Magnetic resonance imaging evaluation of retro-bulbar optic nerve in patients with optic disc pit maculopathy

Background: Optic disc pit (ODP) is a congenital anomaly characterized by indented area of the optic nerve head most likely originating from the incomplete closure of the superior edge of the embryonic fissure. Maculopathy can occasionally complicate this anomaly as intra-retinal and sub-retinal fluid at the macula. In result, maculopathy is associated with a poor visual prognosis due to a serous macular detachment, formation of macular hole, or atrophy of the retinal pigmented epithelium. In this case series, we report of three patients with unilateral ODP. Case report: We attempted to analyze the morphologic changes seen in the ODP and evaluate patients with a complete ophthalmologic evaluation, fundus color photography, spectral-domain optical coherence tomography (SD-OCT) scanning, and magnetic resonance imaging (MRI) of globe and orbit. Magnetic resonance imaging scan was done for optic disc diameter (ODD) and optic nerve sheath diameter (ONSD). Conclusion: We noticed that in the patient who presented with neurosensory detachment in the macula, the ONSD is larger than in the fellow eye and is larger than the remaining two patients with ODP and without neurosensory detachment of the retina

Assessment of retinal and optic disc vascular perfusion density in retinitis pigmentosa patients by optical coherence tomography angiography

Background: The aim of the study was to evaluate the vascular flow density measured by optical coherence tomography angiography in patients with retinitis pigmentosa and to compare it with normal subjects. Material and methods: This was a cross-sectional case control study employing 16 eyes of eight patients with retinitis pigmentosa and 16 eyes of eight healthy subjects. Optical coherence tomography angiography was performed in all subjects. The macula was imaged with a 3 × 3 mm scan, whereas for the optic nerve head, a 4.5 × 4.5 mm scan was taken. Macular and optic disc vascular flow perfusion densities were measured. In addition, the FAZ area was calculated. All data were compared in the two groups. Results: The vascular flow perfusion density in the macular and in the optic nerve head was significantly lower in the retinitis pigmentosa group when compared with the control group. On the other hand, the foveal avascular zones area was not significantly different from controls. Conclusion: Patients with retinitis pigmentosa show a decreased macular and optic nerve head perfusion density compared with healthy subject

Treatment of age related macular degeneration (AMD) currently and in the past

Age-related macular degeneration (AMD) is a disease that blurs the sharp, central vision you need for “straight-ahead” activities such as reading, sewing, and driving. AMD affects the macula, the part of the eye that allows you to see fine detail. AMD causes no pain. AMD is an irreparable disorder, which mostly occurs among people after 50. Nowadays the pathogenesis of AMD is still not entirely clarified, however this disorder has multifactor background, which include interactions between genetic and environmental factors. AMD is divided into two forms: exudative (“wet”) and nonexudative (“dry”). The treatment of age-related macular degeneration depends on the stage of the disease progression. One of the first methods of treatment of exudative AMD was laser photocoagulation with argon laser. Currently, this kind of treatment is used in certain cases of neovascularization in extrafoveal area. Next elderly method of therapy of AMD was a photodynamic therapy (PDT) at year 2000. The treatment consist in intravenous injection of verteporfin and a laser at the same time. At 2002 was in use transpupillary thermotherapy (TTT). Last few years for treatment AMD is used antagonist of vascular endothelial growth factor (VEGF). We distinguish: pegatanib, ranibizumab, bevacizumab and aflibercept. Nowadays all of available methods do not eliminate causes of that disorder and in this connection currently treatment is still symptomatic. Apart from every mentioned method above, nutritional therapy is also essential and it decrease the risk of progression of AMD. The diet should contain products full of vitamin C,E, beta carotene, zinc and copper

Central retinal artery occlusion (CRAO) - case report

Central retinal artery occlusion (CRAO) is an ophthalmic emergency, most commonly caused by an embolism, usually from the carotid arteries. It can be considered as an acute stroke of the eye, and is an ocular analogue of cerebral stroke. The incidence of CRAO is estimated to be 1 in 100 000 people. Risk factors include hypertension, carotid atherosclerosis, structural cardiac pathology, coronary heart disease, cerebral vascular accident, and diabetes mellitus. CRAO usually presents with a sudden, painless loss of vision. 52 - year old male was admitted to the Ophthalmology ER, reporting a painless monocular vision loss in a right eye for two days. After such a long time from the occurrence of symptoms, there weren’t any possible treatment methods for this patient, besides preventing future embolic events. Ophthalmological examination showed only a light perception in a right eye and vision in the left eye was 1.0. Patient was diagnosed to identify risk factors of CRAO: hypertension, hypercholesterolemia, atherosclerosis or thrombophilia. He was qualified for a careful observation for the atherosclerotic risk factors and educated, that in case of occurrence of the similar symptoms, he needs to report to a Ophthalmologist immediately. Currently, there are two main types of treating an acute non-arteritic CRAO: the first: ‘standard’, non-invasive method, and the second: using the thrombolytics deployed intravenously or intra-arterially. Unfortunately, they couldn’t be used to treat described patient, since he has already been in a late phase of CRAO

Disulfiram-alcohol reaction in 49 year old patient

Alcoholism is a disease in which person lose control over the amount of consumed alcohol. The problem of alcohol abuse in Poland concerns about 9% of the population. One of the treatment methods is disulfiram therapy, which is associated with the risk of disulfiram-alcohol reaction. Due to many negative reports of side effects and questionable efficacy, this drug is nowadays rare used. We present a case of a patient who had a disulfiram reaction due to alcohol consumption during disulfiram therapy

Stent fracture as a complication of superficial femoral artery stenting – a case report

Introduction: Peripheral artery disease (PAD) is an atherosclerotic vascular disease that results in obstruction of blood flow in the arteries other than those in the coronary circulation. PAD is often located in lower extremities, with patients presenting symptoms of intermittent claudication or critical lower limb ischemia. Angioplasty and stent implantation are often used in the treatment of PAD. Although these methods are considered as a low invasive and low risk, some factors may limit stent patency in the future. The fracture of the implanted stent may be one of these. Case report: A 68 old man, long-term smoker, with a history of chronic limb ischemia and many vascular surgeries because of PAD was admitted to the hospital with symptoms of the acute limb ischemia. Angiography showed a fracture of the stent implanted during the earlier hospitalization, with a fragment displacement to the left external iliac artery. The patient was successfully treated with catheter-directed thrombolysis. Discussion: Stent fracture is usually asymptomatic, however, it may cause complications, such as restenosis, pseudoaneurysm, perforation of the vessel, and in-stent embolism. The cumulative incidence of the femoropopliteal stent fracture varies from 2 to 65% in several studies. Incidence increases with stent length and is significantly lower in the second generation of nitinol stents, that was designed to have enhanced flexibility and durability

Lower Back Pain, Blamed on Pregnancy, Ended Up with Worsening of Vision: A Case Report

A 51 year-old female was presented with worsening of vision in her right eye; left eye similar problem about one year earlier. Each time responded to methylprednisolone sodium succinate and her discharge diagnosis was the optic nerve neuropathy. The past medical history (PMHx) was remarkable for twenty years of hypertension, anemia of chronic disease and currently on hemodialysis due to her end stage renal disease (ESRD). The most notable part of PMHx was the sacral area pain since her pregnancy at age 28 which had never resolved until the radiational therapy for aneurysmal bone cyst (ABC) which was found in CT imaging. Since the lower back pain is a frequent complain in pregnancy and after deliveries, the complains were neglected until the tumor became unresectable. The radiation therapy produced the shrinkage of ABC, but caused renal injury leading to HTN and ESRD. At age approximately 48, the patient started experiencing worsening of her vision in her left eye, most likely in result of poorly controlled HTN while maintaining her normal vision in her right eye. As stated in the report, the patient was treated in our clinic for worsening of vision in her left eye followed by he vision worsening in her right eye within one year. During the most recent hospitalization a diagnosis of bilateral papilledema we established and left eye’s optic nerve head atrophy was confirmed using both OCT and MR imaging. We believe that ignoring common complaints can lead to uncommon complications causing the most severe consequences for our patients

Identification of the RPGR Gene Pathogenic Variants in a Cohort of Polish Male Patients with Retinitis Pigmentosa Phenotype

The goal of the study was to explore the spectrum of pathogenic variants in the RPGR gene in a group of male Polish patients with a retinitis pigmentosa (RP) phenotype. A total of 45 male index patients, including twins, being members of 44 families, were screened for pathogenic variants in the RPGR gene via the direct sequencing of PCR-amplified genomic DNA and underwent a comprehensive ophthalmological examination in one center located in Poland. A total of two pathogenic and five likely pathogenic variants in eight patients (18%) were detected in the studied cohort. Of these, five variants were novel, and five disease-causing variants (71%) were identified within the ORF15 mutational hotspot of the RPGR gene. The median age of onset of the disease was 10 years (range 6–14 years), the median age during the examination was 30 years (range 20–47 years), and the median visual acuity was 0.4 (range 0.01–0.7). The majority of patients had middle constriction of the visual field and thinning of the central foveal thickness. Dizygotic twins bearing the same hemizygous mutation showed a different retinal phenotype in regard to the severity of the symptoms. This is the first RPGR mutation screening in Poland showing a prevalence of 18% of RPGR pathogenic mutations and likely pathogenic variants in the studied cohort of male patients with an RP phenotype

Double-Needle Yamane Technique Using Flanged Haptics in Ocular Trauma—A Retrospective Survey of Visual Outcomes and Safety

To evaluate visual outcomes and safety of the double-needle technique using flanged haptics (Yamane technique) in patients with aphakia caused by ocular trauma at a trauma referral center. Retrospective: Consecutive interventional case series of 30 patients who underwent the Yamane technique due to posttraumatic aphakia. The double-needle technique using flanged haptics was combined with anterior vitrectomy (group A) in 14 patients, and with pars plana vitrectomy (PPV) (group B) due to retinal detachment, nucleus dislocation into the vitreous cavity, or intraocular lens (IOL) displacement in 16 patients. No intraoperative complications were noted. There was significant improvement in the visual acuity in both groups at the second postoperative visit. However, the visual acuity was significantly worse in the group treated with the Yamane technique combined with PPV. Silicone oil tamponade in PPV group was associated with worse visual acuity, whereas post lensectomy status was associated with poor visual function result in the anterior vitrectomy group. There was one case of slight IOL decentration and one retinal detachment during the postoperative follow-up period in the group with PPV. In this case series, the Yamane technique applied in traumatized eyes was found to be an efficacious and safe procedure. Combining the Yamane technique with PPV due to posterior segment ocular trauma was associated with worse functional results in the follow-up at three months. Further studies with longer follow-up evaluations are required to verify long-term complications