Apolipoprotein AI-Derived Vitreous Amyloidosis: An Elusive Diagnosis

A 56-year-old female presented with vitreous opacity with gradual visual disturbance in her right eye of 1-year duration. A Non-Hodgkin’s lymphoma had been treated 15 years before. Presenting best-corrected visual acuity (BCVA) was 20/200 in her right eye and 20/25 in her left eye. Intraocular pressure was 18 mm Hg bilaterally. Slit-lamp examination revealed no abnormal findings in the anterior segment of both eyes, including the absence of cells and flare. Fundoscopic examination indicated hazy media with the typical glass-wool-like appearance in her right eye. B-scan ultrasound demonstrated that the vitreous was full of middle-echo spots, vitreous opacities, and posterior vitreous detachment occurred. The patient underwent vitreous biopsy and a standard 25-gauge pars plana vitrectomy (diagnostic and therapeutic). Intraoperatively, the eye was noted to have severe diffuse debris and very strong vitreoretinal adhesions. Cytospin smears prepared from the vitreous aspirate indicated amorphous acellular material that stained positively with Congo Red and showed apple green birefringence on polarized microscopy, consistent with the diagnosis of amyloidosis. A genetic evaluation of tongue tissue demonstrated apolipoprotein AI-derived amyloidosis. The BCVA was 20/25 OU at 3 months postoperatively.

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Surgical Management of Intraocular Silicone Oil Microdroplet

Klinische Monatsblätter für Augenheilkunde ◽

10.1055/a-0786-8856 ◽

2019 ◽

Vol 236 (04) ◽

pp. 568-570

Author(s):

Antoine Safi ◽

Thomas Wolfensberger

Keyword(s):

Visual Field ◽

Surgical Technique ◽

Physical Properties ◽

Silicone Oil ◽

Visual Disturbance ◽

Clinical Recovery ◽

Deep Indentation ◽

Vitreous Opacities ◽

Pars Plana ◽

Disposable Instruments

Abstract Purpose Intraocular silicone oil microdroplets have been described after intravitreal injection of anti-VEGF agents packaged at a compound pharmacy. We present a case with the presence of an intraocular silicone oil microdroplet after a vitreoretinal operation using disposable instruments, and the surgical technique for its removal. Methods A 59-year-old patient who had been operated on for vitreous opacities using a disposable 27-g vitrectomy kit complained of a small round structure floating in the eye. It appeared a few days after surgery. The bubble was not present at all times and it disappeared for days on end. Clinical examination of the vitreous and retina during these uneventful periods was normal. The bubble reappeared intermittently without a link to any specific movement for some time but was again absent once the patient was examined. The physical properties of the mobile round lesion could be identified as lighter than aqueous humor, as it was described as being in the center of the visual field if the head was tilted forward. Results As the patient was very bothered by this bubble, a 23-g vitrectomy was performed. During deep indentation of the pars plana over 360 degrees, a tiny bubble of silicone oil could be found buried in the peripheral vitreous base, and controlled aspiration under deep indentation was performed. The patient has been without symptoms since the removal of the droplet and made an uneventful clinical recovery. Conclusion Microdroplets of silicone oil may be present in disposable vitreoretinal instruments and stay in the eye after surgery, causing a visual disturbance. The origin of these droplets may be linked to the plastic tubing of the instruments.

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The Importance of Fluconazole in Treatment of Endogenous Endophtalmitis in Patients Prior Treated Using Negative Pressure Therapy for Wound Closure Contaminated with Meticillin-resistant Staphylococcus aureus

Revista de Chimie ◽

10.37358/rc.17.7.5725 ◽

2017 ◽

Vol 68 (7) ◽

pp. 1598-1601 ◽

Cited By ~ 1

Author(s):

Anisia Iuliana Alexa ◽

Roxana Ciuntu ◽

Alina Cantemir ◽

Nicoleta Anton ◽

Ciprian Danielescu ◽

...

Keyword(s):

Antifungal Agents ◽

Fungal Infections ◽

Prolonged Treatment ◽

Endogenous Endophthalmitis ◽

Pressure Therapy ◽

First Case ◽

Severe Infections ◽

Pars Plana ◽

Delay In Treatment ◽

Vitreous Biopsy

Severe infections with C. albicans should be treated promptly with antifungal agents, any delay in treatment increases the risk of endophthalmitis. The systemic Amphotericin B therapy is the gold standard in the treatment of endophthalmitis, but in the case of fungal infections it has not yet been determined. Numerous studies have shown that the use of Fluconazole is effective in the treatment of fungal endophthalmitis. In this paper, we report two cases (3 eyes) that have been presented for the same accusations of significant decrease of AV (visual acuity), ocular pain and blepharospasm suddenly installed, both of which required urgent antibiotic and intravenous antifungal treatment. Both are diagnosed with endogenous endophthalmitis and vitreous biopsy + VPP (pars plana vitrectomy) are performed, with a negative result of the vitreous culture. In both situations the treatment was with antibiotic and systemic antifungals. Postoperatively, evolution was favorable in the first case and less favorable in the second one. The prognosis depends on the virulence of the microorganisms and the time elapsed until initiation of the treatment. Also, the presence of risk factors such as diabetes, sepsis, recent abdominal surgery (C. Albicans is part of the comesary flora of the digestive tract) have influenced the prognosis decisively. Severe infections with C. albicans should be promptly treated with antifungal agents, any delay in treatment increases the risk of endophthalmitis. Even when prolonged treatment of candidemia is instituted, 3% of patients can develop endogenous endophthalmitis, so ocular evaluation is particularly important for patients immobilized in anesthesia and intensive care units.

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Changes in anterior segment optical coherence tomography following pars plana vitrectomy without tamponade

International Journal of Retina and Vitreous ◽

10.1186/s40942-021-00285-w ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Alireza Khodabande ◽

Massood Mohammadi ◽

Hamid Riazi-Esfahani ◽

Shahab Karami ◽

Massood Mirghorbani ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Anterior Chamber ◽

Pars Plana Vitrectomy ◽

Anterior Segment ◽

Anterior Chamber Depth ◽

Optical Coherence ◽

Mean Values ◽

Iop Measurement ◽

Pars Plana ◽

The Mean

Abstract Background To evaluate changes in anterior segment morphology on anterior segment optical coherence tomography (AS-OCT) following pars plana vitrectomy (PPV) without tamponade. Methods Patients who underwent PPV without tamponade for epiretinal membrane were evaluated. Eligible patients underwent intraocular pressure (IOP) measurement and AS-OCT preoperatively as well as 1 month and 6 months post-operatively. Anterior chamber width (ACW), anterior chamber depth (ACD), trabecular iris angle (TIA), angle opening distance at 500 and 750 µm (AOD), and trabecular iris space area at 500 and 750 µm (TISA) at four quadrants were recorded and analyzed. Additionally, the mean values of TIA (MTIA), AOD (MAOD), and TISA (MTISA) for each eye (mean of four quadrants) were analyzed. Results 23 patients completed the study. The mean age of participants was 56.4 ± 3.6 years of age and 13/23 (56%) were female. Mean IOP of patients was 18.1 ± 1.1, 18.3 ± 1.1, and 18.1 ± 1.2 preoperatively,1 month post-operatively, and 6 months post-operatively, respectively. (p = 0.83). No difference was detected post-operatively in measurements of ACW, ACD, MTIA, MAOD500, MAOD750, MTISA500, and MTISA750. Conclusion Pars plana vitrectomy without tamponade was not associated with changes in anterior chamber morphology.

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Vitrectorhexis in penetrating eye injuries in adults

European Journal of Ophthalmology ◽

10.1177/1120672118804387 ◽

2018 ◽

Vol 29 (6) ◽

pp. 689-693

Author(s):

Miklós D Resch ◽

Anikó Balogh ◽

Gábor L Sándor ◽

Zsuzsanna Géhl ◽

Zoltán Zsolt Nagy

Keyword(s):

Foreign Body ◽

Pars Plana Vitrectomy ◽

Anterior Segment ◽

Posterior Chamber ◽

Ocular Injury ◽

Eye Injuries ◽

Anterior Capsule ◽

Safe Alternative ◽

Anterior Lens Capsule ◽

Pars Plana

Introduction: Vitrectorhexis is an alternative for manual continuous curvilinear capsulorhexis originally developed for paediatric cataract surgery. The aim of our study was the evaluation of the technique in adult patients with penetrating ocular injury and traumatic cataracts. Methods: Eight eyes of 8 patients (23–41 years, all males) had penetrating mechanical corneal trauma. Anterior lens capsule was penetrated in all cases and additional posterior capsule defect in five cases. Intraocular foreign body was detected in one case in the crystalline lens and in two cases in the posterior segment. Standard 23G infusion cannula and vitreous cutter were applied to perform anterior capsule opening, removal of lens material, anterior vitrectomy and pars plana vitrectomy if needed. No phacoemulsification or irrigation/aspiration probe was used. Results: Vitrectorhexis could be performed in 7 out of 8 cases with the preservation of peripheral anterior capsule; primary implantation of posterior chamber intraocular lens was possible in all cases (in the bag in three eyes and into the sulcus in five eyes). Anterior chamber was stable in all cases intraoperatively, and no dropped nucleus or lens fragment loss was observed. Surgery was combined with pars plana vitrectomy in three cases, with foreign body removal (when necessary). No postoperative complication occurred. Conclusion: Vitrectorhexis was found to be an effective and safe alternative method in the management of complex anterior segment trauma cases. With its use, traditional cataract surgical devices can be substituted and additional benefits of vitreous cutter can be utilized in selected cases, especially in young adults.

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High-Frequency Ultrasound Biomicroscopy of the Anterior Segment Morphometry before and Immediately after Pars Plana Vitrectomy

European Journal of Ophthalmology ◽

10.5301/ejo.2010.4949 ◽

2011 ◽

Vol 21 (2) ◽

pp. 173-178 ◽

Cited By ~ 12

Author(s):

Meira Neudorfer ◽

Nir Oren ◽

Adiel Barak

Keyword(s):

High Frequency ◽

Pars Plana Vitrectomy ◽

Anterior Segment ◽

Ultrasound Biomicroscopy ◽

High Frequency Ultrasound ◽

Pars Plana ◽

Frequency Ultrasound

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Evaluation and Management

Retinal Detachment ◽

10.1093/oso/9780195330823.003.0008 ◽

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.

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Pathophysiology, Classification, Clinical Diagnosis and Treatment of Primary Epiretinal Membrane

Güncel Retina Dergisi (Current Retina Journal) ◽

10.37783/crj-0103 ◽

2018 ◽

pp. 262-267

Keyword(s):

Clinical Examination ◽

Epiretinal Membrane ◽

Posterior Vitreous Detachment ◽

Internal Limiting Membrane ◽

Non Invasive ◽

Diagnosis And Classification ◽

Pars Plana ◽

Vitreomacular Interface

Epiretinal membrane (ERM), also known as macular pucker, premacular fibroplasia, premacular gliosis, or cellophane maculopathy is a common vitreoretinal interface pathology that can result in mild to moderate visual impairment with an impact on the quality of life. ERM can be classified as primary “idiopathic” or secondary. Most ERMs occur in individuals older than 50 years, and the prevalence of ERM increases as age increases. The pathological mechanisms are not entirely known, however, the posterior vitreous detachment is thought to be key. Diagnosis and classification of ERM are based on clinical examination findings. However, high resolution spectral domain-optic coherence tomographies (SD-OCTs) have proven to be more sensitive than clinical examination for the diagnosis of numerous disorders of the vitreomacular interface, including ERM. SD-OCTs enable the pre-and postoperative comparison of macular structures in a non-invasive examination. In treatment, surgical intervention entails pars plana vitrectomy with ERM removal with or without internal limiting membrane (ILM) removal. Good visual recovery was present in most patients after surgery.

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