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BACKGROUND/PURPOSE: To report an unusual appearance of severe bilateral serous detachments in a patient with Waldenstrom macroglobulinemia. METHODS: A case report of a Fifty-six-year-old female patient with Waldenstrom macroglobulinemia. RESULTS: A patient with Waldenstrom macroglobulinemia presented with serous retinal detachments at the time of diagnosis with Waldenstrom. The patient's IgM levels remained abnormally elevated in the initial stages of her disease course, leading to dramatic ocular findings and images on optical coherence tomography. Chemotherapy was initiated and IgM levels slowly declined, with some improvement in macular fluid as IgM normalized. CONCLUSION: Waldenstrom macroglobulinemia may lead to dramatic retinal pathology if IgM levels remain elevated. Prompt chemotherapy and reduction of immunoglobulin levels should be undertaken to preserve retinal architecture.
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Angiografía con Fluoresceína/métodos , Retina/patología , Desprendimiento de Retina/etiología , Tomografía de Coherencia Óptica/métodos , Agudeza Visual , Macroglobulinemia de Waldenström/complicaciones , Femenino , Fondo de Ojo , Humanos , Persona de Mediana Edad , Desprendimiento de Retina/diagnósticoRESUMEN
The authors report multimodal imaging including adaptive optics scanning laser ophthalmoscopy (AOSLO) (Apaeros retinal image system AOSLO prototype; Boston Micromachines Corporation, Boston, MA) in a case of previously diagnosed unilateral acute idiopathic maculopathy (UAIM) that demonstrated features of laser pointer maculopathy. The authors also show the adaptive optics images of a laser pointer maculopathy case previously reported. A 15-year-old girl was referred for the evaluation of a maculopathy suspected to be UAIM. The authors reviewed the patient's history and obtained fluorescein angiography, autofluorescence, optical coherence tomography, infrared reflectance, and AOSLO. The time course of disease and clinical examination did not fit with UAIM, but the linear pattern of lesions was suspicious for self-inflicted laser pointer injury. This was confirmed on subsequent questioning of the patient. The presence of linear lesions in the macula that are best highlighted with multimodal imaging techniques should alert the physician to the possibility of laser pointer injury. AOSLO further characterizes photoreceptor damage in this condition. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:782-785.].
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Lesiones Oculares/diagnóstico , Rayos Láser/efectos adversos , Imagen Multimodal/instrumentación , Óptica y Fotónica , Retina/diagnóstico por imagen , Enfermedades de la Retina/diagnóstico , Agudeza Visual , Adolescente , Lesiones Oculares/complicaciones , Lesiones Oculares/fisiopatología , Femenino , Angiografía con Fluoresceína/instrumentación , Fondo de Ojo , Humanos , Oftalmoscopía/métodos , Retina/lesiones , Enfermedades de la Retina/etiología , Enfermedades de la Retina/fisiopatología , Tomografía de Coherencia Óptica/instrumentaciónRESUMEN
MEK inhibitor chemotherapy, used in various malignancies, has been reported to be associated with serous retinal detachments. This study reports serial multimodal imaging focused primarily on infrared reflectance and spectral-domain optical coherence tomography (SD-OCT) in the monitoring of MEK inhibitor retinal toxicity. The benefit of OCT angiography in understanding the pathophysiology of MEK inhibitor toxicity is also shown.
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Protocolos de Quimioterapia Combinada Antineoplásica/toxicidad , MAP Quinasa Quinasa 1/antagonistas & inhibidores , MAP Quinasa Quinasa 2/antagonistas & inhibidores , Imagen Multimodal , Inhibidores de las Quinasa Fosfoinosítidos-3 , Retina/efectos de los fármacos , Desprendimiento de Retina/inducido químicamente , Bencimidazoles/administración & dosificación , Femenino , Angiografía con Fluoresceína , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Imagen Óptica , Neoplasias Ováricas/tratamiento farmacológico , Retina/patología , Desprendimiento de Retina/diagnóstico , Tiazoles/administración & dosificación , Tomografía de Coherencia ÓpticaRESUMEN
PURPOSE: To report two cases where the primary visual complaints were central visual phenomena, with normal fundus biomicroscopy. METHODS: History and clinical examination, fundus autofluorescence, and spectral domain-optical coherence tomography. RESULTS: The authors report 2 patients, a 66-year-old woman and a 77-year-old woman, who complained of a central visual disturbance in one eye. Best-corrected visual acuity was normal. Ophthalmoscopy in the first case was unremarkable and showed minimal retinal pigment epithelial mottling in Case 2. Spectral domain-optical coherence tomography revealed vitreomacular traction with foveal distortion in both eyes, associated with small cysts in the inner retinal layers and in one patient disruption of photoreceptors. CONCLUSION: Central visual phenomena are important clues for central vitreomacular traction, even in the presence of a normal fundus examination. The authors highlight the importance of performing spectral domain-optical coherence tomography evaluation in this setting before considering neurologic or systemic causes.
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Fondo de Ojo , Mácula Lútea/patología , Baja Visión/patología , Desprendimiento del Vítreo/patología , Anciano , Femenino , Humanos , Epitelio Pigmentado de la Retina/patologíaRESUMEN
PURPOSE: To determine the changes in dry eye disease (DED) severity and the percentage of cells expressing HLA-DR on the ocular surface following treatment with lubricant eyedrops containing polyethylene glycol and propylene glycol (PEG/PG) and the gelling agent hydroxypropyl guar (HP-Guar). PATIENTS AND METHODS: Nineteen patients with DED used PEG/PG + HP-Guar eyedrops four times per day for 30 days. Assessments included DED severity (Ocular Surface Disease Index [OSDI], corneal staining, conjunctival staining, tear film break-up time [TFBUT], and Schirmer testing) and impression cytology of the conjunctiva with masked flow cytometry at baseline and at 30 days. RESULTS: There was a significant decrease in corneal staining (P<0.01), OSDI (P=0.02), and TFBUT (P<0.01) following treatment with PEG/PG + HP-Guar. Results from flow cytometry revealed a significant decrease in cells expressing HLA-DR (P=0.02). CONCLUSION: Treatment with PEG/PG + HP-Guar eyedrops showed improvement in dry eye severity and reduction in surface inflammation as indicated by a reduction in HLA-DR expression.
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PURPOSE: To report a case of presumed gemcitabine-induced retinopathy and nephropathy. METHODS: Case Report. Retrospective chart review. RESULTS: A 64-year-old woman with a recent diagnosis of metastatic cholangiocarcinoma presented with progressive visual loss and renal failure shortly after the initiation of a chemotherapy regimen which included gemcitabine. Clinical examination and fluorescein angiography showed findings of severe retinal ischemia. CONCLUSION: Although gemcitabine chemotherapy has been reported to cause a Purtscher-like retinopathy, we propose in our patient a gemcitabine-induced vasculopathy that lead to significant retinal and renal ischemia.
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Antimetabolitos Antineoplásicos/efectos adversos , Desoxicitidina/análogos & derivados , Fallo Renal Crónico/inducido químicamente , Enfermedades de la Retina/inducido químicamente , Trastornos de la Visión/inducido químicamente , Desoxicitidina/efectos adversos , Femenino , Humanos , Persona de Mediana Edad , Estudios Retrospectivos , GemcitabinaRESUMEN
IMPORTANCE: Our experience may be useful to other practitioners using compounded intravitreal agents, those suspecting infectious outbreaks, and those managing fungal endophthalmitis. OBJECTIVE: To describe a series of patients with fungal endophthalmitis following intravitreal injection of combined bevacizumab and triamcinolone acetonide prepared by the same compounding pharmacy. DESIGN AND SETTING: Noncomparative case series. PARTICIPANTS: Eight eyes of 8 patients who received an intravitreal injection of compounded combined bevacizumab-triamcinolone in a period of 3 weeks had subtle, nonspecific findings that were later diagnosed as fungal endophthalmitis. MAIN OUTCOME MEASURES: Visual acuity, response to antimicrobial therapy, and number of vitreoretinal surgical operations after diagnosis of fungal endophthalmitis. RESULTS: Eight patients developed endophthalmitis 41 to 97 days after receiving the intravitreal injection, which was prepared by the same compounding pharmacy. The injections occurred at the same location in New York. Treatment was based on clinical examination findings and knowledge of the etiology of the endophthalmitis. Eventually, all patients were treated with oral voriconazole. Five of 8 patients were initially treated with intravitreal antimicrobial agents. After 3 months of follow-up, visual acuities ranged from 20/50 to hand motions. Local, state, and federal health department officials were involved in investigating the source of the outbreak. CONCLUSIONS AND RELEVANCE: In the current study, we report a fungal endophthalmitis outbreak after intravitreal injection of contaminated, compounded combined bevacizumab-triamcinolone. In this series, Bipolaris hawaiiensis was the identified causative agent. The challenge of medical diagnosis, identification of the source of the outbreak, and management experience are highlighted in our series. Our experience may be useful to other practitioners using compounded intravitreal agents, those suspecting infectious outbreaks, and those managing fungal endophthalmitis.