A Case of Nephrotic Syndrome with Bilateral Serous Retinal Detachment and Shallow Anterior Chamber Associated with Ciliary Body Edema.

Nephrotic syndrome is a disease that causes fluid retention in the body due to loss of protein in the blood, which can lead to serous retinal detachment (SRD) in the macula. We report a case of severe SRD in both eyes and angle closure due to ciliary body edema caused by nephrotic syndrome. A 57-year-old man was admitted to the Department of Nephrology in our hospital for a thorough examination of his generalized edema. He was diagnosed with nephrotic syndrome but proved to be refractory to steroid treatment. Due to distortion symptoms in both eyes on the 30th day of hospitalization, the patient was referred to our department. Best-corrected visual acuity (BCVA) was 0.8 in the right eye and 1.0 in the left eye. Slit lamp examination and anterior segmental optical coherence tomography (OCT) showed shallow anterior chambers in both eyes. Fundus and macular OCT demonstrated severe SRD in the posterior pole of both eyes. After observing the presence of hypoalbuminemia, we considered the possibility of SRD and angle closure due to ciliary edema that resulted from the leaks associated with the nephrotic syndrome. Thereafter, ocular findings improved in conjunction with systemic symptom improvements associated with ultrafiltration and low-density lipoprotein apheresis. On the 60th day of hospitalization, his BCVA improved to 1.2 in both eyes, SRD disappeared, and the anterior chamber depth normalized. This case demonstrates the importance of recognizing SRD and angle closure associated with ciliary body edema as complications linked with nephrotic syndrome.

Multimodal imaging of indapamide-induced bilateral choroidal effusion: a case report.

BACKGROUND: Indapamide, a sulfonamide diuretic used to treat hypertension, has been reported to have ocular side effects of acute angle-closure glaucoma, transient myopia and choroidal effusion whose immediate etiology is uncertain. This report aims to clarify the nature of indapamide-induced edema of the entire eyeball using multimodal imaging. CASE PRESENTATION: A 60-year-old woman who was following a long-term carbohydrate-restricted diet and receiving oral treatment for hypertension was referred to our department for eye pain. Indapamide (1 mg daily) was prescribed for uncontrolled hypertension 5 days before her visit; she took the medication for only 3 days and then stopped due to dry eye. However, she began to feel eye pain the day after her last dose, and the pain gradually intensified. She experienced no decrease in visual acuity at the initial visit; however, an extremely shallow anterior chamber was observed in both eyes, along with a slight increase in intraocular pressure. For differential diagnosis, ocular manifestations were evaluated with wide-field fundus photography, optical coherence tomography (OCT) of both anterior and posterior segments, fluorescein / indocyanine green angiography, ultrasound biomicroscopy and head magnetic resonance, showing edema of the entire eyeball. Treatment with tropicamide and phenylephrine hydrochloride drops resulted in rapid recovery of the anterior chamber depth and disappearance of the choroidal effusion within 3 days. CONCLUSIONS: Multimodal imaging is useful for diagnosing drug-induced choroidal effusion by evaluating ocular conditions before and after treatment.

Mirtazapine-induced bilateral secondary angle closure in a female.

Purpose: To report a case of bilateral secondary angle closure in a female using mirtazapine for 6 months. Patient and method: A 55-year-old female was diagnosed with secondary angle closure in both eyes with raised intraocular pressure, and ultrasound biomicroscopic findings suggestive of ciliary body effusion. It was associated with adjoining cyst presumably because of the use of mirtazapine for depression and sleep disturbances. Results: After the planned discontinuation of mirtazapine, the ocular angle opened, the ciliary body edema decreased, and the cyst regressed in size. The intraocular pressure was controlled with topical timolol (0.5%). Conclusion: Patients with risk factors for angle closure should be prescribed antipsychotic drugs with caution. The peripheral laser iridotomy is not indicated in secondary angle closure due to ciliary body effusion.

Bilateral Transient Myopia with Sulfasalazine Treatment.

PURPOSE: Several case reports of transient drug-induced myopia have been reported, mainly due to sulfa drugs. We present a case of a sudden and significant increase in myopia associated with initiation of Sulfasalazine for long-standing ulcerative colitis in an adult Caucasian female. CASE REPORT: Our patient presented to the emergency room with acute bilateral visual loss. Ocular examination was normal, except for myopia of -4 Diopters (D) in both eyes (BE). The patient was advised to stop the medication, and her vision improved within 4 days to best corrected visual acuity (BCVA) of 6/7.5 with a refractive correction of -0.75 D in her right eye (RE) and BCVA of 6/6 with a refractive correction of -0.50 D in her left eye (LE). CONCLUSION: To the best of our knowledge, this is the second reported case of transient Sulfasalazine-induced myopia.

Ciliary body thickness changes after preoperative anti-inflammatory treatment in rhegmatogenous retinal detachment complicated by choroidal detachment.

BACKGROUND: The literature is scant on the state of the ciliary body, its role in the development of rhegmatogenous retinal detachment (RRD) complicated by choroidal detachment (CD), and on ciliary body changes following the treatment aimed at resolving concomitant inflammation and choroidal attachment. This study assesses the anatomical position and thickness of the ciliary body and investigates the ciliary body changes after anti-inflammatory pre-vitrectomy treatment in RRD complicated by CD. METHODS: Forty-nine patients (49 eyes) with RRD complicated by CD underwent standard ophthalmological examination (including visual acuity assessment, biomicroscopy, ophthalmoscopy, and ocular tonometry) and ultrasound biomicroscopy of the ciliary body, choroid, and retina both before and following anti-inflammatory pre-vitrectomy treatment. RESULTS: At baseline, all subject eyes had ciliary body edema and detachment extending into the choroid. Ultrasonographic ciliary features included ciliary body edema and disorganization of the supraciliary layer of the pars plana, which was evident by the presence of multiple small oblique fibers. In all subject eyes, the treatment resulted in reattachment of the choroid and the ciliary body as well as a reduction in ciliary body edema (total mean ciliary thickness reduced from 0.83 (0.09) to 0.65 (0.09) mm, with a difference of 0.18 (0.07) mm, P < 0.001). CONCLUSIONS: Preoperative anti-inflammatory treatment in RRD complicated by CD results in restoration of the anatomical position of the ciliary body and a statistically significant reduction in ciliary body edema.