Lipemia Retinalis, Macular Edema, and Vision Loss in a Diabetic Patient with a History of Type IV Hypertriglyceridemia and Pancreatitis

Background: Lipemia retinalis is a rare but known complication of elevated serum triglycerides. This case describes the clinical course of a diabetic patient who presented with lipemia retinalis and macular edema, which responded to systemic and local treatments. Case Report: A 40-year-old female with a history of type II diabetes mellitus, hypertriglyceridemia, and pancreatitis presented with decreased vision in the left eye. She had peripapillary and macular edema, intraretinal hemorrhages, and prominent exudates in the setting of lipemia retinalis due to type IV hypertriglyceridemia. She was treated with serial intravitreal bevacizumab injections for macular edema and systemic lipid lowering therapy, and her visual acuity improved back to baseline. Conclusions: In the setting of lipemia retinalis and hypertriglyceridemia, the current patient developed macular edema and vision loss. The macular edema was treated with intravitreal injections of bevacizumab, and the patient experienced a rapid recovery of visual acuity

Coexisting choroidal neovascularization and active retinochoroiditis—an uncommon presentation of ocular toxoplasmosis

Abstract Background Choroidal neovascularization during the active stage of Toxoplasma retinochoroiditis is an uncommon clinical presentation. The authors retrospectively reviewed medical charts of patients with coexisting choroidal neovascular membrane and active Toxoplasma retinochoroiditis. Findings Three patients presented with coexisting choroidal neovascular membrane and active Toxoplasma retinochoroiditis. All lesions had adjacent subretinal hemorrhage. The diagnosis was confirmed based on clinical presentation, fundus fluorescein angiography (FFA), and optical coherence tomography (OCT) findings. The patients were managed with a combination of treatments including intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF), oral anti-Toxoplasma treatment, and oral corticosteroids. In all patients, the retinitis lesion resolved in 6 weeks and the coexisting choroidal neovascular membrane resolved over 6 to 12 weeks. Conclusions Recurrences in Toxoplasma retinochoroiditis are common as satellite lesions adjacent to an old atrophic scar. Coexisting choroidal neovascularization with active Toxoplasma retinochoroiditis is an important presentation and should be suspected in the presence subretinal hemorrhage and managed with a combination of anti-Toxoplasma treatment and intravitreal anti-VEGF. </jats:sec

Endophthalmitis Caused by Gram-Negative Bacteria

Endophthalmitis caused by gram-negative bacteria is less common compared to gram-positive bacteria and generally has poor visual acuity outcomes. More common gram-negative bacteria causing endophthalmitis include species of Pseudomonas, Klebsiella, Proteus, Haemophilus, and Enterobacter. Pseudomonas and Enterobacter are reportedly more common. Gram-negative endophthalmitis may present with symptoms of variable pain, redness, inflammation, and decreased visual acuity. The clinical signs include eyelid edema, conjunctival chemosis/erythema, corneal edema, hypopyon, fibrinous membrane in the anterior chamber or on intraocular lens, vitritis, and periphlebitis (Fig. 17.1)

The Charles Schepens Lecture: Management Options for Vitreomacular Traction: Use an Individualized Approach

To present the management options for vitreomacular traction (VMT) and to recommend an individualized approach to treatment selection. Presented at the American Academy of Ophthalmology Annual Meeting, 2016, Chicago, October 15, 2016 (The Charles Schepens Lecture). None. Review of published literature and clinical trials. Visual and anatomic outcomes of various treatment options for VMT were reviewed. The management options for VMT include pars plana vitrectomy, pneumatic vitreolysis, enzymatic vitreolysis, and observation. The surgical management using pars plana vitrectomy offers the most effective approach for VMT, but there are inherent risks and cost issues. Pneumatic vitreolysis is reported to be cost-effective and may be an anatomically successful nonsurgical option for management. Enzymatic vitreolysis with intravitreal ocriplasmin is another nonsurgical option, but both short- and long-term side effects may occur. Observation in selected patients can be associated with stable visual outcomes during long-term follow-up. The final management decision should be individualized for specific patients depending on the patient's clinical findings, potential risks, probable benefits, and costs of each option

Exudative Retinal Detachment

Exudative retinal detachment refers to the separation of the neurosensory retina from the underlying retinal pigment epithelium (RPE) as a result of abnormalities of the normal hydrostatic/osmotic pressure gradients or transport mechanisms that maintain the physical apposition of these two layers or due to excessive production of extracellular fluid. Exudative retinal detachments lack the presence of a retinal break or vitreoretinal traction and generally display a dome or convex configuration. Exudative retinal detachment is usually associated with local ocular or systemic etiology

Docetaxel-induced maculopathy possibly potentiated by concurrent hydroxychloroquine use

To report a case of bilateral non-leaking cystoid macular degeneration induced by docetaxel, possibly potentiated by hydroxychloroquine. A 63-year-old female patient with a long-term history of rheumatoid arthritis controlled on hydroxychloroquine for 33 years with no evidence of retinopathy developed bilateral loss of vision after having been on docetaxel chemotherapy for breast cancer. Optical coherence tomography showed bilateral cystic maculopathy with no angiographic evidence of leakage on fluorescein angiography. The patient was treated conservatively with no further interventions. Marked improvement of the macular degeneration occurred over the subsequent 9 months, but without visual improvement, although a cataract likely confounded final visual acuity measurement. Docetaxel-induced maculopathy has been previously reported, but with only four case reports in literature, and most often in conjunction with concurrent therapies or conditions also known to cause macular edema. This is the first case report of docetaxel-induced maculopathy in a setting of hydroxychloroquine therapy which may possibly has potentiated the effect of docetaxel to induce maculopathy. Impaired transcellular retinal pigment epithelial transport might be the cause of non-leaking cystic maculopathy

Optical coherence tomography angiography showing perifoveal capillary stability 30 years after fluorescein angiography

Purpose: To report the Optical Coherence Tomography Angiography (OCTA) results as a novel non-invasive diagnostic modality which provides useful information regarding the status of blood flow in diabetic retinopathy. The current study is a long-term follow-up of eyes of patients with proliferative diabetic retinopathy managed with panretinal photocoagulation. Observations: Two patients with proliferative diabetic retinopathy (PDR) were treated with panretinal photocoagulation (PRP) in both eyes in the early 1980s. Fluorescein angiography performed at the baseline visit and follow-up Optical Coherence Tomography Angiography performed at 30 years after initial PRP treatment showed remarkable stability of the perifoveal capillary network. Visual acuity initially and at last follow-up remained 20/25 or better in these patients. Conclusions and importance: Fluorescein angiography and Optical Coherence Tomography Angiography demonstrated that the integrity of the perifoveal capillary network remained remarkably stable at 30 years. Similarly, the visual outcomes were stable inspite of advanced PDR at baseline

Lens Capsule Violation During Anterior Chamber Paracentesis in Pneumatic Retinopexy

This is a report of a 45-year-old woman treated with pneumatic retinopexy for a macula-sparing retinal detachment. During the procedure, an anterior chamber paracentesis was performed, and the anterior lens capsule was punctured leaving a focal, peripheral cataract. The patient was observed for 2 years without progression of cataract or signs of ocular inflammation.</jats:p

Endogenous Endophthalmitis: An Increasing Problem Among Intravenous Drug Users

The article reports on a study to evaluate the characteristics, management and visual outcomes in patients with endogenous endophthalmitis (EFE). The results indicate that EFE represents severe and end organ damage associated with intravenous drug abuse (IVDA) and results in poor visual outcomes.Academi