Pars plana vitrectomy and visual stimulation for treatment of vitreomacular traction secondary to toxoplasmosis retinochoroiditis in a 5-year-old child  <span class="so-article-trans-title" dir="auto"> Translated title: Vitrectomia via pars plana e estimulação visual para tratamento da tração vitreomacular secundária à retinocoroidite por toxoplasmose em criança de 5 anos </span>

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Abstract

ABSTRACT Objective: A unusual case of ocular toxoplasmosis with significant vitreomacular traction is reported. The patient improved significantly following pars plana vitrectomy combined with visual stimulation and occlusion therapy. Methods: The case of a 5-year-old girl with significant unilateral vision loss associated with vitreous condensation and macular traction is described. Results: Pars plana vitrectomy was carried out for vitreomacular traction release. This was followed by visual stimulation and occlusion therapy. Significant improvement was observed. Conclusion: Despite structural damage, the combination of properly indicated surgery and amblyopia management strategies allowed the achievement of maximum vision goals in this case, suggesting structural damage may be associated with functional amblyopia.

Translated abstract

RESUMO Objetivo: Relata-se um caso de apresentação atípica de toxoplasmose ocular, com importante tração vitreomacular. A paciente apresentou melhora significativa após vitrectomia via pars plana, com estimulação visual e oclusão. Métodos: Descreve-se o caso de uma menina de 5 anos, com importante perda de visão unilateral associada à condensação vítrea e à tração macular. Resultados: Foi realizada vitrectomia via pars plana para alívio da tração vitreomacular, seguida de estimulação visual e oclusão. Foi observada melhora significativa. Conclusão: Apesar dos danos estruturais, a combinação de cirurgia bem indicada com estratégias de tratamento da ambliopia permitiu alcançar o máximo do potencial visual nesta paciente, sugerindo que os danos estruturais podem estar associados à ambliopia funcional.

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Critical periods in amblyopia

TAKAO HENSCH, ELIZABETH QUINLAN (2018)

The shift in ocular dominance (OD) of binocular neurons induced by monocular deprivation is the canonical model of synaptic plasticity confined to a postnatal critical period. Developmental constraints on this plasticity not only lend stability to the mature visual cortical circuitry but also impede the ability to recover from amblyopia beyond an early window. Advances with mouse models utilizing the power of molecular, genetic, and imaging tools are beginning to unravel the circuit, cellular, and molecular mechanisms controlling the onset and closure of the critical periods of plasticity in the primary visual cortex (V1). Emerging evidence suggests that mechanisms enabling plasticity in juveniles are not simply lost with age but rather that plasticity is actively constrained by the developmental up-regulation of molecular ‘brakes’. Lifting these brakes enhances plasticity in the adult visual cortex, and can be harnessed to promote recovery from amblyopia. The reactivation of plasticity by experimental manipulations has revised the idea that robust OD plasticity is limited to early postnatal development. Here, we discuss recent insights into the neurobiology of the initiation and termination of critical periods and how our increasingly mechanistic understanding of these processes can be leveraged toward improved clinical treatment of adult amblyopia.

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Vitreoretinal morphology in active ocular toxoplasmosis: a prospective study by optical coherence tomography.

Karita Costa, R L Orefice, W Campos … (2007)

To investigate the third generation optical coherence tomography (OCT3) findings in patients with active ocular toxoplasmosis. A prospective observational case series, including 15 patients with active ocular toxoplasmosis in at least one eye evaluated at a single centre. Vitreoretinal morphological features at baseline and changes within a 24-week follow-up interval on OCT3 were evaluated. The active ocular toxoplasmosis lesion was classified clinically as punctate (n = 6), focal (n = 6) or satellite (n = 3). Retinal layers were hyper-reflective at the active lesion site, and some degree of retinal pigment epithelium-choriocapillaris/choroidal optical shadowing was seen in all patients. In general, the retina was thinned at the active lesion site in eyes with punctate lesions and thickened in eyes with focal and satellite lesions. When detected by OCT3, the posterior hyaloid appeared thickened. While focally detached over punctate lesions, the posterior hyaloid was partially detached, but still attached to the lesion in focal and satellite lesions. Additional findings (not detected on clinical examination) include diffuse macular oedema (n = 6), vitreomacular traction (n = 3) and maculoschisis (n = 1). During follow-up, a decrease in retinal thickness and focal choriocapillaris/choroidal relative hyper-reflectivity were observed at the former lesion site, and posterior vitreous detachment progressed/occurred in all patients. OCT3 enabled identification of morphological features underestimated on clinical examination in patients with ocular toxoplasmosis, which may expand the clinical spectrum of the disease. Further studies are needed to verify the relevance of OCT3 in assisting with the diagnosis and management of ocular toxoplasmosis.

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Neuroplasticity and amblyopia: vision at the balance point.

Vijay Tailor, D. Schwarzkopf, Annegret Dahlmann-Noor (2017)

New insights into triggers and brakes of plasticity in the visual system are being translated into new treatment approaches which may improve outcomes not only in children, but also in adults.

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Author and article information

Journal

Journal ID (publisher-id): rbof

Title: Revista Brasileira de Oftalmologia

Abbreviated Title: Rev. bras.oftalmol.

Publisher: Sociedade Brasileira de Oftalmologia (Rio de Janeiro, RJ, Brazil )

ISSN (Print): 0034-7280

ISSN (Electronic): 1982-8551

Publication date (Print and electronic): 2022

Volume: 81

Electronic Location Identifier: e0012

Affiliations

[2] Goiânia Goiás orgnameUniversidade Federal de Goiás orgdiv1Centro de Referência em Oftalmologia Brazil

[1] Goiânia GO orgnameInstituto Panamericano da Visão Brazil

Article

Publisher ID: S0034-72802022000100502 Publisher ID: S0034-7280(22)08100000502

DOI: 10.37039/1982.8551.20220012

SO-VID: b21a1cd0-a148-42d3-9e64-ed20c5fa8d4f

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This work is licensed under a Creative Commons Attribution 4.0 International License.

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Date accepted : 05 October 2021

Date received : 01 January 2021

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Most cited references 9

Critical periods in amblyopia

Vitreoretinal morphology in active ocular toxoplasmosis: a prospective study by optical coherence tomography.

Neuroplasticity and amblyopia: vision at the balance point.

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