ABSTRACT
In this study, we report paracentral acute middle maculopathy (PAMM) and cotton wool spots (CWS) in a patient with ocular migraine. A 74-year-old man presented with persistent paracentral scotoma in the right eye that began a week prior. His visual acuity was 20/25 in the right eye and 20/40 in the left. Dilated fundoscopy revealed CWS in the right eye. Spectral-domain optical coherence tomography (SD-OCT) showed hyper-reflective bands in the inner nuclear layer corresponding to parafoveal lesions seen on near-infrared imaging in the right eye consistent with the diagnosis of PAMM. Further laboratory studies were unremarkable, and a transthoracic echocardiogram and a carotid ultrasound were unrevealing. The patient was started on brimonidine three times daily in both eyes. The patient reported subjective improvement in the paracentral scotoma and the absence of ocular migraine symptoms at two-month follow-up. We conclude from this case that PAMM and CWS can occur simultaneously in ocular migraine, and we suggest that retinal vascular changes associated with ocular migraine may contribute to ischemia underlying both entities. Additionally, we suggest a potential therapy in brimonidine due to its proposed beneficial effects on retinal vasculature and neuroprotection.
Subject(s)
Fluorescein Angiography , Migraine Disorders , Scotoma , Tomography, Optical Coherence , Visual Acuity , Humans , Male , Aged , Migraine Disorders/diagnosis , Migraine Disorders/drug therapy , Visual Acuity/physiology , Scotoma/diagnosis , Scotoma/physiopathology , Scotoma/drug therapy , Fluorescein Angiography/methods , Acute Disease , Retinal Diseases/diagnosis , Retinal Diseases/drug therapy , Retinal Diseases/physiopathology , Macula Lutea/pathology , Macula Lutea/diagnostic imaging , Visual Fields/physiology , Brimonidine Tartrate/therapeutic use , White Dot Syndromes/diagnosis , White Dot Syndromes/drug therapy , Fundus Oculi , Retinal Vessels/pathology , Retinal Vessels/diagnostic imagingABSTRACT
Choroidal neovascularization (CNV) affects 64-75% of eyes with punctate inner choroidopathy (PIC). Although anti-VEGF agents are considered first-line therapy, there is controversy regarding other modalities, such as immunosuppression. We performed a systematic review of individual participant data (IPD) and generated a dataset of 278 eyes with PIC-related CNV from 45 studies. Forty-two percent presented with moderate visual loss (MVL) or worse. Four different treatment modalities (anti-VEGF, photodynamic therapy, local immunosuppression, and systemic immunosuppression) and most combinations among them were represented. Anti-VEGF injections decreased the likelihood of MVL (Odds Ratio 0.3, p = .027), an effect moderated by presenting visual acuity and patient age. Eyes receiving more than 3 injections were more likely to receive additional therapeutic modalities. Increasing number of modalities was associated with longer follow-up time and did not improve vision. The beneficial effect of anti-VEGF injections persisted when controlling for presenting visual acuity and follow-up time.
Subject(s)
Choroidal Neovascularization , White Dot Syndromes , Humans , Choroidal Neovascularization/diagnosis , Choroidal Neovascularization/drug therapy , White Dot Syndromes/drug therapy , Eye , Fluorescein Angiography , Angiogenesis Inhibitors/therapeutic use , Retrospective StudiesABSTRACT
PURPOSE: To evaluate the clinical course of idiopathic multifocal choroiditis (MFC) and punctate inner choroidopathy (PIC) and the efficacy and safety of treatment options during pregnancy. METHODS: Patients with MFC or PIC and a pregnancy in 2011-2019 from two academic centres were enrolled. For the most recent pregnancy, data on best-corrected visual acuity (BCVA) before and after pregnancy, relapse rate in pregnancy and postpartum period and obstetric, maternal and neonatal outcomes were collected. Treatment regimens consisted of a wait-and-see regime and an immunosuppressive treatment regime with systemic corticosteroids and/or azathioprine, both combined with intravitreal antivascular endothelial growth factor injections when indicated. RESULTS: Sixteen women (26 affected eyes) were included. Median Snellen BCVA was 20/19 before pregnancy and 20/18 after delivery. In seven pregnancies a wait-and-see regime and in nine pregnancies an immunosuppressive treatment regime was carried out. Fourteen intravitreal anti-VEGF injections were given in six pregnancies. The relapse rate during pregnancy was 44% and in the postpartum period 31%. Maternal/obstetrical and fetal complications occurred in 31% and 13% of the pregnancies, respectively. Fifteen healthy children were born and one pregnancy ended in a stillbirth in a patient with a complicated obstetrical history. One patient treated with azathioprine developed intrahepatic cholestasis of pregnancy (ICP). CONCLUSIONS: Among women with MFC and PIC BCVA remained stable during pregnancy despite a relapse rate of 44% in pregnancy. No major maternal, obstetric and fetal complications occurred in pregnant patients treated with systemic corticosteroids, azathioprine or intravitreal anti-VEGF injections, though one patient developed ICP while treated with azathioprine.
Subject(s)
Choroiditis/diagnosis , Fluorescein Angiography/methods , Immunosuppressive Agents/therapeutic use , Pregnancy Complications , Tomography, Optical Coherence/methods , Visual Acuity , White Dot Syndromes/diagnosis , Angiogenesis Inhibitors/administration & dosage , Choroiditis/drug therapy , Female , Fundus Oculi , Humans , Intravitreal Injections , Pregnancy , Prognosis , Receptors, Vascular Endothelial Growth Factor/antagonists & inhibitors , Retrospective Studies , White Dot Syndromes/drug therapyABSTRACT
PURPOSE: To present an unusual case of recurrent multiple evanescent white dot syndrome (MEWDS) following the coronavirus 2019 (Covid-19) vaccination. METHODS: Review of the clinical, laboratory, photographic, and angiographic records of a patient with MEWDS. RESULTS: A 49-year-old female who had MEWDS nine years ago presented to our clinic with blurred vision in her left eye. These symptoms occurred 2 days following Covid-19 vaccination. Fundus examinations and diagnostic testing were consistent with recurrent MEWDS. CONCLUSION: While rare, MEWDS can reoccur following Covid-19 vaccination.
Subject(s)
COVID-19 Vaccines/adverse effects , COVID-19/prevention & control , SARS-CoV-2 , Vaccination/adverse effects , White Dot Syndromes/etiology , Female , Fluorescein Angiography , Glucocorticoids/therapeutic use , Humans , Middle Aged , Prednisone/therapeutic use , Recurrence , Tomography, Optical Coherence , White Dot Syndromes/diagnosis , White Dot Syndromes/drug therapyABSTRACT
BACKGROUND: This paper reports the case of a young man who presented with syphilis masquerading as multiple evanescent white dots syndrome (MEWDS), which turned out to be an acute syphilitic posterior placoid chorioretinopathy (ASPPC) during follow-up. CASE PRESENTATION: A 59-year-old healthy male consulted for a three days' history of visual impairment in both eyes. On multimodal imaging, he was diagnosed as MEWDS. Fundus fluorescein angiography (FFA) showed early peripheral bilateral granular hyperfluorescence that correlated with the yellow-white dots found on fundus exam. Indocyanine green angiography (ICGA) depicted hypofluorescent dots on late phase. Spectral-domain optical coherence tomography (SD-OCT) revealed numerous inner retinal highly reflective deposits in the outer nuclear layer and disruption of the ellipsoid zone. After initial improvement, he presented again for a sudden visual loss at 3 weeks. FFA, ICGA and SD-OCT demonstrated the same but more numerous and outer lesions suggesting an ASPPC. A full inflammatory work-up revealed highly positive titers of rapid plasma regain (RPR) and fluorescent treponemal antibody absorption (FTA-Abs), suggesting a syphilis infection. The ophthalmological manifestations dramatically improved after the patient was admitted for high-dose intravenous penicillin G 24 million per day for 2 weeks. CONCLUSION: This is the first case that reports an ocular syphilitic infection masquerading as MEWDS at presentation and that turns to be an ASPPC. Syphilis serology should be routinely done in every case of atypical MEWDS especially when unusually presented in a young healthy man, with bilateral involvement and a bad clinical evolution.
Subject(s)
Chorioretinitis/diagnosis , Eye Infections, Bacterial/diagnosis , Syphilis/diagnosis , White Dot Syndromes/diagnosis , Acute Disease , Anti-Bacterial Agents/therapeutic use , Chorioretinitis/drug therapy , Chorioretinitis/microbiology , Coloring Agents/administration & dosage , Eye Infections, Bacterial/drug therapy , Eye Infections, Bacterial/microbiology , Fluorescein Angiography/methods , Humans , Indocyanine Green/administration & dosage , Infusions, Intravenous , Male , Middle Aged , Multimodal Imaging/methods , Penicillin G/therapeutic use , Syphilis/drug therapy , Syphilis/microbiology , Tomography, Optical Coherence , Visual Acuity/physiology , White Dot Syndromes/drug therapy , White Dot Syndromes/microbiologyABSTRACT
Purpose: Placoid-pigment-epitheliopathies like Acute-Posterior-Multifocal-Placoid-Pigment Epitheliopathy (APMPPE) and Relentless-Placoid-Choroidopathy (RPC) usually show bilateral involvement. This retrospective case series describes the clinical features with unilateral disease onset.Methods: 21 patients from 9 tertiary referring institutions were collected and evaluated.Results: Seventeen patients were included: 11 (65%) had unilateral placoid-pigment-epitheliopathy consistent with APMPPE, 6 (35%) with RPC (mean age: 28.82 ± 9.1 years). Mean follow-up time was 45 ± 48 months. Forty-one percent fellow-eyes had initial inflammatory signs including vitreous-cells, vascular-sheathing, and ONH swelling. Thirty-five percent developed chorioretinal lesions during follow-up after 19.5 ± 16.9 months. Initial inflammation in fellow-eye was not associated with fellow-eye involvement (p = .5). However, subfoveal choroidal-thickness (SCT) at baseline was significantly thicker in fellow-eyes who developed chorioretinal lesion compared to fellow-eyes who did not (400 ± 70 µm versus 283 ± 127 µm,p = .047).Conclusion: Unaffected fellow-eyes may have inflammatory signs at initial disease-onset and may develop lesions over time. They should be carefully monitored, particularly if they present with an increased SCT.
Subject(s)
Choroid/pathology , Choroiditis/diagnosis , Vision Disorders/diagnosis , White Dot Syndromes/diagnosis , Adolescent , Adult , Azathioprine/therapeutic use , Choroiditis/drug therapy , Drug Therapy, Combination , Female , Follow-Up Studies , Glucocorticoids/therapeutic use , Humans , Immunosuppressive Agents , Inflammation/diagnosis , Inflammation/drug therapy , Male , Middle Aged , Organ Size , Prednisone/therapeutic use , Retrospective Studies , Tomography, Optical Coherence , Vision Disorders/drug therapy , Visual Acuity , White Dot Syndromes/drug therapy , Young AdultSubject(s)
Choroid/pathology , Fluorescein Angiography/methods , Mycophenolic Acid/therapeutic use , Prednisone/therapeutic use , Retinal Pigment Epithelium/pathology , Tomography, Optical Coherence/methods , White Dot Syndromes/diagnosis , Adult , Drug Therapy, Combination , Female , Fundus Oculi , Humans , White Dot Syndromes/drug therapyABSTRACT
An atypical case of acute posterior multifocal placoid pigment epitheliopathy with a clear reappearance of the ellipsoid layer of the retina after Ozurdex® intravitreal implantation is presented. A 51-year-old woman reported a 3-week history of left eye photopsia. On slit-lamp examination, yellowish placoid lesions were found on her left eye fundus. Ancillary tests were performed. The patient was diagnosed as a left eye acute posterior multifocal placoid pigment epitheliopathy, and observational approach was decided. Later, the condition started to progress in an ampiginous manner and a decrease of visual acuity caused by an increase in number and size of the lesions was observed. As the disease was progressing with the conservative, observational approach, and the macula was menaced, an intravitreal dexamethasone implant was injected in the left eye with a consequent improvement of the visual acuity and lesion stabilization. The ellipsoid layer, unidentifiable inside the placoid lesions in previous optical coherence tomography tests, reappeared after the treatment. Intravitreal dexamethasone implants can be used to stabilize acute posterior multifocal placoid pigment epitheliopathy lesions and help resolve the condition. Spectral domain optical coherence tomography can also be useful for monitoring these lesions, as the ellipsoid layer may reappear upon resolution.
Subject(s)
Dexamethasone/administration & dosage , Glucocorticoids/administration & dosage , Retina/drug effects , White Dot Syndromes/drug therapy , Adult , Drug Implants , Female , Fluorescein Angiography/methods , Humans , Intravitreal Injections , Middle Aged , Retina/diagnostic imaging , Retina/pathology , Tomography, Optical Coherence/methods , Visual Acuity/physiology , White Dot Syndromes/diagnostic imaging , White Dot Syndromes/physiopathologyABSTRACT
Purpose: To describe the changes seen on optical coherence tomography angiography [OCTA] in patients with PIC following immunosuppressive therapy.Methods: We reviewed serial OCTA scans from five consecutive PIC patients (5 eyes) with at least 3 months of follow-up, who underwent imaging before and after immunosuppressive therapy. Using ImageJ, superficial and deep retinal vasculature were analyzed for vessel area and foveal avascular zone. Choriocapillaris layer was analyzed for flow signal loss.Results: Five out of five patients received an orbital floor triamcinolone acetonide injection as the initial treatment for periods of activity. Mean choriocapillaris (CC) flow void area obtained after immunosuppressive therapy was significantly lower than the mean CC flow void area obtained prior to treatment (Pre-treatment: 0.270 vs Post-treatment: 0.144; p = .0068). In 2 out of 2 patients with longitudinal visual field testing, CC flow voids were spatially associated with visual field defects, and immunosuppressive therapy was associated with reduced CC flow void area and improved visual function.Conclusion: OCTA can detect alterations in choriocapillaris flow. Longitudinal follow-up demonstrates a centripetal restoration of choriocapillaris flow in response to immunosuppressive therapy. OCTA may be a useful adjunct for monitoring and evaluating treatment of PIC.
Subject(s)
Choroid/blood supply , Ciliary Arteries/physiopathology , Immunosuppressive Agents/therapeutic use , Triamcinolone Acetonide/therapeutic use , White Dot Syndromes/drug therapy , Adolescent , Adult , Blood Flow Velocity/physiology , Computed Tomography Angiography , Female , Fluorescein Angiography , Humans , Middle Aged , Regional Blood Flow/physiology , Tomography, Optical Coherence , Visual Acuity , White Dot Syndromes/physiopathologyABSTRACT
Purpose: To report the long-term prognosis of punctate inner choroidopathy (PIC) or multifocal choroiditis (MFC) and associated zonal outer retinopathy (ZOR).Method: Retrospective study in patients with PIC/MFC and ZOR with a clinical follow-up of 4 years or longer.Results: There were 14 patients in this study (M: F = 11:3). All patients received systemic steroid therapy. The initial and final median logarithm of minimal angle of resolution of BCVA were 1.00 and 0.22 (p = .002). Ellipsoid zone recovery was noted in all patients. The median visual field loss improved from -6.38 dB to -3.41 dB (p = .035). The median of total area of PIC/MFC lesions enlarged from 6.82 mm2 to 8.77 mm2 (p = .005). Recurrent disease was noted in 4 eyes and maintenance steroid was needed in 3 eyes.Conclusion: With steroid therapy, most patients with PIC/MFC and ZOR had good visual prognosis.
Subject(s)
Multifocal Choroiditis/physiopathology , Scotoma/physiopathology , White Dot Syndromes/physiopathology , Adult , Coloring Agents/administration & dosage , Computed Tomography Angiography , Female , Fluorescein Angiography , Follow-Up Studies , Glucocorticoids/therapeutic use , Humans , Indocyanine Green/administration & dosage , Male , Methylprednisolone/therapeutic use , Multifocal Choroiditis/diagnosis , Multifocal Choroiditis/drug therapy , Retrospective Studies , Scotoma/diagnosis , Scotoma/drug therapy , Tomography, Optical Coherence , Treatment Outcome , Visual Acuity/physiology , Visual Fields/physiology , White Dot Syndromes/diagnosis , White Dot Syndromes/drug therapy , Young AdultABSTRACT
PURPOSE: To describe the differential response of two distinct inflammatory signs occurring in eyes with punctate inner choroidopathy. METHODS: Retrospective, observational case series using multimodal imaging. RESULTS: Four eyes of 4 myopic female patients (mean age of 35 years, range 31-42 years) presenting with retinal manifestations of punctate inner choroidopathy. All study eyes had 2 distinct signs of active disease: 1) acute focal hyperreflective lesions splitting the retinal pigment epithelium/Bruch membrane complex on optical coherence tomography which appeared hypoautofluorescent on fundus autofluorescence and 2) more diffuse areas of outer retinal disruption limited to the ellipsoid zone and interdigitation zone on optical coherence tomography and corresponding to hyperautofluorescence on fundus autofluorescence. All patients were treated with oral prednisone and demonstrated prompt regression of the retinal pigment epithelium/Bruch membrane complex lesions with a concurrent, paradoxical centrifugal expansion of outer retinal disruption. The outer retinal disruption eventually resolved in all eyes (mean time of 6 weeks, range 4-10 weeks). CONCLUSION: In patients with punctate inner choroidopathy, two distinct inflammatory signs observed with multimodal imaging display a differential response to systemic corticosteroids. Although focal inflammatory lesions splitting the retinal pigment epithelium/Bruch membrane complex seem to respond rapidly, the more diffuse, transient outer retinal disruption shows little response. This difference in treatment response may reflect different immunological phenomena with independent natural history.
Subject(s)
Bruch Membrane/drug effects , Glucocorticoids/therapeutic use , Inflammation/drug therapy , Prednisone/therapeutic use , Retinal Diseases/drug therapy , Retinal Pigment Epithelium/drug effects , White Dot Syndromes/drug therapy , Administration, Oral , Adult , Bruch Membrane/pathology , Coloring Agents/administration & dosage , Female , Fluorescein Angiography , Humans , Immunosuppression Therapy , Indocyanine Green/administration & dosage , Inflammation/diagnosis , Multimodal Imaging , Ophthalmoscopy , Retinal Diseases/diagnosis , Retinal Pigment Epithelium/pathology , Retrospective Studies , Slit Lamp Microscopy , Tomography, Optical Coherence , White Dot Syndromes/diagnosisABSTRACT
Purpose: To report two cases of syphilitic outer retinopathy that showed diffuse phlebitis on fluorescein angiography (FA).Methods: Retrospective chart review.Results: The two patients had presentation similar to acute zonal occult outer retinopathy (AZOOR), including hyperautofluorescence on fundus autofluorescence and ellipsoid zone disruption on optical coherence tomography. The main difference from AZOOR was the finding of diffuse phlebitis on FA. Both patients recovered well after antibiotic and steroid treatment.Conclusion: FA is especially important for differentiating syphilitic outer retinopathy from AZOOR. Timely diagnosis and treatment with penicillin and cautious use of steroid usually lead to favorable prognosis.
Subject(s)
Eye Infections, Bacterial/diagnosis , Phlebitis/diagnosis , Retinal Vein/pathology , Scotoma/diagnosis , Syphilis/diagnosis , White Dot Syndromes/diagnosis , Adult , Anti-Bacterial Agents/therapeutic use , Ceftriaxone/therapeutic use , Doxycycline/therapeutic use , Electroretinography , Eye Infections, Bacterial/drug therapy , Eye Infections, Bacterial/microbiology , Female , Fluorescein Angiography , Glucocorticoids/therapeutic use , Humans , Male , Middle Aged , Phlebitis/drug therapy , Phlebitis/microbiology , Prednisolone/therapeutic use , Retrospective Studies , Scotoma/drug therapy , Scotoma/microbiology , Syphilis/drug therapy , Syphilis/microbiology , Tomography, Optical Coherence , Visual Acuity/physiology , Visual Field Tests , Visual Fields/physiology , White Dot Syndromes/drug therapy , White Dot Syndromes/microbiologySubject(s)
Disease Management , Fluorescein Angiography/methods , Glucocorticoids/therapeutic use , Retinal Photoreceptor Cell Outer Segment/pathology , Scotoma/diagnosis , Tomography, Optical Coherence/methods , Visual Fields/physiology , White Dot Syndromes/diagnosis , Fundus Oculi , Humans , Male , Scotoma/drug therapy , White Dot Syndromes/drug therapy , Young AdultABSTRACT
PURPOSE: To describe a clinical picture resembling classic multiple evanescent white dot syndrome (MEWDS) potentially triggered by previous or concurrent, apparently unrelated, ocular events and to provide a literature review of similar presentations. DESIGN: Retrospective chart series and literature review. PARTICIPANTS: Consecutive patients diagnosed with MEWDS at the Feinberg School of Medicine, Northwestern University, Chicago, Illinois, and the IRCCS San Raffaele Scientific Institute, Milan, Italy, between July 2019 and June 2020. METHODS: Charts of patients were reviewed. Ophthalmic history, best-corrected visual acuity, spectral-domain OCT results, OCT angiography results, fundus autofluorescence results, ultra-widefield fluorescein angiography results, and indocyanine green angiography results were collected. A PubMed-based search was carried out for similar presentations using the terms MEWDS and white spot syndromes. MAIN OUTCOME MEASURES: An ocular history positive for previous or concurrent ocular events in patients with MEWDS was sought in our cohort and the existing literature. RESULTS: Five eyes of 4 patients (2 females; age range, 16-81 years) were included. The first eye had a history of bilateral Best vitelliform dystrophy and unilateral choroidal neovascularization. The second eye had angioid streaks complicated by choroidal neovascularization and underwent prior thermal laser photocoagulation. The third eye had a history of high myopia and a scleral buckle procedure for retinal detachment. The fourth patient had bilateral idiopathic retinochoroiditis. We identified 16 case reports from 5 previous publications that support a MEWDS-like reaction to previous ocular insults. CONCLUSIONS: We suggest a MEWDS-like reaction may be elicited by ocular events in a subset of susceptible patients. We hypothesize that damage to the outer retina may play a role in triggering the local inflammatory response.
Subject(s)
Retinal Diseases/diagnosis , White Dot Syndromes/diagnosis , Adolescent , Adult , Aged, 80 and over , Angiogenesis Inhibitors/therapeutic use , Coloring Agents/administration & dosage , Computed Tomography Angiography , Female , Fluorescein Angiography , Glucocorticoids/therapeutic use , Humans , Indocyanine Green/administration & dosage , Intravitreal Injections , Male , Multimodal Imaging , Prednisone/therapeutic use , Retinal Diseases/drug therapy , Retinal Diseases/physiopathology , Retrospective Studies , Tomography, Optical Coherence , Vascular Endothelial Growth Factor A/antagonists & inhibitors , Visual Acuity/physiology , White Dot Syndromes/drug therapy , White Dot Syndromes/physiopathology , Young AdultABSTRACT
Multiple evanescent white dot syndrome (MEWDS) is an inflammatory eye disease of the outer retina, retinal pigmented epithelium, choroid presenting with photopsia, loss of vision, and temporal scotoma. The patient was a 31-year-old female with a history of vision loss since 11 days ago (left eye). At presentation, best-corrected Snellen visual acuity was 20/140 in the Snellen chart. We decided to treat her with short time corticosteroid therapy (0.75 mg/kg/day prednisolone which was tapered in 3 weeks) for any possible rapid recovery of vision. The visual acuity of the involved eye was improved to 20/25 and 20/20, one week and three weeks after starting treatment respectively. Thus, it seems that short-term oral steroids might be an alternative method of management for patients with MEWDS.
Subject(s)
Adrenal Cortex Hormones/therapeutic use , Anti-Inflammatory Agents/therapeutic use , Prednisolone/therapeutic use , Vision Disorders/diagnosis , White Dot Syndromes/diagnosis , Administration, Oral , Adult , Child , Female , Humans , Optical Imaging , Recovery of Function , Vision Disorders/drug therapy , White Dot Syndromes/drug therapySubject(s)
Macula Lutea/pathology , Scotoma/diagnosis , White Dot Syndromes/diagnosis , Acute Disease , Administration, Oral , Adult , Crohn Disease/complications , Fluorescein Angiography , Glucocorticoids/therapeutic use , Humans , Macula Lutea/drug effects , Male , Prednisone/therapeutic use , Scotoma/drug therapy , Tomography, Optical Coherence , Visual Acuity/physiology , White Dot Syndromes/drug therapyABSTRACT
PURPOSE: To report a case of acute macular neuroretinopathy in a patient with Susac syndrome. METHODS: Case report. RESULTS: A 39-year-old male patient presented with severe headache, photopsias, and a sudden onset of hearing loss in the right ear. Fluorescein angiography of the right eye revealed multiple branch retinal artery occlusions. Clinical presentation of encephalopathy, hearing loss, and branch retinal artery occlusions, along with characteristic magnetic resonance imaging findings, led to a diagnosis of Susac syndrome. Despite aggressive immunosuppression for four months, the patient later presented with acute macular neuroretinopathy in the left eye. CONCLUSION: Acute macular neuroretinopathy and Susac is a new association of two well-defined disorders. The concurrence of both disorders supports retinal ischemia as the proximate cause of acute macular neuroretinopathy and inflammation as a potential etiology.
Subject(s)
Susac Syndrome/complications , White Dot Syndromes/etiology , Administration, Oral , Adult , Drug Therapy, Combination , Enzyme Inhibitors/therapeutic use , Fluorescein Angiography , Glucocorticoids/therapeutic use , Headache/diagnosis , Hearing Loss, Sudden/diagnosis , Humans , Male , Methylprednisolone/therapeutic use , Mycophenolic Acid/therapeutic use , Prednisone/therapeutic use , Retinal Artery Occlusion/diagnosis , Susac Syndrome/diagnosis , Susac Syndrome/drug therapy , Tomography, Optical Coherence , Vision Disorders/diagnosis , White Dot Syndromes/diagnosis , White Dot Syndromes/drug therapyABSTRACT
Twenty-six-year-old male patient admitted to the outpatient clinic with a complaint of decreased vision in both eyes. Visual acuity was 2/10 in the right and 7/10 in the left eye. Fundus examination revealed bilateral yellow-white subretinal lesions involving the macula. Fluorescein angiography showed hypofluorescent lesions in early and hyperflourescent lesions in the late phase. Optical coherence tomography angiography performed in the acute phase showed bilateral hypofluorescency at the choriocapillary level. A diagnosis of acute posterior multifocal placoid pigment epitheliopathy was given. After steroid treatment, visual acuity was improved to 10/10 and earlier lesions in optical coherence tomography angiography were found to be reduced. In conclusion, optical coherence tomography angiography is a noninvasive imaging technique that can be used in the diagnosis and follow-up of acute posterior multifocal placoid pigment epitheliopathy.
Subject(s)
Fluorescein Angiography/methods , Tomography, Optical Coherence/methods , White Dot Syndromes/diagnosis , Acute Disease , Adult , Glucocorticoids/therapeutic use , Humans , Male , Vision Disorders/diagnosis , Vision Disorders/drug therapy , Vision Disorders/physiopathology , Visual Acuity/physiology , White Dot Syndromes/drug therapy , White Dot Syndromes/physiopathologyABSTRACT
Purpose: To evaluate the long-term outcome of active choroidal neovascularization (CNV) in punctate inner choroidopathy (PIC) or multifocal choroiditis (MFC) after intravitreal bevacizumab treatment.Methods: Retrospective study of consecutive patients of PIC/MFC complicated with active CNV. Outcome measures included best-corrected visual acuity (BCVA), total number of intravitreal injections of bevacizumab and recurrence of CNV. Correlation analysis was performed to find the correlation of various clinical factors and final BCVA.Results: There were 23 eyes in 22 patients with a mean age of 33.22 years included in this study. The mean duration of follow-up was 6.48 years. Improvement of BCVA was noted through the first 3 years and at the final follow-up. BCVA at 1, 6, 12 months and recurrence of CNV were correlated with final BCVA.Conclusion: Most patients of PIC/MFC complicated with CNV managed with intravitreal bevacizumab had improved BCVA over 4 years.
Subject(s)
Bevacizumab/administration & dosage , Choroid/pathology , Choroidal Neovascularization/drug therapy , Multifocal Choroiditis/drug therapy , Optic Disk/pathology , Visual Acuity , White Dot Syndromes/drug therapy , Adolescent , Adult , Aged , Angiogenesis Inhibitors/administration & dosage , Choroidal Neovascularization/complications , Choroidal Neovascularization/diagnosis , Female , Fluorescein Angiography , Follow-Up Studies , Fundus Oculi , Humans , Intravitreal Injections , Male , Middle Aged , Multifocal Choroiditis/complications , Multifocal Choroiditis/diagnosis , Receptors, Vascular Endothelial Growth Factor/antagonists & inhibitors , Retrospective Studies , Time Factors , Tomography, Optical Coherence , White Dot Syndromes/complications , White Dot Syndromes/diagnosis , Young AdultABSTRACT
Hemodialysis-related portosystemic encephalopathy (HRPSE) is a clinical phenomenon where portosystemic encephalopathy (PSE) develops without liver dysfunction, usually caused by changes in the portosystemic blood flow related to hemodialysis. We describe the case of a 22-year old patient with a transjugular intrahepatic portosystemic shunt (TIPS) who developed HRPSE several months after initiation of hemodialysis. Despite initial therapy with laxatives and neomycin symptoms recurred. It was only after relocation of the hemodialysis catheter from the superior caval vein to the femoral vein that symptoms completely resolved.