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American Journal of Ophthalmology Case... Mar 2023To report the clinical and anatomical features of an unusual case of acute idiopathic blind spot enlargement syndrome (AIBSES) with retinal vasculitis.
PURPOSE
To report the clinical and anatomical features of an unusual case of acute idiopathic blind spot enlargement syndrome (AIBSES) with retinal vasculitis.
OBSERVATIONS
A 39-year-old patient, who was a known case of chronic headache with nonspecific visual symptoms for nine years, developed scotomas in her right eye. She was initially diagnosed with AIBSES which had been stable, but later worsened with symptoms of subsequent blind spot enlargement and photopsia on the left eye a year later. Increase in the size of the blind spot over the left eye and stability of the blind spot enlargement over the right eye was documented on Humphrey visual field (HVF) testing. Due to the rapid onset and severity of symptoms, an inflammatory etiology was entertained and this prompted referral to our clinic. At initial presentation, fluorescein angiogram (FA) revealed moderate diffuse vasculitis and disc leakage in the left eye, which existed alongside the enlarged blind spot. Corticosteroid treatment was suggested and initiated. The patient was found to have a reduction in the size of her blind spot and a decrease in severity of retinal vasculitis a month later. Unfortunately, the patient was then lost to follow up and had stopped steroid treatment of her own accord. After nine months without treatment, the patient's blind spot increased to a larger size than her initial presentation, as documented on HVF, with recurrence of vasculitis in the left eye.
CONCLUSION AND IMPORTANCE
This is an unusual case of AIBSES which presented with vasculitis and rapid progression and has responded to steroids. Though monocular AIBSES has been shown to later affect the contralateral eye, concurrent vasculitis with AIBSES has not previously been reported. Furthermore, the response to treatment with reduction in blind spot enlargement is unusual for AIBSES. These findings stress the need for regular monitoring in cases of AIBSES.
PubMed: 36561880
DOI: 10.1016/j.ajoc.2022.101760 -
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 -
Ophthalmic Surgery, Lasers & Imaging... May 2016A 92-year-old man presented with months of progressive blurry vision, worsening acutely in his right eye. He denied pain, diplopia, or photopsias. His history was...
A 92-year-old man presented with months of progressive blurry vision, worsening acutely in his right eye. He denied pain, diplopia, or photopsias. His history was significant for multiple myeloma, prostate cancer, and malignant melanoma of his right shoulder treated with local excision. He had local recurrence with hepatic metastasis of the melanoma treated with radiation and chemotherapy. On examination, his visual acuity was counting fingers in the right eye and 20/60 in the left eye. Amsler grid testing demonstrated metamorphopsia in the right eye. Fundus exam of the right and left eyes revealed multiple, elevated, pigmented choroidal lesions, with associated subretinal fluid in the right macula. This appearance is consistent with hematogenous metastasis of cutaneous malignant melanoma to the choroid and associated serous fluid-causing metamorphopsia. The patient was enrolled in a clinical trial combining plasmid IL-12 with pembrolizumab (Keytruda; Merck, Whitehouse Station, NJ). He passed away 2 months after initial presentation to our clinic. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:497.].
Topics: Aged, 80 and over; Choroid; Choroid Neoplasms; Diagnosis, Differential; Fatal Outcome; Fluorescein Angiography; Fundus Oculi; Humans; Male; Melanoma; Neoplasm Metastasis; Skin Neoplasms; Tomography, Optical Coherence; Visual Acuity; Melanoma, Cutaneous Malignant
PubMed: 27183558
DOI: 10.3928/23258160-20160419-17 -
Klinische Monatsblatter Fur... Sep 2023There are only about 100 case reports on the Acute Idiopathic Blind Spot Enlargement Syndrome (AIBSES). This is characterised by the eponymous visual field loss in the...
There are only about 100 case reports on the Acute Idiopathic Blind Spot Enlargement Syndrome (AIBSES). This is characterised by the eponymous visual field loss in the blind spot area, acute onset photopsia, and funduscopically little or no change in the optic disc area, with conspicuous outer retinal bands on optical coherence tomography (OCT). Typical is the unilateral occurrence. Predominantly young women are affected. While previous reviews of AIBSES either predate the introduction of OCT or focus on differentiation from potentially related outer retinal conditions (e.g., multiple evanescent white dot syndrome and acute zonal occult outer retinopathy), the present review will concentrate on the current perspective and treatment strategies that have been developed and will aim to help increase awareness. Since the first description of AIBSES in the late 1980s, the introduction of OCT has simplified the diagnosis and characterisation of AIBSES as a disease of the outer retina. Nevertheless, misdiagnosis remains common in the spectrum of optic neuritis, as AIBSES may be ignored in differential diagnosis.
PubMed: 37678401
DOI: 10.1055/a-2130-5131 -
Journal of Ophthalmic Inflammation and... Dec 2021Multiple evanescent white dot syndrome (MEWDS) is a rare inflammatory eye condition affecting the outer retina as a consequence of choriocapillaris non perfusion. The... (Review)
Review
BACKGROUND
Multiple evanescent white dot syndrome (MEWDS) is a rare inflammatory eye condition affecting the outer retina as a consequence of choriocapillaris non perfusion. The pathophysiology of MEWDS will be discussed based clinical appraisal and on multimodal imaging appraisal.
METHODS
Narrative review and perspective opinion.
RESULTS
Literature review results helped us to put forward (1) the specific symptomatology (decreased/blurred vision, photopsia, subjective scotomas), (2) the ill-asserted character of clinical findings (foveal granularity, white dots in fundoscopy), (3) and the crucial importance of multimodal imaging with the diagnostic triad of ICGA hypofluorescent areas, BL-FAF hyperautofluorescent areas and loss/damage of IS/OS-ellipsoid zone on SD-OCT that characterise the disease and can practically help the clinician to diagnose MEWDS. A comprehensive alternative perspective of the disease was formulated.
CONCLUSIONS
The bulk of evidence that we are presenting in this review, thanks to new performing non-invasive and invasive imaging modalities, is sufficiently compelling to consider MEWDS as a primary choriocapillaritis/inflammatory choriocapillaropathy. Multimodal imaging allows the clinician to diagnose MEWDS with a high level of certainty and ensures a precise follow-up.
PubMed: 34921620
DOI: 10.1186/s12348-021-00279-7 -
Journal of Neuro-ophthalmology : the... Mar 2021
Topics: Adult; Drug-Related Side Effects and Adverse Reactions; Female; Humans; Immune Checkpoint Inhibitors; Magnetic Resonance Imaging; Melanoma; Nerve Fibers; Nivolumab; Optic Neuritis; Papilledema; Retinal Ganglion Cells; Skin Neoplasms; Tomography, Optical Coherence; Vision Disorders; Visual Acuity; Visual Fields; Melanoma, Cutaneous Malignant
PubMed: 32108668
DOI: 10.1097/WNO.0000000000000909 -
The International Journal of Risk &... 2022The majority of antidepressants inhibit serotonin reuptake and include the selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors...
BACKGROUND
The majority of antidepressants inhibit serotonin reuptake and include the selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and the serotonin reuptake inhibiting tricyclic antidepressants.
OBJECTIVE
The objective of this study was to investigate and describe the range and impact of reported adverse visual effects linked to serotonin reuptake inhibiting antidepressants.
METHODS
Using data from a global database of patient spontaneous reports of drug adverse events, we systematically identified eligible reports of visual problems linked to the use of serotonin reuptake inhibiting antidepressants. We analyzed these data using simple descriptive statistics to present the range and impact.
RESULTS
We identified 124 reports of visual problems. Reports originate from 18 countries and involve 11 different drugs. The most commonly reported symptoms were vision blurred/visual acuity reduced (n = 79, 63.7%), night blindness (n = 22, 17.7%), vitreous floaters (n = 21, 16.9%), photophobia (n = 19, 15.3%), diplopia (n = 15, 12.1%), palinopsia (n = 13, 10.5%), visual field defect (n = 12, 9.7%), photopsia (n = 11, 8.9%) and visual snow syndrome (n = 11, 8.9%). 74 patients indicated that the side effect was bad enough to affect everyday activities, 62 had sought health care, and 50 indicated that their work had been affected. 49 patients reported an enduring vision problem after discontinuation of treatment.
CONCLUSIONS
The data suggest that serotonin reuptake inhibiting antidepressants can produce a range of adverse effects on vision that in some cases can be long-lasting after discontinuation of the drug. Further efforts are needed to understand the mechanisms involved, the incidence among those prescribed these medications, and identify any risk or mitigation factors.
Topics: Antidepressive Agents; Antidepressive Agents, Tricyclic; Humans; Patient Reported Outcome Measures; Serotonin; Selective Serotonin Reuptake Inhibitors
PubMed: 34366298
DOI: 10.3233/JRS-210018 -
Biological & Pharmaceutical Bulletin 2018Paclitaxel and nanoparticle albumin-bound paclitaxel are known to cause adverse events of eye disorders, such as cystoid macular edema. However, at present, the risk...
Paclitaxel and nanoparticle albumin-bound paclitaxel are known to cause adverse events of eye disorders, such as cystoid macular edema. However, at present, the risk factors remain unclear. Therefore, risk factors for eye disorders caused by paclitaxel and nanoparticle albumin-bound paclitaxel were studied. This retrospective study targeted patients who were newly administered paclitaxel or nanoparticle albumin-bound paclitaxel at Kyoto Okamoto Memorial Hospital between April 1, 2012, and March 31, 2017. Eye disorder occurrence was defined as an event in which the pharmacist confirmed the symptoms in a patient interview and the ophthalmologist diagnosed the disorder. To analyze the risk factors, logistic regression analysis using 41 factors was performed. Of 128 subjects, 13 (10.2%) had eye disorders with symptom degrees of Grades 1 and 2. The symptoms were conjunctivitis or subconjunctival hemorrhage (3.1%), visual acuity reduction (2.3%), blurred vision and eye pain (1.6% each), eye mucus, blepharitis, stye, watering eyes, photopsia, and muscae volitantes (0.8% each). In eight patients, the conditions patients improved with spontaneously or with medication use; no improvements were observed the cases of visual acuity reduction, blurred vision, or muscae volitantes. Multivariate logistic regression analysis revealed that a cumulative dose of ≥819 mg/m (odds ratio: 5.34, 95% confidence interval: 1.32-21.60, p=0.019) and baseline alkaline phosphatase ≥256 U/L (odds ratio: 3.74, 95% confidence interval: 1.02-13.70, p=0.046) were significant risk factors associated with eye disorders. In conclusion, it was determined that paclitaxel- and nanoparticle albumin-bound paclitaxel-related eye disorders might be influenced by cumulative dose and baseline alkaline phosphatase.
Topics: Adult; Aged; Aged, 80 and over; Albumins; Alkaline Phosphatase; Antineoplastic Agents, Phytogenic; Eye Diseases; Female; Hospitals; Humans; Logistic Models; Macular Edema; Male; Middle Aged; Nanoparticles; Neoplasms; Odds Ratio; Paclitaxel; Retrospective Studies; Risk Factors; Vision Disorders
PubMed: 30381669
DOI: 10.1248/bpb.b18-00444 -
Ophthalmic Surgery, Lasers & Imaging... Nov 2020Posterior vitreous detachment (PVD) is a separation of the posterior hyaloid from the retina that manifests as photopsias and floaters. Optical coherence tomography...
BACKGROUND AND OBJECTIVE
Posterior vitreous detachment (PVD) is a separation of the posterior hyaloid from the retina that manifests as photopsias and floaters. Optical coherence tomography (OCT) has demonstrated posterior vitreous opacities (PVOs) that may correlate with Shaffer's sign, which may correlate with retinal breaks.
PATIENTS AND METHODS
Patients with symptomatic PVDs were retrospectively reviewed at a single institution by a single provider. Masked qualitative review of SD-OCTs by a single reviewer determined presence of PVOs.
RESULTS
Among 78 patients, PVOs were found in 32 of the patients (41%), and 19 (59%) had retinal breaks. In those without PVOs, six (13%) had a break. Sensitivity and specificity were 76.0% and 75.5%, respectively. Removing patients with vitreous hemorrhages, sensitivity, and specificity of PVOs was 82.4% and 86.4%, respectively.
CONCLUSION
In symptomatic PVDs, PVOs on OCT correlated with the presence of a retinal break, especially in the absence of a vitreous hemorrhage. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:628-632.].
Topics: Humans; Retinal Perforations; Retrospective Studies; Tomography, Optical Coherence; Vitreous Body; Vitreous Detachment
PubMed: 33231695
DOI: 10.3928/23258160-20201104-04 -
Documenta Ophthalmologica. Advances in... Dec 2017To report a case of unilateral cancer-associated retinopathy (CAR) with clinical, serological and electroretinogram (ERG) normalization after aggressive cancer treatment...
PURPOSE
To report a case of unilateral cancer-associated retinopathy (CAR) with clinical, serological and electroretinogram (ERG) normalization after aggressive cancer treatment combined with steroids and rituximab.
METHODS
Work-up included extensive clinical and electrophysiological testing. Also, serological work-up for antiretinal antibodies and oncological screening was organized.
RESULTS
A 45-year-old female presented with progressive photopsias, photophobia and relative central scotoma in the right eye since 6 weeks prior. BCVA was 1.0 in both eyes. Biomicroscopy, IOP and fundus exam were unremarkable. Also, colour vision, autofluorescence imaging, OCT and EOG were normal. Visual fields showed decreased central sensitivity in the right eye. ERG showed a unilateral, electronegative combined and ON-bipolar response. A diagnosis of CAR was suspected. After a diagnosis of an adenocarcinoma of the right ovary, radical ovariectomy and hysterectomy were performed, followed by adjuvant chemotherapy. A whole-body PET scan revealed no metastasis. Treatment with rituximab monoclonal antibodies in combination with corticosteroids was initiated. The patient tested positive for serum autoantibodies against TRPM1, a transient receptor potential cation channel expressed in ON-bipolar cells. During treatment, there was progressive improvement in symptoms and the ERG normalized. Serology confirmed complete clearance of autoantibodies.
CONCLUSIONS
Although rare, unilateral CAR does occur and in cases with high clinical suspicion an oncological work-up is mandatory. Aggressive cancer treatment combined with steroids and rituximab can lead to normalization of the clinical and ERG phenotype, with clearing of antiretinal antibodies.
Topics: Adenocarcinoma; Antineoplastic Agents, Immunological; Female; Humans; Middle Aged; Ovarian Neoplasms; Paraneoplastic Syndromes, Ocular; Retinal Diseases; Rituximab; Steroids; Treatment Outcome
PubMed: 28815346
DOI: 10.1007/s10633-017-9605-y