scholarly journals Anterior Segment Scleral Fluorescein Angiography in the Evaluation of Ciliary Body Neoplasm: Two Case Reports

2016 ◽  
Vol 7 (1) ◽  
pp. 30-38 ◽  
Author(s):  
Amir H. Marvasti ◽  
Jesse Berry ◽  
Maria E. Sibug Saber ◽  
Jonathan W. Kim ◽  
Alex S. Huang
Keyword(s):  
Ciliary Body ◽  
Case Reports ◽  
Anterior Segment ◽  
Caucasian Male ◽  
Improved Outcomes ◽  
Diagnostic Modalities ◽  
Case Presentations ◽  
Conjunctival Vessels ◽  
Ciliary Body Tumor ◽  
Ciliary Body Melanoma

Introduction: Anterior segment tumors can be difficult to detect until tumor growth is substantial enough to cause local signs or symptoms. Earlier detection may result in improved outcomes, particularly the ability to option for globe-conserving therapy. Multiple diagnostic modalities such as ultrasound or optical coherence tomography exist to aid for earlier detection of ciliary body tumors, but they also have limitations. Here we describe the potential for scleral angiography as an adjunctive modality to assist in evaluating anterior segment ciliary body tumors. Case Presentations: A 61-year-old Caucasian male and a 57-year-old Hispanic female presented for ciliary body tumor evaluation. The Caucasian male notably had abnormal scleral, episcleral, and conjunctival vessels in the affected eye. Scleral angiography was performed in both cases with the abnormal vasculature highlighted in the Caucasian male. The Hispanic female did not demonstrate abnormal scleral angiographic patterns. Notably, the Caucasian male also had regions of abnormal scleral angiography arising in locations of otherwise normal appearing sclera. Both patients had the affected eyes enucleated. Histology of the enucleated eyes demonstrated a ciliary body melanoma in the Caucasian male associated with abnormal vascular and tumor infiltration of the scleral bed. The Hispanic female had a pigmented ciliary body adenoma without involvement of the scleral bed. Conclusion: With limited sample size, scleral angiography has the potential to detect abnormal scleral vascular patterns in otherwise normal appearing sclera in cases of ciliary body tumor with scleral vascular invasion.

scholarly journals Newly detected rapid eye movement associated sleep apnea after coronavirus disease 2019 as a possible cause for chronic fatigue: two case reports

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Andreas Rembert Koczulla ◽  
Antje Stegemann ◽  
Rainer Gloeckl ◽  
Sandra Winterkamp ◽  
Bernd Sczepanski ◽  
...  
Keyword(s):  
Sleep Apnea ◽  
Eye Movement ◽  
Case Reports ◽  
White Male ◽  
Chronic Fatigue ◽  
White Female ◽  
Rapid Eye Movement ◽  
Pressure Therapy ◽  
Fatigue Syndrome ◽  
Case Presentations

Abstract Background Coronavirus disease 2019 has become a health problem spreading worldwide with pandemic characteristics since March 2020. Post coronavirus disease 2019 symptoms are more frequent than initially expected, with fatigue as an often-mentioned issue. Case presentations We describe a 32-year-old white male and a 55-year-old white female who suffered from post coronavirus disease 2019 fatigue syndrome. On polysomnography, rapid eye movement associated sleep apnea with an increased hypopnea index during rapid eye movement phases of 36.8 and 19.5 events per hour was found. Based on the patients’ burdensome fatigue symptoms, we initiated automatic positive airway pressure therapy, which diminished sleep apnea (rapid eye movement index: 0.0 in both patients) and, consequently, also the fatigue symptoms. Conclusions Since sleep apnea and coronavirus disease 2019 are both associated with fatigue, a screening for sleep apnea might be considered in coronavirus disease 2019 patients with fatigue syndrome.

Successful treatment of arthritis induced by checkpoint inhibitors with tocilizumab: a case series

2017 ◽  
Vol 76 (12) ◽  
pp. 2061-2064 ◽  
Author(s):  
Sang Taek Kim ◽  
Jean Tayar ◽  
Van Anh Trinh ◽  
Maria Suarez-Almazor ◽  
Salvador Garcia ◽  
...  
Keyword(s):  
Checkpoint Inhibitors ◽  
Case Reports ◽  
Unmet Need ◽  
Case Series ◽  
Receptor Antibody ◽  
Improved Outcomes ◽  
Clinical Scenarios ◽  
Significant Clinical Improvement ◽  
Tnfα Inhibitor ◽  
Factor Α

BackgroundImmune checkpoint inhibitors (ICIs) have significantly improved outcomes for patients with numerous cancers. However, these therapies are associated with immune-related adverse events (irAEs), which are inflammatory side effects potentially affecting any organ. Cases of ICI-induced inflammatory arthritis have also been reported. In general, mild irAEs are treated with corticosteroids, while tumour necrosis factor-α (TNFα) inhibitors are reserved for refractory cases. However, prolonged use of TNFα inhibitor (TNFαi) can induce widespread, significant immunosuppression, which can negatively impact the antitumour efficacy of ICI therapy. Therefore, in clinical scenarios where patients develop severe immunotherapy-induced irAEs, an unmet need exists for alternative therapeutic strategies that are effective and without immune dampening effects.Case reportsThe anti-interleukin (IL)−6 receptor antibody, tocilizumab, is a biological agent Food and Drug Administration approved for the treatment of rheumatoid arthritis and juvenile idiopathic arthritis. Here, we report on three patients who developed severe polyarthritis while receiving ICI therapy and were treated with tocilizumab. All three patients demonstrated significant clinical improvement; one patient maintained a durable antitumour response derived from checkpoint inhibition.ConclusionsThese three cases suggest that anti-IL-6 receptor antibody may be an effective alternative to corticosteroids or TNFαi for the treatment of arthritis irAEs.

scholarly journals Visual Acuity, Contrast Sensitivity and Color Vision Three Years After Iodine-125 Brachytherapy for Choroidal and Ciliary Body Melanoma

2015 ◽  
Vol 9 (1) ◽  
pp. 131-135 ◽  
Author(s):  
Irena Tsui ◽  
Robert M Beardsley ◽  
Tara A McCannel ◽  
Scott C Oliver ◽  
Melissa W Chun ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Contrast Sensitivity ◽  
Color Vision ◽  
Ciliary Body ◽  
Case Series ◽  
Vision Measurement ◽  
Corrected Visual Acuity ◽  
Iodine 125 ◽  
Decrease In Visual Acuity ◽  
Ciliary Body Melanoma

Purpose : To report visual acuity, contrast sensitivity and color vision prior to, 1 year after, 2 years after and 3 years after iodine-125 brachytherapy for choroidal and ciliary body melanoma (CCM). Design : Prospective interventional case series. Participants : Thirty-seven patients (37 eyes) with CCM. Methods : Patients had best-corrected Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity, Pelli-Robson contrast sensitivity and Hardy-Rand-Rittler color vision measurement; comprehensive ophthalmology examination; optical coherence tomography; and ultrasonography at baseline prior to, 1 year after, 2 years after and 3 years after I-125 brachytherapy. Main Outcome Measures : Visual acuity, contrast sensitivity and color vision prior to, 1 year after, 2 years after and 3 years after brachytherapy. Results : Nineteen (19) men and 18 women with mean age of 58 years (SD 13, range 30-78) prior to, 1 year after, 2 years after and 3 years after brachytherapy had mean best-corrected visual acuity of 77 letters (20/32), 65 letters (20/50), 56 letters (20/80) and 47 letters (20/125); contrast sensitivity of 30, 26, 22 and 19 letters; color vision of 26, 20, 17 and 14 test figures, respectively. Decrease in visual acuity, contrast sensitivity and color vision was statistically significant from baseline at 1 year, 2 years, and 3 years after brachytherapy. Decreased acuity at 3 years was associated with mid-choroid and macula melanoma location, ≥ 4.1 mm melanoma height, radiation maculopathy and radiation optic neuropathy. Conclusion : 1, 2 and 3 years after brachytherapy, eyes with CCM had significantly decreased visual acuity, contrast sensitivity and color vision.

scholarly journals COVID-19 Recombinant mRNA Vaccines and Serious Ocular Inflammatory Side Effects: Real or Coincidence?

2021 ◽  
Author(s):  
Arash Maleki ◽  
Sydney Look-Why ◽  
Ambika Manhapra ◽  
Charles Stephen Foster
Keyword(s):  
Inflammatory Diseases ◽  
Case Reports ◽  
Anterior Segment ◽  
Posterior Segment ◽  
Ischemic Optic Neuropathy ◽  
Temporal Artery Biopsy ◽  
Dexamethasone Implant ◽  
Intravitreal Dexamethasone Implant ◽  
The Right ◽  
Intravitreal Dexamethasone

Purpose: To report two cases; bilateral arteritic anterior ischemic optic neuropathy (AAION) and bilateral acute zonal occult outer retinopathy (AZOOR) after COVID-19 mRNA vaccination. Case Reports: The first patient was a 79-year-old female was presented to us 35 days after a sudden bilateral loss of vision, which occurred two days after receiving the second recombinant mRNA vaccine (Pfizer) injection. Temporal artery biopsy was compatible with AAION. At presentation, the best-corrected visual acuity was 20/1250 and 20/40 in the right and left eyes on the Snellen acuity chart, respectively. There was 3+ afferent pupillary defect in the right eye. The anterior segment and posterior segment exams were normal except for pallor of the optic nerve head in both eyes. Intraocular pressure was normal in both eyes. She was diagnosed with bilateral AAION and Subcutaneous tocilizumab 162 mg weekly was recommended with monitoring her ESR, CRP, and IL-6. The second patient was a 33-year-old healthy female who was referred to us for a progressive nasal field defect in her left eye, and for flashes in both eyes. Her symptoms started 10 days after receiving the second recombinant mRNA vaccine (Moderna) injection. Complete bloodwork performed by a uveitis specialist demonstrated high ESR (25) and CRP (19) levels. As a result, she was diagnosed with unilateral AZOOR in her left eye and was subsequently treated with an intravitreal dexamethasone implant in the same eye. At presentation, vision was20/20 in both eyes. The anterior segment and posterior segment exams were completely normal except for the presence of abnormal white reflex in the temporal macula of her left eye. We diagnosed her with bilateral AZOOR. Since she was nursing, intravitreal dexamethasone implant was recommended for the right eye. Conclusion: There may be a correlation between ocular inflammatory diseases with autoimmune mechanism and the mRNA COVID-19 vaccination.

scholarly journals Longitudinal Study on Ocular Manifestations in a Cohort of Patients with Fabry Disease

2019 ◽  
Author(s):  
Langis Michaud
Keyword(s):  
Anterior Segment ◽  
Published Data ◽  
Retinal Vessels ◽  
Enzyme Replacement ◽  
Corneal Haze ◽  
Ocular Manifestations ◽  
Ocular Pressure ◽  
Upper Lid ◽  
Group 2 ◽  
Conjunctival Vessels

ABSTRACTPurposeThis study aims to assess the evolution of ocular manifestations in a cohort of Fabry patients.METHODSThis is a prospective observational study conducted from 2013 to 2017 (5 consecutive exams). All subjects underwent a comprehensive ocular examination including oriented case history, refraction, corneal topography, biomechanical corneal properties and pachometry assessments, aberrometry, anterior segment evaluation, double-frequency visual field (FDT), intra-ocular pressure, and ocular fundus. At baseline, 41 subjects enrolled but 9 dropped-out and 4 files were not kept for analysis (missing data). Remaining 28 subjects were classified into: Group 1 -hemizygotes (HMZ), all on enzyme replacement therapy (ERT) (N=10); Group 2 -heterozygotes (HTZ) actively ERT-treated (N=8), and Group 3 -HTZ not treated (N=10).RESULTSThere is a high intra and inter-subjects variability. At baseline, prevalence of the ocular manifestations found is similar to published data: cornea verticillata (89.2%), conjunctival vessels tortuosity (85.7%), corneal haze (67.8%), retinal vessels tortuosity (64.2%), anterior cataract (39.2%) and posterior cataract (28.5%). Prevalence for new elements are found: upper lid vessels toricity (96.4%) and micro-aneurysms (42.8%). At the end, micro-aneurysms (+82%), posterior cataract (+75%) corneal haze (+21%) anterior cataract (+17%) and retinal vessels tortuosities (+4%) evolved in prevalence and severity despite the fact that 68% of the patients were on ERT. Treated heterozygotes evolved more than other groups (p>0.05)CONCLUSIONERT does not halt the clinical evolution of several ocular manifestations. Longer observational time may be required to fully confirm these findings.

EP.TH.112The Use Ex-Vivo Renal Autotransplantation to Treat Hypertension Secondary to Renal Artery Disease: Two Case Reports

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Noman Saghir ◽  
Reyan Saghir ◽  
Bruno Machado ◽  
Rene Murilo ◽  
Manoj Poojary ◽  
...  
Keyword(s):  
Renal Artery ◽  
Ex Vivo ◽  
Case Reports ◽  
Previous Treatment ◽  
Neoplastic Disease ◽  
Improved Outcomes ◽  
Renal Autotransplantation ◽  
Artery Disease ◽  
The University ◽  
Renal Artery Disease

Abstract Renal Auto transplantation (RAT) is the surgical procedure in which the kidney is initially removed and subsequently re-implanted in a different position, allowing for improved outcomes in conditions involving ureteral pathology, renovascular and neoplastic disease primarily. In this paper, we aim to build upon the understanding of RAT and especially its effectiveness in treating patients with hypertension secondary to renal artery disease, intolerant to previous treatment approaches. In particular, the ex-vivo technique will be focused upon as introduced by Ota et al. in 1967 whereby the use of the workbench is frequently applied for patients requiring in excess of 45 minutes of ischaemic time. We, therefore, put forth two cases managed in co-operation by the University of Arkansas vascular and urology departments. The first of which was a 52-year-old woman with an aneurysmal Lesion reaching the renal artery at the hilum. The second was an 18-year-old woman with Takayasu arteritis. The use of vasopressin had preserved some renal function however at the time of the diagnosis, they were experiencing difficulty in controlling their hypertension, and thus RAT was performed, and the subsequent patient postoperative outcomes and effectiveness have been recorded and analysed as part of this study.

Ciliary Body Melanoma

2012 ◽  
pp. 351-354
Author(s):  
Harry H. Brown ◽  
Chris Bergstrom
Keyword(s):  
Ciliary Body ◽  
Ciliary Body Melanoma

Youssef syndrome with a summary of management options

2021 ◽  
Vol 14 (8) ◽  
pp. e244247
Author(s):  
Anupama Bahadur ◽  
Anoosha K Ravi ◽  
Megha Ajmani ◽  
Rajlaxmi Mundhra
Keyword(s):  
Case Reports ◽  
Therapeutic Options ◽  
Urinary Continence ◽  
Type I ◽  
Ct Urography ◽  
Lower Segment ◽  
Management Options ◽  
Urogenital Fistula ◽  
Diagnostic Modalities ◽  
Youssef Syndrome

Vesicouterine fistula is one of the rare varieties of urogenital fistula. Type I urogenital fistula or Youssef syndrome is characterised by menouria, amenorrhoea and urinary continence and it mostly follows lower segment caesarean delivery. There are only scattered case reports to help guide diagnostic and therapeutic options for this condition. These patients mostly need a combination of diagnostic modalities to confirm the diagnosis. Here, we present one such case of para 4 live 4 with classical symptoms of Youssef syndrome following a laparotomy for uterine rupture repair. CT urography confirmed the diagnosis and cystoscopy helped localise the exact location. Transabdominal fistula excision and repair was done. The paper also presents a summary of diagnostic and therapeutic options for this condition as reported in previous case reports for easy reference for practising gynaecologists and urologists.

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