Purpose Acute macular neuroretinopathy (AMN) is a visual-deteriorating rare clinical entity with an uncertain etiology. We aimed to report a case of AMN and underlying disease of acute myeloid leukemia (AML). Case presentation A thirty-five-year-old female patient with bone marrow biopsy confirmed AML, and bicytopenia, under chemotherapy, complained of sudden paracentral visual field defect in her right eye was referred. Visual acuity was 20/20 in both eyes. Posterior segment evaluation revealed multiple Roth’s spots. Optical coherence tomography (OCT) demonstrated hyper-reflectivity band, in the outer nuclear layer and outer plexiform layer, nasal to the fovea of the right eye, and hyperreflective patch in outer retina segmentation en-face OCT, suggestive of the diagnosis of AMN. Nine days after AMN diagnosis, dyspnea, malaise, and cough was initiated. Ground glass opacities in lung CT scan, beside reverse transcription polymerase chain reaction of severe acute respiratory syndrome coronavirus-2, was conclusive of coronavirus disease 2019 (COVID-19). The patient deceased after 6 days. Conclusion We report a rare case of AMN following AML. Our findings support the role of ischemia in the outer retina, of which AML may contributed to the pathophysiological process. The patient has deceased less than 2 weeks from AMN initiation.

Background/aims To quantify the longitudinal changes of the macular microvasculature and the foveal avascular zone (FAZ) parameters in patients recovered from coronavirus disease-2019 (COVID-19) using optical coherence tomography angiography (OCTA) analysis. Methods This observational, longitudinal study was performed on patients recovered from COVID-19. The OCTA images were recorded at baseline and after 1 and 3 months at the follow-up examination. Vessel density (VD) of the retinal superficial (SCP) and deep capillary plexus (DCP), as well as the area of the FAZ of patients who had recovered from COVID-19, were measured. Results In total, 36 eyes of 18 patients (62.2% female) with a mean age of 34.5 ± 7.5 years old were included. Regarding SCP, while the VDs of the whole image, fovea, and parafovea were comparable at different time points, the mean VDs in inferior hemifield, as well as superior and inferior regions of perifovea, underwent significant reductions at month 3, compared to the baseline. In DCP, the mean of VD in the whole image was 54.3 ± 2.7 at the first visit which significantly decreased to 52.1 ± 3.8( P = 0.003) and 51.4 ± 2.7( P = 0.001) after 1 and 3 months, respectively. The VDs in all regions of parafovea and perifovea revealed a significant reduction after 1 and 3 months, compared to the first visit. The mean FAZ area was 0.27 ± 0.08 mm 2 , 0.26 ± 0.08 mm 2 , and 0.27 ± 0.08 mm 2 at the baseline, month 1, and month 3, respectively ( P > 0.05). Conclusion Based on the results, the patients who had recovered from COVID-19 had a progressive decrease of VD at the follow-up visit 3 months after COVID-19 infection.

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Purpose To report an unusual case of unilateral anterior segment large B-cell intraocular lymphoma (IOL) presenting as a recurrent hypopyon anterior uveitis. Case presentation A 55-year-old female was referred because of recurrent unilateral anterior hypopyon uveitis with partial response to topical corticosteroid. All of the laboratory tests, review of systems and ocular sampling results were unremarkable. Given a high concern for masquerades syndromes, cytological specimens were obtained 3 times and the last sample showed large B cell lymphoma. First, it appeared confined to the eye and initially responded favorably to local chemotherapy (methotrexate and rituximab) but later went on to develop systemic involvement. CNS lymphoma was detected on the third brain MRI 6 months following ocular involvement. At this time, systemic chemotherapy was started. In the last 18 months’ follow-up, visual acuity was 20/30 in the right eye without posterior segment or fellow eye involvement. Conclusion Unusual presentation of intraocular lymphoma as a unilateral isolated anterior hypopyon uveitis should be kept in mind. This report emphasizes the importance of precise work-ups and multiple ocular biopsies to confirm the diagnosis of intraocular lymphoma.

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Objective. To evaluate the midterm longitudinal changes in chorioretinal structures in patients with coronavirus disease 2019 (COVID-19). Methods. Thirty-four eyes of 17 COVID-19 patients were enrolled. The patients underwent retinal and choroidal imaging upon the recovery (baseline) after 1 and 3 months. Retinal measurements in fovea, parafovea, and perifovea were recorded. To calculate choroidal vascularity index (CVI), luminal and total choroidal areas were measured using Sonada's method. Choroidal thickness was measured at the subfovea 500 microns temporal and nasal to the fovea. Results. Mean CVI was 0.64 ± 0.04 at baseline that significantly increased to 0.67 ± 0.05 (P = 0.012) after 1 month and again significantly decreased to 0.63 ± 0.05 after 3 months (P < 0.001). While the stromal component showed a significant decrease between the baseline and first-month values (1.16 ± 0.29 to 1.01 ± 0.27, P = 0.03), the luminal area mostly changed between months 1 and 3 (2.03 ± 0.28 to 1.91 ± 0.23, P = 0.045). The average of subfoveal choroidal thickness and retinal thickness remained unchanged. Conclusion. CVI is increased in patients with COVID-19 1 month after recovery from COVID-19 and returns to baseline values after 3 months. Regarding the reversible nature of changes, there might be a prominent role in inflammation.

Purpose. To report an unusual case of gas expansion following oxygen therapy in a patient with sulfur hexafluoride (SF6) 20% tamponade after pars plana vitrectomy. Case Report. A 40-year-old man came to the clinic with severe ocular pain and redness and also vision decrease in his left eye three days after uncomplicated 23-gauge pars plana vitrectomy, internal limiting membrane peeling combined with phacoemulsification, and using 20% SF6 injection as a tamponade agent due to significant cataract and a full-thickness macular hole. In ophthalmic examinations of his left eye, high intraocular pressure (approximately 70 mmHg), a flat anterior chamber, and a gas-filled vitreous cavity were found. The patient had been hospitalized the day before due to carbon monoxide poisoning and had undergone oxygen therapy with a pure 100% mask for three hours. Conclusion. It seems that oxygen therapy or carbon monoxide poisoning increases the volume of gas in the patient’s vitreous cavity and the nonexpansile percentage of SF6 expands.

Background. To report a patient with central retinal artery occlusion (CRAO) associated with sildenafil overdose. Case Presentation. A forty-two-year-old male presented three hours after sudden painless visual loss in the right eye. BCVA was counting finger in two meters, and relative afferent pupillary defect was positive. Fundus examination revealed retinal whiteness except in a limited area of papillomacular bundle and cherry red spot. He consumed two 100 mg film-coated sildenafil tablet (Vizarsin, Krka, d.d., Novo mesto, Slovenia) twelve hours apart, and the last one was six hours before visual loss. He was diagnosed with CRAO with cilioretinal artery sparing. Although we did not find any emboli, anterior chamber paracentesis was done. Four weeks later, BCVA improved to 20/80, with resolving of retinal edema. Cardiovascular, carotid arteries, and neurologic evaluations were negative for any predisposing factor. Conclusion. CRAO is a vision threatening condition that might be associated with the overdose of sildenafil.