RESUMO
Postpartum patients rarely present to eye casualty. Here we report a case of a seven-day postpartum patient with sudden onset horizontal diplopia and an occipital headache from the perspective of the ophthalmology eye casualty in a tertiary hospital. Intracranial imaging ruled out any acute pathology. The patient required epidural anaesthesia during labour, and a diagnosis of a post-dural puncture headache (PDPH) with an abducens nerve palsy was reached. A blood patch was not provided in this case. The headache settled and the diplopia self-resolved three weeks postpartum. PDPH with extra-ocular muscle paresis is rare, and, as the diplopia onset usually follows the characteristic orthostatic headaches of PDPH, it is likely that these patients are followed up by obstetricians or anaesthetists. These patients rarely present to ophthalmology services to receive this diagnosis, therefore ophthalmologists might not be familiar with this pathology. To our knowledge, this is the first case report of PDPH with cranial nerve palsy that has been documented to present to an ophthalmology department.
RESUMO
BACKGROUND: To study the clinical outcomes of pigment epithelial detachment (PED) associated with neovascular age-related macular degeneration (nAMD) in patients switched from Ranibizumab to Aflibercept. METHODS: Retrospective non-comparative case series. 50 eyes with active nAMD and fovea involving PED of ≥100 µm measured manually using the caliper on the OCT, initially treated with intravitreal Ranibizumab (0.5 mg/0.05 ml) and later switched to Aflibercept (2.0 mg/0.05 ml). The outcome measures of best corrected visual acuity (BCVA), PED height, PED width and number of injections were measured at baseline and at time point of switch, 4 months, 1 year and at last follow up visit post-switch. Three paired t-tests and Pearson's correlations were calculated to analyze variables at switch and change in variables at 1 year. RESULTS: After switch to Aflibercept, the improvement of BCVA was 1.84 (p = 0.11), 1.74 (p = 0.21) and 1.16 (p = 0.45) letters, the change in PED height was - 65.6µm (p < 0.001), - 50.64µm (p = 0.007) and - 68.48µm (p < 0.001) and the change in PED width was - 36.6µm (p = 0.514), + 29.7µm (p = 0.922) and + 118.4µm (p = 0.210) at 4 months, 1 year and the last visit respectively. There was a moderate negative correlation between reduction in PED height at 1 year after switch and PED height at the time of switch to Aflibercept (r = - 0.474, p < 0.05). CONCLUSION: The improvement in BCVA and change in PED width was not statistically significant however the reduction in PED height was significant after switching treatment to Aflibercept. The change in BCVA at 1 year after switch was not correlated with any of the analyzed anatomical characteristics of PED.
