A 65-year-old male patient received intravitreal bevacizumab for age-related macular degeneration. On the first day, he presented with ocular pain, corneal stromal infiltration and dense vitritis. Prompt intravitreal vancomycin and ceftazidime were injected after sampling. Widespread gram-positive cocci were seen on microscopy after staining the vitreous sample. No significant improvement took place the following day and the cornea was completely opacified. The patient underwent an early vitrectomy combined with penetrating keratoplasty. Culture grew Streptococcus salivarius. Postoperative visual acuity was hand motions and the retina was attached.
Objectives: We present a case of epithelial ingrowth after late onset interface fluid syndrome, a rare complication after laser in situ keratomileusis (LASIK). Methods: This patient presented herself to the emergency department with corneal oedema due to endothelial failure after multiple intraocular surgeries. Anterior segment optical coherence tomography (OCT) showed a fluid filled pocket in the LASIK interface, 20 years after LASIK surgery. Results: As a result, she was diagnosed with late onset interface fluid syndrome which resolved after endothelial transplantation (DMEK). However, 3 months after surgery, epithelial ingrowth in the LASIK interface was noticed. We adopted a conservative approach as there was no progression after 3 weeks. Conclusions: Epithelial ingrowth is a rare complication after DMEK, which might be caused by interface fluid induced flap lifting and further facilitated by intraoperative flap manipulation during graft unfolding.
Objective: To highlight the importance of considering systemic metastatic retinal lymphoma (SMRL) in the differential diagnosis of atypical uveitis and to emphasize the need for a comprehensive diagnostic and treatment approach for optimal patient outcomes. Methods: Medical records and imaging of the patient were retrospectively reviewed. Results: A 61-year-old man presented with blurred vision, initially diagnosed as granulomatous uveitis following cataract surgery. Further ocular examination revealed optic nerve infiltration and retinal white infiltrates, prompting additional systemic evaluation. Imaging and biopsy confirmed a diagnosis of primary adrenal non-Hodgkin lymphoma with ocular involvement. The patient underwent R-CHOP chemotherapy and autologous stem cell transplantation during the COVID-19 pandemic, achieving systemic remission. However, due to pandemic-related logistical challenges, he declined further ocular treatment. At 1.5-year follow-up, his final visual acuity was 20/25 in the right eye and 20/125 in the left eye, with persistent cystoid macular edema in the left eye. Conclusion: This case underscores the importance of recognizing SMRL as a potential cause of atypical uveitis, particularly in the presence of optic nerve and retinal infiltrates. It highlights the need for early diagnosis and a multidisciplinary approach, integrating systemic and ocular management to improve patient outcomes.
An 18-year-old male was discovered with an oval, 1PD-sized, well-defined lesion on the inferonasal fovea of the right eye. Multimodal imaging was carried out. The lesion was diagnosed as torpedo maculopathy (TM). Most TM patients have no visual symptoms, are often detected during routine examination, and are generally stable.
Objective:To report a case with a history of previous radial keratotomy who underwent refractive lens exchange with trifocal intraocular lenses. Methods:Case report. Results:A 69-year-old man underwent bilateral RK to correct myopia in both eyes elsewhere 40 years ago. He was admitted to our hospital due to progressive deterioration of vision. The uncorrected distance visual acuity in both eyes was 20/40, and the uncorrected near visual acuity (40 cm) was J10. On slit-lamp examination, mild cataract and four radial keratotomy incisions were found. The patient underwent bilateral refractive lens exchange with trifocal intraocular lenses one-week interval. We were unable to obtain the preoperative data or details of the patient's prior surgeries. Calculations were run with the American Society of Cataract and Refractive Surgery calculator using the Barret True K formula. Postoperative follow-up was continued for approximately six months. No perioperative complications were noted. Conclusions:Six months after the surgery, the refractive outcomes for both eyes had stabilized, and no other complications had occurred. The patient was satisfied with the result.
Objective:To report a rare case of severe bilateral chorioretinopathy associated with ipilimumab in a patient with metastatic melanoma, highlighting the ocular toxicities that may arise from immune checkpoint inhibitors. Methods:A 38-year-old woman receiving ipilimumab (3 mg/kg every 3 weeks) for metastatic melanoma presented with painless bilateral vision loss following her third dose. Clinical assessment included visual acuity testing, fundus examination, fluorescein angiography (FA), and optical coherence tomography (OCT) to evaluate retinal changes. The ipilimumab treatment was discontinued, but the patient refused corticosteroid therapy. Results:Fundus examination and OCT revealed bilateral serous retinal detachments with retinal pigment epithelium (RPE) detachment. FA demonstrated multiple pinpoint leakage areas at the RPE level. Over a three-month follow-up period, visual acuity further declined, resulting in total vision loss in one eye and persistent bilateral serous detachments despite cessation of ipilimumab. Conclusions:This case highlights the potential for severe, irreversible vision loss due to ipilimumab-associated chorioretinopathy, underscoring the importance of early ophthalmological assessment and continuous monitoring in patients undergoing immune checkpoint inhibitor therapy. Early recognition and intervention are critical, especially when systemic corticosteroids are not administered.
A 45-year-old woman with a 7-day history of fever and nausea sought assistance at the emergency department complaining of blurred vision in her right eye. She was recently diagnosed with dengue fever. Fundus showed a discrete well-circumscribed, round yellow-orange lesion localized in the foveal region, retinal hemorrhages, macular oedema, soft exudates, and adjacent perivasculitis in the affected eye. Spectral domain optical coherence tomography (OCT) was compatible with dengue maculopathy. She was closely followed, with complete improvement after 1 week. The increasing incidence of dengue makes essential for the ophthalmologist to recognize this rare condition.
Objective:We present a case of a macular horseshoe tear that demonstrated signs of progression over time that was therefore deemed sight threatening. There are no reports that provide a definitive means to treat such a rare pathology. Methods:Spectral domain optical coherence tomography (SD-OCT) scans were used to monitor subretinal fluid at each follow up. Once confirmation of the accumulation of subretinal fluid was made, vitrectomy surgery including amputation of the horseshoe tear flap, short acting gas tamponade and face down positioning were utilized. Results and conclusion:Macular horseshoe tears can be treated with a vitrectomy approach akin to retinal detachment repair without the need for retinopexy.
Purpose:To present the results of two different surgical procedures, decentered individualized sphero-cylindrical protocol (DISC protocol) and Athens protocol, performed on a 34-year-old patient after being diagnosed with keratoconus in both eyes. Observation:The patient's left eye was subjected to the Athens protocol (phototherapeutic keratectomy (PTK) + partial topo-guided photorefractive keratectomy (TG-PRK) + corneal cross-linking (CXL)). In contrast, the patient's right eye was subjected to the DISC protocol (PTK + DISC excimer ablation + CXL). After administration of topical anesthetic, the patient was subjected to PTK of the central 7 mm optical zone with 50 µm depth of epithelial ablation. After excimer laser ablation in both eyes, riboflavin 0.1% solution was applied topically every 2 minutes for 20 minutes. This was followed by five cycles of 5-minute-long irradiation (for 25 minutes) using a UVA 370 nm at 3.0 mW/cm2 CXL (CSO VEGA CMB X Linker, Florence, Italy) application. 36 months postoperative uncorrected visual acuity (UCVA) of the left eye remained the same as preoperatively, while the best corrected visual acuity (BCVA) was -3.5 Dsph=20/30. In the right eye, UCVA and BCVA were both 20/22. Results of Fourier's analysis of the right eye imply a 52% decrease in corneal irregularity, while in the left eye, corneal irregularity decreased by 12.8%. Values of spheric aberration in Zernike analysis 36 months postoperatively showed a lower increase in Athens protocol than DISC protocol. The index of vertical asymmetry and the index of surface variance showed lower values in both procedures during the whole postoperative period, while the index of height decentration showed a more significant decline in Athens protocol 36 months postoperatively. Conclusion and importance:DISC protocol is a novel approach, with the potential to become a promising strategy for slowing the progression of keratoconus and recovering uncorrected visual abilities.
We present the case of an 18-year-old male who developed a black-colored growth on a bandage contact lens and cornea nine months after undergoing lamellar keratoplasty for advanced keratoconus in his left eye. The growth was identified as Aspergillus niger, which was successfully treated following its removal and microbiological examination.
Objective: Retinoblastoma (Rb) and Langerhans cell histiocytosis (LCH) are rare and distinct diseases that can coexist in a patient. We present a case report of a 5-year-old male who was diagnosed with bilateral retinoblastoma and LCH involving the skull and spine. Methods: The patient underwent a detailed clinical evaluation, including a complete ophthalmic examination, neuroimaging studies, and bone marrow biopsy. A genetic test confirmed the presence of the BRAF V600E mutation in the LCH lesion. Treatment with BRAF inhibitors was initiated for LCH, followed by chemotherapy and left eye enucleation for retinoblastoma. The patient was monitored closely during treatment and at follow-up visits. Results: The patient responded well to therapy, with no evidence of disease recurrence at 12-month follow-up and the enucleated eye was replaced with a prosthesis. The BRAF inhibitor was found to be an effective therapeutic option for the patient with BRAF-positive LCH. Conclusion: Our case highlights the importance of early diagnosis and prompt treatment in managing complex cases with coexisting retinoblastoma and LCH. Treatment with BRAF inhibitors could be a promising therapeutic option for patients with BRAF-positive LCH. Further studies are needed to evaluate the efficacy and safety of BRAF inhibitors in the treatment of LCH. The long-term outcome and potential late effects of combined therapy for coexisting retinoblastoma and LCH should also be monitored closely.
Adult Still’s disease (ASD) is a rare systemic inflammatory disorder for which ocular manifestations have rarely been described. We report a case of 38-year-old Brazilian woman with Purtscher-like retinopathy as a manifestation of ASD. She was diagnosed with Purtscher-like retinopathy based on fundoscopic findings, which revealed vasculitis with diffuse and bilateral perimacular cotton-wool exudates. She also presented with fever, arthritis, weight loss, and a diffuse cutaneous rash. Considering the severity of the retinopathy, she was initially treated with methylprednisolone pulse therapy and oral methotrexate, and later with infliximab, with the treatment changing due to partial recovery of vision loss. Purtscher-like retinopathy is a poor prognostic factor for ASD, as it can lead to permanent visual damage. Thus, early and aggressive immunosuppressive therapy is mandatory.
Purpose: To describe the sequence of events in a case of high myope with myopic traction maculopathy. Methods: Our female patient who is a high myope developed myopic choroidal neovascular membrane (CNVM), for which she received three anti-vascular endothelial growth factor injections (VEGF). It was scarred for a while. Later she developed myopic foveoschisis with macular detachment which progressed over a period with deterioration of vision. Results: She underwent pars plana vitrectomy with silicone oil tamponade. Oil removal was done eight months later. At the last follow up visit, her macula was flat with stable vision. Conclusion: Myopic traction maculopathy (MTM) is a challenging case to manage with its myriad of presentations and complex pathology.
Corneal shield ulcer is a severe complication of atopic keratoconjunctivitis (AKC) and vernal keratoconjunctivitis (VKC). This condition is caused by the mechanical irritation of the corneal epithelium due to giant papillae and toxic epitheliopathy resulting from inflammatory mediators. To date, there have been no reported cases of corneal shield ulcers in the literature without AKC or VKC. However, the authors have reported a unique case of shield ulcer in a patient with keratoconus but no history of AKC or VKC. The cause is hypothesised to be due to mechanical friction between the corneal steep apex and palpebral conjunctiva. Additionally, a new technique, the use of a dry amniotic membrane, is described to manage the persistent epithelial defect in shield ulcers.
Ophthalmomyiasis externa is the most common manifestation of Oestrus ovis (sheep nasal botfly) in humans. Several cases have been reported from various regions of India with the first case reported by Elliot in 1910. Here, we report such a case from North India along with the review of literature from India of the last fifteen years. A farmer presented to us with unilateral ocular symptoms of redness, foreign body sensation and severe watering in left eye who was misdiagnosed as acute conjunctivitis elsewhere. On slit lamp examination, multiple translucent larvae were found in his conjunctival sac. Microbiological analysis revealed them to be larvae of the Oestrus ovis fly. External ophthalmomyiasis is an uncommon entity with ocular symptoms mimicking acute conjunctivitis, hence a thorough examination in every suspicious case of acute red eye is important.
Introduction: Metastatic breast cancer leads to significant challenges in terms of treatment and management, often requiring a multidisciplinary approach due to the potential side effects of chemotherapy and radiotherapy. Case description: We present a case of a metastatic breast cancer patient with central serous chorioretinopathy, recurrent cystoid macular edema, and radiation-induced optic neuropathy that occurred after the treatment with paclitaxel and radiation. A 42-year-old female patient presented to our department with a one-week history of painless, subacute vision loss in her left eye, occurring one year after completing oncological treatment. Her best corrected visual acuity (BCVA) was 20/32 in her left eye, and the optical coherence tomography (OCT) showed central serous chorioretinopathy with spontaneous resolution within 1 month. Seven months later, she presented with a sudden decrease in vision in her right eye; the BCVA was 20/40, the relative afferent pupillary defect was found, and the visual field demonstrated a superior altitudinal defect corresponding to the inferior segmental optic nerve pallor, prompting us to start treatment with prednisolone. Six months later, her vision had fallen to light perception in the right eye and 20/25 in the left eye. The OCT findings were conclusive for cystoid macular edema in her left eye, so we started treatment with aflibercept. Unfortunately, we could not improve the visual outcome in the right eye, which had an amaurotic pupil. Regarding the left eye, the patient experienced recurrent macular edema treated with aflibercept. After several episodes, the patient’s BCVA decreased to 20/50 without any improvement. Conclusion: Herein we stated a young patient with metastatic breast cancer who developed a rare and unusual overlap of side effects: paclitaxel-associated retinopathy and radiation-induced optic neuropathy. We aim to illustrate the challenge of managing advanced breast cancer patients and emphasize the importance of careful monitoring for ocular complications, which can impact the patient’s quality of life.
Objective: To report the clinical findings and results of a patient who underwent deep anterior lamellar keratoplasty (DALK) combined with phacoemulsification. Methods: Retrospective analysis of a case that underwent unsuccessful DALK surgery with no visual gain due to striations on the posterior surface of the donor, permanent interface irregularity, and scarring. Results: Two years after the first DALK surgery, a repeated DALK was performed in combination with phacoemulsification of the cataract that developed during this period. The graft was clear with no signs of rejection or endothelial decompensation, and corrected distance visual acuity was 6/10 in the postoperative last visit, one year after the surgery. Conclusions: Combining the DALK technique with phacoemulsification in patients with coexisting cataracts may help to achieve a good visual outcome and long-term graft survival. Even after an unsuccessful DALK experience, insisting on preserving the patient’s own endothelium resulted in successful vision restoration with no imposition of further risks for graft survival.
Purpose: We report the same side recurrence of multiple evanescent white dot syndrome (MEWDS) subsequent to 532 nm laser treatment for the macular neovascularization (MNV) associated with the first MEWDS episode. Method: Retrospective case documentation with the multimodal imaging. Result: A 24-year-old otherwise healthy woman who was diagnosed as having left MEWDS four years ago was re-examined for a visual disturbance of the duration of one month in the same eye. Fundus evaluation led us to the diagnosis of left extrafoveal inflammatory MNV. Surprisingly, she developed further visual deterioration a month following the uneventful 532 nm laser photocoagulation in her left eye. Fundus examination and multimodal imaging tests confirmed the recurrent MEWDS after full negative laboratory work-up. Visual acuity and fundus changes were improved with the help of a short course oral steroid therapy. Conclusion: MEWDS can very rarely recur and thermal laser photocoagulation may be a possible triggering factor.
Objective: We report the case history and clinical findings in two siblings, a 13-year-old male and a 10-year-old female, who presented with complaints of poor vision since childhood. Both children had blonde hair and depigmented skin. Methods: Ocular examination revealed white eyebrows, white eyelashes, diminished vision in all eyes, hypochromic irides and pendular nystagmus. On dilated fundus examination, hypopigmented fundi with conspicuously visible choroidal vessels were noted. No foveolar reflex could be discerned and spectral domain optical coherence tomography (SD-OCT) of the macula showed an absence of the foveal pit in all four eyes. On pedigree charting the subjects were the 2nd and 3rd offspring of a non-consanguineous married couple. One of the mother’s siblings and one of the grandmother’s siblings also had a similar disorder. Results: The poor definition of the foveal pit at the centre of the macula, i.e. foveal hypoplasia, accounted for poor visual acuity and nystagmus. Both cases had no syndromic associations. Spectacle correction was prescribed to both children, and low-vision aids and sun protection advised. Conclusion: Oculocutaneous albinism (OCA) represents a range of inherited, congenital disorders of hypomelanosis, involving the skin, hair, and eyes with an estimated prevalence of 1 in 17,000 cases. Affected children suffer severe visual disability while early identification may potentially mitigate it, hence there is need to sensitize primary care practitioners regarding the general symptoms of OCA.
