Case Reports in Ophthalmology最新文献

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.

Introduction: Staphylococcus-related marginal keratitis is an inflammation of the corneal periphery characterized by the presence of stromal infiltrates and blepharoconjunctivitis. Conventional treatment consists of antibiotics and corticosteroid eye drops, and recurrence is prevalent upon treatment cessation. In this case report, we present a 1-year follow-up of the results of a novel therapeutic approach for recurrent marginal keratitis using a combination of chlorhexidine and vancomycin eye drops.

Case presentation: A 34-year-old male presented with an 8-year history of recurrent staphylococcus-related marginal keratitis in his right eye, consisting of 5 acute episodes, which under a conventional treatment regimen resolved within 10-14 days. During the follow-up of his right eye, an inflammation in his left eye developed as well. Treatment with a combination of chlorhexidine at 0.02% and vancomycin at 50 mg/mL eye drops brought rapid resolution of the acute inflammation with preservation of the effect for at least 1 year.

Conclusions: A combination of chlorhexidine and vancomycin eye drops may provide an effective treatment for marginal keratitis. It demonstrated rapid improvement and maintained long-term stability, with disease control observed throughout 1-year follow-up.

Introduction: Ocular cystinosis is a rare hereditary lysosomal storage disorder characterized by amino acid cystine deposition in various tissues, prominently affecting the cornea and conjunctiva. While typically diagnosed in childhood, cases in adults may present atypically or as part of the nephropathic spectrum. This report highlights the clinical presentation, diagnosis, and management of ocular cystinosis in a 37-year-old male.

Case presentation: A 37-year-old male presented with complaints of photophobia and ocular discomfort for a duration of 6 months. On slit-lamp examination, characteristic crystalline deposits were observed in the corneal stroma. Additional findings included mild conjunctival injection. Visual acuity was 6/6 in both eyes. Anterior segment optical coherence tomography demonstrated hyperreflective deposits up to corneal stroma, while specular microscopy revealed a normal endothelial cell count and morphology. Systemic evaluation revealed no signs of cystinosis. The patient was treated with topical cysteamine ophthalmic solution 0.44%, resulting in subjective improvement in photophobia and stabilization of corneal findings over a 6-month follow-up period.

Conclusion: This case underscores the importance of recognizing ocular manifestations of cystinosis in adult patients, particularly those with no history or signs of systemic involvement. Early and sustained use of topical cysteamine ophthalmic solutions can significantly mitigate symptoms and prevent progression of corneal changes. Comprehensive management necessitates a multidisciplinary approach to address systemic and ocular sequelae of the disease.

Introduction: Sildenafil, a widely prescribed phosphodiesterase-5 (PDE5) inhibitor for erectile dysfunction, is generally well tolerated. However, ocular vascular complications - including non-arteritic anterior ischemic optic neuropathy, central serous chorioretinopathy, and retinal vein occlusion (RVO) - have been reported. Though rare, such events can occur even in individuals without conventional systemic risk factors.

Case presentation: A 55-year-old man with no prior medical history developed sudden, painless visual blurring in his right eye 48 h after ingesting a single 100 mg dose of sildenafil. Clinical evaluation revealed a superotemporal branch RVO with macular edema. A comprehensive systemic and hematologic workup, including thrombophilia screening and cardiac evaluation, yielded normal results. The patient was treated with an intravitreal injection of bevacizumab, leading to anatomical and visual improvement.

Conclusion: This case draws attention to a possible association between sildenafil use and retinal vascular events, particularly BRVO, even in healthy individuals. The temporal proximity and absence of systemic risk factors suggest a potential dose-independent vascular susceptibility. Clinicians should be aware of this rare but potentially vision-threatening complication.

Introduction: Compared with sub-Tenon's anesthesia (STA), trans-Tenon's capsule retrobulbar anesthesia (TTRBA) provides rapid and complete akinesia. However, excessive anesthetic volume may cause complications such as choroidal detachment (CD).

Case presentation: A 59-year-old man who had previously undergone cataract surgery presented with rapidly progressive visual field constriction in the right eye. The best corrected visual acuity (BCVA) was 20/16; intraocular pressure, 13 mm Hg; and axial length, 29.99 mm. Multiple retinal breaks were detected in the superior and nasal retina, with retinal detachment extending from the superior to the inferior retina. Vitrectomy was performed under local anesthesia. STA (2.5 mL lidocaine) was followed by TTRBA (3.0 mL initially, plus an additional total of 4.5 mL administered in two injections) and 7.5 mg intravenous pentazocine. The cumulative TTRBA volume reached 7.5 mL within 50 min. Immediately after the final injection, an orange choroidal elevation developed across the entire retina, including the macula, without vascular whitening. BCVA recovered to 20/20 at 2 weeks postoperatively, with retinal reattachment.

Conclusion: This case suggests that repeated intraconal anesthetic injections totaling >7 mL in a short time may induce macula-involving serous CD via sustained intraorbital pressure elevation. Thus, limiting volume and considering lower volume alternatives may reduce risk.

Introduction: This report describes a case of spontaneous epiretinal membrane (ERM) separation following an acute symptomatic posterior vitreous detachment (PVD) that was captured on imaging.

Case presentation: A 55-year-old female with a history of an ERM and chronic metamorphopsias in the right eye presented with 2 days of new flashes and floaters. Dilated fundus examination revealed an ERM unchanged from prior and a new Weiss ring. Optical coherence tomography (OCT) demonstrated a new detachment of the posterior hyaloid from the retina with a focal break in the ERM and an area of attachment between the posterior hyaloid and ERM. Six weeks later, OCT revealed complete ERM separation from the retina with restoration of foveal contour.

Conclusion: This case contributes to the existing literature on spontaneous ERM separation via PVD with the mechanism of separation uniquely demonstrated on OCT. Observation may be a reasonable approach for patients with mildly symptomatic ERM who have an attached posterior hyaloid on initial imaging.

Introduction: Orbital cellulitis is a serious infection involving the soft tissues of the orbit. Odontogenic orbital cellulitis (OOC) is an important subtype and typically results from the contiguous spread of a dental infection. One uncommon route for this spread is the development of an oroantral fistula (OAF), a communication between the oral cavity and maxillary sinus which typically arises after extraction of a maxillary molar.

Case presentation: A 47-year-old female presented to the emergency department with a 1-day history of right-sided periorbital edema and pain on extraocular movements. She had a history of a right maxillary dental infection which required tooth extraction 2 months prior to presentation. Her ocular exam revealed right periorbital edema and erythema that extended down to the midface with mild tenderness to palpation. Computed tomography scan showed pre-septal cellulitis, post-septal fat stranding, and a right-sided OAF. The patient had a complete resolution of infection and spontaneous closure of the OAF after 1 month of meropenem 1 g IV daily.

Conclusion: In conclusion, this case highlights a rare presentation of OOC due to an OAF occurring months after dental extraction. Immediate imaging due to atypical history, including lack of dental pain, allowed for prompt identification of the OAF and subsequent use of appropriate broad-spectrum antibiotics resulting in a favorable outcome compared to previously published cases. It is critical to recognize odontogenic infections as treatment differs from other etiologies of orbital cellulitis.

Introduction: Minoxidil is a topical, over-the-counter, FDA-approved drug used to treat male and female pattern hair loss. Three case reports were published associating long-term use of topical minoxidil to central serous chorioretinopathy (CSCR) after 4, 6, and 8 months of use. In this report, we will present a case of CSCR after 1 week of topical minoxidil use that resolved with discontinuation of medication and observation 6 weeks later.

Case presentation: A 34-year-old Hispanic male presented with a 2-week history of central visual loss and flashes in the left eye. His only medication use was 5% topical minoxidil foam for hair loss, which he had started 1 week prior to symptom onset. Ophthalmic exam revealed a round elevation of parafoveal region of the left macula with optical coherence tomography evidence of subretinal fluid and an inferior pigmented epithelial detachment, consistent with CSCR. Given recent initiation of topical minoxidil, we suspected that minoxidil may have induced CSCR. Topical minoxidil was discontinued with recommended observation. There was complete resolution of CSCR at 6-week follow-up.

Conclusion: Subacute, unilateral central visual loss in an otherwise healthy 34-year-old male was found to be caused by minoxidil-induced CSCR. The correlation of topical minoxidil use 1 week prior to symptom onset with resolution of findings 6 weeks after discontinuing the medication suggests CSCR as a side effect of topical minoxidil. This case report suggests that short-term use of topical minoxidil, as short as 1 week, can induce CSCR. Our case shows that minoxidil-induced CSCR can be managed with medication discontinuation and observation.

Introduction: Tube exposure is a serious complication of glaucoma drainage device implantation. We describe a novel surgical approach using a partial-thickness corneal patch graft with conjunctival autograft and fibrin glue in a setting of severe conjunctival deficiency.

Case presentation: We describe a 72-year-old man with chronic angle-closure glaucoma who presented with tube exposure 1 year after Ahmed valve implantation. Risk factors included diabetes mellitus, a failed trabeculectomy, and prior vitrectomy. The conjunctiva surrounding the exposed tube was ischemic and immobile, and the original corneal patch graft had partially degraded. Revision surgery involved suturing a 4-mm partial-thickness corneal button over the exposed tube, anchored to the residual graft edge and sclera. Due to insufficient mobile conjunctiva, a 4 × 3 mm conjunctival autograft was harvested from the temporal bulbar conjunctiva and secured with fibrin glue at the border of the corneal button, partially covering it, to promote epithelialization. At 1-year follow-up, the tube remained fully covered with no recurrence.

Conclusion: This unique surgical approach using a partial-thickness corneal button and conjunctival autograft offers a viable alternative in cases of tube exposure with severe conjunctival deficiency, where traditional techniques such as conjunctival advancement are not feasible.

Introduction: Involuntary muscle stimulation by a nerve other than the normal muscle innervation leads to ocular synkinesis. The most common form of ocular synkinesis, which involves the extraocular muscles, occurs between the abducens and oculomotor nerves.

Case presentation: We describe a case of congenital unilateral trochlear-oculomotor synkinesis in a healthy 31-year-old woman, along with a review of the related literature. The patient shows unusual lid retraction when she depresses and adducts her left eye. Additionally, we discuss the proposed mechanisms underlying the pathophysiology, the ophthalmic workup, and suggested management strategies.

Conclusion: Given its rarity and potential to cause diagnostic confusion, physicians need to be aware of this condition.