Oman Journal of Ophthalmology最新文献

Submacular hemorrhage (SMH) causes irreversible loss of vision as it causes permanent anatomical and functional damage to photoreceptors. The various causes include polypoidal choroidal vasculopathy, neovascular age-related macular degeneration, retinal artery macroaneurysm, high myopia, and trauma. The current treatment modalities include antivascular endothelial growth factor (anti-VEGF) monotherapy, anti-VEGF ± gas pneumatic displacement ± intravitreal recombinant tissue plasminogen activator injection (rtPA), and triple therapy (intravitreal anti-VEGF + intravitreal rtPA + perfluoropropane gas injection). The surgical displacement of the SMH by vitrectomy with subretinal tissue plasminogen activator injection + intravitreal anti-VEGF + gas tamponade has been a valuable addition to our armamentarium. Evidence suggests that this novel technique provides better anatomical and functional outcomes in terms of visual acuity when the surgical displacement is performed within the prompt time frame in comparison to other available modalities of treatment. The current lacuna in the literature is the absence of level 1 evidence to support the surgical displacement as the first-line therapy. Hence, we review the current evidence and provide recommendations regarding this ever-promising therapy that can be vision-saving.

Macular hole surgeries yield positive anatomical and visual results. However, in cases of large or chronic macular holes, closure may be incomplete or unsuccessful. To enhance anatomical closure, vitrectomy combined with multiple adjuvant options has been employed, including inverted internal limiting membrane (ILM) flaps, autologous retinal transplant, amniotic membrane grafts, and autologous blood products. This case report demonstrates the advantage of using a patient's blood as an adjuvant to inverted ILM flaps for successful closure of a large traumatic macular hole.

Carcinoma of the eyelids forms 5%-10% of all skin carcinomas. Porocarcinoma is the malignancy of eccrine sweat glands, mostly seen in the extremities. Only eight cases of this tumor in the eyelid have been reported to date. Eyelid adnexal tumors such as porocarcinoma are quite rare. A 70-year-old male presented with a painless nodule-ulcerative growth in the left lower eyelid for the past 2 years. The mass was 2.7 cm by 3 cm in dimensions and involved the tarsal plate. Incision biopsy gave a histopathological picture similar to a benign adnexal tumor, poroma. Complete excision was done, and the defect was reconstructed with a Tenzel flap. Histopathological analysis of the excised mass showed a malignant tumor arising from sweat glands with epidermal cells arranged in broad anastomotic bands, extending into the dermis, having ductal lamina and cystic components with comedo necrosis and keratinization. A diagnosis of eccrine porocarcinoma of the eyelid was made, and the tumor was staged as T3cN0M0. A whole-body positron emission tomography-computed tomography scan was negative for metastasis. The patient was healthy at 1 year of follow-up without any recurrence.

Periorbital necrotizing fasciitis (NF) is a rare, rapidly progressing condition with significant systemic impact. We report the case of a 44-year-old healthy woman who developed acute left upper eyelid swelling, initially presented with a left ear infection that was treated with topical measures elsewhere. The condition recurred and extended to the eye, exacerbated by a recent childbirth and increased stress from a demanding job. Imaging revealed periorbital edema without intraocular or intracranial spread. Despite initial empirical treatment, the swelling extended to the contralateral eye within 48 h, accompanied by skin sloughing and necrotic margins, necessitating urgent surgical debridement. Cultures identified Streptococcus pyogenes and herpes simplex virus 1 (HSV-1), and histopathology confirmed extensive necrosis and inflammation. Treatment was adjusted based on culture and sensitivity results, leading to significant improvement. Vision remained unaffected, although cicatricial ectropion and lagophthalmos were expected and managed with subcutaneous mixture of triamcinolone and 5-fluorouracil injections, with future plans for skin grafting. This case highlights the unusual presentation of periorbital NF induced by HSV infection in a healthy young woman. The paper emphasizes the need for early recognition, immediate surgical intervention, and meticulous investigation to reduce progression and minimize morbidity in this rare and clinically challenging condition.

This case series includes three consecutive cases who presented with retinal detachment (RD) in acquired retinoschisis due to giant outer lamellar tears. Preoperative widefield optical coherence tomography (WF-OCT) was used for diagnosis and intra-operative optical coherence tomography (iOCT) was used to confirm the extent of retinoschisis, identify borders of retinectomy and identify a safe area for drainage retinotomy. All eyes developed recurrent RD and required repeat surgeries. Learnings from the immediate failure of the first case guided our surgical planning with iOCT-assisted surgery in the next two cases leading to acceptable outcomes. Fellow eye required WF-OCT guided prophylactic laser barrage in two out of three cases. We concluded that preoperative recognition of giant outer layer lamellar tears in retinoschisis is crucial as these cases harbor poor anatomical prognosis and demand patient counseling. We found WF-OCT and iOCT to be very useful in understanding and management of these eyes.

Alezzandrini syndrome (AS) is a rare entity characterized by segmental vitiligo on the face with ipsilateral poliosis, degenerative retinitis, and hearing defect on the same side. We hereby report a rare case of AS who presented to an ophthalmologist just for the treatment of his unilateral whitened eyebrows and eyelashes raising cosmetic concerns. Presence of ipsilateral vitiligo with pigmentary changes limited by midline over forehead aroused suspicion of shingles. However, careful, comprehensive examination and elicitation of some classical signs led to the coincidental diagnosis of the rare AS. Patient was explained possibility of visual deterioration and was advised regular follow up with an ophthalmologist. Hence, all cases of ipsilateral poliosis with segmental vitiligo should always be screened for retinal degeneration and hearing defects. Patients with AS should be managed by a team of ophthalmologists, dermatologists, and otorhinologists.

Cherry red spot (CRS) is a characteristic ophthalmoscopic finding associated with conditions causing retinal ischemia or accumulation of different materials in the retinal nerve fiber layer. We report a retrospective series of three cases with late presentation of bilateral CRS and varied systemic associations. In these long-standing cases, the abnormal deposits remain localised to a small area around the fovea-either due to milder variant of the systemic disease or long-standing nature leading to decrease in deposits. Imaging tools such as fundus autofluorescence and optical coherence tomography help to support the diagnosis where genetic and histopathological examination is not possible.