Case Reports in Ophthalmological Medicine最新文献

Background: Persistent hypotony is a rare but serious complication following antiglaucoma surgery. Identifying the cause and appropriate management is critical to prevent vision loss. Case Presentation: A 56-year-old male presented with 6 months of progressive vision loss in the left eye, 20 years post-antiglaucoma surgery. Examination showed no light perception in the right eye and choroidal and ciliary body detachment with lens subluxation in the left eye. After a month of conservative treatment, intraocular pressure (IOP) in the left eye remained below 6 mmHg, necessitating surgical intervention. Combined suprachoroidal fluid drainage, phacoemulsification, and capsular tension ring implantation improved visual acuity and stabilized IOP. Six months postoperatively, the best corrected visual acuity (BCVA) was 0.3. Conclusions: Prompt identification and treatment of persistent hypotony post-antiglaucoma surgery are essential for visual function restoration and complication prevention.

This case report describes a rare instance of primary orbital teratoma with anophthalmia in a neonate. A 6-day-old female presented with a congenital right orbital swelling and absence of visible ocular structures. MRI revealed a large, well-vascularized orbital mass without intracranial extension, accompanied by malformations in the right cerebral hemisphere. Histopathological examination confirmed a benign, mature/mixed teratoma comprising elements from all three germ layers, including neuroectoderm, mesoderm, and endoderm, with no evidence of malignancy. The patient underwent successful orbital exenteration with an implant at 3 weeks of age.

Objective: This report details the case of a 9-year-old Nigerian girl presenting with proptosis and a fungating ocular mass, which was histologically confirmed as retinoblastoma following exenteration. Introduction: Retinoblastoma is the most common pediatric intraocular malignancy, predominantly affecting infants and children under the age of 5, with leukocoria being the most frequent presenting symptom. The occurrence of retinoblastoma in older children is rare and often associated with atypical presentations. Case Summary: A 9-year-old Nigerian girl presented with a 1-year history of progressive left eye symptoms, including redness, pain, decreased vision, and proptosis. Examination revealed a large, fungating ocular mass with no light perception. Imaging studies (ultrasound B-scan and CT scan) confirmed extensive vitreous infiltration and optic nerve involvement. Histopathological analysis postmodified exenteration confirmed retinoblastoma. The patient clinically tolerated a modified exenteration and the first two of six planned cycles of systemic chemotherapy (vincristine, etoposide, and carboplatin). Unfortunately, she died during the second month of follow-up. The recurrence was characterized by progressive worsening of systemic symptoms and preauricular lymphadenopathy, likely indicating metastatic spread. Conclusion: This case highlights the aggressive progression of advanced retinoblastoma and the consequences of delayed presentation in resource-limited settings. Although the patient demonstrated an initial positive response, clinically tolerating modified exenteration and two cycles of systemic chemotherapy, she rapidly succumbed to the disease. This underscores the critical need for early diagnosis, prompt referral, and improved access to specialized care to enhance outcomes in similar contexts.

Purpose: The purpose of the study is to report a case of ocular toxoplasmosis with branch retinal artery occlusion (BRAO). Case: The patient was a 36-year-old man from Okinawa, Japan, who was generally healthy and had no medical history. He was referred to our hospital with a complaint of sudden loss of vision in the left eye. Best corrected visual acuity was 0.1 in the left eye at the initial examination, and intraocular pressure was 21 mmHg. Anterior segment slit-lamp examination showed a few cells of the anterior segment and anterior vitreous. Fundus examination of the left eye showed retinal vasculitis of the middle and large retinal vessels with occlusion of retinal arterioles in the macular area and edema in all layers of the retina, with dense posterior vitreous cells and flare. Magnetic resonance imaging (MRI) showed a mass shadow at the posterior part of the left eyeball near the macula in the orbit. On laboratory examination, toxoplasma serum IgM and IgG were positive. Based on these results, he was diagnosed with BRAO with concomitant intraocular and extraocular toxoplasmosis. He was then treated with clindamycin, sulfamethoxazole-trimethoprim, and steroids. The inflammation disappeared quickly, and visual acuity improved to 0.6. The inflammation had not flared up even 3 months after the initial visit with decreasing serum toxoplasma serum IgG levels, and the posterior eyeball shadow on the MRI disappeared. Conclusion: A case of BRAO with uveitis with concomitant intraocular and extraocular toxoplasmosis lesions was presented. In cases of unilateral retinal vasculitis with orbital lesions, concomitant intraocular and extraocular toxoplasmosis should also be considered.

Purpose: Describe a case of rapidly diagnosed Listeria monocytogenes endophthalmitis, with a clearly established route of endogenous seeding, treated with dual antibiotics, with outcomes better than many reported. Observations: A 79-year-old male developed Listeria monocytogenes endophthalmitis after a gastrointestinal infection with an associated bacteraemia. Rapid microbiologic diagnosis was obtained via matrix assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF). The case was managed with 3 weeks of benzylpenicillin and 6 weeks of trimethoprim-sulfamethoxazole. Visual acuity in the affected eye was preserved with a mild to moderate residual deficit. Conclusion: Clinicians should be aware of the potential for Listeria monocytogenes endophthalmitis associated with preceding gastrointestinal symptoms. Better outcomes are associated with rapid diagnosis, and the use of dual antimicrobial therapy should be considered.

Purpose: This study is aimed at describing a case of combined CMV retinitis and vitreous hemorrhage in an immunocompromised patient. Observations: A 38-year-old male who is known to have HIV presented to our emergency department complaining of decreasing vision in his left eye. Vitreous hemorrhage and preretinal hemorrhage were observed upon examination and were thought to be caused by CMV retinitis. After initial treatment and worsening condition upon follow-up, a diagnosis of combined CMV retinitis and vasculitis was considered and was treated accordingly. Conclusions: The presence of vitreous hemorrhage in immunocompromised patients should not be attributed to just an ischemic vasculitis alone, and the possibility of concurrent infectious retinitis should be looked for carefully to avoid delay in treatment.

Background: Pseudoxanthoma elasticum (PXE) is a systemic disorder that affects the skin, eyes, and vascular system. It commonly presents with retinal angioid streaks (ASs) and can lead to vision loss due to subretinal neovascularizations and macular atrophy. Diagnosis is confirmed through skin biopsies showing calcified elastic fibers or identifying biallelic ABCC6 pathogenic variants. This case report is novel as it describes the clinical course of choroidal neovascularization (CNV) secondary to PXE treated with vitrectomy and intravitreal ranibizumab and aflibercept injections in both eyes. Case Presentation: A 68-year-old woman presented with vision loss in her right eye. Her medical history included hypertension, uterine fibroids, and multiple drug allergies. Ophthalmic examination revealed radial AS around the optic discs and subretinal hemorrhages in the right eye. Fluorescein angiography and optical coherence tomography confirmed CNV and fresh subretinal hemorrhage. A series of vitrectomies and intravitreal injections of ranibizumab and aflibercept were performed to manage the CNV and submacular hemorrhage. Despite recurrence, subsequent surgeries stabilized her condition, improving her best-corrected visual acuity to 20/125 in the right eye over 6 years. A skin biopsy confirmed the diagnosis of PXE, a condition she had overlooked for over 30 years. Conclusions: This case emphasizes the importance of early detection of AS through thorough fundus examination, alongside comprehensive evaluation for systemic conditions. Management of CNV in PXE involves the prompt use of intravitreal anti-VEGF injections and vitrectomy with tissue plasminogen activator (tPA) for controlling CNV activity and submacular hemorrhage. Ophthalmologists should consider PXE in patients presenting with characteristic skin and eye findings and refer them for dermatological evaluation as necessary.

Objective: We report a case of latent postoperative endophthalmitis caused by Staphylococcus cohnii in a 72-year-old woman. Observation: The patient was referred to the department of ophthalmology with blurry vision in her right eye 12 days after phacoemulsification. The clinical examination showed signs of endophthalmitis. A vitreous tap, with intraocular injection of ceftazidime, was performed, and topical dexamethasone and tobramycin were initiated. The postoperative follow-up showed reduction in the intraocular reaction, and the patient was afterwards discharged. After 6 months, her private ophthalmologist referred the patient again with signs of uveitis and macular edema. The clinical examination showed hypopyon and infiltrates on the posterior lens capsule which led to a vitrectomy with the removal of the posterior lens capsule infiltrate. With no signs of improvement at the postoperative follow-up, the intraocular lens was removed. Results: A pathological examination with H&E, Gram, and Periodic Acid Schiff showed gram-positive cocci in relation to the lens capsule. Polymerase chain reaction was performed, detecting DNA of Staphylococcus cohnii. Conclusion and Importance: Staphylococcus cohnii should be considered in cases of latent endophthalmitis. Staphylococcus cohnii is a gram-positive coagulase-negative bacterium that produces biofilm. Biofilm can promote adherence to implants leading to failure of therapy.

Purpose: The purpose of the study is to describe a case of vitreopapillary traction causing optic nerve head elevation. Observations: This case report describes a 64-year-old male who presented with left cloudy vision for 3 days. Dilated fundus exam showed normal right optic nerve with glial tissue nasally and left optic nerve head elevation and peripapillary hemorrhages in the left eye. Magnetic resonance imaging of the brain and orbits, erythrocyte sedimentation rate, and C-reactive protein were normal. Optical coherence tomography showed bilateral dense vitreous adhesions to the optic disc nasally causing traction and optic nerve head elevation of the left eye. The patient was diagnosed with vitreopapillary traction causing optic nerve head elevation, and observation was recommended. Conclusions and Importance: This case highlights the importance of clinical examination and ancillary testing in differentiating etiologies of optic disc elevation.

This report highlights the first known report of an intraocular eyelash embedded in the inferior midperipheral iris following a routine cataract surgery. A 74-year-old female presented 5 months postoperatively from a full-thickness macular hole repair with a 3+ nuclear sclerotic cataract. She underwent an uneventful left eye cataract extraction with insertion of posterior chamber intraocular lens (PCIOL). Review of surgical video revealed well-draped eyelashes and no introduction of an eyelash into the anterior chamber at any point during surgery. The first postoperative visit was notable for no foreign bodies and centered PCIOL. Then, 1 week postoperatively, the anterior segment examination revealed a linear foreign body embedded in the inferior midperipheral iris, without corneal endothelium touch. The foreign body was removed in the operating room and revealed to be an eyelash by pathology. The patient's visual acuity during her first two postoperative visits was 20/30 and improved to 20/20 with refraction at her 1-month postoperative visit. There was minimal postoperative inflammation and no evidence of endophthalmitis. To prevent introduction of an intraocular eyelash associated with cataract surgery, appropriate measures intraoperatively and postoperatively should be taken, including meticulous draping of the eyelashes and lids, diligent corneal wound hydration, and clear patient education.