Retinal Cases and Brief Reports最新文献

Purpose: To evaluate the safety and potential efficacy of a dexamethasone implant (Ozurdex) administered prior to proton radiation. in patients with tumor-associated exudative retinal detachments.

Methods: This was an investigator-initiated pilot study. Patients diagnosed with choroidal melanomas ≤10 mm thick, detachments spanning > 2 clock hours, and visual acuity of 20/100 or better were randomized 1:1 to receive the dexamethasone implant or no treatment prior to proton radiation. Patients, masked to treatment completed during tumor localization surgery, were evaluated at 6, 14, 28 and 54 weeks after surgery. Efficacy endpoints included retinal detachment resolution, visual acuity preservation, and incidence of neovascular complications. Adverse events associated with the implant were monitored to ensure safety.

Results: Baseline characteristics were similar between the dexamethasone (n=5) and no treatment (n=5) groups; median retinal detachment size was 4 clock hours at presentation in both groups. Four patients (80%) in each group had baseline visual acuity of 20/40 or better. At 12 months, the proportion of patients with resolution of retinal detachment was 40% in the dexamethasone group and 80% in the no treatment group; 60% in the dexamethasone group and 20% in the untreated group had visual acuity of 20/200 or worse. Known adverse effects of dexamethasone, cataract progression and elevated intraocular pressure, occurred in two patients and one patient, respectively, who received dexamethasone.

Conclusions: Improved clinical outcomes were not observed in patients receiving the dexamethasone implant prior to proton radiation. No new safety concerns were identified with the use of dexamethasone in this cohort.

Purpose: To describe an unusual case of cytomegalovirus (CMV) retinitis presenting with significant vitreous inflammation in a lymphoma patient following combined autologous transplantation and chimeric antigen receptor (CAR) T cell therapy.

Methods: This is a retrospective case report. The case was evaluated with multimodal ophthalmic imaging, and the diagnosis was established based on cytological and virological tests.

Results: A 54-year-old male with primary diffuse large B cell lymphoma of the cervical lymph nodes experienced monocular visual loss one month after combined autologous hematopoietic stem cell transplantation and CAR-T cell therapy. Initial examination revealed significant vitreous inflammation, mimicking intraocular lymphoma relapse. After the removal of dusty vitreous in the subsequent diagnostic vitrectomy, extensive retinal vascular occlusion emerged as the key feature with minimal retinal lesions. Cytological and virological studies of the vitreous sample excluded intraocular lymphoma and confirmed CMV retinitis.

Conclusion: This case highlights prominent vitritis as an atypical presentation of CMV retinitis. This report broadens the recognized clinical spectrum of CMV retinitis, underscoring the necessity of considering CMV retinitis in the differential diagnosis of vitreous inflammation, particularly in lymphoma patients with complex immune statuses.

Purpose: To increase our understanding of TUBB4B-associated autosomal dominant retinal degenerations through in-depth retinal phenotyping.

Methods: Two patients with pathogenic heterozygous variants in TUBB4B underwent a comprehensive ophthalmic exam, multimodal imaging with spectral domain optical coherence tomography (SD-OCT), ultra-widefield fundus imaging and short-wavelength (SW) and near infrared (NIR) fundus autofluorescence (FAF). Kinetic and chromatic dark- and light-adapted perimetry co-localized to the SD-OCT scans was performed in the older patient.

Results: A 4 year old, high hyperope (+7D) boy sensorineural hearing loss (SNHL) since one year of age presented with surface elevation of the optic nerves concerning for papilledema. Visual acuities were 20/50 and 20/60 for the right and left eye, respectively. Evaluation revealed optic disc drusen, low-grade foveal hypoplasia and a retina-wide photoreceptor degeneration, most severe in the pericentral retinal sparing of the foveal center. A 43 year-old ∼6D myope woman with a 10-year-history of subtle visual field loss presented with normal visual acuities and generalized constriction of her kinetic fields. There as a retina-wide degeneration with a severe pericentral component encircled a normally laminated central island of normal rod- and cone photoreceptor function by chromatic perimetry. She reported no hearing loss. Genetic testing revealed heterozygous pathogenic variants in TUBB4B (c.1171C>T in the child, c.1168C>T variant in the adult patient).

Conclusions: We find in TUBB4B-associated retinal degeneration a predilection of disease to the pericentral retina with relative central sparing. The findings support a spectrum of severity within a recurring retinal phenotype that reconciles apparent phenotypic variability reported for this condition.

Purpose: To evaluate the role of adjunctive intravitreal moxifloxacin and ranibizumab in the management of recalcitrant and treatment-naïve cases of intraocular tuberculoma.

Methods: The study included 10 eyes of 9 patients diagnosed with intraocular tuberculoma between June 2022 and March 2025 at a tertiary eye care centre in India. .All patients received systemic therapy and biweekly intravitreal injections of moxifloxacin (500 µg/0.1 mL) and ranibizumab (0.5 mg/0.05 mL) until clinical and anatomical regression of the tuberculoma. Patients were stratified into two groups: Group A (recalcitrant cases) and Group B (treatment-naïve cases).Data on imaging features, number of injections, and visual acuity outcomes were analysed.

Results: Group A cases (n=3) had peripheral or ciliary body granulomas and received a 9-month ethambutol-sparing anti-tubercular treatment (ATT) regimen along with local therapy. Two eyes achieved a final visual acuity of 6/6, while one developed cataract with secondary angle closure glaucoma. Group B(n=7) included 4 macular granulomas and 3 cases with panuveitis and peripheral lesions. The three macular cases required fewer than three injections, achieving 6/6 visual outcomes. Two cases experienced reactivation and responded well to repeat local and systemic therapy.

Conclusion: Adjunctive intravitreal moxifloxacin and ranibizumab, when combined with systemic ATT and corticosteroids, appears to be a valuable therapeutic option in the management of intraocular tuberculoma, especially in cases with macular involvement. Tailored local therapy based on clinical phenotype may enhance lesion control and reduce systemic treatment duration.

Purpose: To report a case of asymptomatic grade III lipemia retinalis in the setting of pegylated asparaginase chemotherapy with concomitant glucocorticoid treatment which preceded an episode of acute pancreatitis.

Methods: Case Report.

Results: A 31-year-old male with acute lymphoblastic leukemia developed lipemia retinalis (triglycerides 1907 mg/dL) during consolidation therapy with pegylated asparaginase and glucocorticoids. Discontinuation of asparaginase and initiation of fenofibrate led to complete resolution of retinal findings and normalization of triglycerides. A month later, he developed acute pancreatitis (lipase 660 U/L) which resolved with intensive care management. He remains in remission with stable ocular findings.

Conclusion: Lipemia retinalis may serve as an early ophthalmic marker of chemotherapy-induced hypertriglyceridemia, particularly in the setting of combined glucocorticoid and asparaginase therapy. Prompt recognition is critical, as it can precede life-threatening complications such as acute pancreatitis and guide timely modifications in treatment.

Purpose: To present a case of late-stage group B streptococcus endogenous endophthalmitis in a patient that developed subretinal abscesses in both eyes.

Methods: Blood cultures were positive for group B streptococcus. Echography was done on several occasions and echogenic features of the case are described.

Results: An 80 year old woman with a significant medical history presented with visual acuity of no light perception in both eyes. Bedside examination showed hypopyon and anterior chamber cells. Echography identified subretinal abscesses in both eyes. She underwent anterior chamber paracentesis of both eyes and intravitreal injections of vancomycin (1mg/0.1ml) and ceftazidime (2.25mg/0.1ml). The patient expired 3 days after treatment.

Conclusion: A patient with group B streptococcus-related endogenous endophthalmitis and subretinal abscesses presented with poor visual acuity. B-scan was useful in identifying the subretinal abscesses in both eyes.

Purpose: To report fundus autofluorescence (FAF) characteristics in ophthalmic artery occlusion.

Methods: A 30-year-old male presented with complaints of sudden diminution of vision in the right eye following nasal polypectomy. The patient was evaluated and follow-up of the patient was done, including Optical coherence tomography (OCT), Fundus fluorescein angiography (FFA), Indo-cyanine green angiography (ICGA) and Fundus autofluorescence (FAF).

Result: We describe a case of ophthalmic artery occlusion where we noted hyperautofluorescent whitening of the retinal arterioles.

Conclusion: Hyperautofluorescent arterioles on FAF in retinal arterial occlusion is not yet described and sheds light on the possible pathophysiology of the disease mechanism.

Purpose: To discuss the case of an 82-year-old man with high myopia who developed a full-thickness macular hole (FTMH) following the spontaneous resolution of a central bouquet hemorrhage (CBH) associated with a lacquer crack.

Methods: The patient initially presented with a central scotoma in the right eye, with optical coherence tomography (OCT) showing the presence of CBH. The patient was closely monitored with noninvasive retinal imaging.

Results: Over five months, the CBH gradually reabsorbed, yet vertical hyperreflective lines and disruption of the ellipsoid zone persisted in the foveal area on follow-up OCT scans. Approximately three years after the reabsorption of the hemorrhage, the patient developed a FTMH, despite OCT scans showing no significant vitreomacular traction. The FTMH was treated with vitrectomy and gas tamponade injection, resulting in persistent MH after two vitreoretinal surgeries.

Conclusions: We hypothesize that Müller cell dysfunction, induced by the CBH, may have played a crucial role in the central cleavage that led to the FTMH formation. Given the prolonged interval between the CBH and FTMH development, this case underscores the need for further longitudinal studies to investigate the long-term outcomes of CBHs and the possible association with FTMH formation.

Purpose: To report a case of intrascleral crystal deposition in a patient with genetically confirmed Bietti Crystalline Dystrophy (BCD).

Methods: Case report of a 51-year-old Asian male with high myopia, nyctalopia since early adulthood and progressive visual decline. Clinical examination, fundus photography, infrared reflectance, spectral-domain OCT, and ultra-widefield swept-source (SS) OCT were performed. Genetic testing was performed to evaluate for pathogenic mutations in CYP4V2 .

Results: Pseudocolor fundus photography revealed yellow-white crystalline deposits primarily in the posterior pole with poor visualization of crystals more peripherally. Cross-sectional OCT localized hyperreflective deposits predominantly at the retinal pigment epithelium-Bruch's membrane complex, with additional foci in the outer and inner retina, accompanied by chorioretinal atrophy. Intrascleral crystals were also identified on spectral domain OCT. Ultra-widefield OCT extended the assessment beyond the vascular arcades, revealing peripheral zones of atrophy and scattered crystals not visible on standard field scans.

Conclusion: Intrascleral crystal distribution may aid in broadening the phenotypic spectrum of BCD, supporting more accurate diagnosis and contributing to the understanding of its pathophysiology. UWF and multimodal imaging provide complementary insights into BCD extent and crystal localization. Infrared reflectance outperforms pseudocolor photography for crystal detection, while UWF-OCT expands structural evaluation into the periphery, potentially improving monitoring strategies.

Purpose: To describe the occurrence of methotrexate (MTX) bubbles following serial intravitreal injections in silicone oil (SO)-filled eyes undergoing repair for retinal detachment (RD) and to evaluate outcomes.

Methods: In this retrospective cohort study, nine eyes of nine patients received pars plana vitrectomy (PPV) with SO tamponade and intravitreal MTX injection during surgery and was scheduled for postoperative series per GUARD protocol. MTX bubbles were identified by dilated fundus examination and ultra-widefield imaging. Relevant clinical and imaging parameters were collected.

Results: MTX bubbles were noted in six of nine eyes at a mean of 29.7 days (range: 7-58) following a mean of 3.8 injections (range: 2-6). Mean baseline BCVA was 1.5 logMAR (Snellen equivalent: 20/600), worsening to 1.7 logMAR (Snellen equivalent: CF) at bubble detection. Four of the six eyes with bubbles were eventually found to have emulsified SO. All eyes maintained anatomical reattachment without evidence of toxicity throughout a mean follow-up of 200.7 days (range: 105-241).

Conclusion: Early MTX bubble formation in SO-filled eyes likely reflects immiscibility of the aqueous drug solution and SO. Despite maintained reattachment, sequestration may alter drug distribution. Further research is needed to elucidate whether MTX is a risk factor for SO emulsification.