Case Reports in Ophthalmological Medicine最新文献

Background: Secondary hypertension, particularly in young patients, can manifest as malignant hypertension with ocular complications. We report a case of hypertensive choroidopathy with serous retinal detachment as the initial presentation of malignant hypertension in a young woman with renal failure secondary to antimalarial treatment.

Case presentation: A 19-year-old woman with a history of renal failure following antimalarial treatment presented with sudden, bilateral vision loss (right eye: 20/200, left eye: 20/40). Fundus examination revealed asymmetrical choroidal involvement with serous retinal detachment, more pronounced in the right eye. Her blood pressure was markedly elevated at 230/130 mmHg. Following blood pressure control, the patient's vision improved to 20/20 in both eyes and the serous retinal detachments resolved completely.

Conclusion: This case highlights the importance of considering hypertensive choroidopathy in young patients with secondary hypertension presenting with sudden vision loss. Prompt diagnosis and blood pressure management can lead to complete visual recovery.

Prostaglandin-associated periorbitopathy (PAP) is a known complication of prostaglandin therapy most commonly associated with topical bimatoprost. PAP is characterized by a progressive constellation of eyelid, periorbital, and conjunctival signs that contribute to cosmetic and functional challenges for patients and clinicians. This constellation of findings can produce an asymmetric appearance, symptomatic discomfort, and ocular surface changes to patients. In our case, these changes resulted in previously unreported sight-threatening sequelae from bacterial keratitis. The authors report a case of PAP-induced lagophthalmos and secondary microbial keratitis that necessitated a corneal graft. Reversal of these findings occurred on prostaglandin cessation with dramatic reversal of findings within 8 weeks.

Background: Posterior microphthalmos (PM) typically manifests as retinal thickening, edema, and the presence of papillomacular fold (PMF). We report a case of bilateral PM with macular atrophy and RPE dysfunction. Late-stage of RPE dysfunction in PM is poorly documented in the literature. We present a case that highlights this scenario, aiming to raise awareness of this condition among ophthalmologists.

Case presentation: The authors emphasize the atypical imaging findings associated with PM and RPE dysfunction. This case was initially misdiagnosed as macular edema, leading to the administration of anti-VEGF treatment, a common clinical pitfall in PM due to intraretinal cystoid changes. Nevertheless, no improvement was observed in retinal thickness, as evidenced by OCT examination, or inpatient visual acuity following anti-VEGF therapy.

Conclusion: Our case adds to recently reported cases linking PM and RPE dysfunction. The recognition of the short axial length and the utilization of imaging modalities such as OCT and FFA contribute to the diagnosis of this condition. It is important to note that anti-VEGF therapy is not applicable for this condition.

We present the case of a 9-year-old boy with X-linked retinoschisis (XLRS) who experienced transient resolution of foveal schisis after developing macula-involving retinal detachment. Following successful scleral buckling surgery and retinal reattachment, foveal schisis reappeared.

Sebaceous carcinoma, an uncommon malignant neoplasm, often arises de novo from periocular sebaceous glands. Commonly manifesting as diffuse eyelid thickening, sebaceous carcinoma can mimic other inflammatory processes such as persistent chalazion or blepharitis. Delayed diagnosis often complicates the disease course due to its indolent presentation. Described is a rare case of sebaceous carcinoma entirely confined to the conjunctival epithelium of the upper eyelid. An 80-year-old female presented for evaluation of bothersome "cysts" under her left upper lid as well as blurry vision in her left eye. The patient was repeatedly re-evaluated over the next few months and found to have Meibomian gland dysfunction of the upper and lower left eyelids as well as 3+ diffuse spongy papillary injection of the tarsal conjunctiva in the left upper lid, with large papillae and conjunctival thickening in the left inferior fornix. A conjunctival biopsy was eventually performed when appropriate management of presumed conjunctivitis failed to alleviate the patient's symptoms. Pathological examination of the left upper eyelid tarsal conjunctiva showed epithelium largely replaced by pagetoid spread of intraepithelial sebaceous carcinoma, with an underlying band-like lymphocytic infiltrate. The carcinoma was strongly adipophilin positive with variable EMA, PRAME, and Factor XIIIa positivity, confirming intraepithelial sebaceous carcinoma. The nuclei of the carcinoma had a smudged, salt-and-pepper appearance; however, CK20, INSM-1, and synaptophysin were negative, excluding Merkel cell carcinoma. A sebaceous carcinoma limited to conjunctival epithelium is rare. However, given its potential aggressive nature, it should be included in the differential diagnosis of "nonhealing conjunctivitis" or persistent unilateral irritation of the eyelid.

A 62-year-old female with retinitis pigmentosa presented for a low vision rehabilitation evaluation. An updated spectacle prescription, filters, and task lighting were beneficial, but the patient was left with outstanding needs. She noted that she had lost her independence and felt trapped within her own home with nobody around who could fully understand her situation. Genetic testing confirmed autosomal dominant retinitis pigmentosa and provided answers regarding prognosis and family tree considerations. White cane mobility training allowed her to be more independent when traveling. Independent living skills training equipped her to be safer and more autonomous at home. Assistive technology training empowered her to use her digital devices more efficiently to reconnect with friends, family, and the world. A visually impaired clinical counselor helped the patient to work through the process of grieving her vision loss, while involvement in peer support groups allowed her to connect with a new community and recognize future potential. The training and support resources utilized in this case combined to help an individual adapt in response to a challenging diagnosis and prognosis. Such resources should never be overlooked or underestimated in cases of irreversible vision loss.

Introduction: This study is aimed at describing a patient with unilateral retinal pigment epithelium dysgenesis (URPED) using multimodal retinal imaging combined with ocular microperimetry and multifocal electroretinogram (ERG) analysis. Case presentation: A 56-year-old healthy male was referred for a routine ophthalmologic control. His best corrected visual acuity was 20/20 and 20/25 in the right and left eye, respectively. Fundus examination of the left eye revealed a well-circumscribed, large yellowish-white lesion on the posterior pole that extended from the peripapillary region to the inferior temporal vascular arcade, sparing the fovea. This characteristic fundus picture led us to the diagnosis of URPED. Microperimetry demonstrated a progressive decrease of sensitivity from the normal retina toward the lesion borders, reaching a value of 0 dB at its center. Multifocal ERG displayed a reduction of central amplitudes in the involved eye. Discussion: Our findings indicate a varied degree of sensitivity at the site of the lesion. Despite good visual acuity, multifocal ERG revealed reduced macular function.

Purpose: This study was aimed at presenting a case of Sturge-Weber syndrome and oculodermal melanocytosis in a pediatric patient and offering a viable treatment course to control the glaucoma in both eyes. Observations: A 5-year-old female presents with a large port-wine stain on the left side of her face, retinal pigment changes, and diffuse slate gray pigmentation of the sclera, consistent with Sturge-Weber syndrome and oculodermal melanocytosis. She underwent bilateral trabeculotomy, micropulse cyclophotocoagulation, and staged Ahmed tube insertion for the management of her glaucoma. The pressures have normalized bilaterally after tube insertion, with the last measurement of her eyes under anesthesia revealing intraocular pressures of 25 in the left and 18 in the right. Conclusions: It is possible to achieve intraocular pressure control in a patient with congenital glaucoma associated with Sturge-Weber syndrome and oculodermal melanocytosis using staged Ahmed tube insertion.

The coronavirus disease 2019 (COVID-19) primarily involves the respiratory system, but can manifest with a variety of neuro-ophthalmic symptoms. Here, we describe three cases presenting with neuro-ophthalmic manifestations secondary to COVID-19 at a tertiary center in Nepal. The first case was a 42-year-old male with sudden onset painless loss of vision noticed in the right eye (RE) after COVID-19 infection. Examination findings in the RE showed best corrected visual acuity (BCVA) of 6/18 with relative afferent pupillary defect positive and superior sectoral disk edema in the same eye. The case was diagnosed as RE nonarteritic ischemic optic neuropathy associated with COVID-19 infection. Our second case was a 41-year-old female who developed bilateral sudden diminution of vision associated with headache and vomiting on the third day of testing positive for COVID-19 infection. She had bilateral BCVA of 6/12 and sluggishly reacting pupils in both eyes. Dilated fundus examination showed established disk edema. Imaging of the brain showed dural venous sinus (transverse and sagittal) thrombosis. So, the diagnosis of papilledema secondary to COVID-19 associated cerebral venous sinus thrombosis (CVST) was established. The third case was a 40-year-old male with right sixth cranial nerve palsy, ischemic stroke involving the right occipital lobe and posterior limb of the right internal capsule along with thrombosis of the left common iliac artery in the absence of any other preexisting vascular risk factors. Severe inflammatory reaction to COVID-19 causing a hypercoagulable state may be the causal factor in neuro-ophthalmic findings in our case series.

Purpose: The purpose of this study was to report a case of acute central toxic keratopathy due to exposure to Chinese herbal medicine fluid treating verruca plana. Methods: A 46-year-old woman presented with pain and blurred vision in her right eye for 3 days. Her right eye was unintentionally exposed to a medication in liquid form treating the verruca plana on her eyelids. The drug was a compound preparation with complex Chinese herbal medicinal ingredients. Results: Slit lamp examination showed central diffuse corneal subepithelial haze with granular shapes and anterior stromal opacity. Corresponding with her clinical manifestations, anterior segment optical coherence tomography revealed diffuse abnormal highly reflective signal in the anterior stroma within 349 μm and in vivo confocal microscopy found inflammatory infiltration in the subepithelial and the anterior stromal layer. Thus, tobramycin dexamethasone eye drops and artificial tears were prescribed for her, which proved effective. Her clinical symptoms and signs were both resolved after steroid treatment and remained stable at the 1-month follow-up. Conclusion: Acute central toxic keratopathy could occur after exposure to Chinese herbal medicine fluid, and enhanced topical steroid treatment worked well for alleviating inflammation and reducing corneal opacity.