Zonisamide-induced Choroidal Effusion: A Case Report.

PURPOSE: To describe a case of zonisamide-induced bilateral choroidal effusion. CASE REPORT: A 72-year-old woman presented with a 4-day history of bilateral blurred vision 9 days after initiating oral zonisamide for essential tremor. Clinical examination revealed an asymmetric choroidal detachment with open anterior chamber angle and intraocular pressure within the normal range. Posterior segment ultrasonography and ultrasound biomicroscopy both confirmed the presence of bilateral ciliochoroidal effusion. Zonisamide treatment was discontinued. One month after treatment discontinuation, the ophthalmological examination was normal and no further treatment was needed. CONCLUSION: Zonisamide can cause an idiosyncratic reaction leading to choroidal effusion with or without acute angle closure. Early withdrawal of the causative agent is the key to reversing this condition. These findings indicate that zonisamide and other sulfa-derived drugs must be ruled out in the differential diagnosis of choroidal effusion of unknown cause.

Management of Conjunctival Perforation and XEN Gel Stent Exposure by Stent Repositioning Through the Anterior Chamber.

In recent years, minimally invasive glaucoma surgery has emerged as a novel approach to lowering intraocular pressure. This technique, which is usually reserved for mild to moderate cases, is less invasive than classic filtration surgery and potentially offers a better safety profile. The XEN Gel Stent is implanted through a minimally invasive, ab interno procedure to create a subconjunctival pathway. Conjunctival tissue disruption is minimal, and flow is restricted to avoid hypotony. Data on the optimal approach to managing complications associated with this procedure are limited due to the relatively recent commercialization of this device. Here, we report a case of a persistent leaking bleb caused by XEN Stent exposure, which was managed by ab interno repositioning of the stent through the anterior chamber and direct suturing of the conjunctival defect.

Feasibility of swept-source OCT for active birdshot chorioretinopathy.

PURPOSE: To assess the feasibility of swept-source optical coherence tomography (SS-OCT) for clinical follow-up of patients with birdshot chorioretinopathy (BC). METHODS: Prospective longitudinal, observational, 12-month case-control study in a tertiary care center. The study population included 12 patients (24 eyes) diagnosed with BC and 21 age- and sex-matched healthy controls (42 eyes). The macular areas in both affected and healthy eyes were prospectively analyzed with SS-OCT at 1050 nm, using 2D 12.0-mm radial and horizontal scans and the 3D raster scan protocol (12.0 × 9.0 mm). Anatomical and structural abnormalities, as well as retinal and choroidal thickness (measured automatically), were evaluated and compared with visual field (VF) testing and indocyanine green angiography (ICGA). RESULTS: The most common qualitative abnormalities in the retina were thinning/loss of architecture and outer retinal hyperreflective foci, and in the choroid they were focal depigmentation, thinning/absence of Sattler's layer, generalized thinning, and hyperreflective foci. The most significant changes in the retina from baseline to the 12-month follow-up were decreases in intraretinal cysts, subretinal fluid, and hyaloid thickening. In the choroid, focal depigmentation decreased significantly, while vascular pattern loss increased. Compared to the healthy volunteers, patients with BC had thinner choroids and retinas at both baseline and study end. Retinal thickness decreased significantly in BC patients over the 12-month study period, but choroidal thickness remained unchanged. Findings from ICGA, VF, and SS-OCT were perfectly correlated in most (≈ 60%) patients. CONCLUSIONS: SS-OCT is a non-invasive, rapid method of assessing choroidal and retinal changes in patients with birdshot disease. This technique provides a simple method of monitoring the course of the disease that can be used to complement conventional tests.

Clinical Course of a Presumed Metastatic Uveal Melanoma to the Contralateral Choroid.

We present the ultrasound and optic coherence tomography follow-up of a presumed choroidal metastasis from a contralateral melanoma. A 53-year-old male was diagnosed with uveal melanoma with extraescleral extension in his left eye. A year later, the fundus examination revealed a flat, gray-green, pigmented choroidal lesion in the right eye. The ultrasonography showed a mass, almost flat, and all these findings were compatible with a choroidal melanocytic lesion with risk factors for growth. One month later, melanocytic skin lesions appeared on the scalp, as well as small tumors. Three months later, an ultrasonography on B scan showed a growth of the tumor size. The patient developed a progressive deterioration and died. Three possibilities can explain the occurrence of a choroidal pigmented tumor in the contralateral eye: first, bilateral primary choroidal melanomas; second, both choroidal tumors are metastatic in origin from an unknown primary melanoma; and third, the contralateral tumor is a metastatic tumor from the primary choroidal melanoma.