Retinal Cases and Brief Reports最新文献

Purpose: To present a case of suspected retinal phototoxicity after pars plana vitrectomy in a 45-year-old man undergoing Pre-Exposure Prophylaxis (PrEP) for HIV prevention.

Methods: Retrospective case report. A 25-gauge pars plana vitrectomy was performed for vitreous hemorrhage and retinal breaks. Standard endo-illumination settings were used. No vital dyes were applied. Despite an initial uneventful surgery, a secondary retinal detachment required a subsequent vitrectomy with gas tamponade. Optical coherence tomography (OCT) and blue fundus autofluorescence were performed at each follow-up visit.

Results: Postoperatively, OCT and blue fundus autofluorescence disclosed parafoveal disruption of the outer retinal layers, focal ellipsoid zone discontinuities, and retinal pigment epithelium (RPE) mottling within the illuminated area. At six months, best-corrected visual acuity improved to 20/25, although persistent RPE alterations were evident.

Conclusion: The pattern of outer retinal changes suggests a photochemical injury potentiated by photosensitization from PrEP medication. Our findings underscore the need for new strategies to reduce light exposure during surgery in patients on systemic photosensitizing agents.

Purpose: To demonstrate how an intraocular lens glide can assist in the removal of a large, complex intraocular foreign body (IOFB).

Methods: A case report with a surgical video.

Results: A 29-year-old male presented with an acute, penetrating open-globe injury with a metallic IOFB in the right eye. Emergent open globe repair and metallic IOFB removal was performed. A lens glide was utilized to facilitate the removal of a large, irregularly shaped IOFB by way of the anterior chamber without need to extend a sclerotomy at the pars plana and risk posterior segment complications.

Conclusion: An anterior segment-based, glide-assisted technique is safe and effective for removing large and irregular IOFBs, especially when traditional grasping tools prove ineffective.

Purpose: To report the efficacy of short-term perfluoro-n-octane (PFO) tamponade in combined penetrating keratoplasty (PKP) and pars plana vitrectomy (PPV) for eyes with corneal pathology and proliferative vitreoretinopathy (PVR).

Methods: Six consecutive patients with corneal pathology and PVR underwent PPV using a temporary keratoprosthesis (TKP) and short-term PFO tamponade. PKP was performed with PFO retained in the vitreous cavity either during the initial surgery or at a secondary procedure, depending on graft availability.

Results: Complete retinal reattachment was achieved in all six eyes (100%) at the final visit, including three eyes that required persistent silicone oil (SO) tamponade. Visual acuity improved in four eyes (67%) and decreased in two eyes (33%). Hypotony (< 5 mmHg) was observed in four eyes preoperatively and five eyes postoperatively. Corneal graft failure occurred in one eye during a mean follow-up period of 34.5 (range: 10-83) months. Retaining PFO in the vitreous cavity, compared with SO or fluid, appeared effective in stabilizing the globe and facilitating cornea graft sutures.

Conclusions: Short-term PFO tamponade for combined PKP and PPV may be useful surgical approach for cases involving corneal pathology and PVR.

Purpose: Although treatment with Anti-VEGF is progressively more common, cases of truly long-term follow-up of Retinopathy of Prematurity remain rare. Rarer still is wide-field photographic evidence of a long-term patient journey, with stable untreated peripheral avascular retina - we present such a case.

Methods: Clinical data including acuity and refraction were collected during ophthalmological reviews. Images were captured using Optomap (Optos, United Kingdom).

Results: We report a unique case of 12 years of follow-up with accompanying wide-field imaging, in a case of ROP treated with Ranibizumab. Respiratory disease precluded a safe general anaesthetic for laser treatment, and disease regressed following one dose of Ranibizumab. The peripheral avascular retina has appeared stable without treatment. The child's development has otherwise been unremarkable.The data underscore the utility of Optomap imaging in monitoring ROP's course. The non-invasive nature of UWF imaging has not only provided a comprehensive retinal perspective without the need for sedation but has proven indispensable in evaluating long-term treatment efficacy.

Conclusion: This case exemplifies the potential for long-term stabilization of ROP after anti-VEGF therapy without additional interventions uniquely supported by 12 years of UWF monitoring. Stability has so far been maintained despite the presence of peripheral avascular retina - an outcome that carries significant implications for the management of similar future cases.

Purpose: The aim of this study was to describe a case of endogenous endophthalmitis secondary to Nocardia farcinica and summarize the presentation, management, and prognosis of Nocardia eye infections.

Methods: This was an observational case report and literature review.

Results: A 64-year-old man with a history of chronic lymphocytic leukemia (CLL) presented for three weeks of headache and acute slurred speech. During his admission, he developed decreased vision, floaters, and pain in his left eye, and was found to have a large subretinal infiltrate with overlying vitritis. His endophthalmitis was later determined to be secondary to Nocardia farcinica dissemination based on microbiologic testing. Despite successful systemic nocardial treatment and intravitreal antibiotics, he developed a blind painful eye, and he was offered enucleation.

Conclusion: Nocardia species are rare causes of endogenous endophthalmitis that usually occur in immunosuppressed patients. Delayed diagnosis and resistance to first line empiric intravitreal antibiotics contribute to a poor visual prognosis.

Purpose: To report a case of full thickness macular hole (FTMH) formation as a rare sequelae in Rickettsial post fever retinitis (PFR).

Methods: We report a case of PFR and cystoid macular edema (CME) in both eyes with one eye eventually progressing to form a macular hole. Clinical record and serial multimodal imaging including colour fundus photography, spectral domain optical coherence tomography (SD-OCT) and OCT angiography (OCTA) were analyzed.

Results: A 65- year old gentleman presenting with reduction in vision in both eyes was diagnosed with bilateral Rickettsial PFR with multifocal lesions at the posterior pole along with vitritis and CME. During the course of his treatment he developed a FTMH in one eye and the other eye recovered vision.

Conclusion: Meticulous follow-up and personalized treatment are pivotal for optimizing outcomes and preventing vision loss. Broader case documentation will be key to advancing clinical management for this unusual complication in Rickettsial PFR.

Purpose: To describe a case of bilateral lipid exudative retinopathy secondary to lipoprotein-X - induced hyperlipidemia in a patient who recently underwent liver transplantation.

Methods: A retrospective, longitudinal, chart review was conducted. The patient was seen several times over an eight-month period by a multidisciplinary team. Imaging modalities included ocular coherence tomography (OCT), fundus photography, fluoresceine angiography (FA), and fundus autofluorescence (FAF).

Results: Ophthalmic imaging reveled rapidly progressive bilateral lipid exudation, macular edema, and retinal hemorrhages in association with decreased visual function. Laboratory data revealed dangerously elevated levels of cholesterol, low density lipoprotein, and non-HDL lipoprotein levels in association with normal Apolipoprotein-B levels - diagnostic for lipoprotein-x hyperlipidemia in the setting of cholestasis. Therapeutic plasma exchange was conducted which resulted in markedly reduced lipid levels, decrease in the retinal exudation, and improvement in the visual acuity.

Conclusion: This case highlights an exceedingly rare ocular complication of lipoprotein-x hyperlipidemia and the limited therapeutic treatment options available for improvements in ocular symptoms.

Purpose: To demonstrate optical coherence tomography (OCT) imaging findings of the acute hyperreflective retinal injury preceding retinal ischemic perivascular lesion (RIPL) formation in two patients with differing etiologies.

Methods: Retrospective chart review of two patients with RIPLs and regular macular OCT imaging through their clinical course from initial presentation through treatment and follow-up.

Results: Four eyes of two patients who presented with focal acute hyperreflectivity in the middle retina that developed into a RIPL. The two patients had different underlying pathologies: one with a branch retinal artery occlusion with a history of atrial fibrillation and hypertension and the other with Purtscher's retinopathy and cytomegalovirus retinitis. RIPL formation was consistent, involving middle retina hyperreflectivity developing into inner nuclear layer thinning, outer plexiform layer displacement, and outer nuclear layer expansion.

Conclusion: Similar to other microvascular events in the retinal ischemic cascade, RIPL formation is preceded by a focal hyperreflective lesion. Furthermore, RIPLs are a subclinical consequence of microvascular injury but are not disease specific.

Purpose: The purpose of this article is to describe the novel surgical technique using laser photocoagulation for the management of Candida chorioretinal lesions that are refractory to medical therapy.

Methods: This report presents the use of laser photocoagulation applied to a Candida chorioretinal lesion that was refractory to extensive systemic and intravitreal antifungal medications. The presenting lesion was in an immunosuppressed patient. Argon laser photocoagulation was applied onto and surrounding the Candida chorioretinal lesion.

Results: After laser photocoagulation, the Candida chorioretinal lesion has remained resolved for more than 1 year with no further reactivation, extensions, or satellites.

Conclusion: Candida chorioretinitis can be extremely therapeutically resistant. Current treatment involves systemic and intravitreal antifungals. There are currently limited options for chorioretinal lesions refractory to standard medical therapy. The authors report the novel application of laser photocoagulation as a potential treatment option in refractory cases of Candida chorioretinitis.

Purpose: This case report details the diagnosis and management of a preterm infant with aggressive bilateral retinal pathology.

Methods: A 4-week-old preterm baby girl, born at 28 weeks and 6 days to consanguineous parents, was referred for suspected aggressive posterior retinopathy of prematurity (ROP). She had a family history of bilateral retinal detachments and intellectual disability in an older sister. Clinical assessment included retinal examination, fluorescein angiography, optical coherence tomography, dual-energy x-ray absorptiometry (DEXA), and genetic testing. The genetic testing involved sequence analysis and copy number variation analysis of 25 genes related to vitreoretinopathy.

Results: Retinal examination and fluorescein angiography revealed extensive nonperfusion and telangiectatic vessels in both eyes, and a macula-involving tractional retinal detachment in the left eye. Despite treatment with intravitreal bevacizumab and laser photocoagulation, they progressed to total retinal detachment and no light perception in both eyes. Genetic testing revealed a pathogenic homozygous nonsense mutation in the LRP5 gene (c.3259C>T, p. (Gln1087*)), a mutation not previously reported in association with familial exudative vitreoretinopathy (FEVR). At 10 months of age, DEXA demonstrated normal bone density, diverging from the typical presentation of osteoporosis pseudoglioma syndrome associated with LRP5 mutations.

Conclusion: This case describes a novel mutation in a complex retinal disease and underscores the necessity of considering preterm FEVR in the differential diagnosis of atypical or aggressive ROP in preterm infants. The overlap in clinical features between ROP and FEVR highlights the complexity of diagnosis and management and the importance of genetic testing in preterm infants with retinal vascular abnormalities.