Retinal Cases and Brief Reports最新文献

Purpose: To report a case of a patient with perifoveal exudative vascular anomalous complex (PEVAC) and to analyze morphologic and vascular changes by optical coherence tomography (OCT) and OCT angiography (OCTA) before and after treatment.

Materials and methods: The authors reported a case that received multiple treatments for unresponsive effect to repeated aflibercept intravitreal injections, subthreshold micropulse laser therapy duty cycle 5%. At last, the focal full-dose yellow laser was performed.

Results: A 57-year-old male patient presented with best-corrected visual acuity (BCVA) of 20/50 in his right eye (RE). The fundoscopic evaluation, structural OCT, and OCTA deposed for a diagnosis of PEVAC. The patient underwent three aflibercept intravitreal injections in the RE. Because no changes were detected, the authors opted for multiple sessions of yellow subthreshold micropulse laser therapy duty cycle 5%; however, no signs of regression were registered. Only after a full-dose yellow laser, signs of edema regression were observed. Structural OCT B-scan showed complete restoration of retinal profile, in the absence of any intraretinal or subretinal fluid and PEVAC lesion, whereas the OCTA showed a slight flow deficit at the previous lesion site.

Conclusion and importance: The PEVAC treatment is still unknown. In their experience, the authors reported a case of multiple treatments for unresponsive effect to aflibercept intravitreal injections, subthreshold micropulse laser therapy duty cycle 5%. The focal full-dose yellow laser was the only effective treatment in this patient. The authors proposed the management to share the heterogeneous response at PEVAC entity.

Purpose: To report a case of giant pigment epithelium detachment (PED) secondary to chronic central serous chorioretinopathy successfully treated with photobiomodulation.

Methods: This is a case report.

Results: A 55-year-old man complained worsening of vision in the left eye over the last 18 months. A complete ophthalmological evaluation encompassing best-corrected visual acuity measurement, spectral-domain optical coherence tomography, fundus autofluorescence, fluorescein angiography, and microperimetry was performed. Spectral-domain optical coherence tomography showed several small PEDs around the macula in the right eye and a giant macular serous PED with subretinal fluid in the left eye. Fluorescein angiography disclosed multiple hyperfluorescent roundish areas in the posterior pole bilaterally, with a macular pooling in the left eye. A diagnosis of chronic central serous chorioretinopathy was made, and the patient underwent photobiomodulation with one session for a week for 4 weeks, followed by one session bi-weekly for 2 months. Spectral-domain optical coherence tomography of the left eye showed a gradual flattening of the macular PED at 3 months, with a complete regression of the latter and of the subretinal fluid at 6-month and 12-month follow-up with no residual signs of chorioretinal atrophy on fundus autofluorescence. Best-corrected visual acuity improved from 20/80 at baseline to 20/25 at the last follow-up, and this functional improvement was further confirmed by microperimetry.

Conclusion: Photobiomodulation can be considered a safe and effective treatment strategy for the management of chronic central serous chorioretinopathy with subretinal fluid and serous PED.

Purpose: To present a case of worsening maculopathy and vision loss because of 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 4-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. After 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 report a rare case of optic disk and chorioretinal vascular occlusions in the right eye after sub-Tenon injection of triamcinolone acetonide (STTA) in an older male patient with scleritis and to discuss the associated risk factors and potential alternative therapies.

Methods: The medical history and clinical examination, including fundoscopy, fluorescein angiography (FA), and indocyanine green angiography (ICGA), were conducted to diagnose and evaluate the extent of vascular occlusion after STTA. An extensive literature review was undertaken to ascertain the associated risks and consider other treatment options for scleritis.

Results: Severe circulatory disturbances in the optic disk and chorioretinal regions of the right eye developed after STTA for exacerbated scleritis, as confirmed by FA and ICGA, resulting in a significant decrease in visual acuity. A complex medical history encompassing ophthalmic and systemic health issues may have contributed to this negative outcome. A literature review pointed out the potential complications of STTA and highlighted alternative approaches to scleritis management.

Conclusion: Cautious application of STTA in treating scleritis is crucial, especially in patients with preexisting vascular or ocular conditions. Thus, a multidisciplinary approach and a careful assessment of various treatment options are vital to minimize the risk of severe complications and improve patient outcomes.

Purpose: We describe a case of nontraumatic 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 workup 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 1- and 12 months/1 year postoperative visits, examination showed successful closure of the full-thickness macular hole with resolution of the subretinal fluid and improved VA.

Conclusion: Nontraumatic macular holes in pediatric patients warrant systemic and ocular workup, including fluorescein angiography and laboratory testing. Good anatomic and visual outcomes are generally seen with spontaneous and surgical closures of macular holes in this age group. Early vitrectomy with histologic 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 central retinal artery and common carotid artery occlusions following COVID-19 infection in a young woman with no other risk factors.

Methods: Retrospective analysis of the medical records of a patient hospitalized with COVID 19 infection at the University Hospital Southampton.

Results: The patient was found to have dural venous sinus thrombosis and an acute infarct within the right parietal lobe. There was an occlusive thrombus within the right common carotid artery. Subsequently, she was found to have a right central artery occlusion secondary to the right common carotid artery occlusion.

Conclusion: COVID-19 infection can cause retinal artery occlusion through systemic thrombosis in previously healthy patients.

Purpose: To report a case of branch retinal vein occlusion causing retinal neovascularization 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.

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 neovascularization. Optical coherence tomography 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 panretinal photocoagulation in the involved eye.

Conclusion: Branch retinal vein occlusion and associated neovascularization may represent rare vision-threatening sequela of AH in TSC and manifested in this case with diffuse peripheral retinal nonperfusion secondary to branch retinal vein occlusion-induced ischemia. Optical coherence tomography is a valuable resource in identifying and monitoring AH of the retina.

Purpose: To describe the clinical course of a case of exudative vitreoretinopathy in the setting of homozygous loss-of-function PCDH12 mutations and provide a comprehensive literature review.

Methods: Retrospective case review with associated whole exome sequencing, color fundus photography, and fluorescein angiography.

Results: A 14-year-old male with homozygous loss-of-function PCDH12 mutations presented with bilateral decreased vision. The right eye demonstrated extensive retinal neovascularization, temporal vessel dragging, lipid exudate, and peripheral avascular retina. The left eye had tractional bands emanating from the optic nerve, exudates, and vessel dragging, and peripheral examination revealed extensive avascular retina with neovascularization and fibrotic bands. The patient was treated with sequential laser photocoagulation bilaterally.

Conclusions: PCDH12 is a gene important for vascular integrity with suggested links to Wnt/β-catenin-associated signaling pathways implicated in familial exudative vitreoretinopathy (FEVR) pathogenesis. This case describes a detailed genotype-phenotype link between homozygous PCDH12 loss-of-function mutations and FEVR, suggesting a benefit to ophthalmic referral for PCDH12-associated syndromes as well as PCDH12 testing for genetically undifferentiated FEVR patients.

Purpose: To evaluate the use of autologous blood as an adjuvant in the surgical treatment of idiopathic macular hole (IMH) associated with the inverted internal limiting membrane (ILM) flap technique and gas tamponade.

Methods: Fourteen patients with stage IV idiopathic macular hole and a diameter equal to or greater than 400 μm were retrospectively evaluated. All patients underwent 23-gauge pars plana vitrectomy, ILM peeling with centripetal inverted flap technique, application of autologous blood over the folded ILM flap inside the hole, and tamponade with an air-SF6 (20%) mixture. Patients were instructed to maintain a prone position for 5 days.

Results: Anatomical closure was achieved in all cases. The mean minimum macular hole diameter was 528 μm. The mean best-corrected visual acuity (BCVA) improved from 20/118 (0.77 logMAR units) preoperatively to 20/46 (0.36 logMAR units) postoperatively (p < 0.01). Patients with hole diameters between 400-500 μm improved by 3-4 ETDRS lines, while those with holes >500 μm improved by 1-2 ETDRS lines. The mean follow-up duration was 13.2 months (range: 12-24 months). Only one patient developed mild retinal pigment epithelium (RPE) toxicity related to dye and light exposure.

Conclusions: Autologous blood, used as a sealing plug to stabilize the ILM flap over the macular hole and as a reservoir of growth factors, proved to be an effective adjuvant in promoting anatomical closure in idiopathic macular hole surgery.

Purpose: To describe a unique case of paracentral acute middle maculopathy (PAMM) that heralded the presentation of ocular ischemic syndrome (OIS).

Methods: Medical records of a patient with PAMM and OIS were retrospectively reviewed.

Results: A 72-year-old male presented with foggy vision in the right eye (OD). Macular optical coherence tomography (OCT) revealed PAMM OD. Regression of the hyper-reflective lesions preceded a significant decline in visual acuity from 20/25 to 20/600 OD. The right eye was diagnosed with OIS, showing ischemia and diffuse venular leakage on fluorescein angiography. Carotid Doppler and CT angiography revealed total occlusion of the right ICA. Medical management ensued. No neurovascular or cardiovascular events occurred in the 2-year follow-up. Final visual acuity was hand motions OD.

Conclusions: We describe a patient with total right ICA occlusion that presented with PAMM followed by OIS. Diagnostic imaging and ischemic/embolic work-up are essential for patients with PAMM and OIS.