Pub Date : 2024-03-15eCollection Date: 2024-01-01DOI: 10.4103/tjo.TJO-D-23-00176
Francisco Arnalich-Montiel
This case report presents a unique instance of a 55-year-old male patient exhibiting features of both Terrien marginal degeneration (TMD) and Fuchs' superficial marginal keratitis. Characterized by peripheral corneal thinning vascularization, and a pseudopterygium, the patient experienced recurrent photophobia, redness, and tearing over 15 years. This case challenges the traditional distinction between TMD and Fuchs' superficial marginal keratitis, suggesting a potential common underlying disorder. Mycophenolate mofetil provided a partial response, while pseudopterygium removal led to sustained remission, emphasizing its therapeutic significance. This case highlights the first documented use of mycophenolate in TMD and supports the notion of shared vasculitic origins between TMD and Fuchs' keratitis, raising intriguing questions about targeted therapeutic interventions.
{"title":"Systemic treatment and surgical intervention in inflammatory Terrien disease.","authors":"Francisco Arnalich-Montiel","doi":"10.4103/tjo.TJO-D-23-00176","DOIUrl":"https://doi.org/10.4103/tjo.TJO-D-23-00176","url":null,"abstract":"<p><p>This case report presents a unique instance of a 55-year-old male patient exhibiting features of both Terrien marginal degeneration (TMD) and Fuchs' superficial marginal keratitis. Characterized by peripheral corneal thinning vascularization, and a pseudopterygium, the patient experienced recurrent photophobia, redness, and tearing over 15 years. This case challenges the traditional distinction between TMD and Fuchs' superficial marginal keratitis, suggesting a potential common underlying disorder. Mycophenolate mofetil provided a partial response, while pseudopterygium removal led to sustained remission, emphasizing its therapeutic significance. This case highlights the first documented use of mycophenolate in TMD and supports the notion of shared vasculitic origins between TMD and Fuchs' keratitis, raising intriguing questions about targeted therapeutic interventions.</p>","PeriodicalId":44978,"journal":{"name":"Taiwan Journal of Ophthalmology","volume":"14 1","pages":"108-111"},"PeriodicalIF":1.1,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11034679/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140852250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ocular comorbidities can happen as congenital defective gene associations. We present a 37-year-old female patient who was mentally challenged and had coexisting achromatopsia gene abnormality on genetic analysis. She was operated in childhood for congenital cataract, and posterior chamber intraocular lens (IOL) was implanted at 10 years of age elsewhere. The patient presented 27 years later with luxated IOL with endothelial decompensation. There was a coexisting steep and thin cornea noted on corneal topography. She was managed with pre-Descemet's endothelial keratoplasty with transpositioning of posterior chamber IOL to glued IOL with single-pass four-throw pupilloplasty. Postoperatively, the cornea was clear with centered glued IOL. The lesser postanesthetic challenges and faster rehabilitation are obtained in combination procedures with reduced complications in such rare scenarios.
{"title":"Pre-Descemet's endothelial keratoplasty with glued intraocular lens implantation with pinhole pupilloplasty in a case of ocular comorbidity in achromatopsia.","authors":"Dhivya Ashok Kumar, Amar Agarwal, Swetha Ravichandran","doi":"10.4103/tjo.TJO-D-23-00172","DOIUrl":"https://doi.org/10.4103/tjo.TJO-D-23-00172","url":null,"abstract":"<p><p>Ocular comorbidities can happen as congenital defective gene associations. We present a 37-year-old female patient who was mentally challenged and had coexisting achromatopsia gene abnormality on genetic analysis. She was operated in childhood for congenital cataract, and posterior chamber intraocular lens (IOL) was implanted at 10 years of age elsewhere. The patient presented 27 years later with luxated IOL with endothelial decompensation. There was a coexisting steep and thin cornea noted on corneal topography. She was managed with pre-Descemet's endothelial keratoplasty with transpositioning of posterior chamber IOL to glued IOL with single-pass four-throw pupilloplasty. Postoperatively, the cornea was clear with centered glued IOL. The lesser postanesthetic challenges and faster rehabilitation are obtained in combination procedures with reduced complications in such rare scenarios.</p>","PeriodicalId":44978,"journal":{"name":"Taiwan Journal of Ophthalmology","volume":"14 1","pages":"112-116"},"PeriodicalIF":1.1,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11034698/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140852871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-09DOI: 10.4103/tjo.tjo-d-23-00110
Soumen Chakraborty, Satish Reddy Satty, Badal Kumar Sahu, Soumya Ray
A sudden surge of Mucormycosis cases during the second wave of Covid 19 was observed in certain parts of India. The reasons for this upsurge remain unknown. However its impact on the overall healthcare system was quite overwhelming. In this context this study was decided to estimate and assess the spectrum of orbital involvement in patients with Mucormycosis, to find its association with coexisting disease entities if any, and at the same time evaluate the therapeutic response to established treatment regimens. This descriptive longitudinal study was conducted over a period of six months. Patients presenting with symptoms of Mucormycosis were jointly evaluated by a multi speciality team. After confirmation of diagnosis, patients were treated with intravenous Amphotericin B, surgical debridement of affected sinuses and orbital exenteration when indicated. They were followed up for three months after discharge. Forty-three patients were enrolled in this study. Thirty-seven (86.04%) were COVID positive. All of them had history of steroid exposure during COVID treatment. Ninety five percent of study participants had diabetes mellitus. Twenty-seven (62.79%) patients had orbital involvement. Most common clinical presentation was peri-orbital or facial pain and edema. Besides medical treatment, thirty-nine patients (90.69%) required sinus debridement and nine patients (20.9%) required orbital exenteration. Thirteen patients (30.23%) expired during the follow up period. With treatment disease regressed in twenty patients (46.51%). Diabetes and use of steroids to prevent anticipated cytokine storm may be the inciting factors for Orbital Mucormycosis in COVID patients. Early diagnosis, treatment and control of risk factors are keys for recovery and survival..
{"title":"Resurgence of orbital mucormycosis during COVID-19 pandemic: Study from a tertiary care center in Eastern India","authors":"Soumen Chakraborty, Satish Reddy Satty, Badal Kumar Sahu, Soumya Ray","doi":"10.4103/tjo.tjo-d-23-00110","DOIUrl":"https://doi.org/10.4103/tjo.tjo-d-23-00110","url":null,"abstract":"\u0000 \u0000 \u0000 A sudden surge of Mucormycosis cases during the second wave of Covid 19 was observed in certain parts of India. The reasons for this upsurge remain unknown. However its impact on the overall healthcare system was quite overwhelming. In this context this study was decided to estimate and assess the spectrum of orbital involvement in patients with Mucormycosis, to find its association with coexisting disease entities if any, and at the same time evaluate the therapeutic response to established treatment regimens.\u0000 \u0000 \u0000 \u0000 This descriptive longitudinal study was conducted over a period of six months. Patients presenting with symptoms of Mucormycosis were jointly evaluated by a multi speciality team. After confirmation of diagnosis, patients were treated with intravenous Amphotericin B, surgical debridement of affected sinuses and orbital exenteration when indicated. They were followed up for three months after discharge.\u0000 \u0000 \u0000 \u0000 Forty-three patients were enrolled in this study. Thirty-seven (86.04%) were COVID positive. All of them had history of steroid exposure during COVID treatment. Ninety five percent of study participants had diabetes mellitus. Twenty-seven (62.79%) patients had orbital involvement. Most common clinical presentation was peri-orbital or facial pain and edema. Besides medical treatment, thirty-nine patients (90.69%) required sinus debridement and nine patients (20.9%) required orbital exenteration. Thirteen patients (30.23%) expired during the follow up period. With treatment disease regressed in twenty patients (46.51%).\u0000 \u0000 \u0000 \u0000 Diabetes and use of steroids to prevent anticipated cytokine storm may be the inciting factors for Orbital Mucormycosis in COVID patients. Early diagnosis, treatment and control of risk factors are keys for recovery and survival..\u0000","PeriodicalId":44978,"journal":{"name":"Taiwan Journal of Ophthalmology","volume":"37 29","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139443015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-09DOI: 10.4103/tjo.tjo-d-23-00100
Hwa-Shin Fang, Chang-Sue Yang, Cheng-Kuo Cheng, Yuangwei Wang
A 56-year-old female presented with bilateral progressive blurred vision over 1 month. She has no known malignancy before her initial visit to our ophthalmologic clinic. Her best-corrected visual acuity decreased to hand motion from 30 cm in both eyes. Optical coherence tomography exhibited parafoveal thinning of outer retinal layers bilaterally. Fluorescein angiography and indocyanine green angiography disclosed hypofluorescent spots in late phase in both eyes. The suspicion of cancer-associated retinopathy (CAR) prompted us to investigate and refer for further systemic disease including occult malignancy. The patient was diagnosed with small-cell carcinoma of the endometrium or cervix, which is an extremely rare and aggressive neuroendocrine tumor. The patient was treated with oral prednisone with improved visual acuity. The patient expired from sepsis 2 months after her initial visit to our ophthalmologic clinic. In selected cases, CAR may present before the diagnosis of primary cancer. It is essential to recognize its ophthalmic manifestation for early discovery of primary malignancy.
{"title":"Cancer-associated retinopathy as an initial presentation of gynecologic small-cell carcinoma","authors":"Hwa-Shin Fang, Chang-Sue Yang, Cheng-Kuo Cheng, Yuangwei Wang","doi":"10.4103/tjo.tjo-d-23-00100","DOIUrl":"https://doi.org/10.4103/tjo.tjo-d-23-00100","url":null,"abstract":"\u0000 A 56-year-old female presented with bilateral progressive blurred vision over 1 month. She has no known malignancy before her initial visit to our ophthalmologic clinic. Her best-corrected visual acuity decreased to hand motion from 30 cm in both eyes. Optical coherence tomography exhibited parafoveal thinning of outer retinal layers bilaterally. Fluorescein angiography and indocyanine green angiography disclosed hypofluorescent spots in late phase in both eyes. The suspicion of cancer-associated retinopathy (CAR) prompted us to investigate and refer for further systemic disease including occult malignancy. The patient was diagnosed with small-cell carcinoma of the endometrium or cervix, which is an extremely rare and aggressive neuroendocrine tumor. The patient was treated with oral prednisone with improved visual acuity. The patient expired from sepsis 2 months after her initial visit to our ophthalmologic clinic. In selected cases, CAR may present before the diagnosis of primary cancer. It is essential to recognize its ophthalmic manifestation for early discovery of primary malignancy.","PeriodicalId":44978,"journal":{"name":"Taiwan Journal of Ophthalmology","volume":"14 21","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139443212","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-09DOI: 10.4103/tjo.tjo-d-23-00106
Christina Wang, Arturo Castillo, Federico Cortes-Bejarano, Eduardo Lopez, Eduardo Cunha de Souza, Lihteh Wu
Dengue is the most common arboviral disease. It is typically spread by the bite of an infected female Aedes aegypti or Aedes albopictus mosquitoes. Dengue is endemic in subtropical and tropical regions, but its geographic reach keeps expanding. Ophthalmic manifestations of dengue are common and may present with a wide spectrum of ophthalmic findings. These may range from conjunctival petechiae, retinal hemorrhage, retinal vasculitis to panophthalmitis. Some of these may be vision threatening and may require urgent ophthalmic evaluation. The precise pathophysiologic mechanisms involved in dengue infection involve a complex interplay between host immune responses, virus, and host genes. There is no specific treatment for ocular dengue. Therefore, treatment is supportive. Despite the lack of proven efficacy, corticosteroids have been used in vision-threatening dengue-related ocular complications. Dengue must be considered in endemic areas, and a careful travel history needs to be elicited in nonendemic areas.
{"title":"An update on the ocular manifestations of dengue","authors":"Christina Wang, Arturo Castillo, Federico Cortes-Bejarano, Eduardo Lopez, Eduardo Cunha de Souza, Lihteh Wu","doi":"10.4103/tjo.tjo-d-23-00106","DOIUrl":"https://doi.org/10.4103/tjo.tjo-d-23-00106","url":null,"abstract":"\u0000 Dengue is the most common arboviral disease. It is typically spread by the bite of an infected female Aedes aegypti or Aedes albopictus mosquitoes. Dengue is endemic in subtropical and tropical regions, but its geographic reach keeps expanding. Ophthalmic manifestations of dengue are common and may present with a wide spectrum of ophthalmic findings. These may range from conjunctival petechiae, retinal hemorrhage, retinal vasculitis to panophthalmitis. Some of these may be vision threatening and may require urgent ophthalmic evaluation. The precise pathophysiologic mechanisms involved in dengue infection involve a complex interplay between host immune responses, virus, and host genes. There is no specific treatment for ocular dengue. Therefore, treatment is supportive. Despite the lack of proven efficacy, corticosteroids have been used in vision-threatening dengue-related ocular complications. Dengue must be considered in endemic areas, and a careful travel history needs to be elicited in nonendemic areas.","PeriodicalId":44978,"journal":{"name":"Taiwan Journal of Ophthalmology","volume":"16 6","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139443892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-05DOI: 10.4103/tjo.tjo-d-23-00081
R. Goel, Sonam Singh, Shalin Shah, S. Khanam, Priyanka Golhait, Tanvi Gaonker
The purpose of this study was to compare the outcomes of “closed posterior levator advancement” (CPLA) in acquired aponeurotic and simple congenital ptosis with good levator function (LF). A prospective interventional study was conducted on 20 adult patients, 10 simple congenital ptosis, and 10 acquired aponeurotic ptosis with LF ≥8 mm. Complicated, posttraumatic, neurogenic ptosis and previous lid surgery were excluded. A detailed history and assessment of visual acuity, upper eyelid margin reflex distance (MRD1), margin-crease distance, LF, Bell’s phenomenon, ocular surface disease index (OSDI), and phenylephrine test were undertaken. CPLA was performed in the 20 eyes and were followed up for 3 months. The ages of the study participants ranged from 18 to 64 years, and the male: female ratio was 11:9. There were nine aponeurotic and one congenital severe ptosis, the remaining 10 being mild–moderate ptosis. The etiologies in the aponeurotic group were involutional (2), contact lens wear (1), allergic conjunctivitis (3), and idiopathic in four eyes. The success rates were 90% in both groups. The amount of ptosis correction showed a positive relation with LF (r s = 0.6, P = 0.004) and phenylephrine test (r s = 0.7, P < 0.001). The complications in the aponeurotic group were lagophthalmos (2/10), subjective dry eye (2/10), subconjunctival hemorrhage (1/10), symblepharon (1/10), temporal flare (1/10), and overcorrection (1/10). The congenital group showed only undercorrection (1/10). CPLA is an effective procedure for the treatment of mild–moderate simple congenital and all grades of aponeurotic ptosis with good LF. Response to phenylephrine test serves as a useful guide to the amount of ptosis correction.
{"title":"Comparative evaluation of “closed posterior levator advancement” in simple congenital and aponeurotic ptosis","authors":"R. Goel, Sonam Singh, Shalin Shah, S. Khanam, Priyanka Golhait, Tanvi Gaonker","doi":"10.4103/tjo.tjo-d-23-00081","DOIUrl":"https://doi.org/10.4103/tjo.tjo-d-23-00081","url":null,"abstract":"\u0000 \u0000 \u0000 The purpose of this study was to compare the outcomes of “closed posterior levator advancement” (CPLA) in acquired aponeurotic and simple congenital ptosis with good levator function (LF).\u0000 \u0000 \u0000 \u0000 A prospective interventional study was conducted on 20 adult patients, 10 simple congenital ptosis, and 10 acquired aponeurotic ptosis with LF ≥8 mm. Complicated, posttraumatic, neurogenic ptosis and previous lid surgery were excluded. A detailed history and assessment of visual acuity, upper eyelid margin reflex distance (MRD1), margin-crease distance, LF, Bell’s phenomenon, ocular surface disease index (OSDI), and phenylephrine test were undertaken. CPLA was performed in the 20 eyes and were followed up for 3 months.\u0000 \u0000 \u0000 \u0000 The ages of the study participants ranged from 18 to 64 years, and the male: female ratio was 11:9. There were nine aponeurotic and one congenital severe ptosis, the remaining 10 being mild–moderate ptosis. The etiologies in the aponeurotic group were involutional (2), contact lens wear (1), allergic conjunctivitis (3), and idiopathic in four eyes. The success rates were 90% in both groups. The amount of ptosis correction showed a positive relation with LF (r\u0000 s = 0.6, P = 0.004) and phenylephrine test (r\u0000 s = 0.7, P < 0.001). The complications in the aponeurotic group were lagophthalmos (2/10), subjective dry eye (2/10), subconjunctival hemorrhage (1/10), symblepharon (1/10), temporal flare (1/10), and overcorrection (1/10). The congenital group showed only undercorrection (1/10).\u0000 \u0000 \u0000 \u0000 CPLA is an effective procedure for the treatment of mild–moderate simple congenital and all grades of aponeurotic ptosis with good LF. Response to phenylephrine test serves as a useful guide to the amount of ptosis correction.\u0000","PeriodicalId":44978,"journal":{"name":"Taiwan Journal of Ophthalmology","volume":"2 22","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139449956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-05DOI: 10.4103/tjo.tjo-d-23-00118
Yi-Ching Shao, Lu-Chun Wang, Yi-An Lee
Glaucoma drainage device implantation can be complex and challenging, particularly in patients with conjunctival scarring. However, in this case, involving a young man with refractory glaucoma who had undergone multiple ocular surgeries, the implantation of a Paul glaucoma drainage device was successfully performed after the application of extraocular muscle bridle sutures. The patient exhibited a stable intraocular pressure ranging from 12 to 18 mmHg without antiglaucoma medication during the 3-month follow-up period. Thus, this surgical technique improves the accuracy and ease of inferior-temporal quadrant glaucoma drainage implantation, resulting in good treatment outcomes.
{"title":"Extraocular muscle bridle traction suture assisted Paul glaucoma implant surgery for severe conjunctival scarring","authors":"Yi-Ching Shao, Lu-Chun Wang, Yi-An Lee","doi":"10.4103/tjo.tjo-d-23-00118","DOIUrl":"https://doi.org/10.4103/tjo.tjo-d-23-00118","url":null,"abstract":"\u0000 Glaucoma drainage device implantation can be complex and challenging, particularly in patients with conjunctival scarring. However, in this case, involving a young man with refractory glaucoma who had undergone multiple ocular surgeries, the implantation of a Paul glaucoma drainage device was successfully performed after the application of extraocular muscle bridle sutures. The patient exhibited a stable intraocular pressure ranging from 12 to 18 mmHg without antiglaucoma medication during the 3-month follow-up period. Thus, this surgical technique improves the accuracy and ease of inferior-temporal quadrant glaucoma drainage implantation, resulting in good treatment outcomes.","PeriodicalId":44978,"journal":{"name":"Taiwan Journal of Ophthalmology","volume":"1 12","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139450024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-05DOI: 10.4103/tjo.tjo-d-23-00124
Sheng-Yu Liu, Wan-Jen Hsieh, Hsueh-Wen Hsueh, Chao-Wen Lin
Numerous evidence suggests coronavirus disease 2019 (COVID-19) potentially triggers demyelinating diseases, inclusive of multiple sclerosis (MS), and acute disseminated encephalomyelitis (ADEM), and various mechanisms have been proposed. We report a 42-year-old male presented with bilateral optic neuritis and encephalopathy, 2 weeks following COVID-19 infection. He denied any history or family history of neurological and ocular diseases. Severe bilateral visual impairment (only light perception) and pain with eye movement were reported. Fundoscopy revealed bilateral optic disc swelling. Magnetic resonance imaging showed tortuous bilateral optic nerves with optic nerve and nerve sheath enhancement. Multiple hyperintense nodules in bilateral cerebral white matter were noted on fluid-attenuated inversion recovery T2-weighted imaging without diffusion restriction or gadolinium contrast enhancement. Hypointense nodules in cerebral white matter were also noted on T1-weighted imaging, which implied some old lesions. Dissemination in space and time and cerebrospinal fluid-specific oligoclonal bands confirmed the diagnosis of MS. Both serum aquaporin-4 and myelin oligodendrocyte glycoprotein antibodies were negative. He received pulse steroid therapy for 5 days, followed by slowly tapering oral prednisolone. His vision, ocular motion pain, and encephalopathy improved gradually. However, the visual outcome was still poor (bilateral 20/400), and optic atrophy was noticed during 1-year follow-up. To our knowledge, this is the first case of MS following severe acute respiratory syndrome coronavirus 2 infection presented with bilateral optic neuritis and encephalopathy. Since these manifestations are exceedingly rare in MS, we suspect acute immune reactions induced by COVID-19 could bring about the atypical ADEM-like presentations of MS.
{"title":"Bilateral optic neuritis and encephalopathy as the atypical presentations of multiple sclerosis following severe acute respiratory syndrome coronavirus 2 infection","authors":"Sheng-Yu Liu, Wan-Jen Hsieh, Hsueh-Wen Hsueh, Chao-Wen Lin","doi":"10.4103/tjo.tjo-d-23-00124","DOIUrl":"https://doi.org/10.4103/tjo.tjo-d-23-00124","url":null,"abstract":"\u0000 Numerous evidence suggests coronavirus disease 2019 (COVID-19) potentially triggers demyelinating diseases, inclusive of multiple sclerosis (MS), and acute disseminated encephalomyelitis (ADEM), and various mechanisms have been proposed. We report a 42-year-old male presented with bilateral optic neuritis and encephalopathy, 2 weeks following COVID-19 infection. He denied any history or family history of neurological and ocular diseases. Severe bilateral visual impairment (only light perception) and pain with eye movement were reported. Fundoscopy revealed bilateral optic disc swelling. Magnetic resonance imaging showed tortuous bilateral optic nerves with optic nerve and nerve sheath enhancement. Multiple hyperintense nodules in bilateral cerebral white matter were noted on fluid-attenuated inversion recovery T2-weighted imaging without diffusion restriction or gadolinium contrast enhancement. Hypointense nodules in cerebral white matter were also noted on T1-weighted imaging, which implied some old lesions. Dissemination in space and time and cerebrospinal fluid-specific oligoclonal bands confirmed the diagnosis of MS. Both serum aquaporin-4 and myelin oligodendrocyte glycoprotein antibodies were negative. He received pulse steroid therapy for 5 days, followed by slowly tapering oral prednisolone. His vision, ocular motion pain, and encephalopathy improved gradually. However, the visual outcome was still poor (bilateral 20/400), and optic atrophy was noticed during 1-year follow-up. To our knowledge, this is the first case of MS following severe acute respiratory syndrome coronavirus 2 infection presented with bilateral optic neuritis and encephalopathy. Since these manifestations are exceedingly rare in MS, we suspect acute immune reactions induced by COVID-19 could bring about the atypical ADEM-like presentations of MS.","PeriodicalId":44978,"journal":{"name":"Taiwan Journal of Ophthalmology","volume":"51 2","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139450032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-05DOI: 10.4103/tjo.tjo-d-23-00072
Cyuan-Yi Yeh, Yi-Ting Liang, Cheng-Kuo Cheng
A 67-year-old male presented to our clinic with sudden onset of blurred vision and metamorphopsia of his left eye for 2 weeks. He had a history of combined rhegmatogenous retinal detachment and vitreous hemorrhage and underwent an uneventful pars plana vitrectomy, 360° scleral buckling, and drainage retinotomy for his left eye 3 years ago. The anatomic and visual outcomes after surgery were good, without complications. On examination during this visit, an orange–red subretinal mass connected to the previous drainage retinotomy scar was noted. Spectral-domain optical coherence tomography revealed severe subretinal fluid with type-2 choroidal neovascularization (CNV) mass at the superior nasal macular area in connection with the margin of the previous retinotomy scar. Fundus fluorescein angiography showed an active CNV. The patient underwent monthly intravitreal aflibercept in the left eye. After four doses of aflibercept, his CNV regressed with no recurrence on follow-up at 20 months. In conclusion, iatrogenic CNV is a rare complication following uneventful vitreoretinal surgery and can develop years after the operation. It is crucial to early diagnose and treat it with intravitreal antivascular endothelial growth factor treatment for a favorable outcome and long-term remission.
{"title":"Aflibercept treatment for delayed retinotomy-associated choroidal neovascularization: A case report and literature review","authors":"Cyuan-Yi Yeh, Yi-Ting Liang, Cheng-Kuo Cheng","doi":"10.4103/tjo.tjo-d-23-00072","DOIUrl":"https://doi.org/10.4103/tjo.tjo-d-23-00072","url":null,"abstract":"\u0000 A 67-year-old male presented to our clinic with sudden onset of blurred vision and metamorphopsia of his left eye for 2 weeks. He had a history of combined rhegmatogenous retinal detachment and vitreous hemorrhage and underwent an uneventful pars plana vitrectomy, 360° scleral buckling, and drainage retinotomy for his left eye 3 years ago. The anatomic and visual outcomes after surgery were good, without complications. On examination during this visit, an orange–red subretinal mass connected to the previous drainage retinotomy scar was noted. Spectral-domain optical coherence tomography revealed severe subretinal fluid with type-2 choroidal neovascularization (CNV) mass at the superior nasal macular area in connection with the margin of the previous retinotomy scar. Fundus fluorescein angiography showed an active CNV. The patient underwent monthly intravitreal aflibercept in the left eye. After four doses of aflibercept, his CNV regressed with no recurrence on follow-up at 20 months. In conclusion, iatrogenic CNV is a rare complication following uneventful vitreoretinal surgery and can develop years after the operation. It is crucial to early diagnose and treat it with intravitreal antivascular endothelial growth factor treatment for a favorable outcome and long-term remission.","PeriodicalId":44978,"journal":{"name":"Taiwan Journal of Ophthalmology","volume":"77 5","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139450377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-05DOI: 10.4103/tjo.tjo-d-23-00129
Kuan-Yu Chen, Shirley H. L. Chang
This study aimed to explore the safety and efficacy of laser treatment settings of micropulse transscleral cyclophotocoagulation treatment in glaucoma patients and to evaluate the relationship between intraocular pressure (IOP) reduction and different treatment parameters. A total of 74 eyes in 64 glaucoma patients with IOP over 21 mmHg or under 20 mmHg with visual field progression who underwent micropulse transscleral cyclophotocoagulation treatment were included. Patients were divided into success and failure groups based on criteria of 20% IOP reduction rate. The predictive factors of IOP reduction between success and failure groups and the IOP reduction rates in the different treatment duration groups were evaluated. Predictive factors for IOP reduction were analyzed using univariate and multivariate regression models. Patients in the success group had significantly higher baseline IOP (median: 28.0 vs. 23.0 mmHg; P = 0.016) and longer treatment times (median: 240 vs. 160 s; P = 0.001). Treatment duration range between 200 and 240 s achieved significantly higher intraocular pressure reduction rates (47.8 ± 17.4%) than durations under 140 s (23.1 ± 14.2%). Univariate analysis showed that baseline IOP and treatment duration were significant contributing factors in IOP reduction. Multivariable analysis further demonstrated that treatment duration over 200 s was the significant predictive factor for IOP reduction. Treatment duration settings were the most significant factor of IOP reduction rates in micropulse cyclophotocoagulation. Customized therapy according to the target IOP reduction rate can be applied with different treatment duration settings to achieve optimal outcomes.
{"title":"Comparison of the efficacy of micropulse diode laser transscleral cyclophotocoagulation using different energy protocols","authors":"Kuan-Yu Chen, Shirley H. L. Chang","doi":"10.4103/tjo.tjo-d-23-00129","DOIUrl":"https://doi.org/10.4103/tjo.tjo-d-23-00129","url":null,"abstract":"\u0000 \u0000 \u0000 This study aimed to explore the safety and efficacy of laser treatment settings of micropulse transscleral cyclophotocoagulation treatment in glaucoma patients and to evaluate the relationship between intraocular pressure (IOP) reduction and different treatment parameters.\u0000 \u0000 \u0000 \u0000 A total of 74 eyes in 64 glaucoma patients with IOP over 21 mmHg or under 20 mmHg with visual field progression who underwent micropulse transscleral cyclophotocoagulation treatment were included. Patients were divided into success and failure groups based on criteria of 20% IOP reduction rate. The predictive factors of IOP reduction between success and failure groups and the IOP reduction rates in the different treatment duration groups were evaluated. Predictive factors for IOP reduction were analyzed using univariate and multivariate regression models.\u0000 \u0000 \u0000 \u0000 Patients in the success group had significantly higher baseline IOP (median: 28.0 vs. 23.0 mmHg; P = 0.016) and longer treatment times (median: 240 vs. 160 s; P = 0.001). Treatment duration range between 200 and 240 s achieved significantly higher intraocular pressure reduction rates (47.8 ± 17.4%) than durations under 140 s (23.1 ± 14.2%). Univariate analysis showed that baseline IOP and treatment duration were significant contributing factors in IOP reduction. Multivariable analysis further demonstrated that treatment duration over 200 s was the significant predictive factor for IOP reduction.\u0000 \u0000 \u0000 \u0000 Treatment duration settings were the most significant factor of IOP reduction rates in micropulse cyclophotocoagulation. Customized therapy according to the target IOP reduction rate can be applied with different treatment duration settings to achieve optimal outcomes.\u0000","PeriodicalId":44978,"journal":{"name":"Taiwan Journal of Ophthalmology","volume":"45 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139450093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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