Lifting the White Walker’s curse–Management of Coats’ disease

Background: Coats’ disease, described by George Coats in the early 1900s, is an idiopathic unilateral retinal vascular abnormality with exudation occurring in young males. It is characterized by retinal telangiectasia with intraretinal or subretinal exudation. Coats’ disease is mostly diagnosed in the first to the second decade of life, with a common presentation of leukocoria. Younger patients have a more severe presentation and are associated with poor visual prognosis. Management of Coats’ disease varies from observation, cryotherapy with anti?VEGFs (Vascular Endothelial Growth Factor), and surgery to enucleation. The mode of treatment depends on the age of presentation, the severity of the disease, and the stage of the disease. Through this video, we describe the clinical features, pathology, and surgical management of a 2?year?old child with grade 3B of Coats’ disease. Purpose: To demonstrate successful surgical management of grade 3B of Coats’ disease in a 2?year?old boy. Synopsis: Coats’ disease mostly presents with a diagnostic dilemma due to its varied presentation. Early detection and treatment are the keys to salvaging the eye as well as the vision, hence, avoiding dreadful complications such as neovascular glaucoma or phthisis bulbi. We demonstrate successful surgical management of a child who presented with grade 3B of Coats’ disease. Highlights: Through this video, we aim to describe the clinical features, pathology, and surgical management of a 2?year?old child with grade 3B of Coats’ disease. Combination of external drainage with vitrectomy, challenges faced, and the importance of visual rehabilitation postoperatively

Abordaje interdisciplinario de endoftalmitis endógena neonatal. Reporte de caso / Interdisciplinary approach to endogenous neonatal endophthalmitis. Case report

La endoftalmitis endógena neonatal es una patología poco frecuente que puede causar daño ocular grave. Puede manifestarse en pacientes con comorbilidades, como nacimiento pretérmino, bajo peso al nacer, complicaciones posquirúrgicas perinatales o sepsis.El presente reporte de caso documenta a una paciente pretérmino que fue sometida a múltiples cirugías abdominales. Durante su internación, desarrolló sepsis, meningitis y endoftalmitis endógena neonatal. La frecuencia extremadamente baja de la endoftalmitis endógena a esta edad, la importancia de preservar la salud visual del paciente y el abordaje interdisciplinario son puntos importantes de aprendizaje en este caso.

Neonatal endogenous endophthalmitis is a rare condition that can cause serious eye injuries. It can manifest in patients with comorbidities, such as preterm birth, low birth weight, post-surgical perinatal complications, or sepsis.This case report documents a preterm patient who underwent multiple abdominal surgeries. During her hospitalization, she developed sepsis, meningitis and neonatal endogenous endophthalmitis. The extremely low frequency of endogenous endophthalmitis at this age, the importance of preserving the patient's visual health, and the interdisciplinary approach are important learning points in this case.

Comparison of Evisceration with Primary Orbital Implant Surgery in Endophthalmitis and Phthisis Bulbi

PURPOSE: To evaluate the efficacy and prognosis of evisceration with primary orbital implant placement in patients with endophthalmitis and compare it to phthisis bulbi patients. METHODS: We retrospectively reviewed the medical records of patients who underwent evisceration with primary implant placement by a single surgeon from January 2005 to December 2011 at Pusan National University Hospital. Age, gender, underlying ocular disease, systemic illness, type and size of implant, follow-up period, and the causative organism were evaluated in patients with endophthalmitis. Success rates and prevalence of complications were compared between endophthalmitis and phthisis patients. RESULTS: The present study included 18 patients (18 eyes) with endophthalmitis and 23 patients (23 eyes) with phthisis. Patients in the endophthalmitis group were older than the patients in the phthisis group and no significant differences in gender, size of implant, and underlying diseases between endophthalmitis and phthisis patients were found. Sixteen endophthalmitis and 20 phthisis patients showed successful surgical outcomes with no significant differences (p = 0.31), and implant exchange rates were not significantly different between endophthalmitis and phthisis bulbi patients (p = 0.52). CONCLUSIONS: Evisceration with primary orbital implant placement in patients with endophthalmitis is a safe and effective treatment method. Comparison between endophthalmitis and phthisis showed no significant differences in success outcomes and complication rates.

Sarcoma intraocular felino associado à phthisis bulbi / Feline intraocular sarcoma associated with phthisis bulbi

Two cases of feline intraocular sarcoma were reported in stray cats that presented blindness and hypotonia of the affected eye for years before the tumor development. Phthisis bulbi, a final stage of a severe inflammation of the eye, is frequently unmonitored because eyes are blind, small, opaque, and not painful. Yet, this report shows that monitoring and early enucleation of eyes of cats with phthisis bulbi are important and should be considered as a treatment option, because feline intraocular sarcoma is an aggressive tumor that significantly decreases live expectancy.

Relatam-se dois casos de sarcoma ocular em gatos que apresentavam cegueira e hipotonia nos olhos afetados por anos antes do crescimento neoplásico. Phthisis bulbi, que é o estágio final de um processo inflamatório ocular intenso, geralmente não é monitorado por tratar-se de um olho cego, pequeno e não doloroso. O relato demonstra que o monitoramento e a enucleação precoce de olhos em phthisis bulbi são importantes e devem ser considerados como opções de tratamento, porque o sarcoma intra-ocular é agressivo e pode diminuir significativamente a expectativa de vida.

Clinical Analysis of Fitting a Scleral Shell over Phthisis Bulbi or Discolored Blind Eyes

PURPOSE: To show that scleral shells can be good cosmetic prostheses for phthisis bulbi or discolored blind eyes for which no evisceration or enucleation is indicated. METHODS: Twenty patients with phthisis bulbi or discolored blind eyes were enrolled in this study. All patients were using scleral shells. We evaluated any complications induced by the scleral shells and the cosmetic results during the follow-up period. RESULTS: The average central thickness of the scleral shell was 1.84+/-0.26 mm, and the average volume was 1.52+/-0.25 ml. The average difference in palpebral fissure width between the fellow eye and the eye with a fitted scleral shell was 0.8+/-0.62 mm. One patient complained about ocular irritation and difficulty in fitting but was satisfied with the cosmetic appearance. CONCLUSIONS: Fitting scleral cover shells over phthisis bulbi or discolored blind eyes without evisceration or enucleation could be a successful remedy for enhancing cosmetic appearance.

Herpes Zoster Ophthalmicus Complicated by Hyphema, Glaucoma and External Ophthalmoplegia

PURPOSE: To report a patient with herpes zoster ophthalmicus in whom hyphema, glaucoma and external ophthalmoplegia occurred. CASE SUMMARY: A 59-year-old male patient developed severe ocular pain and decreased visual acuity in his left eye 10 days ago. He had been diagnosed as herpes zoster ophthalmicus 14 days before and given antiviral agent. He could not percept light. His left eye showed hyphema, severe exudative iritis and elevated IOP. Lid drooping and complete external ophthalmoplegia were present in the left eye. Systemic corticosteroid with concomitant antiviral agents and antiglaucomatous agents was administered. RESULTS: Light perception did not recover and phthisis bulbi developed in his left eye at 2 months after the onset of the skin lesion. The patient showed gradual improvement in movement of the lid and external ocular muscle.

Preoperative Axial Length Measured by Ultrasonography in Phthisis Bulbi

PURPOSE: The preoperative axial length measured by ultrasonography in the phthisis bulbi and the postoperative surgical outcome was evaluated in order to determine the surgical procedure of an evisceration or enucleation. METHODS: The preoperative axial length was measured by ultrasonography in 30 eyes of 30 patients with phthisis bulbi from January 2000 to October 2002. Enucleation was performed on 20 eyes with a relatively short preoperative axial length. The axial length of the enucleated globe was measured and compared with the preoperative axial length. Evisceration was performed in 10 eyes with a relatively long preoperative axial length. The size of the implant, the thickness of prosthesis, and the complications were evaluated postoperatively. RESULTS: In the 20 eyes that underwent enucleation, the preoperative axial length was 6.8~16.6 mm (mean 12.4 mm) and the axial length of the enucleated globes was 9.0~20.0 mm (mean 15.3 mm). The size of implants was 16.5~20.0 mm (mean 19.5 mm). In the 10 eyes that underwent evisceration, the preoperative axial length was 13.5~22.7 mm (mean 19.1 mm). The size of the implants was 18.5~20.0 mm (mean 19.4 mm). During a follow-up period of 6-30 months (mean 16.0 months), none of the eyes showed any complications such as conjunctival dehiscence or implant exposure or extrusion. CONCLUSIONS: The preoperative axial length measurement was helpful in deciding if enucleation or evisceration of the phthisis bulbi should be performed. Evisceration was performed sufficiently in cases of a preoperative axial length of 16 mm or more.

A Case of Ossification in the Phthisis Bulbi

Phthisis bulbi, resulting from repeated ocular inflammation and infection or ocular trauma, causes various degeneration of ocular tissue as well as changes in ocular external shape. It shows the impression of scleral thickening with calcification of ocular tissue and an unusual ossification as well. Having observed 31-year-old patients of phthisis bulbi and band keratopathy caused by repeated operation after ocular trauma years ago, we extracted the tan brown colored shell-like firm tissue in posterior segment and report sclerotic impression of some of ocular tissue and histopathologic finding of the typical ossificationof ocular tissue during the course evisceration.

The long-term effects of experimental total retinectomy

Experimental total retinectomy was performed in pigmented rabbit eyes to in vestigate its long-term effects on the operated and nonoperated opposite eyes from both clinical and histological aspects. There was no significant change in intraocular pressure between the preoperative and postoperative measurements during the six months after surgery. Rubeosis iridis, intraocular hemorrhage and phthisis bulbi were not evident in the operated and opposite eyes. Light microscopic examination revealed congestion of the choroidial vessels. There were scattered areas of retinal pigment epithelial cell proliferation. Transmission electron microscopic examination showed apiral mounding of the retinal pigment epithelium. Apical processes were short and reduced in number. Apical processes of the retinal pigment epithelial cells interdigitated with surface processes of the proliferating retinal pigment epithelial cells. There were numerous melanosomes in the cytoplasm of the proliferating retinal pigment epithelial cells. Cell junctions between the retinal pigment epithelial cells were well preserved.