Case Reports in Ophthalmological Medicine最新文献

Introduction: The scleral buckling (SB) or encircling buckle technique has been employed in the management of rhegmatogenous retinal detachment (RRD). While encircling buckle technique offers substantial assistance in managing RRD, particularly for cases involving numerous breaks or extensive detachments, this procedure is time-consuming and associated with complications such as anterior segment ischemia. In contrast, segmental scleral buckling (SSB) provides a more targeted approach for correcting retinal detachments. Thus, SSB is technically straightforward in the hands of an experienced vitreoretinal surgeon. Herein, we delineate anatomical and functional results of SSB in RRD patients.

Result: Seven consecutive patients (seven eyes) with primary RRD were treated with the SSB technique and followed up for 6 months. Postoperatively, all seven individuals exhibited satisfactory buckle positioning and height, with retinal detachments resolving within 24 h. Subretinal fluid drainage was required in five of seven eyes, reflecting the relatively bullous nature of most detachments, whereas two eyes were successfully reattached without drainage. At both 1- and 6-month follow-ups, anatomical and functional improvements were maintained, demonstrating a 100% reattachment rate with no reported surgical complications or instances of redetachment.

Conclusion: In this small, consecutive case series from a tertiary referral centre in Indonesia, SSB achieved favourable anatomical and functional outcomes at 6 months, with no redetachment or serious complications. The procedure was well tolerated, and in our resource-limited setting, the material costs were lower than those of encircling buckling or vitrectomy based on local procurement prices, although we did not conduct a formal economic analysis. We therefore suggest that SSB remains a reasonable primary option for selected RRD cases, particularly in young, myopic patients with a single break. Larger, ideally multicentre studies are needed to confirm these observations and to explore generalisability to less experienced surgeons.

Purpose: The purpose of this study is to report a case of unilateral central retinal artery occlusion (CRAO) as a rare ophthalmic complication following bilateral cosmetic blepharoplasty in a young patient and to highlight its probable causes, management, and preventive considerations.

Methods: A 31-year-old gentleman, with no known comorbidities, presented with complaints of vision loss in the left eye for 6 weeks after undergoing bilateral cosmetic blepharoplasty. At presentation, the best corrected visual acuity (BCVA) was 20/25 in the right eye (OD) and no perception of light (NPL) in the left eye (OS). Intraocular pressure (IOP) was 14 mmHg in both eyes (OU). Pupillary examination revealed a round, regular, and reactive pupil in the right eye, whereas the left pupil was mid-dilated and nonreactive, with a positive relative afferent pupillary defect (RAPD). The fellow eye remained asymptomatic following surgery.

Results: At presentation, optical coherence tomography (OCT) was performed, and it demonstrated marked thinning of the inner retinal layers, consistent with chronic CRAO in the left eye. Given the rarity of CRAO in young individuals, a comprehensive systemic workup was performed, including hematological, inflammatory, coagulation, autoimmune, and cardiac evaluations. All investigations were within normal limits.

Conclusion: CRAO can occur as a rare postoperative complication of cosmetic blepharoplasty. Early recognition, prompt management, and careful postoperative monitoring may prevent the risk of such complications.

This study describes the outcomes of femtosecond laser-assisted cataract surgery (FLACS) in patients with prior corneal scarring and prior anterior lamellar keratoplasty (ALK). Two male patients, aged 65 and 61 years, presented for cataract surgery with a central corneal scar and previous ALK, respectively. Both underwent standard FLACS to address their cataracts amidst these complex corneal conditions. The procedure successfully achieved a centered 5.0 mm capsulotomy without tags or tears, and the lens was segmented into a sextant pattern and removed without difficulty. No serious intraoperative complications occurred. In the first case, best corrected visual acuity improved from 20/150 to 20/40 at 1-month postoperation, with the patient reporting enhanced visual clarity. In the second case, visual acuity improved from 20/800 to 20/100 1 month after surgery, with further enhancement to 20/60 following scleral lens fitting. This study represents an existing technique on the use of FLACS in patients with ALK and corneal scarring. The findings demonstrate that FLACS can be effectively and safely performed in these challenging cases, providing valuable insights into its potential advantages over traditional manual cataract surgery, particularly in patients with compromised ocular structures and limited lens visibility.

Introduction: To report an unusual epiretinal proliferation (EP) case in tubercular serpiginous-like choroiditis.

Case presentation: A 30-year-old female patient with a history of uveitis presented with blurry vision and floaters for 5 days. The visual acuities of the right and left eyes were 7/10 and 9/10, respectively. A slit lamp examination of the right eye showed moderate anterior uveitis with anterior chamber cells of 2+ and 1+ cells in the anterior vitreous. The left eye showed a posterior synechia at the inferior half of the pupil but no cells in the anterior chamber. Mild vitritis was observed in both eyes. A fundus examination revealed two atrophic punch-out lesions in the right eye and multiple pigmented chorioretinal scar-like lesions in the left eye. OCT showed cystoid macular edema in the right eye and a wide epiretinal proliferative membrane in the left eye. The immunocompetent patient had a family history of tuberculosis (TB) infection. The tuberculin skin test resulted in a ≥ 20-mm induration, and the QuantiFERON-TB Gold test was positive. The patient was started on topical and oral steroids. Additionally, anti-TB treatment was added, leading to a favorable outcome. Following treatment, signs of panuveitis showed resolution, and there was an improvement in vision symptoms.

Conclusions: To our knowledge, this may represent one of the first reported cases of EP associated with tubercular serpiginous-like choroiditis.

Purpose: To report a case of a macular neovascular membrane (MNV) 14 years after an episode of acute posterior multifocal placoid pigment epitheliopathy (APMPPE).

Methods: Case report.

Results: A 22-year-old man presented with acute bilateral blurred vision. The best corrected visual acuity (VA) was 20/200 in both eyes. Fundus examination revealed bilateral multiple yellow-gray placoid lesions and macular serous detachments. Multimodal imaging and a systemic workup excluded systemic inflammatory or infectious diseases, confirming the diagnosis of APMPPE. The patient was treated with triamcinolone acetonide, an intravitreal injection in the right eye, and a posterior subtenon injection in the left eye. At the 8-week follow-up, the fundus lesions healed, with resolution of the macular serous detachment in both eyes. The VA improved to 20/63 bilaterally. After being lost to follow-up for 14 years, the patient presented sudden worsening of vision in the left eye. The VA decreased to 20/400 in the left eye due to an extensive subretinal hemorrhage and hard exudates in the macula. After diagnostic confirmation of a Type 2 MNV by optical coherence tomography angiography, the patient was treated with three monthly intravitreal injections of aflibercept. The VA improved to 20/160 a month after the treatment.

Conclusion: The treatment with aflibercept in this rare case of MNV secondary to APMPPE effectively controlled membrane activity. However, the fibrosis and atrophy resulting from the MNV contributed to only a partial recovery of VA. Long-term follow-up of patients with APMPPE is recommended for early detection and treatment of possible MNV development to improve functional outcomes.

Background: This case report discusses cavernous sinus metastases arising from uveal melanoma, which manifested after a 7-year remission period. The diagnosis of systemic metastatic disease was made based on ocular symptoms. To our knowledge, this is the second reported case of metastatic uveal melanoma to the cavernous sinus. The initial presentation posed challenges as it resembled Tolosa-Hunt syndrome, supported by neuroimaging and response to steroid treatment. Initially, suspicion of malignancy was low due to the 7-year remission period with no ocular or systemic signs suggestive of metastasis. However, repeat imaging was performed due to worsening symptoms upon tapering of steroid treatment. Subsequently, a biopsy was obtained which confirmed the diagnosis.

Case presentation: A 76-year-old male with a history of left eye choroidal melanoma treated 7 years earlier and achieving complete remission on subsequent follow-ups presented with worsening pain, diplopia, and left ophthalmoplegia upon tapering steroids. An initial MRI suggested Tolosa-Hunt syndrome. A follow-up MRI revealed enlargement of the left cavernous sinus with enhancing soft tissue, extending into the orbital fissures and foramen rotundum. A left orbital-zygomatic craniotomy biopsy confirmed malignant melanoma metastasis originating from the choroidal melanoma.

Conclusion: This case underscores the challenge of overlapping clinical presentations and the potential for delayed recognition of metastatic malignancies in unusual sites. Therefore, it emphasizes the importance of vigilant follow-up and consideration of surgical biopsy, if feasible, to explore alternative causes.

Purpose: This report describes a patient with anterior and posterior corneal topographic changes who developed refractory keratitis due to Mycobacterium chelonae, associated with soft contact lens use.

Case: A 42-year-old man presented with blurred vision and pain in his right eye. He used disposable soft contact lenses for 2 weeks with appropriate care. He had open-angle glaucoma, atopic dermatitis, and diabetes mellitus. At the initial presentation, a corneal epithelial defect, cell infiltration, strong hyperemia, hypopyon, and inflammation in the anterior chamber were observed. Anterior segment optical coherence tomography disclosed corneal edema and cloudiness, and the central corneal thickness had increased to 988 μm. The best-corrected visual acuity was counting fingers at 10 cm. The patient did not respond to the initial treatment with ofloxacin and steroids. The culture of the scraped sample from the contact lens case grew M. chelonae, and topical tobramycin was administered, which was effective based on antimicrobial susceptibility. It took 4 months to treat the keratitis, and the best-corrected visual acuity improved to 0.5, although anterior and posterior corneal irregularities remained.

Conclusion: Nontuberculous M. chelonae should be considered in patients with treatment-resistant keratitis, especially in contact lens users. Topographic changes are important for evaluating corneal edema and irregular astigmatism, which impair visual function after keratitis.

We report an unusual case of delayed-onset, refractory endophthalmitis caused by Staphylococcus hominis following uncomplicated cataract surgery, characterized by recurrent anterior chamber hypopyon and progressive corneal infiltration requiring tectonic keratoplasty for definitive management. A 74-year-old patient with well-controlled Type 2 diabetes mellitus underwent uncomplicated phacoemulsification with intraocular lens implantation, achieving best corrected visual acuity of 6/6 (Snellen) at 1 month postoperatively. The patient subsequently developed acute vision loss with clinical endophthalmitis. Despite multiple interventions, including vitreous tap, two pars plana vitrectomies with intravitreal antibiotics, and intensive topical therapy, the infection persisted for 5 months with recurrent corneal wound infiltration and hypopyon. All initial vitreous and aqueous cultures remained negative. Following referral to our tertiary center, sequential anterior chamber washes, corneal biopsies, and intracameral antibiotics were performed. S. hominis was eventually isolated from corneal sampling. After the identification of S. hominis, treatment was converted to systemic linezolid and intensive topical vancomycin. Given persistent corneal involvement despite maximal medical therapy, a superior 6-mm tectonic keratoplasty was performed. Following this definitive surgical intervention combined with targeted antimicrobial therapy, the infection was successfully controlled, and intraocular inflammation was completely resolved. This represents the first reported case of S. hominis endophthalmitis presenting with recurrent anterior chamber hypopyon and progressive corneal wound involvement successfully treated with tectonic keratoplasty. The case highlights that S. hominis should be considered in the setting of persistent postoperative endophthalmitis, particularly in diabetic patients, and that tectonic keratoplasty may be required for definitive source control when medical therapy fails to eradicate the infection.

Purpose: The aim of this study is to highlight findings of retrograde maculopathy (RM) on optical coherence tomography (OCT) as a sequela of neuromyelitis optica associated optic neuropathy.

Observations: We report two patients with demyelinating lesions involving the visual pathways due to neuromyelitis optica in whom RM was seen, and in whom the location of the RM corresponded to their visual deficits. In one case, we describe a patient who had a demyelinating chiasmal lesion with bitemporal hemianopia and who had corresponding binasal RM. In another case, we describe a patient who had generalized vision loss in the right eye and who had corresponding diffuse RM in the right macula.

Conclusions and importance: RM is a potential sequela of severe optic neuropathy in neuromyelitis optica and topographically corresponds to severe visual field defects, as well as severe ganglion cell complex loss. Providers should recognize this finding and be aware that they do not need to pursue diagnostic evaluation due to concern for primary macular disease.

Introduction: Granulomatosis with polyangiitis (GPA) is a granulomatous disease with multisystem involvement, frequently with ocular manifestations. It can lead to ocular morbidity due to tissue melting and necrosis.

Case description: A 35-year-old male presented with a painless nodular lesion in the left eye, along with gradual diminution of vision and redness for 2 months. Eight months ago, he was diagnosed with GPA and left eye anterior uveitis. He was treated with topical steroids, topical cycloplegic, pulse cyclophosphamide, oral prednisolone, and azathioprine. At presentation, best corrected visual acuity in the right eye was 6/6 and 1/60 in the left. Left eye showed scleral thinning and necrosis in the superonasal quadrant with +1 cells in the anterior chamber. Intraocular pressure was 10 mmHg. Funduscopy examination showed exudative retinal detachment with hyperemic disc. Since refractory to topical and systemic immunomodulators, he underwent corneoscleral patch graft in the left eye for the progressive scleral thinning along with injection rituximab. Significant improvement was seen at 1 month with corneoscleral patch graft in situ, decreased inflammation with formed anterior chamber depth. However, at 2 months follow-up, the left eye showed worsening of ocular symptoms with progressive scleral thinning, necrosis, and graft lysis with total retinal detachment.

Conclusion: GPA-associated necrotizing scleritis is challenging. A collaborative timely management with aggressive compliant immunosuppressive therapy is a necessity to avoid ocular morbidity.