GMS ophthalmology cases最新文献

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.

A healthy 6-year-old boy presented with acute bilateral vision loss, multiple serous retinal detachments between the vascular arcades and a thickened choroid. Spontaneous resolution occurred over several weeks. We hypothesize that the clinical constellation in our patient is suggestive of acute exudative polymorphous vitelliform maculopathy (AEPVM) or might be an atypical presentation of Vogt-Koyanagi-Harada (VKH) disease. We propose that it was caused by an autoimmune-mediated activation of inflammatory cells at the level of the choroid, induced by an unknown trigger.

Objective: To describe the clinical efficiency of transluminal Nd:YAG laser embolysis (TYE) and hyperbaric oxygen (HBO) as an off-label combined treatment for branch retinal artery occlusion (BRAO) with visible emboli. Methods: A 77-year-old woman had a history of seeing a "shadow" in the lower visual field of the left eye for three days. Platelet-fibrin embolus at the arterial bifurcation was disintegrated by TYE technique and the patient was referred to HBO treatment for 20 sessions. Results: One week after treatment, best-corrected visual acuity improved to 0.8 while a good arterial blood flow in the affected branch was seen. Platelet fibrin plaques had disappeared at fundus, and the pale appearance in the retina had decreased. Conclusions: TYE and HBO combination treatment may be an effective and feasible treatment for restoration of blood flow and vision in BRAO cases caused by visible platelet-fibrin emboli.

Sclerocornea is a rare congenital anomaly with clouding of the peripheral cornea that possibly extends up to the center of the cornea. Characteristically, a clear distinction (limbus) between sclera and cornea is lacking. Early surgical treatment is essential for preventing amblyopia, but penetrating keratoplasty in children carries a relatively high risk of complications. Especially for sclerocornea, penetrating keratoplasty has generally been reported to have a poor surgical outcome and a high risk of complications, including corneoscleral adhesions. Here, we report the 4-year follow-up on a child with sclerocornea, who was successfully operated on at the age of 3 months and had a favorable outcome. Our findings suggest that in some cases, penetrating keratoplasty may be an option to treat sclerocornea in young children.

Objective: To emphasize the importance of an early diagnosis and an adequate treatment in conjunctival tumors. Methods: We present two clinical cases and compare the course of each case: one of conjunctival intraepithelial neoplasia (CIN) which took a positive course, and a fatal case of squamous cell carcinoma (SCC) with intraocular and orbital extension. Results: Epithelial conjunctival malignancies are one of the most prevalent ocular surface tumors. Among these, CIN are the most common. CIN have an excellent prognosis, given adequate treatment. However, when the diagnosis of CIN is late, the epithelial basement membrane will be affected, resulting in SCC. SCC may have poorer results due to its capacity to infiltrate near tissues and create distant metastasis. Conclusion: It is not common today to treat patients with orbital extension of SCC; however, it is crucial to note the importance of an early diagnosis of conjunctival malignancies. An early diagnosis is essential to prevent the transformation to other life-threatening types.

Purpose: To present a 65-year-old patient with macular hole (MH) and submacular hemorrhage (SMH) secondary to a ruptured retinal arterial macroaneurysm (RAM) which was successfully treated with a novel surgical technique. Patient: A 65-year-old woman presented with a 1-week history of sudden-onset visual loss in her right eye. Her best-corrected visual acuity (BCVA) was hand motion in the right eye. Her fundus examination revealed intraretinal and massive subretinal hemorrhage with macular involvement. An MH with an approximate diameter of 600 microns was also noted. The patient was treated by a standard pars plana vitrectomy (PPV) and internal limiting membrane (ILM) peeling, followed by 10 µg recombinant tissue plasminogen activator injection into the submacular space via the MH with a 25-gauge vitrectomy probe. BCVA of the patient increased to 20/320 and 20/60, one and four weeks after surgery, respectively. Optical coherence tomography (OCT) images confirmed the complete anatomical closure of the MH and the restoration of the outer retinal layers such as the external limiting membrane and the ellipsoid zone. Conclusion: This case report expands our knowledge about the management of MH in combination with SMH after a ruptured RAM. We suggest the use of a vitrectomy probe and MH for subretinal recombinant tissue plasminogen activator (rtPA) injection.

Purpose: To report the effects of a single intravitreous injection of bevacizumab for the treatment of secondary choroideal neovascularisation due to large optic disc drusen. Methods: A 14-year-old female patient with painless loss of vision in one eye presented with unusually large optic disc drusen and juxtapapillary choroidal neovascularisation with subretinal hemorrhage. She was treated with a single intravitreous injection of bevacizumab. Results: Visual acuity increased from 20/100 to 20/25 within 4 weeks after injection and remained at this level during the 12-month follow-up period. Conclusions: Bevacizumab is a possible primary treatment option for secondary choroidal neovascularisation due to large optic disc drusen in children as an alternative to other more invasive or complex procedures.

Wooden foreign bodies penetrating through the orbit into paranasal sinuses are rare. We report a case of a young male who complained of double vision, pain and redness after a fall from a tree. There was no external wound over periocular skin. The clinical and radiological examination was suggestive of an inferior orbito-sinal wooden foreign body with floor fracture, which was managed by surgical removal of the foreign body and orbital floor fracture repair using a silicon sheet in a single sitting.

Purpose: To report the recurrence of a macular corneal stromal dystrophy 50 years after penetrating keratoplasty (PKP). Methods: Observational case report Case description: A 76-year-old male patient presented with visual impairment in the right eye (OD) 50 years after PKP in 1962 (44 years after PKP also in the left eye (OS) in 1968) following explosion injury. His visual acuity had already been impaired before the trauma because of bilateral corneal opacities. The central corneal thickness of the graft measured 584 µm (OD) and 544 µm (OS), whilst the peripheral host thickness (8 mm zone), however, was 1233 µm (OD, cranial) and 1131 µm (OS, nasal). The original graft diameter measured 6 mm in both eyes and the recipient cornea was cloudy and gray. The endothelial cell count was measured centrally (OD 1162 c/mm², OS 1320 c/mm²). The visual acuity was 20/100 (OD) and 20/40 (OS). After excimerlaser-assisted repeated PKP (8.0/8.1 mm, OD), the histological analysis of the former graft revealed deposits of acid mucopolysaccharides (AMP) subepithelially, within the interface, in the donor stroma, and in the endothelium, which proved the peripheral recurrence of a macular corneal stromal dystrophy on the graft. Conclusion: Recurrence of macular corneal stromal dystrophy is seldom, but it may occur many decades after PKP. In this patient, the host's stroma was twice as thick as that of the graft. This may be caused by the active production of acid mucopolysaccharides in the host endothelium with secondary endothelial decompensation. Thus, PKP remains the gold standard in the cure of macular corneal dystrophy for long-term visual rehabilitation.

An 8-year-old boy presented with complaints of sudden-onset binocular vertical diplopia of one day duration. Ophthalmic examination showed restricted up- and downgaze movement with rotatory nystagmus. Systemic investigations revealed iron-deficiency anemia and localized acute infarct in the left paramedian rostral and dorsal part of the upper midbrain at the level of the red nucleus on magnetic resonance imaging. The patient was started on oral iron supplement, which resulted in symptomatic as well as clinical improvement after 2 weeks.