A Literatura Oftalmológica e os Arquivos Brasileiros de Oftalmologia como Instrumentos de Educação e Atualização

Universidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaUNIFESP, EPMSciEL

Honorários médicos, Sistema Único de Saúde e ensino da oftalmologia para o século XXI

Universidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaUNIFESP, EPMSciEL

Lentes de contacto, oftalmología

UNIFESPUNIFESPSciEL

Treatment of cytomegalovirus retinitis with an intraocular sustained-release ganciclovir implant

The objective of this prospective study was to evaluate the efficacy and complications of the use of an intraocular sustained-release ganciclovir implant for the treatment of active cytomegalovirus (CMV) retinitis in AIDS patients. Thirty-nine eyes of 26 patients were submitted to ocular surgery. All patients underwent complete ocular examination before and after surgery. The surgical procedure was always done under local anesthesia using the same technique. The mean time for the surgical procedure was 20 min (range, 15 to 30 min). The average follow-up period was 3.7 months. Of all patient, only 4 presented recurrence of retinitis after 8, 8, 9 and 2 months, respectively. Three of them received a successful second implant. All 39 eyes of the 26 patients presented healing of retinitis as shown by clinical improvement evaluated by indirect binocular ophthalmoscopy and retinography. Retinitis healed within a period of 4 to 6 weeks in all patients, with clinical regression signs from the third week on. Six (15.4%) eyes developed retinal detachment. None of the patients developed CMV retinitis in the contralateral eye. The intraocular implant proved to be effective in controlling the progression of retinitis for a period of up to 8 months even in patients for whom systemic therapy with either ganciclovir or foscarnet or both had failed. The intraocular sustained-release ganciclovir implant proved to be a safe new procedure for the treatment of CMV retinitis, avoiding the systemic side effects caused by the intravenous medications and improving the quality of life of the patients.Universidade Federal de São Paulo (UNIFESP)UNIFESPSciEL

Ocular involvement in AIDS patients with central nervous system toxoplasmosis: before and after HAART

PURPOSE: To describe the ophthalmologic involvement in patients with Acquired Immunodeficiency Syndrome - AIDS and central nervous system toxoplasmosis comparing the period before and after highly active antiretroviral therapy (HAART). METHODS: In a retrospective study, we compared 118 Acquired Immunodeficiency Syndrome patients with central nervous system toxoplasmosis who were examined at our institution before highly active antiretroviral therapy (from 1994 - 1996) with 24 patients with Acquired Immunodeficiency Syndrome and central nervous system toxoplasmosis who were being treated with highly active antiretroviral therapy (from 1996 -1999). All patients were submitted to a complete ophthalmological examination as well as specific tests to confirm the diagnosis and there was no intersection between the groups. RESULTS: In the pre- highly active antiretroviral therapy group, it was found that 23% of the patients with central nervous system toxoplasmosis had also ocular toxoplasmosis. Ocular involvement was bilateral in 37.2% of the cases. In the group of patients receiving highly active antiretroviral therapy, who had an average CD4 of 256 cells/mm³ and average of viral load of 52,620 copies, 16.6% had concomitant ocular and central nervous system toxoplasmosis. Ocular involvement was bilateral in 50% of the cases. CONCLUSIONS: Acquired Immunodeficiency Syndrome patients with central nervous system toxoplasmosis have a frequent association with ocular toxoplasmosis. Although the incidence of opportunistic infections has decreased since the introduction of recent antiretroviral therapeutic strategies ocular toxoplasmosis continues to be frequent in patients with cen.ral nervous system toxoplasmosis.OBJETIVO: Descrever o comprometimento ocular em pacientes com AIDS e toxoplasmose do sistema nervoso central, comparando os períodos pré e pós-terapia anti-retroviral (HAART). MÉTODOS: Em estudo retrospectivo, comparamos 118 pacientes com AIDS e toxoplasmose do sistema nervoso central que foram examinados em nossa instituição antes do pré e pós-terapia anti-retroviral (1994-1996) com 24 pacientes com AIDS e toxoplasmose do sistema nervoso central que foram tratados com pré e pós-terapia anti-retroviral (1996-1999). Todos os pacientes foram submetidos a exame oftalmológico completo e a testes específicos para confirmar o diagnóstico e não houve interseção entre os grupos. RESULTADOS: No grupo pré e pós-terapia anti-retroviral, foi encontrado 23% de toxoplasmose ocular entre os pacientes com toxoplasmose do sistema nervoso central. O envolvimento ocular foi bilateral em 37% dos casos. No grupo dos pacientes que receberam pré e pós-terapia anti-retroviral, que tinham CD4 médio de 256 cel/mm³ e carga viral média de 52.620 cópias, 16,6% apresentaram concomitantemente toxoplasmose ocular e toxoplasmose do sistema nervoso central. O envolvimento ocular foi bilateral em 50% dos casos. CONCLUSÃO: Pacientes com AIDS e toxoplasmose do sistema nervoso central apresentam freqüente associação com toxoplasmose ocular. Embora a incidência de infecções oportunistas tenha diminuído desde a introdução de pré e pós-terapia anti-retroviral, a toxoplasmose ocular continua sendo freqüente em pacientes com toxoplasmose do sistema nervoso central.Universidade Federal de São Paulo (UNIFESP)UNIFESP Departamento de OftalmologiaUNIFESP, Depto. de OftalmologiaSciEL

Primary intraocular B-cell lymphoma: case report

Ocular non-Hodgkin's lymphoma is a rare condition that can involve the retina, the vitreous and the optic nerve. It can occur alone or can be associated with lymphoma of the central nervous system and a frequent manifestation is a posterior uveitis of difficult treatment. This kind of ocular tumor is difficult and a challenge to diagnosis. We describe a case of non-Hodgkin's intraocular B-cell lymphoma in a 47-year-old woman who had a posterior uveitis as the first manifestation. We emphasize the importance of a careful investigation and of the general clinical examination since this is the most common type in the eye. We expect to call the attention to this disease that many times appears in an unspecific form with unspecific symptoms.O linfoma não-Hodgkin primariamente intra-ocular é raro, e caracterizado por uma forma extranodal que pode envolver retina, espaço sub-retiniano, vítreo e nervo óptico. Ocorre independente ou associado ao linfoma do sistema nervoso central e freqüentemente na forma de uveíte de difícil tratamento. Esta forma de linfoma é um dos tumores intra-oculares mais desafiantes de se diagnosticar. Relatamos um caso de linfoma não-Hodgkin intra-ocular difuso de células grandes tipo B numa paciente de 47 anos e cuja manifestação inicial foi uma uveíte posterior; enfatizamos a importância de investigação detalhada e da avaliação sistêmica; pois esta é a forma mais freqüente de acometimento ocular. Com esse relato esperamos abordar os principais aspectos desde quadro clínico até diagnóstico chamando a atenção para essa doença que muitas vezes aparece inicialmente com sintomas vagos e inespecíficos.Universidade Federal de São Paulo (UNIFESP) Departamento de OftalmologiaUNIFESP Departamento de OftalmologiaUNIFESP Departamento de Oftalmologia Setor de RetinaUNIFESP Departamento de Oftalmologia Setor de UveítesUNIFESP, Depto. de OftalmologiaUNIFESP, Depto. de OftalmologiaUNIFESP, Depto. de Oftalmologia Setor de RetinaUNIFESP, Depto. de Oftalmologia Setor de UveítesSciEL

Ocular toxoplasmosis: an update and review of the literature

Ocular toxoplasmosis is the most common cause of posterior uveitis worldwide. The infection can be acquired congenitally or postnatally and ocular lesions may present during or years after the acute infection occur. Current treatment controls ocular infection and inflammation, but does not prevent recurrences. We present a review and update on ocular toxoplasmosis and address misconceptions still found in the current medical literature.Universidade Federal de São Paulo (UNIFESP) Instituto da VisãoMcGill University Henry C Witelson Ocular Pathology LaboratoryAlbert Einstein Jewish Institute for Education and ResearchClínica SilveiraUNIFESP, Instituto da VisãoSciEL