A Rare Case of Acute Hemorrhagic Retinopathy Following Intravitreal Melphalan Injection for Persistent Vitreous Seeds in Retinoblastoma

2021 ◽  
pp. 247412642110241
Author(s):  
Renu P. Rajan ◽  
Usha Kim ◽  
Aditya Maitray ◽  
Soumya Jena ◽  
Sagnik Sen
Keyword(s):  
Visual Acuity ◽  
Rare Case ◽  
Hemorrhagic Complication ◽  
Bilateral Retinoblastoma ◽  
Hemorrhagic Events ◽  
Hemorrhagic Complications ◽  
Sudden Decrease ◽  
The Right ◽  
Vitreous Seeds ◽  
Intraretinal Hemorrhages

Purpose: This report describes a case of acute occlusive hemorrhagic complication after intravitreal melphalan for vitreous seeds in retinoblastoma. Methods: A case report is presented. Results: Intravitreal melphalan has been used extensively for vitreous seeds in retinoblastoma. Although melphalan is relatively safe at optimal doses, it can sometimes cause inadvertent complications like hemorrhagic events if the drug is administered close to the retina or in more pigmented eyes. We report a case of a 5-month-old patient with bilateral retinoblastoma who underwent enucleation of the right eye and 2 intravitreal melphalan injections in the left eye (20 µg/0.02 mL) at a 1-month interval for persistent vitreous seeds. After the second injection, there was a sudden decrease in the child’s visual acuity in the left eye, and the retina showed multiple intraretinal hemorrhages and diffuse chorioretinal atrophy. Conclusion: Intravitreal melphalan may cause acute hemorrhagic complications after intravitreal use for retinoblastoma seeds, especially in pigmented eyes.

scholarly journals Bilateral Multifocal Choroidal Osteoma with Choroidal Neovascularization

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Mousavi MirNaghi ◽  
Shoeibi Nasser ◽  
Hosseini SeyedehMaryam ◽  
Saadat Targhi Ali
Keyword(s):  
Visual Acuity ◽  
Choroidal Neovascularization ◽  
Multimodal Imaging ◽  
Rare Case ◽  
Clinical Characteristics ◽  
Intravitreal Bevacizumab ◽  
Imaging Findings ◽  
Choroidal Osteoma ◽  
The Right

Choroidal osteoma has been reported to be unilateral in approximately 80% of cases diagnosed with this condition. Herein we report the clinical characteristics and multimodal imaging findings in a rare case of bilateral multifocal choroidal osteoma. A 32-year-old female presented with decreased visual acuity (VA) in the right eye (20/100), though she had normal VA (20/20) in the left eye. Ophthalmoscopy and multimodal imaging investigation revealed bilateral multifocal choroidal osteoma complicated by choroidal neovascularization (CNV) in the right eye. Following three injections of intravitreal bevacizumab (IVB) for CNV in the right eye, VA improved to 20/40.

scholarly journals Presumed clomiphene-induced optic neuropathy: A case report

2021 ◽  
Author(s):  
Yousef Alizadeh ◽  
Zahra Moravvej ◽  
Yaser Khakpour ◽  
Ebrahim Azaripour ◽  
Mitra Akbari ◽  
...  
Keyword(s):  
At Risk ◽  
Visual Acuity ◽  
Optic Neuropathy ◽  
Clomiphene Citrate ◽  
Anterior Ischemic Optic Neuropathy ◽  
Ischemic Optic Neuropathy ◽  
Acute Visual Loss ◽  
Estrogen Receptor Ligand ◽  
Sudden Decrease ◽  
The Right

Background: Clomiphene citrate is an estrogen receptor ligand with mixed agonistic–antagonistic properties used for the treatment of female and male infertility. Various visual disturbances and several irreversible visual outcomes have been associated with clomiphene citrate. In this report, we present a patient with presumed clomiphene-induced optic neuropathy. Case: A 33-yr-old man with acute visual loss of the right eye was referred to Amiralmomenin Hospital, Rasht, Iran in November 2018. His only medication was clomiphene citrate 100 mg daily, taken for 2 wk for fertility issues. The patient presented with a sudden decrease of visual acuity in the right eye on the 14th day of starting the treatment and subsequently developed complete loss of inferior visual field within a few days. On examination, the visual acuity was 6/20 in the right and 20/20 in the left eyes, with a right relative afferent pupillary defect and decreased red color saturation. The fundus examination revealed optic disc swelling with venous dilation in the right eye and a normal left fundus with a crowded disc (disc-at-risk). The patient was evaluated for systemic disorders, all of which were normal. Findings were suggestive of non-arteritic anterior ischemic optic neuropathy most likely due to clomiphene. Conclusion: As clomiphene may increase blood viscosity, it is hypothesized that reduced flow in a posterior ciliary artery in conjunction with the disc-at-risk contributes to the anterior ischemic optic neuropathy. It is advised that patients with disc-at-risk be aware of the possible non-arteritic anterior ischemic optic neuropathy and those experiencing visual symptoms while taking clomiphene be examined promptly for evidence of optic nerve injury. Key words: Clomiphene citrate, Optic neuropathy, Visual acuity, Ischemia.

scholarly journals Tapioca Melanoma of the Iris: a Case Report

2019 ◽  
Author(s):  
Saeed Karimi ◽  
Pouyan Pahlevani
Keyword(s):  
Visual Acuity ◽  
Case Report ◽  
Rare Case ◽  
Mixed Type ◽  
Spindle Cell ◽  
Complete Regression ◽  
Incisional Biopsy ◽  
Ocular Pain ◽  
Iranian Patient ◽  
The Right

Purpose: To report an extremely rare case of tapioca melanoma of the iris in an Iranian patient. Case Report: A 50-year-old male patient presented with ocular pain and redness in the right eye for two weeks. The visual acuity was 7/10 and the intraocular pressure (IOP) was 30 mmHg. A lobulated amelanotic vascularized and nodular (tapioca-like) iris mass with a 180o extent was seen in the right eye. Incisional biopsy of the mass revealed atypical mixed type (epithelioid and spindle cell) melanoma. Brachytherapy with the ruthenium-106 plaque resulted in complete regression of the tumor. Conclusion: Tapioca melanoma of the iris should be considered in the differential diagnosis of patients presenting with nodular vascularized amelanotic iris mass and elevated IOP. Brachytherapy with ruthenium-106 seems to be an effective treatment for tapioca melanoma of the iris.

scholarly journals A Decrease In Visual Acuity Revealing A Pituitary Apoplexy

2020 ◽  
Vol 2 (3) ◽  
Author(s):  
Joumany Brahim Salem ◽  
Sidi Dahi ◽  
Mahdi Khammaily ◽  
Wafa Akioud ◽  
Yassine Mouzari ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Pituitary Adenoma ◽  
Pituitary Apoplexy ◽  
Ocular Motility ◽  
Light Perception ◽  
Sudden Decrease ◽  
The Right ◽  
Acute Headache ◽  
The Brain ◽  
Decrease In Visual Acuity

Pituitary apoplexy is caused by an infarction or a hemorrhage in a pituitary adenoma. It is a very serious but rare accident. We present the case of a 28-year-old patient with no specific history who had experienced severe acute headache and a sudden decrease in visual acuity. Clinical examination showed a VA with negative light perception on the right and 1/10 on the left , bilateral aréflective mydriasis ODG, ocular motility preserved bilaterally, with normal FO in both eyes. An emergency CT scan of the brain reveals a giant intra-sellar pituitary adenoma and a hemorrhagic area in it’s center evoking a picture of pituitary apoplexy.

Popliteal nodal metastasis from squamous cell cancer of the foot. Case report and literature review

2019 ◽  
pp. 1-2
Keyword(s):  
Case Report ◽  
Lymph Node ◽  
Literature Review ◽  
Squamous Cell ◽  
Rare Case ◽  
Squamous Cell Cancer ◽  
Cell Cancer ◽  
Nodal Metastasis ◽  
Regional Disease ◽  
The Right

We report a very rare case of squamous cell cancer of the right foot which had metastasize to the ipsilateral popliteal lymph node after initial diagnosis and treatment for the loco-regional disease.

Thromboelastography (TEG) results are predictive of ischemic and hemorrhagic complications in patients with unruptured intracranial aneurysms treated with flow diversion

2021 ◽  
pp. 159101992110259
Author(s):  
Kainaat Javed ◽  
Santiago R Unda ◽  
Ryan Holland ◽  
Adisson Fortunel ◽  
Rose Fluss ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Intracranial Aneurysms ◽  
Statistical Significance ◽  
Alpha Angle ◽  
Flow Diversion ◽  
P Value ◽  
Hemorrhagic Complication ◽  
Unruptured Intracranial Aneurysms ◽  
Hemorrhagic Complications ◽  
Groin Hematoma

Introduction Flow diversion is an effective treatment modality for intracranial aneurysms but is associated with ischemic and hemorrhagic complications. Patients treated with flow diversion require dual antiplatelet therapy and subsequent platelet function tests. At our institution, Thromboelastography with Platelet Mapping (TEG-PM) is the test of choice. The primary objective of this study was to identify TEG parameters that are predictive of postoperative complications in patients treated with elective flow diversion. Methods This was a retrospective study of 118 patients with unruptured intracranial aneurysms treated with flow diversion. Data was collected via chart review. Bivariate analyses were performed to identify significant variables in patients who suffered an ischemic stroke or a groin hematoma. ROC curves were constructed for the TEG parameters with statistical significance. Bivariate analyses were repeated using dichotomized TEG results. Results Patients who experienced a symptomatic ischemic stroke had a history of stroke (p value = 0.007), larger aneurysm neck width (p value = 0.017), and a higher alpha angle (p value = 0.013). Cut off point for ischemic complication is 63° on ROC curve with a sensitivity of 100% and specificity of 65%. Patients who experienced a groin hematoma were no different from their healthy peers but had a lower alpha angle (p value = 0.033). Cut off point for hemorrhagic complication is 53.3° with a sensitivity of 82% and specificity of 67%. Conclusion The Alpha Angle parameter of TEG-PM has a sizeable predictive ability for both ischemic complications of the central nervous system and hemorrhagic complications of the access site after elective flow diversion.

scholarly journals Clinical Phenotype of PDE6B-Associated Retinitis Pigmentosa

2021 ◽  
Vol 22 (5) ◽  
pp. 2374
Author(s):  
Laura Kuehlewein ◽  
Ditta Zobor ◽  
Katarina Stingl ◽  
Melanie Kempf ◽  
Fadi Nasser ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Genetic Testing ◽  
Retinitis Pigmentosa ◽  
Fundus Autofluorescence ◽  
Retinal Disease ◽  
New Drugs ◽  
Autofluorescence Imaging ◽  
Full Field ◽  
Tertiary Referral Center ◽  
The Right

In this retrospective, longitudinal, observational cohort study, we investigated the phenotypic and genotypic features of retinitis pigmentosa associated with variants in the PDE6B gene. Patients underwent clinical examination and genetic testing at a single tertiary referral center, including best-corrected visual acuity (BCVA), kinetic visual field (VF), full-field electroretinography, full-field stimulus threshold, spectral domain optical coherence tomography, and fundus autofluorescence imaging. The genetic testing comprised candidate gene sequencing, inherited retinal disease gene panel sequencing, whole-genome sequencing, and testing for familial variants by Sanger sequencing. Twenty-four patients with mutations in PDE6B from 21 families were included in the study (mean age at the first visit: 32.1 ± 13.5 years). The majority of variants were putative splicing defects (8/23) and missense (7/23) mutations. Seventy-nine percent (38/48) of eyes had no visual acuity impairment at the first visit. Visual acuity impairment was mild in 4% (2/48), moderate in 13% (6/48), and severe in 4% (2/48). BCVA was symmetrical in the right and left eyes. The kinetic VF measurements were highly symmetrical in the right and left eyes, as was the horizontal ellipsoid zone (EZ) width. Regarding the genetic findings, 43% of the PDE6B variants found in our patients were novel. Thus, this study contributed substantially to the PDE6B mutation spectrum. The visual acuity impairment was mild in 83% of eyes, providing a window of opportunity for investigational new drugs. The EZ width was reduced in all patients and was highly symmetric between the eyes, making it a promising outcome measure. We expect these findings to have implications on the design of future PDE6B-related retinitis pigmentosa (RP) clinical trials.

scholarly journals Anti-Xa activity and hemorrhagic events under extracorporeal membrane oxygenation (ECMO): a multicenter cohort study

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Richard Descamps ◽  
Mouhamed D. Moussa ◽  
Emmanuel Besnier ◽  
Marc-Olivier Fischer ◽  
Sébastien Preau ◽  
...  
Keyword(s):  
Cohort Study ◽  
Extracorporeal Membrane Oxygenation ◽  
Univariate Analysis ◽  
Hemorrhagic Complication ◽  
Multicenter Cohort Study ◽  
Membrane Oxygenation ◽  
Multicenter Cohort ◽  
Hemorrhagic Event ◽  
Hemorrhagic Events ◽  
Va Ecmo

Abstract Background Hemorrhagic events remain a major concern in patients under extracorporeal membrane oxygenation (ECMO) support. We tested the association between anticoagulation levels and hemorrhagic events under ECMO using anti-Xa activity monitoring. Methods We performed a retrospective multicenter cohort study in three ECMO centers. All adult patients treated with veno-venous (VV)- or veno-arterial (VA)-ECMO in 6 intensive care units between September 2017 and August 2019 were included. Anti-Xa activities were collected until a hemorrhagic event in the bleeding group and for the duration of ECMO in the non-bleeding group. All dosages were averaged to obtain means of anti-Xa activity for each patient, and patients were compared according to the occurrence or not of bleeding. Results Among 367 patients assessed for eligibility, 121 were included. Thirty-five (29%) presented a hemorrhagic complication. In univariate analysis, anti-Xa activities were significantly higher in the bleeding group than in the non-bleeding group, both for the mean anti-Xa activity (0.38 [0.29–0.67] vs 0.33 [0.22–0.42] IU/mL; p = 0.01) and the maximal anti-Xa activity (0.83 [0.47–1.46] vs 0.66 [0.36–0.91] IU/mL; p = 0.05). In the Cox proportional hazard model, mean anti-Xa activity was associated with bleeding (p = 0.0001). By Kaplan–Meier analysis with the cutoff value at 0.46 IU/mL obtained by ROC curve analysis, the probability of survival under ECMO without bleeding was significantly lower when mean anti-Xa was > 0.46 IU/mL (p = 0.0006). Conclusion In critically ill patients under ECMO, mean anti-Xa activity was an independent risk factor for hemorrhagic complications. Anticoagulation targets could be revised downward in both VV- and VA-ECMO.

scholarly journals A Rare Case of Adult Aortopulmonary Window Combined with Anomalous Origin of the Right Pulmonary Artery from the Aorta Leading to Eisenmenger Syndrome

2021 ◽  
Vol 49 (1) ◽  
pp. 030006052098465
Author(s):  
Mingyue Cui ◽  
Binfeng Xia ◽  
Heru Wang ◽  
Haihui Liu ◽  
Xia Yin
Keyword(s):  
Pulmonary Artery ◽  
Rare Case ◽  
Congenital Heart ◽  
Respiratory Tract Infections ◽  
Anomalous Origin ◽  
Aortopulmonary Window ◽  
Eisenmenger Syndrome ◽  
Right Pulmonary Artery ◽  
The Right ◽  
Tract Infections

Aortopulmonary window is a rare congenital heart disease that can increase pulmonary vascular resistance, exacerbate left-to-right shunt and lead to heart failure and respiratory tract infections. Most patients die during childhood. We report a 53-year-old male patient with a large aortopulmonary window combined with anomalous origin of the right pulmonary artery from the aorta, with Eisenmenger syndrome and without surgery.

scholarly journals Chronic Endophthalmitis Caused by Pseudomonas stutzeri

2020 ◽  
Vol 11 (3) ◽  
pp. 595-599
Author(s):  
Saeed T. Alshahrani ◽  
J. Fernando Arevalo
Keyword(s):  
Pseudomonas Stutzeri ◽  
Posterior Chamber ◽  
Topical Steroids ◽  
Sensitivity Testing ◽  
Corneal Incision ◽  
Presumptive Diagnosis ◽  
Lens Extraction ◽  
History Of ◽  
Sudden Decrease ◽  
The Right

A patient presented with complaints of a sudden decrease in vision, ocular redness, and pain in the right eye. The patient had a history of clear lens extraction with intraocular lens (IOL) implantation for myopia 2 years previously. He had been prescribed topical steroids for episodes of inflammation that occurred repeatedly every 1–2 months. With a presumptive diagnosis of chronic endophthalmitis, a 23-G transconjunctival sutureless pars plana vitrectomy (PPV) with delivery of intravitreal antibiotics was performed the next day. Culture sensitivity testing of the vitreous sample indicated <i>Pseudomonas stutzeri</i> that was sensitive to ceftazidime and gentamicin. Two weeks later, the patient presented with sudden loss of vision and all the signs of recurrent endophthalmitis. 23-G transconjunctival sutureless PPV was performed along with removal of the posterior chamber IOL through a corneal incision. Complete resolution was only achieved after removal of the IOL, resulting in excellent visual recovery. Due to its chronic and fulminating nature, <i>P. stutzeri</i> can induce endophthalmitis and should be considered in the differential diagnosis. Aseptic measures are the best prevention.

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