Choroidal involvement in patients with catastrophic anti-phospholipid syndrome: Two case reports.

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.

Surgical management of post-traumatic iris cyst: A case report.

INTRODUCTION AND IMPORTANCE: Cysts of the iridociliary complex could be primary or secondary. Small and asymptomatic iris cysts can be monitored, whereas larger cysts require treatment as they can cause severe complications. Treatment modalities can range from minimally invasive techniques to aggressive surgical procedures. CASE PRESENTATION: We report the case of an 11-year-old child who applied to our department with blurred vision. The anterior segment examination of the right eye revealed an oval, light brown, semi translucid cyst, located in the iris extending to corneal endothelium. The iris cyst was managed surgically. A pigment magma on the anterior surface of the lens was observed and was respected in order not to induce a cataract. Surgical treatment consisted of total removal of the external cyst layer. CLINICAL DISCUSSION: There are numerous different methods for treating iris cysts. The main goal of treatment is to be as little intrusive as possible. Cysts that are small, stable, and asymptomatic can be observed. To avoid major issues, larger cysts may need to be treated. When less intrusive treatments have failed, surgery is always the final option. In our case, the post-traumatic iris cyst was immediately treated surgically by aspiration followed by excision of its wall, because of the significant visual disturbance, the age of the patient, and the corneal endothelial touch. CONCLUSION: Surgical intervention remains the last option, especially when less invasive options did not reveal to be successful due to the extensive nature of the lesion.

Behçet's disease presenting as neuroretinitis with pre-papillary vitreous infiltrate: a case report.

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.

[Multimodal imaging in atypical choroidal nevus]. / Imagerie multimodale d'un nævus choroïdien atypique.

Choroidal nevi are frequent, asymptomatic, usually easy-to-diagnose lesions. They can cause macular syndrome in patients with choridal degeneration or neovascularization. In doubtful cases, the combination of different diagnostic means, such as clinical examination, ultrasound, fluorescein angiography and indocyanine green (ICG) can help to correct the diagnosis. We here report the case of a female patient with atypical choroidal lesion, in whom multimodal imaging allowed to retain the diagnosis of achromic choroidal nevus complicated by choroidal neovascularization.