Surgical Management of a Patient with Anterior Megalophthalmos, Lens Subluxation, and a High Risk of Retinal Detachment

The early development of lens opacities and lens subluxation are the most common causes of vision loss in patients with anterior megalophthalmos (AM). Cataract surgery in such patients is challenging, however, because of anatomical abnormalities. Intraocular lens dislocation is the most common postoperative complication. Patients with AM also seem to be affected by a type of vitreoretinopathy that predisposes them to retinal detachment. We here present the case of a 36-year-old man with bilateral AM misdiagnosed as simple megalocornea. He had a history of amaurosis in the right eye due to retinal detachment. He presented with vision loss in the left eye due to lens subluxation. Following the removal of the subluxated lens, it was deemed necessary to perform a vitrectomy in order to prevent retinal detachment. Seven months after surgery, an Artisan® Aphakia iris-claw lens was implanted in the anterior chamber. Fifteen months of follow-up data are provided.

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Retinal vasoproliferative tumour secondary to retinitis pigmentosa sine pigmento

BMJ Case Reports ◽

10.1136/bcr-2020-240878 ◽

2021 ◽

Vol 14 (5) ◽

pp. e240878

Author(s):

Albert John Bromeo ◽

Sweet Jorlene Lerit ◽

Amadeo Veloso ◽

Gary John Mercado

Keyword(s):

Retinal Detachment ◽

Retinitis Pigmentosa ◽

Laser Photocoagulation ◽

Vision Loss ◽

Peripheral Retina ◽

Focal Laser Photocoagulation ◽

Feeder Vessel ◽

Eye Examination ◽

The Right

Retinitis pigmentosa can be associated with exudative vasculopathy in rare instances, which can manifest as retinal vasoproliferative tumours. We present the case of a 33-year-old woman previously diagnosed with retinitis pigmentosa sine pigmentosa in both eyes. She was asymptomatic and just came in for a routine follow-up eye examination. Thorough examination of the peripheral retina on the right eye revealed a dome-shaped retinal tumour with a feeder vessel and surrounding exudative changes at the superotemporal periphery, consistent with a secondary retinal vasoproliferative tumour from retinitis pigmentosa. She subsequently underwent focal laser photocoagulation of the tumour which resulted in tumour stabilisation. While exudative vasculopathy is very uncommon in retinitis pigmentosa, ophthalmologists need to be aware of its occurrence in such patients. Vision loss may occur from exudation, haemorrhage, retinal detachment and neovascularisation. A thorough examination of the peripheral retina is warranted in these cases.

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Choroidal Neovascularization in Multifocal Choroiditis after Dabrafenib and Trametinib

European Journal of Ophthalmology ◽

10.5301/ejo.5001013 ◽

2017 ◽

Vol 27 (6) ◽

pp. e184-e186 ◽

Cited By ~ 3

Author(s):

Giorgia C. Albertini ◽

Eleonora Corbelli ◽

Maurizio Battaglia Parodi ◽

Francesco Bandello

Keyword(s):

Combination Therapy ◽

Metastatic Melanoma ◽

Choroidal Neovascularization ◽

Multimodal Imaging ◽

Vision Loss ◽

Functional Improvement ◽

Multifocal Choroiditis ◽

History Of ◽

The Right

Purpose To describe a case of bilateral choroidal neovascularization (CNV) in multifocal choroiditis (MFC) associated with dabrafenib and trametinib chemotherapy for metastatic melanoma. Case We present a case of a 57-year-old man with MFC who underwent combination therapy with dabrafenib plus trametinib for metastatic melanoma. The patient presented to our ophthalmology department complaining of bilateral vision loss of 2 days’ duration. He underwent multimodal imaging showing a MFC reactivation complicated by bilateral CNV. The patient underwent 3 ranibizumab injections in the right eye and 7 ranibizumab injections in the left eye. Anatomical and functional improvement has been observed. Conclusions This report emphasizes the importance of strict ophthalmologic follow-up in patients with metastatic melanoma treated with dabrafenib plus trametinib since rare severe ocular toxicities can occur, especially in patients with a history of uveitis.

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Scleral Buckling and Corneal Topography in a Rare Case of Keratoconus with Rhegmatogenous Retinal Detachment in an Indian Patient

Nepalese Journal of Ophthalmology ◽

10.3126/nepjoph.v10i1.21698 ◽

2018 ◽

Vol 10 (1) ◽

pp. 77-81

Author(s):

B N Kalpana ◽

Y D Shilpa ◽

Sneha Priya Prabhakar ◽

S M Ram Prakash ◽

B C Hemalatha ◽

...

Keyword(s):

Atopic Dermatitis ◽

Retinal Detachment ◽

Rhegmatogenous Retinal Detachment ◽

Scleral Buckling ◽

Corneal Topography ◽

Vertical Meridian ◽

History Of ◽

Pars Plana ◽

The Right

Background: Management of Rhegmatogenous Retinal Detachment (RRD) in keratoconus could be challenging in various aspects. Visualisation of fundus due to altered reflex along with axial myopia could pose difficulty while performing pars plana vitrectomy. Our patient underwent Scleral Buckling with good anatomical results. We came across an isolated case of Keratoconus with Retinal detachment without any pre existing comorbidities unlike earlier reports where patients with history of atopic dermatitis had Keratoconus associated with RRD. The main purpose was to know the outcome of scleral buckling and its effect on corneal topography in a case of keratoconus with RRD.Case: A 35 year old female presented with diminution of vision in both eyes since childhood, but more so in the right eye (RE) since last 6 months. She was aphakic with VA of 1/60 and 2/60 in the right and left eye respectively. She was diagnosed as both eyes keratoconus with RE near total rhegmatogenous retinal detachment (RRD) with sub retinal gliosis. She gave no history of vigorous eye rubbing or atopic dermatitis. For RE she underwent uneventful scleral buckling surgery.Observation: In post operative follow up, the retina was attached. Placido based corneal topography was done pre operatively with keratometry reading of RE – K1 62.79@96º, K2 – 55.92@6˚ and repeated at the end of three months follow up with readings of RE – K1-61.45@98˚, K2- 54.50@ 8˚. There were minimal changes in the keratometry values post operatively with flattening of vertical meridian and horizontal meridian.Conclusion: In keratoconus, RD can occur without any predisposed or preceding condition. Although majority of cases are associated with atopic dermatitis and eye rubbing. Scleral buckling (SB) was successful with good functional and anatomical outcome., however it has minimal effect on corneal topography.

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Adenoid cystic carcinoma of the labium oris with rare metastasis to the pleural cavity

BMJ Case Reports ◽

10.1136/bcr-2020-237622 ◽

2021 ◽

Vol 14 (1) ◽

pp. e237622

Author(s):

Osama Mosalem ◽

Anas Alsara ◽

Fawzi Abu Rous ◽

Borys Hrinczenko

Keyword(s):

Side Effects ◽

Adenoid Cystic Carcinoma ◽

Pleural Cavity ◽

Epigastric Pain ◽

Asian Woman ◽

Upper Lip ◽

Adenoid Cystic ◽

History Of ◽

The Right

A 57-year-old Southeast Asian woman with a remote history of adenoid cystic carcinoma (ACC) of the right labium superius oris (upper lip) presented to the hospital with vague epigastric pain. On workup, she was found to have multiple pleural nodules. Histopathology confirmed the diagnosis of metastatic ACC. After 8 months of active surveillance, evidence of disease progression was found and the patient was started on pembrolizumab. Follow-up after starting pembrolizumab showed stable disease with no significant side effects.

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Recurrent Intraocular Lens Dislocation in a Patient with Familial Ectopia Lentis

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18094545 ◽

2021 ◽

Vol 18 (9) ◽

pp. 4545

Author(s):

Tomasz K. Wilczyński ◽

Alfred Niewiem ◽

Rafał Leszczyński ◽

Katarzyna Michalska-Małecka

Keyword(s):

Intraocular Lens ◽

Pars Plana Vitrectomy ◽

Vision Loss ◽

Silicone Oil ◽

Single Case ◽

Recurrent Dislocation ◽

Ectopia Lentis ◽

Pars Plana ◽

The Right

A 36-year-old patient presented to the hospital with recurrent dislocation of the intraocular lens (IOL). The patient with the diagnosis of familial ectopia lentis was first operated on for crystalline lens subluxation in the left eye in 2007 and in the right eye in 2009. In both eyes, lens extraction with anterior vitrectomy and transscleral fixation of a rigid IOL was performed. In 2011, the IOL in the right eye luxated into the vitreous cavity due to ocular trauma. The patient underwent a pars plana vitrectomy with the IOL resuturation to the sclera. Seven years later, a spontaneous vision loss in the right eye was caused by a retinal detachment. The pars plana vitrectomy with silicone oil tamponade and a consequential oil removal three months later were performed in 2018. The follow-up examination revealed recurrent IOL dislocation in the same eye. Due to a history of previous suture-related complications a decision was made to remove the subluxated rigid polymethyl-methacrylate (PMMA) IOL and fixate to sclera a sutureless SOLEKO FIL SSF Carlevale lens. The purpose of this report is to present a single case of a 36-year-old patient who was presented to the hospital with recurrent dislocation of the intraocular lens. In a three-month follow-up period, a good anatomical and functional outcome was finally obtained with transscleral sutureless intraocular lens. This lens is an option worth considering especially in a young patient with a long life expectancy and physically active.

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Catamenial pneumothorax with bubbling up on the diaphragmatic defects: a case report

BMC Women s Health ◽

10.1186/s12905-021-01318-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Bo Dong ◽

Chun-Li Wu ◽

Yin-liang Sheng ◽

Bin Wu ◽

Guan-Chao Ye ◽

...

Keyword(s):

Thoracoscopic Surgery ◽

Lung Lesion ◽

Parietal Pleura ◽

Catamenial Pneumothorax ◽

Endometrial Cells ◽

Retrograde Menstruation ◽

History Of ◽

The Right ◽

Thoracic Endometriosis

Abstract Background Catamenial pneumothorax is characterized by spontaneous recurring pneumothorax during menstruation, which is a common clinical manifestation of thoracic endometriosis syndrome. There are still controversies about its pathogenesis. Case presentation A 43-year-old woman with a history of endometriosis came to our hospital due to recurring pneumothorax during menstruation. Uniportal Video-assisted Thoracoscopic Surgery (VATS) exploration was performed on the eve of menstruating. We thoroughly explored the diaphragm, visceral and parietal pleura: The lung surface was scattered with yellowish-brown implants; no bullae were found; multiple diaphragmatic defects were found on the dome. And surprisingly, we caught a fascinating phenomenon: Bubbles were slipping into pleural cavity through diaphragmatic defects. We excised the diaphragmatic lesions and wedge resected the right upper lung lesion; cleared the deposits and flushed the thoracic cavity with pure iodophor. Diaphragmatic lesions confirmed the presence of endometriosis, and interestingly enough, microscopically, endometrial cells were shedding with impending menses. After a series of intraoperative operations and postoperative endocrine therapy, the disease did not recur after a period of follow-up. Conclusion We have witnessed the typical signs of catamenial pneumothorax at the accurate timing: Not only observed the process of gas migration macroscopically, but also obtained pathological evidence of diaphragmatic periodic perforation microscopically, which is especially precious and confirms the existing theory that retrograde menstruation leads to diaphragmatic endometriosis, and the diaphragmatic fenestration is obtained due to the periodic activities of ectopic endometrium.

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Ab interno 180-degree trabeculectomy with a dual blade in a patient with refractory primary congenital glaucoma

European Journal of Ophthalmology ◽

10.1177/11206721211010402 ◽

2021 ◽

pp. 112067212110104

Author(s):

Mehmet Talay Koylu ◽

Fatih Mehmet Mutlu ◽

Alper Can Yilmaz

Keyword(s):

Intraocular Pressure ◽

Female Patient ◽

Congenital Glaucoma ◽

Safe Procedure ◽

Primary Congenital Glaucoma ◽

History Of ◽

Kahook Dual Blade ◽

The Right ◽

Ab Interno

A 13-year-old female patient with refractory primary congenital glaucoma (PCG) in the right eye who had a history of multiple glaucoma operations underwent ab interno 180-degree trabeculectomy with the Kahook Dual Blade (KDB) targeting the nasal and inferior angles. On postoperative day 1, the intraocular pressure (IOP) of the right eye reduced from 43 to 15 mmHg while on medical therapy. The patient maintained this IOP level throughout the 6-month follow-up. Ab interno KDB trabeculectomy targeting both nasal and inferior angles may be an effective and safe procedure for the treatment of PCG even in eyes with a history of previously failed glaucoma procedures.

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Dematiaceous fungal invasion of a bandage contact lens

BMJ Case Reports ◽

10.1136/bcr-2020-240029 ◽

2021 ◽

Vol 14 (2) ◽

pp. e240029

Author(s):

Anirban Dutta ◽

Sujata Das ◽

Himanshu Sekhara Behera ◽

Ruchi Mittal

Keyword(s):

Contact Lens ◽

Periodic Acid ◽

Significant Risk ◽

Dematiaceous Fungi ◽

Periodic Acid Schiff ◽

Bandage Contact Lens ◽

History Of ◽

Eye Examination ◽

The Right

A 61-year-old man presented with a 1-month history of reduced vision, redness and pain in the right eye. Examination revealed a bandage contact lens (BCL) in situ with diffuse, pigmented deposits. On removal, the underlying cornea was found to be clear. He had been prescribed the BCL 6 months ago following a deep-seated corneal foreign body removal and was unable to follow-up subsequently.The BCL was sent for microbiological and histopathological evaluation. The culture revealed growth of Cladosporium spp, a dematiaceous fungi. Periodic acid–Schiff staining revealed infiltration of pigmented fungal filaments into the substance of the BCL.While contact lens deposits are a frequent finding, fungal deposits are seldom noted. Irregular follow-up and improper lens maintenance are significant risk factors for the same. Early identification and subsequent removal of the lens is vital to prevent infection of the underlying ocular structures.

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Loss of Visual Acuity after Successful Surgery for Macula-On Rhegmatogenous Retinal Detachment in a Prospective Multicentre Study

Journal of Ophthalmology ◽

10.1155/2015/821864 ◽

2015 ◽

Vol 2015 ◽

pp. 1-8 ◽

Cited By ~ 3

Author(s):

Salvatore Di Lauro ◽

Melissa Castrejón ◽

Itziar Fernández ◽

Jimena Rojas ◽

Rosa M. Coco ◽

...

Keyword(s):

Visual Acuity ◽

Retinal Detachment ◽

Visual Loss ◽

Vision Loss ◽

Multicentric Study ◽

Prospective Multicentre Study ◽

Snellen Chart ◽

Pars Plana ◽

Phakic Eyes

Purpose. To quantify the frequency of visual loss after successful retinal detachment (RD) surgery in macula-on patients in a multicentric, prospective series of RD.Methods. Clinical variables from consecutive macula-on RD patients were collected in a prospective multicentric study. Visual loss was defined as at least a reduction in one line in best corrected visual acuity (VA) with Snellen chart. The series were divided into 4 subgroups: (1) all macula-on eyes (n=357); (2) macula-on patients with visual loss at the third month of follow-up (n=53) which were further subdivided in (3) phakic eyes (n=39); and (4) pseudophakic eyes (n=14).Results. Fifty-three eyes (14.9%) had visual loss three months after surgery (n=39phakic eyes;n=14pseudophakic eyes). There were no statistically significant differences between them regarding their clinical characteristics. Pars plana vitrectomy (PPV) was used in 67.2% of cases, scleral buckle in 57.7%, and scleral explant in 11.9% (36.1% were combined procedures).Conclusions. Around 15% of macula-on RD eyes lose VA after successful surgery. Development of cataracts may be one cause in phakic eyes, but vision loss in pseudophakic eyes could have other explanations such as the effect of released factors produced by retinal ischemia on the macula area. Further investigations are necessary to elucidate this hypothesis.

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Spontaneous resolution of invasive cerebral aspergillosis following partial resection in a medically untreated infant

Journal of Neurosurgery Pediatrics ◽

10.3171/2012.4.peds1275 ◽

2012 ◽

Vol 10 (1) ◽

pp. 71-74 ◽

Cited By ~ 3

Author(s):

Sumit Thakar ◽

Yasha T. Chickabasaviah ◽

Alangar S. Hegde

Keyword(s):

Emergency Services ◽

Mass Effect ◽

Cerebral Hemiatrophy ◽

Right Cerebral Hemisphere ◽

History Of ◽

Subcortical Regions ◽

The Right ◽

Mri Study ◽

The Brain

Invasive craniocerebral aspergillosis, often encountered in an immunocompromised setting, is almost uniformly fatal despite radical surgical and medical management, and is frequently a necropsy finding. The authors report a unique, self-resolving clinical course of this aggressive infection in a 10-month-old infant. The infant was brought to the emergency services in altered sensorium with a 1-week history of left-sided hemiparesis, excessive irritability, and vomiting. An MRI study of the brain revealed multiple, heterogeneously enhancing lesions in the right cerebral hemisphere with mass effect. The largest lesion in the frontotemporal cortical and subcortical regions was decompressed on an emergent basis. Histopathological findings were suggestive of invasive aspergillosis, although there was no evidence of the infection in the lungs or paranasal sinuses. Computed tomography–guided aspiration of the remaining lesions and follow-up antifungal therapy were recommended. The parents, however, requested discharge without further treatment. The child was seen at a follow-up visit 3 years later without having received any antifungal treatment. Imaging showed resolution of the infection and features of Dyke-Davidoff-Masson syndrome (cerebral hemiatrophy). This report of invasive cerebral aspergillosis resolving without medical therapy is the first of its kind. Its clinicoradiological aspects are discussed in light of previously reported cases.

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