Retinal Cases and Brief Reports最新文献

Purpose: The aim of this study was to demonstrate the role of optical coherence tomography angiography in the management of dome-shaped maculopathy.

Methods: This was a retrospective case review.

Results: A 52-year-old woman was referred to the authors' retinal service for potential bilateral choroidal neovascular membrane (CNVM) and blurry vision bilaterally. Initial spectacle-corrected visual acuity was 20/30-2 in the right eye and 20/30 + 2 in the left eye. Dome-shaped maculopathy was diagnosed on optical coherence tomography. In both eyes, optical coherence tomography B-scan passing through the fovea showed shallow irregular retinal pigment epithelium elevation suspicious of occult (type 1) CNVM. The outer retinal and choriocapillaris angiograms showed a zone of nonexudative CNVM in the right eye and exudative CNVM in the left eye. Given the persistent subretinal fluid with CNVM in the left eye, the authors elected to perform intravitreal injections of ranibizumab 0.5 mg on a treat and extend regimen. On the most recent follow-up, the best-corrected visual acuity improved to 20/20 in the left eye with no persisting subretinal fluid.

Conclusion: The authors present a case where assessing disease progression and the development of CNVM and evaluating the efficiency of therapies were realized through the application of novel optical coherence tomography angiography technology. This diagnostic tool may be used to guide clinicians in their management of dome-shaped maculopathy, as demonstrated through the authors' experience. Optical coherence tomography angiography can also make it possible to visualize nonexudative CNVM lesions that may be missed on traditional imaging assessments.

Purpose: The objective of this study was to report the use of intravitreal faricimab used as an adjunct in the management of intraocular tuberculosis in a patient with occlusive retinal vasculitis and choroiditis.

Methods: This is a case report.

Results: A 27-year-old Asian man presented with bilateral choroiditis and occlusive retinal vasculitis complicated by retinal neovascularization and vitreous hemorrhage in one eye. The patient had a positive tuberculin skin test, indeterminate interferon-gamma release assay, and Ghon focus on chest radiography. With a diagnosis of intraocular tuberculosis, the patient was treated with antitubercular therapy. Owing to the significant vitreous hemorrhage, he underwent pars plana vitrectomy in one eye. The patient received bilateral faricimab. Within a week of the injection, he had a near-complete resolution of the extensive choroidal and retinal vascular inflammation.

Conclusion: Intravitreal faricimab, given its angiopoietin-2 inhibition and antivascular endothelial growth factor action, maybe a helpful adjunct in intraocular tuberculosis. Whether angiopoietin-2 inhibition provides any additional benefit needs further evaluation in extensive studies.

Purpose: To report our findings in a patient with presumed Kikuchi-Fujimoto disease.

Methods: Report of clinical findings, fundus images, optical coherence tomography, and ultrasonography.

Results: A 19-year-old female patient who presented with an unusual form of symptoms that fit a disease called Kikuchi-Fujimoto disease. A large choroidal mass was observed in the posterior pole; a month later, the mass was completely gone.

Conclusion: Large choroidal masses can occur in patients with Kikuchi-Fujimoto disease, and these do not warrant treatment as they are self-limiting.

Purpose: The aim of this study was to report a case of severe retinal toxicity after an attempted suicidal overdose of antiradiation pills containing a well-known retinal pigment epithelial toxin, potassium iodate.

Methods: Clinical examination and multimodal imaging are provided from a clinic visit 11 years after the suicide attempt.

Results: A 42-year-old patient had widespread retinal atrophy in both eyes with near-complete absence of the retinal pigment epithelium and severe retinal thinning. A few remaining areas of preserved photoreceptors provided her with 20/60 and 20/200 vision in her right and left eyes, respectively, with very constricted visual fields.

Conclusion: Despite being first described over 100 years ago, few cases of iodate retinotoxicity have been reported in the published literature, and most are related to accidental or intentional ingestion of iodate salts used to iodize table salt. This unique case of iodate retinotoxicity secondary to antiradiation tablets highlights the risks of unregulated sale of these agents marketed in the United States as essential components of nuclear apocalypse "go bags" because they have a poor margin of safety and no specific warnings of the risk of permanent blindness with overdosage.

Purpose: Silicone oil (SO) tamponade is frequently used in complex vitreoretinal surgeries, and SO migration into the anterior chamber can lead to complications, such as glaucoma and corneal decompensation. A new technique is described for the efficient removal of emulsified SO droplets, which can adhere strongly to the anterior surface of the iris.

Methods: The tip of an ophthalmic absorption sponge was cut to an approximately 1 mm × 1 mm size. Using forceps, the sponge was inserted through a 25-gauge trocar and then through a corneal paracentesis to gently scrape the surface of the iris to dislodge the adherent SO droplets, which were subsequently aspirated.

Results: This technique efficiently and effectively dislodged and mobilized most emulsified SO droplets, thereby allowing removal through aspiration using a vitrector. Two months after surgery, the retina remained attached, the intraocular pressure decreased from 18 mm Hg to 15 mm Hg, and there were no visible SO droplets in the anterior chamber.

Conclusion: The sweeping technique is a safe and efficient method to dislodge, mobilize, and aspirate emulsified SO droplets that are adherent to the anterior surface of the iris, thereby decreasing the risk of future SO-related complications.

Purpose: The aim of this study was to evaluate the frequency of ocular imaging in patients with hereditary hemorrhagic telangiectasia (HHT) at a large academic medical institution, characterize the choroidal vascular changes on indocyanine green angiography and optical coherence tomography, and explore the relationship of these ocular features with HHT genotypes and systemic manifestations.

Methods: This is a retrospective review of patients with HHT who were seen in the Mayo Clinic ophthalmology department between 2011 and 2021.

Results: Of the 71 patients with HHT identified, 7 patients (10%) had qualifying imaging defined as radial or raster spectral-domain optical coherence tomography scans and/or indocyanine green angiography. Four patients (57%) had enlarged choroidal vessels detected on optical coherence tomography and/or indocyanine green angiography. Three patients (43%) had retinal telangiectasias. Patients with choroidal changes (mean age 67 years) had the endoglin gene mutation, gastrointestinal arteriovenous malformations, and facial and mucocutaneous telangiectasias. By contrast, patients without choroidal changes (mean age 45 years) included the activin A receptor-like kinase 1 gene mutation.

Conclusion: Only a small proportion of patients with HHT undergo ophthalmic imaging at the authors' institution. The presence of choroidal abnormalities is associated with the endoglin gene mutation, older age, corroborating retinal vascular changes, and increased systemic manifestations.

Purpose: Retinal capillary hemangioblastoma is present in about half of the carriers of the von Hippel-Lindau gene mutation and can lead to the evolution of blindness. Herewith is a proposal for surgical intraretinal feeder vessel ligature to induce ischemia of the phakoma and to resolve the exudative secondary retinal detachment, with satisfying results at the 6-month follow-up endpoint.

Methods: The patient underwent a chandelier-assisted 23-gauge pars plana vitrectomy with valved trocars. A bimanual transretinal ligature of the feeder vessel of hemangioblastoma was performed, followed by localized endolaser to ablate the surrounding retina and capillaries, and a polydimethylsiloxane 1,000 final tamponade. After 3 months, exchange of polydimethylsiloxane/air/balanced salt solution, phacoemulsification, and in-the-bag intraocular lens implantation were performed.

Results: At the sixth month, fundus fluorescein angiography showed a significant reduction of blood flow in the phakoma. The final best-corrected visual acuity was 6/6 (9 lines gain obtained compared with the baseline time).

Conclusion: This surgical technique seems to be effective and promising for the treatment of von Hippel-Lindau retinal capillary hemangioblastomas and their related retinal complications.

Purpose: This study aimed to investigate the potential link between methamphetamine use and infectious syphilitic uveitis through a retrospective chart review of four patients with both conditions.

Methods: A retrospective chart review was conducted on four patients with a history of methamphetamine use and presented with vision loss at an emergency department or clinic that was ultimately diagnosed as syphilitic uveitis.

Results: The average age of the four patients was 41.5 ± 9.8 years, and each presented with symptoms of blurry vision after an average of 3 weeks. Clinical and serologic examinations revealed variable severity of syphilitic uveitis in each patient, and a confirmed history of methamphetamine use was found on a review of social history. Each patient had worsening visual outcomes after the initial presentation and diagnosis.

Conclusion: Syphilitic uveitis is a challenging diagnosis because of its similarity with other ocular pathologies. This case series highlights the importance of maintaining a high level of suspicion for syphilis in patients with a history of methamphetamine use and uveitis to enable rapid treatment and prevent visual decline. The poor visual outcomes observed in these four patients underscore the significance of identifying and treating syphilitic uveitis promptly in this population and the barriers to treatment completion.

Purpose: The aim of this study was to report a case of bilateral uveitis, retinal periphlebitis, and optic neuritis associated with a non-pineal central nervous system germinoma.

Methods: This is a case report.

Results: A 32-year-old man presented with episodes of acute painless visual disturbance in each eye and was found to have decreased VA, abnormal color vision, an afferent pupillary defect in the left eye, bilateral optic disc edema, perivenous sheathing, and candle-wax dripping exudates. Optical coherence tomography revealed bilateral intraretinal fluid and posterior vitreous hyperreflective opacities. Fluorescein angiography revealed bilateral optic disc leakage without active small vessel leakage. Magnetic resonance imaging of the brain and orbits revealed enhancing periventricular lesions and enhancement of the left optic nerve and bilateral perioptic nerve sheaths, posterior globes, and optic nerve heads. Brain biopsy was consistent with a central nervous system germinoma. His ocular signs and symptoms improved with chemotherapy for the germinoma.

Conclusion: Central nervous system germinomas, including those located outside the pineal region, can be associated with optic neuritis, uveitis, and periphlebitis including characteristic candle-wax dripping exudates. Ocular signs and symptoms typically improve with treatment of the underlying germinoma.

Purpose: Persistent fetal vasculature may be associated with tractional retinal detachment due to tractional contraction of the fibrovascular stalk. Persistent fetal vasculature is often believed to be congenital and nonprogressive. A rhegmatogenous component is far less common and is typically identified as a postoperative complication and has not been spontaneously reported. The authors present five cases illustrating potential progressive changes and complications that may arise in nonoperated persistent fetal vasculature.

Methods: This was a retrospective case series of five patients who presented with progressive retinal detachments from persistent fetal vasculature.

Results: Five unique cases of persistent fetal vasculature with significant progression from time of initial presentation, four of which included development of rhegmatogenous components.

Conclusion: Patients with persistent fetal vasculature and a seemingly stable tractional detachment should undergo evaluation with a retinal specialist for risk stratification and management because rhegmatogenous detachments may occur due to ocular growth and stretch breaks, and tractional detachments can continue to progress over time.