scholarly journals Acute exudative polymorphous vitelliform maculopathy during pembrolizumab treatment for metastatic melanoma: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ine Lambert ◽  
Giuseppe Fasolino ◽  
Gil Awada ◽  
Robert Kuijpers ◽  
Marcel ten Tusscher ◽  
...  
Keyword(s):  
Retinal Detachment ◽  
Checkpoint Inhibitors ◽  
Pigment Epithelium ◽  
Retinal Pigment ◽  
Anterior Segment ◽  
Subretinal Fluid ◽  
Additional Treatment ◽  
Central Visual Field ◽  
Immunomodulating Therapy ◽  
Neurosensory Retinal Detachment

Abstract Background The use of immunomodulating therapy to treat various cancers has been on the rise and these immune checkpoint inhibitors are known to cause ocular side effects. In this article a case of acute exudative polymorphous vitelliform maculopathy (AEPVM) is reported which developed during a first line treatment with pembrolizumab. Case presentation A 54-year-old woman was referred because of blurry vision in both eyes with a yellow spot in the central visual field of the left eye. These symptoms started after four treatments with pembrolizumab (a monoclonal antibody against the programmed cell death receptor-1) for a metastatic recurrent vaginal mucosal melanoma. Her best corrected visual acuity was 10/10 in both eyes with a correction of + 2.00 bilaterally. There were no inflammatory findings in the anterior segment or the vitreous. Fundoscopy revealed an attenuation of the foveal reflex with subtle yellow-white subretinal macular deposits (vitelliform lesions) in both eyes. Fluorescein angiography did not show staining or leakage in the mid-phase, neither a late staining. Spectral-domain optical coherence tomography of the macula illustrated bilateral neurosensory retinal detachment with a thick, highly reflective band at the outer photoreceptor segment. En face structural OCT at the level of the photoreceptors showed focal areas of increased signal corresponding to hyperreflective vitelliform material. The treatment with pembrolizumab was ceased immediately. During the following visits we slowly saw an improvement of the neurosensory retinal detachment. After almost four months a total resolution of the subretinal fluid was visualized in both eyes without the use of additional treatment, though the vitelliform deposits persisted. Conclusions The development of AEPVM in melanoma patients could be triggered by treatment with Pembrolizumab. Pembrolizumab has the potential to disturb indirectly the retinal pigment epithelium homeostasis with accumulation of lipofuscin deposits and subretinal fluid, both signs of AEPVM.

scholarly journals Central Serous Chorioretinopathy Induced by Work Stress: A Case Report

e-CliniC ◽  
2020 ◽  
Vol 8 (2) ◽  
Author(s):  
Ade J. Nursalim ◽  
Vera Sumual
Keyword(s):  
Risk Factors ◽  
Work Stress ◽  
Central Serous Chorioretinopathy ◽  
Pigment Epithelium ◽  
Retinal Pigment ◽  
Subretinal Fluid ◽  
Blurred Vision ◽  
Reading Text ◽  
Neurosensory Retinal Detachment ◽  
The Right

Abstrak: Central serous chorioretinopathy (CSC) adalah terkumpulnya cairan serosa di bawah lapisan epitel pigmen retina yang mengakibatkan terlepasnya retina neurosensorik (detachment). Keadaan ini dapat disebabkan oleh berbagai faktor risiko, termasuk stres psikologik. Jenis kelamin laki-laki merupakan salah satu faktor risiko CSC. Terapi kondisi psikologik merupakan pena-nganan utama CSC yang diinduksi oleh stres kerja. Kami melaporkan seorang laki-laki berusia 27 tahun yang datang ke Poliklinik Mata RSUP Prof. Dr. R. D. Kandou Hospital dengan keluhan kekaburan mata kanan yang mendadak sejak seminggu lalu tanpa didahului oleh nyeri pada mata. Pasien juga mengalami kesulitan dalam membaca teks dan mengenali wajah bila hanya menggunakan mata kanannya. Pasien telah pergi ke optik tetapi tidak mendapatkan ukuran kacamata yang sesuai. Pasien bekerja sebagai tenaga administrasi dan akhir-akhir ini mendapatkan beban kerja berlebihan. Pasien mengakui bahwa ia mengalami kesulitan dalam mengatur aktivitasnya, dan merasakan kelelahan sepanjang hari serta kehilangan minat kerja. Hasil pemeriksaan mata mendapatkan visus 6/15 untuk mata kanan dan visus 6/6 untuk mata kiri, dan metamorphopsia sedangkan hasil pemeriksaan oftalmoskopi memperlihatkan adanya edema dengan lingkaran kekuningan dan berbatas tidak jelas pada mata kanan. Pemeriksaan lanjut dengan OCT menunjukkan adanya cairan subretinal pada mata kanan disertai terlepasnya lapisan epitel pigmen. Saat kontrol setelah 36 hari, visus mata kanan telah membaik 6/6F2 dan peme-riksaan OCT menunjukkan penurunan tebal makula dari 289 μm pada kunjugan pertama men-jadi 190 μm, serta tidak tampak adanya cairan subretinal. Simpulan kasus ini ialah central serous chorioretinopathy yang diinduksi oleh stres kerja, dengan penanganan utama ialah terapi psikologik untuk memperbaiki kualitas hidup.Kata kunci: central serous chorioretinopathy (CSC), stres kerja Abstract: Central serous chorioretinopathy (CSC) is a condition where serous fluid builds up in the retinal pigment epithelium layer which causes neurosensory retinal detachment. This condition is affected by many risk factors, including psychological stress. Male gender is one of the risk factors for CSC. Treatment to the patient's psychological condition can be the main therapy in handling CSC induced by work stress. We reported a 27-year-old male came to the eye clinic at Prof. dr. R. D. Kandou Hospital complaining of sudden blurred vision in his right eye a week ago without initial pain in the eye. The patient also experienced difficulty in reading text and recognizing people’s face using the right eye. The patient went to an optic store but he did not find suitable glasses. The patient works as an administrative employee and is currently getting a heavy workload at his workplace. The patient admitted that he had issues in managing his life in a day. Patients felt tired throughout the day and had no interest in making any activities. The results of the eye examination showed vision 6/15 in the right eye and 6/6 in the left eye, metamorphopsia, edema with a yellowish circle with an unclear border on the right eye using ophthalmoscopy examination, and a subretinal fluid image in the patient's right eye with epithelial detachment pigment acquired through the examination with OCT. After 36 days from the first visit, the right eye vision was improved to 6/6 F2 and OCT examination resulted in a decrease in macula thickness from 289 μm at the first visit to 190 μm, and there was no subretinal fluid. In conclusion, this was a CSC case induced by work stress, and the main treatment was psychological therapy in order to improve the quality of life (QoL).Keywords: central serous chorioretinopathy (CSC), work stress

scholarly journals Optical coherence tomography in assessment chorioretinal blood flow in patients with central serous chorioretinopathy

2016 ◽  
Vol 15 (4) ◽  
pp. 39-47
Author(s):  
S. I. Zhukova ◽  
A. N. Zlobina ◽  
T. N. Iureva ◽  
A. A. Shchuko
Keyword(s):  
Blood Flow ◽  
Optical Coherence Tomography ◽  
Retinal Detachment ◽  
Central Serous Chorioretinopathy ◽  
Structural Changes ◽  
Pigment Epithelium ◽  
Retinal Pigment ◽  
Pathological Process ◽  
Optical Coherence ◽  
Neurosensory Retinal Detachment

Introduction and purpose. Central serous chorioretinopathy - a disease that manifests itself serous detachment of the neurosensory retina and / or retinal pigment epithelium (RPE). Chronic course of pathological process may be complicated by the development of subretinal neovascularization, and is accompanied by a decrease in visual functions. Despite the large number of studies, there are no pathogenetically oriented and effective methods of treatment of central serous chorioretinopathy today, because there is no consensus on the causes of its origin. To evaluate the accuracy of the information content of chorioretinal blood flow changes in patients with central serous chorioretinopathy, to compare the degree of changes of RPE and hemodynamic disorders in different forms of the disease. Materials and Methods. The study involved 26 patients with central serous chorioretinopathy aged 35 to 54 years. To assess chorioretinal blood flow the optical coherence tomography (OCT) in retinal angiography mode was included in the volume of diagnostic examination. Results. It was demonstrated that the choroidal vessels and RPE are an original target in the realization of the pathological process in central serous chorioretinopathy. The changes in the pigment epithelium and the neurosensory retinal detachment, whose height ranged from 53.4 to 513.0 m (238.3 ± 80.4 - in acute and - 215.5 ± 129.9 - in chronic diseases) were revealed in all patients. In 45 % of cases of acute and 67 % in patients with a chronic form of disease the neurosensory retinal detachment combined with RPE detachment, preventing recovery of macular interface on a background of medical actions. Prolonged existence of ischemia and RPE detachment is accompanied by severe progressive degenerative changes in the retina as a whole, causing resistance to treatment. Conclusions. OCT in angiography mode in the diagnosis of various forms of chorioretinal central serous chorioretinopathy allows visualizing blood flow, evaluating the extent and nature of the structural changes of the retina taking into account hemodynamic disorders. The revealed changes of RPE and choroid, as classification and prognostic criteria of the disease, determine the effectiveness of treatment measures and prognosis of disease.

scholarly journals Spontaneous Closure of the Macular Hole in a Patient with Acquired Vitelliform Lesion

2020 ◽  
Vol 11 (1) ◽  
pp. 16-21
Author(s):  
Masanori Fukumoto ◽  
Shou Oosuka ◽  
Takaki Sato ◽  
Teruyo Kida ◽  
Tsunehiko Ikeda
Keyword(s):  
Retinal Detachment ◽  
Macular Hole ◽  
Rare Case ◽  
Pigment Epithelium ◽  
Retinal Pigment ◽  
Serous Retinal Detachment ◽  
Subretinal Fluid ◽  
Spontaneous Closure ◽  
Retinal Reattachment

In this paper, we report an extremely rare case of spontaneous closure of a macular hole (MH) that developed in a patient in whom acquired vitelliform lesion (AVL) occurred after vitrectomy for atopic retinal detachment (ARD). A 32-year-old male developed ARD in both eyes, and retinal reattachment was achieved after vitrectomy. Five years after surgery, optical coherence tomography showed localized serous retinal detachment (SRD) and a granular lesion with a higher brightness in the subretinal fluid, thus leading to the diagnosis of AVL. One month later, an MH developed, and a follow-up examination performed 6 weeks later revealed that the MH had spontaneously closed and the SRD decreased. In the fovea, fluorescein angiography revealed a window defect due to atrophy of the retinal pigment epithelium (RPE). These findings in this present case suggest the possibility that RPE dysfunction was involved in the development of AVL and MH.

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.

Epidemiology, Prevalence and Incidence of Rhegmatogenous Retinal Detachment

2019 ◽  
pp. 135-137
Keyword(s):  
Risk Factors ◽  
Retinal Detachment ◽  
High Myopia ◽  
Rhegmatogenous Retinal Detachment ◽  
Pigment Epithelium ◽  
Retinal Pigment ◽  
Subretinal Fluid ◽  
Cataract Extraction ◽  
Common Type ◽  
Associated Risk Factors

Rhegmatogenous retinal detachment is the most common type of retinal detachments and occurs when subretinal fluid accumulates between the neurosensorial retina and retinal pigment epithelium. Although often caused by vitreous liquefaction, cataract extraction, high myopia, inflammation, and trauma are other associated risk factors. In this article, epidemiology, prevalence, and incidence of rhegmatogenous retinal detachment are aimed to describe.

scholarly journals Acute Posterior Multifocal Placoid Pigment Epitheliopathy Sharing Characteristic OCT Findings of Vogt-Koyanagi-Harada Disease

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Yuta Kitamura ◽  
Toshiyuki Oshitari ◽  
Masayasu Kitahashi ◽  
Takayuki Baba ◽  
Shuichi Yamamoto
Keyword(s):  
Retinal Detachment ◽  
Pigment Epithelium ◽  
Retinal Pigment ◽  
Late Phase ◽  
Serous Retinal Detachment ◽  
Subretinal Fluid ◽  
Hla Typing ◽  
Blurred Vision ◽  
Fluid Analysis ◽  
Vkh Disease

A 17-year-old male presented with acute bilateral paracentral scotomata and blurred vision. Funduscopic examination showed bilateral macular serous retinal detachment and yellow-white placoid lesions at the level of retinal pigment epithelium. OCT study showed typical VKH disease findings with marked choroidal thickening and macular serous retinal detachment partly with subretinal septa in both eyes. FA demonstrated hypofluorescence at the placoid lesions in the early phase and hyperfluorescence in the late phase. Laboratory investigation showed negative result for HLA-DR4 serotype and the patient’s cerebrospinal fluid test values were within normal range. We made the diagnosis of APMPPE from these results. At 2-month follow-up without the use of corticosteroids, OCT reexamination showed complete amelioration of subretinal fluid in both eyes. Patchy pigmentary lesions also resolved clinically with partial chorioretinal scars. The results in this case suggested OCT findings in APMPPE patients could be similar to characteristic features usually found in acute VKH disease. We recommend comprehensive assessments such as FA, cerebral spinal fluid analysis, and HLA typing which help in leading proper diagnosis.

Multimodal imaging in retinal pigment epithelium rip with exudative bullous retinal detachment

2020 ◽  
Vol 13 (9) ◽  
pp. e235731
Author(s):  
Padmaja Kumari Rani ◽  
Aniruddh Soni
Keyword(s):  
Retinal Pigment Epithelium ◽  
Retinal Detachment ◽  
Multimodal Imaging ◽  
Pigment Epithelium ◽  
Retinal Pigment ◽  
Subretinal Fluid ◽  
Exudative Retinal Detachment ◽  
Bullous Retinal Detachment ◽  
Subretinal Fluid Drainage

A middle-aged man presented with exudative retinal detachment in the left eye. He was previously diagnosed as a case of large pigment epithelial detachment in the same eye, for which he was asked to follow-up closely, citing the risk of an retinal pigment epithelium (RPE) rip. Multimodal imaging confirmed the presence of a large RPE rip with exudative retinal detachment. He is a known retrovirus patient on anti-retroviral therapy with stable CD4 counts. He was diagnosed as a possible case of bullous variant of central serous chorioretinopathy and underwent external subretinal fluid drainage. We highlight the multimodal imaging findings of RPE rip with exudative retinal detachment and its impact on the patients visual acuity.

scholarly journals Subthreshold micro-impulse laser coagulation of retinal detachment in children

Doklady BGUIR ◽  
2020 ◽  
Vol 18 (8) ◽  
pp. 89-96
Author(s):  
Н. A. Sushchenia ◽  
L. N. Marchenko
Keyword(s):  
Visual Acuity ◽  
Retinal Detachment ◽  
Pigment Epithelium ◽  
Retinal Pigment ◽  
Subretinal Fluid ◽  
Posterior Pole ◽  
Laser Coagulation ◽  
Complete Disappearance ◽  
Photoreceptor Layer ◽  
Long Time

Retinal detachment in children often requires multiple revisions. Despite active surgical treatment, subretinal fluid can persist for a long time in the macular region of the fundus. This leads to a decrease in visual acuity after surgery and an unsatisfactory functional result of treatment. In the absence of central vision, children develop amblyopia and secondary strabismus. Reoperations increase the risk of complications. Threshold laser coagulation leads to thermal burns of all layers of the retina with the formation of chorioretinal adhesion, which ensures adhesion of the retinal layers, but irreversibly damages the retinal neuroepithelium. Аs a result, the use of threshold laser coagulation in the macular zone is limited. The method of subthreshold micropulse diode laser ablation (STDLA) was developed on the basis of a clinical examination of 44 pediatric patients of the pediatric ophthalmology department of the Minsk Regional Children's Clinical Hospital, whose level of subretinal fluid in the posterior pole of the eyes remained for a long time after extrascleral surgery for retinal detachment. The proposed exposure parameters provide a selective effect on the cells of the retinal pigment epithelium with laser radiation in the micropulse mode without irreversible thermal denaturation of photoreceptors and without damage to the neuroepithelium in order to stimulate the resorption of subretinal fluid and correct transudative disorders. As a result, the adhesion of the retinal photoreceptor layer to the pigment epithelium is restored. The effectiveness of the method is confirmed by a decrease or complete disappearance of subretinal fluid, adhesion of neuroepithelium according to optical coherence tomography and leads to an increase in visual acuity. The proposed method made it possible to optimize the treatment of children with retinal detachment, to improve the anatomical and functional outcomes of treatment, which is of medical and socio-economic importance.

Rare presentation of choroidal neovascularisation in a case of congenital hypertrophy of retinal pigment epithelium

2021 ◽  
Vol 14 (9) ◽  
pp. e244554
Author(s):  
Ramesh Venkatesh ◽  
Nikitha Gurram Reddy ◽  
Ram Snehith Pulipaka ◽  
Arpitha Pereira
Keyword(s):  
Retinal Pigment Epithelium ◽  
Pigment Epithelium ◽  
Retinal Pigment ◽  
Anterior Segment ◽  
Subretinal Fluid ◽  
Choroidal Neovascularisation ◽  
Rare Presentation ◽  
History Of ◽  
The Right ◽  
Congenital Hypertrophy

A 22-year-old woman presented with a 2-week history of decreased vision, a central scotoma and metamorphopsia in her right eye. Her presenting visual acuity was 6/75 in the right eye and 6/6 in the left eye. Anterior segment examination was normal. Fundus examination of both eyes showed features of bilateral congenital hypertrophy of retinal pigment epithelium (CHRPE) lesions and choroidal neovascularisation (CNV) in the right eye. She was treated with intravitreal injection bevacizumab 1.25 mg/0.05 mL. One month later, there was regression of the CNV and subretinal fluid and her vision improved to 6/12. At the final follow-up visit, her vision was maintained at 6/9 with regression of CNV noted. To conclude, CNV is a rare association of CHRPE. It can lead to vision-threatening problem if it involves the macula and should be identified promptly and managed appropriately.

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