Torpedo Maculopathy. A Case Report.

AIM: Torpedo maculopathy is an incidental, congenital retinal lesion. The typical clinical finding is a unilateral, symmetric, oval, hypopigmented lesion in the inferotemporal macula. In most cases, the lesion is along the horizontal raphe, is torpedo-shaped, and the nasal edge is directed into the foveola. The diagnosis is determined on the basis of its characteristic shape, localization and findings on optical coherence tomography (OCT). The etiology and pathogenesis of torpedo maculopathy is unclear, but it is believed to be a congenital defect of the retinal pigment epithelium (RPE). The aim of this publication is  highlight this diagnosis and to present an incidental finding of torpedo maculopathy in an adult patient. CASE REPORT: A 30-year-old female patient reported for a routine eye examination. Fundus examination of the right eye revealed an oval hypopigmented lesion with a size of 1 disk diameter inferotemporally from the fovea, which was followed by a satellite lesion in the same axis directed into the foveola. Based on OCT, OCT angiography, fundus autofluorescence, and the typical shape and location of the lesion, the patient was diagnosed with torpedo maculopathy in the right eye. CONCLUSION: In general, torpedo maculopathy is an asymptomatic, congenital, benign retinal lesion, which is mostly diagnosed accidentally during a routine fundus examination. TM is non-progressive retinal finding with a minimal risk of deterioration of visual functions, which does not require any treatment. Nevertheless, due to the rare risk of a choroidal neovascular membrane, it is recommended to examine patients once a year. It is necessary to consider this diagnosis when a unilateral hypopigmented lesion is found inferotemporally from the fovea, and to distinguish it from chorioretinal atrophy, scar, vitelliform dystrophy, or other RPE lesions as part of the differential diagnosis.

GIANT PROLACTINOMA. A CASE REPORT.

AIM: Prolactinoma is a pituitary adenoma that secretes prolactin. Approximately 40% of all pituitary adenomas are prolactinomas. According to size, they are divided into micro, macro and giant prolactinomas. In women, prolactinomas cause irregularities of the menstrual cycle such as amenorrhea, galactorrhea, weight gain, in both sexes they cause sterility, hypogonadism, decreased libido and depression. In macroadenomas, symptoms due to the compression of the surrounding structures are also manifested, such as headache, vomiting, lower chiasmatic syndrome and ophthalmoplegia. Loss of the visual field due to compression of the optic chiasm is caused by a tumor larger than 10-15 mm with suprasellar spreading, which breaks through the diaphragma sellae. Giant prolactinomas are larger than 40 mm and make up 1-5% of all prolactinomas. CASE REPORT: In this article I present the case of a 38-year-old woman from Ukraine with advanced chiasmatic syndrome caused by a giant prolactinoma. The tumor is infiltrating the left cavernous sinus, causing left-sided amaurosis and right-sided temporal hemianopsia. CONCLUSION: Inferior chiasmatic syndrome is characterized by bitemporal hemianopsia, a deterioration of visual acuity, bilateral bow-tie descendent atrophy of the optic nerve disc, and hemianopic rigidity of the pupils. Macroprolactinomas occur more frequently in men than in women. The diagnosis is often delayed, probably because the symptoms of hyperprolactinemia are less obvious in men, while women tend to present earlier due to menstrual cycle irregularities. Prolactinomas usually have a good prognosis. Effective medical treatment with dopamine agonists is available. Knowledge of the prolactinoma symptoms could help the diagnosis of compressive lesions of the optic chiasm.

ACUTE RETINAL NECROSIS AFTER INTRAVITREAL DEXAMETHASONE IMPLANT. A CASE REPORT.

INTRODUCTION: Ozurdex® (Allergan Pharmaceuticals, Castlebar Road, Westport, Ireland) is an intravitreal implant containing 0.7 mg of dexamethasone. It is indicated in adult patients for the treatment of diabetic macular edema, cystoid macular edema due to central retinal vein occlusion, and in patients with non-infectious uveitis. Common complications after Ozurdex® administration include an increase in intraocular pressure, cataract progression or conjunctival suffusion. Acute retinal necrosis after Ozurdex® administration is a very rare and serious complication. According to our current research, this is the fourth published case. Extreme caution must be exercised when treating immunosuppressed patients with Ozurdex®. CASE REPORT: This is case report about an immunosuppressed 68-year-old patient with diabetic macular edema, who developed acute retinal necrosis 74 days after Ozurdex® implantation. He suffers from chronic myeloid leukemia and takes the cytostatic imatinib 400 mg once per day. Urgent pars plana vitrectomy (PPV) with silicone oil instillation was performed and antiherpetic drugs were initiated intravenously. Serological examination confirmed an active infection of cytomegalovirus etiology (CMV). CONCLUSION: Acute retinal necrosis is a rare necrotizing retinitis. Corticosteroids administered intravitreally reduce the local immune response, which may cause a primary infection or reactivation of a latent viral infection.

IDIOPATHIC SCLEROCHOROIDAL CALCIFICATIONS. A CASE REPORT.

AIM: Sclerochoroidal calcifications (SCHC) are an uncommon benign ocular condition that occurs in elderly patients. SCHC usually manifest as multiple placoid yellow lesions in the midperipheral fundus, most often in the upper temporal quadrant. They are asymptomatic and often discovered during routine eye examinations in a patient with good visual acuity and visual field. According to the etiology, SCHC are divided into idiopathic, metastatic and dystrophic. CASE REPORTS: This is case report of 2 patients with idiopathic SCHC, who underwent basic eye examinations, fundus photography, optical coherence tomography, ultrasonography, fluorescein angiography, fundusautofluorescence, laboratory screening and in the second case also CT head scan. CONCLUSION: The aim of this publication is to point out the typical features of SCHC and their distinction from more serious conditions that they may resemble.