scholarly journals Two Patients with Atypical Choroidal Detachment

2021 ◽  
pp. 315-319
Author(s):  
Joseph W. Fong ◽  
Heather V. Broyles ◽  
Nour Y. Atassi ◽  
Ahmed B. Sallam ◽  
Sami H. Uwaydat
Keyword(s):  
Retinal Detachment ◽  
Vision Loss ◽  
Oral Prednisone ◽  
Subretinal Fluid ◽  
Visual Outcome ◽  
Posterior Pole ◽  
Choroidal Detachment ◽  
Motion Vision ◽  
Diagnostic Challenge ◽  
History Of

Serous choroidal detachment that is caused by rhegmatogenous retinal detachment (RRD) may present a significant diagnostic challenge as delayed recognition and repair of the underlying RRD can severely impact the final anatomical and visual outcome. We report 2 consecutive patients with atypical choroidal detachments who were later found to have underlying RRDs. A 71-year-old female presented with a 1-week history of painful vision loss and floaters in the left eye. Examination revealed choroidal detachments in the nasal and temporal periphery and an overlying retinal detachment with shifting subretinal fluid. However, no retinal breaks were identified. An extensive laboratory workup and imaging of the orbits were unrevealing. She was treated with 80 mg oral prednisone daily for 2 weeks with subsequent resolution of the choroidals but persistence of the retinal detachment. Similarly, a 52-year-old male presented with a 3-week history of flashes and floaters followed by painful vision loss in the left eye 1 day prior to presentation. He had hand motion vision OS and the intraocular pressure was undetectable by hand-held tonometry OS. Dense brunescent cataract prevented adequate viewing of the posterior pole. B-scan ultrasonography revealed a funnel retinal detachment, with homogenous choroidal echogenicities suggestive of hemorrhagic choroidal detachment. Extensive laboratory workup was unrevealing. The patient was started on 60 mg oral prednisone and re-evaluated every 2 days, but ultrasonography revealed persistence of the choroidal detachment after 1 week. The diagnosis of RRD with an associated choroidal detachment should be considered, even in the absence of an identifiable causative retinal break.

PRO score: predictive scoring system for visual outcomes after rhegmatogenous retinal detachment repair

2021 ◽  
pp. bjophthalmol-2021-320440
Author(s):  
Louis Z Cai ◽  
Jeffrey Lin ◽  
Matthew R Starr ◽  
Anthony Obeid ◽  
Edwin H Ryan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Retinal Detachment ◽  
Scoring System ◽  
Rhegmatogenous Retinal Detachment ◽  
Vision Loss ◽  
Visual Outcome ◽  
Visual Outcomes ◽  
Poor Visual Outcome ◽  
History Of ◽  
Endothelial Growth Factor

Background/aimsTo compare risk factors for poor visual outcomes in patients undergoing primary rhegmatogenous retinal detachment (RRD) repair and to develop a scoring system.MethodsAnalysis of the Primary Retinal detachment Outcomes (PRO) study, a multicentre interventional cohort of consecutive primary RRD surgeries performed in 2015. The main outcome measure was a poor visual outcome (Snellen VA ≤20/200).ResultsA total of 1178 cases were included. The mean preoperative and postoperative logMARs were 1.1±1.1 (20/250) and 0.5±0.7 (20/63), respectively. Multivariable logistic regression identified preoperative risk factors predictive of poor visual outcomes (≤20/200), including proliferative vitreoretinopathy (PVR) (OR 1.26; 95% CI 1.13 to 1.40), history of antivascular endothelial growth factor (VEGF) injections (1.38; 1.11 to 1.71), >1-week vision loss (1.17; 1.08 to 1.27), ocular comorbidities (1.18; 1.00 to 1.38), poor presenting VA (1.06 per initial logMAR unit; 1.02 to 1.10) and age >70 (1.13; 1.04 to 1.23). The data were split into training (75%) and validation (25%) and a scoring system was developed and validated. The risk for poor visual outcomes was 8% with a total score of 0, 17% with 1, 29% with 2, 47% with 3, and 71% with 4 or higher.ConclusionsIndependent risk factors were compared for poor visual outcomes after RRD surgery, which included PVR, anti-VEGF injections, vision loss >1 week, ocular comorbidities, presenting VA and older age. The PRO score was developed to provide a scoring system that may be useful in clinical practice.

Internal limiting membrane graft as a treatment for the retinal detachment secondary to an optic disc coloboma

2021 ◽  
pp. 112067212199268
Author(s):  
Jorge Fernández-Engroba ◽  
Muhsen Saman ◽  
Jeroni Nadal
Keyword(s):  
Visual Acuity ◽  
Retinal Detachment ◽  
Optic Disc ◽  
Subretinal Fluid ◽  
Visual Outcome ◽  
Internal Limiting Membrane ◽  
Subretinal Space ◽  
Direct Closure ◽  
Retinal Tears ◽  
Optic Disc Coloboma

Purpose: To report our anatomical outcome with the internal limiting membrane (ILM) graft procedure in the management of rhegmatogenous retinal detachment (RRD) secondary to optic disc coloboma (ODC). Methods: Description of a new surgical procedure in one eye of one patient who underwent pars plana vitrectomy (PPV) combined with ILM graft technique. Subsequent follow-up included optical coherence tomography (OCT) and visual acuity. Results: After only 1 week, the OCT revealed the ILM graft plugging the retinal tear with complete resorption of subretinal fluid. The sealing effect of this graft persisted after 6 months. However, visual outcome was poor and corrected distance visual acuity was 20/200 as a result of the previous long-standing retinal detachment with loss of photoreceptors. Conclusion: We suggest that ILM graft could be performed as a first line treatment in the management of RRD secondary to ODC. This direct closure of the retinal tears, allows a quick and effective interruption of the communication between the subretinal space and the vitreous cavity. Detecting these retinal tears and applying this technique as soon as possible could achieve not only an earlier anatomical success but obtain good visual results in retinal tears with RRD secondary to ODC. Further studies will be necessary to provide more evidences

Non-central serous chorioretinopathy in a patient with systemic lupus erythematosus and hydroxychloroquine retinopathy

2021 ◽  
Vol 14 (1) ◽  
pp. e237243
Author(s):  
Diogo Hipolito-Fernandes ◽  
Maria Elisa Luís ◽  
Rita Flores ◽  
Rita Anjos
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Central Serous Chorioretinopathy ◽  
Vision Loss ◽  
Subretinal Fluid ◽  
Ophthalmological Examination ◽  
Systemic Lupus ◽  
Diagnostic Challenge ◽  
Hydroxychloroquine Retinopathy ◽  
The Right

Subretinal fluid accumulation in a patient with systemic lupus erythematosus (SLE) may represent a diagnostic challenge. We present a case of a 43-year-old man with baseline diagnosis of SLE and hydroxychloroquine-associated maculopathy who reported progressive vision loss on the right eye, associated with corticosteroids use for an arthritic crisis. Ophthalmological examination did not reveal any acute finding. On optical coherence tomography, subretinal fluid in the perifoveal area was visible on the right eye, with corresponding enlargement of the visual field defect. An increased choroidal thickness was also visible. Fluorescein angiography revealed, on the right eye, two pinpoint areas of leakage and indocyanine green angiography signs of choroidal vascular hyperpermeability. Considering a diagnosis of a non-central central serous chorioretinopathy, corticosteroids use was interrupted, with resolution of the subretinal fluid. This case illustrates the relevance of a multimodal imaging approach to guide the diagnosis of patient with an SLE with subretinal fluid.

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

2017 ◽  
Vol 8 (1) ◽  
pp. 61-66 ◽  
Author(s):  
María Carmen Guixeres Esteve ◽  
Augusto Octavio Pardo Saiz ◽  
Lucía Martínez-Costa ◽  
Samuel González-Ocampo Dorta ◽  
Pedro Sanz Solana
Keyword(s):  
Retinal Detachment ◽  
Vision Loss ◽  
Lens Subluxation ◽  
Intraocular Lens Dislocation ◽  
Common Causes ◽  
History Of ◽  
Anterior Megalophthalmos ◽  
The Right ◽  
Iris Claw

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.

Standardized scleral buckling approach in the management of noncomplex primary rhegmatogenous retinal detachment

2020 ◽  
pp. 112067212094020
Author(s):  
Paolo Radice ◽  
Elisa Carini ◽  
Patrizio Seidenari ◽  
Andrea Govetto
Keyword(s):  
Retinal Detachment ◽  
Rhegmatogenous Retinal Detachment ◽  
Vision Loss ◽  
Case Series ◽  
Subretinal Fluid ◽  
Scleral Buckling ◽  
Full Thickness Macular Hole ◽  
Air Tamponade ◽  
Subretinal Fluid Drainage ◽  
Anatomical Success

Purpose: To analyze the anatomical and functional outcomes of a standardized scleral buckling approach in patients with noncomplex primary rhegmatogenous retinal detachment (RRD). Methods: Retrospective institutional case series of 135 eyes of 131 patients diagnosed with noncomplex primary RRD. All patients underwent scleral buckling surgery with the placement of an encircling 5 mm oval sponge at 15 ± 2 mm posteriorly from the limbus, cryopexy, subretinal fluid drainage, and air tamponade. Results: Final anatomical success at 12 months was achieved in all 135 eyes (100%). Primary anatomical surgical success was obtained in 127 out of 135 eyes (94%), while re-detachment occurred in eight out of 135 cases (6%). Primary anatomical success was significantly lower in pseudophakic eyes ( p < 0.001). At the end of the follow-up period, no vision loss was observed in any patient and both sphere and cylinder refraction shift was mild. There was a low rate of postoperative complications. Nine out of 135 eyes (6.6%) developed full thickness macular hole, whether in 24 out of 135 eyes (17.8%) epiretinal membrane development was noticed. Conclusion: A standardized scleral buckling approach for primary noncomplex RRD may be effective. The technique is reproducible, easier, and quicker to perform if compared to classic scleral buckling procedures, suggesting that it may represent a valuable surgical option. Special care is needed in the management of pseudophakic RRD due to higher risk of RRD recurrence.

Association of Spectral-Domain Optical Coherence Tomography Findings with Visual Outcome of Macula-Off Rhegmatogenous Retinal Detachment Surgery

2015 ◽  
Vol 234 (2) ◽  
pp. 83-90 ◽  
Author(s):  
Hae Min Kang ◽  
Sung Chul Lee ◽  
Christopher Seungkyu Lee
Keyword(s):  
Optical Coherence Tomography ◽  
Retinal Detachment ◽  
Rhegmatogenous Retinal Detachment ◽  
Subretinal Fluid ◽  
Visual Outcome ◽  
Spectral Domain ◽  
Optical Coherence ◽  
Foveal Thickness ◽  
Central Foveal Thickness ◽  
Sd Oct

Purpose: To identify prognostic factors for the visual outcome for patients with macula-off rhegmatogenous retinal detachment (RRD). Methods: The medical records of 27 patients (27 eyes) with macula-off RRD were retrospectively investigated. In addition to clinical characteristics, spectral-domain optical coherence tomography (SD OCT) images were analyzed. Results: The central foveal thickness at baseline was 923 ± 499.5 µm, and the mean height of the subretinal fluid was 697.8 ± 463.6 µm. Dropout of backreflection at the fovea was detected on preoperative SD OCT in 8 patients (29.6%). The external limiting membrane was disrupted in 5 patients (18.5%) as was the photoreceptor integrity in 9 patients (33.3%) at 12 months. On multiple regression analysis, backreflection integrity was the only predictive factor for postoperative visual outcome (B = 0.179, p = 0.020). Conclusions: Backreflection integrity on preoperative SD OCT seems to be helpful in predicting the postoperative visual outcome in macula-off RRD patients.

scholarly journals Fundus flavimaculatus-like in myotonic dystrophy: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Eric Kirkegaard-Biosca ◽  
Mònica Berges-Marti ◽  
Brahim Azarfane ◽  
Esther Cilveti ◽  
Laura Distefano ◽  
...  
Keyword(s):  
Myotonic Dystrophy ◽  
Vision Loss ◽  
Posterior Pole ◽  
The Body ◽  
Inherited Disease ◽  
Case Presentation ◽  
Pattern Dystrophy ◽  
Progressive Muscle Weakness ◽  
History Of ◽  
Fundus Flavimaculatus

Abstract Background Myotonic dystrophy is an inherited disease characterized by progressive muscle weakness and myotonia. It is a multisystemic disorder that affects different parts of the body, including the eye. Dysfunction of ocular muscles, ptosis and cataract are the most common ophthalmologic manifestations, but it can also present with pigmentary changes in the retina. This report presents and discusses an unusual case of a pigmented pattern dystrophy simulating a fundus flavimaculatus in a patient with myotonic dystrophy. Case presentation We present a case of a woman with a history of myotonic dystrophy and complaints of progressive vision loss who presented bilateral retinal pigmentary changes in posterior pole and midperiphery. The characteristics and distribution of pigmented deposits, as well as ancillary tests, showed a retinal phenotype compatible with a multifocal pattern dystrophy or a fundus flavimaculatus. Conclusions There are a few publications about retinal disorders in patients with myotonic dystrophy. When macular area is affected it tends to adopt a patterned-shape defined as butterfly dystrophy or reticular dystrophy. To our knowledge, this is the first report of a patient with myotonic dystrophy and multifocal pattern dystrophy or fundus flavimaculatus.

scholarly journals Iron is neurotoxic in retinal detachment and transferrin confers neuroprotection

2019 ◽  
Vol 5 (1) ◽  
pp. eaau9940 ◽  
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.

The first case of fungal endogenous endophthalmitis caused by Aspergillus nidulans: Diagnostic and therapeutic challenge

2020 ◽  
pp. 112067212093208
Author(s):  
Lucia Mata-Moret ◽  
Clara Monferrer-Adsuara ◽  
Laura Hernández-Bel ◽  
Marisa Hernández-Garfella ◽  
Miriam Torrecillas-Muelas ◽  
...  
Keyword(s):  
Vision Loss ◽  
Visual Outcome ◽  
Endogenous Endophthalmitis ◽  
Pcr Analysis ◽  
Causative Organism ◽  
Systemic Corticosteroids ◽  
First Case ◽  
Dismal Prognosis ◽  
History Of ◽  
High Index Of Suspicion

Significance: Fungal endogenous endophthalmitis is an uncommon and potentially blinding infection. Aspergillus is a causative organism in immunocompromized although is virulent enough to afflict immunocompetents. Their propensity to affect macula usually results in a dismal prognosis; thus, improving visual outcome has always been challenging to clinicians. A. nidulans has only rarely been implicated in exogenous endophthalmitis. Purpose: To report the first case of A. nidulans endogenous endophthalmitis. Case report: An asthmatic 42-year-old female presented with sudden unilateral vision loss due to a submacular abscess that progressively worsened in a matter of days. Vitreous PCR analysis after an urgent vitrectomy was positive for A. nidulans with no active systemic foci found. Oral and intravitreal Voriconazole was prescribed but multiple reactivations led to three vitrectomies in total alongside with subretinal Voriconazole, abscess aspiration, and endolaser. There was complete resolution of the infection and, although visual acuity was poor due to macular scar, enucleation was avoided. Conclusion: Although uncommon, we must consider Aspergillus as the causative organism in apparently immunocompetent patients with history of recent systemic corticosteroids treatment, especially if they suffer a broncopulmonary disorder. Aspergillus is an aggressive organism so a high index of suspicion along with early diagnosis and prompt treatment is the key for better outcomes. We highlight A. nidulans as the causative agent as there are no other reported cases.

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