RESUMO
BACKGROUND: Frosted branch angiitis is a rare, severe condition. It can be either a primary or a secondary condition and is characterized by rapid deterioration of vision and fulminant retinal vasculitis that manifests as diffuse sheathing of retinal vessels, macular edema, papillitis, vitritis and anterior uveitis. We aimed to describe a case of frosted branch angiitis and cerebral venous sinus thrombosis as an initial neuro-Behçet's disease onset. Diagnosis of Behçet's disease was based on the current 2014 International Criteria for Behçet's Disease and the International consensus recommendation criteria for neuro-Behçet's disease. In addition, a literature review using search parameters of "frosted branch angiitis", "Behçet" and "neuro-Behçet" in the PubMed database is presented. CASE PRESENTATION: A 28-year-old Brazilian pardo woman presented to our hospital with abrupt bilateral vision loss associated with recurrent aphthous oral ulcers 6 months before visual symptom onset. A fundus examination showed bilateral widespread retinal vasculitis with venous and arterial white sheathing, optic disc swelling, macular edema, and retinal hemorrhages, leading to the diagnosis of frosted branch angiitis. An extensive systemic workup for retinal vasculitis was uneventful, except for brain magnetic resonance imaging demonstrating cerebral venous sinus thrombosis and lymphocytic aseptic meningitis. A diagnosis of neuro-Behçet's disease was made, and treatment was started with methylprednisolone therapy 1 g/day for 5 consecutive days, followed by oral mycophenolate mofetil and infliximab 5 mg/kg infusion. The patient's response was rapid, with improvement of visual acuity to hand movement and counting fingers by day 7 and final visual acuity of counting fingers and 20/130. CONCLUSIONS: Frosted branch angiitis may be associated with infectious, noninfectious, or idiopathic causes. An extensive workup should be done to exclude systemic vasculitis such as Behçet's disease. Treatment with systemic steroids must be promptly initiated in association with specific treatment aimed at inflammation control and blindness risk reduction.
Assuntos
Síndrome de Behçet/diagnóstico , Imageamento por Ressonância Magnética , Hemorragia Retiniana/diagnóstico , Vasculite Retiniana/diagnóstico , Trombose dos Seios Intracranianos/diagnóstico , Transtornos da Visão/etiologia , Adulto , Antibióticos Antineoplásicos/uso terapêutico , Síndrome de Behçet/tratamento farmacológico , Síndrome de Behçet/fisiopatologia , Feminino , Angiofluoresceinografia , Fundo de Olho , Humanos , Metilprednisolona/uso terapêutico , Ácido Micofenólico/uso terapêutico , Úlceras Orais , Recuperação de Função Fisiológica , Hemorragia Retiniana/tratamento farmacológico , Hemorragia Retiniana/fisiopatologia , Vasculite Retiniana/complicações , Vasculite Retiniana/fisiopatologia , Trombose dos Seios Intracranianos/tratamento farmacológico , Trombose dos Seios Intracranianos/fisiopatologia , Resultado do Tratamento , Transtornos da Visão/fisiopatologiaRESUMO
BACKGROUND: High altitude retinopathy (HAR) includes a number of diseases related to high altitude such as acute mountain sickness (AMS), high altitude pulmonary edema (HAPE) and high altitude cerebral edema (HACE). High altitude retinopathy is mainly characterized by retinal hemorrhages, usually sparing the macular region, a condition specifically known as high altitude retinal hemorrhages (HARH). The pathogenesis of HARH is unclear. Many studies show that lack of oxygen causes an inadequate autoregulation of retinal circulation, causing vascular incompetence. Other retinal changes described in HAR have been reported, such as optical disk edema, optic disc hyperemia, cotton wool exudates, venous occlusions, and macular edema. CASE REPORT: In this paper we present a case of an aviator who developed a unilateral maculopathy through subhyaloid lipid accumulation on a climb to the top of Mt. Everest. The clinical findings are suggestive of an apparent case of temporary altitude-induced visual disruption maybe by the same presumable pathogenesis of HARH. Right eye visual loss was perceived at 5150 m when he was trying to take a photograph 40 d into the expedition. DISCUSSION: The maculopathy developed by this patient adds to the discussion on the pathogenesis of HARH, especially the aspect of this maculopathy and its complete resolution. It seems that autoregulation failure could lead to exudation and lipid deposits in the foveal area. Although macular damage is not a common signal in HARH, checking visual acuity during high altitude expeditions remains an important procedure to avoid late diagnosis as unilateral blindness may not be detected early. Rosas Petrocinio R, Gomes ED. Lipid subhyaloid maculopathy and exposure to high altitude. Aerosp Med Hum Perform. 2016; 87(10):898-900.
Assuntos
Doença da Altitude/fisiopatologia , Montanhismo , Pilotos , Hemorragia Retiniana/fisiopatologia , Adulto , Altitude , Doença da Altitude/complicações , Angiofluoresceinografia , Humanos , Masculino , Doenças Retinianas/diagnóstico por imagem , Doenças Retinianas/etiologia , Doenças Retinianas/fisiopatologia , Hemorragia Retiniana/diagnóstico por imagem , Hemorragia Retiniana/etiologia , Tomografia de Coerência ÓpticaRESUMO
PURPOSE: To evaluate the outcome of pars plana vitrectomy, subretinal tissue plasminogen activator (t-PA) infusion and intraocular gas tamponade with and without postsurgical antivascular endothelial growth factor (VEGF) injection for thick submacular hemorrhage due to exudative age-related macular degeneration (AMD). DESIGN: Retrospective, comparative, interventional case series. METHODS: setting: 2 retina referral centers. The patient population included 101 eyes of 101 patients with neovascular AMD and thick submacular hemorrhage who underwent surgical displacement of the hemorrhage with or without postoperative anti-VEGF injections. Main outcome measures included degree of blood displacement, best and final postoperative visual acuity (VA), and adverse events. Snellen acuity was converted to logMAR for statistical analysis. RESULTS: All patients were followed for a minimum of 3 months (mean, 15.3 months, range, 3-70 months). In 83 (82%) of 101 eyes, the procedure resulted in complete hemorrhage displacement from the fovea. Mean preoperative VA was 20/2255 (2.05 logMAR). The acuity significantly improved to 20/893 (1.65 logMAR) at month 1 (P < 0.001) at month 1; 20/678 (1.53 logMAR) at month 3 (P < 0.001), and 20/1150 (1.76 logMAR) at month 12 (P = 0.002). Best postoperative visual acuity improved by at least 1 line in 83 (82%) of 101 eyes, and 19.6% of eyes gained 3 lines or more at month 3. The visual acuity of the group of eyes that received postoperative anti-VEGF injection (n = 39) showed greater visual acuity improvement 6 months postoperatively compared to the group of eyes that did not receive postoperative anti-VEGF. Postoperative complications included vitreous hemorrhage in 2 eyes, rhegmatogenous retinal detachment in 4 eyes, and recurrent thick subretinal hemorrhage in 6 eyes. CONCLUSIONS: Vitrectomy with subretinal t-PA injection and gas tamponade was found to be relatively effective for displacement of thick submacular hemorrhage with a significant improvement in visual acuity. There is a loss of acuity over time; the addition of postoperative anti-VEGF therapy may help maintain the visual acuity gains.
Assuntos
Tamponamento Interno , Fibrinolíticos/uso terapêutico , Hemorragia Retiniana/terapia , Ativador de Plasminogênio Tecidual/uso terapêutico , Vitrectomia , Degeneração Macular Exsudativa/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Ar , Inibidores da Angiogênese/uso terapêutico , Terapia Combinada , Feminino , Angiofluoresceinografia , Fluorocarbonos/administração & dosagem , Humanos , Injeções Intraoculares , Masculino , Pessoa de Meia-Idade , Decúbito Ventral , Hemorragia Retiniana/diagnóstico , Hemorragia Retiniana/etiologia , Hemorragia Retiniana/fisiopatologia , Estudos Retrospectivos , Hexafluoreto de Enxofre/administração & dosagem , Tomografia de Coerência Óptica , Resultado do Tratamento , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Acuidade Visual/fisiologia , Degeneração Macular Exsudativa/complicações , Degeneração Macular Exsudativa/diagnóstico , Degeneração Macular Exsudativa/fisiopatologiaRESUMO
PURPOSE: To investigate the effect of perfluoro-octane on coagulation studies and on intraoperative hemostasis during vitreoretinal surgery in an animal model. METHODS: In vitro study--comparison of coagulation profiles (bleeding time, whole blood clotting time, partial thromboplastin time, and one-stage prothrombin time) of blood taken from healthy volunteers with and without the addition of perfluoro-octane. In vivo study--comparison of times taken to achieve hemostasis in a rabbit model with large retinal arterial bleeding in vitrectomized and aphakic eyes with and without intraocular injection of perfluoro-octane. RESULTS: In vitro study--perfluoro-octane had no significant effect on coagulation profiles. In vivo study--intraocular perfluoro-octane significantly reduced the time to achieve hemostasis (P < 0.01) at all infusion bottle heights in vitrectomized and aphakic rabbit eyes. CONCLUSIONS: Perfluoro-octane may be used to control bleeding during vitreoretinal surgery. A direct effect on the clotting cascade could not be demonstrated.
Assuntos
Coagulação Sanguínea/efeitos dos fármacos , Embolização Terapêutica/métodos , Fluorocarbonos/administração & dosagem , Complicações Intraoperatórias/terapia , Hemorragia Retiniana/terapia , Vitrectomia/efeitos adversos , Adulto , Animais , Coagulação Sanguínea/fisiologia , Modelos Animais de Doenças , Olho , Fluorocarbonos/farmacologia , Humanos , Injeções , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/fisiopatologia , Coelhos , Valores de Referência , Artéria Retiniana/efeitos dos fármacos , Artéria Retiniana/fisiopatologia , Hemorragia Retiniana/etiologia , Hemorragia Retiniana/fisiopatologia , Resultado do TratamentoRESUMO
PURPOSE: To assess variations in the clinical course of submacular hemorrhages. METHODS: We reviewed fundus photography charts taken of patients during a 27-month period. Thirty-one eyes of 31 patients with submacular hemorrhages under the foveal avascular zone were reviewed. RESULTS: In 20 of the eyes, the underlying etiology was age-related macular degeneration (ARMD). The other 11 eyes had various underlying conditions, including macroaneurysms (two), presumed ocular histoplasmosis syndrome (two), trauma (one), Valsalva's retinopathy (one), idiopathic central serous choroidopathy (one), diabetic retinopathy (two), central retinal vein occlusion (one), and choroidal rupture (one). Of the eyes with ARMD (mean follow-up, 29 months), eight (40%) of 20 showed an improvement in visual acuity (> or = 2 Snellen lines), six (30%) of 20 had a final visual acuity of 20/80 or better, and three (15%) had a final visual acuity of 20/40 or better (range, 20/25 to 20/80). Of the eyes without ARMD (mean follow-up, 29 months), five (45) of 11 had an improvement in visual acuity and five (45%) of 11 attained a final visual acuity of 20/40 or better (range, 20/20 to 20/40). The best predictive factor for poor final visual acuity was the presence of a subretinal neovascular membrane. CONCLUSIONS: Patients with submacular hemorrhage may have spontaneous improvement in visual acuity without surgery. Patients without subretinal neovascular membranes had a better visual improvement rate.
Assuntos
Macula Lutea/fisiopatologia , Hemorragia Retiniana/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças da Coroide/complicações , Feminino , Seguimentos , Fundo de Olho , Humanos , Masculino , Pessoa de Meia-Idade , Fotografação , Doenças Retinianas/complicações , Hemorragia Retiniana/etiologia , Estudos Retrospectivos , Acuidade Visual/fisiologiaRESUMO
Os autores apresentam um caso de paciente com a síndrome de vasculite retiniana hemorrágica multifocal aguda, descrita por Blumenkranz e colaboradores, cuja etiologia permanece desconhecida. No caso apresentado o paciente foi tratado com a prednisona oral com alguns benefícios, com o acyclovir, sem benefício e com a fotocoagulaçäo com laser de argônio nas áreas isquêmicas
Assuntos
Humanos , Masculino , Adulto , Ceratite Herpética/diagnóstico , Diagnóstico Diferencial , Herpes Zoster Oftálmico/diagnóstico , Vasculite por IgA/fisiopatologia , Hemorragia Retiniana/fisiopatologia , Retina , Síndrome de Behçet/diagnósticoRESUMO
Os autores descrevem a história natural de 3 pacientes míopes que apresentam episódios de hemorragia sub-retiniana macular associada a lacquer crack. Em nenhum deles se evidenciou a presença de neovascularizaçäo sub-retiniana. Chamam a atençäo para a begnidade da lesäo, bem como discutem esta alteraçäo patológica
Assuntos
Humanos , Feminino , Masculino , Miopia/patologia , Neovascularização Retiniana/fisiopatologia , Hemorragia Retiniana/fisiopatologia , Angiografia , Brasil , Acuidade Visual/terapiaRESUMO
Apresentaçäo de 7 casos de hemorragia retiniana e/ou vítrea ocorrendo em pacientes sem alteraçöes oculares ou sistêmicas consideradas como predisponentes. Em 5 casos a hemorragia foi desencadeada pela manobra de Valsalva. Discute-se a classificaçäo e a fisiopatologia das hemorragias retinianas por manobra de Valsalva