Showing papers in "Case Reports in Ophthalmology in 2012"
TL;DR: Combined therapy of indirect laser photocoagulation and intravitreal ranibizumab can be effective in the management of aggressive posterior ROP, and resulted in ROP regression in both cases.
Abstract: Purpose: To report on 2 cases of aggressive posterior retinopathy of prematurity (ROP) treated with intravitreal ranibizumab (Lucentis®) and laser photocoagulation. Methods: Two premature females, born at 25 and 26 weeks’ gestation with a birth weight of 530 and 550 g, respectively, with aggressive posterior ROP received combined treatment with laser photocoagulation and intravitreal ranibizumab (0.3 mg [30 µl]) to each eye. Structural outcomes were evaluated by indirect ophthalmoscopy and documented by retinography. Results: An intravitreal injection was made at 34 weeks of postmenstrual age in the first case, followed by laser photocoagulation 1 week later. There was a partial regression of ROP with treatment. Five weeks later, neovascularization regrowth with bleeding in both eyes (intraretinal and subhyaloid) occurred and retreatment with combined therapy was performed. In the second case, single therapy with laser photocoagulation was made at 34 weeks of postmenstrual age. In spite of the confluent photocoagulation in the avascular area, progression to 4A ROP stage occurred 1 week later. Both eyes were retreated 1 week later with intravitreal ranibizumab and laser photocoagulation. Treatment resulted in ROP regression in both cases. There were no signs of systemic or ocular adverse side effects. Conclusion: The cases presented show that combination therapy of indirect laser photocoagulation and intravitreal ranibizumab can be effective in the management of aggressive posterior ROP. Further investigation on anti-VEGF safety in premature infants is necessary . Additional studies are needed to define the role of anti-VEGF in ROP treatment.
44 citations
TL;DR: Perifoveal relaxing incisions in stage IV macular holes that remained unclosed after internal limiting membrane peeling vitrectomy seem to have a positive effect on MH closure rates.
Abstract: Purpose: To report the surgical outcomes of reoperation of unclosed macular holes after initial vitrectomy with internal limiting membrane peeling. Procedures: Seven eyes of 7 patients were submitted to a second procedure in which five radial retinal incisions were made, as deep as the retinal pigment epithelium, beginning one hole diameter away from its borders and extending centripetally until the hole’s margins, avoiding the papilomacular bundle. Gas tamponade was performed and face-down positioning was recommended. Results: Anatomical closure was achieved in all cases with the second procedure. Functional success was achieved in every patient; there was no loss of best corrected visual acuity (BCVA) lines. Mean line score gain was 5.6 lines (range 1–9 lines), with a mean final BCVA of 0.42 (range 0.05–0.5). Conclusions: Perifoveal relaxing incisions in stage IV macular holes that remained unclosed after internal limiting membrane peeling vitrectomy seem to have a positive effect on MH closure rates. Larger case series and an extended follow-up period are necessary in order to assess the efficacy and safety profile of this so far promising technique.
33 citations
TL;DR: The choroidal excavation remained stable for 3 years in 2 eyes, a secondary CNV developed in 1 eye during the course of the disease, and more cases and longer follow-up periods will be necessary to determine the etiology, clinical course, and visual prognosis of eyes with a choroid excavation.
Abstract: Purpose: To report the clinical findings of 2 patients with focal choroidal excavation in the macula detected by spectral-domain optical coherence tomography (SD-OCT).
31 citations
TL;DR: In this paper, a 65-year-old Caucasian woman was suffering from radiation macular edema following ruthenium-106 plaque brachytherapy for a choroidal melanoma on her left eye.
Abstract: Purpose: To report the effective treatment of radiation macular edema following ruthenium-106 plaque brachytherapy for a choroidal melanoma with a dexamethasone 0.7-mg (Ozurdex®) intravitreal implant. Methods: An interventional case report with optical coherence tomography (OCT) scans. Results: A 65-year-old Caucasian woman was suffering from radiation macular edema following ruthenium-106 plaque brachytherapy for a choroidal melanoma on her left eye. She had undergone one intravitreal injection of 0.5 mg bevacizumab (Avastin®, Genentech/Roche) in the following months without functional or anatomical improvement. Seven months after the development of radiation macular edema, she received a single intravitreal injection of dexamethasone 0.7 mg (Ozurdex). Four weeks following the injection, her best-corrected visual acuity improved from 0.3 to 0.5. Radiation macular edema resolved with a reduction of central retinal thickness from 498 µm before Ozurdex injection to 224 µm after Ozurdex injection, as measured by OCT scan. Conclusion: Dexamethasone 0.7 mg (Ozurdex) has proven to be an effective treatment option in retinal vein occlusion and noninfectious uveitis. It can also be considered as off-label treatment in radiation macular edema following ruthenium-106 plaque brachytherapy for a choroidal melanoma.
30 citations
TL;DR: In this paper, a 62-year-old woman with a history of vitreoretinal surgery for vitreous hemorrhage secondary to central retinal vein occlusion (CRVO) received 2 intravitreal injections of bevacizumab 0.5 mg (Avastin®, Genentech/Roche) three months after vitrectomy, without functional or anatomical improvement.
Abstract: We report the case of a 62-year-old woman with a history of vitreoretinal surgery for vitreous hemorrhage secondary to central retinal vein occlusion (CRVO). Because of the persistence of macular edema (ME), she received 2 intravitreal injections of bevacizumab 0.5 mg (Avastin®, Genentech/Roche) three months after vitrectomy, without functional or anatomical improvement. Six months after vitrectomy, she therefore received an intravitreal implant of dexamethasone 0.7 mg (Ozurdex®). An improvement in her best-corrected visual acuity and central macular thickness, as measured by optical coherence tomography, was detected 7 days after the injection, and complete resolution of the ME and retinal hemorrhages was observed 6 months after the injection. Dexamethasone intravitreal implant might be an effective treatment option in ME secondary to CRVO, also in vitrectomized eyes.
22 citations
TL;DR: A patient with necrotising scleritis in whom infliximab was used for short-term steroid-sparing while rituximab took effect enabled disease control without requiring an extended period of high-dose corticosteroid administration or the concurrent use of cyclophosphamide.
Abstract: We report a patient with necrotising scleritis in whom infliximab was used for short-term steroid-sparing while rituximab took effect. This enabled disease control without requiring an extended period of high-dose corticosteroid administration or the concurrent use of cyclophosphamide.
19 citations
TL;DR: Delayed-onset endophthalmitis may occur after uneventful implantation of a preloaded intraocular lens (IOL) and IOL removal is needed to eliminate the bacteria which adhere to the tip of the IOL haptic.
Abstract: Purpose: To report a case of delayed-onset endophthalmitis after implantation of a preloaded intraocular lens (IOL) and examine the surgically removed IOL by scanning electron microscopy (SEM). Case: A 77-year-old female underwent uneventful phacoemulsification and aspiration with preloaded silicone IOL implantation. Since intraocular inflammation unexpectedly worsened 1 month after the surgery, she was referred to our hospital. Her visual acuity was hand motion in the left eye. Hypopyon and fibrin formation were observed in the anterior chamber. A diagnosis of postoperative delayed-onset endophthalmitis was made, and vitrectomy with anterior chamber wash-out was performed. As intraocular inflammation remained unchanged postoperatively, an additional surgery with IOL removal was performed. We cultivated the surgically removed samples of aqueous humor and vitreous fluid under both aerobic and anaerobic conditions, performed 16S rDNA clone library analysis of these clinical samples, and examined the removed IOL by SEM. Result: Inflammation subsided after the re-operation. Although cultures of aqueous and vitreous samples were negative, DNA of Propionibacterium acnes was detected in the aqueous humor. The SEM images showed that the rod bacteria and biofilm-like material formed on the tip of the IOL haptic. Conclusion: Delayed-onset endophthalmitis may occur after uneventful implantation of a preloaded IOL. The SEM findings suggested that the tip of the preloaded IOL haptic might scratch bacteria which adhered to the tip of the injector nozzle when the IOL was inserted into the anterior chamber. In some cases with delayed-onset endophthalmitis, IOL removal is needed to eliminate the bacteria which adhere to the tip of the IOL haptic.
19 citations
TL;DR: Retropupillary aphakic iris-claw intraocular lenses are considered to be a worthwhile option in these cases of megalophthalmos and cataract, since instability is avoided and the procedure is less challenging than suturing the lens.
Abstract: A 44-year-old man with anterior megalophthalmos arrived at the clinic presenting a cataract in the right eye. The corneal diameter was 13 mm. Iridodonesis and phacodonesis were evident during slit lamp examination. Anterior chamber depth was 5.89 mm, and the diameter of the capsular bag was approximately 14.45 mm. Due to the large capsular bag, a standard posterior chamber intraocular lens was considered inadequate because of potential instability. Phacoemulsification and an implantation of an iris-claw lens (Artisan for aphakia®, Ophtec) in the posterior chamber were performed with good results. In the fourth postoperative month, uncorrected distance visual acuity was 20/30, and 20/20 was achieved with +0.75 –1.25 × 10°. We consider retropupillary aphakic iris-claw intraocular lenses to be a worthwhile option in these cases of megalophthalmos and cataract, since instability is avoided and the procedure is less challenging than suturing the lens.
18 citations
TL;DR: Though unusual, ONSMs may occur in children and, in these cases, present a much more aggressive behavior than in adults, and should be differentiated from optic glioma in children because of its aggressive behavior and need for different treatment modalities.
Abstract: Background/Aim: Tumors of the optic nerve are mostly either optic nerve gliomas or optic nerve sheath meningiomas (ONSMs). While gliomas occur in children, most meningiomas are slow-growing tumors affecting middle-aged individuals with progressive visual loss, proptosis, disc edema and optociliary veins on fundus examination. ONSMs are extremely rare in children, with only 14 cases reported in children under the age of 10 years. The purpose of this study is to describe an additional case and review clinical, radiologic and histopathological findings that can help differentiate such tumors in children and allow an early and accurate diagnosis. Case Report: An 8-year-old girl had a 2-year history of progressive proptosis and total visual loss on the right side. A computed tomography scan revealed a well-defined intraconal mass with perioptic calcification. Magnetic resonance imaging showed a tumor surrounding the optic nerve and extending intracranially, with enhancement following gadolinium injection. The patient was submitted to fronto-orbital craniotomy for complete tumor excision. Histological studies identified the neoplasm as ONSM. Conclusions: Though unusual, ONSMs may occur in children and, in these cases, present a much more aggressive behavior than in adults. ONSM should therefore be differentiated from optic glioma in children because of its aggressive behavior and need for different treatment modalities.
18 citations
TL;DR: This case suggests that the combined use of ranibizumab and laser photocoagulation may be considered an effective treatment for JRT type 1, leading to an improvement in both visual acuity and macular edema.
Abstract: Background: Idiopathic juxtafoveolar retinal telangiectasia (IJRT) type 1 represents an uncommon cause of congenital unilateral visual loss and it typically affects males. Decrease in visual acuity is caused by serous and lipid exudation into the fovea with cystoid macular edema. In some cases, spontaneous resolution may be observed, but when there is a progressive loss of visual acuity, laser photocoagulation is often necessary. This treatment is not always successful and therapy for this condition is still controversial. Case Presentation: A 57-year-old man referred a 2-month history of blurred and distorted vision in the right eye. Best-corrected visual acuity was 20/50 in the right eye and 20/20 in the left eye. Fundus examination showed temporal macular edema, confirmed by optical coherence tomography. Fluorescein angiography showed a localized area of hyperfluorescence probably due to telangiectasia type 1 located below the inferior temporal area of the fovea. A combined therapy of intravitreal ranibizumab injection and laser photocoagulation was performed. Visual acuity improved from 20/50 to 20/32 and the therapy was well tolerated by the patient. After 3 years of follow-up, both visual acuity and fundus examination were stable. Conclusions: This case suggests that the combined use of ranibizumab and laser photocoagulation may be considered an effective treatment for JRT type 1, leading to an improvement in both visual acuity and macular edema. We believe that intravitreal ranibizumab injection associated with laser photocoagulation should be considered as treatment for IJRT type 1.
18 citations
TL;DR: Evidence is found that when compared to amphotericin B, voriconazole demonstrates a survival benefit, has less systemic toxicity, and is better tolerated by patients, and there is evidence to support the use of vorIconazole as primary therapy.
Abstract: Background/Aim: To describe a case of invasive orbital aspergillosis and evaluate treatments and outcomes. Methods: A case report and review of orbital aspergillosis treatment with voriconazole in the English language literature. Conclusion: Amphotericin B with debridement is the current standard of care for orbital aspergillosis; however, its prognosis is unfavorable. When compared to amphotericin B, voriconazole demonstrates a survival benefit, has less systemic toxicity, and is better tolerated by patients. While a prospective trial comparing amphotericin B to voriconazole in orbital aspergillosis is not feasible, there is evidence to support the use of voriconazole as primary therapy.
TL;DR: Patients with the diagnosis of Stargardt’s disease with fundus flavimaculatus (FFM) and ABCA4 gene mutation associated with subretinal fibrosis can show atypical fundus findings, highlighting that lifestyle can play a role in the onset of these lesions.
Abstract: Purpose: To report on 4 patients affected by Stargardt’s disease (STGD) with fundus flavimaculatus (FFM) and ABCA4 gene mutation associated with subretinal fibrosis. Methods: Four patients with a diagnosis of STGD were clinically examined. All 4 cases underwent a full ophthalmologic evaluation, including best-corrected visual acuity measured by the Snellen visual chart, biomicroscopic examination, fundus examination, fundus photography, electroretinogram, microperimetry, optical coherence tomography and fundus autofluorescence. All patients were subsequently screened for ABCA4 gene mutations, identified by microarray genotyping and confirmed by conventional DNA sequencing of the relevant exons. Results: In all 4 patients, ophthalmologic exam showed areas of subretinal fibrosis in different retinal sectors. In only 1 case, these lesions were correlated to an ocular trauma as confirmed by biomicroscopic examination of the anterior segment that showed a nuclear cataract dislocated to the superior site and vitreous opacities along the lens capsule. The other patients reported a lifestyle characterized by competitive sport activities. The performed instrumental diagnostic investigations confirmed the diagnosis of STGD with FFM in all patients. Moreover, in all 4 affected individuals, mutations in the ABCA4 gene were found. Conclusions: Patients with the diagnosis of STGD associated with FFM can show atypical fundus findings. We report on 4 patients affected by STGD with ABCA4 gene mutation associated with subretinal fibrosis. Our findings suggest that this phenomenon can be accelerated by ocular trauma and also by ocular microtrauma caused by sport activities, highlighting that lifestyle can play a role in the onset of these lesions.
TL;DR: The aspheric diffractive multifocal IOL Tecnis ZMB00 provides a restoration of the far and near visual function after phacoemulsification surgery for cataract removal or presbyopia correction, which is predictable and independent from the optical power of the implanted IOL.
Abstract: The outcomes of a prospective consecutive study aimed at evaluating the visual and refractive benefit after cataract surgery with the implantation of the aspheric diffractive multifocal intraocular lens (IOL) Tecnis ZMB00 (Abbott Medical Optics) are reported. A total of 31 eyes of 19 patients (age range, 40 to 81 years) underwent phacoemulsification surgery with implantation of this aspheric multifocal IOL. At 6 months after surgery, postoperative spherical equivalent was within ±1.00 D in 96.8% of eyes, with 94.7% of patients presenting a postoperative binocular far LogMAR uncorrected visual acuity (UCVA) of 0.1 or better. Far best-corrected distance VA improved significantly (p < 0.01), with postoperative values of 0.1 or better in 96.8% of eyes. Postoperative near UCVA was 0.10 (equivalent to J1) or better in 93.55% of eyes. Furthermore, the IOL power was found to be very poorly correlated with the postoperative far LogMAR (r = 0.13) and near UCVA (r = 0.13). In conclusion, the aspheric diffractive multifocal IOL Tecnis ZMB00 provides a restoration of the far and near visual function after phacoemulsification surgery for cataract removal or presbyopia correction, which is predictable and independent from the optical power of the implanted IOL.
TL;DR: This paper highlights one case of complete unilateral blindness from direct central retinal artery occlusion associated with third cranial nerve palsy following an apparently uneventful septorhinoplasty.
Abstract: Background: Postoperative vision loss following routine nasal surgery is an extremely rare and devastating complication. We report a case of unilateral blindness due to central retinal artery occlusion associated with third cranial nerve following septoplasty. Case Report: We report a patient who developed an unusual central retinal artery occlusion with unilateral blindness following nasal surgery under general anesthesia. A 45-year-old man underwent a nasal septal surgery for severe epistaxis. Soon after recovery, the patient noticed loss of vision in his right eye and was unable to lift his upper eyelid. Upon ophthalmic examinations, we determined that he had right-sided third cranial nerve palsy with central retinal artery obstruction and ptosis of right upper eyelid, restriction of ocular movements, and no perception of light in the right eye. Postoperative computerized tomography scan revealed multiple fractures of the left medial orbital wall, including one near the optic canal. Ptosis and ocular defects were recovered partially, but visual loss persisted until the last follow-up. Conclusion: This paper highlights one case of complete unilateral blindness from direct central retinal artery occlusion associated with third cranial nerve palsy following an apparently uneventful septorhinoplasty. Ophthalmologists and otolaryngologists should therefore be aware of the possible occurrence of such complications.
TL;DR: Ozurdex may be an effective initial therapeutic approach for Coats’ disease with immediate anatomical response and visual improvement in women with secondary retinal vasoproliferative tumor.
Abstract: Purpose: To report a case of Coats’ disease managed with the dexamethasone intravitreal implant Ozurdex® (Allergan, Inc., Irvine, Calif., USA) combined with retinal photocoagulation. Methods: A 46-year-old female with 20/200 visual acuity was diagnosed with Coats’ disease with secondary retinal vasoproliferative tumor. An initial approach was performed with an intravitreal injection of the sustained-release dexamethasone implant Ozurdex. After reattachment of the retina, the telangiectatic vessels were treated with laser photocoagulation. Results: The patient’s visual acuity improved to 20/25 after the intravitreal Ozurdex. No further recurrences of exudation were evident through the 12-month follow-up. Conclusions: Ozurdex may be an effective initial therapeutic approach for Coats’ disease with immediate anatomical response and visual improvement.
TL;DR: Clinicians should be aware of ocular manifestations of EBV, in order to suggest ophthalmological examination and start treatment promptly before irreversible damage to the optic nerve or retina occurs, and include EBV in the differential diagnosis of chorioretinal atrophic lesions.
Abstract: Epstein-Barr virus (EBV) is a DNA virus that mainly causes infectious mononucleosis. Ocular manifestations are rare and typically mild. Only a few cases of EBV involving the retina or the optic nerve have been reported. Herein, we report the case of a 67-year-old man with bilateral chorioretinitis and optic neuritis due to EBV. The patient had no previous ocular history and presented with decreased vision in both eyes. His past medical history included EBV encephalopathy, which was confirmed serologically, a few months before. Ophthalmological examination revealed bilateral chorioretinitis and optic neuritis, confirmed by fluorescein angiography as well as electrophysiological tests (visual evoked potentials and electroretinogram). It is very important to include EBV in the differential diagnosis of chorioretinal atrophic lesions. Clinicians should be aware of ocular manifestations of EBV, in order to suggest ophthalmological examination and start treatment promptly before irreversible damage to the optic nerve or retina occurs.
TL;DR: It is suggested that intravitreal ranibizumab may be an effective therapeutic option for treating CNV secondary to choroidal osteoma, which is one of the complications that can develop in eyes with choroid osteoma.
Abstract: Choroidal osteoma is an uncommon benign osseous intraocular tumor that typically affects young adult women. Choroidal neovascularization (CNV) is one of the complications that can develop in eyes with choroidal osteoma. We present a case of CNV secondary to choroidal osteoma treated with intravitreal ranibizumab. A 57-year-old lady presented with painless loss of vision with a right-eye visual acuity of 20/800. Fundus examination showed a well-demarcated yellowish peripapillary choroidal osteoma with associated retinal and subretinal hemorrhage due to CNV. Three intravitreal ranibizumab injections at monthly intervals were given and her visual acuity improved to 20/30 following treatment. After 1.2 years of follow-up, the right eye visual acuity was maintained at 20/30 with no evidence of CNV recurrence. Our findings suggest that intravitreal ranibizumab may be an effective therapeutic option for treating CNV secondary to choroidal osteoma.
TL;DR: Two cases of necrotizing keratitis following laser refractive corneal surgery, with stable and controlled Crohn’s disease are described, highlighting the importance of taking precautions considering this and similar autoimmune conditions as a relative contraindication to refractive surgery.
Abstract: Two cases of necrotizing keratitis following laser refractive corneal surgery, with stable and controlled Crohn’s disease are described. A 40-year-old woman developed bilateral stromal inflammation and inferior thinning in the right eye along the flap edge within 1 day of uneventful bilateral IntraLase laser-assisted in situ keratomileusis. The other case is a 30-year-old man who also developed bilateral inferior stromal infiltrates 2 days following photorefractive keratectomy. Both cases were aggressively treated with systemic and topical corticosteroids. The infiltrates in both patients gradually resolved, with one relapse during the 7 months period of follow-up in the first case. These cases highlight the importance of taking precautions considering this and similar autoimmune conditions as a relative contraindication to refractive surgery.
TL;DR: This case suggests that similar cases of cystoid macular edema after cataract surgery can occur, and that intrachoroidal cavitation is observed not only in eyes with pathologic myopia but also in normal eyes with peripapillary atrophy.
Abstract: Purpose: To describe a patient with intrachoroidal cavitation in the normal eye that caused self-limiting recurrent macular detachment and retinoschisis. Case Report: An 80-year-old female patient with intrachoroidal cavitation in the normal eye presented with macular detachment and retinoschisis after cataract surgery. These were treated with intravitreal bevacizumab and then absorbed within 9 months. One year after cataract surgery, the patient presented with macular detachment and retinoschisis in the same eye again. These were absorbed within 4 months without treatment. Conclusion: This case suggests that similar cases of cystoid macular edema after cataract surgery can occur, and that intrachoroidal cavitation is observed not only in eyes with pathologic myopia but also in normal eyes with peripapillary atrophy; intrachoroidal cavitation can cause macular detachment and retinoschisis.
TL;DR: Topical use of MMC during pterygium surgery may be related to serious postoperative complications such as progressive inflammatory corneal melting and the described combination of systemic and local anti-inflammatory treatment along with lamellar keratoplasty and amniotic membrane transplantation.
Abstract: Purpose: To report the management of a case of corneal melting two weeks after pterygium excision with intraoperative topical mitomycin C (MMC). Methods: Case report. Results: A 57-year-old male was referred to our Department for therapy of rapidly progressive corneal melting two weeks after primary pterygium surgery with MMC (0.2 mg/ml) in September 2009. Initial treatment consisted of topical and systemic immunosuppression along with topical antibiotics. Eight days after presentation, the patient underwent successful lamellar keratoplasty and amnion membrane transplantation. Subconjunctival injection of triamcinolone (40 mg/ml) and topical bevacizumab were used to manage the increased fibrovascular activity around the site of the former pterygium. Conclusion: Topical use of MMC during pterygium surgery may be related to serious postoperative complications such as progressive inflammatory corneal melting. The etiology may be multifactorial, which is related to MMC-induced inflammation and/or induced apoptosis. A therapeutic option is the described combination of systemic and local anti-inflammatory treatment along with lamellar keratoplasty and amniotic membrane transplantation. Adjunctive therapy may be needed if recurrence occurs.
TL;DR: An unusual case of conjunctival myxoma in a 47-year-old Taiwanese woman who presented initially with pain and redness is discussed, which complicated the diagnosis and the management at first.
Abstract: Background: Conjunctival myxoma is a type of rare, benign tumor of mesenchymal cells, with fewer than 30 reported cases in the English literature. It is mostly an isolated occurrence but can sometimes be associated with systemic diseases such as Carney complex or Zollinger-Ellison syndrome. It is necessary in clinical practice to differentiate it from other similar lesions, such as amelanotic nevus, lymphangioma, myxoid liposarcoma, spindle-cell lipoma, myxoid neurofibroma, and rhabdomyosarcoma. Case Presentation: The usual presentation of conjunctival myxoma is a translucent, well-circumscribed, and painless conjunctival mass, but in this report we discuss an unusual case of conjunctival myxoma in a 47-year-old Taiwanese woman who presented initially with pain and redness. This atypical presentation complicated the diagnosis and the management at first. Surgical excision of the mass was performed. The mass was found to be a conjunctival myxoma. The patient subsequently underwent extensive evaluation but was found not to have any systemic diseases with known association with conjunctival myxoma. Conclusions: In summary, we present a case of conjunctival myxoma in a 47-year-old Taiwanese woman. The initial presentation with pain and redness was atypical for conjunctival myxoma. The lesion was successfully managed with complete excisional biopsy.
TL;DR: With toric lenses, it is now possible to correct for corneal astigmatism in patients with bilateral ectopia lentis secondary to Marfan’s syndrome as well, provided that the capsular bag is maintained and can be properly centered.
Abstract: The management of ectopia lentis in Marfan's syndrome is challenging. Multiple disease-associated factors conspire to deprive these patients of adequate vision. While optical correction with glasses and contact lenses is usually advocated early on, the irregular astigmatism and even partial aphakia that accompanies advanced cases generally warrant surgical intervention. Several surgical strategies have been devised to manage these challenging cases, including the combination of endocapsular or pars plana lensectomy and iris or scleral fixation of the intraocular lens (IOL) or IOL-bag complex. All of the reported cases have been implanted with IOLs that correct for myopia only. With toric lenses, it is now possible to correct for corneal astigmatism in these patients as well, provided that the capsular bag is maintained and can be properly centered. We report the combination of scleral-fixated Cionni endocapsular rings and toric IOLs in a pediatric patient with bilateral ectopia lentis secondary to Marfan's syndrome.
TL;DR: The present case illustrates that even in the absence of any predisposing risk factors, C.albicans should be considered as a possible differential diagnosis in recalcitrant uveitis, and endogenous candida endophthalmitis can be a result of fungal infections from distant sites such as the toenails.
Abstract: Purpose: To report a case of Candida albicans endophthalmitis with no identifiable predisposing risk factors. Case Report: A 57-year-old male presented with a 3-day history of worsening floaters and reduced visual acuity. Fundoscopy and optical coherence tomography showed presence of fluffy white preretinal and intraretinal infiltrates. With no past medical history or evidence of immunosuppression but having travelled abroad and suffered from diarrhoea, fungal aetiology was thought to be unlikely and as a result, treatment was commenced for toxoplasma. Despite treatment, his vision did not improve. Initial investigations including inflammatory markers, serology for toxoplasmosis, blood culture, chest radiograph and aqueous sampling could not identify a source of infection. However, polymerase chain reaction results from vitreous sampling revealed C. albicans. As a result, the patient was treated with intravenous voriconazole and intravitreal amphotericin B. As initial clinical improvement was limited, a vitrectomy was performed with further intravitreal amphotericin B. Clinical improvement was rapid following vitrectomy. After repeated Gram staining and culture of infected toenails, Gram-positive yeast cells were isolated. Conclusion: Although C. albicans is a frequent cause of endogenous endophthalmitis, patients often have one or more predisposing systemic condition assisting the diagnosis. The present case illustrates that (1) even in the absence of any predisposing risk factors, C.albicans should be considered as a possible differential diagnosis in recalcitrant uveitis, and (2) endogenous candida endophthalmitis can be a result of fungal infections from distant sites such as the toenails.
TL;DR: Clinical improvement was seen after the second dose of intravitreous antibiotics and systemic linezolid, but visual acuity remained at light perception consistent with the ischemic changes observed in the posterior pole.
Abstract: Background: Vancomycin-resistant Enterococcus (VRE) endophthalmitis after penetrating keratoplasty (PKP) is very rare, the management is a challenge due to both the pattern of antibiotic resistance and the aggressive nature of the infectious process. We report the first delayed-onset case of VRE endophthalmitis after PKP. Materials and Methods: Case report of a 51-year-old female with a 7-week history of PKP who arrived at the emergency room with signs and symptoms of endophthalmitis. Initial visual acuity was light perception, and a posterior pole exam was not possible due to the intense vitreous reaction. Mode B ultrasound was used to assess the posterior pole. The patient underwent pars plana vitrectomy and received intravitreous antibiotics. Results: Vitreous stains and cultures were positive for Enterococcus faecium resistant to vancomycin. Donor rim cultures and viral PCR were negative. Treatment was carried out by repeated intravitreal antibiotics and systemic linezolid. Clinical improvement was seen after the second dose of intravitreous antibiotics and systemic linezolid, but visual acuity remained at light perception consistent with the ischemic changes observed in the posterior pole. Conclusion: VRE endophthalmitis might be associated with positive donor rim cultures. Prompt use of systemic linezolid in addition to intravitreous antibiotics is recommendable, but even with prompt treatment, visual prognosis is guarded.
TL;DR: Cyanoacrylate tissue adhesive with iatrogenic incarceration of the autologous iris was effective in treating this type of small corneal perforation and is potentially useful for small paracentral cornean perforations outside the visual axis and without good apposition.
Abstract: Background: Surgical intervention for corneal perforation is indicated when the anterior chamber does not reform within a short period of time. Herein, we report the successful management of a small paracentral corneal perforation using autologous iris incarceration and tissue adhesive. Case: A 41-year-old man developed a small paracentral corneal perforation (0.5 mm in size) in the right eye, while the treating physician attempted to remove the residual rust ring after removal of a piece of metallic foreign body. Observations: The eye was initially managed with a bandage soft contact lens to ameliorate the aqueous leakage; however, without success. Iatrogenic iris incarceration of the wound was first induced, followed by application of cyanoacrylate tissue adhesive to the perforated site. As a result, the anterior chamber was immediately reformed and maintained. Complete corneal epithelialization of the perforation was achieved in 2 months without visual compromises. Conclusions: Cyanoacrylate tissue adhesive with iatrogenic incarceration of the autologous iris was effective in treating this type of small corneal perforation. This technique is simple and potentially useful for small paracentral corneal perforations outside the visual axis and without good apposition.
TL;DR: Both cases presented here had relatively short axial lengths, and it is speculated that a shortened axial length may be a cause of choroidal folds in the acute stage of the disease.
Abstract: Purpose: To report 2 cases of Vogt-Koyanagi-Harada disease accompanied by remarkable choroidal folds in the acute stage. The early indicator of recurrence in these 2 cases was the identification of choroidal folds by spectral-domain optical coherence tomography (SD-OCT). Case Reports: A 68-year-old woman (Case 1) presented with visual loss in both eyes. Funduscopic examination revealed optic disc swelling and serous retinal detachment in both eyes. SD-OCT revealed remarkable choroidal folds and serous retinal detachment. After the initiation of systemic steroid treatment, choroidal folds disappeared rapidly and the amount of serous retinal detachment reduced remarkably. Choroidal folds observed on SD-OCT were the early indicators of recurrence prior to the emergence of serous retinal detachment. A 62-year-old woman (Case 2) presented with bilateral blurred vision and metamorphopsia. SD-OCT showed remarkable choroidal folds and serous retinal detachment in both eyes. After the initiation of systemic steroid treatment, choroidal folds and serous retinal detachment disappeared. At the time of recurrence, choroidal folds were observed by OCT. Discussion: During monitoring of Vogt-Koyanagi-Harada disease treatment, choroidal folds could be an early sign of recurrence. When choroidal folds are observed and recognized as an early indicator of recurrence, a prompt increase in steroids can improve the patients’ prognosis. Finally, both cases presented here had relatively short axial lengths, and we speculate that a shortened axial length may be a cause of choroidal folds in the acute stage of the disease.
TL;DR: The absence of improvement after ILM peeling during the first surgical procedure, accompanied by resolution of the clinical picture with gas tamponade during the second surgical procedure sustained the hypothesis of a subarachnoidal origin of the fluid.
Abstract: Background: The origin of the fluid and precise pathophysiology of optic pit maculopathy remain unclear. It has been suggested that submacular fluid originates either from vitreous or cerebrospinal fluid. We report a case of optic pit maculopathy which was unsuccessfully treated with vitrectomy and internal limiting membrane (ILM) peeling, and subsequently resolved with revision of vitrectomy and gas tamponade. Methods: We report a case of optic disc pit maculopathy, well documented by spectraldomain optical coherence tomography, before and after pars plana vitrectomy with ILM peeling, and its revision with gas tamponade. Results: After ILM peeling, there was no improvement either in visual acuity or in the tomographic aspect of the retina. A revision of the surgery was then needed and gas tamponade was performed, which resulted in a complete resolution of the optic pit maculopathy. Conclusion: The absence of improvement after ILM peeling during the first surgical procedure, accompanied by resolution of the clinical picture with gas tamponade during the second surgical procedure, sustained the hypothesis of a subarachnoidal origin of the fluid.
TL;DR: An 18-year-old Caucasian male with a unilateral macular star and retinal vascular anomalies compatible with adult onset Coats’ disease is presented, which is usually diagnosed in childhood, but rare cases may occur in adults.
Abstract: Purpose: We present the case of an 18-year-old Caucasian male with a unilateral macular star and retinal vascular anomalies compatible with adult onset Coats’ disease Methods: Diagnosis was based on fundoscopic, fluorescein angiography and optical coherence tomography findings Results: The patient presented to our emergency department with complaints of low vision in his left eye (LE) detected 10 days before The best-corrected visual acuity in the LE was 20/50 Fundoscopy of the LE evidenced a complete macular star Optical coherence tomography showed increased retinal thickness, infiltration of the retinal wall, and detachment of the neuroepithelium Angiography revealed no appreciable diffusion in the macula Above the superior temporal (ST) arcade, anomalies in the retinal vasculature were found, with interruption of the peripheral vessels and vessels which were ‘sausage’-like After 1 month, the LE vision evolved to hand movements Laser photocoagulation was performed in the ST quadrant Intravitreal injection of bevacizumab 125 mg/005 ml and photodynamic therapy were performed without any significant changes, progression of ST serous detachment of the neuroepithelium, and finally progression to macular fibrosis Discussion: Coats’ disease is usually diagnosed in childhood, but rare cases may occur in adults Those cases usually have a more indolent course which was not observed in our patient When there is macular involvement, prognosis is more guarded, despite treatment
TL;DR: This is the first illustrated description of 4 consecutive injections for ME induced secondary to retinal vein occlusion, and highlights the quick efficiency of Ozurdex on VA and ME with good reproducibility and tolerance, and without tachyphylaxis phenomenon.
Abstract: Background: Macular edema (ME) treatment has benefited from the recent intravitreal pharmacotherapy development of an intravitreal implant of dexamethasone (Ozurdex®, Allergan, Irvine, Calif., USA). However, its efficiency has never been illustrated beyond 3 injections. Case Presentation: We report the case of a 75-year-old woman with inferior branch vein occlusion, who, after laser photocoagulation treatment and recurrence after intravitreal injection of triamcinolone, benefited from 4 injections of Ozurdex. Her macular thickness and visual acuity (VA) progression were assessed for 17 months. Conclusions: This case report highlights the quick efficiency of Ozurdex on VA and ME with good reproducibility and tolerance, and without tachyphylaxis phenomenon. This is the first illustrated description of 4 consecutive injections for ME induced secondary to retinal vein occlusion.
TL;DR: The diagnosis of ocular toxoplasmosis should be considered in young patients with retinal artery occlusions associated with inflammation, as this is the third case report of a BRAO in a patient in the pediatric population.
Abstract: Purpose: Branch retinal artery occlusion (BRAO), while not uncommon in elderly patient populations, is rare in children and adolescents. We report a case of a BRAO secondary to toxoplasmosis in this demographic. Case: A previously healthy 17-year-old male developed a unilateral BRAO in conjunction with inflammation and increased intraocular pressure. Family history was positive for cerebrovascular accidents in multiple family members at relatively young ages. The patient had a hypercoagulable workup as well as a cardiovascular workup which were both normal. A rheumatologic workup was unremarkable. By 3 weeks, a patch of retinitis was more easily distinguished from the BRAO and the diagnosis of ocular toxoplasmosis was made. Treatment was started with prednisone and azithromycin with subsequent improvement in vision. Toxoplasma antibody levels were elevated for IgG and negative for IgM, IgA, and IgE. The etiology of the BRAO was attributed to ocular toxoplasmosis. Conclusions: Vascular occlusions are rare in toxoplasmosis. This is the third case report of a BRAO in a patient in the pediatric population. The diagnosis of ocular toxoplasmosis should be considered in young patients with retinal artery occlusions associated with inflammation.