Retinal Cases and Brief Reports最新文献

Background/purpose: To describe two cases of patients diagnosed with chronic postoperative cystoid macular edema associated with noninfectious posterior uveitis who had limited treatment response to previous corticosteroid modalities and then received a single intravitreal fluocinolone 0.18-mg implant. Chronic postoperative cystoid macular edema (CME) may occur after intraocular surgery and is a common cause of postoperative visual loss. Sometimes called Irvine-Gass syndrome or persistent pseudophakic CME, chronic postoperative CME complicates roughly 0.1% to 2.0% of low-risk, small-incision phacoemulsification surgeries. There are a number of conventional approaches to chronic postoperative CME management, including topical corticosteroids with or without nonsteroidal anti-inflammatory drugs, intravitreal corticosteroid injections, and vascular endothelial growth factor (VEGF) inhibitor injections, but these options have several limitations. A major shortcoming of conventional formulations of anti-inflammatory therapies for chronic postoperative CME (i.e., topical drops, intraocular, and periocular injections) is the need for repeated dosing in chronic cases, which is expensive and burdensome to patients.

Methods: Series of two case reports. Patient 1, a 75-year-old Latina woman, presented with a history of longstanding, recurrent inflammation after cataract extraction and subsequent vitreoretinal surgeries. Patient 2, an 85-year-old white woman, presented with acute blurred vision, swelling, and pain 5 years after cataract surgery and laser peripheral iridotomy. Both were diagnosed with chronic postoperative CME and ultimately treated with the 3-year sustained-release fluocinolone acetonide intravitreal implant (FAi) 0.18 mg.

Results: Compared with baseline, both patients experienced resolution of their disease symptoms, >3 lines of visual acuity improvement, and macular edema reduction of 56.2% and 38.4% at 15 and 6 months, respectively, after the fluocinolone implant. No steroid related adverse events including any intraocular pressure measurement >25 mmHg were observed.

Conclusion: A single intravitreal fluocinolone 0.18-mg implant can effectively and safely treat vision loss and increased central macular thickness because of chronic postoperative cystoid macular edema associated with noninfectious posterior uveitis. The FAi 0.18 mg provides a safe, long-acting, low-dose anti-inflammatory treatment in patients with noninfectious posterior-segment inflammation associated with chronic postoperative CME.

Purpose: The purpose of this study was to describe an atypical and severe case of giant cell arteritis (GCA).

Methods: This was a case report description.

Results: The authors report the case of a 76-year-old man who presented with severe and progressive bilateral visual loss. On presentation at the ophthalmology emergency room, the patient's right eye (OD) displayed aqueous flare, hyphema, rubeosis iridis , and dense posterior capsular opacification. After YAG laser capsulotomy, vitreous densifications, intraretinal hemorrhages, cotton wool spots, retinal ischemia, and vasculitis were observed in the fundoscopy. The patient's left eye (OS) also presented intraretinal hemorrhages and cotton wool spots around the temporal arcades. The diagnostic workup excluded infectious diseases, demyelinating diseases, and ocular ischemic syndrome due to carotid obstruction. Proteinogram revealed a monoclonal gammopathy, suggesting a possible hematologic condition. High-dose corticotherapy was initiated, which improved the vitreous densifications and enabled the visualization of the pale optic disk. The remaining study did not confirm the diagnosis of hematologic disease. During follow-up, bilateral VA deteriorated, with the development of progressive pallor in the OS optic disk. Follow-up fluorescein angiography demonstrated progressive retinal and choroidal ischemia. Finally, owing to high clinical suspicion, temporal artery Doppler ultrasound was performed, confirming the diagnosis of GCA.

Conclusion: GCA may present multiple ocular features. The knowledge of these different presentations, including retinal and choroidal ischemia or uveitis, is critical for timely diagnosis and treatment initiation. Since patients with GCA often present with vision loss, ophthalmologists may be the first medical doctors who contact with these patients, being on the frontline of GCA diagnosis.

Purpose: To report a case of severe bilateral multifocal placoid chorioretinitis in a patient receiving ipilimumab and nivolumab therapy for metastatic melanoma.

Methods: Retrospective, observational case report.

Results: A 31-year-old woman on ipilimumab and nivolumab for metastatic melanoma developed severe multifocal placoid chorioretinitis in both eyes. The patient was started on topical and systemic corticosteroid therapy, and immune checkpoint inhibitor therapy was paused. After resolution of ocular inflammation, the patient was restarted on immune checkpoint inhibitor therapy without return of ocular symptoms.

Conclusion: Extensive multifocal placoid chorioretinitis may occur in patients undergoing immune checkpoint inhibitor therapy. Some patients with immune checkpoint inhibitor-related uveitis may successfully resume immune checkpoint inhibitor therapy under close collaboration with the treating oncologist.

Purpose: To report a case of atypical, indolent presentation of scleral buckle infection, caused by Cutibacterium acnes (formerly known as Propionibacterium acnes ).

Methods: Observational case report.

Results: A 44-year-old healthy woman with a history of scleral buckling procedure for retinal detachment repair 16 years before presentation was admitted with pain and redness in her left eye for 6 weeks. Conjunctival hyperemia and vascular congestion were noted over the scleral buckle in a circular manner without signs of exposure. After removal of the scleral buckle, culture analysis revealed C. acnes. Systemic amoxicillin was administrated. Over a six-month follow-up, the retina remained attached.

Conclusion: Cutibacterium acnes , known to be associated with chronic postoperative endophthalmitis after cataract surgery, may also lead to scleral buckle infection with an indolent, chronic course.

Purpose: To describe a severe case of crystalline retinopathy secondary to hyperoxaluria from short gut syndrome.

Methods: Case report.

Results: A 62-year-old Caucasian woman with short gut syndrome and end-stage renal disease from renal oxalosis presented with chronic bilateral vision loss. She had previously been treated for presumed occlusive vasculitis. Visual acuity on initial examination was 20/400 right eye and 20/100 left eye with an afferent pupillary defect of the right eye. Examination revealed attenuated retinal vasculature and diffuse crystalline infiltration of retinal arterial lumina and throughout the retinas bilaterally. Optical coherence tomography revealed inner retinal atrophy with crystalline deposition in the inner retinal layers. Fluorescein angiography demonstrated delayed vascular filling and dropout consistent with severe ischemic vasculopathy. It was concluded that the short-gut syndrome led to overabsorption of oxalate with subsequent hyperoxaluria leading to retinal atherosclerotic oxalosis.

Conclusion: Retinal calcium oxalate deposits due to hyperoxaluria have been previously noted; however, this degree of severe retinal vascular infiltration has not been described. Our patient was receiving hemodialysis, which is associated with high rebound increases in systemic oxalate concentrations. It is important to keep hyperoxaluria in mind as a potential cause of retinopathy in patients with end-stage renal disease presenting with vision loss.

Purpose: To report a case of unilateral cytomegalovirus (CMV) panuveitis with occlusive vasculitis after injection of intravitreal dexamethasone implant in a patient with type 2 diabetes mellitus.

Methods: Observational case report.

Results: A 60-year-old immunocompetent man with well-controlled type 2 diabetes mellitus was treated with intravitreal dexamethasone implant for recurrent uveitis that was responsive to steroids. Three months after implantation, the patient develops panuveitis with occlusive vasculitis. Anterior chamber tap confirms diagnosis of cytomegalovirus retinitis. Intravitreal foscarnet and oral valganciclovir led to quiescent disease.

Conclusions: Patients treated with local immunosuppressants should be monitored carefully to assess treatment response and complications, even in the absence of frank immunodeficiency. Quantitative viral PCR can be an effective way to monitor treatment response to antiviral therapy.

Purpose: To describe a rare case of silicone oil emulsification that occurred only three months postoperatively. We discuss the implications for postoperative counseling.

Methods: Retrospective chart review of a single patient.

Results: Thirty-nine-year-old woman who presented with a right eye macula-on retinal detachment that was repaired with scleral buckle, vitrectomy, and silicone oil tamponade. Her course was complicated by extensive silicone oil emulsification within 3 months postoperatively, most likely because of shear forces induced by her daily CrossFit exercise regimen.

Conclusion: Typical postoperative precautions after a retinal detachment repair include no heavy lifting or strenuous activity for one week. These restrictions may need to be more stringent and long-term for patients with silicone oil to prevent early emulsification.

Purpose: To report a case of unilateral, sectoral retinal metastasis of small cell lung cancer (SCLC) that mimicked cytomegalovirus retinitis.

Method: Case report.

Results: A 48-year-old woman presented with a 4-week history of a visual field loss in her right eye. She had a medical history of extensive-stage SCLC with brain metastasis, stable on maintenance atezolizumab for 2 years. On initial presentation, she was diagnosed with cytomegalovirus retinitis. No improvement was observed with 4 weeks of oral valganciclovir. Upon referral for a second opinion, her fundus examination appeared compatible with cytomegalovirus retinitis, and anterior chamber tap for polymerase chain reaction for viral etiologies was performed followed by intravitreal and IV ganciclovir without improvement. She was referred for a third opinion, where diagnostic vitrectomy with vitreous and retinal biopsies were consistent with SCLC metastatic to the retina. The patient underwent enucleation of the right eye for definitive pathologic analysis and subsequently was started on additional systemic chemotherapy.

Conclusion: Retinal metastases are exceedingly rare, particularly retinal metastasis of SCLC. Retinal metastasis should be considered in patients initially diagnosed with viral retinitis who fail to improve despite antiviral therapy, particularly if they have a known history of malignancy. Furthermore, retinal metastasis of SCLC potentially could be misdiagnosed histopathologically as retinoblastoma if the patient's history is unknown and appropriate immunohistochemical stains are not performed.

Purpose: To describe a unique case of X-linked Coats'-like retinitis pigmentosa, a form of exudative retinitis pigmentosa, in association with an RPGR variant, and its management with intravitreal anti-vascular endothelium growth factor drugs, along with a peculiar optical coherence tomography finding observed in a late stage of disease.

Methods: Case report.

Results: A 33-year-old man previously treated with anti-vascular endothelium growth factors for macular edema came to our clinic for bilateral visual loss. A hemizygous RPGR variant (c.2442_2445del) was found and a diagnosis of Coats'-like Retinitis Pigmentosa was made. He was initially treated with carbonic anhydrase inhibitors; when efficacy wore off, he was switched to anti-vascular endothelium growth factor injections in both eyes with improvement. After a year without treatment, VA drastically worsened in both eyes; optical coherence tomography displayed disruption and increased hyper-reflectivity of the inner retinal layers in the right eye.

Conclusion: The c.2442_2445del variant is added to a number of known ORF 15 RPGR mutations associated with Coats'like Retinitis Pigmentosa. Anti-vascular endothelium growth factor treatment was successful in blocking visual loss in our patient and withholding treatment had a negative impact on his visual outcome.

Purpose: Vemurafenib, a BRAF inhibitor, has revolutionized the prognosis of late-stage melanoma patients, rising at the same time concerns about its potential adverse effects. Here is a case of vemurafenib-induced uveitis, peculiar in both its presentation and management.

Methods: Case report, diagnostic, and therapeutic challenge.

Results: Uveitis is a known side effect of vemurafenib. It is generally bilateral, moderate, manageable with topical steroids, and does not require cancer therapy cessation. We present a patient who suffered from a unilateral, severe uveitis after vemurafenib treatment that fully recovered thanks to intravitreal methotrexate injections because conventional corticosteroid therapy was contraindicated.

Conclusion: Uveitis can be a serious ocular adverse effect of vemurafenib, whereas its risk factors and mechanisms remain unknown. As BRAF inhibitors are now used on a regular basis, it is important for clinicians to be aware of this potentially sight-threatening side effect. Intravitreal methotrexate injections may be considered as an effective treatment choice in severe targeted agents-induced uveitis.