RESUMO
We report the case of a patient with multiple myeloma who presented acutely with bilateral vitelliform-like macular lesions. This 85-year-old Caucasian lady was referred for treatment of presumed bilateral neovascular age-related macular degeneration (nAMD). Interestingly, this was a few months after starting on chemotherapy for multiple myeloma. We performed a clinical examination and multimodal imaging. This comprised colour fundus photography, fundus autofluorescence, near-infrared fundus photography, spectral-domain optical coherence tomography, and optical coherence tomography angiography. These tests excluded nAMD and demonstrated instead vitelliform-like macular lesions. Subfoveal vitelliform-like macular lesions, believed to be subretinal deposition of immunoglobulin, are one of the retinal signs of multiple myeloma. This can present acutely mimicking nAMD. These retinal lesions can be a presenting manifestation of the disease or may present later on during the course of the disease. Therefore, acute presentation of vitelliform macular lesions in an elderly patient should arouse suspicion. Serum protein electrophoresis is recommended to detect multiple myeloma at an early stage.
RESUMO
Vogt-Koyanagi-Harada syndrome is a cause of noninfectious panuveitis, leading to significant vision loss in many patients. It is an autoimmune disease occurring in genetically susceptible individuals and clinically presents as bilateral panuveitis with serous retinal detachments and hyperemic, swollen optic discs, which are associated with neurological and auditory manifestations. Early diagnosis and prompt and adequate treatment with immunosuppressive agents (corticosteroids and other immunosuppressive drugs) may halt disease progression and prevent recurrences and vision loss. This review summarizes the current knowledge on the variable clinical aspects of this disease, highlighting diagnostic and treatment strategies.
RESUMO
The choroid is the vascular layer that supplies the outer retina and is involved in the pathogenesis of several ocular conditions including choroidal tumors, age related macular degeneration, central serous chorioretinopathy, diabetic retinopathy, and uveitis. Nevertheless, difficulties in the visualization of the choroid have limited our understanding of its exact role in ocular pathology. Enhanced depth imaging optical coherent topography (EDI-OCT) is a novel, noninvasive technique that is used to evaluate choroidal thickness and morphology in these diseases. The technique provides detailed objective in vivo visualization of the choroid and can be used to characterize posterior segment inflammatory disorders, monitor disease activity, and evaluate efficacy of treatment. In this review we summarize the current application of this technique in ocular inflammatory disorders and highlight its utility as an additional tool in monitoring choroidal involvement in ocular inflammation.
RESUMO
In glaucoma, the major cause of global irreversible blindness, there is an urgent need for treatment modalities that directly target the RGCs. The discovery of an alternative therapeutic approach, independent of IOP reduction, is highly sought after, due to the indirect nature and limited effectiveness of IOP lowering therapy in preventing RGC loss. Several mechanisms have been implicated in initiating the apoptotic cascade in glaucomatous retinopathy and numerous drugs have been shown to be neuroprotective in animal models of glaucoma. These mechanisms and their potential treatment include excitotoxicity, protein misfolding, mitochondrial dysfunction, oxidative stress, inflammation and neurotrophin deprivation. All of these mechanisms ultimately lead to programmed cell death with loss of RGCs. In this article we summarize the mechanisms involved in glaucomatous disease, highlight the rationale for neuroprotection in glaucoma management and review current potential neuroprotective strategies targeting RGCs from the laboratory to the clinic.
