Case Reports in Ophthalmology最新文献

Introduction: Nonhealing or rapidly growing lesions should raise suspicion for malignancy, especially in a patient with a prior history of cancer. The purpose of this case was to highlight the importance of a thorough clinical history. A high index of suspicion and low threshold for biopsy are important, as is a fast diagnosis, as they can make a difference in adequate treatment and prognosis.

Case presentation: We present a case of a 46-year-old female with a history of invasive ductal carcinoma of the breast presenting with a rapidly growing painless right lower eyelid lesion with biopsy remarkable for a high-grade neuroendocrine carcinoma suspected to be a result of metastasis with rare transformation of breast ductal carcinoma.

Conclusion: She had an eyelid lesion recurrence less than 2 months after biopsy and excision, demonstrating the importance of early detection and biopsy with immunohistochemistry to target malignant cells and improve life quality and expectancy.

Introduction: Diwali, a widely celebrated festival across India, is traditionally associated with the extensive use of fireworks. While fireworks add to the festive atmosphere, they pose significant safety risks, particularly to the eyes. Firework-induced ocular injuries range from minor burns to severe trauma, often resulting in lasting visual impairment. This case series examines the range of ocular injuries observed during Diwali, their clinical outcomes, and highlights preventive measures to address this ongoing public health concern.

Case presentation: This retrospective case series includes patients who presented with firework-related ocular injuries at a tertiary eye care center during November 2024, within a week of the Diwali festival. Comprehensive patient histories were documented, followed by detailed ocular examinations. Data collected included injury mechanisms, clinical findings, and treatments administered. The age of the patients ranged from 7 to 35 years, with a predominance of closed globe injuries (5 out of 6 cases), while 1 case was involved in an open globe injury. Injuries were categorized using the Birmingham Eye Trauma Terminology (BETT) into open globe and closed globe injuries and classified according to the Ocular Trauma Scoring System (OTSS). Surgical intervention was required in 2 cases (33%), primarily involving more severe injuries such as conjunctival-scleral tears and traumatic cataracts.

Conclusion: Firework-related ocular injuries during Diwali remain a pressing public health issue, especially for children and bystanders. Although timely medical intervention can improve visual outcomes, severe injuries often result in irreversible vision loss. It is imperative to raise public awareness about firework safety, encourage the use of protective eyewear, and enforce stricter regulations on firework usage. Manufacturers should be mandated to produce safer, less hazardous fireworks. Additionally, directives for registering ocular injury cases at hospitals should be implemented to better understand and address this preventable problem.

Introduction: Paraneoplastic vision loss includes a heterogenous group of ocular disorders that occur in the setting of systemic malignancy. The presenting symptoms are variable but typically include vision loss that is painless, subacute in onset, and ultimately bilateral. The underlying mechanism is thought to involve molecular mimicry due to structural homology between ocular and cancer antigens. Very few cases have reported simultaneous retinopathy and optic neuropathy.

Case presentation: Here, we present the case of a 36-year-old female who developed complete vision loss in the right eye, with both retina and optic nerve changes. Extensive investigation revealed a non-mucinous lung adenocarcinoma.

Conclusion: Presentations of paraneoplastic vision loss include cancer-associated retinopathy, paraneoplastic optic neuropathy, paraneoplastic vitelliform maculopathy, bilateral diffuse uveal melanocytic proliferation, melanoma-associated retinopathy, and opsoclonus-myoclonus syndrome. We suggest use of the term CARON (cancer-associated retinopathy and optic neuropathy) for cases such as this.

Introduction: We report a case of spontaneous closure after early reopening of a previously successfully treated macular hole (MH).

Case presentation: A 73-year-old patient presented with visual acuity of 20/100 and complained of defective vision. Examination and investigations confirmed a full-thickness MH. Surgical intervention led to complete closure of the hole on OCT within 5 days. However, the patient reported recurrence of symptoms 2 weeks later, and reopening of the hole was diagnosed. Re-surgery was advised, but surprisingly, the hole spontaneously closed by the seventh week and remained closed at the last follow-up (6 months post-surgery), with visual acuity improving to 20/50.

Conclusions: Reopening of an MH can occur months or years after successful treatment, and the underlying reasons remain unclear. While reoperation is often indicated, spontaneous healing, although rare, is possible. This case highlights the potential for spontaneous closure of a reopened MH, suggesting that a wait-and-watch approach may be worthwhile before deciding on further surgery.

Introduction: Hydroxyapatite implants are widely used in orbital reconstruction due to their biocompatibility and capacity for osseointegration. Complications such as implant exposure or extrusion typically occur in the early postoperative period, with late-onset cases being exceedingly rare.

Case presentation: This report presents a 78-year-old female who developed hydroxyapatite implant extrusion 7 years after orbital volume augmentation for an anophthalmic socket. She presented with lower eyelid retraction, ectropion, redness, and a fistula in the inferior fornix. Surgical management included implant removal, placement of a dermis fat graft from the abdomen to restore orbital volume, and correction of eyelid deformities using a tarsal strip and full-thickness skin graft. Postoperatively, the patient achieved successful resolution of symptoms, restoration of orbital volume, and correction of eyelid position.

Conclusion: This case emphasizes the need for long-term surveillance following orbital reconstruction and highlights effective management strategies for rare delayed implant extrusion.

Introduction: Neuro-retinitis is a rare ocular manifestation of disseminated tuberculosis (TB), often presenting with optic disc swelling and a macular star. Early diagnosis is essential to prevent permanent visual impairment, especially in TB-endemic areas where such presentations may be overlooked.

Case presentation: We report a case of a 38-year-old male who presented with a 2-week history of progressive, painless vision loss in the left eye. Fundoscopy revealed optic disc swelling and a macular star, suggestive of neuro-retinitis. Systemic evaluation, including chest imaging and immunologic testing, confirmed disseminated TB. Other potential infectious and autoimmune causes were excluded. The patient was initiated on standard anti-TB therapy (isoniazid, rifampicin, pyrazinamide, and ethambutol) along with oral corticosteroids. At 6-week follow-up, his visual acuity improved, and optic disc swelling had decreased.

Conclusion: Neuro-retinitis may be the initial presenting feature of disseminated TB. Clinicians should consider TB in the differential diagnosis of neuro-retinitis, particularly in high-prevalence settings. Early systemic evaluation and prompt initiation of anti-TB therapy can lead to favorable visual and systemic outcomes.

Introduction: We reported a case of late-onset opacification of a hydrophilic acrylic intraocular lens (IOL) that developed years after uneventful phacoemulsification cataract surgery. Remarkably, the calcification-related opacification was successfully reversed in vitro using ethylenediaminetetraacetic acid (EDTA) solution.

Case presentation: An 86-year-old male presented with a 2-year history of progressive visual decline in the right eye (best-corrected visual acuity: 2/200). Slit-lamp examination revealed posterior capsular opacification (PCO), and B-scan ultrasonography showed dense vitreous opacities, precluding fundus and optical coherence tomography (OCT) examinations. He had undergone cataract surgery with implantation of a Rayner monofocal IOL 10 years ago. As for the treatment of vitreous opacities, PCO, as well as investigating fundus diseases, the pars plana vitrectomy was performed. After PCO removal, fundus visualization remained poor. Intraoperative inspection revealed diffuse opacification of the IOL, which was subsequently explanted. Following removal of IOL, fundus examination revealed non-proliferative diabetic retinopathy and asteroid hyalosis. In vitro, the IOL exhibited homogeneous opacification resistant to mechanical cleaning and soaking in sterile water for 1 week. However, immersion in 4% EDTA gradually restored full optical clarity over the course of 1 month. Scanning electron microscopy (SEM) demonstrated small subsurface pits suggestive of prior crystal deposition. Energy-dispersive X-ray spectroscopy detected mainly carbon (C) and oxygen (O), without significant evidence of calcium (Ca), silicon (Si), or phosphorus (P).

Conclusions: This case highlighted the potential reversibility of hydrophilic IOL opacification through EDTA chelation, suggesting a promising direction for therapeutic management of IOL calcification in vivo in the future.

Introduction: Ocular tuberculosis (OTB) can occur in any part of the eye. We present a rare case of an 11-year-old girl with tuberculosis-related neuroretinitis and central retinal vein occlusion (CRVO).

Case presentation: The patient presented due to vision loss in the right eye. An examination detected edema of the optic disc with peripapillary and scattered retinal hemorrhages around the tortuous and dilated retinal veins in the right eye. Optical coherence tomography showed macular edema and subretinal fluid in the right eye. Fundus fluorescein angiography indicated hyper-fluorescence staining of the optic disc and tortuous and dilated retinal veins with wall staining and minor leakage in the right eye. Tuberculin skin test and interferon-gamma release assay were positive. The patient's vision was improved after anti-tuberculosis and systemic glucocorticoid therapy. A literature search found reports on only 5 adult patients with a similar presentation.

Conclusion: Tuberculosis-related neuroretinitis and CRVO in children are rare. Early diagnosis and treatment can somewhat restore the lost vision.

Introduction: Myelin oligodendrocyte glycoprotein antibody disease (MOGAD) is a more recently characterized neuroinflammatory condition which has been implicated with optic neuritis (ON). While the potential causes of central retinal artery occlusion (CRAO) are several, neuroinflammatory causes should not be excluded from the differential diagnosis. Our unusual case presents a patient with prior history of MOGAD-ON and venous stasis retinopathy (VSR) in their right eye, who, in their current presentation, developed a CRAO in their left eye.

Case presentation: A 43-year-old female with a history of concurrent VSR and MOGAD-ON (diagnosed 6 years prior and managed with long-term immunosuppression and oral steroids) in her right eye presented with a five-hour history of pain and blurry vision in her left eye. Examination of the left eye revealed a visual acuity (VA) of 20/80, a cherry red spot (without a visualized embolus), and a new generalized visual field defect. Optical coherence tomography (OCT) revealed diffuse retinal edema in her left eye with multiple layers of retinal thinning. She was referred to stroke neurology and continued oral steroid therapy. At 6-month follow-up, her VA had markedly improved to 20/30 in her left eye, and she had stable OCT parameters.

Conclusion: This unique case demonstrates sequential VSR and CRAO in opposite eyes, which were notable for their association with recurrent MOGAD-ON. Further research is needed to better elucidate the role of MOGAD in vascular occlusive events and whether this relationship may be arteritic in etiology.

Introduction: This case report presents the clinical, histological, and genetic characteristics of a patient with ligneous conjunctivitis and to provide a long-term treatment schedule, using cryo-depleted plasma infusions in combination with topical cyclosporine as a successful therapeutic option.

Case presentation: A 12-year-old Turkish girl experienced years of ocular itching, irritation, and increased light sensitivity. Initial clinical examination revealed the presence of pseudomembranes and giant papillae on the tarsal conjunctivae of both eyes. The biopsy of a membrane from the left eye was taken for histological examination. Manifestations of severe comorbidity since infancy (congenital hydrocephalus, asthma, recurrent respiratory infections, and impaired wound healing) and parental consanguinity prompted a genetic evaluation. The pseudomembranes were composed of fibrin, granulation tissue, and inflammatory cells consistent with the diagnosis of ligneous conjunctivitis. The genetic analysis revealed homozygosity for a pathogenic missense variant in plasminogen (PLG), causing PLG deficiency. Due to severe systemic complications, the patient was successfully treated with cryo-depleted plasma infusions and cyclosporine eye drops, resulting in the complete remission of the ligneous conjunctivitis.

Conclusion: This case report highlights the importance of considering PLG deficiency in patients with recurring chronic conjunctivitis. Long-term treatment with cryo-depleted plasma infusions in combination with short-term use of topical cyclosporine may provide an efficient therapeutic option for ligneous conjunctivitis in patients with PLG deficiency.