ABSTRACT
PURPOSE: To report the successful treatment of a 78-year-old woman with bilateral mantle cell lymphoma involving the optic nerves. Chemotherapy initially was administered in the form of intravitreal methotrexate (MTX) monotherapy and was subsequently combined with systemic ibrutinib. METHODS: Retrospective case report. The diagnosis of CD5-negative mantle cell lymphoma was confirmed via immunohistopathological analysis of an axillary lymph node. Serial ophthalmologic examinations in conjunction with fluorescein angiography, fundus photography, and spectral domain optical coherence tomography were used to assess the treatment response. RESULTS: Prompt improvement in optic nerve infiltration, no significant side effects, and excellent tolerability were noted after two weekly injections of unilateral intravitreal MTX monotherapy. Combined systemic treatment with ibrutinib and bilateral weekly MTX intravitreal injections then resulted in continued regression of optic nerve infiltration bilaterally as confirmed by serial fundus photography and optical coherence tomography. After eight additional bilateral weekly injections, a mild MTX-associated keratopathy developed, which resolved promptly with cessation of injections and administration of topical lubrication. Six weeks after MTX cessation, but with continued ibrutinib treatment, the optic nerves revealed near-complete resolution of the lymphomatous infiltration and the visual acuity improved. CONCLUSION: Intravitreal MTX injections and systemic ibrutinib may represent effective treatment options for patients diagnosed with intraocular mantle cell lymphoma.
Subject(s)
Lymphoma, Mantle-Cell/drug therapy , Methotrexate/administration & dosage , Optic Nerve Neoplasms/drug therapy , Optic Nerve/pathology , Adenine/analogs & derivatives , Aged , Antimetabolites, Antineoplastic/administration & dosage , Dose-Response Relationship, Drug , Drug Administration Schedule , Drug Therapy, Combination , Female , Fluorescein Angiography/methods , Follow-Up Studies , Fundus Oculi , Humans , Intravitreal Injections , Lymphoma, Mantle-Cell/diagnosis , Lymphoma, Mantle-Cell/physiopathology , Optic Nerve Neoplasms/diagnosis , Optic Nerve Neoplasms/physiopathology , Piperidines , Pyrazoles/administration & dosage , Pyrimidines/administration & dosage , Tomography, Optical Coherence/methods , Visual Acuity , Vitreous BodyABSTRACT
PURPOSE: To report treatment of vitamin A deficiency retinopathy with sublingual vitamin A drops. METHODS: Case report with review of the literature. RESULTS: A 69-year-old Caucasian woman with a history of small bowel resection presented with progressive symptoms of bilateral nyctalopia and decreased visual acuity. Ophthalmic examination revealed bilateral conjunctival xerosis and fine white granular deposits in the midperipheral retina suggestive of vitamin A deficiency. Full-field electroretinogram (ERG), multifocal ERG (mfERG), and two-color dark adaptometry revealed significant impairment of rod and cone photoreceptor function. Kinetic perimetry demonstrated depressed macular sensitivity with constriction of the finer isopters. After 5 months of treatment with sublingual vitamin A drops, the patient's vision, ERG, mfERG, dark adaptometry, and perimetry normalized. A review of the literature summarizing the electrophysiologic testing in vitamin A deficiency is also discussed. CONCLUSIONS: This case highlights novel observations on the effects of sublingual vitamin A supplementation for acquired vitamin A deficiency retinopathy. Sublingual vitamin A may represent a viable and efficacious treatment modality for vitamin A deficiency.
Subject(s)
Night Blindness/drug therapy , Retina/physiopathology , Vitamin A Deficiency/drug therapy , Vitamin A/analogs & derivatives , Administration, Sublingual , Aged , Diterpenes , Electroretinography , Female , Humans , Night Blindness/physiopathology , Retinyl Esters , Visual Acuity/physiology , Visual Field Tests , Visual Fields/physiology , Vitamin A/administration & dosage , Vitamin A/blood , Vitamin A Deficiency/physiopathologyABSTRACT
PURPOSE: To present a case of a 71-year-old woman with possible focal choroiditis and secondary serous neurosensory retinal detachment associated with atypical Cogan syndrome. METHODS: Retrospective case report. RESULTS: On initial evaluation, the patient had decreased vision with photopsias and distortion in the affected eye. Her history revealed 3 years of preexisting neurosensory hearing loss and corneal scarring in the affected eye. Examination findings were significant for unilateral interstitial keratitis and focal macular neurosensory retinal detachment. Fluorescein and indocyanine green angiography demonstrated focal macular leakage and staining. Treatment with intravitreal and periocular steroid injections resulted in complete resolution of the subretinal fluid and visual improvement. CONCLUSION: Posterior segment manifestations associated with Cogan syndrome are exceedingly rare. This is the first known case of a serous neurosensory retinal detachment from suspected choroidal inflammation associated with Cogan syndrome. Prompt recognition and treatment with corticosteroids may result in anatomical and functional visual improvement, as in this case.
Subject(s)
Cogan Syndrome/complications , Retinal Detachment/etiology , Aged , Choroiditis/etiology , Female , Humans , Keratitis/etiology , Retrospective Studies , Vestibular Diseases/etiology , Vision, Low/etiologyABSTRACT
PURPOSE: To report a novel case of acute bilateral uveal effusions, angle closure, and acute myopia induced by administration of chlorthalidone. METHODS: Case report. RESULTS: Bilateral shallow anterior chambers, high intraocular pressure, and a myopic shift were encountered in a patient 1 week after initiation of chlorthalidone. Ultrasound evaluation revealed bilateral ciliochoroidal effusions, appositional angle closure, and suspected ciliary body edema. Cessation of chlorthalidone, in addition to administration of cycloplegics and ocular antihypertensives, resulted in prompt resolution of this idiosyncratic reaction. CONCLUSIONS: The antihypertensive medication chlorthalidone may cause bilateral uveal effusions inducing acute angle-closure glaucoma and acute myopia.
