Aims/Purpose: Parainfectious optic neuritis appears between one and 3 weeks after the onset of an infectious episode of viral or more rarely, bacterial aetiology. Hereby we present a case of ...bilateral optic disc edema presented during the course of a chlamydia trachomatis prostatitis, which spontaneously resolved after treatment.
Methods: A 32‐year‐old patient who, in a context of a 10 days evolution prostatitis, suffers from a loss on the lower visual field in the right eye (OD) associated with cervical pain, fever and malaise. Ophthalmologic examination reveals bilateral optic disc oedema, and complementary tests show an elevation of C‐reactive protein up to 104 mg/L, visual evoked potentials with increased latency (more in OD) and the incidental finding of bilateral papillary drusen evidenced on computerized axial tomography.
Results: The detection of chlamydia trachomatis DNA in a semen sample leads to an adjustment of antibiotic treatment. A month later, after fully healing of the prostatitis, the resolution of the papillary oedema in both eyes was observed with persistence of a pseudoedema typical of papillary drusen, as well as an improvement of the visual field whose residual affectation is reduced to arciform defects consistent too with the described drusen.
Conclusions: This case has the peculiarity of presenting an optic disc oedema superimposed on a pseudoedema by papillary drusen. Although choroiditis has been described as a rare ophthalmic manifestation of systemic chlamydia trachomatis infection, there is no previous literature describing optic neuritis. In our patient, the proposed pathogenic mechanism is a parainfectious autoimmune reaction whose prognosis is excellent.
References
1. Chronic Ocular Chlamydia Trachomatis Infection in Rabbits. Boiko et al, 2014.
2. Inflammatory Optic Neuritis. Ayuso et al, 2009.
3. Optic Disc Drusen: a Systematic Review. Allegrini et al, 2020.
Aims/Purpose: To present a case of exogenous endophthalmitis caused by Citrobacter Koseri.
Methods: We present a 66‐year‐old man that works in an animal laboratory exercising their care, who came to ...the emergency department due to sudden loss of vision in his left eye. Using indirect ophthalmoscopy, we observed a dense hemovitreous that prevented visualization of the posterior structures. An ocular ultrasound was performed in which suggestive signs of retinal detachment are intuited, so we decided to perform an exploratory vitrectomy. During exploratory vitrectomy via pars plana, a dense fibrinoid vitreous was observed, with a tear at XIIh of more than 1 h in diameter. The vitrectomy was completed successfully after suturing the sclerotomies.
Results: The postoperative period evolved adequately, but 3 days later, the patient presented to the emergency room with pain and severe ocular inflammation. On physical examination, he presented intense conjunctival hyperemia, signs of corneal melting, and increased ocular tone. Endophthalmitis was diagnosed and treatment was started with reinforced intravitreal and eye drops antibiotics and anti‐inflammatories. 24 h later, the patient went back with an extrusion of the lens that was sent to microbiological study. On physical examination, we observed corneal melting that produced complete corneal perforation with extrusion of purulent and vitreous material and an urgent evisceration was performed. Two days later, the microbiological samples confirmed the Citrobacter Koseri microorganism.
Conclusions: Cases of exogenous endophthalmitis caused by Citrobacter are limited in the literature. In this case, exposed suture material and the epidemiological history of the patient were suspected as the source of infection. Despite early diagnosis and intensive treatment, the clinical course of Citrobacter endophthalmitis is very aggressive and has a poor visual prognosis. In our case it ended with evisceration.
Third surgery of Ahmed valve tube exposure: A case report Fabra, Yolanda Cifre; Prades, Gemma Ortega; Parot, Álvaro Andrés Ojeda ...
Acta ophthalmologica,
January 2024, 2024-01-00, 20240101, Letnik:
102, Številka:
S279
Journal Article
Recenzirano
Odprti dostop
Aims/Purpose: Exposure of the glaucoma drainage devices tube is one of the main postsurgical complications, and it is important not to delay treatment in order to avoid serious situations such as ...endophthalmitis. Our aim is to report a case of a patient with an Ahmed valve tube exposure who had undergone two previous surgeries unsuccessfully.
Methods: We present the case of a 71‐year‐old male patient with diabetic retinopathy with an Ahmed valve in his left eye for 4 years due to neovascular glaucoma. In the first surgery the tube was positioned in the posterior chamber. After two months, displacement of the tube was observed so it was repositioned in anterior chamber with apposition of Ologen® on temporal, superior sclera. Three years later, exposure of the valve tube was seen and it was covered with Tutopatch® and conjunctiva. Recently, on examination, exposure of the valve tube was observed once again. We removed the epithelial cells from the scleral bed with absolute alcohol, after that we revitalized the conjunctival borders of the wound and covered the tube with fascia lata. Finally, we sutured the conjunctiva without tension.
Results: At the moment, the tube remains covered and the superior temporal conjunctiva has a good appearance.
Conclusions: Different repair techniques are described in the bibliography, such as conjunctiva covering, grafting of different materials, repositioning of the tube with grafting, valve removal and implantation in a different quadrant and even definitive removal of the valve. In our case we used a fascia lata graft, which is associated with a lower risk of subsequent exposure. The previous preparation of the scleral bed and the edges of the conjunctiva, as well as a conjunctival suture free of tension and traction are key to obtaining a good result.
Visual impairment is common in people living with dementia and regular ophthalmological exams may improve their quality of life. We evaluated visual function in a cohort of elderly individuals and ...analyzed its association with their degree of cognitive impairment. Participants underwent neurological and neuropsychological exams, neuro-ophthalmological assessment (visual acuity, intraocular pressure, rates of past ophthalmological pathologies, use of ocular correction, treatments and surgeries) and optical coherence tomography (OCT) scan. We analyzed differences in ophthalmological characteristics among diagnostic groups. The final sample of 1746 study participants aged ≥ 50 comprised 229 individuals with Subjective Cognitive Decline (SCD), 695 with mild cognitive impairment (MCI) and 833 with Dementia (Alzheimer disease: n = 660; vascular dementia: n = 92, Lewy body dementia: n = 34; frontotemporal dementia: n = 19 and other: n = 28). Age, gender and education were used as covariates. Patients with Dementia, compared to those with SCD and MCI, presented worse visual acuity (p < 0.001), used less visual correction (p = 0.02 and p < 0.001, respectively) and fewer ophthalmological treatments (p = 0.004 and p < 0.001, respectively) and underwent fewer ocular surgeries (p = 0.009 and p < 0.001, respectively). OCT image quality worsened in parallel to cognitive decline (Dementia vs SCD: p = 0.008; Dementia vs MCI: p < 0.001). No group differences in past ophthalmological disorders or abnormal OCT findings were detected. Efforts should be made to ensure dementia patients undergo regular ophthalmological assessments to correct their visual function in order to improve their quality of life.
Aims/Purpose: To describe a case of cataract and acute pseudo‐exfoliative glaucoma in which combined surgery with a Preserflo implant was performed and required a conjunctival graft to cover the ...device due to the friability of the conjunctiva.
Methods: A 72‐year‐old male with glaucoma in the left eye (LE) with triple hypotensive treatment, who lost follow‐up due to the pandemic, goes to the emergencies for loss of vision in the LE. A medium dilation, pseudo‐exfoliation and white hypermature cataract can be seen. The intraocular pressure (IOP) is 45 mmHg and does not revert to adequate values with topical and systemic maximum hypotensive treatment. A temporary access cataract surgery is performed without complications. The glaucoma procedure is then performed using the Preserflo implant in the upper nasal area, but the suture produced buttonholes and tears in the conjunctiva that forced us to perform an autologous graft of inferior temporal conjunctiva to cover the implant and ensure a tight closure of the flap.
Results: The evolution of AV was favourable. IOP decreased to 10 mmHg and initially at biomicroscopy and Anterior segment optical coherence tomography (AS‐OCT) revealed a diffuse, functioning blister that progressively flattened. The graft was well adhered and positioned. The sclera of the donor area healed by secondary intention. At the 3‐month review, the device was vacuum packed and it was necessary to reintroduce hypotensive eye drops.
Conclusions: The Preserflo implant may be less traumatic than other filtering surgeries. The time with hypotensive eye drops contributes to the friability of the conjunctiva and makes us cover the device with an autograft to complete the surgery initially successfully. Although the chronic conjunctival damage may promote fibrosis, disrupt filtration, and require new hypotensive treatment.
References
1. Gambini G, Carlà MM, Giannuzzi F, Caporossi T, De Vico U, Savastano A, Baldascino A, Rizzo C, Kilian R, Caporossi A, Rizzo S. PreserFlo Microshunt: An Overview of This Minimally Invasive Device for Open‐Angle Glaucoma. Vision (Basel). 2022 Feb 9;6 (1):12.
Neuropsychiatric symptoms (NPS) have been recently addressed as risk factors of conversion to Alzheimer's disease (AD) and other dementia types in patients diagnosed with Mild Cognitive Impairment ...(MCI). Our aim was to determine profiles based on the prominent NPS in MCI patients and to explore the predictive value of these profiles on conversion to specific types of dementia. A total of 2137 MCI patients monitored in a memory clinic were included in the study. Four NPS profiles emerged (classes), which were defined by preeminent symptoms: Irritability, Apathy, Anxiety/Depression and Asymptomatic. Irritability and Apathy were predictors of conversion to dementia (HR = 1.43 and 1.56, respectively). Anxiety/depression class showed no risk effect of conversion when compared to Asymptomatic class. Irritability class appeared as the most discriminant neuropsychiatric condition to identify non-AD converters (i.e., frontotemporal dementia, vascular dementia, Parkinson's disease and dementia with Lewy Bodies). The findings revealed that consistent subgroups of MCI patients could be identified among comorbid basal NPS. The preeminent NPS showed to behave differentially on conversion to dementia, beyond AD. Therefore, NPS should be used as early diagnosis facilitators, and should also guide clinicians to detect patients with different illness trajectories in the progression of MCI.
Orbital sarcoidosis. Case report Martínez, Julia Pérez; Prades, Gemma Ortega; García, Amparo Lanuza ...
Acta ophthalmologica (Oxford, England),
December 2022, 2022-12-00, 20221201, Letnik:
100, Številka:
S275
Journal Article
Recenzirano
Purpose: Sarcoidosis is an autoimmune granulomatous disease that can affect any organ system in the body. Orbital manifestations are relatively uncommon. We present the clinical features and ...management in a case report with orbital sarcoidosis.
Methods: This case report study a 51 year‐old female patient being investigated for headache, blurred vision and diplopia of 7 days onset. She had proptosis of the left eye, diplopia and complete ophthalmoparesis on supraversion and abduction and partial on adduction. The magnetic resonance showed probable orbital inflammation (inflammatory pseudotumor)/Tolosa Hunt syndrome with predominant involvement of the left superior rectus muscle, cavernous sinus, and pachymeninges. Chest X‐ray showed no pathological findings and laboratory tests, thyroid profile, serology, IgG subclasses, angiotensin converting enzyme and autoantibodies were negative. The computed tomography (CT) showed pulmonary lesions compatible with stage III sarcoidosis. After the results of the imaging tests, it was decided to start treatment with a bolus of methylprednisolone for 5 days and then oral prednisone was started with clear clinical and radiological improvement. The mediastinal lymph node biopsy could not be performed due to the decrease in its size.
Results: The patient was treated with decreasing doses of corticosteroids until the disappearance of the orbital and pulmonary radiological symptoms. It has been followed for 2 years without recurrence.
Conclusions: The presentation of sarcoidosis simulating a pseudotumor is uncommon. Despite this, we must take it into account in the differential diagnosis. In our case, the presentation of CT showing a pulmonary lesion compatible with sarcoidosis and the improvement with corticoid treatment made us reinforce the suspicion of a diagnosis of sarcoidosis. In any case, the definitive diagnosis of this pathology is biopsy and pathological analysis.
Late T‐Flux extrusion: A series of 5 cases Parot, Álvaro Andrés Ojeda; Fabra, Yolanda Cifre; Prades, Gemma Ortega ...
Acta ophthalmologica,
January 2024, 2024-01-00, 20240101, Letnik:
102, Številka:
S279
Journal Article
Recenzirano
Odprti dostop
Aims/Purpose: To Report T‐Flux® implant (Zeiss, La Rochelle, France) extrusion, as a new complication of non‐penetrating deep sclerectomy (NPDS). Analyse the risk factors that lead to it. Describe ...the treatment realized, and its complications.
Methods: 5 eyes of 5 patients who had undergone NPDS Surgery and presented a late T‐Flux® extrusion were included in this study. We made an epidemiological description of the cases. The treatment consisted in surgical exploration, extraction of the T‐Flux® and closure of the scleral and conjunctival defect. In 1 patient reopening of the scleral flap was needed to access and extract the implant. In the postoperative, values of intraocular pressure (IOP) and complications were evaluated.
Results: Of the 5 patients, 2 were man and 3 were female, the mean age was 78 years old, the mean time from the implantation until the extrusion was 11 years and 7 months. Mitomycin C was applied intraoperative during the NPDS in all cases, the concentration used was 0.02%, and the application time 1 min. 4 of the patients were operated by the same surgeon, one of the cases was re intervened later with trabeculectomy. All cases presented a partial or total dissolution of the scleral flap. There was no significant variation on the IOP prior and after surgery, The mean IOP at the diagnosis was 14 mmHg, and the mean IOP postoperative was 13.4. One patient had post surgical seidel that resolved without the need of re intervention.
Conclusions: Extrusion T‐Flux® implant is a late postoperative complication of NPDS, unknown up to date, that may occur many years after the original intervention. Treatment consists in surgical extraction and repair. In our experience this complication might be related to mitomycin C use, given that all of our eyes presented a scleral flap necrosis. There is a need of more reports on this complication, to approach its real incidence and predisposing factors.
Aims/Purpose: Study the evolution of the morphology of filtering blebs through AS‐OCT, one, three and six months after Preserflo implant and its correlation with IOP.
Methods: Prospective ...observational study of 16 eyes with cataract and glaucoma, poorly controlled with maximum medical treatment and mean IOP of 23.6 mmHg, which underwent combined surgery with Preserflo and 0.04% MMC. The patients underwent measurement of IOP and AS‐OCT of conjunctival bleb one, three and six months after surgery. Bleb morphology is classified following the Leanzhofer classification as uniform or multiform (multilayer and/or multicystic). The presence of an episcleral aqueous lake in the distal part of the device is also studied.
Results: Of the 16 patients studied, all completed the quarterly check‐up and 9 the six‐monthly check‐up. Of the total number of patients, 9 presented multiform multilayered bleb and 7 multiform multilayered with superficial cysts in the 1st and 3rd month. Of the 9 who completed the study up to the 6th month, 4 maintained their multilayered morphology, and of the remaining 5, who both in the 1st and 3rd month presented a multilayered morphology with superficial cysts, we observed a slight flattening of the bleb. The mean IOP in the 1st month was 12.5 mmHg, 12.6 in the 3rd month and 13.4 in the 6th month. Episcleral lake was observed in 9 cases, which remained present throughout the study.
Conclusions: SA‐OCT is useful for monitoring conjunctival blebs after Preserflo implantation. Despite the slight thinning after the sixth month of the multiform multilayered blebs with superficial cysts, IOP remains stable. Therefore, the presence of multiform blebs and a maintained episcleral lake seem to be related to good hypotensive control.
References
1. Lenzhofer M, Strohmaier C, Hohensinn M, Hitzl W, Sperl P, Gerner M, Steiner V, Moussa S, Krall E, Reitsamer HA. Longitudinal bleb morphology in anterior segment OCT after minimally invasive transscleral ab interno Glaucoma Gel Microstent implantation. Acta Ophthalmol 2019 Mar; 97(2): e231‐e237.
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