Retinal Cases and Brief Reports最新文献

Purpose: To report a case of β-thalassemia trait with iron deficiency anemia presenting as a combined central retinal vein and artery occlusion.

Methods: Case report. A 22-year-old woman presented with sudden-onset blurry vision in the left eye of 3-day duration.

Results: Best-corrected visual acuity was 20/20 and 20/1000 in right and left eyes, respectively. Fundus examination of the left eye revealed optic disk edema, macular whitening with a cherry-red spot, markedly dilated and tortuous retinal veins, and hemorrhages both around the disk and extending into the macula and the periphery. Fundus fluorescein angiography showed delayed filling of retinal vasculature, dilated and tortuous retinal veins, and blocked fluorescence around and beyond the optic disk. Optical coherence tomography scan at presentation showed hyperreflective inner retinal layers with neurosensory detachment. Optical coherence tomography angiography showed that the vessel densities of superficial and deep capillary plexus were remarkably reduced. A diagnosis of β-thalassemia trait combined with iron deficiency anemia was made after hematologic workup. The patient was treated with a course of oral iron supplements, vasodilator (compound Xueshuantong), inhalation of a mixture of 5% carbon dioxide and 95% oxygen, and a nutritional agent (compound anisoine). Six months later, her visual acuity improved to 20/60 in the left eye with complete resolution of all clinical signs.

Conclusion: Combined central retinal vein and artery occlusion is a rare emergency leading to acute vision loss and can manifest in patients with β-thalassemia trait with iron deficiency anemia. Prompt diagnosis and early management is important to treat underlying systemic disorders and to prevent occurrence of a similar episode in fellow eye.

Purpose: To describe a unique case of Gore-Tex (Gore Medical, AZ) suture-associated delayed-onset endophthalmitis in a patient with a history of scleromalacia, pathologic myopia, multiple prior vitrectomies in the setting of a scleral-sutured intraocular lens (IOL).

Methods: A 69-year-old man complained of blurry vision and eye pain 21 months after implantation of a scleral-sutured IOL and was found to have an exposed Gore-Tex suture with scleromalacia, vision loss to hand motion, a hypopyon, and vitritis. He was diagnosed with culture-positive endophthalmitis. He had a previous history of a rhegmatogenous retinal detachment repair and subsequent dislocated IOL in this eye treated with a scleral-sutured IOL. A vitreous tap and injection of broad-spectrum antibiotics and suture removal at the slit lamp were performed at the time of presentation. One week later, he underwent pars plana vitrectomy and removal of the IOL.

Results: After the tap and inject and subsequent lens removal, his vision has returned to his preoperative vision of 20/100 with refraction.

Discussion: Gore-Tex suture is a nonabsorbable and flexible option with great tensile strength that has emerged as a favored alternative to polypropylene for the use in transscleral fixated IOLs. Although endophthalmitis and suture erosion are known complications of this procedure, this report describes one of the first cases of Gore-Tex suture-associated endophthalmitis.

Purpose: To describe two cases of severe peripapillary pachychoroid syndrome successfully managed with monthly intravitreal aflibercept therapy.

Methods: Medical and imaging records were retrospectively reviewed. Patients were imaged with ultra-widefield fluorescein, indocyanine green angiography, and fundus autofluorescence. Spectral-domain optical coherence tomography was performed to evaluate macular edema and choroidal thickness. Optical coherence tomography angiography excluded macular neovascularization.

Results: This report summarizes two cases of peripapillary pachychoroid syndrome complicated by very severe bilateral macular edema. In all four eyes, the diffuse intraretinal and subretinal fluid remarkably improved or completely resolved after monthly intravitreal aflibercept injections with commensurate improvement of visual acuity. Multimodal imaging documented the significant improvement of fluid and the reduction in choroidal thickening in response to anti-vascular endothelial growth factor therapy in each case.

Conclusion: Severe cases of peripapillary pachychoroid syndrome associated with vision loss can be successfully treated with intravitreal aflibercept therapy.

Purpose: To report a rare case of infusion port site tumor seeding of choroidal melanoma after pars plana vitrectomy-assisted biopsy and successful treatment with second plaque brachytherapy.

Methods: Observational case report with clinical data and diagnostic images.

Results: A 55-year-old White woman diagnosed with choroidal melanoma of the left eye was found to have a second intraocular tumor 30 months after plaque brachytherapy and pars plana vitrectomy-assisted tumor biopsy. The second melanoma developed at the 5 o'clock vitrectomy infusion port site. The tumor regressed after plaque brachytherapy, and the patient has not developed systemic metastasis 5 years after diagnosis of intraocular seeding.

Conclusion: Intraocular seeding into the infusion port site, although rare, may be encountered after pars plana vitrectomy-assisted biopsy of choroidal melanoma.

Purpose: Cystoid macular edema is a vision-threatening complication infrequently associated with hydroxychloroquine retinal toxicity. There are limited data on the best treatment for this pathology.

Methods: A retrospective case series is presented.

Results: In this series, we present three cases of cystoid macular edema in patients with diagnosed hydroxychloroquine maculopathy successfully treated with intravitreal dexamethasone implantation.

Conclusion: Minimal literature has been published regarding the best management of cystoid macular edema related to hydroxychloroquine toxicity. Our case series suggests a possible new agent in the treatment of this rare occurrence.

Purpose: We report an unusual case of likely combined retinal artery occlusion and retinal vein occlusion after a sneeze. Widefield swept-source optical coherence tomography-angiography was used to analyze retinal changes at one-month follow-up.

Methods: The patient reported visual symptoms in his left eye immediately after sneezing five times in a row. Fundus examination showed an embolus along the superior arcade. Stroke workup revealed moderate carotid artery stenosis and a subtherapeutic INR. At one-month follow-up, fundus photography and swept-source optical coherence tomography-angiography were obtained.

Results: Fundus photography showed superior retinal whitening and arteriole attenuation, an inferior perifoveal cotton wool spot, and inferotemporal intraretinal hemorrhages. Swept-source optical coherence tomography-angiography showed loss of the deep capillary plexus superiorly and inferotemporally, most consistent with combined retinal artery and retinal vein occlusion.

Conclusion: We report the first case of sneeze-induced combined retinal artery and retinal vein occlusion. The retina is a uniquely accessible window that provides insight into human physiology, and swept-source optical coherence tomography-angiography is a powerful tool that can give further insight into the pathophysiology of an occlusion.

Purpose: To characterize the white dots in white dot fovea, an entity chiefly described in Japan, using adaptive optics imaging and propose a hypothesis regarding their origin.

Method: The patient underwent comprehensive ophthalmic examination, including color and green monochromatic fundus photography, fluorescein angiography, spectral-domain optical coherence tomography, and adaptive optics imaging.

Results: An asymptomatic 66-year-old Korean woman presented with bilateral white, glistening deposits in a ring pattern around the fovea of both eyes. The dots were highly reflective on green monochromatic images, were not visible on fluorescein angiography, and appeared hyperreflective in the inner retina using spectral-domain optical coherence tomography. Adaptive optics showed polygonal granules ranging from 1 to 10 μ m in size. The patient denied any systemic disorder or the use of any medications related to crystalline retinopathy. The patient had lived in Japan for 35 years before just moving to the United States.

Conclusion: The location, small size, and polygonal shape of the dots in white dot fovea are suggestive of intraretinal deposition of crystals, and not cells on the surface of the fovea as has been previously proposed. Carotenoid deposition related to dietary habits is a plausible cause because of the similarity to other retinopathies associated to these compounds.

Purpose: To report the use of a subtenon's vancomycin injection for the treatment of subretinal abscess secondary to methicillin-resistant Staphylococcus aureus endogenous endophthalmitis.

Methods: A 17-year-old man developed endogenous endophthalmitis with subretinal abscess in his right eye secondary to methicillin-resistant Staphylococcus aureus bacteremia from axillary necrotizing fasciitis. Despite prompt treatment with IV vancomycin and an intravitreal vancomycin injection, the patient displayed minimal improvement. The patient was subsequently treated with a subtenon's vancomycin injection. The injection technique is described in detail, as well as a review of the treatment options available for bacterial subretinal abscesses.

Results: On presentation, examination revealed minimal vitritis and a large yellow subretinal abscess superotemporally extending close to the macula with subretinal fluid inferotemporally involving the macula. Four days postintravitreal vancomycin injection, the abscess remained stable and the patient developed an exudative detachment temporally. Vancomycin was injected superotemporally in the subtenon's space with no complications during the procedure or during his postoperative recovery. At seven days postinjection, the subretinal abscess and exudative retinal detachment resolved completely with necrosis at the area of previous abscess.

Conclusion: We present the first successful case of subtenon's vancomycin injection for the treatment of bacterial subretinal abscess. Our case demonstrates that subtenon's injection of antibiotics is a safe and effective nonsurgical management option for bacterial subretinal abscesses.

Purpose: To demonstrate intraoperative dynamic flow through an optic disk pit.

Methods: Retrospective interventional case report.

Results: Surgical management of an optic disk pit involved standard, 25-gauge, pars plana vitrectomy, induction of posterior hyaloid separation with triamcinolone stain, temporal peripapillary laser, and SF 6 gas. Intraoperatively, a remnant of stained vitreous at the optic disk head prolapsed into the optic disk pit with higher intraocular pressure but was drawn back into the vitreous cavity as the intraocular pressure was lowered. This clearly demonstrated a pressure differential across the pit.

Conclusion: Communication between the vitreous cavity and the perineural space of the optic nerve is described histologically. Our case demonstrated dynamic flow through the optic disk pit with intraoperative fluctuation of intraocular pressure.

Purpose: Kearns-Sayre syndrome (KSS) is a mitochondrial DNA deletion syndrome that is characterized by the triad of onset commonly before age 20, pigmentary retinopathy, and chronic progressive external ophthalmoplegia. Here, we present a case of KSS masquerading as myasthenia gravis.

Methods: Case report.

Results: A 15-year-old boy with a presumed diagnosis of myasthenia gravis presented with blurry vision, ophthalmoplegia, and ptosis. He was found to have a mitochondrial pigmentary retinopathy and was eventually diagnosed with KSS after mitochondrial DNA sequencing revealed a novel large-scale deletion of 7.9 kb of mitochondrial DNA from nucleotides 6,578 to 14,460.

Conclusion: We report a case of KSS found to have a novel large-scale mitochondrial DNA deletion. The presence of a mitochondrial pigmentary retinopathy found on dilated examination led to reconsideration of the previous diagnosis of myasthenia gravis and ultimately led to the correct diagnosis of KSS.