ABSTRACT
UNLABELLED: The purpose of this study is to present the first case of a pure 'topiramate maculopathy' without acute glaucoma and/or myopia, which form the classical syndrome. DESIGN: Interventional/observational case report. SETTING: Institutional University Teaching Hospital. PATIENT: A 22-year-old American female, after taking 100 mg of topiramate (Topamax®) a day for 6 days because of a migraine attack, complained of severe visual acuity deterioration of sudden onset in both eyes, regardless of distance (far or near), during the span of 1 day. A complete ocular examination was carried out. Best-corrected visual acuity (BCVA) in the right eye was hand motion and in the left eye was counting fingers. Cycloplegic refraction and pinhole did not improve the visual acuity of patient's eyes. The anterior chamber depth was normal in both eyes. Tonometry was 14 mmHg in both eyes. Fundus biomicroscopy disclosed a maculopathy with macular striae and a cellophane-like reflex. Optical coherence tomography (OCT) showed an undulating profile with congruent retinal folds and choroidal layers plicae. INTERVENTIONAL/OBSERVATION PROCEDURE: Immediate discontinuation of Topamax and steroid therapy. MAIN OUTCOME MEASURES: BCVA, cycloplegic refraction, tonometry, fundus photography, and OCT. Three days after suspension of Topomax and steroid therapy the patient's BCVA was 6/6 in both eyes. Tonometry was 14 mmHg in both eyes. Fundus appearance and OCT features were nearly normal. After 2 years of follow-up, the patient's BCVA, tonometry, macula, and OCT are stable in both eyes. In conclusion, an isolated (unassociated with glaucoma and/or induced myopia) acute maculopathy, previously known as being part of a rare syndrome, has been identified, described, and documented.
Subject(s)
Fructose/analogs & derivatives , Macula Lutea/pathology , Retinal Diseases/chemically induced , Anticonvulsants/adverse effects , Diagnosis, Differential , Female , Fluorescein Angiography , Fructose/adverse effects , Fundus Oculi , Humans , Macula Lutea/drug effects , Migraine Disorders/drug therapy , Retinal Diseases/diagnosis , Tomography, Optical Coherence , Topiramate , Young AdultSubject(s)
Eye Injuries, Penetrating/etiology , Iris Diseases/etiology , Iris/injuries , Lens, Crystalline/physiology , Corneal Injuries , Eye Injuries, Penetrating/surgery , Eyelids/injuries , Gonioscopy , Humans , Intraocular Pressure/physiology , Iris Diseases/surgery , Male , Metals/adverse effects , Middle Aged , Ophthalmologic Surgical Procedures , Rupture , Sclera/injuries , Suture Techniques , Visual Acuity/physiologyABSTRACT
PURPOSE: A pilot study to test a novel, minimal invasive vitrectomy, through one-port pars plana sclerotomy, by 25-G instruments, for selected vitreous, macular and vitreomacular interface disorders. SETTING: institutional. DESIGN: interventional, prospective case series of 14 eyes of 14 patients. The "one-port pars plana vitrectomy" (OPPPV) by 25-G micro-instruments was performed on seven pseudophakic eyes, and the "phacoemulsification OPPPV" (phaco OPPPV) by 25-G on seven presbyopic/cataract phakics. Minimal vitrectomy on eight eyes. Subtotal vitrectomy on six eyes. FOLLOW-UP: 12 months. Main outcome endpoints: surgical feasibility/suitability, patient tolerability, post-operative recovery time. Intra- and post-operative complications were recorded. RESULTS: All OPPPVs by 25 G were completed as planned. Anatomical surgical objectives were fulfilled on all eyes; functional ones on 13 out of 14 eyes. The whole OPPPV group and four of the phaco OPPPV subset of patients tolerated comfortably less than 30' surgical time, and three phaco OPPPV ones less than 45'. Full regimen anti-inflammatory therapy for 2 weeks kept ten eyes out of 14 stable. Post-operatively, two eyes developed a transient alteration of the intraocular pressure. At the end of the follow-up, neither retinal detachment nor endophthalmitis occurred. CONCLUSIONS: OPPPV by 25 G techniques promise to be an effective,comfortable, possible office-based alternative "micro-incisional, minimal invasive vitreous surgery" for selected vitreous, macula and vitreomacular interface disorders. Future research on the safety of the OPPPV by 25 G techniques compared to conventional ones is encouraged.
Subject(s)
Microsurgery/methods , Minimally Invasive Surgical Procedures , Vitrectomy/methods , Adult , Aged , Female , Humans , Intraoperative Complications , Male , Middle Aged , Phacoemulsification , Pilot Projects , Postoperative Complications , Pseudophakia/complications , Retinal Diseases/surgery , Sclerostomy/methods , Time Factors , Visual AcuityABSTRACT
This interventional case report presents an anterior chamber intraocular lens (AC-IOL) translocation technique to manage a case of uveitis-glaucoma-hyphema (UGH) syndrome associated with posterior dislocation of nuclear fragments and vitreitis as a consequence of capsule rupture during cataract surgery. Pars plana vitrectomy followed by an AC-IOL translocation from the anterior chamber to the sulcus without additional surgical corneal incision was performed. At 12 months' follow-up, the original AC-IOL was in stable position in the posterior chamber, with binocular refractive balance and no further astigmatism and resolution of the UGH syndrome.
