A Case of Chorioretinitis with Retinal Angiomatous Proliferation

A 48-year-old woman had an acute blurred vision in the right eye immediately after drainage of liver abscess. Her best corrected visual acuity (BCVA) was 8/400; fundus photography suggested the diagnosis of endogenous endophthalmitis with chorioretinitis and vitritis. Due to the bad systemic condition, a systemic antibiotic combined with periocular triamcinolone (TA) was carried out first. Inflammatory cells in the vitreous cavity were decreased after treatment; however, fundus fluorescein angiography (FFA) showed abnormal dilation and leakage of the capillaries and retinal-choroidal anastomose, supporting that there was retinal angiomatous proliferation (RAP). Vitreous interleukin-6 (IL-6) was only slightly elevated; the ratio of interleukin-10 (IL-10) and IL-6 was less than 1, and the etiological test was negative. After receiving intravitreal vancomycin injection combined with periocular TA injection, the patient’s BCVA was improved from 16/400 to 20/400 with a reduction in vitreous inflammatory cells. However, the patient’s RAP was progressed and her BCVA was dramatically decreased to count finger/30 cm. After intravitreal injection of ranibizumab, the patient’s BCVA was 5/400 with a significant shrink in lesions and absorption of hemorrhage, exudation, and fluid. Thus, we suggest that early anti-inflammatory treatment in conjunction with anti-VEGF may achieve a better prognosis in patients with inflammatory retinal angiomatous proliferation (RAP).

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Optical Coherence Tomography Angiography in idiopathic retinal vasculitis, aneurysms and neuroretinitis (IRVAN) syndrome: A case report

European Journal of Ophthalmology ◽

10.1177/1120672120957593 ◽

2020 ◽

pp. 112067212095759

Author(s):

Meriem Ouederni ◽

Hela Sassi ◽

Zied Chelly ◽

Fehmy Nefaa ◽

Monia Cheour

Keyword(s):

Optical Coherence Tomography ◽

Optical Coherence Tomography Angiography ◽

Retinal Vasculitis ◽

Retinal Neovascularization ◽

Optical Coherence ◽

Fundus Fluorescein Angiography ◽

Blurred Vision ◽

Additional Tool ◽

The Right

Purpose: Since its first description by Chang et al. in 1995, the diagnosis of Idiopathic retinal vasculitis, aneurysms and neuroretinitis (IRVAN) syndrome has been based on the findings of Fundus Fluorescein Angiography (FFA). Our purpose was to describe the utility of optical coherence tomography angiography (OCT-A) in its diagnosis and management. Case description: A 40-year-old female presented with bilateral blurred vision. Her best corrected visual acuity was at 8/10. Fundus examination revealed blurred disc margins, perivascular exudates, arterial sheaths and retinal hemorrhages bilaterally. FFA showed staining of the optic disc with dye leakage in the right eye, a punctuate hyperfluorescence of the temporosuperior artery in the left eye, bilateral vascular sheathing and capillary dropout. OCT-A showed simultaneous presence of papillary aneurysm and neovascularization of the optic nerve head in the right eye, a papillary aneurysm in the left eye and bilateral capillary non-perfusion. Our patient was diagnosed with IRVAN syndrome. Oral steroids associated with panretinal laser photocoagulation and intravitreal injection of bevacizumab in the right eye resulted in vanishing of the papillary neovascularization with no recurrence on OCT-A at 10-month follow-up. Conclusions: OCT-A is an additional tool to FFA for visualization of arterial macroaneurysms and retinal neovascularization without the interference of dye leakage. It well demarcates nonperfused areas and ensures follow-up of retinal neovascularization. Its limitations are the limited field of view and the low sensitivity in detecting arteriolar dilations. Thus, OCT-A is unable to outplace FFA but should be considered alternately with it for non-invasive follow-up of IRVAN syndrome.

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Immune Recovery Uveitis Masked as an Endogenous Endophthalmitis in a Patient with Active CMV Retinitis

Case Reports in Ophthalmological Medicine ◽

10.1155/2013/462968 ◽

2013 ◽

Vol 2013 ◽

pp. 1-4 ◽

Cited By ~ 3

Author(s):

Ligia Figueiredo ◽

Renata Rothwell ◽

Miguel Bilhoto ◽

Rosário Varandas ◽

Sofia Fonseca

Keyword(s):

Highly Active Antiretroviral Therapy ◽

Endogenous Endophthalmitis ◽

Immune Recovery ◽

Blurred Vision ◽

Positive Polymerase Chain Reaction ◽

Immune Recovery Uveitis ◽

Cmv Retinitis ◽

Highly Active ◽

Polymerase Chain ◽

The Right

Cytomegalovirus (CMV) retinitis may occur in profoundly immunocompromised patients and be the initial AIDS-defining infection. The incidence and prevalence of CMV retinitis has declined substantially in the era of highly active antiretroviral therapy (HAART); nevertheless, it remains a leading cause of ocular morbility. We report the case of a 40-year-old man with blurred vision and pain in the right eye, three weeks after the initiation of effective HAART treatment. Ocular examination revealed a panuveitis causing an anterior chamber reaction with hypopyon and a dense vitreous haze. An endogenous endophthalmitis was suspected and treatment was ensued, without improvement. A vitreous tap was performed, and a positive polymerase chain reaction for CMV was found. A diagnosis of immune recovery uveitis (IRU) was made, and the patient responded to treatment with valganciclovir and dexamethasone. IRU is an intraocular inflammation that develops in patients with HAART-induced immune recovery and inactive CMV retinitis, although cases of active CMV retinitis have been described. Presentation with panuveitis and hypopion is rare and may be misleading regarding diagnosis and management.

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Adult Coats Disease Presenting as Subfoveal Nodule

Case Reports in Ophthalmology ◽

10.1159/000487707 ◽

2018 ◽

Vol 9 (1) ◽

pp. 232-237 ◽

Cited By ~ 1

Author(s):

Salim Z. Asaad ◽

Nazimul Hussain

Keyword(s):

Retinal Vessel ◽

Fundus Fluorescein Angiography ◽

The Third ◽

Macular Lesion ◽

Corrected Visual Acuity ◽

Coats Disease ◽

The Right ◽

Lost To Follow Up ◽

Best Corrected Visual Acuity

A 21-year-old female presented with decreased vision in the right eye. Best corrected visual acuity was 6/60 in the right eye and 6/6 in the left eye. Funduscopy of the right eye revealed a subfoveal nodule with surrounding exudates and temporal peripheral retinal vessel telangiectasia with exudation. The patient underwent retinal laser in the areas of telangiectatic vessels and capillary non-perfusion as seen on fundus fluorescein angiography. It was combined with an intravitreal injection of bevacizumab which was repeated twice at monthly intervals. The macular lesion and peripheral vessels along with subretinal exudates showed resolution during the course of treatment. However, the patient was lost to follow-up and returned 5 months later when examination revealed increased macular fibrosis. In the literature, the reported presentation of subfoveal nodule in Coats disease is during the first decade. It progresses to macular fibrosis within a few months. This case illustrates that subfoveal nodule before macular fibrosis in Coats disease may present later, even up to the third decade.

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

Case Reports in Ophthalmological Medicine ◽

10.1155/2020/7049168 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6

Author(s):

Mariana A. Oliveira ◽

Jorge Simão ◽

Amélia Martins ◽

Cláudia Farinha

Keyword(s):

Visual Acuity ◽

Multimodal Imaging ◽

Indocyanine Green Angiography ◽

Optical Coherence Tomography Angiography ◽

Posterior Pole ◽

Blurred Vision ◽

Corrected Visual Acuity ◽

The Right ◽

Yellowish White ◽

Best Corrected Visual Acuity

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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Long-Term Follow-Up Results of a Patient Undergoing Acute Retinal Necrosis: A Case Report and Literature Review

Case Reports in Ophthalmological Medicine ◽

10.1155/2021/9997155 ◽

2021 ◽

Vol 2021 ◽

pp. 1-6

Author(s):

Büşra Köse ◽

Hidayet Erdöl ◽

Dilek Uzlu

Keyword(s):

Visual Acuity ◽

Case Report ◽

Acute Retinal Necrosis ◽

Vascular Involvement ◽

Systemic Steroid ◽

Fundus Fluorescein Angiography ◽

Blurred Vision ◽

Corrected Visual Acuity ◽

Best Corrected Visual Acuity

Purpose. To describe the follow-up and treatment approach of a patient with acute retinal necrosis. Case Report. A 44-year-old male patient, who had complaints of pain in the right eye and blurred vision, was referred to our clinic. Best-corrected visual acuity (BCVA) was 0.4. There was 2+ anterior chamber reaction and diffuse smooth-rounded keratic precipitates. Fundus examination revealed optic nerve and vascular involvement. Fundus fluorescein angiography revealed extensive ischemia in the periphery. Oral antiviral therapy was preferred. In addition, systemic steroid and laser photocoagulation were applied. Nonetheless, retinal detachment developed 2 months later. Detachment, silicon removal, and cataract surgery were performed sequentially. It was observed that the patient was followed for 4.5 years and did not have contralateral eye involvement. Best-corrected visual acuity remained stable at 0.3. Conclusion. Early diagnosis, appropriate treatment, accurate complication management, and frequent follow-up may provide useful vision in patients with acute retinal necrosis.

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Enterococcus faecalisEndogenous Endophthalmitis from Valvular Endocarditis

Case Reports in Ophthalmological Medicine ◽

10.1155/2013/174869 ◽

2013 ◽

Vol 2013 ◽

pp. 1-4 ◽

Cited By ~ 2

Author(s):

Sidnei Barge ◽

Renata Rothwell ◽

Rosário Varandas ◽

Luís Agrelos

Keyword(s):

Visual Acuity ◽

Corneal Edema ◽

Endogenous Endophthalmitis ◽

Lung Edema ◽

Light Perception ◽

Blurred Vision ◽

Posterior Synechia ◽

Intravitreal Treatment ◽

The Right ◽

Made In

We report a case of a 74-year-old female, with a mitral heart valve, who presented with pain and blurred vision in the right eye for 2 days. Her visual acuity was light perception (LP) in the right eye and 20/40 in the left eye. Slit lamp examination showed corneal edema and hypopyon, and a view of the right fundus was impossible. Echography showed vitreous condensation. One day after presentation, the patient developed acute lung edema requiring hospitalization, so she was not submitted to vitreous tap and intravitreal treatment. The cardiac and systemic evaluations revealed a mitral endocarditis secondary toEnterococcus faecalis. The patient improved systemically with treatment with gentamicin, vancomycin, and linezolid. Her visual acuity remained as no LP, and her intraocular pressure (IOP) has been controlled with brimonidine bid despite developing a total cataract with 360° posterior synechia. A cardiac source for endogenous endophthalmitis should be considered in the presence of a prosthetic cardiac valve. The treatment and followup must be made in cooperation with a cardiologist specialist, but the ophthalmologist can play a key role in the diagnosis.

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Giant Intracranial Xanthoma with Blurred Vision as the First Symptom: A Case Report and Literature Review

10.20944/preprints202011.0397.v1 ◽

2020 ◽

Author(s):

Xueting Wang ◽

Xuejiao Li ◽

XuHui Liu ◽

Yizhe Yin ◽

Yalong Dang ◽

...

Keyword(s):

Visual Acuity ◽

Temporal Lobe ◽

Foam Cell ◽

Visual Fields ◽

Density Lipoprotein ◽

The Body ◽

Fundus Photography ◽

Beta Catenin ◽

Blurred Vision ◽

The Right

A 31-year-old male noticed blurred vision in his right eye for five days with no obvious predisposing causes, accompanied by mild dizziness. No obvious nodular lesions were found in the body. The patient’s binocular visual acuity was 20/20. Fundus photography showed the optic nerve swelling and radial superficial retinal hemorrhage of both eyes. Blood panel, urine routine, liver, and kidney function were all normal. Total cholesterol, triglycerides, high-density lipoprotein, and low-density lipoprotein were all in the normal limits. Head MRI showed a mass in the right temporal lobe, clear boundary, and multiple separations, which thinned and disappeared closer to the skull. The right temporal lobe and lateral ventricle were all compressed, with the midline structure shifted to the left. The patient was then transferred to Neurosurgery. During the operation, we observed the tumor had invaded the skull. The actual size of the tumor was 5.6 cm × 7.5 cm × 10.1 cm. Histology revealed foam cell accumulation in the mucous connective tissue of the right temporal lobe. The immunohistochemistry showed: CD34 (+), CD99 (+), EMA (−), GFAP (−), IDH-1 (−), Ki-67 (+) index about 10%, Oliga-2 (−), PR (−), S-100 (−), Vim (+), β-Catenin (+), CD1a (−), CD68 (+). Three months after the removal of the tumor, the visual acuity of both eyes was 20/20; The visual fields were normal, the optic disc edema and retinal hemorrhages had disappeared. MRI indicated the midline structure was back to normal.

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Ocular Biocompatibility of Poly-N-Isopropylacrylamide (pNIPAM)

Journal of Ophthalmology ◽

10.1155/2016/5356371 ◽

2016 ◽

Vol 2016 ◽

pp. 1-6 ◽

Cited By ~ 16

Author(s):

Luiz H. Lima ◽

Yael Morales ◽

Thiago Cabral

Keyword(s):

Inflammatory Reaction ◽

Intravitreal Injections ◽

Tissue Adhesive ◽

Fundus Photography ◽

Histopathological Study ◽

Retinal Diseases ◽

Retinal Damage ◽

Fundus Fluorescein Angiography ◽

The Right

Purpose. To study the safety of intravitreal injections of poly-N-isopropylacrylamide (pNIPAM) tissue adhesive in rabbit eyes. Methods. Twelve study rabbits received an intravitreal injection of 0.1 mL 50% pNIPAM in the right eye. Follow-up examinations included color fundus photography, fundus fluorescein angiography (FA), optical coherence tomography (OCT), and electroretinography (ERG). Subsequent to the last follow-up assessment, the rabbits were sacrificed and histopathological study on the scleral incision sites was performed. Results. All study animals developed mild to moderate levels of inflammatory reaction in the conjunctiva, anterior chamber, and the anterior vitreous during the first month of follow-up. After this period, the level of the inflammatory reaction progressively decreased and completely disappeared after the third month of follow-up. The lens and cornea remained clear during the entire follow-up period. OCT and FA did not show areas of retinal damage or neovascularization. Histological and ERG studies of eyes injected with pNIPAM demonstrated absence of retinal toxicity. Conclusion. Intravitreal injections of pNIPAM were nontoxic in this animal study, and pNIPAM may be safe to be used as a bioadhesive in certain retinal diseases.

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A Vision-Saving Straw in a Retinitis Pigmentosa Patient

Case Reports in Ophthalmology ◽

10.1159/000512059 ◽

2021 ◽

pp. 684-689

Author(s):

Lijun Wang ◽

Jianqing Li ◽

Chi Ren ◽

Peirong Lu

Keyword(s):

Visual Acuity ◽

Retinitis Pigmentosa ◽

Optical Coherence Tomography Angiography ◽

Fundus Photography ◽

Light Perception ◽

Retinitis Pigmentosa Patient ◽

Blurred Vision ◽

Cone Cells ◽

Retinal Arterioles ◽

The Right

We report a case of binocular retinitis pigmentosa (RP) with completely different visual acuity between 2 eyes, which may be contributed by the presence of cilioretinal arteries (CRAs) in 1 eye. A 66-year-old female patient complained of blurred vision after binocular cataract surgeries. Examinations revealed her right eye had 20/25 central visual acuity, but the fellow eye only had light perception. Subsequent fundus photography of both eyes firmed the diagnosis of binocular RP. However, there were some significant differences in retinal vessels, which were attenuated in her left eye in contrast to several spared retinal arterioles in the right eye. Optical coherence tomography angiography showed that the spared vessels might be CRAs. Our case provides an evidence that macular blood flow may contribute to the survival of cone cells in RP.

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Recurrence of Primary Breast Lymphoma Presenting as Bilateral Vitreoretinal Lymphoma

Ocular Oncology and Pathology ◽

10.1159/000515560 ◽

2021 ◽

pp. 1-5

Author(s):

Karishma Habbu ◽

Roshan George ◽

Miguel Materin

Keyword(s):

Brain Mri ◽

B Cell Lymphoma ◽

Intrathecal Chemotherapy ◽

Primary Breast Lymphoma ◽

Blurred Vision ◽

Breast Lymphoma ◽

Central Nervous System Penetration ◽

Vitreoretinal Lymphoma ◽

The Right ◽

Vitreous Biopsy

Purpose: This report describes a case of relapsed primary breast lymphoma (PBL) presenting as vitreoretinal lymphoma (VRL). Methods: We describe the clinical and hematopathologic findings in a patient with relapsed PBL involving the vitreous of both eyes. Results: A 59-year-old woman was treated for PBL with systemic and intrathecal chemotherapy 5 years prior to presentation. Three years later, she presented to an outside clinic with blurred vision in both eyes and bilateral vitritis. She was referred to our clinic with concern for ocular lymphoma. On presentation, the patient’s best-corrected visual acuity was 20/40 in the right eye and 20/25 in the left eye with 3+ vitreous cells in the right eye and 2+ vitreous cells in the left eye. Vitreous biopsy of the right eye revealed CD5-negative/CD10-negative B-cell lymphoma cells on flow cytometry. She had no evidence of disease on brain MRI, lumbar puncture, bone marrow biopsy, or full-body CT scans. She was treated with a regimen of rituximab, methotrexate, procarbazine, and vincristine for central nervous system penetration as well as multiple intraocular injections of methotrexate and rituximab with improvement in vision and ocular inflammation bilaterally. Conclusion: Relapsed PBL can present as bilateral VRL.

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