Retinal Cases and Brief Reports最新文献

Purpose: The aim of the study is to demonstrate the regenerative effects of plasma membrane rich in growth factors as an adjuvant in the surgical treatment of full-thickness macular holes associated with macular telangiectasia Type 2.

Methods: Observational study of a consecutive case series involving Type 2 macular telangiectasia patients with full-thickness macular holes. Best-corrected visual acuity, optical coherence tomography data, anatomical closure rates, and duration of follow-up were documented.

Results: Three patients who met the inclusion criteria were enrolled: two were naive and one was already operated with silicon oil in situ. Median follow-up was 6 months (range 6-18 months), anatomical closure rate was 100%, and median visual acuity change was 20/60 (range 20/40-20/100). No complications related to plasma membrane rich in growth factors were found.

Conclusion: Plasma membrane rich in growth factors is a valuable option for the treatment of full-thickness macular holes associated with macular telangiectasia Type 2. Its application promotes tissue regeneration and facilitates anatomical closure. The technique is reproducible and does not require manipulation of the internal limiting membrane.

Purpose: To study the efficacy and safety of pro re nata regimen of brolucizumab, without loading dose, in treatment-naive patients with neovascular age-related macular degeneration.

Methods: Retrospective, observational study. We included all consecutive patients diagnosed with treatment-naive neovascular age-related macular degeneration undergoing brolucizumab treatment in the Humanitas eye clinic, Turin, Italy between April 2022 and May 2023. Treatment was performed following pro re nata regimen without loading phase. Injection intervals (time between two injections), adverse events, changes in best corrected visual acuity, central macular thickness, maximal retinal thickness, and intraretinal and subretinal fluid were evaluated descriptively up to 1 year after the first injection.

Results: Twenty-one eyes of 21 patients were included in the study. The mean number of injections was 2.4 ± 0.7 at 3 months, 3.0 ± 2.0 at 6 months, 3.1 ± 2.4 at 9 months, and 3.8 ± 2.8 at 12 months, respectively. Best corrected visual acuity significantly improved from 20/80 Snellen (0.6 ± 0.3 LogMAR) to 20/50 Snellen (0.4 ± 0.3 LogMAR) at month 12 ( P = 0.044). Central macular thickness and maximal retinal thickness significantly reduced from 426 µm and 606 µm at baseline to 248 µm and 356 µm at 1-year follow-up ( P = 0.00067 and P = 0.02, respectively). Subretinal fluid and intraretinal fluid also progressively resolved. In contrast, intraocular inflammation events occurred in 9.5% of patients during follow-up. Intraocular inflammation resolved in all patients with prompt treatment without visual sequelae.

Conclusion: In our study, pro re nata regimen of brolucizumab without loading phase seems to be an effective treatment option in treatment-naive neovascular age-related macular degeneration patients, with intraocular inflammation rate similar to the one reported in trials and lower number of injections.

Purpose: To evaluate multimodal imaging of vitelliform lesions in macular telangiectasia type 2.

Method: Color fundus photograph, optical coherence tomography angiography, fundus autofluorescence, and fundus fluorescein angiography.

Result: Vitelliform lesions were found in two cases of macular telangiectasia type 2.

Conclusion: Vitelliform deposits can be present in eyes with macular telangiectasia type 2. Fundus autofluorescence imaging is a highly sensitive modality for detecting vitelliform lesions.

Purpose: To report five cases of postoperative sterile endophthalmitis in patients who underwent pars plana vitrectomy with silicone oil injection for retinal detachment.

Methods: Review of the medical records of five patients who underwent pars plana vitrectomy with silicone oil injection at Southend University Hospital and the Royal Eye Infirmary, Derriford Hospital, University Plymouth Hospitals NHS Trust, for rhegmatogenous or tractional retinal detachment.

Results: All five patients presented with signs of anterior chamber inflammation exhibiting flare, fibrin, and hypopyon in the early or late postoperative period following vitrectomy with silicone oil injection. Treatment with topical antibiotics and steroids was began, with rapid resolution of the anterior chamber inflammatory reaction and no further intervention required.

Conclusion: The use of silicone oil as a tamponade agent for retinal detachment can rarely induce sterile anterior chamber inflammation with signs resembling infectious endophthalmitis. Onset of symptoms, absence of pain, and good response to topical steroids can help differentiate between the two entities.

Purpose: We describe two cases of choroidal involvement in patients with Erdheim-Chester disease (ECD), a rare non-Langerhans cell histiocytosis.

Methods: Short case series.

Results: The first patient was a 25-year-old man with asymptomatic ECD at the level of bones, lung, and central nervous system. Fundus examination revealed bilateral yellowish choroidal infiltration in the superior macula and nasal midperiphery. After initial mild enlargement of the choroidal lesions, treatment with weekly subcutaneous pegylated interferon α2a was started inducing partial regression of the lesions. The second patient was a 45-year-old man with ECD involving the left orbit, maxillary sinus, heart, blood vessels, kidney, retroperitoneum, bones, and testes. Fundus examination of the left eye showed choroidal folds. Macular spectral-domain optical coherence tomography confirmed the folds and revealed underlying choroidal infiltration. Final ocular diagnosis was left choroidal, scleral, and orbital involvement. The patient was initially treated with pegylated interferon α2a, and later with cobimetinib, a Mitogen-activated protein kinase kinase inhibitor, with favorable results. Neither patient developed choroidal neovascularization during the follow-up.

Conclusion: Erdheim-Chester disease is a rare multisystem disorder that can present with ocular involvement, including orbital masses, xanthelasma-like lesions, and, occasionally, choroidal infiltrates. Early recognition and prompt treatment can lead to improvement of ophthalmic and systemic symptoms and prevent further complications. We recommend treating patients with choroidal ECD, regardless of the presence of symptoms, considering these patients are at increased risk of developing choroidal neovascularization.

Purpose: To report two patient cases demonstrating the management of refractory macular holes through the application of temporary thin amniotic membrane grafts, followed by subsequent graft removal on achieving hole closure.

Methods: Comprehensive chart and literature review was conducted using the PubMed database.

Results: We describe two patients who underwent repeat pars plana vitrectomy for treatment of refractory macular holes. In both patients, the epiretinal placement of a thin amniotic membrane graft was done to achieve hole closure. After a period of retinal stabilization, the amniotic membranes were removed because of the healthy appearance of the outer retinal layers and the ellipsoid zone, ultimately resulting in an improved final visual acuity in both patients.

Conclusion: This case series demonstrates a new approach of using a temporary amniotic membrane graft to close refractory macular holes. After graft removal, both patients reported enhanced visual acuity and subjective visual improvement, accompanied by the stable closure of macular holes on serial optical coherence tomography scans.

Purpose: This report describes the case of a 13-month-old boy diagnosed with neurofibromatosis type 1, who presented with retinal vascular abnormalities including extensive nonperfusion and neovascularization. We also discuss the observed changes after photocoagulation treatment.

Methods: A 13-month-old boy presented to the Department of Ophthalmology at Peking University People's Hospital with a reduction in the width of the left palpebral fissure for the past 6 months.

Results: The boy exhibited more than six café-au-lait spots larger than 5 mm in diameter on his trunk and legs. Fundus examination of the left eye revealed significant neovascularization in the temporal periphery of the retina, with late leakage and nonperfusion also noted temporally in fluorescein angiography. Magnetic resonance imaging of the brain and orbits showed an enlarged left sphenoid body, a widened left cavernous sinus, and a large plexiform neurofibroma. Laser treatment was performed on the left eye. Five months later, the neovascularization was controlled.

Conclusion: Careful fundus examinations and systemic reviews, especially fluorescein angiography, are essential. Timely laser treatment is crucial for controlling disease progression and preventing retinal detachment.

Purpose: Describe a case of symmetric bilateral macular atrophy as an ophthalmologic manifestation of Mucolipidosis type 3.

Methods: Multimodal retinal imaging evaluation was performed, with color fundus photograph, fundus autofluorescence, fluorescein angiography, and optical coherence tomography. Genetic testing confirmed the systemic diagnosis.

Results: Genetic testing confirmed the diagnosis of Mucolipidosis type 3, and macular bilateral atrophy was considered a rare manifestation of the systemic disease.

Discussion: Ophthalmologic manifestations in mucolipidosis are rare, with corneal opacities being most reported. Our patient presented bilateral macular atrophy, which had not been previously described in association with the disease, and is important to consider different diagnosis.

Conclusion: It is important to consider different diagnosis, such as retinal dystrophies and conditions causing macular atrophy, and this case highlights the importance of considering rare ophthalmologic manifestations in syndromic diseases.

Purpose: To characterize two cases of focal outer retinal atrophy and hypotony after vitrectomy.

Methods: Retrospective chart review of two patients' records between 2019 and 2023.

Results: Patient 1 underwent vitrectomy, epiretinal membrane peel, and cataract extraction for visually significant macular pucker. She developed hypotony without a wound leak and was noted to have a focal parafoveal area of ellipsoid zone disruption by 1 week postoperatively, which evolved into outer retinal and chorioretinal atrophy within 6 weeks after surgery. This area of atrophy remained stable in size, but the patient later reported a paracentral scotoma. Patient 2 had multiple previous surgeries for retinal detachment with proliferative vitreoretinopathy. Seven years later, the intraocular lens dislocated and was exchanged with scleral fixation of a new intraocular lens. On postoperative Day 1, he had hypotony with macular folds secondary to a leaking sclerotomy wound. The sclerotomies were sutured on postoperative Day 3, and his intraocular pressure normalized. However, he developed a central, focal area of chorioretinal atrophy within 1 week of the initial surgery. The size of this area of atrophy remained stable for years but resulted in reduced central vision.

Conclusion: Hypotony after vitrectomy may rarely predispose patients to the development of focal chorioretinal atrophy.

Purpose: To describe a new technique for placing large epiretinal human amniotic membrane grafts in two eyes with high myopia and recurrent retinal detachment resulting from large breaks over staphyloma not amenable to laser or cryoretinopexy.

Methods: Surgical technique demonstration with video and images. We examined two high myopic eyes with large retinal breaks and recurrent rhegmatogenous retinal detachment that had undergone rhegmatogenous retinal detachment repair with silicone oil tamponade. Break was seen over nasal staphyloma in the first case and over an atrophic area along with retinoschisis at posterior pole in the second case. 25 G vitrectomy with silicone oil removal was done and a large multilayered hAM graft was placed over large retinal breaks. Both eyes receive gas tamponade. The patients were positioned face down for the first week after surgery. Optical coherence tomography scans were performed in the follow-up visits.

Results: Retinal breaks could be successfully closed in both eyes at 2 weeks and 3 months follow-up. Large hAM grafts were stable and nicely visualized on postoperative optical coherence tomography scans and fundus photographs. These grafts were well tolerated with no displacement even at 12 months follow-up. There was no recurrence of rhegmatogenous retinal detachment noted in either eye.

Conclusion: The large overlay hAM grafting is an effective and safe technique for closing large retinal breaks over staphyloma or atrophic retina in high myopes.