Retinal Cases and Brief Reports最新文献

Purpose: To describe the presentation, clinical course, and management of a patient with endogenous Aspergillus endophthalmitis complicated by florid retinal neovascularization.

Methods: A 32-year-old immunocompetent female developed a loss of vision in the right eye one week after receiving intravenous dextrose infusions in a local healthcare setting. Ocular examination revealed dense vitreous exudates for which an urgent vitrectomy was performed, with a presumptive diagnosis of endogenous endophthalmitis. Microbiological analysis of vitreous samples revealed Aspergillus flavus.

Results: Intravitreal and oral antifungals lead to the resolution of inflammation. However, the patient soon presented with large neovascular fronds involving the disc and posterior pole, rapidly progressing to tractional retinal detachment involving the macula. The intravitreal anti-vascular endothelial growth factor (anti-VEGF) ranibizumab was injected, followed by repeat vitrectomy and membrane dissection with gas tamponade. This resulted in a satisfactory anatomical outcome but poor visual gain due to submacular scarring.

Conclusions: Endogenous Aspergillus endophthalmitis warrants early diagnosis and aggressive management to avoid complications such as ocular neovascularization, retinal detachment, and phthisis bulbi. Retinal neovascularization in endogenous endophthalmitis is a rarely observed finding, but if present, it indicates severe ongoing inflammation or underlying retinal ischemia.

Purpose: Presenting a case of peripapillary retinoschisis in a patient with glaucomatous optic neuropathy that resolved after changing therapy from topical bimatoprost to timolol/dorzolamide.

Methods: A 70-year-old female who presented for a second opinion for peripapillary retinoschisis in the left eye.

Results: The patient's visual acuity was 20/25 and 20/30 in the right and left eyes, respectively. Dilated fundoscopy revealed posterior vitreous detachment (PVD) of the left eye, temporal cupping with a superotemporal notch of the left optic nerve, and bilateral macular drusen and pigmentary changes of the retinal pigment epithelium (RPE). Optical coherence tomography of the macula of the left eye showed a PVD, drusen, and peripapillary retinoschisis extending to and involving the fovea. Topical prostaglandin analogue eye drop was discontinued and replaced by dorzolamide/timolol. The peripapillary retinoschisis resolved after medication change over the following 48 months and has not recurred.

Conclusion: We present a case of peripapillary retinoschisis in a phakic patient that developed during treatment with a topical prostaglandin analogue. The schisis resolved after switching the prostaglandin analogue to a topical carbonic anhydrase inhibitor. We suggest that the prostaglandin may have had a role in initiating peripapillary retinoschisis associated with glaucomatous optic neuropathy and that carbonic anhydrase inhibitors are a potential treatment for this condition.

Purpose: To report a case of hypertensive chorioretinopathy complicated by anterior segment neovascularization, refractory to PRP.

Methods: Case Report and Literature Review.

Results: A 57-year-old male with poorly controlled systemic hypertension (exceeding 200/100 mmHg) experienced progressive visual acuity loss in the left eye over two years, with worsening in the last six months. Slit-Lamp examination revealed neovascularization of the angle in the left eye. Fundoscopy disclosed pale choroidal vessels temporal to the macula of both eyes, as well as additional retinochoroidal findings, such as telangiectatic vessels and a rounded shaped pale subretinal region on the right eye and combined vascular occlusion in the left inferior hemi-retina. Fluorescein and indocyanine angiography showed delayed choroidal perfusion and marked retinal ischemia, consistent with severe Hypertensive Chorioretinopathy. Initial treatment with monthly intravitreal anti-VEGF injections and PRP led to remission of anterior segment neovascularization, but recurrence occurred after two months, requiring additional anti-VEGF therapy.

Conclusion: The insufficient response to PRP in this case suggests that choroidal ischaemia may not be as amenable to laser treatment as ischaemic retina. Highlighting the importance of regular follow-up, this report underscores the need for comprehensive hypertensive control to prevent vision-threatening outcomes.

Purpose: We report a case of chronic myeloid leukemia (CML) diagnosed with ocular symptoms, in which dilated and tortuous retinal vessels were observed and monitored using ultra-widefield optical coherence tomography angiography (OCTA).

Methods: Case report of a 13-year-old girl who presented with bilateral photopsia and misty vision in the right eye.

Results: Fundus examination revealed dilated and tortuous retinal arteriovenous veins and yellowish-white exudative lesions along the retinal vessels in both eyes. A similar yellowish-white exudative lesion was observed in the macula of the right eye. A blood test showed a high white blood cell count of 588,400/µL. CML was diagnosed by hematological examination. After one month of treatment for CML, the patient was in complete hematologic remission, and the yellowish-white exudative lesions and dilatation and tortuosity of the retinal vessels improved. Ultra-widefield OCTA revealed dilated and tortuous retinal capillaries, as well as areas of non-perfusion at the initial visit; these findings improved after treatment.

Conclusion: Ultra-widefield OCTA can be used to non-invasively observe extensive retinal vascular and capillary changes in leukemic retinopathy over time.

Purpose: To report mul4modal imaging features in a case of an acute zonal occult outer re4nopathy (AZOOR) complicated with choroidal neovascularization during a follow-up of 18 months.

Methods: A 53-year-old woman was referred for bilateral decreased vision and photopsia.Fundus examina4on showed a circular posterior lesion with a far-peripheral lesion in the right eye and a single peripapillary lesion in the leb eye. The lesions were depigmented in both eyes, bordered by an interrupted yellow-orange line in a beaded appearance. The right eye featured macular atrophy with pigmentary migra4on.

Results: Clinical examina4on, autofluorescence and angiography confirmed the diagnosis of AZOOR. OCT-B scan and angiography OCT confirmed the presence of an ac4ve choroidal neovascularization in the right eye. Intravitreal an4-VEGF was injected in the right eye with a favorable response.

Conclusion: AZOOR is a rare re4nal en4ty with a poorly understood pathogenic mechanism. Choroidal neovascularization is an extremely rare complica4on in AZOOR. We describe mul4modal imaging features of AZOOR with choroidal neovascularization treated by an4-VEGF.

Purpose: To report a case of nonparaneoplastic autoimmune retinopathy in a 10-year-old female with chronic granulomatous disease (CGD) due to compound heterozygous mutations in NCF1.

Methods: The patient was evaluated at Columbia University Irving Medical Center using a comprehensive multimodal imaging protocol that included color fundus photography, short-wave autofluorescence (SW-AF), and spectral-domain optical coherence tomography (SD-OCT). Functional assessments were conducted using Goldmann visual fields and full-field electroretinography (ERG) were completed on-site and followed the ISCEV standard protocols to ensure consistent and reproducible measurements of photoreceptor activity.

Results: A 10-year-old female presented with decreased visual acuity, light sensitivity, and decreased color vision over the past 8 months with no improvement upon refraction. Upon detection of anti-retinal antibodies, treatment was initiated with stabilization and improvement of visual acuity and ERG responses with rituximab treatment. Whole genome sequencing revealed two mutations in NCF1 causing chronic granulomatous disease.

Conclusions: We present a case of autoimmune retinopathy in a CGD patient with compound heterozygous mutations in the NCF1 gene. This novel association may suggest that autoimmunity may be involved the development of the chorioretinal lesions seen in CGD patients. It also supports the use of rituximab in the management of autoimmune retinopathy.

Purpose: To elucidate the serial changes of near-infrared autofluorescence (NIA) imaging in an adolescent male with unilateral solar retinopathy.

Methods: This is a retrospective case report.

Results: The patient received a course of steroids, resulting in gradual improvement in visual acuity from 20/100 to 20/50 over 12 months. NIA findings showed that the hyperautofluorescent ring dissipated, leaving a hypoautofluorescent lesion. While OCT displayed persistent photoreceptor disruption, NIA revealed subtle changes over the follow-up period. The correlation between NIA findings and structural alterations in the photoreceptors and retinal pigment epithelium (RPE) was consistent across all imaging modalities.

Conclusion: NIA imaging serves as a non-invasive tool for monitoring disease progression and evaluating the status of photoreceptors and RPE in solar retinopathy. The changes observed in NIA suggest that early intervention may positively impact the visual prognosis and disease progression. NIA may be a valuable adjunctive tool in the comprehensive evaluation of solar retinopathy.

Purpose: To describe a case of retinal vasculitis associated with tislelizumab, an anti-PD-1 monoclonal antibody, in a patient with esophageal squamous cell carcinoma (ESCC).

Methods: Case report.

Results: A 60-year-old man undergoing treatment with tislelizumab for ESCC was referred for ophthalmologic evaluation. The patient was asymptomatic, but fundoscopic examination revealed peripheral intraretinal hemorrhages in the right eye. Fluorescein angiography revealed bilateral retinal vasculitis that was successfully controlled with systemic corticosteroids without discontinuation of tislelizumab. Four months after prednisone cessation, the patient relapsed with bilateral vision loss, and optical coherence tomography demonstrated subfoveal fluid in both eyes. Oral prednisone was reintroduced, leading to resolution of the subfoveal fluid, though visual acuity did not fully recover.

Conclusions: To our knowledge, retinal vasculitis associated with tislelizumab has not been previously reported. This case highlights the need for close ophthalmologic monitoring in patients receiving immune checkpoint inhibitors, as ocular immune-related adverse events can develop or recur at any point during treatment and even be asymptomatic.

Purpose: Benign Yellow Dot Maculopathy (BYDM) is a rare macular phenotype first described in 2017, characterized by yellow macular dots with preserved visual function. Although is considered a non-progressive condition, long-term follow-up data are limited. This case report presents a 12-year follow-up of a patient with BYDM, offering insights into its long-term stability over time.

Methods: The patient underwent comprehensive multimodal imaging, including optical coherence tomography (OCT), fundus autofluorescence (FAF), electro-oculography (EOG), and microperimetry. Genetic analysis via next-generation sequencing (NGS) was also performed to explore potential genetic associations.

Results: At baseline, FAF revealed characteristic hyperautofluorescent yellow dots in the macular and mid-peripheral retina, while OCT showed no structural abnormalities. EOG demonstrated subnormal responses, suggesting retinal pigment epithelium (RPE) dysfunction, and microperimetry indicated a global reduction in retinal sensitivity. Genetic testing identified two heterozygous variants of uncertain significance (ALMS1 and GPR179), but no pathogenic mutations associated with macular dystrophies. Over the 12-year follow-up, no progression of structural or functional abnormalities was observed, supporting the non-progressive nature of BYDM.

Conclusions: This case represents one of the longest follow-ups reported for BYDM, confirming its long-term stability. Despite subtle functional alterations, the absence of disease progression supports its benign nature. Further research is needed to refine the clinical spectrum of BYDM and distinguish it from other macular disorders.

Purpose: We report a case of a vitreous opacity identified as a white inferiorly located vitreous mass. Vitreous surgical biopsy revealed that it was vitreous metastasis of laryngeal carcinoma.

Methods: A 56-year-old man on immune-chemotherapy for laryngeal carcinoma presented to our hospital with photopsia in his left eye (OS) for two weeks.

Results: Slit-lamp examination revealed 0.5+ cells in the anterior chamber and 0.5+ cells in the vitreous humor OS. The optic nerve papilla was normal in both eyes, although slight macular edema was present OS. A white mass formed by a vitreous opacity precipitated at the inferior of the left fundus. Due to ongoing systemic treatment, the patient was unable to make frequent visits to ophthalmology, and the second visit occurred one month after the initial examination. Fundus angiography revealed retinal vasculitis OS. Two months after the initial visit, tractional retinal detachment with retinal hemorrhage occurred. Therefore, a 25-gauge lens vitrectomy was performed immediately. Histopathological examination of the vitreous obtained intraoperatively revealed atypical squamous cells identified as a vitreous metastasis of laryngeal carcinoma.

Conclusions: Vitreous metastasis of laryngeal carcinoma had not been previously reported. On the initial examination, there were few findings other than a white friable mass presenting as a vitreous opacity precipitating at the inferior of the fundus. Vitreous opacity in patients with carcinoma should be considered a potential indicator of metastatic tumors.