Vision loss in an immunocompetent child post varicella infection: A case report

@#Chickenpox may lead to several neurological complications. Optic neuritis is one of the complications which has rarely been described, especially in immunocompetent individuals. We report a case of an 11-year-old immunocompetent girl who presented with sudden onset bilateral vision loss three weeks after varicella eruption. Ophthalmic examination revealed bilateral optic disc edema. Diagnosis of bilateral optic neuritis secondary to varicella was established based upon the preceding medical history, supported with clinical and radiological fndings.

Changes in circumpapillary thickness parameters measured by optical coherence tomography in patients with optic disc edema / 眼科新进展

Objective To observe the changes in the circumpapillary thickness parameters measured by optical coherence tomography (OCT) in patients with optic disc edema (ODE).Methods Together 36 patients (36 eyes) diagnosed with ODE from October 2012 to October 2015 were included in the study,and 51 age-and gendermatched control subjects (51 eyes) were recruited from among healthy individuals with no history or evidence of current ocular disease.All the subjects were examined for visual acuity,slit lamp,fundus and fundus photography,and all the eyes underwent OCT scan to detect the circumpapillary retinal nerve fiber layer thickness (cpRNFLT) and circumpapillary total retinal thickness (cpTRT).Results After OCT scan,25 ODE patients (5 mild,14 moderate and 6 severe patients) and 30 patients (5 mild,15 moderate and 10 severe patients) were in line with the requirements of cpRNFLT analysis and cpTRT analysis respectively;there were 50 controls meeting the requirements of this study.There was no significant difference in age and sex between ODE patients and the controls (all P ＞0.05).The mean cpRNFLT and cpRNFLT in each quadrant of ODE patients were significantly thickened than those of controls,and the superior cpRNFLT was the thickest,followed by the inferior,then the nasal and temporal cpRNFLT,and the difference was statistically significant (P ＜0.001).The mean cpTRT and cpTRT in each quadrant of ODE patients were significantly thickened than those of controls,and the inferior cpRNFLT was the thickest,followed by the superior,then the nasal and temporal cpRNFLT,and the difference was statistically significant (P ＜0.001).Conclusion Significantly thickening of cpRNFLT and cpTRT has been observed in patients with ODE as compared with controls,so both circumpapillary thickness parameters measured by OCT can be considered as a new non-invasive quantitative index for the detection and research of ODE.

Intravitreal Bevacizumab Injection for Serous Retinal Detachment Associated with Leber's Idiopathic Stellate Neuroretinitis

PURPOSE: To report the effectiveness of intravitreal bevacizumab treatment for serous retinal detachment associated with Leber's idiopathic stellate neuroretinitis. CASE SUMMARY: A 56-year-old male visited our clinic complaining of visual disturbance for three days in his right eye. His best corrected visual acuity was 0.5. Relative afferent pupillary defect and pain when moving eyes were noted in his right eye as well as inflammatory cells in the vitreous cavity. On funduscopic examination, disc swelling with hemorrhage and stellate-shaped hard exudates were noted at the perifovea. Ishihara color vision test showed anomalous trichromacy in his right eye. Hyperfluorescence around the disc was observed on fundus fluorescein angiography. Optical coherence tomography showed disc swelling with serous retinal detachment at the fovea. Inferior altitudinal scotoma was noted on visual field examination. The patient underwent intravitreal bevacizumab injection and topical steroid medication. After six days, the patient's symptoms and disc swelling improved, and decreased subretinal fluid was observed. After six weeks, his best corrected visual acuity was 1.0. Nine weeks later, visual field examination showed nonspecific scotoma. CONCLUSIONS: Intravitreal bevacizumab injection is useful for treating serous retinal detachment associated with Leber's idiopathic stellate neuroretinitis.

Acute Bilateral Visual Loss Related to Orthostatic Hypotension

A 50-year-old man had undergone lumbar vertebral surgery and was confined to bed in the supine position for three months. When he sat up from the prolonged supine position, he showed clinical signs of orthostatic hypotension and reported decreased vision in both eyes. He also had underlying anemia. Ophthalmologic findings suggested bilateral anterior ischemic optic neuropathy (ION) as the cause of the visual loss. Although there are numerous reports of ION in the setting of hemodynamic compromise, such as systemic hypotension, cases of ION-associated orthostatic hypotension are very rare.

Leukemic Infiltration of the Optic Nerve Head as the Initial Manifestation of Leukemic Relapse

PURPOSE: To present a case of leukemic infiltration of the optic nerve head as the initial manifestation of leukemic relapse. CASE SUMMARY: A 65-year-old woman was diagnosed with acute myeloid leukemia. Complete remission was achieved after 4 complete courses of chemotherapy. She complained of a sudden decrease in visual acuity in her left eye. Fundus examination showed severe optic disc edema with peripapillary hemorrhage and serous retinal detachment. Visual acuity and fundus continued to aggravate and high-dose intravenous steroid therapy was instituted. Visual acuity and fundus deteriorated more after treatment. Brain magnetic resonance imaging and CSF study were normal but intrathecal chemotherapy and focal irradiation were performed on account of the suspected CNS involvement of leukemia. Morphologic improvement in the retinal structure was achieved, however, optic atrophy remained and her vision did not recover. CONCLUSIONS: The present case shows the involvement of the optic nerve head as the initial isolated manifestation for the relapse in a patient with complete remission. CNS involvement is rare in acute myeloid leukemia and in particular, the optic nerve is rarely reported as the initial isolated presentation for the relapse. Moreover, the disease progression relatively aggravated after treatment. In the atypical aspects of leukemic relapse, the present case was noticeable.

The Effect of an Intravitreal Triamcinolone Acetonide Injection for Acute Nonarteritic Anterior Ischemic Optic Neuropathy

The purpose of this case report is to evaluate the visual outcome of an intravitreal triamcinolone acetonide injection (IVTA) as a treatment for a patient with acute nonarteritic anterior ischemic optic neuropathy (NAION). A 65-year-old male patient with severe visual loss due to acute NAION was treated with 4 mg/0.1mL IVTA. Fundus examination and measurements of the patient's best-corrected visual acuity and visual field were performed before and after the injection at 2 weeks, 1 month, 3 months, and 6 months. The best-corrected visual acuity changed from 0.05 before the injection to 0.16 at 2 weeks, 0.3 at 1 month, and 0.4 at 3 months and at the final visit. Optic disc swelling had markedly decreased at 1 week postoperatively and disappeared at 2 weeks after the injection. The clinical course of this patient suggests that an IVTA may be effective in increasing visual acuity following an acute NAION. A large randomized controlled trial is needed to assess the efficacy of IVTA as a treatment for NAION.

Papilledema Associated with Anemia in a Patient with Paroxysmal Nocturnal Hemoglobinuria

PURPOSE: To report a case of bilateral optic disc edema associated with hemolytic anemia and paroxysmal nocturnal hemoglobinuria (PNH). METHODS: A 51-year-old woman visited our ophthalmologic clinic complaining of metamorphopsia. Twenty eight years ago, she had been diagnosed with PNH and hemolytic anemia and had received blood transfusion on an irregular basis. The best corrected visual acuity was initially 0.5 in the right eye and 1.0 in the left eye. Light reflex was intact and no afferent pupillary defect was found. Fundus examination revealed severe optic disc swellings with indistinct margins in both eyes. Papillary and peripapillary retinal hemorrhages were also present. RESULTS: A visual field test revealed the enlarged physiologic scotoma in both eyes. Fluorescein angiograms showed hyperfluorescence of the optic disc and blocked fluorescence due to the papillary hemorrhages. Optical coherence tomograms of the optic disc showed the loss of physiologic disc cupping and severe elevation. There was no evidence of an intracranial lesion upon brain magnetic resonance imaging. These findings were compatible with optic disc edema associated with anemia and the management was oriented towards the anemia. At the 2-months follow-up, the best corrected visual acuity of both eyes had improved to 1.0 and optic disc edema markedly decreased. However, the patient's overall physical condition deteriorated and she expired due to dyspnea and hepatic coma.

Hypertensive Optic Neuropathy Related to Chorioretinal Lesions

PURPOSE: To investigate the relationship between chorioretinal lesions and papilledema in patients with hypertensive optic neuropathy. METHODS: We analyzed the angiographic findings of 142 patients (284 eyes) who had been diagnosed with hypertensive chorioretinal disease in the ophthalmic outpatient department of our hospital, from March 2001 to December 2003. We classified hypertensive ocular disorders to either the optic disc edema group or the non-optic disc edema group. RESULTS: There were 34 patients with hypertensive optic neuropathy. With an analysis of color photo and angiographic findings, a significant correlation of optic disc edema was seen in Elschnig's spot, prominent watershed zone, and retinal hemorrhage. CONCLUSIONS: Hypertensive optic neuropathy was significantly related to retinal hemorrhage, Elschnig's spot, and prominent watershed zone. We should carefully observe the patients who have these lesions.

Comparison of Optic Disc Appearance in Anterior ischemic optic neuropathy and Optic neuritis

PURPOSE: Optic disc edema in anterior ischemic optic neuropathy (AION) and optic neuritis (ON) have overlapping features. To determine whether characteristics of optic nerve swelling help to differentiate ON from AION. METHODS: A medical records were reviewed retrospectively for the patients who had been diagnosed as AION or ON in which photographs for acute phase were available. Color of optic disc, distribution of edema, presence of hemorrhage and caliber of artery and vein was analyzed in each fundus photograph. RESULTS: AION was diagnosed clinically in 67% of the cases with altitudinal edema, in 77% of the cases with disc hemorrhage, in 87.5% of the cases with pallid optic disc and in 77% of the cases with vascular abnormality. A pale optic disc with hemorrhage, regardless of the type of edema, always represented AION (100%). Normal-colored optic disc without hemorrhage always also represented optic neuritis (100%). CONCLUSIONS: Analysis of disc characteristics may enhance diagnostic accuracy and help to differentiate AION from ON.