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 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.
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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