Bockstrauss8769
To describe a potential case of pentosan polysulfate maculopathy that appeared to manifest nearly three years after drug cessation.
Complete ophthalmic examination including multimodal fundus imaging, electroretinography, automated perimetry, and molecular testing were performed.
A 44-year-old female with a 435g cumulative exposure to pentosan polysulfate sodium presented 38-months after drug cessation with six months of worsening metamorphopsia and prolonged dark adaptation. Fundus exam and multimodal fundus imaging demonstrated characteristic features of pentosan polysulfate maculopathy, and molecular testing was unremarkable. In contrast, color fundus photos of the same patient acquired at an outside facility 25 months prior did not display features consistent with PPS maculopathy.
This case suggests that new onset clinically detectable pentosan polysulfate maculopathy may develop years after drug cessation. If corroborated, this finding has important ramifications for PPS dosing and surveillance guidelines.
This case suggests that new onset clinically detectable pentosan polysulfate maculopathy may develop years after drug cessation. If corroborated, this finding has important ramifications for PPS dosing and surveillance guidelines.
To describe a patient with a choroidal osteoma treated with PDT to prevent tumor growth in whom choroidal neovascularization (CNV) developed after being treated with PDT.
Case report.
A 5-year-old Hispanic female presented with an asymptomatic choroidal osteoma, temporal to the macula of her right eye. According to the patient's mother, her medical, surgical and family history was unremarkable. At examination, best corrected visual acuity was 20/30 in both eyes. After 11 months of follow-up, signs of tumor growth toward the fovea without any signs of CNV was noted. PDT was performed in order to prevent invasion of the foveola. Two months thereafter, the patient developed CNV in the macula region in the right eye, decreasing visual acuity to 20/200. The patient was treated with four total intravitreal injections of 1.25 mg of bevacizumab over 24 weeks, which resulted in inactivation of the CNV and improved visual acuity to 20/20. CNV had been never reported in her past history as well as her follow up visits over seven years. Deoxycytidine In addition, no evidence of recurrent neovascular activity or tumor growth was reported.
Choroidal osteoma is a benign tumor that can result in vision-threatening complications, caused by tumor growth and tumor decalcification. PDT is an effective modality in inducing choroidal osteoma decalcification and stabilization; however, CNV due to reperfusion following PDT can be seen in the retina.
Choroidal osteoma is a benign tumor that can result in vision-threatening complications, caused by tumor growth and tumor decalcification. PDT is an effective modality in inducing choroidal osteoma decalcification and stabilization; however, CNV due to reperfusion following PDT can be seen in the retina.
To report a case of bilateral sequential, CRVO in a man with newly diagnosed hemoglobin C trait.
A 67-year-old man presented with a one-month history of declining visual acuity. He was diagnosed with left CRVO. Bilateral temporal retinal ischemia and arteriovenous anastomoses on fluorescein angiography suggestive of sickle cell retinopathy prompted a systemic work-up. Hemoglobin electrophoresis revealed an underlying hemoglobin C trait. Six-months after his initial presentation, the patient developed symptomatic right CRVO.
The initial left CRVO was complicated by optic disc swelling and macular edema. Intravitreal anti-angiogenic therapy was initiated and the macular edema resolved. The left eye subsequently developed an epiretinal membrane which was surgically removed. Macular edema in the right eye also resolved after intravitreal anti-angiogenic therapy.
This is the first reported case of bilateral CRVO in a case of hemoglobin C trait. It is possible that erythrocyte inflexibility, caused by hemoglobin C induced dehydration and crystallization, acted concomitantly with hypertension to produce occlusive microangiopathy. This case highlights the need for further investigation in patients presenting with central retinal vein occlusion, especially when bilateral, or when retinal angiography reveals bilateral pathology.
This is the first reported case of bilateral CRVO in a case of hemoglobin C trait. It is possible that erythrocyte inflexibility, caused by hemoglobin C induced dehydration and crystallization, acted concomitantly with hypertension to produce occlusive microangiopathy. This case highlights the need for further investigation in patients presenting with central retinal vein occlusion, especially when bilateral, or when retinal angiography reveals bilateral pathology.
To describe a case of bilateral cystoid macular edema in a patient with long-standing Tramadol hydrochloride use.
Observational case report.
and discussion A 73-year-old female patient was referred for progressive, bilateral decreased visual acuity. The patient was phakic with a best-corrected visual acuity (BCVA) at presentation was 20/50 on the right eye (RE) and 20/64 on the left eye (LE). The patient had a history of low back pain and had been on Tramadol hydrochloride 200 mg/day for 16 years. Bilateral cystoid macular edema (CME) was confirmed by means of multimodal imaging, including OCT angiography. Tramadol intake was progressively reduced over one month and then completely interrupted. At three months follow-up, the cystoid macular edema had completely resolved and BCVA improved in both eyes.
CME may be associated with longstanding treatment with Tramadol hydrochloride. Tramadol hydrochloride associated CME is described, as well as its resolution on Tramadol cessation.
CME may be associated with longstanding treatment with Tramadol hydrochloride. Tramadol hydrochloride associated CME is described, as well as its resolution on Tramadol cessation.
To report a case of paracentral acute middle maculopathy (PAMM) in an otherwise healthy young, multiparous woman in her second trimester of pregnancy.
Case report RESULTS A 38-year-old woman in her twentieth week of pregnancy presented with a four-day history of an acute paracentral scotoma in her left eye. Fundoscopic examination of the left eye was significant for a white-gray lesion inferonasal to the fovea which corresponded with spectral domain-optical coherence tomography (SD-OCT) hyperreflectivity at the outer plexiform layer-inner nuclear layer junction and optical coherence tomography angiography (OCTA) non-perfusion. A diagnosis of paracentral acute middle maculopathy was made. The patient was sent for a hypercoagulability work-up that revealed elevated factor VIII activity, which has been associated with increased risk of complications during pregnancy.
PAMM in pregnancy may be secondary to an underlying hypercoaguable condition. We recommend systemic evaluation and referral to a high-risk pregnancy specialist if PAMM is diagnosed during pregnancy.
