Case report: A case of unilateral combined central retinal vein occlusion, incomplete central retinal artery occlusion, and papillitis following a third dose of COVID-19 vaccination.

Purpose: The aim of this study was to present a case of severe visual loss due to retinal arteriovenous occlusion and papillitis in one eye following vaccination against coronavirus disease (COVID-19). Methods: A 45-year-old man undergoing treatment for hypertension had severely reduced visual acuity in the right eye 1 day after receiving a third dose of a COVID-19 vaccine manufactured by Moderna. Clinical examination showed that the best-corrected visual acuity in the right eye was counting fingers. Other findings included circumferential retinal hemorrhage, perimacular ischemic color, severe macular edema, and severe optic disc swelling, indicating the presence of central retinal vein occlusion, incomplete central retinal artery occlusion, and papillitis. Based on the possibility of post-vaccination inflammation and/or abnormal immune response, three courses of steroid pulse therapy were administered, and the visual acuity slightly improved to 20/1,000. Results: Three months after the onset of symptoms, macular edema disappeared; conversely, retinal thinning of the macula and extensive non-perfusion areas mainly on the nasal side were noted. Conclusion: The findings in this case suggest that inflammation and abnormal immune response after receiving a COVID-19 vaccination may lead to combined retinal arteriovenous occlusion and papillitis.

Bilateral simultaneous endophthalmitis after immediately sequential bilateral cataract surgery.

Purpose: Immediately sequential bilateral cataract surgery (ISBCS) has recently been considered effective due to faster visual rehabilitation and further improvements in quality of life. We report on the treatment course of a case of early postoperative endophthalmitis in both eyes after ISBCS. Observations: The patient was a 75-year-old woman undergoing anticancer treatment for lung cancer, who had been receiving eye drops for bilateral uveitis and secondary glaucoma since 2019. She underwent ISBCS at another hospital in 2022. In that surgery, the same instruments were used for the surgery of both eyes, without resterilization between eyes. On the night of the following day, she became aware of vision loss in both eyes, and at the examination the next day, hypopyon and corneal edema were found and she was diagnosed with bilateral postoperative endophthalmitis, and referred to our hospital. On the same day, anterior chamber irrigation, posterior capsulotomy, and vitrectomy were performed on both eyes, and the intraocular lenses were preserved. There was no recurrence of postoperative inflammation, and visual acuity was 20/30 in both eyes 6 months after vitrectomy. Conclusion: ISBCS is recommended to be performed with complete aseptic separation of the patient's two procedures. This important rule was not followed in this case. ISBCS should be performed in accordance with accepted protocols, such as those of the International Society of Bilateral Cataract Surgeons, the Royal College of Ophthalmologists, and the Canadian Ophthalmological Society.

A case of intraocular inflammation after intravitreal brolucizumab injection monitored by laser flare-cell photometer.

Purpose: To report the efficacy of combination therapy using intravitreal injection of brolucizumab (IVbr) and sub-Tenon's injection of triamcinolone acetonide (STTA) and of monitoring with a laser flare-cell photometer (LFP) in a case of polypoidal choroidal vasculopathy (PCV) with intraocular inflammation (IOI). Observations: A 72-year-old Japanese woman with PCV had her treatment switched to IVbr due to being refractory to aflibercept. Two weeks after starting IVbr, her visual acuity (VA) declined to 0.40 from 0.10 logarithm of the minimum angle of resolution (logMAR) VA at baseline. In addition, the LFP flare increased to 51.2 photon count/ms (pc/ms) compared with the baseline of 16.1 pc/ms. We diagnosed her with the onset of IOI and immediately started treatment with sub-Tenon's injection of 20 mg triamcinolone acetonide (STTA). Two weeks after receiving STTA, her VA had recovered to 0.15 logMAR, and the LFP flare had decreased to 17.9 pc/ms with dry macula. Eight weeks after the first IVbr treatment, the logMAR VA had improved to -0.18 with achievement of dry macula and stabilization of the LFP flare at 12.2 pc/ms. We administered combined therapy using IVbr and STTA to our patient, and 12 weeks later, the logMAR VA remained at 0.00 with dry macula and 18.1 pc/ms for LFP flare. We continued combination therapy, and after 8 months, her logMAR VA remained at -0.08, and optical coherence tomography showed dry macula, while the LFP flare had stabilized at 16.6 pc/ms. Conclusions and Importance: Combination therapy of IVbr and STTA stabilized IOI and achieved dry macula. The LFP flare score clearly showed the degree of and changes in inflammation.