Oftalmologia - UFC

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Oftalmologia USP Divisão de Clínica Oftalmológica do Hospital das Clínicas da Faculdade de Medicina da USP

Case of the Week
Branch Retinal Artery Occlusion with Edema of Axonal Fibers Proximal to Embolus
60 years of age, male: patient showed a sudden visual field defect, the central visual acuity was 0.9, the IOP 18 mmHg. The patient was suffering from increased body mass index BMI, arterial hypertension, and arteriosclerosis of the ipsilateral carotid artery.
Acute phase of artery occlusion (04/2012)
1) Fundus image presenting an embolic occlusion in a branch retinal artery (white arrow) with a retinal edema (*).
2) OCT showing a retinal edema distal to the embolus,
3) The OCT retina thickness- map presenting an edema distal to the embolus and proximal to the embolus. The retina distal to the occlusion and the axonal fibers proximal to the embolus coming from the ischemic retinal ganglion cells showing an edema ( #). The macular area was well perfused with no edema.
Four weeks after acute phase of artery occlusion (05/2012):
4) Fundus image presenting a diminuished retinal edema (*).
5) OCT-image showing an atrophy of the inner retinal layer in the ischemic area.
6) OCT thickness- map presenting a thinning of the initially swollen retina distal to the embolus and of the axonal fibers proximal to the embolus.
See more under http://www.atlasophthalmology.com/atlas/folder.jsf?node=9031&locale=en

Case of the Week:
A 39-year-old woman presented with a history of bilateral vision loss. She had VA of 0.2/0.4. Fundus examination showed no signs of inflammation, no narrowing of the retinal arterioles and no diabetic retinopathy. The amplitudes of the electroretinogram and the visual evoked response were strongly decreased, the latencies were normal. Systemic examination revealed malignant mamma carcinoma.
1) The optic nerve head (L>R) showing a temporal paleness.
2) Optical coherence tomography presenting a thinning of the outer retinal layer in the macula area.
3) w-w-perimetry showing a central scotoma R/L.
Based on these observations, the patient was diagnosed as having CAR. Anti-recoverin antibody was not tested in the patient's serum. She was treated with steroid therapy, but her visual acuity did not improve.
Cancer-associated retinopathy (CAR) is a paraneoplastic neurological syndrome resulting in progressive loss of vision and clinical signs of retinal degeneration. It is associated with various types of cancer and is also considered to be an autoimmune disorder that involves cross-reaction between autoantibodies and retinal proteins.
See more under http://www.atlasophthalmology.com/atlas/folder.jsf?node=9067&locale=en

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