Case Reports in Ophthalmological Medicine最新文献

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.

Purpose: The purpose of the study is to report a 3-month-old Iranian baby girl presenting with bilateral macular and peripheral retinoschisis with a probable diagnosis of X-linked retinoschisis (XLRS).

Methods: The baby underwent an ophthalmic examination under general anesthesia revealing bilateral vitreous hemorrhage, spoke-wheel pattern radiating from the fovea, and severe bullous peripheral retinal elevation. We performed indirect scatter laser photocoagulation with a few spots, which showed a positive response confirming the diagnosis of retinoschisis over rhegmatogenous retinal detachment. Spectral-domain optical coherence tomography (SD-OCT) and intraoperative fluorescein angiography (FA) were also performed to enhance the diagnostic evaluation.

Results: Based on comprehensive clinical examinations and imaging findings, XLRS was determined to be the most likely diagnosis.

Conclusion: This case highlights the importance of including retinoschisis, with possible X-linked inheritance, in the differential diagnosis of bilateral schisis and vitreous hemorrhage in female infants. Although the XLRS phenotype is rare in the female population, it appears to be more severe and manifests at an earlier age. Genetic confirmation is needed to determine the exact etiology.

Massive subretinal hemorrhage secondary to neovascular age-related macular degeneration (nAMD) is relatively uncommon, and reports of secondary angle closure glaucoma associated with such hemorrhage are even rarer. We report a case of a 93-year-old woman with a history of nAMD who developed this condition, along with a review of the relevant literature.

Purpose: To report optical coherence tomography (OCT) biomarkers for nonsurgical management of secondary macular holes.

Case series: We report two cases in which postvitrectomy macular holes were managed with preservative-free intravitreal triamcinolone acetonide (1 mg/0.1 mL). All the patients underwent OCT examination before and after injection. Patients 1 and 2 experienced closure of the macular hole. The OCT biomarkers for the patients were (1) an apical diameter of less than 100 microns, (2) the presence of subretinal fluid, (3) the presence of a perifoveal cuff of fluid, and (4) the absence of preretinal traction.

Discussion: The incidence of secondary macular holes is reported to range from 0.24% to 1.9% of patients who undergo vitrectomy. Secondary macular holes are also reported postvitrectomy due to inadvertent iatrogenic trauma, cystoid macular edema, etc. The treatment of secondary macular holes essentially involves various modifications of the ILM flap technique. There have been reports on the closure of secondary macular holes with the intravitreal injection of triamcinolone acetonide, intravitreal bevacizumab, aflibercept, NSAID, and difluprednate. The identification of OCT biomarkers prior to vitrectomy can help in targeted use of nonsurgical treatment modalities in the management of secondary macular holes with the intravitreal injection of triamcinolone acetonide (1 mg/0.1 mL).

Conclusion: Identification of OCT biomarkers can help in the nonsurgical management of secondary macular holes.

Objective: The aim of this study is to report a case of bilateral foveal cysts in MPS I-H resolving with oral acetazolamide and to highlight the diagnostic value of multimodal retinal imaging and electrophysiological testing.

Introduction: Hurler syndrome (mucopolysaccharidosis Type I-H) is a lysosomal storage disorder that can cause progressive multisystem complications. Retinal involvement often mimics retinitis pigmentosa (RP), and pathology may progress even after early hematopoietic stem cell transplantation (HSCT) due to limited enzyme penetration into ocular tissues.

Case summary: A 17-year-old female with MPS I-H, post-HSCT at 21 months, presented with bilateral visual decline despite a normal clinical fundus exam. Evaluation included spectral-domain OCT (SD-OCT), fundus autofluorescence (FAF), multifocal electroretinography (mfERG), full-field ERG (ffERG), and visual evoked potential. SD-OCT revealed bilateral intraretinal foveal cysts without leakage on fluorescein angiography. FAF showed a bull's eye maculopathy pattern; mfERG showed bilateral macular dysfunction. ffERG revealed rod-cone dystrophy. Two 3-month courses of oral acetazolamide (125 mg three times daily) led to complete cyst resolution and visual improvement.

Conclusion: This case supports the role of systemic carbonic anhydrase inhibitors in treating nonleaking macular cysts in MPS I, similar to RP-related cystoid macular pathologies, and highlights the value of integrating electrophysiological and multimodal imaging, especially in occult retinal disease.

We report a challenging congenital cataract surgery in an adult case of colobomatous microphthalmia associated with intraorbital cyst.

Compressive optic neuropathy (CON) is a condition characterized by optic nerve damage caused by abnormal mechanical pressure. Here, we report a rare case of bilateral CON due to a large, right supraclinoid internal carotid artery (ICA) aneurysm. A 66-year-old female presented to the clinic with complaints of prior, intermittent headaches and decreased visual acuity. Notably, no relative afferent pupillary defect (RAPD) was present on exam. Visual field testing revealed an inferior altitudinal defect oculus dexter (OD) and a superotemporal defect oculus sinister (OS). This visual field pattern strongly suggested a central lesion in the form of a junctional scotoma despite the noted absence of a RAPD on exam. Subsequent magnetic resonance imaging (MRI) revealed a large, right supraclinoid aneurysm, and the patient was treated accordingly. Through this case, one can appreciate how the classically described RAPD may not be present in all cases of CON if both optic nerves are affected. A provider must subsequently use other findings to distinguish between a central and peripheral nerve etiology. The importance of formal visual field testing in all cases of vision loss is highlighted to assess its etiology and aid in making this distinction between a central and peripheral lesion.

Purpose: This report presents the 2-year follow-up of a rare case of ocular injury caused by caterpillar hairs (setae), highlighting the clinical course, complications, and management strategy, including surgical intervention.

Methods: A 39-year-old male presented 6 months after exposure to a caterpillar cocoon with decreased vision, photophobia, floaters, temporal photopsia, and conjunctival injection. Examination revealed multiple setae embedded in the cornea, conjunctiva, and retina, with associated vitreous inflammation and retinal scarring. The patient underwent pars plana vitrectomy, removal of intraocular setae, and endolaser photocoagulation around retinal entry sites.

Results: The patient's vision gradually improved following surgery, stabilizing at 20/20 visual acuity at 2-year follow-up.

Conclusion: This case highlights a quite rare occurrence of intraretinal caterpillar setae and their potential for severe ocular complications. Prompt recognition, detailed examination, timely surgical intervention, and consistent long-term follow-up are critical to preserving vision. Scleral penetration as a potential mechanism for intraocular setae in similar cases should be considered, emphasizing the importance of maintaining a high index of suspicion and intervening at an appropriate time to minimize the risk of deeper tissue involvement and long-term visual sequelae.

Common ocular manifestations of Herpes zoster ophthalmicus (HZO) include conjunctivitis, keratitis, anterior uveitis and ocular hypertension. Immunosuppressed patients are at an increased risk of sequelae including orbital inflammation and meningitis. We present a case of a 47-year-old immunocompetent patient who presented with acute orbital inflammation and viral meningitis, on a background of recent HZO without ocular involvement. Magnetic resonance imaging (MRI) demonstrated enhancement and enlargement of the left extraocular muscles, lacrimal gland and optic nerve sheath and enhancement of the left trigeminal nerve in the prepontine segment extending into the cavernous sinus. A lumbar puncture revealed elevated mononuclear cells consistent with viral meningitis. Cerebrospinal fluid polymerase chain reaction was negative for viruses. The patient was initially treated with intravenous acyclovir, which was followed by oral acyclovir. Oral prednisolone was commenced to treat the orbital inflammation. On 10-week follow-up, inflammatory signs had improved; however, the patient had persisting diplopia, which was managed with prismatic correction.

Birdshot chorioretinopathy (BSCR) is a presumed autoimmune disease of the eye affecting mostly middle-aged women and typically associated with the HLA-A29 genetic haplotype. Presenting symptoms include blurred vision, nyctalopia, and floaters. Classic fundus findings are multiple, bilateral, creamy, oval lesions around the optic nerve, mostly nasal and inferior to the disc. Fluorescein/indocyanine angiography, optical coherence topography, and fundus autofluorescence can be used for diagnosis and disease monitoring. Here, we present a case of a patient with giant cell arteritis (GCA) on tocilizumab who presented with asymptomatic BSCR lesions in both eyes. Both GCA and BSCR have T cell lymphocyte-mediated inflammation and are treated with corticosteroids. In our case, the patient was on a steroid-sparing agent, which may have suppressed symptoms of BSCR. We found no other cases of a patient having both GCA and BSCR.