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Cureus Sep 2022A 58-year-old man with recently diagnosed coccidioidal meningitis presented to the ED with a five-day history of headache, photopsia, blurred vision, and worsening...
A 58-year-old man with recently diagnosed coccidioidal meningitis presented to the ED with a five-day history of headache, photopsia, blurred vision, and worsening encephalopathy. His coccidioidal meningitis had responded well to fluconazole therapy, but three weeks later, he developed acute symptomatic worsening. Unfortunately, his clinical worsening coincided with Arizona's worst seasonal West Nile Virus (WNV) outbreak. He was ultimately found to have WNV neuroinvasive disease. Concurrent coccidioidal and WNV neuroinvasive diseases have not been described in the literature. Fortunately, he improved quickly to his normal baseline without neurologic deficits with supportive therapy for his WNV neuroinvasive disease and remains on lifelong antifungal therapy for coccidioidal meningitis.
PubMed: 36340535
DOI: 10.7759/cureus.29783 -
Frontiers in Neurology 2022Multiple evanescent white dot syndrome (MEWDS) usually manifests as photopsia, enlarged blind spots, scotomas, and blurred vision, which can be classified into positive...
PURPOSE
Multiple evanescent white dot syndrome (MEWDS) usually manifests as photopsia, enlarged blind spots, scotomas, and blurred vision, which can be classified into positive and negative visual phenomena. Visual snow and chromatopsia were rarely reported in these patients. Herein, we described two Chinese female patients with MEWDS who initially presented with visual snow, and one of them also had yellow-tinged vision.
METHODS
First, we performed the chart review of two patients. Second, we reviewed the English literature for all cases of MEWDS through PubMed until December 2021, using the terms "MEWDS" or "multiple evanescent white dot syndrome." We concluded on all the reported patients' demographic features and symptoms. The visual acuity of patients with/without positive or negative visual phenomena was compared through one-way ANOVA.
RESULTS
Patient 1: A 27-year-old Chinese woman experienced continuous visual snow and yellow-tinged vision in the right eye for a week. She noticed tiny white and black dots involving the entire visual field and shimmering light inferiorly. Patient 2: A 22-year-old Chinese woman complained of a gray area with continuous visual snow in the temporal visual field of the left eye for 5 days. The ocular examinations, including fundus autofluorescence (FAF), optical coherence tomography (OCT), and indocyanine green angiography (ICGA), confirmed the diagnosis of MEWDS. Their symptoms resolved spontaneously without treatment. We found 60 MEWDS case reports (147 cases) in PubMed. The mean age was 31.2 years old. The mean LogMAR best-corrected visual acuity was 0.35 ± 0.39 at the first visit and 0.01 ± 0.16 at the last visit. The most common symptoms included blurred vision (72.8%), enlarged blind spot (42.2%), photopsia (37.4%), and scotoma (33.3%). We found the patients with only positive visual phenomena had significantly worse visual acuity at the first and last visit than patients with only negative visual phenomena ( = 0.008) or the patients with both positive and negative visual phenomena ( = 0.026). Four cases similar to visual snow were discovered. Compared to the MEWDS patients without visual snow, the patients with visual snow tend to have a larger proportion of females ( = 0.005) and a better visual acuity at the first visit ( = 0.007).
CONCLUSION
Herein, we expand upon the clinical manifestations of MEWDS with visual snow, and the symptoms attributable to visual snow could precede the onset of MEWDS. Neurologists and ophthalmologists should carefully rule out occult chorioretinopathy before diagnosing visual snow syndrome.
PubMed: 36277919
DOI: 10.3389/fneur.2022.972943 -
Ophthalmology. Retina Mar 2023To report long-term outcomes of patients with asymptomatic retinal detachments (RDs) who did not undergo initial surgical intervention.
OBJECTIVE
To report long-term outcomes of patients with asymptomatic retinal detachments (RDs) who did not undergo initial surgical intervention.
DESIGN
Retrospective case series.
METHODS
A retrospective chart review of patients diagnosed with asymptomatic RD. Patients with symptoms of photopsias or a visual field defect at presentation were excluded.
PARTICIPANTS
Eighteen patients seen and evaluated at the Bascom Palmer Eye Institute between 2011 and 2021.
MAIN OUTCOME MEASURES
Best-corrected visual acuity (BCVA), presence or absence of progression of RD, and whether surgical intervention occurred during follow-up.
RESULTS
The study group included 18 patients (20 eyes). The mean follow-up duration was 5.1 years (range, 0-30 years). Risk factors included myopia (95%), lattice retinal degeneration (60%), and pseudophakia (5%). Most asymptomatic RDs were located in the inferotemporal quadrant (80%), followed by the superotemporal (15%) and inferonasal (5%). No RDs were confined to the superonasal quadrant. The majority (80%) extended posterior to the equator and were ≤ 3 clock hours in size (65%). Five (25%) patients were previously treated with prophylactic laser demarcation. Final BCVA was 20/40 or better in 19 (95%) eyes and between 20/40 and 20/200 in 1 (5%) eye. During the follow-up, 2 (10%) patients exhibited progression of their asymptomatic RD and underwent surgical intervention. Retinal pathology in fellow eyes was previously diagnosed or identified during follow-up in 14 (78%) of 18 patients, of which 2 (11%) patients had bilateral asymptomatic RDs.
CONCLUSIONS
Nonsurgical management with observation may be reasonable as an initial management strategy for asymptomatic patients with RDs in select cases.
FINANCIAL DISCLOSURE(S)
Proprietary or commercial disclosure may be found after the references.
Topics: Humans; Retinal Detachment; Retrospective Studies; Visual Acuity; Retina; Scleral Buckling
PubMed: 36162748
DOI: 10.1016/j.oret.2022.09.004 -
Journal of Clinical Medicine Sep 2022Acute idiopathic blind spot enlargement syndrome (AIBSES) is characterized by unilateral visual field loss in the blind spot area, acute onset photopsia, and...
Acute idiopathic blind spot enlargement syndrome (AIBSES) is characterized by unilateral visual field loss in the blind spot area, acute onset photopsia, and funduscopically few or no optic disc changes. AIBSES predominantly affects young adults and is often misdiagnosed as optic neuritis because of low awareness. Optical coherence tomography (OCT) has become the gold standard in diagnosing AIBSES as a disease of the outer retina. In our case series, we present three consecutive patients with AIBSES followed prospectively with and without steroid therapy. The patients, aged 25 to 27 years, presented in our neuroophthalmology department between 2020 and 2021. We report their disease course and management and discuss therapeutic options, as no well-established procedures exist. Common pitfalls and diagnostic errors are analysed. Two women and one man showed unilateral acute-onset photopsia and blind spot enlargement on perimetry without visual acuity reduction. Spectral domain OCT (Heidelberg Engineering, Heidelberg, Germany) revealed marked peripapillary changes in the ellipsoid zone and autofluorescence in all patients, corresponding to faint blurring of the optic disc margin. Characteristically, there was no P100 latency delay in the visual evoked potential in any of the patients. Two patients received weight-adapted oral prednisolone, which was gradually tapered over six to eight weeks. Two patients showed full recovery of their symptoms at six and seven months after onset, while mild defect healing was seen in one treated patient after 12 months. Follow-up OCT showed restoration of the outer retinal layers 6-12 months after disease onset. Careful history taking and an unprejudiced ophthalmological workup helps in diagnosing AIBSES in young adults with unilateral acute visual field defects. While its etiology is still unclear, accurate diagnosis of AIBSES can be made with peripapillary OCT. In our cases, the disease course of AIBSES was much better than its reputation. Early corticosteroid treatment may support outer retinal reorganisation, which can be followed with OCT in accordance with visual field restoration. This should be addressed in a prospective study.
PubMed: 36142923
DOI: 10.3390/jcm11185278 -
PloS One 2022Photopsia is a photic phenomenon that can be associated with intraocular lenses after cataract surgery. To calculate the relative light intensity of photic effects...
Photopsia is a photic phenomenon that can be associated with intraocular lenses after cataract surgery. To calculate the relative light intensity of photic effects observed after cataract surgery at the foveal region as the most sensitive region of the retina, photopsia was simulated using the ZEMAX optical design software. The simulations are based on the Liou-Brennan eye model with a pupil diameter of 4.5 mm and incorporating implanted IOLs. The hydrophilic IOLs implanted in the eye model have a power of 21 diopter (D) with an optic diameter of 6 mm and 7 mm. Four different intensity detectors are located in specific regions of the eye in this simulation. The ray-tracing analysis was carried out for variations of incident ray angle of 0° to 90° (temporally) in steps of 1°. Depending on the range of incident ray angle, the light intensity was detected at detectors located on the fovea, nasal side of the retina, or the edge surface of the IOLs. Some portion of the input light was detected at specific incident angles in the foveal region. By altering the IOLs edge design to a fully reflective or anti-reflective surface, the range over which the light intensity is detected on the fovea can be shifted. Additionally, with the absorbing edge design, no intensity was detected at the foveal region for incident ray angles larger than 5°. Therefore an absorbing edge design can make photic effects less disturbing for patients.
Topics: Cataract; Computer Simulation; Humans; Lenses, Intraocular; Light; Optics and Photonics; Prosthesis Design; Vision Disorders
PubMed: 35930598
DOI: 10.1371/journal.pone.0272705 -
International Journal of Molecular... Jul 2022Pathogenic variants in DNA-damage regulated autophagy modulator 2 gene () cause a rare autosomal recessive retinal dystrophy and its disease course is not well...
Pathogenic variants in DNA-damage regulated autophagy modulator 2 gene () cause a rare autosomal recessive retinal dystrophy and its disease course is not well understood. We present two Slovenian patients harboring a novel variant and a detailed review of all 23 other patients described to date. Whole exome and whole genome sequencing were performed in the two patients, and both underwent ophthalmological examination with a 2-year follow-up. PubMed was searched for papers with clinical descriptions of DRAM2 retinopathy. Patient 1 was homozygous for a novel variant, p.Met1?, and presented with the acute onset of photopsia and retina-wide retinopathy at the age of 35 years. The patient was first thought to have an autoimmune retinopathy and was treated with mycophenolate mofetil, which provided some symptomatic relief. Patient 2 was compound heterozygous for p.Met1? and p.Leu246Pro and presented with late-onset maculopathy at the age of 59 years. On review, patients with DRAM2 retinopathy usually present in the third decade with central visual loss, outer retinal layer loss on optical coherence tomography and a hyperautofluorescent ring on fundus autofluorescence. Either cone-rod or rod-cone dystrophy phenotype is observed on electroretinography, reflecting the importance of DRAM2 in both photoreceptor types. Non-null variants can result in milder disease.
Topics: Autoimmune Diseases; Cone-Rod Dystrophies; Electroretinography; Humans; Membrane Proteins; Mutation; Pedigree; Phenotype; Retinal Dystrophies; Tomography, Optical Coherence
PubMed: 35806404
DOI: 10.3390/ijms23137398 -
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 -
Arquivos Brasileiros de Oftalmologia 2022A 38-year-old woman presented with photopsias and progressive but painless loss of vision in her right eye. Of note, she had received the first dose of inactivated...
A 38-year-old woman presented with photopsias and progressive but painless loss of vision in her right eye. Of note, she had received the first dose of inactivated COVID-19 vaccine (Sinovac/China National Pharmaceutical Group) 2 weeks prior to the onset of symptoms. Ophthalmic evaluation revealed a wreath-like foveal pattern and multiple gray-white dots throughout the posterior pole associated with discrete vitreous inflammatory reaction. Multimodal imaging analysis confirmed a diagnosis of multiple evanescent white dot syndrome. The patient underwent treatment with corticosteroids and, over the following weeks, her visual acuity improved to standard pattern.
Topics: Adult; COVID-19; COVID-19 Vaccines; Female; Fluorescein Angiography; Humans; Retinal Diseases; Vaccination; White Dot Syndromes
PubMed: 35298582
DOI: 10.5935/0004-2749.20220070 -
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