RMMG - Revista Médica de Minas Gerais

Corneal dystrophies are bilateral and genetically determined changes, with no association with previous inflammatory conditions, eye and / or systemic diseases. Macular stromal dystrophy is characterized by whitish, irregular surface opacities that appear firstly around the central region during the first decade of life and gradually extend to the posterior and peripheral regions, becoming diffuse, with no clear areas between them. These opacities lead to a significant reduction in vision. The objective of this paper is to report the success of a contact lens adaptation with the piggyback system, which simultaneously uses a gelatinous lens and a rigid gas permeable contact lens (RGPCL). It was a challenging case of visual rehabilitation of a young patient with low visual acuity secondary to corneal dystrophy that had already undergone phototherapeutic keratectomy and corneal transplantation without satisfactory visual recovery. The piggyback system, in face of an irregular corneal surface and recurrent episodes of erosion, was a successful alternative for visual recovery, as it combined the visual correction capacity of the RGPCL with the comfort and protection provided by the gelatinous lens. Keywords: Contact Lenses; Corneal Dystrophies, Hereditary; Contact Lenses, Hydrophilic

Benign concentric annular macular dystrophy (BCAMD) is an uncommon disease of which the main feature is the symmetrical and bilateral bull's eye maculopathy. Despite its usual progression with good visual acuity (VA), there might be some variation on its clinical presentation. The following case report is about a 51 year-old female patient who reported progressive and bilateral loss in her VA. Ophthalmological exam revealed bull's eye maculopathy without history of using topical or systemic medications and also no family history. It is important to emphasize the importance of complementary exams, such as fluorescein angiography, optical coherence tomography and autofluorescence, which may help the diagnosis of BMACD. In cases of bull's eye maculopathy, the differential diagnosis plays an essential role, as cone dystrophy, chloroquine intoxication, chronic macular hole and Stargardt's disease must be ruled out.

Keywords Geographic Atrophy. Fluorescein Angiography. Differential Diagnosis. Case Reports.

Introduction: Acute retinal necrosis is a rare form of infectious necrotizing retinitis that affects individuals regardless of sex or age. It is characterized by an acute panuveitis, with associated retinal periarteritis, progressing to a diffuse necrotizing retinitis and, eventually, to retinal detachment. This study aims to report a case of acute retinal necrosis, with unilateral involvement and presumed etiology by herpesvirus. Case description: A 67-year-old man, complaining of eye pain and low visual acuity in his right eye, with 15 days of evolution. He had reduced visual acuity, anterior and posterior uveitis, with lesions suggestive of acute retinal necrosis. The patient was tested for HIV, tuberculosis, syphilis, toxoplasmosis and herpesvirus. He presented positive IgM and IgG for cytomegalovirus and positive IgG for herpes simplex virus, only. Despite the positive IgM for CMV, the treatment with Acyclovir was sustained due to the strong etiological suspicion of herpes simplex. The patient evolved with good response to treatment, progressing with clinical and visual improvement. Discussion: Acute retinal necrosis cases due to infection are frequently related to herpes simplex and varicella zoster viruses, but other viruses of the same family should be investigated. The diagnosis is clinical, in most cases, but etiological confirmation can be performed. The analysis of clinical and epidemiological factors, associated with the according classification of the onset uveitis and the observation of ophthalmological findings is a solid based thread for the etiological definition and for better management of the case. Complementary exams must be carefully requested, and the results must be associated with the clinical presentation before the medical conduct is chosen.

Keywords Uveitis. Retinal Necrosis Syndrome, Acute. Herpesviridae.

Hypertensive choroidopathy is a rare vascular complication, eventually associated with pre-eclampsia, which can lead to visual loss if the underlying disease is not properly managed. This study aims to describe a rare case of a patient with heterozygosity for the prothrombin gene, who had preeclampsia and placental abruption during pregnancy, in addition to intrapartum hemorrhage, and evolved with hypertensive choroidopathy with complete remission.

Keywords Pre eclampsia. Thrombophilia. Prothrombin. Choroid.

Tuberculosis is a systemic disease that can occur with ocular involvement in about 1-2% of cases. The ophthalmopathy clinic is unspecific and difficult to recognize, as the microscopic finding of the pathogen in the lesions is uncommon. In addition, it can lead to irreversible vision loss if not treated early. The present work aims to report a case of ocular involvement of the disease, showing the difficulty of diagnosis and the pharmacological measures adopted at each moment, until the final diagnosis.

Keywords Tuberculosis, Ocular. Tuberculosis. Uveitis. Mycobacterium tuberculosis.

Mucous membrane pemphigoid is a rare, systemic autoimmune disease characterized by the production of antigens against adapted antigens on the skin and mucous membranes. This pathology generates a chronic recurrent inflammatory process and aberrant scarring, the diagnosis difficult in the early stages of the disease. Among other characteristics, it can manifest as a chronic and recurrent conjunctivitis, the difficulty and delays the beginning of treatment. The earlier the diagnosis and the beginning of the intervention, the better the patient's visual prognosis. The present work aims to report a case of mucous membrane pemphigoid, describing its main signs and symptoms and its different forms of presentation, facilitating its early diagnosis and correct correction. The ophthalmologist plays a fundamental role in the evolution of the disease, as he is often one of the first doctors to be sought out by these patients.

Keywords Pemphigoid, Benign Mucous Membrane. Biopsy. Dapsone.

Introduction: Myopia is the main refractive disorder and the main cause of visual loss worldwide. It is estimated that by 2050 half of the world's population will be nearsighted, doubling the current figures for the condition.¹ To fight against the progression of this epidemic, the topical application of different doses of atropine has been discussed.^6,7,8,9 Objective: To highlight in the literature the efficacy of using atropine eye drops to delay myopia in children, considering the differences in dosages. Methods. A systematic literature review was carried out in the Pub-Med and Lilacs databases with the keywords "myopia AND atropine AND children AND treatment". The search resulted in 103 publications in total. From these, literature reviews, meta-analyzes, observational studies, articles on the etiology of the disease were excluded, according to the title. Studies with a randomized clinical trial were included. In addition, articles with up to 5 years of publication were accepted, resulting in 4 studies used. Discussion: The use of atropine eye drops is advantageous because it is a non-invasive, painless and low-cost treatment.6 The use of atropine in different concentrations was tested in the three experimental trials included in the present study. In them, the respective concentrations of the substance in the eye drops were used, being: 0.5%, 0.01%, 0.01% in the study by Chia et al (2016), 0.05%, 0.025% and 0.01% in the study by Yam et al (2019), 0.01% in the study by Diaz-Llopis et al (2018) and 0.5% in the study by Polling et al (2016). The first clinical trial demonstrated that the mean progression of myopia was -1.38 + 0.98 D to 0.01%, being less than 0.01 and 0.5% of atropine. In the data obtained by Yam et al (2019), the concentration of 0.05% was considered the best for reducing the spherical equivalent (SE). The data obtained by Yam (2019) concluded that the best cost-benefit ratio is also in the concentration of 0.05%, still proposing the use of lower concentrations more times a day. Diaz- Llopis (2018) proved that the 0.01% dilution reduced the progression of myopia to -0.14 + 0.35 D compared to the control, which was -0.65 + 0.54 D. Finally, Polling et al (2016) demonstrated that the use of 0.5% atropine for 1 year reduced the progression to -0.1D / year in relation to the group that abandoned treatment, which was -0.5D / year. Conclusion: The usage of low dose atropine seems to be efficient in slowing the progression of myopia in children. However, the studies, although scientifically relevant and with significant samples, have some limitations because they are unable to cover different populations. Therefore, more research is needed to access results of this substance in other groups.

Keywords Myopia. Treatment. Atropine. Children.

Introduction: Diabetic retinopathy (RD) is one of the main complications related to diabetes mellitus (DM) and is the main cause of blindness in people aged between 20 and 74 years. Currently, DR can be diagnosed only by trained specialists, a factor that, in many cases, makes it difficult to identify the condition early. Recent studies reveal that circulating MicroRNAs (miRNAs), a group of conserved short sequences of endogenous RNAs, play a significant role in development of DM. Objective: To analyze the diagnostic and prognostic relevance of microRNA in diabetic retinopathy and its role in the pathogenesis of the disease. Search methodology: Literature review in the PubMed and Scielo databases between 2015 and 2020, using the terms 'English MicroRna as biomarkers' and '' diabetic retinopathy '' as descriptors. Discussion: DR is characterized by lesions and progressive occlusions of retinal vessels. Epigenetic changes, including regulation of miRNAs, contribute to the pathogenesis of the disease. From this perspective, studies show that there is increased or decreased expression of certain miRNAs during the pathogenesis of DR, with miR-200b, miR29b, miR-21 and miR-126 being the most studied today. Final considerations: Studies show that altered levels of circulating miRNA may provide a new biomarker for the detection and monitoring of the disease. Despite the great advances related to the theme in recent years, most studies have been done on animals or on a small sample of humans, requiring further studies with a larger sample.

Keywords Diabetic retinopathy. Biomarkers. MicroARNs.

Acute corneal hydrops (HCA) is a rare complication of keratoconus (2.5 to 3%), which leads to the rupture of Descemet's membrane and passage of aqueous humor to the stroma and corneal epithelium. The surgical treatment of HCA isn't well established in the literature and remains an underused alternative. Patient A, female, 38 years old, visual acuity (AV) of fingers count (DC) at 50cm in the left eye (LE). There was worsening during clinical treatment: AV of hand movement (MM) (16th day) and no longer walked without help (33rd). Optical Coherence Tomography (OCT) with a corneal thickness of 1.69 mm (33rd day). Three days after surgical treatment, she had 0.68 mm at OCT, discreet opacity, adhered MD and final AV of 20/400. Patient B, female, 20 years old, previous keratoconus and acute AV reduction in the right eye: DC at 50 cm. Without improvement in clinical treatment, surgical treatment was performed with intervention on the 14th day, without improvement, OCT with a thickness of 1.67mm. Four stitches of compressive sutures were added in the cornea and after 5 days OCT with 0.60 mm, adhered MD and final corrected AV of 20/150. The objective of this work is to present, through two case reports, the surgical treatment of HCA as an effective, alternative and early results method. Clinical treatment is usually effective, but in case of failure, surgical treatment can be satisfactory. The addition of corneal compression sutures further accelerates recovery and prevents repeated interventions.

Keywords Keratoconus; Cornea; Hydrops.

The crystalline is a biconvex, avascular and transparent structure, located between the iris and the vitreous humor, in constant development throughout life. Patients who suffer trauma in the anterior segment of the eye may compromise some zonules, resulting in inclinations or displacements of the lens in relation to their usual location. This article presents the case of a patient seen in the emergency department of the Regional Hospital of São José (SC) with a crystalline dislocation in the vitreous cavity due to blunt trauma who, after four months, migrated to the anterior chamber spontaneously, being submitted to facectomy intra-capsular. Although severe traumas to the eye region cause crystalline's displacement to the vitreous cavity, especially blunt impacts, we did not find in the current literature registries of the association of dislocation of the crystalline lens to the vitreous cavity with subsequent migration to the anterior chamber, inferring that the case reported here was rare. We wish to improve knowledge and contribute to literary bases about crystalline dislocation, spreading singularities about this clinical occurrence.

Keywords Crystalline. Vitreous Body. Anterior Chamber