Background Subhyaloid and sub–internal limiting membrane (sub‐ILM) hemorrhages secondary to Valsalva retinopathy typically occur in young adults and can cause sudden, significant visual impairment. Spontaneous resolution may be prolonged, and delayed clearance can adversely affect visual recovery. Nd:YAG laser membranotomy has been proposed as an effective, minimally invasive treatment to facilitate rapid visual improvement. Methods This case series included three patients aged 24–27 years who presented with subhyaloid and sub‐ILM hemorrhages secondary to Valsalva retinopathy. The duration of symptoms prior to treatment ranged from 2 to 10 days. The mean horizontal and vertical diameters of the hemorrhages were 3615 and 3289 μ m, respectively. All patients underwent Nd:YAG laser membranotomy. The mean total laser energy applied was 79.7 mJ (range 11–185 mJ). Best‐corrected visual acuity (BCVA) and postoperative complications were assessed. Results Preprocedure BCVA ranged from 6/9 to 1/60. Rapid anatomical and functional improvement was observed in all cases following treatment. At 2 weeks after the procedure, BCVA improved to 6/9 in all patients. No complications such as macular hole formation or retinal detachment were noted during the follow‐up period. Conclusion Nd:YAG laser membranotomy appears to be a safe and highly effective treatment for subhyaloid and sub‐ILM hemorrhages secondary to Valsalva retinopathy, particularly in young patients requiring rapid visual recovery. Larger studies with longer follow‐up are needed to further evaluate long‐term outcomes and potential complications.
Introduction We report a case of unilateral presumed nonarteritic anterior ischemic optic neuropathy (NAION) associated with acute posterior multifocal placoid pigment epitheliopathy (APMPPE). Case Presentation A 59‐year‐old female presented with blurred left vision for 9 days. At the initial examination, her best‐corrected visual acuities (BCVAs) were 20/16 OD and 20/30 OS. No signs of inflammation were observed in the anterior chamber or vitreous. The critical fusion frequency (CFF) was 38 Hz in OD and 27 Hz in OS. Fundus examination revealed optic disc edema in the left eye and multiple placoid lesions in both eyes. Optical coherence tomography showed a serous retinal detachment (SRD) beneath the macula of the left eye. Humphrey field analysis revealed visual field defects in the inferonasal sectoral area at the left eye and mild concentric constrictions in both eyes. Fluorescein angiography revealed early hypofluorescence and late hyperfluorescence in the superotemporal region of the left optic nerve swelling and placoid lesions in both eyes. Indocyanine green angiography revealed multiple hypofluorescent spots in both eyes from the early to late phases. Based on the above findings, a diagnosis of APMPPE complicated by left presumed NAION was made, and oral prednisolone 30 mg/day was started. After 2 months, the left BCVA improved to 20/16, CFF recovered to 37 Hz and SRD and optic nerve edema disappeared. Mild concentric constrictions improved in both eyes but the inferonasal sectoral visual field defects persisted in the left eye; the left nerve fibre layer thinning appeared to be consistent with the remaining inferonasal sectoral visual field defects. Discussion We encountered a case of APMPPE complicated by presumed NAION. Inflammatory vascular occlusion of the short posterior ciliary artery may be involved in the development of NAION.
Nocardia keratitis (NK) is an uncommon infectious keratitis that may present with characteristic or atypical corneal morphology. We report two patients with contrasting clinical appearances and diagnostic courses, highlighting the differing contribution of in vivo confocal microscopy (IVCM) and microbiological testing. A 19-year-old male farmer presented after suspected dust exposure with multiple superficial pinhead infiltrates arranged in a wreath-like pattern. Gram staining showed Gram-positive branching bacilli, and high-quality IVCM demonstrated fine hyperreflective branching structures at the ulcer margin. A 37-year-old male welder presented after ocular trauma with a sharply demarcated paracentral infiltrate. Initial Gram staining was negative, and an IVCM examination performed at a different site was technically limited and non-diagnostic; however, culture on chocolate agar grew Nocardia species after 3 days, and modified acid-fast staining confirmed partially acid-fast branching filaments. Both patients were diagnosed with NK and improved with amikacin-based topical therapy and sulfacetamide. These cases show that NK may have classic or atypical morphology and that a technically limited or inconclusive IVCM examination does not exclude the diagnosis. Corneal scraping, appropriate staining, and culture remain essential when NK is clinically possible.
Purpose The aim of this study is to report extraocular unilateral haptic redocking as an intraoperative rescue for intraocular lens (IOL) decentration during the Yamane technique. Methods A 51‐year‐old woman underwent pars plana vitrectomy, explantation of a dislocated posterior chamber IOL, and flanged intrascleral IOL fixation using the Yamane technique. After externalization of both haptics, IOL decentration was observed. One externalized haptic was redocked into the lumen of a 30‐gauge needle outside the eye, and the contralateral haptic manipulation was converted to a posterior approach under a wide‐angle viewing system. The contralateral haptic was manipulated with the assistance of a vitreous cutter and subsequently inserted into another 30‐gauge needle within the vitreous cavity, allowing repositioning of the decentered IOL. At 3 months postoperatively, uncorrected distance visual acuity improved to 20/15, and the IOL remained stable without clinically significant decentration. Conclusion Extra ocular haptic redocking and vitrector‐assisted posterior haptic manipulation may be useful as a rescue technique for intraoperative IOL decentration during the Yamane technique.
Background Ocular tuberculosis (TB) is an uncommon yet potentially vision‐threatening manifestation of Mycobacterium tuberculosis , particularly difficult to diagnose in immunocompromised individuals. The increasing use of anti–tumor necrosis factor‐ α (anti–TNF‐ α ) agents has markedly heightened the risk of TB reactivation, often with disseminated or extrapulmonary involvement despite negative baseline screening. Case Presentation We describe a 52‐year‐old woman with rheumatoid arthritis receiving long‐term adalimumab and methotrexate who developed disseminated TB with pulmonary, splenic, and ocular involvement after 12 years of anti–TNF‐ α therapy. Baseline screening had shown a negative tuberculin skin test and an indeterminate interferon‐ γ release assay. She presented with constitutional and respiratory symptoms, whereas chest computed tomography demonstrated diffuse micronodular infiltrates consistent with miliary TB. Microbiological confirmation was obtained via bronchoalveolar lavage. Ophthalmologic evaluation revealed bilateral choroidal granulomas with subretinal edema, leading to a diagnosis of ocular TB. Standard antitubercular therapy (ATT) was initiated but required modification due to drug‐induced liver injury. Adjunctive systemic corticosteroids were introduced after antimicrobial therapy and gradually tapered. The patient achieved progressive clinical, radiological, and ophthalmologic improvement, with gradual regression of choroidal lesions. Discussion This case underscores the persistent long‐term risk of TB reactivation during prolonged anti–TNF‐ α therapy and highlights the limitations of current screening strategies in immunosuppressed patients. Ocular TB requires integration of systemic, clinical, and imaging findings; in this patient, microbiologically confirmed disseminated TB together with characteristic bilateral choroidal granulomas supported a definitive diagnosis. Management relies on prompt ATT, discontinuation of immunosuppression, and judicious use of adjunctive corticosteroids. Long‐term follow‐up is essential given the risk of persistent lesions and late recurrence. Reintroduction of biologic therapy may be feasible in selected cases but requires careful risk stratification. Conclusion TB should remain a diagnostic consideration in patients receiving biologic therapy who develop compatible systemic or ocular manifestations, even after long‐term treatment and negative baseline screening. Close multidisciplinary collaboration is essential for the diagnosis and management of ocular TB in this population.
