Chorioretinopathy

脉络膜视网膜病变
  • 文章类型: Case Reports
    背景:小头症伴或不伴脉络膜视网膜病变,淋巴水肿,或智力低下是一种罕见的常染色体显性遗传疾病,由KIF11突变引起,破坏EG5蛋白功能,由于其在视网膜感光纤毛中的表达,影响视网膜和淋巴结构的发育和维持。MCLMR的主要眼部发现是脉络膜视网膜病变。额外的功能可以包括小眼症,闭角型青光眼,持续性增生性原发性玻璃体,白内障,假性结肠瘤,持续性玻璃样动脉,和近视或远视散光。脉络膜视网膜病变的外观为白色至粉红色,圆形,没有血管的非升高的萎缩性区域类似于艾卡迪综合征的腔隙。由于缺乏对病变的系统描述和显着的表型变异性,每个案件都需要一份详细的报告。
    方法:一名在妊娠晚期发现小头畸形的儿童,由于视觉上无意义的白内障,开始在眼科随访。不久之后,她出现了眼球震颤和交叉固定的大角度交替内斜视。她的眼底最初显示出苍白的视盘和色素变化,此后发展视网膜腔隙和视网膜褶皱。她的鉴别诊断伴随着眼底的动态变化,其中包括先天性感染,Leber先天性黑蒙和艾卡迪综合征。在19个月大的时候,遗传检测确定了杂合突变(c.1159C>T,p.Arg387*)在KIF11基因中。患者在2岁时因持续性内斜视接受了双侧内侧直肌收缩手术,有显著的改进。屈光度显示双眼远视散光(0.25-2.50×180OD和0.75-2.00×170OS)。她仍然需要每天2小时的右眼修补。
    结论:该病例报告通过展示独特的视网膜特征组合,扩展了MCLMR的表型谱,为Aicardy综合征的鉴别诊断提供了新的思路。我们的发现强调了与MCLMR相关的显着表型变异性,尤其是眼部受累。这强调了详细的临床评估和全面报告病例的重要性,以提高我们对疾病谱和基因型-表型相关性的理解。
    BACKGROUND: Microcephaly with or without chorioretinopathy, lymphedema, or mental retardation is a rare autosomal dominant disease caused by mutations in KIF11 which disrupt EG5 protein function, impacting the development and maintenance of retinal and lymphatic structures due to its expression in the retinal photoreceptor cilia. The primary ocular finding in MCLMR is chorioretinopathy. Additional features can include microphthalmia, angle-closure glaucoma, persistent hyperplastic primary vitreous, cataract, pseudo-coloboma, persistent hyaloid artery, and myopic or hypermetropic astigmatism. The appearance of the chorioretinal lesions as white to pinkish, round, non-elevated atrophic areas devoid of blood vessels resembles the lacunae in Aicardy syndrome. Due to the lack of systematic description of the lesions and significant phenotypical variability, there is an impending need for a detailed report of each case.
    METHODS: A child with microcephaly detected in the third trimester of gestation began her following in the ophthalmology department due to a non-visually significant cataract. Shortly after, she developed nystagmus and large-angle alternating esotropia with cross-fixation. Her fundus initially showed a pallid optic disc and pigmentary changes, developing thereafter retinal lacunae and a retinal fold. Her differential diagnosis accompanied the dynamic changes in her fundus, which included congenital infections, Leber´s Congenital Amaurosis and Aicardy syndrome. At 19 months old, genetic testing identified a heterozygous mutation (c.1159 C > T, p.Arg387*) in the KIF11 gene. The patient underwent bilateral medial rectus muscle recession surgery at 2 years old for persistent esotropia, with significant improvement. Refraction revealed a hyperopic astigmatism in both eyes (+ 0.25 -2.50 × 180 OD and + 0.75 -2.00 × 170 OS). She continues to require right eye patching for 2 hours daily.
    CONCLUSIONS: This case report expands the phenotypic spectrum of MCLMR by demonstrating a unique combination of retinal features which sheds new light on differential diagnosis from Aicardy syndrome. Our findings emphasize the significant phenotypic variability associated with MCLMR, particularly regarding ocular involvement. This underscores the importance of detailed clinical evaluation and comprehensive reporting of cases to improve our understanding of the disease spectrum and genotype-phenotype correlations.
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  • 文章类型: Case Reports
    背景:慢性肉芽肿病(CGD)是一种罕见的免疫缺陷性疾病,其特征是吞噬功能受损,导致反复感染和肉芽肿形成。NADPH氧化酶复合物成分的基因突变,比如CYBB,NCF1、NCF2和CYBA基因,有助于发病机制。此病例报告探讨了与CGD相关的可能的眼部和血液学并发症。
    方法:一个有玻璃体切除术史的6岁女孩,膜切开术,由于先天性失明(诊断为脉络膜视网膜病变),激光治疗因全身性瘀斑和血小板减少而被转诊至医院。诊断检查最初建议慢性免疫性血小板减少性紫癜(ITP)。随后入院显示有坏死伤口,尿路感染,和复发性血小板减少症。怀疑免疫缺陷,CGD测试,进行了硝基蓝四唑(NBT)和二氢罗丹明(DHR)。她有一个低DHR(6.7),她的NBT测试为阴性(0.0%)。她的整个外显子组测序结果证实常染色体隐性CGD具有纯合NCF1突变。
    结论:该病例强调了CGD的各种临床表现,包括复发性血小板减少症和可能的早发性眼部受累。诊断挑战突出了涉及血液学家的多学科方法的重要性。免疫学家,和眼科医生进行准确的诊断和管理。在CGD中ITP的罕见共存强调了免疫缺陷和自身免疫之间的复杂联系,需要量身定制的治疗策略。
    BACKGROUND: Chronic Granulomatous Disease (CGD) is a rare immunodeficiency disorder characterized by impaired phagocytic function, leading to recurrent infections and granuloma formation. Genetic mutations in NADPH oxidase complex components, such as CYBB, NCF1, NCF2, and CYBA genes, contribute to the pathogenesis. This case report explores the possible ocular and hematologic complications associated with CGD.
    METHODS: A 6-year-old girl with a history of vitrectomy, membranotomy, and laser therapy due to congenital blindness (diagnosed with chorioretinopathy) was referred to the hospital with generalized ecchymosis and thrombocytopenia. Diagnostic workup initially suggested chronic immune thrombocytopenic purpura (ITP). Subsequent admissions revealed necrotic wounds, urinary tract infections, and recurrent thrombocytopenia. Suspecting immunodeficiency, tests for CGD, Nitroblue tetrazolium (NBT) and dihydrorhodamine (DHR) were performed. She had a low DHR (6.7), and her NBT test was negative (0.0%). Her whole exome sequencing results confirmed autosomal recessive CGD with a homozygous NCF1 mutation.
    CONCLUSIONS: This case underscores the diverse clinical manifestations of CGD, including recurrent thrombocytopenia and possible early-onset ocular involvement. The diagnostic challenges highlight the importance of a multidisciplinary approach involving hematologists, immunologists, and ophthalmologists for accurate diagnosis and management. The rare coexistence of ITP in CGD emphasizes the intricate link between immunodeficiency and autoimmunity, requiring tailored therapeutic strategies.
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  • 文章类型: Journal Article
    报告2例疱疹性带状疱疹全葡萄膜炎和脉络膜视网膜病变伴脉络膜色素沉着不足的患者。
    两名患者的回顾性图表回顾。
    我们报告了一系列两名有HZO病史的眼眶炎症和全葡萄膜炎患者,出现斑片状脉络膜色素脱失与脉络膜病变一致。在两种情况下,病变都很广泛,并累及后极和中周。两种情况都显示了椭球区损失的分散区域,荧光素血管造影显示相应的晚期高荧光。OCTA在一种情况下显示出脉络膜毛细血管水平的流动空隙。
    我们的系列研究表明,疱疹性脉络膜视网膜病变可能是一个相对良性的过程,表现较晚,可能涉及大面积的后脉络膜。
    UNASSIGNED: To report two patients with herpetic zoster panuveitis and chorioretinopathy with choroidal hypopigmentation.
    UNASSIGNED: Retrospective chart review of two patients.
    UNASSIGNED: We report a series of two patients with a history of HZO with orbital inflammation and panuveitis, who developed patchy choroidal depigmentation consistent with a choroidopathy. The lesions were extensive and involved the posterior pole and mid-periphery in both cases. Both cases demonstrated scattered areas of ellipsoid zone loss, and fluorescein angiography showed corresponding late hyperfluorescence. OCTA in one case demonstrated flow voids at the level of choriocapillaris.
    UNASSIGNED: Our series suggests that herpetic chorioretinopathy may be a relatively benign process that presents late and may involve large areas of the posterior choroid.
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  • 文章类型: Review
    小头症和脉络膜视网膜病变(MCCRP)是一种罕见的常染色体隐性(AR)疾病,以小头症为特征,发育迟缓,脉络膜视网膜病变,和视力障碍。我们表征了另一位MCCRP与TUBCGP4致病变异相关的患者的长期表型,并分析了文献中先前报道的病例。
    分析患有TUBGCP4相关MCCRP的患者的临床和遗传数据超过19年,并使用PubMed对先前报道的TUBCGP4变异患者进行文献搜索,Scopus,谷歌学者。
    使用外显子组测序进行的分子诊断证明了两种反式TUBCGP4变体:c.1669C>T(p。Arg557*)和c.1746G>T(p。Leu582=)。临床特征包括小头畸形,小眼症,穿孔的脉络膜视网膜病变,视力障碍,眼球震颤,法洛四联症与神经发育迟缓。确定了另外6例先前报告的TUBCGP4相关MCCRP病例。比较了它们的临床和遗传特征。
    TUBCGP4相关小头症和脉络膜视网膜病变,是一种罕见的常染色体隐性神经眼科疾病。我们先证者的临床特征已经稳定了二十年。该综合征的病理生理学尚未完全了解。
    UNASSIGNED: Microcephaly and chorioretinopathy (MCCRP) is a rare autosomal recessive (AR) disorder characterized by microcephaly, developmental delay, chorioretinopathy, and visual impairment. We characterized the long-term phenotype of an additional patient with MCCRP associated with TUBCGP4 pathogenic variants and analysed previously reported cases in the literature.
    UNASSIGNED: Analysis of clinical and genetic data of a patient with TUBGCP4-related MCCRP followed for more than 19 years and literature search for previously reported patients with TUBCGP4 variants using PubMed, Scopus, and Google Scholar.
    UNASSIGNED: Molecular diagnosis using exome sequencing demonstrated two TUBCGP4 variants in trans: c.1669C>T (p.Arg557*) and c.1746 G>T (p.Leu582=). Clinical characteristics included microcephaly, microphthalmia, punched-out chorioretinal lesions, vision impairment, nystagmus, Tetralogy of Fallot and neurodevelopmental delay. Another six previously reported cases of TUBCGP4-related MCCRP were identified. Their clinical and genetic characteristics are compared.
    UNASSIGNED: TUBCGP4-related microcephaly and chorioretinopathy, is a rare autosomal recessive neuro-ophthalmic disorder. Clinical characteristics in our proband have remained stable for two decades. The pathophysiology of this syndrome is not yet fully understood.
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  • 文章类型: Journal Article
    目的:评估诊断为缓解CSC的患者的临床和功能后遗症,通过黄斑OCT,对比敏感度试验,视野10-2和FarnsworthD-15颜色测试。
    方法:纳入并评估了26例通过黄斑OCT解决的CSC患者的27只眼;患者使用Optec6500设备进行了对比敏感度测试,10-2视野与章鱼900Haag-Streit,还有FarnsworthD-15颜色测试.
    结果:通过黄斑OCT观察到20眼(74.1%)的后遗症,对比敏感度为21眼(77.8%),主要是2型缺陷。另外27(100%)的视野10-2改变,对应于中央凹敏感度降低,11只眼(40.7%)对应于中央和中央旁暗点。颜色测试显示11只(40.7%)被评估的眼睛有改变,在其中9例(81.8%)中发现了tritabrase。观察组与治疗组之间的研究没有显着差异。
    结论:CSC尽管在急性期进行了治疗,但仍可能在患者的视觉质量上留下后遗症。干预组治疗前后视力差异无统计学意义。
    OBJECTIVE: To evaluate the clinical and functional sequelae of patients with a diagnosis of resolved CSC, through macular OCT, contrast sensitivity test, visual field 10-2 and Farnsworth D-15 color test.
    METHODS: 27 eyes of 26 individuals with CSC resolved by macular OCT were included and evaluated; the patients underwent a contrast sensitivity test with the Optec 6500 equipment, a 10-2 visual field with an Octopus 900 Haag-Streit, and a Farnsworth D-15 color test.
    RESULTS: Sequelae were observed in 20 eyes (74.1%) by macular OCT and in 21 (77.8%) in contrast sensitivity, predominantly type 2 defect. Also 27 (100%) had a visual field 10-2 altered corresponding to reduced foveal sensitivity, 11 eyes (40.7%) corresponded to central and paracentral scotomas. The color test showed alteration in 11 (40.7%) of the total eyes evaluated, finding tritanomaly in 9 of them (81.8%). No significant differences were observed in the studies between observation group vs the treatment group.
    CONCLUSIONS: CSC can leave sequelae in the visual quality of patients despite treatment in the acute phase. Visual acuity before and after treatment in the intervention group had no significant difference.
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  • 文章类型: Journal Article
    UNASSIGNED: Multifocal choroiditis (MFC) is described as a chronic bilateral progressive inflammatory outer chorioretinopathy, that usually affects healthy myopic Caucasian women with no associated systemic/ocular diseases. This patient had a severe acute presentation of aggressive multifocal choroiditis that was treated with systemic steroids.
    UNASSIGNED: This is a retrospective case report of a 30-year-old, white, European, female who was 10 weeks pregnant. She had bilateral severe vision loss and rapidly progressive rash and arthritis. The patient was extensively investigated for inflammatory and infectious etiologies by a multidisciplinary team including rheumatology and obstetrics and gynecology. Antistreptolysin levels were moderately raised. Serial retinal optical coherence tomography scans were performed and were critical for assessing disease activity and demonstrating the extent of retinal and choroidal lesions.
    UNASSIGNED: This was a challenging case as the patient was pregnant. Nevertheless, a multidisciplinary team, opted for treatment with systemic steroids which then lead to recovery of her vision.
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  • 文章类型: Case Reports
    UNASSIGNED: To describe the findings of long-term follow-up of a case of amyloidosis-associated chorioretinopathy by multimodal imagings, including optical coherence tomography (OCT).
    UNASSIGNED: A 47-year-old woman who had been diagnosed as having systemic amyloidosis was found to have a best corrected visual acuity of 20/13 in both eyes at the age of 41, which subsequently decreased to 20/100 in the left eye and 20/20 in the right eye at age 47. Visual field examination demonstrated worsening of the central scotoma during the follow-up period. Funduscopic examination revealed bilateral white deposits along the choroidal vessels, which became more pronounced over time, along with diffuse pigmentary changes. The fluorescein angiography and indocyanine green angiography findings were consistent not only with atrophic lesions, but also with amyloid deposition (i.e., staining of the vessels).At the baseline, macula OCT revealed a thick hyporeflective band at the choriocapillaris, however, at the last follow-up, it revealed an absent ellipsoid zone, and bilateral progressive retinal pigment epithelium irregularities in both eyes.
    UNASSIGNED: Patients diagnosed as having amyloidosis-related chorioretinopathy may have maintained visual function at the first detection of retinal amyloid deposition, and a number of years may elapse before the patient manifests visual deterioration.
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  • 文章类型: Case Reports
    OBJECTIVE: To review a case of bilateral diffuse chorioretinopathy as a presenting sign of juvenile dermatomyositis (JDM) and review the literature regarding retinal manifestations associated with this disease.
    METHODS: Review of case record and literature regarding retinal manifestations related to juvenile dermatomyositis.
    RESULTS: A 13-year-old girl presented with bilateral diffuse chorioretinopathy as the presenting sign of juvenile dermatomyositis. A review of the literature suggests that retinopathy associated with JDM is a rare finding that is symptomatic to patients and often responds to systemic treatment of juvenile dermatomyositis. This is also the first documented case of paracentral acute middle maculopathy in the setting of juvenile dermatomyositis.
    CONCLUSIONS: Chorioretinopathy is a rare finding in juvenile dermatomyositis. While all patients with JDM likely do not warrant screening ophthalmologic examinations, any patient who has visual symptoms should have a careful dilated examination to evaluate for retinopathy or steroid-induced cataracts.
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  • 文章类型: Case Reports
    方法:一个五岁的病人,诊断为长链3-羟酰基辅酶A脱氢酶缺乏症,被转诊进行眼科检查。他有由并发感染引起的急性代谢危机的病史,以及横纹肌溶解症。眼底镜检查显示乳头周围脉络膜视网膜萎缩和黄斑视网膜色素上皮弥漫性颗粒状外观。双眼最佳矫正视力为6/6,他做了正常的视网膜电图检查.
    结论:我们通过对一个临床病例的描述,对与这种疾病有关的文献和最新发现进行了回顾,以提高对这种罕见疾病的认识。
    METHODS: A five-year-old patient, with a diagnosis of long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency, was referred for an ophthalmological examination. He had a history of acute metabolic crises precipitated by intercurrent infections,as well as rhabdomyolysis. The fundoscopic examination revealed a peripapillary chorioretinal atrophy and a diffuse granular appearance of the macular retinal pigment epithelium. Best corrected visual acuity was 6/6 in both eyes, and he had a normal electroretinography test.
    CONCLUSIONS: We perform a review of the literature and recent findings in relation to this disease through the description of a clinical case in order to improve the knowledge of this uncommon disorder.
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  • 文章类型: Case Reports
    New targeted treatments are being used for patients affected by certain types of cancers with specific gene dysregulation. These new treatments transform the prognosis for the patients but the exact way in which they work is often incompletely known. This can prove to be problematic with regard to potential side effects. Ophthalmologic side effects are particularly difficult to detect in animal models. MEK inhibitors are among these new targeted treatments for which the indications are broad. One of the reported side effects of MEK inhibitors is the appearance of atypical multifocal serous chorioretinopathies which, when present, occur rapidly after starting the treatment and disappear soon after stopping it. We report two documented cases of serous chorioretinopathies secondary to the use of selumetinib, an MEK inhibitor. Both patients were followed for several months after initiating the treatment, using angiography, OCT, and filtered photographs. Only a very few cases have been reported, and the detailed description of two clear-cut cases and their management, as well as a review of the current literature, seems a good way to approach the management of this complication.
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