Case Reports in Ophthalmology最新文献

Introduction: Cushing's syndrome results from excessive exposure to exogenous or endogenous steroid, while cushing's disease is hypercortisolism from an adrenocorticotropic hormone-secreting pituitary adenoma. Secondary ocular hypertension (OHT) accompanied by exophthalmos as the initial presentation of endogenous Cushing's syndrome has rarely been reported.

Case presentation: A 46-year-old Thai woman was referred for OHT treatment despite maximum tolerance to medication. Intraocular pressure (IOP) was 21 mm Hg (right eye) and 25 mm Hg (left eye). Visual acuity was 20/20 in both eyes. Bilateral eyelids were swollen without any palpable masses. Exophthalmometer measurements were 24 mm (right eye) and 23 mm (left eye). Extraocular muscle movements, anterior segment, gonioscopy, and dilated fundoscopic exams were normal bilaterally. Optic nerve head was unremarkable in both eyes. Optical coherence tomography showed marginal inferior thinning of the retinal nerve fiber layer and ganglion cell layer in left eye. Computerized visual field 24-2 was normal bilaterally. She was diagnosed with secondary OHT with exophthalmos in both eyes. Thyroid function and thyroid antibody tests were unremarkable. Orbital and brain computed tomography revealed exophthalmos with an increase of retrobulbar fat bilaterally and a hypodense pituitary lesion. She was diagnosed with Cushing's disease and underwent endoscopic transsphenoidal adenectomy. At 6-month postoperatively, IOP decreased to 16 mm Hg (right eye) and 17 mm Hg (left eye), without any IOP-lowering medications. Exophthalmos also improved as exophthalmometer measurements were 20 mm (right eye) and 19 mm (left eye).

Conclusions: Endogenous Cushing's syndrome should be included in the differential diagnosis of secondary OHT with exophthalmos.

Introduction: The aim of the study was to investigate the ophthalmic manifestations and management of a series of patients with monkeypox-related keratitis.

Case presentation: Two cases diagnosed with monkeypox-related keratitis were reviewed. The first case was for a young lady who presented to the emergency room with ring shape infiltration after a history of body rash. While the second case was for a child who presented to the emergency room with a picture of viral conjunctivitis along with body rash; then, he developed ring-shaped corneal infiltrate. Both patients were diagnosed through viral PCR and treated successfully with antiviral therapy.

Conclusion: Monkeypox-related keratitis is a rare but potentially sight-threatening complication of monkeypox infection. Early recognition and appropriate management are essential in order to minimize the risk of permanent vision loss.

Introduction: This case presents the development of severe fungal keratitis sourced from a green tea bag used as an ocular warm compress.

Case presentation: A 29-year-old healthy patient developed a deep stromal fungal keratitis in his left eye 2 weeks after utilizing a green tea bag as a warm compress to improve meibomian gland dysfunction that ruptured over his eye. Treatment of infection included topical and intrastromal injections of voriconazole. Topical treatment was maintained after hospital discharge for 10 months. Follow-ups were continued until the complete resolution of active infection. Final corrected visual acuity was 0.7 (LogMAR, 0.3 pinhole), and there was residual corneal scarring.

Conclusion: Warm compresses are a first-line treatment for meibomian gland disorders. Although application of warm tea bags over the eyelids appears to be an economical and accessible option, this method should be carefully considered due to the risk of fungal keratitis development.

Introduction: Placental-derived amniotic membranes (AM) can be used for both macular holes (MHs) and corneal defects. Here, we present a short report of a recurrent full thickness MH treated with a folded AM graft.

Case presentation: Best corrected visual acuity improved from 35 letters after MH recurrence to 55 letters after second surgery. Despite the folding and the large size of the AM, optical coherence tomography confirmed the closure of the MH without significant symptom.

Conclusion: This report presents the results of the use of a large folded AM, which showed favourable results in terms of visual acuity improvement and successful MH closure, with no adverse effects observed.

Introduction: Transient sixth cranial (abducens) nerve palsy is uncommon, especially in children, in whom it can herald serious underlying pathology. Sixth nerve palsy has been reported after spinal anesthesia and lumbar puncture and, in very rare cases, after complicated general anesthesia or ocular muscle procedures. Acute strabismus in children is always a concerning occurrence for both parents and clinicians, so an accurate record of documented etiologies is essential to guide appropriate management and to reassure the parents.

Case presentation: Here we report the first case of transient unilateral sixth nerve palsy following general anesthesia for a non-ocular surgical procedure (adenoidectomy) in a 5-year-old child. Ocular motility assessment confirmed right-sided abducens nerve palsy and MRI excluded underlying pathology. The right eye movement gradually improved over the following 2 weeks and the child made a full recovery.

Conclusion: Given the favorable prognosis, watchful waiting is an appropriate management strategy provided that the more common sinister causes of sixth nerve palsy have been carefully excluded.

Introduction: Ocular syphilis is a rare manifestation of syphilis caused by Treponema pallidum which can occur at any stage of infection. It most commonly presents as posterior or panuveitis but can involve various ocular structures, complicating diagnosis.

Case presentation: We describe a case of a 38-year-old female with a 7-month history of progressive blurry vision, floaters, flashes, and photophobia. Upon presentation to the emergency department, the patient's symptoms were initially attributed to a hypertensive emergency given fundoscopic examination revealing of optic disc edema. Despite resolution of hypertensive episode, the patient's symptoms persisted and she presented to our ophthalmology clinic where optical coherence tomography (OCT) showed ellipsoid zone disruption and hyperreflective deposits. Routine screening done at the emergency department for sexually transmitted infections indicated infection with syphilis and human immunodeficiency virus (HIV), for which the patient was instructed to return to the hospital for treatment. Cerebrospinal fluid (CSF) analysis confirmed diagnosis of neurosyphilis, and the patient was treated with 14 days of intravenous penicillin G.

Conclusion: This case highlights the diagnostic challenges posed by ocular syphilis, especially when overshadowed by other conditions like hypertension. This patient's atypical presentation of optic neuritis without uveitis underscores the necessity of considering ocular syphilis in patients with chronic unexplained visual changes, particularly in high-risk populations.

Introduction: A massive suprachoroidal haemorrhage (SCH) is a devastating complication with significant morbidity and poor visual and anatomic outcome. Conventional management is to observe for 7-14 days before surgical drainage. However, permanent structural changes in the retina can occur within this timeframe. Suprachoroidal injection of recombinant tissue plasminogen activator (TPA) may speed up clot breakdown and aid early surgical drainage. We present a case series of macula-involving massive SCH (MSCH) treated with early drainage aided by recombinant tissue plasminogen activator (r-tPA).

Case presentation: Retrospective case series of 3 patients with macula-involving MSCH treated with suprachoroidal r-tPA within 24 h of bleed and early drainage of SCH within 48 h of r-tPA injection, combined with vitrectomy and tamponade. 100 µg of recombinant TPA was injected into the SCH 24 h following initial injury in all patients. Drainage of the SCH was then performed 6-48 h after the injection of r-tPA. Early drainage was successful and visual improvement was seen in all patients. One patient had a recurrence of SCH but was successfully re-treated.

Conclusion: The technique of r-tPA-assisted early drainage of SCH is safe and has promising potential to restore visual function in patients with macula-involving MSCH. Our small sample would indicate that 100 μg/0.4 mL of r-tPA injected within 24 h of bleed allows surgical drainage of SCH as early as day 2 post initial injury. Larger studies are required to investigate further which patients are likely to benefit from this treatment.

Introduction: Endophthalmitis is an exceptionally rare but devastating complication following laser corneal refractive surgery.

Case presentation: We present a case of Pseudomonas aeruginosa endophthalmitis following routine myopic photorefractive keratectomy with mitomycin C application. The patient was referred to a tertiary ophthalmic service with severe post-operative infectious keratitis following initial management at another centre and was treated with intensive fortified antibiotics. The eye subsequently developed endophthalmitis with corneal perforation, necessitating urgent pars plan vitrectomy facilitated by a temporary keratoprosthesis and subsequent therapeutic penetrating keratoplasty. During anaesthetic induction, the patient developed anaphylaxis, most likely secondary to succinylcholine. Aggressive posterior positive pressure was encountered intra-operatively, resulting in spontaneous extrusion of the crystalline lens. We postulate that the posterior positive pressure was caused by several factors, including massive inflammation, and fluid shifts secondary to anaphylaxis and its associated management. The positive pressure was successfully managed and a keratoprosthesis was secured, allowing completion of vitrectomy and therapeutic penetrating keratoplasty. At 6-month follow-up, the vision remains at light perception.

Conclusion: Endophthalmitis is an exceptionally rare but devastating complication following laser corneal refractive surgery, and the use of mitomycin C might have contributed to the rapid progression observed in the current case. Our report also highlights that acute anaphylaxis and its management can lead to posterior positive pressure, and measures should be taken to reduce the potential impacts before intraocular surgery and full-thickness incisions are made.

Introduction: Melanoma-associated retinopathy (MAR) is a distinct subset within the spectrum of retinal-dysfunction disorders. It is triggered by the cross-reaction between circulating antibodies originating from malignant melanoma (MM) and retinal antigens. The timely identification of paraneoplastic retinal diseases is crucial, as it can significantly contribute to the early diagnosis and treatment of underlying malignancies. Currently, increasing awareness of the early clinical manifestations of MAR is essential for clinicians to detect primary or metastatic MMs at an earlier stage.

Case presentation: This report details a case of a patient who initially presented with night blindness and visual field defects as the primary symptoms. Through a comprehensive and systematic examination process, which involved detailed ophthalmological examinations and multidisciplinary diagnostic approaches, esophageal, and cardia MM was ultimately diagnosed. The patient was referred to an external hospital for comprehensive antitumor management, and posttreatment, the patient self-reported a notable improvement compared to the pretreatment state.

Conclusion: The purpose of sharing this case is to clarify the early clinical manifestations of MAR. It is anticipated that this will prompt clinicians to enhance their vigilance and identify primary or metastatic MMs earlier. Early treatment of the primary disease not only has the potential to reduce the risk of irreversible immune-mediated damage to retinal cells but also to improve visual outcomes. This highlights the significance of early diagnosis and intervention in the management of such diseases, providing important reference for clinicians.

Introduction: X-linked inherited retinal dystrophies (IRDs) lead to progressive vision loss in affected males and include choroideremia (CHM), X-linked retinitis pigmentosa (XLRP), and X-linked cone-rod dystrophy (XLCORD). Female carriers may be asymptomatic or manifest disease ranging from mild to severe. Due to the variable manifestation of disease in females, some pedigrees can appear autosomal dominant. However, female carriers presenting as simplex probands are rare and X-linked disease may not be suspected in these cases without genetic testing.

Case presentations: Three affected simplex CHM carriers and six affected simplex XLRP or XLCORD carriers due to variants in RPGR (n = 5) or RP2 (n = 1) were included. Best corrected visual acuity, color fundus photos, fundus autofluorescence (FAF), optical coherence tomography, electroretinography, and Goldmann visual fields were collected. X-chromosome inactivation (XCI) ratios were determined for 4 cases. Age of onset ranged from infancy to 43 years, with nyctalopia as the most common presenting symptom. 4 out of 5 cases with RPGR variants presented with cone or cone-rod dystrophies, while the remaining cases presented with rod-cone dystrophy. XCI analysis revealed extreme skewing in 2 cases who both presented with severe disease. 4 out of 7 cases with FAF demonstrated autofluorescence patterns classic for carrier status. The remaining 3 cases had severe disease and corresponding FAF patterns consistent with their severity.

Conclusion: The absence of family history does not preclude X-linked inheritance in females with retinal dystrophies. Multimodal imaging such as FAF and red-free photos should be included in the workup. As new therapeutic strategies are developed for CHM and RPGR-associated retinal degeneration, including gene therapy, it may become increasingly more important to diagnose symptomatic carriers, as it has been previously shown that earlier intervention is more effective in IRD populations.