Acute Posterior Multifocal Placoid Pigment Epitheliopathy Sharing Characteristic OCT Findings of Vogt-Koyanagi-Harada Disease

A 17-year-old male presented with acute bilateral paracentral scotomata and blurred vision. Funduscopic examination showed bilateral macular serous retinal detachment and yellow-white placoid lesions at the level of retinal pigment epithelium. OCT study showed typical VKH disease findings with marked choroidal thickening and macular serous retinal detachment partly with subretinal septa in both eyes. FA demonstrated hypofluorescence at the placoid lesions in the early phase and hyperfluorescence in the late phase. Laboratory investigation showed negative result for HLA-DR4 serotype and the patient’s cerebrospinal fluid test values were within normal range. We made the diagnosis of APMPPE from these results. At 2-month follow-up without the use of corticosteroids, OCT reexamination showed complete amelioration of subretinal fluid in both eyes. Patchy pigmentary lesions also resolved clinically with partial chorioretinal scars. The results in this case suggested OCT findings in APMPPE patients could be similar to characteristic features usually found in acute VKH disease. We recommend comprehensive assessments such as FA, cerebral spinal fluid analysis, and HLA typing which help in leading proper diagnosis.

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Spontaneous Closure of the Macular Hole in a Patient with Acquired Vitelliform Lesion

Case Reports in Ophthalmology ◽

10.1159/000505315 ◽

2020 ◽

Vol 11 (1) ◽

pp. 16-21

Author(s):

Masanori Fukumoto ◽

Shou Oosuka ◽

Takaki Sato ◽

Teruyo Kida ◽

Tsunehiko Ikeda

Keyword(s):

Retinal Detachment ◽

Macular Hole ◽

Rare Case ◽

Pigment Epithelium ◽

Retinal Pigment ◽

Serous Retinal Detachment ◽

Subretinal Fluid ◽

Spontaneous Closure ◽

Retinal Reattachment

In this paper, we report an extremely rare case of spontaneous closure of a macular hole (MH) that developed in a patient in whom acquired vitelliform lesion (AVL) occurred after vitrectomy for atopic retinal detachment (ARD). A 32-year-old male developed ARD in both eyes, and retinal reattachment was achieved after vitrectomy. Five years after surgery, optical coherence tomography showed localized serous retinal detachment (SRD) and a granular lesion with a higher brightness in the subretinal fluid, thus leading to the diagnosis of AVL. One month later, an MH developed, and a follow-up examination performed 6 weeks later revealed that the MH had spontaneously closed and the SRD decreased. In the fovea, fluorescein angiography revealed a window defect due to atrophy of the retinal pigment epithelium (RPE). These findings in this present case suggest the possibility that RPE dysfunction was involved in the development of AVL and MH.

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Central Serous Chorioretinopathy Induced by Work Stress: A Case Report

e-CliniC ◽

10.35790/ecl.v8i2.31107 ◽

2020 ◽

Vol 8 (2) ◽

Author(s):

Ade J. Nursalim ◽

Vera Sumual

Keyword(s):

Risk Factors ◽

Work Stress ◽

Central Serous Chorioretinopathy ◽

Pigment Epithelium ◽

Retinal Pigment ◽

Subretinal Fluid ◽

Blurred Vision ◽

Reading Text ◽

Neurosensory Retinal Detachment ◽

The Right

Abstrak: Central serous chorioretinopathy (CSC) adalah terkumpulnya cairan serosa di bawah lapisan epitel pigmen retina yang mengakibatkan terlepasnya retina neurosensorik (detachment). Keadaan ini dapat disebabkan oleh berbagai faktor risiko, termasuk stres psikologik. Jenis kelamin laki-laki merupakan salah satu faktor risiko CSC. Terapi kondisi psikologik merupakan pena-nganan utama CSC yang diinduksi oleh stres kerja. Kami melaporkan seorang laki-laki berusia 27 tahun yang datang ke Poliklinik Mata RSUP Prof. Dr. R. D. Kandou Hospital dengan keluhan kekaburan mata kanan yang mendadak sejak seminggu lalu tanpa didahului oleh nyeri pada mata. Pasien juga mengalami kesulitan dalam membaca teks dan mengenali wajah bila hanya menggunakan mata kanannya. Pasien telah pergi ke optik tetapi tidak mendapatkan ukuran kacamata yang sesuai. Pasien bekerja sebagai tenaga administrasi dan akhir-akhir ini mendapatkan beban kerja berlebihan. Pasien mengakui bahwa ia mengalami kesulitan dalam mengatur aktivitasnya, dan merasakan kelelahan sepanjang hari serta kehilangan minat kerja. Hasil pemeriksaan mata mendapatkan visus 6/15 untuk mata kanan dan visus 6/6 untuk mata kiri, dan metamorphopsia sedangkan hasil pemeriksaan oftalmoskopi memperlihatkan adanya edema dengan lingkaran kekuningan dan berbatas tidak jelas pada mata kanan. Pemeriksaan lanjut dengan OCT menunjukkan adanya cairan subretinal pada mata kanan disertai terlepasnya lapisan epitel pigmen. Saat kontrol setelah 36 hari, visus mata kanan telah membaik 6/6F2 dan peme-riksaan OCT menunjukkan penurunan tebal makula dari 289 μm pada kunjugan pertama men-jadi 190 μm, serta tidak tampak adanya cairan subretinal. Simpulan kasus ini ialah central serous chorioretinopathy yang diinduksi oleh stres kerja, dengan penanganan utama ialah terapi psikologik untuk memperbaiki kualitas hidup.Kata kunci: central serous chorioretinopathy (CSC), stres kerja Abstract: Central serous chorioretinopathy (CSC) is a condition where serous fluid builds up in the retinal pigment epithelium layer which causes neurosensory retinal detachment. This condition is affected by many risk factors, including psychological stress. Male gender is one of the risk factors for CSC. Treatment to the patient's psychological condition can be the main therapy in handling CSC induced by work stress. We reported a 27-year-old male came to the eye clinic at Prof. dr. R. D. Kandou Hospital complaining of sudden blurred vision in his right eye a week ago without initial pain in the eye. The patient also experienced difficulty in reading text and recognizing people’s face using the right eye. The patient went to an optic store but he did not find suitable glasses. The patient works as an administrative employee and is currently getting a heavy workload at his workplace. The patient admitted that he had issues in managing his life in a day. Patients felt tired throughout the day and had no interest in making any activities. The results of the eye examination showed vision 6/15 in the right eye and 6/6 in the left eye, metamorphopsia, edema with a yellowish circle with an unclear border on the right eye using ophthalmoscopy examination, and a subretinal fluid image in the patient's right eye with epithelial detachment pigment acquired through the examination with OCT. After 36 days from the first visit, the right eye vision was improved to 6/6 F2 and OCT examination resulted in a decrease in macula thickness from 289 μm at the first visit to 190 μm, and there was no subretinal fluid. In conclusion, this was a CSC case induced by work stress, and the main treatment was psychological therapy in order to improve the quality of life (QoL).Keywords: central serous chorioretinopathy (CSC), work stress

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Iron is neurotoxic in retinal detachment and transferrin confers neuroprotection

Science Advances ◽

10.1126/sciadv.aau9940 ◽

2019 ◽

Vol 5 (1) ◽

pp. eaau9940 ◽

Cited By ~ 8

Author(s):

Alejandra Daruich ◽

Quentin Le Rouzic ◽

Laurent Jonet ◽

Marie-Christine Naud ◽

Laura Kowalczuk ◽

...

Keyword(s):

Retinal Detachment ◽

Vision Loss ◽

Ex Vivo ◽

Pigment Epithelium ◽

Retinal Pigment ◽

Subretinal Fluid ◽

Predictive Marker ◽

Visual Recovery ◽

Neuroprotective Effects

In retinal detachment (RD), photoreceptor death and permanent vision loss are caused by neurosensory retina separating from the retinal pigment epithelium because of subretinal fluid (SRF), and successful surgical reattachment is not predictive of total visual recovery. As retinal iron overload exacerbates cell death in retinal diseases, we assessed iron as a predictive marker and therapeutic target for RD. In the vitreous and SRF from patients with RD, we measured increased iron and transferrin (TF) saturation that is correlated with poor visual recovery. In ex vivo and in vivo RD models, iron induces immediate necrosis and delayed apoptosis. We demonstrate that TF decreases both apoptosis and necroptosis induced by RD, and using RNA sequencing, pathways mediating the neuroprotective effects of TF are identified. Since toxic iron accumulates in RD, we propose TF supplementation as an adjunctive therapy to surgery for improving the visual outcomes of patients with RD.

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Unilateral Vogt-Koyanagi-Harada Disease: A Clinical Case Report

Case Reports in Ophthalmology ◽

10.1159/000441616 ◽

2015 ◽

Vol 6 (3) ◽

pp. 361-365 ◽

Cited By ~ 3

Author(s):

Arminda Neves ◽

Ana Cardoso ◽

Mariana Almeida ◽

Joana Campos ◽

António Campos ◽

...

Keyword(s):

Visual Acuity ◽

Case Report ◽

Retinal Detachment ◽

Serous Retinal Detachment ◽

Subretinal Fluid ◽

Posterior Pole ◽

Exudative Retinal Detachment ◽

The Right ◽

Clinical Records ◽

Vkh Disease

Purpose: To report a case of a 20-year-old female with decreased visual acuity (VA) in the left eye (LE). Methods: This is a retrospective and descriptive case report based on data from clinical records, patient observation and analysis of diagnostic tests. Results: A 20-year-old female presented with decreased VA in the LE for 3 days. Best-corrected visual acuity (BCVA) was 20/20 in the right eye (RE) and 20/40 in the LE. Pupillary function, intraocular pressure, results of external segment examinations and slit-lamp biomicroscopy were normal, bilaterally. RE fundoscopy was normal, and in the LE it revealed papillitis and posterior pole exudative retinal detachment. Optical coherence tomography (OCT) confirmed the macular serous retinal detachment and showed thickening of the posterior choroid also revealed by orbital ultrasound and magnetic resonance imaging (MRI). Fluorescein angiography showed angiographic features typical of Vogt-Koyanagi-Harada (VKH) disease: disseminated spotted choroidal hyperfluorescence and choroidal multifocal hypofluorescence, multifocal profuse leakage in the retina with pooling, serous retinal detachment and optic disc hyperfluorescence. Serological testing for the diagnosis of infectious pathologies was negative, and the review of systems was normal. The patient received systemic steroids and cyclosporine. LE BCVA improved up to 20/20 at 18 months after the diagnosis, with complete reabsorption of subretinal fluid and normal retinal and choroidal thickness by OCT. Conclusion: Despite the unilateral involvement, the clinical and angiographic features were typical of VKH disease, and ophthalmologists should be aware to recognize this rare clinical variant of the disease.

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Acute exudative polymorphous vitelliform maculopathy during pembrolizumab treatment for metastatic melanoma: a case report

BMC Ophthalmology ◽

10.1186/s12886-021-02011-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Ine Lambert ◽

Giuseppe Fasolino ◽

Gil Awada ◽

Robert Kuijpers ◽

Marcel ten Tusscher ◽

...

Keyword(s):

Retinal Detachment ◽

Checkpoint Inhibitors ◽

Pigment Epithelium ◽

Retinal Pigment ◽

Anterior Segment ◽

Subretinal Fluid ◽

Additional Treatment ◽

Central Visual Field ◽

Immunomodulating Therapy ◽

Neurosensory Retinal Detachment

Abstract Background The use of immunomodulating therapy to treat various cancers has been on the rise and these immune checkpoint inhibitors are known to cause ocular side effects. In this article a case of acute exudative polymorphous vitelliform maculopathy (AEPVM) is reported which developed during a first line treatment with pembrolizumab. Case presentation A 54-year-old woman was referred because of blurry vision in both eyes with a yellow spot in the central visual field of the left eye. These symptoms started after four treatments with pembrolizumab (a monoclonal antibody against the programmed cell death receptor-1) for a metastatic recurrent vaginal mucosal melanoma. Her best corrected visual acuity was 10/10 in both eyes with a correction of + 2.00 bilaterally. There were no inflammatory findings in the anterior segment or the vitreous. Fundoscopy revealed an attenuation of the foveal reflex with subtle yellow-white subretinal macular deposits (vitelliform lesions) in both eyes. Fluorescein angiography did not show staining or leakage in the mid-phase, neither a late staining. Spectral-domain optical coherence tomography of the macula illustrated bilateral neurosensory retinal detachment with a thick, highly reflective band at the outer photoreceptor segment. En face structural OCT at the level of the photoreceptors showed focal areas of increased signal corresponding to hyperreflective vitelliform material. The treatment with pembrolizumab was ceased immediately. During the following visits we slowly saw an improvement of the neurosensory retinal detachment. After almost four months a total resolution of the subretinal fluid was visualized in both eyes without the use of additional treatment, though the vitelliform deposits persisted. Conclusions The development of AEPVM in melanoma patients could be triggered by treatment with Pembrolizumab. Pembrolizumab has the potential to disturb indirectly the retinal pigment epithelium homeostasis with accumulation of lipofuscin deposits and subretinal fluid, both signs of AEPVM.

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Photodynamic Therapy with Verteporfin for Chronic Central Serous Chorioretinopathy: A Review of Data and Efficacy

Pharmaceuticals ◽

10.3390/ph13110349 ◽

2020 ◽

Vol 13 (11) ◽

pp. 349

Author(s):

Pierluigi Iacono ◽

Stefano Da Pozzo ◽

Monica Varano ◽

Mariacristina Parravano

Keyword(s):

Photodynamic Therapy ◽

Central Serous Chorioretinopathy ◽

Pigment Epithelium ◽

Retinal Pigment ◽

Serous Retinal Detachment ◽

Subretinal Fluid ◽

Chronic Central Serous Chorioretinopathy ◽

Long Time ◽

Potential Damage ◽

Retinal Disorder

Central serous chorioretinopathy represents the fourth most frequent retinal disorder, occurring especially in young age. Central serous chorioretinopathy is mainly characterized by macular serous retinal detachment and although the clinical course moves frequently toward a spontaneous resolution, the subretinal fluid may persist for a long time, thus evolving to the chronic form, and leading to a potential damage of the retinal pigment epithelium and to photoreceptors. The photodynamic therapy with verteporfin plays an important role in the armamentarium among the many therapeutic options employed in this complex retinal disorder. In this review, the authors aim to summarize data of efficacy and safety of PDT focusing especially on mechanisms of action of the PDT and providing comparative outcomes with the alternative therapeutic approaches, including especially the subthreshold laser treatment.

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Chronic Central Serous Chorioretinopathy; Signs, Diagnosis and Treatment

Güncel Retina Dergisi (Current Retina Journal) ◽

10.37783/crj-0204 ◽

2020 ◽

pp. 104-111

Keyword(s):

Central Serous Chorioretinopathy ◽

Pigment Epithelium ◽

Fundus Autofluorescence ◽

Retinal Pigment ◽

Subretinal Fluid ◽

Fluid Accumulation ◽

Fundus Fluorescein Angiography ◽

Blurred Vision ◽

Chronic Central Serous Chorioretinopathy

Central serous chorioretinopathy (CSCR) is a maculopathy characterized by the separation of the neurosensory layer as a result of fluid accumulation between the retinal pigment epithelium (RPE) and the photoreceptor layer. Classically it is classified as acute and chronic forms. When the disease lasts longer than 4-6 months, it is called a chronic form and comprises 15% of all CSCR cases. Although the exact etiology is unknown; studies emphasize changes in choroidal circulation causing choroidal ischemia and vascular hyperpermeability as well as subretinal fluid accumulation due to deterioration pump function of RPEs. Subretinal fluid accumulation can lead to photoreceptor dysfunction and loss of vision. Classical findings in patients are a decrease in visual acuity, blurred vision, metamorphopsia, micropsia, disturbance in color vision and dark adaptation, and scotomas. Diagnosis and follow-up depend on fundoscopy as well as imaging. Optical coherent tomography is the primary method. Fundus autofluorescence (FAF) is useful in defining RPE changes noninvasively. Fundus fluorescein angiography (FFA) shows the source of leakage. In recurrent, unresolved and chronic cases, OCT, FAF, FFA, and indocyanine green angiography can be used all together to manage the disease, to follow-up its extension, and to diagnose possible neovascular as well as polypoidal component. For the treatment of chronic CSCR patients, besides medical treatments such as carbonic anhydrase inhibitors, mineralocorticoid receptor, and glucocorticoid antagonists and intravitreal vascular endothelial growth factor antagonist (Anti-VEGF) injections, half-dose photodynamic therapy and subthreshold micropulse laser treatment are used. Prospective, controlled trials with large series for the treatment of chronic CSCR warranted.

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Epidemiology, Prevalence and Incidence of Rhegmatogenous Retinal Detachment

Güncel Retina Dergisi (Current Retina Journal) ◽

10.37783/crj-0153 ◽

2019 ◽

pp. 135-137

Keyword(s):

Risk Factors ◽

Retinal Detachment ◽

High Myopia ◽

Rhegmatogenous Retinal Detachment ◽

Pigment Epithelium ◽

Retinal Pigment ◽

Subretinal Fluid ◽

Cataract Extraction ◽

Common Type ◽

Associated Risk Factors

Rhegmatogenous retinal detachment is the most common type of retinal detachments and occurs when subretinal fluid accumulates between the neurosensorial retina and retinal pigment epithelium. Although often caused by vitreous liquefaction, cataract extraction, high myopia, inflammation, and trauma are other associated risk factors. In this article, epidemiology, prevalence, and incidence of rhegmatogenous retinal detachment are aimed to describe.

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