Estudo morfológico das alterações vitreorretinianas em pacientes com retinocoroidite ativa supostamente causada pelo Toxoplasma Gondii: estudo retrospectivo pela Tomografia de Coerência Óptica (OCT 3).

AUTOR(ES)
DATA DE PUBLICAÇÃO

2006

RESUMO

Orefice, JL. Morphological study of vitreoretinal alterations in patients with active retinochoroiditis possibly caused by the Toxoplasma gondii . Prospective study by the optical coherence tomography (OCT 3) 2006. Thesis (Doctorate in Ophthalmology) - Medical School, Federal University of Minas Gerais, Belo Horizonte. Introduction: The ocular toxoplasmosis is one of the most important causes of uveitis in many parts of the world and mainly in Brazil. Classically, toxoplasmic retinochoroiditis is observed as a focus retinitis adjacent to an old chorioretinal scar and is accompanied by vitritis. Another clinical presentation form is the outer punctate. The diagnosis is based on the clinical evaluation of the characteristics of the lesion and the inflammatory reaction. The third generation optical coherence tomography (OCT 3) is a non-invasive and noncontact propedeutical technique. OCT is able to produce cross-sectional views of the retina with a 10um resolution that can help in determining the location of the infiltrated inflammatory and damaged retinal layers, besides identifying complications in the vitreoretinal interface. Place of the study: Uveitis Service of Sao Geraldo Hospital, of Clinics Hospital of the Federal University of Minas Gerais associated with the Center of Advanced Ophthalmology, Belo Horizonte, Minas Gerais, Brazil. Objectives: To evaluate the vitreoretinal alterations, in patients with active retinochoroiditis possibly caused by the Toxoplasma gondii , and to follow their modifications during the cicatricial process. Methodology: Fifteen eyes with active RCST were studied, divided in three forms of clinical presentation: outer punctate form, focal form and satellite form. After complete ophthalmologic exam, eyes were submitted to color fundus photography and optical coherence tomography (OCT 3), using the Radial lines protocol. The follow-up was done biweekly, following the same routine of the first exam. Color fundus photography and OCT were done in 12 (+/-2) weeks and 24(+/-2) weeks. It is considered to be a prospective observational study. Results: The lesions were classified in outer punctate (n=6), focal (n=6), satellite (n=3). In the active phase, the lesions had, as tomographic characteristics, increase of reflectivity of the internal layers of the retina with posterior shadowing of the retinal pigment epithelium - choriocapillaris/choroidal (RPE-cc/Ch) subjacent in all of the eyes. In the outer punctate, there was a retinal thickness decrease at the active lesion. Otherwise, focal and satellite forms showed increased retina. The posterior hyaloid membrane, when detected, was thickened with focal detachment over the lesion in the patients with punctate and partially detached or attached to the lesion in the patients with focal and satellite forms. During the follow-up, the tomographic alterations found at the local of the lesion were characterized by: retinal thickness decrease with relative increase of the reflectivity of the choriocapillaris/choroidal (cc/Ch) compound in all of the eyes. OCT demonstrate alterations like diffuse macular edema, vitreomacular traction and maculoschisis that were not clinically identified. Conclusion: OCT 3 was efficiently capable in identifying distinctive findings of the active retinochoroiditis possibly caused by the Toxoplasma gondii inflammatory process and scar formation. Distinctive Morphological alterations of each form (outer punctate, focal and satellite), and macular alterations not clinically identified.

ASSUNTO(S)

doenças retinianas/diagnóstico decs toxoplasmose ocular/complicações decs tomografia de coerência óptica/métodos decs coriorretinite/diagnóstico decs retina/patologia decs

ACESSO AO ARTIGO

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