Bilateral Acute Macular Neuroretinopathy in a Young Patient: Imaging and Visual Field during Two-Year-Follow-Up

Acute macular neuroretinopathy (AMN) is a rare disorder. We report a case of bilateral AMN in a young female patient, without any risk factors. She referred a positive scotoma in both eyes after flu-like symptoms. Fundus examination revealed parafoveal dark-reddish oval lesions in both eyes. Therefore, we performed visual field, optical coherence tomography (OCT), fluorescein angiography (FA) and indocyanine green angiography (ICG) at baseline and several times during the two years of follow-up. The infrared (IR) imaging showed one rounded hyporeflective lesion in the left eye and two similar lesions in the right eye. The OCT demonstrated the characteristic alterations in the outer retina. The visual field also demonstrated scotomas corresponding with these lesions. The OCT and IR features disappeared at the end of the follow-up except for the left eye, which continued to have hyperreflective spots in the outer plexiform layer. The patient complained about a residual scotoma only in the left eye after two years. Our case shows a difference in disease progression in the two eyes of the same patient, suggesting that several mechanisms can be implicated in the pathology of AMN.

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Acute macular neuroretinopathy in a patient with acute myeloid leukemia and deceased by COVID-19: a case report

Journal of Ophthalmic Inflammation and Infection ◽

10.1186/s12348-020-00231-1 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Ghodsieh Zamani ◽

Sajjad Ataei Azimi; ◽

Ali Aminizadeh ◽

Elham Shams Abadi ◽

Mostafa Kamandi ◽

...

Keyword(s):

Acute Myeloid Leukemia ◽

Myeloid Leukemia ◽

Outer Nuclear Layer ◽

Plexiform Layer ◽

Underlying Disease ◽

Outer Retina ◽

Acute Macular Neuroretinopathy ◽

En Face Oct ◽

The Right ◽

Acute Myeloid

Abstract Purpose Acute macular neuroretinopathy (AMN) is a visual-deteriorating rare clinical entity with an uncertain etiology. We aimed to report a case of AMN and underlying disease of acute myeloid leukemia (AML). Case presentation A thirty-five-year-old female patient with bone marrow biopsy confirmed AML, and bicytopenia, under chemotherapy, complained of sudden paracentral visual field defect in her right eye was referred. Visual acuity was 20/20 in both eyes. Posterior segment evaluation revealed multiple Roth’s spots. Optical coherence tomography (OCT) demonstrated hyper-reflectivity band, in the outer nuclear layer and outer plexiform layer, nasal to the fovea of the right eye, and hyperreflective patch in outer retina segmentation en-face OCT, suggestive of the diagnosis of AMN. Nine days after AMN diagnosis, dyspnea, malaise, and cough was initiated. Ground glass opacities in lung CT scan, beside reverse transcription polymerase chain reaction of severe acute respiratory syndrome coronavirus-2, was conclusive of coronavirus disease 2019 (COVID-19). The patient deceased after 6 days. Conclusion We report a rare case of AMN following AML. Our findings support the role of ischemia in the outer retina, of which AML may contributed to the pathophysiological process. The patient has deceased less than 2 weeks from AMN initiation.

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Case Report: Self-Resolved Macular Edema Secondary to Congenital Retinal Macrovessels

Frontiers in Medicine ◽

10.3389/fmed.2021.771007 ◽

2022 ◽

Vol 8 ◽

Author(s):

Fang Zheng ◽

Kairan Lai ◽

Houfa Yin ◽

Jingliang He ◽

Yufeng Xu ◽

...

Keyword(s):

Macular Edema ◽

Plexiform Layer ◽

Fundus Examination ◽

Pressure Treatment ◽

Fundus Fluorescein Angiography ◽

Good Visual Acuity ◽

Retinal Capillary ◽

Blurry Vision ◽

The Right

PurposeTo report a case of macular edema secondary to congenital retinal macrovessels (CRMs), which resolved spontaneously without any treatment.ObservationsA 39-year-old female presented with blurry vision of the right eye for one day. Fundus examination revealed a branch of artery and vein of the inferior retinal arcade crossing the horizontal raphe. Optical coherence tomography (OCT) through the fovea showed cystoid macular edema in the outer plexiform layer. However, no leakage of the vessels was noticed by fundus fluorescein angiography (FFA). Observation was recommended with close follow-up. Two weeks later, the patient returned with good visual acuity, and the macular edema was resolved spontaneously.ConclusionsMacular edema is a possible complication of CRM by increasing retinal capillary hydrostatic pressure. Treatment is not necessary for this kind of macular edema if no leakage of the vessels is noticed on FFA.

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Large choroidal excavation in pachychoroid disease: A case report

European Journal of Ophthalmology ◽

10.1177/1120672119892428 ◽

2019 ◽

pp. 112067211989242 ◽

Cited By ~ 2

Author(s):

Pierluigi Iacono ◽

Maurizio Battaglia Parodi ◽

Sandro Saviano ◽

Mariacristina Parravano ◽

Monica Varano

Keyword(s):

Optical Coherence Tomography ◽

Visual Acuity ◽

Indocyanine Green ◽

Choroidal Neovascularization ◽

Indocyanine Green Angiography ◽

Fundus Examination ◽

Corrected Visual Acuity ◽

Focal Choroidal Excavation ◽

The Right ◽

Best Corrected Visual Acuity

Purpose: To report the morphological and clinical features of a case of pachychoroid disease with focal choroidal excavation and large choroidal excavation complicated by choroidal neovascularization. Methods: The patient underwent a complete ophthalmologic examination including best-corrected visual acuity assessment, anterior segment and dilated fundus examination, fluorescein and indocyanine green angiography, and spectral-domain optical coherence tomography. Results: During the previous follow-up, the 57-year-old man received a diagnosis of central serous chorioretinopathy in the right eye with a late appearance of a choroidal neovascularization. The best-corrected visual acuity was 20/125 and 20/20 in the right and left eye, respectively. Dilated fundus examination, fluorescein angiography, and indocyanine green angiography confirmed a large subretinal fibrosis corresponding to the evolution of the choroidal neovascularization in the right eye. Spectral-domain optical coherence tomography clearly demonstrated in the right eye a large choroidal excavation below the fibrotic neovascular lesion with multiple hyperreflective foci inside the cavity, and in the left eye, a conforming focal choroidal excavation, bowl-shape type, associated with increased choroidal thickness with pachyvessels. Conclusion: Large choroidal excavation has been rarely reported. Although the pathogenetic mechanisms leading to the formation of large choroidal excavation are still only hypotheses, a combination of primary degenerative inflammatory factors sustaining the focal choroidal excavation formation and disruptive process of the choroidal neovascularization could be retained responsible for the large choroidal excavation.

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INFLUENCE OF RISK FACTORS FOR CARDIOVASCULAR DISEASES, HISTORY OF CARDIOVASCULAR DISEASES, AND STRUCTURAL AND FUNCTIONAL STATE OF THE HEART ON 3-YEAR SURVIVAL IN PERSONS 95 YEARS AND OLDER

Успехи геронтологии ◽

10.34922/ae.2021.34.5.009 ◽

2021 ◽

pp. 727-733

Author(s):

К.А. Ерусланова ◽

А.В. Лузина ◽

Ю.С. Онучина ◽

В.С. Остапенко ◽

Н.В. Шарашкина ◽

...

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Cardiovascular Diseases ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Risk Of Death ◽

History Of ◽

The Right

В последние годы появляется все больше работ, посвященных снижению воздействия классических факторов риска, негативно сказывающихся на выживаемости с возрастом. Целью исследования была оценка влияния сердечно-сосудистых заболеваний, их факторов риска и структурно-функциональных характеристик сердца на трехлетнюю выживаемость лиц 95 лет и старше. В исследовании участвовали 69 пациентов 95 лет и старше (98±1,9 года), из них 61 (88,4 %) женщина и 8 (11,6 %) мужчин. Через 3 года были получены данные о статусе жизни участников: 25 (36,2 %) были живы и 44 (63,8 %) умерли. По результатам проведенного однофакторного регрессионного анализа было определено, что факторы риска и анамнез сердечно-сосудистых заболеваний не ассоциированы с трехлетней выживаемостью. Однако в трехлетнем периоде риск смерти увеличивался в 3 раза при снижении ДАД <75 мм рт. ст., в 7,8 раза - при снижении ФВ ЛЖ <62 % и в 4,9 раза - при увеличении конечного диастолического размера правого желудочка >2,9 см. In recent years, more and more works have appeared that with age, classic risk factors that negatively affect the prognosis (cardiovascular diseases) lose their influence on life expectancy. The study aimed to assess the influence of cardiovascular diseases and their risk factors and structural and functional characteristics of the heart on three-year survival in people 95 years and older. The study involved 69 patients 95 years and older (98±1,9 years), 61 (88,4 %) were women. After 36 months, data were obtained on the participants’ status of life: 25 (36,2 %) were alive, and 44 (63,8 %) died. Based on the regression analysis results, it was determined that risk factors and history of cardiovascular diseases were not associated with 3-year survival. With a 3-year follow-up, the risk of death increases three times with a decrease in diastolic blood pressure less than 75 mm/Hg, 7,8 times with a decrease in left ventricular ejection fraction below 62 %, and 4,9 times with an increase in the end-diastolic size of the right ventricle by more than 2,9 cm.

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Ocular and Systemic Risk Factors of Different Morphologies of Scotoma in Patients with Normal-Tension Glaucoma

Journal of Ophthalmology ◽

10.1155/2017/1480746 ◽

2017 ◽

Vol 2017 ◽

pp. 1-6 ◽

Cited By ~ 3

Author(s):

Ewa Kosior-Jarecka ◽

Dominika Wróbel-Dudzińska ◽

Urszula Łukasik ◽

Tomasz Żarnowski

Keyword(s):

Risk Factors ◽

Visual Field ◽

Systemic Risk ◽

Normal Tension Glaucoma ◽

Visual Field Defects ◽

Disc Hemorrhage ◽

Specific Morphology ◽

Preperimetric Glaucoma ◽

Caucasian Patients

The Aim. The aim of this study was to assess general and ocular profiles of patients with single-localisation changes in visual field. Material and Methods. The study group consisted of 215 Caucasian patients with normal-tension glaucoma with scotoma on single localisation or with preperimetric glaucoma. During regular follow-up visits, ophthalmic examination was carried out and medical history was recorded. The results of the visual field were allocated as paracentral scotomas, arcuate scotomas, peripheral defects, or hemispheric defects. Statistical analysis was conducted with Statistica 12, and p<0.05 was considered statistically significant. Results. Risk factors such as notch, disc hemorrhage, general hypertension, migraine, and diabetes were strongly associated with specific visual field defects. Paracentral defect was significantly more frequent for women (p=0.05) and patients with disc hemorrhage (p<0.001). Arcuate scotoma occurred frequently in patients without disc hemorrhage (p=0.046) or migraines (p=0.048) but was observed in coexistence with general hypertension (p<0.001). The hemispheric defect corresponded with notch (p=0.0036) and migraine (p=0.081). Initial IOP was highest in patients with arcuate scotoma and lowest in patients with preperimetric glaucoma (p=0.0120). Conclusions. The specific morphology of scotoma in patients with normal-tension glaucoma is connected with definite general and ocular risk factors.

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Acute Macular Neuroretinopathy Related to Alcoholic Hepatitis

Case Reports in Ophthalmology ◽

10.1159/000513186 ◽

2021 ◽

pp. 293-298

Author(s):

Grace Anne Mc Cabe ◽

William Gordon Campbell ◽

Thomas Gordon Campbell

Keyword(s):

Alcoholic Hepatitis ◽

Plexiform Layer ◽

Acute Onset ◽

Acute Macular Neuroretinopathy ◽

Microvascular Changes ◽

First Case ◽

Paracentral Scotoma ◽

The Right ◽

Sd Oct ◽

Subfoveal Fluid

A 33-year-old woman admitted for acute alcoholic hepatitis was referred to the ophthalmology department with an acute onset paracentral scotoma of the left eye. On examination, best-corrected visual acuity was Snellen 6/4 in the right eye and 6/9 in the left eye. Dilated left fundus examination revealed wedge-shaped changes at the macula. Spectral-domain ocular coherence tomography (SD-OCT) initially revealed a small cuff of subfoveal fluid and band-like hyperreflectivity extending outwards from the outer plexiform layer consistent with acute macular neuroretinopathy (AMN). Four days later, repeat SD-OCT was performed and it demonstrated resolution of the subfoveal fluid and disruption of the outer retinal layers. At the 6-week follow-up, the patient had no improvement in her symptoms and OCT angiography demonstrated coarsening and microvascular changes in both the deep vascular plexus and the choriocapillaris. To our knowledge, this is the first case of AMN in association with acute hepatitis. Although the exact pathophysiology of AMN remains obscure, this case highlights the benefits of multimodal retinal imaging and aims to bring attention to the possible association of AMN with alcoholic hepatitis.

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Sarcomatoid hepatocellular carcinoma in a young African female

SAGE Open Medical Case Reports ◽

10.1177/2050313x211052452 ◽

2021 ◽

Vol 9 ◽

pp. 2050313X2110524

Author(s):

Abid M Sadiq ◽

Minael G Mjemmas ◽

Adnan M Sadiq ◽

Gilbert Z Nkya

Keyword(s):

Risk Factors ◽

Computed Tomography ◽

Hepatocellular Carcinoma ◽

Overall Survival ◽

Young Female ◽

Herbal Medications ◽

Tender Mass ◽

Malignant Liver ◽

The Right ◽

Clonic Convulsions

Sarcomatoid hepatocellular carcinoma is a rare primary malignant liver cancer. The pathogenesis is unclear; however, the risk factors may be similar to that of conventional hepatocellular carcinoma. We present an 18-year-old female who was admitted due to generalized tonic–clonic convulsions. On examination, we palpated a large non-tender mass in the right upper quadrant. An abdominal computed tomography identified it as hepatocellular carcinoma, and spindle-shaped cells were seen on histopathology. She was counseled on her prognosis but opted for local herbal medications rather than chemotherapy, but unfortunately passed away. We present a rare subtype of hepatocellular carcinoma in a young female which is commonly seen in males above the age of 50 years, and despite its grade and stage, overall survival is poor.

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Temporal crescent syndrome caused by a lateral ventricular glioependymal cyst: case report

Journal of Neurosurgery Pediatrics ◽

10.3171/2020.3.peds2021 ◽

2020 ◽

Vol 26 (3) ◽

pp. 232-236

Author(s):

Izumi Yamaguchi ◽

Kyong-Hon Pooh ◽

Mai Azumi ◽

Yasushi Takagi

Keyword(s):

Visual Field ◽

Visual Field Defect ◽

Striate Cortex ◽

The Body ◽

Blurred Vision ◽

Anterior Portion ◽

Glioependymal Cyst ◽

The Right ◽

Field Defect

Temporal crescent syndrome is a monocular visual field defect involving the temporal crescent of one eye caused by a retrochiasmal lesion. The most anterior portion of the striate cortex is the only area where the retrochiasmal lesion produces a monocular visual field defect. The authors present the case of a 9-year-old boy who presented with mild headache. MRI revealed a cyst with cerebrospinal fluid signal intensity, occupying the body and trigone of the right lateral ventricle. Conservative treatment with regular clinical and radiological follow-up was chosen because neurological examination findings were normal. Three years later, the patient experienced blurred vision with a temporal crescent defect in the left eye. Endoscopic cyst fenestration was performed, and the pathological findings indicated a glioependymal cyst. After surgery, the monocular temporal crescent disorder was resolved. MRI indicated shrinkage of the cyst and improvement in the narrowing of the anterior calcarine sulcus. These findings suggested that the temporal crescent syndrome was caused by a lateral ventricular glioependymal cyst. This is the first known report of temporal crescent syndrome caused by a lateral ventricular glioependymal cyst. In patients with monocular temporal crescent disorder without intraocular disease, a retrochiasmal lesion in the most anterior portion of the striate cortex should be considered.

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Progression of Aortic Regurgitation in Asian Patients with Congenital Sinus of Valsalva Aneurysm

The Heart Surgery Forum ◽

10.1532/hsf98.20131019 ◽

2013 ◽

Vol 16 (4) ◽

pp. 219 ◽

Cited By ~ 1

Author(s):

Zhi-Qiang Li ◽

Ai-Jun Liu ◽

Xiao-Feng Li ◽

Yao-Bin Zhu ◽

Ying-Long Liu

Keyword(s):

Risk Factors ◽

Regression Analysis ◽

Aortic Regurgitation ◽

Long Term Results ◽

Sinus Of Valsalva ◽

Sinus Of Valsalva Aneurysm ◽

Cox Regression Analysis ◽

Cardiothoracic Ratio ◽

The Right

Background: We reviewed the experience of An Zhen and Fu Wai Hospital for congenital sinus of Valsalva aneurysm (SVA) to determine risk factors for aortic valve replacement (AVR) and postoperative progression of aortic regurgitation (AR).Methods: Over a 7-year period, 255 patients underwent surgical repair of an SVA. Aneurysms originated from the right sinus and the noncoronary sinus in 212 patients (83.1%) and 38 patients (14.9%), respectively, and protruded into the right ventricle and right atrium in 171 patients (67.1%) and 80 patients (31.4%), respectively. AR presented in 142 patients (55.7%), 60 patients underwent AVR, and 13 patients underwent aortic valvuloplasty (3 patients eventually received AVR for valvuloplasty failure).Results: All patients survived the operation. Late death occurred in 2 patients (0.8%), and 2 patients (0.8%) experienced anticoagulation-related complications. Logistic regression analysis revealed that infective endocarditis, the cardiothoracic ratio, and a nonruptured SVA were risk factors for AVR. Late follow-up of 150 patients by echocardiographic assessment revealed that AR improved in 17 patients and worsened in 20 patients. Cox regression analysis revealed AR at discharge to be an independent risk factor for AR aggravation at late follow-up.Conclusions: SVA can be repaired with low mortality and excellent long-term results. AR at discharge is an important factor in determining AR aggravation at late follow-up after the operation. We recommend early diagnosis and aggressive treatment for SVA.

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Perifoveal exudative vascular anomalous complex in a highly myopic eye

Therapeutic Advances in Ophthalmology ◽

10.1177/2515841420947930 ◽

2020 ◽

Vol 12 ◽

pp. 251584142094793

Author(s):

Riccardo Sacconi ◽

Enrico Borrelli ◽

Francesco Bandello ◽

Giuseppe Querques

Keyword(s):

Visual Acuity ◽

Fundus Examination ◽

Corrected Visual Acuity ◽

Capillary Plexus ◽

The Right ◽

Superficial Capillary Plexus ◽

Best Corrected Visual Acuity ◽

Past Conditions ◽

Chorioretinal Degeneration

‘Perifoveal Exudative Vascular Anomalous Complex’ (PEVAC) is a perifoveal, unilateral, isolated, perifoveal aneurysm, in otherwise healthy patients. Here, we report a case of PEVAC in a highly myopic eye of a 86-year-old woman affected by a visual decline in the right eye (best-corrected visual acuity of 20/100). She had no other relevant past conditions and/or ocular impairment. Fundus examination in the right eye showed myopic chorioretinal degeneration with a concomitant PEVAC. Structural optical coherence tomography (OCT) showed a round lesion with a hyperreflective wall associated with intraretinal cystic spaces. OCT-angiography nicely disclosed an isolated large aneurysmal retinal dilation featuring the PEVAC with detectable flow in superficial capillary plexus, deep capillary plexus, and avascular slab. This case highlights the importance of discerning between different vascular disorders of the macula, in order to be able to offer the right treatment and/or follow-up to the patient.

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