Ophthalmic manifestations of Cryptococcus gattii species complex: a case series and review of the literature

AIM: To report 4 cases of Cryptococcus gattii (C. gattii) species complex infection with diverse ophthalmic manifestations, and to review the literature to examine pathobiology of disease, classical ophthalmic presentations and outcomes, and treatment modalities for this emerging pathogen. METHODS: Cases of C. gattii meningoencephalitis with ophthalmic manifestations were identified via chart review at two institutions in Australia and one institution in the mid-west region of the United States and are reported as a case series. Additionally, a MEDLINE literature review was conducted to identify all reported cases of C. gattii with ophthalmic manifestations from 1990-2020. Cases were reviewed and tabulated, together with our series of patients, in this report. RESULTS: Four cases of C. gattii with ophthalmic manifestations are presented; three from Australia and one from the USA. A literature review identified a total of 331 cases of C. gattii with visual sequelae. The majority of cases occurred in immunocompetent individuals. Blurred vision and diplopia were the most common presenting symptoms, with papilloedema the most common sign, reported in 10%-50% of cases. Visual loss was reported in 10%-53% of cases, as compared to rates of visual loss of 1%-9% in C. neoformans infection. Elevated intracranial pressure, cerebrospinal fluid (CSF) fungal burden, and abnormal neurological exam at presentation correlated with poor visual outcomes. The mainstays of treatment are anti-fungal agents and aggressive management of intracranial hypertension with serial lumbar punctures. CSF diversion procedures should be considered for refractory cases. Acetazolamide and mannitol are associated with high complication rates, and adjuvant corticosteroids have demonstrated higher mortality rates; these treatments should be avoided. CONCLUSION: Permanent visual loss represents a devastating yet potentially preventable sequelae of C. gattii infection. Intracranial hypertension needs to be recognised early and aggressively managed. Referral to an ophthalmologist/neuro-ophthalmologist in all cases of cryptococcal infection independent of visual symptoms at time of diagnosis is recommended.

Navigation-guided nasal endoscopic surgery for acute vision loss caused by fibrous dysplasia: a case report and review of literatures

Background Bone fibrous dysplasia is a benign disease of bone tissue dysplasia. Vision impairment is the commonest neurological complication of craniofacial fibrous dysplasia. Most of the vision loss caused by craniofacial fibrous dysplasia is usually a gradual process. Very few present with acute visual impairment as described in our case. Case presentation We report a patient with fibrous dysplasia presenting rapidly progressive visual loss in the left eye secondary to bone cyst formation. Transnasal endoscopic surgery guided by navigation with drainage and curettage of this bone cyst and orbital decompression resulted in progressive improvement in visual acuity that returned to normal 1 month post-operatively. Conclusions In cases with acute visual loss due to fibrous dysplasia, emergency surgical treatment should be considered to preserve vision. In the surgical approach, navigation-guided nasal endoscopic surgery may be preferred because of its advantages.

Congenital Blindness and Psychosis: A Literature Review

Low vision has been declared by the World Health Organization (WHO) to be one of the major ophthalmologic problems requiring global attention. Low-vision patients experience a reduced vision-related quality of life due to impaired visual function. However, this condition that interfere their daily life could also make a significant effect on their mental health. Therefore, the final goal of low-vision rehabilitation is to improve the daily quality of life. However, the absence of vision at birth appears to protect against psychosis, whereas later-life visual loss appears to predispose to the development of psychotic symptoms. Thus, our purpose in this literature review is to learn how the onset of visual loss may affect patient's mental health.

Current Therapeutics and Future Perspectives to Ocular Melanocytic Neoplasms in Dogs and Cats

Neoplasms of melanocytic origin are diseases relevant to dogs and cats’ ophthalmic oncology due to their incidence, potential visual loss, and consequent decrease in life quality and expectancy. Despite its non-specific clinical presentation, melanocytic neoplasms can be histologically distinguished in melanocytomas, which present benign characteristics, and malignant melanomas. The diagnosis often occurs in advanced cases, limiting the therapeutic options. Surgery, cryotherapy, radiotherapy, photodynamic therapy (PDT), and laser are currently available therapeutic strategies. As no clinical guidelines are available, the treatment choice is primarily based on the clinician’s preference, proficiency, and the owner’s financial constraints. While surgery is curative in benign lesions, ocular melanomas present a variable response to treatments, besides the potential of tumour recurrences or metastatic disease. This review presents the currently available therapies for ocular melanocytic neoplasms in dogs and cats, describing the therapeutic, indications, and limitations. Additionally, new therapeutics being developed are presented and discussed, as they can improve the current treatment options.

Awareness of Emergency Eye Diseases and Red Flag Symptoms in Population of Western Province

Background: Emergency eye disease can lead to visual loss when the patient delay seeking medical care quickly due to poor knowledge and awareness of red flags and symptoms that eventually end by late diagnosis then possibly devastating outcomes for example permanent visual loss. This study aims to examine the level of awareness and knowledge regarding different emergency eye diseases in Western Province, kingdom of Saudi Arabia. Methodology: This is a cross sectional study conducted via online questionnaire and approved by research ethics of Taif university. SPSS version 25 was used for statistical analysis. Chi-squared, Mann-Whitney and Kruskal Wallis tests were applied, and a P-value of <0.05 was considered as statistically significant. Result: A total of 702 participants to the online questionnaire from the western province of Kingdom of Saudi Arabia, with 565 (80.5%) females and 137 (19.5%) males. Regarding the awareness of different emergent ocular diseases, acute angle closure glaucoma has the highest awareness level (41.7%) and the least was giant cell arteritis (12.4%). Conclusion: This study reflected the awareness and knowledge of retinal detachment, giant cell arteritis and central retinal occlusion in average population of the western province, Kingdom of Saudi Arabia which was extremely low. This will have an impact on seeking medical care early with delay in diagnosis and implementation of treatment that results in significant visual complications. So, we need to raise awareness of society about different emergency ocular conditions and red flags to help overcome the negative outcomes.