Posterior scleritis is a relatively uncommon form of scleral inflammation of the posterior segment of the eye. Clinical manifestations include ocular pain, headache, pain with ocular movements, and loss of vision. A rare presentation of the disease is acute angle closure crisis (AACC) with elevated intraocular pressure (IOP) secondary to anterior displacement of the ciliary body. Various systemic diseases have been described to co-exist with posterior scleritis; however, psoriasis has not been associated with posterior scleritis. Here, we present a case of posterior scleritis which initially presented as AACC in a patient with pre-existing psoriasis. A 50-year-old male with a history of psoriasis under treatment presented to the emergency department with intense sudden ocular pain and loss of vision on the left eye as well as headache and nausea. A thorough medical and ocular history was taken, and a detailed examination of the anterior and posterior segment was completed including visual acuity and IOP. Initial diagnosis of AACC was made, and appropriate actions were taken with partial resolution of his symptoms. However, upon further work-up including ultrasound (B-scan) of the left eye a final diagnosis of posterior scleritis was made. The patient was treated with steroids and nonsteroidal anti-inflammatory drugs which dramatically improved his condition. Photographic evidence of initial presentation and post-treatment condition was obtained and presented in this report. Posterior scleritis is a potentially vision-threatening condition which is usually challenging to diagnose. In this report, we highlight the challenges one might come into when dealing with different manifestations of the same disease, increasing awareness. This case of posterior scleritis presenting as AACC in a patient with a history of psoriasis enhances what we already know from the literature as well as provides some new insights in the clinical manifestations of posterior scleritis in the setting of psoriasis without arthritis.
Purpose To present a case of branch retinal vein occlusion (BRVO) following ChAdOx1 nCoV-19 (Oxford-AstraZeneca) Vaccine. Methods Case report. Results A 60-year old otherwise healthy Caucasian male, presented to the ophthalmology emergency clinic complaining of sudden, painless vision loss in his right eye of 24 h” duration. The patient had received Vaxveria seven days prior. The clinical and fundus examination of the right eye established the diagnosis of BRVO. Conclusion The present case descibes the occurrence of BRVO soon after the vaccination with the Oxford-AstraZeneca vaccine. The close temporal relationship between the BRVO incidence and the vaccination is reinforced by the lack of othe subjective cause to justify the episode.
Background: Rhegmatogenous retinal detachment (RRD) with macular involvement is a sight-threatening condition. Silicone oil (SO) is efficacious for retinal tamponade, especially in complex cases. Whether macular detachment per se or the potential tamponading agent may affect macular microcirculation after RRD repair is a matter of research. Objectives: To investigate macular microcirculation changes using optical coherence tomography angiography (OCT-A) after pars plana vitrectomy (PPV) with intravitreal SO for RRD repair in the early posttreatment period. Design: Prospective comparative cross-sectional study. Data sources and Methods: Fourteen eyes of 14 patients were included in the study. All eyes underwent a single successful PPV with SO tamponade for macula-off RRD. OCT-A was performed to analyze macular microcirculation and visual outcomes at 1 month postoperatively. The fellow unaffected eye was used as control. Results: Vessel density (VD) in the superficial capillary plexus (SCP) was significantly lower at each macular region (fovea, parafovea, and perifovea) of SO-treated eyes compared with the fellow eyes (all p = 0.001). Similarly, perfusion density (PD) in the SCP was significantly lower at each macular region than the fellow eyes (all p = 0.001). There was enlargement of foveal avascular zone (FAZ) area and decrease of circularity at RRD eyes compared with the fellow ones (all p = 0.001). Postoperative logMAR visual acuity (VA) was significantly lower in treated eyes than fellow eyes and correlated inversely with foveal, parafoveal, and perifoveal VD and PD SCP (all p < 0.001). Postoperative VA had no correlation with FAZ parameters. Conclusion: Enlargement of FAZ SCP and decrease in VD and PD SCP during the short-term follow-up were possibly attributable to ischemic changes in the macular area after RRD repair with SO tamponade. In this preliminary study, the flow density in macular capillary plexus may represent an indicator of visual outcomes.
Background and objectives: We aimed to evaluate the effects of the water drinking test (WDT) on several systemic and ocular parameters, including choroidal thickness, which was assessed through optical coherence tomography angiography (OCTA), in glaucoma suspects. Materials and Methods: A total of 40 eyes from 20 glaucoma suspects without any systemic or ocular diseases were included in this prospective observational study. All the participants undertook the WDT, which required the drinking of 1 L of table water in 5 min. The outcome measures included IOP, systolic and diastolic blood pressure (SBP and DBP), mean arterial pressure (MAP), mean ocular perfusion pressure (MOPP), ocular pulse amplitude (OPA), and subfoveal and peripapillary choroidal thickness, which were assessed at baseline and at four 15 min intervals after the WDT. Generalized least squares models and mixed model analyses that take into account repeated measurements were used to assess the changes over time of these parameters. Results: All the ocular and systemic parameters showed statistically significant changes at all time points compared to baseline apart from choroidal thickness. The peak changes were an IOP of 20.1 mmHg versus 17.3 mmHg at 45 min, an SBP of 137.6 mmHg versus 125 mmHg at 30 min, a DBP of 95.9 mmHg versus 85.7 mmHg at 15 min, and an MOP of 53.51 mmHg versus 48.89 mmHg at 15 min. Conclusions: Despite elevations in IOP and significant changes in all the assessed systemic parameters, the WDT was not associated with changes in choroidal thickness in glaucoma suspects.
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