Unusual presentation of cornea verticillata with intravitreal methotrexate in a case of primary intraocular lymphoma

2022 ◽  
Vol 15 (1) ◽  
pp. e246911
Author(s):  
Nasiq Hasan ◽  
Harpreet Kaur Narde ◽  
Amit Kumar Das ◽  
Rohan Chawla
Keyword(s):  
Visual Acuity ◽  
Intraocular Lymphoma ◽  
Cell Type ◽  
Primary Intraocular Lymphoma ◽  
Indirect Ophthalmoscopy ◽  
Corneal Toxicity ◽  
Cornea Verticillata ◽  
The Right ◽  
Vitreous Biopsy

A 56-year-old woman presented with floaters and diminution of vision in the right eye for 1 week. On examination, visual acuity was 20/400 in the right eye and 20/60 in the left eye. Indirect ophthalmoscopy revealed vitritis in the right eye and subretinal deposits in both eyes. Vitreous biopsy of the right eye revealed large B-cell-type primary intraocular lymphoma and the patient underwent multiple intravitreal methotrexate injections (400 μg/0.1 mL) in the right eye and systemic chemotherapy for bilateral disease. Following biweekly injections of methotrexate, her visual acuity improved considerably from 20/400 to 20/60 with resolution of vitritis. However, following eighth dose of intravitreal methotrexate, she experienced visual decline to 20/120 along with photophobia, redness and watering. Whorl-shaped opacities, limbitis and corneal haze were noted on slit-lamp examination. Intravitreal methotrexate was stopped, and the patient was started on frequent topical lubricants, loteprednol, topical folinic acid and oral folic acid. Complete resolution of corneal toxicity was observed at 3 weeks and the injections were suspended as there was no recurrence at 6 months follow-up.

Evaluation and Management

2009 ◽  
Author(s):  
Daniel A. Brinton ◽  
Charles P. Wilkinson
Keyword(s):  
Visual Acuity ◽  
Retinal Detachment ◽  
Posterior Vitreous Detachment ◽  
Anterior Segment ◽  
Careful Examination ◽  
Ocular Motility ◽  
Vitreous Detachment ◽  
Indirect Ophthalmoscopy ◽  
Field Defect

Evaluation of a patient for retinal detachment includes a thorough history and a complete ocular exam, including measurement of visual acuity, external examination, ocular motility testing, testing of pupillary reactions, anterior-segment biomicroscopy, tonometry, and binocular indirect ophthalmoscopy with scleral depression. Posterior-segment biomicroscopy, perimetry, and ultrasonography are also sometimes required. Rhegmatogenous retinal detachment is a diagnosis generally made by clinical examination of the retina alone, but a full history, ocular examination, and sometimes selected ancillary tests are also important parts of the evaluation (Figure 4–1). The symptoms of retinal detachment include fl ashes of light, new floaters, visual Field defect, decreased visual acuity, metamorphopsia, and rarely, defective color vision. The perception of light fl ashes, or photopsia, is due to the production of phosphenes by pathophysiologic stimulation of the retina. The retina is activated by light but is also capable of responding to mechanical disturbances. In fact, the most common cause of light fl ashes is posterior vitreous detachment. As the vitreous separates from the retinal surface, the retina is disturbed mechanically, stimulating a sensation of light. This perception is more marked if there are focal vitreoretinal adhesions. Generally, vitreous separation is benign and may almost be regarded as normal in the senescent eye. In approximately 12% of symptomatic posterior vitreous detachments, however, a careful search of the periphery reveals a tear of the retina. If the fl ashes are associated with floaters, it is wise to assume that a retinal tear exists, until proved otherwise. These symptoms demand a prompt and careful examination of the periphery with binocular indirect ophthalmoscopy and scleral indentation. The patient’s localization of the photopsia is of little value in predicting the location of the vitreoretinal pathology. If no breaks are evident in the first examination after symptomatic vitreous detachment, they rarely appear at a later date. If there is no associated hemorrhage or other pathologic condition, the patient needs counseling only. However, if pigment or blood is detected in the vitreous, a follow-up examination is often required. It is prudent to forewarn patients about the symptoms of retinal detachment. Flashes alone or floaters alone are less significant than if they occur together, in which case they are more likely to be associated with a retinal break.

Primary intraocular lymphoma of T-cell type: report of a case and review of the literature

2004 ◽  
Vol 243 (3) ◽  
pp. 189-197 ◽  
Author(s):  
Sarah E. Coupland ◽  
Gerasimos Anastassiou ◽  
Norbert Bornfeld ◽  
Michael Hummel ◽  
Harald Stein
Keyword(s):  
T Cell ◽  
Intraocular Lymphoma ◽  
Review Of The Literature ◽  
Cell Type ◽  
Primary Intraocular Lymphoma

Unilateral Ectasia characterized by Advanced Diagnostic Tests

2016 ◽  
Vol 5 (1) ◽  
pp. 40-51 ◽  
Author(s):  
Bernardo Lopes ◽  
Marcella Q Salomão ◽  
Isaac C Ramos ◽  
Fernando Faria-Correia
Keyword(s):  
Visual Acuity ◽  
Femtosecond Laser ◽  
Diagnostic Tests ◽  
Diagnostic Methods ◽  
Distance Visual Acuity ◽  
Epithelial Thickness ◽  
Ring Segment ◽  
Intracorneal Ring Segment ◽  
The Right

ABSTRACT To describe a case of very asymmetric ectasia successfully treated by femtosecond laser-assisted intracorneal ring segment implantation, in which the diagnosis of unilateral ectasia in the right eye was based on the clinical findings including history, follow-up, and advanced diagnostic data. The patient's history was positive for ocular allergy with moderate- to-intense eye rubbing only in the right eye. The uncorrected distance visual acuity was 20/63 in the right eye and 20/32 in the left eye. The corrected distance visual acuity (CDVA) was 20/40 in the right eye (-1.75-4.00 × 35°) and 20/16 in the left eye (-0.50-0.25 × 115°). After femtosecond laser-assisted intracorneal ring segment implantation, the right eye improved CDVA to 20/20-1. Concerning ectasia/keratoconus diagnosis, the left eye remained stable over 1 year of follow-up with unremarkable topometric, tomographic, and biomechanical findings. Epithelial thickness mapping by spectral domain optical coherence tomography and very-high-frequency digital ultrasound demonstrated epithelial thickness within normal limits in the left eye. Advanced diagnostic methods along with clinical data enable the distinction from unilateral ectasia cases and subclinical (fruste) keratoconus. Literature review is also performed along with case presentation and discussion. How to cite this article Ramos IC, Reinstein DZ, Archer TJ, Gobbe M, Salomão MQ, Lopes B, Luz A, Faria-Correia F, Gatinel D, Belin MW, Ambrósio R Jr. Unilateral Ectasia characterized by Advanced Diagnostic Tests. Int J Kerat Ect Cor Dis 2016;5(1):40-51.

Macular Telangiectasia Type 2 With Spontaneous Resolution of Intraretinal/Sub-Internal Limiting Membrane Hemorrhage in the Absence of Neovascularization

2017 ◽  
Vol 1 (6) ◽  
pp. 415-419 ◽  
Author(s):  
Varun Chandra ◽  
Rohan Merani ◽  
Alex P. Hunyor ◽  
I-Van Ho ◽  
Mark Gillies
Keyword(s):  
Visual Acuity ◽  
Multimodal Imaging ◽  
Internal Limiting Membrane ◽  
Macular Telangiectasia ◽  
Corrected Visual Acuity ◽  
Visual Improvement ◽  
Macular Telangiectasia Type 2 ◽  
The Right

Purpose: To describe a case of macular telangiectasia type 2 (MacTel) presenting with decreased vision due to intraretinal/sub-internal limiting membrane (ILM) hemorrhage in the absence of neovascularization. Method: Clinical examination and multimodal imaging were performed. Results: A 65-year-old female presented with blurred left vision, recording 20/160 in that eye. There was intraretinal hemorrhage at the left macula centrally, with sub-ILM hemorrhage superiorly and inferiorly. Optical coherence tomography (OCT) showed no evidence of subretinal neovascularization. Imaging of the right macula was consistent with MacTel. The blood spontaneously cleared and the left visual acuity gradually improved to 20/25 by 4 months. Fluorescein angiography confirmed MacTel, and once the hemorrhage resolved, both inner and outer retinal cavitation was identified on OCT of the left macula. The left best-corrected visual acuity remained at 20/25 at 2-year follow-up. Conclusion: Spontaneous resorption of hemorrhage was accompanied by visual improvement.

scholarly journals Primary Intraocular Lymphoma in a Patient with Bilateral Epstein-Barr Virus Panuveitis: A Case Report

2021 ◽  
Author(s):  
Seyedeh Maryam Hosseini ◽  
Mojtaba Abrishami ◽  
Elham Barashki ◽  
Ghodsieh Zamani
Keyword(s):  
B Cell ◽  
Epstein Barr Virus ◽  
Cell Lymphoma ◽  
Antiviral Treatment ◽  
B Cell Lymphoma ◽  
Intraocular Lymphoma ◽  
Primary Intraocular Lymphoma ◽  
Barr Virus ◽  
Epstein Barr ◽  
The Right

Abstract Purpose: Herein, we report a case of primary intraocular lymphoma (PIOL) with the first presentation of bilateral Epstein-Barr virus (EBV)-associated panuveitis and retinitis.Case presentation: A 69-year-old male was referred with a three-day history of blurred vision and pain and redness in his left eye following cataract surgery. Ophthalmic examination revealed panuveitis, vitritis, and necrotizing retinitis with retinal hemorrhage. A month later, the right eye was also involved. Initially, the clinical diagnosis of acute retinal necrosis was made based on clinical manifestation; however, the partial response to intravenous and intravitreal antiviral treatment in the left eye and involvement of the right eye resulted in further investigation of masquerade syndromes. Polymerase chain reaction-based analysis of vitreous sample was positive for EBV, and cytological evaluation was compatible with the diagnosis of B-cell lymphoma. A significant improvement was observed following serial intravitreal rituximab and methotrexate injections. The central nervous system and lungs were involved after 6 months, and the patient expired despite treatment with systemic chemotherapy. Conclusion: There may be an association between EBV panuveitis and primary intraocular B-cell lymphoma.

scholarly journals Case Report: Phototherapeutic Keratectomy for Band Keratopathy Secondary to Chemo-Laser-Cryotherapy for Retinoblastoma

2021 ◽  
Vol 8 ◽  
Author(s):  
Ruoyan Wei ◽  
Meiyan Li ◽  
Weiming Yang ◽  
Haipeng Xu ◽  
Joanne Choi ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Corneal Thickness ◽  
Phototherapeutic Keratectomy ◽  
White Band ◽  
Corrected Distance Visual Acuity ◽  
Band Keratopathy ◽  
History Of ◽  
Distant Visual Acuity ◽  
The Right

Purpose: To report the clinical outcomes of phototherapeutic keratectomy (PTK) for pediatric band keratopathy after treatment for retinoblastoma.Methods: A 5-year-old boy presented with a 2-year history of poor visual acuity and a horizontal gray-white band across the central cornea in the right eye. He was diagnosed with band keratopathy after chemo-laser-cryotherapy for retinoblastoma. The band keratopathy was treated via PTK using the Mel-90 excimer laser with an optical treatment zone of 7.0 mm and ablation depth of 120 μm. The patient was followed at 1 week and 3 months postoperatively.Results: Surgery and postoperative follow-up were uneventful. At the 3-month follow-up, the uncorrected distant visual acuity of the right eye improved to 20/125, and the corrected distance visual acuity improved to 20/70 with a refraction of +10.00 D/−2.50 DC × 15. The clarity of the ablated area was evidently improved. The central corneal thickness decreases from 612 to 584 μm. The optical coherence tomography showed the thin band of hyperreflectivity in the ablated area disappeared, corneal transparency improved and the corneal surface smoothened.Conclusions: PTK is a safe and effective procedure to treat band keratopathy following treatment of retinoblastoma in children. Early intervention can reduce the risk of developing deprivation amblyopia.

scholarly journals Outcomes of intravitreal methotrexate to salvage eyes with relapsed primary intraocular lymphoma

2020 ◽  
pp. bjophthalmol-2020-317199
Author(s):  
Mona Mohammad ◽  
Richard M Andrews ◽  
P Nicholas Plowman ◽  
Gordon Hay ◽  
Amit K Arora ◽  
...  
Keyword(s):  
Systemic Chemotherapy ◽  
External Beam Radiotherapy ◽  
Case Series ◽  
Central Nervous System Lymphoma ◽  
Intraocular Lymphoma ◽  
Cystoid Macular Oedema ◽  
Primary Intraocular Lymphoma ◽  
Retrospective Case ◽  
Tumour Control

PurposeTo report the outcomes of intravitreal methotrexate (MTX) injections to rescue eyes with relapsed primary intraocular lymphoma (PIOL).MethodsRetrospective case series of patients with ocular relapse of PIOL who had initially received systemic chemotherapy (all five cases) and external beam radiotherapy (EBRT) to brain and orbits (two cases). Injections of MTX (400 µg/0.1 mL) were given one time per week for 1 month, every other week for 4 months, followed by a maintenance phase of one injection one time per month for 8 months (total of 20 injections in a year).ResultsFrom April 2008 to February 2016, there were nine eyes of five patients (three men; average age at first presentation 62 years) treated with our rescue protocol of intravitreal MTX injections. Ocular relapse occurred at a mean interval of 15 months (range 5–34 months) after the completion of initial systemic treatment. At mean follow-up of 31 months (range 5–104 months), tumour control was achieved in eight out of nine eyes (89%); one eye failed, with persistent retinal infiltrates despite increasing the frequency of injections, resulting in severe keratopathy. The only other complication occurred in one eye, developing cystoid macular oedema from MTX injections that resolved with topical anti-inflammatory medications and reduced frequency of MTX. There were no cases of reduced vision or ocular relapse, but two patients died (one of central nervous system lymphoma).ConclusionsIntravitreal MTX was a safe and effective treatment modality for relapsed PIOL after systemic chemotherapy and radiotherapy, achieving local tumour control in 89%, and hence represents an optimal choice. However, given the rare nature of PIOL, larger collaborative studies with longer follow-up are needed to corroborate this.

First Clinical Experience with Anti-myelin Oligodendrocyte Glycoprotein Antibody-Positive Optic Neuritis

2020 ◽  
Vol 237 (04) ◽  
pp. 458-463 ◽  
Author(s):  
Jan Heckmann ◽  
Margarita Todorova ◽  
Stefanie Müller ◽  
Philip Julian Broser ◽  
Veit Sturm
Keyword(s):  
Visual Acuity ◽  
Optic Neuritis ◽  
Pulse Therapy ◽  
Myelin Oligodendrocyte Glycoprotein ◽  
Individual Treatment ◽  
Igg Antibodies ◽  
Intravenous Methylprednisolone ◽  
Finger Counting ◽  
The Right

Abstract Background Antibodies against myelin oligodendrocyte glycoprotein (MOG-IgG) have been consistently found in a range of demyelinating disorders. In this context, MOG-IgG-associated optic neuritis (ON) has been suggested as a new subset of optic neuropathy. However, clinical manifestations and distinctive characteristics have only rarely been described. Patients and Methods A retrospective case series of three patients with MOG-IgG-associated ON. Clinical morphological features using imaging techniques are presented. Results Three patients (8-year-old boy, 28-year-old female, 48-year-old male) were included. An 8-year-old boy suffered from a bilateral ON with severe visual loss. The best-corrected visual acuity (BCVA) was 0.05 in the right eye and finger counting in the left eye. The patient had a previous episode of acute disseminated encephalomyelitis (ADEM) with a right abducens nerve palsy. Visual acuity recovered after repeated cycles of intravenous methylprednisolone pulse therapy and 10 cycles of plasma exchange. During the last follow-up, BCVA was 0.9 in the right eye and 0.8 in the left eye. A 28-year-old female presented with a bilateral ON. Her BCVA was 0.5 in the right eye and 0.8 in the left eye. She fully recovered with pulse methylprednisolone therapy (1000 mg/d) with tapering after the second cycle and had a BCVA of 1.0 during the last follow-up visit. A 48-year-old male suffered from a relapsing bilateral ON. At first presentation, BCVA was 0.1 in the right eye and finger counting in the left eye. BCVA fully recovered after each pulse therapy with intravenous methylprednisolone (two cycles). Since the first relapse, the patient has been receiving long-term immunosuppression with rituximab. Despite rituximab and low-dose oral prednisone, the patient had another relapse with a left ON. After a third cycle with intravenous methylprednisolone, he partially recovered. BCVA at last follow-up was 1.0 in the right and 0.8 in the left eye. Conclusions MOG-IgG antibodies have been identified in different acquired demyelinating syndromes. The patients reported had an ADEM followed by bilateral ON, an isolated bilateral ON, and a relapsing bilateral ON. Individual treatment strategies led to substantial visual recovery in all patients. We recommend inclusion of MOG-IgG antibodies in the diagnostic workup at least after the first recurrence of ON since they can serve as a diagnostic and potential prognostic tool and might lead to specific therapeutic recommendations.

Combined external and endoscopic transnasal approach with use of a diamond burr in the removal of a fishing harpoon hook traversing bilateral sphenoid sinuses in a 22-year-old man

2021 ◽  
Vol 14 (5) ◽  
pp. e239055
Author(s):  
Jan Alexeis Lacuata ◽  
Agnes Tirona - Remulla ◽  
Arsenio Claro Cabungcal ◽  
Romiena Mae Santos
Keyword(s):  
Visual Acuity ◽  
Sphenoid Sinus ◽  
Oral Antibiotics ◽  
Orbital Apex ◽  
Transnasal Approach ◽  
Endoscopic Transnasal Approach ◽  
Diamond Burr ◽  
The Right ◽  
Sphenoid Sinuses

A 22-year old construction worker was shot with a fishing harpoon gun on the left side of his face. He consulted at the emergency room 12 days postinjury, stable but with blurring of vision on the right. The shaft of the harpoon was protruding at the left preauricular area; the tip was neither visible nor palpable. Craniofacial CT scan and skull anteroposterolateral radiographs revealed the tip of the harpoon to be at the right orbital apex. A hook attached 1 cm from the tip was lodged in the sphenoid sinus. The hook was dismantled from the shaft via a combined external and endoscopic transnasal approach, enabling the shaft to be gently pulled. The hook, together with the tip, were removed endoscopically. The patient’s visual acuity improved. He was discharged after 2 days on oral antibiotics with no deficits on follow-up.

scholarly journals Nd:YAG Laser Photodisruption for Multilevel Premacular Hemorrhage due to Isolated Retinal Venous Macroaneurysm

2017 ◽  
Vol 2017 ◽  
pp. 1-4
Author(s):  
Kenan Sonmez ◽  
Pehmen Y. Ozcan
Keyword(s):  
Visual Acuity ◽  
Fluorescein Angiography ◽  
Laser Treatment ◽  
Nd:Yag Laser ◽  
Blood Cells ◽  
Internal Limiting Membrane ◽  
Hand Motion ◽  
First Case ◽  
The Right

A 55-year-old man presented with sudden deterioration of vision in the right eye. His visual acuity was reduced to hand motion because of a large multilevel premacular hemorrhage. Nd:YAG laser was performed to drain the entrapped hemorrhage under the internal limiting membrane (ILM) and posterior hyaloid face in the macula into the vitreous. Immediately after laser treatment, streaming of red blood cells into the vitreous gel through the perforation site was observed. At the first-month follow-up, BCVA improved to 20/25 and ILM wrinkling was observed at the macula where the preretinal hemorrhage cleared. Fluorescein angiography revealed an isolated retinal venous macroaneurysm located on the macular branch of the superotemporal vein at the bifurcation site. In contrast to retinal arterial macroaneurysms, retinal venous macroaneurysms are quite rare. To the best of our knowledge, this is the first case reported with multilevel premacular hemorrhage caused by an isolated retinal venous macroaneurysm.

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