Case Reports in Ophthalmological Medicine最新文献

Purpose: To introduce a potential solution for failed glaucoma surgeries by proposing an optional surgical procedure in conjunction with the use of Healaflow (Anteis S.A., Geneva, Switzerland) as a spacer, which may potentially reduce the failure rate. Case Presentation. We present the outcomes of a surgical procedure involving the inferonasal implantation of an ab interno XEN gel stent (Allergan, Dublin, Ireland) in a 74-year-old male patient who was experiencing uncontrolled advanced glaucoma in his left eye. It is important to note that the patient had previously undergone several glaucoma surgeries and procedures in the same eye. During this particular procedure, we utilized Healaflow as a spacer by implanting the stent within a subconjunctival Healaflow "bubble." At 6 months postoperatively, intraocular pressure remained on target. There was no need for additional topical medications, and no change in visual acuity was observed.

Conclusion: For patients with a history of unsuccessful glaucoma surgeries and who are unsuitable candidates for tube shunt procedures or transscleral diode cyclophotocoagulation, an alternative option involves implanting the XEN45 stent in the inferior nasal region in conjunction with the use of subconjunctival Healaflow. This combined approach may provide a potential solution for managing glaucoma in these patients.

A case of a patient with the Alström syndrome (AS) that was misdiagnosed as Leber's hereditary optic neuropathy or retinitis pigmentosa for 13 years is presented. AS is a rare genetic disorder caused by mutations in the ALMS1 gene. AS may lead to abnormal ciliary formation and function. AS affects metabolism, and symptomatology includes type 2 diabetes mellitus (T2DM), obesity, hypogonadism and gynecomastia in males, progressive bilateral sensorineural hearing loss, cardiomyopathy, nonalcoholic fatty liver disease (NAFLD), cirrhosis, and chronic progressive kidney disease. The onset of the above symptoms may vary significantly. The ophthalmic manifestation is early onset cone-rod dystrophy that starts as progressive vision loss, photophobia, and nystagmus in the first months of life. An accurate diagnosis may enable specialists to facilitate a significantly positive effect in the everyday life of a patient. Genetic counseling may also be recommended for these patients. Diagnosis was confirmed by DNA testing, thus highlighting its necessity in everyday practice.

A 50-year-old male patient with sudden visual acuity loss in his right eye came to our clinic. Visual acuity at presentation was 1/10 in right eye and 10/10 in left. The patient was otherwise healthy Caucasian man without any history of previous systemic or ophthalmic disease. There was not any history of amblyopia and refractive error. Anterior segment findings were unremarkable. Three quadrants of retina were fully involved with central retinal vein occlusion (CRVO) features including retinal hemorrhages, retinal edema obscuring retinal details, and cotton wool spots while sparing inferior temporal quadrant. Inferior temporal quadrant sparing in this patient is due to a specific retinal vascular anatomical variation. In conclusion, in unusual presentations of retinal vascular branch obstructions, considering retinal vascular anatomy variations would help us to explain the clinical presentation more precisely in some cases.

Objective: To describe a single surgeon's experience utilizing prompt primary slow-burn transscleral cyclophotocoagulation (CPC) with prior or concurrent anti-VEGF and subsequent aqueous shunt as needed in NVG eyes with near-total synechial angle closure at presentation.

Methods: Retrospective chart review of all NVG patients with uncontrolled IOP, active anterior segment NV, near-total synechial angle closure, and no contraindications to prompt anti-VEGF who received CPC within 3 days of presentation with at least 6 months of follow-up.

Results: Eight patients with mean age 60.6 years were included. Underlying etiologies were CRVO (N = 3), PDR (N = 2), CRAO (N = 1), BRVO (N = 1), and chronic RD (N = 1). All eyes underwent CPC with intravitreal anti-VEGF within 3 days of presentation. Five patients did not require subsequent aqueous shunts through a mean follow-up of 15 months; most recent visual acuities ranged from 20/40 to LP, and IOPs ranged from 5 to 11 mmHg on 0 to 3 IOP-lowering medications. Three patients who required subsequent tubes had complete regression of active anterior segment NV at the time of surgery. Most recent visual acuities ranged from 20/100 to 20/125, and IOPs ranged from 8 to 14 mmHg on 0 meds at a mean follow-up of 10 months. No eyes developed uncontrolled inflammation, sympathetic ophthalmia, or phthisis.

Conclusion: Prompt primary slow-burn CPC with prior or concurrent anti-VEGF may be an effective strategy to immediately lower IOP in acute NVG eyes with active anterior segment NV and near-total synechial angle closure. If IOP becomes uncontrolled later, an aqueous shunt can be implanted in a controlled setting after active anterior segment NV has regressed.

Background: To describe a case of retinal pigment epithelial tears (RPE tears) and serous retinal detachment (SRD) after Ex-PRESS filtration surgery for primary open-angle glaucoma (POAG) combined with ischemic optic neuropathy. Case Presentation. This case report involved a 69-year-old woman who underwent Ex-PRESS filtration surgery for right POAG. She had a history of systemic arteriosclerotic disease and subacute progressive visual field loss due to suspected ischemic optic neuropathy in her right eye. The right preoperative visual acuity was 0.7, and intraocular pressure (IOP) was 19 mmHg with maximum glaucoma eye drops. RPE detachment was not observed in the fundus. On day 9 after surgery, the IOP was 6 mmHg, and mild choroidal detachment was observed. On day 13, although IOP remained almost unchanged at 7 mmHg, bullous SRD was observed in the inferior retina, including the macula, and RPE tears were observed along the superior arcade vessel. While subretinal fluid gradually decreased with increasing IOP, tractional retinal folds persisted along the superior arcade, accompanied by macular degeneration.

Conclusion: We experienced a case of RPE tears after Ex-PRESS filtration surgery. In addition to choroidal detachment in the setting of hypotony, a pathologic condition causing structural fragility of the RPE layer may contribute to the development of RPE tears.

We report a case of a 9-year-old girl presenting with unilateral retinal arteriovenous malformation (AVM) with symptomatic macular edema. Over 5 years of follow-up includes optical coherence tomography (OCT), fundus photographs, and fluorescein angiography at baseline and at follow-up. Systemic and neurologic workup was completed and negative for intracranial AVM. Vision has correlated with macular edema, ranging from 20/20 to 20/80. The patient has received nine injections of intravitreal bevacizumab and has not required an injection for the last couple of years. Follow-up is ongoing.

Purpose: To report a case of ciliovitreal block following ab externo implantation of a XEN gel stent for glaucoma.

Methods: Case report.

Results: An 84-year-old African American male underwent ab externo implantation of a XEN gel stent for elevated intraocular pressure. Several days after the surgery, the patient developed severe eye pain and reduced vision. Examination revealed ciliovitreal block (also called aqueous misdirection or malignant glaucoma) which was unresponsive to medical and laser treatment. Pars plana vitrectomy with anterior and posterior synechialysis and anterior chamber reformation were performed. The ciliovitreal block was resolved, and intraocular pressure brought to acceptable levels, but vision in that eye remained poor, likely due to the period of elevated pressure prior to treatment.

Conclusion: Ciliovitreal block is a rare postsurgical (typically) form of secondary angle closure characterized by narrow or flat central and peripheral anterior chamber, anterior displacement of the lens-iris diaphragm, anterior rotation of ciliary processes, and (usually) elevated intraocular pressure. To our knowledge, this is the first reported case of ciliovitreal block occurring after ab externo XEN implantation. Early diagnosis and treatment are essential for preventing vision loss.

Retinal intravascular lipid aggregates were detected in the left eye in a patient with uncontrolled diabetes and very high blood triglycerides. The patient suffered visual loss in the left eye due to retinal ischemia. Optical coherence tomography, fluorescein angiography, infrared fundus photography, and autofluorescence studies of the retina demonstrated unique findings. Slowed choroidal and retinal flow was detected on fluorescein angiography, and a prominent middle layer membrane sign was present on OCT. Intravascular lipid reflectivity was manifest on retinal infrared and autofluorescence imaging. Eventually, insulin and statin therapy proved effective in reversing the vascular lesions, although retinal atrophy finally ensued. This report of a very rare clinical condition provides unique findings on multimodal retinal imaging and confirms the need for prompt insulin and statin therapy in severe/extreme hypertriglyceridemia and dysregulated diabetes. One similar case was reported in the past when multimodal imaging studies of the retina were not available. The lesions described herein should be differentiated from the more frequently encountered lipemia retinalis as they may confer worse prognosis.