Search

INTRODUCTION : When the ophthalmologist evaluates a patient in the emergency department with a periorbital edema, the first approach should be directed to the distinction between a periorbital/preseptal and an orbital/postseptal cellulitis. The objective examination presents valuable sign that can help in this differentiation. The main causes of cellulitis are bacterial infections, but noninfectious causes can also lead to it. The main purpose of this work is to present 4 clinical cases of patients with the same clinical complaint but whose diagnosis, treatment and follow-up were substantially different. CASE REPORTS: Two of the clinical cases presented patients diagnosed with a preseptal cellulitis, the first caused by an odontogenic abscess and the other caused by a Kerion celsi (a fungal infection). The last two cases presented patients diagnosed with a postseptal cellulitis caused by a frontoethmoidal mucopyocele and a squamous cell carcinoma of the maxillary sinus. The four patients had different clinical presentation and the medical and/or surgical approach varied among them. DISCUSSION: Clinical presentation of a preseptal and a postseptal cellulitis varies and these series of cases demonstrate these semiological differences. With them, we demonstrate the variability of diseases that may be associated and present with a periorbital edema. We also enhance the importance of a correct etiologic diagnosis to a correct therapeutic approach and of a multidisciplinary approach of these patients. It is crucial for the ophthalmologist to be aware of all signs and symptoms that the patient presents with, through a complete clinical history and a detailed objective evaluation, allowing the identification of the potentially severe cases, in which an orbital invasion might exist, leading to a correct orientation and proper treatment., INTRODUÇÃO: Quando o oftalmologista avalia um doente no Serviço de Urgência com edema periorbitário, a primeira abordagem deve ser direcionada para a distinção entre celulite periorbital/pré-septal e celulite orbitária/pós-septal. O exame objetivo apresenta achados valiosos que podem auxiliar nessa diferenciação. As principais causas da celulite são infecções bacterianas, mas causas não infecciosas também podem levar a ela. O principal objetivo deste trabalho é apresentar 4 casos clínicos de doentes com a mesma queixa clínica mas cujo diagnóstico, tratamento e seguimento foram substancialmente diferentes. CASOS CLÍNICOS: Dois dos casos clínicos apresentavam doentes diagnosticados com celulite pré-septal, o primeiro causado por um abscesso odontogénico e o outro causado por um Kerion celsi (uma infecção fúngica). Os dois últimos casos apresentavam pacientes com diagnóstico de celulite pós-septal causada por mucopiocele frontoetmoidal e carcinoma espinocelular de seio maxilar. Os quatro pacientes tiveram apresentação clínica diferente e a abordagem médica e/ou cirúrgica variou entre eles. CONCLUSÃO: A apresentação clínica de uma celulite pré-septal e pós-septal varia e esta série de casos demonstram essas diferenças semiológicas. Demonstramos a variabilidade de doenças que podem estar associadas e apresentar edema periorbitário. Salientamos ainda a importância de um correto diagnóstico etiológico para uma correta abordagem terapêutica e de uma abordagem multidisciplinar destes doentes. É fundamental que o oftalmologista esteja atento a todos os sinais e sintomas que o doente apresenta, através de uma história clínica completa e de uma avaliação objetiva detalhada, permitindo identificar os casos potencialmente graves, nos quais pode haver invasão orbitária, levando a uma orientação correta e um tratamento adequado.

TÍTULO ESPESOR COROIDEO Y MORFOLOGÍA ANALIZADO POR TOMOGRAFÍA DE COHERENCIA ÓPTICA COMO MÉTODO PARA ABORDAR LA PROGNOSIS Y LA PROGRESIÓN DE LA ENFERMEDAD OCULAR DIABÉTICA INTRODUCCIÓN La evidencia clínica in vivo de coroidopatía diabética (DC) ha sido difícil de demostrar clínicamente debido a la falta de medios para visualizar la coroides. Los avances de la tecnología de la tomografía de coherencia óptica (OCT) permitieron la visualización in vivo de la coroides. Los resultados controvertidos en la Diabetes para el grosor coroideo (CT) y la falta de identificación de los cambios morfológicos hacen que la DC identificada con OCT aún no se conozca. PROPÓSITO Evaluar si la medición por CT sola es un parámetro confiable para caracterizar la DC, para caracterizar los hallazgos morfológicos coroidales usando la OCT y la correlación con la CT y la retinopatía diabética (DR). MÉTODOS Estudio cohorte, prospectivo, longitudinal y observacional, donde se siguieron los controles diabéticos y sanos en visitas consecutivas. Los criterios de inclusión fueron: pacientes sanos y diabéticos sin o con cualquier estadio de RD, de 18 años o más, firmados voluntariamente con consentimiento informado. Los criterios de exclusión fueron: tratamiento previo de cualquier tipo para DR; enfermedad ocular previa o en curso o antecedentes de cirugía ocular; opacidades de medios relevantes; errores de refracción mayores que ± 6 dioptrías; medicamentos séricos crónicos o inmunosupresores sistémicos; cualquier condición sistémica grave e incontrolada. Se realizaron estudios previos para identificar los hallazgos morfológicos de la coroides en OCT que se utilizarán como método de clasificación. Evaluación cuantitativa del grosor de la coroides retiniana y subfoveal (SFCT), evaluación cualitativa de los hallazgos morfológicos coroidales y correlación con el estado de la enfermedad diabética retiniana. Evaluación de progresión y relevancia predictiva. RESULTADOS Se incluyeron 96 ojos diabéticos y setenta y ocho ojos sanos. A partir del análisis morfológico de la coroides, encontramos que el 78% de los sanos eran normales y las anormalidades encontradas siempre en las capas de grandes vasos con capas preservadas de coriocapilar / Sattler (ChS). La mayoría de los ojos diabéticos sin anomalías no tenían y las etapas iniciales de DR. Los cambios vasculares coroidales focales se correlacionaron con la enfermedad retiniana subyacente. La atrofia de la capa de ChS o la capa de grandes vasos estaba bien correlacionada con etapas más avanzadas de DR y maculopatía. La progresión de los cambios morfológicos coroidales se evidenció y se correlacionó con la progresión de la enfermedad retiniana. A partir del análisis estadístico: SFCT mostró una gran variabilidad con la dependencia multifactorial. La significación estadística de la correlación con SFCT se encontró solo para la edad para ambos grupos y las anomalías de las capas coroideas para los diabéticos y la presión arterial sistólica para la salud. CONCLUSIÓN SFCT mostró ser dependiente de variables multifactoriales con una amplia gama de valores que muestran que no es un parámetro confiable solo para la evaluación de DC. Con las imágenes de OCT podemos identificar y clasificar como hallazgos morfológicos coroidales normales o anormales. Los hallazgos anormales de la coroides están bien correlacionados con la enfermedad diabética retiniana suprayacente y pueden ser un marcador de evolución o progresión de la enfermedad del efecto del tratamiento. INTRODUCTION Clinical evidence of diabetic choroidopathy (DC) in-vivo has been difficult to demonstrate clinically due to the lack of means to visualize the choroid. Advances of Optical Coherence Tomography (OCT) technology allowed in-vivo visualization of the choroid. Controversial results in Diabetes for choroidal thickness (CT) and lack in the identification of morphologic changes makes DC identified with OCT still to be understood. PURPOSE To evaluate whether CT measurement alone is a reliable parameter to characterize DC, to characterize choroidal morphological findings using the OCT and correlation with CT and the diabetic retinopathy (DR). METHODS A cohort, prospective, longitudinal and observational study, where diabetic and healthy controls were followed in consecutive visits. Inclusion criteria were: healthy and Diabetic patients without or with any stage of DR, aged 18 or more, signed voluntarily informed consent. Exclusion criteria were: previous treatment of any kind for DR; previous or ongoing ocular disease or history of ocular surgery; relevant media opacities; refractive errors greater than ± 6 Diopters; systemic chronic steroid or immunosuppressive medication; any serious and uncontrolled systemic condition. Previous studies were performed to identify choroidal morphological findings on OCT to be used as classification method. Quantitative assessment of retinal and subfoveal choroidal thickness (SFCT), qualitative assessment of choroidal morphological findings, and correlation with the retinal diabetic disease state. Evaluation of progression and predictive relevancy. RESULTS One hundred and ninety-six diabetic eyes and seventy-eight healthy eyes were included. From choroidal morphologic analysis we found: on healthy 78% were normal, and abnormalities found were always on the great vessels layers with preserved choriocapillaris/Sattler (ChS) layers. Most of diabetic eyes with no abnormalities had no and initial stages of DR. Focal choroidal vascular changes were correlated with the subjacent retinal disease. Atrophy of the ChS layer or the great vessels layer was well corelated with more advanced stages of DR and maculopathy. Progression of choroidal morphologic changes was well evidenced and correlated with progression of retinal disease. From statistical analysis: SFCT showed huge variability with multifactorial dependence. Statistical significance of correlation with SFCT was found only for age for both groups and choroidal layers abnormalities for diabetics and systolic blood pressure for healthy. CONCLUSION SFCT showed to be dependent on multifactorial variables with a wide range of values showing not to be a reliable parameter alone for DC evaluation. With OCT images we can identify and classify as normal or abnormal choroidal morphologic findings. Abnormal choroidal findings are well correlated with suprajacent retinal diabetic disease and can be a marker of evolution or progression of the disease of treatment effect.