Retinal Cases and Brief Reports最新文献

Purpose: To report three cases of bleb-related endophthalmitis (BRE) treated with endoscope-assisted vitrectomy and to describe the surgical approach and clinical outcomes.

Methods: We retrospectively reviewed three patients who developed BRE after glaucoma filtering surgery. All patients underwent pars plana vitrectomy (PPV) combined with endoscopic guidance using a 25-gauge endoscope, removal of avascular filtering blebs. Intraoperative findings, postoperative courses, and visual outcomes were evaluated.

Results: Endoscope-assisted vitrectomy enabled visualization of the peripheral vitreous despite corneal edema. In all cases, the infection resolved without recurrence. Postoperative visual acuity improved and exceeded previously reported averages. In one case, endoscopy revealed peripheral retinal degeneration, which was treated intraoperatively with laser photocoagulation, thereby preventing retinal detachment.

Conclusions: Endoscope-assisted vitrectomy may be a useful surgical approach for treating BRE, particularly in cases complicated by corneal edema. The technique allows precise peripheral vitreous removal and facilitates early identification of retinal pathology.

Purpose: To describe a novel surgical approach for managing submacular hemorrhage (SMH) in the setting of extensive panretinal photocoagulation (PRP) where conventional displacement techniques are limited by chorioretinal adhesions.

Methods: We report the case of a 73-year-old monocular woman with neovascular age-related macular degeneration (AMD) and dense PRP scars who presented with an acute, fovea-involving SMH. A modified pars plana vitrectomy (PPV) was performed using submacular tissue plasminogen activator (tPA), perfluorocarbon liquid (PFCL) tamponade to direct blood toward three small retinotomies, active aspiration, and silicone oil placement.

Results: This strategy achieved substantial clot evacuation and anatomic resolution. The patient's final visual acuity improved to 20/200.

Conclusion: Multiple small retinotomies with PFCL-assisted drainage may serve as a viable alternative surgical technique for SMH in eyes with extensive PRP scarring, where retinal adhesions preclude conventional displacement methods.

Purpose: To evaluate the role of intraoperative optical coherence tomography (iOCT) in performing relaxing retinotomies in coloboma related-retinal detachment.

Methods: The patient presents with decreased vision in the right eye (RE) for 1 year, with Snellen's best-corrected visual acuity (BCVA) of 20/100. RE Type 5 Ida-Mann Retinochoroidal coloboma with rhegmatogenous Retinal detachment (RRD). Retinal detachment was treated with 25-gauge pars plana vitrectomy. Subretinal fluid was drained through the intercalary membrane (ICM) break. The microscope-integrated OCT system identified taut ICM after fluid-air exchange. Repeat iOCT was done to check for the adequacy of the retinotomy by looking for flattening of the retina. The step was repeated till the retina was noted to be flat. Circumferential endolaser photocoagulation was done along the entire margin of the coloboma, followed by 5000 centistoke silicone oil injection.

Results: The retina remained attached under oil with the BCVA improved to 20/50 at 6-month follow-up. Conclusion:Intraoperative OCT can assist in deciding the extent of relaxing retinotomy in coloboma-associated retinal detachment with taut ICM.

Purpose: To describe the multimodal imaging (MMI) findings, including en face optical coherence tomography (OCT), of a case of Waldenström-associated immunogammopathy maculopathy.

Methods: Medical and imaging records were retrospectively evaluated. MMI included ultra-widefield (UWF) color fundus photography (CFP), fundus autofluorescence (FAF) and fluorescein angiography (FA). Cross-sectional and en face OCT were also studied.

Results: A 68-year-old man with type 2 diabetes mellitus and anemia was referred for evaluation of macular edema. UWF CFP and FAF showed scattered intraretinal hemorrhages and central SRF in both eyes. UWF FA showed patchy peripheral retinal ischemia but failed to illustrate macular leakage consistent with a silent FA. Cross-sectional OCT illustrated diffuse macular schisis OD and macular detachment OS. En face OCT illustrated a remarkable stellate pattern of schisis in the macula OU and also captured multiple clusters of hyperreflective subretinal deposits, possibly due to macroglobulin accumulation. Serum plasma electrophoresis detected an abnormally elevated monoclonal immunoglobulin M (IgM) spike (4055 mg/dL), and bone marrow biopsy confirmed a systemic diagnosis of Waldenström macroglobulinemia. Anti-VEGF therapy was deferred until monoclonal reduction with systemic chemotherapy.

Conclusion: Immunogammopathy maculopathy and retinopathy can masquerade as macular edema from retinovascular disease and should be suspected with macular detachment and severe central SRF without leakage on FA ("silent FA"). The recognition of these findings with MMI may be critical for the diagnosis and prompt treatment of this systemic disease. En face OCT captured hyperreflective deposits along the outer retinal wall which may represent monoclonal antibodies, known to draw fluid into the subretinal space.

Purpose: West Nile virus (WNV) is a mosquito-borne flavivirus known to cause infectious uveitis. This case represents one of the few endemic cases in Ohio without a prior travel history with unique ocular manifestations.

Methods: Case report.

Results: A 67-year-old female with past medical history of rheumatoid arthritis and past ocular history of right eye enucleation secondary to childhood penetrating trauma presented with left eye photopsias, floaters, photophobia, and headache. Exam revealed anterior chamber cell, Koeppe nodules, keratic precipitates. Funduscopic exam demonstrated vitreous cell and multifocal chorioretinal lesions. Initial testing was negative, and presumed sympathetic ophthalmia was diagnosed. Treatment with topical and systemic steroids was initiated. Patient recall and exam evolution prompted testing for WNV IgM, which was positive. Systemic and topical corticosteroids were tapered as the patient improved.

Conclusion: This case highlights the expanding geographic reach of WNV, the potential for infection despite an unremarkable travel or insect bite history, the novel association of WNV with iris nodules and Kyrieleis plaques, and controversial efficacy of systemic corticosteroids in the management of WNV-associated chorioretinitis.

Purpose: To describe the occurrence of optical coherence tomography (OCT) angiography features of microcysts in the macula due to optic atrophy.

Methods: A 63 year old male, with history of pituitary adenoma, was found to have disc pallor in his left eye and hyporeflective cysts in the inner nuclear layer (INL) at the macula on swept-source optical coherence tomography (OCT). The right eye was phthisical. Fundus fluorescein angiography and OCT angiography were performed to ascertain the cause.

Results: Fundus fluorescein angiography did not show any leakage, pointing to the diagnosis of microcystic macular edema (MME) due to optic neuropathy. OCT angiography and en face OCT demonstrated a striking pattern of the cysts in a circular distribution sparing the fovea at the level of the deep capillary plexus and INL respectively, giving it a "doughnut appearance".

Conclusions: Optic neuropathy related MME demonstrates a typical pattern on OCT angiography that may help to distinguish this condition.

Summary: Optic neuropathy may result in microcysts in the macula that can be mistaken for macular edema. Non invasive optical coherence tomography angiography can show a prominent "doughnut" appearance that helps to characterise this entity and differentiate it from macular edema.

Purpose: To demonstrate two surgical fixation techniques to salvage anteriorly migrated fluocinolone acetonide implants (FAc) (Yutiq; Alimera Sciences Limited, Alpharetta, GA, USA) (Iluvien; Alimera Sciences Limited, Alpharetta, GA, USA).

Methods: Anteriorly dislocated steroid implant pellets were retrieved and successfully suture-fixated to the pars plana or to a newly implanted FAc 0.59 mg implant (Retisert; Bausch & Lomb, Rochester, New York, USA) with non-absorbable suture to securely reposition them into the vitreous compartment.

Results: Both presented techniques successfully refixated implants, which remained fixated at long term follow-up for all patients. All patients tolerated the procedures well with no adverse outcomes or complications from refixation.

Conclusions: The presented surgical techniques offer novel and effective methods to manage anteriorly migrated steroid implants.

Purpose: This report describes the use of pneumatic retinopexy (PnR) for post-trauma retinal detachment with concomitant submacular hemorrhage and traumatic macular hole.

Methods: Retrospective case report.

Results: A 14-year-old male with a left eye injury underwent pneumatic retinopexy (PnR) after sustained submacular hemorrhage (SMH), traumatic macular hole (MH) and an inferior temporal retinal dialysis with an associated rhegmatogenous retinal detachment (RRD). Following informed consent, the procedure involved an anterior chamber tap of 0.5 mL and injection of 0.8 mL sulfur hexafluoride (SF6) gas. Strict facedown positioning was advised postoperatively. Follow-up assessments confirmed displacement of the SMH, retinal reattachment and closure of the macular hole, despite persistent poor visual acuity due to macular atrophy.

Conclusion: The present case demonstrates the potential use of PnR for post-trauma retinal detachment with concomitant submacular hemorrhage and traumatic macular hole.

Purpose: To report a rare and fulminant case of Clostridium septicum endogenous endophthalmitis.

Methods: A case report of a 52-year-old woman with metastatic endometrial cancer who developed sudden vision loss in the left eye 10 hours after presenting with dizziness, moderate fever, and a normal brain computed tomography (CT) scan.

Results: The left eye had no light perception. Slit-lamp examination revealed corneal edema and mild anterior chamber inflammation. Due to a limited fundus view, B-scan ultrasonography was performed, revealing a subretinal hypoechoic lesion with posterior shadowing. Orbital CT subsequently demonstrated intraocular gas pockets, suggesting gas-forming endophthalmitis. Early vitrectomy was performed due to rapid clinical deterioration, but progressive ocular necrosis necessitated enucleation. Clostridium septicum was confirmed in both vitreous and blood cultures. A follow-up abdominal CT revealed a colonic metastasis.

Conclusions: Clostridium septicum endophthalmitis is a rare, fulminant intraocular infection associated with malignancies. The presence of intraocular gas formation on early imaging should raise suspicion for gas gangrene endophthalmitis, and prompt immediate intervention, though visual prognosis remains extremely poor.