Case Reports in Ophthalmology最新文献

[This retracts the article DOI: 10.1159/000536103.].

Introduction: Wilson's disease is a rare autosomal recessive disorder that disrupts copper metabolism. It presents with distinctive ocular manifestations. Oculodermal melanosis, commonly referred to as nevus of Ota, is a painless condition characterized by hyperpigmentation in and around the eye. In this case report, we describe the unique occurrence of both conditions in this pediatric patient.

Case presentation: A 10-year-old girl exhibited classic ocular signs associated with Wilson's disease, including Kayser-Fleischer rings and sunflower-type cataracts. Additionally, she displayed unilateral confluent gray-blue hyperpigmentation consistent with a nevus of Ota. As of now, the patient remains asymptomatic, with preserved visual acuity.

Conclusions: To the best of our knowledge, this case represents the first report of nevus of Ota in a child diagnosed with Wilson's disease.

Introduction: Calciphylaxis is a condition that causes vascular calcification and intimal proliferation with thrombotic occlusion of small-to-medium-sized vessels.

Case presentation: We describe a case of a 64-year-old woman who presented with a clinical picture that was suggestive of anterior arteritic ischemic optic neuropathy due to giant cell arteritis (GCA), but was found to have calciphylaxis confirmed by histologic examination. When calciphylaxis affects the blood supply to the eye, commonly it causes sudden vision loss, pallid optic disk edema, and a relative afferent pupillary defect, all of which were observed in our patient.

Conclusion: There is no known cure for calciphylaxis, while in GCA, high-dose corticosteroid therapy is essential to prevent involvement of the contralateral eye. As the management approaches for these two diseases are different, it is important to have performed a thorough clinical examination along with detailed histopathological testing to rule out calciphylaxis of the temporal artery in patients suspected to have GCA.

This is an observational case report to detail a novel case of scleroderma renal crisis presenting as bilateral exudative retinal detachments in a patient with newly diagnosed systemic sclerosis. An otherwise healthy 58-year-old female presented primarily with vision complaints and was found to have malignant hypertension (230/120 mm Hg) and bilateral exudative retinal detachment on dilated fundus examination and macular OCT scan. Further history revealed sclerodactyly, mild dysphagia, and dyspnea. She was diagnosed with diffuse systemic sclerosis and Sjogren's syndrome complicated by an episode of scleroderma renal crisis based on initial medical workup. She was admitted to intensive care for management of refractory hypertension with IV antihypertensive therapy. Three months after treatment, her visual symptoms and ocular findings resolved. The presence of exudative retinal detachment among other signs of hypertensive retinopathy warrants thorough systemic screening for underlying causes of malignant hypertension, including systemic sclerosis. Treatment of the underlying disease with urgent antihypertensive therapy resolved the exudative retinal detachments and restored vision in the case of a scleroderma renal crisis.

Introduction: Symblepharon is a challenging condition characterized by a painful blind eye. The main goal of treatment is to alleviate discomfort and improve the patient's physical and mental well-being.

Case presentation: An Indonesian male, 38 years old, complained of vision loss and ocular pain in his right eye 1 month ago. The pain frequently manifests as a rapid, piercing, or scorching feeling that extends from the right eye to encompass the entire head. Both of his eyes exhibited symblepharon and xerophthalmia. At the age of 11, he experienced a previous occurrence of raised and blister-like skin lesions. Following his recovery, a gradual formation of membranes occurred, covering both of his eyes. His right eye had light perception for visual acuity, and the intraocular pressure was determined to be soft upon examination. The B-scan ultrasound revealed the presence of a long-term inflammatory or scarring process and a decrease in the length of the axis. The patient underwent surgery without experiencing any improvement. A psychological evaluation identified a headache caused by an eye condition, and we administered antipyretic, anticonvulsant, antidepressant, and multivitamin treatments. The patient saw a reduction in pain intensity from a level of 9 to 5 after undergoing treatment for a duration of 1 week. Patients who have previously undergone surgical treatment for symblepharon should have a comprehensive evaluation when they encounter symptoms of vision loss and ocular discomfort.

Conclusion: The psychological factor is essential for the treatment's success. Treatment of the underlying cause is essential, and the patient must understand the irreversible loss of visual function. A management plan primarily aims to mitigate the adverse impact on the overall well-being and standard of living.

Introduction: This report describes a case of necrotizing scleritis caused by Pseudomonas aeruginosa infection soon after vitreous surgery, which caused severe scleral melting and rapidly progressive necrosis that led to scleral perforation and bacterial endophthalmitis.

Case presentation: The patient was an 86-year-old man with a history of type 2 diabetes mellitus who underwent pars plana vitrectomy (PPV) for vitreous hemorrhage in his right eye. On postoperative day 10, he complained of severe ocular pain and was found to have conjunctival edema and eyelid swelling, which was treated by topical and general systemic antibiotics. His ocular symptoms improved but subsequently worsened. On postoperative day 25, hypopyon and a fibrinous exudative membrane were observed in the anterior chamber, and the fundus could not be visualized. PPV was repeated with addition of silicone oil tamponade. During the surgery, the retina was found to be completely detached with severe anterior scleral melting, perforation, and necrosis, as well as abscess formation. Culture of an eye discharge specimen detected P. aeruginosa. After surgery, antibiotics were administered and the eye was washed with polyvinyl alcohol-iodine solution daily. Ten days later, the eye pain and eyelid swelling were significantly improved. The scleral inflammation gradually resolved without recurrence.

Conclusion: In this case, rapidly progressive necrotizing scleritis caused by P. aeruginosa infection was controlled by a combination of antibiotics, removal of necrotic tissue, and daily eye washing with polyvinyl alcohol-iodine solution.

Introduction: Anecdotal reports and limited reports suggest a possible link between activities involving rapid acceleration and retinal detachment. We present two novel such cases and review existing literature to investigate the plausibility of this association and delineate in what populations such an association may be more likely.

Case presentation: We report 2 cases of retinal detachment following roller coaster riding. The first, a 24-year-old woman with a family history of retinal detachment, presented with floaters after consecutive rides and was found to have an inferior temporal macula-sparing retinal detachment with associated retinal breaks. The second case, a 25-year-old female with a history of high myopia, presented with visual field defect and was found to have a macula-on retinal detachment with an accompanying tear at the edge of an area of lattice degeneration. Both were successfully treated with pneumatic retinopexy followed by laser retinopexy.

Conclusion: Rapid acceleration/deceleration forces, such as those experienced on roller coasters, could potentially lead to retinal detachment. Structural predisposition is likely necessary for acceleration/deceleration injury to lead to retinal detachment, with all known cases having risk factors, including high myopia and positive family history. These same forces in eyes without structural predisposition have resulted in hemorrhage, but not detachment.

Introduction: Antiphospholipid syndrome is one of the most common causes of acquired hypercoagulable conditions which is correlated with ocular conditions not least of which is retinal ischemia due to arterial or venous occlusive insults.

Case presentation: We describe a case of unilateral retinal ischemia in the setting of combined central retinal artery and vein occlusion with associated proliferation of retinal pigment epithelium. The patient was worked-up for the etiology of her presentation which was found to be antiphospholipid syndrome.

Conclusion: Although pigment epithelial proliferation occurs commonly after retinal ischemia, no study has reported complete multimodal imaging of such a pathology or proposed the possible mechanisms explaining such an association.

Introduction: In this case report, we demonstrate the application of an aspheric macular lens (Grieshaber, Alcon) for conducting posterior segment procedures after a posterior capsular rupture (PCR) occurrence during cataract surgery.

Case presentation: During a cataract surgery on a 70-year-old female patient, a PCR was identified, accompanied by the descent of the lens into the vitreous, and prompted subsequent interventions. This involved performing posterior-assisted levitation, anterior segment phacoemulsification, and anterior segment vitrectomy. Subsequently, due to the absence of a BIOM posterior viewing system in the operating room, an aspheric macular lens (Grieshaber, Alcon) was positioned on the patient's eye. Subsequently, pars plana vitrectomy was performed, along with the extraction of residual lens cortical remnants. The procedure concluded with gradually inserting a 3-piece intraocular lens into the sulcus.

Conclusion: When managing posterior capsular rupture, using an aspheric macular lens, such as the Grieshaber (Alcon), can be beneficial.

Introduction: Myelin oligodendrocyte glycoprotein (MOG)-associated disorders can cause inflammation of the central nervous system in various specific organs. Ocular involvement manifests as optic neuritis is one of the most common presentations; other ocular presentations are uncommon. Recently, rare ocular complications have been reported in conjunction with MOG-associated optic neuritis. We reported a rare case of acute venous stasis retinopathy co-occurring with bilateral optic neuritis.

Case presentation: A 27-year-old woman complained of a throbbing headache for 2 weeks before developing visual loss in her right eye. She was diagnosed with presumed central retinal vein occlusion and was scheduled for further investigations. Two days later, she suddenly lost vision in her left eye and was admitted to the hospital. An eye examination revealed tortuous and dilated veins and optic disk swelling, notably in the right eye, compatible with venous stasis retinopathy in both eyes. Her right eye also had a premacular hemorrhage and vitreous hemorrhage. Magnetic resonance imaging showed an enhancement of bilateral optic nerves, and MOG antibody was detected in her serum. She successfully achieved a rapid improvement of vision in the left eye with intravenous methylprednisolone. However, her vision in the right eye did not recover due to dense vitreous hemorrhage.

Conclusion: Venous stasis retinopathy is a rare complication of MOG-associated optic neuritis. High-dose corticosteroids result in a rapid response and excellent symptom recovery. Ongoing reports may uncover new clinical presentations associated with this disorder.