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Simultaneous bilateral inflammatory choroidal neovascularization in a case of healed serpiginous-like choroiditis. 同时双侧炎性脉络膜新生血管愈合一例蛇形样脉络膜炎。
Pub Date : 2022-05-20 eCollection Date: 2022-01-01 DOI: 10.3205/oc000199
Gitanjli Sood, Ramanuj Samanta, Devesh Kumawat, Prateek Nishant

Objective: Inflammatory choroidal neovascularization (i-CNV) is an infrequent but sight-threatening complication of posterior uveitis. Although it can occur in a wide range of infectious and non-infectious uveitides, presence of simultaneous bilateral i-CNV is rare. In this report, we present a unique case of bilateral simultaneous i-CNV in a young patient of healed tubercular serpiginous-like choroiditis.

Method: A 20-year-old male presented with recent worsening of vision in the right eye for one month. Fundus examination revealed bilateral multifocal healed choroiditis lesions with right eye tiny subfoveal hemorrhage raising the suspicion of an underlying choroidal neovascularization. Fundus fluorescein angiography and optical coherence tomography confirmed presence of choroidal neovascular membrane in both eyes.

Result: Resolution of activity was noted in both eyes after bilateral sequential intravitreal bevacizumab injections.

Conclusion: Inflammatory choroidal neovascularization may be seen in patients with healed tubercular serpiginous-like choroiditis, after a long period of quiescence. Simultaneous bilateral presentation is rare but possible, requiring mandatory multimodal imaging of both eyes under high index of suspicion. Early institution of anti-vascular endothelial growth factor may salvage optimum vision in such a scenario.

目的:炎症性脉络膜新生血管(i-CNV)是后葡萄膜炎的一种少见但威胁视力的并发症。虽然它可以发生在广泛的感染性和非感染性血管,但同时存在双侧i-CNV是罕见的。在这个报告中,我们提出了一个独特的病例双侧同时i-CNV在愈合的结核蛇形样脉络膜炎的年轻患者。方法:男性,20岁,近期右眼视力恶化1个月。眼底检查显示双侧多灶性已愈合的脉络膜炎病变伴右眼小的中央凹下出血,怀疑有脉络膜新生血管。眼底荧光素血管造影和光学相干断层扫描证实双眼存在脉络膜新生血管膜。结果:双侧序贯玻璃体内注射贝伐单抗后,双侧眼球活动消退。结论:结核性蛇形样脉络膜炎愈合后可出现炎性脉络膜新生血管。同时双侧表现是罕见的,但可能的,需要在高怀疑指数下强制双眼多模态成像。在这种情况下,早期应用抗血管内皮生长因子可能挽救最佳视力。
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引用次数: 0
Multimodal imaging of a sporadic retinal astrocytic hamartoma simulating retinoblastoma in a newborn. 新生儿散发性视网膜星形细胞错构瘤模拟视网膜母细胞瘤的多模态成像。
Pub Date : 2022-05-20 eCollection Date: 2022-01-01 DOI: 10.3205/oc000198
Bilge Batu Oto, Aslihan Yilmaz Çebi, Oguzhan Kiliçarslan, Ahmet Murat Sarici

Introduction: To report a sporadic astrocytic hamartoma simulating retinoblastoma in a newborn.

Methods: Clinical data was reviewed retrospectively.

Results: A 3-month-old baby with a history of perinatal asphyxia was referred to our ocular oncology clinic with suspected retinoblastoma in the left eye. Dilated fundoscopy revealed a solitary tumor covering the optic disc at the left eye. The whitish-yellow lesion was well-defined, opaque, and minimally calcified. High internal reflectivity and posterior shadowing due to the intralesional calcification, and intratumoral cystic spaces were observed in B-scan ultrasound imaging. Optical coherence tomography imaging showed an intraretinal tumor with cystic spaces and posterior shadowing. The tumor was diagnosed as an astrocytic hamartoma. The systemic evaluation was negative for phacomatoses. The lesion has been observed with multimodal imaging for six years without significant changes.

Conclusions: Retinal astrocytic hamartomas are benign tumors that arise within the retinal nerve fiber layer. Differential diagnosis constitutes high importance since they may be misdiagnosed as retinoblastoma, and therefore may be overtreated. Whereas retinoblastoma requires immediate treatment, retinal astrocytic hamartomas are commonly followed-up. Multimodal imaging with B-scan ultrasonography and optical coherence tomography are useful in distinguishing those two entities.

简介:报告一例新生儿偶发星形细胞错构瘤,模拟视网膜母细胞瘤。方法:回顾性分析临床资料。结果:一个3个月大的婴儿,有围产期窒息史,怀疑左眼视网膜母细胞瘤,被转介到我们的眼科肿瘤诊所。扩大眼底镜检查发现一个孤立的肿瘤覆盖视盘在左眼。黄白色病灶清晰、不透明、轻度钙化。b超表现为高内反射率,瘤内钙化后影,瘤内囊性间隙。光学相干断层扫描显示视网膜内肿瘤伴囊性间隙及后影。肿瘤被诊断为星形细胞错构瘤。系统性评价为阴性。病变已观察多模态成像六年,无明显变化。结论:视网膜星形细胞错构瘤是发生在视网膜神经纤维层内的良性肿瘤。鉴别诊断是非常重要的,因为它们可能被误诊为视网膜母细胞瘤,因此可能被过度治疗。视网膜母细胞瘤需要立即治疗,而视网膜星形细胞错构瘤通常需要随访。多模态成像与b超扫描和光学相干断层扫描是有用的,以区分这两个实体。
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引用次数: 0
Intraoperative optical coherence tomography (I-OCT) assisted passage of the encircling element during retinal detachment surgery 术中光学相干断层扫描(I-OCT)辅助视网膜脱离手术中环形元件的通过
Pub Date : 2022-04-01 DOI: 10.3205/oc000197
A. Markan, N. Gupta, Basavaraj Tigari, Ramandeep Singh, M. Dogra
Objective: To describe the role of microscope integrated optical tomography (Mi-OCT) in passage of the encircling element during retinal detachment surgery. Materials and methods: Mi-OCT was switched on while passing scleral anchoring sutures to secure the encircling element. The depth of the suture tract was seen in real time while the needle was passed through the sclera. The amount of scleral intend achieved was assessed using Mi-OCT at the end of the surgery. Results: The depth of needle tract through the sclera and the amount of scleral indentation achieved while tying the sutures could be successfully analyzed using Mi-OCT. Conclusion: Mi-OCT can be used as an adjunct while training vitreoretinal fellows and trainees in surgical procedures like passage of scleral sutures for anchoring the encircling element.
目的:描述显微镜集成光学断层扫描(Mi-OCT)在视网膜脱离手术中环形元件通过中的作用。材料和方法:Mi OCT在通过巩膜锚定缝线以固定环绕元件时打开。当针头穿过巩膜时,可以实时观察缝合道的深度。在手术结束时,使用Mi-OCT评估预期达到的巩膜量。结果:Mi-OCT可以成功地分析缝合时穿过巩膜的针道深度和巩膜压痕的量。结论:Mi-OCT可作为辅助手段,对玻璃体视网膜研究人员和受训人员进行外科手术培训,如通过巩膜缝线固定环绕元件。
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引用次数: 2
Reversal of vision after bleomycin injection in orbital lymphangioma 博来霉素注射眼眶淋巴管瘤后视力逆转
Pub Date : 2022-03-22 DOI: 10.3205/oc000196
Pratheeba Devi Nivean, Nivean Madhivanan
Lymphangiomas are benign hemartomatous tumors that can occur in all parts of the body, but most frequently in the neck (75%), as well as in the axilla and inguinal areas. Surgical removal is very difficult, as it is very fragile and tumor dissection is very difficult. Ultrasound-guided bleomycin injection directly into the cyst collapses the cyst and shrinks the tumor. It reduces proptosis, discomfort, and cosmetic blemish. We present this case who had gross defective vision and relative afferent pupillary defect in her right eye for 10 days which tremendously improved after injection.
淋巴管瘤是一种良性的血管瘤,可以发生在身体的各个部位,但最常见的是颈部(75%),以及腋窝和腹股沟区域。手术切除非常困难,因为它非常脆弱,肿瘤解剖非常困难。超声引导下博来霉素直接注射到囊肿中,使囊肿塌陷并缩小肿瘤。它可以减少口臭、不适和化妆品瑕疵。我们介绍了这个病例,她的右眼有严重的视力缺陷和相对的传入瞳孔缺陷,持续了10天,注射后情况得到了极大的改善。
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引用次数: 0
Multimodal imaging in choroidal osteomas 脉络膜骨瘤的多模式成像
Pub Date : 2022-02-25 DOI: 10.3205/oc000194
Sugandha Goel, Sudipta Das, A. J. Rijey, D. Das
Choroidal osteoma is a rare benign tumor which is found in the posterior pole of the eye. We herein describe multimodal imaging in two cases of choroidal osteoma. Fundus of our first case showed a yellowish-orange colored subretinal lesion at the posterior pole. Multicolor imaging highlighted the lesion with greenish hue. Infrared reflectance showed hyporeflectance. A dense echogenic plaque persisting in lower gain was noted on B-scan. FFA showed hyperfluorescence with corresponding hypocyanescence on ICG. EDI OCT showed an increase in choroidal thickness with elevated retinal pigment epithelium. The second case showed choroidal osteoma with active choroidal neovascular membrane that responded to intravitreal injection of Ranibizumab.
脉络膜骨瘤是一种罕见的良性肿瘤,见于眼球后极。我们在此描述两例脉络膜骨瘤的多模式成像。我们第一个病例的眼底显示后极有一个黄橙色的视网膜下病变。多色成像显示病变呈绿色。红外反射率呈低反射率。在B型扫描上发现一个持续较低增益的致密回声斑块。FFA在ICG上显示出高荧光和相应的低氰。EDI OCT显示脉络膜厚度增加,视网膜色素上皮升高。第二例为脉络膜骨瘤,有活性脉络膜新生血管膜,对玻璃体内注射雷尼珠单抗有反应。
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引用次数: 1
Atypical lymphoid proliferation of the orbit 眼眶非典型淋巴增生
Pub Date : 2022-02-25 DOI: 10.3205/oc000193
Lee Tomas Obias Tan, Felice Katrina C. Trio-Ranche
Objective: Lymphoproliferative disorders are a group of lesions characterized by abnormal proliferation of lymphocytes. In the orbit, they can occur in the ocular adnexae. These neoplasms have defined clinical and pathologic characteristics and account for more than 20% of all orbital tumors. Several types of lymphoproliferative lesions have been described in the orbit. One example is lymphoid hyperplasia, which commonly involves the lacrimal gland. A benign lesion like lymphoid hyperplasia will show a general normal archetype of the tissues-involved lacrimal gland. We expect a polyclonal group of cells with more or less normal architecture of a follicle. On the other hand, lymphoma will show less organized arrangement of cells, and we expect them to be of monoclonal lineage. Methods: This is a case report of a 55-year-old Filipino female who came in for blurring of vision of both eyes. During her assessment, there was an incidental finding of bilateral upper eyelid swelling, and a 30x15 mm palpable firm mass under the right superior orbital rim and a 30x10 mm mass under the left were noted. The right globe was displaced inferiorly, but no proptosis was seen on exophthalmometry. On plain CT scan, we noted a homogenous mass with molding or contouring around the orbital structures. On coronal view, we noted homogenous masses that mold around the globe and recti, and this also confirmed on axial cuts. A section biopsy was done via anterior orbitotomy. Results: Our patient’s histopath had features of both. On scanning magnification, we noted a very cellular round cell tumor. The round cell lesion seemed to be reminiscent of a germinal center of a lymph node. Around it we noticed the glandular structures, which were expected, since this specimen was from the lacrimal gland. A closer view of the lesion on high power showed these lymphocytes within a germinal center. These are large macrophages that actively phagocytose apoptotic lymphoid cells in germinal centers. We expect to see a lot of them in benign hyperplasia, but only a few will be present in malignancies. In summary, our patient had both benign and malignant features, resulting in a histopath result of atypical lymphoid proliferation. Conclusion: Atypical lymphoid proliferation is a rare orbital tumor with benign and malignant features. There is no standard protocol for treatment, and proper multi-specialty coordination is important. External beam radiation therapy with linear accelerator (LINAC) appears to be an effective treatment, with no recurrence in our patient after 5 months.
目的:淋巴增生性疾病是一组以淋巴细胞异常增殖为特征的病变。在眼眶中,它们可以发生在眼附件中。这些肿瘤具有明确的临床和病理特征,占所有眼眶肿瘤的20%以上。眼眶内有几种类型的淋巴增生性病变。一个例子是淋巴增生,它通常涉及泪腺。淋巴增生等良性病变会显示泪腺相关组织的一般正常原型。我们期望一组多克隆细胞或多或少具有正常的毛囊结构。另一方面,淋巴瘤将表现出较少的细胞组织排列,我们预计它们是单克隆谱系。方法:这是一例55岁的菲律宾女性的病例报告,她因双眼视力模糊而来。在她的评估过程中,偶然发现双侧上眼睑肿胀,注意到右眶上缘下有一个30x15 mm可触及的牢固肿块,左眶下有30x10 mm肿块。右侧眼球向下移位,但在眼球突出测量中未发现眼球突出。在普通CT扫描中,我们注意到眼眶结构周围有一个成型或轮廓的同质肿块。在冠状面上,我们注意到在地球和直线周围形成的同质物质,这也在轴向切割上得到了证实。通过前部眼眶切开术进行切片活检。结果:我们的患者的组织病理学具有这两种特征。在扫描放大镜下,我们发现了一个细胞非常多的圆形细胞肿瘤。圆形细胞病变似乎让人想起淋巴结的生发中心。在它周围,我们注意到了腺结构,这是意料之中的,因为这个标本来自泪腺。用高倍镜仔细观察病变显示这些淋巴细胞位于生发中心。这些是大巨噬细胞,主动吞噬生发中心的凋亡淋巴细胞。我们预计在良性增生中会看到很多,但只有少数会出现在恶性肿瘤中。总之,我们的患者同时具有良性和恶性特征,导致非典型淋巴增生的组织病理结果。结论:不典型淋巴增生是一种罕见的眼眶肿瘤,具有良恶性特征。没有标准的治疗方案,适当的多专业协调很重要。使用线性加速器(LINAC)的外束放射治疗似乎是一种有效的治疗方法,我们的患者在5个月后没有复发。
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引用次数: 2
A case of primary vasoproliferative tumor with full-thickness macular hole 原发性血管增生性肿瘤伴全层黄斑孔1例
Pub Date : 2022-02-08 DOI: 10.3205/oc000189
P. Rishi, Janani Sreenivasan
A 53-year-old female presented with defective vision in the left eye of one week duration with a best-corrected visual acuity (BCVA) of 6/9. Fundus examination showed a primary retinal vasoproliferative tumor (RVPT) at the inferotemporal quadrant and a small full-thickness macular hole (MH). The patient underwent cryotherapy for RVPT, followed later by vitrectomy with internal limiting membrane peeling and gas tamponade. The tumor regressed and the MH was closed with BCVA of 6/9. RVPT can present with remote macular complications like epiretinal membrane, cystoid macular edema, macular exudates, and rarely full-thickness MH. Management should be directed towards the tumor as well as the complication.
患者为53岁女性,左眼视力缺损1周,最佳矫正视力(BCVA) 6/9。眼底检查显示颞下象限原发性视网膜血管增殖性肿瘤(RVPT)和一个小的全层黄斑孔(MH)。患者接受RVPT冷冻治疗,随后进行玻璃体切除术,内限制膜剥离和气体填塞。肿瘤消退,闭合MH, BCVA为6/9。RVPT可出现远端黄斑并发症,如视网膜前膜、囊样黄斑水肿、黄斑渗出,很少出现全层MH。治疗应针对肿瘤及并发症。
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引用次数: 0
Melkersson-Rosenthal syndrome: a rare variant of the monosymptomatic form Melkersson Rosenthal综合征:一种罕见的单症状形式的变体
Pub Date : 2022-02-08 DOI: 10.3205/oc000191
C. Estacia, A. G. Gameiro Filho, Izadora Bouzeid Estacia da Silveira, Rodrigo Rosa Gameiro, Anna Laura Salabert Della Barba
Melkersson-Rosenthal syndrome (MRS) is a rare condition without any known etiology. It is characterized by the triad facial paralysis, facial swelling, and the development of folds and furrows at the tongue (fissured tongue). This study aims to report a case of a 59-year-old patient complaining about asymmetric eyelid swelling that had started two years before, associated with pain and redness on her right eye, without repercussions on her visual acuity. The patient underwent a skin biopsy of the right eye’s lower eyelid, which was compatible with the monosymptomatic form of MRS. Consequently, five injections of triamcinolone were performed for the period of one year, with gradual and satisfactory improvement. One year after the end of the treatment, the patient returned with recurrence of the swelling, and therapy with triamcinolone associated with oral steroids was started. However, due to the lack of improvement, Tacrolimus ointment 0.03% was initiated. The patient evolved with an important and significant reduction of the eyelid edema, still being followed at the Hospital Federal dos Servidores do Estado do Rio de Janeiro.
梅尔克松-罗森塔尔综合征(MRS)是一种罕见的疾病,没有任何已知的病因。其特征是三合性面瘫、面部肿胀以及舌部褶皱和犁沟的发育(裂舌)。这项研究旨在报告一例59岁的患者,她抱怨两年前开始的不对称眼睑肿胀,并伴有右眼疼痛和发红,但对视力没有影响。患者接受了右眼下眼睑的皮肤活检,这与MRS的单症状形式一致。因此,在一年的时间里,进行了五次曲安奈德注射,病情逐渐好转,令人满意。治疗结束一年后,患者再次出现肿胀,开始使用曲安奈德联合口服类固醇进行治疗。然而,由于缺乏改善,开始使用0.03%的他克莫司软膏。患者的眼睑水肿得到了重要而显著的减轻,仍在里约热内卢联邦医院接受随访。
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引用次数: 1
Lose the Nintendo and thou shall be healed! Restoring vision in malingering 丢掉任天堂,你就会痊愈!在装病中恢复视力
Pub Date : 2022-02-08 DOI: 10.3205/oc000192
Michel van Lint, Dave Kloeck, E. V. van Aken
Non-organic visual loss can be hard to prove or explain to the parents of affected children at times. Here, we describe a simple yet effective approach that may help solve both issues by ensuring that the patient refrains from visual stimuli.
非器质性视力丧失有时很难证明或向受影响儿童的父母解释。在这里,我们描述了一个简单而有效的方法,可以帮助解决这两个问题,确保患者避免视觉刺激。
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引用次数: 0
A case of anterior scleritis in association with posterior scleritis – a diagnostic riddle 前巩膜炎合并后巩膜炎1例-一个诊断难题
Pub Date : 2022-02-08 DOI: 10.3205/oc000188
Aditi G Dastidar, Sugandha Goel, D. Kundu, J. Biswas, E. Nigam, Preeti Sharma
We herein report a case of a young female presenting with multiple nodular scleral abscesses mimicking infective scleritis with exudative retinal detachment. Repeated diagnostic scraping for microbiological and histopathological analysis was inconclusive. The patient’s systemic and collagen disease work-up was non-contributory. She was treated with multiple surgical debridement and de-roofing of the abscesses along with antibiotic irrigation. Topical and oral steroid was stopped on worsening of the condition, and the patient was maintained on topical and oral antibiotics. Complete resolution of scleritis and exudative detachment was noted at 1 month follow-up and no recurrence was noted until 6 months.
我们在此报告一个年轻女性的情况下,表现为多发性结节性巩膜脓肿模拟感染性巩膜炎和渗出性视网膜脱离。反复刮痧进行微生物学和组织病理学分析尚无定论。患者的全身和胶原蛋白疾病检查无贡献。她接受了多次手术清创和去顶脓肿以及抗生素冲洗。病情恶化时停用局部和口服类固醇,患者继续使用局部和口服抗生素。随访1个月,巩膜炎和渗出性脱离完全消失,6个月无复发。
{"title":"A case of anterior scleritis in association with posterior scleritis – a diagnostic riddle","authors":"Aditi G Dastidar, Sugandha Goel, D. Kundu, J. Biswas, E. Nigam, Preeti Sharma","doi":"10.3205/oc000188","DOIUrl":"https://doi.org/10.3205/oc000188","url":null,"abstract":"We herein report a case of a young female presenting with multiple nodular scleral abscesses mimicking infective scleritis with exudative retinal detachment. Repeated diagnostic scraping for microbiological and histopathological analysis was inconclusive. The patient’s systemic and collagen disease work-up was non-contributory. She was treated with multiple surgical debridement and de-roofing of the abscesses along with antibiotic irrigation. Topical and oral steroid was stopped on worsening of the condition, and the patient was maintained on topical and oral antibiotics. Complete resolution of scleritis and exudative detachment was noted at 1 month follow-up and no recurrence was noted until 6 months.","PeriodicalId":73178,"journal":{"name":"GMS ophthalmology cases","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43992211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
GMS ophthalmology cases
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