Vision In Eye Research Articles

Multi-organ involvement caused by Scedosporium apiospermum infection after near drowning: a case report and literature review

BackgroundScedosporium apiospermum (S. apiospermum) is a rare fungal pathogen that causes disseminated infections. It rarely affects immunocompetent individuals and has a poor prognosis.Case presentationA 37-year-old woman presented with multiple lesions in the lungs, brain, and eyes, shortly after near drowning in a car accident. The primary symptoms were chest tightness, limb weakness, headache, and poor vision in the left eye. S. apiospermum infection was confirmed by metagenomic next-generation sequencing (mNGS) of intracranial abscess drainage fluid, although intracranial metastases were initially considered. After systemic treatment with voriconazole, her symptoms improved significantly; however, she lost vision in her left eye due to delayed diagnosis.ConclusionWhile S. apiospermum infection is rare, it should be considered even in immunocompetent patients. Prompt diagnosis and treatment are essential. Voriconazole may be an effective treatment option.

Role of Visual Evoked Potential in Direct Traumatic Optic Neuropathy: A Case Report

Traumatic optic neuropathy (TON) is a rare cause of visual impairment following blunt or sharp trauma and the diagnosis is established clinically. Lesions on the optic nerve may not always be visible in neuroimaging examinations. Studies on Visual Evoked Potential (VEP) in TON patients are still limited, despite being beneficial for objectively detecting optic nerve lesions. A 16-year-old male patient was referred to the neurology clinic with a sudden loss of vision in the left eye approximately 25 days after a head injury due to a motor vehicle accident. The patient had epidural bleeding and fractures in the orbital and facial bones, as revealed by a head CT scan. Neurological examination showed a visual acuity of 1/300 in the left eye, left midriasis, and a negative light reflex in the left eye. VEP examination of the left eye revealed prolonged P100 latency and a decrease in P100 amplitude (>50%), indicating a lesion in the left optic nerve. This visual impairment persisted for up to 6 months post-head trauma. TON is a vision-threatening disorder that should be considered in patients with ocular or head trauma and visual impairment. A decrease in amplitude ratio <50% and prolonged P100 latency >140 ms are associated with poor visual function recovery. VEP examination is an objective assessment of visual pathway integrity and serves as one modality for early TON diagnosis and a predictor of visual function prognosis in TON patients. Keywords: diagnostic; prognostic; traumatic optic neuropathy; visual evoked potential

Clinical efficacy of femtosecond laser-assisted phacoemulsification in diabetic cataract patients.

Diabetic patients with cataracts encounter specific difficulties during cataract surgery due to alterations in microcirculation, blood supply, metabolism, and the microenvironment. Traditional phacoemulsification may not fully tackle these issues, especially in instances with substantial preoperative astigmatism. The utilization of femtosecond laser-assisted phacoemulsification, in conjunction with Toric intraocular lens (IOL) implantation, offers a potentially more efficient strategy. This research seeks to evaluate the efficacy and possible complications of this approach in diabetic cataract patients. To investigate the clinical efficacy and complications of femtosecond laser-assisted phacoemulsification combined with Toric IOL implantation in diabetic cataract patients, comparing it with traditional phacoemulsification methods. This retrospective study enrolled 120 patients with diabetes cataract from May 2019 to May 2021. The patients were divided into two groups: the control group underwent traditional phacoemulsification and Toric IOL implantation, while the treatment group received Len Sx femtosecond laser-assisted treatment. Outcome measures included naked eye vision, astigmatism, high-level ocular phase difference detection, clinical efficacy, and complication. There were no significant preoperative differences in astigmatism or naked eyesight between the two groups. However, postoperative improvements were observed in both groups, with the treatment group showing greater enhancements in naked eye vision and astigmatism six months after the procedure. High-level corneal phase difference tests also indicated significant differences in favor of the treatment group. This study suggests that femtosecond laser-assisted phacoemulsification combined with Toric IOL implantation appears to be more effective in enhancing postoperative vision in diabetic cataract patients compared to traditional methods offering valuable insights for clinical practice.

SPONTANEOUS RESOLUTION OF SUBFOVEAL PERFLUOROCARBON: CASE REPORT AND REVIEW OF THE LITERATURE

Purpose: To report a case of spontaneous resolution of subfoveal perfluorocarbon liquid (sPFCL). Methods: A 72-year-old male presented with poor vision in the left eye for two months. Ophthalmic examination revealed a visual acuity of counting fingers at 40 cm, pseudophakia, and rhegmatogenous retinal detachment in the left eye. The patient underwent 23G pars plana vitrectomy associated with a scleral buckle and silicone oil. Postoperatively, a retained sPFCL bubble was observed on OCT image. Results: Postoperatively, the sPFCL bubbles disappeared spontaneously by a full-thickness macular hole. Four weeks after surgery, the macular hole was closed, and visual acuity improved with preservation of foveal depression. Conclusion: Because spontaneous resolution rarely occurs, retinal surgeons prefer early evacuation of sPFCL. Herein, we report a new case of spontaneously resolved sPFCL and discuss the mechanisms for its resolution reported in the literature.

Central Retinal Vein Occlusion in COVID-19

Abstract Central retinal vein occlusion (CRVO) secondary to severe acute respiratory syndrome coronavirus 2–induced coagulation abnormalities is rare. A 32-year-old man presented with bilateral CRVO. He had a history of retinal migraine with occasional floaters and received 2 primary and a booster dose of the BNT162b2 vaccine 7 months prior. Four months before presentation, he developed acute blurring of vision in the left eye and was diagnosed with a nonischemic CRVO with dot-blot hemorrhages. He was managed conservatively with aspirin. Three weeks later, he contracted COVID-19 and received 5 days of nirmatrelvir/ritonavir. Four weeks after his COVID infection, repeat fundoscopic evaluation demonstrated resolving hemorrhages in the left eye but a new CRVO in the right eye. Antivascular endothelial growth factor injections were deferred because of normal visual acuity. He had a normal magnetic resonance imaging of the brain and a normal bilateral carotid duplex and was planned for close follow-up with ophthalmology. COVID-19 patients presenting with visual symptoms should be screened for CRVO.

Choroidal metastasis in a patient with myxoid liposarcoma of the gluteal region – A case report

We describe a rare case of choroidal metastasis from myxoid liposarcoma of the gluteal region in a 62-year-old male patient. Metastasis developed 1.5 years after excision and radiotherapy of primary tumor. He presented with defective vision in the left eye with subretinal elevated mass lesion temporal and inferior to the macula with overlying retinal detachment. Metastatic workup revealed cervical spine and lung metastasis with pleural effusion. Patient was advised palliative chemotherapy and local radiation therapy.

Visual Quality Assessment After FS-LASIK Using Customized Aspheric Ablation Profile for Age-Related Accommodation Deficiency Compensation.

To evaluate clinical outcomes and visual quality 12 months after femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK) performed with the Custom-Q algorithm for correction of myopia with or without astigmatism and compensate for age-related accommodation deficiency. Patients who had Custom-Q FS-LASIK for myopia and myopic astigmatism with age-related accommodation deficiency were included in this retrospective study. Distance, intermediate, and near visual acuities, objective and subjective refractions, Q-factor, corneal higher order aberrations (HOAs), accommodation function, defocus curve, contrast sensitivity, and a subjective questionnaire assessing visual quality were evaluated 12 months postoperatively. Clinical data of 43 cases were analyzed. The mean age was 42.02 ± 1.85 years (range: 40 to 48 years). At the 12-month follow-up visit, there were 43 (100%), 42 (97%), and 33 (77%) patients who achieved a binocular uncorrected distance, intermediate, and near visual acuity, respectively, better than 20/20 separately. Defocus curves revealed better distance vision in the dominant eyes, and the nondominant eyes performed better at intermediate and near vergence (P < .001). The Q-value and corneal spherical aberration coefficient were more positive in the dominant eyes than those in the nondominant eyes (P < .001). The accommodative amplitude and relative accommodation improved binocularly (P < .001). The questionnaire demonstrated high patient satisfaction with near vision, and no one reported having severe visual disturbance. For myopic patients with age-related accommodation deficiency, the Custom-Q algorithm proved to be an effective way to achieve acceptable near vision without compromising distance vision. [J Refract Surg. 2024;40(4):e245-e252.].

The great escape- preserved cilioretinal artery with transient central retinal artery occlusion following snake bite

A 24-year female sustained a snake bite on the lateral side of the left ankle, followed by localized pain and blurring of vision in right eye. Her best corrected visual acuity was 20/20 in the both eyes. Relative afferent pupillary defect was noted in right eye. Fundus examination of right eye showed clear media, normal optic disc and retinal whitening with sparing of small area on macula, temporal to disc with small cilioretinal artery, suggestive of central retinal artery occlusion (CRAO) with presence of cilioretinal artery sparing. Ophthalmic manifestations following a snake bite are uncommon and can arise through diverse mechanism such as hematotoxicity from the snake bite, resulting in CRAO. Although CRAO following snake bite has been reported, we present a very rare case of snake bite induced transient CRAO with presence of spared cilioretinal artery.

Modified tuck in endoimplant: A case report

We describe the successful long-term visual outcome of the modified tuck-in endoimplant in a 56-year-old female patient who presented with defective vision in the left eye for 1 year and was diagnosed with a rare variant of corneal dystrophy with endothelial decompensation. The artificial endothelial layer implantation, optimized with tuck-in haptics, is a novel technology in evolution, showing promising results in patients with corneal endothelial dysfunction.

Choroidal ganglioneuroma- An exceptionally rare choroidal tumor in a child

A 3-year-old male child presented with decreased vision in the right eye. There was an elevated, white mass lesion with heterogeneous lucent areas and focal pigmentation arising from the choroid with irregular margins and subretinal fluid inferiorly. Infective etiologies were ruled out. There was no tumor elsewhere in the body that could have caused a metastasis to the choroid. In view of the non-resolving subretinal fluid and inconclusive diagnosis, the child underwent choroidal biopsy. Histopathology and immunohistochemistry clinched the rare diagnosis of ganglioneuroma of choroid. The child was genetically negative for Neurofibromatosis.

Central retinal vein occlusion with concurrent paracentral acute middle maculopathy secondary to honeybee sting

We report the case of a 45-year-old male who presented with complaints of sudden decreased vision in the right eye (RE) associated with redness and lid swelling. He gave a history of honeybee stings 1 week ago to the right periorbital area. On examination, the patient’s best-corrected visual acuity in RE was 4/60. The anterior segment examination was normal. However, fundus examination and imaging revealed central retinal vein occlusion (CRVO) with paracentral acute middle maculopathy (PAMM) and macular edema. The patient’s routine blood tests were negative for any abnormalities that could have caused the vascular occlusion. The patient was prescribed topical steroids and advised to receive an intravitreal injection of ranibizumab. However, 2 weeks later, the patient returned with improved visual acuity and resolution of macular edema. His transient hypercoagulable state could have been the cause of his ocular symptoms. Few cases of central retinal artery occlusion (CRAO) secondary to bee venom have been reported, but none with CRVO and associated PAMM.

Management of a Rare Case of Full Thickness Penetrated Shrimp Tail in the Cornea – A Case Report

Abstract We report a case about management of penetrated shrimp tail in the cornea. A 32-year-old male, fisherman by profession, presented with redness, watering, and decreased vision in the left eye since 1 day following injury with a shrimp tail. Examination revealed a penetrating corneal foreign body which was identified to be a shrimp tail pointing into the anterior chamber toward the lens in LE. The case was managed surgically by pushing the foreign body with an iris repositor through side-port incision from below, followed by removal of the foreign body with a retina forceps from the corneal surface. Wound closure was done by a single 10-0 nylon suture.

Bilateral dead bag syndrome

Introduction: Posterior capsular rupture (PCR) is defined as breach in the continuity of the posterior part of the capsular bag in the human crystalline lens. Dead bag syndrome (DBS), a term coined by Samuel Masket, is a rare late complication of cataract surgery, which may present with spontaneous posterior capsular tear, causing intraocular lens (IOL) decentration or dislocation. It is usually seen in patients who have undergone an uneventful phacoemulsification with in-the-bag posterior chamber IOL implantation many years ago. Patient and Clinical Findings: A 73-year-old man presented with reduced vision in the right eye 17 years after an uneventful phacoemulsification and in-the-bag posterior chamber IOL implantation. There was no history of trauma to the eye. On examination, a decentered IOL with an inferior PCR was noted. Diagnosis, Intervention, and Outcomes: Decentered IOL was explanted, and a retro-iris–fixated IOL was implanted. Similar findings were noted in the left eye 4 years after the involvement of the right eye. There was no IOL dislocation or decentration. A diagnosis of DBS as the cause of PCR was made. The left eye was managed conservatively, and the patient remains under observation. Conclusions: The case described here seems to correspond to bilateral DBS. Physicians should be alert to look for the possibility of development of a similar complication in the other eye.

Spontaneous expulsive choroidal hemorrhage: A rare ocular catastrophe - A case report

Spontaneous expulsive choroidal hemorrhage is described as a sudden accumulation of blood in the potential space between the choroid and sclera, with the source of the blood being the long or short posterior ciliary arteries. It is observed exclusively in the geriatric population with atherosclerotic vessels associated with hypertension.[4] Massive spontaneous choroidal hemorrhage in the absence of surgery or trauma is an infrequent event, described in isolated case reports, and it results in devastating vision loss.[8] We report a case of a 74-year-old patient with uncontrolled hypertension with a sudden loss of vision in the left eye, later diagnosed as spontaneous expulsive choroidal hemorrhage. The patient was treated conservatively with topical steroids, cycloplegics, antibiotics, antiglaucoma medications, and tight bandages with nil visual prognosis. The patient initially refused surgical management and got discharged against medical advice. However, having been mentally prepared, the patient underwent evisceration at a tertiary eye care center nearby.

Familial Exudative Vitreoretinopathy: A Case Report

Familial Exudative Vitreoretinopathy (FEVR), also known as Chriswick Schepens Syndrome is an inherited condition characterized by failure of vascularization of retinal periphery. This results in variable clinical manifestations such as telangiectasia, hemorrhage, exudation, retinal traction and detachment. Presented herein is a case of a14 year old female who exhibits decrease of vision in right eye since 6 months. Examination shows dragging of disc with tractional band at macula and telangiectatic vessels in temporal retinal periphery. Based on detailed history, clinical examination and investigations, a diagnosis of FEVR is made.

RETINOBLASTOMA IN AN OLDER CHILD: A CASE REPORT

Retinoblastoma is the most common intraocular malignancy of childhood. More than 90% of the patients are under 5-years old. It is uncommon in age above 5 years. In this study we report a case of retinoblastoma in a 9-year-old girl. She presented to our department with decreased vision in left eye noted for 6 days. Vision loss was non-progressive, associated with mild pain. Snellen’s acuity in the affected eye was light perception only. There were no signs of active inflammation in the anterior chamber. Anterior vitreous face demonstrated exuberant vitreous inflammation. A large, elevated, sessile lesion occupying the inferotemporal quadrant was seen just behind the lens with significant adjacent inflammation. Right eye examination was unremarkable. Ultrasound and Magnetic Resonance Imaging demonstrated retinoblastoma with no extra-ocular spread. Enucleation was done and biopsy of ocular tissue and bone marrow trephine biopsy was found normal. We conclude that any suspicious lesion in childhood must be evaluated for retinoblastoma. Even in older child the retinoblastoma may be localized and may have good visual prognosis.

Case Series on Imaging Features of Trilateral and Quadrilateral Retinoblastoma: What Radiologists Need to Know

Objective: To identify the differences between trilateral and quadrilateral retinoblastoma based on radiologic imaging.Case: We found three cases of retinoblastoma at Sanglah General Hospital. The retinoblastoma patients we found were boys under the age of 5. The first patient presented with swelling, pain, and impaired vision in the right eye. The second and third patients presented with eye protrusion and leukocoria. Computed tomography (CT) imaging revealed a calcified mass in the intraorbital region that extended to the cerebral hemispheres. It may be accompanied by hair-on-end periosteal reaction. In the first patient, the mass extended to the pineal gland. In the second and third patients, the mass extended to the suprasellar and pineal regions. Trilateral retinoblastoma consists of a primordial midline neuroectodermal tumor that originates in the pineal or suprasellar region. It is an uncommon combination of unilateral or bilateral retinoblastomas. Quadrilateral retinoblastoma, on the other hand, presents with bilateral retinoblastoma and tumors in both the suprasellar and pineal regions. The histopathology of trilateral and quadrilateral retinoblastoma shows a different pattern from retinoblastoma.Conclusion: Retinoblastoma poses one of the most challenging problems due to its distinct patterns of growth, extension, and recurrence. Intracranial metastasis of trilateral and quadrilateral retinoblastoma exhibits a different pattern. The prognosis and diagnosis of retinoblastoma are significantly influenced by clinical examination, radiologic imaging, and histopathology.

Influence of corneal astigmatism on near and far vision in eyes with bifocal intraocular lenses.

Here, we present a full wave propagation model that quantitatively assesses the effect of astigmatism on visual functions in eyes with diffractive bifocal IOLs. The proposed model with bifocal IOLs evaluated the image quality of each focus at varying degrees of corneal astigmatism with the metrics of modulation transfer function and light-in-the-bucket. The results show that corneal astigmatism alters the distance-near image quality balance. Positive (negative) astigmatism has more detrimental effects on far (near) vision. Additionally, bifocal IOLs are more vulnerable to corneal astigmatism, highlighting the need to consider multifocal toric IOLs with astigmatism greater than 1.0 D. The numerical results closely agreed with previous relevant clinical findings, suggesting the clinical usability of the presented method in predicting the postoperative visual function of patients.

A Case of Posner-Schlossman Syndrome following after Strabismus Surgery

Purpose: To report one case of Posner-Schlossman syndrome following after strabismus surgery.Case summary: A 21-year-old male patient with a previous history of scleral buckling due to rhegmatogenous retinal detachment in right eye, underwent left lateral rectus muscle recession and medial rectus muscle resection surgery for the intermittent exotropia. He complained of blurred vision and pain in the left eye starting from the day after the surgery. When he visited the clinic on the fourth day post-surgery, his best corrected visual acuity was 20/50 and intraocular pressure was 44 mmHg in the left eye. Slit lamp examination revealed corneal edema, 2+ anterior chamber cells, deep anterior chamber, and an open angle in the left eye. After treatment with antiglaucoma eyedrops and steroid eyedrops, the intraocular pressure decreased to 13 mmHg. There were no signs of recurrence during the two-month follow-up period.Conclusions: Posner-Schlossmann syndrome, which occurs after strabismus surgery, must be diagnosed early and treated immediately.

Lutein in chronic diseases: A mini review

Lutein is a xanthophyll carotenoid that can be found in a divergency of fruits and plants. Its main action is to protect eye health and vision. Its antioxidant properties play a crucial role in eye agitations, in decreasing inflammation, in protecting the neural tissues from chemical analyzed hypoxia and cell apoptosis. Lutein supplementation in associa- tion with low-calorie diet had a notable abatement in fat-free mass, visceral fat and serum levels of total cholesterol and LDL (low-density lipoprotein)-cholesterol. Lutein may also have a natural anti-cancer effect. This is because foods rich in lutein have antioxidant activity and oppose inflammation and oxidative stress. The aim of this mini-review was to provide an up-to-date overview of the main effects of lutein in health and disease.