Case Reports in Ophthalmology最新文献

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.

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.