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American Journal of Ophthalmology Case... Jun 2019To report a case of presumed choroidal metastasis from soft tissue myoepithelial carcinoma and highlight challenges in its diagnosis.
PURPOSE
To report a case of presumed choroidal metastasis from soft tissue myoepithelial carcinoma and highlight challenges in its diagnosis.
OBSERVATIONS
A 52-year-old man was referred with a two-week history of photopsia in his left eye. His background medical history included known soft tissue myoepithelial carcinoma metastatic to his bone, lung, liver and chest wall. A large, raised, yellow choroidal lesion was identified nasal to and abutting the optic disc. This lesion demonstrated growth 1 month after presentation. The patient died with widespread metastatic disease 5 months after initial presentation.
CONCLUSION AND IMPORTANCE
Soft tissue myoepithelial carcinoma can rarely metastasise to the choroid and present as a rapidly-growing, yellow, echodense tumour with serous retinal detachment. MRI brain can assist in tumour evaluation and monitoring progression, while immunoperoxidase stains and molecular testing can assist with diagnosis. The condition has an aggressive natural history and poor prognosis.
PubMed: 30886937
DOI: 10.1016/j.ajoc.2019.02.009 -
Neuro-ophthalmology (Aeolus Press) Feb 2019A 73-year-old female with a past medical history of breast cancer, who 10 years earlier experienced complete remission, complained of bilateral visual field...
A 73-year-old female with a past medical history of breast cancer, who 10 years earlier experienced complete remission, complained of bilateral visual field disturbances and photopsia, 2 months prior. Tumour recurrence and metastatic lesions were not found during the medical examination, but antibodies against recoverin were detected in her serum. Despite immunosuppressive treatment with prednisolone and plasmapheresis, rapid and diffuse degeneration of the patient's photoreceptors and deterioration of her visual field were observed. This is a rare case of cancer-associated retinopathy with a long interval (10 years) between the diagnosis of the malignancy and visual loss.
PubMed: 30723523
DOI: 10.1080/01658107.2018.1460761 -
BMC Ophthalmology Dec 2018To report a case of multiple evanescent white dot syndrome (MEWDS) following simultaneous rabies vaccination.
BACKGROUND
To report a case of multiple evanescent white dot syndrome (MEWDS) following simultaneous rabies vaccination.
CASE PRESENTATION
Review of the clinical, laboratory, photographic, optical coherence tomographic (OCT), fundus autofluorescent, angiographic, electrophysiologic, and perimetric records of a patient suffering from MEWDS.
RESULTS
A healthy 33-year-old Chinese female suffering from rapidly progressive visual loss of her left eye associated with photopsia and a para-central scotoma, seven days after receiving simultaneous rabies vaccination. Both anterior segments and fundus examination were unremarkable. The findings on OCT, electrophysiology, and perimetry were pathognomonic for MEWDS.
CONCLUSIONS
The clinical presentation and the benign course were consistent with the diagnosis of MEWDS. No other events could be identified as a cause, other than the rabies vaccination. This case may suggest an autoimmune basis for MEWDS in predisposed patients.
Topics: Adult; Female; Humans; Rabies Vaccines; Retinal Diseases; Scotoma
PubMed: 30526550
DOI: 10.1186/s12886-018-0968-y -
Agri : Agri (Algoloji) Dernegi'nin... Oct 2018Photopsia, fortification spectra, and the slow propagation of a scintillating scotoma across the visual field are typical diagnostic features of the visual aura of...
Photopsia, fortification spectra, and the slow propagation of a scintillating scotoma across the visual field are typical diagnostic features of the visual aura of migraine. In the vast majority of cases, the diagnosis can be made without the need for further investigations. Herein, we report three consecutive cases with an astrocytoma and discuss clinical features of migraine-like visual aura.
Topics: Adult; Astrocytoma; Brain Neoplasms; Diagnosis, Differential; Electroencephalography; Female; Frontal Lobe; Humans; Magnetic Resonance Imaging; Male; Migraine with Aura; Occipital Lobe; Young Adult
PubMed: 30403276
DOI: 10.5505/agri.2017.77598 -
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 -
Indian Journal of Ophthalmology Nov 2018A 44-year-old female presented with central vision loss and photopsia in both eyes since 2 months. Multimodal imaging, field defects, electroretinogram abnormalities,...
A 44-year-old female presented with central vision loss and photopsia in both eyes since 2 months. Multimodal imaging, field defects, electroretinogram abnormalities, and spectral domain optical coherence tomography changes were all suggestive of acute zonal occult outer retinopathy. En-face optical coherence tomography angiography (OCTA) images demonstrated hyper-reflective dots at the level of ellipsoid zone in both eyes in the presence of normal retinochoroidal vasculature. The patient was started on oral azathioprine and prednisolone. On two consecutive monthly follow-ups, en-face OCTA images demonstrated serial changes in the hyper-reflective dot morphology at ellipsoid zone level that have not been previously reported in the literature.
Topics: Adult; Female; Fluorescein Angiography; Fundus Oculi; Humans; Multimodal Imaging; Reproducibility of Results; Retina; Scotoma; Tomography, Optical Coherence; Visual Acuity; White Dot Syndromes
PubMed: 30355889
DOI: 10.4103/ijo.IJO_966_18 -
The Kaohsiung Journal of Medical... Oct 2018
Topics: Adult; Chordoma; Humans; Magnetic Resonance Imaging; Male; Optic Chiasm; Sphenoid Sinus; Vision Disorders; Visual Fields
PubMed: 30309489
DOI: 10.1016/j.kjms.2018.03.003 -
JAMA Ophthalmology Dec 2018Early detection of choroidal melanoma at a small tumor size is emphasized in the literature. However, there is little published information on the specific risks of...
IMPORTANCE
Early detection of choroidal melanoma at a small tumor size is emphasized in the literature. However, there is little published information on the specific risks of plaque-irradiated small choroidal melanoma on visual acuity and metastasis.
OBJECTIVE
To analyze outcomes of plaque radiotherapy for small choroidal melanoma 3 mm in thickness or less.
DESIGN, SETTING, AND PARTICIPANTS
This retrospective noncomparative series at a tertiary referral center included 1780 consecutive patients who had received plaque radiotherapy treatment for small choroidal melanoma.
MAIN OUTCOMES AND MEASURES
Visual acuity outcomes and melanoma-associated metastasis, assessed by Kaplan-Meier analyses.
RESULTS
The mean (SD) patient age at melanoma diagnosis was 58 (14) years. Of 1780 patients, 908 were female (51.0%), and 1752 were white (98.4%). Visual acuity was 20/40 OU or better in 1276 of the patients (71.7%), and the mean (SD) visual acuity was 20/40 (20/50) OU (median, 20/30; range, 20/20 to counting fingers). The mean (SD) tumor basal dimension was 8.8 (2.9) mm (median, 8.0 mm; range, 2.0-20.0 mm) and mean (SD) tumor thickness was 2.6 (0.5) mm (median, 2.7; range, 0.2-3.4 mm). Mean (SD) distance to the foveola was 3.4 (3.9) mm and to the optic disc was 3.7 (3.7) mm. The Kaplan-Meier rate of visual acuity loss (≥3 Snellen lines) was 9.5% (95% CI, 8.2%-11.0%) at 1 year, 39.2% (95% CI, 36.5%-42.0%) at 5 years, and 48.9% (95% CI, 45.6%-52.3%) at 10 years, whereas poor visual acuity (≤20/200) was 7.1% (95% CI, 5.9%-8.4%) at 1 year, 38.2% (95% CI, 35.5%-41.1%) at 5 years, and 53.5% (95% CI, 50.1%-57.1%) at 10 years. Regarding melanoma-associated metastasis, the rate was 0.2% (95% CI, 0.09%-0.6%) at 1 year, 4.5% (95% CI, 3.4%-5.9%) at 5 years, and 8.8% (95% CI, 6.9%-11.1%) at 10 years. Using 1.0-mm thickness increments, the 10-year risk for metastasis was 25.0% (95% CI, 3.9%-87.2%) at 0-mm to 1.0-mm thickness, 5.9% (95% CI, 2.5%-13.5%) at 1.1-mm to 2.0-mm thickness, 8.1% (95% CI, 5.9%-11.0%) at 2.1-mm to 3.0-mm thickness, and 13.4% (95% CI, 8.7%-20.4%) at thicknesses greater than 3.0 mm. The greater relative risk (RR) for metastasis in thinnest tumors was 1.83 (95% CI, 1.09-3.07), which likely represented more aggressive diffuse (flat) melanoma. By multivariable analysis, clinical features predictive of melanoma-associated metastasis included increasing patient age (RR, 1.32 [95% CI, 1.07-1.63] per decade; P = .01), tumor diameter (RR, 1.15 [95% CI, 1.06-1.24] per mm; P < .001), tumor thickness (RR, 2.22 [95% CI, 1.22-4.05] per mm; P = .01), photopsia symptoms (RR, 2.45 [95% CI, 1.35-4.43]; P = .003), and prior treatment before plaque radiotherapy (RR, 3.31 [95% CI, 1.31-8.33]; P = .01).
CONCLUSIONS AND RELEVANCE
This retrospective study suggests that small choroidal melanoma treated with plaque radiotherapy has a 10-year risk for visual acuity loss of 48.9% (95% CI, 45.6%-52.3%) and a 10-risk of systemic metastasis of 8.8% (95% CI, 6.9%-11.1%). In this analysis, each millimeter of increasing thickness and diameter contributed risk for metastatic disease.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Brachytherapy; Child; Choroid; Choroid Neoplasms; Female; Fluorescein Angiography; Follow-Up Studies; Fundus Oculi; Humans; Male; Melanoma; Middle Aged; Neoplasm Metastasis; Neoplasm Staging; Retrospective Studies; Time Factors; Tomography, Optical Coherence; Treatment Outcome; Visual Acuity; Young Adult
PubMed: 30267070
DOI: 10.1001/jamaophthalmol.2018.3881 -
Indian Journal of Ophthalmology Sep 2018Acute zonal occult outer retinopathy (AZOOR) is a retinal disease characterized by a slow onset loss of retinal function with minimally evident fundus changes. Patients...
Acute zonal occult outer retinopathy (AZOOR) is a retinal disease characterized by a slow onset loss of retinal function with minimally evident fundus changes. Patients with AZOOR present with initially progressive scotoma and photopsia. Its pathogenesis has not been definitively determined as of yet. Characteristically, the extent of the visual field defect is unexplained by fundus examination, but there is marked retinal dysfunction, which is evident on multimodal imaging and electrophysiological testing. We herein describe multimodal imaging signatures of AZOOR, in a patient of Indian origin, highlighting the hitherto unreported multicolor channels and near-infrared autofluorescence.
Topics: Adult; Electroretinography; Fluorescein Angiography; Fundus Oculi; Humans; Male; Multimodal Imaging; Retina; Scotoma; Tomography, Optical Coherence; Visual Acuity; White Dot Syndromes
PubMed: 30127169
DOI: 10.4103/ijo.IJO_264_18 -
Ophthalmology and Therapy Dec 2018To present a case of an epithelial inclusion cyst masquerading as an inadvertent bleb in a patient with Marfan syndrome.
INTRODUCTION
To present a case of an epithelial inclusion cyst masquerading as an inadvertent bleb in a patient with Marfan syndrome.
CASE REPORT
A woman with Marfan syndrome presented with a subluxed crystalline lens in her right eye, which progressively subluxed over the following 2 years. A lensectomy was performed with placement of an anterior chamber intraocular lens (IOL); however, the patient experienced blurred vision and photopsias and preferred IOL explantation. The IOL was removed and a scleral-fixated posterior chamber IOL was placed. Vision improved with an uncomplicated postoperative course. Five months later, the patient experienced sudden onset redness and sharp pain in this eye. A 3-mm cystic lesion with tan material was found over a prior scleral incision site. Intraocular pressure was normal and no aqueous leaked from the lesion. Owing to concerns of an infected inadvertent bleb, treatment with topical and oral antibiotics was started, but the lesion did not change in appearance and the patient experienced persistent pain. The lesion was surgically excised and histopathology revealed a conjunctival epithelial inclusion cyst with intralesional keratin. A month later, another conjunctival inclusion cyst developed and was excised per patient preference.
CONCLUSION
Marfan syndrome is characterized by defects in the FBN1 gene and may theoretically lead to an abnormal sclera, increasing the risk of bleb formation after scleral incision. Distinguishing between a filtering bleb and an epithelial inclusion cyst is critical in patient care. Although retained keratin from a cyst may mimic a bleb with purulence, intraocular pressure, aqueous leakage, and response to topical antibiotics may help distinguish between the two.
PubMed: 30117112
DOI: 10.1007/s40123-018-0142-x