Case Report: Vogt-Koyanagi-Harada Syndrome Mimicking Acute Angle-Closure Glaucoma in a Patient Infected With Human Immunodeficiency Virus

Vogt-Koyanagi-Harada disease (VKH) is a rare multisystemic inflammatory autoimmune disorder. Glaucoma secondary to VKH frequently occurs during the recurrent phase of anterior uveitis; however, acute angle-closure glaucoma (ACG) secondary to both VKH and human immunodeficiency virus (HIV) infection has rarely been reported. We describe a case of secondary acute ACG involving VKH, characterized by sudden vision loss, moderately elevated intraocular pressure (IOP), shallow anterior chamber, and fully or partially closed angle, in an HIV-infected patient. Both VKH and HIV infection contributed to the occurrence of ACG due to the leakage and forward rotation of the ciliary body, as well as choroidal effusion. The deterioration of IOP and serous macular detachment were observed after initial corticosteroid therapy. Visual acuity and IOP were improved with subretinal fluid absorption after continued corticosteroid therapy. Understanding the response of IOP and serous macular detachment after corticosteroid therapy is important for clinical practice.

A Patient With Optic Nerve Pit Maculopathy Successfully Treated With Juxtapapillary Laser Photocoagulation

Optic disc pits are rare and congenital or acquired anomalies of the optic disc, usually remaining asymptomatic. However, serous macular detachment or optic disc maculopathy is the most common complication, causing significant visual deterioration, without a current consensus about treatment. A 55-year-old woman with a past medical history of diabetes mellitus and systemic hypertension was referred for an abnormal finding in the retina. The Corrected Distance Visual Acuity (CDVA) was 20/40 in the right eye and 20/30 in the left eye. Marcus-Gunn was negative and Slit-lamp biomicroscopy revealed no pathologic findings in both eyes. Funduscopic examination showed an excavation in the inferotemporal part of the Optic Nerve Head (ONH) with serous macular detachment extending to the optic disc. Based on clinical examination and paraclinical imaging fluorescein Angiogeraphy (FAG) Optical Coherence Tomography (OCT), optic pit maculopathy was diagnosed and the patient underwent Juxtapapillary Laser Photocoagulation (JLP). After 2 years of follow-up, there were anatomical and functional improvements.

Best disease presenting as subretinal pigment epithelium hyperreflectivite lesion on spectral-domain optical coherence tomography: Multimodal imaging features

Purpose To report clinical and multimodal imaging features of Best disease in patients presenting with subretinal pigment epithelium hyperreflective lesions. Design Retrospective study. Methods Clinical examination findings and multimodal imaging features, including color fundus photography, spectral-domain optical coherence tomography (SD-OCT), fundus autofluorescence, fluorescein and indocyanine green angiography (ICGA), and optical coherence tomography angiography (OCTA) images were evaluated retrospectively. Results We assessed 27 eyes of 16 patients with the diagnosis of Best disease. Only patients presenting with serous macular detachment and subretinal pigment epithelium hyperreflective lesion in one or both eyes were included in this study. In 17 of 27 eyes (63%), fibrosis was identified by multimodal imaging techniques. Although there was no sign of active neovascularization on fundus examination or SD-OCT, a vascular network could be identified in 7 eyes (26%) (in 1 eye with OCTA only and in 6 eyes with both OCTA and ICGA). Active neovascularization was seen in 3 eyes (11%). Treatment was recommended for eyes with active neovascularization, and follow-up was scheduled for eyes with quiescent neovascularization and fibrosis. Conclusion Eyes with Best disease with subretinal pigment epithelium hyperreflective lesion and serous macular detachment may show fibrosis, quiescent neovascularization, or active neovascularization. Multimodal imaging techniques are very important for differentiation of these lesions.

Vitrectomy in Serous Macular Detachment Associated with Optic Pit

Optic disc pit is a rare congenital anomaly of the optic disc and may be complicated by maculopathy with progressive vision loss. Optical disc pits are generally unilateral and sporadic, and the pathogenesis of maculopathy is not clear. Optical disc maculopathy (ODP-M) is a condition characterized by intraretinal, subretinal fluid, and retinal layers dissociation (retinoschisis). The origin of the subretinal fluid is controversial, and it is thought to be caused by liquefied vitreous, cerebrospinal fluid (CSF), leakage of the blood vessels in the base of the pit, and choroid. Although there is no consensus on its treatment, pars plana vitrectomy (PPV) alone or combined PPV, juxtapapillary laser photocoagulation, gas tamponade injection are the most frequently used methods in recent years. In this article, literature research was conducted on the possible mechanisms of the optic disc pit and the treatment modalities used.

The Outcomes of Intravitreal C3F8 Gas Tamponade Combined with Laser Photocoagulation Treatment for Optic Disc Pit Maculopathy

Purpose: To share the anatomical results and visual outcomes of intravitreal gas tamponade combined with laser photocoagulation treatment for optic disc pit maculopathy (ODPM). Methods: Intravitreal gas tamponade combined with laser photocoagulation treatmentwas performed on six consecutive patients with ODPM. A 0.3-mL of 100% octafluoropropane (C3F8) gas was injected intravitreally. The patients were then asked to maintain prone position until the C3F8 gas disappeared. Laser photocoagulation was performed the day after the procedure. The outcomes were determined by spectral-domain optical coherence tomography and best-corrected visual acuity (BCVA). Results: In the present study, visual improvement and reduction in serous macular detachment was observed in 83% of the ODPM patients. Complete retinal reattachment was achieved in 66% of the ODPM patients. In one patient, no regression was observed after the repeated treatment and pars plana vitrectomy was performed. The final BCVA improved in five eyes and unchanged in one eye. No postoperative complications were observed during the follow-up period in any patient. Conclusions: Intravitreal C3F8 gas tamponade combined with laser photocoagulation procedure is an effective, minimally invasive, and cost-effective treatment method for ODPM.

Best Disease Presenting as Subretinal Pigment Epithelium Hyperreflective Lesion on Spectral-Domain Optical Coherence Tomography: Multimodal Imaging Features Multimodal imaging in Best disease

PurposeTo report clinical and multimodal imaging features of Best disease in patients presenting with subretinal pigment epithelium hyperreflective lesion.DesignRetrospective study.MethodsClinical examination findings and multimodal imaging features, including color fundus photography, spectral-domain optical coherence tomography (SD-OCT), fundus autofluorescence, fluorescein and indocyanine green angiography (ICGA), and optical coherence tomography angiography (OCTA) images were evaluated retrospectively. ResultsWe assessed 27 eyes of 16 patients with the diagnosis of Best disease. Only patients presenting with serous macular detachment and subretinal pigment epithelium hyperreflective lesion in one or both eyes were included in this study. In 17 of 27 eyes (63%), fibrosis was identified by multimodal imaging techniques. Although there was no sign of active neovascularization on fundus examination or SD-OCT, a vascular network could be identified in 7 eyes (26%) (in 1 eye with OCTA only and in 6 with both OCTA and ICGA). Active neovascularization was seen in 3 eyes (11%). Treatment was recommended for eyes with active neovascularization, and follow-up was scheduled for eyes with quiescent neovascularization and fibrosis.ConclusionEyes with Best disease with subretinal pigment epithelium hyperreflective lesion and serous macular detachment may show fibrosis, quiescent neovascularization, or active neovascularization. Multimodal imaging techniques are very important for differentiation of these lesions.

Presumed Ocular Histoplasmosis Syndrome in the Middle East: A Case Report

Background:Presumed ocular histoplasmosis syndrome (POHS) occurs secondary to infection with Histoplasma Capsulatum (HC), which is an endemic organism in many tropical areas, especially in the United States. However, it has never been proven that HC directly causes POHS, hence the name presumed ocular histoplasmosis syndrome. Patients are usually asymptomatic, but some may present with blurring of central vision. Case Report:A 15-year-old girl, previously healthy, presented with a 2-months history of visual disturbance of the right eye. On physical examination, the visual acuity of the left eye was 20/20 while the right eye was only seeing “hand motion”. Fundus exam of the right eye showed juxtapapillary infiltrates with serous macular detachment, and small retinal and choroidal lesions, while the left eye showed only some small retinal and choroidal lesions. Fluorescein angiography of both eyes showed evidence of chorioretinitis with probable choroidal neovascularization (CNV). The diagnosis of POHS was made and the patient was treated with bevacizumab injections. Follow-up was done clinically and through spectral domain optical coherence tomography (SD-OCT) and showed marked improvement at the level of the macular thickness and CNV. Conclusion: Diagnosing POHS can be quite challenging, especially in cases coming from non-endemic areas. Our case emphasizes the importance of considering POHS in patients presenting with visual disturbance, even in these non-endemic areas, through a careful clinical evaluation and appropriate imaging modalities.

Hyperviscosity-related retinopathy and serous macular detachment in Waldenström’s macroglobulinemia: A mortal case in 5 years

Purpose: To present a 5-year mortal case of Waldenström’s macroglobulinemia-related retinopathy and serous macular detachment. Case report: A 63-year-old man, with unremarkable medical history, presented with bilateral decreased vision for 2 months. Fundus examination revealed bilateral scattered retinal hemorrhages, exudates, venous tortuosity, and serous macular detachment. Hematologic and biochemistry profiles showed pancytopenia with blood smear demonstrating erythrocyte rouleaux formation. Hyperviscosity syndrome was suspected and later Waldenström’s macroglobulinemia was diagnosed by bone marrow biopsy and high concentration of serum IgM. Plasmapheresis and subsequent chemotherapy were arranged. In spite of resolution of most retinal abnormalities, his visual acuity still showed no improvement with a persistent bilateral macular detachment. The patient then died 5 years after the diagnosis of Waldenström’s macroglobulinemia. Conclusions: Long-term toxicity of IgM to the retinal pigment epithelium may impede the resolution of the persistent serous macular detachment, resulting in an inability of recovery in his vision. Therefore, early diagnosis and timely reduction of serum paraproteins by plasmapheresis and chemotherapy is critical for preventing permanent damages to patients’ health and vision.

Visual Side Effects Linked to Sildenafil Consumption: An Update

Phosphodiesterase type 5 (PDE5) inhibitors such as Viagra® (sildenafil citrate) have demonstrated efficacy in the treatment of erectile dysfunction (ED) by inducing cyclic guanosine monophosphate (cGMP) elevation followed by vasodilation and increased blood flow. It also exerts minor inhibitory action against PDE6, which is present exclusively in rod and cone photoreceptors. The effects of sildenafil on the visual system have been investigated in a wide variety of clinical and preclinical studies due to the fact that a high dose of sildenafil may cause mild and transient visual symptoms in some patients. A literature review was performed using PubMed, Cochrane Library and Clinical Trials databases from 1990 up to 2020, focusing on the pathophysiology of visual disorders induced by sildenafil. The aim of this review was not only to gather and summarize the information available on sildenafil clinical trials (CTs), but also to spot subpopulations with increased risk of developing undesirable visual side effects. This PDE inhibitor has been associated with transient and reversible ocular side effects, including changes in color vision and light perception, blurred vision, photophobia, conjunctival hyperemia and keratitis, and alterations in the electroretinogram (ERG). Sildenafil may induce a reversible increase in intraocular pressure (IOP) and a few case reports suggest it is involved in the development of nonarteritic ischemic optic neuropathy (NAION). Reversible idiopathic serous macular detachment, central serous retinopathy and ERG disturbances have been related to the significant impact of sildenafil on retinal perfusion. So far, sildenafil does not seem to cause permanent toxic effects on chorioretinal tissue and photoreceptors as long as the therapeutic dose is not exceeded and is taken under a physician’s direction to treat a medical condition. However, the recreational use of sildenafil can lead to harmful side effects, including vision changes.