ABSTRACT
Background: Retinitis pigmentosa (RP) is a set of inherited rod-cone degenerative diseases that clinically presents with similar signs and symptoms. Mutations in one of more than 70 genes are involved. Patients will commonly present with bone-spicule pigment formation, waxy optic nerve pallor, and attenuated blood vessels in the posterior pole.Symptoms often begin with progressive night blindness, mid-peripheral visual field defects, and eventual tunnel vision. Central vision loss will ultimately occur following loss of rod function. Complete blindness is uncommon. Objective: The aim of this article is to present two cases of retinitis pigmentosa (mother and daughter) trough optalmologic exams in our clinic. The next aim it to show how to menage a low vision service and to treat cystoid macular oedema as a complication of retinitis pigmentosa. Methods: All medical reports are shown in this article. Every diagnostic tool as well as report is a part from our archived history of the patients and has been throughly analysed. We also reviewed available literature using the key words retinitis pigmentosa, cystoid macular oedema, gene therapy. Case presentation: A 38 year old female patient for a low vision consultation. The patient was legally blind secondary to retinitis pigmentosa, which was diagnosed in her late 20s. She reported gradually progressive hazy central vision and decreasing peripheral vision in both eyes as well as severe night blindness. Other than the diagnosis of retinitis pigmentosa in both eyes,the patient had no other remarkable ocular conditions. Findings at that visit included unaided distance visual acuities VOD: 0,04 VOS: 0,06. Pupils were round with brisk responses. Extraocular muscle motility was full in both eyes. Confrontation methode visual fields were noted as temporal loss in the right eye and superior and temporal loss in the left eye. The perimetry test could not be performed due to the lack of correspondece of the patient even after a couple repetitions of the perimetry. She had normal ocular adnexa and quiet lids, conjunctiva, and sclera in both eyes. Corneas in both eyes were noted as clear epithelium, clear stroma, and clear endothelium. Anterior chambers had normal depth, iris with no pathological findings in both eyes; lens incipient sclerotic. Intraocular pressures were noted as 22 mmHg in both eyes with Icare, 21mmHg and 19 mmHg with aplanation tonometry; pahimetry corretional factor was +1 on both eyes. The vitreous was clear in both eyes. Both optic nerves were measured as 0.4 cup-to-disc ratios with no disc edema, disc hemorrhages, notching, or thinning noted.Waxy disc pallor and attenuated blood vessels were observed in both eyes. The macula in both eyes had retinal pigment epithelium (RPE) changes with no edema or hemorrhages. Bone spicule changes were noted 360 in the periphery of both eyes with no holes or tears(Figure 1a+1b+1c+1d). Conclusion: We presented two cases of retinitis pigmentosa - the mother with diagnosed RP more than 15 years ago in need for low vision rehabilitation service and the daughter that got diagnosed after our initial examination and with complications in visual impairment through cystoid macular oedema.
ABSTRACT
Background: Fuchs heterochromic iridocyclitis is a chronic, unilateral iridocyclitis characterized by iris heterochromia. The gradual progression of the disease leads to the development of cataracts, glaucoma, and, occasionally, vitreous infiltration. The trigger for inflammation of the iris and ciliary body is still unknown. There are several as yet unconfirmed theories about the mechanism of occurrence, including Toxoplasma gondii infection, immune dysfunction, infiltration of sensitized lymphocytes, and chronic herpes virus infection. Objective: The aim of this article is to present a case of Fuchs heterochromic iridocyclitis with complications in form of glaucoma and dense cataract in a female patient during a standard ophthalmologic exam in our clinic. The next aim is to show a proper algorithm of treatment in form of carbonic anhydrase inhibitors antiglaucoma medication, cataract surgery with implantation of the intraocular lens, yag laser capsulothomy. Case report: A 55-year-old patient reports to our clinic for an examination. She was informed 7 years ago by her ophthalmologist that her lack of vision in the right eye is irreparable. Ophthalmological examination as well as a positive TORCH test (elevation of IgG for toxoplasma gondii) lead to a diagnosis of Fuchs heterochromic iridocyclitis with complications of glaucoma and dense cataract. Antiglaucoma drops are prescribed, PHACO surgery is performed on the right eye with implantation of the intraocular lens, and yag laser capsulotomy in the follow ups. There was a significant improvement of the visual acuity from light sensation with uncertain projection of the same on the right eye, to 0,5-0,6 Snellen scale. We also educated the patient of her disease as well as the importance of her treatment and follow up consultations. Conclusion: Due to the insidious nature of this condition, along with a mild chronic course, most patients with FHI are not aware of the subtle changes that occur in their eyes. One of the most serious complications of FHI is secondary glaucoma, which can cause permanent vision loss in patients. The main cause of poor vision in patients with FHI is caused by cataract formation, with a prevalence of 23% to 90.7%. We placed special emphasis on educating the patient about her condition and the long-term and importance of regular check-ups to prevent possible recurrent or new complications.
ABSTRACT
BACKGROUND: Malignant hypertension is a condition characterized by severe hypertension and multiorganic ischemic complications. The underlying cause of malignant hypertension can be primary or secondary hypertension, and identification of the cause is mandatory to select the correct treatment to control blood pressure and reduce end-organ damage. Hypertensive retinopathy is a disease that has short-term and long-term consequences for the overall health and mortality of patients. OBJECTIVE: The aim of this article is to present a case of malignant hypertension and hypertnive maculopathy detected in a female patient as well as the positive response that occurs after administration of only one ampoule of triamcinolone subtenonially in two doses in monthly intervals. CASE REPORT: A 50-year-old patient comes to our clinic for an ophthalmological consultation after noticing impaired vision back a few months, especially noticeable on her left eye. Examination of the fundus visualizes PNO of unclear boundaries, especially in the inferior quadrants, mottled hemorrhages localized around the neuroretinal rim, edematous macula with hard deposits in the form of stelatae primarily on the left eye, and cotton wool exudates on the retina on both sides, nevus chorioidee of the right eye. Blood vessels hypertonically altered. On the OCT images of the macula, neurosensory retinal ablations are observed on both sides, intraretinal fluid with intraretinal hard deposits is present, more pronounced on the left. The seriousness of the condition is explained to the patient, as well as that in this state it requires urgent hospitalization, therapy is prescribed in the form of carbonic anhydrase inhibitors to preserve the macula, and a treatment algorithm is arranged in the form of subtenonial application of triamcinolone after dehospitalization. At check-ups, there is a subjective and objective positive shift in the patient's condition. CONCLUSION: The presence of hypertensive retinopathy may help to stratify the patient when assessing the future risk of stroke, coronary artery disease, and heart and kidney failure, even if the hypertension is well controlled.There is also a need to emphasize the obligatory symbiosis of internal medicine and ophthalmological disciplines, as well as to point out the fact that triamcinolone, as one of the very available and more affordable drugs, very effectively helps in the algorithm of treatment of these patients.