A Case of Bilateral Orbital Tuberculosis

PURPOSE: Periocular tuberculosis is common in the form of conjunctival tuberculosis or uveitis; however, orbital tuberculosis is very rare. We report a case of tuberculosis diagnosed based on bilateral orbital masses. CASE SUMMARY: A 64-year-old male with a history of diabetes, hypertension, and chronic obstructive pulmonary disease presented with diplopia. His best-corrected visual acuity was 1.0, and intraocular pressure was 16 mmHg in both eyes. Bilateral proptosis was noted, and inferior orbital masses were palpated in both eyes. On orbital computed tomography, irregular masses were surrounding both globes in the extraconal space. Incisional biopsy of the bilateral orbital masses was performed under local anesthesia. Pathologic examination revealed chronic granulomatous inflammation accompanied by caseous necrosis. The patient was diagnosed with bilateral orbital tuberculosis and underwent triple therapy with isoniazid, rifampin, and ethambutol for 12 months. The orbital masses completely resolved, and there was no recurrence or complication through 12 months after treatment. CONCLUSIONS: To our knowledge, bilateral orbital tuberculosis has not been reported yet. Herein, we report a case of orbital tuberculosis presenting as bilateral orbital masses.

Tube Erosion with Scleral Melting after Ahmed Valve Implantation Using a Synthetic Dural Substitute

PURPOSE: The objective of this case report was to present tube erosion of Ahmed valve implantation using a synthetic dura substitute (Neuro-Patch®, B. Braun, Boulogne, France). CASE SUMMARY: Tube erosion was caused by dissolution of the conjunctiva and partial-thickness scleral tunnel in 5 patients who received Ahmed valve implantation using a synthetic dura substitute for glaucoma treatment 2 to 4 months after the operation. Furthermore, the patients required re-operation for preventing secondary complications such as endophthalmitis. CONCLUSIONS: This case series using a synthetic dura substitute in Ahmed valve implantation demonstrated the risk of tube erosion with scleral tunnel melting and following secondary complications even with a partial-thickness scleral tunnel method.

Short-term Effectiveness of Intravitreal Triamcinolone Injection for Refractory Macular Edema Secondary to Branch Retinal Vein Occlusion

PURPOSE: To evaluate the short-term efficacy of intravitreal triamcinolone (IVTA) injection for the treatment of macular edema secondary to branch retinal vein occlusion (BRVO) refractory to intravitreal bevacizumab injections. METHODS: This retrospective, observational study included 23 eyes of 23 patients with macular edema secondary to BRVO. The patients with macular edema unresponsive to 2 or more consecutive monthly intravitreal bevacizumab injections were treated with IVTA. Best-corrected visual acuity (BCVA) and central foveal thickness (CFT) based on optical coherence tomography were evaluated before IVTA and 1 month and 3 months after IVTA injections. RESULTS: All patients were previously treated with 3.4 ± 1.2 intravitreal bevacizumab injections. The IVTA injection was performed at 4.3 ± 1.7 weeks after the last bevacizumab injection. The logarithm of the minimal angle of resolution (log MAR) BCVA was also decreased from 0.61 ± 0.45 to 0.52 ± 0.35 after 1 month and to 0.58 ± 0.37 after 3 months of IVTA, although without statistical significance (p = 0.114 and 0.412, respectively). Eight eyes (34.8%) showed more than 3 lines improvement of BCVA and 4 eyes (17.4%) showed stable BCVA increasing 2 lines or less. CFT was significantly improved from 512 ± 166 µm to 310 ± 139 µm after 1 month and to 324 ± 159 µm after 3 months of IVTA injections (p = 0.014 and 0.031, respectively). CONCLUSIONS: IVTA was beneficial in some patients with macular edema secondary to BRVO refractory to intravitreal bevacizumab therapy. This study indicates that IVTA could be considered as a treatment option for refractory macular edema associated with BRVO.

Diagnostic Availability of Ultra-Wide-field Fundus Imaging in Korean Patient with Retinal Break

PURPOSE: To evaluate the availability of ultra-wide-field fundus photography compared to fundus examination after pupil dilatation in Korean patients with retinal break. METHODS: For this retrospective case review of consecutive 160 patients, 230 lesions with retinal breaks were recruited. The ultra-wide-field images were taken after fundus examination with pupil dilatation performed by a retinal specialist. We analyzed ultra-wide-field images according to patient characteristics and separated area. We divided lesions into anterior and posterior areas, and each area was separated into 4 quadrants (superior, inferior, temporal, and nasal). RESULTS: The sensitivity of ultra-wide-field imaging for detecting retinal break was 72% (95% confidence interval [CI] 65-79%), and the specificity was 94% (95% CI 90-98%). The sensitivity of detection of posterior retina was 89% (95% CI 85-93%), and that of anterior retina was 72% (95% CI 66-78%); this difference was significant (p = 0.007). There was a significant statistical difference at the inferior quadrant between anterior and posterior retina, but not at superior, temporal, or nasal quadrants. The sensitivity of detection in the inferior quadrant in the anterior retina was 43% (95% CI 29-57%). CONCLUSIONS: Ultra-wide-field fundus photography can detect retinal break, but there is limitation in anterior retinal lesions, especially the inferior area. Therefore, ultra-wide-field fundus photography cannot be an alternative method instead of fundus examination with pupil dilatation.

Choroidoretinopathy and Secondary Angle Closure Attack in Systemic Lupus Erythematosus: A Case Report

PURPOSE: Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder with widespread manifestations that rarely include the eye. We present a case of SLE-associated choroidoretinopathy and secondary angle closure attack in both eyes. CASE SUMMARY: A 58-year-old male was admitted into the urologic department complaining of right scrotal swelling, and then consulted with the ophthalmology department regarding both ocular pain and eye injection. The patient was diagnosed with acute angle closure attack using a slit lamp test and tonometry secondary to choroidoretinitis with choroidal detachment at fundus examination in both eyes. The rheumatologist performed systemic evaluation, including serologic tests, and then diagnosed the patient with SLE. After systemic steroid therapy, intraocular pressure was decreased and choroidal detachment disappeared with improvements of choroidoretinitis in both eyes. CONCLUSIONS: Patients with systemic lupus erythematosus choroidopathy can develop secondary angle closure attack, which can be effectively treated using systemic steroid therapy and antiglaucoma drugs.