暂无摘要。

Objective: This case report aimed to describe the unusual clinical presentation and histopathological features of post-injection endophthalmitis. Methods: A 56-year-old male phakic patient with diabetic retinopathy received an intravitreal injection (Bevacizumab as per the patient) for neovascular glaucoma elsewhere and presented to our center one day after the dose with hypopyon. The eye was relatively white without pain or lid oedema. The patient was treated as a case of post-injection endophthalmitis with two doses of intravitreal antibiotics 48 hours apart. During the follow-up, he developed a Covid infection. After one week, when the media cleared, white exudates were seen in the vitreous cavity with a relatively healthy retina. He was taken up for pars plana vitrectomy and vitreous biopsy for histopathological study. Results: The microscopic examination of vitreous aspirate revealed crystalline deposits without any microorganisms. Two control slides, one with a mixture of intravitreal antibiotics, which were previously injected, and the other with fresh Triamcinolone were also examined. Although the findings of the drug mixture did not match the vitreous aspirate, they matched with triamcinolone, which established it as a case of pseudo endophthalmitis due to triamcinolone injected elsewhere. Discussion: Initially, it seemed like a straightforward case of post-injection endophthalmitis, but a further examination of the vitreous aspirate showed that it was pseudoendophthalmitis due to an intravitreal triamcinolone injection. Despite the patient being phakic, neovascularization or elevated intraocular pressure may have led to the disruption of the blood-ocular barrier and the migration of Triamcinolone into the anterior chamber. Conclusion: The case\'s uniqueness lies in being the first reported case of pseudo endophthalmitis in a phakic patient with an intact lens iris diaphragm. The case also highlighted the judicious use of available resources and out-of-the-box thinking to reach a diagnosis that may not always be obvious. Abbreviations: TA = Triamcinolone acetonide, AC = Anterior chamber, IVB = Intravitreal Bevacizumab, PL = Perception of light.

暂无摘要。

This case report presents the diagnostic features of isolated primary intraocular lymphoma, which was initially misdiagnosed as neovascular age-related macular degeneration. A comprehensive examination using ultrasound, optical coherence tomography, and fundus autofluorescence revealed changes characteristic of vitreoretinal lymphoma. Molecular genetic analysis of the vitreous body showed the presence of a MYD88 gene mutation and B-cell clonality by immunoglobulin heavy chain (IGH) gene rearrangement tests, which confirmed the diagnosis.
Представлено клиническое наблюдение, касающееся особенностей диагностики изолированной первичной внутриглазной лимфомы, которая первично расценена как влажная форма возрастной макулярной дистрофии. Комплексное обследование с применением ультразвукового исследования, оптической когерентной томографии и аутофлуоресценции глазного дна позволило выявить изменения, характерные для витреоретинальной лимфомы. Молекулярно-генетическое исследование стекловидного тела показало наличие мутации гена MYD88 и B-клеточную клональность по генам тяжелой цепи IgH, что подтвердило диагноз.

BACKGROUND: Vitreoretinal lymphoma (VRL) still represents a diagnostic challenge for retinal specialists. Early diagnosis and treatment are critical for a better prognosis. Several diagnostic tools have proven helpful in the identification of VRL abnormalities. However, swept-source OCT angiography (SS-OCT-A) findings and their long-term follow-up are yet to be explored.
METHODS: a 42-year-old man presented with blurred vision in his left eye for 2 weeks. He denied any systemic symptoms. A multimodal imaging examination was performed, raising the clinical suspicion of VRL and guiding the ensuing diagnostic procedures. The patient underwent treatment and at the last FU visit three years later, no disease signs were present on fundus examination, nor on oncologic evaluation. Some novel SS-OCT-A features were identified, and uncommonly reported findings were examined over a long-term follow-up. At baseline multiple hyperreflective alterations were detected on the enface outer retina slabs and choriocapillary analysis revealed low reflectance areas in the foveal and parafoveal areas. One month after the first presentation, multiple hyperreflective retinal lesions in a vertical shape were detected on OCT which appeared on midretinal slabs of enface SS-OCT-A as hyperreflective spots mainly located near second-order retinal vessels. These alterations remarkably reduced after treatment.
CONCLUSIONS: SS-OCT-A may be a useful imaging technique in the detection of VRL, providing ophthalmologists additional findings that assist the diagnosis and follow-up of this disease. This may prove useful for a more timely and precise diagnosis, prompt therapy, and treatment response monitoring. The original aspects found in this case may provide grounds for future studies, ultimately fostering a better understanding of the disease.

BACKGROUND: To describe a case of bilateral multifocal chorioretinitis as the only presentation of acute West Nile virus (WNV) infection in the absence of neurological involvement.
METHODS: A 78-year-old Italian woman was admitted to our emergency department because she noticed blurry vision in both eyes. She did not report fever, fatigue, or neurological symptoms in the last few days. Multimodal imaging showed the presence of bilateral hyperfluorescent lesions with a linear distribution, that corresponded to hypocyanescent spots on indocyanine green angiography. Antibody serology showed the presence of IgM antibodies, IgG antibodies, and ribonucleic acid (RNA) for WNV. Magnetic resonance imaging (MRI) of the brain ruled out central nervous system involvement. Three months later, the patient reported spontaneous resolution of her symptoms and remission of the chorioretinal infiltrates.
CONCLUSIONS: In endemic areas, it is important to think of acute WNV infection as an explanatory etiology in cases of multifocal chorioretinitis, even without neurological involvement.

The article presents a clinical case of bilateral Terson syndrome caused by the manifestation of acute myeloid leukemia. A 32-year-old man complained of a sharp decrease in vision in both eyes. Spontaneous subarachnoid hemorrhage occurred secondary to acute myeloid leukemia. Uncorrected visual acuity (UCVA) amounted to OD=0.01, OS=0.005. The anterior segment was normal in both eyes, voluminous immobile white-gray mass measuring 7-9 DD that completely covered the macula (intense hyperechoic cell suspension with a volume of about 1/2 of the vitreous cavity, ultrasound B-scan) were visualized in the posterior pole of the vitreous body of both eyes under conditions of maximum drug-induced mydriasis. Diagnosis: vitreous hemorrhage due to subarachnoid hemorrhage in both eyes secondary to acute myeloid leukemia. Vitrectomy was performed in both eyes. UCVA increased to 0.05 in both eyes. Vitrectomy contributed to improvement of visual functions and patient quality of life.
В статье представлен клинический случай двустороннего синдрома Терсона, обусловленного манифестацией острого миелобластного лейкоза. Мужчина 32 лет обратился с жалобами на резкое снижение зрения обоих глаз. На фоне острого миелобластного лейкоза произошло спонтанное субарахноидальное кровоизлияние. Некорригированная острота зрения (НКОЗ): OD=0,01, OS=0,005. Передний отрезок глаз без особенностей, в условиях максимального медикаментозного мидриаза в заднем отделе стекловидного тела обоих глаз визуализировались объемные неподвижные бело-серые массы размером 7—9 ДД, которые полностью закрывали макулярную зону (интенсивная гиперэхогенная клеточная взвесь до 1/2 объема полости стекловидного тела, по данным ультразвукового B-сканирования). Диагноз: организовавшийся частичный гемофтальм вследствие перенесенного субарахноидального кровоизлияния обоих глаз на фоне острого миелобластного лейкоза. Была выполнена хирургическая витрэктомия обоих глаз. Достигнуто повышение НКОЗ на обоих глазах до 0,05. Выполнение витрэктомии способствовало повышению зрительных функций и качества жизни пациента.

BACKGROUND: Endogenous Candida endophthalmitis is an emergency that can threaten vision and the eye as a whole organ but also the life of the patient due to its systemic cause.
METHODS: Retrospective case evaluation of the University Hospital for Ophthalmology Halle (Saale) and the Eye Clinic of the Ernst von Bergmann Hospital Potsdam from 2017-2022. (Age, gender, side involvement, underlying diseases, symptoms, preoperative and postoperative visual acuity, diagnostics, treatment and complications). The standardized procedures for endogenous Candida endophthalmitis are explained, the data are compared with the literature and treatment suggestions are presented.
RESULTS: 8 patients with 14 eyes were treated for endogenous Candida endophthalmitis. Of the patients 2 were women and 6 were men. The overall average age was 70.25 years (53-82 years), 6 patients had bilateral eye involvement and 2 patients were affected on one side. All patients had several serious immunocompromising underlying diseases that were the cause of the candidemia. All patients underwent a pars plana vitrectomy (ppV) on the affected eyes except for one male patient who did not obtain permission for anesthesia. In addition to systemic treatment with antimycotics, voriconazole was routinely administered intravitreally during ppV. The patients received further intravitreal doses of voriconazole based on the findings. Vitreous body samples were taken from all patients during the ppV and detection of Candida albicans was possible in all cases. As part of the local perioperative treatment 1 patient received parabulbar administration of a triamcinolone depot in both eyes, 7 patients received a dexamethasone depot in 11 eyes and all 8 patients received findings-oriented local treatment with prednisolone acetate eye drops. visual acuity increased from preoperatively 1.2 logMar to 1.0 logMar. Postoperative retinal detachment did not occur and there were no serious perioperative complications. 2 patients died from one of the underlying diseases after 3 and 25 months, respectively.
CONCLUSIONS: Despite an increasing number of case series, there are still no uniform guidelines for ophthalmologists in Germany. There is agreement regarding systemic treatment and the intravitreal administration of antifungal agents. The role of ppV has not yet been clearly defined and the question of the adjuvant use of steroids (systemic and/or local) has also not been conclusively clarified.
UNASSIGNED: HINTERGRUND: Die endogene Candida-Endophthalmitis ist ein Notfall, welcher Visus und Auge als gesamtes Organ, durch die systemische Ursache aber auch das Leben des Patienten bedrohen kann.
UNASSIGNED: Retrospektive Auswertung der Universitätsklinik und Poliklinik für Augenheilkunde Halle (Saale) und der Augenklinik des Klinikums Ernst von Bergmann, Potsdam von 2017 bis 2022. (Alter, Geschlecht, Seitenbeteiligung, Grunderkrankungen, Symptomatik, Visus prä- und postoperativ, Diagnostik, Therapie und Komplikationen). Es werden die standardisierten Vorgehensweisen bei endogener Candida-Endophthalmitis erläutert, die Daten mit der Literatur verglichen und Therapievorschläge vorgestellt.
UNASSIGNED: Es wurden 8 Patienten mit 14 Augen aufgrund einer endogenen Candida-Endophthalmitis behandelt. 2 Patienten waren Frauen, 6 Patienten waren Männer. Das Durchschnittsalter lag bei 70,25 Jahren (53 bis 82 Jahre). 6 Patienten wiesen eine beidseitige Augenbeteiligung auf, 2 Patienten waren einseitig betroffen. Bei allen Patienten lagen mehrere schwerwiegende immunkompromittierende Grunderkrankungen vor, die ursächlich für eine Candidämie waren. Alle Patienten erhielten an den betroffenen Augen eine Pars-plana-Vitrektomie (ppV) bis auf einen Patienten, der keine Freigabe zur Narkose erhielt. Neben der systemischen Therapie mit Antimykotika wurde während der ppV routinemäßig Voriconazol intravitreal appliziert. Im Anschluss erhielten die Patienten befundadaptiert weitere intravitreale Gaben von Voriconazol. Von allen Patienten wurden im Rahmen der ppV Glaskörperproben genommen, der Nachweis von Candida albicans war in allen Fällen möglich. Im Rahmen der lokalen perioperativen Therapie erhielt 1 Patient an beiden Augen eine parabulbäre Eingabe eines Triamcinolon-Depots (20 mg), 7 Patienten an 11 Augen erhielten ein Dexamethason-Depot (4 mg) und alle 8 Patienten eine befundorientierte Lokaltherapie mit Prednisolonacetat-Augentropfen. Der Visus stieg im Durchschnitt von präoperativ 1,2 logMAR auf 1,0 logMAR an. Eine postoperative Ablatio trat in keinem Fall auf, es gab keine schwerwiegenden perioperativen Komplikationen. Zwei der Patienten verstarben nach 3 bzw. 25 Monaten an einer ihrer Grunderkrankungen.
UNASSIGNED: Trotz einer zunehmenden Zahl an Fallserien fehlt bislang eine einheitliche Leitlinie für Augenärzte in Deutschland. Einigkeit besteht bezüglich der systemischen Therapie und der intravitrealen Eingabe von antimykotischen Wirkstoffen Die Rolle der ppV ist noch nicht eindeutig definiert, und auch die Frage der adjuvanten Anwendung von Steroiden (systemisch und/oder lokal) ist nicht abschließend geklärt.

Analysis and interpretation of the findings for γ-hydroxybutyrate (GHB) in related fatalities remains problematic. Indeed, GHB is a naturally occurring compound present in both the mammalian central nervous system and peripheral tissue. Moreover, a postmortem increase in endogenous GHB concentration has been observed, especially in blood. Facing this issue, the use of an alternative matrix such as vitreous humor (VH) can thus be particularly interesting for GHB testing and quantification. VH is considered to be less prone to postmortem redistribution, is easy to collect, and has relatively few interfering compounds for the analytical process. In this context, the authors report the case of a GHB-related fatality involving 22-year-old male. In this case, GHB femoral blood (FB) (790 mg/L) and vitreous (750 mg/L) concentrations appeared similar with a FB to VH (FB/VH) ratio of 1.05. In addition, other similar cases with both GHB blood and vitreous concentrations were reviewed. Five cases were identified. The blood to VH ratios ranging from 0.13 to 2.58. Finally, GHB stability was documented in postmortem blood and VH, in order to address the reliability of VH as an alternative matrix for GHB quantitation at postmortem. GHB appeared relatively stable in postmortem blood specimens (at 50 mg/L) over a period of 28 days when stored at +4 °C or -20 °C. The same results were observed in VH specimens.

BACKGROUND: Demarcation line in a rhegmatogenous retinal detachment (RD) is a classic finding noted in chronic cases. In this case report, we describe a case of evolution of post-operative demarcation line after pneumatic retinopexy (PnR) in a subtotal rhegmatogenous RD.
METHODS: A 31-year-old male diagnosed with acute, subtotal, macula-off rhegmatogenous RD in the left eye of 15-day duration underwent PnR on the same day. His presenting visual acuity was 6/48 in the left eye. Transconjunctival cryopexy was performed to the retinal break at the same sitting and 0.5 cc of 100% perfluoroproprane (C3F8) gas was injected in the vitreous cavity and right lateral position was advised to the patient.
RESULTS: A pigmentary demarcation line was noted extending the nasal part of the macula along the most dependent part of the detachment on the immediate post-operative day and was more obviously visible on the 2nd and then on the 11th post-operative day. The visual acuity at the last follow-up visit improved to 6/18. Successful reattachment of the retina was noted on the last follow-up visit.
CONCLUSIONS: Post-operative demarcation lines after RD surgery could develop due to subretinal migration of pigments and along the most-dependent part depending upon post-operative positioning of the patient. Careful post-operative positioning, particularly in macula splitting RDs could be important to avoid pigment accumulation along the foveal area.