Case Reports in Ophthalmological Medicine最新文献

Background: This study is aimed at exploring a case of choroidal Langerhans cell histiocytosis (LCH) successfully treated with systemic corticosteroid and immunosuppressant. Case presentation. A 24-year-old man with known multisystem LCH developed loss of vision, ocular pain, conjunctival injection, panuveitis, and a ciliochoroidal mass. After receiving an intravenous methylprednisolone pulse, oral high-dose corticosteroids, and methotrexate, the mass resolved quickly and completely without flare-ups during 6 months of follow-up.

Conclusions: Intraocular involvement of LCH is rare and can present with or without a history of multisystemic disease. The diagnosis is challenging, and the standard treatment is not established. Systemic anti-inflammatory and immunosuppressive therapy could be an effective treatment, as the LCH itself contains an essential element of inflammation and the symptoms may be mainly inflammatory.

Purpose: Cyclic esotropia (alternate-day squint) is a poorly understood form of strabismus that mostly occurs at younger pediatric ages. It demonstrates classically a 48-hour cycle with 24 hours of manifest esotropia and 24 hours of orthotropia, which is conventionally managed by bilateral or unilateral 2-muscle surgery. We aimed to report a child with cyclic esotropia who was surgically treated by a conservative unilateral 1-muscle approach.

Methods: Case report.

Results: A 3.5-year-old girl presented to the strabismus department with an intermittent esodeviation for 2 years that became cyclic in the last 3 months. The diagnosis of primary classical cyclic esotropia was made after seeing her multiple times on different days. The girl was emmetropic bilaterally, had normal visual acuities in both eyes, and high-angle right esodeviation (45-50 ^Δ ) with normal laboratory and MRI results. Unilateral maximal single-muscle recession of the right medial rectus was performed, and the child was followed up for 9 months. The girl developed excellent alignment after the surgery both at distance and near without cyclic pattern, and near-normal stereopsis (by animals: 100 sec. of arc) with binocularity was reached. The girl did not experience under- or overcorrection nor have a recurrence postoperatively.

Conclusion: This is the first report of "one eye single-muscle" surgery for high-angle cyclic esotropia. Conservative unilateral medial rectus recession seems to be sufficient to permanently block the circadian rhythm and restore binocular fusion and stereopsis.

Background: In recent years, immune checkpoint inhibitors (ICI) have been often used for several types of cancers. Immune-related adverse events (irAEs) are autoimmune responses caused by ICI. Among the different types of irAEs, uveitis is common in ophthalmology. Moreover, there are reports on Vogt-Koyanagi-Harada (VKH) disease-like uveitis. In most cases, VKH, as in the usual VKH, is managed with intravenous methylprednisolone therapy. Case Report. A 72-year-old man was diagnosed with gastric cancer, and he was treated with nivolumab, a type of ICI. After eight cycles of nivolumab therapy, he developed fulminant type 1 diabetes mellitus and diabetic ketoacidosis. Thus, the treatment was discontinued. Subsequently, the patient was referred to our department due to bilateral blurry vision. He had decreased visual acuity in both eyes, and slit lamp examination revealed the presence of bilateral anterior chamber cells and keratic precipitates. Fundus examination showed bilateral serous retinal detachment (SRD), wavy retinal pigment epithelium (RPE), and choroidal thickening. Cerebrospinal fluid examination revealed prominent pleocytosis. Thus, we initiated eye drop therapy and subtenon injection of triamcinolone acetonide on the right eye only. After 1 month, SRD and wavy RPE disappeared, and the patient's visual acuity improved. Further, both eyes had similar improvements in visual acuity and abnormal findings. Oral prednisolone was subsequently administered for hearing loss. However, intravenous methylprednisolone was not used, and ophthalmologic findings and visual acuity did not change before and after systemic steroid therapy. One year after disease onset, SRD and wavy RPE did not relapse.

Conclusion: Nivolumab-induced VKH disease-like uveitis can have good outcomes even in a patient managed without intravenous methylprednisolone therapy.

Keratoconus (KC) is a bilateral ectatic corneal disease which results in changes in the corneal architecture and can lead to severe visual impairment. Treatment options depend on the stage of the disease, and they aim either at improving vision or arrest progression. The Bowman layer transplantation (BLT) is a recent surgical option in patients with KC and may postpone corneal transplantation in some patients. We present a case of a 22-year-old patient with a 10-year follow-up history of progressing KC. A first attempt for an intracorneal ring segment (ICRS) implantation when he was 13 years old was unsuccessful due to a superficially implanted segment. At that time, collagen cross-linking was unavailable, and his young age raised concerns about performing a penetrating keratoplasty/lamellar keratoplasty. A BLT was performed with further ICRS implantation with relative disease stability and visual improvement. ICRS implantation in KC patients with BLT has not previously been described in literature and can be an option in selected patients.

Purpose: To evaluate the one-year outcomes of gonioscopy-assisted transluminal trabeculotomy (GATT) in primary congenital glaucoma (PCG) with a history of prior glaucoma surgery.

Methods: A retrospective chart review was performed to identify all PCG patients ≤ 16 years who underwent GATT surgery at Cairo University Children's Hospital from January 2016 to March 2022. Pre- and postoperative intraocular pressure (IOP) and glaucoma medications were collected at 1, 3, 6, 9, 12, and last follow-up visits. Success was defined as IOP ≤ 21 mmHg without (complete) or with (qualified) glaucoma medications at the last follow-up.

Results: Seven eyes of 6 subjects were included in the study. The mean IOP was statistically significantly reduced from 25.7 ± 5.9 mmHg preoperatively to a mean IOP of 12 ± 1.5 mmHg (P = 0.001) at 12 months and 11.5 ± 1.2 mmHg (P = 0.001) at the last follow-up visit. Six eyes (85.7%) achieved complete success, and one eye (14.2%) achieved qualified success. No patients required further glaucoma procedures. No serious intra- or postoperative complications were identified.

Conclusions: Our early experience highlights that GATT can be performed as an alternative procedure before considering conjunctival or scleral glaucoma surgeries.

We herein report a case of glaucoma with an intraocular pressure (IOP) decrease following total gastrectomy (TG) and anticancer treatment for gastric cancer. A 62-year-old male underwent trabeculectomy of the left and right eyes in August 2011 and July 2012, respectively. During the follow-up, IOP of the right eye was 9-12 mmHg (with bimatoprost, dorzolamide, and timolol maleate), and that of the left eye ranged between 14 and 26 mmHg (with bimatoprost, dorzolamide, timolol maleate, and brimonidine tartrate). In December 2014, TG was performed due to gastric cancer. After surgery, the patient received S-1+CDDP, weekly PAC, and CPT-11 therapies. The patient died on March X, 2017. Before TG, the body mass index (BMI) was 29.5 but decreased to 24.8 before the start of the two courses of weekly PAC therapy. IOP of the right eye was 6 mmHg (with bimatoprost), and that of the left eye was 10 mmHg (with bimatoprost, dorzolamide, and brimonidine tartrate), showing decreases. After the initiation of weekly PAC therapy, BMI was approximately 19. IOP of the right eye ranged between 6 and 10 mmHg until the final ophthalmological examination (January 11, 2017), while that of the left eye ranged between 8 and 15 mmHg. In this patient with glaucoma, IOP was not controlled by eye drop treatment, and TG for gastric cancer and postoperative treatment with anticancer drugs resulted in weight loss and a decrease in IOP.

Lipid keratopathy (LK) is a rare disease involving lipid deposition in the cornea resulting in corneal opacification. Primary LK can arise sporadically while secondary LK is seen in patients with a history of ocular trauma, medication exposure, infection, inflammation, or disorders resulting in derangements of lipid metabolism. Secondary LK is more common and occurs due to neovascularization. Use of precipitating medications should be considered in LK workup, particularly for patients in whom other etiologies have been ruled out. Brimonidine, an ocular hypotensive medication, can be associated with LK. We present a case of bilateral secondary LK in a patient with a history of prolonged brimonidine use, without additional contributing factors.

Purpose. We report a case of bacterial keratitis secondary to an undescribed Bergeyella sp. Bergeyella spp. are not easily cultured, and many reports have identified unculturable isolates through broad-range bacterial polymerase chain reaction (PCR). Observations. A healthy 29-year-old male was attempting to repair an acrylic cannabis water pipe when it shattered and a fragment hit him in the left eye. Two weeks later, he presented with foreign body sensation, scleral injection, and photophobia that were refractory to prolonged corticosteroid therapy. Following a subconjunctival triamcinolone injection, the patient developed a hypopyon and multifocal, midstromal, epithelized corneal infiltrates. Broad-range PCR of the aqueous fluid detected deoxyribonucleic acid closely matching the Bergeyella genus. Empiric treatment directed toward gram-negative bacteria led to the clinical resolution of the inflammation. Conclusions and Importance. This is the first reported case of ocular inflammation secondary to a Bergeyella spp.. As broad-range PCR testing becomes more accessible, we anticipate that additional PCR-positive and culture-negative scenarios will occur.

Anterior ischemic optic neuropathy (AION) is the most frequent cause of acute optic nerve damage in the elderly, usually causing acute, unilateral, and painless permanent visual loss. Arteritic anterior ischemic optic neuropathy (AAION) is a result of endothelial cell inflammation and the subsequent thrombosis and occlusion in the blood-supplying arteries of the optic nerve head. AAION accounts only for 5-10% of all AION cases that are associated with vasculitis which usually takes place in the course of a giant cell arteritis (GCA). In this paper, we report a case of AAION following a COVID-19 respiratory infection. Although it is uncertain whether SARS-CoV-2 infection triggered the AAION or was coincidental, the possible association of the events is concerning.

Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) and neuromyelitis optica spectrum disorder (NMOSD) are rare central demyelinating diseases that may affect refractive surgery outcomes. Optic neuritis and brainstem syndromes affecting cranial nerves are particularly relevant to corneal refractive surgery (CRS), such as laser-assisted in situ keratomileusis (LASIK), photorefractive keratectomy, or small incision lenticule extraction. There is currently no existing literature concerning the outcomes of CRS in patients with MOGAD or NMOSD. This article reports the clinical outcome of a MOGAD patient who underwent LASIK.