scholarly journals Optic neuritis as the ocular manifestation of dengue infection: a case report

2021 ◽  
Vol 3 (1) ◽  
pp. 46-51
Author(s):  
Indra Tri Mahayana ◽  
Andreas Surya Anugrah ◽  
Ika Kartika ◽  
Natalia Christina Angsana ◽  
Tatang Talka Gani
Keyword(s):  
Visual Acuity ◽  
Optic Neuritis ◽  
Vision Loss ◽  
Early Recognition ◽  
Dengue Infection ◽  
Young Female ◽  
Blurred Vision ◽  
Colour Perception ◽  
Optic Neuritis Treatment Trial ◽  
Optic Discs

Optic neuritis is characterized by decreased vision, impaired colour perception, relative afferent pupillary defects, and scotoma. Optic neuritis following dengue infection is rare and might be underdiagnosed. The pathophysiology of optic neuritis after dengue infection is still unclear and there are only a few reports. We report a case of bilateral simultaneous optic neuritis in a young female adult following dengue haemorrhagic fever. On presentation, she complained of blurred vision, pain around the eyes, central scotoma, and progressively worsening visual acuity to no perception of light in both eyes. The next day, laboratory examination showed leucopoenia (6.74 [4.5–11.5 103/μL]) and lymphocytosis (52.7 [18–42%]), suggesting viral infection with positive anti-dengue IgM and IgG. The patient received intravenous pulse steroid therapy according to the Optic Neuritis Treatment Trial. At 3 months follow-up, best corrected visual acuity improved to 6/6, with pale optic discs but normal perimetry. Although complications of dengue fever in the eye are rare, early recognition must be established to prevent permanent vision loss.

scholarly journals Early Bilateral Cystoid Macular Oedema Secondary to Fingolimod in Multiple Sclerosis

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
Lei Liu ◽  
Fiona Cuthbertson
Keyword(s):  
Multiple Sclerosis ◽  
Visual Acuity ◽  
Optic Neuritis ◽  
Macular Oedema ◽  
Early Recognition ◽  
Subretinal Fluid ◽  
Cystoid Macular Oedema ◽  
Blurred Vision ◽  
Visual Symptoms

We report a case of fingolimod-associated bilateral cystoid macular oedema in a patient with multiple sclerosis (MS). A 34-year-old female, diagnosed with MS at age of 30, developed bilateral blurred vision 5 days after initiation of fingolimod. She was misdiagnosed as optic neuritis initially and fingolimod was only discontinued 3 weeks after onset of her visual symptoms when OCT showed prominent bilateral cystoid macular oedema and subretinal fluid. Although her left corrected vision returned to 6/6, she had persistently decreased right visual acuity of 6/12 after 5 months. This paper aims to raise awareness among ophthalmologists and neurologists of the importance of early recognition of macular oedema associated with fingolimod.

scholarly journals Optic perineuritis secondary to hyaluronic acid injections: a case report

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Yanjun Hu ◽  
Yingjun Wang ◽  
Yuhua Tong
Keyword(s):  
Hyaluronic Acid ◽  
Oral Prednisolone ◽  
Young Female ◽  
Blurred Vision ◽  
Visual Field Examination ◽  
Case Presentation ◽  
Administration Method ◽  
The Right ◽  
Optic Discs ◽  
The Brain

Abstract Background Although a safe, excellent administration method for hyaluronic acid derivatives has been documented; improper injections can lead to devastating and irreversible consequences. Here, we present the first known case of optic perineuritis caused by hyaluronic acid. Case presentation A young female experienced sudden orbital pain in the right eye after receiving hyaluronic acid injections to the eyebrows. She presented to the eye clinic two weeks later, after developing blurred vision in the right eye. Visual acuity was reduced significantly in the right eye. Automated visual field examination showed defects in both eyes. Fundus examination revealed bilateral swelling of optic discs. Magnetic resonance imaging of the brain demonstrated bilateral perineural enhancement consistent with optic perineuritis. The patient was treated with retrobulbar injection of hyaluronidase and oral prednisolone. Her vision improved with treatment. Conclusions The prognosis for visual outcomes in patients with optic perineuritis is generally excellent. However, a poor prognosis is associated with delays to the initiation of treatment. Recognizing this condition is important, and treatment with corticosteroids should be initiated early.

scholarly journals Infliximab-related Optic Neuritis in a Patient with Crohn's Disease: a Case Report and Literature Review

2021 ◽  
Vol 62 (8) ◽  
pp. 1160-1166
Author(s):  
Su Hwan Park ◽  
Min Seung Kang ◽  
Sang Yoon Kim ◽  
Ji-Eun Lee ◽  
Su Jin Kim
Keyword(s):  
Visual Acuity ◽  
Crohn’S Disease ◽  
Visual Field ◽  
Crohn's Disease ◽  
Optic Neuritis ◽  
Visual Field Defect ◽  
High Dose ◽  
Infliximab Treatment ◽  
Blurred Vision ◽  
Field Defect

Purpose: We report a case of optic neuritis related to infliximab treatment in a patient with Crohn’s disease, along with a review of the relevant literature.Case summary: A 22-year-male patient complained of blurred vision in the left eye for 2-3 weeks. His best-corrected visual acuity was 8/20 in the left eye. Relative afferent pupillary defect was detected in the left eye and the pupils were of equal size. There was no pain on ocular movement. The results of slit-lamp and fundus examinations were normal. A visual field test revealed a central to inferior visual field defect in the left eye. Orbit magnetic resonance imaging revealed perineural enhancement of the left optic nerve. He had a 5-year history of Crohn’s disease and had been treated with intravenous infliximab (600 mg every 2 weeks). A diagnosis of retrobulbar optic neuritis associated with infliximab was made. He was infused with high-dose methylprednisolone, which was changed to per oral administration. His visual acuity and visual field defect improved after 3 months.Conclusions: Tumor necrosis factor-α inhibitors, such as infliximab, may cause optic neuritis. Therefore, history-taking is important for differential diagnosis and appropriate treatment.

scholarly journals IDENTIFYING POST-PARTUM OPTIC NEURITIS IN RURAL AREAS: A CASE REPORT

2020 ◽  
Vol 3 (3) ◽  
pp. 96-99
Author(s):  
Harris Kristanto Soedjono ◽  
Candida Isabel Lopes Sam
Keyword(s):  
Visual Acuity ◽  
Autoimmune Disease ◽  
Optic Neuritis ◽  
Rural Areas ◽  
Vision Loss ◽  
Post Partum ◽  
High Dose ◽  
Folic Acid Deficiency ◽  
Demyelinating Process ◽  
Post Partum Period

Background: Optic neuritis is an inflammatory demyelinating process that causes acute impairment of vision that may appear in one or both eyes, either simultaneously or successively. Case: A 22-year-old woman admitted to Neurology Clinic with chief complaint of sudden vision loss in both eyes simultaneously in the last two days. Additional complaints like headache and dizziness also occur. The patient was in her 7th day of post-partum period when this happened. There was no problem during pregnancy nor delivery. The initial visual acuity was 1/300 in both eyes. The patient then admitted and treated with high-dose corticosteroid. After treatment, the patient went home with visual acuity of more than 6/60. Discussion: This patient may have B6, B12, and folic acid deficiency that can cause demyelinating process of optic nerve. It is also possible as an early manifestation of Multiple Sklerosis, an autoimmune process that arises during post-partum period. Conclusion: Pregnancy has a protective effect to autoimmune disease, whereas post-partum period is immunologically more vulnerable to autoimmune disease. Keywords: optic neuritis, post-partum, sudden vision loss

scholarly journals Cytomegalovirus Retinitis Screening and Treatment in Human Immunodeficiency Virus Patients in Malawi: A Feasibility Study

2019 ◽  
Vol 6 (11) ◽  
Author(s):  
Paulina Ocieczek ◽  
James R Barnacle ◽  
Joe Gumulira ◽  
Sam Phiri ◽  
Tom Heller ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Visual Acuity ◽  
Early Recognition ◽  
Cytomegalovirus Retinitis ◽  
Public Health Issue ◽  
Hospital Data ◽  
Blurred Vision ◽  
Cd4 Counts ◽  
Ocular Symptoms ◽  
Immunodeficiency Virus

Abstract Background Cytomegalovirus retinitis is a treatable cause of blindness in people with human immunodeficiency virus (HIV) typically with CD4 counts <50 cells/mm3. Diagnosis is with indirect fundoscopy, and treatment is with intravitreal ganciclovir injections or systemic therapy. However, diagnosis and treatment are not widely available in Malawi, which has an adult HIV prevalence estimated at 10.6%. This study aimed to establish the prevalence of cytomegalovirus retinitis among people with HIV in Malawi and the feasibility of screening. Methods Patients with CD4 counts <200 cells/mm3 were examined from 2 HIV clinics in Lilongwe and the main government hospital. Data were collected on antiretroviral therapy, ocular symptoms, and visual acuity. Fundoscopy was performed to investigate for features of cytomegalovirus retinitis. Retinal photographs were reviewed by an ophthalmologist. Patients diagnosed with cytomegalovirus retinitis were offered weekly ganciclovir injections, because systemic treatment was not available. Results Five of the 102 people with HIV screened had cytomegalovirus retinitis (4.9%). All affected patients had CD4 counts <50 cells/mm3 (mean, 15 cells/mm3; range, 3–22 cells/mm3). Visual acuity was unhelpful in identifying those with cytomegalovirus retinitis. Symptomatically, only blurred vision was useful. Two patients consented to treatment, 1 of which improved but relapsed after defaulting. Conclusions Cytomegalovirus retinitis screening based on CD4 count is essential to early recognition because visual acuity and symptoms are unreliable. Cytomegalovirus retinitis is a significant yet neglected public health issue in Malawi. Oral valganciclovir is essential to reduce blindness and mortality in those diagnosed but is not yet available. Further screening and advocacy are needed.

scholarly journals The effect of optic neuritis treatment trial (ONTT) combined corticosteroid regimen on pattern reversal visual evoked potentials: a prospective follow-up study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Padmini Dahanayake ◽  
Tharaka L. Dassanayake ◽  
Manoji Pathirage ◽  
Saman Senanayake ◽  
Mike Sedgwick ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Optic Neuritis ◽  
First Episode ◽  
Pattern Reversal ◽  
Treatment Trial ◽  
Normal Range ◽  
P100 Latency ◽  
Pre Treatment ◽  
Optic Neuritis Treatment Trial

Abstract Background The combined corticosteroid regimen of the original Optic Neuritis Treatment Trial (ONTT) is used in many centers to treat optic neuritis. Though pattern reversal visual evoked potentials (PRVEPs) are a sensitive, standard measure of visual conduction in optic neuritis, no studies hitherto have investigated the effect of combined ONTT regimen on PRVEPs. We aimed to determine the effect of combined corticosteroid regimen of the ONTT on changes of PRVEPs in patients with first-episode optic neuritis over 3 months post-treatment. Methods This is a prospective, observational study in which 44 patients with optic neuritis were seen pre-treatment (baseline) and follow-up, at 1 month (FU1) and 3 months (FU2). Twenty-nine patients were treated with ONTT combined regimen (ONTT+ Group) while 15 were conservatively managed without corticosteroids (ONTT- Group). The median latency and amplitude values of the P100 PRVEP component and the visual acuity (i.e. LogMAR values) at pre-treatment, FU1 and FU2 were compared in the two groups using Friedman’s rank test and Wilcoxon Signed Ranks test. Results Median P100 latency improved significantly (to the normal range) as early as by 1 month after the commencement of treatment in the ONTT+ Group, and then remained significantly lower than the baseline over next 2 months. In the ONTT- Group, the median P100 latency improved more slowly over the two follow up assessments and reached the normal range by 3 months. Median visual acuity values also improved significantly at 1 and 3 months after the commencement of treatment in the ONTT+ Group but not in the ONTT- Group. Conclusion ONTT combined corticosteroid regimen improves conduction in the visual pathways of patients with first-episode optic neuritis earlier than does conservative management. We provide electrodiagnostic evidence that combined ONTT regimen–compared with conservative management–results in early remission of visual conduction abnormalities in first-episode optic neuritis.

Central Serous Chorioretinopathy – an Overview

2021 ◽  
Author(s):  
Lieselotte Berger ◽  
Virginie Bühler ◽  
Suzanne Yzer
Keyword(s):  
Visual Acuity ◽  
Central Serous Chorioretinopathy ◽  
Pigment Epithelium ◽  
Retinal Pigment ◽  
Case Series ◽  
Subretinal Fluid ◽  
Laser Coagulation ◽  
Blurred Vision ◽  
Colour Perception ◽  
Spontaneous Course

AbstractCentral serous chorioretinopathy (CSCR) is characterised by retinal serous detachment usually localised in the macular region. CSCR predominantly affects men between 30 and 50 years of age. Traditional classification differentiates between acute (duration shorter than 4 to 6 months) and chronic disease (duration longer than 4 to 6 months). The pathogenesis is multifactorial and current thinking assumes the presence of localised choroidal hyperpermeability with subsequent secondary changes in the retinal pigment epithelium (RPE). The symptoms of acute CSCR include central blurred vision, often with deterioration in visual acuity. Optical coherence tomography (OCT) reveals subretinal fluid (SRF) and/or single retinal pigment epithelial detachments. Fluorescein angiography (FA) usually shows a leaking point with absent or only minor RPE changes in the acute phase and indocyanine green angiography (ICG) highlights circumscribed areas of thickened and hyperpermeable choroid. Acute cases may show spontaneous resolution of SRF, but may also recur and/or become chronic. After the initial diagnosis, spontaneous remission is seen in about 70 to 80% of cases, with a recurrence rate of about 50%. Due to the favourable spontaneous course, it is recommended to wait for 4 to 6 months after the first symptoms manifest. Steroid therapy is considered as a major risk factor. Chronic cases are characterised by slow deterioration in visual acuity with reduced contrast and colour perception. There are extensive RPE changes, with secondary degenerative changes of the photoreceptors. The disease can by complicated by choroidal neovascularisation (CNV), especially in elderly patients. The literature lists a number of treatments: The leakage point (visible in the FA) can be treated by focal laser therapy, either micropulse laser or, if sufficiently distant from the fovea, by argon laser coagulation. Randomised trials in chronic CSCR demonstrated good outcomes with photodynamic therapy. With observation periods ranging from 3 to 6 months, several case series reports found improvement after systemic administration of mineralocorticoid receptor antagonists, carbonic anhydrase inhibitors or non-steroidal anti-inflammatory drugs. In the presence of secondary CNV, anti-VEGF treatment should be initiated. It is unclear whether the combination with PDT might be useful.

scholarly journals Visual outcomes of proton beam therapy for choroidal melanoma at a single institute in the Republic of Korea

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0242966
Author(s):  
Su-Kyung Jung ◽  
Young-Hoon Park ◽  
Dong-ho Shin ◽  
Hak-Soo Kim ◽  
Jong-Hwi Jung ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Proton Beam ◽  
Optic Disc ◽  
Tumor Size ◽  
Vision Loss ◽  
Choroidal Melanoma ◽  
Proton Beam Therapy ◽  
Dose Fractionation ◽  
Optic Discs

We evaluate the ocular effects of proton beam therapy (PBT) in a single institution, in Korea, and identify factors contributing to decreasing visual acuity (VA) after PBT. A total of 40 patients who received PBT for choroidal melanoma (2009‒2016) were reviewed. Dose fractionation was 60‒70 cobalt gray equivalents (CGEs) over five fractions. Complete ophthalmic examinations including funduscopy and ultrasonography were performed at baseline and at 3, 6, and 12 months after PBT, then annually thereafter. Only patients with at least 12 months follow-up were included. During the follow-up, consecutive best-corrected visual acuity (BCVA) changes were determined, and univariate and multivariate logistic regression analyses were performed to identify predictors for VA loss. The median follow-up duration was 32 months (range: 12‒82 months). The final BCVA of nine patients was > 20/40. The main cause of vision loss was intraocular bleeding, such as neovascular glaucoma or retinal hemorrhage. Vision loss was correlated with the tumor size, tumor distance to the optic disc or fovea, maculae receiving 30 CGEs, optic discs receiving 30 CGEs, and retinas receiving 30 CGEs. Approximately one-third of PBT-treated choroidal melanoma patients with good pretreatment BCVA maintained their VA. The patients who finally lost vision (VA < count fingers) usually experienced rapid declines in VA from 6‒12 months after PBT. Tumor size, tumor distance to the optic disc or fovea, volume of the macula, and optic discs or retinas receiving 30 CGEs affected the final VA.

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