GMS ophthalmology cases最新文献

Objective: To report the successful outcome with a single intravitreal ranibizumab injection in a 15-year-old boy with Bietti crystalline dystrophy (BCD) who developed a unilateral macular neovascularization (MNV).

Methods: A retrospective case report.

Results: A 15-year-old Caucasian boy with Bietti crystalline dystrophy was diagnosed to have a unilateral MNV a year after the initial examination with the help of multimodal imaging and he was treated with a single intravitreal ranibizumab injection. Five months later, visual acuity improved and anatomically a dry-looking macula was noted.

Conclusion: MNV is among the rare macular complications of BCD. The present case is the third reported pediatric case with MNV in association with BCD and the first pediatric BCD patient who received a vascular endothelial growth factor inhibitor (anti-VEGF) agent.

Wilson's disease, also called hepatolenticular degeneration, has varied clinical manifestations and poses diagnostic challenges. Kayser-Fleischer ring, when present, is considered pathognomic of Wilson's disease. Although its presence is most commonly seen with the neuro-psychiatric form of the disease, it can also be present in hepatic form and asymptomatic patients. We report a case of unilateral Kayser-Fleischer ring in the normal, functional eye of a patient which subsequently led to the diagnosis of Wilson's disease in the patient. This case also highlights the examination of the normal appearing eye in all the patients presenting with complaints in only one eye.

Introduction: To describe the role of microscope integrated optical tomography (Mi-OCT) in removal of intrastromal corneal foreign body.

Methodology: A young male presented with trauma to the right eye with sugarcane stick. Ocular examination revealed two sugarcane particles, approximately 3.5 mm in greatest dimension, embedded in the corneal stroma. For removal of foreign body, Mi-OCT was switched on and the area of interest was focused. Sugarcane particles appeared as hyperreflective structures embedded in the corneal stroma with everted edges of the overlying corneal epithelium and anterior stroma.

Results: Both the sugarcane particles were removed successfully under real time images provided by Mi-OCT without causing any inadvertent damage to the corneal stroma.

Conclusion: Mi-OCT can be used as an adjunct in emergency surgical procedures like removal of intrastromal corneal foreign bodies with accurate precision.

A young male was brought to the ophthalmic emergency by his family with severe bleeding from both eyes after self-inflicted injury with scissors in a fit of mania. He had a history of schizophrenia and has been on irregular treatment for the past 10 years. Both eyes were severely damaged with avulsion of all extraocular muscles in one eye and a large corneoscleral laceration in the other. We report this unique case of oedipism or self-enucleation where a sharp instrument was used. Self-inflicted injury to the eyes is a rather uncommon phenomenon described in psychiatric patients. It can range from minor abrasions to severe ocular mutilation and loss of sight. The strict observation of these patients while admitted to the hospital and a multidisciplinary approach to ensure their future safety are imperative.

Purpose: To report an occult intraocular foreign body mimicking choroidal melanoma.

Methods: Medical records and imagings of the patient were retrospectively reviewed.

Case description: A 76-year-old male was referred to our ocular oncology clinic with a suspicious hyperpigmented retinal lesion in the left eye. Biomicroscopy showed aphakia and peripheral iridectomy in the left eye. Fundoscopy revealed a pigmented, slightly elevated lesion on the macula of the left eye surrounded by diffuse atrophy. B-scan ultrasonography showed a preretinal hyperechoic lesion with posterior shadowing. There was no choroidal mass in B-scan or optical coherence tomography (OCT) imaging. On further questioning, it was disclosed that the patient had been hit by an iron fragment in the left eye forty years ago.

Conclusion: Choroidal melanoma is a vision- and life-threatening intraocular malignant tumour. Various neoplastic, degenerative, and inflammatory conditions can simulate choroidal melanoma. A previous history of penetrating ocular trauma should lead the surgeon to re-evaluate a diagnosis of melanoma.

Gelatinous drop-like corneal dystrophy (GDLD) is a rare autosomal recessive corneal dystrophy that has been associated with mutations in the TACSTD2 (M1S1) gene, which is normally expressed in corneal epithelial cells. GDLD is characterized by progressive deposition of amyloid in the corneal stroma with rapid recurrence in grafts after penetrating keratoplasty. We report of case of a patient with GDLD treated bilaterally with staged limbal stem cell transplantation and penetrating keratoplasty that resulted in long-term control of his disease. This case demonstrates that staged allogenic limbal stem cell transplantation, before or after penetrating keratoplasty, can be used to restore vision long-term in GDLD patients.

Objective: To report a case of recalcitrant fungal keratitis successfully managed with topical caspofungin acetate in North India.

Methods: Case report and literature review.

Results: An 18-year-old male patient presented with complaints of redness, watering, pain and diminution of vision in the right eye and was referred to our centre as a case of corneal ulcer. The patient was examined and found to have a near total epithelial defect, with corneal infiltrates approximately 8x8 mm. A provisional diagnosis of polymicrobial keratitis was made based on corneal scraping suggestive of S tap h ylococcus aureus and confocal scan revealing fungal hyphae. The patient failed to respond to topical voriconazole 1%, natamycin 5% and moxifloxacin hydrochloride 0.5% with oral voriconazole. In view of the poor response to these drugs, the patient was subsequently administered topical caspofungin 0.5% in place of natamycin and continued on topical and oral voriconazole, in addition to topical moxifloxacin and cycloplegics, which finally led to healing with minimal scarring. The patient attained a best corrected visual acuity (BCVA) of 6/12.

Conclusion: Topical caspofungin may be used as a useful and effective alternative in cases of recalcitrant fungal keratitis. It may result in healing with minimal scarring.

Retinal vascular events may occur as rare complications of glaucoma procedures due to various factors, including exacerbation of ischemia in patients with pre-existing vascular comorbidities, toxic effect of mitomycin-C, and decompression retinopathy. We present the case of a 47-year-old hypertensive male who underwent trabeculectomy for advanced glaucoma in his right eye. At 3 weeks postoperatively, he presented with a drop in visual acuity to light perception with a spike in intraocular pressure. On examination, there was increased bleb vascularity as well as rubeosis. Fundoscopy revealed findings consistent with both central retinal artery occlusion and central retinal vein occlusion. Combined central retinal artery and vein occlusion is a rare retinal vascular condition. Neovascular glaucoma can occur as a sequelae of the ischemic process in the retina. Despite treatment, there is a poor visual prognosis, with the affected eye usually becoming blind from optic atrophy and neovascularization.

Cavernous hemangioma is the most common benign orbital and vascular tumor in adults. It is mostly located intraconally. Nevertheless, when the location is extraconal, the displacement of the globe is opposite the tumor's position. We describe an unusual presentation of this tumor in a 75-year-old female. The only symptom was the presence of epiphora. In the clinical examination, a mass was palpated on the lower orbital rim of the right eye. The magnetic resonance imaging (MRI) showed a well-circumscribed ovoid mass with a strong T2 hyperintensity and progressive contrast filling in T1. Excisional biopsy was performed, which confirmed the diagnosis of cavernous hemangioma. At five months of follow-up, there was no evidence of new symptoms.