GMS ophthalmology cases最新文献

Vasculitis is a common cause of vision loss, and typically painful. In giant cell arteritis, the most common primary vasculitis in adults, we see elevated inflammatory markers, granulomatous inflammation, and associated headache or scalp tenderness. Vision loss caused by granulomatous with polyangiitis (GPA) is rare and typically associated with pain and orbital findings. Our patient presented for shortness of breath and painless vision loss without orbital inflammation or neural enhancement and a normal fundus exam, suggesting posterior ischemic optic neuropathy. Collaboration amongst sub-specialties and obtaining tissue samples are key to diagnosing granulomatosis with polyangiitis to ensure timely treatment of this fatal and blinding disease.

A 43-year-old woman presented with impaired vision and redness in her left eye of 2 weeks duration. She had a pet cat that scratched her forehead 3 weeks before she presented to us. She had no systemic signs such as lymphadenopathy, fever, or fatigue. The respective right and left corrected visual acuities were 20/16 and 20/2000. The anterior chamber of the left eye exhibited inflammation; a fundus examination of that eye revealed optic disc swelling and a serous macular detachment with hard stellate exudates. Based on the recent cat scratch and the ocular findings, cat scratch disease (CSD) was suspected. The results of serologic testing showed elevated titres of IgM and IgG antibodies to Bartonella henselae. Administration of doxycycline and a steroid was initiated. This report describes the occurrence of multiple ocular manifestations of CSD in both the posterior and the anterior segment.

Objective: This report describes a clinically rare case of congenital ectropion involving both upper lids in a one-day-old Indian newborn. We emphasize the importance of non-invasive conservative management with 5% hypertonic saline. Method: Observational case report Result: A term newborn presented to us on day 1 with bilateral upper lid ectropion or 'double congenital ectropion' noted since birth following an uneventful vaginal delivery. Examination revealed severe chemosis and prolapse of upper palpebral conjunctiva bilaterally. The repeated attempts to manually revert the eyelids in position failed. Otherwise, the eyes were normal. We started to treat the baby with topical hypertonic saline (5% sodium chloride), topical antibiotic, and topical lubricant frequently. Eye pads soaked in 5% hypertonic saline were also used. Following five days of treatment, the chemosis and ectropion resolved completely without recurrence. Conclusion: We advocate non-invasive conservative management with 5% hypertonic saline soaked pads over the eyes along with topical antibiotic and lubricants. It should be the first line of treatment in all cases of congenital ectropion, before jumping to any aggressive invasive treatment like tarsorrhaphy, skin grafting etc., or unnecessary referral.

Case report: We report a case of a 26-year-old woman with a previous history of complicated ulcerative colitis, as well as multiple episodes of recurrent anterior uveitis in control with adalimumab and methotrexate, who develops ocular hypertension refractory to topical treatment. The implant of an EXPRESS^® is proposed, but in the immediate post-operative period, the implant causes atalamia and does not achieve the correct control of intraocular pressure. A XEN^® stent was implanted. Due to failure, it was decided to remove the stent and to release a subconjunctival fibrosis that had formed at the subconjunctival portion of the XEN^®, in association with coating by an Ologen^® collagen matrix, which led to an improvement of the results. Conclusions: The surgical management of inflammatory glaucoma is complex in young patients with a scar component. The new minimally invasive techniques are effective in cases refractory to topical treatment, whose characteristics prevent the use of conventional ones.

Primary hyperplastic persistent vitreous (PHPV) or persistent fetal vasculature is a rare clinical entity that presents with leucocoria, microphthalmos, and cataract. It is mostly unilateral. Here we present a report of two cases of bilateral PHPV. One of the patients had associated Peters' anomaly. The entity closely mimics retinoblastoma and should be kept as a differential diagnosis of bilateral leucocoria. Examination under anesthesia, ultrasound B-scan, and aqueous lactate dehydrogenase levels helped us reach the diagnosis and differentiate it from the more serious entity retinoblastoma.

Purpose: Congenital retinal macrovessels (CRM) are large aberrant blood vessels that cross the horizontal raphe. Visual acuity may be negatively affected in cases afflicted with CRM due to macular serous detachment, hemorrhage, exudation, foveolar cyst formation and retinal artery occlusion. Even the presence of an anomalous vessel itself running through the foveal avascular zone may compromise the visual acuity. In this case report, we discuss the multimodal imaging characteristics of a case of symptomatic unilateral CRM-related cystoid macular edema and serous macular detachment in a 13-year-old boy. Observations: Optical coherence tomography angiography (OCTA) imaging of the superficial retina revealed the aberrant vessel and anomalous arteriovenous communication between the aberrant vessel and the retinal artery. The foveal avascular zone also appeared partly distorted. Conclusions: The present case reports the second-youngest patient afflicted with unilateral CRM and associated macular edema. There was spontaneous resolution of macular edema within six weeks. In light of the observations in this case and the literature review, the need to refrain from rapid therapeutic intervention in the eyes of patients affected with CRM and macular edema must be emphasized.

Objective: To report a case of delayed spontaneous closure of traumatic macular hole at 5 months in a 66-year-old man. Traumatic macular holes generally do not close spontaneously after 4 months and over 30 years of age. Methods: A 66-year-old man presented with central blurred vision and metamorphopsia in his right eye for 3 weeks after previous ocular blunt trauma occurring 2 months earlier. Best corrected visual acuity was 6/36 in his right eye, fundus examination and OCT revealed right traumatic macular hole. Results: 4 weeks later, best corrected visual acuity was 6/18, OCT showed initial reattachment of traumatic macular hole margins. 8 weeks later, best corrected visual acuity improved to 6/9, OCT showed almost complete reattachment of the margins, residual outer retinal defect being still present. At 12 weeks after initial presentation, best corrected visual acuity was 6/6, OCT showed normal neuroretinal profile. Conclusion: Clinical monitoring of traumatic macular holes might be performed up to 5 months even in patients >30 years before considering surgery.

A 67-year-old man was referred for iris color change. He was noted to have narrow angles with atrophic iris appearance and visually significant cataracts. The iris findings were consistent with iridoschisis. The patient was recommended to have cataract surgery. Unfortunately, he was lost to follow-up. One year later, he presented with chronic angle closure glaucoma on the right eye with very high pressure and very poor remaining vision. Left-eye vision was also compromised with cataract. Despite the presence of small pupil, abnormal iris stroma, and dense cataract, the patient underwent successful cataract surgery and achieved 20/20 vision post-operatively. Iridoschisis can cause substantial ocular morbidity if not treated timely.

Angioid streaks (AS) are irregular crack-like dehiscences in Bruch's membrane that are often associated with atrophic degeneration of the overlying retinal pigment epithelium. We herein report multimodal imaging of AS. Multicolor imaging highlighted AS in dark orange color. AS were better visualized in infrared reflectance as compared to green reflectance and blue reflectance. Peau d'orange appearance was seen as alternating dark and bright patches on color fundus photography with corresponding hyporeflective and hyperreflective patches on infrared reflectance. Comet lesions showed increased signal on infrared reflectance and hyperautofluorescence. Multicolor imaging is a non-invasive imaging modality which helps in clearly delineating these lesions.