RESUMEN

PURPOSE: To describe choroidal involvement in catastrophic antiphospholipid syndrome (CAPS). METHODS: We report here two cases of bilateral CAPS choroidopathy in two female patients. RESULTS: Case report 1: A thirty-five-year-old female patient, with history of primary anti-phospholipid syndrome (APS), treated with anticoagulants, presented an acute renal failure following a salpingectomy. She complained of bilateral acute blurred vision. Ophthalmologic evaluation revealed visual acuity (VA) of 5/10, extensive serous retinal (SRD) detachment, areas of hypofluorescence on fluorescein angiography (FA), and non-perfusion areas in the choriocapillaris, on optical coherence tomography angiography (OCT-A), in both eyes. Considering the diagnosis of probable CAPS, the patient received intravenous pulse steroids, plasmapheresis, intravenous anticoagulation and haemodialysis, with favourable evolution. Case report 2: A thirty-three-year-old female patient, with history of systemic lupus erythematosus (SLE) and secondary APS, treated with corticosteroids, immunosuppressive agents and anti-coagulation, presented a myocardiac infarction. She complained of bilateral acute blurred vision. Ophthalmologic evaluation revealed VA of 1/10 in the RE and 6/10 in LE, bilateral extensive SRD, leakage points on FA and non-perfusion areas in the choriocapillaris on OCT-A. Criteria of probable CAPS were fulfilled. Treatment with intravenous pulse steroids, anticoagulation and reanimation modalities allowed VA improvement. Alveolar haemorrhage and cardiogenic shock led to fatal evolution. CONCLUSION: Our case reports highlight the importance of early diagnosis and ophthalmic evaluation in CAPS. Multidisciplinary approach and rapid initiation of effective treatment, based on corticosteroids, anticoagulation and plasmapheresis, allow better vital and visual prognosis.

Asunto(s)

Síndrome Antifosfolípido , Humanos , Femenino , Adulto , Síndrome Antifosfolípido/complicaciones , Síndrome Antifosfolípido/diagnóstico , Síndrome Antifosfolípido/terapia , Coroides , Corticoesteroides , Anticoagulantes/uso terapéutico , Esteroides

RESUMEN

The authors report two cases of retinal artery macroaneurysm (RAM) complicated with subhyaloid hemorrhage. There are multiple cases about RAM that have been published; however, none of them present all the different treatments with its benefits and its limitations. Our study highlights all aspects of treatment. RAM is an uncommon pathology that affects generally elderly women with systemic vascular pathologies. It is often unilateral, and the patients stay mostly asymptomatic. Most cases of RAM regress without any treatment. A case of a 54-year-old male, with a medical history of hypertension who presented with an acute and unilateral decreased visual acuity (VA). Initial VA was limited to counting fingers at 1 m in the right eye (RE). The anterior segment was normal in both eyes. A fundus examination in the RE showed a large subhyaloid hemorrhage associated to retinal hemorrhage. Fluorescein angiography in the RE did not reveal any sign of macroaneurysm due to blockage of fluorescein by the hemorrhage. In the left eye, there was a hyperfluorescent paramacular lesion. Optical coherence tomography showed the hyperreflectivity of the subhyaloid hemorrhage and the underlying retinal layers could not be seen. Neodymium-doped yttrium aluminum garnet laser hyaloidotomy was performed for this patient to release the trapped hemorrhage into the vitreous, 3 weeks after initial loss of vision with a good visual outcome after the treatment. An 80-year-old woman, with medical history of rheumatoid arthritis who presented with an acute loss of vision in the RE. VA in the RE was 20/200. She had a nuclear cataract in both eyes. A fundus examination showed a subyaloid hemorrhage. Fluorescein angiography in the RE revealed a hyperfluorescent structure emanating from the superotemporal arcade of the artery compatible with a macroaneurysm. The patient was treated with three intravitreal antivascular endothelial growth factor injections with poor visual outcomes. Vision loss occurs with RAM complications. They mainly involve hemorrhages and macular exudations and are usually associated with poor visual recovery. There is no established treatment for RAM and its complications. There are many options, but the optimal therapy is still unknown.

RESUMEN

OBJECTIVE: To report a case of Behçet's disease (BD) presenting as a panuveitis with neuroretinitis and pre-papillary vitreous infiltrate. MATERIAL AND METHODS: A case report. RESULTS: A 43-year-old male presented with severely decreased vision in the left eye. Ophthalmological examination revealed unilateral non granulomatous panuveitis with occlusive retinal vasculitis, neuroretinitis and pre-papillary vitreous infiltrate. Initial swept source OCT revealed a "funnel-shaped" hyperreflective lesion overlying the optic disc corresponding to the pre-papillary vitreous infiltrate associated with optic disc edema and a serous retinal detachment extending to the macula. Examination by an internal medicine specialist revealed buccal aphthous ulcer and pseudofolliculitis lesions. BD diagnosis was made and the patient received corticosteroid and immunosuppressive therapy. The pre-papillary vitreous infiltrate resolution under treatment was documented with repeat swept source OCT. CONCLUSION: Pre-papillary vitreous infiltrate has been rarely reported in the literature. This finding is a typical feature in severe cases of BD uveitis and is usually associated with a neuroretinitis. Optic disc OCT is useful to make the diagnosis and to monitor the resolution of the pre-papillary vitreous infiltrate.

RESUMEN

-Kyrieleis arteritis is a rare manifestation in posterior uveitis-Kyrieleis arteritis is most frequently reported in ocular toxoplasmosis.-The pathogenesis still highly debated.-It is characterized by the presence of focal, segmental plaques or exudates within retinal arteries.-These plaques are usually reversible.-The prognosis is usually good.

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Corticosteroids have proven their effectiveness in the treatment of cystoid macular edema. Especially after an intravitreal injection. Triamcinolone acetonide is the most commonly used in the treatment of macular edema. Noninfectious endophthalmitis is a form of endophthalmitis that can occur in the absence of a defined germ after an intravitreal injection of triamcinolone acetonide. We report here the case of three diabetic patients, who presented with visual blur, three days after an intra vitreal triamcinolone acetonide injection performed in the right eye. The vitreous inflammation resolved spontaneously in the first two cases after three weeks, and after four weeks for the third. The diagnosis of sterile endophthalmitis was made in view of the spontaneous resolution of the inflammation without the use of intravitreal injection of antibiotics and/or vitreoretinal surgery.

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We report the occurrence of serous retinal detachment (SRD) in acute posterior multifocal placoid pigment epitheliopathy (APMPPE). A 22-year-old man with no general or ophthalmological pathological history presented with an acute and bilateral decreased visual acuity. There was no notion of recent flu or recent vaccination. There were anterior chamber cells and vitreous cells. Fundus revealed white-yellowish lesions, scattered on posterior pole and periphery, associated with SRD in both eyes. Fluorescein Angiography showed early hypofluorescence followed by late hyperfuorescence. Optical coherence tomography (OCT) showed hyperreflective bands of the outer nuclear layer and interruption of the ellipsoid zone associated with bilateral SRD. Repeat OCT revealed a spontaneous and complete regression of SRD in both eyes, and improvement of visual acuity after one week of evolution without any treatment. Serous retinal detachment is an uncommon manifestation of APMPPE. It is more suggestive of Vogt-Koyanagi-Harada disease (VKH), although angiographic features are typically observed in APMPPE. Moreover, spontaneous decrease of SRD within a few days is more in favor of APMPPE.

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Retinal manifestations have been described as an inaugural manifestation of acute leukemia. Retinal hemorrhage, and in particular white-centered hemorrhages are among the most frequently observed signs. We report here the case of a 34-year-old Caucasian man with no medical history who presented to our emergency department with a decrease in visual acuity associated with asthenia. Ophthalmological examination revealed bilateral white-centered hemorrhages. The etiological assessment confirmed the diagnosis of acute myeloid leukemia. Whenever Roth spots are found in fundus examination, a complete ophthalmological examination along with a wide etiological investigation must be conducted.

RESUMEN

Apart from congenital causes, orbital trauma is a leading cause of unilateral vision loss in children. We report the case of a 2-year-old child who was victim of an orbital trauma of the right eye caused by a ballpoint pen. He consulted us the day after the trauma with significant palpebral edema making the examination difficult. An emergency CT scan of the orbit and brain showed the presence of a right intraorbital foreign body. The patient underwent removal of the foreign body by an anterior orbitotomy with general antibiotic therapy and a simple postoperative course. Penetrating trauma to the orbit should raise the suspicion of the presence of a foreign body. A CT scan should be performed to specify its location. The extraction of the foreign body can be a challenge that requires an experienced surgical team.