This case report aims to describe the diagnosis, treatment, and evolution of bilateral, asymmetrical retinal capillary hemangioblastomas treated with argon laser and intravitreal anti-vascular endothelial growth factor and also reports the results of an online survey of treatment preferences among retina and vitreous specialists. A previously healthy 23-year-old female presented to our Retina Department complaining of progressive visual loss in her right eye. Visual acuity at admission was 20/300 in her right eye and 20/20 in her left eye. Anterior segment findings were unremarkable and fundoscopy revealed the presence of retinal capillary hemangioblastomas in both eyes. In the right eye, the hemangioblastoma was associated with pronounced exudation and macular edema; in the left eye, the lesion was quiescent. After a complete anamnesis and genetic counseling, Von Hippel-Lindau disease was diagnosed. Treatment with laser photocoagulation was performed on both eyes. One dose of 0.5 mg intravitreal ranibizumab was applied to the right eye. Two months after treatment, the right eye Case 38 demonstrated improved visual acuity (20/100). Moreover, an important decrease in tumor dimensions and a reduction of vessel tortuosity was seen in both eyes. At 18 months of followup, the patient maintains a good visual acuity without recurrence of the treated tumors. Laser treatment should be considered as the primary treatment option for patients with capillary hemangioblastomas with and without exudation and can be combined with intravitreal antiangiogenics if exudation is significant. Inactive smaller lesions without exudation are likely to have an excellent response to laser treatment alone. Management should be individualized since no consensus between experts has been reached.
PurposeTo report a case of occlusive retinal vasculopathy, secondary to hyperhomocysteinemia.ObservationsA 43-year-old male was examined at the retina outpatient clinic due to complaints of bilateral decrease in visual acuity. The patient underwent a comprehensive ophthalmological examination, wide-field fundus photographs and fluorescein angiography, as well as spectral domain optical coherence tomography with enhanced-deep imaging. The patient had a significant medical history of chronic kidney disease and progressive bilateral vision loss over the last two years, which worsened in the left eye during the past 3 months. Fundus examination revealed a vitreous hemorrhage in the left eye and bilateral proliferative retinopathy. Blood glucose and systemic blood pressure were unremarkable. Plasma homocysteine was reported at >500 μmol/L, which is higher than the corrected reference range by age.Conclusion and ImportanceHyperhomocysteinemia is a rare but well-known disease, capable of accelerating atherosclerotic disease and generating a prothrombotic state that can lead to multiple systemic complications. Despite its low incidence, the disease should be part of the differential diagnosis in patients with bilateral proliferative retinopathy, in the absence of diabetes mellitus and systemic hypertension.
Purpose: To report the result of the Kirby-Bauer test in bacterial cultures from vitreous samples of patients with postsurgical endophthalmitis, in order to assess the bacterial response to first-line antibiotics like vancomycin and ceftazidime through time.Methods: Retrospective, single center study. We reviewed the medical records of all post-surgical bacterial endophthalmitis cases, from 2009 to 2016. We divided our population into two groups according to the date of diagnosis: group 1 (2009-2012) and group 2 (2013)(2014)(2015)(2016). In each group, we noted the response of the grampositive bacteria to vancomycin and gram-negative bacteria to ceftazidime on the Kirby-Bauer test, as well as to the fourth-generation fluoroquinolones moxifloxacin and gatifloxacin. Nominal variables were assessed by Mann-Whitney test, with an alpha value of 0.05 for statistical significance. Chi-square test was applied to nominal variables as appropriate.Results: Group 1: 46.2% of the gram-positive bacteria were sensitive to vancomycin and 83.4% of the gram-negative bacteria were sensitive to ceftazidime (moxifloxacin: 89.5%, gatifloxacin: 68.4%; p<0.01). Group 2: 47.4% of the gram-positive bacteria were sensitive to vancomycin and 66.7% of the gram-negative bacteria were sensitive to ceftazidime (moxifloxacin: 88%, gatifloxacin: 84%; p<0.01) Conclusion:The result found in this study suggest a possible change in the local sensitivity pattern that might have an impact on the treatment of postsurgical endophthalmitis. Moxifloxacin had higher levels of sensitivity and lower resistance on the Kirby-Bauer test than Vancomycin.
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