se desenvuelve con normalidad en su medio familiar.

A 65-year-old patient who underwent an intracapsular extraction of the crystalline lens of the left eye without accidents and 3 months later began to suffer from bilateral papillary stasis was presented. The clinical and neurological examination made was negative. The patient was given 80 mg of prednisona daily, and after 2 months he developed bilateral panuveitis. It was decided to extract the crystalline lens due to pathological cataract in the right eye and to administer 7 mg/kg of cyclosporine twice a day and 10 mg of prednisone during 2 months. The afecction dissapeared as a result of the treatment. It remains a visual scuity of 0,1 in the right eye and of counting fingers in the left eye. There has been no relapse after a 6-year follow-up.The patient is doing well in his familial enviroment.