RESUMO
PURPOSE: To describe the occurrence of acute exudative polymorphous vitelliform maculopathy (AEPVM) as the initial presentation in a human immunodeficiency virus (HIV) positive patient. METHODS: Observational case report of one patient and literature review. RESULTS: An active 21-year-old Caucasian woman presented at our emergency department with anterior segment complaints. Her best corrected visual acuity (BCVA) was 20/20 in both eyes. Fundus examination revealed numerous, polymorphous bleb-like lesions at the posterior pole, corresponding, on structural imaging (optical coherence tomography, OCT) to subretinal detachments (SRD). The bleb-like lesions on infrared imaging were slightly autofluorescent on fundus autofluorescence (FAF). Swept source OCT Angiography showed signal attenuation due to the presence of subretinal fluid in the choriocapillaris segmentation. Multimodal imaging findings were suggestive for AEPVM. Hence, a systemic blood workup was performed. The workup returned positive for HIV and an antiviral therapy was introduced. CONCLUSION: The fortuitous diagnosis of HIV having as the initial presentation AEPVM in an asymptomatic patient highlights the value of a thorough clinical examination and multimodal imaging in correctly diagnosing this rare disorder and its cause. This case report could prove helpful to clinicians faced with this rare scenario.
RESUMO
PURPOSE: The aim of this study was to analyse the safety profile and efficacy of ab interno viscocanaloplasty (ABiC) through to 12 months post-operatively. METHODS: In this retrospective study, the medical records of all patients who underwent ABiC between September 2015 and December 2019 were analysed. Complete success was defined as a 12-month reduction in intraocular pressure (IOP) ≥ 20% from baseline with no concomitant medications. Qualified success criteria were identical, with no more medications than at baseline. RESULTS: In all, 54 eyes of 41 patients were analysed. Mean IOP decreased from 23.6 ± 7.4 mmHg preoperatively to 14.2 ± 2.9 mmHg (-39.8%; p < 0.001) after 12 months. Concomitantly, the number of anti-glaucoma treatment dropped from 2.9 ± 1.0 to 0.6 ± 1.1 (-79.3%; p < 0.001). Amongst patients with a baseline MD < -12.0 dBs, mean IOP decreased from 22.8 ± 9.8 mmHg to 13.8 ± 4.4 mmHg (p = 0.049), with a concomitant reduction of medications from 2.8 ± 1.3 to 1.2 ± 1.3 (p < 0.001). Complete success at 12 months was achieved in 46% of eyes, and qualified success was achieved in 65% of eyes. Amongst eyes with a baseline MD < -12.0 dBs, 50% achieved complete success, and 83.3% achieved qualified success. A total of 19 eyes (35.2%) were considered surgical failure, all due to uncontrolled IOP. Of them, 7 eyes (13.0%) required further filtering surgery. Twelve post-operative adverse events were observed, with early post-operative IOP spikes being the most common (22.2%). CONCLUSIONS: ABIC achieved a statistically significant reduction in IOP and anti-glaucoma medications through 12 months, while maintaining a favourable safety profile in mild-to-severe open-angle glaucoma.