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Journal Francais D'ophtalmologie Nov 2014Visual snow is a symptom described by some patients and poorly recognized by ophthalmologists. It consists in the permanent perception of a textured or a snowy vision,...
INTRODUCTION
Visual snow is a symptom described by some patients and poorly recognized by ophthalmologists. It consists in the permanent perception of a textured or a snowy vision, sometimes associated with palinopsia, exaggerated perception of the blue field entoptic phenomenon and photophobia. We report a group of patients suffering from visual snow in order to precise its characteristics and discuss its pathophysiology.
MATERIALS AND METHODS
Prospective study of patients diagnosed between September 2010 and December 2012 with a visual snow phenomenon. For each patient, a formal ophthalmologic examination, an Amsler grid test, an automated visual field (central 20°), a color vision test (15 Hue), a full field, a pattern and a multifocal electroretinogram as well as flash and pattern visual evoked potentials (Métrovision) were performed. A brain imaging was not systematically performed.
RESULTS
Twelve patients aged 9-48old were included (six men and six women, 85 % of students). Several signs were variably associated with the visual snow phenomenon: palinopsia (50 %), constant blue field entoptic phenomenon (40 %), photophobia (30 %), migraine (30 %); in 20 % of cases, an initial toxic intake was found (20 %).
DISCUSSION
This study highlights the reproducibility of typical symptoms described by patients reporting the visual snow phenomenon. This feature strongly supports the organic origin of the phenomenon. The pathophysiology of this phenomenon, however, remains unclear; the hypothesis of a lower threshold for perception of entoptic images cannot entirely account for the reported symptoms.
PubMed: 25440184
DOI: 10.1016/j.jfo.2014.08.001 -
Retina (Philadelphia, Pa.) Feb 2021Randomized clinical trials have demonstrated the safety and efficacy of ocriplasmin in patients with vitreomacular traction (VMT), including those with macular hole... (Observational Study)
Observational Study
PURPOSE
Randomized clinical trials have demonstrated the safety and efficacy of ocriplasmin in patients with vitreomacular traction (VMT), including those with macular hole (MH). The INJECT study prospectively evaluated ocriplasmin in the setting of clinical practice.
METHODS
INJECT was a Phase 4, multicenter, prospective observational study. Patients were followed up for 12 months. Assessments included nonsurgical VMT resolution, nonsurgical MH closure, best-corrected visual acuity, occurrence of vitrectomy, and adverse events.
RESULTS
The efficacy population (N = 395) received an ocriplasmin injection and had optical coherence tomography-confirmed VMT at baseline. At Day 28, the rate of nonsurgical VMT resolution was 40.7% in the overall group, and the rate of nonsurgical MH closure was 36.0% in the VMT with MH group. At Month 12, the rate of ≥2-line best-corrected visual acuity gain (irrespective of vitrectomy) was 36.8% in the overall group and 59.6% in the VMT with MH group. The percentage of patients who underwent vitrectomy in the study eye was 29.1% in the overall group and 55.6% in the VMT with MH group. Photopsia (9.8%) and vitreous floaters (6.8%) were the most frequent adverse events.
CONCLUSION
The INJECT study showed that ocriplasmin is effective in a clinical setting in patients with VMT, with or without MH. No new safety signals were identified from this large and surgeon-selected patient group, although the significant limitations of the study design without an image reading center and scheduled study visit timings should be noted.
Topics: Aged; Aged, 80 and over; Female; Fibrinolysin; Follow-Up Studies; Humans; Intravitreal Injections; Male; Middle Aged; Peptide Fragments; Prospective Studies; Retinal Perforations; Tomography, Optical Coherence; Treatment Outcome; Vitrectomy; Vitreous Body; Vitreous Detachment
PubMed: 32496343
DOI: 10.1097/IAE.0000000000002862 -
American Journal of Ophthalmology Case... Jun 2022To report a case with multiple evanescent white dot syndrome (MEWDS) following BNT162b2 mRNA COVID-19 vaccination.
PURPOSE
To report a case with multiple evanescent white dot syndrome (MEWDS) following BNT162b2 mRNA COVID-19 vaccination.
OBSERVATIONS
Case: A 67-year-old Japanese female presented with central visual field loss and photopsia in the right eye (OD) for 5 days. She was complaining blurred vision with bright spots in vision in OD, but denied any ocular symptoms in left eye (OS). She had received the second dose of BNT162b2 mRNA COVID-19 vaccine (Pfizer-BioNTech) one day before the onset of visual symptoms; flu-like symptoms such as mild fever and general fatigue also developed along with ocular symptoms such as decreased vision and hypersensitivity to light in OD following the second COVID-19 vaccine. The first dose of vaccine was administrated followed three weeks later by the second dose and was not associated with any ocular or systemic symptoms besides mild pain at the injection site. She had not been followed by any ophthalmologist before the initial visit. At the initial visit, best corrected visual acuity (BCVA) in decimal points was 0.2 in OD and 1.0 in OS. Ophthalmic examination showed multifocal white dots in the posterior retina with moderate vitritis (1+ haze and 2+ cells) in OD. Multimodal imaging in OD showed diffuse disruption of ellipsoid zone with variable punctate hyperreflective lesions at macula on optical coherence tomography, punctate hyperfluorescence in a wreath-like pattern and late staining on fluorescein angiography, and multiple hypofluorescent spots of various sizes in the late phases on indocyanine green angiography. Both multiple hypofluorescent spots and scattered hyperfluorescent spots corresponding to white dots in OD were also seen on fundus autofluorescence. Her laboratory and systemic evaluations were negative for syphilis, tuberculosis, or toxoplasma, and selected autoimmune diseases like sarcoidosis, Behcet's disease, rheumatoid arthritis, and systemic lupus erythematosus. No active intraocular inflammation or abnormality were seen in OS. One week later, the multifocal white dots disappeared in OD, and were almost invisible on fundus photography. At that time, multifocal electroretinogram showed decreased response with low amplitude density across the entire field in OD. The BCVA in OD spontaneously improved to 0.8 without any treatment. Collectively, these clinical course and findings were suggestive of a diagnosis of MEWDS after mRNA COVID-19 vaccination.
CONCLUSIONS AND IMPORTANCE
In this present case, BNT162b2 mRNA COVID-19 vaccination might have been associated with MEWDS-like entity with vision loss. It is important for physicians to monitor the ocular status carefully in patients with visual disturbance after COVID-19 vaccination.
PubMed: 35434421
DOI: 10.1016/j.ajoc.2022.101532 -
Documenta Ophthalmologica. Advances in... Dec 2022To report the clinical features of a patient with melanoma-associated retinopathy (MAR) with anti-transient receptor potential cation channel, subfamily M, member 1...
BACKGROUND
To report the clinical features of a patient with melanoma-associated retinopathy (MAR) with anti-transient receptor potential cation channel, subfamily M, member 1 (TRPM1) autoantibodies showing concomitant Off-bipolar cell dysfunction.
METHODS
We evaluated a patient with a past history of scalp melanoma presented with sudden-onset shimmering photopsia in both eyes. MAR was confirmed with complete ophthalmic examinations, electronegative electroretinogram (ERG), and the presence of anti-TRPM1 autoantibodies by Western blot analysis. S-cone ERG and photopic On-Off ERG were studied in this patient as well.
RESULTS
The patient's best-corrected visual acuity was 6/30 in the right eye and 6/8.6 in the left eye. Fundus and OCT findings were unremarkable. Visual field test showed severe constriction in both eyes. His full-field ERG was electronegative. S-cone ERG recorded preservation of L/M-cone-mediated response and undetectable S-cone-mediated response. Photopic On-Off ERG disclosed attenuated On- and Off-response. Western blot analysis confirmed immunoreactivity of the patient's serum to a 30 kDa TRPM1 recombinant protein. Whole-body positron emission tomography scan detected lymph node metastases in the neck.
CONCLUSIONS
Anti-TRPM1 autoantibody-positive MAR varies greatly in its presentation and clinical course. We present a case of anti-TRPM1 autoantibody-positive MAR with atypical feature of Off-bipolar cell involvement. A complete electroretinographic study together with identification of the pathogenic antiretinal autoantibodies may help better understand and subclassify the disease in the future.
Topics: Humans; Paraneoplastic Syndromes, Ocular; Autoantibodies; Electroretinography; TRPM Cation Channels; Melanoma
PubMed: 36173494
DOI: 10.1007/s10633-022-09901-y -
PloS One 2022Photopsia is a phenomenon that sometimes disturbs patients after cataract surgery. To evaluate the impact of the edge design of intraocular lenses (IOL) on the location,...
Photopsia is a phenomenon that sometimes disturbs patients after cataract surgery. To evaluate the impact of the edge design of intraocular lenses (IOL) on the location, shape and relative intensity of photic effects at the retina caused by photopsia in pseudophakic eyes, photopsia was simulated using ZEMAX software. The structural parameters of the pseudophakic eye model are based on the Liou-Brennan eye model parameters with a pupil diameter of 4.5 mm. The IOLs implanted in the eye model have a power of 21 diopter (D) with optical diameter of 6 mm and 7 mm. From the ray-tracing analysis, covering variations of incident ray angle of 50° to 90° from temporally, a photic image is detected at the fovea at specific ray angles of 77.5° (6 mm IOL) and 78.2° (7 mm IOL). This photic image disappears when a thin IOL with an edge thickness of 0 mm or a thick IOL with absorbing edges is replaced in the eye model. With an anti-reflective edge, this photic image remains, but with a fully reflecting edge it disappears at the critical angles and appears with different shapes at other angles. The intensity of this photic image can be reduced by changing the edge design to a frosted surface. Most of the photic patterns in IOLs are not observed with absorbing and thin edge designs. IOLs with anti-reflecting and fully reflecting edges generate disturbing photic effects at different angles on the fovea. IOLs with frosted edges reduce the contrast of the photic effects and make them less disturbing for patients.
Topics: Cataract Extraction; Computer Simulation; Humans; Models, Biological; Photic Stimulation; Pseudophakia; Scattering, Radiation; Vision Disorders
PubMed: 35051191
DOI: 10.1371/journal.pone.0262457 -
Investigative Ophthalmology & Visual... May 2019Melanoma-associated retinopathy (MAR) is a paraneoplastic syndrome associated with cutaneous malignant melanoma (CMM). Visual symptoms include night blindness,...
PURPOSE
Melanoma-associated retinopathy (MAR) is a paraneoplastic syndrome associated with cutaneous malignant melanoma (CMM). Visual symptoms include night blindness, photopsia, and reduced-contrast sensitivity. An abnormal ERG b-wave and the presence of anti-bipolar cell autoantibodies, including autoantibodies reacting with the ON-bipolar cell TRPM1 channel, help to confirm the diagnosis. The goal of this study was to determine if CMM patients without visual symptoms also express anti-TRPM1 autoantibodies.
METHODS
Serum samples from 15 CMM patients were tested using three assays: immunofluorescent labeling of TRPM1-transfected HEK cells, immunofluorescent labeling of retinal sections from wild-type and TRPM1 knockout mice, and immunoblot detection of a bacterially produced recombinant TRPM1 peptide.
RESULTS
Serum specimens from 5 of the 15 CMM patients without declared visual symptoms were positive for anti-TRPM1 autoantibodies in at least one of the three assays. One of 50 control sera from patients not known to have cancer was also weakly reactive with the TRPM1 peptide.
CONCLUSIONS
Autoantibodies against TRPM1 are present in CMM patient sera without self-reported visual symptoms. Most patients had advanced (stage III and IV) disease and were undergoing aggressive treatments, including immunotherapy. It is unknown if immunotherapy affects the expression of TRPM1 autoantibodies. The presence of TRPM1 autoantibodies may predispose patients for MAR.
Topics: Animals; Autoantibodies; Case-Control Studies; Cells, Cultured; Humans; Melanoma; Mice; Paraneoplastic Syndromes, Ocular; Skin Neoplasms; TRPM Cation Channels; Melanoma, Cutaneous Malignant
PubMed: 31117125
DOI: 10.1167/iovs.19-26775 -
Journal of Medical Case Reports Feb 2015Typical aura without headache (TAWH), which has been rarely reported both at home and abroad, is a rare type of migraine with aura. (Review)
Review
INTRODUCTION
Typical aura without headache (TAWH), which has been rarely reported both at home and abroad, is a rare type of migraine with aura.
CASE PRESENTATION
This is a report on a 64-year-old Chinese migraineur who has had recurrent typical visual aura without headache attacks for more than 30 years, and has been misdiagnosed as having had transient ischemic attacks (TIA) many times. He mainly experienced episodes of 'homonymous blurred vision' or photopsia, which presented as different shapes located at the side or above his visual field, for example, patchy, cord-like, zigzag, curtain-like or irregular shapes. The shape was inconsistent during each attack, however, the color was mainly gray or light blue. The visual symptoms gradually disappeared in about 30 minutes. Our patient has never suffered a headache attack during or after the visual aura. Normal results were observed in his neurological and eye examinations, complete blood test, electroencephalogram and neuroimaging examination.
CONCLUSIONS
TAWH is an uncommon phenomenon of migraine. Migraine with visual aura mainly presents positive and dynamic symptoms. It has a benign course and can be diagnosed after exclusion of other organic diseases such as TIA and epilepsy.
Topics: Diagnostic Errors; Electroencephalography; Headache; Humans; Ischemic Attack, Transient; Male; Middle Aged; Migraine with Aura; Neuroimaging
PubMed: 25884682
DOI: 10.1186/s13256-014-0510-7 -
American Journal of Ophthalmology Case... Jun 2020To report a case of bull's eye maculopathy, a novel finding in a patient with iron overload secondary to hereditary hemochromatosis with a homozygous mutation of the...
PURPOSE
To report a case of bull's eye maculopathy, a novel finding in a patient with iron overload secondary to hereditary hemochromatosis with a homozygous mutation of the gene.
OBSERVATIONS
A 39-year-old man with recently diagnosed hereditary hemochromatosis undergoing treatment by serial phlebotomy presented with bilateral progressive blurry vision and recent onset of photopsias and headaches. Fundus examination revealed a symmetric bull's eye maculopathy with photoreceptor loss and retinal pigment epithelium transmission defects in the area of speckled hyper- and hypo-pigmentation by multimodal imaging. Full field and multifocal electroretinograms demonstrated generalized rod and cone dysfunction with some central preservation of waveforms. Further systemic work-up revealed low ceruloplasmin, mildly decreased serum copper and zinc levels, and low urinary copper. The patient underwent testing for inherited retinal dystrophies, but was not found to have any known pathogenic gene mutations. His ferritin levels normalized with serial phlebotomy and his retinopathy did not appear to progress over 6 months with normalization of his iron levels.
CONCLUSIONS AND IMPORTANCE
We report a case of bull's eye maculopathy in a patient with hereditary hemochromatosis with no previous exposure to iron chelators and no known inherited retinal dystrophy. Ocular involvement in hereditary hemochromatosis is relatively rare. In this case, the patient's low serum ceruloplasmin is thought to have increased the amount of redox-active ferrous iron and potentiated retinal iron toxicity resulting in the observed retinopathy. To the authors' knowledge, this is a potentially novel ocular manifestation of hereditary hemochromatosis.
PubMed: 32258826
DOI: 10.1016/j.ajoc.2020.100674 -
BMJ Case Reports Nov 2019A 64-year-old woman presented with bilateral visual loss with shimmering photopsias as the only clinical manifestation of an occult pancreatic ampullary adenocarcinoma...
A 64-year-old woman presented with bilateral visual loss with shimmering photopsias as the only clinical manifestation of an occult pancreatic ampullary adenocarcinoma causing duct dilatation. Abnormal electroretinograms led to suspicion of cancer-associated retinopathy (CAR), and CT of the abdomen showed an underlying pancreatic malignancy, detected with subclinical liver function tests following diagnosis of CAR. Biopsy showed a T2N0M0 ampullary adenocarcinoma. The patient was managed with Whipple's procedure and adjuvant chemotherapy and has made a good recovery with no progression of her retinopathy. To our knowledge, this is one of the first descriptions of CAR in the context of pancreatic malignancy. It is atypical in its asymmetric presentation and favourable patient outcome. CAR is an important diagnosis to make, as ocular manifestations can be the only indication of an occult malignancy, resulting in a swifter diagnosis and potentially life-saving early intervention.
Topics: Adenocarcinoma; Ampulla of Vater; Female; Humans; Middle Aged; Pancreatic Neoplasms; Retinal Diseases; Vision Disorders
PubMed: 31712238
DOI: 10.1136/bcr-2019-231444 -
Der Ophthalmologe : Zeitschrift Der... Jan 2016Acute annular outer retinopathy (AAOR) is a very rare variant of acute zonal occult outer retinopathy (AZOOR). Both variants are characterized by the perception of a...
Acute annular outer retinopathy (AAOR) is a very rare variant of acute zonal occult outer retinopathy (AZOOR). Both variants are characterized by the perception of a progressive visual field defect and can be accompanied by photopsia. In contrast to AZOOR, a progressive whitish and annular demarcation of the involved retina is observed in AAOR using ophthalmoscopy. Optical coherence tomography (OCT) reveals morphological changes predominantly in the outer retinal layers. Although there is no proof of an effective therapy, in the case presented here further progression could be stopped by a combination of antiviral and immunosuppressive therapy.
Topics: Adult; Antiviral Agents; Diagnosis, Differential; Hallucinations; Humans; Immunosuppressive Agents; Male; Ophthalmoscopy; Scotoma; Tomography, Optical Coherence; Treatment Outcome; White Dot Syndromes
PubMed: 25930180
DOI: 10.1007/s00347-015-0012-z