Perinuclear Antineutrophil Cytoplasmic Antibody-Associated Ocular Manifestations: Case Series and Literature Review.

PURPOSE: To investigate the diversity of ocular manifestations in patients with positive perinuclear antineutrophil cytoplasmic antibody (p-ANCA). METHODS: The clinical records of five patients exhibiting ocular manifestations and testing positive for serum MPO-ANCA were retrospectively reviewed. RESULTS: Three out of five patients were female. The youngest patient was aged 26, whereas the eldest was 83 years old. 80% (n = 4) of them had purely anterior segment involvement, with the commonest manifestation being peripheral ulcerative keratitis and scleritis. Only one patient had posterior segment involvement, specifically posterior ischemic optic neuropathy. Two patients demonstrated unilateral involvement. There was only one patient diagnosed with systemic involvement, presenting as mixed nephrotic and nephritic syndrome, who required a course of intravenous methylprednisolone during the active stage. Three patients required second-line immunosuppressants throughout the course due to frequent relapse. CONCLUSION: Anterior segment ocular manifestations are not uncommon and can be the initial presentation of p-ANCA-associated vasculitis (AAV). Therefore, its evaluation should be considered in establishing the diagnosis of AAV, a life-threatening disease.

Xerophthalmia in Picky Eater Children.

Xeropthalmia refers to a range of ocular symptoms caused by vitamin A deficiency (VAD), ranging from night blindness and Bitot's spots to corneal xerosis, ulceration, and keratomalacia, which can lead to blindness. We report two cases of xerophthalmia in children with intellectual disabilities. Ocular examination revealed generalized conjunctival xerosis, corneal xerosis, and dense superficial punctate keratopathy. Both share a history of a strict self-selective diet of mainly rice and noodles. Serum vitamin A levels for these children showed a very low level (<0.10 µmol/L) and were categorized as severe VAD. One of the cases showed signs of improvement, and the other one succumbed to death secondary to pneumonia. Therefore, proper history-taking, early detection, and prompt treatment are important to prevent the devastating sequelae of VAD.

Unilateral rhino-orbital-cerebral mucormycosis with contralateral endogenous fungal endophthalmitis.

Rhino-orbital-cerebral mucormycosis (ROCM) is an uncommon but fatal fungal infection. We report a rare case of unilateral ROCM with ipsilateral central retinal artery occlusion and contralateral choroiditis, which later progressed to endogenous fungal endophthalmitis. The patient was successfully treated with sinuses debridement, systemic liposomal amphotericin B, and intravitreal amphotericin B. The endophthalmitis completely resolved with good vision, but the ROCM eye remained blind due to central retinal artery occlusion.