Retinal Cases and Brief Reports最新文献

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.

Purpose: To report a case of a reactive retinal astrocytic tumor (RRAT) associated with chronic rhegmatogenous retinal detachment (RRD).

Methods: This is a single, retrospective case report.

Results: An 82-year-old male presented with a one-year history of gradual blurring of vision in both eyes. Visual acuity was 20/160 in the right eye and hand movements in the left eye. Slit-lamp examination revealed a moderately dense cataract in the right eye and a dense cataract in the left eye complicated by 270° posterior synechiae and a fairly mobile retinal detachment on B-scan ultrasound. The patient underwent combined phacoemulsification without intraocular lens implantation, scleral buckling, and pars plana vitrectomy with silicone oil tamponade in the left eye. Intraoperative findings revealed a total RRD with multiple breaks and a small orange nodular mass incidentally overlying the inferotemporal break. Excisional biopsy confirmed a tumor measuring 0.2 cm in diameter. Histopathological analysis showed glial fibrillary acidic protein (GFAP)-positive glial tissue, numerous cluster of differentiation (CD) 31 (CD31)-positive vascular channels, and moderate CD163-positive macrophage infiltration, consistent with RRAT. The retina remained attached postoperatively, with some improvement in vision.

Conclusion: This report describes a rare association between occult RRAT and chronic RRD in an elderly patient. Histopathologic examination of such tumors is essential for accurate diagnosis while surgical management must be tailored to tumor size, location, and associated complications.

Background/purpose: To report choroidal neovascularization (CNV) after macular plug surgery for full-thickness macular hole, detailing four cases-two postinverted internal limiting membrane flap and two posthuman amniotic membrane (hAM) procedures.

Methods: Retrospective, observational small case series. Multimodal imaging investigation comprising optical coherence tomography, optical coherence tomography angiography, and fluoroscein angiography/indocyanine angiography of CNVs after macular plug surgery.

Results: In all cases, CNV affected the fovea, with two cases occurring in refractory macular holes and two in primary idiopathic macular holes. Choroidal neovascularizations in inverted flap cases showed high exudative and fibrotic potential with limited response to antivascular endothelial growth factor treatment. In hAM implantation cases, one CNV remained contained within the hAM, while the other exhibited late leakage near the hAM without exudation on optical coherence tomography. Three cases displayed type 2 CNV, while one showed a mixed CNV pattern. Visual acuity ranged from 20/120 to 20/200. The study categorized these lesions as CNV in plug surgery because of their unique pathogenesis.

Conclusion: Choroidal neovascularization occurring after inverted internal limiting membrane flap surgery with a fill variant shares characteristics such as foveal involvement and poor visual outcomes, likely because of high exudative activity and fibrosis. These findings highlight the need for careful monitoring of CNV in patients undergoing macular plug surgery, particularly those using the inverted internal limiting membrane flap technique. Moreover, we describe the development of CNV inside hAM in the context of peri-hAM atrophy after successful refractory macular hole surgery, without exudative properties beyond the hAM.

Purpose: To investigate the clinical and genetic characteristics of a family with first-degree relatives affected by central serous chorioretinopathy (CSCR).

Methods: Retrospective study of members of a family affected by CSCR. Patients underwent complete ophthalmologic examination, multimodal retinal imaging, and genetic analysis of complement factor H gene was performed.

Results: Three members of an Italian family (father and two sons) were included in this study. The father (74 years) displayed CSCR with macular atrophy, multiple gravitational retinal pigment epithelium abnormalities, and bilateral neovascular membrane. The eldest son (43 years) presented recurrent and bilateral serous retinal detachments with retinal pigment epithelium gravitational-type alterations. The younger son (38 years) showed minimal alterations of the retinal pigment epithelium after acute episodes of CSCR. No pathogenetic sequences were identified by molecular test of complement factor H gene.

Conclusion: Clinical signs of the same pathology in three members of a family suggest the presence of predisposing factors responsible for a possible familial CSCR.

Purpose: The aim of this study is to delineate a novel manifestation linked to the mutation of the membrane-type frizzled-related protein gene: a macular neovascular membrane. The authors provide detailed insights into this rare condition, shedding light on a previously unreported observation and proposing potential pathophysiologic mechanisms.

Methods: A single case report from a tertiary center in Brazil was conducted for evaluation.

Results: A female patient presenting with microphthalmos, retinal pigmentary alterations, and optic disk drusen, which had previously been misdiagnosed as intracranial idiopathic hypertension, was diagnosed with macular neovascular membrane and inherited retinal dystrophy. Genetic testing confirmed the presence of a membrane-type frizzled-related protein mutation, revealing novel manifestation of heterozygous gene mutations (c.498del p. Asn167Thrfs*25 and c.650G>A p. Gly217Glu).

Conclusion: Macular neovascular membrane in the context of retinal dystrophies is a rare occurrence and has not been previously associated with a membrane-type frizzled-related protein mutation. The documentation of this novel observation is crucial for enhancing our understanding of the potential disease presentations, aiding in diagnosis, elucidating the underlying pathophysiology, and guiding appropriate management strategies in such cases.

Purpose: To describe the role of topical fluorometholone in the treatment of eyes with central serous chorioretinopathy complicated by posterior cystoid degeneration.

Methods: Patients with posterior cystoid degeneration associated with central serous chorioretinopathy were prospectively recruited, examined with multimodal imaging, and prescribed for topical fluorometholone four times daily. Eyes with macular neovascularization were excluded based on optical coherence tomography angiography. Spectral-domain optical coherence tomography was used to monitor central retinal thickness, subfoveal choroidal thickness, and the thickness of the anterior sclera.

Results: Five eyes of four patients were included. Intraretinal and subretinal fluid in all eyes had been unresponsive to all standard treatments, but improved remarkably or completely resolved with limited improvement of visual acuity after a mean of 6.0 ± 2.0 weeks of topical fluorometholone administration. In all cases, significant reduction of scleral thickness was observed with no or mild intraocular pressure rise.

Conclusion: Severe cases of central serous chorioretinopathy complicated by posterior cystoid degeneration associated with vision loss may be managed with topical fluorometholone. The positive effects of steroids in central serous chorioretinopathy may be mediated by their effects on reduction of the scleral thickness.

Purpose: To describe a young female patient who presented with unilateral vision loss with multiple bilateral inner retinal lesions after a nonspecific viral illness, likely COVID-19.

Methods: Case Report: We reviewed the medical record, examined the retina, optical coherence tomography images, and fundus fluorescein angiogram of the patient along with the relevant medical literature.

Results: The patient presented to our emergency department at Moorfields Eye Hospital with a 2-week history of new onset floaters and blurred vision in her right eye. On examination she was found to have a low-grade bilateral vitritis, mild right optic nerve head swelling, and multiple white inner retinal lesions in both eyes.

Conclusion: Retinitis can be due to multiple infectious and noninfectious etiologies. In this case report, we discuss a case of rare multifocal inner retinitis from a nonspecific viral illness-likely COVID-19.

Purpose: To report and discuss a case of brainstem anesthesia and contralateral amaurosis after a sub-Tenon block.

Methods: Single surgical case report of a patient who underwent an uncomplicated pars plana vitrectomy for an epiretinal membrane peel in the left eye after a sub-Tenon anesthesia technique.

Results: Postoperatively, the patient experienced symptoms of brainstem anesthesia as well as akinesia, a nonreactive pupil, and reduced visual acuity in the contralateral eye that gradually resolved within 24 hours. Imaging was within normal limits and did not reveal any anatomic abnormalities.

Conclusion: Despite the use of a blunt-ended cannula in a sub-Tenon block, there is a non-negligible risk of it penetrating surrounding structures such as the optic nerve sheath. This case emphasizes the importance of monitoring for brainstem anesthesia and contralateral eye involvement in patients both intra- and postoperatively.