Case Reports in Ophthalmological Medicine最新文献

Purpose: To describe a case of regression of proliferative diabetic retinopathy (PDR) following treatment with semaglutide. Methods: Case report. Results: The case describes a 47-year-old woman with Type 2 diabetes, obesity, hypertension, and dyslipidaemia who had difficulty controlling her blood sugar levels despite oral hypoglycaemic medications. She presented with PDR in her right eye and severe nonproliferative diabetic retinopathy (NPDR) in her left eye. After missing her follow-up appointment for panretinal photocoagulation (PRP), her general practitioner initiated semaglutide therapy. Despite minimal changes in glycaemic control, the patient exhibited resolution of neovascularisation in her right eye and improved diabetic macular oedema (DMO) within 6 weeks of semaglutide therapy. Conclusion: This case report suggests a potential independent role for semaglutide in managing PDR.

Purpose: We describe the clinical findings in a Japanese patient with unilateral traumatic optic neuropathy (TON) who underwent steroid pulse therapy followed by optic canal decompression surgery. The optic nerve function was assessed longitudinally and quantitatively by Goldmann visual fields (GVFs). This was accomplished by measuring the area of each isopter and scotoma, and the findings were compared with the visual acuities recorded during the course of the resolution of the TON. Case Presentation: A 70-year-old man suffered from TON in his left eye after falling from a 3 m cliff. On examination at the Saitama Medical University Hospital, his decimal best corrected visual acuity (BCVA) in his left eye was 0.2. Computed tomography revealed a fracture of the lateral wall of the left orbit, but no obvious optic canal fracture was observed. Steroid pulse therapy was started, and optic nerve decompression surgery was performed. After steroid administration, there was a slight improvement in the visual acuity, and a response in the I/3e isopter was present (area 17.76 deg²). However, the V/4e area decreased from 539.35 to 359.36 deg². Three days after the optic canal decompression surgery, the decimal visual acuity improved to 0.6, and the V/4e area and I/3e area increased to 1122.52 and 46.88 deg², respectively. Postoperatively, there was a marked improvement in the size of the GVFs that corresponded to the improved visual acuity. The visual acuity of the left eye was 0.8 after 6 months, and the GVF was still not completely normal. Conclusions: Our findings showed the course of recovery of the visual acuity and visual field in an eye with TON. The quantification of GVF was helpful in assessing the course of recovery after the treatments. The new quantitative index of the GVFs may be helpful in evaluating the effectiveness of treatments for optic nerve disorders.

Vitreous cysts represent uncommon ophthalmological conditions. Most patients are asymptomatic, but a minority may experience symptoms such as floaters or blurred vision. Here, we report the case of a 2-year-old girl who was incidentally found to have a vitreous cyst in her left eye during a routine outpatient clinic visit. The cyst was observed to move with eye movements, was pigmented, lobulated, and measured 3 mm in diameter. Our patient exhibited several systemic manifestations. We recommended regular follow-up through clinical examinations and monitoring of the cyst using B-scan ultrasound.

Objective: We describe a patient affected by congenital stationary night blindness (CSNB) secondary to CACNA1F and optic neuropathy associated with an AFG3L2 variant. Methods: We performed comprehensive neuro-ophthalmologic examinations, retinal imaging, complete ocular electrophysiology, and brain and optic nerve MRI. Genomic DNA was extracted from the peripheral blood. The patient's DNA was then investigated by next-generation sequencing (NGS) with a panel including 32 genes associated with retinal dystrophy and therefore with a panel including seven genes associated with genetic forms of optic atrophy. Results: The genetic analysis identified a pathogenetic CACNA1F variant causing CSNB and a heterozygous variant in AFG3L2 that alters OPA1 processing and is known to be associated with OPA1-like optic neuropathy. Conclusion: Optic disc atrophy has been previously described as an atypical feature in the phenotype of CSNB CACNA1F-related. In this patient, we found a variant of the AFG3L2 gene that presumably explains the presence of optic atrophy in a subject affected by CSNB. Clinical Relevance: The clinical evidence of optic atrophy, which is atypical in CSNB, should raise the suspicion of concomitant hereditary optic neuropathy and emphasize the importance of broad genetic diagnostic testing to better define the genotype-phenotype correlation.

A 51-year-old male underwent vitrectomy with retrobulbar anesthesia for retinal detachment. Post surgery, he experienced systemic hypotension which normalized after 3 h. The day after, he complained of a central scotoma in the operated eye. Intraocular pressure was normal, but fundus examination revealed hemorrhages and whitening along the papillomacular bundle and macula, with additional whitening in the upper midperipheral region. Multimodal imaging confirmed branch retinal vein, artery, and cilioretinal artery occlusion. Further examination revealed mild-to-moderate obstructive sleep apnea syndrome. Vascular occlusions are potential complications of vitreoretinal surgery, warranting thorough preoperative assessment for underlying risk factors, even if causative mechanism is still unknown.

Purpose: We report our experience of diagnosing and managing metastatic adenocarcinoma of the lungs with primary manifestation to the iris and the ciliary body with the purpose to raise clinical suspicion for systemic malignancy in the presence of undetected ocular mass along with other ocular manifestations. Observations: An 82-year-old male presented with a deterioration of vision and intense pain in the right eye since the day before. With his right eye, he suddenly discerned hand movements only. Intraocular pressure in the right eye was increased. Slit-lamp biomicroscopy revealed a ciliary injection and hemorrhagic mass overlying the temporal half of the iris. The L-9 ultrasound biomicroscopy (UBM) scan documented the tumor completely infiltrating the iris and the ciliary body. We suspected a metastatic eye lesion. CT chest imaging showed a solid expansive formation of the right lung. At the Oncology Department, a fine needle aspiration biopsy was performed under the control of MSCT, which confirmed lung adenocarcinoma. Conclusions and Importance: Although very rarely, pathological changes in the uvea may indicate a metastatic occurrence that needs to be considered in the differential diagnosis. It is important to undergo a wide ophthalmological examination, which in this case included a standardized A-scan echography and UBM, which confirmed the suspicion of a tumor lesion, followed by cooperation with other medical professionals in order to discover a primary diagnosis.

Purpose: The purpose of this study is to present our experience with Hoffman's SFIOL using double-armed Gore-Tex sutures (polytetrafluoroethylene) instead of 9.0 polypropylene suture method in four cases. Observation: In this case series article, we present our experience with Hoffman's SFIOL using double-armed Gore-Tex sutures (polytetrafluoroethylene) instead of 9.0 polypropylene sutures; the postoperative evaluation revealed well-centered IOL which did not exhibit any signs of instability in all four eyes, demonstrating a successful surgical outcome without observed complications. Conclusions and Importance: Hoffman's SFIOL using double-armed Gore-Tex could be safe and effective methods for cases with no adequate capsular support for the IOL implantation. Compared to prolene suture, Gore-Tex gives more tensile strength and requires less manipulation during surgery minimizing postoperative inflammation which could be a valuable option in the nearby future for similar cases.

Background: Epithelial tumors of lacrimal glands are rare and primary ductal adenocarcinoma of the lacrimal gland accounts for only 2% of all epithelial lacrimal gland tumors. Considering its rarity and lack of uniform diagnostic criteria, treatment protocols are not well defined. In this study, we describe a Her-2 positive case and review previously reported cases. Methods: In 2012, a 42-year-old woman affected by primary ductal adenocarcinoma of the lacrimal gland was treated with transpalpebral anterior orbitotomy and adjuvant radiotherapy. In July 2013, she presented local relapse and she underwent orbital exenteration. In November 2013, for neck nodal progression, seven cycles of chemotherapy (cisplatin and epirubicin) associated with a humanized monoclonal antibody-targeting HER 2 therapy (trastuzumab and pertuzumab) were performed, with a marked response rate. Then, she underwent total parotidectomy with right neck lymphadenectomy and adjuvant hadrontherapy. Results: Nine years later (113 months) after treatment completion, the patient was alive without disease and with acceptable toxicity. Conclusions: In primary ductal adenocarcinoma of the lacrimal gland, early diagnosis and multimodal treatments could be crucial, considering its often aggressive tendency. Considering the lack of treatment guidelines, case report recording can be useful in patient management.

Introduction: We describe a unique case of sclerouveitis that progressed to endogenous Fusarium endophthalmitis in a 69-year-old male with chronic lymphocytic leukemia (CLL). We highlight the risk of treating sclerouveitis with oral corticosteroids, which can exacerbate an infection and contribute to disease progression. Case Presentation: A 69-year-old male with CLL on zanubrutinib, a second-generation Bruton's tyrosine kinase inhibitor, was admitted to the hospital for osteomyelitis of the left foot. At presentation, the patient also reported right eye pain for 1 week and vision loss over the course of 1 month. Vision in the right eye was hand motion. Slit lamp examination revealed scleral inflammation in the right eye with violaceous injection, chemosis, inflammation in the anterior chamber, and diffuse subconjunctival hemorrhage. There was significant corneal edema preventing fundus examination. B-scan ultrasonography demonstrated a flat retina with no vitritis or scleral thickening. Forty-eight hours after treatment with oral and topical corticosteroids, the patient's eye pain improved but his vision worsened. Repeat B-scan showed new-onset vitritis. Fungal culture obtained by diagnostic pars plana vitrectomy (PPV) revealed growth of Fusarium. The patient was treated with oral and intravitreal voriconazole in addition to intravenous voriconazole and amphotericin B for systemic therapy. Corticosteroids were discontinued. Despite aggressive therapy, the patient's disposition declined to the point of transitioning to comfort-focused care, and he passed away. Conclusion: Endogenous fungal endophthalmitis is most commonly seen in immunocompromised patients, and oral corticosteroid therapy for such patients should be used with caution as it can worsen an infection. In cases of fusarial endophthalmitis, visual prognosis is poor.

Introduction: Valsalva retinopathy can cause submacular hemorrhage (SMH), which may lead to visual disturbances. SMH can extend into the subinternal limiting membrane (ILM) and vitreous spaces, sometimes occurring concomitantly with full-thickness macular holes (FTMHs). Herein, we describe a case in which sub-ILM hemorrhage was removed without peeling the ILM of the central fovea, thus preserving the foveal ILM. Case Presentation: A 48-year-old female patient developed rapid-onset bilateral visual impairment due to SMH secondary to Valsalva retinopathy. The SMH predominantly consisted of sub-ILM hemorrhage. However, detailed observation was challenging due to the dense sub-ILM hemorrhage in the left eye. Initial best-corrected visual acuity (BCVA) in the right and left eyes were 1.2 and 0.03, respectively. Intravitreal tissue plasminogen activator (tPA) and sulfur hexafluoride (SF6) gas injections were initially administered to displace the SMH in the left eye; however, the SMH could not be successfully displaced. A vitrectomy was then performed. Intraoperatively, an ILM fissure beyond the foveal region was created using ILM forceps. The balanced salt solution was sprayed onto the ILM, and the sub-ILM hemorrhage was drained into the vitreous cavity from the ILM fissure. The surgery successfully displaced the sub-ILM hemorrhage while preserving the foveal ILM. No postoperative complications were observed. Visual acuity remained at 1.2 in the right eye and improved to 1.2 in the left eye 6 months postoperatively. Conclusion: Removing foveal sub-ILM hemorrhage without peeling the foveal ILM can be a viable treatment option to preserve the foveal ILM.