RESUMO
A 58-year-old Caucasian female presented to the retina service with a 2-week history of bilateral decrease in vision. She had stage 4 renal cell carcinoma with osseous metastasis and choroidal metastasis for which she has been treated with Nivolumab immunotherapy. Her exudative retinal detachments resolved after cessation of Nivolumab in association with subtenon steroids (STK) and intravitreal bevacizumab injections. To the best of our knowledge, this is the first report in the literature describing the resolution of Nivolumab-related exudative retinal detachment after early local therapy using STK injections (10 mg), bevacizumab intravitreal injections, and cessation of Nivolumab. We hope by sharing this report to provide new insight into the management of similar patients.
RESUMO
BACKGROUND: To describe the dissection and removal of the anterior hyaloid membrane using the conventional surgical microscope. CASE PRESENTATION: This microscopic surgical approach involves dissecting the anterior hyaloid at the natural anatomical plane. A 30-gauge needle mounted on a 3.0 cc syringe is used to inject filtered air anterior to the anterior hyaloid membrane. Two patients needed this procedure; the first patient was pseudophakic with proliferative diabetic retinopathy, tractional retinal detachment, and vitreous hemorrhage. The second patient was phakic with proliferative diabetic retinopathy, anterior proliferative vitreoretinopathy, and recurrent vitreous hemorrhage. Both patients tolerated the procedure well with no complications. CONCLUSION: Pneumatic dissection of the anterior hyaloid membrane is previously thought to be only possible with the aid of ophthalmic endoscopy. This novel surgical approach provides surgeons with the option to perform pneumatic dissection of the anterior hyaloid when ophthalmic endoscopy is not available. Prospective studies are needed to reveal possible additional benefits or risks associated with this approach.
