Case Reports in Ophthalmology最新文献

Introduction: The FIL SSF intraocular lens (IOL) (Carlevale, Soleko, Italy) is a sutureless scleral-fixated lens designed for cases of aphakia with insufficient capsular support. While generally stable, intraoperative complications such as haptic rupture may occur. We present a novel rescue technique for scleral fixation of FIL SSF IOL following rupture of the trans-scleral plug during combined penetrating keratoplasty, three-port pars plana vitrectomy, and IOL implantation.

Case presentation: During the combined procedure, rupture of one FIL SSF IOL plug was identified. The compromised haptic was externalized into the subconjunctival space. The sclerotomy was sutured to secure the haptic, achieving both immobilization and stable positioning of the IOL. Postoperatively, the patient was followed for 6 months. Best corrected visual acuity reached 0.2 (decimal scale), intraocular pressure was stable at 14 mm Hg in the left eye, the corneal graft remained clear, and the FIL SSF IOL maintained centration without further complications.

Conclusion: This case demonstrates that intraoperative rupture of the FIL SSF IOL haptic can be effectively managed using a scleral anchoring technique. This approach provides a stable and safe alternative for salvaging IOL fixation during complex anterior and posterior segment surgeries.

Introduction: The pachychoroid spectrum refers to a group of chorioretinal disorders including pachychoroid pigment epitheliopathy (PPE), pachychoroid neovasculopathy (PNV), polypoidal choroidal vasculopathy (PCV), and central serous chorioretinopathy (CSC). These conditions are thought to represent progressive stages, beginning with subclinical retinal pigment epithelium (RPE) changes in PPE, advancing to serous retinal detachment in CSC, followed by choroidal neovascularization in PNV, and culminating in aneurysmal dilation of vessels in PCV. We present a rare case of the pachychoroid spectrum in which lesions in all four stages were simultaneously observed in a single, fovea-sparing eye.

Case presentation: An 85-year-old man presented with a 1-month history of a visual disturbance in his left eye. Examination revealed all four stages of pachychoroid disease in the same eye: choroidal neovascular membrane (CNV) with subretinal hemorrhage (pachychoroid neovascularization, PNV), multiple RPE defects (PPE), and findings consistent with CSC and PCV. He was treated with a combination of anti-VEGF injections and focal laser therapy with the lesions stabilizing after 2 years.

Conclusion: Although it has features similar to age-related macular degeneration, pachychoroid spectrum is a distinct disease entity, with a slower onset and greater response to initial therapy. It may necessitate therapies otherwise not used for other causes of neovascularization like focal laser treatment and verteporforin photodynamic therapy. It is a unique pathologic process presenting with varying stages/lesions that have distinct morphological features but are thought to be a part of the same spectrum.

Introduction: Actinic keratosis (AK) is a premalignant epithelial lesion primarily associated with chronic ultraviolet exposure. While it commonly affects sun-exposed skin, its occurrence on the ocular surface is rare. Clinically, it may resemble ocular surface squamous neoplasia (OSSN), necessitating histopathological confirmation for accurate diagnosis and appropriate management.

Case presentation: A 78-year-old male, HBsAg positive, presented with progressive diminution of vision in the right eye for 6 months and a visible mass over the right eye for the past 2 months. Best-corrected visual acuity was 6/12p in the right eye and 6/9 in the left eye. Slit-lamp examination of the right eye revealed a 4 × 1 mm keratotic lesion with surrounding hyperpigmentation on the corneal surface. Both eyes were cataractous. Fundus evaluation was within normal limits in both eyes. A clinical diagnosis of OSSN was considered. The lesion was excised and sent for histopathological analysis, which revealed features consistent with AK. The patient was treated with topical mitomycin C 0.02% and topical prednisolone acetate 1% postoperatively. No recurrence was observed on follow-up.

Conclusion: Ocular surface AK is a rare and potentially premalignant lesion that may mimic OSSN. Clinical suspicion, combined with histopathological examination, is crucial for diagnosis. Surgical excision followed by topical chemotherapy offers effective management and reduces the risk of recurrence or malignant transformation.

Introduction: The aim of the study was to report the intraoperative signs, management, and postoperative outcomes of iris hemorrhage during implantable collamer lens (ICL) surgery.

Case presentation: A 32-year-old Asian woman experienced iris bleeding via a superior incision during distal haptics delivery in ICL surgery for her right eye. The inferior iris was displaced against the ocular wall, resulting in traction-induced vertical elongation and elliptical distortion of the pupil, which indicated excessive iris traction and ultimately led to focal rupture of delicate iris vessels with intraoperative hemorrhage. Immediate injection with ophthalmic viscosurgical device into the anterior chamber aimed to tamponade the bleeding from the broken vessels; after confirming cessation of active bleeding, the surgery was proceeded and completed uneventfully. During postoperative follow-up, slit lamp examination showed persistent intraocular inflammation, increased intraocular pressure (IOP), and hyphema. Right eye was treated with anterior chamber paracentesis for the elevation of the IOP; IOP-lowering medications and topical anti-inflammation eyedrops were continued. No further interventions were performed. Slit lamp examination demonstrated progressive recovery in anterior chamber reaction. No further complications occurred during the follow-up.

Conclusion: Intraoperative iris hemorrhage is a rare but potentially serious complication for ICL surgery; timely intraoperative recognition of the pupil distortion and closely postoperative patient monitoring with medical management can avoid the irreversible damage to the eye.

Introduction: The aim of the study was to evaluate the long-term efficacy of eplerenone in patients with peripapillary pachychoroid syndrome (PPS), a recently described entity characterized by vascular congestion of Haller's layer vessels near the optic nerve.

Case presentations: Three male patients (mean age: 70.3 years) with PPS received oral eplerenone 50 mg daily for 12 months. Baseline and post-treatment choroidal thickness, visual acuity, and retinal fluid status were assessed. At baseline, mean choroidal thickness was 420 µm, and mean visual acuity was 70 letters. After 12 months of treatment, all patients showed a significant reduction in choroidal thickness (mean: 48 µm, p < 0.05) and near-complete resolution of intraretinal and subretinal fluid. No adverse events were reported.

Conclusions: Long-term eplerenone treatment appears effective in reducing choroidal thickness and improving visual outcomes in PPS patients. These findings suggest mineralocorticoid receptor antagonists may be valuable in managing pachychoroid spectrum disorders.

Introduction: Optic disc pit maculopathy is a challenging retinal disease that can significantly impact the quality of life, especially in pediatric patients. We report our surgical approach in the management of an 8-year-old boy with this rare condition who was referred to our clinic.

Case presentation: An 8-year-old male patient presented with visual acuity of 20/200 in the left eye. After complete examination and OCT imaging was performed, the diagnosis of optic disc pit maculopathy (ODPM) was obtained. ODPM is a challenging condition to treat without a gold standard approach, especially in the pediatric population. A surgical approach was decided in order to treat this condition. This involved performing a pars plana vitrectomy and an internal limiting membrane (ILM) flap over the optic disc pit. The operation was successful as the ILM flap covered the optic disc pit sufficiently enough to block communication between the vitreous cavity and the subretinal space. This led to the resolution of macular edema during the postoperative period. One year post surgery, the boy's visual acuity improved to 20/32, accompanied by the patient's overall satisfaction and the anatomical confirmation of the successful result using OCT.

Conclusion: Taking into consideration the surgical difficulties associated with this age group, we highlight the efficacy and safety of the ILM flap inversion technique as a viable surgical option for optic disc pit maculopathy in pediatric patients.

Introduction: Laser photobiomodulation, including retinal rejuvenation therapy (2RT), is a system which selectively targets the retinal pigment epithelium by a concise 3 ns pulse duration. The advantage of this laser system over the traditional thermal laser is that the pulsed, very short duration laser effects can be titrated as spatially confined photodisruptors without resultant conductive thermal spread and therefore collateral damage. It has been investigated primarily in age-related macular degeneration (AMD), particularly in decreasing drusen and slowing the rate of AMD progression. In this case, we have described a case of neovascular maculopathy occurring shortly after 2RT in a young myopic patient.

Case presentation: We report the case of a 28-year-old male who presented with unilateral visual impairment following laser 2RT. Two months before, he was subjected to photorefractive keratectomy for moderate myopia (-3.00 D). The baseline optical coherence tomography (OCT) imaging revealed "sharp-peaked" pigment epithelium detachment (PED) in the subfoveal area. Fluorescein angiography indicated a focal area of irregular foveal hyperfluorescence. Observation was advised, and laser 2RT was performed. However, 1 month later, the patient developed a neovascular lesion in the same eye, confirmed by OCT-angiography, requiring urgent intravitreal anti-VEGF therapy.

Conclusions: In summary, this case illustrates a progressive maculopathy culminating in choroidal neovascularization triggered by laser 2RT in a young myopic patient.

Introduction: Infectious mononucleosis (IM), most commonly caused by Epstein-Barr virus (EBV), classically presents with fever, pharyngitis, and cervical lymphadenopathy. However, less common manifestations such as bilateral periorbital edema, known as Hoagland sign, may precede or obscure more typical features, complicating diagnosis. Although described in the literature for decades, Hoagland sign remains underrecognized in clinical practice, especially in pediatric and young adult patients. This oversight can lead to misdiagnosis, delayed testing, unnecessary antibiotic use, and patient distress.

Case presentation: We present 2 cases of female patients, one pediatric and one young adult, who initially presented with bilateral periorbital edema and nonspecific systemic symptoms. In both cases, infectious mononucleosis was not initially suspected. One patient was treated for streptococcal pharyngitis and later developed a rash typical of antibiotic-associated IM. The second patient was denied EBV testing at an urgent care clinic despite a direct request, due to provider unfamiliarity with the association between periorbital edema and IM. Both were eventually diagnosed with EBV via serologic testing and recovered with supportive care.

Conclusion: These cases highlight a critical gap in provider awareness that, if addressed, could reduce diagnostic delays and improve patient care. Recognizing Hoagland sign as a valid early clue for IM, particularly in female patients,can help differentiate benign viral illness from more concerning differentials such as orbital cellulitis, nephrotic syndrome, or allergic reactions. This report serves as a clinical reminder to include EBV in the differential diagnosis of atraumatic, bilateral eyelid swelling and to educate frontline providers on this underappreciated presentation.

Introduction: Orbital lymphomas, though uncommon, are significant masquerade syndromes that can resemble inflammatory or infectious orbital conditions like orbital cellulitis.

Case presentation: We describe the case of an 80-year-old woman who experienced sudden painful vision loss, proptosis, and limited eye movement, initially treated as orbital cellulitis with compressive optic neuropathy. The absence of clinical improvement led to further imaging and a biopsy, which identified diffuse large B-cell lymphoma.

Conclusion: This case emphasizes the necessity for high clinical suspicion, particularly in older patients, and highlights the diagnostic challenges posed by steroid use and overlapping symptoms with infectious causes. We discuss the significance of a multidisciplinary approach and suggest a clinical checklist for recognizing masquerade syndromes in ophthalmology.

Introduction: Glaucoma following corneal transplantation and artificial iris implantation represents a major therapeutic challenge, and data on optimal surgical management in such complex cases are scarce.

Case presentation: We report the case of a 28-year-old male with uncontrolled intraocular pressure (IOP) after penetrating keratoplasty and Morcher aniridia ring implantation. Despite maximally tolerated medical therapy, IOP remained elevated. PreserFlo MicroShunt implantation was performed successfully, leading to sustained IOP reduction without medications and preservation of graft clarity at 7-month follow-up.

Conclusion: To our knowledge, this is the first reported case of PreserFlo MicroShunt implantation in a patient with combined keratoplasty and Morcher aniridia rings. This case highlights the potential role of PreserFlo as a viable option for IOP control in complex post-traumatic and postsurgical eyes. However, the findings represent a short-term (7-month) outcome, and the long-term efficacy requires further evaluation.