RESUMO
BACKGROUND: Rhinosporidiosis is a rare chronic infection of the mucous membranes caused by the Rhinosporidium seeberi. Approximately 15% of cases of rhinosporidiosis are ocular, occurring mainly in the tarsal conjunctiva. There are only 11 cases of scleral melt with staphyloma formation associated with bulbar conjuctival oculosporidiosis and none of them was associated with partial regression of the scleral ectasia after a corneoscleral tectonic graft. CASE PRESENTATION: a 13-year-old girl with a progressively increasing black mass in the upper nasal part above the cornea of the left eye. The biomicroscopy revealed an oval, bluish mass measuring 10x10x5 mm with congestion of the overlying conjunctiva. Conjunctival biopsy showed sporoblasts of Rinosporidium seeberi. Treatment was conducted by conjunctival resection and tectonic corneoscleral graft (13x13mm) over the staphyloma. Within 1 year of follow-up the patient presented a partial staphyloma reduction, 9x9x2.5 mm, and the patch detached from the lesion. A novel surgical approach was done reducing the corneal patch and no recurrence was seen after 9 months. CONCLUSIONS: This case is one of the largest anterior scleral staphylomas secondary to rhinosporidiosis described in the literature. Scleral anterior staphyloma partial regression is an unusual outcome after a tectonic corneoscleral graft. Infection resolution and graft covering of thinned area contributed to scleral reepithelization.
Assuntos
Transplante de Córnea , Rinosporidiose/parasitologia , Rinosporidiose/cirurgia , Esclera/transplante , Doenças da Esclera/parasitologia , Doenças da Esclera/cirurgia , Adolescente , Animais , Túnica Conjuntiva/parasitologia , Transplante de Córnea/métodos , Feminino , Humanos , Recidiva , Rhinosporidium/isolamento & purificação , Resultado do TratamentoRESUMO
Interstitial keratitis is an inflammation of the corneal stroma without epithelium or endothelium involvement. The underlying causes are mostly infectious or immune mediated. Brazil has one of the highest incidence rates of tuberculosis in the world. Tuberculosis is considered one of the causes of interstitial keratitis. Malnutrition and anemia are risk factors of the disseminated disease. This is a case report of a 10-year-old child who presented with decreased visual acuity and a clinical diagnosis of bilateral interstitial keratitis and sclero-uveitis. The patient had been treated with topical steroids with partial improvement. Examinations revealed severe iron deficiency anemia, negative serologies for human immunodeficiency virus and syphilis, positivity for cytomegalovirus- and herpes simplex-specific IgG, and purified protein derivative of 17 mm. During the follow-up, the patient presented with tonic-clonic seizures, and magnetic resonance imaging findings suggested a central nervous system tuberculoma. Interstitial keratitis improvement was observed after specific tuberculosis treatment. This is the first case report describing the association of interstitial keratitis and central nervous system tuberculoma.
Assuntos
Ceratite Herpética , Ceratite , Tuberculoma , Tuberculose , Criança , Humanos , Ceratite/tratamento farmacológico , Tuberculose/complicações , Tuberculose/patologia , Substância Própria/patologia , Tuberculoma/complicações , Tuberculoma/patologia , Encéfalo , Ceratite Herpética/complicações , Ceratite Herpética/tratamento farmacológico , Ceratite Herpética/patologiaRESUMO
ABSTRACT Interstitial keratitis is an inflammation of the corneal stroma without epithelium or endothelium involvement. The underlying causes are mostly infectious or immune mediated. Brazil has one of the highest incidence rates of tuberculosis in the world. Tuberculosis is considered one of the causes of interstitial keratitis. Malnutrition and anemia are risk factors of the disseminated disease. This is a case report of a 10-year-old child who presented with decreased visual acuity and a clinical diagnosis of bilateral interstitial keratitis and sclero-uveitis. The patient had been treated with topical steroids with partial improvement. Examinations revealed severe iron deficiency anemia, negative serologies for human immunodeficiency virus and syphilis, positivity for cytomegalovirus- and herpes simplex-specific IgG, and purified protein derivative of 17 mm. During the follow-up, the patient presented with tonic-clonic seizures, and magnetic resonance imaging findings suggested a central nervous system tuberculoma. Interstitial keratitis improvement was observed after specific tuberculosis treatment. This is the first case report describing the association of interstitial keratitis and central nervous system tuberculoma.
RESUMO A ceratite intersticial é uma inflamação do estroma corneano sem envolvimento epitelial ou endotelial causada principalmente por doenças infecciosas e imunomediadas. O Brasil tem altas taxas de tuberculose que deve ser lembrada como causa de ceratite intersticial. Desnutrição e anemia são fatores de risco da forma disseminada da tuberculose. Este é um relato de uma criança de 10 anos com redução de acuidade visual e diagnóstico clínico de ceratite intersticial bilateral e esclerouveíte. O paciente obteve melhora parcial da ceratite com corticoide tópico. Exames laboratoriais mostraram anemia ferropriva grave, sorologias negativas para HIV e sífilis; IgM negativo e IgG positivo para citomegalovírus e herpes simplex e PPD positivo (17 mm). Ele evoluiu com crises tônico-clônicas e a ressonância nuclear magnética revelou tuberculoma do sistema nervoso central. A melhora da ceratite intersticial foi observada após tratamento para tuberculose. Este é o primeiro caso que descreve a associação de ceratite intersticial e tuberculoma do sistema nervoso central.
RESUMO
PURPOSE: We examined the structure-function relationship between two perimetric tests, the frequency doubling technology (FDT) matrix and standard automated perimetry (SAP), and two optical coherence tomography (OCT) devices (time-domain and spectral-domain). METHODS: This cross-sectional study included 97 eyes from 29 healthy individuals, and 68 individuals with early, moderate, or advanced primary open-angle glaucoma. The correlations between overall and sectorial parameters of retinal nerve fiber layer thickness (RNFL) measured with Stratus and Spectralis OCT, and the visual field sensitivity obtained with FDT matrix and SAP were assessed. The relationship also was evaluated using a previously described linear model. RESULTS: The correlation coefficients for the threshold sensitivity measured with SAP and Stratus OCT ranged from 0.44 to 0.79, and those for Spectralis OCT ranged from 0.30 to 0.75. Regarding FDT matrix, the correlation ranged from 0.40 to 0.79 with Stratus OCT and from 0.39 to 0.79 with Spectralis OCT. Stronger correlations were found in the overall measurements and the arcuate sectors for both visual fields and OCT devices. A linear relationship was observed between FDT matrix sensitivity and the OCT devices. The previously described linear model fit the data from SAP and the OCT devices well, particularly in the inferotemporal sector. CONCLUSIONS: The FDT matrix and SAP visual sensitivities were related strongly to the RNFL thickness measured with the Stratus and Spectralis OCT devices, particularly in the overall and arcuate sectors.
Assuntos
Glaucoma de Ângulo Aberto/fisiopatologia , Fibras Nervosas/patologia , Tomografia de Coerência Óptica/métodos , Testes de Campo Visual/métodos , Campos Visuais/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Estudos Transversais , Feminino , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Limiar Sensorial/fisiologiaRESUMO
Abstract Objectives: To evaluate the epidemiological profile and prognosis of patients with mechanical ocular trauma. Methods: Descriptive cross-sectional observational study of consecutive patients evaluated during a one-year period at a public referral center in São Luis, Maranhão, Brazil. The Ocular Trauma Score (OTS) was used to estimate final visual acuity. The variables were analyzed using the chi-square test with a significance level of 5%. Results: Out of a total of 154 patients (mean age of 30.1 years), 27.92% were younger than 16 years, and 81.8% were men, with most coming from the state's countryside (55.2%). Most of the patients were dependents (34%) or rural workers (19%). Regarding the OTS prognosis, 33.77% of the patients were category 5 and 31.16% category 1 or 2, indicating worse prognosis. The best prognoses (visual outcomes) were inversely proportional to age and time to treatment (p<0.001). Conclusion: Ocular trauma remains an important cause of ocular morbidity in childhood and in informal work. Adult supervision and socio-educational measures are mandatory to change this scenario.
Resumo Objetivos: Avaliar o perfil epidemiológico e o prognóstico visual de pacientes com trauma ocular mecânico. Métodos: Estudo observacional transversal descritivo de pacientes consecutivos atendidos durante o período de um ano em um centro de referência público em São Luís, Maranhão. O Ocular Trauma Score foi aplicado a fim de estimar a acuidade visual final. As variáveis foram analisadas por meio do teste de Qui-quadrado com nível de significância de 5%. Resultados: Encontrou-se 154 pacientes tratados, a média de idade foi 30,1 anos, 27,92% menores que 16 anos, homens (81,8%) e do interior do Estado (55,2%). A maioria eram dependentes (34%), dos trabalhadores ocorreu o predomínio do trabalhador rural (19%). Quanto ao prognóstico, 33,77% dos pacientes apresentavam-se na categoria 5 e 31,16% na 1 ou 2, de pior prognóstico. Os melhores prognósticos foram inversamente proporcionais a idade e ao tempo até o atendimento (p<0,001). Conclusão: O trauma ocular se mantém como importante causa de morbidade ocular na infância e no trabalho informal. A supervisão de adultos e medidas socioeducativas são fundamentais para mudar esse cenário.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Traumatismos Oculares/diagnóstico , Traumatismos Oculares/embriologia , Traumatismos Oculares/prevenção & controle , Prognóstico , Brasil , Distribuição de Qui-Quadrado , Epidemiologia Descritiva , Estudos Transversais , Morbidade , Estudo ObservacionalRESUMO
OBJECTIVE: To compare the pattern of intraocular pressure (IOP) reduction following selective laser trabeculoplasty (SLT) versus argon laser trabeculoplasty (ALT) in open-angle glaucoma (OAG) patients, and to investigate the ability of initial IOP reduction to predict mid-term success. METHODS: A prospective, nonrandomized, interventional case series was carried out. Consecutive uncontrolled OAG glaucoma patients underwent SLT or ALT; the same preoperative medical regimen was maintained during follow-up. Data collected included age, type of OAG, pre- and postoperative IOP, number of glaucoma medications, and surgical complications. Post-treatment assessments were scheduled at day 1 and 7 and months 1, 3, and 6. RESULTS: A total of 45 patients (45 eyes) were enrolled [SLT group (n = 25); ALT group (n = 20)]. Groups were similar for age, baseline IOP, and number of glaucoma medications (P ≥ 0.12). We found no significant differences in mean IOP reduction between SLT (5.1 ± 2.5 mmHg; 26.6%) and ALT (4.4 ± 2.8 mmHg; 22.8%) groups at month 6 (P = 0.38). Success rates (IOP ≤ 16 mmHg and IOP reduction ≥25%) at last follow-up visit were similar for SLT (72%) and ALT (65%) groups (P = 0.36). Comparing the pattern of IOP reduction (% of IOP reduction at each visit) between groups, we found a greater effect following SLT compared with ALT at day 7 (23.7% ± 13.7% vs 8.1% ± 9.5%; P < 0.001). No significant differences were observed at other time points (P ≥ 0.32). Additionally, the percentage of IOP reduction at day 7 and at month 6 were significantly correlated in the SLT group (R(2) = 0.36; P < 0.01), but not in the ALT group (P = 0.89). Early postoperative success predicted late success in most SLT cases (82%). No serious complications were observed. CONCLUSION: Although mid-term results suggest SLT and ALT as effective and equivalent alternatives, a greater initial IOP reduction was observed following SLT. In addition, the initial IOP reduction was a good predictor of mid-term success in patients undergoing SLT, but not ALT.
RESUMO
PURPOSE: To evaluate the inflammatory response associated with the use of processed porcine pericardium and glycerin-preserved homologous sclera as silicone glaucoma drainage device coverage in a rabbit experimental model. METHODS: Eight New Zealand white rabbits' eyes received an equal-sized glycerin-preserved homologous scleral patch or a double-layered processed porcine pericardium that was sutured to the bare sclera covering a silicone tube. Conjunctival hyperemia was graded using the double-blind method during the immediate postoperative period and during the first, third, and seventh postoperative weeks. After the seventh week, the enucleated eyes were histopathologically examined. They were also evaluated for signs of patch graft melting, tube erosion and chemosis. RESULTS: There was no occurrence of graft melting or tube exposure, although porcine pericardium was associated with greater inflammation through clinical observation. Light microscopy revealed marked inflammation surrounding the porcine pericardium with foreign body granuloma formation. On the other hand, the sclera group presented milder inflammation with foreign body granulomas only around the sutures. CONCLUSIONS: Porcine pericardium is associated with significant inflammation when used as tube coverage in a rabbit model, at both histopathologic and clinical levels, when compared to glycerin-preserved homologous sclera during the seven-week follow-up period.
Assuntos
Implantes para Drenagem de Glaucoma , Glaucoma/cirurgia , Pericárdio/transplante , Esclera/transplante , Animais , Reação a Corpo Estranho/patologia , Hiperemia/patologia , Pericárdio/patologia , Coelhos , Esclera/patologia , Suínos , Fatores de TempoRESUMO
PURPOSE: To evaluate the inflammatory response associated with the use of processed porcine pericardium and glycerin-preserved homologous sclera as silicone glaucoma drainage device coverage in a rabbit experimental model. METHODS: Eight New Zealand white rabbits' eyes received an equal-sized glycerin-preserved homologous scleral patch or a double-layered processed porcine pericardium that was sutured to the bare sclera covering a silicone tube. Conjunctival hyperemia was graded using the double-blind method during the immediate postoperative period and during the first, third, and seventh postoperative weeks. After the seventh week, the enucleated eyes were histopathologically examined. They were also evaluated for signs of patch graft melting, tube erosion and chemosis. RESULTS: There was no occurrence of graft melting or tube exposure, although porcine pericardium was associated with greater inflammation through clinical observation. Light microscopy revealed marked inflammation surrounding the porcine pericardium with foreign body granuloma formation. On the other hand, the sclera group presented milder inflammation with foreign body granulomas only around the sutures. CONCLUSIONS: Porcine pericardium is associated with significant inflammation when used as tube coverage in a rabbit model, at both histopathologic and clinical levels, when compared to glycerin-preserved homologous sclera during the seven-week follow-up period.
OBJETIVO: Avaliar a resposta inflamatória associada com o uso de pericárdio suíno processado e esclera homóloga preservada em glicerina no recobrimento de tubo de drenagem de silicone utilizado em cirurgia de glaucoma em modelo experimental. MÉTODOS: Oito olhos de 8 coelhos albinos da raça Nova Zelândia receberam enxertos do mesmo tamanho de esclera homóloga, preservada em glicerina ou pericárdio suíno processado, suturados à esclera recobrindo um tubo de silicone. Os olhos foram avaliados quanto à hiperemia conjuntival de modo mascarado na primeira, terceira e sétima semanas de pós-operatório. Após a sétima semana os olhos foram enucleados e submetidos a estudo histopatológico. Os olhos também foram avaliados quanto à presença de afinamento do enxerto, exposição do tubo e quemose. RESULTADOS: Não ocorreram casos de afinamento do enxerto ou exposição do tubo, porém o pericárdio suíno esteve associado clinicamente a uma maior inflamação. Achados à microscopia óptica incluíram intensa reação inflamatória em torno do enxerto de pericárdio com formação de granuloma do tipo corpo estranho. Por outro lado, no grupo que recebeu esclera, ocorreu formação de granulomas apenas em torno dos fios de sutura. CONCLUSÃO: O pericárdio suíno esteve associado a maior inflamação tanto à histopatologia quanto clinicamente, quando usado no recobrimento de tubo de silicone, em comparação à esclera homóloga preservada em glicerina, durante o período de acompanhamento de sete semanas.