Case Reports in Ophthalmological Medicine最新文献

Background and aims: Merkel cell carcinoma is a rare highly malignant disease that requires a wide resection and careful reconstruction of the resulting defect. We removed a Merkel cell carcinoma that had developed on the upper eyelid of an 86-year-old man and reconstructed the eyelid using a switch flap.

Methods: The large size of the defect made it difficult to close the lower eyelid switch harvest site. Because of the patient's high risk of bleeding, closure of the switch flap donor site using a malar flap and cartilage graft was not performed. Instead, lateral canthotomy and lateral cantholysis were performed, and the ear-side end of the switch flap donor site was advanced 5 mm toward the nasal side, which allowed closure of the lower eyelid flap donor site.

Results: The switch flap was detached 16 days after the initial surgery. In the 6 months since the surgery, there have been no problems with the function of the eyelids or the cosmetic appearance, or recurrence of the tumor. The results of this case suggest that this method is a good option for large full-thickness upper eyelid defects of 13-20 mm. Lateral canthotomy with lateral cantholysis is a well-known procedure, but there have been no reports of its combination with a switch flap.

Conclusion: We believe that this method is positioned between the direct closure and malar flap, and that this method allows for a quick and minimally invasive reconstruction. The treatment of Merkel cell carcinoma requires extensive excision, and it is easy to meet the aforementioned criteria when it occurs in the upper eyelid. Because this carcinoma occurs frequently in older people, who can have a high bleeding risk, this minimally invasive method is useful for treating Merkel cell carcinoma of the upper eyelid.

Microsporidial ocular infections are being increasingly reported, especially in temperate climates. In this case report, we describe five patients who presented to a private ophthalmology practice in Southeastern Louisiana in 2024, all within 3 months of Hurricane Francine landing. The patients' ages ranged from 5 to 23 and included two female and three male patients. All patients except one had exposure to contaminated water, and microsporidia were detected via PCR in all patients. Microsporidial keratoconjunctivitis was diagnosed based on typical clinical features. The patients were all effectively treated with a course of moxifloxacin and subsequent fluorometholone. This paper reports the typical clinical course of microsporidial keratoconjunctivitis and offers an effective management approach to this condition.

We report two cases of pronounced development of proliferative vitreoretinopathy (PVR) within a few days after 23G revitrectomy with allogeneic platelet concentrate (PC) in persistent macular hole in 2023-2024. None of the cases had relevant risk factors for PVR development such as intraoperative retinal tears. Because the revitrectomy with PC was performed as a no-touch technique after a previous uncomplicated vitrectomy, it is suspected that PC was the etiological factor. Many findings from previous studies indicate that the same growth factors that are secreted by the platelets and that are thought to have a positive effect on the closure of the macular foramina were also responsible for the development of PVR. Vitrectomy with PC-usually performed with autologous PC-is considered a safe standard procedure for the treatment of large and persistent macular holes. Why such a pronounced and early PVR reaction occurred in these two cases is unclear. One possible reason could be the use of allogeneic PC in our cases. To the best of our knowledge, there are no reported cases of this kind.

We reported the clinical course of refractory childhood glaucoma associated with Sturge-Weber syndrome (SWS) treated with Baerveldt glaucoma implant (BGI). The patient was a 14-year-old male diagnosed with SWS after birth. He had previously undergone four trabeculotomies for glaucoma and vitrectomy for submacular hemorrhage from a diffuse choroidal hemangioma in his left eye. Before the BGI surgery, his intraocular pressure was 30 mmHg under full medications. The patient experienced extensive serous retinal and choroidal detachments on Postoperative Day 9. The cause may have been the increased leakage of serous fluid from the choroidal hemangioma and the high venous pressure in the episclera due to SWS. Retinal and choroidal detachments subsided within 8 days with conservative therapy. It is important to avoid postoperative hypotony for the treatment of secondary childhood glaucoma due to SWS.

DOTATATE (1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid [DOTA]-octreotate) is a compound that binds somatostatin receptors seen in tumors such as meningiomas. Here, we present a case of a patient with progressive bilateral ophthalmoplegia due to meningiomatosis involving both cavernous sinuses, which was highlighted by DOTATATE imaging. Some studies have shown DOTATATE imaging is superior to contrast-enhanced magnetic resonance imaging (MRI) in identifying extent of intraosseous meningioma growth, which has been associated with worse prognosis. DOTATATE imaging should be considered in cases of unknown diagnosis of mass lesions and lesions that are in areas not easily accessible to biopsy, such as the cavernous sinuses.

Background: Conjunctival pyogenic granuloma is a benign vascular tumor that typically occurs following an eye injury, trauma, after an eye surgery, or during pregnancy due to hormonal changes. The granulomas are commonly seen at the traumatic or the surgical wound site, where improper wound healing leads to the formation of the granuloma. However, in some cases, the cause of the granuloma remains unknown.

Case presentation: A 47-year-old female presented to the Ophthalmology Outpatient Department at the Central Regional Referral Hospital in Gelephu, Bhutan, with a progressively enlarging, reddish mass in her left eye, 2 months after pterygium excision surgery. Ocular examination revealed a pedunculated, vascular lesion on the conjunctiva consistent with a postsurgical conjunctival pyogenic granuloma. The lesion was managed successfully with complete resolution and no recurrence on follow-up.

Conclusion: This case underscores the need for clinicians to recognize conjunctival pyogenic granuloma as a potential postoperative complication following pterygium excision. Early diagnosis and appropriate management can prevent recurrence and other related complications. To our knowledge, this represents one of the first such cases reported from our hospital in the past 5 years.

Background: The objective of this study is to describe a rare case of orbital compartment syndrome (OCS) following complicated frontoethmoidal mucopyoceles.

Case presentation: This report involves a 72-year-old woman with prior functional endoscopic sinus surgery who presented with acute painful proptosis, tense eyelid swelling, and ophthalmoplegia in her left eye. Imaging revealed infected mucoceles (mucopyoceles) in the left frontal and ethmoidal sinuses with intraorbital extension. Based on clinical and radiological findings, OCS was diagnosed. Emergency management included immediate lateral canthotomy and cantholysis, followed by urgent endonasal drainage of the mucopurulent material. The patient made a full recovery, with only transient eyelid numbness.

Conclusion: This case underscores the importance of prompt recognition and timely coordinated intervention in OCS to prevent irreversible visual loss and intracranial extension.

Purpose: First, to report nevus of Ota accompanying ocular melanoma in Thai patients. Second, to report angle-closure glaucoma as a presentation secondary to ocular melanoma along with a pathological report giving insight into the pathophysiology of secondary glaucoma in uveal melanoma.

Observations: This case describes a patient with a nevus of Ota who experienced gradual, painless vision loss in the left eye, coinciding with the nevus location. Over 7 months, the patient's vision progressively worsened, culminating in the diagnosis of rhegmatogenous retinal detachment. Tumor identification was first achieved through fundus examination at a tertiary care center, and the tumor was subsequently confirmed via ocular ultrasonography. The patient elected against eye enucleation. The patient presented again as a secondary angle-closure glaucoma resulting from ocular melanoma.

Conclusions and importance: This case highlighted the importance of a rare malignant tumor that can accompany a nevus of Ota. Patient symptoms can vary from visual loss to a painful eye. Physician must be aware of the disease and include melanoma in the differential diagnosis in patients with a nevus of Ota. Thorough eye examination is important. Ocular ultrasonography is feasible, simple, and crucial for diagnosis. Accurate staging is vital for choosing the correct treatment strategy to save the patient's life.

Introduction: The Yamane technique is a transconjunctival, sutureless method for scleral fixation of intraocular lenses (IOL) in cases lacking capsular support. While widely adopted because of its efficacy and safety, rare late complications such as IOL subluxation have been reported. We describe a case of late-onset reverse pupillary block with recurrent IOL subluxation following Yamane fixation.

Case presentation: We present a case of a 64-year-old male with a history of cataract surgery and ocular hypertension who underwent Yamane scleral IOL fixation in his left eye. Five years later, he presented with cystoid macular edema, which progressed to a full-thickness macular hole and 360° iris capture of the intraocular lens optic associated with pupillary block. He underwent pars plana vitrectomy, internal limiting membrane peeling, gas tamponade, and IOL repositioning in the sulcus. Despite initial improvement, the patient experienced multiple episodes of IOL subluxation, requiring repeated repositioning and laser iridotomy. Intraoperative findings included IOL tilt and a floppy iris. After the final repositioning, the IOL remained stable at 18-month follow-up, with intraocular pressure controlled and visual acuity partially restored.

Conclusion: Although the Yamane technique is generally safe and effective, this case highlights the potential for late reverse pupillary block and recurrent IOL subluxation. Contributing factors included optic-haptic junction stress, iris instability, and improper scleral tunnel architecture. Proper case selection, careful surgical technique, and close follow-up are essential to minimize the risk of complications.

Purpose: The purpose of this study is to describe a case of exudative retinal vascular macroaneurysm (RVM) associated with retinal racemose hemangioma (RRH).

Methods: The study design is an observational case report.

Results: A 40-year-old woman presented with visual field defects in her right eye. Fundus examination revealed exudative RVM in combination with RRH. Subsequently, subretinal hemorrhage extended toward the macula, and her best-corrected visual acuity declined to 20/63. Treatment consisted of intravitreal bevacizumab injections and retinal photocoagulation for the RVM. This approach led to resolution of the RVM, confirmed by OCTA. Eight months after photocoagulation, her best-corrected visual acuity improved to 20/20.

Conclusion: This case demonstrates the effectiveness of combined intravitreal bevacizumab injections and retinal photocoagulation for treating RVM. The resolution of the RVM was confirmed by OCTA. Wide-field OCTA is indispensable for evaluating the extent of arteriovenous malformations and for tracking post-treatment changes and complications. Considering the potential for recurrence of RVM associated with RRH, careful and ongoing follow-up is necessary.