Pub Date : 2024-07-23DOI: 10.1097/icb.0000000000001644
Brian P. Hall, Joanne Thomas, Jiong Yan, Nieraj Jain
Chloroquine (CQ), primarily used in the management of malaria and autoimmune diseases, has long been known to cause retinal toxicity. However, modern literature with multimodal fundus imaging findings remains limited. This retrospective study explores presumed CQ retinopathy cases at a tertiary United States referral center with an emphasis on multimodal fundus imaging characteristics. Retrospective series of cases of presumed CQ toxicity seen at the Emory Eye Center between 2015-2022. Four males were identified with presumed CQ retinopathy, with median age of 57 years (range 50-59 years). CQ use occurred in malaria-endemic regions in each case, and the medication was self-administered in three cases. Optical coherence tomography consistently revealed outer band loss and varying degrees of foveal sparing. Fundus autofluorescence imaging demonstrated symmetric bull’s eye pattern of AF abnormality with hyperautofluorescence along the rim of diseased tissue. One case exhibited para-vascular hyperautofluorescence in the setting of repeated intravenous CQ exposure. Multimodal retinal imaging revealed distinct yet diverse patterns of degeneration not readily visible on clinical examination. More generally, these findings raise public health concerns regarding self-administration of CQ in malaria-endemic regions.
{"title":"Clinical Characteristics of Four Cases of Presumed Chloroquine Retinopathy","authors":"Brian P. Hall, Joanne Thomas, Jiong Yan, Nieraj Jain","doi":"10.1097/icb.0000000000001644","DOIUrl":"https://doi.org/10.1097/icb.0000000000001644","url":null,"abstract":"\u0000 \u0000 Chloroquine (CQ), primarily used in the management of malaria and autoimmune diseases, has long been known to cause retinal toxicity. However, modern literature with multimodal fundus imaging findings remains limited. This retrospective study explores presumed CQ retinopathy cases at a tertiary United States referral center with an emphasis on multimodal fundus imaging characteristics.\u0000 \u0000 \u0000 \u0000 Retrospective series of cases of presumed CQ toxicity seen at the Emory Eye Center between 2015-2022.\u0000 \u0000 \u0000 \u0000 Four males were identified with presumed CQ retinopathy, with median age of 57 years (range 50-59 years). CQ use occurred in malaria-endemic regions in each case, and the medication was self-administered in three cases. Optical coherence tomography consistently revealed outer band loss and varying degrees of foveal sparing. Fundus autofluorescence imaging demonstrated symmetric bull’s eye pattern of AF abnormality with hyperautofluorescence along the rim of diseased tissue. One case exhibited para-vascular hyperautofluorescence in the setting of repeated intravenous CQ exposure.\u0000 \u0000 \u0000 \u0000 Multimodal retinal imaging revealed distinct yet diverse patterns of degeneration not readily visible on clinical examination. More generally, these findings raise public health concerns regarding self-administration of CQ in malaria-endemic regions.\u0000","PeriodicalId":510632,"journal":{"name":"RETINAL Cases & Brief Reports","volume":"65 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141812835","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 : 2024-07-10DOI: 10.1097/icb.0000000000001626
Meghan J. Smith, Jennifer I. Lim, Felix Y Chau, Ann-Marie Lobo-Chan
To describe two patients with long-standing rheumatoid arthritis (RA) who developed cytomegalovirus (CMV) retinitis (CMVR) while taking tofacitinib. Retrospective case series. A 79-year-old woman with RA, treated with oral tofacitinib 11mg once daily, presented with blurred vision and pain in the right eye. Visual acuity (VA) was hand motion, anterior segment showed iritis and the intraocular pressure (IOP) was 35mmHg. Ophthalmoscopy revealed retinal hemorrhages and overlying vitreous hemorrhage. HIV serology was negative, serum CMV IgG was positive and aqueous polymerase chain reaction (PCR) was positive for CMV (802,000 IU/mL). An 82-year-old woman with a history of RA, treated with tofacitinib 11mg once daily, was referred for a white retinal lesion in the left eye. VA was 20/50, anterior segment was quiet and IOP was 23mmHg. Ophthalmoscopy revealed a yellow retinal lesion with ill-defined margins in the macula. She subsequently developed a new area of peripheral retinal whitening in the right eye. HIV serology was negative, serum CMV IgG was positive and aqueous PCR was positive for CMV (5,200,000 IU/mL). Diagnosis of CMVR in non-HIV individuals requires awareness of the risk of infectious retinitis in patients taking JAK inhibitors for the treatment of autoimmune disease.
{"title":"CMV retinitis in non-HIV immunocompromised individuals on tofacitinib for rheumatoid arthritis","authors":"Meghan J. Smith, Jennifer I. Lim, Felix Y Chau, Ann-Marie Lobo-Chan","doi":"10.1097/icb.0000000000001626","DOIUrl":"https://doi.org/10.1097/icb.0000000000001626","url":null,"abstract":"\u0000 \u0000 To describe two patients with long-standing rheumatoid arthritis (RA) who developed cytomegalovirus (CMV) retinitis (CMVR) while taking tofacitinib.\u0000 \u0000 \u0000 \u0000 Retrospective case series.\u0000 \u0000 \u0000 \u0000 A 79-year-old woman with RA, treated with oral tofacitinib 11mg once daily, presented with blurred vision and pain in the right eye. Visual acuity (VA) was hand motion, anterior segment showed iritis and the intraocular pressure (IOP) was 35mmHg. Ophthalmoscopy revealed retinal hemorrhages and overlying vitreous hemorrhage. HIV serology was negative, serum CMV IgG was positive and aqueous polymerase chain reaction (PCR) was positive for CMV (802,000 IU/mL). An 82-year-old woman with a history of RA, treated with tofacitinib 11mg once daily, was referred for a white retinal lesion in the left eye. VA was 20/50, anterior segment was quiet and IOP was 23mmHg. Ophthalmoscopy revealed a yellow retinal lesion with ill-defined margins in the macula. She subsequently developed a new area of peripheral retinal whitening in the right eye. HIV serology was negative, serum CMV IgG was positive and aqueous PCR was positive for CMV (5,200,000 IU/mL).\u0000 \u0000 \u0000 \u0000 Diagnosis of CMVR in non-HIV individuals requires awareness of the risk of infectious retinitis in patients taking JAK inhibitors for the treatment of autoimmune disease.\u0000","PeriodicalId":510632,"journal":{"name":"RETINAL Cases & Brief Reports","volume":"20 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141661395","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 : 2024-07-10DOI: 10.1097/icb.0000000000001627
A. Majumder, P. Majumder
To report a case of allergic reaction to a tuberculin skin test that incited a panophthalmitis-like reaction with exudative retinal detachment. Retrospective Chart Review A 38-year-old woman presented with sudden onset ocular pain, redness, and protrusion of both eyes following a tuberculin skin test, part of the investigative process for her recent high-grade fever. On presentation to us, her visual acuity was limited to the perception of light in both eyes. Ophthalmic examination revealed fibrinous anterior chamber reaction, sluggish pupils, diffuse conjunctival chemosis, limited ocular movement in all gazes, and inadequate eyelid closure due to proptosis in both eyes. Fundus examination of both eyes showed grade 3+ vitritis and exudative bullous retinal detachment. All other laboratory investigations were within normal limits. The patient demonstrated a remarkable response to pulse corticosteroid therapy, with significant alleviation of ocular symptoms and partial resolution of inflammation. Further treatment was initiated with oral corticosteroids and mycophenolate mofetil, followed by the addition of cyclosporine, which facilitated complete resolution of the exudative retinal detachment with restoration her BCVA to 6/9. This case underscores the importance of ophthalmologists recognizing that acute allergic reactions secondary to tuberculin skin tests can, on rare occasions, present as uveitis, and highlights the need for appropriate management of such conditions.
{"title":"When Tuberculin Stings: A Case of Panophthalmitis Following Tuberculin Skin Test","authors":"A. Majumder, P. Majumder","doi":"10.1097/icb.0000000000001627","DOIUrl":"https://doi.org/10.1097/icb.0000000000001627","url":null,"abstract":"\u0000 \u0000 To report a case of allergic reaction to a tuberculin skin test that incited a panophthalmitis-like reaction with exudative retinal detachment.\u0000 \u0000 \u0000 \u0000 Retrospective Chart Review\u0000 \u0000 \u0000 \u0000 A 38-year-old woman presented with sudden onset ocular pain, redness, and protrusion of both eyes following a tuberculin skin test, part of the investigative process for her recent high-grade fever. On presentation to us, her visual acuity was limited to the perception of light in both eyes. Ophthalmic examination revealed fibrinous anterior chamber reaction, sluggish pupils, diffuse conjunctival chemosis, limited ocular movement in all gazes, and inadequate eyelid closure due to proptosis in both eyes. Fundus examination of both eyes showed grade 3+ vitritis and exudative bullous retinal detachment. All other laboratory investigations were within normal limits. The patient demonstrated a remarkable response to pulse corticosteroid therapy, with significant alleviation of ocular symptoms and partial resolution of inflammation. Further treatment was initiated with oral corticosteroids and mycophenolate mofetil, followed by the addition of cyclosporine, which facilitated complete resolution of the exudative retinal detachment with restoration her BCVA to 6/9.\u0000 \u0000 \u0000 \u0000 This case underscores the importance of ophthalmologists recognizing that acute allergic reactions secondary to tuberculin skin tests can, on rare occasions, present as uveitis, and highlights the need for appropriate management of such conditions.\u0000","PeriodicalId":510632,"journal":{"name":"RETINAL Cases & Brief Reports","volume":"11 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141658810","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 : 2024-07-10DOI: 10.1097/icb.0000000000001628
Victoria A. Marks, Vijitha S. Vempuluru, Carol L. Shields
We report a rare case of systemic Hodgkin lymphoma with presumed intraocular involvement that resolved following systemic chemotherapy. Observational case report. A 32-year-old woman with known stage II Hodgkin lymphoma presented with 3 months of photopsia and decreased vision in the left eye. Fundus examination demonstrated vitreous cells, more than 100 yellow choroidal infiltrates involving the entire fundus, and retinal pigment epithelial defects in the macular region of the left eye. Ultrasonography showed chorioretinal thickening and optical coherence tomography demonstrated vitreous opacities with outer retinal atrophy, irregular retinal pigment epithelial thickening, and hyper-transmission defects. A diagnosis of Hodgkin lymphoma with vitreoretinal involvement was considered. Fine needle aspiration biopsy was considered, but the patient preferred deferral as she was already on cycle 3 of systemic chemotherapy (doxorubicin, bleomycin, vinblastine, dacarbazine). Following the fourth cycle of systemic treatment, the vitreous cells and choroidal lesions resolved. This case details a rare presentation of systemic Hodgkin lymphoma with presumed vitreoretinal and choroidal involvement that responded to anti-Hodgkin lymphoma chemotherapy.
{"title":"Systemic Hodgkin Lymphoma with Presumed Intraocular Involvement","authors":"Victoria A. Marks, Vijitha S. Vempuluru, Carol L. Shields","doi":"10.1097/icb.0000000000001628","DOIUrl":"https://doi.org/10.1097/icb.0000000000001628","url":null,"abstract":"\u0000 \u0000 We report a rare case of systemic Hodgkin lymphoma with presumed intraocular involvement that resolved following systemic chemotherapy.\u0000 \u0000 \u0000 \u0000 Observational case report.\u0000 \u0000 \u0000 \u0000 A 32-year-old woman with known stage II Hodgkin lymphoma presented with 3 months of photopsia and decreased vision in the left eye. Fundus examination demonstrated vitreous cells, more than 100 yellow choroidal infiltrates involving the entire fundus, and retinal pigment epithelial defects in the macular region of the left eye. Ultrasonography showed chorioretinal thickening and optical coherence tomography demonstrated vitreous opacities with outer retinal atrophy, irregular retinal pigment epithelial thickening, and hyper-transmission defects. A diagnosis of Hodgkin lymphoma with vitreoretinal involvement was considered. Fine needle aspiration biopsy was considered, but the patient preferred deferral as she was already on cycle 3 of systemic chemotherapy (doxorubicin, bleomycin, vinblastine, dacarbazine). Following the fourth cycle of systemic treatment, the vitreous cells and choroidal lesions resolved.\u0000 \u0000 \u0000 \u0000 This case details a rare presentation of systemic Hodgkin lymphoma with presumed vitreoretinal and choroidal involvement that responded to anti-Hodgkin lymphoma chemotherapy.\u0000","PeriodicalId":510632,"journal":{"name":"RETINAL Cases & Brief Reports","volume":"31 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141658659","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 : 2024-07-10DOI: 10.1097/icb.0000000000001629
Leonardo Bottazzi, A. Servillo, I. Zucchiatti, R. Sacconi, L. Querques, Francesco Bandello, Giuseppe Querques
To report a case series of exudation in non-neovascular geographic atrophy (GA), which fluctuated and spontaneously almost resolved during the follow-up. A retrospective study was designed to include consecutive cases with geographic atrophy (GA) secondary to age-related macular degeneration (AMD) associated with intraretinal fluid (IRF) but without macular neovascularization (MNV). Three eyes of 2 patients (one male, one female) were enrolled. Spectral domain optical coherence tomography (SD-OCT) and angiographies (OCT angiography and/or dye angiographies) were performed to confirm diagnosis of IRF and the absence of MNV. At baseline best-corrected visual acuity (BCVA) was between 20/50 and 20/36. SD-OCT displayed IRF in the inner and outer retinal layers with an increased central macular thickness. OCT-A and dye angiographies did not show any abnormal neovascular network. Of note, fluorescein angiography showed a leakage in correspondence of the intraretinal cysts, differently from the degenerative pseudocysts. After one month of follow-up, BCVA remained stable, while the IRF spontaneously almost resolved in all cases. To our knowledge, this is the first report of a fluctuating exudation in non-neovascular GA. Future studies are required to better define this potential novel clinical phenotype.
{"title":"FLUCTUATING EXUDATION IN NON-NEOVASCULAR GEOGRAPHIC ATROPHY","authors":"Leonardo Bottazzi, A. Servillo, I. Zucchiatti, R. Sacconi, L. Querques, Francesco Bandello, Giuseppe Querques","doi":"10.1097/icb.0000000000001629","DOIUrl":"https://doi.org/10.1097/icb.0000000000001629","url":null,"abstract":"\u0000 \u0000 To report a case series of exudation in non-neovascular geographic atrophy (GA), which fluctuated and spontaneously almost resolved during the follow-up.\u0000 \u0000 \u0000 \u0000 A retrospective study was designed to include consecutive cases with geographic atrophy (GA) secondary to age-related macular degeneration (AMD) associated with intraretinal fluid (IRF) but without macular neovascularization (MNV). Three eyes of 2 patients (one male, one female) were enrolled. Spectral domain optical coherence tomography (SD-OCT) and angiographies (OCT angiography and/or dye angiographies) were performed to confirm diagnosis of IRF and the absence of MNV.\u0000 \u0000 \u0000 \u0000 At baseline best-corrected visual acuity (BCVA) was between 20/50 and 20/36. SD-OCT displayed IRF in the inner and outer retinal layers with an increased central macular thickness. OCT-A and dye angiographies did not show any abnormal neovascular network. Of note, fluorescein angiography showed a leakage in correspondence of the intraretinal cysts, differently from the degenerative pseudocysts. After one month of follow-up, BCVA remained stable, while the IRF spontaneously almost resolved in all cases.\u0000 \u0000 \u0000 \u0000 To our knowledge, this is the first report of a fluctuating exudation in non-neovascular GA. Future studies are required to better define this potential novel clinical phenotype.\u0000","PeriodicalId":510632,"journal":{"name":"RETINAL Cases & Brief Reports","volume":"72 16","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141662824","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 : 2024-07-03DOI: 10.1097/icb.0000000000001622
Simatul Rashid, Ryan S. Meshkin, Bertan Cakir, S. Hoyek, Elizabeth J. Rossin, D. Eliott, Nimesh A. Patel
Central retinal vein occlusion (CRVO) and rhegmatogenous retinal detachment (RRD) are two distinct retinal conditions that typically affect older patient populations with comorbidities or predisposing risk factors. This case report presents unusual co-occurrences of CRVO and RRD in two young, healthy adult patients and proposes potential etiological factors contributing to the complex presentations. Retrospective case-series of two young, healthy males with no history of systemic diseases who presented with concurrent CRVO and RRD. The first case was a 28-year-old male construction worker, who presented with acute, painless vision loss and extensive intra-retinal hemorrhages in the right eye, tortuous dilated retinal veins, significant macular edema, optic disc edema, and a macula sparing RRD. Treatment included intravitreal injections of bevacizumab followed by RRD repair with scleral buckle, cryotherapy, external drainage, and later a pneumatic retinopexy. His visual acuity had improved from 20/200 to 20/30 in the right eye. The second case was a 19-year-old male patient who also presented with acute painless vision loss in the left eye and was diagnosed with CRVO and concomitant RD. Treatment included intravitreal bevacizumab injections, oral prednisone trial, and surgical repair with scleral buckle, vitrectomy, and silicone oil insertion. Workup for inflammatory, infectious, and hypercoagulable conditions was negative in both cases. Concurrent CRVO and RRD can occur in young healthy patients. Prompt surgery is indicated and treatment with anti-VEGF can be initiated in the perioperative period without complications.
{"title":"Concurrent Central Retinal Vein Occlusion and Rhegmatogenous Retinal Detachment in Two Young Healthy Patients","authors":"Simatul Rashid, Ryan S. Meshkin, Bertan Cakir, S. Hoyek, Elizabeth J. Rossin, D. Eliott, Nimesh A. Patel","doi":"10.1097/icb.0000000000001622","DOIUrl":"https://doi.org/10.1097/icb.0000000000001622","url":null,"abstract":"\u0000 \u0000 Central retinal vein occlusion (CRVO) and rhegmatogenous retinal detachment (RRD) are two distinct retinal conditions that typically affect older patient populations with comorbidities or predisposing risk factors. This case report presents unusual co-occurrences of CRVO and RRD in two young, healthy adult patients and proposes potential etiological factors contributing to the complex presentations.\u0000 \u0000 \u0000 \u0000 Retrospective case-series of two young, healthy males with no history of systemic diseases who presented with concurrent CRVO and RRD.\u0000 \u0000 \u0000 \u0000 The first case was a 28-year-old male construction worker, who presented with acute, painless vision loss and extensive intra-retinal hemorrhages in the right eye, tortuous dilated retinal veins, significant macular edema, optic disc edema, and a macula sparing RRD. Treatment included intravitreal injections of bevacizumab followed by RRD repair with scleral buckle, cryotherapy, external drainage, and later a pneumatic retinopexy. His visual acuity had improved from 20/200 to 20/30 in the right eye. The second case was a 19-year-old male patient who also presented with acute painless vision loss in the left eye and was diagnosed with CRVO and concomitant RD. Treatment included intravitreal bevacizumab injections, oral prednisone trial, and surgical repair with scleral buckle, vitrectomy, and silicone oil insertion. Workup for inflammatory, infectious, and hypercoagulable conditions was negative in both cases.\u0000 \u0000 \u0000 \u0000 Concurrent CRVO and RRD can occur in young healthy patients. Prompt surgery is indicated and treatment with anti-VEGF can be initiated in the perioperative period without complications.\u0000","PeriodicalId":510632,"journal":{"name":"RETINAL Cases & Brief Reports","volume":"117 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141682073","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 : 2024-07-03DOI: 10.1097/icb.0000000000001625
J. G. Alexander, G. A. Samico, Lucas Zago Ribeiro, H. M. Vasconcelos Júnior
To describe multimodal imaging findings in a rare case of didanosine-related retinopathy. Case report. 55-year-old male patient presenting peripheral visual loss and nyctalopia for the last 8 years in both eyes. Previous medical history of HIV, and use of didanosine for almost 10 years. Fundus examination, autofluorescence, and optical coherence tomography showed bilateral symmetrical peripheral chorioretinal atrophy, sparing the posterior pole. Genetic testing was performed to exclude inherited retinopathies. DDI-related chorioretinal toxicity is a rare disease, with few reports in the literature. Multimodal imaging and genetic testing were essential for precise diagnosis. The limitation of this report includes the late presentation of the patient to our clinic, making the evaluation difficult to determine early signs of toxicity and to determine the precise length of DDI treatment and whether or not the degeneration progressed shortly after cessation of the medication.
{"title":"MULTIMODAL IMAGING OF DIDANOSINE-RELATED RETINOPATHY","authors":"J. G. Alexander, G. A. Samico, Lucas Zago Ribeiro, H. M. Vasconcelos Júnior","doi":"10.1097/icb.0000000000001625","DOIUrl":"https://doi.org/10.1097/icb.0000000000001625","url":null,"abstract":"\u0000 \u0000 To describe multimodal imaging findings in a rare case of didanosine-related retinopathy.\u0000 \u0000 \u0000 \u0000 Case report.\u0000 \u0000 \u0000 \u0000 55-year-old male patient presenting peripheral visual loss and nyctalopia for the last 8 years in both eyes. Previous medical history of HIV, and use of didanosine for almost 10 years. Fundus examination, autofluorescence, and optical coherence tomography showed bilateral symmetrical peripheral chorioretinal atrophy, sparing the posterior pole. Genetic testing was performed to exclude inherited retinopathies.\u0000 \u0000 \u0000 \u0000 DDI-related chorioretinal toxicity is a rare disease, with few reports in the literature. Multimodal imaging and genetic testing were essential for precise diagnosis. The limitation of this report includes the late presentation of the patient to our clinic, making the evaluation difficult to determine early signs of toxicity and to determine the precise length of DDI treatment and whether or not the degeneration progressed shortly after cessation of the medication.\u0000","PeriodicalId":510632,"journal":{"name":"RETINAL Cases & Brief Reports","volume":"91 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141683640","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 : 2024-07-03DOI: 10.1097/icb.0000000000001621
A. AlBloushi, Sarah Mohammed Almuwarraee, Fadwa Al Adel
In this article, we reported a case of secondary multiple evanescent white dot syndrome (MEWDS) that occurred in a patient with optic disc coloboma A case report A 23-year-old otherwise healthy man experienced decreased vision and photopsia in the right eye for one month. He reported poor visual acuity in the left eye because of refractive amblyopia. His best-corrected visual acuity was 20/100 in the right eye and 20/80 in the left eye. An examination of the right eye showed that the patient had optic disc coloboma. The results of multimodal imaging indicated MEWDS in the right eye. The patient was observed for four weeks. The MEWDS lesions improved, as determined by multimodal imaging, and his best-corrected visual acuity improved to 20/20 in the right eye. Reports of secondary MEWDS have increased, and optic disc coloboma may trigger a MEWDS-like reaction.
{"title":"Optic Disc Coloboma May Trigger Multiple Evanescent White Dot Syndrome: Expanding the Clinical Spectrum","authors":"A. AlBloushi, Sarah Mohammed Almuwarraee, Fadwa Al Adel","doi":"10.1097/icb.0000000000001621","DOIUrl":"https://doi.org/10.1097/icb.0000000000001621","url":null,"abstract":"\u0000 \u0000 In this article, we reported a case of secondary multiple evanescent white dot syndrome (MEWDS) that occurred in a patient with optic disc coloboma\u0000 \u0000 \u0000 \u0000 A case report\u0000 \u0000 \u0000 \u0000 A 23-year-old otherwise healthy man experienced decreased vision and photopsia in the right eye for one month. He reported poor visual acuity in the left eye because of refractive amblyopia. His best-corrected visual acuity was 20/100 in the right eye and 20/80 in the left eye. An examination of the right eye showed that the patient had optic disc coloboma. The results of multimodal imaging indicated MEWDS in the right eye. The patient was observed for four weeks. The MEWDS lesions improved, as determined by multimodal imaging, and his best-corrected visual acuity improved to 20/20 in the right eye.\u0000 \u0000 \u0000 \u0000 Reports of secondary MEWDS have increased, and optic disc coloboma may trigger a MEWDS-like reaction.\u0000","PeriodicalId":510632,"journal":{"name":"RETINAL Cases & Brief Reports","volume":"62 s284","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141683131","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 : 2024-07-03DOI: 10.1097/icb.0000000000001619
Kipp R Morgan, Paige J Richards, Jonathan S Chang
To present a patient with neovascular AMD treated systemically with the biosimilar bevacizumab-awwb (Mvasi) with superior SRF resolution when compared to continuous and repeated intravitreal treatments. Retrospective single case report. After 3 years of monthly aflibercept treatment for nAMD, the patient had persistent subretinal fluid (SRF). Systemic bevacizumab-awwb (Mvasi) infusions were initiated by her oncologist for ovarian cancer and SRF resolved for the first time. After one additional aflibercept injection, and continued bevacizubam-awwb infusions for her cancer, SRF did not recur. Thirteen weeks later, at final follow-up before the patient passed away, the macula remained dry and no additonal intravitreal treatment was given. When systemic anti-VEGF biosimilar therapy was administered, there was improved anatomy and prolonged duration of effect compared to the intravitreal therapy alone. Adverse systemic effects limit the routine use of systemic anti-VEGF therapy for retinal disease. However if a patient requires systemic anti-VEGF or anti-VEGF biosimilar therapy for malignancy, it may also benefit retinal disease leading to benefits in quality of life and fewer office visits.
{"title":"Systemic anti-VEGF biosimilar therapy associated with improved macular anatomy and duration of effect in a patient with nearly recalcitrant neovascular age-related macular degeneration","authors":"Kipp R Morgan, Paige J Richards, Jonathan S Chang","doi":"10.1097/icb.0000000000001619","DOIUrl":"https://doi.org/10.1097/icb.0000000000001619","url":null,"abstract":"\u0000 \u0000 To present a patient with neovascular AMD treated systemically with the biosimilar bevacizumab-awwb (Mvasi) with superior SRF resolution when compared to continuous and repeated intravitreal treatments.\u0000 \u0000 \u0000 \u0000 Retrospective single case report.\u0000 \u0000 \u0000 \u0000 After 3 years of monthly aflibercept treatment for nAMD, the patient had persistent subretinal fluid (SRF). Systemic bevacizumab-awwb (Mvasi) infusions were initiated by her oncologist for ovarian cancer and SRF resolved for the first time. After one additional aflibercept injection, and continued bevacizubam-awwb infusions for her cancer, SRF did not recur. Thirteen weeks later, at final follow-up before the patient passed away, the macula remained dry and no additonal intravitreal treatment was given.\u0000 \u0000 \u0000 \u0000 When systemic anti-VEGF biosimilar therapy was administered, there was improved anatomy and prolonged duration of effect compared to the intravitreal therapy alone. Adverse systemic effects limit the routine use of systemic anti-VEGF therapy for retinal disease. However if a patient requires systemic anti-VEGF or anti-VEGF biosimilar therapy for malignancy, it may also benefit retinal disease leading to benefits in quality of life and fewer office visits.\u0000","PeriodicalId":510632,"journal":{"name":"RETINAL Cases & Brief Reports","volume":"171 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141682055","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 : 2024-07-03DOI: 10.1097/icb.0000000000001620
Alessandro Feo, Neda Abraham, Mostafa Mafi, David Sarraf
To describe a case of recalcitrant bilateral peripapillary pachychoroid syndrome (PPS) treated with high-dose (HD) intravitreal aflibercept injections. Medical and imaging records were retrospectively evaluated. Multimodal imaging included ultra-widefield indocyanine green and fluorescein angiography and fundus autofluorescence. Tracked optical coherence tomography (OCT) B scans were reviewed to assess intra- (IRF) and subretinal fluid (SRF), and to measure choroidal thickness (CT). Macular neovascularization was excluded with OCT angiography. A 75-year-old man with bilateral PPS and severe peripapillary and macular edema underwent multiple sessions of photodynamic therapy, intravitreal aflibercept injections, and corticosteroid eye drop application with minimal improvement of the fluid. After two monthly intravitreal HD aflibercept injections, the peripapillary and macular fluid was almost completely resolved with commensurate choroidal thickness reduction and significant visual gain in each eye. High-dose intravitreal aflibercept therapy may lead to remarkable anatomical and functional improvement in eyes with recalcitrant PPS.
描述一例采用高剂量（HD）玻璃体内注射阿弗利贝赛普治疗顽固性双侧毛细血管周围丘疹综合征（PPS）的病例。 对医疗和成像记录进行了回顾性评估。多模态成像包括超宽场吲哚菁绿和荧光素血管造影以及眼底自动荧光。对跟踪光学相干断层扫描（OCT）B扫描进行了审查，以评估视网膜内积液（IRF）和视网膜下积液（SRF），并测量脉络膜厚度（CT）。通过 OCT 血管造影排除了黄斑新生血管。 一名 75 岁的男性患者患有双侧 PPS 以及严重的毛细血管周围水肿和黄斑水肿，他接受了多次光动力疗法、玻璃体内阿弗利百普注射以及皮质类固醇滴眼液治疗，但积液改善甚微。在每月进行两次玻璃体内高剂量阿弗利百普注射后，毛细血管周围和黄斑水肿几乎完全消退，脉络膜厚度也相应减小，每只眼睛的视力都有显著提高。 高剂量玻璃体内阿弗利百普疗法可使顽固性PPS眼球的解剖和功能得到显著改善。
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