Retinal Cases and Brief Reports最新文献

Purpose: The purpose of the study is to show the excellent anatomical result of the inverted flap-assisted technique with platelet-rich plasma under air for retinitis pigmentosa complicated with macular hole.

Methods: A 32-year-old woman, previously diagnosed with retinitis pigmentosa, was referred to our department complaining of decreased central vision in her left eye for 4 weeks. At the time of presentation, the optical coherence tomography and fundoscopy examination showed the presence of a macular hole of 620 μ m in diameter. The closure of the macular hole was observed after the surgical procedure, but endophthalmitis occurred 5 days, postoperatively.

Results: In our presented case, the cover flap-assisted technique with platelet-rich plasma under air for retinitis pigmentosa complicated with macular hole resulted in excellent anatomical outcomes with unremarkable visual recovery.

Conclusion: The physiopathology of full-thickness macular holes in retinitis pigmentosa patients remains still not fully elucidated. Pars plana vitrectomy with the adjunct of highly concentrated pure platelet-rich plasma have shown successful results.

Purpose: To describe a case of perfluoro-n-octane (PFO) retention, migration into the anterior chamber, and the subsequent formation of iris nodules after the repair of a giant retinal tear.

Methods: Patient data were collected by a manual chart review. All patient information was deidentified.

Results: Slit-lamp photographs demonstrate nodules on the iris surface and retained PFO in the anterior chamber. Ultrasound biomicroscopy shows multifocal hyperreflective signals on the iris surface, corresponding to the retained PFO within the iris.

Conclusion: Retention and migration of PFO to the anterior chamber after retinal detachment repair can lead to formation of nodules on the surface of the iris.

Purpose: To report a case of a patient who suffered a full-thickness macular hole because of the accidental utilization of the selective laser trabeculoplasty mode of a dual mode laser.

Method: Case report.

Results: A 69-year-old woman experienced vision loss in her left eye immediately after undergoing attempted neodymium:yttrium-aluminum-garnet capsulotomy using a neodymium:yttrium-aluminum-garnet-selective laser trabeculoplasty laser system. Postinjury visual acuity was 20/25 and 20/800 in the right and left eyes, respectively. Ophthalmic examination and multimodal imaging revealed multiple macular hemorrhages and an irregular full-thickness macular hole. The patient required multiple surgeries including an autologous retinal transplant to achieve hole closure.

Conclusion: Macular hole formation is a devastating consequence of inadvertent use of the selective laser trabeculoplasty mode when performing a neodymium:yttrium-aluminum-garnet laser capsulotomy with a neodymium:yttrium-aluminum-garnet-selective laser trabeculoplasty laser system. The authors emphasize the importance of ensuring the correct mode is selected for treatment to minimize the risk of retinal damage and permanent vision loss.

Purpose: Introduce a unique case of primary vitreoretinal lymphoma with a new optical coherence tomography finding.

Methods: A case report. A 67-year-old healthy man with complaints of blurry vision in his right eye.

Results: The patient's visual acuity was 20/60 and 20/20 in the right and left eyes, respectively. Anterior segment examination of the right eye demonstrated mild inflammation. Dilated fundoscopy revealed 2+ vitreous haze and 4+ disk edema. Optical coherence tomography of the macula in the right eye revealed optic nerve head swelling and thickening of the retina. Fluorescein angiography demonstrated mild leakage and staining of vessels along the inferotemporal arcade in the right eye. Labs were within normal limits except positive Herpes simplex virus 1 IgG. Initially, the patient was treated for herpetic panuveitis for 3 weeks with a favorable response. However, the clinical condition deteriorated as a new abnormality was identified in the macular region of the right eye through optical coherence tomography. Considering intraocular lymphoma as a potential diagnosis, the patient underwent a diagnostic vitrectomy. The vitreous sample analysis confirmed primary vitreoretinal lymphoma through immunohistochemistry and flow cytometry. The patient exhibited a rapid response after the initiation of intravenous and intravitreal methotrexate treatment.

Conclusion: The presence of subretinal fluid accompanied by suspended hyperreflective lesions originating from the roof of the subretinal fluid pocket on the optical coherence tomography of macula "stalactite sign" may serve as a characteristic sign indicative of primary vitreoretinal lymphoma; however, further investigation using robust studies is necessary to examine this hypothesis.

Purpose: To describe novel microperimetry and imaging findings in two patients affected by extensive macular atrophy with pseudodrusen-like appearance without signs of retinal pigment epithelium atrophy.

Methods: Case series. Both patients underwent mesopic and dark-adapted two-color scotopic microperimetry, followed by multimodal imaging assessment including ultra-widefield photography, fundus autofluorescence, high-resolution optical coherence tomography, optical coherence tomography angiography, and high-magnification module.

Results: Albeit normal visual acuity, both patients had a significant reduction of retinal sensitivity-especially under scotopic cyan conditions. One patient had macular pigment abnormalities, whereas the combination of blue and near-infrared autofluorescence modalities highlighted different patterns of pseudodrusen-like lesions.Of notice, high-resolution optical coherence tomography revealed a marked separation between the retinal pigment epithelium and Bruch membrane, containing a hyperreflective material with two different reflectivities. Optical coherence tomography angiography excluded the presence of macular neovascularization and documented several choriocapillaris flow voids. High-magnification module images showed severe alteration of photoreceptors' mosaic in the perifovea.

Conclusion: Our comprehensive assessment of two stage 1 extensive macular atrophy with pseudodrusen-like appearance patients revealed a predominant damage of perifoveal rods over areas of retinal pigment epithelium-Bruch membrane separation. These findings underscore the importance of basal laminar deposits in the initial stages of extensive macular atrophy with pseudodrusen-like appearance, contributing to a deeper understanding of its underlying mechanisms.

Purpose: To describe the clinical response and safety profile of the novel HIF-2ɑ inhibitor belzutifan in treating a giant retinal hemangioblastoma with extrascleral extension associated with von Hippel-Lindau syndrome.

Methods: A 71-year-old woman with Von Hippel-Lindau syndrome presented with a giant retinal hemangioblastoma with extrascleral extension in her only remaining eye. She had no light perception in the right eye and intraocular pressure was 48. She requested enucleation because of chronic pain, but because of concern for significant bleeding given the size of the neoplasm, a trial of belzutifan was initiated.

Results: Within 3 months of treatment initiation, the patient reported an 80% reduction in pain. Magnetic resonance imaging showed 30% reduction in longest tumor diameter. Dose adjustments were guided by serum hemoglobin levels, allowing the patient to remain on the medication for over a year with continued tumor regression on MRI and avoid enucleation.

Conclusion: Retinal hemangioblastoma with extrascleral extension is exceedingly rare and its treatment is complex, often requiring enucleation or external beam radiotherapy. This report demonstrates the use of belzutifan to safely and successfully reduce ocular tumor burden of complicated retinal hemangioblastoma with extrascleral extension, ultimately decreasing the need for enucleation.

Purpose: To present a case of familial exudative vitreoretinopathy with nasal retinal involvement and aim to describe the clinical presentation, diagnostic findings, management strategies, and genetic testing.

Methods: An evaluation of a 31-year-old female patient with familial exudative vitreoretinopathy presenting with predominate nasal retinal involvement. Diagnostic tests-including fundus examination, optical coherence tomography, fluorescein angiography, and genetic testing-were performed. The patient's management involved intravitreal injection of 1.25 mg/0.05 mL of bevacizumab in the left eye and sectoral panretinal photocoagulation in both eyes.

Results: The patient exhibited discrete neovascularization and tortuosity predominantly localized to the nasal retinal blood vessels. Optical coherence tomography imaging showed macular schisis and vitreomacular traction without retinal detachment. Genetic testing identified a likely pathogenic variant associated with autosomal dominant and recessive exudative vitreoretinopathy. Treatment with bevacizumab and panretinal photocoagulation resulted in regression of neovascularization and improvement in macular schisis. Conclusion: This case report highlights an atypical presentation of familial exudative vitreoretinopathy with nasal retinal involvement. Early recognition and genetic testing aids in diagnosis and management.

Purpose: We discuss a case of macular edema and retinal hemorrhage associated with scleromyxedema.

Methods: A case report is presented.

Results: A 64-year-old man with history of deep vein thrombosis and pulmonary embolism presented with new-onset rash in the setting of switching anticoagulation treatments. He developed blurred vision, was found to have macular edema and dot blot retinal hemorrhages that improved with systemic and topical corticosteroids.

Conclusion: Systemic autoimmune conditions including scleromyxedema should be considered in the workup of occult cystoid macular edema.

Purpose: To present an orbital extranodal marginal zone B-cell lymphoma (mucosa-associated lymphoid tissue lymphoma) with increased choroidal thickness as the first diagnostic sign.

Methods: A patient presented with mild blurred vision in the left eye. Progressively increased choroidal thickness was demonstrated by enhanced depth imaging-optical coherence tomography and ocular ultrasound-confirmed diffuse choroidal effusion. Orbital MRI revealed a well-circumscribed intraconal orbital mass surrounding the optic nerve and molding around the globe. An orbital biopsy of the lesion with subsequent histologic and immunohistochemical analyses demonstrated mucosa-associated lymphoid tissue lymphoma.

Results: After initial treatment with rituximab without improvement, the patient received orbital radiotherapy (36 Gy in 20 sessions). A reduction in choroidal thickness was observed during follow-up visits. Congestion of the choroidal vasculature and choroidal infiltration by the lymphoma are discussed as possible causative mechanisms.

Conclusion: Enhanced depth imaging-optical coherence tomography can be a helpful tool to detect the presence of orbital lymphoid tumors in contact with the globe and to monitor response to therapy.

Purpose: To describe idiopathic multifocal choroiditis with chorioretinal atrophy developing choroidal flow voids on optical coherence tomography angiography that preceded a recurrence of the disease.

Methods: Case report.

Results: A 24-year-old woman presented with visual field changes and occasional photopsias. Systemic workup for syphilis, tuberculosis, and sarcoidosis was negative. Clinical findings and multimodal imaging were consistent with idiopathic multifocal choroiditis with chorioretinal atrophy, complicated by inactive choroidal neovascularization in her right eye. She was treated with systemic corticosteroids with a taper over 3 months without change in her examination. She was then stable for 2 years. At that point, the patient experienced increased photopsias, but her examination result was unchanged. Optical coherence tomography angiography showed multiple flow voids in the choroid that were not present 6 months ago. No lesions were seen on other imaging modalities. Structural optical coherence tomography showed some subtle hyperreflectivity throughout the choroid that was previously absent. Given the unknown significance of these flow voids, the patient was asked to return for follow-up in 1 month. Her photopsias improved, and her vision remained normal. On repeat examination after 1 month, the patient had developed a few subtle yellow lesions in the superonasal quadrant of the left eye. There were no macular lesions. The repeat optical coherence tomography angiography revealed that the flow voids were fading.

Conclusion: Imaging findings using optical coherence tomography angiography in our patient with idiopathic multifocal choroiditis showed choroidal flow voids that preceded clinical recurrence, not detected by other imaging modalities. Future studies should determine whether optical coherence tomography angiography can be used to detect subclinical lesions preceding clinical recurrences of idiopathic multifocal choroiditis.