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British Journal of Hospital Medicine... Oct 2021Retinal detachments are a potentially sight-threatening ophthalmic emergency that may result in significant, irreversible vision loss. The risk of developing retinal...
Retinal detachments are a potentially sight-threatening ophthalmic emergency that may result in significant, irreversible vision loss. The risk of developing retinal detachment increases with advancing age, myopia and trauma. Pre-existing retinal degenerations can precipitate a pre-detachment symptomatic period of photopsia or floaters, allowing clinicians to intervene early and prevent detachments. Novel imaging techniques, such as spectral-domain optical coherence tomography, and well-established topographic modalities, such as B scan, can help to elucidate the type of detachment and any underlying causes, and help with surgical management. The overarching goal of treatment is to identify and seal all retinal holes, relieve vitreoretinal traction and prevent further recurrence. Prompt prophylactic retinopexy of retinal holes and tears is crucial in preventing retinal detachment, the main treatments of which are pars plana vitrectomy, tamponading agents and silicone scleral buckle.
Topics: Humans; Retinal Detachment; Retinal Perforations; Scleral Buckling; Treatment Outcome; Vitrectomy
PubMed: 34726948
DOI: 10.12968/hmed.2021.0145 -
Journal of Neuro-ophthalmology : the... Mar 2022Syphilis is an uncommon cause of optic nerve head edema; however, differentiating syphilis from other etiologies of optic nerve head swelling may be challenging. We...
BACKGROUND
Syphilis is an uncommon cause of optic nerve head edema; however, differentiating syphilis from other etiologies of optic nerve head swelling may be challenging. We describe 4 cases of ocular syphilis presenting with swollen optic nerve head(s) without overt signs of intraocular inflammation to better define the phenotypic presentation of this condition to allow its early recognition and treatment and discuss potential pathophysiological mechanisms of syphilitic optic neuropathy.
METHODS
Retrospective case series of patients presenting to a tertiary neuro-ophthalmology practice with a swollen optic nerve head(s) but no overt signs of intraocular inflammation, which was eventually determined to be secondary to syphilis.
RESULTS
Four patients were included in the study. The mean age was 43 years, 2 were women and 2 had bilateral involvement. Two patients had a recent history of skin rash, and one patient was investigated for abdominal pain and elevated liver enzymes. Two patients presented with photopsias and preserved visual function, whereas 2 presented with vision loss. Although chorioretinitis was present in all cases, it was very subtle in all and was only appreciated on fundus autofluorescence (FA) in 3 of 4 cases. Three patients demonstrated evidence of optic perineuritis on neuro-imaging. All patients were treated with a course of intravenous penicillin with a variable degree of visual recovery.
CONCLUSIONS
Systemic symptoms are common in patients with syphilic optic neuropathy. Optic disc edema as a manifestation of syphilis is usually accompanied by subtle chorioretinitis, which is best appreciated on FA. Optic perineuritis is common in patients with syphilitic optic neuropathy, with its pathophysiology likely similar to meningitis seen in neurosyphilis.
Topics: Adult; Chorioretinitis; Female; Humans; Inflammation; Male; Optic Nerve Diseases; Papilledema; Retrospective Studies; Syphilis; Vision Disorders
PubMed: 34629401
DOI: 10.1097/WNO.0000000000001302 -
Survey of Ophthalmology 2011Acute zonal occult outer retinopathy (AZOOR) is a rare unilateral or bilateral disease of unknown etiology characterized by focal degeneration of photoreceptors. A total... (Review)
Review
Acute zonal occult outer retinopathy (AZOOR) is a rare unilateral or bilateral disease of unknown etiology characterized by focal degeneration of photoreceptors. A total of 131 cases of AZOOR (205 eyes), including the variant known as acute annular outer retinopathy, have been reported in the English language literature. In this group of predominantly white individuals, average age at presentation was 36.7 years, and the male:female ratio was 1:3.2. The majority of patients complained of the acute onset of a scotoma, which was associated with photopsia. Visual acuity was 20/40 or better in 74% of tested eyes, and fundus examination was unremarkable in 76% of eyes. Blind spot enlargement, with or without other field defects, was observed in 75% of the visual fields examined, and electroretinographic abnormalities were recorded in 99% of patients tested. Typically patients retained good visual acuity, although retinal pigment epithelial disturbances commonly developed over time. It was unusual for visual field loss to continue beyond six months. Various treatments have been attempted in patients with AZOOR--including systemic corticosteroids, other systemic immunosuppressive agents, and different antimicrobials--but none have been proven effective.
Topics: Adult; Diagnosis, Differential; Diagnostic Imaging; Female; Humans; Male; Scotoma; White Dot Syndromes
PubMed: 21056448
DOI: 10.1016/j.survophthal.2010.07.004 -
Transactions of the American... 1948
Topics: Atrophy; Disabled Persons; Humans; Light; Optic Nerve; Vision, Ocular
PubMed: 18124019
DOI: No ID Found -
Klinische Monatsblatter Fur... May 1998Photopsias are unformed luminous spontaneous visual hallucinations, often described as flickering or wiggling lights, sometimes like a glare. Phosphenes are more intense...
BACKGROUND
Photopsias are unformed luminous spontaneous visual hallucinations, often described as flickering or wiggling lights, sometimes like a glare. Phosphenes are more intense and of shorter duration whereas migraine fortifications have a specific time course and succession of events. Recognition of this symptom is often poor, hence patients are wrongly investigated.
PURPOSE
To describe the clinical presentation and electroretinographic characteristics of patients with photopsias.
METHODS
4 patients were worked-up with clinical, psychophysical, angiographic and electroretinographic examinations.
RESULTS
Despite normal fundus and angiographic examinations, full-field electroretinogram was diagnostic in all cases. Retinal dysfunction involved either inner or outer retina. Paraneoplastic, and probable autoimmune/inflammatory retinopathies were found in our cases.
CONCLUSION
Photopsias are often secondary to sick retinal cells. In the presence of photopsias, investigations should be directed towards the retina and electroretinography is the gold standard. Recognition of the symptom should prevent useless and potentially harmful investigations for the patient.
Topics: Diagnosis, Differential; Electroretinography; Female; Hallucinations; Humans; Light; Middle Aged; Perceptual Disorders; Phosphenes; Retina; Retinal Diseases; Visual Acuity; Visual Fields
PubMed: 9677589
DOI: 10.1055/s-2008-1034916 -
Indian Journal of Ophthalmology Jul 2024Acute Zonal Occult Outer Retinopathy (AZOOR) is characterized by sudden visual impairment, often presenting with scotoma and photopsia in young to middle-aged adults,... (Review)
Review
Acute Zonal Occult Outer Retinopathy (AZOOR) is characterized by sudden visual impairment, often presenting with scotoma and photopsia in young to middle-aged adults, showing a female predominance. This condition, distinct from genetic disorders like retinitis pigmentosa, lacks a hereditary basis and exhibits unique fundus changes and imaging features indicative of outer retinal dysfunction. Recent advancements have broadened our understanding, identifying variants like Acute Annular Outer Retinopathy (AAOR) and Multizonal outer retinopathy and retinal pigment epitheliopathy (MORR), each with specific clinical presentations and imaging characteristics. The diagnosis of AZOOR and its variants primarily relies on excluding other conditions through comprehensive evaluation, including imaging and serological testing. Treatment approaches, including the use of corticosteroids and immunosuppressives, remain debated, with some evidence suggesting benefits in the early stages. The prognosis of AZOOR varies, with most patients experiencing stabilization, although complications like choroidal neovascularization may occur, requiring targeted therapy. This manuscript elucidates the complexity of AZOOR, emphasizing the necessity of high clinical suspicion and the role of advanced imaging in diagnosis and management.
Topics: Humans; White Dot Syndromes; Scotoma; Tomography, Optical Coherence; Fluorescein Angiography; Fundus Oculi; Visual Acuity; Visual Fields; Electroretinography
PubMed: 38454854
DOI: 10.4103/IJO.IJO_3228_23 -
Obstetrical & Gynecological Survey Apr 2012This review aims to summarize existing information concerning visual disturbances in (pre) eclampsia that have been described in the literature. Preeclampsia is one of... (Review)
Review
UNLABELLED
This review aims to summarize existing information concerning visual disturbances in (pre) eclampsia that have been described in the literature. Preeclampsia is one of the leading causes of maternal and fetal morbidity and mortality worldwide. Visual disturbances in (pre)eclampsia seem to be frequent phenomena. Therefore, the obstetrician/gynecologist may encounter women with serious, and sometimes debilitating, pathology of the visual pathways. Established ophthalmic entities associated with (pre)eclampsia are cortical blindness, serous retinal detachment, Purtscher-like retinopathy, central retinal vein occlusions, and retinal or vitreous hemorrhages. Ensuing visual symptoms include blurry vision, diplopia, amaurosis fugax, photopsia, and scotomata, including homonymous hemianopsia. In general, aside from lowering the blood pressure and preventing (further) seizures with magnesium sulfate, no specific therapy seems indicated for (pre)eclamptic women who experience visual changes. Although in most cases visual acuity returns to normal within weeks to months after the onset of symptoms, rarely permanent visual impairment can occur. Health care providers such as emergency room physicians, obstetricians, family physicians, neurologists, and ophthalmologists should be aware that acute onset of visual symptoms in pregnant women can be the first sign of (pre)eclampsia. Given that visual changes are a diagnostic criterion for severe preeclampsia, obstetricians should appreciate the significance of these changes and discuss appropriate diagnostic options with the ophthalmologist. Affected women can be reassured that most cases are transient.
TARGET AUDIENCE
Obstetricians and gynecologists, ophthalmologists, neurologists, family physicians, emergency room physicians
LEARNING OBJECTIVES
After completing this CME activity, obstetricians and gynecologists should be better able to classify visual disturbances at an early stage during pregnancy, interpret acute onset of visual disturbances as the first sign of preeclampsia, and evaluate possible residual visual symptoms during follow-up.
Topics: Blindness, Cortical; Female; Humans; Pre-Eclampsia; Pregnancy; Prognosis; Retinal Detachment; Retinal Hemorrhage; Retinal Vein Occlusion; Vision Disorders; Vitreous Hemorrhage
PubMed: 22495060
DOI: 10.1097/OGX.0b013e318250a457 -
Journal of Vascular Surgery Nov 2011Amaurosis fugax is a manifestation of retinal ischemia, commonly described in the setting of carotid atherosclerotic disease. Thromboembolic, and less frequently,...
Amaurosis fugax is a manifestation of retinal ischemia, commonly described in the setting of carotid atherosclerotic disease. Thromboembolic, and less frequently, hemodynamic mechanisms have been described as responsible for producing negative symptoms of transient monocular vision loss during periods of wakefulness. We report an unusual presentation in which the patient became symptomatic during sleep. Initially, photopsias-positive symptoms were experienced, which caused the patient to awaken; this was immediately followed by transient monocular vision loss. Carotid endarterectomy was curative.
Topics: Aged, 80 and over; Amaurosis Fugax; Carotid Stenosis; Endarterectomy, Carotid; Female; Hemodynamics; Humans; Sleep; Treatment Outcome; Ultrasonography
PubMed: 21723066
DOI: 10.1016/j.jvs.2011.04.059 -
American Journal of Ophthalmology Case... Jun 2022To report a patient who developed a cancer associated retinopathy (CAR) like syndrome in the setting of pembrolizumab and lenvatinib combination therapy for metastatic...
PURPOSE
To report a patient who developed a cancer associated retinopathy (CAR) like syndrome in the setting of pembrolizumab and lenvatinib combination therapy for metastatic endometrial carcinoma. Symptoms resolved with normalization of objective functional tests following cessation of medications.
OBSERVATIONS
A 52-year-old female with history of endometrial carcinoma, managed with pembrolizumab infusions and daily oral lenvatinib treatment for 18 months, presented to a tertiary eye center with complaints of nyctalopia, photosensitivity and photopsia. Further investigations revealed a reduction in b-wave amplitude on full field ERG (ffERG), a mild color vision deficit, and positive antiretinal antibodies against carbonic anhydrase II, enolase and arrestin. A preliminary diagnosis of CAR was made. One month following diagnosis, the patient discontinued both lenvatinib and pembrolizumab and subsequently reported significant improvement in her eye symptoms and vision. Repeat ffERG had normalized with a robust b-wave, with an improvement noted on repeat color vision testing. A presumed diagnosis of immunotherapy-induced retinopathy was made, with clinical findings mimicking CAR.
CONCLUSIONS AND IMPORTANCE
Pembrolizumab and lenvatinib treatment may be associated with a reversible retinopathy, with presentation very similar to CAR.
PubMed: 35265774
DOI: 10.1016/j.ajoc.2022.101449