A Case of a Young Asymptomatic Woman with Optic Disc Drusen and Vasculitis

Purpose: We present the case of a young woman with optic disc drusen and peripheral vasculitis. Methods: Diagnosis was based on fundoscopic, optical coherence tomography as well as fluorescein angiography (FA) findings. Results: An asymptomatic 34-year-old female patient with no systemic pathology was referred to our hospital from her optician for retinal findings. Fundoscopy revealed mild disc swelling that could be attributed to the presence of optic disc drusen in both eyes. There was fundoscopic evidence of periphlebitis in the periphery confirmed by FA findings. Conclusions: In our case, the unique feature was the presence of optic disc drusen and retinal periphlebitis. The patient’s disc configuration may have contributed to a predisposition for vasculitis in addition to vessel tortuosity

Central Serous Chorioretinopathy with Subretinal Deposition of Fibrin-Like Material and Its Prompt Response to Ranibizumab Injections

Purpose: Central serous chorioretinopathy (CSCR) manifests as neurosensory detachment of the macula and can be attributed to focal or multifocal leakage in the retinal pigment epithelium (RPE). Fibrin accumulation in the subretinal space is an unusual and heretofore unreported visually damaging manifestation of severe CSCR. Methods: The patient was followed up with the use of biomicroscopy, fluorescein angiography, and optical coherence tomography (OCT). Results: A 32-year-old woman was referred to our department complaining of metamorphopsia and decreased visual acuity in the right eye. Best-corrected visual acuity (BCVA) was 20/40 in the right eye and 20/20 in the left eye. Biomicroscopy revealed an irregularly shaped foveal elevation and wrinkling in the right eye. OCT showed a steep neurosensory retina elevation with a highly reflective material accumulation in the subretinal space, presumably fibrin. Our diagnosis was CSCR complicated by subretinal fibrin accumulation. Since most of these cases resolve spontaneously, the patient was kept under observation; 1 month later, the fibrin accumulation had expanded subfoveally (BCVA 20/200). The patient was offered 3 intravitreal ranibizumab injections. After the initial injection, BCVA improved to 20/50 and, after the 3 injections, to 20/30. Two months later (BCVA 20/30), fresh leakage was observed at the margin of the original lesion, and an additional intravitreal ranibizumab injection was performed. After another 2 months, BCVA stabilized at 20/25 and remained stable throughout the 12 months after the initial injection. Conclusions: Prompt recognition of CSCR complicated by subretinal fibrin and immediate intervention may result in recovery from this potentially devastating complication. Ranibizumab may be an alternative treatment option in the management of refractory CSCR complicated by subretinal fibrin accumulation

Peripapillary Neovascular Membrane in a Young Pregnant Woman and Prompt Response to Ranibizumab Injections following Uneventful Delivery

Purpose: Occurrence of choroidal neovascularization (CNV) during pregnancy has been reported as a complication of presumed ocular histoplasmosis syndrome or punctuate inner chorioretinopathy. To our knowledge, idiopathic CNV (ICNV) during pregnancy has only been reported once in the relevant literature. Bevacizumab has been used for the treatment of ICNV in small case series. However, there is limited experience regarding the use of ranibizumab for the management of ICNV. Case Report: A 31-year-old woman in the eighth month of her second pregnancy was diagnosed with mild macular and papillary edema. She was followed up using biomicroscopy, fluorescein angiography (FA), and optical coherence tomography (OCT). After 3 months, visual acuity further deteriorated and funduscopy, FA and OCT findings revealed a juxtapapillary choroidal neovascular membrane (CNVM). After two ranibizumab injections, best-corrected visual acuity increased significantly, physiological macular anatomy was restored and no subretinal fluid was observed. Discussion: In this case report, we present a young pregnant patient with peripapillary ICNV and neurosensory detachment involving the macula, and treatment of the eye with intravitreal ranibizumab following uneventful delivery. Increased angiogenic factor levels associated with pregnancy may contribute to the onset of CNV although this relationship has to be investigated experimentally. The rapid response to ranibizumab suggests that this anti-VEGF agent may be an alternative treatment option in the management of peripapillary ICNV

Spontaneous traumatic macular hole closure in a 50-year-old woman: a case report

<p>Abstract</p> <p>Introduction</p> <p>Traumatic macular holes (TMH) are well-known complications of ocular contusion injury. Spontaneous closure occurs in approximately 50% of cases, but rarely after the age of thirty. We report a case of spontaneous closure of a full thickness macular hole due to a blunt trauma and we suggest possible mechanisms for this closure.</p> <p>Case presentation</p> <p>A 50-year-old Greek woman was referred with a history of reduced best-corrected visual acuity after blunt trauma to her right eye. Diagnosis was based on fundoscopic, optical coherence tomography as well as fluorescein angiography findings with follow-up visits at two days, 20 days and five months. Fundoscopy revealed a full-thickness TMH with a minor sub-retinal hemorrhage and posterior vitreous detachment. The presence of a coagulum in the TMH base was observed. Subsequently, TMH closure was observed.</p> <p>Conclusion</p> <p>The clot in the TMH base, potentially a hemorrhage by-product containing a significant quantity of platelets, may have simulated the clot observed after autologous serum use, thus facilitating a similar effect. This may have stimulated glial cell migration and proliferation, thus contributing to spontaneous hole closure.</p

Matrix metalloproteinase concentration in the subretinal fluid and the vitreous and its correlation with the progression of retinal detachment

Matrix metalloproteinases are involved, after activation, in extracellular matrix component degradation, basement membrane remodeling and generally ECM homeostasis. They also regulate the deposition of excess ECM components. Generally, excess MMP production leads to increased ECM degradation. The balance between MMPs and their endogenous inhibitors (TIMPs) is critical for ECM turnover. Loss of the MMP/TIMP balance is an inherent factor in the pathogenesis of several diseases including remodeling of the vitreoretinal matrix during proliferative vitreoretinopathy (PVR). The role of MMPs in rhegmatogenous retinal detachment (RRD) is currently under investigation. A number of MMPs has been detected in the subretinal fluid and the vitreous during RRD, implying that they may be involved in the RRD process. The aim of this study was the investigation of the activity of MMP-1, -2, -3, -8 and -9 and TIMP-1 in the subretinal fluid (SRF) and the vitreous obtained from patients suffering from RRD. Sixty-nine patients were included in this study, while SRF or vitreous samples were collected according to the surgical procedure selected for the treatment of each individual patient. […]Η δράση των μεταλλοπρωτεϊνασών συνίσταται στην αποδόμηση συστατικών της εξωκυττάριας θεμέλιας ουσίας και των βασικών μεμβρανών, καθώς και στην αναδιαμόρφωσή τους (remodeling). Συγχρόνως οι MMPs αποτρέπουν την εναπόθεση περίσσειας θεμέλιας ουσίας που είναι αποτέλεσμα αυτής της αναδιαμόρφωσης. Οι MMPs είναι πρωτεολυτικά ένζυμα, που χαρακτηρίζονται από αλληλοεπικαλυπτόμενα υποστρώματα δράσης, σπουδαιότερο των οποίων είναι τα κολλαγόνα. Η αυξημένη παραγωγή μεταλλοπρωτεϊνασών μπορεί να οδηγήσει σε αυξημένη αποδόμηση της εξωκυττάριας θεμέλιας ουσίας. Γενικότερα οι MMPs είναι σημαντικές για τη διατήρηση ενός φυσιολογικού ισοζυγίου παραγωγής και αποδόμησης της εξωκυττάριας θεμέλιας ουσίας. Το γεγονός αυτό επιτυγχάνεται με την ύπαρξη ισορροπίας παραγωγής, ενεργοποίησης και αναστολής μεταξύ των MMPs και των αναστολέων τους (TIMPs). Ο ρόλος των MMPs στην αποκόλληση του αμφιβληστροειδούς αποτελεί αντικείμενο μελέτης. Ένας αριθμός MMPs έχει ανιχνευθεί στο υπαμφιβληστροειδικό υγρό και το υαλοειδές κατά την αποκόλληση και υπάρχουν ενδείξεις ότι μπορεί να εμπλέκονται στη διαδικασία της ρηγματογενούς αποκόλλησης. Σκοπός της παρούσας μελέτης ήταν η ανίχνευση και ο ποσοτικός προσδιορισμός των επιπέδων των μεταλλοπρωτεϊνασών MMP-1, proMMP-2, MMP-2, MMP-3, MMP-8, proMMP-2, MMP-9 και του αναστολέα τους TIMP-1 σε 69 δείγματα (37 υπαμφιβληστροειδικού υγρού και 32 υαλοειδούς) από ασθενείς πάσχοντες από ρηγματογενή αποκόλληση του αμφιβληστροειδούς. Το υπαμφιβληστροειδικό υγρό δεν υφίσταται υπό φυσιολογικές συνθήκες στον οφθαλμό και για το λόγο αυτό ως μάρτυρες χρησιμοποιήθηκαν 9 δείγματα υαλοειδούς από δότες οργάνων σώματος, όπως αναφέρεται στη βιβλιογραφία. Στη συνέχεια, διενεργήθηκε έλεγχος ύπαρξης συσχετίσεων με κλινικές παραμέτρους της ρηγματογενούς αποκόλλησης (έκταση και παλαιότητα της αποκόλλησης και βαθμός της παραγωγικής υαλοειδοαμφιβληστροειδοπάθειας-PVR) και, επίσης, με την κατάσταση της ωχράς, την τοπογραφία της ρωγμής, την ύπαρξη υποτροπής και τέλος με συνυπάρχοντα συστηματικά νοσήματα, όπως σακχαρώδης διαβήτης και υπέρταση. […

Bilateral identical intervals between phacoemulsification procedures performed 23 years before retinal detachment

We aim to present a case of bilateral rhegmatogenous retinal detachment (RRD) after successful phacoemulsification procedures performed 23 years before RRD onset and surgical management. A 57-year-old female presented with blurred vision due to floaters in the left eye. The patient was followed up with dilated fundus examination. The patient underwent bilateral uneventful cataract extraction 23 years before the baseline visit with the use of phacoemulsification. Dilated fundus examination revealed RRD in the left eye that was managed with a 25G pars plana vitrectomy, cryopexy, and 16% C3F8 expandable gas. Thirty-three days following the procedure in the left eye, the patient presented with RRD in the right eye. Management included a 25G pars plana vitrectomy with cryopexy and 20% SF6 expandable gas. Phacoemulsification ultrasound energy appears to bring about changes in the peripheral vitreous and retina that may manifest several decades following uncomplicated cataract extraction

Alström’s Syndrome, Leber’s Hereditary Optic Neuropathy, or Retinitis Pigmentosa? A Case of Misdiagnosis

A case of a patient with the Alström syndrome (AS) that was misdiagnosed as Leber’s hereditary optic neuropathy or retinitis pigmentosa for 13 years is presented. AS is a rare genetic disorder caused by mutations in the ALMS1 gene. AS may lead to abnormal ciliary formation and function. AS affects metabolism, and symptomatology includes type 2 diabetes mellitus (T2DM), obesity, hypogonadism and gynecomastia in males, progressive bilateral sensorineural hearing loss, cardiomyopathy, nonalcoholic fatty liver disease (NAFLD), cirrhosis, and chronic progressive kidney disease. The onset of the above symptoms may vary significantly. The ophthalmic manifestation is early onset cone-rod dystrophy that starts as progressive vision loss, photophobia, and nystagmus in the first months of life. An accurate diagnosis may enable specialists to facilitate a significantly positive effect in the everyday life of a patient. Genetic counseling may also be recommended for these patients. Diagnosis was confirmed by DNA testing, thus highlighting its necessity in everyday practice

Posttraumatic Sphingomonas paucimobilis Endophthalmitis

A rare case of Sphingomonas paucimobilis endophthalmitis secondary to a penetrating globe injury with a retained intraocular foreign body is presented. A 30-year-old man presented with severe pain following a penetrating left eye injury. Visual acuity (VA) was 6/120. Slit-lamp examination revealed perforation of the temporal cornea and iris, hypopyon, and a fibrinous membrane covering the pupil. Ultrasonography showed dense vitreous infiltration and an orbital CT-scan confirmed the presence of a metallic foreign body in the vitreous cavity. Topical and systemic therapy were initiated. Pars-plana vitrectomy combined with phacoemulsification was performed in order to remove the foreign body; vitreous samples were acquired and Sphingomonas paucimobilis, sensitive to ceftazidime, was identified. To the best of our knowledge, this is the first report of Sphingomonas paucimobilis endophthalmitis following penetrating ocular injury. In this case, Sphingomonas paucimobilis was not resistant to antibiotics. This allowed for a good healing response following vitrectomy despite the fact that long-term retinal complications resulted in low VA