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Clinical Case Reports Aug 2021Central vision loss, photopsia, floaters, and macular edema in a highly myopic patient can easily be misinterpreted as high myopia complications. In atypical cases,...
Central vision loss, photopsia, floaters, and macular edema in a highly myopic patient can easily be misinterpreted as high myopia complications. In atypical cases, detailed examination and a thorough diagnostic workup are required to establish the proper diagnosis, which is often beyond the scope of diagnoses initially considered.
PubMed: 34429993
DOI: 10.1002/ccr3.4601 -
Retinal Cases & Brief Reports Nov 2022To describe the peripheral optical coherence tomography findings in a female choroideremia carrier.
PURPOSE
To describe the peripheral optical coherence tomography findings in a female choroideremia carrier.
METHODS
A 56-year-old woman was referred for visual disturbance complaining of some occasional photopsias and increasing difficulty with her vision at night in both eyes. Best-corrected visual acuity was 20/20 in the right eye and 20/150 in the left eye. Fundus examination revealed mildly tilted disks and peripapillary atrophy with subtle retinal pigment epithelial changes in the periphery.
RESULTS
Macular optical coherence tomography in the right eye appeared unremarkable, but the in the left eye, there was diffuse ellipsoid zone band disruption. Green-light fundus autofluorescence revealed mottled areas of decreased autofluorescence in the mid and far periphery creating an irregular mosaic pattern. Peripheral optical coherence tomography scans revealed more diffuse ellipsoid zone alterations than were apparent on the fundus autofluorescence imaging. Genetic testing revealed a heterozygous pathogenic variant in the CHM gene (c.715C>T, p.Arg239). An additional heterozygous mutation was noted in the CNGB1 gene (c.290+2T>C, splice donor).
CONCLUSION
Choroideremia carriers may manifest widespread photoreceptor alterations, which may be more extensive than apparent on fundus autofluorescence imaging.
Topics: Female; Humans; Middle Aged; Choroideremia; Tomography, Optical Coherence; Fundus Oculi; Heterozygote; Vision Disorders; Retinal Pigments; Fluorescein Angiography; Cyclic Nucleotide-Gated Cation Channels
PubMed: 33394956
DOI: 10.1097/ICB.0000000000001109 -
Ophthalmology. Retina Oct 2020To determine factors predictive of visual outcome in patients with circumscribed choroidal hemangioma treated with photodynamic therapy (PDT). (Comparative Study)
Comparative Study
PURPOSE
To determine factors predictive of visual outcome in patients with circumscribed choroidal hemangioma treated with photodynamic therapy (PDT).
DESIGN
Retrospective case series.
PARTICIPANTS
Seventy-nine patients with circumscribed choroidal hemangioma treated with PDT.
METHODS
Patients with circumscribed choroidal hemangioma treated with PDT were identified, and factors predictive of final visual acuity were assessed.
MAIN OUTCOME MEASURES
Factors predictive of final visual acuity of 20/40 or better versus 20/50 or worse.
RESULTS
Seventy-nine eyes of 79 patients with circumscribed choroidal hemangioma were treated with PDT. All tumors were unilateral and posterior to the equator. Mean largest basal diameter was 5.7 mm (range, 2.0-10.0 mm); mean thickness was 3.0 mm (range, 1.4-4.5 mm). A total of 116 PDT sessions were performed (mean, 1.5 sessions; range, 1.0-7.0 sessions). Standard duration PDT was used in most cases (83 seconds; n = 110/116 [95%]). Mean follow-up was 43 months. Of 79 patients, 49 (62%) demonstrated good visual acuity (≥20/40) and 30 (38%) showed intermediate to poor visual acuity (≤20/50) after PDT. A comparison (final visual acuity, good vs. intermediate to poor) revealed a statistically significant difference in baseline features of photopsia (100% vs. 0%; P = 0.04), initial visual acuity of 20/40 or better (77% vs. 23%; P < 0.001), mean tumor basal diameter (5.4 mm vs. 6.2 mm; P = 0.03), mean tumor thickness (2.9 mm vs. 3.2 mm; P = 0.01), cystoid macular edema (CME) involving the foveola (30% vs. 70%; P = 0.001), retinal edema overlying the lesion (39% vs. 61%; P = 0.003), retinoschisis involving the foveola (0% vs. 100%; P = 0.002), lack of CME regardless of foveola involvement at presentation (79% vs. 21%; P < 0.001), previous treatment (33% vs. 67%; P = 0.04), and CME progression after treatment (0% vs. 100%; P = 0.006). Partial or complete resolution of subretinal fluid was achieved in 93% of patients.
CONCLUSIONS
In this comparative analysis, PDT was an effective treatment method for circumscribed choroidal hemangioma. Good final visual outcome (≥20/40) was correlated with good baseline visual acuity, smaller tumor size, lack of CME, and lack of treatment before PDT.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Choroid Neoplasms; Female; Fluorescein Angiography; Hemangioma; Humans; Male; Middle Aged; Photochemotherapy; Photosensitizing Agents; Retrospective Studies; Tomography, Optical Coherence; Treatment Outcome; Verteporfin; Visual Acuity; Young Adult
PubMed: 32344158
DOI: 10.1016/j.oret.2020.04.018 -
Pediatric Neurology Jan 2022Visual snow syndrome (VSS) is a neurological disorder characterized by persistent positive visual disturbances. VSS is known to be a rare condition; however, it is... (Review)
Review
INTRODUCTION
Visual snow syndrome (VSS) is a neurological disorder characterized by persistent positive visual disturbances. VSS is known to be a rare condition; however, it is becoming increasingly recognized by neurologists and neuroophthalmologists. Despite this, it is not commonly described in pediatric patients.
METHODS
We describe a pediatric girl with onset of persistent visual phenomena at age 13 years, which she described as "TV static," with associated afterimages, photopsia, nyctalopia, and photophobia. These visual disturbances have persisted for two years.
RESULTS
The patient's MRI revealed approximately 15 T2/fluid-attenuated inversion recovery hyperintensities in keeping with changes secondary to migraine. The ophthalmologic examination did not reveal an underlying cause. The patient's visual symptoms have been resistant to medications.
CONCLUSION
VSS is a recently described syndrome that is debilitating to patients. Further case descriptions, characterization of presentation, and management of patients with VSS, specifically in pediatric cases, are required.
Topics: Adolescent; Female; Humans; Migraine Disorders; Vision Disorders
PubMed: 34736063
DOI: 10.1016/j.pediatrneurol.2021.08.005 -
Retinal Cases & Brief Reports May 2021Axitinib (Inlyta, New York, NY) is a kinase inhibitor indicated for the treatment of advanced renal cell carcinoma after failure of one previous systemic therapy. A case...
PURPOSE
Axitinib (Inlyta, New York, NY) is a kinase inhibitor indicated for the treatment of advanced renal cell carcinoma after failure of one previous systemic therapy. A case of bilateral retinal hemorrhages and cotton wool spots associated with axitinib is reported.
METHODS
A 62-year-old woman with a 4-year history of renal cell carcinoma with metastases was treated with axitinib at a maximum oral daily dose of 8 mg. Soon after beginning higher dose therapy, she developed blurred vision, floaters, and photopsias.
RESULTS
Funduscopic examination of both eyes revealed cotton wool spots and retinal hemorrhages that improved with cessation of therapy.
CONCLUSION
Axitinib may be associated with microangiopathic retinal toxicity.
Topics: Axitinib; Carcinoma, Renal Cell; Drug-Related Side Effects and Adverse Reactions; Female; Humans; Kidney Neoplasms; Middle Aged; Protein Kinase Inhibitors; Retina; Retinal Hemorrhage; Visual Acuity
PubMed: 30015771
DOI: 10.1097/ICB.0000000000000771 -
Retinal Cases & Brief Reports May 2023To evaluate a patient with multiple evanescent white dot syndrome with multimodal imaging including high-resolution spectral-domain optical coherence tomography.
PURPOSE
To evaluate a patient with multiple evanescent white dot syndrome with multimodal imaging including high-resolution spectral-domain optical coherence tomography.
METHODS
The patient was evaluated with wide-field color and autofluorescence imaging, microperimetry, and near-infrared imaging. Spectral-domain optical coherence tomography was performed using an instrument capable of 3- μ m axial resolution, the high-resolution Heidelberg Spectralis.
RESULTS
A 28-year-old woman developed photopsias and a scotoma in the field of vision of her left eye. She had multiple whitish spots with granularity in her fovea, consistent with the diagnosis of multiple evanescent white dot syndrome. She had supportive fluorescein angiographic and autofluorescence findings. Because of the high resolution and good layer contrast, it was possible to create en face slab images of the external limiting membrane, ellipsoid zone, interdigitation zone, and retinal pigment epithelium. The external limiting membrane showed no abnormalities. There were multiple regions of decreased reflectance in the ellipsoid zone slab but even more prominent changes in the interdigitation zone. The retinal pigment epithelium showed nearly no variation in layer reflectivity. With resolution of symptoms, the color and autofluorescence images returned to normal, the defects in the ellipsoid zone almost completely resolved, and the interdigitation zone continued to show abnormalities.
CONCLUSION
Although past studies concluded that the ellipsoid zone was the main region of involvement in multiple evanescent white dot syndrome, high-resolution spectral-domain optical coherence tomography suggests the interdigitation zone was more prominently affected in this case.
Topics: Female; Humans; Adult; Tomography, Optical Coherence; Retina; Retinal Diseases; White Dot Syndromes; Fovea Centralis; Fluorescein Angiography
PubMed: 34580246
DOI: 10.1097/ICB.0000000000001192 -
Archivos de La Sociedad Espanola de... Sep 2021A presentation is made of two cases of acute zonal occult outer retinopathy (AZOOR); one a young man of 19 years, and the other a 42-year-old woman. The young man...
A presentation is made of two cases of acute zonal occult outer retinopathy (AZOOR); one a young man of 19 years, and the other a 42-year-old woman. The young man complained of unilateral scotoma and photopsia. The woman presented with bilateral visual loss and photopsia. Multimodal imaging, including fundus photography, fluorescein angiography, fundus autofluorescence, spectral-domain optical coherence tomography, and visual field testing, supported the diagnosis of AZOOR. The differential diagnosis is complicated, since it has clinical features in common with other retinopathies. This means that it is essential to use modern imaging tests, especially those where the characteristic trizonal pattern is shown, such as in autofluorescence and OCT.
Topics: Adult; Female; Fluorescein Angiography; Humans; Male; Scotoma; Visual Acuity; White Dot Syndromes; Young Adult
PubMed: 34479708
DOI: 10.1016/j.oftale.2020.07.010 -
BMC Ophthalmology Nov 2022Acute annular outer retinopathy (AAOR) is an uncommon disease. To date, there are few documented cases in the literature. Our case report is the first to describe a case...
BACKGROUND
Acute annular outer retinopathy (AAOR) is an uncommon disease. To date, there are few documented cases in the literature. Our case report is the first to describe a case of acute annular outer retinopathy in a patient with invasive ductal breast carcinoma.
CASE PRESENTATION
The patient presented with photopsias and visual loss approximately 3 weeks prior to a diagnosis of invasive ductal breast carcinoma. We have documented the outer annular white ring seen in the acute phase of this disease and correlate it anatomically with Spectral-domain optical coherence tomography (SD-OCT) imaging. We identified RPE atrophy with nodular hyperreflectivity and loss of ellipsoid layer within the white annular ring with corresponding visual field loss. Fundus autofluorescence correlated with structural alterations seen on SD-OCT and showed both presumed active hyperautofluorescent zones with patchy hypoautofluorescent zones of atrophy and a classic annular hyperautofluorescent border. This case provides additional information about the natural history of this rare entity and its prognosis and varied presentation.
CONCLUSIONS
The authors report a single case of acute annular outer retinopathy in a patient with invasive ductal breast carcinoma with the corresponding SD-OCT, fundus autofluorescence and visual field findings, during the acute phase of the disease. These findings provide new insight into the characteristic features, etiology and progression of this rare disease.
Topics: Humans; Female; Fluorescein Angiography; Retinal Diseases; Tomography, Optical Coherence; Vision Disorders; Acute Disease; Atrophy; Breast Neoplasms
PubMed: 36434575
DOI: 10.1186/s12886-022-02647-w -
Case Reports in Ophthalmology 2020Appropriate medical management can be an alternative in those patients with submacular cysticercosis in whom achieving good visual outcome with vitreoretinal surgery is...
Appropriate medical management can be an alternative in those patients with submacular cysticercosis in whom achieving good visual outcome with vitreoretinal surgery is not possible. We report the case of a 25-year-old female who presented complaining of blurred vision in her left eye associated with photopsias and metamorphopsias of 3 months duration. Initial visual acuity in the right eye was 20/20 and 20/100 in the left eye. Upon indirect ophthalmoscopy in the left eye, a yellow-white, dome-shaped, elevated lesion with foveal involvement was observed. The rest of the ophthalmological examination proved normal. With clinical findings and images, submacular cysticercosis was diagnosed, and vitreoretinal surgery was suggested. Nevertheless, the patient did not accept the treatment; therefore, medical management was initiated. Central nervous system involvement was ruled out, and treatment with praziquantel and systemic prednisolone was initiated. Cysticercosis was resolved with significant improvement of her symptoms and visual acuity.
PubMed: 32774298
DOI: 10.1159/000508030 -
Case Reports in Ophthalmology 2021We report a case of morning glory disc anomaly in a young patient with tractional retinal detachment successfully repaired with complex pars plana vitrectomy, membrane...
We report a case of morning glory disc anomaly in a young patient with tractional retinal detachment successfully repaired with complex pars plana vitrectomy, membrane peel, laser, and oil tamponade. A 19-year-old female with a history of right morning glory disc anomaly associated with PAX6 gene mutation presented with floaters, photopsia, central scotoma, and visual acuity (VA) of 1/200. A complex macula-involving tractional retinal detachment centered around the optic nerve with a morning glory disc anomaly. Retinal detachment was treated with 25-gauge pars plana vitrectomy with difficult separation of the posterior hyaloid. Fibrous preretinal membranes were peeled, a temporal relaxing retinotomy was required, subretinal fluid was drained through a superonasal retinotomy during air-fluid exchange, endolaser was applied, and tamponade was achieved with 1,000-centistoke silicone oil. The retina remained attached at 1-year follow-up, with VA count fingers throughout. Morning glory disc is a rare congenital anomaly associated with PAX6 gene mutation that most often occurs unilaterally. It is rarely associated with tractional retinal detachment. Optimization of visual outcome is imperative despite a poor visual prognosis.
PubMed: 34177542
DOI: 10.1159/000516205