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 To analyze three cases of visual acuity improvement after treatment with spironolactone in patients with dome‐shaped macular and related serous retinal detachment. Methods We evaluated four eyes of three patients of 38, 49 and 64 years old with serous retinal detachment associated with dome‐shaped macula. The patients were treated daily with oral spironolactone 50mg. Ophthalmic examination included best‐corrected visual acuity (BCVA) and central retinal thickness (CRT), determines by optical coherence tomography (OCT). They were evaluated on their first visit and on monthly follow‐up visits. Results The first patient's pretreatment BCVA was 20/80 in both eyes; after treatment BCVA improved to 20/50 in the right eye and 20/40 in left eye. Second patient's pretreatment right eye's BCVA was 20/100, and one month after treatment improved to 20/63. The patient stopped the treatment due to a secondary effect (asthenia) and two month later visual acuity declined to 20/80. The last patient's pretreatment BCVA in his right eye was 20/200 and four months after treatment was 20/63. Conclusions We evaluated a mineralocorticoid antagonist treatment for serous retinal detachment associated with dome‐shaped macula in myopic patients. One to six months after treatment with the mineralocorticoid antagonist spironolactone, the subretinal fluid and CRT were significantly reduced and there was an improvement in BCVA.
Purpose Mucous membrane pemphigoid is a systemic disorder that primarily affects mucous membranes. When localized to conjunctiva, it is know as ocular cicatricial pemphigoid (OCP), a potentially blinding desease resulting in progressive conjunctival fibrosis and ocular surface failure.Women are affected more than men by a ratio of 8:1. Age on onset is usually age 60 to 80 and rarely younger than 30. We describe the case of a patient with OCP secondary to intravitreal implant of ranibizumab. Methods We describe the case of a patient with OCP secondary to intravitreal implant of ranibizumab. Results A 85 years old woman with bilateral macular degeneration, treated with intravitreal implants of ranibizumab in the right eye, began with a non specific queratoconjunctivitis in the right eye after the second administration of intravitreal ranibizumab. In numerous ophthalmology follow‐ up appointments the patient presented red right eye and increased amount of tears. Six months later, after another intravitreal implant of ranibizumab, the patient presented a subepithelial fibrosis, as fine gray‐white striae in the inferior fornix. The patient was treated with topic corticosteroid, cyclosporin 0,2%, autologous serum eye 20% with a significant improvement. A systemic treatment with 15 mg methotrexate once a week and the suspension of intravitreal implants of ranibizumab was necessary to control the progression of the OCP. Conclusions In some patients, systemic drugs (practolol, D penicilamine…), have triggered the onset of OCP. The term pseudopemphigoid or drug‐induced pemphigoid may be used to describe these cases. There are not cases of POC secondary to ranibizumab described on the literature.
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.
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