Purpose Tacrolimus is an immunosuppressant drug which is often used after allogenic transplant to prevent organ rejection. It blocks T‐cell development and inhibits cytokine synthesis. We report the case of a patient who developed bilateral optic neuropathy as a suspected complication of tacrolimus therapy. Methods A 75 year‐old man who underwent orthotopic kidney transplant in 2013 was treated with tacrolimus since that moment without toxic blood levels at any moment. He had a history of moderate hypertension but neither other atherosclerotic risk factors nor ophthalmological disease associated. He came to the Emergency department for the first time in 2015, when he noticed sudden blurred vision in his left. His best corrected visual acuity (BCVA) in his left eye was 20/30. Dilated fundus examination revealed hyperemia, haemorrhages and swelling of the disc with distended veins. Visual field analyser showed a superior altitudinal defect in the left eye. Complete blood count, erythrocyte sedimentation and C‐reactive protein were normal. He underwent oral treatment with prednisone 60 mg in descendent pattern. In the follow‐up the visual field worsened, with abolished visual field, BCVA was hand movement at one meter distance and a relative afferent pupillary defect in his right eye was demonstrated. Optic disc showed evidence of atrophy. The right eye examination was unremarkable. Results Two years later in 2017 the patient came back to the Emergency department complaining of severe painless visual loss in his left eye. Fundoscopy revealed an optic disc edema with splinter haemorrhages which was confirmed with the OCT where we could see a diffuse edema of the fibre layer. Conclusions We should be aware of ophthalmological symptoms in patients who have been receiving therapy with tacrolimus, even in the absence of toxic blood levels of that drug.
Purpose Oculocutaneous albinism (OCA) is a group of genetic diseases with an autosomal dominant pattern. It affects skin, hair and eyes, leading in an hypopigmentation of all these organs. In ophthalmology we can observe a low visual acuity, photophobia, nystagmus, foveal hypoplasia and retinal hypopigmentation. The hypopigmentation may also affect the iris with a characteristic iridian translucence. The disease is also associated with chiasm alterations. Methodss We present the case of a 40 year old patient that was referred to our service to confirm the diagnosis of oculocutaneous albinism. The patient presents a severe hypopigmentation of the skin and hair. She also referred a low visual acuity since birth. She didn't presented family antecedents, or personal ophthalmologic history. Results The best corrected visual acuity (BCVA) was 0.1 in both eyes. The patient presented horizontal nystagmus and iridian translucence. The fundus examination revealed an important retinal atrophy that showed the choroidal circulation.The optical coherence tomography (OCT) revealed a foveal hypoplasia, atrophy in the epithelial retinal epithelium. Conclusions In the patients that the diagnosis of oculocutaneous albinism is not clear, the use of an objective complementary test may be determinant before the genetic diagnosis. This case shows the utility of macular OCT to guide the molecular diagnosis.
Purpose Choroidal neovascularization associated to ocular toxoplasmosis is a known complication of the disease. The important role that the intravitreal anti‐VEGF therapy plays on the CNV has been well‐established. Also, the efficacy of the treatment in CNV secondary to ocular toxoplasmosis in adult patients it has been long described, however there are not cases reported in young patients. The purpose is to describe the efficacy of intravitreal ranibizumab in CNV secondary to ocular toxoplasmosis in children. Methods We present the case of an 8‐year‐old patient with history of ocular toxoplasmosis comes to the hospital with a sudden loss of visual acuity in the right eye (BCVA: 20/200). The fundoscopy shows an old toxoplasmosis scar associated with new perilesional hemorrhages and macular edema. We confirmed these lesions with a SS‐OCT which demonstrated the subretinal fluid associated with a RPE disruption and foveal fibrosis. CNV presence was suggested due to these retinal changes and we decided to treat with intravitreal injections of ranibizumab and anti‐parasitic treatment. Results After three injections of ranibizumab and 6 months of follow up, all the CNV signs have disapeared and the patient has a good recovery of the visual acuity (BCVA: 20/25). Conclusions Intravitreal ranibizumab may be an effective treatment in CNV secondary to ocular toxoplasmosis also in children. In our case, three injections of ranibizumab controlled the secondary CNV, however it is necessary long‐term studies to determinate the effectivity and frequency of the treatment in these patients.
Purpose To describe a case report of a 35 years old metal worker with a corneal ulcer in his right eye treated with an antibiotics ointment by a primary care doctor that presented blurry vision two days later. Methods Examination of the anterior chamber by slit lamp, tonometry was used to determine intraocular pressure, funduscopy, Swept‐Source OCT and CT scan were performed. Results The patient right eye presented intense epibulbar and tarsal hyperemia, and it had a 1x1 mm corneal ulcer, positive in the fluorescent test, and an iridium hole below. Tyndall 2+ and IOP of 18 mmHg. No cataract was detected. Funduscopy examination showed a moderate amount of vitreous hemorrhage. A CT scan, retinography and a Swept‐Source OCT were performed and they revealed an intraocular foreign body located in the optic nerve area. The foreign body was removed via pars plana vitrectomy 23G surgery, requiring a magnet a demarcating laser. After four months the patient has a 20/20 visual acuity with no cataract. Conclusions This case underlines that although CT scan is considered the “gold standard” for the detection, localization and characterization of intraocular foreign bodies, new image techniques as Swept‐Source OCT can be a non invasive and accurate search tool in cases of intraocular foreign body.
Purpose Systemic lupus erythematosus (SLE) is a multisystem autoimmune disorder affecting multiple organ systems frequently with a relapsing and remitting clinical course. It may have ocular manifestations at posterior pole, cornea, conjunctiva, sclera, uveal tract and optic nerve. SLE is a complex disease with dysregulation of the immune system with defects in the innate and adaptive immune systems. Methods A 40‐year‐old Spanish woman was diagnosed with SLE 5 years before. At the time she underwent treatment with a tapering dose of oral prednisone (currently 10 mg/day) and hydroxychloroquine because of a relapse only with cutaneous involvement. She came to the emergency department because she noticed a nasal visual field defect and flashes in her right eye. Her best corrected visual acuity (BCVA) was 20/20 in both eyes and slit‐lamp anterior segment examination was unremarkable. Right fundus showed multiple cotton wool spots along the vessels, and some intraretinal haemorrhages in the inferior temporal branch retinal.Right fundus fluorescein angiography revealed an active vasculitis with abnormal vessel permeability and leakage of the dye together with a branch retinal artery occlusion along the inferotemporal arcade without ischemic areas. Her left eye was normal. She was treated with high‐dose steroid (intravenous methylprednisolone 500 mg/day during 3 days). Then, she completed 2 doses of intravenous cyclophosphamide 400 mg and oral prednisone (45 mg/day) and hydroxychloroquine 400 mg/day. Results The following week the fundus examination demonstrated resolution of haemorrhages without neovascularization or cotton wool spots. BCVA remained 20/20 and visual field exam slightly improved. Conclusions SLE may lead to severe unilateral vasculitis. However, an early diagnosis and aggressive treatment allow the resolution of the disease without many sequelae.
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