Case Of Maculopathy Research Articles

A case of maculopathy from rush poppers.

A case of maculopathy from rush poppers.

A proposed protocol of intravitreal injection of methotrexate for treatment of primary vitreoretinal lymphoma.

Primary central nervous system lymphoma (PCNSL) is a non-Hodgkin lymphoma involving the brain with possible leptomeningeal and ocular involvement. This study aimed to evaluate the safety and efficacy of modified intravitreal injection regimen of methotrexate (MTX) for therapeutic management of vitreoretinal lymphoma. Forty human immunodeficiency virus (HIV)-negative Chinese patients with primary vitreoretinal lymphoma were included in this retrospective noncomparative interventional case series study. Patients were treated with a modified protocol of intravitreal injection of MTX (400 µg/0.1 ml) according to the Intensive-Consolidation-Maintenance regimen. The Intensive phase of once-weekly intravitreal injections for 1 month, followed by the Consolidation phase of one injection every 2 weeks for 1 month, and then the Maintenance phase of once monthly for 1 month, for a total of 7 injections. The primary main outcome measures were clinical response to intravitreal chemotherapy, number of injections for clinical remission, progression-free survival (PFS), overall survival (OS), visual acuity (VA), complications during the study period, and cause of death were investigated. The duration of follow-up from the commencement of injection of MTX was 12-73 months (median 28, 30.55 ± 14.73 months). A total of 61 eyes of 40 patients were cleared clinically from malignant cells after a median 6.57 ± 3.12 (median 6, range 1-14) times of injection of MTX. A second remission was induced in 3 patients, who were treated with a further course of intravitreal chemotherapy after tumour recurred in their eyes. The median PFS and OS were 20.82 months (95% CI 14.64-27.01) and 29.29 months (95% CI 16.16-42.41), respectively. Complications that occurred during the period of treatment and follow-up included corneal epitheliopathy (3 of 61 eyes) and cataract (6 of 61 eyes). There were no cases of maculopathy, vitreous haemorrhage, optic atrophy, and sterile endophthalmitis. No patient had an irreversible loss of vision that could be attributed to the intravitreal injection of MTX. It can be concluded that the modified intravitreal injection regimen of MTX is an effective therapeutic approach in inducing clinical remission of intraocular involvement in PCNSL patients, associated with few complications. However, further study needs to be conducted to indicate whether the proposed approach extends life expectancy. Primary central nervous system lymphoma (PCNSL) can involve the vitreous and retina and is associated with a poor clinical outcome, with a survival rate of less than 3 months in absence of undergoing an effective therapeutic strategy. Methotrexate (MTX) is the most efficient cytotoxic drug for patients with vitreoretinal involvement in primary vitreoretinal lymphoma (PVRL), through intravitreal injection of MTX. In our experience, the modified protocol of intravitreal MTX according to the Intensive-Consolidation-Maintenance regimen, was effective in inducing clinical remission of PVRL with few complications. The accumulating clinical results brought us to propose the consideration of this protocol as a good first-line treatment option for PVRL.

Maculopathy Associated With Osmotic Blood- Brain Barrier Disruption and Chemotherapy in Patients With Primary CNS Lymphoma.

To describe the incidence, characteristics, and risk factors of a pigmentary maculopathy in patients with primary central nervous system (CNS) lymphoma treated with blood-brain barrier disruption (BBBD) therapy. This retrospective chart review included patients with biopsy-proven primary CNS lymphoma treated with or without BBBD therapy who underwent an ophthalmic examination after starting systemic treatment. Clinical data and all available retinal imaging were analyzed. Fifty-eight patients met inclusion criteria. Twenty-one of 36 patients treated with BBBD therapy had a bilateral pigmentary maculopathy. None of the 22 patients treated with conventional chemotherapy had similar changes. Additional findings in patients treated with BBBD included geographic retinal pigment epithelium atrophy, subretinal fluid, and in one case, choroidal neovascularization. Some cases of maculopathy resulted in reduced visual acuity. The presence of a pigmentary maculopathy was associated with a higher number of BBBD treatment sessions (20.1 vs 13.3, P = .016), but not vitreoretinal lymphoma involvement or intravitreal methotrexate injections. In this cohort, 58.3% of patients with primary CNS lymphoma treated with BBBD and chemotherapy were found to have a bilateral pigmentary maculopathy. This maculopathy can result in reduced visual acuity and is associated with the number of BBBD treatment sessions. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:S5-S12.].

The role of fundus fluorescein angiography in classification and diagnosis of macular diseases: A hospital-based study

AIMS AND OBJECTIVES: The aims and objectives of this study is to assess the role of fundus fluorescein angiography (FFA) in classification and diagnosis of macular diseases. SETTING AND DESIGN: This was an 1-year hospital-based study conducted at KLES, Dr. Prabhakar Kore Hospital, Belagavi, Karnataka. METHODOLOGY: The present study was conducted in the Department of Ophthalmology, KLES, Dr. Prabhakar Kore Hospital and Medical Research Centre, Belagavi, on 66 participants from January 1st, 2016 to December 31st, 2016. METHODS: An 1-year hospital-based study was conducted on 66 patients who attended the outpatient department. A detailed history was obtained from all the patients and a thorough ocular and systemic examination were done. All the patients were examined by conventional methods of ophthalmoscopy (direct, indirect, and slit lamp examination with +90 D lens) followed by FFA. The clinical ophthalmoscopy and fluorescein angiography findings were analyzed and categorized. RESULTS: Sixty-six participants were analyzed and sub-divided into categories of age-related macular degeneration (ARMD), diabetic maculopathy, vascular occlusive disorders, Central Serous Chorioretinopathy (CSCR), inflammatory causes, macular dystrophy, and macular hole. FFA confirmed the diagnosis in 62% of the cases and altered the diagnosis in 38% of cases. It also classified the lesions in 64% of cases. CONCLUSION: FFA has played a major role in diagnosing wet ARMD. It was of immense value in diagnosis and classification of diabetic maculopathy cases. It is a superior diagnostic modality in differentiating macular edema from macular ischemia in vascular disorders. It provides definitive diagnosis in CSCR by detecting the exact site of leakage. It is of immense value in the diagnosis of macular edema in inflammatory diseases. FFA played an important role in the diagnosis of macular dystrophy and macular hole cases.

A Case of Bilateral Maculopathy Caused by High-Voltage-Induced Spark Injury

Purpose: To report a case of maculopathy after exposure to a high-voltage spark. Case summary: A 40-year-old male patient visited our clinic complaining of visual disturbance in both eyes 1 day after exposure to a high voltage arc discharge. His best corrected visual acuity was 4/20 in both eyes. On fundus examination, a yellowish retinal scar was observed at the foveal area. The spectral domain optical coherence tomography (SD-OCT) showed inner segment/outer segment line disruption. The best corrected visual acuity was 4/20 in both eyes and SD-OCT showed a remaining inner segment/outer segment line disruption after 3 years. Conclusions: Maculopathy can result from exposure to a high voltage arc discharge exposure. J Korean Ophthalmol Soc 2016;57(1):141-144

Development of a cost-effectiveness model for optimisation of the screening interval in diabetic retinopathy screening.

The English NHS Diabetic Eye Screening Programme was established in 2003. Eligible people are invited annually for digital retinal photography screening. Those found to have potentially sight-threatening diabetic retinopathy (STDR) are referred to surveillance clinics or to Hospital Eye Services. To determine whether personalised screening intervals are cost-effective. Risk factors were identified in Gloucestershire, UK using survival modelling. A probabilistic decision hidden (unobserved) Markov model with a misgrading matrix was developed. This informed estimation of lifetime costs and quality-adjusted life-years (QALYs) in patients without STDR. Two personalised risk stratification models were employed: two screening episodes (SEs) (low, medium or high risk) or one SE with clinical information (low, medium-low, medium-high or high risk). The risk factor models were validated in other populations. Gloucestershire, Nottinghamshire, South London and East Anglia (all UK). People with diabetes in Gloucestershire with risk stratification model validation using data from Nottinghamshire, South London and East Anglia. Personalised risk-based algorithm for screening interval; cost-effectiveness of different screening intervals. Data were obtained in Gloucestershire from 12,790 people with diabetes with known risk factors to derive the risk estimation models, from 15,877 people to inform the uptake of screening and from 17,043 people to inform the health-care resource-usage costs. Two stratification models were developed: one using only results from previous screening events and one using previous screening and some commonly available GP data. Both models were capable of differentiating groups at low and high risk of development of STDR. The rate of progression to STDR was 5 per 1000 person-years (PYs) in the lowest decile of risk and 75 per 1000 PYs in the highest decile. In the absence of personalised risk stratification, the most cost-effective screening interval was to screen all patients every 3 years, with a 46% probability of this being cost-effective at a £30,000 per QALY threshold. Using either risk stratification models, screening patients at low risk every 5 years was the most cost-effective option, with a probability of 99-100% at a £30,000 per QALY threshold. For the medium-risk groups screening every 3 years had a probability of 43-48% while screening high-risk groups every 2 years was cost-effective with a probability of 55-59%. The study found that annual screening of all patients for STDR was not cost-effective. Screening this entire cohort every 3 years was most likely to be cost-effective. When personalised intervals are applied, screening those in our low-risk groups every 5 years was found to be cost-effective. Screening high-risk groups every 2 years further improved the cost-effectiveness of the programme. There was considerable uncertainty in the estimated incremental costs and in the incremental QALYs, particularly with regard to implications of an increasing proportion of maculopathy cases receiving intravitreal injection rather than laser treatment. Future work should focus on improving the understanding of risk, validating in further populations and investigating quality issues in imaging and assessment including the potential for automated image grading. Integrated Research Application System project number 118959. The National Institute for Health Research Health Technology Assessment programme.

Évaluation en pratique clinique des nouvelles stratégies de dépistage des maculopathies toxiques au plaquénil, selon les nouvelles recommandations de l’American Academy of Ophthalmology. Étude prospective monocentrique à propos de 184 patients

To compare the results, in clinical practice, of screening procedures for hydoxychloroquine retinopathy, according to the new recommendations of the American Academy of Ophthalmology of 2011. Hundred and eighty-four patients on long-term hydroxychloroquine underwent ophthalmologic evaluation, including fundus examination, 10.2 automated visual field, fundus autofluorescence, SD-OCT optical coherence tomography, and multifocal ERG, whenever possible, in a prospective monocentric study. There was a significant correlation (P<0.05) between cumulative HCQ dose and positive results on SD-OCT and 10.2 visual field. There were no significant correlations between high cumulative HCQ dose and positive results for fundus examination, autofluorescence, or multifocal ERG. Average cumulative doses between the healthy group (946g) and the maculopathy group (1427g) were significantly different (P<0.05). Out of 184 patients, 12 toxic maculopathies were found (prevalence 6.5%). For these 12 cases, 5 were diagnosed at clinical stages, and 7 were diagnosed in the early preclinical stage. Ten patients had positive visual fields, and 8 patients had pathological SD-OCT signs. Autofluorescence was affected in the clinical stage, but not in the preclinical stage. In four out of the twelve cases of maculopathy, patients had pathological ERG results. The significant correlation between cumulative HCQ dose, considered as the main risk factor for maculopathy, and positive SD-OCT and 10.2 visual field results render the combination of these two tests the basis of the screening strategy for plaquenil maculopathy. These results suggest using a simplified screening procedure, including annual SD-OCT and 10.2 visual field while taking the cumulative dose into account. Multifocal ERG seems more helpful for diagnostic confirmation than screening, especially for the preclinical stage. Fundus autofluorescence is not an efficient test for early diagnosis.

A Case of Maculopathy from Handheld Green Laser Pointer

A Case of Maculopathy from Handheld Green Laser Pointer

Maculopathy due to drug inhalation

Case reportA case of maculopathy due to “poppers” is described. DiscussionPoppers is a drug composed of various forms of alkyl nitrite. A 39 year-old man, who had been using poppers for years, was seen in the clinic with phosphenes, reduced visual acuity and central scotoma. The SD-OCT in the right eye showed disruption at the level of the IS/OS junction line. The SD-OCT scan in the left eye showed an outer rectangular retinal hole and an outer retinal cyst.

Handheld Laser Pointer Maybe a Dangerous “Toy”: A Case of Maculopathy from DPSS Red Handheld Laser Pointer

To describe a case of maculopathy induced by a handheld laser pointer in a 12-year-old male patient. He was exposed to handheld DPSS red laser pointer of 100 mW for some second. He was complained of central scotoma. His visual acuity decreased in both eyes. Fundus examination showed a grayish lesion in foveal region. Fluorescein angiogram showed hypofluorescence in the central macula in early phase with late ill-defined leakage. Optical coherence tomography (OCT) revealed the disruption of the retinal epithelium and edema in the foveal area. He was treated with one dose of Triamcinolone aceonide (40 mg) periocular injection in his both eyes combined with oral Chinese patent medicine for one month. Four weeks later, the patient’s visual acuity increased markedly, OCT showed unhealed retinal epithelium disruption. Laser pointer would be a dangerous “toys”, both parents and teachers should pay attention to it.

Maculopatía por drogas de inhalación

Case reportA case of maculopathy due to «poppers» is described. DiscussionPoppers is a drug composed of various forms of alkyl nitrite. A 39 year-old man, who had been using poppers for years, was seen in the clinic with phosphenes, reduced visual acuity and central scotoma. The SD-OCT in the right eye showed disruption at the level of the IS/OS junction line. The SD-OCT scan in the left eye showed an outer rectangular retinal hole and an outer retinal cyst.

Retinoschisis and macular detachment associated with acquired enlarged optic disc cup

We describe a case of maculopathy consisting of macular retinoschisis and serous macular detachment occurring in a patient with an acquired enlarged optic disc cup, similar to the maculopathy observed in congenital optic nerve abnormalities, mainly optic nerve pits and colobomas, without vitreomacular traction nor angiographic leak. Pars plana vitrectomy with argon laser endophotocoagulation and gas tamponade was found to be useful. Traction from membranes covering deep optic disc cups may create small retinal dehiscences, as described in congenital optic nerve abnormalities, which will enable the liquefied vitreous to pass, leading to retinoschisis with or without associated neurosensory detachment. Vitrectomy, photocoagulation, and gas tamponade may be a useful therapy for this entity.

Spectral domain optical coherence tomography of myopic traction maculopathy

Purpose Here we document 2 cases of macular schisis-like appearance in high myopia analyzed with spectral domain optical coherence tomography (SDOCT). Methods In Case 1, a 58-year-old patient with high myopia manifesting a recent onset of decreased vision in the right eye (OD) is presented. In Case 2, a 45-year-old patient with a lifelong history of no light perception and high myopia OD is presented. Results In Case 1, biomicroscopy found a posterior staphyloma associated with subtle retinal thickening in the patient’s right eye. SDOCT confirmed the presence of macular traction associated with a schisis-like appearance. In Case 2, a posterior staphyloma associated with significant macular thickening was observed during biomicroscopy. SDOCT found macular traction and a schisis-like appearance. Conclusions These presentations are consistent with myopic traction maculopathy. Few myopic traction maculopathy cases have been studied with SDOCT. The time domain optical coherence tomography and SDOCT analysis suggests that the etiology of this condition may be secondary to preretinal and extraretinal traction exhibited in degenerative high myopia.

OPERATING MICROSCOPE LIGHT-INDUCED PHOTOTOXIC MACULOPATHY AFTER TRANSSCLERAL SUTURED POSTERIOR CHAMBER INTRAOCULAR LENS IMPLANTATION

The purpose of this study is to report the features of operating microscope light-induced retinal phototoxic maculopathy after transscleral sutured posterior chamber intraocular lens (TSS PC-IOL) implantation. The charts of 118 patients who underwent TSS PC-IOL implantation surgery at Chonbuk National University Hospital (Jeonju, Korea) between March 1999 and February 2008 were retrospectively reviewed. Fourteen patients underwent combined 3-port pars plana vitrectomy and TSS PC-IOL implantation (vitrectomy group), and 104 patients underwent TSS PC-IOL implantation only (nonvitrectomy group). All surgeries were performed under the same coaxial illuminated microscope. All diagnoses were confirmed through careful fundus examination and fluorescein angiography (FA). Diagnoses of retinal phototoxic maculopathy were established in 10 (8.47%) of 118 TSS PC-IOL implantation cases. Phototoxic maculopathy occurred more frequently in the vitrectomy group than in the nonvitrectomy group (6/14 versus 4/104, respectively; P < 0.001, chi-square = 24.21). Affected patients reported decreased vision and were found to have coarse alterations of the retinal pigment epithelium (RPE). In 5 of the phototoxic maculopathy cases (50%), the visual acuity was 20/200 or worse. Operating microscope light-induced retinal phototoxic maculopathy can occur more frequently after TSS PC-IOL implantation than after casual cataract surgery, especially when TSS PC-IOL is combined with vitrectomy surgery. Surgeons should take precautions to prevent retinal phototoxicity after TSS PC-IOL implantation and vitrectomy.

Central retinopathy associated with ciliary body and choroidal melanomas

Various patterns of retinopathy can be responsible for the clinical presentation of uveal melanoma.1 Occasionally a peripheral choroidal or ciliary body melanoma may present with macular pathology.2 We present five...

Fundus Near Infrared Fluorescence Correlates with Fundus Near Infrared Reflectance

To analyze the occurrence of near infrared (NIR) fluorescence in relation to NIR reflectance, blue-light-excited autofluorescence, angiograms, and funduscopy. Observational consecutive case series in patients with macular diseases. Imaging was performed with a confocal scanning laser ophthalmoscope for NIR reflectance, blue-light-excited autofluorescence, NIR fluorescence, and fluorescein and indocyanine green (ICG) angiograms. In cases in which NIR fluorescence was observed, five to nine images were averaged. The leakage of the scanning laser ophthalmoscope was analyzed. In the 291 eyes analyzed, NIR fluorescence was observed in 51 and was graded weak in 27 with wet age-related macular degeneration (AMD, 10 cases), dry AMD with pigment clumping (n=7), chronic central serous choroidopathy (CSC; n=5), choroidal nevi (n=2), subretinal hemorrhages (n=2), and chloroquine maculopathy (n=1). Strong NIR fluorescence was found in 24 eyes, with wet AMD (n=14), subretinal hemorrhages (n=8), and choroidal nevi (n=2). Except for four eyes, we observed a strong correlation of NIR fluorescence and increased NIR reflectance at identical fundus location (92.2%). NIR fluorescence corresponded with increased blue-light-excited autofluorescence in 21 of 31 patients with AMD and in 4 of 5 patients with chronic CSC, but in none of the 4 patients with nevi. Funduscopy showed that structures with NIR fluorescence were pigmented or consisted of degraded blood. Barrier filter leakage of the imaging system was 6.2x10(-6). The high correlation of NIR fluorescence and reflectance indicated that part of the observed NIR fluorescence is pseudofluorescence, whereas gray-scale analysis indicated that both NIR autofluorescence and pseudofluorescence contribute to the NIR fluorescence images. Quantification of leakage of the imaging system indicated a significant part of the observed NIR fluorescence is NIR autofluorescence. As NIR fluorescence derives from pigmented lesions, melanin is a possible source if NIR reflectance is also increased. Comparison with blue-light-excited autofluorescence showed differences between AMD and patients with nevi. NIR autofluorescence was also detected in single cases of maculopathy without corresponding NIR reflectance.

Antioxidant vitamin and mineral supplementation for preventing age-related macular degeneration.

Some observational studies have suggested that people who eat a diet rich in antioxidant vitamins (carotenoids, vitamins C and E) or minerals (selenium and zinc) may be less likely to develop age-related macular degeneration. The aim of this review is to examine the evidence as to whether or not taking vitamin or mineral supplements prevents the development of age-related macular degeneration. We searched the Cochrane Eyes and Vision Group specialised register, the Cochrane Controlled Trials Register - Central, MEDLINE, reference lists of identified reports and the Science Citation Index. We contacted investigators and experts in the field for details of unpublished studies. The most recent searches were conducted in June 1999. All randomised trials comparing an antioxidant vitamin and/or mineral supplement (alone or in combination) to control were included. We included only studies where supplementation had been given for at least one year. Both reviewers independently extracted data and assessed trial quality. Currently there is only one published trial included in the review so no data synthesis was conducted. One trial is included in the review. This was a primary prevention trial in Finnish male smokers with four treatment groups: alpha-tocopherol alone, beta-carotene alone, alpha-tocopherol and beta-carotene, placebo. The add-on maculopathy study was conducted in a subset of the main trial cohort. 269 cases of maculopathy (14 late stage age-related macular degeneration) were identified. There was no association of age-related macular degeneration with treatment. There is no evidence to date that people without age-related macular degeneration should take antioxidant vitamin and mineral supplements to prevent or delay the onset of the disease. The results of five large ongoing trials are awaited.

Pattern and Ganzfeld electroretinograms in macular disease.

The pattern electroretinogram has been found to be abnormal in all except three cases of maculopathy. This is in contrast to other electrophysiological tests, which are frequently unaffected. The degree of reduction is related to the loss of visual acuity. The response to focal flashes is less affected than the response to pattern.