فهرست مطالب صهبا فکری

To report a case of hypertensive chorioretinopathy.

A 31-year-old man was referred with the complaint of blurred vision and severe headache 1 month ago. Bilateral disc swelling and exudative retinal detachment, as well as scattered yellow lesions, were evident below the retina. Multiple lumbar punctures with the suspicion of idiopathic intracranial hypertension (IIH) and methyl prednisolone pulse therapy with the diagnosis of Vogt-Koyanagi-Harada (VKH) disease had been performed for him during the last month. A very high blood pressure (BP) was detected for the patient and his visual acuity and headache improved after urgent and intensive BP control.

Hypertensive chorioretinopathy may be misdiagnosed as IIH, ocular inflammation, or other disorders because of the overlap between the presenting signs, but it should be thought of as the first differential diagnosis due to its life-threatening nature.

To report a case of periocular xanthogranuloma with adult-onset asthma in Hodgkin Lymphoma association with intermediate uveitis.

A 51-year-old man presented with the complaint of blurred vision in both eyes and bilateral periocular masses. He had a history of Hodgkin lymphoma treated by chemotherapy 10 years ago with no recurrence. Respiratory problems with small periocular nodules occurred 3 years after completion of chemotherapy. Multiple incisional biopsies were all negative for recurrence of lymphoma. Anti-asthma therapy was started for the patient with close follow-up. During past years, periocular and upper eyelid nodules enlarged very slowly leading to severe mechanical ptosis and bilateral intermediate uveitis and uveitic macular edema emerged. Excisional biopsy was done and the diagnosis of xanthogranuloma was confirmed by pathology exam. No recurrence was seen after 6 months.

History of Hodgkin lymphoma and chemotherapy may predispose the patient to future inflammatory disorders like Periocular xanthogranuloma with adult-onset asthma and intermediate uveitis.

To determine the effect of intravitreal injection of bevacizumab (IVB), which is the standard treatment for diabetic macular edema, along with vitamin D supplementation, on diabetic macular edema in patients with vitamin D deficiency.

Generally, 83 eyes of 83 patients with diabetes mellitus (DM) type 2 and diabetic macular edema (DME) were studied. The patients were divided into 3 groups: normal vitamin D levels + IVB administration (Group 1, n=29), vitamin D insufficient/deficient + IVB administration (Group 2, n=26), and vitamin D insufficient/deficient + IVB administration+ oral vitamin D supplementation (Group 3, n=28). All groups received 3 monthly IVB injections and group 3 received oral vitamin D supplementation simultaneously. The patients were followed up 1, 3, and 6 months after the third baseline IVB with clinical examination, CDVA, and CMT measurements.

The mean baseline CDVA (LogMAR) in groups 1, 2, and 3 was 0.68 ± 0.16, 0.72 ± 0.14, and 0.71 ± 0.1, respectively. In months 1, 3, and 6, after the basic triple IVB injection, visual acuity improved in all groups, but the increase in visual acuity in month 6 was statistically significant in the group treated with vitamin D supplement (group 3) and the group with normal vitamin D levels (group 1) compared to the vitamin D deficiency untreated group (group 2) (P<0.001). Mean CMT decreased in all groups following IVB injections (466.83 ± 57, 527.46 ± 42.3, and 500.61 ± 56.01 microns in groups 1, 2, and 3, respectively), but similar to visual acuity, only in month 6, these changes were significantly different in groups 1 and 3 compared to group 2 (P<0.001).

The correction of vitamin D deficiency in DME patients with type 2 diabetes and vitamin D deficiency, in addition to IVB injections, may play a role in improving CDVA and CMT.

To report a case of bilateral neuroretinitis as the first sign of underlying pheochromocytoma.

A 14-year-old girl was referred to our clinic with the complaint of progressive visual loss in her left eye 2 weeks ago. She was under systemic steroid therapy and one injection of periocular triamcinolone was done for her. Dilated funduscopy revealed bilateral disc swelling, cotton-wool spots, arterial narrowing, venous dilation and engorgement, macular exudates in star-shaped formation; all symptoms were more prominent in the left eye with no significant finding in the anterior segment examination. Examination of the anterior segment was not particularly significant. By impression of bilateral neuroretinitis, blood pressure was checked urgentlyو which was 200/120 mmHg. Finally, pheochromocytoma was diagnosed for her during a complete systemic workup.

Bilateral neuroretinitis mandates thorough systemic workup, including blood pressure control as this ocular finding, may be the first sign of an underlying life-threatening disorder.

To compare the effect of loteprednol 0.5% versus fluorometholone 1.0% on intraocular pressure (IOP) after photorefractive keratectomy (PRK).
PRK was performed in 124 eyes of 62 participants; one eye of each participant randomly received loteprednol 0.5% and the fellow eye had fluorometholone 1.0% postoperatively. Participants were followed up for three months postoperatively. Ocular discomfort and redness, ocular pain, visual outcomes, corneal haze, and IOP were compared between the two groups after surgery.
There was no significant difference between the two groups in uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and manifest refraction at the end of follow up. At postoperative 3 month, UDVA >20/25 was achieved in 95% of the loteprednol group and 92% of the fluorometholone group (p > 0.05). Neither visually significant corneal haze nor ocular hypertension (IOP rise >10 mmHg or IOP > 21 mmHg) was seen in any group. The mean IOP was 13.7±2.2 mmHg in the loteprednol group and 13.7±2.0 mmHg in the fluorometholone group preoperatively (p > 0.05). No significant change was observed in IOP in the study groups at postoperative months 1 and 2. However, IOP was similarly decreased (1±2.2 mmHg) in both groups at postoperative month 3. There was a significant association preoperative IOP and reduction in IOP at postoperative month 3 (regression coefficient = -0.56). No significant correlation was found between preoperative spherical equivalent and reduction in central corneal thickness postoperatively. The participants of both groups had ocular pain for 2.0 ± 1.60 days on average (0 to 7 days). No participant reported ocular discomfort or eye redness after they commenced the drugs.
No significant difference was observed between loteprednol 0.5% and fluorometholone 1.0% in efficacy and side effects, especially high IOP, after PRK.