Case Reports in Ophthalmology最新文献

[This corrects the article DOI: 10.1159/000550116.].

[This corrects the article DOI: 10.1159/000550003.].

[This corrects the article DOI: 10.1159/000549864.].

Introduction: Choroidal osteoma is a rare, benign ossifying tumor of the choroid that can present with clinical features overlapping those of inflammatory choroidal lesions. In patients with a history of Vogt-Koyanagi-Harada (VKH) disease, distinguishing between inflammatory relapse and non-inflammatory choroidal pathology can be particularly challenging. This case report highlights the diagnostic pitfalls associated with choroidal osteoma in the setting of prior VKH and underscores the importance of comprehensive multimodal imaging to ensure accurate diagnosis and appropriate management.

Case presentation: A 39-year-old female with a 14-year history of VKH disease, who had been stable off immunosuppressive therapy since 2016, presented in early 2024 with a 7-week history of cloudy vision in the right eye. She was initially diagnosed with a recurrent posterior VKH relapse and treated with high-dose intravenous corticosteroids followed by an oral taper, resulting in symptomatic improvement. However, further multimodal imaging - including wide-field fundus photography, optical coherence tomography (OCT), fundus autofluorescence, OCT angiography, fluorescein angiography, enhanced depth imaging OCT (EDI-OCT), and B-scan ultrasonography - revealed a yellow-orange, minimally elevated subretinal lesion associated with focal choroidal excavation. These findings were consistent with choroidal osteoma and confirmed by EDI-OCT and B-scan ultrasonography.

Conclusion: This case illustrates a rare instance of choroidal osteoma masquerading as a posterior relapse of VKH disease. It emphasizes the critical importance of differentiating inflammatory from non-inflammatory choroidal lesions in patients with a history of uveitis. Careful interpretation of multimodal imaging is essential to avoid misdiagnosis, prevent unnecessary immunosuppressive treatment, and reduce associated risks, ultimately leading to improved patient outcomes.

Introduction: Management of dropped lens nuclei can be challenging, and several approaches have been reported, including perfluorocarbon liquid (PFCL) flotation and the kebab technique with intraocular diathermy. However, these approaches require dedicated instruments and may involve risks such as residual PFCL retention, thermal injury, or increased cost. This study presents a case of modified kebab technique using a 27-gauge illuminated light pipe to safely retrieve a dropped lens nucleus, without requiring the use of PFCL or diathermy.

Case presentation: A patient who experienced a posterior capsule rupture with a dropped nucleus during cataract surgery subsequently underwent pars plana vitrectomy using a 27-gauge three-port system on the following day. After core vitrectomy and removal of the vitreous surrounding the dropped nucleus, the nucleus was gently brought closer using suction from the vitreous cutter. The tip of the 27-gauge light pipe was inserted into the nucleus, advanced to fully penetrate it, and used to establish firm fixation. The nucleus was then elevated into the anterior chamber and removed via phacoemulsification while being rotated. Postoperatively, no complications were observed, and the patient's visual acuity improved from 20/100 (logMAR 0.7) to 20/20 (logMAR 0.0) at 1 month after surgery.

Conclusion: This modified kebab technique using a 27-gauge illuminated light pipe allows nucleus fixation and retrieval in selected cases, without the routine use of PFCL or diathermy. This simple technique may serve as a practical salvage option, particularly when dedicated instruments are unavailable.

Introduction: Carotid cavernous fistula (CCF) is abnormal vascular connections between the cavernous sinus and the carotid artery or its branches, leading to orbital signs. This rare case report illustrates the diagnostic complexities posed by orbital cellulitis and concomitant CCF.

Case presentation: A 52-year-old male with a recent trauma of dehiscent internal carotid artery (ICA) presented initially with bacteremia, fever, tachycardia, and leukocytosis. Based on the orbital symptoms, including proptosis, chemosis, and restricted extraocular in the right eye, the patient was diagnosed with orbital cellulitis. His ocular manifestations deteriorated despite the improvement of systemic symptoms, signs, and laboratory results during systemic antibiotic treatment. A faint bruit and pulsatile proptosis were found in the right eye; thus, neuroimaging was performed. Magnetic resonance venography and computed tomography angiogram demonstrated a direct CCF with arterialized flow in the cavernous sinus, and superior ophthalmic vein dilation. Endovascular coil embolization successfully resolved the CCF, yet the patient experienced permanent vision loss in the affected eye due to an afferent pupillary defect, a neurological sequelae attributed to either orbital cellulitis, CCF or both.

Conclusion: The significant overlap in symptoms of orbital cellulitis and CCF complicates diagnosis. When two diseases coexist, the diagnosis becomes more complex. This rare case report highlights that CCF should be considered a potential concurrent pathology in patients with head and neck trauma presenting with orbital cellulitis. In addition, CCF can be considered in trauma patients exhibiting dehiscent ICA, irrespective of orbital symptoms, and prior to performing neuroimaging.

Introduction: Inflammatory cerebral amyloid angiopathy (CAA-ri) is a rare immune response to vascular amyloid-β. Ocular involvement is exceptional, and the retina may represent an accessible biomarker of disease activity.

Case presentation: A 67-year-old woman with probable CAA-ri developed recurrent floaters and transient visual obscurations during steroid tapering, with bilateral optic disc edema and peripapillary hemorrhages. Multimodal retinal imaging supported an inflammatory hemorrhagic retinal arteriolar microangiopathy (normal CSF opening pressure; TREX1 negative). Retinal findings resolved after intensified immunosuppression (steroids plus mycophenolate), recurred during tapering, and resolved again after switching to cyclophosphamide with steroid escalation; brain MRI remained largely unchanged and brain biopsy later confirmed inflammatory CAA.

Conclusion: Multimodal retinal imaging may provide a dynamic, sensitive peripheral biomarker to monitor disease activity and treatment response in CAA-ri, even when cerebral MRI appears stable.

Introduction: Eye injuries caused by a high-pressure water jet are rarely reported and mostly occur in sporadic trauma. This study aimed to describe various ocular injuries caused by water jets, with a particular emphasis on injuries inflicted by water cannon vehicles used during riots.

Case presentations: This case series presents eleven eyes of 9 patients injured from a direct high-pressure water jet used by the police in Israel as a riot control measure during a demonstration. All patients admitted to the emergency room with blunt ocular trauma had undergone clinical examination by an ophthalmologist. Of which, hyphema was the most common ocular injury observed, affecting 8 out of the 11 eyes examined, followed by traumatic mydriasis and vitreous hemorrhage in 54% and 36% of patients, respectively. In this series, 2 of 9 patients required ocular surgery. Injuries requiring surgical intervention were retinal detachment, lens dislocation, and vitreous hemorrhage.

Conclusion: Water jet injuries may inflict severe damage to the globe and orbital structures. Care should be taken in preventing such injuries inflicted by water cannon vehicles used during riots.

Introduction: The aim of this study was to report a case of segmental deep capillary plexus ischemic injury after COVID-19 infection in a vaccinated otherwise healthy male.

Case presentation: A healthy 38-year-old male presented with a complaint of not being able to see above his fixation point in the left eye. He had developed a positive scotoma 2 weeks after a COVID-19 infection. Examination showed a branch retinal arteriole occlusion in the inferotemporal quadrant with an area of subtle arcuate retinal whitening inferior to the fovea. Systemic workup was unremarkable. His vision remained 20/20, with a persistent scotoma over 2 months. Severe thinning of the inner nuclear layer and marked attenuation of the outer plexiform layer in an arcuate segment inferior to the fovea were detected with optical coherence tomography (OCT). OCTA revealed a flow void in the deep capillary plexus inferior to the fovea and cessation of the blood flow distal to the occluded retinal arteriole.

Conclusion: This case highlights the deep capillary plexus's unique vulnerability to COVID-19-related occlusion, likely due to its high autoregulatory demand and dense vascular architecture. It emphasizes the need for further investigation into retinal microvascular complications of the disease.

Introduction: Thelazia callipaeda is a parasitic nematode that infects the eyes of humans and other mammals. This case highlights its incidental discovery during ocular surgery and underscores the importance of preoperative vigilance.

Case presentation: The parasite was identified intraoperatively in a 74-year-old female with a long-standing history of diabetes who was undergoing surgery for diabetic tractional retinal detachment in her right eye. She reported poor hygiene habits but no direct pet contact. The parasite, found within the conjunctival sac, was excised and confirmed by pathological examination. Postoperative care included antibiotic eye drops. At the 3-month follow-up, her best corrected visual acuity had improved to 6/120 with no recurrence.

Conclusion: This case emphasizes the critical role of comprehensive preoperative examination for the timely detection of ocular parasites to prevent complications. It also highlights the need for clinician awareness of Thelazia infection, particularly in high-risk individuals, and the importance of appropriate postoperative follow-up to optimize outcomes and minimize recurrence risk.