GMS ophthalmology cases最新文献

Ophthalmomyiasis externa is the most common manifestation of Oestrus ovis (sheep nasal botfly) in humans. Several cases have been reported from various regions of India with the first case reported by Elliot in 1910. Here, we report such a case from North India along with the review of literature from India of the last fifteen years. A farmer presented to us with unilateral ocular symptoms of redness, foreign body sensation and severe watering in left eye who was misdiagnosed as acute conjunctivitis elsewhere. On slit lamp examination, multiple translucent larvae were found in his conjunctival sac. Microbiological analysis revealed them to be larvae of the Oestrus ovis fly. External ophthalmomyiasis is an uncommon entity with ocular symptoms mimicking acute conjunctivitis, hence a thorough examination in every suspicious case of acute red eye is important.

Corneal shield ulcer is a severe complication of atopic keratoconjunctivitis (AKC) and vernal keratoconjunctivitis (VKC). This condition is caused by the mechanical irritation of the corneal epithelium due to giant papillae and toxic epitheliopathy resulting from inflammatory mediators. To date, there have been no reported cases of corneal shield ulcers in the literature without AKC or VKC. However, the authors have reported a unique case of shield ulcer in a patient with keratoconus but no history of AKC or VKC. The cause is hypothesised to be due to mechanical friction between the corneal steep apex and palpebral conjunctiva. Additionally, a new technique, the use of a dry amniotic membrane, is described to manage the persistent epithelial defect in shield ulcers.

Purpose: We report the same side recurrence of multiple evanescent white dot syndrome (MEWDS) subsequent to 532 nm laser treatment for the macular neovascularization (MNV) associated with the first MEWDS episode.

Method: Retrospective case documentation with the multimodal imaging.

Result: A 24-year-old otherwise healthy woman who was diagnosed as having left MEWDS four years ago was re-examined for a visual disturbance of the duration of one month in the same eye. Fundus evaluation led us to the diagnosis of left extrafoveal inflammatory MNV. Surprisingly, she developed further visual deterioration a month following the uneventful 532 nm laser photocoagulation in her left eye. Fundus examination and multimodal imaging tests confirmed the recurrent MEWDS after full negative laboratory work-up. Visual acuity and fundus changes were improved with the help of a short course oral steroid therapy.

Conclusion: MEWDS can very rarely recur and thermal laser photocoagulation may be a possible triggering factor.

Objective: To report the clinical findings and results of a patient who underwent deep anterior lamellar keratoplasty (DALK) combined with phacoemulsification.

Methods: Retrospective analysis of a case that underwent unsuccessful DALK surgery with no visual gain due to striations on the posterior surface of the donor, permanent interface irregularity, and scarring.

Results: Two years after the first DALK surgery, a repeated DALK was performed in combination with phacoemulsification of the cataract that developed during this period. The graft was clear with no signs of rejection or endothelial decompensation, and corrected distance visual acuity was 6/10 in the postoperative last visit, one year after the surgery.

Conclusions: Combining the DALK technique with phacoemulsification in patients with coexisting cataracts may help to achieve a good visual outcome and long-term graft survival. Even after an unsuccessful DALK experience, insisting on preserving the patient's own endothelium resulted in successful vision restoration with no imposition of further risks for graft survival.

Objective: We report the case history and clinical findings in two siblings, a 13-year-old male and a 10-year-old female, who presented with complaints of poor vision since childhood. Both children had blonde hair and depigmented skin.

Methods: Ocular examination revealed white eyebrows, white eyelashes, diminished vision in all eyes, hypochromic irides and pendular nystagmus. On dilated fundus examination, hypopigmented fundi with conspicuously visible choroidal vessels were noted. No foveolar reflex could be discerned and spectral domain optical coherence tomography (SD-OCT) of the macula showed an absence of the foveal pit in all four eyes. On pedigree charting the subjects were the 2^nd and 3^rd offspring of a non-consanguineous married couple. One of the mother's siblings and one of the grandmother's siblings also had a similar disorder.

Results: The poor definition of the foveal pit at the centre of the macula, i.e. foveal hypoplasia, accounted for poor visual acuity and nystagmus. Both cases had no syndromic associations. Spectacle correction was prescribed to both children, and low-vision aids and sun protection advised.

Conclusion: Oculocutaneous albinism (OCA) represents a range of inherited, congenital disorders of hypomelanosis, involving the skin, hair, and eyes with an estimated prevalence of 1 in 17,000 cases. Affected children suffer severe visual disability while early identification may potentially mitigate it, hence there is need to sensitize primary care practitioners regarding the general symptoms of OCA.

We present a case of a young woman who presented with blurring of vision in her right eye, worsening on near work. Detailed ophthalmic and neurological evaluation was done, which revealed light near dissociation, vermiform iris movements, constriction to diluted pilocarpine with absent deep tendon reflexes. Laboratory investigation indicated mild iron deficiency anemia and reduced vitamin D3 level. On orthopedic evaluation she was diagnosed with right knee joint arthritis and grade 1 patellar chondromalacia. Neuroimaging was within normal limits. Magnetic resonance imaging (MRI) pelvis and lumbar spine showed left ovarian cyst, small periurethral cyst and small hemagioma in left sacral ala. A diagnosis of Holmes-Adie syndrome was made and she was prescribed photochromatic glasses.

Background: Pseudophakic cystoid macular edema (CME) following primary anterior-chamber intraocular lens (ACIOL) implantations is commonly seen. Intravitreal triamcinolone acetonide (IVTA) injections have shown significant improvement in visual acuity and retinal thickness in refractory pseudophakic CME. Pseudohypopyon following IVTA injection is a known entity.

Objective: To report a rare complication of transient acute vision loss due to ACIOL coating with triamcinolone acetonide particles following intravitreal injection.

Methods: Case study.

Results: A patient developed pseudophakic cystoid macular edema two months post complicated cataract operation with ACIOL implantation. Despite topical steroid treatment, CME persisted and the patient was administered intravitreal triamcinolone acetonide injection. Acute vision loss due to dense coating of ACIOL with triamcinolone particles was noted on the next day. Conservative management led to spontaneous clearing of intraocular lens (IOL) and resolution of CME in 4 weeks.

Conclusions: Opacification of ACIOL following IVTA injection is a rare complication which can be seen in eyes with compromised zonular/capsular bag integrity.

Purpose: Idiopathic elevated episcleral venous pressure (IEEVP) or Radius-Maumenee syndrome (RMS) is a rare disease without any identified underlying cause. An increasing episcleral venous pressure (EVP) leads to raised intraocular pressure (IOP) and consequently glaucomatous damage of the optic nerve. The objective of this paper is to report this rare condition as well as its clinical management.

Observations: During cataract evaluation a 38-year-old female patient referred to redness in her right eye that had started more than 3 years before. The IOP was 22 mmHg in her right eye and 14 mmHg in her left eye, although she was already using Timolol drops. Biomicroscopy revealed diffusely engorged episcleral vessels, without any other relevant findings. Intracranial magnetic resonance imaging (MRI) was normal. For that reason, the diagnosis of RMS was established. After 3 months, the patient remains in use of Timolol and Latanoprost eye drops, with intraocular pressure within normal levels. She continues to be followed up on a regular outpatient basis.

Conclusions and significance: RMS is a diagnosis of exclusion, based on clinical findings and imaging exams. Treatment includes eyes drops and surgery in refractory cases.

Objective: To present a rare case of cancer-associated retinopathy secondary to gallbladder carcinoma.

Methods: Retrospective case report. Drugs used in case report: methylprednisolone (Medrol), CAS number: 83-43-2, producer: Pfizer; carboplatin, CAS number: 41575-94-4, producer: Accor; etoposide, CAS number: 33419-42-0, producer: Teva; methotrexate (Ledertrexate), CAS number: 59-05-2, producer: Pfizer.

Results: A 57-year-old Moroccan man was referred with bilateral progressive vision loss in the last 4 months. At presentation, best corrected visual acuity (BCVA) was counting fingers for the right eye and 20/500 for the left eye. Examination demonstrated signs of vitritis, an electronegative full-field electroretinography (FF-ERG), ocular coherence tomography (OCT) abnormalities and multiple hyperautofluorescent round lesions on fundus autofluorescence imaging (FAF). The diagnosis of cancer-associated retinopathy (CAR) was considered, thus a positron emission tomography-computed tomography (PET-CT) was performed and revealed the presence of a metastasized gallbladder carcinoma. Additional fluorescence in situ hybridization (FISH) showed seropositivity for anti-retinal autoantibodies. High-dose corticosteroids together with anti-tumoral medication (carboplatin-etoposide) gradually improved the BCVA to 20/66 for the right eye and 20/20 for the left eye.

Conclusions: Consider the diagnosis of CAR in patients with progressive concentric visual field loss, uveitis and fundus abnormalities, especially if bilateral. If CAR is suspected, perform a full work-up: FF-ERG, OCT, and whole-body PET-CT. In the treatment of CAR, immunosuppressives are mostly used, combined with antitumoral therapy. However, in the long-term, progressive visual loss is expected in most cases.