Clinical Characteristics of Retinoblastoma Patients whose Diagnosis was Difficult due to Atypical Ocular Manifestation

PURPOSE: To report the clinical characteristics of retinoblastoma patients whose diagnosis was difficult due to atypical ocular manifestations. METHODS: Among retinoblastoma patients who were diagnosed and treated from January 1999 to December 2014 at Seoul National University Children's Hospital, 6 patients whose diagnosis was difficult were retrospectively reviewed. Factors including age, sex, family history, initial findings, time to final diagnosis, histopathologic examination, additional treatment, and survival rate were evaluated. RESULTS: Among 6 patients, 5 were male, and the mean age at the initial visit was 32.9 ± 19.1 months. None of the patients had family history, and all presented with unilateral lesion at the initial visit. The initial diagnoses were Coats' disease and uveitis in 2 patients, respectively, and persistent hyperplastic primary vitreous and traumatic hyphema in 1 patient, respectively. During an intensive short-term follow-up of 8.3 ± 5.3 weeks, 2 patients showed malignant cells after external subretinal fluid drainage procedure, and 4 patients demonstrated increasing ocular size or calcification in imaging. These patients received enucleation under suspicion of malignancy and were finally diagnosed with retinoblastoma after histopathologic examination. There were 2 patients with optic nerve involvement, and 3 patients underwent additional systemic chemotherapy. Five patients were followed-up for 7.6 ± 6.3 years after enucleation, and the mean age at final follow-up was 10.6 ± 7.4 years. CONCLUSIONS: Retinoblastoma is one of the diseases in which early diagnosis and treatment are important. However, some cases are difficult to diagnose, even for experienced clinicians. If there are no typical manifestations such as mass or calcification and early findings show retinal detachment, glaucoma, pseudohypopyon, or hyphema, intensive short-term follow-up to exclude retinoblastoma is needed.

Macular Pseudohypopyon in Bilateral Terson's Syndrome

PURPOSE: To report a case of a macular pseudohypopyon in the right eye in bilateral Terson's syndrome. CASE SUMMARY: During a right eye vitrectomy of a 56-year-old female patient who showed bilateral Terson's syndrome with subarachnoid hemorrhage, a macular pseudohypopyon was observed. In an oval-shaped subinternal limiting membrane cyst (4x2 diameter size disc) including the central fovea, white exudates with fluid levels were present. The macular pseudohypopyon in the right eye was suspected to have occurred during the absorption of the subinternal limiting membrane hemorrhage. In the left eye, white exudates were clustered in the central fovea. In the right eye, the central fovea was above the fluid level of the pseudohypopyon, and corrected visual acuity was 1.0 after 6 months. Two months after the operation, the pseudohypopyon was absorbed.

Triamcinolone Regurgitation into Anterior Chamber after Intravitreal Triamcinolone Injection

PURPOSE: To report triamcinolone regurgitation into the anterior chamber after intravitreal triamcinolone injection for macular edema. METHODS: A total of 402 eyes (432 cases) received intravitreal injection of triamcinolone acetonide for macular edema from November 2002 to December 2004. A retrospective review included the medical records of all patients who showed regurgitation into the anterior chamber after intravitreal triamcinolone injection. The clinical outcome and any complications were analyzed. RESULTS: Regurgitation was observed in 9 of 402 eyes (11 of 432 cases, 2.55%) after intravitreal triamcinolone acetonide injection. All were phakic eyes. Pseudohypopyon was observed during the follow-up period but resolved gradually without any significant complications. Intravitreal injection of triamcinolone acetonide results in increased visual acuity (p<0.01) and decreased macular thickness (p<0.01) after 2 weeks of injection. CONCLUSIONS: Triamcinolone particles that regurgitated into the anterior chamber gradually resolved without any significant complications. These can, however, mask symptoms of endophthalmitis and delay accurate diagnosis, so careful follow-up examination is imperaive.