Case Reports in Ophthalmological Medicine最新文献

Goldenhar syndrome (GS), also known as Franceschetti-GS, encompasses a spectrum of congenital anomalies affecting the eyes, ears, face, and vertebrae. This case report highlights a 2-day-old female patient diagnosed with GS presenting a rare manifestation of bilateral complete eyelid colobomas. The patient, with associated renal and cardiac problems, underwent surgical interventions, including bilateral lower lid frost suture tarsorrhaphy and subsequent upper lid reconstructions. Despite challenges and complications, the patient showed varying degrees of improvement in corneal conditions postsurgery. The discussion provides insights into the clinical features, diagnosis, and multidisciplinary management of GS. The presented case emphasizes the importance of tailored surgical approaches in addressing the complex ocular manifestations of GS, aiming for functional and aesthetic outcomes. Ongoing follow-up and further reconstruction surgeries are planned to optimize visual outcomes and address residual complications.

Purpose: The aim of this study is to report a unique case where brolucizumab administration resolved multilayered pigment epithelial detachment (MLPED) lamellae. Observations: An 80-year-old gentleman with polypoidal choroidal vasculopathy developed MLPED from long-term ranibizumab treatment. Switching to brolucizumab led to visual acuity improvement after three doses and complete resolution of fluid, reduced choroidal thickness, and MLPED collapse. Notably, the patient experienced a recurrence of MLPED, which again resolved after the fourth dose of brolucizumab. Conclusions and Importance: This case underscores the effectiveness of brolucizumab in resolving MLPED lamellae, a previously unreported phenomenon. Furthermore, it highlights the potential for visual acuity improvement despite MLPED resolution. Brolucizumab's mechanism of action, including its potent antivascular endothelial growth factor properties and enhanced tissue penetration, may contribute to the collapse of MLPED by modulating subretinal pigment epithelial fluid dynamics. Further research into molecular pathways, cellular interactions, and safety profiles is warranted to optimize the therapeutic role of brolucizumab.

Objective: This study is aimed at describing a unilateral presentation of acute iris transillumination following contralateral vitrectomy with postoperative endophthalmitis. Methods: This case study is based on the medical record of a patient who presented to our hospital in 2017. Results: A 70-year-old female patient presented to our department with metamorphopsia and decreased vision in the right eye. She was diagnosed with a Stage 3 macular hole in the right eye for which she underwent 23G pars plana vitrectomy with gas tamponade. Postoperative topical treatment of tobramycin/dexamethasone was administered. Nine days after surgery, she presented to a different medical center with postoperative endophthalmitis in the right eye. Oral moxifloxacin was administered, an intravitreal injection with vancomycin was performed, and topical treatment with dexamethasone/chloramphenicol and neomycin/polymyxin B/dexamethasone was started. One month after surgery, she presented again to our department, this time with scleritis with associated anterior uveitis of the left eye. She was treated with oral ibuprofen, topical prednisolone acetate, and atropine sulfate, which resulted in clinical resolution. Three weeks after this episode, the left eye showed patchy transillumination of the iris matching the bilateral acute iris transillumination (BAIT) syndrome phenotype; however, the iris in the right eye remained normal. Conclusion: To the best of our knowledge, this case is the first to show a unilateral phenotype of BAIT after contralateral vitrectomy. This suggests that previous vitrectomy, injection of vancomycin, or topical corticosteroids or chloramphenicol could be protective against the development of acute iris transillumination.

Purpose: The aim of this study is to evaluate the efficacy and safety of intravitreal faricimab dosing interval at and beyond 24 weeks in patients with diabetic macular edema (DME) and neovascular age-related macular degeneration (nAMD). Methods: This study is a retrospective case series of eight patients with persistent DME and nAMD who received intravitreal faricimab at and beyond the 24-week (6-month) dosing interval regimen. Results: The majority of patients experienced an improved mean best-corrected visual acuity (BCVA) of 9.9 letters; congruent anatomical improvement (mean central macular thickness (CMT)) decrease of 44 μm on optical coherence tomography (OCT) is demonstrated at 6 months despite extended faricimab dosing intervals. Conclusions: Extended intravitreal faricimab dosing intervals at and beyond 24 weeks maintained visual and anatomical outcomes in patients over 1 year. This suggests the feasibility of personalized extended dosing tailored to each patient's disease activity, potentially reducing treatment burden.

Purpose: The purpose of this study is to report a rare case of conjunctival melanoma (CM) in a black male patient and provide a comprehensive literature review of all documented cases of CM in the black population. Methods: A case report highlighting a black patient with newly diagnosed CM was described. A comprehensive literature review was conducted to determine the prevalence of CM in the black population. Results: Extensive CM in situ in a 46-year-old black male patient was treated with excision and cryotherapy. The patient subsequently required repeat cryotherapy and topical Mitomycin C therapy due to a recurrence of pigmentation. A literature review identified 46 cases of CM in the black population. Conclusions: CM has rarely been observed in the black population. With this current case report, there are only 47 black patients found in the literature with this ocular surface tumor. Further detailed documentation on the presentation, location, and outcomes of CM in this population is imperative to better screen and treat this demographic.

An 18-year-old male presented with bilateral vision loss, worsening over 10 days in the left eye and rapidly in the right eye following a suspected viral respiratory infection. On admission, his best corrected visual acuity (BCVA) was 0.9 in the right eye and 0.025 in the left. No inflammation was found in the anterior segment or vitreous body, but both eyes showed multiple yellow-white, plaque-like lesions in the retina and choroid, with foveal involvement in the left eye. Diagnostic tests revealed choriocapillaris flow deficits (optical coherence tomography angiography (OCTA)), hyperreflective changes in the outer retina and choroidal thickening (optical coherence tomography (OCT)), hypofluorescence and patchy hyperfluorescence (fluorescein angiography (FA)), hypoautofluorescence with peripheral hyperautofluorescence (fundus autofluorescence (FAF)), reduced a- and b-wave amplitudes (electroretinogram (ERG)), and scotomas with decreased retinal sensitivity (visual field (VF)). The presence of HLA-B15 and HLA-B35 antigens was confirmed. Treatment with oral methylprednisolone and intravenous acyclovir led to significant improvement within 1 day. BCVA improved to 0.9 in the right eye and 0.25 in the left, with further improvement to 0.9 and 0.5 9 days after discharge. Full visual recovery was achieved within 5 weeks. This case underscores the diagnostic value of OCTA and suggests a potential genetic predisposition linked to HLA-B15 and HLA-B35. It also highlights the effectiveness of methylprednisolone and acyclovir in APMPPE following a viral infection.

Purpose: Sarcoidosis is a systemic inflammatory disease associated with ocular involvement in 20%-30% of cases. The current gold standard for detecting sarcoidosis is computed tomography of the thorax, which is 73% sensitive. Definitive diagnosis necessitates biopsy, with Schaumann bodies and non-necrotizing granulomas serving as key pathological hallmarks. Observations: Our patient, a 44-year-old White female, presented for a second opinion on her bilateral chronic intermediate uveitis with intractable chronic cystoid macular edema of the left eye. Our clinical suspicion for sarcoidosis was high, but the computed tomography thorax scan did not show any abnormal findings. A routine mammogram completed 4 weeks prior to our initial evaluation showed axillary lymph node enlargement with calcifications. Subsequent biopsy was consistent with sarcoidosis. Treatment with mycophenolate mofetil resolved the uveitis and macular edema. Conclusions and Importance: The diagnosis of sarcoidosis can be challenging due to nonspecific ocular signs and the potential for falsely negative findings on imaging. This case highlights the importance of patient education and self-surveillance regarding the characteristic systemic symptoms of sarcoidosis, which commonly involve the lungs, eyes, skin, joints, etc. Our report demonstrates the significance of maintaining a high level of suspicion for sarcoidosis in patients with characteristic ocular findings, even when initial imaging results are negative or inconclusive.

Purpose: The purpose of this study is to elucidate varying etiology and presentations of frosted branch angiitis (FBA), a rare immune-mediated retinal vasculitis. Methods: In this case series, four curated cases confined to varying spectrums of FBA have been described. Detailed fundoscopic documentation with pertinent imaging was performed in all the cases. The cases were managed adequately as per protocol and retrospectively analyzed. Results: Our first case is unique as it has been rarely reported in extant ophthalmic literature. The case is presented as progressive outer retinal necrosis in cytomegalovirus (CMV) retinitis accompanied by FBA. The second case is a Kleiner Type 3 FBA with viral prodrome. Our third case is the fourth reported case in literature of FBA following penetrating trauma. This case is instrumental in confirming the hypothesis of Type 3 hypersensitivity reaction in the slow deposition of immune complexes in the periarteriolar region as a pathophysiology for FBA. The fourth case is the first reported case of coexisting bilateral flecked retina and FBA. It also had an unusual association with tuberculosis mimicking tubercular vasculitis. Conclusion: This gamut of unique cases may contribute to a better understanding of the variability of clinical presentation of FBA in a more detailed manner for future reference.

Introduction: Accidental retinal injuries caused by lasers without appropriate eye protection are not rare; most cases are unilateral. We report the case of a medical nurse who sustained bilateral foveal damage through indirect exposure to a picosecond dermal laser. Case Presentation: A 23-year-old nurse working in a cosmetic surgery clinic was using a picosecond KTP/Nd:YAG laser for tattoo removal. Because the procedure was complicated, she neglected the use of protective eyewear and experienced dazzle. Thirty minutes after starting the procedure, she developed central scotomas in both eyes. We examined her eyes the next day. Ophthalmologic examination revealed best-corrected decimal visual acuity (BCVA) of 0.6 in the right eye and 0.3 in the left eye. Spectral domain-optical coherence tomography showed a hyperreflective inner retinal layer with a lamellar defect and focal outer retinal detachment in the right eye; the left eye exhibited intra- and subretinal foveal hemorrhages. Injections of sub-Tenon's triamcinolone acetonide (12 mg/0.3 mL) in the right eye and intravitreal tissue plasminogen activator (30 μg/0.05 mL) in the left eye were administered on the same day. Two weeks later, a full-thickness macular hole (FTMH) was identified in the right eye; pars plana vitrectomy was required 6 weeks after initial presentation. Because the FTMH failed to close, a second procedure was performed 2 months later. One year after initial presentation, BCVA in the right eye had improved to 0.4. Although the FTMH remained closed, an outer retinal layer defect persisted. In the left eye, foveal hemorrhage resolved within 1 month of initial presentation. At the 1-year follow-up, BCVA in the left eye was 0.4; outer retinal layer disruption was evident at the central fovea. Conclusions: Continuous Nd:YAG laser exposure during cosmetic procedures likely caused the bilateral foveal damage observed in this case. All individuals using lasers must be aware of the importance of protective goggles.

Purpose: We describe the diagnostic challenge by melanocytomas originating from locations other than the optic nerve. Methods: This is a retrospective case report of two patients who presented with vitreous hemorrhage with underlying melanocytomas. Results: Both patients had hemorrhage obscuring indeterminant uveal masses; fine-needle aspiration biopsies confirmed melanocytoma with necrosis and atypia and, in one case, concern for malignant transformation. Conclusion: Melanocytomas are rare, benign melanocytic lesions that resemble nevi. In contrast to optic nerve melanocytoma, those involving the choroid and ciliary body lack specific clinical characteristics. Vitreous hemorrhage is an underrecognized complication, and uveal melanocytoma must be included in the differential diagnosis of vitreous hemorrhage with associated ciliary body or choroidal mass. Biopsy is required for definitive diagnosis and to identify malignant transformation of the lesion, a rare but possible occurrence.