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BMJ Case Reports Jan 2021A 49-year-old Asian Indian woman, with a previous history of biopsy proven stage IV primary lung adenocarcinoma with metastasis to liver, bones and central nervous...
A 49-year-old Asian Indian woman, with a previous history of biopsy proven stage IV primary lung adenocarcinoma with metastasis to liver, bones and central nervous system, presented with 1-month history of photopsia in right eye. She was on oral erlotinib since 6 months. Dilated fundus examination of right eye revealed a solitary dome-shaped brownish elevated lesion of approximately 1-disc diameter along the inferotemporal midperiphery with surrounding areas of hypopigmentation. Based on multimodal imaging, a diagnosis of resolved solitary unilateral choroidal metastasis from lung carcinoma in the right eye was made. In view of inactive and regressed choroidal metastasis, no intervention was mandated.
Topics: Adenocarcinoma; Antineoplastic Agents; Base Sequence; Biomarkers, Tumor; Choroid Neoplasms; Erlotinib Hydrochloride; Exons; Female; Genes, erbB-1; Humans; Incidental Findings; Lung Neoplasms; Middle Aged; Sequence Deletion
PubMed: 33462020
DOI: 10.1136/bcr-2020-238131 -
American Journal of Ophthalmology Case... Mar 2021We report a patient with unilateral symptoms presenting with bilateral multiple evanescent white dot syndrome (MEWDS) in order to highlight the utility of multimodal...
PURPOSE
We report a patient with unilateral symptoms presenting with bilateral multiple evanescent white dot syndrome (MEWDS) in order to highlight the utility of multimodal imaging in revealing asymptomatic lesions in the fellow eye and underscore the importance of looking for silent bilateral disease.
OBSERVATIONS
A 39-year-old man presented with blurry vision and photopsias in the left eye (OS). Funduscopic examination revealed characteristic granular white dots in the posterior pole OS. Multimodal imaging included fundus autofluorescence, which revealed numerous hyperautofluorescent lesions in both eyes, more than appreciated on clinical examination alone and corresponding ellipsoid disruption on OCT. Seven bilateral cases have been previously reported, all of which are asymmetric, similar to the case reported and are summarized here.
CONCLUSIONS AND IMPORTANCE
While MEWDS is most often thought of as a unilateral disease, it may rarely present bilaterally as in the case presented here. Multimodal imaging is especially useful in diagnosis and follow-up. Fundus autofluorescence may be the most sensitive and practical test for detecting MEWDS, revealing lesions in the absence of white dots on clinical exam.
PubMed: 33376834
DOI: 10.1016/j.ajoc.2020.101004 -
Acta Ophthalmologica Sep 2021Effectiveness of ocriplasmin for vitreomacular traction (VMT) varies depending on the presence of common ocular conditions and patient selection criteria. We carried out... (Meta-Analysis)
Meta-Analysis
PURPOSE
Effectiveness of ocriplasmin for vitreomacular traction (VMT) varies depending on the presence of common ocular conditions and patient selection criteria. We carried out a systematic literature review and meta-analysis of ocriplasmin studies conducted in real-world settings (RWS) and compared outcomes with those from randomized controlled trials (RCTs).
METHODS
We included prospective and retrospective studies from RWS documenting effectiveness of ocriplasmin in patients with VMT with or without MH, and RCTs of ocriplasmin versus control. Key end-points were vitreomacular adhesion resolution (VMAR), nonsurgical MH closure, need for vitrectomy and safety. We conducted meta-regression on pooled results to evaluate effects of baseline covariates and study design on outcomes.
RESULTS
Thirty RWS (2402 patients) and 5 RCTs (737 patients) were included epiretinal membrane (ERM) and broad VMA were more prevalent in RCTs. Primary VMAR, vitrectomy and MH closure rates were comparable between RWS and RCTs. Rates of nsVMAR were significantly higher in RWS than RCTs (odds ratio 1.66; 95% confidence interval [CI]: 1.18-2.34). nsVMAR rates were inversely associated with ERM prevalence (odds ratio 0.20; 95% CI: 0.08-0.51). Compared with the recent OASIS trial, RWS reported a higher incidence of new/worsening subretinal fluid cases and less photophobia, photopsia, vitreous floaters, electroretinogram abnormalities and MH progression.
CONCLUSIONS
Ocriplasmin was significantly more effective in achieving nsVMAR in RWS than in RCTs. Lower ERM prevalence in RWS was the single significant explanatory variable for this difference. Conclusions on ocriplasmin safety in RWS are limited due to inconsistent reporting.
Topics: Fibrinolysin; Humans; Intravitreal Injections; Peptide Fragments; Randomized Controlled Trials as Topic; Retinal Diseases; Tomography, Optical Coherence; Visual Acuity
PubMed: 33369248
DOI: 10.1111/aos.14686 -
Cureus Nov 2020Serologic tests for syphilis can be quite complex. The screening and confirmatory tests, which number at least eight, are mathematically interpreted as a total of 16...
Decomplexifying Serum and Cerebrospinal Fluid (CSF) Serologic Testing of Neurosyphilis: A Case Report of Ocular Syphilis and Highlights of the Principles of Serologic Testing.
Serologic tests for syphilis can be quite complex. The screening and confirmatory tests, which number at least eight, are mathematically interpreted as a total of 16 possible combinations, if we choose one test from each of two sets of four. However, this bewildering complexity is simplified if we apply certain principles. We reiterate and propose four axioms. First, we distinguish between treponemal versus non-treponemal tests. The former, the treponemal test, is specific for the spirochete, treponema pallidum, and is used as a confirmatory test. It rarely declines over time. The latter, the non-treponemal test, is a screening test and reflects treponemal or tissue damage, is reported as a titer, and is used to monitor disease activity. We usually need both for screening and confirmatory diagnostic testing. Secondly, for rapid plasma reagin (RPR) tests, a non-treponemal serology test titer of at least 1:8 is suggestive of syphilis, but not necessarily neurosyphilis. A false-negative test usually registers below this dilution level and may be due to the "prozone phenomenon". Serum RPR titers are usually greater than 1:32. Thirdly, a negative treponemal test in the cerebrospinal fluid excludes neurosyphilis and a positive test is highly sensitive but lacks specificity, usually due to blood contamination. Most patients with neurosyphilis will have a positive non-treponemal test in the cerebrospinal fluid (CSF) with elevated protein and pleocytosis. Fourthly, a serological cure is defined as at least a four-fold decline in a non-treponemal test titer at three and six months, or a persistently low titer after treatment. Patients who do not fulfill these criteria are known as "serofast". We describe the case of a 38-year-old man with human immunodeficiency virus-type 1 who developed bilateral optic disc edema with photopsias and transient visual obscurations.
PubMed: 33354477
DOI: 10.7759/cureus.11533 -
American Journal of Ophthalmology Case... Dec 2020The aim of this report is to describe a patient who presented with a central hyper-reflective line (HRL) with spectral domain-optical coherence tomography (SD-OCT) after...
PURPOSE
The aim of this report is to describe a patient who presented with a central hyper-reflective line (HRL) with spectral domain-optical coherence tomography (SD-OCT) after posterior vitreous detachment that evolved to full thickness macular hole (FTMH) with subsequent spontaneous resolution.
OBSERVATIONS
A 59-year-old patient presented with a history of photopsia and floaters followed by the development of a central scotoma in the right eye (OD). The left eye (OS) was normal. On examination, visual acuity (VA) was 20/20- OD and 20/20 OS. Retinal examination OD was remarkable for a retinal tear, and SD-OCT demonstrated a central HRL. The patient underwent laser retinopexy to barricade the retinal tear. Sequential SD-OCT of the macula was performed and the patient eventually developed a small FTMH 8 months after the baseline presentation. VA was correspondingly reduced to 20/80 OD. Upon return after 4 months, the hole was completely resolved with improvement of VA to 20/20 OD.
CONCLUSION
Vitreomacular traction (VMT) may lead to foveal dehiscence. This instability can be detected with SD-OCT as a vertical hyperreflective stress line that is a risk factor for progression to a FTMH. With release of VMT, FTMH can spontaneously close.
PubMed: 33195877
DOI: 10.1016/j.ajoc.2020.100950 -
BMJ Case Reports Nov 2020Cancer-associated retinopathy (CAR) belongs to the paraneoplastic retinopathy syndromes and manifests itself by rapidly progressive vision loss, scotoma and photopsia....
Cancer-associated retinopathy (CAR) belongs to the paraneoplastic retinopathy syndromes and manifests itself by rapidly progressive vision loss, scotoma and photopsia. We herein reported the case of a 77-year-old woman without a cancer history who presents typical CAR symptoms. A complete workup followed by lung biopsy enabled the detection of a pulmonary carcinoid tumour. Treatment of oral cortisone was then initiated with dramatic improvements in the symptoms.
Topics: Aged; Biopsy; Carcinoid Tumor; Diagnosis, Differential; Female; Fluorescein Angiography; Fundus Oculi; Humans; Lung Neoplasms; Paraneoplastic Syndromes, Ocular; Retina; Retinal Diseases
PubMed: 33139354
DOI: 10.1136/bcr-2020-235046 -
Genes Oct 2020A retrospective review of the clinical records of patients seen at the Oxford Eye Hospital identified as having mutations was performed. The data included symptoms,...
A retrospective review of the clinical records of patients seen at the Oxford Eye Hospital identified as having mutations was performed. The data included symptoms, best-corrected visual acuity, multimodal retinal imaging, visual fields and electrophysiology testing. Three participants were identified with biallelic pathogenic sequence variants detected using a targeted NGS gene panel, two of which were novel. Participant I was a Nepalese male aged 68 years, and participants II and III were white Caucasian females aged 69 and 10 years old, respectively. All three had childhood onset nyctalopia, a progressive decrease in central vision, and visual field loss. Patients I and III had photopsia, patient II had photosensitivity and patient III also had photophobia. Visual acuities in patients I and II were preserved even into the seventh decade, with the worst visual acuity measured at 6/36. Visual field constriction was severe in participant I, less so in II, and fields were full to bright targets targets in participant III. Electrophysiology testing in all three demonstrated loss of rod function. The three patients share some of the typical distinctive features of retinopathies, as well as a novel clinical observation of foveal ellipsoid thickening.
Topics: Aged; Child; Eye Diseases, Hereditary; Female; Humans; Male; Mutation; Night Blindness; Orphan Nuclear Receptors; Pedigree; Retinal Degeneration; Retinal Dystrophies; Retinitis Pigmentosa; Visual Fields
PubMed: 33138239
DOI: 10.3390/genes11111288 -
Indian Journal of Ophthalmology Nov 2020
Topics: Humans; Lung Neoplasms; Retinal Diseases; Vision Disorders
PubMed: 33120614
DOI: 10.4103/ijo.IJO_58_20 -
American Journal of Ophthalmology Case... Dec 2020To report a case of acute idiopathic blind spot enlargement syndrome (AIBSES) following influenza vaccination.
PURPOSE
To report a case of acute idiopathic blind spot enlargement syndrome (AIBSES) following influenza vaccination.
OBSERVATIONS
A 57-year old woman presented with a one-month history of photopsia, temporal visual field disturbance on the right eye, 11 days following the administration of the influenza virus vaccine. Visual acuity was 20/30, and color vision remained normal. Examination revealed mild venular dilation at the edge of the right optic disk and was otherwise unremarkable. Visual field testing revealed enlargement of the right physiological blind spot. Medical workup, including brain CT scan, brain MRI, RPR, antibodies, Chest X-Ray, ANA, and PPD testing, was found within normal limits. Ancillary testing was compatible with an assessment of AIBSES secondary to influenza virus vaccination.
CONCLUSIONS AND IMPORTANCE
Although direct causation may not be absolutely established by a single report, our case suggests that the influenza virus vaccine may serve as an immunological trigger for some cases of AIBSES. Thoughtful vaccination history is of the utmost importance when evaluating patients with AIBSES, as it may help elucidate the underlying precipitating factor. To our knowledge, this is the first reported case of AIBSES following influenza virus vaccination.
PubMed: 33083635
DOI: 10.1016/j.ajoc.2020.100949 -
Open Heart Oct 2020To determine the impact of ivabradine on outcomes important to patients with angina pectoris caused by coronary artery disease. (Meta-Analysis)
Meta-Analysis
Effects of adding ivabradine to usual care in patients with angina pectoris: a systematic review of randomised clinical trials with meta-analysis and Trial Sequential Analysis.
OBJECTIVE
To determine the impact of ivabradine on outcomes important to patients with angina pectoris caused by coronary artery disease.
METHODS
We conducted a systematic review. We included randomised clinical trials comparing ivabradine versus placebo or no intervention for patients with angina pectoris due to coronary artery disease published prior to June 2020. We used Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, Cochrane methodology, Trial Sequential Analysis, Grading of Recommendations Assessment, Development, and Evaluation, and our eight-step procedure. Primary outcomes were all-cause mortality, serious adverse events and quality of life.
RESULTS
We included 47 randomised clinical trials enrolling 35 797 participants. All trials and outcomes were at high risk of bias. Ivabradine compared with control did not have effects when assessing all-cause mortality (risk ratio [RR] 1.04; 95% CI 0.96 to 1.13), quality of life (standardised mean differences -0.05; 95% CI -0.11 to 0.01), cardiovascular mortality (RR 1.07; 95% CI 0.97 to 1.18) and myocardial infarction (RR 1.03; 95% CI 0.91 to 1.16). Ivabradine seemed to increase the risk of serious adverse events after removal of outliers (RR 1.07; 95% CI 1.03 to 1.11) as well as the following adverse events classified as serious: bradycardia, prolonged QT interval, photopsia, atrial fibrillation and hypertension. Ivabradine also increased the risk of non-serious adverse events (RR 1.13; 95% CI 1.11 to 1.16). Ivabradine might have a statistically significant effect when assessing angina frequency (mean difference (MD) 2.06; 95% CI 0.82 to 3.30) and stability (MD 1.48; 95% CI 0.07 to 2.89), but the effect sizes seemed minimal and possibly without any relevance to patients, and we identified several methodological limitations, questioning the validity of these results.
CONCLUSION
Our findings do not support that ivabradine offers significant benefits on patient important outcomes, but rather seems to increase the risk of serious adverse events such as atrial fibrillation and non-serious adverse events. Based on current evidence, guidelines need reassessment and the use of ivabradine for angina pectoris should be reconsidered.
PROSPERO REGISTRATION NUMBER
CRD42018112082.
Topics: Aged; Angina Pectoris; Cardiovascular Agents; Female; Humans; Ivabradine; Male; Middle Aged; Patient Safety; Quality of Life; Randomized Controlled Trials as Topic; Risk Assessment; Risk Factors; Treatment Outcome
PubMed: 33046592
DOI: 10.1136/openhrt-2020-001288