Retinal Cases and Brief Reports最新文献

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.

Purpose: To report a case of bilateral rhegmatogenous retinal detachment following pazopanib treatment and the rationale for selecting scleral buckling as the treatment approach.

Methods: A case report of a 67-year-old woman with clear cell renal cell carcinoma and metastatic progression, who was treated with pazopanib. The patient developed bilateral rhegmatogenous retinal detachment with macular involvement. Scleral buckling was performed on both eyes.

Results: Scleral buckling led to immediate and sustained retinal reattachment in both eyes. Postoperatively, the patient developed acute bilateral periorbital inflammation and chronic pain in the left eye.

Conclusion: Scleral buckling effectively treated the retinal detachment in this pazopanib-treated patient. It may be a preferred treatment option over pars plana vitrectomy with laser retinopexy, since literature review revealed a case report of failed laser retinopexy in a pazopanib-treated patient. Further research is needed to determine the relationship between pazopanib and postoperative periorbital inflammation and chronic eye pain.

Purpose: To present a case of a dislocated posterior lamellar graft into the vitreous cavity in an eye that was post pars plana vitrectomy.

Methods: Retrospective case report.

Results: A middle-aged man underwent pars plana vitrectomy (PPV), pars plana lensectomy (PPL), and SSIOL fixation following a traumatic eye injury. The patient required subsequent Descemet stripping automated endothelial keratoplasty (DSAEK) for corneal edema, and the posterior lamellar graft was lost intraoperatively into the posterior segment. The graft was surgically retrieved one week later, followed by a successful placement of a new posterior lamellar graft. Histopathological examination of the retrieved graft after one week in the vitreous cavity revealed viable endothelial cells, a novel finding in a posteriorly dislocated DSAEK graft. The newly placed graft remained attached and healed well, with the patient achieving a visual acuity (VA) of 20/80 at three months post-operatively.

Discussion: Posteriorly dislocated grafts may be suitable for transplantation to the corneal stroma following prompt retrieval from the vitreous cavity. Prompt retrieval and appropriate surgical techniques are critical for optimizing outcomes in such clinical scenarios.

Purpose: To report a case of bilateral serous retinal detachment occurring early in the course of thrombotic thrombocytopenic purpura (TTP), with a complete and sustained visual and anatomical recovery following rituximab treatment.

Methods: Clinical and laboratory assessments were performed, supplemented by serial optical coherence tomography imaging. Treatment was pursued with corticotherapy, plasmapheresis and rituximab.

Results: Vision-threatening serous retinal detachments associated with TTP responded favorably to rituximab, leading to a complete retinal reattachment within one week and full visual recovery within one month.

Conclusion: Serous retinal detachment should be considered in cases of acute painless visual loss in patients with TTP. Prompt escalation of immunotherapy, particularly rituximab, seems to safeguard excellent visual and anatomical outcomes.

Purpose: To report a case of a 43-year-old female with post intravitreal injection endophthalmitis who presented with segmental perivascular sheathing simulating frosted branch angiitis.

Methods: We promptly suspected and treated the atypical presentation of post anti-VEGF bacterial endophthalmitis with pars plana vitrectomy and intraocular and oral antibiotics.

Results: Patient showed dramatic response to the treatment and made full visual recovery with resolution of clinical signs.

Conclusion: Frosted branch angiitis (FBA), though typically associated with autoimmune conditions, malignancies, or certain viral infections, may also present as an early manifestation of bacterial endophthalmitis. Prompt initiation of treatment can significantly improve visual outcomes.

Purpose: To report a case of a female patient in her 90s who presented with an inferotemporal serous retinal detachment after accidental subretinal triamcinolone acetonide (TCA) injection following orbital floor injection for cystoid macular oedema.

Methods: Observational case report.

Results: There was an acute intraocular pressure elevation immediately following the injection that resolved with medical management. TCA has been reported to potentially be toxic to the outer retinal layers. However, the retinal detachment gradually resolved without intervention with resolution of the cystoid macular oedema and improvement in visual acuity.

Conclusions: Conservative management may be an option following a careful detailed assessment in selected cases of accidental subretinal TCA injection.

Purpose: To demonstrate the novel use of a 31-gauge needle for flanged intrascleral intraocular lens (IOL) fixation using the double-needle technique.

Methods: Flanged intrascleral IOL fixation was performed using the ZELOSTAT 31G (ASTI, Shizuoka, Japan) needle in a 73-year-old male with right IOL subluxation.

Results: The IOL was successfully fixated with smooth intraoperative handling, excellent postoperative outcomes, no complications, and minimal refractive error.

Conclusion: The 31-gauge needle has a larger inner diameter compared to the conventional 30-gauge thin-wall needle, which may facilitate intrascleral IOL fixation procedures.

Purpose: To report the finding of a hyperreflective ganglion cell layer band (HGB) in a genetically confirmed case of isolated NCL3-associated retinal degeneration.

Methods: Multimodal imaging, including ultra-widefield fundus photography and optical coherence tomography (OCT) was used to assess findings.

Results: A 21-year-old male with progressive vision loss since age 6 presented with light perception vision, nyctalopia, and photophobia. Genetic testing revealed compound heterozygous NCL3 variants (Glu295Lys and a splice-site mutation), consistent with NCL3-associated retinal dystrophy without systemic neurologic features. Fundus exam showed diffuse retinal pigment epithelial (RPE) mottling, arteriolar narrowing, and intraretinal pigment. Spectral domain optical coherence tomography (SD-OCT) demonstrated outer retinal atrophy, and a continuous hyperreflective band within the ganglion cell layer.

Conclusion: This report highlights a previously undescribed finding of a hyperreflective ganglion cell layer band in isolated NCL3-associated retinopathy, further expanding the spectrum of structural inner retinal changes seen in this condition and underscoring the role of Müller cell and ganglion cell involvement in the pathogenesis of NCL3-linked retinal degeneration.

Purpose: To report aggressive surgical management for bilateral acute neonatal endogenous Candida endophthalmitis in the different presenting spectrums of the disease.

Methods: Ultra-widefield fundus photo documentation for both eyes at presentation and after the surgical procedure. Surgical video with stepwise precautions while performing the procedure of pars plana lensectomy for lens abscess, vitrectomy for vitreous exudates, and cryotherapy for fungal granuloma in neonatal endogenous endophthalmitis.

Results: A 2-month-old baby with a history of premature birth was referred to our hospital by the treating pediatrician with a clinical suspicion of endogenous endophthalmitis in the right eye. The baby was diagnosed with acute synovitis of the right knee and was on treatment. On examination, the right eye showed a focal lens abscess with pars plana granuloma, with a temporal retinal fold and persistent fetal vasculature stalk arising from the disc. The left eye showed floating posterior vitreous exudates. The right eye underwent pars plana lensectomy and vitrectomy. A cryotherapy was performed for the granuloma, and an intravitreal antifungal was injected. The left eye underwent lens-sparing vitrectomy with intravitreal antifungal. Both eyes' vitreous biopsy samples confirmed Candida by fungal polymerase chain reaction (PCR). The pediatrician continued systemic antifungal. Both eyes showed resolved endogenous endophthalmitis with favorable outcomes at 1-month post-surgery.

Conclusion: Early aggressive surgical intervention with lensectomy for lens abscess, complete vitrectomy with base shaving, Cryotherapy for fungal granuloma, and intravitreal and systemic antifungal agents for endogenous endophthalmitis plays a pivotal role in targeting localized fungal lesions to control their progression.