scholarly journals Bilateral Adie’s Pupil following Laser Treatment of the Ischemic Peripheral Retina for Uveitis: A Case Report

2021 ◽  
pp. 909-914
Author(s):  
Satoko Akahane ◽  
Takao Hirano ◽  
Sayuri Shu ◽  
Toshinori Murata
Keyword(s):  
Laser Photocoagulation ◽  
Unknown Origin ◽  
Light Sensitivity ◽  
Posterior Uveitis ◽  
Additional Treatment ◽  
Peripheral Retina ◽  
Blurred Vision ◽  
Laser Treatments ◽  
Old Japanese ◽  
Left Pupil

Adie’s pupil is a neurological condition of unknown origin with unusual, asymmetric presentation known as anisocoria with the enlarged pupil failing to react to light. It is believed that this pupillary abnormality results from damage to the ciliary ganglion or postganglionic short ciliary nerves. Affected individuals (usually female) may be symptomatic with photophobia or difficulty reading in the diseased eye. Although most Adie’s pupil cases are idiopathic, previous studies have associated photocoagulation and uveitis with symptom onset. To the best of our knowledge, there have been no reports of specific means of preventing Adie’s pupil. We describe a patient who experienced varying severities of Adie’s pupil after separate laser treatments of the ischemic peripheral retina for uveitis. Fluorescein angiography revealed peripheral retinal nonperfusion in the bilateral eyes of a 37-year-old Japanese female who had been suffering from posterior uveitis. To avoid proliferative changes, 360° laser photocoagulation of the retinal nonperfusion region located in the far periphery was first delivered to the left eye over 2 sessions. Soon after treatment, the patient complained of acute photophobia and blurred vision in the treated eye. Ocular examination revealed left pupil dilation and poor light sensitivity, although the pupil was reactive to a close stimulus. The left pupil also displayed positive denervation sensitivity based on the dilute pilocarpine (0.125%) test. Adie’s pupil was diagnosed based on these observations. Three months later, similar, albeit milder, findings were observed in her right eye after 360° peripheral laser photocoagulation that was more conservatively performed over 4 sessions. Four months after the first treatment, her subjective visual function had improved, and the pupil diameter had decreased to a normal size in both eyes without additional treatment. We encountered a patient whose severity of Adie’s pupil was apparently reduced by more conservative laser photocoagulation of the ischemic peripheral retina.

Retinal Findings of a Unique RTEL1 Mutation in Dyskeratosis Congenita

2017 ◽  
Vol 1 (6) ◽  
pp. 411-414
Author(s):  
Benjamin G. Wajda ◽  
Alexander S. Platt ◽  
April D. Ingram ◽  
Anna L. Ells
Keyword(s):  
Fluorescein Angiography ◽  
Telomere Length ◽  
Laser Photocoagulation ◽  
Dyskeratosis Congenita ◽  
Peripheral Retina ◽  
Wide Field ◽  
Inherited Disease ◽  
Fundus Imaging ◽  
Pan Retinal Photocoagulation ◽  
Retinal Photocoagulation

We describe the retinal manifestations of a patient with a unique mutation of the Regulator of telomere length 1 ( RTEL1) gene resulting in dyskeratosis congenita (DC), a rare, fatal, inherited disease. A 4-year-old boy with DC was referred for ophthalmology consult by his attending hematologist and underwent a complete ophthalmic examination, including wide-field fundus imaging and fluorescein angiography. The patient was found to have bilateral retinal vasculopathy and extensive microvascular abnormalities in addition to avascular regions in the temporal peripheral retina. He received multiple pan-retinal photocoagulation treatments in both eyes. Our case highlights the importance of ophthalmic screening and fluorescein angiography and the potential need for timely laser photocoagulation for sight-threatening retinopathy in patients with DC.

scholarly journals Clinical Course and Results of Anti-VEGF Therapy of Retinopathy of Prematurity

2021 ◽  
Vol 18 (1) ◽  
pp. 136-142
Author(s):  
L. A. Katargina ◽  
E. N. Demchenko ◽  
L. V. Kogoleva
Keyword(s):  
Retinopathy Of Prematurity ◽  
Functional Outcomes ◽  
Clinical Course ◽  
Repeated Administration ◽  
Additional Treatment ◽  
Research Centre ◽  
Peripheral Retina ◽  
Laser Coagulation ◽  
Anti Vegf

The clinical course of active retinopathy after anti-VEGF therapy, the possibility and timing of recurrence of the disease, anatomical and functional outcomes of treatment are widely discussed in the press, not fully studied and relevant.Purpose: to study the clinical course of active retinopathy of prematurity after anti-VEGF therapy and clinical and functional outcomes.Patients and Methods. Children with active retinopathy of prematurity, who turned to the Helmgoltz National Medical Research Centre of Eye Diseases after anti-VEGF therapy, examined by indirect binocular ophthalmoscopy and digital retinal camera (RetcamShuttle). Children were monitored from 1.5 to 6 years (average 2.94 ± 1.47). All children underwent routine examination, 4 children older than 3 years underwent optical coherence tomography.Results. In all cases, after anti-VEGF therapy, there was a decrease in vascular activity and continued vascularization of the retina. Recurrence of the disease requiring additional treatment, were detected in 11 (42.3 %) eyes within 6–22 weeks (in average 13.33 ± 5.57) after intravitreal anti-VEGF therapy. Laser coagulation of the retina was carried out in 4 children (7 eyes) and repeated administration of anti-VEGF drug — 2 children (4 eyes), which led to regression of the disease. In the long-term period, all 13 (100 %) children had successful outcomes.Conclusion. Anti-VEGF therapy is effective in plus-zone 1 disease and posterior aggressive retinopathy of prematurity. Its advantages include the ability to treat retinopathy in zone 1 posterior, the absence of “blockade” of the peripheral retina with the possibility of continued growth of blood vessels to the periphery, lower frequency and severity of myopia. The disadvantages include the possibility of recurrence of the disease, which requires long-term regular monitoring.

scholarly journals Direct Photocoagulation Guided by Merged Retinal Images for the Treatment of Focal Diabetic Macular Edema

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Yoshihiro Takamura ◽  
Takehiro Matsumura ◽  
Shogo Arimura ◽  
Makoto Gozawa ◽  
Masakazu Morioka ◽  
...  
Keyword(s):  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Laser Photocoagulation ◽  
Retinal Thickness ◽  
Functional Results ◽  
Retinal Images ◽  
Image Guided ◽  
Corrected Visual Acuity ◽  
Laser Treatments ◽  
Best Corrected Visual Acuity

Purpose. To introduce a novel laser photocoagulation (PC) protocol named merged image-guided PC (MIG-PC), which included merging the images of the fundus, optical coherence tomography (OCT) map, and fluorescein angiography (FA). We compared the anatomical and functional results between MIG-PC and FA-guided PC (FG-PC) for the treatment of focal diabetic macular edema (DME). Method. We examined the treatment outcomes in 27 consecutive eyes treated with MIG-PC compared with 28 matched eyes treated with FG-PC. We identified the microaneurysms (MAs) located in the focal edema areas and ablated them using focal PC. Best-corrected visual acuity (BCVA) and retinal thickness (RT) measured using OCT were compared between the groups at baseline and 2, 4, 8, 12, and 24 weeks after treatment. Results. The foveal and perifoveal RT were reduced after treatment in both the groups, and the perifoveal RT in the MIG-PC group was significantly lower than that in the FG-PC group at 4 weeks and thereafter. BCVA in the MIG-PC group was significantly higher than that in the FG-PC group at 12 and 24 weeks. The numbers of laser spots (p=0.0001), additional laser treatments (p=0.0121), and intravitreal injection of ranibizumab (p=0.0012) in the MIG-PC group were significantly lower than those in the FG-PC group (Mann–Whitney test). Conclusion. MIG-PC contributed to the improvement in BCVA and reduction in RT, number of laser shots required, and retreatment rates. Based on our data, MIG-PC can be recommended for the treatment of focal DME. This trial is registered with ID UMIN000030390.

Retinal vasoproliferative tumour secondary to retinitis pigmentosa sine pigmento

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.

scholarly journals Adie’s tonic pupil presenting with unilateral photophobia successfully treated with dilute pilocarpine

2020 ◽  
Vol 13 (1) ◽  
pp. e233136
Author(s):  
Hatim Batawi ◽  
Jonathan A Micieli
Keyword(s):  
Symptomatic Relief ◽  
Pharmacological Therapy ◽  
Blurred Vision ◽  
Third Nerve Palsy ◽  
Tonic Pupil ◽  
History Of ◽  
Blurry Vision ◽  
The Right ◽  
Pharmacological Testing ◽  
Left Pupil

A 40-year-old healthy man presented with a 4-month history of photophobia, blurred vision and a right dilated pupil. Examination revealed a right pupil that was not reactive to light but constricted strongly to a near target and slowly redilated when he looked back in the distance. Pharmacological testing with dilute pilocarpine 0.1% resulted in constriction of the right pupil but no change in the left pupil. This also resulted in resolution of his photophobia and blurry vision. Neurological examination was otherwise normal, and a diagnosis of Adie’s tonic pupil was made. The main differential diagnosis to consider for a large pupil is a third nerve palsy, pharmacological mydriasis, tonic pupil and local iris processes, such as iris sphincter tears from trauma. Knowledge of the key features of these conditions can avoid wasted resources from unnecessary testing. Dilute pilocarpine 0.1% three times a day can be considered as a pharmacological therapy for symptomatic relief.

Active iris vascular tufts bleeding successfully treated with argon laser photocoagulation

2018 ◽  
Vol 28 (2) ◽  
pp. 241-242 ◽  
Author(s):  
Ambreen Sarmad ◽  
Fadi Alfaqawi ◽  
Monali Chakrabarti ◽  
Arijit Mitra ◽  
Bushra Mushtaq
Keyword(s):  
Visual Acuity ◽  
Intraocular Pressure ◽  
Case Report ◽  
Laser Photocoagulation ◽  
Argon Laser ◽  
Active Bleeding ◽  
Blurred Vision ◽  
Argon Laser Photocoagulation ◽  
The Right ◽  
Effective Use

Purpose: Iris vascular tufts (IVT) are rare biomicroscopic capillary outgrowths from the pupillary margins. Patients are usually asymptomatic until presenting with blurred vision due to spontaneous hyphema or with raised intraocular pressure. Case report: A 61-year-old woman presented to eye casualty with left eye (LE) blurred vision and discomfort for 1 day. Her external ocular examination was unremarkable and visual acuity was 6/6 in the right eye (RE) and 6/9 in the LE. Biomicroscopic examination revealed a 2-mm hyphema in her LE and bilateral multiple small IVT and active bleeding from IVT at the pupillary margin of the LE at the 5 o’clock position. Diagnosis of LE active bleeding from IVT was made and she underwent argon laser photocoagulation directed at the source of bleeding. The bleeding stopped immediately after the second burn. She was followed up for 3 months; her visual acuity was 6/5 and 6/6 in the RE and LE, respectively, with no further problems. Conclusions: Iris vascular tufts are benign and recurrent hemorrhages are unlikely. Therefore, definitive argon laser photocoagulation or surgical treatment are reserved to arrest further episodes of hyphema. Our case demonstrates the effective use of argon laser photocoagulation to completely arrest active bleeding from IVT and excellent recovery of hyphema with no further problems for 5 years.

scholarly journals A Case of Idiopathic Dense Vitreous Hemorrhage: Suspected Rupture of a Large Retinal Arterial Macroaneurysm on the Optic Disc

2021 ◽  
pp. 634-639
Author(s):  
Shizuka Takahashi ◽  
Kentaro Nishida ◽  
Hirokazu Sakaguchi ◽  
Kohji Nishida
Keyword(s):  
Macular Hole ◽  
Optic Disc ◽  
Vitreous Hemorrhage ◽  
Unknown Origin ◽  
Internal Limiting Membrane ◽  
Sudden Onset ◽  
Acute Onset ◽  
Blurred Vision ◽  
Disc Diameter ◽  
Retinal Arterial Macroaneurysm

We report a novel case of vitreous hemorrhage associated with suspected rupture of 2-disc-diameter retinal arterial macroaneurysm on the optic disc. A 90-year-old woman presented with blurred vision (sudden onset) in her left eye. Examination of the fundus revealed acute onset vitreous hemorrhage of unknown origin without retinal detachment. She underwent vitrectomy, but after excision of the dense vitreous hemorrhage, a 2-disc-diameter hematoma appeared on the optic disc and was removed promptly. Because the bleeding at the base of the hematoma was of arterial origin and pulsating, the first vitrectomy could not achieve hemostasis. Five days after the first surgery, we performed a second vitrectomy. This revealed a subretinal hemorrhage along the superior and inferior arcade vessels and a macular hole, which was almost completely closed with an inverted internal limiting membrane flap. Unfortunately, the macular hole reopened 41 days after the second surgery. In patients presenting with only a large hematoma on the optic disc, it might be prudent to leave the hematoma. However, this large retinal arterial macroaneurysm was on a rare location on the optic disc, making it doubly difficult for the surgeons to diagnose and choose the best option intraoperatively. The differential diagnosis for dense vitreous hemorrhage of unknown origin should include a large retinal arterial macroaneurysm on the optic disc.

scholarly journals Sub internal limiting membrane hemorrhage followed by bilateral optic disc hemorrhage in Kikuchi-Fujimoto disease: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Tomohito Sato ◽  
Koji Kanda ◽  
Yusuke Kawamura ◽  
Masaru Takeuchi
Keyword(s):  
Optic Disc ◽  
Cervical Lymphadenopathy ◽  
Unknown Origin ◽  
Internal Limiting Membrane ◽  
Lymph Node Biopsy ◽  
Disc Hemorrhage ◽  
Old Japanese ◽  
Cervical Lymph Node Biopsy ◽  
Neodymium:Yttrium Aluminum Garnet Laser ◽  
Sudden Decrease

Abstract Background Kikuchi-Fujimoto disease (KFD) is a necrotizing lymphadenitis, and presents fever of unknown origin and cervical lymphadenopathy. Ocular complications are unusual in KFD. Here we report a case of sub internal limiting membrane (ILM) hemorrhage followed by bilateral optic disc hemorrhage in KFD. Case presentation A 16-year-old Japanese man perceived a sudden decrease of right vision 3 days after onset of fever with unknown origin and left cervical lymphadenopathy. At presentation, visual acuity (VA) of right eye was 0.05 in decimal chart (1.30: converted to logarithm of minimum angle of resolution: logMAR). Fundus photograph showed extensive sub-ILM hemorrhage in right eye, and optic disc hemorrhages in both eyes. Fluorescein angiography presented hypo- and hyperfluorescences in optic disc of right eye, and hyperfluorescence in the disc of left eye. To make a definitive diagnosis, cervical lymph node biopsy was performed, and KFD was diagnosed pathologically. Thereafter, fever, headache and the cervical lymphadenopathy disappeared spontaneously. The sub-ILM hemorrhage was drained into the vitreous cavity by neodymium:yttrium-aluminum-garnet laser (Nd: YAG) hyaloidotomy. VA recovered to 1.5 (− 0.18: logMAR VA) in right eye. Conclusion Sub-ILM hemorrhage and optic disc hemorrhage are a KFD-related ocular complication.

scholarly journals An atypically distributed fleck case with multiple retinal pigment epithelial detachments

2021 ◽  
Vol 11 (1) ◽  
pp. 1-3
Author(s):  
Sercan Cate ◽  
Caglar Bektas ◽  
Burak Turgut
Keyword(s):  
Optical Coherence Tomography ◽  
Retinal Pigment Epithelial ◽  
Pigment Epithelium ◽  
Retinal Pigment ◽  
Peripheral Retina ◽  
Fundus Examination ◽  
Blurred Vision ◽  
Pigment Epithelial ◽  
The Right ◽  
Internal Reflectivity

A 45-year-old female patient presented with complaints of blurred vision and metamorphopsia with a duration of two months. Visual acuities were 0.1 in the right eye and 1.0 in the left eye. Fundus examination revealed bilateral, subretinal, round and yellow-white flecks with scattered localization in the fovea, macula and peripheral retina. Flecks were mostly concentrated in the macula and midperipheral fundus however were rare in the peripheral fundus. In fluorescein angiography, flecks were stained as well-demarcated hyperfluorescent lesions. In optical coherence tomography, there were hump-shaped lesions which have medium degree internal reflectivity at the level of retinal pigment epithelium along with hyporeflective dome-shaped pigment epithelial detachments. No genetic predisposition was found. As a consequence of these findings, the patient was diagnosed with an atypically distributed fleck case with multiple retinal pigment epithelial detachments

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