Case Reports in Ophthalmology最新文献

Introduction: Intralesional triamcinolone acetonide is a widely used treatment for scarring skin conditions such as keloid and is known to have retinal vascular complications if administered in the periocular region.

Case presentation: A 32-year-old female experienced a prompt onset transient vision decrease and a delayed onset, slow-resolving vison loss in the right eye (OD) following the last of a series of triamcinolone acetonide corticosteroid (TAC) injections in her right earlobe for a disfiguring keloid. Clinically, she developed a branch retinal arterial occlusion accompanied by features of a central retinal vein occlusion. The TAC particles that entered the retinal circulation are implicated in the thrombo-embolic occlusion of the branch retinal artery and subsequent blockage of the central retinal vein.

Conclusion: This case should alert clinicians that there is always a potential hazard for retinal vascular occlusion when corticosteroid is injected in the region of the head and face because of the rich anastomoses between the external and internal carotid artery circulations.

Introduction: Patients with Leber's hereditary optic neuropathy (LHON) have a higher risk of developing multiple sclerosis (MS) than the general population. The coexistence of LHON and MS, also known as Harding's syndrome complicates the diagnosis of optic neuropathy, particularly when the underlying genetic mutation is a rare cause of LHON like DNAJC30.

Case presentation: We present a 26-year-old woman with progressive, sequential, painless, bilateral visual loss which was unresponsive to steroids, and two temporally distinct episodes of neurological disturbance suggestive of central nervous system demyelination. Thorough investigations including serological tests ruled out other causes, including negative neuromyelitis optica and myelin oligodendrocyte protein (MOG) antibodies and nutritional deficiencies. MRI detected areas of demyelination within the spinal cord and brain (infratentorial and periventricular areas). After genetic analysis revealing c.152A>G (p.Tyr51Cys) mutation at the DNAJC30 gene, LHON was suggested. She was prescribed with idebenone and her visual acuity resolved to normal at 4-year follow-up.

Conclusion: This case further expands the clinical presentations of DNAJC30-related LHON and underscores the importance of considering LHON in patients with demyelinating syndrome presenting with severe bilateral visual loss and presumed optic neuritis unresponsive to steroids.

Introduction: We aimed to report macular morphological changes observed on optical coherence tomography (OCT) in a child with familial exudative vitreoretinopathy (FEVR), experiencing macular traction caused by fibrovascular tissue (FT), who underwent vitrectomy.

Case presentation: A 7-year-old girl presented with the chief complaint of decreased visual acuity in the left eye during a school examination. Fundus examination revealed retinal folds with FT extending from the peripheral retina to the posterior pole of the left eye. Despite interventions such as retinal photocoagulation and encircling buckling aimed at reducing the traction on the macula, OCT revealed persistent deep retinal folds and a thickened outer nuclear layer (ONL), indicating gradually increasing macular traction, which contributed to vision loss. A subsequent vitrectomy alleviated the macular traction, enhanced the retinal morphology, and reduced ONL thickening regardless of persistent ectopic inner foveal layers.

Conclusions: Macular morphological changes before and after vitrectomy in a pediatric case of FEVR can be observed using OCT. Vitrectomy with FT removal may be effective in partially improving macular morphology in FEVR with macular traction.

Introduction: Vitreous, retinal, and suprochoroidal hemorrhages might develop secondary to trauma, retinal tear or detachment, neovascularization due to ischemic retina. If the clearance of retinal and vitreous hemorrhages can be accelerated, more effective treatments can be planned for the underlying pathology.

Case presentations: We present 6 different cases with dense vitreous, preretinal, and subretinal hemorrhages due to Valsalva retinopathy, polypoid choroidal vasculopathy, diabetic retinopathy, neovascular age-related macular degeneration, retinitis pigmentosa with vasculitis, and myopic choroidal neovascularization. To accelerate the clearance of these dense intraocular hemorrhages, a novel nonsurgical method of electromagnetic iontophoresis (MagnoVision™) was used together with some appropriate medications in an outpatient setting without any complications or side effects. In all cases, liquefaction of the intraocular hemorrhage began by 5 days and mostly resolved by 10 days. This nonsurgical rapid clearance allowed us to diagnose and evaluate the underlying retinal and choroidal pathologies earlier and to treat them appropriately as early as possible.

Conclusion: Combined use of electromagnetic iontophoresis, subtenon platelet-rich plasma and bevacizumab injection, and oral bromelain can be considered as an effective and safe new treatment method for vitreous and retinal hemorrhages without any need for surgical intervention.

Introduction: Herein, we report on the option and clinical advantage of the Preserflo MicroShunt insertion into the posterior chamber ciliary sulcus in a patient with advanced pseudoexfoliation glaucoma at a high risk of corneal decompensation.

Case presentation: We describe a 64-year-old advanced pseudoexfoliation glaucoma patient who despite maximal tolerated medical therapy and two failed glaucoma surgeries, still suffered from uncontrolled intraocular pressure (IOP) of 36 mm Hg in his left eye. The patient underwent the implantation of the Preserflo MicroShunt. The shunt was placed nasally into an area of unscarred conjunctiva, with the anterior part of the shunt inserted into the ciliary sulcus. Postoperatively, the patient's IOP dropped to 6 mm Hg on the first day and stabilized at 11 mm Hg at the 6-month mark. An elevated, posteriorly located bleb was observed, and the patient no longer required additional topical medications. Endothelial cell (EC) count remained stable with no signs of corneal edema. The patient did not experience any serious postoperative complications.

Conclusion: Implantation of the Preserflo MicroShunt into the ciliary sulcus appears to be a viable option for patients at high risk of corneal decompensation, hence, offering effective IOP control while minimizing EC loss. Further studies with larger patient groups are warranted to better evaluate the safety and efficacy of this technique.

Introduction: Thermal injuries associated with cosmetic eyelid surgery can significantly impair corneal integrity, potentially leading to vision loss. Conventional management, including bandage contact lens use, topical steroids, lubrication, autologous serum tears, and vitamin C, plays a crucial role in preventing long-term complications. This case report explores the potential benefits of multilayer amniotic membrane transplantation (AMT) as an adjunct to standard therapy for treating diathermy-associated corneal burns. Review of the literature advocates the beneficial effects of supplementary AMT in managing thermal corneal trauma.

Case description: A 75-year-old man presented with unilateral diathermy-associated corneal laceration superior to the visual axis following cosmetic blepharoplasty. Vision had deteriorated from his baseline 20/30 to 20/125 postoperatively. Intervention involved multilayer AMT alongside standard care, including topical steroids and antibiotics, oral doxycycline, and vitamin C. Postoperative course was monitored with anterior segment optical coherence tomography (AS-OCT) imaging. By 3 months, complete corneal healing and restoration of baseline visual acuity were achieved.

Conclusion: This is the first documented case of multilayer AMT as an effective supplement to conventional management of diathermy-associated corneal injury. While AMTs unique properties likely contributed to corneal healing and visual recovery, the results should be interpreted in the context of a multimodal therapeutic approach.

Introduction: Demarcation laser photocoagulation (DLP) is an infrequently utilized modality for limited retinal detachments. The current study, a retrospective consecutive case series, reviewed anatomic and visual outcomes in these patients at a single academic center.

Case presentations: A search of the electronic medical record identified 10 eyes of 10 patients. Five of the 10 patients were asymptomatic at the time of initial treatment. Five patients had symptoms corresponding to retinal detachment. The asymptomatic patients remained stable without progression at the last follow-up (range 1-8 years). In 2 of 5 symptomatic patients, the retinal detachment progressed through the laser demarcation and, subsequently, underwent vitreoretinal surgery. At the last follow-up, the retina was attached in all five symptomatic patients.

Conclusion: In this small series of patients undergoing DLP, the retina remained stable in asymptomatic patients but the retinal detachment progressed through the laser demarcation in the majority of symptomatic patients.

Introduction: Immunoglobulin G4-related disease (IgG4-RD) is a systemic, immune-mediated disorder marked by the infiltration of IgG4-positive plasma cells and fibrosis in affected organs. This report presents a rare case of a patient with isolated nodular scleritis as an IgG4-RD (in a more precise way antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis [AAV] and IgG4-RD overlap syndrome).

Case presentation: A 51-year-old woman was referred with the presumed diagnosis of conjunctival lymphoma due to a painful, salmon-colored lesion in the superior conjunctiva of the right eye. A biopsy of the conjunctiva showed a lymphoplasmacytic infiltrate with multiple IgG4-positive cells (>200 cells/high power field), elevated IgG4/IgG ratio of 66% and fibrotic tissue without obvious vasculitis, confirming the diagnosis of IgG4-related disease (IgG4-RD). ANCAs directly against myeloperoxidase were also positive, suggesting AAV. Given that the clinical signs align with both disease entities, it was concluded that the case fits in its restricted sense the newly described overlap syndrome. The scleritis was successfully treated with a tapering dose of corticosteroids and rituximab.

Conclusion: This case illustrates a rare presentation of scleritis as an IgG4-RD (in a more precise way AAV and IgG4-RD overlap syndrome) and demonstrates that rituximab and low dose of corticosteroids can lead to remission.

Introduction: Macular hole is a rare complication in patients with retinitis pigmentosa that significantly reduces visual acuity. Although vitreous surgery for macular holes generally yields favorable outcomes, postoperative macular atrophy has been reported. We report the second case of retinitis pigmentosa in a patient who developed a 13-year progressive macular atrophy after macular hole surgery.

Case presentation: A 64-year-old Japanese woman, who had been diagnosed with retinitis pigmentosa at 52 years of age, presented to our hospital with blurred vision in her left eye. Phacovitrectomy of the left eye was performed after a full-thickness macular hole was revealed by optical coherence tomography. We stained the internal limiting membrane during surgery using 0.05% indocyanine green and peeled it around the macular hole. Nevertheless, slight atrophy of the retinal pigment epithelium appeared in the left macula 17 days after surgery. The macular hole closed 1 year after surgery, and the macular atrophy gradually became more apparent and enlarged. Thirteen years later, atrophy had expanded to 2.5-disc diameters, and the left decimal best-corrected visual acuity was 0.1; no macular degeneration appeared in the right eye. Genetic examination revealed compound heterozygous variants in the EYS gene.

Conclusion: Macular atrophy can develop after dye-assisted macular hole surgery for patients with retinitis pigmentosa. Potential risk factors for the development of postoperative macular atrophy include dye toxicity, light toxicity, surgical intervention in the macula, postoperative inflammation, and genotype. However, the exact cause of atrophy remains uncertain.

Introduction: Acute zonal occult outer retinopathy (AZOOR) is a rare inflammatory retinal disease with rapid outer retinal function loss, photopsias, unremarkable fundus findings, and electroretinography abnormalities. AZOOR diagnosis can be challenging due to its overlap with other retinal conditions, such as acute idiopathic blind spot enlargement syndrome and autoimmune retinopathies (AIRs). Multimodal imaging, including fundus autofluorescence and optical coherence tomography, has improved detection, revealing progressive outer retinal damage. Although the etiology of AZOOR remains uncertain, autoimmune mechanisms and viral associations have been proposed. Recent studies have identified anti-retinal antibodies, complicating differentiation from other AIRs.

Case presentation: A 63-year-old male presented with photopsias, floaters, and worsening vision in his left eye. He had a prior diagnosis of AIR with serum antibodies against enolase, arrestin, and heat shock protein 27 (HSP27). Despite corticosteroid therapy, his visual acuity worsened from 20/20 to 20/60. Fundus examination showed subtle changes, and multimodal imaging revealed outer retinal damage consistent with AZOOR. He was started on mycophenolate mofetil, cyclosporine, and intravenous immunoglobulin. Over a year of follow-up, his vision improved to 20/25, and imaging showed stabilization of retinal damage.

Conclusion: This case report highlights AZOOR can be associated with secondary np-AIR. Multimodal imaging, electrophysiologic testing of retina and retinal pigment epithelial, and anti-retinal antibody may be helpful for diagnosis of these patients. A combination of conventional immunomodulatory therapy and IVIg can help with controlling AZOOR and secondary np-AIR.