Retinal Cases and Brief Reports最新文献

Purpose: This report describes the use of the injectable intravitreal fluocinolone acetonide 0.18mg implant (FAI) for chronic postoperative cystoid macular edema (CME) in an eye with a silicone oil-filled vitreous cavity.

Methods: A retrospective chart review was performed including surgical, clinical, and imaging data.

Results: The patient had multiple complicated vitreoretinal surgical procedures including long-term silicone oil tamponade. The eye developed chronic CME, which responded to intravitreal steroid therapies and subsequently received FAI for longer-term control. The eye had no complications related to FAI.

Conclusion: FAI is a long-acting steroid that may be beneficial in controlling chronic CME. It can be considered for use in eyes with silicone oil tamponade, but further studies are required to better understand the pharmacokinetics and utility of the FAI when injected into silicone oil-filled vitreous cavities.

Purpose: To present a case of worsening maculopathy and vision loss due to vitreopapillary traction associated with an anomalous optic nerve head in a pediatric patient successfully managed with pars plana vitrectomy.

Methods: Retrospective case report.

Results: A 13-year-old boy presented with unilateral maculopathy that slowly progressed over a four-year period. As his visual acuity declined, he became increasingly symptomatic. The macular pathology occurred in the setting of vitreopapillary traction overlying multiple congenital optic nerve abnormalities, including a myelinated nerve fiber layer and a Bergmeister papilla. Following pars plana vitrectomy to alleviate the traction, the patient's macular appearance improved, and his vision slowly recovered to baseline.

Conclusion: There are limited reports of congenital optic nerve anomalies associated with vitreopapillary traction and maculopathy among any age group. This report illustrates a pediatric case in which removal of traction on the nerve head by pars plana vitrectomy was the key therapeutic intervention to alleviate the maculopathy.

Purpose: To describe a novel case of secondary multiple evanescent white dot syndrome in a patient with North Carolina Macular Dystrophy (NCMD).

Methods: The patient was evaluated with ultra-widefield color and autofluorescence imaging, fluorescein angiography, and spectral-domain optical coherence tomography.

Results: A 43-year-old man with longstanding blurred vision in both eyes acutely developed glare in the right eye after an upper respiratory illness. He had chorioretinal atrophy in both eyes consistent with North Carolina Macular Dystrophy, which was later confirmed by genetic testing. He alsyo had white spots in the macula of the right eye consistent with secondary MEWDS. The diagnosis of secondary MEWDS was confirmed with fundus autofluorescence and fluorescein angiography, as well as a negative infectious workup. His symptoms and the retinal lesions had resolved by 11 weeks and after a short course of oral corticosteroids.

Conclusion: Prior studies have suggested a link between disruption of the RPE/Bruch's membrane complex and secondary MEWDS. This report describes the first case of secondary MEWDS after NCMD and provides further support for this association.

Purpose: To report five cases of post-operative 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 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 post-operative period following vitrectomy with silicone oil injection. Treatment with topical antibiotics and steroids was commenced, 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 a case of non-traumatic macular hole in a pediatric patient associated with numerous epiretinal lesions throughout the macula.

Methods: A healthy 9-year-old girl presented to retina clinic with several months of blurry vision in the right eye. Clinically, there was a full-thickness macular hole with serous detachment and white epiretinal tufts. Spectral-domain optical coherence tomography confirmed the presence of the full-thickness macular hole with hyperreflective epiretinal proliferations in the right eye and an unremarkable left eye. Systemic work-up was negative. After a short period of observation, the patient underwent vitrectomy with internal limiting membrane peel and 14% C3F8 gas tamponade in the right eye. Multiple intraoperative samples were sent for further testing, which were also negative.

Results: At one and six-month postoperative visits, examination showed successful closure of the full-thickness macular hole with resolution of the subretinal fluid and improved visual acuity.

Conclusion: Non-traumatic macular holes in pediatric patients warrant systemic and ocular work-up, including fluorescein angiography and lab testing. Good anatomic and visual outcomes are generally seen with spontaneous and surgical closures of macular holes in this age group. Early vitrectomy with histological analysis of ocular samples should be considered in pediatric macular hole cases associated with vitreoretinal traction, especially those with epiretinal abnormalities.

Purpose: To report a case of bilateral optic disc pit (ODP) maculopathy using a different treatment approach.

Methods: Observational case report.

Results: A 17-year-old male presented with blurred vision in both eyes. His visual acuity was 20/400 in the right eye and 20/200 in the left eye. Fundus examination revealed bilateral temporal ODP and maculopathy. Optical coherence tomography scans showed severe intraretinal schisis-like changes, subretinal fluid, and parafoveal vitreomacular traction due to posterior hyaloid thickening in both eyes. Pars plana vitrectomy, in combination with internal limiting membrane peeling and gas tamponade, was performed on his left eye. A conservative approach was preferred due to high myopia and milder maculopathy in the right eye. Regressed maculopathy was found after spontaneous posterior vitreous detachment in the right eye.

Conclusion: Our case report may contribute to the knowledge regarding the role of vitreomacular abnormalities in the pathogenesis of ODP maculopathy.

Purpose: Surgical outcome of presumed Autosomal Recessive Bestrophinopathy (ARB)with full thickness macular hole and retinal detachment managed by pars plana vitrectomy.

Methods: A retrospective observational case series of two eyes of two patients who underwent 25 G pars plana vitrectomy with peeling of internal limiting membrane and SF6 tamponade and were assessed with respect to best corrected visual acuity, fundus photographs and spectral domain optical coherence tomography.

Results: Type 1 closure of macular hole was achieved along with resolution of retinal detachment in both patients.

Conclusion: 25 G pars plana vitrectomy with peeling of internal limiting membrane and SF6 tamponade can result in favorable outcome in macular hole associated retinal detachment in patients with presumed Autosomal recessive Bestrophinopathy.

Purpose: To report a case of branch retinal vein occlusion (BRVO) causing retinal neovascularization (NV) and vitreous hemorrhage associated with astrocytic hamartoma (AH) involving the optic nerve head in a patient with tuberous sclerosis complex (TSC). We review the natural history of the clinical presentation and posit its etiology.

Methods: Electronic health records were reviewed for patient history and demographics and multimodal ophthalmic imaging including fundus photography, fluorescein angiography, and optical coherence tomography (OCT).

Results: Neovascularization emanating superiorly and inferiorly from a large AH of the optic nerve head was identified as the cause of a longstanding vitreous hemorrhage. Retinal nonperfusion was also found in superior peripheral quadrants, most notably distal to the superior NV. OCT was useful in visualizing small retinal AH in the fellow eye that was otherwise undetected on prior dilated fundus examinations. The patient was treated with intravitreal anti-VEGF and superior sectoral PRP in the involved eye.

Conclusion: BRVO and associated NV may represent rare vision-threatening sequela of AH in TSC and manifested in this case with diffuse peripheral retinal nonperfusion secondary to BRVO-induced ischemia. OCT is a valuable resource in identifying and monitoring AH of the retina.

Purpose: To report a case of bilateral ocular cryptococcosis in an immunocompetent patient without neurologic findings.

Methods: Case report.

Results: A 30-year-old healthy Caucasian man presented with painless blurred vision in the left eye. Examination showed bilateral serous detachments and white retinal lesions. The visual acuity (VA) was 20/40 in the right eye and hand motions in the left eye. Neurologic workup and serologies were negative, and a computer tomography-positron emission tomography scan showed diffuse lymph node enlargement with metabolic activity and a suspected lymphoproliferative disorder. The myelogram and immunohistochemistry were normal. A biopsy of the cervical lymph nodes was positive for Cryptococcus neoformans. He was treated with antifungal medications and had complete resolution of the subretinal fluid and VA improvement.

Conclusion: Cryptococcosis is a rare entity in an immunocompetent person. A systemic workup is necessary to diagnose cryptococcosis and initiate prompt treatment.