Retinal Cases and Brief Reports最新文献

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.

Purpose: To present a case of bilateral severe Harada-like reaction with bacillary layer detachments secondary to pembrolizumab therapy for metastatic signet ring cell carcinoma.

Methods: Case report.

Results: A 33-year-old black male with a medical history of aggressive metastatic signet ring cell carcinoma treated with Pembrolizumab developed a bilateral Harada-like reaction with bacillary layer detachment. The ocular disease improved after he was treated with high dose systemic corticosteroids and the pembrolizumab was discontinued. Local periocular steroid injections were given to treat the ocular inflammation and to facilitate systemic corticosteroid taper. A Harada-like reaction recurred after switching to nivolumab.

Conclusion: Pembrolizumab can cause a Harada-like syndrome with bacillary layer detachment. Once the pembrolizumab is discontinued, and systemic and local corticosteroids are given, the ocular findings can resolve. Switching to a different checkpoint inhibitor may lead to a recurrence of ocular disease.

Purpose: Despite its low risk profile and high efficacy described in several studies, there appears to be an increasing number of reports describing sterile inflammatory reactions following intravitreal administration of Faricimab. Purpose of this case report is to highlight the occurrence of recurrent sterile endophthalmitis following repeated intravitreal Faricimab administration, emphasizing the need for awareness and careful monitoring of this adverse reaction.

Methods and results: We present the case of an 83-year-old caucasian woman, who was treated with intravitreal Faricimab for neovascular age-related macular degeneration (nAMD) in her left eye (OS). Shortly after the first administration, she experienced progressive, painless visual deterioration, along with a pronounced inflammatory reaction in the anterior and posterior segments, including granulomatous keratic precipitates. Based on these findings, the diagnosis of endophthalmitis was made. Following hospital admission, immediate treatment led to resolution of the condition and recovery of visual acuity.On the first day after the second administration of Faricimab, the patient again experienced painless visual deterioration accompanied by a severe inflammatory reaction OS. Immediate treatment once more resulted in resolution of the condition and recovery of visual acuity. In both instances, no microbial growth was detected in fungal cultures or aerobic and anaerobic cultures from aqueous humor and vitreous samples.

Conclusion: We present a case of recurrent endophthalmitis in the same patient following two intravitreal administrations of Faricimab. Considering the clinical presentation and course, as well as the microbiological findings, a sterile inflammatory reaction is likely in both instances.

Purpose: To present a refined technique utilizing subretinal injection of Balanced Salt Solution (BSS) for the closure of refractory macular holes.

Methods: This case report details a 70-year-old female patient with a refractory macular hole in the left eye, who underwent pars plana vitrectomy (PPV) combined with internal limiting membrane (ILM) peeling, gas tamponade, and subretinal injection of BSS.

Results: One month postoperatively, optical coherence tomography (OCT) confirmed successful closure of the macular hole, with best-corrected visual acuity (BCVA) improving to 20/100 in the affected eye. At six-month follow-up, the macular hole remained closed, and OCT revealed partial restoration of the ellipsoid zone and external limiting membrane. BCVA was maintained at 20/100.

Conclusion: Subretinal BSS injection appears to be an effective technique for closing refractory macular holes, offering a promising option for complex cases.

Purpose: To describe a novel combined surgical technique using an amniotic membrane (AM) plug for choroidal hole closure and comprehensive epiciliary membrane removal to reverse chronic hypotony after open globe injury.

Methods: We present a case of a 36-year-old male who developed severe hypotony and recurrent retinal detachment following multiple surgeries for open globe trauma. The surgical approach involved repeat pars plana vitrectomy (PPV), meticulous excision of circumferential epiciliary membranes, peripheral retinectomy, and transplantation of a dried AM plug into a large choroidal hole, followed by silicone oil tamponade. After anatomical recovery, silicone oil removal and a secondary AM patch over the exposed retinal pigment epithelium (RPE) were performed.

Results: The AM plug provided effective closure of the choroidal hole, prevented suprachoroidal silicone oil migration, and supported reattachment of the retina and choroid. The patient's intraocular pressure improved from 4 mmHg preoperatively to 10-11 mmHg postoperatively, with stable retinal anatomy and no recurrence of hypotony or epiciliary membranes during follow-up.

Conclusions: This combined surgical technique offers a promising option for complex, refractory hypotony following open globe injury with choroidal hole and proliferative vitreoretinopathy. Further studies are warranted to validate its efficacy and long-term outcomes in a broader cohort.

Purpose: To evaluate the safety and effectiveness of minimal posterior vitrectomy combined with minimal internal limiting membrane (ILM) peeling and the injection of DisCoVisc under perfusion to fix the inverted single flap of the ILM for the closure of macular hole (MHs) without gas tamponade.

Methods: Minimal vitrectomy was performed on 12 eyes of 12 patients presenting with MHs. During the surgical procedure, only vitreous gel between vascular arcades was removed. The DisCoVisc was then injected under perfusion to fix the inverted ILM single flap. The vitreous cavity was tamponaded with balanced salt solution (BSS), and patients kept a non-strict face-up position for 24 hours postoperatively.

Results: By the last follow-up, all 12 eyes (100%) had completely closed MH. Optic coherent tomography (OCT) revealed that 10 eyes exhibited U-shaped closure, while 1 eye showed V-shaped closure and another demonstrated W-shaped closure. The average area of ILM peeling was 7.76 ± 2.14 mm2, and ILM flap covering the macular hole was 4.80 ± 1.29 mm2. Preoperatively, the BCVA was 1.26 ± 0.52 LogMAR, which improved to 0.57 ± 0.37 LogMAR at the last follow-up (P=0.001). The IOP on the first postoperative day was 17.46 ± 9.34 mmHg, comparable to the preoperative IOP of 15.49 ± 2.94 mmHg (P=1.000). Last follow-up, the IOP (12.48 ± 2.45 mmHg) was lower than preoperative(P=0.001).

Conclusion: This technique is not only straightforward and time-efficient but also effectively closes MHs and enhances postoperative vision, all while avoiding the discomfort associated with gas tamponade and face-down position.

Purpose: To highlight the diagnostic and therapeutic challenges of endogenous candida endophthalmitis in a preterm neonate with aggressive retinopathy of prematurity (A-ROP) and to emphasize the role of multimodal imaging in achieving accurate diagnosis and successful management.

Methods: We report a case of a preterm infant with A-ROP who presented with yellowish-white macular lesions and vitreous opacities. The initial clinical impression was ocular toxoplasmosis. However, a diagnostic dilemma arose between toxoplasmosis and fungal endogenous endophthalmitis. Optical coherence tomography (OCT) findings and systemic evaluation ultimately supported a diagnosis of Candida endophthalmitis. The infant was treated with intravitreal voriconazole and systemic antifungal therapy.

Results: Multimodal imaging, including ultrawide-field fundus photography and OCT, revealed features consistent with fungal chorioretinitis. Notably, OCT demonstrated the characteristic "rain cloud sign," supporting the diagnosis of fungal endophthalmitis. Following three doses of intravitreal voriconazole, there was marked regression of the retinal lesions and complete resolution of the vitreous haze.

Conclusion: Endogenous Candida endophthalmitis should be considered in preterm infants with systemic risk factors and posterior segment involvement. Multimodal imaging especially OCT is pivotal in resolving diagnostic dilemmas, distinguishing fungal infections from other differentials such as toxoplasmosis, and monitoring therapeutic response.

Purpose: To describe a modified scleral fixation technique for a 4-haptic foldable intraocular lens (IOL) using 10-0 looped polypropylene sutures, aimed at reducing suture exposure risks and enhancing centration stability in eyes with inadequate capsular support.

Methods: This retrospective interventional study included 9 eyes of 9 patients, who underwent modified scleral fixation of a 4-haptic foldable IOL between January 2023 and January 2024.

Results: Over a mean follow-up period of 10.89 months, postoperative LogMAR best-corrected visual acuity (BCVA) improved significantly (20/43 vs. 20/130 preoperatively). The mean IOL tilt was 0.27 ± 0.09 µm, with acceptable endothelial cell loss (9.96%). No intraoperative or postoperative complications were observed.

Conclusion: This technique performed through a small incision, achieves reliable IOL positioning and visual improvement via four-point fixation while effectively eliminating suture-related complications.

Purpose: This study evaluates the feasibility and utility of subretinal fluorescein dye injection in identifying retinal breaks during retinal detachment vitrectomy.

Methods: Fluorescein dye was diluted to a concentration ranging from 0,01mg/mL to 0,001mg/mL and delivered via 41G needle to the subretinal space. Four retinal detachment surgeries were performed using the NGENUITY® and CONSTELLATION® systems. A blue filter was adapted to the CONSTELLATION® light source, and image gain was increased on the NGENUITY® system to enhance visualization. Fluorescein dye leaked through the retinal break, thereby enabling its identification.

Results: Fluorescein leakage effectively facilitated the precise localization of the retinal break in the four cases described. No signs of retinal toxicity or adverse effects were observed. All patients experienced stable anatomical reattachment throughout the follow-up. Electroretinogram in two patients showed no signs of retinal toxicity.

Conclusion: Subretinal fluorescein dye injection offers a valuable adjunct for identifying elusive primary retinal breaks, especially in recurrent or persistent retinal detachments in vitrectomized eyes, complementing standard vitreous base vitrectomy inspection. Precise localization may reduce reliance on additional retinotomies, perfluorocarbon liquids, or extensive laser treatments, minimizing surgical risks. Further studies are necessary to evaluate the long-term efficacy, safety profile, and potential complications associated with this technique.