Coincident Acute Macular Neuroretinopathy and Paracentral Acute Middle Maculopathy in COVID-19

An ophthalmology consultation was requested for a 29-year-old woman complaining of visual field defects. The patient had presented to the emergency department with cough and high fever one day earlier. Chest computed tomography demonstrated pneumonia and two severe acute respiratory syndrome coronavirus 2 polymerase chain reaction tests were positive. The patient had undergone renal transplantation 11 years ago due to glomerulonephritis. Best-corrected visual acuity (BCVA) was 20/40 in the right eye and 20/30 in the left eye. Fluorescein angiography showed macular hypoperfusion, and optical coherence tomography (OCT) showed hyperreflectivity in the inner nuclear, outer plexiform, and outer nuclear layers, as well as discontinuity of the ellipsoid zone. Perimetry confirmed bilateral central scotoma. Levels of D-dimer and fibrinogen were 0.86 g/mL and 435.6 g/mL, respectively. The patient was diagnosed as having concurrent acute macular neuroretinopathy and paracentral acute middle maculopathy and was given low-molecular-weight heparin treatment for one month. Her BCVA improved to 20/20 in both eyes, and regression was observed in the retinal findings, hyperreflectivity and ellipsoid zone disruption on OCT, and scotoma in perimetry. Inflammation, thrombosis, and glial involvement may play a role in the pathogenesis of retinal microvascular impairment in COVID-19

Autoimmune retinopathy

Purpose of review Autoimmune retinopathy (AIR) is an immune-mediated disorder characterized by progressive visual loss, abnormal electroretinographic and visual field findings in the presence of circulating anti-retinal antibodies. This review highlights advances made toward understanding the pathophysiology, clinical manifestations, and trends in the management of AIR. Recent findings The pathophysiology of AIR is likely antibody-mediated. AIR serum autoantibodies are variable in their size and retinal tissue they target and can also be present in healthy controls and multiple autoimmune diseases. Rarely, AIR may be associated with dysregulated self-tolerance mechanisms in the thymus. Despite progress in research, our understanding of AIR remains incomplete. Lack of standardized methods for anti-retinal antibody testing continues to challenge the interpretation of seropositivity. Conventional immunosuppressives have been further studied, and promising immunomodulatory therapies, such as targeted B-cell therapy, have been introduced. Newer imaging modalities such as fundus autofluorescence and spectral domain optical coherence tomography may be helpful in diagnosis, monitoring progression of disease and response to treatment. Summary AIR is a rare but vision-threatening disease whose pathogenesis is poorly defined. Lack of standardized clinical or laboratory criteria further complicates the diagnosis and management. Despite recent progress, further basic science research into the autoimmune process is needed. Prospective controlled clinical trials with immunomodulatory therapy can help define future treatment paradigms Keywords anti-retinal autoantibodies, autoimmune retinopathy, cancer-associated retinopathy, immunosuppression, melanoma-associated retinopathy, recoverin, uveiti

Icare Pro Rebound Tonometrenin Glokom Hastalarında Otururken ve Yatar Pozisyonlarda Kullanımının Değerlendirilmesi.

Amaç: Oküler hipertansiyon (OHT) ve açık açılı glokom (AAG)'lu hastalarda oturur pozisyonda Icare Pro rebound tonometre (IPRT) ile yapılan ölçümlerin Goldmann aplanasyon tonometresi (GAT) ve non kontakt tonometre (NKT) ile kıyaslanması ve yatar pozisyona geçişle göz içi basıncı (GİB)'nda meydana gelen değişimi incelemek. Gereç ve Yöntemler: OHT veya AAG tanılarıyla takipli yaş ortalaması 61,4±11,8 yıl olan 33 hastanın 66 gözü çalışma kapsamına alındı. Hastaların oturur pozisyondaki GİB ölçümleri sırasıyla IPRT, NKT ve GAT ile yapıldı. Oturur pozisyondaki GİB ölçümleri tamamlandıktan sonra hastalar yatar pozisyona getirilip 10 dakika beklendikten sonra IPRT ile GİB ölçümleri yapıldı. İstatistiksel değerlendirme için Anova, Pearson korelasyon ve Paired samples t testleri kullanıldı. Bulgular: Oturur pozisyonda ortalama GİB ölçümleri IPRT ile 17,3±3,1 mmHg, NKT ile 16,0±3,4 mmHg, GAT ile 16,7±2,8 mmHg olarak tespit edildi (p=0,07). Üç tonometre arasında anlamlı ve iyi derecede korelasyon olduğu belirlendi (p0,001). Yatar pozisyonda IPRT ile saptanan ortalama GİB değeri 19,5±3,2 mmHg idi. GİB oturur pozisyondan yatar pozisyona geçildiğinde 2,2±0,7 mmHg artış gösterdi ve bu fark istatistiksel olarak anlamlı bulundu (p0,0001). Sonuç: Yatar pozisyonda da ölçüm yapabilen IPRT çalışma grubumuzda hem GAT hem de NKT ile iyi korelasyon gösterdi. Yatar pozisyona geçmekle göz içi basıncında artış meydana gelmektedir. Glokom progresyonunda olası risk faktörlerinden biri olan bu artış IPRT ile belirlenebilir. Anahtar Kelimeler: Glokom, açık açılı; göz hipertansiyon