Retinal Cases and Brief Reports最新文献

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.

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.