Management of Acute Posterior Multifocal Placoid Pigment Epitheliopathy (APMPPE): Insights from Multimodal Imaging with OCTA

A 28-year-old man presented to the emergency room with blurred vision in the right eye for two days. He reported a preceding flu-like illness one week earlier. His best-corrected visual acuity (BCVA) was 20/40 in the right eye and 20/25 in the left eye. There was no anterior chamber inflammation or vitritis in either eye. He presented multiple yellowish-white placoid lesions in the posterior pole, some involving the foveal area, bilaterally. General examination and systemic investigation were unremarkable. Multimodal evaluation with fluorescein angiography, indocyanine green angiography, and spectral domain and optical coherence tomography angiography (OCTA) were consistent with the diagnosis of acute posterior multifocal placoid pigment epitheliopathy. Due to centromacular involvement with decreased BCVA, treatment with oral methylprednisolone was started after infectious causes were ruled out. After two weeks, the patient presented functional and anatomical improvement. OCTA showed partial reperfusion of the choriocapillaris in the affected areas, in both eyes.

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Large choroidal excavation in pachychoroid disease: A case report

European Journal of Ophthalmology ◽

10.1177/1120672119892428 ◽

2019 ◽

pp. 112067211989242 ◽

Cited By ~ 2

Author(s):

Pierluigi Iacono ◽

Maurizio Battaglia Parodi ◽

Sandro Saviano ◽

Mariacristina Parravano ◽

Monica Varano

Keyword(s):

Optical Coherence Tomography ◽

Visual Acuity ◽

Indocyanine Green ◽

Choroidal Neovascularization ◽

Indocyanine Green Angiography ◽

Fundus Examination ◽

Corrected Visual Acuity ◽

Focal Choroidal Excavation ◽

The Right ◽

Best Corrected Visual Acuity

Purpose: To report the morphological and clinical features of a case of pachychoroid disease with focal choroidal excavation and large choroidal excavation complicated by choroidal neovascularization. Methods: The patient underwent a complete ophthalmologic examination including best-corrected visual acuity assessment, anterior segment and dilated fundus examination, fluorescein and indocyanine green angiography, and spectral-domain optical coherence tomography. Results: During the previous follow-up, the 57-year-old man received a diagnosis of central serous chorioretinopathy in the right eye with a late appearance of a choroidal neovascularization. The best-corrected visual acuity was 20/125 and 20/20 in the right and left eye, respectively. Dilated fundus examination, fluorescein angiography, and indocyanine green angiography confirmed a large subretinal fibrosis corresponding to the evolution of the choroidal neovascularization in the right eye. Spectral-domain optical coherence tomography clearly demonstrated in the right eye a large choroidal excavation below the fibrotic neovascular lesion with multiple hyperreflective foci inside the cavity, and in the left eye, a conforming focal choroidal excavation, bowl-shape type, associated with increased choroidal thickness with pachyvessels. Conclusion: Large choroidal excavation has been rarely reported. Although the pathogenetic mechanisms leading to the formation of large choroidal excavation are still only hypotheses, a combination of primary degenerative inflammatory factors sustaining the focal choroidal excavation formation and disruptive process of the choroidal neovascularization could be retained responsible for the large choroidal excavation.

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Optic coherence tomography angiography follow-up in a case of Purtscher-like retinopathy due to atypical hemolytic uremic syndrome

European Journal of Ophthalmology ◽

10.1177/1120672119833277 ◽

2019 ◽

Vol 30 (3) ◽

pp. NP14-NP17 ◽

Cited By ~ 1

Author(s):

Juan Francisco Santamaría Álvarez ◽

Anna Serret Camps ◽

Javier Aguayo Alvarez ◽

Olga García García

Keyword(s):

Optical Coherence Tomography ◽

Visual Acuity ◽

Hemolytic Uremic Syndrome ◽

Optical Coherence Tomography Angiography ◽

Atypical Hemolytic Uremic Syndrome ◽

Optical Coherence ◽

Corrected Visual Acuity ◽

Capillary Plexus ◽

Uremic Syndrome ◽

Best Corrected Visual Acuity

Purpose: To report a case of Purtscher-like retinopathy due to atypical hemolytic uremic syndrome and the changes seen in the optical coherence tomography angiography before and after treatment with eculizumab. Case description: A 22-year-old man with an unremarkable medical history presented with acute, bilateral blurred vision and headache of 1-week duration. Best corrected visual acuity of 20/50 and 20/40, respectively, in the patient’s right eye and left eye. Funduscopy revealed multiple cotton-wool spots associated with intrarretinal fluid. Swept source optical coherence tomography revealed multifocal retinal detachments with increased choroidal thickness. Optical coherence tomography angiography showed areas of ischemia in both capillary plexus. Due to concurrent symptoms and laboratory analysis, he was diagnosed with atypical hemolytic uremic syndrome and secondary Purtscher-like retinopathy; therefore, treatment with eculizumab was initiated. After 2 months revascularization of the previous ischemic areas was seen in the optical coherence tomography angiography that were correlated with best corrected visual acuity improvement. Conclusion: Our findings suggest that evaluation of the macular capillary plexus revascularization by optical coherence tomography angiography during the disease could help to predict an improvement of best corrected visual acuity in these patients and the measurement of choroidal thickness could give us information about the resolution of the pathologic process.

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Absent Foveal Pit, Also Known as Fovea Plana, in a Child without Associated Ocular or Systemic Findings

Case Reports in Ophthalmological Medicine ◽

10.1155/2018/2146826 ◽

2018 ◽

Vol 2018 ◽

pp. 1-5

Author(s):

Laura Hernandez-Moreno ◽

Natacha Moreno Perdomo ◽

Tomas S. Aleman ◽

Karthikeyan Baskaran ◽

Antonio Filipe Macedo

Keyword(s):

Optical Coherence Tomography ◽

Visual Acuity ◽

Caucasian Male ◽

Corrected Visual Acuity ◽

Abnormal Structure ◽

Ophthalmologic Examination ◽

Foveal Hypoplasia ◽

Systemic Manifestations ◽

The Right ◽

Best Corrected Visual Acuity

The purpose of this report is to describe a case of bilateral foveal hypoplasia in the absence of other ophthalmological or systemic manifestations. We characterize the case of a 9-year-old Caucasian male who underwent full ophthalmologic examination, including functional measures of vision and structural measurements of the eye. Best corrected visual acuity was 0.50 logMAR in the right eye and 0.40 logMAR in the left eye. Ophthalmoscopy revealed a lack of foveal reflex that was further investigated. Optical coherence tomography (OCT) confirmed the absence of foveal depression (pit). OCT images demonstrated the abnormal structure of retina in a region in which we expected a fovea; these findings were decisive to determine the cause of reduced acuity in the child.

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Combined Anterior Sclera Staphylectomy and Vitrectomy with Anterior Sclera Staphyloma and Vitreous Hemorrhage Occurring 38 Years after Cataract Surgery

Case Reports in Ophthalmological Medicine ◽

10.1155/2011/340859 ◽

2011 ◽

Vol 2011 ◽

pp. 1-3

Author(s):

Qinxiang Zheng ◽

Ronghan Wu ◽

Wensheng Li

Keyword(s):

Visual Acuity ◽

Cataract Surgery ◽

Ocular Surface ◽

Vitreous Hemorrhage ◽

Combined Surgery ◽

Bilateral Cataract ◽

Corrected Visual Acuity ◽

The Right ◽

Best Corrected Visual Acuity

Introduction. To report a case of anterior sclera staphyloma and vitreous hemorrhage occurring over 38 years after bilateral cataract surgery.Methods. A 58-year-old man presented with anterior sclera staphyloma and vitreous hemorrhage in the right eye, after bilateral cataract surgery, over 38 years ago. We performed combined anterior sclera staphylectomy and vitrectomy of right eye for anterior sclera staphyloma and vitreous hemorrhage.Results. Forty-eight months after the combined surgery, best-corrected visual acuity was 0.3 (+10.00/−4.50 × 60) with eutopic stitches of the corneoscleral junction on the superior nasal quadrant and a stable ocular surface.Conclusions. This is the first reported case of anterior sclera staphyloma with vitreous hemorrhage successfully managed by combined surgery.

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

Journal of VitreoRetinal Diseases ◽

10.1177/2474126417731478 ◽

2017 ◽

Vol 1 (6) ◽

pp. 415-419 ◽

Cited By ~ 1

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.

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DMEK IN KERATOCONUS WITH ACUTE HYDROPS: A CASE REPORT

Vision Pan-America The Pan-American Journal of Ophthalmology ◽

10.15234/vpa.v17i3.510 ◽

2018 ◽

Vol 17 (3) ◽

pp. 81

Author(s):

Lucio V L Maranhão ◽

Paulo E C Dantas ◽

Natalia R L Ramalho ◽

Wanessa P Pinto

Keyword(s):

Visual Acuity ◽

Corneal Edema ◽

Descemet Membrane Endothelial Keratoplasty ◽

Hand Motion ◽

Severe Visual Loss ◽

Corrected Visual Acuity ◽

Corneal Hydrops ◽

The Right ◽

Initial Results ◽

Best Corrected Visual Acuity

We describe the initial results of a Descemet Membrane Endothelial Keratoplasty (DMEK) procedure for acute corneal hydrops in a 45-years female with keratoconus that presented with severe visual loss in the left eye (OS). The patients’ best-corrected visual acuity at presentation in the right eye was 20/80 and hand motion in OS. Slit-lamp examination revealed an extensive Descemet’s membrane tear and stromal corneal edema in OS. Two months after the DMEK procedure, the patient presented with a best corrected visual acuity of 20/200 in the affected eye, corneal edema improvement, and an attached Descemet graft.

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LETTER TO THE EDITOR Excision of Congenital Bilateral Persistent Pupillary Membrane in a Child with Exotropia

The Open Ophthalmology Journal ◽

10.2174/1874364101509010033 ◽

2015 ◽

Vol 9 (1) ◽

pp. 33-35

Author(s):

Michiko Iida ◽

Tatsuya Mimura ◽

Mari Goto ◽

Yuko Kamei ◽

Aki Kondo ◽

...

Keyword(s):

Visual Acuity ◽

Case Report ◽

Surgical Treatment ◽

Histopathological Examination ◽

Crystalline Lens ◽

Ocular Tissues ◽

Corrected Visual Acuity ◽

The Right ◽

Best Corrected Visual Acuity ◽

High Hyperopia

Purpose : To report the clinical and histopathological findings of a patient who had bilateral persistent pupillary membrane with exotropia and high hyperopia. Methods : Case Report: A 7-year-old boy presented with a persistent pupillary membrane in both eyes. His best corrected visual acuity (BCVA) was 20/20 in the right eye and 20/32 in the left eye with exotropia of 18 prism diopters. He underwent surgical resection of both membranes. At 5 months postoperatively, BCVA was 20/20 with final bilateral refraction of +6.5 D in both eyes. Exotropia and photophobia showed improvement immediately after surgery. Histopathological examination revealed typical features of normal iris tissue in the excised membranes. Conclusion : Bilateral persistent pupillary membranes were excised successfully without injury to other ocular tissues, including the crystalline lens. Surgical treatment may be required for the management of persistent pupillary membrane associated with visual impairment such as exotropia or photophobia.

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Optical coherence tomography angiography in myopic choroidal neovascularization after intravitreal ranibizumab

European Journal of Ophthalmology ◽

10.1177/1120672118785495 ◽

2018 ◽

Vol 29 (2) ◽

pp. 239-243

Author(s):

Gilda Cennamo ◽

Francesca Amoroso ◽

Stefano Schiemer ◽

Nunzio Velotti ◽

Mariacristina Alfieri ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Visual Acuity ◽

Choroidal Neovascularization ◽

Optical Coherence Tomography Angiography ◽

Pathologic Myopia ◽

Optical Coherence ◽

Intravitreal Ranibizumab ◽

Corrected Visual Acuity ◽

Best Corrected Visual Acuity

Purpose: To describe the optical coherence tomography angiography characteristics of myopic patients with choroidal neovascularization secondary to pathologic myopia during ranibizumab therapy. Methods: Nineteen patients were enrolled in this prospective study (13 females, 6 males, mean age 55.25 ± 9.63 years) for a total of 20 eyes examined (14 right eyes, 6 left eyes). Images were analyzed independently by two examiners. Results: Mean follow-up was 5.75 ± 1.88 months, with a mean intravitreal injections of 1.90 ± 0.44. Mean best-corrected visual acuity at baseline was 0.39 ± 0.18 logMAR versus 0.26 ± 0.16 logMAR 6 months after treatment. The neovascular area (Z = –2.091, p = 0.037) was significantly reduced after treatment, whereas vessel density was not (Z = –1.848, p = 0.065). Moreover, the best-corrected visual acuity was increased (Z = –3.055, p = 0.002). Neovascular area was significantly correlated with best-corrected visual acuity, at both baseline and follow-up (p < 0.05). Conclusion: Our data suggest that optical coherence tomography angiography is a reproducible non-invasive examination with which to monitor changes in the neovascular area in patients with pathologic myopia treated with ranibizumab.

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Corneal Toxicity Following Exposure to Asclepias Tuberosa

The Open Ophthalmology Journal ◽

10.2174/1874364101711010001 ◽

2017 ◽

Vol 11 (1) ◽

pp. 1-4 ◽

Cited By ~ 3

Author(s):

Lauge Hjorth Mikkelsen ◽

Hassan Hamoudi ◽

Cigdem Altuntas Gül ◽

Steffen Heegaard

Keyword(s):

Visual Acuity ◽

Differential Diagnosis ◽

Corneal Endothelium ◽

Rare Case ◽

Corneal Oedema ◽

Blurred Vision ◽

Corrected Visual Acuity ◽

Corneal Toxicity ◽

Best Corrected Visual Acuity ◽

Plant Latex

Purpose: To present a case of corneal toxicity following exposure to milky plant latex from Asclepias tuberosa. Methods: A 70-year-old female presented with blurred vision and pain in her left eye after handling an Ascepias tuberosa. Clinical examination revealed a corneal stromal oedema with small epithelial defects. The corneal endothelium was intact and folds in Descemets membrane were observed. The oedema was treated with chloramphenicol, dexamethasone and scopolamine. Results: The corneal oedema had appeared after corneal exposure to the plant, Asclepias tuberosa, whose latex contains cardenolides that inhibit the Na+/ K+-ATPase in the corneal endothelium. The oedema resolved after 96 hours. After nine months the best corrected visual acuity was 20/20. Conclusion: Corneal toxicity has previously been reported for plants of the Asclepias family. This is a rare case describing severe corneal toxicity caused by exposure to latex from Asclepias tuberosa. Handling of plants of the Asclepias family should be kept as a differential diagnosis in cases of acute corneal toxicity.

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Macular Hole Progression following Ocriplasmin Intravitreal Injection

Case Reports in Ophthalmological Medicine ◽

10.1155/2014/403461 ◽

2014 ◽

Vol 2014 ◽

pp. 1-2 ◽

Cited By ~ 1

Author(s):

Edward Casswell ◽

Guillermo Fernandez-Sanz ◽

Danny Mitry ◽

Sheila Luk ◽

Rahila Zakir

Keyword(s):

Optical Coherence Tomography ◽

Visual Acuity ◽

Intravitreal Injection ◽

Macular Hole ◽

Optical Coherence ◽

Vitreomacular Adhesion ◽

Blurred Vision ◽

Corrected Visual Acuity ◽

Best Corrected Visual Acuity

Ocriplasmin is a protease which has been approved for the treatment of symptomatic vitreomacular adhesion (VMA). A 63-year-old presented with blurred vision in the left eye and a best corrected visual acuity of 6/18. Optical coherence tomography revealed VMA with an underlying macular hole and she subsequently underwent a left intravitreal ocriplasmin injection. One week after the injection, VMA had been released but with enlargement of the macular hole and a drop in her BCVA to 6/60. This persisted at 1 month after the injection. It is important to warn patients that ocriplasmin may lead to an enlargement of their macular hole with resultant loss in visual acuity.

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