RESUMO
A 35-year-old female with a history of metastatic breast cancer (BC) presented with unilateral blurred vision and floaters over 6 weeks. Examination findings showed vitreous opacities and a vasculitis concerning for an infectious process. Diagnostic vitrectomy revealed no infectious cause, but rather metastatic cells in the vitreous, with no obvious retinal or choroidal metastatic focus. In this report we illustrate a case of vitreous metastasis in a patient with metastatic BC, highlighting the importance of recognizing this rare entity which can mimic an inflammatory or infectious process. Novel to this report is the use of modern wide-field retinal imaging, spectral-domain optical coherence tomography, and a surgical video to document the findings of this disease entity.
RESUMO
PURPOSE: To use multimodal imaging to document the relatively rapid clinical evolution of handheld laser-induced maculopathy (HLIM). To demonstrate that inadvertent ocular injury can result from devices mislabeled with respect to their power specifications. METHODS: The clinical course of a 17-year-old male who sustained self-inflicted, central macular damage from a 20-25 s direct stare at a red-spectrum, handheld laser pointer ordered from an internet retailer is provided. Retrospective review of multimodal imaging that includes fundus photography, fluorescein angiography, MultiColor reflectance, eye-tracked spectral domain optical coherence tomography (SD-OCT), fundus autofluorescence, and microperimetry is used to describe the evolving clinical manifestations of HLIM in the first 3 months. RESULTS: Curvilinear bands of dense hyperreflectivity extending from the outer retina and following the Henle fibers were seen on SD-OCT immediately after injury. This characteristic appearance had largely resolved by 2 weeks. There was significant non-uniformity in the morphological characteristics of HLIM lesions between autofluorescence and reflectance images. The pattern of lesion evolution was also significantly different between imaging modalities. Analysis of the laser device showed its wavelength to be correctly listed, but the power was found to be 102.5-105 mW, as opposed to the <5 mW described on the label. CONCLUSION: While the immediate SD-OCT characteristics are highly specific for handheld laser -induced maculopathy, this finding can undergo rapid resolution in the span of several days. In the absence of this finding, other multimodal imaging clues and a careful history may aid in recognizing this diagnosis. A greater awareness regarding inaccurate labeling on some of these devices could help reduce the frequency of this preventable entity.
